Mohammed T. Abou-Saleh

HISTORICAL BACKGROUND 5forces also introduced unwarranted clinical strictures, such as theexclusion of non-cognitive symptoms 43,44 and false age boundaries,which took many years to disappear.THE FORMATION OF THE CONCEPT OFINVOLUTIONAL MELANCHOLIAThe concept of ‘‘senile or involutional psychoses’’, which featuredso prominently in Kraepelin’s early classification, included: preseniledelusional insanity, senile dementia, late catatonia andinvolutional melancholia 45,46 . The reasons that led Kraepelin toseparate this group were mostly theoretical, to wit, that theyappeared during a period of life when ‘‘sclerotic’’ changes werebeginning to occur; the same factor accounted for their badprognosis 46 .The general history of melancholia and depression has beenanalysed elsewhere 47–49 . Suffice it to say here that by the 1860sdepression was considered to be an independent syndromeresulting from a primary disorder of affect. This meant thathallucinations, delusions and cognitive impairment were secondaryto the pathological feelings. This conviction was particularlystrong towards the end of the century, when emotional mechanismsbecame popular in the explanation of most forms of mentaldisorder 50 . By the end of the century the metaphor of depressionas a form of ‘‘reduction’’ or ‘‘loss’’ had become firmly established.No better example can be found than the fact that up to 1893(fourth edition) Kraepelin felt obliged to classify all forms ofagitated depression as mania! 51 .KRAEPELIN AND INVOLUTIONAL MELANCHOLIAMuch of the current confusion on the meaning of involutionalmelancholia can be explained if attention is given to thecircumstances of its historical development (for a full analysis ofthis process and list of references, see reference 52). Theconventional story 53–56 is that up to the seventh edition of histextbook Kraepelin considered involutional melancholia as aseparate disease, and that when confronted by the evidencecollected by Dreyfus 57 , he decided to include it, in the eighthedition, under the general heading of manic depressive insanity.Indeed, this account was first offered by Kraepelin himself (seereference 57, p. 169).The story is, however, more complex and it is unlikely that thefindings of Dreyfus alone caused Kraepelin’s change of heart. Forexample, Thalbitzer 58 claimed that his own work had also beeninfluential (p. 41). In the eighth edition Kraepelin abandoned notonly involutional melancholia but the entire group of ‘‘senilepsychoses’’. A recent statistical analysis of Dreyfus’s old series hasalso shown that his conclusion that the natural history ofinvolutional melancholia was no different from that of depressionaffecting younger subjects was wrong 51 .CONCLUSIONSThis short chapter, providing a historical vignette on the origin ofthe language of old age psychiatry, suggests that it was bornduring the nineteenth century from three conceptual sources:theories of ageing, neurobiological hypotheses concerning brainsclerosis, and the realization that specific forms of mental disordermight affect the elderly. Two clinical illustrations were provided,one pertaining to the origins of the concept of senile dementia,and the other to the notion of involutional melancholia.REFERENCES1. Huber J-P, Gourin P. Le vieillard dément dans l’Antiquité classique.Psychiatrie Française 1987; 13: 12–18.2. Minois G. Histoire de la Vieillesse. De l’Antiquite´ a` la Renaissance.Paris: Fayard, 1987.3. Reveillé-Parise JH. 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