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Charles Krauthammer’s Quiet Contribution to Our Understanding of Bipolar Disease

He’s best remembered for his political essays, but the late author started his professional career studying and advocating for mental health in America.

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Charles Krauthammer, the Pulitzer Prize-winning columnist at The Washington Post, died Thursday afternoon from cancer.

While best remembered for his thoughtful essays in many of the country’s top publications, Krauthammer’s first career was as a physician—one that, while short-lived, deeply influenced his prose and approach and was, by all accounts, groundbreaking.

It wasn’t easy, however. During Krauthammer’s first year at Harvard Medical School, he had a devastating accident, the type that might have stymied many people from pursuing a career. Jumping off a diving board, his spinal cord got severed at C5. Krauthammer proceeded to spend 14 months in the hospital. It was an accident that confined him to a wheelchair, but one that he rarely discussed.

He simultaneously attended school, graduating on time in 1975 with a degree, then pursued a residency in psychiatry at nearby Massachusetts General Hospital, earning the top spot of chief resident his final year.

That year turned out to be an important one that would establish Krauthammer as someone who not only had a voracious capacity for learning but also a unique sense of discovery. In November 1978, Krauthammer and his co-author, Gerald Klerman, published a paper in the Archives of General Psychiatry, in which they identified that what was at the time called “mania” could actually be indicative of other mental disorders. This “secondary mania,” as he called it, was a variant that was distinct from bipolar disorder, something that could eventually signal dementia in older adults:

In reviewing the literature, we have found that mania occurs secondary to drugs, infection, neoplasm, epilepsy, and metabolic disturbances. These cases are best considered secondary manias. They suggest that mania—like, for example, hypertension—is a syndrome with multiple causes and that with further research many manic syndromes currently considered primary will be shifted into the secondary category.

The following year, Krauthammer published again, this time a deep dive into the epidemiology of bipolar disorder. It launched his career in psychiatry, which catapulted him to direct planning and psychiatric research in Washington, D.C., with the Carter administration.

It was at this time the former political science and economics major began to pen essays in the The New Republic, capturing enough attention to become Vice President Walter Mondale’s speech writer. His innate fluency with words and his knowledge of psychiatry made him a natural contributor to the third edition of the Diagnostic and Statistical Manual of Mental Disorders, which had published a couple editions by then, categorizing mental disorders and their neurobiological symptoms.

By 1984, Krauthammer was granted board certification in psychiatry by the American Board of Psychiatry and Neurology.

In a time when mental illness had yet to achieve public-health recognition and was still viewed through heavy handed stereotypes that categorized bipolar disease as mania (a term rarely, if at all, used now), Krauthammer’s recognition of the disease as a fundamental neurochemical imbalance was unusual and striking. It put forth an academic and popular proposal that seemed odd at the time: Some people struggled with their emotions and mental aptitude not because they were “crazy” or “stupid” but because of chemical imbalances in the brain. In the abstract for one of his papers, Krauthammer went so far as to compare secondary mania to hypertension, normalizing what many dismissed as “acting psycho” to a common ailment.

Krauthammer carried forward that analytical aspect in his subsequent work, often breaking down political euphemisms and challenging people’s preconceptions. That approach also emerged in his last column, in which he poignantly described his battle with cancer not with a doctor’s clinical factual form but with a philosopher’s meditation: “I was steadily, if slowly, overcoming each obstacle along the way and gradually making my way back to health ... This is the final verdict. My fight is over.”