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Psychopath

THE MASK OF SANITY

Section 2: The Material

Part 2: Incomplete manifestations or suggestions of the disorder

20. Degrees of disguise in essential pathology

 

 

Energy Enhancement          Enlightened Texts         Psychopath           The Mask Of Sanity

 

 

The voice is Jacob's voice, but the hands are the hands of Esau.

-Genesis 27:22

20. Degrees of disguise in essential pathology

The cases already reported are only a few among many hundreds whom I have

observed. All of these people, when their records over the years are considered, strike

one as remarkably similar. If the story of each could be told in detail, it is believed that

the similarity would become more plain to any reader. It is the contention of the

present argument that this personality disorder shapes and hardens into the outlines of a

very definite clinical entity or reaction type, into a pattern of disorder quite as

recognizable and as real as any listed in psychiatric nomenclature. When a large number

of such patients are considered carefully, the vagueness with which they are often

regarded lessens and the type emerges certainly not less sharp than that type on which is

based the concept of schizophrenia. But vague as the concept of schizophrenia remains

and various as its manifestations are, the schizophrenic, when recognized, is promptly

called a patient with mental illness and treated as such, The psychopath, however,

continues to be treated as a petty criminal at one moment, as a mentally ill person at the

next, and again as a well and normal human being-all without the slightest change in his

condition having occurred. I do not have any dogmatic advice as to a final or even a

satisfactory way of successfully rehabilitating these psychopaths but believe that it is

important for some consistent attitude to be reached.

In the hope of letting major features of the clinical picture emerge more clearly,

the following case reports are added. The persons already described are regarded as

typical examples showing the disorder in its distinct clinical manifestations of disability.

Many of them are plainly unsuited for life in any community; some are as thoroughly

incapacitated, in my opinion, as most patients with unmistakable schizophrenic

psychosis. Whether this is

THE MATERIAL 189

 

to be regarded as a more or less willful contrariness or as a sickness like schizophrenia,

in which the patient is to be protected and looked after, may for the moment be put

aside.

In the reports that follow, an effort has been made to present persons who are

able to make some sort of adjustment in life and who may perhaps be regarded as less

severely incapacitated, and in varying degrees. These patients are offered as examples

showing, in some respects, indications of the same disorder seen in the others. In them,

however, it may be regarded as milder or more limited. The psychopathologic process,

the deviation (or the arrest), is, as with the others, a process affecting basic personal

reactions; but here it has not altogether dominated the scene. It has not crowded

ordinary successful functioning in the outer aspects of work and social relations entirely

out of the picture.

Some of these patients I believe are definitely psychopaths but in a milder degree,

just as a patient still living satisfactorily in a community may be clearly a schizophrenic

but nevertheless able to maintain himself outside the shelter of a psychiatric hospital.

Others might not deserve to be called psychopaths but seem to show strong, even if not

consistent, tendencies and inner reactions characteristic of the group. They might be

compared to the plain and complete manifestations of the psychopath as the schizoid

personality might be compared to the schizophrenic patient who is obviously psychotic.

An example will perhaps make this comparison more concrete.

Some years ago I was consulted by a man 32 years of age whose only complaint

was of a general listlessness which he had noticed for about a year. He was a tall, rather

slender person, slightly brittle in manner, and gave a definite impression of being not

very much worried about his complaint. He lived with his parents in a small town

where he made an excellent salary as an expert in looking after electrical machinery in a

large mill. He enjoyed the title of engineer though he had no formal education beyond

that obtained in a rustic high school. Examination soon brought out the fact that he

had never had sexual relations with a woman. He had, however, made the attempt not

once but many times, the first attempt being twelve years ago. He succeeded in having

erections but premature ejaculation always occurred, and he failed entirely to effect an

entrance.

This situation, which most young men would find extremely distressing, he spoke

about very casually. Questions concerning his attitudes toward love and women

brought rather stereotyped answers. He denied ever having scruples about fornication.

To him it was evidently neither good nor bad. His attempts to practice were, it would

seem, made with a vague idea of doing what was the custom. He professed to be

concerned in overcoming

190 THE MASK OF SANITY

his inability to perform intercourse and showed no embarrassment and little reticence

about sexual questions but gave a strong impression of having only the shallowest

interest. His entire emotional life seemed perfunctory and without warmth. Nothing in

his experience could be elicited which brought forth any vividness or enthusiasm. He

said that he was at present going with a girl whom he would like to marry, but his

attitude toward her seemed without any tangible desire or eager anticipation. At times

he gave a stilted, incongruous little laugh that sounded almost exactly like the

manneristic laugh so familiar in actual schizophrenics. No delusions or hallucinations

could be brought out. He had been leading an outwardly successful life and was a fairly

conscientious and reliable member of society.

The man just mentioned could certainly not be called legally incompetent at

present. Nor would he, by most psychiatrists, be classed as a case of schizophrenia,

with all the practical implications of being adjudged psychotic. He is mentioned in

order to compare him with the patient who is psychotic and who is frankly

schizophrenic.

As an example of the developed schizophrenic, let us consider a former patient

of mine who often sat for hours in a corner staring vacantly into space, his lips moving

and silly, grimacing smiles flitting across his face. Sometimes this man would not

answer questions, apparently not even hearing them, so absorbed was he in subjective

contemplation. Again he would grin glassily and wink his eye or occasionally speak with

passion about strange machinery in a distant city which enemies whom he referred to

merely as "they" were using to inject queer colors into his thoughts and sometimes to

make him ejaculate. This man at times suddenly attacked others. It was eminently

necessary to keep him on a closed ward and under close supervision.

In some of the cases to be presented, such a comparison probably would not be

justified. Some patients might more accurately be thought of as showing scattered

indications of such a disorder, suggestions of a disturbance central in nature but well

contained within an outer capsule of successful behavior much deeper that the merely

logical and theoretical rationality of the fully disabled psychopath. In those who

consistently support themselves and pass regularly as acceptable members of the social

group, we can only be astonished at the difference between such technical outer

adjustment and the indications of deeper pathologic features so similar to those found

in the complete manifestation of the disorder.

There are many patients who show relatively circumscribed antisocial behavior or

temporary episodes of gross, general delinquency, who have, I feel, much less in

common with the obvious psychopath than those who

THE MATERIAL 191

make a better outward impression but who consistently show signs of inner subjective

reactions typical of the clinically disabled patient.

These patients with temporary or circumscribed maladjustment or self-defeating

behavior will be referred to later at greater length.* They are mentioned here to

distinguish them not only from the fully manifested psychopath but also from those

who, over the years, show more subtle indications of widespread and intractable defect

or deviation in essential personal reactions and subjective evaluations.

The psychopathologic process, or state, which I believe is seriously disabling the

patients already presented may be regarded as affecting in part and in varying degree

those yet to be discussed. It may now be added that I believe that in these personalities

designated as partially or inwardly affected, a very deep-seated disorder often exists.

The true difference between them and the psychopaths who continually go to jails or to

psychiatric hospitals is that they keep up a far better and more consistent outward

appearance of being normal. This outward appearance may include business or

professional careers that continue in a sense successful, and which are truly successful

when measured by financial reward or by the casual observer's opinion of real

accomplishment, It must be remembered that even the most severely and obviously

disabled psychopath presents a technical appearance of sanity, often one of high

intellectual capacities, and not infrequently succeeds in business or professional activities

for short periods, sometimes for considerable periods.

I maintain, however, that the actual but concealed pathology in some of the

patients now to be described is in a deeper sense also far-reaching and profound.

Although they occasionally appear on casual inspection as successful members of the

community, as able lawyers, executives, or physicians, they do not, it seems, succeed in

the sense of finding satisfaction or fulfillment in their accomplishments. Nor do they,

when the full story is known, appear to find this in any other ordinary activity. By

ordinary activity we do not need to postulate what is considered moral or decent by the

average man but may include any type of asocial, or even criminal, activity so long as its

motivation can be translated into terms of ordinary human striving, selfish or unselfish.

The chief difference between the patients already discussed and some of those to

be mentioned lies perhaps in whether the mask or facade of psychobiologic health is

extended into superficial material success. I believe that the relative state of this

outward appearance is not necessarily consistent

_____________________

* See Chapter 36.

192 THE MASK OF SANITY

with the degree to which the person is really affected by the essential disorder. An

analogy is at hand if we compare the catatonic schizophrenic, with his obvious

psychosis, to the impressively intelligent paranoid patient who outwardly is much more

normal and may even appear better adjusted than the average person. The catatonic

schizophrenic is more likely to recover and, despite his appearance, is often less

seriously disordered than the paranoiac.

It becomes difficult to imagine bow much of the sham and hollowness which

cynical commentators have immemorially pointed out in life may come from contact in

serious issues with persons affected in some degree by the disorder we are trying to

describe. The fake poet who really feels little; the painter who, despite his loftiness, had

his eye chiefly on the lucrative fad of his day; the fashionable clergyman who, despite his

burning eloquence or his lively castigation of the devil, is primarily concerned with his

advancement; the flirt who can readily awaken love but cannot feel love or recognize its

absence; parents who, despite smooth convictions that they have only the child's welfare

at heart, actually reject him except as it suits their own petty or selfish aims: all these

types, so familiar in literature and in anybody's experience, may be as they are because of

a slight affliction with the personality disorder now under discussion. I believe it

probable that many persons outwardly imposing yet actually of insignificant emotional

import really are so affected.

Let us not, however, attempt to explain all pretense and all fraud on this basis.

There are many other psychopathologic reactions besides the one with which we are

now concerned. And some of these, too, are capable of producing such results. Let us

be especially chary about assuming this limitation in our enemies or our neighbors. The

mechanisms of reaction formation, projection, rationalization, and many other

distorting influences work in all of us at the behest of envy, pique, or prejudice. It is not

easy to estimate correctly the degree of our neighbor's sincerity, the worth of an artist's

production, or the clergyman's real motive.

Some of the episodes or symptoms mentioned in the brief sketches that follow

may represent less profound inner disturbance than anything properly belonging with

that of the real psychopath. Many of the acts might in isolation occur in the lives of

people who at length achieve excellent adjustment not only externally but also within

themselves. The material to follow is offered not primarily for the purpose of making a

diagnosis of psychopathic personality but in illustration of features which specifically

characterize the psychopath and which may, against a background of better general

adjustment, emerge in sharper clarity. What can be learned from fantasy or dream in the

normal person, from prejudice or many socially admired

THE MATERIAL 193

forms of self-renunciation, has been of value in psychiatric efforts to understand

schizophrenia and other grave personality disorders. Many of the characteristics and

reactions seen in extreme exaggeration among the psychotic appear sometimes to be

utilized by those of great talent and excellent psychiatric status in the successful pursuit

of valuable personal and social aims.210 It is unlikely that the specific reactions of the

psychopath can be directly utilized for important positive accomplishment. It is

believed, however, that many persons in bewilderment and frustration temporarily fall

into similar reactions and eventually, finding better means of adaptation, profit from

what has been learned through the pathologic experiences.

The following accounts are given, then, for what light they may reflect on the

serious clinical disorder manifested in the previous cases.

 

Next: Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 21. The psychopath as businessman

 

Energy Enhancement          Enlightened Texts         Psychopath           The Mask Of Sanity

 

 

Section 2, Part 2

 

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 20. Degrees of disguise in essential pathology
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 20. Degrees of disguise in essential pathology, The cases already reported are only a few among many hundreds whom I have observed. All of these people, when their records over the years are considered, strike one as remarkably similar. If the story of each could be told in detail, it is believed that the similarity would become more plain to any reader. It is the contention of the present argument that this personality disorder shapes and hardens into the outlines of a very definite clinical entity or reaction type, into a pattern of disorder quite as recognizable and as real as any listed in psychiatric nomenclature at energyenhancement.org

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 21. The psychopath as businessman
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 21. The psychopath as businessman, No attempt will be made to give a detailed history of this man. Suffice it to say that the incidents mentioned are not isolated experiences in the general life pattern but rather expressions of a motif which persistently recurs to interrupt the outward serenity. He is now 50 years of age, and he has gone on to achieve considerable business success, being an equal partner in a wholesale grocery concern. As a businessman there is much to be said for him. Except for his periodic sprees, he works industriously at energyenhancement.org

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 22. The psychopath as man of the world
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 22. The psychopath as man of the world, The psychopath as man of the world comes from excellent stock and his educational background includes four years at a celebrated preparatory school and three at a well-known university. During his student days he took no interest whatsoever in any of his studies. His shrewdness, his skill at utilizing the work of his friends, from whose papers he usually patched together his own themes and essays, and his reliance on cheating in examinations enabled him to stay in the University through his junior year. His real interests during this period consisted in decking himself with fine clothes in which to saunter about, in presiding at social gatherings, and in flimsy but pretentious lovemaking with a large number of prominent young ladies. In the eyes of these and of their mothers he passed as a dashing beau, almost as an arbiter elegantiarum at energyenhancement.org

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 23. The psychopath as gentleman
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 23. The psychopath as gentleman, This man, whom for convenience we may call W. R. L., first came to my attention professionally when seen strapped down during hydrotherapy in a continuous tub. There, surrounded by dozens of the most complete madmen an imaginative layman could conceive, he strained, cursed, bellowed, and hurled defiant imprecations at all about him at energyenhancement.org

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 24. The psychopath as scientist
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 24. The psychopath as scientist, Limitations of space allow only a few highlights to be thrown on this mans interesting career. Though still in the late twenties, he was already a doctor of philosophy, and the co-author of several creditable papers on subjects in the general field of physics at energyenhancement.org

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 25. The psychopath as physician
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 25. The psychopath as physician, When first seen by me, he was still in his early forties. From the country town in which he was practicing medicine an inquiry came concerning his professional ability. Everyone regarded him as a brilliant man. His patients loved him, and while he was working regularly, his collections were more than adequate. It was often impossible to find him, for now and then, in the classic manner, he lay out in third-rate hotel rooms or in the fields semiconscious until he could be found and coaxed back home at energyenhancement.org

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 26. The psychopath as psychiatrist
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 2: The Material , Part 2: Incomplete manifestations or suggestions of the disorder, 26. The psychopath as psychiatrist, In the group who show some fundamental characteristics of the typical psychopath but who make a good or fair superficial adjustment in society are sometimes found men who hold responsible positions. Lawyers, business executives, physicians, and engineers who show highly suggestive features of the disorder have been personally observed. Perhaps one would think that the psychiatrist, with good opportunity to observe the psychopath, would eschew all his ways. I believe, however, that a glimpse can be given of characteristics of the psychopath in such a person at energyenhancement.org

 

 

 
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