gill ancient psychoterapy

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Ancient PsychotherapyAuthor(s): Christopher GillSource: Journal of the History of Ideas, Vol. 46, No. 3 (Jul. - Sep., 1985), pp. 307-325Published by: University of Pennsylvania PressStable URL: http://www.jstor.org/stable/2709470.

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ANCIENT PSYCHOTHERAPYBY CHRISTOPHER GILL

My title should perhaps be phrased as a question: Ancient Psy-chotherapy? For the aim of this article is not, primarily,to describe thevarious ancient practices which were called therapeiatespsuches ( cureof the soul ). Rather it is to ask whether we can find anything in theAncient World which resembles what we, currently, call 'psychother-apy'.* This term is used to cover a range of contemporary psychiatricpractices. But it is verbal psychotherapy I have especially in mind, thekind of activity described by Anthony Storr, for instance, in his recentbook, The Art of Psychotherapy,'which is designed to give guidance toBritish medical graduates entering psychiatry. 'Psychotherapy', as Storrdefines it, is the art of alleviatingpersonaldifficultiesthrough the agencyof words and a personal,professionalrelationship. The kind of treatmenthe discusses in analyticaland individual, and involves only two partic-ipants, the patient and the therapist (vii).The psychotherapeutic method, as Storr describes it, is not highlypredetermined,and varies from patient to patient. But it consists, essen-tially, of an attempt to induce the patient to explore his own feelings,wishes, anxieties and fantasies, as franklyas possible, in a way that helpshim to uncover the roots of his personal problems and try to solve them.Storr is not an orthodox Freudian, Jungian, Adlerian, or Kleinian (noris he, less orthodoxly, a Laingian or Lacanian);and so his method doesnot rest on any particular set of psychological theories, about the un-conscious, for instance, or the causation of neurosis. He does, however,assume that people, at some level, 'know' the reason for their distressand anxiety, and that psychotherapy can help to make them more fullyawareof this, and thus betterable to deal with their emotional difficulties.In comparisonwith Freud, Storrlays less stresson the bare act of bringingto consciousness the source of the problem,and more on the developmentof the kind of autonomy or 'integrity' of personality that can deal withthe problem.2The role of the therapist, as he presents it, is a subtle one,

* This article is based on a paper read to a seminar on Ancient Religion in CorpusChristi College, Oxford. I am grateful to the members of the seminar for their helpfulcomments on the paper, particularly John Bramble. I would also like to thank DavidDickinson, Brett Kahr, Geoffrey Lloyd, and David Owen, for their useful criticisms ofan earlier version of this article.

1 (London, 1979). I am grateful to Graeme Feggetter for drawing my attention tothis book.2 Cf. Storr's earlier book, The Integrity of Personality (London, 1960). This alignsStorr to the approach sometimes called 'ego psychology'; see n. 15 below for other

approaches.

307Copyright 1985 by JOURNAL OF THE HISTORY OF IDEAS, INC.

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308 CHRISTOPHER GILLwhich is neither passive nor overtly active. The therapist tries to avoidtaking the place of the patient's autonomy (by explicit advice or instruc-tion), but nonetheless suggests, by questions and implicit guidance, waysin which the patient may develop his own autonomy. The therapistplaysa role, as a person, in the therapeutic process: he often is, and shouldbe, the object of 'transference', that is, someone to whom the patient'transfers' feelings of love and hate which are related to the 'workingthrough' of his problems. But this is a role he plays not as an individualbut as a therapist; the process is not designed to bind the patient emo-tionally to the therapist, but to enable him to develop normal relationsoutside the therapeutic context.In summarizing Storr's account of psychotherapy, I do not wish tosuggest that I regard his psychiatric method as necessarily ideal or nor-mative.3 In fact, I will have occasion to refer to psychiatric methodswhich are rather differentfrom Storr'slater in this article. But it is useful,nonetheless, to have a fairly representativestatement of what is meant,in contemporary usage, by 'psychotherapy',as a referencepoint for com-parison with what we find in the Ancient World; and it is for that reasonthat I have summarized Storr's account.

As well as giving a specific answer to the question whether psy-chotherapy, in this sense, or anything closely resembling it, did or didnot exist in the Ancient World, I am interested in seeing how discussionof this questionbears on the comparative'mapping'of ancient and modernpractices. I am also interested in demarcatingthe various conceptions ofthe self that the ancient and modern practices in this area presuppose.4The question of comparative 'mapping' is one of immediate importance.For I take it as obvious that there is nothing in the Ancient World exactlylike the psychotherapyStorr describes;there is no class of persons whoseprofession corresponds exactly to that of modern psychiatrists and psy-chotherapists.5To identify the nearest equivalents to modern psycho-therapy, we need to look at the borders of certain ancient areas, theborders of religion and medicine, on the one hand, and of medicine andphilosophy, on the other. I hope the remainder of this article will makeit clear why I think these areas are the most important ones to examinefor this purpose.

3Storr himself sees the method as best suited for the treatment of neurosis ratherthan psychosis (160ff); althoughthe psychotherapeutictreatmentof psychosis is advocatedin, e.g., Bertram P. Karon and Gary V. VanDenBos, Psychotherapyof Schizophrenia:The Treatmentof Choice (New York, 1981).4 I discuss another aspect of this subject in The Question of Character-Developmentin Plutarch and Tacitus, Classical Quarterly,33 (1983), 469-87.5Cf. Walther Riese, An Outline of a History of Ideas in Psychotherapy, Bulletinof the History of Medicine, 25 (1951), 442-56, Bennett Simon, Mind and Madness inAncient Greece: The Classical Roots of Modern Psychiatry (Ithaca and London, 1978),217.



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ANCIENT PSYCHOTHERAPY 309As far as the scope of this discussion is concerned, the 'AncientWorld' signifies here the Greco-Roman World. Given the kinds of evi-dence we have available, I shall have little to say about Greece prior tothe late fifth century,B.C., and relativelylittle to say about Greco-Romanculture after the second century, A.D. (with the exception of certainmedical texts). Within these time-limits, there seems to be a good dealof continuity in the kinds of practice I am concerned with; and so thediscussion will move ratherfreely between periods of Classical Antiquity.One topic I say nothing about is Christianity. I omit this topic althoughI think Christianityis potentially important for this question, both in the

Ancient World and in later periods,6but it seems to me impossible todo justice to the role of Christianity in a survey of this length, and so Ileave it wholly on one side.7The bordersof religion and medicine.-One point of entry to thisarea is a striking passage in Aristophanes' comedy, the Wasps, n whichthe slave Xanthias describes the symptoms of the disease (nosos) thathas afflicted his master'sfather, Philocleon, and then enumeratesvariousunsuccessfulcures (7 ff.). Xanthias mentions a number of what we mightcall 'obsessions', that is, conditions of preternatural attraction (beingphilo-) to dice, drink, or foreigners. He then specifies Philocleon's con-dition (he is phileliastes, in love with jury-service ), a condition whichis convincingly 'obsessive': Philocleon even dreams about jury-service(92-93). The slave then describes the methods used to try to cure this'disease': verbal dissuasion, katharsis (ritual purification with water),initiation in the Corybantic rites, and incubation (sleeping overnight) inAsclepius' sanctuary. All these methods have failed and the 'madman'has been locked up (114ff.). The point of the passage is basically satirical(Aristophanes in parodying the Athenian passion for jury-service); butthe passage seems to throw incidental light on contemporary treatmentof the mentally disturbed. If we leave aside the attempt at verbal dis-suasion, the three methods mentioned seem to be of a similar type. Theyare clearly linked with religious practice; and they are also 'curative', insome sense, although they are not all especially associated with madness.8The Corybanticrites, in particular,are regularlypresentedin our sources

6 See, e.g., Michel Foucault's suggestion that Christian confessional practice pavedthe way for psychoanalytic self-scrutiny, The Historyof Sexuality:An Introduction(Har-mondsworth, Penguin, 1981), 20ff., 60ff., 115ff.7For some of the relevant material, see Georg Misch, A History of Autobiography nAntiquity, 2 vols. (London, 1950), II, Part III (on self-scrutiny and confesssional liter-ature). See also G. Kittel, ed., Theological Dictionary of the New Testament (GrandRapids, Michigan, 1965), s.v. therapeuo, aomai, nosos.

8 See furtherE. R. Dodds, The Greeks and the Irrational (Berkeley and Los Angeles,1951), 35-37; G.E.R. Lloyd, Magic, Reason and Experience:Studies in the Origin andDevelopmentof Greek Science (Cambridge, 1979), 40ff., and Robert Parker, Miasma:Pollution and Purification in early GreekReligion (Oxford, 1983), esp. chaps. 7-8.



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310 CHRISTOPHER GILLas being religious rituals which are capable of curing states of emotionaldisturbance and anxiety.9 Plato describes them as a means of 'homeo-pathic' cure of emotional agitation (that is, the cure of inner agitationby external agitation, in the form of violent music and dancing).?1Thisis the kind of process Aristotle seems to have in mind in the Politics,when he mentions the katharsis of emotions such as pity, fear, andexcitement (enthousiasmos) through religious music of an intense andexciting kind.11The Corybantic rites are not unique; as Dodds pointsout, they belong to a family of religious rituals (of which Bacchic ritesare another prominent example) which induce ecstatic or orgiastic ex-periences and so bring to the participants some kind of satisfaction andpeace of mind.12If we take these types of religious cure as a group, how close is thetreatment to modern psychotherapy?It is clearly quite unlike the kindof psychotherapyAnthony Storrdescribes. Indeed, if there are analoguesin modern Western societies for this type of ancient practice, they mightseem to lie outside psychotherapy,in 'hot-gospel'Christianity,faith-curesat Lourdes, or drugs, mysticism, and 'heavy rock' music. However, it isworth trying to analyze what these ancient practices do or do not havein common with the kind of psychotherapy I have described. Both theancient and the modern practices presuppose that anxiety and distresscannot be cured simply by inducing the suffering person to exerciserational self-discipline. The son of Philocleon (if we take this comicexample seriously) failed to 'persuade'his father, before he had recourseto katharsis,Corybanticrites, and incubationto treat the 'disease'(Wasps,114-24). Analogously, modern psychotherapists do not try to reasonpatients out of their neurosis simply by an appeal to their capacity forconscious self-control. They try to probe the unconscious levels of per-sonality, which are not amenable to self-control in the usual sense, in anattempt to find the unrecognizedsources of the neurosis. The differencesbetween the ancient and modern practices are also fairly obvious, how-ever. The ancient practices were not predominantly verbal, and did notinclude sustained dialogue; they were also, by the same token, relativelyimpersonal. Corybanticand Bacchic rituals, as far as we can reconstructthem, were essentially the same for all the individuals participating in

9See I. M. Linforth, The Corybantic Rites in Plato, Universityof CaliforniaPub-lications in Classical Philology, 13.5 (1946), 121-62 and Telestic Madness in Plato,Phaedrus, 244d-e, ibid., 13.6 (1946), 163-72.10Plato, Laws, 790d-791a.1 Politics, 1341b32ff.,esp. 1342a4-15.This passage has often been taken to shed lighton Aristotle's comment about katharsis through tragedy in Poetics, 1449b24-31. For an

interpretation of Aristotle's idea of tragic katharsis as a theory about 'group-psycho-therapy', see P. Lain Entralgo, The Therapyof the Word in Classical Antiquity (NewHaven and London, 1970), 183ff.12 Dodds, op. cit., 77-80.



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ANCIENT PSYCHOTHERAPY 311them.13 Some of our evidence suggests that people with particular psy-chological problems were attracted to particularrituals (the irrationallyfrightened were drawn to the Corybantic rites, for instance) and foundthem satisfying.14 But, in the rites themselves, there does not seem tohave been any overt attempt to explore the individual's problems or torebuild his confidence.In this respect,then, there seems to be ratherlittle in common betweenthe methods of modern psychotherapy and ancient rituals of the Cory-bantic type. However, it is worth noting that there are some types ofmodern psychotherapy which are much closer to the ancient rituals. Inthe United States, in particular, alongside the standard types of psycho-analysis and psychotherapy, therapeutic methods have been developedwhich lay much less emphasis on the verbal exploration of the patient'spsychological state and much more on the discharge of emotion in ex-pressive physical action.'5In some methods, the use of dialogue is omittedaltogether; and the treatment consists entirely of attempts to find thekind of physicalaction (for instance,muscularrelaxation,violent gestures,screaming) that gives the patient emotional release. This type of therapyis often conducted in groups, and the mutual excitement generated bythe group is an important factor in inducing the patient to relax hisnormal constraints and express himself physically.'6This type of therapyis much closer to ancient rituals of the Corybantic type. Indeed, somepsychotherapistsof this type are interested in these ancient practices, aswell as in similar practices in contemporary undeveloped cultures, re-gardingthem as prototypes for their own methods.'7However, it is worthexamining precisely how close these parallels are. It is clear that bothancient and modern methods provide some kind of expressive actionwhich gives emotional release. However, the personal and psychologicalcontent of the modern practice is much more important and overt thanit was in the ancient rites, as far as we can reconstruct these. The modernparticipant is encouraged to find the gestures or movements that helphim relax, to scream out his inmost feelings ('Love me', 'I hate you'), to'act out' his suppressed urges.'8Even in treatments where the elementof explicit analysis is very small, the therapeutic context (and the prev-alence, in American culture at least, of a psychotherapeuticapproach topersonallife) predisposesthe participantto think in terms of his individual

13 There were, of course, differentroles within the ceremony (e.g. ministrant, initiatedworshipper, candidate for initiation), but the performanceof these roles does not seemto vary in ways that reflect the individual psychology of the participant.14Cf. Dodds, op. cit., 78-79.

'5Michael P. Nichols and Melvin Zax, Catharsis n Psychotherapy New York, 1977).16 Nichols and Zax, Chaps. 5 and 7.17 Nichols and Zax, Chap. 2.18 Examples from Nichols and Zax, 109ff., 140, 148-9.



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312 CHRISTOPHER GILLneeds and satisfactions.By comparison,the Greekreligiousmethods seemto have been corporate, ritualistic, and impersonal.This generalization, if it is a valid one, seems to apply to a ratherbroad area in Antiquity, indeed to most of the treatments offered inancient religious and religio-medicalcontexts. However, it is worth look-ing closely at two examples where our evidence is unusually full, to seehow far we should qualify this generalization about the impersonality ofthe treatment offeredin these contexts. The first example is that of AeliusAristides, who is famous for his account of his own prolonged and variedillnesses and the numerous treatments he applied to them.19These treat-ments were inspired by dreams which Aelius had during incubation inAsclepius' sanctuary. Aelius believed that Asclepius used these dreamsto prescribe remedies to him; and that, in this sense, his illness wasreceiving individual treatment by Asclepius.20Aelius himself does notregardhis treatmentas psychotherapybecause he sees his illness as beingphysical and Asclepius as being a medical doctor in the usual sense (albeita divine one). But, from our point of view, what is psychiatrically inter-esting about his account is that it shows how the temple of Asclepiusprovided a context in which a person could (with religious, medical andsocial support)explore his psycho-physical individuality, and could treat,with partial success, diseases which were at least partly psychosomatic.For, on Aelius' evidence, a good deal is left up to the individual patientof Asclepius. The patient has the prescriptivedreams,and interpretsthem(with assistance from friends, doctors, and contemporary techniques ofdream-interpretation)21n that sense, he discovers his own treatment. Wealso know, from Aelius' case, that he could discover and insistently apply,cures which were medically insane (by ancient as well as modern stan-dards)but which, nonetheless, had a temporarilybeneficial effect.22Thus,while Aelius is not, in an obvious sense, exploring his own psychology(in fact, in some ways he seems markedly blind to his own character),23the Asclepian context does not seem to provide a framework in whichAelius, in a sense, explores his own psychophysical individuality, andfinds a very personaltreatment for very personaldiseases. In that respect,Asclepius' temple provides a psychotherapeutic context, though onewhose methods are unlike any modern psychotherapy.The case of Lucius, in Apuleius' novel, Metamorphoses or The GoldenAss) is in some ways comparable,as an example of a religious 'cure' that

19A lucid account of Aelius Aristides' SacredDiscourses, ncludingtranslatedextracts,is given in A.-J. Festugiere, Personal Religion among the Greeks (Berkeley and LosAngeles, 1954), Chap. vi.20The 'personal' nature of their relationship, as Aelius sees it, is not confined todreams;cf. Festugiere, ibid., 95-97.

21 Cf. ibid., 10lff., Lloyd, op. cit., 41-43.22 Cf. Festugiere, ibid., 92-95.23 Ibid., 97-98, Misch, op. cit., 506-07.



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ANCIENT PSYCHOTHERAPY 313has a strongly personal dimension. Apuleius' hero comes to feel that Isiscares for him, as an individual; for she not only miraculously changeshis bodily shape (restoring him from ass to human), but attaches as aprecondition a complete change in his way of life. He is to transformhislife, previously dominated by curiosity about magic, into one dominatedby religiousdevotion, and to rejectthe sexual pleasuresthat were formerlyimportant to him and become celibate.24By non-Christianstandards,thisis a striking portrayal of religious 'conversion', and one that places anunusual stress on the impact of the conversion on the life of the initiate.25It is not so much the moralaspect of the conversionthat Apuleius stresses,but rather the fascination of the initiate with the religious rituals, espe-cially the initiation into the 'mysteries'of the cult, and the quasi-personalrelationship he feels he has with the goddess. The underlying idea seemsto be that this religious absorption has 'cured' Lucius of his previousrestless curiosity about magic, and at the same time provided a focus forhis whole life, channelling all his desires into his love for Isis.26It isdifficult to say how far we can draw inferences, from this peculiar pieceof fiction, about the kind of 'psychotherapeutic'help an ancient mysteryreligion could provide. But one point that emerges very clearly is thatreligious rituals may be apparently impersonal (the Isis rituals are thesame for all worshippers,and the initiation ceremony is the same for allinitiates); and yet they can have an intensively personal significance fora particular person. Not only do the rituals have an intense emotionalpower for Lucius, but they make sense for him (because of the distinctiverole the conversion has played in his life) in a way they could not makesense for anyone else. Thus, this example, together with that of AeliusAristides, should partly qualifyour generalizationabout the impersonalityof ancient religious rituals, considered as a form of therapy.27

Folk-psychotherapy'n Greek Drama.-I shall turn shortly from theborders of religion and medicine to medicine proper, and to its borderswith philosophy. But, first I want to considerbriefly some of the evidencewe find in Greek drama,especially tragedy, for what one might call 'folk-psychotherapy', that is, psychotherapy which is not connected with anyspecific discipline or practice, such as medicine, philosophy, or religion.In an articleon the Bacchae, Georges Devereux describesthe dialogue24 Apuleius, Metamorphoses, ines 15; cf. lines 6 and 11, 19. See further G. N. Sandyand J. Gwyn Griffiths in Aspectsof Apuleius' GoldenAss, ed. B. L. Hijmans and R. Th.van der Paardt (Groningen, 1978), 123ff. (esp. 130-04), and 141ff (esp. 156-58).25Cf. A. D. Nock, Conversion(Oxford, 1933), Chap. IX, esp. 155; Festugiere, op.cit., 77-84.26 Festugiere notes the inexplicabilis voluptas (Metamorphoses, 11, 24) Lucius takesin prolonged gazing at the cult statue of Isis, op. cit., 80-84; cf. Gwyn Griffiths (n. 24

above), 156-58.27 See further, on the personal and psychological significance of folk-rituals, ClaudeLevi-Strauss,StructuralAnthropology London, 1968), Chap. X, esp. 198-204.



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314 CHRISTOPHER GILLin which Cadmus helps Agave make the transition from madness tosanity as the first surviving account of an insight-and-recall orientedpsychotherapy, which sheds light upon an aspect of Greek attempts totreat psychiatric illness, which is not otherwise attested. 28This claim(which I shall discuss shortly) serves as a reminder of the fact that, inseveral Greek tragedies, we see people being helped out of madness, orhelped to accept the consequences of their madness, and that this helpis sometimes given sensitively and effectively. In two notable scenes, inSophocles' Ajax and Euripides'Heracles, we see the portrayal of a manwho is now sane coming to terms with what he did when he was mad.In both cases, his first instinct is to kill himself out of a sense of shame;this instinct is opposed successfully by Theseus in the Heracles, andunsuccessfully by Tecmessa in the Ajax. It is perhaps significant that, inthe Heracles, Theseus is strongly 'supportive' to Heracles. He abstainsfrom criticism of Heracles; he offers him unconditional friendship and anew home; he ignores the risk of pollution from contact with a man whohas murdered his own family; he ascribes responsibility for the act toHera; he claims that all gods, as well as all men, are doomed to errorand misfortune.29n this way, he leads Heracles to face what he has donein madness and still want to live.30Ajax too is not criticised, either byTecmessa or the chorus, when he recovers from his madness. But theprincipal response of Tecmessa is to make demands on Ajax (that heshould continue living, so that he can protect his family, 492ff.). Also,Tecmessa, as a woman, and a slave-wife, cannot be 'supportive'to Ajaxin the same way as Theseus is to Heracles. There are, of course, otherdifferencesbetween the protagonistsand the situations of the two plays.31But the contrast in the responses to the ex-madman-support on theone hand and demand on the other-seems potentially significant. Thecontrast may simply reflect differentdramaticrequirementsin each case;but it may also point to a general awareness in Greek society of theproblemof finding the right way to deal with the after-effectsof madness.Both Ajax and Heracles are sane at the time of these 'therapeutic'dialogues. In Euripides' Bacchae, however, Agave is partially mad onstage for a considerable time; and the dialogue with Cadmus helps tolead her out of madness into a sane recognition of what she has done.Camus' treatment of her is sensitively 'supportive'(as Devereux shows);and Cadmus is sensitive too to the ways he can reawaken Agave's saneconsciousness and sense of herself.32Devereux makes the further claim

28 The Psychotherapy Scene in Euripides'Bacchae, Journal of Hellenic Studies, 90(1970), 35-48 (quotation from 35).29Heracles, 1163ff., esp. 1191, 1218ff, 1234-6, 1311ff, 140ff.

30 See further, H. H. O. Chalk, Arete and Bia in Euripides' Herakles, Journal ofHellenic Studies, 82 (1962), 7ff.31 Cf. Simon, op. cit., 137-39.

32 Cf. Devereux, op. cit., 40-47.



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ANCIENT PSYCHOTHERAPY 315that this scene is 'the first surviving example of insight-and-recallorientedpsychotherapy' (35). Devereux claims that Cadmus does not simply tellAgave what she did while she was mad (that is, tear her own son,Pentheus, apart) but helps her rememberthis, overcoming her psycho-logical 'resistance'to doing so. However, Devereux's interpretationis notthe most natural reading of the text. On the face of it, what is presentedis, first, a period in which Agave is half-mad and rememberskilling, butthinks she has killed a lion; second, a period in which Agave is sane,and cannot rememberkilling at all.33This discontinuity of memory be-tween madness and sanity is paralleled in the portrayals of Ajax andHeracles too.34 Devereux's interpretation is based less on specific indi-cations in the text than in the generalsimilarity he finds between Agave'sbehavioron stage (for instance, 'adefensivehypomanicexaltationmaskingunderlying grief ... a coy, hysterical foolishness') and the behavior ofpsychotics in therapy 'resisting' insight into their condition.35Devereux'sclaim is an interesting one; and his reading of the scene makes it into areproduction of 'psychotherapy' in a very modern sense. But, in theabsence of any strong textual support, Devereux is vulnerable to thecriticism that he has superimposed on the scene a significance which itdoes not have. What we seem rather to have here is a portrayal of oneperson helping another from madness to sanity, and then treating hergently as she reenters normal consciousness. This is interesting enough,as an indication of Greek awareness of how to treat people in suchsituations;but the scene does not seem to be as different from the othercases in Greek tragedy as Devereux claims.Another striking scene, and one that has received less attention,occurs, again, in Aristophanes' Wasps.Philocleon's son, after failing ina second attempt at rational persuasion, seems to pander to his father's'madness'. He sets up a curious 'psycho-drama' in which a courtroomscene is enacted inside the household, and the father is given the role ofjuror in a dispute between two domestic dogs (760ff.). At first, the sonseems to be simply reinforcing his father's obsession. But then, withinthe drama,he managesto 'rig'the verdict;thus, by convincing Philocleonthat he has voted for acquittal,he succeeds in breakinghis father'slifelonghabit of condemnation. At this, Philocleon experiences some kind ofemotional collapse, and hands himself over to his son for a completechange in his style of life.36 t is difficult to distinguish here good comic

33The two periods are presented in 1165-1258, and 1271-1301 (esp. 1286ff) respec-tively. Agave's transition to sanity is brought about during 1259-1270.34 See Sophocles, Ajax, 31lff; Euripides,Heracles, 1094ff, esp. 1122;cf. Devereux, op.cit., nn. 6, 18.35 Devereux, 37. Of the lines Devereux discusses, only 1278 seems to lend much

support to his thesis.36 986ff, cf. 875-84. The subsequent action shows that the reform of Philocleon'scharacter is only skin-deep, however.



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316 CHRISTOPHER GILLtheatre (the ridiculous portrayal of Philocleon's fanatical addiction tojury-service) from the representation of a psychologically credible situ-ation.37But the scene does seem to include the idea of workingon madness'from within'; that is, of playing the madman's game, and working fora change of attitude within the game. If this is so, it gives us evidenceof a technique that is not well-documented in the Ancient World. It isnot until a much later date that we find discussion of similar techniquesin medical writings. The Roman doctor Celsus advocated agreeing withthe patient instead of opposing him, and turning his mind slowly andimperceptiblyfrom irrationaltalk to somethingbetter. Thus, for instance,he tried to allay a wealthy patient's obsessive fear of starvation by an-nouncing pretended legacies from time to time.38This medical techniqueseems similar to that used by Aristophanes' figure, though it lacks thedramatic conversion within the 'mad' state that is so striking a featureof the scene in the Wasps.39This evidence in Greek drama presents a number of difficulties ofinterpretation. However, we can say that the plays show the mad andex-mad being handled gently and with sensitivity;and this portrayalmayreflect a generalawarenessof the importanceof treatingdisturbedpeoplein this way. But, if we discount Devereux's interpretationof the Bacchae,there seems to be no evidence of a developed technique of psychotherapyin the modern sense; that is, a technique designed to give the patientinsight into the basic causes of the mental disturbance and so effect acure for this.

The bordersof medicine and philosophy. So far we have found agood deal of evidence, in ancient religion and drama, for practices whichare in some way comparableto modern psychotherapy,but nothing thatresembles it closely. One problem has been the difficulty of determiningthe presuppositionsabout the nature of mental illness and its treatmentwhich underlie religious practices and dramatic representations. Thisproblem is less acute in the next area I want to explore, the borders ofmedicine and philosophy. For both ancient doctors and philosophersoffered some accounts of mental or psychic diseases, and of their cure;and the philosophers are especially articulate about the kind of diseaseand treatmentthey have in mind. However, as we shall see, there is somedoubt about whether either doctors or philosophers quite engage in 'psy-chotherapy', as we understand this term. Ancient doctors were not un-aware of what we call 'mental' illnesses, although their main concernwas with what we call 'physical' illnesses. But they did not, on the other

37 For other components of the comedy of the scene, see Aristophanes, Wasps,ed.D. M. MacDowell (Oxford, 1971), 249-50.38 Celsus, 3.18 (mid first century A.D.).39 See Riese, op, cit., 442, for a comparable, but more successful, case of dramaticconversion in 11th c. Arabic medicine.



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ANCIENT PSYCHOTHERAPY 317hand, develop to any great extent distinctively mental or psychologicaltechniques to deal with these illnesses. Their normal methods of treat-ment, like those of most modern non-psychiatric doctors, were physicalrather than psychological; and this is largely true of their treatment ofmental illnesses. Philosophers, by contrast, were very much concernedwith the area of the psychological, and sometimes claimed to be 'doctors'of psychic diseases. However, they mostly seem to have had in mindwhat we should regard as moral failings rather than mental illness. Andtheir methods of cure, correspondingly, consist of moral instruction, ofvarious kinds, rather than 'therapy' in our sense. To that extent, neithertype of ancient curequitecorrespondsto modem psychotherapy;althoughthere are some strikingborderlinecases, on the more psychological mar-gins of medicine, and on the more medical margins of philosophy, thatare worth considering closely.Let us take medicine first. It is striking that, in the Wasps,while somany other remedies are tried for Philocleon's 'madness', nobody thinksof sending for a doctor. This seems to suggest that, as we would expectfrom other evidence, Greek doctors were associated primarily with thetreatment of physical rather than mental illness.40This does not meanthat there is no evidence of interest in mental illness in medical texts inthe Hippocratic corpus and elsewhere. We find accounts of cases ofillnesses of the mind (gnome) or the psyche, which give close attentionto such features as irrational anxieties and distress as well as distortionsin perception.41We also find the beginnings of the classification of suchillnesses. For instance, doctors distinguish between phrenitis and mel-ancholy. Phrenitis is an acute deliriouscondition, markedby, for instance,feverish hand movements and hallucination; melancholy is a chroniccondition, affecting the digestion as well as the emotions, and defined byits diagnosis (an excess of black bile).42The extent to which these illnesses were conceived as a separateclassof diseases (mental or psychological rather than physical) is generallynot very easy to determine. It depends on the extent to which the writerin question regarded it as important to reach a view on the nature of,and relations between, psyche and body.43But, as far as treatment goes,it is clear that, in this as in other areas of ancient medicine, the methodswere largely physical. Drugs were prescribed,often with purgative func-tions, for acute conditions; long-term changes in diet and regime were

40Cf. Lain Entralgo, op. cit., 169-70, Simon, op. cit., 215ff.41 See Jackie Pigeaud, La Maladie de L'Ame: Etude sur la relation de 'ame et du

corps dans le tradition medico-philosophique ntique (Paris, 1981), 42-45, 95ff., 124ff.,Lain Entralgo, op. cit., 161-63. (Here and subsequentlyI renderpsuchein its more familiarform psyche.)42 Cf. Pigeaud, ibid., 71ff., 122ff., and H. Flasher, Melancholie und Melancholikerinden medizinischen Theoriender Antike (Berlin, 1966).43 See Pigeaud, ibid., Chap. I, esp. 32ff.



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318 CHRISTOPHER GILLprescribedfor chronic conditions. In the Hippocratic corpus, for instance,we find a descriptionof a 'troublesomeillness',phrontis,whose symptomsinclude unexplainedinternalpains and irrational fears and anxieties. Themedical treatise prescribes hellebore to purge the head, then a laxativeto purge the bottom. Then asses' milk, no wine, no sport or walks. Underthis treatment, the illness will go away in time.... 4 In other cases, bycontrast, wine is prescribed,in moderatequantities, to counteract anxietyor depression.45To what extent were illnesses of this kind also treatedby non-physical means? It had been recognized since Homer that theskilful doctor entertains with words or stories, while he administersherbs or drugs.46 t was also sometimes recognized that the effectivenessof a doctor's treatment depended on his success in gaining his patient'scooperation.47This evidence of realization of the value of the 'bedsidemanner' falls short, however, of attesting to the existence of what onecould reasonably call psychological treatment. Did ancient doctors evertry to cure mental illnesses by psychological means?In fact, there are certain rather interesting discussions in medicaltexts of psychological treatments of the mentally disturbedthough someof the texts are from late antiquity. Caelius Aurelianus is a particularlyvaluable source of evidence of this kind. He seems to have written in thefifth century, A.D.; but much of his material is based on that of Soranus(early second century, A.D.).48Caelius advocates the use of psychologicaltreatmentin conjunctionwith physical treatment;his psychological treat-ment aims to counteract the state of mind of the sick person. Thus, heproposes visits to the theatre (comedy for the sad and tragedy for thegiddy and childish), to restore the 'mean' state of mind (mediocritas)that constitutes sanity. He also recommends attendance at philosophicaldiscussions; for philosophers remove fear, sadness, and anger by theirwords, and this helps to providea considerableimprovementin the bodilycondition. Here, dialogue, of a certain kind, makes its appearance inthe therapeuticprocess. Presumably,Caelius has in mind the exhortationsto emotional self-control typical of Stoic philosophy, for instance, in theRoman Empire (which I shall note again shortly). Does Caelius alsoadvocate therapeutic dialogue between doctor and patient? Even in thecase of those afflictedbyphrenitis(an acute, deliriouscondition), dialoguecan be helpful. Caelius'recommendationsarebased againon the principleof trying to counteract the sick person's state of mind. Overexcitedpatients should be addressed gravely (like children); depressed and irri-tated patientsshould be addressedgently, with a cheerful and encouraging

44De MorbisII, VII, Littre, 108-110;cf. Pigeaud, ibid., 126, and, for a similarexample,Simon, op. cit., 218-19.45Cf. Pigeaud, ibid., 497-503.46Iliad, 11, 643; 15, 392-94, cf. Lain Entralgo, op. cit., 24.47Plato, Gorgias,456b, cf. Lain Entralgo, op. cit., 97.4 Pigeaud, op. cit., 20-21.



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ANCIENT PSYCHOTHERAPY 319manner. Authority, in particular, can play a useful role in dealing withthe insane: the doctor should try to find someone whom the patientrespected when sane and present him to the patient to recall him to hissane state of mind.In discussing the psychological techniques of dealing with the insane,Caelius is contributingto a subjectwhich had interested doctors for sometime. Celsus, for instance,writing in the first century, A.D., had suggestedreading to educated patients well, or indeed badly, if that would serveto jolt them into rationalthought. Caeliusdevelops this suggestion, urgingthe doctor to find topics (such as agricultureor navigation) that interestthe patient, and, if he has no special interests, to ask him about trivialitiesor play chess. Caelius emerges from his writings as a rather sensitivedoctor, and a 'liberal' (as we might say) in his treatment of the insane.He opposes the crude or brutal techniques sometimes used-starvation,heavy drinking, or flogging. Celsus had advocated a discriminating useof violence, as a kind of 'shock-treatment',to startle the madman out ofhis mental state. Caelius rejects such treatment;if he has to use ropes torestrain the insane, he winds wool around them so as not to hurt thepatient.49He also rejects the use of music in therapy, which had beenadvocated by Asclepiades, among others, and which was, in a sense, acontinuation of the Corybantic cure.50In general, he opposed 'homeo-pathic' treatment, that is, the attempt to cure emotional excitement byinducing excitement; his own method, as we have seen, is consistently'allelopathic', designed to counteract the existing mental disturbance.51It is understandable that Pigeaud should describe Caelius as le seulpsychiatre coherent de l'Antiquite (112). Apart from the fact that hispsychological methods, given their limitations of aim, seem reasonableones, he has a clear and consistent view of the nature of madness andthe treatment appropriate to it. He sees madness as a physical illnesswith mental or psychological side-effects.52Both body and mind can, andshould be, treated; and since body and mind interact, the treatment ofone aspect of insanity can help to cure the other.It is clear that we have evidence here, in the later medical tradition,of practices in some ways more like modern psychotherapythan we havefound elsewhere in the Ancient World. The patient is treated, by somedoctors at least, as an interrelatedcomplex of mind and body, amenableto psychological as well as physical treatment for mental disorders. Heis also sometimes treated as an individual; his long-term interests andcapacities, as well as the transient play of his moods and reactions, arenoted, and responded to, by the more perceptive doctors. The medical

49For refs. in Caelius and Celsus, see Pigeaud, op. cit., 109-11, 427.50 Cf. Dodds, op. cit., 79-80, and nn. 9-11 above.51 Cf. Pigeaud, op. cit., 109-112.52 See Storr, The Art of Psychotherapy,93-94; cf. Chap. 13.



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320 CHRISTOPHER GILLtreatment includes an attempt to institute some kind of dialogue, and toestablish personal contact, with the patient. However, it seems anoverstatement to claim that the methods used by Caelius, or any otherancient doctor we know of, constitute psychotherapy of the kind I de-scribed at the start of this article. The principal reason for not makingthis claim is that, in ancient medicine, the verbal and psychological partof the treatmentis only ancillaryto the physical treatment. Verbaltherapyis not seen as a means of uncovering the source of the mental disorderand thus opening the way for the removal of the disorder.Fundamentally,the mental disorder is seen (by Caelius, for instance) as a by-product ofa physical disease. There is a contrasthere with the views of some moderntherapists (including Anthony Storr), as regards at least some kinds ofmental disorder. While these therapists accept the need to use drugs toalleviate extreme mental disturbance, they regard therapeutic dialogueas the only way to uncover the causative roots of the disturbance, andso bring about a lasting cure. There seems to be no evidence for thisview in ancient medicine, and it is not a view which is consistent withthe primarily physical approach to illness (including madness) that wefind there.The idea that searching dialogue can reach the root cause of a person'sproblems in living, and can produce a cure for them, is, however, adominant theme in one ancient discipline, that of philosophy. This makesancient philosophy sound very much like modern psychotherapy.But wefind in this area the general difficulty of knowing whether the termsmental 'sickness' and 'cure', are being used in anything like the samesense as in ancient (and modern) medicine; or whether these terms arebeing used to denote the rather different ideas of moral defectiveness andmoral instruction.The belief that the philosophercan function as a doctorof the psyche emerges in the late fifth and early fourth century, B.C. Weare told that Antiphon founded an art to cure griefs, analogous to thatwhich among doctors serves as a basis for the treatment of diseases. InCorinth, near the market-place,he set up a room with a sign announcingthat he was able to treat with words those in distress. He asked themthe causes (of their distress) and offered consolation. 53 Our evidencedoes not enable us to determine his techniques with any certainty; butthe idea that there exists a psychological analogue for the technique ofmedicine becomes a standard one. Democritus claims that, Medicineheals diseasesof the body;wisdom frees the psyche from passions (path-e) ;and this claim seems to be connected with his attempt to find a systematicway of freeing mankind from despair (dusthumia) and producing cheer-

53Cf. Lain Entralgo (whose translation of the relevant passage I give, in modifiedform), op. cit., 97-98, and G. B. Kerferd, The Sophistic Movement (Cambridge, 1981),51.



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ANCIENT PSYCHOTHERAPY 321fulness (euthumia).54Plato, in particular,appropriatesthe idea that phi-losophy is a quasi-medicine, sometimes combining this idea with theclaim that the Socratic type of dialogue is the most effective method ofcure for psychic illness. The locus classicus is the start of the Charmides,an early Platonic dialogue. Here, Socrates presents himself as a specialkind of doctor, who will not cure the body without the psyche, and whowill not attempt to cure until he has made a diagnostic examination ofthe psyche of the patient, Charmides, to see if he possesses s-phrosune(self-control) or not. The diagnostic test and the proposed 'cure' areconducted in Socrates' distinctive method of questioning dialogue, theelenchus.55The Socratic method may seem, superficially, like a psycho-therapeutic dialogue in the modern sense; for instance, both types ofdialogue require the 'patient' to examine himself closely. But the actualcontent of the dialogue is a very different one. Instead of exploring theparticularitiesof personal life (especially its emotional aspects), Socraticdialogue examines a person's capacity for defining abstract ideas (suchas sophrosune).Given the Socratic tendency to identify moral excellencewith knowledge, this procedure makes sense; but it means that Socraticdialogue is a quite different kind of technique from modern psycho-therapy.In his later writings, Plato explores fully the idea that moral defec-tiveness is a sickness of the psyche, and, as such, requires cure, of somekind, rather than punishment.56This approach is taken up by the Stoics,who catalogue in some detail the various sicknesses of the psyche (thatis, what we normally think of as vices), and reflect at length on thepossibility and means of curing these.57The term 'sickness of the psyche'is used with rather more plausibility by the Stoics and the later Platothan by Socrates in the Charmides. For they use it to denote the psy-chologically richer area of a person's relationship to his emotions orpassions, particularly those to which he is particularly liable.58LaterStoics are interested in examining, in a psychologically realistic way, theextent to which a person can master his own particularemotional weak-nesses. They are also interested in the way in which this process of self-correctioncan be promotedby therapeuticdialoguewith anotherperson.59

However, the fact remains that philosophers such as Plato and theStoics were operating with a conception of psychic sickness and curethat it significantly different from that used by ancient or modern med-54 Fragment 31; cf. Pigeaud, op. cit., 443-45.55Cf. Plato, Sophist,227-30, where Socratic dialectic is describedas a meansof bringingabout a quasi-medical purgation (katharsis)of psychic diseases.56 Cf. M. M. Mackenzie, Plato on Punishment (Berkeley, 181), Chaps. 10-11.57 Cf. Pigeaud, op. cit., Chap. 3.58Ibid., 291ff.59 See, esp., Seneca, De Ira and De TranquillitateAnimi; cf. Pigeaud, op. cit., 315ff,503ff, and, on Posidonius, 276ff.



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322 CHRISTOPHER GILLicine. Stoic 'madness', for instance, does not necessarily manifest itselfto the suffererin the kinds of distress and anxiety that ancient medicinesaw as symptomatic of melancholy and that modern medicine sees assymptomatic of neurosis. Nor does Stoic madness necessarily manifestitself to the observer in the kinds of pronounced abnormalityof behaviorthat ancient medicine saw as symptomatic of phrenitis and that modernmedicine sees as symptomatic of psychosis. This reflects the fact that theStoics, like Plato, did not proceed by accepting the notions of madnessand sanity that were current in their society and then attempting to finda psychologically richer account of these. Instead, they wanted to revisethese notions, in line with their radical and revisionary moral theories.0Modern psychotherapists, since Freud, have produced revisionary psy-chological theories, too; but their theoretical work has developed directlyout of clinical experience of people who already seemed to themselvesor their society to be abnormal or distressed.

Are there any areas of overlap between the ancient medical andphilosophical approaches to psychic illness? Did the philosophers everset out to cure people who were 'sick' or disturbed in a medical sense?Pigeaud argues that we can find evidence for certain kinds of overlap,particularly with respect to what we call 'neurosis'.61He points to Lu-cretius' descriptionof the ennui and restless anxiety that afflicted Romanaristocrats, and of the ways in which they felt 'weighed down' by careswhose origin was unclear to them. Lucretius sees these feelings as thesymptoms of a 'sickness' whose primary cause is an unrecognized fearof death. He undertakes to cure this sickness by his teaching; and hispoem constitutes a kind of therapeutic dialogue, designed for this pur-pose.62 Pigeaud also points to the quasi-therapeuticform of Seneca's DeTranquillitateAnimi. At the start of this work, Serenus describes, asthough to a doctor (ut medico, 1, 2) his currentsymptoms:indeterminateanxiety, dissatisfaction with himself, inability to settle down to any onecourse of action. Pigeaud notes that these symptoms are close to someof the symptoms of melancholy, as described in medical texts. Thissuggests that some ancient philosophers, as well as doctors, recognizedwhat we call 'neurosis' (that is, anxiety and distress which are not ex-plained by the external circumstances of a person's life), and that the

60Plato's account of the tyrannicalpsyche in Republic,Book IX, might seem a counter-instance: the psyche, 'maddened'by desire (573a-e), behaves in a way that might be seenas mad in conventional terms (574d-575a). But Plato did not write the account in orderto analyse conventional madness, but to dramatize his revisionary ethical theories.61 Pigeaud, op. cit., 513-14.62Lucretius, 3.1051ff., cf. Pigeaud, op. cit., 205ff., and B. Farrington, Form andPurpose in the De Rerum Natura, in Lucretius, ed. D. R. Dudley (London, 1965), 19-34.



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ANCIENT PSYCHOTHERAPY 323philosophers, as well as the doctors, attempted to offer a cure.63Pigeauddoes not claim that these passages in Lucretius and Seneca constitute thedemarcation of a new area of ancient thought, combining the curativeaims of medicine with the developed psychology of philosophy and thusconstituting a method which might reasonablybe comparedwith modernpsychotherapy.The two areas remaindistinct, though closely juxtaposed.Pigeaud's statementof the position seems a fair one. Both ancient doctorsand philosophers sometimes recognized what we call 'neurosis' thoughneither of them conceived it quite as we do. Neurotic behavior was takenby doctors as a symptom of the physical disease of melancholy, and byphilosophers as a symptom of intellectual and moral weakness. The twoapproaches to 'neurosis' co-existed, but were not bridged or synthesizedin antiquity.64Conclusion. What conclusions can be drawn from this survey oftypes of practice in the Ancient World? This survey seems to suggestthat modern psychotherapy holds a place which was not recognized inthe Ancient World, between medical and religious therapy on the onehand, and philosophical therapy on the other. Ancient medical and re-ligious practice seems to presupposethat the roots of emotional disturb-ance lie in some region of the person that is 'irrational' in some sense,and not amenable to therapy through dialogue. For religion, this regionis the one that is reached through Corybantic rites or initiation intomystery cults, a region accessible to divine dialogue (through dreams andvisions) but not to human dialogue. For medicine, the source of irra-tionality is usually taken to be a physical one. Humoral imbalance, forinstance, is the supposed cause of melancholy, which doctors tried tocure by administeringdrugs such as hellebore. Enlightened doctors (Cae-lius Aurelianus, for instance) supplementedsuch treatmentwith attemptsto establish personal contact with mad patients. Similarly, in ordinarylife (if we can draw any inferences from Greek drama), people wereconscious of the need to talk to the mad, and ex-mad, with special careand sensitivity. But neither in medicine, drama, or religion do we findattempts to discover the roots of mental disturbance and so effect a cureby verbal therapy alone.In ancient philosophy, on the other hand, dialogue is much morecentral; and ancient philosophical dialogue (like modern psychothera-peutic dialogue) aimed at inducing the 'patient' to examine himself andimprove his capacity for autonomous living. Ancient ethical philosophyalso tended to assume that personal problems in living derive from the

63 Pigeaud, op. cit., 204-08, 506, 516-18. One might compare Antiphon's attemptedcure (n. 53 above), although the kinds of distress he tried to cure may have had moredeterminatecauses.64Pigeaud attributes to Pinel (the grandfather of modern psychiatry) the eventualattempt to join the two traditions in a systematic way, op. cit., 245-47, 531-35.



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324 CHRISTOPHER GILLirrational regions of the psyche. Unlike the other ancient disciplines,however, ancient philosophy held that these regions are amenable torational control, and that therapeuticdialogue can help a person to gainrational self-mastery. This is an assumption which ancient philosophymay seem to share with modern psychotherapy,but there are significantdifferences in the types of dialogue used and in the psychological as-sumptionson which they rest. With the exception of the unusual 'Socratic'dialogue, ancientphilosophicaldialoguewas overtly didactic in character.The philosopher gave instruction, argued, urged; he was not, like amodern psychotherapist, typically reticent, interrogative, and concernedto draw the other person out. Also, ancient philosophical dialogue wasexplicitly moral or evaluative in character. There is no attempt, as inmodern psychotherapy,to create a morally-neutral,'free' space, in whichthe patient is invited to be absolutely frankabout himself, without fearingthe therapist'scondemnation. There are also differencesin psychologicalassumptions. While ancient moral philosophy is interested in (indeed,preoccupiedwith) the 'irrational', t does not recognize, to any significantextent, the notion of the 'unconscious'. Certainly, the attempt to probethe person's unconscious, by the exploration of dreams, fantasies, orverbal associations, forms no part of ancient philosophical therapy. An-cient philosophy approaches the person as a conscious agent, who ispotentially capable of controlling his emotions and desires by deliberatechoice. He is not treated as someone in whom the conscious self is, soto speak, only the surface level, and whose behavior is determined, to asignificantextent, by unconscious desiresand fears.65 n this respect, then,modern psychotherapy occupies a space not occupied in the AncientWorld, between the non-verbal techniques of religion and medicine andthe verbal techniques of philosophy. The space it holds in modern timeswould be hard, perhaps impossible, to imagine without the expansion ofpsychological conceptions we associate with Freud.66In pointing to this gap in the ancient range of therapies, I do notintend to disparage the facilities available for the mad and emotionallydisturbed in the Ancient World. My aim has been to try to demarcatedifferences and similarities rather than to argue for the superiority orinferiorityof ancient or modern institutions. In fact, the two main classesof the mentally sick, as we now distinguish them, seem to have had somekind of recourse, during much of the period of Classical Civilization. Forthe 'ravingmad' or psychotics, the medical professionattempted to bring

65 In modern psychotherapy, there is considerable dispute about the nature of theunconscious and the extent of its power. But to allocate some role (often a large one) tothe unconscious in the determination of behaviour has been characteristic of psycho-therapy since Freud.

66 For recent appraisals of Freud's conceptions, see Philosophical Essays on Freud,ed. Richard Wollheim and James Hopkins (Cambridge, 1982), and Ilham Dilman, Freudand the Mind (Oxford, 184).



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ANCIENT PSYCHOTHERAPY 325about some kind of cure, sometimes in a humane and sympathetic way.67For those looking for a cure for fears, anxieties, and distresses with noobvious source (neurotics, as we call them), a range of therapies existed,religious, medical, and philosophical in character. Jung suggests that agood many of the people who go to psychotherapists in the twentiethcentury are really sufferingfrom the lack of any strong moral or spiritualconviction; and that older people, especially, are troubled essentially bythe fear of death.68If people were troubled for similar reasons in theAncient World, they had no shortage of would-be therapists, especiallyfor the treatment of the fear of death.69

The University College of Wales, Aberystwyth.

67According to Michel Foucault, Madness and Civilization(New York, 1967), thisattempt was rarely made in modern Europe before the Nineteenth Century.68 C. G. Jung, Modern Man in Search of a Soul (London, 1933), 120ff.

69 Ancient 'mystery' cults, e.g. that of Isis, typically offered the hope of immortalityof the psyche to initiates. For philosophical exhortations to overcome the fear of death,see Pigeaud, op. cit., 205-08, 349-53.

gill ancient psychoterapy

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