Le mal n'est pas à notre porte, il rôde en chacun de nous, parfois habilement déguisé par l'idéalisme et la piété religieuse.

Hieronymus Bosch, Ecce Homo, 1490.

Melancholia is a concept of depressive illness with an extensive literature and a detailed history. Its recognition as a form of ‘‘madness’’ with ‘‘bodily causes’’ has been consistent for 3000 years. Except for two periods in western history – the Middle Ages, when church teachings dominated western thought, and again in the twentieth century, particularly in the USA, when psychoanalytic notions dominated psychiatric thinking – melancholia was identified as a disorder in brain function.

Melancholia was identified by Hippocrates in the fifth century BCE as a persistent sadness and morbid thoughts that had their source in a disorder of the brain. In ‘The Sacred Disease,’ he wrote:

And men ought to know that from nothing else but thence [from the brain] come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations. And by this, in an especial manner, we acquire wisdom and knowledge, and see and hear, and know what are foul and what are fair, what are bad and what are good, what are sweet and what are unsavory . . . And by the same organ we become mad and delirious, and fears and terrors assail us, some by night, and some by day, and dreams and untimely wanderings, and cares that are not suitable, and ignorance of present circumstances . . . All these things we endure from the brain when it is not healthy, but is more hot, more cold, more moist, or more dry than natural . . . And we become mad from humidity [of the brain].

Hippocrates described a specific syndrome, not a vague dysphoria or dourness of character. Although rooted in beliefs in the essential balance of four body humors for health, other early images of melancholia define the same syndrome. Galen and Arateus, both writing in the first century CE, considered melancholia as an aZiction of the brain. Arateus described:

And yet in certain of these cases there is mere anger and grief and sad dejection of mind . . . they are suspicious of poisoning or flee to the desert from misanthropy or turn suspicious or contract a hatred of life. Or if at any time a relaxation takes place, in most cases hilarity supervenes. The patients are dull or stern, dejected or unreasonably torpid . . . they also become peevish, dispirited and start up from a disturbed sleep.

Plutarch noted that when a man is melancholic:

Every little evil is magnified by the scaring spectres of his anxiety. He looks on himself as a man whom the gods hate and pursue with their anger . . . Awake, he makes no use of his reason; and asleep, he enjoys no respite from his alarms. His reason always slumbers; his fears are always awake. Nowhere can he find escape from his imaginary terrors.