Psychopath Hervey Cleckley THE MASK OF SANITY, Section 4: Some questions still without adequate answers, Part 1: What is wrong with these patients?, 63. Further consideration of the hypothesis

63. Further consideration of the hypothesis

In attempting to account for the abnormal behavior observed in the psychopath,

we have found useful the hypothesis that he has a serious and subtle abnormality or

defect at deep levels disturbing the integration and normal appreciation of experience

and resulting in a pathology that might, in analogy with Henry Head's classifications of

the aphasias, be described as semantic. Presuming that such a patient does fail to

experience life adequately in its major issues, can we then better account for his clinical

manifestations? The difficulties of proving, or even of demonstrating direct objective

evidence, for hypotheses about psychopathology (or about ordinary subjective

functioning) are too obvious to need elaborate discussion here.

If the psychopath's life is devoid of higher order stimuli, of primary or serious

goals and values, and of intense and meaningful satisfactions, it may be possible for the

observer to better understand the patient who, for the trivial excitement of stealing a

dollar (or a candy bar), the small gain of forging a $20.00 check, or halfhearted

intercourse with an unappealing partner, sacrifices his job, the respect of his friends, or

perhaps his marriage. Behind much of the psychopath's behavior we see evidence of

relatively mild stimuli common to all mankind. In his panhandling, his pranks, his

truancy, his idle boasts, his begging, and his taking another drink, he is acting on

motives in themselves not unnatural. In their massive accumulation during his career,

these acts are impressive chiefly because of what he sacrifices to carry them out. If, for

him, the things sacrificed are also of petty value, his conduct becomes more

comprehensible.

Woolley, in an interesting interpretation of these patients, compared them with

an otherwise intact automobile having very defective brakes.219 Such an analogy

suggests accurately an important pathologic defect which seems to exist. In contrast

with an automobile, however, the braking functions of the human organism are built

into the personality by reaction to life experience, to reward and punishment, praise and

blame, shame, loss, honor, love, and so on. True as Woolley's hypothesis may be, it

seems likely that more fundamental than inadequate powers to refrain is the inadequate

emotional reactivity upon which the learning to refrain must be based. Even with good

brakes on his car, the driver must have not only knowledge of but also feeling for what

will happen otherwise if he is to use them correctly and adequately.

Some of the psychopath's behavior may be fairly well accounted for if we

SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 389

grant a limitation of emotional capacity. Additional factors merit consideration. The

psychopath seems to go out of his way to make trouble for himself and for others. In

carelessly marrying a whore, in more or less inviting detection of a theft (or at least in

ignoring the probability of detection), in attempting gross intimacies with a debutante in

the poorly sheltered alcove just off a crowded ballroom, in losing his hospital parole or

failing to be with his wife in labor just because he did not want to leave the crap game at

midnight (or at 3 A.M.), in such actions there seems to be not only a disregard for

consequences but an active impulse to show off, to be not discreet but conspicuous in

making mischief. Apparently he likes to flaunt his outlandish or antisocial acts with

bravado.

When negative consequences are negligible or slight (both materially and

emotionally), who does not like to cut up a little, to make a bit of inconsequential fun,

or perhaps playfully take off on the more sober aspects of living? Dignity might

otherwise become pompousness; learning, pedantry; goodness, self-righteousness. The

essential difference seems to lie in how much the consequences matter. It is also

important to remember that inclination and taste are profoundly shaped by capacity to

feel the situation adequately. A normal man's potential inclination to give the pretty

hatcheck girl $100.00 would probably not reach awareness in view of his knowledge that

this would result in his three children's not having shoes or in his having to humiliate

himself by wheedling from a friend a loan he will never repay.

If, as we maintain, the big rewards of love, of the hard job well done, of faith

kept despite sacrifices, do not enter significantly in the equation, it is not difficult to see

that the psychopath is likely to be bored. Being bored, he will seek to cut up more than

the ordinary person to relieve the tedium of his unrewarding existence. If we think of a

theater half-filled with ordinary pubertal boys who must sit through a performance of

King Lear or of Beethoven's Ninth Symphony, we need ask little of either imagination

or memory to bring to mind the restless fidgeting, the noisy intercommunication of

trivialities, the inappropriate guffaws or catcalls, and perhaps the spitballs or the

mischievous application of a pin to the fellow in the next seat.

Apparently blocked from fulfillment at deep levels, the psychopath is not

unnaturally pushed toward some sort of divertissement. Even weak impulses, petty and

fleeting gratifications, are sufficient to produce in him injudicious, distasteful, and even

outlandish misbehavior. Major positive attractions are not present to compete

successfully with whims, and the major negative deterrents (hot, persistent shame,

profound regret) do not loom ahead to influence him. If the 12-year-old boys could

enjoy King Lear

390 THE MASK OF SANITY

or the Ninth Symphony as much as some people do, they would not be so reckless or

unruly. If the son of a family long honored in the community (and husband of a wife at

her wits' end) felt about going to jail and about being widely known as a jailbird, as most

people do, he could not, after dozens of brief incarcerations, drop in on somewhat

similar acquaintances (just back at work after their own periods of detention) and gaily

twit them with such greetings as, "What kind of a bird can't fly?"

In a world where tedium demands that the situation be enlivened by pranks that

bring censure, nagging, nights in the local jail, and irritating duns about unpaid bills, it

can well be imagined that the psychopath finds cause for vexation and impulses toward

reprisal. Few, if any, of the scruples that in the ordinary man might oppose and control

such impulses seem to influence him. Unable to realize what it meant to his wife when

he was discovered in the cellar flagrante delicto with the cook, he is likely to be put out

considerably by her reactions to this. His having used the rent money for a midnight

long-distance call to an old acquaintance in California (with whom he bantered for an

hour) also brings upon him censure or tearful expostulation. Considering himself

harassed beyond measure, he may rise from the dining room table in a petty tantrum,

curse his wife violently, slap her, even spit on her, and further annoyed by the sudden

weeping of their 6-year-old daughter, throw his salad in the little girl's face before he

strides indignantly from the room.

His father, from the patient's point of view, lacks humor and does not

understand things. The old man could easily take a different attitude about having had

to make good those last three little old checks written by the son. Nor was there any

sense in raising so much hell because he took that dilapidated old Chevrolet for his trip

to Memphis. What if he did forget to tell the old man he was going to take it? It

wouldn't hurt him to go to the office on the bus for a few days. How was he (the

patient) to know the fellows were going to clean him out at stud or that the little bitch

of a waitress at the Frolic Spot would get so nasty about money? What else could he do

except sell the antiquated buggy? If the old man weren't so parsimonious he'd want to

get a new car anyway!

And why did he (the father) have to act so magnanimous and hurt about settling

things last Saturday night down at the barracks? You'd think from his attitude that it

was the old man himself who'd had to put up with being cooped in there all those hours

with louse-infested riff-raff! Well, he'd thanked his father and told him how sorry he

was. What else could a fellow do? As for that damned old Chevrolet, he was sick of

hearing about it. His grudge passing with a turn of thought, he smiles with halfaffectionate,

playfully cordial feelings toward the old man as he concludes, "I ought to

tell him to take his precious old vehicle and stick it up his _____!"

SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 391

Lacking vital elements in the appreciation of what the family and various

bystanders are experiencing, the psychopath finds it hard to understand why they

continually criticize, reproach, quarrel with, and interfere with him. His employer,

whom he has praised a few hours before, becomes a pettifogging tyrant who needs

some telling off. The policeman to whom he gave tickets for the barbecue last week

(because he is such a swell guy) turns out to be a stupid oaf and a meddler who can't

mind his own business but has to go and arrest somebody just because of a little

argument with Casey in the Midnight Grill about what happened to a few stinking dollar

bills that were lying on the bar.

Adolescents who feel a need to kick over the traces often seek to do so in

unconventional, spectacular, daring and sometimes shocking acts that often are

motivated primarily by impulses of defiance. Similar impulses of defiance no doubt

contribute to the psychopath's behavior. Figures representing authority or respectability

naturally irk him. They are smug and meddlesome in his eyes and tempt him to show

them what he really can do. If he cannot actually remember his parents, on the eve of a

whipping, telling him "this is going to hurt me more than it does you," he, like all

people, gets the idea. Through the damage he does to himself he has a way of getting

back at or disciplining them, along with his wife, his friends, and all sorts of selfrighteous

people who volunteer to "do him good" and to meddle.46

It is not necessary to assume great cruelty or conscious hatred in him

commensurate with the degree of suffering he deals out to others. Not knowing how it

hurts or even where it hurts, he often seems to believe that he has made a relatively mild

but appropriate reprimand and that he has done it with humor. What he believes he

needs to protest against turns out to be no small group, no particular institution or set

of ideologies, but human life itself. In it he seems to find nothing deeply meaningful or

persistently stimulating, but only some transient and relatively petty pleasant caprices, a

terribly repetitious series of minor frustrations, and ennui.

Like many teenagers, saints, history-making statesmen, and other notable leaders

or geniuses, he shows unrest; he wants to do something about the situation. Unlike

these others, as Lindner has so well and convincingly stressed, he is a "rebel without a

cause."188 Reacting with something that seems not too much like divine discontent or

noble indignation, he finds no cause in the ordinary sense to which, he can devote

himself with wholeheartedness or with persistent interest. In certain aspects his

essential life seems to be a peevish bickering with the inconsequential. In other aspects

he suggests a man hanging from a ledge who knows if he lets go he will fall, is likely to

break a leg, may lose his job and his savings (through the disability and hospital

expenses), and perhaps may injure his baby in the carriage

392 THE MASK OF SANITY

just below. He suggests a man in this position who, furthermore, is not very tired and

who knows help will arrive in a few minutes, but who, nevertheless, with a charming

smile and a wisecrack, releases his hold to light a cigarette, to snatch at a butterfly, or

just to thumb his nose at a fellow passing in the street below.

In his work on obsessive disorder, Straus brings out and develops a concept very

germane to the present discussion.270 Beneath severe obsessive disorder he often finds

indications of a distaste for life as it is ordinarily lived, a nauseous rejection of what is

normally most appealing, and an attitude toward the world that finds in our chief

sources of joy the equivalent of decay and filth. These observations are interesting and

extraordinarily articulate. They seem to elucidate from an independent viewpoint other

and important aspects of what has elsewhere been presented as confusion of love and

hate.209

It is impossible to give briefly an adequate account of what Straus brings out. Its

relation to our subject is of interest. The psychopath does not seem to share the

obsessive patient's specific pathologic evaluations, but he also reacts to the milieu of

human life as if it had been altered in its essential qualities. The alteration in the

psychopath is by no means similar to what Straus depicts. The obsessive patient

according to Straus spends his life desperately trying to avoid what he finds so

disgusting and horrible. The psychopath looks as if he were reacting to what is trivial by

showing that he just doesn't give a damn. Having no major goals or incentives, he may

be prompted by simple tedium to acts of folly or crime. Such prompting is not opposed

by ordinary compunction or concern for consequences.

The psychopath certainly does not seem to be warding off anything similar to

what the obsessive patient solemnly seeks to ward off with disgust. He may, however,

be flouting something very different in an unrecognized or poorly recognized mockery

or travesty whereby he demonstrates that he is not emotionally involved.

The lack of aversion to conduct and situations which to the normal person are

repulsive is striking and paradoxical in the psychopath. This is no impressive than the

disgust Straus finds in obsessive patients. It might in fact be regarded as an equally basic

alteration of the normal reaction but an alteration toward the other extreme. The

opposite reactions of depression and manic euphoria have been interpreted as diverse

responses to an identical inner pathologic situation.79 The prude and the pathologically

wanton often seem to be influenced chiefly by the same misconception of sexuality as

being intrinsically ignoble and, to the female, degrading. So, too, the active life rejection

believed by Straus to underlie obsession and the indifference to major human values

underlying the psychopath's life scheme

SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 393

may themselves be thought of as profoundly pathologic reactions in opposite directions.

A world not by any means identical but with some vivid features of both these

underlying situations can be found in Huysmans' Against the Grain42 and in Jean-Paul

Sartre's Nausea.252 In the satirical novels of Evelyn Waugh, also, an atmosphere difficult

to describe sometimes develops - an atmosphere that may give the reader awareness of

attitudes and evaluations genuinely illustrative of deeply distorted or inadequate

reactions to life.290,293

In none of this fiction does one find evidence of the obsessive patient's reaction

to what he scrupulously rejects as if it were filth. The leading characters depicted

therein show a peculiar cynicism which is more conscious and directed and purposive

than the behavior of the psychopath. But none of the characters presented show even

an approximate awareness of what is most valid and meaningful and natural in human

beings. A negative response to life itself, an aversion at levels more basic than ordinary

morals or the infraconscious foundations of taste and incentive, is conveyed subtly and

impressively.

It is difficult to illustrate by incident, by the expressed attitude of the characters

depicted, or by any clearly implied evaluation of the authors the specific quality of what

is evoked in these novels as the essence of an unhappy, mutilated, and trivial universe in

which all the characters exist. The sense of pathology pervades to levels so deep that

rational scrutiny cannot reach and meet the fundamental implications; nor can inquiry

satisfactorily demonstrate its precise source. If the actual world and main's biologic

scope were only that conveyed in these interesting works, it would perhaps be less

difficult to account for obsessive illness and for the psychopath's career as reasonable

reactions to a situation where no course is possible except one profoundly pathologic in

one way or another.

Thoughtful contemplation of what is depicted in these works of fiction suggests a

world as fundamentally altered as what Straus presents as the world of the obsessive

patient. In the effective and terse implication of general emotional incapacity in these

characters, the authors succeed in evoking awareness of a sort of quasi-life restricted

within a range of staggering superficiality. This, rather than those aspects of the works

that apparently brought them popularity, may deserve high literary appraisal as concise

and valuable communications of something that is by no means easy to convey in direct

language. Such a superficiality and lack of major incentive or feeling strongly suggest

the apparent emotional limitations of the psychopath.

In his discussion of what arouses disgust in his obsessive patients, Straus brings

out memorable points. Not by literal falsification of objective facts

394 THE MASK OF SANITY

but by seeing and feeling the facts in a pathologic mode is the world altered. He says:270

Curls on a head look lovely and attractive, but the same hair found in the soup

is disgusting; perhaps we should like to cut one of these curls as a souvenir, but we

should be disgusted to collect the hair left in a comb. Saliva spit out is disgusting, an

expression of our contempt, but on fresh lips and tongue the saliva is not disgusting.

Separation from the integrity of the living organism turns the physiognomy from

delight to disgust. This transition indicates a transition from life to death; it signifies

decay. Disgust is directed more against decay, the process of decomposition, than

against the dead. A skeleton, a mummy, may be frightening, even horrible, but not as

disgusting as a cadaver which has just been brought from a river to the morgue.

Through the writings of Jonathan Swift excellent illustration is given of a peculiar

distortion of those sympathetic relations which constitute the very essence of biology.

It is not the charm of a lovely woman that attracts Swift's attention but the fact that she

has sweat pores, excretions. Similar pathologic preoccupations with decay have also

been noted by Havelock Ellis and cogently discussed.74,75 To the psychopath the basic

axioms of life must seem different from what they seem to normal people and also very

different from what they seem to people with severe obsessive disorders. Obsessive

patients, according to the concept of Straus, are unable to appreciate what is normally

obvious about many positive aspects of experience. This underlying and often

unrecognized attitude can be better illustrated than described. Let us consider briefly an

item that is vividly pertinent:

A young man who apparently was not quite happy in his marriage had been seen

occasionally with other women. According to rumor he had been or was about to be

unfaithful to his wife. A cousin, also married and a few years older, was, in my

presence, attempting to bring the other fellow to his senses. The counselor was a man

of remarkable learning and intellect. He did not approach the problem by harping on

conventional morality or the personal injustice that the other's wife might be done.

Maintaining a light touch, half-teasing in his remarks but also seriously trying to be

helpful, he spoke of how often young married men drift astray. He made, in a playful,

unmoralizing style, some good arguments for avoiding adultery. Then, as if to diminish

the temptations which he felt might be troubling the young man, he said: "Remember

that when you kiss a girl you are sucking on the end of a tube twenty-five feet long and

that the other end is filled with____."*

* The speaker did not have symptoms of obsessive-compulsive neurosis or any features of the

psychopath.

SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 395

Exposition or further discussion can contribute little or nothing to the remark as

it stands. Whether the estimated length of the gastrointestinal tract is accurate or not

has little pertinence. No one can argue with the literal truth of the counselor's

statement. But who can avoid wondering about what might have led to the arrival at

such a conception of a woman's kiss? And to such a response to such a stimulus?

What Straus and Havelock Ellis have brought out is not discernible in the

reactions of the psychopath. It is, as a matter of fact, somewhat veiled in the reactions

of most obsessive patients. Observation of the psychopath makes it increasingly plain,

however, that he is not reacting normally to the surroundings that are ordinarily

assumed to exist. I cannot clearly define the specific milieu which such a patient

encounters and to which his reactions are related. There is much to suggest that it is a

less distinctly or consistently apprehended world than what Straus describes as the inner

world of the obsessive patient. It is my belief that it may be a world not less abnormal

and perhaps more complexly confusing. We should remember, however, that we have

no direct evidence to prove that a deficiency or distortion of this sort exists in the

unconscious core of the psychopath. We can only say that his behavior strongly and

consistently suggests it. This discussion has been based, of course. on a hypothesis that

the psychopath has a basic inadequacy of feeling and realization that prevents him from

normally experiencing the major emotions and from reacting adequately to the chief

goals of human life.

There are other theories that attempt to explain the disorder without taking into

consideration the question of such a defect. Alexander has assumed that the

psychopath's behavior arises from forces similar to those which in the psychoneurotic

are by many believed to be the fundamental cause of his distressing symptoms.9,11

Postulating unconscious conflict and repressed impulses also in the psychopath, he was

led to believe that the antisocial, unprofitable, and self-damaging acts of the psychopath

are purposive and unconsciously motivated expressions of the conflict. In the classic

neurosis, subjective symptoms develop and the patient complains of weakness,

headache, or obsessions or develops compulsive rituals, conversion paralysis, blindness,

and so on. As these manifestations are thought by some to be reactions of the organism

to inner stress, reactions that serve the purpose of protection, relief of anxiety, and

gratification (by substitution or displacement) of rejected or frustrated impulses, so, too,

according to Alexander, the pathologic behavior of the other type of patient is an acting

out of impulses similarly neurotic. Thus interpreted, the psychopath has, in a sense,

genuine and adequate reasons (like the neurotic for his symptoms) for the apparently

foolish and uncalled-for things he does that damage himself and others. He himself

does not know the reasons or clearly recognize his

396 THE MASK OF SANITY

aims or the real nature of the impulses, and his acts do not constitute a wise solution for

his problem; but the acts, according to Alexander, are purposive. This concept of the

psychopath as acting out the neurotic problem (in contrast with the more passive

development of ordinary symptoms) has been accepted by many

psychoanalysts.79,180,188,207 It is an interesting concept, but it rests chiefly on

psychoanalytic theories and assumptions about the unconscious and not upon regularly

demonstrable evidence.

Some interpretations of schizophrenia79 assume that it is largely through the

relatively undamaged remnants of the personality that the positive features of the

psychosis emerge. If the process is complete, if the personality has, so to speak, entirely

dissolved in the underlying id, the machinery to express most of the usual symptoms

will be lacking. In response to stress and conflict, what remains of the personality

produces, by familiar mechanisms, most of what is generally regarded as characteristic

of the disorder. The more fundamental feature, and the one that particularly

distinguishes schizophrenia from the psychoneuroses, is the disintegration of the per.

sonality.87 In the psychopath we maintain there is also a generalized abnormality or

defect of the personality that can be compared with schizophrenia and contrasted with

ordinary psychoneurosis (in which the personality is "intact" and the organism maintains

"sane" social relations). It cannot be said that the disorder is that of schizophrenia, but

in the whole of the patient's life we find such inadequacy of response, such failure of

adaptation, that it seems plausible to postulate alterations more fundamental and more

extensive than in classic psychoneurosis.

Beyond the symptomatic acts of the psychopath, we must bear in mind his

reaction to his situation, his general experiencing of life. Typical of psychoneurosis are

anxiety, recognition that one is in trouble, and efforts to alter the bad situation. These

are natural ("normal") whole personality reactions to localized symptoms. In contrast,

the severe psychopath, like those so long called psychotic, does not show normal

responses to the situation. It is offered as an opinion that a less obvious but

nonetheless real pathology is general, and that in this respect he is more closely allied

with the psychotic than with the psychoneurotic patient. The pathology might be

regarded riot as gross fragmentation of the personality but as a more subtle alteration.

Let us say that instead of macroscopic disintegration our (hypothetical) change might be

conceived of as one that seriously curtails function without obliterating form.

In addition to outwardly visible demolition or shattering in material structures,

other changes may occur. These may be intracellular and leave the appearance

unchanged but greatly alter the substance. Colloidal variations in concrete may rob it of

its essential properties although the appearance

SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 397

of the material remains unaltered. Steel under certain conditions is said to crystallize

and lose much of its strength. The steel so affected looks the same as any other, and no

outer evidence of the molecular rearrangement which has so greatly altered the

substance can be detected. For the purpose of analogy, one can consider not only

intracellular or molecular but also intramolecular changes. Let us think of the

personality in the psychopath as differing from the normal in some such way. The form

is perfect and the outlines are undistorted. But being subtly and profoundly altered, it

can successfully perform only superficial activities or pseudofunctions. It cannot

maintain important or meaningful interpersonal relations. It cannot fulfill its purpose of

adjusting adequately to social reality. Its performance can only mimic these genuine

functions.

Karl Menninger, in Man Against Himself,207 picturesquely developed the argument

that antisocial behavior sometimes represents an indirect search for punishment, a

veiled but essentially self-destructive activity. The hypothesis of an active "death

instinct" advanced by Freud is, in this dramatic study, applied to many types of

disorder.8,87 In localized symptoms, as well as in broad maladjustments, self-damaging

impulses are interpreted as fulfilling their negative purpose.

In the patients presented here the general pattern of life seems to be more

complex. Although thefts are sometimes committed, checks forged, and frauds

perpetrated under circumstances that invite or even assure detection, similar deeds are

also frequently carried out with shrewdness and foresight that are difficult to account

for by such an interpretation. It is also characteristic for the real psychopath to resent

punishment and protest indignantly against all efforts to curtail his activities by jail

sentences or hospitalization. He is much less willing than the ordinary person to accept

such penalties. In the more circumscribed symptoms of acting out, in many of the

disorders referred to by Fenichel79 as impulse neuroses, the unconscious but purposive

quest for punishment might more plausibly be conceived of as a major or regular

influence.247 The validity of such an assumption, however, whether or not it is plausible,

must be determined by what actual evidence can be produced to establish it, and not by

mere surmises and inferences about what may or may not be in the unconscious.