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Gendering the Brain in Ancient Medicine

Jessica L. Wright

The University of Texas at San Antonio

This paper explores how Hippocratic authors described gender differentiation in the brain and its malleability. It further examines the consequences of gender differentiation in discourses surrounding two brain-based illnesses: phlegmatic flux, caused by moisture in the brain, and prominent in Hippocratic texts; and phrenitis, caused by dryness of the brain, and prominent in late antiquity, when it played a significant role in discussions of the relationship between body, brain, and soul (McDonald; Wright; Thumiger), I show that catarrh was gendered feminine, while phrenitis signified hyper-masculinity, and I suggest that by analyzing narratives about these illnesses in light of the gendering of brain substance in ancient medicine, we can draw out latent understandings about the malleability of gender at the level of the brain, and anxieties about its management.

Building on studies of the brain in ancient medicine (Lo Presti; Rocca; von Staden; Wright), as well as on analysis of gendered bodies in Hippocratic and Galenic medical theory (Dean-Jones; Flemming; King 1998; King 2013), I demonstrate that the female brain, like the female body in general, was wet, while the male brain was dry. There were two co-existing explanations for this difference: (1) female bodies were phlegmatic, and phlegm was a wet humour; (2) (adult) male brains were dried out through sexual intercourse, which drained them of moisture in the production of seminal fluid. In other words, the gendered quality of the brain, as signified by the loss of hair, could be shaped through sexual activity. The gendered brain was plastic, not only in response to regimen (drying foods dry out the brain, and vice versa), but also in accordance with the assumption of expected gender roles. Eunuchs, as the ancient truism had it, do not go bald ([Arist.] Prob. 10.57).

The most common brain pathology in Hippocratic medicine is catarrh, or the flux of phlegm from the brain (e.g. On the Sacred Disease). Catarrh led to ulceration, putrefaction, seizures, and delirium. It was caused by excess phlegm, and was therefore particularly associated with the female bodies. That is to say, the most common disease of the brain was an excess of female qualities (moisture, phlegm), leading to loss of bodily control and reason. A drying regimen was required for women, and for any men of phlegmatic constitution, in order to curb their brain’s tendency to leak into their blood-vessels and other organs. Through catarrh, brain became a site for managing the threats of a feminized body. 

In late antiquity, the most prominent brain disease was not catarrh, but phrenitis. Phrenitis—acute fever with acute delirium—was caused by the brain becoming too hot and dry. Among Christian authors it was associated especially with the hyper-masculinization of extreme ascetic practice. Phrenitis gave the body unusual strength by drying out and so toughening the brain and nerves. In the same way, extreme ascetic practice was thought to give both body and soul extraordinary strength that masked fatal disease. If the brain could be masculinized through sexual activity, it could also be masculinized through ascetic practice; but, as was standard in ancient regimen, balance was key, and the extent to which the individual “masculinized” their brain needed to be carefully controlled.

This paper demonstrates that the brain was a central site for negotiating gender in ancient medicine. In particular, it explores how gendered differentiation of brain substance prompted the development of disease discourses that regulated the adoption of a proper regimen, in order to avoid hyper-feminization or hyper-masculinization and the madness that might follow. I suggest that the shift in focus from flux to phrenitis was motivated by shifting gender dynamics in late antique Christianity, where it was (at least rhetorically) acceptable for women to masculinize their bodies through ascetic practice, but where there was also a pressing need to curb the excesses of ascetic austerity and the spiritual and political power that it could attract.  

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