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Evolution of the bipolar disorder concepts for 150 years   by Camille

The bipolar disorder was born 150 years ago in France under the name of "circular madness". After 1900 and for half a century, the disorder gathered all the mood disorders. For three decades, the illness returned to its original identity thanks to the works of two researchers, one from Switzerland and the other one from Sweden. The illness received its name from a German psychiatrist and acquired an international reputation due to the diffusion of his documentations.

The bipolar disorder was born on Wednesday 24 of July, 1850 in Paris. Jean Pierre Falret mentioned a "special form (of madness) that we call circular" characterized by alternation of excited periods with a period, usually longer of despondency. He noticed that the succession of mania and melancholy was manifested in a regular way. The disorder developed under the form of a repeated circle of pathological states. He edited a book in 1854 on the subject.
Jules Baillarger proposed the term of "double form of madness". For a while his description outshined the description of Falret´s circular madness. However, this is the one which corresponds exactly with what is categorized as bipolar disorder nowadays.
In 1845 Griesinger, the founder of the German modern psychiatry adopted the notion of "unique psychosis", according to it mania, melancholy, dementia were evolutionary phases of a same disorder. At this period Falret was convinced that the so-called mental illness didn´t have reality in Nature. "Natural forms" should exist defined by its cause, its symptoms and the evolution of them. At this time the cause was unknown but it was possible to separate different natural forms below two conditions. The first one was to know the "fundamentals" symptoms and it didn´t limit the prognostic based on "superficial" symptoms. Falret defined the depression as a conjunction of sadness, psychomotor slowing, food disorder y sleep disorder and others "symptoms of found". The second condition was to take into account the illness evolution. In 1864 Falret said that two authentic natural forms existed: the general paralysis and the circular madness.
In the second half part of the 19th century people spoke about the madness of "double form". Kahlbaum who has adopted the Falret ideas recognized that the only approach possible was the clinic method. Kraepelin has adopted his position. The nosology of Kraepelin is considerable in 1883, 1909 and 1915. For him the circular disorder was individualized from the mental pathology. In 1896 he announced the decisive step to work on symptomatic conception to clinic conception of the madness. He has isolated the true illness taking in account the apparition conditions, the evolution and the finalization. In 1899, the dichotomy of the psychosis was born based on the "finalization conditions". Kraepelin gathered the mood disorders, the manic episodes or depression, isolated or recurrent, and so the circular madness into a main entity: the manic-depressive disorder. It is characterized by a non-evolution toward a mental deterioration. The severe depression was called melancholy and could evolve into dementia. He declared confirming that whatever the manic-depressive form of the subject, it in his family it existed a rise of mood disorder. The manic-depression develops by genetic heritage which is accepted for half a century.
Until after the Second World War the Kraepelin concepts were adopted. In 1911 were described neurotic depression, like depression and mania reactive to psychotic intensity. The illness was again considered as personality disorder which was no generally accepted. Since 1966, two works have transformed the situation. One is on the etiology and nosology of the depressive endogenous psychosis forms written by Jules Angest, Zurich. The second is on the study of depressive recurrent psychosis unipolar and bipolar written by Carlos Perris, Umea. They compared the heredity of the psychosis according to the depressive or cyclic type.
Wernicke was a "divisor" and individualized the "distress psychosis" in 1895 and has inspirated Kraepelin in his "mixed states". Kleist proposed a complex classification of the psychosis and has integrated the mood disorder. Leonhard in 1957 separated radically in the mood disorders the forms he called of monopolar, manic or depressive and the bipolar forms. He showed that a bipolar presented a cyclotimic personality in his family while in the case of depressed monopolar, the family members presented a "subdepressive" personality.
Peris changed the monopolar term to unipolar and demonstrate that in bipolar parents or bipolar siblings there are high morbid risks of similar manifestations. He noticed that women are more affected by the unipolar disorder. The beginning of the illness starts between 25 and 29 years for the bipolar and between 40 and 44 years for the unipolar. In 1968, Angst and Perris were associated to publish an article. In 1969 Zerbin-Rudin has made for the first time an analysis of all the data available using the twin method. In timic psychosis 81 % of the cases were concurrent with unipolar or bipolar psychosis. Dunner, Gershon y Goodwin in 1970 subdivided the bipolar into two types, I and II according the existence of frank mania or hypomania in the medical history. They have included the unipolar term to the bipolar as they share the same hereditary characteristics and age of starting.
The international diffusion of the new concept was linked to its adoption in 1980 by the DSM-III. It was centered on the endogenic and united manic-depressive psychosis. Since then the disorder was defined by major depression episodes, manic states, hypomania, mixed episodes described as pure symptoms defined by diagnostic criterions. In 1994 the endogen manic-depressive psychosis term was substituted by bipolar disorder in the DSM-IV. The specific and atypical disorders disappeared. The bipolar II disorder which was atypical was converted as a complete variety.
The classification of the DSM-IV kindles the attention of the population because of its simplicity. The "others mood disorders" gather the timic states which cause is known (depression, major depression, mania o mixed) and in another way the etiology. The criterion of the bipolar disorder is symptomatic: "the presence of antecedents of manic episodes, of mixed episodes or of hypomanic episodes accompanied by usually major depressive episodes". Three varieties exist. The diagnosis of bipolar I and II needs the presence of one episode of mania or mixed in the first case and one episode of hypomania in the second case. The existence of a major depression in the type II is not indispensable for the type I. The cyclotimic disorder rests on the coexistence within two years of hypomanic and depressive episodes without having the intensity of a major depression. This classification is based and the combination of two simple criterions, intensity and evolution aspect.
Once again as in the distant period of its beginning, the characters of the true "natural forms" appeared. The CIE-10 follows in the big lines the ideas of the DSM-IV however it hasn´t accepted all its positions. Many clinic and biological investigations will be necessary to precise the concepts. However, along all its history, the bipolar disorder has not presented such strength in its bases and it is presented as the most established mental illness.

About the Author

Camille Jolly is the owner of the http://www.bipolarpencelartinfo.com website. She was diagnosed bipolar I in 2005 and now she evolves to a bipolar type II. Her history is the history of a severe bipolar who strongly knows the depression, mania, hyperactivity, paranoia and psychosis. Visit her website to discover her incredible life and her artistic talents.

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