The descriptive psychopathology of melancholia in Roubinovitch and Toulouse's 1897 monograph “La Mélancolie”

Our modern syndrome of major depression developed over the 19th century and assumed its largely current form in Europe during the last decades of that century. A defining monograph in that historical development in German-speaking Europe was published by Krafft-Ebing in 1874. In this article, we provide a detailed commentary (and an English translation) of key sections of a monograph—“La Mélancolie” (The Melancholy) published by Roubinovitch and Toulouse in 1897—that plays a parallel role in the Francophone world. We emphasize six features of this important document. First, is it thoroughness, covering, with often vivid descriptions, the symptoms, signs, subtypes, course of illness, and outcome of melancholia. Second, this work describes the key features of the evolution of the concept of melancholia over the prior century. Third, we also see in this monograph important references to the leading explanatory psychophysiological model for melancholia developed in the middle third of the 19th century—melancholia as psychalgia or “mental pain.” Fourth, the authors are committed to attempting to understand, in psychological terms, key features of the melancholic syndrome and in particular the development of delusions. Fifth, they give great emphasis to a symptom/sign pair in their diagnosis and description of melancholia: psychological suffering accompanied with resignation and “psychophysical decrease.” Sixth, these authors attend to the lived experienced of their melancholic patients, considering some key themes, such as derealization, now emphasized in phenomenological studies of depression. Seventh, they have an insightful view of the evolution of psychiatric diagnoses that applies to the modern day—that disease identification in psychiatry lags behind that most parts of medicine as our diagnostic categories are still “only provisional symptomatic groupings which will one day be replaced by more exact conceptions of the nature of the relationships which unite the facts.”