“Mania” and Insanity

One of the primary symptoms of bipolar disorder is a heightened mood or mental state known as mania (or a less severe form of the same state, hypomania). However, before anyone ever suspected the existence of bipolar illness, mania had a very different definition. In the 1800s, when organized treatment of mental health problems was in its infancy, the word mania was used to describe any and all forms of insanity. Unfortunately, this early use of the word and term “maniac,” has led to confusion about its meaning among people.

First Notions of Bipolar Illness

The first real notions of bipolar illness appeared in the mid-1800s, when two French psychiatrists independently reported cases of people who experienced cycling bouts of what we would now called mania and depression. However, neither of these psychiatrists used the terms ‘bipolar illness’ or ‘bipolar disorder’ to describe these cases. Instead, one of them referred to the condition as “dual-form insanity,” while the other referred to it as “circular insanity.”

Distinctly Different From Schizophrenia

Before the 20th century, most psychiatrists classified the symptoms of bipolar illness as symptoms of schizophrenia. This situation truly began to change when a German psychiatrist first noticed that, unlike those with untreated schizophrenia, people with bipolar disorder experience periods of more or less normal mental health. However, this psychiatrist focused on the presence of psychosis in bipolar individuals and named the condition “manic-depressive psychosis.” (It’s true that some people with severe bipolar disorder experience psychosis symptoms, but this is not necessarily typical.)

Mania as the Defining Symptom

The phrase “manic-depressive illness” first entered widespread use among medical professionals in the 1950s. However, until the 1960s, no psychiatrists consistently identified bipolar illness as a condition that includes periods of mania, hypomania, major depression or a less serious form of depression. This meant that even experienced professionals would lump people with bipolar symptoms together with people affected only by depression or schizophrenia-related psychosis. Fortunately, developments that took place throughout the decade led to an understanding that only certain people experience mania, the defining symptom of bipolar illness.

The Arrival of Bipolar Disorder

The term “bipolar disorder” started replacing the term “manic-depressive illness” in the 1980s. The main motivation for this change wasn’t medical. Instead, the medical community and society in general began to perceive manic depression as a stigmatizing, potentially harmful way of referring to bipolar symptoms. All modern guidelines now use the term ‘bipolar disorder’. Despite this fact, some professionals in the field still feel that from a medical point of view, manic-depressive illness is a more exact term.

The Current Situation

In the U.S., the mental illness definitions used by practicing doctors come from an organization called the American Psychiatric Association (APA). These definitions were last updated in 2013 and currently, the APA recognizes three main bipolar and related disorders:

  • Bipolar I disorder
  • Bipolar II disorder, and
  • Cyclothymia or cyclothymic disorder

Each of these conditions features its own specific symptoms of mania/hypomania and depression. The APA also recognizes four less well-defined bipolar conditions:

  • Substance/medication-induced bipolar and related disorder
  • Bipolar and related disorder due to another medical condition
  • Other specified bipolar and related disorder, and
  • Unspecified bipolar and related disorder

Each of these conditions is only diagnosed in certain situations. The nuances of bipolar disorder that can vary from individual to individual so we must proceed on a case-by-case basis when trying to answer the question, ‘What does bipolar mean’?



“Bipolar Disorder” – National Institute of Mental Health

From Mania to Bipolar Disorder” – Bipolar Disorder – Clinical and Neurobiological Foundations

“A Short History of Bipolar Disorder” – Psychology Today


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