The advent of guilt feelings as a common depressive symptom: a historical comparison on two continents.

Historical shifts in the symptomatology of mental disease are surprisingly overlooked but common phenomena that should cast considerable light on the relation between social and intrapsychic processes. The enormous increase in chronicity and mortality in mental hospitals during the second half of the 19th century, and the shift from the shell-shock of the first World War to the battle fatigue of the second are examples which have been well documented but not well explained. The advent of guilt feelings in depression or melancholia is a lesser known instance but one with perhaps greater theoretical significance. Melancholia has been known almost throughout recorded history, but until the 16th century the number of recorded cases exhibiting exaggerated guilt feelings and self-accusations was very small, and the old physicians did not include them in their descriptions of the condition. In Asia and in Africa, moreover, it is claimed that these symptoms are rare even today, except among the Westernized. If we fully understood the other features of the disease or if the symptoms had no relevance to course and treatment, these facts might be treated simply as curiosities; but neither is the case. Depression is still not adequately understood, and some theories on it derive largely from the exaggerated guilt feelings and the psychic structure which is supposed to produce the latter. Hence it could be instructive to examine under what conditions these symptoms first became common in different societies.