Doctor's Review: Medicine on the Move

October 22, 2017
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Body and soul

Robert Burton discussed depression in a whole new way... back in 1621

Depression is arguably the mental bane of modern times and, as such, is also the bread and butter of the myriad minds who try to treat it. From psychiatrists and psychologists to captains of industry and pharmacy, no other mental condition means so much to so many. And while this dark disorder is as misunderstood as it is widespread, it might also be seen as a symptom of society’s sickness at large: the effect of changing times, changing mores and changing medicine.

In the 17th century, the world was similarly in flux and one very great, very depressed scholar set out to explore all the mysteries of melancholia, a condition he saw exploding around him. The Anatomy of Melancholy by Robert Burton is the book our own Sir William Osler referred to as “the greatest medical treatise written by a layman.” And, while it may have been penned nearly four centuries ago, it remains a modern marvel and literary masterpiece unto itself.

The golden compilation

“The Golden Compilation,” as Osler called it, was the life’s work of a very curious clergyman. Robert Burton was born into a well-to-do family in Leicestershire, England, on February 8, 1577. Not much is known about his early years, but it seems that his rise to melancholy-fueled superstardom began at Oxford, the venerable institution where he would spend virtually all his years as a divinity scholar. He started at Brasenose College at 17 and in 1599 was accepted to Christ Church.

There, he became librarian and vicar, positions he held for the rest of this life. The first edition of The Anatomy of Melancholy was published in 1621. As the near-obsessive subject of his life’s work, Burton revised each of the subsequent six editions substantially, the final version being published posthumously in 1651.

From page one, it was obvious that this was a book like no other. First, Burton employed as narrator a sort of fictitious alter ego in the form of a contemporary Hippocrates, a depressed yet brilliant philosopher named Democritus Junior, perhaps with the intent to distance himself from the subject. It is with a classical zeal that he then tackles depression, or melancholia as it was then known. A good place to start since it was Hippocrates who first simply, but accurately, characterized depression as “fear and dependencies, if they last a long time.”

A hint at the author’s verbosity is suggested in the tome’s complete title: The Anatomy of Melancholy: what it is, with all the kinds, causes, symptoms, prognostics, and several cures of it. In three partitions, with their several sections, numbers, and subsections. Philosophically, medicinally, historically, opened and cut up. The reader’s suspicion is confirmed a thousand pages later.

To be fair, it is a subject that merits detailed consideration, though the book’s length also points to the author’s own motives since he believed that keeping bust was one of the best treatments for depression, even admitting that “I write of melancholy by being busy to avoid melancholy.” Burton must have been a profoundly depressed person indeed, for he devoted his entire life to revising it, rewriting it and generally pondering over his chef d’oeuvre.

Sense of humours

By the Middle Ages, the theory of the four humours still held sway in treating every medical problem and it’s through this lens that Burton perceived depression. While Burton believed that melancholia’s physical origins lay in a buildup of black bile, what makes his work unique and prescient is that he viewed the disorder holistically. Melancholia, then, was not so much a religious or humoral problem nor a temperamental one, but rather a medical and philosophical one... an approach foreshadowing the psychoanalysts that would come so many centuries later.

Depression, he believed, was a sickness of both body and mind, and no one solution would be enough to understand or cure it; melancholy was, and is, one extremely complicated condition.

Although The Anatomy of Melancholy deals head-on with depression, it must also be seen as a compendium of 17th-century life. Burton delves into virtually every aspect of the human experience in his examination of the subject, touching on biology, literature, philosophy, theology, spirituality and a great many medical disciplines including anatomy, physiology and neurology.

As such, it is a window into the post-Reformation European world of the time, when the power of the church was slipping into the hands of the monarchies, when science and learning were poised to replace religion and superstition as the driving force in all things.

Symptoms and solutions

The book itself is comprised of three parts. The first examines the causes and symptoms of melancholy; the second, the treatments and cures; the third, the religious and love-induced forms. In today’s terms, melancholia would be practically synonymous with clinical depression, and it is most significant that Burton viewed it as such: a disease, rather than a temperament, that presented itself in ways ranging from moodiness to madness and one with a specific set of causes, symptoms and cures.

Indeed, there was something for everyone in this weighty endeavour. Anyone who found him or herself down in the dumps surely could have identified with the depressive condition for, as Burton almost lovingly put it, “The Tower of Babel never yielded such confusion of tongues as the Chaos of Melancholy doth of Symptoms.” Among its causes, he identified — in addition to a surplus of black bile — too much or too little food, sleep, sex and exercise.

As for the cures, in a book this big he was bound to hit some nails on the head. Simply stating the known facts at the time, he summarized an enormous selection of the available treatments for depression, including, but not limited to, prayer, bloodletting, medicines and tinctures, trepanning, witchcraft, talismans and cannabis. Burton, however, named one favourite: “In my judgement, none so present, none so powerful, none so apposite as a cup of strong drink, mirth, music and merry company.”

A good laugh

Overall, Burton employed a no-nonsense approach to treating his own depression and logically advised his readers to actively and regularly seek out laughter whenever possible. When he was feeling sad, he himself liked to go down to the docks and listen to the working men swear and insult each other, something that never failed to amuse him. His sense of humour informs the entire book as well and he manages to mix the serious with the silly in a way to perhaps lighten this very difficult topic. When he recommends, for example, that depressed individuals consider wearing a ring carved from the forefoot of a donkey, he surely intends to elicit a laugh.

The Anatomy of Melancholy was widely heralded upon its publication, if not yet as one of the greatest works of non-fiction ever written. Despite the fact that it is dense, obscure and nearly unreadable in passages, it was instantly beloved by some of the greatest minds of the time. It is a work of great humour, satire, wit and wisdom, carefully considering the condition of melancholy within the greater framework of history, human nature and science... a sort of perfect expression of the best in Classical Greek and Renaissance thought.

Centuries later, it continued to exert profound influence over those who read it. Among its fans were 18th-century poet and essayist Charles Lamb as well some of the most depressed Romantics, including Samuel Coleridge, John Keats and Lord Byron. The Anatomy of Melancholy’s biggest supporter by far, however, was Samuel Johnson. Of it, he famously stated that it was “the only book that ever took him out of bed two hours sooner than he wished to rise.” Indeed, its clever turns of phrase, surprising flights of fancy, good-natured sarcasm, brilliant analyses and profoundly insightful passages mark it as one of the greatest books ever written.

Self-fulfilling prophecy?

Burton died on January 25, 1640. He was 63, the exact age at which he had predicted he would meet his end courtesy of a complex series of mathematical horoscope calculations embarked on several years prior. The cause of his demise remains somewhat of a mystery; at the time some believed the moody auteur hung himself to avert the humiliation of being wrong about his death date. He had also somewhat suspiciously championed forgiveness of suicide in The Anatomy of Melancholy, on the grounds that these poor souls were too sick to know what they were doing.

But Burton was first a deeply religious man and no one was certain for sure. He was permitted to be buried in consecrated ground, beneath the north aisle of his beloved Christ Church Cathedral. Not surprisingly, this man of many words had earlier authored his own epitaph, carved into a stone memorial topped by a bust of his head: “Known by few, unknown to even fewer — he lies Democritus Junior, to whom melancholy gave life and death.”

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