Abstract
In an age where terrorists, sexual deviants and rogue entrepreneurs consistently figure in headline news, it is not surprising that dangerous individuals and their personal attributes loom large in the public consciousness. Psychiatry has been fairly unwillingly drawn into the debate about the defining characteristics of such individuals and what (if anything) can be done to cure or at least control them. Current developments in Victoria are simply indicative of wider trends throughout Australia and New Zealand; as at the time of writing this review (December 2002) there are no fewer than three separate enquiries taking place into the legislative and clinical fates of people variously described as being dangerous, having ‘complex needs’ and having one or other type of mental ‘impairment’. This book is therefore timely and sobering. It confirms the maxim that history repeats itself: dangerous people have always been difficult to identify, foresee and treat, and the assigning of labels such as ‘defective’, ‘moral imbecile’, ‘psychopath’ or ‘antisocial personality disorder’ does little to clarify the conceptual confusion surrounding them. Personality, as the author argues, is ultimately an ‘artefact of Government’ with ‘Government’ being broadly defined as all the complex relationships of knowledge and power which enmesh both individuals and whole populations. The history of the concept of ‘personality disorder’ has been the history of the development of a linguistic and social ‘space’ in which the complex notions underpinning the term can be ultimately realized. The notion of the ‘incurably aggressive’ was refined largely because medical professionals in early colonial Australia succeeded in a power-struggle with asylum keepers over who would provide what sort of treatment to asylum inmates: the ‘untreatable’ became those for whom psychiatrically auspiced ‘moral treatment’ would not work.
Further refinements to the notion of ‘untreatable’ came with the separation of ‘acute’ from ‘chronic’ cases, the ‘defective’ from the ‘lunatic’, the ‘moral imbecile’ of normal intelligence from the truly intellectually disabled ‘idiot’ and, finally, the use of neuro-anatomy, psychological testing and complicated statistical techniques to separate out a class of people who are, despite being frighteningly close to ‘normal’, both ‘incurable’ and ‘dangerous’. Throughout all of this, personality becomes: … not merely a set of traits or the unique characterizing bundle of attributes of individuals that we might once have thought of as a character resume but has in addition a connection to how persons are thought about as being governed… it might also be argued that personality has become a domain of techniques for the exercise of freedom in liberal forms of Government. That is, that individuals are required to conduct their freedom – they are ‘obliged to be free’ – by the activity of fooling themselves into personhood by developing techniques of ‘making up one's self’ in a constructed space known as personality. (pp. 151–152.)
Thus (for example) the efforts of the mental hygiene movement during the first half of the twentieth century were aimed not only at the primary prevention of psychiatric disorders but also at the development of a ‘wholesome personality’. This prescriptive approach was in turn accompanied by a conceptual shift so that the focus was moved away from the control of clearly disordered individuals (those with an obvious psychiatric disorder) to the aberrant personality who might be identified only by reference to their more ‘normal’ fellow citizens: a shift, in other words, away from clear individual pathology to the more subtly defined extremes of statistical distribution.
Unfortunately, this book, despite its insights, does not address its central theme particularly well. The first challenge is its rather dense style which (without wishing to stereotype other books in the area) seems to be similar to other works which have a post-modernist approach. This is a pity because clinicians need to know and understand the concepts with which the author is working. ‘Personality’, ‘personality disorder’ and ‘antisocial personality disorder’ are too often used as terms which describe real things, rather than (as the author tries to show) simply constructions of language which simply provide space for social, political and so-called ‘scientific’ ways of thinking to develop. A second problem with the book is that many of the straw men it sets up do not exist. For example, its clichéd references to psychiatrists' inability to predict dangerousness rests on literature which is now 20 years old. Even a superficial perusal of work done in the last decade would indicate that the claims for predicting the risk of violence in particular individuals are now substantially more modest, guarded and backed by an impressive array of good-quality empirical studies. The third, and probably the most significant, problem with this book is that, ultimately it does not really consider the very thoughtprovoking questions about the nature of the relationship between personality disorder and dangerousness posed in its first chapter. According to the author, ‘the argument advanced in this book is that the modern concept of personality comes into existence as an index of risk management’. Yet the complex and difficult concepts involved in the construction of the notion of ‘risk’ are not really discussed, except perhaps in passing references to (for example) the use of ‘dangerousness’ in defining the category of ‘moral imbecile’ at the beginning of the last century. Despite the book's exhaustive (and very insightful) discussion of the development of the concept of ‘personality’ (and the associated notion of incorrigibility), it is curiously silent as to how and why the personality disordered finally become the dangerous monsters of recent folklore. Sadly, this book does not really attempt to even consider the range of explanations available concerning the nature of the link between personality disorder and dangerousness. It is thus only the beginning, albeit a useful beginning, to the enquiries which still need to be carried out in this fraught but most important interface between law, psychiatric and culture/ social theory.