The patient was raised in the same environment with his sister and brothers, but from early youth, unlike the other children, he showed some signs of his present inadaptability. He learned rather easily in school and successfully completed his studies each year until he reached the sixth grade. His truancy then became so pronounced that he could not be kept in school any longer. On being sent to a strict military school, he proved intractable and was expelled after a few weeks. Though remarkably lazy and unpersevering, he showed at this time what appeared to be a slight interest and an astonishing talent in tinkering with radios. His parents, who throughout his whole life have shown exceptional patience and gone to no little expense and trouble with him, sent him to New York to study radio work. He was very eager to go and urged this plan on the family. His older brother, the physician, was a house officer in a New York hospital at the time and agreed to keep in touch with him and try to exercise any necessary supervision.
From the very beginning it became apparent that the venture was useless. Chester could not be induced to attend classes. He showed no interest whatsoever in his work or in anything else, lying about his room much of the time and going out alone on adventures without much purpose or content on missions to borrow a dollar through solemn-faced fraud or, by cheating or some sort of chicanery, to pick up a little extra change or to beat the game by getting a free ride on the bus or the subway and, perhaps, to climax the day by slipping out of a restaurant without paying for his meal. His brother, after earnest and persistent efforts to persuade him to take advantage of his opportunities, had to give up and send him home.
Many other efforts have been made to help this young man find some place in normal life. Various positions have been found for him, but he always refuses to maintain the slightest interest in any work.
The ordinary pleasures of mankind seem to have as little charm for him as work. Though he has had sexual relations with prostitutes and other available girls, he never formed a real attachment for any. Even casual physical encounters with women claim his interest far less than sporadic bouts of solitary drunken torpor in remote cotton fields or aimless hours spent idling about uninspiring hamburger stands and poolrooms. When at 22 years of age he ran off to enlist in the army, his father did not try to interfere, hoping the discipline of that life would stabilize him.
Since the incidents just mentioned, he has on several other occasions obtained parole and violated it promptly by carrying out various antisocial acts which seemed to have no definite purpose, no conceivable explanation in terms of human impulse. He has also succeeded again in escaping from closed wards. On getting out, he always repeats his former conduct. Sometimes he has remained cooperative for a month or more, abiding by the rules of his ward, helping attendants with their work, assisting and directing frankly psychotic patients. During such periods he would talk frequently with his physician, discussing his plans for the future, maintaining that he fully realized drinking or stealing or not taking life seriously enough was his trouble and declaring that he would never act so unwisely again.
He appeared to be a sane, quick-witted young man with good judgment and reasonably earnest intentions. So convincing was the impression he made that time after time the various physicians who had charge of his case would decide that parole was advisable despite his history. Within a few hours or sometimes a few days, he would appear at his home in a wretched state, land in jail because of unacceptable behavior, take an automobile and get caught, or, lacking opportunity for something more active to do, get himself too drunk to leave town and fall into the hands of the local police.
On one occasion, several days after being returned by his family from such an escapade, Chester came to me smiling and at ease. He spoke briefly of his plans for the future and insisted on having parole at once. In support of this request he sought to make the point that he had proved himself trustworthy and reliable under all circumstances. Looking me squarely in the face, he asserted with modest firmness, “You know that I’m a man of my word.” He repeated this statement several times and spoke most intelligently and convincingly in his own behalf. When asked how he pretended to be a man of his word after breaking it so many times, so flagrantly, and so recently, he showed no sign of being confounded.
His memory was of course clear, and he accurately recognized all the circumstances under which he had given his word not to leave the hospital, not to steal or to forge or to drink whiskey, as well as his invariably and prompt violations of every promise. He seemed to seek in the phrase a man of his word, which he uttered in tones of quite pride and assurance, some magical charm which would irrationally persuade me to trust him. Indeed, he himself appeared to be well convinced by his statement. On seeing this man for the first time, one would have read into him a fair degree of sincerity and conviction. To me he seemed rather to be activated by a mimicry of these things, an insubstantial shadow of emotion which the patient, knowing nothing else, confused in his own mind with what he assumed other people felt when they used such a tone. Having never in his whole life, so far as I could find in examining him, looked a fact of this sort in the face, he was untroubled by even the hardest, sharpest contrast between fact and falsehood and stood free to indulge, with a kind of automatic imitation-sincerity, in any fantasy he chose.
During his repeated hospitalizations, his case was reviewed many times. No evidence of a psychosis in the commonly accepted sense of the word was found in his past record or in his current behavior or thought. At each presentation before the medical staff, every member has agreed that he is “sane and competent” and that he should be classified under the term psychopathic personality. He is bright rather than dull, and his reasoning powers on all general matters and on test questions are average or better than average.
Here, then, is a man whose measurable intelligence is not at fault, whose extrinsic situation is normal, and who is entirely free from the delusions and other mental disorders of the recognized psychoses. His environment is favorable and his opportunities, past and present, insofar as they can be estimated, appear better than the average. He is not visibly indifferent or emotionally isolated in the ordinary sense of those words, but, in sharp contrast to the schizophrenic or the deteriorated patient with organic brain disease, he reacts with a very natural antipathy to his situation when confined. Several of the psychiatrists who observed him have expressed the belief that he detests being in the hospital more than any man they ever saw there.
Why, then, does he always take these active steps to get himself back in confinement just as soon as he gets away? It has been clearly demonstrated to him that he will have to spend most of his life in confinement as long as he persists in his present ways. The opinion held by some physicians is that such people as this patient are merely spoiled, that they would behave more sensibly if not pampered, and that if promptly confined to jail or left in whatever other difficulties they bring down on their own heads, they would finally control themselves. I believe that consistent, prompt and regular punishment for unacceptable conduct is of great value in treating most people who persist in flagrant misbehavior, delinquency or crime. I believe it is usually of far more value than any form of dynamic psychotherapy. In this patient, however, it proved quite ineffectual. No ordinary punishment could be much more severe than confinement on a closed ward is to this particular man. He has had it thoroughly explained to him that he will remain here until he can adapt himself to normal life outside. He not only gives up everything that other people seek but also, because of confinement, he sacrifices the chance to follow the inappropriate and bootless patterns of behavior into which he falls almost at once when left to his own devices.
Whatever strange goals or pseudogoals there may be to prompt and shape his reactions as a member of the community, these too, it seems, fail to motivate him sufficiently, fail to induce decisions and acts that would give him the freedom to pursue them. It has been demonstrated to Chester repeatedly, in the hardest aspects of the concrete, that
his characteristic acts put him back in a situation he finds particularly disagreeable. This does not produce the slightest modification in his behavior.
If we attempt to interpret his antisocial conduct as a rebellious manifestation, a symbolic protest against customs, principles, people, and institutions which he will not accept, we might presume he would take more pains to avoid the interruption of his efforts along this line. If there is unconscious need for him to make trouble in the community and to achieve heroic stature as a general nuisance, his steps to fulfill this need seem peculiarly illogical. They promptly result in the termination of his action. Arguments for such motivation in more effective criminal careers and in circumscribed patterns of delinquency seem more plausible than in such a case as this. If loitering, theft, swindling, “disgracing himself,” running up debts, and social sabotage in general are his goals, the pursuit of these he must give up when he comes under close supervision on the closed ward.
Is he seeking, then, not to fulfill these goals but to frustrate the impulses to fulfill them? Or is he seeking punishment as something even more desirable than the perverse goals surmised above? The claim of such motivational schemes has been advanced.8,207 Perhaps some patients who show more interest in their predicaments may reveal hidden attitudes, old won grudges, or forgotten but distorting influences that suggest such an interpretation.
From this patient, however, none of the many psychiatrists who dealt with him could obtain any underlying material to confirm such speculations. As hypotheses about his disorder, such interpretations impress me as having very little plausibility. It might be assumed that if deep penetration of his personality and adequate exploration of his innermost life could be achieved, substantial evidence of cause and effect would emerge in some convincing explanation. It seems likely, however, that a valid explanation would prove to be one far more complex than anything just suggested. An important clinical feature of his disorder seemed, nevertheless, to lie in the specific and obdurate difficulty in finding out anything at all about less superficial attitudes or real inner purposes and meanings.
In closing the summary of this case, let the point be emphasized again that this man does not seem driven by hot temptations to his injudicious deeds. What he does when free fails to give him much pleasure. Chester is in no way like a man who sacrifices all the ordinary satisfactions of life for some enthralling sin which will later bring him to ruin. The well-known human motives which sometimes lead a respected and successful businessman to lose fortune and family in his pursuit of an illicitly loved woman or of some other transitory but enticing joy are not discernible in this case.
My candle burns at both ends;
It will not last the night;
But ah, my foes, and, oh, my friends—
It gives a lovely light.
Edna St. Vincent Millay
“A Few Figs from Thistles”
Such a scheme of life, whatever might be said for its final wisdom, has no apparent place in this patient’s maladjustment. The allegory of Faust selling his soul to the Devil in order to quench a thirst for rarer joys than this life holds is absurdly inappropriate.
It is most difficult to believe that he is reacting to powerful drives which force or compel him into obviously disastrous actions. On the contrary, everything about him suggests a drifting approach, a casual and weak impulse, a halfhearted whim rather than an explosive release of passion in the forbidden deed. Instead of a pathologic intensity of drive there seems instead to be a pathologic general devaluation of life, a complex deficiency, confusion, or malfunction in what chooses aims and directs impulse.
Nothing that he expresses or that can be observed about him suggests a great stress or inner conflict in which strong opposing forces clash and from which emerges deep instinctual gratification as he makes off with a stolen automobile, thoroughly cleans out an opponent by fraud in crap shooting, saddles his father with a heavy debt, or drains his bottle and brawlingly defies the police. Nor is there anything yet detected about him that suggests true relief of inner tension as he reacts to society’s restraints and retaliations. If these are his fundamental mechanisms, they are so deeply concealed that they show no surface or subsurface repercussion of emotion that suggests in the least their nature or their existence.
15. Walter
Walter is an only child. In the old South Carolina city where he spent his early years, he is remembered by his first playmates as having been not only normal but also a particularly desirable friend. During his grammar school days he was a good but not an exceptionally bright pupil. He was happily at ease with boys his own age, being generally looked to as a leader, though never aloof or dictatorial. He was somewhat less inclined than usual to the more destructive forms of mischief so dear to the typical young male, yet no child could have been more secure from the taunts often evoked by primness or piety in the schoolboy. It is nothing short of incredible to imagine the term sissy, withering and still unhackneyed stigma of those times, ever having been applied to Walter by anyone. That term, in fact, could not have been defined better by those who used it than as his direct opposite.
Even to the present, several men who were slightly younger schoolboys on the fringe of the group in which he held his admired position testify to the graciousness and kindness with which he treated them. All agree that he was, perhaps, the only older boy they recall as being entirely free from the popular tendency to bully and persecute his worshipful juniors. If his subsequent course were not known, it is likely that a poll taken among his former associates would reveal an almost unanimous belief that Walter showed more promise of becoming a respected, happy member of his community than any of the group.
In the pleasant little city of some 50,000 people his general situation in life appeared fortunate. The father was particularly honored.
Starting life with a good name but little money and only a high school education, the father established himself as a cotton factor and soon attained complete financial security. During his son’s infancy he had played an important part in freeing the city of a corrupt political machine, and he continued active in civic work, one of the genuine ornaments of his community. Never a politician in the unpleasant sense of the word, he has all his life exercised strong and altogether unmercenary constructive influence in municipal affairs, occasionally heading committees to treat with the state or federal government about public matters.
Notably upright and capable, the father is still, in his early seventies, a man of sincere geniality and unusual tolerance. Though free from professional camaraderie, he is gifted with an unselfconscious knack of friendliness, an easy, unforced humor.
Younger people, feeling in him a lively, almost naive warmth of humanity, tend to forget that he is a very old man. His dignity is and has always been indisputable but entirely without stiffness. The mother is known as a quiet woman of gentle breeding, chiefly interested in her home but generally liked and admired. Both parents are Episcopalians and attend a church which has come down from colonial times.
It would be hard to imagine an environment farther from moral laxity on the one hand or fanaticism and excessive efforts at piety on the other than that of Walter’s youth. He apparently enjoyed all the pleasures and advantages available to boys of the leading families in his community. Not only social service reports but also the opinion of his contemporaries indicate that he was as free from pampering and undue license as from overzealous severity.
After entering high school he gradually drifted away from his earlier friends, began to lose interest in his studies, and began to show alarming irresponsibility. The change in him was at first imperceptible. No one could say definitely when he began to lose identity with the modest, frank character of his early youth and to become, instead, notable for juvenile arrogance, a petulant irritability, a quick and limitless facility at lying.
His parents soon began to find him a problem. Nothing seemed to suit him. Purposeless truancy from school, night wanderings, a di
srespectful attitude toward his elders, and open, fretful defiance at any attempt, however gentle or however firm, to guide or control him became ever more prominent. He became dissatisfied and carping and always spoke as if the world were to blame for each difficulty that he made for himself and for others.
Some of the other boys with whom he had grown up began at this stage of their lives to indulge in what they regarded as dissipation. Cigarette smoking, occasional surreptitious experiences with strong drink, and indiscreet behavior with the opposite sex were adventurously essayed and almost incessantly talked about by the more wayward spirits. Many of these boys were regarded by their elders as sowing their wild oats, as perhaps preparing to go to the dogs. Their conduct was far more weightily regarded by themselves, many exulting in what they imagined to be precocious careers of worldly license. Walter did not concern himself particularly with these pursuits.
During his third year of high school Walter ran away from home, having no plan or discernible purpose. His money soon became exhausted, and his father brought him home. Shortly afterward he ran away again. He had been very disagreeable to his parents since his first misadventure and seemed bored and aimless. The father, thinking he might learn something to his profit, allowed him to stay away, supplying him with sums of money from time to time.
Before long he succeeded in getting work as an unskilled laborer at a factory in a large industrial city on the eastern seaboard. Losing this place, he soon found another. After working a few weeks or sometimes a few months, he always fell into difficulty with his employers, often losing positions because of his high-handed and dictatorial ways, drifting about from one place to another. He dressed rather flashily and squandered money that his father sent him on making a cheap display. Much of his leisure was spent standing around on street corners or strutting about in front of cigar stores. Meanwhile, he lived among uneducated and depressing people in a dreary section of town and seemed to have no interest in finding suitable associates or surroundings. Though he indulged in casual relations with prostitutes, there is no record of his ever having regarded any woman as a love object. What relations he has had of this sort, though not infrequent, seem very insignificant in the story of his life, involving little emotion, implying no sexual contact of two personalities beyond the more or less mechanical friction of the parts technically involved.
The Mask of Sanity Page 20
