Medicalizing melancholia: exploring profiles of psychiatric professionalization

The nineteenth century was the site of radical changes in understanding mental illness. The professionalization of psychiatry consisted primarily of the discipline's aspiration to the status of an expert medical subspecialty. While all forms of insanity were eventually reframed in medical terms, melancholia--for moral and nosological reasons--assumed a special role that made it an ideal diagnosis for conceptual reframing. Our analysis of the journal literature of the nineteenth and early twentieth centuries in North America and Germany traces several ways in which melancholia was medicalized. As the care for the insane shifted into the professional realm of physicians and medical terminology came to replace prior descriptors of mental illness, melancholia was replaced by depression. In addition, the process of delineating affective pathology assumed a distinctly medical flavor. Finally, melancholia was firmly medicalized when its boundaries blurred with neurasthenia. Differences in how ordinary affective terms became medicalized in German and North American psychiatry illustrate the importance of local historical approaches.