A short history of bipolar disorder.
The historical terms used for the bipolar extremes both have their origins in Ancient Greek. ‘Melancholy’ derives from melas (‘black’) and chole (‘bile’), because Hippocrates believed that depressed mood resulted from an excess of black bile. ‘Mania’ is related to menos (‘spirit,’ ‘force,’ ‘passion’), mainesthai (‘to rage,’ ‘to go mad’), and mantis (‘seer’), and ultimately derives from the Indo-European root men- (‘mind’). ‘Depression,’ a modern near synonym for melancholy, is much more recent in origin, and derives from the Latin deprimere (‘press down’, ‘sink down’).
The idea of a relationship between melancholy and mania can be traced back to the Ancient Greeks, and particularly to Aretaeus of Cappadocia, a physician and philosopher in the time of Nero or Vespasian. Aretaeus described a group of patients who would “laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill” only to be “torpid, dull, and sorrowful” at other times. Although he did suggest that both patterns of behaviour resulted from one selfsame disorder, this notion did not gain currency until the industrial age.
The modern concept of bipolar disorder originated in the 19th century. In 1854, psychiatrists Jules Baillarger (1809-1890) and Jean-Pierre Falret (1794-1870) independently presented descriptions of the illness to the Académie de Médecine in Paris. Baillarger called it folie à double forme (‘dual-form insanity’), whereas Falret called it folie circulaire (‘circular insanity’).
Having observed that the illness clustered in families, Falret postulated a strong genetic basis.
In the early 1900s, psychiatrist Emil Kraepelin (1856-1926) studied the natural course of the untreated illness and found it to be punctuated by relatively symptom-free intervals. On this basis, he distinguished the illness from dementia praecox (schizophrenia) and named it manisch-depressives Irresein (‘manic-depressive psychosis’). He emphasized that, in contrast to dementia praecox, manic-depressive psychosis had an episodic course and a more benign outcome.
Interestingly, Kraepelin did not distinguish people with both manic and depressive episodes from those with only depressive episodes with psychotic symptoms. It is only in the 1950s that German psychiatrists Karl Kleist (1879-1960) and Karl Leonhard (1904-1988) proposed this divide, from which stems the contemporary emphasis on bipolarity, and hence on mania/hypomania, as the defining feature of the illness.
The term ‘bipolar disorder’ first appeared in the third, 1980 revision of the DSM (DSM-III). It has gradually replaced the older term ‘manic-depressive illness,’ which, although more accurate and descriptive, did nothing to discourage people with bipolar disorder from being stigmatized as ‘maniacs.’