By David West
Depression has plagued mankind throughout its existence. Even the earliest written records describe the condition in words that many of us would recognize today. Very little was understood about this pervasive condition until much more recently.
Depression in Ancient Civilization
Ancient civilizations, including the Romans and Egyptians, often viewed depression as a problem of the spirit and blamed the condition on supernatural entities. Most treatments were primitive, harsh, and conducted by religious shamans or priests.
However, even during the Greek and Roman era, physicians were making a link between depressive symptoms and the brain. The Greek physician Hippocrates, author of the still widely recognized Hippocratic Oath, developed the Four Humors theory as the basis of mental health.
Hippocrates (born in 460 BCE)believed that wellness derived from an internal balance of four bodily fluids -- yellow bile, phlegm, black bile, and blood. Any disturbances to this balance would result in various ailments, including depression.
Melancholia, the Greek term for depression, arose due to an overabundance of black bile. While black bile doesn’t biologically exist, the Greeks associated organic decay with this substance.
Hence, an individual with too much black bile becomes nihilistic, unmotivated, and preoccupied with death and sadness. Hippocrates and other enlightened physicians of the time attempted to restore humoral balance through a protocol of music, exercise, and bloodletting.
Depression in the Middle Ages and Renaissance
During the Middle Ages, the divergent views on depression that evolved during the Greek and Roman era deepened. Communities that still regarded depression as a spiritual affliction continued to turn to religious treatments, which were becoming increasingly more inhumane.
Mental illnesses, including depression, sparked a form of moral panic. People believed these conditions were contagious and enacted harsh punishments such as imprisonment. At the other end of the spectrum, medieval physicians retained the Hippocratic view of depression and continued to advocate for humane treatments.
During the Renaissance, Oxford-educated author Robert Burton wrote the seminal text, The Anatomy of Melancholy. Published in 1621, the book introduced the revolutionary concept that external factors, such as poverty and isolation, can cause depression. Burton recommended many of the same treatments Hippocrates extolled centuries before.
Depression in the Enlightenment Age
The rise of mechanical technologies during the 17th and 18th-centuries finally shifted mainstream views on the causes and cures for depression. Scholars began to view the human body as a form of machine. Conditions like depression therefore arose due to some type of malfunction.
Physicians held varying opinions on the exact source of the dysfunction. Some doctors interpreted depression as the result of an internal conflict that may be resolved by discussing matters with close friends.
Others believed that the condition was the result of ‘bad wiring’ in the nervous system. During this period, very bizarre treatments such as spinning devices were developed to correct faulty brain systems.
Depression in the Modern Era
Throughout the 18th and 19th centuries, depression continued to be regarded as a personal failing. It was not until the late 1700s that depressive symptoms were observed and classified in a clinical setting.
French physician Phillippe Pinel (born 1745) encountered patients at Bicêtre Hospital outside of Paris and noted their positive response to talk therapy. He replaced the traditional protocols of bloodletting with observation and careful conversations. Pinel also began to collect the patient’s information into reports and case studies.
He eventually used these observations to author the two-part series Medico-Philosophical Treatise on Insanity (1809). In the book, he classifies depression into several distinct disorders. This marks the beginning of clinical psychiatry and informs the work of later researchers.
During the 20th century, immense advances in technology enabled researchers to investigate internal brain processes. Neuropsychologists could better understand how external situations could trigger brain activity that led to depressive symptoms.
To standardize depression diagnostics amongst mental health providers, the American Psychiatric Association published the first Diagnostic and Statistical Manual of Mental Disorders (DSM). The reference book is updated every few years and is the basis of diagnostic tests for depression.
Insights into the biological processes that underlie depression resulted in the development of pharmaceutical solutions. Tricyclic antidepressants were the earliest form of medical treatment. These prescriptions help the brain maintain adequate levels of serotonin and norepinephrine, two neurotransmitters associated with mood.
While effective, tricyclics caused many side effects. Milder treatments such as selective serotonin reuptake inhibitors (SSRIs) were developed throughout the 1980s and 1990s.