The Mask of Sanity

by Hervey Cleckley

  Dostoevski’s Prince Myshkin in The Idiot, a person of great wisdom and spiritual insight, yet eccentric and in some ways inadequate, might be called a psychopath by writers who use this term loosely for maladjusted or uneven geniuses. He is, however, a person who feels more profoundly than the ordinary man the very aspects of life to which our patients are numb.

  In the figure of Zuleika Dobson, Max Beerbohm gives an impression not so much of indicating a personality, even in caricature, as of lightly embodying his fantasy. This wraithlike figment is used to suggest a carelessness about the fate of others, a preoccupation with trivialities, an absolute and mysterious incapacity for serious emotion that, in a way both outlandish and whimsical, echoes something of the psychopath. She nevertheless succeeds consistently in her aims.21

  Ibsen’s Peer Gynt, although he, too, belongs perhaps in Elfland and very little in the ordinary world, shows a capacity for spiritual failure, an almost perverse unreliability, and an insouciance in self-frustration that suggests a translation of our problem, or some aspect of it, into poetry.

  The children presented by Richard Hughes in A High Wind in Jamaica138 and those very different children Henry James gives us in The Turn of the Screw suggest an incapacity for normal feeling, an unalterable, subtle, and sinister resistance to human approach that might be compared to the callousness of the psychopath. Both authors seem to be more concerned with general aspects of life or of evil, however, than with a personality disorder.

  Ferenc Molnár’s Liliom,222 an altogether astonishing character to the average reader or theater-goer, fails all who trust him and fails himself with the prodigious consistency of a real psychopath. His final manifestation of the old inadequacy, even after being brought back from the dead to earth, really suggests that the dramatist may have had in mind something like the psychopath as we know him. His power to arouse inalienable devotion in women is also as impressive as what we see in real patients. Liliom’s suicide, his capacity to admit his misdeeds with what impresses one as a measure of sincerity, his warmth, and his depicted strength and fearlessness all stand out in contrast, however, to the personality patterns discussed in this book.

  In Proust’s Remembrance of Things Past, the Baron de Charlus, a masterpiece of psychopathology no less than of literary creation, would of course be classed as a psychopath in the broad and once orthodox meaning of the term. This most imposing and vivid character shows not only homosexuality but a taste for flagellation and other deviations of the sexual impulse, and he shows them as they can seldom be appreciated from the reading of textbooks. There is much about Charlus to suggest that he also shares in some measure the special disorder that we treat here. He seems to care little for the rights of others or for their suffering. He is found repeatedly in fantastic and shameful situations. Much of his abnormal behavior becomes more comprehensible, however, once we grant the authenticity of his abnormal sexual cravings. There are indications of a real learning and a more nearly sincere culture than in the personalities we describe here. A paradoxical and fragmentary but not totally false dignity in his living contrasts with the psychopath’s great lack in this respect.

  Charlus might justifiably be classed as a partial psychopath, at least. As in some psychopaths seen clinically, he has specific sex deviations which are basic (as contrasted with incidental careless acts of perversion) and which readily account for much of his folly. This figure is depicted as surpassingly haughty in cultural and social aloofness, as a superesthete who aggressively represents almost an apotheosis of the secondary defensive reactions pointed out as typical of the real homosexual by Greenspan and Campbell.102

  Such a figure as Jondrette (or Thénardier) of Les Miserables shows petty opportunism, little ability to profit by mistakes, an extreme degree of selfishness, and a talent for failure. Although these are superficially suggestive of the psychopath, I believe that Jondrette and others like him are conceived as rascals with a better organized antisocial revolt than what is seen in the psychopath. Svidrigailov in Crime and Punishment is more strange than Jondrette and appears for a time entirely callous to such feelings as pity or pride. He finally shows a magnanimity that distinguishes him from our subject.

  Many female characters have been presented by novelists and dramatists as astonishingly faithless and astonishingly deficient in the stronger, richer emotions. In some of these the spiritual limitation appears to be absolute and unchangeable. Nina Leeds of Eugene O’Neill’s Strange Interlude was regarded by some critics as shameless, immoral, and self-seeking to an extreme degree. The still celebrated Scarlett O’Hara in Gone With the Wind,221 in some contrast to Nina, fails regularly to respond to sincere emotion in her lovers and pursues above all else aims that are fundamentally egocentric and trivial. Nina Leeds, however, seems capable of real feeling toward her first lover, and her reactions after his death, all of which are based on strong emotional drives, can be understood without assuming the same type of disorder postulated in the psychopath. In fact, she shows very little in common with such a disorder.

  Scarlett O’Hara, in my opinion, is a very convincing figure and really shows some of the emotional impoverishment described here in the patients presented as partial psychopaths. Her incapacity for a true commitment in love is apparently unmodifiable; her egocentricity is basic. She seems to be without means of understanding the strong emotions in those about her or of having adequate awareness of what makes them act when they act in accordance with principles they value. Unlike the complete psychopath, she successfully pursues ends that lead to her material well-being and she avoids putting herself in positions of obvious folly and shame. In her, however, we sense an inward hollowness and a serious lack of insight.

  An interesting feature of Gone With the Wind and one that illuminates an important distinguishing characteristic of the psychopath can be found in a comparison between Scarlett O’Hara and Captain Rhett Butler. Although the captain’s conduct is often at variance with most ethical standards, although he evades joining wholeheartedly in the war effort and even seeks to gain personal profit through complications of the war, he can hardly fail to give readers the impression of a man warmly and deeply human. If his objective misdemeanors and other bits of wrongdoing are added up and balanced against Scarlett’s actions in the book, it is possible that his score would be technically worse and that he would be more liable to legal action and social censure.

  Scarlett, as a matter of fact, is kind in the shallower ranges of feeling, rather consistently considerate about all matters except the most vital. The real contrast becomes clear when fundamental personal issues are at stake. Here Captain Butler’s nuclear integrity and his valid reactions of love and compassion are communicated not so much by narration and exposition or by what he directly says as in small reflections of his essential personality that cumulatively reveal him.

  It might be argued that of the two, Scarlett, as depicted in the novel, is on the whole a more conforming person, one who can better avoid conduct which will bring about social retaliation. Without attempting a judgment based on ethical absolutes, which is not the province of this book, a significant contrast can be shown between what appears to be the inmost core of each. As indicated already, the fictional Scarlett O’Hara would be a poor representative of the clinical psychopath, but limitations in her personality so effectively brought out in the novel seem closely related in quality to the more disabling deficit that I believe is fundamental in the enigmatic disorder.

  Anyone concerned at all with psychiatry is likely to find in Jenny Hagar Poster Evered of The Strange Woman (Ben Ames Williams)295 detail and concreteness familiar in the direct study of patients but hard to put into medical histories. In that she does not respect the rights of others and particularly in that she reacts in anything but a normal way in the deepest personal relations, Jenny might be proclaimed a psychopath whose deviation is extraordinarily complete. Sharply distinguishing points emerge when we consider the persistent purposiveness, the strong and s
ustained malice with which this woman works to destroy all happiness for children, husbands, and paramours. A conscious brutality prevails. Destructive impulses are directed consistently by open hate.

  In contrast with this picture of a well-organized paranoid life scheme we find the typical psychopath not consistently seeking to inflict major disaster on anyone. More characteristic is the psychopath’s pettiness and transiency of affect (both positive and negative) and his failure to follow a long-range plan, either for good or for evil. The emotional damage he may (and often does) inflict on others, mate, parents, children, is not, it seems, inflicted for any major voluntary purpose or from a well-focused motive but from what weighs in at little more than whim or caprice. He does not seem to intend much harm. In the disaster he brings about he cannot estimate the affective reactions of others which are the substance of the disaster. A race of men congenitally without pain sense would not find it easy to estimate the effects of physical torture on others. A man who had never understood visual experience would lack appreciation of what is sustained when the ordinary person loses his eyes. So, too, the real psychopath seems to lack understanding of the nature and quality of the hurt and sorrow he brings to others.

  In contrast to anything of this sort, Jenny shows a rather accurate awareness of how it is going to hurt as she skillfully, and in response to consistent impulse, pursues her plans. All this is very typical of severe paranoid reactions seen clinically. Jenny is also depicted as having components of overt sadomasochistic deviation. Elements of callousness (from incomplete comprehension) are probably necessary for such reactions. Followed far enough inside the surface of action and consciousness, such callousness might be found based on similar pathology to that which constitutes the psychopath’s basic incompleteness. As clinical pictures, nevertheless, there is more to contrast than to identify the two life schemes.

  To illustrate a feature of what I shall subsequently try to formulate as the psychopath’s real underlying condition, the remarkable character of Adrian Harley in George Meredith’s The Ordeal of Richard Feveral212 offers an excellent example. This “wise young man” makes a very successful and comfortable adjustment to life in its exterior aspect. He is, of course, no psychopath in the full sense as this disorder is described here. He is a most shrewd, urbane, and learned person. His learning is, furthermore, in the humanities. Yet his incapacity to feel the actual living, the tragedy and joy that are so real to Richard and to Lucy Desborough, is absolute. He does not apparently intend to be cruel but, perhaps chiefly because of a particular blindness, his shrewdness is used consistently to bring about disaster. He is entirely without insight and remains unable to see that he has seriously damaged others. No schizophrenic could be less cognizant of what existence means to Richard and Lucy than Adrian Harley as he stands with them on a terrace in the Isle of Wight chanting Greek hexameters into the sunset. If we consider such an emotional limitation as that seen in Scarlett O’Hara or in Adrian Harley as similar to what is seen in the psychopath, we must admit that many persons regarded as normal show less marked limitations of the same sort. This, I believe, is entirely true, just as many ordinary persons are slightly schizoid or slightly cyclothymic.

  In the literature of this century such characters as Jeeter Lester of Tobacco Road (Erskine Caldwell)38 and Pop-Eye (Sanctuary by William Faulkner)78 deserve brief consideration. The first of these seems to learn little indeed by experience. He is callous to many situations involving himself and others that the ordinary man could scarcely bear. Jeeter Lester impresses me, however, as very little akin to the psychopath. His shiftlessness and resignation are entirely passive. He is to some extent a natural victim of his surroundings. He shows no active drive toward such folly and failure as lure the psychopath, but merely an aimless drifting. He is, despite all his frailties and follies, somehow warm with humanity.

  The other figure, Pop-Eye, is depicted as a malign and vindictive man who pursues criminal aims successfully though somewhat peculiarly. His delight in watching the girl he has chosen for himself ravished by another man is extraordinary in the annals of orthodox criminal taste but is comprehensible in terms of voyeurism and masochism and especially in view of his own sexual impotence. An incompletely overt homosexuality is perhaps even more strongly contributory to this choice of role. Although there are features in common, he does not belong among the personalities discussed here.

  In Don Birnam, hero of The Lost Week-End (Charles Jackson),145 we find a psychiatric presentation of remarkable force. Beneath the surface of alcoholic addiction, very complicated and subtly distorted causal factors reveal themselves. Eventually a picture emerges in which important features of the psychopath are discernible. There are also contrasts. In Birnam awareness of major frustration is more clear, and anxiety and despair are not successfully avoided. What has happened and is still happening is bizarre and terrifying to the subject since he retains some important degree of insight. When measured against the typical psychopath, this rather remarkable fictional creation suggests another comparison.

  Several times recently, patients in early, incomplete schizophrenic reactions have impressed me with varying degrees of ability to see or sense the strangeness and gravity of the processes operant within themselves. In sharp contrast to the ordinary patient with schizophrenia, in whom unawareness and indifference characterize the subject’s attitude to all that is so obviously grotesque or tragic to the observer, these patients reacted to some degree as if with the fear, bewilderment, and horror that might be expected in one who recognizes such changes as occurring within himself. Many schizophrenics may show anxiety, alarm, and other strong affective reactions toward other matters, particularly toward delusional projection. This very different atypical residue of insight struck me not only as a remarkable feature but as one affording the observer an unusual viewpoint, the viewpoint of seeing, to some degree, this indescribable process through the eyes of the subject. Ordinarily the disintegration in schizophrenia is such, in specific quality whatever the degree, that the patient does not see the changes in himself with sufficient accuracy to react to them vividly or with anything like the emotional responses of an ordinary person.

  In Don Birnam a good many things are revealed as within or near his own comprehension which suggest what may lie beneath the reactive patterns of the psychopath but, if there, are so far beneath that the typical psychopath is unaware of them and indifferent. The observer also has peculiar difficulty in gaining direct access to what may be beneath the surface. Although it may not be accurate to give the unqualified diagnosis to this marvelously interesting fictional patient, it is undeniable that he shows very convincingly, important features of the psychopath.

  A literary creation who impresses me as remarkably like a psychopath in the full sense is Dostoevski’s senior Karamazov, father of the wonderful and puzzling brothers who themselves offer so much of interest to the psychiatrist. The elder Karamazov is not only free from major human feelings, but he also drives actively at folly. He shows a greedy relish for the very sort of buffoonery and high jinks that the psychopath seeks. He has no regard apparently for consequences and cannot be persuaded by reason or appealed to by sentiment. He appears superficially to be a man of strong passions, but in my opinion this is only an appearance. He does not pursue selfish or vicious ways consistently in the aim of self-interest. He immerses himself in indignity for its own sake. He does outrageous things, especially to his son Dimitri, yet he is not adequately motivated by consistently vindictive or cruel impulses.

  The personality and behavior of Mildred as she appears in Of Human Bondage (Somerset Maugham)204 also have features that are difficult to reconcile with anything except this disorder, and this disorder in a serious degree. To petty, affective promptings this girl responds appropriately as a rule. All the stimuli that in the normal person evoke serious and lasting responses she perceives little more than a blind man perceives the sunset.

  Her positive responses to the trivial, the
cheap, and the vulgar are understandable in view of the affective limitations so memorably revealed. It is not through savage and violent impulses that she mangles or destroys, but because only mild affect is necessary for action when the larger emotional consequences are invisible. They are invisible not through lack of rational foresight but through specific and more profound defects of evaluation. It is not at all necessary to assume genuine cruelty of any magnitude in Mildred as she reviles the man who has so convincingly demonstrated love for her and whom she wounds as only he could be wounded by the final epithet—cripple. So far as she can tell, she is doing little more than what anybody might do if moderately irked.

  Like the full psychopath, Mildred cannot continue to provide successfully for her material needs. Unlike what is typical, she does not appear to be especially clever or to have great superficial charm and promise. Nevertheless, she illustrates, perhaps even more accurately than Karamazov the father, some of the features that seem to be fundamental in our subject.

  I have seldom seen in fiction so complete and so faithful a portrayal of the psychopath as in the character Rags in The Story of Mrs. Murphy (Natalie Anderson Scott).256 No attempt is made to explain why this man behaves as he does. He is revealed, not by efforts at description and exposition, but with rare fidelity in the concrete rendering of his behavior. The author of this book understands something fundamental about the true psychopath that often is notably lacking in textbook accounts. This is communicated in a form singularly impressive and worthy of careful study.