Depression isn’t a modern disease. It’s been recorded throughout history, and many English kings – including Henry VIII – were believed to have suffered from what their doctors would have called “excessive melancholy”. Shakespeare immortalized the symptoms of depression in Hamlet, wherein the Prince of Demark complained:
“…I have of late, but wherefore I know not, lost all my mirth, forgone all custom of exercises; and indeed, it goes so heavily with my disposition that this goodly frame, the earth, seems to me a most sterile promontory; this most excellent canopy, the air, look you, this brave o’erhanging firmament, this majestical roof fretted golden fire: why it appeareth nothing to me but a foul and pestilent congregation of vapors. …Man delights me not; nor woman neither … [I am] “troubled with …an unseperable sadnesse which turneth into dispayre … O, that this too too sullied flesh would melt, thaw and resolve itself into a dew, or that the Everlasting had not fixed His canon ‘gainst self-slaughter! O God, God, how weary, stale, flat, and unprofitable seem to me all the uses of this world!”
But how was this illness treated? What could be done to make you merry again in merry old England?
The Tudor’s embraced the humoral theory of medicine, wherein the body was composed of four “humors”, or elements, which had to be kept in balance to maintain health. These humors were earth, air, water, and fire, and each one had its own attributes and humoral fluid. Earth was cold and dry, made black bile, and produced serious or melancholy thoughts. Air was warm and wet, generated blood, and made you jolly and possibly foolhardy. Water was cold and wet, caused the body to produce phlegm, and would make you calm in the correct amounts but lethargic when it was found in excess. Fire was hot and dry, created yellow bile, and could fill you with ambition or make you too quick tempered.
If you were depressed, then you were diagnosed as having too much black bile in your constitution. This means that the cold/dry black bile had to be counteracted with hot/wet cures that stimulated the production of sanguine air. You would have been treated via food, medicine, and certain acts of physician-prescribed sympathetic magic.
The treatment would have been two pronged. First, you would have been told to eschew anything that would cause you to produce melancholy fluids, from chill-inducing dry foods to sad songs. Some of the cold and dry foods you would have been told to avoid were fresh milk, yogurt, aged cheese, mint, citrus fruits, lettuce, cucumbers, melons, fish, rabbit meat, barley and barley bread, red wine, leeks, beans, asparagus, chamomile, and oysters. If you did have to eat certain things that were considered too cold to be good for a melancholy person, such as fish during fasting days, the fish would have been “heated” as much as possible. It would have been cooked via a method that would promote humoral heat, such as roasting, rather than boiling it. Warming condiments and sauces containing hot spices – like sugar, pepper, mustard, cinnamon and ginger — could also be served with cold foods to knock some of the chill off.
You also would have been cautioned not to wear cold or dry colors and materials, such as blue linens, to facilitate the warming of your humors. In fact, you would need to shy away from blue altogether, since blue/black was the signature color of melancholy humor. That’s why to this day, we feel “blue” when we are sad or can be in a “black” mood when upset or unhappy.
In humoral medicine, astrology was a huge factor in one’s health. The moon and Saturn were astrological bodies that generated black bile, and their placements in your natal horoscope determined your risk of developing melancholy. Even if they weren’t strongly aspected in the depressed patient’s horoscope, he or she would have been warned away from going outside on a moonlit night, or wearing pearls and blue gemstones that were associated with those celestial bodies because it could worsen the feelings of sadness or prevent them from being alleviated by other means.
Secondly, you would have been asked to consume foods that built up your blood and to embrace cheering activities and apparel. You would have been encouraged to feast upon eggs, garlic, beef, chicken, duck, lamb, mutton, walnuts, apples, olives, spinach, light colored wines, mead, ale, and onions. Most ‘sharp’ spices or flavors would have been hot as well, and foods would have been prepared with cardamom, rosemary, borage, cloves, basil, bay leaves, and other warming ingredients in them. You would have been encouraged to play games and listen to funny tales and jokes, as well as taking in fresh air and exercise, especially on sunny days. You would have been urged to wear yellow, orange, and red, and to adorn yourself with gemstones (or facsimiles thereof) were associated with Jupiter, Mars, and the sun, such as rubies, garnets, rose quartz, topaz, coral, carnelian, and citrine.
Sometimes you would have had to use a fine balance between foods, because you needed the wet element in wet/cold dishes without the cooling factor, and the hot element in hot/dry comestibles without decreasing your moisture further. Dairy, which was usually considered cold, should have been off limits to the melancholy patient, but milk products were also the desired wet edibles that would relieve dryness. What to do? You could change the milk into a ‘warmer’ version of itself, such as butter or soft cheese. Butter was warming for the liver and thus was thought to stimulate helpful blood production in the depressed person. However, butter was believed to be “gold in the morning, silver at noon, and lead at night” so butter eaten in the afternoon or later would be deleterious regardless of its potential warmth. Food preparation and quality also mattered in regards to humoral characteristics. Beef that was fatty was considered warmer than lean beef, but meat baked in a pie was colder than meat that was boiled. Even the age of the animal when it was slaughtered made a difference. For instance, mutton was hot and dry, so hot/wet lamb was a better dish for treating excessive melancholy.
The humors are, of course, balderdash, but the treatments based on them weren’t always ineffective. For example, fresh air, sunshine, and physical activity help ease the symptoms of mild to moderate depression. Furthermore, one of the most popular and common ‘prescriptions’ for melancholy was to ingest St John’s wort, a herbal remedy which has been proven to be an effective antidepressant for many people. Tudor physicians would have prescribed St John’s wort because it was considered one of the hottest herbs available, and would theoretically burn away the chill of black bile. The plant was ruled by the celestial sign Leo and the sun, and imbued with the essence of fire. It was also thought to be a perfect blood stimulant because it was associated with St John, the apostle who was conceptualized to be aligned with the element of air and the astrological “water-bearer” Aquarius. Modern medical researchers believe St John’s wort is effective in alleviating depression because it either boosts production or uptake of serotonin in the brain, rather than a mystical connection with the sun and air, but the results – a decrease in unhappiness – are the same.
Hopefully, with enough spinach, roasted lamb, aromatic sauces, exercise and sunshine the melancholy patient was put aside the blues and once again become cheerful and gamesome. If not, then at least the depression was understood to be an illness – an imbalance of the humors – beyond the patient’s control, and was subsequently less stigmatized. The application of ‘willpower’ was not thought to be the cure for melancholy, the way that modern sufferers of mental illness are told to “get over it”. In that regard, the premodern medical practitioner had a better grip on the underlying involuntary nature of depression than many contemporary Westerners. Unlike today, it was understood during the Tudor era that you could but hope that you and your loved ones were lucky enough to be well-balanced and cheerful.
“And blessed are those hose blood and judgment are so well commingled, that they are not a pipe for Fortune’s finger to sound what stop she please. Give me that man that is not passion’s slave, and I will wear him in my heart’s core” Hamlet, Act 3, Scene 2