Clark Lawlor, From Melancholia to Prozac: A History of Depression

Clark Lawlor, From Melancholia to Prozac: A History of Depression (Oxford: Oxford University Press, 2012). 288 pages. £14.99. ISBN 978-0-19-958579-3.

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What’s in a word? In his celebrated Darkness Visible: A Memoir of Madness, William Styron protests most vehemently against the vocabulary of twentieth-century psychiatry. For the last eighty years, he writes, the word ‘depression’ ‘has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its insipidity, a general awareness of the horrible intensity of the disease when out of control.’ ‘Depression,’ for Styron, lacks the ‘magisterial presence’ of the centuries-old melancholia, and its banality and atonality are at odds with ‘the blacker forms of the disorder.’

Are ‘melancholia’ and ‘depression’ historically and culturally specific names for the same experience or set of experiences? Is a history of depression from antiquity to the present day the history of an idea, a signifier, a type of person, a disorder of mood, a disease? What would count as evidence in the writing of such a history, and why?

Bracketing these questions, Clark Lawlor’s From Melancholia to Prozac: A History of Depression opens instead with the captivating case study of Samuel Johnson. While it is no secret that this intellectual giant of the eighteenth century suffered from severe bouts of what Boswell called ‘hyochondriack disorder,’ Johnson is a refreshingly original choice from the ever-increasing list of prominent persons known to have suffered from ‘morbid temperament.’ Lawlor’s prologue sparkles with insights into Dr Johnson’s melancholy. Exploring the connections between Johnson’s psychic and physical suffering, his literary endeavours and life experiences, relationships and religious convictions, Lawlor highlights the different forms taken by the black dog over the course of Johnson’s life and the various ways he sought relief. We hear from Boswell and subsequent biographers, naturally, but also from Johnson himself, through letters, diaries, prayers, and novels, and even see a physiognomic portrait of his downcast melancholic expression. This close textual engagement with a range of primary sources and with scholarly interpretations of Johnson’s experiences shows Lawlor in his element as an expert in eighteenth-century literature.

From Melancholia to Prozac: A History of Depression emerged from the impressive Leverhulme Trust-funded project Before Depression, which Lawlor co-directed with Allan Ingram, Stuart Sim and Richard Terry. In contrast to the project’s more specialist academic publications, this book is aimed, according to the publishers, at ‘readers of popular science and those interested in the history of medicine and depression.’ Starting with Homer’s Illiad and ending somewhere after Elizabeth Wurtzel’s Prozac Nation, the book’s 202 substantive pages span three millennia of European writing on what has variously been understood as a humoral imbalance, nervous complaint, psychological response to loss, biological disease, and much else besides. ‘By examining the history of melancholia and depression,’ Lawlor writes, ‘we can see that the depressed patient is not reducible to a biochemically deficient machine, but an individual embedded in a complex social environment.’ Few people may be familiar with all the works covered in From Melancholia to Prozac, but fewer still will fail to grasp its central argument.

The magnitude and complexity of Lawlor’s undertaking is daunting. However, the announcement mid-way through the chapter on ‘Victorians, Melancholia, and Neurasthenia’ that ‘we will shuttle between different nations and cultures as we trace the often uneven development of ideas about melancholia and related depressive states through the century’ points towards a confusion or perhaps uncertainty about what exactly is being studied and why. At times the book feels dutiful, as in its cataloguing of competing nineteenth- and twentieth-century medical definitions of depression; at other times it is rather cursory. Romanticism, surely the period most strongly associated with the virtues of a melancholic disposition, is given only two pages. Hamlet and Samuel Beckett are offered as exemplary melancholics, but with none of the close-reading, subtlety or scholarly flair that brought the case study of Johnson to life. Somewhere along the way, we lose access to the first-person perspective and with it a sense of why this project is such an important one. Questions concerning the relationship between experience and representation are dealt with obliquely if at all, and the issue of how ‘melancholia’ and ‘depression’ fit within broader conceptions of ‘madness’ is not thoroughly investigated.

Except for a brief discussion of cross-cultural psychiatry, there is little explicit engagement with fundamental conceptual, philosophical and historiographic questions about the universality, or not, of ‘depressive experience’. Referring to medical anthropologist Arthur Kleinman’s famous study of depression in China, a study which still informs debates about ‘somatised’ or ‘masked’ depression, Lawlor writes:

The difficulty for Kleinman and others of this postmodern and culture-bound perspective is that it now becomes unclear in what sense depression can meaningfully be said to exist at all. How can lower back pain be equated with sadness? Where is the common pathology? Kleinman is equivocal on the issue because he persists in referring to a phenomenon called ‘depression’ that is experienced across cultures and even historical eras, even if it might be differently expressed.

Lawlor is right to highlight this tension in Kleinman’s work, but he does not recognise in it an invitation to reflect upon his own endeavour. Are there more or less accurate ways of understanding and representing depression and if so, by which criteria should they be judged? From Melancholia to Prozac declines to answer such questions directly, and so falls between the gaps of, on the one hand, more focussed and theoretically ambitious histories of madness (such as Klibansky, Panofsky, & Saxl’s Saturn and Melancholy: Studies in the History of National Philosophy, Religion and Art; or more recently Metzl’s Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs and Ehrenberg’s The Weariness of the Self) and, on the other, more ‘popular’ and polemic works which aim to shape contemporary debates about mental health and illness (think Greenberg’s, Manufacturing Depression: The Secret History of a Modern Disease or Horowitz and Wakefield’s The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder). As someone located in the interdisciplinary field of medical humanities, I have great admiration for work which traverses disciplinary and discursive boundaries in order to unpack the complex histories of (medical) ideas. From Melancholia to Prozac, however, subordinates the literary scholar’s attention to textual and philosophical detail – analytic virtues so artfully put to use in the prologue – to the less lively task of surveying three thousand years of thinking and writing about depression in Europe and America. This book offers an accessible introduction to the ways in which melancholy and depression have been made sense of over the centuries, particularly through its helpful suggestions for further reading. But I suspect that what might linger longest with its academic readers are not the summaries and overviews of major works, but vivid descriptions of despair, such as penned by Johnson after completion of the Dictionary:

My task perform’d, and all my labours o’er,
For me what lot has Fortune now in store?
The listless will succeeds, that worst disease,
The rack of indolence, the sluggish ease.
Care grows on care, and o’er my aching brain
Black melancholy pours her morbid train.

Angela Woods, Durham University