The Treatment of Psychopaths

Abstract

The term ‘psychopath’ is in common use, has a long history, and has a special legal meaning in the Mental Health Act (1959) of England and Wales. Nevertheless, as a forensic psychiatrist I find the term unhelpful and avoid it whenever possible. Craft (1966) has described the psychopath as being primarily an affectionless and impulsive person who frequently shows one or more of the characteristic secondary features of aggression, lack of remorse after a misdeed, lack of foresight, and social inadequacy. Like most observers Craft also added the exclusion clause that the patient under consideration must be free from psychosis. This last criterion always puzzles me a bit because in the days when I thought I knew what a psychopath was I was convinced that a significant number of them slipped in and out of psychosis, and are, for example, particularly prone to develop paranoid psychoses in prisons.