History of depression 1

History of depression
What was previously known as melancholia and is now known as clinical depression, major depression, or simply
depression and commonly referred to as major depressive disorder by many health care professionals, has a long
history, with similar conditions being described at least as far back as classical times.

Prehistory to medieval periods

In Ancient Greece, disease was thought due to an imbalance in the four
basic bodily fluids, or humors. Personality types were similarly thought
to be determined by the dominant humor in a particular person.
Derived from the Ancient Greek melas, "black", and khol, "bile",[1]
melancholia was described as a distinct disease with particular mental
and physical symptoms by Hippocrates in his Aphorisms, where he
characterized all "fears and despondencies, if they last a long time" as
being symptomatic of the ailment.[2]

Aretaeus of Cappadocia later noted that sufferers were "dull or stern;

dejected or unreasonably torpid, without any manifest cause". The
humoral theory fell out of favor but was revived in Rome by Galen.
Melancholia was a far broader concept than today's depression;
prominence was given to a clustering of the symptoms of sadness,
The four temperaments (clockwise from top left;
dejection, and despondency, and often fear, anger, delusions and sanguine; phlegmatic; melancholic; choleric)
obsessions were included.[3] according to an ancient theory of mental states

Influenced by Greek and Roman texts, physicians in the Persian and

then the Muslim world developed ideas about melancholia during the Islamic Golden Age. Ishaq ibn Imran (d. 908)
combined the concepts of melancholia and phrenitis.[4] The 11th century Persian physician Avicenna described
melancholia as a depressive type of mood disorder in which the person may become suspicious and develop certain
types of phobias.[5]
His work, The Canon of Medicine, became the standard of medical thinking in Europe alongside those of
Hippocrates and Galen.[6] Moral and spiritual theories also prevailed, and in the Christian environment of medieval
Europe, a malaise called acedia (sloth or absence of caring) was identified, involving low spirits and lethargy
typically linked to isolation.[7] [8]
History of depression 2

17th to 19th centuries

The seminal scholarly work of the 17th century was English scholar Robert
Burton's book, The Anatomy of Melancholy, drawing on numerous theories and
the author's own experiences. Burton suggested that melancholy could be
combated with a healthy diet, sufficient sleep, music, and "meaningful work",
along with talking about the problem with a friend.[9] [10]
During the 18th century, the humoral theory of melancholia was increasingly
challenged by mechanical and electrical explanations; references to dark and
gloomy states gave way to ideas of slowed circulation and depleted energy.[11]
German physician Johann Christian Heinroth, however, argued melancholia was
a disturbance of the soul due to moral conflict within the patient.
Eventually, various authors proposed up to 30 different subtypes of melancholia,
and alternative terms were suggested and discarded. Hypochondria came to be
seen as a separate disorder. Melancholia and Melancholy had been used
interchangeably until the 19th century, but the former came to refer to a Frontispiece of the 1638 edition of
pathological condition and the latter to a temperament.[3] The Anatomy of Melancholy

The term depression was derived from the Latin verb deprimere, "to press
down".[12] From the 14thcentury, "to depress" meant to subjugate or to bring down in spirits. It was used in 1665 in
English author Richard Baker's Chronicle to refer to someone having "a great depression of spirit", and by English
author Samuel Johnson in a similar sense in 1753.[13] The term also came in to use in physiology and economics.
An early usage referring to a psychiatric symptom was by French psychiatrist Louis Delasiauve in 1856, and by the
1860s it was appearing in medical dictionaries to refer to a physiological and metaphorical lowering of emotional
function.[14] Since Aristotle, melancholia had been associated with men of learning and intellectual brilliance, a
hazard of contemplation and creativity. The newer concept abandoned these associations and, through the
19thcentury, became more associated with women.[3]
Although melancholia remained the dominant diagnostic term, depression gained increasing currency in medical
treatises and was a synonym by the end of the century; German psychiatrist Emil Kraepelin may have been the first
to use it as the overarching term, referring to different kinds of melancholia as depressive states.[15] English
psychiatrist Henry Maudsley proposed an overarching category of affective disorder.[16]

20th and 21st centuries

The influential system put forward by Kraepelin unified nearly all types of mood disorder into manicdepressive
insanity. Kraepelin worked from an assumption of underlying brain pathology, but also promoted a distinction
between endogenous (internally caused) and exogenous (externally caused) types.[15]
German psychiatrist Kurt Schneider coined the terms endogenous depression and reactive depression in 1920,[17] the
latter referring to reactivity in mood and not reaction to outside events, and therefore frequently misinterpreted. The
division was challenged in 1926 by Edward Mapother who found no clear distinction between the types.[18]
The unitarian view became more popular in the United Kingdom, while the binary view held sway in the US,
influenced by the work of Swiss psychiatrist Adolf Meyer and before him Sigmund Freud, the father of
psychoanalysis.[19]
History of depression 3

Freud had likened the state of melancholia to mourning in his 1917 paper
Mourning and Melancholia. He theorized that objective loss, such as the loss of a
valued relationship through death or a romantic break-up, results in subjective
loss as well; the depressed individual has identified with the object of affection
through an unconscious, narcissistic process called the libidinal cathexis of the
ego.

Such loss results in severe melancholic symptoms more profound than mourning;
not only is the outside world viewed negatively, but the ego itself is
compromised.[20] The patient's decline of self-perception is revealed in his belief
of his own blame, inferiority, and unworthiness.[21] He also emphasized early life
experiences as a predisposing factor.[3]

Sigmund Freud argued that Meyer put forward a mixed social and biological framework emphasizing
depression, or melancholia, could reactions in the context of an individual's life, and argued that the term
result from loss and is more severe depression should be used instead of melancholia.[16]
than mourning.
The DSM-I (1952) contained depressive reaction and the DSM-II (1968)
depressive neurosis, defined as an excessive reaction to internal conflict or an identifiable event, and also included a
depressive type of manic-depressive psychosis within Major affective disorders.[22]
In the mid-twentieth century, other psychodynamic theories were proposed. Existential and humanistic theories
represented a forceful affirmation of individualism.[23] Austrian existential psychiatrist Viktor Frankl connected
depression to feelings of futility and meaninglessness.[24] Frankl's logotherapy addressed the filling of an "existential
vacuum" associated with such feelings, and may be particularly useful for depressed adolescents.[25] [26]
American existential psychologist Rollo May hypothesized that "depression is the inability to construct a future".[27]
In general, May wrote, "depression ... occur[s] more in the dimension of time than in space,"[28] and the depressed
individual fails to look ahead in time properly. Thus the "focusing upon some point in time outside the depression ...
gives the patient a perspective, a view on high so to speak; and this may well break the chains of the ...
depression."[29]
Humanistic psychologists argued that depression resulted from an incongruity between society and the individual's
innate drive to self-actualize, or to realize one's full potential.[30] [31] American humanistic psychologist Abraham
Maslow theorized that depression is especially likely to arise when the world precludes a sense of "richness" or
"totality" for the self-actualizer.[31]
A half century ago, diagnosed depression was either endogenous (melancholic), considered a biological condition, or
reactive (neurotic), a reaction to stressful events.[32] Debate has persisted for most of the twentieth century over
whether a unitary or binary model of depression is a truer reflection of the syndrome;[32] in the former, there is a
continuum of depression ranked only by severity and the result of a "psychobiological final common pathway",[33]
whereas the latter conceptualizes a distinction between biological and reactive depressive syndromes.[17] The
publishing of DSM-III saw the unitarian model gain a more universal acceptance.[32]
History of depression 4

In the mid-20th century, researchers theorized that depression was caused by a

chemical imbalance in neurotransmitters in the brain, a theory based on
observations made in the 1950s of the effects of reserpine and isoniazid in
altering monoamine neurotransmitter levels and affecting depressive
symptoms.[34] During the 1960s and 70s, manic-depression came to refer to just
one type of mood disorder (now most commonly known as bipolar disorder)
which was distinguished from (unipolar) depression. The terms unipolar and
bipolar had been coined by German psychiatrist Karl Kleist.[15]

The term Major depressive disorder was introduced by a group of US clinicians

in the mid-1970s as part of proposals for diagnostic criteria based on patterns of
symptoms (called the Research Diagnostic Criteria, building on earlier Feighner Isoniazid was the first compound to
[35] [36] be called an antidepressant.
Criteria), and was incorporated in to the DSM-III in 1980. To maintain
consistency the ICD-10 used the same criteria, with only minor alterations, but
using the DSM diagnostic threshold to mark a mild depressive episode, adding higher threshold categories for
moderate and severe episodes.[36] [37]

The ancient idea of melancholia still survives in the notion of a melancholic subtype. The new definitions of
depression were widely accepted, albeit with some conflicting findings and views, and the nomenclature continues in
DSM-IV-TR, the latest version, published in 2000.[38]
There have been some continued empirical arguments for a return to the diagnosis of melancholia.[39] [40] There has
been some criticism of the expansion of coverage of the diagnosis, related to the development and promotion of
antidepressants and the biological model since the late 1950s.[41]

See also
History of mental disorders
Classification of mental disorders

References
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[2] Hippocrates, Aphorisms, Section 6.23
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is_4_26/ ai_n29132028/ pg_1?tag=artBody;col1). Journal of Mental Health Counseling. . Retrieved 2008-11-06.
[27] Geppert CMA (May 2006). "Damage control" (http:/ / www. psychiatrictimes. com/ display/ article/ 10168/ 51281). Psychiatric Times. .
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[28] May 1994, p.133
[29] May 1994, p.135
[30] Boeree, CG (1998). "Abraham Maslow: Personality Theories" (http:/ / www. social-psychology. de/ do/ pt_maslow. pdf) (PDF). Psychology
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abstract/ 157/ 8/ 1195). American Journal of Psychiatry 157 (8): 11951203. doi:10.1176/appi.ajp.157.8.1195. PMID10910777. (abstract).
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[34] Schildkraut, JJ (1965). "The catecholamine hypothesis of affective disorders: A review of supporting evidence". American Journal of
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[36] Philipp M, Maier W, Delmo CD (1991). "The concept of major depression. I. Descriptive comparison of six competing operational
definitions including ICD-10 and DSM-III-R" (http:/ / www. springerlink. com/ content/ y2460650rm747035/ ). European Archives of
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History of depression 6

Cited texts
American Psychiatric Association (2000a). Diagnostic and statistical manual of mental disorders, Fourth Edition,
Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Publishing, Inc.. ISBN0890420254.
Barlow DH; Durand VM (2005). Abnormal psychology: An integrative approach (5th ed.). Belmont, CA, USA:
Thomson Wadsworth. ISBN0534633560.
Beck, Aaron T.; Rush J, Shaw BF, Emery G (1987) [1979]. Cognitive Therapy of depression. New York, NY,
USA: Guilford Press. ISBN0898629195.
Kent, Deborah (2003). Snake Pits, Talking Cures & Magic Bullets: A History of Mental Illness. Twenty-First
Century Books. ISBN0761327045.
Hergenhahn BR (2005). An Introduction to the History of Psychology (5th ed.). Belmont, CA, USA: Thomson
Wadsworth. ISBN0534554016.
Parker, Gordon; Dusan Hadzi-Pavlovic, Kerrie Eyers (1996). Melancholia: A disorder of movement and mood: A
phenomenological and neurobiological review. Cambridge: Cambridge University Press. ISBN052147275X.
Article Sources and Contributors 7

Article Sources and Contributors

History of depression Source: http://en.wikipedia.org/w/index.php?oldid=362863767 Contributors: A man in space, Casliber, Centonup, Centrx, Cosmic Latte, Editor2020, Garrondo, Geb11,
Jfdwolff, Jonathan Drain, Mrmpsy, Msasscts, PigFlu Oink, Rjwilmsi, Rreagan007, Snowmanradio, 4 anonymous edits

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Image:LavaterHollowayFaces.png Source: http://en.wikipedia.org/w/index.php?title=File:LavaterHollowayFaces.png License: unknown Contributors: Thomas Holloway (1748-1827),
illustrator; Johann Caspar Lavater, author (1741-1801)
Image:The Anatomy of Melancholy by Robert Burton frontispiece 1638 edition.jpg Source:
http://en.wikipedia.org/w/index.php?title=File:The_Anatomy_of_Melancholy_by_Robert_Burton_frontispiece_1638_edition.jpg License: Public Domain Contributors: Robert Burton
(1577-1640)
Image:Sigmund freud um 1905.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Sigmund_freud_um_1905.jpg License: Public Domain Contributors: ChristophT
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