Section 2: The Material

Part 2: Incomplete manifestations or suggestions of the disorder

26. The psychopath as psychiatrist



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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.

Let us first direct our attention to him many years ago when, as an author of

some papers on psychiatric subjects, he attracted the interest of


several inexperienced young physicians then at the beginning of their careers. The

articles, it is true, were marred by grammatical errors and vulgarities in English a little

disillusioning in view of the suave and pretentious style attempted by the author. At the

time, however, they impressed this little group of naive admirers as having all the

originality that the author so willingly allowed others to impute to them, and, as a matter

of fact, implied not too subtly himself in every line of his work.

When seen later at a small medical meeting at which no experienced psychiatrists

were present, this author seemed very grand indeed. The actual ideas expressed in his

paper were, to be fair, culled from the primers of psychiatry and psychology, but he had

an authoritative way of making them seem entirely his own, and marvelous, too.

Despite his cool and somewhat commanding air, he succeeded in giving an impression

of deep modesty. Everything seemed to accentuate his relative youth which, in turn,

hinted of precociousness and of great promise. The effect he had on his audience, most

of whom were general practitioners from small towns, was tremendous. An

opportunity to meet this splendid figure of a psychiatrist and to sit at his feet during the

rest of the evening was avidly welcomed by several of his new admirers.

Dr. _____, though still in his middle thirties, enjoyed a wide and enviable

reputation in a section of the country where psychiatrists were at the time almost

unknown. After some work at hospitals in a distant state where he was born, he had

come and set up as a specialist in his present habitat. He soon obtained a small

institution in which he began to direct treatment of psychiatric patients. Reports

indicate that it flourished and expanded greatly.

It was generally agreed that his learning and ability were chiefly responsible for

his rapid rise to local prominence. Ephemeral rumors hinted that the idolized Dr. ____

made a practice of treating by expensive and doubtful procedures any patient of means

whom he could obtain for as long as the money lasted and of then dismissing him or

sending him promptly to a state hospital. It was also heard that with female patients he

sometimes suggested, or even insisted on, activities (as therapy) which are specifically

proscribed in the Hippocratic oath. But what physician has not had similar things said

about him? The impressive bearing of the man and his reiterated and rather eloquent

appeals for higher scientific consecration on the part of his colleagues snuffed out these

feeble stirrings of adverse criticism which were almost universally ascribed to jealousy.

The lion of the evening seemed to put himself out in being gracious to his young

admirers who were indeed nobodies on the fringe of the wonderful field which he

seemed to dominate. His good fellowship was so hearty


and yet so suave that one could scarcely bring himself to see the faint underlying note of


The privilege of driving this relatively great personage out to a country place

where hospitality beckoned was seized by one of the young physicians, In the car an

attempt was made to turn the conversation to psychiatric questions which Dr. ____ had

raised in his papers. He made a few stilted replies but soon drifted from the subject into

talk that was hardly more than pompous gossip, His companion, fearing that such a

learned man might be talking down to spare him the embarrassment of

incomprehension, kept returning to psychiatry, trying to make it plain that no such

embarrassment would discount the pleasure of hearing the master. Soon the replies of

this alleged master left the young man in serious doubt not only as to the great one's

knowledge, but even as to his interest in the subject.

Dr. _____, in his more popular talks and articles, as well as occasionally in those

directed toward rustic medical groups, often gave psychiatric interpretations of literature

and art. One of his more recent efforts in this line touched briefly but ambitiously on

the works of Marcel Proust. Being then in the middle of an earnest pilgrimage among

the psychopathologic wonders of Remembrance of Things Past, the fledgling psychiatrist,

perhaps hoping to make a good impression but also eager for enlightenment, ventured a

question on this subject.

The master at this time was calm and alert, but his remarks were so beside the

point that his disciple wavered. Dr. _____ was perfectly self-assured, in fact politely

pontifical, but the more he talked the clearer it became that he had not read the book at all. It

finally became equally clear that even Proust's name was unfamiliar, and the disquieting

suspicion dawned on his admirer that he had never encountered it except in the excerpt

from some review which he had apparently come upon and used. He had not been

sufficiently interested in what he plagiarized even to retain the name and was now

imputing it to some imaginary Viennese psychiatrist. He followed this pretension only

for a moment, however, and only as a stepping stone to banalities with which he was

familiar and about which he spoke with such deliberation and assurance that they almost

seemed marvelous. Never in all this persiflage did he show the least sign of confusion

or timidity. Apparently he felt that he had kept intact his impressive front. Even at this

stage of the acquaintanceship it was hard to avoid suspicion that any important

distinction between such a front and more substantial things was not in the orbit of his


With some remark about putting aside these grave and ponderous subjects, he

sang a few lines of a surprisingly obscene ditty, clapped his companion


on the back, and suggested with gusto: "When their social doings are over, let's you and

I go get us a couple of good frisky chippies!"

Despite the conviviality implicit in this remark (and no less in his tone), in some

way hard to describe he still maintained the attitude of one who means to insist on his

distinct superiority even while for a moment generously waiving certain restrictions of

caste and allowing his companion a more respectable footing, It was only a quasiequality

that he offered, however-an indulgence such as an adult might allow a child

who on some special occasion is permitted to sit up and play that he is grown. The

friendship he seemed to offer was at best a morganatic one.

His discourse during the rest of the drive, especially after he had stopped on the

way for "a couple of quick ones," was coarse and humorless. It seemed impossible to

strike a sincere idea from him on any subject.

On arriving at the host's place, a merry but entirely civilized company was found

drinking highballs, singing around the piano, or talking enthusiastically in small groups.

The singing was in key, and the talking was not loose or aimless. For the most part the

gathering was composed of people who, though lively, had some interest in general

ideas as contrasted with the trivia of daily life, and a few slowly ingested drinks brought

out humorous and interesting conversation. The house was not very large or the

furnishing spectacular, but the place, like the men and women present, gave a strong

impression to the newcomer that he was in orderly surroundings, among people of

dignity and good will.

A young, very good-looking married woman who had an amateur but genuine

interest in psychiatric questions and who meant to be polite to the distinguished

stranger, began talking to him with enthusiasm. He soon led her off into another room.

A moment later, on passing through this room, one of the young physicians was hailed

by a feminine voice and, responding, found the two in a nook, the lady pulling herself

away from the doctor with some effort but with equanimity. It was plain that his

crudely aggressive overtures were not welcome to her and she urged the other man, who

was an old friend, to join them on the davenport. Apparently trying to start a

conversation, she asked the celebrity about psychoanalysis, a subject on which he

sometimes expounded to lay gatherings in such a way as to give the erroneous

impression that he was a qualified analyst.

"If I could get you out in a car I'd psychoanalyze you right now," he muttered,

low but loud enough to be overheard, accompanying his words with a confident leer.

The savant had evidently misread the spirit of the party. The lady rose, smiled quickly at

her other companion as if to say she knew a disagreeable fellow when she saw one, and

quietly rejoined a group.


Dr. _____ now expressed the desire for straight liquor, making strong,

derogatory remarks about highballs and those who drank them. Ordering his former

disciple to come, he strode toward the kitchen. The former disciple, by this time feeling

heavily responsible for the master, made haste to follow.

In the kitchen Dr. _____ began to order the servants about in profane and

petulant fashion. He had gulped one or two small whiskeys when several men

wandered in looking for ice. One of these, an eager intern, expressed interest in the

important investigative work which Dr. _____ had begun now, in loud, boastful tones,

to announce himself engaged in.

"If you want a job there, son, just lemme know," he thundered. Swaggering

about, he made an all-embracing gesture. "At the ______ Institute I'm it. I'm the big

cheese, I tell you." No one saw fit to dispute these claims.

He began then a tirade on the subject of his executive ability, his scientific

standing, his knowledge of the stock market, his sexual power, and his political

influence. Having delivered himself of this, he pushed his audience aside and sauntered

back into the sitting room. There he recognized an old acquaintance, a physician who

had formerly been on the resident staff with him at some hospital but in an inferior

capacity. This man, a newcomer, was talking with the hostess in the midst of a small

group of men and women.

"Why you old son of a bitch!" Dr. ______ shouted. "Come over here and set

your goddamned a__ in this chair and talk to your chief."

It was no time for vacillation. The newcomer and the young physician who had

accompanied Dr. _____ to the party caught each other's eye and quickly hurried the

celebrity to the door. He pulled back at first but soon came along satisfactorily as both

companions sought so earnestly to cajole him that the words of each were lost to the

other. Turning to his companions just as the door was gained, he shouted:

"Chippies, did you say?"

On the way to his hotel he began to protest. He was by no means confused from


"Be goddamned if I go there! What kind of dirty bastards are you anyway?"

He became insistent - nay, even defiant - about going where he could obtain

women. The new member of the party, who had seen him through many such episodes

and who, to the other escort's relief, kindly assumed charge of the case, advised that he

be humored.

Dr. ____ himself, through an effervescence of obscene threats, muttered

directions to the driver. Expecting to find an ordinary brothel, both


of his companions were surprised to arrive at a large outdoor pavilion where an orderly

dance was going on. Before a definite decision could be reached about what to do, Dr.

_____ was out of the car.

“Luke! Luke!” he yelled imperiously.

A pleasant-looking man appeared.

“You've got to get us a good piece of t___ and get it quick, boy!” he ordered.

"We'll wait here and watch 'em dance by."

The man called Luke, so far as could be learned, was under serious obligations to

Dr. ____ and apparently meant to obey him. He confided that he had stood by his

friend and benefactor in many such sprees in this town. Luke had pleasant manners and

was not drinking.

“God, that's one!” the savant muttered. "What an ____! Can you get that slut out

here, Luke?" He was far enough away not to be overheard by the dancers. Luke smiled

and shook his head. "There's one!" the doctor commented again with enthusiasm.

"She's rutting! That one's rutting! I can tell it." His subsequent remarks can hardly be

suggested even in writing on a medical subject.

His two companions left him now in custody of Luke with instructions that he be

brought back to the car when this was possible without violence. Luke had asked not to

be left with sole responsibility.

Some time later the doctor returned. It was difficult to judge whether or not he

had gained all the satisfaction he sought. He made it plain that he had found a

companion but despite his boastful garrulousness did not give the final details of the

encounter. In view of his windy frankness, this caused doubt as to how far he had

succeeded in his aims. Beyond question he had made considerable progress. He

announced this much loudly, holding up a finger, sniffing it as he did so, and making a

comment of such ingenious distastefulness that even his brother physicians blenched

with revulsion. The new disciple could not but ruminate about what appraisals of

woman and of human relationships, what attitudes toward basic goals, prevailed beneath

this successful man's ordinarily impressive exterior.

On the road back to his hotel he cursed truculently at other cars. He came in

willingly. While going up on the elevator, he pinched the buttocks of the girl who ran

the machine, apparently oblivious of several passengers. There was no gaiety or human

touch in these actions, only a sullen, derogatory aggressiveness. He uttered vague

challenges and threats emphasizing his combative prowess and his readiness to fight

anyone who might take issue with him on any question.

On entering his room, he immediately made for a whiskey bottle and began

calling raucously for ice. He became loud and offensive when his companions sought

to excuse themselves, banged the table with his fists,


and offered grandiosely to fight and to fight at once. He was a tall, powerful man and

by no means too drunk to put on a lively and embarrassing scene if crossed.

He cursed the bellboy, who had arrived meanwhile, with such foul oaths it was

incredible that he took them. Pouring himself a quick drink, he called for careful

attention from his companions.

Had he told them about his children? No. They must see pictures of them. He

began to praise them extravagantly, to extol his love for them it, sickening terms of

pathos, or pseudopathos. He spoke of his plans for their future. His entire manner

began to change, and it was plain that he had determined notions about keeping all his

children what he called pure. A surprisingly moralistic aspect of this psychiatrist began

to appear. Cheap expressions of sentimentality fairly gushed from him. In a loosely

emotional strain he recited rhymes by Edgar A. Guest about the little ones. Then he

momentarily broke down and blubbered. Tears ran down his cheeks.

The bellboy had brought ice and Dr. _____ insisted on pouring out drinks,

swaggering about now in his earlier manner. When his companions insisted on leaving,

he promptly announced that he would accompany them. He could not be persuaded to

go to bed and quickly became overbearing when persuasion continued. Though he had,

of course, taken a good deal of whiskey, he seemed to know perfectly what he was

doing. In fact, he did not really seem drunk in the ordinary sense of the word. Both of

his companions felt that this was not a person irresponsible for the moment who must

be protected and prevented from doing things he would regret. On the contrary, one

was strongly impressed that this was the man himself.

Going down on the elevator he renewed his practices on the polite girl who

operated it, becoming so annoying to her that his companions had to interfere. He

called a taxi and insisted that all proceed at once to a brothel. Having had enough

experience for one night in trying to be their brother's keeper, his companions were

obdurate. He drove off, cursing them viciously as disgraceful specimens of humanity

and making derogatory remarks about their virility.

"What's the matter with him?" asked the younger.

"Just a queer fellow that way," replied the one who knew him well. "He's cool

and calculating, a good executive, and a rather pleasant man superficially during the

week, though always a little arrogant. Even when on the job he's not to be trusted.

Every time he gets a chance, he does just about what you've seen him do tonight. He

keeps under wraps of outer dignity at the hospital and he's careful not to take them off

under circumstances


which would cause him to get in serious trouble. He passes as a great gentleman in

polite but unsophisticated circles at home. But the cloak must be very uncomfortable.

Almost every weekend he makes an opportunity to get it off, and he's always then just

the man you saw tonight."

"But won't his reputation suffer from what he did tonight?"

"Probably not. He is a long way from home. Since the town is small, he

evidently assumed that all the people he was thrown with tonight were country

bumpkins who don't count for much and who would be overawed by him. He judges

people only by superficial appearances of wealth and power, and he is seldom impressed

except by gaudy display. He kept up a good front at the medical meeting. He is

exceedingly shrewd, in a shallow sense, about where and when he behaves naturally. At

home he often goes off into swamps with groups of men far beneath him in his own

estimation and who are apparently flattered to be chosen. The trips are ostensibly to

catch catfish or, in the winter, to shoot ducks; but actually it's merely to get rowdily

drunk, boast and shout inanely, and sprawl about on the ground or in muddy boats

around the camp. He wasn't drunk tonight. Out in the swamp he often passes through

this obscene, blustering phase in an hour or two and reaches the sodden state that one

might suspect is his goal.

"Sometimes he wants women. It doesn't matter what women or under what

circumstances. Some of the people who know him say that he prefers low,

unprepossessing partners, but it has always seemed to me that there was no preference

at all, and I've seen him often. A beautiful woman means no more to him than an

imbecilic harlot, but on the other hand the harlot means no more than the beautiful


"Sometimes when the idea of sex is stirring him he gets too drunk to make much

of his opportunities. I'll never forget one incident. It was about daybreak down in the

swamps where we'd been fishing. He'd gone out on a sexual mission pretty drunk. We

found him at a whitewashed shack. It was time to leave for home so another fellow and

I rolled him off a fat illiterate washerwoman. She must have weighed two hundred


"'Sakes, Boss,' she muttered, 'he's far gone dis time. Ain't done nuthin' yet!' It

was my last fishing trip with him."

The next morning with fresh sunlight streaming into the hotel, the youngest

member of the group, having finished breakfast, met Dr. _____ in the lobby. He was

emerging from a telephone booth. Tall, self-assured, clear-eyed, neat as a dandy, and

fashionably dressed, he looked the fine figure of a man.

He spoke affably. With a disarming, boyish smile he made some reference to the

previous evening. His polite expressions and poised tone made


clear the implication that it had been a pleasant occasion and had cemented friendships.

The inconspicuous trace of condescension first noted on meeting him was now more

obvious, but this somehow tended to make his cordiality seem more precious. He was

as sober as a man can be and showed no signs of hangover. Indeed, as his other

companion of the night had said, he must have been drinking very moderately.

The former admirer of Dr. _____, who was an old friend of the lady whom he

had offered to "psychoanalyze" in a parked car before, stopped at her house later in the

day to say goodbye before leaving the city.

"Come in. I must speak to you," she said. There was some indignation in her

tone but more mischief and merriment.

"What about your friend, the famous psychoanalyst?" she said, relishing, in all

friendliness, the other's discomfiture. She was a person of some sophistication and

poise. Being also pretty, vital, and desirable to men, she knew well how to take care of

herself in ordinary company. She had been married for several years and gave a strong

impression of being happy and in love with her husband.

"Well," she continued, "I must tell you. You are interested in queer people."

"Early this morning the cook came and woke me up. 'It’s the telephone,' she

said. 'Damn the telephone, Lou!' I told her. 'Don't you know I was up till all hours last

night?' 'Yes'm,' she answered, 'but the gentleman says you'll speak with him, and it's

important business.'

"I picked up the phone, "'Good morning, Mary' said an unfamiliar, self-assured,

masculine voice. I was wondering who it could be - knowing me well enough to use my

first name and still so pompous. Then, just as I recognized the voic

"'Mary, this is Doctor _____.' From his tone you'd have judged he thought I

ought to sing for joy!

" 'Yes indeed,' I said. He then baldly suggested that I make a date with him for

this afternoon. He'd come out for me at 4 P.M. or, better still, he suggested, I could

meet him at a drugstore downtown.

"Really, there was something so superior about him, a sort of indescribably cool

insolence, or I don't know what … about his manner, I mean ….and after last night! …

not just the proposition itself … that I fairly turned white with rage.

"I wanted so much to blast him with scorn that I was at a loss for words. When

you get that mad it's easy to lose your head. The calm and effective expression of

indignation by which ladies in Victorian novels squelched 'insults' is hard to put into the

idiom of today. Trying not to


make myself unnecessarily ridiculous, but trusting the reply would register as final, I


" 'Is that so? Sorry, but I'm afraid I'll have to forego that pleasure.'

"He then insisted, not like a lover or even like one who's making any decent

pretense of being a lover, but coolly, almost arrogantly, like a fake gentleman who's after

a servant girl. I must have succeeded in making myself a little clearer by this time, for he

resigned himself about this afternoon. But I wasn't done with him.

"He then began to say that he would be back in this city soon, probably every

now and then. He'd like to see me on some of these occasions. He'd call me when he

came. No, perhaps it would be better if he dropped me a note and let me know when

he'd be here. Then I could call him! I was getting so vexed that I scarcely caught the

implication that he didn't want to telephone and find George here.

"For a moment I couldn't answer. Then I suddenly remembered the way he

announced himself: 'Mary, this is Doctor _____!' The overwhelming effrontery of the

whole farce came over me. It was too much! 'Mary, this is Doctor _____!' That

priceless ass calling me by my first name and referring to himself as 'Doctor _____!'

And under such circumstances! Why, he probably pictured us having our little bout of

'love' in the same strain. 'You're so lovely, Mary, do let me take off your pants!' 'Oh,

Doctor - (blushing), you're so genteel and handsome!'

"Can you beat it! I ask you as an old friend! The bumptious swine didn't even

have enough delicacy in what he probably thought of as lovemaking to grant me the

intimacy to call him Jack, or Harry, or Percival, or Happy Hooligan, or whatever else

he's named. He's such an indescribable prig that he probably doesn't even allow himself

to think of himself in terms of a first name.

"I just had time to get out the words which must have come with something of a


"'Yes, you just wait until I call you!'

"I'm ashamed to confess they were almost lost in a burst of laughter. It wasn't

ladylike at all the way I laughed. It was belly-shaking laughter. Homeric laughter.

Rabelaisian laughter, maybe. I couldn't stop.

"Lou, the cook, came back in and asked what was the matter. 'I can't explain,' I

told her and went on laughing.

"What sort of people are you psychiatrists anyway?" she now asked in her

spirited, arch way, again enjoying her old friend's discomfiture which was now almost

lost in wonder and amusement. "I bet that bat-house troubadour went away thinking I

had become hysterical with delight at the opportunity he offered."


"That might not be absurd after all," the friend murmured, remembering the selfpossession

and happy assurance with which Dr. _____ had emerged from the telephone

booth that morning.

This case is offered for what it may be worth. No diagnosis of psychopathic

personality has been made. Occasional news of him over the next few years indicated

that he was still outwardly well adjusted. I believe it likely that he continues to prosper

and I have not the faintest notion that he will ever reach the wards of a psychiatric

hospital except in the capacity of a physician and executive. He does not really succeed

in impressing people of discernment, though he continues to think he succeeds in this.

He impresses many people who are themselves essentially undiscriminating. He cannot

tell these from others with sounder judgment and regards himself as a great success

socially as well as financially.

Such a personality shows suggestions of an inner deviation qualitatively similar to

what is found in the fully developed sociopath. The shrewdness is typical. Unlike

others, such as Max, whose cleverness brings only momentary success in objective

dealing with the world, this man's similar cleverness is applied with enough persistence

for him to advance continuously. He advances financially and, within limits, even

professionally. He is a smart fellow and, in a very superficial sense, has a glib facility in

medical activities. In relations with the public he shows an excellent knack, an artful

sense of showmanship.

For the more fundamental questions that immediately confront a person

interested in psychiatry he apparently has no awareness, and therefore no concern. The

problems of life that make up the chief and underlying interest for real psychiatrists do

not exist for him. He is said to give many of his patients about what they feel they need.

With relatively uncomplex and emotionally shallow persons his amazing self-confidence

is perhaps more quickly effective than the deeper understanding, with its inevitable lack

of certainties, that another sort of man would bring to his work.

His patients are reported to show improvement that compares favorably with

that shown by most of the patients treated by physicians whose aims are more serious.

We must not forget that pseudoscientific cultists frequently succeed in relieving

psychoneurotic patients of their symptoms by absurd measures. These practitioners, if

they work in accordance with the fundamental principles of their craft, have no

awareness of the real problems underlying such symptoms and little or no ability to help

patients understand and deal with these problems. Such a man as this appears to be

similarly limited. If one imagines his attempting pertinent psychiatric study of a

seriously motivated person, of a person whose world is quite foreign to him, the picture

becomes farcical.


This man then, the traits already mentioned notwithstanding, is one who, unlike

the obvious psychopath, succeeds over many years in his outer adjustment. Granting

that the behavior just described is fairly typical and is persisted in, the conclusion

follows that inwardly he is very poorly adjusted indeed, The quality of happiness he

knows and the degree of reality in which he experiences so much that is major in human

relations are such that, despite his superficial success, he must fail to participate very

richly in life itself.

Let it be pointed out that the drunkenness, immature sex attitudes, execrable

taste, and deceit are not in themselves the basis for suspecting that this man is affected

in some measure with the same disorder that affects the patients presented previously.

Many readers would perhaps dismiss all this with the thought that our man might be

more properly called a bad fellow and his status left at that. The significant points are


His impulse to drink does not seem to be motivated by the hope of shared gaiety.

His attitude in sexual aims is so self-centered as to give the impression that even when

carrying out intercourse with women he is essentially solitary, isolated in evaluations so

immature that what satisfaction he achieves must be in concepts of a phallic damaging

and despoiling of the female with simultaneous reassurances to puerile concepts of his

own virility. Such confusing and fragmentary achievement, common enough in a

groping boy of thirteen, is a poor and pathologic substitute for fulfillment compatible

with deep personality integration and is inadequate for one even remotely as near adult

as what is implied by this man's outer surface.

His lack of taste and judgment in human relationships seems inconsistent with his

opportunity to learn and with his ability to learn in other modes of knowing where such

values and meanings do not enter. His apparent hypocrisy is probably not a conscious

element of behavior. At least he is unaware of how it would seem to others, even if he

assumed all the facts were known to them. It has, perhaps, never occurred to him that

there might be people in the world who had other fundamental aims than his own

dominant aim to drop the disguise in which he has acted his part perhaps not too

comfortably during the week, and plunge into what I would call activity more

representative of perverse or disintegrative drives, of aims at sharp variance with

everything his outer self seems to represent.

I am well aware that many basic impulses appear in forms not socially acceptable,

that they might be called immoral, vulgar, or criminal or be described by other

unpleasant words. The person here discussed, when seen without his mask, seems not

to be directed in any consistent and purposive scheme by these socially unacceptable

tendencies but largely to blunder about at their behest. In his outer front he functions

in accordance with all


the proprieties, large and small, but here the reality is thin and personal participation

halfhearted. He is somewhat like a small boy who succeeds in maintaining decorum and

even in getting a good mark for conduct while in the schoolroom under teacher's

watchful eye. Though he looks attentive, he is only shrewdly compromising, biding his

time to get at what is to him more important. When the bell rings and he escapes from

what he finds to be an artificial situation, an area of formalities and polite pretenses, he

becomes natural and plays in accordance with what he takes to be the actual rules and

real aims of existence.

The small schoolboy learns eventually to reconcile what the classroom

represented and what he sought in his hours of play. He finds in his work

responsibilities and ways of celebrating much that is compatible, a core at least, that he

can integrate into constructive, self-fulfilling, and, on the whole, harmonious expression

of basic impulses.

In such a man as the one we are considering, little harmony of this sort appears.

Unlike those presented as clinical psychopaths, he has learned to carry out the

formalities rather consistently and appears as actually living in a constructive and socially

adapted pattern. Actually this is a surface activity, a sort of ritual in which not much of

himself enters, For his more natural and inwardly accepted impulses he has found little

reconcilable with what he gives lip service to. So he must turn to patterns of behavior

so immature and (subjectively) chaotic that they mock and deny all that his surface


The outer layers of socially acceptable functioning extend little deeper into affect

than any other exercise empty of all but formality. He has apparently learned to carry

out a lip service in matters that he finds unreal and tedious and to take pride in how well

this is performed. As an alternative to the barren channels of formality, the inner man

finds for the more valid fulfillment of real impulse only pathways or outlets that sharply

deviate from the surface channels, that cannot in any way be integrated with them, and

that in themselves remain relatively archaic, poorly organized, undirected toward any

mature goal, and socially regressive or self destructive.

It is confusing to interpret such a personality in terms of bad and good. From a

psychiatric viewpoint, at least, such aspects of a maladjusted human being cannot be

assessed authoritatively.

Years after the incidents recorded in this report, some news of the good doctor

was received which I believe would stand as "Paradox in Paradise." It was brought to

the young psychiatrist who had accompanied Dr. _____ during the spree just cited by

an earnest, middle-aged lady with a strong penchant for talking about psychology and

psychiatry and


psychoanalysis, about anything containing the prefix psyche for that matter. Striking at

once for her hearer's closest interests, she began to talk about a wonderful lecture she

had recently heard in a distant town at some woman's club or literary society which was

fostering the cause of mental hygiene.

The lecturer was marvelous, she insisted. He stirred up such enthusiasm that half

the ladies present had begun to study psychology. And his subject! He talked about the

queerest people! They were not exactly insane, but they really did the most fantastic

things! They were even harder to understand than lunatics themselves! But the lecturer

understood them, though he confessed in all modesty that some points about them

were a puzzle even to one of his own experience. He was a most impressive person - so

poised and authoritative, yet always quiet-spoken. He was such an intellectual person. A

man of wide and profound culture. And such a gentleman!

"I declare, I believe half of the women in our club wished they could exchange

roles with his wife! With all that grasp of psychology, just imagine what a husband he

must be!"

She would like to learn more about these people … psychopathic personalities or

psychopaths the doctor had called them. And the doctor's name … She uttered it in

hushed tones of admiration.


Next: Section 3: Cataloging the material , Part 1: Orientation, 27. Conceptual confusions which cloud the subject


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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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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





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