Psychopathic Personalities

PSYCHOPATHIC PERSONALITIES. - By this are meant those abnormal personalities that suffer and make society suffer (K. Schneider). In the last century people readily spoke of moral insanity (Pritchard), of which Carpenter and Maudsley were authoritative supporters; of manie raisonnante (Pinel), of folie lucide (Trélat), of folie morale (Falret). Much insistence was placed (Magnan) on the nosographic autonomy of such syndromes. The first views of Lombroso (1872-85) on constitutional immorality were directly linked to Morel's doctrine, which inserted moral insanity into the framework of degeneration: the born criminal, as the representative of a true mental degeneration, with the anthropological stigmata of somatic decadence, the visible frame of ethical degradation. After 1885 Lombroso claimed to assimilate congenital criminality to a variety of epilepsy, thereby asserting an ever more marked pathologism.

The first to deal systematically with the psychopathology and the nosographic classification of psychopaths was J. L. A. Koch, who in 1893 published a careful study with the significant title Die psichopathischen Minderwertigkeiten; for this author, that is, abnormality was equivalent to a diminution, to a lessening: minus habens, abnormal, psychopath were equivalent terms. Jaspers, in 1913, acutely showed the untenability of the position that, until then, considered the concept of disease as a concept of value, and this both in general medicine and in psychiatry: the value-concept of what is pathological thus came to be resolved into a concept of Being, free from value (wertfreier Seinsbegriff). In 1923 Gruhle in his Psychology of the Abnormal affirmed the clear separation of evaluating (Bewerten) from knowing (Erkennen). For him, psychopath is equivalent to abnormal, without considering at all the value of the abnormal; therefore, in this sense, the genius and the criminal would be equivalent. In 1923 Kurt Schneider set out his conception on a much more practical plane, seeking to group together those abnormals with whom the physician has to deal. His definition, which is the one given above, does not rest on any value judgment, in that it admits the possibility that plus habentes individuals, abnormal precisely by virtue of their value, may not suffer or make others suffer, that is, may not be psychopaths. In terms of Aristotelian gnoseology, the abnormal is a more generic and extensive concept, the psychopath is a more specific and comprehensive concept. The concept of "norm" (v. BIOMETRIA; NORMOTIPO) contains within itself important philosophical and psychological questions, both as ideal norm (what should be normal) and as real norm (what is normal), both as average norm (a general, biological-natural, rational concept, free from contradictions, but formal and empty) and as value norm (an individual, psychological-human concept, rich in content); such concepts, however, are all relative: e.g., the concept of average norm can be useful only in biological and natural-science questions, the concept of "norm as value" only in psychological and spiritual-science questions. K. Schneider seeks to overcome the relativism of the concept of norm with his concept of "real average norm, without value judgment"; however, in this way the individual is considered not in his comprehensible individual intrinsicality, but in his incomprehensible extrinsicality, that is, he is taken as an average man, not as an individual.

Almost all authors today agree (Müller-Suur) in holding that abnormal personalities are quantitative divergences (not qualitative) more pronounced than those that are considered variations of a personality within the sphere of the real average norm. The transition between normal and abnormal personalities occurs by successive degrees, without clear limits, imperceptibly (at the extremes of a Gaussian curve).

Psychopathic personalities do not constitute anything "pathological," if by "pathological" are meant those psychic disturbances (qualitative abnormalities) that are conditioned by organic processes, by their functional consequences and by their outcomes; that is to say, the somatic correlate of psychopathic personalities is not a disease or a malformation; one could think, at most, of a quantitative abnormality of structure or function. Classical psychiatry sharply and fundamentally separates abnormal (psychopathic) personalities from the psychoses, cyclothymic and schizophrenic, postulated with good reason as "pathological." Even some English-language authors seem today to return to this distinction (Karpman). There are no degrees of transition between psychopathic personalities and psychoses, even if a certain constitutional predisposition for the latter cannot be denied (e.g., schizoidism). Abnormal personalities are congenital variations, deriving from a generic disposition, not necessarily hereditary; they are largely affected by the development and the oscillations of their non-lived substratum (unerlebt) and by the effect of events charged with emotional value (Erlebnisse).

CLASSIFICATION

Individual human characteristics can be arranged schematically, at least within certain limits, and the various psychopathic types can be derived from their various exaggerations. The classification most followed today is that of Schneider, which is asystematic, because he considers the existence of a pure systematic patho-characterology impossible. Schneider describes a series of types, not comparable with one another, while nevertheless admitting the possibility of numerous and manifold combinations among them. It is important to know the descriptive account of psychopathic personalities, above all for differential diagnosis with the psychoses and therefore for the different severity of prognostic judgment. At times the differentiation can be extremely difficult, as, for example, often happens with regard to the schizophrenic "defect."

Schneider distinguishes: 1) hyperthymic psychopaths, simple and "compensated" (the latter seem to fall not within the true psychopathies but only within the abnormalities): they are impulsive, lively, active subjects, but negligent, superficial, full of good intentions that will never be carried out. 2) Depressive psychopaths, with a melancholic variant and a variant of ill humor; the latter are cold, suspicious, grumbling, harsh, irritable, dysphoric, at times wicked and malicious. 3) Psychopaths insecure about themselves, a variety not very far from the preceding one and largely reducible to Kretschmer's "sensitive" types. This is an inner insecurity, with little self-confidence, accompanied by shyness; often, but not always, the feeling of inadequacy concerns the ethical attitude, with a marked sense of self-guilt. From this type of personality there frequently derive: 4) anancastic psychopaths, the phobic, the obsessive (v. psicosi ossessiva): through thoughts, representations, feelings, impulses, compulsive actions, there always stands out the fundamental psychopathological character of "compulsion," that is, of a content of consciousness from which the subject cannot free himself, while at the same time judging it as absurd in its content or at least as rigidly dominant without any reason. 5) Fanatical psychopaths, markedly active, expansive personalities; the personal fanatic (querulomaniac) fights for his alleged right, the fanatic of the idea fights for his program. There are, however, also calm and taciturn fanatics, detached from reality, extravagant, fantastic, like certain sectarians (Schneider's "matte Fanatiker"); in the jealous, personalities not simply expansive but more complex (Kretschmer), as also in querulomaniacs, paranoid "developments" can be brought about. 6) Psychopaths in need of worth (Geltungsbedürftige): these are personalities who want to appear more than they really are. This need for worth is shown in an eccentric manner, in order to attract attention, or else boastful tales are told or nonsense is acted out: that is, this is what used to be called

"pseudologia fantastica" and what is better designated by the term Renommieren; these individuals, who might be called knights of industry, play a veritable theatrical part, the one that real life denies them. 7) Psychopaths labile in mood: this is an excessive reactivity in the depressive sense upon a background that, in itself, is not reactively determined; such ill humor, such dysphoria almost always underlie excesses in drinking, vagabondage (poriomania), prostitution; the ill humor here is always primary; at times such mood-labile individuals are designated as "epileptoid," but without any reason, indeed incorrectly. 8) Explosive psychopaths: excitable, irritable, choleric personalities, with primitive reactions (Kretschmer). 9) Athymic psychopaths (Gemütlose): these are personalities with little or no sense of compassion, shame, repentance, honor; they are often cold, rigid, brutal, cruel, instinctive; one cannot speak here of "weakness of the moral sense," understood in the field of the frenasthenias, because such subjects have no congenital intellectual deficits; they are practically inaccessible to every attempt at correction, improvement, education; one must not forget that besides criminal athymic individuals (especially sexual ones) there are also social athymic individuals, iron natures, who "walk over corpses"; here the intelligence is often excellent. 10) Abulic psychopaths (Willenlose): they are easily influenced, accessible and therefore partially re-educable; their social face is given by their lack of firmness. 11) Asthenic psychopaths, not in the physical sense but only in the characteristic sense; they are subjects who complain of a scant capacity for concentration and performance, of deficiency of memory, at times of Erlebnisse of depersonalization (the world of perceptions, one's own feelings and one's own actions appear distant, unreal, faded).

Such typological classifications and subdivisions have often been criticized, and often rightly so. One speaks of psychopathic types as of a diagnosis; these are, however, frameworks that bring out only certain particular properties; the individual possesses very many other properties, indeed innumerable and also very important ones, for example, ethical ones, which, not interfering with the diagnostic designation, remain in obscurity, unclassified. On the other hand, the typological denomination of psychopaths often makes one believe that one can arrive at a "total" or almost total understanding of the individual, whereas in reality the classification is always incomplete and particular and is based on characteristics situated at different psychic depths: using the concepts of J. H. Schultz, one could say that there exist nuclear psychopaths (Kerupschopathen) and peripheral or frame psychopaths (Randpsychopathen).

A very important conceptual and methodological difference between psychopathies and psychoses lies in the fact that in the latter one tends to prescind from the content, from the theme, from the individual imprint, in order to penetrate into the structural, the "formal"; in the psychopathies, instead, what is essential is the content, the quid. And it is precisely in this that the difficulty of the descriptive framing of psychopathic types resides; all the more so since certain characterological traits mutually exclude one another, while others often coincide: a compensated hyperthymic cannot be insecure about himself, a fanatic cannot be abulic, even though the two opposites do not logically exclude each other: thus, not rarely hyperthymic individuals are explosive and depressive individuals are often asthenic. It is evident that "the immeasurable territory of psychic being, even in its abnormal variants, does not allow itself to be abstractly dominated by any kind of clinical diagnosis, by any module of pathological denominations" (Schneider).

Nor should one believe that the typological denomination of a psychopath is necessarily an indication of something lasting: anyone can be in youth a person insecure about himself or one in need of worth, and, subsequently, lose such characteristics or compensate for them almost completely; this often happens in the case of asthenic individuals.

Few authors have considered which traits of personality can be weakened, strengthened, developed or even formed by Erlebnisse and which cannot; in the weaker dispositions (Anlage) the factor of plasticity is very marked, for example, in the insecure, in the depressive, in the asthenic.

Kahn spoke clearly of "psychopathic episodes," both endogenous and reactive; upon the latter psychotherapy exerts an effective action because it too is an Erlebnis.

In any case, bearing in mind these clinical reservations, the typology (and Schneider explicitly recognizes this) can still today be usefully employed despite its limited cognitive value.

Bruno Callieri

MORAL IMPUTABILITY

For an accurate determination of moral imputability, individual abnormal cases must be considered separately. Abnormalities, in fact, as such, are nothing but abstractions: in reality there are only abnormal individuals, so that, except in cases in which the activity of the higher faculties suffers no detriment and those in which this activity is totally disturbed, the degree of imputability in cases of abnormality varies according to the various afflicted individuals. The extreme cases, in which imputability remains entire or is completely removed in p. p., are to be considered exceptional. Generally imputability does not remain intact, but neither is it annulled: it is only diminished. The diminution of imputability concerns only those acts that are influenced by the abnormality and not the others. The diminution, moreover, occurs by considering only the value of the act at the moment of the imputability in question that may have existed, directly and indirectly, both with regard to the abnormality itself and with regard to its effects. The entire moral judgment must also take these responsibilities into account.

Pietro Palazzini