What was previously known as
melancholia
Melancholia or melancholy (from el, µέλαινα χολή ',Burton, Bk. I, p. 147 meaning black bile) is a concept found throughout ancient, medieval and premodern medicine in Europe that describes a condition characterized by markedly d ...
and is now known as ''clinical depression'', ''major depression'', or simply ''depression'' and commonly referred to as
major depressive disorder
Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introdu ...
by many health care professionals, has a long history, with similar conditions being described at least as far back as classical times.
Ancient to medieval period
![LavaterHollowayFaces](https://upload.wikimedia.org/wikipedia/commons/a/af/LavaterHollowayFaces.png)
In Ancient Greece, disease was thought due to an imbalance in the four basic bodily fluids, or ''
humors
Humorism, the humoral theory, or humoralism, was a system of medicine detailing a supposed makeup and workings of the human body, adopted by Ancient Greek and Roman physicians and philosophers.
Humorism began to fall out of favor in the 1850s ...
''. Personality types were similarly thought to be determined by the dominant humor in a particular person. Derived from the
Ancient Greek
Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...
, "black", and , "bile",
melancholia
Melancholia or melancholy (from el, µέλαινα χολή ',Burton, Bk. I, p. 147 meaning black bile) is a concept found throughout ancient, medieval and premodern medicine in Europe that describes a condition characterized by markedly d ...
was described as a distinct
disease
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
with particular mental and physical symptoms by
Hippocrates
Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
in his ''Aphorisms'', where he characterized all "fears and despondencies, if they last a long time" as being symptomatic of the ailment.
Aretaeus of Cappadocia
Aretaeus ( grc-gre, Ἀρεταῖος) is one of the most celebrated of the ancient Greek physicians. Little is known of his life. He presumably was a native or at least a citizen of Cappadocia (Roman province), Cappadocia, a Roman province in ...
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
Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
. Melancholia was a far broader concept than today's depression; prominence was given to a clustering of the symptoms of sadness, dejection, and despondency, and often fear, anger, delusions and obsessions were included.
Physicians in the
Persian
Persian may refer to:
* People and things from Iran, historically called ''Persia'' in the English language
** Persians, the majority ethnic group in Iran, not to be conflated with the Iranic peoples
** Persian language, an Iranian language of the ...
and then the
Muslim world
The terms Muslim world and Islamic world commonly refer to the Islamic community, which is also known as the Ummah. This consists of all those who adhere to the religious beliefs and laws of Islam or to societies in which Islam is practiced. I ...
developed ideas about melancholia during the
Islamic Golden Age
The Islamic Golden Age was a period of cultural, economic, and scientific flourishing in the history of Islam, traditionally dated from the 8th century to the 14th century. This period is traditionally understood to have begun during the reign ...
.
Ishaq ibn Imran (d. 908) combined the concepts of melancholia and
phrenitis
The term phrenitis was employed in ancient Greece by Hippocrates and his followers. It refers to acute inflammation of mind and body, not in a theoretical but in a descriptive sense. Its presumed seat was never anatomically or conceptually well de ...
. The 11th century Persian physician
Avicenna
Ibn Sina ( fa, ابن سینا; 980 – June 1037 CE), commonly known in the West as Avicenna (), was a Persian polymath who is regarded as one of the most significant physicians, astronomers, philosophers, and writers of the Islamic G ...
described melancholia as a
depressive type of
mood disorder
A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the ''Diagnostic and Stat ...
in which the person may become suspicious and develop certain types of
phobia
A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avo ...
s.
His work, ''
The Canon of Medicine
''The Canon of Medicine'' ( ar, القانون في الطب, italic=yes ''al-Qānūn fī al-Ṭibb''; fa, قانون در طب, italic=yes, ''Qanun-e dâr Tâb'') is an encyclopedia of medicine in five books compiled by Persian physician-phi ...
'', became the standard of medical thinking in Europe alongside those of Hippocrates and Galen. Moral and spiritual theories also prevailed, and in the Christian environment of medieval Europe, a malaise called ''
acedia
Acedia (; also accidie or accedie , from Latin , and this from Greek , "negligence", "lack of" "care") has been variously defined as a state of listlessness or torpor, of not caring or not being concerned with one's position or condition in th ...
'' (sloth or absence of caring) was identified, involving low spirits and lethargy typically linked to isolation.
[Merkel, L. (2003]
The History of Psychiatry PGY II Lecture
(PDF) Website of the University of Virginia Health System. Retrieved on 2008-08-04
The seminal scholarly work of the 17th century was English scholar
Robert Burton's book, ''
The Anatomy of Melancholy
''The Anatomy of Melancholy'' (full title: ''The Anatomy of Melancholy, What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it. In Three Maine Partitions with their several Sections, Members, and Subsections. Ph ...
'', drawing on numerous theories and the author's own experiences. Burton suggested that melancholy could be combatted with a healthy diet, sufficient sleep, music, and "meaningful work", along with talking about the problem with a friend.
During the 18th century, the humoral theory of melancholia was increasingly being challenged by mechanical and electrical explanations; references to dark and gloomy states gave way to ideas of slowed circulation and depleted energy.
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 sub-types of melancholia, and alternative terms were suggested and discarded.
Hypochondria
Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. An old concept, the meaning of hypochondria has repeatedly changed. It has been claimed that this debilitating cond ...
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 pathological condition and the latter to a temperament.
The term ''depression'' was derived from the
Latin
Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...
verb , "to press down". From the 14th century, "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
Samuel Johnson (18 September 1709 – 13 December 1784), often called Dr Johnson, was an English writer who made lasting contributions as a poet, playwright, essayist, moralist, critic, biographer, editor and lexicographer. The ''Oxford ...
in a similar sense in 1753. The term also came into use in
physiology
Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
and
economics
Economics () is the social science that studies the Production (economics), production, distribution (economics), distribution, and Consumption (economics), consumption of goods and services.
Economics focuses on the behaviour and intera ...
.
An early usage referring to a psychiatric symptom was by French psychiatrist
Louis Delasiauve
Louis Delasiauve
Louis Jean François Delasiauve (14 October 1804, Garennes-sur-Eure – 5 June 1893, Paris) was a French psychiatrist.
In 1830 he earned his doctorate in Paris, and for the next eight years practiced medicine in Ivry-la-Bataill ...
in 1856, and by the 1860s it was appearing in medical dictionaries to refer to a physiological and metaphorical lowering of emotional function.
Since
Aristotle
Aristotle (; grc-gre, Ἀριστοτέλης ''Aristotélēs'', ; 384–322 BC) was a Greek philosopher and polymath during the Classical period in Ancient Greece. Taught by Plato, he was the founder of the Peripatetic school of phil ...
, 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 19th century, became more associated with women.
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
Emil Wilhelm Georg Magnus Kraepelin (; ; 15 February 1856 – 7 October 1926) was a German psychiatrist.
H. J. Eysenck's ''Encyclopedia of Psychology'' identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychi ...
may have been the first to use it as the overarching term, referring to different kinds of melancholia as ''depressive states''.
English psychiatrist
Henry Maudsley
Henry Maudsley FRCP (5 February 183523 January 1918) was a pioneering English psychiatrist, commemorated in the Maudsley Hospital in London and in the annual Maudsley Lecture of the Royal College of Psychiatrists.
Life and career
Maudsley w ...
proposed an overarching category of ''affective disorder''.
20th and 21st centuries
In the 20th century, the German psychiatrist Emil Kraepelin was the first to distinguish manic depression. The influential system put forward by Kraepelin unified nearly all types of mood disorder into ''manic–depressive insanity''. Kraepelin worked from an assumption of underlying brain pathology, but also promoted a distinction between
endogenous
Endogenous substances and processes are those that originate from within a living system such as an organism, tissue, or cell.
In contrast, exogenous substances and processes are those that originate from outside of an organism.
For example, es ...
(internally caused) and
exogenous
In a variety of contexts, exogeny or exogeneity () is the fact of an action or object originating externally. It contrasts with endogeneity or endogeny, the fact of being influenced within a system.
Economics
In an economic model, an exogeno ...
(externally caused) types.
Around 1980, Kraepelin defined the term manic depression, which is also known as bipolar disorder. This mental health condition causes people to have mood swings, such as emotional highs and lows. Manic depression and bipolar disorder are considered the same thing because of these mood swings.
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
Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies explained as originatin ...
, the father of psychoanalysis.
![Sigmund freud um 1905](https://upload.wikimedia.org/wikipedia/commons/8/8f/Sigmund_freud_um_1905.jpg)
Freud had likened the state of melancholia to mourning in his 1917 paper ''Mourning and Melancholia''. He theorized that
objective
Objective may refer to:
* Objective (optics), an element in a camera or microscope
* ''The Objective'', a 2008 science fiction horror film
* Objective pronoun, a personal pronoun that is used as a grammatical object
* Objective Productions, a Brit ...
loss, such as the loss of a valued relationship through death or a romantic breakup, results in
subjective loss as well; the depressed individual has identified with the object of affection through an
unconscious
Unconscious may refer to:
Physiology
* Unconsciousness, the lack of consciousness or responsiveness to people and other environmental stimuli
Psychology
* Unconscious mind, the mind operating well outside the attention of the conscious mind a ...
,
narcissistic
Narcissism is a self-centered personality style characterized as having an excessive interest in one's physical appearance or image and an excessive preoccupation with one's own needs, often at the expense of others.
Narcissism exists on a co ...
process called the ''libidinal
cathexis
In psychoanalysis, cathexis (or emotional investment) is defined as the process of allocation of mental or emotional energy to a person, object, or idea.
Origin of term
The Greek term ''cathexis'' (κάθεξις) was chosen by James Strachey ...
'' 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.
The patient's decline of self-perception is revealed in his belief of his own blame, inferiority, and unworthiness. He also emphasized early life experiences as a predisposing factor.
Meyer put forward a mixed social and biological framework emphasizing ''reactions'' in the context of an individual's life, and argued that the term ''depression'' should be used instead of ''melancholia''.
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.
In the mid-20th century, other psycho-dynamic theories were proposed.
Existential
Existentialism ( ) is a form of philosophical inquiry that explores the problem of human existence and centers on human thinking, feeling, and acting. Existentialist thinkers frequently explore issues related to the meaning, purpose, and valu ...
and
humanistic
Humanism is a philosophical stance that emphasizes the individual and social potential and agency of human beings. It considers human beings the starting point for serious moral and philosophical inquiry.
The meaning of the term "humani ...
theories represented a forceful affirmation of individualism. Austrian existential psychiatrist
Viktor Frankl
Viktor Emil Frankl (26 March 1905 – 2 September 1997)
was an Austrian psychiatrist who founded logotherapy, a school of psychotherapy that describes a search for a life's meaning as the central human motivational force. Logotherapy is part ...
connected depression to feelings of futility and
meaninglessness.
Frankl's
logotherapy
Logotherapy was developed by neurologist and psychiatrist Viktor Frankl and is based on the premise that the primary motivational force of an individual is to find a meaning in life. Frankl describes it as "the Third Viennese School of Psychothe ...
addressed the filling of an "existential vacuum" associated with such feelings, and may be particularly useful for depressed adolescents.
American existential psychologist
Rollo May
Rollo Reece May (April 21, 1909 – October 22, 1994) was an American existential psychologist and author of the influential book '' Love and Will'' (1969). He is often associated with humanistic psychology and existentialist philosophy, ...
hypothesized that "depression is the inability to construct a future". In general, May wrote that depression "occur
more in the dimension of time than in space,"
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."
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.
American humanistic psychologist
Abraham Maslow
Abraham Harold Maslow (; April 1, 1908 – June 8, 1970) was an American psychologist who was best known for creating Maslow's hierarchy of needs, a theory of psychological health predicated on fulfilling innate human needs in priority, cul ...
theorized that depression is especially likely to arise when the world precludes a sense of "richness" or "totality" for the self-actualizer.
Cognitive psychologists offered theories on depression in the mid-twentieth century. Starting in the 1950s, Albert Ellis argued that depression stemmed from irrational "should" and "musts" leading to inappropriate self-blame, self-pity, or other-pity in times of adversity. Starting in the 1960s, Aaron Beck developed the theory that depression results from a "cognitive triad" of negative thinking patterns, or "schemas," about oneself, one's future, and the world.
In the mid-20th century, researchers theorized that depression was caused by a
chemical imbalance
Scientific studies have found that different brain areas show altered activity in humans with major depressive disorder (MDD), and this has encouraged advocates of various theories that seek to identify a biochemical origin of the disease, as opp ...
in neurotransmitters in the brain, a theory based on observations made in the 1950s of the effects of
reserpine
Reserpine is a drug that is used for the treatment of high blood pressure, usually in combination with a thiazide diuretic or vasodilator. Large clinical trials have shown that combined treatment with reserpine plus a thiazide diuretic reduces m ...
and
isoniazid
Isoniazid, also known as isonicotinic acid hydrazide (INH), is an antibiotic used for the treatment of tuberculosis. For active tuberculosis it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol. For l ...
in altering monoamine neurotransmitter levels and affecting depressive symptoms. During the 1960s and 70s, manic-depression came to refer to just one type of mood disorder (now most commonly known as
bipolar disorder
Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
) which was distinguished from (unipolar) depression. The terms unipolar and bipolar had been coined by German psychiatrist
Karl Kleist
Karl Kleist (born 31 January 1879 in Mulhouse, Alsace, died 26 December 1960) was a German neurology, neurologist and psychiatry, psychiatrist who made notable advances in descriptive psychopathology and neuropsychology. Kleist coined the terms un ...
.
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
The Research Diagnostic Criteria (RDC) are a collection of influential psychiatric diagnostic criteria published in late 1970s under auspices of Statistics Section NY Psychiatric Institute, authors were Spitzer, R L; Endicott J; Robins E. PMID 115 ...
, building on earlier
Feighner Criteria The Feighner Criteria are a set of influential psychiatric diagnostic criteria developed at Washington University in St. Louis between the late 1950s to the early 1970s.
The criteria are named after a psychiatric paper published in 1972 of which J ...
), and was incorporated into 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.
DSM-IV-TR
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
excluded cases where the symptoms are a result of
bereavement
Grief is the response to loss, particularly to the loss of someone or some living thing that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cogniti ...
, although it was possible for normal bereavement to evolve into a depressive episode if the mood persisted and the characteristic features of a major depressive episode developed.
The criteria were criticized because they do not take into account any other aspects of the personal and social context in which depression can occur.
In addition, some studies found little empirical support for the DSM-IV cut-off criteria, indicating they are a diagnostic convention imposed on a continuum of depressive symptoms of varying severity and duration.
The ancient idea of ''melancholia'' still survives in the notion of a melancholic sub-type. The new definitions of depression were widely accepted, albeit with some conflicting findings and views, and the nomenclature continues in DSM-IV-TR, published in 2000.
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. In 2013, a study found that
Afghan
Afghan may refer to:
*Something of or related to Afghanistan, a country in Southern-Central Asia
*Afghans, people or citizens of Afghanistan, typically of any ethnicity
** Afghan (ethnonym), the historic term applied strictly to people of the Pas ...
s have the highest rate of depression in the world.
See also
*
History of mental disorders
Historically, mental disorders have had three major explanations, namely, the supernatural, Biology, biological and Psychology, psychological models. For much of recorded history, deviant behavior has been considered supernatural and a reflectio ...
*
Classification of mental disorders
The classification of mental disorders is also known as psychiatric nosology or psychiatric taxonomy. It represents a key aspect of psychiatry and other mental health professional, mental health professions and is an important issue for people wh ...
References
Cited texts
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{{DEFAULTSORT:history of depression
Major depressive disorder
Mood disorders
Depression