Krafft-Ebing's 1874 monograph “Melancholia: A Clinical Study”

Abstract

BackgroundIn 1874, the German neuropsychiatrist Richard von Krafft-Ebing (RKE) published one of the most influential monographs on melancholia in the latter half of the 19th century entitled “Melancholia: A Clinical Study.” This monograph has not been translated into English nor extensively discussed in the modern Anglophonic literature. ResultsThe monograph has three chapters describing, respectively, Melancholia without Delusions, Melancholia with precordial anxiety and Psychotic Melancholia. The last chapter includes a discussion of retarded and agitated forms of melancholia. The text combines detailed vivid clinical descriptions with etiologic theories involving mental, brain and autonomic processes. RKE supports the psychalgic theory of melancholia in which, analogous to Tic Douloureux causing terrible pain to a normal touch, brain ganglia became hypersensitive and create a sustained mental pain in response to normal intrapsychic or environmental stimuli. RKE was especially interested in the development of delusions in melancholia, for which he proposed several distinct pathways. His clinical description of melancholia, including 8 of 9 DSM-5 A criteria for major depression, is quite modern. ConclusionsThis essay, accompanied by an on-line complete English translation of RKE's essay, provides the opportunity for Anglophonic clinicians, students, and scholars to access this historically important essay on Melancholia. The psychophysiological framework of psychalgia adopted by RKE could explained how normal social and introspective experiences would, in melancholic patients, be interpreted in a distorted manner, reinforcing themes of inadequacy, failure, and worthlessness, thereby producing a sustained mood state of intense mental pain of melancholia or psychalgia.