x Abu Dhabi, UAESunday 23 July 2017

In praise of sadness, and centuries of melancholic genius

On world mental health day, we should consider how many cases of depressions should be treated as illness.

"The heat of the sun blazed out to irradiate the dark: a bud burst open, jewel-like, in the temple of the heart"

That verse was penned in the 12th century by the Benedictine abbess, Hildegarde Von Bingen, who is today celebrated as Europe's first known female composer, one of the greatest poets of the medieval period and the writer of Europe's earliest known morality play.

In May she was declared a saint by Pope Benedict XVI. Much of Hildegarde's work was inspired by her visions, which contemporary scholars often attribute to migraine auras. Hildegarde also experienced periods of deep melancholia, a condition we now call depression.

Migraine and depression frequently occur together, especially among women. Those who experience migraines are 40 per cent more likely to experience depression, according to recent research led by Dr Tobias Kurth, an epidemiologist at Brigham and Women's Hospital in Boston.

For Hildegarde, however, these "afflictions" were actually viewed as the source of her talents and great work. This idea of the melancholic genius stretches back to the classical philosophers of antiquity. In a work attributed to Aristotle, for example, we read: "Why is it that all men who have become outstanding in philosophy, statesmanship, poetry or the arts are melancholic?"

This view of depression as both a gift and curse can be seen in the writings of later periods too. Melancholia is often described as the affliction of a deep thinker, an indication that a person engages in self-reflection and contemplation of the world.

Such a temperament, characterised by refined sensibilities, an agile mind and superior wit, was viewed as a predisposition to greatness. As one English poet, Charlotte Smith (1749 to1806), wrote: "Those paint sorrow best who feel it most."

The earliest known complete treatise dedicated entirely to melancholia was written in the 10th century by Ishaq Ibn Imran, an Iraqi physician working in Kairouan (then the capital of Tunisia). A millennium later, some of Ibn Imran's thoughts are surprisingly similar to contemporary psychological discourse.

"Melancholy affects the soul through fear and sadness," Ibn Imran wrote. "Sadness is defined by the loss of what one loves; fear is the expectation of misfortune."

This resonates with contemporary ideas about the role of loss - real or imagined - in cognitive theories of depression. Similarly, Ibn Imran's coupling of fear and sadness aligns with current thinking about depression and anxiety. Ibn Imran also viewed melancholia as a condition particularly likely to arise in thinkers and scholars.

Today, that idea of the benefits of depression has practically vanished. Depression is no longer viewed as both a gift and a curse - just a curse.

Perhaps our over-reliance on the false promise of quick-fix medication has made us forget how to experience negative emotional states productively. We view depressive illness as an enemy to be fought, never as a messenger to be heeded.

Medication may, in some cases, relieve symptoms, but what else do we lose? Perhaps we deny ourselves the lessons and the growth that may have arisen from considering the experience differently. Therapy has a vital role to play in managing severe depressive states, but the immediate conceptualisation of the condition as a disease rooted in chemical imbalances is less than helpful.

The over-medicalisation of common human experience may be robing us of our future St Hildegardes. At the same time, we should be careful not to over-romanticise melancholy as proof of one's intellect, depth and heightened sensibilities.

Hildegarde's interpretation of her affliction led to dazzling works of brilliance. Today, such symptoms would elicit a prescription for Prozac. I'm not saying psychological pain is a good thing, but rather than always view it as a foe to be vanquished, maybe occasionally we could look for a useful message. Perhaps in some instances, it is simply the psychological equivalent of growing pains.

Today, October 10, is world mental health day. This year the theme is "Depression: A Global Crisis". Presently the World Health Organization claims 350 million people are effected by depression worldwide. What we really need to know, is how much of this depression should actually be treated as illness?

 

Justin Thomas is a professor of psychology at Zayed University in Abu Dhabi