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Jeff Baker, BSBA-IT, Bipolar Aid, Bella Vista, AR 72715 USA firstname.lastname@example.org
A Complete History of Bipolar Disorder
by Jeff Baker
information and misinformation persistently flow from the media
regarding the topics of bipolar
are the written history and etymology relating to the disorders.
also suffered from these afflictions as recorded in humankind's
earliest writings. The older history of bipolar
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.
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
recognized and named by the ancient Greeks. Even during the past two
centuries, few experts and laypersons embraced manic-depression
a medical ailment despite its being one of the world's oldest physical/mental illnesses...
A BRIEF BIPOLAR DISORDER HISTORY (4:00)
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
from Egyptian writers as long ago as 2,000
B.C. The notion of a
condition is not found among the writers' accounts of mania
being either insane
can one determine whether or not an ancient or historical figure
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
Written historical accounts
confession/profession of state-of-mind (e.g., desiring death)
Third-party observations of
the subject and concomitant events
early Greek terms melancholia
applied to those exhibiting behaviors that we know today as bipolar
The Greek melas
as “black” and chole
These terms predated Hippocrates'humoral
stemming from an excess of either yellow or black-and-yellow bile.
theory that an
excess of a bodily fluid was prescient, as we now know
an excess of brain neurotransmitters.
Excess black chole
thought to cause depression.Menos
a “spirit,” “passion” or “force.” To “rage” or go
“mad” derived from mainesthai.
in force for at least one century after the fall of the Roman empire.
terms for mental issues included ania,
or “production of “intense mental stress.” 'Manos'
“relaxing” of the mind or soul. Five other terms added to the
confusion surrounding mania
used in pre-Hippocratic poetry and mythologies. Claudius
Roman physician, surgeon and philosopher, extended the “humors”
He championed Hippocrates'
theory of four specific humors. He also claimed that infinitely
variable blends of the four humors
human temperaments and moods:
Blood – sanguine
Black bile – melancholic
Yellow bile – choleric
Phlegm – phlegmatic
one of the earliest recorded illnesses known to man. The first
well-defined concept relating mania
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
were written in the second century. They defined
torpidity and sorrow. This observation and connection of bipolar
behavior in individuals failed to gain currency until 1650.
or “depression,” became the Latin clinical term for the
world dominance. Depression
was defined as “to press down” or “to sink down.” Also
linking the bipolar
was Rome's Soranus
(98-177 A.D.) He identified mania
individual diseases. He also
many others regarded melancholia
form of manic
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
the superior mental gifts of artists, poets, writers and all creative
minds of his time.
tells of ignorance and fear leading to the first
patients during 300 – 500 A.D. These unfortunates were branded as
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
were judged to be victims of their own wrongdoing during the Middle
Ages. During the 18th
healthier attitudes toward those souls suffering mood
began to develop. Gardenswartz
also notes that, as the names for bipolar
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.
* * *
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.
* * *
Canon of Medicine, recording the charactice of trance state as a healing therapy. This
1025 A.D. document spelled out manic-depressive
differentiated from the illnesses of mania,
Lianclearly described bipolar
a mental illness in his 1583 Eight
Treatises on the Nurturing of Life.
scholar, writer and Anglican clergyman Robert
in 1621, reviewed 2,000 years of medical and philosophical wisdom. He
in its own right in The
Anatomy of Melancholia.
it also genetically linked family members with
was remarkable. Burtonalso proffered music and dance as possible treatments for those with
writings referred to a disorder
exhibiting two mood states within the brain. In 1686, Swiss physician
the first to connect the distinctive ends of the mood spectrum,
calling it manico-melancolicus.
the 1800s' first decade, Phillipe
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,
on Madness and Melancholy
also defined bipolar
foundation for modern thinking on bipolar
in January 31, 1854. French psychiatrist and neurologist Jules
described a distinction between bipolar
also identified bipolar
oscillating mania and depression, or “dual-form
A mere two
weeks hence, Jean-Pierre
resulting in a “whodunnit first?” row with Baillarger.Falret's
efforts led to the term bipolar
importantly, he linked depression
to suicide. In 1875 he termed Manic-Depressive
also noted the disease seemed to spread among families, a genetic
the condition that
is still accepted today.
owe the categorization of bipolar
as an illness to Falret,”
according to Jules
of Zurich University Hospital in Switzerland. Falret
encouraged diverse medical testing in hopes of arriving at an
efficacious drug therapy for mood
However, by the late 1800s, most clinicians still clung to the view
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.
1903, psychoanalyst Carl
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."
(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”
categorized the actual course of manic-depressive
1913, having observed from patients' moods that mania
were episodic in nature. He also noted they were separated by a short
term of normalcy in both mood and energy. He believed mood
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
His approach was generally accepted and lasted through the 1930s.
Austrian neurologist Sigmund
weighed in during the early 1900s and began treating bipolar
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.
1949, Australian psychiatrist John
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
showed promise and
throughout Europe. But in the U.S., salt substitutes were suspect,
posing the possibility of toxicity or death, so Lithium was banned
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.
Doctors experimented further with lithium in the 1950s, and 1960s'
lithium's efficacy in the treatment of manic-depression.
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."
were humanized instead of demonized with the realization that
treatment could help them. The U.S. Food and Drug Administration
granted approval for
lithium therapy for treatment of mania
1970. It was then that the U.S. Congress finally enacted laws and
standards to help bipolar
as a prophylactic for manic-depressive
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
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.
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
antidepressants, mood stabilizers, neuroleptics, antipsychotics
are used today.
2004, a possible gene determining susceptibility to bipolar
discovered. Many other studies prove a
circadian rhythms and positive lifestyle changes can help delay or
prevent future episodes of bipolar
lifestyle changes include proper diet, exercise, cognition, sleep and
the restoration of circadian rhythms.
present, despite Lithium's overall advantages in treating bipolar
drugs are becoming the preferred choice for first treatment of acute
They achieve quicker activation and superior control of psychomotor
skills. Treatments involving neuroleptics
like Risperidone and Clozapine offer limited success in
However, the side-effects
of neuroleptics are strong, varied and often frightening.
threatening are the anticonvulsants,
like carbamazipine, divalproex and valproate that appeared in the
late 1970s. They were successfully used to treat bipolar
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
in off-label fashion. They routinely
with undocumented “off
combinations that work best for their patients. Nonetheless, lithium
carbonate decreases bipolar
by 80% overall. It remains as an 85% initial treatment option for
Lithium carbonate also demonstrates mild antidepressant qualities. It has been shown to reduce mental patient suicidality by 60%.
In conclusion, we find:
oldest observations of early man's emotions took place before the first early Egyptian documentation of mood
first recorded notice of high and low mood
a medical issue came from ancient Egyptian writings
Bipolar theory, knowledge,
diagnosis, and treatment methods improved slowly and incrementally until the mid-1950s
of, diagnosis and treatment of manic-depression
the latter 1900s
A combination of
psychiatric drugs, psychological counseling and patient lifestyle
changes now permit stabilization and management of patients' moods
pandemic nature of bipolar
likely result in an emphasis on how genetic means and/or alternate
therapies may lead to either bipolar
or a cure within the next two decades
* * *
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...