“Response to my post “Bipolar Epidemic?”

I am very grateful for the thoughtful comments I have received about my small essay, “Bipolar Epidemic?” The surge in bipolar diagnoses in children is understandably a sensitive and controversial subject for many, especially those with children who are directly affected. My broader point, however—that whenever there is an explosion in a particular diagnosis, there is some cause for worry—seems not to have been fully understood. A few additional comments may help clarify what I had hoped to say before.

The great psychiatrist Emil Kraepalin (1856-1926) was the first to use the term manic depression and to distinguish it from dementia praecox, later redubbed schizophrenia by Eugen Bleuler, who refuted Kraepalin’s idea that the disease always led to deterioration of the patient’s mental faculties. Kraepalin classified hundreds of mental diseases through a close study of patient histories. Like many contemporary psychiatrists he regarded these illnesses as primarily genetic and biological and, as is maintained today, found that manic depression runs in families. Kraepalin, like his contemporary Freud, was confident that one day the genetic and neurobiological roots of these illnesses would be uncovered. For bipolar disorder, that day is yet to come. What this means is that unlike the measles, for example, which has a known cause, a diagnosis of bipolar disorder depends on a physician’s perception of symptoms or a pattern of symptoms in his or her patient. Its etiology remains unknown.