Perceptions and attitudes concerning individuals with disabilities in ancient Greece : physical exercise as a means of prevention and treatment of health-related problems

In the history of human kind in all ethnic groups and communities there have been individuals with physical or mental disabilities. Until the 18th century not only these individuals did not receive any support or care by their community but they were rather treated as inferior with a diminishing way. More or less the same attitude occurs to the ancient Greek world, where old age, limited psychomotor skills and potential disability were perceived as evidence of deprivation of the grace of gods. A minor acknowledgment of individuals with disabilities started from Athens, since there were several benefits introduced on behalf of the disabled for the very first time in the history of human kind. In the ancient times Greeks made use of physical exercise as a mean for therapeutic as well as prevention purposes against various diseases. Thus, a great number of distinguished physicians such as Herodikos and his student Hippocrates recommended physical exercise as the ideal treatment of several health-related problems.


A brief report on the stance and attitude concerning individuals with disabilities in various communities from the antiquity to the 18 th century
Studying the history of the human kind leads to the safe conclusion that there have always been individuals with mental or physical disabilities in all communities and that the attitudes towards people with disabilities would vary depending on the era, the nature of disability (mental or physical) and the cultural values featuring in the society where disabled individuals lived in (De Pauw & Gavron, 1995).
Mainly, those individuals were treated to a greater or a lesser extent in a derogatory manner.Nevertheless, there were certainly some societies that regarded them in a more humane way, whereas other societies were prejudiced against them or they perceived them as subjects of adoration or something divine.
Especially in the societies of the prehistoric times or the ancient times (3000-500 b.C) when prejudice dominated, there was no exception for ✉ stavrianos12@hotmail.gr 1 Aristotle University of Thessaloniki, Faculty of Physical Education and Sport Science, Thessaloniki, Greece individuals with disabilities 1 .A typical example of such prejudices found mainly in the prehistoric times is that in Indian and Asian communities such individuals were left to die so as to improve the quality of the community (De Pauw & Gavron, 1995).Another feature of the prehistoric communities is the piercing of the skulls of individuals with disabilities as a method of treatment.It was then believed that the evil spirits that had occupied the person would exit through the hole that was drilled in the skull leading to their healing (Stasinos, 1991).Overall, it can be said that in the prehistoric period individuals with disabilities were regarded as pariahs, of lower quality and in many cases even cursed and possessed by evil spirits.
In later historic periods, Hippocrates, the father of medicine, was the first to approach disability in a scientific way, claiming that it was not God or demons that harm people but some kind of a disease (Tzouriadou, 1995).Furthermore, during the Hellenic and Roman era, there was the onset of more favorable and humane ideas concerning individuals with disabilities.
In the middle ages of the western world, where prejudices and obsessions were dominant, these individuals with disabilities were again treated with suspicion and rejection.Depending on the nature of disability, they would either be submitted to exorcisms, or tortures, or confined in monasteries or exploited as jokers in the courts of the palaces (Tzouriadou, 1995).Thus, it can be said that until the 18th century, apart from the fact that individuals with disabilities were not receiving any support or care from the societies they lived in, they were actually treated brutally, they were acquainted with rejection, social isolation, or became victims of exploitation (Fotiadou, 2008).

The renaissance and the French revolution create favourable conditions for individuals with disabilities
The Renaissance and the later French Revolution (late 18th century) created, among other things, a favorable atmosphere toward individuals with disabilities, with a transition noticed from fear, prejudice and suspicion to acceptance and determination to educate disabled 1 The term "disability" is general and refers to people who have a reduced or total lack of body and mind skills.According to the World Health Organization (WHO), individuals with disabilities are considered to be all people (De Pauw & Gavron, 1995).It's the same era when people started treating children in a more humane way.Children were rescued and offered care on public expenditure while later as adults they were accommodated and received care in special institutions for the poor (Hewett & Forness, 1974).Thus, during this period individuals with disabilities were institutionalized with limited possibilities, but on the other hand they could also receive education, apart from more severe cases that they were taken over by a philanthropist teacher.Although they were provided with accommodation, nutrition and clothing, the fact that no further treatment concerning their disabilities was supplied accordingly plus that the institutes were situated in the countryside far away from society, shows that society was not yet ready to accept those individuals as functioning members (Carter, Van Andel & Robb, 2011).
The first free-of-charge schools for the deaf and the blind children made their appearance in the late decades of the 18th century.More specifically in the decade of 1760, the first free schools for the deaf commenced their operating in Paris (Ammons & Eickman, 2011).After 1800, this favorable atmosphere and institutionalization of individuals with disabilities would gradually pass from Europe beyond the Atlantic Ocean, to the US with special institutes established from 1818 to 1894 for individuals with mental disabilities alongside with such for the blind and the deaf.
Isolated institutionalization was considered the most effective treatment for those individuals, with those suffering from serious diseases institutionalized for life, while those with milder forms of diseases were considered as eligible and suitable for work according to their potential (Winnick, 2000).Overall, during this period some individuals with disabilities started being more acceptable and comprehensible by organized communities, while at the same time individualized education started to emerge and promoted in isolated environments, though.
persons with a severe disability resulting from physical or mental disabilities.We therefore distinguish between the physically disabled and the mentally disabled.

Results the 19 th and 20 th century period: treatment, education, recreation and sports for individuals with disabilities are organized
In that entire positive atmosphere occurred during the 18th century and the first attempt to educate individuals with disabilities, the first recreational opportunities for individuals with disabilities took place in the early 19th century.Thus, in some hospitals and state institutes, bowling was used for recreational reasons alongside music and other forms of entertainment.Later in the same century, educational and recreational practice outdoors, in the countryside would appear first in Europe and later in the USA, while worth mentioning are the first campuses for children with disabilities created in 1888 (DePauw & Gavron, 1995).
The favorable attitude toward individuals with disabilities started spreading in other sectors, too.So, during the late 19th and early 20th century in some European countries, special education classes were created, with this model later adopted by the U.S.A., with increase of special schools at greater numbers.
On the whole, 20th century according to DePaw & Gavron (1995) was characterized as a period of increased interest in individuals with disabilities especially in the fields of education, psychology and medicine.During the 20thcentury, a transition is also noticed from the medical model of approaching individuals with disabilities to the educational one with integration and acceptance as essential features.Nowadays there is a tendency in the developed countries in favor of inclusion policies of individuals with disabilities in schools, employment and communities (Sherrill, 2004).

Exercise as a means of treatment in several ancient societies
The application of an adapted program of Physical Education corresponding to the specific needs of individuals with disabilities as well as the significant development in the field of sports concerning individuals with disabilities are relatively recent developments.Nevertheless, the use of exercise for therapeutic purposes is not a recent phenomenon (Winnick, 2000).
Therapeutic practice of exercise is found in the ancient world in many societies such as in China (about 2700 B.C.), in the ancient Egyptians, the Greeks and the Indians (DePauw & Gavron, 1995), with specific special exercises developed for patients who suffered from several chronic diseases or musculoskeletal problems.A very few references can be located in international bibliography concerning the use of exercise for therapeutic purposes by the ancient communities with the exception of the ancient Greek world indicative once again of the splendor of the ancient Greek civilization.
Nonetheless, all the civilized societies that tried to promote their health status via exercise extracted their information from the ancient Greek world (Mouratidis, 2007).It is widely known that the acknowledgement of the importance of exercise for the healing of the body was first introduced by the Greeks.The physician called Herodicus was the founder and the first teacher of medicinal exercise while his student Hippocrates who is considered the father of Medicine laid the, undisputed so far, foundations of massage and therapeutic exercise (Eustathianos, 1927).

Stance and attitude of the ancient Greek world toward individuals with disabilities
In the ancient Greek world, social exclusion of those who deviated from normal was granted.In general, old age, limited psychomotor skills and potential disability were evidence of deprivation of the grace of gods (Sahaj, 2011).Furthermore, in the two big state-cities, Athens and Sparta, there was the phenomenon of killing disabled babies and children (Penrose, 2015).An example of the Spartan rough treatment and the emphasis they put on the health of young children is the fact that upon birth the children that were assessed as unhealthy were thrown away from a cleft called Caiadas in mountain Taygetos (Ploutarxos, Parallel Lives.I.16.6).Of course, there are other theories such as that by Freeman suggesting that these children were nurtured by Eilotes (servants in ancient Greece) as if they were their own children (Freeman, 1969).
The Greeks who hoped to occupy distinguished posts and achieve a high hierarchy status in society tried to hide their body imperfections (Sahaj, 2011).It is also believed that ancient Greeks used to exercise naked so that there would be no chance that they could hide anybody flaws and every athlete no matter what sport he competed he used to exercise all the parts of his body for its harmonious growth and avoidance of unpleasant conditions resulting from partial exercise (Mouratidis, 2007).Disapproval of the ancient Greeks toward an ugly and flawed body can be seen on an Athenian vessel of the 6th century which is displayed in the British Museum.On this vessel two very athletic young men are depicted while there is two more standing on the left one of whom is obese and not athletic at all.From their movements it is obvious that the obese man is angry probably because of the sarcastic remarks of the athletes (Mouratidis, 2008).
A slight acknowledgement of individuals with disabilities begins in Athens where Athenian people used to offer a certain amount (3 mnas) to the « weak» as a benefit for not being capable of supporting themselves, also allowing them to be exempted from military duties (Penrose, 2015).In addition to that, Aristotle acknowledged disability by saying "Even though none of us blames the one who was born with disability, nevertheless we do blame those whose ugliness results from negligence and lack of exercise" (Aristotelis, Nicomachean Ethics.III.5.1114a).Generally, if a person with disability was somehow accepted, that would entail that he had some special skills.A typical example is Perikles who despite the fact that he had a big and long head, which was disproportionally big compared to his body, he managed to govern Athens.That is the main reason why Pericles in almost all his portraits or statues appears wearing a helmet on his head in an attempt of the artists to protect him appearing ridiculous.Another example is the famous orator and politician Demosthenes, who although he had a speech problem, he managed to become one of the most important orators in Greece.Demosthenes is considered the father of logotherapy, since he managed to correct his speaking skills walking along the seaside and delivering speeches with his mouth full with pebbles (Sahaj, 2011).

The ancient Greeks use exercise as a means of promotion of the "Kaloskagathos" (citizen with a beautiful body and kind spirit), but also as a means of healing of physical and mental diseases.
Exercise in the ancient Greek world played an important role, since the main objective of the Greek education was the development of citizens with beautiful, athletic bodies and kind spirits (kalokagathia).This means that they wanted to have citizens with harmonious and symmetrical growth in body and mind, that is, in good shape physically and mentally.The importance of exercise for the ancient Greeks can be clearly seen in the recommendation which Socrates made to a young man called Epigenis, who in case he neglected his body and his physical education would run the danger of getting killed in battle or being captured during retreat (Ksenofon, Memorabilia.III.12.1); while to another young man is sharing this conversation with him who also had neglected his body Socrates stated that he needs to bear always in mind and not forget the nasty results of abstinence from exercise such as loss of memory, bad character, as well as loss of sense which makes every spiritual pursuit impossible (Ksenofon,. The Greeks, apart from using exercise as an important part of general education, they used exercise for therapeutic purposes as well.If we go back to the classic Hellenic eras, we will realize that the educator (called paedotrivis) and the gymnast (the teacher of physical education) used to cooperate with the physician for the prevention and treatment of several diseases, something that is confirmed by the great philosophers Aristotle and Plato.Aristotle indeed claims that due to scientific thinking two scientific arts emerged concerning the human body and health, that is, medicine and exercise (Kaimakamis, 2005).Moreover, he also mentioned chorotherapy (dance therapy) claiming that with the Bakchikoi dances (Vakhikoi) seizures of depression can be overcome and individuals through cleansing can get rid of their painful experiences.In the ancient Greek world, a lot of famous and distinguished doctors recommend a variety of fundamental exercises of gymnastics as means of restoration from several musculoskeletal diseases (Mavrovouniotis, Malkogeorgos & Argiriadou, 2006).
Kinesiotherapy was also widely known in Greece.Its proponents were great geniuses of those times such as Plato and Hippocrates.Hippocrates`s teacher, Herodicus, one of the greatest Greek doctors was the first to recommend physical exercise for various diseases.His student, Hippocrates also recognized the therapeutic importance of exercise and he was a major proponent of hiking, walking and running for prevention and healing purposes (Sahaj, 2011).Xenophon, Dion Chryssostomos and others also refer to the usefulness of exercise and its use in the treatment of many diseases (Mouratidis, 2007).Thus, coexistence of medicine and exercise are found in "Peri Diaitis" (About Diet) by Hippocrates, in "Hygienic Logous" (Healthy Speeches) by Galinos, the "Gymnastiko" (Exercise) by Philostratos and many other works by doctors who dealt with healing of the mind or body.

Galinos, for example, writes in his Healthy
Speeches about kinesiotherapy: "One needs to go through a therapeutic exercise (gymnasion) during which, movements should be made in a symmetrical way in terms of quantity, slower in terms of quality (at a lower degree) and with many intervals in between, while relieving rubbing is necessary during these intervals" (Galinos, Healthy Speeches.III.6).The same doctor in the "Healthy Speeches" refers to the relation between exercise and mental health, stating that unpleasant conditions of the soul and the body such as sadness, insomnia, anger, systematic wine drinking, venereal diseases and many cutaneous diseases can be healed by rubbing, ointment application and special physical exercises (Galinos,Healthy Speeches. I.6).He also refers to a specialist, a physical tutor called Theontas, whose description reminds us of the modern experts in sports and exercise physiology and experts in therapeutic exercise, specialized in training and rehabilitation, recommending a variety of horizontal bar exercises for the restoration of certain musculoskeletal problems (Galinos,Healthy Speeches. II.71).
Hippocrates believed that the part of physical effort related to maintenance of good health and fitness concerns exercise (physical education) whereas the use of exercise for therapeutic purposes concerns medicine.In his written work, he makes use of exercise not only for prevention and maintenance of good health, but also for the restoration of several physical malformations and even for diseases.He further recommends dance, balance exercises and rope walking (walking with gear), as types of exercise that promote good health to its best (Kaimakamis, 2005).In his work "About Diet", for example, he refers to the beneficial effects of walk on the body and their significance in losing fat and maintaining body weight to its normal limits.He also refers to several other forms of exercise and sports such as running, horse riding, wrestling and others, that he also examines in terms of their therapeutic importance for various diseases and their beneficial effect on the correct growth of the human body (Eustathianos, 1927).Finally, he writes that respiratory exercises help the individual to relieve anxiety caused by nightmares while at the same time he analyses how to treat kyphosis explicitly.
Rhuphus the Ephesian, an ancient Greek doctorphilosopher who is also acknowledged by Galinos as a famous and distinguished doctor, lived in the 1 st and early 2 nd century b.C.Kinesiotherapy is for him a therapeutic factor and very useful for the treatment of various diseases, analyzing particularly its contribution to the healing of arthritis (Eustathianos, 1927).
The immediate relation between medicine and exercise, though, is even more obvious from gymnasiums and palestras (wrestling schools) that were close to the Asclepieia, while the priests of god recommended physical exercise to the sick people who sheltered in altars.From signs and inscriptions found in the altar of Asclepius in Epidavros, it is reported that patients who suffered from pains and insomnia were cured after following exercise (Mouratidis, 2007).From all the above mentioned, it is obvious that exercise and participation in sports were perceived as forms of treatment in Asclepieia, recommending walking and running with bare feet, horse riding, spas (probably swimming as well) and passive exercises.There is even reference to some examples of humans that god Asclepius cured using exercise as part of the treatment.
Agesistratus addresses god Asclepius to get a remedy for his migraines, toughing him a particular movement from pangration sport as part of the treatment.
Additionally, Hermodicus from Lampsakos, cured his own physical weakness after god Asclepius` s instruction to start weight lifting and finally Aristeides reports that he was cured from several disorders by visiting Asclepieia and using physical exercise as a basic means of the healing process (Kilby, 1979).
There are even more examples of ancient Greek athletes who took up exercise for therapeutic purposes in the first place and ended up being champions, highlighting the great importance of exercise in the ancient Greek world.As a first example, Pyron from Helida achieved a victory in Olympia and came second in the Nemea events, although in his childhood he suffered from dystrophy before he started to compete in Pentathlon so as to reinforce his immune system and cure himself (Sahaj, 2011).Another example relates to Mys the Egyptian who took up exercise to cure the atrophy of his arm and eventually became a great wrestler.Even Stratonas from Alexandreia used exercise to cure a serious disease of his spleen and managed to become an Olympic medallist at the 178 th Olympiad of 68 b.C (Giatsis, 2006).Plato also states that Herodicus from Syllmbria became a good gymnast due to his disease which made him combine medicine with exercise (Giatsis, 2006).All these cases do not differ from current reality.The careers of the Paralympic athletes begin in a similar way.Usually everything starts with a disease or a disability; the athletes start initially with treatment and restoration and they gradually enter the training process and following succession in restoring their motor skills on the sport of their choice, they often enter international competitions.The relationship of exercise and medicine continued its existence following the antiquity of the Greek world, since Christian leaders in East and West agreed participation to exercise that is related to better health.In this way, many ancient world practices were preserved in Byzantium as well as in the modern era (Giatsis, 2006).

Conclusion
Since the dawn of the world in all human societies, individuals with disabilities were always present, who, to a lesser or greater extent, were considered pariahs, people of lower quality and in many cases as they were cursed and dominated by evil.Negative attitudes toward these individuals started to change during the Renaissance and French Revolution period when a slight acceptance, education, treatment and recreation of those people took place for the first time.During the 19th and the 20th century -mainly after the second half of the 20th century -special classes including special treatment, education, recreation and sports were founded and their number rapidly increased.
The ancient Greek world, to a lesser or greater degree, expressed a repulsion against disability and generally against the ugly and lacking of fitness body.Hippocrates was the first to approach disability in a scientific way, supporting that physical or mental disorders are caused by certain diseases and not punishment by gods.Thus, Hippocrates himself as well as other eminent physicians began using exercise as a means of prevention and treatment of several physical or mental diseases.This practice was also identified in Asclepieia where priests regarded exercise as a fundamental part of the treatment of patients.
Overall, one might claim that the ancient Greeks were the first who got sensitized toward disability and analyze relative disability conditions in a scientific way, laying for the first time the foundations of therapeutic exercise.