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Incidence of depression is increasing. One explanation is that aspects of our modern lives are responsible. Loss of in person connections, fast paced and sometimes bewildering communication, the increase in temporary and insecure work. A British Prime Minister who seemingly can’t tell whether he is at a party or in a meeting. Henry Maudsley wrote, “an increase of (depression) is a penalty which an increase of our present civilisation necessarily pays.” Maudsley [1] wrote this in 1867 but he could have written it today. And he used the word ‘insanity’ rather than ‘depression’, but the point is the same. Are we driving ourselves insane? And have we been doing so for over a hundred years? To understand this, we need to understand how we came to think of ourselves as depressed.
Depression through the ages [2]
Historically, sadness was divided into ‘sadness with cause’, and ‘sadness without cause’, also known as melancholia. Melancholia was considered a medical disorder because there was no apparent reason for the person’s symptoms. This distinction has a long history, going all the way back to Hippocrates and Aristotle.
The early 10th
century Arabic physician Ishaq ibn Imran defined melancholia as “irrational, constant sadness and dejection” but noted that “the loss of a beloved child or an irreplaceable library can release such sadness and dejection that melancholy is the result.” The implied existence of non-beloved children and the equating of beloved children with libraries are interesting side issues. In the 19th
century, Mercier defined melancholia as “a disorder characterised by a feeling of misery which is in excess of what is justified by the circumstances in which the individual is placed.” This makes sense intuitively. If my irreplaceable library is burned to the ground I will be very sad, despondent, and have little interest in doing things. This is different from waking up one day and having those same feelings without an apparent cause. These early thinkers believed that melancholia had some physical cause, such as a misalignment of the humours.
Freud (1856-1939) attempted to understand depression by uncovering hidden desires and motivations, rather than physical imbalances, but nevertheless maintained the traditional distinction. He wrote:
Although grief involves grave departures from the normal attitude to life, it never occurs to us to regard it as a morbid condition and hand the mourner over to medical treatment. We rest assured that after a lapse of time it will be …
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