Melancholia or melancholy (Ancient Greek: μελαγχολία, romanized: melancholía; from μέλαινα χολή, mélaina cholḗ, 'black bile') is a concept found throughout ancient, medieval, and premodern medicine in Europe that describes a condition characterized by markedly depressed mood, bodily complaints, and sometimes hallucinations and delusions. Besides a pathological condition, melancholy could also refer to a mood or temperament and at times it was even used as a description of the human condition in general. Melancholy (or more precisely the 'black bile', from which melancholy derives its name) was regarded as one of the four temperaments matching the four humours. Until the 18th century, doctors and other scholars classified melancholic conditions as such by their perceived common cause – an excess of a notional fluid known as "black bile", which was commonly linked to the spleen. Hippocrates and other ancient physicians described melancholia as a distinct disease with mental and physical symptoms, including persistent fears and despondencies, poor appetite, abulia, sleeplessness, irritability, and agitation. Later, fixed delusions were added by Galen and other physicians to the list of symptoms. In the Middle Ages, the understanding of melancholia shifted to a religious perspective, with sadness seen as a vice and demonic possession, rather than somatic causes, as a potential cause of the disease. During the late 16th and early 17th centuries, a cultural and literary cult of melancholia emerged in England, linked to Neoplatonist and humanist Marsilio Ficino's transformation of melancholia from a sign of vice into a mark of genius. This fashionable melancholy became a prominent theme in literature, art, and music of the era. Between the late 18th and late 19th centuries, melancholia was a common medical diagnosis. In this period, the focus was on the abnormal beliefs associated with the disorder, rather than depression and affective symptoms. In the 19th century, melancholia was considered to be rooted in subjective 'passions' that seemingly caused disordered mood (in contrast to modern biomedical explanations for mood disorders). In Victorian Britain, the notion of melancholia as a disease evolved as it became increasingly classifiable and diagnosable with a set list of symptoms that contributed to a biomedical model for understanding the mental disease. However, in the 20th century, the focus again shifted, and the term became used essentially as a synonym for depression. Indeed, modern concepts of depression as a mood disorder eventually arose from this historical context. Today, the term "melancholia" and "melancholic" are still used in medical diagnostic classification, such as in ICD-11 and DSM-5, to specify certain features that may be present in major depression. The 20th and 21st century accounts of depression are the successors of melancholia in psychiatry, but melancholia (or melancholy) also had a much wider use before the 19th century. It was a subject with which not only psychiatrists and doctors, but also philosophers, poets, artists, and writers all engaged. This led to a relatively ambiguous field of meaning, in which melancholy was accommodated within an understanding of human nature on the basis of humoral theory. Related terms used in historical medicine include lugubriousness (from Latin lugere, 'to mourn'), moroseness (from Latin morosus, 'self-will or fastidious habit'), wistfulness (from a blend of wishful and the obsolete English wistly, meaning 'intently'), and saturnineness (from Latin Saturninus, 'of the planet Saturn').
Early history
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