Moral insanity  

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Moral insanity (Latin - mania sine delirio; French - folie raisonnante or folie lucide raisonnante, monomanie affective; German - Moralisches Irresein) is an obsolete medical diagnosis first described by the French humanitarian and psychiatrist Philippe Pinel in 1806. A form of mental derangement in which the intellectual faculties are unaffected, but the moral principles of the mind were "depraved or perverted". He 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 bears a great debt to the work of Philippe Pinel, 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.

Contemporary misunderstanding of the term derives from the fact that the meaning of the term "moral" was quite different in the nineteenth century context from that of the present day. Then, it referred to psychological more often than ethical concerns. Thus, moral referred to the intellectual in contrast to the connative and affective. Likewise the term moral treatment referred to a set of psychosocial techniques rather than ethical practice.

The context leading to the conceptualisation 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 in which delusional symptoms were required. In legal trials this definition had proved to be a great source of embarrassment to alienists due to the fact that 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. 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.

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