constantinople. 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. at the turn of the century, england and france combined had only a few hundred individuals in asylums. 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 was soon disappointed. psychiatrists were pressured by an ever-increasing patient population. the average number of patients in asylums kept on growing. asylums were quickly becoming almost indistinguishable from custodial institutions, and the reputation of psychiatry in the medical world had hit an extreme low. scientific advances emil kraepelin studied and promoted ideas of disease classification for mental disorders. in the early 1800s, psychiatry made advances in the diagnosis of mental illness by broadening the category of mental disease to include mood disorders, in addition to disease level delusion or irrationality. the term psychiatry (greek "ψυχιατρική", psychiatrikē) which comes from the greek "ψυχή" (psychē: "soul or mind") and "ιατρός" (iatros: "healer") was coined by johann christian reil in 1808. jean-étienne dominique esquirol, a student of pinel, defined lypemania as an 'affective monomania' (excessive attention to a single thing). this was an early diagnosis of depression. in 1870 louis mayer, a gynecologist in germany, cured a woman's "melancholia" using a pessary: "it relieved her physical problems and many severe disorders of mood ... application of a mayer ring improved her quite considerably." according to the american journal of obstetrics and diseases of women and children mayer reportedly decried the "neglect of the investigation of the relations between mental and sexual diseases of women in german insane hospitals". the 20th century introduced a new psychiatry into the world. different perspectives of looking at mental disorders began to be introduced. the career of emil kraepelin reflects the convergence of different disciplines in psychiatry. kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry. following his appointment to a professorship of psychiatry and his work in a university psychiatric clinic, kraepelin's interest in pure psychology began to fade and he introduced a plan for a more comprehensive psychiatry. kraepelin began to study and promote the ideas of disease classification for mental disorders, an idea introduced by karl ludwig kahlbaum. the initial ideas behind biological psychiatry, stating that the different mental disorders were all biological in nature, evolved into a new concept of "nerves" and psychiatry became a rough approximation of neurology and neuropsychiatry. however, kraepelin was criticized for considering schizophrenia as a biological illness in the absence of any detectable histologic or anatomic abnormalities.: 221 while kraepelin tried to find organic causes of mental illness, he adopted many theses of positivist medicine, but he favoured the precision of nosological classification over the indefiniteness of etiological causation as his basic mode of psychiatric explanation. following sigmund freud's pioneering work, ideas stemming from psychoanalytic theory also began to take root in psychiatry. the psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums. freud resisted subjecting his theories to scientific testing and verification, as did his followers. as evidence-based investigations in cognitive psychology led to treatments like cognitive behavioral therapy, many of freud's ideas appeared to be unsupported or contradicted by evidence. by the 1970s, the psychoanalytic school of thought had become marginalized within the field. otto loewi's work led to the identification of the first neurotransmitter, acetylcholine. biological psychiatry reemerged during this time. psychopharmacology became an integral part of psychiatry starting with otto loewi's discovery of the neuromodulatory properties of acetylcholine; thus identifying it as the first-known neurotransmitter. neuroimaging was first utilized as a tool for psychiatry in the 1980s. the discovery of chlorpromazine's effectiveness in treating schizophrenia in 1952 revolutionized treatment of the disorder, as did lithium carbonate's ability to stabilize mood highs and lows in bipolar disorder in 1948. psychotherapy was still utilized, but as a treatment for psychosocial issues. in the 1920s and 1930s, most asylum and academic psychiatrists in europe believed that manic depressive disorder and schizophrenia were inherited, but in the decades after world war ii, the conflation of genetics with nazi racist ideology thoroughly discredited genetics. now genetics are once again thought by some prominent researchers to play a large role in mental illness. the genetic and heritable proportion of the cause of five major psychiatric disorders found in family and twin studies is 81% for schizophrenia, 80% for autism spectrum disorder, 75% for bipolar disorder, 75% for attention deficit hyperactivity disorder, and 37% for major depressive disorder. geneticist müller-hill is quoted as saying "genes are not destiny, they may give an individual a pre-disposition toward a disorder, for example, but that only means they are more likely than others to have it. it (mental illness) is not a certainty.” molecular biology opened the door for specific genes contributing to mental disorders to be identified. deinstitutionalization main article: deinstitutionalisation asylums: essays on the social situation of mental patients and other inmates (1961), written by sociologist erving goffman, examined the social situation of mental patients in the hospital. based on his participant observation field work, the book developed the theory of the "total institution" and the process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor". the book suggested that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role, in other words of "institutionalizing" them. asylums was a key text in the development of deinstitutionalisation. at the same time, academic psychiatrist and psychoanalyst thomas szasz began publishing articles and books that were highly critical of psychiatry and involuntary treatment, including his best-known work the myth of mental illness in 1961. in 1963, 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. later, though, the community mental health centers focus shifted to providing psychotherapy for those with acute but less serious mental disorders. ultimately there were no arrangements made for actively following and treating severely mentally ill patients who were being discharged from hospitals. some of those with mental disorders drifted into homelessness or ended up in prisons and jails. studies found that 33% of the homeless population and 14% of inmates in prisons and jails were already diagnosed with a mental illness. in 1973, psychologist david rosenhan published the rosenhan experiment, a study with results that led to questions about the validity of psychiatric diagnoses. critics such as robert spitzer placed doubt on the validity and credibility of the study, but did concede that the consistency of psychiatric diagnoses needed improvement. psychiatry, like most medical specialties, has a continuing, significant need for research into its diseases, classifications and treatments. psychiatry adopts biology's fundamental belief that disease and health are different elements of an individual's adaptation to an environment. but psychiatry also recognizes that the environment of the human species is complex and includes physical, cultural, and interpersonal elements. in addition to external factors, the human brain must contain and organize an individual's hopes, fears, desires, fantasies and feelings. psychiatry's difficult task is to bridge the understanding of these factors so that they can be studied both clinically and physiologically.