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Melancholia

[mel-uhn-koh-lee-uh, -kohl-yuh]

Melancholia (from Greek μελαγχολία - melagcholia, also called lugubriousness, moroseness, or wistfulness), in contemporary usage, is a mood disorder of non-specific depression, characterized by low levels of enthusiasm and eagerness for activity. In a modern context, "melancholy" applies only to the mental or emotional symptoms of depression or despondency; historically, "melancholia" could be physical as well as mental, and melancholic conditions were classified as such by their common cause rather than by their properties. Similarly, melancholia in ancient usage also encompassed mental disorders which would later be differentiated as schizophrenias or bipolar disorders.

History

The name "melancholia" comes from the old medical theory of the four humours: disease being caused by an imbalance in one or other of the four basic bodily fluids, or humours. Personality types were similarly determined by the dominant humour in a particular person. Melancholia was caused by an excess of black bile; hence the name, which means 'black bile' (Ancient Greek μέλας, melas, "black", + χολή, kholé, "bile"); a person whose constitution tended to have a preponderance of black bile had a melancholic disposition. See also: sanguine, phlegmatic, choleric.

Melancholia was described as a distinct disease with particular mental and physical symptoms in the fifth and fourth centuries BC. Hippocrates, in his Aphorisms, characterized all "fears and despondencies, if they last a long time" as being symptomatic of melancholia.

In the medieval Arab world, the Arab psychologist Ishaq ibn Imran (d. 908), known as "Isaac" in the West, wrote an essay entitled Maqala fi-l-Malikhuliya, in which discovered a type of melancholia: the "cerebral type" or "phrenitis". He carried out a diagnosis on this mental disorder, describing its varied symptoms. The main clinical features he identified were sudden movement, foolish acts, fear, delusions and hallucinations. In Arabic, he referred to this mood disorder as "malikhuliya", which Constantine the African translated into Latin as "melancolia", from which the English term "melancholia" is derived.

Ali ibn Abbas al-Majusi (d. 982) discussed mental illness in his medical encyclopedia, Kitab al-Malaki, which was translated into Latin as Liber pantegni, where he discovered and observed another type of melancholia: clinical lycanthropy, associated with certain personality disorders. He wrote the following on this particular type of melancholia: "Its victim behaves like a rooster and cries like a dog, the patient wanders among the tombs at night, his eyes are dark, his mouth is dry, the patient hardly ever recovers and the disease is hereditary."

In The Canon of Medicine (1020s), Avicenna dealt with neuropsychiatry and described a number of neuropsychiatric conditions, including melancholia. He described melancholia as a depressive type of mood disorder in which the person may become suspicious and develop certain types of phobias. The Canon of Medicine was also translated into Latin in the 12th century.

The most extended treatment of melancholia comes from Robert Burton, whose The Anatomy of Melancholy (1621) treats the subject from both a literary and a medical perspective. Burton wrote in the 16th century that music and dance were critical in treating mental illness, especially melancholia. In November 2006, Dr. Michael J. Crawford and his colleagues again found that music therapy helped the outcomes of Schizophrenic patients.

A famous allegorical engraving by Albrecht Dürer is entitled Melencolia I. This engraving portrays melancholia as the state of waiting for inspiration to strike, and not necessarily as a depressive affliction. Amongst other allegorical symbols, the picture includes a magic square, and a truncated rhombohedron The image in turn inspired a passage in The City of Dreadful Night by James Thomson (B.V.), and, a few years later, a sonnet by Edward Dowden.

The cult of melancholia

During the early 17th century, a curious cultural and literary cult of melancholia arose in England. It was believed that religious uncertainties caused by the English Reformation and a greater attention being paid to issues of sin, damnation, and salvation, led to this effect.

In music, the post-Elizabethan cult of melancholia is associated with John Dowland, whose motto was Semper Dowland, semper dolens. ("Always Dowland, always mourning.") The melancholy man, known to contemporaries as a "malcontent," is epitomized by Shakespeare's Prince Hamlet, the "Melancholy Dane." Another literary expression of this cultural mood comes from the death-obsessed later works of John Donne. Other major melancholic authors include Sir Thomas Browne, and Jeremy Taylor, whose Hydriotaphia, Urn Burial and Holy Living and Holy Dying, respectively, contain extensive meditations on death.

A similar phenomenon, though not under the same name, occurred during Romanticism, with such works as The Sorrows of Young Werther by Goethe or Ode on Melancholy by John Keats.

In the 20th century, much of the counterculture of modernism was fueled by comparable alienation and a sense of purposelessness called "anomie."

Melancholy in Arab culture

The Arabic word found as ḥuzn and ḥazan in the Qur'an and hüzün in modern Turkish refers to the pain and sorrow over a loss, death of relatives in the case of the Qur'an. Two schools further interpreted this feeling. The first sees it as a sign that one is too attached to the material world, while Sufism took it to represent a feeling of personal insuffiency, that one was not getting close enough to God and did not or could not do enough for God in this world. The Turkish writer Orhan Pamuk in the book Istanbul further elaborates on the added meaning hüzün has acquired in modern Turkish. It has come to denote a sense of failure in life, lack of initiative and to retreat into oneself, symptoms quite similar to melancholia. According to Pamuk it was a defining character of cultural works from Istanbul after the fall of the Ottoman empire. One may see similarities with how melancholic romantic paintings in the west sometimes used ruins from the age of the Roman empire as a backdrop.

As a parallel with physicians of classical Greece, ancient Arabic physicians and psychologists also categorized ḥuzn as a disease. Al-Kindi (c. 801–873 CE) links it with disease-like mental states like anger, passion, hatred and depression, while Avicenna (980–1037 CE) diagnosed ḥuzn in a lovesick man if his pulse increased drastically when the name of the girl he loved was spoken. Avicenna suggests, in remarkable similarity with Robert Burton, many causes for melancholy, including the fear of death, intrigues surrounding one's life, and lost love. As remedies, he recommends treatments addressing both the medical and philosophical sources of the melancholy, including rational thought, morale, discipline, fasting and coming to terms with the catastrophe.

The various uses of ḥuzn and hüzün thus describe melancholy from a certain vantage point, show similarities with Female hysteria in the case of Avicenna's patient and in a religious context it is not unlike sloth, which by Dante was defined as "failure to love God with all one's heart, all one's mind and all one's soul". Thomas Aquinas described sloth as "an oppressive sorrow, which, to wit, so weighs upon man's mind, that he wants to do nothing".

Footnotes

Other notes

Melancholia is a specific form of mental illness characterized by depressed mood, abnormal motor functions, and abnormal vegetative signs. It has been identified in medical writings from antiquity and was best characterized in the 19th Century. In the 20th Century, with the interest in psychoanalytic writing, "major depression" became the principal class in psychiatric classifications. [See Taylor MA, Fink M: MELANCHOLIA for details of history.]

In 1996, Gordon Parker and Dusan Hadzi-Pavlovic described Melancholia as a specific disorder of movement and mood. [Melancholia" A Disorder of Movement and Mood, Cambridge UK: Cambridge University Press, 1996]. More recently, MA Taylor and M Fink crystallized the present image of melancholia as a systemic disorder that is identifiable by depressive mood rating scales, verified by the present of abnormal cortisol metabolism (abnormal dexamethasone suppression test), and validated by rapid and effective remission with ECT or tricyclic antidepressant agents. It has many forms, including retarded depression, psychotic depression, post-partum depression and psychosis, abnormal bereavement.

References

Fink M, Taylor MA. Resurrecting melancholia. Acta Psychiatrica Scandinavica 2007; Supplement 433: 14-20.
Taylor MA, Fink M. Melancholia: The Diagnosis, Pathophysiology and Treatment of Depressive Illness. Cambridge UK: Cambridge Universwity Press, 2003.