A group of academics have raised the possibility that the eighteenth-century Scottish poet Robert Burns had bipolar disorder, making the laudable enough claim for their work that accepting that ‘the national bard might have been depressive could increase acceptance of mental health issues’. While they were probably aware of the contradiction, in retrospectively diagnosing Burns with a disorder that didn’t even exist as a concept during his lifetime, the scholars risked making one of the fundamental mistakes in the study of the history of psychiatry. Burns himself knew his condition as ‘melancholia’ or ‘hypochondria’, and these conditions had their own discrete cultural associations and intimations during his time. Surely studying how these now defunct psychological categories used to be thought about might have more to tell us about how Burns experienced his mental illness than an un-historically imposed category of a later culture’s creation?
The approach these scholars adopted to studying the mind of this poet of the past has an eerie and rather surprising analogy in the way mental illnesses are diagnosed in modern psychiatric culture. If the Burns scholars assumed to use an abstract scientific category to separate Burns’s mental illness from his lived experience, his culture, and the language he had available for thinking through his condition, then DSM-5 – the psychiatrists’ manual for diagnosing mental illness – does something similar for people who suffer with mental health problems today. DSM-5’s exhaustive descriptions of different categories of mental illness tend to assume that these diseases come primarily from some fault in the body, that the causes and symptoms of a given illness will be consistent from patient to patient, and that an identical cure – usually drugs or cognitive behavioural therapy – can be effected on anyone suffering from that given group of symptoms. There is little here that reflects the view of the clinical psychologist who has recently stressed the ‘overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse’. Nor of the many psychoanalysts who argue that it is not ‘curing’ the disease behind the symptoms, but recalibrating the way a given patient relates to those symptoms in their life, that forms the most effective therapy. If we think in words, and mental illnesses are afflictions of the mind, then they must, to some degree, begin in language, even if this need not exclude a biological dimension. What the Burns scholars and DSM-5 have in common, however, is an indifference to this possibility that mental illness and distress are socially situated and emerge from and can be comprehended only though social and cultural interaction.
In The Gay Science, Nietzsche argues that while modern science may claim to have achieved superior powers of ‘explanation’, what it does better suits the name ‘description’. ‘We do not explain any more than our predecessors’, he remarks, it is only that ‘our descriptions are better’. DSM-5 would seem to be exemplary performance of this kind of excessive description that never quite reaches explanation. For all its exhaustive accounts of the diseases it documents, it is questionable whether the model of mental illness it promotes can give us insight into what mental illness actually is. Nietzsche suggests that what holds us back from really getting to grips with the things we try to explain is the peculiar human narcissism of discussing everything only in terms of human agency. ‘Nobody has “explained” a push’, he remarks, because while we can talk very eloquently about the person doing the pushing and the person or object getting pushed, or even about the physics of the forces involved, the space of the ‘push’ in itself lies elusively and irreducibly outside our conventional forms of communication. The same is true of many illnesses: like a push, a cough or cancer just is, and beyond speaking of the humans they affect or the biological processes that underpin them, language fails when we try to strip back their human associations and explain them as they are. Uniquely, however, this is not quite the case with mental illness, which takes place only in the bounds of interaction between human beings. Surprisingly enough, madness may be one of the very few phenomena actually within grasp of human explanation as opposed to mere description: not because when we speak of it we manage to slip out of the anthropocentric habits Nietzsche warns us about, but precisely because it is one of the rare things to which such habits of thought are entirely appropriate.
To speak of melancholic illnesses in human terms: is this not exactly what the literature of melancholy –before and after Burns – has always tried to do? We would be foolish and sentimental to consider that studying the literature of melancholy could provide a cure for mental distress, but it may be able to articulate ways in which the melancholic can assert their presence in the world, rather than being reduced to a diagnostic category, which, it seems, does little to allow them to comprehend their own situation.