TEMPERAMENT

Ancient Origins

The concept of temperaments in Western medicine finds origin and early elaboration in ancient Greece; subsequently, it was developed and expanded by the Arabs, followed by Galen and the Romans. In the protomodel, four cardinal elements (Air, Fire, Earth, Water) were imagined to comprise the world; all things were composed of these elements, in differing proportions. Elementary forces or qualities were seen to act upon all things. These qualities were innumerable, but four came to be regarded as especially significant: heat, cold, dry, and moist. The protomodel of four elements and four qualities proved useful in the understanding and classification of natural observations, but was not sufficiently specific to organic life. Attempts to comprehend the basis of health and disease required a new formulation, a new schema.

Certain substances were observable in the human body. Blood, for example, was commonly observed from wounds. Phlegm, too, could be seen, running from the nose. Bile might be vomited up from administration of a cholagogue. Early treatises assumed unlimited humors in the body, but four, including Water, became definitive. Water, however, was one of the universal elements. It was not directly observable in the body: urine, though watery, is not Water. Another substance, black bile (congealed blood), had been regarded as a pathogenic agent in writings of the fifth century B.C.. According to Henry E. Sigerist, M.D., black bile "was held responsible for a great variety of diseases, ranging from headache, vertigo, paralysis, spasms, epilepsy, and other mental disturbances, to quartan fever and diseases of the kidneys, liver, and spleen".¹ In the latest of the Hippocratic writings (The Nature of Man), atrabilious black bile is distinguished from the bilious humor, yellow bile, and named as one of the four cardinal humors. Sigerist reports that this treatise, commonly attributed to Polybus, is the starting point for humoral theory.² Equilibrium among these humors (blood, yellow bile, black bile, phlegm) was thought to constitute health.

The Emergence of Constitutional Types

In observing similarities among individuals with respect to traits, behaviors, and patterns of disease, the idea of constitutional types began to emerge. The philosopher-scientist Theophrastus (B.C. c372-c287) noticed that black bile appeared to dominate in men of genius, and this dominance did not indicate inherent pathology. Here was the first delineation of a psychobiological constitutional type. The Arabs developed typologic characteristics for all four humors. "Combined with astrological elements", says Sigerist, "the theory was developed and extended still further in the West, in the Middle Ages and the Renaissance."³ These ideas provided foundation for the work of Galen (aka, Claudius Galenus, A.D. c130-c200), a Greek physician and writer, who practiced in Rome. In a revolutionary undertaking, Galen dissected the Barbury ape in an effort to discover the loci and actions of humors in organs of the body. His clinical concepts of causation were empiric, including ideas of initial, evident, external, preceding, active, conjunctive, adjuvant and maintaining causation; this had great appeal for physicians and scientists alike.⁴ But his deductive, rather than inductive, approach to constitutional types and temperament made it necessary for him to seek examples of the constructs he generated, and this proved problematic.⁵ His theories and system of therapeutics were to influence the study and practice of Western medicine until the renaissance, some 1400 years later⁶, but the Galenic types bear little resemblance to our concepts of the temperaments today.

In the 19th and Early 20th Centuries...

The idea of the four humors has deeply affected our concept of personality. Sanguine, choleric, melancholic, and phlegmatic remain meaningful adjectives in our vocabulary. Popular books on humoral typology appear from time to time. The Four Temperaments in Children7, published in 1896, is the oldest in my possession; it was written by Bernhard Hellwig as a guide for teachers. A neatly penned script on the page of contents reads: Critique: Psychologists say it's unscientific - lacks rigor, precision, control of facts. Nevertheless it sure is widespread in use and application, or trials at it! Feb.29.40. R.N.S.

The perception that people are similar, that they exhibit characteristics or attributes which may be classified by type, was a key premise in the psychologies of the past century. The number four figured prominently in many of the theories developed during this period. William Strauss and Neil Howe tell us that the four temperaments "regained some of their former esteem", in the twentieth century.

The turnabout came in the years around World War I, when a new generation of European psychologists revolted against positivism and made fourfold thinking popular again. E. Adickes wrote of four worldviews (traditional, agnostic, dogmatic, innovative); Eduard Spranger of life types (theoretical, aesthetic, religious, economic); Ernst Kretschmer of abnormal temperaments (anesthetic, hyperesthetic, melancholic, hypomanic); and in the twentieth century's best know quaternity, Swiss psychologist Carl Jung wrote of attitude types based on psychological functions ([thinking], intuition, feeling, sensation). ⁸ [This note provides a table of the twentieth century temperament schemata listed by Strauss & Howe in the above excerpt.]

More Contemporary Schemata...

Let's examine a few more recent schemata that have developed along this line.

The model below is adapted from the work of Melvyn Kinder, in Mastering Your Moods⁹ Kinder posits two continua, one indicating action tendency in terms of extroversion and introversion, and the other, state of arousal. He identifies four temperaments (sensor, focuser, seeker, discharger), placing each in a quadrant indicating its action tendency and threshold of arousal. For instance, the sensor is extraverted and easily aroused. Kinder provides descriptions for each temperament¹⁰, and one clearly can see in these the key features of ancient humoral prototypes.

Kinder's four temperaments are readily correlated with those of humoral theory.

Hans Eysenck studied two continua (extrovert~introvert and stable~unstable), plotting his results in four quadrants which, it is suggested, might represent the four temperaments (Melancholic, Phlegmatic, Choleric, Sanguine). These quadrants are further divided by keywords, to create a circle of subtypes.¹¹ I've adapted Eysenck's model, below.

Dragan M. Svrakic et al. present a seven-factor model of temperament and character, developed to facilitate differential diagnosis in personality disorders. They evaluate the efficacy of self-reports to read a comprehensive personality of seven dimensions, including novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence. At issue was whether such self-reports could serve as a reliable guide in differential diagnosis and treatment. The results were positive.¹²

In the same issue of Archives of General Psychiatry, C. Robert Cloninger et al., with Svrakic contributing, describe these seven factors in terms of a psychobiological model of temperament and character. They delineate self-directedness, cooperativeness, and self-transcendence as character traits; novelty seeking, harm avoidance, reward dependence, and persistence were distinguished as temperament traits.¹³

Cloninger's psychobiological delineations of novelty seeking, harm avoidance, reward dependence, and persistence ¹⁴ do not square perfectly with with Kinder's formulations. The theses are different, but the predicates bear sufficient resemblance to classical humoral theory that, with due care, we can establish the following correlations between the formulations presented by Cloninger and Kinder.

In 1998, when I first read Cloninger's work, it struck me that persistence was a better descriptor for melancholic, rather than choleric temperament. Certainly persistence is a key feature of the former; and reward dependence, construed as striving to gain an objective, is a goal-oriented choleric thrust. Closer scrutiny of Cloninger's temperament dimensions suggests that reward dependence more properly correlates with the melancholic, where the "reward" involves gain from social attachment and approval of others. But let's apply a little latitude, here.

What if we deemphasize the heriditable bias of sentimentality and need for approval, and instead construe reward dependence in more intrapersonal terms, rather than interpersonal? Would that denature the dimension too much? Perhaps so. Kinder's Focuser is more persistent than reward dependent, and his Discharger, more reward dependent than persistent. Persistence, "perseverence despite frustration and fatigue", applies to melancholic and choleric, simply in different directions, introversive versus extroversive. Where reward dependence is cast in the sense of Cloninger, emphasizing social attachment and approval of others, it suggests a proclivity toward sadness and depression, the melancholic. Similarly, where persistence is evaluated with respect to extroversive activity, it correlates with the choleric. I therefore set the correspondences in deference to Cloninger, but add my own in contrast, because both seem to apply.

In this sketch of contemporary schemata, we have seen that contemporary formulations may be correlated with the temperaments of humoral theory. Although there arose a split between mind and body in the subsequent history of Western thought, there was no separation in ancient theory. Contemporary psychobiological models are exploring this unicity again, in dimensions quite beyond the scope of the ancient schema, even as Freud and Jung anticipated.

Yet there remains substance in the observations presented to us from antiquity. Popular books on the four temperaments often facilitate one's identification of type by means of an inventory of traits. In the following adaptation of a questionnaire presented by Xandria Williams¹⁵, for instance, the objective is to identify which one of the four types predominates in personality. Williams tells us that where one temperament is dominant, it will usually prove easy to read. Some people exhibit a dual temperament, and others, a trinity. Only rarely does one come across a quaternity and, says Williams, "certainly not a balanced one".

Scan the lists below, see what you think.