Dangerous severe personality disorder – not a new problem

Sir: People with dangerous severe personality disorder have long been recognised by psychiatrists to be beyond the remit of the psychiatric services. This point is nicely illustrated by a case summary of a patient admitted in 1838 to the newly opened Northampton Asylum (now St Andrew's Hospital).

A 26-year-old labourer said to be suffering from ‘insanity caused by intoxication and sleeping at night in the open’ was transferred to the asylum from Oakham Gaol. He had a history of violent assault and in prison had been kept heavily ironed. In hospital he continued to exhibit episodic violence. Thomas Prichard, the medical superintendent, wrote ‘he went on very well until yesterday when he broke out into open mutiny. He is a reckless profligate’. He was not placed in mechanical restraints, as this was against the philosophy of the hospital, but solitary confinement and low rations were used. The patient exhibited no signs of ‘insanity’ throughout his stay. A month after admission Dr Prichard wrote ‘I do not consider him a proper inmate for an establishment like ours. I very much doubt that we possess the power of reclaiming him (by moral management) and firmly believe the treadwheel or cat o’ nine tails would be found more efficacious'. Prichard applied to the hospital governors for permission to discharge the patient. This being granted, 6 weeks after admission he was sent home and nothing more was heard of him.

Today, under the Government's new Mental Health Bill, his fate might be very different.