Training Clinical Psychologists for a Mulitcultural World

If there could be professional psychology training programs in which the explicit commitments to social justice, where the unpacking and critiques of the values, assumptions, and practices (Prilleltensky & Nelson, 2001) in psychology were incorporated into in their curriculum, what would they look like? What would such programs contain, both in their coverage of theories and research and in their transformative practices (praxis)? I could begin at any number of points, but for now I will consider the competency of Diversity.

Multicultural Education for Social Justice

. . . multiculturalism is about social justice, cultural democracy, and equity. (Sue, Carter, Casas, Fouad, Ivey, Jenson, et al., 1998, p. 5)

In this section, I will begin by introducing some criticism of the current state of multicultural education, the thrust of which is that what began as a transformative endeavor has become controlled and diluted affirmation. I will then emphasize the importance of liberation pedagogy as praxis for social justice. The last two sections recognize the necessity of acknowledging the linguistic turn in theories of oppression and the transformative potential of postcolonial criticism for our contributions in a globalized world.

Critique of contemporary multicultural education

Multicultural education, envisioned at its inception during the 1960s civil rights movement as “an effective counter-hegemonic strategy to reverse centuries of racialized domination in the United States” (Baltodano, 2006, p. 123) has failed to achieve its goal. Baltodano mourns that,

"what began as a politically inspired counterhegemonic movement was gradually appropriated and soon became merely another mainstream policy, more and more defined by the interests of the dominant class. . .Consequently, the institutional and social policies of the multicultural project stagnated, leaving untouched the complex economic conditions that transformed the welfare state of the 1960s to the transnational, global economy of the 21^st century. (2006, p. 124)"

Stephen May (1999) concurs that multicultural education has not resulted in significant improvements for minority students, has not effectively altered majority students’ racism, nor replaced “the inherent monoculturalism of school practice;” further, multicultural education has seemed to have little or no impact on our society’s racial inequities (p. 1). The failure of multiculturalism, according to some, was its oversimplification of social power relations, its “deracialized” conceptualization of education, “an educational approach which reifies culture and cultural difference, and which fails to address the central issues of racism within society” (May, 1999, p. 2). In addition, there has been little “substantive change in the structure of teacher education and in the attitudes of teachers toward cultural diversity” (Baltodano, 2006, p. 124).

On the other hand, there are problems related to a program based on race-oppression alone. For one thing, the focus on color reinforces the binary dimension of black and white, and is thus requires a perpetual bond with its uniformly constructed oppressor. There is also the likelihood that the privileging of race obscures other potentially involved marginal subjectivities, such as gender, class, and religion (May, 1999, p. 2).

The Critical Pedagogies, as articulated by Paolo Friere, Henry Giroux and Peter Mclaren, have introduced a non-racist, theoretically sophisticated, transformative model they have linked to

"wider issues of socio-economic and political inequality. The ongoing ravages of late capitalism-particularly on the poor and the marginalized-are increasingly being addressed and contested by critical multicultural educators, again most notably in the US. . .In the process, the inexorable globalization of capital, its effects on the economies of nation-states, its links with historical and contemporary forms of racism and colonialism, and its impact on the changing nature of work and patterns of employment are also being critically examined."

The critical multiculturalists influenced by Freire and others have been criticized for their failures to effective link their theories to actual educational programming or policies.

Finally, all of the above have stayed within the boundaries of specific western nationalities, addressed themselves to “national markets with their own particular historical and ideological emphases. Little, if any, reference is made to developments elsewhere and attempts to build a cross-national perspective have been extremely rare” (May, 1999, p. 5). In my next post, I propose a shift to a transcultural education for clinical psychologist of the 21^st century.

Threats to Child Development in Developing Countries, continued

The HIV/AIDS Pandemic

According to the UNAIDS data (2006), Southern Africa is the world region most affected by HIV/AIDS, and that is where most of the children living with HIV live. Other high infection regions are in the Caribbean, Latin America, and South/Southeast Asia. South Africa, where I have direct experience, has the 6^th highest prevalence in the world; almost 20% of its citizens are estimated to be infected, and new infections are increasing with no sign of reaching a natural limit. However, the disease is not equally distributed among South African society: Black Africans have the highest prevalence (18.4%) compared to other racial groups (whites-6%; coloured-7%; indians-2%).

Indeed, while anyone can get the virus under the right conditions, HIV/AIDS is not an egalitarian disease; even in affluent countries the groups most at risk for contracting the virus have shifted to the poor, and particularly the female poor. Like the history of Tuberculosis, which today can only be found in impoverished and abandoned communities in the poorest regions of the world (or the poorest sections of western cities), HIV/AIDS is globally selective of its victims; it is most virulent among the poor in the poorest nations and there is evidence that the highest rates of infection now occur in women (Farmer, 2001; Walker, 2007).

The HIV/AIDS pandemic has perpetuated its most devastating effects upon the poor in developing countries across the world, particularly in sub-Saharan Africa, including South Africa. In 2003, one fifth of South Africa’s adults were HIV positive and 16,000 were dying every day (Hunter, 2003). The highest death rates occur among employable adults, decimating the income-generating members of communities, leading to lower tax income to support community infrastructures, such as education and the now over utilized health services. This cycle of AIDS and poverty has meant that South Africa has dropped dramatically over the course of the last five year on the scale of economic development, creating greater numbers of poor and people vulnerable to the virus and without adequate services.

While the afflicted in the early years were predominantly heterosexual men who, due to Apartheid’s system of separate homelands for Black South African employable men, who were forced to become migrants in order to earn a living for white mines and factories in large cities. Far from their wives, these men caught and spread the virus through their exchanges with sex-workers, who also had migrated to cities for money to survive. By 2003, the HIV/AIDS epidemiology statistics made a gender switch: women came to make up two-thirds of Africans infected with HIV (Hunter, 2003). South African women also came to have a higher prevalence than men; 18% compared to 13%, and that gender infection gap is thought to be widening. Women, like children, are more vulnerable than adult men because they have no power or rights in their communities. However, global statistics remind us that, even in our own country, it is poverty that makes misogyny so toxic. [UN on Women}

The high occurrence of HIV in southern African women has meant that, due to vertical infection, rates of HIV in children have also risen. About 90% of infected children get virus from their mothers during pregnancy, birth, and/or breast milk. Without antiretroviral treatment (HAART): (a) 1 in 3 infected newborns will die before age one, (b) over ½ die before reaching their 2^nd birthday, and (c) most are dead before 5 years. In Zimbabwe and Botswana child mortality rates have doubled since 1990. Tragically, only 15% of the 780,000 children living with HIV in these regions were receiving treatment at the end of 2006; every hour, 40 children die due to AIDS.

As the greatest number of infections and deaths are adults ages 20-35, the physical, emotional and cognitive impacts of HIV/AIDS on infants and children has reached a tragic scale; more and more poor households are headed by grandmothers and children who have, respectively, lost their children and parents to AIDS-related diseases. In addition to suffering the stresses of multiple losses, upheaval of their family systems, inadequate care from ill-prepared or frail caregivers, and removal from their homes, infants have been infected with the virus by their HIV+ mothers. Before ART, infection was an early death sentence for a child; with treatment, these children still face the stresses above, and many will grow up in institutional settings.

Linda Richter and colleagues of South Africa’s Human Sciences Research Center (HSCR) report that “it has been argued, particularly where children are concerned, HIV/AIDS needs to be treated as a broad developmental concern rather than as a narrow health or even public health issue” (Richter, Manegold & Pather, 2004, p. 4).

As a result of the AIDS Pandemic, a new international crisis category has emerged: “Orphans and Vulnerable Children” (OVC). These are (Richter, Manegold & Pather, 2004, p. 3):

1. Children infected with the virus
2. Children living in regions with high infection rates affected by the stress, the decrease in services and the damage to social institutions
3. Children

• Who lose a parent or parent substitute
• Who live in a household in which one or more people are ill, dying or deceased
• Who live in households which receive orphans
• Whose caregivers are too ill to continue to look after them
• Living with very old and frail caregivers
• Older than 15 years of age

HIV/AIDS has torn apart South African family structures more effectively than Apartheid’s homeland and migrant worker systems. Here is a partial list of the impact of the virus on South African families (Richter, Manegold & Pather, 2004, p. 5):

1. "The emergence of child- or adolescent-headed households
2. An increase in elderly caregivers, and children caring for old people;
3. Increases in household dependency ratios;
4. Separation of siblings
5. Family breakdown
6. Child abandonment
7. Remarriage”

AIDS has also impacted communities by producing declines in skilled and professional services, strains on health care and educational service delivery, and extreme stress on small communities who must absorb the children of the dead and dying into their care (Richter, Manegold & Pather, 2004, p. 6). HIV/AIDS is ravaging sub-Saharan societies, especially by diminishing health, welfare & education systems due to the extreme volume of needs due to the epidemic, loss of people to staff these institutions due to AIDS-related illness & death, and reduced tax-base because of the illness & death of employable persons (Richter, Manegold & Pather, 2004, p. 5).

The next set of influences on the impact of AIDS in South Africa will leave us in no doubt of its complex web of psychological, social, physical forces and needs. This set consists of the influences of gender, age, and household location (Richter, Manegold and Pather, 2004, p. 7-8):

Gender

• Education for boys valued more highly (they are considered to be potentially more economically productive), so girls are often the ones to leave school or work to care for the sick or younger children;
• Female-headed households are poorer than those headed by men;
• Female-headed households tend to allocate more of the family’s resources to children’s healthcare and education than male heads;

Age

• Infants and toddlers are most vulnerable to effects of AIDS and health risks;
• Preschoolers are vulnerable to malnourishment, abuse and neglect, poor stimulation, and lack of opportunities for schooling;
• Adolescents are vulnerable to school drop-out, sexual exploitation, and overwork;
• All children are vulnerable to the emotional consequences of multiple losses, including parents, and to being separated from their homes and communities.

Location of household

• Rural households are typically poorer and have fewer employed adults than urban households;
• Children are expected to contribute substantially to subsistence activities
• Social networks in informal urban areas are less developed and less supportive;
• Caregivers often leave their children alone because of their “livelihood activities.”

Like on the global stage, South African HIV positive children’s mental health and cognitive developmental needs have historically been neglected in the child development research and in most intervention programs. South Africa is not the only developing country lacking national psychoeducational data. Most child development research and programming has been done with U.S. and European samples, and psychologists in western nations have not concerned themselves with internationalizing their theories and studies, particularly in those parts of the globe with the greatest needs for help and understanding. In the international and national responses to the HIV/AIDS pandemic in southern Africa, “psychological” has, until recently, been considered a less important or less acute problem than HIV/AIDS affected children’s nutrition and shelter, as if, Linda Richter (2003) suggests, their “need for food and shelter is greater than their need to feel loved by others and to respect themselves” (p. 245). The 2007 HIV and AIDS and STI Strategic Plan for South Africa, 2007-2011, makes no mention of insuring that children’s conditions actively contribute to rather than undermine their emotional and social development, and by extension their academic achievement and potential to contribute to South African society. This oversight confirms the relative neglect of orphans’ and vulnerable children’s mental health and achievement by funders and policy makers, at least in South Africa. National policies that support multifaceted treatments in the services of children’s development are crucial components of meeting the first and second UN Millennium Development Goals: (a) eradication of extreme poverty and hunger, and (b) insuring that all children complete primary schooling.

As the preceding suggests, we know a fair amount about the risks and stressful conditions that occur under conditions of chronic poverty and HIV/AIDS; however, there are as yet only a few studies on the psychological effects of HIV/AIDS and poverty on South Africa’s (and other severely affected nations’) children, including their cognitive functions, academic achievement, and mental health (Cluver, 2007; Richter, 2003; Walker, 2007). For example, studies on the mental health of AIDS orphans are not only few in number but incapable being interpreted across studies; the variabilities of procedures, measures and samples used makes it impossible to come to firm conclusions. There are suggestive trends, however, such as the higher levels of psychological problems in AIDS African orphaned children, such as internalizing problems (hence depression and anxiety), symptoms of post-traumatic stress, behavioral problems, and delinquency (Cluver & Gardner, 2007; Cluver, Gardner & Operario, 2007). However, more research on the mechanics of increased mental health problems in these children is needed in order to better understand the factors in their lives “which are acting as stressors or buffers in mental health outcomes” in order to inform options for therapeutic intervention” (Cluver & Gardner, 2007, p.9).

A 2003 round-table on mental health consequences of the pandemic, compiled by the Human Sciences Research Council includes a list of people projected to be likely to experience mental health problems due to AIDS by 2015: those who are uncertain about their HIV status, people living with the infection, families and caregivers of people with HIV/AIDS, children and adolescents orphaned by AIDS, people caring for AIDS orphans, and those who fit into more than one of the previous categories (Social Aspects of HIV/AIDS and Health Research Programme, 2003, p. 40).

International and national studies are unanimous on calling for internationally accepted measures and indicators for child development for planning, monitoring, and assessment (Cluver & Gardner, 2007; Engle, et al., 2007; Irwin, Siddiqi, & Hertzman, 2007; Social Aspects of HIV/AID and Health Research Programme, 2003). “Very few of the programs that try to intervene for children, families and communities have been monitors systematically and none have been rigorously evaluated (experimentally). This has meant an over-reliance on local knowledge to the detriment of building a knowledge base on “the real impacts of AIDS” and “what the responses should be in any given context” (Richter, Manegold & Pather, 2004, p. 7).

Need for Interventions

We must also ask ourselves, where are the western psychologists when there is so much global poverty? A South African psychologist asks why it is that in psychology, have we such a “lack of knowledge in terms of interventions to prevent and ameliorate the effects of poverty on infants and small children. In our professional child development journals and conferences, why is there no strong and growing theme that expresses concern for the compromised conditions which the majority of infants and small children in the world live” (Richter, 2003, 245)?

There are urgent needs for the design and implementation of culturally sensitive and evidence based intervention programs to improve the conditions of infants’ and young children’s psychological development in impoverished communities across the globe. More than ever, psychologists need to prioritize humility and collaboration as practices by cooperating with local networks of community health services (professional and paraprofessional), community members and leaders, nongovernment organizations, and politicians in order to be effective in the developing world. Psychologists living in developing countries are hard at work trying to meet these needs, but there are not enough of them to tackle these problems on their own. Where should we Western psychologists turn, if we want to make a difference?

Thankfully, there are a number of opportunities for western psychologists to explore of sufficient diversity that we can choose the type and degree of investment we want to make from international and global psychological associations and publications. Another way we can help is to expand the engagement of psychologists and trainees in the field of international/global psychology by developing undergraduate and graduate curricula and practice opportunities.

Removing Stones and Demons: Medieval "Psychotherapies"

The image to the right (a "permanent" feature) is a painting by Hieronymous Bosch and is entitled, The Cure of Folly: Extracting the Stone of Madness. This early form of psycho-surgery was emblematic in Renaissance art.

For the time being, I will upload some images I have found. Later on, I will edit for more description and explanation.

In my previous post, I included images of demons being exorcised as examples of the association between insanity and the demonic. I have more images, which I will include below as examples of healing the 'mad'.

Removing the Stone

Let us begin with the stone removal operations. (Much gratitude to Jessica Palmer's bioephemera; I had found these images on my own, but she has well surpassed my efforts with her impressive art history annotations.) The more recent works are actually characatures of 'quacks', so I'm including them under somewhat false pretenses.

Jan Sanders van Hemessen's The Surgeon

Pieter Breughel's Witch of Malleghen

Here is a close-up of the witch at work

Frans Hals, Das Narrenschneiden

HW Weydmans, Removing the Stone

I cannot find the artist for this caricature, L'Operation Inutile

This could be mistaken for a cure of folly: it is a medieval image representing the proper cure for epilepsy


Exorcism

Christ Cures a Madman

Christ exorcises a man's demons
The Possession of St. Catherine

Exorcising frog-demons

Christ exorcising demons

Rubens' The Miracle of St. Ignacius

Images of Madness

Many years ago I had the pleasure of encountering Psychiatrist Sandar Gilman's books, Seeing the Insane (1982) and Disease and representation: Images of illness and madness to AIDS (1988). This was the beginning of what has become for me an obsession with how mental illness, medical, mental health & academic experts, science, and 'the self' have been reflected (projected?) in the arts and popular culture. Later, I discovered that there is an academic discipline that houses persons with similar preoccupations, Culture Theory.

One of the less admirable delights furnished by this arcane interest comes from learning how little awareness psychologists seem to have of the relationship between popular imagery and science. In an attempt to whipe out of my smugness, I am going to post some of the imagery provided by Gilman as well as those I've hunted down myself. I want to popularize popular culture's views of psychological (scientific) matters, as it were.

Images of Insanity, according to Gilman, began to show up during the Middle Ages with such stable features that a veritable iconography for the appearances of persons living outside the boundaries of sanity at the time. These were the Maniac, the Possessed, the Wild Man, the Melancholic, and the Holy Fool.

To those living in medieval Europe, madness was conceived of as a primitive power of revelation capable of upsetting the fragile illusion equilibrium and exposing the terrible perils, desolation and evil that riddled the world.

The wild man resembled an animal more than a human, which secured him a place outside of the higher realm of humanity. He carried a stick, like the Fool, and represented the chaos, isolation, and rootlessness viewed as an anathema to denizens of medieval European towns, villages and rural hamlets.

Madness was understood to bridge the world of appearances in which people lived their lives with all that was sinful, monstrous, inhuman, and unnatural. This realm of nightmare was accessible as temptations to sin, coming to the sane in dreams. The visions of madmen were the dreams of the rest of humanity. The growing preoccupation of Europeans in the late middle ages and early renaissance came in part from their experiences with the decimation and physical horrors of the Black Death, or Bubonic Plagues.
The painting on the left is a wing from the amazing Isenheim Alter, painted by Matthias Grünewald. It is called the Temptation of St. Anthony. Anthony is being tempted by everything that is eval, inhuman and unnatural. Note the Bubonic plague victim in the lower left corner. Parenzano's Temptati from 1492 is another temptation example.

Gilman claims that the renaissance portrayals of madness (and temptation) reflect the perceived threats and secrets in the world.



















In the late 15th century, madness became a kind of "deja-la" of death. Foucault wrote, "It is the tide of madness, its secret invasion, that shows that the world is near its final catastrophe; it is man's insanity that invokes and makes necessary the world's end" (Madness & Civilization, p. 17).

Hieronimous Bosch's Mad-Meg (Dulle Grete) was meant to instill fear of damnation in the viewers, and I find it hair-raising today. Meg, whose insanity is clear from the iconography Bosch includes (the staff & bladder--see below--, her movement or traveling stature,and other oddities in her apparel). She is surrounded by the terrible world she represents.

Images of madness appeared in special relationships to Christianity. Sometimes the mad were believed to have unique access to holiness or divine messages. This may be a carryover from classical times when the oracles in that pantheistic context were typically delirious when channeling a deity.


On the other hand, the insane were also viewed as more susceptible to influences of the devil, requiring exorcisms to rid them of their demons. For example, the image to the left is a very old one of a saint expelling a demon from the man kneeling before him.

The image on the right concerns the same theme: the woman on the right has been brought to some church setting to get rid of her madness/demon. The demon can be seen flying out of her mouth.Similarly, a saint is expelling demons from the man on the left.The demented or possessed also came to develop a special iconographic position that is evident in both of these above examples. The person suffering from possession is often held up by others as his or her head (and sometimes body) collapses backwards, arms stretched out rigidly on either side. In Raphael's Transfiguratio, in which Jesus ascends into heaven, a man whos is possessed is held up and pointed out by others as needing healing by the transfiguring god.

The same posture shows up in one of two etchings by Breugel of mad women being led away from their town. The woman on the right is raising her right arm somewhat, and leaning back into the poor man trying to steer her somewhere else than her home town. This picture also tell the story of the insane as increasingly homeless outcasts from their places of origin. This them of rootlessness will be taken up below with the theme, The Ship of Fools.

This is the position of frenzy, abandon, and loss of reason. We can find the same visual metaphor for submission to higher power for cure in the humanizing of asylums by Pinel, and then in clinic of Charot.

The image to below is a propaganda-like painting of Pinel (for a new rational, humane treatment of the mentally ill) shows him freeing the patients of La Saltpetriere from their chains. His patient is a woman who assumes a position which both suggests her unreason, her vulnerability to patriarchial reason, and the taming of her dangerous sexuality. The association of madness with sexual wantoness, delerium, and women is not new, but took on great resonance in this context of morally righteous 'humane' treatments. The insane are also being freed from their shackles of exile, at least that was the hope. Mental illness was a moral problem, not a sign of demonic possession. Through reason, clean living, and moral training, most of an asylum's men and women could eventually return home; they had only to subject themselves to the authority of their doctor.




Later, we see this same figural relationship reappear in the imagistic pedagogy of French psychiatrist, Charcot, which took place at the same Parisian hospital. Freud spent a short time in attendance at Charot's seminars, many of which consisted of demonstrations by the master like that presented in the painting below.

This painting, commissioned by Charot, is the most famous representation of him: As the man we credit with starting the clinical/medical approach to psychology and with creating the first clinical research lab imbedded in a hospital rather than a university, this image of Charot instructing his students in the treatment of hysteria is iconic. The patient's pose, swooning with her breasts prominently in view, reflects her utter submission to Charcot's brillance. All the medical students are men; the only other woman in the room is a nurse from hysteria ward in Saltpetriere.

The painter, Paul Richer, painted himself into the center-rear of image, as well as his large, if faint, drawing of a woman in a cataclyptic pose from Charcot's Iconographie photographique de la Salpêtrière. His drawing, which could be seen by every patient on Charcot's stage, is on the right.

The Photographic Iconography of Salpêtriere consists of photographs taken by Bourneville and Regnard; most were made in a photographic laboratory created by Charcot for the purpose of documenting the diagnostic phases of hysterical attacks. The drawing of the woman on the left looks like our icon of possession; it was drawn by Richer from a photograph.

George Didi-Huberman in his fascinating book, Invention of Hysteria: Charcot and the Photographic Iconography of the Salpetriere, upacks the theatricality of his Tuesday morning lectures, as well as the performative demands of the setting. Didi-Huberman is not alone in arguing that the "hysteria" that Charcot documented and demonstrated in his lectures was seldom found anywhere else. Freud was on to him.

The Iconography includes photographs of induced postures, brought about by a variety of hypnotic methods. The photograph of "Lethargy" on the right was prompted by a sudden flash of light.

The Holy Fool

One of the most common icons alerting the viewer to the troubled mental status of a human image, like the illuminated Psalm 52 on the left, was the presence of a staff or large stick, often with a bladder tied to its upper end. In evidence from the middle ages through the 17th century, a staff was to be found in the hands of all thought to be possessed by the Devil: fools, melancholics, witches, and madmen. The image on the left is called "A Witch and her Familiars," all of whom require staffs for identification. The cats, I assume we already know about witches.

Fools are widely scattered in medieval and renaissance illuminated texts. Most often the can be found in the minute decorations in the margins of a page--a search for fools in these contexts can be quite entertaining.

Music and dance are also incorporated into images of fools, folly, mania, and madness. The trope of Dancing Fools or Insane can be found from the middle ages up into the 19th century. I've inserted two examples:









Below is another images of a fool with staffs; this one is facing Death:

The painting on the right by Hieronimous Bosch is of a theme popular during the northern Renaissance, A Ship of Fools. While everyone on this ship of fools is intended to be a fool, Bosch also made sure that one of the figures had all the appropriate icons for the role: The seated figure on the upper right has a staff with a bladder at the end and a horned cowl. The cowl was associated with a monk's hood, but in the case of fools is marred by simulated, rather silly, devil's horns. The image to its left is a woodcut by Holbein, whose woodcuts illustrated Sebastian Brandt's widely popular book, Stultifera Navis, Das Narrenschiff, or The ship of Fools.

Rather than a state that mirrored the demonic consequences of humanity's sinfulness, Renaissance Folly came to mean flaws in an individual's moral character. The defects portrayed in the various ships of fools were those found in everyone, not just the mad. Fools lacked the tragic condition of the insane.

Perhaps only an Idiot Fool (Holbein the Younger) would, because its doubled construction, qualify as irrevocably beyond the bounds of sanity, but that was hardly the case. Here, the fool is shown mocking death--his bladder raised to strike and his finger irreverently in his mouth. Meanwhile, death gleefully leads the fool off to the tune of dancing music played on his bagpipe.

And then, of course, there is the Educated Fool....Holbein's woodcut includes a feather-duster rather than a staff; perhaps that was the 15th century version of Ginko.


The Ship of Fools also carries the theme of vagrancy and rootlessness, which was seen by the people of the Renaissance as flaws in character. This was a particular hardship of those seen as mad, for they were little tolerated in their communities and were sent drifting as beggars from place to place until they came more and more to be incarcerated--first into prisons along with imprisoned criminals, and then later into their own separated institutions.

Melancholy

Gilman describes how, at the beginning of the middle ages, the image of the melancholy individual became the iconic figure of madness in general. One of the Four Humors, Melancholy represented an isolated life out of balance with the real world. Gibson includes a poem by the best-loved German poet of the thirteenth century, 

Walther von der Vogelweide, to demonstrate how the position of the body, as image, communicated a state of being we have come to associate as "internal." The state of the "self" described by the Minnesinger, Walther, would be readily understood as melancholic.

I sat down on a stone
And crossed my legs
And set my chin and cheek
In my hand.
Then I pondered very earnestly
How one ought to live one's life on earth.
I could not find the solution. 
from Gilman (1982) "Seeing the Insane"

Solis the Elder's (1514-1562) woodcut, Melancholicus, reflects an emblematic theme at the time; the numbing impact of the conflicts at that time between the humanism sweeping the continent and Roman Catholic tradition. The message is a negative moral judgment of melancholy: melancholy had the effect of paralysis and a state of tension due to a conflict between opposing powers, in this case between nature created by God and science made my mankind. 

Much more well known is the etching on the right, Melancholia I, by Northern Renaissance artist, 
 Albrecht Dürer, is one of my favorite works of art (which may give away my dominant Humor). The posture of the angel, pensive and darkened face, chin and cheek leaning heavily on her hand, exudes melancholy to the viewer, even those who do not know the title of the work of the iconography of melancholy. Her clenched and hidden hands suggest that she is ineffectual and her inactivity, in light of the many tools and recent scientific technologies surrounding her, can suggest the moral defect, sloth. The sleeping dog is also implies an inability to act. Finally, melancholy was associated with characteristics of passivity and excessive emotionality; e.g., the Feminine (Gilman, 1982).

The painting on the left from 1553 has the same iconography and the title is The Melancholy, painted by Lucas Cranach, a contemporary of Albrecht Dürer. Here, too, we see the idle angel and sleeping dog, but the images of humanistic science are missing. The playful children may extend the idleness theme. In the background, inside a dark cloud, is the diabolical image of witches riding on goats and pigs. Cranach may be suggesting that melancholy was a state of suspension between two negative outcomes; the passivity of the indolent or diabolical delusions. The right path was to be found elsewhere. To provide a temporal context, Cranach was a friend to and painted a portrait of Martin Luther (1529).