330 Abnormal Psychology
By the 1940s, neuropsychological assessment of psy-
chotic patients employed a range of tests for the assessment
of brain damage (Benton & Howell, 1941). They largely fo-
cused on cognitive functions such as memory, attention, and
other components such as the subtests of general adult
intelligence tests. The combination of neuropsychological
tests, EEG and its derivatives, and clinical neurological
examination provided the main tools for investigating brain
psychopathology connections until well into the second half
of the twentieth century. After that, new techniques of brain
imaging were to revolutionize the strategies of research.
Theories of Origin and Research
in Antisocial Personality
Much experimental research has been generated by clinical
assumptions about the characteristics and etiology of antiso-
cial personality disorder. Keep in mind that most of these
studies have been restricted to subjects in prisons or in psy-
chiatric facilities. Such subjects are not only more likely to be
extreme in their manifestation of sociopathy, but the effect of
imprisonment of hospitalization may have influenced the
obtained results.
Early theories of motivation postulated that all organisms
are driven by a need to reduce sensory stimulation. In 1949,
Hebb suggested instead that behavior can be motivated to
increase sensory stimulation. Quay (1965) hypothesized that
sociopaths, compared to normal people, have a lower basal
reactivity to stimulation and so need more intense sensory
input in order to maintain a level of cortical function ade-
quate for the subjective experience of pleasure. Hence, they
require more intense levels of stimulation.
It has also been suggested that the antisocial behavior of
sociopaths reflects their inability to delay gratification of
emotions and inhibit their impulses to action. Research re-
sults are inconsistent in their support of this hypothesis.
Behaviorism and Behavior Therapy
Neopavlovian behaviorism, in the forms developed by Hull
at Yale and Eysenck in the United Kingdom, devoted much
effort to the understanding of the processes associated with
disordered behavior. The logic underlying the application of
behavioral principles to the task of changing behavior were
relatively straightforward. Maladaptive behavior was ac-
quired (i.e., learned) and maintained in the same way that any
other behavior is learned, namely by the circumstances sur-
rounding when it first occurred and its consequences. The
maladaptive behavior was either followed by some desired
consequence (a reward), or served to avert some undesirable
consequence (a punishment). This general principle war-
ranted the deduction that treatment should consist of extin-
guishing the maladaptive behavior by removing its rewards
while, at the same time, giving rewards to the patient when-
ever normal behavior was displayed. When the behavior was
primarily avoidant, the principle was that repeated exposure
to the feared stimulus without any aversive consequences
would ultimately lead to extinction of fear and the emergence
of more adaptive behavior.
The effectiveness of these techniques had been demon-
strated in the animal laboratory, but their application to ac-
tual patients was another matter. Psychoanalytic doctrine
had asserted that the overt behavior was a “symptom” of an
underlying intrapsychic conflict, and that removing the
symptom without solving the conflict could not be curative.
Thus, it was claimed, the symptom might disappear when
treated by behavioral methods, but that a new symptom
would emerge to take its place. This hypothesized phenome-
non was called “symptom substitution.” From the behavioral
perspective, the so-called symptom was the problem, not
just an indicator of an invisible problem. Although later
studies were to show that the psychoanalytic claim was un-
founded, the hegemony of psychoanalysis in psychiatric
practice effectively prevented any extensive use of behav-
ioral methods with patients. Although Salter (1949) pub-
lished his classic Conditioned Reflex Therapyin 1949, not
until the deficiencies of psychoanalytic treatment had been
demonstrated did the way open for applying behavioral
treatment. This development did not occur until after mid-
century, and occurred at first more widely in the treatment of
children’s behavior problems in the classroom and the home,
where psychiatric influences were usually minimal.Recent ApproachesThe half century that spanned the period 1950 to 2000 saw
major changes in almost every aspect of theory and practice
in psychopathology. One of the first was the decline of
psychoanalysis.The Decline of PsychoanalysisIt is important to note that the influence of psychoanalysis
within psychiatry in the United States far exceeded its influ-
ence in psychiatry in other countries. The combined member-
ship of the psychoanalytic societies of Austria, Denmark,
France, Germany, The Netherlands, Italy, Sweden, and
Switzerland by 1961 amounted to only 250 people (Szasz,
1961). In these countries and Great Britain, the psychoana-
lyst need not have had medical training, whereas in the