Robert Burton's The Anatomy of Melancholy

The Anatomy of Melancholy (Full title: 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) is a book by Robert Burton, first published in 1621.
(Wikipedia)

Burton's book consists mostly of a collection of opinions of a multitude of writers, grouped under quaint and old-fashioned divisions; in a solemn tone Burton endeavoured to prove indisputable facts by weighty quotations. The subjects discussed and determined by Burton ranged from the doctrines of religion to military discipline, from inland navigation to the morality of dancing-schools.

On its surface, the book is presented as a medical textbook in which Burton applies his vast and varied learning, in the scholastic manner, to the subject of melancholia (which includes what is now termed clinical depression). Though presented as a medical text, The Anatomy of Melancholy is as much a sui generis work of literature as it is a scientific or philosophical text, and Burton addresses far more than his stated subject. In fact, the Anatomy uses melancholy as the lens through which all human emotion and thought may be scrutinized, and virtually the entire contents of a 17th-century library are marshalled into service of this goal.

In his satirical preface to the reader, Burton's persona Democritus Junior explains, "I write of melancholy by being busy to avoid melancholy." The Anatomy is a wide-ranging document, containing digressions and commentary. Whatever its strengths as a medical text or as a historical document, it is the Anatomy's vast breadth – addressing topics such as digestion, goblins, the geography of America, and others – and the particularly characteristic voice of its author that are most commonly cited by its admirers as the main sources of its appeal. Both satirical and serious in tone, the Anatomy is "vitalized by (Burton's) pervading humour", and Burton's digressive and inclusive style, often verging on a stream of consciousness, consistently informs and animates the text.

(Wikipedia)

From Melancholia to Prozac by Clark Lawlor - review

Our understanding of misery has changed less than we think

Jenny Diski

guardian.co.uk, Friday 2 March 2012 09.00 GMT


Sacred insight: detail from The Vision of St Hildegard, attributed to Battista Dossi. Photograph: Bridgeman Art Library

In the middle of the 12th century Hildegard of Bingen explained the aetiology of melancholia. The clue was in the name. Black bile, too much of it: "It causes the veins in the heart to overflow; it causes depression and doubt in every consolation so that the person can find no joy in heavenly life and no consolation in his earthly existence." It was the result of an imbalance of the four humours that circulate in the body. A physician as well as a nun and composer, she is very specific about the biology and anatomy of the humours: "Each of the dominating humours is covered with a quarter of the one coming after and a half of the third. The weaker humour regulates the two parts and the remaining part of the third, to make sure it doesn't exceed its limits."


From Melancholia to Prozac: A History of Depression
by Clark Lawlor

Today, we believe we know better. Depression is largely considered to be an imbalance of the neurochemistry in the brain, and is treated accordingly. Clark Lawlor explains the contemporary view: "An early model was norepinephrine, one of the amine family …too little meant depression, too much meant elation. Serotonin deficiency is possibly the most well-known of the contenders for causing depression." Selective serotonin reuptake inhibitors (SSRIs such as Prozac) increase the amount of serotonin in the brain, and are now the most widely prescribed response to a modern diagnosis of depression and even the newer, milder condition of dysthymia – chronic low mood and sadness, perhaps equally well described as "melancholia".

People on SSRIs often feel better. Which is odd, because the number of people whose mood is improved is only very slightly above that of control groups taking placebos, and some drugs that actually reduce serotonin levels are statistically as effective as antidepressants which increase those levels.

The fact is that, as a non-neurologist and non-biochemist, I have no more real understanding about the functioning of genes, the resulting brain chemistry and the effect on mood than Hildegard of Bingen had about the proportion and action of the humours on the veins in the heart. It seems, too, that psychiatrists aren't entirely sure about the chemical mechanisms of depression. Even so, I pop a prophylactic Prozac every morning, because if I don't think too hard about what I don't know, like the early moderns, the notion of chemical imbalance makes some sense to me (in conjunction with other causes) of my life-long tendency to sink into debilitating depression.

Lawlor's history of the journey from Aristotle and Galen on melancholia, to Aaron Beck's and Martin Seligman's cognitive behavioural approach to depression is notably not a story of progress and increased understanding, but of changes in culture, language and technology about a particular common human condition. It is most valuable as a history of thought about the varying degrees of sadness and despair that have been consistently experienced from antiquity to the present day. Timothie Bright's 1613 description of the effect of excessive black bile – "which shut up the hart as it were in a dungeon of obscurity, causeth manie fearfull fancies … whereby we are in heaviness, sit comfortless, feare distrust, doubt dispaire, and lament, when no cause requireth it" – is as good a picture of depression as I know it as any I've heard or read.

It's surprising, then, when Lawlor says that the early moderns' understanding of what seemed to them like an epidemic of melancholia as a result of the imbalance of bodily humours is "alien to our contemporary world view, even if we can discern similarities with modern symptoms". He uses the phrase "profound strangeness" about their treatment of melancholia with both religious and physical cures. Call the religious spiritual or psychological, and the physical purgings an attempt to rebalance the system, and neither their descriptions nor their fundamental ignorance seem all that different from our own flailing attempts to deal with what again looks like an epidemic of depression.

The Elizabethan picture is confusing, with melancholia being recognised as a fashionable pose, a disorder of the mind, a sign of genius and a precursor of psychosis, but it was hardly more diversely understood than it has been since modernity offered us psychoanalytical, physicalist and cognitive versions of the experience of what is now officially called "major depressive disorder". MRI scans and biochemistry are our new tools, but they are as subject to interpretation as the possibility of the spleen overheating and tipping the system into a hot, dry, burnt condition of melancholia.

Galen's assumption was that the perfect balance is rare, and that most people were in flux, tipping more or less away from balance according to their own behaviours, the environment and their humoral predispositions. This is hardly alien to our understanding of how the body, mind and external circumstances work inextricibly together, and how difficult it is to discern any single cause of mental functioning, positive or negative, no matter how much we yearn for a simple, certain explanation. Perhaps the ancients and early moderns were better at living with uncertainty than we are.

The main theme running through the second half of Lawlor's book is the way in which our present understanding of depression has been increasingly simplified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the power that drug companies seem to have had in the creation of some of those definitions. Checklists appear there which assist doctors (or anyone with the list) to diagnose depression via elementary symptom spotting. Causes become irrelevant because they are so much harder and more expensive to know about and to treat. Humoral imbalance, a rackety childhood, who cares? If you have five of the designated symptoms every day over a two-week period, a doctor can confidently diagnose depression and medicate it.

Some people claim (as Freud would) that this has resulted in the pathologising of normal sadness. Even grief is now subject to a time-limit. DSM-V, due out in 2013, will have a new condition called "complicated grief disorder", which allows doctors to treat excessive mourning (designated by a symptom list) as depression within a few weeks of a bereavement, and puts a limit on normal mourning at six months. It isn't just that we want certainty, we seem to have come to the conclusion that feelings of sadness or a low mood are not just intolerable but actually abnormal.

Unfortunately, rather as if he were trying to make more simple sense of the subject than there was and is to be made, Lawlor's book is an overly brisk addition to the history of and thinking about melancholia and depression. It reads like a series of notes for a longer and more considered book and is broken into sub-headings in which major topics such as romantic melancholy and Christianity's influence on depression are wrapped up in little more than a page and a half of text.

There's a good bibliography, so I suppose anyone particularly interested can find more substance than is on offer here, but it isn't clear who the intended reader is who urgently wants these more considerable books boiled down. The long inquiry into melancholia and depression is so full of extraordinary writing – Ficino, Burton, Shakespeare, Donne, Milton, Keats and Coleridge, Freud, Styron, Kristeva – that this exiguous "what comes next" approach feels meagre.

• Jenny Diski's What I Don't Know about Animals is published by Virago.