March 19, 2021

“I write on melancholy, by being busy to avoid melancholy,” wrote Robert Burton, in his masterpiece of 1621, The Anatomy of Melancholy, the longest, richest, most digressive, charming and varied self-help book ever published.

Melancholy then, exactly 400 years ago, was understood as a condition which affected the body, the mind and the soul. The humours were imbalanced, overtaken by an excess of black bile. “There is no greater cause of melancholy than idleness, no better cure than business,” Burton wrote. Lovers, solitaries, thinkers, artists, scholars, the sad and the fearful were all prey to it.

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In her superb new monograph about Burton’s work, A User’s Guide to Melancholy, Mary Ann Lund, a scholar of Renaissance literature, explains how melancholy has always had a span as wide as the mind’s horizon. Feeling doleful, dejected and withdrawn? That would be melancholy. Mad as two snakes? Melancholy again.

Although we have abandoned melancholy as a medical condition, we have retained something of its broad and pervading air. It has become a thoughtful sort of sadness, one that is not necessarily entirely unpleasant. There is longing, nostalgia and some regret in it. Welsh has an untranslatable word for it, hiraeth, a kind of melancholy produced by feeling alienated from one’s dream of home. We may feel melancholy without knowing quite why; we may even enjoy it, which former ages saw as one of its dangers.

“It is Siren-like and alluring, promising the pleasurable life of solitude, leisure, and contemplation before it traps its victim into an inescapable cycle of loneliness and self-destructive thought patterns,” Lund writes, of the melancholy Burton studied.

She picks out some of Burton’s case studies of melancholy’s extremes. Here is the man who was afraid to urinate lest he drown his town; here the baker who believed himself made of butter and became understandably fearful of standing near his oven; here is Charles VI of France who believed he was made of glass, and the Emperor Charlemagne, who became infatuated with a woman, and on her death with her ring, and after the ring was cast into a lake, with the lake.

It is not for us to diagnose these conditions. As Lund puts it, wisely, “substituting our new words for old detracts from the dignity of those who suffered, talked about and treated mental disorders in the past’.

Rather, what is thrilling about melancholy for us now is that it is a holistic condition. It is a disease which afflicts the soul and spirit as much as the body and mind. As a consequence, Burton suggests, it must therefore be treated in a multi-dimensional way. He is adamant that there is no universal cure: treatment must be tailored to the individual.

My favourite of Burton’s case histories is the story of the Earl of Montford, afflicted with dejection, who was treated by the Paduan physician Giambattista da Monte in 1549. Da Monte told his patient to leave the stressful environment of Court, to abstain from pork, fish and sex, and to spend easeful time at the Earl’s family home on Lake Constance. The Earl asked for and received a compromise on the sex ban, did otherwise as he was told, and healed. One suspects most of us would.

But the lesson here is Da Monte’s diverse, comprehensive and individual approach. For a model which concentrates merely on symptoms, as much contemporary pharmaceutically led medicine does, cannot be as effective as one which also addresses causes.

In 2018 I had a breakdown — an extreme case of melancholy, in Burton’s terms — complete with mania and delusions. I did not imagine that I was made of glass or butter, thankfully, though such at least might have kept me quiet indoors.

Instead, comparatively workaday fantasies of aliens and security services — and the possibility of world peace, if only I could bring it about — led me to range around madly, to write off my car, to wind up, naked but for my boots, on the roof of an alarmed farmer’s Land Rover, and eventually to hospital.

Writing Heavy Light, the story of my breakdown and healing, worked for me in the same way that Burton’s Anatomy seems to have done for him. You research, arrange and explore what happened to you. By talking through your experiences in an intimate dialogue with the reader — a generous, forgiving, interested figure in my conception, and slightly more time-pressed than Burton’s seems to have been, given Anatomy runs to over 1300 pages in paperback — you find a kind of harmony with them, and with your condition.

Investigating options for my treatment and researching the many ways in which we have conceived of the mind’s distempers was engrossing and often shocking. Recovery rates from breakdown were as good as ours in the early twentieth century, when it was accepted you could have a nervous collapse and then get better.

Psychiatry accepts that things went badly awry in the early 1960s, with the chemical imbalance theory, which held that distress came from a deficiency or excess, not in the humours, but in our brains. Psychotropic chemical solutions were mass-prescribed. The problem, as the sublimely melancholy Blackadder of the trenches said of the alliance system preceding the First World War, was that the theory was bollocks.

Happily, we are moving towards a Burtonian conception of mental distress which gives equal roles to the mind, body and spirit in the restoration of wellbeing. If you are suffering, we now know, you need time off work, a support group of family and friends, exercise, the guidance of a physician who may or may not prescribe medication, an acceptance that we all suffer sometimes, as well as the help and perspective offered by the arts, nature and creativity.

This was Burton’s original prescription, and we now share it. Researching Heavy Light, I found a widespread and growing conviction, shared by psychiatrists and psychologists, that holistic treatment — what the President of the Royal College of Psychiatrists, Dr Adrian James, refers to as “the biopsychosocial approach” — is the most hopeful way through what Burton would have seen as a worldwide crisis of melancholy.

All of us know someone who suffers. This may partly be due to the pandemic, which forced introspection on to so many, and partly because we talk about it, with a frankness that the internet has surely multiplied. I found that Burton’s conviction that what ails you ails you alone, in a specific and personal way, was vital to my recovery. Taking control of the language was crucial.

“How would you have treated me when I was in the grip of delusions?” I asked Yasmin Ishaq, a leading NHS practitioner in Open Dialogue, a progressive treatment for psychosis and schizophrenia which achieves dramatic results through talk and support, with a minimal role for medication.

“We normalise them,” she told me. “I would have said, ‘This is an absolutely understandable reaction to what has happened to you.’” Open Dialogue understands delusions as a kind of emergency language, a way of making sense of a world the sufferer can no longer bear.

Still, I was haunted by the fear that despite a long and robust recovery, I might not ever quite come back from what had happened to me. But then came a quietly amazing thing. “It’s not about curing, it’s about healing,” Yasmin Ishaq said.

It was so simple and yet it was an epiphany. In Burton’s terms, I was given permission to think about my path as an ongoing rebalancing — of humours, in his conception; of body and mind, of work and life, of rest and relationships, in ours.

Discussing melancholy and acute traumatic crisis with Mary Ann Lund and the psychiatrist Ahmed Hankir on Radio 4 last week, I used the term breakdown. The astonishing Hankir, an award-winning clinician who has performed his stigma-busting show The Wounded Healer to 75,000 people in 13 countries, queried the term. He experienced his crisis, he said, as a breakthrough.

And this is why I rather love the idea of Burton’s melancholy. It accepts a universe of different experiences and reactions, a universe as vast as humans are various. In his Ode on the subject, John Keats saw “veiled melancholy’s sovran shrine” as omnipresent – in his case, even in the “temple of delight”. Burton’s expanse of melancholy, he suggests, if only in tints and splashes, is part of all of us.

Horatio Clare’s Heavy Light: A Journey Through Madness, Mania and Healing is published by Chatto & Windus.