Ancient Greece and Rome
The earliest mentions of bipolar disorder in medical literature date back to Hippocrates (460-370 B.C.), a physician in ancient Greece who’s often referred to as “the father of medicine.” He was the first to document two extreme moods: feeling extremely low (what we now call depression) and feeling extremely energized or excited (mania).
Hippocrates described the state of extreme sadness as “melancholia.” “Melas” meant black and “chole” meant bile, so the term means “black bile.” Mania, on the other hand, was thought to be caused by too much yellow bile.
Another Greek physician, Aretaeus of Cappadocia, who lived during the first century, is credited with being the first to express the concept of a mood spectrum, with these extreme moods on each end. He was also the first to determine that melancholia and mania were associated with a problem in the brain.
Plato (428-348 B.C.), an Athenian philosopher, delved into the concept of mania and described two types in his writings: “One involving a mental strain that arises from a bodily cause of origin, the other divine or inspired.” Hippocrates and Aretaeus were able to distinguish between the two, and they each worked to prove that melancholia and mania were biological conditions, not just psychological reactions to a situation.
Linking the Depression and Mania Cycles
Up until the mid-19th century, depression and mania were considered separate conditions with different symptoms. Around 1850, a French psychiatrist named Jean-Pierre Falret (1794-1870) created a new and separate disorder encompassing both syndromes. He called it “folie circulaire,” in which someone had a continuous cycle of depression, mania, and varying intervals of times in between.
Around the same time, another French psychiatrist and neurologist, Jules Baillarger, described a condition he called “folie à double forme.” His definition allowed for periods of mania and depression, but without intervals in between. In time, he said, one extreme would simply turn into the other.
Meanwhile, a German psychiatrist named Karl Kahlbaum (1828–1899) grouped mental disorders into two categories: those that caused a limited disturbance of the mind and those that caused a complete disturbance in the mind.
By the turn of the century, Emil Kraepelin (1856-1926), another German psychiatrist who’s considered the founder of modern psychiatry, unified all types of affective disorders into one condition called manic-depressive insanity. And despite some opposition, Kraepelin’s theory was adopted -- for a time.
The DSM
In the 1950s, experts created the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) in an attempt to standardize and categorize mental illness. The DSM-I broke down Kraepelin’s singular condition of manic-depressive insanity into three types: manic, depressed, and other. The cycle of bipolar disorder was classified under “other.”
When the DSM-II came out in 1968, some of the terminology changed. Instead of manic-depressive insanity, it was called manic-depressive illness. The third type switched from the vague “other” to “circular,” which was defined as “at least one attack of both a depressive episode and a manic episode.”
The third edition of the DSM, published in 1980, was the first time bipolar disorder was identified as such. It was also the first appearance of modern criteria for defining the mood disorder, and the first time it was separated as a condition from generalized depression.
Today, bipolar disorder is broken down into four types:
- Bipolar I: Having one or more episodes of mania lasting for at least 7 days. A depressive episode may or may not occur.
- Bipolar II: Having depressive episodes alternating with somewhat manic episodes, but not full manic episodes.
- Cyclothymic disorder: Switching between depressive and manic states for at least 2 years, with periods of normal mood lasting less than 8 weeks.
- Unspecified bipolar disorder: When a person does not meet any of the above descriptions but has had significant mood elevation.
In the first half of the 20th century, doctors tried treating patients with various types of medications, including barbiturates. Lithium gained research in the 1950s and 1960s and was approved by the FDA for bipolar disorder in the 1970s. Anti-seizure medications and antipsychotic medications have since gained FDA approval for treatment.
Differences by Culture
Bipolar disorder, like other mental health conditions, is found in people around the world, as well as throughout the ages. But they don’t always have the same experiences with diagnosis and treatment.
In the 1990s, several studies were published that documented differences in bipolar disorder based on the culture of the patient. Between 0.3% and 1.5% of people are diagnosed with bipolar disorder. The World Health Organization estimates that 45 million people worldwide have this condition.
Research shows that bipolar disorder is likely underdiagnosed in Black populations, and probably also in other racial/ethnic minority groups in the U.S. This is due in part to gaps in mental health care treatment, stigma about mental illness, and language barriers.
There may also be differences in how some people of different cultures experience their symptoms. Some studies have found people of Asian descent are more likely to report the physical symptoms related to mental health problems and less likely to report the emotional symptoms of mental health issues.
Medication to stabilize mood and psychological/social support are key parts of treatment, the World Health Organization and other medical organizations note.
