The case was presented as evidence of melancholia as a disease of the physiology of emotion rather than an illness causing visible and lasting structural damage to the brain. This failure to find lesions on her brain was, however, used as a defence of the cerebral theory rather than to rebuke it. Her subsequent death was deemed the result of liver failure unrelated to her mental disturbance the post-mortem examination revealed no abnormalities of brain tissue. He cited in support of this argument the case of a forty-six-year-old woman diagnosed with melancholia.
8 He suggested that, while visible lesions may not always be discovered, indeed may not occur at all, mental disease nonetheless always entailed a disorder of brain function. In a speech delivered at Hanwell Asylum the same year as the article quoted above, John Hitchman forcefully argued that ‘ n every case of insanity, there is irritation, or disease of the grey matter in the encephalon’. 7 Internally, melancholia was conceptualised in physiological (functional) rather than anatomical (structural) language as a form of insanity that rarely left visible marks on the brain. Cases of intense melancholia have come under our notice and care, in which we could not trace the faintest semblance of delusion of any kind’.
The answer offered by the author 6 was decisive: ‘We doubt it. An editorial in the Journal of Psychological Medicine in 1850 posing the question ‘Are delusions always present in melancholia?’ is illustrative of this approach. Externally, it was perceived as a form of mental disease in which emotion was the main, or only, faculty affected, and as such it could present without delusion of thought. The biomedicalmelancholia that emerged at mid-century had two important conceptual features, one external and one internal. 5 Moreover, it is equally important to note that both these explanations are quite far apart from the twenty-first-century neurochemical model for disorders of mood. The twenty-first-century reader must, however, note that to suggest, as Enlightenment physician Phillipe Pinel did, that strong passions can be a cause or symptom of madness, is something quite different from suggesting that emotion is a physiological process prone to disorder and disease. It was foundational to the modern medical concept of disordered mood, and has persisted in some form or another until the present.
4 This idea, emerging before psychiatry itself, proved popular, flexible, and durable. At the turn of the century, medical writers had begun to argue that the ‘passions’ played a central role in milder forms of insanity. This chapter maps the shifting nosological status of melancholia in mid-century British medical literature, beginning in the 1830s and ending with Sankey’s review of contemporary literature on the topic.
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