a decidedly american outlook, meaning that differing disorders or concepts of illness from other cultures (including personalistic rather than naturalistic explanations) may be neglected or misrepresented, while western cultural phenomena may be taken as universal. culture-bound syndromes are those hypothesized to be specific to certain cultures (typically taken to mean non-western or non-mainstream cultures); while some are listed in an appendix of the dsm-iv they are not detailed and there remain open questions about the relationship between western and non-western diagnostic categories and sociocultural factors, which are addressed from different directions by, for example, cross-cultural psychiatry or anthropology. historical development antiquity in ancient greece, hippocrates and his followers are generally credited with the first classification system for mental illnesses, including mania, melancholia, paranoia, phobias and scythian disease (transvestism). they held that they were due to different kinds of imbalance in four humors. middle ages to renaissance the persian physicians 'ali ibn al-'abbas al-majusi and najib ad-din samarqandi elaborated upon hippocrates' system of classification. avicenna (980−1037 ce) in the canon of medicine listed a number of mental disorders, including "passive male homosexuality". laws generally distinguished between "idiots" and "lunatics". thomas sydenham (1624–1689), the "english hippocrates", emphasized careful clinical observation and diagnosis and developed the concept of a syndrome, a group of associated symptoms having a common course, which would later influence psychiatric classification. 18th century evolution in the scientific concepts of psychopathology (literally referring to diseases of the mind) took hold in the late 18th and 19th centuries following the renaissance and enlightenment. individual behaviors that had long been recognized came to be grouped into syndromes. boissier de sauvages developed an extremely extensive psychiatric classification in the mid-18th century, influenced by the medical nosology of thomas sydenham and the biological taxonomy of carl linnaeus. it was only part of his classification of 2400 medical diseases. these were divided into 10 "classes", one of which comprised the bulk of the mental diseases, divided into four "orders" and 23 "genera". one genus, melancholia, was subdivided into 14 "species". william cullen advanced an influential medical nosology which included four classes of neuroses: coma, adynamias, spasms, and vesanias. the vesanias included amentia, melancholia, mania, and oneirodynia. towards the end of the 18th century and into the 19th, pinel, influenced by cullen's scheme, developed his own, again employing the terminology of genera and species. his simplified revision of this reduced all mental illnesses to four basic types. he argued that mental disorders are not separate entities but stem from a single disease that he called "mental alienation". attempts were made to merge the ancient concept of delirium with that of insanity, the latter sometimes described as delirium without fever. on the other hand, pinel had started a trend for diagnosing forms of insanity 'without delirium' (meaning hallucinations or delusions) – a concept of partial insanity. attempts were made to distinguish this from total insanity by criteria such as intensity, content or generalization of delusions. 19th century pinel's successor, esquirol, extended pinel's categories to five. both made a clear distinction between insanity (including mania and dementia) as opposed to mental retardation (including idiocy and imbecility). esquirol developed a concept of monomania—a periodic delusional fixation or undesirable disposition on one theme—that became a broad and common diagnosis and a part of popular culture for much of the 19th century. the diagnosis of "moral insanity" coined by james prichard also became popular; those with the condition did not seem delusional or intellectually impaired but seemed to have disordered emotions or behavior. the botanical taxonomic approach was abandoned in the 19th century, in favor of an anatomical-clinical approach that became increasingly descriptive. there was a focus on identifying the particular psychological faculty involved in particular forms of insanity, including through phrenology, although some argued for a more central "unitary" cause. french and german psychiatric nosology was in the ascendency. the term "psychiatry" ("psychiatrie") was coined by german physician johann christian reil in 1808, from the greek "ψυχή" (psychē: "soul or mind") and "ιατρός" (iatros: "healer or doctor"). the term "alienation" took on a psychiatric meaning in france, later adopted into medical english. the terms psychosis and neurosis came into use, the former viewed psychologically and the latter neurologically. in the second half of the century, karl kahlbaum and ewald hecker developed a descriptive categorizion of syndromes, employing terms such as dysthymia, cyclothymia, catatonia, paranoia and hebephrenia. wilhelm griesinger (1817–1869) advanced a unitary scheme based on a concept of brain pathology. french psychiatrists jules baillarger described "folie à double forme" and jean-pierre falret described "la folie circulaire"—alternating mania and depression. the concept of adolescent insanity or developmental insanity was advanced by scottish asylum superintendent and lecturer in mental diseases thomas clouston in 1873, describing a psychotic condition which generally impacts those aged 18–24 years, particularly males, and in 30% of cases proceeded to "a secondary dementia". the concept of hysteria (wandering womb) had long been used, perhaps since ancient egyptian times, and was later adopted by freud. descriptions of a specific syndrome now known as somatization disorder were first developed by the french physician, paul briquet in 1859. an american physician, beard, described "neurasthenia" in 1869. german neurologist westphal, coined the term "obsessional neurosis" now termed obsessive-compulsive disorder, and agoraphobia. alienists created a whole new series of diagnoses that highlighted single, impulsive behavior, such as kleptomania, dipsomania, pyromania, and nymphomania. the diagnosis of drapetomania was also developed in the southern united states to explain the perceived irrationality of black slaves trying to escape what was thought to be a suitable role. the scientific study of homosexuality began in the 19th century, informally viewed either as natural or as a disorder. kraepelin included it as a disorder in his compendium der psychiatrie that he published in successive editions from 1883. "psychiatrists of europe! protect your sanctified diagnoses!" cartoon by emil kraepelin, 1896. in the late 19th century, koch referred to "psychopathic inferiority" as a new term for moral insanity. in the 20th century the term became known as "psychopathy" or "sociopathy", related specifically to antisocial behavior. related studies led to the dsm-iii category of antisocial personality disorder. 20th century influenced by the approach of kahlbaum and others, and developing his concepts in publications spanning the turn of the century, german psychiatrist emil kraepelin advanced a new system. he grouped together a number of existing diagnoses that appeared to all have a deteriorating course over time—such as catatonia, hebephrenia and dementia paranoides—under another existing term "dementia praecox" (meaning "early senility", later renamed schizophrenia). another set of diagnoses that appeared to have a periodic course and better outcome were grouped together under the category of manic-depressive insanity (mood disorder). he also proposed a third category of psychosis, called paranoia, involving delusions but not the more general deficits and poor course attributed to dementia praecox. in all he proposed 15 categories, also including psychogenic neurosis, psychopathic personality, and syndromes of defective mental development (mental retardation). he eventually included homosexuality in the category of "mental conditions of constitutional origin". the neuroses were later split into anxiety disorders and other disorders. freud wrote extensively on hysteria and also coined the term, "anxiety neurosis", which appeared in dsm-i and dsm-ii. checklist criteria for this led to studies that were to define panic disorder for dsm-iii. early 20th century schemes in europe and the united states reflected a brain disease (or degeneration) model that had emerged during the 19th century, as well as some ideas from darwin's theory of evolution and/or freud's psychoanalytic theories. psychoanalytic theory did not rest on classification of distinct disorders, but pursued analyses of unconscious conflicts and their manifestations within an individual's life. it dealt with neurosis, psychosis, and perversion. the concept of borderline personality disorder and other personality disorder diagnoses were later formalized from such psychoanalytic theories, though such ego psychology-based lines of development diverged substantially from the paths taken elsewhere within psychoanalysis. the philosopher and psychiatrist karl jaspers made influential use of a "biographical method" and suggested ways to diagnose based on the form rather than content of beliefs or perceptions. in regard to classification in general he prophetically remarked that: "when we design a diagnostic schema, we can only do so if we forego something at the outset … and in the face of facts we have to draw the line where none exists... a classification therefore has only provisional value. it is a fiction which will discharge its function if it proves to be the most apt for the time". adolph meyer advanced a mixed biosocial scheme that emphasized the reactions and adaptations of the whole organism to life experiences. in 1945, william c. menninger advanced a classification scheme for the us army, called medical 203, synthesizing ideas of the time into five major groups. this system was adopted by the veterans administration in the united states and strongly influenced the dsm. the term stress, having emerged from endocrinology work in the 1930s, was popularized with an increasingly broad biopsychosocial meaning, and was increasingly linked to mental disorders. the diagnosis of post-traumatic stress disorder was later created. mental disorders were first included in the sixth revision of the international classification of diseases (icd-6) in 1949. three years later, in 1952, the american psychiatric association created its own classification system, dsm-i. the feighner criteria group described fourteen major psychiatric disorders for which careful research studies were available, including homosexuality. these developed as the research diagnostic criteria, adopted and further developed by the dsm-iii. the dsm and icd developed, partly in sync, in the context of mainstream psychiatric research and theory. debates continued and developed about the definition of mental illness, the medical model, categorical vs dimensional approaches, and whether and how to include suffering and impairment criteria. there is some attempt to construct novel schemes, for example from an attachment perspective where patterns of symptoms are construed as evidence of specific patterns of disrupted attachment, coupled with specific types of subsequent trauma. 21st century the icd-11 and dsm-5 are being developed at the start of the 21st century. any radical new developments in classification are said to be more likely to be introduced by the apa than by the who, mainly because the former only has to persuade its own board of trustees whereas the latter has to persuade the representatives of over 200 countries at a formal revision conference. in addition, while the dsm is a bestselling publication that makes huge profits for apa, the who incurs major expense in determining international consensus for revisions to the icd. although there is an ongoing attempt to reduce trivial or accidental differences between the dsm and icd, it is thought that the apa and the who are likely to continue to produce new versions of their manuals and, in some respects, to compete with one another. criticism there is some ongoing scientific doubt concerning the construct validity and reliability of psychiatric diagnostic categories and criteria even though they have been increasingly standardized to improve inter-rater agreement in controlled research. in the united states, there have been calls and endorsements for a congressional hearing to explore the nature and extent of harm potentially caused by this "minimally investigated enterprise". other specific criticisms of the current schemes include: attempts to demonstrate natural boundaries between related syndromes, or between a common syndrome and normality, have failed; inappropriateness of statistical (factor-analytic) arguments and lack of functionality considerations in the analysis of a structure of behavioral pathology; the disorders of current classification are probably surface phenomena that can have many different interacting causes, yet "the mere fact that a diagnostic concept is listed in an official nomenclature and provided with a precise operational definition tends to encourage us to assume that it is a "quasi-disease entity" that can be invoked to explain the patient's symptoms"; and that the diagnostic manuals have led to an unintended decline in careful evaluation of each individual person's experiences and social context. psychodynamic schemes have traditionally given the latter phenomenological aspect more consideration, but in psychoanalytic terms that have been long criticized on numerous grounds. some have argued that reliance on operational definition demands that intuitive concepts, such as depression, need to be operationally defined before they become amenable to scientific investigation. however, john stuart mill pointed out the dangers of believing that anything that could be given a name must