For most psychiatrists the term ‘melancholia’ signifies the persistence across history of a particular clinical presentation of major depression. However, the term has a broader cultural history and the manifold forms of melancholia across time share paralysing states of mind and the frantic search for recovery of meaningful action.

Literary critic Walter Benjamin (1892–1940) studied melancholia in culture. His subjects included the 17th century German Baroque Play of Mourning (Trauerspiel) during the never-ending European wars of religion; the 19th century French poet and essayist Charles Baudelaire (1821–1867) during the monumental and disorienting modern urban transformation of Paris; and the early 20th century Surrealists in the bewildering aftermath of the mechanised slaughter of the First World War. All lived during periods when personal illusions of harmony and completeness were shattered. Faced with breakdown and fragmentation, the melancholic is compelled to question long-held assumptions and ‘brood’ over the ‘pieces’. Dürer's 1514 engraving ‘Melancolia I’ offers a classic pictorial representation. ‘Head-clutchers’ on health websites serve as our contemporary version.

The predicaments and responses of Benjamin's grübler (brooders) offer instructive allegories for understanding the diverse experiences of our melancholic patients. In the Trauerspiel, the king, rather than dominate as a sovereign, flails in the face of conflict before finally meeting his fate as a corpse. In Baudelaire, the writer, rather than personify Romantic genius, is reduced to purchasable commodity by contributing commissioned pieces to the new commercial daily press. These risk becoming no more than inauthentic souvenirs of his age. In Surrealism, the artist, stunned by the senselessness of technologically sophisticated annihilation, rather than aspiring to fine technique and formal beauty transforms into a sarcastic jester, contemptuous of pretensions of ‘reason’ and seeking a higher reality in chance, dreams and free associations.

Benjamin adds depth to Freud's (1856–1939) Mourning and Melancholia (1918) with his suggestion that the mourner is not only lost in an alienating (mental) landscape but experiences himself as thoroughly known by the unknown at the same time as feeling that he had once known himself, but no longer. Could this be the experience of the mute melancholic in front of the (imagined) ‘all knowing’ doctor?

Mourning begets speechlessness and melancholia mutism. Alternatively, they may be expressed in lamentation, according to Benjamin the most undifferentiated form of human expression. Having brooded in the presence of a knowing unknown, some turn to religion or spirituality. Prayer and ritual can contribute to recovery of meaning, language and action. Benjamin though, having committed himself to an admittedly idiosyncratic materialism, did not. He and others look for other ways out. Sometimes psychiatrists can help too, especially if empathically attuned to brooding.