The Anatomy of Melancholy

Subsection 4. Mental impairment, frenzy, madness, hydrophobia, lycanthropy, St Vitus’s dance and ecstasy.

Mental impairment, fatuity or folly is, according to some, a general name for all the following kinds. Laurentius and Altomarus include madness, melancholy and the rest under this name, calling it their highest genus. If distinguished from them, it is either natural or inborn, arising from some defect in the organs and an excess of brain matter, as we see in ordinary fools; its severity generally varies from person to person, and accordingly some have more understanding than others. Or it is acquired, an accompanying condition or symptom of another disease, which comes and goes; if it persists, it is a sign of melancholy itself.

Phrenitis, which the Greeks derive from the word phrēn, is a disease of the mind involving continual madness or mental confusion accompanied by an acute fever; or it is an inflammation of the brain or its membranes, with an acute fever, that causes madness and confusion. It differs from melancholy and madness because their confusion occurs without a fever. In phrenitis it is continual, with sleeplessness, impaired memory and so on. Melancholy is generally silent; this is clamorous. Physicians identify many other such differences.

Celsus and many other writers group madness, frenzy and melancholy together. Others leave frenzy aside and make madness and melancholy a single disease—a position Jason Pratensis argues at particular length. They hold that the difference is only one of degree, of more or less, one being a stage of the other and both arising from the same cause. They differ “in a greater or lesser degree,” Gordonius says, as the humour is intensified or diminished. Aretaeus, Alexander Tertullianus, Guianerius, Savonarola and Heurnius hold the same view; Galen himself discusses the two together because of their affinity. But most modern writers treat them separately, and I shall follow them in this treatise.

Madness is therefore defined as severe mental derangement, or raving without fever, far more violent than melancholy: full of anger and clamour, with alarming looks, actions and gestures, disturbing patients much more violently in both body and mind, without fear or sorrow, and with such headlong force and boldness that sometimes three or four men cannot restrain them. It differs from frenzy only in lacking fever and in the patients’ generally having better memory.

It has the same causes as the other disorders: scorched choler, overheated blood, an inflamed brain and so on. Fracastorius adds an appropriate duration and mature age to this definition, to distinguish it from the condition of children. He requires it to be an established incapacity, to separate it from passing disturbances that arise accidentally and disappear again, as after taking henbane, nightshade, wine and the like.

This madness has several kinds. One is ecstasy, a familiar state for some people: Cardan says he could enter it whenever he pleased. In this state Indian priests deliver their oracles, and the witches of Lapland, as Olaus Magnus writes in book 3, chapter 18, “foretell everything in ecstasy,” answering whatever you ask—what your friends are doing, where they are, how they fare and so on.