Prichard, James Cowles

   (1786–1848)

   Best known for his concept "moral insanity," Prichard was born at Ross in Herefordshire, England, into a cultivated Quaker family but was raised in Bristol. He earned his M.D. from Edinburgh in 1808, and shortly thereafter began practicing medicine in Bristol. There, he began studies of an anthropological nature (e.g., why do Africans have black skin). In 1811, he was elected physician to St. Peter’s Hospital, which had many psychiatric patients. Based on this experience, in 1822 he wrote his Treatise on Diseases of the Nervous System . . . Comprising Convulsive and Maniacal Affections (1822), which pioneered a number of concepts in epileptology, including that of "partial epilepsy," involving some particular part of the body. (See Epilepsy.) In an article in The Cyclopaedia of Practical Medicine (1833–1835), Prichard first proposed the notion of moral insanity as a form of partial insanity involving mainly the passions and the will but not otherwise "madness," meaning no hallucinations or delusions. He enlarged his notions in 1835 in Treatise on Insanity and Other Disorders Affecting the Mind. Prichard said, "This form of mental derangement has been described as consisting in a morbid perversion of the feelings, affections, and active powers, without any illusion or erroneous conviction impressed upon the understanding." Intelligence was preserved in the disorder: "They often display great ingenuity in giving reasons for the eccentricities of their conduct . . . and justifying the state of moral feeling under which they appear to exist. In one sense, indeed, their intellectual faculties may be termed unsound; they think and act under the influence of strongly excited feelings, and persons accounted sane are, under such circumstances, proverbially liable to error both in judgment and conduct" (pp. 20–21).

   Yet, Prichard did not otherwise well delineate the term, and it was quickly overtaken by the more careful definitions of the French and German nosologists. (The English have never been in the international forefront of disease-naming.) Nonetheless, in the judgment of psychiatry historians Richard Hunter and Ida Macalpine, "It was Prichard who first put at the centre of the psychiatric map the many mental disorders which reveal themselves only by disturbances of affect and behaviour and which had been largely neglected at the periphery" (Three Hundred Years of Psychiatry, p. 837). For later generations, "moral insanity" came to be synonymous with sociopathy and psychopathy, although that is not what Prichard understood by it.