“But I’ve got to see you at once,” Walter insisted. “I tell you I’m in trouble.” The other, becoming vexed at such insistence and at the highhanded, preemptory tone, explained that his own affairs were urgent also and asked to be told more about the matter. Walter would give no details. He became more demanding. “I tell you I want to see you. You come on down to 1321 Juniper Street. I’ll be in front of the house. And if you’ve ever traveled fast in your life you travel fast now.”
At this the other man became rebellious. He frankly stated that he could not and would not tear himself away from his own business at such a time on such an inscrutable errand. Walter then began to compromise and at last grudgingly agreed to a meeting in a few hours. His whole manner in the conversation was that of one who demands fulfillment of an obligation, not of one who requests a favor.
On arriving at the address given, the former acquaintance was at once beckoned by an abrupt jerk. of the thumb to draw aside under a tree.
“I’m in a sort of jam,” Walter said condescendingly. “Owe a man three dollars. I’d like for you to let me have that amount.”
“I’m sorry,” said the other, determined not to give anything after being so inconsiderately put upon, “I haven’t got it on me.”
Walter thereupon became insistent. Making it plain that he did not believe what the other man said, he continued as if demanding his rights, “Well, what have you in your pockets? just give me what you have. That will be all right.” Finally, uncomfortable at participating in this shameless demonstration, the other gave over some small change and left.
Walter continued on the same course, losing positions which his father obtained for him in other cities. Sometimes he worked for two or three months, but even during such periods he had many small social difficulties. He was sent to private institutions several times for whiskey cures and returned to take up immediately his well-known ways. Once he went to an evangelist’s meeting, professed salvation, and assumed for a week or ten days an attitude of piety and spoke of carrying on the Lord’s Work. Despite this period of propriety, he was in the police barracks about three or four times each month.
He disappeared again and was sought for several days by his anxious parents. A week later a friend of the family, on returning to her house which had been closed during her absence from the city, found him inside, stretched on the floor, snoring. He was disheveled and dirty. After a little shaking and shouting he aroused, blinked at her calmly, and acted as if he had been disturbed by some irresponsible person who must be treated as an indulgent grown person treats a child. In the house was also a half-dressed woman of frankly disreputable character whom he had brought with him. The rugs were stained with overturned drinks and bottles and Mason jars were scattered over the floors. Unwashed dishes were piled in stacks or littered broken about the rooms. Several disarranged beds were heaped with stale sheets. Here and there furniture was overturned or burned with cigarettes. “Sorry,” said Walter as if making gallant apology for having accidentally jostled a lady in a crowd, “I am made so miserable at home that I had to come in.”
He was sent again to the hospital by his father, following a series of misadventures somewhat more trying than usual. On arrival he was moderately influenced by drink but well aware of his actions. “Ask me no questions and I’ll tell you no lies,” he shouted gaily. “Yep, I’ve been drunk for five weeks. Drank a pint today. Carry it pretty well, don’t I?”
He soon sobered up and insisted on leaving stating that he had never done anything out of the ordinary and that he was sane and in the wrong place. He spoke convincingly of plans he had made to study air conditioning and of great engineering opportunities that awaited him in this field. Seeing him for the first time, it would have been easy to believe that he was a gifted and energetic young man whose ambitions were to be fulfilled as soon as he obtained his freedom.
Despite his many evasions and his opinions contrary to fact, no delusion, in the sense ordinarily understood by psychiatry, was ever found in Walter. After careful study and prolonged observation, he was again given the diagnosis of psychopathic personality. He was discharged at the end of five weeks as sane.
According to trustworthy reports he is continuing without any notable change in his former ways.
16. Joe
This patient came in the custody of two friends, both state officers in the American Legion, to apply for admission to the hospital. He had with him commitment papers showing that he had at his own request been declared incompetent.
Joe was alert and intelligent and conducted himself in a manner that suggested a person of poise, good judgment, and firm resolution. He was anything but the sort of figure that might come to mind in thinking of a patient sent for admission to such an institution.
He frankly admitted that he was not “insane” in the ordinary sense of the word and therefore was not eligible according to the letter of the law for admission into a hospital of this sort. He urged, however, that he be accepted, stating that for the last sixteen or seventeen years he had been drinking to great and foolish excess in periodic sprees. He seemed to be remarkably frank and straightforward, admitting that he had made an unholy mess of his life and caused misery untold for his wife, his parents, and his friends. At times he became much depressed, he said, when ruminating over the magnitude of his failure. He appeared earnest in his strongly expressed determination to pull himself together and make a fresh start.
A rather unusual and impressive sincerity seemed to distinguish this man from some with similar histories of psychopathic drinking and psychopathic failure. He did not promise to become a new man. He admitted that he knew it would be most difficult for him to change his ways and seemed to realize that his many collapses in the past after similar good intentions told against his present chances.
Records which accompanied him gave the information that three years previously Joe had attempted suicide by severing veins in both arms. Definite scars were visible four or five inches above the wrists. Since he had not played up this phase of his case, his statement that he had really tried to kill himself was particularly convincing. Though such patients, officially not psychotic and considered responsible for their own troubles and misdeeds, are not technically eligible, it was decided to take this man.
His history of a suicide attempt furnished plausible grounds for calling him an emergency, and his apparently desperate intention of escaping from the pattern of his past folly promised that treatment in a mental hospital might give him a chance to gain insight and forge new resolution which he would need in starting over again.
During the month of psychiatric study and constant observation that preceded diagnosis before the staff, this man proved to be a model patient. He was cheerful, convivial, alert, and energetic. He asked for work and at once made himself useful, checking out laundry, typing various lists, helping psychotic patients, and performing many other duties. Quick, accurate, and reliable, he seemed to take a real pleasure in all work that he could get and actually accomplished much more than an average man could.
He was at all times in perfect contact, reasonable, optimistic, and plainly intelligent. During examinations he told his story with a remarkable appearance of frankness and insight.
“I suppose, doctor, I am still a child emotionally,” he admitted in explanation of the fifteen years during which he threw away many valuable positions, lost his wife, and went repeatedly to sanatoriums which offer whiskey cures and to mental hospitals. He seemed to realize that his conduct was extremely irrational and without reward, agreeing that he had been quite unhappy nearly all the time and a source of grief and despair to others.
Drinking, Joe said, was not in his opinion the cause of his trouble but merely a symptom of some obscure flaw in his makeup. This defect he found it hard to define or describe, although he spoke very intelligently and almost, it might be said, profoundly. He distinguished between his own case and the various psychoses, maintaining that he was entirely sane
but admitting that, though sane, he had behaved more foolishly that a bona fide “lunatic,” and for no purpose.
He mentioned the writings of Freud, Jung, Bleuler, and William A. White and showed unusual familiarity for a layman with psychiatric terminology as well as a surprisingly good acquaintance with the literature.
“I suppose I must be a constitutional psychopath,” he concluded after describing his many opportunities, his many confident resolutions to adjust, and his inevitable, quick failures.
As in so many cases of this sort, drink, being a tangible and superficial activity, is often stressed by the family and the patient as if it were the major source of difficulty. Being at a loss to account for antisocial and self-damaging acts in terms of real purpose, it is customary for them to decide that these must have been carried out because some drinks had been taken. I do not share such a belief. This patient, like a good many others, was more inclined to discuss drinking than his more essential difficulties, so this at first was the chief topic.
“But why do you drink?” he was asked. “Why do you let yourself take the first drink, when you realize by now to what it will lead?” It was hard to say, he admitted. He felt he had not for many years obtained pleasure from the effects of whiskey. Even if there had been some extraordinary pleasure in drinking, he felt sure this would not have been worth even a small part of the price he had paid.
Perhaps habit was a factor, Joe suggested; perhaps he was emotionally conditioned to repeat this disastrous step, no matter how plainly reason warned him against it. He spoke of possible forces within his mind that might seek failure, unconscious tendencies to defeat himself. Desire to escape from the difficulties and failures of life, he felt, might influence him to seek intoxication. On the other hand, he believed the failure and difficulties would not occur if he did not drink. He was confident that drunkenness led to the many disastrous actions he had taken.
Joe emphasized his belief in a vicious cycle of sequences, the drink causing him to get in grave difficulty, to lose what he most wanted, and then his subsequent disappointments causing him to seek refuge in drink. Though some causal influence may lie in this, it is apparently secondary and superficial. When in extremely advantageous positions, in situations he described as ideal, without provocation or known purpose, he often acted in such a way as to lose all that he said he found desirable and to make failure inevitable and spectacular.
On being asked if he really found life worth while, if a normal life offered anything to him, he quickly answered that it did. He appeared frank in affirming that there was in him a strong and persistent will to succeed, an urge to get at the satisfactions of existence which most people choose in preference to the sort of career he had known with its almost fantastic and presumably frustrating reverses and maladjustments.
As Joe discussed the possibility that impulses unrecognized by him might play a part in his way of life, he seemed like one with an almost Socratic respect for the depth and extent of the unknowable. It was entirely possible, he maintained, that he might be deceiving himself. Perhaps, he admitted, there were tendencies within, whose presence he did not suspect. As he continued, he spontaneously questioned his essential sincerity but in such a way as to make him seem even more sincere than heretofore.
This man’s apparent insight, freedom from evasiveness, and willingness to admit himself responsible for his misfortunes are, it might be said, inconsistent with his history, which is typically that of a psychopath. In my opinion, however, none of these qualities which appeared to be so highly developed in him are real. It is perhaps more accurate to say that, whatever reality there may be in these qualities, it is not integrated into the person’s functioning. It does not emerge objectively in the actuality of behavior.
In time, his insight comes to seem but a mimicry of insight. He uses the words which one who understood would use, but they do not have a corresponding meaning. He speaks with every evidence of conviction and sincerity, but when one studies him over a period of time, it becomes apparent finally that he is merely going through the motions, that he is not actually living the feelings he describes so well. His evasiveness, of almost Dostoevskian complexity, consists in an openness which is actually no openness at all. He freely gives up discrediting information about his weakness and his failures and appears to take them with ardent seriousness, to understand them, to regret them to the bottom of his heart, and to intend to learn and profit by them. But all the while he is, for the most part, merely using the words, the gestures, and the expressions without entering into the feeling and the understanding. We find ourselves dealing not so much with a genius at acting but with a person who, in the most important matters, has no capacity of distinguishing between what is acting and what is not.
Joe is not really facing facts now but only acting in charade in which he faces imitation facts. He says he is responsible for his failures and seems to accept this responsibility honestly and to have normal regret for the pain he has caused others, but in studying him it becomes apparent that the regret is something quite different from what we have presumed he was talking about and that he is able to act as if it were profound only because he is utterly unaware of what real and serious regret is—because he does not experience real and serious emotions.
It is difficult to describe this impression without implying that the patient’s reactions are being identified with deliberate fraud or with hypocrisy in its ordinary meaning. There is, however, a fundamental difference. Psychopaths notoriously deceive and falsify, with strict awareness of the intention and about any sort of situation.
Voluntary and quite conscious decisions to lie occur and are carried out in discussing the points on which we attempt to estimate insight and the genuineness of emotions, desire, grief, remorse, love. In addition to such factors, however, we encounter misleading reports of another sort.
In all probability, Joe was often accurately describing his reactions insofar as he could. Something left out of his experience made it impossible for him to see that the words he used did not refer to such emotional actualities as they would in another. One might say this constitutes a kind of strange and paradoxical sincerity, something a little like the report of a color-blind man (without knowledge of his defect) who after investigation swears conscientiously that the horizon is gray, though it actually blazes with all the colors of the sunset.
Such a comparison is, however, full of implications that may mislead us. It can also be said that this particular patient, when it suits his purposes, does not hesitate to falsify with full deliberation.
In time a typical glibness about the major social disasters of his life reveals itself, and one sees that this man has a sort of pride in the spectacular capers he has cut. He admits that he is to blame for his wife’s having had to divorce him because of nonsupport, periods of desertion, and gross, repetitive, and almost publicly transacted acts of infidelity. Even now, while full of expressed intentions to change his ways, he shows no genuine concern for the fate of this former wife and little or none for his children. He admits his childishness, his failures in ever undertaking, and his flagrant lack of consideration for others. He admits some dozen or two arrests in the last year and a half, for causing disorder in public and for unacceptable conduct while drinking. But he is very solemn in assuming that he is a man of honor in the most unqualified sense, despite what he confesses as his faults. He states that he will not break his word and that he had never committed an act against anyone else for which he should have been arrested. He admits that the alleged suicide attempt was a pure fraud and that he had made a false statement about it in order to get into the hospital. He had cut his arms only to frighten his wife and parents and to create a dramatic scene in order to gain his ends with them. He describes his exploit in detail, admitting its extreme childishness. He remembers that he took care to pull over a chair and to fall with a great thud and clatter so that he would attract sudden attention and become at once the center of an exciting scene.
This, for the sort of man he is known to be, is admitting a great deal. But he at once insists that he has always been a man of his word, ignoring the many incidents in his history to the contrary. He leaves out many well-established facts which would not fit in with the picture he now means to give of himself, as a man who has done many foolish and unpardonable things but who is still a “gentleman” fundamentally. He always insists that the many women with whom he has had relations were those who would obviously excite romantic feelings, though this is by no means true. He says repeatedly that sexual relations are no pleasure to him unless he gives the woman pleasure too, but one can see that this is an opinion he has picked up from reading and that it has nothing to do with the reality of his life. Actually his experiences with women have been casual, incomplete, and of so little real significance to him that he has been known to drink himself into a state of impotence rather than continue even the primary physical exercises of the relationship. Later he says that no woman among the many with whom he has had intercourse ever afforded anything of serious significance to him; but he feels that this is rather to his credit as a romantic lover. “I am in love with love!” he concludes tritely.
Joe speaks of his misadventures with what would pass for admirable humor, and this would have been real humor had there been a contrasting seriousness in his understanding to give it meaning. But his light touch in dealing with his own faults and his own follies loses significance when it becomes apparent that for him there is no tragic reality against which it is maintained.
Now 38 years of age, he is athletic, well groomed, and rather handsome. The story of his life as he gives it is in most of the outer facts identical with the story as given in social service reports and by his friends.
The Mask of Sanity Page 22