The Elephant in the Room

This Article is a response to thoughtful commentaries by Jennifer Radden (2013) and Louis A. Sass and Elizabeth Pienkos (2013) on my paper, which investigates the continuity between melancholia and depression. In the following, I address the challenges presented by the commentators and attempt to clarify and deepen my position.

In my paper, I have explored the history of melancholia and depression with special emphasis on the question of their possible continuity—with the knowledge that any such attempt inevitably brings with it a whole cluster of theoretical challenges. Therefore, I tried to remain modest in my conclusions, but I also wanted to contribute to the debate by showing that there might be something like a middle position (although nearer the ‘continuity’ view) between what I called the ‘unproblematic continuity view’ and ‘discontinuity view.’ Roughly, the argument was that, when adopting a certain fine-grained approach-which involves reconsidering the unity of melancholia, its religious forms and the emergence of the term ‘depression’—a modest continuity view can be defended.

Whereas Sass and Pienkos are inclined to accept a probable continuity between the concepts of depression and melancholia, they nevertheless illustrate how some current usages of both ‘depression’ and ‘melancholia’ do not seem to involve lowered mood. In that case, the modest continuity view would appear less convincing.

First, Sass and Pienkos draw on the work of Alain Ehrenberg to show that in current discourse ‘depression’ may also describe feelings of exhaustion, inhibition or lack of self-confidence. In this sense, depression constitutes a socially sanctioned classification attributed to those who are exhausted from having to live up to the elevated performance standards of a culture of achievement. Sass and Pienkos are right to draw attention to this development, and we may add that there are additional ways in which ‘depression’ has become a part of the everyday vocabulary with which people address their personal identities. In this type of usage, low mood does not necessarily constitute the core meaning of depression. Clearly, the meanings of popular diagnostic categories tend to blur as they increasingly become woven into everyday vocabularies. They become ‘moving targets.’ But that notwithstanding, it still seems to me that low mood constitutes an important part of those meanings. Ehrenberg (2010) explores the curious entanglement between transformations in our normative understanding of both individuality and depression and argues that depression is the emblematic social pathology of contemporary society. Ehrenberg sustains his argument by showing a shift of emphasis from mental pain to the obstruction in the ability to act, inhibition, slowing down and asthenia (Ehrenberg 2010, 166). Ehrenberg’s sociological diagnosis—as I understand it—demonstrates a shift in focus to those aspects that are taken to be crucial with regard to realizing the ideals of contemporary society. This is how depression becomes ‘the other’ of the contemporary ideal of self-realization. However, this shift in focus does not necessarily entail that low mood is no longer a part of the picture.

Second, acknowledging the variety of meta-morphoses that the historical concept of melancholia has undergone, Sass and Pienkos note that melancholia in contemporary psychiatry can sometimes refer to a condition characterized by mood states so profoundly low that they should be acknowledged as qualitatively different from those in depression. It is of course right that the DSM IV lists a category called ‘Depression with Melancholic Features.’ But is it important to emphasize that ‘With Melancholic Features’ only functions as a specifier (American Psychiatric Association 2000, 419) and may only be applied to episodes that occur as a part of depression.

Radden (2013) underlines that the strength of the discontinuity position, which largely stems from the fact that, at least until the nineteenth century, melancholia also referred to symptoms associated with psychotic states. Today, some of these would likely be classified as belonging to schizophrenia spectrum disorders. In the same way, states of anxiety and continuous mistrustful attitudes toward others (which melancholia also covered at certain historical points) would today be understood as characterizing anxiety disorders or persecutory paranoia. Radden is right to insist that melancholia encompassed not only dejected...