Psychopath Hervey Cleckley THE MASK OF SANITY, Section 1: An Outline of the Problem, 4. Method of presentation

Before attempting to define or describe the psychopath (antisocial personality), to

contrast him with other types of psychiatric patients, or to make any attempt to explain

him, I would like to present some specimens of the group for consideration.

This procedure will be in accord with the principles of science in method at least,

since, as Karl Pearson pointed out in The Grammar of Science, this method always consists

of three steps: 119

1. The observation and recording of facts

2. The grouping of these facts with proper correlation and with proper distinction

from other facts

3. The effort to devise some summarizing or, if possible, explanatory statement

which will enable one to grasp conveniently their significance

Long ago, keeping these steps clearly in mind, Bernard Hart gave an account in

The Psychology of Insanity119 of personality disorder that has, perhaps, never been surpassed

for clarity and usefulness. Psychopathology has not been a static field, and many new

concepts have arisen which make Hart's presentation in some respects archaic and

unrepresentative of viewpoints prevalent today in psychiatry. This point

notwithstanding, the method followed by Hart remains an example of how the

problems of a personality disorder can be approached with maximal practicality with

minimal risks of mistaking hypothesis for proof or of falling into the schismatic

polemics that, scarcely less than among medieval theologians, have confused issues and

impeded common understanding in psychiatry. Without claims to comparable success

in the effort to follow Hart's method, I acknowledge the debt owed one who set so

excellent an example in the early years of this century.

The most satisfactory way in which such clinical material could be presented is, in

my opinion, as a series of full-length biographic studies, preferably of several hundred

pages each, written by one who has full access to

AN OUTLINE OF THE PROBLEM 21

the life of each subject. Only when the concrete details of environment are laid in, as,

for instance, in an honest and discerning novel, can the significance of behavior be well

appreciated. Certainly no brief case summary and probably no orthodox psychiatric

history can succeed in portraying the character and the behavior of these people as they

appear day after day and year after year in actual life.

It is not enough to set down that a certain patient stole his brother's watch or that

another got drunk in a poolroom while his incipient bride waited at the altar. To get the

feel of the person whose behavior shows disorder, it is necessary to feel something of his

surroundings. The psychopath's symptoms have for a long time been regarded as

primarily sociopathic.233,235,236 It is true that all, or nearly all, psychiatric disorder is in an

important sense sociopathic, in that it affects adversely interpersonal relations. In most

other disorders the manifestations of illness can, however, be more readily

demonstrated in the isolated patient in the setting of a clinical examination. In contrast,

it is all but impossible to demonstrate any of the fundamental symptoms in the

psychopath under similar circumstances. The substance of the problem, real as it is in

life, disappears, or at least escapes our specialized means of perception, when the patient

is removed from the milieu in which he is to function.

All that surrounds and has ever surrounded the schizophrenic or the man with

severe obsessive illness is, of course, important to us if we seek to understand why these

people became disabled. Lacking all information except what might be gained from

either of these patients (with whom one is, let us say, confined in an oxygen chamber on

the moon), the observer will, nevertheless, have little trouble in discerning that there is

disorder and in discovering a good deal about the general nature of the disorder.

Aside from questions of cause and effect, we have little opportunity even to

realize the existence of the subject we must deal with unless the psychopath can be

followed as he departs from the (essentially in vitro) situation of physician's office or

hospital and takes up his activities in the community on a real and (socially) in vivo

status.

It is with such convictions in mind that we shall often include detail of the

environment, perhaps digress to the patient's husband or parents, report glimpses of the

patient through the eyes of a lay observer, and at times attempt, from what material is

available, a tentative reconstruction of situations that can be experienced adequately

only at firsthand. It is regrettable that so much detail of this sort is difficult and often

impossible to obtain. Without adequate knowledge of his specific surroundings in the

community, there is no way for more than the insubstantial image of his being, like the

picture projected from a lantern slide, to reach awareness. The real clinical

22 THE MASK OF SANITY

entity is approachable only in the unstatic, actual process of the patient's life as he takes

his specific course as a personal and sociologic unit.

The disorder can be demonstrated only when the patient's activity meshes with

the problems of ordinary living. It cannot be even remotely apprehended if we do not

pay particular attention to his responses in those interpersonal relations that to a normal

man are the most profound.

If no schizophrenic had ever spoken, we would probably have little realization of

what we understand (incomplete as this is) of auditory hallucinations. The

schizophrenic can, by his verbal communication, give us some useful clues in our efforts

to approach many of his problems. Little or nothing of this sort that is reliable can, by

ordinary psychiatric examination, be obtained from the psychopath. Only when we

observe him not through his speech but as he seeks his aims in behavior and

demonstrates his disability in interaction with the social group can we begin to feel how

genuine is his disorder. Studying the psychopath almost entirely in the orthodox clinical

setting in which patients ordinarily appear is like examining the schizophrenic with our

ears so muffled that his reiterated and quite honest claims of hearing voices of the dead

talking to him from the sun (and from his intestines) fail to reach our perception.

If another analogy be permitted, let us say that a pair of copper wires carrying

2,000 volts of electricity, when we look at them, smell them, listen to them, or even

touch them separately (while thoroughly insulated from the ground), may give no

evidence of being in any respect different from other strands of copper. Let us,

however, connect them to a motor (or have someone seize both of them at once) and

we find out facts not to be perceived otherwise. The unmistakable evidence of

electricity appears only when the circuit is made. So, too, the features that are

most important in the behavior of the psychopath do not adequately emerge when this

behavior is relatively isolated. The qualities of the psychopath become manifest only

when he is connected into the circuits of full social life.

The sort of presentation our problem requires is, of course, impossible.

However, in an effort to give at least a vivid glimpse of the material under

consideration, I have made use of a somewhat different form of report than that

customarily offered.

The impersonal and necessarily abstracted picture of these psychopaths in a

purely clinical setting fails to show them as they appear in flesh and blood and in the

process of living. In the restricted and arbitrary range of activities afforded by hospital

life, their tendencies cannot be so truly and vividly demonstrated as in the larger world.

To know them adequately, one must try to see them not merely with the physician’s

calm and relatively detached eye but also with the eye of the ordinary man on the

streets,

AN OUTLINE OF THE PROBLEM 23

whom they confound and amaze. We must concern ourselves not only with their

measurable intelligence, their symptomatology (or, rather, lack of symptomatology) in

ordinary psychiatric terms, but also with the impression they make as total organisms in

action among others and in all the nuances and complexities of deeply personal and

specifically affective relationships. To see them properly in such a light, we must follow

them from the wards out into the marketplace, the saloon, and the brothel, to the

fireside, to church, and to their work.

In attempting this, however incompletely and inadequately, it is perhaps desirable

for us not to trade our naivete at once for the experienced clinician's discriminating

viewpoint. Let us first watch them in their full conduct as human beings, not neglecting

even the impression they make on Tom, Dick, and Harry, before trying to frame them

in a scheme of psychopathology.

The terms I shall use to describe them may often imply that they are blamed for

what they do or suggest an attitude of distaste or mockery for some of their behavior.

Most psychiatrists regard such patients, unlike those suffering from ordinary psychoses,

as legally competent and responsible for their misconduct and their difficulties. The

faulty reactions in living which these patients show are indeed difficult to describe

without sometimes using terms that come more readily to moralists or sociologists or

laymen than to psychiatrists. The customary psychiatric terminology does not, I believe,

offer a range of concepts into which we can fit these people successfully.

With other patients whose disorder is frankly recognized, we can, by our

impersonal and specifically medical language, communicate fairly well to each other

what we have observed. Some aspects of the psychopath which elude such language

may be reflected, however imperfectly, in the simplest accounts of direct impression by

those who have been closest to him and have felt the impact of his anomalous reactions.

For these reasons, then, and with apology, reference may be made to some actions as

outlandish, foolish, fantastic, buffoonish.

The chief aim of this book is to help, in however small a way, to bring patients

with this type of disorder into clearer focus so that psychiatric efforts to deal with their

problems can eventually be implemented. It has of course been necessary and in every

way desirable to eliminate all details that might lead to the personal identification of any

patient whose disorder has been studied and recorded. All patients referred to have

been carefully shielded from recognition. It is nevertheless true that the psychopath

engages in behavior so unlike that of others and so typical of his disorder that no act can

be reported of a patient from Oregon seen ten years ago without strongly suggesting

similar acts by hundreds of psychopaths carried out

24 THE MASK OF SANITY

in dozens of communities last Saturday night. I can only express regret to the scores of

people whose sons, brothers, husbands, or daughters I have never seen or heard of but

who have, no doubt, reproduced many or perhaps all of the symptoms discussed in this

volume. This disorder is so common that no one need feel that any specific act of a

psychopath is likely to be distinguishable from acts carried out by hundreds of others.

In discussing the possible influence of environment on the development of this

disability, I hope I will not promote unjustified regret or remorse in any parent.

Hundreds of times fathers and mothers have discussed their fear that some error or

inadequacy on their part caused a child to become a psychopath. Most parents of such

patients personally studied impress me as having been conscientious and often very kind

and discerning people. As will be brought out later, I do not believe obvious

mistreatment or any simple egregious parental errors can justifiably be held as the

regular cause of a child's developing this complex disorder. All parents, no doubt, make

great as well as small mistakes in their role as parents. It has seemed at times that the

very points about which some mothers and fathers feel most uneasiness are the

opposite of those so regretted by others and assumed to be the crucial mistakes that

have contributed to the maladjustment of a child. Less than in most other kinds of

psychiatric disorder has it seemed to me that one could find and point out as causal

influences gross failures on the part of the parents which people of ordinary wisdom

and good will might have readily avoided.

During recent years it has become popular to blame parents in glib and sweeping

terms for all, or nearly all, of the misconduct or inadequacy of their children. It has also

become popular to insist that society and not the one who commits the crime should be

held responsible for murder, rape, or armed robbery.57 Sometimes these claims are made

without any appeal to evidence at all but merely by repetition of the familiar cliche.

Some psychiatrists have even attempted to account for antisocial behavior by assuming

that the parents unconsciously want their sons or daughters to commit criminal or

immoral acts and that the progeny carry out these wishes while remaining unconscious

of their motives.148-150 These conclusions, like many others that have been drawn in the

attempt to give fundamental and dynamic explanations of things still unknown, rest

chiefly on theoretical assumptions-assumptions made on the basis of analogy or

arbitrarily interpreted symbolism about what is in the unconscious but what is never

brought forth into consciousness or otherwise submitted or demonstrated. This, I

maintain, does not constitute genuine evidence as it is known to science, law, or

common sense. I hope that the great numbers of conscientious and honorable parents

who to my knowledge have struggled courageously

AN OUTLINE OF THE PROBLEM 25

over the years, despite grief and frustration, to rehabilitate their sons and daughters (and

to make restitution in their behalf to society) will not be led by such fanciful

explanations to blame themselves unjustly.

Cruvant and Yochelson62 have expressed the opinion that strong and

inappropriate negative attitudes toward psychopaths are commonly aroused in

psychiatrists who attempt to deal with them as patients. It is scarcely surprising if such

reactions tend to occur, when one considers all the disappointments and the frustrations

involved in treatment and the repeatedly demonstrated irresponsibility and callousness

of these patients.

When there is an opportunity to follow the career of a typical psychopath, his

pattern of behavior appears specific-something not to be confused with the life of an

ordinary purposeful criminal or of a cold opportunist who, in pursuit of selfish ends,

merely disregards ethical considerations and the rights of others.

This pattern, I believe, differs no less distinctly than the specific and idiomatic

thought and verbal expressions of schizophrenia differ from those of the mentally

defective and from other psychiatric conditions. Never in faults of logical reasoning, or

in verbal confusion or technical delusion, but rather in the sharper reality of behavior,

the psychopath seems often to produce something as strange and as obviously

pathologic as the following statement taken from the letter of a patient with

schizophrenia:

Financial service senses worries of 35 whirlpools below sound 1846, 45, 44, A.D.

Augusta City treasury, Richmond County treasury, United States Treasury of Mississippi

River flood area. Gentlemen will you come to . . . and idenafy none minastrative body

that receives the life generated by fourth patented generative below sound. Further

arrange financial credit for same. Would like two bedrooms at up town Hotel and

convenient to roof garden. Until you gentlemen decide further what my occupation is you

may as well announce me as comforting 35 whirlpools below sound. May you gentlemen

have gray eyes and thick bones as the flat sense minastrated are very valuable in idenafying

me.

Even such a relatively simple bit of word salad stands out at once as indicative of

profound and specific disorder within the writer. As in the words of the schizophrenic,

so in the behavior of the psychopath there seems to work a positive knack for

producing situations which can be accounted for only in terms of a psychiatric

condition which is unique.

Psychopath

THE MASK OF SANITY

Section 1: An Outline of the Problemf