In 1801, French psychiatrist Philippe Pinel became the first psychiatrist to diagnose “mania without delirium,” or deviant behavior in the absence of psychotic symptoms. In 1835, British psychiatrist J. C. Prichard used the phrase “moral insanity” to refer to individuals who made impulsive decisions that deserved moral condemnation and who were incapable of effective decision-making. These people, despite their intelligence, served their own interests, yet became largely dependent on others. In the 1890s, J. L. Koch suggested that physiological makeup was partially responsible for what we now call psychopathic behavior. Koch used the term to refer to all personality disorders. Krafft-Ebing linked psychopathy with deviant sexual drives, which enlarge greatly on normative sadistic impulses, leading to unprovoked violent behavior. Later, Freud referred to “criminality from a sense of guilt,” whereby the individual felt relief from guilt immediately

after committing violent and aggressive acts. Dr. Hervey Cleckley, to whom Larson refers, was writing in 1940s America.

The term “psychiatry” was first used in 1908 in Germany by Johann Christian Reil. George III of England was committed to what was then called a lunatic asylum in 1788, and asylums became more common throughout the 19th century. Benjamin Rush, the founding father of American psychiatry, recommended bloodletting as a treatment for mania in 1812.