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From Melancholia to Prozac: Depression throughout History

Sketch of a woman diagnosed as suffering from melancholia. Lithograph, 1892, after a drawing made for Sir Alexander Morison (Wellcome Library, London).

As the new Bethlem Museum of the Mind will reflect on, Bethlem – or Bedlam – continues to loom large in the public imagination, often as a lens through which ideas about mental health care and treatment are cast. That this is the case for researchers as well as journalists is aptly illustrated in a recent book by Clark Lawlor, From Melancholia to Prozac.

Lawlor refers several times to the “enduring” image of public visiting to eighteenth-century Bethlem, which he describes as “a combination of prison and freak show”.1 He uses this to contrast with nineteenth-century claims to offer “moral treatment” (as, indeed, asylum reformers did in the 1830s and ‘40s). Both ideas he seems to accept at face value, something that we at the Archives and Museum certainly remain wary of: championing or demonising the past can easily serve modern agendas.

Indeed, the main problem with Lawlor’s book is a frequent lack of critical historical thinking. As part of a project to explore depression before this modern label was applied, Lawlor retrospectively diagnoses various historical conditions as equating with modern depression. Many historians of psychiatry would argue against viewing clinical depression as the same as melancholia, hypochondriasis or neurasthenia (all terms used in the past to describe conditions that had some association with low mood). This is not to say that any of these states of illness are somehow imaginary: simply that prevailing cultural and medical concerns impact on not only the ways in which they are described, but also how they are experienced.

One particular example offered by Lawlor, acedia, is a case in point. When medieval monks were suffering from this condition, the low mood and lethargy they descibed might well be described as depression today. However, this was certainly not the most important component of acedia to these monks: most prominent was the loss of spiritual and religious feeling, something which had previously dominated every activity of their daily lives in an isolated monastery. Even the most devout person in the modern world is unlikely to put such an all-encompassing emphasis on spiritual connection today, and therefore cannot experience its loss in the same way that a thirteenth-century monk would have done.

Back to Bethlem, and Lawlor reproduces an image of Cibber’s famous statues, using them to claim the physiognomic emphasis on diagnosing depression in the late seventeenth and early eighteenth centuries. Yet, on viewing the original statues, school groups at the museum frequently comment that “Melancholy Madness” doesn’t look sad to them. Might different facial expressions have meant different things to people around 1700? Might they have associated other emotional experiences than sadness with melancholy, such as the fear highlighted in the Carnival of Emotions ? We certainly cannot be certain that clinical depression is the culmination of one universal story of understanding extreme misery.