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Monday, 9 April 2012

From Melancholia to Prozac: A history of depression - book review on FIDDAMAN blog

QUEEN Victoria would have said she was grieving in proper proportion to her loss.

Today we would most likely diagnose her excessive mourning as "complicated grief disorder", and treat her accordingly: Pop a Prozac, Ma'am, and you'll feel better in the morning. No doubt Her Majesty would not be amused at such a crude attempt to rid her of her preferred state of melancholia.

Clark Lawlor, in his cultural history of depression and melancholia, commits much of the second half of the book to exploring the manner in which our present understanding of what constitutes mental illness has been influenced by drug companies keen to present doctors with simple definitions and even simpler "cures", the idea that a pill popped in the morning will make you healthy, wealthy and wise.

He quotes Ronald Wallace [on Prozac]: "So much happiness! It seems everything I touch shines back, all smiles."

But as many of us who have been filed under a "major depressive disorder" tag can attest, drugs like Prozac are not sufficient weaponry to combat what Churchill so famously called the Black Dog of depression. And beneath our need for quick fixes lies the question: do we now see normal human emotions, such as sadness, grief and loneliness as diseases that need to be medically treated?

And even those of us who, severely depressed, benefit from modern medications; do we really understand what the payback is? Probably not, argues Lawlor.

It was Aristotle, Lawlor tell us (or more likely one of his followers), who first made the irrepressible link between melancholia and supposed genius. The Aristotelian position stated: "Why is it that all men who have become outstanding in philosophy, statesmanship, poetry or the arts are melancholic ... .?"

Such a link, says Clark, went against the later Galenic notion of the sluggish and dull melancholic, a depressive overwhelmed by the darkness of the black bile -- or as 20th-Century psychiatry would have it; a person incapacitated by a chemical imbalance in the brain.

And certainly, while it might be nice to believe that our illness stems from an unrecognised genius, this is rarely the case.

Clark's analysis of depression/melancholia -- from Classical thought through to Renaissance, Romantic and Victorian interpretation --reveals how, despite our progress in neurobiology and psychiatry, we seem no nearer to understanding the intricacies of the mind; the links between extreme emotions and creativity and how they can teeter over into despair and destruction.

So where the Ancients would talk of "an imbalance of the humours; the more severe the imbalance, the more severe the symptoms of melancholia", the Romantics valorised a certain version of melancholia which served the needs of their creativity; "an excuse for meditative midnight excursions into the creative psyche, as well as a psychological space for envisioning social change".

By the 20th Century we had what was called the "New Depression", a chemical imbalance based on symptoms, and therefore more simply treated by a 'one size fits all' model.

Hopefully we are beginning to see attempts to forge a "model of the human that escapes the reductionism of biochemical definitions". The "New Melancholia" aims to treat the afflicted in a more holistic manner; acknowledging the usefulness of drugs like Prozac but admitting that the mind/body and the circumstances which affect it are just far too complicated to be amenable to a quick fix. This is the beauty and tragedy of the human condition.

- Clark Lawlor

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