Recognizing and Treating Depression in Medieval Times: An Examination

Middle Age society, with its primitive understanding of medicine and complex spiritual beliefs, faced challenges in recognizing and treating conditions like depression. However, works of art, literature, and medical texts from the time provide some insights into how depression was perceived and approached during this period.

Depression in the Medieval Era

Medicine in the Middle Ages was incredibly primitive by today's standards. Depression as we know it was not recognized as an illness. Instead, the concept of melancholia was widely understood. This term referred to a state of being depressed, often associated with a build-up of black bile, one of the four humours believed to affect human health and mood.

The Four Humours Theory

According to the four humours theory, a balance between blood, phlegm, black bile, and yellow bile was necessary for good health. This theory was heavily influenced by the works of the Greek physician Galen, who described the humours as responsible for both physical and emotional well-being.

Blood: Dominated those who were sanguine and generally healthy and optimistic. Phlegm: Dominated those who were phlegmatic and calm and reserved. Black Bile: Dominated those who were melancholic and prone to sadness and depression. Yellow Bile: Dominated those who were choleric and fiery and quick-tempered.

If an imbalance occurred, it was believed that a person's mood and health could be negatively affected. Treatment focused on restoring this balance through a combination of spiritual, psychological, and physical methods.

Treatment Approaches

As previously mentioned, treatment for depression in the Middle Ages would have been both spiritual and psychological, with a strong emphasis on the spiritual aspects. Confession and counseling from a confessor were common practices. However, given the societal structure, there were likely few if any "shrinks" treating patients in this context.

Physical treatments also played a role, including laxatives, purgatives, and blood-letting. These practices aimed to eliminate the excess black bile believed to cause melancholia. It's important to note that the effectiveness and safety of these treatments are subject to question from a modern medical perspective.

Historical References and Cultural Representations

While depression wasn't fully recognized in the Middle Ages, there are historical references to similar conditions described in ancient texts. Sumerian texts and Biblical references have been cited, though it's unclear how these conditions were treated in the Middle Ages.

A more direct reference to depression can be found in the works of Shakespeare. For example, in his play Antony and Cleopatra, Cleopatra is described as being in a melancholic state, which could be interpreted as depression. Similarly, in Romeo and Juliet, the lovers experience a form of broken heart, which could be seen as a precursor to depression.

One of the most famous representations of depression during the Middle Ages is Albrecht Dürer's woodcut, Melancholia. A personal visit to his workshop in Nürnberg, where I purchased a print, further solidifies the cultural understanding of melancholia.

During the Middle Ages, fish in sweet sauce was a dish specifically tailored for those suffering from melancholia. Cod or haddock, prepared with an abundance of sugar, was the typical choice. This recipe underscores the belief that certain foods could impact a person's mood by balancing the humours. It's worth noting that during this period, sugar was a highly valued and rare commodity, considered more a medicine than a sweetener.

The popularity of this dish changed as sugar production increased in the 15th and 16th centuries, driven by the rise of plantations in the Canaries and the West Indies. By the late middle ages, sugar had become more widely available, changing the culinary landscape and the medicinal use of sweet treats.

Conclusion

The recognition and treatment of depression in the Middle Ages were vastly different from modern practices. While medication was not as sophisticated as today, treatments like confession, counseling, and dietary regimens were common. The study of these historical approaches offers valuable insights into the human condition, even centuries ago.