Descriptive Psychopathology: The Signs and Symptoms of ...

24 Section 1: Present, past, and futuredisorder and was understood to include episodes of mania. Catatonic stupor wasreported. 10The humoral theoryAmong classical Greek ideas, the humoral theory of disease and mental illnesswas the longest lasting. Hippocrates formulated four basic body substances, orhumors: blood, phlegm, and black and yellow bile. In balance, these humorselicited health. 11 Imbalance led to illness and behavioral deviation. Diseases weregrouped and named by the humor considered fundamental to their expression.“Melancholia”, for example, refers to the belief that it was an expression of excessblack bile (melan, black and choleric from the gall bladder). Temperament deviationswere recognized as sanguine (an optimistic cheerfulness), melancholic(a pessimistic sadness), choleric (a general irritability), and phlegmatic (a tendencytoward apathy). Chaucer, Shakespeare, Ben Jonson, and George Eliot, amongmany writers, relied on the humor construct in rendering fictional characters, andhumoral descriptors of personality remain part of modern usage.The humoral theory held sway until the end of the nineteenth century,accounting for treatments such as purging, blistering, bleeding, and cupping.George Washington, the first president of the USA, was excessively bled for whatwas likely a Strep throat, accelerating his death. 12Religious dogmaReligious dogma dominated Western thought from the fall of Rome until themodern era. Its influence on the formulations of mental illness and behavioraldeviation was varied. Zilboorg, a psychiatric historian of the mid-twentiethcentury, paints the uniform picture of mental illness in the European MiddleAges as widely attributed to evil possession or sinful choice. He describes suffererschained in dungeon-like structures, tortured, and burned as witches. 13 This wasnot always the case.In addition to religious dogma, interpretations of behavioral syndromesincluded the humoral theory and physiological and psychological notions ofetiology. The blending of such differing ideas was not troubling to medievalsociety. Celtic Ireland, while attributing madness to supernatural forces, alsorecognized it as illness and developed a detailed legal system for the care of thementally ill (the Bloodlyings Code). 14 The early Anglo-Saxon tradition alsoadvanced “cures” for persons with “troubling of foul spirits”. 15The English legal system for incompetence was most advanced. The psychiatricallyafflicted were characterized as either “natural fools” or “idiots” (developmentallyimpaired from birth or shortly thereafter), or as non compos mentis(all other behavioral disturbances). Adjudicated under the aegis of the Court of