The Origin of the Concept of Manic Depressive Illness

Early medical sources reveal that for centuries, people have been aware that "excitement" and "depression" can be part of a single disorder. In the second century A.D., Aretaeus, a medical philosopher, described a group of patients who demonstrated these extremes. He said that these patients would "laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill" only to be "torpid, dull, and sorrowful" at other times. Aretaeus felt that this euphoric and melancholy behavior could be linked to one disorder. His findings went largely unnoticed and unsubstantiated until the seventeenth century. Also in the second century A.D., Soranus of Ephedrus described mania and melancholia as two distinct disorders, but conceded that some felt that mania and melancholia are caused by the same disorder.

Early Chinese authors spoke of bipolar disorder as a mental illness. Around 1583, Gao Lian, the Chinese encyclopedist, described bipolar disorder in his book Eight Treatises on the Nurturing of Life.

In 1686, Theophile Bonet used the term "manico-melancolicus" to describe the connection between mania and melancholia. In the 1830's, Falret and Baillarger, two French physicians, became the first to isolate and identify the symptoms of the disease Falret called "circular insanity." Baillarger described a biphasic mental illness causing episodes of mania and depression. Baillarger focused on the depressive phases of the illness. Falret thoroughly described the symptoms and hereditary factors of "circular insanity." Farlet recognized that many patients with bipolar disorder had a family history of bipolar disorder, which led him to believe that there is a genetic link. He encouraged physicians to seek an effective drug treatment for the disorder. In 1875, his recorded findings were termed Manic-Depressive Psychosis, a psychiatric disorder.

The German psychiatrist Emil Kraepelin (1856-1926) accurately and vividly described manic-depressive illness. He distinguished the difference between manic depression and schizophrenia. Emil Kraepelin is heralded as the father of modern psychiatry.

Even though psychiatrists were beginning to understand manic depression, there was still no effective treatment. The common solution to bipolar disorder was long-term hospitalization, where patients were basically warehoused. The development of medication for manic depression began in an Australian lab in 1948, when Dr. John Cade, senior medical officer in the Mental Hygiene Department of Victoria, thought that urea would be effective in the treatment of manic depression. He needed an agent to help the substance dissolve in water, which turned out to be lithium. He quickly found the solution had a calming effect on guinea pigs. Further experimentation showed that it was not the urea, but the lithium that was the active agent. He tested lithium on human subjects and saw remarkable results.

The term manic-depressive illness was first used in 1958. In 1980, the term bipolar disorder replaced manic-depressive disorder in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III).

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