The History of Melancholy

By Francis Zimmerman

Francis Zimmermann holds the chair of South Asian Anthropology & the History of Science, at the School for Advanced Studies in the Social Sciences, Paris. He lectured at the University of Michigan on December 16, 1994, on universals in the scholarly traditions of medicine; the event was co-sponsored by the Working Group on Health of the International Institute & the Center for South & Southeast Asian Studies.

Even if the medical concepts involved appear to be completely obsolete, the history of melancholy is of interest to a modern audience for at least two reasons.

Melancholia was one of the cardinal forms of madness in earlier times & its name & concept encapsulate the whole history of humoralism, since melancholia is black bile, one of the peccant humors recognized in Hippocratic & Galenic medicine that have counterparts in the classical system of Ayurvedic medicine in India.

A study of humoral medicine that would be respectful of classical phrasings, philosophical tenets & technical concepts of scholarly medicine, might help the modern anthropologist & epistemologist of medicine to elaborate upon concepts currently in use, like somatization, illness as a culturally constructed experience of disease, etc., which have never been grounded on any knowledge of medical history.

The history of melancholy is also important to understand the recent developments of cultural psychology.

My first encounter w/melancholy was, as a South Asianist, in my research on Ayurvedic psychiatry. I've been attempting to make sense of the alleged relationship between the torments of Love, Grief & Fear & the vitiation of pneuma & other vital fluids in the body.

Earlier reflections published in The Discourse on Remedies in the Land of Spices (Le Discours des Remedes au Pays des Epices, Paris 1989; English version, Berkeley, forthcoming from the University of California Press) have been followed by a study of patterns common to the Galenic & Ayurvedia Scholarly Traditions of Medicine (Paris, in press).

The purpose of my inquiries into the history of melancholy was to make sense of statements such as, "Love, grief & fear provoke wind,'' which are found in Sanskrit texts, or equivalent statements like Hippocrates's aphorism in Greek, "Grief & fear, when lingering, provoke melancholia.''

Do such statements relate to some clinical reality, irrespective of the cultural context, which would make the study of classical medical knowledge relevant to modern cultural psychology?

Some of the most innovative work on emotion is occurring in cross-cultural research on depression. The publication of Culture & Depression by Arthur Kleinman & Byron Good in 1985 (Berkeley, Univ. of California Press) was a landmark in this field, at the confluent of anthropology, psychology & literary studies.

Literary studies are involved, because the most telling expressions of depression, sadness, exhaustion, consumption, loss, grief & melancholy, are to be found in romance & poetry.

Furthermore, these public expressions of affects have been shaping the cultural patterns of affect in our society. Melancholy has been shaped in the form of a culture-bound syndrome, from Latin antiquity thru 19th century Romanticism, in Western Europe. Similarly, burning out & the drastic wasting of all vital fluids have been shaped in the form of a culture-bound syndrome in India.

One interesting conceptual & methodological problem that arises from cross-cultural studies of depression is that of universals of emotion. Is depressive disorder a Western cultural construct or a universal schema?

To recognize the existence of such a schema doesn't mean we must admit that it's a psychobiological process. We can see such schemata rooted in the rhetoric & imagery of scholarly traditions of medicine. The history of melancholia is that of an innately human experience of suffering becoming the object of a cultural construct. As a mood or emotion, the experience of being melancholy or depressed is at the very heart of being human:

• feeling "down" 
• blue 
• unhappy
• being dispirited
• discouraged
• disappointed
• dejected
• despondent
• melancholy
• depressed 
• despairing

many aspects of such affective experiences are within the normal range.

Everyone suffers from this kind of metaphorical melancholia, as Robert Burton said, because "Melancholy in this sense is the character of mortality'' (The Anatomy of Melancholy, I.I.I.5.), that is, a figure of the human condition. To be melancholic or depressed isn't necessarily to be mentally ill or in a pathological state.

It's only w/greater degrees of severity or longer durations when dispositions are transformed into habits as Burton would say that such affective states come to be viewed as pathological. On choosing to focus on melancholy as a clinical condition, we are faced w/the issue of whether it's a disease or some other sort of assemblage of signs & symptoms.

But we can rely on the very rich historiography of the theme in literature & philosophy, starting w/the Letters of Hippocrates.

When Hippocrates, called by the people of Abdera, to cure Democritus from his alleged madness, went to visit him one day, he found Democritus in his garden in the suburbs at Abdera, under a shady tree, w/a book on his knees, busy at his study, sometimes writing, sometimes walking.

The subject of his book was Melancholy & madness. About him lay the carcasses of several beasts, recently cut up by him & anatomized, not that he had contempt for God's creatures, as he told Hippocrates, but to find the seat of his black bile or Melancholy, whence it proceeds & how it was engendered in men's bodies, w/the intention that he might better cure it in himself, by his writing & observations.

"I do anatomize & cut up these poor beasts, he said to Hippocrates, to see the cause of these distempers, vanities & follies,'' which are the burden of all creatures. I've been quoting Robert Burton¹s paraphrase of the celebrated Letter to Damagetus in the Preface of his Anatomy.

Melancholy, or Sorrow in the Eastern traditions of medicine & philosophy, is the very essence of lived experience. This lived experience was described by physicians, in the context of humoral medicine, as materialized in vital fluids, the humors, especially black bile & pneuma.

At the core of traditional psychiatry, there's an imagery of fluids, that will thicken & become very similar to the dregs of wine, or turn acrid as vinegar, ferment & give off bubbles of gas, as Galen says of black bile in severe cases of melancholia.

This imagery is the materialization of a psychological experience.

Raymond Klibansky, Erwin Panofskky & Fritz Saxl, in Saturn & Melancholy: Studies in the History of Natural Philosophy, Religion, & Art (London New York, 1964), have commented magnificently upon a classical analysis of melancholy by Aristotle, who used the image of wine to expose the nature of black bile.

Black bile, just like the juice of grapes, contains pneuma, which provokes hypochondriac diseases like melancholia. Black bile like wine is prone to ferment & produce an alternation of depression & anger, an alternation of cuthymia & dysthymia (the thymos being the fluid essence of emotion).

Fluids are the materialization of mental fluctuations & this concept of affect remained prevalent down to the 19th century. The example of melancholia teaches something of the classical conceptions of relationships between body & mind.

It shows, Burton says (L2.5.1), how the body, being material, works upon the immaterial soul, by mediation of humours & spirits, which participate of both & ill-disposed organs. It illustrates the circle of sympathetic disorders, in which distractions & perturbations of the mind alter the temperature or temperament of the body, which in turn will cause the distemperature of the soul.

Therefore, before the advent of Cartesianism & even later, parallel to the development of intellectualist psychology, there remained an ancient tradition of humoral psychology which is of interest to us, now, in showing us the way to a renewed anthropology of emotions linked to environment, local contexts, climatic factors & dietetic resources.

The history of melancholy teaches us a number of useful concepts, schemes & analytical constructs that could be used today in the context of social & epistemological studies of medicine. The concept of substitution, e.g., was invented by Galen to interpret diseases like melancholy, assuming there was a substantial identity between the flows of humours & the fluctuation of thought.

In a chapter of his treatise On the Affected Parts (Book III, chapter 10), Galen locates these fluctuations in the brain conceived of "as a homoiomeric part,'' that is, as a tissue & not an organ. The brain as a tissue materializes the flow of affects.

The thickened humours collected in the brain injure it now as an organ, now as an homoiomeric part, thus creating "substitutions of epilepsy & melancholia'': epilepsy - when blocking the conduits & melancholia - when impairing the tissue that materializes emotions.

I'd surmise that the classical concept of the substitution of two sympathetic affections for one another is still useful today in our analysis of what psychiatrists call somatization. Indeed we must take some distance from classical nosology (the branch of medicine that deals with the classification of diseases), since ancient categories like epilepsy & melancholia don't actually correspond to clinical realities described in scientific medicine.

We should also be more precise in the commentary of texts & Galen¹s citation should be put back in the context of an elaborate epistemology, where "affections," e.g., are carefully distinguished from "dispositions," & "diseases."

One of the tenets of medical anthropology for the last 20 years has been to distinguish between disease (an analytical construct) & illness (the culturally informed flow of lived experience). This distinction, invented in the early 1970's by culturally oriented physicians, wasn't grounded on any historical knowledge.

However, all the scholarly traditions of medicine, not only in the West but also in India & elsewhere, have been developing concepts of affections, dispositions & habits, accidents & the trajectory of "sympathetic diseases," in other words, semantic networks that capture the meaning of illness.

The classical knowledge of Humanism & Renaissance medicine culminated in Robert Burton's Anatomy of Melancholy in the beginning of the 17th century & I shall conclude this brief review by mentioning the recent publication of a definitive, critical edition (T.C. Faulkner, N. K. Kiessling & R. L. Blair, Eds., Oxford, Clarendon Press, Three Volumes, 1989-1994).

One might very well conclude that this masterpiece of English literature has no longer anything to teach us in the domain of medicine, but it's of the utmost interest to any anthropologist or cultural psychologist studying emotions.

Emotions have come to the forefront of contemporary social science research, because we have come to recognize that they play the central role in cognition as well as in politics. Emotions have been traditionally approached thru the study of rhetoric.

The cultural shaping of sentiments in Europe from the Renaissance onwards, as Norbert Elias has shown in his celebrated book The Civilization of Manners, was based on classical rhetoric. Elegant figures of speech borrowed from the Latin manuals of rhetoric were transposed into elegant manners to be displayed by the well-educated ladies & gentlemen.

But this transposition of rhetoric into manners is also to be observed in the domain of classical medicine. What's of interest to us in Robert Burton's Anatomy isn't so much the contents as the format, the very project of an anatomy - displaying What it is, With all the kinds, causes, symptoms, prognostics, and several cures of it, Philosophically, Medicinally, Historically opened & cut up (as the subtitle reads) & the rhetoric used to describe & analyze the flow of experience.

Let me just give here a sample of congeries (work heaps) & Senecan style (curt style, with abruptness & jaggedness) used to convey the sense of an epidemical disease (from the Preface).

"And to omit all impertinent digressions, to say no more of such as are improperly melancholy, or metaphorically mad, lightly mad, or in disposition ["disposition" being contrasted w/"disease'' proper], as:

• stupid
• angry
• drunken
• silly
• sottish
• sullen
• proud
• vainglorius
• ridiculous
• beastly
• peevish
• obstinate
• impudent
• extravagant
• dry
• doting
• dull
• desperate
• harebrain
• mad
• frantic
• foolish
• heteroclite

which no new hospital can hold, no physick [medicine] help my purpose & endeavor is, in the following discourse, to anatomize this humour of Melancholy [i.e., black bile], thru all his parts & species, as it's a habit or an ordinary disease & that philosophically, medicinally, to show the causes, symptoms & several cures of it, that it may be better avoided...& that splenetic hypochondriacal wind especially, which proceeds from the spleen & short ribs.

Being then as it is, a disease, that so often, so much crucifies the body & mind.'' The history of melancholy thus based on classical readings is a history of the traditional rhetoric of emotions & the figures of speech are as many keys to the observation of behavior in clinical settings as well as in ethnographic fieldwork.

We tend to assume that illnesses are universals. We argue that, whether or not a particular society treats depression as a disease, e.g., the syndrome of chronic exhaustion is a ubiquitous illness behavior that can be described & interpreted in all sorts of situations & contexts.

Therefore, the task of anthropology in a clinical context is to interpret illness meanings. The patient's body idiom, beyond the physical pain, may be expressing:

• the pain of failure
• the pain of loneliness
• soliciting love & support 
• warding off distressing thoughts

but we must find appropriate modes of discourse to translate the patient's body idiom.

The history of classical medicine & related literature, including belles lettres & Renaissance rhetoric, might provide us w/tools for such interpretive tasks.