The Mask of Sanity

by Hervey Cleckley

  A thought expressed by William James in 1902 and quoted by Wells deserves renewed attention:”294

  Yonder puny fellow however, whom everyone can beat suffers no chagrin about it, for he has long ago abandoned the attempt to “carry that line,” as the merchants say, of Self at all. With no attempt there can be no failure; with no failure no humiliation. So our self-feeling in this world depends entirely on what we back ourselves to be and do. It is determined by the ratio of our actualities to our supposed potentialities; a fraction of which our pretensions are the denominator and the numerator our success: thus, Self-esteem = Success/Pretensions. Such a fraction may be increased as well by diminishing the denominator as by increasing the numerator. To give up pretensions is as blessed a relief as to get them gratified; and where disappointment is incessant and the struggle unending, this is what men will always do. The history of evangelical theology, with its conviction of sin, its self-despair, and its abandonment of salvation by works, is the deepest of possible examples, but we meet others in every walk of life. … How pleasant is the day when we give up striving to be young—or slender! Thank God, we say, those illusions are gone. Everything added to the self is a burden as well as a pride.

  Something relevant to the points now under consideration may be found also in Sherrington’s comment on reactions (or inlaid precautions) against unbearable pain or stress in the human organism. He says:257

  Again in life’s final struggle the chemical delicacy of the brain-net can make distress lapse early because with the brain’s disintegration the mind fades early—a rough world’s mercy towards its dearest possession.

  There are, it seems, many ways for this to occur without signs of any change which we yet have objective means to detect, chemically or microscopically. Such changes may occur under the stimulus of agents that do not have direct physical contact with the brain or with any part of the body.

  Withdrawal, or limitation of one’s quest in living, appears in many forms. The decision for taking such a step may be consciously voluntary, but it seems likely that many influences less clear and simple may also play a part. In the earliest years of human life a great deal of complicated shaping may occur, with adaptive changes to promote survival by an automatic refusal (inability) to risk one’s feelings (response) in the greatest subjective adventures. In adult life such decisions sometimes emerge in clear deliberation.

  The activity of the psychopath may seem in some respects to accomplish a kind of protracted and elaborate social and spiritual suicide. Perhaps the complex, sustained, and spectacular undoing of the self may be cherished by him. He seldom allows physical suicide to interrupt it.47 Be it noted that such a person retains high intelligence and nearly all the outer mechanisms for carrying on the complicated activities of positive life. It is to be expected then that his function in the opposite (regressive) emotional direction might be more subtle than those of a less highly developed biologic entity. The average rooster proceeds at once to leap on the nearest hen and have done with his simple erotic impulse. The complex human lover may pay suit for years to his love object, approaching her through many volumes of poetry, through the building up of financial security in his business, through manifold activities and operations of his personality functions, and with aims and emotions incomparably more complicated and more profound than that of the rooster. When complexly organized functions are devoted to aimless or inconsistent rebellion against the positive goals of life, perhaps they may enable the patient to woo failure and disintegration with similar elaborateness and subtlety. His conscious or outer functioning may at the same time maintain an imitation of life that is uniquely deceptive.

  Perhaps the emptiness or superficiality of life without major goals or deep loyalties, or real love, would leave a person with high intelligence and other superior capacities so bored that he would eventually turn to hazardous, self-damaging, outlandish, antisocial, and even self-destructive exploits in order to find something fresh and stimulating in which to apply his relatively useless and unchallenged energies and talents.

  Like so much of what is often called dynamic interpretation of psychiatric disorder and of human behavior, these thoughts are purely speculative and without the slightest support of evidence. They are offered with no pretense whatsoever of constituting a scientific explanation.

  The more experience I have with psychopaths over the years, the less likely it seems to me that any dynamic or psychogenic theory is likely to be established by real evidence as the cause of their grave maladaptation. Increasingly I have come to believe that some subtle and profound defect in the human organism, probably inborn but not hereditary, plays the chief role in the psychopath’s puzzling and spectacular failure to experience life normally and to carry on a career acceptable to society. This, too, is still a speculative concept and is not supported by demonstrable evidence.

  65. Surmise and Evidence

  If, in the so-called psychopath, we have a patient profoundly limited in ability to participate seriously in the major aims of life, how, we might inquire, did he get that way? Reference has been made to the traditional viewpoint from which it was assumed that an inborn organic defect left these people “constitutionally inferior” or “moral imbeciles.” Such a congenital defect, it must be readily admitted, may exist and may account for the failure to experience life normally and hence to react sanely.

  During the earlier decades of the twentieth century this concept of the psychopath prevailed. It was widely believed that these patients, often called constitutional inferiors, came almost exclusively from families loaded with stigmata of degeneration and signs of neuropathic taint.123 As time passed it was noted that typical psychopaths were also seen in families of very respectable, ethical, and successful people and were entirely free from all physical stigmata of degeneration. Many pointed out that some of the statistical studies giving evidence of hereditary factors are not as reliable as they were once thought. Even the famous studies of the Jukes and the Jonathan Edwards families have been severely criticized and called fallible by some.275

  As already mentioned, Healy124,125 long ago pointed out that antisocial behavior often seemed to occur as a response to unhappy life situations, and Alexander formulated such disorder in psychoanalytic terms as a purposive acting out of unconscious pathologic conflict.9,11

  The concept of acting out, in lightly disguised symbolic deeds, might be vividly illustrated in the case reported here in which a man responded to what is often spoken of as being in the doghouse by putting on his dog’s collar and spectacularly caricaturing canine behavior.* Another response to a similar situation can be found in the patient who literally got into a kennel at the veterinarian’s and so exhibited himself.* Although these incidents picturesquely illustrate Alexander’s concept of acting out, they do not in themselves constitute evidence of an unconscious conflict which he has assumed causes the behavior. Neither patient showed any reaction that would support belief in the presence of inner, unconscious feelings of guilt or of the type of conflict attributed to psychopaths in such interpretations. The assumption of such guilt in these two patients must be made purely on faith in the theory.

  Many other psychiatrists have attempted to explain the psychopath in terms of psychogenic causation. The studies of Greenacre led her to conclude that the confusing influence of a stern, authoritarian father and an indulgent or frivolous mother is common in the early background of the psychopath. It is plausible to feel that such an influence might contribute to rebellious reactions and to a detective development of conscience and of ordinary social and personal evaluation.101 Karpman, in his extensive work with character and behavior disorders, offers the opinion that in most cases a psychogenic etiology can be established if adequate investigation is made.160,161,162,163 A relatively small percentage of those we call psychopaths, he believes, are not so motivated. These, presumably disordered because of inborn or constitutional defect, he distinguishes from the majority and calls anethopaths.161r />
  Knight’s studies of severe alcoholics, many of whom were considered psychopaths, led him to believe that they often had “a parental background characterized by inconsistency and lack of unanimity in parental discipline resulting in conflicting unstable identifications in the son.” A weak, pampering mother in combination with a domineering father whose severity was fitful and inconsistent appeared frequently in the background of Knight’s cases. He feels that important causal relations between this early situation and the subsequent disorder are likely.169,170 Knight says:170

  Innumerable personality shadings and accents are possible from a son’s reaction to such parental management, but one regular result seems to be the fostering of excessive passive demands and expectations in the son, such passive, childish, feminine wishes being in marked conflict with masculine strivings inculcated by the father and by the cultural ideology absorbed from schooling and from contacts with other males.

  I have over many years looked hopefully for evidence of parental influences on my patients such as those discussed by Greenacre and Knight. I have not, however, been able to find regularly, or even very frequently, the environmental pattern in early life that impressed them as, perhaps, offering an explanation of the problems found in their patients. I have also seen many well-adjusted people, and also many with problems very unlike those of the psychopath, who come from homes similar to those described by Greenacre and by Knight.

  Adelaide Johnson has expressed a strong conviction that the delinquency of a child or teenager is sometimes caused by the parents’ own unconscious impulses toward antisocial conduct. The child or teenager, she tells us, is craftily used as a pawn and unconsciously encouraged in theft, arson, sexual promiscuity, violence, or sexual perversion in order to fulfill the parents’ unconscious emotional needs to carry out such conduct themselves.148,149,150 According to this formulation, the child, even after he has become an adult, remains unconscious of the parents’ adverse influence and of his real motives for antisocial conduct. Furthermore, Johnson reports that the parents are often unwilling to give up their vicarious criminal satisfactions and that they may actively block the psychiatrist’s attempts at therapy. Such an explanation has been accepted as a common cause for the psychopath’s disorder by a number of prominent psychiatrists.229

  Perhaps there are delinquents and psychopaths in whom such influences play an important part. Let us remember, however, that some methods of trying to determine what is in the unconscious may allow us unwittingly to project items from our theories into the assumed motivation of the patient and also of his parents. If persistent but unconscious antisocial impulses are really active in the parents, we might also ask ourselves if such tendencies might have been conveyed to the offspring by hereditary factors. I think it very unlikely that the parents of the patients presented here and of the others studied by me found satisfaction, unconsciously or otherwise, in the persistent misconduct of their sons and daughters.

  Lindner183 devoted almost an entire volume, Rebel Without a Cause, to the detailed report of one psychopath studied by hypnoanalytic methods. He believed that through processes of preverbal memory he was able to obtain from the patient a true report of significant and traumatic experiences which he dated as occurring at 6 or 8 months of age. Lindner gives a detailed and ingenious explanation of how he believes these experiences caused the patient to develop seriously disturbed relations with his parents and eventually to adopt the typical role of the psychopath. Despite the strong convictions of Lindner, his excellent presentation, and the superb title of his book, Rebel Without a Cause, there is much that makes me skeptical about the significance of experiences reported as having occurred at such an early age and about the validity of what may be recalled through preverbal memory or established chiefly by the interpretation of symbols and dreams.

  One reason for my skepticism is derived from the implausible and sometimes fantastic events occasionally reported by my own patients as having occurred in early childhood or infancy. Sometimes this material has impressed me from the beginning as fabrication or fantasy confused with memory. When teaching young physicians in psychiatric residency training I was often also impressed by the influence of the examiners convictions on items of experience reported by such patients. I found that some of these patients could be led on in almost any direction to report almost any sort of infantile recollection one sought to produce.

  This proclivity in some patients may play a significant part in explaining how conscientious therapists find confirmation for widely differing and sometimes contradictory theories during prolonged investigations of a patient’s infantile experiences and unconscious attitudes. It has tended to make me increasingly cautious about accepting as necessarily true historical data even from much later periods of life from patients who seem to be of this type. It has often been noted that the psychopath will very convincingly report entirely false incidents and attitudes in others, particularly in parents, that tend to put responsibility for his difficulties upon them.

  It is also true that experiences ordinarily withheld or deeply repressed in other people are often quickly and readily divulged by these patients. Disgraceful and extremely uninviting deeds are sometimes reported with a relish that suggests pride in them. Although shame and terrible conflict are sometimes claimed in such matters and superficial indications of such claims may be impressive, I am unable to find at any level evidence that such affects are major or even quite real. This is a factor deserving constant attention, for it can enter very subtly into material obtained from patients of this sort. The point most difficult to corroborate, in my own experience, is the actual or innermost personal reaction of these patients to the events they report. It is more difficult than with others to tell what the events mean to them.

  Some comments made by Jenkins are pertinent, it seems to me, to the question of whether or not psychopaths are acting out a conflict based upon unconscious feelings of guilt:147

  Effective challenge to a basic faith always causes pain and a reaction ridden with emotion in which the issues can easily become clouded … This challenge has been felt by some of the defenders of the modern psychodynamic faith which, at least initially, tended to a narrow conception that functional mental disorders and maladjustments are always due to conflicts within the personality. To enlarge this concept with a realization that morbid conditions and gross maladjustments may be due primarily to a lack of conflict within the personality represents a readjustment of thinking which is apparently beyond the flexibility of many professional persons. There is of course, a semantic problem involved. It was not difficult for mankind to understand poisoning, for it is easy to grasp the proposition, “what he ate made him sick.” The understanding of the vitamin deficiency diseases was more difficult because of the greater semantic difficulty of the proposition, “what he did not eat made him sick.” Yet this second proposition is as true and as necessary to any adequate consideration of illness as is the first. In the same way many of our dynamically oriented colleagues have great difficulty with the proposition, “The conflict he does not have makes him a psychopath.” This concept is true and necessary, but requires at least a flexible application of classical psychodynamic theory.

  Theories are advantageous when they stimulate some resourceful new attack on a problem. They are handicapping when they make it difficult for us to recognize important facts …

  If indeed we must get into the area of theory—and this is not entirely avoidable—I should like to propose that psychopaths differ from psychoneurotics and indeed contrast with them in their most important characteristics. The typical psychopath and the typical psychoneurotic are, in some important regards, on opposite sides of the normal. Where the psychoneurotic suffers from excessive inner conflict, the psychopath makes others suffer from his lack of inner conflict. Only the person who does not come in contact with serious cases of this sort, or whose mind is literally imprisoned by his faith in a theory can brush aside this fundamental diffe
rence.

  I have become increasingly convinced that some of the popular methods presumed to discover what is in the unconscious cannot be counted upon as reliable methods of obtaining evidence. They often involve the use of symbolism and analogy in such a way that the interpreter can find virtually anything that he is looking for. Freud, for instance, from a simple dream reported by a man in his middle twenties as having occurred at 4 years of age drew remarkable conclusions. The 4-year-old boy dreamed of seeing six or seven white wolves sitting in a tree. Freud interpreted the dream in such a way as to convince himself that the patient at 18 months of age had been shocked by seeing his parents have intercourse three times in succession and that this played a major part in the extreme fear of being castrated by his father which Freud ascribed to him at 4 years of age. No objective evidence was ever offered to support this conclusion. Nor was actual fear of castration ever made to emerge into the light of consciousness despite years of analysis.55,88