Historical Understandings of Depression Continued
Rashmi Nemade, Ph.D., edited by Kathryn Patricelli, MADuring the late 1700s and early 1800s, there were a variety of complex explanations for depression. Some doctors and authors suggested that aggression was the real cause of depression. They suggested exercise, music, drugs and diet as treatments. They also stressed the importance of discussing problems with a close friend or a doctor. Others thought that depression was caused by an internal conflict between unacceptable impulses and a person's conscience. Advances in general medical knowledge caused other scientists to believe in and search for organic (physical) causes of depression.
Towards the beginning of the 1800s, new therapies for depression were developed. This included water immersion, which involved keeping people under water for as long as possible without drowning them. It also included a special spinning stool to cause dizziness in order to rearrange the contents of the brain into the correct positions. Benjamin Franklin introduced an early form of electroshock therapy. Horseback riding, special diets, enemas and vomiting were also recommended treatments.
Depression was first distinguished from schizophrenia in 1895 by the German psychiatrist Emil Kraepelin. During this same period, psychodynamic theory was invented. Psychoanalysis, the psychotherapy based upon the psychodynamic theory, became increasingly popular as a treatment for depression. In a 1917 essay, Sigmund Freud explained melancholia as a response to loss. This was either real loss (such as the death of a spouse), or symbolic loss (such as the failure to achieve an important goal). Freud believed that a person's unconscious anger over loss weakened the ego, which resulted in self-hate and self-destructive behavior. Freud recommended psychoanalysis (the "talking cure") to resolve unconscious conflicts and reduce the need for self-abusive thoughts and behavior. Other doctors during this time viewed depression as a physical disease and a brain disorder.
Treatments during the late 1800s and early 1900s were usually not adequate for people with severe depression. Because of this, many desperate people were treated with lobotomy, which is the surgical destruction of the frontal portion of a person's brain. This had become popular as a "calming" treatment at this time. Lobotomies were often unsuccessful. They caused personality changes, the inability to make decisions, and poor judgment. Even worse, they sometimes lead to a coma or even death. Electroconvulsive therapy (discussed in a later section of this center), was a popular treatment for schizophrenia, but this treatment was also used for people with depression.
Influenced by hundreds of years of back and forth debate as to whether depression was best thought of as a mental or physical problem, and by increasing knowledge of the brain and brain chemistry, the medical community of the 1950s and 60's accepted a classification that divided depression into subtypes based on supposed causes of the disorder. "Endogenous" depression came from within the body and was caused by genetics or some other physical problem. People with endogenous depression were supposed to view themselves as the source of their own suffering and to think that everything was their fault. Their emotional pain was thought to be unaffected by the attitudes or responses of the people around them. In contrast, "neurotic" or "reactive" depression was caused by some significant change in the environment, such as the death of a spouse, or other significant loss, such as the loss of a job. Individuals with reactive depression were thought to feel isolated, victimized and abandoned. They were told to view the cause of their problems as something external to themselves. People with reactive depression were thought to develop bodily symptoms and to make suicide attempts as a means of getting support from the people around them.
The 1950s were also important in the search for organic causes and treatments for mental illness. In 1952, doctors noticed that a tuberculosis medication (isoniazid) was also useful in treating people with depression. Shortly after this significant finding, the practice of using medications to treat mental illness gained greater favor. Psychiatry, which had previously looked to psychotherapy as their therapy of choice, started to emphasize the use of medications as primary treatments for mental illnesses. During the same period, new theories in psychology added to the approaches of psychotherapy. Behaviorism, and the Cognitive Behavioral school of thought, as well as Client-centered (Humanistic) therapy, and Family Systems therapies joined Psychodynamic psychotherapy as popular treatment options. We will discuss these psychological theories, including what they have to say about the causes of and treatments for depression in more detail in a later section of this center.
Currently, rather than adopting either the mind or the body explanation of depression, scientists and mental health professionals recognize that depressive symptoms have multiple causes. In the current view, depression can be caused by both mental and physical causes at the same time. It is no longer necessary to choose a single cause. No single cause is going to be fully explain and account for all types of depression. Because it has become the accepted view that depression frequently has multiple causes, including biological, psychological and social causes, it has also become the normal belief that multiple professions and approaches to treatment have important roles to play in helping people overcome depression.
Resources
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Articles
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Introduction and Types of Depressive Disorders
- Major Depressive Disorder and Related Conditions
- Classic Symptoms of Major Depressive Disorder
- The Development and Course of Major Depressive Disorder
- Differential Diagnosis and Specifiers of Major Depressive Disorder
- Prevalence and Co-Occurring Conditions
- Disruptive Mood Dysregulation Disorder
- Persistent Depressive Disorder (Dysthymia)
- Premenstrual Dysphoric Disorder
- Related Disorders / Conditions
- Historical and Current Understandings
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Biology, Psychology and Sociology
- Biology of Depression - Neurotransmitters
- Biology of Depression - Neuroplasticity and Endocrinology
- Biology of Depression - Genetics and Imaging
- Biology of Depression - Psychoneuroimmunology
- Psychology of Depression- Psychodynamic Theories
- Psychology of Depression- Behavioral Theories
- Cognitive Theories of Depression - Aaron Beck
- Cognitive Theories of Depression - Ellis and Bandura
- Cognitive Theories of Depression - Seligman
- Sociology of Depression - Effects of Culture
- Social and Relational Factors in Depression
- Lifestyle Factors and Environmental Causes of Depression
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Treatment - Medication and Psychotherapy
- Treatment: When to Seek Professional Help and Where to Find Help for Depression
- Measuring Depression
- Clinician-Rated and Self-Report Questionnaires/Tests for Depression
- Types of Treatment for Depression
- Types of Treatment Continued
- Medications for Depression
- Antidepressants for Depressive Disorders
- Mood Stabilizers for Depressive Disorders
- Non-Medication Medical Therapies for Depressive Disorders
- Psychotherapy - Evidence-Based Treatments for Depression
- Cognitive Behavioral Therapy for Depression
- Cognitive Behavioral Therapy for Depression Continued
- Interpersonal Therapy for Depressive Disorders
- Behavior Therapy for Depressive Disorders
- Psychodynamic Therapy for Depressive Disorders
- Group, Family and Couples Therapy for Depressive Disorders
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Alternative Medicine and Self-Help Resources
- Complementary and Alternative Treatments for Major Depression
- Major Depression and St. John's Wort
- Major Depression and Exercise
- Major Depression and Omega 3 Fatty Acids
- Major Depression Serotonin Precursors: SAMe
- Major Depression Serotonin Precursors: 5-HTP
- Acupuncture for Depression
- Music Therapy and Relaxation Therapy for Depression
- Self-Help Methods for Major Depression
- Community and On-line Self-Help Resources for Major Depression
- Depression Reading List
- Special Issues
- References
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Introduction and Types of Depressive Disorders
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- Is Post Traumatic Stress Disorder Curable?
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- My Father, The Sociopath...
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- Giving Up - Dad of three - Sep 15th 2008
- Counting ritual - Zami - Aug 30th 2008
- dont understand me
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- Is there help for a person who has always been a 'little depressed'
- Depression Treatment
- Please help.
- Lovely, however... - Julie C. - Jul 14th 2008
- I am really worried about my mental health (19yr old female)
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- Help?
- Major Depressive Disorder Severe with Psychotic Features
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- Help!!!: Laci
- Is the memory of my father dooming my relationship?
- Worried about thoughts
- How long will i be on medication for treatment of my depression
- My Mother Won't Go For Depression Treatment!
- Where do i start to get on the road to recovery
- What is wrong with me?
- Stuck in an on-again, off-again relationship for 10 years
- Depression Treatment
- How do I get my dr.s to understand and help me?
- STUCK IN A RUT
- What treatments are available after you've tried the medicines of last resort?
- no one will help!
- Should I seek help?
- A fighting couple
- Do I have a mental health problem?
- Whats wrong with me?
- depression and employment
- how do you treat depression in teenager males?
- Is it ok to feel this way?
- Have DID: Getting Worse Not Better
- Can we contact my mother's doctor?
- anxiety or going crazy?
- ADD, Tourettes or both?
- Depressed
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- Will this ever end
- Get Supported
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- should a depressed person marry?
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- Anger?
- What type of exams can proven that a person has bipolar disorder?
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- Depression Is a Choice
- Depression, the Mood Disease
- Depression-Free for Life
- Doctors of Deception
- Down Came the Rain
- Dysthymia and the Spectrum of Chronic Depressions
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- Essential Psychopharmacology of Depression and Bipolar Disorder
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- Lucy Sullivan Is Getting Married
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- My Depression
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- Depression and its Treatment
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