The conversation, once begun, developed amazingly. The younger man not only promised to behave from now on in an exemplary fashion but analyzed and discussed his past in such a way that the older found there was little that could be added. Despite his interest and his experience in such matters, he had seldom, if ever, encountered a more plausible interpretation of human mistakes and social confusion, of how distortion of aims and maladjustment develop out of the complicated influences and situations of modern living. Even more than the pertinent presentation of cause and effect and the cogent steps proposed for solution, the young man’s appearance of sincerity in all these realizations impressed the older counselor. He spoke as the wisest and most contrite of men would speak and seemed to have a more detailed and deeper understanding of his entire situation than even the most sagacious observer could reach.
The patient talked not only of what he would avoid but discussed plans for work and recreation, for development and progressive maturation. Tom emphasized how his irregular hours and unforeseen absences had kept his parents much of the time not sure whether he was dead or alive. Before the ride was over, the judicious counselor was encouraged and deeply optimistic. In addition, he was so impressed by points this young man had brought out and by his apparent earnestness and resolution that he felt himself wiser from the experience. Moved and stimulated, he admitted that he had obtained new and valuable viewpoints on life and deeper seriousness. He had been stimulated to review his own patterns of behavior and to seek a better and more progressive plan of self-expression. In this frame of mind he bade the patient good-night, letting him out of the car at the front gate of the parents’ home.
The patient did not even enter the house. After going in the gate, he walked through the grounds, went out by a back entrance, and was not heard from that night. He was not, in fact, heard from for a week. News then came of his being in jail again at a nearby town where he had forged, stolen trifles, run up debts, and carried out other behavior familiar to all who knew him.
This young man apparently has never formed any substantial attachment for another person. Sexually he has been desultorily promiscuous under a wide variety of circumstances. A year or two earlier he married a girl who had achieved considerable local recognition as a prostitute and as one whose fee was moderate. He had previously shared her offerings during an evening (on a commercial basis) with friends or with brief acquaintances among whom he found himself. He soon left the bride and never showed signs of shame or chagrin about the character of the woman he had espoused or of any responsibility toward her.
During the war Tom maintained over some months an offhand relationship with the wife of a man in combat overseas. When in town he ate at her house, sometimes slept there with her, but was as heedless of her and her feelings as of his parents. She apparently suffered some anxiety when, after making plans and promises to do something special with her, he disappeared and she heard nothing from him until he called her from another city (reversing the charges) to chat casually and sometimes to speak eloquent words of endearment. Sometimes he took precautions to deceive her about his sporadic sex relations with other women; sometimes he forgot or did not bother.
On returning from his trips during the war, he sometimes told interesting stories of having been for a time in the Navy, narrating with vivid and lifelike plausibility action in which he had participated and which led to the destruction of a German submarine off Jamaica or the pursuit of a raiding warship off the coast of Greenland. Again he would talk at length about his experiences transporting airplanes from Miami to Havana or accidents leading to hospitalization and operation and diverse adventures with nurses, other patients, interns, etc. Once, during a stag party discussion of venereal disease, he even fabricated an account of having caught one or more of these unenviable maladies and enlightened his listeners about treatments he had received, drugs, dosage, and complications.
None of these fraudulent stories had a real element of delusion. When really caught in the lie about any of them and confronted with definite proof, he often laughed and passed it off as a sort of joke.
After these events and many others similar in general but differing in detail, Tom seemed modestly pleased with himself, effortlessly confident of the future. He gave the impression of a young man fresh and unhardened, in no respect brutalized or worn by his past experiences. He also seemed a poised fellow, one who would make his decisions not in hotheaded haste but calmly, whether these were prompted by immediate whim or by intentions he had much time to entertain.
9. George
This man was 33 years of age at the time I first saw him and admitted him to a psychiatric hospital. He stated that his trouble was “nervousness” but could give no definite idea of what he meant by this word. He was remarkably self-composed, showed no indication of restlessness or anxiety, and could not mention anything that he worried about. He went on to state that his alleged during the war. He then proceeded to elaborate on this in an outlandish story describing himself as being cast twenty feet into the air by a shell, landing in his descent astride some iron pipes, and lying totally unconscious for sixty days, during all of which he hovered between life and death.
A physical examination showed George without any evidence of injury or illness. In fact, he was a remarkably strong and active man, 6 feet tall and 170 pounds in weight. Later, in an athletic meet held on the hospital grounds, he showed himself an exceptional sprinter and broadjumper, surpassing many able competitors ten years younger than himself in these events. Prolonged observation and psychiatric study brought out no sign or suggestion of a psychosis or a psychoneurosis. Despite his original complaint of “nervousness,” he was at all times calm and without the slightest evidence of abnormal anxiety. He ate and slept well, did not complain of any worries, and was free of phobias, compulsions, conversion reactions, tics, and all other ordinary neurotic manifestations.
Records of this man’s career show that he has been confined in various mental hospitals approximately half the time since he became of age. In addition to periods ranging from a few weeks to six months at federal institutions in Texas, Tennessee, Mississippi, Georgia, and Florida, he was also frequently sent by the government to private psychiatric hospitals and invalids’ homes. Between these experiences he spent a good part of his time in the local county jail or in other jails at Birmingham, Montgomery, Mobile, or other towns which he visited. He was taken in sometimes for drunkenness and disorderly conduct, at other times for writing bad checks, petty theft, reckless driving of automobiles, obtaining money under false pretenses, snatching the purse from a prostitute, taking possession of a house whose owners were off on vacation, and similar actions. Extravagant but insincere threats to harm his wife and four children made after taking a few drinks and lunacy charges also accounted for a dozen or so arrests.
During all the observation at various hospitals mentioned previously, as well as at a state mental hospital where George also spent a short time, no technical evidence of a psychosis or a psychoneurosis is mentioned. His wife and friends have repeatedly persuaded local authorities to consider him as mentally deranged and to have him sent to hospitals rather than let him face the various charges brought against him from time to time.
On other occasions, when he was refused admission by hospitals where physicians had already studied him more than once and declared him sane, competent, and not in need of psychiatric treatment, friends and relatives have had him arrested, have prevailed upon local doctors to sign statements that he is deranged and dangerous, and have brought pressure to bear so that hospitals, in the light in which the case was presented, had no choice but to readmit him.
The doctors involved in such procedures, country practitioners for the most part, never mention technical evidence that would indicate a psychosis or a psychoneurosis as they are described in the textbooks. Such statements as these are typical:
Something is decidedly wrong mentally. I don’t think I have ever come in contact with
a man as unreliable as he is. He worries everybody that has fooled with him until they hate him. The County authorities are tired of boarding him as he is not a criminal. (Family Physician)
Everybody who comes in contact with him agrees that he should be confined permanently … very unreliable as to his word of honor. (County physician)
A physician who owns a private hospital located at a town nearby, in explaining his refusal to accept the patient again, ends by saying “we do not cater to his class.”
He is described as frequently drinking whiskey to excess and as sometimes taking Veronal, Luminal, Amytal, and bromides to ease himself in the aftermath of a spree. Although there is no record of alcoholic hallucinations, many bizarre and notable actions are described when the patient has had something to drink.
On a cold February day he rushed, fully clothed, down to the creek and sprang in. After thrashing about, yelling and cursing to no purpose and creating a senseless commotion, he swam back to land without difficulty. One fine spring evening he is said to have run entirely naked through the streets of the town. He once sat up all night under the house striking matches aimlessly.
Generally believed reports indicate that late one night he, with several drinking companions, succeeded in releasing a half-tamed bear from the cage in which it was kept at a filling station to attract trade. A good deal of fright, some civic uproar, and hasty precautionary measures ensued. Assiduous and painstaking effort by a number of local volunteers led to the bear’s relatively uneventful return to his cage. According to available information, the bear was not terribly dangerous but sufficiently so to make a man of anything like ordinary responsibility sharply restrain all impulses to loose him on the outskirts of an unprepared community. The patient denied having been a party to this exploit but the evidence against him is strong.
In view of this man’s failure to make any effort to conduct himself sensibly through so many years, there is no wonder that many are found to say that he is of unsound mind. He has done no work except for occasional periods when for a week or ten days he would show considerable promise in such occupations as automobile salesman, clerk in a grocery store, soda jerk, or bootlegger’s assistant. It was not long before he proceeded, in the language of an elderly uncle often called on to deal with these problems, to “launch himself on another pot-valiant and fatuous rigadoon.”
After studies of his case were completed, and on the basis of his cooperative and technically sane behavior, he was given parole privileges. He promised, of course, not to drink or to break any other rule of good conduct and expressed many fine intentions positively and reassuringly. Six days later he staggered into his ward and attempted to go to bed without being noticed by the attendant. On being found so plainly “in his cups,” he raged petulantly, first denied any contact with stimulants, and finally, with indignation, admitted having taken one-half glass of beer. His eyes were bloodshot, he could scarcely stand, and he spoke in wild, boastful, almost unintelligible accents. A bottle of cheap whiskey was discovered hidden under his mattress.
According to the custom of the hospital, George was now confined to a closed ward where his superficial sanity stood out arrestingly from the delusional babbling and the blank-faced, staring inertia of his psychotic fellows. He was always intelligent and agreeable, frequently pointing out the obvious inconsistency of his being confined among “insane” people. Pleading important business downtown, he was, after three weeks, given a pass to go out in the care of a hospital attendant for a few hours. He returned in good condition, but when night came on, he refused to go to bed, cursed, and spat at the nurse who tried to advise him. His breath reeked of raw liquor, and a search disclosed a half-empty pint bottle in his pocket. The attendant who took him to town denied having allowed him to purchase whisky and could only surmise in astonishment that the patient must have slipped off for a moment and obtained the bottle while pretending to go to the toilet.
A few weeks after this incident, the patient’s wife came to town and asked to take him out on a pass, agreeing to assume full responsibility. When she returned him to the hospital, it was evident that he had drunk liberally, and the wife confessed herself as having been unable to deal with him.
The next day a man living near the hospital advised that he had fired a revolver at the patient on being alarmed by his behavior. George, after loitering about the premises boisterous and vaguely threatening, began to fumble at a window as if trying to force his way in. The shot had not been aimed at George but only in his general direction in order to frighten him. This end was satisfactorily achieved, for at the report he made off in a clatter of undignified haste.
About a month later, on strong promises of good behavior, George was again given parole. Within a few days he climbed over the fence and hired an automobile. After racing in this for a while about the road to no special purpose, he wrecked it in the city streets and was taken to jail.
This cycle of events was repeated several more times. The man was obviously not where be belonged when confined on a closed ward with extremely psychotic patients of the ordinary type, just as plainly he showed himself unable to remain on an open ward with mildly psychotic patients who succeeded in adapting themselves to a life of limited freedom. Finally, on being kept under close supervision for several weeks following a senseless and troublesome spree, he demanded his discharge in a well-written letter emphasizing his sanity and the inappropriateness of his hospitalization. He was released accordingly.
Six months later he was sent back to the hospital from the local jail, where he had been confined after striking a Negro man with a shovel. He had, as was his wont, been drinking but showed little evidence of being affected by alcohol. The other man was walking peacefully by when our patient engaged him in a dispute about possession of the pavement. “Flown with insolence and [perhaps] with wine,” he found the other’s conciliatory attitude not to his taste, waxed more overbearing, and ended by felling his presumed adversary with a deft blow. He did not on this occasion seem to lose control of himself like a man in a genuine rage who might have struck blow after blow. His deed seemed prompted more by fractiousness and impulses to show off than by violent passion.
His application for admission was at first refused by the hospital, since only patients suffering from mental disorder in the commonly accepted sense are eligible. His wife and influential friends thereupon invoked higher authorities, who arranged for him to be taken. This time he was again found to be free from all symptoms of recognized mental disorder, and his condition was classified in the following terms: (1) no nervous or mental disease and (2) psychopathic personality. He did not complain of nervousness as he had at the time of his first admission but instead insisted that he was a sane and well man and demanded full privileges to come and go as he pleased, saying that the authorities who arranged for him to come to the hospital had promised him this.
It was plain that George regarded the hospital simply as an expedient by which he might escape the legal consequences of his behavior. After being kept for a few weeks on a closed ward, he was allowed to go out on the grounds alone with the understanding that after a few days he would be discharged as sane and competent. He could not, however, keep out of trouble. On the third day of his freedom he was seen by the guard driving at high speed through the gate in a car belonging to one of the physicians. Chase was offered, and after a lively race he was overtaken about fifteen miles from the hospital, having battered in a fender and knocked off a headlight of the car on the way.
It is hardly necessary to point out that this man had repeatedly been instructed in the rules to be observed while on parole, that he knew the driving of an automobile by a patient in this hospital to be a serious violation of his trust, not to speak of the theft, or the unauthorized borrowing he proclaimed it to be. When finally caught, he appeared as sane as before, showing no evidence of any episodic loss of his usual reasoning power. He had not been drinking when he took the automobile and, of course, the pursuit
was too hot for him to obtain liquor while in flight, though in view of his previously demonstrated ingenuity and dispatch in fulfilling this want, it would scarcely have been surprising to find him properly rattled.
On his return to the hospital, he did not show the slightest sign of remorse over having taken possession of and having succeeded in damaging the car belonging to a physician who had always been particularly kind to him. The owner’s willingness to free him from responsibility for his deed he took as a matter of course, expressing neither gratitude nor satisfaction. In fact, he dismissed the whole matter as insignificant, and his prevailing attitude was that of a man generally ill used. Some weeks later he was sent home.
About six months afterward his wife telegraphed the hospital that she could no longer cope with her husband, whom she described as being still in such folly as that already recounted. He did not, however, arrive by the train he boarded. It was subsequently learned that he got off along the way, obtained a few drinks, and made a clamorous nuisance of himself in the station until the police came to cut short his activities.
A little later he was readmitted following a series of misadventures in no way different from those already mentioned but including a period in the state mental hospital. He was alert and rational and just as he had always been before, except for the presence of a urethral discharge of gonococcic origin. He gave a false account of his activities, saying that he had been working on a farm and had been in no trouble at all. The records showed that he had not turned his hand to make an honest dollar since he left and that a week had seldom passed without his buffoonish or antisocial activities arousing consternation in the neighborhood and bringing him to the attention of the police.
He was freely communicative and scarcely waited for encouragement to give an explanation of how he came by his gonorrhea. The records show that after causing some commotion in town by maudlin or threatening outbursts on the streets and silly, pompous threats about harming his wife, he had been brought in, bedraggled and disconsolate, from a ditch where he lay and confined to jail.
The Mask of Sanity Page 11