Criminality and Psychiatry

   In his novel East of Eden (1952), John Steinbeck wrote of the character Cathy Ames:

   It is my belief that Cathy Ames was born with the tendencies, or lack of them, which drove and forced her all of her life. Some balance wheel was misweighted, some gear out of ratio. She was not like other people, never was from birth. And just as a cripple may learn to utilize his lack so that he becomes more effective in a limited field than the uncrippled, so did Cathy, using her difference, make a painful and bewildering stir in the world. (Viking ed., 1970, pp. 72–73)

   The term "psychopath" was anticipated by English philosopher Jeremy Bentham (1748–1832) in his 1817 work on hedonism, A Table of the Springs of Action: Shewing the Several Species of Pleasures and Pains: "Psychological dynamics . . . has for its basis psychological pathology. Pleasure and exemption from pain fail to be considered everywhere in the character of ends: pleasure and pain here in the character of means" (Collected Works, p. 87). Some writers have seen James C. Prichard’s diagnosis "moral insanity" in his Treatise on Insanity (1835) as the first practical incorporation of the concept of psychopathy, yet the term as Prichard uses it is too vague to qualify for that distinction.

   The "Central European" criminal psychopath. Viennese psychiatrist Ernst von Feuchtersleben (1806–1849), in his 1845 Textbook of Medical Psychology (Lehrbuch der ärztlichen Seelenkunde), popularized the term "psychopathy" in the narrower sense of a disordered personality rather than an urge to avoid pain: "We call psychopathies or disorders of the personality [Psychopathieen oder Persönlichkeits-Krankheiten] . . . those composite conditions, in which the reciprocal relationship between the psychic and the physical is diseased in a number of ways, so that the empirical personality of the individual appears disordered [getrübt]" (pp. 262–263).

   As early as Morel’s writing on mental disorders in 1860, the psychopath is seen as a criminal. Morel said of "degenerate persons" (he did not use the term "psychopath"): "From the intellectual and moral viewpoint, hereditary influences of a pernicious nature . . . become converted early into unhealthy tendencies such as drunkenness, suicide, and vagabondage" (p. 580). Among European writers under the influence of Morel’s degeneration theory, criminals became increasingly "born criminals." In 1888, Julius Ludwig August Koch (1841–1908), director of the state asylum at Zwiefalten in Württemberg, introduced in his Brief Guide to Psychiatry (Kurzgefasster Leitfaden der Psychiatrie; 1888) the concept of what he called "psychopathic inferiorities" (psychopathische Minderwertigkeiten). Of those with "inborn psychopathic degeneration," he said: "These creatures appear quite frequently in the ranks of the evil-doers [Bösewichte]" (p. 45).

   It was via the writings of Cesare Lombroso and Eugen Bleuler that this kind of psychopath influenced generations of scholarship on criminality and character disorder. Eugen Bleuler’s 1896 book on The Born Criminal (Der geborene Verbrecher), together with Lombroso’s earlier writings on Criminal Man (1876) and Criminal Woman (1893), created the dark figures who stalked through life driven as much by their genes as by poverty and social conditions.

   In 1929, right-wing Munich psychiatrist Johannes Lange (1891–1938) buttressed these views by adumbrating the genetics of criminality in a book entitled Crime and Destiny: Studies of Criminal Twins (Verbrechen als Schicksal: Studien an kriminellen Zwillingen; translated into English in 1930). Lange said, "The biologist, and even more the doctor who has to deal with the individual criminal, cannot help again and again seeing fate in crime, stronger than the free-will of the individual. The natural tendencies one is born with, the surrounding world he grows up in, these are essentially destiny" (p. 21 of English translation). As Willi Mayer-Gross and co-authors commented in their 1954 textbook, Clinical Psychiatry, "The effect of Lange’s work, which attracted very great attention at the time, was to suggest that . . . the make-up of personality was determined almost exclusively by hereditary factors; and that social behaviour itself was the almost inevitable product of the personality" (p. 99).

   Yet, Lange’s findings received some confirmation in the work of another pioneer of psychiatric genetics, Aaron J. Rosanoff (1878–1943), at the time in private practice in Los Angeles, in an article in 1934 on "Criminality and Delinquency in Twins" in the Journal of Criminal Law and Criminology. Rosanoff wrote, "Our material indicates that in two-thirds of the cases of adult criminality in monozygotic twins, when one is criminal the other is likewise criminal" (p. 932). He amplified his views in a 1941 book on the same subject (in 1939 he became director of the Department of Institutions in California). These eugenist views of criminality and psychopathy fueled sterilization laws in a number of countries.

   The psychoanalytic psychopath. Psychoanalytic writing produced a milder version of psychopathy in which the psychopath was made not born. The 1925 work of Viennese educator and psychoanalyst August Aichhorn (1878–1949), Verwahrloste Jugend (translated into English in 1935 as Wayward Youth), accented libidinal misadventures: "Given certain disturbances in the libido organization . . . the child remains asocial. . . . This means that he has not repudiated completely his instinctual wishes but has suppressed them so that they lurk in the background awaiting an opportunity to break through to satisfaction. This state we call ‘latent delinquency’; it can become ‘manifest’ on provocation" (p. 4 of English translation). Franz Alexander’s (1891–1964) research (begun in Berlin, continued in Chicago) on the "neurotic character," notably as found in the International Journal of Psychoanalysis in 1930, asserted that misbehaving psychopaths were basically "acting out."

   The Anglo–American criminal psychopath. The doctrine of social causation inspired much Anglo-Saxon research on psychopathy, beginning with Edinburgh psychiatry professor Sir David Henderson’s (1884–1965) 1939 book, Psychopathic States. Henderson saw psychopathy more as a result of social emargination than heredity: "There is so much more security and courage and happiness when we form part of the herd, but the psychopath does not correspond to the herd type, he has not the instinct of fellowship with his fellow-men. Such a state leads almost inevitably to fatalism and despair, the reaction to which may be either aggressive or submissive" (p. 133). Henderson believed such individuals could be rehabilitated.

   An American milestone was Hervey Cleckley’s The Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality (1941). Cleckley (1914–1984), professor of psychiatry at the Medical College of Georgia in Augusta, indicted the psychopath’s upbringing, not his genetics. Comparing the family dynamics of psychopathy to those Leo Kanner had described for autism, Cleckley said, "There is . . . reason for me to feel that degrees of central coolness . . . have played a part in the early environment of some patients who, when we see them twenty years later, react as psychopaths" (p. 475). (Cleckley is also remembered as co-author of The Three Faces of Eve [1957], which sparked an epidemic of "multiple personality disorder." The title of prison psychologist Robert M. Lindner’s (1914–1956) portrait, Rebel Without a Cause: The Story of a Criminal Psychopath (1944), echoes on in the James Dean movie of 1955. Lindner called psychopathic personality "a Pandora’s box," and said that the multitude of terms for it evidenced its half-understood nature: "constitutional psychopathic inferiority, moral imbecility, semantic dementia, moral insanity, sociopathy, anethopathy, moral mania, egopathy, tropopathy, etc." (p. 3). Different entirely from the European psychopath was the one that stepped forth from William Maxwell McCord (1930–1992) and Joan Fish McCord’s (1930–2004) book, Psychopathy and Delinquency (1956)—he was an instructor in social psychology at Harvard; she a member of the Laboratory of Human Development there. The Mc-Cords’ juvenile psychopath was asocial, "driven by primitive desires," highly impulsive, aggressive, and felt little guilt. Above all, he had "a warped capacity for love" (pp. 6–14). The authors recommended an innovative sort of "milieu therapy." (See PSYCHOTHERAPY on the origins of milieu therapy.)

   In 1952, in the first edition of the DSM series, DSM "One," the psychopathic personality became "sociopathic personality disturbance: antisocial reaction"; in subsequent DSM editions as well, "psychopath" ceased to be an independent diagnosis, although the term remained in use within psychiatry. In the 1970s and after, under the influence of behavioral genetics, the classical Central European approach to psychopathy experienced something of a rebirth. In 1976, Samuel Guze in Criminality and Psychiatric Disorder wrote that "at least some cases of sociopathy may arise from ‘abnormal’ or ‘altered’ brain function." "It is not yet possible to unravel the tangled skein of evidence concerning heredity and environment in sociopathy, but it is difficult to ignore completely the indications of a biological contribution to its etiology" (p. 142). Almost 30 years after those lines were penned, In his Biology and Crime (2001), David C. Rowe (ca. 1950–2003) of the Interdisciplinary Program in Genetics at the University of Arizona was able to ask, "is there a gene for crime"? (See also Conduct Disorder; Personality Disorders; Psychiatric Genetics.)