Arieff, Alex J.

Rotman, David B.

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Psychopathic Personality: Some Social and Psychiatric Aspects

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Journal of Criminal Law and CriminologyVolume 39 | Issue 2 Article 41948Psychopathic Personality: Some Social andPsychiatric AspectsAlex J. ArieffDavid B. RotmanFollow this and additional works at: https://scholarlycommons.law.northwestern.edu/jclcPart of the Criminal Law Commons, Criminology Commons, and the Criminology and CriminalJustice CommonsThis Article is brought to you for free and open access by Northwestern University School of Law Scholarly Commons. It has been accepted forinclusion in Journal of Criminal Law and Criminology by an authorized editor of Northwestern University School of Law Scholarly Commons.Recommended CitationAlex J. Arieff, David B. Rotman, Psychopathic Personality: Some Social and Psychiatric Aspects, 39 J. Crim. L. & Criminology 158(1948-1949)PSYCHOPATHIC PERSONALITYSome Social and Psychiatric AspectsAlex J. Arieff and David B. RotmanDr. Arieff has been Attending Neurologist in the CIok County (Ill.) Hospitalsince 1945; Assistant Psychiatrist in the Psychiatric Institute of the MunicipalCourt of Chicago, and a member of the American Board, Neurology and Psychiatry,since 1940; Secretary of the Chicago Neurological Society since 1946. From 1934he has been successively Clinical Assistant, Instructor and Associate in the North-western University Department of Nervous and Mental Diseases.Dr. Rotman has been Director of the Psychiatric Institute in the MunicipalCourt of Chicago from 1933 until his recent death. During several years also he hadbeen Clinical Professor of Psychiatry in the University of Illinois. Earlier he hadbeen Senior Physician in the Chicago State Hospital, and Associate Professor ofPsychiatry in Rush Medical School. During World War I he was a member of theNeuropsychiatric Division of the United States Army.-EDITOR.There is no category in the entire array of psychiatric classi-fications that is being misused more than is the term "psycho-pathic personality." It has indeed become the waste basket ofpsychiatry, displacing even dementia praecox from its positionof primacy. The fact that the name psychopathic personality hasso many aliases is proof positive of the ambiguity that surroundsit. In Forensic psychiatry, it functions even more as a wastebasket and as a blanket cover-all for persons who indulge inanti-social conduct and are found to be neither psychotic norfeebleminded. Witness the fact that in some penal institutionsit is stated that as many as 35 per cent of the population fall intothis category.' Even in the most conservative estimates of penalpopulations, such as the Illinois State Penitentiary, Dr. RoyBarrick,2 State Criminologist, reports that 25 per cent of the in-mates fall into this category.The draft leading to our National Army of World War II isa good cross section of our population. It is, therefore, veryinteresting to peruse the data offered by both our draft boardand our military department. In the Boston, Massachusetts,Induction Center, (Solomon & Yakovlev) 3 out of 1,931 rejections,1 R. S. Banay; Contemporary Criminal Hygiene, Oakwood Press, Baltimore, 1946,pp. 45.2 Personal Communication.From: Psychiatric Institute, The Municipal Court of ChicagoDepartment of Mental and Nervous Diseases, Northwestern UniversityMedical SchoolRead at the First Medicolegal Congress, St. Louis, Missouri, January20, 1949.3 H. C. Solomon and P. I. Yakovlev: Military Neuropsychiatry, W. B. SaundersCo., Philadelphia, 1944.PSYCHOPATHIC PERSONALITY603 or 31 per cent were psychopathic personalities, includingchronic alcoholics. Even psychoneurosis with 26 per cent camein second best. In the armed forces, Stearns and Schwab,4 re-porting on 500 neuropsychiatric casualties in the Navy, foundpsychopathic personality was second, and followed only theneurotic.Not infrequently, this diagnosis is arrived at in a negativeand arbitrary manner. Since the person is not psychotic, is notfeeble-minded and continues to be recidivistic, he must be a psy-chopathic personality. As time goes on we are learning moreabout the psychopathic personality, and as psychiatrists aremore able to make the diagnosis on the basis of positive ratherthan negative findings. As our scientific knowledge progresses,we are certain that there will be an appreciable shrinkage in thenumber of maladjusted individuals finally and definitely labeledas psychopathic personalities. Already there is some evidencethat the electroencephalograph will enable us to keep this diag-nosis down. Workers in this field are beginning to delineate forus some actual patterns of brain pathology discernable by thismethod. Silverman5 found E.E.G., or brain wave deviations, in80% of his studies. Banay6 reporting on the Sing Sing prisonpopulation reports that one-third of the aggressive psychopathsshow an abnormal brain wave pattern. Gibbs,7 on the other hand,in a small group with more intensive study feels that in the truepsychopath, there is no E.E.G. deviation. However, the E.E.G.fiidings discussed by the previous authors may perhaps help usdifferentiate the symptomatic from the essential types of psy-chopathic personality.Under the term idiopathic psychopath (Antethopathy), Karp-man8 includes only those psychopaths in which the most carefulsearch fails to reveal any trace of psychogenic factors, in contra-distinction to the symptomatic psychopathy which includes allreactions, and which bear close resemblance on the surface towhat we call psychopathic behavior, except that in these casesit is not difficult to elicit psychogenesis behind the psychopathicindulgence. Likewise, we find the same concept put forth by hisdisciple Kavka,9 who makes an interesting study of one case toarrive at a diagnosis of symptomatic rather than idiopathic psy-chopathic personality. Their efforts should give further impetus4 A. W. Stearns and R. S. Schwaab: Journal Maine, M.A. 34; 81-89, May, 1943.5 D. Silverman: Archives of Neurology and Psychiatry, 50, 18, July, 1943.6 B. S. Banay: Op. cit.7 F. and E. A. Gibbs: Personal Communication.8 Benjamin Karpman: Jour. of crim. Psychopathol. 3:112, 1941.9 3. Kavka: Jour. Nero. and Ment. Diseases; 106, 19, July, 1947.1948]ALEX ,. AEIEFF AND DAVID B. BOTMANto future investigations along the lines similar to those whichhave broken down the term epilepsy into idiopathic and sympto-matic types, resulting in a shrinkage of the percentage of idio-pathic epileptics, thereby very effectively altering our under-standing, treatment and our prognosis of epilepsy.Heretofore, too much energy has been consumed in so-calleddiagnostic refinements dealing with classifications of sub-groups. Almost every investigator into the subject seemed im-pelled to enrich our literature with highly personalized classifi-cations and not always because of a sense of altruism.'0 Theauthors of this paper are much impressed with the fact that agood deal that has been written about the psychopathic person-ality has been of an excathedra nature and not always by personswho have had sufficient experience over a lengthy period withlarge numbers of psychopaths to make their contribution validif not authoritative." With this thought in mind, we have under-taken the study of a breakdown of the large group of psycho-pathic personalities who have passed through our hands at thePsychiatric Institute of the Municipal Court of Chicago over aperiod of time extending from 1931 to the present date, 1947.Another value of our study comes from the fact that eight psy-chiatrists contributed to the diagnosis of psychopathic person-ality. This fact eliminates the bias of one investigator, of onediagnostician, and represents the diagnoses of a considerablyvaried group, drawn from all of the psychiatric schools, rangingfrom the precise organicist to the avowed and trained psycho-analyists.We wish to call attention to Figure I which is a study of ourcase load from 1941 through 1947. The dotted curve cases, thenumber of patients examined yearly, shows a gradual increasefrom 1941 through 1947. Curve "x" relates to the percentageof those diagnosed as a psychopath and indicates a drop from1943 through 1936. This drop is to be expected for two reasons,namely, many of the persons of the age range involved were in10 D. B. Rotman, M.D.: Journal American Medical Association, 127; 564March 10, 1945.11 Benjamin Karpman, op. cit.E. Yahn: Psychopathic Personalities, translated by H. F. Dunbar, Yale Univ-sity Press, New Haven, 1931.W. Bromberg: This JouRNA, 28: 70, 1937.H. M. Cleckley: The Mask of Sanity, C. V. Mosby Co., St. Louis, 1941.E. A. Strecker and F. G. Ebaugh: Practical Psychiatry, P. Blakestone, Son &Company, Philadelphia, 1925.W. A. White: Outines of Psychiatry, Nervous and Mental Diseases PublishingCo., Washington, 1929.B. Glueck: Studies in Forsenic Psychiatry, Little, Brown & Company, Boston,1916.[VOL 39PSYCHOPATHIC PERSONALITYthe army during this period and others were riding on the crestof an economic wave. There was a precipitous rise during 1947.This may be attributed to the post-war let-down and also to thedrives against sexual offenders which naturally brought a risein the psychopathic group. The curve connecting "o" is theFigure I-Case Loadsame as curve "x," but from which the youthful offenders,(those less than 21 years of age) who may be unstable merelybecause of adolescent maladjustment have been deleted. How-ever, it can be seen that the parallelism between these curves in-dicates that we are not misjudging even our psychopaths of be-low the age of 21.Analysis of EducationConstitutional psychopathy is not synonymous with mentaldeficiency. It is not incompatible with attainment in formal edu-cation. Out of 25 unselected cases, it is ascertained that therewas an average of 2.4 years in the high school period of educa-1948]ALEX J. ABIEFF AND DAVID B. ROTMANtion and of that number, three were of college level. Only twoof the group lacked a formal education.1002 Z1Mflfl~T80% 20%.In'gure xi-worK iecorQAge Incidence at Time of Examination HereAn interesting fact brought out by our study is that the aver-age age at the time of the first psychiatric examination at thisInstitute was 33 years, whereas further study of the case his-tories of these individuals discloses that their average age atthe time of their first anti-social act was 18. This can be assumedto indicate that psychiatric examinations were regrettably notmade at the earliest level of detection so that available treat-ments might be instituted.Sibling RelationshipAn attempt -was made to study our material from the stand-point of sibling relationship in the family setting. The mostnoteworthy fact was that of the 25 cases there was only one"only child". To us this appears to be a very significant findingand definitely places our group in the non-neurotic category,in that previous studies indicate that in the neurotic groupsthere is a high incidence of an "only child situation". Ourpsychopaths were in family groups in which there were an aver-[Vol. 398PSYCHOPATHIC PEBSONALITYage of 3.8 children which approximates the ideal size of familiesas set-up by mental hygienists. It is estimated that the averagenumber of siblings in the American home is 4.2. These figureswould indicate that the sociologic factor, namely, the size ofthe family is not pertinent to the psychopathic personalitypicture.Cause of Arrest, Present and PreviousOf the present cause of arrest, 12, or almost half were of abenign character, which may be interpreted as meaning thatthe innocuousness of an offense does not preclude this seriousdiagnosis. However, on previous offenses, 13 had been in con-flict with the law because of serious findings, whereas 11 hadpreviously been arrested only on minor charges. Combiningpast and present findings, we found that 68 per cent were atone time guilty of serious offenses and therefore could be con-sidered capable of future serious antisocial acts. The numberof offenses ranged from one to 20 with an average of four.TABLE ISEVERITY OF OFFENSESSeriousBenign AntisocialPresent .............................. 48% 52%Previous ............................. 44% 52%All ................................... 28%/ 68%Previous offenses range from (1-20) average of 4.Previous Therapy and RecommendationsIn the main, this group showed a tendency to be institutional-ized. Of the 25 cases, seven had been placed in psychiatricestablishments and 11 in penal institutions. In other words, 18out of 25 or 72 per cent of cases had been previously institution-alized. This, of course, corroborates that which we all aclmowl-edge, namely, the inefficiency of established treatment facilitiesnow available.Concerning the matter of treatability of this group, only sixor 24 per cent were considered safe for ambulatory psychiatrictreatment, and another six were considered so refractory asto warrant the recommendation of protracted correctional insti-tutional care. The recommendation of psychotherapy should notbe misconstrued as envisaging a favorable prognosis.Family AttitudeAs a rule, the majority of families are too often defensivetoward their relatives, which prevents the carrying out of rec-1948]ALEX J. ARIEFF AND DAVID B. ROTMANommendations. In this group only 28 per cent were defensive,20 per cent felt hopeless and 20 per cent understood the situa-tion well.Work RecordOne of the most constant features of the maladjustment ofthis group is the work record. Of the 25, 16 or 64 per centdefinitely had a poor work record; 5 or 20 per cent had indiffer-ent records. In only 4, or 16 per cent of the cases could thework record be considered good. This is a significant symptom.Incidence of Venereal InfectionContrary to the general impression, that there is a high inci-dence of venereal disease in this group, our figures indicate thatonly one had had a luetic infection and only three had had aNeiserian infection.Marital StateA study of the marital status leads us to the following find-ings: 19 or 76 per cent of the group ventured into marriage.Only six or 25 per cent remained single. Of the married group,seven apparently did not run into marital discord. Twelve, or48 per cent, definitely had marital difficulties, and eight or 32 percent, ventured into multiple marriages. Apparently the psycho-path does not have a too good an understanding of the duty andobligations of the marital state and has difficulty in continuingin such a situation without either changing partners or meetingthe marital situation with discord.Sexual AdjustmentIn the sexual adjustment, we considered two groups, those whohave made a relatively good sexual adjustment and those whohave made poor ones. In the poor sexual adjustment, we haveplaced those who are excessively promiscuous; those who wereof homosexual tendencies and those who exhibited tendenciestoward the commission of acts of sexual aggressiveness. Of thisgroup, 15 or 60 per cent gave definite evidence of a poor sexualadjustment. In eight, or 32 per cent, the adjustment was goodand in two of questionable level.AlcohelismThere has been much written about the relationship of alco-holism to the psychopathic state. All Forensic psychiatrists havebeen confronted with the difficulty of deciding whether a given[Vol. 398PSYCHOPIATHIC 1PIgSONALITYcase is basically psychopathic with alcoholism as a prominentsymptom in the picture, or the reverse with alcoholism playingthe primary role and the psychopathy the secondary one. In ourcase load, nine, or 36 per cent, gave a history of alcoholism.This is somewhat higher than the 29.95 per cent of alcoholicdiagnoses, in our entire case load made in this laboratory from1941 to the present time. (David B. Rotman. 10 ) It is certainlynot the answer to the vexing problem of the interrelationship ofalcoholism and the psychopathic personality.SummaryThe diagnosis of psychopathic personality enters into all courtclinics as a major concern. In 1947, 15 per cent of the cases of thePsychiatric Institute of the Mlunicipal Court of Chicago were sodiagnosed. In penal populations the percentage may run as highas 35 per cent.It is important to differentiate the true from the symptomaticpsychopathic personality. The E.E.G. may be of assistance here.The average educational level of this group was 2.4 high schoolgrades, eliminating lowered intelligence as an important factor.The siblings' average was 3.8 approximating the average idealof 4.2 children per family. This would seem to divorce the prob-lem from sociological dominance.The offense was benign in about half the patients. However,of all the offenses, present and past, 68 per cent were of a seriousnature.In only six per cent was ambulatory psychotherapy recom-mended. On the other hand, protracted correctional institutionalcare was recommended in an additional six per cent.A poor work record was found in 64 per cent of the patients.This looms up as a very important item.Although 76 per cent married, 48 per cent had marital discord.Likewise in 60 per cent of the group there was a poor sexualadjustment.In 36 per cent, alcoholism contributed to maladjustment.The family attitude was defensive in only 28 per cent of thecases, in contrast to the families reaction to other types of per-sonality disorder in which case they proved to be highly defen-sive.Conclusion1. The problem of psychopathic personality is a complex oneand scientific efforts should be made to clarify the subject mat-ter by more careful use of the term based upon positive findings.1948]166 ALEX J. ARIEFF AND DAVID B. BOTMAN [Vol. 392. Efforts to seek aid of laboratory methods should be encour-aged even though our present day information, garnered fromthe E.E.G., is still not concrete.3. The failure of our efforts to find sociological factors asstrongly pertinent to the etiology of this disorder, leaves uswith no alternative than to return to the rather hackneyed con-cept of the constitutionality of this disease. It should encourageus also to intensively explore the constitutional basis of thisdisorder, thus furthering the differentiation of the symptomaticfrom the essential types of psychopathic personality.

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Psychopathic Personality: Some Social and Psychiatric Aspects

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