From Madness to Mental Illness

We all know and understand (more or less) where mental illness comes from. Sometimes it's hereditary. Other times it has to do with drug/alcohol use during pregnancy. Sometimes it's due to vaccinations (but not really, vaccines don't do that)

Thanks modern science.

But some 400 years ago, modern science wasn't, well, quite as modern as it is now.

What people believed in was the four humors. To quote La Primaudaye (1594): "We understand by a Humor, a liquid and running body into which the food is converted in the liver, to this end that bodies might be nourished and preserved by them. And as there are four elements ...so there are four sorts of humors answerable to their natures, being all mingled together with the blood."

The four humors are blood, yellow choler, phlegm, and black bile. Any imbalance thereof in the body would cause some classification of mental disorder.

To much black bile would cause  Melancholy, classified by abnormally gloomy or depressed characteristics.

For those that are up to it, Robert Burton wrote (quite a lengthy) treatise on melancholy found here, at Project Gutenberg.


Interestingly, back then, melancholy was thought to sometimes lead to insanity, if the melancholy had been present for too long. This is obviously a stark contrast to 400 years later when we no longer know our mental illnesses to be caused by an overexposure to one of our four internal elements. Not to say that isn't close. Some mental disorders such as bipolar disorder are caused by chemical imbalances in the body.

They would use words that reflected the notion that the ratios of humors in the body placed one in a given state of mind. These diagnoses included sanguine (optimistic/silly, too much blood) choleric (violent, too much choler) phlegmatic (dull, to much phlegm) and melancholy (depressed, too much black bile). All of these were viewed as a spectrum, with somewhere in the middle being the "Golden Temperature" (i.e. perfectly healthy) and madness at the extremities.

We no longer posses such a unifying spectrum of all mental illnesses. We have identified many different causes, and have countless specific names. So we refer to "madness" as mental illness (slowly rearing away from mental retardation for political correctness). We have spectrums to denote the intensity of a given disorder, such as Autism, but they are specific to each disorder, as we now know that each one is caused by sometimes totally different factors.

Here's a question then: If one were to stage a Shakespearean play in a modern setting, do you act upon semi-obscure notions of where madness comes from, or do you adapt the play to fit modern understanding?