- Back to the Nineteenth Century Is Progress
history, monomania, impulse control disorders, DSM
John Sadler Eloquently Makes the case that the phenomena of criminality, wrongful conduct, and mental illness are befuddled in current diagnostic manuals, for example, the Diagnostic and Statistical Manual (DSM)-IV-TR. The lack of clarity in the “vice–mental disorder relationship” reflects centuries old struggles to create clear demarcations between “mad” and “bad.” Sadler points out that the DSMs have been and are both the products of historical, cultural, and social forces and the purveyors of defining boundaries that shape contemporary psychiatric and judicial practices. Sadler does American psychiatry a great service by resurrecting a discussion that was quite rich in the nineteenth century, but generally dormant in the twentieth. I thought I could best use this commentary by bringing to the attention the readers of Philosophy, Psychiatry & Psychology the scope of the debate amongst Sadler’s nineteenth-century predecessors.
Philippe Pinel, who presented the first clear modern description of the form of mental illness subsequently named moral insanity appeared well aware, in the early years of the nineteenth century, of the difficulties there would be accepting the concept of a limited or partial moral mania:
There are certain rare examples of a peculiar turbulent and embittered character, who otherwise show no evidence of disturbed reason. Ought they to be included under the heading of “mania without delirium?” At any rate the authorities have preferred to have them admitted to asylums rather than let them mix with delinquents in houses of correction.(As cited by Walk 1954, 821)
James Cowles Prichard, a British physician, is credited with “inventing” the term moral insanity, which he defined as “a morbid perversion of the feelings, affections, and active powers, without any illusion or erroneous conviction impressed upon the understanding” (Prichard 1837, 20; 1842). Prichard warned against the failure to recognize this form of insanity, illustrating his point with what we might now refer to as pyromania:
Many lunatics, whose disorder was merely a destructive propensity, have set fire to houses or public buildings, and it is not to be doubted that men have been occasionally executed as criminals for such actions, who, if they had been kept in confinement, would have proved to be insane. Until the existence of moral insanity is distinctly recognized, there will always be a danger of this event ensuing in the trials of mischievous lunatics.(Prichard 1837, 287)
Prichard referred to such acts as “instinctive madness” (Prichard 1842). [End Page 19]
Isaac Ray, the first American to specifically address these matters (in the first edition of his Treatise on The Medical Jurisprudence of Insanity (1838), defined “partial moral mania,” indicating that, “In this form of insanity, the derangement is confined to one or a few of the affective faculties, the rest of the moral and intellectual constitution preserving its ordinary integrity” (p. 186). Ray highlighted those partial moral mania he considered to “have the most important legal relations” (p. 187): “an irresistible propensity to steal,” “an inordinate propensity to lying,” “erotic mania,” “a morbid propensity to incendiarism,” and “homicidal insanity” or “homicidal monomania” (pp. 187–234). Ray cogently described what we would categorize today as an impulse disorder: “Amid the rapid and tumultuous succession of feelings that rush into his mind, the reflective powers are paralyzed, and his movements are solely the result of a blind, automatic impulse with which the reason has as little to do, as with the movements of a newborn infant” (p. 261). Ray believed these monomanias “completely annulled . . . all moral responsibility for acts committed under their influence,” and consequently “the laws can rightfully inflict no punishment on their unfortunate subjects” (p. 276).
Ray, like his European predecessors, was not insensitive to the conundrum these partial moral manias would likely produce:
True, cases of a disputable character sometimes occur—cases in which we may well doubt whether the active principle is depravity or disease. I have no wish to conceal any difficulty which this subject may present(Ray 1861, 120).
The English translation of Esquirol’s treatise in 1854 supported Ray’s views. In a lengthy chapter on the different forms of...