Jesper Vaczy Kragh considers the history of “psychopathy” in child psychiatry, and asks what the contemporary discipline and the humanities might learn from the disappearance of this diagnosis.
Some years ago, while working through psychiatric archives of the early twentieth century, I kept encountering a diagnosis that seemed strangely out of place. It appeared in patient records, institutional reports, psychiatric journals, newspaper articles, and political debates. Doctors worried about it. Policymakers discussed it. Educational authorities sought solutions to it.
The diagnosis was psychopathy.
Today, the term immediately evokes images of criminality, delinquency, or violence. Yet the children described in the archives were often neither. Some were restless and impulsive, others struggled in school, resisted authority, lied, or simply failed to behave as adults expected. What united them was not a specific set of symptoms, but the perception that they deviated from accepted norms of childhood behaviour.
As an historian of psychiatry, I find diagnoses like psychopathy fascinating because they remind us that psychiatric categories are historical creations. They emerge, change, and sometimes disappear altogether (Scull 2009). The psychopathic child was once a central concern of child psychiatry. Today, the diagnosis has largely vanished.
Its disappearance raises a broader question: how different was child psychiatry a century ago from the discipline we know today?
Child psychiatry then and now
At first glance, the answer to the previous question might seem obvious. The most immediate difference lies in the diagnosis itself. ADHD and autism, the most discussed childhood diagnoses of today, did not occupy a comparable position in psychiatric practice during the first half of the twentieth century (Smith 2017). Child psychiatrists encountered children who were inattentive, impulsive, socially withdrawn, or behaviourally different. But they interpreted these symptoms in other ways. The children existed. The diagnosis did not (Silverman 2012).
This distinction is important because it challenges a common assumption about psychiatric history. There is often a temptation to look backwards and identify historical examples of contemporary disorders. Was the child diagnosed as psychopathic in 1930 actually autistic? Did another child ‘really’ have ADHD?
Such questions are understandable, but they risk obscuring what is historically interesting. As historian Matthew Smith (2012) has convincingly shown, historical examples of early ADHD are also more ambiguous than is often assumed. Diagnoses do more than describe behaviour; they reflect particular ways of understanding childhood, normality, and disorder. The challenge is not to determine whether psychiatrists of the past correctly identified modern conditions; it is to understand why categories such as psychopathy appeared meaningful in their own time.
My research on child psychopathy in Denmark has shown how central this diagnosis became under the development of child psychiatry in the early twentieth century (Kragh 2026). Psychopathy functioned as a remarkably broad category. It could encompass emotional instability, behavioural problems, educational difficulties, aggressive conduct, lack of self-control, or perceived moral deficiencies, but also quietness, being passive or introverted.
Because of the flexibility of the diagnosis, it proved useful to psychiatrists struggling to make sense of children who fell outside prevailing expectations. It provided a language through which teachers, doctors, parents, social workers, and politicians could discuss troublesome children, and debate what should be done about them.
Historical differences
The difference between past or present extends far beyond diagnostic labels. One striking contrast concerns how common childhood psychiatric disorders were believed to be. During much of the twentieth century, child psychiatrists generally regarded mental disorders as relatively rare. Child psychiatry was concerned with exceptional children rather than ordinary childhood development. The field defined itself through its attention to a limited number of problematic cases.
Today, the situation is very different. Diagnostic categories, such as ADHD and autism, have become part of everyday vocabulary. Many children are assessed, diagnosed, and supported thorough psychiatric and psychological services. Questions about diagnosis are no longer confined to medical specialists but have become matters of public discussions among parents, teachers, journalists, and policymakers.
Historical research cannot fully explain why childhood psychiatric diagnoses became so much more common. As Matthew Smith’s (2019) work on ADHD suggests, greater awareness, changing diagnostic criteria, expanded services, and broader environmental and social changes may all have contributed. What is clear, however, is that childhood diagnosis has moved from the margins of public attention to its centre. Before the late 1950s, hyperactive and inattentive children were rarely discussed in psychiatric literature or the media (Smith 2012). Today, diagnosis plays a central role in how children’s behaviour is understood, managed, and debated.
Another difference concerns which children attracted psychiatric interest in the first place. When I read early twentieth-century psychiatric records, I am continually struck by the prominence of institutionalised children. Many children discussed in the early psychiatric literature came from orphanages, children’s homes, reformatories, and other welfare institutions. These children were highly visible to the authorities and often attracted attention precisely because they failed to adapt to institutional environments. As a result, the earliest child psychiatric patients frequently came from socially marginal groups. They were poor, neglected, institutionalised, delinquent, or otherwise viewed as social problems before psychiatrists ever became involved.
Image courtesy of Birgitte Brun. Reproduced with permission.
Today, the picture is broader. Most children who receive diagnosis such as autism and ADHD live with their families and attend ordinary schools. Child psychiatry no longer focuses solely on marginalised populations but addresses developmental and psychological differences across the social spectrum. The preferred solutions have changed as well. Reading psychiatric files from the first part of the twentieth century, one is struck by how frequently institutional placement was regarded as the best response to behavioural difficulties. Psychiatrists, social authorities, and politicians often advocated specialised homes for psychopathic children, where they could be observed, treated, educated, and disciplined. Removal from ordinary surroundings was frequently considered beneficial, both for the child and for society.
Institutionalisation occupies a much less prominent role today. Contemporary approaches generally emphasise inclusion, family involvement, educational support, and treatment within the community, whenever possible. Rather than separating children from everyday environments, the goal is usually to help them remain within them.
To modern readers, earlier reliance on institutions may appear misguided, yet historical judgement is rarely straightforward. Institutional care reflected broader assumptions about expertise, social order, and the role of the state. Just as we may struggle to understand the confidence psychiatrists placed in psychopathy, future generations may find some of our assumptions equally surprising. This possibility is perhaps the most intriguing lesson offered by the history of child psychiatry.
Lessons from history
Working in psychiatric archives often produces a curious sense of familiarity and distance at the same time. The children themselves feel recognisable. Parents worry, teachers struggle, doctors search for explanations, and children find themselves misunderstood, excluded, or unable to meet expectations. But the language used to interpret these experiences can feel entirely foreign.
This tension reminds us that childhood difficulties have a history, but so do the concepts used to explain them. The problems may appear familiar; the frameworks through which they are understood are not.
The history of child psychopathy illustrates this point particularly well. A diagnosis that once stood at the centre of child psychiatry now survives largely as an historical curiosity. Its rise and fall demonstrate how psychiatric knowledge changes over time and how diagnostic categories reflect the social concerns of the periods that produce them.
For historians, the psychopathic child remains important not because the diagnosis was correct or incorrect. Rather, it matters because it reveals a different way of understanding childhood difference. It belonged to a world in which childhood mental disorders were thought to be rare, concentrated among marginalised groups, and often best addressed through institutions.
The child diagnosed with autism and ADHD today inhabits a very different world. The point is not that one system simply replaced another, nor is it to suggest that contemporary diagnoses are destined to disappear in the way psychopathy did. History will not tell us what the future of psychiatry will look like. It can, however, encourage a certain humility. Diagnoses that once appeared self-evident have now vanished. Categories that seem indispensable today may one day be reconsidered. Child psychiatry has never been static, and neither have society’s ideas about childhood itself.
Perhaps that is why the story of the psychopathic child still matters. Its disappearance reminds us that psychiatric knowledge has a history, and that every generation develops its own ways of defining, explaining, and responding to childhood difference. Recognising this history encourages us to view contemporary diagnoses not as timeless truths, but as categories shaped by changing scientific, social, and cultural concerns.
About the author
Jesper Vaczy Kragh is Professor of History at the University of Southern Denmark and Principal Investigator of the DFF-funded project Danish Child Psychiatry in the Clinic and Beyond. His research explores the history of psychiatry, with a particular focus on child psychiatry, psychiatric diagnosis, and the changing ways societies have understood childhood mental disorders. You can find him on LinkedIn: Jesper Vaczy Kragh.
References
Kragh, Jesper Vaczy. 2026. “Diagnosing Deviance: Psychopathy and Rise of Child Psychiatry in Denmark.” Journal of the History of Medicine and Allied Sciences 2026: jrag033. https://doi.org/10.1093/jhmas/jrag033.
Silverman, Chloe. 2012. Understanding Autism: Parents, Doctors, and the History of a Disorder. Princeton University Press.
Smith, Matthew. 2012. Hyperactive: The Controversial History of ADHD. Reaktion Books.
Smith, Matthew. 2017. “Hyperactive Around the World? The History of ADHD in Global Perspective.” Social History of Medicine 30: 767–87. https://doi.org/10.1093/shm/hkw127.
Smith, Matthew. 2019. “‘Snips and snails and puppy dog tails’: Boys and behaviour in the USA.” Canadian Bulletin of Medical History 36: 51–79. https://doi.org/10.3138/cbmh.236-112017.
Scull, Andrew. 2009. Hysteria: The Disturbing History. Oxford University Press.
