From 2014:

EPA-1246 – Typus melancholicus: from tellenbach to the nowadays

C. Widakowich

Psychiatry, Ambroise Paré Hospital, Brussels, Belgium

DOI: http://dx.doi.org/10.1016/S0924-9338(14)78484-6

Thank you Béatrice. The newest paper is the following, indeed:

The concept of Typus Melancholicus (TM) has been proposed by German psychiatrist Hubertus Tellenbach (1914–1994) in 1960 to describe the pre-morbid and inter-morbid personality of endogenous or melancholic depression. This entity has been traced through the study of 119 melancholic's patients, stayed at the University Hospital of Heidelberg, which showed distinctive personality traits: the order attachment, strong moral conscience, intolerance ambiguity and hypernomie-heteronomy. Tellenbach uses a typological and phenomenological approach allows the description of styles, ways of being and becoming ill, with a vulnerability to specific situations (moving, pregnancy, career change). Melancholy would settle after the meeting between the TM with a particular vulnerable situation. This clearly calls into question the classical idea that sees Kraepelinienne endogenous depression as a disease determined by heredity and lack of stressors.

DOI: http://dx.doi.org/10.1016/S0924-9338(14)78484-6

The question doesn't ask for general research on TMP criteria or validity, but states that they can be used to "prevent the development of depressive episodes". An indicator is a diagnostic tool, not a therapeutic treatment. An indicator, by itself, cannot prevent any disorder.

If the questioner is trying to find a treatment, rather than a diagnostic indicator, they will not find it in the TMP criteria or instruments, good as they have been shown to be as an indicator.

The best treatments for depressive episodes of most types are still the traditional kinds of psychotherapy, augmented by pharmacology when indicated and by the technique of transcending (as taught by Transcendental Meditation, Natural Stress Relief, or similar structured courses).

Disclaimer: I am a teacher and researcher specializing in transcending. I am not a trained mental health professional. I do not receive a salary for my work.

References:

Dimensions of the Typus melancholicus personality type.

Kronmüller KT1, Backenstrass M, Kocherscheidt K, Hunt A, Fiedler P, Mundt C.

Transcendental Meditation. http://www.tm.org/research-on-meditation ..

Natural Stress Relief: http://www.nsrusa.org/research.php .

In my opinion Typus Melancholicus is the consequence of misunderstanding depression.

As a matter of fact, it is a potentially curable illness, starting possibibly  at birth, and not a definitive, therefore incurable, state.

This mistake is the consequence of both under-diagnosing depression, especially bodily features, and of a poorly effective treatment.

Moreover, definitions are dogmatic, variable with time and, last but not least, their sensitivity  has nerver been studied.

See La dépression et son traitement : aspects méconnus. Bernard Maroy L'Harmattan Paris 2011 and its abstract in English attached below

@ Bernard Maroy. Thank you for your message and depang.doc. You have a lot of experiences with alcoholic patients showing curable depressive symptoms and bodily features. 

However, there is no contradiction to the main hypothesis of TM. According to Hubertus Tellenbach Typus melancholicus seems to be a depressive character ("homo bonus"), who does not like to drink much alcohol.

Dear Karl. Alcoholism is only one of the multiple possible consequences of depression.

I agree that there is frequently a predisposition (probably genetic) for depression. However, this predisposition does'nt lead always to depression.

Moreover, predisposition implies present absence of any sign.  Where is then the Typus? If signs are already present, why should  not call this state depression?

So, I fail to see where is room for Typus.

Dear Renzo. A Typus can't be seen as a reversible state and, hardly, as dynamic one.

For depression, as for any problem, it's of paramount importance to distinguish causative from modulating factors.

Circular phenomenoms, as far as psychiatry is concerned, occurs principally as reaonning.

Dr. Maroy,

The published papers on Typus Melancholicus show that these specific criteria have been studied for their statistics, and correlate with the DSM criteria for major depression.

But I agree with you that depression is curable, having seen cures myself, caused mainly by the regular practice of the deep meditation technique known as transcending. I also agree that depression is under-diagnosed and under-treated.

Your overview shows an interest in addiction, which is also (easily) cured through the practice of transcending. All my meditation clients who report addictive behaviors, including substance abuse, stop those behaviors after beginning the regular practice of transcending. The latency before stopping varies from client to client, from immediate to several months.

I must disagree with you that the cause of depression is a family history with a "complex transmission" (learned and/or genetic). If this were the case, then depression could be cured through simple education (learned) or could be difficult to cure (genetics). Neither is the case.

Antidepressants are only effective in less than 50% of those with depression, but for a significant percentage they are very effective. It is this remarkable effectiveness in some cases that originally lead clinicians toward the conclusion that depression is mostly caused by an imbalance among the various neurotransmitters.

The effectiveness of antidepressants is not well correlated with a family history of depression, which is further evidence that depression is at least frequently a result of neurochemical imbalance (from some unspecified root cause).

However, the existence of cures based on psychotherapy alone, while rare, and on the practice of transcending, which is common, gives evidence that this imbalance in neurotransmitters is actually not so much a cause as an end result.

Your summary includes worry over surgery, disease, etc., as a possible cause of depression. In my opinion, it is not this exogenous worry over problems in life that causes depression. It is stress stored and accumulated in the nervous system (see www.nsrusa.org/about-stress.php) that causes every psychological problem in life, including worry, addiction, and depression. I come to this conclusion based on the observed fact that psychological problems all reduce or disappear with the regular practice of transcending. This can only be due to the stress-reducing effect of transcending, which removes the root cause of all the problems, stress (see the citation for my definition of stress). Again, this opinion is based on the observation of many clients (total: 2000 worldwide).

You write, "Many symptoms worry the patient but do not stop them continuing their daily lives much, there no reason to treat at the moment and reassurance is enough." I most definitely do not agree with ignoring such symptoms. Any psychological problem, no matter how small, can be cured or ameliorated easily through the deep rest of transcending, and so deserves to be. A small problem now can easily grow to become a large problem later, since once stress gains a foothold, it only increases with time. Again, this statement is based on observation.

Your summary mentions many subclinical symptoms that can be used to detect stress (example: distortions of the normal sense of taste). I agree that these can be very useful for diagnosing problems, but disagree that they point to specific disorders that can then be treated. In most cases, these are puzzling, and no specific organic disorders or diseases are found. This is because stress tends to hide itself as a cause of problems. Sometimes the best evidence that stress is a cause is the fact that the problems disappear upon the elimination of the stress.

I highly commend your paper as an excellent list of diagnostic symptoms, most of which are ignored in practice. However, diagnosis is only the first step, and effective therapy is just as important. There are several doctors who regularly refer their patients to me for instruction in transcending. They do this only because their patients improve much faster, based on the increased effectiveness of talk therapy and psychopharmacology when the regular practice of transcending is added. Eliminating the root cause, stresses, is really effective.

Another question concerns duration of treatment. Both talk therapy and medications must be continued for several years. In some cases, medication must be continued for the rest of the patient's life. When stresses are dissolved through transcending, they are permanently eliminated, eliminating any associated stress-related disorders or problems, and these problems do not return even if the practice of transcending is stopped.

Another relevant topic is compliance. There is nothing attractive about either talk therapy or medications. Both are frequently annoying to patients. But transcending is very different, since the peace and happiness that happen during the practice is a positive piece of feedback that tends to keep practitioners regular. When you really enjoy something, you want to do it. I find that even those clients who stop practicing transcending due to discomfort later get support, get their technique corrected, and return to regular practice.

I hope that my comments are of help in establishing a new line of inquiry into the cause and cure of depression.

Dear David

I thank you very much for your remarks.

Altogether, I underline that depression is the underlying cause of stressability and not the reverse. It's a matter of fact that going down is easier that going up,especially when ignition is dysregulated.

However, it's wiser tuning ignition than hoping a later, more favorable, slope or trying adjusting the rallye.

DSM (I, II,III, IV or V? Did depression change meanwhile?)  criteria fail to be "Tables of the Law" as they change fairly frequently.

% of curability is tightly linked to the algorythm used. As long as therapists will remain reluctant to associations, results will remain poor. With a better algorythm, you could reach a higher % of success (approximately 90% with mine).

Depression, in fact, is a syndrome rather than an illness. It can be the consequence of very various (possibly associated) causes, from heredity to pancreas carcinoma. I agree that both fail to be curable by education.

Neurotransmitters imbalance is a largely outdated concept. It is  more probably an epiphenomenon, except for neuro-protectors.

Familial correlations suppose exhaustive diagnosis which is impossible, according to the low sensitivity, especially as far as non-psychiatric features are concerned. Loose end of stool is as diagnostic as low mood, for example.

Worries are consequences of objective surrounding modulated by perception.

It's obvious that the same surrounding is felt very differently by various persons. Stressability (or resilience) is the key of the problem and mainly the consequence of depression, main cause of low resilience. So, worrying, for anything, cancer as well, is more the consequence of depression than it's cause, surrounding being, at most, a worsening factor.

It's of paramount importance to realize that any input to brain is converted into biochemical events. Therefore, psychotherapy or meditation are not basically different of anti-depressants. However, in my somatician professionnal experience, chemotherapy seems to be more efficient than psychotherapy.

Anyway, everybody prefers using his own favorite weapon, Saxons: ax and Romans: pilum. This is'nt a reason to despise others and, if your favorite tool is screw-driver, it does'nt mean that adjustable spanner is useless.

I apologize because the paper has been written many years ago, before I realized efficiency of non-pharmacological treatments. I ment that anti-depressants were not allways warranted for depressive sign, if not too boring and that symptomatic treatment could be enough, if needed.

I fail to understand meaning of "sub-clinical symptoms". They can be highly distressing, especially taking into account higher suffering of depressed persons and as sensitive to anti-depressant treatment, at least pharmacological.

I agree completely with your sentence: "Eliminating the root cause is really effective" but I disagree with this root cause which is, in my opinion, not stress itself (by definition a subjective event) but its real deep cause: depression.

I agree completely with compliance's problems. It's a matter of fact that depressive patients are frequetly reluctant to accept their diagnosis and, moreover, taking "drugs". Other, non-pharmacological methods, by-passing this problem, can be saving.

I realize since 30 y. that my opinion is "shocking" and difficult to digest, but it is very efficient on diagnostic and therapeutic points of view.

Thank you again for your pertinent remarks.

Dear Dr. Maroy,

Thank you for your reply.

"Altogether, I underline that depression is the underlying cause of stressability and not the reverse."

My experiences with my clients convince me that stress (as defined at www.nsrusa.org/about-stress.php) is the underlying cause of most forms of depression. Note that stress is not restricted to psychodynamic mechanisms; it can have physical generators as well (such as a loud and startling sound), and it can have biochemical mediators (stored stress).

Also note that we live in a stressful world, so we acquire stress not only from the obvious challenges and insults of life, but also from the stressful people and situations we encounter every day. The remarkable thing is not that some people show difficult-to-understand disorders, but that some of us do not.

"However, it's wiser tuning ignition than hoping a later, more favorable, slope or trying adjusting the rallye."

I'm not familiar with the way you use certain words here. I assume that "ignition" means an event that triggers (rather than causes) a depression. I do not understand the use here of "slope" or the meaning of "rallye", which may mean "to bring into order again" or to "revive one's strength".

If you mean that we should endeavor to reduce environmental influences that trigger depressions, I definitely disagree. Encouraging a patient to be delicate and avoiding of life is no way to live, and results in more problems with time, not fewer. You must not have meant this.

"DSM (I, II,III, IV or V? Did depression change meanwhile?) criteria fail to be "Tables of the Law" as they change fairly frequently."

You are quite right about the DSM. It was DSM III-R, although some papers note the similarity of TMP with DSM-IV and DSM-V items.

"As long as therapists will remain reluctant to associations, results will remain poor. With a better algorythm, you could reach a higher % of success (approximately 90% with mine)."

I don't understand your use of "associations" here. And do you mean by "a better algorithm" something other than the 4 of 5 symptoms that DSM uses? By the way, I'm amazed at your 90% success rate with major depression. Utterly amazed.

"Depression, in fact, is a syndrome rather than an illness."

Depression is both a syndrome (set of symptoms) and an illness (unhealthy condition), so this comment seems to make no sense.

"It can be the consequence of very various (possibly associated) causes, from heredity to pancreas carcinoma. I agree that both fail to be curable by education."

Depression cannot be caused by heredity or a carcinoma. These conditions can only act as triggers. No one has as yet proven a specific cause of depression (I am only claiming that based on my observations). My claim that stress is the primary cause is based on my observation, but it has not been proven either. In your case, you don't appear to present a single, clear cause.

"Neurotransmitters imbalance is a largely outdated concept."

If true, this fact would surprise both clinicians and researchers, who see confirmation of the imbalance theory every day.

"Familial correlations suppose exhaustive diagnosis which is impossible,"

I agree. My success with transcending fortunately is independent of family history. All my clients notice beneficial effects in life, starting from their first experience of transcending, even the "normal" ones.

"Loose end of stool is as diagnostic as low mood, for example."

Each of your listed triggering factors is very low in incidence or dependability. Their validity, in my opinion, is in widening the factors that are included when making a diagnosis of any kind of depression. More on this below.

"Worries are consequences of objective surrounding modulated by perception."

Worries have little to do with facts or perceptions. They have much to do with stored stresses and habits of feeling powerless or attached to past or future events.

Understanding this is crucial, because stresses can be eliminated through transcending (deep rest with mental alertness) and habits can be dropped through introspection/contemplation of our actual experience.

"It's obvious that the same surrounding is felt very differently by various persons."

Exactly. This is the reason that actual environmental facts or events are not causes of depression (although they may be triggers). Depression is certainly caused by dysfunctions in the nervous system. Remove the dysfunctions (stresses), and the depression vanishes. We see this; it is not theoretical.

"So, worrying, for anything, cancer as well, is more the consequence of depression than it's cause, surrounding being, at most, a worsening factor."

I agree. Worrying is caused by dysfunction, stress, which is a characteristic of the nervous system, not the environment. People who worry will find things to worry about. They will blame the things they worry about for their discomforts. But other people will not find any worry at all about the same things in the environment. Worry has nothing to do with the subjects of the worry, the meaning or story involved.

"It's of paramount importance to realize that any input to brain is converted into biochemical events. Therefore, psychotherapy or meditation are not basically different of anti-depressants. However, in my somatician professionnal experience, chemotherapy seems to be more efficient than psychotherapy."

I agree. It is obvious that in most cases, a drug that works is more efficient than talk therapy that works.

What is not yet understood is that overloads of experience (overloads due to an already weak nervous system) can induce the creation and storage of new stresses. This is the reason we all have accumulating stresses, and hence stress-related disorders, as we age. See my paper on stress.

We all sleep and dream, which clear away some of this accumulated dysfunction. But we all lack the fourth state of consciousness, transcendental consciousness or restful alertness (samadhi), the regular experience of which eliminates all of the stresses that survive sleeping and dreaming.

"Anyway, everybody prefers using his own favorite weapon, Saxons: ax and Romans: pilum. This is'nt a reason to despise others and, if your favorite tool is screw-driver, it does'nt mean that adjustable spanner is useless."

That is certainly true, but that is not a correct analogy here. A favorite analogy of mine is a jet plane compared to roller skates as a method of travel. If your goal is getting to the destination, prefer the jet plane. If your goal is enjoying the journey, a jet plane may be inferior.

I would only use an analogy like this to describe transcending, because it is so much more efficient than any other stress-reducing technology we know, as a jet plane is a more efficient form of transportation. But the analogy ultimately fails, because, like a scenic rollerskate ride, transcending is inherently enjoyable. It is fun to enjoy deep rest, and fun to see the interesting effects as stresses leave.

"I fail to understand meaning of "sub-clinical symptoms". They can be highly distressing, especially taking into account higher suffering of depressed persons and as sensitive to anti-depressant treatment, at least pharmacological."

I just meant that a change in taste, so foods become bitter, is not a cause for hospitalization, or even for consulting a doctor. Yet it can indicate the beginning of a psychological problem that could benefit from early intervention.

I teach transcending without asking for any symptoms, because I know that everyone already has lots of stored stress. They may have adapted well to their dysfunctions, but they will only understand that situation of underlying stress when their stresses begin to release and they see how wonderful life can be. Life should be lived in peace and happiness, not in a fruitless and never-ending search for peace and happiness.

"...I disagree with this root cause which is, in my opinion, not stress itself (by definition a subjective event) but its real deep cause: depression."

Not everyone is depressed, yet almost everyone has some deficits, limitations, or problems due to stored stresses. If we limit ourselves to treating depression, we are limiting the number of people we can help. Of course, that assumes that we have a technology that actually works to fix the root problem, the stress that causes dysfunction and limitation in the nervous system, and that this technology does not have unwanted side effects. Unlike medication, transcending is all-natural, free of side effects. This results from its status as the fourth major state of consciousness (as shown by objective physiological markers).

This is why the USA Veterans Administration is conducting a study of whether transcending should be offered to veterans as a treatment for PTSD, and the US NIH is sponsoring studies of the effects of transcending on heart disease. (These studies are specifically on Transcendental Meditation, a specific course to learn transcending.)

Stress is not a subjective event. It is a lasting but reversible biochemical change in the nervous system. Please read my definition of stress to understand how this can be: www.nsrusa.org/about-stress.php .

"I realize since 30 y. that my opinion is "shocking" and difficult to digest, but it is very efficient on diagnostic and therapeutic points of view."

If I understood your book overview, I see nothing shocking about your statements. They seem commonsense to me. But then (disclaimer) I am not a trained mental health professional. If you have found a better set of criteria to diagnose mental health disorders than the TMP or the DSM, that is wonderful.

However, I sincerely doubt that you have discovered a new form of therapy that is better than transcending, which is thousands of years old.

Thank you for this interesting discussion.

I agree with Renzo: "Personality, if we want to use this concept, should be viewed as a dynamic system, not a static one. The fact that depression can be etiologically related to external factors is not contradictory with the fact that  specific internal dispositions may foster its development."  In my opinion, there are excellent psychodynamic - and therapeutic -  methods  to give  an answer or to prevent a monopolar depression in case of signs and symptoms of TM, f.i. the so called  "Situationstherapie" (Tellenbach).

Dear Bernard, thanx for your reply.

In my opinion, TM, as Beatrice told us   -  and if the signs of this typical melancholic personality are known  -  is exactly situated between the obvious facts of predisposition and later following depressive signs. Therfore prevention is so important. We see in many families with generations of severe depressive episodes also some "not yet ill persons" with signs of TM and "a vulnerability to specific situations (pregnancy, career change). So depression can "settle after the meeting between the TM with a particular vulnerable situation". DOI: http://dx.doi.org/10.1016/S0924-9338(14)78484-6

In addition to this special question and another (new) question concerning risc factors of extended suicide in the case of Andreas L. some lines of an article abstract:

"The essential feature of the melancholic type is orderliness, which manifests in the following three areas: work, behavior, and conscientiousness. The interpersonal relationships of people with the melancholic type are described as "Being-for-others", which is analogous to altruism. People with the melancholic type think highly of common sense and duty. Furthermore, they cannot lower their level of aspiration even if the quality and quantity of their work is beyond their abilities or their capacities are weakened. In these premelancholic situations, pre-melancholic persons are forced to choose either quality or quantity and are plunged into the depths of despair, which means a hiatus or onset of melancholia. Thus, Tellenbach analyzed the complementary relationship between premelancholic situations and a premorbid personality at the beginning of melancholia."

Ohmae S: [Rethinking the theory of melancholia (Tellenbach): its construction process and theoretical significance]. Seishin Shinkeigaku Zasshi. 2013;115(7):711-28. [Article in Japanese]