Galen built on the work of Hippocrates, and his writing was extremely influential in the field of medicine for many centuries thereafter. He joined the humoural qualities (warm, moist, cold, and dry) into pairs and connected them with various seasons and humours. He also developed a theory of temperaments that used the predominant humour in a person to describe his or her bodily composition. These temperaments indicated “the diseases to which a person would be susceptible, as well as the behaviors and emotions to which he would be inclined” (Jackson, 1986, p. 43). These terms were later used to describe psychological disposition in a characterological sense, but they were not initially used in this manner. When combined with the work of Hippocrates, the melancholic temperament was associated with black bile and was believed to have the qualities of being cold and dry. In addition, it was associated with autumn and the cosmic element of Earth.


The Stoics viewed emotions associated with melancholia and other passions of the soul as cognitive distortions that led a person away from what is important and what matters in life. They emphasized control, free choice, and a rational mind, and they believed that people should focus their energies on these areas rather than on elements that they could do nothing about. The Stoics believed that people should be indifferent to “external things,” as external forces are indifferent to us. Included in this category of external things were “parents, friends, children (or a lack thereof), honor, political status, whether we are rich or poor, beautiful or plain, strong or weak, healthy or sick, even whether we live or die” (Groff, 2004, p. 141). As we have little to no control over many of these areas in our lives, it was said that they belong to the realm of fate, nature, providence, and the divine. Furthermore, Stoicism held that to concern ourselves with these issues and to allow our happiness to be determined by them would only mean setting ourselves up for failure. Investing our energy and thoughts into unchangeable things actually acts against our self-interest in terms of the pursuit of happiness. Therefore, the accompanying emotions of these faulty investments were seen as completely intemperate and irrational.

The ultimate goal of Stoicism is to “attain (a) universal standpoint” that “everything is as it should and must be” “and to affirm all existence as it is, rather than how we think it should be from the limited perspective of the human being” (Groff, 2004, p. 141). This sentiment is echoed in the story of Candide, also known as The Optimist, written by Voltaire in 1759. However, the story is, in many ways, a satire on stoicism, as it depicts countless misfortunes—including rape, murder, disease, political persecution, war, and the loss of wealth, family, and true love—befalling its main character Candide and his mentor Pangloss. Throughout all of these truly catastrophic events, Pangloss reiterates the story’s moral: that this is the best of all possible worlds and it could not be any other way (Voltaire, 2012).

The Stoics believed that emotions were irrational, violent, and, by their very nature, excessive. They likened them to diseases that should be cured and believed that they should be eradicated from the individual entirely (Groff, 2004, p. 141). The only acceptable emotions were known as “good affections,” which included cheerfulness, discretion, and a virtuous habit of will; these were “species of quiet emotion befitting the wise,” in contrast to the turbulent passions that were more characteristic of melancholia (Jackson, 1986, p. 17). Emotions that could not be considered good affections were, thus, relegated to the domain of vice. By framing emotional experience in these terms, Stoicism contributed to judgments on morality that were infused into societal conceptualizations of mental illness. Those who demonstrated composure, moderation, and reason were considered virtuous and therefore good, whereas those who exhibited untempered passions were said to be indulging in vices and were therefore considered bad. This way of thinking reduced the workings of the mind to a matter of moral constitution, and treatments dating all the way into the 19th century reflect this. Some cultural groups to this day maintain a moralistic view of psychological distress. This viewpoint led to the implication that rather than suffering from a condition that caused pain over which they had no control, persons struggling with melancholia were actively choosing irrationality and madness over reason. The Catholic church was no help in this regard. Acedia and tristitia, conditions quite similar to melancholia and sometimes used interchangeably with it and each other, were viewed as sinful by the church and contributed to the widespread societal vilification of those who suffered from emotional pain.

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