The Anatomy of Melancholy: how Robert Burton helped shape our understanding of the mind

One such story that was included in Burton's book was that of the non-urinating Italian man – a case study that might surprise modern readers. The 16th-century writer André du Laurens, physician to King Henri IV of France, records what happened: the patient told his doctors that he would rather die than go to the toilet because, if he relieved himself, he would drown his home city of Siena.

At first the patient’s physicians tried to reason with him. They pointed out that the cubic capacity of his bladder was hardly equal to the task of submerging a whole city. Even 10,000 people, they said, would not be able to flood a single house. But the gentleman would not be convinced.

Seeing that his life was now in danger, the doctors hit on a novel treatment – if an extreme one. Rather than trying to persuade him through logic, instead they entered into his delusory state. They started a fire in the house next door and triggered Siena’s fire alarm system – the ringing of church bells. The servants became bit-part actors in the drama, shouting out: “To the fire, to the fire!” Then the civic worthies came to visit the patient. They pleaded with him for help: there was only one way to save the town, and that was if he urinated and put out the fire.

So this melancholic man realised the danger and stepped up to the challenge of being Siena’s first human fire hose. As he relieved his bladder, he was instantly cured. The doctors’ unusual treatment succeeded, its elaborate and even theatrical method enabling their patient to live out his false belief and – quite literally – flush it out of his system.

What was Robert Burton's definition of melancholy?

During the 16th and 17th centuries – the cultural high-water mark of melancholy – the condition was seen as slippery, infinitely varied in its manifestations, and nearly impossible to categorise.

Burton says of sufferers that there are “scarce two of two thousand that concur in the same symptoms. The tower of Babel never yielded such confusion of tongues, as the chaos of melancholy doth variety of symptoms.” While one patient feared urinating, another was convinced he was made of glass; one thought he had a giant head; another that he was a cockerel.

Some melancholics succumbed to despair and met a violent end; others simply wasted away with shame or embarrassment. Burton doggedly attempted to document all the cases he read, comparing himself to a “ranging spaniel” who picked up a scent and pursued it to its end.

Scratching the itch

Why did Burton devote himself to chronicling this condition? He observed that he suffered from melancholy himself and was driven to write about it as a form of self-therapy, or even as a symptom: “One must scratch where it itcheth,” he said. That claim is borne out by the history of his book. After the Anatomy was first published in 1621, five more editions appeared, each enlarged with new stories of melancholy he had found through his omnivorous reading from the shelves of Renaissance learning: medicine, history, philosophy, theology and literature. In 1651, 11 years after Burton’s death, his publishers printed the sixth edition of the Anatomy, now grown to more than half a million words.

Why were people fascinated by melancholy?

The Anatomy clearly captured the imagination of English Renaissance readers. But what was it that made its subject so appealing? A major reason is that melancholy was seen as a fashionable ailment. From ancient Greece onwards, the condition was associated not only with sadness and fear, but also with intellectual and creative genius. The pseudo-Aristotelian Problems asked the question: “Why is it that all those men who have become extraordinary in philosophy, politics, poetry or the arts are obviously melancholic…?”

In the late 15th century, the Italian Neoplatonist scholar Marsilio Ficino argued that melancholy was the companion of scholarly introspection. Drawing on astrological theory, he claimed that Saturn cast its influence over deep thinkers, bringing contemplative wisdom but also a kind of holy madness. This brand of melancholy gave a dark glamour to the condition: it was a source of inspiration to artists and writers, while young gentlemen of the Tudor period fashioned themselves – like Hamlet – as lone, pensive figures, wearing black. Put simply, it looked good to be melancholy.

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Bewitching thoughts

Yet being melancholy was far from a safe occupation, as Burton knew all too well. He describes it as like a Siren, that mythical creature who lured sailors to their watery deaths through her sweet singing. Melancholy can start out pleasantly enough: a person might want to spend time in solitary contemplation, wandering alone in woods or down by the river. “A most incomparable delight it is so to melancholise, and build castles in the air,” he comments. Though seemingly innocent, this behaviour starts to intrude on everything, until the person experiencing it can no longer control it: “These fantastical and bewitching thoughts so covertly, so feelingly, so urgently, so continually set upon, creep in, insinuate, possess, overcome, distract, and detain them, they cannot, I say, go about their more necessary business, stave off or extricate themselves, but are ever musing, melancholising, and carried along.” Burton’s language hints at the experience he is describing: each word spills into the next one, just as “bewitching thoughts” crowd into the sufferer’s mind.

Pleasurable or “sweet” melancholy isonly one side of the coin. On the other is anguish, desperation, inescapable sorrow and terror. Burton charts the many variations of this dangerous illness in his book, through the stories of those who suffered from it as well as the prescriptions given by Renaissance physicians. The Anatomy of Melancholy takes its subject seriously: Burton ambitiously attempts to delineate the wide contours of mental suffering, as they had been understood from antiquity up to the 17th century.

The etymology of melancholy and the theory of 'black bile'

Melancholy is a mental disorder that, writes Burton, is rooted in the body. The term literally means “black bile”, one of the four humours of the human body, according to ancient Greek physiology. In humoral theory, blood is hot and wet, yellow bile (or choler) is hot and dry, phlegm is cold and wet, and black bile (or melancholy) is cold and dry. These four humours are essential for living, and a healthy person maintains them in a perfect balance. But most people have a predominance of one humour, which influences not only their physical health but also their personality. As people get older, they lose some of their natural heat and moisture. This means that, while young people might be prone to the anger and passionate moods triggered by choler, older people are less hot-tempered but also tend to be more melancholic: sad, solitary and timorous.

It is not simply an excess of black bile that causes melancholy: all of the humours, on their own or in combination, can cause the condition. As Galenic medical theory
(so named after the ancient Greek physician Aelius Galenus) explains it, this is because the humours can become corrupted or burnt through sickness or bad living, producing vapours that travel to the brain and affect the imagination. This can then produce different varieties of melancholy, corresponding to the original humour. For example, while a sanguine person – someone whose humoral complexion is dominated by blood – is characteristically cheerful, a sanguine melancholic is unable to restrain his hilarity.

Such was the case of a man called Brunsellius, who, Burton tells us, was sitting at church one day when a woman fell asleep during a sermon and fell off a bench. While most of the people who saw it laughed, the sanguine melancholic Brunsellius was so overcome that “for three whole days after he did nothing but laugh, by which means he was much weakened”.

Too much “chamber-work”

Behaviour and habits could alter the “complexion” or balance of humours in the body, especially anything that used up the body’s heat and moisture – such as through sweating or riotous living. In extreme cases, this could lead not just to melancholy but to outright madness. For instance, Burton charts the case of a man in Italy who “married a young wife in a hot summer, and so dried himself with chamber-work, that he became in short space from melancholy, mad”. The older man’s lust affected not only his body, but also his state of mind.

Just as too much sex could cause melancholy, so could other kinds of excess. Burton tells the cautionary tale of a group of young men in Agrigento in Sicily who spent a long session drinking in a tavern, until they became convinced they were in a ship during a storm. To prevent shipwreck, they started to throw the furniture out of the tavern’s windows into “the sea”. Hauled before the magistrate, they knelt before him as a sea god, beseeching him to be merciful to them in return for which they would build him an altar when they reached land.

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Among the reasons why The Anatomy of Melancholy has proven popular is that Burton’s advice for dealing with this pervasive condition is often wise and humane. He may be distilling hundreds of years’ worth of learned medical theory, but he also tells his readers simple things like “hope the best” and – his very last piece of advice in the book – “be not solitary, be not idle”. While the Anatomy is a huge and unwieldy self-help book, it is also practical. Burton wants his readers to get better, not to be gripped by the sufferings of a condition that he himself knows well.

The legacy of Burton's Anatomy of Melancholy

In the 400 years since the Anatomy’s first appearance, readers have been puzzled, entertained, frustrated and absorbed by Burton’s book and the disease at its centre. It has provided inspiration for Romantic poets, source material for novelists from Laurence Sterne to George Eliot to Philip Pullman, and a rich diversion for many.

The Anatomy’s subject may have slipped from official diagnoses of mental health conditions, but melancholy still resonates in our own time. Perhaps what we can learn most from the way Burton and his Renaissance contemporaries treated this condition is its all-encompassing nature. Ranging through so many different symptoms – from sadness and terror to delusion, from despondency to wild exuberance – melancholy stands as a marker for the breadth of human fragility to which everyone was and is susceptible.

For Burton and his Renaissance contemporaries, melancholy revealed how people’s bodies, minds and spirits were intimately interlinked, so much so that grief could show itself in a skin rash, or a physical sickness in an unshakeable low mood. As Burton concludes – though far from hopelessly – melancholy touches us all, for it is no more or less than “the character of mortality”.

Dr Mary Ann Lund is associate professor of Renaissance English literature at the University of Leicester. She is the author of A User’s Guide to Melancholy (Cambridge, February 2021). BBC Radio Four's The New Anatomy of Melancholy is available on BBC iPlayer

This article was first published in the December 2021 issue of BBC History Magazine