Mary Cregan Ph.D.

The Scar

How Melancholy Seizes the Brain

A brief history

Posted Apr 03, 2019

Biological psychiatrists understand melancholia as a severe mood disorder associated with dysfunctions along the body’s hypothalamic-pituitary-adrenal axis.

A recent textbook defines the illness as “a recurrent, debilitating, pervasive brain disorder that alters mood, motor functions, thinking, cognition, perception and many basic physiologic processes.”

The earliest description appears in ancient Greece in the fifth century B.C.E., when Hippocrates and his followers ascribed melancholia’s prolonged sieges of fear and anxiety, aversion to food, sleeplessness and irritability, to an excess of black bile in the spleen. The word is a transliteration to Latin from Greek (melan—“black, dark, murky,” plus khole—“bile”) into Latin. While early writers thought the spleen was dominant in determining the temperament of melancholy people, they also understood that melancholia disturbs the mind because it affects the brain. Galen, a second-century Greek physician, was clear about the illness’s distorting effect on thought, feeling, and social relationships, writing of despondent patients who “hate everyone whom they see, are constantly sullen and appear terrified, like children or uneducated adults in deepest darkness.” In seventeenth- century England, Samuel Butler cast the melancholic in similar terms, as a person trapped in the echo chamber of his own distorted mind: “A melancholy man is one that keeps the worst company in the world, that is, his own, and though he be always falling out and quarrelling with himself, yet he has not [the] power to endure any other conversation. His head is haunted, like a house, with evil spirits and apparitions, that terrify and fright him out of himself, till he stands empty and forsaken.”

For the deeply religious, the conviction of inner badness that accompanies melancholia slides all too readily into a belief that one has been cast out by God. The case of the seventeenth- century Englishwoman Hannah Allen provides an instance of severe melancholic delusion expressed as spiritual trial. She was already in a state of depression when she received the news that her husband, a sailor who was often away from home, had died at sea. Her severe condition became dramatically worse, and she tried to kill herself. She later described her experience to a spiritual counselor: “I would often say, I was a thousand times worse than the Devil. . . .  My sins are so great, that if all the sins of all the devils and damned in hell, and all the reprobates on earth were comprehended in one man; mine are greater; There is no word comes so near the comprehension of the dreadfulness of my condition as that, I am the Monster of the Creation: in this word I much delighted.” Allen’s grandiose self-damnation sounds like a classic— if rather gleeful—expression of depressive psychosis. When she recovered, she agreed that she had been suffering from melancholy and that she had no moral reason to think herself so evil.

In 1682, the Presbyterian preacher Timothy Rogers found himself so disabled by melancholia that he had to leave his position in London and retire to the countryside. Once he recovered, he wrote a book in the hope that his experience and counsel would be useful to other sufferers, as well as their families and friends. He describes “what dreadful apprehensions a soul has, that is under desertion,” and offers comfort to those convinced that God has abandoned them. Rogers understands that melancholia is an ailment of the body that afflicts the mind, and he emphasizes the distinction between a person who feels guilty and a person who is very ill: “There is a very great difference between such as are only under trouble of conscience, and such whose bodies are greatly diseased at the same time . . .  Melancholy seizes on the brain and spirits, and incapacitates them for thought or action.” It can overwhelm people who are naturally inclined to it “by the loss of children” or some “unlooked for disappointment that ruins all their former projects and designs.” He writes, too, of the insomnia that is one of melancholia’s chief torments: “It is very reviving to a man that is in pain all the day, to think that he shall sleep at night; but when he has no prospect nor hope of that for several nights together . . .  he is then like one upon a rack, whose anguish will not suffer him to rest.”

As a former patient, Rogers advises friends and family members not to argue with sufferers, nor to respond to their complaints by asserting that it’s “nothing but imagination and whimsy. It is a real disease, a real misery that they are tormented with: and if it be fancy, yet a diseased fancy is as great a disease as any other; it fills them with anguish and tribulation.” The Puritan preacher Cotton Mather, across the Atlantic in the Massachusetts Bay Colony, took a sharply contrasting approach, seeing malingering and whining in cases where Rogers sees suffering: “These melancholics do sufficiently afflict themselves, and are enough their own tormentors. As if this present evil world would not really afford sad things enough, they create a world of imaginary ones.” Anyone in the depths of the illness could only feel worse in the face of this exasperated “pull yourself together” response, whereas Rogers counsels faith and patience. Since he knows of no medicine that can help, he emphasizes that prayer is the only recourse for an illness so frightening, one that can arrive without cause and stay so long.

Excerpted from The Scar. Copyright (c) 2019 by Mary Cregan. Used with permission of the publisher, W. W. Norton & Company, Inc. All rights reserved.