The History of Depression - Time to Prepare

The term “depression” has been around since the early 1800s, but it did not come into use until 1885. This paper will discuss how depression became a part of our vocabulary and what events led to its popularization during that time period.

This series of articles is now available as a professionally designed, distraction-free ebook that you can read at your leisure while offline. To purchase, go to this link.

Do you have a history of depression? Isn’t sadness simply a fact of life, like cancer? You can’t truly write a history of cancer; you may write about how it was treated or diagnosed, but not a history of the illness itself. Isn’t it simply that?

In the West, depression is usually thought of as a biological condition similar to any other medical ailment (and how we came to this conclusion is what we’ll look at today!). The analogy is appealing because it reduces the stigma associated with mental illness; just as you wouldn’t feel terrible about treating a tumor on your spleen, you shouldn’t feel awful about seeking treatment for an unseen tumor on your brain.

But, as much as we’d want it to be, mental illness in general, and depression in particular, isn’t as straightforward as we’d like. It’s a combination of hereditary and environmental factors, physical and mental health, and biological and psychological factors. It’s also both personal and cultural in nature.

This means that how we experience despair and make meaning of what’s going on in our lives is influenced not just by our inner sensations, but also by what our society tells us those feelings should imply. And that interpretation has shifted dramatically across time and space, and it continues to do so now. It’s critical to understand how and why this is the case.

Why It’s Important to Know About Depression’s History

I’ll be honest and say that, although this article is extremely intriguing (I believe! ), it is a bit dry and lengthy. You may be tempted to skip it in favor of our other articles on depression’s origins and remedies, but I hope you decide to read it nonetheless.

Learning about the cultural history of depression in the West helped me put my own experiences of despair into context. For starters, it’s reassuring to know that sadness has been a problem for humanity for thousands of years. The belief that their condition is unique and that no one understands what they’re going through is a typical cognitive bias among those who are depressed. The illusion of your depression’s uniqueness falls away when you read descriptions of Abraham Lincoln’s acute sadness or Samuel Johnson’s journal entries suffering over his dismal moods.

Furthermore, the history of depression offers a far more complex perspective on this mental and emotional condition that we now refer to as an illness. Depression was a Janus-faced disease that could be both a scourge and a godsend throughout most of Western history.

Finally, researching the history of depression reveals different schools of thought regarding the causes and treatments of depression that have existed since Ancient Greece and continue to do so now. Rather than progressing steadily, our knowledge of depression has swung back and forth throughout the ages, with various treatments and ideologies blooming and fading.

I hope that at the conclusion of this crash course in the history of depression, you’ll have a fresh perspective on the subject. It will also serve as a springboard for future investigation into how to control the black dog in our own life.

Let’s get this party started.

Greece and Rome in Antiquity

Ancient Greece provided some of the first records of what we now call depression, and what was then known as melancholia. A vase from 400 BC portrays a depressed and gloomy Orestes taking part in a purification procedure to rid himself of the Furies – injustice-avenging ghosts — who had pursued him following his mother’s murder. Euripides portrays Orestes’ protagonist as suffering many of the classic signs of depression, including loss of food, excessive sleeping, a lack of drive to wash, continual sobbing, chronic weariness, and a feeling of powerlessness.

More descriptions of gloomy people may be found in other popular Greek literature as well. For example, Jason the Argonaut was a renowned Homeric hero who, in the face of hardship, you’d expect him to show nothing but action and resolution. His great cloak slips away as he shipwrecks off the coast of Libya, and he becomes completely helpless and gloomy.

In Hippocrates’ 4th century works, melancholia appears as an ailment in the Greeks’ more scientific books. Melancholia, according to the ancient physician, was a gloomy mood brought on by an imbalance of the body’s “humors” or fluids. The human body, according to Hippocrates, is made up of four substances: blood, yellow bile, black bile, and phlegm. Any illness or disease in the body was caused by an overabundance of one of these fluids, and the doctor’s task was to restore balance to the humors by purging, bloodletting, and/or medicine.

Depressive sadness, according to Hippocrates and other ancient Greek doctors, was produced by an excess of cold black bile in the body (hot black bile caused mania or madness). The severity of the depressed condition is proportional to the amount of chilly black bile present. A patient’s black bile had to be lowered to cure him of his ailment.

While it’s easy to mock Hippocrates’ theory, he was correct in concluding that mental illnesses, such as severe melancholia, were caused by the brain: “It is the brain that makes us mad or delirious, inspires us with dread and fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absentmindedness, and acts contrary to habit.” These symptoms arise when the brain is not in good condition and becomes unusually hot, chilly, wet, or dry.”

Depression, according to the ancient Greeks, was caused by an excess of frigid black bile (one of the fluids that make up the human body), which had both benefits and downsides. “Why are all those who have become great in philosophy, statesmanship, poetry, and the arts melancholic?” Aristotle wondered.

The fact that one may experience varied degrees of melancholy is implicit in this humor-driven approach to melancholy. Someone may have a little overabundance of black bile and suffer from moderate melancholia, or they could have a major pile-up that leads to catastrophic mental disease. The moderate version, according to Greek scholars, was associated to intellect and creativity. Aristotle claims that heroes like Lysander, Ajax, Plato, and Socrates had a moderate melancholy temperament, and that it was their blue moods that permitted them to execute great actions and ponder high ideas in Problematic 30, a book ascribed to him.

The study and treatment of melancholia was maintained by ancient Roman physicians. Galen, a Roman physician from the second century, would have a notably long-lasting impact on its treatment. Galen, like Hippocrates, thought that melancholia and other mental diseases were caused by a humoral imbalance, but he also felt that certain people are born with a temperament that predisposes them to the disease, and that medicine could do nothing to help them.

Spiritual and philosophical views competed with the humor-based, medical treatment to depression. Depression or insanity, according to Greek temple priests, was a spiritual affliction from the gods, and could only be remedied by appealing the gods for mercy. Plato, on the other hand, took a more intellectual approach to the subject. Depression, he believed, was a spiritual illness that might be treated by balancing the three aspects of a man’s psyche: reason, desire, and thumos.

The Roman Stoics developed a philosophical approach to melancholy, claiming that mental and emotional problems are produced by an erroneous appraisal of one’s experiences and circumstances. These thinkers thought that how you interpreted traumatic or stressful experiences in your mind may either increase or decrease your anxiety (and consequently your melancholia). As a result, they concluded that merely altering your cognitive picture of your situation may help you feel better.

For the following 400 years, melancholia treatments multiplied in Greece, and many of them were exhausted by the Renaissance. For ages, physicians recommended potions, prayer, philosophical thought, strolling, napping in hammocks, and drinking human breast milk to patients suffering from depression.

The Middle Ages

The ancient notion of sadness being founded in one’s disfavor with the gods was carried through into the Middle Ages, although this time the gods were those of Christianity rather than the Greek pantheon. Melancholy was a warning to clergy in Medieval Europe that someone was living a wicked life and needed to repent. Severe sadness was formerly thought to be a symptom of demonic possession. In reference to Psalm 91, John Cassian, a monk famed for his spiritual works, named melancholy the “noonday devil.” As a penance for their misdeeds, he advised melancholics to isolate themselves from family and friends and engage in arduous physical work in isolation.

Melancholy was formerly connected with laziness, which was considered a vice in the Middle Ages.

Not only was melancholy seen as an indication of wickedness, but being sad was also regarded as a sin in and of itself; the Latin name for the deadly sin of sloth, acedia, was vast in scope and embraced everything from laziness to melancholy. In fact, many of the clergy who wrote about people suffering from acedia portrayed them as being depressed. Cassian, for example, portrays a fellow “slothful” monk as follows:

“He looks around anxiously this way and that, sighing that none of the brethren have come to see him, and frequently goes in and out of his cell, and frequently gazes up at the sun, as if it were too slow in setting, and so a kind of unreasonable confusion of mind takes possession of him like some foul darkness,” says the narrator.

The slothful individual is described similarly in The Canterbury Tales, published in the 14th century, as one who is overwhelmed with despair, lack of hope, and “outrageous sadness.” This persistently depressed attitude is accompanied by sluggishness and indifference toward life, which stops the slothful person from accomplishing good deeds. Sloth becomes a sin against the Holy Spirit if it is not repented of. The relationship between melancholy and the sin of sloth, according to Andrew Solomon, author of The Noonday Demon, may have given birth to much of the stigma that still accompanies sadness today.

Renaissance

Some Renaissance philosophers felt that sadness was created by considering the disparity between human divine potential and earthly capability.

Renaissance philosophers not only drew inspiration from ancient Greece for their art and philosophy, but also for their understanding of melancholy. Instead of perceiving depression as a symptom of sin, Renaissance poets and philosophers saw it through the prism of Aristotle, seeing it as a potential trigger for brilliance and grandeur. The melancholics, according to Italian Renaissance scholar Marsilio Ficino, were such because they wanted to grasp God’s mystery and splendor but recognized they’d never be able to do so here on Earth; the gap between their lofty potential and their leaden feet drove them to despair. “As long as we are God’s ambassadors on earth, we are always tormented by homesickness for the heavenly fatherland,” Ficino said. Melancholy became a badge of pride for Renaissance Europeans, signifying depth, soulfulness, and intellectual subtlety.

Being gloomy became somewhat trendy in Renaissance Europe, according to this new (again) idea of melancholy as the source of brilliance. Aristocrats and intellectuals took great delight in characterizing themselves as gloomy, and some dedicated articles and whole volumes to the Janus-faced mental condition. For example, Robert Burton, a 15th-century English scholar and melancholy sufferer, wrote The Anatomy of Melancholy, a 1,000-page tome that examines the condition’s origins, causes, and cures. While Burton provided antidotes for sadness, he also highlighted the creative benefits that come with it.

This concept of stylish sadness has found expression in popular culture. Sullen, downcast, and melancholy characters were often included in plays as persons with deep insight into the human condition, the most renowned of whom being possibly Shakespeare’s Hamlet.

Enlightenment

Changes in attitudes about sadness accompanied the Enlightenment’s achievements in science and technology. The 18th century witnessed the emergence of steam-powered machines, which generated mechanical comparisons of how the human body and mind operated; physicians of the time considered melancholy as a malfunction of the human machine. Faulty hydraulics (blood flow) or a breakdown in the flexibility of the body’s fibers, as well as “untuned” nerves, were proposed as possible causes. It was also popular to believe that this disease might be handed on from parent to kid.

The argument that sadness was produced by the increased comforts and pleasures made attainable by industrialisation was advanced by 18th century English physician George Cheyne. Cheyne advocated a spartan vegetarian diet to offset the deleterious consequences of this increasing opulence (though he himself had a hard time abiding by it; the man loved to eat meat). Other philosophers and scientists agreed with Cheyne’s idea, and it was especially popular among the aristocracy, who found luxury to be both pleasurable and inconvenient. “Melancholy, dejection, despair, and even self-murder are the consequences of the dismal perspective we take of things in this relaxed condition of body,” Edmund Burke wrote. Exercise or labor is the greatest cure for all of these ills.” A melancholy himself, Samuel Johnson felt that harsh, country living created healthy and emotionally strong individuals, but city life drained their resistance and rendered them subject to despair.

Philosophers and scientists of the Enlightenment praised reason and scorned sadness as a result of illogical thought.

The reliance on reason during the Enlightenment led to another key shift in the West’s understanding of sadness. The rational was treasured by Enlightenment philosophers, who scorned the gloomy attitude as anything but; like the Stoics, they regarded the condition as the product of incorrect reasoning. Depression was not a source of creativity, as some Renaissance thinkers believed, but rather a senseless craziness.

Romanticism

Just when it appeared that a concept of melancholy as entirely negative had taken hold of Western civilization, the Romantics resurrected the notion that gloomy emotions were fertile ground for creative genius and insightful wisdom in the first half of the nineteenth century.

In what Emerson named “The Age of Introversion,” gloomy temperament was seen as one of multiple inborn personalities, each with its own set of benefits and downsides. The melancholy temperament was “marked by not just gloominess, asceticism, and misanthropy, but also intense contemplation, tenacity, and enormous force of action,” according to Joshua Wolf Shenk in Lincoln’s Melancholy. It was admired—even glorified—to be solemn and sensitive, to feel profoundly the anguish and sweat of the human soul.” Lincoln’s own severe, lifelong melancholy (he declared himself “the most miserable man living” at the age of 32) propelled him into public service and drew citizens to him “as a person” with “access to the deep channels of the soul—the waters of sadness, the bedrock of constancy, the gold of mirth,” according to Shenk. He was a guy bereft of joys who knew the tribulations of the common man.

It was therefore part of living truthfully to embrace and make the most of one’s gloomy temperament rather than combatively battling against it. Romantics believed that if it was properly harnessed, passion might lead to heroic action and, of course, creative creation. Odes to sadness and dejection were written by poets such as John Keats and Samuel Taylor Coleridge. Lord Byron referred to his gloomy moods as “a terrifying gift,” while intellectuals such as Schopenhauer and Kierkegaard found solace, if not joy, in their despair and worry. “In my tremendous sadness, I liked life, because I loved my melancholy,” wrote the latter.

Melancholy was seen by Romantics as a good mood that encouraged creativity and meditation. To produce a dismal atmosphere in themselves, they sought out bleak literature, art, and scenery.

Romantics praised emotion and intuition, believing that both might be discovered not just in pleasure, but also in probing the soul’s depths and dark corners. Reading sad poetry or walking in a desolate and dreary environment to intentionally induce a melancholy mood was thought to be a helpful practice for self-knowledge.

While melancholy-as-insight had a brief resurgence, it was short-lived. In the mid- and late-nineteenth century, advances in psychology and biology laid the groundwork for our present understanding of depression as a mental disorder that hampered, rather than aided, being one’s authentic self.

The Rise of Neurasthenia in the Victorian Era

Some Victorians believed that low emotions were caused by “neurasthenia,” a nervous system overwork caused by the fast pace of contemporary life.

By the mid-nineteenth century, psychology had established itself as a distinct area of study from biological medicine. Emerging psychiatrists thought that sadness was induced by an overworked nervous system. Many individuals reported feeling restless, sluggish, and melancholy, which American neurologist George Miller Beard ascribed to the rapid speed of industrialisation and the introduction of new technologies. He devised the word “neurasthenia” to characterize this supposedly new ailment that had developed as a result of contemporary life’s “nervous excitation.”

To prevent neurasthenia, Americans and Europeans in the mid- and late-nineteenth century were urged to regulate their “nerve power” should it be over-taxed, resulting in a breakdown into severe depression. Sufferers were advised to stay away from alcohol and meat, as well as late hours and unpleasant company. Walking and decent conversation were also recommended for maintaining one’s mentality in excellent shape.

Neurasthenic shocks and breakdowns were thought to be more common in males, especially those in white collar occupations, since they were “more exposed to multiple sources of cerebral excitation amid the stress and turmoil of the world,” according to Beard. Blue collar guys were supposed to be immune since they already did physical work on a regular basis. Male office employees were advised to limit their sexual behavior, which included masturbation (women, on the other hand, might be prescribed sexual release, administered by her physician). They were also advised not to overwork their brains in order to prevent exhausting their nerve forces, and to channel their energy in a healthy manner via physical sports and exercise.

Neurasthenia patients would sometimes seek treatment at a sanitarium, hoping that a program of fresh air, nutritious diet, and exercise would alleviate their anxiety and restore nervous system equilibrium.

In severe instances of neurasthenia, the patient would be admitted to a sanitarium and placed on a diet of wholesome foods, exercise, fresh air, and lots of enemas to restore their nerve strength. In order to earn a fast cash, snake oil salesmen created “brain and nerve” medicines to sell to persons suffering from the current ailment.

The Victorian focus on neurasthenia was part of a greater change in how people thought about depression. Until now, the illness was thought to be caused by a flaw in the mind, brain, or body. However, by the middle of the nineteenth century, it had come to be regarded as an emotional disease. While this shift in focus may look little at first glance, it is really rather substantial. Instead of the body and mind impacting emotions, or more precisely moods, this new perspective significantly transformed how physicians and psychologists handled the treatment of depression; one’s emotions were perceived as affecting the body and mind. This viewpoint would later give birth to “mood science” in the twentieth century, and had a substantial impact on current depression treatment.

With the transition to treating melancholy as a mood illness came a shift in the terminology used to describe its symptoms. “Depressed spirits” or “depressed emotions” were one of the signs of melancholy (and its closely related sister, neurasthenia) in the nineteenth century. Doctors gradually came to refer to a person suffering from melancholy as having mental or emotional sadness. While the term “depression” didn’t replace “melancholy” as a term for the mental condition until the middle of the twentieth century, the process had begun a century before.

Finally, in 1895, German psychiatrist Emil Kraepelin made substantial and long-lasting advances to mental health care by being the first to distinguish between manic depression and schizophrenia, as well as to properly classify varieties of melancholy depending on severity. He also believed that the “depressive condition” had a biological and hereditary foundation, and that curing melancholy required medical intervention.

Freudianism in the early twentieth century

Psychoanalytic therapists believed that depression and anxiety sprang from the unconscious mind, which could be controlled by talking about one’s childhood experiences and other life events.

Freud’s psychoanalytical approach to sadness competed with Kraepelin’s psychobiological approach. Sigmund Freud stated in his article “Mourning and Melancholy” that although both mourning and melancholy shared the same signs of depression, melancholy was a sad mood without a reason, or at least an unknown, unconscious cause. Allowing a person to go through the natural grieving process may help them heal from their grief without the need for assistance. Melancholy, on the other hand, needed psychoanalysis to uncover its hidden causes.

Other Freudian psychoanalysts claimed that sadness was a kind of narcissism at its foundation. Sandor Rado thought that melancholics were merely seeking praise and affection from different “love objects,” and that sadness was the consequence of that love not being returned. Melanie Klein and others argued that melancholy was caused by a mother’s rejection; the more the mother’s animosity, the greater the sadness.

Adolf Meyer bridged the gap between Sigmund Freud’s psychoanalytical concept of depression and Kraepelin’s psychobiological theory. Meyer hypothesized that early childhood events, as well as genetics, might predispose a person to depression. He also felt that a person’s prior experiences and heredity were not destiny, and that people might spend their lives in such a way that they were less prone to mental illness. He also argued that depression, rather than melancholy, should be used to define a state of severe and persistent poor mood. As a result of Meyer’s work, “depression” has become the clinical word we use today.

From the mid-twentieth century until the present day

Advances in neuroscience have offered psychiatrists and psychologists remarkable insights into how the mind functions by the middle of the twentieth century. They discovered, for example, that brain activity is made up of both chemicals and electricity, that various areas of the brain are responsible for different behaviors, and that altering these factors may affect how a person behaved and felt. With this knowledge, therapies like as electroshock therapy and lobotomies were carried out in the hopes of curing, or at the very least reducing, melancholy moods.

The introduction of formal categories to identify diverse mental diseases was another key development of the twentieth century. In 1952, psychologists and psychiatrists created the American Diagnostic and Statistical Manual of Mental Disorders to help standardize and treat mental illness as if it were a medical condition. The word melancholy was substituted with depressed response in the first version of the DSM to represent a severe low mood caused by an internal conflict or an identifiable event such as job loss or divorce.

Pharmaceutical firms discovered mood-altering medications at the same time as psychiatrists started diagnosing mental ailments. Tranquilizers were popular as a remedy for anxiety in the 1950s, and Miltown and Valium became cultural icons in mid-century America. The concept of medications being able to change undesired mental states would pave the road for their development and adoption in the treatment of depression.

However, until such pharmacological breakthroughs could be made, Freudian psychoanalysis remained the most common therapy to mental disease. If you were depressed in the 1970s, you’d go sit on the conventional psychologist’s couch and participate in talk therapy.

A rebirth of the concept that depression was not something that needed to be “treated” with medications or treatment, but was instead a true, valid component of one’s personality — a vehicle for inspiration and self-discovery – ran simultaneously throughout postwar society, at least among creative types. Mental illness was seen as a harmful anomaly that needed to be flattened into a culturally acceptable standard of normality by mid-century authors such as Sylvia Plath, Thomas Szasz, R. D. Laing, and Michel Foucault.

The introduction of mood-altering medications altered the popular perception of depression from a mental illness to a disease having biological underpinnings, similar to diabetes.

This opposing viewpoint, as well as psychoanalysis, was quickly superseded by the rise of the psychobiological approach to mental disease. Drug firms and psychologists started presenting evidence that depression was just a chemical imbalance in the brain that could be treated with specialized medications. They often compared depression to a bodily ailment such as diabetes. The issue was basic and obvious: just as a diabetic need insulin to maintain blood sugar balance, a depressed person requires medications to maintain brain balance.

Advocates for the psychoanalytical and psychobiological camps were increasingly at odds, and the argument between them became especially heated in the years leading up to the publication of the DSM-III in 1980. The DSM-III was created to enhance psychiatric diagnostic consistency and validity, as well as make it more symptom-based rather than cause-based. The Freudians were more concerned in treating the psychological origins of mental disease, while the psychobiological group claimed that medications might be used to treat the symptoms. Each party wanted the DSM to stress their point of view.

The new mental disease categories, which were established to help physicians make unambiguous diagnoses for insurance reasons, were also hotly discussed. Pharmaceutical corporations campaigned for the additional categories because they could only promote and sell treatments that addressed a particular ailment under FDA restrictions. Pharmaceutical corporations might produce and sell more medications if more illness categories were recognized. And, certainly, with the publication of the DSM-III, medicines targeting serotonin in the brain surged. Prozac was first sold in the United States in 1991, followed by Zoloft in 1992, Paxil in 1992, and Celexa in 1998. Antidepressant use in the United States has increased from roughly 2.5 million in 1980 to over 40 million presently in little over 30 years. That’s a 1500% growth in only a few years.

Psychobiologists frequently consider the final form of the DSM-III as a tremendous success for psychobiologists and a significant setback for psychoanalysts, according to psychology historians. The term “major depressive disorder” was used to distinguish it from anxiety and neurosis. A patient required to meet three criteria to be diagnosed with MDD: 1) a dysphoric mood (depressed, hopeless), 2) at least four symptoms from a list that includes hunger, tiredness, poor energy, loss of interest in usual activities, and excessive guilt, and 3) the symptoms had to endure for at least two weeks (in the original draft symptoms needed to last for a month, it was changed to two weeks without explanation). Other depression classifications, such as dysthymic disorder, which is characterized by a mild but sustained low mood, were added in addition to MDD.

The DSM established criteria for mental illnesses, allowing them to be classified and diagnosed more easily. It’s also possible that it contributed to overdiagnosis and a focus on the symptoms of depression rather than the reasons.

With the DSM-III, diagnosing depression was as simple as ticking off the prescribed criteria. Patients might now be diagnosed with depression by their family doctor (rather than a psychiatrist) and walk out with a prescription to help ease the symptoms. However, although identifying depression has grown more straightforward, it may have become too straightforward. DSM-III didn’t make a clear distinction between natural melancholy and depression, and it didn’t account for life events like divorce or job loss, which may put people in a funk. As a consequence, many individuals who may otherwise have chalked off their poor mood to “natural” melancholy started seeking therapy for depression. Despite the clearer diagnostic criteria, research has revealed that clinicians in experimental settings still come to varied judgments about how to identify a patient (in which doctors are given a hypothetical list of symptoms and asked to reach a diagnosis).

In the end, although the medicalization of depression served to alleviate some of the stigma associated with the “black dog,” it may have unwittingly pathologized normal feelings and behavior, putting millions of Americans on medications they didn’t need. (We’ll discuss more in-depth regarding the usefulness of anti-depressants in our previous piece on various therapies for depression; short answer: it helps for some individuals, but not everyone.)

New types of treatment emerged at the same time as the development of medications to treat depression. The new ideas appearing in the late twentieth century were more brief and focused toward instant outcomes, rather than the more drawn-out and abstract psychoanalytical approach that frequently took years. Aaron Beck, a psychiatrist at the University of Pennsylvania, established the most well-known innovative treatment in the 1960s. This kind of talk therapy, known as cognitive behavioral therapy (CBT), is based on the idea that depression is caused by erroneous, negative cognitions. CBT’s purpose is to assist the depressed person in challenging their incorrect ideas and replacing them with ones that are more in touch with reality. Despite the fact that CBT and other talk treatments have acquired public recognition, few Americans suffering from depression seek them out since they are time and money consuming. Drugs are just more handy and efficient for many individuals.

By adding grades to the DSM-IV, which was issued in 2000, a few adjustments in the diagnosis of depression were made. As a result, if a person only exhibits two of the four signs of severe depression, they may be labeled with moderate depressive disorder. It further said that a person who was experiencing poor mood as a result of the death of a loved one would not be diagnosed with MDD. The DSM-V, which was released in 2013, attempted some re-categorizing to assist limit probable over-diagnosis of depression, but opponents believe it fell short of that aim for a number of reasons. To begin with, the bereavement exception was eliminated, allowing those who are mourning the death of a loved one to be labeled as clinically depressed (the idea of also including grief as a mental disorder in and of itself was suggested and debated, but ultimately not included). Dysthymic disorder (low-grade, long-term depression) was reclassified as prescient depressive disorder in the DSM-V.

And that’s where we’re at right now.

Conclusion

As our barnstorm through the history of depression in the West shows, society’s perceptions of its nature and treatment have shifted back and forth like a pendulum throughout time. Humors that used to be balancing humors are now balancing neurotransmitters. Stoicism’s proper thinking has evolved into cognitive behavioral therapy’s right thinking. The use of depression as a vehicle for understanding the human condition has waxed and waned, but it is currently back in vogue. Our knowledge of depression has never been consistent, clear, or progressed in a linear manner.

This isn’t to say that depression is a cultural construct; rather, how a society interprets and treats depression is influenced by culture. This is supported by research on the prevalence of depression in various regions of the globe. “Only 1% of the population in Taiwan can be diagnosed with major depressive disorder [using the standards set by DSM-IV], that is, having had a major depressive episode at some point in life,” writes academic psychiatrist Nassir Ghaemi in his book On the subject of depression. “Nearly 20% of the population in Paris meets that definition.” Iran has roughly 1%, the United States has about 5%, and Canada has about 10%.” This gap is startling in and of itself, especially when you consider that other mental diseases, such as schizophrenia and bipolar disorder, affect 1% of the population worldwide.

Furthermore, depression rates in the United States have risen considerably during the previous century. By the age of 75, just 1% of Americans had had a serious depressive episode in 1905. By the age of 24, 6% of people in 1955 had undergone a serious depressive episode. According to some estimates, 10% of the adult population in the United States, or roughly 30 million individuals, suffers from depression at some time throughout the year. While there are various plausible causes for this increase in depression (which we’ll discuss in more detail in the next piece), our culture’s shifting attitude about the illness (and sad emotions in general) is undoubtedly one of them. Is increased understanding of depression allowing more individuals to get treatment that they would not have received 100 years ago? Is it just me, or is contemporary life depressing? Is it just that our culture’s focus on happiness and extroversion makes individuals believe they’re clinically sad if they’re not delightfully euphoric all of the time?

The basic conclusion is that something seems to be happening on a societal level that is generating an increase in reported depression rates. That’s partially due to the fact that we’re still debating the same issues that people have been debating for thousands of years. Is depression caused by biology, psychology, or the environment? Is it possible to get rid of sadness by altering your mindset? What is the relationship between the mind, the body, and the spirit? Is depression always a terrible thing, or may it have some benefits? Is depression an essential element of one’s genuine self, a tool for discovering one’s true self, or an impediment to becoming one’s true self?

These days, we tend to choose responses that stress the biological and genetic, and we believe that sadness should be addressed and eradicated as quickly as a virus. However, even as I type this, hypotheses that have dominated the area for the last two decades are being challenged. We’d be well to remember that specialists throughout history have felt as certain in their ideas as we do in ours. Taking a medicine or conversing on a sofa to relieve sadness may sound as ridiculous as balancing one’s black bile in a thousand years.

All of this ambiguity may seem to be discouraging. It may, however, be rather freeing. It’s sad to be told there’s just one way to perceive and deal with depression, and then to attempt that technique and fail. Isn’t it preferable to have a multi-faceted approach and embrace the flexibility to experiment with what works for you rather than being bound to one road and one perspective? To let go of the notion that everything before it was incorrect, and that the way we perceive sadness now is the only way to look at it?

Because it’s not as if we don’t know anything and have been fumbling about in the dark from the dawn of time. Right thinking, physical activity, long walks, excellent conversation, tough living, medications, and even bloodletting(!) may be precisely what the doctor ordered; and the old knowledge combined with contemporary understanding may be the greatest path ahead. But aren’t we getting ahead of ourselves? For the time being, let’s put the black dog’s history behind us and prepare to move on to the current thinking about its origins next week.

Continue reading the series here:

Depression is a battle I’ve had to fight for a long time. What Are the Causes of Depression? Male Melancholy Signs and Symptoms Depression and Its Treatment

Also, listen to my podcast on the roots of depression with Dr. Jonathan Rottenberg: