Cancer and Melancholy — the Psychological and Physical Sisters of Disease

Cancer is known as the Emperor of all Maladies — it is aggressive, fierce and unforgiving; no other disease can be compared to it. Centuries of literature have painted all forms of cancer with the same brush; it is a battle to be fought, with little history of defeat.

When we think of cancer, we tend to picture a faceless, malevolent entity; a dictator which exploits its power through numbers. Formed from mutations in the DNA of a single human cell, the smallest of symptoms can explode into a torrent of disaster, destroying everything in its path. In today’s world, cancer frequently appears on everyone's most feared list — what with the alarming rates of pollution, radiation and the introduction of harmful additives and enhancers, cancer always seems to loom around the corner.

But it isn’t the alarming nature of cancer that is intriguing; it is the centuries of history behind cancer research, the very biography of cancer itself, that captures one’s attention. Within the centuries-long life story of cancer, one chapter has captivated me — its symbolic and historical links with mental illness, or more specifically, melancholy.

This appears to be a very strange area of interest, considering that the two illnesses are incredibly dissimilar, and are seldom associated with each other. This is exactly what makes the links between the two diseases so fascinating; what could possibly make the most feared physical illness, and the most common mental illness — two completely different worlds of Medicine — so eerily similar?

It all dates back to Ancient Greece, in the time of the famed Father of Medicine — Hippocrates. In 400 BC, Hippocrates proposed a medical theory which impacted the future of Medicine for centuries to come: humourism.

Hippocrates’ theory of humourism laid forth the idea that the body was composed of four crucial fluids, known as humours, which controlled the body’s inner balance; an excess of one fluid would result in illness. Hippocrates proposed that the four cardinal humours were blood, yellow bile, phlegm, and black bile.

An excess of blood was said to cause hot inflammations; an excess of yellow bile was said to cause jaundice, and an excess of phlegm was said to cause tubercles (the formation of large, hard nodules, commonly caused by tuberculosis), nodules of lymph, and catarrh (the inflammation of mucous membranes in bodily cavities), among other illnesses.

Black bile was considered to be the most malicious and remorseless of the four humours; any excess of it would result in the most ruthless of illnesses. In around 160 AD, a Greek physician known as Claudius Galen proposed that cancer and melancholy, more commonly known today as depression, were caused by an excess of black bile. They were referred to as the “physical and psychological diseases” of black bile.

The described characteristics of black bile itself were very fitting of these illnesses — black bile was said to be oily, thick, cold and dry, all of which have the same connotations that were associated with cancer and depression: connotations of death, fear, and negativity.

Of this link, the author Siddhartha Mukherjee writes in his book, Emperor of all Maladies, “Galen reserved the most malevolent and disquieting of the four humours: black bile. (Only one other disease, replete with metaphors, would be attributed to an excess of this oily, viscous humour: depression. Indeed, melancholia, the medieval name for “depression,” would draw its name from the Greek melas, “black,” and khole, “bile.” Depression and cancer, the psychic and physical diseases of black bile, were thus intrinsically intertwined.)”

The fluid nature of black bile was also used to explain the mental fluctuations that occur with depression, and this analogy remained prevalent in explanations of cancer well into the nineteenth century; Galen suggested that black bile, being as free-flowing and prevalent as any other liquid, would fill any void it reached, making cancer just as pervasive as the mental instability associated with melancholy. These explanations lured many doctors, and a belief system was passed through the generations.

This inevitable connection between the two illnesses has been upheld through the years, despite the theory of humourism having been debunked in the 1790s. This is largely due to the culturally construed experiences associated with both illnesses — Robert Burton, the English scholar and author of The Anatomy of Melancholy, described depression as “the character of mortality”. Both cancer and depression are experiences riddled with strong and distinct themes of mortality, where death is, more often than not, the endpoint.

Although this can be the case with almost all physical illnesses, with cancer mortality is the forefront element of the disease, which explains why it is so strongly feared in all walks of life.

The connections between oncology and psychiatry; therefore, dig deeper than simply mental illness. In 400 BC, Hippocrates proposed a medical theory which impacted the future of medicine for centuries to come: sometimes in the most unexpected ways; by studying the histories behind these connections, some of the most profound discoveries are born.