Psychiatry  

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	Most psychiatric illnesses [[uncurable|cannot currently be cured]], although recovery may occur. While some have short time courses and only minor symptoms, many are [[Chronic (medicine)|chronic]] conditions which can have a significant impact on a patients' quality of life and even life expectancy, and as such may be thought to require long-term or life-long treatment. Effectiveness of treatment for any given condition is also variable from individual to individual.		Most psychiatric illnesses [[uncurable|cannot currently be cured]], although recovery may occur. While some have short time courses and only minor symptoms, many are [[Chronic (medicine)|chronic]] conditions which can have a significant impact on a patients' quality of life and even life expectancy, and as such may be thought to require long-term or life-long treatment. Effectiveness of treatment for any given condition is also variable from individual to individual.
		+	==History==
		+	===Ancient times===
		+	Starting in the 5th century BC, mental disorders, especially those with [[psychosis|psychotic]] traits, were considered [[supernatural]] in origin.<ref name=Elkes13>Elkes, A. & Thorpe, J.G. (1967). ''A Summary of Psychiatry''. London: Faber & Faber, p. 13.</ref> This view existed throughout [[ancient Greece]] and [[ancient Rome|Rome]].<ref name=Elkes13/> Early manuals written about mental disorders were created by the Greeks.<ref name=Shorter1>Shorter, E. (1997), p. 1</ref> In the 4th century BC, [[Hippocrates]] theorized that physiological abnormalities may be the root of mental disorders.<ref name=Elkes13/><ref name=Elkes13/> Religious leaders and others returned to using early versions of [[exorcism]]s to treat mental disorders which often utilized cruel, harsh, and barbarous methods.<ref name=Elkes13/>
		+
		+	===Middle Ages===
		+	{{Cite check|section|date=September 2010}}
		+	{{Main|Islamic psychology}}
		+	The first [[psychiatric hospital]]s were built in the [[Islamic Golden Age|medieval Islamic world]] from the 8th century. The first was built in [[Baghdad]] in 705 AD, followed by [[Fes]] in the early 8th century, and [[Cairo]] in 800 AD. Unlike medieval Christian physicians who relied on [[demonic possession|demonological explanations]] for mental illness, [[Islamic medicine|medieval Muslim physicians]] relied mostly on [[clinical psychology|clinical observations]]. They made significant advances to psychiatry and were the first to provide [[psychotherapy]] and [[moral treatment]] for mentally ill patients, in addition to other forms of treatment such as [[bathing|bath]]s, drug [[medication]], [[music therapy]] and [[occupational therapy]]. In the 10th century, the [[Persian people|Persian]] physician [[Muhammad ibn Zakarīya Rāzi]] (Rhazes) combined [[psychology|psychological]] methods and [[physiology|physiological]] explanations to provide treatment to mentally ill patients. His contemporary, the [[Arab]] physician Najab ud-din Muhammad, described a number of mental illnesses such as [[agitated depression]], [[neurosis]], [[priapism]] and [[erectile dysfunction|sexual impotence]] (''Nafkhae Malikholia''), [[psychosis]] (''Kutrib''), and [[mania]] (''Dual-Kulb'').<ref name=Syed>Syed (2002), p.7-8</ref>
		+
		+	In the 11th century, another Persian physician, [[Avicenna]], recognized "[[physiological psychology]]" in the treatment of illnesses involving [[emotion]]s, and developed a system for associating changes in the [[pulse]] rate with inner feelings, which is seen as a precursor to the [[word association]] test developed by [[Carl Jung]] in the 19th century.<ref>Syed (2002), p. 7</ref> [[Avicenna]] was also an early pioneer of [[neuropsychiatry]], and first described a number of neuropsychiatric conditions such as [[hallucination]], [[insomnia]], [[mania]], [[nightmare]], [[melancholia]], [[dementia]], [[epilepsy]], [[paralysis]], [[stroke]], [[vertigo (medical)|vertigo]] and [[tremor]].<ref>S Safavi-Abbasi, LBC Brasiliense, RK Workman (2007), "The fate of medical knowledge and the neurosciences during the time of Genghis Khan and the Mongolian Empire", ''Neurosurgical Focus'' '''23''' (1), E13, p. 3.</ref>
		+
		+	Psychiatric hospitals were built in [[Middle Ages|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.<ref name=Shorter4>Shorter, E. (1997), p. 4</ref> Founded in the 13th century, [[Bethlem Royal Hospital]] in [[London]] is one of the oldest psychiatric hospitals.<ref name=Shorter4/> By 1547 the City of London acquired the hospital and continued its function until 1948.<ref name=Shorter5>Shorter, E. (1997), p. 5</ref> It is now part of the National Health Service and is an [[NHS Foundation Trust]].
		+	[[Image:Philippe Pinel.jpg|thumb|Many consider [[Philippe Pinel]] to be the father of modern psychiatry.]]
		+
		+	===Early modern period===
		+	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 being applied.<ref name= Shorter5/> In 1758 English physician [[William Battie]] wrote the ''[[Treatise on Madness]]'' which called for treatments to be utilized in asylums.<ref name=Shorter9>Shorter, E. (1997), p. 9</ref> Thirty years later the new ruling monarch in England, [[George III of the United Kingdom|George III]], was known to be suffering from a mental disorder.<ref name= Elkes13/> Following the King's [[remission (medicine)|remission]] in 1789, mental illness was seen as something which could be treated and cured.<ref name=Elkes13/> By 1792 French physician [[Philippe Pinel]] introduced [[moral treatment|humane treatment]] approaches to those suffering from mental disorders.<ref name=Elkes13/> [[William Tuke]] adopted the methods outlined by Pinel and that same year Tuke opened the [[The Retreat|York Retreat]] in England.<ref name=Elkes13/> That institution became known as a model throughout the world for humane and moral treatment of patients suffering from mental disorders.<ref name=Borthwick>Borthwick, A.; Holman, C.; Kennard, D.; McFetridge, M.; Messruther, K.; Wilkes, J. (2001). The relevance of moral treatment to contemporary mental health care. ''Journal of Mental Health, 10'', 427-439.</ref> It inspired similar institutions in the United States, most notably the [[Brattleboro Retreat]] and the Hartford Retreat (now the [[Institute of Living]]).
		+
		+	===19th century===
		+	At the turn of the century, England and France combined only had a few hundred individuals in asylums.<ref name=Shorter34>Shorter, E. (1997), p. 34</ref> By the late 1890s and early 1900s, this number skyrocketed to the hundreds of thousands.<ref name=Shorter34/> The United States housed 150,000 patients in mental hospitals by 1904.<ref name=Shorter34/> [[German language|German speaking]] countries housed more than 400 public and private sector asylums.<ref name=Shorter34/> These asylums were critical to the evolution of psychiatry as they provided a universal platform of practice throughout the world.<ref name=Shorter34/>
		+
		+	Universities often played a part in the administration of the asylums.<ref name=Shorter35>Shorter, E. (1997), p. 35</ref> Due to the relationship between the universities and asylums, scores of competitive psychiatrists were being molded in Germany.<ref name=Shorter35/> Germany became known as the world leader in psychiatry during the nineteenth century.<ref name=Shorter34/> The country possessed more than 20 separate universities all competing with each other for scientific advancement.<ref name=Shorter34/> 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.<ref name=Shorter34/> Britain, like Germany, also lacked a centralized organization for the administration of asylums.<ref name=Shorter41>Shorter, E. (1997), p. 41</ref> This deficit hindered the diffusion of new ideas in medicine and psychiatry.<ref name=Shorter41/>
		+
		+	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.<ref name=Shorter40>Shorter, E. (1997), p. 40</ref> By 1840, asylums as therapeutic institutions existed throughout Europe and the United States.<ref name=Shorter46>Shorter, E. (1997), p. 46</ref>
		+	[[Image:Emil Kraepelin2.gif|thumb|right|[[Emil Kraepelin]] studied and promoted ideas of disease classification for mental disorders.]]
		+
		+	However, the new and dominating ideas that mental illness could be "conquered" during the mid-nineteenth century all came crashing down.<ref name=Shorter46/> Psychiatrists and asylums were being pressured by an ever increasing patient population.<ref name=Shorter46/> The average number of patients in asylums in the United States jumped 927%.<ref name= Shorter46/> Numbers were similar in England and Germany.<ref name=Shorter46/> Overcrowding was rampant in France where asylums would commonly take in double their maximum capacity.<ref name=Shorter47>Shorter, E. (1997), p. 47</ref> Increases in asylum populations may have been a result of the transfer of care from families and [[poorhouse]]s, but the specific reasons as to why the increase occurred is still debated today.<ref name=Shorter48>Shorter, E. (1997), p. 48</ref><ref name=Shorter49>Shorter, E. (1997), p. 49</ref> 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<ref name=Rothman>Rothman, D.J. (1990). ''The Discovery of the Asylum: Social Order and Disorder in the New Republic''. Boston: Little Brown, p. 239. ISBN 978-0-316-75745-4</ref> and the reputation of psychiatry in the medical world had hit an extreme low.<ref name=Shorter65>Shorter, E. (1997), p. 65</ref>
		+
		+	===20th century===
		+	====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.<ref name=Shorter101>Shorter, E. (1997), p. 101</ref> Kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry.<ref name=Shorter101/> 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.<ref name=Shorter102>Shorter, E. (1997), p. 102</ref><ref name=Shorter103>Shorter, E. (1997), p. 103</ref> Kraepelin began to study and promote the ideas of disease classification for mental disorders, an idea introduced by [[Karl Ludwig Kahlbaum]].<ref name= Shorter103/> 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.<ref name=Shorter114>Shorter, E. (1997), p. 114</ref> Following [[Sigmund Freud]]'s death, ideas stemming from [[psychoanalytic theory]] also began to take root.<ref name=Shorter145>Shorter, E. (1997), p. 145</ref> The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums.<ref name=Shorter145/> By the 1970s the psychoanalytic school of thought had become marginalized within the field.<ref name=Shorter145/>
		+	[[Image:Acetylcholine.svg|right|thumb|[[Otto Loewi]]'s work led to the identification of the first neurotransmitter, [[acetylcholine]].]]
		+
		+	Biological psychiatry reemerged during this time. [[Psychopharmacology]] became an integral part of psychiatry starting with [[Otto Loewi]]'s discovery of the first neurotransmitter, [[acetylcholine]].<ref name=Shorter246/> [[Neuroimaging]] was first utilized as a tool for psychiatry in the 1980s.<ref name=Shorter270>Shorter, E. (1997), p. 270</ref> The discovery of [[chlorpromazine]]'s effectiveness in treating [[schizophrenia]] in 1952 revolutionized treatment of the disease,<ref name="Turner2007">{{Cite journal|author=Turner T. |title= Unlocking psychosis |journal=Brit J Med |year=2007 |volume=334 |issue=suppl |pages=s7 |doi=10.1136/bmj.39034.609074.94 |pmid=17204765}}</ref> as did [[lithium carbonate]]'s ability to stabilize mood highs and lows in [[bipolar disorder]] in 1948.<ref>Cade, JFJ; ''Lithium salts in the treatment of psychotic excitement''. Med J Aust 1949, 36, p349-352</ref> Psychotherapy was still utilized, but as a treatment for psychosocial issues.<ref name=Shorter239>Shorter, E. (1997), p. 239</ref> Genetics were once again thought to play a role in mental illness.<ref name=Shorter246>Shorter, E. (1997), p. 246</ref> Molecular biology opened the door for specific genes contributing to mental disorders to be identified.<ref name= Shorter246/>
		+
		+	====Anti-psychiatry and deinstitutionalization====
		+	{{Main|Anti-psychiatry}}
		+	{{See also|Political abuse of psychiatry}}
		+	The introduction of [[psychiatric medication]]s and the use of [[medical laboratory|laboratory]] tests altered the [[doctor-patient relationship]] between psychiatrists and their patients.<ref name=Shorter273>Shorter, E. (1997), p. 273</ref> Psychiatry's shift to the [[hard science]]s had been interpreted as a lack of concern for patients.<ref name=Shorter273 /> [[Anti-psychiatry]] had become more prevalent in the late twentieth century due to this and publications in the media which conceptualized mental disorders as myths.<ref name= Shorter274>Shorter, E. (1997), p. 274</ref> Others in the movement argued that psychiatry was a form of social control and demanded that institutionalized psychiatric care, stemming from Pinel's thereapeutic asylum, be abolished.<ref name=Shorter277>Shorter, E. (1997), p. 277</ref> Incidents of physical abuse by psychiatrists took place during the reign of some totalitarian regimes as part of a system to enforce political control. Some of the abuse even continued to the present day.<ref>Sunny Y. Lu & Viviana B. Galli, ''The Journal of the American Academy of Psychiatry and the Law''</ref> Historical examples of the abuse of psychiatry took place in [[Nazi Germany]],<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12817666&dopt=Abstract The killing of psychiatric patients in Nazi German...[Isr J Psychiatry Relat Sci. 2003&#93; - PubMed Result<!-- Bot generated title -->]</ref> in the [[Soviet Union]] under [[Psikhushka]], and in the [[apartheid]] system in [[South Africa]].<ref>[http://www.info.gov.za/speeches/1997/06160x76497.htm Mental Health During Apartheid<!-- Bot generated title -->]</ref>
		+
		+	[[Electroconvulsive therapy]] (ECT) was one treatment that the anti-psychiatry movement wanted eliminated.<ref name=Shorter282>Shorter, E. (1997), p. 282</ref> They alleged that ECT damaged the brain and was used as a tool for discipline.<ref name=Shorter282/> While some believe there is no evidence that ECT damages the brain,<ref name=Weiner>Weiner, R.D. (1984). Does ECT cause brain damage? ''Behavioral and Brain Sciences, 7'', 153.</ref><ref name=Meldrum>Meldrum, B.S. (1986). Neuropathological consequences of chemically and electrically induced seizures. ''Annals of the New York Academy of Sciences, 462'', 18693.</ref><ref name=Dwork>Dwork, A.J.; Arango, V.; Underwood, M.; Ilievski, B.; Rosoklija, G.; Sackeim, H.A.; Lisanby, S.H. (2004). Absence of histological lesions in primate models of ECT and magnetic seizure therapy. ''American Journal of Psychiatry, 161'', 576-578.</ref> there are some citations that ECT does cause damage.<ref name=Breggin>Peter R. Breggin, M.D., Electroshock: It's Brain Disabling Effects.</ref><ref name=Sammant>Dr. Sidney Sament Clinical Psychiatry News, March 1983, p. 4.</ref> Sometimes ECT is used as punishment or as a threat and there have been isolated incidents where the use of ECT was threatened to keep the patients "in line".<ref name=Shorter282/> The prevalence of psychiatric medication helped initiate [[deinstitutionalization]],<ref name=Shorter280/> the process of discharging patients from psychiatric hospitals to the community.<ref name=Shorter279>Shorter, E. (1997), p. 279</ref> The pressure from the anti-psychiatry movements and the ideology of community treatment from the medical arena helped sustain deinstitutionalization.<ref name=Shorter280/> Thirty-three years after deinstitutionalization started in the United States, only 19% of the patients in state hospitals remained.<ref name=Shorter280/> [[Mental health professional]]s envisioned a process wherein patients would be discharged into communities where they could participate in a normal life while living in a therapeutic atmosphere.<ref name=Shorter280/> Psychiatrists were criticized, however, for failing to develop community-based support and treatment. Community-based facilities were not available because of the political infighting between in-patient and community-based social services, and an unwillingness by social services to dispense funding to provide adequately for patients to be discharged into community-based facilities.
		+
		+	====Transinstitutionalization and the aftermath====
		+	In 1963, [[President of the United States|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.<ref name=Shorter280>Shorter, E. (1997), p. 280</ref> Later, though, the Community Mental Health Center's focus was diverted to provide psychotherapy sessions for those suffering from acute but mild mental disorders.<ref name=Shorter280/> Ultimately there were no arrangements made for actively and severely mentally ill patients who were being discharged from hospitals.<ref name=Shorter280/> Some of those suffering from mental disorders drifted into homelessness or ended up in prisons and jails.<ref name=Shorter280/><ref name=Slovenko>Slovenko, R. (2003). The transinstitutionalization of the mentally ill. ''Ohio University Law Review, 29'', 641.</ref> Studies found that 33% of the homeless population and 14% of inmates in prisons and jails were already diagnosed with a mental illness.<ref name=Shorter280 /><ref name=Torrey>Torrey, E.F. (1988). ''Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill''. New York: Harper and Row, pp.25-29, 126-128. ISBN 978-0-06-015993-1</ref>
		+
		+	In 1972, psychologist [[David Rosenhan]] published the [[Rosenhan experiment]], a study analyzing the validity of psychiatric diagnoses.<ref name=Rosenhan>Rosenhan, D. (1973). [http://www.sciencemag.org/cgi/content/abstract/179/4070/250 On being sane in insane places]. ''Science'' '''179''', 250-258.</ref> The study arranged for eight individuals with no history of psychopathology to attempt admission into psychiatric hospitals. The individuals included a graduate student, psychologists, an artist, a housewife, and two physicians, including one psychiatrist. All eight individuals were admitted with a diagnosis of schizophrenia or bipolar disorder. Psychiatrists then attempted to treat the individuals using psychiatric medication. All eight were discharged within 7 to 52 days. In a [[Rosenhan experiment#The_non-existent impostor experiment|later part of the study]], psychiatric staff were warned that pseudo-patients might be sent to their institutions, but none were actually sent. Nevertheless, a total of 83 patients out of 193 were believed by at least one staff member to be actors. The study concluded that individuals without mental disorders were indistinguishable from those suffering from mental disorders.<ref name=Rosenhan/> Critics such as [[Robert Spitzer (psychiatrist)|Robert Spitzer]] placed doubt on the validity and credibility of the study, but did concede that the consistency of psychiatric diagnoses needed improvement.<ref name=Spitzer2005>Spitzer, R.L.; Lilienfeld, S.O.; Miller, M.B. (2005). Rosenhan revisited: The scientific credibility of Lauren Slater's pseudopatient diagnosis study. ''Journal of Nervous and Mental Disease, 193'', 734-739.</ref>
		+
		+	Psychiatry, like most medical specialties has a continuing, significant need for research into its diseases, classifications and treatments.<ref name=Lyness16>Lyness, J.M. (1997). ''Psychiatric Pearls''. Philadelphia: F.A. Davis Company. ISBN 978-0-80-360280-9{{Full|date=January 2010}}<!--page no. needed--></ref> Psychiatry adopts biology's fundamental belief that disease and health are different elements of an individual's adaptation to an environment.<ref name=Guze130>Guze, S. B. (1992), p. 130</ref> But psychiatry also recognizes that the environment of the human species is complex and includes physical, cultural, and interpersonal elements.<ref name=Guze130/> In addition to external factors, the [[human brain]] must contain and organize an individual's hopes, fears, desires, fantasies and feelings.<ref name=Guze130/> Psychiatry's difficult task is to bridge the understanding of these factors so that they can be studied both clinically and physiologically.<ref name=Guze130/>
	== Fictional portrayals of psychiatrists ==		== Fictional portrayals of psychiatrists ==

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Psychiatry is a medical specialty dealing with the prevention, assessment, diagnosis, treatment, and rehabilitation of the mind and mental illness. Its primary goal is the relief of mental suffering associated with symptoms of disorder and improvement of mental well-being. This may be based in hospitals or in the community and patients may be voluntary or involuntary. Psychiatry adopts a medical approach but may take into account biological, psychological, and social/cultural perspectives. Treatment by medication in conjunction with various forms of psychotherapy may be undertaken and has proved most effective in successful treatment. The word 'psychiatry' derives from the Greek for "healer of the spirit" (ψυχ- (spirit) + ιατρος (physician)).

Most psychiatric illnesses cannot currently be cured, although recovery may occur. While some have short time courses and only minor symptoms, many are chronic conditions which can have a significant impact on a patients' quality of life and even life expectancy, and as such may be thought to require long-term or life-long treatment. Effectiveness of treatment for any given condition is also variable from individual to individual.

Contents 1 History 1.1 Ancient times 1.2 Middle Ages 1.3 Early modern period 1.4 19th century 1.5 20th century 1.5.1 Disease classification and rebirth of biological psychiatry 1.5.2 Anti-psychiatry and deinstitutionalization 1.5.3 Transinstitutionalization and the aftermath 2 Fictional portrayals of psychiatrists 3 Psychiatrists

History

Ancient times

Starting in the 5th century BC, mental disorders, especially those with psychotic traits, were considered supernatural in origin.<ref name=Elkes13>Elkes, A. & Thorpe, J.G. (1967). A Summary of Psychiatry. London: Faber & Faber, p. 13.</ref> This view existed throughout ancient Greece and Rome.<ref name=Elkes13/> Early manuals written about mental disorders were created by the Greeks.<ref name=Shorter1>Shorter, E. (1997), p. 1</ref> In the 4th century BC, Hippocrates theorized that physiological abnormalities may be the root of mental disorders.<ref name=Elkes13/><ref name=Elkes13/> Religious leaders and others returned to using early versions of exorcisms to treat mental disorders which often utilized cruel, harsh, and barbarous methods.<ref name=Elkes13/>

Middle Ages

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The first psychiatric hospitals were built in the medieval Islamic world from the 8th century. The first was built in Baghdad in 705 AD, followed by Fes in the early 8th century, and Cairo in 800 AD. Unlike medieval Christian physicians who relied on demonological explanations for mental illness, medieval Muslim physicians relied mostly on clinical observations. They made significant advances to psychiatry and were the first to provide psychotherapy and moral treatment for mentally ill patients, in addition to other forms of treatment such as baths, drug medication, music therapy and occupational therapy. In the 10th century, the Persian physician Muhammad ibn Zakarīya Rāzi (Rhazes) combined psychological methods and physiological explanations to provide treatment to mentally ill patients. His contemporary, the Arab physician Najab ud-din Muhammad, described a number of mental illnesses such as agitated depression, neurosis, priapism and sexual impotence (Nafkhae Malikholia), psychosis (Kutrib), and mania (Dual-Kulb).<ref name=Syed>Syed (2002), p.7-8</ref>

In the 11th century, another Persian physician, Avicenna, recognized "physiological psychology" in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with inner feelings, which is seen as a precursor to the word association test developed by Carl Jung in the 19th century.<ref>Syed (2002), p. 7</ref> Avicenna was also an early pioneer of neuropsychiatry, and first described a number of neuropsychiatric conditions such as hallucination, insomnia, mania, nightmare, melancholia, dementia, epilepsy, paralysis, stroke, vertigo and tremor.<ref>S Safavi-Abbasi, LBC Brasiliense, RK Workman (2007), "The fate of medical knowledge and the neurosciences during the time of Genghis Khan and the Mongolian Empire", Neurosurgical Focus 23 (1), E13, p. 3.</ref>

Psychiatric 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.<ref name=Shorter4>Shorter, E. (1997), p. 4</ref> Founded in the 13th century, Bethlem Royal Hospital in London is one of the oldest psychiatric hospitals.<ref name=Shorter4/> By 1547 the City of London acquired the hospital and continued its function until 1948.<ref name=Shorter5>Shorter, E. (1997), p. 5</ref> It is now part of the National Health Service and is an NHS Foundation Trust.

Early modern period

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 being applied.<ref name= Shorter5/> In 1758 English physician William Battie wrote the Treatise on Madness which called for treatments to be utilized in asylums.<ref name=Shorter9>Shorter, E. (1997), p. 9</ref> Thirty years later the new ruling monarch in England, George III, was known to be suffering from a mental disorder.<ref name= Elkes13/> Following the King's remission in 1789, mental illness was seen as something which could be treated and cured.<ref name=Elkes13/> By 1792 French physician Philippe Pinel introduced humane treatment approaches to those suffering from mental disorders.<ref name=Elkes13/> William Tuke adopted the methods outlined by Pinel and that same year Tuke opened the York Retreat in England.<ref name=Elkes13/> That institution became known as a model throughout the world for humane and moral treatment of patients suffering from mental disorders.<ref name=Borthwick>Borthwick, A.; Holman, C.; Kennard, D.; McFetridge, M.; Messruther, K.; Wilkes, J. (2001). The relevance of moral treatment to contemporary mental health care. Journal of Mental Health, 10, 427-439.</ref> It inspired similar institutions in the United States, most notably the Brattleboro Retreat and the Hartford Retreat (now the Institute of Living).

19th century

At the turn of the century, England and France combined only had a few hundred individuals in asylums.<ref name=Shorter34>Shorter, E. (1997), p. 34</ref> By the late 1890s and early 1900s, this number skyrocketed to the hundreds of thousands.<ref name=Shorter34/> The United States housed 150,000 patients in mental hospitals by 1904.<ref name=Shorter34/> German speaking countries housed more than 400 public and private sector asylums.<ref name=Shorter34/> These asylums were critical to the evolution of psychiatry as they provided a universal platform of practice throughout the world.<ref name=Shorter34/>

Universities often played a part in the administration of the asylums.<ref name=Shorter35>Shorter, E. (1997), p. 35</ref> Due to the relationship between the universities and asylums, scores of competitive psychiatrists were being molded in Germany.<ref name=Shorter35/> Germany became known as the world leader in psychiatry during the nineteenth century.<ref name=Shorter34/> The country possessed more than 20 separate universities all competing with each other for scientific advancement.<ref name=Shorter34/> 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.<ref name=Shorter34/> Britain, like Germany, also lacked a centralized organization for the administration of asylums.<ref name=Shorter41>Shorter, E. (1997), p. 41</ref> This deficit hindered the diffusion of new ideas in medicine and psychiatry.<ref name=Shorter41/>

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.<ref name=Shorter40>Shorter, E. (1997), p. 40</ref> By 1840, asylums as therapeutic institutions existed throughout Europe and the United States.<ref name=Shorter46>Shorter, E. (1997), p. 46</ref>

However, the new and dominating ideas that mental illness could be "conquered" during the mid-nineteenth century all came crashing down.<ref name=Shorter46/> Psychiatrists and asylums were being pressured by an ever increasing patient population.<ref name=Shorter46/> The average number of patients in asylums in the United States jumped 927%.<ref name= Shorter46/> Numbers were similar in England and Germany.<ref name=Shorter46/> Overcrowding was rampant in France where asylums would commonly take in double their maximum capacity.<ref name=Shorter47>Shorter, E. (1997), p. 47</ref> 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.<ref name=Shorter48>Shorter, E. (1997), p. 48</ref><ref name=Shorter49>Shorter, E. (1997), p. 49</ref> 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<ref name=Rothman>Rothman, D.J. (1990). The Discovery of the Asylum: Social Order and Disorder in the New Republic. Boston: Little Brown, p. 239. ISBN 978-0-316-75745-4</ref> and the reputation of psychiatry in the medical world had hit an extreme low.<ref name=Shorter65>Shorter, E. (1997), p. 65</ref>

20th century

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.<ref name=Shorter101>Shorter, E. (1997), p. 101</ref> Kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry.<ref name=Shorter101/> 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.<ref name=Shorter102>Shorter, E. (1997), p. 102</ref><ref name=Shorter103>Shorter, E. (1997), p. 103</ref> Kraepelin began to study and promote the ideas of disease classification for mental disorders, an idea introduced by Karl Ludwig Kahlbaum.<ref name= Shorter103/> 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.<ref name=Shorter114>Shorter, E. (1997), p. 114</ref> Following Sigmund Freud's death, ideas stemming from psychoanalytic theory also began to take root.<ref name=Shorter145>Shorter, E. (1997), p. 145</ref> The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums.<ref name=Shorter145/> By the 1970s the psychoanalytic school of thought had become marginalized within the field.<ref name=Shorter145/>

Biological psychiatry reemerged during this time. Psychopharmacology became an integral part of psychiatry starting with Otto Loewi's discovery of the first neurotransmitter, acetylcholine.<ref name=Shorter246/> Neuroimaging was first utilized as a tool for psychiatry in the 1980s.<ref name=Shorter270>Shorter, E. (1997), p. 270</ref> The discovery of chlorpromazine's effectiveness in treating schizophrenia in 1952 revolutionized treatment of the disease,<ref name="Turner2007">Template:Cite journal</ref> as did lithium carbonate's ability to stabilize mood highs and lows in bipolar disorder in 1948.<ref>Cade, JFJ; Lithium salts in the treatment of psychotic excitement. Med J Aust 1949, 36, p349-352</ref> Psychotherapy was still utilized, but as a treatment for psychosocial issues.<ref name=Shorter239>Shorter, E. (1997), p. 239</ref> Genetics were once again thought to play a role in mental illness.<ref name=Shorter246>Shorter, E. (1997), p. 246</ref> Molecular biology opened the door for specific genes contributing to mental disorders to be identified.<ref name= Shorter246/>

Anti-psychiatry and deinstitutionalization

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