The British Journal of Psychiatry have a regular series called “In 100 Words”, which produces some gems. This month they have Melanchola in 100 Words, featuring perhaps the most influential musician you haven’t heard of, Robert Johnson.
I got stones in my pathway/And my road seems dark at night/I have pains in my heart/They have taken my appetite.
Robert Johnson, known as the King of the Delta blues singers, distilled into these lines the essence of severe depressive illness – somatic ills, fear and suspicion, emotional and physical pain, nocturnal troubles and struggle against obstacles. The words are one with the powerful, haunting music. ICD-10 and DSM-IV have their place, but poets have often been there before us, and done a better job. We can all learn from Robert Johnson, born just 100 years ago.
I’ve previously written about the blues and what shade of blue they were talking about, here. But this actually isn’t the first Melancholia in 100 Words to appear in the BJP. Here’s another one from 2009
Melancholia is a classical episodic depressive disorder that combines mood, psychomotor, cognitive and vegetative components with high suicide risk. In the present psychiatric classification it is buried as a modifier in both bipolar and unipolar depressions. It is hardly used to characterise patients in the clinic or research.
The syndrome is frequently recognised in delusional and agitated depression, and in the elderly. Cortisol or sleep EEG abnormalities are prognostically helpful. Melancholia is particularly responsive to tricyclic antidepressants and electroconvulsive therapy but not to selective serotonin reuptake inhibitors or psychotherapy. Recognising melancholia as a distinct disorder improves clinical care and research.