Bipolar disorder is one of the most highly investigated neurological disorders. The National Institute of Mental Health (NIMH) estimates that it affects nearly 4.5 percent of adults in the United States. Of these, nearly 83 percent have “severe” cases of the disorder.
Unfortunately, due to social stigma, funding issues, and a lack of education, less than 40 percent of people with bipolar disorder receive what the NIMH calls “minimally adequate treatment.” These statistics might surprise you, given the centuries of research that have been conducted on this and similar mental health conditions.
Humans have been trying to decipher the causes of bipolar disorder and determine the best treatments for it since ancient times. Read on to learn about the history of bipolar disorder, which is perhaps as complex as the condition itself.
Aretaeus of Cappadocia began the process of detailing symptoms in the medical field as early as the 1st century in Greece. His notes 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 people and lifted the spirits of depressed people. Today, lithium is a common treatment for people with bipolar disorder.
The Greek philosopher Aristotle not only acknowledged melancholy as a condition, but cited it as the inspiration for the great artists of his time.
It was common during this time for people across the globe to be executed for having bipolar disorder and other mental conditions. As the study of medicine advanced, strict religious dogma stated that 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 (nonspecific depression) using music and dance.
While mixed with medical knowledge, the book primarily serves as a literary collection of commentary on depression and a vantage point of the full effects of depression on society.
It did, however, expand deeply into the symptoms and treatments of what’s now known as clinical depression: major depressive disorder.
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-melancholicus.”
This was a substantial step in diagnosing the disorder because mania and depression were most often considered separate disorders.
Years passed and little new information was discovered about bipolar disorder until the 19th century.
The 19th century: Falret’s findings
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 people switching through severe depression and manic excitement, and is considered to be the first documented diagnosis of bipolar disorder.
In addition to making the first diagnosis, Falret also noted the genetic connection in bipolar disorder, something medical professionals still support to this day.
The 20th century: Kraepelin’s and Leonhard’s classifications
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’s believed to be the first person to seriously study mental illness.
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 has its earliest roots in the 1950s from German psychiatrist Karl Leonhard and others. This system was important to better understand and treat these conditions.
Late 20th century: The APA and the DSM
The term “bipolar” means “two poles,” signifying the polar opposites of mania and depression. The term first appeared in the American Psychiatric Association’s (APA) Diagnostic 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 fifth version (DSM-5), the DSM is considered the leading manual for mental health professionals. It contains diagnostic and treatment guidelines that help doctors manage the care of many people with bipolar disorder today.
The concept of spectrum was developed to target specific difficulties with more precise medications. Stahl lists the four major mood disorders as follows:
- manic episode
- major depressive episode
- hypomanic episode
- mixed episode
Our understanding of bipolar disorder has certainly evolved since ancient times. Great advances in education and treatment have been made in just the past century alone.
Today, medication and therapy help many people with bipolar disorder manage their symptoms and cope with their condition. Still, there’s a lot of work to be done because many others aren’t getting the treatment they need to lead better quality lives.
Fortunately, research is ongoing to help us understand even more about this confusing chronic condition. The more we learn about bipolar disorder, the more people may be able to receive the care they need.