Section 4: Some questions still without adequate answers

Part 1: What is wrong with these patients?

65. Surmise and evidence



Energy Enhancement          Enlightened Texts         Psychopath           The Mask Of Sanity



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.

During the earlier decades of the twentieth century this concept of the

psychopath prevailed. It was widely believed that these patients, often called

constitutional inferiors, came almost exclusively from families loaded with stigmata of

degeneration and signs of neuropathic taint.123 As time passed it was noted that typical

psychopaths were also seen in families of very respectable, ethical, and successful people

and were entirely free from all physical stigmata of degeneration. Many pointed out that

some of the statistical studies giving evidence of hereditary factors are not as reliable as

they were once thought. Even the famous studies of the Jukes and the Jonathan

Edwards families have been severely criticized and called fallible by some.275

As already mentioned, Healy124,125 long ago pointed out that antisocial behavior

often seemed to occur as a response to unhappy life situations, and Alexander

formulated such disorder in psychoanalytic terms as a purposive acting out of

unconscious pathologic conflict.9,11

The concept of acting out, in lightly disguised symbolic deeds, might be vividly

illustrated in the case reported here in which a man responded to what is often spoken

of as being in the doghouse by putting on his dog's


collar and spectacularly caricaturing canine behavior.* Another response to a similar

situation can be found in the patient who literally got into a kennel at the veterinarian's

and so exhibited himself. Although these incidents picturesquely illustrate Alexander's

concept of acting out, they do not in themselves constitute evidence of an unconscious

conflict which he has assumed causes the behavior. Neither patient showed any

reaction that would support belief in the presence of inner, unconscious feelings of guilt

or of the type of conflict attributed to psychopaths in such interpretations. The

assumption of such guilt in these two patients must be made purely on faith in the


Many other psychiatrists have attempted to explain the psychopath in terms of

psychogenic causation. The studies of Greenacre led her to conclude that the confusing

influence of a stern, authoritarian father and an indulgent or frivolous mother is

common in the early background of the psychopath. It is plausible to feel that such an

influence might contribute to rebellious reactions and to a detective development of

conscience and of ordinary social and personal evaluation.101 Karpman, in his extensive

work with character and behavior disorders, offers the opinion that in most cases a

psychogenic etiology can be established if adequate investigation is made.160-163 A

relatively small percentage of those we call psychopaths, he believes, are not so

motivated. These, presumably disordered because of inborn or constitutional defect, he

distinguishes from the majority and calls anethopaths.161

Knight's studies of severe alcoholics, many of whom were considered

psychopaths, led him to believe that they often had "a parental background

characterized by inconsistency and lack of unanimity in parental discipline resulting in

conflicting unstable identifications in the son." A weak, pampering mother in

combination with a domineering father whose severity was fitful and inconsistent

appeared frequently in the background of Knight's cases. He feels that important causal

relations between this early situation and the subsequent disorder are likely.169,170 Knight


Innumerable personality shadings and accents are possible from a son's reaction to

such parental management, but one regular result seems to be the fostering of

excessive passive demands and expectations in the son, such passive, childish,

feminine wishes being in marked conflict with masculine strivings inculcated by the

father and by the cultural ideology absorbed from schooling and from contacts with

other males.

* Chapter 21, The psychopath as businessman.

 Chapter 24, The psychopath as scientist.


I have over many years looked hopefully for evidence of parental influences on

my patients such as those discussed by Greenacre and Knight. I have not, however,

been able to find regularly, or even very frequently, the environmental pattern in early

life that impressed them as, perhaps, offering an explanation of the problems found in

their patients. I have also seen many well-adjusted people, and also many with problems

very unlike those of the psychopath, who come from homes similar to those described

by Greenacre and by Knight.

Adelaide Johnson has expressed a strong conviction that the delinquency of a

child or teenager is sometimes caused by the parents' own unconscious impulses toward

antisocial conduct. The child or teenager, she tells us, is craftily used as a pawn and

unconsciously encouraged in theft, arson, sexual promiscuity, violence, or sexual

perversion in order to fulfill the parents' unconscious emotional needs to carry out such

conduct themselves.148-150 According to this formulation, the child, even after he has

become an adult, remains unconscious of the parents' adverse influence and of his real

motives for antisocial conduct. Furthermore, Johnson reports that the parents are often

unwilling to give up their vicarious criminal satisfactions and that they may actively

block the psychiatrist's attempts at therapy. Such an explanation has been accepted as a

common cause for the psychopath's disorder by a number of prominent psychiatrists.229

Perhaps there are delinquents and psychopaths in whom such influences play an

important part. Let us remember, however, that some methods of trying to determine

what is in the unconscious may allow us unwittingly to project items from our theories

into the assumed motivation of the patient and also of his parents. If persistent but

unconscious antisocial impulses are really active in the parents, we might also ask

ourselves if such tendencies might have been conveyed to the offspring by hereditary

factors. I think it very unlikely that the parents of the patients presented here and of the

others studied by me found satisfaction, unconsciously or otherwise, in the persistent

misconduct of their sons and daughters.

Lindner183 devoted almost an entire volume, Rebel Without a Cause, to the detailed

report of one psychopath studied by hypnoanalytic methods. He believed that through

processes of preverbal memory he was able to obtain from the patient a true report of

significant and traumatic experiences which he dated as occurring at 6 or 8 months of

age. Lindner gives a detailed and ingenious explanation of how he believes these

experiences caused the patient to develop seriously disturbed relations with his parents

and eventually to adopt the typical role of the psychopath. Despite the strong

convictions of Lindner, his excellent presentation, and the superb title of his book, Rebel

Without a Cause, there is much that makes me


skeptical about the significance of experiences reported as having occurred at such an

early age and about the validity of what may be recalled through preverbal memory or

established chiefly by the interpretation of symbols and dreams.

One reason for my skepticism is derived from the implausible and some. times

fantastic events occasionally reported by my own patients as having occurred in early

childhood or infancy. Sometimes this material has impressed me from the beginning as

fabrication or fantasy confused with memory. When teaching young physicians in

psychiatric residency training I was often also impressed by the influence of the

examiners convictions on items of experience reported by such patients. I found that

some of these patients could be led on in almost any direction to report almost any sort

of infantile recollection one sought to produce.

This proclivity in some patients may play a significant part in explaining how

conscientious therapists find confirmation for widely differing and sometimes

contradictory theories during prolonged investigations of a patient's infantile

experiences and unconscious attitudes. It has tended to make me increasingly cautious

about accepting as necessarily true historical data even from much later periods of life

from patients who seem to be of this type. It has often been noted that the psychopath

will very convincingly report entirely false incidents and attitudes in others, particularly

in parents, that tend to put responsibility for his difficulties upon them.

It is also true that experiences ordinarily withheld or deeply repressed in other

people are often quickly and readily divulged by these patients. Disgraceful and

extremely uninviting deeds are sometimes reported with a relish that suggests pride in

them. Although shame and terrible conflict are sometimes claimed in such matters and

superficial indications of such claims may be impressive, I am unable to find at any level

evidence that such affects are major or even quite real. This is a factor deserving

constant attention, for it can enter very subtly into material obtained from patients of

this sort. The point most difficult to corroborate, in my own experience, is the actual or

innermost personal reaction of these patients to the events they report. It is more

difficult than with others to tell what the events mean to them.

Some comments made by Jenkins are pertinent, it seems to me, to the question

of whether or not psychopaths are acting out a conflict based upon unconscious feelings

of guilt:147

Effective challenge to a basic faith always causes pain and a reaction ridden with

emotion in which the issues can easily become clouded. … This challenge has been

felt by some of the defenders of the modern psychodynamic faith which, at least

initially, tended


to a narrow conception that functional mental disorders and maladjustments are

always due to conflicts within the personality. To enlarge this concept with a

realization that morbid conditions and gross maladjustments may be due primarily to a

lack of conflict within the personality represents a readjustment of thinking which is

apparently beyond the flexibility of many professional persons. There is of course, a

semantic problem involved. It was not difficult for mankind to understand poisoning,

for it is easy to grasp the proposition, "what he ate made him sick." The

understanding of the vitamin deficiency diseases was more difficult because of the

greater semantic difficulty of the proposition, "what he did not eat made him sick."

Yet this second proposition is as true and as necessary to any adequate consideration

of illness as is the first. In the same way many of our dynamically oriented colleagues

have great difficulty with the proposition, "The conflict he does not have makes him a

psychopath." This concept is true and necessary, but requires at least a flexible

application of classical psychodynamic theory.

Theories are advantageous when they stimulate some resourceful new attack on a

problem. They are handicapping when they make it difficult for us to recognize

important facts....

If indeed we must get into the area of theory - and this is not entirely avoidable - I

should like to propose that psychopaths differ from psychoneurotics and indeed contrast

with them in their most important characteristics. The typical psychopath and the typical

psychoneurotic are, in some important regards, on opposite sides of the normal. Where

the psychoneurotic suffers from excessive inner conflict, the psychopath makes others

suffer from his lack of inner conflict. Only the person who does not come in contact with

serious cases of this sort, or whose mind is literally imprisoned by his faith in a theory can

brush aside this fundamental difference.

I have become increasingly convinced that some of the popular methods

presumed to discover what is in the unconscious cannot be counted upon as reliable

methods of obtaining evidence. They often involve the use of symbolism and analogy

in such a way that the interpreter can find virtually anything that he is looking for.

Freud, for instance, from a simple dream reported by a man in his middle twenties as

having occurred at 4 years of age drew remarkable conclusions. The 4-year-old boy

dreamed of seeing six or seven white wolves sitting in a tree. Freud interpreted the

dream in such a way as to convince himself that the patient at 18 months of age had

been shocked by seeing his parents have intercourse three times in succession and that

this played a major part in the extreme fear of being castrated by his father which Freud

ascribed to him at 4 years of age. No objective evidence was ever offered to support

this conclusion. Nor was actual fear of castration ever made to emerge into the light of

consciousness despite years of analysis.55,88


Faithfully following Freud's method of establishing proof by analogy, a

prominent psychiatrist in his well-known book Beyond Laughter 103 has given us a

remarkable interpretation of the drum majorette. Most of us are likely to think that the

average man's pleasant reaction to these well-built, sparsely clad young ladies who

prance happily and often somewhat sexily before the band at football stadiums can be

pretty well accounted for by tastes and impulses quite obvious in nearly anyone's

consciousness. Such tastes and impulses, according to the interpretation in Beyond

Laughter, must be considered as superficial or perhaps even as the result of reaction

formation. The lissome girl, we are solemnly told, stands out before the grouped band

just as an erect penis stands out before the larger mass of the body. This analogy is

taken as evidence that interest and excitement about the provocative lass do not lie

primarily in the fact that any ordinary man would find her attractive. In our

unconscious she is said to be equated with the erect male organ, and it is maintained

that men really feel toward her, as she stands projected before the group, as they

unconsciously feel toward the penis of another male. Our positive reactions toward her,

we are told, arise from our unrecognized and unaccepted homosexuality. No

corroborative evidence is offered, nor any doubt expressed, about this interpretation. It

is soberly offered as a fact, presumably discovered by science.103

The Dutch psychiatrist Peerbolte238 uses a similar method of analogy to establish

what he considers satisfactory evidence of emotional trauma during embryonic or fetal

life. A patient dreams that she is in a chapel and that the figure of Christ with a wooden

leg walks toward her. The interpreter concludes that this indicates that she was

frightened and shaken up by her father's penis when those who were to become her

parents had intercourse while she was a fetus in her mother's uterus.

Distrust for such glib use of the popular methods of interpretation has been

strongly expressed by a few prominent and well-qualified psychoanalysts. Masserman,

in a delightful article, gives us an important lesson in his brilliant satire, "The

Psychosomatic Profile of an Ingrown Toenail." Let us quote from this article:202

Consider, I said, the toenail. Anthropologists have pointed out that man's mind

developed when his arms were freed of the task of locomotion so that he could walk

about the earth in an upright position, manipulating its resources and thinking about

the heavens. Moreover, osteologists tell us that all of this in turn depended upon the

hallux and its toenail. But libidinally speaking, the nail represents even more than this.

Actually, it is the most protuberant part of the body, hard and rounded; in locomotion

it describes a most suggestive to-and-fro movement-obviously, then, it is a basic penile

symbol displaced


for a change, downward. But let us also remember the anatomic origin of this

important little phallus, namely the nail-bed - also a most significant term. This in turn

consists of an invagination of vascular tissue into a zone called, with intuitive

propriety, the stratum germinativurn or matrix - a region consummately feminine in its

conformation, physiology, and import. Here, then, we have a psychosomatically

significant microcosm; a womb-equivalent ever generating a masculine imago which

normally goes forth to meet, ex. plore, and conquer the external world.

But now consider what happens when this normal functionirig is disrupted by

frustration and conflict; when, specifically, the erect nail is stubbed and traumatized, or

is too long opposed by unyielding reality in the form of a repressive shoe. Clinically

and perhaps personally we know the effects all too well: the nail, particularly at the

peripheral portions of its individuality (or more technically, its - ego boundaries") turns

about and digs its way back into the flesh of its origin. To those properly

indoctrinated with psychosomatic understanding, however, a much deeper significance

can be discerneq in this process. It will be obvious, indeed, that the counter-cathected

ungual masculinity, blocked from its exteriorizing libidinal outlets, introverts upon

itself and eventually even seeks final regression through the mechanism of reencapsulation

and vascularization - i.e., a return to uterine existence. This formula,

derived as it is by analogic thinking enlightened by metapsychologic insight, could of

course stand on its merits alone about as well as others derived from similar research

endeavors; fortunately, however, it can be further validated by objective clinical

observation. Thus, it can be demonstrated that analysands of both sexes with ingrown

toenails actually do have masculine aspirations and intra-uterine fantasies, and the mere

fact that analysands without ingrown toenails have the same unconscious dynamisms

serves merely to emphasize once again how the study of the abnormal can reveal

profound truths about all mankind.

The material just quoted is from a lecture that Masserman gave to point out, by a

playful reduction to absurdity, some of the overenthusiastic and unreliable uses of

dynamic methods in psychology and psychiatry. Let its quote also his comments on the

audience's reaction to his lecture:202

Here I ended my Lecture on Psychosomatics, rewarded by what I was sure was an

understanding gleam in the eye of some of my listeners and trusting that, though I

lacked the ribaldry of a Rabelais or the subtlety of a Voltaire, I might still have aroused

a healthy whimsy of doubt about some of the verbal gymnastics that pass for serious

thinking and investigation in the field. Imagine my constetnation, therefore, when on

meeting some of the members of the audience days and weeks later I was actually

congratulated on the clinical and analytic perspicacity with which I had derived the

specific dynamic formula for the etiology and possible therapy of that hitherto

unexplored psychosomatic disorder-onychocryptosis, or ingrown toenail!


In dwelling on the pitfalls and possibilities of error that we face in attempts to

explain the psychopath's disorder on a psychogenic basis, I do not mean to discount

sober efforts to accomplish this by realistic methods. Let us, however, be cautious and

tentative and try always to distinguish surmise from evidence.

I have noted incidents in the early life of some psychopaths that might serve as

factors likely to promote rebellion against society, distort the normal aims of life,

interfere with the development of basic values, and go far, perhaps, toward accounting

for much of the behavior so familiar to all who know them well. Some of these early

experiences might indeed go far toward explaining their emotional status that has been

so effectively and succinctly summarized by William and Joan McCord in their excellent

book. They say: 191

The psychopath feels little, if any, guilt. He can commit the most appalling acts,

yet view them without remorse. The psychopath has a warped capacity for love. His

emotional relationships, when they exist, are meager, fleeting, and designed to satisfy

his own desires. These last two traits, guiltlessness and lovelessness, conspicuously

mark the psychopath as different from other men.

But similar experiences also can be demonstrated in the background of many

well-adjusted, happy, and successful adults. In a few of the cases reported here an

impressive account was given of incidents and reported reactions (with indications of

emotion) that could theoretically be said to explain emotional withdrawal (despite

maintenance of excellent rational contact) from the areas or levels of living in which

severe hurt, deep joy, genuine pride, shame, dignity, and love are encountered and

experienced. Protest reactions, loss of insight, an acting out of unconscious impulses, a

behavioral caricature, or a diatribe against life and its (for the psychopath) subjective

emptiness could be interpreted as major causal factors in the disorder we encounter

clinically. Such interpretations may be correct, but usually there are more elements of

assumption or speculation than of evidence in what is offered in support of the


A very large percentage of the psychopaths I have studied show backgrounds that

appear conducive to happy development and excellent adjustment. Whatever part

psychogenic factors may play, I am inclined to believe that there may be an important

relationship between the abstruse, paradoxically compounded, and ambivalent nature of

the influences and the complex and deeply masked nature of the disorder such factors

may shape. If such a relationship exists, it may to some degree explain the special

difficulties we have encountered in obtaining from the psychopath convincing

subjective information about what has happened and about how he was affected by it.


In the patients presented here, social service reports and all ordinary information

usually indicated normal and helpful family attitudes and general environments. The

families themselves often impressed the examiner as good, healthy, wise, and eminently

well-adjusted people whose children were particularly fortunate because of what they

could offer as parents. When opportunities arose, as they sometimes did, to learn more

of matters inward, subtle, and deeply personal, the observer was occasionally led to

suspect that even in these apparently superior parents there were attitudes, frustrations,

emotional confusions, and deficiencies that might have played a masked but crucially

adverse role in the infinite complexities and paradoxes of parent-child relationships.

This is not to say that the parents were wrongly judged as conscientious or as

superior people or that in many important respects they were not well adjusted. Despite

conscientiousness and a good deal of wisdom and success, characteristics might exist

which could, perhaps, subtly distort the milieu of an infant or a child.246

People may be fair, kind, and genial, may hold entirely normal or even admirable

attitudes about all important matters and yet unknowingly lack a simple warmth, a

capacity for true intimacy that seems to be essential for biologic soundness

(substantiality) in some basic relationships. There are men and women of whom it

might correctly be said that it is impossible for them ever to become really personal.

This aspect (or ingredient) of human experience is difficult to describe or to signify

accurately. We do not encounter it squarely in thinking but feel it in perceptive modes

or at reactive levels not readily translatable into speech.96 Let us remember, however,

that such qualities may be found in parents of those who are not psychopaths.

Some who show only superior qualities in all their activities as citizens, in their

work, and in all definable responsibilities seem to feel little need for the sort of specific

attachment and affective closeness which perhaps constitute the core of deep and

genuine love. They also seem to have little perception of such a need in others. There

are people who show in changeless formality, poise, and cool "sensible attitudes" outer

indications of what is being discussed, but it is not they who concern us at present. In

others, genial informality and manifestations of more than ordinary warmth may prevail

in relatively superficial friendships and routine social contacts, in professional and

business associations, at dinner parties, and at club meetings. Where intimacy is

normally limited they may be spontaneous and show cordiality as real as anything

appropriate for such occasions. Their inner formality and remoteness is not

encountered until the observer approaches areas of privacy, deep levels of personal

affect that ordinarily are only reached in relations between mates, between parent and

child, or in


the few other very intimate and cherished friendships or sharings of personal

understanding and feeling that man never achieves in wholesale measure. Parents of

this sort may give an impression of affording each other and the child all that is ideal,

and affording it in abundance. One such parent will, however, leave the other (if

normal) so deprived in essential needs that the child may be turned to for the exclusive

and possessive intimacy normal between mates but full of pathologic potentialities in

the other relationship.

The observations reported by Kanner in his study of infantile autism illustrate

some of the points that are being discussed here. 157 In the brilliant and outstandingly

successful parents of these serioulsly disabled infants a complex and profound

emotional deficiency was regularly encountered. During all my years of experience with

hundreds of psychopaths, however, no type of parent or of parental influence, overt or

subtle, has been regularly demonstrable.

Both hereditary factors and influences of the frustrating, or antisocial

environment seem evident in the development of delinquency in many of the patients

described long ago by Healy.123 In the background of the intelligent, charming

psychopath who appears in a family of prominent, ethical, and successful citizens, it is

often far more difficult to find convincing evidence to account for his disorder on either

basis. If an inborn biologic defect exists and plays an important part in such a

psychopath's disorder, it is not necessary to assume that the defect is hereditary.

Perhaps it may be the result of a sublte failure in maturation, an agenesis of unknown

etiology. A much simpler and more grossly manifested defect of this sort is familiar in

the pathology of congenital cerebral palsy. It is well known that encephalitis may be

followed by changes in behavior and personality that cause some who have suffered

from it to become indistinguishable from the psychopaths we have been discussing and

that these changes may occur without any physical signs of neurologic damage.

Many psychiatrists 40,196, 278 have continued to express the conviction that some

organic injury or deficiency underlies the psychopath's dysfunction. Although no

neurologic lesion has been regularly demonstrated in the typical psychopath, it is also

true, as Thompson reminds us, that no satisfactory proof of psychogenic factors as the

cause of his disorder has been established. Referring to formulations of the

psychopathology in terms of environmental influences, he says: 278

Here too much is missing that might give us a rational explanation which would be

subject to scientific scrutiny, and which would meet the postulates of science necessary for


Numerous observers have reported records of electroencephalographic

abnormality in psychopaths. 98,172,259 Others have failed to confirm these


findings of a specific abnormality.93,261 Over the past two decades still other investigators

have expressed the conviction that there are nonspecific but definitely abnormal

electroencephalographic findings in a significant percentage of psychopaths.73,133,134,278 In

his interesting and valuable study, Psychopathy: Theory and Research, Hare in 1970 makes

this summarizing comment:116

In spite of their limitations, the EEG studies of psychopathy have produced rather

consistent results. One finding, that the widespread slow-wave activity often found in

psychopaths bears a certain resemblance to the EEG patterns usually found in

children, has led to a cortical immaturity hypothesis of psychopathy. A second

hypothesis, based on the presence of localized EEG abnormalities, is that psychopathy

is associated with a defect or malfunction of certain brain mechanisms concerned with

emotional activity and the regulation of behavior. Finally it has been suggested that

psychopathy may be related to a lowered state of cortical excitability and to the

attenuation of sensory input, particularly input that would have disturbing

consequences. [pp. 35-36]

A number of observers during the last decade have been impressed with the

influence of chromosomal abnormality on aggressive and antisocial activity in the male.

At one time it was reported that Richard Speck, who was convicted of murdering eight

student nurses in Chicago in 1967, was an example of this condition. This report was

subsequently proved false. Some commentators have gone so far as to argue that men

with the XYY chromosomal pattern should be freed of legal responsibility for crimes of

violence.168 Hare's recent comment on this subject impresses me as pertinent and


Recent findings show that the presence of an extra Y chromosome in males (for

example, XYY instead of the Normal XY) may be related to extremely aggressive

behavior (see the very readable account by Montagu, 1968). Whereas XYY

chromosome complements are very rare in the normal population, it appears that this

chromosome abnormality is found in about 2 to 3 percent of males whose behavior is

so violent and aggressively antisocial that incarceration or institutionalization is

required. In most cases these XYY males are over six feet tall, and they are frequently

of subnormal intelligence. Whether the XYY complement is related to extremely

aggressive forms of psychopathy (as opposed to other forms of criminal, antisocial

behavior) is as yet unknown. Even if it is, the relationship would not really provide

evidence one way or the other on the role of hereditary factors in psychopathy, since

the XYY complement is not inherited - it apparently reflects the failure of the sex

chromosomes to separate properly during formation of the sperm. Finally, the rarity

of the disorder means that it could account for only a very small proportion of

criminal behavior in general and aggressive psychopathy in particular. [p. 72]


If a neurologic defect does exist in the psychopath, it is also quite possible that

influences in the milieu may play an important part also in shaping his pattern of life. It

seems to me likely that such a defect, if present, must be one that affects complex

mechanisms of integration in a subtle and abstruse manner. Some of the superior

capacities encountered so often in psychopaths suggest that their difficulties might arise

not only from deficiencies but possibly, even if rarely, by misused assets.

It seems reasonable to believe that there are varying susceptibilities to failure or

to psychiatric disorder. Such susceptibilities may not necessarily be defects or

intrinsically negative qualities. Could not superior emotional responses contribute to a

boy's developing maternal attachments that can prove crippling in the degree to which

he has capacity for loyalty? May not the precociously brilliant child, because of his

advancement, encounter deep personal and social problems earlier than the average?

And, will he, perhaps, sustain trauma that he might have avoided with additional

experience? Such experience may be available to the mediocre child who, in his slower

progress, meets the confusing situation a little later. Those whose feelings are highly

developed may be more susceptible to hurt than others. The goals of the superior

person often demand of him complicated choices and sacrifices that the average person

never has to face. Disillusion and suffering because of frustrations escaped by most of

his fellows might, it seems reasonable to think, in the child of great talent and

potentiality, stimulate attitudes of withdrawal and cynical rejection or other pathologic

reactions. Exceptional talent or capacity seems almost regularly to call for exceptional

achievement or fulfillment and to put the subject under extraordinary responsibility and

into situations peculiarly complex. Courage and initiative lead man not only to take

physical risks but sometimes also into subjective ventures of many sorts with many


What we value in some as steadfastness may arise from potentialities that,

through different shaping, might emerge in others as incorrigibility, inelasticity, or

perhaps as those elements which may make a psychiatric disorder irreversible. Granting

the likelihood of great variation in the basic potentialities of the organism, let us not

forget that in so complex a matter as personality maturation and social adjustment not

only defects but talents also may contribute to conflict, to confusion, to distortion of

the life pattern, and, perhaps, to serious clinical disorder.

If what is good or wise or sound comes, or appears to come, mixed, so to speak,

with what is untrue or deleterious and is identified in a single concept, and designated by

the same term, peculiar difficulties may be noted. Such difficulties, it seems reasonable

to think, might be especially disturbing to the superior child. Conscientious acceptance

of what is most


necessary for normal growth and development may, under these circumstances,

sometimes necessitate commitments to what must later be rejected if the organism is to

survive. The deeper the capacity for loyalty, the more profound may be the stress,

confusion, and eventual disillusionment.

The psychopath's inner deviation from the normal impresses me as one subtly

masked and abstruse. So, too, it has often seemed that interpersonal and environmental

factors, if they contribute to the development of his disorder, are likely to be ones so

disguised superficially as to appear of an opposite nature. Something pertinent to this

concept may be conveyed in these words by Thompson:277

Everything spiritual and valuable has a gross and undesirable malady very

similar to it and possessing the same name. Only the very wise can distinguish

between them.

I do not believe that the cause of the psychopath's disorder has yet been

discovered and demonstrated. Until we have more and better evidence than is at

present available, let us admit the incompleteness of our knowledge and

modestly pursue our inquiry.


Next: Section 4: Some questions still without adequate answers, Part 2: What can be done?, 66. Illness and misconduct


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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