From Black Bile to the Bipolar Spectrum: A Historical Review of the Bipolar Affective Disorder Concept

The terms melancholia and mania have their etymologies in classical Greek. Melancholia is derived from ‘melas' (black) and ‘chole' (bile), highlighting the term's origins in pre-Hippocratic humoral theories [ 1 ]. Where depression/melancholia was viewed as an excess of black bile, the humoral perspective saw mania as arising from an excess of yellow bile [ 2 ], or a mixture of excessive black and yellow bile [ 3 ]. The exact origins of the term mania however, are not as clear-cut as those outlined for melancholia. The Roman physician, Caelius Aurelianus, proposes several origins for the word mania, including the Greek word ‘ania', meaning to produce great mental anguish. He also suggests ‘manos', meaning relaxed or loose, which would approximate to an excessive relaxing of the mind or soul [ 4 ]. There are at least five other etymological candidates proposed by Aurelianus for the word mania and the confusion surrounding the exact etymology is attributed to its varied usage in the pre-Hippocratic poetry and mythologies [ 4 ].