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Melancholia has always been on the minds of philosophers and healers. Hippocrates, Sufi mystics, Romantic poets, Buddhists, and Ayurvedic practitioners have described it as an inexplicable despondency, attributed variously to a loss of religious faith, overinvestment in materialism, or the dysregulation of internal somatic processes. In a way, the history of melancholy is the history of humankind's struggle to describe and treat suffering. This tradition has not ended with the modern-day equivalent of melancholy, major depressive disorder.
Despite the diversity of explanations, melancholia was always understood as a complex process through which the psychological experience of sadness was materialized. Similarly, major depressive disorder is understood as a psychobiological disorder that includes a sad or depressed mood with somatic disturbances of appetite, energy, and sleep. However, we continue to struggle to understand why people become depressed, in the hope we might better heal them. Complicating matters is the fact that how one's suffering is expressed varies significantly across race, culture, and class.
Expressions of depression are overdetermined by the personal meanings individuals attach to their symptoms. Does the personal context of depressive symptoms confound today's standardized treatments for depression? And the questions of evolutionary psychiatry also cloud the picture: Is depression an appropriate response to external conditions that provoke psychic pain? Does this imply the need for social treatments as opposed to individualized ones?
The article under review speaks to some of these ancient questions. The study is unique in that it is the first attempt to compare the efficacy of short-term dynamic therapy (specifically, supportive-expressive treatment) to contemporary antidepressant therapy, as well as to a placebo control for the treatment of depression. Also notable is that the study population was recruited from a poor urban population with a l