The first book opens with verse in which Boethius, accompanied by the Muses (the inspiring geniuses of poetry), expresses deep sadness at his misfortune and imprisonment.

The narrative changes to prose as Boethius notices a majestic woman standing near his bed. She is the personification of Philosophy. Philosophy commands the Muses—“these hysterical sluts” (4)—to go away, insisting that only her philosophical medicine can bring healing to Boethius. 

Philosophy tells Boethius that the “cloud of worldly concern” (6) has led him to forget his philosophical background and learning. She dries his tears to help him recognize her identity.

Boethius recognizes Philosophy, whom he describes as “my nurse in whose house I had been cared for since my youth” (7). Philosophy answers that she will stand by him in his hardships, which have been caused by hatred for her name. She recalls that such revered philosophers as Socrates were also persecuted, and that later the Stoic and Epicurean philosophers carried off bits and pieces of the Socratic heritage, thus gaining a false reputation for wisdom.