La senda de la virtud es muy estrecha y el camino del vicio, ancho y espacioso.

Henri-Émile-Benoît Matisse, La Musique, 1907.

For mania, Kraepelin described a progression in severity from hypomania to mania to delirious mania. For melancholia, he described a parallel progression of simple retardation, retardation with delusions and hallucinations, and stuporous conditions.

Various attempts to distinguish depressive mood disorders were made. One attempt divided depressed patients with anxiety as ‘‘reactive’’ to stress (psychoneurotic), and an autonomous form that had a systemic or biologic basis. The arguments were of popular interest at the beginning of the twentieth century, with prominent British authors arguing for a unitary model.

Melancholia was described as a specific disorder by Aubrey Lewis (1934b) in his detailed study of 61 melancholic patients:

Melancholia is one of the great words in psychiatry. SuVering many mutations, at one time the tenacious guardian of outworn schemes or errant theories; presently misused, cavilled at, dispossessed, it has endured into our own times, a part of medical terminology no less than of common speech. It would seem profitable to consider the history of this word, and of the states of fear and distress with which it has from the beginning been associated.