• 1 Hdt. 4.90, Hippoc. Epid. 5.9 (Littré 5.208 bottom), Paus. 5.5.11, Nic. Alex. 253; Hom. Il. 9.446; (...)
• 2 This scholarly view is among other things founded on a statement of Celsus (1^st century AD), who (...)

1In ancient Greece, illnesses might be explained as the result of a number of different causes — pollution, natural causes, morally bad behaviour, and divine vengeance being among them.¹ A current scholarly hypothesis is that illnesses in ancient Greece were at first believed to be caused by the anger of the gods, in time evolving into a more rational approach to disease, seeing its aetiology as natural. This change would be due to the rise and expanding popularity of the Greek art of medicine.²

• 3 For this shift as seen in shame turned into guilt as an internalized notion with the individualit (...)
• 4 Dodds (1951), p. 28–63, esp. p. 31–37, 151–152. Internalization of emotion is an explanatory tool (...)
• 5 See Pettazzoni (1929–1936), passim, e.g. vol. 2(1), (1935), p. vii–xi, and Bendlin (2001), p. 129 (...)

2Hand in hand with the hypothesis of rationalization we find the hypothesis of internalization. This model that a fatalistic view on the cause of disease, as sent by the gods, became internalized, so that it came to be believed that your own choices and actions, not the will of the gods, caused disease.³ This notion was connected to a general internalization of emotions, as discussed by E.R. Dodds. He argued that Greece in the Archaic period moved from being a shame culture to becoming a guilt culture.⁴ According to R. Pettazzoni, and following him, A. Bendlin, the feeling of guilt as a phenomenon is a universal occurrence, and seems difficult to see as the product of a social evolution.⁵

• 6 Herzog and Kavvadias lean towards one single redaction: Herzog (1931), p. 58, Kavvadias (1883), p (...)
• 7 IG IV² 1, 121–124. Translations are available in Herzog (1931) and LiDonnici (1995). In this pape (...)

3This article is an attempt argue that perceptions of the cause of disease have been multi-explanatory all through ancient Greek history. In particular, as a case study, I will examine the collection of healing inscriptions, iamata, of Epidauros, which have an underestimated heuristic potential on the different ideas related to the cause of disease among the worshippers of Asklepios at the time. The iamata (literally “remedies”) are 70 narratives collected, edited, and inscribed around 350 BC on four large stones slabs and set up in the sanctuary of Asklepios at Epidauros for all to read, possibly to convince the worshippers of the healing power of the god, and inspire new healings.⁶ According to LiDonnici’s stylistic analysis, some of the testimonials presumably date back to c. 450 BC, and the latest ones probably come close to the editing and inscribing of the stelae in 350 BC.⁷ The chosen case study thus limits my investigation to the Classical and Hellenistic Greek world, and in particular to the cult of Asklepios.

• 8 This opinion was much founded on the IG IV² 1, 432 (Ἀπόλλωνι καὶ Ἀσκληπιῶι συγγνώμοσιν, “To Apoll (...)
• 9 Nock (1939), p. 19, referring to the story of Amphimnastos, iama C47 (see discussion of this belo (...)
• 10 Kudlien (1978), p. 6. He sees the confessions as perhaps accredited to oriental influence, possib (...)
• 11 The Edelsteins (Edelstein – Edelstein [1945], p. 113–118) write that Asklepios became so popular (...)

4K. Latte⁸ and A.D. Nock⁹ have argued for the presence of detailed confessions of guilt in the iamata of Epidauros. F. Kudlien agrees that some of the iamata give us evidence of early Greek confessions, but writes that these are indeed the only examples in the cult of Asklepios for such an otherwise non-Greek mentality.¹⁰ Most importantly, though, the Edelsteins established the cult of Asklepios as an early representative of a focus on the individual and on the importance of purity, when approaching the divine, not only of the body but also of the mind.¹¹

• 12 I use the term “sacred law” for lack of a better phrase. On the problematic concept of these cult (...)
• 13 Translation: Peels-Matthey (2018), p. 93. See also this article passim for an in-depth contextual (...)
• 14 To J. Bremmer (2002) the edition of Bouffartige (1979) is the most reliable. Bouffartige shows th (...)
• 15 Examples of this type of mentality is found in Philostratus’ Vita Apollonii 1.10 (a rich man sacr (...)

5Sacred laws emphasizing the importance of entering the sanctuary with both a ritually pure body as well as a pure mind appear in late Hellenistic times.¹² There is, notably, no inscription which antedates late Hellenistic or Roman times, apart from, possibly, the so-called “Theophrastus inscription”. It reads “ἁγνὸν χρὴ ναοῖο θυώδεος ἐντὸς ἰόντα | ἔμμεναι^. ἁγνεία δ’ ἐστὶ φρονεῖν ὅσια,” “He who goes inside the sweet smelling temple must be pure. Purity is to think pious thoughts.”¹³ It was believed to have been displayed at Epidauros and to date to the 4^th century BC, as Theophrastus, who allegedly referred to the inscription, lived then. This quote, entailing a reference to the inscription, is found in the much later De Abstinentia (2.19) by Porphyry, who is supposedly citing Theophrastus’ work On Piety. J. Bremmer has, convincingly in my opinion, shown that the text is not a quote of Theophrastus, and so cannot have this early date.¹⁴ The importance of having a pure mind when praying to Asklepios, and not primarily to please the god with expensive donations, would then rise, but not be the rule, in Hellenistic times.¹⁵

• 16 Hdt. 4.90, Hippoc. Epid. 5.9 (Littré 5.208 bottom), Paus. 5.5.11, Nic. Alex. 253. See further Roh (...)
• 17 Parker (1983), p. 219, n. 67 with further references.
• 18 Hom. Il. 9.446; Aesch. fr. 45 (TrGF 3); Herodas 4.17–18. See the discussion in Parker (1983), ch. (...)

7Firstly, pollution (miasma) appears as an explanation in the case of skin diseases.¹⁶ Although purifications were a common treatment of disease (not only skin disease), pollution as an aetiology does not appear in the literary evidence. For instance, none of the sacred laws concerning polluted persons banned from entering a temple included the diseased.¹⁷ On the other hand, purification performed by popular purifiers was one of the most common healing techniques in both Archaic and Classical times, and the underlying reason for purifications in healing might have been that disease was assimilated to dirt which could be washed off.¹⁸

• 19 Given the biblical status of Homer in Classical Greece, it is not unlikely that this perceived ca (...)
• 20 The men cast the defilement into the sea, “οἱ δ’ἀπελυμαίνοντο καὶ εἰς ἅλα λύματα βάλλον…” It is n (...)
• 21 Cf. Od. 11.198–201, and further Lloyd (2003), p. 17.
• 22 The purification in the sea was more likely a purification before the sacrifice, and not a method (...)

8Secondly, disease could be perceived as caused by an angered god. The classical example in Greek literature of a god causing illness appears in the Iliad 1.37–54, where Apollo sends a plague.¹⁹ After the outbreak of plague the whole army is purified (Il. 1.314–317, ἀπολυμαίνεσθαι used), probably in salt water as the sea was close, whereupon a sumptuous sacrifice is offered to Apollo.²⁰ The Greeks discover the cause of the god’s wrath not to be, as expected by Achilleus, a forgotten vow or sacrifice (1.65–67), but the calling upon Apollo by Chryses to revenge the wrong done him and his daughter. This is, however, the only passage in Homer’s works where illness or pain is associated with the gods, and notably the disease chosen for a punishment strikes on an epic scale.²¹ Sacrifice (preceded by a purification) clearly was the way of appeasing the angered Apollo.²²

• 23 In any case, epic and tragedy are not necessarily an accurate reflection of the mentality of the (...)
• 24 See Lloyd (2003), p. 90: “Tragedy is all about the gods and prophecies fulfilled…” On Sophocles, (...)

9Thirdly, the perception existed that unethical or immoral behaviour might cause disease. Thebes was struck by the plague in Œdipus Tyrannus (22–39), in response to its kings’ misdeeds. In the events that unfold in the myth, Oedipus had not wronged a god, but broken a social taboo.²³ Here, as in the Iliad, a whole group is affected (the army of the Greeks and the city of Thebes), and the cause of this major catastrophe is seen as divine. Oedipus is in the end a victim of a divine prophecy, so the cause of the plague should not be taken as commonplace. The royal families of tragedy in a way carry their misfortunes and diseases in their fate, inherited at birth.²⁴ They are not people with whom the spectators would easily identify, and we cannot expect that an Athenian shoemaker watching the play would think that his particular illness was caused by the gods in the same way.

• 25 Another early example is Lysias 6.1–2, where punishment by disease is inflicted upon persons havi (...)
• 26 Ar. fr. 58 (Austin, CGFP).

10However, if not one particular god’s anger was the cause of a disease, then a divine factor might somehow be seen as punishing those who had opposed social laws and morality by sending a disease.²⁵ In a possible fragment of Aristophanes’ Heroes the chorus says “We are the guardians of good things and ill; we watch out for the unjust, for robbers and footpads, and send them diseases (spleen, coughs, dropsy, catarrh, scab, gout, madness, lichens, swellings, ague, fever). That’s what we give to thieves…”.²⁶ Here it is the unjust, criminals who have offended social laws, who are punished with disease by divinities.

• 27 See e.g. Nissen (2009), p. 58–60.
• 28 See discussion on this in Lloyd (2003), p. 41–43. On the Sacred Disease is generally thought to h (...)
• 29 Hippoc. Morb. sacr. ch. 1 (Littré vi.362), ch. 4 (Jones).
• 30 Morb. sacr. ch. 1 (Littré vi.360–362), ch. 4 (Jones).
• 31 Esp. 14 and with the comments on this work in Zhmud (2006), p. 55. See also Barton (2005).
• 32 Hes. Op. 101–104: “The earth is full of evils and the sea is full. Some diseases come upon men by (...)

11Fourthly, there existed, already from Archaic times, the belief that the aetiology of disease was natural.²⁷ The Hippocratic On the Sacred Disease²⁸ states that since the divine purifies us, it is irreligious to accuse gods of causing miasmata (μιαίνεσθαι) in the form of diseases.²⁹ The author of On the Sacred Disease further argues that all diseases have natural causes (as well as in a way being divine, as nature is divine), but that no particular god can be held responsible (as done by the itinerant purifiers who are the target the author wishes to discredit).³⁰ This idea is presented also in the Hippocratic On Ancient Medicine.³¹ This perception of the causality of disease as natural can in fact be seen already in the Odyssey (11.198–201), where the wasting disease is described as a hateful state, not caused by any god, but just as a matter of fact. Furthermore, Hesiod in Work and Days (101–104) describes the diseases set free by Pandora, in effect describing them as bestowing misfortune on men by their own accord.³² As disease in the ancient world was ubiquitous, and cures mostly lacking, ascribing a particular god to every disease would simply be impractical.

• 33 Graf (2009).
• 34 On the cult of Asklepios, its origin, spread, popular appeal, connection with the Hippocratic sch (...)

12Four different, co-existing aetiologies of disease can thus be discerned in the ancient Greek world. Which take on disease was then chosen in the cults of the healing gods, supplying the needs of worshippers with common diseases, such as oedema and infected wounds? We have seen that Apollo, considered the prime healer in Archaic times, could cause disease.³³ The cult of his doctor son, Asklepios, sprung forth from the cult of Apollo.³⁴ Asklepios was also the patron of Hippocratic physicians, and many of his cures were reminiscent of Hippocratic cures (further on this below). This background might make for an interesting take on the cause of disease in his cult. Furthermore, as the Late Classical period has been suggested in previous research as introducing a change of mentality surrounding the notions of purity and guilt and their possible connection to disease, what better material to analyse than the iamata of Epidauros.

• 35 Dillon (1994), p. 243 and 253. See LiDonnici (1995), p. 18, for the function of the iamata to hei (...)
• 36 See supra n. 4. Nos. C49-D70 are too fragmentary to use.

13Before examining the iamata, we need to answer the question: do they reflect the perceptions of the afflicted either by straightforward remarks, or as preconceived notions? The iamata, as discussed by Dillon and LiDonnici, had the purpose of establishing the power of the god and to fill the worshippers with hope and expectations of what cures might be obtained.³⁵ As Dillon has showed, a message to the worshippers is also put across to trust the powers of the god, and, of course, to pay the fees for the cure. In all likelihood, the iamata could only fulfil these purposes if the suppliants could identify themselves with the suppliants in these stories. If the help-seekers are to believe in the possibility of the miraculous, they had to relate to the people of the stories and their general background. Hence it is my view that the conceptions seen in the iamata concerning a cause of the illness would be close to what the suppliants were thinking themselves. As stated above, there are 70 narratives in total, of which 21 are too fragmentary to use in the analysis.³⁶

• 37 Cf. Chaniotis (1997), p. 152–153.
• 38 Kudlien (1978), p. 6; Chaniotis (1997), p. 152–153, and Versnel (2011), p. 295 and 415.
• 39 Herzog (1931), p. 31.
• 40 LiDonnici (1995), p. 125; LSJ, 1226, s.v. ὁμολογέω, allows for both translations, the first, “agr (...)

14In a few of the iamata, worshippers were punished by Asklepios, and this has been seen to support an argument for the cult of Asklepios commencing a shift in society towards a notion that moral behaviour affected the state of the body. The most important iamata in this respect are Echedoros of Thessaly (A7), Kaphisias (B36), and the fishmonger Amphimnastos (C47).³⁷ Before we turn to these three, we must mention the fragmentary iamata C54 and C58, which have been put forward by Kudlien to support the presence of confessions of guilt in the iamata, as the verb ὁμολογέω is present (the verb can be read in the inscription, but the surrounding sentence is gone).³⁸ Herzog translates the verb ὁμολογέω (in both fragments declined in active aorist third person singular) as “gestand” (“he/she admitted”),³⁹ whereas LiDonnici translates with “he/she agreed” (the most common translation for ὁμολογέω).⁴⁰ The fragmentary state of these inscriptions makes it impossible to conclude what is agreed upon (or, possibly, admitted), and neither C48 nor C54 can be taken as any proof of the presence of confessions of guilt in the iamata.

• 41 The seven are A7, A11, B22, C47 (“worshippers who do not follow the cult rules”) and A3, A4, and (...)

15There are seven iamata in the corpus of 70 iamata from Epidauros that show how the god punishes worshippers. Admittedly, not all of them have as strong a sense of the god punishing. They may be divided into describing two groups of people: firstly, those who do not observe the correct rules of worship, and secondly, people who are unbelievers and do not have faith in the miracles of Asklepios.⁴¹

• 42 The translation is not entirely clear. These could be slave marks or marks of soldiers. See the d (...)

16To the first category belong iamata A7, A11, B22, and C47. In the iama A7 Echedoros had received money from Pandaros in order to make a dedication to Asklepios, but he failed to do so. In spite of this he went to the sanctuary and slept there. He saw Asklepios there in a vision, and upon being questioned he denied having received any money from Pandaros. Instead, he promised to have an image inscribed and dedicate it at the sanctuary should Asklepios cure him. The character of Echedoros’ and Pandaros’ ailments seems to have been the fact that they both had marks, or tattoos, on their foreheads.⁴² The god tied Pandaros’ fillet around Echedoros, and told him to take off the fillet in the morning and wash his face at the fountain and look at his reflection in the water. Echedoros did as told, and he discovered that in addition to his own mark the god had added Pandaros’. A7, just as B22 below, are quite paradigmatic in revealing that Asklepios should always be given the promised payment for the cure. Of course, failing to do so might be seen as a moral fault, but the main message in this particular iama is that a cultic prescription should always be respected.

• 43 LiDonnici (1995), p. 121 (also for the edition of the Greek text chosen above); Chaniotis (2012), (...)

19The verb ἐξικετεύσαντος can be translated as “confessed”,⁴³ but I am of the opinion that δηλοῖ is better intended in the broader sense “to make known”, as “confessed” admittedly does not fit the context, as it strongly carries modern cultural connotations and concerns. The iama would not make sense if the people in the square were not told why the fish burned, and then again, why they came back to life again. Further, when Amphimnastos tells his story the god’s power is made clear and the importance of following the cult rules conveyed.

• 44 Cf. Petrovic – Petrovic (2016), p. 5–6, n. 16, on this iama as an example that the man did not ad (...)

20Iamata A3, A4, and B36 belong to the category of unbelievers. In the iama A3 a man who was paralysed in all his fingers except one came to the god. When he was looking at the plaques in the sanctuary he didn’t believe the cures. As expected, when he incubated he felt that he sat below the temple and played knucklebones, when the god came to him and stretched out his fingers, whereupon they were cured. The god asked him if he still did not believe in the inscriptions around the sanctuary, and he answered “no”. The god replied that since he did not believe in them before, he should be called “Unbeliever” (῎Απιστος).⁴⁴

• 45 Cf. Chaniotis (2012), p. 130–133.
• 46 The story about the cup seems to be part of common Mediterranean folklore (or broken crockery bei (...)

21Further, in iama A4 Ambrosia from Athens arrived in the sanctuary, being blind in one eye. She ridiculed some of the cures set up in the sanctuary as being impossible. The god came to her in a dream, and asked her to set up a silver pig in the sanctuary as a memorial of her ignorance. Thereupon he made her well again. Last, in the fragmentary B36 we meet Kaphisias, who laughed at the treatments of Asklepios. He was consequently injured in his foot in a riding accident, but after having earnestly prayed, καθικετεύσας, to the god he became well.⁴⁵ Compared with the previous examples of Unbelievers, it would seem that it was graver to laugh at the god’s power than just not to believe in them. Another iama, which involves both a non-believer and a believer, is A10, where a baggage-carrier on his way into the sanctuary falls and ampng other things his master’s drinking-cup gets broken. He tries to put it back together again, but a passer-by says that not even Asklepios at Epidauros could mend that cup. The baggage-carrier consequently walks into the sanctuary, and when he opens his bag again, the cup is whole (and is later dedicated to the god). The message here is clearly the same, as in the above quoted stories: not to doubt the god’s miraculous powers.⁴⁶

• 47 Iama A15.
• 48 On pathology as reflected and understood in literature in ancient Greece, see e.g. Grmek (1989), (...)

23Most of the iamata do not give any information on the perceived cause of the disease. Hence, the prescribed cures do not reveal any indication that the ailments of the worshippers would have been considered as originating from wrongdoing. In some of the iamata there is, though, a clear connection between the illness and the cure: a lame man is asked to carry a large stone.47 Similarly, in A5, a mute boy speaks, when asked to answer the god. In iama A3, a man with paralyzed fingers had them straightened by Asklepios. This may suggest a notion that the joints needed to be turned into place, just as a Hippocratic doctor would do. Another parallel to medical cures is when Asklepios in A9 cured a man with an eye disease by mixing a drug and pouring it into his eyes, giving the impression of a natural cause of the problem. Similarly, in B40, a man with a wounded eye had it cured by Asklepios pouring a drug into it. In A12, a man with a spearhead stuck in his head had it removed by Asklepios (the cause of the problem thus being bad relations between humans, having nothing to do with the gods). B30 gives a similar story, where a barb was stuck in a man’s lung and, severely festering, it fell out by itself after he slept in the abaton. A more remarkable story is B32, where a man with a spearhead stuck through both his eyes had it removed by Asklepios and regained his sight. All of these stories concerning injuries which are not disease stricto sensu and would not have fallen under the category of ailment caused by the god. One of the oldest branches of Greek medicine was surgery. Greek medicine was one of the big advocates for natural proto-scientific explanation of disease and hence its influence on the Epidaurian cures is of interest.48

• 49 Cf. Hippoc. Morb. 4.596–600, on different intestinal worms, and how the patient should be cleaned (...)

24Particularly interesting are a number of cases where Asklepios and his helpers operated on the incubants. In A13, a man with his abdomen full of leeches had them surgically removed by Asklepios, also here a clear reference to surgery by doctors. A woman with an intestinal worm had it surgically removed in a similar manner in B23. In B25 Sostrata, who likewise suffered from intestinal parasites, had an operation. In contrast, in B41 Asklepios removed intestinal parasites by giving the worshipper a drug to drink, which made her vomit.⁴⁹ In all of these cases, the common ailment of intestinal parasites is treated as an affliction anyone might incur.

• 50 Cf. Theophrastus Hist.pl. 7.6.2, recommending the juice of a lettuce plant against dropsy and Hip (...)
• 51 See Hippoc. Off. (In the Surgery), 1–6, on the layout of the operating room, equipment, and assis (...)

25Continuing with a slightly different example, in A19, a bald man regained his hair when the god applied a drug. Not knowing how the Hippocratic school would have treated this aesthetical condition (if at all), the cause of the loss of hair was here perceived as curable by a medical drug anointed on the relevant part of the body: a natural cause. In B21, a woman with dropsy was cured by the god opening her body and letting out the excess fluid. This points to the perception of a natural cause, although doctors at the time were more likely to prescribe a diet or medications to evacuate water from the body, or more cautious surgical methods.⁵⁰ In B27 a man with a sore was surgically cured by Asklepios and his assistants. The story is graphic and entails an operating table, a clear reference to worldly medicine.⁵¹ Likewise, a man with a cancerous sore in iama C66 was cured by Asklepios removing the sore.

• 52 Bath in cold water: (pond, river) B37, C53. Bath in bath-house (not stated whether prescription o (...)
• 53 See e.g. Parker (1983), p. 207–211, esp. 211.
• 54 See Villard (1994), p. 48–52 on baths in the Hippocratic writings. E.g. Hippoc. Aff. 212 (4), vap (...)

26In three iamata we find possible prescriptions for taking a bath.⁵² One might think that points towards the bath being in essence a purification and hence the cause of the illness being some form of pollution. On the other hand, purifications were commonly administered as cures, most often without any pollution having first been identified as a cause for the disease, but just by habit and belief in the efficacy of the remedy.⁵³ Further, baths were one of the most common prescriptions in worldly medicine, and the reason for giving different baths as a remedy is mostly explained as an attempt to regulate the bodily humours.⁵⁴

• 55 I. Cret. I xvii 19.
• 56 Galen, De simplicium medicamentorum temperamentis ac facultatibus 11.26 (12.345 K); Chaniotis (19 (...)
• 57 I.Cret. I, XVII, 11A (l. 4–13); 11B, 12A-B, 14A, 17–20 (Edelstein – Edelstein [1945] testimonia 4 (...)
• 58 See the argumentation in Müller (1987), p. 194–199.
• 59 Müller (1987), p. 194–199.
• 60 Diet: Arist. Or. 47.45, 49.6, 49.24, 49.34, 49.35 and 49.37; drugs: 48.13; poultices: 49.25; bloo (...)
• 61 Nissen (2009), p. 42, 61.

27Similarly, in a cure inscription from Lebena,⁵⁵ Asklepios ordered a woman to put burnt shell together with oil of roses, mallow, and olive oil on a wounded finger, thus curing her. Chaniotis has shown how burnt shell was known for healing in ancient medicine (Galen).⁵⁶ Other Cretan iamata may also reflect prescriptions concerning food and diet.⁵⁷ Further, the inscription of Aelius Theon, dating from Roman times and found in Pergamon, clearly shows the influence from medical diet on Asclepian cures:⁵⁸ “For 120 days I have drunk nothing in the early morning, but have eaten fifteen corns of white pepper and half an onion, as the god ordered, and so I have clearly been saved from many and great dangers.”⁵⁹ The cures prescribed by Asklepios to Aelius Aristides further include the otherwise medical treatments of diet, poultices, blood-letting, and drugs.⁶⁰ Cécile Nissen has analysed the close relations existing between Hippocratic doctors and Asclepian cult, above all for Roman times but also as concerns Classical Greece.⁶¹

• 62 As has been remarked by Lloyd (1979), p. 40–41.
• 63 Excepting iama B36, the man who laughed at Asklepios and was hurt in a riding accident.

28To sum up, when contextualizing the aetiology of disease of the Epidaurian cures, they best compare with the perceptions of worldly medicine and contemporary medical science.⁶² In other words, the most common causal explanation in the iamata is that of natural causes and most of the cures are influenced by medical cures. In the few miracles where worshippers are punished with an illness, it is the same illnesses with which they arrived,⁶³ but were re-given after the cure, as they had not paid the healing fee.

• 64 For the concept of cultural groups within a larger society, see e.g. International Encyclopedia o (...)
• 65 Veyne (1983), passim, esp. p. 11 and 33. More developed, on this subject, see also Versnel (1990) (...)
• 66 Oberhelman (2013), xv.
• 67 Lloyd (1979), esp. p. 295–296 and 421–422; Kleinman (1980); Ramsey (1988); McNamara (2003–2004), (...)

30The psychology underlying multi-explanatory causality of disease (divine, moral, natural) might be looked for in the context of the event. If a phenomenon is ubiquitous, there is no point in searching for a particular cause, other than that this is part of everybody’s lot. A sudden and unusual illness, or a disease such as the plague striking Athens under the Peloponnesian war, might more readily open up for searching for a particular cause or remedy that has to do with divine agency. It is important to remember, though, that the historical study of causal thinking in social groups can never arrive at disclosing one general type of causal reasoning for the whole group. There will always be different cultural communities within a society,⁶⁴ and even within the group there will always be duality of beliefs, that is two contradictory explanations of an event or phenomenon can be accepted as equally true by the same individual.⁶⁵ Even though a development in Greek religion from late Hellenistic times (or earlier as argued by Petrovic and Petrovic) demands the pure mind of the worshipper, this does not have to effect or construct the lack of it as a cause of disease. As we have seen, it seems that there are many different explanations of disease at any given time. I would argue that causal reasoning of phenomena fills the needs of a society, group, or individual, and that these needs change with every given situation. Without many different ways of reasoning around causes of disease (including not taking any position at all), the historically known phenomenon of medical pluralism would not exist. In most societies, as scholars today agree upon, the opposition between “rational” versus “irrational” medicine (as traditionally framing historical development in the field of history of medicine), is more and more replaced by a historical model where the medical system is culturally constructed.⁶⁶ Medical pluralism (the use of several medical systems: conventional, complementary as well as alternative medicine) in societies is recognized, and different ways of studying it have been developed.⁶⁷ Without a society encompassing many different and at times contradictory explanations on the cause of disease, there would not be medical pluralism.