An Epidemic of Melancholy
Beginning in England in the seventeenth century, the European world was stricken by what looks, in today's terms, like an epidemic of depression. The disease attacked both young and old, plunging them into months or years of morbid lethargy and relentless terrors, and seemedâperhaps only because they wrote more and had more written about themâto single out men of accomplishment and genius. The puritan writer John Bunyan, the political leader Oliver Cromwell, the poets Thomas Gray and John Donne, and the playwright and essayist Samuel Johnson are among the earliest and best-known victims. To the medical profession, the illness presented a vexing conundrum, not least because its gravest outcome was suicide. In 1733 Dr. George Cheyne lamented “the late frequency and daily increase of wanton and uncommon self-murders, produced mostly by this distemper,” and speculated that the English climate, combined with sedentary lifestyles and urbanization, “have brought forth a class of distemper with atrocious and frightful symptoms, scarce known to our ancestors, and never rising to such fatal heights, and afflicting such numbers in any known nation. These nervous disorders being computed to make almost one-third
of the complaints of the people of condition in England.”
1
A hundred years later, little had changed: “[Nervous] complaints prevail at the present day,” claimed a contemporary, “to an extent unknown at any former period, or in any other nation.”
2
Samuel Johnson, the intellectually prodigious son of impecunious parents, first fell prey to depression in 1729 at the age of twenty, shortly after being forced to leave Oxford for a lack of funds. According to his friend and biographer James Boswell, himself a victim of depression, Johnson's “morbid melancholy” began to “afflict him in a dreadful manner” upon his return to his parents' home.
He felt himself overwhelmed with an horrible hypochondria, with perpetual irritation, fretfulness, and impatience; and with a dejection, gloom, and despair, which made existence misery. From this dismal malady he never afterwards was perfectly relieved; and all his labours, and all his enjoyments, were but temporary interruptions of its baleful influence.
3
Without a degree or much possibility of a career, he spent hours sitting and staring at the town clock without seeming to notice the time. He took long walks, pondering suicide. But it was not only the prospect of poverty and failure that rendered him vulnerable, because years later, at the height of his success as a writer and popularity as a conversationalist, the illness struck again. “
My terrors and perplexities have so much increased,
” he wrote in his early fifties, “that I am under great depression ⦠Almighty and merciful Father look down upon my misery with pity.”
4
To the English, the disease was “the English malady,” described in Timothie Bright's
Treatise of Melancholie
in the late sixteenth century, and exhaustively analyzed by the Anglican minister Robert Burton in his 1621 classic,
The Anatomy of Melancholy
. But the rainy northern island was not the only site visited by the disease; all of Europe was afflicted. According to Andrew Solomon, the concern
with melancholy originated in Italy and was carried back to England by English tourists.
5
It seemed primarily a Spanish problem, however, to the Italian political theorist Giovanni Botero, who observed in 1603 that the men of that country “have more than a bit of melancholy, which makes them severe in manner, restrained and sluggish in their undertakings,” and the problem was rampant in the court of Philip III.
6
By the eighteenth century, melancholy was as much a German disease as an English one,
k
presenting later historians of that nation with the paradox that “the era of dawning light, the Enlightenment” should also be characterized by “black gall and melancholy persons”âsuch as the editor Karl Philipp Moritz, who “could sit all day, without any thoughts, scribbling on paper, and could loathe himself for the loss of time, without having the energy to use this time any better.”
7
In France, which produced the famous melancholic Jean-Jacques Rousseau,
8
the disorder did not become a major literary theme until the mid-nineteenth century, when it afflicted, among others, the poet Charles Baudelaire. From the nineteenth century on, depression figures prominently in the biographies of the notable: the Russian novelist Leo Tolstoy, the German social scientist Max Weber, the American psychologist William James.
The disease grew increasingly prevalent over the course of the twentieth century, when relatively sound statistics first became available, and this increase cannot be accounted for by a greater willingness on the part of physicians and patients to report it. Rates of schizophrenia, panic disorders, and phobias did not rise at the same time, for example, as they would be expected to if only changes in the reporting of mental illness were at work.
9
According to the World Health Organization, depression is now the fifth leading cause of death and disability in the world, while ischemic heart disease trails in
sixth place.
10
Fatalities occur most dramatically through suicide, but even the mild form of depressionâcalled
dysthemia
and characterized by an inability to experience pleasureâcan kill by increasing a person's vulnerability to serious somatic illnesses such as cancer and heart disease. Far from being an affliction of the famous and successful, we now know that the disease strikes the poor more often than the rich, and women more commonly than men.
Just in the last few years, hundreds of books, articles, and television specials have been devoted to depression: its toll on the individual, its relationship to gender, the role of genetic factors, the efficacy of pharmaceutical treatments. But to my knowledge, no one has suggested that the epidemic may have begun in a particular historical time, and started as a result of cultural circumstances that arose at that time and have persisted or intensified since. The failure to consider historical roots may stem, in part, from the emphasis on the celebrity victims of the past, which tends to discourage a statistical, or epidemiological, perspective.
l
But if there was in fact a beginning to the epidemic of depression, sometime in the sixteenth or seventeenth century, it is of obvious concern here, confronting us as it does with this question: Could this apparent decline in the ability to experience pleasure be in any way connected with the decline in
opportunities
for pleasure, such as carnival and other traditional festivities?
There is reason to think that something like an epidemic of depression in fact began around 1600, or the time when Burton
undertook his “anatomy” of the disease. Melancholy, as it was called until the twentieth century, is of course a very ancient problem, and was described in the fifth century BCE by Hippocrates. Chaucer's fourteenth-century characters were aware of it, and late medieval churchmen knew it as
acedia,
which was technically a sin, since it often led to the neglect of religious obligations. So melancholy, in some form, had always existedâand, regrettably, we have no statistical evidence of a sudden increase in early modern Europe, which had neither a psychiatric profession to do the diagnosing nor a public health establishment to record the numbers of the afflicted. All we know is that in the 1600s and 1700s, medical books about melancholy and literature with melancholic themes were both finding an eager audience, presumably at least in part among people who suffered from melancholy themselves. Samuel Johnson, for example, was an admirer of Burton's
Anatomy of Melancholy,
asserting it “was the only book that ever took him out of bed two hours sooner than he wished to rise.”
11
Increasing interest in melancholy is not, however, evidence of an increase in the prevalence of actual melancholy. As the historian Roy Porter suggested, the disease may simply have been becoming more stylish, both as a medical diagnosis and as a problem, or pose, affected by the idle rich, and signifying a certain ennui or detachment. No doubt the medical prejudice that it was a disease of the gifted, or at least of the comfortable, would have made it an attractive diagnosis to the upwardly mobile and merely out-of-sorts. Nervous diseases in general, Dr. Cheyne asserted, “never happen, or can happen to any but those of the liveliest and quickest natural parts whose Faculties are the brightest and most spiritual, and whose Genius is most keen and penetrating, and particularly when there is the most delicate Sensation and Taste, both of pleasure and pain.”
12
By the mid-eighteenth century, melancholy did indeed become a stylish stance among the affluent English, inspiring the insipid sentiments expressed in poems like Thomas Warton's “The Pleasures of
Melancholy” and Elizabeth Carter's “Ode to Melancholy,” which reads in part: “COME, Melancholy! silent power/Companion of my lonely hour ⦠/ Thou sweetly sad ideal guest.”
13
In fact the notion that melancholy was an exclusively elite disease was common enough to be a subject for satire. In a mid-eighteenth-century English play, a barber complains of melancholy and is told: “Melancholy? Marry, gup, is
melancholy
a word for a barber's mouth? Thou shouldst say heavy, dull, and doltish: melancholy is the crest of the courtier's arms!”
14
For their part, physicians probably were eager to diagnose melancholy, or, as it was sometimes called, “spleen,” among their better-off patients and, in general, to wrest the treatment of nervous disorders away from the clergy.
But melancholy did not become a fashionable pose until a full century after Burton took up the subject, and when it did become stylish, we must still wonder: Why did this particular stance or attitude become fashionable and not another? An arrogant insouciance might, for example, seem more fitting to an age of imperialism than this wilting, debilitating malady; and enlightenment, another well-known theme of the era, might have been better served by a mood of questing impatience. Even when melancholy became popular as a poetic theme and social affectation, there were individual sufferers, like the poet William Cowper, who could hardly have chosen their affliction. He first fell prey in his twenties, when anxiety about an exam led to a suicide attempt that necessitated an eighteen-month stay in an asylum. Four more times in his life he was plunged into what he called “a melancholy that made me almost an infant”
15
and was preserved from suicide only by institutionalization. And it is hard to believe he could have been feigning when he wrote to a friend, toward the end of his life, “I have had a terrible nightâsuch a one as I believe I may say God knows no man ever had ⦠Rose overwhelmed with infinite despair, and came down into the study execrating the day I was born with inexpressible bitterness.”
16
Nor can we be content with the claim that the apparent epidemic of melancholy was the cynical invention of the men who
profited by writing about it, since some of these were self-identified sufferers themselves. Robert Burton confessed, “I writ of melancholy, by being busy to avoid melancholy.”
17
George Cheyne was afflicted, though miraculously cured by a vegetarian diet of his own devising. The Englishman John Brown, who published a best-selling mid-nineteenth-century book on the subject of the “Increase of low Spirits and nervous Disorders,” went on to commit suicide.
18
Something
was happening, from about 1600 on, to make melancholy a major concern of the reading public, and the simplest explanation is that there was more melancholy around to be concerned about.
There remains the question of whether melancholy, as experienced by people centuries ago, was the same as the disease we now know as depression. Even in today's
Diagnostic and Statistical Manual of Mental Disorders
, the definitions of mental illnesses always seem a little fuzzy around the edges; and there was not even an attempt, until the eighteenth century, at a scientific or systematic nomenclature. “Melancholy,” in Burton's account, sometimes overlaps with “hypochondria,” “hysteria,” and “vapors”âthe last two being seen as particularly feminine disorders.
19
But on the whole, his descriptions of melancholy could, except for the prolix language, substitute for a modern definition of depression: “Fear and Sorrow supplant [those] pleasing thoughts, suspicion, discontent, and perpetual anxiety succeed in their places” until eventually “melancholy, this feral fiend,” produces “a cankered soul macerated with cares and discontents, a being tired of life ⦠[who] cannot endure company, light, or life itself.”
20
If we compare the accounts of melancholics from the past with one of the best subjective descriptions of depression from our own timeâWilliam Styron's 1990 book
Darkness Visible
âwe find what certainly looks like a reasonable concordance. Styron found himself withdrawing from other people, even abandoning his own guests at a dinner party, while Boswell said of Johnson during one of his episodes of melancholy, “He was so ill, as, notwithstanding his
remarkable love of company, to be entirely averse to society, the most fatal symptom of that malady.”
21
Styron listed “self-hatred” as a symptom, while the highly productive Johnson repeatedly upbraided himself for leading “a life so dissipated and useless.”
22
More flamboyantly, John Bunyan bewailed what he called his “original and inward pollution”: “That was my plague and my affliction. By reason of that, I was more loathsome in my own eyes than was a toad.”
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