In 1085 AD, a Lombard princess named Sichelgaita ripped up her cheeks with her nails and tore out her hair while delivering a eulogy for her husband, who was still alive. Apparently, Princess Sichelgaita’s actions were no cause for alarm among those who witnessed them. As documented in the first-recorded medical compendium focusing primarily on women’s health, there were enough prescriptions for this kind of behaviour that modern academics assume women in Salerno of that era were incredibly prone to melancholy and passion — and to receiving treatment for it. After all, black bile, it was believed, caused not only sadness, but also lovesickness, irrational behaviour, and uncontrolled physical impulses. The standard treatment? A facial balm brewed from bird grease. Over the centuries, other melancholics have received anything from a change in diet to a controlled session of bloodletting in order to quell their pain.
In Salerno, a small port city in Italy along the Tyrrhenian Sea and the European seat of medical theory in the Middle Ages, 11th-century physicians knew what they were doing when it came to wellness. The medical theory at the time was none other than the four humours of ancient medicine — whereby the blood, phlegm, black bile, and choler in your body supposedly dictated your physical and psychological well being. First conceptualised by the Ancient Egyptians and Mesopotamians before being systemised in Ancient Greece, the humours were then expanded upon by the Islamic empire and subsequently the European Middle Ages. It was the only accepted medical theory for 2,000 years in the Middle East and Europe until just a couple of centuries ago. Physicians bloodlet Mozart, sick with rheumatic fever (caused, they thought, by an excess of black bile in the brain), and George Washington, who woke up one morning with a sore throat (this time the diagnosis was inflammation of the throat, to be relieved via bloodletting). Neither worked; academics still debate whether they died from the bloodletting procedures.
Black bile, also known as melancholy, is the humour that remains most recognisable today. Mythologized by Shakespeare, Ben Johnson, and countless others, the disease was first written about by Hippocrates in the 5th century BCE, who listed its symptoms as despondency, irritability, and sleeplessness. His successors added delusions, passions, obsessiveness, sensitivity, and madness to the list. Robert Burton, author of the riveting The Anatomy of Melancholy, writes that Dido’s suicide was due to melancholy, as was Medea’s rage. Black bile, cold and dry, was stored in the spleen; however, when it travelled to the brain, the excess of liquid caused extreme despondency and even death.
Today, we’d call Princess Sichelgaita, along with Dido, Medea, and countless others, 'unwell', a colloquial phrase used by millennials and Gen Z to talk — and often joke — about undiagnosed malaise. While the phenomenology has changed over time, melancholy hasn’t gone anywhere. Now, it’s understood as anything from depression to a passing sour mood to a deep, perhaps daily, existential dread — and yes, many of us are diagnosed or undiagnosed melancholics.
How do we treat our melancholy today? Surprisingly, not all that differently. Even with psychiatry and therapy at its least taboo, we still use similar tools and language as the ancients to understand and balance mood disturbance. As Noga Arikha writes in her deeply researched book Passions and Tempers: A History of the Humours, the ancient treatment for melancholy included “exercise, moist foods, massages, baths, music, poetry, exemplary tales from the lives of sages, and sexual distraction.” In other words, it’s what we now call self-care, and encompasses things like cult exercise classes like spin classes, mindfulness seminars, wellness retreats, along with countless social media accounts from wellness “experts” — sages, perhaps. Arikha also cites helpful treatments for melancholics like “light and gardens, calm and rest, purges and laxatives” and “warm baths with moistening plants.” The ancient treatments are like a modern-day mental health how-to, practised with fervour in the company of our many houseplants.
Thankfully, bloodletting is no longer recommended as a cure for our darkest mental states. Instead, we have medication prescribed for clinical depression. But depression has been difficult for psychiatrists to categorise since its inception, and today, the word “clinical” is used to signify that medical resources — whether they be medication, analysis, or therapy — must step in. And even when people utilise medical treatment for depression, they often supplement it with other tools and remedies, from supplements to exercise to astrology, the latter of which was also used by many ancient and medieval physicians to understand mood disturbances.
Often called “proto-psychology,” the humoral theory dictated specific personality traits — not unlike astrology. The basis of the theory is that everyone is born with a unique balance of the four bodily liquids that can change based on environment, diet, season, and age. If you’re prone to melancholy — black bile — you’re morose and obsessive, but you’re also sensitive, highly analytical, and your intuition may simply suggest that you’re in tune with a higher power, like God. If you have an abundance of blood, you’re happy, perhaps even to a delusional degree — so happy you’re apathetic to the suffering of others. Phlegm? You’re the peacemaker and the kindest of them all — but you’re also sluggish and lazy. Have a lot of choler and you’re in for some fun; you’re irritable, prone to bouts of rage, ambitious and gregarious. Like with all personality tests, everyone has aspects of each type of humour, but usually one or two temperaments are more pronounced within someone, thus creating your unique and individualised self.
Though this might not sound scientific, it undoubtedly sounds familiar. Today, we’re inundated with everything from personality type quizzes to memes that break down what kind of people we are. Dr. Roxanne Sholevar, MD, a psychiatrist in Boston, theorises that astrology — a tool to understand the individual psyche — has become popular again because talking about mental health has become less stigmatised. “People are trying to gain insight into themselves by being more introspective,” Dr. Sholevar explains. It was similar the last time medical astrology was in wild vogue during the 16th century in Europe, where, Arikha writes, astrology “called for reflection, not abdication of responsibility.”
That we are prone to self-reflection is not new, nor is the fact that we constantly seek to self-improve; we are a distinctly anxious species terrified to exist in ambiguity and uncertainty in a world that is ever unstable. The stakes have always been high in this arena of mental and physical well being. Ancient physicians — Hippocrates, Galen, Ibn Sina, and Al-Razi, among many others — were also philosophers, and they were deeply concerned with whether the body was a vessel for the soul; moderating its ailments helped you reach the goal of living a good life. Today, we don’t have appointed philosopher-doctors who subsequently tell us how to treat our bodies and minds (nor do I think we should; although, Dr. Fauci tried!). In fact, many of us don’t have a spiritual community at all — nor a primary care physician. Instead, we have the influx of direct-to-consumer brands and a capitalist economy that profits off our unmet needs. When modern medicine cannot help — either because it is inaccessible or unaffordable, or because we can’t find treatment — we rely on alternatives. They offer cures much in the way ancient medicine did — through miraculous healing and fervent testimony in the shape of customer reviews.
I often think of Trota of Salerno, the first female professor of medicine, who was known throughout Italy in the 11th century for her healing powers. Many academics debate whether Trota was a woman, although there are records from 12th-century Anglo-Norman writers that describe travelling to Salerno to see a famous female doctor, assumed to be Trota. The medical compendium, The Book on the Diseases of Women According to Trota, includes everything from gynaecology and dental care to makeup and mental health; there are instructions on how to combat an itchy vagina (take camphor, litharge, laurel berry, and egg white to mix into a pessary or enema) and abdominal pain (draw a bath with saxifrage, sea holly, old cabbages, marshmallow, root of dovesfoot cranebill), as well as removing wrinkles (take the juice of stinking iris, which will “raise” and “erupt” the skin, causing it to be “pulled off” to appear, ultimately, “delicate”).
No, the manual should not be used for modern gynaecology today, despite the fact that heating compresses can, for example, help manage endometriosis pain. But, its language speaks to modern-day concerns with cosmetic and spiritual betterment through wellness. The treatment for removing wrinkles resembles retinol and the ancient use of bird grease is all too similar to skincare trends involving, as Jia Tolentino writes in her 2017 New Yorker essay on skincare as coping mechanism, “donkey milk, snail slime, placenta cream, pig collagen.” When Tolentino bought “a cleanser that made your dead skin cells come off like eraser scraps,” she was “unsure if [she] was buying skin care or a psychological safety blanket, or how much of a difference between the two there really is.”
In the 18th century, modern medicine finally moved on to focus on germ-theory, cellular pathology, and the cardiovascular system, yet the language of the humours was still alive and well, and remains so today. It has just been repurposed by the wellness industrial complex, and we, persistently melancholic through centuries, consume it, thinking it will make us healthy and happy. Skincare brand Naturopathica sells a liquid herbal supplement named “Reishi Immune Tincture.” “The use of reishi,” the company writes, “dates back 2,000 years to Traditional Chinese Medicine where it was thought to restore energy and build immune strength.” Los Angeles’ famed health food store Erewhon plucks from ancient medical language as well. On the glass bottles for their $13 juices, the label writes, “let juice be thy medicine and medicine be thy juice.”
There are those of us who don’t purchase these products. Spending $60 on moisturiser adds up. Instead, we may make remedies and treatments at home, seeking instead a connection to Indigenous and plant medicine to make us feel whole. I’m pretty sure that the potion of ginger, cinnamon sticks, turmeric, lemon, and peppercorn that my grandmother makes me when I’m sick helps me fight off a cold, and I recommend it to my friends. Scientific proof of whether these things will make us happy or “well” is not the point, exactly. Indulging in these treatments offers a path towards betterment, and similarly to spiritual pursuits, it isn’t about perfecting the final product — it’s about the small, daily joys involved in balancing your temperaments.
What wellness is not, of course, is medicine. As Dr. Jen Gunter writes in the New York Times, wellness “used to mean a blend of health and happiness.” Now, it’s become “a false antidote to the fear of modern life and death.” There are risks — to both the individual and the collective, as can be seen during the Covid pandemic, with some people’s refusal to trust science over their instincts. Gunter emphasises how many of those who opt for alternative medicine delay medical care. There’s also the illusory truth effect, where “even a single exposure to information that sounds like it could be quasi-plausible can increase the perception of accuracy.” Most importantly, “there can be no modern wellness industry without medical conspiracy theories” — something that is reflected in the many people in America who remain unvaccinated thanks to the unwarranted belief that the Covid vaccine is more dangerous than the disease.
While there are countless things that modern medicine has illuminated, there are countless others that remain a mystery. Most of the brain is still unknown, and once-breakthrough theories, like Freud’s theory of hysteria, have been disproven. (Though even that was only removed from the Diagnostic and Statistical Manual of Mental Disorders in 1980; hysteria’s etymology, naturally, is from Hippocrates theory that the uterus is the site for mania.) Medically speaking, the humours today translate as endocrinology and neurology, two fields based on chemical and hormonal balance; two fields that are comparatively uncharted. And in medicine’s gray areas, it’s not just wellness that swoops in. There’s also the pharmaceutical industry, which has profited from the psychiatric theory that depression is caused by a chemical imbalance in the brain. The medical community can be single-minded in treating clinical depression; often psychiatrists rush to prescribe medication to balance those chemicals, without adequately warning patients that many of those medications can also be dangerous.
Here is where the melancholy in me comes out: There will always be uncertainty in medicine, and we will always fill that doubt with faith in the speculative. Medicine is a constantly evolving landscape, one where many fields are underfunded, and many conditions are riddled with variables that are simply out of the control of patients and physicians. Medicine is also unaffordable, especially in the United States, and chronic illnesses which are often misdiagnosed get little validation or proper treatment.
Only a few, tenuous trends give me optimistic pause. In the 19th century, chemist Justus von Liebig broke food down into its chemical components and advanced the notion that human bodies are universally similar, rather than inherently individualised. This trend deepened; today, many people approach nutrition by thinking less about the individual, and more about the planet. Despite the culture war America continues to fight during the pandemic, there are communities who took care of each, and frameworks of public health that shifted — ever so slightly — to consider our bodies as one with the environment. Perhaps now I am afflicted with an excess of blood; I am delusional and dangerously optimistic. I’m not sure. The industrial revolution brought epidemics of disease and illness never seen before. And we will only survive the anthropocene if we reconsider our individual health as it relates to the collective, and the planet. Daunting as that may be, it’s still possible. It’s something to believe in.
Mina Seçkin is the author of The Four Humours. It is her first novel.