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New book: From Melancholia to Prozac by Clark Lawlor
Kes: while the reviewer concludes that some parts of this book are rather cursory, this styill sounds fascinating enough that I am going to add it to my reading list.
full review at
http://www.guardian.co.uk/books/2012/mar/02/from-melancholia-to-prozac-review
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Our understanding of misery has changed less than we think
In the middle of the 12th century Hildegard of Bingen explained the aetiology of melancholia. The clue was in the name. Black bile, too much of it: "It causes the veins in the heart to overflow; it causes depression and doubt in every consolation so that the person can find no joy in heavenly life and no consolation in his earthly existence." It was the result of an imbalance of the four humours that circulate in the body. A physician as well as a nun and composer, she is very specific about the biology and anatomy of the humours: "Each of the dominating humours is covered with a quarter of the one coming after and a half of the third. The weaker humour regulates the two parts and the remaining part of the third, to make sure it doesn't exceed its limits."
Today, we believe we know better. Depression is largely considered to be an imbalance of the neurochemistry in the brain, and is treated accordingly. Clark Lawlor explains the contemporary view: "An early model was norepinephrine, one of the amine family …too little meant depression, too much meant elation. Serotonin deficiency is possibly the most well-known of the contenders for causing depression." Selective serotonin reuptake inhibitors (SSRIs such as Prozac) increase the amount of serotonin in the brain, and are now the most widely prescribed response to a modern diagnosis of depression and even the newer, milder condition of dysthymia – chronic low mood and sadness, perhaps equally well described as "melancholia".
People on SSRIs often feel better. Which is odd, because the number of people whose mood is improved is only very slightly above that of control groups taking placebos, and some drugs that actually reduce serotonin levels are statistically as effective as antidepressants which increase those levels.
The fact is that, as a non-neurologist and non-biochemist, I have no more real understanding about the functioning of genes, the resulting brain chemistry and the effect on mood than Hildegard of Bingen had about the proportion and action of the humours on the veins in the heart. It seems, too, that psychiatrists aren't entirely sure about the chemical mechanisms of depression. Even so, I pop a prophylactic Prozac every morning, because if I don't think too hard about what I don't know, like the early moderns, the notion of chemical imbalance makes some sense to me (in conjunction with other causes) of my life-long tendency to sink into debilitating depression.
Lawlor's history of the journey from Aristotle and Galen on melancholia, to Aaron Beck's and Martin Seligman's cognitive behavioural approach to depression is notably not a story of progress and increased understanding, but of changes in culture, language and technology about a particular common human condition. It is most valuable as a history of thought about the varying degrees of sadness and despair that have been consistently experienced from antiquity to the present day. Timothie Bright's 1613 description of the effect of excessive black bile – "which shut up the hart as it were in a dungeon of obscurity, causeth manie fearfull fancies … whereby we are in heaviness, sit comfortless, feare distrust, doubt dispaire, and lament, when no cause requireth it" – is as good a picture of depression as I know it as any I've heard or read.
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full review at
http://www.guardian.co.uk/books/2012/mar/02/from-melancholia-to-prozac-review
block quote start
Our understanding of misery has changed less than we think
In the middle of the 12th century Hildegard of Bingen explained the aetiology of melancholia. The clue was in the name. Black bile, too much of it: "It causes the veins in the heart to overflow; it causes depression and doubt in every consolation so that the person can find no joy in heavenly life and no consolation in his earthly existence." It was the result of an imbalance of the four humours that circulate in the body. A physician as well as a nun and composer, she is very specific about the biology and anatomy of the humours: "Each of the dominating humours is covered with a quarter of the one coming after and a half of the third. The weaker humour regulates the two parts and the remaining part of the third, to make sure it doesn't exceed its limits."
Today, we believe we know better. Depression is largely considered to be an imbalance of the neurochemistry in the brain, and is treated accordingly. Clark Lawlor explains the contemporary view: "An early model was norepinephrine, one of the amine family …too little meant depression, too much meant elation. Serotonin deficiency is possibly the most well-known of the contenders for causing depression." Selective serotonin reuptake inhibitors (SSRIs such as Prozac) increase the amount of serotonin in the brain, and are now the most widely prescribed response to a modern diagnosis of depression and even the newer, milder condition of dysthymia – chronic low mood and sadness, perhaps equally well described as "melancholia".
People on SSRIs often feel better. Which is odd, because the number of people whose mood is improved is only very slightly above that of control groups taking placebos, and some drugs that actually reduce serotonin levels are statistically as effective as antidepressants which increase those levels.
The fact is that, as a non-neurologist and non-biochemist, I have no more real understanding about the functioning of genes, the resulting brain chemistry and the effect on mood than Hildegard of Bingen had about the proportion and action of the humours on the veins in the heart. It seems, too, that psychiatrists aren't entirely sure about the chemical mechanisms of depression. Even so, I pop a prophylactic Prozac every morning, because if I don't think too hard about what I don't know, like the early moderns, the notion of chemical imbalance makes some sense to me (in conjunction with other causes) of my life-long tendency to sink into debilitating depression.
Lawlor's history of the journey from Aristotle and Galen on melancholia, to Aaron Beck's and Martin Seligman's cognitive behavioural approach to depression is notably not a story of progress and increased understanding, but of changes in culture, language and technology about a particular common human condition. It is most valuable as a history of thought about the varying degrees of sadness and despair that have been consistently experienced from antiquity to the present day. Timothie Bright's 1613 description of the effect of excessive black bile – "which shut up the hart as it were in a dungeon of obscurity, causeth manie fearfull fancies … whereby we are in heaviness, sit comfortless, feare distrust, doubt dispaire, and lament, when no cause requireth it" – is as good a picture of depression as I know it as any I've heard or read.
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