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Psychopath

THE MASK OF SANITY

Section 1: An Outline of the Problemf

3. Not as single spies but in battalions

 

 

Energy Enhancement          Enlightened Texts         Psychopath           The Mask Of Sanity

 

 

In attempt to determine the incidence of this disorder in the population as a

whole is opposed by serious difficulties. The vagueness of officially accepted criteria for

diagnosis and the extreme variation of degree in such maladjustment constitute primary

obstacles. Statistics from most psychiatric hospitals are necessarily misleading, since the

psychopath is not technically eligible for admission and only those who behave in such

an extremely abnormal manner as to appear orthodoxly psychotic (that is to say, as

suffering from another and very different disorder) appear in the records. If the

traditional legal and medical rules were regularly followed, statistics from state hospitals

and from the federal psychiatric institutions would show no psychopaths at all. Let it

also be noted that these institutions contain a vast majority of the patients hospitalized

in the United States for mental disorder. Most statistical studies, therefore, cannot be

regarded as even remotely suggesting the prevalence of this disability in the population.

These facts notwithstanding, it is still impressive to note what the records of a

typical psychiatric institution reveal during a period of twenty-nine months shortly

before the first edition of this book was published in 1941.* During this period 857 new

patients were admitted to one federal hospital, where a staff of ten psychiatrists,

including myself, classified them after careful examination and study. Of this group,

102 received the primary diagnosis of psychopathic personality, being considered free of

any other mental disorder that could account for the difficulties that led to their

admission. This group, comprising nearly one-eighth of all those admitted, indicates

that the disorder is far from rare. The records also show 134 other patients classified

under alcoholism or drug addiction, many of whom I believe, for reasons brought out in

the appendix, were fundamentally like those diagnosed as psychopaths, the addiction

and other complications

* See Appendix for details of this survey.

18 THE MASK OF SANITY

being secondary. If even one-half of these are considered as psychopaths, we arrive at a

figure of 169, or almost one-fifth of the total.

These statistics from one psychiatric institution cannot, of course, be taken as

proof that the disorder is so prevalent everywhere. One must not overlook the fact,

however, that each of these patients was accepted despite rules specifically classifying

him as ineligible and often as a result of conduct so abnormal or so difficult to cope

with that he was considered a grave emergency. Another factor worth mentioning is the

psychopath's almost uniform unwillingness to apply, like other ill people, for

hospitalization or for any other medical service. The survey at least suggests that these

patients are common and that they constitute a serious problem in the average

community and a major issue in psychiatry.

I have been forced to the conviction that this particular behavior pattern is found

among one's fellow men far more frequently than might be surmised from reading the

literature. If the nature of the disorder in question defines itself throughout the course

of this work with sufficient sharpness and clarity to be recognizable as a pathologic

entity, little doubt will remain that it presents a sociologic and psychiatric problem

second to none.

The man who develops influenza or who breaks his arm nearly always thinks at

once of calling his doctor. The unconscious victim of a head injury is promptly taken

by his family, by his friends, or, lacking these, by casual bystanders to a hospital where

medical attention is given. Persons who develop anxiety, phobia, or psychosomatic

manifestations are likely to seek aid from a physician. Even those who demur and delay

since they fear they will be called weak or silly because of symptoms commonly classed

as psychoneurotic can be, and usually are, persuaded by their families after varying

periods of reluctance to ask for help.

Children, of course, often seek to avoid both the pediatrician and the dentist,

despite the advice of parents. But the parent seldom fails, when need of treatment is a

serious matter, in getting the child, with or without his willingness, into the hands of the

doctor. Many patients ill with the major personality disorders we classify as psychoses

do not voluntarily seek treatment. Some do not recognize any such need and may

bitterly oppose, sometimes by violent combat, all efforts to send them to psychiatric

hospitals. Such patients, however, are well recognized. Medical facilities and legal

instrumentalities exist for handling the problem, and institutions are provided to accept

such patients and hold them, if necessary against their own volition, so long as it is

advisable for the patient's welfare or for the protection of others.

When we consider on the other hand these antisocial or psychopathic

personalities, we find not one in one hundred who spontaneously goes to his

AN OUTLINE OF THE PROBLEM 19

physician to seek help. If relatives, alarmed by his disastrous conduct, recognize that

treatment, or at least supervision, is an urgent need, they meet enormous obstacles. The

public institutions to which they would turn for the care of a schizophrenic or a manic

patient present closed doors. If they are sufficiently wealthy, they often consider a

private psychiatric hospital. It should also be noted here that such private hospitals are

necessarily expensive and that perhaps not more than 2 or 3 percent of our population

can afford such care for prolonged periods. No matter how wealthy his family may be,

the psychopath, unlike all other serious psychiatric cases, can refuse to go to any

hospital or to accept any other treatment or restraint. His refusal is regularly upheld by

our courts of law, and grounds for this are consistent with the official appraisal of his

condition by psychiatry.

Nearly always he does refuse and successfully oppose the efforts of his relatives

to have him cared for. It is seldom that a psychopath accepts hospitalization or even

outpatient treatment unless some strong means of coercion happens to be available.

The threat of cutting off his financial support, of bringing legal action against him for

forgery or theft, or of allowing him to remain in jail may move him to visit a physician's

office or possibly to enter a hospital. Subsequent events often demonstrate that he is

acting not seriously and with the understanding he professes but for the purpose of

evasion, whether he himself realizes this or not. He usually breaks off treatment as soon

as the evasion has been accomplished.

Since medical institutions traditionally refuse to accept the psychopath as a

patient and since he does not voluntarily, except in rare instances, seek medical aid, it

might be surmised that prison populations would furnish statistics useful in estimating

the prevalence of his disorder. It is true that a considerable proportion of prison

inmates show indications of such a disorder.31,184,240 It is also true that only a small

proportion of typical psychopaths are likely to be found in penal institutions, since the

typical patient, as will be brought out in subsequent pages, is not likely to commit major

crimes that result in long prison terms. He is also distinguished by his ability to escape

ordinary legal punishments and restraints. Though he regularly makes trouble for

society, as well as for himself, and frequently is handled by the police, his characteristic

behavior does not usually include committing felonies which would bring about

permanent or adequate restriction of his activities. He is often arrested, perhaps one

hundred times or more. But he nearly always regains his freedom and returns to his old

patterns of maladjustment.

Although the incidence of this disorder is at present impossible to establish

statistically or even to estimate accurately, I am willing to express the opinion that it is

exceedingly high. On the basis of experience in psychiatric

20 THE MASK OF SANITY

out-patient clinics and with psychiatric problems of private patients and in the

community (as contrasted with committed patients), it does not seem an exaggeration to

estimate the number of people seriously disabled by the disorder now listed under the

term antisocial personality as greater than the number disabled by any recognized

psychosis except schizophrenia. So far as I know, there are no specific provisions made

in any public institution for dealing with even one psychopath.

 

Next: Section 1: An Outline of the Problem, 4. Method of presentation

 

Energy Enhancement          Enlightened Texts         Psychopath           The Mask Of Sanity

 

 

Section 1

 

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 1: An Outline of the Problem, 1. Sanity-a protean concept
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 1: An Outline of the Problem, 1. Sanity-a protean concept, A millionaire notable for his eccentricity had an older and better balanced brother who, on numerous fitting occasions, exercised strong persuasion to bring him under psychiatric care. On receiving word that this wiser brother had been deserted immediately after the nuptial night by a famous lady of the theatre (on whom he had just settled a large fortune) and that the bride, furthermore, had, during the brief pseudoconnubial episode, remained stubbornly encased in tights, the younger hastened to dispatch this succinct and unanswerable telegram at energyenhancement.org

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 1: An Outline of the Problem, 2. Traditions that obscure our subject
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 1: An Outline of the Problem, 2. Traditions that obscure our subject, Raising general questions about personality disorder, we have briefly considered (1) persons suffering from illnesses that progress to major mental disability and (2) the numerous citizens of our nation, many of them able and well educated, who hold beliefs generally regarded as unsupported by evidence and considered by many as irrational or even fantastic. Aside from these groups and aside from all types of patients recognized as psychotic, there remains for our consideration a large body of people who are incapable of leading normal lives and whose behavior causes great distress in every community at energyenhancement.org

  • Psychopath Hervey Cleckley THE MASK OF SANITY, Section 1: An Outline of the Problem, 3. Not as single spies but in battalions
    Psychopath Hervey Cleckley THE MASK OF SANITY, Section 1: An Outline of the Problem, 3. Not as single spies but in battalions, In attempt to determine the incidence of this disorder in the population as a whole is opposed by serious difficulties. The vagueness of officially accepted criteria for diagnosis and the extreme variation of degree in such maladjustment constitute primary obstacles. Statistics from most psychiatric hospitals are necessarily misleading, since the psychopath is not technically eligible for admission and only those who behave in such an extremely abnormal manner as to appear orthodoxly psychotic (that is to say, as suffering from another and very different disorder) appear in the records. If the traditional legal and medical rules were regularly followed, statistics from state hospitals and from the federal psychiatric institutions would show no psychopaths at all. Let it also be noted that these institutions contain a vast majority of the patients hospitalized in the United States for mental disorder. Most statistical studies, therefore, cannot be regarded as even remotely suggesting the prevalence of this disability in the population at energyenhancement.org

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

 

 

 
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