Chapter 8. ILLNESS
During the period of Romanticism, people not only reevaluated melancholia retrospectively but also sought to place the whole world in the parentheses of melancholia. The notion of melancholia, along with the related image of love, could be regarded as huge parentheses: according to the Romantics, it was only within these that the world had a chance to speak up. If the world sought nevertheless to assert its own right, then by doing so it would sooner or later bring about the death of melancholics as it became unable to set limits on their desires. The notion of melancholia was never so broad, nor so fragile: its huge dominion was girded by the closely set border markers of death. We see the last major efforts of melancholia: following the Renaissance, melancholia gradually shallowed out into a mood, an emotional state that — and hence its enemies’ haughty self-assurance — was supposedly only a state of the soul, and for that reason it had no “objective” place in the world’s scheme of things. It was pointless to waste much time on it. The Romantics, together with lovers who hastened to their assistance, strove once more, one last time, to make melancholia global, to conjure up a law out of a mood, something of universal validity out of a feeling. Their death and their failure pointed to the ultimate hopelessness and futility of their undertaking, as did the disapproving shakes of the heads of enemies girt with the armor of their scientific spirit; for the age not only allowed the individual to be omnipotent only in the sheer ardor of emotions and eliminated even the idea of striving for the unconditional — insisting deceitfully and misleadingly that anyone was free to choose among moods — but also impoverished those very moods by its own ever more ramifying scientific spirit: it claimed that the mood was unconnected with the world, that it was simply a manifestation of the soul, of unknown origin, that did not create a new world and even in the best case was merely an impression of what was already present.
In the eighteenth century, on the heels of research concerning the nervous system, the conviction grew that the cause of melancholia was the nervous system itself, which, in turn, was responsible only for itself. In this view, a person became melancholic neither because of his (physical or psychological) situation in the world nor because of his interpretation of existence, but because of his own narrowly understood physical constitution. The belief in black bile was shattered in the eighteenth century; the interpretation based on the pathology of humors was replaced by a neurophysiological interpretation that explained melancholia through the stimulation of nerve fibers. In 1765, Anne-Charles Lorry distinguished between mélancolie humorale and mélancolie nerveuse, the latter being derived from changes in the nerve fibers (De Melancholia et Morbis Melancholicis). It was in connection with melancholia and melancholics that medical science in the eighteenth century introduced the remarkably vague expression of a “weak” nervous system. It may be an imprecise term, but for the scientific mind it was not something to be brushed aside: it created an apparent connection (closed circuit) in which the affliction of the soul was derived from a weakness of the nervous system, and the disturbance of the soul was responsible for the weakness. Melancholia was stuck in a vicious circle, which came as a godsend for positivists: people who move in closed circuits are not in contact with the world, and anyone who has lost touch with the world can have only false ideas.1 Physicians of the age unanimously complained about the excessively broad, elusive meaning of the term “melancholia”; indeed, two millennia of interpretations of existence were hard to squeeze into a concept that was supposed to have a well-defined and delimited scientific meaning. The term “melancholia” was replaced by new expressions: it was renamed “monomania” and, later, “lypemania” (by Philippe Pinel and Jean-Étienne Dominique Esquirol, respectively). Later, in the mid-nineteenth century, when the concept of the so-called unitary psychosis (Einheitspsychose) was developed, melancholia came to be seen as the initial stage of madness in general.2 Despite being classified with mental disorders in the strict sense, melancholia still had an excessively wide signification: in Wilhelm Griesinger’s classification, it still embraced certain aspects of the condition nowadays called schizophrenia. In Die Melancholie (1874), Richard Krafft-Ebing narrowed the broad scope of interpreting melancholia by identifying it as depression, and later as the depressive stage of so-called manic-depressive disease. (The illness, which had been described as far back as Aretaeus of Cappadocia, returned to the purview of psychiatry in the nineteenth century: it was introduced into the domain of psychiatry and neurology under the designation folie circulaire by Jean Falret and Jules Baillarger in the 1850s, independently of each other, whereas in 1864, Théophile Bonet had called it folie maniaco-mélancolique. At the end of the century, Kraepelin broke apart the previous unitary psychosis on the basis of clinical practice: he adopted a theory that identified depression and melancholia, specifying depression to be the physical symptoms typical of melancholia, but still retained the concept of melancholia.) Melancholia became one of the diseases attended by intellectual degradation, the increasingly severe variants of which were melancholia simplex, melancholia gravis, paranoid melancholia, fantastic melancholia, and delirious melancholia. (Kraepelin, though unable to prove it, hypothesized that melancholia was produced by changes in the cerebral cortex.)
Identifying certain depressive symptoms (which had always typified melancholia) as being melancholia itself was a dethronement: a relatively well-circumscribed cluster of symptoms appropriated for itself the concept of melancholia, only for the original name to be banished and finally supplanted by that of depression. (Pinel, for example, did not mean by “monomania” a melancholic diathesis but a monoideatic depressive illness.) One cannot fail to notice the straining of the scientific mentality: for the sake of regularity and accurate description, science chops up phenomena and extends its attention merely to what it is capable of delimiting. Since in principle everybody possesses some kind of weltanschauung, and an interpretation of life is one of the preconditions of existence, a melancholic interpretation of being does not necessarily imply illness. Therefore, positivist minds since the nineteenth century have been obliged to distinguish two kinds of melancholy: one, despondency, does not call for medical intervention, but the other, an endogenous psychosis, belongs to the domain of psychiatry. To avoid misunderstandings, the latter is usually renamed depression. What had earlier been inconceivable took place: neither the notion of melancholia of antiquity nor that of the Renaissance or the Baroque recognized that kind of sharp delimitation of healthy and sick melancholia. (It was perhaps only the Middle Ages that dared to draw a boundary between health and sickness with a similarly firm belief.) Up until the eighteenth century, medical science undertook the task of interpreting existence openly, and therefore when it came to melancholia, it was just as unable to offer an unequivocal definition as any school of philosophy that had set itself the goal of explaining existence. (One may be put in mind of Robert Burton’s treatise on melancholia: even after reading the more than one thousand pages of that work, one finds it impossible to define melancholia precisely — but having fought one’s way through the labyrinths of the melancholic interpretation of life, one is nonetheless left richer in experience, if not in knowledge.) The medical science of the nineteenth and twentieth centuries likewise interpreted existence in its own way, but did it tacitly, despite its declared intention and its goal, as was recognizable first and foremost in its methodology. The slicing up of melancholia, the narrowing down of the concept, the absolutization of “bodily” symptoms, and the attempt to impose a closed, clinical systematization on the “psychological” symptoms — what else was this if not an obvious interpretation of human existence? Science, acting under the spell of facts that are held to be palpable, is inclined to eschew value judgments: the illusory nature of its methodology, however, is especially glaring in the case of psychiatry. And since the interpretation of being (whether that is overt or covert) is a process that cannot be closed, psychiatry, if it strives for definitive conclusions, commits violence against human existence. One can never describe the world per se, said Kant; whatever one might write down is always inside the world. The narrowing down of the concept of melancholia by science was a warning of an internal, unspoken dilemma of medical science itself. It seemed that medicine of old, which had no wish to describe melancholia (or any other medical condition) as being a closed, unitary disease to be interpreted mainly in physical terms, relating it instead to existence as a whole, knew more about melancholia (and the nature of diseases) than medical science of the most recent times, spellbindingly well-founded as it may be in scientific terms. This scientific method forwent from the very outset probing any of its own boundaries or setting the investigated disease and the ensuing changes in a broader context of being. The disruption of melancholia in the modern age is explicable by this imposed methodological confinement.