Patients with long-standing mental illness have been around for far longer than the medical specialty of psychiatry. I'd feel comfortable saying they've been around as long as humanity.
Even when only considering western hospitals of the modern era, Bethlem Royal Hospital in London, England was founded in 1247. It is considered the oldest psychiatric institution in the western world and general consensus is that Bethlem was a specialty hospital for the mentally ill by the 1300s.
So, one can easily argue that physicians have been trying to care for patients with chronic mental illness for literal centuries.
However, the creation of the modern practice of psychiatry is relatively recent.
For context, the historical challenge with mental health care was that it was limited to largely custodial care. Throughout most of western medical history, providing care for the chronically mentally ill meant providing housing and general support to patients who otherwise had no way to provide for themselves due to their mental illness.
If you spend time reading about the history of psychiatric hospitals, you will learn about the complicated history of attempting to fund these custodial care homes for the chronically mentally ill. Different cities and societies all experimented with ways to generate enough revenue to pay for the required long term care. However, the ethical mistakes of those eras led to the social associations currently linked to words like asylum and institution.
For most of modern medical history, treating mental illness in a way that would eventually allow patients to leave custodial care didn't have any realistic clinical tools.
Even with the advent of psychoanalysis in the early 20th century, available treatments focused on talk therapy and were geared towards patients able to navigate frequent outpatient appointments.
I would argue that the creation of psychiatry as we currently know it started with the invention of chlorpromazine.
Chlorpromazine was developed in the early 1930s, when a French pharmaceutical company was investigating medications that could cause sedation without relying on opioid medications. For context, prior to the development of modern sedatives, physicians relied heavily on opium-based medications for any necessary sedation and also for cough control. An alternative family of medications was sought after because it would help prevent the known side effects of opium use including over sedation, constipation, and addiction.
By the early 1950s, chlorpromazine was being distributed for clinical testing, and military hospitals noted that not only did it work well as a sedative, but patients reported improved well-being after dosing. This led to clinical testing in psychiatric patients, and by 1954 chlorpromazine was approved for treatment of psychotic disorders. By the 1960s, chlorpromazine had been used to treat millions so of people worldwide and was a recognized treatment for schizophrenia.
Historically, chlorpromazine has had several key contributions to creating the field of psychiatry:
As a medical intervention, it meant that physicians capable of managing medication side effects were necessary. This contributed to the formalization of a medical specialty focusing on treating the mentally ill, which later became known as psychiatry.
It meant that previously chronic, untreatable mental health patients had an opportunity for treatment rather than just custodial care. Many psychotic patients were able to leave custodial care for the first time in western medical history
The development of chlorpromazine led to the pharmaceutical widespread realization that mental illnesses could benefit from medication interventions. This in turn led to the development of other psychotropics. For instance, isoniazid was later developed for treatment of tuberculosis in the early 1950s, but eventually led to coining the term antidepressant when it was found to improve depression in patients.
In fairness, many argue that the development of modern psychiatry started in the 1940s with the development of lithium. However, I think the important take away point is similar: A medication for previously untreatable mental health patients emerged, bringing physicians firmly into mental health care.
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