The Four Humours

Original physiology and medecine were based on a concept of the “four humours” present in the body

Physical health was seen as being dependent on a balance of the four elemental fluids of blood, yellow bile, phlegm and black bile within the body. These were allied with the four elements of Air (blood), Fire (yellow bile), Water (phlegm), and Earth (black bile). By way of an extension, the state of the human mind, personality and character was described in relation to these categories.
Blood was associated with hot and moist air, and a physiology and temperament so classified was seen as being “sanguine”, meaning healthy, happy, amorous, passionate and generous, possibly courageous, too. The ancients and medieval physicians discovered that blood-letting seemed to relieve certain illnesses, but tended to use it in many cases that were probably unwarranted. It is still used today in treating patients with Haemochromatosis, a genetic disease that results in absorption of all iron ingested in the body instead of a small amount.
A person linked to yellow bile was thought to be “choleric” because of humour hot and dry like fire. This temperament could cause violent outburst and a vengeful character, probably also resulting in recognised illnesses for this type.
Watery phlegm, being cold and moist, described perfectly the “phlegmatic” type of person whom the ancients saw as of a cowardly disposition, dull and pale, and probably suffering from illnesses of the lungs and breathing.
The cold and dry personality, on the other hand, was said to be “melancholic” and related to the black bile suggestive of the earth element. This category is still applicable today with more and more patients suffering from the “Black Dog”, depression that is more and more common in younger and younger people today.
Galen is often regarded as the father of present day medecine (or parent to be politically correct but it does not sound right). He lived a couple of centuries after the birth of Christ. He had patients who were obviously mentally ill, and they were tagged then with names such as “lunacy” and “mania”, which seem much less kind than the inoffensive “bipolar disorder” that is the preferred term today for what these people might have had. Galen prescribed alkaline spring baths for his patients with mania. I wonder how he knew to do that? As it turns out, lithium salts are abundant in many spring waters on the earth.
The story jumps to 1948 in Australia, where a young unknown scientist in the field of psychiatry, by the name of JFJ Cade, is trying to discover the cause of manic depressive illness, to use the discarded term for bipolar. He looks in the urine of those affected with the condition (as scientists naturally do, yuk) to see if there are any clues. And in the course of those investigations, for some reason, he comes fortuitously to inject guinea pigs with Lithium Carbonate. He notices that the guinea pigs become lethargic. For some reason, God knows why(! ), he decides to inject his patients with Lithium Chloride, and in 1949 published a preliminary clinical trial in the quite obscure Medical Journal of Australia. His reports showed that he had discovered something amazing, for the patients with “psychotic excitement,” as he called it, improved a great deal.
Twenty years later the Food and Drug Administration in the United States endorses Lithium as an efficacious treatment for bipolar disorder. Today it remains the frontline treatment for the disorder. Other drugs and adjunct psychotherapy are contenders only to be possible treatments. And Freud’s theory was obviously wrong: Bipolar disorder was not a symptom of repressed internal conflict, but a result of neurological mis-functioning. The rest is history. Lithium has mad such a difference in the lives of many.
What remains from these characteristics today is the rich vocabulary associated with typical personalities and the psychological, rather than physiological, health aspects linked to them. (See Eysencks’ chart above).
When I was little, I instinctively reacted to adults in my life in this way. For example, there was Uncle Eric, of whom I was afraid, because of his “choleric” disposition: the flash of his blue eyes, his jerky movements at the reins of the draught horses, red face flushed in anger and loud voice. Although he had a good heart, and I grew to understand him in later years, this image of him remained at the bottom of my consciousness. Interestingly, his main health problem became emphysema, a blockage of the lungs that could be seen in symbolic terms as caused by drying-out from lack of oxygen (too much fire!).
Uncle Garby, whom I loved, was as gentle as a lamb, generous, funny and of a more “sanguine” personality, like that of a child. He is still healthy in his nineties and outliving most of his seven siblings.
Grandma, although she was warm and loving towards me, was probably of a “melancholic” disposition towards the end of her life, when she sat in the whicker chair on the veranda and looked out at the world through her memory voice.
Grandpa (“Pop”) on Dad’s side of the family was a mixture of the “phlegmatic” and “sanguine” because he was a wise man, and had learnt how to harness his anger and sadness under a cloak of dry wit and good humour. It is interesting to note, however, that he later suffered greatly from gall bladder stones, symbolic, perhaps, of too much emotional control during his life.
So the ancients were right in their observation of the importance of balance, even if the details and evidence-base of their medecine were questionnable.

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