The History of Bipolar Disorder

Abstract

Our contemporary construct of bipolar disorder (BD) is only relatively recent in terms of the history of psychiatry. In this chapter, we begin by tracing the origins of this concept from the early writings of the classic Greek and Roman medical writers, through to the observations of the first European academic ‘alienists’ such as Pinel, Esquirol, and Griesinger in the eighteenth and nineteenth centuries. We then consider the first claims for delineation of a distinct condition akin to BD by the French psychiatrists Falret and Baillarger, who described, respectively, la folie circulaire and la folie à double forme. The journey from those accounts to our modern concept of BD is then traced through the nineteenth and twentieth century works of the German academic clinicians Kraepelin, Wernicke, Kleist, and Leonhard, with later critical validations being undertaken by Angst, Perris, and Winokur in the 1960s. We then explore the incorporation of BD into the modern operationalised diagnostic criteria such as the Research Diagnostic Criteria and DSM-III in the late twentieth century. In considering this history of the concept of BD, several broad themes become apparent. First, the consistency of the clinical descriptions stands out, from the earliest classical observations to those of the eighteenth and nineteenth century alienists to contemporary operationalised criteria. Second, one cannot help but be struck by the oscillation over time between narrow and broad concepts of this condition: from the very circumscribed descriptions of Falret and Baillarger to the all-encompassing ‘manic-depressive insanity’ of Kraepelin. In many ways, the contemporary controversy between the narrow definition of BD as reflected in DSM-IV and -5 and the breadth of the ‘soft bipolar spectrum disorder’ recapitulates this historical tension. Third, however, there is at the same time a clear linearity in the development of ideas, with each ‘generation’ of academic psychiatrists being influenced by, and refining the concepts of, their predecessors.