Dr Fiachra Byrne (University College Dublin) 

The Prototypical Personality Disorder

Psychopathy has been described as ‘one of the most important concepts to ever emerge in forensic psychology and law’.[1] The association of this prototypical personality disorder with antisocial and criminal behaviour and its apparent widespread prevalence within prison and offender populations has long made it a fit object of both medical and political concern. Its salience for forensic psychiatry and prison medicine is also predicated on its occupation of a diffuse and ill-defined boundary space between criminality and mental illness. Although a nebulous and divisive concept even amongst medical professionals, the creation of psychopathic disorder as a legal entity in England and Wales in 1959 owes much to the campaigning efforts of British psychiatrists. Despite its historical significance and relevance to contemporary research, psychopathy is not currently a recognized discrete personality disorder in either the International Statistical Classification of Disease and Related Health Problems (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Instead, a range of related but non-identical clinical and legal constructs, most notably ‘Anti-Social Personality Disorder and Conduct Disorder’, have since supplanted it in these official taxonomies.

Mental Defect

In the early twentieth century, ‘mental defect’ was typically considered ‘the one vital mental constitutional factor in the etiology of crime’.[2] Yet, despite the passage of the Mental Deficiency Acts (1913, 1927), relatively few prisoners were dealt with under this legislation. By the mid-twentieth century the category mental deficiency, as applied to criminal and prisoner populations, was declining in salience and this provided space for the propagation of other diagnostic categories, including psychopathic personality. Dr Kenneth Milner, Medical Superintendent at Aston Hall Mental Deficiency Institution and a former medical officer at Dartmoor Prison, writing in 1949, doubted that anything approaching 10 per cent of the prison population could be considered mentally defective and cited an investigation of 200 unselected prisoners by his senior colleague at Dartmoor, Dr John Landers, which ‘did not find one frank mental defective, although 8.5 per cent were of subnormal intelligence’.[3] Likewise, Dr Norwood East, the former Medical Commissioner of Prisoners, considered that the importance of mental defectiveness in relation to crime had been exaggerated and this had delayed the forensic study of psychopathic personalities.[4]

Non-Sane, Non-Insane

For East, the psychopath was largely commensurate with the so-called ‘non-sane, non-insane’ – that is, those offenders who while meeting the legal criteria for responsibility were yet deemed mentally abnormal – a proportion of whom would eventually inhabit Grendon Psychiatric Prison, which opened in 1962. Largely in common with the views of the Scottish psychiatrist David Henderson, East was also clear that the psychopathic personality should not be understood in terms of mental defect, and that it was a persistent, maladaptive, and antisocial disorder. Henderson, in his influential 1937 monograph, Psychopathic States, had in fact delineated three psychopathic subtypes – the aggressive, passive and creative types. While a precise definition of the psychopathic personality remained singularly elusively and the construct itself controversial, Henderson’s conception of the aggressive psychopath was particularly decisive in framing the evidence of medical witnesses, such as Maxwell Jones and Louis Minski, lobbying the Percy Commission. The commission’s report formed the basis of the 1959 Mental Health Act, which, while defining psychopathic disorder in terms of its persistence and independence from mental deficiency, also focused on its aggressive and antisocial traits.

Prison Population

East had been circumspect in his assessment of the prevalence of psychopathic personality within the prison population, estimating that it might apply to some five per cent of inmates. While such an appraisal was considered appropriate for the operation of the 1959 Act, other experts reasoned that anywhere between half and three-quarters of prisoners could be regarded as having a psychopathic personality to some degree.[5] In more recent studies, some 63 per cent of male remand prisoners, 49 per cent of male sentenced prisoners and 31 per of female prisoners have been assessed as having antisocial personality disorder.[6]

Dangerous and Severe Personality Disorder

Psychiatric opinion and lobbying, despite evident divisions, had been influential in the 1959 legislative definition of psychopathic disorder. However, the decline of medical influence was indicated by the UK government’s introduction in 1999 of the highly questionable medico-legal term, ‘Dangerous and Severe Personality Disorder’ together with an associated prison treatment programme, at great expense, and despite the express disapproval of the majority of UK-based forensic psychiatrists.[7] This ‘substantial overlap’ between psychopathy and the criminal and prison populations, indicates the circularity of the concept as psychopathy, and indeed other ‘severe personality disorders’, are substantially defined in terms of aggressive behaviour and criminal history;[8] this has led some to consider the category to be one of ‘doubtful validity’.[9]

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Notes

Image Credit: El psicópata / Psychopath, 1993, Dibujos de juventud (CC BY-NC 2.0).

[1] T. Nicholls and J. Petrilla, ‘Gender and Psychopathy’, Behavioral Sciences & the Law, 23:6 (2005), 729-741, p. 729.

[2] C. Goring, The English Convict (London, 1913), p. 184.

[3] K. Milner, ‘Delinquent Types of Mentally Defective Persons’, Journal of Mental Science, 95:401 (1949), 842-859, p. 842.

[4] N. East, ‘Psychopathic Personality and Crime’, Journal of Mental Science, 91, 385 (1945), 426-446, p. 426.

[5] T.C.N. Gibbens, O. Briscoe and S. Dell, ‘Psychopathic and Neurotic Offenders in Mental Hospitals’ in A.V. de Reuck and R. Porter (eds), The Mentally Abnormal Offender (London, 1968), pp. 143-148, p. 144.

[6] N. Singleton et al., Psychiatric Morbidity Among Prisoners: Summary Report (London, 1997), p. 10.

[7] A.W. Haddock et al., ‘Managing People with Severe Personality Disorder: A Survey of Forensic Psychiatrists’ Opinions’, BJPsych Bulletin, 25: 8 (2001), 293–296.

[8] T. Seddon, ‘Dangerous Liaisons: Personality Disorder and the Politics of Risk’, Punishment and Society, 10 (2008), 305.

[9] J.S. Callender, Free Will and Responsibility (Oxford, 2010), p. 287.