From Melancholia to Prozac: Depression throughout History

As the new Bethlem Museum of the Mind will reflect on, Bethlem – or Bedlam – continues to loom large in the public imagination, often as a lens through which ideas about mental health care and treatment are cast. That this is the case for researchers as well as journalists is aptly illustrated in a recent book by Clark Lawlor, From Melancholia to Prozac.

Lawlor refers several times to the “enduring” image of public visiting to eighteenth-century Bethlem, which he describes as “a combination of prison and freak show”.¹ He uses this to contrast with nineteenth-century claims to offer “moral treatment” (as, indeed, asylum reformers did in the 1830s and ‘40s). Both ideas he seems to accept at face value, something that we at the Archives and Museum certainly remain wary of: championing or demonising the past can easily serve modern agendas.

Indeed, the main problem with Lawlor’s book is a frequent lack of critical historical thinking. As part of a project to explore depression before this modern label was applied, Lawlor retrospectively diagnoses various historical conditions as equating with modern depression. Many historians of psychiatry would argue against viewing clinical depression as the same as melancholia, hypochondriasis or neurasthenia (all terms used in the past to describe conditions that had some association with low mood). This is not to say that any of these states of illness are somehow imaginary: simply that prevailing cultural and medical concerns impact on not only the ways in which they are described, but also how they are experienced.

One particular example offered by Lawlor, acedia, is a case in point. When medieval monks were suffering from this condition, the low mood and lethargy they descibed might well be described as depression today. However, this was certainly not the most important component of acedia to these monks: most prominent was the loss of spiritual and religious feeling, something which had previously dominated every activity of their daily lives in an isolated monastery. Even the most devout person in the modern world is unlikely to put such an all-encompassing emphasis on spiritual connection today, and therefore cannot experience its loss in the same way that a thirteenth-century monk would have done.

Back to Bethlem, and Lawlor reproduces an image of Cibber’s famous statues, using them to claim the physiognomic emphasis on diagnosing depression in the late seventeenth and early eighteenth centuries. Yet, on viewing the original statues, school groups at the museum frequently comment that “Melancholy Madness” doesn’t look sad to them. Might different facial expressions have meant different things to people around 1700? Might they have associated other emotional experiences than sadness with melancholy, such as the fear highlighted in the Carnival of Emotions? We certainly cannot be certain that clinical depression is the culmination of one universal story of understanding extreme misery.

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1 Clark Lawlor, From Melancholia to Prozac (Oxford: Oxford University Press, 2012), p. 80

Sketch of a woman diagnosed as suffering from melancholia.

Lithograph, 1892, after a drawing made for Sir Alexander Morison (Wellcome Library, London).

Book Review: ‘Human Traces’

Back in March and April we posted reviews of books with mental health themes. Now we are pleased to add another review, written this time by a work experience student who was recently with us:

‘In the days leading up to, and during, my work experience placement at Bethlem Archives and Museum, I read Human Traces by Sebastian Faulks. I found the book of particular interest at this time because of the ways in which what I was reading linked with all that I was learning and experiencing at the Archives. The book is set in the years around the late nineteenth and early twentieth centuries and is about the attempts of two fictional doctors, Thomas Midwinter and Jacques Rebière, to make some kind of breakthrough in understanding and treating mental illnesses, back in a time when very little was known about these sorts of disorders.

‘On the first day of my work experience placement I sat in on an educational visit from a school to the Archives. This began with a talk about the history of the hospital and how, in the past, the Bethlem has tried to treat and cure patients. Once again, I found myself making connections between this and Human Traces, especially in terms of the descriptions of the wards and of the use of ‘occupation’ to try and keep the patients busy and distract them from their problems. For example, nineteenth-century Bethlem had a library, sewing, sport teams, a choir and other activities which were available to the patients. All this was also around the time in which Thomas Midwinter, in the book, was working in a large county asylum which also offered its inmates such employment as sewing, gardening, working in a laundry, kitchen or workshop and farming. Another example of entertainment which Bethlem would provide was a monthly ball, an occurrence which is also found within Human Traces, although only once at the county asylum – at Christmas time.

‘During my time here, I have been able to look a little bit at some of the case books for patients admitted in the early 1880s – the same time period within which Human Traces is set. It was possible for me to examine in contrast the real patients and those created by Faulks and see how each were treated in Bethlem in comparison with the attempts of the doctors and alienists at the same time in Human Traces. I found this the most interesting of connections as it seemed that some of the characters in the book could have been taken directly from the doctors’ notes in the casebooks. The case books also provide another connection with Human Traces as Thomas Midwinter, whilst working in the county asylum, was concerned at the lack of records of the patients and so painstakingly wrote up case books of his own, such as the ones kept at the archive.

‘The book Human Traces by Sebastian Faulks is one which I have really enjoyed reading and its vivid descriptions offer a fairly accurate view of the development of the understanding of mental health around the turn of the 20th Century. It is concerned with the development of psychiatry to such an extent that this rather dominates the book; however, there are many sub-plots which relate to less scientific and more conventional themes such as love, family and friendship.’

History of Emotions: New Blogs and more

Following a recent fascinating conference on the topic of ‘Mastering the Emotions’, the Centre for the History of Emotions at Queen Mary, University of London, have set up a new History of Emotions blog. The blog, which includes several reviews of the many topics covered during the recent conference, will include reviews as well as historical perspectives on current affairs, contemporary culture, and public policy. Ideas of feeling and emotionality have long been bound up in concepts of mental health and ill-health, as well as shifting understandings of what it means to be human and the connections between man and animals. As the recent Centre conference enquired, what does it mean to master one’s emotions? Following the emergence of the modern category of ‘the emotions’ in the early nineteenth century, many writers became concerned with the potentially involuntary nature of human feeling, and the problem of constricting emotions – and producing them on demand – has since troubled psychologists, physicians, philosophers, scientists, writers and artists alike. For topics exploring the pathologisation, regulation, manipulation and repression of emotions, see abstracts from conference papers here, and reviews of the event on the History of Emotions blog here.

This new blog joins the well-established h-madness, which some of our readers may have come across previously. This blog includes reviews of books, journals and conferences within the field of the history of psychiatry, forming a resource for scholars interested in the history of madness, mental illness and their treatment (including the history of psychiatry, psychotherapy, and clinical psychology and social work). Meanwhile, postgraduate researchers in the history of medicine recently decided to set up their own blog on the topic. A recent discussion forum indicated the strong interest in many aspects of the history of psychiatry among such researchers, with papers refuting the “no-neurosis myth” of the Second World War (the widely promoted idea that civilians did not suffer from “war neurosis”), exploring the way in which masculinity was framed in the nineteenth century asylum, and the role of the family in new schizophrenia support groups in the 1970s. The website for this group is still in progress, but Twitter users can sign up for updates by following @PGHistMed.

 
History of Emotions: “Surprise” and “Disgust” in Darwin’s The Expression of the Emotions in Man and Animals, Wellcome Library, London

Biography and its Place in the History of Psychology and Psychiatry

Biography has often been dismissed within academic circles, regarded as an unsophisticated approach to history. However, a recent one-day symposium at the UCL Centre for the History of Medicine begged to differ, and highlighted the importance of the topic in a field attempting to understand and explore the human mind. Indeed, biography can help us investigate the methods of these human sciences themselves, as Professor Daniel Todes indicated in a paper on the well-known experiments of Ivan Pavlov. For Todes, we cannot fully appreciate Pavlov’s methods in insolation from the man himself for, as Pavlov declared: “That which I see in dogs I immediately transfer to myself.”

More questions were raised by the day than answered. According to Dr Mathew Thomson, this is not an issue, but rather an important element of the biographical approach. Thomson suggested that biography is a way to challenge the very idea of a firm answer, and indicate the complexities of any historical topic. By way of example, he explored the volume of biographical essays on psychoanalyst David Eder, published after Eder’s death by a variety of contributors. What strikes Thomson is the sheer lack of biographical coherence in these essays, for, naturally, Eder meant very different things to different people. Moreover, for many of these contributors, psychoanalysis was not simply a method used by the analyst. Instead, it became regarded as something expressed in the personality and presence of the analyst himself, making biography vital to understanding its very nature.

One problem with biography, Dr Peter Hegarty suggested, is the struggle a writer has with determining what is appropriate: how should we write about other people’s lives? Such a question is many-sided, for it affects both the historian and his or her subject. Two papers approached this directly, exploring the use of biographical information in case histories, in the late nineteenth-century asylum in England and two early twentieth-century institutions for juvenile delinquency in Romania. Both indicated the way certain aspects of an individual’s history might be especially highlighted by researchers (in both history and psychiatry) in order to draw a particular conclusion. Yet, as this fascinating day constantly impressed on all who attended, many different conclusions might indeed be possible, and a psychiatric record only gives us one tiny facet of the very varied lives and experiences of individuals.

Visit the conference website, where it is hoped that abstracts of papers will soon be available.

Pavlov’s dogs with their keepers at the Physiology Department, Imperial Institute of Experimental Medicine, St Petersburg, 1904

Image courtesy of Wellcome Images

A Visit to the Science Museum Stores

The recent meeting of London’s Museums of Health and Medicine  gave some of our staff a fascinating opportunity to explore the Science Museum’s stores  in a pre-meeting tour. Housed in the former headquarters of the Post Office Savings Bank, Blythe House is a huge warren of beautifully tiled corridors, of which the basement and most of the ground floor house the history of medicine collection. Most of this enormous and fascinating assortment of objects was collected by Henry Wellcome, whose life and work is the subject of the ‘Medicine Man’ exhibition at the Wellcome Collection.

The history of medicine collection includes a remarkable array of exhibits, including two whole rooms dedicated to prosthetic limbs! The museum uses the former purpose of the building well; a secure bank vault, for example, houses the historical surgery equipment. “Everything in this room can kill you!” warned our guide, as he turned the massive wheel on the solid vault door.

Scattered throughout this vast collection are a large number of items relating to the history of psychiatry and psychology, and the Museum employs a specialist Curator of Psychology, supported by the British Psychological Society. You might remember our post earlier this year about the Psychoanalysis exhibition, which included some of these exhibits. As well as antique asylum equipment, the collection contains items relating to early psychological testing, such as IQ test puzzles, and there is a ‘Psychology Trail’ around the Museum galleries. To explore the Science Museum’s History of Psychology and Medicine collections further, click here.

Birdcage from the Sussex Lunatic Asylum: Science Museum, London