Ranft Hildegard of Bingen 107

7. Donoghue HD, Lee OY-C, Minnikin DE, et al. scientifically examined and given a medical diagnosis.
Tuberculosis in Dr Granville’s mummy: a molecular reex- Proceedings of the Royal Society of Medicine 2010; 277:
amination of the earliest known Egyptian mummy to be 51–55.

Author biographies
W Benson Harer Jr, MD, DHl, FACOG, FRSM is a retired obstetrician/gynaecologist. He is Ex-President of the
American College of Obstetricians and Gynaecologists and a retired Clinical Professor of Obstetrics and
Gynaecology at the Western University of Health Sciences, Pomona, California. He also served as an Adjunct
Professor of Egyptian Art at California State University, San Bernardino (Email: wbhjr1@gmail.com)

Eddie Tapp MD, FRCPath was Consultant Histopathologist and Director of Pathology at the Royal Preston
Hospital during 1976–1997 and Consultant Pathologist to the Home Office from 1986 to 2010. He has been
involved in the examination of mummies in England and Egypt. He developed the use of endoscopes to sample
internal organs of mummies for histologic examination (Email: dretapp@aol.com)

Journal of Medical Biography

22(2) 107–115

Ruminations on Hildegard of Bingen ! The Author(s) 2014

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(1098–1179) and autism DOI: 10.1177/0967772013479283
jmb.sagepub.com

Patricia Ranft

Abstract
The article brings together contemporary research on autism spectrum disorder and historical sources concerning the
medical condition of a 12th century nun, Hildegard of Bingen, to test two hypotheses: first, that Hildegard manifested
disabilities that meet the criteria for autism spectrum disorder and, second, that medieval monasticism was unwittingly
well-suited to treat Hildegard’s condition. Abundant Hildegardian sources document traces of autism spectrum disorder
behaviour in Hildegard’s unusual childhood and the composite picture that emerges, when these individual traits are
gathered together, is consistent with an autism spectrum disorder diagnosis. The role monasticism played in helping
Hildegard overcome these behaviours is documented and aspects that monasticism shares with modern autism spectrum
disorder treatment programs are identified. By recognizing the presence of autism spectrum disorder traits in a major
cultural leader of another era and by identifying the type of life she lived while those traits were minimized, we gain
insight into the history of autism, medieval monastic life and effective elements of autism spectrum disorder treatment.

Keywords
Hildegard of Bingen, autism, Asperger, monasticism

Introduction
In 1942 Leo Kanner (1894–1981) used the term ‘early
infantile autism’ to describe the behavioural problems
of a group of 11 children. A few months later Hans
Asperger (1906–1980) described the social skills
another group manifested as ‘autistic psychopathy’.1
With these two reports, the modern study of autism
begins. This is not, of course, to say that autism itself
begins in modernity, only that it is not documented
before the 20th century. Establishing the presence of
the disorder in ages past is pertinent to research for it
can help us determine if and what environmental fac-
tors contribute to the disorder and also shed light on
treatment methods. Obviously this is not an easy task,
133 Hampton Roads Avenue, Hampton, VA, USA
Corresponding author:
Patricia Ranft, 133 Hampton Roads Avenue, Hampton, VA 23661, USA.
Email: ranft1p@cmich.edu
108
particularly since no test exists even today to establish
definitively the presence of the disorder. Because there
is no neurobiological marker for autism, the physical
absence of the subject is not a disqualifying factor and a
historical investigation is theoretically possible. Second,
in cases relating to autism, heteroanamneses (medical
histories as reported by others) weigh most heavily in
diagnostic conclusions. When one can find a historical
person with a documented medical history, one can
proceed to draw a tentative conclusion, remembering
at all times that even modern diagnosis is tentative.
Multiple reports of Hildegard of Bingen’s medical his-
tory exist. Because medieval and hagiographical
sources are often formed around topos, one must scru-
tinize such sources warily but, when done appropri-
ately, the result is informative.
Today when one speaks of autism one is probably
referring more inclusively to autism spectrum disorders
(ASD): autism, Asperger’s syndrome, pervasive develop-
mental disorder not otherwise specified, Rett’s disorder,
and childhood disintegrative disorder (Heller’s
Syndrome). By 1994 the American Psychiatric
Association and the World Health Organization had
developed diagnostic tools for these disorders. They
are all characterized by varying degrees of impaired
communication and social skills, by repetitive patterns
of behaviour, and often by unusual sensory experiences.
It is sometimes hard to distinguish one from another; for
example, the difference between high functioning autism
and Asperger’ syndrome is difficult to discern.
Diagnostic tools are limited and depend heavily on het-
eroanamneses. ASD manifests itself in many ways and
degrees. To date, effective pharmacotherapic interven-
tion has not been achieved. More success has been
seen in behaviour modification and in parent/subject
education. Early intervention has the highest success
rate in treatment. Individualized programs have a spe-
cialized and structured curriculum and a strong commu-
nication component; systematic pedagogy and intense
engagement appear to be making the most progress
toward growth in cognitive and communication skills.
Contact with typical peers, family involvement and flexi-
bility of approaches are also seen as beneficial.2
Born near Alzey in Germany to parents of low nobil-
ity, Hildegard was a revered religious, intellectual and
cultural leader of her day. Her parents offered her in
oblation in her eighth year and hired a nurse to care for
her; at age 14 she voluntarily became enclosed in the
anchorhold (a tiny cell attached to a church) of magis-
tra Jutta of Sponheim (1092–1136). Over the years this
small group of anchorites expanded and when Jutta
died Hildegard became head of the thriving commu-
nity. She began writing her masterpiece Scivias five
years later and in 1147 a Papal Commission encouraged
her to write more. As her fame grew, so did the
Journal of Medical Biography 22(2)
community, necessitating a move to Rupertsberg and
then to Bingen where she died.
Medical and herbal treatments; treatises on natural
science and theology; musical, poetic, and dramatic
compositions; the creation of the only medieval private
language: these are only some of her accomplishments.
Biographical information is found in five sources in
addition to extensive autobiographical comments
strewn throughout her works.3 This relatively large
number of sources allows us sketch a reasonably reli-
able history of Hildegard’s medical life, even in the
presence of topos these sources employ.
Childhood
The Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV TR) tells us that impairments in
verbal and nonverbal communication are primary diag-
nostic features of ASD. Delays in social communica-
tion before the age of three years are a qualifying
characteristic for autism although speech delay is not
characteristic of Asperger’s. However, all ASD children
share restricted or repetitive interests and behaviour
and impaired social interaction. When we examined
Hildegardian sources, we found descriptions that meet
these criteria. Guibert of Gembloux (1124/25–1213)
writes that, because Hildegard was her parents’ 10th
child, they decided ‘to set her apart through their
mutual decision and free offering as their own tithe’.
But Hildegard’s parents may not be the ones who
imposed her social isolation. It may have been
Hildegard’s reality, for Guibert also says she ‘was in
truth completely set apart, since from her infancy she
made herself a stranger to all the cares and all the chil-
dren of the world’. He adds ‘Her father and mother had
separated her from their other offspring; in a way they
had abandoned her to hope in God’s mercy alone, so
that she was casting herself totally on him not only in
her thoughts but with her whole self’.
While the topos of worldly separation is common in
hagiography, Guibert’s emphasis goes beyond the
common template; even as a baby, Hildegard is socially
isolated and dependent on God for her whole being,
body, and soul: ‘And she likewise sought to bear no
part of the world with her, into the wide embrace of
his loyal live. There he cherished her and nourished her,
and for as long a season as was suitable, hid her in the
shelter of his presence from the plotting of people in the
cleft of the rock and in a hollow of the wall, to be
protected from the heat, the storm, and the rain’.4 He
emphasizes her physical well-being again when he tells
us that her parents were distraught over their inability
to find her a proper environment, ‘for they were afraid,
and the sting of this fear caused them so slight worry
that if this tithe-offering of the Lord were to remain out
Ranft
in the open, it might be preyed upon by the birds of the
air, which eat the seed falling by the wayside, or by the
beasts of the field which prowl about at night seeking
their food’.5 With abundant scriptural images of spirit-
ual dangers available, Guibert chose images of physical
dangers. The concerns of Hildegard’s parents went
beyond the conventional concerns about a daughter’s
spiritual health and focused instead on her actual phys-
ical and social conditions.
These descriptions leave the door open to the possi-
bility that her parents’ decision to send her outside the
home was thrust upon them by Hildegard’s condition;
perhaps they felt inadequate to the task of rearing a spe-
cial needs child. Such interpretation is consistent with a
priest’s testimony at Hildegard’s canonization inquest
that, after realizing Hildegard did not learn in normal
ways, ‘the parents wondered about her, and perceiv-
ing that her ways were different from those of other
people, made arrangements for her enclosure in a
monastery’.6
Theodoric of Echternach’s (dated 1192) Life of
Hildegard also describes Hildegard’s abnormalities,
stressing their early onset: ‘Even in her earliest years a
precocious purity seemed to very much withdraw her
from all the normal ways of the worldly’.7 Always
descriptions of her oddities are couched in positive
terms but that does not negate the basic reality
being reported: Hildegard’s behaviour fell outside the
norm. Modern historian of medieval literature, Peter
Dronke concludes that Hildegard’s ‘intense, even
morbid, fear of the outer world’ went well beyond the
sanctity topos and that ‘her constant illness made her
less capable of coping within the ways that ordinary
people could’.8 Exactly what that ‘illness’ is, Dronke
does not say.
The repeated and lengthy references to childhood in
Hildegardian sources are unusual. In medieval hagiog-
raphy, the early years are barely mentioned; yet
Hildegard’s childhood looms large throughout the
sources.9 Surely this indicates that her contemporaries
knew it was distinctive, worthy of note. Hildegard
thinks it distinctive enough to discuss it frequently.
She remembers being frustrated when communicating:
‘In my third year of age I saw so great a light that my
soul trembled, but, because I was still an infant, I could
not convey anything about it’.10
As an adult, she acknowledged awareness of child-
hood weaknesses: ‘I have always seen this vision in my
soul, even from my infancy, when my bones and nerves
and veins had not yet grown strong’.11 The exact nature
of her early weaknesses is unclear but she tells us of ‘a
recurring ailment I have suffered from my mother’s
milk until now, which wore out my flesh and sapped
my strength’.12 Guibert writes that at mid-life she still
‘shrank from the embarrassment and was slow to obey.
Hildegard of Bingen 109
Moreover, apart from that slow and continuous ail-
ment by which she had been oppressed almost from
her infancy . . . she grew worse, not simply by chance
but because she was laid low by an illness sent from
God. So she lay prostrate on her bed, tossed about by
her long-standing distress. She was like one dumb who
could not open her mouth, but held back her speech
within her’.13
Adult years
Theodoric reports that, although magistra Jutta
‘rejoiced in [Hildegard’s] progress’, as a young adult
Hildegard was still known for ‘her silence and fewness
of words’ and a ‘weakness’ that had possessed her
‘almost from her very infancy’.14 At a certain point in
Hildegard’s life she tried to break her silence but her
first incoherent attempts ended with her listeners con-
fused and Hildegard in crisis and tears and regression:
‘‘I was quite exhausted by these things and asked my
nurse if she could see anything apart from outward
objects. ‘Nothing’, she then replies, but she saw none
of them. Then, seized by a great fear, I did not dare
to tell about these things to anyone, although in my
conversations and my lessons I used to announce
many things about the future. And on occasions
when I was completely inundated by this vision, I
would say many things which were strange to my
hearers, and I behaved more like an infant than one
of my years’’.15
Hildegard tells us it was ‘my fear of people at the time’
that kept her from communicating.15 This suffering was
only alleviated in mid-life when she finally found some-
one who could teach her how to write: ‘A certain noble-
woman to whom I had been entrusted for instruction
observed these things and laid them before a certain
monk known to her’. Together they devised a strategy
to break through Hildegard’s communication barrier
by stressing written over oral communication. When
she ‘told these things to a certain monk, my magis-
ter . . . he listened generously to these strange tales. He
marvelled at them, and ordered me to discreetly write
them out until he could see what they were and where
they came from’.16
The trial of silence is one commonly found within
ASD. Hildegardian sources describe a child with such a
trial, beset with an undefined ‘weakness’, social isola-
tion, deficits in expressive oral communication, diffi-
culty in expressing needs, extreme distress at failed
attempts at relationship and withdrawal in the face of
failure. Likewise, what Hildegard tells us next conforms
to the unusual sensory experiences of many ASD
110
individuals. She describes how her atypical visual
powers helped her access to knowledge outside herself:
‘‘In this vision I understood without any human
instruction the writings of the prophets, of the
Gospels, and of other saints and of certain philoso-
phers, and I expounded a number of their texts,
although I had scarcely any knowledge of literature,
since the woman who taught me was not a scholar.
Then I also composed and sang chant with melody,
to the praise of God and his saints, without being
taught by anyone, since I had never studied neumes
[in plain chant, a note or group of notes to be sung
to a single syllable] or any chant at all’’.17
While some scholars hold that this is evidence of
migraine, perhaps it is more suggestive of hyperlexia,
a syndrome many researchers hold is a symptom within
ASD.18 Typically the hyperlexic person learns visually,
has significant difficulty with verbal language and has a
precocious reading ability.19 This describes Hildegard.
Her innate musical abilities are also consistent with
savant skills that approximately 10% of the autistic
population possesses (as compared to 1% of the general
population).20 Guibert’s portrait of Hildegard similarly
is suggestive. He describes Hildegard’s unusual cogni-
tive skills, telling us that ‘whoever reads these [autobio-
graphical explanations] may well be struck speechless
with awe at this strange manner, unknown to the world
till now, of illuminating the human mind’.21 Hildegard
insists that hers is visual, not mystical, knowledge: ‘I
never suffer the defect of ecstasy in these visions. And
fully awake, I continue to see them day and night’.22
She is particularly aware of how odd her visionary access
to knowledge is and is intimidated by it: ‘Indeed I always
tremble in fear, since I know that I cannot safely rely on
my own innate capacity’. Nevertheless, she understands
that such access to knowledge is a rare gift: ‘And I imme-
diately knew the meaning of the exposition of the
Scriptures . . . though I did not have the interpretation
of the words of their texts or the division of the syllables
or the knowledge of cases or tenses. But I had sensed in
myself wonderfully the power of mystery of secret and
admirable visions from my childhood’.23 She describes
her cognitive process thus: ‘Whatever I see or learn in his
vision I retain for a long period of time, and store it away
in my memory. And my seeing, hearing, and knowing
are simultaneous, so that I learn and know at the
same instant’.24
Hildegard is aware of her powers of memory; a highly
retentive memory is another frequently documented
characteristic of ASD individuals, as is a preference for
using gestalt strategy to learn – ‘‘memorization of
unanalyzed ‘chunks’ of information including speech
as well as visual stimulus input’’.25 Guibert attributes
Journal of Medical Biography 22(2)
this pedagogical approach to Hildegard.26 Unlike non-
ASD children, Hildegard’s dependency on visual learn-
ing is near total: ‘I have no knowledge of anything I do
not see there, because I am unlearned’. In her writings
she adds ‘no words of my own . . . since I am not taught
in the vision to write the way philosophers do.
Moreover, the words I see and hear in the vision are
not like the words of human speech, but are like a blaz-
ing flame and a cloud that moves through clear air’.27
While Hildegard was ready to communicate in writing,
she employed Volmar (dated 1173) as her amanuensis to
‘clothe her words – however bare and unpolished – in a
more presentable dress’.28 Still, her communicative and
cognitive processes left Hildegard frustrated: ‘I can by
no means grasp the form of this light, any more than I
can stare fully into the sun’.29
Hildegard’s uses the word visio to designate her fac-
ulty of vision, her experience of this faculty and the
content of that vision.30 According to Dronke ‘what
is exceptional in Hildegard, and what she herself felt
to be unique, is that this mode of vision was for her
absolutely concurrent with physical sight. There was
not the least suspension of her normal faculties; her
insights had nothing to do with dream or daydream
or trance or hallucination or extasis’. She is not describ-
ing mystical, extra-ordinary, spiritual communication
from God; she is describing what her bodily eyes see.
Hildegard believed that her visio was ‘linked in a mys-
terious way with her recurrent bodily afflictions’ and
that all this set her apart.31 Dronke’s analysis of
Hildegard’s visual knowledge resonates with research-
ers’ understanding of ASD adults’ use of visual
knowledge.32
That Hildegard should excel as an intellectual force
in her adult life likewise is compatible with ASD pro-
files. As Hans Asperger observed, ‘to our own amaze-
ment, we have seen that autistic individuals, as long as
they are intellectually intact, can almost always achieve
professional success; usually in highly specialised aca-
demic professions, with a preference for abstract con-
tent’.33 Often ASD individuals happily ‘find a niche for
themselves among a group of people’ – perhaps a
monastic community? – ‘who value their oddities and
differences. Their single-mindedness and willingness to
abandon outside interests are frequently the formula
for success, particularly in science, art, and music’.34
These conditions are present in Hildegard’s adult life.
Even the fields of interest Asperger identifies as partial
to ASD individuals are areas where Hildegard made
major contributions.
Treatment
Early identification and intervention are key factors in
the successful treatment of ASD and sources tell us
Ranft
Hildegard’s parents did both. They recognized
Hildegard’s social peculiarities at an early age and
addressed the situation first by separating her from her
siblings and then by placing her in a program.35 She was
probably placed with a comital family in Sponheim, a
town close enough to facilitate parental oversight. Her
parents employed a nurse to care for her on a one-to-one
basis, even while they kept looking for a more perman-
ent solution. Years later they found Jutta. ‘When
through spreading report the holy virgin’s enterprise
became widely known the lady Hildegard’s parents
heard about it and were overwhelmed with a feeling of
great joy, because they understood that God was offer-
ing them an opportunity and providing a place where
they might bring his tithe-offering for safe-keeping’.36
Such concern for a daughter’s physical well-being is
an unusual topos in women’s vitae. Guibert reinforces
this concern by offering two scriptural metaphors (Mt
13 : 4 and Ps 103 : 20–21) on survival and vulnerability.
With Jutta, her parents found a magistra who would
teach Hildegard how to survive within a rigorous
monastic routine. It may seem commonplace and there-
fore insignificant for medieval parents to seek monastic
placement for daughters until one notes how similar the
routines of monastic life and ASD treatment programs
are. Each is highly structured, individualized with low
teacher/student ratios, demands hierarchical relation-
ships and intense engagement, offers systematic teach-
ing and encourages family/community involvement.
And while the monastic life requires silence at certain
times, it also requires the daily chanting of the Divine
Office.37 The combination might be ideal for ASD indi-
viduals. The scheduled periods of silence would elimin-
ate undue pressure on learning effective communication
skills; the chanting would present an ideal situation for
gestalt language learning techniques. According to
ASD researchers, when repetition and eventual memor-
ization of multiword utterances without analysis were
followed by a subsequent break down of these ‘chunks’
into meaningful segments, then progress in communi-
cation skills follows.38
Undoubtedly the parents were drawn to Jutta herself
as well as the structure of monastic life. From what we
know about Jutta, theirs was a wise choice. Jutta’s
biographer paints a portrait of an excellent teacher con-
cerned with matters beyond the spiritual; she possessed
‘wisdom both in spiritual matters and in dealing with
various other needs’ and delivered ‘sound warnings and
counsels’. She had ‘the greatest discernment for all situ-
ations . . . was indeed busy about many things as
Martha was’ and gave generously ‘to those who came
suffering some affliction’. Moreover, she adapted her
teaching methods to the individual needs of her stu-
dents: ‘She accommodated herself humbly and wisely
to the character and station of each person’. She was
Hildegard of Bingen 111
undiscriminating and ‘taught ungrudgingly whomever
she could’. She relied on her own creativity but did not
ignore the wisdom of tradition or the laity; she lectured
on ‘all that she herself had learnt from the inspiration
of the Holy Spirit, the tradition of the elders, and the
report of the faithful’. Lastly, she was an original thin-
ker: ‘She came to know things . . . neither through nor
from any human source’.39 In short, Jutta would be an
ideal choice today for tackling the complex pedagogical
problems inherent in teaching a teenager with ASD.40
We know little of what happened between Hildegard
and Jutta except that Hildegard became Jutta’s star
pupil. After Jutta’s death ‘no one was judged more
worthy to succeed her in the honour of teaching’ than
Hildegard. Interestingly, Guibert notes Hildegard’s
most admired traits: ‘Accordingly, with the unanimous
consent of the sisters – for they were secure concerning
her discernment and self-control – she was chosen to
exercise the supervision of discipline over them’.41 Two
additional attributes are noted: ‘Because of her discre-
tion and sobriety, she appeared to all not only as irre-
proachable, but as both pleasing and worthy of
emulation’.42 Discernment, self-control, discretion,
sobriety: again, these are not usually important virtues
in abbesses’ topos. They are, however, important traits
within a special learning environment, particularly self-
control. For some ASD adults, behaviour modification
of repetitious, involuntary physical actions is among
the hardest tasks to conquer. We know that
Hildegard had to struggle with self-control even late
in life, especially when she ‘received the heavenly com-
mand to change her place of dwelling . . . Sometimes she
would suddenly rise from her bed and walk round all
the corners and rooms of the anchorhold, all the while
unable to speak’.43 Hildegard’s anxiety was so extreme
that she actually believed ‘I would have died before my
time’.44 Such reaction is within the norm for ASD indi-
viduals, as is Hildegard’s resort to intense repetitive
motion and loss of speech.
Assessment of language skills is a major component
in ASD diagnosis. Identification of their onset, devel-
opment, deficiencies, impairment and precocious usage
is necessary for treatment as well. The latter is quite
significant here, for Hildegard’s unusual linguistic
skills are evident in her construction of an ‘unknown
language’, lingua ignota, and her accompanying
‘unknown alphabet’, litterae ignotae. Such languages
are both social and anti-social for they include and
exclude at the same time. For ASD individuals a pri-
vate language would increase their wider sense of iso-
lation but possibly form a bridge to an elite informed
group. In addition, ‘every imaginary tongue is elabo-
rated in tandem with a fantastic temporal or spatial
locus . . . created via an act of projection’.45 Visionary
loci provide the creator with knowledge of the
112
language. This is how Hildegard explains the origin of
her language: God told her in a vision ‘to form
unknown letters’.46 Furthermore, private languages
‘are spoken in the name of an-Other’; the human cre-
ator is the voice for an external agent. An ASD indi-
vidual with hyperlexia or one who uses gestalt strategy
in language learning would present a private language
in a similar manner. Hildegard constructed her lan-
guage in obedience to another. Lastly, because private
languages entail appropriation of linguistic forms,
vocabulary, and structure from public languages, they
‘also move in the direction of infantile speech’.47
Reversion to earlier communication patterns could be
a pedagogical strategy; one builds more mature com-
munication skills by going back and strengthening the
foundation. It could also be a way for ASD individuals
to meet the challenges of the inflexibility of conven-
tional languages. If Hildegard composed her language
long after she overcame most of the impediments of
ASD, then both possibilities make sense. When she
started writing, she possessed limited communication
skills and needed constant assistance from a secretary.
After her last secretary, Volmar, died, Hildegard wrote
unaided in learned form and style.48 Somehow through
the years she learned how to communicate more
effectively. Lingua ignota could have been part of that
learning process.
Hildegard’s scientific contributions
Then there is the matter of Hildegard’s scientific con-
tributions. Eleventh-century interest in the Incarnation
led to 12th century interest in Creation; her strictly
structured treatises Physica and Causae et curae are
components of the scientific movement born of this
interest.49 While we can explain her scientific interests
as a response to her historical context, there could be
another contributing factor involved: ASD. In
Dronke’s words, ‘as a medical writer [Hildegard’s]
whole inclination is to look at human beings in their
empirical reality: they are organisms that can be
accounted for in terms of physical principles’.50
Hildegard’s scientific originality was rooted in her
‘highly imaginative, visually oriented intellect’ that pic-
tured structures and events ‘in an entirely unique and
creative manner’.51 It may be that she is so successful at
this because, like many ASD individuals, an objective
approach and visionary involvement in cognitive pro-
cesses came naturally to her.
There are some aspects of Hildegard’s life that at first
appear incongruous to ASD, particularly her ability to
empathize. It is plain from her correspondence that,
when people sought her advice, Hildegard responded
appropriately. Recent advances in cognitive science
may hold the key to reconciling Hildegard’s later
Journal of Medical Biography 22(2)
empathizing skills with her earlier ASD behaviours.
Successful therapy could have intervened and developed
the less empathic side of her brain. A mere generation ago
this solution would not have been considered but current
knowledge of the brain now renders such a possibility a
probability. The neuroplasticity of the brain allows it to
repair damaged regions, to grow new neutrons to rezone
regions to assume new tasks, and to change the circuitry
that weave neutrons into networks for feeling, suffering,
thinking and imagining.52 There is nothing within the
physiology of the brain, therefore, that would disallow
Hildegard learning how to empathize as an adult. The
monastery, though unaware, offered her the therapy she
needed. Her total immersion into monastic life with its
regulated and structured family community, its specia-
lized and narrow interests and its individualized direction
and models – all elements that current treatment pro-
grams embrace – could conceivably have repaired or
rezoned her brain to correct any impaired empathizing
ability. Hildegard may well be an example par excellence
of what Simon Barn-Cohen calls a person ‘who in a sense
has outgrown [her] diagnosis . . . [and] who reminds us
how important environment is’.53
Affinity with the disabled
In Hildegard’s canonization petition witnesses provided
vivid testimony about her close association with the
mentally/socially disabled. In every chapter witnesses
testified to Hildegard’s care or cure of those ‘disturbed
in mind’, ‘out of his mind’, ‘insane’, ‘very much insane’
and, especially, those with epilepsy.54 Besides having a
special bond with these sufferers, she seemed to possess
an advanced understanding of such disabilities as dis-
tinct from demonic possession. Ancient and medieval
societies assumed mental/social instability was caused
by evil spirits; they lacked tools to diagnose or treat the
disturbed as a medical problem. Yet Hildegard’s writ-
ings display a sophisticated appreciation of the role the
brain played in determining behaviour.55 That
Hildegard also suffered from temporal lobe seizures is
possible and could explain her affinity with those with
epilepsy. It would be interesting to pursue that possi-
bility elsewhere although such a diagnosis would not
invalidate a diagnosis of ASD.
The story of Sigewize lets us see this appreciation in
practice. An abbot asked Hildegard to treat one
Sigewize who had ‘lost the right use of her senses and
actions, and was constantly shouting out and doing
unseemly things’. The abbot had concluded that
Sigewize was possessed. Hildegard was not so sure.
She eliminated the possibility by imposing an elaborate
exorcism on Sigewize and, when it failed, Hildegard
brought Sigewize to her monastery for group therapy.’
At the arrival of this woman we were quite terrified as
Ranft
to how we might cope with seeing and hearing her’,
Hildegard confesses, but she was determined to help
her. She decided to mainstream Sigewize: ‘We found
a place for her in the living quarters of the sisters.
From then on’, Hildegard explains, they immersed
her in the same routine in which Jutta immersed
Hildegard as a teenager.56 Sigewize participated in all
aspects of their monastic routine including daily
Chapter where the community gathered to tend to the
day’s business; Chapter was also where a woman could
discuss her failures, problems and limitations, and
receive feedback from the Community. Throughout
her account of Sigewize’s story, Hildegard employs
demonic metaphors but, when we sift through the
images, what she is describing is successful therapy.
She is not describing the dramatic release of
Sigewize’s spirit from a spell but a cure for her body.
It took place slowly ‘day afterday’57 until finally ‘she
continued in her right senses, both of soul and body as
long as she lived’. There is yet another, shorter anec-
dote that illustrates Hildegard’s grasp of mental/social
illness and its proper treatment: ‘There was another
woman who, on account of the wild fury of her
raving, was bound with strong chains. When this
woman was led to [Hildegard] she ordered her
unchained. Immediately, to the amazement of everyone
present, she recovered her health of mind and body
and, giving thanks, returned to her own’.58
Ruminations
Whether Hildegard had an innate sense of proper diag-
nosis and treatment of the disabled, realized how suc-
cessful Jutta’s treatment of her own ASD problems was
or simply had a special rapport with them, we may
never know. The sources only tell us that she had a
particular affinity for those suffering from disabilities
other than spiritual or physical ones; they do not tell
us why. Still, the sources tell us much.
To summarize, Hildegard had some very specific
abnormalities as a child. The sources report that her
parents searched long and hard for a school and a tea-
cher who would fit her needs. They inform us that, after
years of living a structured life under close supervision,
Hildegard was a high-functioning adult, capable of
leadership within a group of similar individuals.
Autobiographical sources tell us that she possessed
many characteristics found in DSM-IV TR’s criteria
for ASD. Her writings, be they about natural science,
medicine, drama, music or theology, are authored by
someone whose thought is strictly organized and
framed by a select few images. We see in the sources
how Hildegard craved structure and devoted much
energy to taxonomy. She fixated on her visions, her
treatises are filled with repetition and her music
Hildegard of Bingen 113
employs patterns of echo and geometric formulas.
Her lingua ignota and litterae ignotae tell us that she
experienced language in unique ways. Her life as a nun
did not place high demands on empathy as would, for
example, the life of wife and mother. Rather, her life
was structured around restricted and repetitious behav-
iour: set routines, formal rituals, intense interests and
typical preoccupations. It did not require (sometimes
even discouraged) typical empathizing skills including
emotive responses, eye contact and comforting or
intimate relationships. Her social contacts were often
intellectual, maintained through correspondence and
overwhelmingly with those who shared her interests.
At the same time, she was known throughout the
region for her success in dealing with the mentally
and socially disabled. Her spiritual exercises provided
regular positive reinforcement of acceptable social
behaviour.
In short, sources tell us that Hildegard manifested
many of the traits listed in DSM-IV TR’s criteria for an
ASD diagnosis and that as an adult she lived in an
environment similar to that which modern clinicians
create to treat ASD.
It is not implied here that medieval religious were all
autistic or that monasteries were disguised treatment
centres for the socially disabled. Monasticism is a spir-
itual institution created to achieve spiritual goals.
Nevertheless, human institutions can and do fulfil a
multitude of secondary functions and still remain
viable so long as the primary purpose is not forgotten.
Medieval monasticism, however unwittingly, was well
suited for fulfilling the secondary function of integrat-
ing a spectrum of behavioural phenotypes into its life.
Much as the process of mainstreaming ASD individuals
in today’s schools is leading many to high-functioning,
independent lives, so might medieval ASD individuals
have been mainstreamed in monasteries with similar
results. Modern schools were not originally intended
to treat behavioural disorders but are doing so with
great success. Monasticism was not constructed inten-
tionally to treat behavioural disorders but it was par-
ticularly well-suited to do so. Such a thesis of secondary
function is hardly revolutionary. Historians have long
recognized that monasteries often fulfilled non-spiritual
functions (for example, providing an alternative to
unwanted marriage or pregnancies or for ‘excess’ nobil-
ity) while still remaining viable spiritual institutions. In
Hildegard we have an example of an individual who
suffered various behavioural problems while young
and yet, through ‘treatment’ and neuroplasticity,
found her niche within a highly structured, focused
community.
The proposal here is compatible with traditional
interpretations of Hildegard’s life and with current
interpretations of medieval monasticism. The thesis
114
does not in any way diminish Hildegard’s accomplish-
ments. Hildegard is an example of an individual who
reached her full potential despite her early problems. 19.
What those problems were can never be identified reli-
20.
ably. Such is the dilemma of history – and of ASD.
21.
Nevertheless, the sources do give us much food for 22.
thought.
References and notes 23.
1. Kanner L. Autistic disturbances of affective contact. 24.
Nervous Child 1943; 2: 217–250; Frith U. Autism and 25.
Asperger syndrome. Cambridge: Cambridge University
Press, 1991; and Wing L. Kanner’s syndrome: a historical
perspective. In: Wing L (ed.) Early childhood autism.
26.
Oxford: Pergammon Press, 1976, pp.3–14.
27.
2. American Psychiatric Association. Diagnostic and statis-
28.
tical manual of disorders, text revision. 4th ed.
Washington, DC: American Psychiatric Association,
2000 [hereafter DSM-IV TR]; Filipek P, et al. The screen-
ing and diagnosis of autism spectrum disorders. Journal
29.
of Autism and Developmental Disorders 1999; 29: 439–484;
30.
and Filipek P, et al. Practice parameter: screening and
31.
diagnosis of autism. Neurology 2000; 55: 468–479. 32.
3. Hozeski B. The book of the rewards of life. New York:
Oxford University Press, 1994, pp.9–10; Baird J and
Erhmann R (transl.) The letters of Hildegard of Bingen. 33.
Oxford: Oxford University Press, 1994–2004 [hereafter
Letters]; and Hart C and Bishop J (transl.) Scivias. New 34.
York: Paulist Press, 1990. A collection of sources, includ- 35.
ing ‘Vita domnae Juttae inclusae’ [hereafter VJ], ‘Vita 36.
Sanctae Hildegardis,’ [hereafter VSH], and Guibert of 37.
Gembloux’s biographical letter, are found in Silvas A,
tr. Jutta and Hildegard: The Biographical Sources.
University Park: Pennsylvania State University Press,
1998. 38.
4. Letter 38, in Jutta, pp.103–104.
5. Ibid 107. Some hagiography offers physical suffering as
proof of sanctity but here the parents’ worry is about
possible physical danger, not a statement about actual
suffering.
6. Acta Inquisitionis, in Jutta, pp.103–104.
7. VSH 1:1, in Jutta, p.138.
8. Dronke P. Women writers of the middle ages. Cambridge:
Cambridge University Press, 2001, p.147.
9. Guibert, Letter 38.3; 38:13; VSH 1:8; 2:2; 2:3; 2:5; 2:8;
2:9; 2:10; in Jutta, 103–104; 115; 150; 158; 159; 165; 170;
214; 224; 225; 227; and 229. 39.
10. VSH 2:2, in ibid, p.158. 40.
11. VSH 1:8, in ibid, p.150.
12. VSH 2:2, in ibid, p.159.
13. Letter 38, in Jutta, p.115. 41.
14. VSH 1:2, in ibid, p.140. 42.
15. VSH 2:2, in ibid, p.159. 43.
16. VSH 2:2, in ibid, pp.159–160.
17. VSH 2:2, in ibid, p.160. 44.
18. Some think this is a description of migraines. See Flanagan 45.
S. Hildegard of Bingen, 1098–1179. London: Routledge,
Journal of Medical Biography 22(2)
1998, pp.199–211; and Sachs O. Migraines. Berkeley:
University of California Press, 1985, pp.106–108.
Yapko D. Understanding autism spectrum disorders.
London: Jessica Kingsley, 2003.
ibid, p.52.
Letter 38, in Jutta, p.114.
Letter 103r, in Letters, 2:23. For medieval understanding
of vision and visionary knowledge, see Ranft P. Women
in western intellectual culture, 600–1500. New York:
Palgrave Macmillan, 2002, pp.55–56.
Scivias, pp.59–60.
Letter 103r, in Letters, 2:23.
Wetherby A, Prizant B and Schuler A. Understanding the
nature of communication and language impairments.
In: Wetherby A and Prizant B (eds) Autism spectrum dis-
orders. Baltimore: Paul H. Brookes, 2001, p.121.
Letter 38, in Jutta, p.115.
Letter 103r, in Letters, 2:23.
Letter 38, in Jutta, p.116. Her unpolished writing was not
due solely to her Latin: ‘‘The things I write are expressed
in unpolished Latin, for that is the way I hear them in my
vision’’.
Letter 103r, in Letters, 2:33.
Dronke, Women writers, p.146.
ibid, pp.146–147.
Dronke, ibid, p.200, also recognizes a disability: ‘‘Despite
her constant illness – or perhaps because of it, in that it
impelled her to concentrate . . .’’.
Quoted in Baron-Cohen S. The essential difference.
London: Penguin, 2004, pp.168–169.
See ibid, pp.160–169.
Letter 38, in Jutta, p.104.
Letter 38, in ibid, p.107.
Some ASD individuals develop echolalia, and chanting
the Office could function as short-term therapy for this;
it forces one to recite the next line but does it within a
repetitious cycle.
Wetherby. Understanding, p.121; and Dawson G and
Osterling J. Early intervention in autism. In Guralnick
M (ed.) The effectiveness of early intervention.
Baltimore: Paul H. Brookes, 1997, pp.307–326, identify
these characteristics of effective programs: (1) imitation
of others; (2) use of language; (3) appropriate play; (4)
appropriate social interactions; (5) low staff-to-subject
ratio; (6) structured classrooms; (7) visual clues for tran-
sitions between activities; (8) visual clues to define expect-
ations; (9) functional approach to problem behaviours;
and (10) focus on communication skills. These are also
present in monasticism.
VJ, 5–6, in Jutta, pp.71–76.
Jutta had her own peculiarities; she read silently in an age
where oral recitation was the norm (ibid, 4, in Jutta, p.71)
and she had a prodigious memory (ibid, 2, in Jutta, p.67).
Letter 38, in Jutta, p.111.
Letter 38, in ibid, p.112.
VSH, 1:6, in Jutta, p.146. Such repetitive motion is a
particularly vivid description of ASD behaviour.
Letter 75, in Letters, 1:163.
Wittenstein L. Our knowledge of the external world.
Chicago: Open Court, 1929, p.42.
Tsoucalas et al. Queen Cleopatra and the other ‘Cleopatras’ 115

46. Letter 8, in Letters, 1:43.
47. Schnapp J. Virgin words: Hildegard of Bingen’s Lingua
ignota and the development of imaginary languages
ancient to modern. Exemplaria 1991; 3: 272–273.
48. Dronke. Women writers. p.194: ‘‘Here, late in life, we see
how Hildegard had acquired the power to construct com-
plex, fluent, and fluid sentences, apparently quite
unaided’’.
49. Ranft P. How the Doctrine of The Incarnation shaped
western culture. Lanham, MD: Rowan, Littlefield, 2012.
50. Dronke. Women writers, p.171.
51. Glaze F. Medical writer. In: Newman B (ed.) Voice of the
living light. Berkeley: University of California Press, 1990,
p.135.
52. Grafma J, Christen Y (ed.) Neuronal plasticity. New
York: Springer, 1999; and Filogano G (ed.) Brain plasti-
city. New York: Plenum Press, 1997.
53. Baron-Cohen. Essential difference, p.163.
54. Quotes: Acta Inquisitionis, 6, 3, 4, 10, in Jutta, pp.261–
266. The most frequent problems cured were demonic
possession and epilepsy; eight witnesses testify to
Hildegard’s cure of ‘many’ parsons with epilepsy; 25–
33% of ASD children develop seizures. See Deykin E
and MacMahon G. The incidence of seizures among chil-
dren with autism. American Journal of Psychiatry 1979;
136: 1310–1311.
55. Berger M. On natural philosophy: selections from cause et
cure. Rochester, NY: DS Brewer, 1999, pp.56–65, where
she tells us a fiery light ‘‘permeated my whole brain’’ and
then ‘‘inflamed my whole heart and my whole breast.’’
There are also an inordinate number of words for head in
lingua ignota.
56. VSH, 22, in Jutta, p.203.
57. Letter 27r, in Letters, 1:91.
58. VSH, 22, 26, in Jutta, pp.205, 208.

Author biography
Patricia Ranft is Emeritus Professor of History at Central Michigan University. She is the author of four books on
medieval women and numerous other books and articles. Her latest books, How the Doctrine of the Incarnation
Shaped Western Culture and The Theology of Peter Damian, were published in 2012.

Journal of Medical Biography

22(2) 115–121

Queen Cleopatra and the other ! The Author(s) 2014

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‘Cleopatras’: their medical legacy DOI: 10.1177/0967772013480602
jmb.sagepub.com

Gregory Tsoucalas, Antonis A Kousoulis,

Effie Poulakou-Rebelakou, Marianna Karamanou,
Maria Papagrigoriou-Theodoridou and George Androutsos

Abstract
Cleopatra is a female figure widespread in Greece (especially in Macedonian territory), Egypt and Syria during the
Hellenistic era. Ancient women doctors bearing the name Cleopatra have been identified by a systematic search through
the ancient Greek, Latin and Egyptian bibliography, including original resources from the first century BC. Fictional and
non-fictional figures have been distinguished and their works identified. Queen Cleopatra of Egypt, Galen’s physician
assistant, the outcast Metrodora, Cleopatra the Alchemist and Cleopatra the Gynaecologist deliver a story of medicine
and name-giving that confuses researchers of the past and intrigues those of the present.

Keywords
Cleopatra, Metrodora, Galen, Aëtius, Tzetes, Trotula, Egypt

University of Athens, Greece

Introduction Corresponding author:

Antonis A Kousoulis, 131 Lambrou Katsoni str, Moschato, Athens,18344,
Cleopatra is a female figure widespread in various Greece.
areas, especially including Egypt, Greece (mostly in Email: antonis.kousoulis@gmail.com