What should we do with 'melancholy'? I don't mean should Zoloft or, God forbid, Paxil be prescribed. I mean with the word, 'melancholy', with the idea it denotes. One response is that it's dispensable, except perhaps to poets with over-active imaginations. For mild, persistent lack of affect we've chosen 'dysthymia'. For more serious lassitude and absent resolve we have 'depression'. Add to depression some periods of hyper-action and there's manic depression or bi-polar disorder. On this score 'melancholy' has been subdivided out of business, an anachronism from a premedical era. Perhaps, though, there is something else, some other condition of the human spirit that melancholy could designate, a condition that is not a disease yet shares some of its felt qualities with depression.
To address this issue presupposes that something else is more or less settled. This is whether the types or categories of psychological dysfunction are best defined by clusters of traits (affective, cognitive or behavioral) or by underlying conditions that produce them. These are interesting and important questions, ones that Jennifer Radden's fine collection of previously published essays can help us with.
Radden is Professor of Philosophy at the University of Massachusetts in Boston. She has written widely and perceptively on philosophical issues surrounding mental health and therapy. These include her Madness and Reason (1985) and Divided Minds and Successive Selves (1996) and she has edited The Nature of Melancholy (2000) and The Philosophy of Psychiatry (2004). Moody Minds Distempered; Essays on Melancholy is a wonderful collection on the history and nature of ideas about melancholy and the relationships between historical understandings of the phenomenon and contemporary diagnostic categories. Unlike many collections from a single philosopher, the treatments cohere very well, approximating as closely as a collection can to the chapters of a text.
Radden seems to believe, as I do, that to grasp a topic properly one must look to its history. And so she describes the understanding of melancholia of Teresa of Avila who treated the condition among the nuns of the Carmelite Order, which Teresa founded (Ch. 1). Radden notes that even in the sixteenth century we find Teresa struggling to distinguish melancholia from other conditions, both more and less troubling, and whether this should be done with reference to underlying causes or observable states of affect or behavior. This is an early sighting of some of the controversy surrounding the new symptom cluster approach to the DSM instituted by Robert Spitzer and others in the 1970s. For a contemporary critique of the modern DSM see Christopher Lane's Shyness: How Normal Behavior Became a Sickness, 2007 (Reviewed by John Mullen on Metapsychology).
Robert Burton's The Anatomy of Melancholy (1621) wrestled with distinguishing within melancholy, described as a combination of sadness and fear, between transient and the more settled melancholy, the latter reflecting an entrenched personality disorder. Burton had the ancient and popular theory of humors with which to develop an explanatory model that would account for this disorder. Radden includes as well a brief discussion of feminist ideas about melancholy's successor, depression, its prevalence among women and its understanding by some as a societal rage turned inward.
One of the most philosophically satisfying analyses (Ch. 4) concerns the degree to which the ancient "melancholy" actual fits into the contemporary category, "depression". Radden notes four similarities including emphases on fear and sadness, the objectlessness of these affects, hypersensitivity and finally an alteration between states of grandiosity and lassitude. Against these she notes two points of difference. The first is that historical discussions of melancholia involved other symptoms such as excessive scruples, likely stemming from religious training, and melancholy's association with intellectual elites. Radden does not mention that in romantic thinking this latter association was largely reserved to males. Put simply, the soul-burdened male withered away in melancholy while the body-burdened woman withered away in consumption. In some romantic traditions, melancholy and consumption (TB) were metaphorical twins.
Radden tackles directly the issue of whether psychiatric categories are best defined by clusters of affects and behaviors (she refers to this as the descriptivist model) or by the underlying causes of these clusters (the causal model). Robert Spitzer led the development of the modern DSM and rejected much of the psychodynamic taxonomic language that had prevailed in the early versions, up through DSM II (1968). His reasoning was that prior categories were theory laden, committing therapists to particular orientations and therapies. Radden notes a drawback of the descriptivist approach, that it eliminates the possibility of employing the disease category as an explanation of its symptoms. It makes perfect sense to explain breathing difficulties by reference to underlying TB as a state of the lungs. But if depression is nothing more than a small set of affects and behaviors, then one cannot, without circularity, explain for example affectlessness by reference to depression. This loss of explanatory power has another consequence, which is that it discourages the development of theory and the research questions that theory implies. In addition there is a tendency to think of certain traits or behaviors that are unrelated to the symptoms (or defining clusters) as evidence of "masked depression". Radden notes back pain, dizziness and headache in Chinese and African cultures and "acting out" in western culture. But the trait cluster approach makes such claims incomprehensible. Despite these drawbacks, Radden writes, "Despite its explanatory paucity, the limited nature of surface psychiatry permits it to avoid dangers and errors arising from overreaching." But she continues, "Although overreaching without conceptual warrant, only causal ontologies seem to promise the goals we all desire."  This ambivalence on Radden's part is the mark of a serious and confident philosopher.
The issue remains of what is left that is of any use from the historical ideas of the concept of melancholy. Of course these ideas, though related, were yet diverse. But there is something that Robert Burton wrote in Anatomy that suggests an answer, "And from these melancholy dispositions no man living is free, no Stoick (sic), none so wise, none so happy, none so patient, so generous, so godly, so divine ... Melancholy is in this sense the character of Mortality." Here we have the suggestion that mortality itself, our own humanness, gives rise to melancholy. Melancholy was a persistent feature of the romantic movement of about 1770 to 1830, in Germany and in England (later in France). It was connected with the idea of weltschmerz, "world-weariness". Romanticism glorified a new human freedom and the knowledge that set that era apart from earlier ones as the human is set apart from the brute, the adult from the child. But correlated with this higher life of freedom and knowledge was an acute realization of individual mortality and so of life's futility. Within this view of life it was possible neither to "abide in the moment" (Goethe) or to get an inch closer to the prize. Later in Albert Camus, Sisyphus becomes the prevailing symbol of this. Melancholy designated the weariness associated with mortal futility. Its cause was not the futility itself but the knowledge of it and a spiritual tiredness that stems from the heroic attempt to overcome what cannot be avoided. This explains the connection between melancholy and the intellectually elite. It is they who know of life's futility and so it is they who suffer most acutely the sting of melancholy. And on this view melancholy is both a malady and a sign of a higher stage of human life. Jennifer Radden hits upon some of these matters in her interesting chapter on Peter Kramer's Against Depression, 2005.
I recommend this collection of essays very highly.
© 2010 John D. Mullen
John D. Mullen is professor emeritus of philosophy at Dowling College in New York. He is the author of Kierkegaard's Philosophy: Self-Deception and Cowardice in the Present Age (1995), Hard Thinking: The Re-Introduction of Logic to Everyday Life (1995) and with Byron M. Roth, Decision Making: Its Logic and Practice (1990). He lives and writes in Gloucester, Massachusetts.