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[Perspectives] Bipolar disorder

Riffing on Raymond Carver’s most famous title is about as original as paraphrasing Jane Austen’s most famous first line, but what do we talk about when we talk about bipolar disorder? Does this deceptively simple term denote a human experience with a very long history or a neuropharmaceutical frame with a comparatively short one? Mania, as the psychiatrist and historian David Healy has observed, is an ancient and enduring concept, with analogous terms in Indian and Chinese medical cosmologies. For Hippocratic physicians, thinking in terms of balance and imbalance, mania was a feverish excitation of the encephalon—the consequence of an excess of hot bile or a deficiency of cooling phlegm—whose opposite was not melancholy but stupor.