Reasons to Stay Alive

Through the memoir, Haig references the way societal perceptions of mental illness and people’s general experience with it has shifted over time. In Chapter 17, he refers to the outdated name for depression, “melancholia,” and suggests this was a more uncommon disease—or more uncommonly diagnosed—than contemporary depression as we know it today.

Despite its prevalence in modern society, depression and other forms of mental illness have existed since ancient times, with written accounts dating back to 2000 BCE, four thousand years ago. In this time, depression was considered a spiritual illness instilled by malignant or demonic forces. This belief led to brutal treatments in an effort to drive away spiritual forces, often leaving the patient worse off than they were before.

It wasn’t until around 400 BCE that another perspective began to emerge. This was put forth by Hippocrates, often referred to as the father of modern medicine. He established a system of humors, or bodily fluids, which influenced a person’s behavior: yellow bile, black bile, phlegm, and blood. People with an excess of any one of these humors would be considered choleric, melancholic, phlegmatic, or sanguine, and each state was associated with certain personality traits. Melancholia grew out of a belief that having too much black bile in the body would encourage sadness, introspection, and excessive fear, what we now recognize as anxiety.

While this belief system was overly simplistic, it represented a shift into an age in which philosophers and scientists were making a concentrated effort to better understand the body and mind. The writings of people like Hippocrates would go on to inform modern advances in understanding mental illness.

Stigma, in the form of superstition and fear, persisted around depression even into the 16th century. Mental illness was often seen as proof of witchcraft or other supernatural influence. In 1621, a clergyman named Robert Burton published a treatise called Anatomy of Melancholy, in which he explored potential causes and treatments for melancholic disorder. Other writers and medical professionals continued his work. In the 18th and 19th centuries, depression was believed to be an innate inherited disorder, and those experiencing it were often regulated to the fringes of society; it’s during this time that the stereotypical image of the “mad artist” began to emerge, with a melancholic temperament strongly associated with creativity and genius.

In the 20th century, new practices emerged as treatments for mood disorders. Sigmund Freud, who founded psychoanalysis, advocated talk therapy as treatment; other theorists such as Aaron Beck and Martin Seligman looked at ways in which lived experiences informed depressive behavior. During the mid-20th century, controversial practices were introduced such as electroshock therapy, lobotomies, and drug treatments. The later 20th century and early 21st saw a rise in behavioral therapy as an alternative for these invasive treatments.

As Haig explores in his memoir, social stigma against mental illness still exists today. Often it is seen as a weakness, rather than a disability. He argues that this stigma is more pervasive against men than it is women, with a higher proportion of males with depression dying by suicide. However, the conversation around mental health is much broader and inclusive than it has ever been, with Haig’s work playing a small part in this movement. Society’s understanding of mental illness has become more and more refined with time, and as new discoveries are made, people with mental illness will become increasingly less ostracized and benefit from more support.