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Jeff Baker, BSBA-IT, Bipolar Aid, Bella Vista, AR 72715 USA email@example.com
A Complete History of Bipolar Disorder
by Jeff Baker
Much information and misinformation persistently flow from the media regarding the topics of bipolar disorder and clinical depression. Lesser-known are the written history and etymology relating to the disorders. Ancient people also suffered from these afflictions as recorded in humankind's earliest writings. The older history of bipolar disorder is both vague yet surprisingly prescient. Up-and-down mood swings were observed and identified back to antiquity; the infirmity's subtleties required more than six centuries to flesh out.
Bipolar disorder is a worldwide pandemic affliction. It is a maturing topic, yet it remains a hazy conversation among the general public. It represents the 2nd-highest reason for disability worldwide. Specific symptoms of mania followed by clinical depressionwere recognized and named by the ancient Greeks. Even during the past two centuries, few experts and laypersons embraced manic-depression as a medical ailment despite its being one of the world's oldest physical/mental illnesses...
A BRIEF BIPOLAR DISORDER HISTORY (4:00)
Extreme mood and energy levels have beset humankind since its beginnings. Bible characters like Jonah, King David, Job,Samson and many others demonstrated either unipolar(clinically depressive) or bipolar disorder characteristics. Accounts of depression came from Egyptian writers as long ago as 2,000 B.C. The notion of a bipolar condition is not found among the writers' accounts of mania as being either insane or psychotic.
How can one determine whether or not an ancient or historical figure suffered mania,depression or both? It is actually not too difficult when one marshals the aid of historians, Bible scholars, psychologists, anthropologists and psychiatrists. Here are some of the things they look for to determine manifestation of mood disorders:
Written historical accounts
Subject confession/profession of state-of-mind (e.g., desiring death)
Third-party observations of the subject and concomitant events
The early Greek terms melancholia and mania were applied to those exhibiting behaviors that we know today as bipolar disorder. The Greek melas translates as “black” and chole as “bile” or “gall.” These terms predated Hippocrates'humoral theory of mania stemming from an excess of either yellow or black-and-yellow bile. The theory that an excess of a bodily fluid was prescient, as we now know mania results from an excess of brain neurotransmitters. Excess black chole was thought to cause depression.Menos related to mania as a “spirit,” “passion” or “force.” To “rage” or go “mad” derived from mainesthai. This Hippocratichumoralhypothesis remained in force for at least one century after the fall of the Roman empire.
Roman physician Caelius Aurelianus' terms for mental issues included ania, or “production of “intense mental stress.” 'Manos' meant “relaxing” of the mind or soul. Five other terms added to the confusion surrounding mania as used in pre-Hippocratic poetry and mythologies. Claudius Galenus, Roman physician, surgeon and philosopher, extended the “humors” philosophy. He championed Hippocrates' theory of four specific humors. He also claimed that infinitely variable blends of the four humors determine human temperaments and moods:
Blood – sanguine
Black bile – melancholic
Yellow bile – choleric
Phlegm – phlegmatic
Bipolar disorder is one of the earliest recorded illnesses known to man. The first well-defined concept relating mania and melancholy as results of black bile arose during the first century A.D. Greek physician and philosopher Aretaeus of Cappadocia observed patients who laughed, played, and danced all day and into the open markets. They cavorted as if they were victors of some contest or game. The earliest descriptions of the mania and depression relationship were written in the second century. They defined melancholia as dullness, torpidity and sorrow. This observation and connection of bipolar behavior in individuals failed to gain currency until 1650.
Deprimere, or “depression,” became the Latin clinical term for the melancholy phase of manic-depression during Rome's world dominance. Depression was defined as “to press down” or “to sink down.” Also linking the bipolar states was Rome's Soranus of Ephesus (98-177 A.D.) He identified mania and melancholia as individual diseases. He also knew many others regarded melancholia as a form of manic disease in 150 A.D. Northern Roman spas were used to treat agitated, euphoric patients. Visionary Soranus noted the waters' lithium salts were seemingly absorbed by patients' bodies, calming them and making them feel better. Greek philosopher Aristotle, who named in 325 B.C. four sources of hedonism,credited mania for the superior mental gifts of artists, poets, writers and all creative minds of his time.
Dr. Cara Gardenswartz tells of ignorance and fear leading to the first euthanasia and executions of bipolar patients during 300 – 500 A.D. These unfortunates were branded as being either possessed by demons or crazed. They were “treated” and “punished” by using bloodletting, chained restraints, myriad potions, electric eels applied to their skulls and witchcraft cures. Those troubled with mental disorders were judged to be victims of their own wrongdoing during the Middle Ages. During the 18th and 19th centuries, healthier attitudes toward those souls suffering mood disorders began to develop. Gardenswartz also notes that, as the names for bipolar disorder changed, so did treatment methods. They included sedative and barbiturate therapies, institutionalization, crude electro-convulsive therapy (ECT) and prefrontal lobotomies. These treatments were routinely performed up until the 1950s. And ECT is now back in use.
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Today, when medication and psychotherapy fail to ease the symptoms of bipolar and clinical depression, there are other options to try. Brain stimulation techniques such as electroconvulsive therapy (ECT), for example, can be used to treat major depression that hasn't responded to standard treatments. With ECT, an electric current is briefly applied through the scalp to the brain, inducing a seizure. The shocks are applied in a series of treatments. In addition, less-invasive alternative therapies such as Transcrainial Magnetic Stimulation (TMS), Vagus Nerve Stimulation (VNS), yoga and hypnosis sometimes work for severe-to-mild depression.
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Persian physician Avicenna wrote The Canon of Medicine, recording the charactice of trance state as a healing therapy. This 1025 A.D. document spelled out manic-depressive psychosis, as differentiated from the illnesses of mania, schizophrenia and rabies. Chinese Gao Lianclearly described bipolar disorder as a mental illness in his 1583 Eight Treatises on the Nurturing of Life. English scholar, writer and Anglican clergyman Robert Burton, in 1621, reviewed 2,000 years of medical and philosophical wisdom. He concluded depression was a mental illness in its own right in The Anatomy of Melancholia. That it also genetically linked family members with the disorder was remarkable. Burtonalso proffered music and dance as possible treatments for those with bipolar disorder.
British physician Richard Napier's late 17th century writings referred to a disorder exhibiting two mood states within the brain. In 1686, Swiss physician Theophile Bonet wroteSepuchretum. In ithe was the first to connect the distinctive ends of the mood spectrum, calling it manico-melancolicus. In the 1800s' first decade, Phillipe Pinel'sTreatise on Insanity identifiedbipolar disease, and was the first to release mental patients from confinement, starting a mass movement for humane treatment for the mentally ill.Concurrently, John Haslam'sObservation's on Madness and Melancholy also defined bipolar disease.
The foundation for modern thinking on bipolar disorder originated in January 31, 1854. French psychiatrist and neurologist Jules Baillarger described a distinction between bipolar disorder and schizophrenia. He also identified bipolar illness as causing oscillating mania and depression, or “dual-form insanity.” A mere two weeks hence, Jean-Pierre Falret described “circular insanity,” resulting in a “whodunnit first?” row with Baillarger.Falret's efforts led to the term bipolar affective disorder and, more importantly, he linked depression to suicide. In 1875 he termed Manic-Depressive Psychosis a psychiatric disorder. Falret also noted the disease seemed to spread among families, a genetic component for the condition that is still accepted today.
“We owe the categorization of bipolar disorder as an illness to Falret,” according to Jules Angst, M.D., and Robert Sellaro, BSc, of Zurich University Hospital in Switzerland. Falret encouraged diverse medical testing in hopes of arriving at an efficacious drug therapy for mood disorders. However, by the late 1800s, most clinicians still clung to the view that mania and melancholia were distinct, chronic afflictions with deteriorating courses.
The first laboratory of psychology was born at Johns Hopkins University in 1883. In 1890, New York state passed the State Care Act, ordering indigent mentally ill patients out of poor-houses and into state hospitals for treatment, developing the first institution for psychiatric research in the U.S.A. The first psychological clinic developed at University of Pennsylvania, establishing the birth of clinical psychology in 1896. In 1936, frontal lobotomies were performed to cure mental illness. Electroshock (ECT) therapy was soon developed in 1938.
In 1903, psychoanalyst Carl Gustav Jung differentiated manic-depression both with and without psychotic states. They are now classified as Bipolar I (with psychosis) and Bipolar II (without psychosis), per definitions currently found in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). The DSM is reckoned to be “The Psychiatrist's Bible” and was first published in 1952. Jung birthed a new school of thought known as "Analytical Psychology."
German psychiatrist Emil Kraepelin (1856-1926), is regarded as “the father of modern scientific psychiatry and psychopharmacology.” He published The Textbook of Psychiatry and regarded mental disorders as biologically-based, improved on Falret's concepts, and employed German psychiatrist Karl LudwigKahlbaum's“cyclothymia” theory. Kraepelin categorized the actual course of manic-depressive psychosis in 1913, having observed from patients' moods that mania and depression were episodic in nature. He also noted they were separated by a short term of normalcy in both mood and energy. He believed mood disorders were biological in origin. Kraepelin grouped diseases by classification of common symptom patterns rather than by simple similarities. He theorized specific brain or other biological pathology was responsible for each major psychiatric disorder. His approach was generally accepted and lasted through the 1930s.
Austrian neurologist Sigmund Freud weighed in during the early 1900s and began treating bipolar patients with psychoanalysis. He achieved limited results with this talk therapy and attributed the illness to unresolved developmental conflicts and childhood trauma—all at the expense of established biological theories. He also originated the most accurate and simplest definition of major depression as being "anger turned against oneself." Freud committed suicide by ingesting morphine after a season of self-analysis.
In 1949, Australian psychiatrist John Cade of the Bundoora Repatriation Hospital in Melbourne, accidentally discovered lithium urate seemed to calm guinea pigs. During this period when lobotomies and electro-convulsive therapy (ECT) were widely used, he successfully tested lithium and other various compounds on WWII veterans manifesting "shell shock" and manic-depressive psychosis. Lithium Carbonate showed promise and was first used throughout Europe. But in the U.S., salt substitutes were suspect, posing the possibility of toxicity or death, so Lithium was banned for psychiatric use during the 1950s.
Freud’sfollowers saw depression and mania (and other states) as not necessarily biological, but as maladaptive reactions to one’s environment. Freud'smindsetwas the dominant mindset of psychiatry when the APA published the DSM-I in 1952, replete with its inclusion of “manic-depressive reaction.”A 1952 article in the Journal of Nervous and Mental Disorders announced the likelihood of bipolar genetic distribution throughout families. The U.S. Congress' nonacceptance of the bipolar diagnosis left patients institutionalized and prevented financial help for both patients and families. Thorazine became the first psychiatric drug introduced in 1952, an antipsychotic drug that put many patients into a trance-like "manageable" state.
Adolf Meyerproposed the manic-depressivereaction was of biogenetic factors with psychological and social influences. The term was first appeared in 1952's first DSM edition. In the 1960s, Jules Angst and others identified “chronic” depression and parsed it out from “recurrent” depression. But the Kraepelin model still held. During the 1970s, psychiatrist Frederick Goodwin and others regarded recurrent depression as a close cousin to bipolar rather than a sibling of chronic depression. German psychiatrist Karl Leonhardfirst introduced the sub-classified terms “bipolar”(manic-depressive) and “unipolar”(clinically depressive). DSM-II appeared in 1968 and defined manic-depressiveillness from a psychodynamic viewpoint. DSM-III in 1980 radically shifted that perspective to a biomedical approach. It also officially defined bipolar disorder in place of the more stigmatic term “manic-depression.”
Each subsequent DSM edition has increasingly broken down all mental disorders to their more elemental, nuanced and interactive parts. “Bipolar Disorder” became DSM-III's designated name for “manic-depression” in 1980, despite its lesser accuracy. The more simplistic term “bipolar” provided a more understandable “up-and-down” two-pole concept for patients and lay persons alike, per Dr. Robert L. Spitzer of Columbia University. He and his team wrote the DSM-III, a sturdy instrument that did away with calling bipolar patients “maniacs.” Again, the term “bipolar” was found to reduce the stigma that resulted from the coarse-sounding term “manic-depression.” The terms manic-depressive illness and bipolar disorder were defined and used since the 1950s and 1980s, respectively. The DSM-IV was published in 1994. It explained the difference between the wilder Bipolar I mania as compared with the lesser Bipolar II hypomania. The DSM-5 was released in May 2013.
U.S. Doctors experimented further with lithium in the 1950s, and 1960s' literature championed lithium's efficacy in the treatment of manic-depression. Antipsychotic medications like chlorpromazine were the preferred treatment for bipolar disorder before lithium therapy became prevalent. Meanwhile, U.S. psychiatrists were typically mis-diagnosing bipolar disorder as being schizophrenia. Only in the 1960s did the emphasis on mood elevation as being the true nature of the defining feature of bipolar disorder emerge. Dr. Aaron Beck published a psychological model of depression suggesting thought plays a significant role in the development, course and maintenance of depression.
Disabled mentally ill persons resided in mental facilities in 1955. Today they receive either Federal SSI or SSDI payments and are left to survive on their own. Thorazine and Prozac became the secondary wave of psychotropic drugs in 1997, paving the way for psychiatric medical treatment in the same way penicillin use revolutionized general medicine. Use of these meds ushered in the psychopharmacology era...[in which]..."we have very effective and safe treatments for a broad array of psychiatric disorders." - Psychiatrist Richard Friedman, M.D. The Boston Globe trumpeted in June 2007: "The development of powerful drugs has revolutionized the treatment of mental illness."
Finally, bipolar patients were humanized instead of demonized with the realization that treatment could help them. The U.S. Food and Drug Administration (FDA) granted approval for lithium therapy for treatment of mania in 1970. It was then that the U.S. Congress finally enacted laws and standards to help bipolar patients. Lithium then became accepted as a prophylactic for manic-depressive illness in 1974. The National Association of Mental Health (NAMI) was created by the U.S. government as a result. NAMI is credited with increasing research efforts in this regard. Simultaneously, clinical studies defined the differences of symptoms and causes of bipolar disorder between adults and children. The independent Depression and Bipolar Support Alliance (DBSA) was founded in 1985. It offers training of mental health professionals and counselors and information for the public. More importantly, it trains peer-leaders for Bipolar Support Groups across America. 1,000 such groups were active in 2010 and the number of them keeps pace with the staggering increase of those (diagnosed and undiagnosed) who suffer mood disorders.
Kraepelin's 1921 findings and today's resurgence of the disorders' biological and psychosocial process were combined during the 1990s. Today's use of cognitive, support and insight-oriented psychological therapies supplement the latest drug therapies in the successful treatment of bipolar disorder. Antiepileptics, antidepressants, mood stabilizers, neuroleptics, antipsychotics and sedatives are used today. In 2004, a possible gene determining susceptibility to bipolar disorder was discovered. Many other studies prove a patient's stable circadian rhythms and positive lifestyle changes can help delay or prevent future episodes of bipolar disorder. These lifestyle changes include proper diet, exercise, cognition, sleep and the restoration of circadian rhythms.
At present, despite Lithium's overall advantages in treating bipolar disorder, neuroleptic drugs are becoming the preferred choice for first treatment of acute mania. They achieve quicker activation and superior control of psychomotor skills. Treatments involving neuroleptics like Risperidone and Clozapine offer limited success in preventing bipolar episodes. However, the side-effects of neuroleptics are strong, varied and often frightening.
Less threatening are the anticonvulsants, like carbamazipine, divalproex and valproate that appeared in the late 1970s. They were successfully used to treat bipolar patients who were unresponsive to or endangered by lithium. Another important advantage to this drug class is the extremely mild and short-term side-effect suite that accompanies it. Psychiatrists often use psychotropic drugs in off-label fashion. They routinely experiment with undocumented “off label” drug combinations that work best for their patients. Nonetheless, lithium carbonate decreases bipolar episodes by 80% overall. It remains as an 85% initial treatment option for bipolar disorder. Lithium carbonate also demonstrates mild antidepressant qualities. It has been shown to reduce mental patient suicidality by 60%.
In conclusion, we find:
The oldest observations of early man's emotions took place before the first early Egyptian documentation of mood swings
The first recorded notice of high and low mood swings as a medical issue came from ancient Egyptian writings
Bipolar theory, knowledge, diagnosis, and treatment methods improved slowly and incrementally until the mid-1950s
Knowledge of, diagnosis and treatment of manic-depression has accelerated greatly since the latter 1900s
A combination of psychiatric drugs, psychological counseling and patient lifestyle changes now permit stabilization and management of patients' moods
The pandemic nature of bipolar disorder will likely result in an emphasis on how genetic means and/or alternate therapies may lead to either bipolar disorder episode prevention or a cure within the next two decades
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Any history is incomplete without its termination in the now:
Depression and Bipolar Disorder are among the most common diseases in the world. Studies shows sufferers manifest many illnesses more commonly than do the general population. Mood disorders are more often causal, co-exist, or result from: extreme stress, anxiety disorders, schizophrenia, substance abuse, diabetes,metabolic syndrome, cardiovascular disease, obesity, immunological abnormalities, multiple sclerosis, cancer, osteoporosis, shortened lifespan, accelerated aging, migraine headaches and suicide...then there are the many injurious and deadly side-effects caused by prescribed psychiatric medicines. These two mood disorders often do not respond to initial medication. Bipolar Disorder and Major Depression can affect anyone-including the rich, the successful and the famous among us...