Exorcise

Exorcise (pronounced ek-sawr-sahyz)

To seek to expel from a person or place an evil spirit by means of adjuration or solemn religious ceremonies.

1350-1400: Use of the verb predated this date but formerly it entered Middle English from the fourteenth century Old French exorciser from the Late Latin exorcizāre, derived from the Ancient Greek exorkízein (bind by oath; banish an evil spirit) and the sense "call up evil spirits to drive them out" was dominant by the sixteenth century.  In England, exorcize was actually an alternative spelling but this is now one the rare instances in English where the US adopted -ise rather than -ize which some etymologists suggest may have been because of the influence of "exercise" although why that would be compellingly persuasive seems never discussed.  What is more likely is the use of "exorcise" in so many church documents brought to the American colonies, there being more reluctance to edit "sacred" works.  Some US academic sources do suggest exorcize is "a rare but correct" alternative, a concession not extended to exercize.  The rarest of the related forms are exorcismal, exorcisory, exorcistical and the wonderful exorcistic.

The noun exorcism (a calling up or driving out of evil spirits) was a fifteenth century creation formation from the Late Latin exorcismus, from the Ancient Greek exorkismos (administration of an oath) which, in Ecclesiastical Greek existed as exorkizein (exorcise, bind by oath), the construct being ex- (out of) + horkizein (cause to swear), from horkos (oath) of uncertain origin although some have suggested there's a link to  herkos (fence), the idea being of a oath with boundaries one accepts as "restrictions, ties & obligations" or "a magical power that fences in the swearer".  It's speculative and one etymologist noted dryly that the discipline's enthusiasm to adopt the view "was restrained".  A fourteenth century form describing the ritual was spelled exorcization.

Exorcism: Vade retro satana (Step back, Satan)

Saint Francis and the Dying Impenitent (1788) by Francisco Goya (1746-1828)

Exorcism in Christianity is the practice of casting out demons from a person or place possessed by the Devil.  Although the biblical origins are dubious, depending on contested translations, by early in the second century of Christianity, the word was in general use and paintings of exorcists and their ceremonies are among the darker and more dramatic in medieval and later sacred art.

In the Roman Catholic Church, the rituals were formalized in 1614 because of Rome’s concerns about clandestine, underground exorcisms performed without their consent and the guidelines remained substantially unchanged until the Vatican’s revisions in 1999, a process necessitated by a late twentieth-century spike in demand.  Interestingly, for more than a decade after the Second Vatican Council (Vatican II (1962-65)), it was really not done for clergy to speak of Satan as if he really existed, the modernizing church preferring the language of psychology and psychiatry for those displaying symptoms which would once have been blamed on the Devil.

Exorcism of Nicole Aubry (1563), etching by unknown artist.

Popular culture, especially cinema, revived interest in the ritual, with both churches and the medical profession reporting an upsurge in claims of demonic possession and most significantly, Saint Pope John Paul II (1920–2005, pope 1978-2005) had a more robust attitude to the Devil’s role upon earth than any of his twentieth century predecessors.  In 2004, JPII again warned that occult and new age practices were raging out of control in Europe, providing gateways for evil that could result in demonic attachment and possession.

It’s been good business for the Holy See ever since.  The most recent Course on Exorcism and Prayer of Liberatio, held at the Pontifical Athenaeum Regina Apostolorum (an educational institute under the auspices of the Congregation of the Legionaries of Christ) in Rome, attracted some two-hundred and fifty priests from fifty countries.  Until the disruption caused by COVID-19, the week-long course, entitled Exorcism and the Prayer of Liberation had been held every year since 2005, attendance more than doubling over the years.  Cost per head was €300,  (Stg£252, US$315); bookings were essential and an entry-ticket included discounts on rooms and food & beverage in several Rome hotels.

The Exorcism of Charles II of Spain

Charles II of Spain (Carlos Segundo 1661–1700), was the last king of the Spanish Habsburg dynasty, sovereign of the Spanish Empire which stretched from Mexico to the Philippines.  The only surviving son of his predecessor, Philip IV (1605-1665) and his second wife, Mariana of Austria (1634-1696), his birth was greeted with enthusiasm by the Spanish people because, as was the fashion of the time, had the old king died without a male heir, a war of succession would have ensued.

However, Charles was physically disabled, disfigured, mentally retarded and found later to be impotent, usually a drawback for any king but a disovery which brought relief to many courtiers.  He uttered no words until the age of four, didn’t take his first step before he was almost nine, suffering throughout childhood a range of diseases including measles, varicella, rubella, and smallpox.  Left almost uneducated because of his frailty, his mother was regent most of his reign and he came to be known to history as El Hechizado (the Bewitched), the name applied because both court and country believed his mental and physical incapacities were due to an act of witchcraft.  Modern science suggests otherwise, the condition actually the consequence of the strong preference for endogamy within the Spanish branch of the Habsburg royal family which led to its segregation toward neighbor communities and the emergence of consanguinity.  In short, Charles II was inbred: his grandparents were at the same time his great-grandparents; her father, who was married to her sister's daughter, was also her great-uncle, and her mother happened to be her cousin as well.  One could see how things might not have turned out well and the condition was well-known in Europe and not restricted to aristocracy and royalty.  The slack enforcement of marriage laws on much of the continent was one of the reasons there were so many victims of the Nazi euthanasia (Aktion T4, 1939-1945) programme and the scandal of Byzantine Emperor Heraclius (circa 575–641; emperor 610-641) marrying his niece Martina (circa 590-circa 644) had been made still worse by the condition of some of the children the union produced.

However, to speak of incest in the royal family was just not done so the feeling at the time was to blame witches or the Devil and the court sought the advice of Fray Antonio Álvarez Argüelles, vicar of the Encarnación de Cangas del Narcea convent and a noted Asturian exorcist who advised “…last night the demon told me that the King is evilly bewitched to rule and to beget. When he was 14 years old, he was enchanted with a chocolate in which the brains of a dead man were dissolved to take away his health, corrupt his semen and prevent his generation”.

Exorcism of Charles II of Spain, engraving by Lechard, circa 1840.

That must have been convincing because soon after the king was subjected to what was, even by the standards of the time, a most macabre exorcism.  By coincidence, the remains of his ancestors were being transferred to a new pantheon at the Royal Seat of San Lorenzo de El Escorial and the exorcist had their coffins opened, conducting a ceremony in which the corpses of his relatives and, in an advanced state of putrefaction, that of their his beloved first wife (María Luisa de Orleans (1662-1689)), were exhibited, the hope being the array of the dead would drive off the demons so tormenting the king.

It was in vain and the suffering continued.  Ill his whole life and king since the age of three, he lingered until 1700, dying at thirty-nine, the announcement one of the more eagerly awaited events in the courts and chancelleries of Europe, such was the anticipation of the struggles which would erupt to decide the succession.  Summarizing a sad life in Carlos, the Bewitched (1962, published in the US as Carlos: The King who would Not Die), his English biographer John Langdon-Davies (1897–1971) wrote: "Of no man is it more true to say that in his beginning was his end; from the day of his birth, they were waiting for his death".  On his deathbed, his last words were: "Everything hurts".

Gabardine

Gabardine (pronounced gab-er-deen or gab-ah-deen)

(1) A firm, tightly woven fabric of worsted, cotton, polyester, or other fiber, with a twill weave.

(2) An ankle-length loose coat or frock worn by men, associated especially with Jews, in the medieval period.

(3) In casual use, any of various other garments made of gabardine, once associated especially with raincoats worn by children (mostly archaic).

1510–1520: The spelling gabardine is a variant spelling of gaberdine, almost certainly from the Old French gauvardine & gallevardine (a long, loose outer garments much associated with pilgrims), from the Middle High German wallewart (pilgrimage (Wallfahrt in the German)), from the Spanish gabardina, possibly a conflation of gabán (from the Arabic qabā (men’s over-garment) and tabardina (diminutive of tabard or tabard (a sleeveless jerkin consisting only of front and back pieces with a hole for the head))).  The construct of the German Walfahrt was the Proto-Germanic wal- (source also of Old High German wallon (to roam, wander, go on a pilgrimage) + the Proto-Germanic faran (to go), from the primitive Indo-European per- (to lead, pass over).  The evolution of the word in Spanish was probably influenced by the Spanish gabán (overcoat) & tabardina (coarse coat) although the alternative etymology suggest it was an extended form of gabán and the Spanish word was borrowed and underwent alterations in Old French.  Gaberdine was documented from the 1510s while gabardine in the sense of "dress, covering" dates from the 1590s.  The meaning "closely woven cloth" dates from 1904 and the tightly woven fabric remains popular with designers for suits, pants, jackets, summer wear and especially overcoats.  Originally made from worsted wool, the twill weave fabric is now often rendered with synthetic and cotton blends and is renowned for its versatility and durability.

Lindsay Lohan, in Ami three button jacket and flare-fit trousers in wool gabardine with Ami small Deja-Vu bag, Interview Magazine, November 2022.  The car is a Jaguar XJS (1975-1996) convertible.  Jaguar didn't offer full convertible coachwork until 1988 but under contract, between 1986-1988, the Ohio-based coachbuilders Hess & Eisenhardt converted some 2000 coupés.  Unlike many out-sourced conversions, the Hess & Eisenhardt cars were in some ways more accomplished than the factory's own effort, the top folding completely into the body structure (al la the Mercedes-Benz R107 (1971-1989) or the Triumph Stag (1969-1977)).  However, to achieve that, the fuel tank had to be removed, replaced by twin tanks and this necessitated duplicated plumbing and pumps, something which sometimes proved troublesome.  There were reports of fires but the tale Jaguar arranged buy-backs so they might be consigned to the crusher is an internet myth. 

The diary (The Struggle for Survival 1940-1965) entry of Winston Churchill’s (1875-1965; UK prime-minister 1940-1945 & 1951-1955) physician (Sir Charles Wilson (Lord Moran); 1882-1977)) for 6 August 1942 records that in Cairo, there were some two-thousand, apparently unproductive, British Army officers who wore a very smart uniform called a gabardine and that in the slang of other units, they were called “the gabardine swine”.

The Gadarene Swine by Alan Coustick.

The play on words is based on the New Testament tale of the Miracle of the Gadarene Swine, referred to sometimes in academic writing as the exorcism of the Gerasene demoniac.  The miracle performed by Christ is the driving from a man demons which are allowed to take refuge in a herd of swine which then run down a slope into a lake where they drown.  The miracle is recounted in the three Synoptic (Matthew, Mark & Luke) Gospels, but not in that of John.  Matthew’s (8:28–34) account is short and differs in detail from Mark (5:1–20) & Luke (8:26–39), both of which include narrative descriptions which have informed the exorcism rites of the church ever since and the story has since Augustine attracted theologians and scholars who have found layers to interpret and it’s the origin too of the English proverbial word gadarene which describes or cautions against a “headlong or potentially disastrous rush to do something".  The Biblical reference to Gadarene is geographical although it’s uncertain exactly where the events transpired.

In philosophy, the Gadarene Swine Fallacy (GSF) is the logical fallacy of supposing (1) because a group is in the right formation, it is therefore on the right course or (2) supposing that because an individual has strayed from the group and isn't in formation, that they are off course.  The point of the GSF is that regardless of the vantage point from which a thing is viewed, mere appearances do not of necessity contain sufficient information accurately to convey what is right or wrong.  Moral theologians, legal theorists and others have been both satisfied and troubled by the miracle.  Saint Augustine's (354–430) immensely influential view was the story illustrated the special status God granted to man in the universe; that Christians have no obligations to God's other creatures, Jesus sacrificing two thousand swine to save the soul of one man and had it been a herd of ten-thousand he'd have seen them drowned too.  Augustine didn’t discuss the supposed right of Jesus to send to their death a large herd of pigs presumably the property of another who may have relied on them to feed and care for his family but this has since been discussed.

The Christian position must be that Christ is a Divine Being and therefore sovereign over the entire creation; the world is his dominion: “For every beast of the forest is mine, and the cattle upon a thousand hills” (Psalm 50:10).  That includes pigs and his actions gained the approbation (Mark 5:20) of those who watched the exorcism for they “marveled” (although they also asked him to leave town, the reasons for that of some theological dispute).  Technically too, Jesus could have quoted the Old Testament prohibitions of Leviticus who, among his list of abominations condemned swine as “unclean” (Leviticus 11) and thus fit for little but death by demonic possession.  Leviticus and Christ would also have agreed that whatever value some might place on the heads of two-thousand swine, it is nothing compared to the worth of one human soul.

Even before animal rights activism became main-stream, the orthodox Augustinian view (and those of the neo-Augustinian apologists) had been criticized.  The hardly impartial atheist Bertrand Russell (1872–1970) discussed the miracle in Why I am Not a Christian (1927), finding it appalling that someone omnipotent and therefore presumably able just to cast the demons into oblivion chose instead to kill two-thousand pigs.  Modern activists Like Tash Petersen would doubtless be harsher still in their judgement than Lord Russell.

The Miracle of the Gadarene Swine (circa 1000), unknown artist; Canterbury, England; tempera colors, gold leaf & ink on parchment; The J Paul Getty Museum, Los Angeles.

In the centre of this miniature removed from a Gospel book, Jesus and his followers confront two men whose half-dressed, unkempt state suggest they are possessed by evil demons.  Jesus performs an exorcism, transferring the demons into a herd of swine.  Matthew wrote that the herd "ran violently down a steep place into the sea," where "they perished in the waters". The illuminator closely followed the story as Matthew described it, depicting the swine hurtling down the cliff into the sea at the bottom of the page. At the top right, shepherds run to the city to report the miracle.  In the work, the events are arranged in three horizontal bands, the main focus on the middle figures whose emphatic gestures and tense body movements recount the vivid story.

Mania

Mania (pronounced mey-nee-uh or meyn-yuh)

(1) Excessive excitement or enthusiasm; craze; excessive or unreasonable desire; insane passion affecting one or many people; fanaticism.

(2) In psychiatry, the condition manic disorder; a combining form of mania (megalomania); extended to mean “enthusiasm, often of an extreme and transient nature,” for that specified by the initial element; characterized by great excitement and occasionally violent behavior; violent derangement of mind; madness; insanity.

(3) In mythology, the consort of Mantus, Etruscan god of the dead and ruler of the underworld.  Perhaps identified with the tenebrous Mater Larum, she should not be confused with the Greek Maniae, goddess of the dead; In Greek mythology Mania was the personification of insanity.

(4) In popular use, any behavior, practice, cultural phenomenon, product etc enjoying a sudden popularity.

1350–1400: From the Middle English mania (madness), from the Latin mania (insanity, madness), from the Ancient Greek μανία (manía) (madness, frenzy; enthusiasm, inspired frenzy; mad passion, fury), from μαίνομαι (maínomai) (I am mad) +‎ -ῐ́ᾱ (-íā).  The –ia suffix was from the Latin -ia and the Ancient Greek -ία (-ía) & -εια (-eia), which form abstract nouns of feminine gender.  It was used when names of countries, diseases, species etc and occasionally collections of stuff.  The Ancient Greek mainesthai (to rage, go mad), mantis (seer) and menos (passion, spirit), were all of uncertain origin but probably related to the primitive Indo-European mnyo-, a suffixed form of the root men- (to think)," with derivatives referring to qualities and states of maenad (mind) or thought.

The sense of a "fad, craze, enthusiasm resembling mania, eager or uncontrollable desire" dates from the 1680s, the use in English in this sense borrowed from the French manie.  In Middle English, mania had sometimes been nativized as manye. The familiar modern use as the second element in compounds expressing particular types of madness emerged in the 1500s (bibliomania 1734, nymphomania, 1775; kleptomania, 1830; narcomania 1887, megalomania, 1890), the origin of this being Medical Latin, in imitation of the Greek, which had a few such compounds (although, despite popular opinion, most were actually post-classical: gynaikomania (women), hippomania (horses) etc).

The adjective maniac was from circa 1600 in the sense of "affected with mania, raving with madness" and was from the fourteenth century French maniaque, from the Late Latin maniacus, from the Ancient Greek maniakos, the Adoption in English another borrowing from French use; from 1727 it came also to mean "pertaining to mania." The noun, "one who is affected with mania, a madman" was noted from 1763, derived from the adjective.  The adjective manic (pertaining to or affected with mania), dates from 1902, the same year the clinical term “manic depressive” appeared in the literature although, perhaps strangely, the condition “manic depression” wasn’t describe until the following year although the symptoms had as early as 1857 been noted as defined as “circular insanity”, from the from French folie circulaire (1854).  It’s now known as bi-polar disorder.  The constructions hypermania & submania are both from the mid-twentieth century.  The adjective maniacal was from the 1670s, firstly in the sense of "affected with mania" and by 1701 "pertaining to or characteristic of a maniac; the form maniacally emerged during the same era.  Mania is quite specific but craving, craze, craziness, enthusiasm, fad, fascination, frenzy, infatuation, lunacy, obsession, passion, rage, aberration, bee, bug, compulsion, delirium, derangement, desire & disorder peacefully co-exist.

Noted manias

Anglomania: An excessive or undue enthusiasm for England and all things English; rarely noted in the Quai D'Orsay.

Anthomania: An extravagant passion for flowers; although it really can’t be proved, the most extreme of these are probably the orchid fanciers.  Those with an extravagant passion for weed are a different sub-set of humanity and are really narcomanics (qv) although there may be some overlap. 

Apimania: A passionate obsession with bees; beekeepers tend to be devoted to their little creatures so among the manias, this one may more than most be a spectrum condition.

Arithmomania: A compulsive desire to count objects and make calculations; noted since 1884, it’s now usually regarded as being within the rubric of obsessive-compulsive disorder (OCD).

Bibliomania: A rage for collecting rare or unusual books.  This has led to crime and there have been famous cases.

Cacodaemomania: The obsessive fixation on the idea that one is inhabited by evil spirits.  To the point where it becomes troublesome it’s apparently rare but there are dramatic cases in the literature, one of the most notorious being Anneliese Michel (1952–1976) who was subject to the rites of exorcism by Roman Catholic priests in the months before she died.  The priests and her parents (who after conventional medical interventions failed, also become convinced the cause of her problems was demonic possession) were convicted of various offences related to her death.  Films based on the events leading up to death have been released including The Exorcism of Emily Rose (2005), Requiem (2006) and Anneliese: The Exorcist Tapes (2011).

Callomania: The obsessive belief in one’s own beauty, even when to all others this is obviously delusional.

Dipsomania: The morbid craving for alcohol; in pre-modern medicine, it was used also to describe the “temporary madness caused by excessive drinking”, the origin of this being Italian (1829) and German (1830) medical literature.

Egomania: An obsessive self-centeredness; it was known since 1825 but use didn’t spike until Freud (and others) made it widely discussed after the 1890s and few terms from the early days of psycho-analysis are better remembered.

Erotomania: Desperate love, a sentimentalism producing morbid feelings.

Flagellomania: An obsessive interest in flogging and/or being flogged, often as one’s single form of sexual expression and thus a manifestation of monomania (qv).  The English Liberal Party politician Robert Bernays (1902-1945), the son of a Church of England vicar, was a flagellomanic whose proclivities were, in the manner of English society at the time, both much discussed and kept secret.  He was also an illustration of the way such fetishes transcend other sexual categories.

Gallomania: An excessive or undue enthusiasm for France and all things French; rarely noted in the British Foreign Office.

Graphomania: A morbid desire to write.  Niccolò Machiavelli (1469-1527; Italian diplomat, philosopher and political advisor of the Renaissance) attributed many of the problems he suffered to his graphomania and he was right, his sufferings because of what he wrote, when it was written and about whom.

Hippomania: An excessive fondness for horses; an affliction which often manifests as the intense and passionate interest in horses developed by some girls who join pony clubs and fall in love.

Hypermania: There’s a definitional dualism to hypermania; it can mean either an extreme example of any mania or, as used by clinicians, specifically (and characterized usually by a mental state with high intensity disorientation and often violent behavior), a severe case of bipolar disorder (the old manic-depression).  The earlier term was hypomania (A manic elation accompanied by quickened perception), one of the earliest (1882) clinical terms from early-modern psychiatry.

Kleptomania: The obsessive desire to steal; in early (1830s) use, the alternative form was cleptomania.  The klepto element was from the Ancient Greek kleptes (thief, a cheater), from kleptein (to steal, act secretly), from the primitive Indo-European klep- (to steal), from the root kel- (to cover, conceal, save) and was cognate with the Latin clepere (to steal, listen secretly to), the Old Prussian au-klipts (hidden), the Old Church Slavonic poklopu (cover, wrapping) and the Gothic hlifan (to steal) & hliftus (thief).  The history of the word kleptomania is of interest also to sociologists in that as early as the mid-nineteenth century, there was controversy about the use by those with the capacity to buy the services of doctors and lawyers were able to minimize or escape the consequences of criminal misbehavior by claiming a psychological motive.  The argument was that the “respectable” classes were afforded the benefit of this defense while the working class were presumed to be inherently criminal and judged accordingly.  The same debate, now also along racial divides, continues today.

Logomania: An obsession with words.  It differs from graphomania (qv) which is an obsession to write; logomania instead is a fascination with words, their meanings and etymologies.

Megalomania: Delusions of greatness; a form of insanity in which the subjects imagine themselves to be great, exalted, or powerful personages.  It was first used in the medical literature in 1866 (from the French mégalomanie) and came to be widely applied to many politicians and potentates the twentieth century.

Micromania:  "A form of mania in which the patient thinks himself, or some part of himself, to be reduced in size", noted first in 1879 and twenty years later used also in reference to insane self-belittling.  In the twentieth century and beyond, micromania was widely used, sometimes humorously, to refer to things as varied as the sudden consumer in interest in small cars to the shrinking size of electronic components.   

Monomania: An insane obsession in regard to a single subject or class of subjects; applied most often in academic, scientific or political matters but can be used about anything where the overriding mental impulses are perverted to a specific delusion or the pursuit of a particular thing.

Morphinomania: A craving for morphine; one of the earliest of the words which noted specific addictions, it dates from 1885 but earlier still there had been morphiomania (1876) and morphinism (1875) from the German Morphiumsucht.  In the medical literature, morphinomaniac & morphiomaniac rapidly became common.

Narcomania: The uncontrollable craving for narcotic drugs and a term which is so nineteenth century, the preferred modern form being variations of "addiction".

Necromania: An obsession to have sexual relations with the bodies of the dead although, perhaps surprisingly, practitioners (those who treat rather than practice the condition) classify many different behaviors which they list under the rubric of necromania, some of the less confronting being a morbid interest in funeral rituals,  morgues, autopsies, and cemeteries.   Those whose hobbies include the study of the architecture of crypts and tombs or the coachwork of funeral hearses might be shocked to find there are psychiatrists who classify them in the same chapters as those who enjoy intimacy with corpses.

Nymphomania: The morbid and uncontrollable sexual desire in women.  Perhaps the most celebrated (and often sought) of the manias, it dates from 1775, in the English translation of Nymphomania, or a Dissertation Concerning the Furor Uterinus (1771) by French doctor Jean Baptiste Louis de Thesacq de Bienville (1726-1813), the construct being the Ancient Greek nymphē (bride, young wife; young lady) + mania.  The actual condition is presumed to have long pre-dated the term.

Onomatomania: One obsessively compelled to respond with a rhyming word to the last word spoken by another (something possible even with orange and silver).  It’s thought to co-exist with other conditions, especially schizophrenia.

Phonomania: An uncontrollable urge to murder; those who suffer this now usually described as the more accessible “homicidal maniac”.  When applied especially to serial killers, the companion condition (just further along the spectrum) is androphonomania which, if properly argued, could be a defense against a charge of mass-murder but counsel would need to be most assiduous in jury selection.

Plutomania: The obsessive pursuit of wealth (and used sometimes in a clinical setting to describe an "imaginary possession of wealth").

Pyromania: A form of insanity marked by a mania for destroying things by fire.  It was used in German in the 1830s and seemed to have captured the imagination of Richard Wagner (1813–1883); the older word for the condition was incendiarism.

Rhinotillexomania: Nose picking. Gross, but a thing which apparently often manifests when young but fades, usually of its own volition or in reaction to the disapprobation of others.

Trichotillomania: The compulsion to pull-out one’s hair.  The companion condition is trichtillophagia which is the compulsive eating of one’s own hair, one of a remarkable number of eating disorders.

Definitional variations in the criteria for mania, DSM-IV & DSM-5

The study and classification of idea of manias had been part of psychiatry almost from its origin as a modern discipline although the wealth of details and fragmentation of nomenclature would come later, the condition first noted “increased busyness”, the manic episodes characterized by Emil Kraepelin (1856-1926; a founding father of psychiatric phenomenology) as those of someone who was “…a stranger to fatigue, his activity goes on day and night; work becomes very easy to him; ideas flow to him.” 

Whatever the advances (and otherwise) in treatment regimes, little has changed in some aspects of the condition.  In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013), the primary criterion of mania remains “a distinct period of abnormally and persistently elevated, expansive, or irritable mood” and “abnormally and persistently increased goal-directed activity or energy” but did extend duration of the event to qualify for a diagnosis.  In the DSM-IV (1994), the criterion for a manic episode only required “a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week” whereas DSM-5 now requires in addition the presence of “abnormally and persistently increased goal-directed activity or energy”; moreover, these symptoms must not only last at least one week, they must also be “present most of the day, nearly every day.”

The changes certainly affected the practice of the clinician, DSM-5 substantially increasing the complexity associated with the diagnosis and treatment of bipolar disorder, no longer requiring that clinically significant symptoms which may be present should be ignored.  All those years ago, Kraepelin conceptualized manic-depression as a single illness with a continuum of episodic presentations including admixtures of symptoms which have long since been considered opposing polarity.  DSM-5 thus represents an advance with the possibility of improved treatment outcomes because it enables clinicians to diagnose mood episodes and specify the presence of symptoms inconsistent with pure episodes; a major depressive episode with or without mixed features and manic/hypomanic episodes with or without mixed features.

The revisions in DSM-5 also reflect the efforts of the editors over several decades to simplify diagnostic criteria while developing more precise categories of classification.  In the DSM-IV, both bipolar disorder and major depressive disorder were included in one chapter of mood disorders and a “mixed state” was a subtype of bipolar I mania, a diagnosis of a mixed state requiring that criteria for both a manic episode (at least three or four of seven manic symptoms) and a depressive episode (at least five of nine depressive symptoms) were met for at least one week.  In DSM-5, bipolar disorder and depressive disorders have their own chapters, and “mixed state” was removed and replaced with “manic episode with mixed features” and “major depressive disorder with mixed features.”