The Anatomy of Melancholy

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.