“Pain and suffering begin with existence and end when it ends, and this end gives pain and suffering to those who survive.” — Jean-Luc Nancy
But aesthetics immediately raises the problem of anaesthesia, anaesthetics: neither pleasure nor pain, neither pathos nor passion. A classical tradition denominated varieties of anaesthesia under such headings as ataraxia, apatheia, adiaphora and so on; such rubrics were philosophically valuable insofar as they designated the achieved detachment of the sage from the derisory quotidian concerns of the world. Among the less elevated conditions afflicting humankind which nonetheless also bespoke something of this detachment, without, of course, a consonant value being attached to them , was melancholy. Melancholy did, in fact, acquire a peculiar value: to the extent that it participated in a detachment from the things of the world in a way that was similar to that of the philosopher, it was worthy of respect; to the extent, however, that this detachment was suffered as an immensely painful, manifestly undesirable complaint, it was considered a failing or a sin. Melancholy has thus been considered, to parody Kant, a suffering without suffering. Hence the ambivalence of a figure such as the ancient atomist Democritus (notoriously joyful), whose ethics were easily inverted by Robert Burton, who published, in an early modern England itself notorious for its melancholics, his encyclopaedic Anatomy of Melancholy under the pseudonym Democritus Junior. One can see why Slavoj Zizek, though denouncing the garden-variety cultural studies valorisation of “melancholia” over “mourning,” can still end up affirming that “melancholy (disappointment at all positive, observable objects, none of which can satisfy our desire) effectively is the beginning of philosophy (2000 : 660).
Melancholia, moreover — as the invocation above of Democritus Junior might suggest — is also consistently linked to materialist philosophies. Such a materialism is itself paradoxical. On the one hand, melancholy is utterly detached from the things of the world, and hence seemingly anti-material, anti-materialistic. On the other hand, melancholy is immured absolutely in the things of the world — there is no other world but this — to the point where the world itself has lost all sense. The world dissolves into objects-without-possible-relation. Albrecht Dürer’s etching of the melancholy angel is exemplary in this regard. As Giorgio Agamben writes, in the course of a gloss on Dürer’s image:
Indeed, depression in contemporary first-world societies has now reached, as doctors, academics, journalists, politicians, multinational governmental agencies and pharmaceutical companies agree , “plague proportions.” The easy journalese of the phrase “plague proportions” should not prevent us from wondering as to the work being done by this metaphor: depression is not a transmittable disease, like SARS, for instance, one that might be contained through quarantining its victims and developing an easily-administered cure, although one might certainly still wish for genetic therapy (The Weekend Australia, June 21-2. 2003: 13). Then again, it’s also tempting to suggest that such metaphors still unconsciously govern a great deal of medical practice that prides itself on its own “materialism.”
Certainly, the current overwhelming dominance of medical technologies, personnel, and institutions over the bodies of those who are the world’s richest people, that is, those who live in the first world, is not simply linked to its effectivity or scientific foundation. This is a fact at once acknowledged and camouflaged in the literature, which often literally sparkles with statistics and desperation. The hallucinatorily named “Centre of Excellence in Depression and Related Disorders” (a beyondblue initiative) is self-confessedly concerned with publicising depression and with offloading government costs of specialists onto GPs and community organizations (its other major concern is with insurance claims). In order to do this in any economically- and publicly-viable way, however, it needs to make depression not a mental health issue but a health issue, i.e., on the level with bowel cancer and heart disease. If such an ideological operation seems doomed to failure on its own terms, it is calibrated to exclude all questions of a sense of depression: therapies such as psychoanalysis, which depend on language having a symbolic efficacity for human life, are a priori excluded from the realms of genetics, physiology and neuroscience. “Depression,” we might say, is what happens to melancholy when the sufferer’s words are considered absolutely meaningless or, at best, mere reports of affect. Depression is a literally mindless melancholy, an acephalic melancholy.
This project is implicitly flagged by beyondblue’s “Principles for action,” among which we discover: “Respect for human rights and dignity,” “A population health approach,” “An evidence-based approach” and “Sustainable action.” The logic underlying these principles was a volatile issue during the discussion at the Australian Freud Conference 2 May 2003, where most of the analysts were complaining bitterly that they had been cut out of beyondblue and other governmental psychiatric initiatives on depressive disorders. In the place of psychoanalysis, of course, we find drug therapies and CBT. So the great medical opposition between “listening” and “dispensing,” psychoanalysis versus Prozac, seems today to be on the side of dispensing. The great early paean to Prozac was issued by Peter Kramer, Listening to Prozac (1993), a massive bestseller. Note how Kramer’s title attempts to reconfigure the distinction between “listening” and “dispensing,” in the favour of dispensing: Prozac is a wonder drug precisely because it is the drug that overcomes the very distinction — to the point that one now listens to it as if it were the true subject of depression.
It is more than possible that depression has a physical aetiology (brain lesions, genetic predispositions, etc.) and that such a disease ought to be treated physically. Tests carried out at Massachusetts Mental Hospital during the 1970s showed that the crude anti-psychotic drugs then available were far more effective than any analysis. But in the long term? Who knows? As Mikkel Borch-Jacobsen notes: “Under the impact of antidepressants, not only was the distinction between the psychoses and the neuroses (and, by the same token, the professional niche of psychoanalysts) erased, but also that between psychiatry and general medicine. Everything has become depression, because every condition responds to antidepressants, the new panacea.” (The London Review of Books, 11 July 2002). “So,” Borch-Jacobsen notes, “farewell Kierkegaard and Heidegger.” Or as Kramer puts it, “Perhaps what Camus’s Stranger suffered — his anhedonia, his sense of anomie — was a disorder of serotonin. Kierkegaard’s fear and trembling and sickness unto death are at once spiritually significant and phenomenologically unremarkable, quite ordinary spectrum traits of mammals, affects whose interpretation in metaphysical terms is wholly arbitrary” (1993:296).
Yet, if pharmacology has made great advances in treatment, the causes of depression seem to have become even more opaque. As David Healy remarks in one of his groundbreaking studies of the psychopharmacological era:
Given the failures of pseudo-scientific psychology and current neuroscientific explanations, unbridled speculation as to the true causes of conditions such as depression remains, as ever, rife amongst humanities academics (such as myself). Oliver Bennet , for example, writes:
Jason Glynos and Yiannis Stavrakakis: note that:
Freud draws a crucial distinction between “mourning” (a natural process of grieving for a lost object, and an attempt to come to terms with this loss) and between “melancholia” (a refusal to give up on the lost object). For Freud, melancholia has many possible triggers, but it essentially revolves around the loss of a loved object. This loss creates extreme difficulties for the subject:
Although, as noted, melancholia exhibits similar symptoms to those of mourning, it differs from mourning in a number of crucial ways. Whereas the lost object is always consciously recognised by the mourner, the melancholic’s lost object is sometimes unknown or unconscious — they do not know what they have lost. This unconscious status of the lost object proves extremely problematic, and in a number of senses. For Freud, the overwhelming sadness of melancholia cannot be worked through insofar as the object remains unconscious. Furthermore, the psychic energy or libido freed by the loss of the object is thereafter withdrawn into the ego itself by a thoroughgoing identification with that object. In melancholia this terrible sequence — loss, repression, egoic identification with the loss — entails that the melancholic person constantly persecutes him, or herself, turning against their own ego their ambivalence about the loss. As Freud notes, whereas mourning recognises the loss of an object that was “good” and “loved,” the melancholic’s relation to the lost object is necessarily more ambivalent, i.e., a dense complex of love and hate. For Freud, the bitter recriminations that a melancholic typically turns against him- or herself are rather more appropriate to the lost object itself:
Yet there is another point to be made here, precisely about the apparent asociality considered characteristic of melancholy: that is, the tendency of the depressive person to exhaustion, sluggishness, withdrawal from the world. Such features are very often noted in the literature about depression, from personal accounts to governmental documents; sometimes these features are understood as causes, at other times as symptoms. Yet Freud emphasizes that the melancholic is prone to all sorts of externalised self-reproaches which are performed before others — whether those others are family or friends, medical professionals, or even fantasmatic figures. As Judith Butler has noted, “the performance of melancholia as the shameless voicing of self-beratement in front of others effects a detour that rejoins melancholia to its lost or withdrawn sociality.”(1997: 181). What this means, among other things, is that the melancholic retains a link to the society from which he or she simultaneously withdraws by showing, in one way or another, that they are no longer able to perform (as expected) in that society. If “shame” is one of the very important social emotions (shame is, by definition, shame before the eyes of others, crucial, among other things, in instilling a sense of prohibited/correct behaviour in infants), there is then something about the overwhelming sadness and enervation of melancholy that can be considered an attempt to evade and incarnate shame. Melancholy would then be an ambivalent defence against shame, which encrypts, retains the shame of the other within. Depressives begin to act in ways that they would never countenance when well; or, to put this differently, they patently expose themselves as acting in ways that “well” people would never countenance. And because Freud considers that melancholia is integrally constituted by rage at other(s) turned back upon the self, it is then possible to consider melancholia a peculiarly self-lacerating and unconscious form of social revolt. Many sufferers have themselves noted that, along with Lewis Wolpert, although being “totally self-involved” in their sickness they would suffer “panic attacks if left alone.”(2001: xv). And sufferers constantly speak of the peculiar shame that attaches to their disorder. As the French novelist Marie Cardinal puts it: “I was ashamed of what was going on inside of me, of this uproar, of this disorder, of this agitation.”(2000:3). Almost every writer on the topic notes — not always consciously or explicitly — the close link in depressives between their feelings of shame and their “shameless” actions. Cardinal herself, noting that madness doesn’t seem so shameful among the impoverished or aristocracy, gives an explanation based on socio-economic class: “When the madness comes from inbreeding or poverty, it may be understood. But when it comes out of a comfortable life where there is good health and that poise conferred by money decently earned, in such a case, it is a disgrace,”(14). For Freud, however, sufferers can be so shameless because it is not really themselves that they are addressing — it is the other encrypted inside them.
To return to the metaphors of depression-as-plague already briefly noted above: if Freud’s account retains any pertinence, it is possible that the widespread hope for magic bullets and isolation of plague-vectors in relation to depression may be, in a particular but unexpected way, essentially correct. Depression is transmitted in the form of shame before others, to the extent that it has now become so fearful it can only be publicised as an entirely-normal physiological possibility. On the basis of the preceding remarks, my own speculation is therefore that the attempt to normalise and control depression and the effects of depression through public ventures such as beyondblue will not work. On the contrary, depression will continue to flourish, suddenly striking anyone, anywhere. This is not simply due to the familiar paradoxes of definition, performative creation, competing specialisations or causal overdetermination characterized in the following. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Diseases (Fourth Edition) aka DSM-IV, requires that, for a clinical diagnosis of depression to be made, five or more of the following symptoms must be present over at least a two-week period: depressed mood most of the day; diminished interest or pleasure; significant gain or loss of weight; inability to sleep or sleeping too much; reduced control over bodily movements; fatigue; feelings of worthlessness or guilt; inability to think or concentrate; thoughts of death or suicide. But that leaves a lot out, such as the problems of the relationships between anxiety and depression, or the relationships between “postnatal depression” and depression “proper.” The abiding mutability and fuzziness of the category leads to genuine problems in diagnosis, treatment and prognosis. Is depression a single disease or a complex of diseases? If a complex, then how should it be diagnosed and treated? Are there differences in degree or in kind between forms of depression? What sort of diagnostic criteria can be applied to separate out the various elements of the disease? Is there more depression about these days, or is it just that our diagnoses have become more nuanced? Is it under- or over-reported? How is it linked to other diseases, some which seem to have a clear organic causality, some of which don’t (hypochondria or chronic fatigue syndrome, for instance)?
Having indicated problems associated with the paradoxical nature if how it is understood and defined, the most debilitating obstacle for the depressive to overcome is the social structure of depression itself. The shame of depression will never be overcome, precisely because depression is integrally bound up with shame; this shame is only intensified by advertising claims that there should be nothing shameful about depression; after all, if Freud still has something to contribute to this debate, for a depressive there may well be something (unconsciously) enjoyable about their shame.
It is also crucial to note the non-neurotic structure of melancholy, which is more akin to perversion than to neurosis or psychosis. Almost every psychoanalytically-inflected theorist agrees on this. Freud, Kristeva, Butler, Agamben all suggest that the perverse disavowals of melancholy function similarly to the disavowals of the fetishist. But if the fetishist fixates on a particular kind of object, the melancholic’s problem is precisely the loss of object or, to use more Lacanian terms, the loss of the object-cause of desire. These psychoanalytic writers imply that any overcoming of melancholia requires a certain imaginative invention of solutions for and by each particular sufferer. Although they are certainly interested in discerning regularities in the symptomatology and theory of the disease, these regularities by no means have the status of biophysical laws. Their work suggests that medical difficulties in clarifying the fuzziness of the category of depression — not to mention the often wildly divergent responses of sufferers to medication and therapy — are absolutely irresolvable. Because melancholy is precisely an intense affective rejection by the sufferer of his or her contemporaneous technologies and modes of life, i.e., the lack that founded their objects, the sufferer cannot simply be treated by those very technologies which he or she is (unconsciously) rejecting. Language necessarily fails in talking about melancholia, as symbolic bonds are central among the “things of the world” which the melancholic resists. This is why the title of Cardinal’s account of her recovery from depression is so significant: The Words to Say It. This state of affairs renders many of the supposed “treatments” part of the problem itself.
On such accounts, melancholy — to the very extent that it seems to be bound up with a loss it cannot abandon — is at the same time an unconditional demand for something new. The depressive is typically obsessed with everything that he or she cannot bear about the world, which suggests also that he or she will not put up with fake solutions. In this sense, melancholy is not backward-looking, but rather authentically forward-looking, or, more precisely, subsists in a temporality skewed between already-over and not-yet. Its cure would then be at least partially dependent on the sufferer’s ability to reinvigorate both self and world by an imaginative solution (and not just a chemical solution). This solution involves the creation of new objects. Despite all appearances, then, melancholy would be a necessary stage in the invention of new possibilities for life; it might even, unexpectedly, as Burton’s Democritus Junior suggests, provide the indispensable underlining of joy.
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Oliver Bennett (2001). Cultural Pessimism: Narratives of Decline in the Postmodern World (Edinburgh: Edinburgh University Press)
beyondblue annual report 2001-2002 (downloaded 6 May 2003)
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(London & New York: Karnac)
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