The Magazine

Four Temperaments

How medicine saw the human body for two millennia.

Jul 30, 2007, Vol. 12, No. 43 • By LAWRENCE KLEPP
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Passions and Tempers

A History of the Humours

by Noga Arikha

HarperCollins, 400 pp., $27.95

It's much better being melancholy than depressed, much less depressing. If you're depressed you take pills, but if you're melancholy you belong to a picturesque 2,500-year-old saturnine tradition in which poets and artists were practically obligated to be melancholy, as were lovers and philosophers. ("I tried to be a philosopher," the long-lost schoolmate of Dr. Johnson told him, "but cheerfulness kept breaking through.") Melancholics also have an English classic on their side, one of the thickest, most eccentric, and most unread of them, Robert Burton's meandering masterpiece The Anatomy of Melancholy (1621).

Noga Arikha's Passions and Tempers, a history of melancholia and the other three "humours" in theory and practice, doesn't meander all that much (Burton's final edition ran to nearly 1,500 pages). Arikha, who grew up in Paris and lives in London and New York, doesn't have, like Burton, a vagrant, hoarding style that reflects the cloudy condition she's writing about. Maybe she's just too sanguine. But she does cover a lot of spongy ground, turning up all sorts of strange medical conjectures, some of them supplying humor in the modern sense.

The humours were the four bodily secretions that determined health and temperament: black bile (melancholia in Greek), blood, choler, and phlegm. They were supposed to be in balance. An acute excess of one or another caused specific ailments, which were treated by herbs and regimens that promised to restore the balance. A chronic dominance of one over the others produced each of the four possible temperaments: melancholic (moody, sensitive, reclusive, imaginative), sanguine (confident, easygoing, sociable, spontaneous), choleric (irritable, hot-tempered, aggressive), phlegmatic (cool, calm, stolid, subdued). The theory was thus all-purpose, medical and psychological, a sanguine theory if there ever was one, and it lasted a long time, from its origins in the ancient Greek world around 500 B.C. until the end of the 17th century.

And as Arikha points out in her concluding chapters, it has recently been revived in more ways than one. The study of brain chemistry has led to new explanations of mood and temperament in terms of deficiencies and excesses of subtle secretions, while the vogue for herbal and "alternative" therapies has often relied on the ancient Chinese and Indian versions of keeping bodily essences in balance.

The original theory was radical in its time, closely allied to the emergence of Greek philosophy and the rationalism and naturalism that came with it. It was an attempt to explain things like disease and behavior without recourse to gods or spirits--to see nature and human nature as self-regulating equilibrium systems with their own laws. Empedocles and other philosophers had arrived at the idea that nature was divided into four elements (earth, air, fire, water), and since the body was a microcosm of the universe, it must be ruled by their counterparts: black bile (earth), blood (air), choler (fire), phlegm (water). Hippocrates, born circa 460 B.C., added empirical and ethical details, and the humours were off on their illustrious career, the fledgling medical profession hanging on to them for dear life.

Further contributions came from the 2nd-century physician Galen, the 11th-century Persian Muslim polymath Avicenna, and, during the Renaissance, the Florentine Neoplatonist philosopher Marsilio Ficino. Not to mention the quacks. Much of Arikha's book is devoted to reassuring medieval and early modern medical nonsense: Reassuring not because we've so spectacularly overcome it but because the confidence with which it was offered teaches us something about surefire medical remedies and theories in general--always irrefutably proven, always leaving town in a hurry.

There was a good deal of folk wisdom, accurate observation, and common sense involved in medical practice based on the humour system, which recommended things still worth recommending, like moderation and balance in diet, regular exercise, and avoiding stressful emotions. But most of the more speculative cause-and-effect explanations lapsed into lunacy: Women who were frightened by a black cat while pregnant would give birth to dark-haired, dark-complexioned babies, for instance, and the black moods of melancholia should be treated with white surroundings and food (opposites cure) or, on a contrary theory, by black foods (like cures like).

Standard remedies for melancholia and other complaints also included soothing music, baths, broths, and herbal infusions, plus applied leeches, methodical bleeding, "enemas and clysters, poultices," and potions, pills, and ointments made with everything from mint and saffron to turpentine. Some worked quite well, some killed the patient quite well. Much like today. The slice of Montaigne that she uses as an epigraph to one of her chapters should be displayed above the pharmacist's counter at your local drug store:

Among all my acquaintance, I see no people so soon sick, and so long before they are well, as those who take much physic; their very health is altered and corrupted by their frequent prescriptions. Physicians are not content to deal only with the sick, but they will moreover corrupt health itself, for fear men should at any time escape their authority.

There are fascinating chapters on the Black Plague and its subversive effects on both medical and ecclesiastical authority (since neither doctors nor priests could protect themselves or others), early anatomical drawings, how modern astronomy changed the view of the body, the challenge to medical orthodoxy posed by the cryptic alchemical mysticism of Paracelsus, explanations of why women were more lustful and more "witless, maniacal, and frantic from love" than men, and Albrecht Dürer's mysterious, densely detailed allegorical drawing of a pensive bearded angel, Melancolia I (1514).

She has put so much into it that it seems churlish to mention what she's left out, but this is the sort of nuisance that book reviewers get paid to be. I was surprised that she didn't cite Ben Jonson's 16th-century "comedy of humours," which includes such plays as Every Man in His Humour and Every Man Out of His Humour. While discussing the melancholic vapors of the artistic temperament, she somehow resisted the irresistible art-history classic on artists' melancholy and madness, Rudolf and Margot Wittkower's Born Under Saturn. The most famous melancholy character in literature, Hamlet, is mentioned only in passing. Rabelais, a doctor by profession who made fun of humours (along with everything else), doesn't get through the door.

And what about how the word humour went from something medical to something funny? It happened only in the 18th century, and our civilization developed a "sense of humour" only in the 19th century. It was thought by the French and others at the time to designate something peculiarly English, something bordering on nonsense, which is what the theory of the humours itself always bordered on. But Arikha has made a good story out of it, one that reminds us how easily knowing a little can be mistaken for knowing a lot.

Lawrence Klepp is a writer in New York.