Courtroom sketch of Jeffrey Epstein
Our view of psychopathy, aka antisocial personality disorder, has changed with the times
STUDY: Schulert SB, History of Psychiatry 2026; doi:10.1177/0957154X261435550
STUDY TYPE: Historical analysis
FUNDING: Independent
Diagnostic Change: A Timeline
Dr. Schulert, a historian at the University of Wisconsin-Madison, analyzes American psychiatric literature from 1906 to 1941, examining how gender shaped the concept of psychopathy.
Early 19th century
- Psychopathy conceived as immoral behavior without signs of mental illness, unexplained by psychosis, mania, delirium, or intellectual deficits. Philippe Pinel, J.C. Pritchard, and J.L. Koch pen the first descriptions in Europe.
1906–1915: Early Mental Hygiene Era: “Misfits”
- Adolf Meyer introduces the psychopathy diagnosis to American psychiatry, and psychopath becomes associated with delinquents, unstable individuals. Unlike today’s antisocial, they evoke pity, “weak willed” and suggestible.
1910s: Biological Ideas
- Psychopathy becomes associated with developmental disabilities (“Infantilism”), physical or endocrine abnormalities, and gets taken up by the eugenics movement.
1920s: Gender Nonconformity
- Psychopathy vied as part of non-standard gender expression and homosexuality. Both men and women commonly diagnosed.
- (Homosexuality was originally classified as a type of psychopathy, but was removed from the DSM in 1974. Get the full story in our Carlat Podcast).
1920s-1930s: Rise of the “Self-satisfied” Psychopath
- As male military patients flooded veterans’ hospitals after WWI, psychiatrists increasingly saw psychopathy as the self-satisfied, “hard and unfeeling” psychopath.
- This was a major conceptual shift from weak/inferior to strong, egocentric, antisocial, lacking remorse, defiant, aggressive.
1941: A Male Stereotype
- Hervey Cleckley’s classic book The Mask of Sanity crystalized today’s stereotype with “a durable image of a superficially charming but inherently destructive man.” In the psychoanalytic model, psychopathy was caused by an unresolved Oedipal conflict, a myth that placed the son, not a daughter, at its center.
Today
- Psychopathy keeps changing names, first to sociopathy and now antisocial personality disorder.
- In popular culture, it has been merged with narcissism the Dark Triad (learn more in our Carlat podcast Epstein on the Couch).
- Recently, one of the first effective psychotherapies for antisocial came out of England, drawing from psychoanalytic concepts.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
