Madness: A Brief History Read Online Free PDF Page B

melancholy. The categories of mania and melancholy—representing hot and cold, wet and dry, ‘red’ and ‘black’ conditions respectively—became ingrained, intellectually, emotionally, and perhaps even aesthetically and subliminally, in the educated European mind, rather, perhaps, as key psychoanalytical concepts (repression, defence, projection, denial) did in the twentieth century.
     
    The clinical gaze
    Greek medicine did not develop this plausible and satisfying explanatory framework in the abstract: it was clinically grounded and full of practical applicability to the sick. Case histories from the Hippocratic writings onwards record mental abnormalities. In one, a woman is noted as being rambling in her speech and mouthing obscenities, exhibiting fears and depression and undergoing ‘grief’; another woman, suffering anguish, ‘without speaking a word ... would fumble, pluck, scratch, pick hairs, weep and then laugh, but ... not speak’. A case which reads like delusional melancholia, said to arise from black bile collecting in the liver and rising to the head, involved a condition which ‘usually attacks abroad, if a person is travelling a lonely road somewhere, and fear seizes him’.
     

    6 Melencolia by A. Dürer, 1514. A despondent winged female figure holding a geometrical instrument surrounded by attributes associated with knowledge. The sands of time are running out; nature too is in decay.
     
    As noted, Greek medicine, with its routine binary  thinking, singled out two main manifestations of mood and behavioural disturbance, mania and melancholia. The fullest early clinical descriptions of these were advanced by a contemporary of the great Galen, Are-taeus of Cappadocia (ad c. 150-200), in his On the Causes and Signs of Diseases. He observed of one case of melancholy:
Sufferers are dull or stern: dejected or unreasonably torpid, without any manifest cause: such is the commencement of melancholy, and they also become peevish, dispirited, sleepless, and start up from a disturbed sleep. Unreasonable fears also seize them. ... They are prone to change their mind readily, to become base, mean-spirited, illiberal, and in a little time perhaps simple, extravagant, munificent not from any virtue of the soul but from the changeableness of the disease. But if the illness become more urgent, hatred, avoidance of the haunts of men, vain lamentations are seen: they complain of life and desire to die; in many the understanding so leads to insensibility and fatuousness that they become ignorant of all things and forgetful of themselves and live the life of inferior animals.
    Melancholia, as is evident from this clinical account, was not, as it would later be for Keats and other Romantic poets, a fashionably dreamy sadness. For Aretaeus and for Classical medicine in general, it was a severe mental disturbance. Anguish and dejection were its essential elements, but also involved were powerful emotions springing from hallucinations and sensations of suspicion, mistrust, anxiety, and trepidation. ‘The patient may imagine he has taken another form than his own,’ Aretaeus commented on the delusions of the depressed:
one believes himself a sparrow; a cock or an earthen vase; another a God, orator or actor, carrying gravely a stalk of straw and imagining himself holding a sceptre of the World; some utter cries of an infant and demand to be carried in arms, or they believe themselves a grain of mustard, and tremble continuously for fear of being eaten by a hen.
    Similar tropes—one man too terrified to urinate in case he drowned the whole world, another sure he was made of glass and about to shatter at any moment—were recycled right through to Robert Burton’s Anatomy of Melancholy (1621) and beyond.
    For Aretaeus, depression was a grave condition, its delusions, obsessions, and idées fixes highly destructive. ‘The melancholic isolates himself, he is afraid of being persecuted and imprisoned, he torments