The Mask of Sanity

by Hervey Cleckley

  After considerable correspondence his relatives agreed to his returning home. In the meantime, they had been busy removing obstacles that might lie in the way of his readjustment. A good position had been found, one offering easy hours, congenial work, an excellent salary, and opportunity for advancement. Attractive quarters were being prepared where he could live under the super-vision of his relatives until he got established. His brothers and sisters all showed themselves not only eager to help him but extraordinarily aware of subtle subjective difficulties that lay ahead and always tactful to spare him the humiliation that one might think inevitable in his situation. They were as anxious not to embarrass him and to avoid any appearance of meddling as to give encouragement and support. His future seemed certainly to offer a maximum of security against all the factors that lead men to fail.

  These encouraging developments were explained to the patient. He admitted himself pleased but his manner did not imply feelings proportionate to his good fortune. In fact, he seemed to take things somewhat as a matter of course. His restless impatience to go out at once was not assuaged by preparations for him to leave within seventy-two hours. The money to pay for his transportation had already been received and he knew this. He pressed his demand to leave at once although he knew that the brief delay was requested by his relatives in order to prepare things to his own advantage. On being told that he could not leave immediately, he insisted on having a pass to go into town for a few hours, stating that he had to buy a hat, some shoes, and a few other things before going home.

  A man considered sane and plainly of superior intelligence could scarcely seem to be in danger of doing anything at this stage of events to interfere with the plans devised for his rehabilitation. His physician, nevertheless had a long talk with him, reviewing his history, trying to exert a helpful influence, to focus his attention on possible dangers, and to review with him his plans and resolutions.

  Superficially Jack did not appear to need help. Laughing, he stated that he would scarcely be such a fool as to throw away the freedom that now awaited him after all these months of unhappy confinement. He knew perfectly well why it had been necessary for him to come to the hospital. He said he realized clearly that if he took a drink his family would not take him back, that it would be necessary for him to begin all over again the weary, distasteful life on closed wards among “insane” men. With quick reassurances he stated that he did not even feel an inclination to drink but admitted that he knew, from his former experiences, if he took even one he might take too much. He had learned his lesson, he said, smiling confidently. The impression of excellent insight, of a steadfast determination to avoid any setback in his new career, was perfect—a little too perfect perhaps. His own confidence in himself was too quick, too easy, and too sure. He gave all the right answers with a glibness that, had he not been so polite, might have suggested a slight impatience. He used all the words that a man would use who understood and appreciated the miserable folly that lay behind him and meant to have done with it.

  He was given a pass and left the hospital smiling, well dressed, his head high with confidence, his firm promise to return after a few hours given in ringing tones of conviction. Nothing further was heard from him until the next morning when, behind bars at the police barracks, he regained his wits sufficiently to identify himself. A policeman on night rounds, attracted by his hoarse groans, had come upon him floundering among rubbish and weeds in the mire of a canal bank in a squalid neighborhood. Though blubbering and abusive, he offered no definite resistance and was led off in slovenly shame, his new clothes torn by brambles, tin cans, and broken glass and stained with mud and urine.

  He was returned to the hospital and after sobering up could give no plausible explanation for his conduct. He did not appear to feel that one was needed. He showed no indication of blaming himself and far less disappointment than one would have expected. His tendency now was to hold others responsible for his failure. He insisted that he had only taken a little beer and explained that he took it because the doctor in charge of his case had promised to send him home but failed to do so.

  This disheartening escapade naturally interrupted the plans for his going home and he was put back on a closed ward. His family, however, soon decided to try him again and within two weeks asked for his release, stating that the position for him was still available.

  In order to prevent any further complications, the patient was put on the train by an attendant. He arrived at home with a pungent odor of cheap whiskey on his breath and strongly under the influence of alcohol but still able to walk. For several weeks his family bullied themselves to keep him sober, at work, and away from crap games, front expeditions to sell mill workers nonexistent insurance, and glib attempts to float loans with his father’s business associates. He ignored their efforts.

  Among many other unacceptable items of conduct are recorded these: driving off in his brother’s car and not returning it for three days, becoming involved in a scheme to dispose of stolen goods, and participating in an illegal game of chance known as “the numbers,” by which many Negroes were defrauded of small sums. From time to time Jack would drink himself into the familiar state of maudlin stupefaction and lie around disheveled, inert, and apparently quite miserable.

  On being returned to the hospital he dismissed his failure with nonchalance, smiled cavalierly, and admitted, “I just fell off the wagon.” This was his attitude long after all effects of intoxication had subsided.

  He remained on a closed ward for a month, never showing the slightest indication of any recognized mental disorder, He was at this period somewhat fault-finding and wanted many small attentions. This was, however, entirely in keeping with his natural dissatisfaction with confinement. While going out with a group to the dining hall one evening, he escaped. Instead of making any serious or intelligent effort to get beyond reach of the hospital, he went to a disreputable roadhouse nearby and promptly became so obstreperously vocal and conspicuously offensive that he was located and brought back to the hospital by attendants.

  After being successfully kept on a closed ward for six more weeks, he again escaped by opening a door with a key he had stolen from an attendant. Two days later he was taken up by the sheriff in a nearby village, dirty, disheveled, and miserable, after an inane spree.

  He was now placed on a closely supervised ward to prevent him from escaping again and repeating these adventures. Here he was surrounded by extremely psychotic patients, many of whom were disturbed most of the time, babbling unintelligible nonsense and waving at the empty air, and all of whom he of course found vividly unsuitable as company. Obviously he did not belong in such surroundings, but it was difficult to find any other way to keep him in the hospital. After several weeks, in order to make his situation a little less unpleasant, he was allowed to go out on the lawn in front of the ward for short periods. His physician hoped that his recent unhappy experience might have taught him to handle himself a little more judiciously. This proved, however, to be false, for he again violated his parole by leaving the hospital and indulging in all sorts of nonsensical behavior typical of that already mentioned. This led him promptly into the hands of the police.

  His subsequent history is the same. Each time he is confined on a closed ward among delusional, hallucinated patients, or those deteriorated to a “vegetative” level of existence, his physician, struck with the incongruity, hopes that he will be able to take more responsibility upon himself and, encouraged by his completely rational external aspect and conversation, not to speak of his reassuring promises to abide by the rules, gives him a little freedom. Sometimes he gets along well for a few weeks, perhaps for a month or more, but always he ends up throwing away what has been gained, violating his parole, and soon becoming involved in activities that demand the loss of his liberty.

  Every possible effort is made to keep him in pleasant surroundings and on wards where patients are in relatively good mental condition, but he makes this difficult by
his repeated violation of all agreements.

  When last heard from he was, after a long period of confinement, out again on parole and for several weeks had conformed to rules. He is energetic, quick witted, alert, and jovial. No one talking with him would ever think that it had been necessary to keep him on closed wards among psychotic people.

  How long Jack will last in this status no one can say. I have little hope that it will be long and no hope at all that he will be able to leave the hospital and lead a normal life outside.

  14. Chester

  In his first admission to the closed ward of a psychiatric hospital, Chester W., 24 years of age, was friendly and alert. His freedom from anything that would suggest an ordinary psychosis was immediately noticeable. He explained to the examiner that he did not suffer from any nervous or mental disorder and emphasized the statement that no question of such a condition had ever come up in his case. He said that he came to the hospital for further examination of a serious injury to his ankle which he sustained while in the army and for which he hoped to get a pension.

  When told frankly that, according to accompanying reports, he had been admitted because of persistent antisocial and irresponsible behavior, spectacular alcoholic episodes, and extreme maladjustment, he affected considerable surprise and insisted that some mistake had been made. In fact, his surprise seemed real.

  It was pointed out to him that unquestionable evidence from his parents, relatives, and friends, as well as from a social service report, established the fact that he had been stealing, defrauding others, and making a boisterous nuisance of himself when drunk since he was 16 years of age.

  It was brought to his attention that he had been expelled from a military school for gross and inveterate misconduct, had been confined in jail a dozen times recently for similar reasons, and had been supported and protected by his father, who spent a good part of his time getting this son out of the troubles which he made for himself and others almost daily. The patient appeared as if very much astonished at such reports, denied everything, and, in a convincing fashion, dismissed the question of all personal difficulties and maladjustment as little short of preposterous.

  After careful observation in the hospital for a month, no evidence of delusions, hallucinations, or any other sign of what is regarded as a psychosis could be discovered. Chester was presented before a medical staff of ten psychiatrists who unanimously considered him sane and competent and made the diagnosis of psychopathic personality. He was kept in the hospital on pretexts and out of common sense because of his long history of extreme maladjustment.

  He was at all times alert and usually cooperative, reacted with a very natural dislike to being on a closed ward, and continually asked for a discharge, insisting that he was entirely sane and improperly hospitalized.

  On being granted parole of the grounds, he promptly left without permission and went home. At the insistence of his father he was granted a furlough status. Within a few days he had insolently suggested sexual intercourse to a respectable matron, committed several inconsequential thefts, and sold for $1.25 a good rug taken from his parents’ home. After having a few drinks, he is reported to have cursed and further expressed his contempt by spitting on the foot of a great uncle who encountered him on the street and politely engaged him in conversation. Later that afternoon he talked eloquently to a half-dozen or so bystanders in the park about patriotism, honor, God, and the true meaning of morality.

  Meanwhile, he had cashed several small checks on a nonexistent bank account and, posing as the emissary of a respected cousin (whose husband was cashier in a local bank), obtained $15.00 which he convinced an old friend of the family was needed to settle a small obligation that had arisen after banking hours.

  When drinking, he usually became rowdy. He made no effort whatsoever to find employment and roamed about the town or countryside, often sleeping in the woods and fields. His father and brothers had no choice but to seek him out in the byways and hedges and bring him in, often laboring strenuously at this task far into the night. He was often found dirty, disheveled, and alone. Toward his family he was sullen and carping, his reactions those of petty irritation. He complained constantly that his father meddled with him and at times ascribed all his troubles to this interference. Finding it impossible to supervise such a person, even with the frequent assistance of local police, who obligingly locked him up in jail for a day or two during his worst episodes, the father soon sent him back to the hospital.

  On arrival he was manifestly vexed and seemed at a loss to understand his situation. “I can’t see why they don’t let me alone. I don’t bother anybody. Why can’t I go about my business like any other man?” These and similar remarks he repeated many times in tones showing well the dissatisfaction that any normal man would feel on being, without cause or reason, deprived of his liberty.

  Before returning to the hospital, Chester had complained bitterly to his father, stating that he would kill himself rather than come. The father recognized this threat of suicide as insincere but typical of the somewhat dramatic airs often assumed by the patient. Except for past experience with such threats, it would have been natural to think desperation would be consistent with his intensely strong distaste for restraint of any sort.

  He was kept now on a closed ward, from which he repeatedly schemed to escape, once stealing keys from an attendant and several times fomenting plots among other patients. After two weeks he succeeded in his efforts and soon appeared at home (fifty miles from the hospital) in a magnificent state of boisterous intoxication. He continued at home in complete idleness except for some enterprising petty thefts, long speeches about the need of increased virtue in women (delivered in local poolrooms), several brawls arising from his being caught cheating at dice games, some bold-faced begging, and numerous maneuvers to obtain money illegally, including forgery.

  Despite peaceful intervals of a week or more, he continued to demonstrate an irresponsibility so utter that one is taxed to describe it. After several additional experiences in jail he was brought back to the hospital by his father, who confessed himself at his wits’ end.

  During psychiatric examinations the patient again denied that he had caused any trouble or done anything which would justify his being brought to the hospital. He admitted having taken a few drinks and tried to conclude some wise business deals but still insisted that he never drank much or ever behaved irresponsibly or in such a way as to cause trouble.

  He glibly dismissed all the massive accumulation of detail concerning his lack of responsibility, his failure to show normal interests in life, his indifference to the serious trouble he gave relatives and friends, and the purposeless folly that had consumed all his efforts for years. The adroitness with which he denied everything and the brisk, facile manner in which he excused himself and glossed over his record made it clear that his mind was free of any seriousness whatsoever in regard to his past and of any real intention to behave more sensibly in the future. One thing only in this man impressed his examiners as having some emotional weight. This was his vivid chagrin at being confined and his persistent, restless longing to be free.

  Many attempts were made to make him realize that he could stay out of the hospital only by avoiding inappropriate conduct and acts plainly damaging or embarrassing to others and by conducting himself so as not to be an unbearable burden on his family and on the community. He admitted that he did not really enjoy or have any particular reason for doing as he did, and reports substantiate this, representing him as a sullen, glum fellow in bars and poolrooms, a man without convivial gaiety or other signs of stimulation, apparently more unhappy in his efforts to celebrate than in his usual state.

  I am convinced that this man obtains no delight at all from whiskey, that whatever may be his purpose in drinking, it does not result in the attainment of pleasure. Every effort was futile to make him see what was so obvious, that he had brought his troubles on himself, and that only by staying sober could he retain his fr
eedom. He absolutely refused to face any fact and slipped nimbly from reality to the world of his evasions.

  A few weeks later, because of a death in his family, he was allowed to go home in custody of his father. He immediately got out of the house and slipped off to a nearby town, where he drank himself into a state of maudlin intoxication, made a nuisance of himself in several public houses, engaged in minor street brawls, and wandered cursing and muttering aimlessly through the streets until found by his relatives.

  At the funeral the next day, having skillfully obtained more whiskey, Chester appeared at first poised and sober. Signs of drunkenness, however, soon appeared, and the patient proceeded to make a shocking and memorable impression. Vomiting and defecating while in the aisle of the church contributed to this effect. As an elder brother was attempting to expedite his departure with minimum conspicuousness, these momentary and incomplete reactions took place.

  The father sent him back to the hospital as soon as arrangements could be made. Although the patient could not have been unaware that his father had informed the hospital of his conduct and explained the circumstances under which he returned, he said with the greatest assurance on arriving that he had voluntarily come back before expiration of his furlough, merely for the day and in order to have the furlough extended. He insisted that his conduct at home had been above reproach and demanded parole privileges until arrangements were made for him to leave the hospital. At this time he was entirely free from all effects of alcohol.

  This man is the son of a rather prosperous farmer and merchant. His home is in a Southern town of four thousand inhabitants. His father, though not highly educated, is a successful, sensible man and genuinely respected in the community. Of his three siblings, a sister is married and in good circumstances, one brother is a physician, and the other is a lawyer. All are successful and seem well adapted to their environment.