The Anatomy of Melancholy

I have tried to demonstrate that Freud and his psychiatric successors were dead wrong in their claims of the origins of depression. By the apparent report of depressives themselves, so far as we can tell, and according to myth and literature when they deal with the subject, depression has nothing to do with an Oedipus Complex, and nothing to do with a child resenting, coveting, or feeling rivalry with a parent. It comes from a traumatic childhood, caused in most cases by a parent abusing a child.

But the most likely objection today to the claim that depression is caused by childhood abuse is not Freudian, that it is caused by an unresolved Oedipus complex. Instead, frozen in the popular mind is the notion that depression is about a “chemical imbalance.” It is this purely materialist explanation that is most regularly heard.

Let us clarify what is meant. Showing that certain chemicals are in different proportions in the brains of the depressed by itself proves nothing, for it cannot show causation. Does a lack of serotonin cause glum thoughts, or do glum thoughts produce a lack of serotonin? Proof for the “chemical imbalance” theory would be the discovery of a “depression gene” found in diagnosed “depressives” and not in the general public. That at least would imply causation.

Absence of evidence is not evidence of absence, but with our knowledge of the human genome expanding quickly, it is troubling and telling that all attempts to isolate a “depression gene,” or other “mental illness genes,” have come to naught. Black swans may roost, but each year that passes makes this a less plausible explanation. Statistically, it is true, some psychologists believe they have isolated a genetic component to mental illness: the depressed are statistically a bit more likely to have gene X or gene A than the general population. But note that we would expect that even based on our Dymphna Complex theory: if the unusually beautiful or unusually intelligent or unusually athletic are more prone, due to envy, to be abused, and abuse is the cause of mental illness, we too would expect to find such a statistical genetic link--just so long as there is a genetic factor in physical attractiveness, intelligence, or athletic ability.

The “chemical imbalance” theory also grows harder to defend as the statistics show depression becoming year by year a more common ailment. The National Ambulatory Medical Care Survey (NAMCS) finds that the number of people diagnosed with depression in the US has increased by 450% just since 1987. The WHO warns that, worldwide, “By 2020, depression will be the second leading cause of world disability and by 2030 it is expected to be the largest contributor to disease burden” (World Federation for Mental Health, “Depression: A Global Crisis,” 2012).

One does not see epidemics of genetic diseases.

It is possible to argue that this apparent pandemic is due to “better detection” and so more common treatment for depression. But if so, the actual suicide rate should be going down, as more people get treated. Instead, it too is rising. “From 1999 to 2010, the suicide rate among Americans ages 35 to 64 rose by nearly 30 percent” (Tara Parker, “Suicide Rates Rise Sharply in U.S.” NY Times, May 2, 2013). The US Center for Disease Control reports the overall suicide rate increased from 11.3 suicides per 100,000 people in 2007 to 12.6 suicides per 100,000 people in 2013 (Janet Singer, “Increase in Suicide Rates and Teen Depression,” PsychCentral).

Accordingly, the “chemical imbalance” explanation does not seem to fit. Is it something in our diet?

And it is not given much credence, it seems, at least currently, in the medical community. Both WebMD and Medicine Net cite the most common cause of depression as child abuse, not genetic factors, although there may also be some hereditary component.

Yet “chemical imbalance” persists as the preferred explanation in the popular mind.

To some, perhaps, because it is purely and grossly materialist, it seems more “scientific.”

Yet it is plainly not scientific or based on any evidence. It is at best a hypothesis, in conflict with the available evidence. And it has been with us for a very long time; longer than has science itself.

Hero legends were not the only pre-modern studies of depression and mental illness. More familiar to most, in fact, is the theory of the four humours. You might have heard of them in a non-medical context: humours are the traditional characters of comedy. They are “humourous.”

This humour theory held that all illnesses are indeed caused by a “chemical imbalance.” This is why surgeons used to let blood: to get the toxic humours out.

Melancholy, specifically, “black bile,” caused what we now call depression, and, if the imbalance was great, other mental illnesses: hypochondria, schizophrenia, mania.

The human body, in this conceptualization, contains four vital fluids: blood, phlegm, bile or choler, and melancholy or “black bile.” Too much of one, and not enough of another, causes all illness. But they also have mental effects. If blood dominates, you are “sanguine” - contented and optimistic. If phlegm dominates, you are “phlegmatic” - unemotional, calm. If bile dominates, you are “choleric” - quick to anger. If black bile dominates, you are “melancholic” - sad and anxious.

We know now that this is all unscientific. But did anyone ever seriously think that it was scientific?

Why, for example, four humours, not five, or three, or seventeen? Why are some plainly visible bolidy liquids not included? Where, for example, is saliva? Sweat? Tears?

What determines a “balance”? Isn’t that a purely philosophical concept?

How can this same factor explain both temperament and illness? Should not everyone of the same temperament suffer from the same illnesses?

It is, at best, this “chemical imbalance” idea, philosophical rather than scientific in its origins. And probably metaphorical.

When it is applied on the stage, in comedy, it produces notably unrealistic results. The stock characters or “humours” of comedy, while funny, are utterly two-dimensional. They are not like real people at all. They are like the phlegmatic Wimpy in the old Popeye comic strips. They are little automatons.

Some writers may well have taken this system literally and scientifically. It is hard to tell. Until recently, medical thinkers and natural philosophers (they would not have used the word “scientists”) did not write literally. For example, chemical texts of the same time mostly concerned themselves with turning lead into gold, and achieving personal immortality, through something called the “Philosopher’s Stone.”

Surely this, too, was transparently a metaphor: a philosophical, not a physical, stone.

In the pre-Modern, pre-science world, it was common practice for such natural philosophers to write in parables, expressly so that the ignorant would not understand—on the model of the parables of Jesus. They were “mages” or “magicians.” A magician does not reveal his tricks. The rubes, most folks probably always being instinctively materialists, were expected not to understand. This was funny; it was entertaining; and it preserved the livelihood and authority of the cognizant few.

If this humoural theory became a standard explanation, then, it was not on any physical evidence. It was show business. It was an effective marketing ploy.

Robert Burton’s celebrated and exhaustingly exhaustive 1621 treatise The Anatomy of Melancholy is the classic study of the theory in English. It usefully compiles essentially all that had been written on “melancholy” and its effects to that time. Despite the title, however, it actually gives little prominence to the humoural theory: it is just one cited among many, tucked into a chapter titled “Particular Symptoms from the influence of Stars, parts of the Body, and Humours.” And Burton’s account reveals that the theory was never consistent or consistently held. When he comes to discuss the “matter” of melancholy as a humour, Burton finds it pretty much up in the air. “What this humour is, or whence it proceeds, how it is engendered in the body, neither Galen, nor any old writer, hath sufficiently discussed…. Montanus, in his Consultations, holds melancholy to be material or immaterial; and so doth Arculanus” (p. 229). “Paracelsus wholly rejects and derides this division of four humours and complexions” (p. 230).

It was always something fixed more in the popular imagination than in the actual medical texts.

Whatever unscientific considerations made the theory of the humours popular in the pre-Modern world, also support the modern claims of chemical imbalance. There is something about the theory that most people must find satisfying, pleasing, or reassuring.

And it is not at all hard to see what it is—beyond, that is, the theory’s pure materialism. The theory of the humours, as well as the modern chemical concept, absolve us of moral blame. If we are all just bags of chemicals, that decide what we think and feel, we are not responsible for our acts. We are compelled to them without choices. We are “born this way.”

That is reassuring, if we want to do something morally bad. It is more reassuring if we have already done something morally bad. We can say,

“I am not bad tempered. Don’t blame me for destroying our TV with the baseball bat. I’m choleric by nature.”

“I am not lazy. Don’t blame me for not contributing to the rent. I’m phlegmatic by nature.”

This is exactly the selling point used by the modern “chemical imbalance” corps. The theory is presented as an enlightened advance, because it remove any guilt over mental illness. It is not their fault they are depressed. They are sick. It is a chemical imbalance.

This might even be superficially attractive to some of the depressed. After all, they are characteristically, like Oedipus or Heracles, wracked with guilt. But it is a poisoned chalice.

It is perverse if the cause of depression and mental illness is what we say it is. Would it really help the victims of the Holocaust to be reassured that it was all really no one’s fault? We are not removing blame from the mentally ill. We are conveniently removing blame from the people who went after their egos with a baseball bat long ago.

This might seem progressive to some. It is hardly helpful to the mentally ill.

One common symptom of real depression, we see in all the stories, is a fierce dedication to justice and the right. Accordingly, this “no blame” approach is never going to work over the long run. It will only make the innate outrage—the depression—worse. It adds insult to injury. It grabs away from the depressed hero, given the chance, his or her one remaining raison d’étre.

Peter Breggin, in Toxic Psychiatry, argues that the credibility given to this “chemical imbalance” theory in modern times is based entirely on political considerations. You will recall that Freud saw plainly in his early patients that neurosis had roots in some form of childhood abuse. Then he retracted the claim, without public explanation, and substituted one that seems intrinsically less plausible: the Oedipus Complex.

Something similar happened again in the 1950s. Again, in clinical practice, some psychiatrists working with autistic children had concluded that child abuse—or rather, more specifically, neglect by the mother—as a critical factor in the development of mental illness. Silvano Arieti, for example, noticed that autistic children often speak of themselves as “you” and not infrequently of the mother as “I” (Wikipedia).

This theory is often now described as “discredited”; yet, Breggin points out, it does not seem ever to have been discredited by any sort of clinical or scientific evidence. Rather, what happened is that the parents of autistic children and schizophrenics lobbied fiercely that they were being unfairly blamed. Some of them were psychiatrists.

There are two awkward considerations here: first, the hero legends, Aristotle, and others, suggest that especially prominent families, such as the families of kings, are especially prone to having depressed or mentally ill kids. Accordingly, any suggestion that parents are responsible for mental illness is going to involve an implicit condemnation of a healthy selection of the rich and powerful. Especially if they are ruthless and selfish, they are not going to take this lying down. Second, as Alice Miller’s example suggests, the sort of people who are inclined to be abusive parents are naturally inclined to become analysts; they can get their sadistic jollies in both situations. A lot of foxes have probably been put in charge of henhouses here.

This makes the reality of childhood abuse as the cause for depression and mental illness, even if it is obvious, a hard sell.

And so the “chemical imbalance” explanation was embraced as a blameless alternative. Probably not for the first time.

But political convenience, in modern or in Medieval times, does not make it any more likely to be true.

If maternal neglect causes autism, on the other hand, that would easily explain why rates of autism have been rising sharply in recent decades: more mothers have left full-time child care and entered the workforce.

Burton, the great authority for the theory of the humours, does not seem himself to have taken the theory very seriously. He gives every evidence of putting himself at an ironic distance from it all—indeed, from all theories regarding his subject. He openly reserves the right at the beginning of his book to withhold information from the reader: “I am a free man born, and may choose whether I will tell; who can compel me?” And he does not put his own name on the book, a typical and natural expression of detachment. He uses the pen name “Democritus Junior,” on the grounds, he says in a book-length introduction, that he was continuing a study of melancholy that Democritus himself, a pre-Socratic Greek philosopher, left unfinished.

In making this assertion, Burton is relying on an apocryphal tale of Democritus and Hippocrates, featured by La Fontaine. And this fable, like most fables, is meant to teach a lesson, not to report historic fact. It is narrative as objective correlative.

Hippocrates interviews Democritus in his garden

La Fontaine’s story is odd in several ways. First, there is no record in Democritus’s surviving writings that he was interested in melancholia. If one wanted to take an ancient philosopher as representative of melancholy, the obvious choices would be Theophrastus or Heraclitus. “Theophrastus, the philosopher who was the first to write a whole book on melancholy, ... said of Heraclitus that owing to melancholy he left most of his work unfinished or lost himself in contradictions” (Klibansky, Panofsky, and Saxl, Saturn and Melancholy, London: Thomas Nelson & Sons Ltd., 1964, p. 41).

Sad Heraclitus and cheerful Democritus

In fact, conventionally, Democritus is contrasted to Heraclitus as uncommonly cheerful. The two are shown paired like the comic and tragic masks of Greek drama. Heraclitus was the “weeping philosopher”; Democritus was the “laughing philosopher.” Montaigne wrote, for example, “Democritus and Heraclitus were two philosophers, of whom the first, finding the condition of man vain and ridiculous, never went out in public but with a mocking and laughing face; whereas Heraclitus, having pity and compassion on this same condition of ours, wore a face perpetually sad, and eyes filled with tears.”

So Democritus, portrayed in the fable as a melancholic, was the traditional image of the opposite.

This is the implicit context, surely, of La Fontaine’s fable. We are being advised that we are reading a joke. If some don’t get it, that is part of the joke.

According to the story, Democritus (and oddly not Heraclitus) decided to get to the bottom of the issue of depression, aka melancholy, and so began carving up animals in search of this “black bile.” His neighbours decided he had gone mad in his solitude, and summoned Hippocrates, the great physician, to find out what was wrong. Hippocrates came upon Democritus in his garden outside the city, surrounded by animal carcasses. He saw that Democritus (and oddly not himself, the famous physician) was engaged in legitimate medical research, and concluded that the neighbours were wrong.

As Burton retells the tale,

“Coming to visit him one day, he [Hippocrates] found Democritus in his garden at Abdera, in the suburbs, under a shady bower, with a book on his knees, busy at his study, sometimes writing, sometimes walking. The subject of his book was melancholy and madness; about him lay the carcases of many several beasts, newly by him cut up and anatomised; not that he did contemn God’s creatures, as he told Hippocrates, but to find out the seat of this atra bilis, or melancholy, whence it proceeds, and how it was engendered in men's bodies, to the intent he might better cure it in himself, and by his writings and observation teach others how to prevent and avoid it. Which good intent of his, Hippocrates highly commended: Democritus Junior [Burton himself] is therefore bold to imitate, and because he left it imperfect, and it is now lost, quasi succenturiator Democriti, to revive again, prosecute, and finish in this treatise” (Burton, “Democritus Junior to the Reader”).

The conventional moral of La Fontaine’s tale is that the great mass of the people can often be wrong. They cannot understand the motivations, movements, and interests of a great mind.

“The little tale suffices to show that we may rightly take exception to the judgments of the mob. That being so, in what sense is it true, as I have read in a certain passage, that the voice of the people is the voice of God?” (The Original Fables of La Fontaine, trans. F. C. Tilney; Book VII, No. 26)

Well and good, and true enough: but this is a red flag up the pole alerting readers that the common or superficial reading of Burton’s own book, and of the nature of melancholy, is likely to be mistaken.

To hammer the point home, Burton devotes the rest of his long introduction to pointing out step by step, in ever-widening circles, that all we think we know is folly. The reality is usually the opposite of what it seems, skim milk masquerades as cream, and we keep getting it all upside down.

Now (for alas! how foolish the world has become),
A thousand Heraclitus’, a thousand Democritus’ are required.
Now (so much does madness prevail), all the world must be 

Sent to Anticyra, to graze on Hellebore.

La Fontaine argues in his moral that the common people are commonly wrong. Burton argues that everyone is. Quite possibly including Hippocrates and Democritus.

There is an interesting and obvious fact about melancholy, the substance, “black bile.” Nobody has ever seen it. We have seen blood; we have seen phlegm, if the thing we now call phlegm is the substance meant. We sometimes see bile. But nobody has ever seen black bile. Nobody has ever seen the fluid called “melancholy.”

Not even Democritus, surrounded by the corpses of dissected animals in his garden. As Burton says, “he left his research unfinished.”

Burton, it appears, is pointing out that black bile is not a part of the physical world. If there were such a physical substance, Democritus, hundreds of years BC, would have found it in these dissections. If not he, others would have found it in the thousands of years since. Even in the days of Democritus, it was perfectly apparent to anyone that there was no such substance.

Let us see plainly, then, that the humours are objective correlatives. They are physical metaphors for the emotional experiences they describe rather than physical causes for them.

If they are objective correlatives, what does this image of “black bile” suggest about depression and mental illness generally?

Black, as a reference to sadness and fear, is obvious enough. The image of blackness or darkness is almost always used to describe depression. Churchill called it his “black dog.” James Thomson called his long poetic description of depression “The City of Dreadful Night.” It began

“The City is of Night; perchance of Death
 But certainly of Night; for never there
Can come the lucid morning’s fragrant breath
After the dewy dawning’s cold grey air:
The moon and stars may shine with scorn or pity
The sun has never visited that city,
For it dissolveth in the daylight fair.”

As for “bile,” given the metaphoric meaning of “bile,” “anger,” this suggests that depression is somehow a close kin to anger. Sometimes black bile is said to be either blood or bile “putrefied” from being kept too long in the body. Ergo, too much repressed anger or repressed happiness causes depression.

This sounds like a reference to abuse.

Bile is a substance we normally only see if we have thrown up, and thrown up more than once. We get it in the second vomiting, once the contents of our stomach are gone. Imaginatively, if our life situation is one which prompts a spiritual nausea, and yet we cannot vomit it up or expel or get away, if we must keep it all in, we end up riddled with black bile: with melancholy, with mental illness.

Burton says none of this. But that is neither here nor there, given the noted tendencies of pre-modern “scientific” writing. If he did, this would imply that he considers the idea “folly.” By his implied rules, the truth is whatever he doesn’t say.

He does seem to give us something more symbolically in his frontispiece. He draws attention to it, “explaining” its images in a long poem.

Top three panels of Burton's frontispiece

Most striking, and mysterious, are the first three panels. At the top, in the centre, sits Democritus in his garden, surrounded, Burton says, by the corpses of his experimental subjects.

About him hang there many features,
Of Cats, Dogs and such like creatures,
Of which he makes anatomy,
The seat of black choler to see.

Interestingly, the actual picture shows no dissected animals. Perhaps this is another way for Burton to suggest the whole thing is invisible, immaterial, spiritual, not physical.

To the left of Democritus is a panel which Burton tells us depicts jealousy. It shows a semi-wild scene, with various water fowl, and two bulls and two cocks fighting.

To the left a landscape of Jealousy,
Presents itself unto thine eye.
A Kingfisher, a Swan, an Hern,
Two fighting-cocks you may discern,
Two roaring Bulls each other hie,
To assault concerning venery.
Symbols are these; I say no more,
Conceive the rest by that’s afore.

Among other things, he is surely drawing attention to the use of symbols in his work. Here water, liquid, as with the humours, perhaps represent emotion generally. Waters “rage”; we “pour out our hearts.”

To the right of Democritus is a panel which Burton says depicts solitude. It too shows a wild scene, a “desert” (that is, a place men have deserted). Oddly, this desert includes domestic animals: a dog and a cat, sleeping.

The next of solitariness,
A portraiture doth well express,
By sleeping dog, cat: Buck and Doe,
Hares, Conies in the desert go:
Bats, Owls the shady bowers over,
In melancholy darkness hover.
Mark well: If’t be not as’t should be,
Blame the bad Cutter, and not me.

“Solitude,”or the experience of the interior, spiritual world, is something represented equally well by wild nature and by dreaming sleep.

Other panels seem more straightforward and not symbolic: below are the images of a melancholy unrequited lover, a hypochondriac, a religious devotee (an apparent example of “religious melancholy”) and a lunatic. These we can see as simpler illustrations of the book’s topic, relating directly to topics discussed the text.

But the top three panels do not. In the book, Burton does not discuss jealousy or solitude in any comprehensive way, or as something especially germane to the study of melancholy.

Above Democritus’s head, in the sky of the central panel, we see the astrological sign of Saturn. This is, plainly and literally, a symbol. And although not visually prominent, it is in fact given pride of place: top and centre.

Burton explains in his rhyme that Saturn is “Lord of Melancholy.”

“Over his head appears the sky,
And Saturn Lord of melancholy.”

This, then, is Burton’s ruling symbol.

What do we know of Saturn?

There are not that many myths about him, not that many traditions.

We know that he, cognate with the Greek Cronus, was the father of all the gods. That is the prime fact about Saturn.

The second is that he ate his children.

Cronus snacking

And there we have, again, surely, the Dymphna myth.

For all the centuries the humoural system was in existence, there was a parallel or concurrent tradition that the melancholic were “children of Saturn.” Klibansky, et al, write, “Nearly all the writers of the later Middle Ages and the Renaissance considered it an incontestable fact that melancholy, whether morbid or natural, stood in some special relationship to Saturn, and that the latter was really to blame for the melancholic’s unfortunate character and destiny” (Saturn and Melancholy, p. 127).

Given Saturn’s relationship with his children, this seems significant.

The two side panels perhaps hint at the rest of the story. The parent is jealous of the child. He or she, like Saturn, imagines they will be supplanted by a new generation. Hence the “jealousy” reference; the panel on the left.

And the panel to the right is our “green world.” It is the exile of the melancholic; either effect or cure of the panel to the left.

Burton explains his book as being the antidote to his own melancholy. “I write of melancholy, by being busy to avoid melancholy.” He himself, whatever else he says in the book, has chosen the cure of solitude, of solitary study.

Burton nowhere hints in the book itself that the cause of melancholy might be parental abuse. Perhaps he foresaw and understood what happened to Freud’s original seduction theory, or to the theory of “refrigerator mothering.” The rich and powerful you shall have always with you. He hints that melancholy might in some cases have to do with experiences of “evil attendance, negligence, and many gross inconveniences,” in childhood, but refers only, and oddly, to teachers and nursemaids. One subsection is titled “Non-necessary, remote, outward, adventitious, or accidental causes: as first from the Nurse.”

This seems safe enough; nurses are generally taken from the poorer classes.

However, as a rare exception, Burton delicately adds that it is even possible that a good nurse might be preferable to a birth mother:

“And if such a nurse may be found out, that will be diligent and careful withal, let Phavorinus and M. Aurelius plead how they can against it, I had rather accept of her in some cases than the mother herself, … Some nurses are much to be preferred to some mothers. For why may not the mother be naught, a peevish drunken flirt, a waspish choleric slut, a crazed piece, a fool (as many mothers are), unsound as soon as the nurse? There is more choice of nurses than mothers; and therefore except the mother be most virtuous, staid, a woman of excellent good parts, and of a sound complexion, I would have all children in such cases committed to discreet strangers. ... This is an excellent remedy, if good choice be made of such a nurse.”

It looks like an afterthought; but strictly speaking, by this logic, more children must in fact be harmed by bad mothers than by nurses (“there is more choice of nurses than of mothers”), and would be better off with a nurse. The issue is not bad nurses: it is bad nursing, or, put more plainly, bad mothering.

Similarly, instead of directly blaming the father, Burton titles the next subsection “Education a Cause of Melancholy,” and focuses on bad teachers; “for if a man escape a bad nurse, he may be undone by evil bringing up.”

Surely he is being coy: who is most involved in the raising of a child? His third grade teacher? Burton makes the role of the parents here more obvious by its odd omission.

But these are only brief mentions buried in a long book. Burton seems superficially to be simply a compiler of all the published wisdom of the doctors and philosophers on the causes, symptoms, and possible cures of melancholy.

Yet this very compilation, and the size of this compilation, produces an odd effect. Repeatedly, Burton reports authorities saying the opposite of one another. The natural conclusion, after over 900 pages, is that everything can cause melancholy, anything can be a symptom, and anything that might cure it might also cause it. One is reminded of—and Burton more than once refers to—the Book of Ecclesiastes: “Vanity of vanities, saith the Preacher, vanity of vanities; all is vanity.”

Where does that leave us?

Laughing, with Democritus. All is folly. Pointlessness is Burton’s point.

It is all an elaborate joke. The cure has been right in front of us all along: right in front of our noses. It is “the Work,” as the alchemists used to say. It is in the mental exercise, the retreat into the mental universe, involved in a book. Go thou, ye melancholic, and do likewise.

Of the proposed effect of reading the book, Burton writes in a prefatory poem,

From twitch of care thy pleasant vein may save,
May laughter cause or wisdom give perchance.
…
Gain sense from precept, laughter from our whim.

It is, and is meant to be, whimsical.

And so, regardless of the cause, Burton’s prescription for melancholy is, aside from solitude, the obvious one of laughter.

His great book was understood in this terms, it seems, by many of its greatest fans. Charles Lamb wrote, “His manner is to shroud and carry off his feelings under a cloud of learned words.” Samuel Johnson advised Boswell, if melancholy thoughts kept him up at night, to “compose himself to rest” by reading from this “valuable work.”

That said, we must not take much else that Burton says too seriously.

Humours are humorous. That’s about it.