THE MASK OF SANITY

Section 3: Cataloging the Material

Part 3: A clinical profile

57. Fantastic and uninviting behavior with drink and sometimes without

 

 

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57. Fantastic and uninviting behavior with drink and sometimes without

Although some psychopaths do not drink at all and others drink rarely,

considerable overindulgence in alcohol is very often prominent in the life story.

Delirium tremens and other temporary psychoses directly due to alcohol were not

commonly found in the hundreds of patients observed by me.

The view of some professional moralists to the effect that demon rum is the

fundamental cause of disaster such as that of the psychopath appears to have little claim

to validity. It has been pointed out already that an irreconcilable difference in primary

aim appears to exist between the ordinary person who drinks too much and the

psychopath. This may be restated briefly as follows: The ordinary drinker gets into

trouble by drifting with enthusiasm into the opinion that if two or six or eight drinks

have made him feel so good, another (or two more or perhaps five more) will make him

feel just so much better. Such rationalizations may assist the normal drinker, especially

if he has serious fundamental conflicts, in a progress toward becoming a neurotic

drinker or toward an alcoholic breakdown.

I cannot say that it is impossible in certain persons for a state of mental disorder

identical with that described here as psychopathic personality to be reached eventually in

this way. Often, however, these neurotic drinkers, in sharp contrast with the

psychopath, worry about their state when sober, are capable of making an earnest effort

to get well under psychiatric treatment, and lack most of the deeper personality features

of the psychopath. Even in the neurotic drinker it is more often an independent and

preexisting personality maladjustment rather than the alcohol which is primarily causal.

Many psychiatric observers make this vividly clear and no less convincing.

356 THE MASK OF SANITY

An interesting interpretation of alcoholism from a psychoanalytic viewpoint has

been offered by Knight.169,170

A major point about the psychopath and his relation to alcohol can be found in

the shocking, fantastic, uninviting, or relatively inexplicable behavior which emerges

when he drinks - sometimes when he drinks only a little. It is very likely that the effects

of alcohol facilitate such acts and other manifestations of the disorder. This does not

mean, however, that alcohol is fundamentally causal. Good criteria for differentiation

between psychopaths and others who drink, moderately or excessively, can be found in

what tendencies emerge after similar amounts have been consumed.

A peculiar sort of vulgarity, domineering rudeness, petty bickering or buffoonish

quasi-maulings of wife, mistress, or children, and quick shifts between maudlin and

vainglorious moods, although sometimes found in ordinary alcoholics with other serious

patterns of disorder, are pathognomonic of the psychopath and in him alone reach full

and precocious flower. Even in the first stages of a spree, perhaps after taking only two

or three highballs, he may show signs of petty truculence or sullenness but seldom of

real gaiety or conviviality. Evidence of any pleasurable reaction is characteristically

minimal, as are indications that he is seeking relief from anxiety, despair, worry,

responsibility, or tension.

Alcohol, as a sort of catalyst, sometimes contributes a good deal to the long and

varied series of outlandish pranks and inanely coarse scenes with which nearly every

drinking psychopath's story is starred. Free from alcohol, such a patient would scarcely

sit under a house all night idly striking matches, or, concealing himself behind book

stacks, urinate from the window of a public library on passersby in the street below.

Nor would he, like the psychopathic son of a prominent family, suddenly, as a prank,

decide to climb into a tree at a busy street corner, where he deliberately undressed,

shouting wildly and puerilely to draw public attention. This man could not be

persuaded to withdraw until the local fire department was called to remove him. The

alcohol probably does not of itself create such behavior. Alcohol is not likely to bring

out any impulse that is not already potential in a personality, nor is it likely to cast

behavior into patterns for which there is not already significant subsurface predilection.

The alcohol merely facilitates expression by narcotizing inhibitory processes.136 In cases

of this sort very little narcotizing may be needed. The oil which lubricates the engine of

an automobile neither furnishes the energy for its progress nor directs it.

Psychopaths often indulge in these strange performances after drinking relatively

little. They know perfectly well what they have done before when drinking and, with

these facts squarely before their altogether clear and rational

CATALOGING THE MATERIAL 357

awareness, decide to drink again. It is difficult indeed for me to see any substantial

grounds for placing the responsibility for the drinking psychopath's deeds primarily on

alcohol instead of on the disorder which, in ways no less serious even if less spectacular,

he shows also when entirely sober.

Although his most theatrical exploits in public are usually carried on when

drinking, the psychopath, even after he has been free from all alcohol for months, as for

instance, when he is in a psychiatric hospital, retains all the essential personality features

which have been mentioned. These show little or no tendency to diminish when he

cannot drink. These words translated from Aeschylus, "Bronze is the mirror of the

form; wine of the heart," express something pertinent about alcohol and man, whether

the man be ill or well.

All the curious conduct reported in patients who drank and who were presented

here occurred in the absence of delirium tremens, alcoholic hallucinosis, or any other of

the well-known psychoses due directly to intoxication. Of course, such psychotic

conditions may occur in psychopaths and in neurotic drinkers. It is important to keep

such symptoms separate, since they are clearly due to another type of mental disorder.

Most of this asocial, unacceptable, and self-defeating behavior associated with the

psychopath's drinking seems to occur without the benefit of extreme inebriation. If

actual confusion from alcohol prevailed or states of genuine amnesia were induced

before the grotesque shenanigans began, intoxication could more plausibly be suspected

of playing a larger causal role. The psychopath often reacts in this typical way while in

perfect orientation, with unclouded awareness and in anything but the deeply drugged

state thought by some to be a prerequisite.

For whatever reason the psychopath may drink, it is true that, in contrast with

others who use alcohol to excess, he hits upon conduct and creates situations so bizarre,

so untimely, and so preposterous that their motivation appears inscrutable. Many of his

exploits seem directly calculated to place him in a disgraceful or ignominious position.

He often chooses pranks and seeks out situations that would have no appeal for the

ordinary person, whether the ordinary person be drunk or sober. The observer

sometimes wonders if a truly astonishing ingenuity, or an actively perverse inventiveness

is directing him, so consistently does he bring off scenes not only uncongenial but even

unimaginable to the average man.

Furthermore, these exploits seem to such little purpose, almost as hard to

understand on the assumption that they are for amusement or play as on the grounds of

utility. One patient with numerous other outstanding incidents in his career, while

sitting at a formal dinner party given by friends in

358 THE MASK OF SANITY

honor of his birthday, turned coolly and spat with deliberation on the cake as it was

brought to his side for him to cut.

One patient who developed typical symptoms early in life showed, long before he

had ever touched anything alcoholic, prankish tendencies worth noting here. When

taken into a store by his parents to be fitted with new clothes, he often allowed

intestinal gas to pass quietly but with vivid olfactory manifestations. Considerable

embarrassment and vexation were experienced by the clerks and by his parents, but he

was never ruffled and apparently took mild or moderate pleasure in the situation. He

occasionally resorted to these tactics while riding with his parents and dignified

company in a car when the windows were tightly closed because of cold weather. A few

times he discomfited his family considerably by the same means in church. At first the

parents accepted his apologies after reprimands and they were inclined to believe his

innocent-faced explanation that an involuntary lapse of control had occurred. The

timing of events and the predilection for close places and special surroundings, as well

as the emergence of other behavior, convinced them in time that these acts were

deliberate.

Another young psychopath who had never encountered liquor of any sort did

many things that would not attract the ordinary mischievous teenager. Finding time a

little heavy on his hands (and his parents out of the house for a few hours), he took

tools from the cellar and, working with no little skill and dispatch, got the connections

of the bathroom toilet apart, put into the outlet pipe a small electric motor, and then

carefully reconnected the fixture. The subsequent flooding, mess, trouble, and expense

did not seem to give him hilarious mirth or vindictive satisfaction. Certainly he showed

no evidence of such feeling in a degree to warrant his risking the punishment he

received.

The pranks or buffoonery of the sober adult psychopath naturally differ

somewhat from those typical of adolescence or earlier. With a few drinks the similarity

of the adult's behavior often increases.

 

Next: Section 3: Cataloging the material, Part 3: A clinical profile, 58. Suicide rarely carried out

 

Energy Enhancement          Enlightened Texts         Psychopath           The Mask Of Sanity

 

 

Section 3, Part 3

 

 

 

 

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