Who Discovered Depression?

The History of Depression

St. Bernard of Clairvaux exorcising someone possessed, by Ferrer Bassa (circa 1290-ca 1348), painting on wood
De Agostini/G. Dagli Orti/Getty Images

Just who discovered depression? Well, there isn't really one person who can be pointed to as first discovering it. Since it is a universal psychological state that we all go through to some degree at one time or another, depression has been known about probably since the beginning of humanity. Rather than discovering it, it has really been more a matter of trying to understand what causes it and how we can best help people who are suffering from it.

Earliest Accounts of Depression

The earliest written accounts of what we now know as depression appeared in the second millennium B.C. in Mesopotamia. In these writings, depression was discussed as being a spiritual rather than physical condition, with it, as well as other mental illnesses, being thought of as being caused by demonic possession. As such, it was dealt with by priests rather than physicians.

The idea of depression as being caused by demons and evil spirits has existed in many cultures, including the ancient Greeks, Romans, Babylonians, Chinese and Egyptians, and was often treated with such methods as beatings, physical restraint and starvation in an attempt to drive the demons out. The ancient Greeks and Romans, however, were of two minds on the matter, with many doctors also considering it to be a biological and psychological illness. These doctors used therapeutic methods such as gymnastics, massage, diet, music, baths and a medication containing poppy extract and donkey's milk to treat their patients.

Physical Causes of Depression

As far as physical causes, a Greek physician named Hippocrates is credited with the idea that depression, or melancholia as it was known then, was caused by an imbalance in four body fluids, called humors: yellow bile, black bile, phlegm and blood. Specifically, melancholia was attributed to an excess in black bile in the spleen.

Hippocrates' treatments of choice included bloodletting, baths, exercise and diet.

A Roman philosopher and statesman named Cicero, in contrast, believed that melancholia was caused by psychological causes such as rage, fear and grief.

In the last years before Christ, a very common belief among even educated Romans was that depression and other mental illnesses were caused by demons and by the anger of the gods. Cornelius Celsus (25BC-50 AD) is reported as recommending the very harsh treatments of starvation, shackles and beating in cases of mental illness. A Persian doctor named Rhazes (865-925 AD), however, did see mental illness as arising from the brain and recommended such treatments as baths and a very early form of behavior therapy which involved positive rewards for appropriate behavior.

During the Middle Ages, religion, especially Christianity, dominated European thinking on mental illness, with people again attributing it to the devil, demons or witches. Exorcisms, drowning and burning were popular treatments of the time.

Many were locked up in "lunatic asylums." While some doctors continued to seek physical causes for depression and other mental illnesses, they were in the minority.

During the Renaissance, which began in 14th century Italy and spread throughout Europe during the 16th and 17th centuries, witch hunts and executions of the mentally ill were still quite common; however, some doctors were revisiting the idea of mental illness having a natural rather supernatural cause.

In the year 1621, Robert Burton published a book called Anatomy of Melancholy, in which he outlined both social and psychological causes for depression such as poverty, fear and loneliness. In this volume, he made recommendations such as diet, exercise, travel, purgatives (to clear toxins from the body), bloodletting, herbs and music therapy in the treatment of depression.

During the 18th and 19th century (the Age of Enlightenment), depression came to be viewed as a weakness in temperament which is inherited and cannot be changed, with the resulting idea that people with this condition should be shunned or locked up.

During the latter part of the Age of Enlightenment, doctors began to suggest the idea that aggression was at the root of this condition. Treatments such as exercise, diet, music and drugs were now advocated and doctors suggested that it was important to talk about your problems with your friends or a doctor.  Other doctors spoke of depression as resulting from internal conflicts between what one wants and what one knows is right. And yet others sought to identify the physical causes of this condition.

Treatments for Depression

Depression treatments during this era included water immersion (people were kept under water for long as possible without drowning) and a spinning stool to induce dizziness, which was believed to put the brain contents back into their correct positions. Benjamin Franklin is also reported to have developed an early form of electroshock therapy during this time. In addition, horseback riding, diet, enemas and vomiting were recommended treatments.

In 1895, the German psychiatrist Emil Kraepelin became the first to distinguish manic depression as an illness separate from dementia praecox (the term for schizophrenia at the time). Around this same time, Psychodynamic Theory and psychoanalysis -- the type of psychotherapy based upon this theory -- were developed. In 1917, Sigmund Freud wrote about mourning and melancholia where he theorized about melancholia as being a response to loss, either real (for example, a death) or symbolic (failure to achieve a desired goal). Freud further believed that a person's unconscious anger over his loss lead to self-hatred and self-destructive behavior. He felt that psychoanalysis could help a person resolve these unconscious conflicts, reducing self-destructive thoughts and behaviors. Other doctors during this time, however, saw depression as a brain disorder.

During the late 19th and early 20th centuries, treatments for severe depression were generally not enough to help patients, leading many people desperate for relief to having lobotomies (surgery to destroy the frontal portion of the brain), which were reputed to have a "calming" effect. Unfortunately, these surgeries often caused personality changes, a loss of decision-making ability, poor judgement and sometimes even lead to the patient's death. Electroconvulsive therapy (an electrical shock applied to the scalp in order to induce a seizure) was also sometimes used for patients with depression.

During the 1950s and '60s, doctors divided depression into subtypes of "endogenous" (originating from with the body) and "neurotic" or "reactive" (originating from some change in the environment).  Endogenous depression was thought to result from genetics or some other physical defect, while the neurotic or reactive type of depression was believed to be the result of some outside problem such as a death or loss of a job.

The 1950's were an important decade in the treatment of depression due to the fact that doctors noticed that a tuberculosis medication called isoniazid seemed to be helpful in treating depression in some people. Where depression treatment had previously been focused only on psychotherapy, drug therapies now started to be developed and added to the mix. In addition, new schools of thought, such as Cognitive-Behavioral and Family Systems Theory emerged as alternatives to Psychodynamic Theory in depression treatment.

At the present time, depression is considered to arise from a combination of multiple causes, including biological, psychological and social factors. Psychotherapy and medications which target molecules called neurotransmitters are generally the preferred treatments, although electroconvulsive therapy may be utilized in certain instances, such as in treatment-resistant depression or severe cases where immediate relief is required. Other, newer, therapies, including transcranial magnetic stimulation and vagus nerve stimulation, have also been developed in recent years in an attempt to help those who have failed to respond to therapy and medications, since, unfortunately, the causes of depression are more complex than we yet understand, with no one treatment providing satisfactory results for all.

So, in summary, while there is no single person who can be credited with discovering depression, there have been a whole series of great thinkers who have contributed -- and continue to contribute -- to our growing understanding of just what this illness really is.

References:

"Depression Through the Ages:  Melancholoy Journey."  The Economist.  Published:  May 26, 2012.  The Economist Newspaper Limited.  Accessed:  September 30, 2014.

"Hysteria, Demons, and More: Depression Throughout History."  Health.  Published:  Unknown.  Health Media Ventures. Inc.  Accessed:  September 30, 2014.

Nemade, Rashmi, Natalie Staats Reiss and Mark Dombeck.  "Major Depression and Other Unipolar Depressions."  MentalHelp.net.  Updated:  September 19, 2007.  CenterSite, LLC.  Accessed:  September 30, 2014.

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