View source for Psychiatry

{{Short description|Branch of medicine devoted to mental disorders}}
{{Distinguish|Clinical psychology}}
{{pp-move}}
{{Infobox medical specialty
| title = Psychiatry
| image = Psi and Caduceus.svg
| focus = [[Mental health]]
| specialist = [[Psychiatrist]]
| glossary = [[Glossary of psychiatry]]
| diseases = [[Schizophrenia]], [[mood disorder|mood]], [[impulse-control disorder|impulse-control]], [[eating disorder|eating]], [[neurodevelopmental disorder|neurodevelopmental]], [[personality disorder|personality]], [[substance use disorder]]s
|subdivisions=[[Neuropsychiatry]], [[biological psychiatry]], [[social psychiatry]], [[interventional psychiatry]]|tests=[[Mental status examination]], [[psychological testing|psychological]], [[cognitive test|cognitive]], [[personality test]]s
}}

'''Psychiatry''' is the [[medical specialty]] devoted to the [[diagnosis]], treatment, and prevention of deleterious [[mental disorder|mental condition]]s.<ref>{{cite journal|title=First-year medical student objective structured clinical exam performance and specialty choice| vauthors = Backes KA, Borges NJ, Binder SB, Roman BJ |year=2013|journal=International Journal of Medical Education|volume=4|pages=38–40 |doi=10.5116/ijme.5103.b037 |doi-access=free}} {{open access}}</ref><ref>{{cite journal|title=Psychiatry and Its Dichotomies|vauthors=Alarcón RD|year=2016|journal=Psychiatric Times|volume=33|issue=5|page=1|url=http://www.psychiatrictimes.com/cultural-psychiatry/psychiatry-and-its-dichotomies|access-date=2016-07-26|archive-date=2019-01-30|archive-url=https://web.archive.org/web/20190130214411/http://www.psychiatrictimes.com/cultural-psychiatry/psychiatry-and-its-dichotomies|url-status=live}}</ref> These include matters related to [[cognition]], [[perception]]s, [[Mood (psychology)|mood]], [[emotion]], and [[behavior]].

Initial psychiatric assessment of a person begins with creating a [[Medical history|case history]] and conducting a [[mental status examination]]. Laboratory tests, physical examinations, and [[psychological test]]s may be conducted. On occasion, [[neuroimaging]] or [[neurophysiological]] studies are performed.<ref name=NIMHSite/> 

Mental disorders are diagnosed in accordance with diagnostic manuals such as the ''[[International Classification of Diseases]]'' (ICD),<ref name ="Do mental health professionals use diagnostic classifications the way we think they do? A global survey">{{Cite journal|author=First, M |author2=Rebello, T |author3=Keeley, J |author4=Bhargava, R |author5=Dai, Y |author6=Kulygina, M |author7=Matsumoto, C |author8=Robles, R |author9=Stona, A |author10=Reed, G |title=Do mental health professionals use diagnostic classifications the way we think they do? A global survey|journal=World Psychiatry|language=en|volume=17|issue=2|pages=187–195|pmid = 29856559| date = June 2018 | doi=10.1002/wps.20525|pmc=5980454 }}</ref> edited by the [[World Health Organization]] (WHO), and the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM), published by the [[American Psychiatric Association]] (APA). The fifth edition of the DSM ([[DSM-5]]) was published in May 2013.<ref name=Kupfer>{{cite journal|vauthors=Kupfer DJ, Regier DA|title=Why all of medicine should care about DSM-5|journal=JAMA|volume=303|issue=19|pages=1974–5|date=May 2010|pmid=20483976|doi=10.1001/jama.2010.646}}</ref>

Treatment may include [[psychotropic]]s (psychiatric medicines), [[psychotherapy]],<ref>{{cite journal|vauthors=Gabbard GO|title=Psychotherapy in psychiatry|journal=International Review of Psychiatry|volume=19|issue=1|pages=5–12|date=February 2007|pmid=17365154|doi=10.1080/09540260601080813|s2cid=25268111}}</ref><ref>{{cite web | title = Psychiatry Specialty Description | publisher = American Medical Association | url = https://www.ama-assn.org/specialty/psychiatry-specialty-description | access-date = 10 October 2020 | archive-date = 12 October 2020 | archive-url = https://web.archive.org/web/20201012155934/https://www.ama-assn.org/specialty/psychiatry-specialty-description | url-status = live }}</ref> [[substance-abuse treatment]], and other modalities such as [[Interventional psychiatry|interventional]] approaches, [[assertive community treatment]], [[Community reinforcement approach and family training|community reinforcement]], and [[supported employment]]. Treatment may be delivered on an [[inpatient]] or [[outpatient]] basis, depending on the severity of functional impairment or risk to the individual or community. Research within psychiatry is conducted by [[psychiatrist]]s on an interdisciplinary basis with other professionals, including [[clinical psychologists]], [[epidemiologists]], [[Nursing|nurses]], [[social workers]], and [[occupational therapists]].  Psychiatry has been controversial since its inception, facing criticism both internally and externally over its [[medicalization]] of mental distress, reliance on [[Medication|pharmaceuticals]], use of [[coercion]], influence from the [[pharmaceutical industry]], and its historical role in [[social control]] and contentious treatments. 

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==Etymology==
[[File:American Lady Against The Sky.jpg|thumb|The word ''[[wiktionary:psyche|psyche]]'' comes from the [[ancient Greek]] for '[[soul]]' or '[[butterfly]]'.<ref>{{cite magazine| vauthors = Rabuzzi M |title=Butterfly Etymology|magazine=Cultural Entomology Digest |issue=4 |url= http://www.insects.org/ced4/etymology.html |date=November 1997|archive-date=3 December 1998|archive-url=https://web.archive.org/web/19981203024144/http://www.insects.org/ced4/etymology.html}}</ref> The fluttering insect appears in the [[coat of arms]] of Britain's [[Royal College of Psychiatrists]].<ref>{{cite journal|vauthors=James FE|date=July 1991|title=Psyche|journal=Psychiatric Bulletin|volume=15|issue=7|pages=429–31|doi=10.1192/pb.15.7.429|doi-access=free}}</ref>]]

The term ''psychiatry'' was first coined by the German [[physician]] [[Johann Christian Reil]] in 1808 and literally means the 'medical treatment of the [[soul]]' (''[[Wikt:psych|ψυχή psych-]]'' 'soul' from [[Ancient Greek]] ''psykhē'' 'soul'; ''[[Wikt:-iatry|-iatry]]'' 'medical treatment' from Gk. ιατρικός ''iātrikos'' 'medical' from ιάσθαι ''iāsthai'' 'to heal'). A medical doctor specializing in psychiatry is a [[psychiatrist]] (for a historical overview, see: [[Timeline of psychiatry]]).

==Theory and focus==
{{quote box
| quote = "Psychiatry, more than any other branch of medicine, forces its practitioners to wrestle with the nature of evidence, the validity of introspection, problems in communication, and other long-standing philosophical issues" <small>([[Psychiatry#cite note-Guze4-5|Guze, 1992, p.4]]).</small>
| width = 24em
}}

Psychiatry refers to a field of medicine focused specifically on the [[mind]], aiming to [[Medical research|study]], [[Preventive healthcare|prevent]], and [[treatment of mental disorders|treat]] [[mental disorder]]s in [[human]]s.<ref name=Guze4>{{harvnb|Guze|1992|p=4}}.</ref><ref name=Storrow1>{{cite book| vauthors = Storrow HA |date=1969|title=Outline of Clinical Psychiatry|location=New York|publisher=Appleton-Century-Crofts|page=1|isbn=978-0-390-85075-1|oclc=599349242}}</ref>{{sfn|Lyness|1997|p=3}} It has been described as an intermediary between the world from a social context and the world from the perspective of those who are mentally ill.{{sfn|Gask|2004|p=7}}

People who specialize in psychiatry often differ from most other [[mental health professional]]s and [[physician]]s in that they must be familiar with both the [[social science|social]] and [[biology|biological sciences]].<ref name=Storrow1/> The discipline studies the operations of different organs and body systems as classified by the patient's subjective experiences and the objective physiology of the patient.{{Sfn|Guze|1992|p=131}} Psychiatry treats mental disorders, which are conventionally divided into three general categories: [[Mental disorder|mental illnesses]], severe learning disabilities, and [[personality disorder]]s.{{sfn|Gask|2004|p=113}} Although the focus of psychiatry has changed little over time, the diagnostic and treatment processes have evolved dramatically and continue to do so. Since the late 20th century, the field of psychiatry has continued to become more biological and less conceptually isolated from other medical fields.{{sfn|Gask|2004|p=128}}

===Scope of practice===
{{further|Neurology#Overlap with psychiatry}}
[[File:Neuropsychiatric conditions world map - DALY - WHO2002.svg|thumb|upright=1.15|[[Disability-adjusted life year]] for neuropsychiatric conditions
per 100,000&nbsp;inhabitants in 2002:{{Div col|small=yes|colwidth=10em}}
{{legend|#b3b3b3|No data}}
{{legend|#ffff65|Less than 10}}
{{legend|#fff200|10–20}}
{{legend|#ffdc00|20–30}}
{{legend|#ffc600|30–40}}
{{legend|#ffb000|40–50}}
{{legend|#ff9a00|50–60}}
{{legend|#ff8400|60–80}}
{{legend|#ff6e00|80–100}}
{{legend|#ff5800|100–120}}
{{legend|#ff4200|120–140}}
{{legend|#ff2c00|140–150}}
{{legend|#cb0000|More than 150}}{{div col end}}]]
Though the medical specialty of psychiatry uses research in the field of [[neuroscience]], [[psychology]], [[medicine]], [[biology]], [[biochemistry]], and [[pharmacology]],<ref name=Pietrini>{{cite journal|vauthors=Pietrini P|title=Toward a biochemistry of mind?|journal=The American Journal of Psychiatry|volume=160|issue=11|pages=1907–8|date=November 2003|pmid=14594732|doi=10.1176/appi.ajp.160.11.1907|doi-access=free|department=Editorial}}</ref> it has generally been considered a middle ground between [[neurology]] and psychology.{{sfn|Shorter|1997|p=326}} Because psychiatry and neurology are deeply intertwined medical specialties, all certification for both specialties and for their subspecialties is offered by a single board, the American Board of Psychiatry and Neurology, one of the member boards of the American Board of Medical Specialties.<ref>{{citation|title=Specialty and Subspecialty Certificates|date=n.d.|website=American Board of Medical Specialties|url=http://www.abms.org/member-boards/specialty-subspecialty-certificates/|access-date=27 July 2016|archive-date=23 January 2020|archive-url=https://web.archive.org/web/20200123231140/https://www.abms.org/member-boards/specialty-subspecialty-certificates/|url-status=live}}</ref> Unlike other physicians and neurologists, psychiatrists specialize in the [[doctor–patient relationship]] and are trained to varying extents in the use of psychotherapy and other therapeutic communication techniques.{{sfn|Shorter|1997|p=326}} Psychiatrists also differ from psychologists in that they are physicians and have post-graduate training called residency (usually four to five years) in psychiatry; the quality and thoroughness of their graduate medical training is identical to that of all other physicians.<ref name=Hauser>{{cite web| vauthors = Hauser MJ |title=Student Information |url= http://www.psychiatry.com/student.php |website=Psychiatry.com|access-date=21 September 2007|archive-url=https://web.archive.org/web/20101023095258/http://www.psychiatry.com/student.php|archive-date=23 October 2010}}</ref> Psychiatrists can therefore counsel patients, prescribe medication, order [[medical laboratory|laboratory test]]s, order [[neuroimaging]], and conduct [[physical examination]]s.<ref name=NIMHSite>{{cite web|publisher=National Institute of Mental Health|date=January 31, 2006|title=Information about Mental Illness and the Brain (Page 3 of 3)|website=The Science of Mental Illness|access-date=April 19, 2007|url=http://science-education.nih.gov/supplements/nih5/Mental/guide/info-mental-c.htm|archive-date=12 October 2007|archive-url=https://web.archive.org/web/20071012140052/http://science-education.nih.gov/supplements/nih5/Mental/guide/info-mental-c.htm}}</ref> As well, some psychiatrists are trained in [[interventional psychiatry]] and can deliver interventional treatments such as [[electroconvulsive therapy]], [[transcranial magnetic stimulation]], [[vagus nerve stimulation]] and [[ketamine]].<ref>{{Cite web |date=2024-07-27 |title=Handbook of Interventional Psychiatry - Handbook of Interventional Psychiatry |url=https://interventionalpsych.org/ |access-date=2024-08-28 |website=interventionalpsych.org |language=en-US}}</ref>

===Ethics===
{{See also|Ethical issues in psychiatry (disambiguation)}}
The [[World Psychiatric Association]] issues an [[ethical code]] to govern the conduct of psychiatrists (like other purveyors of [[professional ethics]]). The psychiatric code of ethics, first set forth through the Declaration of Hawaii in 1977 has been expanded through a 1983 Vienna update and in the broader Madrid Declaration in 1996. The code was further revised during the organization's general assemblies in 1999, 2002, 2005, and 2011.<ref name=WPAethics>{{cite web|date=21 September 2011|title=Madrid Declaration on Ethical Standards for Psychiatric Practice|url=http://wpanet.org/detail.php?section_id=5&content_id=48|website=World Psychiatric Association|access-date=3 November 2014|archive-url=https://web.archive.org/web/20160304140238/http://wpanet.org/detail.php?section_id=5&content_id=48|archive-date=4 March 2016}}</ref>

The World Psychiatric Association code covers such matters as [[confidentiality]], the [[Capital punishment|death penalty]], ethnic or cultural discrimination,<ref name="WPAethics" /> [[euthanasia]], genetics, the [[dignity|human dignity]] of incapacitated patients, media relations, organ transplantation, patient assessment, research ethics, sex selection,<ref name="Lopez">{{cite journal|vauthors=López-Muñoz F, Alamo C, Dudley M, Rubio G, García-García P, Molina JD, Okasha A|title=Psychiatry and political-institutional abuse from the historical perspective: the ethical lessons of the Nuremberg Trial on their 60th anniversary|journal=Progress in Neuro-Psychopharmacology & Biological Psychiatry|volume=31|issue=4|pages=791–806|date=May 2007|pmid=17223241|doi=10.1016/j.pnpbp.2006.12.007|quote=These practices, in which racial hygiene constituted one of the fundamental principles and euthanasia programmes were the most obvious consequence, violated the majority of known bioethical principles. Psychiatry played a central role in these programmes, and the mentally ill were the principal victims.|others=Cecilio Alamoa, Michael Dudleyb, Gabriel Rubioc, Pilar García-Garcíaa, Juan D. Molinad and Ahmed Okasha|s2cid=39675837}}</ref> [[coercion]],<ref>{{Cite journal |last1=Herrman |first1=Helen |last2=Allan |first2=John |last3=Galderisi |first3=Silvana |last4=Javed |first4=Afzal |last5=Rodrigues |first5=Maria |last6=the WPA Task Force on Implementing Alternatives to Coercion in Mental Health Care |date=2022-01-11 |title=Alternatives to coercion in mental health care: WPA Position Statement and Call to Action |journal=World Psychiatry |language=en |volume=21 |issue=1 |pages=159–160 |doi=10.1002/wps.20950 |pmid=35015368 |pmc=8751569 }}</ref> [[torture]],<ref name="Gluzman">{{cite journal|vauthors=Gluzman SF|title=Abuse of psychiatry: analysis of the guilt of medical personnel|journal=Journal of Medical Ethics|volume=17 Suppl|issue=Suppl|pages=19–20|date=December 1991|pmid=1795363|pmc=1378165|doi=10.1136/jme.17.Suppl.19|quote=Based on the generally accepted definition, we correctly term the utilisation of psychiatry for the punishment of political dissidents as torture.|doi-access=free}}</ref><ref name="Debreu">{{cite book|chapter-url=http://books.nap.edu/openbook.php?record_id=9733&page=21|vauthors=Debreu G|veditors=Corillon C|title=Science and Human Rights|chapter=Introduction|page=21|access-date=2007-10-04|year=1988|publisher=The National Academies Press|url=https://www.nap.edu/catalog/9733/science-and-human-rights|doi=10.17226/9733|pmid=25077249|doi-access=free|quote=Over the past two decades the systematic use of torture and psychiatric abuse have been sanctioned or condoned by more than one-third of the nations in the United Nations, about half of mankind.|isbn=978-0-309-57510-2|archive-date=2015-09-10|archive-url=https://web.archive.org/web/20150910065933/http://www.nap.edu/catalog/9733/science-and-human-rights|url-status=live}}</ref> and up-to-date knowledge.

In establishing such ethical codes, the profession has responded to a number of controversies about the practice of psychiatry, for example, surrounding the use of [[lobotomy]] and [[electroconvulsive therapy]].

Discredited psychiatrists who operated outside the norms of [[medical ethics]] include [[Harry Bailey]], [[Donald Ewen Cameron]], [[Samuel A. Cartwright]], [[Henry Cotton (doctor)|Henry Cotton]], and [[Andrei Snezhnevsky]].<ref name="Kirk2013">{{cite book| vauthors = Kirk S, Gomory T, Cohen D |title=Mad Science: Psychiatric Coercion, Diagnosis, and Drugs|year=2013|publisher=Transaction Publishers|location=New Brunswick, NJ|oclc=935892629|isbn=978-1-4128-4976-0}}</ref>{{Page needed|date=March 2015}}

===Approaches===
Psychiatric illnesses can be conceptualised in a number of different ways. The [[biomedical model|biomedical]] approach examines signs and symptoms and compares them with diagnostic criteria. Mental illness can be assessed, conversely, through a narrative which tries to incorporate symptoms into a meaningful life history and to frame them as responses to external conditions. Both approaches are important in the field of psychiatry<ref>{{cite journal|vauthors=Verhulst J, Tucker G|title=Medical and narrative approaches in psychiatry|journal=Psychiatric Services|volume=46|issue=5|pages=513–4|date=May 1995|pmid=7627683|doi=10.1176/ps.46.5.513}}</ref> but have not sufficiently reconciled to settle [[biopsychiatry controversy|controversy]] over either the selection of a psychiatric [[paradigm]] or the specification of [[psychopathology]]. The notion of a "[[biopsychosocial model]]" is often used to underline the multifactorial nature of clinical impairment.<ref name="McLaren N 1998 86–92; discussion 93–6"/><ref name="McLaren_madness">{{cite book|title=Humanizing Madness| vauthors = McLaren M |year=2007|isbn=978-1-932690-39-2|publisher=Loving Healing Press|location=Ann Arbor, MI}}{{Page needed|date=September 2010}}</ref><ref name="McLaren_psychiatry">{{cite book|title=Humanizing Psychiatry| vauthors = McLaren N |year=2009|isbn=978-1-61599-011-5|publisher=Loving Healing Press|location=Ann Arbor, MI}}{{Page needed|date=September 2010}}</ref> In this notion the word ''model'' is not used in a strictly scientific way though.<ref name="McLaren N 1998 86–92; discussion 93–6" /> Alternatively, Niall McLaren acknowledges the physiological basis for the mind's existence but identifies [[cognition]] as an [[Antireductionism|irreducible]] and independent realm in which disorder may occur.<ref name="McLaren N 1998 86–92; discussion 93–6"/><ref name="McLaren_madness"/><ref name="McLaren_psychiatry"/> The biocognitive approach includes a [[Mentalism (philosophy)|mentalist]] [[etiology]] and provides a natural [[Dualism (philosophy of mind)|dualist]] (i.e., non-spiritual) revision of the biopsychosocial view, reflecting the efforts of [[Australians|Australian]] psychiatrist Niall McLaren to bring the discipline into scientific maturity in accordance with the paradigmatic standards of [[Philosophy of science|philosopher]] [[Thomas Kuhn]].<ref name="McLaren N 1998 86–92; discussion 93–6">{{cite journal|vauthors=McLaren N|title=A critical review of the biopsychosocial model|journal=The Australian and New Zealand Journal of Psychiatry|volume=32|issue=1|pages=86–92; discussion 93–6|date=February 1998|pmid=9565189|doi=10.3109/00048679809062712|s2cid=12321002}}</ref><ref name="McLaren_madness"/><ref name="McLaren_psychiatry"/>

Once a medical professional diagnoses a patient there are numerous ways that they could choose to treat the patient. Often psychiatrists will develop a treatment strategy that incorporates different facets of different approaches into one. Drug prescriptions are very commonly written to be regimented to patients along with any therapy they receive. There are three major pillars of psychotherapy that treatment strategies are most regularly drawn from. [[Humanistic psychology]] attempts to put the "whole" of the patient in perspective; it also focuses on self exploration.<ref name="humanistic">{{cite web| vauthors = Michael H |title=Humanistic Therapy|website=CRC Health Group.|access-date=29 March 2015|url=http://www.crchealth.com/types-of-therapy/what-is-humanistic-therapy|archive-url=https://web.archive.org/web/20190602153855/https://www.crchealth.com/types-of-therapy/what-is-humanistic-therapy|archive-date=2 June 2019}}</ref> [[Behaviorism]] is a therapeutic school of thought that elects to focus solely on real and observable events, rather than mining the unconscious or ''subconscious''. [[Psychoanalysis]], on the other hand, concentrates its dealings on early childhood, irrational drives, the unconscious, and conflict between conscious and unconscious streams.<ref name="psychoanalysis">{{cite web|vauthors=McLeod S|date=2014|title=Psychoanalysis|website=Simply Psychology|access-date=29 March 2015|url=http://www.simplypsychology.org/psychoanalysis.html|archive-date=19 April 2015|archive-url=https://web.archive.org/web/20150419052206/http://www.simplypsychology.org/psychoanalysis.html|url-status=live}}</ref>

===Practitioners===
{{Main|Psychiatrist}}
{{One source section|date=August 2017}}
All [[physician]]s can diagnose mental disorders and prescribe treatments utilizing principles of psychiatry. [[Psychiatrist]]s are trained physicians who specialize in psychiatry and are certified to treat [[mental illness]]. They may treat outpatients, inpatients, or both; they may practice as solo practitioners or as members of groups; they may be self-employed, be members of partnerships, or be employees of governmental, academic, nonprofit, or for-profit entities; employees of hospitals; they may treat military personnel as civilians or as members of the military; and in any of these settings they may function as clinicians, researchers, teachers, or some combination of these. Although psychiatrists may also go through significant training to conduct [[psychotherapy]], [[psychoanalysis]] or [[cognitive behavioral therapy]], it is their training as physicians that differentiates them from other [[mental health professional]]s.

====As a career choice in the US====
Psychiatry was not a popular career choice among medical students, even though medical school placements are rated favorably.<ref name="link.springer.com">{{cite journal|vauthors=Brown M, Barnes J, Silver K, Williams N, Newton PM|title=The Educational Impact of Exposure to Clinical Psychiatry Early in an Undergraduate Medical Curriculum|journal=Academic Psychiatry|volume=40|issue=2|pages=274–81|date=April 2016|pmid=26077010|doi=10.1007/s40596-015-0358-1|s2cid=13274934}}</ref> This has resulted in a significant shortage of psychiatrists in the United States and elsewhere.<ref>{{cite web|vauthors=Japsen B|date=15 September 2015|title=Psychiatrist Shortage Worsens Amid 'Mental Health Crisis'|website=Forbes|url=https://www.forbes.com/sites/brucejapsen/2015/09/15/psychiatrist-shortage-worsens-amid-mental-health-crisis/|access-date=8 September 2017|archive-date=9 September 2017|archive-url=https://web.archive.org/web/20170909004934/https://www.forbes.com/sites/brucejapsen/2015/09/15/psychiatrist-shortage-worsens-amid-mental-health-crisis/|url-status=live}}</ref> Strategies to address this shortfall have included the use of short 'taster' placements early in the medical school curriculum<ref name="link.springer.com"/> and attempts to extend psychiatry services further using [[telemedicine]] technologies and other methods.<ref name=THIELE>{{cite journal|vauthors=Thiele JS, Doarn CR, Shore JH|title=Locum tenens and telepsychiatry: trends in psychiatric care|journal=Telemedicine Journal and e-Health|volume=21|issue=6|pages=510–3|date=June 2015|pmid=25764147|doi=10.1089/tmj.2014.0159|doi-access=free}}</ref> Recently, however, there has been an increase in the number of medical students entering into a psychiatry residency. There are several reasons for this surge, including the intriguing nature of the field, growing interest in [[psychiatric genetics|genetic biomarkers involved]] in psychiatric diagnoses, and newer pharmaceuticals on the drug market to treat psychiatric illnesses.<ref>{{cite journal|doi=10.1176/appi.pn.2015.4b15|title=2015 Match Finds Big Jump in Students Choosing Psychiatry |journal=Psychiatric News |volume=50|issue=8|page=1|year=2015| vauthors = Moran M }}</ref>

===Subspecialties===
The field of psychiatry has many subspecialties that require additional training and certification by the [[American Board of Psychiatry and Neurology]] (ABPN). Such subspecialties include:<ref>{{cite web|title=Taking a Subspecialty Exam|website=American Board of Psychiatry and Neurology|url=http://www.abpn.com/become-certified/taking-a-subspecialty-exam/|access-date=2015-09-19|archive-date=2015-09-05|archive-url=https://web.archive.org/web/20150905061842/http://www.abpn.com/become-certified/taking-a-subspecialty-exam/|url-status=live}}</ref>

* [[Addiction psychiatry]], [[addiction medicine]]
* Brain injury medicine<ref>{{cite web|url=https://www.abpn.com/become-certified/taking-a-subspecialty-exam/brain-injury-medicine/|title=Brain Injury Medicine|website=American Board of Psychiatry and Neurology|access-date=2017-08-20|archive-date=2017-08-20|archive-url=https://web.archive.org/web/20170820203143/https://www.abpn.com/become-certified/taking-a-subspecialty-exam/brain-injury-medicine/|url-status=live}}</ref><ref>{{cite journal| vauthors = Hausman K |date=6 December 2013|title=Brain Injury Medicine Gains Subspecialty Status|journal=Psychiatric News|volume=48|issue=23|page=10|doi=10.1176/appi.pn.2013.11b29}}</ref>
* [[Child and adolescent psychiatry]]
* [[Liaison psychiatry|Consultation-liaison psychiatry]]<ref>{{cite web|url=https://www.abpn.com/become-certified/taking-a-subspecialty-exam/psychosomatic-medicine/|title=Psychosomatic Medicine|website=American Board of Psychiatry and Neurology|access-date=2017-08-20|archive-date=2017-08-20|archive-url=https://web.archive.org/web/20170820203107/https://www.abpn.com/become-certified/taking-a-subspecialty-exam/psychosomatic-medicine/|url-status=live}}</ref>
*[[Forensic psychiatry]]
* [[Geriatric psychiatry]]
* [[Hospice and palliative medicine]]
* [[Sleep medicine]]<ref>{{cite web|url=https://www.abpn.com/become-certified/taking-a-subspecialty-exam/sleep-medicine/|title=Sleep Medicine|website=American Board of Psychiatry and Neurology|access-date=2017-08-20|archive-date=2017-08-20|archive-url=https://web.archive.org/web/20170820203807/https://www.abpn.com/become-certified/taking-a-subspecialty-exam/sleep-medicine/|url-status=live}}</ref>
{{wikibooks|Psychiatry}}
{{Wikiquote}}
{{wiktionary}}
{{Wikiversity}}
{{commons category|Psychiatry}}
Additional psychiatry subspecialties, for which the ABPN does not provide formal certification, include:<ref name=UKReq>{{cite web|website=The Royal College of Psychiatrists|date=2005|title=Careers info for School leavers|access-date=March 25, 2007|url=http://www.rcpsych.ac.uk/training/careersinpsychiatry/careerbooklet.aspx|archive-date=9 July 2007|archive-url=https://web.archive.org/web/20070709051515/http://www.rcpsych.ac.uk/training/careersinpsychiatry/careerbooklet.aspx}}</ref>
* [[Biological psychiatry]]
* [[Community mental health service|Community psychiatry]]
* [[Cross-cultural psychiatry]]
* [[Emergency psychiatry]]
*[[Evolutionary psychiatry]]
* [[Global mental health]]
* [[Learning disability|Learning disabilities]]
* [[Military psychiatry]]
* [[Neurodevelopmental disorder]]s
* [[Neuropsychiatry]]
* [[Interventional psychiatry|Interventional Psychiatry]]
* [[Social psychiatry]]

[[Addiction psychiatry]] focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. [[Biological psychiatry]] is an approach to psychiatry that aims to understand mental disorders in terms of the biological function of the nervous system. [[Child and adolescent psychiatry]] is the branch of psychiatry that specializes in work with children, teenagers, and their families. [[Community psychiatry]] is an approach that reflects an inclusive [[public health]] perspective and is practiced in [[community mental health services]].<ref>{{cite web|website=American Association of Community Psychiatrists|url=http://www.comm.psych.pitt.edu/mission.html|publisher=University of Pittsburgh School of Medicine, Department of Psychiatry|title=About AACP|access-date=August 5, 2008|archive-date=6 September 2009|archive-url=https://web.archive.org/web/20090906041751/http://www.comm.psych.pitt.edu/mission.html}}</ref> [[Cross-cultural psychiatry]] is a branch of psychiatry concerned with the cultural and ethnic context of mental disorder and psychiatric services. [[Emergency psychiatry]] is the clinical application of psychiatry in emergency settings. [[Forensic psychiatry]] utilizes medical science generally, and psychiatric knowledge and assessment methods in particular, to help answer legal questions. [[Geriatric psychiatry]] is a branch of psychiatry dealing with the study, prevention, and treatment of mental disorders in the [[Old age|elderly]]. [[Global mental health]] is an area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide,<ref name="Patel">{{cite journal|vauthors=Patel V, Prince M|title=Global mental health: a new global health field comes of age|journal=JAMA|volume=303|issue=19|pages=1976–7|date=May 2010|pmid=20483977|pmc=3432444|doi=10.1001/jama.2010.616|department=Commentary}}</ref> although some scholars consider it to be a neo-colonial, culturally insensitive project.<ref>{{cite book|title=Decolonizing Global Mental Health: The Psychiatrization of the Majority World | last1= Mills |first1=C |publisher=Routledge |isbn=978-1-84872-160-9|location=London|oclc=837146781|date=2013-11-11}}</ref><ref>{{cite book|title=Crazy like us| vauthors = Watters E |isbn=978-1-84901-577-6|location=London|oclc=751584971|year=2011}}</ref><ref>{{cite book|title=Mental health, race and culture| vauthors = Suman F |date=2010|publisher=Palgrave Macmillan|isbn=978-0-230-21271-8|edition=3rd|location=Basingstoke, Hampshire|oclc=455800587}}</ref><ref>{{cite book|title=Mental health worldwide: culture, globalization and development| vauthors = Suman F |isbn=978-1-137-32958-5|location=Houndmills, Basingstoke, Hampshire|oclc=869802072|date=2014-04-11}}</ref> [[Liaison psychiatry]] is the branch of psychiatry that specializes in the interface between other medical specialties and psychiatry. [[Military psychiatry]] covers special aspects of psychiatry and mental disorders within the military context. [[Neuropsychiatry]] is a branch of medicine dealing with mental disorders attributable to diseases of the nervous system. [[Social psychiatry]] is a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental well-being.

In larger healthcare organizations, psychiatrists often serve in senior management roles, where they are responsible for the efficient and effective delivery of mental health services for the organization's constituents. For example, the Chief of Mental Health Services at most VA medical centers is usually a psychiatrist, although psychologists occasionally are selected for the position as well.{{citation needed|date=May 2013}}

In the United States, psychiatry is one of the few specialties which qualify for further education and board-certification in [[pain management|pain medicine]], [[palliative care|palliative medicine]], and [[sleep medicine]].

===Research===
Psychiatric research is, by its very nature, interdisciplinary; combining social, biological and psychological perspectives in attempt to understand the nature and treatment of mental disorders.<ref name=UManchester>{{cite web|website=University of Manchester|title=Research in Psychiatry|access-date=13 October 2007|url=http://www.manchester.ac.uk/research/areas/subareas/?a=s&id=44694|archive-date=23 December 2007|archive-url=https://web.archive.org/web/20071223064538/http://www.manchester.ac.uk/research/areas/subareas/?a=s&id=44694}}</ref> Clinical and research psychiatrists study basic and clinical psychiatric topics at research institutions and publish articles in journals.<ref name=Pietrini/><ref name=NYSPI>{{cite web|title=New York State Psychiatric Institute|date=15 March 2007|access-date=13 October 2007|url=http://nyspi.org/|archive-date=5 November 2020|archive-url=https://web.archive.org/web/20201105232057/https://nyspi.org/|url-status=live}}</ref><ref name=CPRF>{{cite web|title=Canadian Psychiatric Research Foundation|date=27 July 2007|access-date=13 October 2007|url=http://www.cprf.ca/|archive-date=10 October 2007|archive-url=https://web.archive.org/web/20071010110827/http://www.cprf.ca/}}</ref><ref name=Elsevier>{{cite web|website=Elsevier|date=8 October 2007|title=Journal of Psychiatric Research|access-date=13 October 2007|url=http://www.elsevier.com/wps/find/journaldescription.cws_home/241/description|archive-date=30 September 2020|archive-url=https://web.archive.org/web/20200930221852/https://www.elsevier.com/journals/journal-of-psychiatric-research/0022-3956|url-status=live}}</ref> Under the supervision of [[institutional review board]]s, psychiatric clinical researchers look at topics such as neuroimaging, genetics, and psychopharmacology in order to enhance diagnostic validity and reliability, to discover new treatment methods, and to classify new mental disorders.<ref name=Mitchell>{{cite book|vauthors=Mitchell JE, Crosby RD, Wonderlich SA, Adson DE|date=2000|title=Elements of Clinical Research in Psychiatry|url=https://archive.org/details/elementsofclinic0000unse|url-access=registration|location=Washington, DC|publisher=American Psychiatric Press|isbn=978-0-88048-802-0|oclc=632834662}}</ref>{{Page needed|date=August 2017}}

==Clinical application==

===Diagnostic systems===
{{see also|Diagnostic classification and rating scales used in psychiatry}}
[[Psychiatric assessment|Psychiatric diagnoses]] take place in a wide variety of settings and are performed by many different [[health care provider|health professionals]]. Therefore, the diagnostic procedure may vary greatly based upon these factors. Typically, though, a psychiatric diagnosis utilizes a [[differential diagnosis]] procedure where a [[mental status examination]] and physical examination is conducted, with [[pathological]], [[psychopathological]] or [[psychosocial]] histories obtained, and sometimes [[neuroimaging|neuroimages]] or other [[neurophysiological]] measurements are taken, or [[personality test]]s or [[cognitive test]]s administered.<ref name=Meyendorf>{{cite journal|vauthors=Meyendorf R|title=[Diagnosis and differential diagnosis in psychiatry and the question of situation referred prognostic diagnosis]|language=de|journal=Schweizer Archiv für Neurologie, Neurochirurgie und Psychiatrie = Archives Suisses de Neurologie, Neurochirurgie et de Psychiatrie|volume=126|issue=1|pages=121–34|year=1980|pmid=7414302|trans-title=Diagnosis and differential diagnosis in psychiatry and the question of situation referred prognostic diagnosis}}</ref><ref>{{cite book| vauthors = Leigh H |date=1983|title=Psychiatry in the practice of medicine|location=Menlo Park, CA|publisher=Addison-Wesley|isbn=978-0-201-05456-9|pages=[https://archive.org/details/psychiatryinprac0000unse/page/15 15, 17, 67]|oclc=869194520|url=https://archive.org/details/psychiatryinprac0000unse/page/15}}</ref>{{sfn|Lyness|1997|p=10}}<ref name=Hampel>{{cite journal|vauthors=Hampel H, Teipel SJ, Kötter HU, Horwitz B, Pfluger T, Mager T, Möller HJ, Müller-Spahn F|title=[Structural magnetic resonance tomography in diagnosis and research of Alzheimer type dementia]|language=de|journal=Der Nervenarzt|volume=68|issue=5|pages=365–78|date=May 1997|pmid=9280846|doi=10.1007/s001150050138|s2cid=35203096|trans-title=Structural magnetic resonance imaging in diagnosis and research of Alzheimer's disease}}</ref><ref name=Townsend>{{cite journal| vauthors = Townsend BA, Petrella JR, Doraiswamy PM |date=July 2002|title=The role of neuroimaging in geriatric psychiatry|journal=Current Opinion in Psychiatry|volume=15|issue=4|pages=427–32|doi=10.1097/00001504-200207000-00014|s2cid=147489857}}</ref> In some cases, a brain scan might be used to rule out other medical illnesses, but at this time relying on brain scans alone cannot accurately diagnose a mental illness or tell the risk of getting a mental illness in the future.<ref>{{cite web|url=http://www.nimh.nih.gov/health/publications/neuroimaging-and-mental-illness-a-window-into-the-brain/neuroimaging-and-mental-illness-a-window-into-the-brain.shtml|website=National Institute of Mental Health|date=2009|title=Neuroimaging and Mental Illness: A Window Into the Brain|publisher=U.S. Department of Health and Human Services|archive-date=1 June 2013|archive-url=https://web.archive.org/web/20130601212528/http://www.nimh.nih.gov/health/publications/neuroimaging-and-mental-illness-a-window-into-the-brain/neuroimaging-and-mental-illness-a-window-into-the-brain.shtml}}</ref> Some clinicians are beginning to utilize [[genetics]]<ref name=Krebs>{{cite journal|vauthors=Krebs MO|title=Future contributions on genetics|journal=The World Journal of Biological Psychiatry|volume=6 |issue=Sup 2|pages=49–55|year=2005|pmid=16166024|doi=10.1080/15622970510030072|s2cid=44658585}}</ref><ref name=Benes>{{cite journal|vauthors=Hensch T, Herold U, Brocke B|title=An electrophysiological endophenotype of hypomanic and hyperthymic personality|journal=Journal of Affective Disorders|volume=101|issue=1–3|pages=13–26|date=August 2007|pmid=17207536|doi=10.1016/j.jad.2006.11.018}}</ref><ref name=Vonk>{{cite journal|vauthors=Vonk R, van der Schot AC, Kahn RS, Nolen WA, Drexhage HA|title=Is autoimmune thyroiditis part of the genetic vulnerability (or an endophenotype) for bipolar disorder?|journal=Biological Psychiatry|volume=62|issue=2|pages=135–40|date=July 2007|pmid=17141745|doi=10.1016/j.biopsych.2006.08.041|s2cid=23676927}}</ref> and automated [[speech]] assessment<ref name=Low>{{cite journal|vauthors=Low DM, Bentley KH, Ghosh, SS|title=Automated assessment of psychiatric disorders using speech: A systematic review|journal=Laryngoscope Investigative Otolaryngology|volume=5|issue=1|pages=96–116|date=2020|doi=10.1002/lio2.354|pmid=32128436|pmc=7042657|doi-access=free}}</ref> during the diagnostic process but on the whole these remain research topics.

===Potential use of MRI/fMRI in diagnosis===
In 2018, the [[American Psychological Association]] commissioned a review to reach a consensus on whether modern clinical [[MRI]]/[[fMRI]] will be able to be used in the diagnosis of mental health disorders. The criteria presented by the APA stated that the biomarkers used in diagnosis should: 
#"have a sensitivity of at least 80% for detecting a particular psychiatric disorder"
#"should have a specificity of at least 80% for distinguishing this disorder from other psychiatric or medical disorders"
#"should be reliable, reproducible, and ideally be noninvasive, simple to perform, and inexpensive"
#"proposed biomarkers should be verified by 2 independent studies each by a different investigator and different population samples and published in a peer-reviewed journal"

The review concluded that although [[neuroimaging]] diagnosis may technically be feasible, very large studies are needed to evaluate specific biomarkers which were not available.<ref>{{cite journal | vauthors = First MB, Drevets WC, Carter C, Dickstein DP, Kasoff L, Kim KL, McConathy J, Rauch S, Saad ZS, Savitz J, Seymour KE, Sheline YI, Zubieta JK | display-authors = 6 | title = Clinical Applications of Neuroimaging in Psychiatric Disorders | journal = The American Journal of Psychiatry | volume = 175 | issue = 9 | pages = 915–916 | date = September 2018 | pmid = 30173550 | pmc = 6583905 | doi = 10.1176/appi.ajp.2018.1750701 }}</ref>

===Diagnostic manuals===
{{See also|Diagnostic and Statistical Manual of Mental Disorders}}
Three main diagnostic manuals used to classify mental health conditions are in use today. The [[ICD-11]] is produced and published by the [[World Health Organization]], includes a section on psychiatric conditions, and is used worldwide.<ref name="ICD10">{{Cite web |title=ICD-11 |url=https://icd.who.int/en |access-date=2024-01-24 |website=icd.who.int}}</ref> The [[Diagnostic and Statistical Manual of Mental Disorders]], produced and published by the [[American Psychiatric Association]] (APA), is primarily focused on mental health conditions and is the main classification tool in the [[United States]].<ref name=DSM >{{cite book|author=American Psychiatric Association|date=2000|title=Diagnostic and Statistical Manual of Mental Disorders|edition=4th, text revision|location=Washington, DC|publisher=American Psychiatric Publishing, Inc.|isbn=978-0-89042-025-6}}</ref> It is currently in its fifth revised edition and is also used worldwide.<ref name=DSM/> The [[Chinese Society of Psychiatry]] has also produced a diagnostic manual, the [[Chinese Classification of Mental Disorders]].<ref name=Chen>{{cite journal|vauthors=Chen YF|title=Chinese classification of mental disorders (CCMD-3): towards integration in international classification|journal=Psychopathology|volume=35|issue=2–3|pages=171–5|date=March–June 2002|pmid=12145505|doi=10.1159/000065140|s2cid=24080102}}</ref>

The stated intention of diagnostic manuals is typically to develop replicable and clinically useful categories and criteria, to facilitate consensus and agreed upon standards, whilst being atheoretical as regards etiology.<ref name=DSM/><ref name=Essen>{{cite journal| vauthors = Essen-Möller E |date=September 1961|title=On classification of mental disorders|journal=[[Acta Psychiatrica Scandinavica]]|volume=37|issue=2|pages=119–26|doi=10.1111/j.1600-0447.1961.tb06163.x|s2cid=145140298}}</ref> However, the categories are nevertheless based on particular psychiatric theories and data; they are broad and often specified by numerous possible combinations of symptoms, and many of the categories overlap in symptomology or typically occur together.<ref name=Mezzich>{{cite journal | vauthors = Mezzich JE | title = Patterns and issues in multiaxial psychiatric diagnosis | journal = Psychological Medicine | volume = 9 | issue = 1 | pages = 125–137 | date = February 1979 | pmid = 370861 | doi = 10.1017/S0033291700021632 | s2cid = 44798734 }}</ref> While originally intended only as a guide for experienced clinicians trained in its use, the nomenclature is now widely used by clinicians, administrators and insurance companies in many countries.<ref name=Guze2>{{cite journal | vauthors = Guze SB | title = The need for toughmindedness in psychiatric thinking | journal = Southern Medical Journal | volume = 63 | issue = 6 | pages = 662–671 | date = June 1970 | pmid = 5446229 | doi = 10.1097/00007611-197006000-00012 | s2cid = 26516651 }}</ref>

The DSM has attracted praise for standardizing psychiatric diagnostic categories and criteria. It has also attracted controversy and criticism. Some critics argue that the DSM represents an [[unscientific]] system that enshrines the opinions of a few powerful psychiatrists. There are ongoing issues concerning the [[Validity (statistics)|validity]] and [[Reliability (statistics)|reliability]] of the diagnostic categories; the reliance on superficial [[symptoms]]; the use of artificial dividing lines between categories and from '[[Normality (behavior)|normality]]'; possible [[cultural]] bias; [[medicalization]] of human distress and financial [[conflicts of interest]], including with the practice of psychiatrists and with the [[pharmaceutical industry]]; political controversies about the inclusion or exclusion of diagnoses from the manual, in general or in regard to specific issues; and the experience of those who are most directly affected by the manual by being diagnosed, including the [[consumer/survivor movement]].<ref name="concept&evolution">{{cite journal|vauthors=Dalal PK, Sivakumar T|title=Moving towards ICD-11 and DSM-V: Concept and evolution of psychiatric classification|journal=Indian Journal of Psychiatry|volume=51|issue=4|pages=310–9|date=October–December 2009|pmid=20048461|pmc=2802383|doi=10.4103/0019-5545.58302|doi-access=free}} {{Open access}}</ref><ref>{{cite journal|vauthors=Kendell R, Jablensky A|title=Distinguishing between the validity and utility of psychiatric diagnoses|journal=The American Journal of Psychiatry|volume=160|issue=1|pages=4–12|date=January 2003|pmid=12505793|doi=10.1176/appi.ajp.160.1.4|doi-access=free}}</ref><ref>{{cite journal|vauthors=Baca-Garcia E, Perez-Rodriguez MM, Basurte-Villamor I, Fernandez del Moral AL, Jimenez-Arriero MA, Gonzalez de Rivera JL, Saiz-Ruiz J, Oquendo MA|title=Diagnostic stability of psychiatric disorders in clinical practice|journal=The British Journal of Psychiatry|volume=190|issue=3|pages=210–6|date=March 2007|pmid=17329740|doi=10.1192/bjp.bp.106.024026|doi-access=free}}</ref><ref>{{cite journal|vauthors=Pincus HA, Zarin DA, First M|title="Clinical significance" and DSM-IV|journal=Archives of General Psychiatry|volume=55|issue=12|pages=1145; author reply 1147–8|date=December 1998|pmid=9862559|doi=10.1001/archpsyc.55.12.1145|department=Letters to the Editor}}</ref>

==Treatment==

===General considerations===
[[File:NIMH Clinical Center.JPG|right|thumb|NIMH federal agency patient room for Psychiatric research, Maryland, US]]
Individuals receiving psychiatric treatment are commonly referred to as ''[[patient]]s'' but may also be called ''[[customer|client]]s'', ''[[consumer]]s'', or ''service recipients''. They may come under the care of a psychiatric physician or other psychiatric practitioners by various paths, the two most common being self-[[Wikt:referral|referral]] or referral by a [[primary care physician]]. Alternatively, a person may be referred by hospital medical staff, by [[court order]], [[involuntary commitment]], or, in countries such as the UK and Australia, by [[sectioning]] under a [[mental health law]].

A psychiatrist or medical provider evaluates people through a [[psychiatric assessment]] for their mental and physical condition. This usually involves interviewing the person and often obtaining information from other sources such as other health and social care professionals, relatives, associates, law enforcement personnel, emergency medical personnel, and [[List of diagnostic classification and rating scales used in psychiatry|psychiatric rating scales]]. A [[mental status examination]] is carried out, and a [[physical examination]] is usually performed to establish or exclude other illnesses that may be contributing to the alleged psychiatric problems. A physical examination may also serve to identify any signs of [[self-harm]]; this examination is often performed by someone other than the psychiatrist, especially if [[blood test]]s and [[medical imaging]] are performed.

Like most medications, psychiatric medications can cause [[adverse effect (medicine)|adverse effects]] in patients, and some require ongoing [[therapeutic drug monitoring]], for instance [[full blood count]]s, [[blood plasma|serum]] drug levels, renal function, liver function or thyroid function. [[Electroconvulsive therapy]] (ECT) is sometimes administered for serious conditions, such as those unresponsive to medication. The efficacy<ref>{{cite journal|vauthors=Moncrieff J, Wessely S, Hardy R|title=Active placebos versus antidepressants for depression|journal=The Cochrane Database of Systematic Reviews|issue=1|pages=CD003012|date=26 January 2004|volume=2012|pmid=14974002|doi=10.1002/14651858.CD003012.pub2|pmc=8407353}}</ref><ref>{{cite journal|vauthors=Hopper K, Wanderling J|title=Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative followup project. International Study of Schizophrenia|journal=Schizophrenia Bulletin|volume=26|issue=4|pages=835–46|date=January 2000|pmid=11087016|doi=10.1093/oxfordjournals.schbul.a033498|url=https://academic.oup.com/schizophreniabulletin/article-pdf/26/4/835/5423995/26-4-835.pdf|doi-access=free}}</ref> and adverse effects of psychiatric drugs may vary from patient to patient.

===Inpatient treatment===
{{More citations needed section|date=August 2017}}
[[Treatment of mental illness|Psychiatric treatments]] have changed over the past several decades. In the past, psychiatric patients were often [[psychiatric hospital|hospitalized]] for six months or more, with some cases involving hospitalization for many years.

Average inpatient psychiatric treatment stay has decreased significantly since the 1960s, a trend known as [[deinstitutionalization]].<ref>{{cite book | doi=10.1108/s1057-629020160000017001 | chapter=Same Problem, Different Century: Issues in Recreating the Functions of Public Psychiatric Hospitals in Community-Based Settings | title=50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities | series=Advances in Medical Sociology | date=2016 | last1=Fisher | first1=William H. | last2=Geller | first2=Jeffrey L. | last3=McMannus | first3=Dana L. | volume=17 | pages=3–25 | isbn=978-1-78560-403-4 }}</ref><ref>{{cite report|last1=Lutterman|first1= Ted|first2= Robert|last2= Shaw|first3= William|last3= Fisher|first4= Ronald|last4= Manderscheid|title =Trend in Psychiatric Inpatient Capacity, United States and Each State, 1970 to 2014|location= Alexandria, VA|publisher = National Association of State Mental Health Program Directors|date = 2017|url =  https://www.nasmhpd.org/sites/default/files/TACPaper.2.Psychiatric-Inpatient-Capacity_508C.pdf |archive-url=https://web.archive.org/web/20220901040231/https://www.nasmhpd.org/sites/default/files/TACPaper.2.Psychiatric-Inpatient-Capacity_508C.pdf |archive-date=2022-09-01 |url-status = live}}</ref><ref>{{cite journal | vauthors = Bao Y, Sturm R | title = How do Trends for Behavioral Health Inpatient Care Differ from Medical Inpatient Care in U.S. Community Hospitals? | journal = The Journal of Mental Health Policy and Economics | volume = 4 | issue = 2 | pages = 55–63 | date = June 2001 | pmid = 11967466 | url = http://icmpe.org/test1/journal/issues/v4pdf/4-055_text.pdf | access-date = 2019-09-05 | archive-date = 2022-09-04 | archive-url = https://web.archive.org/web/20220904184944/http://icmpe.org/test1/journal/issues/v4pdf/4-055_text.pdf | url-status = live }}</ref><ref>{{cite journal | vauthors = Mechanic D, McAlpine DD, Olfson M | title = Changing patterns of psychiatric inpatient care in the United States, 1988–1994 | journal = Archives of General Psychiatry | volume = 55 | issue = 9 | pages = 785–791 | date = September 1998 | pmid = 9736004 | doi = 10.1001/archpsyc.55.9.785 }}</ref> Today in most countries, people receiving psychiatric treatment are more likely to be seen as [[general out-patient clinic|outpatients]]. If hospitalization is required, the average hospital stay is around one to two weeks, with only a small number receiving long-term hospitalization.<ref>{{cite journal | vauthors = Lee S, Rothbard AB, Noll EL | title = Length of inpatient stay of persons with serious mental illness: effects of hospital and regional characteristics | journal = Psychiatric Services | volume = 63 | issue = 9 | pages = 889–895 | date = September 2012 | pmid = 22751995 | doi = 10.1176/appi.ps.201100412 }}</ref> However, in Japan psychiatric hospitals continue to keep patients for long periods, sometimes even keeping them in [[physical restraints]], strapped to their beds for periods of weeks or months.<ref>{{Cite news|url = https://www.washingtonpost.com/world/asia_pacific/japan-mental-health-patients/2021/06/18/e07334f2-c2a7-11eb-89a4-b7ae22aa193e_story.html |title = Japan's Mental Health Crisis: Patients in Restraints and Overcrowded Facilities |newspaper = The Washington Post|date = 2021-06-18|access-date = 2023-11-14}}</ref><ref>長谷川利夫. (2016). 精神科医療における隔離・ 身体拘束実態調査 ～その急増の背景要因を探り縮減への道筋を考える～. 病院・地域精神医学, 59(1), 18–21.</ref>

Psychiatric inpatients are people admitted to a hospital or clinic to receive psychiatric care. Some are admitted involuntarily, perhaps committed to a secure hospital, or in some jurisdictions to a facility within the prison system. In many countries including the United States and Canada, the criteria for involuntary admission vary with local jurisdiction. They may be as broad as having a mental health condition, or as narrow as being an immediate danger to themselves or others. Bed availability is often the real determinant of admission decisions to hard pressed public facilities.

People may be admitted voluntarily if the treating doctor considers that safety is not compromised by this less restrictive option. For many years, controversy has surrounded the use of involuntary treatment and use of the term "lack of insight" in describing patients. Internationally, mental health laws vary significantly but in many cases, involuntary psychiatric treatment is permitted when there is deemed to be a significant risk to the patient or others due to the patient's illness. Involuntary treatment refers to treatment that occurs based on a treating physician's recommendations, without requiring consent from the patient.<ref>{{cite web| vauthors = Unzicker R, Wolters KP, Robinson DE |author-link1=Rae Unzicker |title=From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves|url=http://www.ncd.gov/newsroom/publications/2000/privileges.htm|website=[[National Council on Disability]]|archive-url=https://web.archive.org/web/20101228231912/http://www.ncd.gov/newsroom/publications/2000/privileges.htm|archive-date=28 December 2010|date=20 January 2000}}</ref>

Inpatient psychiatric wards may be secure (for those thought to have a particular risk of violence or self-harm) or unlocked/open. Some wards are mixed-sex whilst same-sex wards are increasingly favored to protect women inpatients. Once in the care of a hospital, people are [[psychiatric assessment|assessed]], monitored, and often given medication and care from a multidisciplinary team, which may include physicians, pharmacists, psychiatric nurse practitioners, [[psychiatric and mental health nursing|psychiatric nurses]], clinical psychologists, psychotherapists, psychiatric social workers, occupational therapists and social workers. If a person receiving treatment in a psychiatric hospital is assessed as at particular risk of harming themselves or others, they may be put on constant or intermittent one-to-one supervision and may be put in physical restraints or medicated. People on inpatient wards may be allowed leave for periods of time, either accompanied or on their own.<ref>{{cite book|title=Acute inpatient psychiatric care: A source book|publisher=World Health Organization|location=Darlinghurst, Australia|year=2003|isbn=978-0-9578073-1-0|oclc=223935527|author=Treatment Protocol Project}}</ref>

In many developed countries there has been a massive reduction in psychiatric beds since the mid 20th century, with the growth of community care. Italy has been a pioneer in psychiatric reform, particularly through the no-restraint initiative that began nearly fifty years ago. The Italian movement, heavily influenced by Franco Basaglia, emphasizes ethical treatment and the elimination of physical restraints in psychiatric care. A study examining the application of these principles in Italy found that 14 general hospital psychiatric units reported zero restraint incidents in 2022.<ref>{{Cite journal |last1=Pocobello |first1=Raffaella |last2=Camilli |first2=Francesca |last3=Rossi |first3=Giovanni |last4=Davì |first4=Maurizio |last5=Corbascio |first5=Caterina |last6=Tancredi |first6=Domenico |last7=Oretti |first7=Alessandra |last8=Bonavigo |first8=Tommaso |last9=Galeazzi |first9=Gian Maria |last10=Wegenberger |first10=Oliver |last11=el Sehity |first11=Tarek |date=January 2024 |title=No-Restraint Committed General Hospital Psychiatric Units (SPDCs) in Italy—A Descriptive Organizational Study |journal=Healthcare |language=en |volume=12 |issue=11 |pages=1104 |doi=10.3390/healthcare12111104 |doi-access=free |pmid=38891179 |issn=2227-9032|pmc=11171828 }}</ref>

Standards of inpatient care remain a challenge in some public and private facilities, due to levels of funding, and facilities in developing countries are typically grossly inadequate for the same reason. Even in developed countries, programs in public hospitals vary widely. Some may offer structured activities and therapies offered from many perspectives while others may only have the funding for medicating and monitoring patients. This may be problematic in that the maximum amount of therapeutic work might not actually take place in the hospital setting. This is why hospitals are increasingly used in limited situations and moments of crisis where patients are a direct threat to themselves or others. Alternatives to psychiatric hospitals that may actively offer more therapeutic approaches include rehabilitation centers or "rehab" as popularly termed.{{citation needed|date=August 2008}}

===Outpatient treatment===
Outpatient treatment involves periodic visits to a psychiatrist for consultation in his or her office, or at a community-based outpatient clinic. During initial appointments, a psychiatrist generally conducts a psychiatric assessment or evaluation of the patient. Follow-up appointments then focus on making medication adjustments, reviewing potential medication interactions, considering the impact of other medical disorders on the patient's mental and emotional functioning, and counseling patients regarding changes they might make to facilitate healing and remission of symptoms. The frequency with which a psychiatrist sees people in treatment varies widely, from once a week to twice a year, depending on the type, severity and stability of each person's condition, and depending on what the clinician and patient decide would be best.

Increasingly, psychiatrists are limiting their practices to psychopharmacology (prescribing medications), as opposed to previous practice in which a psychiatrist would provide traditional 50-minute psychotherapy sessions, of which psychopharmacology would be a part, but most of the consultation sessions consisted of "talk therapy". This shift began in the early 1980s and accelerated in the 1990s and 2000s.<ref>{{cite journal|vauthors=Mojtabai R, Olfson M|title=National trends in psychotherapy by office-based psychiatrists|journal=Archives of General Psychiatry|volume=65|issue=8|pages=962–70|date=August 2008|pmid=18678801|doi=10.1001/archpsyc.65.8.962|doi-access=free}}</ref> A major reason for this change was the advent of managed care insurance plans,{{Clarify|reason=Is this true globally?|date=January 2022}} which began to limit reimbursement for psychotherapy sessions provided by psychiatrists. The underlying assumption was that psychopharmacology was at least as effective as psychotherapy, and it could be delivered more efficiently because less time is required for the appointment.<ref>{{cite journal|vauthors=Clemens NA|title=New parity, same old attitude towards psychotherapy?|journal=Journal of Psychiatric Practice|volume=16|issue=2|pages=115–9|date=March 2010|pmid=20511735|doi=10.1097/01.pra.0000369972.10650.5a}}</ref><ref>{{cite journal|vauthors=Mellman LA|title=How endangered is dynamic psychiatry in residency training?|journal=The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry|volume=34|issue=1|pages=127–33|date=March 2006|pmid=16548751|doi=10.1521/jaap.2006.34.1.127}}</ref><ref name="pmid20048220">{{cite journal|vauthors=Mojtabai R, Olfson M|title=National trends in psychotropic medication polypharmacy in office-based psychiatry|journal=Archives of General Psychiatry|volume=67|issue=1|pages=26–36|date=January 2010|pmid=20048220|doi=10.1001/archgenpsychiatry.2009.175|doi-access=free}}</ref><ref name="pmid11779262">{{cite journal|vauthors=Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA|title=National trends in the outpatient treatment of depression|journal=JAMA|volume=287|issue=2|pages=203–9|date=January 2002|pmid=11779262|doi=10.1001/jama.287.2.203|doi-access=free}}</ref>{{efn|name="Comparative efficacy debate"|This article does not enter into that debate or seek to summarize the comparative efficacy literature. It simply explains why managed care insurance companies stopped routinely reimbursing psychiatrists for traditional psychotherapy, without commenting on the validity of that rationale.}}{{Excessive citations inline|date=January 2022}} Because of this shift in practice patterns, psychiatrists often refer patients whom they think would benefit from psychotherapy to other mental health professionals, e.g., clinical social workers and psychologists.<ref>{{cite news|title=Talk Doesn't Pay, So Psychiatry Turns to Drug Therapy|vauthors=Harris G|url=https://www.nytimes.com/2011/03/06/health/policy/06doctors.html|newspaper=The New York Times|date=March 5, 2011|access-date=March 6, 2011|archive-date=September 4, 2011|archive-url=https://web.archive.org/web/20110904155713/http://www.nytimes.com/2011/03/06/health/policy/06doctors.html|url-status=live}}</ref>

=== Telepsychiatry ===
{{Excerpt|Telepsychiatry}}

==History==
{{main|History of psychiatry}}

===Earliest knowledge===
The earliest known texts on mental disorders are from ancient India and include the Ayurvedic text, [[Charaka Samhita]].<ref>{{cite book|title=Cultural Sociology of Mental Illness: An A-to-Z Guide|volume=1|page=386|publisher=[[SAGE Publications]]| veditors = Scull A |date=2014|oclc=955106253|isbn=978-1-4833-4634-2}}</ref><ref>{{cite book|title=Health and Illness: A Cross-cultural Encyclopedia|page=[https://archive.org/details/healthillnesscro0000levi/page/42 42]|publisher=ABC-CLIO|location=Santa Barbara, CA| vauthors = Levinson D, Gaccione L |year=1997|oclc=916942828|isbn=978-0-87436-876-5|url=https://archive.org/details/healthillnesscro0000levi/page/42}}</ref> The first hospitals for curing mental illness were established in India during the 3rd century BCE.<ref>{{cite book|title=Faith and Mental Health: Religious Resources for Healing|chapter=History of Mental Health Care|page=[https://books.google.com/books?id=jt5RmK_h2jgC&pg=PA36 36]| vauthors = Koenig HG |publisher=Templeton Foundation Press|location=West Conshohocken|date=2005|oclc=476009436|isbn=978-1-59947-078-8}}</ref>

Greek philosophers, including [[Thales]], [[Plato]], and [[Aristotle]] (especially in his {{lang|la|[[On the Soul|De Anima]]}} treatise), also addressed the workings of the mind. As early as the 4th century BC, the Greek physician [[Hippocrates]] theorized that [[mental disorder]]s had physical rather than supernatural causes. In 387 BCE, Plato suggested that the brain is where mental processes take place. In 4th to 5th century B.C. Greece, Hippocrates wrote that he visited [[Democritus]] and found him in his garden cutting open animals. Democritus explained that he was attempting to discover the cause of madness and melancholy. Hippocrates praised his work. Democritus had with him a book on madness and melancholy.<ref>{{cite book| vauthors = Burton R |title=The Anatomy of Melancholy: What it is with All the Kinds, Causes, Symptoms, Prognostics, and Several Cures of it: in Three Partitions, with Their Several Sections, Members and Subsections Philosophically, Medicinally, Historically Opened and Cut Up|date=1881|publisher=Chatto & Windus|location=London|ol=3149647W|pages=[https://books.google.com/books?id=DAIGAAAAQAAJ&pg=PA22 22], [https://books.google.com/books?id=DAIGAAAAQAAJ&pg=PA24 24]}}</ref> During the 5th century BCE, mental disorders, especially those with [[psychosis|psychotic]] traits, were considered [[supernatural]] in origin,<ref name=Elkes13>{{cite book| vauthors = Elkes A, Thorpe JG |date=1967|title=A Summary of Psychiatry|location=London|publisher=Faber & Faber|page=13|oclc=4687317}}</ref> a view which existed throughout [[ancient Greece]] and [[ancient Rome|Rome]],<ref name=Elkes13/> as well as Egyptian regions.<ref>{{cite book| vauthors = Dumont F |date=2010|title=A history of personality psychology: Theory, science and research from Hellenism to the twenty-first century|location=New York|publisher=Cambridge University Press|oclc=761231096|isbn=978-0-521-11632-9}}</ref>{{Page needed|date=August 2017}} [[Alcmaeon of Croton|Alcmaeon]], believed the [[brain]], not the [[heart]], was the "organ of thought". He tracked the ascending sensory nerves from the body to the brain, theorizing that mental activity originated in the [[Central nervous system|CNS]] and that the cause of [[mental illness]] resided within the brain. He applied this understanding to classify mental diseases and treatments.<ref name="Pietrini" /><ref>{{Cite journal |last1=Janssen |first1=Diederik F. |last2=Hubbard |first2=Thomas K. |date=May 2021 |title=Psychology: Early print uses of the term by Pier Nicola Castellani (1525) and Gerhard Synellius (1525). |journal=History of Psychology |volume=24 |issue=2 |pages=182–187 |doi=10.1037/hop0000187 |pmid=34081519 |s2cid=235334263 |issn=1939-0610}}</ref>  Religious leaders often turned to versions of [[exorcism]] to treat mental disorders often utilizing methods that many consider to be cruel or barbaric methods. Trepanning was one of these methods used throughout history.<ref name=Elkes13/>

In the 6th century AD, [[Lin Xie]] carried out an early [[Experimental psychology|psychological experiment]], in which he asked people to draw a square with one hand and at the same time draw a circle with the other (ostensibly to test people's vulnerability to distraction). It has been cited that this was an early psychiatric experiment.<ref name=":1">{{Cite journal |last1=Janssen |first1=Diederik F. |last2=Hubbard |first2=Thomas K. |date=May 2021 |title=Psychology: Early print uses of the term by Pier Nicola Castellani (1525) and Gerhard Synellius (1525). |journal=History of Psychology |volume=24 |issue=2 |pages=182–187 |doi=10.1037/hop0000187 |pmid=34081519 |s2cid=235334263 |issn=1939-0610}}</ref>

The [[Islamic Golden Age]] fostered early studies in [[Islamic psychology]] and psychiatry, with many scholars writing about mental disorders. The Persian physician [[Muhammad ibn Zakariya al-Razi]], also known as "Rhazes", wrote texts about psychiatric conditions in the 9th century.<ref name="WaelMohamed">{{cite web| vauthors = Mohamed WM |date=August 2008|title=History of Neuroscience: Arab and Muslim Contributions to Modern Neuroscience|website=International Brain Research Organization|url=http://ibro.info/wp-content/uploads/2012/12/Arab-and-Muslim-Contributions-to-Modern-Neuroscience.pdf|archive-date=10 June 2014|archive-url=https://web.archive.org/web/20140610082740/http://ibro.info/wp-content/uploads/2012/12/Arab-and-Muslim-Contributions-to-Modern-Neuroscience.pdf}}</ref> As chief physician of a hospital in Baghdad, he was also the director of one of the first [[bimaristan]]s in the world.<ref name="WaelMohamed" />

The first [[bimaristan]] was founded in [[Baghdad]] in the 9th century, and several others of increasing complexity were created throughout the [[Arab world]] in the following centuries. Some of the bimaristans contained wards dedicated to the care of mentally ill patients.<ref>{{cite journal | vauthors = Miller AC | title = Jundi-Shapur, bimaristans, and the rise of academic medical centres | journal = Journal of the Royal Society of Medicine | volume = 99 | issue = 12 | pages = 615–617 | date = December 2006 | pmid = 17139063 | pmc = 1676324 | doi = 10.1177/014107680609901208 }}</ref> During the [[Middle Ages]], [[Psychiatric hospital]]s and lunatic asylums were built and expanded throughout  [[Europe]]. Specialist hospitals such as [[Bethlem Royal Hospital]] in [[London]] were built in [[Middle Ages|medieval Europe]] from the 13th century to treat mental disorders, but were used only as custodial institutions and did not provide any type of treatment. It is the oldest extant psychiatric hospital in the world.<ref name=Shorter4>{{harvnb|Shorter|1997|p=4}}.</ref>

An ancient text known as ''[[Huangdi Neijing|The Yellow Emperor's Classic of Internal Medicine]]'' identifies the brain as the nexus of wisdom and sensation, includes theories of personality based on [[Yin and yang|yin–yang]] balance, and analyzes mental disorder in terms of physiological and social disequilibria. Chinese scholarship that focused on the brain advanced during the [[Qing Dynasty]] with the work of Western-educated Fang Yizhi (1611–1671), [[Liu Zhi (scholar)|Liu Zhi]] (1660–1730), and Wang Qingren (1768–1831). Wang Qingren emphasized the importance of the brain as the center of the nervous system, linked mental disorder with brain diseases, investigated the causes of dreams, [[insomnia]], [[psychosis]], [[Depression (mood)|depression]] and [[epilepsy]].<ref name=":1" />

===Medical specialty===
The beginning of psychiatry as a medical specialty is dated to the middle of the nineteenth century,{{sfn|Shorter|1997|p=1}} although its germination can be traced to the late eighteenth century. In the late 17th century, privately run asylums for the insane began to proliferate and expand in size. In 1713, the Bethel Hospital Norwich was opened, the first purpose-built asylum in England.<ref>{{cite web|url=http://www.heritagecity.org/research-centre/social-innovation/the-bethel-hospital.htm/|title=The Bethel Hospital|publisher=Norwich HEART: Heritage Economic & Regeneration Trust|archive-date=13 November 2011|url-status=usurped|archive-url=https://web.archive.org/web/20111113072643/http://www.heritagecity.org/research-centre/social-innovation/the-bethel-hospital.htm/}}</ref> In 1656, [[Louis XIV of France]] created a public system of hospitals for those with mental disorders, but as in England, no real treatment was applied.{{sfn|Shorter|1997|p=5}}

During the [[Age of Enlightenment|Enlightenment]], attitudes towards the mentally ill began to change. It came to be viewed as a disorder that required compassionate treatment. In 1758, English physician [[William Battie]] wrote his ''Treatise on Madness'' on the management of [[mental disorder]]. It was a critique aimed particularly at the Bethlem Royal Hospital, where a conservative regime continued to use barbaric custodial treatment. Battie argued for a tailored management of patients entailing cleanliness, good food, fresh air, and distraction from friends and family. He argued that mental disorder originated from dysfunction of the material brain and body rather than the internal workings of the mind.<ref>{{cite journal|vauthors=Laffey P|title=Psychiatric therapy in Georgian Britain|journal=Psychological Medicine|volume=33|issue=7|pages=1285–97|date=October 2003|pmid=14580082|doi=10.1017/S0033291703008109|s2cid=13162025}}</ref>{{sfn|Shorter|1997|p=9}}

[[File:Philippe Pinel à la Salpêtrière.jpg|thumb|Dr. Philippe Pinel at the Salpêtrière, 1795 by [[Tony Robert-Fleury]]. Pinel ordering the removal of chains from patients at the Paris Asylum for insane women.]]
The introduction of moral treatment was initiated independently by the French doctor [[Philippe Pinel]] and the English [[Quaker]] [[William Tuke]].<ref name=Elkes13/> In 1792, Pinel became the chief physician at the [[Bicêtre Hospital]]. Patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms. Pinel's student and successor, [[Jean Esquirol]] (1772–1840), went on to help establish 10 new mental hospitals that operated on the same principles.<ref>{{cite journal| vauthors = Gerard DL |title=Chiarugi and Pinel considered: Soul's brain/person's mind|journal=Journal of the History of the Behavioral Sciences|volume=33|issue=4|pages=381–403|date=September 1997|url=http://www3.interscience.wiley.com/journal/45798/abstract|url-access=subscription|doi=10.1002/(SICI)1520-6696(199723)33:4<381::AID-JHBS3>3.0.CO;2-S}}{{dead link|date=February 2019|bot=medic}}{{cbignore|bot=medic}}</ref>

Although Tuke, Pinel and others had tried to do away with physical restraint, it remained widespread into the 19th century. At the [[The Lawn, Lincoln|Lincoln Asylum]] in England, [[Robert Gardiner Hill]], with the support of [[Edward Parker Charlesworth]], pioneered a mode of treatment that suited "all types" of patients, so that mechanical restraints and coercion could be dispensed with—a situation he finally achieved in 1838. In 1839, Sergeant John Adams and Dr. [[John Conolly]] were impressed by the work of Hill, and introduced the method into their [[St Bernard's Hospital, Hanwell|Hanwell Asylum]], by then the largest in the country.<ref name="Suzuki">{{cite journal|vauthors=Suzuki A|title=The politics and ideology of non-restraint: the case of the Hanwell Asylum|journal=Medical History|volume=39|issue=1|pages=1–17|date=January 1995|pmid=7877402|pmc=1036935|doi=10.1017/s0025727300059457|doi-access=free}}</ref><ref name="taom">{{cite book| veditors = Bynum WF, Porter R, Shepherd M |date=1988|series=The Anatomy of Madness: Essays in the history of psychiatry|volume=3|title=The Asylum and its psychiatry |publisher=Routledge |location=London |oclc=538062123|isbn=978-0-415-00859-4}}</ref>{{Page needed|date=August 2017}}

The modern era of institutionalized provision for the care of the mentally ill, began in the early 19th century with a large state-led effort. In England, the [[Lunacy Act 1845]] was an important landmark in the treatment of the mentally ill, as it explicitly changed the status of [[mental illness|mentally ill]] people to [[patients]] who required treatment. All asylums were required to have written regulations and to have a resident qualified [[physician]].<ref name="Wright, 1999">Wright, David: "Mental Health Timeline", 1999</ref>{{full citation needed|date=November 2014}} In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country.

In the United States, the erection of state asylums began with the first law for the creation of one in New York, passed in 1842. The [[Utica State Hospital]] was opened around 1850. Many state hospitals in the United States were built in the 1850s and 1860s on the [[Kirkbride Plan]], an architectural style meant to have curative effect.<ref>{{cite book| vauthors = Yanni C |title=The Architecture of Madness: Insane Asylums in the United States|publisher=Minnesota University Press |location=Minneapolis |year=2007 |url=https://books.google.com/books?id=fJOC_rSW1kgC |isbn=978-0-8166-4939-6|via=Google Books}}</ref>{{Page needed|date=August 2017}}

At the turn of the century, England and France combined had only a few hundred individuals in asylums.{{sfn|Shorter|1997|p=34}} By the late 1890s and early 1900s, this number had risen to the hundreds of thousands. However, the idea that mental illness could be ameliorated through institutionalization ran into difficulties.<ref name=Shorter46>{{harvnb|Shorter|1997|p=46}}.</ref> Psychiatrists were pressured by an ever-increasing patient population,<ref name=Shorter46/> and asylums again became almost indistinguishable from custodial institutions.<ref name=Rothman>{{cite book|vauthors=Rothman DJ|date=1990|title=The Discovery of the Asylum: Social Order and Disorder in the New Republic|location=Boston|publisher=Little Brown|page=[https://archive.org/details/discoveryofasylu00roth/page/239 239]|isbn=978-0-316-75745-4|url=https://archive.org/details/discoveryofasylu00roth/page/239}}</ref>

In the early 1800s, psychiatry made advances in the diagnosis of mental illness by broadening the category of mental disease to include [[mood disorder]]s, in addition to disease level [[delusion]] or irrationality.<ref name=WCFCD>{{cite journal|vauthors=Borch-Jacobsen M|title=Which came first, the condition or the drug?|journal=London Review of Books|date=7 October 2010|volume=32|issue=19|pages=31–33|url=http://www.lrb.co.uk/v32/n19/mikkel-borch-jacobsen/which-came-first-the-condition-or-the-drug|access-date=30 November 2012|archive-date=13 March 2015|archive-url=https://web.archive.org/web/20150313201452/http://www.lrb.co.uk/v32/n19/mikkel-borch-jacobsen/which-came-first-the-condition-or-the-drug|url-status=live}}</ref> The 20th century introduced a new psychiatry into the world, with different perspectives of looking at mental disorders. For [[Emil Kraepelin]], the initial ideas behind biological psychiatry, stating that the different mental disorders are all biological in nature, evolved into a new concept of "nerves", and psychiatry became a rough approximation of neurology and neuropsychiatry.{{sfn|Shorter|1997|p=114}} Following [[Sigmund Freud]]'s pioneering work, ideas stemming from [[psychoanalytic theory]] also began to take root in psychiatry.<ref name=Shorter145>{{harvnb|Shorter|1997|p=145}}.</ref> The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums.<ref name=Shorter145/>

[[File:Acetylcholine.svg|left|thumb|[[Otto Loewi]]'s work led to the identification of the first neurotransmitter, [[acetylcholine]].]]
By the 1970s, however, the psychoanalytic school of thought became marginalized within the field.<ref name=Shorter145/> Biological psychiatry reemerged during this time. [[Psychopharmacology]] and [[neurochemistry]] became the integral parts of psychiatry starting with [[Otto Loewi]]'s discovery of the neuromodulatory properties of [[acetylcholine]]; thus identifying it as the first-known neurotransmitter. Subsequently, it has been shown that different neurotransmitters have different and multiple functions in regulation of behaviour. In a wide range of studies in neurochemistry using human and animal samples, individual differences in neurotransmitters' production, reuptake, receptors' density and locations were linked to differences in dispositions for specific psychiatric disorders. For example, the discovery of [[chlorpromazine]]'s effectiveness in treating [[schizophrenia]] in 1952 revolutionized treatment of the disorder,<ref name="Turner2007">{{cite journal|vauthors=Turner T|title=Chlorpromazine: unlocking psychosis|journal=BMJ|volume=334 |issue=Suppl 1|pages=s7|date=January 2007|pmid=17204765|doi=10.1136/bmj.39034.609074.94|doi-access=free}}</ref> as did [[lithium carbonate]]'s ability to stabilize mood highs and lows in [[bipolar disorder]] in 1948.<ref>{{cite journal|vauthors=Cade JF|title=Lithium salts in the treatment of psychotic excitement|journal=The Medical Journal of Australia|volume=2|issue=10|pages=349–52|date=September 1949|pmid=18142718|pmc=2560740|doi=10.1080/j.1440-1614.1999.06241.x}}</ref> Psychotherapy was still utilized, but as a treatment for psychosocial issues.{{sfn|Shorter|1997|p=239}} This proved the idea of neurochemical nature of many psychiatric disorders.

Another approach to look for biomarkers of psychiatric disorders is [[neuroimaging]]{{sfn|Shorter|1997|p=246}} that was first utilized as a tool for psychiatry in the 1980s.{{sfn|Shorter|1997|p=270}}

In 1963, [[President of the United States|US president]] [[John F. Kennedy]] introduced legislation delegating the [[National Institute of Mental Health]] to administer Community Mental Health Centers for those being discharged from state psychiatric hospitals.<ref name=Shorter280>{{harvnb|Shorter|1997|p=280}}.</ref> Later, though, the Community Mental Health Centers focus shifted to providing psychotherapy for those with acute but less serious mental disorders.<ref name=Shorter280/> Ultimately there were no arrangements made for actively following and treating severely mentally ill patients who were being discharged from hospitals, resulting in a large population of chronically homeless people with mental illness.<ref name=Shorter280/>

==Controversy and criticism==
{{Main|Controversy surrounding psychiatry}}

The institution of psychiatry has attracted controversy since its inception.<ref name="crit-psych">{{cite journal | vauthors = Middleton H, Moncrieff J |year=2019 |title=Critical psychiatry: a brief overview |journal=BJPsych Advances |volume=25 |pages=47–54 |doi=10.1192/bja.2018.38 |s2cid=149547063|doi-access=free }}</ref>{{Rp|page=47|quote="The institution of psychiatry has attracted controversy since its 19th century origins, initially from public campaigners with experience of asylum life."}} Scholars including those from [[social psychiatry]], [[psychoanalysis]], [[psychotherapy]], and [[Critical Psychiatry Network|critical psychiatry]] have produced critiques.<ref name="crit-psych" />{{Rp|page=47|quote=Other perspectives that challenge the hegemony of
the now dominant biological view of mental disorder
include social psychiatry, psychotherapy and psy-
choanalysis. Critical psychiatry is indebted to this
background.}} It has been argued that psychiatry confuses disorders of the mind with disorders of the brain that can be treated with drugs;<ref name="crit-psych" />{{Rp|page=53}}{{Rp|page=47|quote="The idea that psychiatric conditions are equiva-
lent to medical diseases suggests that psychiatric
practice is straightforward and uncontroversial.
Illnesses should be eradicated wherever possible,
and coercion is sometimes justified because mental
illness can disrupt insight. Disturbances of thought
and behaviour are sufficiently understood as
medical conditions, underpinning much of how
mental health difficulties are viewed and responded
to, and who has authority over them. Unfortunately,
this position glosses over a number of conceptual
difficulties, which critical psychiatry considers
important."}} that its use of drugs is in part due to lobbying by drug companies resulting in distortion of research;<ref name="crit-psych" />{{Rp|page=51|quote=There is considerable criticism of the dominant role
drug treatment plays in contemporary psychiatry.
Critics point to the enormous influence of the
pharmaceutical industry, accusing it of overselling
its products, inflating their benefits and understating
adverse effects}} and that the concept of "mental illness" is often used to label and [[social control|control]] those with beliefs and behaviours that the majority of people disagree with;<ref name="crit-psych" />{{Rp|page=50|quote=The fact that [psychiatric diagnosis] can be presented as an objective, scientific endeavour means it is easily open to abuse, and powerful groups can
define any socially repudiated behaviour as
'mental illness' in order to eradicate or control it.
Generally agreed examples of this include the desig-
nation of male homosexuality as a mental disorder
up until the 1970s, and the application of a 'diagno-
sis' of drapetomania to African American slaves
intent on escaping.}} and that it is too influenced by ideas from medicine causing it to misunderstand the nature of mental distress.<ref name="crit-psych" /> Critique of psychiatry from within the field comes from the [[critical psychiatry]] group in the UK.

Double argues that most critical psychiatry is [[Antireductionism|anti-reductionist]]. Rashed argues new mental health science has moved beyond this reductionist critique by seeking [[Integrative psychotherapy|integrative]] and [[Biopsychosocial model|biopsychosocial]] models for conditions and that much of critical psychiatry now exists with orthodox psychiatry but notes that many critiques remain unaddressed.<ref>{{Cite journal | vauthors = Rashed MA |date=2020 |title=The critique of psychiatry as we enter the third decade of the 21st century: Commentary on… Critical psychiatry |journal=BJPsych Bulletin |language=en |volume=44 |issue=6 |pages=236–238 |doi=10.1192/bjb.2020.10 |issn=2056-4694 |pmc=7684776 |pmid=32102717}}</ref>{{Rp|page=237}}

The term ''[[anti-psychiatry]]'' was coined by psychiatrist [[David Cooper (psychiatrist)|David Cooper]] in 1967 and was later made popular by [[Thomas Szasz]]. The word ''Antipsychiatrie'' was already used in Germany in 1904.<ref>Bangen, Hans: Geschichte der medikamentösen Therapie der Schizophrenie. Berlin 1992, {{ISBN|3-927408-82-4}}, page 87</ref> The basic premise of the [[anti-psychiatry movement]] is that psychiatrists attempt to classify "normal" people as "deviant"; psychiatric treatments are ultimately more damaging than helpful to patients; and psychiatry's history involves (what may now be seen as) dangerous treatments, such as [[psychosurgery]] an example of this being the frontal lobectomy (commonly called a [[lobotomy]]).<ref name=":0">{{cite news|url=https://www.scientology.org/scientology-today/clearwater-citizens-commission-on-human-rights-center-opening.html|title=Citizens Commission on Human Rights Expands its Activities to Expose and Handle Psychiatric Abuse in Clearwater, Tampa Bay via New Center|work=Scientology|access-date=2018-03-10|archive-date=2018-03-11|archive-url=https://web.archive.org/web/20180311140608/https://www.scientology.org/scientology-today/clearwater-citizens-commission-on-human-rights-center-opening.html|url-status=live}}</ref> The use of lobotomies largely disappeared by the late 1970s.

==See also==
{{col div|colwidth=30em}}
* [[Glossary of psychiatry]]
* [[Medical psychology]]
* [[Biopsychiatry controversy]]
* [[Child and adolescent psychiatry]]
* [[Telepsychiatry]]
* [[Psychiatry Innovation Lab]]
* [[Anti-psychiatry]]
* [[Controversies about psychiatry]]{{colend}}

==Notes==
{{Notelist}}

==References==
===Citations===
{{Reflist}}

===Cited texts===
{{refbegin}}
* {{cite book | vauthors = Gask L |year=2004|title=A Short Introduction to Psychiatry|location=London|publisher=SAGE Publications Ltd.|isbn=978-0-7619-7138-2|oclc=56009828}}
* {{cite book | vauthors = Guze SB |year=1992|title=Why Psychiatry Is a Branch of Medicine|location=New York|publisher=Oxford University Press|isbn=978-0-19-507420-8|oclc=25315637}}
* {{cite book | vauthors = Lyness JM |year=1997|title=Psychiatric Pearls|location=Philadelphia|publisher=F.A. Davis Company |isbn=978-0-8036-0280-9|oclc=807453406}}
* {{cite book | last=Shorter|first=E |year=1998|orig-date=1997|title=A History of Psychiatry: From the Era of the Asylum to the Age of Prozac|url=https://archive.org/details/historyofpsychia0000shor|url-access=registration|location=New York|publisher=John Wiley & Sons, Inc.|isbn=978-0-471-24531-5|oclc=60169541 |ref={{sfnref|Shorter|1997}}}}
{{refend}}

==Further reading==
{{Refbegin|30em}}
* {{cite book| veditors = Berrios GE, Porter R |date=1995|title=The History of Clinical Psychiatry|location=London|publisher=Athlone Press|oclc=1000559759|isbn=978-0-485-24211-9}}
* {{cite book|vauthors=Berrios GE|date=1996|title=History of Mental symptoms: The History of Descriptive Psychopathology since the 19th century|location=Cambridge|publisher=Cambridge University Press|oclc=668203298|isbn=978-0-511-52672-5}}
* {{cite journal|vauthors=Burke C|date=February 2000|title=Psychiatry: a "value-free" science?|journal=[[Linacre Quarterly]]|volume=67/1|pages=59–88|doi=10.1080/20508549.2000.11877569|s2cid=77216987|url=http://www.cormacburke.or.ke/node/369|access-date=2011-01-22|archive-date=2021-11-29|archive-url=https://web.archive.org/web/20211129195128/http://www.cormacburke.or.ke/node/369|url-status=live|url-access=subscription}}
* {{cite encyclopedia| vauthors = Ford-Martin PA | veditors = Longe JL, Blanchfield DS |date=2002 |title=Psychosis |encyclopedia=Gale Encyclopedia of Medicine |edition=2nd |volume=4 |location=Detroit |publisher=Gale Group |oclc=51166617}}
* [[Gavin Francis|Francis, Gavin]], "Changing Psychiatry's Mind" (review of [[Anne Harrington]], ''Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness'', Norton, 366 pp.; and [[Nathan Filer]], ''This Book Will Change Your Mind about Mental Health: A Journey into the Heartland of Psychiatry'', London, Faber and Faber, 248 pp.), ''[[The New York Review of Books]]'', vol. LXVIII, no. 1 (14 January 2021), pp.&nbsp;26–29. "[M]ental disorders are different [from illnesses addressed by other medical specialties].... [T]o treat them as purely physical is to misunderstand their nature." "[C]are [needs to be] based on distress and [cognitive, emotional, and physical] need rather than [on psychiatric] diagnos[is]", which is often uncertain, erratic, and unreplicable. (p.&nbsp;29.)
* [[Sue Halpern|Halpern, Sue]], "The Bull's-Eye on Your Thoughts" (review of [[Nita A. Farahany]], ''The Battle for Your Brain: Defending the Right to Think Freely in the Age of Neurotechnology'', St. Martin's, 2023, 277 pp.; and [[Daniel Barron]], ''Reading Our Minds: The Rise of Big Data Psychiatry'', Columbia Global Reports, 2023, 150 pp.), ''[[The New York Review of Books]]'', vol. LXX, no. 17 (2 November 2023), pp. 60–62. Psychiatrist [[Daniel Barron]] deplores psychiatry's reliance largely on subjective impressions of a patient's condition – on [[pattern recognition|behavioral-pattern recognition]] – whereas other medical specialties dispose of a more substantial armamentarium of objective diagnostic [[technologies]]. A psychiatric patient's [[diagnosis|diagnoses]] are arguably more in the eye of the physician: "An [[anti-psychotic]] 'works' if a [psychiatric] patient ''looks and feels'' less [[psychotic]]." Barron also posits that [[speech|talking]] – an important aspect of psychiatric [[diagnostics]] and treatment – involves vague, subjective [[language]] and therefore cannot reveal the [[brain]]'s objective workings. He trusts, though, that [[Big Data]] technologies will make psychiatric [[signs and symptoms]] more quantifiably objective. Sue Halpern cautions, however, that "When numbers have no agreed-upon, scientifically-derived, extrinsic meaning, quantification is unavailing." (p. 62.) 
* {{cite journal|vauthors=Hirschfeld RM, Lewis L, Vornik LA|title=Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder|journal=The Journal of Clinical Psychiatry|volume=64|issue=2|pages=161–74|date=February 2003|pmid=12633125|doi=10.4088/JCP.v64n0209}}
* {{cite journal| vauthors = Hiruta G | veditors = Beveridge A |title=Japanese psychiatry in the Edo period (1600-1868)|journal=History of Psychiatry|volume=13|issue=50|pages=131–51|date=June 2002|doi=10.1177/0957154X0201305002|s2cid=143377079}}
* {{cite journal|vauthors=Krieke LV, Jeronimus BF, Blaauw FJ, Wanders RB, Emerencia AC, Schenk HM, Vos SD, Snippe E, Wichers M, Wigman JT, Bos EH, Wardenaar KJ, Jonge PD|title=HowNutsAreTheDutch (HoeGekIsNL): A crowdsourcing study of mental symptoms and strengths|journal=International Journal of Methods in Psychiatric Research|volume=25|issue=2|pages=123–44|date=June 2016|pmid=26395198|doi=10.1002/mpr.1495|pmc=6877205|hdl=11370/060326b0-0c6a-4df3-94cf-3468f2b2dbd6|url=https://pure.rug.nl/ws/files/30435764/2015_Van_der_Krieke_Jeronimus_HowNutsAreTheDutch_A_Crowdsourcing_Study_of_Mental_Symptoms_and_Strengths.pdf|access-date=2019-12-06|archive-date=2019-08-02|archive-url=https://web.archive.org/web/20190802163143/https://pure.rug.nl/ws/files/30435764/2015_Van_der_Krieke_Jeronimus_HowNutsAreTheDutch_A_Crowdsourcing_Study_of_Mental_Symptoms_and_Strengths.pdf}}
* {{cite journal|vauthors=McGorry PD, Mihalopoulos C, Henry L, Dakis J, Jackson HJ, Flaum M, Harrigan S, McKenzie D, Kulkarni J, Karoly R|title=Spurious precision: procedural validity of diagnostic assessment in psychotic disorders|journal=The American Journal of Psychiatry|volume=152|issue=2|pages=220–3|date=February 1995|pmid=7840355|doi=10.1176/ajp.152.2.220|citeseerx=10.1.1.469.3360}}
* {{cite journal|vauthors=Moncrieff J, Cohen D|title=Rethinking models of psychotropic drug action|journal=Psychotherapy and Psychosomatics|volume=74|issue=3|pages=145–53|year=2005|pmid=15832065|doi=10.1159/000083999|s2cid=6917144}}
* Singh, Manvir, "Read the Label: How psychiatric diagnoses create identities", ''[[The New Yorker]]'', 13 May 2024, pp. 20-24. "[T]he ''[[Diagnostic and Statistical Manual of Mental Disorders]]'', or ''DSM'' [...] guides how Americans [...]  understand and deal with [[mental illness]]. [...] The ''DSM'' as we know it appeared in 1980, with the publication of the ''DSM-III'' [which] favored more precise diagnostic criteria and a more scientific approach [than the first two ''DSM'' editions]. [H]owever, the emerging picture is of overlapping conditions, of categories that blur rather than stand apart. No disorder has been tied to a specific [[gene]] or set of genes. Nearly [p. 20] all genetic vulnerabilities implicated in mental illness have been associated with many conditions. [...] As the philosopher [[Ian Hacking]] observed, labelling people is very different from labelling [[quark]]s or [[microbe]]s. Quarks and microbes are indifferent to their labels; by contrast, human classifications change how 'individuals experience themselves – and may even lead people to evolve their feelings and behavior in part because they are so classified.' Hacking's best-known example is [[multiple personality disorder]] [now called [[dissociative identity disorder]]]. Between 1972 and 1986, the number of cases of patients with multiple personalities exploded from the double digits to an estimated six thousand. [...] [I]n 1955 [n]o such diagnosis [had] existed. [Similarly, o]ver the past twenty years, the prevalence of [[autism]] in the United States has quadrupled [...]. A major driver of this surge has been a broadening of the definition and a lowering of the diagnostic threshold. Among people diagnosed with autism [...] evidence of the [[psychological]] and [[neurological]] traits associated with the condition declined by up to eighty per cent between 2000 and 2015. [[Temple Grandin]] [has commented that] [p. 21] 'The spectrum is so broad it doesn't make much sense.' [Confusion has also surrounded the term "[[sociopathy]]", which] was dropped from the ''DSM-II'' with the arrival of '[[antisocial personality disorder]]' [...]. Some scholars associated sociopathy with remorseless and impulsive behavior caused by a brain injury. Other people associated it with an antisocial personality. [T]he psychologist [[Martha Stout]] used it to mean a lack of [[conscience]]." (p. 22.) Yet another confusing [[nosological]] entity is [[borderline personality disorder]], "defined by sudden swings in [[Mood (psychology)|mood]], [[self-image]], and perceptions of others. [...] The concept is generally attributed to the psychoanalyst [[Adolph Stern]], who used it in 1937 to describe patients who were neither [[neurosis|neurotic]] nor [[psychotic]] and thus [were] 'borderline.' [It has been noted that] key symptoms such as [[identity disturbance]], outbursts of [[anger]], and unstable interpersonal relations also feature in [[narcissistic personality disorder|narcissistic]] and [[histrionic personality disorder]]s. [Medical sociologist] [[Allan Horwitz]] [...] asks why the ''DSM'' still treats B.P.D. as a [[personality disorder|disorder of personality]] rather than [[mood disorder|of mood]]. [p. 23.] [T]he process of labelling [[Reification (fallacy)|reifies]] categories [that is, endows them with a deceptive quality of "[[Wiktionary:thingness|thingness]]"], especially in the age of the [[Internet]]. [...] [P]eople everywhere encounter models of illness that they unconsciously embody. [...] In 2006, a [Mexican] student [...] developed devastating leg pain and had trouble walking; soon hundreds of classmates were afflicted." (p. 24.)     
* {{cite web|website=National Association of Cognitive-Behavioral Therapists|url=http://www.nacbt.org/whatiscbt.htm|title=What is Cognitive-Behavioral Therapy?|access-date=20 September 2006|archive-date=25 September 2006|archive-url=https://web.archive.org/web/20060925210024/http://www.nacbt.org/whatiscbt.htm|url-status=live}}
* {{cite journal|vauthors=Van Os J, Gilvarry C, Bale R, Van Horn E, Tattan T, White I, Murray R|title=A comparison of the utility of dimensional and categorical representations of psychosis. UK700 Group|journal=Psychological Medicine|volume=29|issue=3|pages=595–606|date=May 1999|pmid=10405080|doi=10.1017/s0033291798008162|s2cid=38854519 }}
* {{cite book|vauthors=Walker E, Young PD|date=1986|title=A Killing Cure|url=https://archive.org/details/killingcure00walk|url-access=registration|edition=1st|location=New York|publisher=H. Holt and Co.|oclc=12665467|isbn=978-0-03-069906-1}}
* {{cite journal|vauthors=Williams JB, Gibbon M, First MB, Spitzer RL, Davies M, Borus J, Howes MJ, Kane J, Pope HG, Rounsaville B|title=The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability|journal=Archives of General Psychiatry|volume=49|issue=8|pages=630–6|date=August 1992|pmid=1637253|doi=10.1001/archpsyc.1992.01820080038006}}
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