The Anatomy of Melancholy

Subsection 2. The Part Affected The Faculty Affected and the People Affected

I find some disagreement among writers about the principal part affected by this disease: whether it is the brain, the heart or some other organ. Most think it is the brain. Since the disease is a kind of mental derangement, the brain must necessarily be affected in its substance, whether secondarily or in itself. The trouble is not in its ventricles or in any blockage within them, for that would produce apoplexy or epilepsy, as Laurentius rightly observes.

Instead, it lies in a cold, dry imbalance of the brain’s substance, which has become impaired and too cold, too dry or else too hot, as in mad people and those inclined to madness. Hippocrates confirms this, as do Galen, the Arab physicians and most of our recent writers.

Marcus de Oddis, in a consultation quoted by Hildesheim, and five others cited there take the opposite view, because fear and sorrow are emotions seated in the heart. But Montalto adequately answers this objection. He does not deny that the heart is affected through its proximity, as Melanelius proves from Galen; so too are the diaphragm and many other parts. By nature’s law, they suffer together and share one another’s feelings.

But since this disease is caused by an antecedent act of imagination together with appetite, and the spirits obey these powers and are subordinate to the principal organs, the brain must first be affected as the seat of reason, and then the heart as the seat of emotion.

Capivaccius and Mercurialis discuss this question at length. Both conclude that the seat of the disease is the interior of the brain. From there it is communicated to the heart and other lower parts, which suffer with it and are greatly disturbed—especially when it arises through the influence of another part: the stomach; the myrach, as the Arab physicians call it; the whole body; the liver or spleen, which are seldom unaffected; the pylorus; the mesenteric veins; and so on.

For our body is like a clock: if one wheel goes wrong, all the others are thrown out of order and the whole mechanism suffers. A human being is composed with such admirable workmanship, harmony and exquisite proportion, as Ludovicus Vives elegantly explains in his Fable of Man.

Almost as many doubts arise about the faculty affected: whether imagination alone, reason alone or both. Hercules de Saxonia argues from Galen, Aetius and Altomarus that the fault lies entirely in imagination. Bruel agrees. Montalto, in his second chapter on melancholy, refutes their doctrine and illustrates the contrary view with many examples:

the man who thought himself a shellfish; a nun; and a despairing monk who could not be persuaded that he was not damned. Reason was at fault as well as imagination, since it failed to correct this error. Such people often kill themselves and believe many absurd and ridiculous things. If reason is unimpaired, why does it not expose the error, calm them and persuade them?