Disease models in “The Sorrows of Young Werther”

Goethe's masterpiece bears an unexpected message for 21st-century critical care.

Masterpieces like Goethe's "The Sorrows of Young Werther” are timeless. This book is surprisingly relevant nowadays, in the midst of a mental health crisis. The book story, and how Germans received and reacted to it in the late 1700s surprisingly echoes our younger generation in the 21st century.

However, you are not here to read about psychology or literature. I am so aware of my limitations that, while it may seem I have opinions about anything, I am smart enough to limit my assertions to my thin area of knowledge. We develop this kind of smartness after years of daily clinical rounds.

Goethe's masterpiece bears an unexpected message for 21st-century critical care.

Werther is a young educated man suffering from what we could call depressive symptoms or a form of anhedonia. To improve his condition, he moves to an idyllic rural area and leads a modest life seeking moderation in his eating, drinking, taking sunlight, and exercising.

In the final scene, Werther attempts against his own life by shooting a pistol in his head, scattering blood all over his office. The physician arrives and finds Werther still breathing. The physician promptly performs a venoclysis and bleeds the young man. Later on the same day, Werther is pronounced dead.

Although irrelevant to the narrative, the bleeding seemed absurd to my intensivist eyes. How could the physician bleed a patient in hemorrhagic shock? The answer is simple: wrong disease model.

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In this post:

• Galen’s four humors model

• Is Medicine at its apogee?

• Where does decadence come from?

• The naïve “additivist”

• The Shock Journal stands for an Asimovian utopia

• Cassandra (from mythology)

• Our father Willian Osler would be disappointed with us

• Biological plausibility should structure medicine

• Biological constructs instead of clinical constructs

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By the end of the 18th century, physicians still practiced some form of Galenic medicine. Galen (129 - 216 AD) left a long-living influence on Western Medicine. His practice explained health and disease by the four humors (fluids) theory, where health is a product of a harmonious balance of the humors, and disease results from humors unbalance.

Interestingly, such unbalances also relate to the expression of psychological traits. The words are still in use, as living proofs we 21st-century physicians are Galen's successors. More than elements of a disease model, "humor” combines a state of mind or personality with the corresponding fluid.

The four humors are: