Melancholia: How Ancient Societies Grappled to Understand and Treat Depression

Depression is a serious mental disorder and a state of being that troubles many people all over the world. It is not a condition to be taken lightly – it can weigh down on a person immensely and can even claim lives.  It is a state of extreme sadness, of apathy and lethargy, and an all-consuming melancholy. Depression is like a mire into which a person sinks, slowly and uncontrollably. Getting out of this state can be a big challenge. But a challenge that can be overcome. So, we can imagine that people in ancient times had a hazy understanding of what depression is and struggled to help those affected with it. Can we learn anything from the history of depression and its treatment across the ages?

How The Ancients Understood Depression

Today’s science and medicine has shed a lot of light on this serious condition. And thanks to that, it can be helped. While sadness is a normal human emotion and a part of life, major depression is not. Depression can come in bouts, lasting for a short period of time, or can be a major clinical disorder that constantly weighs a person down. Either way, such a condition is dangerous, and requires treatment and attention. It is estimated that more than 160 million people around the world suffer from major depression. If not helped, they can be consumed by this state and take their own lives.

One must wonder, how did ancient societies understand this extreme state? The first clues lie amongst the philosophers of Ancient Greece . This civilization was at the forefront of all things scientific, mental issues included. And, surprisingly, they characterized the illness quite accurately considering the time. 

The famed Ancient Greek physician, Hippocrates, described this severe mental state as a distinct disease. He named it “ melancholia”, from Ancient Greek “melas” (“black”), and “kholé”, (“bile”), and stated that all “fears and despondencies, if they last a long time”, are the usual symptoms of the illness.

However, his understanding of this melancholia was much broader than it is today and included several other symptoms which are no longer directly associated with depression. These were anger, fear, obsessive behaviors, and delusions.

Shamash was the Mesopotamian sun-god (Prioryman / CC BY-SA 4.0)

Shamash was the Mesopotamian sun-god (Prioryman / CC BY-SA 4.0 )

While Hippocrates gave the first “medical” or scientific description of the illness, there are still some mentions that go even further back in time. However, they are not as detailed. In the cradle of civilization, Mesopotamia, there is mention of such an ailment as far back as 2,000 BC!

Still, the Mesopotamians considered it a spiritual state, a trouble caused by demonic possession . So, a depressed person of that era would call to his aid not a doctor, but a holy man . One could also hope to dispel the “fears” by offering a sacrifice to the god Shamash in an elaborate ritual.

An Imbalance of Bile?

The Greeks however, more than a millennia later, had a better grasp of the human ailments. Their understanding was nevertheless still crude. Hippocrates believed that melancholia, as with most other such ailments, was caused by an imbalance in humors.

The four humors, and their relationship to the natural order (Wellcome Trust / CC BY 4.0)

The four humors, and their relationship to the natural order (Wellcome Trust / CC BY 4.0 )

The Greeks based a lot of their diagnoses on the so-called “humors”, which were four bodily fluids: blood, phlegm, black bile, and yellow bile. Hippocrates claimed that melancholia was caused by an excess of black bile in the spleen. Thus, his treatment for the condition was bloodletting, dieting, vigorous exercise, and hot or cold baths.

It wasn’t until the Roman statesman Cicero, a few centuries later, that a more logical diagnosis was given. Cicero said that melancholia had roots in fear, anger, and – above all – grief.

From Compassion to Abuse

However, in the following centuries, treatment of this ailment did not progress. Across the world, many odd and cruel “treatments” for depression were implemented. Generally, in post-classical and early medieval societies, depressed people were shunned and seen as weak. Thus, they were most often abused.

It was often reported that such patients were thrown in dungeons, shackled and beaten. But as the world progressed, so did our understanding of depression and the need to help those afflicted. One of the pioneers in that treatment was the Persian physician, Muhammad ibn Zakariya al-Razi. 

Positive Reinforcement for Proper Behavior

Al-Razi accurately described depression as stemming from the brain. He called it a “melancholic obsessive-compulsive disorder”, which stems from the changes of blood flow in the brain. He urged all the doctors to treat their patients with kindness and special care, and emphasized positive reinforcement, i.e. rewards for proper behavior.

Following successful treatments, al-Razi would discharge the patient and provide them with a sum of money. This would help them with immediate needs back in society and help with their transition. This is considered to be the first recorded case of psychiatric aftercare. And we can safely assume that Muhammad al-Razi successfully cured many cases of depression with his careful and kind approach to treatment.

Muhammad ibn Zakariya al-Razi (Wellcome Trust / CC BY 4.0)

Muhammad ibn Zakariya al-Razi (Wellcome Trust / CC BY 4.0 )

Possession by the Devil

Alas, there were many competing theories at that time and positive treatment of depression did not catch on. With the coming the medieval period, a “ Dark Age ” fell upon Europe, shunning those afflicted with depression. Christianity influenced diagnosis, and mental illness was commonly seen as possession by the devil or demons.

Often crude methods were employed as a cure, chief of them being exorcism. Of course, chanting Christian prayers in hopes of relieving a person of the “demon” possessing it is not an efficient treatment for clinical depression.

Sadly, more than often, afflicted people were persecuted openly, abused, or killed. Depression and other mental issues were often seen as signs of witchcraft, and many innocent people suffered cruel deaths at the hands of the Christian clergy.

The Dangers of Prolonged Isolation

But physicians during this period learned to recognize the symptoms of depression. Oddly enough, it was within Christianity that symptoms could be observed, in particular amongst the ascetic monks.

The hermits and anchorites of the Christian movement wanted to shun the earthly life, and thus fled into remote areas where they lived in total solitude, devoted to prayer and introspection. But this is an unnatural state and can have profound effects on the mind and spirit.

Hermits were often associated with depression due to their self-isolation (Unknown Author / Public Domain)

Hermits were often associated with depression due to their self-isolation (Unknown Author / Public Domain )

During the Middle Ages, many hermits were described as suffering from a state called “acedia,” which was described as grief, indifference, and a great spiritual discomfort: all symptoms of depression. The state resulted from prolonged isolation from society and the rigorous deprivations that the hermits endured. Thus, it was seen that depression can be “induced” as well.

A New Light on Depression

Starting in the 14th century, depression received its name: the one we use today. It comes from the Latin verb “deprimere” (“to press down”), and “to depress” was used to signify low spirits.

With the Renaissance around the 16th century, philosophical, scientific, and medical thinking once more came to the forefront. A famed English author wrote of the condition in 1665, calling it “a great depression of spirit,” a description that later became established. 

From the end of the Renaissance and to the end of the Enlightenment, the Classical Age sheds new light on depression and its treatments. It was understood as an alienation of the mind and the imagination, to be fought with reason. A depressed person was considered one struck with emptiness, an absence of meaning, and great sadness.

It was around this time that the most important work on depression for that period was published: “The Anatomy of Melancholy” in 1621. It was published by Robert Burton, a scholar, a teacher and a vicar at Oxford University. He was one of the pioneers who took a thorough and profound look at “melancholy”, addressing many theories and describing firsthand experiences.

Burton proposed that depression was to be battled by all the reasonable and positive remedies: plenty of sleep, a healthy diet, music, arts, meaningful work, and a positive talk about the problem with a friend. 

Robert Burton (Walker & Boutall / Public Domain)

Robert Burton (Walker & Boutall / Public Domain )

Burton himself was a lifelong sufferer from depression.

Depression Seen Through the Eyes of Learned Men

In the following centuries, the concept of “melancholia” (as it was still widely called) was continuously explored and studied. The ancient theory of “humors” came to be seen as flawed and incorrect, and new pioneering medical and psychological studies appeared.

The German physician, Johann Christian Heinroth (1773-1843), described the state as a disturbance of the soul that stemmed from a moral conflict within the patient. Thus, he saw it as a psychological state. Many learned men and physicians from the period began categorizing melancholia into distinct sub-groups, depending on the afflictions. 

Over time, the term depression began to be used more often, before at last supplanting the outdated “melancholia”. Emil Kraepelin (1856-1926), a German psychiatrist, was likely the first to use depression as an overarching term, and was also the first to distinguish manic depression and to describe bipolar disorder .

During this time, Sigmund Freud also tackled the subject of depression, arguing that it could result from loss, and that it takes up a form more severe than standard mourning. He proposed a complex theory, stating that objective loss results in subjective loss also.

As an example, he took depression that stems from a loss of valued romantic relationship. Freud claimed that the depressed person has identified with the object of affection unconsciously, and the loss has severe psychological effects that are more profound than mourning.

When Philosophy and Psychology Mingle

In the 20th century, philosophy and psychology were often intertwined, both searching for an explanation for depression. Existentialism and were the foremost schools of philosophy associated with depression and its treatment.

Viktor Frankl (1905-1997), the Austrian existential psychiatrist, connected depression to an overpowering feeling of insignificance, futility, and meaninglessness. He proposed that the “existential vacuum” that these feelings produce had to be filled with meaningful things.

Another unique theory came from the American existentialist psychologist, Rollo May (1909-1994). He argued that depression is “the inability to construct a future”, and that a person suffering from it “fails to look ahead in time properly”. Such a feeling is commonly connected with a sense of insignificance and a lack of meaning in the world. 

Rollo May (Unknown Author / Public Domain)

Rollo May (Unknown Author / Public Domain )

Humanist psychologists argued that depression stems from a gap between the pressures and standards of society, and the individual’s natural need to reach its full potential. Sadly, modern times placed all too high standards in society, and ordinary people – often in their formative years – find themselves unable to reach these impossible standards.

Feelings of self-pity, worthlessness, and lack of meaning all result from this. In a sense, society is partially to blame for high rates of depression. In the 1950s, Albert Ellis claimed that depression originated in irrational “shoulds” and “musts,” impossible standards and needs from society. This, he stated, led to unneeded self-pity and self-blame.

Always a Brighter Tomorrow

Thankfully, modern medicine and modern science have a good foothold in the battle against depression. Those who seek aid can win the fight against depression, especially in the developed parts of the world. Medicine, therapy, and a change of lifestyle are major remedies in this fight.

Still, sadly, a lot of depressed people from impoverished corners of the world are faced with discrimination, abuse, and lack of help. Depression claims many lives each year. In the fight against this, it must be remembered that depression is a state of mind that can be overpowered and dealt with.

Looking back onto history and understanding the affliction that grips us, we can work to overcome it. For as we all know, tomorrow is a brand new day.

Top Image: There have been many theories and many treatments for depression over the millennia of human history. Source: Love the wind / Adobe Stock.

By Aleksa Vučković

References

Bourin, M. 2020. History of depression through the ages. Archives of Depression and Anxiety.

Lawlor, C. 2012. From Melancholia to Prozac: A history of depression. OUP Oxford.

Schimelpfening, N. 2020. The History of Depression. Verywellmind. [Online] Available at: https://www.verywellmind.com/who-discovered-depression-1066770

Various, 2016. The History of Depression. The Oxford Handbook of Mood Disorders.

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