Psychopathic
Disorder by
TDSYCHOPATHIC ?/ fined in as
"a
disorder is dethe 1959 Mental Health
persistent
disorder
disability of mind (whether ?deluding subnormality of
or
or not
intelli-
gence) which results in abnormally aggressive or seriously irresponsible conduct
the part of the patient, or is susceptible to meditreatment". The Act also specifies lhat promiscuity or other immoral conduct should not alone be a cause on
and requires
al
)?r
action. Among
jj1? subject, define
the
recent writers on McCords (1959)
psychopathic disorder as conthe following cardinal features: firstly, guiltlessness or lack of ?name; secondly, lovelessness, or
fining
^capacity
to love or feel affection or to other humans; whilst Craft ^ "63) in addition cites impulsiveness 0r liability to act on the spur of the without forethought for the uture; and fourthly antisociality, or actual commission of illegal acts, as necessary parts of the full diagnostic syndrome. The Act, both books referred to above, and most other authors on the subject, recognise that
relate
foment
Uiere
are
degrees of personality dis-
Urbance varying
from normal to full
Psychopathic disorder.
^s/chopathic inferiority .
These
r?rn
statements
are
a
long
way
the original idea of "psychopathic inferiority" first elaborated by in 1889, as a general term for *nV mental disorder, and which Postulated a constitutional predisposi-
^0ch
!?n covering deviations and eccen5lcities of behaviour including syndromes now covered by the term Ueurosis". In fact, the term psychoPath is an example of a word which as once used to describe a fairly range of disorders in psychiatry, which has come to be successively Jnd etlned over the last 80 years so that
Michael
Crait,
M.D.
it is now only properly applied in Britain to the legal syndrome outlined in the first paragraph. A good deal of research has taken place in recent years, which shows that like other syndromes such as "chronic bronchitis" which doctors in the past have had much difficulty in outlining, psychopathy is a diagnosable entity with an aetiology which may well be particularly its own, and for which, although different methods have met with some success, the best treatment has yet to be developed. The causation of psychopathic personality can be considered from several points of view.
Heredity
and environment
Genetic endowment and environmental influences are the first two. Study here is complicated by the fact that the very parents who might endow their children with genetically adverse traits, are usually those same parents who may well give their children such an unfortunate environment that it is difficult to know which to cite as a cause of the psychopathic disorder. The only reliable way to differentiate between these is to follow the course of uniovular have twins who been separated shortly after birth and subjected to different environmental influences in
their developing years. Studies such
as
those of Newman
(1937), Schwesinger (1952) and Slater (1953) show that although such identical twins have a very similar response to environmental stimuli,
differing environments bring out a differing and continuing reaction pattern from each nevertheless can
twin and it is clear that the resultant adult personality depends to a great Such on the environment. extent studies have also shown that the development of intelligence in one
twin in
favourable environment can apace, whilst if the other is restricted by adverse influences it may well appear duller. It appears probable that due to genetic endowa
proceed
early pre-natal or post-natal influences, certain types of personality
ment or
have a particular susceptibility to adverse environmental circumstances. The environmental circumstances are responsible for the time sequence and initiation of a psychopathic disorder. Brain
damage
relationships
ment of
delinquency
or
psychopathy-
Later parent-child relationships seel1 from current research to be mos important elements in the product^ of delinquency and psychopath)' Bowlby's views, as redefined by Ain5 worth (1962) are in line with thi5' Lewis shows that maternal and patef nal hostility and disinterestedness aftl common findings in the history those with later personality distortion' the Gluecks (1962) in their compart'' son of 500 Massachussets' juveni'?l delinquents with 500 controls, brin?5 forth a mass of evidence that both maternal and patent poverty of relationships correlatil highly with later delinquency; McCords (1959) show that combinations of maternal and patef nal adverse attitudes correlate wit'3 particular varieties of crime; whils'a Craft (1963) shows that among psychopaths of sufficient severity tl; be candidates for Special Hospit3.; treatment, all except two had bot'1 parents who could be classified a'
showing
Fourthly,
maternal separation as a in psychopathy is commonly associated with the name of John Bowlby, but recent research has shown that it is very doubtful whether any of John Bowlby's original (1952) hypotheses are now tenable. Even Bowlby himself (1956) has admitted that the case was probably overstated. As Wootton (1959) has pointed out "that the damage (caused by maternal separation) is life-long or irreversible, that maternal deprivation is a major factor in criminal behaviour, or that the younger the child the greater the risk, all these must be regarded as quite unproven hypotheses". She states, and backs her statement with much evidence, that it remains to be proved that maternal separation as such is a pathogenic factor in psychopathy, and states that all that has been proved so far is "as things are at present children have a better chance of finding dependable love in families than in institutions". causative
betweef relationship paternal absence and later develop
convincing
A third cause is brain damage. Early investigators noted that this appeared to be responsible for differences between twins reared in the same environment. More recent investigations have shown that damage to the temporal lobe of the brain is particularly likely to produce aggressive and impulsive personalities, which may return to normal after surgical removal of a damaged temporal lobe, but this successful surgical treatment is unfortunately very rare.
Parental
In fact there has been no study *c date showing unequivocally thf delinquents receive more than the'j fair share of maternal separation, 0> that separated children are parties larly delinquent. The arguments aft dealt with at length elsewhere (Crafl 1963). Hilda Lewis's book whic' studied 500 children in Kent remoV^ from their parents is perhaps tb' most convincing evidence on this sub ject to date, and she too notes tb' common finding that there is also
factor
tb?(j
particula'j ^
neglectful, entirely passive, consisfr or unpredictably errati'b in the upbringing of their children, d
ently hostile
The fact that most reliable recent studies lead in the same
afl{?
dire^ profit
tion suggests that this is a very able field for future work. It it is unconfirmed possible, although that the existence of one loVfC( orientated parent, continuously contact with the developing chil%v prevents the development of
seefl^1
psychopathic disorder. 18
sevef'p
a
Farr,ily
and group influences set of factors important n the development of psychopathic 'sorder might be described as the ntluence of local group values and reet culture. These consist of conrelatives; of dominant spoiling gures such as a ! grandmother and of 'oungs in poor affective contact. as studies in Glasgow and have shown, delinquency ; nd recidivism can often be pincertain streets or areas, uo!nte
gingham
'
^nthropo!ogical evidence
From the anthropological point of !ew it might be thought that the lQse-knit western family, with the
of parental attitudes at ^culcation 0se quarters for many formative liable to ,^rs,Ce might be particularly disorder where so
jtk
psychopathic are persistently adverse. psychopathic disorder is in socially-defined syndrome, use
attitudes Ale?f though
,^rtthe a
first three cardinal clinical outlined initially enables one to iJ^pare syndromes developed in e^tern countries with those devel,0 ^ Ped in societies not primarily based the family unit. In the Samoans, ?
;c8ns
.
ead east
(1962) found feeding and
Number
that
a
diffusion of
nurturing among
of
females of all ages Ppeared to ensure the child greater t, ntinuity of human care and love an Possible in those societies where t, made by the child is li ?le to be to one mother ! figure only. ,
^ttachment
?
rJn the jewuP?n
children are communal nursery
Hutterites,
in large bvdrfe(^ / adults and one
are
mainly depen-
Peers for human , Such children have en found to become unduly depend Upon members of their own age and less independent at SCence than western children of co
their
^Panionship.
ad?VP c0? ^mparable
age groups. But family has advantages as fio, es disadvantages, to judge from from Israel, for the percenta ?f those admitted to mental
Vv^ln8as
probably
hospitals with personality disorders is in Kibbutzi where the reared in large communal nurseries, than from other Israeli communities where the upbringing of children is based on the family unit
slightly higher children
are
(Haslevi, 1960).
Diagnosis There has been very little advance in improvement in diagnostic methods in the field of psychopathic disorder in recent years. The difficulty is in defining the point at which psychopathic disorder can be differentiated from lesser degrees of personality disturbance. Tong and Murphy (1960) have recently reviewed stress reactivity and conditioning in relation to psychopathy and Craft and others (1962) describe a new method of
electroencephalographic but
both
assessment,
agree that several tests are more reliable than any one test used by itself. It seems probable that we shall have to await the refinement of a suitable group of tests and the aid of predictive indices before one can face a court and say that there is undoubted evidence of psychopathic disorder in the same way that one can vouch for, say, diabetes by using the glucose tolerance test. papers
Treatment Treatment has varied enormously, but has been more individual and empirical than any validated method assessed by any adequate follow up. Those who believe the condition is almost incurable, such as Cleckley, advocate destructive operations such as leucotomy, whereas Sturup regards an indefinite sentence as a necessity for treatment. Down the years there have been ardent advocates for drugs, such as amphetamine and barbiturates, physical procedures such as E.C.T., psychoanalysis and group psychotherapy, all characterised by enthusiastic initial reports and by inadequate follow-up studies. Only recently have any adequate follow-up studies of those diagnosed as psychopathic been presented:
Where
8-year follow-up of prisoners diagnosed as psychopathic found that 24% over an 8-year period had either one or no further reconvictions. Among these sufficiently severely disturbed to need admission to the maximum security wards of the special hospitals at Rampton, Broadmoor and Moss Side, Tong and McKay's figures show that at least 5% of all patients leave each Further data, Craft (1959) year. show that a group of such patients Gibbens in his
evaluated, and all
Brain damaS actions. 1 of the temporal lobe caU5 be a limbic systems may major tive factor, but it is more likely anti-social
genetic
ACKNOWLEDGEMENTS 1
Dr. Prentice and Dr. Gibbens the Royal Institution and Bethle11
Maudsley Hospitals, both
tutors
1
the author, are thanked for early present help and encouragement.
indif-
REFERENCES Bowlby, J. 1952: Maternal care and mental bc> ? (W.H.O.) Geneva. Ainsworth, M.; Boston, M.; Rosenbluth, D. The effects of mother-child separation, a f Brit. J. Med. Psychol. (29) 211 up study. Ainsworth, M. 1962: The effects of mate', deprivation; a review of findings and controve in the content of research strategy. W." Pub. Health Papers 14 p. 97. Cleckley, H. 1953: Discussion section, J. CI'0' Exp Psychol. (13) 179. Craft, M. J. 1959: Personality disorder and o Lancet (1) 856. ness. Craft, M. J. 1962: Psychopathic personalities',* review of diagnosis aetiology, treatment t prognosis. Brit. J. Criminol. (1) 237. Craft, M. J. 1963: 10 Studies into Psychop"1'1 Disorder, a report to the Home Office Mental Health Research Fund. (
1^.
the child is in the there is one love-orientated parent and no severe brain damage street adverse culture, severe or
Whilst
family,
to
tlj^
capable
dangerous adolesaggressive because he is embittered. From the lax, spoiling parental or grandmother combination come some of the relatively untrained impulsive adolescents who respond readily to directive leadership in later
likely
followed
various treatment methods are notf which are available for this disor^c
more
not
predisposition
adverse parental or group influeflc' upon the developing child are common factors, and it seems pr?: able that if the latter are sufficiefl1 severe genetic predisposition is A' necessary. Recent follow-up stud' show that even the severely affect of improvement, af are
cent who is
psychopathy is
say is tfr
particularly
ferent parent come at least some affectionless children and from these and the cold hostile parent probably
years.
one can
SUMMARY
alisation worse for the developing child, but it seems that the majority of cases of psychopathic disorder have both parents who are neglectful, hostile or unpredictably erratic in the training of their children. There is evidence to suggest that from the
the
^
Aided by the passage of the 19' Mental Health Act the syndrome ? psychopathic disorder is now limited as one with the cardie of features clinical guiltlessne; ^ affectionlessness, impulsivity
Prevention and treatment The next consideration is methods of prevention and treatment. Whilst one can do very little about genetic endowment, this is not by itself an important factor. Loss of a parent is a misfortune, and arid institution-
springs
a
permissive units, nor sho' term approaches are likely to g1' any long-term success. (Craft, 1963.)
for wall who had been treated moderate personality disorder for over six years showed that five years after discharge from hospital treatment over 78% were in employment and only 6% had been reconvicted (1962). These figures demonstrate the success of treatment.
or
adolescent has
neither
followed up five years after discharge have the same record in job holding and reconviction as a control group with lesser personality disturbance. A study of patients in Devon and Corn-
apathetic, neglectful, passive
an
developed psychopathic disorder ing to repeated court appearance,' requires fairly lengthy help, 9VI years and usually including perioj in penal units. For such people t* best treatment has yet to be adequate
convicted
develop. 20
J
M. J., Cr?ft. .Urnand
and Fabisch, G. and K.erridge, a psychopathic U68) 541. T. C. N., Pond, p,ens, ~?rk, D. 1959: A follow to
W., Stephenson, G., D
1962: 100 AdmisMent. Sci.
unit. J.
and Stafford D. up study of criminal J. Ment. Sci. (105) 108 and S. 1962: Family Environment and Paul, Routledge and Kegan A.
Psychopaths. E.
LondqUenCy'
H. S. 1960: Mental Illness in Israel, Health, Jerusalem. 1^89: Lestfaden der Psychiatrie. i' L. 1893: Die psychopathischen Minder8 e'1Maier Ravensburg. O.U.P., deprived Children.
KorhniSTtry Koch
w?'
I_e,v-
Londo^' ^r^rd'
an^ J- 1959: Origins of Crime. Univ" Press- NYC1962: A cultural anthropologist's anr.' Ho i?>ac^ to maternal deprivation. W H.O. Pub. 4ealth Papers (14) 45.
Mean
Newman, H. H. Freeman; F. N. Holzinger, K. 1937: Twins: a study of heredity and environment.
Schwesinger, G. C. 1952: The effect of differential on twin relations identical parent-child resemblance in personality. Act. a Genet. Med. Gemell (1) 40. Slater, E. T O. 1953: Psychotic and Neurotic Illness in twins. M.R.C. special reports. Series No. 278 H.M.S.O.
Sturup, G. 1948: Management and Treatment of Psychopaths in a special institution in Denmark. Proc. Roy. Soc. Med (41) 765. Tong, J.; Murphy, I. 1960: A review of stress reactivity research. J. Ment. Sci. (106) 1,273. Tong, J. and Mackay, G. W., 1959: A statistical F.U. of mental defectives of dangerous or violent propensities. Brit. Journal of Delin(9) 276. quency. Wootton, B. 1959: Social Science and Social Pathology. Allen and Unwin. London. Annual Reports of the Ministry of Health: H.M.S O.
Disorder by
TDSYCHOPATHIC ?/ fined in as
"a
disorder is dethe 1959 Mental Health
persistent
disorder
disability of mind (whether ?deluding subnormality of
or
or not
intelli-
gence) which results in abnormally aggressive or seriously irresponsible conduct
the part of the patient, or is susceptible to meditreatment". The Act also specifies lhat promiscuity or other immoral conduct should not alone be a cause on
and requires
al
)?r
action. Among
jj1? subject, define
the
recent writers on McCords (1959)
psychopathic disorder as conthe following cardinal features: firstly, guiltlessness or lack of ?name; secondly, lovelessness, or
fining
^capacity
to love or feel affection or to other humans; whilst Craft ^ "63) in addition cites impulsiveness 0r liability to act on the spur of the without forethought for the uture; and fourthly antisociality, or actual commission of illegal acts, as necessary parts of the full diagnostic syndrome. The Act, both books referred to above, and most other authors on the subject, recognise that
relate
foment
Uiere
are
degrees of personality dis-
Urbance varying
from normal to full
Psychopathic disorder.
^s/chopathic inferiority .
These
r?rn
statements
are
a
long
way
the original idea of "psychopathic inferiority" first elaborated by in 1889, as a general term for *nV mental disorder, and which Postulated a constitutional predisposi-
^0ch
!?n covering deviations and eccen5lcities of behaviour including syndromes now covered by the term Ueurosis". In fact, the term psychoPath is an example of a word which as once used to describe a fairly range of disorders in psychiatry, which has come to be successively Jnd etlned over the last 80 years so that
Michael
Crait,
M.D.
it is now only properly applied in Britain to the legal syndrome outlined in the first paragraph. A good deal of research has taken place in recent years, which shows that like other syndromes such as "chronic bronchitis" which doctors in the past have had much difficulty in outlining, psychopathy is a diagnosable entity with an aetiology which may well be particularly its own, and for which, although different methods have met with some success, the best treatment has yet to be developed. The causation of psychopathic personality can be considered from several points of view.
Heredity
and environment
Genetic endowment and environmental influences are the first two. Study here is complicated by the fact that the very parents who might endow their children with genetically adverse traits, are usually those same parents who may well give their children such an unfortunate environment that it is difficult to know which to cite as a cause of the psychopathic disorder. The only reliable way to differentiate between these is to follow the course of uniovular have twins who been separated shortly after birth and subjected to different environmental influences in
their developing years. Studies such
as
those of Newman
(1937), Schwesinger (1952) and Slater (1953) show that although such identical twins have a very similar response to environmental stimuli,
differing environments bring out a differing and continuing reaction pattern from each nevertheless can
twin and it is clear that the resultant adult personality depends to a great Such on the environment. extent studies have also shown that the development of intelligence in one
twin in
favourable environment can apace, whilst if the other is restricted by adverse influences it may well appear duller. It appears probable that due to genetic endowa
proceed
early pre-natal or post-natal influences, certain types of personality
ment or
have a particular susceptibility to adverse environmental circumstances. The environmental circumstances are responsible for the time sequence and initiation of a psychopathic disorder. Brain
damage
relationships
ment of
delinquency
or
psychopathy-
Later parent-child relationships seel1 from current research to be mos important elements in the product^ of delinquency and psychopath)' Bowlby's views, as redefined by Ain5 worth (1962) are in line with thi5' Lewis shows that maternal and patef nal hostility and disinterestedness aftl common findings in the history those with later personality distortion' the Gluecks (1962) in their compart'' son of 500 Massachussets' juveni'?l delinquents with 500 controls, brin?5 forth a mass of evidence that both maternal and patent poverty of relationships correlatil highly with later delinquency; McCords (1959) show that combinations of maternal and patef nal adverse attitudes correlate wit'3 particular varieties of crime; whils'a Craft (1963) shows that among psychopaths of sufficient severity tl; be candidates for Special Hospit3.; treatment, all except two had bot'1 parents who could be classified a'
showing
Fourthly,
maternal separation as a in psychopathy is commonly associated with the name of John Bowlby, but recent research has shown that it is very doubtful whether any of John Bowlby's original (1952) hypotheses are now tenable. Even Bowlby himself (1956) has admitted that the case was probably overstated. As Wootton (1959) has pointed out "that the damage (caused by maternal separation) is life-long or irreversible, that maternal deprivation is a major factor in criminal behaviour, or that the younger the child the greater the risk, all these must be regarded as quite unproven hypotheses". She states, and backs her statement with much evidence, that it remains to be proved that maternal separation as such is a pathogenic factor in psychopathy, and states that all that has been proved so far is "as things are at present children have a better chance of finding dependable love in families than in institutions". causative
betweef relationship paternal absence and later develop
convincing
A third cause is brain damage. Early investigators noted that this appeared to be responsible for differences between twins reared in the same environment. More recent investigations have shown that damage to the temporal lobe of the brain is particularly likely to produce aggressive and impulsive personalities, which may return to normal after surgical removal of a damaged temporal lobe, but this successful surgical treatment is unfortunately very rare.
Parental
In fact there has been no study *c date showing unequivocally thf delinquents receive more than the'j fair share of maternal separation, 0> that separated children are parties larly delinquent. The arguments aft dealt with at length elsewhere (Crafl 1963). Hilda Lewis's book whic' studied 500 children in Kent remoV^ from their parents is perhaps tb' most convincing evidence on this sub ject to date, and she too notes tb' common finding that there is also
factor
tb?(j
particula'j ^
neglectful, entirely passive, consisfr or unpredictably errati'b in the upbringing of their children, d
ently hostile
The fact that most reliable recent studies lead in the same
afl{?
dire^ profit
tion suggests that this is a very able field for future work. It it is unconfirmed possible, although that the existence of one loVfC( orientated parent, continuously contact with the developing chil%v prevents the development of
seefl^1
psychopathic disorder. 18
sevef'p
a
Farr,ily
and group influences set of factors important n the development of psychopathic 'sorder might be described as the ntluence of local group values and reet culture. These consist of conrelatives; of dominant spoiling gures such as a ! grandmother and of 'oungs in poor affective contact. as studies in Glasgow and have shown, delinquency ; nd recidivism can often be pincertain streets or areas, uo!nte
gingham
'
^nthropo!ogical evidence
From the anthropological point of !ew it might be thought that the lQse-knit western family, with the
of parental attitudes at ^culcation 0se quarters for many formative liable to ,^rs,Ce might be particularly disorder where so
jtk
psychopathic are persistently adverse. psychopathic disorder is in socially-defined syndrome, use
attitudes Ale?f though
,^rtthe a
first three cardinal clinical outlined initially enables one to iJ^pare syndromes developed in e^tern countries with those devel,0 ^ Ped in societies not primarily based the family unit. In the Samoans, ?
;c8ns
.
ead east
(1962) found feeding and
Number
that
a
diffusion of
nurturing among
of
females of all ages Ppeared to ensure the child greater t, ntinuity of human care and love an Possible in those societies where t, made by the child is li ?le to be to one mother ! figure only. ,
^ttachment
?
rJn the jewuP?n
children are communal nursery
Hutterites,
in large bvdrfe(^ / adults and one
are
mainly depen-
Peers for human , Such children have en found to become unduly depend Upon members of their own age and less independent at SCence than western children of co
their
^Panionship.
ad?VP c0? ^mparable
age groups. But family has advantages as fio, es disadvantages, to judge from from Israel, for the percenta ?f those admitted to mental
Vv^ln8as
probably
hospitals with personality disorders is in Kibbutzi where the reared in large communal nurseries, than from other Israeli communities where the upbringing of children is based on the family unit
slightly higher children
are
(Haslevi, 1960).
Diagnosis There has been very little advance in improvement in diagnostic methods in the field of psychopathic disorder in recent years. The difficulty is in defining the point at which psychopathic disorder can be differentiated from lesser degrees of personality disturbance. Tong and Murphy (1960) have recently reviewed stress reactivity and conditioning in relation to psychopathy and Craft and others (1962) describe a new method of
electroencephalographic but
both
assessment,
agree that several tests are more reliable than any one test used by itself. It seems probable that we shall have to await the refinement of a suitable group of tests and the aid of predictive indices before one can face a court and say that there is undoubted evidence of psychopathic disorder in the same way that one can vouch for, say, diabetes by using the glucose tolerance test. papers
Treatment Treatment has varied enormously, but has been more individual and empirical than any validated method assessed by any adequate follow up. Those who believe the condition is almost incurable, such as Cleckley, advocate destructive operations such as leucotomy, whereas Sturup regards an indefinite sentence as a necessity for treatment. Down the years there have been ardent advocates for drugs, such as amphetamine and barbiturates, physical procedures such as E.C.T., psychoanalysis and group psychotherapy, all characterised by enthusiastic initial reports and by inadequate follow-up studies. Only recently have any adequate follow-up studies of those diagnosed as psychopathic been presented:
Where
8-year follow-up of prisoners diagnosed as psychopathic found that 24% over an 8-year period had either one or no further reconvictions. Among these sufficiently severely disturbed to need admission to the maximum security wards of the special hospitals at Rampton, Broadmoor and Moss Side, Tong and McKay's figures show that at least 5% of all patients leave each Further data, Craft (1959) year. show that a group of such patients Gibbens in his
evaluated, and all
Brain damaS actions. 1 of the temporal lobe caU5 be a limbic systems may major tive factor, but it is more likely anti-social
genetic
ACKNOWLEDGEMENTS 1
Dr. Prentice and Dr. Gibbens the Royal Institution and Bethle11
Maudsley Hospitals, both
tutors
1
the author, are thanked for early present help and encouragement.
indif-
REFERENCES Bowlby, J. 1952: Maternal care and mental bc> ? (W.H.O.) Geneva. Ainsworth, M.; Boston, M.; Rosenbluth, D. The effects of mother-child separation, a f Brit. J. Med. Psychol. (29) 211 up study. Ainsworth, M. 1962: The effects of mate', deprivation; a review of findings and controve in the content of research strategy. W." Pub. Health Papers 14 p. 97. Cleckley, H. 1953: Discussion section, J. CI'0' Exp Psychol. (13) 179. Craft, M. J. 1959: Personality disorder and o Lancet (1) 856. ness. Craft, M. J. 1962: Psychopathic personalities',* review of diagnosis aetiology, treatment t prognosis. Brit. J. Criminol. (1) 237. Craft, M. J. 1963: 10 Studies into Psychop"1'1 Disorder, a report to the Home Office Mental Health Research Fund. (
1^.
the child is in the there is one love-orientated parent and no severe brain damage street adverse culture, severe or
Whilst
family,
to
tlj^
capable
dangerous adolesaggressive because he is embittered. From the lax, spoiling parental or grandmother combination come some of the relatively untrained impulsive adolescents who respond readily to directive leadership in later
likely
followed
various treatment methods are notf which are available for this disor^c
more
not
predisposition
adverse parental or group influeflc' upon the developing child are common factors, and it seems pr?: able that if the latter are sufficiefl1 severe genetic predisposition is A' necessary. Recent follow-up stud' show that even the severely affect of improvement, af are
cent who is
psychopathy is
say is tfr
particularly
ferent parent come at least some affectionless children and from these and the cold hostile parent probably
years.
one can
SUMMARY
alisation worse for the developing child, but it seems that the majority of cases of psychopathic disorder have both parents who are neglectful, hostile or unpredictably erratic in the training of their children. There is evidence to suggest that from the
the
^
Aided by the passage of the 19' Mental Health Act the syndrome ? psychopathic disorder is now limited as one with the cardie of features clinical guiltlessne; ^ affectionlessness, impulsivity
Prevention and treatment The next consideration is methods of prevention and treatment. Whilst one can do very little about genetic endowment, this is not by itself an important factor. Loss of a parent is a misfortune, and arid institution-
springs
a
permissive units, nor sho' term approaches are likely to g1' any long-term success. (Craft, 1963.)
for wall who had been treated moderate personality disorder for over six years showed that five years after discharge from hospital treatment over 78% were in employment and only 6% had been reconvicted (1962). These figures demonstrate the success of treatment.
or
adolescent has
neither
followed up five years after discharge have the same record in job holding and reconviction as a control group with lesser personality disturbance. A study of patients in Devon and Corn-
apathetic, neglectful, passive
an
developed psychopathic disorder ing to repeated court appearance,' requires fairly lengthy help, 9VI years and usually including perioj in penal units. For such people t* best treatment has yet to be adequate
convicted
develop. 20
J
M. J., Cr?ft. .Urnand
and Fabisch, G. and K.erridge, a psychopathic U68) 541. T. C. N., Pond, p,ens, ~?rk, D. 1959: A follow to
W., Stephenson, G., D
1962: 100 AdmisMent. Sci.
unit. J.
and Stafford D. up study of criminal J. Ment. Sci. (105) 108 and S. 1962: Family Environment and Paul, Routledge and Kegan A.
Psychopaths. E.
LondqUenCy'
H. S. 1960: Mental Illness in Israel, Health, Jerusalem. 1^89: Lestfaden der Psychiatrie. i' L. 1893: Die psychopathischen Minder8 e'1Maier Ravensburg. O.U.P., deprived Children.
KorhniSTtry Koch
w?'
I_e,v-
Londo^' ^r^rd'
an^ J- 1959: Origins of Crime. Univ" Press- NYC1962: A cultural anthropologist's anr.' Ho i?>ac^ to maternal deprivation. W H.O. Pub. 4ealth Papers (14) 45.
Mean
Newman, H. H. Freeman; F. N. Holzinger, K. 1937: Twins: a study of heredity and environment.
Schwesinger, G. C. 1952: The effect of differential on twin relations identical parent-child resemblance in personality. Act. a Genet. Med. Gemell (1) 40. Slater, E. T O. 1953: Psychotic and Neurotic Illness in twins. M.R.C. special reports. Series No. 278 H.M.S.O.
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