The earliest reported accounts of what is now known today as depression come from Mesopotamia.
Second-millennium B.C.E. writings referred to depression as a spiritual rather than a physical or a mental condition. Being depressed meant being possessed by demons and evil spirits, a condition often dealt with by simple methods. Beatings and starvation were supposed to drive the demons out and provide relief to the sick soul (still depressed?).
Matters improved during the Greco-Roman period. Although many still believed that depression, like other mental illnesses, was a form of punishment inflicted by the gods, it did start to emerge as a biological and psychological illness. The 4th-century B.C.E. Greek physician Hippocrates, dubbed the father of medicine, pointed out that depression can be identified (initially referred to as “melancholia”) by the presence of the following symptoms: despondency, food aversion, insomnia, irritability, fear, low self-esteem, and anxiety (to name a few).
His observations led him to believe that what many considered a manifestation of a weak mind was in fact an illness.
Hippocrates proposed that the condition was caused by imbalanced body fluids called humours: yellow bile, black bile, phlegm, and blood. Melancholia was believed to be caused by an excess of black bile, which in turn was linked to coldness and dryness and manifested itself mainly in autumn. He also identified a contrasting condition characterized by periods of intense excitement and hyperactivity, which he argued was related to an excess of yellow bile.
‘Doctor Love’
Similarly, the 2nd-century physician Aretaeus of Cappadocia, who is considered the greatest medical scholar of Greco-Roman antiquity after Hippocrates, emphasized the cyclical nature of episodes of the condition and remarked that it may be associated with mania. However, neither physician combined the effects of both diseases to define one single disorder – bipolar disorder, formerly known as manic depression.
Aretaeus further stated that some cases might be triggered by external events such as the loss of a close person or of unrequited love, which in ancient texts was often described as one of the reasons behind suicides.
For Aristotle, suicide was the act of a weak mind, since to die for love or to avoid an “uneasiness of any kind” does not speak of the character of courage but of a “servile spirit”. Worse, he implies that one could expect suicide from a woman but not a true man, since it is proper for the “effeminate mind to fly from calamitous and laborious situations”.
Aretaeus did not dwell on the subject. Instead he prescribed love as medicine. In his work entitled “Causes and Signs of Chronic Diseases,” the physician recounts “a story that some incurably melancholic person fell in love with a girl, and when the doctors could do nothing to help, love cured him. I think, however, that he was in love from the start and that he was feeling down and disheartened because of the bad luck he was having with the girl, and so seemed to ordinary people to be melancholic. He had no idea at that point that it was love, but when he realized his love for the girl, he stopped feeling down, and he got rid of his anger and sorrow, and the joy sobered him up out of his sad state. For his mind was restored by doctor love.”
If love was not on the menu, there were also more easily available methods: eating blackberries and leeks, and above all, not avoiding addressing the matter, meaning speaking about one’s symptoms, which was an unusual approach for the time.
Hippocrates’ treatments, on the other hand, were far from pleasant, as they involved purging and blood-letting aimed at removing excess fluids and thereby restoring humoral balances. After all, as he famously declared, “Extreme remedies are very appropriate for extreme diseases.”
Of course, there were things that one could do to try to prevent illnesses by keeping the “humours” in equilibrium. There was an overall consensus among ancient Greek physicians that the human body is a delicate organism that must be kept in balance in order to remain healthy and perform at its optimal level. Thus, from the early days, diet was regarded as the central pillar of health. Eating seasonally, meaning adjusting one’s diet to the weather and season, was of crucial importance when not only preventing illnesses, but also was considered critical in treating conditions such as depression.
A touch of genius
The great Aristotle and his followers further developed the ideas expressed by Hippocrates in the 3rd century B.C.E. work entitled “Problemata”.
Cold was identified as the number one contributor to the development of “groundless despondency”. Aristotle also pointed out that less severe imbalances of bile led to a melancholic temperament, rather than illness, which seems to be one of the earliest attempts to make a differentiation between feeling depressed versus having depression.
Some might have taken comfort in Aristotle’s words of wisdom, since the philosopher was also one of the first to suggest that experiencing sadness is proper for intellectuals and creative souls.
“Why is it that all those who have become eminent in philosophy or politics or poetry or the arts are clearly of an atrabilious temperament, and some of them to such an extent as to be affected by diseases caused by black bile (…)”. As he himself stated, “There is no genius without some touch of madness”.
Despite these remedies, depression did not disappear. The following Classic thinkers and physicians continued to study “melancholy” with the hope of finding effective treatments to fight the silent disease.
The 1st-century Greek physician Soranus of Ephesus was one of the first to promote physical wellness as a measure of improving mental health. Physical activity became an indispensable step in fighting depression, and remains prescribed to this day. Decades of research have established that engaging in physical activity has a positive effect on mental health and can be an effective antidepressant in mild cases of depression.
Soranus was also the first known to promote psychological interventions, such as listening to the sound of dripping water to induce sleep.
Galen of Pergamum, the Greek physician to the Roman emperor Marcus Aurelius, developed detailed theories in his work “On the Affected Parts” about how different humoral abnormalities led to differing subtypes of melancholia. He also explored the relationship between various personality types, ranging from sanguine, choleric, melancholic, to phlegmatic. He is believed to be the earliest to consider that one’s temperament may lead to the development of a mental condition.
Depression was also studied beyond the classical world. The Persian philosopher and physician Avicenna, known as one of the greatest thinkers and medical scholars in history, in his work entitled “Canon of Medicine,” suggested that depression affects both the body and soul and promoted the use of persuasive talking as a method of treatment, which makes him the precursor of psychoanalysis and cognitive behavior therapy.
But from about C.E. 500 onwards, things started to look gloomy again. Religion took hold of people’s minds, with Christianity (or more accurately, the re-interpretation of it by the clergy) starting to dominate the social order. There was a significant shift away from the notion that mental illnesses should be treated similarly to physical illnesses, and therefore be treated by physicians. Instead, mental disorders, including depression, once again became the evident sign of depravity, evil, and sin.
Drowning and burning alive became favored treatments of the time thanks to people like Hildegard of Bingen (1098-1179), a German mystic nun who proposed a slightly altered version of the humoral theory of melancholia, writing in her “englithened” work that black bile had come to exist because of original sin.
Of course, not all agreed. For example, the Saturnists believed that melancholia was caused by celestial powers that tormented the most talented and creative members of society. Melancholia became a sign of intelligence (back to Aristotle) and so, they taught – it was an experience to cherish.
