Statistics, Classification, and the Standardisation of Melancholia

This chapter situates melancholia in the context of the administrative framework that was constructed in British asylum medicine from the 1840s onward. In the last quarter of the century, the interaction between administrative and statistical practices and a theoretical framework based on physiological psychology, produced melancholia as an increasingly standardised disease category with a clear symptomatology. This thematic chapter maps in detail the historical trajectory of what emerged as the main features of biomedical melancholia in the late nineteenth century: mental pain, depression, religious delusions, and suicidal tendencies. The chapter demonstrates the different and complex historical roots of these symptom categories, showing that they were made into features of melancholia in very different ways, none of which were inevitable or straightforward.

The Scientific Foundation of Disordered Mood

This chapter maps how early nineteenth-century experimental physiology provided a biological foundation for mental disorders in which no visible changes to brain tissue could be found. It charts the emergence of ‘psychological reflex action’, a key concept that facilitated a view of emotion as automated and involuntary, and thus prone to malfunction. The chapter follows the trajectory of psychological reflexion from internal scientific medicine to what became known as ‘physiological psychology’, where it provided mid-century British writers with the tools to create a biomedical framework for the phenomenon of disordered mood. The chapter ends by looking at how physiological psychology was gradually taken up by mid-century asylum physicians writing on mental disease.

Diagnosing Melancholia in the Victorian Asylum

This chapter takes a close look at the mutually constitutive relationship between asylum casebooks and published literature on mental disease. It follows melancholia as it travelled back and forth between the casebook and the textbook, emerging as an increasingly coherent diagnosis. While medical literature presented melancholia in remarkably standardised terms toward the end of the century, by comparing published accounts with asylum journal notes from major county asylums situated in different parts of the country, this chapter shows how a vast and vastly divergent range of human expressions and experiences were moulded to fit increasingly narrow diagnostic criteria, and brings into focus the conflicts that arise and the negotiations that take place when complex human emotions are labelled and categorised as mental disorders.

The Classification of Melancholia in Mid-Nineteenth-Century British Medicine

This chapter traces melancholia from the early nineteenth century, when its nosological status as an independent disease category was contested, up until the 1860s. At this time, the view that insanity could be chiefly of the emotional kind, that is, largely without delusion of thought, was rapidly gaining ground among European medical writers. This shift from more traditional views of madness was crucial as it provided the epistemological foundation and conceptual framework necessary for disordered mood to become a possible and plausible medical concept. The chapter charts the nosological trajectory of melancholia through the work mid-century British physicians, who began to appropriate physiological language to speak about disordered mood and melancholia, increasingly abandoning older models.

Introduction: Disordered Mood as Historical Problem

The introduction situates the narrative of this book—the reconceptualisation of melancholia in nineteenth-century psychiatry—firstly in the context of current attempts to ‘resurrect’ melancholia as a psychiatric diagnosis, secondly in relation to the history of melancholia more broadly, and finally in the context of past and present debates about classification in psychiatry. The core argument of the book is briefly outlined: in the nineteenth century, melancholia was reconfigured as a modern biomedical disorder of emotion. Two developments in particular were foundational to this new model of melancholia. The first was the uptake of physiological language and concepts into psychological medicine. The second was the institutionalisation of medical statistics together with a standardisation of asylum recording practices.

Conclusion: Melancholia, Depression, and the Politics of Classification

The conclusion briefly highlights some alternative models of melancholia at the turn of the twentieth century, before turning the focus to the decline of the melancholia diagnosis and the rise of clinical depression as the new dominant mood disorder in diagnostic literature. The Conclusion considers how the developments outlined in the previous chapters have been foundational not only for the modern psychiatric concepts ‘mood disorder’ and ‘clinical depression’, but also more broadly for classification and clinical practice in twentieth- and twenty-first-century psychiatry. Finally, the book turns the spotlight to the politics of psychiatric classification, and asks what is at work, and at stake, when psychiatry tries to label, classify, and diagnose psychological distress.

Melancholia and the New Biological Psychiatry

This chapter centres on the development of a neurophysiological model of melancholia, which emerged within the new academic psychiatry in the German states at mid-century, and was taken up into British literature in the 1860s and 70s. It considers Wilhem Griesinger’s model of psychological reflex action, which he used to explain the aetiology of mental disorders. Building on Griesinger’s model, Richard von Krafft-Ebing in Germany and Henry Maudsley in Britain offered two of the period’s most comprehensive descriptions of melancholia as a modern biomedical mood disorder. Finally the new neurophysiological model of melancholia is considered in relation to neurasthenia, a fashionable diagnosis in the United States in the last quarter of the century.