HIPPOCRATES AND HUMOURALISM
One of the earliest known conceptualizations of depression, then encompassed under the term melancholia, is found in the writings of Hippocrates dating back to the 5th century B.C. Hippocrates’s work characterized melancholia as being associated with “aversion to food, despondency, sleeplessness, irritability, restlessness,” as well as prolonged fear or depression (Jackson, 1986, p. 30). These symptoms continue to be found in descriptions of melancholia throughout the ages, and the entire medical field was based on Hippocrates’s work for centuries to come.
It is only relatively recently that we have begun using the term emotions to describe feeling states. Throughout history, emotions were called affections, passions, and perturbations of the soul, translated from the Latin derivations of these terms (Jackson, 1986, p. 15). The word depression began appearing in English during the 14th century. It comes from the Latin word deprimere, which means to press down. When broken down, “de” means down from and “premere” means to press. As such, depression has connotations of being pressed down both physically and emotionally. The term was also often applied to one’s status and fortune, as these were closely linked with one’s mental status. To suffer from melancholy in many respects was to lose touch with reason, to be considered a madman and/or a sinner, and to be treated as such. Therefore, one’s position in society could be negatively and drastically altered by mental conditions.
Pythagorean and medical ideas of the time laid the groundwork for Hippocrates, who was the first to combine them all into a cohesive medical system in his work Nature of Man. His theory, which came to be known as “humouralism,” posited that there are four main fluids in the body, known as: blood, phlegm, yellow bile, and black bile. Each of these humours was associated with a particular season, and, in keeping with common medical thought at the time, equilibrium among all of the humours was the key to good health, whereas disequilibrium resulted in illness.
In this way, Hippocrates was able to link the fluids in the body with physical, mental, and emotional states. At that point in time, psychology had not yet evolved as its own field and so all ailments fell within the medical—and sometimes spiritual or religious—domain. Doctors wanted an empirical method of explaining and treating disease, and since the contents of the mind (thoughts and feelings) could not be directly examined, they relied on physiological explanations for mental states. This was their solution to the mind-body problem. Therefore, poor health encompassed physical as well as psychic maladies, and the latter needed to be described in terms of the former.
Melancholia was a broad term used to encompass a wide range of diseases, including conditions of a psychological, somatic, and medical nature. As a condition, melancholia was believed to be the result of an overabundance of black bile within an individual. Some viewed black bile as one of the four humours naturally occurring in the body. Others believed that black bile was caused by a “noxious degeneration of the yellow bile, or, alternatively, of the blood” (Jackson, 1986, p. 8). Black bile was believed to be removed from the blood through the spleen, and an overabundance could cause sickness through various methods, one of which involved it traveling up and entering the brain—where it could then negatively affect the mind. This humoural concept became instrumental in shaping thinking about melancholia for centuries to come.