• Introduction
• Emblematic & Literary Figures
• Humanism & Occultism
• Melancholy & Medicine
• Melancholic Spaces

Melancholy and Medicine

Etienne Esquirol (1772-1840) studied medicine and worked with Philippe Pinel on mental alienation. He soon became famous for his private asylum, created in 1801, and for the publication of his thesis, Des passions considérées comme causes, symptômes et moyens curatifs de l'aliénation mentale (The consideration of passions as causes, symptoms and means of cure in cases of insanity). Esquirol believed that mental disorders resulted from unbalanced passions, and he urged the government to create appropriate structures for the curing of the mentally ill. He published Des maladies mentales (Mental Maladies) in 1838, only two years before his death. In that treatise, Esquirol tries to classify different types of mental disorders. Chapter VIII is entitled “De la lypémanie ou mélancolie,” and tries to rephrase and to medicalize the concept of melancholy. Esquirol replaces “melancholy” with a term that will shape mental alienations studies for a long time: monomania. Esquirol creates the term lypemania to signify a type of depressive monomania. Lypemania is hereditary, and affects subjects with “un tempérament mélancolique.” Ancient characteristics of melancholy have not totally disapeared from Esquirol’s treatise, since the physical characteristics of the lypémaniaque resemble those of the ancient melancholic.

Les auteurs, depuis Hyppocrate, donnent le nom de mélancolie au délire caractérisé par la morosité, la crainte et la tristesse prolongées. Le nom de mélancolie a été imposé à cette espèce de folie parce que, selon Galien, les affections morales tristes dépendent d’une dépravation de la bile. (…) Il est certain que le mot mélancolie, même dans l’acception des anciens, offre souvent à l’esprit une idée fausse, car la mélancolie ne dépend pas toujours de la bile. Cette nomination ne saurait convenir à la mélancolie, telle que la définissent les modernes. Cette double considération m’a fait poser le mot monomanie formé de seul et de manie, terme qui exprime le caractère essentiel de cette espèce de folie dans laquelle le délire est partiel, permanent, gai ou triste. Le mot mélancolie… doit être laissé aux moralistes et aux poètes.
— Des maladies mentales considérées sous les rapports médicale, hygiénique et médico-légal,
Vol.1, chapter VIII.

In chapter XII of Des maladies mentales considérées sous les rapports médicale, hygiénique et médico-légal, Esquirol treats the problem of mania in general. He dissociates “les manies” from monomania and lypemania: the latter display “un délire triste ou gai, … partiel et circonscrit dans un petit nombre d’idées et d’affections.” Manias in general influence not only "les affections," that is, emotions, but also the intelligence of the patient. Esquirol uses the illustration on plate X to describe the physical manifestations of mania, and on the next page, on plate XI, he compares it to the same subject when the crisis is over.

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In this article Connolly continues his investigation of melancholy. He writes here a case study about a patient who was affected, as he calls it, of “religious melancholia”: this woman, he says, was convinced that “her faults were unpardonable.” He claims that the chaplain and the religious instances failed to help her (Connolly later blames the “frantic preachers” for the aggravation of such states of “morbid melancholy”). But physicians seem themselves quite powerless in front of the problem. The patient eventually recovers as the summer draws in, and “her melancholy thoughts, fixed on the self, eventually disappeared.” In this instance, both priests and doctors remained helpless, which suggests a feeling of powerlessness on their part as they are confronted with patients who suffer from melancholy, a feeling which in turn may be somewhat similar to the discouragement at the infinity of the world and at the limits of human knowledge expressed in Dürer’s Melencolia I.

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Darwin published The Expression of the Emotions in Man and Animals thirteen years after The Origins of Species. His aim here is to study the involuntary signs of emotions (such as anger, fear, or grief) in human beings and in animals. The volume starts with muscular and biological considerations that apply to both human beings and animals. Darwin goes on to study animals’ expressions of emotions, as can be seen on these two images of dogs. Dogs and cats, being domestic animals, are the principal subjects of his investigation, but later on in the book Darwin also writes about monkeys.

The expression of grief shown here (plate II p. 181) has a tremendous importance for Darwin’s theory: his argument is that such expressions of suffering (sadness, grief, melancholy) are human versions of an anterior animalistic cry that has evolved across the ages. The baby’s screams are similar to that anterior state. In adults, signs of melancholy are not to be found in such screams, but in “oblique eyebrows” and “depressed corners of the mouth.”

We can understand how it is, that as soon as some melancholy state passes through the brain, there occurs a just perceptible drawing down of the corners of the mouth, or a slight raising up of the inner ends of the eyebrows, or both movements combined, and immediately afterwards a slight suffusion of tears. (…) The above actions may be considered as vestiges of the screaming fits, which are so frequent and prolonged during infancy.
— Darwin, Charles, 1809-1882. The expression of the emotions in man and animals ; with photographic and other illustrations. London: John Murray, 1872

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Jean-Martin Charcot (1825-1893) was a French neurologist. He worked for most of his life in the Salpêtrière in Paris, attracting students from all over Europe to his lectures (among them were Pierre Janet and Sigmund Freud). Charcot was particularly interested in hysteria: he believed that hysteria was the product of a hereditary weak neurological system, which could be triggered by a trauma. He was convinced that hysteria was a neurological and biological sickness, and he tried to cure it through the use of hypnosis. One illustration from vol. 1 shows one of the many sections of the brain found in Charcot’s Diseases of the Nervous System. The two sketches (one of which was drawn by Charcot) that illustrate hysterical patients at the time of their attacks, are in vol. 2. Charcot is dealing with the same problem as the one posed by melancholy: even though he was convinced that hysteria and mental illnesses in general were of a neurological nature (biological cause), he was puzzled at the fact that they seem to emerge in conjunction with a trauma (psychological cause).