Melancholia or melancholy (from Greek: µέλαινα χολή melaina chole,[1] meaning black bile)[2] is a concept found throughout ancient, medieval, and premodern medicine in Europe that describes a condition characterized by markedly depressed mood, bodily complaints, and sometimes hallucinations and delusions.

Hippocrates and other ancient physicians described melancholia as a distinct disease with mental and physical symptoms, including persistent fears and despondencies, poor appetite, abulia, sleeplessness, irritability, and agitation.

[13] Today, the term "melancholia" and "melancholic" are still used in medical diagnostic classification, such as in ICD-11 and DSM-5, to specify certain features that may be present in major depression.

In the complex elaboration of humorist theory, it was associated with the earth from the Four Elements, the season of autumn, the spleen as the originating organ and cold and dry as related qualities.

[7] In the 10th century Persian physician Al-Akhawayni Bokhari described melancholia as a chronic illness caused by the impact of black bile on the brain.

"[28] In Middle-Ages Europe, the humoral, somatic paradigm for understanding sustained sadness lost primacy in front of the prevailing religious perspective.

[10][31] In his study of French and Burgundian courtly culture, Johan Huizinga[32] noted that "at the close of the Middle Ages, a sombre melancholy weighs on people's souls."

Ideas of reflection and the workings of imagination are blended in the term merencolie, embodying for contemporaries "a tendency", observes Huizinga, "to identify all serious occupation of the mind with sadness".

[34] Painters were considered by Vasari and other writers to be especially prone to melancholy by the nature of their work, sometimes with good effects for their art in increased sensitivity and use of fantasy.

[36] The image in turn inspired a passage in The City of Dreadful Night by James Thomson (B.V.), and, a few years later, a sonnet by Edward Dowden.

The most extended treatment of melancholia comes from Robert Burton, whose The Anatomy of Melancholy (1621) treats the subject from both a literary and a medical perspective.

[37] But to leave all declamatory speeches in praise of divine music, I will confine myself to my proper subject: besides that excellent power it hath to expel many other diseases, it is a sovereign remedy against despair and melancholy, and will drive away the devil himself.

Ismenias the Theban, Chiron the centaur, is said to have cured this and many other diseases by music alone: as now they do those, saith Bodine, that are troubled with St. Vitus's Bedlam dance.

Another major English author who made extensive expression upon being of an melancholic disposition is Sir Thomas Browne in his Religio Medici (1643).

In the visual arts, this fashionable intellectual melancholy occurs frequently in portraiture of the era, with sitters posed in the form of "the lover, with his crossed arms and floppy hat over his eyes, and the scholar, sitting with his head resting on his hand"[44] – descriptions drawn from the frontispiece to the 1638 edition of Burton's Anatomy, which shows just such by-then stock characters.

In the 20th century, much of the counterculture of modernism was fueled by comparable alienation and a sense of purposelessness called "anomie"; earlier artistic preoccupation with death has gone under the rubric of memento mori.

In 1907, the German psychiatrist Emil Kraepelin influentially proposed the existence of a condition he called 'involutional melancholia', which he thought could help explain the more frequent occurrence of depression among elderly people.

[49] He surmised that in the elderly "the processes of involution in the body are suited to engender mournful or anxious moodiness", though by 1913 he had returned to his earlier view (first expounded in 1899) that age-related depression could be understood in terms of manic-depressive illness.

[51] In 2006, Michael Alan Taylor and Max Fink also defined melancholia as a systemic disorder that could be identified by depressive mood rating scales, verified by the presence of abnormal cortisol metabolism.

[57] MRI studies have indicated that melancholic depressed patients have issues with the connections between different regions of the brain, specifically the insula and fronto-parietal cortex.