page_title: History of depression
section_title: 20th and 21st centuries
hierarchical_section_title: History of depression / 20th and 21st centuries
caption_attribution_description: Deutsch: Sigmund Freud war ein bedeutender österreichischer Arzt, der als Begründer der Tiefenpsychologie und Psychoanalyse gilt. English: Sigmund Freud was an Austrian neurologist and the founder of the psychoanalytical school of psychology. Čeština: Neurolog a zakladatel psychoanalýzy Sigmund Freud
context_page_description: What was previously known as melancholia and is now known as clinical depression, major depression, or simply depression and commonly referred to as major depressive disorder by many Health care professionals, has a long history, with similar conditions being described at least as far back as classical times.
context_section_description: The influential system put forward by Kraepelin unified nearly all types of mood disorder into manic–depressive insanity. Kraepelin worked from an assumption of underlying brain pathology, but also promoted a distinction between endogenous (internally caused) and exogenous (externally caused) types.
  German psychiatrist Kurt Schneider coined the terms endogenous depression and reactive depression in 1920, the latter referring to reactivity in mood and not reaction to outside events, and therefore frequently misinterpreted. The division was challenged in 1926 by Edward Mapother who found no clear distinction between the types.
  The unitarian view became more popular in the United Kingdom, while the binary view held sway in the US, influenced by the work of Swiss psychiatrist Adolf Meyer and before him Sigmund Freud, the father of psychoanalysis.
  Freud had likened the state of melancholia to mourning in his 1917 paper Mourning and Melancholia. He theorized that objective loss, such as the loss of a valued relationship through death or a romantic break-up, results in subjective loss as well; the depressed individual has identified with the object of affection through an unconscious, narcissistic process called the libidinal cathexis of the ego.
  Such loss results in severe melancholic symptoms more profound than mourning; not only is the outside world viewed negatively, but the ego itself is compromised. The patient's decline of self-perception is revealed in his belief of his own blame, inferiority, and unworthiness. He also emphasized early life experiences as a predisposing factor.
  Meyer put forward a mixed social and biological framework emphasizing reactions in the context of an individual's life, and argued that the term depression should be used instead of melancholia.
  The DSM-I (1952) contained depressive reaction and the DSM-II (1968) depressive neurosis, defined as an excessive reaction to internal conflict or an identifiable event, and also included a depressive type of manic-depressive psychosis within Major affective disorders.
  In the mid-20th century, other psychodynamic theories were proposed.  Existential and humanistic theories represented a forceful affirmation of individualism. Austrian existential psychiatrist Viktor Frankl connected depression to feelings of futility and meaninglessness. Frankl's logotherapy addressed the filling of an "existential vacuum" associated with such feelings, and may be particularly useful for depressed adolescents.
  American existential psychologist Rollo May hypothesized that "depression is the inability to construct a future". In general, May wrote, "depression ... occur[s] more in the dimension of time than in space," and the depressed individual fails to look ahead in time properly. Thus the "focusing upon some point in time outside the depression ... gives the patient a perspective, a view on high so to speak; and this may well break the chains of the ... depression."
  Humanistic psychologists argued that depression  resulted from an incongruity between society and the individual's innate drive to self-actualize, or to realize one's full potential. American humanistic psychologist Abraham Maslow theorized that depression is especially likely to arise when the world precludes a sense of "richness" or "totality" for the self-actualizer.
  Cognitive psychologists offered theories on depression in the mid-twentieth century. Starting in the 1950s, Albert Ellis argued that depression stemmed from irrational "should" and "musts" leading to inappropriate self-blame, self-pity, or other-pity in times of  adversity. Starting in the 1960s, Aaron Beck developed the theory that depression results from a "cognitive triad" of negative thinking patterns, or "schemas," about oneself, one's future, and the world.
  A half century ago, diagnosed depression was either  endogenous (melancholic), considered a biological condition, or reactive (neurotic), a reaction to stressful events. Debate has persisted for most of the 20th century over whether a unitary or binary model of depression is a truer re
caption: Sigmund Freud argued that depression, or melancholia, could result from loss and is more severe than mourning.
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