Galen states that the appetitive part is physiologically associ- ated with the qualitative mixture of the liver, and the spirited part with that of the heart. There is mutual causation between these mixtures (temperaments) and the functions of the metabolic system and the distri- bution of blood, heat, and vital pneuma. The structure and functioning of this physical level strongly influences the faculties and capacities of the soul. 238 In Galen’s view, the pathological states of the soul, such as delir- ium, mania, lethargy, epilepsy, and melancholy, have humoral causes. 239 Excessive emotions can influence the humoral system, and changes in it have effects on emotional inclinations. 240 The effects of excessive black bile on the melancholic temperament, occurrent mental disturbances, and on chronic mental illness are often mentioned. 2