Section 4: Some questions still without adequate answers

Part 1: What is wrong with these patients?

61. A basic hypothesis



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461. A basic hypothesis

Now that we have proceeded with our task through the stages of (1) presenting

observations of the gross material and (2) sifting and tabulating as conveniently and

intelligibly as we were able the pertinent residue of our data, let us attempt the next step.

This will consist in searching for some concept or formulating some theory that might

satisfactorily account for the facts observed. Much of the material appears

contradictory, not only in the ordinary world of average or normal living but even in the

world of mental disorder commonly granted to be less readily comprehensible in terms

of ordinary reason. Even the accepted postulates which help us come to some

understanding of the patient with hysteria or the delusional schizophrenic seem at first

to fail when applied to the psychopathic, or antisocial, personality.

A patient whose fragmented personality prevents him from becoming aware of

significant facts and puts him at the mercy of fantasies indistinguishable from what is

real may conduct himself in a fashion that strikes us as altogether absurd and irrational if

we fail to take into consideration this fragmentation. A man who is sane by the

standards of psychiatry, aware of all the facts which we ourselves recognize, and free

from delusions but who conducts himself in a way quite as absurd as many of the

psychotic becomes another problem altogether. The observer is confronted with a

paradox within the already baffling domain of mental disorder.

In the attempt to arrive at an applicable conception, one consistent with the facts

of our observation, I find it necessary first of all to postulate that the psychopath has a

genuine and very serious disability, disorder, defect, or deviation. To say that he is

merely queer or perverse or in some borderline state between health and illness does

little or nothing to account for the sort of behavior he demonstrates objectively and

obviously. The practice, quite popular until recent years, of classifying the disorder of

these patients, no matter how plain their incapacity to lead normal lives, as (1) no

nervous or mental disease and (2) psychopathic personality, whatever


the sanctions afforded by tradition, emerges not only as a misleading practice but also as

sometimes promoting absurdity when we honestly examine the material to which such

terms are applied.

Let us for a moment consider the essential evidence brought out in staff meetings

on which experienced psychiatrists establish in an obvious case the diagnosis of

schizophrenia and on which legal action is taken to declare the patient psychotic and

incompetent (insane) and commit him for treatment. In the brief summarizing

statement to support such opinions we often find such words as these:

The history shows that he has failed repeatedly to make a satisfactory adjustment in the

social group. His actions indicate serious impairment of judgment and show that he cannot

be relied upon to conduct himself with ordinary regard for the safety of himself or of

others. His irrational and unacceptable behavior has, furthermore, occurred without

normal or adequate motivation. He shows no real insight into his condition and tends

often to project the sources of his troubles to the environment. His emotional reactions

are grossly impaired and he has repeatedly shown inappropriate or inadequate affect. We

may say, then, that he is psychotic, incompetent, incapable of carrying on the usual

activities of life, and in need of close supervision.

Such facts have often over many decades constituted more convincing evidence

for the diagnosis of schizophrenia than the delusions and hallucinations also frequently

present but sometimes not demonstrable in that psychosis. All of these statements just

recorded (excepting only the one word "psychotic") may be applied with full validity to

the psychopath. This, of course, does not make him a patient with schizophrenia but it

does, I maintain, afford grounds for saying he has a grave psychiatric deficit, and

grounds that cannot be dismissed lightly. Although I insist on the gravity of his

abnormality, I frankly admit that it is a different kind of abnormality from all those now

recognized as seriously impairing competency. It is an abnormality that differs more

widely in its general features from any of those than they differ from one another.

The first and most striking difference is this: In all the orthodox psychoses, in

addition to the criteria just mentioned, or to some of these criteria, there is a more or

less obvious alteration of reasoning processes or of some other demonstrable

personality feature. In the psychopath this is not seen. The observer is confronted with

a convincing mask of sanity. All the outward features of this mask are intact; it cannot

be displaced or penetrated by questions directed toward deeper personality levels. The

examiner never hits upon the chaos sometimes found on searching beneath the outer

surface of a paranoid schizophrenic. The thought processes retain their normal aspect

under psychiatric investigations and in technical tests


designed to bring out obscure evidence of derangement. Examination reveals not

merely an ordinary two-dimensional mask but what seems to be a solid and substantial

structural image of the sane and rational personality. He might then be thought of, in

the full literal sense, as an example of what Trélat meant to designate by his expressive

term, la folie lucide. Furthermore, this personality structure in all theoretical situations

functions in a manner apparently identical with that of normal, sane functioning.

Logical thought processes may be seen in perfect operation no matter how they are

stimulated or treated under experimental conditions. Furthermore, the observer finds

verbal and facial expressions, tones of voice, and all the other signs we have come to

regard as implying conviction and emotion and the normal experiencing of life as we

know it ourselves and as we assume it to be in others. All judgments of value and

emotional appraisals are sane and appropriate when the Psychopath is tested in verbal


Only very slowly and by a complex estimation or judgment based on

multitudinous small impressions does the conviction come upon us that, despite these

intact rational processes, these normal emotional affirmations, and their consistent

application in all directions, we are dealing here not with a complete man at all but with

something that suggests a subtly constructed reflex machine which can mimic the

human personality perfectly. This smoothly operating psychic apparatus reproduces

consistently not only specimens of good human reasoning but also appropriate

simulations of


* After some years of experience with them, I was forced to conclude that, theoretical technicalities

notwithstanding, severe psychopaths showed a disorder, in some important respects, more like the disorder

of those classed as psychotic than the mild or questionable deviation presumed by official psychiatric

standards. It was therefore interesting in 1938 to encounter an opinion expressed by Karl Menninger about

patients of this type.

After stating that in his earlier psychiatric experience he regarded alcohol addiction as a bad habit and a

little later as a neurotic manifestation, Menninger adds, "Now I regard is as near a psychosis." He also

states, "I would be inclined, if one of my young relatives had to have either schizophrenia or addiction to

alcohol, to believe that his chance for getting back into normal life would be greater if he had schizophrenia"


Althought the term psychopathic personality was not used to designate the patients of whom Menninger

speaks, it is plain that he is referring to the underlying personality disorder and not to the direct effects of

drinking. I feel that this personality disorder is the one discussed here. This term is, in fact, used by the

author of the paper Menninger is discussing, and there seems no reason to doubt that it is the psychopath to

whom these statements apply and no reactive or neurotic drinkers. 170

In view of our traditional practice of calling persons diagnosed as antisocial personality legally sane and,

in many institutions of judging them ineligible for treatment, an opinion of such disorders expressed in 1804

by John Cox is of interest. Dr. Cox wrote, "Persons of this description might appear actuated by a bad heart,

but the experienced physician knows that it is the head and not the heart which is defective." (Cited in

Henderson. 128)


normal human emotion in response to nearly all the varied stimuli of life. So perfect is

this reproduction of a whole and normal man that no one who examines him in a

clinical setting can point out in scientific or objective terms why, or how, he is not real.

And yet we eventually come to know or feel we know that reality, in the sense of full,

healthy experiencing of life, is not here.

Fortunately for the purpose of this discussion, but unfortunately indeed in any

other light, an objective demonstration is available which coincides perfectly with our

slowly emerging impression. The psychopath, however perfectly he mimics man

theoretically, that is to say, when he speaks for himself in words, fails altogether when

he is put into the practice of actual living. His failure is so complete and so dramatic

that it is difficult to see how such a failure could be achieved by anyone less defective

than a downright madman* or by a person totally or almost totally unable to grasp

emotionally the major components of meaning or feeling implicit in the thoughts that

he expresses or the experiences he appears to go through. In the actions of his living,

then, he confirms our subjective impression, or it might be said that our surmise

coincides with the objective and demonstrable facts.

During my early observation of psychopaths that preceded publication of the first

edition of this book in 1941, I was so much impressed with the degree of maladjustment

in these patients that I felt at the time, and said, they should be called psychotic.

Subsequent consideration led me long ago to change this opinion and to find myself in

complete accord with Richard L. Jenkins who in 1960 wrote:117

Hervey Cleckley, in The Mask of Sanity, expresses the belief that the

psychopathic personality is a psychosis not technically demonstrable, maximally

concealed by an outer surface of intact function and manifested only in behavior.

The disagreement I would express with this intriguing definition is that, to me, it

strains the concept of psychosis past the breaking point. A psychosis is a major

mental disorder. A psychopathic personality shows not a disorder of personality

but rather a defect of personality, together with a set of defenses evolved around

that defect. The defect relates to the most central element of the human

personality: its social nature. The psychopath is simply a basically asocial or

antisocial individual who has never achieved the developed nature of homo


There is another important point against classifying the psychopath's

grave defect with the psychoses. Though I believe he is in degree as maladjusted


* This violent and unfortunate term I use with apology but cannot spare here because of its clear-cut



for leading an acceptable life as the psychotic patient, I do not believe there are

similar reasons to consider him legally irresponsible or morally blameless for the

frauds he perpetrates and the crimes he may commit.

Let us then assume, as a hypothesis, that the psychopath's disorder, or defect, or

his difference from the whole or normal or integrated personality consists of an

unawareness and a persistent lack of ability to become aware of what the most

important experiences of life mean to others. By this is not meant an acceptance of the

arbitrarily postulated values of any particular theology, ethics, esthetics, or philosophic

system, or any special set of mores or ideologies, but rather the common substance of

emotion or purpose, or whatever else one chooses to call it, from which the various

loyalties, goals, fidelities, commitments, and concepts of honor and responsibility of

various groups and various people are formed.* Let us assume that this dimension of

experience which gives to all experience its substance or reality is one into which the

psychopath does not enter. Or, to be more accurate, let us say that he enters, but only

so superficially that his reality is thin or unsubstantial to the point of being insignificant.

Let us say that, despite his otherwise perfect functioning, the major emotional

accompaniments are absent or so attenuated as to count for little. Of course he is

unaware of this, just as everyone is bound, except theoretically, to be unaware of that

which is out of his scale or order or mode of experience. If we grant the existence of a

far-reaching and persistent blocking, absence, deficit, or dissociation of this sort, we

have all that is needed, at the present level of our inquiry, to account for the psychopath.

The effort to express what is meant by experiencing life in a full sense, or by

awareness of a solid emotional contact, runs through the psychoanalytic literature,

which so often stresses the difference between an actual, or emotionally participating,

understanding of some important situation and a mere verbal or academic

understanding, however complete in that dimension.11,188 This point is also implicit in

the concepts of Adolf Meyer's psychobiology, which, by its very definition of terms,

shows that it is striving to emphasize the wholeness of experience or the full meaning of



* A vast difference exists, of course, between what various persons regard as good or beautiful or

desirable. John Locke observed that "those who are canonized as saints among the Turks lead lives

that we cannot with modesty here relate." "An apple by Paul Cezanne is of more consequence

artistically than the head of a Madonna by Raphael," is the initial sentence in a well-known work on

painting.34 In contrast with all the various diversities of viewpoint and degrees of conviction found

among ordinary people, the so-called psychopath seems to hold no real viewpoint at all and to be free

of any sincere conviction in what might be called either good or evil.49


Among lay observers of human problems and human values is sometimes found a sharp

awareness of the very point I mean to stress in trying to describe the so-called


A poet of our century, Donald Parson, 232 chilled by the dead perfection of the

celebrated glass flowers at Harvard, seems to see and translate into metaphor and

allegory something closely related to the problem of the personalities discussed here and

whose outer state I am trying to describe as a mask of sanity:

I stand in wonder. What amazing art!

No counterfeit is this, but counterpart

Itself, carved with the infinite detail

That makes the plodding step of patience fail.

From life's authentic prompt-book is this leaf.

And here are flowers, petaled every one

To cup the rain and captivate the sun:

The poignant lilac whose sharp sword of scent

Can make the memory bleed - that sacrament

We call a rose - a thousand other blooms,

Forever mummied in their crystal tombs.

And yet … somehow … as I behold

These mimic plants, they leave the fancy cold;

Then, frigid patterns, sleep inviolate

Within your glassy cells. Unkindly fate

Denied you death and so denied you life

I want my plants to feel the tonic strife

Of all the testing elements; to know

The flagellation of the rain, the snow,

The scathing sun, the shrapnel of the hail;

To bear the hundred lashes of the gale

And all that soul of man or flower needs

For flowering - the rivalry of weeds,

Not clipped or clamped in time's unyielding vise -

Eternal molds of sempiternal ice -


Farewell, stark forms. No more can you beguile,

You wear the sleety artificial smile

That freezes as it falls. My earthly flowers

Can hear the wing-beat of the flying hours

And, blushing for your deep immortal lie,

Are unafraid - nay, eager - proud-to die.

So shall they burgeon with a sweeter breath

Because, like us, they wait the frost of death.

"Glass Flowers"

Although to the casual reader these words may suggest more readily the obvious

artificiality familiar in the schizophrenic and the schizophrenic's withdrawal from the

pain and pleasure of objective life, a point may be made that the full implication of the

poem more properly bears on the state of these personalities we now discuss.

Such outward perfection as that seen in the glass flowers at Harvard and such

complete lack of participation in the essence of life and mortality suggest wonderfully

the situation which me mean to portray in the personalities described in this volume.

The schizophrenic does not preserve the intact outer form and function of a complete

personality, but the psychopath does.

Without suffering or enjoying in significant degree the integrated emotional

consequences of experience, the psychopath will not learn from it to modify and direct

his activities as other men whom we call sane modify and direct theirs. He will lack the

real driving impulses which sustain and impel others toward their various widely

differing but at least subjectively important goals. He will naturally lack insight into how

he differs from other men, for of course he does not differ from other men as he sees

them. It is entirely impossible for him to see another person from the aspect of major

affective experience, since he is blind to this order of things or blind in this mode of


It must be granted of course that the psychopath has some affect. Affect is,

perhaps, a component in the sum of life reactions even in the unicellular protoplasmic

entity. Certainly in all mammals it is obvious. The relatively petty states of pleasure,

vexation, and animosity experienced by the psychopath have been mentioned. The

opinion here maintained is that he fails to know all those more serious and deeply

moving affective states which make up the tragedy and triumph of ordinary life, of life

at the level of important human experience. Such capacities vary widely, of course,

among normal people and are perhaps proportionate to the general personality

development, or, in a far-reaching sense, to true cultural level. The scope or the

substantiality of such reactions, if they could be accurately


and objectively estimated, would, perhaps more than any other criteria, make it possible

to judge how successful and how complete an experiment in nature216 a particular

person has proved to be. A Beethoven, a Dante, or an Aeschylus, if his real inner life is

faithfully represented in his works, would probably present no less a contrast in this

aspect with the illiterate and unimaginative peasant or the successful pickpocket than in

objective accomplishments. Nevertheless, no normal person is so unevolved and no

ordinary criminal so generally unresponsive and distorted, that he does not seem to

experience satisfaction, love, hate, grief, and a general participation in life at human

personality levels much more intense and more substantial than the affective reactions

of the psychopath. My concept of the psychopath's functioning postulates a selective

defect or elimination which prevents important components of normal experience from

being integrated into the whole human reaction, particularly an elimination or

attenuation of those strong affective components that ordinarily arise in major personal

and social issues.

However intelligent, he apparently assumes that other persons are moved by and

experience only the ghostly facsimiles of emotion or pseudoernotion known to him.

However quick and rational a person may be and however subtle and articulate his

teacher, he cannot be taught awareness of significance which he fails to feel.* He can

learn to use the ordinary words and, if he is very clever, even extraordinarily vivid and

eloquent words which signify these matters to other people. He will also learn to

reproduce appropriately all the pantomime of feeling; but, as Sherrington said of the

decerebrated animal,257 the feeling itself does not come to pass.

Even his splendid logical faculties will, in real life situations, produce not actual

reasoning but that imitation of reasoning known as rationalization, for in the synthesis

by which reasoning contributes to sound judgment, the sense of value, that is, the value

of truth and feeling, cannot be missing. When this is missing, the process is only

rationalization, something which, however technically brilliant, does not satisfactorily

guide and shape action. And no difference between the two is more fundamental.58

When we conceive of the thought, the emotional responses, the general psychic

processes, and the behavior of a person in whom is postulated a defect of this sort, we

have arrived at something identical or all but identical with the psychopath as he appears

in actual life.

When we say that a disorder at deep levels of personality integration prevents

experience from becoming adequately meaningful to the subject,


* "Intellect is invisible to the man who has none." (From Schopenhatser's Essays, "Our Relation to



we become vulnerable to the accusation of talking nonsense. It is easy indeed to

become unclear, if not to appear actually ridiculous, in attempting to express a point,

however tentatively, on these fundamental Matters. A reviewer in the New England

Journal of Medicine says of the concept here advanced:221

If that (understanding of the meaning of life] is the disease from which the

psychopathic inferior suffers, this term can be applied to most of us and certainly to

the reviewer, since, so far as he knows, no one has yet given us an insight into the

meaning of life. [p. 349]

Such a comment is appealing and not without humor, but it scarcely meets the

issue in a responsible manner. We need not assume that a normal man understands the

ultimate purpose of life or even that he is remotely near final accuracy in his evaluations

of his own bits of experience in order to believe that the psychopath is, in comparison,

seriously disabled by the specific deficiency we are attempting to formulate.

Although "meaning" or "the meaning of life" can be applied to a philosophic or

religious system that attempts to explain man and the universe, it must be obvious that

such an application is not intended here. By saying that a good deal of the affective

substance which people find in life experiences is lacking in the psychopath's responses,

we seek only to point out that he is not adequately moved and that he does not find

subjective stimuli to make the major issues of life matter sufficiently to promote

consistent striving. Furthermore, he cannot achieve true and abiding loyalty to any

principle or any person. It is difficult, perhaps, to express anything about such a matter

without inviting misunderstanding. Such an affective alteration of fundamental

experience is generally granted in the schizophrenic, who shows superficial indications

of it. In the psychopath, although it is so strongly indicated by his conduct, this

alteration is well masked by his misleading surface. It should not be said that such an

estimate can be scientifically proved in either case, or that any subjective state in another

can be so established.

In Brenden Maher's important work devoted to current problems of psychiatry

and psychology published in 1973, thirty-two years after my first effort to formulate

these concepts, I find support and encouragement in this comment on subsequent

studies of the psychopath:194

Dr. Cleckley's book, The Mask of Sanity, has been the stimulus for most of the

experimental research that has been conducted into the problem of psychopathy. It is

one of the best examples available of careful clinical observation leading to hypotheses

(not conclusions) which can then be put to controlled test. The wealth of clinical

anecdote with which each point is illustrated renders it difficult to find any


one sequential extract from the book that might serve to present his hypotheses in a

systematic fashion. The extract in this volume consists of several portions of the text

selected and assembled to be maximally coherent, while letting Cleckley's own views

be presented in his own words.

From Cleckley's hypothesis there has developed naturally a major interest in the

psychobiology of the psychopath's emotional experience -or lack of it. A prima facie

credence must be given to the possibility that the psychopath is deficient in those

bodily responses that give rise to the emotional experiences of anxiety, pity and the

like. Hare, one of the major investigators of the present time, examines this

explanation and presents the pertinent data in his paper here. The paper is not

previously published elsewhere and it provides a new synthesis of findings from

several related lines of research on the topic. [p. 197]


Next: Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 62. The concept of masked personality disorder or defect


Energy Enhancement          Enlightened Texts         Psychopath           The Mask Of Sanity



Section 4, Part 1


  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 61. A basic hypothesis
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 61. A basic hypothesis, Now that we have proceeded with our task through the stages of (1) presenting observations of the gross material and (2) sifting and tabulating as conveniently and intelligibly as we were able the pertinent residue of our data, let us attempt the next step. This will consist in searching for some concept or formulating some theory that might satisfactorily account for the facts observed. Much of the material appears contradictory, not only in the ordinary world of average or normal living but even in the world of mental disorder commonly granted to be less readily comprehensible in terms of ordinary reason at

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 62. The concept of masked personality disorder or defect
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 62. The concept of masked personality disorder or defect, Let us consider further the concept of disorders or defects that are deeply or centrally located. The contrast between such a pathology and one that is peripheral and visible can be demonstrated readily in speech disorders. The man whose tongue has been severely mutilated will not be able to pronounce his words clearly. Perhaps he can only mutter unintelligibly. Even a child or a savage can see where the trouble is and understand why function is disrupted. If the hypoglossal nerves are cut, the tongue, although itself unmarred, will not move and words cannot be uttered at

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 63. Further consideration of the hypothesis
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 63. Further consideration of the hypothesis, In attempting to account for the abnormal behavior observed in the psychopath, we have found useful the hypothesis that he has a serious and subtle abnormality or defect at deep levels disturbing the integration and normal appreciation of experience and resulting in a pathology that might, in analogy with Henry Head's classifications of the aphasias, be described as semantic. Presuming that such a patient does fail to experience life adequately in its major issues, can we then better account for his clinical manifestations? The difficulties of proving, or even of demonstrating direct objective evidence, for hypotheses about psychopathology (or about ordinary subjective functioning) are too obvious to need elaborate discussion here at

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 64. Aspects of regression
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 64. Aspects of regression, The persistent pattern of maladaptation at personality levels and the ostensible purposelessness of many self-damaging acts definitely suggests not only a lack of strong purpose but also a negative purpose or at least a negative drift. This sort of patient, despite all his opportunities, his intelligence, and his plain lessons of experience, seems to go out of his way to woo misfortune.47 The suggestion has already been made that his typical activities seem less comprehensible in terms, of life-striving or of a pursuit of joy than as an unrecognized blundering toward the negations of nonexistence at

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 65. Surmise and evidence
    Psychopath Hervey Cleckley THE MASK OF SANITY, ASection 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 65. Surmise and evidence, If, in the so-called psychopath, we have a patient profoundly limited in ability to participate seriously in the major aims of life, how, we might inquire, did he get that way? Reference has been made to the traditional viewpoint from which it was assumed that an inborn organic defect left these people 'constitutionally inferior' or 'moral imbeciles.' Such a congenital defect, it must be readily admitted, may exist and may account for the failure to experience life normally and hence to react sanely at





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