In ancient times people became depressed

Free University of Berlin

From "black gall" to "empty self": the story of melancholy has been told many times

By Isabella Heuser and Sara Zeugmann

The term "melancholy" appeared as early as ancient times: Within the four-juice theory, "melancholy" denotes "black gall". The melancholic was one of the four temperament types - next to the joyful sanguine, the quick-tempered choleric and the lame phlegmatic. At that time, melancholy was used to describe a pathological sadness, mostly with fear and paralyzing inner emptiness, often associated with delusions. This discouraged-sad state of mind and mood was already attributed to physical causes back then. Modern research has also shown that the so-called melancholic depressions that we are talking about today have their causes in the changed "cross-talk" of the nerve cells and always bring with them pronounced physical complaints.

The Byzantine doctor Galenus of Pergamon, who developed approaches to a psychopathology in the 2nd century AD, was also in the tradition of the theory of temperament. He explained that the darkening of the brain by the black bile produced in the spleen was like an external darkness that made people fearful.

Referring to the ancient scholars, the Elizabethan scholar Robert Burton published the book "Anatomy of Melancholy" in 1621 under the pseudonym "Democritus junior". In it, Burton states that unfavorable planetary constellations during childbirth and melancholy parents and extreme weather made them susceptible to melancholy. Triggers are, among other things, difficult to digest food, fear, envy, selfishness and poverty. In addition to vegetative symptoms such as palpitations and tremors, he described grief and fear. Burton, who himself suffers from phases of melancholy, gives us a very clear idea of ​​how a person affected feels: "If there is hell on earth, you will find it in the heart of a melancholy person."

The melancholy turned into depression

Today we know that depression can, as a rule, be triggered by unfavorable environmental conditions such as poverty or other life circumstances that are perceived as stressful: Melancholic depression can only develop when a certain "sensitivity" of the person is present due to genetic makeup or traumatic early childhood experiences. Depression is therefore always influenced by the environment and genetically.

In 1896 the German psychiatrist Emil Kraepelin coined the term “Involutionsmelancholie”. He defined this as "all pathological, sad or anxious moods of older age, which do not represent the course of other forms of insanity." Originally, Kraepelin was referring to women in the menopause and men with age-related changes in the brain that lead to depressed mood and cognitive Losses resulted. In 1908 Kraepelin, under the influence of the studies of his pupil Georges Louis Dreyfus, rejected the concept of involutional melancholy and abolished the separation he once postulated between melancholy and manic-depressive illness ("circular insanity"). Dreyfus had accompanied Kraepelin's patient and observed that the more depressed states were often accompanied by manic symptoms.

In the subsequent psychiatric literature, melancholy is described as a serious illness with an acute onset, melancholy and comprehension disorders, psychomotor and vegetative impairments. Psychotic experiences, manic phases and suicidal thoughts are further characteristics.

In his essay "Mourning and Melancholy" from 1916, Sigmund Freud made an important contribution to differentiating between states of depressed mood. According to Freud, grief marks the loss of something known, while melancholy marks an “unknown loss”. In contrast to mourning, melancholy is characterized by a lowering of self-esteem: “The melancholic shows us one more thing that is missing in mourning, an extraordinary lowering of his sense of self, a great impoverishment of the self. With mourning the world has become poor and empty, with melancholy it is the self. "

Today the concept of melancholy has been almost entirely replaced by that of depression. Melancholy now only serves to more precisely determine the syndromes in diseases of the emotional world. In the fourth edition of the magazine "Diagnostic and Statistical Manual of Psychiatric Disorders" the melancholic subtype of depression is distinguished from other forms of development. What is meant is a form of severe depression - a disease that affects the whole person. The two most important stress systems of the organism are overactive, metabolic processes are significantly changed and sleep is deeply disturbed. The fact that many of the historical observations can be confirmed to this day is also reflected in the current diagnostic criteria of the melancholic subtype: pronounced loss of interest and joylessness, an inability to react emotionally to favorable events, early morning awakening, a clear depression in the morning, a psychomotor problem Restlessness or inhibition as well as a marked loss of appetite and weight. With regard to the treatment of depressed patients of the melancholic subtype, the best therapeutic success is achieved with a combination of behavioral therapy and medication.

Isabella Heuser is professor and director of the clinic and university outpatient department for psychiatry and psychotherapy at the Charité, Benjamin-Franklin campus. Sara Zeugmann is a research assistant.