László Földényi - Melancholy

One comes across the first traces of a connection between bile and spirit (temperament) in Homer, who, although not mentioning black bile, does nevertheless associate the color black with a darkening of mood. The fact that Agamemnon’s “heart was black with rage, and his eyes flashed fire” ( Iliad , bk. 1, 103) is just as much a consequence of a change in bile as of rancor on account of Calchas’s prophesy. Bile and the color black make their first joint appearance in Sophocles’ tragedy Women of Trachis: according to the poet, the arrow dipped into the “black gall” of the Lernaean Hydra was poisoned (565). Thus, the dramatist, who, as a priest, was also a physician, considered black bile— —to be harmful, a poison for the body. The description and interpretation of that poison, the black bile, are linked to Hippocrates at the end of the fifth century BCE. “Now the body of man,” he writes, “contains blood, pituita, and two kinds of bile — yellow and black; and his nature is such that it is through them that he enjoys health or suffers from disease” ( On the Nature of Man , 4). Hippocrates initially derived the ailment known as melancholia from the blackening of the gall ( was a malady of the so-called choleric category, ), not from black bile, as in his later works. He is of the opinion that if the juices were distributed in a bad ratio, or rather — after introducing the term black bile —one of the juices did not mix appropriately with the other, then the organism would fall ill. The constitution of the human body was a function of that mixing; the Greeks designated mixing and constitution with the same word: . The cosmocentric Greek view considered humanity to be an organic part of the universe rather than setting it in opposition. 1Admixture, which was originally related to the joining of constituent elements, was responsible for everything; for the state of the cosmos as well as for the human body, constitution, and character; indeed, as Ptolemy expounds in his Tetrabiblos , even for the influencing power of celestial cycles. Hippocrates pays little attention to the spiritual aspect of constitution and much more to the physical components, although a worldview that sees the state of the body and the cosmos in unity contains implicitly a belief in the unity of body and mind. Melancholia, Hippocrates avers, is an indisposition of the body: the dense humor of black bile gains ascendancy at the expense of the other humors, and poisons the blood, which can be the cause of maladies from headaches through diseases of the liver and stomach to such conditions as leprosy. Blood , however, is the nidus of the mind, Hippocrates says; the mental consequences of poisoning the blood by black bile are thereby explicable. Black bile per se is not an illness, and becomes that only as a result of bad mixing ( ): melancholia (black bile), which primarily points to a mental condition, is a particular case of the bad distribution of black bile ( ), in which the bodily state is coupled with fear ( ) and depression ( ). According to Hippocrates, the so-called dry type of temperament is prone to that ailment (it is concomitant with the drying out and thickening of the bile), which is also influenced by the weather and the seasons. In his medical treatise On Airs, Waters, and Localities , he writes as follows: “But if the season is northerly and without water, there being no rain, neither after the Dog Star nor Arcturus; this state agrees best with those who are naturally phlegmatic, with those who are of a humid temperament, and with women; but it is most inimical to the bilious; for they become much parched up, and ophthalmies of a dry nature supervene, fevers both acute and chronic, and in some cases melancholy” (ch. 10, 84–91). The disorder caused by black bile, melancholia, may originate in the body, but in these circumstances it also affects the mood. In The Third Book of Epidemics , Hippocrates discusses melancholia of a physical origin as a disturbed state of the mind: a female patient he had examined was sleepless and averse to food, and “her temperament was melancholic” ( , 17.2). The word means alike “mood,” “mental ability,” “mind,” “heart,” “frame of mind,” “insight”—all these meanings are implied inseparably in that single Greek word, and that laconicism alerts one to a relative wealth: the capabilities of the mind and the spirit cannot be stowed in separate “sacks” but attest to a uniform stance toward and interpretation of existence, invisibly and yet firmly intertwined with the likewise manifold world of the body. Melancholia is a sickness of both temperament and constitution, of mind and body, and : the unity of the spirit and the cosmic mixture of elements defining the physical condition. Melancholia is the dissolution and indisposition of these two — can there be a more expansive, more daring medical approach to things? The origin is physical 2—Hippocrates relates that when he visited Democritus, who was not only melancholic himself but wrote a treatise about the malady, he found the philosopher sitting under a tree and dissecting animals to find the cause of the melancholic mood — whereas the outcome is eminently intellectual. And vice versa: the origin, being physical, is cosmic and superhuman (a product of the interplay of wind, landscape, season, climate, even the planets and stars), but its effect manifests in a person’s matchless and unique psychic and intellectual qualities, making him or her radically different from everyone else. Thus, in Hippocrates’ view, the illness of melancholia is the result of some kind of anomaly: the balance of the micro- and macrocosm has tipped, order (the cosmos) has broken down, disorder has set in, and the affected person no longer obeys the indissoluble laws of the universe and his or her own fate. —they have stepped out of themselves, fallen into ecstasy, Hippocrates says of melancholics at one point, and his eloquent use of the medial, reflexive form of the verb points to penetrating observation: the subjects are not only thrown upon the mercy of a will that is alien to them but they are also the objects of their own actions. Melancholics stand outside the customary rules of life; but fate, which wanted it to be so, is their own fate as well: their life, the relationship they have evolved with fate, determines their state (malady) just as much as does the cosmos, over which they have no control . This, however, Hippocrates does not say — voicing such ideas in the world of self-explanatory phenomena would have struck people as verging on the suspicious.