{"id":9874,"date":"2007-06-20T00:00:00","date_gmt":"2007-06-20T04:00:00","guid":{"rendered":"http:\/\/localhost\/thenewatlantis.com\/publications\/melancholys-whole-physician"},"modified":"2021-07-12T10:15:30","modified_gmt":"2021-07-12T14:15:30","slug":"melancholys-whole-physician","status":"publish","type":"article","link":"https:\/\/www.thenewatlantis.com\/publications\/melancholys-whole-physician","title":{"rendered":"Melancholy’s Whole Physician"},"content":{"rendered":"
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\r\n Discussed in this article <\/div>\r\n \r\n
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\r\n \r\n The Anatomy of Melancholy <\/a>\r\n <\/div>\r\n \r\n
\r\n Robert Burton <\/div>\r\n \r\n
\r\n NYRB Classics ~ 2001
1392 pp. ~ $29.95 (paper) <\/div>\r\n <\/div>\r\n<\/div><\/div>\n\n

The mental illness called depression is far more savage than its name suggests. The word\u2019s economic meaning has become more fearsome than its medical one, whose force has been eroded by common usage: we say, \u201cI\u2019ve been depressed,\u201d when we\u2019ve been a little glum, down in the mouth, under the weather \u2014 a minor disturbance, equilibrium soon restored. And anyway, the term was never appropriately ferocious to begin with, suggesting a mere dip in the road rather than the sulfurous sinkhole that engulfs you and all you love and sends you into infernal freefall like the host of wicked angels, plummeting in terror with no end in sight, no hope of seeing the beautiful face of God again. The illness requires a word that renders this sense of bottomless horror, inescapable pain, irreparable loss \u2014 even though the horror, pain, and loss are, in most cases, treatable. \u201cO the mind, mind has mountains; cliffs of fall\/Frightful, sheer, no-man-fathomed,\u201d the manic-depressive Gerard Manley Hopkins wrote in one of his Sonnets of Desolation in 1885. Desolation sounds more precise and evocative than depression, though it is hard to imagine it in a clinician\u2019s mouth. Our language reserves such emotional exorbitance for artist-types, expecting doctors to be more sober and carefully euphemistic. And this cautious medical language does possess a pedestrian good sense: a doctor\u2019s saying \u201cI\u2019m prescribing some Prozac and cognitive behavior therapy for your desolation\u201d would seem more than a touch grotesque, like lipstick on a death\u2019s head. The preferred treatment these days, which does tend to work, somehow fits the euphemism.<\/p>\n

There was a word for this awful scorching anguish that enjoyed medical currency for millennia but has since become a dusty curio: melancholy. Melancholy is now mostly a literary word, and in the pejorative sense which hard scientists and medical men assign to the merely literary. Indeed, Peter D. Kramer, a clinical professor of psychiatry at Brown University, writes in his 2005 book Against Depression<\/a> <\/em>that the literary tradition of \u201cheroic melancholy\u201d needs to be severely re-evaluated, so that it will not stand in the way of the project to eradicate the medical illness depression as we have eradicated smallpox. The Problems<\/em>, believed to have been written by followers of Aristotle, inaugurated this literary tradition, asking why remarkable men \u2014 Heracles, Ajax, Bellerophon, Socrates, Plato, the Spartan general Lysander \u2014 are so often melancholic, in some cases given to raging madness. Renaissance scholars rediscovered the Problems<\/em>, and the Florentine humanist Marsilio Ficino identified melancholy as a hallmark of the intellectual vocation; his acolytes exalted melancholy in order to prove their vocational aptitude. Shakespeare canonized the melancholy Hamlet, whose tragedy Kramer calls \u201carguably the seminal text of our modern culture.\u201d With the feckless lover and suicide Werther, Goethe completed the triumph of melancholy. Kierkegaard described creative genius as the wailing of a soul in torment. Baudelaire and Dostoevsky sorrowfully measured the fevered modern soul\u2019s distance from salvation. In the twentieth century, hangdog French philosophers in seedy raincoats allured those nauseated by life as the Pied Piper did unwitting schoolchildren. Innumerable depressive stars shine blackly in the modern artistic and philosophic heavens. Heroic melancholy continues to have a forceful grip \u2014 Kramer might say a death grip \u2014 on our culture.<\/p>\n

Medical science, on the other hand, has taken off in an entirely different direction, exploring the neurochemical basis of depression since the development of the first anti-depressants, the monoamine-oxidase inhibitors (MAOIs) in the 1950s. The neurotransmitters serotonin and norepinephrine, which facilitate the movement of impulses across the synapse between one nerve ending and the next, are known to affect mood profoundly; although the complex whys and wherefores remain mysterious, low serotonin levels are connected with depression, high levels with elevated mood. A more recent generation of medications known as selective serotonin reuptake inhibitors (SSRIs) sharpened and subtilized the action of the MAOIs, without the earlier drugs\u2019 perilous side effects. Prozac, Paxil, and Zoloft are among the best known SSRIs \u2014 and some of the most widely prescribed drugs in America.<\/p>\n

Research has followed the lead of this therapeutic success and produced further proof that depression is a medical illness affecting neurophysiology. Depression has been shown to cause the brain actual physical injury, which then contributes to further depression. In 1999 the anatomist Grazyna Rajkowska demonstrated with computer-aided mapping that, in certain regions of the prefrontal cortex of depressed patients, cells known as glia, which protect and support the neurons, were vitiated, disordered: the longer the depression, the worse the brain damage. Later that year, a psychiatrist expert in radiology, Yvette Sheline, revealed the correlation between the duration of depression and the degree of atrophy of the hippocampus and amygdala, parts of the brain associated with emotion. The brain damage was significant, and persisted even when the illness was in remission. The physiological research of Robert Sapolsky further suggested the intimate relation of stress, depression, and cell death. Stress can trigger depression, and depression in turn becomes a chronic stressor, which damages the hippocampus and other brain cells; the switch in the hippocampus that normally signals the adrenal glands to stop producing stress hormones gets stuck, so that even minor adversity causes those hormones to run amok; they suppress the brain cells\u2019 capacity to repair and regenerate themselves, resulting in lasting injury.<\/p>\n

All this makes talk of suffering poets and falls from grace sound literary and overheated where cool scientific rationality is called for, but literary men down the ages have understood what modern doctors increasingly fail to grasp: that depression is an affliction demanding spiritual as well as physical healing. Robert Burton, an Anglican vicar and a fellow of Christ Church, Oxford, presses the point with eloquent urgency in his 1,500-page masterpiece, still vital after nearly four centuries, although not often read, The Anatomy of Melancholy<\/a> <\/em>(1621):<\/p>\n\n\n

It is a disease of the soul on which I am to treat, and as much appertaining to a divine as to a physician, and who knows not what an agreement there is betwixt these two professions? A good divine either is or ought to be a good physician, a spiritual physician at least, as Our Saviour calls Himself, and was indeed (Matt. iv, 23; Luke v, 18; Luke vii, 21). They differ but in object, the one of the body, the other of the soul, and use divers medicines to cure: one amends animam per corpus <\/em>[the soul through the body], the other corpus per animam <\/em>[the body through the soul] as our Regius Professor of Physic well informed us in a learned lecture of his not long since…. Now [melancholy] being a common infirmity of body and soul, and such a one that hath as much need of a spiritual as a corporal cure, I could not find a fitter task to busy myself about, a more apposite theme, so necessary, so commodious, and generally concerning all sorts of men, that should so equally participate of both, and require a whole physician. A divine in this compound mixed malady can do little alone, a physician in some kinds of melancholy much less, both make an absolute cure.<\/p><\/blockquote>\n\n\n

Melancholy as Burton describes it, and prescribes for its treatment, is in crucial respects a richer moral phenomenon than depression as it is treated today. Burton is writing in the nascent days of the modern scientific project for the conquest of nature and \u201cthe relief of man\u2019s estate,\u201d in the words of his contemporary Francis Bacon, but he is somewhat behind the times: with a staggering breadth of learning, he invokes repeatedly, indeed literally a thousandfold, the wisdom of the ancients, both classical and Biblical, whom Bacon and his successors leave bobbing fecklessly in the wake of their inexorable advance upon the radiant future. The Baconian project has of course triumphed, and it would be insane to want to undo some of its most spectacular successes: psychiatric medications developed during the last fifty years have made it possible for persons who in Burton\u2019s day \u2014 and indeed in far more recent days \u2014 would have been chained in phrenic dungeons to live relatively normal lives. However, marvelous technical sophistication has come at a serious moral price. Psychiatrists now tend increasingly to treat the condition rather than the patient. Intense mental and spiritual pain is offered a purely physical fix. The full human implications of mental illness are worn away as pills are becoming ever more effective and insurance companies are becoming ever less inclined to cover the costs of psychotherapy. To recover the sense of what such suffering means to the sufferer, one might do well to look at a classic text from a time when the neurochemistry of mental illness was not even a glimmer in the Baconian eye and moral tribulation was the essence of melancholy.<\/p>\n\n

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\r\n\t\t“All the World is Melancholy”\t<\/h5>\r\n<\/div><\/div>\n\n

R<\/span>obert Burton knows melancholy from the inside; prolonged combat at close quarters has familiarized him with the adversary. \u201cConcerning myself, I can peradventure affirm with Marius in Sallust, \u2018That which others hear or read of, I felt and practised myself; they get their knowledge by books, I mine by melancholizing.\u2019\u201d Like the virtuous lady who was a leper and gave all she had to build a hospital for lepers, he goes on, \u201cI will spend my time and knowledge, which are my greatest fortunes, for the common good of all.\u201d Although divinity is his calling and the highest activity there is, he turns to melancholy as a subject because it sorely needs elucidating and he is just the man for the job. Melancholy has chosen him \u2014 \u201cI was fatally driven upon this rock\u201d \u2014 perhaps more than he has chosen melancholy.<\/p>\n

He begins by examining the subject from a philosopher\u2019s point of view, adopting the moniker Democritus Junior, after the thinker who was stricken with hilarity at the spectacle of human folly and the misery it causes. The people of Democritus\u2019 native city, Abdera, believed him mad, and called in the nonpareil physician Hippocrates to confirm their opinion. The great men found themselves at odds: Democritus flayed humanity for its ridiculous longings and bestial appetites, while the gentler Hippocrates held that men cannot help their wants and so should be forgiven. In the end, however, Hippocrates told the startled Abderans that although Democritus certainly ought to dress and eat better, \u201cthe world had not a wiser, a more learned, a more honest man, and they were much deceived to say he was mad.\u201d<\/p>\n

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