Medically Modified Eyes: A Baptismal Cataract Surgery in Clement of Alexandria

In her influential book, Making Christians, Denise Buell challenges traditional scholarship on Clement of Alexandria by exploring the rhetoric of kinship and procreation metaphors as they relate to Christian identity.¹ While she examines the gendered rhetoric of these metaphors, Buell downplays their medical background: “Clement's primary metaphor for the procreative act cannot be traced directly to either Hippokratic or Aristotelian texts. Neither of these sources offers a precedent for describing the very act of procreation as analogous with the sowing of seed into a field/soil.”² More recently, however, scholars have begun to note the significance of Clement's medical references in his text:³ a move that parallels the shift occurring in scholarship on medical reasoning in late ancient Christianity more broadly.⁴ 

Matthew Chalmers, for example, has grounded his exploration of medical terminology in Clement's writings in the revivification of the work of Herophilus and Eristratus in the second century C.E.⁵ More directly, Jacqueline Lagrée has proposed a “medical model” that underlies Clement's writings.⁶ In particular, Lagrée writes that the benefit of the medical model “lies in articulating harmoniously both the individual's different faculties—body and soul—and developing the powers that are specific to him as man.”⁷ The medical model, in other words, provides the perfect metaphor to blur the line between the corporeal and the spiritual. Further, Lagrée argues, the medical model offers a counterpoint to sophistic rhetoric: “Rhetoric claims to determine the values of social life and provide the means to excel in the community's life, while medicine seeks to treat the individual as a whole and, therefore, proposes a model of wisdom that is in competition with philosophical wisdom.”⁸ It is this medical model, with its emphasis on bringing together the body and the soul, to which Clement turns in his Paedagogus. Clement explains that the Word is both the Healer and the Educator:

This emphasis on the whole creature and healing both body and soul is significant. Clement is using the medical model as a metaphor for salvation, but he is also using the conceptual field of the body to describe an identical process that happens to the soul. Throughout Paedagogus, Clement explains that each person is ill and in need of a doctor (1.9.83), is blind (1.9.83), and cannot learn until she has been cured (1.1.3). The Word is that doctor who heals and counsels (1.1.1), cures passions (1.1.1), and offers the nourishing medicine of His counsel (1.1.3, 1.2.6). In Protrepticus 1.8.2, Clement writes, “The Logos is like a good doctor who covers some sick bodies with plaster, scrapes or bathes others, opens them by iron, burns them, sometimes amputates with the saw when it is still possible to cure the subject, at least in part, and in one of his members.”¹⁰ In Paedagogus 1.8.62, Clement explains that the Word is the surgeon who must cut out the disease of the passions from the soul.

It is this last metaphor, that of the divine surgeon, that I will examine more fully in what follows. More specifically, I will explore Clement's metaphor of the divine ophthalmologist who must perform the cataract surgery of baptism that enables the percipient to see and to know God.¹¹ By engaging a medical metaphor for baptism, Clement blurs the line between the physical and the spiritual, drawing from the source-domain of the physical eye of the body to describe the target domain of the spiritual eye of the soul.¹² This metaphor was not merely a way of describing an otherwise ineffable process, but it also offered Clement a rich source for his rhetoric of defining and producing difference in a material way.¹³ With its close link to epistemology and to the transformation of the beholder, this medical metaphor allows Clement to describe the baptized Christian as fundamentally different, and as part of an elite group that can see and know God.

In my first section, I focus on the visual component of Clement's metaphor of baptism as a cataract surgery. In this section, I offer background on the connection between vision and epistemology, showing that Clement links knowledge of God to vision or blindness of the eye of the soul, drawing from an Epicurean theory of visual perception and epistemology. I also demonstrate that prior to the cataract surgery of baptism, according to Clement, a person was in a state of darkness, ignorance, or blindness, though she received the divine effluence or seed of salvation that was available to all. In the second section, I return to the theme of cataract surgery, exploring the history of cataract surgery to show that this medical metaphor enables Clement to describe Christians as part of a small group that has been transformed by the divine ophthalmologist. In the third section, I explore the nature of the medical modification that occurs through the surgery. Because the natural state of the eye of the soul was blinded by a cataract, such a person was likely to focus instead on the eye of the body, falling into the trap of Narcissus. It is only through the transformation of cataract surgery that one's eye of the soul becomes open to the divine light, changing the very nature of one's vision from intromission to extramission. This is not a return to a former state, but a shift to a radically different and deified state, enabling Clement to describe and define Christian difference and identity in terms of the medically modified eyes: only the baptized Christian has the transformed vision capable of seeing and knowing the divine.

In Paedagogus 1.6.29, Clement writes, “Ignorance is darkness, for it makes us fall into sin and lose the ability to see the truth clearly. But knowledge is light, for it dispels the darkness of ignorance and endows us with keenness of vision.”¹⁴ The Greek here is significant. Darkness causes one to become ἀμβλυωποῦντες, dim-sighted, concerning truth, while light makes one διορατικὸν, clear-sighted. Even worse, Clement explains, are “the worldly wise who, believing themselves wise, have blinded their own eyes.”¹⁵ The natural state of a person, according to Clement, is one of darkness, ignorance, and dim-sightedness or even blindness. This state requires knowledge and light to bestow clear-sightedness.

Light and dark have been metaphors for knowledge and ignorance at least as far back as the pre-Socratic philosopher Parmenides in the fifth century B.C.E.¹⁶ For Clement, darkness is not merely the lack of sensory input, but the lack of cognitive action: ignorance is darkness. Light, on the other hand, provides illumination of the mind, allowing cognition to take place. Linked to mental activity, light represents knowledge. Modern English continues the trend of rhetorically pairing the concepts seeing and knowing, and this is most evident through colloquialisms such as the common “I see what you mean.” These linguistic pairings of sight and knowledge permeate our language to the extent that they have become inert metaphors, mere remnants of a scientific belief long since gone.¹⁷ In the world of Late Antiquity, however, visual metaphors were living, tied closely to a material understanding of the world and the correspondingly tactile nature of sight.¹⁸ At its most basic level, ancient theories of visual perception fall into two broad categories: intromission and extramission.¹⁹ The theory of intromission held that every object emits tiny films, εἴδωλα, ἀπόρροια, or simulacra, that fly through the air and impress upon a person's eyes or sometimes also into their minds.²⁰ The theory of extramission, sometimes called the visual ray theory, held that some sort of visual ray extended from the eye to the object, touching the object and transmitting the image back to the eye.²¹ Both views shared the assumption that sight, and the knowledge gleaned therefrom, occurs through tactile means, though each theory has different consequences on the reliability of such knowledge and its effect on the viewer.

This tactile process and its link to epistemology is crucial background to understand the visual component of Clement's metaphor of baptism. Continuing in Paedagogus 1.6.29, Clement writes, “The quickest way to loose those bonds [of ignorance] is to make use of man's faith, and God's grace, for sins are forgiven through the one divine remedy, baptism in the Word.”²² This divine remedy (παιωνίῳ φαρμάκῳ) of baptism is the medicine that can take a person from the state of dim-sighted ignorance to that of clear-sighted knowledge.

Not only does Clement describe the outcome of baptism in visual terms, but he also engages a direct visual and medical metaphor to describe the process of baptism. The key passage is Paedagogus 1.6.28 in which Clement begins by describing the state of the sinful person before baptism:

This impediment, Clement explains, prevents the person from receiving external light, and the person has no light within. This passage offers our first hint at Clement's theory of visual perception.

Clement also describes this lack of an internal light in Paedagogus 3.11.70 as well, where he addresses Matthew 6:22, which reads: “The eye is the lamp of the body. So, if your eye is healthy, your whole body will be full of light” (NRSV).²⁴ This Matthean verse is often used to describe a theory of extramission in which the eye contains a kind of fire that extends from the eye as a ray, enabling the person to see.²⁵ Clement, however, reinterprets this verse through the lens of intromission. In describing the eye in Matthew 6:22, Clement writes, “what is inside is illuminated and made visible by the light that shines through it.”²⁶ In other words, the eye is like a doorway that allows the interior to be illumined by the exterior shining light. Though, as we saw in Clement's metaphor for baptism, the pre-baptized state is one of darkness, ignorance, and dim-sightedness. Thus, the doorway is closed to that external light, “like those suffering from some blinding eye-disease who… must first remove the impediment from their eyes before they can have clear vision.”²⁷ 

The phrase eye of the soul is common in Clement, though he varies his terminology with ὄψις ψυχῆς,²⁸ τοῦ ὁρατικοῦ τῆς ψυχῆς,²⁹ and τὸ τῆς ψυχῆς ὄμμα.³⁰ Although the latter, τὸ ὄμμα τῆς ψυχῆς, is common in Plato,³¹ Plato's theory of extramission is not the source from which Clement draws his theory of visual perception.³² Both phrases also appear regularly in Philo,³³ though Clement also departs from Philo regarding his theory of visual perception.³⁴ Philo portrays a middle-Platonic theory of visual perception;³⁵ however, as demonstrated through Clement's interpretation of Matthew 6:22 and in his baptismal metaphor, Clement describes a theory that is most consistent with intromission, popularized by Epicurus.³⁶ Indeed, much has been written on Clement's reliance on Epicureanism for his theory of epistemology, in general,³⁷ and Epicurus's theory of conception formation, in particular.³⁸ 

As noted above, the theory of intromission posits that every object emits tiny films (εἴδωλα, ἀπόρροια, or simulacra) that enter a person's eyes or sometimes also their minds.³⁹ In Herodotus 49, Epicurus describes a stream of εἴδωλα that enters either the eyes or the mind, according to their size.⁴⁰ Larger εἴδωλα of visible bodies enter the eye of the body, but smaller dianoetic εἴδωλα of invisible bodies enter the eye of the mind. This eye of the mind, for Epicurus, is a sensory organ that functions in parallel to the eye of the body.⁴¹ For example, in Fragment U353, Sextus Empiricus explains that Epicurus thinks that εἴδωλα of the gods come to a person while she sleeps and allow that person to form an idea of divine.⁴² These smaller, invisible dianoetic εἴδωλα are physical and enter the eye of the mind in the same way that larger εἴδωλα enter the eye of the body.

Based on his use of Epicurean sensory perception, it follows that Clement's eye of the soul functions as a sensory organ much like Epicurus’ eye of the mind that receives dianoetic εἴδωλα. In Paedagogus 1.63.37, Clement writes of knowledge and vision of God, quoting 1 Corinthians 2:9.⁴³ Clement, however, changes the phrase καὶ ἐπὶ καρδίαν ἀνθρώπου οὐκ ἀνέβη to ἐπὶ νοῦν ἀνθρώπου [οὐκ] ἀνέβη.⁴⁴ In other words, he has changed the location: knowledge of God, according to Clement, directly enters one's mind rather than one's heart. This distinction may seem subtle, but it lends further credence to the idea that Clement is describing an Epicurean process for knowledge of God.

An Epicurean process for knowledge of God helps to explain Clement's writing in the Stromateis: “Hence, the apostle says, ‘Now we see as through a mirror, but then face to face’ by those sole, pure, and incorporeal contacts of the intellect (τῆς διανοίας ἐπιβολάς).”⁴⁵ Raoul Mortley points out that this phrase, τῆς διανοίας ἐπιβολάς, is a technical term of Epicurean epistemology found in Diogenes Laertius to describe a criterion of certainty.⁴⁶ Thus, Clement describes knowledge of God in Epicurean terms in which the eye of the soul tangibly encounters the divine.⁴⁷ 

However, this enlightenment happens only after the “cataract surgery” of baptism. Prior to baptism, Clement describes the eye of the soul as one of darkness, ignorance, and dim-sightedness or even blindness. Indeed, it seems that, before baptism, a person can hardly use the eye of the soul at all, though there is some glimmer of hope. Writing about bringing truth down from the holy mountain of God, Clement writes, “Let truth, sending forth her rays of light into the farthest distance, shine everywhere upon those who are wallowing in darkness.”⁴⁸ As God shines the light onto all who are wallowing in darkness, some divine effluence enters those who are baptized or not. In fact, when writing of the partial truth that can be found in philosophers such as Plato, Clement describes a hint of that light: “Well done, Plato, you have hit the truth. But do not give up. Join me in the search for the good. For there is a certain divine effluence instilled into all men without exception, but especially into those who spend their lives in thought.”⁴⁹ 

This divine effluence (ἀπόρροια θεϊκή) is precisely the same term Empedocles, fifth-century B.C.E. philosopher, offers for his effluence: ἀπόρροια. Some label Empedocles a quasi-atomist, though he did not separate the world simply into atoms and void, as did the traditional atomists like Leucippus.⁵⁰ Instead, Empedocles explained that every body in the world was made up of the four elements of fire, water, earth, and air, as well as the two powers of strife (the principle of separation) and love (the principle of union).⁵¹ From Alcmaeon, Empedocles appropriated the idea that the body is made up pores (πόροι) that serve as channels that transmit sensation to the brain.⁵² Every object emits effluences that enter into pores for sense-perception.⁵³ 

In other words, just as Epicurus posited that the gods emitted divine dianoetic εἴδωλα that enter a person's mind and grant her an idea of the gods, so also Clement suggests that God emits divine effluence (ἀπόρροια), and these incorporeal contacts of the intellect (τῆς διανοίας ἐπιβολάς) grant each person a bit of the truth, though full knowledge is only available once the cataract has been removed from the eye of the soul. In this way, when Clement describes the world as filled with the seed of salvation (τὴν γῆν σωτηρίου σπέρματος),⁵⁴ he is referring to a physical process by which divine particles enter into the eye of the soul. This metaphor is so prevalent in Clement that Salvatore Lilla has traced Clement's use of the picture of the shower by which “God inspired the philosophers by dropping particles of the Logos into their minds.”⁵⁵ 

Although each person has received a bit of the divine effluence in his or her eye of the soul, Clement cautions against those who attend too much to the eye of the body. Clement describes those who trusted their sight and then began to worship the sun and moon.⁵⁶ Others, Clement warns, can become beguiled by art, as he recounts the tale of a man so in love with a statue that he had intercourse with the marble.⁵⁷ In each of these cases, Clement describes a misuse of the eye of the body that may result in the same fate as that of Narcissus: “It did the handsome Narcissus no good to gaze on his own image, as the Greek myth tells us.”⁵⁸ On the contrary, those who focus instead on the eye of the soul may contemplate the divine.⁵⁹ 

Clement encourages his readers instead to direct their gazes towards the divine light.⁶⁰ Clement writes, “but in our view the image of God is not an object of sense made from matter perceived by the senses, but a mental object. God, that is, the only true God, is perceived not by the senses but by the mind.”⁶¹ Clement here distinguishes between αἰσθητός (a sensory perceptible object) and νοητός (a mental object). God is not perceived by the eye of the body but is instead perceived by the eye of the mind. However, one cannot make full use of the eye of the mind on her own, but she must rely on the divine surgeon to perform the medical modification described by the baptismal metaphor. In Paedagogus 1.6.28, Clement reminds his readers that in the pre-baptized state, the eye of the soul is covered by an impediment that prevents one from seeing or making contact with the divine. Thus, we return to the medical metaphor of the divine surgery to remove this impediment.

The concept of an impediment in the eye first brings to mind the injunction in Matthew 7:5 and Luke 6:42 to remove the plank from one's own eye before removing the speck from the eye of one's brother. Although it is possible that Clement had these verses in mind, his linguistic choices are significant, leading me to believe that he was influenced by medical sources as well. Rather than using δόκος, as in Matthew and Luke's description of the impediment, Clement uses the phrase τὸ ὑπόχυμα τῶν ὀφθαλμῶν, a medical phrase used by Galen to refer to a cataract of the eye.⁶² In doing so, Clement draws from the source domain of eye-diseases to describe the target domain of what happens to one's soul in baptism. In this section, I will explore the source domain behind the metaphor to better understand Clement's meaning.

Although the term cataract (cataracta, καταρράκτης) was not recorded until 1070 C.E.,⁶³ the disease and its attempted cures had been well documented long before.⁶⁴ Celsus describes the formation of cataracts: “a humour forms… as it gradually hardens is an obstacle to the visual power within.”⁶⁵ Pedanius Dioscorides lists 26 potential remedies for cataracts in De materia medica, ranging from eighteen different herbal remedies to a mixture of fried mussels and honey.⁶⁶ By far, the most commonly described solution for cataracts is usually termed couching from the French word coucher, which means “to lie down.”⁶⁷ In couching, one uses a needle to move the cataract out of the way of vision, allowing gravity to pull the cataract down in the eye as if it were lying (coucher). Galen describes this method, explaining that the full removal of cataracts was impossible, however one might change their position,⁶⁸ preventing the cataract from blocking a person's vision.⁶⁹ 

Aelian points to the behavior of goats as the source of humans’ knowledge for this surgery: “When the Goat perceives that its sight has become clouded it goes to a bramble and applies its eye to a thorn. The thorn pricks it and the fluid is discharged, but the pupil remains unharmed and the Goat regains its sight without any need of man's skill and manipulation.”⁷⁰ Whatever the method's original source, Celsus offers the best description of this surgery required for “long established” cataracts in De medicina.⁷¹ After some preoperative care, the patient is seated facing the light while restrained by an assistant.⁷² Celsus writes,

As is likely no surprise, such a delicate surgery performed in antiquity was not always successful nor without its dangers.⁷⁴ This is why Celsus recommends waiting for a “long established” cataract, though he cautions that “old age is not favorable for treatment,” and that “vision can be destroyed permanently by a slight movement.”⁷⁵ 

Indeed, couching was neither a common nor safe procedure. Lisa Trentin writes, “This was perhaps the most delicate and dangerous of eye operations in antiquity, since it involved penetration of the interior of the eye.”⁷⁶ Trentin goes on to catalogue the medical and non-medical sources that report accidental eye loss from a botched eye surgery.⁷⁷ Thus, although visual impairment was common in ancient Greek⁷⁸ and Roman⁷⁹ society, the number of people who satisfy Celsus’ requirements for cataract surgery—not too old, but with a long-established cataract—and who also would be willing to risk blindness was a relatively small number.

Despite the risks associated with it, cataract surgery is precisely the metaphor Clement engages to describe baptism: “like those suffering from some blinding eye-disease who… must first remove the impediment from their eyes before they can have clear vision.”⁸⁰ Clement accomplishes several things with the rhetoric of this metaphor. First, the visual rhetoric allows Clement to link the baptism ritual to knowledge of God. Only those who have had the impediment removed from their eyes may see and know God. Second, the medical rhetoric enables Clement to blur the spiritual and the physical, bringing together the whole creature: body and soul. The baptism of the eyes is a dual baptism that links the eye of the body to the eye of the soul. In Excerpta ex Theodoto Clement writes,

By using a medical metaphor, Clement can describe the physical act of baptism as a corresponding spiritual surgery for the eye of the soul. Lastly, by utilizing a metaphor of an uncommon and potentially dangerous surgery, Clement is describing a process that not many people undertake: only those who are young enough, whose cataract is long-established, and who are willing to risk blindness.⁸² This enables Clement to describe the baptized Christian as part of an elite group linked through baptism to perfection and to gnosis.⁸³ By utilizing a metaphor of an uncommon and dangerous surgery, Clement is rhetorically constructing Christian identity in terms of difference: Christians have been fundamentally and materially transformed through the cataract surgery of baptism.

Once a person has had the cataract removed from the eye of the soul, she is no longer the same. Indeed, Clement writes, “This is one grace of enlightenment, that we no longer are in the same state as before we were cleansed.”⁸⁴ In this section, I will turn to the transformation that occurs in the cataract surgery of baptism, highlighting the material nature of that transformation.

In describing the enlightenment that occurs when one removes the impediment from the eye, Clement writes, “This is an admixture of eternal sunlight, giving us the power to see the eternal light. Like indeed attracts like; so it is that what is holy attracts Him who is the source of holiness, who properly speaking is called Light.”⁸⁵ The second half of this quote, “Like indeed attracts like” echoes the Empedoclean expression like by like. The key here is the Empedoclean principle of συμμετρία: every object, as well as every percipient, is a mixture of the four elements, so when an object's effluence enters a person's pores, that effluence is perceived by the corresponding pore: dark by means of watery pores, bright by means of fiery pores, and so on.⁸⁶ This principle is most often described by the shorthand popularized by Theophrastus: “like by like,” meaning that one can only see something external by means of the corresponding element already contained within.⁸⁷ 

This is significant for Clement's baptismal metaphor: “Like indeed attracts like; so it is that what is holy attracts Him who is the source of holiness, who properly speaking is called Light.”⁸⁸ Prior to baptism, according to Clement, a person did not contain internal divine light, and was therefore incapable of seeing or knowing the divine. It is only through this divine cataract surgery of baptism that the impediment is removed from the eye, allowing the external divine light to enter in. Baptism is literally “bathing the mind in light.”⁸⁹ 

This divine light dispels the darkness of ignorance, but it also grants the percipient the power needed to see the divine light. Clement writes,

The external and eternal source of the divine light may now be seen by the means of the divine light now within: like by means of like, or divine light by means of divine light.

This process grants the percipient “spiritual sight which is clear and unimpeded and lightsome,” which means the fundamental nature of one's sight has changed in baptism.⁹¹ Clement implies that baptism combines one's natural vision of intromission with that of deified extramission: “How can we help desiring Him who has made clear the mind that lay buried in darkness, and sharpened the light-bearing eyes… Let us admit the light, that we may admit God. Let us admit the light, and become disciples of the Lord.”⁹² Through baptism, one admits the light, thereby admitting God. In doing so, the person also transforms her eyes into “light-bearing” eyes (φωσφόρα), a term also used by Plato to describe extramissive eyes.⁹³ Thus, according to Clement, a person originally had no internal light and could only receive minimal pieces of truth though the eye of the soul by intromission. After baptism, however, the cataract is removed, divine light enters in and grants the percipient the power to see by means of extramission. Thus, the very nature of vision is changed in this act, and the percipient becomes more like God through these deified eyes.⁹⁴ Once the person receives this power, she can then begin to contemplate truth: “So, let us who are the sons of the true light not shut out that light, but, turning within into ourselves, casting light upon the vision of the inner man, let us contemplate truth itself, welcome its rays and discover with clarity and insight what is the truth of dreams.”⁹⁵ 

The fact that Clement used the eyes to describe this deified transformation of baptism is significant beyond its link to epistemology. Antón Alvar Nuño has traced the physiognomical tradition and its relationship to the saying “the eyes are the mirror of the soul.”⁹⁶ He explains that the evil eye is often associated with a kind of double pupil, so physiognomists claimed to determine a person's character by looking at the eyes: “[This] ocular irregularity is used as a device for social exclusion.”⁹⁷ In other words, the physiognomists used the eyes to mark a person as other. In a similar but inverted fashion, Clement also used an ocular irregularity (light-bearing eyes, φωσφόρα) to describe the baptized Christian as other. However, Clement used this otherness not as a tool of social exclusion, but as an identifier of deified inclusion. The baptized Christian is no longer like the rest of society, but she is now physically transformed through her light-bearing eyes. She is now included into an elite and deified group of baptized and transformed Christians.

Thus, for Clement, baptism is not a return to the initial state of communion with God, but is instead a transformation to a radically different state: a shift from being cut off from the divine light to communion and admixture with that light. Unlike amputation metaphors that may cut a person away from the Christian body,⁹⁸ Clement here describes a kind of surgical procedure necessary to join the Christian body: the removal of a cataract that enables the person to see and to know God.⁹⁹ 

Medical metaphors, in general, allow authors to blur the lines between the corporeal and the spiritual, describing a process that brings together both the body and the soul. By combining the medical with the visual, Clement joins together the eye of the body with the eye of the soul to describe vision and knowledge of God that is transformed through baptism. Through the visual component of this metaphor, Clement links baptism to knowledge of God. Through the medical component, Clement describes the natural state of a person as one of blindness because the eye of the soul is innately covered by a cataract. In this state, one may receive only glimmers of true knowledge in the form of divine effluences. In order to receive true knowledge and have clear vision, however, one must remove the cataract from the eye of the soul in baptism. By utilizing an uncommon and dangerous surgery as his metaphor, Clement describes the baptized Christian as part of a small and elite group of people who are fundamentally and radically different than the rest of humanity through their deified eyes.

Clement is describing and defining Christians in terms of their medically modified eyes. Only the baptized Christian has the cataract removed, allowing the divine light to enter. Only the baptized Christian can fully use her modified vision to see and to know God. In this way, Clement can write, “Away then, away with our forgetfulness of the truth! Let us remove the ignorance and darkness that spreads like a mist over our sight; and let us and get a vision of the true God, first raising to Him this voice of praise, Hail, O Light.’’¹⁰⁰