The development of psychopathologies that afflict mental health has been conceptualised and studied over the years. These theories have helped psychiatrists and psychologists comprehend the etiologies of mental illnesses and their treatment approaches to help those in distress.

In 1884, the Russian psychiatrist, Balinsky, gave a succinct description of what constitutes a psychopath at a court appearance: “The psychopath… is a type which has only recently come under the notice of medical science… Beside his own person and his own interests, nothing is sacred to the psychopath”.

Psychopathy is a personality and behavioural disorder comprising inter-related deficits in the emotional, interpersonal and behavioural aspects of a person. In a person with psychopathy, the lack of regards for those around him is contributed in part by the lack of empathy that is best understood as the inability to feel for others. Empathy is predominatly a function of the limbic system of the nervous system, in particular the amygdala. Abnormal functions of the amygdala have been demonstrated in functional imaging of people diagnosed with psychopathy.

Similar to people with personality disorders, where key domains of functioning such as family, social, work and academic functioning are affected, people with psychopathy are more likely to cause mental anguish and pain to those around them. The phenomenology of psychopathy places greater emphasis on the affective and interpersonal features of the individual compared to those with cluster B personality disorders such as antisocial personality disorder and borderline personality disorder.

From another historical perspective, the word psychopath literally means “suffering soul”, it was coined by John Seabrook in the 1880s. “Suffering soul” conjures an image of a spiritual soul tormented over the actions of the body, with no imminent relief or hope in sight, an image of helplessness and pain.

The treatment for psychopathy and personality disorders require a holistic approach because these are pervasive and persistent mental disorders that have varied clinical presentations, multifactorial etiological basis and persistent dysfunctions across different domains of life-function. Treatment modalities and services may include psychotherapy, assessment and mitigation reports for courts and legal counsels, specialist reports for SAF Medical Board for suitable emplacement as well as treatment of other co-morbid psychiatric disorders.

Dr John Bosco Lee

Forensic Psychiatrist, Singapore