The Noonday Demon (58 page)

John Keats wrote, “I have been half in love with easeful death”—for the very exercise of life was too exquisitely painful to bear. In his paradigmatic “Ode on Melancholy” and in the “Ode on a Grecian Urn,” he speaks with unbearable sadness of a temporality which makes the most cherished thing the most sad, so that there is in the end no separation between joy and sorrow. Of melancholy itself he says:

So Shelley also conjures the mutability of experience, the quickness of time, the sense that a respite from sorrow is followed only by greater sorrow:

In Italy, Giacomo Leopardi echoed the sentiment, writing, “Fate has bequeathed unto our race / no gift except to die.” This is a far cry from the moodiness of Thomas Gray pondering beauty in a country churchyard; it is the earliest nihilism, a vision of utter futility, more like Ecclesiastes (“Vanity of vanities: all is vanity”) than like
Paradise Lost.
In Germany, the feeling would acquire a name beyond that of melancholy:
Weltschmerz,
or world-sadness. It would become a lens through which all other feeling would have to be perceived. Goethe, the greatest exponent of
Weltschmerz,
did perhaps more than any other author to delineate the stormy, tragic nature of existence. In
The Sorrows of Young Werther,
he narrates the impossibility of entry into the true sublime: “In those days I yearned in happy ignorance to get out into the unfamiliar world, where I hoped to find so much nourishment, so much enjoyment for my heart, wherewith to fill and to satisfy my aspiring, yearning bosom. Now I am returning from the wide world—O my friend, with how many disappointed hopes, with how many ruined plans? . . . Does not man lack force at the very point where he needs it most? And when he soars upward in joy, or sinks down in suffering, is he not checked in both, is he not returned again to the dull, cold sphere of awareness, just when he was longing to lose himself in the fullness of the infinite?” Depression, here, is truth. Charles Baudelaire introduced the word
spleen
and its concomitant emotion to French romanticism. His dank world of sorry evil could no more manage to transcend melancholy than could Goethe’s striving after the sublime:

Beside this poetic line runs a philosophical one that reaches back beyond Kant’s romantic rationalism, Voltaire’s optimism, and Descartes’s
relative dispassion to a fearful impotence and helplessness rooted in the character of Hamlet or even to
De Contemptu Mundi.
Hegel, in the early nineteenth century, gave us, “History is not the soil in which happiness grows. The periods of happiness in it are the blank pages of history. There are certain moments of satisfaction in the history of the world, but this satisfaction is not to be equated with happiness.” This dismissal of happiness as a natural state to which civilizations might reasonably aspire initiates modern cynicism. To our ears, it seems almost obvious, but in its time it was a heretical position of gloom: the
truth
is that we are born into misery and will miserably go on, and that those who understand misery and live intimately with it are the ones who best know history past and future. And yet glum Hegel states elsewhere that to give in to despair is to be lost.

Among philosophers, Søren Kierkegaard is depression’s poster boy. Free of Hegel’s commitment to resisting despair, Kierkegaard followed every truth to its illogical final point, striving to eschew compromise. He took curious comfort from his pain because he believed in its honesty and reality. “My sorrow is my castle,” he wrote. “In my great melancholy, I loved life, for I loved my melancholy.” It is as though Kierkegaard believed that happiness would enfeeble him. Incapable of loving the people around him, he turned to faith as an expression of something so remote as to be beyond despair. “Here I stand,” he wrote, “like an archer whose bow is stretched to the uttermost limit and who is asked to shoot at a target five paces ahead of him. This I cannot do, says the archer, but put the target two or three hundred paces further away and you will see!” While earlier philosophers and poets had spoken of the melancholic man, Kierkegaard saw mankind as melancholic. “What is rare,” he wrote, “is not that someone should be in despair; no, what is rare, the great rarity, is that one should truly not be in despair.”

Arthur Schopenhauer was an even greater pessimist than Kierkegaard because he did not believe that pain is ennobling in any way; and yet he was also an ironist and an epigrammatist for whom the continuity of life and history was more absurd than tragic. “Life is a business whose returns are far from covering the cost,” he wrote. “Let us merely look at it; this world of constantly needy creatures who continue for a time merely by devouring one another, pass their existence in anxiety and want, and often endure terrible affliction, until they fall at last into the arms of death.” The depressive, in Schopenhauer’s view, lives simply because he has a basic instinct to do so “which is first and unconditioned, the premise of all premises.” He answered Aristotle’s age-old suggestion that men of genius are melancholy by saying that a man who has any real intelligence will recognize “the wretchedness of his condition.” Like
Swift and Voltaire, Schopenhauer believed in work—not because work breeds cheer so much as because it distracts men from their essential depression. “If the world were a paradise of luxury and ease,” he wrote, “men would either die of boredom or kill themselves.” Even the bodily pleasure that should remove one from despair is only a necessary distraction introduced by nature to keep the race alive. “If children were brought into the world by an act of pure reason alone, would the human race continue to exist? Would not a man rather have so much sympathy with the coming generation as to spare it the burden of existence?”

It was Friedrich Nietzsche who actually attempted to bring these views back to the specific question of illness and insight. “I have asked myself if all the supreme values of previous philosophy, morality, and religion could not be compared to the values of the weakened, the
mentally ill,
and neurasthenics: in a milder form, they represent the same ills. Health and sickness are not essentially different, as the ancient physicians and some practitioners even today suppose. In fact, there are only differences in degree between these two kinds of existence: the exaggeration, the disproportion, the nonharmony of the normal phenomena constitute the pathological state.”

The mentally troubled and the mentally ill turned back into people in the nineteenth century. Having spent the previous hundred years like animals, they were now to be imitators of middle-class propriety—whether they wished it or not. Philippe Pinel was among the earliest reformers of treatment for the mentally ill, publishing his
Treatise
in 1806. He introduced the notion of “the moral treatment of insanity,” which, given that “the anatomy and pathology of the brain are yet involved in extreme obscurity,” seemed to him the only way forward. Pinel set up his hospital to conform to high standards. He persuaded his chief of staff to “exercise towards all that were placed under his protection, the vigilance of a kind and affectionate parent. He never lost sight of the principles of a most genuine philanthropy. He paid great attention to the diet of the house, and left no opportunity for murmur or discontent on the part of the most fastidious. He exercised a strict discipline over the conduct of the domestics, and punished, with severity, every instance of ill treatment, and every act of violence, of which they were guilty towards those whom it was merely their duty to serve.”

The chief achievement of the nineteenth century was the establishment of the asylum system for residential care of the mentally ill. Samuel Tuke, who managed one such institution, said, “In regard to melancholiacs, conversation on the subject of their despondency is found to be highly injudicious. The very opposite method is pursued. Every means
is taken to seduce the mind from its favorite but unhappy musings, by bodily exercise, walks, conversation, reading, and other innocent recreations.” The effect of this kind of program (as opposed to the punishing shackles and bizarre “taming” techniques of the previous century) was, according to the master of another asylum, that “melancholia, not deepened by the want of all ordinary consolations, loses the exaggerated character in which it was formerly beheld.”

Asylums pullulated like toadstools after a rainstorm. In 1807, 2.26 persons in every ten thousand of England’s general population were judged to be insane (a category that would have included the severely depressed); in 1844, the number was 12.66, and by 1890, it was 29.63. That there were thirteen times as many nutters in the late Victorian period as there were at the dawn of the century can be explained only in small part by the actual increase of mental illness; in fact, in the sixteen years between Parliament’s two Lunatics Acts (of 1845 and 1862), the number of identified poor mentally ill people doubled. This was occasioned in part by the increasing willingness of people to identify their relatives as crazy, in part by more rigorous standards of sanity, and in part by the depredations of Victorian industrialism. The same depressive, not sufficiently ill for Bedlam, who would once have skulked silently around the kitchen was now removed from the jolly family circle of Dickensian Britain and placed out of reach, where he did not interrupt social interaction. The asylum gave him a community in which to operate, but it also cut him off from the company of those who had any natural cause to love him. The growth of the asylum was also intimately connected to the growth in rates of “cure”—if some people’s illness could actually be ameliorated through time in an asylum, then it was very nearly a duty to place anyone who might be at the brink of a lifetime of misery somewhere where he might be saved.

The principle of the asylum was to go through a long sequence of refinements. It was already a topic of debate in parliamentary select committees in 1807. The first Lunatics Act passed by Parliament required that every county provide asylum for the poor insane, including the severely depressed; and the 1862 Act to Amend the Law Relating to Lunatics opened up the possibility of voluntary confinement, so that those experiencing symptoms might, with the approval of medical authorities, put themselves into asylums. This provision demonstrates quite clearly how far the asylum had come; you would have had to be far more than crazy to check yourself into one of the eighteenth century’s hospitals for the insane. By this time, county asylums were being run with public funds; private asylums run for profit; and registered hospitals (such as Bedlam, which in 1850 housed some four hundred patients)
for the more acutely ill supported with a mix of public funds and private charitable contributions.

The nineteenth century was a time of classifications. Everyone debated the nature of illness and its parameters, and everyone redefined what had previously been simply identified as melancholy into categories and subcategories. Great theoreticians of classification and cure succeeded one another rapidly, each determined that some minor adjustment of his predecessor’s theory would improve treatment by leaps and bounds. Thomas Beddoes wondered already in the first year of the century “whether it be not necessary either to confine insanity to one species, or to divide it into almost as many as there are cases.”

Benjamin Rush, in America, believed that all insanity was a fever that had become chronic. This condition, however, was subject to external influence. “Certain occupations predispose to madness more than others. Poets, painters, sculptors, and musicians, are most subject to it. The studies of the former exercise the imagination, and the passions.” Delusional depression was strong among Rush’s patients. One, for example, was a sea captain who believed absolutely that he had a wolf in his liver. Another believed himself to be a plant. The plant man was persuaded that he needed to be watered, and one of his friends, a bit of a prankster, took to urinating on his head, so enraging the patient as to effect a cure. Though Rush, unlike others, did not rise to Pinel’s level of sympathy for patients, he did, unlike his predecessors, believe in listening to them. “However erroneous a patient’s opinion of his case may be, his disease is a real one. It will be necessary, therefore, for a physician to listen with attention to his tedious and uninteresting details of its symptoms and causes.”

W. Griesinger, working in Germany, reached back to Hippocrates and declared once and for all that “mental diseases are brain diseases.” Though he was not able to identify the origin of these brain diseases, he firmly insisted that there was one; and that the fault in the brain should be located and then treated, either preventatively or curatively. He accepted the movement of one mental illness into another, what we might call dual diagnosis, as part of
Einheitspsychose
—the principle that all mental illness is a single disease and that once your brain goes wonky, anything can happen in it. This principle led to the acceptance of manic-depression, the understanding that patients who fluctuated between extreme states might have a single disease rather than two in fateful alternation. On the basis of this work, brain autopsies became common, especially in instances of suicide.