History of psychiatry

Ancient
Starting in the 5th century BCE, mental disorders, especially those with psychotic traits, were considered supernatural in origin, a view which existed throughout ancient Greece and Rome. The beginning of psychiatry as a medical specialty is dated to the middle of the nineteenth century., although one may trace its germination to the late eighteenth century.

Early manuals about mental disorders were created by the Greeks. In the 4th century BCE, Hippocrates theorized that physiological abnormalities may be the root of mental disorders. In 4th to 5th Century B.C. Greece, Hippocrates wrote that he visited Democritus and found him in his garden cutting open animals. Democritus explained that he was attempting to discover the cause of madness and melancholy. Hippocrates praised his work. Democratus had with him a book on madness and melancholy.

Religious leaders often turned to versions of exorcism to treat mental disorders often utilizing cruel and barbaric methods.

Middle Ages
Specialist hospitals were built in Baghdad in 705 AD, followed by Fes in the early 8th century, and Cairo in 800 AD.

Physicians who wrote on mental disorders and their treatment in the Medieval Islamic period included Muhammad ibn Zakarīya Rāzi (Rhazes), the Arab physician Najab ud-din Muhammad, and Abu Ali al-Hussain ibn Abdallah ibn Sina, known in the West as Avicenna.

Specialist hospitals were built in medieval Europe from the 13th century to treat mental disorders but were utilized only as custodial institutions and did not provide any type of treatment. Founded in the 13th century, Bethlem Royal Hospital in London is one of the oldest lunatic asylums. By 1547 the City of London acquired the hospital and continued its function until 1948. It is now part of the National Health Service and is an NHS Foundation Trust.

Early modern period
In 1621, Oxford University mathematician, astrologer, and scholar Robert Burton published the English language ''The Anatomy of Melancholy, What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it. In Three Maine Partitions with their several Sections, Members, and Subsections. Philosophically, Medicinally, Historically, Opened and Cut Up''. Burton wrote "I write of melancholy, by being busy to avoid melancholy. There is no greater cause of melancholy than idleness, no better cure than business." Unlike English philosopher of science Francis Bacon, Burton assumes that knowledge of the mind, not natural science, is humankind's greatest need.

In 1656, Louis XIV of France created a public system of hospitals for those suffering from mental disorders, but as in England, no real treatment was applied. In 1713 the Bethel Hospital Norwich was opened, the first purpose-built asylum in England, founded by Mary Chapman. In 1758 English physician William Battie wrote his Treatise on Madness which called for treatments to be utilized in asylums. Thirty years later, then ruling monarch in England George III was known to be suffering from a mental disorder. Following the King's remission in 1789, mental illness came to be seen as something which could be treated and cured. The French doctor Philippe Pinel introduced humane treatment approaches to those suffering from mental disorders. As a result of his work, the Governor of the Bicêtre psychiatric hospital in Paris released psychiatric patients from their chains in 1793, beginning what has been called the bright epoch of psychiatry. At the York Retreat, a Quaker-run asylum in England which opened in 1796, a form of moral treatment evolved independently from Pinel under the lay stewardship of the tea and coffee merchant William Tuke. Tuke's Retreat became a model throughout the world for humane and moral treatment of patients suffering from mental disorders. The York Retreat inspired similar institutions in the United States, most notably the Brattleboro Retreat and the Hartford Retreat (now the Institute of Living).

19th century
In 1808, Johann Christian Reil coined the term psychiatry (Greek "ψυχιατρική", psychiatrikē) which comes from the Greek "ψυχή" (psychē: "soul or mind") and "ιατρός" (iatros: "healer").

In the early 1800s, psychiatry made a significant advance in diagnosis of mental illness by broadening the category of mental disease to include mood disorders, in addition to disease level delusion or irrationality. Jean-Étienne Dominique Esquirol, a student of Pinel, made the first elaboration of what was to become our modern depression, lypemania, one of his affective monomanias (excessive attention to a single thing).

At the turn of the century, England and France combined had only a few hundred individuals in asylums. By the late 1890s and early 1900s, this number had risen to the hundreds of thousands. The United States housed 150,000 patients in mental hospitals by 1904. German speaking countries housed more than 400 public and private sector asylums. These asylums were critical to the evolution of psychiatry as they provided places of practice throughout the world.

On continental Europe, universities often played a part in the administration of the asylums and, because of the relationship between the universities and asylums, scores of psychiatrists were being educated in Germany. However, because of Germany's individual states and the lack of national regulation of asylums, the country had no organized centralization of asylums or psychiatry. Britain, unlike Germany, possessed a national body for asylum superintendents - the Medico-Psychological Association - established in 1866 under the Presidency of William A.F. Browne.

In the United States in 1834 Anna Marsh, a physician's widow, deeded the funds to build her country's first financially stable private asylum. The Brattleboro Retreat marked the beginning of America's private psychiatric hospitals challenging state institutions for patients, funding, and influence. Although based on England's York Retreat, it would be followed by specialty institutions of every treatment philosophy.

In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country. This was the year in which William A.F. Browne achieved his appointment as Superintendent of the Crichton Royal at Dumfries in southern Scotland.

However, the new idea that mental illness could be ameliorated during the mid-nineteenth century were disappointed. Psychiatrists were pressured by an ever increasing patient population. The average number of patients in asylums in the United States jumped 927%. Numbers were similar in England and Germany. Overcrowding was rampant in France where asylums would commonly take in double their maximum capacity. Increases in asylum populations may have been a result of the transfer of care from families and poorhouses, but the specific reasons as to why the increase occurred is still debated today. No matter the cause, the pressure on asylums from the increase was taking its toll on the asylums and psychiatry as a specialty. Asylums were once again turning into custodial institutions and the reputation of psychiatry in the medical world had hit an extreme low.

Argentina's government put numerous obstacles in the way of hospital development. For example in Buenos Aires, 1880s to 1980s, mental hospitals suffered serious overcrowding and appalling living conditions; lack of suitable staff and resources; and low rates of confinement compared to similar periods in modern nations.

Disease classification and rebirth of biological psychiatry
The 20th century introduced a new psychiatry into the world. Different perspectives of looking at mental disorders began to be introduced. The career of Emil Kraepelin reflects the convergence of different disciplines in psychiatry. Kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry. Following his appointment to a professorship of psychiatry and his work in a university psychiatric clinic, Kraepelin's interest in pure psychology began to fade and he introduced a plan for a more comprehensive psychiatry. Kraepelin began to study and promote the ideas of disease classification for mental disorders, an idea introduced by Karl Ludwig Kahlbaum. The initial ideas behind biological psychiatry, stating that the different mental disorders were all biological in nature, evolved into a new concept of "nerves" and psychiatry became a rough approximation of neurology and neuropsychiatry. However, Kraepelin was criticized for considering schizophrenia as a biological illness in the absence of any detectable histologic or anatomic abnormalities. While Kraepelin tried to find organic causes of mental illness, he adopted many theses of positivist medicine, but he favoured the precision of nosological classification over the indefiniteness of etiological causation as his basic mode of psychiatric explanation.

Following Sigmund Freud's death, ideas stemming from psychoanalytic theory also began to take root. The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums. By the 1970s the psychoanalytic school of thought had become marginalized within the field.

Biological psychiatry reemerged during this time. Psychopharmacology became an integral part of psychiatry starting with Otto Loewi's discovery of the neuromodulatory properties of acetylcholine; thus identifying it as the first-known neurotransmitter. Neuroimaging was first utilized as a tool for psychiatry in the 1980s. The discovery of chlorpromazine's effectiveness in treating schizophrenia in 1952 revolutionized treatment of the disease, as did lithium carbonate's ability to stabilize mood highs and lows in bipolar disorder in 1948. Psychotherapy was still utilized, but as a treatment for psychosocial issues. In the 1920s and 1930s, most asylum and academic psychiatrists in Europe believed that manic depressive disorder and schizophrenia were inherited, but in the decades after World War II, the conflation of genetics with Nazi racist ideology thoroughly discredited genetics. Now genetics were once again thought to play a role in mental illness. Molecular biology opened the door for specific genes contributing to mental disorders to be identified.

Transinstitutionalization and the aftermath
Asylums: Essays on the Social Situation of Mental Patients and Other Inmates is a 1961 book by sociologist Erving Goffman. The book is one of the first sociological examinations of the social situation of mental patients, the hospital. Based on his participant observation field work, the book details Goffman's theory of the "total institution" and the process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor," suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role, in other words of "institutionalizing" them. Asylums was a key text in the development of deinstitutionalization.

In 1963, US president John F. Kennedy introduced legislation delegating the National Institute of Mental Health to administer Community Mental Health Centers for those being discharged from state psychiatric hospitals. Later, though, the Community Mental Health Center's focus was diverted to provide psychotherapy sessions for those suffering from acute but mild mental disorders. Ultimately there were no arrangements made for actively and severely mentally ill patients who were being discharged from hospitals. Some of those suffering from mental disorders drifted into homelessness or ended up in prisons and jails. Studies found that 33% of the homeless population and 14% of inmates in prisons and jails were already diagnosed with a mental illness.

In 1973, psychologist David Rosenhan published the Rosenhan experiment, a study with results that led to questions about the validity of psychiatric diagnoses. Critics such as Robert Spitzer placed doubt on the validity and credibility of the study, but did concede that the consistency of psychiatric diagnoses needed improvement.

Psychiatry, like most medical specialties has a continuing, significant need for research into its diseases, classifications and treatments. Psychiatry adopts biology's fundamental belief that disease and health are different elements of an individual's adaptation to an environment. But psychiatry also recognizes that the environment of the human species is complex and includes physical, cultural, and interpersonal elements. In addition to external factors, the human brain must contain and organize an individual's hopes, fears, desires, fantasies and feelings. Psychiatry's difficult task is to bridge the understanding of these factors so that they can be studied both clinically and physiologically.