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MENTAL HEALTH IN HISTORICAL PERSPECTIVE
From Melancholia
to Depression
Disordered Mood in
Nineteenth-Century Psychiatry
Åsa Jansson
Mental Health in Historical Perspective
Series Editors
Catharine Coleborne
School of Humanities and Social Science
University of Newcastle
Callaghan, NSW, Australia
Matthew Smith
Centre for the Social History of Health and Healthcare
University of Strathclyde
Glasgow, UK
Covering all historical periods and geographical contexts, the series
explores how mental illness has been understood, experienced, diagnosed,
treated and contested. It will publish works that engage actively with
contemporary debates related to mental health and, as such, will be
of interest not only to historians, but also mental health professionals,
patients and policy makers. With its focus on mental health, rather than
just psychiatry, the series will endeavour to provide more patient-centred
histories. Although this has long been an aim of health historians, it has
not been realised, and this series aims to change that.
The scope of the series is kept as broad as possible to attract good
quality proposals about all aspects of the history of mental health from
all periods. The series emphasises interdisciplinary approaches to the field
of study, and encourages short titles, longer works, collections, and titles
which stretch the boundaries of academic publishing in new ways.
From Melancholia
to Depression
Disordered Mood in Nineteenth-Century
Psychiatry
Åsa Jansson
Institute for Medical Humanities
Durham University
Durham, UK
© The Editor(s) (if applicable) and The Author(s) 2021. This book is an open access
publication. Published with the support of the Wellcome Trust.
Open Access This book is licensed under the terms of the Creative Commons Attribution
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use, sharing, adaptation, distribution and reproduction in any medium or format, as long
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Commons license, unless indicated otherwise in a credit line to the material. If material
is not included in the book’s Creative Commons license and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder.
The use of general descriptive names, registered names, trademarks, service marks, etc.
in this publication does not imply, even in the absence of a specific statement, that such
names are exempt from the relevant protective laws and regulations and therefore free for
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The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
For Annika. Thank you, for everything.
Preface
This book has been a long time in the making. The seeds were sown in
2009 when I started researching an M.A. dissertation on melancholia and
depressed mood in Wilhelm Griesinger’s work, and quickly realised that
there was a much bigger story to be told about what happened to the
melancholia concept in nineteenth-century psychiatry. This story became
the focus of a Ph.D. thesis on which this book is based.
Melancholia is a topic that has attracted vast attention from writers
across disciplines and genres, spanning a range of perspectives. At the
same time, much existing work on melancholia is underpinned by a
common theme: the belief that melancholy is a timeless human emotion,
a phenomenon that has remained largely constant as our societies have
changed, a shared experience that connects us to our ancestors of past
historical periods. Seen in this way, melancholy is a core feature of
humanity, as is its pathological mutation, melancholia. To understand
melancholia, then, is to understand something about what it means to
be human: to suffer without apparent cause.
As this is the context in which this book is written, and as it will
inevitably be read against the backdrop of a large catalogue of works
on melancholia and melancholy, it is only right that I confess that my
interest in this topic and my original motivation for exploring it are less
ambitious and more mundane than those of many of the writers who
have sought to make sense of this ubiquitous yet elusive feature of the
human condition. My initial interest in mood disorders arose in relation
vii
viii PREFACE
This led me to start asking questions about our current separation of affec-
tive (mood) and cognitive (schizo) disorders, which began in the nine-
teenth century and was cemented in the twentieth. That story is yet to be
told, and doesn’t form part of this book. But it looms in the background
and illustrates one of the most important differences between nineteenth-
century melancholia and clinical depression, in that delusions and hallu-
cinations are only a secondary and much less talked about feature of the
latter.
Finally, it should be emphasised that there are many ways in which one
can write the history of nineteenth-century melancholia. This book is an
attempt to write it as the history of medical and psychiatric conceptions of
what melancholia was—and became—in this period. In other words, this
book is not a search for answers about what melancholia feels (or felt)
like or why people are apparently afflicted by it. Nor is it an attempt to
right historical wrongs in psychiatry by demonstrating the timelessness of
melancholia as a medical condition. And it is not a critique of the ubiquity
of the clinical depression concept. These are all important issues, which
to various extents form the context for the present story, but they have
been, and are still being, comprehensively discussed elsewhere. This book
is the story of how the first modern mood disorder was created.
Why is this important? There are undoubtedly many reasons, but the
most fundamental is this: ‘knowledge about human beings changes what
people are’.2 An historical perspective on such knowledge is crucial. It
allows us to understand where it comes from, how it emerged, how it
operates, and most importantly how it becomes central to our lives. It
shows us that such knowledge is not permanent or universal. Mood disor-
ders constitute a particular, historically specific way of making sense of
and experiencing emotional distress. What shedding light on this histor-
ical specificity does is show us that the existence of this framework is not
inevitable. It’s very much real today—people are diagnosed with mood
disorders and experience themselves as suffering from these conditions—
but it hasn’t always been. This way of understanding emotional distress
is neither right nor wrong; it can be both helpful and harmful. What is
important is that we are equipped with the tools to think critically about
its place in our lives and the work that it does, and to equally allow for
2 Roger Smith, Being Human: Historical Knowledge and the Creation of Human Nature
(Manchester: Manchester University Press, 2007), 8.
PREFACE xi
I’m indebted to many people and institutions for their help and support
in the research and writing of this book. Thanks first of all to Molly
Beck at Palgrave Macmillan for her enthusiastic interest in and support
for the book, as well as to Maeve Sinnott for continuous support and
guidance during the writing process. Thanks also to the editors of the
Mental Health in Historical Perspective series, Catharine Coleborne and
Matthew Smith, and to the anonymous peer reviewers for their helpful
comments on the proposal and manuscript.
This book would not have been possible without a generous scholar-
ship from the Wellcome Trust (grant number 092988/Z/10/Z), which
allowed me to research and write the thesis on which the book is based.
I’m also grateful to my colleagues and friends at the University of London
whose feedback at various stages of this project in its early years was instru-
mental in shaping the story that eventually became the present book, in
particular my Ph.D. supervisors Thomas Dixon and Rhodri Hayward, as
well as Sarah Chaney, Chris Millard, Jennifer Wallis, Tom Quick, Stephen
Jacyna, and Sonu Shamdasani. I’m also especially grateful to Felicity
Callard for continuous support and advice over the years.
Thanks also to my colleagues at the Institute for Medical Humani-
ties and Hearing the Voice at Durham University, in particular Angela
Woods, Sarah Atkinson, Victoria Patton, Ben Alderson-Day, Chris Cook,
Charles Fernyhough, Kaja Mitrenga, and Mary Robson. Working in a
collaborative and interdisciplinary context over the last few years has had
xiii
xiv ACKNOWLEDGEMENTS
Index 229
xv
CHAPTER 1
If mania and melancholia took on the face that we still recognise today, it is
not because we have learnt to ‘open our eyes’ to their real nature during the
course of the centuries; and it is not because we have purified our perceptive
processes until they became transparent. It is because in the experience of
madness, these concepts were integrated around specific qualitative themes
that have lent them their own unity and given them a significant coherence,
finally rendering them perceptible.1
Michel Foucault, History of Madness (1961)
In the summer of 1874, Moses B., a young doctor, was brought into
Edinburgh Royal Asylum at Morningside. According to his family, he
had become so intent on taking his own life that they saw no other
option but to have him certified as insane and admitted to the hospital.
One of the doctors who examined him in his home had written in the
medical certificate that Moses suffered from severe ‘delusions’, which
had him convinced that ‘his soul is lost, that he ought to die’ and that
‘he is committing great sins’. When Moses arrived at Morningside, the
attending physician noted in the patient journal that the young man’s
‘depression’ was ‘considerable’, and made a note of his ‘suicidal tenden-
cies’, which, based on family testimony, consisted in ‘taking belladonna,
refusing food, &c’. Moses B. was subsequently diagnosed with melan-
cholia, with emphasis given to his pronounced ‘suicidal tendencies’, which
required that he be placed under close observation.
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