The introductory chapter of Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, by Frederick K. Goodwin and Kay Redfield Jamison, provides an excellent description of how Emil Kraepelin first classified manic depression (or bipolar disorder) and related conditions in the late 19th century, and how his work has influenced the way in which psychiatrists treat these illnesses today.
Kraepelin (1856-1926, right), who is considered to be the founder of modern psychiatry, was the first to distinguish between manic depression and schizophrenia, which were at the time both classified as “psychosis.” He referred to the latter as dementia praecox, and defined it as “a peculiar simple condition of mental illness occurring at a youthful age.”
Kraepelin believed that all forms of mental illness had a biological basis. He also recognized that manic depression is actually a complex group of related disorders, and emphasized that the proper understanding of individual cases required the documentation of symptoms over long periods of time.
In 1893, Kraepelin published a textbook called Psychiatrie, which contained his classifications of schizophrenia, manic depressive illnesses and other conditions. The book also contained descriptions of the symptoms and pathologies associated with each illness, based on his clinical observations and those of a number of other psychiatrists. It is in the eighth edition of this book, published in 1910, that we find the first reference to Alzheimer’s Disease.
Vincent van Gogh, who was a contemporary of Kraepelin’s, is known to have suffered from manic depression. The artist was institutionalized because of the condition and, later on, his depression led him to commit suicide at the age of 37.
During his short life, van Gogh wrote thousands of letters, most of which are preserved (and some of which are soon going on display at the Royal Academy in London). These correspondences provide details of the artist’s manic depression.
For example, in this letter to Emile Bernard, dated 20th November 1889, van Gogh writes:
You’ll understand that this combination of red ochre, of green saddened with grey, of black lines that define the outlines, this gives rise a little to the feeling of anxiety from which some of my companions in misfortune often suffer, and which is called ‘seeing red’.
In an earlier letter, dated 11th December 1882, and addressed to his brother Theo, he writes:
You ask about my health – last summer’s trouble is really quite gone, but I feel rather depressed at present, whereas at other moments, when my work progresses well, I am quite cheerful, and feel kind of like a soldier who isn’t at home in the guardhouse, and argues thus to himself, “Why must I be in prison here, when I should be much better off among the rank and file where I belong?”
In other correspondences, van Gogh describes his feelings of paranoia and despair, and some of the hallucinations he experienced. They also show that he cycled between periods of elation and desperation, and that his illness grew worse with time. van Gogh’s letters therefore demonstrate Kraepelin’s remarkable insight into mental illness.