‘Uncontrollable emotionality’: depression and diagnosis in the RCP library

The RCP library – despite the existence of the Royal College of Psychiatrists, which received its Royal Charter in 1926 – has collected books about depression, hysteria and other mental health issues for many years. Today, following World Mental Health Day on 10 October, we look at some of these items and the changes in diagnosis and treatment that they document.

For anyone who suffers from depression, anxiety or other mental health issues, the daily battle to counteract prejudice and stereotypes can be exhausting. Part of the battle lies in the fact that many people still do not recognise that it is not a sign of weakness, but a disease which we are all vulnerable to at different times of our lives. In our most recent acquisition on depression, The Noonday Demon (London: Vintage Books, 2014), Andrew Solomon illustrates the dichotomy between ‘ordinary’ sadness and depression as follows:

Depression is not just a lot of pain; but too much pain can compost itself into depression. Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance.

He goes on to describe his own experience of depression in vivid detail. He describes how, on visiting his home after a long absence, he empathises with an old oak tree, smothered in vines. He says ‘It was hard to say where the tree left off and the vine began’, and then relates how he too had been smothered by his depression:

My depression had grown on me as that vine had conquered the oak; it had been a sucking thing that had wrapped itself around me, ugly and more alive than I.

In 2012 the mental health foundation focused on depression for World Mental Health Day, stating that in any given year, 1 in 4 people will suffer from some form of mental illness, with depression the most common mental health issue. Many people seek help from their local surgeries but are disappointed by the response they get. Access to mental health services may be improving slowly, with recent calls for an acknowledged ‘parity of esteem’ between mental and physical health, but often the first response is to offer an exclusively pharmaceutical solution.

In Manufacturing Depression (London: Bloomsbury Publishing, 2010), the psychotherapist Gary Greenberg talks about the way in which the pharmaceutical industry had influenced and driven the treatment and diagnosis of depression. He describes how some ‘depression doctors’ have convinced swathes of people, living in hard economic times, that their unhappiness and discontent ‘can be corrected with a quick trip to the drugstore’. Instead of advising patients to seek emotional support and understanding from friends, relatives, or trained therapists and counsellors where available, pills are promoted as the answer to everything; a facile quick fix.

Certainly pills can’t answer everyone’s needs and the conception of depression as a disease may encourage a too limited approach to treatment. Depression is a multi-faceted condition that can eat away at an individual for years or suddenly overwhelm them. Treatments need to be personalised for the individual, taking account of their own needs and opinions; giving them the right to tell their own tale, write their own narrative. Unfortunately the provision of trained counsellors is still patchy and varies considerably from region to region. Busy doctors often can’t provide the thing that might make the most difference to patients; the experience of being listened to; of being heard.

Hysteria: the Biography. Andrew Scull, published Oxford,2009

In times past however reactions to and treatment for mental illness were even more constrained. In Hysteria: the Biography (Oxford: Oxford University Press, 2009), Andrew Scull considers the treatment of World War 1 victims of shellshock or what was then known as hysteria. Previously considered a largely feminine condition, the sheer number of soldiers reporting psychiatric symptoms challenged preconceived notions of feminine fragility. The word hysteria itself is from the Greek for uterus; an archaic reference to classical ideas about the instability of women’s internal organs.

As Scull puts it:

What was one to make of soldiers who suddenly lost the power of speech or hearing; who professed to be blind; who stammered, or twisted convulsively, or walked with a peculiar and unnatural gait; who wept or screamed unceasingly or displayed other symptoms of uncontrollable emotionality.

The initial reaction of many senior military men was to put those afflicted before a firing squad as cowardly traitors, but in time the taste for blood diminished and medics were given the task of curing the increasing number of victims and returning them to the front.

According to one contemporary expert, Charles Mercier, mental disorders only occurred in people whose constitution was ‘defective’ and such ‘degenerates’ were ‘weak, terrified, and decrepit souls … people deserving harsh treatment rather than sympathy and pensions’. A few privileged officers received slightly less barbaric treatment than enlisted men, but the most common treatments were a mixture of forceful persuasion and electrotherapy. Scull recounts one instance of an Austrian doctor who ‘applied powerful electrical shocks to men’s mouths and their testicles, forcing other shell-shocked soldiers to observe the “treatment” they were about to undergo’. At the Queen Square Neurological Hospital in London similar treatments prevailed; with mute patients subjected to a strong electrical current applied to the pharynx.

Hopefully we have come some way since these devastating treatments but there is still some way to go in terms of public understanding of mental health conditions and true ‘parity of esteem’ amongst the medical profession.

Explore the RCP library catalogue for more information on depression and other mental health issues.

Claire Sexton, collections development librarian

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