Hamlet: A Humoral Diagnosis

By Sarah Holland, December 1996

The essay that follows was researched and written by Sarah Holland as part of the course on Shakespeare by Individual Studies, 1996; it is reprinted here with her permission. While copyright is retained by Sarah Holland and the University of Victoria, this material may freely be used for educational and non-profit purposes, so long as the author and source are cited.
Please remember that plagiarism is not research.

Dr. Laurentius M.D.: "How are you doing today, Hamlet?"

Hamlet: "...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, [sigh]" (1.3.303)

Dr. Laurentius: "Tsk tsk. My boy, it's obvious. You've got a bad case of melancholy."

As identified by a modernized Dr. Laurentius, Hamlet is a case study in humoral imbalance. Shakespeare and his contemporaries thought about the physiological processes of the body and their relation to the mind and soul within the framework of the four humors. Hamlet's "antic disposition" and emotionally consuming deliberations are less perplexing when he is seen as an example of a melancholic individual. One could question whether his humoral disproportions were excessive to the point of provoking true insanity, but this is not the object of this paper. After briefly outlining the Elizabethan humoral physiology-psychology, I will apply the treatise of the sixteenth century Laurentius to the character of Hamlet.

The dominant theory of medicine and much of its practice in the Elizabethan Age was derived from the ancient Greeks. Galen of Pergamon, a surgeon of gladiators, spent most of his second century A.D. career in Rome. His writings incorporated the works of Hippocrates and two leading Alexandrian physicians, Erasistrates and Herophilus. His works comprehensively rationalized and systematized ancient Greek medicinal knowledge and exercised authority for over fourteen centuries (Hoeniger 71). By Shakespeare's time, errors had been pointed out in Galen's work and there was growing skepticism towards his theory and method. Galen's basic assumptions persisted widely, however, and Shakespeare makes frequent use of traditional Galenic notions and utilizes his audience's familiarity with them.

Galen believed that all material things were composed of earth, fire, water and air. Each element was characterized by two primary and opposite qualities: warmth versus coolness, moisture versus dryness. Being material, human beings were made up of particular individualized combinations of the humors, which were analogues of the four elements. Like Aristotle, Galen assumed that everything in the body was purposeful as a part of a complex living building (Clendening 41). The four humors phlegm, choler, yellow bile and black bile worked in tandem with each other. Health, both mental and physical, was determined by blended or properly proportioned humors, sickness and disease by improper proportions. The influence of the humors extended beyond the physiological realm and different humors were linked directly to certain psychological or emotional characteristics.

It was a common Renaissance scholarly belief that the works of ancient Greece were superior to anything produced since. Thus, the Galenic conception of humoral physiology and psychology was extremely influential in Shakespeare's day. Andreas Laurentius (1558-1609), one of the most prominent physicians of the period and Professor of Medicine at Montpellier summarized:

...there are four humours in our bodies, Blood, Phlegme, Choler and Melancholie; and that all these are to be found at all times in every age, and at all seasons to be mixed and mingled together within the veins, though not alike for everyone: for even as it is not possible to finde the partie in whom the foure elements are equally mixed...there is alwaies someone which doth over rule the rest and of it is the partie's complexion named: if blood doe abound, we call such a complexion, sanguine; if phlegme, phlegmatic; if choler, cholerike; and if melancholie, melancholike (Laurentius 84).
Like the four elements, humors were characterized by two qualities. Blood (like air) had the qualities of heat and moisture, phlegm (like) water had coldness and moisture, yellow bile (like fire) had heat and dryness. The earth was considered the heaviest of elements and melancholy, with its coldness and dryness, was seen as the heaviest of the humors.

While the doctrine of the four humors may seem improbable today, it did rest on an empirical basis. Blood and phlegm, for example, look different, smell different and taste different. Medical diagnosis was aimed at determining the status of the humoral mixture in the body. A physician might examine the humor in the blood by tasting. If the blood contained an excess of choler it was thin and bitter, phlegm was tasteless and liquid, blood itself medium red and sweet, and melancholy murky and sour (Hoeniger 104). Once a physician diagnosed a patients humoral condition, he sought either to remove or counterbalance the humor whose excess caused the trouble by bloodletting, purging or administering an enema or to strengthen deficient humors with diet or drugs.

The physiological aspects of the four humors were inextricably linked with the psychological. Different humors were linked directly to certain passions. While Laurentius deals little with the passions of the mind and their effects on human functioning, Robert Burton discussed it in his Anatomy. He describes how the passions of the mind influence the body humours, thereby producing changes in the body and mind:

For as the Body works upon the mind, by his bad humorurs, troubling the spirits and sending gross fumes into the Brain; and so per consequens disturbing the Soul, and all the faculties of it.... [so] the mind effectually works upon the Body, producing by his passions and perturbations, miraculous alterations (Edgar 208)
One's particular humoral disposition dictated one's temperament, constitution or complexion as the Elizabethans called it.

Melancholy had a specialized and essential role in the function of the body. It served to feed the spleen and protect the blood from becoming too thin. (Hoeniger 106). Laurentius describes in his Discourse of the Preservation of Sight: of Melancholike Diseases: of Rhuemes and of Old Age, the symptoms of a man with a dangerous excess of melancholy:

The melancholike man... is out of heart... fearfull and trembling... he is afraid of everything... a terror unto himselfe... he would runne away and cannot goe, he goeth always fighting, troubled with... an unseperable sadnesse which turneth into dispayre... disquieted in both body and spirit... subject ot watchfullness, which doth consume him... dreadful dreams... he is become as a savadge creature haunting the shadowed places, suspicious, solitarie, enemie to the sunne, and one whom nothing can please, but only discontentment, which forgeth unto inselfe a thouand false and vain imaginations (Laurentius 82).
According to Laurentius' symptomatology, Hamlet is suffering from severe humoral imbalance. Evidence from Shakespeare's text directly and convincingly correlates to the portrait of Laurentius' melancholike. Hamlet is "out of heart"; all the other characters in the play notice how "th'exterior nor the inward man Resembles what it was"(2.2.7) and they are puzzled by his words and actions. When he visits Ophelia he is "fearfull and trembling", "Pale as his shirt, his knees knocking each other "(2.1.81). It seems to Ophelia, that he is "afraid of everything", she describes he had "a look so piteous in purport, As if he had been loosed out of hell To speak of horrors"(2.1.82). Hamlet's conflict is within himself; berating his indecision he calls himself an "ass", a "coward", indeed, he is "a terror within himself...he would runne away and cannot goe." Hamlet is "troubled with ...an unseperable sadnesse which turneth into dispayre" to the point of considering suicide:
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 (1.2.129).
Hamlet is "disquieted in both body and spirit" telling his mother "I have that within which passes show; These but the trappings and the suits of woe. (2.1.86) Hamlet is not sleeping well, he is "subject of watchfullness, which doth consume him, describing to Horatio "Sir in my heart there was a kind of fighting That would not let me sleep"(5.2.4). He complains of "dreadful dreams" to Rosencrantz, complaining magnificently: "O God, I could be bounded in a nutshell and count myself a king of infinite space, were it not that I have bad dreams."(2.2.258). Hamlet is "suspicious", grilling Rosencratnz and Guildenstern: "Were you not sent for? Is it your own inclining? Is it free visitation?" (3.1.280) Hamlet is "one whom nothing can please, but only discontentment", damning all the world, he exclaims:
        ...O God, God,
How weary, stale, flat, and unprofitable
Seem to me all the uses of this world?
Fie on't, ah fie, 'tis an unweeded garden
That grows to seed. Things rank and gross in nature
Possess it merely (1.2.132)
Horatio observes how this distress "forgeth unto itselfe a thousand false and vain imaginations", noting "He waxes desperate with imagination"(1.4.87) and that Hamlet speaks in "wild and whirling words"(1.5.131).

Using Laurentius' description as a checklist provides ample evidence for a melancholic diagnosis. Hamlet's behavior was indicative of his melancholic imbalance; his depression, anguish and reticence in avenging his father are distinct symptoms of his humoral disorder. At the risk of sounding trite or even facetious, I wonder how different the play would have been if someone had simply relieved the poor boy of his bad blood.

Works Cited

  1. Clendening, Logan. Source Book of Medical History. New York: Dover Publications, Inc. 1942.
  2. Edgar, Irving I. Shakespeare, Medicine and Psychiatry. New York: Philosophical Library, Inc. 1970.
  3. Hoeniger, David F. Medicine and Shakespeare in the English Renaissance. London: Associated University Presses, Inc. 1992.
  4. Laurentius, Andreas. A Discourse of the Preservation of Sight: of Melancholike Diseases: of Rheumes and of Old Age (1599). London: Oxford University Press. 1938.

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This page last updated April 8 1997.