On Melancholy: the Physiological aspects of depression and bi-polar

Last night, I posted a semi-defense of certain controversial comments made in the wake of Robin Williams’ suicide and a general suggestion of how Matt Walsh, Rush Limbaugh, Bryan Kemper and others might have done better.

Part of Matt Walsh’s appeal is that, like the early Limbaugh, he uses sensationalistic packaging to get people’s attention to pieces that are usually very thoughtful. In this case, which backfires horribly because his piece isn’t as thoughtful as he thinks, he emphasized the notion that “Robin Williams didn’t die of a disease; he died of a choice.” At one point, he says, “First, suicide does not claim anyone against their will.”

He anticipates this response a few paragraphs above, but that is precisely the problem. Mental health issues, addiction, etc., reduce or remove culpability. Now, the mentally ill person may remain culpable for what is done while sane, but the question–which none of us can answer in this life–is whether the person who commits suicide truly has control of his or her will.

People like causes. They like to have someone or something to blame, especially if it isn’t themselves. “He was depressed because his career was in the tank” is an easy target versus “He was depressed because he had a genetic condition that made it difficult to control his emotions.” That gets into a mess of problems about free will versus determinism. Then there’s the controversial, “He was post-abortive,” which I want to discuss in a separate post, but while guilt, financial troubles, or frightening medical diagnoses may contribute to mental health issues, we cannot deny that there are physiological components. Matt Walsh is right that there are spiritual components, but wrong to dismiss “chemical imbalances” as modernist mumbo jumbo. Physiological understandings of depressive disorders are nothing new at all.

It is precisely “He was depressed because of XYZ” that is “modernist mumbo jumbo,” originating with Freud’s era.  Back in the old days, instead of “chemical imbalances,” people talked about “humors.” Melancholy is usually associated with depression, though the “melancholic temperament” would be what we now call “bipolar” and possibly include even autism. The melancholic is concerned about the troubles of the world, prone to mood swings, etc. Literature’s most notorious melancholic is perhaps Prince Hamlet from Shakespeare’s eponymous play. Three major movies made of the play within a decade demonstrate different psychological interpretations of the character:

The Zeffirelli/Gibson film (1990) depicts Hamlet as bipolar, mostly manic or “rapid cycling.”  
The Branagh/Branagh (1996) version depicts Hamlet as almost sociopathic (choleric), with the melancholy a complete facade.
The Almereyda/Hawke (2000) version depicts Hamlet as straight-up clinically depressed.  

Either way, all effective writers are natural psychologists and write their characters so well that they can be readily diagnosed (always baffles me that people insist you can’t “diagnose” fictional characters because a particular health problem or mental health issue wasn’t named: people still had problems).  Shakespeare drew from the psychology of his day and also left the character open to interpretation because he was aware of the debates that existed even then.

One of the concerns Walsh, and many others raise in critiquing a biological interpretation of mental health, is the spiritual component.  Fr. John Corapi would compare it to any physical disease: you might have a genetic predisposition to something. Then you add in the component of an actual physical trauma, poor nutrition, etc. Then bacteria come into the wound and infect it.

With mental health, you may have a genetic predisposition to bi-polar, depression, schizophrenia, autism spectrum, etc. You experience traumas that other experience but they hurt you more because of your predispositions. Things that might cause a brief situational depression for anybody are devastating (or, conversely, one thrives in a crisis). Then the demons, like bacteria in a wound, come along and whisper “You’re unworthy.” They infect the emotional wound and refuse to leave.  That certainly needs to be dealt with, and most treatment programs acknowledge it.  

“Madame has moments of melancholy,” says Max in Billy Wilder’s Sunset Boulevard (1950).  Norma Desmond, also clearly bipolar (mania demonstrated by her literally insane, rambling “script” that she’s been working on for years), has made several attempts on her life, and Max has removed all the doorknobs in the house, as well as all knives and razors (“Madame got the razor from your room, and she cut her wrists!”)

If Robin Williams had shot himself, certain people would be calling for restricting the ability of mentally ill people to own guns. They cite statistics on gun deaths in America, more than half of which are suicides.  It is noteworthy that these same people objected to “politicization” of his death when some pro-lifers pointed to his status as a post-abortive father (post-abortion syndrome contributing to many suicides), or when Rush Limbaugh, ironically or inadvertently “politicized” his death by complaining about the media politicizing it.  Yet the same people would have readily “politicized” it if it had been a gun suicide.

That’s another easy cause, though, that  people look for.  They try to say, “It’s guns,” except when it’s not guns.  Nobody is talking about legal action to restrict ownership of ropes, or belts, or plastic bags, or knives or razors by mentally ill people.  The real issue there is why people must rely on the government for everything. 

A desperate person will find a means.

One last observation under this topic is the question of medication.  Some people will say, “See?  This proves meds don’t work!” or “This proves meds make things worse!”  One of the reasons it’s important to nail down the right diagnosis is that the wrong medicine really can be disastrous.  Someone with bipolar needs to be on bipolar meds, not necessarily anti-depressants or anti-anxiety meds, which can cause a horrible mania and, in turn, drastic behavior.  

Accurate diagnosis is so very important, as are accurate treatment methods.  

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