Medieval depression was understood as a complex affliction which could take many forms, but two main frameworks existed. One originated from religion, and was called acedia. The other came from medicine, and was called melancholy.

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Acedia was technically a sin. It was first depicted as the illness of isolated monks, and characterised as "lassitude, weariness, inaction, carelessness" (Jackson, 1981). While acedia was one of the cardinal vices, it was also already described as a disease, one that arose from low spiritual life, and "a state of depression" (Wenzel, Sin of Sloth).

At first, acedia was mostly known in religious circles, but as confession became obligatory following the council of 1216, and as priests had access to books listing the various sins to help in confession, they started to spread this concept.

Acedia was often compared to other afflictions, such as sloth, desperatio (literally, despair) and melancholy. Thomas Aquinas associated acedia with the passions, making it part of the physical world. This made acedia more forgivable, as it originated nature more than sin. This brought its definition slightly closer to the second important depressive form: melancholy.

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Melancholy was classified as an illness. It was already described in antiquity, as a disorder of the black bile. Medieval descriptions stated that "the sufferer was sad, misanthropic, suspicious, tired of life, and often, but not always, afflicted with one of a number of circumscribed delusions." These delusions could range from hallucinations to delusions of being "somebody else, perhaps a king, an animal (often a cockerel), or a demon." (Sari Katajala-Peltomaa, 2014). Melancholy was also at times accompanied by suicidal feelings, and a number of fears, like fearing to be swallowed by the earth.

Melancholy was believed to be a natural disposition that some people were born with, but it was also seen as a consequence of ageing. It is generally believed that a melancholic character was met with compassion, rather than agression. (Jackson, 1981).

A famous medieval sufferer of melancholy was King Duarte of Portugal. He wrote about his affliction, describing his "sin of sadness that proceeds from disordered will". He was thought to be predisposed to melancholy, but it was also understood that tragic events had worsened the disease. (McCleery, 2009).

A variant of melancholy was lovesickness. This was a particularly common theme of late medieval literature, with the image of the "depressed, fretting, passive, and physically ill lover". (Toohey, 1992).

The remedies for melancholy were to counter it with its opposite. Sufferers were to surround themselves with joy and laughter. Spending time with friends and making one's home pleasant was important. If the sufferer was willing to hear reason, then talking through the delusions could be attempted. For lovesickness in particular, listening to music and song was suggested. Remedies also included special diets, ways of sleeping, and some medicines. But all of these methods came with disclaimers that they did not always work as intended. (Suciu, 2019; Katajala-Peltomaa 2014). Melancholy was understood to be a difficult ill to cure throughout the entire middle ages.

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References:

* Sari Katajala-Peltomaa and Susanna Niiranen, Mental (Dis)Order in Later Medieval Europe, volume 12, Brill, 2014.

* Stanley W. Jackson, ACEDIA THE SIN AND ITS RELATIONSHIP TO SORROW AND MELANCHOLIA IN MEDIEVAL TIMES, Bulletin of the History of Medicine, Vol. 55, No. 2 (SUMMER 1981), pp. 172-185.

* TOOHEY, PETER. “Love, Lovesickness, and Melancholia.” Illinois Classical Studies, vol. 17, no. 2, 1992, pp. 265–286.

* Iona McCleery, Both “illness and temptation of the enemy”: melancholy, the medieval patient and the writings of King Duarte of Portugal (r. 1433–38), 2009, Pages 163-178.