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Wednesday 26 June 2013

Readings: Anxiety Disorders in The Anatomy of Melancholy

A Condensed Edition
I’ve been reading a bit from The Anatomy of Melancholy by Robert Burton (1577-1640), a contemporary of Shakespeare. He was a scholar at Oxford University and spent most of his life writing and rewriting the book, which is something of a dog’s breakfast of observations, anecdotes, humourous asides, and advice for those afflicted by melancholy - what today we would call depression.

Although much of the content is only tangentially related to the subject of depression, Burton reveals the motivation behind the work in his preface:

"I write of melancholy, by being busy to avoid melancholy. There is no greater cause of melancholy than idleness; no better cure than business."

Essentially it was a self-help book: by occupying himself with its creation, Burton strove to extricate himself from the depression he himself experienced.

One of his passages is striking for its descriptions of anxiety-related conditions, paralleling modern observations about the same conditions.  Here’s a passage, broken up by my interruptions:

Montanus [2nd century Christian convert who believed himself a prophet] speaks of one that durst not walk alone from home, for fear he should swoon or die. 

This sounds intriguingly like what today we would call agoraphobia. Directly translated as "fear of the agora (marketplace), in fact it is a fear of physical symptoms overtaking a person while they are away from home. It is the symptoms that are feared, not the marketplace.

A second fears every man he meets will rob him, quarrel with him, or kill him.

Paranoia perhaps – or hypervigilant stress?

A third dares not venture to walk alone, for fear he should meet the devil, a thief, be sick; fears all old women as witches, and every black dog or cat he sees suspecteth to be a devil, every person comes near him is malificiated [possessed, I think, though I may be mistaken], every creature, all intend to hurt him, seek his ruin; 

Supernatural fears seem to be somewhat less common these days, but may find their counterpart in fears of alien abduction, etc. And it is not uncommon to hear a fearful person describe strangers as malevolent beings ready to judge or harm them.

another dares not go over a bridge, come near a pool, rock, steep hill, lie in a chamber where cross beams are, for fear he be tempted to hang, drown, or precipitate [throw] himself. 

Now this is interesting! Burton, referencing Montanus, describes the thinking underlying most fear of heights, which is actually a fear of loss of impulse control. Notice that he is not saying the person wants to commit suicide: They fear throwing themselves off the height on impulse. They don't want to do it. But they worry they might anyway, on impulse.  This is exactly what people with fear of heights report - a sense of being drawn or tempted over the edge. In effect, they aren't afraid of heights, nor of falling (no one fears that the bridge might be unsound and about to collapse). They are afraid of jumping.

If he be in a silent auditory, as at a sermon, he is afraid he shall speak aloud at unawares, something indecent, unfit to be said. 

This is a fairly standard obsessive thought seen in many with OCD. I'll start to yell or say inappropriate things in a play, or at a concert, or in church. They don't generally do it, but there is a fear that they might.

If he be locked in a close room, he is afraid of being stifled [suffocated; unable to breathe properly] for want of air, 

This is the core fear underlying most cases of claustrophobia. It isn't the enclosure, usually, it is the sense of being unable to breathe - despite conscious knowledge that there is plenty of air and that suffocation is not a real danger.

and still carries biscuit, aquavitae, or some strong waters about him, for fear of deliquiums [essentially, fainting], or being sick; 

This describes the habit of many people who suffer panic attacks of carrying objects as safety aids. Common ones these days include cell phone, anti-anxiety medication, water bottle, and so on. many who suffer panic attacks of compulsively carrying safety aids (water, cell phone, antianxiety medication) in the event of an attack. Aqua vitae and strong waters, in Burton's case, essentially means booze. And indeed some folks with anxiety problems do this too.

or if he be in a throng, middle of a church, multitude, where he may not well get out, though he sit at ease, he is so misaffected. 

This describes a person who manages to suppress the desire to flee but only with great distress.

He will freely promise, undertake any business beforehand, but when it comes to be performed, he dare not adventure, but fears an infinite number of dangers, disasters, etc.

Every therapist has seen this: the person who fully understands the idea of facing one’s fears and selects a task that seems perfectly reasonable to them in the office, but never winds up being carried out.

*   *   *

Burton may not have managed to cure his own mood disorder, but he certainly had an understanding of many aspects of anxiety and its manifestations.

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