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ASPD: A Historical Retrospective

Antisocial Personality Disorder: A Historical Retrospective

Neophytos Gregoriou
European University Cyprus

Stun. Nos: F20132024


PSY330 Psychopathology I
Fall Semester 2015
Date of Submission 8/12/15

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Abstract
This research paper tries to point out the basic development of the Antisocial
Personality Disorder, from the old days until today. First we explain what this disorder
is and the basic information the DSM-V includes in its pages in relation to the
disorder. Then we take a brief look on how it was treated back then, the role Pinel had
in all this, then important people who help shape the disorder and in the end how the
modern times act upon it.
Keywords: Pinel, DSM-V, Antisocial Personality Disorder, Retrospection

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Antisocial Personality Disorder: A Historical Retrospective
The Disorder
Antisocial Personality Disorder is an undesirable ominous disorder for a
person and for good reasons. People diagnosed with this disorder might go to the
extent of having murderous intends and all the way to go on a killing spree, but that is
going to its extreme (Houser, 2012). People infected by it are characterized by
being impulsive; disregard the safety of their own lives and others. Furthermore the
people infected are indifferent for the laws of his/her country and the social norms
set by the social community. This is correlated by the fact that they dont think about
the consequences of their course of action or they just dont care for that matter. They
also seem to be aggressive towards others and many times become hostile. They can
also be diplomatic - having the trait of manipulation up their sleeve- and that makes
them hard to work within the framework of therapy (Houser, 2012). In the DSM-V it
is stated that this disorder shows more prevalence in males rather than females and its
noted that its related in people with low socioeconomic status. In addition experts
have said: people who strive to survive might show some symptoms of this disorder
but wrongly assessed as such and due to that it is recommended for the therapist to
consider the patients socioeconomic status. The DSM-V has 4 criteria for diagnosis.
In the first; 3 or more out of 7 indications must be identified to the patient. Indications
like being deceitful, behave outside of the social norms, to not care about the law, be
reckless and careless; putting their safety and others in danger, have a lack of remorse
and so on. In the other criteria its stated that for official diagnosis the person needs to
be over 18, whats more; there needs to be evidence for the disorder before her/his 15
birthday and finally antisocial behavior is not exclusive in the fabric of schizophrenia
or bipolar disorder (American Psychiatric Association, 2013).

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First Glimpses of the Disorder
During the 17th century the people of the community and the families that
lived there had to deal with the mentally ill people. Not only with them but also had to
care for the handicaps, watch out for criminals and so on. During the 18th century
people with personality disorders or with psychotic feature and generally anything
that would make them seem weird, were called Lunatics and had to be cared, again,
by their own family. If they were unwanted by their family that was going to be very
unfortunate for them as they were sent -how they called them back then- to the
madhouse (Shimmon, 2011). An example of those so-called madhouses was the
Bethlem Royal Hospital, or just Bedlam. There was evidence that the treatment given
to the insane it was nothing more than chaining them up, pulling out whips and hitting
them. Not only but they stripped them of their clothes, letting them without clothes
on, freezing and making them eat nothing but dirty food. All this monstrous behavior
was due to their dehumanization, calling them Lunatics, that they are mad or insane.
(Andrews, 1991)
During the late 18th century a Physician called Philippe Pinel was supposed to
become a catholic priest until he was given the responsibility of caring for the insane.
This is where we can finally say that the enlightenment optimism took effect, after all
these years were called the enlightenment age. Pinel was baffled when he saw the
mentally ills living conditions; he said that the only reason these people act like
animals are because they were treated as such. Pinel then freed the unfortunate from
their chains. This great nosologist favored the Moral Treatment where the treatment of
a mental disorder was based on the psychology; on the emotions of the individual and
the human morality, rather than chaining them up and making them suffer, or doing a
spiritual catharsis of the soul by exorcising the demons who possessed them (Porter,

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1998). Pinel started observing the insane and one step at a time he begun to categorize
them into different groups based on their symptomatology. It was in the year 1801 in
which Pinel published his book called Treatise on Insanity and as it written in the
book it contains Principle of a new and more practical nosology of maniacal
disorders that has yet been offered to the public (Pinel, 1962). We can say with
conviction that all of these was new for the people living in that age. In the book Pinel
had categorized these mental disorders into 5 categories, one of them is called manie
sans delire, in English is translated as Mania without delirium or insanity without
delirium. This is approximately into what we call Antisocial disorder (Kavka, 2003).
Pinel had said that it was partially affective insanity, meaning: the persons personality
was affected but his cognitive understanding; his intelligence was not affected in any
way (Adams, 2002). Its important to note here that in the mid-19th century after the
madhouses crumbled a new asylum emerge, this time they were called lunatic
asylums and the first one of the bunch was Montrose Royal Lunatic Asylum or
Sunnyside Royal hospital. In there, no one was chained, no one was whipped, but
instead they had colorful garden and people working there to keep things clean and
sanitary. The reason these kind of asylum were built was because of the effect of
Pinels point of view, and not just him but the whole Moral treatment movement that
seek to find more humane ways to treat people with these disorders (Porter, 1998)
How Things Progressed
The term psychopathy had different meaning throughout history, like Baron
von Feuchtersleben used it to refer to people with schizophrenic features and
psychotic symptoms (Sass, 2009), to George E. Partridge coined the term sociopath
back in 1930 so he and other would be able to refer by using this word- to people
who have no interest in the norms or social relationship and laws. when this term was

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popularized it helped shape the antisocial disorder as we know today. Back then it was
added to international classifications of diseases (ICD) (Partridge, 1929). Now, a few
years later Hervey M. Clekley reshaped the word psychopathy to the understanding of
an antisocial persons behavior. Clekley explained that there is a correlation between
aggressive behavior and violence but he had noted; psychopathic people do not feel
angry or do not show any emotion in anyway and the acts of violence are the genesis
of pleasure. People with psychopathic features do not get overwhelmed with rage and
arent messy, instead they are cold and thorough. (Patrick, & Zempolich, 1997) He
added that a psychopath will not let himself be seen as a monster instead it has many
manifestation: he can be seen as a gentleman, he can be a businessman, psychopathy
has many disguises (Cleckley, 1964). Clekley as we I said before, helped shape this
term and eventually was added in the DSM-III. During the 20th century psychopaths
were sent to asylum. The asylums in that age had a new conviction; methods of
treatment that were supposed to be scientific and had positive results. Few of the
method were: lobotomies performed on the patients brain. Another two would be
insulin shock therapy and electroconvulsive therapy in which it had some effects to
people with clinical depression, but way more unwanted side effects. One might say
that the living condition and the way the patients were treated can be compared to the
days back to the madhouse called Bethlem Royal Hospital which I talked about
before. (Shorter, 1997).
How Things are Today
Coming back to modern times the Antisocial Personality Disorder is included
in the DSM-V which can enlighten us with ways for prognosis with the criteria that
has to be met and some other additional information about the nature of the disorder.
Experts say that there is no cure for antisocial personality disorder although some

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options for treatment are available. One of these treatments is through the concept of
schema therapy. The schema therapy is relatively new to the field and I still studied.
The Schema therapy is a mixture of treatment methods and most common are from
behavior, cognitive and experiential (Bernstein, Arntz, & Vos, 2007). Psychoanalysis
is another method but its hard due to the nature of the patient. They dont feel they
need help, they dont care about the world or about themselves, they can also be
manipulative and falsely show progress when in truth there I none. Currently there are
no medications to use for treatment but psychiatrist may use medications for mood
stabilization and tune down their aggression (Shorter, 1997). As we can see we have a
lot of roads to travel until we come across a satisfactory treatment for these kinds of
people.

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