Madness and Melancholia

It is a Pleasure to comment on Somogy Varga’s intriguing paper, which offers welcome insight into the historical sources, changing uses, and underlying assumptions pertaining to the concept of ‘melancholia,’ especially in relationship to ‘depression.’ We found Varga’s discussion of the relationship between affect and cognition in past discussions of melancholia and depression to be illuminating, especially given the emphasis on cognitive distortions in contemporary psycho-pathology. His explanation of the gradual evolution of the depression concept from melancholia sheds interesting light on current notions. All in all, we find Varga’s arguments persuasive, and are inclined to agree with him (and others whom he cites) concerning the considerable affinity and probable continuity between the concepts of depression and of melancholia. We do, however, wish to make a couple of points that, although not exactly contradicting what Varga calls his ‘modest continuity view,’ tend nevertheless to take this comparison in a rather different direction.

Our first point concerns the fact that at least some current usages of ‘depression’ seem to have moved this concept somewhat away from what Varga refers to as its core semantic meaning, namely, lowered mood. Indeed it could be argued that, rather like ‘melancholia’ in pre-modern Europe, ‘depression’ in contemporary Western culture has come to serve as a culturally approved and rather all-purpose concept and complaint, one that is deeply grounded in current cultural values and that offers a nonstigmatized alternative to, or avenue for withdrawal from, certain cultural imperatives. Our second point is an attempt to clarify, and in some ways justify, an important current usage of the concept of ‘melancholia,’ one that would foreground its difference from depression proper by emphasizing the melancholic patient’s transcendence of any mere disorder of mood or emotion, no matter how exaggerated the latter may be. We make brief reference to some anecdotal phenomenological evidence supporting the latter point.

The Meaning of ‘Depression’

Varga describes the appearance of the concept of ‘depression,’ first in descriptions of melancholia and then as an independent syndrome, as reflecting “the increasing emphasis on affective aspects,” in particular, “sadness, gloom and anxiety symptoms . . . without a reasonable cause” (Varga 2013, 146). He also describes “the emergence of a concept of mind informed by faculty psychology” (147), in which the syndrome was understood less in holistic terms (as a unity of complementary symptoms) and more in light of a purported etiological relationship between two distinct factors, namely, (distorted) cognition and (lowered) affect, with one serving more as cause, the other more as consequence (and with affect taking on the primary causal role during the nineteenth century, replaced by cognition in the second half of the twentieth century). However, some other writers have noted that ‘depression,’ at least as understood and applied in current psychiatric discourse, actually goes beyond feelings of inappropriate sadness or irrational guilt or ‘self-torment.’

In particular, the French sociologist Alain Ehrenberg (2010), who attributes the growing prevalence of the depression concept to cultural and societal factors, notes that ‘depression’ can in fact now refer to a remarkably wide variety of symptoms or experiences that are difficult to consolidate. Not only does ‘depression’ describe a syndrome characterized by lowered mood and thoughts of guilt or worthlessness, but it may also describe feelings of exhaustion, impotence, inhibition, vulnerability, paralysis, dependency, lack of self-confidence, anxiety, or an inability to cope with frustration. There are even forms of so-called ‘masked depression’ in which lowered mood may not be evident at all.

To explain this, Ehrenberg notes that most Western individuals experience a kind of freedom that has been unheard of in past decades. The dominant message is that ‘anything is possible,’ and ‘be all that you can be.’ Beneath the rhetoric of liberation, this creates an immense personal pressure to achieve ever-greater success, Ehrenberg (2010) argues. Indeed, he states, we are now trapped in a situation where “nothing is truly forbidden, [but] nothing is truly possible” (p. 7). Ehrenberg terms the inability to sustain the motivation to succeed a ‘weariness of the self.’ This is a condition in...