Psychopathy and Sociopathy

Historical and Modern Definitions

Historically, psychopathy has generated enormous debate; changing meaning, confusing nomenclature, and uncertain diagnostic criteria have plagued it. Psychopathy is the first personality disorder recognized in psychiatry and has an extensive history—dating back many centuries in biblical, classical, and medieval writings. The attachment of moral value (that is, psychopaths as either mad or bad) to psychopathy has significantly affected its transformation in meaning over the years.

In 1801, Phillipe Pinel defined psychopathy as morally neutral—labeling the disorder manie sans délire (insanity without delirium) and referring to patients who were impulsive, violent, and self-harming yet appeared to maintain intact reasoning and understand the irrationality of their actions. However, in the decades that followed, other professionals such as Benjamin Rush (1745–1813) and J. C. Prichard (1786–1848) distorted its meaning into one of social condemnation. This fluctuating orientation of morality continued over the next century with the contributions of theorists such as J. L. Koch (1841–1908) and Emil Kraepelin (1856–1939).

The modern definition of psychopathy is based on the work of Hervey Cleckley, who published a seminal text, The Mask of Sanity (1941). Cleckley stated that psychopaths wear a mask of psychological and emotional normalcy, but that underneath they are actually automatons who only mimic a personality, human feelings, and empathy. Cleckley compiled an informal list of traits he believed to characterize the psychopathic personality: interpersonally, they are grandiose, arrogant, callous, superficial, and manipulative; affectively, they are short-tempered, unable to form strong emotional bonds with others, and lacking in empathy, guilt, or remorse; and behaviorally, they are irresponsible, impulsive, and prone to violate social and legal norms and expectations. Cleckley argued that criminality and violence were not inherent to the definition of psychopathy and observed that individuals could use psychopathic traits for successful criminal or noncriminal careers.

Robert Hare later standardized the definition of psychopathy by creating a reliable and valid method for its identification—the Psychopathy Checklist. Its most recent (2004) edition, the Psychopathy Checklist—Revised (PCL-R), which has become the gold standard for the measurement of psychopathy, combines a structured clinical interview with the evaluation of collateral data (official criminal records, medical and psychiatric reports, and so on). Interviewers rate a twenty-item checklist on a zeroto forty-point scale, where a score of thirty is considered the cutoff value indicating psychopathy. The current checklist identifies two major clusters (or factors) of psychopathic traits, each comprised of two subclusters (or facets).

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