A Cold Black Humour

Anglican priest, was one of the most educated and widely read men of his day. He lived from 1577 to 1640 and is remembered for his influential treatise, The Anatomy of Melancholy (1). Lacking knowledge of biophysical processes, early healers sought to develop models for the treatment of mental illness. In Anatomy, Burton reviews this history as well as the most modern theories of the 17th century. At that time, melancholy referred to all mental diseases and conditions and was considered one of four humours that controlled body systems: blood was a hot, sweet, red humour; phlegm was cold and moist; and choler was hot and dry. But melancholy was " cold and dry, thick, black, and sour, begotten of the more feculent part of nourishment, and purged from the spleen. " In the 17th century, treatment for an imbalance in melancholy might have included teas, infusions, or broths of laurel, white hellebore, bugloss, marigold, or pennyroy-al — or even bloodletting with horse leeches. Burton discusses the debate on whether the brain, the heart, or some other body organ is the source of melancholy, then observes, " Our body is like a clock, if one wheel be amiss, all the rest are disordered. " This metaphor remains apt for describing the role of mental health in overall wellness. Modern integrative neuroscience demonstrates that the commonly accepted divide between mental and physical illnesses is a false dichotomy: almost all diseases are influenced by a combination of genomics, environment, and social conditions. Chapman et al have reviewed the epi-demiologic association of depressive disorders, the most common forms of mental illness, and asthma, arthritis, cardiovascular disease, cancer, diabetes, and obesity (2). Kramer, in his comprehensive text Against Depression, discusses current supporting research in neurobiology (3). Chronic stress leads to the release of stress hormones that damage brain cells, especially in the hippocampus. The hippocampus regulates this hormone release, but as it becomes more damaged, regulation decreases, hormone release increases, and more brain cells are destroyed. This cycle affects organs throughout the body so that, for example , people with a history of depression have decreased bone density, increased risk of clotting, greater brain damage from stressors such as infections, higher rates of stroke, and higher rates of heart attack. Thus, there is both biologic and epidemiologic evidence to link environmental stress and depression to neurologic, hematologic, and car-diovascular disorders. Even in modern times, …