[lbo-talk] Ehrenreich on depression

Colin Brace cb at lim.nl
Tue Apr 3 01:39:06 PDT 2007


[interesting article but I don't get the sense that Ehrenreich has ever had to grapple with depression herself]

How we learned to stop having fun

We used to know how to get together and really let our hair down. Then, in the early 1600s, a mass epidemic of depression broke out - and we've been living with it ever since. Something went wrong, but what? Barbara Ehrenreich unpicks the causes of our unhappiness

Barbara Ehrenreich Monday April 2, 2007

Guardian

Beginning in England in the 17th century, the European world was stricken by what looks, in today's terms, like an epidemic of depression. The disease attacked both young and old, plunging them into months or years of morbid lethargy and relentless terrors, and seemed - perhaps only because they wrote more and had more written about them - to single out men of accomplishment and genius. The puritan writer John Bunyan, the political leader Oliver Cromwell, the poets Thomas Gray and John Donne, and the playwright and essayist Samuel Johnson are among the earliest and best-known victims. To the medical profession, the illness presented a vexing conundrum, not least because its gravest outcome was suicide. In 1733, Dr George Cheyne speculated that the English climate, combined with sedentary lifestyles and urbanisation, "have brought forth a class of distemper with atrocious and frightful symptoms, scarce known to our ancestors, and never rising to such fatal heights, and afflicting such numbers in any known nation. These nervous disorders being computed to make almost one-third of the complaints of the people of condition in England."

To the English, the disease was "the English malady". But the rainy British Isles were not the only site visited by the disease; all of Europe was afflicted.

The disease grew increasingly prevalent over the course of the 20th century, when relatively sound statistics first became available, and this increase cannot be accounted for by a greater willingness on the part of physicians and patients to report it. Rates of schizophrenia, panic disorders and phobias did not rise at the same time, for example, as they would be expected to if only changes in the reporting of mental illness were at work. According to the World Health Organisation, depression is now the fifth leading cause of death and disability in the world, while ischemic heart disease trails in sixth place. Fatalities occur most dramatically through suicide, but even the mild form of depression - called dysthemia and characterised by an inability to experience pleasure - can kill by increasing a person's vulnerability to serious somatic illnesses such as cancer and heart disease. Far from being an affliction of the famous and successful, we now know that the disease strikes the poor more often than the rich, and women more commonly than men.

Just in the past few years, hundreds of books, articles and television specials have been devoted to depression: its toll on the individual, its relationship to gender, the role of genetic factors, the efficacy of pharmaceutical treatments. But to my knowledge, no one has suggested that the epidemic may have begun in a particular historical time, and started as a result of cultural circumstances that arose at that time and have persisted or intensified since. The failure to consider historical roots may stem, in part, from the emphasis on the celebrity victims of the past, which tends to discourage a statistical, or epidemiological, perspective. But if there was, in fact, a beginning to the epidemic of depression, sometime in the 16th or 17th century, it confronts us with this question: could this apparent decline in the ability to experience pleasure be in any way connected with the decline in opportunities for pleasure, such as carnival and other traditional festivities?

There is reason to think that something like an epidemic of depression in fact began around 1600, or the time when the Anglican minister Robert Burton undertook his "anatomy" of the disease, published as The Anatomy of Melancholy in 1621. Melancholy, as it was called until the 20th century, is of course a very ancient problem, and was described in the fifth century BC by Hippocrates. Chaucer's 14th-century characters were aware of it, and late-medieval churchmen knew it as "acedia". So melancholy, in some form, had always existed - and, regrettably, we have no statistical evidence of a sudden increase in early modern Europe, which had neither a psychiatric profession to do the diagnosing nor a public health establishment to record the numbers of the afflicted. All we know is that in the 1600s and 1700s, medical books about melancholy and literature with melancholic themes were both finding an eager audience, presumably at least in part among people who suffered from melancholy themselves.

Increasing interest in melancholy is not, however, evidence of an increase in the prevalence of actual melancholy. As the historian Roy Porter suggested, the disease may simply have been becoming more stylish, both as a medical diagnosis and as a problem, or pose, affected by the idle rich, and signifying a certain ennui or detachment. No doubt the medical prejudice that it was a disease of the gifted, or at least of the comfortable, would have made it an attractive diagnosis to the upwardly mobile and merely out-of-sorts.

But melancholy did not become a fashionable pose until a full century after Burton took up the subject, and when it did become stylish, we must still wonder: why did this particular stance or attitude become fashionable and not another? An arrogant insouciance might, for example, seem more fitting to an age of imperialism than this wilting, debilitating malady; and enlightenment, another well-known theme of the era, might have been better served by a mood of questing impatience.

Nor can we be content with the claim that the apparent epidemic of melancholy was the cynical invention of the men who profited by writing about it, since some of these were self-identified sufferers themselves. Robert Burton confessed, "I writ of melancholy, by being busy to avoid melancholy." George Cheyne was afflicted, though miraculously cured by a vegetarian diet of his own devising. The Englishman John Brown, who published a bestselling mid-19th-century book on the subject, went on to commit suicide. Something was happening, from about 1600 on, to make melancholy a major concern of the reading public, and the simplest explanation is that there was more melancholy around to be concerned about.

And very likely the phenomena of this early "epidemic of depression" and the suppression of communal rituals and festivities are entangled in various ways. It could be, for example, that, as a result of their illness, depressed individuals lost their taste for communal festivities and even came to view them with revulsion. But there are other possibilities. First, that both the rise of depression and the decline of festivities are symptomatic of some deeper, underlying psychological change, which began about 400 years ago and persists, in some form, in our own time. The second, more intriguing possibility is that the disappearance of traditional festivities was itself a factor contributing to depression.

[...]

full: http://lifeandhealth.guardian.co.uk/health/story/0,,2047969,00.html

--

Colin Brace

Amsterdam



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