By appreciating the importance of social context, we can enhance our understanding of disease. Why did depression become so popular as a diagnosis along with the advent of Prozac? Why did the diagnosis of depression vastly expand in the 1980s? Various instances beg the question of whether we focus on, or even design, certain diseases to suit our culture.
Dr Clark Lawlor
Researchers from Northumbria University will examine disease in its socio-cultural context in an attempt to discern what makes certain ailments fashionable. In a three-year project funded by the Leverhulme Trust, academics will investigate literature, medicine and culture from 1660 to 1832, and compare their findings with present day data.
In the 18th
Century, consumption and gout were viewed somewhat positively by society. Consumption, for example, was seen as a poetic disease and even resulted in what were considered to be positive symptoms such as alternately red and pale cheeks, and the perceived heightening of sensibility and intelligence. A modern comparison might be drawn with anorexia, whereby certain sections of the fashion community have sought models with figures symptomatic of the eating disorder.
I spoke to Dr Clark Lawlor, Reader in English Literature at Northumbria University, to find out what he hopes to achieve by studying the fashion of disease. I began by asking Dr Lawlor whether or not our tendency to romanticise certain illnesses has been present throughout history.
"Absolutely," he replied. "Although the names, and certainly our understanding, of certain illnesses have changed over the years, many conditions were mythologised by classical civilisations. This was not only done by medics, but also by writers and philosophers. The school of Aristotle, for example, famously considered melancholia to be a condition that afflicted those who were particularly intelligent or heroic. This is a myth that has persisted right up to the present day.
"Many people believe that certain types of suffering can provide special insight. Obviously, this can be a double-edged sword as deep insight can sometimes reinforce depression. For example, Robert Burton, the 17th
Century Oxford scholar who wrote The Anatomy of Melancholy
, said that melancholy was a condition of the intellectual."
When it comes to the question of why
certain diseases are romanticised, Dr Lawlor believes that it depends on the specifics of the particular ailment.
"The symptomatology of a disease can clearly affect how it is viewed," he explained. "Consumption for example – or what is now known as pulmonary tuberculosis – is a wasting disease of the lungs. As such, it resulted in several symptoms that proved useful in glamorising and romanticising the condition. It made you thin, and for both men and women of the period, this could be an attractive feature. It also made you alternately pale and flush, and this actually corresponds to traditional notions of feminine beauty.
"Also, in relative terms, the disease didn’t cause much pain. As there aren’t many nerves in the lungs, one can suffer from consumption for some time and only exhibit a slight cough. It was also seen as a disease that heightened one’s alertness. Of course, there was no physiological basis for this, but it all fed into the mythology. Consumption delivered the complete package; it made you thin, it didn’t cloud your mind, it didn’t induce great agony and it didn’t lead to madness. One could think of melancholia in similar terms; poets frequenting graveyards at midnight because they are feeling a bit gloomy. Obviously, this is the fashionable perspective. If you really have depression, it isn’t funny; it’s just very bad."
I asked Dr Lawlor how studying disease in its socio-economic context, might help to provide insights into how certain ailments might be tackled.
Consumption - or pulmonary tuberculosis - was a fashionable disease in the 18th Century
"It should help us to study how diseases operate within their cultures and why some come to be viewed in a positive manner," he responded. "We need to adopt a historical perspective because specific periods are associated with specific understandings of body and mind. Currently, for example, we are interested in genes and epigenetics. We have a modern understanding of the body. In the late 18th
Century, they were still moving towards notions that we might recognise in modern medicine.
"Medical understanding might help to promote some diseases over others, but so can socio-cultural factors. If we return to consumption, it was viewed as a good way for a Christian to die. People had time to plan their deaths and to think about distributing their estate amongst their dependents. It also allowed sufficient time to repent and to make peace with God. From a religious perspective, therefore, consumption was a fashionable disease.
"We are not medics. We are not aiming to cure diseases. However, by appreciating the importance of social context, we can enhance our understanding of disease. Why did depression become so popular as a diagnosis along with the advent of Prozac? Why did the diagnosis of depression vastly expand in the 1980s? Various instances beg the question of whether we focus on, or even design, certain diseases to suit our culture.
Dr Lawlor concluded our conversation by discussing the ways in which the positive societal perception of a disease can aid one’s chances of recovery.
"Susan Sontag famously wrote that in the 1960s and 1970s, cancer was seen as a stigma," he explained. "Moral fault was placed with the person that had it. We still see a bit of this today. Some people assume that a patient has cancer because they smoked too much or ate the wrong things. It could be, therefore, that if society had a more positive image of cancer, diagnoses and even recovery rates might improve. I think that we’re getting better when it comes to cancer. However, mental illness still comes with such connotations, and often, people just don’t want to talk about it. If one can destigmatise a disease, patients might be more willing to come forward and doctors could get access to those who need treatment." Dr Lawlor’s latest book, From Melancholia to Prozac: a History of Depression, is now available from leading retailers.