Hypomania and Mania in the Modern Sense

   (1881)

   In a monograph on mania (called Mania [die Manie]), Emanuel Ernst Mendel (1839–1907), who headed a wellknown private nervous clinic in the Berlin suburb of Pankow and was said to be the last psychiatrist to master completely both psychiatry and neurology, proposed the existence of a disease entity that he called "hypomania": "indicating forms of mania with the typical clinical picture but in lesser degree."* The characteristics: "The * The term "hypomania" had been used by previous writers to mean a lesser degree of insanity, not mania in the modern sense. See, for example, Henry Johnson (1805–1877), On the Arrangement and Nomenclature of Mental Disorders (1843), where he calls hypomania a useful synonym for Esquirol’s concept of monomania, or "partial insanity." patients begin, as they say, ‘to really enjoy life.’ Bars, theaters and dances they might previously have avoided are now sought out, trips planned and quickly taken." Mendel emphasized a kind of moral egotism (not part of what was later considered to be the typical "hypomanic triad" of elated mood, pressured speech, and increased motor activity): "With increased self confidence they brush aside the doubts about the possible difficulties facing their projects; they also cut off further discussion. In these cases their egotistical character is particularly striking; they treat the relatives with indifference. Everything is oriented . . . toward the satisfaction of their own wishes and desires." Then the characteristic excesses of mania emerge, Mendel said: "They pay little attention to money, throwing it out the window, and in short order they run through actually astonishing sums" (pp. 38–40).

   Mendel also recast the definition of mania itself, not as a mood disorder but as a "pathological acceleration in the succession of ideas and the pathologically increased excitability of the brain’s motor centers" (p. 175). Before Mendel, chronic mania meant basically agitated dementia, a disease that went progressively downhill; Mendel’s mania and hypomania were recoverable. Mendel was also an authority on the pathology of neurosyphilis, but he is remembered for his work on mania in the modern sense and for his coinage of hypomania. (See also Manic-Depressive Illness.)