Timothy Kent Holliday //
In the scant historiography of bipolar disorder, David Healy’s Mania stands out almost by default. The central premise of Healy’s book is one that most historians and medical humanities scholars would probably agree with: that disease is made, and that disease-making is a historical process. Healy explains in his conclusion: “Whatever view we have of a disease like manic-depressive insanity will necessarily be intimately tied up with how we view the self and its brain and issues of human responsibility” (248).
However, Healy is wrong to say that it was in Paris in the 1850s where and when “the concept of bipolar disorder first came into being” (xvi). Even assuming that he meant within a Western context, he is still wrong. In Philadelphia, in 1794—sixty years before neurologist Jules Baillarger’s folie à double forme and psychiatrist Jean-Pierre Falret’s folie circulaire—a young medical student, Edward Cutbush, wrote a dissertation on insanity, specifically focusing on what was known at the time as tonic and atonic mania. While, Cutbush observed, “from the earliest periods of medical science” Western medical writers had divided insanity into “mania” and “melancholia,” Cutbush himself dissented. “I infer,” he declared, “that they are different states of the same disease,” often occurring in alternation with each other (7).
In his dissertation, Cutbush distinguished between tonic mania and atonic mania. The (a)tonic in the name essentially referred to muscle tone. Persons in a state of tonic mania were tense, spirited, agitated to the point of delusion. On the other hand, persons exhibiting atonic mania slouched, their tendons lolling slackened beneath their flesh. These were not distinct populations, however. Some patients exhibited both types of mania, in the form of a cyclical condition that Cutbush acknowledged but did not name. Cutbush explained that the two manias had a “known tendency … to alternate with each other,” making management difficult and manifestation unpredictable (13).
Something of a proto-eugenicist, Cutbush favored a treatment regimen comprising a mixture of depletion, fear, and coercion in cases of tonic mania. Directly quoting Scottish medical professor John Gregory, Cutbush alluded that it was “highly criminal” for one to knowingly risk passing hereditary diseases to one’s offspring—“particularly (that most dreadful of all human calamities) madness” (Gregory 188-9 qtd. in Cutbush 12). On occasion, patients reported that they could sense the pending onset of tonic mania. Such instances were helpful to the attending physician, as Cutbush called for the strict isolation of patients during periods of tonic mania (35). Patients often became “dejected” after becoming “acquainted with their situation,” but Cutbush noted that shame often meant that recovery was imminent (16).
Cutbush’s dissertation was perhaps not as innovative as he made it out to be. By 1794, famed Philadelphia physician Benjamin Rush—later lauded as “the father of American psychiatry” by the American Psychiatric Association—had already described both tonic and atonic mania (Cutbush 12). But historians, including historians of psychiatry and psychiatric scholars like Healy, have by and large failed to note the significance of Cutbush’s thesis as it pertains to historical understandings of disabled “bodyminds.” Contemporary disability studies scholars use the concept of “bodymind” to explore linkages and overlappings between “body” and “mind” (Price 2). U.S. Americans in the eighteenth and nineteenth centuries were not “always already” sick. As the common wisdom of the time went, “disease is virtually disorder” (Hodge 5). And as the common wisdom among historians goes, disease is historically constructed. At the nexus of those two statements is how medical humanities scholars can begin to understand historical bodyminds.
Importantly, Healy’s book mentions neither Cutbush nor tonic/atonic mania. Maybe that is because tonic/atonic mania and bipolar disorder are not “the same thing.” Rather, it is most helpful to think of them as culturally bound analogues, much like folie à double forme and folie circulaire. Like people with bipolar disorder, people with tonic/atonic mania inhabited bodyminds that vacillated between two poles. Unlike people with bipolar disorder, however, people with tonic/atonic mania lived in a medical milieu that did not see neurochemistry in quite the same way as bipolar people in the twenty-first century. From the perspective of a bipolar scholar, it appears obvious that tonic/atonic mania as a cyclical condition was bipolar-the-adjective, but not bipolar-the-noun. To ignore tonic/atonic mania in histories of bipolar disorder, and of disability broadly, is to fail to recognize it as a bipolar ancestor, relegating this iteration of “that most dreadful of all human calamities” to obscurity.
 See John Gregory, The Works of the Late John Gregory, M.D., vol. 1 (Edinburgh, Scot.: W. Creech, 1788).
 Indeed, mentions of Cutbush are relatively few and far between. For a rare example, see Katie E. Walk, “Mental Illness in Early American Fiction: Charles Brockden Brown and the Sentimental Novelists,” Master’s thesis (Eastern Illinois University, 2015).
Cutbush, Edward. An Inaugural Dissertation on Insanity. Philadelphia, Pa.: Zachariah Poulson, Junior, 1794.
Gregory, John. The Works of the Late John Gregory, M.D. Vol. 1. Edinburgh, Scot.: W. Creech, 1788.
Healy, David. Mania: A Short History of Bipolar Disorder. Baltimore, Md.: Johns Hopkins University Press, 2008.
Hodge, Hugh L. Essay on the Pathology and Therapeutics of Cholera Maligna. Philadelphia, Pa.: J. R. A. Skerrett, 1833.
Price, Margaret. “The Bodymind Problem and the Possibilities of Pain.” Hypatia 10, no. 10 (2014): 1-17.
Walk, Katie E. “Mental Illness in Early American Fiction: Charles Brockden Brown and the Sentimental Novelists.” Master’s thesis. Eastern Illinois University, 2015.
Image source: Statues of “raving” and “melancholy” madness, each reclining on one half of a broken segmental pediment, formerly crowning the gates at Bethlem [Bedlam] Hospital. Engraving by W. Sharp, 1783, after T. Stothard after C. Cibber, 1680. Wellcome Collection. Public Domain Mark