The Faces of Depression in Literature

by Josefa Ros Velasco (Volume editor)
Edited Collection XXIV, 234 Pages

Table Of Content

  • Cover
  • Title
  • Copyright
  • About the editor
  • About the book
  • This eBook can be cited
  • Table of Contents
  • List of Contributors
  • Preface: From Boredom to Depression (From Philosophy to Psychology) (Josefa Ros Velasco (Harvard University, Cambridge))
  • Abbreviations
  • Part I Spirituality and Depression from the Middle Ages to Modernity
  • 1 Acedia and Its Relation to Depression (Derek McAllister (Baylor University, Texas))
  • 2 Depression in Ricardian Dream Visions (Nancy Ciccone (University of Colorado))
  • 3 Giambattista Vico and the Melancholy of History (Miriam Muccione (University of Chicago))
  • 4 Depression in the Literature of the Health Reform and Mental Hygiene Movement: An Example of Ellen G. White Writings (Pawel Zagozdzon (Medical University of Gdansk, Poland))
  • Part II Secularization of Depression in Modern and Contemporary Literature
  • 5 Nihilism, Depression, and Wholeheartedness. Metacognitive Strategies in 19th-Century Literature (Søren Harnow Klausen (University of Southern Denmark))
  • 6 Can Melancholy Be Heroic? Walter Benjamin and the Vicissitudes of Melancholy (Shannon Hayes (Tennessee State University))
  • 7 Anhedonia, Dysthymia, and Tristasia: Depressed Characters in Alice McDermott’s Novels (Gail Shanley Corso (Neumann University, Pennsylvania))
  • 8 Broken Promise: Depression as Ex-Gifted Girl Identity in Elizabeth Wurtzel’s Prozac Nation (Nora Augustine (The University of North Carolina at Chapel Hill))
  • 9 Unclean Subject(s) of Depression within the Singaporean State (Hannah Ming Yit Ho (University of Brunei Darussalam))
  • Part III Narrations and Metaphors on Depression from and for the Clinical Practice
  • 10 Inner Voices: Literary Realism and Psychoanalysis (Josie Billington (University of Liverpool))
  • 11 Rewriting Mecca: Teaching about Late-Life Depression Using John Metcalf’s “The Years in Exile” (Lucia Gagliese (York University, Ontario))
  • 12 This Aisle Has More Than Two Sides: Insights into Depression, Provided by Medical Doctors (Angelika Potempa (The University of Texas Rio Grande Valley))
  • 13 Metaphors of Depression in American Short Fiction (Ioana Unk (Independent Scholar, California))
  • Index

List of Contributors

Josefa Ros Velasco (Harvard University, Cambridge)

Derek McAllister (Baylor University, Texas)

Nancy Ciccone (University of Colorado)

Miriam Muccione (University of Chicago)

Pawel Zagozdzon (Medical University of Gdansk, Poland)

Søren Harnow Klausen (University of Southern Denmark)

Shannon Hayes (Tennessee State University)

Gail Shanley Corso (Neumann University, Pennsylvania)

Nora Augustine (The University of North Carolina at Chapel Hill)

Hannah Ming Yit Ho (University of Brunei Darussalam)

Josie Billington (University of Liverpool)

Lucia Gagliese (York University, Ontario)

Angelika Potempa (The University of Texas Rio Grande Valley)

Ioana Unk (Independent Scholar, California)

Preface: From Boredom to Depression (From Philosophy to Psychology)

Josefa Ros Velasco

Harvard University, Cambridge

“You get depressed because you know that you’re not what you should be.”

Brian Hugh Warner (Marilyn Manson)

The Long Hard Road Out of Hell (1998)

I had never been interested in depression academically speaking, or so I thought. Depression was, for me, a state of anguished sadness—whose roots or reasons were sometimes explicable and sometimes nonconceptualizable1—generally experienced as a constant whisper and, from time to time, more intensely and painfully. I know it because I suffered from such a state throughout my entire life: a permanent restlessness. I am convinced that this was what prompted me to study philosophy at the age of 17 to better understand myself. I never considered the option of enrolling in psychology and much less in psychiatry or something like that. I did not appreciate any connection between that state and the mental health sciences, even though I had seen a therapist, on two or three occasions—when the intensity curve reached unbearable peaks—who gave me tablets for combating depression that, I have to say, made me feel much better—I do not remember the name of that drug, it sounded like … I-don’t-know-nine. Philosophy did not help me at all. On the contrary, it increased my malaise to astronomical levels. When I hit rock bottom—I knew it because melancholy turned into paranoia and, in a short run, I developed an exaggerated arachnophobia—one of my last visits to a mental health professional—this time a psychiatrist—at the age of 22 concluded with the diagnosis of an Obsessive-Compulsive Disorder (OCD) with depressive symptoms. I went straight to the pharmacy—as I would have to do every month for the next few years and, as I later realized, for the rest of my life—to buy my Aremis;2 this time I remember the name. Except when I had the brilliant idea, a couple of years ago, of stopping the treatment—coinciding with a professional promotion that took me to Harvard University, in Massachusetts, to work on my subject of research: boredom—I have not experienced such a time of collapse or crisis again. In those days, I had such a wrong time, and it took me so long to rediscover a zest for life after resuming my treatment—which, by the way, took more than a month to arrive in the United States—that I have never cast doubt again on the fact that my proneness to depression had at least something to do with the mental health sciences—or maybe I had become addicted to pills. However, at that moment, I did it, and I argued that the melancholy that had made Kierkegaard or Sartre so special had to be released. In an attempt to accept and self-affirm myself with my multiple defects, I was convinced that the state I called—and also other people called—depressive was part of me. I remember myself that summer deciding to open the Pandora’s Box that my Aremis so carefully guarded. My doctoral work on boredom was the culprit.

My doctoral dissertation was devoted to deepening and relating the positions of the German philosopher Hans Blumenberg and Professor of Classical Studies Peter Toohey (University of Calgary, Alberta) on the adaptive function of boredom and its role in human evolution as a counterweight to current mental health professionals who claim the existence of a problem of chronic boredom fundamentally physiological. Then I came into contact for the first time with the question of depression from an objective point of view: researchers often linked boredom and depression as two mutually influencing states, often dependent on each other, as part of the same phenomenon that feeds back incessantly—a snake biting its own tail. My refusal to accept boredom as a state-related to mental health, even if we call it chronic, also led me to distrust what I believe that were other states or other personality traits assimilated: depression, anxiety, stress … It was my interest in boredom that made me come into contact, by chance, with the world of mental illness, with personality and behavior disorders, with the DSM and, of course, with the critics of the latter and its excesses. That is how I came to think, when I concluded my doctoral dissertation, that whatever was happening to me was outside of the sanitary domain and that everyone was wrong. That time, like many others, the wrong one, and who was exceeding the competences was me.

After recognizing my mistake and regaining the strength to continue working on my research on boredom—down-to-earth—I decided to adopt another approach to boredom: I began delving into the philosophical, theological, and literary narratives throughout the history of the West in which boredom had been understood as a phenomenon related to health to clarify the path by which it had come to become a matter of psychological and psychiatric interest in the 20th and 21st centuries. To that task, I dedicated my time in the Department of Romance Languages and Literatures at Harvard University. Moreover, once again, I came across the couple boredom-depression. However, this time, it was not just a promising partner for contemporary researchers but one of those lifelong marriages in which one of the spouses does not go anywhere without the other, and only death separates.

Boredom and depression went hand in hand from the texts of antiquity to those of the most immediate present. Suffice to mention the biographies of Gaius Marius and Pyrrhus of Epirus, in Plutarch’s De viris illustribus (see optionally Toohey 1987, 1988, 2004—especially the first one, “Plutarch, Pyrrh. 13: άλνς ναντιώδης”—and also Ros Velasco 2017, 2021). Notably, this union began becoming more evident from the late Middle Ages and early Renaissance, when acedia started to merge in melancholy (see, at the beginning, Ponticus, according to Hernán Vázquez 2015; Cassian, from the point of view of Peretó Rivas 2010, 2011, 2013 [in this last work we can see also the association of boredom and depression in Hugues of Miramar], 2014, 2017; Saint Thomas, as Echavarría stated in 2005 [see also, again, Peretó Rivas 2011, 2014]; or, more generally, Márquez 2001 and Piovano 2016, to name a few—by the way, many disagree with this thesis [see Aguirre Baztán 1994; Rovaletti and Pallares 2014; and especially Forthomme 2000, 2003, among many others]. With regard to its secularization into melancholy, see Bunge 1999; Bäumer and Carm 2011; Eisenberg 2013; the list of works is endless)3 and later during Romanticism and the birth of Existentialism, with the ennui and the mal de vivre (see, to choose some cases among millions, the novels by Goethe, Flaubert, Dostoevsky or Tolstoy—these are my favorite examples). In this sense, the Greek terms aegritude (θλίψη, aegritudo) and black bile (μέλαινα χολή, melaina chole), the Latins acedia and taedium vitae, Renaissance tristitia and melancholia, the modern ones spleen, nausée, noia, Weltschmerz … were all of them one and the same thing or did they refer to different phenomena?

Since the second phase of my postdoctoral time began, I realized that if I wanted to track the history of boredom as psychopathology through philosophical, theological, and literary sources, I would have to venture into the history of depression. Now I see that they are two inseparable tasks and, in the same way, two tough challenges. That is because boredom and depression are intertwined, mistaken one for the other, coated on the same and different clothes at the same time over the centuries. I figured I would find lots and lots of books and papers on the history of depression, and that was the case. However, most of them were part of a purely medical framework. What I did not find was any title to explore the presence of depression in its different variables through different narratives that go beyond mental health disciplines such as philosophy or literature, which are precisely the ones I work with. Apart from those authors who cover the topic of depression from the most orthodox mental health field, some others have devoted their efforts to analyze mental diseases in literature but go through depression superficially. Just a few focus on the antecedents of depression by taking into account literary, philosophical, and theological narratives (e.g. Clark Lawlor From Melancholia to Prozac: A History of Depression, 2012). To sum up, I realized that many titles, including both books and papers, were addressing the topic of depression nowadays. However, almost none of them were focused on such a multidisciplinary approach to depression. Then, I was clear that it was time to get in touch with those who were interested in this approach worldwide to get to know each other, share our concerns, and contribute something valuable to the scientific community.

This book project was conceived during the last summer (2018) as part of my own postdoctoral research abovementioned, at Harvard University, under the guidance of Prof. Dr. Mariano Siskind, through which I attempt now to analyze the antecedents of some contemporary mental disorders, such as boredom and depression, from the wide variety of narratives at our hands beyond medical treatises. As I have already introduced, I particularly focus on those literary, philosophical, and theological narratives of the past, in which such conditions were understood not as mental disorders themselves, in the contemporary sense, but as existential, and even moral conditions, to track the evolution of their understanding until the present time. When dealing with depression, I am always surprised by how famous this disorder is today and how little is known about its antecedents in human cultural manifestations over history.

We all know that the NIMH (National Institute of Mental Health) has meticulously defined depression as a common but serious mood disorder that causes severe symptoms (asthenia, anhedonia, abulia, among many others) that affect how people feel, think, and handle daily activities such as sleeping, eating, or working. The NIMH has also established the cause of depression is a combination of genetic, environmental, and psychological factors that affect approximately 216 million people (3% of the world’s population), mostly ranged from 20 to 30 years old. Nowadays, depression is also known for its many synonyms: clinical depression, MDD (Major Depressive Disorder), unipolar depression, unipolar disorder, depressive episode, and recurrent depressive disorder, to name a few. However, do we agree concerning the historical antecedents of depression? Are we working hard enough to clarify them and to reach an agreement? Are we taking into account the multiple narratives through which depression has been described over history from a multidisciplinary approach?

The impulse of delving into those antecedents, and keeping on going with my own research, motivated me the most to be in touch with colleagues who were working on this topic and with whom I shared these concerns. After launching a call during the last summer, I received a response from about twenty people with whom I keep in touch—at least with most of them—until now. We then decided to contribute our works to a collective book to move forward the research on the antecedents of depression, which we considered we should clearly understand not only to improve diagnosis and treatments at present but also to know more about some other related phenomena such as boredom. Under the title The Faces of Depression in Literature, this collective book attempts to bring together specialists and scholars in the topic from a multidisciplinary approach to explore the narratives of depression over time and discuss about their approximations to current, clinical understanding of MDD, that is, their similarities and differences, taking into account the environmental and psychological factors on which such a mental disorder depends in each historical period. Our goal is to clarify the background of depression by paying attention to its representation through these narratives and revaluate them as means of acquiring knowledge in an interdisciplinary way. While psychology and psychiatry may have the correct terminology and definitions, these narratives have the unique power of exemplification and clarification. Ultimately, we attempt to facilitate the understanding of MDD, the task of diagnosing, and the application of therapies related to narrations of depression.

The Faces of Depression in Literature comes to rethink depression by collecting in one place the most innovative approaches to the many names and shapes of depression we can find in literary, theological, and philosophical texts over time. This is, to my very knowledge, the first time that a well-experienced, diverse, and multidisciplinary group of specialists focused on the study of the antecedents of depression gather to promote a cross-border dialogue in order to overcome the recognized limitations of the current understanding of this topic. We want to publish the book to which researchers and academics, from one end to the other, have to come to be updated and clarify their ideas concerning the antecedents of depression according to a wide variety of narratives. We want to give a voice to underestimated manifestations of depression we can find in literature, philosophy, theology, and even early medical works. In this sense, this book will take a fresh look at an old phenomenon by considering it from rather unusual angles, trying to widen our understanding of depression and related phenomena.

This book meets the interests of graduate students and researchers in humanities, including philosophers, historians, cultural theorists, literature and art experts and enthusiasts, and even artists and writers themselves and, even, specialists in mental health and cognitive psychology because the study of depression involves mental processes such as attention, memory, perception, creativity or language use, to name a few. Moreover, our approach is not exclusively directed towards a specialized audience but wants to also reach out to the non-specialists. Considering how many people, friends, families, and colleagues are impacted in one or another form by depression, our project meets a broader need, too: that of educating ourselves about how to live and cope with depression.

The following break-down of our efforts attests to the multi and interdisciplinary approaches to depression. Part one, entitled “Spirituality and Depression from the Middle Ages to Modernity,” will consist of four chapters explaining how predecessors of depression and depression understood as we do today can be found in medieval, Renaissance, and modern narratives through different names such as acedia, tristitia, melancholie. The authors will discuss to what extent modern depression can be seen as the natural evolution of those old concepts grounded in the phenomenon of spirituality.

Chapter one, “Acedia and Its Relation to Depression,” by philosophy Ph.D. candidate Derek McAllister (Baylor University, Texas), goes through the relationship between acedia and depression after claiming that the results of the recent work done in this regard are a mixed bag. In this first chapter in which he engages the recent scholarship comparing acedia with depression, McAllister endeavors to clarify the concept of acedia used by Medieval authors such as Evagrius, Cassian, Gregory, and Thomas Aquinas, to name a few, using literature from other disciplines, including specialists such as Wenzel, Bloomfield, Newhauser, and others. His key two theses are: first, the concept of acedia is not identical to the concept of depression. Acedia is not merely a primitive psychological predecessor to depression, but it marks off significantly different ways of being, not least because of one’s spiritual relation to God. Second, however, it is still possible that an instance of acedia can coincide with an instance of depression, if one’s condition, or state of affairs, is such that each term can be correctly and truthfully applied.

Dr. Nancy Ciccone (University of Colorado, Denver) is in charge of the second chapter of this volume, “Depression in Ricardian Dream Visions.” The specialist in medieval literature showed that whereas Chaucer provides salient examples of depressive symptoms in Middle English dream visions, beginning with his narrator’s inability to either eat or sleep, the anonymous Pearl-poet presents a father unable to recover from the death of his daughter. According to her approach, Chaucer’s narrators find relief in reading, sleeping, dreaming, and presumably the activity of writing the dream narrative. Whether or not the Pearl’s narrator finds relief from his dream, however, is questionable, despite his ghost-daughter’s Christian teachings. As Dr. Ciccone admits, some scholars accuse the narrator of acedia. However, her presentation argues that his acedia is a symptom, not a sin fostering his continued grief. To support this point, she focuses on the definitions and cures for depression recommended by Avicenna and embedded in images throughout the narrative in terms of flora, jewels, and exercise. These images suggest somatic healing available to the poem’s audience, still reeling from their losses in the Black Death, on the one hand, and the political upheaval caused by the Richard II and the Lords Appellant, on the other hand. Whereas Christianity provides spiritual and intellectual comfort for late 14th-century England, the Pearl narrative reveals the gap between religious ideology and emotional recovery.

Chapter three, “Giambattista Vico and the Melancholy of History,” by Ph.D. candidate at the Department of Romance Languages and Literatures in the University of Chicago, Miriam Muccione, is about the Neapolitan philosopher who said that all human civilizations develop through a cycle of birth, growth, maturity, and decadence, bracketed between two forms of barbarism; a barbarism of the senses, belonging to the infancy of human mind and societies, and a conclusive corruption of human rationality and civic cohesion, which Vico calls barbarism of reflection or second barbarism. By comparing Vico’s main work, The New Science, with Vico’s autobiographical account in his Life of Giambattista Vico Written by Himself, Muccione’s chapter has the twofold purpose of examining Vico’s barbarism of reflection both at the individual and collective level, and to attempt a reading of the role that such a malady of human reason may still have in a Vichian conception of social advancement, though a melancholic one. A reflection on the limits that Vico assigns to human rationality will be of current interest in the perspective of a critique of the material progress of humankind in present times.

Chapter four was contributed by the academic teacher at the Medical University of Gdansk, Poland (Department of Hygiene and Epidemiology), and psychiatrist Dr. Pawel Zagozdzon. “Depression in the Literature of the Health Reform and Mental Hygiene Movement: An Example of Ellen G. White Writings” recovers the health principles from the writings of the most translated female non-fiction author in the history of literature, Ellen G. White, which contributed to making the Seventh-day Adventists—one of the most extended living groups of people in the world. Zagozdzon’s chapter explores how White used the concept of depression. Moreover, he analyzes how she understood the causes of a depressed mood and how to preserve one’s mental health.

Part two, “Secularization of Depression in Modern and Contemporary Literature,” will show the manifestations of modern and contemporary depression in five chapters that revolve around the 18th, 19th, and 20th centuries to the present narratives to analyze how depression was secularized from the spiritual framework. From philosophical to purely literary approaches, authors will deal with the concepts and issues surrounding depression in modern and post-modern approaches such as nihilism, identity, or feminism.

Søren Harnow Klausen, Professor of Philosophy at the University of Southern Denmark, proposes a chapter entitled “Nihilism, Depression, and Wholeheartedness. Metacognitive Strategies in 19th-Century Literature,” in which he explains how in 19th-century literature and philosophy, depression-like states of mind were associated with nihilism, which was depicted more like a condition that befalls individuals than a deliberately adopted attitude. Professor Harnow Klausen looks at two insightful and literarily engaging treatments of depression and nihilism from the mid-19th century, one by Kierkegaard, the other by Tolstoy. In Kierkegaard’s “Crop Rotation,” the principal challenge to a meaningful life is diagnosed as boredom. It provides indirect evidence for the pathological condition of its pseudonymous author and the limitations of the otherwise ingenious techniques he devises for overcoming boredom (some of which resemble what is now referred to as metacognitive strategies). The author will further illustrate this view of depression with Tolstoy’s description in War and Peace of the main character, Pierre Besuchov, as suffering from a lack of orientation and self-acceptance, which at times takes on pathological forms.

Chapter six, “Can Melancholy Be Heroic? Walter Benjamin and the Vicissitudes of Melancholy,” by Assistant Professor of Philosophy, Dr. Shannon Hayes (Tennessee State University), establishes, despite the long-standing association of melancholy with creative, poetic activity, that melancholic depression remains chastized as an unpolitical mode of existence associated with stagnancy, paralysis, and a willful alienation. If one accepts Marx’s claims that under capitalism, we are already dismembered and distanced in our strategic relations, then melancholy has a political aspect and can be understood as a mood. As Benjamin recognized, the fatigue and weariness of the melancholic body grant us an insight into the decay and fragmentation that characterizes social existence. For Hayes, melancholy does not produce one’s alienation; it reveals it and exacerbates it in its unveiling. In her chapter, she explores the vicissitudes of melancholy in the poetic figures of Charles Baudelaire and Erich Kästner, the latter a poet of the Weimar Republic. Although both are melancholic and share an insight into the social, these figures differ in how they put their melancholic insights to work: according to Benjamin, Baudelaire enacts a heroic, emancipatory melancholy, while Kästner enacts a dangerous, nihilistic melancholy, coined by Benjamin as left-wing melancholia. It is precisely the difference between heroic and nihilistic melancholy that this chapter will illuminate.

Professor of English, Dr. Gail Shanley Corso (Neumann University, Pennsylvania), contributed chapter seven “Anhedonia, Dysthymia, and Tristasia: Depressed Characters in Alice McDermott’s Novels” in which she delves particularly into Alice McDermott’s contemporary fiction, whose characters exhibit a range of response to love and loss—sorrow, pretense and lies, delusions, loss of interest in pleasure, and even, attempts at suicide. She demonstrates that these characters often exhibit depression in many forms. While some might experience memory loss concerning trauma, others experience a heightened sense of specific incidents in their life.

Chapter eight “Broken Promise: Depression as Ex-Gifted Girl Identity in Elizabeth Wurtzel’s Prozac Nation,” by English and Comparative Literature Ph.D. candidate Nora Augustine (The University of North Carolina at Chapel Hill), addresses Elizabeth Wurtzel’s bestselling 1994 memoir, Prozac Nation: Young and Depressed in America—a creative non-fiction account of the author’s lifelong depression and eventual recovery with the aid of medication. Augustine reads Wurtzel’s depressed persona through the lens of longstanding cultural discourses that link depression to thwarted childhood giftedness. In particular, Prozac Nation is seen to illustrate a range of so-called Gifted Girl dilemmas as described in feminist psychology research of the 1960s and 1970s. Exploring how Wurtzel’s contexts (slightly) value her extraordinary achievements and yet harmfully contrast them with “normal” femininity, Augustine revisits the often-devalued Prozac Nation as a valuable case study in the troubled relationship between giftedness, depression, and gender in a post-feminist United States context.

Chapter nine, “Unclean Subject(s) of Depression within the Singaporean State,” by Dr. Hannah Ming Yit Ho (University of Brunei Darussalam), closes this third part. Here, this expert in melancholy within contemporary fiction addresses Amanda Lee Koe’s Ministry of Moral Panic by discussing the gendering of a diseased mind and body within Singaporean experiences of self-injury, suicide, sickness, and homosexual tendencies. Focusing on the depressed subject, she argues that the literary expressions of the unclean citizen-subject are wrought with (non-)dysphoria, which, in turn, reveals the intricate complexities of the depressive affective disorder to expose the individual’s anxiety with the body politic and attendant distress with social stigmatization. Psychosomatic depression is thus explored and illuminated within intersecting cultural and political contexts. By interrogating the cultural burden, identity politics, and human fallibility associated with such an affliction, this chapter challenges gendered instances of distress that taint the wholesome image of the self, which is promoted within Singapore’s national interests in the clean city.

Finally, part three, “Narrations and Metaphors on Depression from and for the Clinical Practice,” will consist of four chapters in which authors will explain how narratives and metaphors themselves, contemporary or not, can help fight against depression and understand our symptoms of depression nowadays. In this case, the contributors will introduce innovative and well-known methodologies to fight against depression through literature from fiction and non-fiction writings, clinical experiences, and critical theory.

First of all, Prof. Josie Billington, from the University of Liverpool, opens the last section with chapter ten, “Inner Voices: Literary Realism and Psychoanalysis.” In this contribution, Prof. Billington argues that the realist novel and psychoanalytic theory and practice might be regarded as analogous projects, connected mainly via the realist novel’s virtuoso employment of free indirect mode, against those who claim the realist novel and the development of psychoanalysis are usually regarded as two historically distinct and consecutive responses to the loss of religious explanations for mental suffering, rather than intrinsically connected. Following this proposal, Prof. Billington states that as a means to capture and give back to the subject thoughts or emotions which the subject hardly dares or bears to own—especially what Wilfred Bion calls 0, the moment of reality, or the powerful no thing of experience and thought—FID probes the hidden and inner as psychoanalysis seeks to do, “piercing the obscurity of those minute processes which prepare human misery and joy, those invisible thoroughfares which are the first lurking-places of anguish or unhappy consciousness.” (George Eliot) The explication of this prior connection is particularly pertinent at a time when literary reading (of fiction and novels in particular) is increasingly used as an adjunct or alternative to establish psychological therapies for mental health issues (see Billington 2016).

Chapter eleven “Rewriting Mecca: Teaching about Late-Life Depression Using John Metcalf’s ‘The Years in Exile’,” by Clinical Health Psychologist and Associate Professor of Kinesiology and Health Science at York University, Toronto, Dr. Lucia Gagliese, reminds us that late-life depression is highly prevalent and is associated with physical, cognitive, and social dysfunction as well as increased mortality, including suicidality. She is worried that despite this, clinical understanding and treatment of late-life depression remains inadequate; many healthcare professionals are poorly trained in its recognition. In this chapter, the depiction of late-life depression in a Canadian short story, “The Years in Exile” by John Metcalf, will be considered from psychological and gerontological perspectives. The protagonist of the story will be presented as a case study employing current and historical approaches to the assessment and diagnosis of depression, including DSM criteria. The risks and buffers of late-life depression, as depicted in the story, will be considered, with attention paid to gender, marital status, independent vs. dependent living, physical function, trauma, and social isolation. Concordances and discrepancies with cognitive-behavioral and lifespan-developmental theories of late-life depression and meaning-making through life review/reminiscence are considered too. Dr. Gagliese’s chapter argues that analysis of short fiction through a health narrative lens may be an effective interdisciplinary educational strategy.

Chapter twelve, “This Aisle Has More Than Two Sides: Insights into Depression, Provided by Medical Doctors,” by Angelika Potempa, Assistant Professor of Philosophy at The University of Texas Rio Grande Valley, is on whether and how the difficult topic of depression is talked about in the memoirs of medical doctors in the United States. As she affirms, depression enters the life of the medical professional not only in the pursuit of diagnosing, treating of and caring for patients but also in the form of their suffering and/or that of colleagues, friends, and family members. Of special interest for this chapter are the particular framework of background values and the understanding of medicine and illness that shines off in the professional healers’ memoirs and that are tied to their characterizations of depression and the depressed. The times remembered reach mainly from the 1950s to the present. Her approach is interdisciplinary but grounded in philosophy, especially, epistemology and ethics.

Finally, from California, the independent scholar Ioana Unk wrote chapter thirteen, “Metaphors of Depression in American Short Fiction.” As a member of the American Psychological Association, Unk aims to illustrate depression as a disintegration of the psychological mechanisms that hold the frail human life together and make it look meaningful, in the American short fiction of the recent years. She recognizes that psychologists and psychiatrists have a particular arsenal of tools (diagnostic manuals, depression scales, elaborate descriptions of symptoms) that help them define depression in its many forms. People suffering from depression, on the other hand, may experience this mood disorder differently, as a collapse of their hopes and illusions about life and its purpose. When this illusion is replaced by a brutal and constant awareness of the human limitations, and of the only sure thing about life, namely its ending, depression happens. She will go through the many metaphors of depression in the literature that can help us clarify the understanding of depression.

The Faces of Depression in Literature is not only a book consisting of isolated proposals on the relationship between literature, philosophy, theology, and depression. Contributors have read in-depth others’ chapters to ensure the composition was coherent enough and that the progression presented represents a strong achievement in the understanding of depression through the introduced narratives. We all are engaged with this topic to the point that we wanted to meet each other to share our approaches face-to-face, so I organized a homonymous Seminar as part of the ACLA Annual Meeting in March 2019 (Washington D.C.) from which some of the final ideas for this book emerged. We also met each other again in May 2019, as part of the workshop Depression as a Creative and Destructive Force in Contemporary Literature I organized at Harvard University.

I would like to thanks the contributors to this volume—especially Dr. Potempa for her double-check of this preface—as well as Peter Lang and my first contact the editor Meagan Simpson—thank you always for your interest in this book, your trust, and patience. As editor of The Faces of Depression in Literature, I cannot but be grateful with the Department of Romance Languages and Literatures (RLL) at Harvard University and the Real Colegio Complutense (RCC) at Harvard for granting me with the postdoctoral fellowship that made possible for me to complete this work. Finally, my personal acknowledgments or dedications are for my favorite artist—whose words opened this introduction—the American singer, composer, actor, writer, painter, and director Brian Hugh Warner (Marilyn Manson): in your art I always found relief; when I listen to your songs, I know that I am what I should be.


1 1. This term was coined by the German philosopher Hans Blumenberg (1920–1996), to refer to those absolute realities or phenomena that cannot be described under rational premises. See his Theory of Nonconceptuality in “Ausblick auf eine Theorie der Unbegrifflichkeit.” (1979 [1996])

2 2. Aremis Sertraline is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Sertraline affects chemicals in the brain that may be unbalanced in people with depression, panic, anxiety, or obsessive-compulsive symptoms. Sertraline is used to treat depression, obsessive-compulsive disorder, anxiety disorders (including panic disorder and social anxiety disorder), post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD) (Aremis Sertraline 100mg Tablets Patient Information Leaflet, 2019).

3 3. Apart from the above mentioned, some other titles I consider of enough importance in this regard are “Acedia: Its Evolution from Deadly Sin to Psychiatric Syndrome” (1965), by psychiatrist Mark Altschule; “Acedia: The Etiology of Work-Engendered Depression” (1990), by Steven Bartlett (Willamette University); Mística y depresión: San Juan de la Cruz (1997), by psychiatrist Francisco Javier Álvarez Rodríguez (CAULE); or “Before Depression: The Medieval Vice of Acedia” (2007), by Robert Daly (Medical Upstate University), among many, many others. I strongly recommend the reading of my forthcoming book La enfermedad del aburrimiento, to be published presumably along 2021, to delve into this topic.


Aguirre Baztán, Á. 1994. Estudios de etnopsicología y etnopsiquiatría. Barcelona: Marcombo.

Altschule, M. D. 1965. “Acedia: Its Evolution from Deadly Sin to Psychiatric Syndrome.” The British Journal of Psychiatry 111 (475): 117–119. https://doi.org/10.1192/bjp.111.471.117.

Álvarez Rodríguez, F. J. 1997. Mística y depresión: San Juan de la Cruz. Madrid: Trotta.

Bartlett, S. J. 1990. “Acedia: The Etiology of Work-engendered Depression.” New Ideas in Psychology 8 (3): 389–396. https://doi.org/10.1016/0732-118X(94)90026-4.

Bäumer, R., and M. Plattig Carm. 2011. Noche oscura y depresión. Crisis espirituales y psicológicas: naturaleza y diferencias. Bilbao: Desclée de Brouwer.

Billington, J. 2016. Is Literature Healthy? Oxford: Oxford University Press.

Blumenberg, H. 1996. Shipwreck with Spectator. Cambridge, MA: The MIT Press.

Bunge, G. 1999. Akedia. Il male oscuro. Magnano: Qiqajon.

Daly, R. 2007. “Before Depression: The Medieval Vice of Acedia.” Psychiatry 70: 30–51.

Echavarría, M. 2005. La praxis de la psicología y sus niveles epistemológicos según Santo Tomás de Aquino. Girona: Documenta Universitaria.

Eisenberg, E. S. 2013. “El retorno de la acedia. Una variante de la depresión en la actualidad.” V Congreso Internacional de Investigación y Práctica Profesional en Psicología XX Jornadas de Investigación Noveno Encuentro de Investigadores en Psicología del MERCOSUR. Buenos Aires: Universidad de Buenos Aires.

Forthomme, B. 2000. De l’acédie monastique à l’anxio-dépression: Histoire philosophique de la transformation d’un vice en pathologie. Paris: Institut d’édition Sanofi-Synthélabo.

Forthomme, B. 2003. Phénoménologie des sentiments corporels. Argenteuil: Le Cercle Herméneutique.

Hernán Vázquez, S. 2015. “Las implicancias psicopatológicas de la acedia en Evagrio Póntico.” Revista Latinoamericana de Psicopatología Fundamental 18 (4): 679–703. http://dx.doi.org/10.1590/1415-4714.2015v18n4p679.7.

Lawlor, C. 2012. From Melancholia to Prozac: A History of Depression. New York, NY: Oxford University Press.

Márquez, F. 2001. “Posibles estados depresivos en la vida monacal: una aproximación psicológica.” Revista de Psicopatología y Psicología Clínica 6 (3): 213–216. https://doi.org/10.5944/rppc.vol.6.num.3.2001.

Peretó Rivas, R. 2010. “Acedia y depresión. Entre pecado capital y desorden psiquiátrico.” IV Jornadas Nacionales de Filosofía Medieval. Buenos Aires: Universidad de Buenos Aires.

Peretó Rivas, R. 2011. “Acedia y depresión. Aportes para una reconstrucción histórica.” Eä Journal 3 (1): 1–20.

Peretó Rivas, R. 2013. “‘Moritur in solitudine’: la acedia en la vida de Hugo de Miramar.” Stylos 22: 174–186.

Peretó Rivas, R. 2014. “Acedia y depresión como cuidado por la sepultura en el mundo clásico y sus ecos contemporáneos.” Acta médico-histórica Adriática 12 (2): 231–246.

Peretó Rivas, R. 2017. “Angustia y acedia como patología en el monacato medieval, manifestaciones y recursos curativos.” Anuario de Estudios Medievales 47 (2): 769–794.

Piovano, A. 2016. Acedia. Bogota: San Pablo.

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Ros Velasco, J. forthcoming 2021. La enfermedad del aburrimiento. El camino de la metáfora hacia la medicalización y sus alternativas.

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Toohey, P. 1988. “Some Ancient Notions of Boredom.” Illinois Classical Studies 13 (1): 151–164.

Toohey, P. 2004. Melancholy, Love, and Time: Boundaries of the Self in Ancient Literature. Michigan, MI: University of Michigan Press.

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1 Acedia and Its Relation to Depression

Derek McAllister

Baylor University, Texas


There are prima facie grounds for thinking acedia and depression are somehow related. Acedia, that old deadly sin of sloth, is marked characteristically by idleness, laziness, aversion to work, slackness, and even sorrow. Depression is marked characteristically by sadness, dullness, loss of pleasure, emptiness, and, sometimes, irritability—these are stereotypical characterizations, to be sure; nevertheless, it is instructive beginning with such familiar but crude generalizations, then proceed to analyze, clarify and correct them as needed. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies at least one necessary condition for inclusion in the category of depressive disorders, i.e., a sad, empty, or irritable mood:

The common feature of all [depressive] disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. What differs among them are issues of duration, timing, or presumed etiology. (American Psychiatric Association 2013, 155)

The DSM has, since its third iteration (1980), overtly eschewed reference to etiology as a diagnostic criterion for depression in favor of identifying symptoms and behavior in descriptivist language as diagnostic criteria.1 This intentional move leaves room for clinicians and practitioners to theorize, on a case-by-case basis, about the etiology of any particular person’s depression,2 rather than have the matter settled legislatively at the outset. In what follows, I shall be assuming this descriptivist understanding of depression.

As for the relation between acedia and depression, no one doubts that there is a clear similarity between them. The trouble develops when we attempt to specify the relation further: are acedia and depression identical? Is acedia a kind of depression? Is there any historical continuity between them?

←3 | 4→

I should say at this point: there is a crucial distinction to be made between (1) the concept of acedia and (2) an instance of acedia3and likewise for depression. The trouble that arises from asking the above questions is often the product of our own conflating of this critical distinction. For when one asks, Are they identical?, it can only mean to ask whether an instance of acedia is numerically identical with an instance of depressionthe two concepts themselves are so obviously qualitatively non-identical that that question is hardly worth asking; and numerical identity, if it is the sort of thing that requires extension, would not seem to be amiable to abstract objects like concepts or definitions.4 Yet when one asks, Is there any historical continuity between acedia and depression?, she obviously means to inquire about the conceptual history of depression, and not whether one’s particular occasion of depression has arisen out of an earlier episode of acedia—although, as we shall see, this is certainly a question worth asking. Keeping this distinction in mind will be important going forward, and I hope, where I did not state it, the reader will be keen to discern which sense I am indicating.

In recent discussions, there is no consensus regarding the relationship between acedia and depression. While most writers consider them not to be identical, many opt to interpret acedia using more up-to-date, contemporary psychiatric terms, thus essentially medicalizing an otherwise spiritual ailment (Altschule 1965; Jackson 1981; Jehl 2005; Azzone 2012). Others consider acedia to lie on a continuum with other maladies like ennui (Irvine 1999),5 or taedium vitae (Jehl 2005).6 Still, others dismiss tying depression too closely to acedia, given the differences they present either in agential freedom (Daly 2007) or in sinful culpability (Altschule 1965; Webb 2017). In my view, there is something right about the latter two of these suggestions. More precisely, I argue for the following two theses. First, the concept of acedia is not identical with the concept of depression; nor, for that matter, is acedia merely a primitive psychological conceptual predecessor to depression, but it marks off significantly different ways of being not least because of one’s spiritual relation to God. As Lucrèce Luciani-Zidane (2009, 13) has said, “acedia is entangled in the heart (or life) of Christian dogma.” My second thesis, however, is that an instance of acedia maybe sometimes coextensive with an instance of depression. That means a case of one might also be a case of the other. Alternatively, if they are not the same, we can understand why someone might mistakenly identify them, given that these two conditions are so similar in their symptomatology.

I have divided this chapter into three cohesive movements or parts. First, in order to establish a correct conceptual understanding of acedia, I cull the main features of acedia as understood from the early Christian capital vices ←4 | 5→tradition.7 We shall see that, within this tradition itself, while there is some divergence in the ways acedia is understood, there is still enough cohesive unity to detect an unbreakable strain, a “continuous exfoliation” (Wenzel 1960b, 175), each strand “representing the true main line of the concept’s development.” (Wenzel 1960b, 179) Second, I critically examine some recent attempts to define the relationship between acedia and depression in the scholarship of psychiatry, philosophy, and theology. Third and finally, I turn to my main topic concerning the relation of acedia to depression.

What Is Acedia? Its Main Features Culled from Principal Historical Texts and Thinkers

To begin, we require a precise answer to the question What is acedia? Those who have some familiarity with the conceptual history of acedia will perhaps suggest there is a prior question: Which acedia are we inquiring about? Siegfried Wenzel, in his masterful opus The Sin of Sloth, explains that, “in looking over the whole medieval period,” there are at least “three types of acedia: monastic, Scholastic, and popular, which can be localized with some accuracy in time and, even more so, in literary genres.” (1960b, 179)8 However, pace the well-placed concerns of those with prior familiarity, we should not mistake this divergence for there being fundamental disagreement about what acedia is. As Wenzel immediately clarifies: “But never did a later form completely replace an earlier one.” (1960b, 179) In the later forms, for example, we can detect the still-present monastic elements that were once characteristic of the earlier forms. Moreover, as Wenzel maintains, despite their differences, the different types of acedia enjoy a cohesive unity centered on an “unbroken mainstream in its history,” namely, the association of acedia with “idleness and negligence in spiritual deeds.” (1960b, 179) Acedia gets different emphases, in different people’s hands, with different audiences—something we can expect with the different times and places acedia appears in the medieval literature.9

From that cohesive unity, we can cull the following main features of acedia. First, acedia is irreducibly spiritual. Second, acedia has especially notable psychological manifestations. In what follows, I shall briefly explain what I mean by these features.

Acedia Is Irreducibly Spiritual

By claiming that acedia is irreducibly spiritual, I am not claiming that it is merely spiritual, nor that it is an entirely spiritual phenomenon. Instead, it has ←5 | 6→a spiritual component that is both essential to it and which is irreducible. It is essential in the sense that acedia cannot be understood apart from its spiritual import. Moreover, this spiritual sine qua non is irreducible in that any attempt to analytically reduce it in simpler terms (such as its affects, an individual’s psychological states) will be hopelessly incomplete. Moreover, acedia also has a proximate spiritual etiology.

Acedia is a capital vice, one of the seven deadly sins. That does not mean deadly in the sense that it is the worst possible sin that one can commit, but in how it can surreptitiously take root and lead to further sins. Its origins are from among the 4th-century desert monastics as one of the logismoi, or evil thoughts, which tempts the monk away from prayer and devoted religious life. However, importantly, it can be resisted. For Evagrius, the demon of ακηδία was to be countered with fortitude and perseverance, and “after its struggle the soul is taken over by a peaceful condition and by unspeakable joy.” (1990b, 12) Cassianic remedies for acedia divide into two: (1) keeping the cell via cultivating fortitude (1894b) and (2) manual work (1894a). This latter remedy, of course, accords well with how we understand sloth today. If the connection from spiritual to manual work is not clear, manual work here is included because it is the external work of the monk, which itself is tied deeply to his religious vocation.10 Even the sweeping of floors can be a deeply religious activity.11 As one author puts it:

If we give credence to the monks, we are therefore dealing with more than bad moods, psychic fluctuations or moral defects. It is a question of the resolve that arises in the wake of a decisive choice for which the monk has risked his life and to which he must hold no matter what: to realize one’s full potential in oneness with God. He has bet everything that he has and everything that he is on this. Acedia is therefore so dangerous for him since it causes him to throw away everything and thus to miss out on what matters most in the realization of his full potential, which is the primary purpose of the monastic life. (Bamberg 1991, 87, qtd. in Joest 2004, 144 n.100)

Acedia eventually makes its way out of the desert to the wider world, evidence that it is not merely a monk’s vice.12

Pope Gregory the Great in the 6th century also characterizes sloth in spiritual terms. One antidote he recommends for acedia is a “longing after the Creator, which gives over the sloth of negligence [cum torporem negligentiæ],13 and kindles the frost of former insensibility with the fire of holy love.” (1844, I.4.23.42) Gregory implores us to turn our attention upon things—spiritual things—that dispel despair and invigorate hope. First, we are to look to the saints that we may “be refreshed with the examples of the righteous … Let us see then how beautiful is the activity of those who pursue ←6 | 7→their course, and learn how disgraceful is the sloth of the sluggish [hebetudo pigrorum].” (1844, V.24.8.17) Second, we are to reflect upon the cross, our own salvation, and the glory to come. After beautifully narrating the whole story of redemption and salvation, that gospel foolishness “that so far from the guilt of [the penitent’s] debt being binding on him, gifts are heaped upon him more abundantly even after his sin,” Gregory immediately interjects, “Whose sloth [torpor] would not be startled at the elevation of so high a thought?” (1844, V.27.15.30) Thus, Gregory clearly has in mind the spiritual vice of acedia. When transmitted to English as early as the 10th century, Ælfric abbot of Eynsham cites Gregory as a main influence and uses the word slæƿð (an early version of sloth), making no secret that the referent here is the vice of acedia (1966, XVI, XXI).14

Aquinas in the 13th century follows this tradition of acedia as a capital vice, adding that “acedia, as we understand it here, denotes sorrow for spiritual good [acedia … nominat tristitiam spiritualis boni].” (2010, II-II.35.1.co) Previously, Cassian had distinguished between acedia and tristitia, while Gregory had acedia subsumed under tristitia; here, Thomas considers acedia a species of tristitia.15 Acedia becomes a mortal sin, and is most destructive, when it “reaches to the reason, which consents in the dislike, horror, and detestation of the Divine good [quae consentit in fugam et horrorem et detestationem boni divini], on account of the flesh utterly prevailing over the spirit.” (2010, II-II.35.3.co) Here, just as in the desert, the problem is centrally a lack of love or disconcern for the things of God. From its sapling stage as a logimos to its fully grown stage as a mortal sin, acedia is an irreducibly spiritual phenomenon.

Acedia Has Especially Notable Psychological Manifestations

From Evagrius to Cassian, Gregory to Aquinas, acedia has maintained a characteristic twofold effect: listlessness and restlessness. On the one hand, acedia evokes certain affects and behavior like sorrow, torpor, laziness (idleness), languor, lethargy, tepidity, and inertia. On the other hand, acedia evokes a certain restlessness: diversions (idleness), unwillingness to work, roaming of the mind on vain or trivial things, procrastination, and boredom.16

This latter effect of restlessness, or busyness, should not be mistaken for productive busyness.17 It is characterized by a deep, inarticulable aversion to the meaningful, spiritually-imbued work of the cloister, in favor of other tasks that either are not as urgent, are not as important, or are simply not the task given to this individual monk. Whereas the first effect produces sorrow, this latter effect of restlessness may result in activities that are entertaining, or, ←7 | 8→as we would say in English, diversions.18 This entertainment, however, is not lasting. Instead of gaining consolation by visiting the brethren, as Evagrius (1990b, 12) writes, the monk is weakened all the more by this very supposed remedy.

No amount of rest or frivolity will ever deeply satisfy the person plagued by acedia, since, as we saw, acedia is irreducibly spiritual and its roots lie much deeper than where temporary distractions can penetrate. This must be kept in mind even as we acknowledge that acedia characteristically manifests psychologically as either listlessness or restlessness.

Sloth’s Lost Familiarity in Recent Times, which Coincides Historically with the Advancement of Psychiatry

After the Scholastic period, i.e. from the 13th century onward, the vice of acedia would reemerge periodically as an object of practical devotional interest, or as an item of theological study within the larger framework of virtues and vices, and emphasis was—though not always—typically placed on acedia’s external effect of laziness and slothfulness (to the neglect of its other effect, restlessness). Wenzel explains,

The shift from a state of mind [taedium] to external behavior [ydelnesse in servitio Dei] pervades and informs the entire popular image of acedia, which emphasizes, not the emotional disorientation of disgust for the divine good, but rather the numerous observable faults which derive from such a state. (1960b, 88)

So even at this early point in history, we start to see a diluting of the old capital Sin—from its twofold effect to a single effect, laziness, from a focus on internal character and emotional disposition to external acts.

Over time, the capital vice of acedia, de dicto, would be more or less forgotten. When sighted, de re, one might recognize what the thing is, yet we would have no name for it. It is perhaps easy to understand why, since acedia is, after all, very difficult to identify in a person. As a nameless vice, it creeps in slowly and unseen. Boudon (1683, 337–338) does not use the term acedia, but his description is vividly similar:

The venom of this vice consists of numbness, which sinks into the senses, by which the soul is made to slumber and remain in an idle state … It is recognized quite late …[and] almost no one knows it, because it does not lead directly to evil. (see also Surin 1829, 102–103)

All the while, it seems a good number of us can recall having “had something of this vice, as all men have it, being a strong general malady.” (Surin 1829, 103)

←8 | 9→

In the 19th century, Søren Kierkegaard’s character Judge Wilhelm in Either/Or (1987, II, 185) was familiar with the old deadly Sin, as such, mentioning it in his diagnosis of A the aesthete:

Nero’s nature was depression [Tungsind]. In our day, it has become somewhat prestigious to be depressed [tungsindig]; as far as that goes, I can well understand that you find this word too lenient; I hold to an ancient doctrine of the Church that classifies depression [Tungsind] among the cardinal sins.19

Unfortunately, the Hongs’ translation, though it is the standard translation today, renders the Danish Tungsind (literally, heavy-mindedness) as the more loaded and presuming term depression. Kierkegaard, of course, did not use the term depression, which would not have been in common usage at that time, but neither did he elect for the contemporary Danish word Melancholi,20 opting instead to give a descriptive and general label of heavy-mindedness. So it is a mistake to identify Kierkegaard’s usage of Tungsind with our notion of depression. This concern aside, it is clear that Kierkegaard has in mind—by having some obscure, inarticulable notion in the mouth of Judge Wilhelm—both the vice of acedia and Romanticism’s melancholy, the latter of which is seen as “somewhat prestigious” to have, and the former of which is clearly undesirable. By the end of the 19th century, from a psychiatric perspective, melancholy had become virtually synonymous with depression.21 While the complicated relation of likeness between acedia and a melancholic disposition was indeed not lost on the melancholy Dane, acedia has come to be misunderstood by more recent authors.

Attempts to Delineate the Relationship between Acedia and Depression in Recent Scholarship: Psychiatry, Philosophy, Theology

We turn now to some recent attempts to specify the relationship between acedia and depression; the results are, as one might expect, a mixed bag. I shall take these in order roughly from the most grievously mistaken to those that are more delicately honest. It will turn out that any honest, rigorous account of acedia, let alone any comparison of depression to acedia, must be undertaken with careful nuance and distinctions which preserve the integrity of acedia’s spiritual reality while respecting its psychosomatic reality.

In a short article Mark D. Altschule22 (1965) traces what he considers the visible, linear development of acedia from a deadly sin to a psychiatric disorder, but in doing so, he seems to neglect the importance of acedia entirely as a sin. Altschule rejects the notion that acedia is a sin at all, stating laconically, ←9 | 10→without any sense that what he is saying is controversial, that “according to Cassian, feelings of anger, acedia, and depression were deadly sins; however, today they are regarded as psychiatric symptoms.” (1965, 117) This “we now know” posture23 in the spirit of Enlightenment progress, as old theories come to be replaced, and we come to know better is oftentimes proven right. However, sometimes the attitude is a subtle mask for the “uncritical acceptance of the intellectual climate common to our own age.” (Lewis 1955, 207)24 To be fair to Altschule, we shall look at the support he offers to determine whether this posturing is warranted.

As support, Altschule points to two other instances in which he claims that psychiatric understanding gradually replaced a sin paradigm for explaining human action:25 witchcraft in the 16th century and insanity in the 19th century.26 However, these are both highly dubious cases of theory replacement. First, Altschule points to “a few sixteenth-century writers” who recognized that “witchcraft was a manifestation not of sin but of mental illness.” (1965, 117n) He does not mention these writers by name, but he gestures in a note towards Richard Hunter and Ida MacAlpine’s Three Hundred Years of Psychiatry (1963). Of course, witchcraft hysteria and overreaction is well-known. What Altschule misjudges is what difference this makes to a sin paradigm for explaining human action. It is not a mark against a sin paradigm in toto to say that level-headed contemporaries were offering better alternative explanations for alleged witchcraft behavior. Take, for example, Reginald Scot’s “Not Witchcraft But Melancholie” (1584),27 in which Scot offers melancholic behavior—understood broadly—as a reasonable explanation for producing some of the behavior associated with accused witches.28 Even while offering this alternative explanation—and others, such as “coosinage,29 dotage,30 and poisoning” (1584, 11)—Scot nevertheless maintains the reality of sin and the supernatural.31 If one looks closer, one can see that Scot’s work is not so much a denial of the reality of witches or witchcraft; it is a reasoned censure upon (1) the guessing “proofs” and presumptions (2) by disreputable folk (3) on bad evidentiary grounds.32

More importantly, it is clear that Scot also still assumes, on the whole, a sin paradigm for explaining human action. Those who visited witches to seek counsel were guilty of idolatry,33 because it was a sure sign that such individuals believed witches to possess certain supernatural powers34 reserved only for God.35 Therefore, in fact, Altschule is wrong if he is intimating that Reginald Scot thought that “witchcraft was a manifestation not of sin but of mental illness.” (1965, 117n) Scot thought we could explain witchcraft behavior by intentional and malicious cozenage, or deception, just as much ←10 | 11→as by the melancholic or strange behavior of “poore … old women, which are themselves deceived.” (1963, 33) Furthermore, Scot rightly thought this melancholic possibility was consistent with and did not undermine a sin paradigm for explaining human action.

As for his second point, Altschule (1965, 118n) points to yet another truly bad example of, allegedly, psychiatric understanding replacing a sin paradigm: 19th century psychiatrists who gradually began to realize that it was “mental disease [that] caused what at that time was often called sinful behavior (For example, Feuchtersleben, in his Principles of Medical Psychology (1847), stated that in insanity as in sleep ‘ “the old Adam” appears’).” However, Feuchtersleben is in no way suggesting that mental disease is the superior explanation for what was once thought a sinful behavior. Feuchtersleben’s quote appears in the context of a broader discussion concerning the nature of dreams, not insanity, as Altschule claims. Moreover, pace Altschule, Feuchtersleben’s concern is well-placed. Feuchtersleben first acknowledges that very often dreams are not reliable: “It is evident that the understanding, fettered in dreams, can give no instruction to the understanding when unfettered.” (1847, 166) For example, it is foolish for a military “general to abandon a good position because he has had an ill-omened dream.” (1847, 166) On the other hand, he continues, sometimes a man’s dreams can supply him with information about himself.

But that dreams may, nevertheless, become psychologically and even ethically of deep importance as respects an individual, follows from the above-mentioned power of obscured ideas. Through this power, dreams may give a man historical information respecting himself, and hence, according to a favorite expression, “he may divine like a prophet looking backwards.” As when the sun has gone down, the countless stars, not visible in the daytime, appear on the dark ground of the firmament, so, at the call of fancy, the forgotten images of bygone days rise up and show the mind its former shape. This observation likewise points to the delicate affinity of dreams with pathological states of mind, where, too, as it were, ‘the old Adam’ appears, and is in every sense interesting to the psychological physician. (1847, 166)

Some of this self-insight is of immense psychological and ethical importance; Feuchtersleben uses ‘the old Adam’ to refer to original sin, or a human’s (Postlapsarian) natural propensity to be seduced away from the good. Nowhere does Feuchtersleben suggest a biocentric model or disease paradigm should replace this former way of thinking. If anything, his response here indicates that he considers medical science to be consistent with a sin paradigm—or, at the very least, consistent with the denial of materialism, as he explicitly states earlier.36

←11 | 12→

Not only are Altschule’s supporting examples of purported theory replacement bereft of any real substance, but Altschule, in the remainder of his paper, also gives us no other reason to think that acedia, once a deadly sin, is now merely a psychiatric symptom. He claims that “the condition [acedia] came to be considered merely a subdivision or a variety of depression,” saying further that “Depression was, of course, another of the deadly sins” (1965, 118), but this is untrue. To conclude something this extraordinary, Altschule would either have to have committed eisegesis or to have read a bad translation. More specifically, he claims, “the writings of … Aquinas included this definition of acedia.” (1965, 118) In fact, Thomas never uses any variant of the word depression to define acedia. He uses “aggravatio animi” (2010, I-II.37.2), the weighing down of the soul, and “tristitia aggravans” (2010, I-II.35.8.arg3), a sadness which weighs down. But Thomas himself says that he is using this kind of depression only metaphorically, as when he compares love to heat, or pleasure to being widened.37 In any case, Thomas certainly could not have had the psychiatric concept of depression that Altschule had. While we can admire Altschule’s pioneering spirit on this topic, we cannot ignore that much of his commentary on acedia is simply misguided. Ironically, what he (rightly) accuses Petrarch of, Altschule falls victim to himself: “solipsistic misinterpretation of the meaning of acedia.” (1965, 119)

Marcia Webb38 (2017) also recognizes some similarities between early conceptions of acedia, which associate the sin closely with tristitia [sorrow], and the contemporary psychological disorder of depression. However, Webb rejects those associations of acedia with sorrow, let alone any association of acedia with depression, because, she reasons, it causes harm and perpetuates the stigma associated with mood disorders. Webb is willing to grant that acedia’s other features—restlessness, spiritual apathy, boredom, sluggishness—may have legitimate application in contemporary culture, but she explicitly rejects acedia’s connection to sadness.

Webb offers at least two reasons for this rejection. First, she thinks that there is so much conceptual confusion about the nature of acedia that this makes its purported connection to sorrow tenuous; if it is tenuous and if we have countervailing reasons to reject it (e.g. its harmfulness), then, ceteris paribus, we should reject this connection. Second, Webb thinks there is little theological or biblical grounds for considering sorrow to be sinful. In response to the first concern, I must point out that, while there is variation in the way authors through the centuries have conceptualized acedia, this does not imply any great disunity or confusion about what acedia is. Moreover, to support this charge of conceptual confusion, Webb offers shoddy evidence, quoting at length a 14th-century confessional prayer of acedia, then ←12 | 13→remarking that it is a “haphazard” collection of minor offenses: neglect in prayer, failure to rebuke one’s wife, and indulgence in checkers, among other things (2017, 76–77). She concludes that this is evidence for acedia’s “confused and convoluted history.” (2017, 79) However, Webb fails to note that this genre of literature—penitential and confessional formulas (see Wenzel 1960b, 83–84)—rather than being a conceptual account of acedia, is intended to function as an inventory of specific acts of sin under kinds of sin. These petty offenses, trivial as they seem, do nothing to confuse the concept of acedia; instead, they are given as practical examples of acedia’s application. Furthermore, the excerpt she quotes unsurprisingly includes other attributes of acedia,39 but she does not take issue with these or propose that we reject these as veritable attributes of acedia. By parity of reasoning, if we reject the one attribute, sorrow, we should reject the other attributes, such as slothfulness and restlessness, for the same reason. Alternatively, we should reject neither, which is the better option, given what we have said about the genre of confessional formulas.

For Webb’s second concern, she notes that not only does Christian Scripture contain precepts to love and comfort those who mourn, who are weary, and so on; but also the term ἀϰηδία is found nowhere in the Greek New Testament (2017, 76). Webb either does not notice or coyly withholds the fact that Wenzel (1960b, 6–7), whom she cites for this fact, also tells us, in the very preceding paragraph, that the term occurs nine times in the Septuagint, a standard Greek translation of the Old Testament. In any case, it seems that much of what is driving Webb’s aversion to associate sorrow with acedia is a misunderstanding of what these authors mean by sorrow. Taking Aquinas, for example, he defines tristitia as a species of dolor (pain). Dolor manifests when two conditions meet: (1) the conjoining of something bad [to oneself] and (2) the perception of this conjoining (2010, I-II.35.1.co). Tristitia is a specific kind of dolor that is caused by an interior apprehension on the part of the intellect or the imagination (rather than by exterior sensory perception) (2010, I-II.35.2.co). So tristitia is, very generally, just the essential cognitive awareness that something bad has met with me. As for acedia (qua passion), it is a specific kind of tristitia where “the mind is weighed down so much, that even the limbs become motionless.” (2010, I-II.35.8.co) This would indeed appear to describe a weariness or sluggishness of a kind, such as when, for instead, I become aware of all the great burden of work I have to do. This slothfulness does not seem like sorrow, but in Thomas’s technical sense of tristitia, it is.

There are yet other authors who have handled the relation more delicately, although space prohibits discussing each one in much detail. Robert ←13 | 14→Daly’s40 (2007) concern with the recent discussion on agential freedom in depression leads him to argue that acedia is not identical to depression. What Daly gets right is that, yes, acedia is a condition for which one is (usually) culpable, whereas depression, commonly understood, is not. While this is enough to say they are conceptually non-identical, we might question the received wisdom of depression’s non-culpability. By this, folks usually have in mind direct culpability, and in this they are right, but it does seem plausible that one could, in some cases, be indirectly or partially responsible for his depressed condition.41 Another author, Jennifer Radden42 (2002), acknowledges that acedia is a “disorder not of the body but of the soul” (2002, 70), thus giving due import to its status as a spiritual affliction, yet she strangely situates “Cassian’s discussion of melancholy” (2002, 69)—not acedia—alongside other historical authors in her history of melancholy.

Perhaps most accurate is Stanley Jackson43 (1981), who recognizes the real complexity of acedia and the subtlety of its conceptual evolution from the monastics to the present day. Nevertheless, Jackson overlooks or omits some essential features of acedia. He seems to conflate Aquinas’s important distinction of acedia as a passion and species of tristitia, on the one hand, with acedia as a cardinal Sin, on the other hand (1981, 178). Also, while Jackson notes acedia’s obvious connection to idleness in work (1981, 174), he does not explain why this is important, and this is a critical omission. No mere historical accidental association, at acedia’s center, is an aversion to vocation (calling, vocatio), whether this is the spiritually imbued, meaningful work of the anchorite’s cell or it is the rightly relating to and being drawn to union with God as we see in Thomas’s writings.

What Is the Relation of Acedia to Depression?

As I have noted from the outset, a satisfying answer to this question requires distinguishing between (1) the concept of acedia and (2) an instance of acedia—and likewise for depression. Recall my two theses, first, the concept of acedia is not identical with the concept of depression; and that, second, it is possible that an instance of acedia could be coextensive with an instance of depression, in whole or in part, such that one could easily be mistaken for the other. And recall, importantly, that I am assuming here a descriptivist understanding of depression as represented in the DSM.44

The first thesis is easy enough to see. The concept of acedia is not identical with the concept of depression since they do not contain the same descriptive information.45 It is likely why most writers have not taken a strong position of strict identity on the matter. Indeed, Daly (2007, 45) writes, “Any thesis ←14 | 15→that simply identifies acedia with melancholia or depression is not credible.” A hundred years prior, in 1908, the Rev. Charles Taylor writes, “To replace the complex acedy by sadness or sloth is to evade a difficulty.” (I, 66) If we assume the APA’s DSM descriptivist account of depression, which is largely silent on the matter of etiology, we end up with distinct (i.e., non-identical) concepts: because, after all, the Desert Fathers, Scholastics, and spiritual writers were far from silent about the etiology of acedia. Plus, however one comes to acquire or be in a state of acedia, it was never regarded as merely a set of psychological and somatic symptoms, as a descriptivist would write it up. No, an instance of someone afflicted by acedia was viewed through the theological lens of (monastic) Christianity. So the two concepts are not the same, and thus what they describe may be entirely different goings-on.

This, of course, does not rule out the possibility that the two concepts might operate as different terms that, at times, pick out the same token instance. That leads to my second thesis: that an instance of acedia can be, sometimes, coextensive with an instance of depression, where an instance of one might be an instance of the other. That is, despite using different descriptive information (i.e., diagnostic symptoms), each term may refer (roughly, i.e., in whole or part) to the same object. That is more or less the way synonyms work (frightened, afraid), how translations work (water, l’eau), and how the genus-species relation works (colored, red).

Since, however, the terms depression and acedia function more like definite descriptions than rigid designators,46 the problem is a little more complicated. While a rigid designator will invariably refer to the same object, and while an object can have multiple names rigidly designating it (e.g. Hesperus and Phosphorus), definite descriptions may or may not always pick out the same object. Take, for example, these two definite descriptions: the United States president and the leader of the free world. While they may at times designate the same individual, it is certainly not necessary that they always do so, as the latter, while it has sometimes designated the former, it may also genuinely designate—at various times, past, present, or future—some other head of state (though presumably not two individuals at once). Moreover, these designations are not arbitrary, since both descriptions have determinate content that either applies to an object or does not. My contention is that sometimes both descriptions apply to the same object.

The matter is further complicated by the fact that we are dealing not with an object like a human person, which we can easily see and identify, but with an object that is a state of affairs, diachronically continuous yet seemingly ephemeral when it comes to identifying and naming. Let us call this state of affairs one’s condition. I do not mean the having of a specific condition or ←15 | 16→other, as when one has bronchitis, for instance; I mean, rather, the condition of, or current state of, one’s mental states, affects, neurochemistry, dispositions to interact with the world, and so on. Besides, the having of a condition of the former sort is inexact, although a common way of speaking about depression, since depression is not like a bacterium, virus, or infection. Of these we might say (only when using shorthand) that an individual has E. coli,47 for instance; but if we wished to be more precise, we would say that he has in his possession or his body a specific strain or instance of E. coli, for example: an instance (e.g. ~50 CFU, or colony forming units) of E. coli O157:H7 (Lim et al. 2010, 3). That is because the former is a kind and the latter is an instance of that kind. We can usually get away with such verbal shorthand, but sometimes it goes awry.

This is all the more apparent when we are discussing mood disorders. When I say a person has depression, there remains a looming ambiguity. For this could mean that a person possesses either (1) the kind itself of depression, or (2) an instance of that kind,48 or (3) a particular state of affairs such that it can genuinely be called or labeled (an instance of) depression. It is no small matter since each claim says something different about what the individual possesses. The first option is nonsensical since it suggests that a person uniquely possesses the entire kind to himself,49 while the second, as I said above, is a common yet inexact way of speaking about depression; the third is ideal since it is a more exact way of speaking. Note that I do not get this third option with communicable diseases, bacteria, viruses, because in those cases, an individual actually does possess an instance of the kind in the form of a particular strain of the foreign substance that, once external to the body, has entered the body. This is not the case with depression. Therefore, when I say a person has depression, what he possesses is a certain state of affairs (i.e., the current state of his mental states, affects, neurochemistry, dispositions to interact with the world, and so on). Using shorthand, we can call this state of affairs his condition (used in the spirit of option three, rather than option two). Thus, one’s condition, used in this sense, need not be pathological. One’s condition might be such that we may call it normal sadness, or it might be such that we ought to call it depression. Another upshot of using this third option is that if theoretical concepts come to change, one’s condition will not.50

This groundwork prepares the way for us to see how an instance of depression can also be an instance of acedia. We begin with the condition a person is in, the current state of his mental states, affects, neurochemistry, dispositions to interact with the world. Suppose that these are such that we can correctly call his condition (an instance of) depression. If the person has ←16 | 17→come to be in his state via some spiritual etiology, and some of his symptoms are the same as those of acedia as chronicled by the spiritual writers, then we can correctly call his condition (an instance of) acedia. Thus, our person has both an instance of depression and an instance of acedia51 (or, we might say—though we would be going off-script from the DSM’s descriptivism—that our person has a religious kind, or form, of depression, assuming by this that we incorporate into that term a robust understanding of acedia). Of course, I point here only to the cases in which they overlap. There are presumably several cases where they do not, where there is an instance of only one and not the other. We would need empirical data to determine the frequency of occurrences of each.52

Finally, recall Webb’s concern with the dangers of associating sorrow with sin. This had led her to deny that sin causes psychological disorders categorically. This concern resonates with me, and I can see the harm it can cause. While well-intentioned, however, this categorical exclusion is much too hasty, for it may not be true. Webb is correct, citing Daly, that we cannot “simply identify” (2017, 77) acedia with depression (by this, I assume she means we cannot identify the concepts). But there are many relations beyond strict identity that Webb fails to consider. For example, we may have both an instance of depression and an instance of acedia, a possibility which I have described above. Or, at the very least, we may have an epistemically underdetermined situation. Even if sin does not cause psychological disorder properly, we can certainly admit that it can cause symptoms that mirror psychological disorder. Then, given that psychological disorders are notoriously difficult to conclusively diagnose, along with the difficulty inherent in discerning the etiology of a given set of symptoms, we cannot categorically rule out the possibility that a person’s condition is an instance of acedia.


I have argued that while the concept of acedia is not identical to the concept of depression, the two may nevertheless overlap in their instances. Many concerns remain in light of what I have argued, most glaringly those involving how to diagnose acedia, how to address and treat cases in which both are present, and what potential harms this view may evoke. With space prohibiting a full discussion, here we may briefly catalogue some practical implications this has for clinicians who diagnose depression (and spiritual leaders who counsel on acedia), and for a proper theology of psychological disorder among laypersons in the church. (1) It brings into relief potential (indirect) agential culpability for one’s depressive-like symptoms (assuming that that ←17 | 18→person’s real diagnosis is instead acedia, or more appropriately speaking acedia, or an instance of both). You may be wondering—rightly—how we are to know when and how often this parenthetical clause gets triggered. The truth is, more often than not, we do not know. Since it is so difficult in practice to discern, this (2) epistemic opacity forces us to be cautious and kind in going about making both lay-judgments and any formal judgment (e.g. diagnosis). This, I anticipate, should steer off many potential harms or abuses we fear, if we maintain a serious epistemic humility about whether a particular person has depression or acedia or both. This goes not only for those in lay contexts, but also for religious workers and mental health workers, who would benefit significantly from increased communication and translation between their disciplines. Further, depending on what one’s condition truly is, we may be invited to (3) recast how we interpret our suffering in light of our condition or symptoms. Depending on what one’s condition truly is, there may be no difference in phenomenological experience or the actual badness of the suffering, but there will no doubt be a difference in how one conceptualizes the suffering, and perhaps also in how one comprehends, accepts, and resolves to move forward in the suffering. Finally, (4) it prompts us to reexamine the lingering issues of pathologization and the pharmaceuticalization of depressive-like symptoms. On a more practical level, for instance, we need to wrestle with questions like whether someone who is ostensibly experiencing acedia should be treated with antidepressant medication. These and many other nearby issues must be the subject of further rigorous and charitable thinking.53


1 1. Robert L. Spitzer says as much from his time as chair of the Task Force on Nomenclature and Statistics (later renamed Work Group to Revise DSM-3): “Our advisory committee on affective disorders … took an atheoretical descriptive approach—one that does not prevent anyone from further speculation or classification on the basis of presumed etiology.” (1984, 547) I have doubts about whether these descriptions are truly atheoretical. Janet Stoppard (2000) shares doubts specifically about the DSM-4, arguing that the definition of mental disorder is not purely descriptive and atheoretical, as is usually claimed. See also Radden (2017, 99 n.30), as well as Horwitz et al. (2016), for more on this descriptivist approach.

2 2. Possible etiologies or causal origins of depression might be: biological (familial and genetic influences, endocrine system, circadian rhythms, neurotransmitters), psychological (stress and allostatic load, negative ideation, learned helplessness), social-cultural (marital relations, lack of social support). This list is certainly not exhaustive (Barlow et al. 2017, 238–250).

3 3. Or, we could say, between a description of the thing and the thing itself.

4 4. Below, I return to a weaker version of this question, namely the qualitative similarity between the concepts of acedia and depression.

5 5. In Irvine’s words, “It is my argument that the fragmentation of the subject occasioned by the new phase of modernity (sometimes called ‘high modernity’ or ‘post-industrialism’) lies on a continuum with, but is qualitatively different from, earlier states of subjective suffering.” (1999, 7; emphasis added) These “earlier states of subjective suffering”? “Acedia, Tristitia and Sloth,” as his title says.

6 6. Jehl (2005, 458) writes that taedium vitae and tristitia were “absorbed into the tradition of the concept of melancholy.” Jehl’s assessment seems to be merely descriptive of what has happened, but not normative.

7 7. The principal early theological and philosophical thinkers and texts where we first find acedia are: Evagrius of Pontus (1990a, 1990b), John Cassian (1894a, 1894b), Gregory the Great (1844), and Thomas Aquinas (2003, 20102011).

8 8. To the monastic type, we can assign Evagrius and perhaps Cassian. Gregory the Great, himself a former monk—“the great pope who never lost his nostalgia for the monk’s solitude” (Wenzel 1960b, 23)—fits somewhere in between the monastic type and the Scholastic type. Thomas Aquinas’s treatment certainly is assigned to the Scholastic type, along with other summae theologiae of the 13th century. What is called the popular type is not merely the common or popular notion of sloth—though it indeed includes that—it is also marked by an emphasis on external, practical signs and effects. It is called popular in the sense of populus, since this kind of acedia was found in works written for laypersons, especially from the 13th to the 15th century, with emphasis on the practical religious life: catechetical handbooks, questionnaires, sermons, devotionals, confessional formulas, and encyclopedias. “This emphasis [on external faults as opposed to abstract states of mind] is so prominent as almost to determine the essence of the vice in the popular image after 1200; but it had occurred already earlier, in the works written for laymen during the eighth and ninth centuries.” (Wenzel 1960b, 177) Some of these, like questionnaires and confessional formulas, can be seen as literary genres in their own right (see Wenzel 1960b, 83–84).

9 9. For an excellent conceptual history of acedia, Siegfried Wenzel’s book (1960b) and dissertation (1960a) are frankly unrivaled for their scholarly depth, breadth, and integrity. Also of merit are Forthomme (2000), Nault (2005, 2006), Luciani-Zidane (2009), which concern acedia in particular, and Bloomfield (1952), and Newhauser (2007), which concern the Sins in general. See also chapter two of my dissertation (McAllister, forthcoming 2020) for a comparatively brief conceptual history of acedia and more on its relation to depression.

10 10. “[T];he Collationes [Conferences] treats of the monk’s ‘inner dispositions,’ whereas the Instituta [Institutes] is concerned with the external regulations given to a [cenobitic] monastic community in need of a rule.” (Wenzel 1960b, 22; see also Cassian 1894b, Pt. I preface).

11 11. As we are taught by Brother Lawrence, for instance. Outside of the religious life, one need only to think of C.S. Lewis’s description in the sermon “Learning in War-Time” (2009), who likens the student to a priest: each has to undertake dreary, monotonous tasks which are far removed from, yet consistent with, the telos of his vocation.

12 12. “[I]f it is a question of the monastic life in general, acedia is not just one temptation among many, it is quite simply the temptation, the calling into question of one’s entire existence, the major identity crisis, in which the very foundations of everything are ←18 | 19→severely shaken.” (Joest 2004, 144) It is the temptation for monastics, because in his day-to-day activities, the monk is starkly aware of God’s claim and calling upon his life, and no aversion to his day-to-day activities can easily arise to a doubting of the rationale behind the life he has undertaken. The general contours of acedia, however, can still be seen regardless of the believer’s vocation. The more aware an individual is of God’s calling on his life, the more deeply the effects of acedia can penetrate.

13 13. A word study in Moralia in Iob (1844) reveals that the English word sloth (in John Henry Parker’s 1844 English edition) is used as a fitting translation from at least six different Latin words: torpor, pigritia, desidia, ignavus, hebetudo, and inertia.

14 14. According to Wenzel (1960b, 165), Ælfric characterizes this vice as “unwillingness to do any good.”

15 15. Thomas’ proposal is a classic example of the Scholastic synthesis of disparate views. It is consistent with each of the previous views while offering a further nuanced distinction.

16 16. Even if we do not know the newly coined word, we are all familiar with the idea of procrastibaking, doing anything (in this case, baking) to avoid the more important work we are supposed to be doing.

17 17. Busyness, taken in one sense, can be considered an opposing virtue to acedia, so long as the work is important, meaningful, and tied to one’s spiritual vocation, whatever that may be. This virtue is present not only in Cassian’s remedies above but also is “fairly frequent in Middle English devotional literature and … allegorical works and medieval drama. Even Chaucer follows this trend: ‘This firste stok was ful of rightwisnesse … and loved besinesse, Ayeinst the vyce of slouthe, in honestee’.” (Wenzel 1960b, 89)

18 18. The Romance languages preserve this connection even more clearly: such as divertir (Fr., Sp., Pt.), from divertere (Lat.), which can mean variously to divert/distract or to entertain; as well as the derived adjectives divertente (It.) and divertissant (Fr.), which mean entertaining, funny, or amusing. A similar etymological connection may be preserved in the word lustig (Ger., Swed.) for funny or amusing, in the words lustig (Dut.) and lystig (Dan.) connoting merry or cheerful, and in the now-obsolete Middle English word lusty for pleasant, merry, or delightful. That is to say, given the clear connection to its other meaning lustful, each of these iterations can suggest the mind’s fleeting away to pleasurable yet frivolous objects.

19 19. See Kierkegaard’s 1839 journal entry, which directly touches upon this passage (1987, II, 381).

20 20. See Ferrall and Repp (1843, 197), for a Danish-English dictionary from Kierkegaard’s time. Kierkegaard certainly knew the word Melancholi, as evidenced by a cursory search on http://sks.de, the Skrifter, the comprehensive and searchable online collected writings of Kierkegaard in Danish.

21 21. Earlier periods in the history of psychiatry were limited in their nosologies, often using either of the general categories mania or melancholy, then specifying further from there. Thus melancholy was previously understood to encompass a wide spectrum of disorders, not only excessive or prolonged sorrow (see Hosack 1821, 58).

22 22. Mark D. Altschule, M.D. (1906–1988) was a Clinical Professor of Medicine at Harvard. See Flanagan (1965a, 1965b) for direct responses to Altschule’s work of 1965.

23 23. Plantinga (2011, 307) comments upon this selfsame attitude: “A particularly charming phrase, here, is the obligatory ‘as we now know’; we were previously wallowing in ignorance and superstition, but now, thanks to science, we finally know the truth.”

24 24. Lewis (1955, 207) coins “chronological snobbery” as “the uncritical acceptance of the intellectual climate common to our own age and the assumption that whatever has gone out of date is on that account discredited.”

25 25. This includes human mental action (i.e., thoughts), as well as passions (emotions, feelings), though, technically speaking, a passion, since it is passive, is not properly an action.

26 26. Altschule’s wording is this: “The gradual process by which the concept of sin came to acquire psychiatric connotations.” (1965, 117n) But it is clear that he thinks that the sin paradigm for explaining human action has no place in psychiatry, saying “medicine does not concern itself with sin per se; accordingly, various items among those that an earlier age designated as sin might be regarded by a later era as either normal behaviour or neurotic or psychotic behaviour.” (1965, 118n)

27 27. Hunter and MacAlpine’s title for the excerpt from Scot’s original The diſcouerie of Witchcraft (1963). Among all the 16th-century writers in this volume, which amounts to no more than twenty out of some 330 items total, this is the most obvious and plain example of witchcraft being subverted by melancholy or any other psychiatric concept in the 16th century. The only other entry which treats directly of witchcraft and melancholy is King James VI of Scotland and I of England’s The Description of Sorcerie and Witchcraft (1963, 47). For his part, those who insist on “attributing their [accused witches’] confeſſions or apprehenſions, to a naturall melancholicque humour,… they ſall finde that that will be ouer ſhort a cloak to couer their knavery with.” (1597, 29–30) For any reasonable person can see that their symptoms differ: melancholics are subject to “leannes, palenes, deſire of ſolitude: and if they come to the higheſt degree thereof, mere folie and Manie: where as by the contrarie, a great nomber of them that euer haue bene convict or confeſſors of Witchcraft,… ſome of them rich and worldly-wiſe, some of them fatte or corpulent in their bodies, and moſt part of them altogether giuen ouer to the pleaſures of the fleſh, continual haunting of companie, and all kind of merrines, both lawfull and vnlawfull, which are thinges directly contrary to the ſymptomes of Melancholie, whereof I spake.” (1597, 30)

28 28. Scot writes of “How melancholie abuſeth old women,” saying “I meane not of cooſening [cozening] witches, but of poore melancholike women, which are themſelves deceived. For you ſhall underſtand, that the force which melancholie hath, and the effects that it worketh in the bodie of a man, or rather of a woman … troubled with this diſeaſe, imagine manie ſtrange, incredible and impoſſible things …[such as] one that was in great perplexitie, imagining that his noſe was as big as a houſe.” (Scot 1584, 52–53)

29 29. Or coosening art, a now obsolete term for cozen (to cheat or defraud).

30 30. Most likely, in this context, meaning foolish talk associated with old age or senility.

31 31. Simply note Scot’s original (1584) title page, which cites 1 John 4:1, hinting at the rationale for his investigation: “Beleeue not euerie ſpirit, but trie the ſpirits, ‘whether they are of God; for manie falſe prophets are gone out into the world, &c’.”

32 32. Scot enumerates each of these three in the opening epistle to, incidentally, his “couſen” Sir Thomas Scot Knight, &c.: “See firſt whether the evidence be not frivolous, & whether the proofs brought against them be not incredible, conſiſting of gheſſes, preſumptions, & impoſſibilities contrarie to reaſon, ſcripture, and nature. See alſo what perſons complaine upon them, whether they be not of the baſeſt, the unwiſeſt, & most faithles kind of people. Alſo may it pleaſe you to waie what accuſations and crimes they laie to their charge, namelie: She was at my houſe of late, she would have had a pot of milke, she departed in ←19 | 20→a chafe bicauſe she had it not, she railed, she curſſed, she mumbled and whiſpered, and finallie she ſaid she would be even with me: and ſoone after my child, my cow, my ſow, or my pullet died, or was ſtranglie taken.” (1584; see 1963, 32–33)

33 33. “Truelie I for my part cannot perceive what it is to go a whoring after strange gods, if this be not. He that looketh upon his neighbors wife, and luſteth after hir, hath committed adulterie [In the margin: ‘To go to witches, &c. is idolatrie.’]. And truelie, he that in hart and by argument mainteineth the ſacrifice of the maſſe to be propitiatorie for the quicke and the dead, is an idolater; as alſo he that alloweth and commendeth creeping to the croſſe, and ſuch like idolatrous actions, although he bend not his corporall knees.” (Scot 1584, 12)

34 34. “[T]hey can raiſe and ſupreſſe lightening and thunder, raine and haile, clouds and winds, tempeſts and earthquakes. Others doo write, that they can pull downe the moone and the ſtarres … that they can cure diſeaſes ſupernaturallie, flie in the aire … They can raiſe ſpirits (as others affirme) drie up ſprings, turne the courſe of running waters, inhibit the ſunne, and ſtaie both day and night, changing the one into the other … They can bring ſoules out of graves.” (Scot 1584, 10)

35 35. “[N]either is there any mention made of these kinds of witches in the Bible. If Chriſt had knowne them, he would not have pretermitted to invaie againſt their preſumption, in taking upon them his office: as, to heale and cure diſeaſes; and to worke such miraculous and ſupernaturall things, as whereby he himſelfe was ſpeciallie knowne, beleeved, and publiſhed to be God; his actions and cures conſiſting (in order and effect) according to the power by our witchmoongers imputed to witches.” (Scot 1584, 11) Scot then doubles down, saying the mere belief itself is idolatrous: “In like maner I ſay, he that attributeth to a witch, ſuch divine power, as dulie and onelie apperteineth unto GOD (which all witchmongers doo) is in hart a blaſphemer, an idolater, and full of groſſe impietie, although he neither go nor ſend to hir for aſſiſtance.” (1584, 12)

36 36. In response to a charge that “the study of medicine … favours a disposition to materialism,” Feuchtersleben replies that this charge is “unjust.” (1847, 8) “No one has more occasion than the physician, to recognise the power of mind and the perishable nature of matter; and if he do not attain to this recognition, the fault is not in the science, but in himself, in not having thoroughly studied it, for here, we may say as Bacon did of philosophy, ‘when superficially studied it excites doubt, when thoroughly explored it dispels it’.” (1847, 8) Sir Francis Bacon, whom he favorably quotes, was a devout Anglican.

37 37. “The effects of the passions of the soul are sometimes named metaphorically because of a likeness to sensible bodies, given that the movements of an animal appetite are similar to the inclinations of a natural appetite. It is in this way that intense heat (fervor) is attributed to love, being widened (dilatatio) is attributed to pleasure, and being weighed down (aggravatio) is attributed to sadness.” (2010, I-II.37.2.co)

38 38. Marcia Webb has both a M.Div. theology degree and a Ph.D. in clinical psychology. She is presently an Associate Professor of Psychology at Seattle Pacific University.

39 39. “I have remained immobile in the early stages of goodness, and I have not progressed … I have often given way to frivolous and empty thoughts, and have permitted my mind to wander in such things.” (qtd. in Webb 2017, 77)

40 40. Robert W. Daly, M.D. is Professor Emeritus of Bioethics and Humanities and Professor Emeritus of Psychiatry at SUNY Upstate Medical University.

41 41. We need only something like the following more general principle to be true, that one can, through actions for which he can be held responsible, contribute to his psychological distress or disordering to the point that he develops a diagnosable condition.

42 42. Jennifer Radden, D.Phil. Oxon. is Professor Emerita at UMass Boston.

43 43. The late Stanley W. Jackson, M.D. (1920–2000) was Professor of Psychiatry and History of Medicine at Yale University School of Medicine.

44 44. The problem might resolve itself more easily if we were discussing depression from a clinical perspective and permitted to hazard and employ different theories concerning etiology. We could, for instance, come away with a handy category of religious depression, which might be closer to acedia.

45 45. By Leibniz’s Law of the Indiscernibility of Identicals, x=y → ∀F(Fx ↔ Fy), if x and y refer to the same object, then x and y will not differ in any of their properties—it is somewhat strange to use their, since, in a case of numerical identity, there is only one object. Moreover, if there is some property that x has but y does not have, or vice versa (i.e., they are not qualitatively identical), then x and y are not the same object (i.e., not numerically identical). What goes for concrete objects also goes for abstract things lacking extension, like concepts or definitions. If two definitions differ in any respect, then they are not the same definition.

46 46. See Saul Kripke’s (1980) Naming and Necessity for the distinction between rigid designators and definite descriptions.

47 47. We would never say that someone has the E. coli. This awkward construction seems to connote a reference to the genus; our acknowledgment that this is an incorrect way of speaking, likely reveals that we are not claiming the individual owns a genus.

48 48. A person can indeed be said to possess a kind by having an instance of that kind. I can say here only that I believe this is yet another case of speaking loosely; however, it may be correct to speak this way in some cases, as when discussing certain properties like red. In some manner, the kind red is truly fully present in an instance of red (i.e., it lacks none of its brilliance, hue, and shade); though in another sense, it is also true that the kind red is not fully present in an instance of red (i.e., one instance of red does not account for the entire kind of red).

49 49. This seems strange whether it be understood on a Platonist-type view, since a thing participates in a Form but never fully appropriates it; or on an Aristotelian-type view, where, even though a substantial form may be fully present in a thing, one instance of a substantial form rarely ever (unless, perhaps, it is sui generis) accounts for the entirety of that kind of form.

50 50. For instance, S. T. Coleridge does not cease to have melancholy when that concept becomes outdated. Some might object that this approach is too reductionistic, but I prefer to say it more accurately captures what a person has. In any case, I am not opposed to using terms and labels like depression and acedia; this so-called reductionistic descriptive account would only be initial, a diagnostic first step before we apply our conceptual terms du jour. It is especially useful for comparing conditions across history and cultures.

51 51. I say some because it is reasonable to think, concerning both depression and acedia, that a person may present with only some of the characteristic symptoms and yet the corresponding term would still correctly apply. One certainly need not check off all the symptoms.

52 52. A certain stripe of Kierkegaardian might venture to say that all instances of depression are instances of acedia, since all of life is to be lived before God. However, that is a topic for another paper (1993, 124).

53 53. My special gratitude goes to C. Stephen Evans, Nick Colgrove, and Harrison Lee for providing me with a friendly conversation about these important topics. Also, I am grateful for the lively sharing and interaction with the participants of The Faces of Depression in Literature seminar at the 2019 ACLA National Meeting at Georgetown University, as well as the participants of the 2019 Annual Conference on Medicine and Religion at Duke University. Finally, I owe the editor of this volume, Josefa Ros Velasco, an enormous thanks for her gracious spirit and her vision, hard work, and ambition to see this project through.

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2 Depression in Ricardian Dream Visions

Nancy Ciccone

University of Colorado

In Chaucer’s dream vision known as the Book of the Duchess (c. 1368), the narrator wonders how he can still be alive: “I have gret wonder, by this light,/How that I live, for day ne night/I may not slepe.” [“I am amazed, by this light,/how I am still alive for neither day nor night/can I sleep.”] (1987, 1–3)1 He complains of idle thoughts continuously plaguing his mind (1987, 4). Having suffered for eight years, he has lost all discernment: “Joye or sorowe, wherso hyt be/For I have felynge in nothyng.” [“Everything seems the same to me—whether joy or sorrow, wherever it comes from—because I don’t feel anything.”] (1987, 10–11) Whereas modern analyses might consider him suffering from clinical depression, the narrator diagnoses himself as suffering from “melancolye.” (1987, 23) According to Medieval medical discourses, he is correct. Among his ailments is “sorwful imaginacioun” (1987, 14), a primary symptom of the disease.

Most literary scholars, however, diagnose him with lovesickness because Chaucer’s dream visions borrow from French sources that designate unrequited love as causing their narrators’ depressive melancholia. As Peter Toohey (1992, 267) has found, such a medical identification reaches back at least to Galen (c. 130–200 CE). He diagnosed it when an emaciated, feverish woman, who has insomnia, quickened her pulse at the mention of a particular dancer. Galen and other early medieval humoralists from the 3rd through the 5th centuries note that lovesickness presents symptoms likened to melancholia but indicative of a depressive state not based on the excess of black bile, the root definition of the humor (Toohey 1992, 267–268). According to Toohey’s research, “descriptions of melancholia as a depressive disease seem to begin seriously about the same time as do descriptions ←27 | 28→of depressive lovesickness.” (1992, 283)2 Later, medieval medical texts treat lovesickness, translated as hereos or amor heroes, as a subset of melancholia. Lowes (1914) has traced the influence of works by al-Razi (c. 860–925) and by Avicenna (980–1037) on 14th-century practitioners. Although various physicians add commentary to their received translations, Lowes’s lengthy quotations demonstrated that identification and treatments coalesce. One of Chaucer’s contemporaries, John of Tornamira (1330–c. 1396), for example, treats lovesickness as a species of melancholia: “amor heroes cum sit una species melancoliae.” (qtd. in Lowes 1914, 504) Bernardus Gordonis (fl. end of 14th century) clarifies: “Love is diseased blood/unwholesomeness of the mind.” [“Amor est mentis insania.”] (qtd. in Lowes 1914, 502) By the time we reach the literature of the 14th century, lovesickness proliferates to a near “textual epidemic.” (Lowes 1914, 226) In the long and late periods, the depression accompanying melancholia and lovesickness binds them together. They flourish in the literary genre of dream visions.

In the Duchess, Chaucer’s narrator tackles his sorrowful imagination by reading Ovid. In another of his dream visions, Parliament of Fowls (c. 1382), Chaucer’s narrator finds Cupid incomprehensible. He begins with a dictum cadged from Horace to the effect that a lifetime is too short to perfect the writing of poetry. Chaucer applies the principle to the understanding of love (1987, 1–7). Knowing nothing of it except what he reads in books, the narrator turns away from the topic to read Scipio’s Dream (1987). In so doing, Chaucerian narrators, perhaps unwittingly, follow medical advice. As Olson has argued (1982, 46), reading literature can be prescribed to treat melancholia, one of the extreme emotions of the accidentes animae, because it provides therapeutic pleasure. For Chaucer’s narrators, however, reading also lulls them to sleep and so, at least, relieves their insomnia. In Chaucer’s Parliament and Duchess, the narrator’s dreams investigate love. However, ambiguous their conclusions on the topic, the sleep that ensues restores balance, the key to maintaining good health among the four medieval humors (Avicenna 2013, 68). Although lovesickness survives as a staple in literature, if not its centerpiece, the genre of the dream vision does not thrive after this period. However, over 200 were written between the 16th and the 15th centuries (Lynch 1988, 1). Our most famous secular English authors—Chaucer, Langland, Gower—rely on it during the last quarter of the 14th century under Richard II’s tumultuous reign (1367–1400), which engenders the term Ricardian literature (Burrow 1971). In keeping with French versions, many of the English dream visions entail an ethical debate to foster appropriate behavior for the lovesick. The popularity of the genre, however, accompanies another medieval development. As Steven Kruger (1999, 55) has ←28 | 29→pointed out, the influx of medical texts during the later Middle Ages further enables the genre to become a place for the merging of medical and moral discourses: “A new somatic treatment of dreaming is in the way it enables a bringing together of a different kind of dream—internally and externally motivated, celestial and mundane, angelic, demonic, and human.” (1999, 62) Kruger’s insights called for “recognizing the somatic possibilities” of the literary dream vision, in order “to move away from the simple allegorizing and spiritualizing tendencies” in the critical literature (1999, 62). A focus on depression fosters a response to Kruger’s suggestion because medieval melancholia entails the somatic.

Along with the merging of medical and moral discourses and lovesickness and melancholia, I focus here on another merging: that between lovesickness and grief. Since we grieve the loss of what we love, medieval medical discourses treat both types of depression as heart ailments. For comparison with the Chaucerian lovesick, I turn to a grieving narrator in another Ricardian dream vision, the anonymous Pearl (c. 1360–1395). This comparison is, admittedly, somewhat unfair. The Pearl is overtly theological in contrast to Chaucerian dream visions. Chaucer always has his tongue in his cheek. His narrators protest too much, and his literary antics may, in turn, alleviate sufferers of depression by entertaining them.

In contrast to the narrators in Chaucer’s dream visions, Pearl’s gravity invites empathy for the narrator even as he too distracts fellow sufferers with a narrative. In short, the poets rely on entirely different registers. Whereas the Duchess’s narrator fails to feel anything, grief overwhelms the Pearl’s narrator. However, he too finds himself stymied. In turn, medieval therapies for these forms of depression differ despite presenting similar symptoms. Treatments for lovesickness include frequent coition, declarations of love, even flagellation (Lowes 1914, 501, 506). Assuaging grief, however, depends on religious belief and the passage of time to ease it, rather than precise action. To explore the representation of grief, I first address the Pearl narrator’s symptoms. I then consider them in light of treatments from medieval medical discourses. Finally, I take an even more comprehensive view by contextualizing the significance of merging the medical and moral, lovesickness, and grief, within the late 14th-century social context.

In Pearl, grief first presents as lovesickness. The narrator claims he is “fordolked of luf-daungere/Of that privy perle withouten spot.” [“grievously wounded by love’s power for [his] own spotless pearl.”] (Gordon 1974, 11–12) Conforming to its French dream vision models, the narrative furthermore begins in a locus amoenus, frequently a setting for courtly romance. However, the beautiful garden turns out to also be a graveyard. ←29 | 30→The jeweler who lost his precious pearl there turns out to be a father who lost his two-year-old daughter named Pearl. As in Chaucer’s dreams, the Pearl’s dream will investigate the topic that causes depression. No matter whether the narrators in Ricardian dream visions seek a requited love or a dead daughter, their subsequent dreams somewhat miss the mark. Pearl’s ghost-image will assure her father that she is okay. She attempts to mitigate his grief by teaching him Christian doctrine. Whereas literary scholars debate whether or not those teachings comfort him, the focus on depression highlights an equal consideration overlooked in the critical literature: the Pearl-poet sprinkles medications for melancholia throughout the narrative. In other words, the narrative images themselves provide somatic treatment to moderate the narrator’s grief.

The entire narrative of the Pearl centers on the heart. Marti (1991, 83) has found the narrative to be “a body structured around the formal and thematic nucleus of the heart—a heart that is literal as well as metaphorical”; it spatially and temporally centers the poem in the shape of a pearl (1991, 143). Marti correlated the heart with the pearl the Pearl-Maiden wears and with the heart of the Lamb. Among the literal correspondences, however, is the narrator’s heart. For the narrator, it is the location of his grief: “devely dele in my hert denned.” [“a desolating grief lay deep in my heart.”] (Gordon 1974, 51) The 11th-century physician Avicenna locates the life force, the animalistic faculty, in the heart which manages the breath (2013, 89). In the 7th century, Isidore of Seville’s chapter on medicine, “Entymologia,” clarifies the connection through anatomy: the heart is next to the lungs so that the heart controls breathing (1964, I.118). Avicenna, however, provides a blueprint describing the characteristics of melancholia and remedies for those who come after him. He prescribes “pearl and silk,” to counteract difficult things and improve the breath needing adjustment in the treatment of depression (Gruner 1930, 9.1119, 547). For Avicenna, breath refers to a vitality, which is constrained in depression and grief (Gruner 1930, IV.16, §134). The lost pearl suggests the Pearl narrator’s inability to follow Avicenna’s prescription of the materials to improve his breath. He initially describes the pearl as that which had granted him happiness and well-being: “al [his] hele.” [“all [his] health.”] (Gordon 1974, 16) Avicenna further distinguishes between fear and depression, which fall together under “contraction of the chest or heart.” (Gruner 1930, 7.1116, 544) “Depression has much to do with saddening things and the heart does not tolerate them much.” (1930, 7.1116, 544) The condition “impels one to stand still for the purpose of either resisting or repelling.” (1930, 7.1116, 544) For diagnosis, depression (oppression of the chest) exhibits “(a) sense of threatening injury” and “(b) no desire to ←30 | 31→flee.” (1930, 7.1116, 544) Having lost all his well-being, the Pearl narrator’s laments and efforts to retrieve his pearl attest to a threatening injury. He also returns to the very place he lost his pearl: “I lest hyr in on erbere”; “I entred in þat erber grene.” [“I lost her in an arbor”; “I entered into that green arbor.”] (Gordon 1974, 9, 38) The narrative indicates the speaker’s psychological stasis through geography. Returning to the place of his loss, he is unable to move on. He has no desire to flee, nowhere else to go. Stillness will also enter into his dream. His heart is stunned when he first views the Pearl-Maiden (1974, 176, 179). In awe, he famously stands “as hawk in halle” (1974, 184) and later in the narrative, “as stylle as dased quayle.” (1974, 185) The figurative language of birds emphasizes his inability to fly, to flee. Whereas Chaucer’s narrator in the Duchess complained of psychological paralysis, the Pearl’s narrator exhibits it physically. In both cases, the narrators’ depression presents as being arrested in the progress of their lives.

According to Avicenna (2013), seasonal changes factor into the causes of disease. Summer “breaks downs humors and weakens strength and natural functions due to its excessive disintegration. It reduces blood and phlegm and increases the bitter yellow bile, then at its tail end, black bile increases.” (2013, 131) The Pearl narrative begins in August, probably the Feast of the Assumption, August 15. While the feast day complements the overall Christian message, the time of year also contributes to an excess of the black bile, the melancholia, complementing the father’s care ful colde, usually translated as sorrow. In other words, the poet’s word choice for the narrator’s sorrow suggests the coldness characteristic of the melancholic, unable to be warmed by the weather.

Nevertheless, the environment also offers treatment. The narrator collapses from his grief upon a “flowery turf” with “suche odour to my hernes shot.” [“with the fragrances shooting into his brains.”] (Gordon 1974, 58) Firing into his brains, the aromas target the site where Avicenna located depression in contrast to fear, which affects the body (Gruner 1930, 7.1116, 544). However, reminiscent of the locus amoenus of courtly romance, the catalog of garden flowers also conveys their particular medicinal benefits. The gillyflower constitutes a “healing clove”; the ginger fosters an “energizing anti-irritant; the gromwells’ ‘stony nutlets’ resemble pearls”; the peony emblematizes “Παιάν, the Greek god of healing.” (Stern 1970, 76) In addition to their symbolic meanings, the flowers accord with Avicenna’s prescription: “sweet aromatics [to] strengthen the breath.” (Gruner 1930, 2.119, 547) Davenport (1978, 11) has further pointed out that the spices enthrall all of the narrator’s senses: “involving not only sight,” but also “touch,” “sound,” “taste and smell.” (27–28, 6, 19, 29) While the narrator’s reason ←31 | 32→has set him at peace—“Though resoun sette myselven sight” (Gordon 1974, 52)—his “wreched wylle” (1974, 56) continues suffering. In effect, the narrative distinguishes between the intellect located in the narrator’s resoun and his wylle. The spices bypass both as they shoot into the physiology of his brains.

The narrator, furthermore, acknowledges the comfort Christianity offers: “kynde of Kryst me comfort kenned.” [“the nature/mercy of Christ has been taught to me.”] (Gordon 1974, 55) It just does not help. As a result, some literary scholars find the narrator lacking faith, his stasis indicative of acedia. The depth of the narrator’s grief suggested to Hillman (1970, 10) the sin of covetousness. Scholarly debate has ensued as to whether the sin of stultitia, foolishness, needs to be added to that of covetousness, and whether sinfulness resulted from loving earthy goods too much or from mistaking the daughter as an object (see Cherniss 1987, 158). Among his critics, Nolan (1977, 160) characterized the narrator’s error as the sin of pride, hubris, and in so doing, addressed the problem of his self-absorption. Depression entails for the Duchess’s and the Pearl’s narrators an obsession with their feelings. However, whereas the Pearl narrator’s grief speaks of sins, they also indicate symptoms of depression rather than a moral failing.

Distracting him from melancholy, medieval aromatherapy substitutes for the books Chaucerian narrators read. Each provides relief from being overwhelmed by self-absorption. Such distractions invite sleep. Collapsing to the ground, the Pearl narrator’s “spyryt þer sprang in space.” [“spirit springs into space.”] (Gordon 1974, 61) On one level, the garden of flowers that die and are reborn mimic the cycle of life and death that grieves the narrator. On another level, sleep is the vehicle by which healing progresses as it does in Chaucer’s dream visions. The garden hosts prescriptions for ailments to testify to the somatic healing the Christian God bestows on mortals. Among other embedded images that aided healing and discussed below, sleep eventually enables the narrator to move on from the garden/graveyard.

As the dreamer dreams, the vision of the Pearl-Maiden, her splendor, and the richness of the landscape provide additional antidotes to his grief: “The adubbemente of þo downeȝ dere/Garten my goste al greffe forȝete.” [“The adornment of those glorious hills/made my spirit forget all grief.”] (Gordon 1974, 85–86) However, much the landscape reflects the dreamer’s projection of aristocratic opulence; it accords with Avicenna’s instructions. The “crystal klyffeȝ” [“crystal cliffs”] (1974, 74), silver leaves (1974, 77), “emerad, saffer, oþer gemme gente” [“emerald, sapphires, or noble gem”] (1974, 118) aim to counteract “disagreeable things” (1974, 118) and to release vital breathing. Crystal, in particular, elicits physical effects through sensory perception. ←32 | 33→Although hard and cold, it refracts light and therefore provides heat. Galvez (2014, 18) has argued for the literary image to convey an intense moment of subjectivity due to its use in mirrors. Applying her findings to the Pearl suggests that the narrator’s gaze becomes ours; even if the Pearl-Maiden represents his wish fulfillment, we share in the reflection. The gems and stones further signify various meanings for the original audience of the poem, and as Stern (1970, 82) has noted: “Gemology was so common in the exegetical tradition that it is hardly possible that the poet did not take his jewel symbolism for granted”—especially pearls.

Much of the interpretative literature treats pearls in terms of either their religious or courtly significance.3 Nevertheless, they also cure melancholy. The narrative pivots on the image of the pearl; it slides in its denotations of meaning, sometimes literal and sometimes figurative. However, whether akin to the Matthew’s Pearl of Great Price (13:45–46) or Anne’s adornment as Richard’s queen, literal pearls also figure in pharmacology. Not only does Avicenna specifically single them out to alleviate depression (above), but the Legenda Aurea (c. 1275) introduces Saint Margarita, whose name derives from the Persian word for pearl, with a description of the jewel’s properties “to be contrary to the heart’s passion, and to comfort the spirit.” [“Virtus autem hujus lapidis diciture esse contra cordis passionem, et ad spiritus confortationem.”] (Gordon 1974, 28) The actual pearl occurs in the medieval pharmacopeia as an essential cure for a host of diseases. The Cyrurgie of Guy de Chauliac (c. 1363; Getz 1991) lists the “margary perles, ben colde and drye” are known for “cleren and conforten.” [“Margery pearls, being cold and dry” are known “to purify and to comfort.”] (Ogden 1971, 624)4 The pearl is especially prescribed for heart ailments and melancholy: “And if it þe cardiacle comeþ of malencoly and of coler togedir … let him vse oftetymes in his metis lymail of golde and þe poudir of margerie peerless þat ben good for þe cardiacle þat is with a feuer also.” [“And if heart disease [caused by excessive emotion] comes from melancholy [black bile] and colic [yellow bile] together, make the medicine of gold filings and powdered pearl that are also good for the passion that is with a fever.”] (Getz 1991, 146, f.187v, 19–21)5 The apothecary Richard de Montpellier who sent a prescription including pearls to Edward I (1237–1307), suffering from dysentery (Getz 1991, 19), believes that such remedies were copied pro forma. For its pharmaceutical effects, the pearl needs to be ground to a powder, and the first description of the dream landscape includes “precious perleȝ of oryente” on the ground (Gordon 1974, 82). Cherniss (1987, 158) has pointed out the irony here due to “the narrator’s grief over the loss of a single gem” when they appear in abundance. However, the poet’s word choice—“Þe grauayl þat ←33 | 34→on grounde con grynde” [“The gravel on the ground, ground”] (Gordon 1974, 81–82)—also brings to mind the grinding of the pearls as if for a prescription. Within this landscape, the dreamer subsequently “al greffe forȝete,” as if momentarily cured of his melancholy (Gordon 1974, 86).

Despite the Pearl-Maiden’s lessons on Christian doctrine, her father continues to question her well-being. How can she be one of the 144 thousand saved? When she was so young at death, how can she appear as a maiden? The narrator responds to Matthew’s parable of the laborers in the vineyard as “unresounable” (Gordon 1974, 590), “bot a fable.” (1974, 592) His mercantilism insists each be rewarded according to the hours of work (1974, 595). Perhaps he cannot grasp a situation so different from his experiential one. He wants to know what her castle looks like, where she lives. She finally reveals to him a vision of the New Jerusalem. At this point in the narrative, the narrator disregards the Pearl-Maiden’s warnings that he must keep his distance. He wants to reach her and splashes into a river separating them. The movement wakens him. He sums up his dream experience: “If it be veray and soth sermoun/That thou so stykes in garlande gay/So wel is me in thys doel-doungoun/That though art to that Pryces paye.” [“if it be [an] actual and true account/that you are set in a fair garland/it is well for me in this sorrowful dungeon/That you are in the Prince’s pleasure.”] (1974, 1185–1188) The conditional sentence somewhat undermines the dream’s religious comfort. Nevertheless, despite such shortcomings in his understanding and along with the gift of Christ’s grace, the images of somatic healing and the relief of sleep assist in putting him back on his feet. After waking, he goes to church to receive communion. Alone at the beginning of the narrative, he now rejoins the Christian community. Even if still grieving, even in some doubt about the veracity of his dream, he is able to act, to leave the gravesite.

Medieval scholars argue over whether or not the dream comforts the Pearl’s narrator and relieves him of his depressive melancholia. Some interpreters attempt to reconcile the narrative’s two primary perspectives: Christian spirituality, represented by the Pearl-Maiden and humanistic grief, represented by the jeweler-father. In her introduction to the TEAMS edition of Pearl, Stanbury (2001, part 10) has articulated the interpretative conundrum with a question: “does the poem resolve in an aristocratized and utopic vision, or is there a remnant, the narrator himself, not totally encapsulated within a formal sacramental or courtly system?” Gilbert (2011, 187–189), for another example, deployed Lacan’s concept of anamorphosis to posit a rapprochement between the mortal and heavenly spheres, so that each sphere animates the other. By way of contrast, Davenport (1978, 51) has found the poet’s answer to grief to be “by believing in an existence other than the earthly.” ←34 | 35→Attributing comfort to the narrator, Hillman (1945 [1970], 14) has asserted a kind of conversion resulting from the jeweler’s comprehension of the Pearl-Maiden’s teachings.6 If nothing else, these viewpoints taken together reveal the narrative gap between a faith-based religious ideology and the emotional grief of loss, dependent on the audience/reader. In effect, the Pearl evidences a textual indeterminacy comparable to that found in Chaucer’s dream visions, however much they differ. However, with its complex concatenation, symbolic numbers, elaborate punning, sophisticated semiotics, this jewel of a poem also contributes to the images of somatic healing that may constitute a prescription for its original audience. They, too, are Christians, familiar with the doctrine the Pearl-Maiden reiterates. Moreover, they, too, have endured loss and hardship resulting from Richard’s governance and the ravaging plagues.

Although we do not know the exact date in which the Pearl was written, we do know something about the late 14th-century English audience. Even at the risk of over-simplifying, two social crises warrant mention. In terms of economics, Richard II was emptying the British coffers. He taxed the populace to support the 100 Years War (1337–1453), and to the aristocracy’s disappointment, was losing their French properties. Also, the Pole Tax was the final straw that led to the Peasant’s Revolt of 1381, the first recorded social revolution in England that produced little actual change. The rebels notably rallied around another dream vision, Langland’s Piers Plowman (c. 1370), however much they may have misinterpreted it. Richard also added economic insult to such injury by entertaining lavish courts. The Pearl’s glittering descriptions of the dream landscape and especially of the New Jerusalem suggest that such lavishness belongs in dreams and heaven, not decorating the court and the king’s favorites, even if the poet himself was a royalist. In the last twenty years of the century, power shifts from the King to the Lord’s Appellant and somewhat back to the king, which must have affected the social structure as armies were raised and battles fought within England and France until Richard was deposed in 1399.

The other major social crisis the Pearl evokes is that of the Bubonic plague. In 1348–1349, it had decimated England, and it returned in waves throughout that century. Moldering bodies (Gordon 1974, 306, 320, 857, 958) recur throughout the Pearl narrative. The white and pure jewel is muddied by the ground in which it is lost: “Thy corse in clot mot calder keye.” [“Your body in clay must colder sink.”] (1974, 320) The narrator mourns the marring of his “pryuy perle wythouten spot” [“his own spotless pearl”] (1974, 12), “To þenke hir color so clad in clot.” [“to think her complexion so clad in clay.”] (1974, 22) In that the Pearl-Maiden’s “flesch be layde to rote” [“flesh is laid to rot”] (1974, 958), he lets his imagination intensify his grief. ←35 | 36→Within the dream, the narrator even refers to himself as “bot mokke and mul.” [“muck and dust.”] (1974, 905) David Coley (2013, 231) has associated the different valences in “the spotty and the clean” with the plague symptoms. As Coley argued, “Pearl heightens its affective potential by absorbing the language and imagery of the pestilence into its mingled allegorical and elegiac narratives.” (2013, 241) These insights complement the images of somatic healing in Pearl, for they represent a prescription for a traumatized, surviving audience. An entire population, already aware of the Christian afterlife, needs to begin the process of recovery, to re-enter the quotidian demands of continuing their lives after experiencing the losses brought on by economic instability and by plague.

Whether Chaucer’s or the Pearl-Poet’s narratives, the medieval dream vision suggests an appeal beyond that of courtly romance with its focus on fin’amors, fine love, and beyond that of Christian faith with its attention to moral behavior. The Pearl, for one example, provides a place of empathy for a community in times of crisis. Much literature arguably does that, but the dream vision mainly fills a gap because it targets cultural issues in an imaginary landscape in much the same as some science fiction does today wrestling with inequality, global warming, apocalyptic visions, and even love. Imagining shows us how some people, who may not know what to do, yet find a way to act, whether it is the practice of reading that produces relief from anxiety or the ideas from reading that furnish strategies enabling us to sleep and to rise the next morning.


1 1. I have placed the modern English translations after the Middle English quotations. All translations are mine unless otherwise noted. The line number following the quotations refers to their respective Middle English narratives. The Pearl vocabulary usually alludes to more than one meaning, so we have relied on the forward-slash to indicate alternatives.

2 2. For a recent medical finding on the connection between lovesickness and the brain, see Templin et al. (2019).

3 3. The critical literature is vast. Examples include Ackerman (1964), Gatta (1974), Arthur (1987), Clopper (1991), Hatt (2015) for religion; Bennett (1992), Barr (2000), Bowers (2001) for the aristocratic court; Muscatine (1972) for the combination of the two.

4 4. The Cyrurgie is an anonymous translation of Guy’s Inventarium sui collectorium in parte cyryrgicali medicine thought to have been written in Avignon, 1362 (p.v.). Benjamin Lee Gordon (1959, 383) credits John of Gaunt with having made the text available to English surgeons during the One Hundred Year’s War after he noted the skill of the French surgeons responding to battle injuries.

5 5. Although the Middle English version is a translation from the 15th century, it is based on the Compendium medicinae, written about 1250. See also Anna Nardo (1985, 34–36) for a history of the pearl as a cure for melancholy.

6 6. Aers (1993, 55–56) provides a summary of those literary critics, before his writing, who advocate for the narrator’s reclamation of his faith and those who read the conclusion skeptically.

←36 | 37→


Ackerman, R. W. 1964. “The Pearl Maiden and the Penny.” Romance Philology 17: 615–623.

Aers, D. 1993. “The Self Mourning: Reflections on Pearl.” Speculum 68 (1): 54–73. https://doi.org/10.2307/2863834.

Arthur, R. G. 1987. “The Day of Judgment is now: A Johannine Pattern in the Middle English Pearl.” American Benedictine Review 38: 227–242.

Avicenna. 2013. Avicenna’s Medicine. Rochester, VT: Healing Arts Press.


XXIV, 234
ISBN (Book)
Publication date
2020 (June)
New York, Bern, Berlin, Bruxelles, Oxford, Wien, 2020. XXIV, 234 pp.

Biographical notes

Josefa Ros Velasco (Volume editor)

Josefa Ros Velasco is Associate and Teaching Assistant in the Department of Romance Languages and Literatures at Harvard University and Real Colegio Complutense at Harvard Postdoctoral Fellow. Dr. Ros Velasco holds a Ph.D. in Philosophy with International Mention at the Excellent Program of Doctorate in Philosophy at the Complutense University of Madrid (UCM, Spain), funded by the Spanish Ministry of Culture and Education. Her current research is multidisciplinay, focusing on the evolution of the understanding of boredom as a mental pathology. She is the author of The Culture of Boredom (2020) and Boredom Is in Your Mind (2019).


Title: The Faces of Depression in Literature