Descriptive Psychopathology: The Signs and Symptoms of ...

333 Chapter 14: PersonalitySheldon’s empirical efforts (among many others) to relate body type to illness andtemperament (particularly Janet’s constructs of extraversion and introversion)were outgrowths of phrenology. 3 Their construct was that personality, like bodytype, was the result of maturational processes. This idea foreshadowed presentunderstanding of personality.Psychopathic constitutionsNineteenth-century efforts at objective description of personality were inconsistent.The term “moral insanity” mixed constructs of disease and trait, initiallymeaning mood disorder and then antisocial personality. 4 The prevailing view wasthat deviant personality traits reflected a constitutional (i.e. biological) deficit.Ernst von Feuchtersleben introduced the term psychopathy in 1845 to mean aconstitutionally disordered personality without psychosis. Julius Ludwig AugustKoch elaborated this concept of psychopathic inferiorities in 1888, indicating aconstitutional degeneration (the source of the word “degenerate”) that expresseditself not as psychosis but as various trait behaviors, such as a lack of forcefulness,being weak-willed, and shy. Koch considered persons with these conditions at riskfor psychiatric illness. Pierre Janet added hysterical personality as a predispositionto hysteria and neurosis in 1893.In 1896, Bleuler opined about the “born criminal” and “pathological liars andswindlers”. In 1915, his list of abnormal personality types included excitable,irresolute, hedonistic, eccentric, liars and swindlers, “enemies of society” (antisocialpersonality), and the quarrelsome. Kraepelin presented his classification ofpsychopathic personalities in the 1904 seventh edition of his textbook. Kraepelinalso considered these conditions to be trait deviations. 5In the twentieth century, Kurt Schneider offered a descriptive classification ofpersonality disorders which he defined in the modern sense of maladaptive traitbehavior causing the patient or others to suffer. He considered personality andpersonality disorder to reflect individual “constitution”, the result of biologicalmaturation modified by environment. Schneider used the terms “psychopathy”and “psychopath” as generic terms for personality disorder. His efforts were basedon extensive clinical experience rather than empirical study. 6 Schneider’s topologyinfluenced German and British clinicians for decades until replaced by theICD-10 formulation.Psychoanalytic theorySigmund Freud offered another view of personality with three major componentsinteracting unconsciously in a dynamic tension, thus “the dynamic unconscious”.The id represented inborn immutable instinctive drives seeking expression withoutregard for reality. The ego represented mechanisms of adaptation to reality.