Attempts to define and treat insanity were evident since ancient times in the Indian subcontinent. Formal services for the care of the mentally ill, as in northern America, were introduced in the eighteenth century, under British influence. In the nineteenth century, as psychiatry evolved in Britain, these ideas were introduced in India, although the lack of specialists was a matter of concern. In contrast, the close links between European and British practice transformed ideas about psychiatry and neurology, in the latter half of the nineteenth century. Doctors with special interest or training in psychiatry were appointed to manage the asylums across India and they were often familiar with Kraepelin’s ideas regarding nosology and the nature of psychiatric disease. The clustering of symptoms that he used to define dementia praecox and manic-depressive insanity had wide acceptance. Since this outlook was shared by many British psychiatrists in the inter-war years, these became further entrenched as many specialist psychiatrists from India trained in the UK in this period. Kraepelin’s interest in the comparative study of syphilis, and cultural influences in outcomes of psychoses, also found ready acceptance. Not surprisingly, the observations on heredity and eugenics as applied to mental illness also gained some acceptance. The strong biomedical conceptualisation of mental disorders, as distinct syndromes, with identifiable biological characteristics and outcomes, continues to find resonance. The teaching of psychiatry in post-Independence India relied heavily on the phenomenological school to define syndromes. The discovery of drug treatments and the urge to define psychiatry as a medical discipline have helped consolidate Kraepelin’s biomedical conceptualisation in India. Whether this has led to a neglect of the understanding of other psycho-social factors or to an unfairly restricted view of psychiatry remains to be seen.