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Depression Treatment: Part 1

Depression Treatment

Early practices around depression treatment arose from ancient Greeks’ perception that mental disorders were the result of angry gods taking revenge on helpless humans (Beck, 2014). As a result, people would seek healing through rituals involving magic and religion as well as through spending time at temples in hopes of attaining a cure. No mental health institutions existed to provide treatment–the burden of care rested on the family of the person suffering from mental illness. 

Greek doctors worked to counter the idea that mental illness was connected to the spiritual world, and suggested treatments such as restraints and counseling. However, much of their focus remained on disorders with outwardly disruptive behavioral factors rather than disorders like depression, in which symptoms are largely emotional or internal and may go unnoticed by a casual observer (Beck, 2014). Other treatments, such as bloodletting, purging, and physical exercise were also employed (Belmuth, 2017).

In the 19th century, Phillppe Pinel, a French doctor,  introduced the idea that depression involved psychological processes, such as negative thoughts (Balmuth, 2017). Another of Pinel’s accomplishments was advocating for the humane treatment of the mentally ill–who were left chained in institutions for decades during this time. Instead, Pinel suggested treatment that more closely resembles care provided in modern day institutions, such as occupational therapy, developing good rapport with staff providing treatment, and even an early version of talk therapy (Encyclopedia Britannica, 2021). Meanwhile, in America, pioneering psychiatrist Benjamin Rush connected mental processes to events with biological underpinnings occurring in the brain, and also held that mental illness and other illnesses both originated in the body. Towards the mid-1800s, English psychiatrists Daniel Tuke and John Bucknil proposed a neurological etiology of depression and suggested treatment addressing  psychological factors–as well as opium in severe cases (Balmuth, 2017).

It was not until the 20th century that treatment was based on a more modern conceptualization of depression etiology. In Germany, psychiatrist Emil Kraepelin devised a classification system to capture different types of depression while conducting longitudinal studies of patients with mental illness. Sigmund Freud, an Austrian neurologist, developed theories about depression involving sexual development and grief (Balmuth, 2017). Freud’s theories led to the development of psychoanalysis, which involved treatment by way of bringing to conscious awareness unconscious factors that play a role in the development of mental illness. Freud distinguished normal grief from depression and suggested that the former should not be treated to avoid interrupting the grieving process. During the early 20th century, depression was split into two major categories, melancholic depression that was more severe and required inpatient treatment, and nonmelancholic depression that was linked to psychological or social factors and could be addressed in an outpatient setting (Horwitz et al., 2016). As this brief history illustrates, a primitive and incomplete understanding of depression informed treatment for thousands of years. This conceptualization led to holding people with depression responsible for their illness, as well as barbaric treatment. Evidence-based depression treatment has a relatively recent advent, with the last two centuries ushering in an era of humane treatment that recognizes the role of the mind, brain, and psychosocial factors in creating the experience of depression. 

References

Balmuth, E. (2017). From black bile to the brain: Tracing melancholia and depression. https://www.phdnet.mpg.de/offspring-blog/2017/from-black-bile-to-the-brain

Beck, J. (2014, January 23). Diagnosing mental illness in ancient Greece and Rome. The Atlantic. https://www.theatlantic.com/health/archive/2014/01/diagnosing-mental-illness-in-ancient-greece-and-rome/282856/

Encyclopaedia Britannica. (2021, April 16). Philippe Pinel. Encyclopedia Britannica. https://www.britannica.com/biography/Philippe-Pinel

Horwitz, A., Wakefield, J. C., & Lorenzo-Luaces, L. (2016). History of depression. In R. J. DeRubeis, & D. R. Strunk (Eds.),  The Oxford handbook of mood disorders (pp. 1-24). https://doi.org/10.1093/oxfordhb/9780199973965.013.2

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