Melancholia
Melancholia is an apocalyptic drama created by filmmaker Lars von Trier. The idea for the film came to Trier during a therapy session. His therapist mentioned to him that depressive people are often calm during a crisis because they already expect bad things to happen. They have been to psychologically bleak places before. Trier sought to create a film demonstrating this idea with the main character, Justine, based on himself.[1]
Depression, once called "melancholia," is a broad term used to describe persistent and intense sadness. Major depressive disorder (MDD) is defined as "depressed mood most of the day, nearly every day."[2] MDD is an episodic mood disorder and can have different presentations based upon various symptoms being experienced.[3] The diagnosis of MDD is polythetic, meaning the disorder is categorized by common symptoms. To meet the diagnostic criterion for MDD, a client must experience a minimum of five of the nine symptoms listed, which include: (1) depressed mood, (2) loss of interest and pleasure, (3) weight disturbances, (4) sleep disturbances, (5) psychomotor changes, (6) fatigue/loss of energy, (7) excessive guilt or worthlessness, (8) indecisive or trouble concentrating, (9) thoughts of suicide or death.[4] These symptoms must cause significant distress and dysfunction to the patient. Furthermore, symptoms must not be caused by substances or other medical conditions. In addition to this criterion, a patient must not experience manic episodes.
Common treatments for MDD include psychotherapy and antidepressants, both long-term and intermittent use.[5] Researchers are also looking into genotyping to predict the most effective dosages and types of antidepressants for patients.[6] Other treatment options include ketamine, popular due to its rapid effects on suicidal ideation, and electroconvulsive therapy.[7] In Melancholia, Justine receives none of these treatments despite exhibiting most of the symptoms listed above.
Justine exhibits at least seven of the symptoms of MDD. First, she experiences a persistent depressed mood. The film begins on her wedding day, what is usually considered to be a happy event. However, as the evening wears on, it is revealed to the audience that she is pretending to be happy, putting on a happy face to not disturb her guests with her depression. In her words, "I smile, and I smile, and I smile," despite not feeling happy. Also, comments from her family make it clear that this is not her first major depressive episode.
Second, she demonstrates a loss of interest in pleasurable activities. During the wedding, she becomes increasingly despondent. In the following days, she shows little to no interest in pleasurable activities such as riding her horse, dining with her family, or taking advantage of the lavish estate she resides in. Despite having a wealth of opportunity in a picturesque setting to engage in pleasurable activities, she is uninterested.
Third, she might be experiencing weight disturbances, but it is not entirely clear. Claire, Justine's sister, tries to persuade Justine to eat by surprising Justine with her favorite meal. Justine, lethargic and unstable, manages to get to the table to try a bite, but as she begins to chew, she cries uncontrollably. She sobs, "It tastes like ash." This is another indication that she has lost interest in activities she once found pleasurable, and it could be an indicator of appetite and weight loss problems. However, more information is needed to make an accurate assessment.
Fourth, she experiences sleep disturbances. She sleeps quite a lot, even during the day. Yet, despite what appears to be an ample amount of sleep, she is still fatigued and unrested. It might also be that she is in bed for hours during the day without sleeping.
Fifth, disturbances in Justine's psychomotor skills are a prominent symptom. She has trouble getting into bed, walking, and eating. At one point her motor skills are so impaired that she cannot even bathe on her own. Her sister Claire attempts to help her get into the bathtub, but Justine cannot lift her foot and instead whimpers, "I can't." She falls to the floor helpless to bathe herself or even get into the tub so that her sister may bathe her.
Sixth, Justine is fatigued and has little energy. As stated previously, she is slow to move, and at times unable to move. She requires assistance when walking, eating, and bathing. When Claire tries to get Justine to bathe, Justine responds, "I'm so tired." After spending hours in bed, Justine still lacks energy.
Seventh, excessive guilt and worry do not seem to be present. However, it is possible she is experiencing them without expressing them to the audience. For this reason, I do not see the presence of persistent guilt and worry. In fact, I see the opposite. As the rogue planet Melancholia approaches earth, she seems to be quite calm, almost happy.
Eighth, Justine's inability to concentrate is most apparent in her irresponsiveness. She does not seem to concentrate on anything or make any decisions, because for a substantial portion of the movie she is somewhat unresponsive to attempts to help her. Another example of her inability to concentrate is when her boss asks her for a marketing "tag line" and she is unable to provide one. She has difficulty concentrating and fulfilling her job requirements.
Ninth and lastly, Justine's relationship with the rogue planet Melancholia mimics her relationship with death. She commented to her sister, "If you think I'm afraid of a planet, you're too stupid." Justine was not frightened by Melancholia, nor by death. Several times throughout the movie the presence of Melancholia appears to be soothing, even making her smile. On another occasion, she lies outside naked in the moonlight staring at Melancholia with no fear at all. At times she even smiles upward at Melancholia. It is as if death is her solution to MDD.
In conclusion, Trier did an excellent job of accurately portraying a person suffering from major depressive disorder. I suspect his personal experience with depression influenced his ability to depict depression accurately, respectfully, and artfully. Kirsten Dunst's performance as Justine was an exceptional representation of depression and gave the audience both a haunting and compassionate look at a person suffering from MDD.
Notes and Citations
[1] Feinstein, H. (2011, May 20). Lars von Trier: "I will never do a press conference again." IndieWire. https://www.indiewire.com/news/general-news/lars-von-trier-i-will-never-do-a-press-conference-again-54069/
[2] American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 160–68, ISBN 978-0-89042-555-8
[3] Kim, Y.-K., & Park, S.-C. (2021). An alternative approach to future diagnostic standards for major depressive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 105, 110133. https://doi.org/10.1016/j.pnpbp.2020.110133
[4] Zimmerman, M., Ellison, W., Young, D., Chelminski, I., & Dalrymple, K. (2015). How many different ways do patients meet the diagnostic criteria for major depressive disorder? Comprehensive Psychiatry, 56, 29–34. https://doi.org/10.1016/j.comppsych.2014.09.007
[5] Cosci, F., Mansueto, G., & Fava, G. A. (2020). Relapse prevention in recurrent major depressive disorder. A comparison of different treatment options based on clinical experience and a critical review of the literature. International Journal of Psychiatry in Clinical Practice, 24(4), 341–348. https://doi.org/10.1080/13651501.2020.1779308
[6] Skryabin, V., Rozochkin, I., Zastrozhin, M., Lauschke, V., Franck, J., Bryun, E., & Sychev, D. (2022). Meta-analysis of pharmacogenetic clinical decision support systems for the treatment of major depressive disorder. The Pharmacogenomics Journal, 23(2–3), 45–49. https://doi.org/10.1038/s41397-022-00295-3
[7] de A. Simoes Moreira, D., Gauer, L. E., Teixeira, G., Fonseca da Silva, A. C., Cavalcanti, S., & Quevedo, J. (2023). Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis. Journal of Affective Disorders, 330, 227–238. https://doi.org/10.1016/j.jad.2023.02.152
