Defining the Elephant: a History of Psychopathy, 1891-1959 Susanna Elizabeth Evelyn Shapland Department of History, Classics and Archaeology Birkbeck, University of London Thesis submitted for the degree of Doctor of Philosophy, February 2019 1 DECLARATION I confirm that all material presented in this thesis is my own work, except where otherwise indicated. Signed .............................................. 2 ABSTRACT Although ‘psychopath’ is a term which is still in use by psychiatrists, it has come to be used as a way of dismissing individuals as irredeemably ‘bad’, untreatable or unpleasant, both by professionals and the public. This attitude is supported by existing histories of psychopathy that are in fact simply histories of the criminal personality, and rely upon retrofitting the diagnosis to historical examples of criminal or problematic behaviour to support their claims of psychopathy’s universal and timeless nature. This thesis disrupts that narrative. By examining the ways in which the terms psychopath, psychopathy and psychopathic are used in historical context, and how this changed over time, it challenges the idea of psychopathy as a fixed and value-free term, and reveals that there were multiple, competing versions of psychopathy in a history rich with contested meanings and overlapping usage. In analysing discussions of how psychopaths were diagnosed, managed and treated, it shows that the history of psychopathy is marked by a fundamental lack of agreement over the parameters of this ‘wastebasket’ diagnosis, which time and again proved too useful to discard. 3 ACKNOWLEDGEMENTS My thanks go first and foremost to my supremely patient supervisor, Joanna Bourke. Her inexhaustible enthusiasm and thought-provoking and perceptive feedback have been inspirational. Thank you to all the wonderful and friendly staff at the Wellcome Library for their help over the years, and also to those at the British Library, mainly for their dogged determination in tracking down John Gunn’s elusive but vital 1993 editorial. Thank you to everyone in the world of academia who has offered me support, encouragement, food for thought and copies of their work, most especially Simon Jarrett and Janet Weston, as well as Greg Eghigian, Thomas Dixon, Lyndsay Galpin, Hazel Morrison, Martyn Pickersgill, Stef Eastoe, Hazel Croft, Louise Hide, Sean Brady, Clare Makepeace and David Jones. My heartfelt thanks also go to Todd Whitelaw and Lesley Fitton. Thank you to everyone at Birkbeck who have given me support during this process, most particularly my mentor Tim Reynolds, but also to Tehyun Ma, Mark Pimm and Liz Hughes, not least for putting me in touch with Henrietta Mbeah-Bankas, to whom I am greatly indebted. I am also grateful for the help and support I have received from the NHS at various times during this period, most notably from Karen Sandhu and Marcus Kupczak. My unreserved gratitude also goes to Adam Knowles for his incredible and enduring support, and for challenging my thinking on issues such as irredeemability. Thank you to Wanda, who has provided sporadic support, frequent distraction and has constantly questioned my preconceived notions of ‘good’ and ‘bad’. And to Andrew: I wouldn’t have started this thesis if it hadn’t been for your encouragement, and I certainly wouldn’t have finished it without your relentless support. Thank you for always making time to engage with my arguments, read my work and solve my technology problems, and for always believing that I’d get here in the end. 4 TABLE OF CONTENTS List of Abbreviations Used ............................................................................................................. 6 INTRODUCTION .............................................................................................................................. 7 Chapter I: Semantics .................................................................................................................... 37 EVOLUTION Chapter II: Problematisation ........................................................................................................ 58 Chapter III: Criminalisation .......................................................................................................... 86 SITUATION Chapter IV: Identification ........................................................................................................... 111 Chapter V: Location .................................................................................................................... 134 SOLUTION Chapter VI: Eradication .............................................................................................................. 158 Chapter VII: Containment .......................................................................................................... 182 Chapter VIII: Cure ....................................................................................................................... 201 CONCLUSION .............................................................................................................................. 228 Appendix I .................................................................................................................................. 241 Bibliography ............................................................................................................................... 244 5 LIST OF ABBREVIATIONS USED ACTO Advisory Council on the Treatment of Offenders APA American Psychiatric Association APD Antisocial Personality Disorder BJD British Journal of Delinquency BJP British Journal of Psychiatry BMA British Medical Association BMJ British Medical Journal DSM Diagnostic and Statistical Manual DSPD Dangerous and Severe Personality Disorder EUPD Emotionally Unstable Personality Disorder ICD International Classification of Diseases (also International Statistical Classification of Diseases, Injuries, and Causes of Death; International Statistical Classification of Diseases and Related Health Problems) ISTD Institute for the Study and Treatment of Delinquency JMS Journal of Mental Science (forerunner to the BJP) MHA Mental Health Act OEDO Oxford English Dictionary Online PTSD Post-Traumatic Stress Disorder RMPA Royal Medico-Psychological Association (forerunner to the Royal College of Psychiatrists) RSM Royal Society of Medicine UK United Kingdom US United States of America WHO World Health Organisation 6 INTRODUCTION ‘I can’t define an elephant; but I know one when I see one’.1 This near-nonsensical but oft- repeated observation introduced a 1944 paper analysing contemporary thinking on the subject of psychopathy.2 The authors, two British psychiatrists, used it to emphasise the perceived confusion and lack of consensus amongst the wise men of psychiatry as they attempted to define what was agreed to be an important subject: the psychiatric concept of psychopathy. Taking evidence from around the world, they established that there was disagreement on the definition, classification, aetiology and treatment of the disorder, despite the existence of a profusion of material on each of these aspects. Today, there are parallel voices of dissent questioning the concept of psychopathy, but they tend to be drowned out by a narrative of a universally-accepted diagnosis shored up by evidence of its apparent existence across continents and millennia. There is moreover a general lack of interest in questioning the diagnosis or rehabilitating its recipients, precisely because of its inherent stigma and connotations of ‘badness’. By looking at the history of psychopathy in Britain during a crucial period of its development, I hope to ask questions of the process of psychiatric diagnosis more broadly. I believe that this examination of psychopathy’s history will problematise the function of those diagnostic labels that possess such negative connotations that the very act of bestowing them can be tantamount to abuse, as they can result in the individuals labelled being at best dismissed, at worst being written off as untreatable or just straightforwardly wicked. Why Do We Need a History of Psychopathy? Psychopathy today is widely accepted as a valid psychiatric construct. In other words it is believed that the hypothesis ‘about the etiology, pathology, and development’ of psychopathic disorder can be reliably and consistently measured.3 In the case of psychopathy, the main means of measurement is Robert Hare’s Psychopathy Checklist-Revised (PCL-R), first published 1 Desmond Curran and Paul Mallinson, ‘Psychopathic Personalities’, Journal of Mental Sciences, 90, (1944), p.266. 2 The elephant metaphor is cited approvingly by a number of other psychiatrists, suggesting it was considered a good analogy for the case of psychopathic personality. See for example W. Norwood East, ‘Psychopathic Personality and Crime’, Journal of Mental Science, 91:383, (1945), p.430; D. Stafford-Clark, Desmond Pond and J.W. Lovett-Doust, ‘The Psychopath in Prison: A Preliminary Report of a Co-operative Research’, British Journal of Delinquency 2:2, (1951), p.117. 3 Robert J. Campbell, Campbell’s Psychiatric Dictionary (OUP, Oxford, 2009), p.1020. 7 in 1980, and its derivatives.4 Together they are ‘the dominant instruments for the assessment of psychopathy’.5 Psychopathy as operationalised by the PCL-R is respected as a reliable predictor of violent recidivism in various countries around the world, and is considered to be more consistent in this than the diagnosis of Antisocial Personality Disorder (APD), as set out in the