Melancholy and Depression Not quite the same thing

Part of a letter on Archetypal Studies in Melancholy and Depression. Jan 2025.

Living the Blues.

“Depression, or Melancholy Without the Gods”, James Hillman, 1999.¹
“Depression is Melancholy minus its charms”, Susan Sontag, 1978.²

Living the Blues.³

Shades of Blue.⁴
Hillman’s quote references melancholy as a condition of the soul and archetypal reality, while Sontag’s context is the cultural, sociological, and personal meaning. Despite the 20 years between these quotes, both writers understand melancholy, the term used to describe a particular disposition and behaviour for over 2000 years, as something different from the modern term, depression. And both draw from historical ideas on the subject.

A Fairly Depressing History of the Blues.⁵
2400 years ago, Hippocrates describes ‘fear and sadness lasting a long time’ as melancholy, that is, literally, ‘black bile’, produced in excess by the spleen.⁶ His ‘four humours’ theory⁷ maintained its central position in medicine for the next 2000 years. But views on melancholy itself shifted like the tides.

100 years after Hippocrates, Aristotle, around 300 BCE, associates melancholy with imagination and says that it is an oscillation between genius and madness. Galen, around 200 CE, adds delusions to the list of symptoms. In Middle-Ages Europe, between 500 and 1500 CE, the somatic four-humours paradigm of melancholy lost its place against the prevailing religious perspective. ‘Sadness’ becomes tristitia vel acedia, one of the seven vices first enumerated by Pope Gregory I in the 6th century and elaborated further in the 13th century by St. Thomas Aquinas.⁸ When a patient could not be cured, it was believed that the melancholia was a result of demonic possession.⁹

During the Renaissance, around 1500, often referred to as The Golden Age of melancholy, Ficino and others revived the idea of depression as part of artistic genius, and ‘all great philosophers, artists and poets’ are melancholic.¹⁰

In the Classical age, 1600-1800, from the completion of the Renaissance to the end of the Enlightenment, there is a new reversal: melancholy is considered an alienation of the rational mind. It must be fought with reason. Melancholy becomes a disease of wrong thinking rather than biology or a disposition influenced by the planets.

In 1621, Robert Burton published his Anatomy of Melancholy, which helped shift the idea of melancholy as a bodily illness to a disorder of the mind.¹¹ Burton condemns this ‘melancholy fashion’, especially amongst religious people. Nevertheless, somatic treatments, such as bloodletting, and restricted diet,¹² continue, to treat ‘disorders of the nerves’.

Michel Foucault’s ‘Madness and Civilisation’ highlights the next shift from the ‘great confinement’, after Descartes’ philosophy of reason¹³ and the creation of the General Hospital in 1656.¹⁴ ‘Fools’ and other ‘undesirables’ require isolation. From 1656, one in a hundred inhabitants, including melancholics, were interned in Paris for being ‘unreasonable’ and therefore fools.

The Romantic era, at the start of the 19th century, after the social disruptions of the French Revolution, saw a revival of melancholy as a position of honour for sensitive individuals, who must separate themselves from society.¹⁵

After the ‘great confinement’, a growing population of ‘crazy, vagabonds, foolish, bad women, and libertines’ is relegated to General Hospitals. Philippe Pinel¹⁶ visits these places and establishes the ‘moral treatment’ of ‘fools’ through an interpersonal relationship between the doctors and the madman. And publishes his work in 1801. And here we have the birth of psychiatry.¹⁷

Esquirol (1772-1840), pupil of Pinel, says that the term melancholy defines a habitual state of sadness of certain individuals, and ‘must be reserved for moralists and poets’. Falret (1794-1870) develops a new form of ‘moral treatment’: bullying. The mad must be made to give up their wrong thinking and behaviour under penalty of sanctions.

And by the late nineteenth century, there is a new theory of melancholy – degeneration. Morel (1809-1873) proposes the ‘physical, intellectual and moral degenerations of the human species’, bringing in sociological factors. Intoxication, alcoholism, misery, and more, are progressive hereditary issues, and this is at the root of the various mental disorders. This theory branches out into theories of social hierarchy, racial prejudice and the rise of fascism.¹⁸

Kraepelin published his ‘Introduction to Clinical Psychiatry’ in 1907.¹⁹ He differentiates melancholy, depressive circular states, catatonic stupor, manic-depressive mixed states, catatonic excitation and more. These are biomedical conditions that requires medical intervention, which, by the 1920’s and 1930’s, were mainly psychosurgery²⁰, including lobotomy²¹, insulin ‘shock’ treatments²², and, just as Nazi Germany and fascist Italy were really getting going, electroconvulsive therapy (ECT).²³

The attitude seems to be, ‘If we do not know what it is, we can at least try to get rid of it’. Neuroleptics are discovered in Paris in 1952, and the antidepressant effect of imipramine in Switzerland in 1956. And so begins the the era of commercialisation of modern psychotropic drugs.²⁴

Freud, on the other hand, described melancholy as a psychological condition, not a disease to heal. No longer a result of humoral pathology, astrological influence, or nervous disease, melancholy arose from a disjunction in self-identity. For Freud, and his followers, Abraham and Klein, depression is the result of an oedipal or narcissistic conflict, and is a question of resolving the repressed conflict by analysing the resistances.

After Freud, the term ‘melancholy’ fell out of use, with diagnoses of depression finding favour instead.

The modern diagnostic criteria for the major depressive episode are listed in ICD-10 and the DSM-5.²⁵ These are the ‘bibles’ guiding the diagnosis, and the medical aid monies received, for treating all psychiatric illness. Sub-divisions and made-up categories of depression ad infinitum.²⁶ According to the American Psychiatric Association, publishers of the DSM, ‘research indicates’ that more than 17% of the world’s population suffers from major depression during their lifetime.²⁷ Meanwhile, investigators found that 60% of the expert advisors for the DSM were paid by drug companies for their contributions.²⁸

The current psychiatric best thinking on depression concerns ‘brain plasticity’. It’s about how antidepressant drugs and antipsychotics will rewire your brain, and grow the stuff you need, and then you won’t be depressed.²⁹ Even though repeated research has shown that placebos work just as well as antidepressants.³⁰ We already know it’s not what the doctor gives, but that the doctor gives.³¹ This thinking is also connected to ketamine therapy,³² currently the only ‘legally sanctioned’ psychedelic.³³ The big news is that having a psychedelic trip can give you a spiritual experience, which can change your life and lift your depression. Which, curiously, is about finding meaning, not growing neurotransmitters.

Inside out. Upside down.
That’s the nosology.³⁴ It describes the classification of disease based on observation and symptoms. Our noses sense that something’s off.³⁵ For over 2000 years, medical texts³⁶ assumed a connection between the inner person and their outside world, including the planets and the invisible forces that influenced the manifest world. For just the last 200 years, at least in the West, but increasingly all over the planet, the world has no soul and it’s all and only about the biological individual, the ego literalised, and pathology has been reduced to what can be seen and measured. Hence neurobiology, attempting to fix the brain as if that was the mind, character, or disposition.³⁷

Back in the early 16th century, Paracelsus³⁸ offered his view that joined practical science with a soulful perspective: ‘The physician must have knowledge of man’s other half, that half of his nature which is bound up with astronomical philosophy; otherwise he will be in no true sense man’s physician, since Heaven retains within its sphere half of all bodies and all maladies. What is a physician who knows nothing of cosmography?’ ³⁹

Hillman agrees. He says, ‘There is something about feeling the weight of the world. That if you are not depressed with the fish turning belly up in the rivers and the trees being chopped down left and right and the rest of it, you are not living. How could the soul – your soul – not be sensitive to the soul of the world? That is one of the oldest ideas that we have in Western thought, that the soul of the world and the soul of the human being are interconnected.’ ⁴⁰

The way of soul is living with uncertainty and ambiguity. ‘We are lived by forces we pretend to understand’ ⁴¹ often quoted by Hillman, pokes a finger in the forehead of the pseudo-science of clinical psychology and psychiatry.⁴² More absurd names might offer a temporary defence, or the illusion of control, against the interruption of the gods in our lives; and the cocktail of powerful drugs, or ECT, might numb the emotions to make a person no longer care. Repeated ketamine sessions offer short-term relief, ‘lasting for several days or even weeks’.⁴³ But none of these address the experience of depression and anxiety,⁴⁴ or what this might ask of the soul. For that, we require other ways of understanding and behaving.

The Therapeia 2025 gives attention to these matters.