History of PDs - Part III

In his work (1939), Henderson described three types of psychopaths. Aggressive psychopaths were violent, suicidal, and prone to substance abuse.

In his work (1939), Henderson described three types of psychopaths. Aggressive psychopaths were violent, suicidal, and prone to substance abuse. Passive and inadequate psychopaths were over-sensitive, unstable and hypochondriacal. They were also introverts (schizoid) and pathological liars. Creative psychopaths were all dysfunctional people who managed to become famous or infamous.

Twenty years later, in the 1959 Mental Health Act for England and Wales, "psychopathic disorder" was defined thus, in section 4(4):

"(A) persistent disorder or disability of mind (whether or not including subnormality of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient, and requires or is susceptible to medical treatment."

This definition reverted to the minimalist and cyclical (tautological) approach: abnormal behavior is that which causes harm, suffering,or discomfort to others. Such behavior is, ipso facto, aggressive or irresponsible. Additionally it failed to tackle and even excluded manifestly abnormal behavior that does not require or is not susceptible to medical treatment.

Thus, "psychopathic personality" came to mean both "abnormal" and "antisocial". This confusion persists to this very day. Scholarly debate still rages between those, such as the Canadian Robert, Hare, who distinguish the psychopath from the patient with mere antisocial personality disorder and those (the orthodoxy) who wish to avoid ambiguity by using only the latter term.

Moreover, these nebulous constructs resulted in co-morbidity. Patients were frequently diagnosed with multiple and largely overlapping personality disorders, traits, and styles. As early as 1950, Schneider wrote:

"Any clinician would be greatly embarrassed if asked to classify into appropriate types the psychopaths (that is abnormal personalities) encountered in any one year."

Today, most practitioners rely on either the Diagnostic and Statistical Manual (DSM), now in its fourth, revised text, edition or on the International Classification of Diseases (ICD), now in its tenth edition.

The two tomes disagree on some issues but, by and large, conform to each other.