To the English, the disease was "the English malady". But the rainy British Isles were not the only site visited by the disease; all of Europe was afflicted.
The disease grew increasingly prevalent over the course of the 20th century, when relatively sound statistics first became available, and this increase cannot be accounted for by a greater willingness on the part of physicians and patients to report it. Rates of schizophrenia, panic disorders and phobias did not rise at the same time, for example, as they would be expected to if only changes in the reporting of mental illness were at work. According to the World Health Organisation, depression is now the fifth leading cause of death and disability in the world, while ischemic heart disease trails in sixth place. Fatalities occur most dramatically through suicide, but even the mild form of depression - called dysthemia and characterised by an inability to experience pleasure - can kill by increasing a person's vulnerability to serious somatic illnesses such as cancer and heart disease. Far from being an affliction of the famous and successful, we now know that the disease strikes the poor more often than the rich, and women more commonly than men.
Just in the past few years, hundreds of books, articles and television specials have been devoted to depression: its toll on the individual, its relationship to gender, the role of genetic factors, the efficacy of pharmaceutical treatments. But to my knowledge, no one has suggested that the epidemic may have begun in a particular historical time, and started as a result of cultural circumstances that arose at that time and have persisted or intensified since. The failure to consider historical roots may stem, in part, from the emphasis on the celebrity victims of the past, which tends to discourage a statistical, or epidemiological, perspective. But if there was, in fact, a beginning to the epidemic of depression, sometime in the 16th or 17th century, it confronts us with this question: could this apparent decline in the ability to experience pleasure be in any way connected with the decline in opportunities for pleasure, such as carnival and other traditional festivities?
There is reason to think that something like an epidemic of depression in fact began around 1600, or the time when the Anglican minister Robert Burton undertook his "anatomy" of the disease, published as The Anatomy of Melancholy in 1621. Melancholy, as it was called until the 20th century, is of course a very ancient problem, and was described in the fifth century BC by Hippocrates. Chaucer's 14th-century characters were aware of it, and late-medieval churchmen knew it as "acedia". So melancholy, in some form, had always existed - and, regrettably, we have no statistical evidence of a sudden increase in early modern Europe, which had neither a psychiatric profession to do the diagnosing nor a public health establishment to record the numbers of the afflicted. All we know is that in the 1600s and 1700s, medical books about melancholy and literature with melancholic themes were both finding an eager audience, presumably at least in part among people who suffered from melancholy themselves.
Increasing interest in melancholy is not, however, evidence of an increase in the prevalence of actual melancholy. As the historian Roy Porter suggested, the disease may simply have been becoming more stylish, both as a medical diagnosis and as a problem, or pose, affected by the idle rich, and signifying a certain ennui or detachment. No doubt the medical prejudice that it was a disease of the gifted, or at least of the comfortable, would have made it an attractive diagnosis to the upwardly mobile and merely out-of-sorts.
But melancholy did not become a fashionable pose until a full century after Burton took up the subject, and when it did become stylish, we must still wonder: why did this particular stance or attitude become fashionable and not another? An arrogant insouciance might, for example, seem more fitting to an age of imperialism than this wilting, debilitating malady; and enlightenment, another well-known theme of the era, might have been better served by a mood of questing impatience.
Nor can we be content with the claim that the apparent epidemic of melancholy was the cynical invention of the men who profited by writing about it, since some of these were self-identified sufferers themselves. Robert Burton confessed, "I writ of melancholy, by being busy to avoid melancholy." George Cheyne was afflicted, though miraculously cured by a vegetarian diet of his own devising. The Englishman John Brown, who published a bestselling mid-19th-century book on the subject, went on to commit suicide. Something was happening, from about 1600 on, to make melancholy a major concern of the reading public, and the simplest explanation is that there was more melancholy around to be concerned about.
And very likely the phenomena of this early "epidemic of depression" and the suppression of communal rituals and festivities are entangled in various ways. It could be, for example, that, as a result of their illness, depressed individuals lost their taste for communal festivities and even came to view them with revulsion. But there are other possibilities. First, that both the rise of depression and the decline of festivities are symptomatic of some deeper, underlying psychological change, which began about 400 years ago and persists, in some form, in our own time. The second, more intriguing possibility is that the disappearance of traditional festivities was itself a factor contributing to depression.
One approaches the subject of "deeper, underlying psychological change" with some trepidation, but fortunately, in this case, many respected scholars have already visited this difficult terrain. "Historians of European culture are in substantial agreement," Lionel Trilling wrote in 1972, "that in the late 16th and early 17th centuries, something like a mutation in human nature took place." This change has been called the rise of subjectivity or the discovery of the inner self and since it can be assumed that all people, in all historical periods, have some sense of selfhood and capacity for subjective reflection, we are really talking about an intensification, and a fairly drastic one, of the universal human capacity to face the world as an autonomous "I", separate from, and largely distrustful of, "them". The European nobility had already undergone this sort of psychological shift in their transformation from a warrior class to a collection of courtiers, away from directness and spontaneity and toward a new guardedness in relation to others. In the late 16th and 17th centuries, the change becomes far more widespread, affecting even artisans, peasants, and labourers. The new "emphasis on disengagement and selfconsciousness", as Louis Sass puts it, makes the individual potentially more autonomous and critical of existing social arrange-ments, which is all to the good. But it can also transform the individual into a kind of walled fortress, carefully defended from everyone else.
Historians infer this psychological shift from a number of concrete changes occurring in the early modern period, first and most strikingly among the urban bourgeoisie, or upper middle class. Mirrors in which to examine oneself become popular among those who can afford them, along with self-portraits (Rembrandt painted more than 50 of them) and autobiographies in which to revise and elaborate the image that one has projected to others. In bourgeois homes, public spaces that guests may enter are differentiated, for the first time, from the private spaces - bedrooms, for example - in which one may retire to let down one's guard and truly "be oneself". More decorous forms of entertainment - plays and operas requiring people to remain immobilised, each in his or her separate seat - begin to provide an alternative to the promiscuously interactive and physically engaging pleasures of carnival. The very word "self", as Trilling noted, ceases to be a mere reflexive or intensifier and achieves the status of a freestanding noun, referring to some inner core, not readily visible to others.