How Everyone Became Depressed

The rise and fall of the nervous breakdown

The Inability to Cry

Really depressed? Cry a lot? You’ll probably respond to treatment.

But if you find that you can’t cry, that you can’t feel anything, what then?

The inability to feel anything -- neither sadness nor anything else – is one of the danger signs in melancholic depression. Melancholia is the severe form of depressive illness. Melancholic patients would typically be deeply sad. Since the Ancients, profound sadness, often without an apparent cause, has screamed “melancholia.” And screamed it loudly because such patients are at risk of suicide.

But beyond deep sadness there is feeling . . . nothing. This really should sound an alarm.

The English poet Elizabeth Barrett Browning captured this inability to cry In her 1844 poem “Grief,” She likened grief to

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 “. . . a silence like death—

Most like a monumental statue set

In everlasting watch and moveless woe

Till itself crumble to the dust beneath.

Touch it; the marble eyelids are not wet:

If it could weep, it could arise and go.”

 

Melancholic individuals, she thought, were like marble statues. The ability to weep would thus set people free of melancholia; but many cannot weep because they cannot feel anything.

In 1913 the German psychopathologist Karl Jaspers brought the inability to feel into the medical tent, calling it “the feeling that one doesn’t have any more feelings, the subjective blocking of thought.” (Karl Jaspers,1913, 67).

So, in a clinical interview, it’s really important to sort out your patient’s feelings. Sad? Anxious? Beyond sadness? Beyond sadness was in the past often considered a suicide marker in psychiatry. This is what the study of psychopathology is all about, finely differentiating among signs and symptoms because some of them can serve as red flares.

So, of course we do this today, don’t we?

Actually, not.

The Diagnostic and Statistical Manual of the American Psychiatric Association, the fifth edition of which in 2013 became the world guide to psychiatry, is silent on loss of the ability to feel, at least in depression. This fifth edition, a gross purple thing with its 947 pages, says nothing about loss of feelings in the depression section.

But in the schizophrenia section we encounter, in the negative symptoms section, “diminished emotional expression”; what used to be called “emotional blunting” has always, and correctly, been considered a sign of chronic psychotic illness, what came to be called “schizophenia.”

But hey! As you curl into an inert ball in bed in the depths of your melancholia, you don’t have schizophrenia! You are perfectly rational, able to get up and listlessly fix the family dinner, and wonder why the children’s antics no longer bring you pleasure – because, really, nothing does. You’ve got the Karl Jaspers symptom. You don’t feel anything.

I’m writing this as though you were a patient reading it. But loved ones and friends may be reading it as well. This is a warning rocket going off in the sky, but it’s a rocket that’s not in DSM. There’s a lot of the psychiatry of yesteryear that’s not in DSM. Loud have been the complaints among senior psychiatrists today about the residents not learning any “psychopathology.” This is the kind of thing they mean.

Edward Shorter, Ph.D., is the Jason A. Hannah Professor in the History of Medicine at the University of Toronto.

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