How Was Bipolar Disorder Treated Before the 20th Century?

Extreme cyclical mood swings between elation and despair were known as manic depression until 1980, when the American Psychiatric Association renamed the condition "bipolar disorder." It's been recognized since ancient times, and victims were typically institutionalized with criminals and the destitute, and treated the same as those with other forms of mental illness, such as schizophrenia.

Mania

• Throughout the ages, mania was not believed to need treatment because the person was happy. It was only when doctors realized that the happiness represented a mental pendulum swing whose other extreme was depression that mania was recognized as part of a pattern of illness.

Ancient Treatments

• The Egyptians believed depression was caused by reversals of fortune or loss of status, and the best cure was to talk it out or to look to religious faith. The Greeks attributed depression to an overabundance of black bile in the body, and mania to yellow bile. They believed bleeding or purging helped the system regain balance.

  Socrates believed mental illness was a blessing from heaven to be cherished. Aristotle thought music could cure melancholia. Hippocrates believed people could chase the blues away with abstinence, exercise and a diet of vegetables.

Diagnostic Shift

• Physical explanations eventually gave way to theories that mental illness originates in the mind. However, causes were thought to be demonic possession or moral weakness that could be cured only through exorcism or religious zeal. Sufferers were outcasts in their communities, and many were convicted of consorting with devils and burned at the stake.

Confinement

• In the 1300s, Bedlam in London became a notorious insane asylum. Inmates were crowded and chained to walls in dark, dank cells with little light, no fresh air, and terrible food. They were often abused like animals. In the 1700s, people would visit Bedlam to watch the insane for entertainment.

  In the 1700s, if families kept their mentally ill members at home, they were locked away and just kept alive. Many of the poor mentally ill ended up living in squalid almshouses.

Mental Hospitals

• In 1752, the Quakers founded the Pennsylvania Hospital and treated the mentally ill in humane and sanitary conditions. In 1769, Benjamin Rush opened the first American asylum for the mentally ill in Williamsburg, Virginia, and became known as "America's first psychiatrist." He didn't believe in straitjackets or other restraints. Instead, he strapped people in a "tranquilizing chair" that completely immobilized them, supposedly to make them relax. He also used the "gyrator," a wheel patients were strapped to with their heads facing out, which was then spun to make the blood therapeutically rush to their heads. His circulating swing was a gyrator patients could sit in.

  Thanks to a crusader named Dorothea Dix, who pushed for more humane treatment of criminals and the mentally ill, more than 30 hospitals for the indigent mentally ill were built in the United States in the last half of the 1800s, and their living conditions improved.