Wednesday, April 21, 2010

Diagnosis sociopath: the hate

(cont.)
The appropriate designation for what is today known as psychopathy underwent several changes and iterations. In 1891, Koch used the term psychopathic inferiority to characterize individuals who engaged in abnormal behaviors due to heredity but who were not insane. They were determined to have moral defects, but these defects were not equated with viciousness or wickedness. This new terminology (i.e., psychopathic inferiority) described emotional and moral aberration based on congenital factors and found wide acceptance in Europe and America. However, notwithstanding Koch’s efforts, the meaning of psychopathy in subsequent years once again became something quite pejorative but also something more reflective of the internal world and personality traits of the individual.

Maudsley (1897/1977) was a British psychiatrist who asserted that persons prone to moral imbecility could not be rehabilitated in prisons. Maudsley argued that moral imbecility was caused by cerebral deficits. As such, he believed it was useless to punish those who could not control their actions and wrote the following as evidence of moral imbecility: "When we find young children, long before they can possibly know what vice and crime means, addicted to extreme vice, or committing great crimes, with an instinctive facility, and as if from an inherent proneness to criminal actions . . . and when experience proves that punishment has no reformatory effect upon them—that they cannot reform—it is made evident that moral imbecility is a fact, and that punishment is not the fittest treatment of it."

Krafft-Ebing (1904) was even less sympathetic toward those considered morally depraved[,] assert[ing] that such individuals were “without prospect of success” and commented that “these savages . . . must be kept in asylums for their own[good] and [for] the safety of society.” It was at this historical juncture that psychopathic individuals were regarded as impervious to rehabilitation and that chronic social deviance was equated with pathology.

By 1915, Kraepelin expanded Koch’s psychopathic inferiority terminology to contain categories essentially defined by the most vicious and wicked of disordered offenders. His psychopathic personalities described in detail the “born criminal . . . the excitable, shiftless, impulsive types, the liars, swindlers, antisocial and troublemaking types”. Clearly with these characterizations, Kraepelin moved the focus of psychopathy back to one of moral judgment and social condemnation.

Interestingly, as Millon et al. (1998, p. 19) note, his categories of psychopathic personalities more closely represent our conceptualization of psychopathy and ASPD today. He described these disordered individuals as "the enemies of society . . . characterized by a blunting of the moral elements. They are often destructive and threatening . . . there is a lack of deep emotional reaction; and of sympathy and affection they have little. They are apt to have been troublesome in school, given to truancy and running away. Early thievery is common among them and they commit crimes of various kinds."

Tuesday, April 20, 2010

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.

Monday, April 19, 2010

Diagnosis sociopath: overview

This week I want to talk about the origin of and continuing confusion over sociopathy as a psychiatric diagnosis. Unless otherwise indicated, the material/information is taken (edited for length) from "The Confusion Over Psychopathy (I): Historical Considerations," a paper by Bruce A. Arrigo and Stacey Shipley, printed in International Journal of Offender Therapy and Comparative Criminology, 45(3), 2001 325-344.
Notwithstanding its extensive heritage, psychopathy has been plagued by changing and uncertain diagnostic nomenclature. For example, a great deal of confusion currently exists regarding the relationship between Antisocial Personality Disorder (ASPD), as identified by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM–IV), and the modern construct of psychopathy as explained by Cleckley (1941) and further refined and empirically validated by Hare (1985, 1991). Although contemporary research supporting the diagnosis of psychopathy is at its strongest, mental health professionals remain perplexed when diagnosing, treating, or making recommendations to the court system about these individuals.

In general, we note that the psychopathic label (i.e., explanation) has changed from the morally neutral view of Pinel (1801/1962) to the more truculent and disparaging characterization described by Kraepelin (1915). In addition, the designation itself has evolved from the unpopular term insanity, to the controversial expression moral, to the present moniker psychopathic. The elusiveness of the psychopathic construct and its meaning is further confounded by the theoretical basis out of which social scientists approach and investigate this mental disorder. Indeed, some researchers invoke descriptors for psychopathy, implying that the individual experiences morality problems that are solely personality based, exclusively congenitally or biologically derived (Ellard, 1988; Schneider, 1958; Smith, 1978), or principally behaviorally grounded (American Psychiatric Association, 1994). Moreover, notwithstanding these interpretations, Hare’s (1996) empirical and qualitative findings consistently demonstrate that the psychopath has distinctive affective, interpersonal, and behavioral attributes.

Psychopathic individuals historically and at present are almost uniformly considered difficult, if not impossible, to treat. We submit that the diagnostic confusion surrounding psychopathy (i.e., the label and its meaning) and the adverse consequences persons in the mental health and criminal justice systems (potentially) experience in the wake of such a determination, warrant closer scrutiny. Although clearly not exhaustive, this overview will provide an important backdrop, making it possible to assess provisionally how psychopathy evolved into a mental disorder and a pejorative label.

In particular, we will consider the logic of linking psychopathy, as applied to forensic clients, with the behavioral diagnosis of ASPD. This notwithstanding, the progression of thought contained within each of the components or categories demonstrates the course of psychopathy’s development and demonstrates how each has ostensibly functioned along a continuum (e.g., social condemnation as morally neutral to morally reprehensible, the disorder’s description based on personality to behavioral traits, and the locus of treatment from asylums to prisons).

Wednesday, April 14, 2010

Can a child be a sociopath?

A mother sends her adopted son back to Russia with the note: "I am sorry to say that for the safety of my family, friends, and myself. I no longer wish to parent this child. As he is a Russian national, I am returning him to your guardianship. . . . He is violent and has severe psychopathic issues."

There are a few fun things about this piece of news. First, like Octomom, this is a subject on which everyone seems to have an opinion, from those that think that this is part of a plot by Russia to export its sociopaths to the U.S., to those that think that all you need is love to make him turn good. Second, the kid's life is probably ruined now that he is outted for eternity as a psychopath, but it is a good cautionary tale for other misbehaving child sociopaths, particularly those with foreign citizenship. Third, this video:


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