Intended for healthcare professionals


A history of psychiatry in 1500 words

BMJ 2021; 374 doi: (Published 09 August 2021) Cite this as: BMJ 2021;374:n1443
  1. Claire Hilton, historian in residence
  1. Royal College of Psychiatrists
  1. claire.hilton6{at}

Claire Hilton, historian in residence, Royal College of Psychiatrists, discusses some aspects of the history of psychiatry and explores some ancient ideas and more recent attitudes and developments, including treatments, service delivery, and mental health law

Psychiatry today, perhaps more than any other branch of medicine, has continuities with the past. King Lear said, “O let me not be mad, not mad, sweet heaven,”1 which chimes with today’s “dementophobia;” a fear of losing one’s mind, a new word on the web that is not yet in the Oxford English Dictionary. Despite recent advances, neuroscience and psychology still cannot fully explain many disorders of mind, thought, and behaviour—the manifestations of which still engender fear and stigma, affecting patients and the people close to them.

From the distant past

Ancient texts located the mind—intellect and emotions—in the heart. The Bible mentions King Solomon asking God for wisdom, “a discerning heart” (1 Kings 3:9), and the Quran states, “their hearts may reason” (Sura 22:46). The heart mirrors our emotions—with palpitations, rate changes, “missing” a beat and so on. These somatic sensations provided “evidence” for the heart as the seat of the mind, while mental disorders, typically lacking obvious brain pathology, provided no clues to the contrary. Today, the heart-emotion legacy continues into social media “”.

Classical Greek medicine—for example, Galen c.129-216 CE—conceptualised mental and physical wellbeing and dysfunction as the balance between four “humours:” black bile, yellow bile, blood, and phlegm. Remedies derived from this hypothesis perpetuated into the 19th century, such as those prescribed for King George III when afflicted with “madness.” His treatments included bleeding and purging, which aimed to relieve his suffering and restore his health. We cannot criticise previous generations of physicians for their knowledge and well meaning interventions, although their unquestioning reverence for medical doctrine leaves me feeling uneasy. When William Harvey …

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