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Art and Images in Psychiatry
June 2012

Lovesickness: Erasistratus Discovering the Cause of Antiochus' Disease

Arch Gen Psychiatry. 2012;69(6):549. doi:10.1001/archgenpsychiatry.2012.105

When the erotic appetite provokes a melancholy brooding, fires the passions, burns the humors and wastes the strengths of the body, love “is not merely behavior resembling sickness, but it is a true disease, virulent, and dangerous.”–Battista Fregoso (15th century).1(p3)

Despairing when his son Prince Antiochus was desperately ill, Seleucus, king of Syria, summoned the distinguished Greek physician Erasistratus (circa 330-255 BC) to diagnose his malady. Erasistratus and his colleague Herophilis from Alexandria in Egypt were renowned for their medical treatments that were based on their understanding of human anatomy and neuroanatomy, derived from dissecting the bodies of condemned criminals. Erasistratus is said to be the first physiologist, the first to appreciate that the heart is a pump, and the first to accurately describe the 1-way passage of blood through the heart's valves.2 Centuries before William Harvey described the circulation of the blood, Erasistratus recognized how veins and arteries were connected to the heart. Herophilus, his colleague in Alexandria, Egypt, timed the pulse, linked the pulse to the beating of the heart, and recognized its clinical importance. Erasistratus relied chiefly on hygiene, diet, baths, and exercise (rather than purgatives and bloodletting) as treatments. He anticipated psychosomatic medicine in observations grounded in anatomy and physiology and in hypothesis testing.

Benjamin West (1738-1820), American. Erasistratus Discovering the Cause of Antiochus' Disease, 1772. Oil on canvas, 50 × 72 in (127 × 183 cm). Private collection. Photograph © 2012 Christie's Images. Courtesy of the Collection of the Birmingham Museum of Art, Alabama.

Erasistratus used his understanding of physiology and pulse diagnosis in his diagnosis of Antiochus, who was weak, emaciated, and near death. Like other physicians who had examined him, Erasistratus found nothing physically wrong with Antiochus. Thus, he suspected a mental cause of Antiochus' suffering. Plutarch, in his Lives, describes his diagnostic method:

Erasistratus perceived quite easily that [Antiochus] was in love . . . [When] any of the beauties of the court came in, male or female, he would study the countenance of Antiochus . . . When any one else came in, Antiochus showed no change; but whenever [his stepmother] Stratonicé came to see him, as she often did, either alone, or with Seleucus, lo, those tell-tale signs [of love] . . . stammering speech, fiery flushes, . . . palpitations. . . . 3(p93-97)

Erasistratus told the old king that his son's diagnosis was lovesickness, but that the object of his love was unattainable. Antiochus' love could never be gratified because he was in love with Erasistratus' very own wife. Seleucus quickly sought to persuade Erasistratus to give her up to save his son. The cagey physician replied “[t]hou art his father and yet thou wouldst not have done so if Antiochus had set his affections on [your wife] Stratonicé.”3(p95) With great emotion, the king said that, if heaven would redirect his son's passions, he most gladly would give her up. Erasistratus clasped his hand and revealed it was Stratonicé who inspired such passion. Antiochus had chosen to die rather than disclose his disgraceful secret. Inspired by his son's allegiance, Seleucus agreed to give up his wife and split his kingdom in two, making Antiochus ruler of Upper Asia. Antiochus and Stratonicé wed in 294 BC.

The painting Erasistratus Discovering the Cause of Antiochus' Disease (cover) by the American expatriate Benjamin West is a sensitive portrayal showing Antiochus lying prostrate in bed.4 A cloaked and melancholy King Seleucus sits cradling his son's head in his arms. Erasistratus is shown with his left hand on Antiochus' heart and his right hand feeling Antiochus' right wrist for his pulse. While doing so he bids Stratonicé and her retinue of young women to enter the room. The quickening of Antiochus' heartbeat and the increase in his pulse when Stratonicé enters confirm the diagnosis.

The most extensive early examination of love pathology is Jacques Ferrand's 1645 classic Erotomania or a Treatise Discoursing of the Essence, Causes, Symptoms, Prognosticks, and Cure of Love, or Erotique Melancholy.1 Among the preferred cures were sexual intercourse, distraction, defaming the beloved, and drug treatments.

Modern-day lovesickness can have serious consequences. John W. Hinckley Jr shot President Ronald Reagan to impress the actress Jodie Foster, hoping to use this historical deed to gain her respect and love. Later, he was to proclaim that this was “the greatest love offering in the history of the world.”

The terminology for lovesickness has changed over time. Erotic melancholy is not a subtype of mental disorder but erotomania is. Erotomania is the delusional belief that another person, generally of higher social status, is in love with you. There are primary forms, pure erotomania, and secondary forms, part of a broader psychiatric category (for example, schizophrenia or bipolar disorder). When limited to the manic phase, it may resolve with drug treatment. When co-occurring with schizophrenia, its prognosis is poor.5

Biological correlates of love are a subject of investigation with neuroimaging. Functional magnetic resonance imaging studies present photographs of romantic partners or children to the subject to evaluate brain activation. Patterns of brain activation that correlate with romantic love differ from maternal love. In romantic love, the regions of the hypothalamus associated with sexual arousal are activated. These regions are not activated in maternal love. In maternal love, the facial regions are specifically activated. Commonly activated regions for the 2 types of love are in the striatum, part of the reward system of the human brain. In both maternal love and romantic love, based on the brain regions activated, apprehension and social judgment are somewhat suspended!6

Ciavolella M. A treatise on lovesickness. Beecher DA, trans. Syracuse, NY: Syracuse University Press; 1990
Adler RE. Medical Firsts: From Hippocrates to the Human Genome. Hoboken, NJ: John Wiley & Sons, Inc; 2004
Henderson J, edPlutarch Lives IX. Perrin B, trans. Cambridge, MA: Harvard University Press; 1920
Stechow W. “The love of Antiochus with faire Stratonica” in art.  Art Bull. 1945;27:221-237Google ScholarCrossref
Kennedy N, McDonough M, Kelly B, Berrios GE. Erotomania revisited: clinical course and treatment.  Compr Psychiatry. 2002;43(1):1-611788912PubMedGoogle ScholarCrossref
Zeki S. The neurobiology of love.  FEBS Lett. 2007;581(14):2575-257917531984PubMedGoogle ScholarCrossref