Aretaeus of Cappadocia began the quest into the disorder by beginning the process of detailing symptoms in the medical field as early as the 1st Century in Greece. His notations on the link between mania and depression went largely unnoticed for many centuries.
The ancient Greeks and Romans were responsible for the terms “mania” and “melancholia,” which are now the modern day manic and depressive. They even discovered that using lithium salts in baths calmed manic patients and lifted the spirits of depressed people. Today, lithium is a common treatment for bipolar patients.
The Greek philosopher Aristotle not only acknowledged melancholy as a condition, but thanked it as the inspiration for the great artists of his time.
It was common during this time that people across the globe were executed for having bipolar disorder and other mental conditions because as the study of medicine advanced, strict religious dogma stated these people were possessed by demons and should therefore be put to death.
In the 17th Century, Robert Burton wrote the book, The Anatomy of Melancholy, which addressed the issue of treating melancholy (non-specific depression) using music and dance as a form of treatment. While mixed with medical knowledge, the book primarily serves as a literary collection of commentary of depression, and vantage point of the full effects of depression on society. It did, however, expand deeply into the symptoms and treatments of what is now known as clinical depression.
Later that century, Theophilus Bonet published a great work titled Sepuchretum, a text that drew from his experience performing 3,000 autopsies. In it, he linked mania and melancholy in a condition called “manico-melancolicus.”
This was a substantial step in diagnosing the disorder because mania and depression were most often considered separate disorders.
Centuries past, and little new was discovered about bipolar disorder until French psychiatrist Jean-Pierre Falret published an article in 1851 describing what he called “la folie circulaire,” which translates to circular insanity. The article details patients switching through severe depression and manic excitement, and is considered the first documented diagnosis of bipolar disorder.
Besides the diagnosis, Falret noted the genetic connection in bipolar disorder, something medical professionals still believe to this day.
However, the history of bipolar disorder changed with Emil Kraepelin, a German psychiatrist who broke away from Sigmund Freud’s theory that society and the suppression of desires played a large role in mental illness. Kraepelin recognized biological causes of mental illnesses. He is believed to be the first person to seriously study mental illnesses.
Kraepelin’s Manic Depressive Insanity and Paranoia in 1921 detailed the difference between manic-depressive and praecox, which is now known as schizophrenia. His classification of mental disorders remains the basis used by professional associations today.
A professional classification system for mental disorders—which was important to better understand and treat conditions—has its earliest roots in the early 1950s from German psychiatrist Karl Leonhard and others.
The term “bipolar”—which means “two poles” signifying the polar opposites of mania and depression—first appeared in the American Psychiatric Association’s Diagonostic and Statistical Manual of Mental Disorders (DSM) in its third revision in 1980.
It was that revision that did away with the term mania to avoid calling patients “maniacs.” Now in its fourth revision with a fifth version due in 2013, the DSM is considered the leading manual for mental health professionals.
The current version of the DSM lists the following subtypes of bipolar disorder with the following diagnostic criteria:
Bipolar I Disorder
- at least one manic episode and one or more major depression episode
- equally common in men and women, with the first episode in men usually being mania, and the first episode in women typically being major depression.
Bipolar II Disorder
- major depression
- instead of full-on mania, they experience hypomania: high energy, impulsiveness, and excitability, but less severe as full-fledged mania.
- more common in women than men
- less severe mood swings
- episodes shifting from hypomania to mild depression
- rapid changes in mood—with four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.
- may have more than one episode in a week or even within one day
- more common in people who have their first episode at a younger age
- affects more women than men
Rapid-Cycling Bipolar Disorder
The DSM-V is expected to reflect “a significant reformulation in how personality disorders are identified and assessed. The change integrates disorder types with pathological personality traits and, most importantly, levels of impairment in what is known as ‘personality functioning,’” according to a press release from the American Psychiatric Association.