Some Thoughts on Psychiatric Medication and the Place of the Humanities

Robert Burton’s Anatomy of Melancholy opens with an apocryphal tale of the ancient philosopher Democritus:

Hippocrates relates at large in his Epistle to Damegetus, wherein he doth express, how coming to visit him one day, he found Democritus in his garden at Abdera, in the suburbs, under a shady bower, with a book on his knees, busy at his study, sometimes writing, sometimes walking. The subject of his book was melancholy and madness; about him lay the carcases of many several beasts, newly by him cut up and anatomised; not that he did contemn God’s creatures, as he told Hippocrates, but to find out the seat of this atra bilis, or melancholy, whence it proceeds, and how it was engendered in men’s bodies, to the intent he might better cure it in himself, and by his writings and observation teach others how to prevent and avoid it.

I begin with this strange episode—the “anatomy” which provides Burton’s text with its title—as it elegantly illustrates the perspective I’d like to consider here: that mental illness is a product of physiological forces and may be treated through the same means that one might use to treat an infection or a fever. This perspective is widespread, even axiomatic, in our own time.

As you are all certainly aware, our centre has recently been criticized in the political arena. Liberal MP Andrew Robb singled out our work as an example of “questionable” research, arguing that the ARC should focus on supporting research that will produce “genuine medical and scientific advances” (The Australian 8 Nov 2012). Robb’s indictment is representative of a widespread belief in the efficacy and pragmatic value of the empirical sciences, compared to which humanistic inquiry appears impractical, insular, and increasingly obsolete. Questions of emotion, according to this school of thought, should be left to those working in science and medicine who can produce sound, empirically verifiable knowledge about mental illness and other psychological phenomena.

Among the strongest arguments for this position is the recent success of pharmacology in the treatment of mental illness. Over the last few decades, anti-depressant and anti-anxiety medications have become ubiquitous in psychiatric treatment. Though their rise has attracted various controversies, their efficacy is attested by patients and practitioners alike, and their use, having outstripped traditional talk therapies, shows no sign of abating. The ascendance of pharmacological treatments for depression would appear to fulfil that desire attributed to Democritus in Burton’s tale for a cure for melancholy: an effective medical means for countering the harmful and often ruinous effects of mental illness. And it would also seem to confirm something like Democritus’s belief that melancholy is atra bilis, black bile, a fluid in the body: since the rise of anti-depressants, the belief that depression is caused by a chemical imbalance in the brain has become orthodox in medicine and psychiatry.

A recent essay in Salon magazine by the writer Diana Spechler on her experience with an anti-anxiety medication (available at http://www.salon.com/2012/07/28/my_klonopin_fog) provides some useful perspective on this topic. Spechler suffered for years from severe insomnia, a condition that greatly disrupted her life and work. As the years passed, her sleeplessness worsened, and her nights witnessed bouts of panic and terror: “I’d snap awake gasping. My heart would thrash in my ears. In the dark, I would conjure thoughts of death — my loved ones dying, nuclear war, biblical plagues, my own demise.” Her condition seemed to defy all explanation and to resist all conventional remedy. When it finally became intolerable, she asked her therapist to recommend a psychiatrist and began taking medication for anxiety.

Spechler reports that her condition improved almost immediately upon taking the medication. The sleeplessness that had plagued her for years relented, and she was freed from her former spasms of panic and anxiety. She felt relaxed, tranquil, like a “normal” person. The change in Spechler’s condition seems to represent the fulfilment of the desire for a “cure” for melancholy expressed in Burton, and to provide strong evidence that the maladies of the mind are as treatable as the ills of the body. Taking the case into account, it is hard to not to cede ultimate authority in matters of the mind to modern medicine and empirical science, whose endeavours in other areas have yielded such miraculous success. What is the place of the humanities, whose methods are so often unsure and whose answers so often tentative, in addressing such pressing problems? Should not questions of mental health simply be submitted to the regime of medical science in the hopes that the scourge of depression and anxiety might be treated with the same success as polio in the mid-twentieth century?

But Spechler’s further experience with the drug shows that the matter is not so simple. The effects the medication were not limited to restfulness and tranquillity. In addition to her improved sleep, she experienced other changes in her behaviour and state of mind: “I found my range of emotions narrowed, my reactions uncharacteristically mild.” Most troubling was an inability to write: “every morning, I sat down to work and stared at the blank screen, the cursor blinking in time with the dull rhythm of my heart… My emotions dulled, I had nothing to say.” Freed from the “mind-forged manacles” of irrational anxiety and fear, she also found herself without the inspiration to pursue her craft. Her sleeplessness, it seemed, was deeply enmeshed with the passions, cares, doubts, and fears that drove her literary output: she could not suppress one without also suppressing the other.

The dual effect of the medication—allaying her anxiety, but also inhibiting her desire to write—suggests that her condition was a more complex phenomenon than we might at first have imagined. It wasn’t simply that a material thing called “anxiety” that resided in her brain had been treated like a virus, restoring her to an ideal wholeness or health. Instead, her behaviour and sensibility had been subtly altered in such a way as to change the path that she had set for herself. Under the effects of the medication, she felt like a different person: “So this was what it was like not to be a writer.” The medication had impacted not only her health, but her way of life, her professional position, her means of self-recognition. She could never be entirely free from her anxiety, if that freedom required that she relinquish the passions and ambitions that had come to constitute her identity. Anxiety was thus not simply an illness to be cured, but a way of being that extended over time and across the events and interactions that comprised her life’s history.

Certainly her physiology played an important role in this situation, but the configurations of behaviour and experience that arose from it cannot be considered “material” in the reductive sense. By this I do not mean to posit some ghostly essence beyond the scope of science. I mean simply to suggest that mental states such as anxiety involve behaviours and interactions that can only manifest themselves in the broad realm of lived experience, a realm inherently resistant to the reduction and mathematization demanded by empirical inquiry. Spechler’s condition was not simply a matter of illness and health. As a central component of her way of life, one which had helped her to establish a career and forge an identity, Spechler’s anxiety had a history. As historians and critics, we are ideally positioned to assess this broader historical dimension of emotion, which falls outside of the purview of empirical study.

I’ll conclude by turning back to Burton. The anecdote of Democritus does not represent the extent of Burton’s perspective on melancholy: throughout the Anatomy, the conception of melancholy careers from something so gross that it might be extracted from the brain via surgery to something infinitely fine and subtle, something that colours and conditions every aspect of one’s way of being. In the dialogic poem that opens the text, Burton both bemoans and celebrates his own melancholy, vacillating between lament and exaltation:

When I go musing all alone

Thinking of divers things fore-known,

When I build castles in the air,

Void of sorrow and void of fear,

Pleasing myself with phantasms sweet,

Methinks the time runs very fleet.

All my joys to this are folly,

Naught so sweet as melancholy.

When I lie waking all alone,

Recounting what I have ill done,

My thoughts on me then tyrannise,

Fear and sorrow me surprise,

Whether I tarry still or go,

Methinks the time moves very slow.

All my griefs to this are jolly,

Naught so mad as melancholy.

As we can see from the poem, Burton attributes his imaginative capacities and his restive, anxious affliction to the same source. Like Spechler’s anxiety, Burton’s melancholy is inseparable from his pleasures, his work, and his identity. Burton famously claims that he writes of melancholy in order it cure it in himself. Writing is thus a form of therapy for melancholy and also the fulfilment of melancholy, the inevitable document of a condition that produces both terrible distress and joyful inspiration.

Posted by Ross Knecht