Melancholy

The word melancholy, which refers to a state of low spirits, sadness, and anxiety, comes from the Greek terms melas (black) and chole (bile). The historical meaning of the concept of melancholy has been superseded by modern terms such as depression; whereas melancholy is now used to refer to a state of lingering sadness, from antiquity to the development of prepsychiatric medicine the term was used to describe a medical condition.

In antiquity, the word melancholy referred to a medical disturbance of the mind and the soul that was contrasted with other states of madness, such as mania, a chronic mental disorder without fever, and phrenitis, an inflammation of the brain with fever. The specificity of melancholy was believed to be related to its cause in the body: black bile. Like the three other bodily humors—blood, yellow bile, and phlegm—black bile was understood to affect the body as well as the soul; in excess, it was seen as the cause not only of melancholy but also of cancer, elephantiasis, and hemorrhoids.

The Hippocratic corpus mentions black bile, but melancholy is not prominent. One of the Aphorisms (6.23) states that “if sadness and fear last for a long [Page 1075]time, the state is melancholic.” A treatise from the Aristotelian tradition, Problem XXX, which connects the melancholic state to exceptional men, was very influential. In the treatise On Black Bile, Galen focuses on the physiological aspects of this humor. The twofold nature of black bile—that it is both necessary to life and yet in excess so potent that it is able cause anthrax, elephantiasis, and melancholy—is clear in this text. The cure for melancholy aims at reducing black bile through purgation with white hellebore. Other authors show more doubts about the possibility of a cure. Aretaeus of Cappadocia (1856) gives a vivid account of persons suffering from melancholy:

On the physical side, the skin of melancholics was said to become green-black, and they were said to have great appetites while remaining emaciated.

During the Middle Ages, the whole theory of the bodily humors was systematized, and the melancholic emerged as one of the four temperaments—that is, a type of person with characteristics, both physical and mental, determined by the melancholic humor. Robert Burton's Anatomy of Melancholy, first published in 1621, is emblematic for the Renaissance: The author organizes the classical sources about melancholy around scrutiny of himself. Although alternative ideas concerning the treatment of melancholy were put forward, the ancient theories were influential well into the nineteenth century.

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