Letter: `Psychopath' label

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The Independent Culture
Sir: Whilst sharing much of Professor Simon Wessely's indignation that the psychiatric profession should come in for yet more criticism in a situation which is to a large extent beyond the profession's control, we are dismayed by some of his conclusions ("You can't just lock up psychopaths", 29 October).

It makes for good humour, but it is inaccurate to say that "antisocial personality disorder" is "doctor-speak for being a nasty piece of work". All sorts of people are nasty pieces of work without suffering from any sort of personality disorder, and many patients with antisocial personality disorder are far from being a nasty piece of work.

In the current debate the labels "psychopath" and "personality disorder" are being used to imply a coherent diagnostic group. Those of us who treat and research patients who meet the current criteria for personality disorder, have come to realise that these patients show marked differences, whether in early life experiences, lifestyle or achievements. Most also suffer from a concurrent psychiatric syndrome - depression, anxiety, a psychosis or an addiction - in addition to their particular personality traits. It is usually the psychiatric disorder that causes the patient to suffer, and to seek help. Such disorder may also lie behind any antisocial behaviour.

We do not in any case use the label "psychopath"; it has become a term of opprobrium because it has no therapeutic usefulness. We find the best therapeutic approach is to carefully assess each patient's psychiatric and social needs, to individuate them and to provide what can be done to help each case. Some personality traits may make patients difficult or unrewarding to work with and may delay recovery. Despite this, it should be within the remit of a multidisciplinary mental health team to make an assessment, which focuses on illness rather than on the more chronic personality problems, even though with time these too can be assisted.

Professor Wessely says that the Home Secretary is asking for internment without trial. Psychiatrists do not detain patients of any category as a form of internment without trial and we do not believe that the Home Secretary is asking them to do so. The powers of the Mental Health Act are simply available in order to provide some individuals whose mental disorder affects their judgement with assistance in a way which takes account of their poor judgements and which is surrounded by very important and stringent safeguards. The Act calls for treatment in hospital against the patient's will in appropriate circumstances if "it is necessary for the health or safety of the patient, or for the protection of other persons". It is primarily for the health of the patient and, as we have indicated, a lot can be done to assist patients with personality disorders if resources are available. The fact that a lot of patients who should be admitted to hospital are not being admitted is related as much to a shortage of those resources as to anything else.

JOHN GUNN

Professor of Forensic Psychiatry

ANTHONY MANN

Professor of Epidemiological Psychiatry

The Maudsley

London SE6

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