Antiquity In Ancient Greece,
Hippocrates and his followers are generally credited with the first classification system for mental illnesses, including
mania,
melancholia,
phrenitis,
insanity,
paranoia,
panic,
epilepsy and
hysteria. They held that they were due to different kinds of imbalance in four
humors. many of these terms are still used in modern psychiatric and neurological practice
Middle ages to Renaissance The
Persian physicians 'Ali ibn al-'Abbas al-Majusi and
Najib ad-Din Samarqandi elaborated upon Hippocrates' system of classification.
Avicenna (980−1037 CE) in the
Canon of Medicine listed a number of mental disorders, including "passive male homosexuality". Laws generally distinguished between "idiots" and "lunatics".
Thomas Sydenham (1624–1689), the "English Hippocrates", emphasized careful clinical observation and diagnosis and developed the concept of a
syndrome, a group of associated symptoms having a common course, which would later influence psychiatric classification.
18th century Evolution in the scientific concepts of
psychopathology (literally referring to diseases of the mind) took hold in the late 18th and 19th centuries following the
Renaissance and
Enlightenment. Individual behaviors that had long been recognized came to be grouped into
syndromes.
Boissier de Sauvages developed an extremely extensive psychiatric classification in the mid-18th century, influenced by the medical
nosology of
Thomas Sydenham and the biological
taxonomy of
Carl Linnaeus. It was only part of his classification of 2400 medical diseases. These were divided into 10 "classes", one of which comprised the bulk of the mental diseases, divided into four "orders" and 23 "genera". One genus,
melancholia, was subdivided into 14 "species".
William Cullen advanced an influential medical nosology which included four classes of neuroses: coma, adynamias, spasms, and vesanias. The vesanias included
amentia, melancholia, mania, and
oneirodynia. Towards the end of the 18th century and into the 19th,
Pinel, influenced by Cullen's scheme, developed his own, again employing the terminology of genera and species. His simplified revision of this reduced all mental illnesses to four basic types. He argued that mental disorders are not separate entities but stem from a single disease that he called "mental alienation". Attempts were made to merge the ancient concept of
delirium with that of insanity, the latter sometimes described as delirium without fever. On the other hand, Pinel had started a trend for diagnosing forms of insanity 'without delirium' (meaning hallucinations or delusions) – a concept of partial insanity. Attempts were made to distinguish this from total insanity by criteria such as intensity, content or generalization of delusions.
19th century Pinel's successor,
Esquirol, extended Pinel's categories to five. Both made a clear distinction between insanity (including mania and dementia) as opposed to
mental retardation (including
idiocy and imbecility). Esquirol developed a concept of
monomania—a periodic delusional fixation or undesirable disposition on one theme—that became a broad and common diagnosis and a part of popular culture for much of the 19th century. The diagnosis of "
moral insanity" coined by
James Prichard also became popular; those with the condition did not seem delusional or intellectually impaired but seemed to have disordered emotions or behavior. The botanical taxonomic approach was abandoned in the 19th century, in favor of an anatomical-clinical approach that became increasingly descriptive. There was a focus on identifying the particular psychological faculty involved in particular forms of insanity, including through
phrenology, although some argued for a more central
"unitary" cause. The concept of
hysteria (wandering womb) had long been used, perhaps since ancient Egyptian times, and was later adopted by Freud. Descriptions of a specific syndrome now known as
somatization disorder were first developed by the French physician,
Paul Briquet in 1859. An American physician, Beard, described "
neurasthenia" in 1869. German neurologist
Westphal, coined the term "
obsessional neurosis" now termed
obsessive-compulsive disorder, and
agoraphobia. Alienists created a whole new series of diagnoses that highlighted single, impulsive behavior, such as
kleptomania,
dipsomania,
pyromania, and
nymphomania. The diagnosis of
drapetomania was also developed in the Southern United States to explain the perceived irrationality of black slaves trying to escape what was thought to be a suitable role. The scientific study of
homosexuality began in the 19th century, informally viewed either as natural or as a disorder. Kraepelin included it as a disorder in his Compendium der Psychiatrie that he published in successive editions from 1883. In the late 19th century, Koch referred to "psychopathic inferiority" as a new term for moral insanity. In the 20th century the term became known as "psychopathy" or "sociopathy", related specifically to antisocial behavior. Related studies led to the DSM-III category of
antisocial personality disorder.
20th century Influenced by the approach of Kahlbaum and others, and developing his concepts in publications spanning the turn of the century, German psychiatrist
Emil Kraepelin advanced a new system. He grouped together a number of existing diagnoses that appeared to all have a deteriorating course over time—such as
catatonia,
hebephrenia and dementia paranoides—under another existing term "
dementia praecox" (meaning "early
senility", later renamed schizophrenia). Another set of diagnoses that appeared to have a periodic course and better outcome were grouped together under the category of manic-depressive insanity (mood disorder). He also proposed a third category of psychosis, called paranoia, involving delusions but not the more general deficits and poor course attributed to dementia praecox. In all he proposed 15 categories, also including psychogenic neurosis, psychopathic personality, and syndromes of defective mental development (mental retardation). He eventually included homosexuality in the category of "mental conditions of constitutional origin". The neuroses were later split into anxiety disorders and other disorders. Freud wrote extensively on hysteria and also coined the term, "anxiety neurosis", which appeared in DSM-I and DSM-II. Checklist criteria for this led to studies that were to define
panic disorder for DSM-III. Early 20th century schemes in
Europe and the
United States reflected a brain disease (or
degeneration) model that had emerged during the 19th century, as well as some ideas from
Darwin's theory of
evolution and/or
Freud's
psychoanalytic theories. Psychoanalytic theory did not rest on classification of distinct disorders, but pursued analyses of unconscious conflicts and their manifestations within an individual's life. It dealt with neurosis, psychosis, and perversion. The concept of
borderline personality disorder and other personality disorder diagnoses were later formalized from such psychoanalytic theories, though such ego psychology-based lines of development diverged substantially from the paths taken elsewhere within psychoanalysis. The philosopher and psychiatrist
Karl Jaspers made influential use of a "biographical method" and suggested ways to diagnose based on the form rather than content of beliefs or perceptions. In regard to classification in general he prophetically remarked that: "When we design a diagnostic schema, we can only do so if we forego something at the outset … and in the face of facts we have to draw the line where none exists... A classification therefore has only provisional value. It is a fiction which will discharge its function if it proves to be the most apt for the time". Mental disorders were first included in the sixth revision of the
International Classification of Diseases (ICD-6) in 1949. Three years later, in 1952, the
American Psychiatric Association created its own classification system, DSM-I. There is some attempt to construct novel schemes, for example from an
attachment perspective where patterns of symptoms are construed as evidence of specific patterns of disrupted attachment, coupled with specific types of subsequent trauma.
21st century The
ICD-11 and
DSM-5 are being developed at the start of the 21st century. Any radical new developments in classification are said to be more likely to be introduced by the APA than by the WHO, mainly because the former only has to persuade its own
board of trustees whereas the latter has to persuade the representatives of over 200 countries at a formal revision conference. In addition, while the DSM is a bestselling publication that makes huge profits for APA, the WHO incurs major expense in determining international consensus for revisions to the ICD. Although there is an ongoing attempt to reduce trivial or accidental differences between the DSM and ICD, it is thought that the APA and the WHO are likely to continue to produce new versions of their manuals and, in some respects, to compete with one another. == Criticism ==