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Depression - history of the disorder

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Main article: Clinical depression

Prehistory to medieval periodsEdit

Lavater1

The four temperaments (clockwise from top right; choleric; melancholic; sanguine; phlegmatic), according to an ancient theory of mental states

Notes in the Ancient Egyptian document known as the Ebers papyrus appear to refer to emotional distress of the heart or mind, which has been interpreted as sadness or depression.[1] Passages of the Hebrew Bible (Old Testament), composed and compiled between the 12th and 2nd centuries BC, have been interpreted as describing mood disorders in figures such as Job, King Saul and in the psalms of David.[2]

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 kholé, "bile",[3] 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.[4] 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, dejection, and despondency, and often fear, anger, delusions and obsessions were included.[5][5]

Influenced by Greek and Roman texts, physicians in the Persian and then the Muslim empire developed ideas about melancholia during the Islamic Golden Age. Ishaq ibn Imran (d. 908) combined the concepts of melancholia and phrenitis.[6] The 11th century physician Avicenna described melancholia as a depressive type of mood disorder in which the person may become suspicious and develop certain types of phobias.[7] His work, the Canon of Medicine, became the standard of medical thinking in Europe alongside those of Hippocrates and Galen.[8] 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.[9][10]

17th to 19th centuries Edit

File:The Anatomy of Melancholy by Robert Burton frontispiece 1638 edition.jpg

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.[11][12] 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.[13] 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 pathological condition and the latter to a temperament.[5]

The term depression was derived from the Latin verb deprimere, "to press down".[14] 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.[15] 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.[16] 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.[5]

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.[2] English psychiatrist Henry Maudsley proposed an overarching category of affective disorder.[17]

20th and 21st centuries Edit

The influential system put forward by Kraepelin unified nearly all types of mood disorder into manic–depressive insanity, with a separate category of dementia praecox (now known as schizophrenia). Kraepelin worked from an assumption of underlying brain pathology, but also promoted a distinction between endogenous (internally caused) and exogenous (externally caused) types.[2] German psychiatrist Kurt Schneider coined the terms endogenous depression and reactive depression in 1920,[18] 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.[19] 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.[20]

Freud had emphasized early life experiences and conflicting psychological drives; he associated melancholia with psychological loss and self-criticism.[5] 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.[17] 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.[21]

A half century ago, diagnosed depression was either endogenous (melancholic), considered a biological condition, or reactive (neurotic), a reaction to stressful events.[22] 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;[23] in the former, there is a continuum of depression ranked only by severity and the result of a "psychobiological final common pathway",[24] whereas the latter conceptualizes a distinction between biological and reactive depressive syndromes.[18] The publishing of DSM-III saw the unitarian model gain a more universal acceptance.[23]

File:Isoniazid skeletal.svg

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.[25] 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.[2]

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 Criteria),[26] and was incorporated in to the DSM-III in 1980.[27] 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.[27][28] 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. There have been some continued empirical arguments for a return to the diagnosis of melancholia.[29][30] 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.[31]

See alsoEdit

References & BibliographyEdit

  1. Nasser, M. (1987) "Psychiatry in Ancient Egypt" (PDF). Bulletin Of The Royal College Of Psychiatrists, Vol 11 (December): 420–22
  2. 2.0 2.1 2.2 2.3 Davison, K (2006). Historical aspects of mood disorders. Psychiatry 5 (4): 115–18.
  3. Liddell, Henry George and Robert Scott (1980). A Greek-English Lexicon (Abridged Edition), United Kingdom: Oxford University Press.
  4. Hippocrates, Aphorisms, Section 6.23
  5. 5.0 5.1 5.2 5.3 5.4 Radden, J (March 2003). Is this dame melancholy? Equating today's depression and past melancholia. Philosophy, Psychiatry, & Psychology 10 (1): 37–52.
  6. Jacquart D. "The Influence of Arabic Medicine in the Medieval West" in Morrison & Rashed 1996, pp. 980
  7. Amber Haque (2004), Psychology from Islamic perspective: Contributions of early Muslim scholars and challenges to contemporary Muslim psychologists, Journal of Religion and Health 43 (4): 357–377 [366].
  8. S Safavi-Abbasi, LBC Brasiliense, RK Workman (2007), The fate of medical knowledge and the neurosciences during the time of Genghis Khan and the Mongolian Empire, Neurosurgical Focus 23 (1), E13, p. 3.
  9. Daly, RW (2007). Before depression: The medieval vice of acedia. Psychiatry: Interpersonal & Biological Processes 70 (1): 30–51.
  10. Merkel, L. (2003) The History of Psychiatry PGY II Lecture (PDF) Website of the University of Virginia Health System. Retrieved on 2008-08-04
  11. Kent 2003, p. 55
  12. The Anatomy of Melancholy by Robert Burton. Project Gutenberg. URL accessed on 2008-10-19.
  13. Jackson SW (July 1983). Melancholia and mechanical explanation in eighteenth-century medicine. Journal of the History of Medical and Allied Sciences 38 (3): 298–319.
  14. depress. (n.d.). Online Etymology Dictionary. Retrieved June 30, 2008, from Dictionary.com
  15. includeonly>Wolpert, L. "Malignant Sadness: The Anatomy of Depression", The New York Times. Retrieved on 2008-10-30.
  16. Berrios GE (September 1988). Melancholia and depression during the 19th century: A conceptual history. British Journal of Psychiatry 153: 298–304.
  17. 17.0 17.1 Lewis, AJ (1934). Melancholia: A historical review. Journal of Mental Science 80: 1–42.
  18. 18.0 18.1 Schneider, K (1920). Zeitschrift für die gesante. Neurol Psychiatr 59: 281–86.
  19. Mapother, E (1926). Discussion of manic-depressive psychosis. British Medical Journal 2: 872–79.
  20. Parker 1996, p. 11
  21. American Psychiatric Association (1968). "Schizophrenia" Diagnostic and statistical manual of mental disorders: DSM-II (PDF), Washington, DC: American Psychiatric Publishing, Inc.. URL accessed 2008-08-03.
  22. Cite error: Invalid <ref> tag; no text was provided for refs named Parker07
  23. 23.0 23.1 Parker G (2000). (abstract) Classifying depression: Should paradigms lost be regained?. American Journal of Psychiatry 157: 1195–1203.
  24. Akiskal HS, McKinney WT (1975). Overview of recent research in depression: Integration of ten conceptual models into a comprehensive clnical frame. Archives of General Psychiatry 32: 285–305.
  25. Schildkraut, JJ (1965). The catecholamine hypothesis of affective disorders: A review of supporting evidence. American Journal of Psychiatry 122 (5): 509–22.
  26. Spitzer RL, Endicott J, Robins E (1975). The development of diagnostic criteria in psychiatry. (PDF) URL accessed on 2008-11-08.
  27. 27.0 27.1 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. European Archives of Psychiatry and Clinical Neuroscience 240 (4–5): 258–65.
  28. Gruenberg, A.M., Goldstein, R.D., Pincus, H.A. (2005) Classification of Depression: Research and Diagnostic Criteria: DSM-IV and ICD-10 (PDF). Wiley.com. Retrieved on October 30, 2008.
  29. Bolwig, Tom G. (2007). Melancholia: Beyond DSM, beyond neurotransmitters. Proceedings of a conference, May 2006, Copenhagen, Denmark. Acta Psychiatrica Scandinavica Suppl 115 (433): 4–183.
  30. Fink M, Bolwig TG, Parker G, Shorter E (2007). Melancholia: Restoration in psychiatric classification recommended. Acta Psychiatrica Scandinavica 115 (2): 89–92.
  31. Healy, David (1999). The Antidepressant Era, p. 42, Cambridge, MA: Harvard University Press.

Key textsEdit

BooksEdit

Zilboorg G, Henry G W. (1941) A history of medical psychology. New York: W. W. Norton and Company,

PapersEdit

  • Berrios GE. Melancholia and depression during the 19th century: a conceptual History. British Journal of Psychiatry 1998 Sep, 153: 298-304.

Additional materialEdit

BooksEdit

PapersEdit

External linksEdit

History of medicine article on depression]

Depression
Types of depression
Depressed mood | Clinical depression | Bipolar disorder |Cyclothymia | |Dysthymia |Postpartum depression | |Reactive | Endogenous |
Aspects of depression
The social context of depression | Risk factors | Suicide and depression | [[]] | Depression in men | Depression in women | Depression in children |Depression in adolescence |
Research on depression
Epidemiology | Biological factors  |Genetic factors | Causes | [[]] | [[]] | Suicide and depression |
Biological factors in depression
Endocrinology | Genetics | Neuroanatomy | Neurochemistry | [[]] | [[]] | [[]] |
Depression theory
[[]] | Cognitive | Evolution | Memory-prediction framework | [[]] |[[]] | [[]] |
Depression in clinical settings
Comorbidity | Depression and motivation | Depression and memory | Depression and self-esteem |
Assessing depression
Depression measures | BDI | HDRS | BHS |CES-D |Zung |[[]] |
Approaches to treating depression
CAT | CBT |Human givens |Psychoanalysis | Psychotherapy |REBT |
Prominant workers in depression|-
Beck | Seligman | [[]] | [[]] |
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