Monday, July 15, 2013

A Short History of Depression

We've discussed Depression from a number of different angles, but we've yet to discover its history. Not so much where did it come from. One may be sure that mental illness generally has been a thorn in the side of humanity ever since man first set foot on earth, and even animals are diagnosed with the condition.

But who first became aware of it? Homer's 'Iliad' gives us a glimpse, when Ajax rescues Achilles, only to see Achilles' armour given away to Odysseus. He flies into a terrible rage and slaughters a flock of sheep in the belief that they're the enemy. After coming to his senses, he's so overcome with shame, that he kills himself.

Here, though, we see a mental disorder directly attributable to two outside acts. The armour he considers that he's won is given away to another, which infuriates him to the point where he becomes unbalanced. Then he has a go at the poor old sheep, at which time he's probably hallucinating. When sanity re-visits him, the shame he feels forces him into suicide.

A different time, different situation to that which we're used, but the outcome's the same. A psychotic outburst, the likes of which we've seen down the centuries to the present day.

Hippocrates, in 400 B.C.E. used the names 'Mania' and 'Melancholia' to describe certain conditions of the mind that he noticed himself. Aulus Cornelius Celsus, in 30 C.E., wrote his treatise "De Re Medicana," in which he described melancholia and even mentioned depression. He was of the opinion that it was caused by black bile.

The next landmark hypothesis seems to have been put forward by Maimonides in the twelfth century. Among many other accomplishments, he was a Jewish physician who was the first to see the possibility that Melancholia was a discrete disease entity, in other words rather than seeing pain as the direct result of trauma or physical injury, he considered that it fundamentally changed the entire nervous system.

As we've seen with Celsus and his black bile theory, depression and similar mental disorders were considered physical in origin, so Maimonides certainly took a step in the right direction.

It seems that the diagnostic wheels of mental illness ground slow indeed, for it wasn't until 1686 that a doctor named Bonet described an illness he named Maniaco Melancholicus, and two hundred years after that, the doctor Jules Falret called the condition of alternating moods of mania and depression, 'folie circulaire.'

However, in 1899, the German psychiatrist, Emil Kraepelin, explained the illness as 'manic - depressive psychosis.' He freely admitted that he'd stood on the shoulders of the doctors who'd gone before him. The methods and criteria he used for his diagnosis of the condition are very similar to those used today.

He was born on the 15th. February 1856 and died on the 7th. October 1926. He considered psychiatric illness to be both a biological and genetic problem. He's the first to have divided psychosis into two forms; Manic Depression, which we know now as being both major depression and bi-polar disorder, and Dementia Praecox. It should be pointed out, though, that Arnold Pick first used this Latin description in 1891.

However, in 1896, Kraeplin first brought the illness to the attention of the public when he gave a detailed description of it. The condition is now known to us as Schizophrenia. When you look back over the centuries that have gone before, and consider the suffering endured by so many people who had no idea what was wrong with them, any more than did the doctors, it makes you very glad to live in the twenty first century, warts and all

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