psychopathic personality

(¦sī·kə¦path·ik ′pər·sə′nal·əd·ē)

(psychology) An emotionally immature individual characterized by pronounced defects in judgment and prone to impulsive, generally amoral or antisocial behavior.

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Strictly speaking, this term should be applied to all varieties of abnormal personality (see personality disorder). Schneider (1958) defined the psychopathic personality as an abnormal personality who either suffers because of his abnormality or makes the community suffer because of it. In the UK and the USA greater emphasis has been placed on the second part of this definition, mainly because of the frequent involvement of such persons in breaches of the law. American authors prefer the terms 'sociopath' and 'antisocial psychopath' which more clearly define the individual by virtue of his criminal propensities. In the UK, before the Mental Health Act of 1959 the psychopath was an entity unrecognized by law, but the Act defined psychopathic disorder as 'a persistent disorder or disability of mind (whether or not including subnormality of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient, and requires or is susceptible to medical treatment'. Although a good deal of controversy surrounds the last seven words of this definition, quite clearly the Act considered psychopathic disorder to be a form of mental illness. If such a person is 'ill' — and he would be the last person so to regard himself — it is up to the medical profession to treat him. The Mental Health Act of 1983 apparently recognizes the questionable value of medical treatment, as the phrase is omitted from its definition of psychopathic disorder. None the less, the term stays under the general heading of mental disorder.

Numerous attempts have been made to identify the principal characteristics of the psychopath. The term in a general sense is often applied to adolescent or young adult males who appear unable to conform to the rules of society. The qualities of this sort of person's psychological make-up include an inability to tolerate minor frustrations, an incapacity for forming stable human relationships, a failure to learn from past experiences, however unpleasant they might have been, and a tendency to act impulsively or recklessly. Henderson (1939), in a well-known essay on the subject, divided psychopathic personalities into three categories: the predominantly inadequate, the predominantly aggressive, and the creative. They are by no means mutually exclusive but, whereas the first two have gained general acceptance and receive more psychiatric attention, far less has been heard about the creative psychopath, whose sometimes erratic behaviour may seem less significant than the creations of his fertile imagination. He is less likely to come before the courts or to the attention of the mental health services, for his eccentricities are not usually regarded as indicative of mental disorder.

The question of whether, in the long run, psychopaths do learn from experience was considered in a follow-up study of children who showed persistent antisocial behaviour in St Louis (Robins 1966). Of those who survived — there was a high mortality from accidents, suicide, and alcoholism — a significant number appeared to be keeping out of trouble by middle life, finding that relative conformity was preferable to constant conflict with society and the law. Whether maturation or learning from experience was the more responsible for this beneficial change is uncertain, but it does appear that some so-called antisocial psychopaths do ultimately learn to mend their ways. There was little evidence that medical treatment had made much contribution to this outcome.

It is often said — erroneously as it happens — that our present-day concept of psychopathic personality originates from the introduction of the diagnosis of moral insanity into English medical and legal theory and practice by J. C. Prichard, a Bristol physician, in 1835. At the time, Prichard and many others were considerably influenced by Gall's writings on phrenology which localized human propensities to specific parts of the brain. Among these propensities was included the moral faculty, and it was widely assumed that moral insanity was caused by a derangement of that part of the brain concerned with making a choice between good and evil. Prichard, however, was using the term 'moral insanity' to denote emotional disturbances — delusions and hallucinations — that were devoid of the usual hallmarks of insanity. None of his cases bore the remotest resemblance to the present-day psychopath, but because he used the word 'moral' it was widely believed that this form of insanity was responsible for the actions of individuals who exhibited a persistent tendency to indulge in criminal behaviour — hence the plea of moral insanity in the courts in attempting to exculpate the offender from the full penalties of the law. Understandably, it was not an excuse that found much favour with the judges of the day. As they reasonably pointed out — and it has continued to be pointed out — it was impossible to decide whether a crime had been caused by the innate wickedness of the offender, or whether it resulted from a fit of moral insanity.

The Mental Deficiency Act of 1927 softened the term 'moral imbecile' — incorporated in the earlier Act of 1913 — to 'moral defective', but retained in its definition the words 'mental defectiveness coupled with strongly vicious or criminal propensities', and added 'who require care, supervision and control for the protection of others'. This was the forerunner of the psychopathic disorder definition in the Mental Health Act of 1959. Because many of those so constrained were not devoid of normal intelligence, placing them in hospitals for the mentally defective was neither appropriate nor beneficial.

Why psychopathic personality? As already mentioned, Schneider used the term to denote all varieties of abnormal personality, but his subgroups of explosive, affectionless, and weak willed come close to Henderson's categories of aggressive and inadequate psychopaths. Koch in Germany in 1891 introduced the term 'psychopathic inferiority' as a catch-all phrase implying a constitutional predisposition not only to neurosis but also to abnormalities and eccentricities of behaviour. At the time of his writing, psychiatric thought was dominated by concepts of degeneration and the hereditary transmission of 'the taint of insanity'. As such degeneration was often attributed to parental excesses, particularly alcoholism and sexual profligacy, it is understandable that what at first sight appeared to be persistent immoral or criminal behaviour became linked with the prevailing notions about psychopathic inferiority and moral insanity. Although in Britain the Royal Commission on the Law Relating to Mental Illness, 1954–7, repeatedly used the word 'psychopath', it avoided making any precise definition of what the word meant. Baroness Wootton (1959) considered that the modern psychopath is the linguistic descendant of the moral defective, which takes us back to 19th-century writings on moral insanity. Whatever word is used, it has to be admitted that making clear distinction between the mentally healthy offender and the presumably mentally abnormal one is not an easy task.

The question thus arises whether psychopathic personality should be classed as a form of mental disorder. Opinions differ widely, but as the psychopath now has legal status the existence of such a condition has understandably been put forward in criminal proceedings as a plea for mitigation of sentence. In some cases of homicide, the verdict has been reduced from murder to manslaughter on the basis of diminished responsibility as defined in the Homicide Act of 1959. But many psychiatrists would have reservations about claims that psychopathic disorder is a mental illness on a par with neurosis or psychosis. While it could be argued that it amounts to an abnormality of mind which could seriously impair the responsibility of an offender for his alleged homicidal act, what is 'abnormality of mind' in this context? The subject was clarified by Lord Chief Justice Parker, who said that it meant 'a state of mind so different from that of ordinary human beings that the reasonable man would term it abnormal'. He went on to indicate that such an opinion applied to a person's acts, his ability to decide whether they were right or wrong, and his capacity for exercising will power to control such behaviour in accordance with rational judgement. None the less, as Nigel Walker (1965) comments, 'It is clear ... that while a diagnosis of psychopathy is now recognized by English courts as an acceptable basis for a defence of diminished responsibility, the psychopath's chances of succeeding in this defence are by no means high'.

The causes and treatment of psychopathic disorder are as contentious as its legal implications. Theories of aetiology have included brain damage in childhood, late maturation of the central nervous system, and adverse circumstances of upbringing, particularly difficult relationships with parents and those in authority. As far as treatment is concerned, there is little evidence that a purely psychiatric approach to the problem has been successful. Controlled studies are hard to come by, but one such investigation found that firm but sympathetic handling in a disciplined environment was better than a more permissive approach based on group therapy and a self-governing type of regime. As the psychopath appears to lack the inner controls normally developed during childhood and adolescence, this result is hardly surprising. Time, however, seems to be a significant factor in treatment, an observation which could be interpreted as favouring the late maturation theory of psychopathic disorder. But in all probability learning over a period of years may also play a part in this process of maturation.

(Published 1987)

— F. A. Whitlock

Bibliography
• Craft, M. J. (1965). Ten Studies into Psychopathic Personality.
• Henderson, D. (1939). Psychopathic States.
• Robins, L. N. (1966). Deviant Children Grown Up.
• Schneider, K. (1958). Psychopathic Personalities. Trans. M. W. Hamilton.
• Walker, N. (1965). 'Liberty, liability and culpability'. Medicine, Science and the Law, Jan.
• Whitlock, F. A. (1967). 'Prichard and the concept of moral insanity'. Australian and New Zealand Journal of Psychiatry, 2.
• Wootton, B. (1959). Social Science and Social Pathology.

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