The History Of Depression: How Depression And Treatments Have Changed Over Time

The field of mental health has worked tirelessly to change the stigma around mental illness, particularly in regard to mood disorders like depression. And, they have made huge improvements on what society knows and believes about these issues. But unless you know the history of depression, you can't fathom how far we’ve come.

Depression is not, by any means, a new problem. While it may seem like it's something that we are just starting to learn more and more about, it has been around for thousands of years that we know of.

There are accounts of depression from many different cultures in history. This includes the Egyptians, Greeks, Babylonians, Romans, and Chinese. However, in people in ancient history, did not know what depression was, nor were they familiar with the concept of a mood disorder or mental health disorder. They had very different ideas about what caused it and how to treat it.

Depression in the Ancient World

Back in ancient Greece and Rome, depression was initially called s melancholia. The Greek physician Hippocrates believed the body was made up of four fluids, or “humors”: phlegm, yellow bile, black bile, and blood. According to the humors theory, if the body produced too much or too little of any of these fluids, various maladies could result. Too much black bile, he believed, produced melancholia. Therefore, to treat melancholia, the easiest answer was to reduce the black bile in the person's body. This was something that they tried through bloodletting, purging, and medication.

While this theory of course appears silly to us today, Hippocrates also believed that symptoms of depression had something to do with the brain.

Some notable ancient Greeks also believed some forms of madness (as was then the term) were linked to creativity and genius. . The philosopher Aristotle once wrote “No great mind has ever existed without a touch of madness.” Indeed, he claimed that Plato and Socrates were melancholic figures and that this was part of the reason for their brilliance.

“Inspired,” or “frenzied” forms of madness were especially venerated. Socrates himself, glorifying madness, is reported to have said “...there is also a madness which is a divine gift, and the source of the chiefest blessings granted to men,” and that when it comes to poetry and art, “...the sane man disappears and is nowhere when he enters into rivalry with the madman.” The type of madness characterized here, with its description of trance-like states and manic episodes, is would what we would today perhaps recognize as bipolar disorder (formerly known as manic depression).

Depression in the Middle Ages

The widely accepted theory of the Medieval view of mental health is that mental illnesses were viewed as evidence of demonic possession, witchcraft, or the consequence of sin.

However, the full picture appears to be somewhat more complex. A study of 57 different contemporary accounts of various mental illnesses found that just 16% of those attributed the conditions to supernatural causes. And in most of those cases, the medieval authors appeared to be attacking a perceived enemy of their religious values.

Another study on supposed “exorcisms” on the mentally ill found most of these accounts were literary inventions, rather than eye-witness accounts.

Rather than exorcisms, the mainstream medieval approach to treating depression and other mental health conditions and other mental health conditions continued to be based on humoral theory. Treatment methods used focused on “purging” the body via laxatives and bloodletting, among other approaches.

And while the narrative of demon-obsessed hysteria does not stand up to scrutiny, cruel treatment did sometimes occur; a person who disturbed the peace due to their mental health disorder could be given physical punishment or locked up.

Yet while clearly a long way off from modern treatment methods, medievals had a better understanding of the nature of mental health than given credit for. Evidence suggests they were surprisingly open to multiple causes of mental illness, with overwork and abuse of alcohol being among those considered.

Compassion was also not unheard of. In 13th Century England, for example, individuals known to be mentally disturbed would be given state evaluations to determine whether or not they had soundness of mind. The examiners nonetheless were open to some people simply being more prone to madness and used naturalistic and commonsense methods to make their determination - no burnings or drownings. Those found incapable of appropriate behavior or caring for themselves would be entrusted to the care of state-supervised guardians.

Oftentimes these guardians would clergy. Monks would surround sufferers in a circle of hands of support and angelic voices. This approach - called the “laying on of hands” -  has more scientific support than it would seem - one study found it led to a reduction in disease and treatment symptoms in cancer patients. Evidence shows it can also benefit depressed people - one found the laying on of hands led to lower levels of depression, anxiety, and stress in patients, even if they weren’t themselves religious.

Depression in the Renaissance

Much like in the classical and medieval eras, the Renaissance understanding of mental illness continued to be influenced by humor's theory, as well as the idea of madness being a divine gift. However, it was also around this time that many people began to look more for natural causes for and treatment of depression.

In 1621, the first book on depression appeared: “The Anatomy of Melancholy” by Richard Burton. The book discussed various natural treatments for depression that we might recognize today, such as exercise, diet travel, and herbs, and music therapy.

Depression in the Enlightenment

During the Enlightenment era, beliefs started to change again about depression and it was during this time that they started to approach our modern understanding While doctors continued to be influenced by humor theory, some believed depression stemmed from displaced and excessive anger - a theory which has some basis of support.

For example, the Diagnostic and Statistical Manual of Mental Disorders - which is the handbook of the American Psychiatric Association - lists “irritability” as one of the symptoms of depression for children and adolescents. Though curiously that symptom is not mentioned for adult cases, two large studies have found high levels of anger and irritability in respectively two-thirds and half of those surveyed with a depressive disorder.

That said, many also believed that those that were suffering simply needed to do hard, physical work and get more exercise to correct the problem. There were also some extreme forms of treatment, such as a spinning stool. It was believed that spinning someone until they were dizzy could help to correct things in the brain to put an end to their depression. And, it's reported that Benjamin Franklin came up with one of the first types of electroconvulsive therapy.

Near the end of the Enlightenment period, French psychiatrist Philippe Pinel called for the end of the shackling of mentally ill patients, provided some of the earliest writings on schizophrenia and other mental disorders, and introduced the classification of mental illness. It’s also around this time, and moving into the 19th Century and Victorian era, that the field of clinical neuroscience began to take shape.

Depression in the Victorian Era

A lot more progress was made during the Victorian era, the field of cognitive psychology began to emerge. The term depression appeared for the first time in this century. However, there was still much confusion about what caused depression and how to treat it.

Many believed that depression was caused by the modern world. They thought that those that lived white-collar lives were more susceptible and those that were blue-collar workers were immune to being depressed. Therefore, they believed that physical labor and exercise were important parts of treatment. Doctors began creating sanitariums where people could go to be exposed to fresh air, exercise, and healthy eating.

In the 19th century, those looking to make money started to sell nerve and brain pills to people that were suffering from melancholy. And it wasn't until this time in history that people started to connect melancholy with emotions. This is a significant shift in perspective because it helped doctors to begin to see that emotions and the way people think could also impact the body instead of it only working the other way.

As we neared the 1900s, a German psychiatrist Emil Kraepelin began to separate melancholy based on levels of severity and started to make a push for treating it through medical intervention. Over the next hundred years, there were incredible leaps and bounds made in the understanding of depression, depressive symptoms, and forms of treatment. Adolf Meyer that separated the term melancholy from depression, thus giving us the medical term depression as we know it today. The idea of the affective disorders was proposed by the English psychiatrist Henry Maudsley.

Depression Today

Today we have a more thorough understanding of the human brain. We have learned a lot about the biological factors behind depression, such as how different parts of the brain control different things, and how genetics work.  We also learned there were different depressive states, rather than simply depression.

The medical model of depression continued to take shape in the 1920s, as experts in cognitive psychology divided depressive states into reactive and endogenous depression. The concept of depression as a mood disorder, in which depressive symptoms were seen as a medical issue, also gained further acceptance.

There was also a lot of progress made in 1952 when mental health professionals such as psychiatrists and psychologists created the American Diagnostic and Statistical Manual of Mental Disorders. This helped to create a more rigorous diagnostic criteria, as well as pave the way for more formal and standardized treatments for depressive disorders.

In 1956, Swiss psychiatrist Roland Kuhn pioneered the use of Imipramine, the first modern antidepressant. For many years thereafter, the use of tricyclic antidepressants continued to grow with some believing it to be the best form of treatment for depression.

The DSM also continued to be updated over the years as they began to break out and break down different forms of depression. In the 1960’s, unipolar disorders like depression were separated from manic depression, which is now known as bipolar disorder. Andhey began to come up with a list of symptoms that could be used to diagnose depression. In the 1970s, the term major depressive disorder (major depression) was introduced by the DSM-III of the American Psychiatric Association, and is what is used in the field of psychology for severe depression. In the 1980’s, seasonal affective disorder, another kind of mood disorder, was coined by National Institute of Mental Health psychiatrist Norman E. Rosenthal.

Our understanding of depression as a complex condition was furthered enhanced in 1997 when the World Health Organization put out the 10th edition of the International Classification of Diseases (ICD-10). The ICD-10 advanced our understanding of the depressive episode by breaking it down into two sub-categories: mild depressive episode and major depressive episode.

With all of the knowledge that psychologists and psychiatrists have gained, we have continued to develop new and effective treatment options  for major depression, such as Cognitive Behavioral Therapy, a type of cognitive therapy that targets helping patients learn to replace negative thoughts with positive ones and other forms of coping strategies to deal with depression.

We have learned over the years that generally a combination of treatments is best used instead of just one approach. And, we have learned the importance of self-care such as eating right and exercising just like many people have theorized throughout history. However, we also understand the importance of formalized therapy in the form of medication and therapy to treat depression.

You Can Reach Out For Help

If you're struggling with depression, it's important for you to know that there are multiple forms of therapy available to help you overcome it. Unlike what was believed in ancient history, depression is a treatable health condition. If you've never talked to anyone about what you are feeling or your symptoms before, contact a local therapist or an online therapist to start the process. With all the modern discoveries that we have and the treatment that is at our fingertips, such as online counseling, there is no reason for anyone to have to continue to live with and suffer through depression.

And while we do have some way to go on ending the stigma that surrounds Mental Health, we have come incredibly far throughout our history. But, the rate of depression continues to increase in America, which is something that needs to be addressed. If you think that you may be dealing with it, it's time to get help.

Questions People Commonly Ask About The History of Depression

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