Straight to the point

Was depression invented by the American elites in the Nineties? Since Prozac was introduced in 1987, it is true that the “major depressive disorder” — coined in the medical literature of the Eighties as a stop-gap measure — has taken remarkable hold.

When the first antidepressants were developed in the Fifties, the condition was considered so rare that the drug research seemed like a waste of money. But in a 2017 survey, 12.7% of Americans had taken antidepressants in the past month (and nearly twice as many women as men). It is not to deny the existence of catatonic states of despair to suggest that there may have been a definitional leak.

One might retort that “depression” was simply “under-diagnosed”, but equally present in every earlier stage of human history. Consider, though, the discovery of SSRIs, a class of drugs that combined lifetime use with a better safety profile than earlier antidepressants (just weight gain, sexual dysfunction, and the occasional suicide upon withdrawal). And consider the context of that discovery: a world where pharmaceutical companies fund much of the research used in their own regulation, and that research is easy to skew. In short, it is a truth universally acknowledged that a pharmaceutical company in possession of a new drug shall be in want of an endemic illness. As the GlaxoSmithKline slogan bluntly went: “Does your soul have a cold?”

Still, it would be sophomoric to think that depression was wholly and solely constructed by Big Pharma. Until recently, it was understood that “no man living is free, no stoic, none so wise, none so happy, none so patient, so generous, so godly, so divine, that can vindicate himself; so well composed, but more or less, some time or other he feels the smart of” melancholy. So wrote Robert Burton, a reclusive life-long fellow of Oxford, four centuries ago, in his freewheeling account of sadness, The Anatomy of Melancholy.

Burton was writing in one of the last periods where the role of the writer wasn’t to express an individual thesis, but instead to summarise everything. As such, his Anatomy has little in the way of synthetic thought. As Burton says, “I have read many Bookes, but to little purpose, for want of good method, I have confusedly tumbled over divers Authors in our Libraries, with small profit, for want of Art, Order, Memory, Judgment.” He can’t even settle on a definition of melancholy — “whether it be a cause or an effect, a disease or symptom … I will not contend about it” — but he does examine some potential causes. Black bread, melons, hot air, cold air, excessive exercise, defective exercise, the stars, God, hot baths, a hot brain, Calvinism, Catholicism, excessive studying, excessive merrymaking, excessive “chamber-making”.

As for melancholy’s symptoms, “the tower of Babel never yielded such confusion of tongues, as the chaos of melancholy doth variety of symptoms”. Indeed, it’s sometimes difficult to separate cause from symptom, as in the glorious description “lascivious by reason of much wind”. Burton’s aim is to “adventure yet in such vast confusion and generality to bring them into some order; and so descend into particulars”. Many of these loopy excursions come to a familiar enough conclusion: melancholy’s cause is sin, and its cure is God: “We ought to fear our own fickle estates, remember our miseries and vanities, examine and humiliate ourselves, seek to God, and call to Him for mercy.”

But Burton does not deny the importance of strategies to combat melancholia. These include behavioural changes — drink a glass of water upon waking; seek hills or mountains; “be not solitary, be not idle” — and mental ones — avoid prolonging passionate thoughts; avoid believing in predestination; “be meek, merciful, and patient”. There is comfort here, for the post-modern reader. Thanks to the rapid rise of neuroscience and the branding of depression as a “brain disease”, many third-party carriers reimburse doctors for medication management only, and many depressed people are simply handed a prescription by a general practitioner and told to check in in six weeks. In Burton’s day, the old Galenic system of humours did emphasise the physical. But these days depression is treated like heartburn; in more exploring reaches, it’s treated by impersonal, one-size-fits-all cognitive behavioural therapy, now the province of therapy apps advertised by Instagram scroll.

At the extremes, the “chemical imbalance” theory raises troubling questions about human character; and its Brave New World-style treatment can make the human being feel like an unruly dog. No matter how many analogies one can make to infectious disease or broken legs, depression is experienced at a complicated level inextricable from one’s most virtuous traits — sensitivity, self-criticism, ambition — and to think of oneself as merely a malfunctioning machine or a bundle of “trauma reactions” can impoverish the self.

The experience of The Anatomy is one of overload, and perhaps it is best to read it with the desperation and joy of Samuel Johnson, who “frequently resorted to [The Anatomy] for the purpose of exhilaration” while running his tiny, failing school at Edial Hall. Its very eclecticism and capaciousness is its virtue. Perhaps reading anecdotes about ancient kings won’t cure you: but given that depression rarely is “curable” at all, there’s something beautiful about feeling this continuity of human experience, across time and space, to feel one’s sadness as part of a world history full of delight and variety. Compare the experience of the sad person today, asking their doctor for Prozac or maybe playing with an adult colouring book, to the experience of a Samuel Johnson. The first is made to feel small and simple; the second is made to feel himself more intelligent, more dignified, more ambitious. Moreover, as any reader of Shakespeare’s tragedies will know, the early Moderns had a way of laughing about despair, solitude, even suicide — a kind of manic sad clowning found absent from the way most people talk about mental health now, both infantilising and deadly serious. Burton, after all, wrote The Anatomy under the name Democritus Junior: the laughing philosopher.

I read The Anatomy the winter after my first law school exams, ambivalent about a course of study that was beginning, nonetheless, to gel into inevitability. I was staying on the couch of a family member in Florida, in a condo surrounded by red and orange tropical plants and buzzing constantly with the exertions of a leaking air conditioner. Through the screen door, at any hour of the day or night, I could see the recently discharged woman next door swaying silently in front of a blue-fuzz TV. Against her state, obviously, The Anatomy is of little use. But for the sort of low-grade malaise I found myself in — the sense that my fears would never disappear but my possibilities, one by one, would — The Anatomy made me feel a little bit better. I read it on the beach, I read it over diner milkshakes, I read it on hot and sleepless nights, on that orange leather sofa that congealed to my skin.

The Anatomy clocks in at 1,392 pages — my paperback quickly broke in half — and any paragraph swims through a dizzying array of references, Homeric through Renaissance; medical, theological, and philosophical. On the one hand, its difficulty made me feel accomplished; and on the other hand, it made me feel, basically, that it was fine to be scared, to still be doubting. I could try cabbage one day, clear water another, oranges, opening windows, perfume, walking in fields, sweet-scented baths, confessing to a friend, faith in God, eating earlier, fasting, seeing sunlight upon waking, reading Herodotus, reading Elizabethans. And above all, as Burton’s last section of course requires, truly and steadfastly resisting despair.

Small consolations, it’s true, but ones that fit into a life well lived — unlike antidepressants, with their dubious efficacy and their near-certain, unpleasant side effects; and unlike so much of self-help, with its individualism, and its transactional focus on convenience and utility. Burton’s salves are enriching, not subtracting. They make the reader feel, in some small way, in control of their condition, an active agent. As the habit makes the monk, the medicine makes the patient, and against the pop psychology and medical cocktails more commonly on offer, there’s something to be said for the demanding and delightful sublimations of The Anatomy. That the book is often baffling only further recommends it. It feels good to do something difficult; and it feels good to get out of one’s own time, to defamiliarise one’s own condition: though people may have always felt sad, they felt differently about feeling sad.

The Anatomy of Melancholy won’t cure depression. But there’s something comforting about this futility: if sadness has always existed and always will, even for those, like Burton, of exemplary learning and unparalleled discipline, even in the most foreign reaches of time and place, even after 13,000 pieces of advice and 400 years, then we might try to make something generative of some of the pain, to “write of melancholy, by being busy to avoid melancholy”.

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