Madness: A Brief History Read Online Free PDF

caught chills. Each fluid also had its distinctive colour—blood being red, choler yellow, phlegm pale, and melancholy dark. These hues were responsible for body coloration, explaining why particular races were white, black, red, or yellow, and why certain individuals were paler, swarthier, or ruddier than others.

    5 This bath-house containing six men and an onlooker is an allegory of the four humours and five senses; after Dürer, c. 1496.
     
    Humoral balance also explained the temperaments, or what would, in later centuries, be called personality and psychological dispositions. Thus someone generously endowed with blood would present a florid complexion and have a ‘sanguine’ temperament, being lively, energetic, and robust, though perhaps given to hot-bloodedness and a short temper. Someone cursed with surplus choler or bile might be choleric or acrimonious, marked by an acid tongue. Likewise with phlegm (pale phlegmatic in character) and black bile (a person with swarthy appearance and a saturnine disposition, giving off ‘black looks’). There was, in short, boundless explanatory potential in such rich holistic interlinkages of physiology, psychology, and bearing, not least because correspondences were suggested between inner constitutional states (‘temper’) and outer physical manifestations (‘complexion’). Analogy-based explanatory systems of this kind were not just plausible but indispensable so long as science had little direct access to what went on beneath the skin or in the head. The values of Periclean Athens regarded the human body as noble, even sacred, and hence ruled out dissection.
    Holistic in its disposition, humoral thinking had ready explanations for the plunge from health into illness, both physical and psychological (though in a holistic system, these were never polarized). All was well when the vital fluids cooperated in their proper balance. Illness resulted when one of them gathered (became ‘plethoric’) or dwindled. If, perhaps through faulty diet, the body made too much blood, ‘sanguineous disorders’ followed—in modern idiom, we might say that blood pressure rose—and one got overheated and feverish. One might, by consequence, have a seizure or apoplectic fit, or grow maniacal. Deficiency of blood or poor blood quality, by contrast, meant loss of vitality, while blood loss due to wounds would lead to fainting or death. Specifically in terms of mental disorder, excesses both of blood and of yellow bile could lead to mania, whereas a surplus of black bile—being too cold and dry—resulted in lowness, melancholy, or depression.
    Fortunately such imbalances were capable of prevention or correction, through sensible lifestyle, or by medical or surgical means. The person whose liver ‘concocted’ a surfeit of blood or whose blood was polluted with toxins—both could cause mania—should undergo blood-letting (also known as phlebotomy or venesection), which was to enjoy a long future as the prophylactic and therapeutic sheet-anchor in Europe’s lunatic asylums. A change of diet could help. Raving madmen would be put on a ‘diluting’ and ‘cooling’ diet, with salad greens, barley water, and milk, and a ban on wine and red meat. Enormously detailed recommendations were spelt out for the regulation of diet, exercise, and lifestyle.
    Humoralism provided a comprehensive explanatory scheme, staking out bold archetypal parameters (hot/ cold, wet/dry, etc.) and embracing the natural and the human, the physical and the psychological, the healthy and the pathological. Plain and commonsensical to the layman, it was also capable of technical elaboration by the physician.
    Within humoralism’s easy-to-visualize grid of opposites, it was simple to picture mental conditions as extensions of physical ones. In a scheme in which healthiness lay in equilibrium and sickness in extremes, mania implied—almost required—the presence of an equal but opposite pathological state: