Hello, again, loyal readers, editor Kevin here welcoming you to guest writer Isabel DuBois' third installment in a three-part series examining the history of mental health treatment for women in the 19th century. If you haven't read parts and , I encourage you to check them out.
What we recognize today as depression was, in the Victorian era, popularly known as melancholia or melancholy. The name "melancholia" comes from the old medical belief in the four humours. Early medicine believed that every disease or ailment was caused by an imbalance in one or more of the four basic bodily liquids, or humours. According to Hippocrates and subsequent tradition, melancholy was caused by an excess of black bile, hence the name, which means "black bile" in Greek. A person whose constitution tended to have a preponderance of black bile had a melancholic disposition. Melancholy, like depression, ranged in seriousness from mild and temporary bouts of sadness to longer, more extreme episodes, characterized by insomnia, lack of appetite, and suicidal thoughts. Symptoms of melancholy were easy to recognize, although medical opinions often differed on what caused the condition. As a result, treatment plans for the melancholic patient varied. In an article in the 1850 edition of the People’s Medical Journal, Dr. Thomas Harrison Yeoman shared a catalogue of symptoms for melancholy, writing that “the leading characteristics of melancholy are—a love of solitude, gloom, fear, suspicion, and taciturnity.”
Many medical practitioners of the time found it useful to divide melancholy into categories by symptom. This served to separate the more severe forms of melancholy, such as those accompanied by violent outbursts, mania, or delusions, from the more “ordinary” forms of melancholy in which the patient was merely reclusive and sad. In his 1871 book Insanity and its Treatment, Dr. G. Fielding Blandford classified melancholy as being either acute or subacute. Dr. Thomas Yeoman goes a step further in his book, Encyclopaedia of Domestic Economy, dividing melancholy into four separate types: 1) Gloomy Melancholy; 2) Restless Melancholy; 3) Mischievous Melancholy; and 4) Self-Complacent Melancholy.
Unfortunately for Victorian doctors and their patients, there were no antidepressant drugs available in the nineteenth century. Instead, doctors generally treated melancholy by recommending specialized diets and regimens of rest and relaxation via the rest cure, a treatment created by Silas Weir Mitchell, which consisted of weeks of forced feedings and bed rest with no mental stimulation. Some doctors would also recommend the “shower bath,” advising patients to shower often and, afterward, to “rub the whole body well with coarse flannel.” This was a much less traumatic option than the water therapy offered at some asylums, wherein patients were plunged into cold baths or, as in one case related by Dr. John Bell in his 1859 book A Treatise on Baths, “bound in a cart, stripped, and blindfolded” and then subjected to “a great Fall of Water” from twenty feet above. Some Victorian doctors went further with their treatments, advising their melancholy patients to drink alcohol, to take morphine, or even, in the case of women (if they were single) to get married and start a family. Dr. Blandford recommended a diet which featured alcohol at almost every meal, followed by a dose of chloral or morphia, intense sedatives, at night to help the melancholic patient sleep.
While great strides have been made in the field of psychology, we can’t dismiss entirely the Victorian efforts to understand the mind. Indeed, compared with the early asylums—rough, brutal places where the most disturbed patients were chained in windowless rooms with straw bedding—the mid-Victorian era was positively progressive. Theories that still hold today, such as the value of occupational therapy, were becoming fashionable. It was here that the shift away from the idea of control from without, via chains and shackles, and towards a patient’s control from within, via treatment or cure, began.
Sources:
Bell, John. A Treatise on Baths: Including Cold, Sea, Warm, Hot, Vapour, Gas, and Mud Baths. Philadelphia: Lindsay & Blakiston, 1859.
Blandford, G. Fielding. Insanity and its Treatment. Philadelphia: Henry C. Lea, 1871.
Flint, Austin. Clinical Medicine: A Systematic Treatise on the Diagnosis and Treatment of Diseases. Philadelphia: Henry C. Lea, 1879.
Matthews, Mimi. MimiMatthews.com. April 3, 2017. Accessed August 20, 2021.
Maudsley, Henry. The Physiology and Pathology of the Mind. New York: D. Appleton and Company, 1872.
Nasim Jumana, Rumaisa. City University of New York Masters Thesis. 2019.
Webster, Thomas. Encyclopaedia of Domestic Economy. New York: Harper & Brothers, 1855.
Yeoman, Thomas Harrison. The People’s Medical Journal, and Family Physician, Vol. L. London: George Vickers, Strand, 1850.