In the first chapter I introduce some methodological issues pertaining to the history of mental health: on the one hand, the issue of anachronism, the problem of retrospective diagnosis, on the other, the importance of maintaining intelligibility across cultures. When it comes to the ancient world, there are specific problems related to the nature of medical sources in Greek and Latin, and our limited access to the medical practices underlying them; in addition, the genre 'biography of disease' has its own pitfalls, namely those of attributing ‘essence’ to what appears, prima facie, to be most of all a construct: a disease concept or label such as phrenitis. Finally, in this chapter I consider the label phrenitis, its etymological meanings and the implications of the name vis-à-vis localization (chest? lungs? diaphragm? heart?) and mental life (mind? character? soul? mental capacities?). I also discuss the ‘Homeric’ appeal of the phrēn/phrenes, the name of the body part from which the label originates. The poetic archaism of phrēn/phrenes combined with its medical use made it both understandable as a generic term for mental life and specifically a ‘medical’ term to indicate the diaphragm, and contributed to making phrenitis a long-lasting disease concept.

Localization is a key move in the history of medicine across cultures, arguably; but a parallel, if not alternative, narrative can be noticed in the Graeco-Roman tradition (and elsewhere), which I have called one of ‘delocalization’, discussed in Chapter 3:namely, the approach to disease, and especially mental disease, in terms of ‘holistic’ impact on the patient. This surfaces most prominently in some authors, but can also be noticed as a matter of discussion of the locus affectus in great thinkers like Galen. In this particular strand of the history of phrenitis the key authors who have reached us are the Roman author of De medicina, Celsus; the Atomist philosopher and doctor Asclepiades; and the thinkers of the Methodist tradition, represented most extensively by Caelius Aurelianus as far as phrenitis is concerned. This chapter surveys the relevant texts by Celsus and Caelius and the fragmentary evidence on Asclepiades, where an important cluster of shared principles emerges: an interest in psychology and in the health of the individual ‘as a whole’, a disregard for the localization of the disease in a specific body part, and of fever as a key pathological indicator, and a strong inclination towards psychotherapeutical and ‘soothing’ measures.

Chapter 2 begins with classical medicine, exploring the sources of so-called Hippocratic medicine, nosological and clinical, as well as other lesser-known authors from the fourth century BCE such as Diocles and Praxagoras. The limited material preserved on our topic from Hellenistic medicine (Herophilus and Erasistratus) is also surveyed. The richest information is preserved by the writings of the Hippocratic Corpus, where phrenitis first appears, and where it is richly described, both in nosological profiles and with reference to specific patients. Its core traits are by this point established: fever, localization in the chest , and an association with winter also showed by the co-morbidity with, and analogy to, pleuritis and pneumonia. Interestingly, the phren/phrenes are seldom mentioned in discussions of phrenitis, and when they are, not in their traditional, ‘Homeric’ psychological function, or directly as locus affectus, thus signalling a desire to distance the pathological narrative from traditional poetic models.

Chapter 5 covers the clinical part of the account left to us by the medical authors of the imperial period: the case histories, pathological descriptions and clinical narratives as they appear in Anonymus Parisinus, Aretaeus and Galen, as well as the medical developments in the following centuries, which will proceed very much along the lines traced by Galen. This is illustrated by the late-antique sources included in the last section of the chapter: Oribasius, Aetius, Alexander of Tralles and Paul of Aegina. The topics analysed include patient profiling and behaviours; the topic of ‘neighbouring diseases’ and ‘similar diseases’ to phrenitis (pleuritis and pneumonia, but especially lethargos as cold brain fever, symmetrical to the hot brain fever which is phrenitis); and the recurring symptoms. These form a clear picture by now, featuring fever, sensorial disturbance, cognitive damage, various ‘neurological’ signs like (notably) 'flocillation' (the compulsive picking of hair or flocks from one's clothes and blankets), sleep disturbance, voice alteration, expectoration, a certain quality of the urine and pulse, respiratory issues, and a rich and varied psychological disturbance, where hallucination stands out.

Chapter 4 moves to the medical texts of the imperial age, addressing first the theoretical approaches, under the subdivisions ‘localization’, semiotics, chronology and aetiology. The time frame involved here is the first to sixth centuries CE, with the main focus on Aretaeus and Galen. The two famous physicians offered strong accounts of phrenitis in terms of localization (with a centre towards the heart, first, and the brain, second), and also introduced sophisticated discussions about ‘sympathy’ and co-affection in the disease. They also addressed symptomatology and, in the case of Galen especially, took phrenitis as exemplary case for semiotic discussions and the exploration of causes.

The final chapter is devoted to the ‘death of phrenitis’. The end of the active life of the disease can be described as taking place through three avenues, and producing three outcomes. First of all, in a somatic sense, phrenitis gives way to meningitis and meningo-encephalitis, the inflammation of the brain and its membranes; secondly, its symptomatology evolves into what in modern pathology is defined as a syndrome, that of ‘delirium’; thirdly, one last, ‘softer’ outcome of phrenitis is the lay concept of stress, classified as ‘stress syndrome’ in contemporary taxonomies. This specific story of one specific disease, in the final conclusions, is discussed as exemplary of the dynamics behind the ‘birth’, ‘life’ and ‘death’ of biological concepts more generally.

As the narrative moves beyond the highways of the Graeco-Roman medical traditions, and enters the post-antique reception and elaboration of this canon, the dynamics of translation and assimilation into different languages and cultural milieus become more relevant. Chapter 7 explores the Byzantine transmission of the ancient material, at first sight more faithfully based on Galenic models and their encyclopaedic abridgements, and then the Syriac and Arabic traditions and the problems posed by translation when it comes to such a loaded term as phrenitis. The chapter moves on to the medieval medical sources in Latin (translations from the Arabic, as well as original elaborations in Latin, especially those of the school of Salerno) and to the medical writings produced in Arabic in the Iberian peninsula by Arabic and Jewish authors.

Chapter 6 looks at the construction of the phrenitic man in wider culture, from non-technical discussions of the disease to its allegorical or hyperbolical honing to a paradigm of folly, ignorance, depravity and moral weakness. In this chapter I look at the earliest occurrences of the term in Greek in non-medical writings, which are fairly late (Hellenistic: Menander's Aspis), and then at the bulk of the ancient evidence, which is largely ethical-philosophical and, most of all,found in theological, prudential and hagiographic contexts. Augustine is the central author here, whose contruction of the phreniticuswill be a most influential model in the centuries to come.

This chapter concerns the afterlife of phrenitis in the early-modern and modern era, in three main directions: the ‘anatomization of the past’ and the trajectories of Hellenism in the texts and doctrines of the medical doctors in this era; the development of Renaissance anatomy, and the post-mortem pathological discussions on the localization of phrenitis; the alternative approaches represented by Paracelsus and Paracelsianism. In the second part of the chapter the modern era is addressed through a number of episodes, or case studies: university medicine; patient reports; an episode of phrenitis contagiosa; the parallel of phrenitis in veterinary studies; the topic of drunkenness and lack of moderation in lifestyle and their role in phrenitis.