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Moral insanity

Moral insanity

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Moral insanity is a medical diagnosis first described by the French humanitarian and psychiatrist Philippe Pinel
Philippe Pinel
Philippe Pinel was a French physician who was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy...

 in 1806. According to Pinel, moral insanity was manie sans délire (mania without delusion) and had no relation to the moral faculty. Moral insanity was a form of mental derangement in which the intellectual faculties were unaffected, but the affects or emotions were damaged, causing patients to be carried away by some kind of furious instinct (instincte fureur). Mania without delusion was a chronic disturbance of the emotions. James Cowles Prichard
James Cowles Prichard
James Cowles Prichard MD FRS was an English physician and ethnologist. His influential Researches into the physical history of mankind touched upon the subject of evolution...

 defined moral insanity as: "madness consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses, without any remarkable disorder or defect of the interest or knowing and reasoning faculties, and particularly without any insane illusion or hallucinations."

The concept of moral insanity is indebted to the work of Philippe Pinel
Philippe Pinel
Philippe Pinel was a French physician who was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy...

, which was acknowledged by Prichard, and his invention of the mental diseases of partial and affective insanity. Manie sans délire, later known as folie raissonante involved a form of partial insanity. That is, the sufferer was thought to be mad in one area only and that thus the personality of the individual might be distorted but his or her intellectual faculties were unimpaired. Both moral insanity and monomania
Monomania
In 19th century psychiatry, monomania is a single pathological preoccupation in an otherwise sound mind. Emotional monomania is that in which the patient is obsessed with only one emotion or several related to it; intellectual monomania is that which is related to only one kind of delirious idea...

are irrationalities of the otherwise rational mind: in both disorders the mind is fragmented into parts that are normal and parts that are dysfunctional. The distinction between moral insanity and monomania appears to be the difference between a milder systemic malfunction and a more severe but isolated one. The symptoms of moral insanity can increase, causing a degeneration into monomania. "On the surface, monomania can thus appear even more circumscribed a form of derangement than moral insanity."

Contemporary misunderstanding of the term derives from the double meaning of the word "moral" in the nineteenth century context. According to Erdmann Mueller (1899, author of a comprehensive treatise on moral insanity): "the word moral in the concept moral insanity is derived from the word affective in Esquirol's terminology and the translation of moral as virtuous or ethical is the result of a misunderstanding due to the double meaning of the word." Likewise the term moral treatment
Moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns...

 referred to a set of psychosocial techniques rather than ethical practice. Under Pinel's guidance, patients were freed from chains and shackles.

The context leading to the conceptualization of this diagnostic category was undoubtedly borne out of the frustration of alienists (the term is approximately equivalent to the modern day one of psychiatrist) by the definition of madness provided by John Locke
John Locke
John Locke FRS , widely known as the Father of Liberalism, was an English philosopher and physician regarded as one of the most influential of Enlightenment thinkers. Considered one of the first of the British empiricists, following the tradition of Francis Bacon, he is equally important to social...

 in which delusional symptoms were required. In legal trials this definition had proved to be a great source of embarrassment to alienists because unless delusional symptoms could be clearly shown judges would not consider a plea of insanity.

Several historians have entirely discredited the notion that the diagnostic category of moral disorder was a forerunner of psychopathic disorder
Psychopathy
Psychopathy is a mental disorder characterized primarily by a lack of empathy and remorse, shallow emotions, egocentricity, and deceptiveness. Psychopaths are highly prone to antisocial behavior and abusive treatment of others, and are very disproportionately responsible for violent crime...

. As stated by the historian F.A. Whitlock: "there [is] not the remotest resemblance between their examples [Pinel's and Prichard's] and what today would be classed as psychopathic personality." Prichard's "moral insanity" was a catch-all term of behavioural disorders whose only feature in common was an absence of delusions: it is not cognate with the modern diagnostic category of antisocial personality disorder
Antisocial personality disorder
Antisocial personality disorder is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition , as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood...

.

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