Diagnosis sociopath: origins

(cont.)

As previously stated, the psychopathy construct has a long history with changing personality patterns and clinical characteristics, dating back through the past two centuries.

Phillipe Pinel is generally credited with recognizing psychopathy as a specific mental disorder. Pinel advocated for appropriate, moral treatment rather than cruel interventions (e.g., bloodletting, cold baths) as the preferred method of intervention for the psychiatrically ill (Pinel, 1801/1962). Pinel’s contributions occurred in France shortly after the French Revolution. Prior to this time, France was ruled by a strict class structure and sanity was judged by the Old Testament of the Bible. In 1801, Pinel observed that some of his patients engaged in impulsive acts, had episodes of extreme violence, and caused self-harm. He noted that these individuals were able to comprehend the irrationality of what they were doing. There was no evidence of what is now considered psychosis, and their reasoning abilities did not appear to be impaired. He described these men as suffering from manie sans délire (insanity without delirium). As Pinel explained, “I was not a little surprised to find many maniacs who at no period gave evidence of any lesion of understanding, but who were under the dominion of instinctive and abstract fury, as if the faculties of affect alone had sustained injury” (p. 9). His observations were very controversial during this era, especially because a low intellect and symptoms of psychosis were the typical criteria for identifying mental illness (Stevens, 1993).

In the early 1800s, Benjamin Rush, an American psychiatrist, also documented confusing cases that were described by clarity of thought along with moral depravity in behavior. However, Rush (1812) went beyond Pinel’s more affectively based description and maintained that moral derangement was either a birth defect or was caused by disease. Rush believed this condition was primarily congenital. As he stated, “There is probably an original defective organization in those parts of the body which are preoccupied by the moral faculties of the mind”. In addition, Rush held that “it is the business of medicine to aid both religion and law, in preventing and curing their moral alienation of the mind”. The American psychiatrist maintained that the lack of morality was primarily hereditary, yet unstable environments were largely responsible for fostering its growth. Rush further claimed that offenders with mental defects were best treated in medical rather than custodial institutions. Benjamin Rush is recognized as one of the first to begin what has since become a long-standing practice of social condemnation toward individuals labeled psychopathic.