Humoural Bodies and Balanced Minds

Closing keynote lecture given at the conference "Situating Mental Illness: Between Scientific Certainty and Personal Narrative", organized by Giovanni Frazzetto at the ICI (Institute for Cultural Inquiry), Berlin, April 28th-29th, 2011

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Watch the video of the talk here




It’s a tall order to speak after these wonderfully rich, wide-ranging, provocative papers – and thank you Giovanni for your generous invitation, and for organizing such a stimulating conference. Since my talk closes it, I want to take us further away from where we stand today than we have so far – beyond the immediate European past, beyond the immediate cultural framework within which we have been speaking, and also into our bodies.

I would begin, if you may, on a personal note – for my father died exactly one year ago today. So today is his Jahrzeit, and it seems perfect to mark it here - he would be proud to see me standing at this podium, and I would like to think he would appreciate what I have to say now. He died without believing in an after-life – he was too much of a naturalist, too passionate a follower of scientific endeavours to imagine that anything could survive our bodies once they stopped working, to believe that the mind could outlive the brain. He believed in some sort of soul, I think, but did not dare pronounce himself as to the possibility of its survival. Survival was of the work – he was a painter, and his work is what remains of his embodied existence.[2] He counted on that to be the case. Of course genetic material also survives – and indeed, he died knowing I was carrying a baby, his grandson, who was born two months later, guaranteeing a continuum, and representing a genetic reincarnation of sorts.

I am a naturalist too, but I always found myself arguing against what I saw as the reductionism that seemed to accompany his passion for science, and which was at odds with his belief in - and need for - the transcendental power of art, so central to his life. It seems a feature of our minds that an idea of transcendence must assert itself even where materialism is most firmly held, and I am quite sure my father was no exception. It is in light of this mitigated naturalism that I want to explore the nature of the mind, in order then to define the realm of the illnesses that afflict it. 


Western naturalism can be understood as the explanation of biological and physical phenomena by appeal to nature, rather than to gods and divine forces extraneous to the phenomena themselves. It began in 5th century BC, pre-Socratic Greece, when one started to rely on human reason, not just priestly revelation, to account also for ailments of the human body and mind. The body was at that point seen as a microcosm of the macrocosm that was the universe: each was composed of the same four elements that Democritus had classified – air, water, earth, fire. [3] To these elements corresponded four combinations of qualities – hot, cold, dry, wet. Animal and human physiology was constituted of four types of fluids, called humours, concocted in the liver out of digested foods, and endowed with these qualities. The four humours were phlegm (water, cold and wet, winter, lungs), choler or yellow bile (fire, hot and dry, spring, liver), blood (air, hot and wet, summer, gall), and melancholy or black bile (earth, cold and dry, autumn, spleen). Everyone was born with all humours, but in proportions that varied from individual to individual, were partly determined by the constellation at birth or even conception, and fluctuated according to part of body, time of day, season, location, or time of life.[5] In a healthy organism, these four humours were in proportion with each other, in isonomia. An imbalance or dyscrasia between the humours that made up the body’s particular krasis or complexion was the mark of illness.[6]

Humoural physiology thus appeared at the dawn of medicine, enshrined within Hippocratic texts that were compiled over two or three centuries, written by physicians some of whom were followers of Hippocrates, mythologized as the founder of our medicine.[7] Galen, the 2nd century AD physician, extended the role of humours to temperaments. Synthesizing the Hippocratic corpus with the psychologies of Plato and especially Aristotle, he also showed how the passions of the soul were embodied, conditioned by humoural physiology. In turn, humoural disorders could give rise to emotional disorders. It was unclear whether the one caused the other – in fact the question of cause did not arise explicitly. What seemed clear was an intimate correlation of humoural physiology with both temperament and mood - with both dispositional and occurrent behaviour, in today’s parlance.[8]

The humoural model enriched itself over the centuries, first via the Arabic and Persian translations of, and commentaries upon the Greco-Roman texts and later Byzantine compilations (humours are “akhlat” in Arabic);[9] and then within Europe itself. A guide called the Regimen sanitatis salernitatum remained popular for centuries. It was translated from the Arabic into Latin in the 12th or 13th century, combining “folk” beliefs and high theory (based on Avicenna’s Canon, al-Majusi’s Liber pantegni, and the Isagoge Ioannitii in tegni Galeni, a collection of Galenic texts established in 9th-century Baghdad and retranslated into Latin in the 11th). And it advocated a balanced life without excesses as the best way to ensure continued health and prevent ill-health – it must be said that humoural conceits, which underlied phlebotomies, purges and the like, were better at preventing than curing. Moderation was the key, in drink, food, exercise, and so on; so was adaptation to current, local climate and air.[10] One had to pay attention to what Galen had defined as the so-called “naturals” and “non-naturals”. Naturals were elements, humours, temperaments, faculties of the mind, moral qualities - and pneuma, the air, breath or spirit which was thought to be the instrument of the soul and the principle of life. The non-naturals included all the variables that could affect the krasis: air, food and drink, sleep and wakefulness, excretion and retention, humours in a pathogenic state, and the passions of the soul, which could induce illnesses of the body. These categories survived well into the Renaissance and beyond. We saw in Lisa Appignanesi’s talk how, in 1810, they made up the bulk of causes of depression. There also survived Plato’s division of the soul into a spiritual and an appetitive part, combined with the initially Aristotelian tripartite division of the soul into the appetitive, sensitive and rational parts, localized respectively in the interconnected liver, heart, and brain. (Plato had located reason in the heart and appetite in the liver.) The appetitive soul, responsible for nutrition and reproduction, was shared by all living creatures; the sensitive soul, shared with animals, gave us sensations and perception; and the rational soul was ours alone, at least in its highest aspects.[11] Humours and pneuma travelled from one ensouled organ to the other within nerves conceived as hollow, and arteries and veins, along with their respective spirits, or pneumata. These spirits underwent refinement at each stage, from appetitive in the liver to vital in the heart and animal in the brain, ensuring a continuum between perception, sensation, and thought. In short, the humoural system was holistic. It described embodied, thinking beings.[12]

This deterministic model was not reductionist. Humans alone of all animals are aware of their mortality and represent to themselves the corporeal emotions that indicate fears, desires and attachments. The centrality of what we today call consciousness in defining human uniqueness mattered all the more in a world where it was imperative to hold on to an immortal soul, not only because religious institutions ruled life quotidian and political, but, more concretely, because death was omnipresent, because the birth of a child often came along with its mother’s death, because nature was tough and life “nasty, brutish and short”. Humans must differ from the brutish animals. Hence the development, in parallel to Galenic medicine, of a moral psychology in which the absence of virtue or moral discipline was as nefarious as bad food, a reminder of animality, an illness of the soul. In turn, health was virtue, and maintaining physical and emotional balance guaranteed a virtuous disposition. Balance consisted in remedying an excess of cold with heat, an excess of moist with dry, and vice versa. On the Galenic model, it was paramount that strong emotions should be dealt with appropriately, to avoid driving the body to an excessive state of imbalance. So anger, for instance, which partook of an excess of the choleric humour – hot and dry - had to be counterbalanced with substances, foods, herbs, drinks, or pharmaceuticals endowed with opposite qualities. An excess of black bile or melancholy, which was cold and dry, could be remedied with hot, moist substances, as well as stories and soothing music or walks in fresh air. It wasn’t so much that illnesses of the mind were morally perilous as that it was wrong not to attempt to remedy them, through one’s own will, or with the help of either a physician – a doctor of the body – or a priest – a doctor of the soul.


As I argued in my book on the matter, not only did the humoural model survive for over 2500 years – it was recycled into different forms even after its demise. It could have begun to unravel with the development of comparative anatomy from the 16th century on, and especially the work of Vesalius;[13] or, a fortiori, with Harvey’s authoritative account, in the early 17th century, of the circulation of the blood via the lungs, through the motion of the heart.[14] Instead, treatments based on it continued to be performed. The psychosomatic organism allowed by the three souls model lived on even while anatomical revisions rendered this model obsolete. Descartes himself wrote about the passions of the soul, saving the psychosomatic being from the mind-body dualism he erected in the name of mechanism.[15] And what prevailed in the 17th century was the Gassendist alternative to Cartesianism, which preserved the three souls: it was more realistic and more usable. It adopted the atomism of Lucretius, that great materialist, and adapted it to the dictates of  a Christianity informed by neo-Stoicism, singling out the rational soul as beyond the purview of natural philosophy; it also took stock of innovations in natural philosophy, by turning Lucretian atoms into corpuscles. By the 18th century, one might be a mechanist, like Hermann Boerhaave, who envisioned the body, its health and ill-health in terms of hydrostatics, or a vitalist, like Georg Ernst Stahl, for whom the entire body was imbued with soul, essential to its very life. At this point, a multiplicity of theories circulated – but in effect the soul was becoming the body. To be a naturalist was to be a full-blown materialist – political conditions allowed the religious pourtours of bodily considerations to be lifted. Humours were replaced by nerves, with the likes of Albrecht von Haller and William Cullen at the forefront of a burgeoning neuropsychology and neuropathology.[16] Nervous diseases took over from humoural ailments, though ancient traditions and new notions commingled and coexisted. The very term “neurologie”, or doctrine of the nerves, for instance, had been coined in 1664 by Thomas Willis. [17] A great investigator of the brain, he explained sensation, perception, emotion and cognition in terms of the old animal spirits flowing through the nerves, and he believed melancholy, the condition usually and etymologically associated with an excess of black bile, was due to the agitations of these spirits rather than to a humoural imbalance. He still resorted to humoural treatments in his medical practise, and he claimed his studies steered clear of the rational soul.

Melancholy was in fact a broad concept – its long history begins with the Hippocratics, starts in earnest with the Problemata XXX, a text wrongly attributed to Aristotle, and has not ended. In 1586, Timothy Bright had described it in his On the Causes of Melancholy as a case of vapors “annoying” the heart and “passing up to the brain”, where it “counterfeits terrible objects to the fantasy, and polluting both the substance, and spirits of the brain, causes it without external occasion, to forge monstrous fictions”. Since the heart had “no judgement of discretion in itself”, it gave “credit to the mistaken report of the brain” and broke “into that inordinate passion, against reason”. This was the humoural genesis of mania and hysteria, which in their old acception were akin to what we call today common nervous breakdowns and endogenous depressions – and I say this with the caveat we need in any naming process, as others here have discussed. The contemporary equivalents of melancholy range from ordinary blues, unhappy romantic passion, passing depression, the mild existential pain that suffuses our everyday lives, artistic reverie - all within our capacity to control and steer to an extent at least – to the pathologized conditions of the residents of insane asylums, which today have their own aetiology, from obsessive compulsion to schizophrenia.

For a long time melancholy was thought to consist in the excessive agitation of the humours and spirits that undermined the exercise of rational faculties. But in the Enlightenment, the passage from humours to nerves as an explanatory model for mental states led to crucial studies concerning what was now named the nervous system. For Philippe Pinel in Napoleonic France, as for Francesco Chiarugi in Italy and Benjamin Rush in the US, madness no longer needed to be contained, its excesses perpetually balanced for the sake of social order by debilitating phlebotomies performed upon a passive, pathetic animal.[18] In the hands of these practitioners, the patient now rose as a human agent, endowed with a history and will power. One had to encourage the patients to access their reason, obscured as it had been by their disturbances, some of which could have an organic, cerebral basis, but many of which had “moral causes, and more or less deep commotions that have been felt in the epigastric area”, as he had written in his Nosographie philosophique (vol. 3), first published in 1798. This was a book in which all disorders were called “névroses”. The term had been coined as “neuroses” by William Cullen, on the basis of what his contemporary Robert Whytt, himself a student of the mechanist Boerhaave, had described as “illness of the nerves”. Whytt had chosen that expression after showing in 1764 that nerves were not hollow, and thus that the vapours of decomposing animal spirits or fermented female semen could not travel through them to produce symptoms of so-called “hysteria”, as had been thought. In fact the epigastric area mentioned by Pinel was the “hypochondria” of Hippocratic-Galenic medicine, and hypochondria was itself the name for a broadly psychosomatic disturbance that was the male counterpart of hysteria.

In the course of the 19th century, while psychiatric nosology continued apace, neuroscientists thought they should search for a cerebral basis for mental disturbance, often on the basis of pathological anatomy. There was a vogue for the study of spectacular aphasias, some of which had been classified as melancholy in the humoural heyday of the 16th and 17th centuries: so Robert Burton described in his great Anatomy of Melancholy [19] a man who would not sit near the fire for fear that his legs melt, for he believed they were made of butter. Freud started out by studying the brain and nervous system, in line with the neurological establishment, before giving up on that effort and turning to the notion of repression: with psychoanalysis, the mind became embodied again, detached from the brain – for mental distress often manifested as bodily symptoms. It was the observation of hysteria, understood as a psychosomatic syndrome – that is, as the corporeal symptoms of mental disturbances – that to an extent led to Freud’s developing his treatment method. In contrast, though, much of neuroscience and neuropsychiatry, captivated by that infinite object that is the brain, turned away from the embodied subjects to whom Freud was listening.

Neurocentrism endures today. And as we’ve heard, in psychiatry it is the biomedical approach to mental illness or psychic distress that has pride of place. There seems to be a consensus amongst the speakers regarding the limitations of positing an organic basis for “disorders” constructed as these are out of disparate symptoms. But not all advocates of the biomedical approach are physical reductionists with regard to the ailments they investigate or treat. And amongst neuroscientists, few are the hard-core determinists who seriously believe one can locate or reify processes in the brain - as does the media today, and as did phrenologists in the 19th century. [20] Yet the implacable inner logic of the unconscious can have an organic manifestation that is recognizable as such; and correlations between brain chemistry and debilitating depression or psychoses are important to investigate intelligently. So for instance we know that trauma produces changes in brain chemistry, that in cases of extreme fear the amygdala in the limbic system are activated and higher cortical areas are shut down, the connections between the two bypassed for the “fight or flight” reaction to occur – and so, where trauma is prolonged or repeated, deep cerebral changes will probably take place.[21] Whatever these might be, they are not the issue when there is trauma, though I think there is some grounds for hoping that the neuroscience of emotion could help calibrate the resort to chemistry of some sort that is sometimes necessary to help those in serious psychic pain. The new field of “neuropsychoanalysis” was kickstarted by Mark Solms to encourage the collaboration between neuroscience and psychoanalysis, and to help determine the boundaries of the relevance and usability to each other of each other’s data, especially in the light of the new divorce between psychoanalysis and the neuropsychological sciences.

But it is easy to disregard that whatever is left out of neurological, molecular and genetic maps might in fact be central to the map of the mind. The mind is larger than the brain, to paraphrase Emily Dickinson’s “The Brain - is wider than the Sky - / For - put them side by side - / The one the other will contain / With ease - and You – beside”.[22] It is harder for analysts to take the leap toward hard science than for neuroscientists to appeal to the humanly significant stories that emerge from couches instead of fMRI machines. Some neuroscientists working on memory, its dysfunctions and repressions (like Cristina Alberini at Mount Sinai), are making use of the “talking cure” – they understand how fruitful is the mindful working through of the passions, the quest to rebalance the ratio of conscious to unconscious by rejigging the hydraulics of repression and expression. But this use of post-Freudian psychology by contemporary natural philosophy is also limited, since the language used to describe introspective, subjective experience differs in nature from that used to describe scientific data.

Both sides, however, unite in overlooking the actual body, which even in psychoanalytic settings is only addressed as a theoretical construct. Yet without the body, its humours, spirits or pneumata and pneuma, there would be neither brain nor memory, neither fear nor desire, neither greed nor anger. We act out of bodily need, it is as bodies that we are born, that we love, remember, beget other beings; and it is the body that dies. We are mortal creatures, separate from each other yet dependent on one other; our long infancy and childhood creates not only our bonds but also our complex, tripartite souls, our fragilities, frictions, fantasies, and convictions. There is no clear boundary between these complexities or neuroses, and the disorders and delusions some of which may be born out of the refusal to accept this condition – as we all seem to agree, mental illness can be another name for acute existential distress. Hence the longevity of the notion of melancholy, which offers a continuum between ordinary perception and mad delusions. We cannot reduce mental to brain illness. Mind-brain identity remains a philosophical knot. (Which is why, pace Allen Francis, I think philosophers are all the more necessary that neuroscience makes inroads.) As was said here again and again, causal correlations don’t tell the whole human, embodied story. Even in the case of trauma I described earlier, the cerebral areas in question regulate the body’s responses, and the body continuously sends messages to the brain: the hormones and neurotransmitters released in stress situations (adrenaline, noradrenaline, cortisol) notably affect heartbeat rates. The central nervous system is humourally connected to the heart, just as it is to the guts, seat of the enteric nervous system.

From a naturalist’s point of view, this is how the humoural continuum endures - in the guise of the newly identified and named physical substrata of cognition, emotion and sensation. The old souls are as alive as ever, psyche and soma perpetually, dynamically intertwined, the one an aspect of the other. A substantial portion of medical and psychiatric treatments, not to mention pharmaceutical companies, rely on the placebo effect, that most banal of psychosomatic manifestations. Priests in the service of Asklepios, the Greek god of healing who survived as a powerful deity even into the 6th century AD, were very good at triggering placebo responses. Asklepeia, the temple complexes where the sick and dying converged, were sited on water and offered spa services, part of those high end treatments John Forrester listed yesterday, which very probably relieved many - and possibly cured a few. [23]


So we’ve returned to ancient Greece: I want to recuperate from there the idea that mental suffering is enacted in the body, and inversely, that bodily ailments can translate into mental states. For this psychosomatic organism is no longer central to the metaphysics that sustain our medical and moral psychology. Yet the growth of alternative medicines and body practices over the last decades testifies to our need to consider it more carefully. These alternatives usually come not from Greece, but from eastern cultures, like China and India, where the psychosomatic organism is a given and treatments are holistic.

Most remarkable is perhaps the increasing popularity of yoga.[24] Used in the West mostly as a source of asanas, or positions, for the sake of exercise, it is in fact one of the chief six philosophies of India. It rests on a psychology, sankhya, that is in itself a metaphysics and a cosmology, and depends on a body that is profoundly humoural. Yoga is based on a complex, manifold set of texts and practises for which asana is only one of the eight so-called limbs or ashtanga, as codified in the foundational Yoga Sutras of Patanjali.[25, 25a] Yoga is a complex technology used to enable the dissolution of the changeable, ego-driven illusion of subjectivity that separates cosmic and individual consciousness, macrocosm and microcosm. Within hinduism, the ultimate goal of yoga - of union between mind, body and spirit - is moksha, the release or liberation from avidya, ignorance of one’s true self, which imprisons one in the suffering of karma and locks one into the continuous flow of samsara, the cycle of perpetual reincarnation. Through its prolonged practice, one can eventually enter samadhi - the ultimate meditative state in which self and objects are no longer separate. This state of pure awareness marks the unveiling of purusha, or soul, the innermost, higher conscious self beyond our daily, embodied self’s constant metamorphoses, and enables the manifestation as atman, the cosmic self, of brahman, the ontic principle or ultimate reality underlying the world. [26]

Perhaps the most powerful aspect of yoga practice – and of meditation practices related to its Buddhist versions, such as zen - is the focus on prana, breath or air. Prana is the Sanskrit equivalent of the Greek pneuma, the principle of life thanks to which the operations of the tripartite soul were interconnected - and a concept that has gone missing from the biomedical model of the mind-brain. The overlap between pneuma and prana is less surprising if one considers how many notions of metaphysics and medicine are common both to pre-Socratics and to the Upanishads, even to some Vedic texts: the idea of reincarnation was adopted in Greece by Pythagoreans and Orphics, and that of brahman is close to Anaximander’s notion of the infinite. There are also overlaps with the Stoicists’ goal of achieving epistemological and spiritual purity by embracing cosmic reality or pneuma without emotional encumbrance. And the division of the world and knowledge into appearance and reality is, of course, also that of Plato’s.

The similarities and putative borrowings have been fascinatingly explored by Thomas McEvilley in The Shape of Ancient Thought, and this is a huge, important topic, fit for another conference. But I want to make good on my initial promise that I would take us beyond the immediate cultural framework within which we have been speaking. We need to do this in order to locate our ordinary, thinking selves and thus understand our pathologies, and to remember how fragile these selves are. In extreme cases of mental illness, self-representation may be jeopardized and selfhood dismantled – and this irrespective of how one is to define, diagnose or categorize mental illness. Yet isn’t the state of jeopardy also normal? Isn’t the border between normalcy and pathology porous? When Hamlet sees his father’s ghost, is he just melancholic, or is he deluded? The epistemological conundrum associated with one’s asking such questions dissolves as soon as one takes a deep breath and engages in the meditative act. And I suggest that one may dissolve the health-illness dichotomy and bypass the related problems of reductionism by returning to the roots of humoural physiology, before it became entwined with Christian metaphysics and its associated moral psychology.

The body is matter. It putrefies and dies. And so the metaphysics of mind requires a natural philosophy or science of matter – that is, the study of consciousness requires a theory of physiology. Yoga, or rather sankhya, its theoretical counterpart, is a dualist synthesis of the study of spirit and the study of matter, since purusha or atman [27] is extricated out of prakriti, primordial matter or fundamental form, of which the mind and the body are embodied products; and of course yoga enables the experiential synthesis of both, through the mastery of prana, which enables the mastery of the body-mind. Each purusha manifests itself as consciousness, or chitta, under three tendencies, qualities or aspects that characterize all of creation and are called gunas: sattva (balance, light, goodness, purity), rajas (motion, action, energy, passion), and tamas (resistance, darkness, inertia, ignorance). Chitta itself is the center of the five sheaths or koshas; around it are ego ahamkara, intellect or reason buddhi, mind manas (as perception and sensation, not brain – brain is only its tool), vital air prana (as energy), and matter purusha (physiology, including brain and spine). Mind uses brain, brain uses prana, breath uses nerves, nerves deal with the five sense organs or panchendriyas and five organs of action or karmendriyas (mouth, hands, feet, genitals, anus). Prana travels through channels or nadis, which meet as nodes at the seven chakras, or energy fields which govern the so-called subtle body and the sense and motor functions of the gross, musculo-skeletal body.[28]

Prana does not actually mean breath per se – the breath is a manifestation of prana, itself the energy or life force, the conductor of respiration and thus of conscious attention, the coordinator between senses and mind. To direct the breath is to direct the mind. The practice of pranayama within carefully calibrated asana leads to the mind’s stillness and to the overcoming of the body’s grip on itself: it enables the self to cease identifying with ceaseless motions of the mind and mental projections, including knowledge, concepts, memories, fantasies and delusions. In other words, yoga, in its various acceptions, assumes that our ordinary, conscious selves are illusions, that our beliefs are delusions, our attachments fictions, that all these idols of the mind, as Francis Bacon would call them, are the cause of existential unhappiness. Those yogis who would overcome this state are not after sanity but after wisdom, the end of suffering, and ultimately bliss. On this view, the health-illness dichotomy is irrelevant. What matters is enlightenment; though, as it happens, some yogis who follow the path of renunciation might well be construed as mentally ill, just as could be any prophet reporting visions of divinity.[29

But modern practitioners do seek sanity, health, and well-being - all dependent on the humoural balance one may find in Asklepeian spas. In India, the basis for this all-encompassing medicine is called ayurveda, or science of life: it is to the body what yogais to the spirit, and what tantra, an esoteric school historically associated with yoga but more congenial to ordinary lives, is to the mind. In both sankhya and ayurveda, emotional disorders arise when we live in adharma, out of dharma, in disharmony with the universal laws of nature. Like Greek humouralism, ayurveda relies on the correspondence between macrocosm and microcosm. So, just as the three gunas are made of the five (not four) elements or bhutas of the cosmos – earth, air, fire, water, and here ether – so are the three humours or doshas constitutive of the body: vatta or wind, pitta or bile and kapha or phlegm. And just as the gunas are the qualities of mind and spirit, so the doshas are the qualities of our body and psyche. Doshas each correspond to a different combination of all gunas, as well as to an element: vatta corresponds to air, pitta to fire, kapha to water.[30] One can thus be a sattvic, rajasic, or tamasic vitta, or pitta, or kapha. Just as in Greece, the proportions between doshas determine individual constitutions and susceptibilities, and thus which practices of pranayama and asana to engage in. But unlike the humours, the doshas are not neutral. The word itself means “corrupting agent”. In its ordinary state, the body is thus corrupted, by doshas, which can be combined in exactly 62 potentially pathogenic ways. The 63rd combination is a state of balance – so in most cases and for most people, the state of health is a perpetual process of imbalances, all the more so since, just as with Galen, the non-naturals constantly affect all aspects of it. (Woody Allen would recognize himself in this system.) In contrast, the doshas also exist in their positive form as vital essences of which prana (air) is one; the other two are tejas (fire) and ojas (water). An excess of the dosha weakens these essences. Ayurvedic treatments include foods and spices, just as does the western humoural system.

The system of trigunas and tridoshas delivers a psychopathology of mind, even though within it what we understand as “mental illness” is necessarily multilayered. There is a word for insanity or delusion, unmada, and six recognized types of mental disorders, associated with combinations of doshas as well as with external factors, all of which can be corrected through ayurvedic treatments. This is very similar to the Greco-Roman system, whereby humoural imbalances could be treated through the administration of phlebotomies and pharmaceuticals, or through a change of environment. But ayurveda, in its association with sankhya yoga, goes further.[31, 31a] For if prakriti is matter in its natural state, so vikriti is diseased matter, disorder, which can be caused by the attachments of ahamkara – ego, the sense of subjective selfhood - to its illusions. This is why the dissolution of ego through meditation, pranayama and mantra, can amount to a corrected perception of the order of things, to a clear awareness of purusha. Within sankhya psychology, the practice of yoga enables the guna of sattva to prevail over rajas and tamas - that is, for clarity and light to prevail over agitation and darkness. Psychological imbalance is a product of compounded error, of repeated reponses to a distorted vision that breeds complications, knots, neuroses. Those who are unable to attain a sattvic state suffer. Those who oscillate between rajas and tamas are deeply troubled, in our contemporary terms perhaps psychotic. They are unable to practice yoga. At best they may be drugged out of their fluctuations – with those pills that are supposed to bring order to disordered inner worlds.


Despite its many layers, accretions, emendations and variations, this extremely elaborate philosophy, only a few aspects of which I have barely skimmed over here, has broadly remained identical in its basic principles for about 5000 years. It was likely born in Mesopotamia and might well have spread to Greece as well as to India – there are seals in the Indus Valley[32] dating from the Sumerian period that depict figures in the lotus position, in a Sumerian style. Through historical accident, it has become a vital tradition in western countries where philosophy overcame its early Greek origins – as if we needed to recuperate the origins of our origins, which turn out to reside in the east once considered so remote. Here naturalism still prevails, but the consoling presence of pneuma has returned to the realm of nature. Disorders can be understood as disharmony between elements, as a psychic arrhythmia, blocked channels, a lack of breath. For Tibetan buddhists, death starts to occur when prana ceases, dissolving out of the individual body and into consciousness.

My father had learned some Sanskrit in his early twenties. He remembered fragments from the Upanishads, and he was the first person to tell me about atman and purusha. I have only begun to understand what these are now. Here [33] is Shiva Nataraja, Shiva as the Lord of Dance. The rather positivist neuroscientist V. S. Ramachandran ends his latest book, The Tell-Tale Brain: A Neuroscientist’s Quest for What Makes us Human, by reminding us how, in Hindu terms, what we – we as in scientists and naturalists, but also ordinary, psychologically bound humans – take to be knowledge is in fact an illusion, and nothing but ignorance. “It’s the illusion”, he writes, “that all of us scientific types suffer from, that there is nothing more to the Universe than the mindless gyration of atoms and molecules, that there is no deeper reality behind appearances. … It is the logical delusion that after death there is nothing but a timeless void. Shiva is telling us that if you destroy this illusion [the demon Apasmara] and seek solace under his raised left foot (which he points to with one of his right hands), you will realize that behind external appearances (Maya), there is a deeper truth.” This sculpture is perhaps the best known depiction of the Hindu conception of the cycle of life: it is a conception that my father might have agreed with. It is one which, I think, makes beautiful sense.

© Noga Arikha


Passions and Tempers

Passions and Tempers: A History of the Humours

A 2500-year journey that explores the origins of humours in ancient Greece through the present day. Published by Ecco (HarperCollins). Read more.



Articles and Essays

Body and Soul

Written for Lapham´s Quarterly issue on "Flesh".


Lectures and Academic

A New Republic of Letters?

Talk given at conference on Global Humanities, Italian Cultural Institute, New York.


Humoural Bodies and Balanced Minds

Keynote talk given at conference "Situating Mental Illness", ICI, Berlin, spring 2011


La quête de l´équilibre: âme, vertus, humeurs

Piece published in the French journal Corps (March 2010)


"Just Life in a Nutshell": Humours as Common Sense

Written for a symposium on "Folk Epistemologies" at Columbia University, in 2007. Published in The Philosophical Forum.


Opaque Humors, Enlightened Emotions, and the Transparent mind

Published in the journal Res: Anthropology and Aesthetics (Harvard University Press), issue 51, spring 2007.


Chronological Archive