Abstract
Despite a good deal of argument to the contrary (Maughs, 1941; Hunter and Macalpine, 1963; Walk, 1954; Walk and Walker, 1961; Craft, 1965; Whitlock, 1967) it is still commonly believed that Prichard's ‘moral insanity’ (1835) was the forerunner of our present-day concept of psychopathic (sociopathic) personality; the most recent example of this appearing in the paper by Davies and Feldman (1981), who write: ‘In 1801 Pinel described a condition termed by him manie sans délire, the notable feature of which was that the sufferer showed bouts of extreme violence but with no signs of psychosis … Prichard confirmed Pinel's observation and coined the term “moral insanity” which led to “a marked perversion of the natural impulses”.’ A number of modern textbooks (Sim, 1974; Friedman et al, 1975; Slater and Roth, 1977; Trethowan, 1979) also appear to regard moral insanity as the precursor of psychopathic disorder, although Trethowan correctly noted how the word ‘moral’ denoted ‘affective’ and was not being used in the usual ethical sense. He went on, however, to write that Prichard described cases showing antisocial or even criminal behaviour.
Highlights
Despite a good deal of argument to the contrary (Maughs, 1941; Hunter and Macalpine, 1963; Walk, 1954; Walk and Walker, 1961; Craft, 1965; Whitlock, 1967) it is still commonly believed that Prichard's 'moral insanity' (1835) was the forerunner of our present-day concept of psychopathic personality; the most recent example of this appearing in the paper by Davies and Feldman (1981), who write: 'In 1801 Pinel described a condition termed by him man;e sans delire, the notable feature of which was that the sufferer showed bouts of extreme violence but with no signs of psychosis
One might ask, has the error persisted? One might conjecture that few of the writers who maintain the identity of moral insanity and psychopathy have troubled to refer to the original texts
The second patient was probably subject to attacks of temporal lobe epilepsy with characteristic epigastric sensations rising into the neck and head, but without proceeding to a grand mal convulsion
Summary
Despite a good deal of argument to the contrary (Maughs, 1941; Hunter and Macalpine, 1963; Walk, 1954; Walk and Walker, 1961; Craft, 1965; Whitlock, 1967) it is still commonly believed that Prichard's 'moral insanity' (1835) was the forerunner of our present-day concept of psychopathic (sociopathic) personality; the most recent example of this appearing in the paper by Davies and Feldman (1981), who write: 'In 1801 Pinel described a condition termed by him man;e sans delire, the notable feature of which was that the sufferer showed bouts of extreme violence but with no signs of psychosis. Tuke (1892), like Maudsley, was clearly puzzled by examples of moral insanity diagnosed in individuals involved in criminal proceedings, but he warned against an excessive preoccupation with its association with crime and went on to discuss cases characterized by sudden attacks of depression for no cause as well as abnormal behaviour as the precursors of coarse brain disease This is in marked contrast to the ideas of modem writers on psychopathy; Scott (1960) excluded individuals with epilepsy, organic brain disease and psychosis' from his criteria for such a diagnosis. It is arguable that, had this gradual transformation from moral insanity via moral deficiency to psychopathy not occurred, psychiatry today would not be saddled with the thankless task of trying to treat individuals who can hardly be said to be either 'insane' or 'imbecile' in any generally accepted sense
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