Childlessness was a tragedy for a woman in the ancient near East and the barren wife was likely to be despised by her husband, family and society at large. In the Old Testament, three childless women are described whose infertility was relieved by divine intervention, resulting in the birth of important patriarchal leaders.

Sarah, the mother of Isaac, was 90 years old when she heard she was to have a baby.

Gen. 18:13 ‘And the Lord said to Abraham, why did Sarah laugh and say shall I indeed bear a child now that I am old’.

The only other recorded emotional reaction Sarah has to her infertility is that she was harsh to Hagai, Abraham's other wife and the mother of Ishmael – ‘then Sarah dealt harshly with her (Hagai) and she ran away from her’.

We know even less about the infertility of the mother of Samson. Her story is described in the book of Judges and she is known only as the wife of Manoah.

Judg. 13:13 ‘And the angel of the Lord appeared to the woman and said to her “although you are barren, having no children you shall conceive and bear a son.”’ In due course she gave birth to Samson. Her existence in the Bible relates solely to her maternal function and the text says nothing about her personal feelings, her relationships, or even her name as she is identified only through her husband, as ‘the wife of Manoah’.

The third woman, Hannah, is also childless but eventually gives birth to another important biblical prophet, Samuel. However, her story is very different from the other two women's stories and the Bible gives a very personal account of her feelings, her sadness at the infertility, her relationship with her husband, Elkanah, the difficulties and envy of living with Elkanah's other wife, Peninnah, who did have children, as well as her misery, described in sufficient detail to make a diagnosis of depression likely.

1 Sam. 1:2 ‘He (Elkanah) had two wives: the name of one Hannah, and the name of the other Peninnah. Peninnah had children, but Hannah had none… 1:6 her rival (Penninah) used to provoke her severely, to irritate her because the Lord had closed her womb. 7 Therefore Hannah wept and would not eat. 8 Her husband said to her ‘Hannah why do you weep? Why do you not eat? Why is your heart so sad?… 10 She wasdeeply distressed and prayed to the Lord and wept bitterly. 11 She made this vow “Oh Lord of hosts, if only you will look on the misery of your servant and remember me and not forget your servant but will give to your servant a male child then I will set him before you as a Nazirite until the day of his death.” 12 As she continued praying before the Lord, Eli (the priest) observed her mouth. 13 Hannah was praying silently, but her voice was not heard; therefore Eli thought she was drunk. 14 So Eli said to her “How long will you make a drunken spectacle of yourself.” But Hannah answered “No my Lord, I am a woman deeply troubled, I have drunk neither wine nor strong drink, but I have been pouring out my soul before the Lord. 16 Do not regard your servant as a worthless woman, for I have been speaking out of my great anxiety and vexation all the time.” 17 Then Eli answered “Go in Peace; the God of Israel will grant the petition you have made to him”… 18 Then the woman went to her quarters, ate and drank with her husband and her countenance was no longer sad… 19 And then they went back to their house at Ramah. Elkanah knew his wife Hannah and the Lord remembered her. In due time Hannah conceived and bore a son. She named him Samuel for she said “I have asked him of the Lord”.’

In this account we learn of Hannah's great distress because of her infertility and a sufficient number of symptoms are mentioned to make a diagnosis of depression. Thus, Hannah is weeping, feels bitterness, misery and sadness, but after her prayer her countenance is no longer sad (possible depressive facies which is then relieved). Further, there is irritability, especially with Peninnah, loss of appetite, general distress, vexation and anxiety. There is also a curious loss of voice while she prays. This could be no more than silent prayer, but as she is mouthing the words, the high priest Eli believes her to be intoxicated. This picture is typical of aphonia, a hysterical conversion symptom commonly associated with depression.

The biblical feminist literature attributes great significance to Hannah's tale. It is the story of a woman with infertility and her psychological reactions, her relationships with her husband and God, her feelings towards her husband's other wife and the depression associated with her infertility. It stands in stark contrast to the earlier impersonal accounts of the childlessness of Sarah and the wife of Manoah where only their impaired maternal function is reported. Hannah's tale is also of great importance to psychiatry, particularly to the history of psychiatry. There are very few accounts of depression in the literature of the ancient world, and they appertain only to men, even though depression is more common in women. Hence it is likely that Hannah's story represents the first description of depression (and hysterical aphonia) in a woman.

Hannah is thought to have lived in the 11th century bce, but the books of I and II Samuel were probably compiled sometime between the 7th and the 9th century bce, more than two millennia before the more definitive accounts of depression written by Burton in the 17th century ad. Liaison psychiatry concerns the association between a psychiatric disorder and a general medical condition. Infertility is a recognised gynaecological disorder and so Hannah's tale represents the first recognisable case of liaison psychiatry.