The milestones of mania in the Western civilizations may be traced back to Samuel's description of the erratic mood swings of King Saul. The association of exhuberant temperament, creativity, leadership, and mood disorders has also been documented since Antiquity. The beneficial effect of water rich in lithium and the opposite effect of hashish on manic excitement were described centuries ago. Since Kraepelin we have a coherent and reliable framework for the diagnosis and classification of those affected by such conditions. From the use of Rawvolfia serpentina (reserpine) to modern antipsychotics, antidepressants, and mood-stabilizers, through the rediscovery of lithium and the development of ECT, the XX Century brought recovery and health to many of those afflicted (and lucky enough to have access to good psychiatric care).

There is some debate now on where to set the limits for the diagnosis of hypomania and, hence, of bipolar, manic-depressive illness. By setting too low a threshold (e.g., hypomania = overactivity for 1 or 2 days, as assessed by a self-rated questionnaire in the general population), psychiatry would run the risks of overinclusiveness (overlapping with normal temperament and with some personality disorders), overtreatment, iatrogenesis, and diffusion of identity (both for this hard-wired mental disorder and for the profession as a medical specialty). In light of the current limitations in the provision of effective mental health services for severe cases of mood disorders all over the World, the undue spread of this diagnosis will hardly set another milestone on its 3,000 year history, and may just be a detour.