From Melancholia to Depression: Disordered Mood in Nineteenth-Century Psychiatry.

My book From Melancholia to Depression: Disordered Mood in Nineteenth-Century Psychiatry charts how melancholia was reconceptualized in the nineteenth century as a modern mood disorder and a precursor to clinical depression. The book shows how this occurred chiefly in two ways. First, the idea of disordered mood as a medical concept was created through the appropriation of language from experimental physiology into the realm of psychopathology. Second, the interplay of statistical and diagnostic practices formed the basis for modern psychiatric classification and facilitated the standardization of melancholia as a psychiatric diagnosis. These developments were key to the reconceptualization of melancholia and the subsequent emergence of clinical depression, and were foundational to modern psychiatric theory and practice.

The Origin of Our Modern Concept of Depression-The History of Melancholia From 1780-1880: A Review.

The modern concept of depression arose from earlier diagnostic formulations of melancholia over the hundred years from the 1780s to the 1880s. In this historical sketch, this evolution is traced from the writings of 12 authors outlining the central roles played by the concepts of faculty psychology and understandability. Five of the authors, writing from 1780 through the 1830s, including Cullen, Pinel, and Esquirol, defined melancholia as a disorder of intellect or judgment, a "partial insanity" often, but not always, associated with sadness. Two texts from the 1850s by Guislain, and Bucknill and Tuke were at the transition between paradigms. Both emphasized a neglected disorder-melancholia without delusions-arguing that it reflected a primary disorder of mood-not of intellect. In the final phase in the 1860s to 1880s, 5 authors (Griesinger, Sankey, Maudsley, Krafft-Ebing, and Kraepelin) all confronted the problem of the cause of delusional melancholia. Each author concluded that melancholia was a primary mood disorder and argued that the delusions emerged understandably from the abnormal mood. In this 100-year period, the explanation of delusional melancholia in faculty psychology terms reversed itself from an intellect to mood to a mood to intellect model. The great nosologists of the 19th century are often seen as creating our psychiatric disorders using a simple inductive process, clustering the symptoms, signs, and later the course of the patients. This history suggests 2 complexities to this narrative. First, in addition to bottom-up clinical studies, these nosologists were working top-down from theories of faculty psychology proposed by 18th century philosophers. Second, for patient groups experiencing disorders of multiple faculties, the nosologists used judgments about understandability to assign primary causal roles. This historical model suggests that the pathway from patient observation to the nosologic categories-the conceptual birth of our diagnostic categories-has been more complex than is often realized.

Wild melancholy. On the historical plausibility of a black bile theory of blood madness, or hæmatomania.

Nineteenth-century art historian John Addington Symonds coined the term hæmatomania (blood madness) for the extremely bloodthirsty behaviour of a number of disturbed rulers like Ibrahim II of Ifriqiya (850-902) and Ezzelino da Romano (1194-1259). According to Symonds, this mental pathology was linked to melancholy and caused by an excess of black bile. I explore the historical credibility of this theory of 'wild melancholy', a type of melancholia that crucially deviates from the lethargic main type. I conclude that in its pure form Symonds' black bile theory of hæmatomania was never a broadly supported perspective, but can be traced back to the nosology of the ninth-century physician Ishaq ibn Imran, who practised at the Aghlabid court, to which the sadistic Ibrahim II belonged.

[The melancholy of the philosopher in the Intercenales (1424-1439)]. / Los síntomas melancólicos del filósofo en las Intercenales (1424-1439) de Leon Battista Alberti.

This essay analyzes the presence of the modern concept of melancholy in the Intercenales (1424-1439) by the humanist Leon Battista Alberti. The Intercenales is a collection of satirical, allegorical and moralizing writings composed with the purpose of entertaining an audience of close friends. In spite of the fact that the term "melancholia" does not appear in the text, this paper argues that Alberti's character of "the philosopher" is melancholic, since he is "ill in the soul" (suffering from morbus animi), and his illness is evidenced by a series of physical and psychological symptoms associated with melancholy in the classical and medieval medical traditions. These symptoms are stomach pain, pallor, insomnia, a rich memory, a propensity to study at night, and an ability to have premonitory dreams. With this characterization Alberti promotes a connection between melancholy and being a genius, which is distinctive to the Renaissance and the basis for the modern concept of melancholy. The essay concludes that the ultimate purpose of the Intercenales is to cure, from a literary and philosophical point of view, the illness of the melancholic philosopher.

Los síntomas melancólicos del filósofo en las Intercenales (1424-1439) de Leon Battista Alberti / The melancholy of the philosopher in the Intercenales (1424-1439)

This essay analyzes the presence of the modern concept of melancholy in the Intercenales (1424-1439) by the humanist Leon Battista Alberti. The Intercenales is a collection of satirical, allegorical and moralizing writings composed with the purpose of entertaining an audience of close friends. In spite of the fact that the term "melancholia" does not appear in the text, this paper argues that Alberti's character of "the philosopher" is melancholic, since he is "ill in the soul" (suffering from morbus animi), and his illness is evidenced by a series of physical and psychological symptoms associated with melancholy in the classical and medieval medical traditions. These symptoms are stomach pain, pallor, insomnia, a rich memory, a propensity to study at night, and an ability to have premonitory dreams. With this characterization Alberti promotes a connection between melancholy and being a genius, which is distinctive to the Renaissance and the basis for the modern concept of melancholy. The essay concludes that the ultimate purpose of the Intercenales is to cure, from a literary and philosophical point of view, the illness of the melancholic philosopher.

Towards Modern Depressive Disorder: Professional Understanding of Depression in Interwar Britain.

This article examines the way in which British psychiatrists defined, categorized, and applied depression in the period between the two World Wars. To analyze the professional understanding and application of the notion, various expert literatures will be analyzed, such as textbooks, medical journals, and medical documents kept in daily practice. Through the analysis, this article suggests that in the interwar decades, the status of depression as a distinct mental disorder was far from established in terms of its definition, terminology, and classification, although the disorder had already become the most prevalent mental illness by the turn of the century. Also, this article argues that the early twentieth century should be recognized as a part of the long evolution through which depression achieves its modernity, beginning in the early twentieth century and ending in the post-war era. Such findings about a specific psychiatric diagnosis can be applied to the explanation of contemporary psychiatry. At least before the Second World War, British psychiatry had not yet entered into its modern phase and was still under the strong influence of the Victorian medical tradition. Thus, this article claims that in order to understand British psychiatry and its characteristics against this historical background, continuity should be stressed rather than modernity.

A circular depression at the spinoglenoid notch of a prehistoric Andean scapula: Plausible evidence of suprascapular nerve entrapment by a paralabral cyst.

While intraosseous cysts have been described in the paleopathological literature, it is rare to find reports concerning effects of soft tissue cysts, although they are relatively common in clinical contexts. Here we present plausible evidence of an extraosseous paralabral cyst, seen in an adult scapula from a Late Intermediate period commingled tomb (ca. AD 1200) at the northern highland site of Marcajirca, Ancash, Peru. The scapula demonstrated a smooth-sided concave depression at the spinoglenoid notch. The depression was notable for its regular appearance, with no bone deposition or destruction. Rather than reflect an intraosseous pathology, the defect likely resulted from pressure erosion from a space-occupying mass. A narrow strip of flattened bone connected the depression to the posterior-superior aspect of the glenoid. The location and morphology of the depression and its connection with the glenoid are consistent with the effects of a paralabral cyst that arose secondary to a tear of the posterior-superior glenoid labrum. A labral tear may act as a one-way valve permitting fluid to flow along a path of least resistance, often to the spinoglenoid notch. A cyst at the spinoglenoid notch would compress the suprascapular nerve, causing weakened function of infraspinatus and its eventual atrophy.

The conundrum of depression clinical trials: one size does not fit all.

In this paper we review the history of antidepressant (AD) development, since the discovery of imipramine in 1957 to the present day. Through this exploration we will show that the increasing placebo response is likely a red herring and that a higher magnitude of placebo response is not an adequate explanation for AD trials' high failure rates. As a better explanation for their lack of success, we will examine some of the fundamental flaws of AD clinical trials and their origins in historical forces. We focus on underpowering, which occurs as a consequence of unrealistic expectations for AD performance. In addition, we describe the lack of precision in the depression outcome measurements for the past 40 years and show how these measures contrast with those used in clinical trials of other chronic diseases, which use simpler outcome measures. Finally, we describe the role of regulatory agencies in influencing clinical trial design and how the assumption that 'one size fits all' for the past 60 years has led to flawed design of AD clinical trials.

De la bilis negra a la escolástica: la Celestina como arquetipo de la melancolía maléfica en el Siglo de Oro / From dark humor to scholastic: Celestine as archetype of malefic melancholy in Spanish Golden Age

La tensión dialéctica entre cuerpo y espíritu, derivada de su propia naturaleza dual, ha articulado el discurso de la Melancolía desde sus orígenes. Como resultado encontramos distintos arquetipos bioculturales de melancolía, nacidos de la urdimbre secular entre el empirismo y las creencias del imaginario colectivo de cada sociedad. El análisis de los rasgos psicológicos y la fisonomía de la Celestina, entendida como la representación literaria de la melancolía maléfica, nos permite reconstruir el itinerario de interrelaciones entre humoralismo y escolástica medieval que moldearon esta particular "encarnación" de la misma

Dialectical tension between body and mind have articulated the discourse of melancholy since its origin. As result melancholic archetypes are the result of secular conjunction between empirical and faith-based beliefs on contemporary collective subconscious. The analysis of Celestine spiritual and physical aspects, read as a literary representation of malefic melancholy, allow us to recover the underlying interweave between humoralism and mediaeval scholastic that shaped this specific melancholic 'embodiment'

[Indian 'humor' in medical knowledge during the 16th and 17th centuries]. / El 'humor' de los indios en el saber médico de los siglos XVI-XVII.

During the first Modern Era (15th-17th c.), bodily health and expressions of physiognomy were explained under the doctrine of humors. This doctrine -based on Corpus Hipocraticum-established a close relation between humors (blood, yellow bile, phlegm, and black bile), qualities (dry, moist, warm, and cold) and the elements (water, air, earth, and fire). One of these humors -black bile-, commonly a hallmark of the melancholic temperament, was associated to the complexion and nature of American Indians. This accusation was legitimized by the empirical examination of the physiognomy of a subject that was melancholic, sad and pusillanimous. In this article, we describe, based on the analysis of colonial texts (16th-17th c.), how the essential premises of the humor theory were transferred to the New World and in particular and how the Indian complexion was defined through the examination of subjects plagued by black humor and phlegm. With this, we determine the way these individuals -referred as 'Indians'- were inscribed in medical knowledge, during the global spread of the Hippocratic-Galenic postulates.

El 'humor' de los indios en el saber médico de los siglos XVI-XVII / Indian 'humor' in medical knowledge during the 16th and 17th centuries

During the first Modern Era (15th-17th c.), bodily health and expressions of physiognomy were explained under the doctrine of humors. This doctrine -based on Corpus Hipocraticum-established a close relation between humors (blood, yellow bile, phlegm, and black bile), qualities (dry, moist, warm, and cold) and the elements (water, air, earth, and fire). One of these humors -black bile-, commonly a hallmark of the melancholic temperament, was associated to the complexion and nature of American Indians. This accusation was legitimized by the empirical examination of the physiognomy of a subject that was melancholic, sad and pusillanimous. In this article, we describe, based on the analysis of colonial texts (16th-17th c.), how the essential premises of the humor theory were transferred to the New World and in particular and how the Indian complexion was defined through the examination of subjects plagued by black humor and phlegm. With this, we determine the way these individuals -referred as 'Indians'- were inscribed in medical knowledge, during the global spread of the Hippocratic-Galenic postulates.

As melancolias e as depressões: o biopoder, as produções de sentido e de discursos / The melancholy and depressions: biopower, the meaning productions and speeches

O objetivo deste estudo é o de apresentar as produções de sentidos das melancolias edepressões, a partir de um breve histórico dos estudos psicanalíticos de Fédida (2009), Dunker(2015), Kehl (2009), entre outros. Para isso, partiu-se dos conceitos de história, discurso, construçãosocial de sentido e vontade de verdade, propostos por Foucault (1979; 1995). Para fundamentara leitura sobre o entendimento do que seria a depressão na atualidade, foi realizado umlevantamento sobre o deslocamento semântico do termo, as ideologias permeadas pelos diagnósticose medicalizações em excesso, assim como o contexto histórico-social da hipermodernidade, o qual circunscreve e nomeia alguns de seus sujeitos sociais como deprimidos

I Want to Believe: A Short Psychobiography of Mary Baker Eddy.

The 18th and 19th centuries were beset with new religious movements in the United States: Shakers, Latter Day Saints, Millerites, and Seventh Day Adventists to name a few. One group, Christian Science, held radically different views than their counterparts and their origins lay in the most unlikely of places, a perpetually ill and poor woman from New Hampshire. Much has been said about Mary Baker Eddy: some say that she was a prophet, others that she was a fraud. Herein no such judgments are made. This study seeks to look into the life of Mary Baker Eddy from a psychological lens in the hopes that insight can be gained into the founding of the First Church of Jesus Christ Scientist and perhaps to allay the binary of Mrs. Eddy as either prophet or fanatic.

[Müller-Hegemann's classification of depressions of 1964 as a proposal for a conceptualization of affective disorders: A critical review]. / Müller-Hegemanns Systematik der Depressionen von 1964 als Vorschlag zur Konzeptualisierung der affektiven Störungen. Eine kritische Analyse.

Against the background of current discussions on the classification of psychiatric disorders, this study analyses and discusses the East-German psychiatrist Dietfried Müller-Hegemann's concept of a clinical classification of depressions of 1964.In his paper, Müller-Hegemann differentiated between two main forms of depression, namely the "vitally tinged depression" (= melancholy), found mainly in the depressive phases of the manic-depressive disorder, and the "depressive disgruntlement" (= dysthymia) seen in "reactive and neurotic depression", "involutional depression", and in the depressive states in psychopathic personalities. Due to a lack of sufficient biological evidence, Müller-Hegemann refrained from a purely etiological differentiation.His proposal is significant in so far as it provided a classification that could easily be used in clinical practice, and at the same time, by pointing to the traditional concept of melancholy and by calling for a differentiated psychopathology, anticipated aspects of topical interest.

[The nosological evolution of bipolar affective disorder]. / A bipoláris affektív zavar nozológiai fejlodése.

The nosological improvement of the bipolar disorder (manic-depression) follow the written history of psychiatry. The symptoms of manic and depressive episodes and mixed states were described in the ancient times. In my summary I accompany the taxonomic improvement, the changing of diagnostic categories and the work of the most important researchers from the beginning to these days.