Moral insanity referred to a type of mental disorder consisting of abnormal emotions and behaviours in the apparent absence of intellectual impairments, delusions, or hallucinations. It was an accepted diagnosis in Europe and America through the second half of the 19th century. The physician James Cowles Prichard first used the phrase to describe a mental disorder in 1835 in his Treatise on insanity and other disorders affecting the mind. He defined moral insanity as: "madness consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses, without any remarkable disorder or defect of the interest or knowing and reasoning faculties, and particularly without any insane illusion or hallucinations." The concept of moral insanity was indebted to the work of physician Philippe Pinel, which was acknowledged by Prichard. Pinel had described mental diseases of only partial, affective, insanity. His concept Manie sans délire (Latin – mania sine delirio; French – folie raisonnante or folie lucide raisonnante, monomanie affective; German – Moralisches Irresein) referred to insanity without delusion. That is, the person was thought to be mad in one area only and thus the personality of the individual might be distorted but his or her intellectual faculties were unimpaired. The term 'moral', at that time and taken originally from French, could mean emotional rather than necessarily referring to ethics. Diagnostic schemes The term 'moral insanity' had been used earlier by Thomas Arnold (physician) and Benjamin Rush in referring to what they saw as a result of madness – a disruption or perversion of the emotions or moral sense. This usage had little to do with Prichard's diagnostic definition of the term as a form of madness itself, however. Overall, Prichard defined insanity as a, "chronic disease, manifested by deviations from the healthy and natural state of the mind." He then proposed four broad categories. Moral insanity was for disorders that only seemed to arise from a person's feelings and habits, not his intellect. The other three types involved increasing degrees of intellectual abnormality: a partial derangement that was limited to certain trains of thought; a full mania, by which was meant 'raving madness' regardless of topic; and lastly, a breakdown of any connections between ideas, referred to as incoherence or dementia. Prichard considered that some early nosologists, namely Sauvages, Sagar and Linnaeus, had distinguished between medical conditions with hallucinations and those involving depraved appetites or