SINCE THE advent of the psychopharmacological revolution, manic-depressive illness has been the flagship for modern psychiatric research, a paradigm that inspired and shaped many other areas of research. Today, through the accumulation of knowledge of this illness and its treatment, it constitutes one of the extraordinary success stories of modern biochemical science. Almost 30 years ago, Robins and Guze1 outlined 4 criteria for diagnostic validity in psychiatric disorders: clinical phenomenology, genetics, course, and treatment response. In each of these areas, our accumulated knowledge about manic-depressive illness is indeed impressive. But we face a paradox. Despite all we know, the illness too often remains unrecognized or misdiagnosed and inappropriately or ineffectively treated. The criteria of Robins and Guze encompass the 4 articles2- 5 in this issue about the illness and can serve as springboards to comment on the contemporary understanding of this fascinating and challenging illness.
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