Some of them [melancholics] imagine that they do not have a head. We saw something of the sort close to the city of Kairouan. We burdened his [the patient’s] head with a qalansuwa (tiara) which we made of lead and put on his head in place of a helmet. Then he realised that he had a head. – Ishaq Ibn Imran, On Melancholy

Ishaq Ibn Imran calls Rufus of Ephesus’s work “a pleasing book on melancholy”. In it, Rufus identifies three subtypes of melancholy, but focuses on one: hypochondria. “This disease starts out in the region beneath the rib-cartilage [i.e. the hypochondria] and at the [cardiac] orifice of the stomach… Yet, one could have derived this name for them [‘hypochondriacs’] from a term denoting the faculties of the soul” (Yaqb al-Kaskar, Compendium on Medicine). Rufus’s position, as with Galen’s, is that there are two main reasons for melancholy: a disposition, and a disease (or innate and acquired). The introduction to this edition seems to make the “disposition” seem almost fashionable, a la Daniel, but I don’t see (at least here) that melancholy is a fashionable disposition to have.

Melancholics believe things because their bodies back them up. For example, they might believe that they have no head because their head feels light. As opposed to the belief that melancholics are wholly surface and no substance, or that their beliefs are unrelated to their bodies, Rufus believes that the body and the mind affect each other. Also, when melancholy “settles” (as in leprosy or other disorders) there is no melancholy; melancholy is a result of black bile being diffused in the blood. The head and stomach are connected through the esophagus; the diet makes people melancholy, and what happens to the stomach can affect the head. Ingesting emetics and purging is the best remedy.

People who are scholars and spend a lot of time thinking are predisposed to melancholy. ‘Noone who devotes too much effort to thinking about a certain science (ilm) can avoid ending up with melancholy.’ How can we be certain,
if we are obsessed by illusions, that this description does not apply to us?” (Miskawaih, Epistle on the Soul and the Intellect). Melancholy is tripartate, as Galen believed; however, Rufus names only hypochondria (windy melancholy), not head or body melancholy. Galen’s thinking in the 300s is influenced by Rufus in the second century. He also influenced Ishaq Ibn Imran, whose On Melancholy was later translated by Constantine.

I am most interested in Rufus’s focus on digestion and links to mental health. I also think the case studies that close out this collection of fragments are going to be useful in illuminating what the treatment of melancholy actually looked like (and they are interesting to read in their own right). For example: “The reason for his illness was the constant contemplation of geometrical sciences; he also had social intercourse with kings.” The testimonials also make me wonder how the physicians’ claims that they have cured patients of their melancholy through songs and food measure up to the experience of chronic melancholy in the classical period (statements like “for the rest of his life, no attack recurred” (73)).