Insomnie : maladie des époques au cours desquelles on ordonne aux hommes de fermer les yeux.

Joseph Wright, The Alchemist in Search of the Philosopher's Stone, 1771.

The recent literature has equally compelling descriptions. In a memoir of his illness, the novelist William Styron oVers a poignant description of melancholia. After depending on alcohol ‘‘as a conduit to fantasy and euphoria, and to the enhancement of the imagination’’ for more than 40 years, he was suddenly unable to drink without experiencing nausea, ‘‘wooziness,’’ and epigastric distress. He slowly became melancholic.

At first he experienced malaise; the shadows of nightfall seemed more somber, the mornings less buoyant. Insomnia and a host of bodily fears followed and everything ‘‘slowed down.’’ He became suicidal, explaining that: ‘‘The pain of severe depression is quite unimaginable to those who have not suVered it, and it kills in many instances because its anguish can no longer be borne.’’

Frightened of these thoughts, he turned to a hospital for asylum. Its protection and the support of antidepressant medication and of friends allowed him to heal slowly; he avers that the protection served him well.

A physician describes his experience with melancholia:

Depressive illness is probably more unpleasant than any disease except rabies.

There is constant mental pain and often psychogenic physical pain too. If one tries to get such a patient to titrate other pains against the pain of his depression one tends to end up with a description that would raise eyebrows even in a medieval torture chamber.

Naturally, many of these patients commit suicide. They may not hope to get to heaven but they know they are leaving hell. Secondly, the patient is isolated from family and friends, because the depression itself reduces his affection for others and he may well have ideas that he is unworthy of their love or even that his friendship may harm them. Thirdly, he is rejected by others because they cannot stand the sight of his suVering . . . Fourthly, the patient tends to do a great cover-up . . . he does not tell others how bad he feels.