Melancholia and Depression: From Hippocratic Times to Modern Times
“Moody, muddy, Moorditch melancholy”
If Shakespeare was correct, the web of our life is of a mingled yarn, good and ill. Like physical pain, sadness is something that enters the experience of each one of us at some time or other. Small wonder that mental distress should have attracted the notice of medical philosophers for over two thousand years. The humoral conception of disease propounded by Galen coupled low spirits with a surfeit of black bile; hence the term “melancholia.” Over the centuries came a series of dissertations by writers such as Rufus of Ephesus, Aretaeus of Cappadocia, Galen, Alexander of Tralles, Paul of Aegina, and the Persian Avicenna. The catalog of contributors extends throughout the Middle Ages. In 1621, Robert Burton published his Anatomy of Melancholy, which has been described as the most sententious book ever written; yet it can be read as a fascinating imaginative work.
Now we meet a worthy addition to the notable company of humanists in Professor Stanley Jackson, whose amplitudinous volume has been issued by the Yale University Press. The author is well qualified to undertake such a stupendous task on three counts: first, he occupies the chair of psychiatry at Yale, secondly, he is a medical historian, and thirdly he is a writer of distinction.
Professor Jackson carefully guides us through the wilderness of medical thinking since classical times. In ancient Greece mental illness was recognized, and physicians in their wisdom identified three categories, namely phrenitis (i.e., delirium), mania, and melancholia. However odd their ideas about causation, however bizarre their therapies, the physicians of that time were sound clinical observers. Rufus, for example, in the first century AD, recognized that melancholics were gloomy and filled with fears and doubts. Some were intolerant of loud noises. Others longed to die. A few were perpetually washing their hands, an eccentricity accepted nowadays as a compulsion. He also specified as symptoms an aversion to food and drink; alarm at the presence of animals; and a tormenting conviction that serpents were lodged within the belly.
Other bizarre delusions were reported by Rufus. One victim imagined that he had been transformed into an earthenware jar. Another thought his skin had become parchment. Yet another that he had no head. A few melancholics were endowed with the gift of divination. Among somatic symptoms, flatulent indigestion was a common complaint. Even the physical appearance might alter, with bulging eyes and eyelids blinking, the lips thickened, the skin dusky and hirsute. Rufus noted that melancholia was commoner in men, but when women were afflicted, the sorrow went deeper. Depression was especially frequent in the elderly. It was realized that in some instances the misery was due to a recent calamity, whereas in others no obvious cause could be found.
Perhaps it was the profundity of the depression in women that induced Dürer in 1514 to portray Melencolia as a female. Admirers of Anita Brookner will recall what she recently had to say upon this topic:
Melancholy is usually portrayed as …
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