10 People Who Shaped How We View Bipolar Disorder
John McManamy | July 8, 2015
We may think we know what bipolar is, but our perceptions have been evolving for at least two thousand years, and we’re only just beginning …
Aretaeus of Cappadocia
The ancients had previously identified both mania and depression. Aretaeus of Cappadocia, living two thousand years ago, was the first we know of to interpret the two as part of the same condition.
In 1851, the French psychiatrist Jean-Pierre Falret came up with “la folie circulaire” (circular insanity) to explain the continuous pattern of depression, mania, and “normal” that he observed in his patients.
This view encourages us to examine our episodes in relationships to each other rather than in isolation.
In 1899 the German psychiatrist Emil Kraepelin coined the term “manic-depression,” which he viewed as part of a unified illness that included most forms of unipolar depression as well as what we now call bipolar.
In addition to mood cycles, Kraepelin also postulated similar patterns to our thoughts and volitions, plus he added a layer of personality temperaments.
In the 1950s and 60s, this Danish psychiatrist conducted clinical trials that convinced a skeptical psychiatric establishment that lithium was effective in the treatment and prevention of bipolar episodes. Thanks to his efforts, lithium treatment soon became widespread, and gave hope to millions.
In the 1950s, the German psychiatrist Karl Leonhard proposed splitting manic-depression into bipolar on one hand and unipolar depression on the other. This was based on his own research that pointed to differences in family background and clinical course.
As a result of his efforts and those who came later, bipolar is a much narrower illness than originally conceived by Kraepelin.
Robert Spitzer was the driving force behind the DSM-III of 1980. This particular edition of psychiatry’s diagnostic bible was a total game-changer.
Start with the fact that it drove a stake in the legacy of Freud. To that, add that it reduced the complexity of mental illness to a system of simplified symptom checklists. Then add that it carved unipolar and bipolar in a way that encouraged the over-diagnosis of the former and under-diagnosis of the later.
Former head of the NIMH and co-author (with Kay Jamison) of the authoritative Manic-Depressive Illness, former host of The Infinite Mind heard on NPR, tireless speaker and writer, Frederick Goodwin has been without equal in educating clinicians and researchers, patients and loved ones, and the general public on the nature of manic-depression and its treatments.
Note his preference for the term manic-depression over bipolar.
Frederick Goodwin’s co-author of Manic-Depressive Illness and Johns Hopkins professor, Kay Jamison is more widely celebrated as the author of her highly acclaimed 1995 memoir of madness, An Unquiet Mind.
The effect of this and her other works has been to give our illness a human face.
Commented the Guardian in 2011: “In the 16 years since An Unquiet Mind was first published, no greater book about manic depression – or bipolar disorder – has appeared.”
Born in Lebanon to Armenian parents, UCSD psychiatrist Hagop Akiskal is the foremost proponent of the bipolar spectrum. Taking his lead from Kraepelin, Dr Akiskal encourages us to view the spectrum as a range of overlapping conditions that embrace many subtle shades of bipolar, as well as various forms of unipolar and anxiety, one which also extends into personality and temperament.
In 2013, in his Director’s Blog, Thomas Insel, who has led the NIMH since 2002, stunned the psychiatric establishment by declaring the DSM “at best, a dictionary,” one that lacked scientific validity. Moreover, he declared, “Patients with mental disorders deserved better.”
Dr Goodwin wrote the front cover blurb for my 2006 book, Living Well with Depression and Bipolar Disorder. A public service award I received in 2007 bears Dr Schou’s name.