REGIMEN

A Healthy Lifestyle


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“A man ought to handle his body like the sail of a ship,” wrote Plutarch, the first-century-CE philosopher, “and neither lower and reduce it much when no cloud is in sight, nor be slack and careless when managing it when he comes to suspect something is wrong.”

Thinkers in the ancient world were as focused on preserving health as they were on curing illness. Despite the medical advances of Galen’s era, doctors still struggled to treat a variety of ailments, and they knew it was preferable to prevent illness in the first place. Sailing is a recurring metaphor in texts about regimen—diet, exercise, lifestyle—as it is easier to keep a ship steady than to right its course. Balance is important.

Mosaic of a ship rowed by men carrying shields. A man in white is tied to the mast.

Mosaic detail of Ulysses meeting with sirens in a scene from Homer’s Odyssey. Roman, 3rd century CE. National Museum of Bardo, Tunisia: 2884A. Photo: Konrad Zelazowski / Alamy Stock Photo.

Doctors and philosophers alike were interested in a systematic plan for living and ascribed both a physical and a moral value to a proper regimen. Advice on living well is presented in different kinds of texts for expert as well as general readers, and the scientific, social, and ethical aspects of an individual’s regimen often bleed into one another. Galen considered himself a physician-philosopher, and such concerns occasionally overlap within his writings too.

A regimen provides a way to manage the external factors that can influence health. While much about the body is unchangeable, a regimen is within one’s control. Galen writes:

“Health consists in a definite proportion of so-called constituent elements, of warm, cold, moist, and dry . . . whoever is able to preserve these, will be the best guardian of health.”

Everyone possesses all of the elements, according to Galen, but in most people, one or two are dominant. Too much or too little of any element leads to disease, but the external actions we take have the power to rebalance our internal systems.

A row of four mosaic squares with guilloche borders. Each square depicts a different winged figure in motion, draped in a colored cloth (from left to right: green, red, blue, yellow).

The “Four Seasons” mosaic. Roman, 250–300 CE. Stone and glass. House of the Drinking Contest, Antioch, Greece. H. 178.8 cm; W. 518.2 cm. Virginia Museum of Fine Arts: Adolph D. and Wilkins C. Williams Fund, 51.13. Photo: Virginia Museum of Fine Arts. CC BY-NC.

Galen categorizes four different ways that our lifestyle brings our bodies into contact with the external world in his book Keeping Well: there are “things to be administered” (items we take in, such as food, drink, and air); “things to be removed” (excrement, urine, fluids purged through vomiting, venesection, etc.); “things to be done” (walking, riding, exercise, massage, sex, sleep, etc.); and “things to be applied” (anything that touches the skin, e.g., during bathing and anointing).

Two greenish-purple figs sit on a windowsill, while a golden-brown disk of bread rests underneath.

Detail of bread and figs. Roman, 45–79 CE. Fresco. Herculaneum. Museo Archeologico Nazionale di Napoli: 8625. Photo: Ministero per i Beni e le Attività Culturali e per il Turismo / Museo Archeologico Nazionale di Napoli.

While the right proportion of these “things” is necessary, there’s no one-size-fits-all prescription, and the exact recommendations will be different for each person according to their individual needs. The balance is not static for each person either, and varies across the life cycle from childhood through old age. For Galen, the body responds and changes according to its environment and over time.

While Galen believed that a person’s activities affected their physical health, he also maintained that one’s mental state played a role. Internal emotions, too, can influence wellness, and he recounts cases of patients suffering physical problems caused by fear, anger, and grief. Cultivating the mind was just as essential as caring for the body, and Galen also wrote books on how to regulate emotions (Avoiding Distress and Affections and Errors, for example), and focused particularly on how to cope with unpleasant feelings in the face of loss or misfortune. While improperly managed negative feelings can have a deleterious effect on the body, a disciplined mind can also help when physical problems arise; Galen writes with admiration about the orator Aelius Aristides, an acquaintance with “a strong soul and a weak body,” whose mental strength buoyed his resilience in the face of illness. Galen understood that there was a connection between mind and body, and that this relationship was reciprocal.

Keeping Well, Galen’s most extensive description of an ideal approach to regimen, is a fairly lengthy book by his standards—he acknowledges this self-consciously in the course of his text. The great attention he devotes to what we now call “preventative medicine” is indicative of a regimen’s power. For Galen, many aspects of lifestyle were part of a continuum of wellness, from health maintenance to healing; food, for example, could be consumed for its ability to sustain well-being, or as a medication with an aim to heal.

A page illustrating an orange carrot with green leaves on top.

Text describing the uses of medicinal vegetables with an illustration of a carrot. From Dioscorides (1st century CE), De materia medica (Vienna Dioscorides; Byzantine, ca. 515 CE), 312r. Österreichische Nationalbibliothek: Codex Vindobonensis Med. gr. 1. Photo: CPA Media Pte Ltd / Alamy Stock Photo.

Contemporary scientists are increasingly returning to such a notion, and it is now common for doctors to first recommend lifestyle changes prior to prescribing medication for conditions that can be improved in this way.

A painting divided into a row of three squares containing shelves of fruit. The square on the left shows a pitcher of water and green, underripe fruit; the square in the center depicts small fruit in a bowl with a glass of wine; the square on the right contains pinkish-orange, ripe fruit.

Detail of food and drink. Roman, 45–79 CE. Fresco. Museo Archeologico Nazionale di Napoli: 8645. Photo: Ministero per i Beni e le Attività Culturali e per il Turismo / Museo Archeologico Nazionale di Napoli.

But in the ancient world, a prevention-minded approach played an outsize role in comparison with medicine today, in part because regimen held greater explanatory potential: ancient thinkers were unaware of germ theory, and disciplines like virology and microbiology still were centuries away. That Galen’s recommendations—based on his theoretical understanding of the humors and attentive observation of individual patients—frequently accord with the recommendations of present-day health experts makes his insights even more remarkable.