Classification Through the Ages

Early History: Humors, Witches, and the Moon

(from Blashfield, 1998 and

            According to Blashfield (1998), the first evidence of classification comes from an Egyptian writer in the 19th century BC.  The writer provided a description of women who experienced physical symptoms that migrated around the body (this would later be called hysteria.)  Blashfield also notes that Psalm 102 provides an excellent clinical description of depression.

Despite these early efforts, the ancient Greeks seem to be the first to formalize classification.  In the 4th century BC, Hippocrates promoted a theory that mental and physical illnesses were due to an imbalance of humors.  Galen (129-216 AD) extended Hippocrates theory to personality types, naming the types sanguine, phlegmatic, choleric, melancholic (class notes, 1/22/04.)  This tradition foreshadows modern psychologists who research the relationships between abnormality and chemical imbalance.

            In the Middle Ages, mental disorders were thought to be the work of demonic forces.  Clergymen, not physicians or scientists, were seen as the healers.  The most significant attempt at psychiatric classification was made by Gilbertus Anglicus.  His Compendium Medicine (1230) offered descriptions of mania, melancholia, lethargy, epilepsy, and demonic possession (

During the Renaissance, classification saw the influence of witchcraft and supernatural ideas.  Malleus Maleficarum (The Hammer of the Witches), the Inquisition, and Paracelsus’ ideas about the relationship between phases of the moon and “lunacy” dominated thought (

The Shift Toward Biology

(All material is from except for Hammond, which is from Blashfield,1998)

In the late 17th century, the pendulum began to swing toward a biological explanation of mental disease:

...nature, in the production of diseases, is uniform and consistent; so much so, that for the same disease in different persons symptoms are for the most part the same; and the self same phenomena that you could observe in the sickness of a Socrates you would observe in the sickness of a simpleton.                                                                                           
                                                                                                                                British physician Thomas Sydenham (1624-1689)

            The reign of King George III of England was also influential in this theoretical shift.  King George III was psychotic for nearly the last decade of his reign.  However, he requested that a physician, not a clergyman, dispense his treatments.

            The 18th century saw the birth of psychiatry as a discipline and a flurry of classification systems from different psychiatrists.  Boissier de Sauvages created the most extensive psychiatric classification in history, including 2400 “species of disorders” (

            Another significant system was created by William Cullen in his First Lines in the Practice of Physic (1777-1784).  Cullen proposed four classes of neuroses: coma, adynamias, spasms, and vesanias.  The vesanias included amentia, melancholia, mania, and oneirodynia.  The next important player was Phillipe Pinel (1745-1826), who is often considered the founder of psychiatry.  While Pinel agreed with Cullen’s classification, Pinel stated that mental disorders are not separate entities but stem from a single disease that he called “mental alienation.”

            Jean-Etienne Dominique Esquirol
(1772-1840) was a student of Pinel.  Esquirol’s most significant contribution was his work Mental Maladies (1838), a compilation of observations from various asylums.  Esquirol foreshadowed many of today’s diagnostic categories in his descriptions of delusional, emotional, and volitional disorders.  Although he agreed with other scientists who took a biological stance on mental disorders, Esquirol postulated that social or psychological factors could trigger the symptoms.

            William A. Hammond, an American neurologist, also proposed a classification in the 19th century.  Hammond described 6 classes of disorders, including perceptual insanities, intellectual insanities, emotional insanities, volitional insanities, compound insanities, and constitutional insanities (Blashfield, 1998).  Although most of his 47 diagnoses would be unrecognizable by today’s standards, he described a few disorders present in today’s classification systems, such as intellectual monomania with exaltation (Bipolar I, Manic), reasoning mania (Narcissistic Personality Disorder), and intellectual subjective morbid impulses (Obsessive-Compulsive Disorder.)