Mania: A Short History of Bipolar Disorder

October 9, 2008

Healy is a controversial psychiatrist whose critics have been vociferous in denouncing his ideas and have even gone so far as to claim he has lost the plot. But his study of bipolar disorder has an important if controversial message.

He argues that the pharmaceutical industry is "disease mongering" in order to sell treatments, that this is shaping scientific data and conceptions of mental disorders, and that there is no better example of drug companies' stranglehold on research and ultimately academic freedom than research into manic-depressive disorder. Healy discusses with complete clarity use of conveniently vague terms such as "mood stabilisers", which allow drug companies to sidestep clinical trials, and, more worryingly, to prescribe drugs for "mood disorders" to children aged as young as two.

Healy's arguments have strong currency when one considers that a large proportion of the authors published in the Journal of the American Medical Association have received funding from drug companies, and this indeed may compromise the independence of research. Whether you heap approbation or venom on Healy, his message forces us to question diagnosis of and treatment for bipolar disorder. Science should be questioning, and by studying the history of mental disorder we see that culture and politics sometimes determine the data we accept and the data we reject. Historical analysis informs us of politically or scientifically inconvenient and long-forgotten observations, opening up the potential for new perspectives. It also shows us that disease-mongering and the use of the latest jargon in the interests of the academy have always been part of the scientific landscape. Healy reminds us that this is never ideal.

Despite the controversy that Healy's book will engender, it is informative, enjoyable and highly readable. Notwithstanding the controversial discussion around the impartiality of diagnosis and treatment, he provides a clear account of mania and bipolar disorder. He follows the concept of mania from ancient Greek and Roman civilisations through to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) classification of bipolar disorder. Charting the changing definitions through the centuries, he shows how culture and society shape them. He demonstrates how links were established between brain function and mental illness and describes the emergence of psychopharmacology.

Healy's clinical experience and scholarship make the book a pleasure to read. The history he presents is punctuated with details that demonstrate his familiarity with the primary sources. The analysis of the rivalry between Jules Baillarger and Jean-Pierre Falret and between Emil Kraepelin and Carl Wernicke are informative and entertaining, and show how politics influences scientific findings.

We live in a time when definitions of the human condition and discussions of mental functioning are shaped by a language of political correctness. We perceive any deviation from a culturally determined norm as having scope for treatment and drug intervention to return the human experience to some pre-determined ideal state. Healy makes us aware that we are on a journey of discovery about the relationship between brain structure, neural function and human behaviour, and that our current understanding is shaped by the times in which we live.

Mania: A Short History of Bipolar Disorder

By David Healy. Johns Hopkins University Press. 320pp, £16.50. ISBN 9780801888229. Published 18 July 2008

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