‘Disagreeing Likeness’
Depression’s contemporary contexts and paradigms
‘There is in all melancholy a ‘similitudo dissimilis’, like mens’ faces, a disagreeing likeness…’. Robert Burton, The Anatomy of Melancholy. 1621
It is one thing to survey the cultural, religious, psychological and medical
dimensions of depressive illness to which Luther’s consolation was responding, but quite another to understand the complex facets of depression in today’s global
context. It is rightly observed by many that these are two different worlds, and yet
as they are placed side by side, it becomes clear that they are not ‘worlds apart’.
The experiences of depressive illness, as described by depressive melancholics in previous eras, including Luther’s, are strikingly like those recounted by depression suffers today.
Likewise, today’s remedies and responses in many ways parallel those of earlier
ages. Medicine, naturopathy, psychology, Christian and other spiritualities are all brought to bear as interventions for depression today, just a Constantinus
Africanus, Galen, Paracelsus, Gerson and Luther applied them in their ancient, medieval and renaissance societies.
As observed in our historical exploration of depressive melancholia, depressive illness is today characterised by its presence right across the cultural, literary, religious, scientific and socio-economic strata of society. Despite modern advances in medical and psychological treatments, it continues to be a common feature of human experience; quite recognisable across various communities and eras, yet
notoriously ‘changeling’ in the forms of its presentation.
A Widening Discussion
Shifting Paradigms
Since the major shift that took place during the nineteenth century, from a wider and more culturally integrated view of melancholia to the dominant medical-
scientific construction of depression that held sway through the twentieth century, there has been still another movement in the way western communities are
understanding and responding to depressive illness in these post-modern times. While medical and psychological approaches are still highly significant, there is a widening discussion taking place which shows a shift away from the dualism, rationalism and empiricism of the past century, and a greater openness towards human narrative, affect, experience and spirituality. This discussion is happening among people who suffer from the illness and among those who live with and care for them. People from many different helping backgrounds are taking part,
representing various types of therapies and interventions, and those who are interested in pastoral care and spirituality of various kinds.
This discussion is a healthy and promising development which is happening in many different sections of the community. It is going on at the level of scholarly debate through books and journal articles, conferences and forums of various kinds.
Popular news media and magazines carry depression news and stories consistently. Through online blogs, forums and chat lines, depression sufferers themselves share their situations with each other, making personal connections and discussing issues of mutual interest such as the effectiveness of different medications, helpful strategies for coping, perspectives on suffering, spirituality and relationships.
This broader discussion is reflected in the Australian community through the
beyondblue materials on depression and anxiety. Through its comprehensive program, this national depression initiative continues to have a significant impact on the depression awareness of Australians. It has improved both the level of understanding about the illness itself, and the level of help-seeking by people who are experiencing symptoms.
Beyondblue has responded to this widening conversation and growing diversity by providing accurate and helpful information from as many different viewpoints, on as many different ‘complementary and lifestyle interventions’ for depression as possible. Its resource bank includes not only the various medical and psychological interventions, but also approaches that have usually been considered ‘alternative’, such as aromatherapy, music therapy, meditation, massage and prayer.
On the wider scene, natural therapies like herbalism and homeopathy, together with simple lifestyle issues like sleep , exercise, diet and nutrition, family
relationships, sex and finance are all now part of the discussion. Australian radio personality, Tamra Mercieca 1 is an example of how depression sufferers are
seeking a broader approach to the illness, and are prepared to try different things and open themselves to a wide range of options.
In conversations with depression sufferers it becomes clear that people often have begun to research, explore and reflect on what is happening in the whole of their lives, and on how they are living them. This reflection may cover medical care and drug treatment, but takes in a wider range of issues too, including habits, routines and influences that affect daily wellbeing on the physical, emotional, relational and spiritual levels.
Feminist Perspectives
Within the wider discussion, feminist perspectives are important for understanding the significant gender issues around depressive illness in western culture today. Recent feminist scholarship of various types has shown something crucially important in this respect: that, at many different levels, the issues involved in depressive illness for women are markedly different to those of men and require different approaches to treatment.2
The evolution of feminist thought from the 1960s and 1970s has moved the discussion of depression among women on from issues of career and equal opportunity toward the deeper and more complex issues of cultural and familial roles, unearthing some of the deep social structures which affect depression as suffered by women.3
Depression has often been described in feminist writing as a ‘gendered problem’, since statistically it has always affected more women than men. It is this issue more than any other that has (directly and indirectly) occupied feminist thought and
1 Tamra Mercieca, The Upside of Down.
2Kira Cochrane, ‘Why Do So Many Women Have Depression?’ The Guardian, April 29, 2010, accessed August
2013, http://www.theguardian.com/society/2010/apr/29/women-depression-allison-pearson.
3 Janet M. Stoppard, Understanding Depression: Feminist Social Constructionist Approaches (London: Routledge,
writing on depression. Many theories have been put forward to explain the disparity, but there does not seem to be any strong consensus about its cause.
Previous eras took the higher rate of depressive illness among women to mean that women were psychologically weaker than men and therefore more prone to mental defects. Renaissance melancholy is depicted in art as a bored, distracted and
indolent woman.4 Nineteenth century Victorian society saw women as inherently
unreliable and prone to hysteria due to the mood fluctuations associated with their menstrual cycle. Female expressions of rebellion against the social order or
assertions of personal freedom were viewed as madness. Most of the psychiatric photographic studies and drawings of melancholics from the period seem to be of women subjects. These stereotypes continued to be powerful for a long time, well into the 1960s, and were perpetuated by psychiatric practice. Valium (Diazepam), a new drug on the scene around this time, was prescribed to women so frequently
that it became known as ‘mother’s little helper’, after the song by the Rolling Stones.5
It is not surprising, then, that early feminists were quick to denounce such
stereotypes and to criticise the psychiatric profession of the time. Jean Baker Miller, a psychoanalyst, psychiatrist, and exponent of cultural feminism, claimed that widespread depressive illness among women was caused by a loss of cultural roles. Responding to the demands of society by conforming to gendered social roles, women mourned the loss of needed freedom and identity. In Miller’s view, the oppressive affiliations and loyalties that depress women grew out of patriarchal male expectations.6
While a higher rate of melancholia and depression among women has been documented over many centuries, the relative rate of depression among women continues to rise steeply today, which has drawn some to wonder whether the feminist movement has not, in recent decades, made things worse rather than
4 The famous examples are the engraving, Melancholia 1, created in 1514 by Albrecht Dürer, and Lukas Cranach
the Elder’s Melancholy: An Allegory of 1531. See Ty Alyea, ‘Angst and Paralysis: Visualizing Melancholia from Albrecht Durer to Lars Von Trier’,VIZ., February 10, 2012, accessed August 2013,
http://viz.dwrl.utexas.edu/content/angst-and-paralysis-visualizing-melancholia-albrecht-durer-lars-von-trier.
5 More information about this song can be seen at ‘Mother's Little Helper by The Rolling Stones’, Song Facts,
accessed September 2013, http://www.songfacts.com/detail.php?id=460.
better. Dorothy Rowe suggests that by sandwiching women between their professional lives and the valuable roles of wife and mother (both demanding vocations in life), our culture has made the psychological pressures on women today unbearable. Having a career does not obviate the expectation for a woman (or perhaps her own desire) to also be an attentive and engaged mother.7
The more recent research of feminist psychologist Janet Stoppard has drawn on feminist scholarship in order to explore underlying social constructions of
depression among women from a cultural and psychosocial perspective.8 She has
shown that it is a complex and multi-layered issue, in which social roles
undoubtedly play a significant part. Stoppard’s research looks at the way in which depression affects women over the course of life, and notes the specificity of female depressive illness and its relation to peculiar types of stress and adversity in
women’s lives. She identifies the ‘girl-poisoning culture’ of western society, the stress of conflicting expectations on women to be ‘good mothers’ and the issues for women around depression and aging.9
It is interesting to note the number of women writers who have recently broken the
‘stigmatic silence’ about women suffering depression, and lifted the lid on their own specifically-female experiences of the illness. Stephanie Merritt,10 Gwyneth Lewis,11
Sally Brampton12 and Daphne Merkin13 have all contributed to the de-shaming of
depression and of the women who suffer from it. These precious glimpses into
women’s experiences open a new horizon in depression studies today.
Narrative, Autobiography and Poetry
Throughthe profusion of depression narrative, biography and autobiography that has been published recently, there has been a definite re-valuing of the personal and subjective aspects of the illness. The experience of the person–of affect,
7 Dorothy Rowe was interviewed and quoted by Kira Cochrane, for her article about novelist Allison Pearson.
See Cochrane, ‘Why Do So Many Women Have Depression?’
8 Stoppard, Understanding Depression: Feminist Social Constructionist Approaches. 9Ibid.
10 Stephanie Merritt, The Devil Within: A Memoir of Depression (London: Vermillion, 2009).
11 Gwyneth Lewis, Sunbathing in the Rain: A Cheerful Book About Depression (London: Haper Perenniel, 2006). 12 Sally Brampton, Shoot the Damn Dog: A Memoir of Depression (London: Bloomsbury, 2008).
13Daphne Merkin, ‘A Journey Through Darkness’, New York Times Magazine, May 6, 2009, accessed October
sensation and emotion–has returned to the public arena, after having been all but banished by the strict objectivity of medical science and the increasingly
descriptivist approach of psychiatry.14 Among the many notable examples here is Andrew Solomon’s The Noonday Demon: An Atlas of Depression,15 in which the
author reflects deeply on his own experiences from almost ‘every point on the
compass’, talking not only about medical treatment but also historical, social, political, religious and spiritual aspects. As a knowledgeable yet humble fellow traveller, he offers his own observations and responses for readers to weigh against their own.
As in the romantic period of melancholy in the eighteenth and nineteenth centuries, one of the most healing forms of therapy for some depression sufferers today is to read or listen to the memoirs and poetry of writers who have been able to give authentic voice to their own depression. As others have observed, to feel
understood from the inner world of experience is one of the things that can truly relieve the loneliness of depression. Arguably, the two most powerful examples of this today are Australian poet, Les Murray16 and Welsh poet, Gwyneth Lewis,17 who
have both written autobiographical prose and poetry on their experience of depressive illness.
The Continuing ‘Melancholy Tradition’
I believe that we find ourselves today at an historical vantage point where we see our era making its own contribution to the understanding of the ancient human phenomena of melancholy and depression. While valuable and helpful, this
contribution is not definitive, superior or complete, but merely ‘one among others’
that have been offered for their time–and perhaps not even the best one at that.
Contemporary experience bears out the famous statement of Robert Burton in the seventeenth century about this illness’s symptoms showing a ‘disagreeing likeness
14 For an historical and methodological analysis of this point see Radden, The Nature of Melancholy, 32-4. 15 Andrew Solomon, The Noonday Demon: An Atlas of Depression (New York: Scribner, 2001).
16 Les Murray, Killing The Black Dog: A Memoir of Depression (New York: Farrar, Strauss & Giroux, 2011). To view
a podcast of Les Murray speaking about his depression and reading his poems on depression, see Les Murray,
‘Les Murray on Killing the Black Dog (p1)’, YouTube video, 23:44, posted by ‘themonthlyvideo’, May 2, 2013, accessed September 2013, http://www.youtube.com/watch?v=IYTRZniglVY.
17 Her autobiographical work is Lewis, Sunbathing in the rain. Her poems on depression are published in
(similitudo dissimilis), like men’s faces’.18 The melancholy-depression experience
defies efforts to precisely categorise or tame it,19 even the efforts of modern
psychiatry, with its constant refining and reviewing of categories. However, the mysterious paradox is that, as in past eras where this complexity and uncertainty was also present, so also today depression sufferers share a great commonality of personal experience, and draw strength from this shared experiential knowledge of depression as a universally recognisable human journey.
We are not witnessing the final exposé of ‘what depression is’, ‘how it works’ and
‘how to remedy it’, but rather the continuation of the ancient melancholy tradition. We too are participants in this unfolding multi-structured narrative through which we find ourselves in conversation with Aristotle, Hippocrates, Avicenna, Paracelsus, Luther, Kraepelin and many other characters in the story past, along with today’s
protagonists: medical science, psychology, spirituality and sociology.
Depression and Happiness
From this vantage point, some writers today have begun to critique the culture of entitlement and the mythology of ‘happiness’ in western culture, as if suffering (and in particular, mental suffering) is or ought to be escapable through the apparently- endless range of available distractions and pleasures. An alternative attitude which is quickly gaining allies is that depression is in many ways the natural and necessary counterpoint of joy and pleasure, the deep ravines that are inevitably juxtaposed to
life’s mountain peaks, part of the natural economy of human life.
Melancholy is at the bottom of everything, just as at the end of all rivers is the sea. Can it be otherwise in a world where nothing lasts, where all that we have loved or shall love must die? . . . The gloom of an eternal
mourning enwraps, more or less closely, every serious and thoughtful soul, as night enwraps the universe.20
Andrew Solomon, writing from his deep personal experience of depression, reflects:
18 Robert Burton, The Anatomy of Melancholy, First published 1621, 1932 ed., edited by Holbrook Jackson (New
York: New York Review Books, 2001), 397.
19Ibid.
20 Henri-Frédéric Amiel, Amiel’s Journal:The Journal In time of Henri-Frédéric Amiel, 2nd edition, translated by
It is possible (though for the time being unlikely) that, through chemical
manipulation, we might locate, control and eliminate the brain’s circuitry of
suffering. I hope we will never do it. To take it away would be to flatten out experience, to impinge on a complexity more valuable than any of its component parts are agonising.21
Reprising Freud’s metaphor of mourning to reframe depression, Darian Leader talks
about the way in which treatment for depression can be driven by the desire to take the quickest route to no pain, rather than the best route to healing. A healthy life requires its seasons of mourning and sorrow, and what we really need is to attend to, rather than run away from, them.22
Social Dimensions
Sociological Constructions of Depression
As it has woven its way in and out of the fabric of cultures and societies over the
centuries, depression’s ‘colours have been set off differently’. The many variables at work in any one social context will interact uniquely with the illness. Cross-cultural studies have shown how differently depressive illness can present in different cultural and social settings.23
In sixteenth century Germany depressive melancholia was a socially accepted reality, depicted in art and openly spoken and written about. Its later social station at the height of the Renaissance was quite intellectually glamorous. In later
nineteenth century Europe, it was a female form of madness. In the twentieth century depression has been objectified and medicalised. Its sufferers have become
‘patients’ who need treatment and are frequently socially stigmatised as ‘mentally
ill’. Today new social and community efforts to build awareness and de-mystify depression are working to break down the aura of medical pathology and nurture greater social acceptance and empathy.24
21 Solomon, The Noonday Demon, 38.
22 Darian Leader, The New Black: Mourning, Melancholia, and Depression (London: Penguin, 2008). 23 For a rich and fascinating survey of this issue see Kleinman and Good, Culture and Depression.
24beyondblue have adopted the strategy of actively listening to people speaking out about their illness in order
to inform and focus their programs. See Bonnie Vincent, ‘The Power of blueVoices’, Health Voices 5 (October 2009): 10-11, accessed October 2013, https://www.chf.org.au/pdfs/hvo/hvo-2009-5-power-bluevoices.pdf. See
This ‘changeling’ nature of depression is what has made, and continues to make, it so maddeningly difficult to understand and treat. Given the immense and rapid social transformations we have experienced in the western world in the last fifty years, it is no wonder that depressive illness has been in such a state of accelerated flux.
Social Effects of Modernity and Postmodernity
The growth of personal autonomy and individual self-consciousness during the modern era created the necessity for persons to find meaning and hope within, rather than through, connection and community. The social agenda of continuous linear progress in society, driven by education, science and technology, leaves little room in the social mainstream for those who find themselves unable to move on and keep up. Dan Blazer25 points out how all this has led towards social isolation