Jane Welsh Carlyle

The last years- 6:Diagnosis

Menu

Introduction and Site Guide

Biography

What Jane Thought

What They Thought

Personality

HEALTH:

1 The Lady Harriet Years

Jane had been in generally poor health for some years, but these last three produced new and specific symptoms and illnesses. In 1863 she had a brief attack of trigeminal (or facial) neuralgia for ten days in March; severe neuralgia affecting the left arm and hand for some months beginning in September; and a bad fall on the 22^nd September.

The most severe illness, with depression and other symptoms, lasted from December,1863 until September of 1864. During this time she had depression of mood; periods of psychomotor retardation, alternating with agitation; suicidal thoughts; persistent fears of insanity; a firm conviction that she was dying, and an acute fear of the sea. She had vaginal irritation causing intense restlessness. She lost all appetite and lost weight. She withdrew socially, with a total loss of interest in everything. Her letters ceased and she refused to see visitors. All this is symptomatic of a severe depressive illness.

In 1865 she had a recurrence of neuralgia, this time in the right arm and hand, lasting some five months. Both of these attacks probably had their origin in cervical spondylosis.

The Time Sequence

The temporal relation of these symptoms and diseases is important. At first sight her depression seems perfectly understandable: a reaction to her circumstances. She was ageing, had been in frail health for years; she had lived with Carlyle writing Frederick for over 11 years, and he had not been the most sociable of husbands during that time. And he only finished the book at the end of this period – in January, 1865. Her depression began after a frightening accident, and after she had been suffering from painful neuralgia for some months. Surely, it can be argued, all this is enough to account for her depression of mood?

But this was more severe depression than anything she had experienced during many unhappy years. And her friends and relatives agreed. All of them, including her husband, recognised that she had never been so unwell, so completely different from her usual self. Many were convinced that she was mortally ill.

Left arm/right arm

Events provided almost a controlled experiment, permitting the physical and the psychological symptoms to be separated. She had neuralgia of the left arm before and during the depressed period; she developed identical symptoms in the right arm a year later. She stated explicitly then that the pain was just as severe, and the incapacity was greater because she was right-handed. She did not stop letter writing as she did when her left arm was affected. On the contrary: she immediately set herself to learning to write with the left hand, and succeeded.

The same argument applies, if not so dramatically, to her other symptoms. She appeared to recover from the physical injuries of the accident within a few weeks, and it was after that that the depression began. The pain and irritation coincided with the depression, but outlived it – and again she endured it later without any depression of mood.

Most convincing of all is the recovery from depression. Immediately before returning to London, she was writing letters showing that most of her physical complaints remain, although they were less constant. When she reached London, her husband and her friends, who last saw her months earlier, and feared that they would not see her again because she looked so unwell, were astonished, moved to tears and embraces to see her so much better. What they were seeing was not a physical recovery but recovery from depression. She was her old self again, but mentally rather than physically– cheerful, sociable and talkative. That this is the case is well illustrated by her carpenter, seeing her after a long absence, when she returned to London. He told her that he was sorry to see her ‘fallen so suddenly into infirmity.’ He was observing her persisting physical ill-health. And her ability to make a joke of his remarks shows at the same time that her sense of humour had returned.

Carlyle’s Own Summary

For the rest of her life – a mere eighteen months – she remained frail, weak, unable to walk any distance, suffered from neuritis in the right arm, slept poorly, looked very ill, and suffered from her itch. When she was called a ‘living miracle’, her husband and others were referring not to her physical health but to her recovery from depression.

In his Reminiscences, written within weeks of her death, Carlyle confirms this separation of bodily and mental state in the ‘last epoch’ after her return to London:

‘It was still loaded with infirmities; bodily weakness, sleeplessness, continual or almost continual pain, a weary misery, so far as body was concerned; but her noble spirit rose above all that to a really singular degree. The Battle was over, and we were sore wounded; but the Battle was over and well. It was remarked by everybody that she had never been observed so cheerful and bright in mind as in this last period. The poor bodily department, I constantly hoped this too was slowly recovering.’

And also:

‘She was surely very feeble in the Devonshire time (March, etc 1865); but I remember her as wonderfully happy.’

Elsewhere he describes her a ‘suffering aged woman, accepting her age and feebleness’, and as ‘wonderfully bearing her sleepless nights and thousandfold infirmities.’

Cervical Spondylosis

Cervical spondylosis is a common degenerative condition affecting the bones in the neck – the cervical spine. It is most commonly caused by ageing, and seen in those over 60 years of age. The changes result in partial obstruction of the nerve roots leaving the spinal canal in this area – usually between the 5^th and 6^th or 6^th and 7^th vertebrae. This results in symptoms in the parts of the body supplied by these nerves. There may be pain and headache, usually at the back of the head, pain in the neck and shoulder, and pain, tingling sensations and loss of powers in the hands and arms. In severe cases the legs may be involved with difficulty in walking. Treatment with a cervical collar, or more rarely surgery, may help, but the condition often improves spontaneously after some months.

All this fits with Jane’s symptoms, and her having separate attacks, one on each side, also suggests the diagnosis. It is possible that her physical weakness was related to progress of this disease, and that it affected her lower limbs, causing walking difficulties.

In addition she probably had advancing cardiovascular disease, evidenced by her anginal pains in her last year, and by her sudden death.

Depressive Illness

The psychiatric classification of mood disorders has changed much over the last fifty years. There are two international classifications, with minor differences. The most widely used is the Diagnostic and Statistical Manual of Mental Disorders, now in its fourth edition: ‘DSM 4'. This illness is more common among women (10% to 25% over a lifetime) than among men (5% to 12% over a lifetime).

DSM4 has operational criteria for making the diagnosis:

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

1.      depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful)..

2.      markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

3.      significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

4.      insomnia or hypersomnia nearly every day

5.      psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

6.      fatigue or loss of energy nearly every day

7.      feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

8.      diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

9.     recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

A comparison of these criteria with Jane’s symptoms during the period in question shows that she fits them well, having almost all of them rather than the minimum of five needed to make the diagnosis.

Conclusions

What does it all matter? Jane was diagnosed as having a depressive illness before, by Sir James Crichton-Browne. But he placed it years earlier and related it to the Ashburton years. She was gloomy at that time, but understandably depressed, and able to write about it extensively both in letters and in a journal. The difference between this and the later episode is clear, when the symptoms were more obviously those of a depressive illness than any episodes of unhappiness in her life that preceded it.

This is the only evidence of overt psychiatric disorder in Carlyle or his wife, and worth recording for that reason alone. Despite a family history of psychotic illness, Carlyle himself was never clinically depressed, but had, of course, a famously gloomy personality. His wife had a cheerful outlook on life except when justifiably unhappy, and during this episode of depression following her accident .