In the eighteenth century, melancholia was thought of not as a curable mental affliction, but as one of the primary forms of madness.
Melancholia means ‘black bile’, one of the four bodily humours recognised by the Hippocratic and Galenic systems of medicine that prevailed in Britain and elsewhere well into the 18th century. It was an excess of this ‘black bile’ which was thought to cause the malady. Aristotle thought black bile might ‘ferment’ to produce the anger and depression seen as characteristic of the malady.
Whatever the differences between writers on their views of how the disease was caused, all agreed that it led to symptoms of intense mental pain, depression and a general sense of failure and gloom, which could cause people to become insane and kill themselves.
The magisterial book on all forms and concepts of the disease was written in England:
“The Anatomy of Melancholy, What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it. In Three Maine Partitions with their several Sections, Members, and Subsections. Philosophically, Medicinally, Historically, Opened and Cut Up” Robert Burton, first published in 1621.
There were probably as many treatments offered as there were physicians interested in the disorder, from locking people up to enemas and special dietary regimes. Burton’s own suggestions for treatment have a distinctly modern ring to them. He believed that melancholy could be dealt with by following a healthy diet, getting sufficient sleep, listening to music, and engaging in “meaningful” types of work. He also promoted talking about the problem with a friend.
Other approaches were more brutal. Amongst these, sea bathing (‘thalassotherapy’) became quite prevalent. Not our pleasant kind of splashing about in the sea, but a strict and violent form of immersion designed to induce first shock (from being plunged into cold water) then fear (by being held under until almost drowning). The purpose was, apparently, to cause the brain to ‘re-arrange’ itself into a better and more harmonious state. Others made the patient sit on a stool which whirled them around until they became dizzy and disoriented.
Benjamin Franklin even devised a primitive form of electro-convulsive therapy, using an electrostatic generator (a machine which produces electricity by rubbing material against a glass ball or cylinder turned by a crank) with a Leyden jar to stored the energy produced. On the whole, he considered his results disappointing, though he did note the propensity for electric shocks to the brain to destroy memory—something later proponents of electro-convulsive therapy seem to have missed for many decades.
Here’s an even more violent ‘cure’ for “hypochondria” (an alternative term for melancholy at the time) from Dr Benjamin Rush, an American doctor and signer of the Declaration of Independence in 1776. His answer was mercury, taken orally!
“Mercury acts in this disease, 1, by abstracting morbid excitement from the brain to the mouth. 2, by removing visceral obstructions. And, 3, by changing the cause of our patient’s complaints and fixing them wholly upon his sore mouth. The salivation will do still more service if it excite some degree of resentment against the patient’s physician or friends.”
The idea that giving you violent diarrhoea, a sore mouth and inciting your resentment against others could help lift your depression is little short of idiocy! Cure by heavy metal poisoning!
The plain fact was that medical knowledge of the time was more or less helpless in the face of most mental illnesses, so we should not be too critical. Even today, clinical depression is not treatable easily.
While it’s clear that melancholy (in its artistic sense) is not the same as depression, it could be hard to avoid moving from the one into the other. Depression generally destroys motivation and induces lethargy and a pervasive sense of the hopelessness of any endeavour. Melancholy’s intensity of introspection and reflection produced in some a powerful driving force towards artistic achievement. In others, it slipped into an aesthetic flaccidness and self-indulgence.
Too often, melancholy became mostly an affectation, since its milder characteristics made the condition seem desirable, especially to the emerging Romantic Movement. There was a distinct appeal in maintaining the posture of a dignified, wistful and gloomy aloofness. It also became associated with the idea of possessing both a full amount — even an excess — of sensitivity to sentiment (itself highly regarded as an attribute of a cultured mind) and a creative mind. We will explore more of both of these aspects in a following posting.
Robert Burton was a man centuries ahead of his time! Even if he didn’t understand the exact cause, he knew the answer.
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