2021 June The Anatomy of Melancholy

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To mark the 400th Anniversary of

The Anatomy of Melancholy by Robert Burton (1621),

Professor Brendan Kelly investigates Edward Worth’s 1676 edition.

 

Robert Burton, The Anatomy of Melancholy (London, 1676), title page.

 

The prehistory of ‘madness’ goes back to earliest times. Mental illness has always been with us. Every spiritual tradition has, at one time or other, blamed human ‘madness’ on the work of gods or devils, or the result of supernatural forces that sought to disturb the affairs of man, wreak havoc or exert revenge for unspecified infringements. Sometimes ‘madness’ was the result of obvious wrong-doing, sometimes the vagaries of deities, sometimes just bad luck. Responses were often harsh: while some who ‘heard voices’ were hailed as saints or mystics, most were dismissed as mad, persecuted, confined, ostracised or constrained to lives of wandering, loneliness, destitution and early death.

Depression and melancholia, in particular, have been described since ancient times. In the Bible, the prophet Jonah became ‘angry enough to die’ and asked God for death: ‘Now O Lord, take away my life, for it is better for me to die than to live’. The prophet Job suffered greatly and asked, in mental agony: ‘Why did I not perish at birth, and die as I came from the womb?’ ‘I have no peace, no quietness, I have no rest, but only turmoil’, he cried: ‘I loathe my very life, therefore I will give free rein to my complaint and speak out in the bitterness of my soul’.

In a more clinical vein, classical Greek physician Hippocrates described melancholia as an identifiable medical condition with both mental and physical symptoms, and provided clinical descriptions that match remarkably well with our understanding of depression today, over two millennia later. Perhaps the finest and most detailed account of depression, however, is to be found in a 1621 book by Robert Burton, titled The Anatomy of Melancholy.

There is an excellent copy of Burton’s treatise in the Edward Worth Library (1733), home to the remarkable book-collection assembled by Edward Worth (1676-1733), a notable Dublin physician. Housed in the historic Dr Steevens’ Hospital, the library is sandwiched between Heuston train station on the banks of the River Liffey on one side and, on the other, St Patrick’s University Hospital, Ireland’s first psychiatric hospital. St Patrick’s was founded in 1746 following the bequest of Jonathan Swift (1667-1745), satirist, writer and Dean of St Patrick’s Cathedral. The Edward Worth Library is hushed and tranquil – the perfect place to consult a 1676 copy of the eighth edition of Burton’s classic volume.

 

Portrait of ‘Democritus Junior’ (i.e. Robert Burton), on the title page of The Anatomy of Melancholy (London, 1676).

 

Robert Burton (1577-1640) was an English scholar at Oxford University. He suffered terribly from depression and anxiety that were caused, he believed, by an excess of ‘black bile’. Burton’s masterpiece, The Anatomy of Melancholy, is a vast, encyclopaedic and tremendously over-inclusive account of his condition. Burton digresses from the subject of melancholia repeatedly, mixes his own thoughts with scientific observations, and frequently slips into stream of consciousness. No editor would permit such indulgences today.

Notwithstanding these features – and possibly because of them – Burton’s book is a fascinating, intoxicating and utterly unpredictable read that evokes depression rather than explains it, and offers a window into Burton’s mind as much as it does into melancholia more generally. Burton writes:

‘If our leg or arm offend us, we covet by all means possible to redress it, and if we labour of a bodily disease, we send for a physician; but for the diseases of the mind we take no notice of them: lust harrows us on the one side; envy, anger, ambition on the other. We are torn in pieces by our passions, as so many wild horses, one in disposition, another in habit; one is melancholy, another mad; and which of us all seeks for help, doth acknowledge his error, or knows he is sick?’

 

Melancholy, according to Burton, is ‘either in disposition or habit’:

‘In disposition, is that transitory Melancholy which goes and comes upon every small occasion of sorrow, need, sickness, trouble, fear, grief, passion, or perturbation of the mind, any manner of care, discontent, or thought, which causes anguish, dullness, heaviness and vexation of spirit, any ways opposite to pleasure, mirth, joy, delight, causing forwardness in us, or a dislike. In which equivocal and improper sense, we call him melancholy, that is dull, sad, sour, lumpish, ill-disposed, solitary, any way moved, or displeased. And from these melancholy dispositions no man living is free, no Stoic, none so wise, none so happy, none so patient, so generous, so godly, so divine, that can vindicate himself; so well-composed, but more or less, some time or other, he feels the smart of it. Melancholy in this sense is the character of Mortality… This Melancholy of which we are to treat, is a habit, a serious ailment, a settled humour, as Aurelianus and others call it, not errant, but fixed, and as it was long increasing, so, now being (pleasant or painful) grown to a habit, it will hardly be removed’.

 

Personification of ‘love-melancholy’ on the title page of The Anatomy of Melancholy (London, 1676).

 

The only problem with Burton’s splendid manuscript is its sprawling vastness: virtually everything is listed as a cause of depression and virtually everything is listed as a cure. To confuse matters further, Burton obsessively wrote and re-wrote The Anatomy of Melancholy throughout his lifetime: ‘I write of melancholy, by being busy to avoid melancholy’, he explained. As a result, Burton’s book is multi-layered, uneven and inconsistent – as well as revelatory, humorous and, at times, depressing.

 

John Worth’s signature on the title page tells us that he bought the book in Dublin in May 1685.

 

Tragically, no original manuscript survives. The copy of The Anatomy of Melancholy in the Edward Worth Library dates from 1676, the year in which Edward Worth was born. It is a London edition that was owned by Worth’s father, John Worth (1648-88), who, like Swift, was Dean of St Patrick’s Cathedral.

On its publication in 1621, The Anatomy of Melancholy received a mixed reception, but it is widely hailed as a masterpiece today. The book went out of print in 1676 and was re-issued over a century later, in 1800. By that time, the situation regarding the melancholic had changed considerably. By the start of the nineteenth century, there was a surge of interest in caring for the mentally ill, large public asylums were being planned and built in many parts of the world, and other writers joined Burton in describing depressive states of mind and speculating about their causes.

Today, four centuries after Burton’s searing, if obsessive, account of melancholia, the biological basis of depression remains somewhat mysterious. Treatment has, of course, improved, based on a ‘bio-psycho-social’ approach to the condition. There are physical or ‘biological’ treatments (such as medication), psychological treatments (such as cognitive-behaviour therapy) and social interventions (reflecting the personal and social contexts in which depression and suicidality develop). All of these approaches are, in an ideal world, combined together to reflect the circumstances and needs of any given person experiencing depression or suicidal thoughts.

This multiplicity of approaches to depression finds it roots in the complexity of melancholia itself, which was first expounded in substantial detail by Burton in 1621. Indeed, it is now clear that The Anatomy of Melancholy played a significant role in the early recognition of depression, elucidation of its many features and exploration of its infinite variety and effects. On this basis, Burton’s account of the condition remains an essential document in the history of psychiatry. It also provides a searing insight into a unique, if troubled, mind that was unafraid to explore its darkest corners.

Even today, we benefit from Burton’s bravery and his insights.

 

Personification of hypochondria on the title page of The Anatomy of Melancholy (London, 1676).

 

Brendan Kelly is Dun’s Librarian at the Royal College of Physicians of Ireland and Professor of Psychiatry at Trinity College Dublin.

 

Sources

Burton R. The Anatomy of Melancholy. New York: New York Review of Books, 2001.

Kelly BD. Hearing Voices: The History of Psychiatry in Ireland. Dublin: Irish Academic Press, 2016.

Scull A. Madness in Civilization: A Cultural History of Insanity from the Bible to Freud, from the Madhouse to Modern Medicine. London: Thames & Hudson Ltd., 2015.

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