Europe
The Middle Ages carried on the classical idea of
depression being rooted in one’s disfavor with the gods, but this time the gods
were those of Christianity, rather than the Greek pantheon. For clerics in
Medieval Europe, melancholy was a sign that one was living sinfully and in need
of repentance. In fact, severe melancholy was sometimes seen as a sign of
demonic possession. John Cassian, a monk known for his mystical writings,
called melancholy the “noonday demon,” in reference to Psalm 91. He recommended
that melancholics withdraw from family and friends and perform hard manual
labor in solitude as punishment for their sins.
Not only was melancholy seen as a sign of sinfulness,
being in a depressed state was considered sinful in and of itself; the Latin
word for the deadly sin of sloth, acedia, was broadly defined
and included everything from laziness to melancholy. In fact, many of the
clerics who wrote about individuals beset with acedia described
them as being in the throws of depression. For example, Cassian describes a
fellow “slothful” monk this way:
“He looks about anxiously this way and that, and sighs
that none of the brethren come to see him, and often goes in and out of his
cell, and frequently gazes up at the sun, as if it was too slow in setting, and
so a kind of unreasonable confusion of mind takes possession of him like some
foul darkness.”
The Canterbury Tales, written in the 14th century,
similarly describes the slothful person as one who is filled with despair, loss
of hope, and “outrageous sorrow.” This excessive low mood is followed by sluggishness
and general apathy towards life, which in turn prevents the slothful person
from performing good works. If not repented of, sloth becomes a sin against the
Holy Ghost. Andrew Solomon, author of The Noonday Demon, suggests that this
connection between melancholy and the sin of sloth may have given rise to much
of the stigma that surrounds depression today.
From the 4th century, the Christian hermit movement will
highlight the dangers of melancholy. The anchorites are Christians who decide
to live in solitude and for that they retire to the desert to break with a
society they consider in perdition. In this isolation, one of the dangers that
threatens them is acedia. The acedia is, initially, a discomfort linked to the
excess of deprivation which seizes the monks. This term means
"negligence", "grief", "indifference". By seizing
this symptom, which among the desert monks is rather psychic discomfort than
"evil", Christians turn it into emissions of evil and evil thoughts.
It becomes the most formidable temptations in connection with the demon and the
moral fault. Acedia becomes a divine punishment. It will haunt the monasteries
of the West but also the secular society until the end of the Middle Ages.
Intriguingly, the origins of this particular and peculiar
term are actually quite clear: the writings of Evagrius Ponticus, a 4th century
monk living as "part of a cluster of hermit colonies [...] some forty to
sixty miles south of Alexandria. He described it as a demon, which leads the
monk to "hatred against this place, against life itself, and against the
work of his hands, and makes him think he has lost the love among his brethren
and there is none to comfort him." This is pre-medieval, but as above, it
forms the foundation for acedia, and will change little through later
centuries. Note before we move on that acedia is not the same
as depression (or even melancholia) and that it is not the
same as sloth. "Lassitude, weariness, inaction, carelessness, and neglect
were all aspects of acedia," but it would be an inaccurate depiction to
merely leave it there.
Evagrius' description would be conveyed into the Medieval
era by John Cassian's *Twelve Books on the Institutes of the Coenobia
[=monastaries] and the Remedies for the Eight Principal Faults." One of
these faults was the spirit of accidie, to which Cassian devotes book 10. When
it "has taken possession of some unhappy soul," he writes, "it
[...] makes the man lazy and sluggish [...] he complains that he is cut off
from spiritual gain, and is of no use in the place." When and if it overcame
a monk, "it either [made] him stay in his cell idle and lazy, without
making any spiritual progress, or it [drove] him out from thence and [made] him
restless and a wanderer, and indolent in the matter of all kinds of work".
Over the course of the Medieval era, acedia evolved. Some
lists of the chief vices omitted it entirely; Gregory the Great subsumed it
under dejection (he also lowered the number of sins to seven.) As the 11th
century bled into the 12th, acedia underwent "a shift in emphasis from
mode of behavior to state of mind." At this point, acedia was still
largely restricted to men of God, but after the fourth Lateran council (of
1215) mandated mass religious education, acedia became more and more a part of
public consciousness.
While acedia was a sin, it was still something that could
be treated, by penance or confession. There was (and is?) a long history of
priests as healers of the soul, and this medicalization of sin certainly
existed in these case of acedia. It was also following the Lateran reforms that
acedia began its transformation into sloth: while it had previously been
emphasized as a state of mind, "the common man's image of acedia came to
center around spiritual idleness or neglect in the performance of spiritual
duties."
Treatments for mental disorder were quite diverse. Some
were theoretically based: bloodletting, baths, head surgery, or a diet change
to rid oneself of noxious humors: sexual diversion to aid the lovesick:
exorcism and Holy Communion to aid the possessed. Others were not: music,
pleasant scenes, prayer, and religious relics were thought to be beneficial
regardless of the diagnosis (which was often tentatively held in any case).
Records of the illnesses of the painter Hugo van der Goes (c. 1435-.1482 CE)
and the French King Charles VI (1368-1422 CE) portray well-meaning onlookers
suggesting a variety of diagnoses and remedies, none of them very successful.
An instance of the solicitude shown Charles during his periods of illness was
his court’s procurement of a mistress, Odette de Champ-divers, when the king
refused to recognize his wife.
Persia
A Persian doctor named Rhazes (865–925 CE), however, did
see mental illness as arising from the brain. He recommended such treatments as
baths and a very early form of behavior therapy which involved
positive rewards for appropriate behavior.
Rhazes, whose full name was Abu Bakr Muhammad ibn
Zakariya al-Razi (865–925 AD), was a Persian physician, chemist, and
philosopher who made significant contributions to the fields of medicine and
alchemy during the Islamic Golden Age. While Rhazes did not specifically
address depression as a distinct disorder, his works contained valuable insights
into the treatment of various mental and emotional conditions, which could be
related to what we now understand as depression. Here are some of his views on
treatment:
1. Holistic
Approach: Rhazes advocated for a holistic approach to medicine, emphasizing
the importance of considering the physical, psychological, and social aspects
of a patient's well-being. He believed that illness could result from
imbalances in these areas.
2. Diet
and Lifestyle: Rhazes recognized the role of diet and lifestyle in
maintaining health and preventing illness. He advised patients to adopt a
balanced diet, engage in regular physical activity, and maintain a harmonious
daily routine. These recommendations aimed at promoting overall well-being,
which could indirectly benefit mental health.
3. Humoral
Theory: Like many scholars of his time, Rhazes adhered to the humoral
theory, which posited that imbalances in bodily humors (blood, phlegm, black
bile, and yellow bile) could lead to illness. While this theory is outdated by
modern standards, it influenced his approach to treatment, including treatments
for conditions that might today be categorized as depressive.
4. Therapeutic
Regimens: Rhazes recommended therapeutic regimens that included various
interventions, such as dietary adjustments, herbal remedies, and physical
activities. He believed that restoring the balance of bodily humors could help
alleviate physical and mental symptoms.
5. Psychological
Care: Rhazes recognized the importance of a patient's mental and emotional
state in the healing process. He encouraged providing emotional support and
reassurance to patients as part of their treatment.
6. Avoidance
of Excessive Stress: Rhazes acknowledged that chronic stress and overwhelming
life circumstances could negatively impact a person's health. He recommended
avoiding excessive stressors and adopting relaxation techniques, which could
indirectly benefit mental well-being.
7. Use
of Herbal Remedies: Rhazes was known for his contributions to pharmacology
and the use of herbal remedies. While his focus was primarily on physical
ailments, some of the herbs and natural substances he recommended might have
had mood-altering effects that could be beneficial for individuals experiencing
emotional distress.
Sources and Additional Information:
https://www.artofmanliness.com/health-fitness/health/the-history-of-depression/
https://www.verywellmind.com/who-discovered-depression-1066770
https://www.peertechzpublications.com/articles/ADA-6-145.php
