Mental illness, or its equivalent, has been recognised for as long as there have been records,and possibly before. Early Egyptian papyri contain references to mental disturbances. Cases of mental disorder are recorded in the Old Testament where they are often equated with possession by evil spirits (for example, Saul, David and Nebuchadnezzar). Greek writings began to propose mental aberrations as disease. Hippocrates appeared to regard mental illnesses as having bodily causes which required treatment. Plato proposed that the behaviour of a grown man could be affected by childhood experiences. It is important to recognise, however, that the conceptual framework within which psychopathological descriptions have been set has changed greatly over the years. It may not be justified to assume that terms such as ‘mania’, ‘melancholia’ and ‘hypochondria’ mean the same now as they did even a few hundred years ago.Aristotle labelled emotions and suggested people were drawn to positive experiences and avoided pain. Hippocrates classified mental illness into mania, paranoia, melancholia and epilepsy. He also coined the term ‘hysteria’, but was referring to a condition of women in which the womb wandered in the pelvis until cured by sexual intercourse! The Romans were generally more punitive towards mental illness, advocated whipping or ducking to purge the body of ghosts.The Christian Church dominated thinking on mental illness in the Middle Ages, producing
the extremes of charity and cruelty to those afflicted. Islamic psychiatry in the Middle Ages used hospital treatment for the mentally ill, who were revered as messengers from God. Art and literature from the Renaissance era suggests an attitude of ridicule or fear towards the mentally ill in this period.
Search for a physical site for psychological and spiritual entities commenced in the 17th century. At this time, institutions for the insane such as London’s Bethlem Hospital did exist,but conditions and treatments were unpleasant. Physicians such as Pinel in France in the 18th century began to advocate kinder treatments and the removal of chains. Pinel began the definition of psychological phenomenology by describing mood swings, hallucinations and flight of ideas. The recurrent mental disorder suffered by King George III in the 18th century aroused public interest and led to parliamentary consideration of the care of the mentally ill through Britain. Hypnosis was introduced by Mezmer and explored further by Charcot and
Freud in the 19th century. The preoccupation with classification was continued by Kraepelin and Bleuler. Kraepelin developed the concept of dementia praecox (later more commonly known by Bleuler’s term of schizophrenia) and its separation (by virtue of poor prognosis)from manic‐depressive insanity (with a better prognosis).
The First World War, and cases of ‘shell shock’ led to interest in the idea that exposure to stress and untoward events could cause illness and nervous symptoms. After the First World War, there was expansion of psychiatric facilities and a broadening of their scope. In the 1920’s and 1930’s, physical treatments were introduced such as malarial treatment for neurosyphilis, insulin coma therapy for schizophrenia, electroconvulsive therapy and psychosurgery.


The 1950’s heralded the introduction of psychotropic medication such as lithium,
chlorpromazine, tricyclic and MAOI antidepressants. This revolutionised treatment of
psychiatric illness, with greater optimism about treating mental illness and a reduction of psychiatric beds from 150,000 in the 1950’s to around 45,000 in the 1990’s. Another reason for
the decline in beds was a change in social attitudes, fulled by Goffman (1961) who wrote a highly critical review of large psychiatric institutions in the USA, terming them ‘total institutions’.
The origins of asylums in the 19th century as places of safe haven for people with mental illness were rooted in social concerns of the day. Their demise and subsequent fall similarly reflected change in public opinion driving policy with respect to community care. In the 21st century, recent debate suggests that we are witnessing re‐institutionalisation, with an increasing number of secure forensic beds, an increase in compulsory admissions to hospital,and an increase in supported housing run by private facilities.