ENERGY BLOCKAGE REMOVAL
|2005 AND 2006|
THE MASK OF SANITY
Section 2: The Material
20. Degrees of disguise in essential pathology
The voice is Jacob's voice, but the hands are the hands of Esau.
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
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
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
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.
Section 2, Part 2