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The case of King Saul: did he have recurrent unipolar depression or bipolar affective disorder?

Published online by Cambridge University Press:  02 January 2018

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Copyright © Royal College of Psychiatrists, 2011 

It is widely accepted that Saul, the first king of Israel, had a mental disorder. Probably it was depression, soothed when David played on his harp: ‘And whenever the evil spirit from God came upon Saul, David took the lyre and played it in his hand, and Saul would be relieved and feel better and the evil spirit would depart from him (1 Sam. 16:23).’

Rather less well known are two passages that suggest he may have suffered from mania as well. Thus, shortly after being anointed king by the prophet Samuel but before he assumed the throne, Saul gets lost in the woods while searching for some lost donkeys, and there he meets a band of prophets.

10:10 ‘When they were going from there to Gibeah a band of prophets met him and the spirit of God possessed him and he fell into a prophetic frenzy along with them. 11 When all who knew him before saw how he prophesied with the prophets the people said to one another “What has come over the son of Kish? Is Saul also among the prophets?” 12 A man of the place answered “And who is their father?” Therefore it became a proverb “ Is Saul among the prophets?” 13 When his prophetic frenzy had ended he went home.’

This passage describes a brief episode where Saul behaved out of character and was in a state of prophetic frenzy similar to that of the prophets (many of whom were accepted as being mad and subject to prophetic ecstasy). The second episode of possible mania occurs towards the end of Saul's reign when, in a jealous rage, he and his army are pursuing David across the desert and they have heard David is in a place called Naioth.

19:23 ‘He went then towards Naioth in Ramah; and the spirit of God came upon him. As he was going he fell into a prophetic frenzy until he came to Naioth in Ramah. 24 He too stripped off his clothes and he too fell into a frenzy before Samuel. He lay naked all that day and all that night. Therefore it is said, is Saul also among the prophets?’

Both episodes of mania may have occurred in the presence of others who also went into states of excitement suggesting epidemic hysteria. Thus, in the first episode it is the prophets Saul encounters and in the second episode all his soldiers fell into a state of prophetic frenzy. Saul strips off his clothes, which sometimes occurs in mania and the pattern in the second episode is similar to the first episode, with the people commenting on his change of character as he briefly behaves like a prophet. Towards the end of his life, Saul descends into a state of paranoia, which culminates in death by suicide following defeat by the Philistines. This may indicate that Saul's condition was more serious than depression. If the above two brief excerpts are accepted as signifying manic episodes, then perhaps Saul qualifies for a DSM–IV diagnosis of bipolar affective disorder.

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