(Nyíri, Antropológiai vázlatok, 127)
Hegel called an unconditional trust in the material the “science of captivity” because it prevented people from discovering themselves in what is not themselves and so prevented them from admitting that mind and matter are inseparable from each other, whether it is a matter of the universe or the human body as a microcosm. It was no accident that classical German philosophy, with its idealism and trust in both human freedom and the omnipotence of the mind, strongly influenced those physicians who were looking for a way out of the internal contradictions of somatocentric medicine. Romantic psychotherapy and medical science7 upheld the old conviction that diseases of the brain and mood disorders were not explicable only physically, and by considering environmental and cultural factors, they made psychotherapy dynamic and placed the mental disorders in a wider context. By doing so they not only preserved the pathos of freedom, characteristic of classic idealism, but also gave voice to the idea that human beings could not be divided into body and psyche but instead formed a body-psyche unit, the distinguishing mark of which was the ability to create a culture. The body-psyche-culture triad formed a context in which each member determined the others. Thereby the scope of diseases was broadened, and the diseases themselves were differentiated: in the latter half of the nineteenth century, Paul Möbius distinguished endogenous and exogenous diseases on the basis of whether the mental disorder had an external precipitating fact. So-called endogenous psychoses are those cases in which one does not know the precipitating and sustaining somatic processes and alterations, and the illnesses are not comprehensible from the life history or personality of the affected patient. In the end, every element in the body-psyche-culture aggregate acts on everything — and it appears that the broader the horizon in which an illness is set, the less unequivocal the effects, and the greater the chance of endogeny holding good. If I declare of melancholics that, in the last analysis, the surrounding culture is responsible for their condition, what I have said is true (after all, animals cannot be melancholic),8 but from the standpoint of medical practice, the statement carries little weight. If, on the other hand, I searched for exogenous traumata, I might be on the right path, but I would be deferring the etiological understanding of the disease. The essence of endogenicity, which the neurologist Hubert Tellenbach called “endon,” spans and determines the entire personality. It is not identical with either the psychic or the somatic structure, but contains both, and it follows changes of the environment, too. The endon forms a complex network, influencing the overall personality and its dynamics at the molecular and cellular levels: gender, physique, and the individual forms of behavior are just as dependent on it as are abilities, character, and intelligence — that is, the endon is what enlivens the personality and makes it exclusive and unique. The relationship between endogenicity and exogenicity is cultural, and endon and world are imaginable only in close symbiosis. For that reason, Tellenbach sensibly supplemented the word “endogenous” with a new term: in writing about melancholia, he refers to its being an endocosmogenic illness. In other words, in contrast to the somatic approach, he links the body’s inner state and the general state of culture: “We consider as being endogenous what steps forward as a unit of the basic temperament in every occurrence of life. The endon is, in origin, the physis which evolves in endogenous phenomena, slumbering in them, and by physis (‘nature’) we mean the basic imprint prior to the formation of the personality, its structure, so to say. . The way of being of the endon is not only transsubjective, and consequently metaphysiologic, but at the same time transobjective, and consequently metasomatologic, but the endon materializes both psychically and physically” (Tellenbach, Melancholy: History of the Problem, Endogeneity, Typology, Pathogenesis, Clinical Considerations, 41; emphasis in the original). This bold train of thought, which puts even philosophers to shame, was the firm conviction of a practicing neurologist and psychiatrist. It is hard not to discover the medico-philosophical tradition behind this thinking, yet nosocentric medicine is just as uncomprehending of its medical aspects as positivism is of its philosophical considerations.
The interpretation of melancholia as endocosmogenic depression expands the concept so greatly that strictly objectivist medicine might justly feel that the ground has been cut from under its feet. It seems as though some kind of deadly relativism were not only obliterating the difference between physical and mental diseases, but also making the relation between illness and health relative. As far as melancholia is concerned, this might lead to a radical revision of the medical diagnosis of the last two centuries: is it possible, after all, that melancholia cannot be defined as an illness? To be able to consider this, it is necessary to make a few remarks about the role of the body-psyche problem in diseases. On the one hand, the physical consequences of the soul’s functioning, or the influences that the physical state exercises on the soul, are undeniable; on the other hand, none of the sciences dealing with man is able to clarify satisfactorily what is actually taking place. I decide to do something, then get on my feet and carry it out — in all likelihood, it is the ultimate riddle of existence how a thought assumes the form of will and physical action. Science talks about interaction (that is, the relation of body and soul is causal) or parallelism (that is, body and mind behave in compliance with each other), but that does not take us a whit nearer to the solution of the problem, and in any case both those suppositions are unprovable. The inadequacy of language, and of thought adhering to language, arouses the suspicion that perhaps the way this question is posed is wrong: perhaps the reason we cannot find a solution to the problem is that we are posing a false problem. In all probability, the distinction between the words “body” and “soul” is one of the most fatal misunderstandings of our culture, and on the basis of what we have exposed so far, our conviction is that melancholia is precisely that gap (lesion) in human culture pointing to the fact that it is a matter of a misunderstanding, but an inevitable misunderstanding. The history of culture is a series of fatal misunderstandings: this melancholic assertion can be translated into our own language thus: the “essence” of man is that he is continually surpassing himself, and since he is unclosable, his essence is conceptually and objectively indefinable.
The ultimate indefinability of the relationship between body and soul points to this negativity, but even thinking about this relationship is a warning of the ultimate negativity: one may talk about body and soul, but this is obviously incorrect. Every moment of our lives proves that these apparently ultimate units are manifestations of an unknown, maelstrom-like chasm, of the foundations of our being, at which, for want of anything better, one is able only to hint. “Body” and “psyche” are mere words, references, and they have an allegorical role: whichever one speaks about, in reality one is not talking about that but about something else, in spite of one’s intentions and convictions. One cannot overcome the inadequacy of language: the words themselves cannot be made more precise; at most, the relationship we have developed toward them can be modified and shaped. It seems that it was only ever possible to stammer about the body-soul problem: at all events, Aristotle’s thoughts are like such stammering, though this stammering is precisely a sign that in fact he does not wish to make statements about the soul and the body but about the inaccessible human essence. “The soul is, in a way, all existing things,” he says (On the Soul, 431b), and elsewhere: “The soul must be. . capable of receiving the form of an object” (ibid.). Or: “All natural bodies are organs of the soul” (