Well into the eighteenth century, the only types of mental illness – then commonly called “delirium” or “mania” – were depression (melancholia), psychoses and delusions. At the beginning of the 19th century, the French psychiatrist Pinel coined the term “manie sans delire” (madness without fantasies). Patients who lacked impulse control often lashed out in frustration and were prone to violent outbursts. He observed that such patients were not delusional. He was referring, of course, to psychopaths (subjects with antisocial Personality disorder). Across the ocean in United States, Benjamin Rush made similar observations.
In 1835, the British J. C. Pritchard, senior physician at the Bristol Infirmary (hospital) published a seminal work entitled “Treatise on Insanity and Mental Disorders”. He, in turn, hinted at the latest “moral insanity.”
To quote moral insanity in it consisted of “a morbid perversion of the natural senses, affections, inclinations, mind, habits, moral dispositions, natural impulses without any notable disturbance or deficiency of the understanding, or of the faculties of knowing or reasoning, and especially without any.” madness, delusion or hallucination” (p. 6).
He then goes on to highlight a highly developed psychopathic (antisocial) personality;
“(A) The propensity to steal is sometimes moral insanity, sometimes leading to, if not the only reason.” (p. 27). Eccentricity of manners, a singular and absurd custom, a propensity to the common activities of life, which are usually exercised in one way or another, is the reason for many acts of moral insanity, but it can hardly be said to contribute sufficient evidence. to be his own” (p. 23).
“However, whatever such things are observed about a varied and intractable character with the decay of social affections, the aversion to the nearest relatives and friends once beloved – in short, the change in the character of each character becomes the cause. sufficiently marked.” (p. 23).
However, the differences between personality, affective and moderate disorders were still unclear.
Pritchard was still troubled;
(a) A large proportion of the most beautiful examples of moral insanity are those in which a tendency to sadness or melancholy is the predominant feature. in addition to natural motion. (pp. 18-19).
Another half century had to pass before a classification system emerged that offered differential diagnoses of mental illnesses without delusions (later known as personality. disorders), affective disorders, schizophrenia and depressive illnesses. However, the name Moris was widely used.
Henry Maudsley in 1885 described a patient who:
“(Having) no capacity for true moral affection – all his impulses and desires, to which he yields without criticism, are selfish; his course of action seems to be governed by evil impulses, which he encourages and obeys without any evident desire to resist them. “(“Responsibility in mental illness”, p. 171).
But Maudsley already belonged to a generation of doctors who felt more uncomfortable with the vague and judgmental currency of “moral insanity” and tried to make it a little more scientific.
Maudsley bitterly criticizes the ambiguous term “moral insanity”:
“(It is) an alienation of the mind, which has only the appearance of a vice or a crime, so that many consider it a vain invention of the doctors (p. 170).
In his book “Die Psychopatischen Minderwertigkeiter”, published in 1891, the German doctor J. L. A. Koch tried to improve the situation by suggesting the phrase “psychopathic infertility”. He limited his diagnosis to people who are not retardation or mental retardation ill, but still show a rigid pattern of dishonesty and dysfunction throughout their more disorderly life In later editions, he replaced “inferno” with “personality” to avoid sounding judgmental. Hence the “psychopathic personality”.
Twenty years after the controversy, the diagnosis was found in the seminal 8th edition of E. Kraepelin’s “Lehrbuch der Psychiatrie” (“Clinical Psychiatry: the art of students and doctors”). During that time he earned an entire chapter in which Kraepelin suggested six additional types of excitability: excitability. unstable, perverse, lying, predatory, quarrelsome.
However, the focus was on antisocial behavior. If someone’s action caused discomfort or pain or even annoyed someone or just annoyed the norms of society, one was bound to be diagnosed as “psychopathic”.
In his influential books “The Psychopathic Personality” (9th ed, 1950) and “Clinical Psychopathology” (1959), another German psychiatrist, K. Schneider sought to expand the diagnosis to include people who hurt and harm themselves and others. Patients who are depressed, socially anxious, overly nervous and fragile are all considered by him to be “psychopaths” (in other words, abnormal).
This expansion of the definition of psychopathy directly challenged the work of the Scottish psychiatrist, Sir David Henderson. In 1939, Henderson published “Psychopathic States,” a book that would become an instant classic. In it he stated that, although not mentally subnormal, psychopaths are people;
(T)have exhibited behavior disorders of an antisocial or antisocial nature, usually of a recurring episodic type, throughout their life or from an early age in many cases they taught that social, penal, and medical care methods are difficult to move, or that there is no adequate provision of a preventive or curative nature.
But Henderson went much further than that and went beyond the narrow view of psychopathy (of the German school) then prevalent throughout Europe.
In his work (1939), Henderson described three types of psychopaths. Aggressive psychopaths were violent, murderous, and prone to substance abuse. Passive and inadequate psychopaths were oversensitive, unstable and hypochondriacs. They were also introverts (schizoids) and pathological liars. Creative psychopaths were all dysfunctional people who became famous or became infamous.
Twenty years later, in the 1959 Mental Health Act for England and Wales, “psychopathic disorder” was defined as follows, in section 4(4);
“(A) a persistent mental disorder or defect (whether or not including subnormal intelligence) that results in abnormally aggressive or grossly irresponsible behavior in the patient, and requires or receives medical treatment.”
This definition goes back to the minimalist and cycles (tautological): it is abnormal behavior that harms others, affects illness or discomfort. Such behavior is inherently violent or reckless. In addition, it could not be tackled, even excluding obviously abnormal behavior that does not require or receive medical treatment.
Thus “psychopathic personality” means both “abnormal” and “antisocial”. This confusion continues to this day. There is still an academic debate between those, such as the Canadian Robert Hare, who distinguish psychopathy from the patient with antisocial personality disorder alone, and those (orthodox) who want to avoid ambiguity and use the latter term.
But this clouded construction resulted in co-morbidity. Patients are often diagnosed with multiple and widely involving personality disorders, traits, and styles. As early as 1950, Schneider wrote:
“Any clinician would be very embarrassed if he were to inquire about the appropriate types of psychopaths (that is, abnormal personalities) to encounter in one year.”
Today, most physicians rely on either the Diagnostic and Statistical Manual (DSM), now in its fourth, revised, edition, or the International Classification of Diseases (ICD), now in its tenth edition.
The two volumes disagree on some issues, but are largely consistent with each other.
