History of Research on Clinical Depression

Historical Background

Descriptions of depression and depression-related mental disorders date back to antiquity (Summerian and Egyptian documents date back to 2600 BC). However, it was Hippocrates (460–370 BC) and his disciples who first studied these conditions systematically and introduced the term ‘‘melancholia’’ to describe the symptoms and to provide a physiological explanation of their origin. Hippocrates described a syndrome of melancholia as a distinct disease with particular mental and physical symptoms; he characterized all "fears and despondencies, if they last a long time" as being symptomatic of the ailment.  It was a similar but 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.

The Hippocratic School attempted to link the balance of the postulated four humors (blood, yellow bile, black bile and phlegm) with the temperament and personality, and the latter two with the propensity to  develop  one  of  the  four  diseases  (mania,  melancholia,  phrenitis  and paranoia). It is interesting that Hippocrates considered symptom duration as a diagnostic criterion for melancholia by stating in one of his aphorisms (the 23rd) that ‘‘if sorrow persists, then it is melancholia’’.

Subsequent eminent authors of antiquity (Aretaeus of Capadokia, Galen and others) continued using the term melancholia and elaborated further on its symptomatology, its causation and its delineation from related disorders. The essentials of the traditional views on melancholia were retained during the middle ages and long after. The publication of Robert Burton’s Anatomy of Melancholy in 1621, in addition to presenting an excellent description of a sufferer’s feelings, provided an informative review of the prevailing concepts on the nature of the illness at the time.

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. 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. His work, The Canon of Medicine, 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 (sloth or absence of caring) was identified, involving low spirits and lethargy typically linked to isolation.

The term depression itself was derived from the Latin verb deprimere, "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 in a similar sense in 1753. 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. 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 19th century, became more associated with women.

The term ‘‘melancholia’’ survived as the only speciļ¬er of morbid mood and disposition until Kraepelin, at the end of the nineteenth century, introduced the term ‘‘manic-depression’’ to separate nosologically mood disorders from dementia praecox, known after Bleuler as schizophrenia.

Sigmund Freud 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. 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 first version of the DSM (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.

Historical Approaches to the Depression Treatment

The ancient scientists did not possess the knowledge, equipment, and opportunity of the modern researchers, however, their therapeutic approach is interesting not just from historical perspectives. May be, the humanistic views, not contaminated by the modern civilization, have the core values, you can use in your daily life…

Early Egypt                       
Cause of Depression: Loss of Status or Money
Treatment: Talking it Out , Religion, Suicide is accepted

Old Testament 
Cause of Depression: Despair, Cognition 
Treatment: Faith

Cause of Depression: Demons
Treatment: Exorcism

Cause of Depression: Heaven – sent, Not shameful                                  
Treatment: None, A Blessing

Cause of Depression: Melancholia
Treatment: Music

Cause of Depression: Melancholia, Natural and Medical Causes
Treatment: Abstinence excesses, Vegetable Diet, Exercise

Cause of Depression: A Form of Madness
Treatment: Entertaining Stories, Diversion, Persuasion Therapy

Cause of Depression: Psychic functions of the brain affected
Treatment: Confrontation, Humor, Exercise

Sources and Additional Information:
Depressive Disorders by Mario Maj and Norman Sartoris


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