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Preventive Self-Help and the Six Nonnaturals: Remedies from Burton’s Anatomy of Melancholy

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Philosophical Issues in Pharmaceutics

Part of the book series: Philosophy and Medicine ((PHME,volume 122))

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Abstract

Among the ideas and themes in Burton’s Anatomy of Melancholy (1621) with apparent bearing on the treatment of depression in our own times, four are the subject of the present chapter. First, these herbal and other remedies were to be taken as part of a broader regimen of which no single part could be omitted. The regulation of exercise, fresh air, sleep, diet, evacuation, and feelings, believed to together keep the bodily humors in healthy balance, demanded habits and practices that were essential accompaniments to one another and to other measures. This was eclectic and holistic healing, only effective when combined. Second, adhering to this regimen was, for the most part, the individual’s own responsibility: it was an extensive self-help program. Third, it was preventive medicine, thought to ward off the symptoms of melancholy before they became entrenched and difficult to treat. And, finally, underlying and reinforcing these practical recommendations were ideas about the causes of, and remedies for, melancholy that are consonant with some recent challenges to the application of mainstream conceptions of disease in today’s medicine when it comes to the treatment of depression. Inasmuch as he seems to eschew “common cause” etiological models (as he does “magic bullet” or single-remedy assumptions), Burton’s account corresponds more closely to the network-based models beginning to be proposed for disorders of mood or affect.

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Notes

  1. 1.

    Recent historical works include Arikha (2007), Gowland (2006), Lund (2010), and Schmidt (2007).

  2. 2.

    All references are to the 1632 edition of the Anatomy of Melancholy (Burton 1989–2000, Thomas Faulkner, Nicolas Kiessling, and Rhonda Blair eds).

  3. 3.

    For this aspect of humoral lore, see Arikha (2007) and Gowland (2006).

  4. 4.

    The imagination, in his words “misinforming the heart, causeth all these distemperatures, alteration and confusion of spirits and humours” (I,2,3,1: 249). On the role of imagination, see Haskell (2011).

  5. 5.

    The use of black hellebore as a purgative by no less of an authority than Hippocrates is taken to confirm that, employed carefully, this plant is a strong and effective remedy against melancholy.

  6. 6.

    Culpeper’s work was first published as The English Physician, or Herball. (Culpeper 1985).

  7. 7.

    Borage and Hellebore are depicted in two of the eleven scenes and described as “The best medicines that ere God made” (Argument of the Frontispiece (lxii)).

  8. 8.

    The purgative function of these herbs, it has been emphasized, was symbolic as much as actual; purging purified: “…the replacement of the thick, overloaded blood of melancholics, heavy with bitter humours, with the light, clear blood whose fresh movement would dissipate delirium” (Foucault 2006: 310).

  9. 9.

    On the prevalence of such self-help texts in that era, see Lund (2010).

  10. 10.

    Scholars differ somewhat in the extent to which they interpret Burton’s seemingly cautious remarks on demons. See Gowland (2006).

  11. 11.

    The influence of Epicureanism in Europe came later, during the second half of the seventeenth century (Long 1986: 242).

  12. 12.

    These “phantastical and bewitching thoughts… so urgently, so continually set upon, creep in, insinuate, possess, overcome, distract and detain…[some people] cannot go about their more necessary business, stave off or extricate themselves, but are ever musing, melancholizing, and carried along…” (I,2,2,6).

  13. 13.

    Burton uses the words “cure” and “cured” in describing these treatments but confusingly to our modern ears, since cure has come to mean completed and successful remedy.

  14. 14.

    From the National Research Council and Institute of Medicine Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults are recommendations for “interventions before the disorder occurs [that offer] the greatest opportunity to avoid the substantial costs to individuals, families, and society that these disorders entail” (O’Connell et al. 2009: 1, emphasis added).

  15. 15.

    For some perspective, one estimate gives the relapse rate of symptoms during remission and recurrence after an episode of untreated depression at between 50 and 80% (Biegler 2011: 153).

  16. 16.

    See Kupfer et al. (1989).

  17. 17.

    See Cuijpers (1997).

  18. 18.

    The Global Burden of Disease Study’s predictions that depressive disorder would rise to second among the causes of disability were confirmed for some countries by 2002, by which time it ranked first in others (Mathers et al. 2008).

  19. 19.

    Recent research has distinguished “true” melancholic from non-melancholic depression employing criteria including severity and treatment responsiveness (Taylor and Fink 2006, Shorter and Fink 2010, Shorter 2011, and Parker and Hadzi-Pavlovic 1996).

  20. 20.

    “Integrated medicine” has been defined as combining mainstream biomedicine with complementary and alternative medicine, so that such effects can be attained (Dobos and Tao 2011: 11).

  21. 21.

    Research on patients seeking treatment for anxiety and depressive disorders (SADD), designed to measure the effectiveness of more holistic approaches, found them comparable to the effects of conventional (and homeopathic) medicine (Grimaldi-Bensouda et al. 2012).

  22. 22.

    Lifestyle includes “exercise, nutrition and diet, time in nature, relationships, recreation, relaxation and stress management, religious or spiritual involvement, and service to others” (Walsh 2011: 579). For a review of the effect of combined treatments on depression, see Pampallona et al. (2004). See also Stahl et al. (2014).

  23. 23.

    Aside from mainstream psychiatry, several consumer-driven movements including the recovery model have more strongly emphasized these approaches, it must be added, although these will not be discussed further here. See, for example, Jacobson and Greenley (2001).

  24. 24.

    Placebo responses are complex, multiform, and multimodal; it has been observed, involving many interacting neuronal systems that orchestrate changes in pain, motor control, mood, anxiety, memory, and motivation; and both conscious expectations and unconscious conditioning “move the molecules of change along the distributed biological systems, subserving cognition, emotions, pain control, reward and learning” (Nayak and Patel 2014: 74).

  25. 25.

    For a review of these differences, see Harrington (1997) and Jopling (2008) and Finnis et al. (2010). The anthropological perspective is to be found in Moerman (2002). The Declaration of Helsinki (2000) prohibits as unethical placebo-controlled trials for life-threatening conditions (or when proven safe and effective treatments are available) (World Health Organization 2001). Moreover, there is a strong ethical prohibition on deceiving patients, which complicates the design of placebo-controlled studies. For the data, see Jopling (2008: 117–40); for the explanations, see Harrington (1999); and on definitional issues, see Moncrieff et al. (2004) and Jopling (2008).

  26. 26.

    Recent efforts to define placebo effects, together with a revised definition, are provided by Jopling (2008: 132–47).

  27. 27.

    Empirical research on the networks model of depression is thus far limited. But one study of symptoms caused by stressful life events has shown the network model to have significant predictive advantages over common cause hypotheses (Cramer et al. 2011).

  28. 28.

    The relation between more and less severe forms of depression is disputed, those distinguishing melancholic and non-melancholic depression asserting a categorical separation. Moreover antidepressant medicines have long been known to outperform placebo more robustly when severe disorder is involved (Klein 1974).

  29. 29.

    Healy traces the initial magic bullet to 1930s work resulting in the first antibiotics (sulfa drugs).

  30. 30.

    That a multifactorial etiology for depression argues for a multipronged approach to intervention is voiced in some recent analyses. See Jacob (2012).

References

  • American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • Berrios, H. 2011. Preface to Diseases of the Imagination and Imaginary Disease in the Early Modern Period. In ed. Yasmin Haskell, xv–xxiii. Brepols Publishers.

    Google Scholar 

  • Biegler, P. 2011. The Ethical Treatment of Depression: Autonomy Through Psychotherapy. Cambridge, MA: MIT Press.

    Book  Google Scholar 

  • Borsboom, D., and A.O. Cramer. 2013. Network Analysis: An Integrative Approach to the Structure of Psychopathology. Annual Review of Clinical Psychology 9: 91–121.

    Article  Google Scholar 

  • Brown, W. 1998. The Placebo Effect. Scientific American 278: 90–95.

    Article  Google Scholar 

  • Burton, R. 1989–2000. The Anatomy of Melancholy. 6 vols. In Vols I-III: Text; vols IV-VI: Commentary by Bamborough JB and Dodsworth M, ed. T. Faulkner, N. Kiessling, R. Blair. Oxford: Oxford University Press.

    Google Scholar 

  • Cramer, A.O.J., D. Borsboom, S.H. Aggen, and K.S. Kendler. 2011. The Pathoplasticity of Dysphoric Episodes: Differential Impact of Stressful Life Events on the Pattern of Depressive Symptom Inter-correlations. Psychological Medicine 42: 957–965.

    Article  Google Scholar 

  • Cuijpers, P. 1997. Bibliotherapy in Unipolar Depression. Journal of Behavior Therapy and Experimental Psychiatry 28: 139–147.

    Article  Google Scholar 

  • Culpeper, N. 1985. Culpeper’s Compete Herbal. Ware: Omega Books.

    Google Scholar 

  • Dobos, G., and I. Tao. 2011. The Model of Western Integrative Medicine: The Role of Chinese Medicine. Chinese Journal of Integrative Medicine 17: 11–20.

    Article  Google Scholar 

  • Eardley, S., F.L. Bishop, P. Prescott, et al. 2012. A Systematic Literature Review of Complementary and Alternative Medicine Prevalence in EU. Research in Complementary Medicine 19(Suppl 2): 1661–4119.

    Google Scholar 

  • Eherenberg, A. 2010. The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age. Montreal: McGill-Queens University Press.

    Google Scholar 

  • Embry, D.D. 2011. Behavioral Vaccines and Evidence-Based Kernels: Nonpharmaceutical Approaches for the Prevention of Mental, Emotional, and Behavioural Disorders. Psychiatric Clinics of North America 34: 1–24.

    Article  Google Scholar 

  • Finnis, D., T. Kaptchuk, F. Miller, and F. Benedetti. 2010. Biological, Clinical and Ethical Advances of Placebo Effects. Lancet 375: 686–695.

    Article  Google Scholar 

  • Foucault, M. 2006. History of Madness. Trans. Jonathan Murphy and Jean Khalfa. London/New York: Routledge.

    Google Scholar 

  • Frass, M., R.P. Strassl, H. Friehs, et al. 2012. Use and Acceptance of Complementary and Alternative Medicine Among the General Population and Medical Personnel: A Systematic Review. The Ochsner Journal 12: 45–56.

    Google Scholar 

  • Gowland, A. 2006. The Worlds of Renaissance Melancholy: Robert Burton in Context. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Grimaldi-Bensouda, L., P. Engel, J. Massol, et al. 2012. Who Seeks Primary Care for Sleep, Anxiety and Depressive Disorders from Physicians Prescribing Homeopathic and Other Complementary Medicine? Results from the EP13 population survey. British Medical Journal Open 2: 001498.

    Google Scholar 

  • Hahn, R.A. 1999. The Nocebo Phenomenon: Scope and Foundations. In The Placebo Effect: An Interdisciplinary Exploration, ed. A. Harrington, 56–76. Cambridge: Harvard University Press.

    Google Scholar 

  • Harrington, A., ed. 1999. The Placebo Effect: An Interdisciplinary Exploration. Cambridge: Harvard University Press.

    Google Scholar 

  • Haskell, Y., ed. 2011. Diseases of the Imagination and Imaginary Disease in the Early Modern Period. Turnhout: Brepols Publishers.

    Google Scholar 

  • Healy, D. 1997. The Anti-Depressant Era. Cambridge: Harvard University Press.

    Google Scholar 

  • Hollandare, F., S. Johnsson, M. Randestad, M. Tilfors, et al. 2011. Randomized Trial of Internet-based Relapse Prevention for Partially Remitted Depression. Acta Psychiatrica Scandinavica 124: 285–294.

    Article  Google Scholar 

  • Jacob, K.S. 2012. Depression: A Major Public Health Problem in Need of a Multi-sectorial Response. The Indian Journal of Medical Research 136(4): 537–539.

    Google Scholar 

  • Jacobson, N., and D. Greenley. 2001. What is Recovery? A Conceptual Model and Explication. Psychiatric Services 52: 482–485.

    Article  Google Scholar 

  • Jopling, D. 2008. Placebos and Placebo Effects. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Kendler, K.S., P. Zachar, and C. Craver. 2011. What Kinds of Things are Psychiatric Disorders? Psychological Medicine 41: 1143–1150.

    Article  Google Scholar 

  • Kirsch, I., ed. 1999. How Expectancies Shape Experience. Washington, DC: American Psychological Press.

    Google Scholar 

  • Kirsch, I., T.J. Moore, A. Scoboria, and S.S. Nicholls. 2002. The Emperor’s New Drugs: An Analysis of Antidepressant Medication Data Submitted to the U.S. Food and Drug Administration. Prevention and Treatment 5, Article 23.

    Google Scholar 

  • Klein, D.F. 1974. Endogenomorphic Depression: A Conceptual and Terminological Revision. Archives of General Psychiatry 31: 447–454.

    Article  Google Scholar 

  • Kramer, P. 2005. Against Depression. New York: Viking.

    Google Scholar 

  • Kupfer, D.J., E. Frank, and J.M. Perel. 1989. The Advantage of Early Treatment Intervention in Recurrent Depression. Archives of General Psychiatry 46: 771–775.

    Article  Google Scholar 

  • Long, A.A. 1986. Hellenistic Philosophy: Stoics, Epicureans, Sceptics. 2nd ed. Berkeley/Los Angeles: University of California Press.

    Google Scholar 

  • Lund, M. 2010. Melancholy, Medicine and Religion in Early Modern England: Reading The Anatomy of Melancholy. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Mathers, C., D.M. Fat, and J.T. Boerma. 2008. The Global Burden of Disease: 2004 Update. Geneva: World Health Organization.

    Book  Google Scholar 

  • McLaughlin, K.A. 2011. The Public Health Impact of Major Depression: A Call for Interdisciplinary Prevention Efforts. Prevention Science 12: 361–271.

    Article  Google Scholar 

  • Merry, S., S.E. Hetrick, G.R. Cox, et al. 2012. Evidence-Based Child Health. Cochrane Review Journal 7: 1409–1685.

    Google Scholar 

  • Moerman, D. 2002. Meaning, Medicine, and the ‘Placebo Effect’. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Moncrieff, J. 2009. The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. New York: Palgrave MacMillan.

    Google Scholar 

  • Moncrieff, J., S. Wessely, and R. Hardy. 2004. Active Placebos Versus Antidepressants for Depression. Cochrane Database of Systematic Reviews 1: CD003012.

    Google Scholar 

  • Mora, M.S., Y. Nestoriuc, and W. Rief. 2011. Lessons Learned from Placebo Groups and Anti-depressant Trials. Philosophy Transactions of the Royal Society of London: Series B 366: 1879–1888.

    Article  Google Scholar 

  • Mrazek, P.J., and R.J. Haggerty, ed. 1994. Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. Washington, D.C.: National Academies Press.

    Google Scholar 

  • Murray, C.J., and A.D. Lopez. 1997. Alternative Projections of Mortality and Disability and the Contribution of Risk Factors: Global Burden of Disease Study. Lancet 349(9063): 1436–1442.

    Article  Google Scholar 

  • Nayak, D., and P. Patel. 2014. Neural Mechanisms of Placebo Effects. Psychiatric Annals 44(2): 74–78.

    Article  Google Scholar 

  • O’Connell, M.E., T. Boat, and K.E. Warner (eds). 2009. Preventing Mental, Emotional and Behavioral Disorders Among Young People: Progress and Possibilities. National Research Council (US) and Institute of Medicine (US) Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Intervention. Washington, DC: National Academies Press.

    Google Scholar 

  • Palazidou, E. 2012. The Neurobiology of Depression. British Medical Bulletin 101: 127–145.

    Article  Google Scholar 

  • Pampallona, S., S. Bollini, G. Tibaldi, B. Kupelnick, and C. Munizza. 2004. Combined Pharmacotherapy and Psychological Treatment for Depression: A Systematic Review. Archives of General Psychiatry 61: 714–719.

    Article  Google Scholar 

  • Parker, G., and D. Hadzi-Pavlovic, ed. 1996. Melancholia: A disorder of Movement and Mood: A Phenomenological and Neurobiological Review. Cambridge: Cambridge University Press.

    Google Scholar 

  • Radden, J. 2003. Is This Dame Melancholy? Equating Depression and Melancholia. Psychiatry, Philosophy and Psychology 10(1): 37–52.

    Article  Google Scholar 

  • ———. 2009. Moody Minds Distempered: Essays on Melancholy and Depression. New York: Oxford University Press.

    Google Scholar 

  • ———. 2013. Shared Descriptions: What Can be Concluded? Commentary. Philosophy, Psychiatry and Psychology 20: 157–159.

    Article  Google Scholar 

  • Rhead, J.D. 2014. The Deeper Significance of Integrative Medicine. Journal of Alternative and Complementary Medicine 20: 329–329.

    Article  Google Scholar 

  • Schmidt, J. 2007. Melancholy and the Care of the Soul: Religious, Moral Philosophy and Madness in Early Modern England. Aldershot: Ashgate Publishing Company.

    Google Scholar 

  • Shorter, A. 2011. Still Tilting at Windmills Commentary on: The Myth of Mental Illness. The Psychiatrist 35(5): 183–184.

    Article  Google Scholar 

  • Shorter, A., and M. Fink. 2010. Endocrine Psychiatry: Solving the Riddle of Melancholia. New York: Oxford University Press.

    Google Scholar 

  • Stahl, S.T., et al. 2014. Coaching in Healthy Dietary Practices in At-risk Older Adults: A Case of Indicated Depression Prevention. The American Journal of Psychiatry 171: 499–505.

    Article  Google Scholar 

  • Taylor, M.A., and M. Fink. 2006. Melancholia: The Diagnosis, Pathophysiology, and Treatment of Depressive Illness. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Turner, E.H., et al. 2008. Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy. The New England Journal of Medicine 358: 252–260.

    Article  Google Scholar 

  • Van Straten, A., P. Cuijpers, and N. Smits. 2008. Effectiveness of a Web-Based Self-help Intervention for the Symptoms of Depression, Anxiety, and Stress: Randomized Controlled Trial. Journal of Medical Internet Research 10(1): e7.

    Article  Google Scholar 

  • Van Voorhees, B.W., et al. 2011. Internet-Based Depression Prevention over the Life Course: A Call for Behavioral Vaccines. Psychiatric Clinics of North America 34(1): 167–183.

    Article  Google Scholar 

  • Varga, S. 2013. From Melancholia to Depression: Ideas on a Possible Continuity. Philosophy, Psychology and Psychiatry 20(2): 141–155.

    Article  Google Scholar 

  • Walsh, R. 2011. Lifestyle and Mental Health. The American Psychologist 66: 579–592.

    Article  Google Scholar 

  • Wichers, M. 2014. The Dynamic Nature of Depression: A New Micro-Level Perspective of Mental Disorder that Meets Current Challenges. Psychological Medicine 44: 1349–1360.

    Article  Google Scholar 

  • World Medical Association. 2001. World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. Bulletin of the World Health Organization 79(4): 373.

    Google Scholar 

  • Zachar, P. 2014. A Metaphysics of Psychopathology. Cambridge, MA: MIT Press.

    Book  Google Scholar 

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  1. Philosophy Department, The University of Massachusetts Boston, Boston, MA, USA

    Jennifer Radden

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    Dien Ho

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Radden, J. (2017). Preventive Self-Help and the Six Nonnaturals: Remedies from Burton’s Anatomy of Melancholy . In: Ho, D. (eds) Philosophical Issues in Pharmaceutics. Philosophy and Medicine, vol 122. Springer, Dordrecht. https://doi.org/10.1007/978-94-024-0979-6_14

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