Medicine and the Seven Deadly Sins in Late Medieval Literature and Culture

by Virginia Langum

  This image, and indeed the homilist’s use of medicine throughout the sermon, counters Lollard literalism by complicating the division of spirit and letter. For if Christ’s sacrifice can only be read literally, what is its continuing meaning for the faithful. Concerned that the sickness might relapse, Christ ordains “the wise recipe of confession,” whereby the faithful can seek treatment for their sins. 74 Christ’s sacrifice whereby he “poured out the blood of his heart to cure you from your sickness and purge you from your sin” continues to be administered through priests. Rigorous literalism threatens not only the health of the religious community, as seen earlier in the image of the cloak, but also the health of individual souls. In another context, the homilist urges priests to “lay [their] book aside” and exercise their discretion when assigning penance if they see a man or woman on the verge of despair. 75

  The emphasis on faith and the salvation of souls over knowledge and book learning for their own sake is a recurring theme in the sermon collection, and one that the homilist specifically relates to medical learning. For example, he uses physiological digestion to describe the sacrament. Here, the mysterious internal workings of the body are compared with the greater mystery of transubstantiation.Since you cannot give a natural reason for those things that you see in nature, do not marvel if this venerable sacrament, which is above nature, exceeds your reason, for since food and drink that you take into your body is turned by virtue of natural heat into your flesh and blood, so much more may almighty God who created all out of nothing by virtue of his words turn the substance of bread and wine into his body and blood. 76

  Although comparable, digestion and transubstantiation are not directly correspondent. Furthermore, the greater mystery serves to remind the audience of human ignorance of much simpler matters—which might have been particularly resonant for an Oxford audience.

  This theme of intellectual humility is further heightened by the previous discussion in the sermon of the value of the seven liberal arts.Christ Jesus, lamenting the foolishness of such a rational creature, descended into the schools of the Church to teach us a new lesson. And what, do you think? Not of grammar, or logic, or astronomy, or music …. This lesson is more necessary to the human soul than Horace or Ovid, or all the poets, who ever were. Even if you have never looked at Terence or Scotus you can enter the kingdom of heaven, even if you are ignorant of Euclid or Plato you can be saved. 77

  Ultimately, medicine serves the homilist and the faithful as a tool by which the spiritual can be understood, if imperfectly, through learning, natural reason, and empiricism. However, while serving as a useful and rich source of imagery and argument, medicine as metaphor also reminds the faithful of their weaknesses, whether of body, mind, or spirit.

  Medicine as Metonymy

  In The Rule of Metaphor, Paul Ricoeur distinguishes between metaphor and metonymy as follows: “metonymy rests on contiguity and metaphor on resemblance.” 78 This contiguity or proximity often entails a physical adjacency, just as bottle is adjacent to liquor in “taking to the bottle.” However, the related or proximate element, “bottle,” is not a material part of the absent referent, “liquor,” as it would be in an synecdochal structure. Both metonymy and synecdoche “point one directly to the absent term.” 79 But where synecdoche refers to an element via a component of that element, metonymy refers to an element via a related or associated element.

  Medieval accounts of rhetoric use and define both synecdoche and metonymy. Synecdoche means the same as it does today: “a figure … whanne a part is set for al, either al is set for oo part.” 80 Denominatio denotes metonymy in classical and medieval rhetoric. 81 Whereas the modern English “denomination” simply signifies naming, the term has a more specific rhetorical meaning in Middle English. However, Middle English texts do not use “denominacioun” consistently as a synonym for metonymy. John Trevisa’s translation of De Proprietatibus Rerum explains that although “angels kynde haue no mater noþir lineaciouns and schappe of body,” they are often painted “in bodilich liknes, and scripturis makeþ of mynde þat þey haueþ diuers lymes [parts] and schappis.” It is through “denominaciouns of lymes þat beþ iseye, vnseye [invisible] worchinges of heuelinche inwittis [spirits] beþ vndirstonde.” Elucidating some of these “denominaciouns,” For example, Trevisa writes that by the angels’ hair is understood “affecciouns and þouʒtes þat springeþ of þe roote of þouʒt and mynde.” Yet these comparisons suggest symbolic correspondence, rather than metonymy. Therefore, to avoid confusion, I use Ricoeur’s definition of metonymy, which exists between the realms of metaphor, or the purely symbolic, and the material.

  How might sin and medicine relate contiguously—that is, metonymically—on the boundaries between metaphor and materiality? In this section I suggest that medical and religious accounts of the passions explore the metonymic relationship of medicine and sin. Medieval texts vary in their distinctions between passions and sins, as well as offering different accounts of the point at which a passion becomes a sin (if indeed at all), the physiological necessity of the passions, ways of acting upon the passions, and the involvement of reason and will. Whereas theologians usually take care to distinguish passions in their writings on the sins, pastoral writers are often more ambiguous. The passions are critical to understanding human culpability and distinguishing deliberate sinful acts from the unavoidable and universal experience of being human.

  Early theologians, such as Augustine, incorporate the passions into their discussions of post-lapsarian man. Although humans had passions before the Fall, they were then under the total control of the rational will. Since the Fall, humans have experienced passions as spontaneous reactions to stimuli, just as animals do. However, Augustine argues in The City of God that passions are expressions of the will. If the will is moral, so are the passions. If the will is deviant, so, too, are the passions. 82 After first experiencing an involuntary impression, a person makes a judgment on the value of this impression. Therefore, the passions, when understood as involving the reason and will, are morally either good or bad. 83 Gregory the Great thought that wrongly directed passions became venial sins immediately, even if they occur too rapidly to be controlled by the will. 84 These positions were much debated in the following centuries. 85

  However, in the later Middle Ages, the circulation of medical knowledge changed the vocabulary and frame of the discussion. Middle Eastern medicine incorporated the passions into the Galenic system of the four humors (melancholy, choler, phlegm, and blood) and the three spirits (vegetative, vital, and animal). 86 Passions were considered one of the “non-naturals” that influenced human health and disposition; the others were diet, sleep, air quality, excretion, and exercise. Responding to sense impressions, the passions influenced physical changes in the body. One of the most widely cited sources on the passions in the later Middle Ages, the Persian physician Ali ibn al-’Abbas al-Majusi (d. c. 994), whose name was Latinized as Haly Abbas, describes the passions as forces that prompt vital spirits and natural heat to move either toward or away from the heart. For Haly Abbas, the passions are joy, sadness, fear, anger, anxiety, and shame. 87 While the passions are not themselves “natural,” they can effect physiological changes in the body. Physicians often used the passions in medical treatments, and at other times, remedied them with other medical treatments, such as herbs. 88

  Rather than simply symptomatic of humoral balances—sadness, for example, as a symptom of melancholic imbalance—the humors are believed to actually affect the ways in which the body experiences the passions; that is, how quickly they pass or how slowly they build. For example, the Canon of Medicine by the Persian physician Ibn Sina (d. 1037), Latinized as Avicenna, contrasts anger experienced as choleric, which quickly subsides, with anger experienced as a melancholic, which builds slowly into rancor. 89 Translated slightly later than Haly Abbas, in the mid-twelfth century, Avicenna’s writings on passions were also very influential in late medieval thought. His own De Anima draws on Aristot
le’s De Anima. 90

  Avicenna also posits a tripartite division of the soul: the vegetable soul responsible for nutrition, growth, and reproduction; the animal (or sensitive) soul responsible for apprehension and movement; and the human (or intellective) soul responsible for reason and choice. Passions belong to both the sensitive and the intellective soul. After receiving sense impressions from the sensitive soul, the human estimative power makes judgments about the potential pain, pleasure, or harm caused by objects. Particular judgments activate particular movements; for example, away from or toward an object. In this way, the physiological effects of the passions serve the intellect’s judgments. For Avicenna, the physical body follows the lead of the immaterial soul. As an example, Avicenna describes the healing power of positive thinking as a way in which the intellect alone can produce physiological changes.

  In his writings, Avicenna also considers certain passions shared by humans and animals, as well as distinctively human emotions such as shame and wonder. Whereas preservation instincts or previous experiences drive the passions experienced by animals, human passions incorporate a variety of other considerations, such as social norms, values, and habits. 91 This distinction is consistent with that made in later medieval medical texts, which explain that both animals and people are subject to passions, but that animals are led by their passions, whereas human passions are subject to reason or the rational power. As the English encyclopedist Bartholomaeus Anglicus writes in De Proprietatibus Rerum, “wraþþe [wrath], fitinge, indignacioun, enuye [envy], and suche passiouns” “ariseþ in oþir bestis … withoute discrecioun. But in men suche passiouns buþ [are] ordeyned [controlled] and iruled by certeyn resoun [reason] of wit.” 92 Avicenna divides the passions into the concupiscible passions, which involve desire for food, money, and sex, and the irascible passions, which involve the desire for victory or to avoid unpleasant things. For Avicenna, the irascible passions include pain, sadness, fear, and anger. 93

  Drawing on medical and earlier philosophical works, particularly those ideas of Avicenna as described above, Aquinas’ treatise on the passions, enclosed in his Summa Theologica, is the most extensive discussion of the passions in the Middle Ages, which “set the agenda for later medieval discussions of the passions.” 94 Aquinas suggests that there are two kinds of passions: passions of the body [passiones corporalis] and passions of the soul [passiones animae]. The passions of the body include hunger, thirst, and pain, while the passions of the soul include sorrow and love. The passions of the soul, however, are natural, and therefore ethically neutral, psychosomatic responses to stimuli. 95 They belong both to the soul and to the body. The material movement of the body—transmutatio corporalis—always accompanies an immaterial movement of the soul. Passions are motions or movements of the sense faculty on apprehending a “sense good” or a “sense evil.” Sense good and sense evil simply refer to objects known through the senses. Such bodily changes may include the enlargement or contraction of the heart, a decrease or increase in the pulse and the movement of the limbs. However, these changes are simultaneous with the mental changes, rather than acting according to a “cause and effect” relationship. 96 Humans and animals share the passions of the soul. However, Aquinas also designates intellectual affections as shared by humans, angels, and God. These are movements of the will, which involve only the intellective faculty. However, in practice, the affections often blend into the sense faculty, as we will see in relation to some of the more intellective sins such as pride and envy. 97

  Following Avicenna, Aquinas categorizes the passions as either concupiscible, driven by the perceived pleasure or pain incurred by the perceived object, or irascible, driven by the perceived difficulty of acquiring or avoiding the perceived object. Irascible passions are experienced only after concupiscible passions. The concupiscible passions are love, hatred, desire, aversion, pleasure, and sorrow; the irascible passions are hope, despair, fear, daring, and anger.

  Although the passions themselves are ethically neutral, the actions and thoughts that proceed from them are not. Therefore, the role of reason in the passions is fundamental to Aquinas’ anthropology. To live an ethical life is not a matter of removing oneself from the passions, rather passions are fundamental to an ethical life. 98 It falls to human reason to rule the passions, guiding them to virtuous actions and thoughts. However, reason can be misguided and at times overwhelmed by the intensity of passion. In these cases, passions can facilitate sin.

  Furthermore, the body and its physiological dispositions can influence the passions. Although the will is free, the natural state of the body may incline the soul to act in certain ways, such as through habit. Aquinas also argues for the power of habit to moderate spontaneous reactions. The repeated interaction of passion and reason creates certain character traits. Although free to act differently, people are disposed to act in certain ways by the patterns created by passion and reason. 99 One reader of Aquinas gives these examples: “the grumpy individual becomes habitually alert to opportunities for sarcastic remarks, and skilled in their delivery; the Boy Scout is quick to help an elderly woman cross the street, even after his daily good deed, and makes conversation with her easily.” 100

  For Aquinas, the will and all human activity directed by the will conduce toward happiness, or at least the perception thereof. Sin lies in the faulty perception of happiness. For Aquinas, “there are no supernatural forces of evil at work in the deadly sins but the human’s soul’s quite understandable but mistaken pursuit of a lesser good.” 101 Likewise, there is no conflict between human nature and desires and the commandments of God, a point raised in pastoral manuals. On the contrary, God’s law is “ancillary to our natural inclinations.” 102 Rather than a defect in or danger to virtue, the passions are essential to virtue. “Virtue consists not in the forced submission of passion to reason, or the evisceration of passion into something manageable, but the rational ordering of the various faculties toward human flourishing.” 103 Of course, the role of the passions in virtue must involve reason. Accordingly, Aquinas groups the passions by the virtues: temperance with the concupiscible passions; fortitude with fear and daring; magnanimity, with hope and despair; meekness with anger.

  Whereas Aquinas conceives the passions as belonging to both the body and the soul, and thus contiguous to vice and virtue, other medieval thinkers present the passions differently. A later, contentious voice emerges in the writings of the English Franciscan friar William Ockham (d. 1347), who roundly rejects the idea of virtue as passion rightly seasoned with reason and sin the inverse. Instead, Ockham locates passions strictly in the sensitive soul, necessitating an even stronger line on the neutrality of the passions and the sharp separation between passion and sin. 104 If passions are located only in the sensitive soul and do not involve reason, they cannot become the basis for virtue or vice. Accordingly, Ockham attempts to dismantle any blame (when framed as vice) or reward (when framed as virtue) for natural or innate qualities.

  Whereas Aquinas might be “the voice of the unflappable clinician” seeking a pathology of evil and offering an “almost utterly naturalized picture of the vice,” Ockham leaves the question of the body, its passions, and its inclinations to the physicians. 105 For example, he describes how heat leads to a superabundance of passions in the body. Mortifying the flesh and fasting might weaken the body’s hot quality. However, balancing the influence of qualities such as heat on the humors and passions “is mainly a matter for physicians to determine, since they should have more experience with changes in bodily humors.” 106

  While providing an intriguing counterpoint to Aquinas, Ockham faced censure for his ideas, which are unlikely to reflect a widespread understanding of or sympathy with attitudes toward the separation of body and sin. In attributing tinder for sin [fomes peccati] to the body and not to the sensitive soul, Ockham also claimed that Christ would necessarily have experienced passions and desires, such as sexual lust. For this idea, among others, he faced charges of heresy. 1
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  However, in addition to particular conceptions of the passions found in Latin theological contexts, passions are more simply understood as impulses that need to be controlled because they could prompt sin. For example, in a sermon for the Day of the Martyr, John Wycliffe (d. 1384) writes that passions result in either “synne” or “mede” [reward], depending on how they are “reulid” [ruled]. 108 Comparably, in his translation of Boethius’ Consolation of Philosophy (ca. 1380), Geoffrey Chaucer warns against allowing the passions to “overcomen” or “blenden [blind]” the listener or reader. 109

  The topic of the passions also intrigues the English bishop Reginald Pecock (d. ca. 1461), who in several of his vernacular works engages with the distinction of vice and passion. Pecock provides a systematic account of the distinction between passion and sin that is consistent with contemporary accounts. He defines passions as “suffryngis of þe wil” rather than “actijf [active] or wirching [working] deedis of oure wil.” 110 Stirred by sense impressions—that which is seen, heard, touched, smelled, or tasted—passions are themselves not ethical; they are neither virtues nor vices.

  Due to their basis in the humors and complexions, passions cannot be eradicated, according to Pecock. However, they can be controlled by balancing the humors, which is accomplished by managing diet and the other non-naturals. For example, the passion of envy can be controlled by manipulating the melancholic humor. 111 However, if a passion repeatedly develops into a sin, that sin can become habitual. As Pecock writes, when a “disposicioun” develops into a “degre of stabilnes and of vnremouabilness, þanne it is clepid [called] an ‘habite.’” 112