Galen system is based on three pillars: the affected body part, the type of qualities imbalanced, and the degree of imbalance. Therefore, he only distinguishes between mental illness and impaired consciousness when there is a difference between these two entities in any of these three pillars. Thus, he distinguishes phrenitis from melancholia but not from mania. The emphasis on the system, on the other hand, enables him a very tight notion of disease, where symptoms, mechanisms, affected organ and treatment are closely linked.

Like their forerunners, post-Hellenistic doctors also grappled with the unclear boundaries between healthy versus pathologic sleep, and consciousness-unconsciousness. Furthermore, they incorporated new diseases and redefined others - like lethargy - that were specifically associated with this process. Celsus considered sleep as all-or-nothing phenomenon, without recognising different depths. Regarding mental capacities, he subsumed most of them in his idea of mens/animus. Aretaeus, on the other hand did conceive different depths of sleep, and his eclectic method enabled him to find alternative pathophysiological explanations to characterise several of its main features. Similarly, although his organization of mental capacities varied according to what he was explaining, the opposition gnômê-aisthêsis was important in his idea of mind.

4 Post-Hellenistic authors present a more compartmentalised idea of diseases in general and of impaired consciousness in particular. Unlike the Hippocratics, who barely discussed mental illness, these authors did distinguish impaired consciousness from mental illness through a classificatory system of dichotomic oppositions, additionally they discussed new conditions which are not mentioned in the HC. In most theorisations, perceptions play an increasingly relevant role to understand these conditions.

Some Hippocratic doctors regarded sleep as a healthy process, and some as a pathological one; some of them struggled to distinguish between hallucinations and nightmares, and some between deep dreamless sleep and total loss of consciousness. This chapter explores how different treatises from the Hippocratic corpus navigated these ambiguities, how they explained different depth of sleep (i.e. different levels of consciousness), and how such understanding relates to their views on mental capacities (which they subsumed in concepts such as phronesis, sunesis, gnômê, and nous).

A diachronic look at the contrast between mental illness and impaired consciousness among these ancient doctors shows a trend towards a more compartmentalised idea of these conditions, a stronger notion of disease, and a progressive abstract framing of clinical findings into theoretical classificatory models and comprehensive pathophysiological systems.

Contrary to mainstream scholarship’s opinion, the Hippocratic corpus presents many cases of impaired consciousness, but only a few of mental illness. By looking at three study cases, this chapter describes how these doctors understood conditions where patients act weirdly or were not their usual selves, and how they construed the notion of disease.

In face of the difficulty of establishing clear biological boundaries between sleep and the other forms of impaired consciousness, the sociological and anthropological analyses can provide hints as to where those limits were set in real life. The terminological analysis suggested a common feature that persisted throughout the different authors and periods: different levels of consciousness (from drowsy to hyperactive, and from delirium to koma) where always related to the impairment of mental capacities, regardless of the way in which each medical writer grouped or understood them.

Unlike mental disease, which presupposes a strongly theory-laden concept, impaired consciousness or delirium is currently conceived in medicine as a cluster of symptoms. This chapter contrasts these two constructs, and discusses our current idea about the notion of disease.

Galen conceived sleep and wakefulness as a continuum that depended on the mixture of qualities within the ruling part of the puschê (the hêgemonikon) located in the brain. Naturally, in his system whenever pathological sleep occurred the doctor needed to determine if the brain was affected directly or by sympathy (from another organ), and the precise imbalance of qualities that needed to be counteracted by their opposites. His idea of mind was very accurately and hierarchically structured: it resided in the logical part of the soul, located in the brain, and several diseases with impaired consciousness compromised its normal functioning.

This chapter examines the assumptions, concepts, and narratives historians use to study US relations with the natural world: with biological and chemical agents, environmental and physical phenomena, natural resources, and plants, animals, and microbes. Looking beyond the experiences and activities of human beings, it asks how non-human actors and forces can help explain the history of foreign relations. It surveys some of the key medical, scientific, and environmental issues that have shaped the history of foreign policy and international affairs, with an eye toward the methods scholars can employ to analyze these topics most profitably. Although studying these subjects can present methodological challenges, this chapter offers tools and strategies for overcoming those potential roadblocks. Becoming more attuned to medical, scientific, and environmental topics, as the chapter shows, challenges our assumptions about foreign relations in productive ways, offering fresh perspectives on conventional narratives and novel ways of studying the past.

How did peatlands respond to human visions of growth and development? Peat extraction entangled humans and peatlands in a relationship marked by irritation, sometimes confrontation. Examining incidents of malaria outbreaks and fire at and around peat extraction sites, this chapter highlights the agency of peatlands in the history of Russia’s fossil economy. It identifies peat extraction sites as spaces of environmental injustice and points to a crucial irony running through the history of human–peatland relationships in imperial and Soviet Russia: Peatlands had long been imagined as dangerous and useless, but they turned into unsettling landscapes only once they became part of Russia’s industrial metabolism. Central Russia’s peatland environments were not just a backdrop to history but actively challenged and constrained the different ways in which people tried to make use of them.

Disease outbreaks have been some of the most impactful events in the history of cities. The specter of plague and other epidemics provides stories of dreaded rapid social disruption and in some cases social collapse. The objective of this application chapter is to investigate through a set of case studies how disease outbreaks and epidemics can rapidly shift from a stress to a crisis and in turn drive significant policy transitions and transformations. The chapter introduces how disease crises disrupt daily life in cities and what have been some basic approaches in response. The chapter examines four cases of disease outbreaks that resulted in crises and significant transitions. The examples include two bubonic plague outbreaks (Marseille, France, in the 1720s; Hong Kong, China, in the late 1890s), one flu event (Spanish flu in St. Louis, US, in 1918), and COVID-19 spread (in Seoul, Korea, in 2020). The cases illustrate how the rapid onset of disease simultaneously severely disrupted everyday life and brought on a sudden health crisis that was built upon existing social and economic tensions.

After the conquest of the Caribbean, Mexico, and Peru, Spanish dominance in the Americas was maintained through a combination of “soft” and “hard” power: a mixture of armed coercion and an elaborate legal-administrative apparatus which ensured that tension rarely escalated into full-blown conflict. The sturdiness of Spain’s empire may also be attributed to other significant factors, including epidemiology (differential immunity), topography, and the avoidance of certain types of military engagement, all of which tended to intersect with or reinforce the deployment of “soft” and “hard” power. There were at least three broad threats to Spain’s dominance: external enemies, particularly rival European states covetous of the economic advantages Spain obtained from its New World dominions; unsubdued Amerindians on the fringes of Spanish settlement, who clung to their autonomy and effectively controlled vast swathes of territory through to the end of the colonial period; and an internal, heterogeneous group from all rungs of the socioeconomic ladder, from wealthy, privileged merchants to mistreated African slaves. At some point or other from 1521 until 1808, an internal challenge to Spanish dominance emerged from every sector of colonial society. Whether by design or felicitous coincidence, external and internal threats to Spanish dominance were rarely coterminous, which may help to explain the empire’s resilience and longevity.

The plays of Sean O’Casey are filled with aches and pains, debilitating diseases, and traumatic wounds. He was himself a disabled writer. Furthermore, his presentation of disease and disability is inseparable from his critique of class, militarism, and masculinist ideology. This chapter shows how O’Casey’s depictions of disability are more nuanced than they may at first appear. He does demonstrate an essentialist tendency to see female resilience as a triumph over the failures of male impairment, yet, in plays such as Juno and the Paycock and The Silver Tassie, O’Casey allows space for contrary readings that speak with relevance to contemporary understandings of disability.

Echo’s Bones and Other Precipitates (1935) was written during an exceptionally difficult period in Beckett’s life during which he suffered two bereavements in rapid succession, resulting in the deterioration of his health. The collection, which has its antecedents in poetry ranging from Ovid to Joyce, focuses on the successive metamorphoses of the embodied self, including birth, illness, ageing, death, and decay. Through close readings of a number of the poems, the chapter analyses the ways in which Beckett’s early poetry can be understood as a type of anti-poetry that resists traditional conceptions of the aesthetic as beautiful, as conceptual, and as combining the sensory with the spiritual. The language and imagery of Echo’s Bones, with its refusal of metaphor and its lexical and syntactical resistance to interpretation, also resists the metaphysical consolations of poetry.