Une demi-heure de méditation est essentielle sauf quand on est très occupé. Alors une heure est nécessaire.

Dante Gabriel Rossetti, Beata Beatrix, 1863.

In the nineteenth century melancholia was recognized as a core illness among many forms of insanity. One writer defined six classes of insanity: melancholia, mania, fatuitas, stupiditas, amentia, and oblivio’’. Another oVered five ‘‘species’’ of insanity: melancholia, mania with and without delirium, dementia, and idiocy. Yet another author divided insanity into three orders, with mania and melancholia combined asone. Mania was considered a higher form of melancholia or as the same illness in a diVerent form. A specific view is expressed by the apothecary of London’s Bethlem Hospital, John Haslam, in 1809 (Hunter and Macalpine, 1982, p. 580):

As the terms Mania andMelancholia are in general use, and serve to distinguish the forms under which insanity is exhibited, there can be no objection to retain them; but I would strongly oppose their being considered as opposite diseases. In both there is an equal derangement. Other observers emphasized the connection between the mood disorders of depression and mania. Descriptions of a circular insanity were detailed by Falret (1854) and Baillerger (1854).19 Falret described melancholia:

At the commencement of this phase . . . the patients begin to withdraw and now speak only rarely. Sometimes they express remorse over their previous condition . . . the patients withdraw, remaining all alone and motionless . . . they are now meek, and their humility may go so far as for them to refuse treatment in the belief that they do not deserve it. This despondency becomes more pronounced daily . . . [and] the patient is transformed into a statue . . . were he not coaxed to eat, the patient would not bother to seek food . . .

The thought processes are very slow; rarely this may result in complete cessation of all intellectual activity . . . his movements are sluggish or absent. The face is pale; the features sag, suggesting dejection rather than anxiety . . . Appetite is decreased, and the patient eats little; digestion is equally slow and defecation is laborious.

Nevertheless, there are a certain number of patients who present with specific preoccupations, among which we have noticed ideas of humility, of ruin, of being poisoned, or of guilt.