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Accounts of the history of psychiatry tend to place the origins of recognisable forms of a specialist profession at the very beginning of the nineteenth century (Porter, 2002; Scull, 1979a), with the formal establishment of professional associations and journals occurring in the 1840s. Before this there were ‘mad-doctors’ who ministered to the insane and confined them in ‘madhouses’, while occupying ‘a niche slightly above a witch doctor in the public imagination’ (Boime, 1991, p. 79).

The transformation was energised by two innovations that involved the identification of ‘the mind’ of the patient as itself a significant field of enquiry and treatment. Firstly, there was the emergence of moral treatment, a landmark that initiated the practice of systematic ‘psychological’ treatment. While on the one hand this was arguably a significant precursor to many different forms of psychological treatment that were to follow, it was also a key argument that justified the large-scale building of asylums across many parts of Europe and North America in the nineteenth century (Scull, 1979a). The asylums came to dominate the landscape of mental illness for well over a century and in many ways we still live in their shadow (Rogers and Pilgrim, 2014). Secondly, there was the development of a set of ideas that construed some instances of serious criminality (particularly involving violence) as symptoms of mental disorder. This claim of expertise in criminal and legal matters was fundamental to the aspiration for professional status and recognition (Goldstein, 1987). Both innovations were underpinned by the relatively novel idea of a psychological domain – a world of the mind – which could be explored and treated by those with sufficient expertise (Jones, 2017a).

Examination of these ideas illustrates how the development of psychiatry needs to be understood as a product of various and often contradictory forces. Alongside the intention to find ways of alleviating distress were the more entrepreneurial pressures of those who wanted to build professional status and earn a living. There were also the anxieties of governments conscious of the threat posed by those who did not conform to social norms.