A History of Depression

The 20th century has been dubbed the ‘age of anxiety’. By the 1950s one in every 20 Americans was routinely swallowing a sedative over breakfast. In the mid-1990s Prozac had become the second best-selling drug in the world. It was billed as the magic bullet for depressives. Despite some evidence that anti-depressants are only marginally more effective than placebos more and more people turn to drugs to alleviate their sadness. In From Melancholia to Prozac, Clark Lawlor (who is Reader in English Literature at Northumbria University) reminds us that, while drugs do work for some depressed people, we would do better to treat sufferers in more holistic, culturally embedded ways.

Before he comes to that conclusion Lawlor turns to the past. He sets out systematically to trace the changing scientific and medical beliefs about this dreadful affliction from classical times onwards. In classical writings, he tells us, depression – or, more correctly, melancholia – was ascribed to imbalance in the humours, or the four fluids (blood, black bile, yellow bile, and phlegm) that made up the body. Melancholic people possessed an excess of black bile. When overheated, black bile produced a burnt ash called ‘melancholic adust’ or ‘atrabilious melancholy’. Social context mattered: too much ‘dark wine’, too little sleep and romantic frustrations could activate the condition. Drastic action had to be taken: sufferers were bled; their innards were purged; they were persuaded to imbibe a poison made from the flowering plant hellebore, which induced profuse diarrhoea and vomiting.

William Harvey’s discovery of the circulation of blood provided a way to explain how ‘some Chymical Liquors’ could spread melancholia via the blood throughout the body. In the words of Thomas Willis (1621-75) in melancholics the ‘animal spirits’ lost their translucent quality and became ‘obscure, thick, and dark, so that they represent the Image of things, as it were in a shadow, or covered with darkness’.

These ways of thinking about depression were dramatically overturned in the second part of the 18th century with the shift towards neurology. Famously, William Cullen (1710-90) sought to explain all diseases as linked to the nervous system. For Cullen melancholia was ‘partial insanity’ caused by ‘a degree of torpor in the motion of the nervous power’. The stage was set for the gradual reinterpretation of melancholy as ‘depression’, or an affective disorder. Crucially Sigmund Freud jettisoned ideas about imbalance or physical malfunction, substituting psychic loss and unconscious conflicts as causes of depression. Psychodynamic understandings of depression have subsequently clashed with cognitive and biochemical ones.

From Melancholia to Prozac belongs to a familiar genre in the history of medicine: it is the biography of an illness. What it does not do is tell us why ideas changed. The mechanism of transformation is never clear beyond the statement that particular ‘great men’ possessed different ideas, which they were able to persuade other people to adopt. In this sense Lawlor has wasted an opportunity to move the history of depression beyond familiar territory. Nevertheless his rallying cry for a ‘return to melancholia’ or a way of tackling depression that ‘escapes the reductionism of biochemical definition’ is passionately argued and likely to ignite debate.

Joanna Bourke is Professor of History at Birkbeck, University of London and author of What It Means To Be Human (Virago, 2011).