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Mental Disorders

by Theodore Millon, Erik Simonsen, Roger Davis & Morten Birket-Smith (Editors)
Guilford Press, 2002
Review by Colin A. Holmes, Ph.D. on Jun 6th 2003


The newly published paperback version is eminently good value. It remains the most recent book to review the state of knowledge of the clinical aspects of the concept of psychopathy. The authors are leading researchers in the field, and the chapters cover almost all the major topics, as well as some that are less familiar (such as one on parental licensure), and are grouped into five sections: history and viewpoints, typologies, etiology, comorbidity and treatment. The book has been carefully edited so as to ensure wide coverage without sacrificing the particular perspectives of each author, and judgements as to the strongest chapters will depend on the reader's theoretical interests and preferences.

I have only a couple of criticisms. Firstly, the historical chapter seems less successful than the others, and unnecessarily restricted in its range of sources. As a brief example, although his pioneering contribution is dismissed by the authors as a misuse of Pinel's "morally neutral clinical syndrome", Rush's concept of "moral derangement" actually dates from 1786, 15 years before Pinel's notion of manie sans delire, and employs the quite different language of the Scottish 'faculty' psychologists. Rush coins the terms, 'micronomia', to refer to all cases of weakened or limited 'moral faculty' (i.e. ethical awareness), and 'anomia' to refer to its total absence. By 1812, the date assigned to his views in this chapter, he had moved away from this explicitly moral concept, perhaps because the radical challenge such views represented to the existing cultural and political order caused them to be ignored by the establishment. There are many other examples in which the subtleties of the historical record seem to have been sacrificed to broad generalizations which represent what might be termed the 'received view'. My complaint about restricted sources, is exemplified by the fact that the only book, as far as I am aware, which is devoted entirely to the history of the concept of psychopathy (Werlinder 1978), the first edited collection of clinical papers on psychopathic disorder in the English language, if we discount Karpman's mixed psychoanalytical material of the 1940s (Craft 1966), the first major collection of research papers (Hare & Schalling 1978), and the stream of publications arising out of Ronald Blackburn's pioneering research with psychopathic offenders in Britain from the 1960s onward, are all overlooked.

The second criticism is that, although the text is bursting at the seams and something had to give, it is disappointing not to see a systematic review of assessment tools, especially given a) continuing uncertainty over the role of psychopathy and PCL-R scores in predicting violent recidivism, and b) the development of a range of assessment tools specifically for the DSM-IV personality disorders. For the whole issue of assessment, however, we can turn to the text edited by Gacono (2000), devoted exclusively to that topic.

As it is, this is the ideal starting point for the trainee clinician, and a thought-provoking read for the experienced psychopathy specialist. Of course, much has happened in the last five years, and a second volume would be an exciting prospect.



Craft M (ed.) (1966) Psychopathic Disorders. Oxford: Pergamon Press.

Gacono CB (ed) (2000) The Clinical and Forensic Assessment of Psychopathy: A Practitioner's Guide. Trenton NJ: Erlbaum Associates.

Hare RD, Schalling D (eds.) (1978) Psychopathic Behaviour: Approaches to Research. New York: John Wiley.

Werlinder H (1978) Psychopathy: A History of the Concepts. Uppsala: Almqvist and Wiksell.


© 2003 Colin A. Holmes


Dr Colin A Holmes, School of Nursing Sciences, James Cook University, Townsville, Queensland, AUSTRALIA