Psychopath Hervey Cleckley THE MASK OF SANITY, Section 3: Cataloging the material, Part 2: A comparison with other disorders, 36. A case showing circumscribed behavior disorder

36. A case showing circumscribed behavior disorder

When behavior disorder is circumscribed, in a child or in an adult, one may

sometimes feel that symptomatically the patient resembles a psychopath but that a

different sort of personality lies behind the manifestation. Instead of essential

indifference to the pathologic situation, we sometimes see genuine zeal to avoid the

faulty and self-damaging acts. It is not rare to find relatively normal attitudes to most

aspects of life and sometimes healthy and admirable personality features.

In such patients, unlike psychopaths, it is more often possible to bring out valid

responses and to learn about experiences and relations that have been influential over

years and that may have played an important part in causing the poorly adapted

behavior. Strong indications can sometimes be found that inner and poorly understood

emotional confusions and conflicts are provoking repetitive rebellious and ineffective

antisocial conduct. A brief discussion of one such patient may be germane:

This young woman in her middle twenties voluntarily sought help front an

internist widely known for his interest in personality problems; he referred

CATALOGING THE MATERIAL 273

her for psychiatric treatment. Her spontaneous complaint was of sexual promiscuity

which she feared would damage her socially. She expressed the opinion that, aside from

what these doings might cause others to think of her, she herself deemed them wrong

and highly undesirable.

A virgin until approximately two years earlier, she had since that time had full

sexual relations with over twenty different men. She denied any personal attachment or

romantic attitudes toward these partners, to whom she had yielded casually, promptly,

and apparently without conflict or indecision. She had obtained pleasant reactions from

the physical contact and after the first few ventures began to respond regularly with

genital orgasm. She had never entertained illusions to the effect that any of this

considerable group of men were enamored of her and said she had no desire to bring

out such feelings in them. Her appearance was distinctly attractive and her figure

particularly well endowed with anatomic features likely to arouse and enhance erotic

interest.

An articulate and apparently a candid girl, she showed little reluctance to discuss

either her sexual adventures or any other material. In most respects she showed

evidence of better than ordinary maturity and a considerable sophistication without

affectedness. Her general intelligence was even better than might have been expected

from her good record at college and subsequent success in her work.

In journalism she had made rapid progress as a writer of advertisements and of

feature articles on the daily paper in one of the largest cities in her state. She did not, as

many newspaperwomen do, write for the society columns or deal chiefly with material

considered of special interest to women. She often discussed politics, scientific

developments, and economic problems. Nothing in her appearance or manner,

however, suggested masculine characteristics, tastes, or attitudes. She dressed in such a

way as to make the most of her looks and had interests and hobbies predominantly

feminine.

Although the excitement of physical relations seemed to have been genuine and

full orgasm occurred and left her without the feeling that anything might be lacking, the

experiences reported impressed the examiner, in some important respects, as relatively

shallow. She gave as her reason or motive for doing what she regarded as wrong (and as

unwise) a mounting sense of tension and a specific desire that she found too strong to

resist. It seemed likely that she was really influenced by natural feelings of this sort but

not to any unusual degree.

In fact, it was chiefly the matter of relieving a trivial or, at most, a rather

moderate need than of being driven by intense passions or allured by breath-taking or

exquisite possibilities of fulfillment.

274 THE MASK OF SANITY

Although she had made her charms fully available to so many men, she usually

permitted only a single encounter of this sort. Shortly after the beginning of her

promiscuity she had continued with one partner through three dates at intervals of

several days, and a few months later she equaled this record with another man. Several

other times she had repeated her adventure with the same partner through two sessions.

The rule for many months had, however, been one night with almost anybody

but two with none. Considering her physical attributes and personal attractiveness, it is

not surprising that those who had been so generously treated, often on the first date,

wished to continue. She felt not only an aversion for this but also for seeing or having

anything further to do with the partner. She realized that after such full and prompt

compliance or cooperation at the beginning it would be difficult indeed to keep matters

more or less platonic thereafter.

She was cognizant of the old analogy between getting the first olive out of a

bottle and getting the first kiss and of its even greater applicability to what she had

offered without even initial delay or any impediment whatsoever.

This did not, however, appear to be the chief factor in her breaking off relations.

There was a primary loss of interest in the partner. No evidence emerged of an

appreciable sense of shame on her part or of uneasiness about meeting unflattering

attitudes and appraisals that might develop toward a girl who lets herself be taken so

readily.

Nor did she worry about perhaps drawing out strong feelings in the partner,

about his developing a binding attachment that might cause him distress. She was not,

so far as she was aware, designing her conduct so as to enjoy the frustration or

disappointment of all these men by cutting them off so abruptly from a quite lively

pleasure they had reason to hope would remain available.

Completion of the sexual act was not followed by remorse or self-recrimination.

Relieved and pleased, she had no wish for any sort of personal closeness or intimacy

with her companion but, on the other hand, she did not feel strong revulsion. She had

not sought personal intimacy in the beginning, and nothing happened, despite rather

delightful somatic sensations, that gave incentives in this direction. After satisfaction

occurred, she did not react with negative feelings toward sexuality or promiscuity as she

might had there been strong conscious conflict between an intensely passionate yearning

and the ordinary resistances to such conduct under such conditions. She evaluated her

behavior as wrong, dangerous, and puzzling, but this evaluation was steady. Her

attitude did not lead to a fierce struggle

CATALOGING THE MATERIAL 275

against the impulses toward such behavior, succumb temporarily to overpowering

passions, and then arise to invoke shame and bitter regret.

She did not feel impelled by any special need for variety in changing her partners

so promptly and in embracing so many, nor did she have the mistaken idea, so

commonly encountered in problems of female promiscuity, that she was proving her

charms and sex appeal by the fact that so many men had relations with her. She had

been popular with men for a long time before her present habits began, and she realized

better than most women that almost any female, even one of distinctly mediocre

attractions, would not have trouble in getting seduced by practically any number of

males alert for opportunities of free entertainment of this sort.

Though sometimes succumbing with almost unparalleled rapidity as soon as her

date began his advances, she often pretended to be reluctant and made him go through

a good many overtures, both verbally and with caresses, before cooperating.

She could not, however, recall having even once, since over a year previously,

failed in full cooperation on the man's initial attempt. Although not unresponsive

sensually to kisses and caresses, it was not the heightening or prolongation of ecstatic

pleasure that prompted her to hold out for a while and allow these preliminaries to run

their course.

She expressed, in fact, a preference for "going on, getting to it, and getting it over

with." She distinctly enjoyed observing with skepticism a man's efforts to pretend he

might be taking her seriously, his tactics in going through rituals of deception so

common and sometimes rather elaborate, which the predatory male uses to get his way

with the ladies. She was not conscious, during early discussion of these matters, of any

real hate or contempt but admitted it made her feel that by seeing through these

hypocritical ruses and pseudoemotional maneuvers she was getting the better of the

man in their encounter.

It had not occurred to her that this would be regarded by most as an almost

fantastically inaccurate way of scoring in such a contest, since the adversary never failed

to gain all his ends. She admitted awareness that men would be inclined to take her

lightly, to say the least, on finding that she could be so casually induced to have

intercourse, and by so many. She seemed to regret this and to show some concern

about it, but hardly to do so in ordinary or adequate degree.

She admitted that the feeling of satisfaction and superiority she attained through

her prompt recognition of the date's concealed intentions and through inwardly

mocking him in the steps he took to work the situation

276 THE MASK OF SANITY

toward seduction while pretending other attitudes was distinctly pleasant to her and that

she valued it highly.

The more this was discussed, the larger part she estimated it to have played in her

motivations. She did not recognize any deeply derogatory attitude in this but found in it

something more like the thrill of a game in which one enjoys outwitting and defeating,

according to fair rule s of the contest, an opponent who is not disliked or despised

because of this. She did not feel tempted to show that she saw through the date's

pretenses by her manner and attitude, by so telling him, or by making him fail to achieve

his obvious aims with her.

As about other matters, she entered frankly into the discussion of relations she

had previously maintained with an older woman. The patient voluntarily brought up

this subject and did not seem to have had any intention to evade it.

Shortly after moving to the city where she now worked, she had met this woman,

who immediately showed warm cordiality and treated her with attention that suggested

both affection and admiration. This new friend, although almost fifteen years older

than the patient, was youthful in appearance and in spirit, attractive to men, and

extremely intelligent. She and her husband also were on the faculty of a local college.

This woman, whose knowledge of literature, music, and of many other matters was

considerable, seemed to the patient distinctly the most delightful and understanding

person encountered in all her life.

A tremendous new interest was aroused in my patient, who found in fiction,

poetry, psychological books, and in almost all the activities of life, meaning and delight

she had never before discovered or deemed possible.

She felt uniquely understood and really cared for in a way that made everything

she had regarded in the past as understanding and love seem perfunctory and trivial.

For the first time she felt very close to someone and was thus able, for the first time, to

realize that this had heretofore been missing.

The patient had been popular with both girls and boys and had never considered

herself as lonely or isolated. Her friendship with other girls had, she now discovered,

been relatively superficial. She realized more clearly also how little her popularity with

boys had led to any personal intimacy or valuable shared understanding. She learned far

more in a short time from this new friend than she had during all the years at college,

and what she learned filled life with interest, humor, and all sorts of marvelous pleasures

and goals.

She found confirmation of attitudes she had developed toward many of the

conventional and uninspiring ideas, demands, limitations, and expectations

CATALOGING THE MATERIAL 277

she had encountered in her family. Achieving what she felt was new and real

understanding which she could apply to conflicts and uncertainties that had troubled her

as long as she could remember, she now felt secure, independent, and almost

triumphantly eager for the future and its opportunities.

Soon her friend's husband had to go elsewhere for several months of work on a

research project. She welcomed the opportunity to give up her own quarters and stay in

the house of this wonderful and inspiring guide and benefactress. Despite the

complications and interruptions of her hostess's two small children (whom the patient

seemed to enjoy playing with and to love), there were greater opportunities for listening

together to symphonies, for reading aloud Shakespearean plays, and for discussion over

a few highballs until long past midnight.

She shared her friend's room and soon was sleeping in the same twin bed with

her, both finding the nearness and the contact delightful. Lying together in the dark,

thrilled with evidences of being understood and loved, she liked to talk and to listen and

to have close physical contact with her idol. Both women made lively and articulate by

highballs and by delight, found it easy to murmur to each other all sorts of things

concerning admiration and love and what each meant to the other.

From close embraces, to kisses, to mutual masturbation, things proceeded

without our patient's giving very distinct thought to whether or not there was anything

homosexual, anything perverse or queer about such practices. The older and more

sophisticated of the two was the other's symbol of the ideal. What she approved and

considered natural and delightful was almost automatically accepted by the other.

Furthermore, she got the strangest new delights from what happened while they

were in bed together. She had, as a matter of fact, not only erotically exciting sensations

but distinct orgasms from the digital caresses and stimulations of the other. She did not

think of herself and the other woman as something equivalent to husband and wife or

as one pretending to be a man and the other acting the part of a woman under such

circumstances. Both were women, in the patient's feelings, but there were wonderful

and unforeseen revelations, sensual as well as intellectual and otherwise, in all this prized

experience.

She was not preoccupied with resentment toward the absent husband. Without

quite knowing why, she would not have wanted him to know every detail about what

she and his wife did. But he did not loom in her concepts as a distinct rival, nor did

their mutual masturbation seem to intrude distinctly into the areas supposedly reserved

for husbands and wives. She was more concerned about the fact that her main source

of happiness

278 THE MASK OF SANITY

would be curtailed, that she could not be so often with this wonderful person after the

husband returned and she went back to her regular quarters.

The sensuous feelings and the startlingly delightful and new experience of orgasm

were all tied in with her affection and love and unstinted admiration for the wonderful

person who had brought so much to her. She had learned something about

homosexuality not only from books but from her efforts several years earlier as

president of a students' honorary society at college to help a freshman who had shown

what seemed to her serious and regrettable tendencies of this sort. It sometimes

occurred to her that what she and the totally wise friend did might be regarded as

perverse or like the misdeeds of that girl at college, but such thoughts had little more

force in her evaluation of the acts than some farfetched philosophic abstraction which

might be literally true in syllogisms but without relation to actualities of experience.

These sexual activities were a private and secret delight, one part of the many things

they shared and into which no one else entered.

As she discussed this matter, freely and without hedging or apparent shame, she

seemed to have little or no fear that she might be homosexual also felt that she was

probably not what this term indicates in its reference to full and fixed lesbian women.

Her physically erotic relations with the other woman had been in some respects a

substitutive practice, though what it might stand for was not well formulated among her

goals. Her reaction, in certain aspects, seemed akin to what a normal, adolescent boy

might experience in masturbating while immersed in vivid fantasies of intercourse with

the image of the girl he has chosen as a sweetheart and wants someday to marry.

There was, however, an important difference. She had no definite referential

imagery in which a male figure could be located as the personally and fully embraced

partner in the world of delightful feelings that were evoked. There was no channellized

structure, as in the example of the romantically masturbating boy, to conduct her

aspirations toward a real and well-defined goal. Although there were resemblances, her

experience apparently lacked features essential to the persistent pattern of true

homosexuality. In the first rewarding intimacy she had experienced with another

human being, this delightful and exciting physical contact seemed wonderful, and she

found it in no way disturbing or objectionable.

Such a situation could scarcely have arisen for a man under similar circumstances

without vastly more pathologic actualities and consequences, for in the virgin male

genital aims are nearly always clearer and less ambiguously merged in general and

nonsexual personal relations.

After some months of what had been the most delightful time in this patient's

life, her beloved friend and idol announced that their relations must

CATALOGING THE MATERIAL 279

be terminated. The young girl could not conceive of any valid reason for such a

decision. The articulateness of her preceptor failed at the task of making clear or

acceptable what was, nevertheless, made final. Soon afterward this indescribably wise

and wonderful being moved away, her husband having been given a position much to

his advantage at a university in another section of the country.

The young lady we are concerned with was puzzled, sad, and hurt beyond

anything that she could express or explain. After having for the first time in her life

exposed and offered her intimacy, love, adoration, longings, and everything else that she

had heretofore automatically and fearfully guarded, she found herself rejected. Her

emotional commitment had led to loneliness and frustration and to the shame and hurt

of being discarded.

It was not difficult for this intelligent girl to begin discovering that without

knowing it she had for some time been deliberately and actively engaged in the process

of throwing herself away. She had been thrown away by the only person to whom she

had offered and fully given herself. Unable to make verbal comment on her hurt and

betrayal, she formulated and, in another way, expressed comment in behavior that spoke

with more authority than any language. She began to understand that by so damaging

herself she was, not in the mere light symbols of language but in terms more concrete,

trying to explain to the one who had rejected her how much this rejection hurt. This

could not be adequately conveyed without pain also to the one her desperate message

must reach. The banishment inflicted by this other, she had already found, constituted a

wall that could be penetrated, if at all, only by an emotional projectile of great traumatic

force.

Going back a little farther, let us consider the situation of this girl prior to her

meeting with the older woman. Since she could first remember, it had seemed obvious

to her that civilization was devised in such a way as to give the human male many

undeserved advantages over the human female. Little boys could wander off on treeclimbing,

hiking, or other adventures, but little girls were more restricted. Boys became

airplane pilots, surgeons, generals, whereas nearly all women, as she saw it, became

wives who day after day performed routine household tasks, washed dishes, nursed

babies, and seldom got out to have any fun, even at night.

Furthermore, husbands did not seem to find them attractive. Even the funny

papers joked about how dull a wife was as compared to the stenographer and showed

husbands on every possible occasion gleefully slipping away from prosaic and dowdy

figures at home to get "a night out with the boys." As her life progressed, she had

steadily encountered facts to corroborate the implications of an old saying fairly

common in her childhood,

280 THE MASK OF SANITY

"Why you can't get any more lift out of that than out of kissing your own wife."

When she had wanted to be a general or a cowboy leader in those early games in

the park, the others laughed at her and said she was only a girl. Facts such as her being

able to run faster and climb better than some of the boys did not matter. No, the

decisions were all determined by the irrelevant point about her being a girl.

She had to stay at home sometimes and help her mother with the dishes or other

tasks. Daddy, after reading the morning paper, went off and stayed the whole day

among all the excitements of town. There is no need to give much from the thousands

of incidents, real and familiar to anyone, which she encountered and from which she

logically derived her distorted convictions that active and exciting lives are open to men

whereas wives are expected to live in the circumscribed orbit of a house, carrying out

repetitious tasks and dull, petty, routines and often becoming creatures of convention,

careless of their looks, shapeless, and uninspiring.

In her reactions to these formulations she did not derive envy and admiration for

man as compared with woman. It was not through any real virtue or superiority that

these males had all the interesting work and freedom and fun. It was because of

conventions and rules, based not on facts but on tradition, that men had this advantage.

They were often smug enough and biased enough to think they deserved such a

break. Women, not taking the trouble to think things through, placidly accepted such

an arrangement. She did not want to be a man or more like a man, but she was

determined to evade as much as possible these artificial impediments. Instead of

throwing her life away in a meek gesture to empty conventions, she would go after the

interesting things. The success and independence she might achieve, the fun she might

have, would, aside from their intrinsic value, be a comment on the fallacies she had

detected and would oppose.

Under hypnosis and narcosis as well as in unaltered awareness, she gave much

detail that filled in a convincing picture of her childhood environment. Hundreds of

memory items emerged to disclose her father not as cruel but as an arbitrary and moody

disciplinarian in small matters. Her parents did not (to her) seem to find intimacy,

fulfillment, or very much real fun together in their marriage.

The mother (in her eyes) lived in trivial activities and was bored, boring, and

fretful but unaware of the reasons. The patient's outlook and aims had slowly taken

form in reaction to the model of marriage she found, or thought she found, in her

home. As she grew, she discovered in her general

CATALOGING THE MATERIAL 281

surroundings thousands of items which seemed to support and which further shaped

opinion and inclination.

It should not be assumed that the marriage of these parents was all that it

appeared to the little girl. Details of it which she encountered at susceptible moments

might be accurate without being representative of the whole. So, too, as she grew and

observed the world about her, she found facts which continued to confirm her early

evaluations.

Anyone can find dull housewives and distant, bored husbands. Everyone knows

that the immature male may take advantage of the "double-standard" and see how far he

can get with girls under the pretense of love, only to react with the precise and

unflattering opposite of love in degree proportionate to their acquiescence. During an

early discussion of the disadvantages of marriage for girls, the patient cited as evidence

two young couples who often went together on automobile trips, the two husbands

sitting together in front, the wives ignored on the rear seat. All the observations given

as evidence by the patient seemed to be true and accurate. Her interpretations also

seemed, for the specific instances she cited, correct.

If a man and a woman value so much the opportunity to be together on dates,

why should they almost immediately after marriage so change as to choose even a

person of the same sex to sit by in preference to the mate? Custom or courtesy might

suggest that, as in seating arrangements at dinner parties, husbands and wives, in this

limited sense, be swapped about. But can anything except the absence of basic sexual

and personal interest make men turn regularly to men and women to women on

occasions when married couples gather? The patient found in scores of incidents she

had observed indications that these couples were not particularly close to each other or

having much fun together.

Among other examples she pointed out how often at parties the husbands drifted

or sometimes almost raced for the kitchen, where, in purely male company, they spent

much of the evening, frankly oblivious of the wives stranded together in the living

room.

I could not but agree with her that such behavior was consistent with and might

indicate serious attrition, if not indeed the unhappy and untimely death, of what it is

natural to seek in heterosexual love relations. Her basic concept can, perhaps, be

conveyed by a joke she told. It is an old joke, but expressive:

A husband who habitually paid little attention to his wife did not even

look up from his paper when she came down one day in a new and breathtaking

dress. She tried in vain to make him notice and admire it. She was a goodlooking

and voluptuous woman and resented being ignored. Not succeeding

282 THE MASK OF SANITY

in getting the husband to raise his eyes even momentarily to regard her, she ran back

upstairs. Resolved to shake him from his lethargy, she stripped and came down

again, completely naked. Announcing she was on her way downtown to shop, she

paused for his appraisal. Finally she succeeded in getting him to glance up from the

paper. Before returning to peruse it, he indifferently remarked, "Umph! Need a

shave, don't you."

Among her married friends she had observed many wives who received strict

allowances dealt out to them as if they were children or servants by husbands who

would not even divulge to their mates and reputed equals any fundamental information

about the family's finances. Everything concerning their business affairs, to which these

husbands seemed to devote most of their lives and interest, was withheld from wives

who were, the patient felt, appraised as too inconsequential or undeserving to share in

these matters sacred to the male world.

Many of her conclusions might apply correctly to the specific cases from which

she drew them. She had, apparently, with precocious accuracy, sensed and ferreted out

negative points in specific husbands and specific wives that others, accepting more

optimistic generalizations, would have overlooked. Her ideologies and the general

shaping of her aims and actions had been strongly conditioned by the implicit

assumption that all marriage was necessarily what she had seen it to be in many

instances. Argument with her about this overgeneralization would scarcely have altered

her fundamental outlook.

In the course of time, however, as she brought up the concrete details of

experience with increasing amounts of affect, she became aware of distortions and

evasions formerly screened by her dogmatic ideologies. Eventually she could see (and

feel) that it was her mother (or the image she had made of her mother as a child) which

she had rejected and that this did not demand rejection of the feminine role itself. She

could see also that while she had determined not to accept all the limitations she

believed inherent in woman's status sociologically, this distortion had not extended into

deeper biologic levels. She had not, in turning from the mother, identified herself with

her father and determined to be a man. Had this occurred, far more serious problems

might have arisen for this girl.

Marriage was very strongly rejected as an ambition. Reactions to her mother and

to her father apparently combined in this negative force and contributed to a distorted

response to this major feminine role. She examined again and felt again the effects

upon her of her older brother. It was he for whom money had to be saved so that he

could go to medical school. She recalled that at first she had been very fond of him and

proud of him. As she continued to reorient herself to what had appeared to

CATALOGING THE MATERIAL 283

be preference on the parents' part for his ambitions, while deprivations were demanded

of her so that he could attain the independence of being a physician, she became better

able to see these things in the general context of her life.

Incidents scorned at the time and since then neglected, when now recalled and

reappraised, indicated parental pride in her also. It became possible for her to see that

this had not been sufficiently valued by her because it was pride in her as a girl and for

qualities unlike those she specifically needed for competition with her brother.

It is impossible to set down here all the myriad events that came up for this girl's

reappraisal or the affective reactions and shaping of attitudes that, seen as a whole,

seemed to account for her rejection of marriage and fear to give herself in any deep,

personal intimacy with men. Nothing that is said as a generalization about her life

pattern can convey what emerged as she reproduced it in the concrete form of

innumerable incidents. Nor would any explanation in general terms have been useful in

her efforts to reorient herself as were the explanations she herself gradually arrived at.

The sexual relations with men, begun several months after the break with her

lesbian partner, soon convinced her of something she had not wanted to admit at the

time-that the sexual organs of man and woman are appropriately designed for contact

and work together in such a way as to get better sensual results than anything possible

with two female bodies, which are not anatomically equipped for such a feat. She was

forced to admit this although she continued to deny all possibility of other genuine and

happy relations between man and woman.

This at first was a blow to her, for she sought to preserve in idealized perfection

her concept of the relation with the other woman as being in every respect superior to

anything possible between woman and man. She had jealously guarded those feelings

and impulses which, in being bestowed, constitute falling in love. In her sexual activities

with the series of men she went to unusual lengths in trying to keep all relations and

contacts of any importance to herself and to let her sensations remain confined,

localized, and impersonal. Capacities to love another, to give genuine intimacy (herself)

to another, drawn out initially by the homosexual partner, were less deeply buried than

heretofore and hence demanded more vigilant protection from arousal by man.

In having intercourse with men she continued also her old competition with the

other sex, rejecting them as lovers or needed complements to herself in personal

matters, but seeking to outwit them or to find some basis, however farfetched and

flimsy, on which she could mock them in their sexual tactics.

284 THE MASK OF SANITY

Her promiscuous relations appeared eventually to the patient as having been used

to carry out several purposes simultaneously:

1. They satisfied a need for sensual pleasure and orgasm that had, since her

experiences with the woman, become clearer and more urgent.

2. By cheapening herself as a sexual object, she expressed reproach and criticism

of one who had discarded her and made a protest against being so treated.

3. She reaffirmed her rejection of woman's role in marriage by caricaturing in her

own attitude the personal relations of the heterosexual act.

4. She found an aspect of the situation, however farcical and insubstantial, by

which she could think of herself as mocking the man (his not realizing she knew

what he was after).

5. She tried to ensure her freedom from any need of marrying by getting

localized genital pleasures and relief while keeping distinctly withdrawn from truly

personal relations.

6. By changing partners on each occasion, she expressed her freedom from

attachment, her disdain for any important relationship in connection with the act.

This practice also made it impossible for an attachment to develop and threaten

the sort of lonely security she had built up over so many years.

It took her much less time and effort to reach the foregoing conclusions than to

realize emotionally that she had, without suspecting it, been very much influenced by a

need (not admitted) to find something she had never realized was desirable and

necessary until she had sensed a misleading clue to it in her close personal relations with

the older woman.

It was more difficult still for her to accept the possibility that anything of this

nature might be worth seeking in a man. This possibility did not become acceptable to

her so much through its direct examination or continuing reappraisal of what she had

experienced with the woman, but chiefly, it seemed, through the relation of present and

recent matters, to aims, attitudes, and reactions recognizable in her childhood and,

under varying aspects, in the year-by-year pattern of her life. She at first brought out

material with little affective reaction to it. Later her feelings about incidents already

mentioned were allowed expression.

It was less difficult for her to give up her sexual promiscuity than to alter her

attitude toward marriage. Even the possibility that male and female have personality

features and resources for erotic relations with each other comparable to the situation

anatomically (which she had found so superior to the deviated homosexual experience)

was a possibility it took her much time to accept.

The fear, born in her childhood, of losing that freedom which would

CATALOGING THE MATERIAL 285

enable her to escape the fate she saw as inevitable for every housewife, strove long and

stubbornly against the recognition of anything that might modify her concepts and her

affective reactions to them. These concepts, warning her perpetually from within, had,

it seems, blocked many nascent impulses that might have led her years ago into

experiences which could not but modify her basic fear. Not by reasoning alone but only

by experiencing something directly, something directly between herself and man, was it

likely that sufficient modification could occur for her to continue improvement.

From a small and very reluctant beginning, such experiences developed, and with

them came changes of attitude extending much deeper than the presence or absence of

the symptoms she had once expressed in her behavior.

No attempt has been made to bring out anything very deep or remarkable about

this patient. She illustrates, however, several points useful for our purpose. The

outlandishly promiscuous and poorly motivated sexual activity that constituted the

objective clinical manifestation of her trouble was entirely typical of what we find in the

real psychopath. Her conduct in this respect would seem to argue well for that

diagnosis. The lack of adequate conscious purpose, of anything resembling irresistible

passion or even strong ordinary temptation, to account for such inappropriate and

unrewarding behavior seems even more characteristic than the bare deeds.

Important distinctions can be made, however, between this localized expression

and the similar but generalized malfunctioning that distorts the psychopath in all his

serious performances. Not only was this young lady consistently successful and

purposive in her work and in all other social relations, but her emotional attitudes and

responses in almost every situation except those centering about sexual aims were

normal and adequate. In the erotic situation she not only behaved unwisely and

unsuccessfully but also showed evidence of distorted evaluations, of affective confusion,

and of serious deficit. In a crude analogy it might be said that her pathology compared

with the widespread pathology of the psychopath somewhat as a carbuncle caused by a

staphylococcic infection compares to staphylococcic septicemia.

Despite many superficial resemblances to serious and predominant homosexual

reactivity and life patterning, she had retained, beneath the surface, biologic and

fundamental heterosexual potentiality. Her experiences with the seriously deviated

woman awakened or liberated needs and capacities for close, devoted, and

understanding human relations. In the framework of this broad awakening, genital

impulses were also stimulated, though misdirected. For the patient, it appears that she

found in the experience

286 THE MASK OF SANITY

perience with the older woman expression for much that she had missed long ago in

parental relations as well as in friendships and the usual heterosexual gropings of

adolescence.

The somewhat clarified and freed genital impulses did not seem to be integrated

into the broader pattern of personal arousal in such as way as to constitute real and

firmly fixed homosexuality, but rather, they appeared to accompany, in a confusing but

additive sense, the other and surrounding affective capacities and urges as all emerged.

In a confusion which she could not evaluate, reacting to several important needs or

urges, she hit upon the maladapted behavior pattern in which she presented herself.

Her personality as a whole remained sufficiently intact or normally functional for

her to give to the physician and to herself an account of earlier experiences and her

reactions to them sufficiently valid for plausible explanation of the disordered behavior

to emerge. The awareness of important influences shaping the pattern of behavior

made available to the patient (as well as to the observer) some understanding of this

pattern. On the basis of this, slowly but progressively, helpful modifications were made

by the patient in her evaluations and in her adaptation.

It is quite possible that in the fully disordered psychopath similar but far more

complicated causative influences exist behind the clinical manifestations. In the real

psychopath a gross lack of sincerity and insight seriously impedes all efforts to obtain

information essential to interpretation. We must also consider the possibility that the

psychopath may be born with a biologic defect that leaves him without the capacity to

feel and appreciate the major issues of life or to react to them in a normal and adequate

manner.

Psychopath

THE MASK OF SANITY

Section 3: Cataloging the Material

Part 2: A comparison with other disorders

36. A case showing circumscribed behavior disorder