On being detected in activities that would produce fear, shame, or consternation in others, this patient often showed simple insouciance. Once at college she did so well for so long that hope returned to her family. Apparently she had found herself at last. After a succession of excellent reports, one showing failures in four subjects appeared. Anna was called on long-distance telephone by her father, who wanted to lose no time in trying to find some remedy for the trouble.
Her easy, happy laughter relieved him deeply, even before she had time to go on and explain the mistake that had been made in the dean’s office. She had just heard of it but had not realized the rather comical error had been transmitted to any report that reached him and her mother. Actually she had not realized it was quite time for these reports to be mailed out. She had been, you see, pretty busy—but “mighty happy,” too. Warmed within and deeply reassured, he left the telephone completely at ease.
Within a few days, sure enough, there came official acknowledgment of the mistake. The grades of another girl had been confused with those of his daughter. The true report was even better than those excellent ones that had been coming regularly now for months. The dean’s signed name and the official school paper and forms would have dispelled any suspicions of fraud had suspicions arisen. Anna’s tone and manner when she spoke over the telephone were such, however, that no doubt at all seemed justified.
Soon truly disturbing information came from the school. Not only was Anna failing dismally in all studies, but serious misconduct had brought the question of her expulsion to a crucial point. Wiring his daughter that he was taking the first train, the father also instructed her to make appointments for him with the college authorities.
On arriving he found that no appointments had been made. He was entirely unexpected. He was surprised, furthermore, to find that Anna had left for the weekend, after convincing the house mother that she had parental permission to visit an imaginary aunt. Apparently she typed letters and forged signatures to bring off this deception with cleverness comparable to that employed in getting the school stationery and report forms and successfully utilizing these to send back the false reports to her family.
On her return after the weekend she seemed surprised to find her father still there and at first expressed vexation with him. He never learned just what misadventures befell his daughter, who had apparently roamed about in a large city nearby. She took all the discussion of her recent acts with equanimity, apologized for her mistakes, and admitted that it was quite inexpedient to bring off such deceptions when it was apparent to her they would certainly and promptly be discovered. She said she did not know precisely why she had acted in such a plainly injudicious way, but she never seemed curious or really concerned about the possibility of discovering a reason for the behavior.
What would have happened to this patient had it not been for the extraordinarily ample estate of her family and for their persistent care? One can only speculate. We need not here estimate how many times she was released from jails in widely scattered cities by their efforts, how many times she was hospitalized, how many beginnings with psychotherapy were made by various experts. It is interesting to note that Anna, unlike so many whose conduct closely resembles hers in other respects, seems never to have committed a major felony or tried to do serious physical injury to another.
It is true that she was badly beaten up in some sort of night spot brawl in St. Louis. On this occasion several of her ribs were fractured, and a lung was punctured; her brother, who flew to her aid from Baltimore, thought at first her injuries would prove fatal. Though occasionally, when drinking, she has taken an active part in slapping or hair-pulling incidents, she has shown little inclination to attack. In similar episodes she rarely initiated gross vocal disputes or was vulgarly aggressive with words. Calmness seemed more characteristic of her than high temper, although it is recorded that in her teens she was expelled from one academy for publicly telling off a school authority in a speech vehemently and versatilely obscene and closing with references anything but flattering to the state of his “third leg.”
Many of these incidents which in isolation appear spectacular occurred while Anna passed in the community as a reliable, conforming, and extraordinarily attractive woman. Much of the time she seemed poised, polite, and a paragon of happy behavior. For a while during her early twenties she taught a Sunday school class. Her teachings were ethically admirable and she gave a strong impression of sincerity. She often worked for a month or more at a time, efficiently and with what seemed pleasure, at the Red Cross and in other welfare activities. Most who knew her casually in these endeavors would have been genuinely astonished to learn that she had any serious personality problem.
Once while hospitalized for a week or ten days, she left the almost universal impression of being a delightful patient. Courteous, composed, undemanding, and cheerful, she took discomforts and minor pains in a way that elicited admiration. During this brief period, in which a benign nodule was surgically removed from her breast, she casually accepted cunnilingual attentions from a female attendant (apparently a true lesbian) and also sought to entice an intern. In these enticements she went so far as to get the fly of his trousers open before accepting his determination to refrain.
Occasionally during her early thirties, but also a few times since, Anna had engaged in a pastime known in some circles as gangbanging. There were minor variations of procedure. Usually drinks with five or six men, whom she might pick up in one of the less inviting honky-tonks or frolic spots about town, constituted the first phase. Later the group rode out into the country and all her companions had sexual relations with her, each taking his turn. On such an exploit, argument once arose about whether or not she had stolen a cigarette lighter belonging to an escort, and the group, uniting against her, threw Anna in a creek and then drove off, leaving her to walk home.
This patient spent a good deal of time reading. In contrast to many psychopaths who readily claim all sorts of entirely imaginary learning, she showed considerable familiarity with literature of many sorts. She seemed to read Shakespearean plays, the major Russian novels, pulp magazines, and comic books with about the same degree of interest. Her factual knowledge about what she had read seemed good, though it must be admitted she often falsified with assurance when questions led her into unknown areas.
She played complicated music on the piano with fine technical skill and spent a good deal of time doing so. She had an accurate acquaintance with current scales of intellectual and esthetic fashion and could probably have avoided offense even to the most snide of editors of the most avant-garde of little magazines. How she reacted to such matters in the innermost and final chamber of her being can only be surmised. My impression is that King Lear and Amazing Confessions elicited responses in no fundamental way different.
There is little I can offer in explanation for the biologic enigma I trust is apparent. Despite abundant time to approach the patient directly, unusually rich detail furnished by others, and even the rare chance of treating psychiatrically more than one other upon whose life her own had impinged traumatically (and, so it would almost seem, of seeing her through more than one set of eyes), despite all this, I cannot reveal the forces that patterned her. I have opinions, but opinions are not facts.
Without claiming there is anything demonstrable or profoundly explanatory in such an appraisal, I would give these impressions. It is unlikely that she experienced (in what can reasonably be called ordinary awareness) much of the emotion that we associate with the various deeds she has carried out. In both quantity and quality her emotions, I believe, have regularly fallen short of the affect we almost automatically assume must prompt, accompany, or follow such actions as hers. Though appearances of emotion were sometimes impressive in Anna, it seems probable that these were chiefly facsimiles of actual feeling, an automatic and undesigned mimicry. Though she had vexations and minor satisfactions and though she could at times get mad and could be a little fond
of people, Anna never really seems to have meant much harm to others or to herself.
One of the physicians who had often treated her expressed his bewilderment about how real seemed her disregard of what was obvious, how strangely she escaped the subjective consequences of her experiences. Taking a phrase from the Russian novel about prostitution, Yama, to embody his reaction, he said, “All the horror is in just this—that there is no horror.”176
A thoughtful and now elderly member of her family whose advice her parents and one of her early husbands had often sought was particularly impressed with what he described as an unbelievable but somehow authentic innocence that Anna never seemed to lose. Experiences which would harden an ordinary person conspicuously or ensure a conscious cynicism, mordant and profound, seem to fall lightly on her spirit, to leave her surprisingly serene. The person just mentioned, after more than two decades of concern with her problems, finds even more surprising than all the unfortunate acts combined, Anna’s thoughtless assumption that she is to be trusted in all matters, that her behavior has been essentially honorable and ladylike, and the fact that her self-respect is apparently bright and unblemished.
Seeking to give his impression of this strange equanimity, of these paradoxical attributes of innocence, he once quoted:
She hath wasted with fire thine high places,
She hath hidden and marred and made sad
The fair limbs of the Loves, the fair faces
Of gods that were goodly and glad.
She slays, and her hands are not bloody;
She moves as a moon in the wane,
White-robed, and thy raiment is ruddy,
Our Lady of Pain.
A. C. Swinburne
“Dolores”
13. Jack
My prolonged acquaintance with our next subject began on the occasion of his return for a fourth period of hospitalization. He was accompanied by the sheriff who had brought him from jail in Winston-Salem, N.C. He was affable and courteous, entirely rational in his conversation. Though rather carelessly dressed, he made an imposing figure of a man; he was 6 feet, 3 inches tall, weighed 210 pounds, had red hair, blue eyes, a quick, humorous glance, and a disarming smile. Though 45 years of age, he appeared to be in the early thirties. His body retained good athletic lines, and he sat or stood with an easy poise.
Jack gave no impression of evasiveness but, on the contrary, seemed rich in understanding and serious in his desire to be helpful. He admitted that he had been a periodic drinker for many years, stating that he worried about his life and drank to forget; he described fleeting alcoholic hallucinations which he said he had occasionally experienced. “I once thought there was a 6-foot porpoise in bed with me all night. I have seen a little man no bigger than your finger standing at the window talking to me. One night cats came with heads like lions, also lions with heads like cats.” He was perfectly aware that these manifestations were unreal and attributed them to the effects of alcohol, expressing amusement at their absurdity.
As a matter of fact, it is doubtful if these hallucinatory experiences were real. After knowing him better, it seemed likely to me that he had made up these stories, thinking they would help him gain admittance to the hospital. Any difficulties aside from that of merely drinking excessively he denied, emphatically but good humoredly dismissing all such questions as inapplicable to someone like himself.
He is a man from an urban community, of a family, though not particularly distinguished or wealthy, generally regarded as gentlefolk. The details of his childhood are not known except from his own account. He got along satisfactorily in his studies, completed high school, and decided not to go to college but began to work. He first obtained a minor position in a bookstore, changed to various other clerical employments, and then took up engineering, He had begun to drink a little when 17 years of age but, according to his own report, did not go on serious sprees until in his early twenties.
Although Jack changed about rapidly and lost many positions, he apparently found it rather easy to succeed, once earning a large income as assistant city engineer. Evidently he had at this stage already begun to cause trouble. His relatives, most of whom had much less income than the patient, were called upon frequently to pay him out of debt, to exert influence on his employers, and occasionally to get him out of jail. His work was sporadic and frequently interrupted by protracted bouts of drinking or by sudden trips to other towns during which he lost large sums gambling, ran up debts buying things for which he had little use, borrowed heavily from old friends, now and then forged or otherwise defrauded, and often fell into the hands of the police. His confident, reassuring manner and his easy way with people went far to make up for his lack of reliability or any serious, sustained interest in his work.
His relations with women have always been casual. He had frequent sexual experiences but failed to develop any lasting attachment. He contracted syphilis in the early twenties, received intensive treatment, and was apparently cured. During the war he was promoted to the rank of sergeant and had the misfortune to contract gonorrhea.
Though genial, talkative, and a splendid mixer when sober, he did not choose to do his drinking in convivial surroundings. Whether he started alone or with others, he would on occasions continue to drink day after day, keeping himself in a sodden, maudlin, or highly irritable state, more or less barricaded in some cheap hotel room or brothel until succored by his friends or relatives or arrested as a nuisance by the police. Sometimes, after being primed with a few drinks, he would hire a Negro boy to drive him out into the country where, having brought along a supply of raw corn whiskey, he would alternately drink in sullen fits or lie snoring and semistuporous among the weeds. His stock being at last exhausted, the boy would faithfully bring him into town and throw him on the mercy of hard-taxed friends or relatives.
One can but imagine the young Negro as he would sit hour after hour, sometimes day after day, in solemn attendance on his white gentleman, watching the latter crash stumbling about the bushes, lie semicomatose, breathing stertorously in the underbrush, or come lurching again up to the automobile, muttering a demand for more liquor. It is easy to imagine the naive face remotely amused but never entirely free from awe and wonder as he listens to his temporary employer blubbering and raving in meaningless syllables of despair or waking echoes from lonely pinelands with his inane curses. What can he make of this nonsensical melodrama in which he is called on to play his inconspicuous but necessary part? He has been taught that the white man is boss and that his ways are marked out by wisdom. The white man has money and influential friends and seems to be free from penalty for his folly. Yet this young and inexperienced Negro is humorous. Though mystified as we all are by these happenings, he cannot but smile as he contemplates the ways of this world.
As years went on, this man’s conduct became worse. No matter how hard Jack’s relatives worked to obtain positions for him, he lost them within a week or ten days, sometimes through drinking, sometimes through simple, gross neglect without the benefit of drink. Other jobs he lost by haughtily dressing down an employer, by overcharging customers and pocketing the gain, by engaging in petty rackets and illegal schemes to defraud, or by various additional misdemeanors and delinquencies.
He was sent several times to take whiskey cures at various private sanatoriums and was also hospitalized for short periods in psychiatric institutions and once at a state mental hospital. He was always found “sane and competent” and discharged after a short period.
In time he became an all but unbearable burden on the other members of his family. The oldest brother, vice-president of a local bank, another brother successful in business, a married sister in good circumstances, and another sister unmarried but financially independent and prominent in club work all strove to their utmost to help him. The task of supporting him was but a small part of their problem. If kept in the house by any of his family, he persisted in his overbearing, riotous ways, proved unmanageable, and disorganized the ent
ire household. Sometimes he took silver or other valuable objects belonging to a sister or a brother and pawned or sold them. He seemed unable to feel that there was need to make restitution. If he boarded outside, he shortly fell into the hands of the police, usually after incurring debts and behaving in such a way as to involve all concerned with him in great embarrassment and difficulty.
During observation at the hospital he was always alert and polite, free from any suggestion of delusions or hallucinations. He impressed his examiners as being very open and frank. He admitted that he had never realized the seriousness of his problems until recently. He took a lively interest in his surroundings, showed excellent reasoning power at all times, and seemed eager to take advantage of his treatment in the hospital in order to gain a fresh outlook with the earnest intention of leading a happier and more successful life in the future. His memory was excellent; he was nearly always in good spirits, energetic, affable, and fond of company. The Wassermann blood test was negative, as were spinal fluid Wassermann and colloidal gold tests. Neurologic and psychiatric examinations were entirely negative. The medical staff, after six weeks of study, considered him sane and competent, granted him parole of the grounds, and recommended discharge after a short time.
Jack remained on parole for about two months without getting into serious difficulty. His family, citing his long record of maladjustment, asked that lie be kept in the hospital until the staff was “sure he had become normal.” He began at this stage to grow impatient about leaving, insisting that he was now able to go out and live a satisfactory life and that there was no reason for him to be kept longer. Indeed, on the basis of his appearance then one would have been at a loss to find even the flimsiest excuse for holding him.
The Mask of Sanity Page 18