Mania: a short history of bipolar disorder

Abstract

Mania: A Short History of Bipolar Disorder By David Healy (Baltimore, Md.: Johns Hopkins University Press, 2008) (296 pages; $24.95 cloth) This well-written and compelling book goes well beyond historical analysis of a single illness, bipolar disorder, once called manic depression, to fundamentally question relationship between science of psychiatry and business of psychopharmacology. The author, David Healy, is a professor of psychiatry whose previous works, The Antidepressant Era (1998) and Let Them Eat Prozac (2004), raised serious concerns about increased risk of suicide with certain medications. Mania draws from both primary historical sources and interviews to build on these previous accounts by arguing that pharmaceuticals have become less about breakthrough commodities, like penicillin and insulin, and more about marketing and manipulation of public views on health and illness. In book's first chapters, Healy takes on claims that bipolar disorder can be traced to ancient Greeks. He points out that Greek physicians relied on publicly visible signs to make diagnoses-the swelling, heat, and redness of a tumor, smell of urine, mute rigidity of stupor, frenzy of delirium (p. 12). In contrast, modern-day psychiatrists base diagnoses on words of patients or even third parties, such as parents or teachers. Even famous story of woman from Thasos, frequently cited as an early case of bipolar disorder, apparently a condition of nausea, fever, and spasms. Mania during this period more likely delirium, according to Healy. Melancholia stupor or lethargy. Against a background of lethal epidemics of antiquity, Healy concludes, bipolar disorder was almost an irrelevance (p. 8). A similar approach to debunking idea that bipolar disorder a widespread condition in past societies takes reader through subsequent chapters on evolution of medical science. During Renaissance, for instance, attention within European scientific community shifted from observable behavior to internal mental states. This typified in Willis's anatomical work that revealed brain as a solid organ, a new vision that in turn laid groundwork for fields of neurology and psychology. Sydenham's study of hysteria likewise contributed to emphasis on mind rather than body in explaining psychiatric conditions. In threading these developments together, Healy moves on to consider the brain in asylum, noting how building of asylums in nineteenth century gave physicians unprecedented access to persons with various forms of mental illness. The first clear descriptions of bipolar disorder by French psychiatrists soon followed. However, this disorder remained quite rare, according to Healy. Reviewing nearly 3,500 admissions to asylum in North Wales between 1875 and 1924, he found only 123 individuals who were admitted for what we would now call bipolar disorder. …