Shared Descriptions: What Can Be Concluded?

Somogy Varga’s Discussion of the shared meanings that link descriptions of melancholia from past eras with those of depressive states in our own times is a compelling reminder of the depth and interest to be found in the history of medicine. He brings new insights to the disagreement between those who find an unproblematic continuity between the earlier and later descriptions and those who are less persuaded by the similarities than by the differences they exhibit. The position Varga himself adopts is nearer the ‘continuity’ view. It is based on a reconsideration of descriptions of these conditions that places particular focus on the characteristic affective states of sadness and apprehension that are a re-occurring feature, as well as certain allegedly explanatory analyses that in their own ways seem to frame and unify pre-modern claims and even unite earlier with much later accounts. I am in considerable sympathy with Varga’s subtle and careful analyses. And I agree with his insistence that underlying assumptions such as those involved in humoral theory, in the associationist metaphysics that emerged from neo-Platonism, and in faculty psychology, each need to be remembered as we read medieval and early modern writing about melancholy, and nineteenth century works on depression.¹ Employing this approach, Varga succeeds in showing further ways to buttress the continuity position.

There remain historical details about which I am not quite satisfied, although our differences perhaps reflect little more than issues of emphasis. I note two of these. First, the force of the discontinuity position challenged by Varga comes in great part from the seemingly broader extension accorded the term ‘melancholia,’ at least until the nineteenth century. Melancholia was regularly linked to what were known as disorders of the imagination, symptoms today associated with the psychotic states of delusion and hallucination that are not exclusive to or even typical of depression so much as of what we now know as schizophrenia spectrum disorders. In addition, melancholia covered the ‘scruples’ that most closely resemble today’s obsessions and compulsions; it included the states of apprehension that later came to be categorized as anxiety disorders, and it covered the mistrustful attitudes toward others characterizing today’s persecutory paranoia. Varga acknowledges but is apparently not impressed by these dissimilarities of extension, yet they seem to me to pose a challenge for the continuity thesis, because at least the supposed ‘continuities’ provided by humoral theories and associationist metaphysics were taken to undergird the whole disparate collection of melancholy symptoms. (He is on stronger ground in emphasizing the unifying role of the affective states of fear and sadness without cause, and I agree with him that the emphasis on these offers a convincing source of continuity between earlier and later descriptions.)

A second quibble over the historical claims is this: Varga takes the self-loathing associated with melancholy in seventeenth-century writing such as Bunyan’s to contradict any suggestion that Freud’s ‘Mourning and Melancholia’ inaugurated the attitudes of self-disgust and self-loathing that are some of the hallmarks of twentieth-century depression. Space does not allow the kind of support necessary to entirely refute Varga’s assessment, yet I find it somewhat troubling that it omits reference to the way religiously focused distress and self-accusation mark seventeenth-century descriptions of all, and not merely disordered, experience; in citing evidence of these self-focused attitudes from the sixteenth century, it fails to note the way the self became the focus of attention in many respects during the Renaissance period; and at the same time, it ignores how self-loathing diminishes by the more secular accounts of melancholy from the eighteenth century.

Part of my interest in Varga’s discussion lies in an area he avoids in choosing to pursue these questions of continuity without entering the ontological debate about what kinds of things melancholy and depression are.² His is not an arbitrary decision: a justification is offered for focusing exclusively on the similarities and differences between earlier and later descriptions - remaining, we might say, at...