Abstract
Freud (1917/1964) starts his “Mourning and Melancholia” paper by cautioning us against “any over-estimation of the value of our conclusions” (p. 243), recognising the difficulty of grouping varied clinical manifestations into a unity. Modern society offers us no shortage of such a process, executed in line with the biomedical model and seemingly with ease and an undeniable certainty. Lay people are pervasively disclosing their allegedly fixed, objective, and guaranteed mental health diagnosis—self-diagnosed or not—as if it was a suffix to their name. Health professionals generate and feed this pattern by increasingly diagnosing according to the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association [APA], 2013)—despite its many shortcomings—as the dominant way of approaching patients’ suffering (for insightful, critical accounts of the DSM, see Vanheule, 2017; Verhaeghe, 2004). Amid such an atmosphere, Hook and Vanheule’s edited book Lacan on Depression and Melancholia offers an extremely timely, ground-breaking breath of fresh air that productively functions as a unique alternative to biomedical diagnosing.
By drawing on Freud’s (1917/1964) seminal work “Mourning and Melancholia,” as many papers in the collected book do, and building on it with the use of Lacanian psychoanalytic theory as well as compelling case studies, the book significantly enhances our understanding of depression and melancholia that has clinical implications for their treatment. Unlike the DSM (APA, 2013), which classifies suffering “on a priori grounds” (p. 78) and based on the accumulation of surface-level symptoms, a Lacanian perspective diagnoses according to the structure and function of symptoms. What may appear as similar depressive manifestations in various individuals can indicate distinct functions/structures, necessitating diverse clinical approaches.
The book competently demonstrates the latter by covering two out of three major Lacanian structures, psychosis and neurosis, with some subcategories: melancholia is considered one subcategory to psychosis (a “psychotic depression”); and manic depression another subcategory of psychosis. A depressed mood can be an attempt to solve/disguise via repression a conflict related to having given up on one’s desire, reflecting a neurotic depression as skilfully demonstrated by one of the book’s authors, Stephanie Swales, in the chapter, “Depression Reconsidered: The Well-Spoken, Neurotic Conflicts, and Desire.” Or, a depressed mood can present a psychotic melancholia or manic-depression when the symptom(s) primarily function to mediate an overproximity of the Other, as lucidly outlined particularly by Leader’s and Stijn’s chapters.
The chapters taken together cover rich, wide-ranging perspectives, from Morel’s chapter that questions the taken-for-granted view on what terrorism involves, and Grigg’s focus on the processes of forgetting and remembering in mourning, to the concept of creativity as imaginatively outlined by Brenner as well as Webster and Gherovici. The book itself is arguably structured like a symptom, inclusive of a multiplicity of singular perspectives with both complementary and contradictory content. It does well to include opposing perspectives to encourage the reader to ask questions such as, is melancholia an act of creative sublimation (Brenner) or is sublimation a defence against melancholia (Webster & Gherovici)?
Hook and Vanheule’s book expands beyond mourning and melancholia by offering a valuable Lacanian perspective on diagnosis in general. In this way, the book significantly advances Freudian theory just by the fact of drawing on Lacanian theory with its more explicit focus on structure. The other aspect that furthers both Freudian and Lacanian theory is the use of illustrative case studies, whether it be from a memoir or clinical practice. This is really one of the book’s main strengths that also neatly functions to make the notoriously difficult-to-understand Lacanian theory more accessible. There is a skilful intertwinement between theory and clinical practice where the singularity of each case is respected, never offering universal solutions while nevertheless providing invaluable clinical guidance for practitioners.
On the other hand, the papers also take seriously the content of symptoms whereby insight is gained into the specificity of melancholia and depression that is not easily translatable, or reducible to, structures with other content (i.e., anorexia, anxiety, etc.). However, given the Lacanian focus, the book arguably takes the content of symptoms too far at times and, by virtue, neglects a discussion on the link between structure and content. Vanheule in “In Between the Signifier and the Real” mentions how monotonous discourse can reflect the suspension of the circulation of signifiers, and Hook argues in his chapter, “The Complex of Melancholia”— although cautioning against a rigid generalisation—that a desire to disappear from the constraints of the symbolic order can be associated with the death drive commonly found in melancholia. These types of reasonings are in line with a tendency within the Lacanian field to focus on the disappearance/lack of desire and symbolic–imaginary constructions in favour of structures equalling or resembling psychosis (see, for instance, influential works such as Loose, 2002; Verhaeghe, 2004), which the book also tends to lean more on. This problematises not only the distinction between structure and content but also that between neurosis and psychosis—which the Millerian concept of “ordinary psychosis” touches upon (Miller, 2009)—and tends to neglect the deceiving multilayers that can sometimes be present in symptoms. That is, monotonous speech and a desire for disappearing could in some instances reflect a refusal of existing symbolic-imaginary constructions rather than directly mimicking a “minimal” structure. Other content, particularly increasing modern psychosomatic symptoms, could also indicate depressive positions. Or, do they cease to be depressive positions without the related content? Adding explorations pertaining to sociocultural influences may have facilitated such a discussion, which is only mentioned in passing by some authors, as arguably the dominant capitalist idea of being independent of / detached from the Other blurs the distinction between psychosis and neurosis as well as between content and structure.
Considering that in practice the boundary is not always clear cut between conceptualisations, it was my experience that the book sometimes leaned too much on definitive binaries that further hindered a discussion on the link between content and structure. The binaries of overwhelming presence versus lack and infinite versus completed mourning, typically associated with psychosis and neurosis respectively, came across at times too separated and lacking in nuance. The standout chapters then became those where nuance and caution were adopted and productive questions were asked, in particular Webster and Gherovici’s “Dressing up the Death Drive: Mourning as a Defence Against Melancholia” as well as Leader’s “The Specificity of Manic-Depressive Psychosis.” In the latter, Leader takes structure seriously in tentatively proposing that melancholia, instead of being a separate subcategory of psychosis, could belong to schizophrenia.
Overall, Hook and Vanheule’s edited book proficiently substantiates complex Lacanian and Freudian theory via digestible but appropriately mysterious content and significantly contributes rich insight to the field. Anyone who is a health professional, clinician, student, researcher, or academic within the social sciences will want to read it.