The Anatomy of Melancholy

But to leave this brief description, the most usual symptoms are these: “a throbbing near the back,” a beating about the back that is almost constant. The skin is often rough and dry, especially, as Aretaeus observes, around the arms, knees and knuckles. The midriff and heartstrings burn and throb alarmingly; and when this vapour or fume is stirred and flies upwards, the heart itself beats, suffers severe pain and faints. “The throat is closed by dryness, so that the condition can scarcely be distinguished from suffocation of the womb”: like fits of the womb. “In most, the bowels discharge nothing; in others, a little acrid, bilious matter; the urine is yellow.”

They often complain, says Mercatus, of great pain in their heads, around their hearts and hypochondria, and likewise in their breasts, which are frequently sore. They sometimes feel ready to faint; their faces are inflamed and red; they are dry, thirsty, suddenly hot, much troubled by wind, unable to sleep, and so on. From this arise “wild delirious imaginings,” a brutish kind of mental derangement; troubled sleep; terrible dreams at night; “a somewhat rustic shame and timid diffidence,” a foolish kind of bashfulness in some; distorted notions and opinions; dejection of mind; much discontent; and perverse judgment.

They are prone to loathe, dislike and disdain, to grow weary of every object, and so on. Almost everything is tiresome to them; they waste away, unable to decide what to do, prone to weep and tremble, timid, fearful, sad and without any hope of better fortune. For the time they delight in nothing, but love to be alone and solitary, though this does them more harm. They remain in this state as long as the vapour lasts; but soon they are as pleasant and cheerful as ever in their lives, singing, talking and laughing in good company whenever occasion offers. Thus it takes them in fits from time to time, unless the disorder is long established, when it is more frequent, violent and continuous.

Many cannot find words to express themselves, or say how it affects them or what ails them; you cannot understand them or tell clearly what to make of their words. Sometimes they are so far gone, so stupefied and distraught, that they think themselves bewitched and fall into despair: “prone to weeping and despair, with pains in the breasts and hypochondria.” Mercatus therefore adds that now their breasts ache, now their hypochondria, belly and sides, then their heart and head; now heat troubles them, then wind, now this, now that. They are weary of it all; yet they will not, or again cannot, say how, where or what troubles them, though they are in great pain and agony and complain frequently, always grieving, sighing, weeping and discontented, usually “without an evident cause.”