History of bipolar disorder
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Cyclical variations in moods and energy levels have been recorded at least as far back as several thousand years. The words "
melancholia Melancholia or melancholy (from el, µέλαινα χολή ',Burton, Bk. I, p. 147 meaning black bile) is a concept found throughout ancient, medieval and premodern medicine in Europe that describes a condition characterized by markedly dep ...
" (an old word for depression) and "mania" have their
etymologies Etymology ()The New Oxford Dictionary of English (1998) – p. 633 "Etymology /ˌɛtɪˈmɒlədʒi/ the study of the class in words and the way their meanings have changed throughout time". is the study of the history of the form of words and ...
in
Ancient Greek Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...
. The word melancholia is derived from ''melas''/μελας, meaning "black", and ''chole''/χολη, meaning "bile" or "gall", indicative of the term's origins in pre- Hippocratic humoral theories. A man known as Aretaeus of Cappadocia has the first records of analyzing the symptoms of depression and mania in the 1st century of Greece. There is documentation that explains how bath salts were used to calm those with manic symptoms and also help those who are dealing with depression. Even today,
lithium Lithium (from el, λίθος, lithos, lit=stone) is a chemical element with the symbol Li and atomic number 3. It is a soft, silvery-white alkali metal. Under standard conditions, it is the least dense metal and the least dense solid el ...
is used as a treatment to bipolar disorder which is significant because lithium could have been an ingredient in the Greek bath salt. Centuries passed and very little was studied or discovered. It wasn't until the mid-19th century that a French psychiatrist by the name of
Jean-Pierre Falret Jean-Pierre Falret (; 26 April 1794 – 28 October 1870) was a French psychiatrist. He was born and died in Marcilhac-sur-Célé.
wrote an article describing "circular insanity" and this is believed to be the first recorded diagnosis of bipolar disorder. Years later, in the early 1900s, Emil Kraepelin, a German psychiatrist, analyzed the influence of biology on mental disorders, including bipolar disorder. His studies are still used as the basis of classification of mental disorders today.


The linguistic origins of mania in relation to bipolar disorder

The linguistic origins of mania, however, are not so clear-cut. Several etymologies are proposed by the
Roman Roman or Romans most often refers to: *Rome, the capital city of Italy *Ancient Rome, Roman civilization from 8th century BC to 5th century AD *Roman people, the people of ancient Rome *''Epistle to the Romans'', shortened to ''Romans'', a letter ...
physician Caelius Aurelianus, including the Greek word ""ania", meaning to produce great mental anguish, and "manos", meaning relaxed or loose, which would contextually approximate to an excessive relaxing of the mind or soul. There are at least five other candidates, and part of the confusion surrounding the exact etymology of the word mania is its varied usage in the pre-Hippocratic
poetry Poetry (derived from the Greek ''poiesis'', "making"), also called verse, is a form of literature that uses aesthetic and often rhythmic qualities of language − such as phonaesthetics, sound symbolism, and metre − to evoke meanings i ...
and mythologies.


Relationship between mania and melancholia

The idea of a relationship between mania and melancholia can be traced back to at least the 2nd century AD. Soranus of Ephesus (98–177 AD) described mania and melancholia as distinct diseases with separate etiologies; however, he acknowledged that "many others consider melancholia a form of the disease of mania". The earliest written descriptions of a relationship between mania and melancholia are attributed to Aretaeus of Cappadocia. Aretaeus was an
eclectic Eclectic may refer to: Music * ''Eclectic'' (Eric Johnson and Mike Stern album), 2014 * ''Eclectic'' (Big Country album), 1996 * Eclectic Method, name of an audio-visual remix act * Eclecticism in music, the conscious use of styles alien to th ...
medical philosopher who lived in
Alexandria Alexandria ( or ; ar, ٱلْإِسْكَنْدَرِيَّةُ ; grc-gre, Αλεξάνδρεια, Alexándria) is the second largest city in Egypt, and the largest city on the Mediterranean coast. Founded in by Alexander the Great, Alexandria ...
somewhere between 30 and 150 AD. Aretaeus is recognized as having authored most of the surviving texts referring to a unified concept of manic-depressive illness, viewing both melancholia and mania as having a common origin in "black bile".


Origin of bipolar disorder as a mental illness

A clear understanding of bipolar disorder as a mental illness was recognized by early Chinese authors. The encyclopedist Gao Lian (c. 1583) describes the malady in his ''Eight Treatises on the Nurturing of Life'' (Zun Sheng Ba Qian). The basis of the current conceptualisation of manic-depressive illness can be traced back to the 1850s; on January 31, 1854, Jules Baillarger described to the French Imperial
Academy of Medicine Academy of Medicine or Academy of Surgery may refer to: Asia Israel *Jerusalem Academy of Medicine Malaysia *Academy of Medicine of Malaysia Singapore *Academy of Medicine, Singapore Europe Austria * Josephinian Military Academy of Surgery * M ...
a biphasic
mental illness A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
causing recurrent oscillations between mania and depression, which he termed ''folie à double forme'' ('dual-form insanity'). Two weeks later, on February 14, 1854,
Jean-Pierre Falret Jean-Pierre Falret (; 26 April 1794 – 28 October 1870) was a French psychiatrist. He was born and died in Marcilhac-sur-Célé.
presented a description to the Academy on what was essentially the same disorder, and designated ''folie circulaire'' ('circular
insanity Insanity, madness, lunacy, and craziness are behaviors performed by certain abnormal mental or behavioral patterns. Insanity can be manifest as violations of societal norms, including a person or persons becoming a danger to themselves or to ...
') by him. The two bitterly disputed as to who had been the first to conceptualise the condition. These concepts were developed by the German
psychiatrist A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
Emil Kraepelin (1856–1926), who, using Kahlbaum's concept of
cyclothymia Cyclothymia ( ), also known as cyclothymic disorder, psychothemia/psychothymia, bipolar III, affective personality disorder and cyclothymic personality disorder, is a mental and behavioural disorder that involves numerous periods of symptoms of ...
, categorized and studied the natural course of untreated bipolar patients. He coined the term ''manic depressive
psychosis Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
'', after noting that periods of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals where the patient was able to function normally.


Distinction between manic-depression with and without psychotic states

The first diagnostic distinction to be made between manic-depression involving psychotic states, and that which does not involve psychosis, came from
Carl Jung Carl Gustav Jung ( ; ; 26 July 1875 – 6 June 1961) was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philo ...
in 1903.Thompson, J. (2012) A Jungian Approach to Bipolar Disorder, Soul Books Jung's distinction is today referred to in the DSM-IV as that between 'bipolar I' (mania involving possible psychotic episodes) and 'bipolar II' (hypomania without psychosis). In his paper Jung introduced the non-psychotic version of the illness with the introductory statement, "I would like to publish a number of cases whose peculiarity consists in chronic hypomanic behaviour" where "it is not a question of real mania at all but of a hypomanic state which cannot be regarded as psychotic". Jung illustrated the non-psychotic variation with 5 case histories, each involving hypomanic behaviour, occasional bouts of depression, and mixed mood states, which involved personal and interpersonal upheaval for each patient.


Initial treatment options

After
World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
, John Cade, an Australian
psychiatrist A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
, and Shirley Andrews, an Australian
biochemist Biochemists are scientists who are trained in biochemistry. They study chemical processes and chemical transformations in living organisms. Biochemists study DNA, proteins and Cell (biology), cell parts. The word "biochemist" is a portmanteau of ...
, were investigating the effects of various compounds on veteran patients with manic depressive psychosis. In 1949, Cade and Andrews discovered that
lithium carbonate Lithium carbonate is an inorganic compound, the lithium salt (chemistry), salt of carbonate with the chemical formula, formula . This white Salt (chemistry), salt is widely used in the processing of metal oxides. It is listed on the World Health O ...
could be used as a successful treatment of manic depressive psychosis. Because there was a fear that table salt substitutes could lead to toxicity or death, their findings did not immediately lead to treatments. In the 1950s, U.S. hospitals began experimenting with lithium on their patients. By the mid-60s, reports started appearing in the medical literature regarding lithium's effectiveness. The U.S. Food and Drug Administration did not approve of lithium's use until 1970.


Progression from manic-depressive "reaction" to manic-depressive "illness"

The term "manic-depressive ''reaction''" appeared in the first
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
Diagnostic Manual in 1952, influenced by the legacy of Adolf Meyer who had introduced the paradigm illness as a reaction of biogenetic factors to psychological and social influences. Subclassification of bipolar disorder was first proposed by German psychiatrist Karl Leonhard in 1957; he was also the first to introduce the terms ''bipolar'' (for those with mania) and ''unipolar'' (for those with depressive episodes only). In 1968, both the newly revised classification systems ICD-8 and DSM-II termed the condition "manic-depressive ''illness''" as biological thinking came to the fore.


Current classification of bipolar disorder

The current
nosology Nosology () is the branch of medical science that deals with the classification of diseases. Fully classifying a medical condition requires knowing its cause (and that there is only one cause), the effects it has on the body, the symptoms that ...
,
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
, became popular only recently, and some individuals prefer the older term because it provides a better description of a continually changing multi-dimensional illness.
Empirical Empirical evidence for a proposition is evidence, i.e. what supports or counters this proposition, that is constituted by or accessible to sense experience or experimental procedure. Empirical evidence is of central importance to the sciences and ...
and theoretical work on bipolar disorder has throughout history " seesawed" between psychological and biological ways of understanding. Despite the work of emphasizing the psychosocial context, conceptions of bipolar disorder as a genetically based illness dominated the 20th century. Since the 1990s, however, there has been a resurgence of interest and research into the role of psychosocial processes.


See also

*
Bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...


Citations


References

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Further reading

* * {{Bipolar disorder Bipolar disorder Depression (mood) Mood disorders
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