Reviewed by Whitney White, MS CMHC, NCC., LPC
In the history of mental health, depression has been thoroughly researched in an attempt to understand the condition. The discovery of depression and the growth of knowledge about it can be attributed to many thinkers and scientists. Knowing how depression was thought of in past and how that has transformed over the years can be helpful in understanding the present research and future considerations.
Although depression may be seen differently across cultures, it's still generally regarded as a mental health problem. At present many factors are seen as contributing to its development. These include genetic, environmental, physical, mental, biological, psychological, individual, and cultural factors.
There has been much documentation from healers, and philosophers throughout ages that show how long depression has been observed. In their documents, explicit descriptions were given on people's struggles and on discovering effective treatment options for depression.
What Is the Historical Background of Depression?
Historically, depression, which can also be called major depression or clinical depression, was previously referred to as melancholia. The word "melancholia” can be traced to early accounts discovered in the ancient texts of the Mesopotamians (second-millennium B.C.E). This was a time when mental illnesses were commonly attributed to demonic possession and the main solution was to be recommended to priests for treatment.
Different cultures around the world held fast to this idea that depression was caused by being possessed by evil spirits and demons. Some of the identified cultures that held this belief include the ancient Greeks, Romans, Chinese, Babylonians, and Egyptians. Some cultures tended to inflict inhumane or corporal punishment such as beating, starvation, and physical restraint to exorcise the demons or spirits they believed caused the depression.
There were some medical practitioners (ancient Roman and Greek doctors) during this period that clearly understood that the root cause of depression could be attributed to psychological and biological illness. Their ideas prompted them to effectively utilize some treatment options including massage, baths, gymnastics, music, diet, and medication (with the composition of donkey's milk and poppy extract) for their patients.
What's Depression in Ancient Greek and Roman philosophy?
Although there were numerous individuals before the Common Era that strongly believed that depression and other mental ailments were caused by the anger of the gods or demonic possessions, there were several brilliant minds that believed that they were caused by mental and physical factors.
In ancient Greek history, there was a physician named Hippocrates who claimed that an imbalance in the humours (the four body fluids including blood, yellow bile, phlegm, and black bile) caused melancholia (depression). He explained specifically that when the spleen contained too much black bile, it could result in melancholia. Hippocrates' recommendation of treatment options included diet, exercise, baths, and bloodletting.
Contrary to Hippocrates' idea about melancholia, Cicero (a Roman philosopher and statesman) explained that the cause of melancholia can be attributed to some psychological risk factors including grief, fear, and rage.
What's Depression in the Common Era (CE)?
The Common Era, in the Gregorian calendar, it begins with year 1.
The inhumane treatment options for "melancholia" during the ancient times were also adopted during the Common Era. Aulus Cornelius Celsus, a Roman encyclopedist and medical doctor known for the medical work “De Medicina"(26 BCE–50 CE), also recommended brutal methods of treatment such as shackles, beating, and starvation for mental ailment.
On the contrary, Abu Bakr Mohammad Ibn Zakariya al-Razi, a Persian physician, philosopher, alchemist, and polymath (854 –925CE) explained that mental illness emanated from the human brain. The treatment options he recommended included an early form of behavior therapy and baths.
What's Depression During the Middle Ages?
During this period, different forms of religion, specifically Christianity, reestablished the belief system in Europe that mental illness was caused by witches, demons, or the devil. Based on this, specific forms of treatment were adopted which included drowning, burning, and exorcism (in fact, many individuals were kept in "lunatic asylums"). Nonetheless, there was a small minority of 'physicians" who believed that mental illness can be attributed to physical and psychological causes such as poor diet, imbalanced bodily humor, and grief.
What's Depression During the Renaissance?
The Renaissance can be traced back to the 14th century in Italy, which then later found its way into Europe in the 1500s and 1600s. It was a period in Europe when mentally ill individuals were witch-hunted and executed. However, some doctors supported the medical theory of Hippocrates that mental illness should be attributed to the natural cause rather than spiritual, and humane medical treatment approaches should be used.
Robert Burton in 1621 published the book "Anatomy of Melancholy". In this book, he outlined the psychological and social causes of depression including fear, poverty, and social isolation. In his book he listed some options of treatments for depression including diet, travel, exercise, marriage, purgatives, distraction, herbs, bloodletting, and music therapy.
What's Depression during the Age of Enlightenment?
This was a period when it was believed that depression was an unchangeable weakness of temperament (irrational thinking) that was inherited. During this time, individuals suffering from depression were avoided or incarcerated. Consequently, a lot of people with mental challenges became poor and lost their homes, and some were committed to facilities intended to house the mentally ill.
Towards the end of the Age of Enlightenment, a suggestion was made by doctors on the idea that the root cause of depression is aggression. This led to the recommendations of exercise, music, diet, and drugs as treatment options, and also that it's pertinent for depressed people to discuss their problems with their loved ones or doctors.
Furthermore, there were some doctors during this period that understood depression as a condition triggered by internal conflicts between what you might want and what you believe to be right. There were others who researched its physical causes.
The treatment methods adopted during the Age of Enlightenment were water immersion and the use of spinning stool to reset the brain contents back to where they belong. Other treatments included vomiting, enemas, diet changes, horseback riding, and electroshock therapy.
What's Depression in the 19th and 20th Centuries?
These centuries witnessed incredible development in different aspects of life of which mental health was not an exception. In the late 1800s, Emil Kraepelin, a German psychiatrist, was recognized as the first person to distinguish manic depression (bipolar disorder) from dementia praecox (schizophrenia). In the 19th and 20thcenturies, different theories were developed such as psychodynamic and psychoanalytic theories. These theories birthed several empirical explanations including the following:
- Psychoanalytic Explanations: One notable person who gave psychoanalytic explanations to depression was Sigmund Freud, an Austrian neurologist and the founder of psychoanalysis (1856-1939). He explained depression as a response to a loss such as death or failure which could result in self-destructive behavior and self-hatred. From his standpoint, psychoanalysis could help overcome these conditions. However, some other doctors saw melancholia as a brain disorder.
- Behavioral Explanations: Here, behaviorists saw depression as a behavior that could be learned through experience and not a mental illness caused by unconscious forces. Because of this, they believed that if depressive behaviors can be learned, it can also be unlearned. Also, behaviorists saw the principles of learning such as reinforcement and association as methods through which more effective and healthier behaviors can be established and strengthened. However, psychologists, today discovered that experience is not the only factor that determines behavior.
- Cognitive Explanations: Different theories of depression associated with cognition began to develop in the 1960s and 1970s. Aaron T. Beck, an American Psychiatrist and a professor emeritus (department of psychiatry, University of Pennsylvania) who is recognized as the father of cognitive-behavioral therapy (CBT) and cognitive therapy proposed that people's way of negative interpretation of events could contribute to depressive symptoms. In addition, Martin Seligman, a psychologist, suggested that one of those factors that could contribute to the development of depression is learned helplessness. This theory centers on the fact that people usually relent doing something to change their situation because they feel their efforts will not count. Consequently, it makes them feel hopeless and helpless.
- Biological and Medical Explanations: Here, the focus is placed on factors such as genetics, hormones, brain chemistry, and brain anatomy. From studies, it's claimed that the biological explanations paved way for the development of antidepressants and how they are increasingly used in the treatment of depression. In addition, the medical explanations (medical model of mental disorders) which emerged in the 1970s suggested that physical factors are responsible for all mental disorders. So, as physical illnesses can be treated with medication, mental health conditions can as well be treated in such a way.
What are the Treatment Options for Depression in the 19th and 20th Centuries?
Different forms of treatments emerged during the 19th and 20th centuries. Some of these included;
- Lobotomies: A surgery to destroy the prefrontal lobe of the brain. It helped patients appear calm. However, it led to a loss of decision-making ability, personality changes, poor judgment, and even death.
- Electroconvulsive therapy (ECT):A seizure can be induced by applying an electric shock to the scalp.
- The use of isoniazid: A tuberculosis medication was seen to be potent enough to deal with depression.
- Drug therapies: The use of antidepressants to treat depression. Some of these drugs include Tofranil (imipramine) and tricyclic antidepressants (TCAs). Others include Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine) that emerged in 1987, 1991, and 1992 respectively. They are otherwise called selective serotonin reuptake inhibitors (SSRIs).
Thereafter, newer antidepressants, such as atypical antidepressants namely trintellix (vortioxetine), Wellbutrin (bupropion), and serotonin-norepinephrine reuptake inhibitors (SNRIs), emerged.
What's Depression Today?
Today, depression is well-recognized and observed as a common and serious mental illness that can interfere with your daily activities. It's a mental health condition that warrants a visit with your doctor or therapist. This depression test can help you identify symptoms that you may be having.
In 1980, major depressive disorder (MDD) was included in DSM-III after it was first introduced in the 70s by clinicians in the US. Today, much clearer views have been given about depression. Researchers now claim that different factors such as social, psychological, and biological are responsible for depression. Nonetheless, ongoing research is necessary to have a better understanding of both causes and treatments for depression.