Archive for November, 2010

History of the Antisocial Personality Disorder – up to 20th century

November 14, 2010 9 comments

Cow, Dog, Sheep, Apple, Strawberry, Horse, Orange, Snake, Giraffe, Pear, Blueberry.

If I tell you to memorize the list of words given above, you will very likely use clustering to do that. After all, it is easy to remember something when you put it into a conceptual category, such as fruits and animals. The same process of concept formation exists when we define human behavior. When a person is belligerent, callous, insensitive and impulsive, we realize that we need to come up with a label through which we would describe these behavioral patterns that defy conventional norms. Now, for diagnostic purposes, clinical psychologists and personality disorder theorists use antisocial personality disorder as the commonly accepted term in order describe all the cognitive and behavioral patterns that through our folk psychology we attribute to sociopaths, antisocials, and psychopaths interchangeably.  Nevertheless, the term did not acquire a scientific meaning overnight. What are, then, the meaning’s origins?

There is no specific date that I can list. Humans have a variety of adjectives that are very similar to what we would describe as antisocial PD, and they probably use/used them indiscriminately.  A merchant who was been cheated by a customer somewhere in the 18th century would employ such expletives as knave, rogue, low-birth, villain, and scoundrel to describe the customer, while today, a citizen who is outraged by the government would rely on qualifiers like godless, blood-sucker, and fear-monger when describing a politician. These words, however, have little objective value. English language is rich in profanity and beauty, and its use is often influenced by our mistakes of attribution, us-versus-them thinking, education level, and culture. Psychology, a social science, requires a distinct definition based on observations.

Philippe Pinel, a French physician who developed a more humane approach towards the care of mental patients, noted in his Treatise on Insanity(1806) that several of his patients had a tendency for damaging and impulsive behavior. These patients, in addition to their hazardous inclinations, had an unimpaired intelligence and a full awareness about their wrongful behavior. Pinel described these patients as having la folie raisonnante (“insane without delirium” or “manic without delirium”). It is important to notice that he did not use the term in a derogatory, value-laden fashion. The definition was intended to be descriptive.

The same attitude that Pinel had towards the use of terms in describing pathologies was not shared by other physicians. For the most part, it was believed that someone who committed a morally wrong act because of dispositional factors.  It was out of question to feel pity for a thief or criminal; hence, antisocials were worthy of condemnation. James Cowles Prichard borrowed some of Pinel’s findings and coined the term moral insanity, which many physicians used to show their condescension to those who had no restraint against immoral compulsions. This attitude started a confirmation bias that was prevalent throughout the 19th century, 20th century, and 21st century pathology of antisocial personality disorder.

A prime example of this confirmation bias was the work of Cesare Lombroso, an Italian criminologist who tried to link anatomical defects to antisocial behavior.  Lombroso thought that criminals and other delinquents have some atavistic similarities with beasts. That is, the more beast-like you look, the more criminal you are. (A book by Samuel Robert Wells, which you can find here, has a large number of findings and drawings related to atavism). Here is a drawing that exaggerates some of those similarities:

A man with atavistic features. From: New Physiognomy or Signs of Character (1871)


Needless to say, such studies were performed in a Freudian fashion, where contradictory evidence is overlooked or neglected. The conclusions reached were of no good, too. For example, look at the drawing below. Based on arbitrary physiological differences between low and high foreheads, here is the recommendation given in Well’s book:

If thou hast a long, high forehead, contract no friendship with an almost spherical head; if thou hast an spherical head contract no friendship with a long, high, bony forehead. Such dissimilarity is especially unsuitable for matrimonial union.

A drawing showing the alleged psychological relationship between high and spherical foreheads. From: New Physiognomy or Signs of Character (1871)

Similar, absurd conclusions were reached by looking at differences between the profiles of different people and their intelligence:

Grades of Intelligence. From: New Physiognomy or Signs of Character (1871)

Luckily, at the end of the 19th century, physicians abandoned the penchant to morally classify individuals and approached the study of the antisocial personality disorder from a scientific perspective–through observation. J.L. Koch proposed in 1981 that the term moral insanity be dropped because it had a stigma attached to it and replace it with psychopathic inferiority. Eventually the word inferiority was discarded because it had a negative connotation and the term psychopathic was used (Millon et. al, 2004).

In the next post, I will talk about Demon Doctors.