While the emergence of suicidality as a defining symptom of melancholia was closely tied to the medical certificates of insanity and the growing body of asylum statistics, ‘mental pain’ had rather different origins. Mental pain was conceived of as analogous to somatic pain, and like the latter had a solid biomedical explanation and trajectory. However, the patients to whom the melancholia diagnosis was affixed appeared to speak of their pain as something quite different. Patients’ own expressions of sin and guilt, and stories offered by distressed relatives and spouses, were interpreted by physicians and presented in medical language. This practice of interspersing curt keyword descriptions of symptoms with verbatim patient quotations created a language of diagnosis and classification in which medical and lay descriptions were awkwardly fused. This is equally apparent in descriptions of religious delusions as a symptom of melancholia, as will be seen below. Both mental pain and religious delusions as symptoms of melancholia illustrate the tension between spiritual and scientific worldviews in the period, reflecting a culture where the two were simultaneously conflicting and closely intertwined. In the late nineteenth century the term mental pain was deployed by physicians as a predominantly biological description of melancholic suffering, but its meaning had gradually shifted from earlier spiritual language to eventually enter medico-scientific nomenclature through early modern medical writings that more comfortably straddled the emerging divide between scientific and spiritual conceptions of the human condition.
Much existing scholarly work on the history of pain is concerned with the medieval and early modern periods; however, a rich literature has begun to emerge that seeks to historicise nineteenth- and twentieth-century conceptions of pain. Javier Moscoso’s Pain: A Cultural History (2012) addresses ontological evolutions of pain from medieval Christian conceptions to modern scientific ones. With the advent of nineteenth-century scientific medicine, he perceives a shift whereby the sufferer’s ‘private experience’ was objectified through new ways of constituting, explaining, and labelling pain. In a context where pain, like so many other aspects of society, had to be measurable, there was no room for ‘unjustified claims and disproportionate laments’ from the suffering subject. ‘As opposed to introspection and testimony’, he argues, ‘the new science of the intimate sense had to be rooted in physiology and physics’. What emerged within psychological medicine, however, was a more complex picture. The circular relationship between clinical practice and theoretical discussions created a space within which psychological pain was constituted as physiological, and as an object that could be recorded and measured in statistical tables. Yet doctors were only able to access the nature of this mental pain through patient testimony. The trouble of recording and diagnosing the abstract pain of emotional life lay in the fact that its chief manifestation was through language, which revealed nothing about the internal neural processes that were believed to be the ‘real’ source of patients’ mental pain.
An important consequence of medico-psychological perceptions of the mental suffering that melancholic patients expressed as one having traceable (but regrettably not observable) physiological roots, was that any references to God, sin, and divine retribution were translated into patient journals and medical literature as ‘religious delusions’. However, when mapping the shifting meanings of mental pain from earlier non-medical usages to its later emergence as physiological metaphor and finally a psychological phenomenon with an explicable biological basis, the source of the melancholic patient’s perception becomes apparent. In a series of letters written at the turn of the eighteenth century, clergyman and religious thinker John Norris and philosopher Mary Astell debated the relationship between mental pain and sin. Astell asserted that ‘I cannot form to my self any Idea of Sin which does not include in it the greatest Pain and Misery’. Committing a sin against God would, she argued, result in mental pain. In much the same way as ‘a musical Instrument, if it were capable of Sense and Thought, would be uneasie and in pain when harsh discordant Notes are play’d upon it; so Man, when he breaks the Law of his Nature, and runs counter to those Motions his Maker has assign’d him…must needs be in Pain and Misery’. For Astell, then, to act against God and nature was to act sinfully and to cause pain. A similar understanding of mental pain as sin was expressed a few years later by another English clergyman, Richard Fiddes, who in his Fifty Two Practical Discourses on Several Subjects (1720) explained that ‘what I principally here intend, by mental Pain, is, that Anguish and Remorse of Mind, which Sinners so naturally feel, and all of them, more or less, when they call their own Ways to remembrance, and reflect upon their sins.’
It is significant to note the unambiguous way in which this point of view established a causal trajectory between unnatural and ungodly conduct and the experience of mental pain. A century and a half later, British physicians turned this argument on its head, suggesting that the mental pain felt by melancholics would render the act of suicide—the ultimate crime against God and nature—both ‘logical’ and ‘natural’. Victorian medical psychologists were keen to assert the irrelevance of moral judgement when explaining the symptoms and causes of mental disease, but their case notes allude to people for whom the moral implications of their painful emotions were a great source of distress. The association between religion and mental pain was rooted in a centuries-old spiritual worldview where Man’s duties to God were foremost, and where to act against divine law was for faithful Christians an unequivocal source of pain and despair. It is not surprising that a relationship between religious morality and emotional distress that had endured in some form or another for centuries appeared to prevail among melancholic patients against medico-scientific explanations that were, by comparison, embryonic.
The medico-psychological understanding of mental pain that emerged in the nineteenth century arose chiefly from a different epistemological context, that of experimental physiology, yet the two conceptions remained in a close and often antagonistic relationship throughout the period. It should also be noted that in early modern literature, spiritual and medical conceptions of pain were not mutually exclusive, and such perceptions were not simply erased with the advent of physiological psychology in the nineteenth century. It follows that early modern ideas about mental pain as an ‘evil’ or as ‘sin’ cannot be simply excluded from late nineteenth-century meanings of the term. Moreover, the adoption of mental pain as a medical phenomenon was not a straightforward production of nineteenth-century physiological psychology, but, like the creation of modern physiology itself, a gradual process where old and new terminology was fused to espouse medical theories about body and mind set in current explanatory frameworks.
When mental pain entered the realm of nineteenth-century physiological psychology and psychological medicine, then, it did so from an eclectic past. Victorian medical scientists used the term in specific ways to explain the psychological suffering that was the manifestation of cerebral irritation producing a state of disordered emotion. Earlier chapters showed how the perceived ‘irritation’ of the cerebral nerves would over time affect the ‘tone’ of the brain, causing painful emotional and ideational associations to occur. Andrew Hodgkiss has traced the history of ‘pain without lesion’ in nineteenth-century European medicine, investigating precisely this conception of how mental pain was perceived to materialise. He pays particular attention to how ideas about cerebral irritation and reflexive action functioned to constitute a physiological model for pain without traceable organic cause in the work of Johannes Müller, Wilhelm Griesinger, and Thomas Laycock. Key to making sense of nineteenth-century psycho-physiological conceptions of pain without lesion is, Hodgkiss argues, the argument, proposed by Laycock, that mental sensations alone were enough to cause irritation of the nerves.
Central to psycho-physiological ideas about mental pain favoured by British medical psychologists in the late nineteenth century was a belief that such pain functioned in much the same way as physical pain. In a similar manner to cerebral irritation and psychological reflex action, mental pain in nineteenth-century physiological psychology held the ambiguous status of being at once metaphorical and literal. Experimental data concerned observable bodily reactions, and knowledge derived from empirical research was extrapolated and analogously applied to speak about mental operations—that which could not be observed. At the same time, however, analogies were believed to represent what was actually occurring in the brains of people. Terms like ‘irritation’, ‘reflexion’, ‘tone’, and ‘pain’ when applied to speak of the mind were seen as explicating cerebral processes as well as psychological operations. This can be seen in Griesinger’s discussion of mental pain in the second, extended edition of his textbook. He suggested that it resulted from mental irritation, both of the kind that manifested in psychological exaltation, and of its opposite, depression, and that such pain could be triggered by external as well as internal factors. Citing recent experiments by German physiologist Moritz Schiff, Griesinger held that the sensation of pain ‘could only be transmitted through the grey substance’, suggesting that pain originated in the brain. This explained, he argued, how mental pain could arise endogenously, through a ‘special irritation’ of the cerebral tissue.
Older meanings did not simply vanish, however, and they continued to facilitate conceptions of self for the melancholic patients to whom this label was affixed. As will be seen below, where patients communicated a spiritual suffering, their physicians saw a physiologically constituted pain that manifested as a psychological phenomenon. Nevertheless, mental pain was a useful medical concept in the building of a solid biomedical foundation for mental disease. The sensation of pain was an important tool in physiological experiments on nervous function, particularly in its relationship with automated muscular reactivity. It was helpful if one could show that the same connection existed between psychological pain and involuntary action. Such arguments became problematic towards the end of the century, however, when physicians focussed their attention on the perceived prominence of suicidal actions in non-delusional melancholics, as will be seen below. It was more difficult to maintain that suicide, suicidal attempts, and suicidal tendencies were morbid impulses (as was often the case earlier in the century) when the subject was believed to be capable of rational thought. In this context, then, suicidality was reconceptualised, so that mental pain and depression came to function as ‘logical’ and ‘rational’ causes of suicidal intent in people perceived to suffer from simple (non-delusional) melancholia.
Source- Jansson Å. (2021) Statistics, Classification, and the Standardisation of Melancholia. In: From Melancholia to Depression. Mental Health in Historical Perspective. Palgrave Macmillan, Cham.