As the British novelist L. P. Hartley famously observed, “the past is a foreign country, they do things differently there,” and we must indeed be wary of projecting modern experience onto people who did not think and act as we do. And yet, though beliefs and assumptions have changed, the human body has not. Physically we are no different to a Roman emperor or a Neolithic hunter. If, therefore, people in the past suffered depression, how did they explain and treat it?
Depression in the Ancient World
Though they may not have used the word, it seems clear that people in the ancient world did experience depression. For example, in the earliest Greek literature, The Iliad and The Odyssey, several characters exhibit depressive symptoms: weeping, shunning others, losing energy and hope etc. When his beloved comrade Patroclus is killed in The Iliad, Achilles withdraws into his tent, stops eating, and avoids contact with his men. After Orestes kills his mother in Euripides’ play (written in Athens over two thousand years ago), he suffers insomnia, chronic exhaustion, and a loss of appetite and desire.
Throughout most of human history, mental illness was explained in terms of possession. The Babylonians, Chinese and Egyptians, for example, all described it in this way. Treatments thus focussed on driving demons and evil spirits out of the body. Not everyone agreed with this view, however. Hippocrates, born around 460 BC on the Greek island of Kos, approached depression in a more rational manner. He believed that the body was composed of four “humors” or fluids: phlegm, blood, yellow bile and black bile. In a healthy individual, these humors were settled and stable. When they became unbalanced, physical and mental illness followed. The doctor’s job was to restore this balance through bloodletting, herbs, and so on.
Depression (or “melancholia,” as the Greeks called it) was explained by an excess of black bile. Interestingly, the Greeks also made a distinction between what we would now call “manic” and “unipolar” depression. When the black bile was hot, mania followed. Normal or classic depression arose when there was an excess of cold black bile.
The Romans also recognized depression. Galen, born in the 120s in what is modern Turkey, moved to Rome and became private physician to the Emperor Marcus Aurelius. Galen shared the Hippocratic view of depression, but he also believed that some are just born that way and suffer from what we would now call a “depressive personality.” It is interesting to note that even today arguments continue about whether or not depression can be inherited, with some favoring nature, some nurture.
Of course, the Greeks and Romans were not the only peoples to try the more rational, scientific approach. In the 9th century, for example, the Persian physician Rhazes, who practised in what is today Baghdad, held the brain responsible for mental illness and recommended bathing and rewarding positive behavior as treatments.
Medieval Christianity
Unsurprisingly perhaps, Medieval Europeans defined “melancholia” in religious terms. St Augustine, who was to exert an enormous influence over the Middle Ages, argued that reason set human beings apart from other animals. This was a gift from God, and its loss a sign of God’s displeasure. To fall away from reason was to fall away from God. And what could be more “unreasonable” than weeping, hiding away, and refusing to eat? Influenced by Augustine’s writings, Medieval Europeans argued that the depressed were being punished for their sins. They had fallen from the light and, added the fifth century monk Cassian, their friends should stay away or accept guilt by association.
Depression was also linked to the sin of sloth, which is why the depressed were often sent to work in the fields. Cure them of sloth, it was thought, and you may cure them of depression as well (oddly enough, mild depression can be eased by fresh air, natural light and exercise!). Indeed, the Medieval church defined “acedia,” or sloth, in a way that resembles modern descriptions of depression. Sloth/depression then became equated with original sin and thus with the roots of evil. Even today, some Christians will accuse depressives of ingratitude, of being, in a sense, in revolt against the gift of life.
The Age of Reason and the Romantic Rebellion
Since the 17th century, two different approaches to depression have appeared: the rational and the romantic. The Medieval period, or “Middle Ages,” traditionally ended with the Italian Renaissance in the 15th century. But the Renaissance was more an artistic re-birth than a revival of Greek rationality. The rational, or scientific, era began in England, Holland and France in the 17th century, leading to the Enlightenment in the 18th century. The Romantics, who were concentrated largely in Germany, France and England, rebelled against the new emphasis on science and reason, and in particular on the technological and social changes these had created.
The birth of science brought with it a new understanding of the human body and mind. According to the French philosopher Descartes, the world could be divided into two substances, mind and matter. Matter, which included animals, plants, and the human body itself, was machine-like and, according to men like the English philosopher Francis Bacon, could be analyzed and understood like any other machine.
As religious faith declined, mind came to be seen as nothing more than a by-product of matter. In other words, there was only matter (consciousness or mind being the result of material processes). So depression followed when the brain malfunctioned. Indeed, this view is still popular today, with many seeking explanations in MRI scans and the work of neuroscientists. And victims of depression will be prescribed anti-depressants to “top up” their serotonin and dopamine levels – rather like topping up the oil or gas in a malfunctioning car. Though 18th century doctors blamed poor blood flow or “untuned nerves,” the principle was the same: like today, answers were sought in material processes, not in demonic possession or the anger of God.
The decadent, urban nature of modern life also came under attack. Samuel Johnson, for example, himself prone to crippling bouts of depression (or “vile, black melancholy,” as he put it), argued that city life weakened and enfeebled people. For Johnson, and indeed Edmund Burke, the solution lay in fresh air, exercise, and a return to rural life. The 18th century English doctor George Cheyne also thought the comforts of modern life were to blame and argued for a simple, vegetarian diet instead of the meat, sugar, and rich sauces on which the wealthy gorged. Again, there is something to be said for this view. After all, sugary, refined, and junk foods are known to lower mood, while a vegetarian diet (if combined with fresh, oily fish and other protein) can lift it.
Around the turn of the 19th century, however, a new movement gathered pace, known today as Romanticism. The Romantics, who included poets like Wordsworth, Coleridge, and Shelley, and artists like Caspar David Friedrich and J. M. W. Turner, rebelled against this worship of science and the machine, favouring spontaneity and emotion instead. The English poet Byron, for example, (himself a manic depressive) wrote that “it is better to be in pain than to feel nothing at all.”
Not only did the Romantics consider depression a sign of depth and sensitivity, it was also thought to be the price one paid for greater insight and knowledge. Thus, in a sense, to be happy was to be shallow and ignorant. Indeed, Shelley even wrote an ode to dejection. The Romantics also valued authenticity, which they set against the fake, artificial manners and rituals of upper-class life. Better to be honestly and authentically depressed than to fake happiness. Even today, some view depression as a cool and interesting pose. Fashion magazines, for example, often feature a pale, solitary figure in black clothes, wandering through a dreary landscape. And bands like Joy Division, Radiohead, The Smiths, Nirvana etc appeal in part because the downbeat lyrics make them seem so raw and honest.
How we understand, and treat, depression has changed. And if it has changed in the past there is no reason to believe it will not change in the future. Today, explanations are sought in neurotransmitters and genetics. A century or two from now, these may be considered as absurd as demonic possession seems to us!