IT HAS become a psychiatric commonplace to say that the psychopathic personality diagnosis is a wastebasket—too generalized, too inexact, too all-inclusive. The 202 variations of this diagnosis collected by Cason,1 which vary from "volitional inferiority" to "constitutional psychopathic inadequate" to "sociopath" demonstrate this diagnostic confusion and conceptual inexactness. A life-long student of the subject, Dr. Ben Karpman, has properly asked: "Is psychopathic personality a disease or a peculiarity of behavior?" This basic question to which this paper addresses itself, has wide implications, encompassing not only diagnosis and classification, but also management, therapy, and indeed the total attitude of psychiatry toward this group of troublesome individuals.
In approaching this question, the diagnostic position of the psychopathic concept, let us focus on a first consideration, namely the meaning of a "diagnosis." A diagnosis itself is a technical device in medicine; it is