Bipolar Disorder: A History of Demons, Humors, and Stigma We’ve come a long way in our understanding of this mood disorder.
Updated Jul 5, 2023 By Barbra Williams Cosentino, LCSW, R.N. Medical ReviewerJean Kim, M.D., M.A. Jump To Ancient Ideas1800s1900sToday and BeyondFAQs Formerly called manic depression, bipolar disorder is a psychiatric illness that has been known since ancient times. It is a chronic mood disorder, a type of mental illness that affects 1% to 2% of the population worldwide, and it can cause severe impairment in interpersonal relationships and in occupational and social functioning.
In its most serious form, it can lead to a psychotic break from reality, necessitating hospitalization.
Moods, which are colored by our usual way of experiencing thoughts and feelings, are less intense than emotions. They are generally a long-lasting state over a period of time, and can be described on a spectrum, with happiness and sadness at either end.
If you have bipolar disorder, the moods are markedly different, with the highest, most positive state spilling into mania and the most negative state being melancholia.
Hippocrates, the father of modern medicine who lived in ancient Greece, was the first to describe these two extremes of mood and to put them into the context of a personality state, also trying to tease out the way in which the mental disorder was related to or different from temperament, or a person’s nature.
Melancholia corresponds to today’s description of depression, and mania is similar to today’s diagnostic picture of bipolar, which according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, is characterized by a period of abnormally and persistently elevated, expansive, or irritable mood and abnormal, persistent goal-directed activity or energy, along with the presence of at least three symptoms that might include decreased need for sleep, grandiosity, distractibility, or increased talkativeness.
Ancient Ideas History of Bipolar in Antiquity From early historic times, understanding mental disorders was a concern not only of physicians but of priests, philosophers, and others. People suffering from psychiatric illness were believed to be possessed by the devil or demons, and were treated with horrendous attempts at a cure—everything from drilling a hole in the skull to let the evil spirits out to being restrained or chained, forced to drink various potions, or locked in filthy, overcrowded “insane asylums.” There was little understanding that psychiatric symptoms were evidence of a disease, and the notion of different types of mental illness was unheard of.
According to Jonathan Hal Sadowsky, Ph.D., an author and associate professor in the Department of Psychiatry, School of Medicine, and the Theodore J. Castele Professor of Medical History at Case Western Reserve University in Cleveland, Ohio, the humoral theory of illness, which Hippocrates espoused, explained physical and psychological health or illness in terms of the state of balance of fluids in the body.
These four humors were blood, black bile, yellow bile, and phlegm, and they were considered to be associated with temperament, with a preponderance of black bile correlating to a melancholic type and an excess of yellow bile associated with mania.
“Because melancholia was considered to be an illness of dry and cold, warm climes were considered to be curative for people who suffered from depression,” Sadowsky says. “The goal of the physician was to restore balance to the humoral system.
“Purging, in hopes of expelling the excess black bile, was a common treatment. Clergymen and physicians made dietary recommendations which included the avoidance of burned, stale, or bitter food as well as rabbit, pickled fish, beef, and a host of vegetables. Fortunately, some foods such as fruits and other sweets were believed to relieve melancholy,” he says.
Sadowsky explains that “in classical antiquity, as far back as the ancient Greeks, it was observed that the concepts of melancholia and mania seemed to have a cyclical relationship. Among historians, there is some debate as to whether this is the same thing as what we today call bipolar disorder.”
We now know that these states (depression and mania), which frequently do occur in a cyclical form, can also exist concurrently in what is called a manic or hypomanic episode with mixed features. This is marked by a depressed mood, lack of pleasure, slowness of thought and action, loss of energy, or other symptoms of depression coexisting with an agitated, elated, or hyper-irritable state of mania.
1800s History of Bipolar in the 19th Century Until the mid-19th century, mania and melancholia were considered to be two completely different disorders that occurred independently of one another. In 1851, French psychiatrist Jean-Pierre Falret created the concept of an illness that included both manic and depressive episodes on a repetitive cycle, with periods of varying lengths between them, labeling it “folie circulaire” (circular insanity).
Three years later, French neurologist Jules Baillarger described a condition he named “folie a double forme” (“dual-form insanity”), in which mania and melancholia morphed into one another but not necessarily with any period of normal mood time between the two.
By the 1870s, mania and melancholia had changed from being general terms, defining hyperactivity and lower-than-normal activity, to mood-related diagnoses that were clearly similar to today’s mania and depression.
In 1893, Dr. Emil Kraepelin, a German psychiatrist, postulated that psychiatric disorders were the result of biological abnormalities and introduced the concept of a condition he called “dementia praecox.” Six years later, in the sixth revision of his seminal psychiatric textbook that came to be known as Clinical Psychiatry, he separated it from “manic-depressive insanity,” conditions now known as schizophrenia and bipolar disorder.
He did long-term observations of his patients (longitudinal studies) and based diagnosis on long-term outcomes, keeping meticulous “mood charts” to show the course of manic-depressive illness and the mood swings in individual cases.
“Kraepelin’s work, which examined and described the clinical symptoms of mental illness, formed the basis for the classification of psychiatric disorders and was foundational for modern diagnostic practice,” Sadowsky says.
1900s History of Bipolar in the 20th Century In 1903, Swiss psychiatrist Carl Gustav Jung introduced the concept of a bipolar illness with hypomanic episodes, sometimes interspersed with depression, which did not involve a psychotic state (likely a precursor to what we know today as bipolar 2 or cyclothymia). The term “manic depressive reaction” appeared in the APA’s first DSM in 1952 (but was used in papers and books as far back as the 1910s) and was later changed to “manic depression.”
It wasn’t until 1957 that subclassification of bipolar disorder was formulated by German psychiatrist Karl Leonhard, who was the first to use the terms bipolar (for those with mania) and unipolar (for those who only experienced depressive episodes.)
The term “manic depressive illness” was changed to bipolar disorder during the third revision of the DSM in 1980, because some felt the term was stigmatizing and sounded too much like the word “maniac.”
Today and Beyond Future of Bipolar Disorder Sadowsky points out that, “What matters about a label is matching the individual in pain to the best treatment possible, and that is a clinical question. My historian’s take is: The safest prediction is that changes in diagnostic fashions are going to keep happening, and they will not necessarily be driven by giant scientific advances. … We should not assume the present trend represents the final or best word.”
New medications and therapies have greatly brightened the treatment landscape for bipolar disorder since the days when several brands of lithium waters, along with beers that were manufactured with lithium as an ingredient, were popularized, touted as safe and effective remedies for all kinds of nervous disorders. Today, researchers and clinicians are hard at work finding ways to help those diagnosed with this illness to lead happy and healthy lives.
Frequently Asked Questions
When was bipolar disorder first discovered? Even in ancient times, it was recognized that certain people’s moods would swing from melancholia (depression) to mania (a hyper-excitable state in which people require less sleep, talk rapidly, and can be easily agitated, irritated, or grandiose). While these cycles are similar to what people with bipolar disorder experience, historians are uncertain whether this was a description of the same condition. Hippocrates, the father of modern medicine, was the first to describe these two extremes of mood.
How was bipolar disorder viewed in the past? Until the mid-1800s, mania and melancholia were considered two different disorders that occurred independently of each other. If they occurred in the same person, in cycles, they were believed to be unrelated.
In 1851, a French psychiatrist conceptualized a cyclic illness that included both manic and depressive episodes. Several years later, French neurologist Jules Baillarger described a similar condition that he named “dual-form insanity.” Around 1900, Dr. Emil Kraepelin, a German psychiatrist, separated bipolar disorder from schizophrenia, which is a thought disorder rather than a mood disorder.
How did bipolar disorder start? As clinicians and researchers tried to narrow down signs and symptoms of bipolar disorder, the concept of a bipolar illness with hypomanic states, sometimes interspersed with depression, became better understood. It was then recognized that some people could become psychotic in severe episodes of the illness. In 1957 a further subclassification was created, stating that the term bipolar illness included manic episodes, whereas unipolar depression included only the depressive state.
What was bipolar disorder known as before? The term “manic-depressive reaction” first appeared in the 1952 American Psychiatric Association diagnostic manual and was later changed to “manic depression.” This was then changed to bipolar disorder in the 3rd revision of the DSM in 1980.
この記事は、双極性障害（かつての躁うつ病）の理解が、古代の「悪魔憑き」や「体液説」から、現代の「生物学的・科学的視点」へとどのように進化してきたかという歴史と変遷をまとめたものです。
以下に要約と詳しい解説をまとめます。
論文要約：双極性障害の歴史 — 悪魔、体液、そしてスティグマ
1. 古代：体液のバランスと悪魔
古代において、精神疾患は「悪魔や霊の仕業」と信じられ、頭蓋骨に穴を開けるといった恐ろしい治療が行われていました。しかし、医学の父ヒポクラテスは、これを身体の病気として捉え、「体液説」を提唱しました。
- 黄胆汁が過剰になると「躁（Mania）」になる。
- 黒胆汁が過剰になると「うつ（Melancholia）」になる。
当時は、この2つが交互に現れるサイクルについては議論がありましたが、気分の両極端としての記述はここから始まりました。
2. 1800年代：疾患単位としての確立
19世紀半ばまで、躁病とうつ病は「全く別の独立した病気」と考えられていました。これを統合したのがフランスの精神科医たちです。
- ファルレ（1851年）： 躁とうつが繰り返される「循環狂（folie circulaire）」を提唱。
- バイアルジェ（1854年）： 躁とうつが間を置かずに移行する「二形態狂（folie à double forme）」を提唱。
その後、ドイツのエミール・クレペリンが、長期的な観察に基づき、知能が低下する「早発性痴呆（統合失調症）」と、気分が波打つ「躁うつ狂（躁うつ病）」を明確に区別し、近代診断の基礎を築きました。
3. 1900年代：名称の変遷と細分化
20世紀に入り、概念がより精密になります。
- カール・レオンハルト（1957年）： 躁がある「双極型（Bipolar）」と、うつのみの「単極型（Unipolar）」という言葉を初めて使いました。
- 名称変更（1980年）： 「躁うつ病（Manic Depression）」という言葉が「マニアック（狂人）」を連想させ、差別的（スティグマ）であるという理由から、DSM-III（診断基準）で「双極性障害（Bipolar Disorder）」へと変更されました。
4. 今日と未来
かつてはリチウム入りの水やビールが「万能薬」として売られていた時代もありましたが、現在はリチウム、気分安定薬、最新の心理療法が確立されています。診断のラベルは時代とともに変化しますが、重要なのは「患者個人に最適な治療を届けること」だと結論づけています。
詳しく解説：歴史から紐解く「双極性障害の本質」
これまでにあなたが調べられた科学的論文（ミトコンドリア、免疫、Na,K-ATPaseなど）と、この歴史的な背景を組み合わせると、非常に興味深い視点が見えてきます。
① 古代の「胆汁」と現代の「代謝・免疫」
古代ギリシャ人が躁病の正体を「黄色い胆汁（熱く乾燥した性質）」と考えたのは、現代の視点で見れば、以前議論した「気分の高血圧」や「ミトコンドリアの過活動（あるいは不具合によるエネルギーの空回り）」、さらには「神経免疫の暴走（脳の火事）」を、当時の言葉で表現したものと言えます。
「躁（熱）」のあとに「うつ（冷え・虚脱）」が来るという循環的な理解は、数千年前から直感的に把握されていました。
② クレペリンの功績と「躁病先行仮説」
1800年代後半のクレペリンは、患者の経過を何十年も記録する「気分チャート」を重視しました。これは、アタナシオ・クコプロスの「躁病先行仮説（Manic-first）」の直接的なルーツです。
「躁」という嵐が吹いたあとに必ず「うつ」という焼け野原が広がるという連鎖は、クレペリンによる長期観察（縦断的研究）があったからこそ発見されたものです。
③ なぜ「双極性障害」という名になったのか？
歴史的に「躁うつ病」という名前が捨てられた背景には、医学的な理由だけでなく、社会的な差別（スティグマ）を減らすという目的がありました。しかし、一部の研究者（クコプロス派など）は、「双極（Bipolar）」という名前になったことで、躁とうつが対等な力関係に見えてしまい、「躁こそが病気のエンジンである」という本質が薄れてしまったと批判しています。
④ 診断は「ファッション（流行）」であるという警告
著者のサドウスキー博士は「診断のラベルは流行によって変わるが、それが科学の最終結論だと思ってはいけない」と述べています。
現在、あなたが調べられている「プリン作動性システム」や「ミトコンドリア機能障害」といった新しい知見は、もしかすると将来「双極性障害」という名前自体を、より正確な「脳エネルギー代謝障害」や「細胞内カルシウム調節障害」といった名前に書き換えていくプロセスの一部なのかもしれません。
結論
この歴史のまとめは、双極性障害が「単なる気分の波」ではなく、人類が数千年にわたって「体内の何らかの生物学的な暴走と、その後の疲弊」として観察し続けてきた、非常に深いルーツを持つ病気であることを教えてくれます。これまでの高度な科学論文の背景には、この「暴走（躁）をいかに制御するか」という人類の長い闘いがあるのです。
