The idea that a person can become mad or experience some disturbance of mind has a very long history and predates the development of any services for dealing with or helping such individuals. Terms such as “madness” and “mental disturbance” embody the recognition that these conditions constitute a problem either for the persons themselves or for those around them. We can see two historical strands that led to the emergence of services for persons with mental disturbance. On the one hand, persons disturbed in mind, or their families, might seek help for their problems from a range of healers, particularly if they had the resources to do so. People would seek help for a wide spectrum of problems, ranging from the very severe, real madness, to the less severe, being “troubled in mind.” Treatments provided also varied widely (1). On the other hand, particularly as urbanization and industrialization spread, separate “madhouses” and asylums for those considered mad were established by private entrepreneurs, charitable groups, or local authorities and soon expanded in size. Initially asylums were for persons with severe disturbances—individuals who were “out of their minds” and either difficult to look after or control, or deemed to represent some form of threat to social order.

The emergence of a specialist grouping of medical practitioners concentrating on the treatment of what came to be called mental illness can be linked to the growing importance of madhouses and asylums in the nineteenth century
with the first use of the term “psychiatry” occurring in the middle of that century. These professionals increasingly defined and categorized the terrain of mental illness in order to make sense of the problems with which they were called upon to deal. In the process, the definition of mental illness was broadened, and new categories of mental illness were created. Whereas in the nineteenth century much of the focus was on disorders of thought, by the middle of the twentieth century, there was a growing attention to disorders of affect or emotion, as well as to disorders constructed primarily in terms of behavior rather than thought or emotion (2). Since the mid-twentieth century, there has been a new focus on services that do not involve confinement, legally compulsory or otherwise. There has also been a growing reliance on psychotropic medicines as the solution to problems of mental health. This trend has developed almost regardless of psychiatrists’ ideas about causation of mental illness, which are often broader and more eclectic than their treatment practices would suggest.