21 mai 2008

The company of fools may first make us smile, but in the end we always feel melancholy.

Pierre-Narcisse Guérin, Le Retour de Marcus Sextus, 1799.

The concept of melancholia was brought to life in the description.

Melancholia is a depressed state [meaning subdued, not a diagnostic category] of the entirepersonality reaction. Depression of spirits, psychomotor retardation and general torpidity of mind and body are its essential features. Invariably associated with these are insomnia, indigestion and constipation. It is true that morbid, restless anxiety often colours the depression, but in typical cases it is the general slowing up of the rhythm that characterizes the clinical picture.

Mental depression may be due to many causes, both physical and mental; toxemia reflex irritation and physical fatigue on the one hand and psychological stress on the other are responsible for many instances. But in the melancholic state – using that term to indicate a particular clinical condition – there is a sluggishness of mind manifested by diYculty in thinking, poverty of ideas and loss of attentive control that is not found in any kind of simple nervous epression. In well-developed cases the ‘‘slow-motion’’ life of melancholia is extraordinarily haracteristic; slow movements, retarded reaction and diYculty of ready response combine to present us with appearances that are familiar to all who have much to do with cases of mental disease. It is a clinical picture accentuated by the foetid breath, furred tongue and story of digestive troubles which express the inhibited gastro-intestinal functions. The lacklustre expression, lifeless hair and greasy complexion, which are equally common, complete a characteristic facies. In more severe degrees of melancholia one finds, as will be noted later, such symptoms as the above combined with hallucinations and delusions. The latter are usually concerned with ideas of wrong-doing, evil, disaster and death. The man who believes that he has committed the ‘‘unpardonable’’ sin and will not admit any doubt about it is always suVering from melancholia. No anxiety state representing a psychoneurosis ever produces a reaction of this kind.