German neurologist and psychiatrist V. Griesinger, who made a great contribution to the pathological anatomy of mental disorders, believed that melancholia, like any other mental disorder, can be considered from the point of view of the improper functioning of the nerve cells of the brain. Griesinger emphasized the role of strong emotions in cases where the patient experiences feelings of guilt, and noted that this feeling is more important than immediate physical affect. He considered professional activity as a means to achieve recovery of the patient. In Griesinger’s classification in a state of mental depression or melancholy, its subtypes such as hypochondria, simple melancholia, melancholy with torpor, with destructive aspirations and with the stimulation of volitional activity (Griesinger V., 1867) stood out.
K. Wernicke, like his teacher, the Viennese neurologist T. Meinert, tried to explain mood disorders with histological or gross anatomical damage to the nervous system.
In Germany, K. Kalbaum proposed to use in describing depression a number of terms that have not lost their relevance to the present. In particular, they include the concept of “cyclothymia”, which characterizes unsharply expressed periods of mood change – from low to high. Before Calbaum, many psychiatrists attributed to the manifestations of depression symptoms of catatonia (monotonous postures, negativism, stereotyped movements). He wrote that the picture denoted by the name of “atonic melancholia” is true melancholy with sad thoughts, because in many cases the patient’s face does not reveal any suffering, sometimes he even smiles and from a state of “stupor” can turn to strong excitement. Calbaum considered that dysthymia, affection of the affective sphere in the form of depression or excitement, should be attributed to vecordia or enfrenia — psychosis with persistent or changing symptom complexes. By luck or panfenia – psychosis with alternating symptom-complexes – is actually melancholia (Kahlbaum K., 1874).
The German psychiatrist E. Krepelin – the creator of the first scientific classification of mental illness – contributed to the study of depression, highlighting the criteria for the differential diagnosis of “early dementia” (schizophrenia) and manic-depressive psychosis, which, in his opinion, was characterized by the possibility of complete recovery and periodic alternation of deep depression and manic state, along with the existence of “light” gaps. In the classification of Crepelin melancholy was given a modest place. It was assumed that it can develop only in the elderly. Depression of the involutionary period, in his opinion, is a real melancholy, and its slower course and not sharply pronounced, in comparison with circular psychosis, inhibition should be considered its distinctive features. Melancholy at a young age always acts as a forerunner of circular psychosis, unless it is the initial phase of early dementia (dementia praecox) (Kraepelin E., 1896).
First of all, French psychiatrists did not agree with this point of view, for whom it was not clear why the cases of melancholy, occurring at a young age, cannot be the same in character and genesis as in the elderly? According to Kraepelin, periodic mania and periodic melancholia completely lost their independence due to circular psychosis, which received a new name – manic depressive insanity. Kraepelin also emphasized the importance of mixed states, the possibility of combining melancholic thoughts with motor or speech arousal (Kannabikh Yu.V., 1928). This doctor paid particular attention to the toxic effects of alcohol on the body, believing that the destruction of the brain due to such effects is more pronounced than due to manic-depressive psychosis.
In the classification of the German psychiatrist, heir to the Meinert-Kraft-Ebing department, melancholia or gloomy insanity (mental retardation neurosis) was attributed to mental diseases of a fully developed brain. The following two forms stood out: simple melancholy and melancholy with dullness. Kraft Ebing believed that melancholia is a disease of the healthy brain, in contrast to periodic psychosis, which should be referred to as degenerative forms of mental disorders.
The classification of the well-known Russian psychiatrist S. Korsakov implied such forms of melancholia as dysthymia, typical melancholia and its atonic variety. Melancholic insanity (vesania melancholica) was related to mixed forms of mental disorders.
Of particular interest to the phenomena of the unconscious, to the sexual life of a person, clearly manifested at the end of the XIX century, affected the views on depressive states. The famous French psychiatrist M. Sharko expanded the boundaries of hysteria, incorporating in it some of the variants of modern depression. In particular, he referred to psychiatric anorexia as hysteria, which some modern researchers consider to be a manifestation of depression. In fairness, it should be noted that, prior to Charcot, the English psychiatrist D. Bird also attributed the symptoms of depression to signs of “neurasthenia.” It seems that a number of symptoms of mental disorders, depending on the views of their time, moved from neurasthenia and hysteria to depression. A significant number of patients who were diagnosed with neurosis at that time increased the need for new methods of psychotherapy. Those conditions that today are classified as hidden forms of depression, the Swiss neurologist P. Dubois treated with the help of rational psychotherapy – the forerunner of modern cognitive therapy. A great contribution to the psychotherapeutic treatment of depression was made by representatives of psychoanalysis.