We say about one person that he is melancholic and about another that he is depressed. Who would fail to sense the difference? Depression has counted as an illness in every age, but the judgment of melancholia has always been unsettled: on the basis of the kinship of its symptoms with those of depression, it was considered to be an illness in the Middle Ages, and in antiquity or the Renaissance it could mean “outstanding health.” The depressive always experiences his condition as a burden, an illness, in which his biological being is extensively affected; the melancholic, on the other hand, is possibly unaware of his own melancholia: the melancholic experience of fate does not necessarily rule out serenity. Everyday parlance is a reminder of what science passes over in silence: melancholia offers a deeper (and thus, less easily accessible) insight than depression into the interconnections of existence. It is precisely that boundlessness that disturbs science, which imagines that the ever-expanding horizons of humankind can be fenced in — after all, interpretations of being cannot be diagnosed. It has been seen how the bourgeois mentality strove to tame and ransack melancholia following the Renaissance. In the nineteenth century, medical science took over the role of the tamer, disputing the original meaning of melancholic attempts to explain existence (the bourgeois world could not permit the world to be explained, or even experienced, on the basis of a point of view radically different from its own), and it referred them to the authority of learned specialists. History is not a monolithic formation, however, nor was the human mind carved from a single block: horizons cannot be caught up with. Just as the notion of melancholia has retained in everyday parlance the profundity and infinite openness of the original meaning, down to the present day, the unitary diseases born of the constraints of medical science and stipulated by the age are always fragile and exposed to continual change. In Wilhelm Griesinger’s 1845 classification, which became one of the foundational works of psychiatry in the nineteenth century (
Pathologie und Therapie der psychischen Krankheiten, or Mental Pathology and Therapeutics, as it became known in English translation), melancholia, or, more precisely, the stadium melancholicum, assumed symptoms of schizophrenia, which are in fact alien to it, and Griesinger himself included the most diverse manifestations of mental disorders under the label “melancholia.” There were, of course, plenty of precedents for that, going back to antiquity: melancholia had always been associated with a variety of mental illnesses. What was new was the restriction of melancholia exclusively to the ambit of mental illnesses, thus limiting its meaning as well. In Kraepelin’s clinical taxonomy, which was supposed to eliminate the inaccuracies associated with unitary psychosis, it was the use of “depression” and “melancholia” that became inaccurate. In 1896, Kraepelin finally dropped the concept of melancholia altogether from his taxonomy and used the word “depression” instead (see Edward Shorter, A Clinical Dictionary of Psychiatry, 82). A few years later (in 1904), at a meeting of the New York Neurological Society, the Swiss-born American psychiatrist Adolf Meyer recommended that no further use be made of the term “melancholia”: “[It] implied a knowledge of something that we did not possess and which had been employed in different specific by different writers. If, instead of melancholia, we applied the term depression to the whole class, it would designate in an unassuming way what was meant by the common use of the term melancholia” (quoted in Michael Alan Taylor and Max Fink, Melancholia, 6).3 Yet depression is not a uniform concept either: in bipolar depression (or “dépression circulaire”), the symptoms of “melancholia” alternate with those of “mania,” whereas in unipolar or recurrent depression, the illness is characterized by the alternation of episodes of “melancholia” and episodes of “health only.” According to recent observations, psychotic symptoms (delusions of grandeur or persecution, catatonic episodes, acoustic hallucinations, underlying schizophrenic symptoms) are present in 20–25 percent of patients in depressive periods, though American researchers reckon that nowadays the majority of depressions are not psychotic but neurotic in origin. Thanks to that, depression has become the most frequently diagnosed illness. It appears that melancholia is being finally expelled from the psychiatric vocabulary: the term, which had featured previously, was removed from the third (1987) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III—see Taylor and Fink, Melancholia) as “a term from the past,” though in the fourth edition (1994) it reappeared as one of the subspecies of depression (“major depression with melancholia”). In the latest revision of the International Statistical Classification of Diseases and Related Health Problems (2012), melancholia crops up in the main category Mental, Behavioral and Neurodevelopmental Disorders, in the subgroup Major Depressive Disorder, Single Episode, within the group Other Depressive Episodes, partly as a self-standing entity (ICD-10-CM F32.9) and partly as “Involutional Melancholia (Recurrent Episodes) (Single Episode)” (F32.8). “Psychosis” (codes 290–299) mentions “involutional melancholia” as a depressive subtype of “major depressive disorders” (code 296.2).