Mood Swings

A psychiatrist surveys the mind and the wider world

Childhood Bipolar: An America Fad, in 1845 Paris

A study in 19th century geography
Christopher Lane, Ph.D.
This post is a response to "The bipolar child is a purely American phenomenon": An interview with Philip Dawdy by Christopher Lane, Ph.D.

My colleague Christopher Lane has written interesting blog posts, but this interview from three years ago, which I recently noticed, raises a topic whose title, at least, is dubious.

Does childhood bipolar disorder only happen in America? The Australians also seem to think so, as another psychiatrist blogger has described.  

But I wonder if these journalists and Australian psychiatrists ever heard of the advice of the great Canadian physician William Osler? He counseled: Read the old books, and the journals.

Before making such claims as in this interview, they might have read some of the classic 19th century textbooks of psychiatry, such as Esquirol's 1845 Mental Maladies. Esquirol was the prime disciple of Philippe Pinel, the founder of modern psychiatry with its emphasis on biological causes and humanistic approaches (called "moral therapy"). Pinel emphasized the importance of observation and classification, and his student Esquirol produced, decades later, his classic descriptive work. In 1854, about a decade after Esquirol's text, two of Esquirol's students (Falret and Baillarger) would describe what is generally considered the first modern description of bipolar disorder, more or less as it is defined today. What they called mania is what we call mania.

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So it is relevant to examine what Esquirol said about the age of onset of mania in his hospital in Paris. I would refer those interested to the "Table of Ages" on page 380 of Mental Maladies (a worthwhile read that can be downloaded free online). There you will note that 34 out of 466 patients with mania, admitted to two Paris mental asylums, were in the 15 to 20 age range. That's 7 percent of all cases of mania.  

According to the National Comorbidity Survey epidemiological study, about 13 percent of all cases of adult bipolar disorder begin by age 10. Thirteen percent now in the U.S., 7 percent then in Paris. That is twice as much (though it includes non-hospitalized cases, unlike the Paris study), but the diagnosis was clearly seen, not infrequently, in mid-19th century France.  

If childhood bipolar disorder is an American phenomenon, then Paris must be a little town in Kansas. 

And, by the way, which pharmaceutical company was behind this 1845 French fad? 

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston. more...

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