Disordered Emotions

By Åsa Jansson

I

As a historian of the emotions, I am intrigued by the idea – so prevalent in the late-modern world – that our emotions can be a source and site of pathology, of illness; that there is a point at which our sadness, ennui and melancholy morph into clinical depression. The idea that profound and debilitating suffering constitutes psychiatric illness and that this pathological quality gives legitimacy to emotional pain that might otherwise appear disproportionate, belongs, just like the psychiatric profession itself, to the modern period. But how did it emerge and become cemented as medico-scientific knowledge?

It is not unusual to find references in current medical literature to experiences in the pre-modern past, held up as examples that today’s psychiatric conditions have always existed but were not previously recognized as such. However, a growing body of research in the field of the history of the emotions indicates that people in other times and cultures did not only express their feelings differently, but that theirs were different feelings, differently felt.[1] It follows from this that before modern emotional disorders became part of our repertoire of medical conditions, people were not able to experience themselves as suffering from such illnesses, no matter how certain we are today that we can identify signs of depression, schizophrenia, or trauma in medieval texts.[2] While the idea of pathological emotionality may appear timeless and universal to the twenty-first-century reader for whom ‘mood disorders’ are an established medical category and a widely occurring human experience, historically these phenomena are rather recent.

In the early-to-mid nineteenth century, melancholia (a medical category that had existed in some form since antiquity) was re-conceptualized as a form of ‘affective insanity’, a mental disease that could manifest without intellectual delusion and where the main symptom of illness was disordered mood. Writing in the 1860s, Victorian psychiatrist Henry Maudsley offered a detailed description of how this mental state emerged. He suggested that ‘sympathetic’ or ‘reflexive’ morbid activity in the body causing repeated ‘irritation’ of the brain would gradually affect the overall ‘tone’ of this organ, eventually resulting in ‘disordered emotion’.[3] Maudsley’s words might sound a little alien to the modern reader. Indeed, nineteenth-century melancholia was qualitatively different from our time’s depression, both in regard to internal biological explanations and the overall symptom picture, but also in terms of how patients experienced their illness. At the same time, however, this description of pathological emotionality provided the conceptual framework for our late-modern ‘mood disorders’.

L0026692 A woman diagnosed as suffering from melancholia. Lithograph,

Lithograph from 1892 depicting a woman suffering from melancholia, the most common form of emotional insanity diagnosed in Victorian asylum patients. Wellcome Images.

II

As one historian has shown, the concept of ‘emotions’ belongs to the modern period, where it gradually came to eclipse older categories anchored in a theistic language and view of the body-mind relationship, such as ‘passions’, ‘appetites’, and ‘affections’.[4] Conceptualized as a secular psychological phenomenon, ‘emotion’ would in one sense become a broader category than the traditional ones it replaced. At the same time, however, emotion understood within a modern scientific framework was a narrow category, in that it was increasingly perceived as a process, or event, contained within the human nervous system.

At least since the late eighteenth century, physicians had been arguing that the emotions (or, at this time, the passions) were a key component in mental disease, and that some forms of insanity only partially affected the intellect. However, the model of ‘disordered emotion’ outlined by Maudsley above had its conceptual roots not in asylum medicine but in experimental physiology. Physiological language and concepts allowed physicians to speak about internal processes that could not be observed with the naked eye. As natural scientists increasingly agreed that the brain was the sole organ of the mind, the language of internal medicine was applied also to psychological phenomena.

In the early nineteenth century, experiments in physiology carried out on living animals to investigate nerve function facilitated a re-configuration of early modern ideas about ‘sympathy’ into a physiological ‘reflex’. German psychiatrist Wilhelm Griesinger and British physiologist Thomas Laycock drew upon such research to suggest that reflexive action did not only apply to sensory-motor activity, but also to the operations of the mind; that is, to ideas and emotions.[5] Laycock referred to this physiological activity as ‘cerebral’ reflexion, whereas Griesinger called it ‘psychical’ reflex action.

To illustrate this phenomenon, Laycock used the example of hydrophobia (fear of water), outlining three ways in which such phobia could be induced – ‘three classes of irritations [of the brain] inducing the reflex acts of gasping and spasm of the respiratory muscles’. The first two involved either the sight of water or bodily contact with it. The third referred to ‘an idea excited by the sound of water dropping, or by the mention of water.’ Once the fear of water – an emotional reaction – had been induced, the patient ‘immediately attempts to remove it. This movement is strictly involuntary, and not the result of sensation.’[6] In other words, Laycock suggested that a morbid emotional reaction producing involuntary muscular movement did not require sensory stimuli to the body, but could be triggered by an idea alone.

Like Laycock, Griesinger suggested that ideas could excite both motor action and emotional reactions. For Griesinger, however, external stimuli (such as Laycock’s ‘sound’ or ‘mention’ of water) were not necessary to produce morbid emotion. The brain could react both to external and internal stimuli and produce from any combination of these entirely new impressions and ideas, and ideas kept in mental storages (geistiger Vorrath) could spontaneously and internally react upon one another.[7] This model formed the basis of Griesinger’s theory of mental disease.[8] If an increasing number of negative impressions were stored and subsequently reacted both with further external irritants and with each other internally, the brain would be subjected to repeated ‘irritation’. Eventually, the process of automated or reflexive psychological reaction would become disordered. The brain would then begin to produce morbid reactions, such as pathological feelings of displeasure, in response to factors that would not trigger such reactions in a healthy mind.[9]

A metaphor for explaining brain activity that proved particularly useful in nineteenth-century psychological medicine was that of ‘tone’ referred to by Maudsley above. For Griesinger, ‘tone’ denoted both something tangible, like the physical tone of a muscle, as well as a kind of mental harmony, the maintenance of which was a prerequisite for a healthy mind. He suggested that the ‘muscle tone’ of ‘cell tissue and blood vessels’ must be seen as separate from anything we might call ‘the soul’. This muscle tone was subject to reflex action independently of the will. However, he firmly held the brain to be the seat of consciousness and intellect, suggesting that the ‘tone’ of the brain was affected by the nature of mental images (Vorstellungen). For instance, ‘sad’ images could serve to ‘slacken’ the tone of the brain.[10]

Thus, terms like ‘tone’ and ‘irritation’ used to describe the state and function of organs were applied to the mind within a framework where mental activity was conceptualized as the unseen but presumed activity of the brain. Laycock and Griesinger explained mental operations through the concept of cerebral reflexion. Both perceived the emotions, together with ideas and the will, as produced in the brain – such reflexive action was, in other words, both psychological and cerebral.

III

While most nineteenth-century metaphors for explaining brain activity have been replaced by terms that make more sense in our late-modern technological world (such as ‘wiring’), the conceptual framework describing the emotions as reflexive, automated reactions that can become ‘disordered’ has persisted into the present. This physiological model was widely appropriated by psychiatrists in the late nineteenth century, including Henry Maudsley, one of the most influential medical writers of the period. Maudsley drew upon both Laycock’s and Griesinger’s work in developing his theory of mental disease. For Maudsley, emotional reactions were what ensued in response to any form of imbalance between the individual and her or his environment. The ‘equilibrium between the individual and his surroundings’ could ‘be disturbed by a subjective modification, or an internal commotion, as well as by an unwonted impression from without.’[11]

Such ‘commotion’ would generally consist in some form of ‘derangement’ elsewhere in the body. This would then affect the brain, resulting in cerebral morbidity. Once this state had been reached, virtually any impression, including those that would trigger feelings of pleasure in a mind free from disease, would cause painful emotions. This state would prevail when the equilibrium of the mind was permanently upset, or, rather, when the ‘tone’ of the brain was disturbed. The kinds of mental reactions that were likely to occur in response external or internal stimuli would depend on the ‘psychical tone, the tone of the supreme nervous centers’, which was different in each individual as it was the long-term product of ‘past thoughts, feelings, and actions, which have been organized as mental faculties’.[12]

Maudsley’s physiological theory of emotion led him to suggest that pathological emotionality could present without disturbance of the intellect. Thus, he rejected ‘the present artificial classification [of insanity], which is not really in conformity with nature’.[13] Instead, Maudsley proposed two umbrella categories: affective and ideational insanity, with the former pertaining to forms of mental disease where only the emotions were affected. In this way, he unambiguously established as a medical principle the concept of pathological mood without intellectual derangement.

IV

To sum up, Laycock and Griesinger developed mental reflex models that facilitated the idea of pathological emotional reactions. Griesinger and Maudsley both stressed the role of the emotions as the key to understanding the emergence of mental disease, and finally, with Maudsley’s system of classification, pathological emotionality was unequivocally cemented as a specific, distinct form of mental disorder.

The metaphorical and conceptual transfers of knowledge from physiology to psychological medicine that occurred in the work of these mid-century writers was particularly complex in the sense that the new psycho-physiological language was at once applied to talk about an organ – the brain – and its perceived function – the mind – and the operations of these, which, while for materialists like Laycock and Griesinger were understood as strictly organic, could nevertheless not be observed with the naked eye, but only theorized using language extrapolated from the observable somatic realm of internal medicine. What occurred here was not, then, simply a transfer from the physical to the psychological, but rather the creation of a new sphere within medical science,[14] from which a modern secular framework for explaining the emotions and their disorders was able to emerge.

The nineteenth-century psycho-physiological explanation of disordered emotion was founded upon an understanding of the brain and mind that was in many ways significantly different from what scientist believe today, yet the overall conceptual model of emotion as a reflexive physiological event that can become a source and site of illness has proved durable in modern psychiatry, psychology and neuroscience. It continues to guide present research into the emotions and their disorders, but more than this, it importantly governs what we perceive the emotions to be, both as a central feature of the human condition, and as a private and intimate experience.

Åsa Jansson is a member of the Center for the History of the Emotions at Queen Mary, University of London, where earlier this year she defended her PhD thesis entitled, ‘The Creation of “Disordered Emotion”: Melancholia as Biomedical Disease, c. 1840-1900’. 

Feature image: Tofranil (imipramine), one of the early ‘tricyclic’ antidepressants, first entered the Western market in 1958 and is still prescribed today, Wellcome Library.  http://wellcomeimages.org/

[1] Last year, members of the Queen Mary Center for the History of the Emotions staged a ‘Carnival of Lost Emotions’, an event in which a number of feelings from earlier historical periods were re-enacted in front of an audience. A short film of the Carnival can be viewed here: https://emotionsblog.history.qmul.ac.uk/2013/10/the-carnival-of-lost-emotions-video/

[2] See e.g. Donna Trembinski, “Comparing Premodern Melancholy/Mania and Modern Trauma: An Argument in Favor of Historical Experiences of Trauma”, History of Psychology, 14:1 (2011): pp. 80-99; Jerome Kroll and Bernard Bachrach, The Mystic Mind: The Psychology of Medieval Mystics and Ascetics (New York: Routledge, 2005).

[3] Henry Maudsley, The Physiology and Pathology of the Mind (London: Macmillan, 1867), p. 139.

[4] Thomas Dixon, From Passions to Emotions: The Creation of a Secular Psychological Category (Cambridge: Cambridge University Press, 2003), p. 21. See also (by the same author): “‘Emotion’: The History of a Keyword in Crisis”, Emotion Review, 4 (2012): pp. 338-344.

[5] Wilhelm Griesinger, “Ueber psychische Reflexactionen: Mit einem Blick auf das Wesen der psychischen Krankheiten”, reprinted in Gesammelte Abhandlungen, Erster Band: Psychiatrische Abhandlungen (Amsterdam & Berlin: E.J. Bonset, 1968 [1843]); Thomas Laycock, “On the Reflex Function of the Brain”, British and Foreign Medical Review, 19 (1845): pp. 298-311.

[6] Laycock, “On the Reflex Function of the Brain”, pp. 301-302.

[7] Griesinger, “Ueber psychische Reflexactionen”, pp. 11-12.

[8] This theory was developed more fully in a monograph first published in 1845. An expanded and revised version appearing in 1861 became one of the century’s most influential European textbooks of mental disease. Wilhelm Griesinger, Die Pathologie und Therapie der psychischen Krankheiten, 2 Aufl. (Stuttgart: Adolf Krabbe, 1861).

[9] Ibid, pp. 24-25; 35-36.

[10] Ibid, pp. 10-11.

[11] Maudsley, The Physiology and Pathology of the Mind, pp. 129, 134-135.

[12] Ibid, pp. 135-137.

[13] Ibid, pp. 137, 322. Emphasis in original.

[14] What is referred to as ‘physiological psychology’ or ‘psycho-physiology’. See e.g. Kurt Danziger, “Mid-Nineteenth-Century British Psycho-Physiology: A Neglected Chapter in the History of Psychology”, in The Problematic Science: Psychology in Nineteenth-Century Thought, eds. William R. Woodward and Mitchell G. Ash (New York: Praeger, 1982); L.S. Jacyna, “Somatic Theories of Mind and the Interests of Medicine in Britain, 1850-1879”, Medical History, 26 (1982): pp. 233-258; Roger Smith, “Physiological Psychology and the Philosophy of Nature in Mid-Nineteenth Century Britain” (PhD Thesis, University of Cambridge, 1971).

2 comments

  1. Barbara Brookes

    How do humoral ideas play into these conceptions of emotional states?

    Like

  2. Reblogged this on DailyHistory.org and commented:
    Åsa Jansson at Remedia has written an article asking at what point in history did the “idea that profound and debilitating suffering constitutes psychiatric illness” morph into “medico-scientific knowledge.” Jansson is a historian of emotions and she approaches mental illness from a different perspective than most medical historians. It is a fascinating post and worth reading.

    Like

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