The History of Melancholy
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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, and its name and concept encapsulate the whole history of humoralism, since melancholia is black bile, one of the peccant humors recognized in Hippocratic and 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 and technical concepts of scholarly medicine, might help the modern anthropologist and 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 with melancholy was, as a South Asianist, in my research on Ayurvedic psychiatry. I have been attempting to make sense of the alleged relationship between the torments of Love, Grief, and Fear and the vitiation of pneuma and 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 and 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 and fear provoke wind,'' which are found in Sanskrit texts, or equivalent statements like Hippocrates's aphorism in Greek, ``Grief and 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 and Depression by Arthur Kleinman and Byron Good in 1985 (Berkeley, Univ. of California Press) was a landmark in this field, at the confluent of anthropology, psychology and literary studies. Literary studies are involved, because the most telling expressions of depression, sadness, exhaustion, consumption, loss, grief, and melancholy, are to be found in romance and 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 through nineteenth century Romanticism, in Western Europe. Similarly, burning out and the drastic wasting of all vital fluids have been shaped in the form of a culture-bound syndrome in India. One interesting conceptual and 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 does not mean we must admit that it is a psychobiological process. We can see such schemata rooted in the rhetoric and 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'' or blue or unhappy, being dispirited, discouraged, disappointed, dejected, despondent, melancholy, depressed, or 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 is not necessarily to be mentally ill or in a pathological state. It is only with 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 with the issue of whether it is a disease or some other sort of assemblage of signs and symptoms. But we can rely on the very rich historiography of the theme in literature and philosophy, starting with 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, with a book on his knees, busy at his study, sometimes writing, sometimes walking. The subject of his book was Melancholy and madness. About him lay the carcasses of several beasts, recently cut up by him and 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, and how it was engendered in men's bodies, with the intention that he might better cure it in himself, by his writing and observations. ``I do anatomize and cut up these poor beasts, he said to Hippocrates, to see the cause of these distempers, vanities, and follies,'' which are the burden of all creatures. I have been quoting Robert Burton's paraphrase of the celebrated Letter to Damagetus in the Preface of his Anatomy. Melancholy, or Sorrow in the Eastern traditions of medicine and 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 and pneuma. At the core of traditional psychiatry, there is an imagery of fluids, that will thicken and become very similar to the dregs of wine, or turn acrid as vinegar, ferment and 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, and Fritz Saxl, in Saturn and Melancholy: Studies in the History of Natural Philosophy, Religion, and 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 and produce an alternation of depression and anger, an alternation of cuthymia and dysthymia (the thymos being the fluid essence of emotion). Fluids are the materialization of mental fluctuations, and this concept of affect remained prevalent down to the nineteenth century. The example of melancholia teaches something of the classical conceptions of relationships between body and mind. It shows, Burton says (L2.5.1), how the body, being material, works upon the immaterial soul, by mediation of humours and spirits, which participate of both, and ill-disposed organs. It illustrates the circle of sympathetic disorders, in which distractions and 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, and 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 and dietetic resources.
The history of melancholy teaches us a number of useful concepts, schemes, and analytical constructs that could be used today in the context of social and epistemological studies of medicine. The concept of substitution, for example, was invented by Galen to interpret diseases like melancholy, assuming there was a substantial identity between the flows of humours and 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 and 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 and melancholia'': epilepsy—when blocking the conduits—and melancholia - when impairing the tissue that materializes emotions. I would 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 and melancholia do not actually correspond to clinical realities described in scientific medicine. We should also be more precise in the commentary of texts, and Galen's citation should be put back in the context of an elaborate epistemology, where ``affections,'' for example, are carefully distinguished from ``dispositions,'' and ``diseases.'' One of the tenets of medical anthropology for the last twenty years has been to distinguish between disease (an analytical construct) and illness (the culturally informed flow of lived experience). This distinction, invented in the early 1970s by culturally oriented physicians, was not grounded on any historical knowledge. However, all the scholarly traditions of medicine, not only in the West but also in India and elsewhere, have been developing concepts of affections, dispositions and habits, accidents and the trajectory of ``sympathetic diseases,'' in other words, semantic networks that capture the meaning of illness.
The classical knowledge of Humanism and Renaissance medicine culminated in Robert Burton's Anatomy of Melancholy in the beginning of the seventeenth century, and I shall conclude this brief review by mentioning the recent publication of a definitive, critical edition (T.C. Faulkner, N. K. Kiessling and 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 is 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 through 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 and gentlemen. But this transposition of rhetoric into manners is also to be observed in the domain of classical medicine. What is of interest to us in Robert Burton's Anatomy is not 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 and cut up (as the subtitle reads)— and the rhetoric used to describe and analyze the flow of experience. Let me just give here a sample of congeries (work heaps) and Senecan style (curt style, with abruptness and 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 with ``disease'' proper], as stupid, angry, drunken, silly, sottish, sullen, proud, vainglorius, ridiculous, beastly, peevish, obstinate, impudent, extravagant, dry, doting, dull, desperate, harebrain, and mad, frantic, foolish, heteroclite, which no new hospital can hold, no physick [medicine] help my purpose and endeavor is, in the following discourse, to anatomize this humour of Melancholy [i.e., black bile], through all his parts and species, as it is a habit or an ordinary disease, and that philosophically, medicinally, to show the causes, symptoms, and several cures of it, that it may be better avoided...and that splenetic hypochondriacal wind especially, which proceeds from the spleen and short ribs. Being then as it is, a disease, that so often, so much crucifies the body and mind.'' The history of melancholy thus based on classical readings is a history of the traditional rhetoric of emotions, and 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, for example, the syndrome of chronic exhaustion is a ubiquitous illness behavior that can be described and interpreted in all sorts of situations and 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 and support and warding off distressing thoughts, but we must find appropriate modes of discourse to translate the patient's body idiom. The history of classical medicine and related literature, including belles lettres and Renaissance rhetoric, might provide us with tools for such interpretive tasks.
Francis Zimmermann holds the chair of South Asian Anthropology and 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 and the Center for South and Southeast Asian Studies.