Member 3 Immediate cause of the preceding symptoms

To give some reassurance to melancholic people troubled by these symptoms, no better course, in my judgment, can be taken than to show them the causes from which the symptoms proceed. They do not come from devils, as they suppose, nor mean that they are bewitched or forsaken by God, or that what they hear or see is as many of them believe, but arise from natural, internal causes. By knowing these, they may better avoid the effects, or at least endure them more patiently.

The most grievous and common symptoms are Fear and Sorrow, without a cause, which even the wisest and most judicious people cannot avoid in this disorder. Aetius discusses at length why this is so in Tetrabiblos 2.2, in his first problem, drawing on Galen, book 2, On the Causes of Symptoms, 1. Galen attributes everything to the cold that is black. He thinks that when the spirits are darkened and the substance of the brain is cloudy and dark, all its objects appear terrible. The mind itself, through those dark, obscure, dense fumes rising from black humours, remains in continual darkness, fear and sorrow. Terrible, monstrous fictions occur in a thousand shapes and apparitions, with violent passions that disturb and eclipse the brain and imagination.

Fracastorius, in book 2 On Understanding, would have cold be the cause of Fear and Sorrow. Those who are cold are indisposed to mirth, dull and heavy, naturally solitary and silent; this is not because of any internal darkness, as physicians think, for many melancholic people boldly remain and walk in the dark, and delight in it: “only the cold are timid.” If they are hot, they are merry; and the hotter they are, the more furious and fearless, as we see in madmen. But this reasoning does not hold, for then no melancholic person whose condition proceeds from scorched choler should be afraid.

Averroes mocks Galen’s reasons and offers five arguments to refute them. So does Hercules de Saxonia, in his Treatise on Melancholy, chapter 3, assigning other causes. These are extensively criticized and refuted by Aelianus Montaltus, chapters 5 and 6; Lodovicus Mercatus, On the Treatment of Internal Diseases, book 1, chapter 17; Altomarus, On Melancholy, chapter 7; Guianerius, treatise 15, chapter 1; Bright, chapter 17; Laurentius, chapter 5; and Valesius, Medical Controversies, book 5, controversy 1. They conclude that a disordered constitution produces black fluid; blackness obscures the spirits; and the obscured spirits cause fear and sorrow.

Laurentius, chapter 13, supposes these black fumes especially affect the diaphragm or midriff, and so “consequently” the mind, which is obscured as the Sun is by a cloud. Almost all the Greeks and Arabs, and Latin writers ancient and modern, subscribe to this opinion of Galen: “internal darkness obscures the mind, as external darkness harms children.” Just as children are frightened in the dark, melancholic people are frightened at all times, having the internal cause within them and always carrying it about.

Whether these black vapours proceed from the black blood around the heart, as T. W., the Jesuit, thinks in his Treatise of the Passions of the Mind, or from the stomach, spleen, midriff or all the disordered parts together, makes no difference. They keep the mind in a perpetual dungeon and oppress it with continual fears, anxieties, sorrows and the like.

It is common for those who are well to laugh at this dejected faint-heartedness and the other symptoms of melancholy, to amuse themselves with them, and to marvel at such things as fancies and trifles that people could resist and withstand if only they chose. But let anyone who marvels in this way consider: if someone suddenly told him that some of his closest friends were dead, could he help grieving? Or if he were placed on a steep rock where he was in danger of falling, could he feel safe? His heart would tremble with fear and his head would be dizzy.

P. Byarus, in his Treatise on Plague, gives an example, as I have mentioned: suppose, he says, someone walks along a plank. If it lies on the ground, he can do so safely; but if the same plank is laid over deep water as a bridge, he is powerfully disturbed. It is nothing but his imagination, “the impression of falling,” which his other bodily parts and faculties obey.

Yes, but you argue that such people have a just cause for fear, a real object of fear. So too do melancholic people have an internal cause: a perpetual fume and darkness producing fear, grief and suspicion, which they carry with them. It is an object that cannot be removed, but clings as closely and inseparably as a shadow to a body—and who can drive away or outrun his shadow? Remove the heat of the liver, the cold stomach, the weak spleen; remove those scorched humours and the vapours rising from them, the black blood from the heart and all external disturbances. Take away the cause, and then tell them not to grieve or fear, or be heavy, dull and sluggish. Otherwise advice can do little good. You might as well tell someone suffering from an ague not to be thirsty, or someone wounded not to feel pain.

Suspicion follows close on the heels of fear and sorrow, arising from the same source. So Fracastorius thinks: fear causes suspicion, and they constantly suspect that some treachery or secret plot is being contrived against them; they always distrust. Restlessness proceeds from the same source; a variety of fumes makes them like and dislike things. Solitude, avoidance of light, weariness of life and hatred of the world arise from the same causes, for their spirits and humours are opposed to light. Fear makes them avoid company and keep away, lest they be mistreated or hissed at, or go too far themselves, as they constantly fear.

They are prone to sexual desire because of wind. An abundance of choler makes them angry, irritable and continually fretting, causing frightening dreams and violent disturbances both asleep and awake. Their supposition that they have no heads, that they fly or sink, that they are pots or glasses, and so on, comes from wind in their heads. Hercules de Saxonia ascribes this to the various movements of the animal spirits: their expansion, contraction, confusion, alteration, darkness, and disordered heat or cold, excluding all material humours.