The Mask of Sanity
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* “And these signs shall follow them that believe; in my name they shall cast out devils; they shall speak with new tongues; they shall … take up serpents and if they drink any deadly thing it shall not hurt them” —[Mark 16:17–18]. ↑
* Stedman’s Medical Dictionary (1972): “Psychopath: The subject of a psychoneurosis. One who is of apparently sound mind in the ordinary affairs of life but who is dominated by some abnormal sexual, criminal or passional instinct.”
Dorland’s Illustrated Medical Dictionary (1974): “Psychopath: a person who has an antisocial personality. sexual p., an individual whose sexual behavior is manifestly antisocial and criminal.”
Blakiston’s New Gould Medical Dictionary (1949) gives: “A morally irresponsible person: one who continually comes in conflict with accepted behavior and the law.”
Curran and Mallinson (1944) say: “The only conclusion that seems warrantable is that some time or other and by some reputable authority the term psychopathic personality has been used to designate every conceivable type of abnormal character.” ↑
* The ease with which defective heredity may be found in any case in which one looks for it is well known. A study published in 1937 revealed that 57 percent of a group of normal people showed a positive family history of “neuropathic taint.” ↑
* See Appendix for details of this survey. ↑
* Such traits can occasionally be found even in wise and reliable people. A highly regarded and respected friend of mine, a doctor of philosophy, recently appointed professor of physics in a small but distinguished college, and the author of several useful and accurate contributions to scientific literature, is the first who comes to mind.
This distinguished man has often regaled groups of acquaintances, myself among them, with accounts of working his way through the university by playing professional ice hockey at night, later setting type on a newspaper for several hours, rising before daylight to stoke tugboats on the waterfront, riding thirty-four miles to a high school to teach one subject and thirty-four miles back, as well as keeping house in a three-room apartment shared with six aviators and relieving the janitor of the building one hour during each twenty-four. All these activities were spoken of as being carried out simultaneously and along with full-time work at the university. He described in great detail and with apparent familiarity the duties of these positions. His only studying, he said, was done on the subway en route to his various duties.
The same friend once came up from behind while another man and I were commenting on the height of a cliff on which we stood. The hazards of a dive from the position were being idly discussed.
The newcomer at once estimated, probably with commendable accuracy, the height, the angle of landing, and all the technicalities of such a dive. He then launched into an astonishing description of a dive he had made in early youth from a bridge 167 feet above the Guadalquiver.
One of the students to whom this excellent scholar lectures stated that it is the custom for each succeeding class to tabulate his adventures and their duration in these pseudoreminiscences and therefrom compute his age. The top figure so far is 169 years. Several classes have bettered 150. The students have great respect for him and confidence in him, as a teacher and as a man. They are particularly devoted to him.
Let it be clearly understood that the person discussed in this footnote is not being brought forward as illustrative of the subject of this study. He is no part of a psychopath. He is, in fact, a character whose essential traits lie at the opposite extreme. The reminiscences here ascribed to him are not told boastfully or for the purpose of shielding himself or of gaining any material end. He is strikingly free of arrogance, kind to a remarkable degree, and altogether worthy of his strong reputation as a good and reliable man. His word in any practical matter is to be respected. ↑
* Not all of these need be brought out here. ↑
* I have reliable, firsthand information on Jane’s situation in addition to what came through the present case. ↑
* See Chapter 32 for further discussion of these points, particularly of the contrast between “compulsive” and “impulsive” symptoms. ↑
* See Chapter 36. ↑
* This reference to hearing voices is, of course, made in jest. He has never experienced hallucinations. ↑
* One of the most attractive and intelligent nurses in the hospital had, several years previously, married a patient whose disorder was diagnosed as psychopathic personality and who was much more obviously a poor marital risk than our present subject. The story of her experiences with him could not be adequately given without devoting our entire volume to it. ↑
* See Chapter 36. ↑
* Pinel, Esquirol, Rush, Woodward, Conolly.205 ↑
* In metaphysics or in personal formulations of religious conviction and other individualized value judgments, such concepts may be essential and necessary to human endeavor. Medicine (including psychiatry) has nothing to say against the value of methods and concepts that apply to the subject in dealing philosophically, theologically, or personally with matters beyond its bounds and from aspects impertinent to its task. The methods of medicine do not apply here. Such responsibilities do not belong to the doctor. He may work in Metaphysics or mysticism, but there is no evidence that by medical methods he can solve such problems. ↑
* In Henry’s original text from which the quotation was taken by Sadler, this list of physical deformities and organic brain and spinal cord diseases and abnormalities precedes a description of mental deficiency, to which it has pertinent application. ↑
* It is only proper to emphasize that Dr. Healy’s subsequent writings do not suggest any identification of the type of patients we are discussing with other sorts of disorder related to organic brain disease. His work, on the contrary, stands out among the most valuable efforts of those who h
ave helped clarify these matters. ↑
* I have discussed these questions at length in another work, The Caricature of Love. ↑
* Such a conclusion would, however, be as seriously wrong as to assume that the inveterate reader of sentimental rhymes gave evidence of a strong inclination for poetry or that the empty and aggressive braggart were really of stoic fiber. ↑
* Carlyle said, “True humour springs not more from the head than from the heart; it is not contempt, its essence is love; it issues not in laughter, but in still smiles which lie far deeper. It is a sort of inverse sublimity, exalting, as it were, into our affections what is below us.” Cited in Parkhurst.231 ↑
* After some years of experience with them, I was forced to conclude that, theoretical technicalities notwithstanding, severe psychopaths showed a disorder, in some important respects, more like the disorder of those classed as psychotic than the mild or questionable deviation presumed by official psychiatric standards. It was therefore interesting in 1938 to encounter an opinion expressed by Karl Menninger about patients of this type.
After stating that in his earlier psychiatric experience he regarded alcohol addiction as a bad habit and a little later as a neurotic manifestation, Menninger adds, “Now I regard is as near a psychosis.” He also states, “I would be inclined, if one of my young relatives had to have either schizophrenia or addiction to alcohol, to believe that his chance for getting back into normal life would be greater if he had schizophrenia”206
Although the term psychopathic personality was not used to designate the patients of whom Menninger speaks, it is plain that he is referring to the underlying personality disorder and not to the direct effects of drinking. I feel that this personality disorder is the one discussed here. This term is, in fact, used by the author of the paper Menninger is discussing, and there seems no reason to doubt that it is the psychopath to whom these statements apply and no reactive or neurotic drinkers.170
In view of our traditional practice of calling persons diagnosed as antisocial personality legally sane and, in many institutions of judging them ineligible for treatment, an opinion of such disorders expressed in 1804 by John Cox is of interest. Dr. Cox wrote, “Persons of this description might appear actuated by a bad heart, but the experienced physician knows that it is the head and not the heart which is defective.” (Cited in Henderson.128) ↑
* This violent and unfortunate term I use with apology but cannot spare here because of its clear-cut emphasis. ↑
* A vast difference exists, of course, between what various persons regard as good or beautiful or desirable. John Locke observed that “those who are canonized as saints among the Turks lead lives that we cannot with modesty here relate.” “An apple by Paul Cezanne is of more consequence artistically than the head of a Madonna by Raphael,” is the initial sentence in a well-known work on painting.34 In contrast with all the various diversities of viewpoint and degrees of conviction found among ordinary people, the so-called psychopath seems to hold no real viewpoint at all and to be free of any sincere conviction in what might be called either good or evil.49 ↑
* “Intellect is invisible to the man who has none.” (From Schopenhauer’s Essays, “Our Relation to Others.”) ↑
* The speaker did not have symptoms of obsessive-compulsive neurosis or any features of the psychopath. ↑
* Chapter 21, The Psychopath as Businessman. ↑
* Chapter 24, The Psychopath as Scientist.
↑
* Chapter 34, The Ordinary Criminal. ↑
* Durham v. United States, 214 F 2nd 862, D.C. Cir., 1954. ↑
* All comments on the policies and practices of the Veterans Administration apply to the period (1935–1937) when these patients were observed by me and do not apply to current policies and practices. ↑
* These are considered here on the basis of their usual condition without reference to their behavior in the alleged episodic “psychotic” periods. ↑