The Mask of Sanity

by Hervey Cleckley

  Though several years after the event Stanley can still give a remarkable account of his sudden jet flight to Europe and his adventures in Brussels, there is a great deal that in retrospect makes it difficult to see how even he could have convinced so many people of so many implausible things. The newspaper accounts and pictures (some of which his parents still retain) establish the fact beyond question that Stanley got to Brussels and that he must have attracted a great deal of attention. Telephone calls from newspapermen and from people connected with the American embassy, his parents report, confirm this and indicate that Stanley must have created a remarkable stir and a great deal of confusion. His own report, which can hardly be counted upon as accurate or trustworthy, pictures him as being hailed and feted in Brussels in a style and on a scale almost comparable to the welcome Charles Lindbergh received in New York after his historic solo first airplane flight across the Atlantic ocean.

  This account of Stanley began with headlines from a newspaper. It seems to me appropriate to close the report with another small item of news that appeared in 1975 in a local paper.

  “PREACHER” BLESSES AUGUSTAN’S WALLET, COLLECTS $175 FEE

  An agreeable young man who identified himself as a “preacher” blessed an Augusta man’s wallet Tuesday and collected a $175 fee. Augusta Police said.

  The preacher, dressed in a black suit and hat, with black-string tie, showed up at the door of John Doe, 1436 Maple Street, early Tuesday afternoon, police said.

  According to reports Doe and the helpfully concerned cleric prayed together. The preacher then asked if he could bless Doe’s wallet.

  Doe told police he found $175 missing from the wallet after the preacher left.

  Neither this item nor the first identifies Stanley as the protagonist. Both, however, reflect something of his all but inimitable qualities and skills and convey to anyone who has known him a vivid sense of his presence.

  Part II: Incomplete Manifestations or Suggestions of the Disorder

  The voice is Jacob’s voice, but the hands are the hands of Esau.

  —Genesis 27:22

  20. Degrees of Disguise in Essential Pathology

  The cases already reported are only a few among many hundreds whom I have observed. All of these people, when their records over the years are considered, strike one as remarkably similar. If the story of each could be told in detail, it is believed that the similarity would become more plain to any reader. It is the contention of the present argument that this personality disorder shapes and hardens into the outlines of a very definite clinical entity or reaction type, into a pattern of disorder quite as recognizable and as real as any listed in psychiatric nomenclature. When a large number of such patients are considered carefully, the vagueness with which they are often regarded lessens and the type emerges certainly not less sharp than that type on which is based the concept of schizophrenia. But vague as the concept of schizophrenia remains and various as its manifestations are, the schizophrenic, when recognized, is promptly called a patient with mental illness and treated as such, The psychopath, however, continues to be treated as a petty criminal at one moment, as a mentally ill person at the next, and again as a well and normal human being—all without the slightest change in his condition having occurred. I do not have any dogmatic advice as to a final or even a satisfactory way of successfully rehabilitating these psychopaths but believe that it is important for some consistent attitude to be reached.

  In the hope of letting major features of the clinical picture emerge more clearly, the following case reports are added. The persons already described are regarded as typical examples showing the disorder in its distinct clinical manifestations of disability. Many of them are plainly unsuited for life in any community; some are as thoroughly incapacitated, in my opinion, as most patients with unmistakable schizophrenic psychosis. Whether this is to be regarded as a more or less willful contrariness or as a sickness like schizophrenia, in which the patient is to be protected and looked after, may for the moment be put aside.

  In the reports that follow, an effort has been made to present persons who are able to make some sort of adjustment in life and who may perhaps be regarded as less severely incapacitated, and in varying degrees. These patients are offered as examples showing, in some respects, indications of the same disorder seen in the others. In them, however, it may be regarded as milder or more limited. The psychopathologic process, the deviation (or the arrest), is, as with the others, a process affecting basic personal reactions; but here it has not altogether dominated the scene. It has not crowded ordinary successful functioning in the outer aspects of work and social relations entirely out of the picture.

  Some of these patients I believe are definitely psychopaths but in a milder degree, just as a patient still living satisfactorily in a community may be clearly a schizophrenic but nevertheless able to maintain himself outside the shelter of a psychiatric hospital. Others might not deserve to be called psychopaths but seem to show strong, even if not consistent, tendencies and inner reactions characteristic of the group. They might be compared to the plain and complete manifestations of the psychopath as the schizoid personality might be compared to the schizophrenic patient who is obviously psychotic. An example will perhaps make this comparison more concrete.

  Some years ago I was consulted by a man 32 years of age whose only complaint was of a general listlessness which he had noticed for about a year. He was a tall, rather slender person, slightly brittle in manner, and gave a definite impression of being not very much worried about his complaint. He lived with his parents in a small town where he made an excellent salary as an expert in looking after electrical machinery in a large mill. He enjoyed the title of engineer though he had no formal education beyond that obtained in a rustic high school. Examination soon brought out the fact that he had never had sexual relations with a woman. He had, however, made the attempt not once but many times, the first attempt being twelve years ago. He succeeded in having erections but premature ejaculation always occurred, and he failed entirely to effect an entrance.

  This situation, which most young men would find extremely distressing, he spoke about very casually. Questions concerning his attitudes toward love and women brought rather stereotyped answers. He denied ever having scruples about fornication. To him it was evidently neither good nor bad. His attempts to practice were, it would seem, made with a vague idea of doing what was the custom. He professed to be concerned in overcoming his inability to perform intercourse and showed no embarrassment and little reticence about sexual questions but gave a strong impression of having only the shallowest interest. His entire emotional life seemed perfunctory and without warmth. Nothing in his experience could be elicited which brought forth any vividness or enthusiasm. He said that he was at present going with a girl whom he would like to marry, but his attitude toward her seemed without any tangible desire or eager anticipation. At times he gave a stilted, incongruous little laugh that sounded almost exactly like the manneristic laugh so familiar in actual schizophrenics. No delusions or hallucinations could be brought out. He had been leading an outwardly successful life and was a fairly conscientious and reliable member of society.

  The man just mentioned could certainly not be called legally incompetent at present. Nor would he, by most psychiatrists, be classed as a case of schizophrenia, with all the practical implications of being adjudged psychotic. He is mentioned in order to compare him with the patient who is psychotic and who is frankly schizophrenic.

  As an example of the developed schizophrenic, let us consider a former patient of mine who often sat for hours in a corner staring vacantly into space, his lips moving and silly, grimacing smiles flitting across his face. Sometimes this man would not answer questions, apparently not even hearing them, so absorbed was he in subjective contemplation. Again he would grin glassily and wink his eye or occasionally speak with passion about strange machinery in a distant city which enemies whom he referred to merely as “they” w
ere using to inject queer colors into his thoughts and sometimes to make him ejaculate. This man at times suddenly attacked others. It was eminently necessary to keep him on a closed ward and under close supervision.

  In some of the cases to be presented, such a comparison probably would not be justified. Some patients might more accurately be thought of as showing scattered indications of such a disorder, suggestions of a disturbance central in nature but well contained within an outer capsule of successful behavior much deeper that the merely logical and theoretical rationality of the fully disabled psychopath. In those who consistently support themselves and pass regularly as acceptable members of the social group, we can only be astonished at the difference between such technical outer adjustment and the indications of deeper pathologic features so similar to those found in the complete manifestation of the disorder.

  There are many patients who show relatively circumscribed antisocial behavior or temporary episodes of gross, general delinquency, who have, I feel, much less in common with the obvious psychopath than those who make a better outward impression but who consistently show signs of inner subjective reactions typical of the clinically disabled patient.

  These patients with temporary or circumscribed maladjustment or self-defeating behavior will be referred to later at greater length.* They are mentioned here to distinguish them not only from the fully manifested psychopath but also from those who, over the years, show more subtle indications of widespread and intractable defect or deviation in essential personal reactions and subjective evaluations.

  The psychopathologic process, or state, which I believe is seriously disabling the patients already presented may be regarded as affecting in part and in varying degree those yet to be discussed. It may now be added that I believe that in these personalities designated as partially or inwardly affected, a very deep-seated disorder often exists. The true difference between them and the psychopaths who continually go to jails or to psychiatric hospitals is that they keep up a far better and more consistent outward appearance of being normal. This outward appearance may include business or professional careers that continue in a sense successful, and which are truly successful when measured by financial reward or by the casual observer’s opinion of real accomplishment, It must be remembered that even the most severely and obviously disabled psychopath presents a technical appearance of sanity, often one of high intellectual capacities, and not infrequently succeeds in business or professional activities for short periods, sometimes for considerable periods.

  I maintain, however, that the actual but concealed pathology in some of the patients now to be described is in a deeper sense also far-reaching and profound. Although they occasionally appear on casual inspection as successful members of the community, as able lawyers, executives, or physicians, they do not, it seems, succeed in the sense of finding satisfaction or fulfillment in their accomplishments. Nor do they, when the full story is known, appear to find this in any other ordinary activity. By ordinary activity we do not need to postulate what is considered moral or decent by the average man but may include any type of asocial, or even criminal, activity so long as its motivation can be translated into terms of ordinary human striving, selfish or unselfish.

  The chief difference between the patients already discussed and some of those to be mentioned lies perhaps in whether the mask or facade of psychobiologic health is extended into superficial material success. I believe that the relative state of this outward appearance is not necessarily consistent with the degree to which the person is really affected by the essential disorder. An analogy is at hand if we compare the catatonic schizophrenic, with his obvious psychosis, to the impressively intelligent paranoid patient who outwardly is much more normal and may even appear better adjusted than the average person. The catatonic schizophrenic is more likely to recover and, despite his appearance, is often less seriously disordered than the paranoiac.

  It becomes difficult to imagine how much of the sham and hollowness which cynical commentators have immemorially pointed out in life may come from contact in serious issues with persons affected in some degree by the disorder we are trying to describe. The fake poet who really feels little; the painter who, despite his loftiness, had his eye chiefly on the lucrative fad of his day; the fashionable clergyman who, despite his burning eloquence or his lively castigation of the devil, is primarily concerned with his advancement; the flirt who can readily awaken love but cannot feel love or recognize its absence; parents who, despite smooth convictions that they have only the child’s welfare at heart, actually reject him except as it suits their own petty or selfish aims: all these types, so familiar in literature and in anybody’s experience, may be as they are because of a slight affliction with the personality disorder now under discussion. I believe it probable that many persons outwardly imposing yet actually of insignificant emotional import really are so affected.

  Let us not, however, attempt to explain all pretense and all fraud on this basis. There are many other psychopathologic reactions besides the one with which we are now concerned. And some of these, too, are capable of producing such results. Let us be especially chary about assuming this limitation in our enemies or our neighbors. The mechanisms of reaction formation, projection, rationalization, and many other distorting influences work in all of us at the behest of envy, pique, or prejudice. It is not easy to estimate correctly the degree of our neighbor’s sincerity, the worth of an artist’s production, or the clergyman’s real motive.

  Some of the episodes or symptoms mentioned in the brief sketches that follow may represent less profound inner disturbance than anything properly belonging with that of the real psychopath. Many of the acts might in isolation occur in the lives of people who at length achieve excellent adjustment not only externally but also within themselves. The material to follow is offered not primarily for the purpose of making a diagnosis of psychopathic personality but in illustration of features which specifically characterize the psychopath and which may, against a background of better general adjustment, emerge in sharper clarity. What can be learned from fantasy or dream in the normal person, from prejudice or many socially admired forms of self-renunciation, has been of value in psychiatric efforts to understand schizophrenia and other grave personality disorders. Many of the characteristics and reactions seen in extreme exaggeration among the psychotic appear sometimes to be utilized by those of great talent and excellent psychiatric status in the successful pursuit of valuable personal and social aims.210 It is unlikely that the specific reactions of the psychopath can be directly utilized for important positive accomplishment. It is believed, however, that many persons in bewilderment and frustration temporarily fall into similar reactions and eventually, finding better means of adaptation, profit from what has been learned through the pathologic experiences.

  The following accounts are given, then, for what light they may reflect on the serious clinical disorder manifested in the previous cases.

  21. The Psychopath as Businessman

  No attempt will be made to give a detailed history of this man. Suffice it to say that the incidents mentioned are not isolated experiences in the general life pattern but rather expressions of a motif which persistently recurs to interrupt the outward serenity.

  He is now 50 years of age, and he has gone on to achieve considerable business success, being an equal partner in a wholesale grocery concern. As a businessman there is much to be said for him. Except for his periodic sprees, he works industriously. He has contributed foresight and ability to the business, whereas his partner has contributed the stability necessary to keep things going when he is out of action.

  He is pleasant and affable during his normal phases, which make up the greater part of his time. One gets the impression, however, that ordinary life is not very full or rich, that strange gods are ever calling him, and that the call is far dearer to his heart than anything else. He is, perhaps, like a man who through necessity has given himself over to foreign ways for
most of his hours and who goes on fairly patiently but without spontaneity until the time when he can throw it all aside for a while and go wholeheartedly at what he finds really to his taste.

  These recesses are sometimes taken at intervals of a week; occasionally several months go by without one. They sometimes last merely a few days, sometimes a week or more.

  He does not drink in groups with men and women whom he meets in the ordinary course of his life. It would never occur to him to have a cocktail party or to serve whiskey to friends in his own house. Apparently he can see no point in what might be called ordinary or normal drinking, in the sense, say, of taking several highballs to be warm and lively, to talk more gaily to pretty women and cut a finer figure in their eyes, to be more playful, to throw aside the routine problems of the day, and to express oneself a little more vividly.

  If he drinks at all, it is to reach a state of roaring folly and perhaps to continue until he may fall limp. He frequently goes out of the city and, in some hotel of dubious standing, gathers a few coarse companions and begins to pour liquor into himself on such occasions. His associates are usually uninteresting drifters or vagrants ready to accept any handout. Sometimes obvious psychopaths are included. Often harlots are called into the room where this noisy group of fat, middle-aged men are already staggering about, sweaty in their undershirts or lying out half stupefied across the beds or on the floors.

  The women are stripped or encouraged to strip themselves, and among those men still able to flounder about a great clamor arises. The women are chased about and fumbled over. Intercourse is accomplished by the more energetic ones, not in the privacy ordinarily considered desirable but in the presence of all and often on beds across which a more sodden member of the group lies snoring.

  Men and women stumble about, the men pouring more and more whiskey into themselves, the women usually drinking little but occasionally picking their senseless companions’ pockets. Daylight often finds a few of this jolly brotherhood still wobbling feebly or crawling about the room in search of more liquor.