MENTAL HEALTH IN HISTORICAL PERSPECTIVE From Melancholia to Depression Disordered Mood in Nineteenth-Century Psychiatry Åsa Jansson Mental Health in Historical Perspective Series Editors Catharine Coleborne School of Humanities and Social Science University of Newcastle Callaghan, NSW, Australia Matthew Smith Centre for the Social History of Health and Healthcare University of Strathclyde Glasgow, UK Covering all historical periods and geographical contexts, the series explores how mental illness has been understood, experienced, diagnosed, treated and contested. It will publish works that engage actively with contemporary debates related to mental health and, as such, will be of interest not only to historians, but also mental health professionals, patients and policy makers. With its focus on mental health, rather than just psychiatry, the series will endeavour to provide more patient-centred histories. Although this has long been an aim of health historians, it has not been realised, and this series aims to change that. The scope of the series is kept as broad as possible to attract good quality proposals about all aspects of the history of mental health from all periods. The series emphasises interdisciplinary approaches to the field of study, and encourages short titles, longer works, collections, and titles which stretch the boundaries of academic publishing in new ways. More information about this series at http://www.palgrave.com/gp/series/14806 Åsa Jansson From Melancholia to Depression Disordered Mood in Nineteenth-Century Psychiatry Åsa Jansson Institute for Medical Humanities Durham University Durham, UK Mental Health in Historical Perspective ISBN 978-3-030-54801-8 ISBN 978-3-030-54802-5 (eBook) https://doi.org/10.1007/978-3-030-54802-5 © The Editor(s) (if applicable) and The Author(s) 2021. This book is an open access publication. Published with the support of the Wellcome Trust. Open Access This book is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this book are included in the book’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the book’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and informa- tion in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover credit: Teodoro Ortiz Tarrascusa/Alamy Stock Photo This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland For Annika. Thank you, for everything. Preface This book has been a long time in the making. The seeds were sown in 2009 when I started researching an M.A. dissertation on melancholia and depressed mood in Wilhelm Griesinger’s work, and quickly realised that there was a much bigger story to be told about what happened to the melancholia concept in nineteenth-century psychiatry. This story became the focus of a Ph.D. thesis on which this book is based. Melancholia is a topic that has attracted vast attention from writers across disciplines and genres, spanning a range of perspectives. At the same time, much existing work on melancholia is underpinned by a common theme: the belief that melancholy is a timeless human emotion, a phenomenon that has remained largely constant as our societies have changed, a shared experience that connects us to our ancestors of past historical periods. Seen in this way, melancholy is a core feature of humanity, as is its pathological mutation, melancholia. To understand melancholia, then, is to understand something about what it means to be human: to suffer without apparent cause. As this is the context in which this book is written, and as it will inevitably be read against the backdrop of a large catalogue of works on melancholia and melancholy, it is only right that I confess that my interest in this topic and my original motivation for exploring it are less ambitious and more mundane than those of many of the writers who have sought to make sense of this ubiquitous yet elusive feature of the human condition. My initial interest in mood disorders arose in relation vii viii PREFACE to the politics of the pharmaceutical industry and the medicalisation of psychological distress that provides a lucrative market for drug companies. I once offered this explanation in a scholarship interview, and it didn’t go down very well. It was not, it seemed, how or why one is supposed to do history. It was, however, the truth, though that original motivation has since been superseded by a more fundamental desire to understand how knowledge in the psy disciplines is produced, in particular relating to psychiatric classification. But I was never particularly interested in exploring melancholy as a feeling. In the field of the history of psychiatry, the question that often looms—usually unspoken—over our heads when we talk about our research is that of personal experience. Do you write about melan- cholia because of your own struggles with pathological low mood? The short answer to that is no. My interest is more broadly in the produc- tion of psychiatric knowledge about people, how our emotions, thoughts, and actions become symptoms of psychiatric diagnoses. Depression has become ubiquitous, more so than any other psychiatric condition—the WHO considers it to be a leading cause of disability worldwide and the prescription and consumption of antidepressant medication continue to rise every year. I wanted to understand how we got to this point. But when I delved into the world of historical scholarship on depression and melancholia I soon discovered that a significant piece of the puzzle was missing. The more I read, the more evident it became that something funda- mental occurred in the nineteenth century. Most writers on the topic, whether they subscribe to a narrative of continuity or one of change, recognise that today’s Major Depressive Disorder doesn’t correspond to past conceptions of melancholia. But nineteenth-century melancholia was not only significantly different from clinical depression as understood today, it was equally different from the various forms of traditional melan- choly madness that came before. As German Berrios has noted, a shift occurred that was about more than just a change in language.1 The recon- ceptualisation of melancholia in the nineteenth century facilitated the later emergence of clinical depression in the twentieth, but it also paved the 1 German E. Berrios, “ Melancholia and Depression during the Nineteenth Century: A Conceptual History,” British Journal of Psychiatry 153 (1988): 298–304. PREFACE ix way for the creation of other affect-based diagnostic categories, such as bipolar disorder, borderline personality disorder, and anxiety disorders. The story of how melancholia was reconfigured along biomedical lines is not, then, only the story of a specific diagnosis, or state of mind, it is also the story of how the modern concept ‘mood disorder’ was created. That story didn’t begin on asylum wards, but with the rise of a new discipline: experimental physiology. The epistemological framework that was created in the early nineteenth century to explain the internal opera- tion of emotions and ideas continues to form the basis for how we think about psychological events today, and consequently informs the direction of current research into the mind and brain. If we want to understand how we arrived at this point in history where ‘depression’ is an illness that can be treated with psychotropic medication and therapeutic strategies aimed at teaching us to ‘regulate’ our emotions, we must first understand how the idea of disordered mood as a medical condition became possible in the first place. And we must also understand the relationship between statistics and diagnostic practices, another distinctly modern development that is crucial to mapping the creation not just of mood disorders but of most modern psychiatric diagnoses. This book, then, is an attempt to redress a significant gap in the history of depression and melancholia, and of mood disorders more generally. It arises from a desire to understand how knowledge that is absolutely fundamental to the human experience in the twenty-first century was created and made real. So, I didn’t come to this topic because of an interest in melancholy as a feeling or a personal experience with depres- sion. But of course, an interest in psychiatric knowledge is an interest in knowledge about human distress and suffering, and in this way it concerns us all. Most if not all of us will experience psychological distress at some point in our lives (whether or not that distress is pathologised and diagnosed). And what I found once I immersed myself in the archival records of Victorian asylums was that while I don’t necessarily relate to twenty-first-century descriptions of clinical depression, some of the ways in which nineteenth-century asylum patients diagnosed with melancholia expressed their distress resonated with me deeply.