A Short History of Bipolar

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The terms used for the bipolar extremes, ‘melancholy’ (depression) and ‘mania’ both have their origins in Ancient Greek. ‘Melancholy’ derives from melas ‘black’ and chole ‘bile’, because Hippocrates thought that…

The terms used for the bipolar extremes, ‘melancholy’ (depression) and ‘mania’ both have their origins in Ancient Greek. ‘Melancholy’ derives from melas ‘black’ and chole ‘bile’, because Hippocrates thought that depression resulted from an excess of black bile. ‘Mania’ is related to menos ‘spirit, force, passion’; mainesthai ‘to rage, go mad’; and mantis ‘seer’, and ultimately derives from the Indo-European root men- ‘mind’ to which, interestingly, ‘man’ is also sometimes connected. (‘Depression’, the clinical term for melancholy, is much more recent in origin and derives from the Latin deprimere ‘press down’ or ‘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, who was a physician and philosopher in the time of Nero or Vespasian (first century AD). Aretaeus described a group of patients that who ‘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 suggested that both patterns of behaviour resulted from one and the same disorder, this idea did not gain currency until the modern era.

The modern psychiatric concept of bipolar disorder has its origins in the nineteenth century. In 1854, Jules Baillarger (1809–1890) and Jean-Pierre Falret (1794–1870) independently presented descriptions of the disorder to the Académie de Médicine in Paris. Baillarger called the illness folie à double forme (‘dual-form insanity’) whereas Falret called it folie circulaire (‘circular insanity’). Falret observed that the disorder clustered in families, and correctly postulated that it had a strong genetic basis.

In the early 1900s the eminent German psychiatrist Emil Kraepelin (1856–1926) studied the natural course of the untreated disorder and found it to be punctuated by relatively symptom-free intervals. On this basis he distinguished the disorder from démence précoce (schizophrenia) and coined the term ‘manic–depressive psychosis’ to describe it. Kraepelin emphasized that, in contrast to démence précoce, manic–depressive psychosis had an episodic course and a more benign outcome.

Interestingly, Kraepelin did not distinguish between people with both manic and depressive episodes and people with only depressive episodes with psychotic symptoms. This distinction dates back only to the 1960s, and is largely responsible for the modern emphasis on bipolarity, and hence on mood elevation, as the defining feature of the disorder.

The terms ‘manic–depressive illness’ and ‘bipolar disorder’ are comparatively recent, and date back from the 1950s and 1980s respectively. The term ‘bipolar disorder’ (or ‘bipolar affective disorder’) is thought to be less stigmatizing than the older term ‘manic–depressive illness’, and so the former has largely superseded the latter. However, some psychiatrists and some people with bipolar disorder still prefer the term ‘manic–depressive illness’ because they feel that it reflects the nature of the disorder more accurately.

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