ABSTRACT
It is remarkable that almost one hundred years ago Dr. Emil Kraepelin (1) described the essential process of affective illness progression, based on his careful charting of episodes of affective illness and the potential precipitating circumstances with which they were associated. While he spoke of the inherent variability of the illness course both within and between subjects, he noted an overall tendency for the illness to increase in frequency over time, with a decreasing duration of well intervals between successive episodes. At the same time, he noted that the first episodes of mania or depression were often precipitated by psychosocial stressors, but that with the appearance of enough episodes, they would begin to recur in a highly similar form “quite without external occasion” (p. 181) (1). Thus, he captured the ideas of both increasing automaticity and vulnerability to recurrence as a function of number of prior episodes. He attributed this progression to inherent genetic mechanisms interacting with recurrences of stressors and episodes themselves.
