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Aretaeus of Cappadocia

Volcanic activity and consequent eruptions in Cappadocia have created a subterranean land with unshakeable, fire resistant, rock houses that maintain a stable temperature throughout the extremes of both winter and summer (shown above). After the crucifixion of Jesus Christ, the first Christians and all of the apostles, including the Virgin Mary, took refuge in the underground city of Cappadocia. Hiding from the Romans and living together in cramped conditions in the underground city, at this time, and in subsequent years, it is possible that people may have lived in these shelters for months and years. In these confined and stressful conditions, inhabitants of Cappadocia probably manifest more than their fair share of highs and lows that possibly provided Aretaeus the opportunity to observe people and their mood states at close quarters. It is only conjecture as to what extent this environment and background contributed to his descriptions of melancholy, which he considered to be both mental and physical, and his deliberations on euphoria as a form of catharsis. However, ultimately he managed to correctly link the two phases of manicdepressive illness, what is now know as bipolar disorder, an observation that forms a foundation as unshakeable to this day as the rocks of Cappadocia.

Having divided the endogenous psychoses into manic-depressive illness and dementia praecox, in 1899 Kraepelin proposed the use of manic-depressive insanity to describe all forms of recurrent psychoses (1). He partitioned this from dementia praecox (what is now called schizophrenia) on the basis of disease symptomatology, course of illness and associated family history. However, the earliest recorded observations of bipolar disorder extend back almost two millennia, to the second century AD. Aretaeus of Cappadocia (150 AD), a practitioner in Rome, made the observation that euphoria can immediately follow melancholy. He suggested a connection between the two phases of manic-

depressive illness with a periodic nature: It appears to me that melancholy is the commencement and a part of mania. (2) This is a tremendous insight that raises some interesting considerations. For instance, what prompted him to observe the different phases of cyclical mood disorders and whether at that time, there was something unique about his background and Cappadocia that was conducive to this insight. Cappadocia is exactly in the middle of Anatolia, the peninsula between Asia and Europe. A lack of wood in this geographical area and the occurrence of frequent earthquakes would have forced inhabitants to seek refuge in the naturally occurring stone blocks in this region.

Omer Aydemir1, Gin S. Malhi2

1 Department of Psychiatry, School of Medicine, Celal Bayar University, Manisa, Turkey 2 Department of Psychological Medicine, Northern Clinical School, University of Sydney, Australia



Dr. Omer Aydemir Psychiatry, Celer Bayar Universitesi, Hastanesi Psikiyatri Klinigi, Manisa 45010, Turkey. Tel: +902362350357; Fax: +902362350357; E-mail:

Acta Neuropsychiatrica 2007: 19:6263 2007 The Authors Journal compilation 2007 Blackwell Munksgaard DOI: 10.1111/j.1601-5215.2007.00182.x

References 1. KRAEPLIN E. PSYCHIATRIE, 5th edn. Leipzig: Barth, 1896. 2. KOTSOPOULOS S. Aretaeus the Cappadocian on mental illness. Compr Psychiatry 1986;27: 171179.