Melancholia or melancholy (; from )Burton, Bk. I, p. 147 is a concept found throughout ancient, medieval, and premodern medicine in Europe that describes a condition characterized by markedly depressed mood, bodily complaints, and sometimes hallucinations and delusions. Besides a pathological condition, melancholy could also refer to a mood or temperament and at times it was even used as a description of the human condition in general.Vinkesteijn (2025) The Language of Melancholy. Routledge.
Melancholy (or more precisely the 'black bile', from which melancholy derives its name) was regarded as one of the four temperaments matching the four humours.Vinkesteijn (2025) The Language of Melancholy. Routledge. pp 13-48 Until the 18th century, doctors and other scholars classified melancholic conditions as such by their perceived common causean excess of a notional fluid known as "black bile", which was commonly linked to the spleen. Hippocrates and other ancient physicians described melancholia as a distinct disease with mental and physical symptoms, including persistent fears and despondencies, poor appetite, abulia, sleeplessness, irritability, and agitation. Later, fixed delusions were added by Galen and other physicians to the list of symptoms. In the Middle Ages, the understanding of melancholia shifted to a religious perspective, with sadness seen as a vice and demonic possession, rather than somatic causes, as a potential cause of the disease.
During the late 16th and early 17th centuries, a cultural and literary cult of melancholia emerged in England, linked to Neoplatonist and humanist Marsilio Ficino's transformation of melancholia from a sign of vice into a mark of genius. This fashionable melancholy became a prominent theme in literature, art, and music of the era.
Between the late 18th and late 19th centuries, melancholia was a common medical diagnosis.Berrios G E (1988) Melancholia and Depression during the 19th Century. British Journal of Psychiatry 153: 289–304 In this period, the focus was on the abnormal beliefs associated with the disorder, rather than depression and affective symptoms. In the 19th century, melancholia was considered to be rooted in subjective 'passions' that seemingly caused disordered mood (in contrast to modern biomedical explanations for mood disorders). In Victorian Britain, the notion of melancholia as a disease evolved as it became increasingly classifiable and diagnosable with a set list of symptoms that contributed to a biomedical model for understanding the mental disease. However, in the 20th century, the focus again shifted, and the term became used essentially as a synonym for depression. Indeed, modern concepts of depression as a mood disorder eventually arose from this historical context. Today, the term "melancholia" and "melancholic" are still used in medical diagnostic classification, such as in ICD-11 and DSM-5, to specify certain features that may be present in major depression. The 20th and 21st century accounts of depression are the successors of melancholia in psychiatry, but melancholia (or melancholy) also had a much wider use before the 19th century. It was a subject with which not only psychiatrists and doctors, but also philosophers, poets, artists, and writers all engaged. This led to a relatively ambiguous field of meaning, in which melancholy was accommodated within an understanding of human nature on the basis of humoral theory.Vinkesteijn (2025) The Language of Melancholy. Routledge. pp 158-198
Related terms used in historical medicine include lugubriousness (from Latin ), moroseness (from Latin ), wistfulness (from a blend of wishful and the obsolete English wistly, meaning ), and saturnineness (from Latin ).
Early history
The name "melancholia" comes from the old medical belief of the four humours: disease or ailment being caused by an imbalance in one or more of the four basic bodily liquids, or humours. Personality types were similarly determined by the dominant humor in a particular person. According to Hippocrates and subsequent tradition, melancholia was caused by an excess of black bile,Hippocrates, De aere aquis et locis, 10.103 , on Perseus Digital Library hence the name, which means "black bile", from Ancient Greek μέλας (), "dark, black",μέλας , Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus Digital Library and χολή (), "bile";χολή , Henry George Liddell, Robert Scott, A Greek–English Lexicon, on Perseus Digital Library a person whose constitution tended to have a preponderance of black bile had a melancholic disposition. In the complex elaboration of humorist theory, it was associated with the earth from the Four Elements, the season of autumn, the spleen as the originating organ and cold and dry as related qualities. In astrology it showed the influence of Saturn, hence the related adjective saturnine.
Melancholia was described as a distinct disease with particular mental and physical symptoms in the 5th and 4th centuries BC. Hippocrates, in his Aphorisms, characterized all "fears and despondencies, if they last a long time" as being symptomatic of melancholia.Hippocrates, Aphorisms, Section 6.23 Other symptoms mentioned by Hippocrates include: poor appetite, abulia, sleeplessness, irritability, agitation.Epidemics, III, 16 cases, case II The Hippocratic clinical description of melancholia shows significant overlaps with contemporary nosography of depressive syndromes (6 symptoms out of the 9 included in DSM American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition. APA, Washington DC., pp. 160–161. diagnostic criteria for a Major Depressive).
In ancient Rome, Galen added "fixed delusions" to the set of symptoms listed by Hippocrates. Galen also believed that melancholia caused cancer. Aretaeus of Cappadocia, in turn, believed that melancholia involved both a state of anguish, and a delusion. In the 10th century Persian physician Al-Akhawayni Bokhari described melancholia as a chronic illness caused by the impact of black bile on the brain. He described melancholia's initial clinical manifestations as "suffering from an unexplained fear, inability to answer questions or providing false answers, self-laughing and self-crying and speaking meaninglessly, yet with no fever."
In Middle-Ages Europe, the humoral, somatic paradigm for understanding sustained sadness lost primacy in front of the prevailing religious perspective.Azzone P. (2013) pp. 23ff.Azzone P (2012) Sin of Sadness: Acedia vel Tristitia Between Sociocultural Conditioning and Psychological Dynamics of Negative Emotions. Journal of Psychology and Christianity, 31: 50–64. Sadness came to be a vice (λύπη in the Greek vice list by Evagrius Ponticus,Guillamont A., Guillamont C. (Eds.) (1971) Évagre le Pontique. Traité pratique ou le moine, 2 VV.. Sources Chrétiennes 170–171, Les Éditions du Cerf, Paris tristitia vel acidia in the 7 vice list by Pope Gregory I).Gregorius Magnus. Moralia in Iob. In J.-P. Migne (Ed.) Patrologiae Latinae cursus completus (Vol. 75, col. 509D – Vol. 76, col. 782AG) When a patient could not be cured of the disease it was thought that the melancholia was a result of demonic possession.Farmer, Hugh. An essay on demoniacs of the New Testament 56 (1818)
In his study of French and Burgundian courtly culture, Johan HuizingaHuizinga, "Pessimism and the ideal of the sublime life", The Waning of the Middle Ages, 1924:22ff. noted that "at the close of the Middle Ages, a sombre melancholy weighs on people's souls." In chronicles, poems, sermons, even in legal documents, an immense sadness, a note of despair and a fashionable sense of suffering and deliquescence at the approaching end of times, suffuses court poets and chroniclers alike: Huizinga quotes instances in the ballads of Eustache Deschamps, "monotonous and gloomy variations of the same dismal theme", and in Georges Chastellain's prologue to his Burgundian chronicle,"I, man of sadness, born in an eclipse of darkness, and thick fogs of lamentation". and in the late 15th-century poetry of Jean Meschinot. Ideas of reflection and the workings of imagination are blended in the term merencolie, embodying for contemporaries "a tendency", observes Huizinga, "to identify all serious occupation of the mind with sadness".Huizinga 1924:25.
Painters were considered by Vasari and other writers to be especially prone to melancholy by the nature of their work, sometimes with good effects for their art in increased sensitivity and use of fantasy. Among those of his contemporaries so characterised by Vasari were Pontormo and Parmigianino, but he does not use the term of Michelangelo, who used it, perhaps not very seriously, of himself.Britton, Piers, "Mio malinchonico, o vero... mio pazzo": Michelangelo, Vasari, and the Problem of Artists' Melancholy in Sixteenth-Century Italy, The Sixteenth Century Journal, Vol. 34, No. 3 (Fall, 2003), pp. 653–675, , A famous allegorical engraving by Albrecht Dürer is entitled Melencolia I. This engraving has been interpreted as portraying melancholia as the state of waiting for inspiration to strike, and not necessarily as a depressive affliction. Amongst other allegorical symbols, the picture includes a magic square and a truncated rhombohedron. The image in turn inspired a passage in The City of Dreadful Night by James Thomson (B.V.), and, a few years later, a sonnet by Edward Dowden.
The most extended treatment of melancholia comes from Robert Burton, whose The Anatomy of Melancholy (1621) treats the subject from both a literary and a medical perspective. His concept of melancholia includes all mental illness, which he divides into different types. Burton wrote in the 17th century that music and dance were critical in treating mental illness.Cf. The Anatomy of Melancholy, subsection 3, on and after line 3480, "Music a Remedy":
In the Encyclopédie of Diderot and d'Alembert, the causes of melancholia are stated to be similar to those that cause Mania: "grief, pains of the spirit, passions, as well as all the love and sexual appetites that go unsatisfied."
English cultural movement
During the later 16th and early 17th centuries, a curious cultural and literary cult of melancholia arose in England. In an influential 1964 essay in Apollo, art historian Roy Strong traced the origins of this fashionable melancholy to the thought of the popular Neoplatonist and humanist Marsilio Ficino (1433–1499), who replaced the medieval notion of melancholia with something new:
The Anatomy of Melancholy (The Anatomy of Melancholy, What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it... Philosophically, Medicinally, Historically, Opened and Cut Up) by Burton, was first published in 1621 and remains a defining literary monument to the fashion. Another major English author who made extensive expression upon being of an melancholic disposition is Sir Thomas Browne in his Religio Medici (1643).
Night-Thoughts (The Complaint: or, Night-Thoughts on Life, Death, & Immortality), a long poem in blank verse by Edward Young was published in nine parts (or "nights") between 1742 and 1745, and hugely popular in several languages. It had a considerable influence on early Romantics in England, France and Germany. William Blake was commissioned to illustrate a later edition.
In the visual arts, this fashionable intellectual melancholy occurs frequently in portraiture of the era, with sitters posed in the form of "the lover, with his crossed arms and floppy hat over his eyes, and the scholar, sitting with his head resting on his hand"descriptions drawn from the frontispiece to the 1638 edition of Burton's Anatomy, which shows just such by-then stock characters. These portraits were often set out of doors where Nature provides "the most suitable background for spiritual contemplation" or in a gloomy interior.