Mania: A Short History of Bipolar Disorder, Biographies of Disease series by David Healy

Abstract

Health& History 11/2 2009 157 David Healy, Mania: A ShortHistory ofBipolar Disorder, Biographies of Disease series (Baltimore, MD: Johns Hopkins University Press, 2008). ISBN 9780801888229 (HC). 6 lineillustrations, 320 pp. David Healy has amixed reputation among his psychiatric colleagues. Many, sometimes grudgingly, regard him as a good historian of the subject. He is demonised by others for an alleged contribution to the antipsychiatry of the treatment of depression because of a preoccupation with the role of the multinational drug companies in the promotion of theirproducts, with allegations of cover-ups of suicidal behaviour. Such previous book titles as Let Them Eat Prozac: The Unhealthy Relationship between thePharmaceutical Industry and Depression (2004) demand his rehabilitation as a more serious and objective historian. Mania has always been one of themost devastating psychiatric illnesses. It ismarked by furious energy and overactivity leading to disinhibited behaviour and grandiose plans and actions. The social cost is often in ruptured relationships and even family fortunes. Its relationship with depression has provided much of the historical development of the concept. Emil Kraepelin established the great 'Kraepelian Dichotomy' of dementia praecox and manic depressive insanity. He was thus a great 'lumper' of all of the various sorts of mood disorders that had come to him through the century. The essential feature in his observation was that, unlike the other, later known as schizophrenia, manic depressive insanity did not lead to dementia?that is, it was subject to remission. In the twentieth century the splitters again moved in, indicating reasonably that not every depressed person had the potential to become manic and eventually thenames were changed tounipolar and bipolar, thenbipolar I and bipolar II and some even more complicated splits.Much of psychiatric classification in the twentieth century has been closely related to pharmacological treatment, in this case the development of lithium and its successors. The question ishow well Healy has put theflesh on those bones. His book invites comparison with the recent similarly sized Before Prozac: The Troubled History of Mood Disorders inPsychiatry (2008) by theprofessional historian Edward Shorterwho, in my opinion did itbetter,particularly regarding the complicated relationship between official classification, drug licensing, drug company promotion, and disease concepts. Lithium arrived in 1949 inone of thebest known bits of psychiatric folklore, invented by modest Melbourne psychiatrist John Cade. It 158 BOOKREVIEWS was poorly regarded in theUnited States and indeed was not widely accepted until the late 1960s with the advocacy of theDane, Mogens Schou. Healy is a littlepuzzled that lithium, a cheap drugmade out of rocks, influenced thinking about the diagnoses without the backing of the drug companies. I lived through this era, butmy own memory is that the influence of the drug on diagnosis was much stronger in the United States than itwas in the British tradition of psychiatry, where the concept of 'manic depressive illness' as it was called then, was no different from the rebadged 'bipolar disorder.' In fact diagnostic habits did change in theUnited States when psychiatrists became convinced that lithium was effective in acute and preventative treatment. This also coincided with the decline of psychoanalysis as themainstream of psychiatry in that country, which led to a fall infrequency of thediagnosi s of schizophrenia. The diagnosis had been based on such derived concepts as reality testing or ego boundaries rather than the so-called 'operational criteria' that were tohit theworld with thepublication by the American Psychiatric Association in 1980 of itsDiagnostic and Statistical Manual, now the DSM-1V-TR. Was theuse of the term 'bipolar disorder' in theDSM, which has become universal throughout theworld, no more than rebadging? which abounded in themanual?or the invention of a new disease? I think thatHealy exaggerates the latter, suggesting thatone of several suggested diagnoses thatdid not quite make it into themainstream? 'cycloid psychosis'?was an intermediary. Even less believable is that the concepts of introversion and extraversion became mixed up in the diagnosis of bipolar disorder. The most recent development?and I agree with Healy here?is 'back to the future,' as a lucrativemarket was detected for themodern versions of drugs whose official indications were for schizophrenia. The fact is that, for those of us who can remember treatingmanias before lithium, itwas the older precursors of...