Burton classifies the then current treatments for depression. There were the illegal ones “from the Divel, Magicians, Witches, &c., by charmes, spels, incantations, Images, &c.,” and the legal ones, “immediately from God a Jove principium, metiatelly by Nature, which concernes & works by 1. Physician; 2. Patient; 3. Physicke.” Though he rambles through dozens of categories of treatment, he does in the end say that the “chiefest” consists in trying to address directly the “passions and perturbations of the mind,” and he commends “opening up” to friends and seeking out “mirth, music, and merry company.” He recommends his own catalog of treatments: marigold, dandelion, ash, willow, tamarisk, roses, violets, sweet apples, wine, tobacco, syrup of poppy, featherfew, Saint-John’s-wort if “gathered on a Friday in the hour of Jupiter,” and the wearing of a ring made from the right forefoot of an ass.
Burton tackles also the difficult problem of suicide. While melancholy was voguish in the late sixteenth century, suicide was forbidden by law and by Church, the prohibition strengthened by economic sanctions. If a man in England at this time committed suicide, his family had to give up all his chattel, including plows, rakes, merchandise, and other material necessary for any kind of economic life. A miller from a small town in England lamented on his deathbed, after having given himself a fatal wound, “I have forfeited my estate to the king, beggared my wife and children.” Careful once more of the censors of his own day, Burton discusses the religious implications of suicide, but acknowledging how intolerable acute anxiety is, he wonders “whether it be lawful, in this case of melancholy, for a man to offer violence to himself.” He later writes, “In the midst of these squalid, ugly, and such irksome days, they seek at last, finding no comfort, no remedy in this wretched life, to be eased of all by death . . . to be their own butchers, and execute themselves.” This is striking because, until Burton, the matter of depression had been quite separate from the crime against God of self-annihilation; and in fact the word suicide appears to have been coined shortly after the publication of Burton’s magnum opus. The book includes stories of those who ended their lives for political or moral reasons, who made the choice out of aggrieved prudence rather than out of illness. It then proceeds to the suicides of people who are not rational, and so brings together these two matters, previously held to be anathema, to make suicide into a single topic of discussion.
Burton describes a winning sequence of melancholy delusions—a man who thought he was a shellfish, some who believe “that they are all glasses, and therefore will suffer no man to come neere them; that they are all corke, as light as feathers, others as heavy as lead, som are afraid their heads will fall off their shoulders, that they have frogs in their bellies, &c. Another dares not goe over a bridge, come neere a poole, rock, steep hill, lye in a chamber where crosse beames are, for feare he be tempted to hang, drowne, or praecipitate himselfe.” These delusions were characteristic of melancholy at this time, and accounts of them abound in the medical and common literature. The Dutch writer Caspar Barlaeus at various stages of his life believed himself to be made of glass and to be made of straw, which might at any moment catch fire. Cervantes wrote a novella, The Glass Licentiate, about a man who believed himself to be made of glass. Indeed such a misapprehension was so common that it is referred to by some doctors of the time simply as “the glass delusion.” It occurs as a phenomenon in the popular literature of every Western country at about this time. A number of Dutchmen were persuaded that they had glass buttocks and were at great pains to avoid sitting down lest they break; one insisted that he could travel only when packed in a box with straw. Ludovicus a Casanova wrote a long description of a baker who believed himself to be made of butter and was terrified of melting, who insisted on being always completely naked and covered with leaves to keep him cool.
These delusions generated systems of melancholic behavior—they caused people to dread ordinary circumstances, to live in constant fear, and to resist any human embrace. Those who suffered from them seem invariably to have suffered from the usual symptoms—unwarrantable sadness, constant exhaustion, lack of appetites, and so on—that we associate with depression today. This tendency to delusion, which had existed to some extent in earlier periods (Pope Pius II recounts that Charles VI of France, called “the Foolish,” had believed already in the fourteenth century that he was made of glass and had iron ribs sewn into his clothing so that he would not break if he fell; along these lines ancient delusions had been recorded by Rufus) and which reached its apex in the seventeenth century, is not unknown today. There are recent reports of a depressed Dutch woman who believed that her arms were made of glass and would not get dressed lest she break them, and patients with schizo-affective conditions frequently hear voices and see visions; obsessive-compulsives are driven to equally irrational fears, such as a terror of uncleanliness. However, the delusional nature of depression has tended, with the advance of modernity, to be less specific. All of these seventeenth-century delusionals are really manifesting paranoias and conspiracy fears and the sense that the ordinary demands of life are beyond their scope, and those sensations are absolutely characteristic of modern depression.
I can remember, in my own depression, being unable to do ordinary things. “I can’t sit in a movie theater,” I said at one stage when someone tried to cheer me up by inviting me out to a film. “I can’t go outside,” I said later. I didn’t have a specific rationale for these feelings, didn’t expect to melt at the movies or to be turned to stone by the breeze outside, and I knew in principle that there was no reason why I couldn’t go outside; but I knew that I couldn’t do it as surely as I now know that I can’t leap tall buildings in a single bound. I could (and did) blame my serotonin. I do not think that there has been any convincing account of why the delusions of depression took on such concrete form in the seventeenth century, but it would seem that until scientific explanations and treatments for depression began to emerge, people devised explanatory armatures for their fears. Only in a more mature society could one be afraid to be touched or to stand or to sit without concretizing the fear as being predicated on having a glass skeleton; and only in a sophisticated context might one experience an irrational fear of heat without actually describing a fear of melting. These delusions, which can seem puzzling to modern practitioners, are more easily grasped if they are contextualized.
The great transformer of seventeenth-century medicine, at least from the philosophical standpoint, was René Descartes. Though his mechanistic model of consciousness was not so far removed from the Augustinian tradition of dividing soul and body, it had specific ramifications for medicine, and especially for the treatment of mental illnesses. Descartes placed considerable emphasis on mind’s influence on body and vice versa, and described in The Passions of the Soul how the state of the mind may immediately affect the body, but his followers tended to work on the assumption of a total mind-body split. In effect, a Cartesian biology came to dominate thinking; and that biology was largely wrong. Cartesian biology caused considerable reversal in the fate of the depressed. The endless hairsplitting about what is body and what is mind—whether depression is “a chemical imbalance” or “a human weakness”—is our legacy from Descartes. Only in recent years have we begun to resolve this confusion. But how did Cartesian biology take on such power? As a psychologist at the University of London put it, “In my experience, no body, no mind, no problem.”
Thomas Willis, working to prove the bodily susceptibility of the mind, published in midcentury Two Discourses Concerning the Soul of Brutes, the first coherent chemical theory of melancholy, one that was not contingent on ancient humoral theories of black bile, spleen, or liver. Willis believed that an “inkindled flame” in the blood was supported by “sulfureous food” and “nitreous air” and that the brain and nerves focused the resulting spirits to guide sensation and motion. For Willis, the soul is a physical phenomenon, the “shadowy hag” of the visible body that “depends upon the temperament of the bloody m
ass.” Willis thought that a variety of circumstances could turn the blood salty and so limit its flame, which would cut down the illumination in the brain and give rise to the brain darkness of melancholy. Willis believed that this salination of the blood could be caused by all kinds of external circumstances including the weather, excessive thinking, and insufficient exercise. The brain of the melancholic fixates on its sights of darkness and incorporates them into character. “Hence, when that the vital flame is so small and languishing, that it shakes and trembles at every motion, it is no wonder if that the Melancholick person is as it were with a sinking and half overthrown mind always sad and fearful.” The effect of this kind of problem if sustained would be an organic transformation of the brain. The melancholic blood can “cut new Porosites in the neighboring bodies”; the “Acetous disposition of the Spirits” and “Melancholik foulnesses” alter “the conformation of the brain itself.” Then the spirits “observe not their former tracts and ways of their expansion, but they thickly make for themselves new and unwonted spaces.” Though the origins of this principle are confused, the reality indicated is confirmed by modern science; persistent depression does indeed alter the brain, carving out “unwonted spaces.”
The end of the seventeenth and the beginning of the eighteenth centuries saw enormous strides in science. Accounts of melancholy underwent significant shifts as a consequence of new theories of the body, which brought with them a series of new theories about the biology of the mind and its dysfunctions. Nicholas Robinson proposed a fibrous model of the body and, in 1729, said that depression was caused by failure of the elasticity of fibers. About what we would now call talking therapies, Robinson was not confident. “You may as soon attempt to counsel a Man out of the most violent Fever,” he wrote, “as endeavour to work any Alteriation in their Faculties by the Impressions of Sound, tho’ never so eloquently apply’d.” Here begins the total abandonment of the melancholic as an individual whose ability to explain himself might be considered in his cure.
In 1742, Hermann Boerhaave pursued this idea and came up with the so-called iatromechanical model, according to which all the functions of the body could be explained through a theory of hydraulics; he treated the body “as a living and animated Machine.” Boerhaave posited that the brain is a gland, and that nervous juices from this gland travel around in the blood. Blood is made of many different substances mixed together, and when the balance is confused, he held, problems ensue. Depression occurs when the oily and fatty stuffs of the blood accumulate and the nervous juices are in short supply. Under these circumstances, the blood stops circulating in the appropriate places. Boerhaave argued that the reason for this was often that one had used up too much of the nervous juice in thinking (which was taxing); the solution was to think less and act more, so producing a better balance of the components of the blood. Like Willis, Boerhaave was onto something: reduced blood supply to certain areas of the brain may result in depression or in delusion; and the onset of depression in the senile elderly is often based on the failure of blood to circulate correctly in the brain, where certain areas have become thick (as though coagulated) and do not absorb the blood’s nourishments.
All this theory served the dehumanization of the human. Julien Offray de La Mettrie, one of Boerhaave’s great champions, scandalized the godly when he published his L’Homme Machine in 1747; he was cast out of the French court and went to Leiden, only to be cast out of Leiden and die at the age of forty-two in remote Berlin. He suggested that man was nothing more than a consortium of chemical substances engaged in mechanical actions—the theory of pure science as it has come down to us. De La Mettrie maintained that living substance was by nature irritable, and that from its irritation all action derived. “Irritability is the source of all our feeling, of all our pleasure, of all our passion, and of all our thoughts.” The view depended on a concept of human nature that was, above all, orderly; disorders such as depression amounted to malfunctions of the wondrous machine, a departure from, rather than an element of, its function.
From here it was a short step to conceive of melancholy as an aspect of the general problem of mental illness. Friedrich Hoffman was the first to suggest coherently and forcefully what would come to be genetic theory. “Madness is an hereditary disease,” he wrote, “and continues often during life; it has sometimes long intermissions, in which the patient appears perfectly in his senses; and returns at regular periods.” Hoffman proposed some rather conventional cures for melancholy, then endearingly said that “of madness in young women from love, the most effectual remedy is marriage.”
Scientific explanations of the body and of the mind developed at a vastly accelerated pace throughout the eighteenth century. But in an Age of Reason, those without reason were at a severe social disadvantage, and while science made great leaps forward, the social position of the depressed made great leaps backward. Spinoza had said at the end of the seventeenth century, foreshadowing the triumph of Reason, that “an emotion comes more under our control, and the mind is less passive in respect to it, in proportion as it is more known to us,” and that “everyone has the power of clearly and distinctly understanding himself and his emotions, and of bringing it about that he should become less subject to them.” So the melancholic would be now not a demonic but a self-indulgent figure, refusing the accessible self-discipline of mental health. Apart from the time of the Inquisition, the eighteenth century was probably the worst time in history to suffer from a rough mental disorder. While Boerhaave and de La Mettrie were theorizing, the severely mentally ill, once they were so categorized by their relatives, were treated half as though they were lab specimens and half as though they were wild animals fresh from the jungle and in need of taming. Obsessed with the manners and mores, hostile to those who did not comply with them, and titillated by alien peoples brought back from colonial territories, the eighteenth century imposed severe punishment on those whose erratic behavior seemed to threaten convention, no matter what their class or nationality. Segregated from their society, they were placed in the all-lunatic world of Bedlam (in England) or in the horror hospital of Bicêtre (in France), places that would drive the most implacably rational to insanity. Though such institutions had long existed—Bedlam was founded in 1247 and was a home for pauper lunatics by 1547—they came into their own in the eighteenth century. The concept of “reason” implies natural concord among human beings and is essentially a conformist notion; “reason” is defined by consensus. The idea of incorporating extremes into the social order is antithetical to such reason. By the standards of the Age of Reason, extremes of mental condition are not remote points on a logic continuum; they are points wholly outside of a defined coherence. In the eighteenth century, the mentally ill were outsiders without rights or position. So societally constricted were the delusional and the depressed that William Blake complained, “Ghosts are not lawful.”
Among the mentally ill, the depressed had the advantage of being relatively docile and were therefore abused in just slightly less atrocious ways than were the maniacal and the schizophrenic. Filth, squalor, torture, and misery were the lot of the melancholic through the Age of Reason and the Regency. Society squashed the notion that those with severe psychological complaints might recover from them; once you had shown yourself to be barmy, you went into the mental hospital and you stayed there, for you were no more likely to emerge into human reason than was a captive rhinoceros. The chief physician of Bedlam, Dr. John Monro, said that melancholy was intractable and that “the cure of the disorder depends on management as much as on medicine.” Those who suffered from the most severe forms of melancholy were often subjected to the most horrifying treatments. Boerhaave himself had proposed causing great physical pain in patients to distract them from the pain within their minds. Virtually drowning depressives was not uncommon, and mechanical devices of Boschian complexity were produced to make melancholiacs swoon and vomit by turns.
Those with milder (but still severe) depression of
ten found themselves living nearly clandestine lives in consequence of that complaint. James Boswell wrote at length, to his friends, about his experiences with depression; and so, after him, did the poet William Cowper. Their accounts give a feeling for the grievous suffering attached to depression throughout this period. In 1763, Boswell wrote: “Expect not in this letter to hear of anything but the misery of your poor friend. I have been melancholy to the most shocking and most tormenting degree. I sunk altogether. My mind was filled with the blackest ideas, and all my powers of reason forsook me. Would you believe it? I ran frantic up and down the streets, crying out, bursting into tears, and groaning from my innermost heart. O good GOD! what have I endured! O my friend, how much was I to be pitied! What could I do? I had no inclination for anything. All things appeared good for nothing, all dreary.” Later that year he added, writing to another friend, “A deep melancholy seized upon me. I thought myself old and wretched and forlorn. All the horrid ideas you can imagine, recurred upon me. I took general speculative views of things; all seemed full of darkness and woe.” Boswell undertook the writing of ten lines a day addressed to himself and found that by describing what he was going through as he went through it, he could keep some measure of sanity, though he filled his lines with ellipses. So we find entries such as “You was direfully melancholy and had the last and most dreadful thoughts. You came home and prayed . . .” and a few days later, “Yesterday you was very bad after dinner, and shuddered with dire ideas. You was incertain and confused and lay, talked of going to bed, and could scarcely read Greek . . .”
The Noonday Demon Page 44