Bipolar disorder historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

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* The connection between mania and melancholia dates back to the 2nd Century CE.
* Soranus of Ephesus (98-177 CE), a Greek physician, characterized mania and melancholia as separate illnesses.
* German psychiatrist Emil Kraepelin (1856-1926) examined and classified the natural course of patients with untreated bipolar disorder years prior to the discovery of mood stabilizers.
* In 1902, Kraepelin created the term manic depressive psychosis to describe these patients.
* In 1957, Karl Leonhard, a German psychiatrist, coined the terms bipolar and unipolar to describe subclassifications of manic depressive psychosis (bipolar disorder).
* Bipolar was used to describe cases with manic episodes.
* Unipolar was used to describe cases characterized by the presence of depressive episodes and the lack of manic episodes.

## Historical Perspective

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* Humans have experienced cycles of varying moods and energy levels for thousands of years.
* The terms melancholia and mania originated in Ancient Greece.
* Melancholia originates from the Greek words melas and chole, meaning "black" and "bile" or "gall"[1] respectively.
* Mania originates from the Greek words ania and manos, meaning "to produce great mental anguish" and "relaxed or loose" respectively.
* Both mania and melancholia were thought to arise from imbalances in the body's humors. Mania was thought to result from excess amounts of yellow bile, while melancholia was thought to result from excess black bile.
* The connection between mania and melancholia dates back to the 2nd Century CE.[2]
* Soranus of Ephesus (98-177 CE), a Greek physician, characterized mania and melancholia as separate illnesses[3] during a period where many viewed melancholia as a type of mania.
* Aretaeus of Cappadocia, a medical philosopher who lived between the years 30 and 150 CE, is credited with the earliest accounts of a connection between melancholia and mania. Aretaeus wrote many texts that survive today in which he described manic-depressive disease that he believed originated in black bile.
* Early Chinese authors established clear classification of bipolar disorder as a mental illness. For example, author and encyclopedist Gao Lian (c. 1583) described the disorder in Eight Treatises on the Nurturing of Life.[4]
* The modern psychiatric understanding of manic-depressive illness is often traced to the 1850s.
* On January 31, 1854, French psychologist Jules Baillarger presented a description of a biphasic mental illness characterized by alternating periods of mania and depression to the French Imperial Academy of Medicine. Baillarger termed the illness "folie à double forme" (dual-form insanity).
* German psychiatrist Emil Kraepelin (1856-1926) examined and classified the natural course of patients with untreated bipolar disorder years prior to the discovery of mood stabilizers.
* In 1902, Kraepelin created the term manic depressive psychosis to describe these patients.
* He observed that periods of acute illness (manic or depressive) were often preceded and followed by symptom-free periods in which patients were able to function normally.[2]
* Following the Second World War, Australian psychiatrist Dr. John Cade conducted research on the effectiveness of different compounds in treating veterans with manic-depressive illness. Through his research, Dr. Cade found that lithium carbonate was effective at treating manic-depressive illness[3]. Lithium was not widely used as a treatment immediately following Dr. Cade's discovery as many held fears of its toxicity. However, following the use of lithium in the treatment of manic-depressive disorder in some hospitals beginning in the 1950s and reports of the benefits of lithium treatment in medical journals in the 1960s, the Food and Drug Administration approved the use of lithium as a treatment for manic-depressive illness in 1970[4].
* In 1952, the phrase "manic-depressive reaction" was included in the first American Psychiatric Association Diagnostic Manual, demonstrating the belief that the disease was a result of a reaction of biogenetic factors to social/environmental factors.[5]
* In 1957, Karl Leonhard, a German psychiatrist, coined the terms bipolar and unipolar to describe subclassifications of manic depressive psychosis (bipolar disorder).[6]
* Bipolar was used to describe cases with manic episodes.
* Unipolar was used to describe cases characterized by the presence of depressive episodes and the lack of manic episodes.
* In 1968, ICD-8 and DSM-II both called the condition "manic-depressive illness," demonstrating the increasing biological thinking surrounding the condition.[7]
* The current term for the condition, bipolar disorder, recently became popular, though some prefer the old nosology and claim that "manic-depressive illness" better described the multifaceted illness.

## References

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1. ↑ Liddell, Henry George and Robert Scott (1980). A Greek-English Lexicon (Abridged Edition). United Kingdom: Oxford University Press. ISBN 0-19-910207-4.
2. ↑ Kraepelin, Emil (1921) Manic-depressive Insanity and Paranoia ISBN 0-405-07441-7
3. ↑ Cade J. F. J. (1949). "Lithium salts in the treatment of psychotic excitement" (PDF). Medical Journal of Australia. 2: 349–352.
4. ↑ P. B. Mitchell, D. Hadzi-Pavlovic (2000). "Lithium treatment for bipolar disorder" (PDF). Bulletin of the World Health Organization. 78 (4): 515–519.
5. ↑ Goodwin & Jamison. p60-61
6. ↑ Goodwin & Jamison. p62
7. ↑ Goodwin & Jamison. p88

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