Western psychiatry emerged as a medical specialty caring for the mentally ill over the course of the late 18th and early 19th centuries. This emergence was a contingent process, dependent on the co-occurrence of three historical developments that together shaped the young discipline. The first was the rise of the mind as an entity with numerous active faculties in the conceptual space between the body and the Christian soul. Only by the latter half of the 18th century was it common to conceptualize conditions like mania or melancholy as mental illnesses. The second advance critical to psychiatry’s proto-specialty status, with its increasing focus on a mechanistic understanding of disease, was the rejection of humoral theories of insanity in favor of the brain and nerves as the seat of madness. The third development was the rise of the asylum. Only in dedicated institutions could mad-doctors be exposed to large numbers of the insane, permitting the development of a specialized clinical vocabulary grounded in faculties of mind, which led to new nosologic systems. The decline of humoral medicine, with its purges, bleeding, and emetics, and the urgent clinical need for care produced, in early asylums, the first novel treatment from the young specialty: moral therapy. We tell this story focusing mainly on the work of five philosophers and physicians: Descartes, Willis, Locke, Boerhaave, de Sauvages, and Cullen. Throughout its history, psychiatry has struggled with its sometimes disconjugate goals of understanding both mind and brain, with alternating efforts to expel one of these tasks from the profession. A historical perspective demonstrates that psychiatry is a profession inextricably linked to these two contrasting projects—and, indeed, jointly constituted by them.

西方精神病学在 18 世纪末和 19 世纪初成为治疗精神病患者的医学专业。这种出现是一个偶然的过程，取决于共同塑造年轻学科的三个历史发展的共同发生。第一个是思想作为一个实体的兴起，在身体和基督教灵魂之间的概念空间中具有许多活跃的能力。直到 18 世纪下半叶，才普遍将躁狂或忧郁等状况概念化为精神疾病。对精神病学的原始专业地位至关重要的第二个进步是，它越来越关注对疾病的机械理解，它拒绝了精神错乱的体液理论，而将大脑和神经视为疯狂的根源。第三个发展是庇护的兴起。只有在专门的机构中，疯子才能接触到大量的疯子，从而发展出一种以心智为基础的专门临床词汇，从而产生了新的疾病学系统。体液医学的衰落，以及它的清除、出血和催吐剂，以及对护理的迫切临床需求，在早期的庇护所中产生了来自年轻专业的第一个新疗法：道德疗法。我们讲述这个故事主要关注五位哲学家和医生的工作：笛卡尔、威利斯、洛克、布尔哈夫、德索瓦奇和卡伦。纵观其历史，精神病学一直在努力实现其理解思想和大脑的有时不一致的目标，并交替努力将其中一项任务从专业中剔除。从历史的角度来看，精神病学是一个与这两个截然不同的项目密不可分的职业——事实上，它们是由它们共同构成的。