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Logo of medhistThe Wellcome Trust Centre of the History of Medicine (UCL)Medical History
Med Hist. 2008 October; 52(4): 567–568.
PMCID: PMC2570453
Book Review
Passions and tempers: a history of the humours
Reviewed by Fay Bound Alberti
University of Lancaster
Noga Arikha.
Passions and tempers: a history of the humours, New York,  HarperCollins,  2007, pp. xxi, 376, illus., US$27.95, Can.$34.95 ( hardback 978-0-06-073116-8). 
This is an ambitious and expansive history of the humours—of blood, yellow bile, black bile and phlegm—from the classical world to the present day. Arikha's argument is clear: “our various humours are keys to the map of our psyche” (p. 291). The peculiar blend of psychological and physiological characteristics that make us human, and individuals, has historically been understood through the explanatory power of the fluids that move around the body, and (crucially) between the mental and the physical realms. In the process, “the original four humours imagined by the ancients have been multiplied by the hundreds into hormones, enzymes, neurotransmitters, particles, and the like” (p. xix). Notwithstanding Cartesian philosophy and microbiology, the explanatory power of the humours remains intact.

Arikha's approach is enthusiastic, combining literary and medical texts, and she demonstrates a keen grasp of classical and early modern theories of the body and its workings. Despite its intellectual ambitions, however, this book is above all else a good summary of Galenism and its application throughout a range of medical theories and practices. There are times when Arikha's broad brush-strokes are insufficient to deal with specificities—the cultural meanings of the humours as material entities, for instance, receive little attention. An example of this is the simplicity with which she deals with blood as just another humour that “served the same explanatory functions as those fulfilled by humours”, rather than asking exactly why and how it was regarded as “the engine of life” (p. 190).

In many ways, Arikha's insights are correct—humoral interpretations of the body have survived for centuries as metaphors for personality types and in concepts of balance for explanations of health and disease: one need only think of the thriving alternative (now complementary) therapy movement, and a variety of non-western traditions that similarly strive for holism. And yet there is nothing particularly novel about this observation: it is an example, if ever there was one, of Roy Porter's classic reference to “old wine in new bottles”. It is also instructive that Arikha's approach to the modern period is far more selective than her approach to earlier periods, when it is easier to make things “fit”. There is no reference in her linear narrative to evolutionary biology, to experimental physiology, or to anything that lies beyond the scope of her reading of the humours as a lesson in the preservation of mind/body holism.

There are additional methodological problems above and beyond Arikha's limited source base and selectively chosen “ologies”. One difficulty is her lack of engagement with the burgeoning growth in emotion history and emotion theory over recent decades, according to which it is insufficient to talk about emotions as entities that are “in there” and that could be entirely understood if only we had the right tools to “get them out”. Emotions are generally regarded as something other than “functions of our evolved physiology” (p. 282). Furthermore, we can no longer legitimately use the terminology of “passions” and “emotions” interchangeably and without reference to their historical and epistemological context.

A related problem concerns the discrepancy between the historical sensitivity that Arikha demonstrates in her explication of historical texts, and the presentism with which she addresses modern medical knowledge. Or more specifically, how she prioritizes certain forms of knowledge over others. Because her argument needs to harness neuro-humoralism, she places considerable emphasis on modern neurobiological thinking about such concepts as “emotion” (p. 275), “consciousness” (pp. 23–4) and the “self” (pp. 280–1) as linked to the soma, and uses the works of Antonio Damasio, in particular, as evidence of the “gut-level emotive responses without which we seem unable to function” (p. 282).

There is a lack of theoretical analysis in Arikha's approach to these accounts, as though constructions of scientific knowledge as constructs must not, in this case, impede the meta-narrative of continuity amidst change. What is ultimately frustrating about the book, therefore, is that Arikha engages with the principles of scientific knowledge itself less as an act that shapes meaning and experience than as an objective yet flawed and collective endeavour to get it right. Consequently the book turns out to be more about medical “mistakes” than beliefs, and above all else the pursuit of some elusive truth. According to the author, “the book concerns itself primarily with our capacity to make mistakes even when our questions are right”. And why is this so? “In a sense, we are all children in our relation to scientific information” (p. xx). Is this really an accurate assessment of the maturity of the histories of science and medicine in the twenty-first century? If so, maybe it is time to grow up.