“There are individuals who, from various physical or moral causes,” says Esquirol, “fall into a state of corporeal torpor and mental depression. They complain of want of appetite, dull pain in the head, sense of heat in the stomach and viscera, borborygmi, and constipation of the bowels; while they exhibit little or no indication of disease. In the female sex, the natural secretions become suspended. As the complaint advances, the features alter, and the countenance exhibits anxiety; the complexion becomes pale or sallow; there is a sense of tightness, or even pain, in the epigastrium; a kind of compression in the head, which prevents them from fixing their attention, or arranging their thoughts; a general torpor or lassitude, which keeps them inactive. They dislike to move out, and love to loll about on a sofa; they are irritated if you advise them to take exercise; they abandon their ordinary avocations, neglect their domestic concerns, become indifferent to their nearest connexions; in short, they will neither converse, nor study, nor read, nor write, shunning society, and being impatient of the inquiries and importunities of friends. In this state they become filled with gloomy ideas (_idées noires_), despair of ever being better, desire or even invoke death, and sometimes destroy themselves, from a conviction that they are no longer capable of fulfilling their duties in society. These people are perfectly sane on all subjects of conversation; their impulse to suicide being strong in proportion to the activity of their former avocations, and the importance of their former duties. I have seen their disease (for it is a disease) continue for months, and even years. I have seen it alternate with mania and with perfect health. I have seen patients who would be six months of the year maniacal or in sound health, and the other six months tormented with these gloomy ideas and impulses to suicide.”