Thursday, 11 May 2017

Melancholic Habits

In this post, Jennifer Radden, Professor in the Philosophy Department at the University of Massachusetts, introduces her new book: Melancholic Habits: Burton's Anatomy & the Mind Sciences.

When the process of writing a book is long and slow, as this was, one enters not entirely sure where one will end – or at least, expecting mind-change as the result of the process. For me, for this book, that change was considerable, and so incremental that it is hard to identify the moments it occurred or the sequences engendering it. Some of the befores and afters stand out, though.

I’d read Burton for years, and alluded to aspects of his Anatomy of Melancholy in earlier writing. But the recognition that it was possible to find a coherent model of mind and disorder (“disease,” in his pre-modern sense) implicatively related not to the actual detail of his remedies but to his remedial principles, emerged slowly as I worked through the first and second Partitions.

My unorthodox and ahistorical approach was itself part of the hindrance to seeing this coherence. I wasn’t sure, am still not, whether this is a legitimate way to approach any historical text. It certainly wouldn’t usually be. Yet the inchoate and elusive nature of the subject matter, combined with the sheer, bamboozling and distracting detail Burton willfully introduces at every turn, seemed to allow, and perhaps require, something unusual.

Then I stumbled on Christopher Tilmouth’s writing about the Anatomy, which seemed to support the idea that a partly-submerged foundation lies in there somewhere, from which a coherent picture can be discerned. To the extent that Tilmouth undertook that excavation, he seemed to see the picture as I did, moreover, although there was clearly much more journeyman work to be done, especially in tying the ideas about mind, body and disorder with the remedial end of things.

So: grateful and emboldened, although remaining cognizant that such cherry-picking was dangerous, and may be unwarranted, I continued. If it had a warrant, was my idea, then it was because despite the differences between melancholy then and today’s mood disorders, these conditions today are so little understood, so costly in terms of human suffering, so widespread and epidemic in their effects (depression is often said to be the “common cold” of mental disorders), that extreme measures might be permitted - and help, from any quarter, might be pursued. If there were even a chance that Burton may have hidden some answers in the Anatomy (however inadvertently), we may need to cut corners to find them.

How much of all that did I know when I began? Not much: it was no more than a vague, hopeful, hunch.

A second front on which I can identify ideas that developed as I went along lies with the matter of what sort of disorder Burton was talking about, and the whole complex question of the relation between Melancholy and depression that, I had long been worrying away at.

Today’s mood disorders are generally taken to include anxiety with depression, just as melancholy was always described as a combination of fear and sadness. But of course (again like “melancholy,”), in the vague, contradictory and confusing symptom clusters and descriptions associated with depression in today’s diagnostic psychiatry, the category of “depression” covers both: feelings and attitudes on the apprehension, worry, fear, anxiety axis, as well as on the sadness, sorrow, dejection, despair one. I began with few illusions about depression as a category. I was well aware of the disputes over the relation between depression and anxiety in the so-called comorbidity problem they raise -  as well as in the issues concerning ‘normal sadness’ with respect to bereavement; true melancholic depression or melancholia proper, and so on.

When, several years into the project, I read Kendler’s and Zachar’s work on network models of disorder, however, I better saw the extent to which whatever sort of thing depression is, it isn’t a happy fit with much that is assumed in contemporary diagnostic psychiatry. It eludes psychiatry’s categorical approach, for example, as well as the standard issue “common cause” model of disease, and the magic bullet conception of cure promoted by much modern medicine, of which psychopharmacology is so emblematic. With that recognition, I could better register the significance of Burton’s emphasis on the illimitable number of causes and symptoms of melancholy, as well as the stress he lays on eclectic remedial responses, and on dangerous mental habits.

Another, related conviction emerging with these ideas about what sort of things mood disorders are - when “mood disorder” covers both Burton’s melancholy and today’s depression - pushing me towards the idea that they may not resemble other mental disorders very closely at all. In some earlier writing on depression and the self, I’d tried to sort out why depression seems to stand alone, distinct and different from most other diagnostic entities. But as I explored the social norms surrounding sadness and sorrow in relation to Burton’s ideas about the universality of melancholy states, and also excavated what I ended up taking to be a kind of  “ habituation model” of melancholy, I seemed to be further and further away from any standard psychiatric conception of disordered mood.

With its hint that whatever kind of kinds mental disorders are, they are all the same kind, mental disorder as a broad category has always seemed to me a clumsy one, whether as the subject of a strict definition, or as a looser, Wittgensteinian analysis. In that respect, symptoms are safer subjects for analysis than particular disorders, and particular disorders than any more overarching taxon.

But these changes in my thinking seemed to suggest something stronger, as well: that the mood disorder associated with depression may be of a different kind altogether. This hypothesis, if we can call it that, directs us to reflect on the role played by melancholy moods in the earlier era, when so much of normal as well as abnormal psychology was framed and construed in terms of all-encompassing humoral explanation. If depression symptoms are similarly pervasive in their reach and significance, not only because of their prevalence but as prominent cultural signifiers, then continuing to classify depression alongside other mental disorders may be misleading.

The years of completing this book have brought developments in the world in relation to depression. Increasing recognition of its economic and social costs worldwide has since the beginning of the new century turned attention to public health methods and approaches, with their emphasis on prevention over treatment. Also, forms of cognitive therapy have emerged as the main treatment for depression proffered as an alternative to solely psychopharmacological approaches.

By the time I was writing, these trends had made real headway. They seemed to mirror the ideas Burton espoused, with his emphasis on self-help, early prevention, and the practice of a Stoic-inspired care of the soul that was a recognizable antecedent of cognitive therapy. These actual, real world Burtonian trends encouraged me. Paired with new ideas about the nature of mental disorders, they prompted a focus on the implicative connections between underlying theoretical conceptions of disorder and these practical prescriptions. The alternative picture of disorder that can be found in Burton could then be seen to resemble that introduced by Kendler and his colleagues in their work on network models of depression. And if I’m onto something in excavating a kind of habituation model submerged within the Anatomy that includes his remedial principles, then perhaps we’re finding a useful new – if old – way of thinking about disordered moods, which incorporates both explanations and prescriptions.

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