Early Historical Forerunners

The antisocial personality has been known since at least the ancient Greeks. In the 1800s, the origins of antisocial behavior were associated with the philosophical debate between free will and determinism. Given such a context, the physicians of the 1800s naturally wondered whether antisocial persons could understand the consequences of their own actions. Philippe Pinel (1801, 1806) referred to a form of madness known as la folie raisonnante, a tendency toward impulsive and self-damaging acts in the presence of unimpaired intelligence and full awareness of actions. Pinel's observation was intended to be descriptive, not value-laden. The idea that psychopathology could occur in the absence of mental confusion then spread throughout Europe but was still hotly debated.

Other physicians regarded antisocial individuals as being defective in character and, therefore, worthy of moral condemnation. The term moral insanity, first used by Prichard (1835), crystallized this notion. Prichard held that despite understanding the choices before them, their conduct was swayed by overwhelming compulsions. He also broadened the syndrome to include diverse emotional and mental conditions, all of which shared a common inability to guide themselves according to an inner sense of rightness, goodness, and responsibility. Though unscientific, the idea of moral insanity still has a certain appeal, if only because the normal person often has no way of identifying with the more pathological actions of antisocials and psychopaths. Dahmer and Mudgett, discussed briefly at the beginning of this chapter, provide two examples. Toni is certainly less extreme, though we still wonder why she cannot understand the consequences her actions will have on her life.

Subsequent writers suggested parallels between anatomical defects and defects of character, though in a way that would be considered amusing today. For example, some believed that a specific cerebral center controlled morality (Maudsley, 1874). Just as some individuals are colorblind, some were regarded as morally blind. Other writers held that antisocials were born delinquents possessing common physical features, such as a large, projecting lower jaw, outstretched ears, sloping forehead, left-handedness, robust physique, precocious sexual development, insensitivity to pain, and muscular agility (Lombroso, 1887). Stone (1993) suggests that society needs the comfort of believing that criminals somehow look different to reassure ourselves that we are protected from true psychopaths, who cloak themselves with the trite and ordinary.

Toward the end of the nineteenth century, psychiatry began to turn away from moral classification and toward observational research. Koch (1891) proposed that the term moral insanity be replaced by psychopathic inferiority, explicitly casting the syndrome as an "inferiority of brain constitution" (p. 54). Though his intentions were the same as those of Pinel—to classify scientifically rather than morally—the choice of words was poor. "Inferiority" was eventually dropped in later usage, after the term traveled to the United States. The term psychopathic, literally meaning "psychological pathology," endured for the first three decades of the twentieth century, referring to a broad range of conditions far beyond our contemporary antisocial personality. Cleckley's 1941 work crystallized the construct of psychopathy in its modern form, thus launching a research tradition that has flourished ever since.

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