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# A short history of psychiatry

- Topic

From early asylums to moral treatment, diagnosis by course, psychoanalysis, the first psychiatric medicines and care in the community.

Updated Nov 13, 2026

## Key points

- Pinel and William Tuke promoted moral treatment, humane care of people with mental illness, which shaped the first public asylums in the early 1800s.
- Kraepelin separated dementia praecox (progressive course) from manic-depressive illness (episodic course): diagnosis by course, a concept that DSM and ICD still rely on.
- In 1911 Eugen Bleuler renamed dementia praecox schizophrenia.
- Chlorpromazine entered psychiatry in 1952 with Delay and Deniker in Paris, after the surgeon Henri Laborit saw that it produced calm indifference without loss of consciousness; later antipsychotics grew from it.
- After chlorpromazine was approved in the United States in 1955, the state mental hospital population there fell by more than 75% by 1980, as care moved to the community.
- DSM-III (1980) introduced explicit diagnostic criteria; DSM-5 followed in 2013.

## What it is

Modern psychiatry took shape in the early 1800s, when reformers such as Philippe Pinel and William Tuke promoted humane care of people with mental illness (moral treatment), which inspired the first public asylums. In the late nineteenth century Emil Kraepelin sorted the major psychoses by their course into dementia praecox and manic-depressive illness, and in 1911 Eugen Bleuler renamed dementia praecox schizophrenia. Psychoanalysis then shaped psychiatry for about half a century. From 1952 chlorpromazine transformed treatment, and after 1955 large mental hospitals emptied as care moved to the community, while DSM-III (1980) brought explicit diagnostic criteria.

## Key facts

- The public asylums began as small therapeutic hospitals but became large, overcrowded institutions focused on containment.
- Kraepelin did not believe that single symptoms identify an illness; a disorder is a combination of symptoms plus its course over time.
- Laborit saw that chlorpromazine produced indifference without loss of consciousness, and its calming effect in the first psychiatric patient was immediate.
- Chlorpromazine treatment spread around the world between 1953 and 1955 and transformed disturbed wards.
- Deinstitutionalization without enough community services left many former patients homeless, a lesson for current mental health reform.

## Milestones in the history of psychiatry

| When | Who or what | Why it matters |
| --- | --- | --- |
| Early 1800s | Pinel and Tuke | Moral treatment: humane care; the model for the first public asylums |
| Late 1800s | Kraepelin | Psychoses classified by course: dementia praecox vs manic-depressive illness |
| 1911 | Bleuler | Renames dementia praecox schizophrenia |
| Mid-1900s | Psychoanalysis | Dominates psychiatry for about half a century and pushes classification aside |
| 1952 | Delay and Deniker; Laborit | Chlorpromazine enters psychiatry; later antipsychotics follow |
| 1955–1980 | Deinstitutionalization (United States) | State hospital population falls by more than three quarters; care moves to the community |
| 1959 | Imipramine | A tricyclic antidepressant, launched in the United States |
| 1980 | DSM-III | Explicit diagnostic criteria |
| 2013 | DSM-5 | The fifth edition of the DSM |

## Test yourself

Think of the answer, then tap the question to see it.

## What was moral treatment?

The humane care of people with mental illness promoted by Pinel and Tuke, which shaped the first public asylums in the early 1800s.

## On what basis did Kraepelin separate dementia praecox from manic-depressive illness?

On their course: dementia praecox was progressive and deteriorating, while manic-depressive illness was episodic.

## Who introduced chlorpromazine into psychiatry, and when?

Jean Delay and Pierre Deniker in Paris in 1952, after the surgeon Henri Laborit noticed that it calmed patients without loss of consciousness.

## What did DSM-III (1980) change?

It introduced explicit diagnostic criteria for each disorder, modelled on the Feighner research criteria.

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## Connections

## Related 5

- [Classifying mental disorders: DSM-5-TR and ICD-11](https://durgical.com/en/behavioral-science/classifying-mental-disorders-dsm-5-tr-and-icd-11/)
- [Electroconvulsive therapy](https://durgical.com/en/behavioral-science/electroconvulsive-therapy/)
- [Psychodynamic therapy, transference and countertransference](https://durgical.com/en/behavioral-science/psychodynamic-therapy-transference-and-countertransference/)
- [Levels of mental health care and involuntary admission](https://durgical.com/en/behavioral-science/levels-of-mental-health-care-and-involuntary-admission/)
- [Community and global mental health](https://durgical.com/en/behavioral-science/community-and-global-mental-health/)

## Related conditions 2

- [Schizophrenia](https://durgical.com/en/conditions/schizophrenia/)
- [Bipolar disorder](https://durgical.com/en/conditions/bipolar-disorder/)

## In Pharmacology 3

- [Chlorpromazine](https://durgical.com/en/pharmacology/chlorpromazine/)
- [First-generation antipsychotics](https://durgical.com/en/pharmacology/classes/first-generation-antipsychotics/)
- [Tricyclic antidepressants (TCAs)](https://durgical.com/en/pharmacology/classes/tricyclic-antidepressants/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Fifty years chlorpromazine: a historical perspective](https://pmc.ncbi.nlm.nih.gov/articles/PMC2655089/) (Neuropsychiatric Disease and Treatment (PubMed Central), 2007); [Emil Kraepelin: A pioneer of scientific understanding of psychiatry and psychopharmacology](https://pmc.ncbi.nlm.nih.gov/articles/PMC2927892/) (Indian Journal of Psychiatry (PubMed Central), 2010); [The history of nosology and the rise of the Diagnostic and Statistical Manual of Mental Disorders](https://pmc.ncbi.nlm.nih.gov/articles/PMC4421901/) (Dialogues in Clinical Neuroscience (PubMed Central), 2015); [Cycles of reform in the history of psychosis treatment in the United States](https://pmc.ncbi.nlm.nih.gov/articles/PMC10302760/) (SSM - Mental Health (PubMed Central), 2023).

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