When Purging Melancholy Gave Way to Treating Depression
“The passions of melancholy doe more strongly worke in the minde of man, then doe those which come of any pleasant and delectable cause.” –from A Method unto Mortification, 1608.
First, to answer the question posed in the title and to make it clear that this is a linguistic, not a medical analysis. The changeover in printed literature actually happened around 1970, when “treat depression” began to appear more often than “purge melancholy”:
There are various caveats associated with Google NGrams data and you can dive into them if you like. What the graph makes reliably clear is that while writing about purging melancholy enjoyed several peaks and troughs in the 18th century before beginning a steady decline around 1820, treating depression became a talking point in literature around 1970 and shows no signs of stopping. Are we better off for this shift in perspective on our distress?
We take it for granted today that depression is a widespread phenomenon in Western societies and we now have an industry that purports to treat it, usually with drugs. Indeed, you would have to be living under a rock to be unaware that the medical and pharmaceutical industries offer curatives. Advertisements for antidepressants follow a script that has lapsed into cliché: gloomy music introduces an unhappy camper (often, an attractive young white woman) who expresses her distress as we watch her unable to cope with the routines of ordinary life. Then the music takes an upbeat turn and a voiceover warns us of truly alarming possible side effects while we watch the lady forget her troubles and get happy, once she gets on the drug. Here’s an example.
Just as we take for granted that depression is a thing, we take for granted that the treatment of it belongs in the hands of the healthcare and pharmaceutical industries. It wasn’t always so and it’s revealing to compare the contemporary narratives that accompany distress with those of earlier times.
To begin, are we talking about the same thing? Was the melancholy of yesteryear the same thing as the depression of today? I think there’s good evidence that it was. Here are a few examples and descriptions of melancholy from the English Historical Book Collection, (accessed via Sketch Engine):
One while in Malancholy sits he pynes himselfe away. William Warner, Albions England (1586)
This bred in the King a deep melancholy ; and filled his head with suspitious imaginations; the like whereof he had never beene slow to apprehend. He was much vexed: and so much the more, for that he knew, neither well to whom, nor perfectly whereof to complaine. Sir Walter Raleigh, The History of the World (1617)
Melancholia and Mania, which they describe and distinguish thus: Both of them to be when the understanding is so disturbed, that men imagine, speak, and do things, which are most absurd, and contrary to all reason, sense, and use of men. But their difference to be in this; that melancholia is attended with fear, sadness, silence, retirednesse and the like symptomes: Mania with rage, raving, and fury, and actions suitable; which is most properly styled madnesse.” Joseph Mede, Discourses on divers texts of Scripture delivered upon severall occasions (1642)
Melancholy ( melancholia ) is by Physicians reckoned for one of the four humors of mans body, and resembles the Earth, as Choler doth the fire; Blood the air; Phlegm the water. It is said to be the grossest of all four, which, if it abound too much, causeth heaviness and sadness of mind. Thomas Blount, Glossographia, (1661)
The Properties of the Melancholia are: to proceed from some Disorder in the Mind. To be preceded by Anxiety, Want of Sleep, intense Thought, frequent Anger, or any violent Passion; profuse Venery, Pain in the Head, Suppression of the natural Evacuations, burning and lasting Fevers . . . to manifest it self by Fear and Sadness, and the Colour of the Skin. Peter Shaw, A treatise of incurable diseases (1723)
Melancholy as a descriptor of a mental state began a decline in usage early in the 19th century, just as depression began to gain ground. Today they have essentially swapped places (setting aside the spike that reflects references to the economic depression of the 1930s):
But the verbs accompanying melancholy and depression have also changed. Our ancestors worked on purging melancholy, often as a do-it-yourself exercise. Today we largely outsource treating depression to prescribing professionals.
Just how did that purging thing work? Here are a few quotes from the same corpus noted above:
Honey and rose water strengthen all parts, and purge melancholy.
Ladies have for Pages, now and then, to purge their melancholy.
Cleare vp your voyces, and tune them to the pulse, and harmony of this harp. This sound, beleeue [believe] me, wil banish Satan, and thoroughly purge away melancholy, that grateful seat of the wicked Genius.
An Asse eats the herb Asplenum to purge his melancholy ; of whom the Physitians have learned to Minister the same herb for the same purpose.
An early 18th century songbook was titled Pills to Purge Melancholy:
The songbook’s title was taken in turn from a humorous 1599 pamphlet.
Purging melancholy emerges, from the context of its usage, as an uncomplicated, usually one-and-done operation, often with no requirement of professional supervision or expense. Treating depression, as we all know, is typically a long, expensive, and often disruptive process that may or may not succeed — though you might never guess this from the fairytale narratives of antidepressant commercials that also treat it as an easy, one-and-done trick.
In an opinion piece that appeared last year in Psychology Today, an earnest doctor of psychiatry proposed a change to the way that depression is treated in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of mental healthcare professionals. Dr. Mark Ruffalo argues that the DSM should be amended to include melancholia as a disorder separate from more ordinary kinds of depression, one that requires specific biological interventions. Less serious cases of depression should respond to psychotherapy, though Ruffalo notes that antidepressants “are all-too-frequently used in these cases, particularly by primary care physicians and other non-psychiatrists.”
If you click on the link to Dr. Ruffalo’s piece you’ll find a sidebar that includes other links to “Depression Essential Reads”. Does this not underpin how thoroughly modern mental health authorities are vested in the prevailing view of depression? It’s a treatable pathology that they own and manage.
Not all modern authorities on mental health hold the same views. For example, an influential paper from Professor Roger T. Muller lays out an alternative case well in “An Epidemic of Depression or the Medicalization of Distress?” Here are some quotes:
Pathologizing distress as illness may lead individuals to increasing self-identification as helpless and reliant on the services of health professionals.
A willing coalition of doctors, researchers, advocacy groups, drug companies, and sufferers support the idea that there is an epidemic of the illness that we now call major depression.
Those with incentives, particularly financial ones, have elevated rates of major depression because it serves their interests. These incentives are particularly powerful for drug companies to improve their sales and profits. Drug companies attempt to expand their market for depression as for all medical illnesses, and they sponsor depression awareness campaigns, medical education, depression carer meetings, and conferences.
We are inundated today in a way that our ancestors never were with information about what ails us, and what the modern healthcare industry offers to mend it. In this environment we can lose sight of the fact that we are not obliged to accept the contemporary diagnosis or the treatment of the ills that assails our minds. Why continue to feed at the ideational trough that your time, place, and culture presents when it is that very time, place, and culture that may have led you to the unhappy state you are in?
Distress is endemic to the human condition. Understanding your own distress does not require that you fit it to the carefully curated set of narratives about it that this time and place offer to you. The profit motive inherent in the prevailing narratives, along with their removal of agency from the person most affected, make you wonder whether the old-fashioned, DIY approaches to purging melancholy offer us something today.