Why Did Manic Depression Become Bipolar Disorder?

The phrase "manic depression" has its origins rooted in ancient Greece, where the term was used as early as the first century to describe symptoms of mental illness. In her book Bipolar Expeditions: Mania and Depression in American Culture, author Emily Martin writes,

"The Greeks believed that mental derangement could involve imbalance among the humors, as when melancholy, heated by the fluxes of the blood, became its opposite, mania."

In the late 1800s, Jean-Pierre Falret, a French psychiatrist, identified "folie circulaire," or circular insanity, manic and melancholic episodes that were separated by periods that were free of symptoms. It is through his work that the term manic-depressive psychosis became the name of this psychiatric disorder. It's noteworthy that "psychosis" was included, thus excluding all types of what we know as bipolar disorder that do not include psychotic features.

In 1902, Emil Kraepelin organized and classified what used to be thought of as unitary psychosis into two categories. Manic-depression was the term he used to describe mental illnesses centered in emotional or mood problems. Dementia praecox, literally meaning "premature madness," and later renamed schizophrenia, was his title for mental illnesses derived from thought or cognitive problems.

In the early 1950s, Karl Leonhard introduced the term bipolar to differentiate unipolar depression (major depressive disorder) from bipolar depression. In 1980, with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the term manic depression was officially changed in the classification system to bipolar disorder.

In the last few decades, the medical profession, and psychiatry specifically, has made a concerted effort to shift the vernacular to the official DSM diagnostic term of bipolar disorder. There are a number of reasons cited for this shift, including:

• Manic depression has generally been used to denote a wide array of mental illnesses, and as classification systems have become more sophisticated, the new term of bipolar disorder allows for more clarity in a diagnosis.
• The terms "manic" and "mania" have been greatly stigmatized. Consider popular phrases such as "Manic Monday," Animaniacs, homicidal maniac, and the like. Similarly, the term "depression" is used flippantly by the general public for periods of sadness that don't really qualify as clinical depression.
• Bipolar disorder is more of a clinical term and therefore, less emotionally loaded.
• Manic depression emphasizes the predominant emotional symptoms but seems to exclude the physical and/or cognitive symptoms also present.
• The term manic depression excludes the cyclothymic or hypomanic (bipolar II disorder) versions of the disorder.

There are four types of bipolar disorder recognized in DSM-5. They include:

• Bipolar I disorder: For this type to be diagnosed, you must have manic or mixed episodes lasting at least a week or manic symptoms that were severe enough that you needed to be hospitalized. Depressive episodes are often present too.
• Bipolar II disorder:  Hypomanic, or depressive episodes happen in this type, but not manic episodes
• Cyclothymic disorder or cyclothymia: This type is a milder kind of bipolar and is diagnosed when you've had both hypomanic and milder depressive episodes for at least two years.
• Bipolar disorder not otherwise specified (BP-NOS): In BP-NOS, you have symptoms of bipolar that don't fulfill the criteria necessary for a diagnosis of any of the other three kinds of bipolar and your symptoms are clearly not normal behavior for you.