Virginia Institute of Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University.
JAMA Psychiatry. 2020 Aug 1;77(8):863-868. doi: 10.1001/jamapsychiatry.2019.4709.
The modern concept of depression arose from earlier diagnostic formulations of melancholia over the hundred years from the 1780s to the 1880s. In this historical sketch, this evolution is traced from the writings of 12 authors outlining the central roles played by the concepts of faculty psychology and understandability. Five of the authors, writing from 1780 through the 1830s, including Cullen, Pinel, and Esquirol, defined melancholia as a disorder of intellect or judgment, a "partial insanity" often, but not always, associated with sadness. Two texts from the 1850s by Guislain, and Bucknill and Tuke were at the transition between paradigms. Both emphasized a neglected disorder-melancholia without delusions-arguing that it reflected a primary disorder of mood-not of intellect. In the final phase in the 1860s to 1880s, 5 authors (Griesinger, Sankey, Maudsley, Krafft-Ebing, and Kraepelin) all confronted the problem of the cause of delusional melancholia. Each author concluded that melancholia was a primary mood disorder and argued that the delusions emerged understandably from the abnormal mood. In this 100-year period, the explanation of delusional melancholia in faculty psychology terms reversed itself from an intellect to mood to a mood to intellect model. The great nosologists of the 19th century are often seen as creating our psychiatric disorders using a simple inductive process, clustering the symptoms, signs, and later the course of the patients. This history suggests 2 complexities to this narrative. First, in addition to bottom-up clinical studies, these nosologists were working top-down from theories of faculty psychology proposed by 18th century philosophers. Second, for patient groups experiencing disorders of multiple faculties, the nosologists used judgments about understandability to assign primary causal roles. This historical model suggests that the pathway from patient observation to the nosologic categories-the conceptual birth of our diagnostic categories-has been more complex than is often realized.
从 18 世纪 80 年代到 19 世纪 80 年代的一百年间，现代抑郁症的概念源于早期忧郁症的诊断。在这篇历史综述中，从 12 位作者的著作中追溯了这种演变，这些著作概述了官能心理学和可理解性概念的核心作用。其中 5 位作者（包括卡伦、皮内尔和埃斯基罗尔）从 1780 年至 19 世纪 30 年代将忧郁症定义为智力或判断力的障碍，一种“部分精神错乱”，通常但并非总是与悲伤有关。19 世纪 50 年代的两篇文本，一篇来自于吉斯兰，另一篇来自于巴克纳尔和图克，标志着这一模式的转变。两者都强调了一种被忽视的障碍——没有妄想的忧郁症，认为它反映了一种主要的情绪障碍——而不是智力障碍。在 19 世纪 60 年代至 80 年代的最后阶段，5 位作者（格里辛格、桑基、莫兹利、克拉夫特-埃宾和克雷佩林）都面临着妄想性忧郁症病因的问题。每位作者都得出结论，忧郁症是一种主要的情绪障碍，并认为妄想是从异常情绪中可以理解地产生的。在这 100 年的时间里，用官能心理学术语来解释妄想性忧郁症的解释从智力到情绪再到情绪到智力的模式发生了逆转。19 世纪的伟大分类学家们常常被认为是用简单的归纳法创造了我们的精神障碍，将症状、体征和后来的患者病程聚类。这段历史为这个叙述提出了两个复杂性。首先，除了自下而上的临床研究，这些分类学家还自上而下地从 18 世纪哲学家提出的官能心理学理论中工作。其次，对于经历多种官能障碍的患者群体，分类学家使用可理解性判断来分配主要的因果作用。这种历史模式表明，从患者观察到分类学类别（我们诊断类别的概念诞生）的途径比通常意识到的要复杂得多。
