Johnson and Boswell: "Vile Melancholy"9 and ""The Hypochondriack9" William B

657 JOHNSON AND BOSWELL: "VILE MELANCHOLY"9 AND ""THE HYPOCHONDRIACK9" WILLIAM B. OBER, M.D. Hackensack Medical Center Hackensack, New Jersey D EPRESSION has replaced melancholia as a psychiatric term because we no longer credit the humoral notion of "black bile" as its cause. Yet Timothy Bright's A Treatise of Melancholie (1586) is the first mono- graph in English on a psychiatric topic. He recognized melancholia as an emotional disturbance not accompanied by dementia; in keeping with Tudor humoral theory, he wrote that "melancholic humor ... is settled in the spleane and with his vapour annoyeth the harte and passing up to the brayne, coun- tersetteth terrible onjects to the fantasie ... causeth it without externall oc- casion to forge monstrous fictions. .. the brayne hath plentifully drunke of that spleneticke fogge... and the pure and bright spirites so defiled and eclipsed."' Bright's humoral ideas were adopted by Elizabethan and Jaco- bean writers, notably in Robert Burton's Anatomy ofMelancholy (1621). The Puritan movement in Britain, allied to Calvinist doctrines of total human depravity and the lack of remission of sin by contrition or confession, con- tributed to the widely held sense of despair and impending doom that perme- ates much literature of the first six decades of the 17th century. Only with Thomas Willis's post-Restoration insights in Pathologiae Cerebri et Nervosae (1667) and De Anima Brutorum (1672) did the first steps to- ward "modern" neuropsychiatry appear. He laid the groundwork for an organic and mechanical concept of mental disease. That his "explosive par- ticles" and "animal spirits" have given way to more refined biochemical ideas about the neural impulse does not diminish their importance in the history of ideas. When Willis wrote that "Melancholy is commonly defined to be a raving without a Feavor or fury, joined with fear and sadness ... it is a complicated Distemper of the Brain and Heart,"2 he was assigning reason to the brain and emotion to the heart much as we do today. Address for reprint requests: Hackensack Medical Center, 30 Prospect Avenue, Hackensack, N.J. 07601 Vol. 61, No. 7, September 1985 658 658W.W. B. OBER In the 18th century depression had such synonyms as low spirits, the spleen, the vapours, as well as such classical terms as hysteria and hypochondriasis. In 1682 Thomas Sydenham denied the traditional idea that hysteria was due to a disturbance of the womb and peculiar to women. Its symptoms, he noted, were identical with hypochondriasis, then thought to be peculiar to men, and he insisted they were the same disease. The descriptions of symptoms range from mild anxiety states through organic conversion complaints to true depressive psychosis. Humoral vocabulary persisted, vide The Spleen, a Pindarique Ode' (1701) by Anne, Countess of Winchilsea, who suffered from it: Falsely the Mortal Part we blame Of our deprest and pondrous frame ... The Cause indeed is a defect in Sense, But still the Spleen's alleg'd and still the dull pretence.3 Physicians such as John Purcell, Sir Richard Blackmore, Bernard Mandeville, William Stukeley, and Nicholas Robinson published monographs that at- tempted to describe and explain depression, reconciling humoral and mechanical theories with variable success. But the most influential treatise that domi- nated 18th century ideas about the disease was George Cheyne's The English Malady (1733). The malady, he argued, was peculiarly English because of "The Moisture of our Air, the Variableness of our Weather ... the Richness and Heaviness of our Food ... the Inactivity and sedentary Occupations of the better Sort ... and the Humour of living in great, populous and conse- quently unhealthy Towns.' '4 Particularly dangerous was the cold, damp, penetrating east wind sweeping in over England from the North Sea. Thomas Gray, who "trembled at an east wind,"5 described his prevail- ing mood as "a white melancholy, or rather Leucocholy, ' and confessed to episodes of deeper depression. His "Elegy, Written in a Country Church- yard" tells us that "Melancholy had marked him for her own," referring to the youth who lies buried there. William Cowper, who suffered from re- ligious melancholia and weathered three suicide attempts, agreed with Cheyne, Gray, and others about the role of climate, "the unhealthful East that breathes the spleen"7 and depression's predilection for England: "It pleased God that I should be born in a country where melancholy is the na- tional characteristic; and of a house more than commonly subject to it. To say the truth, I have often wished myself a Frenchman.' '8 An astonishing statement from a writer so quintessentially English! Bull. N.Y. Acad. Med. MELANCHOLY AND THE HYPOCHONDRIACK 659 SAMUEL JOHNSON But the writers who examined themselves and their depressions most closely were Samuel Johnson and James Boswell. Most people who read Johnson are immediately struck by how firm his ideas are and the force with which he expresses them. Few writers so consistently achieve such good sense and sound judgment. Yet one of the ironies of biography is that a mind so resolute when applied to life and letters suffered such anguish when it came to mastering its owner's emotions. The outline of his early struggles is familiar-not enough money to continue for an Oxford degree, "mental breakdown" on returning to Lichfield, failure as a schoolmaster, years of penury writing in London, his wife's death, loneliness, despair. His medical history is also familiar-scrofula as a child, poor eyesight, compulsive neurotic tics, asthma, and a variety of sicknesses. But recognition and repu- tation came with his Dictionary (1755), when he was in his mid-40s, then Rasselas (1759), and a royal pension (1762). Despite accumulated honors, despite a circle of loyal, devoted friends, many of them distinguished, during most of his adult life Johnson was subject to episodes of depression, usually characterized by self-reproach for indolence, feelings of guilt, and almost constant fear of insanity. As an intellect, Johnson towered above his melancholic predecessors, yet he too was a victim. Boswell first met Johnson in 1763 after the successes cited above, and we are much better informed about the last two decades of his life than the first five. Unlike Boswell's journals, Johnson's diaries are not given to exten- sive self-revelation; they are reticent. Recent research has revealed more data about the external circumstances of Johnson's younger years than we knew a generation ago, but we have only fragmentary information about his psy- chic turmoil as a young adult. What we know about his formed adult psy- che comes from his own writings and the posthumous biographies by Boswell, Hester Thrale Piozzi (who knew him only after he had turned 50), and Sir John Hawkins (who had met him somewhat earlier). Johnson returned to Lichfield from Oxford at the end of 1729. It was an unhappy household, and Johnson's bitter disappointment at leaving Oxford was compounded by the failure of his father's bookselling business and his father's declining health. Johnson rapidly sank into a state of depression; at the outset it seemed like a reactive depression with adequate external cause in the circumstances of a young man with few prospects. But it lasted two years in its profound form and persisted, though slowly improving, three years more. During the phase of profound depression Johnson was apathetic. Vol. 61, No. 7, September 1985 660 W. B. OBER 660~~~~~~~~~~~~~~~~~~~~~~~~~ W.B OE Writing many years later, he said he could look at the town clock for an hour and not know what time it was, as good an image as any to convey the immobilizing effect of depression on perception, intellect, and initiative. There is a vague hint that he might have entertained thoughts of suicide, but the phrase "fearfull that there was something wrong in his constitution, which might impair his Intellects, or shorten his Life"9 can equally well be inter- preted as fear that he was suffering from an organic disease. Boswell's comments are descriptive rather than analytical, and, given John- son's reticence about that period of his life, wisely so: [H]e felt himself overwhelmed with an horrible hypochrondria, with perpetual irrita- tion, fretfulness, and impatience; and with a dejection, gloom, and despair, which made existence misery. From this dreadful malady he never afterwards was perfectly relieved; and all his labours, and all his enjoyments, were but temporary interruptions of its baleful influence.... That it was, in some degree, occasioned by a defect in his nervous system, that inexplicable part of our frame, appears highly probable. 10 Boswell and a few of Johnson's intimate friends knew that he lived in almost continual fear of insanity, and he exculpates his hero: But let not little men triumph knowing that Johnson was an HYPOCHONDRIACK.... Though he suffered severely from it, he was not therefore degraded. The powers of his great mind might be troubled, and their full exercise suspended at times, but the mind itself was ever entire.... I am aware that he himself was too ready to call such a complaint by the name of madness. But there is surely a clear distinction between a disorder which affects only the imagination and spirits, while the judgment is sound, and a disorder by which the judgment is impaired. I Boswell makes a major psychiatric distinction. Though Johnson was severely depressed in 1730-31 and on later occasions, he never lost his reason. He was never agitated in the technical sense; he experienced no hallucinations. Unhappy though he was, he could cope with daily living. Nonetheless, the apathetic depression of those years must be reckoned as a major psychiatric illness, and it set the pattern for subsequent episodes, mercifully shorter and less severe.

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