What is felt for prostitute, sweetheart, casual pickup, mistress, or wife is not anything that can bring out loyalty or influence activities into a remedial or constructive plan, Not do sexual desires always seem to compete successfully against such trivial impulses as wanting to hang about street corners or idle in juke joints where the psychopath may, by tampering with slot machines or cheating at dice or cards, pick up a little change and demonstrate his cleverness to the other fellows. So little is apparently found in heterosexual experience that deviate impulses (even when weak) are sometimes accepted and acted upon largely because of reasons like the reason why all cats look gray at night.
For the person who has ever known even one mature and normal erotic fulfillment, it is impossible to imagine turning by choice to a biologically inappropriate partner or placing partial or deviated aims above what has been so obviously well designed for the purpose. What the human organism shows anatomically is scarcely more clear than the emotional evidence, at physiologic as well as at broader interpersonal levels of reactivity. Even from more remote and less tangible sociologic aspects, nature has left no room here for doubt. It is difficult, without postulating an extremely dulled or otherwise inhibited sensual response in heterosexual experience, to account for the psychopath who can drift into deviate pranks as approximations or acceptable novelties in the same field. It has been said that “the thalamus outdid itself in devising pleasures to go with the conjugating act itself.”298 Without great support from ethics or convention, it seems these would suffice for normal choice in the intact personality.
The familiar record of sexual promiscuity found in both male and female psychopaths seems much more closely related to their almost total lack of self-imposed restraint than to any particularly strong passions or drives. Psychopaths sometimes seem by preference to seek sexual relations in sordid surroundings with persons of low intellectual or social status. Often, however, the convenience by which what is little more than a whim can be gratified may play a greater part in this than specific preference. Another and more serious kind of sordidness also seems to constitute real inducement.
Entanglements which go out of their way to mock ordinary human sensibility or what might be called basic decency are prevalent in their sexual careers. To casually “make” or “lay” the best friend’s wife and to involve a husband’s uncle or one of his business associates in a particularly messy triangular or quadrilateral situation are typical acts. Such opportunities, when available, seem not to repel but specifically to attract the psychopath. Neither distinct appeal of the sex object nor any formulated serious malignity toward those cuckolded or otherwise outraged seems to be a major factor in such choices. There is more to suggest a mildly prankish impulse such as might lead the ordinary man to violate small pedantic technicalities or dead and preposterous bits of formality as a demonstration of their triviality.
Sexual exploits often seem chosen almost purposively to put the subject himself, as well as others, in positions of sharp indignity and distastefulness. The male psychopath who goes through legal matrimony with the whore he has picked up for the evening furnishes a clear example. And so does the well-born woman who submits to several men in rapid succession, none of whom takes the least trouble to conceal his contempt for her. I have seen psychopaths who seriously attempted to seduce sisters, mothers-in-law, and even their actual mothers. One boasted to his wife in glowing detail of his erotic feats with her mother and with his own. His excellent talents at lying lead me to doubt the truth of his claims. I have little doubt, however, that he would have hesitated to carry out all that he boasted of if the ladies had allowed him to proceed.
Beneath his outwardly gracious manner toward women and his general suavity and social charms, the male psychopath (or part psychopath) nearly always shows an underlying predilection for obscenity, an astonishingly ambivalent attitude in which the amorous and excretory functions seem to be confused. He sometimes gives the impression that an impulse to smear his partner symbolically, and even to wallow in sordidness himself, is more fundamental than a directly erotic aim, itself hardly more to him than a sort of concomitant and slightly glorified back scratching.
60. Failure to Follow Any Life Plan
The psychopath shows a striking inability to follow any sort of life plan consistently, whether it be one regarded as good or evil. He does not maintain an effort toward any far goal at all.47,53 This is entirely applicable to the full psychopath. On the contrary, he seems to go out of his way to make a failure of life. By some incomprehensible and untempting piece of folly or buffoonery, he eventually cuts short any activity in which he is succeeding, no matter whether it is crime or honest endeavor. At the behest of trivial impulses he repeatedly addresses himself directly to folly. In the more seriously affected examples, it is impossible for wealthy, influential, and devoted relatives to place the psychopath in any position, however ingeniously it may be chosen, where he will not succeed eventually in failing with spectacular and bizarre splendor. Considering a longitudinal section of his life, his behavior gives such an impression of gratuitous folly and nonsensical activity in such massive accumulation that it is hard to avoid the conclusion that here is the product of true madness—of madness in a sense quite as real as that conveyed to the imaginative layman by the terrible word lunatic. With the further consideration that all this skein of apparent madness has been woven by a person of (technically) unimpaired and superior intellectual powers and universally regarded as sane, the surmise intrudes that we are confronted by a serious and unusual type of genuine abnormality. Not merely a surmise but a strong conviction may arise that this apparent sanity is, in some important respects, a sanity in name only. When we consider his actual performance, evidence of mental competency is sorely lacking. We find instead a spectacle that suggests madness in excelsis, despite the absence of all those symptoms that enable us, in some degree, to account for irrational conduct in the psychotic.
Section Four: Some Questions Still Without Adequate Answers
Part I: What Is Wrong with These Patients?
61. A Basic Hypothesis
Now that we have proceeded with our task through the stages of (1) presenting observations of the gross material and (2) sifting and tabulating as conveniently and intelligibly as we were able the pertinent residue of our data, let us attempt the next step.
This will consist in searching for some concept or formulating some theory that might satisfactorily account for the facts observed. Much of the material appears contradictory, not only in the ordinary world of average or normal living but even in the world of mental disorder commonly granted to be less readily comprehensible in terms of ordinary reason. Even the accepted postulates which help us come to some understanding of the patient with hysteria or the delusional schizophrenic seem at first to fail when applied to the psychopathic, or antisocial, personality.
A patient whose fragmented personality prevents him from becoming aware of significant facts and puts him at the mercy of fantasies indistinguishable from what is real may conduct himself in a fashion that strikes us as altogether absurd and irrational if we fail to take into consideration this fragmentation. A man who is sane by the standards of psychiatry, aware of all the facts which we ourselves recognize, and free from delusions but who conducts himself in a way quite as absurd as many of the psychotic becomes another problem altogether. The observer is confronted with a paradox within the already baffling domain of mental disorder.
In the attempt to arrive at an applicable conception, one consistent with the facts of our observation, I find it necessary first of all to postulate that the psychopath has a genuine and very serious disability, disorder, defect, or deviation. To say that he is merely queer or perverse or in some borderline state between health and illness does little or nothing to account for the sort of behavior he demonstrates objectively and obviously. The practice, quite popular until recent years, of classifying the disorder of these patients, no matter how plain their inc
apacity to lead normal lives, as (1) no nervous or mental disease and (2) psychopathic personality, whatever the sanctions afforded by tradition, emerges not only as a misleading practice but also as sometimes promoting absurdity when we honestly examine the material to which such terms are applied.
Let us for a moment consider the essential evidence brought out in staff meetings on which experienced psychiatrists establish in an obvious case the diagnosis of schizophrenia and on which legal action is taken to declare the patient psychotic and incompetent (insane) and commit him for treatment. In the brief summarizing statement to support such opinions we often find such words as these:
The history shows that he has failed repeatedly to make a satisfactory adjustment in the social group. His actions indicate serious impairment of judgment and show that he cannot be relied upon to conduct himself with ordinary regard for the safety of himself or of others. His irrational and unacceptable behavior has, furthermore, occurred without normal or adequate motivation. He shows no real insight into his condition and tends often to project the sources of his troubles to the environment. His emotional reactions are grossly impaired and he has repeatedly shown inappropriate or inadequate affect. We may say, then, that he is psychotic, incompetent, incapable of carrying on the usual activities of life, and in need of close supervision.
Such facts have often over many decades constituted more convincing evidence for the diagnosis of schizophrenia than the delusions and hallucinations also frequently present but sometimes not demonstrable in that psychosis. All of these statements just recorded (excepting only the one word “psychotic”) may be applied with full validity to the psychopath. This, of course, does not make him a patient with schizophrenia but it does, I maintain, afford grounds for saying he has a grave psychiatric deficit, and grounds that cannot be dismissed lightly. Although I insist on the gravity of his abnormality, I frankly admit that it is a different kind of abnormality from all those now recognized as seriously impairing competency. It is an abnormality that differs more widely in its general features from any of those than they differ from one another.
The first and most striking difference is this: In all the orthodox psychoses, in addition to the criteria just mentioned, or to some of these criteria, there is a more or less obvious alteration of reasoning processes or of some other demonstrable personality feature. In the psychopath this is not seen. The observer is confronted with a convincing mask of sanity. All the outward features of this mask are intact; it cannot be displaced or penetrated by questions directed toward deeper personality levels. The examiner never hits upon the chaos sometimes found on searching beneath the outer surface of a paranoid schizophrenic. The thought processes retain their normal aspect under psychiatric investigations and in technical tests designed to bring out obscure evidence of derangement. Examination reveals not merely an ordinary two-dimensional mask but what seems to be a solid and substantial structural image of the sane and rational personality. He might then be thought of, in the full literal sense, as an example of what Trélat meant to designate by his expressive term, la folie lucide. Furthermore, this personality structure in all theoretical situations functions in a manner apparently identical with that of normal, sane functioning. Logical thought processes may be seen in perfect operation no matter how they are stimulated or treated under experimental conditions. Furthermore, the observer finds verbal and facial expressions, tones of voice, and all the other signs we have come to regard as implying conviction and emotion and the normal experiencing of life as we know it ourselves and as we assume it to be in others. All judgments of value and emotional appraisals are sane and appropriate when the psychopath is tested in verbal examinations.*
Only very slowly and by a complex estimation or judgment based on multitudinous small impressions does the conviction come upon us that, despite these intact rational processes, these normal emotional affirmations, and their consistent application in all directions, we are dealing here not with a complete man at all but with something that suggests a subtly constructed reflex machine which can mimic the human personality perfectly. This smoothly operating psychic apparatus reproduces consistently not only specimens of good human reasoning but also appropriate simulations of normal human emotion in response to nearly all the varied stimuli of life. So perfect is this reproduction of a whole and normal man that no one who examines him in a clinical setting can point out in scientific or objective terms why, or how, he is not real. And yet we eventually come to know or feel we know that reality, in the sense of full, healthy experiencing of life, is not here.
Fortunately for the purpose of this discussion, but unfortunately indeed in any other light, an objective demonstration is available which coincides perfectly with our slowly emerging impression. The psychopath, however perfectly he mimics man theoretically, that is to say, when he speaks for himself in words, fails altogether when he is put into the practice of actual living. His failure is so complete and so dramatic that it is difficult to see how such a failure could be achieved by anyone less defective than a downright madman* or by a person totally or almost totally unable to grasp emotionally the major components of meaning or feeling implicit in the thoughts that he expresses or the experiences he appears to go through. In the actions of his living, then, he confirms our subjective impression, or it might be said that our surmise coincides with the objective and demonstrable facts.
During my early observation of psychopaths that preceded publication of the first edition of this book in 1941, I was so much impressed with the degree of maladjustment in these patients that I felt at the time, and said, they should be called psychotic. Subsequent consideration led me long ago to change this opinion and to find myself in complete accord with Richard L. Jenkins who in 1960 wrote:117
Hervey Cleckley, in The Mask of Sanity, expresses the belief that the psychopathic personality is a psychosis not technically demonstrable, maximally concealed by an outer surface of intact function and manifested only in behavior. The disagreement I would express with this intriguing definition is that, to me, it strains the concept of psychosis past the breaking point. A psychosis is a major mental disorder. A psychopathic personality shows not a disorder of personality but rather a defect of personality, together with a set of defenses evolved around that defect. The defect relates to the most central element of the human personality: its social nature. The psychopath is simply a basically asocial or antisocial individual who has never achieved the developed nature of homo domesticus.
There is another important point against classifying the psychopath’s grave defect with the psychoses. Though I believe he is in degree as maladjusted for leading an acceptable life as the psychotic patient, I do not believe there are similar reasons to consider him legally irresponsible or morally blameless for the frauds he perpetrates and the crimes he may commit.
Let us then assume, as a hypothesis, that the psychopath’s disorder, or defect, or his difference from the whole or normal or integrated personality consists of an unawareness and a persistent lack of ability to become aware of what the most important experiences of life mean to others. By this is not meant an acceptance of the arbitrarily postulated values of any particular theology, ethics, esthetics, or philosophic system, or any special set of mores or ideologies, but rather the common substance of emotion or purpose, or whatever else one chooses to call it, from which the various loyalties, goals, fidelities, commitments, and concepts of honor and responsibility of various groups and various people are formed.* Let us assume that this dimension of experience which gives to all experience its substance or reality is one into which the psychopath does not enter. Or, to be more accurate, let us say that he enters, but only so superficially that his reality is thin or unsubstantial to the point of being insignificant. Let us say that, despite his otherwise perfect functioning, the major emotional accompaniments are absent or so attenuated as to count for little. Of course he is unaware of this, just as everyone is bound, except theoretically, to be unaware o
f that which is out of his scale or order or mode of experience. If we grant the existence of a far-reaching and persistent blocking, absence, deficit, or dissociation of this sort, we have all that is needed, at the present level of our inquiry, to account for the psychopath.
The effort to express what is meant by experiencing life in a full sense, or by awareness of a solid emotional contact, runs through the psychoanalytic literature, which so often stresses the difference between an actual, or emotionally participating, understanding of some important situation and a mere verbal or academic understanding, however complete in that dimension.11,188 This point is also implicit in the concepts of Adolf Meyer’s psychobiology, which, by its very definition of terms, shows that it is striving to emphasize the wholeness of experience or the full meaning of reactions.24,69,223 Among lay observers of human problems and human values is sometimes found a sharp awareness of the very point I mean to stress in trying to describe the so-called psychopath.
A poet of our century, Donald Parson,232 chilled by the dead perfection of the celebrated glass flowers at Harvard, seems to see and translate into metaphor and allegory something closely related to the problem of the personalities discussed here and whose outer state I am trying to describe as a mask of sanity:
I stand in wonder. What amazing art!
No counterfeit is this, but counterpart
Itself, carved with the infinite detail
That makes the plodding step of patience fail.
From life’s authentic prompt-book is this leaf.
And here are flowers, petaled every one
To cup the rain and captivate the sun:
The poignant lilac whose sharp sword of scent
Can make the memory bleed—that sacrament
We call a rose—a thousand other blooms,
The Mask of Sanity Page 52