The chronic and disabling illness we know today as bipolar disorder was poetically named “la folie circulaire,” or “the circular insanity,” in 1854, for its characteristic shifting between high and low moods. It became known as “manic depression” a few years later. (1)
As recently as the 1950s, the United States Congress refused to acknowledge maniac depression as a legitimate illness. In wasn’t until the early 1970s that maniac depression was legally recognized, and laws enacted allowing patients suffering from it to receive Social Security benefits. (1) That term has since been replaced with “manic depression.”
In the 1980 edition of the DSM-IV, the illness was renamed “bipolar disorder” and classified into four types: bipolar I disorder, bipolar II disorder, cyclothymia, and bipolar disorder not otherwise specified, which is also known as bipolar disorder NOS. (2)
Bipolar disorder can be deadly, seemingly intent on the destruction of its host. A person caught in the orbit of la folie circulaire is 20 times more likely than the general population to attempt suicide. (2) Of those who do attempt suicide, 25 to 50 percent will succeed. (3)
The Danger of Misdiagnosis
What makes bipolar disorder particularly insidious is that it is notoriously difficult to diagnose. Bipolar patients usually seek help when depressed, since the mania or hypomania of bipolar disorder are rarely experienced by the patient as undesirable. For that reason, bipolar disorder is often misdiagnosed as simple unipolar depression.
The misdiagnosis of depression is dangerous. Monotherapy antidepressants such as SSRIs can induce rapid cycling and mania in a bipolar patient. (1) Rapid cycling occurs when a patient experiences four or more manic/hypomanic or depressive episodes in a year, drastically destabilizing their lives. (6)
Further complicating diagnosis is that the mania of bipolar disorder may present in one person as a decreased need for sleep and rapid-fire thoughts, in another as grandiosity and overspending, and in yet another as razor’s edge irritability with flashes of anger. Or mania may be comprised of any combination of the above. (4)