Psychiatry is the medical specialty devoted to the diagnosis,
prevention, study, and treatment of mental disorders. These
include various maladaptations related to mood, behaviour, cognition,
and perceptions. See glossary of psychiatry.
Initial psychiatric assessment of a person typically begins with a
case history and mental status examination. Physical examinations and
psychological tests may be conducted. On occasion, neuroimaging or
other neurophysiological techniques are used. Mental disorders are
often diagnosed in accordance with clinical concepts listed in
diagnostic manuals such as the International Classification of
Diseases (ICD), edited and used by the
World Health Organization
World Health Organization (WHO)
and the widely used
Diagnostic and Statistical Manual of Mental
Disorders (DSM), published by the American Psychiatric Association
(APA). The fifth edition of the DSM (DSM-5) was published in 2013
which re-organized the larger categories of various diseases and
expanded upon the previous edition to include information/insights
that are consistent with current research.
The combined treatment of psychiatric medication and psychotherapy has
become the most common mode of psychiatric treatment in current
practice, but contemporary practice also includes a wide variety of
other modalities, e.g., assertive community treatment, community
reinforcement, and supported employment. Treatment may be delivered on
an inpatient or outpatient basis, depending on the severity of
functional impairment or on other aspects of the disorder in question.
An inpatient may be treated in a psychiatric hospital. Research and
treatment within psychiatry as a whole are conducted on an
interdisciplinary basis, e.g., with epidemiologists, mental health
counselors, nurses, psychologists, public health specialists,
radiologists, and/or social workers.
2 Theory and focus
2.1 Scope of practice
2.5 As a career choice
3 Clinical application
4.1 General considerations
6 Controversy and criticism
7 See also
8.2 Cited texts
9 Further reading
10 External links
The word psyche comes from the ancient Greek for soul or butterfly.
The fluttering insect appears in the coat of arms of Britain's Royal
College of Psychiatrists
The term "psychiatry" was first coined by the German physician Johann
Christian Reil in 1808 and literally means the 'medical treatment of
the soul' (psych- "soul" from
Ancient Greek psykhē "soul"; -iatry
"medical treatment" from Gk. iātrikos "medical" from iāsthai "to
heal"). A medical doctor specializing in psychiatry is a psychiatrist.
(For a historical overview, see Timeline of psychiatry.)
Theory and focus
"Psychiatry, more than any other branch of medicine, forces its
practitioners to wrestle with the nature of evidence, the validity of
introspection, problems in communication, and other long-standing
philosophical issues" (Guze, 1992, p.4).
Psychiatry refers to a field of medicine focused specifically on the
mind, aiming to study, prevent, and treat mental disorders in
humans. It has been described as an intermediary between the
world from a social context and the world from the perspective of
those who are mentally ill.
People who specialize in psychiatry often differ from most other
mental health professionals and physicians in that they must be
familiar with both the social and biological sciences. The
discipline studies the operations of different organs and body systems
as classified by the patient's subjective experiences and the
objective physiology of the patient. 
Psychiatry treats mental
disorders, which are conventionally divided into three very general
categories: mental illnesses, severe learning disabilities, and
personality disorders. While the focus of psychiatry has changed
little over time, the diagnostic and treatment processes have evolved
dramatically and continue to do so. Since the late 20th century the
field of psychiatry has continued to become more biological and less
conceptually isolated from other medical fields.
Scope of practice
Neurology § Overlap with psychiatry
Disability-adjusted life year
Disability-adjusted life year for neuropsychiatric conditions per
100,000 inhabitants in 2002.
less than 10
more than 150
Though the medical specialty of psychiatry uses research in the field
of neuroscience, psychology, medicine, biology, biochemistry, and
pharmacology, it has generally been considered a middle ground
between neurology and psychology. Because psychiatry and neurology
are deeply intertwined medical specialties, all certification for both
specialties and for their subspecialties is offered by a single board,
the American Board of
Psychiatry and Neurology, one of the member
boards of the American Board of Medical Specialties. Unlike other
physicians and neurologists, psychiatrists specialize in the
doctor–patient relationship and are trained to varying extents in
the use of psychotherapy and other therapeutic communication
techniques. Psychiatrists also differ from psychologists in that
they are physicians and have post-graduate training called residency
(usually 4 to 5 years) in psychiatry; the quality and thoroughness of
their graduate medical training is identical to that of all other
physicians. Psychiatrists can therefore counsel patients,
prescribe medication, order laboratory tests, order neuroimaging, and
conduct physical examinations.
See also: Ethical issues in psychiatry (other)
Like other purveyors of professional ethics, the World Psychiatric
Association issues an ethical code to govern the conduct of
psychiatrists. The psychiatric code of ethics, first set forth through
the Declaration of Hawaii in 1977, has been expanded through a 1983
Vienna update and, in 1996, the broader Madrid Declaration. The code
was further revised during the organization's general assemblies in
1999, 2002, 2005, and 2011. The
World Psychiatric Association
World Psychiatric Association code
covers such matters as patient assessment, up-to-date knowledge, the
human dignity of incapacitated patients, confidentiality, research
ethics, sex selection, euthanasia, organ transplantation,
torture, the death penalty, media relations, genetics, and
ethnic or cultural discrimination.
In establishing such ethical codes, the profession has responded to a
number of controversies about the practice of psychiatry, for example,
surrounding the use of lobotomy and electroconvulsive therapy.
Discredited psychiatrists who operated outside the norms of medical
ethics include Harry Bailey, Donald Ewen Cameron, Samuel A.
Cartwright, Henry Cotton, and Andrei
Psychiatric illnesses can be conceptualised in a number of different
ways. The biomedical approach examines signs and symptoms and compares
them with diagnostic criteria.
Mental illness can be assessed,
conversely, through a narrative which tries to incorporate symptoms
into a meaningful life history and to frame them as responses to
external conditions. Both approaches are important in the field of
psychiatry, but have not sufficiently reconciled to settle
controversy over either the selection of a psychiatric paradigm or the
specification of psychopathology. The notion of a "biopsychosocial
model" is often used to underline the multifactorial nature of
clinical impairment. In this notion the word "model" is
not used in a strictly scientific way though. Alternatively, a
"biocognitive model" acknowledges the physiological basis for the
mind's existence, but identifies cognition as an irreducible and
independent realm in which disorder may occur. The
biocognitive approach includes a mentalist etiology and provides a
natural dualist (i.e. non-spiritual) revision of the biopsychosocial
view, reflecting the efforts of Australian psychiatrist Niall McLaren
to bring the discipline into scientific maturity in accordance with
the paradigmatic standards of philosopher Thomas Kuhn.
Once a medical professional diagnoses a patient there are numerous
ways that they could choose to treat the patient. Often psychiatrists
will develop a treatment strategy that incorporates different facets
of different approaches into one. Drug prescriptions are very commonly
written to be regimented to patients along with any therapy they
receive. There are three major pillars of psychotherapy that treatment
strategies are most regularly drawn from. Humanistic psychology
attempts to put the "whole" of the patient in perspective; it also
focuses on self exploration.
Behaviorism is a therapeutic school
of thought that elects to focus solely on real and observable events,
rather than mining the unconscious or subconscious. Psychoanalysis, on
the other hand, concentrates its dealings on early childhood,
irrational drives, the unconscious, and conflict between conscious and
Main article: Psychiatrist
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All physicians can diagnose mental disorders and prescribe treatments
utilizing principles of psychiatry. Psychiatrists are physicians who
specialize in psychiatry and are certified to treat mental illness.
They may treat outpatients, inpatients, or both; they may practice as
solo practitioners or as members of groups; they may be self-employed,
be members of partnerships, or be employees of governmental, academic,
nonprofit, or for-profit entities; they may treat military personnel
as civilians or as members of the military; and in any of these
settings they may function as clinicians, researchers, teachers, or
some combination of these. Although psychiatrists may also go through
significant training to conduct psychotherapy, psychoanalysis or
cognitive behavioral therapy, it is their training as physicians that
differentiates them from other mental health professionals.
As a career choice
Psychiatry is not a popular career choice amongst medical students,
even though medical school placements are rated favorably. This
has resulted in a significant shortage of psychiatrists in the United
States and elsewhere. Strategies to rectify this have included the
use of short 'taster' placements early in the medical school
curriculum  and attempts to extend psychiatry services further
using telemedicine technologies and other methods.
The field of psychiatry has many subspecialties that require
additional training and certification by the American Board of
Neurology (ABPN). Such subspecialties include:
Brain Injury Medicine
Child and Adolescent Psychiatry
Hospice and palliative medicine
Psychosomatic medicine (also known as consultation-liaison
Additional psychiatry subspecialties, for which ABPN does not offer
Cognition diseases as in various forms of dementia
Global Mental Health
Addiction psychiatry focuses on evaluation and treatment of
individuals with alcohol, drug, or other substance-related disorders,
and of individuals with dual diagnosis of substance-related and other
Biological psychiatry is an approach to
psychiatry that aims to understand mental disorders in terms of the
biological function of the nervous system. Child and adolescent
psychiatry is the branch of psychiatry that specializes in work with
children, teenagers, and their families.
Community psychiatry is an
approach that reflects an inclusive public health perspective and is
practiced in community mental health services. Cross-cultural
psychiatry is a branch of psychiatry concerned with the cultural and
ethnic context of mental disorder and psychiatric services. Emergency
psychiatry is the clinical application of psychiatry in emergency
Forensic psychiatry utilizes medical science generally, and
psychiatric knowledge and assessment methods in particular, to help
answer legal questions.
Geriatric psychiatry is a branch of psychiatry
dealing with the study, prevention, and treatment of mental disorders
in the elderly.
Global Mental Health
Global Mental Health is an area of study, research and
practice that places a priority on improving mental health and
achieving equity in mental health for all people worldwide,
although some scholars consider it to be a neo-colonial, culturally
Liaison psychiatry is the branch
of psychiatry that specializes in the interface between other medical
specialties and psychiatry.
Military psychiatry covers special aspects
of psychiatry and mental disorders within the military context.
Neuropsychiatry is a branch of medicine dealing with mental disorders
attributable to diseases of the nervous system.
Social psychiatry is a
branch of psychiatry that focuses on the interpersonal and cultural
context of mental disorder and mental well-being.
In larger healthcare organizations, both public and private,
psychiatrists often serve in senior management roles, where they are
responsible for the efficient and effective delivery of mental health
services for the organization's constituents. For example, the Chief
of Mental Health Services at most VA medical centers is usually a
psychiatrist, although psychologists occasionally are selected for the
position as well.
In the United States, psychiatry is one of the few specialties which
qualify for further education and board-certification in pain
medicine, palliative medicine, and sleep medicine.
Psychiatric research is, by its very nature, interdisciplinary;
combining social, biological and psychological perspectives in attempt
to understand the nature and treatment of mental disorders.
Clinical and research psychiatrists study basic and clinical
psychiatric topics at research institutions and publish articles in
journals. Under the supervision of institutional
review boards, psychiatric clinical researchers look at topics such as
neuroimaging, genetics, and psychopharmacology in order to enhance
diagnostic validity and reliability, to discover new treatment
methods, and to classify new mental disorders.[page needed]
Diagnostic classification and rating scales used in
Psychiatric diagnoses take place in a wide variety of settings and are
performed by many different health professionals. Therefore, the
diagnostic procedure may vary greatly based upon these factors.
Typically, though, a psychiatric diagnosis utilizes a differential
diagnosis procedure where a mental status examination and physical
examination is conducted, with pathological, psychopathological or
psychosocial histories obtained, and sometimes neuroimages or other
neurophysiological measurements are taken, or personality tests or
cognitive tests administered. In some cases, a
brain scan might be used to rule out other medical illnesses, but at
this time relying on brain scans alone cannot accurately diagnose a
mental illness or tell the risk of getting a mental illness in the
future. A few psychiatrists are beginning to utilize genetics
during the diagnostic process but on the whole this remains a research
Diagnostic and Statistical Manual of Mental Disorders
Three main diagnostic manuals used to classify mental health
conditions are in use today. The
ICD-10 is produced and published by
the World Health Organization, includes a section on psychiatric
conditions, and is used worldwide. The
Diagnostic and Statistical
Manual of Mental Disorders, produced and published by the American
Psychiatric Association, is primarily focused on mental health
conditions and is the main classification tool in the United
States. It is currently in its fifth revised edition and is also
used worldwide. The
Chinese Society of Psychiatry has also
produced a diagnostic manual, the Chinese Classification of Mental
The stated intention of diagnostic manuals is typically to develop
replicable and clinically useful categories and criteria, to
facilitate consensus and agreed upon standards, whilst being
atheoretical as regards etiology. However, the categories are
nevertheless based on particular psychiatric theories and data; they
are broad and often specified by numerous possible combinations of
symptoms, and many of the categories overlap in symptomology or
typically occur together. While originally intended only as a
guide for experienced clinicians trained in its use, the nomenclature
is now widely used by clinicians, administrators and insurance
companies in many countries.
The DSM has attracted praise for standardizing psychiatric diagnostic
categories and criteria. It has also attracted controversy and
criticism. Some critics argue that the DSM represents an unscientific
system that enshrines the opinions of a few powerful psychiatrists.
There are ongoing issues concerning the validity and reliability of
the diagnostic categories; the reliance on superficial symptoms; the
use of artificial dividing lines between categories and from
'normality'; possible cultural bias; medicalization of human distress
and financial conflicts of interest, including with the practice of
psychiatrists and with the pharmaceutical industry; political
controversies about the inclusion or exclusion of diagnoses from the
manual, in general or in regard to specific issues; and the experience
of those who are most directly affected by the manual by being
diagnosed, including the consumer/survivor movement.
The publication of the DSM, with tightly guarded copyrights, now makes
APA over $5 million a year, historically adding up to over $100
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NIMH federal agency patient room for Psychiatric research, Maryland,
Individuals with mental health conditions are commonly referred to as
patients but may also be called clients, consumers, or service
recipients. They may come under the care of a psychiatric physician or
other psychiatric practitioners by various paths, the two most common
being self-referral or referral by a primary-care physician.
Alternatively, a person may be referred by hospital medical staff, by
court order, involuntary commitment, or, in the UK and Australia, by
sectioning under a mental health law.
Persons who undergo a psychiatric assessment are evaluated by a
psychiatrist for their mental and physical condition. This usually
involves interviewing the person and often obtaining information from
other sources such as other health and social care professionals,
relatives, associates, law enforcement personnel, emergency medical
personnel, and psychiatric rating scales. A mental status examination
is carried out, and a physical examination is usually performed to
establish or exclude other illnesses that may be contributing to the
alleged psychiatric problems. A physical examination may also serve to
identify any signs of self-harm; this examination is often performed
by someone other than the psychiatrist, especially if blood tests and
medical imaging are performed.
Like most medications, psychiatric medications can cause adverse
effects in patients, and some require ongoing therapeutic drug
monitoring, for instance full blood counts serum drug levels, renal
function, liver function, and/or thyroid function. Electroconvulsive
therapy (ECT) is sometimes administered for serious and disabling
conditions, such as those unresponsive to medication. The
efficacy and adverse effects of psychiatric drugs may vary
from patient to patient.
For many years, controversy has surrounded the use of involuntary
treatment and use of the term "lack of insight" in describing
patients. Mental health laws vary significantly among jurisdictions,
but in many cases, involuntary psychiatric treatment is permitted when
there is deemed to be a risk to the patient or others due to the
patient's illness. Involuntary treatment refers to treatment that
occurs based on the treating physician's recommendations without
requiring consent from the patient.
Mental health issues such as mood disorders and schizophrenia and
other psychotic disorders were the most common principle diagnoses for
Medicaid super-utilizers in the
United States in 2012.
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Psychiatric treatments have changed over the past several decades. In
the past, psychiatric patients were often hospitalized for six months
or more, with some cases involving hospitalization for many years.
Today in most countries, people receiving psychiatric treatment are
more likely to be seen as outpatients. If hospitalization is required,
the average hospital stay is around one to two weeks, with only a
small number receiving long-term hospitalization..
However, in Japan psychiatric hospitals continue to keep patients for
long periods, sometimes even keeping them in physical restraints,
strapped to their beds for periods of weeks or months .
Psychiatric inpatients are people admitted to a hospital or clinic to
receive psychiatric care. Some are admitted involuntarily, perhaps
committed to a secure hospital, or in some jurisdictions to a facility
within the prison system. In many countries including the USA and
Canada, the criteria for involuntary admission vary with local
jurisdiction. They may be as broad as having a mental health
condition, or as narrow as being an immediate danger to themselves
and/or others. Bed availability is often the real determinant of
admission decisions to hard pressed public facilities. European Human
Rights legislation restricts detention to medically certified cases of
mental disorder, and adds a right to timely judicial review of
People may be admitted voluntarily if the treating doctor considers
that safety isn't compromised by this less restrictive option.
Inpatient psychiatric wards may be secure (for those thought to have a
particular risk of violence or self-harm) or unlocked/open. Some wards
are mixed-sex whilst same-sex wards are increasingly favored to
protect women inpatients. Once in the care of a hospital, people are
assessed, monitored, and often given medication and care from a
multidisciplinary team, which may include physicians, pharmacists,
psychiatric nurse practitioners, psychiatric nurses, clinical
psychologists, psychotherapists, psychiatric social workers,
occupational therapists and social workers. If a person receiving
treatment in a psychiatric hospital is assessed as at particular risk
of harming themselves or others, they may be put on constant or
intermittent one-to-one supervision, and may be put in physical
restraints or medicated. People on inpatient wards may be allowed
leave for periods of time, either accompanied or on their own.
In many developed countries there has been a massive reduction in
psychiatric beds since the mid 20th century, with the growth of
community care. Standards of inpatient care remain a challenge in some
public and private facilities, due to levels of funding, and
facilities in developing countries are typically grossly inadequate
for the same reason. Even in developed countries, programs in public
hospitals vary widely. Some may offer structured activities and
therapies offered from many perspectives while others may only have
the funding for medicating and monitoring patients. This may be
problematic in that the maximum amount of therapeutic work might not
actually take place in the hospital setting. This is why hospitals are
increasingly used in limited situations and moments of crisis where
patients are a direct threat to themselves or others. Alternatives to
psychiatric hospitals that may actively offer more therapeutic
approaches include rehabilitation centers or "rehab" as popularly
Outpatient treatment involves periodic visits to a psychiatrist for
consultation in his or her office, or at a community-based outpatient
clinic. Initial appointments, at which the psychiatrist conducts a
psychiatric assessment or evaluation of the patient, are typically 45
to 75 minutes in length. Follow-up appointments are generally shorter
in duration, i.e., 15 to 30 minutes, with a focus on making medication
adjustments, reviewing potential medication interactions, considering
the impact of other medical disorders on the patient's mental and
emotional functioning, and counseling patients regarding changes they
might make to facilitate healing and remission of symptoms (e.g.,
exercise, cognitive therapy techniques, sleep hygiene—to name just a
few). The frequency with which a psychiatrist sees people in treatment
varies widely, from once a week to twice a year, depending on the
type, severity and stability of each person's condition, and depending
on what the clinician and patient decide would be best.
Increasingly, psychiatrists are limiting their practices to
psychopharmacology (prescribing medications), as opposed to previous
practice in which a psychiatrist would provide traditional 50-minute
psychotherapy sessions, of which psychopharmacology would be a part,
but most of the consultation sessions consisted of "talk therapy."
This shift began in the early 1980s and accelerated in the 1990s and
2000s. A major reason for this change was the advent of managed
care insurance plans, which began to limit reimbursement for
psychotherapy sessions provided by psychiatrists. The underlying
assumption was that psychopharmacology was at least as effective as
psychotherapy, and it could be delivered more efficiently because less
time is required for the appointment. For
example, most psychiatrists schedule three or four follow-up
appointments per hour, as opposed to seeing one patient per hour in
the traditional psychotherapy model.[a] Because of this shift in
practice patterns, psychiatrists often refer patients whom they think
would benefit from psychotherapy to other mental health professionals,
e.g., clinical social workers and psychologists.
Main article: History of psychiatry
The earliest known texts on mental disorders are from ancient India
and include the Ayurvedic text, Charaka Samhita. The first
hospitals for curing mental illness were established in India during
the 3rd century BCE.
The Greeks also created early manuscripts about mental disorders.
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
found him in his garden cutting open animals.
that he was attempting to discover the cause of madness and
Hippocrates praised his work.
Democritus had with him a
book on madness and melancholy. During 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, as well as Egyptian
regions.[page needed] Religious leaders often turned to
versions of exorcism to treat mental disorders often utilizing methods
that many consider to be cruel and/or barbaric methods.
Islamic Golden Age
Islamic Golden Age fostered early studies in Islamic psychology
and psychiatry, with many scholars writing about mental disorders. The
Persian physician Muhammad ibn Zakariya al-Razi, also known as
"Rhazes", wrote texts about psychiatric conditions in the 9th
century. As chief physician of a hospital in Baghdad, he was also
the director of one of the first psychiatric wards in the world. Two
of his works in particular, El-Mansuri and Al-Hawi, provide
descriptions and treatments for mental illnesses.
Abu Zayd al-Balkhi, known to the west as "Avicenna", was a Persian
polymath during the 9th and 10th centuries and one of the first to
classify neurotic disorders. He pioneered cognitive therapy in order
to treat each of these classified neurotic disorders. He classified
neurosis into four emotional disorders: fear and anxiety, anger and
aggression, sadness and depression, and obsession. Al-Balkhi further
classified three types of depression: normal depression or sadness
(huzn), endogenous depression originating from within the body, and
reactive clinical depression originating from outside the body.
Specialist hospitals were built in
Baghdad in 705 AD, followed by
Fes in the early 8th century, and
Cairo in 800 AD.
Specialist hospitals such as
Bethlem Royal Hospital
Bethlem Royal Hospital in
built in medieval Europe from the 13th century to treat mental
disorders, but were used only as custodial institutions and did not
provide any type of treatment.
The beginning of psychiatry as a medical specialty is dated to the
middle of the nineteenth century, although its germination can be
traced to the late eighteenth century. In the late 17th century,
privately run asylums for the insane began to proliferate and expand
in size. In 1713 the Bethel Hospital Norwich was opened, the first
purpose-built asylum in England. 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.
During the Enlightenment attitudes towards the mentally ill began to
change. It came to be viewed as a disorder that required compassionate
treatment. In 1758 English physician
William Battie wrote his Treatise
on Madness on the management of mental disorder. It was a critique
aimed particularly at the Bethlem Hospital, where a conservative
regime continued to use barbaric custodial treatment. Battie argued
for a tailored management of patients entailing cleanliness, good
food, fresh air, and distraction from friends and family. He argued
that mental disorder originated from dysfunction of the material brain
and body rather than the internal workings of the mind.
Philippe Pinel at the Salpêtrière, 1795 by Tony Robert-Fleury.
Pinel ordering the removal of chains from patients at the Paris Asylum
for insane women.
The introduction of moral treatment was initiated independently by the
Philippe Pinel and the English
Quaker William Tuke.
In 1792 Pinel became the chief physician at the Bicêtre Hospital.
Patients were allowed to move freely about the hospital grounds, and
eventually dark dungeons were replaced with sunny, well-ventilated
rooms. Pinel's student and successor,
Jean Esquirol (1772–1840),
went on to help establish 10 new mental hospitals that operated on the
Although Tuke, Pinel and others had tried to do away with physical
restraint, it remained widespread into the 19th century. At the
Lincoln Asylum in England, Robert Gardiner Hill, with the support of
Edward Parker Charlesworth, pioneered a mode of treatment that suited
"all types" of patients, so that mechanical restraints and coercion
could be dispensed with — a situation he finally achieved in 1838.
In 1839 Sergeant John Adams and Dr.
John Conolly were impressed by the
work of Hill, and introduced the method into their Hanwell Asylum, by
then the largest in the country.[page needed]
The modern era of institutionalized provision for the care of the
mentally ill, began in the early 19th century with a large state-led
effort. In England, the
Lunacy Act 1845 was an important landmark in
the treatment of the mentally ill, as it explicitly changed the status
of mentally ill people to patients who required treatment. All asylums
were required to have written regulations and to have a resident
qualified physician.[full citation needed] In 1838, France
enacted a law to regulate both the admissions into asylums and asylum
services across the country. In the United States, the erection of
state asylums began with the first law for the creation of one in New
York, passed in 1842. The
Utica State Hospital
Utica State Hospital was opened
approximately in 1850. Many state hospitals in the
United States were
built in the 1850s and 1860s on the Kirkbride Plan, an architectural
style meant to have curative effect.[page needed]
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. However,
the idea that mental illness could be ameliorated through
institutionalization ran into difficulties. Psychiatrists were
pressured by an ever-increasing patient population, and asylums
again became almost indistinguishable from custodial
In the early 1800s, psychiatry made advances in the diagnosis of
mental illness by broadening the category of mental disease to include
mood disorders, in addition to disease level delusion or
irrationality. The 20th century introduced a new psychiatry into
the world, with different perspectives of looking at mental disorders.
For Emil Kraepelin, the initial ideas behind biological psychiatry,
stating that the different mental disorders are all biological in
nature, evolved into a new concept of "nerves", and psychiatry became
a rough approximation of neurology and neuropsychiatry. Following
Sigmund Freud's pioneering work, ideas stemming from psychoanalytic
theory also began to take root in psychiatry. The psychoanalytic
theory became popular among psychiatrists because it allowed the
patients to be treated in private practices instead of warehoused in
Otto Loewi's work led to the identification of the first
By the 1970s, however, the psychoanalytic school of thought became
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
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 disorder, 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
In 1963, US president
John F. Kennedy
John F. Kennedy introduced legislation
National Institute of Mental Health
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
Centers focus shifted to providing psychotherapy for those suffering
from acute but less serious mental disorders. Ultimately there
were no arrangements made for actively following and treating severely
mentally ill patients who were being discharged from hospitals,
resulting in a large population of chronically homeless people
suffering from mental illness.
Controversy and criticism
Main article: Controversy surrounding psychiatry
Controversy has often surrounded psychiatry, and the term
anti-psychiatry was coined by psychiatrist David Cooper in 1967 and
was later made popular by Thomas Szasz. The basic premise of
anti-psychiatry is that: psychiatrists attempt to maliciously classify
"normal" people as "deviant;" psychiatric treatments are ultimately
more damaging than helpful to patients, and psychiatry's history
involves (what may now be seen as) dangerous treatments, such as the
frontal lobectomy (commonly called, a lobotomy). Several former
patient groups have been formed often referring to themselves as
Additionally, the Church of Scientology (through one of its
self-described "Humanitarian Efforts") created a "museum" in Los
Angeles, CA (USA) which purports to show the evolution of the "evils"
of psychiatry and psychology over time. The specific
Scientology-related organization, the Citizens Commission on Human
Rights (CCHR), is entirely devoted to the Anti-
That said, there has been a great deal of criticism about the veracity
of specific information provided to the public and the conclusions
drawn within the "exhibits."  
Bullying in psychiatry
Psychiatry Innovation Lab
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^ Alarcón RD (2016). "
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