{"id":35249,"date":"2013-04-11T23:57:59","date_gmt":"2013-04-12T03:57:59","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=35249"},"modified":"2013-04-12T00:13:37","modified_gmt":"2013-04-12T04:13:37","slug":"the-eye-of-the-storm-3","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/04\/11\/the-eye-of-the-storm-3\/","title":{"rendered":"the eye of the storm…"},"content":{"rendered":"
Talking Rock Creek nearby was so named by the Cherokee because the rocky bed creates so much turbulence in places that the stream itself seems to be speaking simultaneously in multiple tongues. When I first encountered it, I thought of the many stories that make one up a single person’s narrative, all playing at the same time. I think of it now because I’m going to try to discuss a story with too many voices for a simple blog post – Melancholia.<\/font><\/strong><\/sup><\/em><\/div>\n

\"Melancholia:Melancholia [black bile] comes to us from antiquity, described as a temperment long before there was even the concept of disease<\/em>. While I’m no expert on the topic, I’ve written about it several times [melancholia… <\/a> and an ode to melancholia…<\/a>]. From my vantage, it’s a unique clinical syndrome that differs from other depressions in a number of ways. I remember my thought the first time I ever saw a case: "Other depressions are adverbs or adjectives, coloring experience. Melancholia is a noun!" I’m the kind of psychiatrist that is always exploring the history for causes, but with these patients, I give up quickly. It doesn’t feel like the right thing to do. Their mood disturbance transcends anything conversational or experiential. Often they can’t describe their feeling at the time, but can talk about it later. It’s a feeling unlike grief or sadness. I gave my best shot describing it here<\/a> when I was dealing with a particular case. In an editorial last year called Bringing Back Melancholia<\/a>, Dr. Bernard Carrol described it in verse:<\/p>\n

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So, why does it need to be brought back<\/em>? Because in 1980, it went away<\/em> – subsumed under Major Depressive Disorder as a type<\/em>. In prior classifications and general discussions, there were two kinds of depression – variously dichotomized Endogenous vs. Exogenous, Melancholia vs. Depressive Neurosis, Endogenomorphic vs. Characterologic. We thought of them as Depression as a disease [probably biological] and Depressive Neurosis arising from life, personality – something psychological. There was evidence moving towards defining biomarkers for Melancholia [Dexamethasone Suppression Test, Bernard Carroll; and reduced REM Latency on EEG, David Kupfer]. When the DSM-III came out, all the different depressive syndromes had been lumped together under Major Depressive Disorder. I’ve talked the why<\/em> of that to death. Here are several versions [Major Depression: the orphanage…<\/a>, what price, reliability?…<\/a>]. The short take is that removing psychoanalysis from psychiatry was an over-riding concern in the 1980 revision, and they were afraid that any fractionation of depression at all might allow the diagnosis Depressive Neurosis<\/em> to live on. So they essentially sacrificed the Disorder most likely to yield a biological etiology\/biomarker in the process. That, by the way, is just my own opinion. Historian Dr. Edward Shorter put it another way in his book, Before Prozac<\/a>. He concluded… <\/p>\n