What Is the History of Depression?

The history of depression is a long one. Throughout history, people have observed depression, experienced it, and tried to understand and treat it. The symptoms of depression were first described about 2500 years ago, and humans have been grappling with the concept ever since. The quest for understanding depression has been well-meaning but at times horribly misguided.

For insights into how we have understood and misunderstood this illness, here’s a glimpse into the history of depression in the Western world.

The History of Depression and How People Have Understood It

Despite depression’s long history, there are only three main ways in which people have conceptualized it.  At various times, we humans have seen depression as  

• Spiritual, rooted in demonic possessions, demonic forces, or punishment from the gods
• Biological/physical, marked by problems in the human body or brain
• Mental, involving psychological struggles

Originally, depression was called melancholia. It was Hippocrates—the ancient Greek father of medicine—who coined the term.  

Hippocrates had a decent understanding of this condition. He believed that having symptoms doesn’t mean that someone has melancholia but that symptoms must be disruptive and have lasted long enough to cause a significant problem.  These criteria are included in our modern depression diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) published by the American Psychiatric Association.

Hippocrates also knew that depression has a physical component. He was a bit off, though, in where or how depression was connected to the systems of the body. He identified four body fluids—yellow bile, black bile, blood, and phlegm—and implicated too much black bile in the spleen as a cause of melancholia.

The attitude toward melancholia was similar throughout ancient Greek and Roman histories. People largely took a scientific approach and understood it to be a physical illness that could be treated. When the Roman Empire collapsed, though, humanity plunged into (figurative) darkness and became superstitious and fearful. The understanding of depression fell to superstition and fear as well. While a small number of doctors continued to seek physical causes, most of society saw depression as something sinister and those who had it possessed by evil.  

As Europe began to emerge from the darkness, understanding of melancholia once again turned to the more scientific realm. In 1621, a man by the name of Robert Burton published a book about depression (The Anatomy of Melancholy), and he introduced the idea that melancholia has a physical, social and psychological basis.

From the 18th century through today, people have conceptualized depression in ways positive and negative, often at the same time by different groups of people. Depression, which has been the term since it replaced “melancholia” in the 19th century, has been viewed as a(n):

• Character weakness
• Result of repressed aggression and anger
• Internal conflicts between desire and morality
• Disease-based medical, biological disorder
• Psychological issue, originating in the mind
• Brain disorder
• Learned behavior
• Cognitive problem (thoughts)
• Result of learned helplessness
• Socially rooted problem

The way people have thought about depression throughout history affected the way they treated depression and those living with it.

Depression History: Treatment Through the Ages

During those periods of history when depression was associated with witchcraft, demonic possessions, and the devil, people with symptoms were treated cruelly. Many lost their lives during “treatment,” and others were locked away for life in asylums. Examples of what was done to cure people of their depression include:

• Beatings
• Restraining
• Starvation
• Exorcisms
• Drowning or near-drowning with water immersion
• Burnings at the stake
• Shunning

People with depression weren’t always treated badly, at least not on purpose. In Greco-Roman times, bloodletting was common to release bad humors (liquids). This was unpleasant but not punitive. Other ways someone might have been treated for depression in the ancient world:

• Exercise
• Diet
• Music therapy
• Massage
• Time in a bathhouse
• Medication with poppy extract (an opiate)

After the Dark Ages through the 19th century, depression treatment was like treatment in ancient times but with some new additions:

• Use of enemas or vomiting to purge toxins from the body
• Spinning rapidly on a stool to reset the brain
• Medication
• Herbs
• Psychotherapy
• Electric shock therapy

By the 20th century, treatment of depression began to improve, but it started out horribly with a procedure known as the lobotomy in which the neural connections in the brain’s frontal lobe are severed from the rest of the brain. Other treatments were and still are better. Medications target activity in the brain associated with depression. Many forms of therapy exist to address all aspects of depression: cognitive, behavioral, emotional, social, and more.

Thanks to our awareness of the history of depression, we can grow in the right direction as we continue to study and refine our knowledge of depression. One of the most valuable lessons is that depression is complex and not a weakness. When people in the future study our understanding of depression, may they see accuracy and compassion.

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