The History of Bipolar Disorder
Since ancient times, humans have been trying to decipher the cause of bipolar disorder. As far back as ancient Greece, physicians and scientists have been trying to determine how to best treat the highs and the lows of the condition. It has changed names many times, and has been written in the history books as both a disorder of the divinely inspired, as well as being a sign of damnation by the devil himself.
Today, bipolar disorder is one of the most highly investigated neurological disorders. And yet, like those who studied the condition before us, the answer as to what causes bipolar disorder, and how best to treat it, remain very much a work in progress. Social stigma, funding and lack of education are still contributing factors as to why there are no clear answers, despite centuries of research.
Ancient Beginnings
A physician by the name of Hippocrates (460-370 B.C.) traditionally considered by many to be the “father of medicine,” was the first to document two extreme moods: feeling extremely low melancholia (depression) and feeling extremely energized or excited (mania).
Plato (428 – 348 BC) a philosopher, delved into the concept of mania in his writings. He believed mania was a “divine state.” Describing two different kinds of mania, one “that involves a mental strain that arises from a bodily case of origin, the other is divine inspired.” He goes on to describe several other “types” of mania including the erotically inspired (hypersexuality) and prophetic inspiration (intuition).
Aristotle (384-322 BCE) not only acknowledged melancholy as a condition but also cited it as inspiration for the great artists of his time. “Why is it that so many of those who have become outstanding in philosophy, statesmanship, poetry or the arts have been melancholic?”
Aretaeus of Cappadocia (130-140 CE) was the first to develop the concept of a link between mania and depression and to develop a mood spectrum, with extreme moods on either end.
Hippocrates and Aretaeus both distinguished differences between depression and mania and worked to prove that melancholia and mania were biological conditions not just a psychological reaction to a situation.
11th – 15th Century
By the late Middle Ages – economic and political turmoil began to threaten the power of the Roman Catholic Church. Supernatural theories of mental disorders again dominated Europe, fueled by natural disasters like plagues and famines, that lay people interpreted as brought about by the devil.
Beginning in the 13th Century, the mentally ill, especially women, began to be persecuted as witches
15th -17th Century
At the height of the witch hunts, the Protestant Reformation plunged Europe into religious strife. Two Dominion monks wrote the Malleus Maleficarum (1486) as the ultimate guide to witch hunts. From 1486 until the late 18th Century, this “legal and theological” document was regarded by both Catholics and Protestants as the authoritative guide to both the detection and extirpation of witchcraft. Trusted as the authoritative source of information concerning Satanism and as a guide to Christian defense, it did much to spur on and sustain witch hunting for the next two hundred years.
Johann Weyer, a physician and demonologist broke from the theories held in the Malleus Maleficarum, publishing a celebrated expose of witchcraft delusion. Weyer, in his writings, presents one of the first scientific approaches to the study of mental illness. He asserts that most witches are actually suffering from mental illness and backs this claim with careful descriptions from his own clinical experience.
Reginald Scot (1538-1599), an Englishman and Member of Parliament, tried to convince people in the mid-late 16th century, with his penning of The Discoverie of Witchcraft (1584), that accused witches were actually women with mental illnesses. His aim was to prevent the prosecution of the poor, aged and the simple which were popularly credited with being witches. He blamed the maintenance of superstition on the Catholic Church and numerous sympathetic writer’s to the Church’s teachings.
The Church’s Inquisition banned both Weyer’s and Scot’s writings. Witch hunting didn’t decline until the 17th and 18th centuries, after more than 100,000 presumed witches had been burned at the stake.
19th Century
In 1851, a French psychiatrist, Jean-Pierre Falret, wrote an article where he described something called “la foile circulaire,” or circular insanity. Believed to be the first documented diagnosis of bipolar disorder his work explains the continuous pattern of depression, mania and “normal” that he observed in his own patients. Falret also notably, mentions the genetic condition of bipolar disorder, a theory professionals still use to this day.
Around the same time psychiatrist and neurologist Jules Baillarger, described a condition called “folie á double ferme” or dual-form insanity. His observations, allowed for periods of depression and mania, but without intervals in between. In time he said, one extreme would always just turn into another.
20th Century
According to Sigmund Freud (1856-1939), the father of psychoanalysis, mental illness rises when ego is incapable of maintaining control of the id and the superego, when impulses are too strong. In other words, because of society when someone suppresses one’s desires for a prolonged time… a mental illness will occur. Usually this is caused (according to Freud) by childhood trauma.
German scientist Emil Kraepelin (1856-1926) broke this theory for the first time and suggested biological causes for mental illness versus conforming to societal norms. In 1899, he made the distinction between psychosis and dementia praecox, or modern day schizophrenia. His work “Manic Depressive Insanity and Paranoia,” details his belief that manic-depressive disorders and melancholia (depression), were exogenous thus treatable. Where dementia praecox fell amongst the endogenous, or incurable illnesses. The concepts embodied in Kraepelin’s classification system did not originate with him, but he was the first to synthesize them into a workable model that could diagnose mental health patients.
Published for the first time in 1950, The Diagnostic and Statistical Manual of Mental Disorders (DSM-1), broke down Kraepulin’s singular condition of manic depressive insanity into three types: manic, depressed and other.
In 1950, another German scientist by the name of Karl Leonhard created a professional classification system for mental disorders called the Clinical Pictures of Phasic Psychoses. This system was key to the understanding and treatment of these disorders.
Late 20th Century
The term bipolar means “two poles” – signifying the opposites of mania and depression. The term first officially appeared in 1980 in the 3rd edition of The Diagnostic and Statistical Manual of Mental Health (DSM-3). The revision was key because it did away with the term mania, specifically to avoid patients being called “maniacs.” Currently, the manual is in its 5th edition. The DSM-5 is considered the leading manual for mental health professionals. Today there are 3 classifications for bipolar disorder.
- Bipolar I
- Bipolar II
- Cyclothymic Bipolar
Today
Yes, the understanding of bipolar disorder has advanced, especially over the last century, however, there is still much research to be done. The number of people who still go undiagnosed or misdiagnosed is staggering. Efforts by health care systems need to continue to attend to the development of medication, therapies and understanding in order to allow better access for ALL those who are affected.
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