The Mask of Sanity

by Hervey Cleckley

  I believe that if such a patient shows himself grossly incompetent in his behavior, he should be so appraised. It is necessary to change some of our legal criteria to make attempts at treatment or urgently needed supervision possible for him, the most serious objections are primarily theoretical. Perhaps our traditional definitions of psychiatric disability can stand alteration better than these grossly defective patients and those about them can stand the present farcical and sometimes tragic methods of handling their problems.

  This is not to say that all people showing features of this type should be regarded as totally disabled. It is here maintained that this defect, like other psychiatric disorders, appears in every degree of severity and may constitute anything from a personality trait through handicaps of varying magnitude, including maximum disability and maximum threat to the peace and safety of the community.

  63. Further Consideration of the Hypothesis

  In attempting to account for the abnormal behavior observed in the psychopath, we have found useful the hypothesis that he has a serious and subtle abnormality or defect at deep levels disturbing the integration and normal appreciation of experience and resulting in a pathology that might, in analogy with Henry Head’s classifications of the aphasias, be described as semantic. Presuming that such a patient does fail to experience life adequately in its major issues, can we then better account for his clinical manifestations? The difficulties of proving, or even of demonstrating direct objective evidence, for hypotheses about psychopathology (or about ordinary subjective functioning) are too obvious to need elaborate discussion here.

  If the psychopath’s life is devoid of higher order stimuli, of primary or serious goals and values, and of intense and meaningful satisfactions, it may be possible for the observer to better understand the patient who, for the trivial excitement of stealing a dollar (or a candy bar), the small gain of forging a $20.00 check, or halfhearted intercourse with an unappealing partner, sacrifices his job, the respect of his friends, or perhaps his marriage. Behind much of the psychopath’s behavior we see evidence of relatively mild stimuli common to all mankind. In his panhandling, his pranks, his truancy, his idle boasts, his begging, and his taking another drink, he is acting on motives in themselves not unnatural. In their massive accumulation during his career, these acts are impressive chiefly because of what he sacrifices to carry them out. If, for him, the things sacrificed are also of petty value, his conduct becomes more comprehensible.

  Woolley, in an interesting interpretation of these patients, compared them with an otherwise intact automobile having very defective brakes.219 Such an analogy suggests accurately an important pathologic defect which seems to exist. In contrast with an automobile, however, the braking functions of the human organism are built into the personality by reaction to life experience, to reward and punishment, praise and blame, shame, loss, honor, love, and so on. True as Woolley’s hypothesis may be, it seems likely that more fundamental than inadequate powers to refrain is the inadequate emotional reactivity upon which the learning to refrain must be based. Even with good brakes on his car, the driver must have not only knowledge of but also feeling for what will happen otherwise if he is to use them correctly and adequately.

  Some of the psychopath’s behavior may be fairly well accounted for if we grant a limitation of emotional capacity. Additional factors merit consideration. The psychopath seems to go out of his way to make trouble for himself and for others. In carelessly marrying a whore, in more or less inviting detection of a theft (or at least in ignoring the probability of detection), in attempting gross intimacies with a debutante in the poorly sheltered alcove just off a crowded ballroom, in losing his hospital parole or failing to be with his wife in labor just because he did not want to leave the crap game at midnight (or at 3 A.M.), in such actions there seems to be not only a disregard for consequences but an active impulse to show off, to be not discreet but conspicuous in making mischief. Apparently he likes to flaunt his outlandish or antisocial acts with bravado.

  When negative consequences are negligible or slight (both materially and emotionally), who does not like to cut up a little, to make a bit of inconsequential fun, or perhaps playfully take off on the more sober aspects of living? Dignity might otherwise become pompousness; learning, pedantry; goodness, self-righteousness. The essential difference seems to lie in how much the consequences matter. It is also important to remember that inclination and taste are profoundly shaped by capacity to feel the situation adequately. A normal man’s potential inclination to give the pretty hatcheck girl $100.00 would probably not reach awareness in view of his knowledge that this would result in his three children’s not having shoes or in his having to humiliate himself by wheedling from a friend a loan he will never repay.

  If, as we maintain, the big rewards of love, of the hard job well done, of faith kept despite sacrifices, do not enter significantly in the equation, it is not difficult to see that the psychopath is likely to be bored. Being bored, he will seek to cut up more than the ordinary person to relieve the tedium of his unrewarding existence. If we think of a theater half-filled with ordinary pubertal boys who must sit through a performance of King Lear or of Beethoven’s Ninth Symphony, we need ask little of either imagination or memory to bring to mind the restless fidgeting, the noisy intercommunication of trivialities, the inappropriate guffaws or catcalls, and perhaps the spitballs or the mischievous application of a pin to the fellow in the next seat.

  Apparently blocked from fulfillment at deep levels, the psychopath is not unnaturally pushed toward some sort of divertissement. Even weak impulses, petty and fleeting gratifications, are sufficient to produce in him injudicious, distasteful, and even outlandish misbehavior. Major positive attractions are not present to compete successfully with whims, and the major negative deterrents (hot, persistent shame, profound regret) do not loom ahead to influence him. If the 12-year-old boys could enjoy King Lear or the Ninth Symphony as much as some people do, they would not be so reckless or unruly. If the son of a family long honored in the community (and husband of a wife at her wits’ end) felt about going to jail and about being widely known as a jailbird, as most people do, he could not, after dozens of brief incarcerations, drop in on somewhat similar acquaintances (just back at work after their own periods of detention) and gaily twit them with such greetings as, “What kind of a bird can’t fly?”

  In a world where tedium demands that the situation be enlivened by pranks that bring censure, nagging, nights in the local jail, and irritating duns about unpaid bills, it can well be imagined that the psychopath finds cause for vexation and impulses toward reprisal. Few, if any, of the scruples that in the ordinary man might oppose and control such impulses seem to influence him. Unable to realize what it meant to his wife when he was discovered in the cellar flagrante delicto with the cook, he is likely to be put out considerably by her reactions to this. His having used the rent money for a midnight long-distance call to an old acquaintance in California (with whom he bantered for an hour) also brings upon him censure or tearful expostulation. Considering himself harassed beyond measure, he may rise from the dining room table in a petty tantrum, curse his wife violently, slap her, even spit on her, and further annoyed by the sudden weeping of their 6-year-old daughter, throw his salad in the little girl’s face before he strides indignantly from the room.

  His father, from the patient’s point of view, lacks humor and does not understand things. The old man could easily take a different attitude about having had to make good those last three little old checks written by the son. Nor was there any sense in raising so much hell because he took that dilapidated old Chevrolet for his trip to Memphis. What if he did forget to tell the old man he was going to take it? It wouldn’t hurt him to go to the office on the bus for a few days. How was he (the patient) to know the fellows were going to clean him out at stud or that the little bitch of a waitress at the Frolic Spot would get so nasty about money? What else could he do except sell the antiq
uated buggy? If the old man weren’t so parsimonious he’d want to get a new car anyway!

  And why did he (the father) have to act so magnanimous and hurt about settling things last Saturday night down at the barracks? You’d think from his attitude that it was the old man himself who’d had to put up with being cooped in there all those hours with louse-infested riff-raff! Well, he’d thanked his father and told him how sorry he was. What else could a fellow do? As for that damned old Chevrolet, he was sick of hearing about it. His grudge passing with a turn of thought, he smiles with half-affectionate, playfully cordial feelings toward the old man as he concludes, “I ought to tell him to take his precious old vehicle and stick it up his _____!”

  Lacking vital elements in the appreciation of what the family and various bystanders are experiencing, the psychopath finds it hard to understand why they continually criticize, reproach, quarrel with, and interfere with him. His employer, whom he has praised a few hours before, becomes a pettifogging tyrant who needs some telling off. The policeman to whom he gave tickets for the barbecue last week (because he is such a swell guy) turns out to be a stupid oaf and a meddler who can’t mind his own business but has to go and arrest somebody just because of a little argument with Casey in the Midnight Grill about what happened to a few stinking dollar bills that were lying on the bar.

  Adolescents who feel a need to kick over the traces often seek to do so in unconventional, spectacular, daring and sometimes shocking acts that often are motivated primarily by impulses of defiance. Similar impulses of defiance no doubt contribute to the psychopath’s behavior. Figures representing authority or respectability naturally irk him. They are smug and meddlesome in his eyes and tempt him to show them what he really can do. If he cannot actually remember his parents, on the eve of a whipping, telling him “this is going to hurt me more than it does you,” he, like all people, gets the idea. Through the damage he does to himself he has a way of getting back at or disciplining them, along with his wife, his friends, and all sorts of self-righteous people who volunteer to “do him good” and to meddle.46

  It is not necessary to assume great cruelty or conscious hatred in him commensurate with the degree of suffering he deals out to others. Not knowing how it hurts or even where it hurts, he often seems to believe that he has made a relatively mild but appropriate reprimand and that he has done it with humor. What he believes he needs to protest against turns out to be no small group, no particular institution or set of ideologies, but human life itself. In it he seems to find nothing deeply meaningful or persistently stimulating, but only some transient and relatively petty pleasant caprices, a terribly repetitious series of minor frustrations, and ennui.

  Like many teenagers, saints, history-making statesmen, and other notable leaders or geniuses, he shows unrest; he wants to do something about the situation. Unlike these others, as Lindner has so well and convincingly stressed, he is a “rebel without a cause.”188 Reacting with something that seems not too much like divine discontent or noble indignation, he finds no cause in the ordinary sense to which, he can devote himself with wholeheartedness or with persistent interest. In certain aspects his essential life seems to be a peevish bickering with the inconsequential. In other aspects he suggests a man hanging from a ledge who knows if he lets go he will fall, is likely to break a leg, may lose his job and his savings (through the disability and hospital expenses), and perhaps may injure his baby in the carriage just below. He suggests a man in this position who, furthermore, is not very tired and who knows help will arrive in a few minutes, but who, nevertheless, with a charming smile and a wisecrack, releases his hold to light a cigarette, to snatch at a butterfly, or just to thumb his nose at a fellow passing in the street below.

  In his work on obsessive disorder, Straus brings out and develops a concept very germane to the present discussion.270 Beneath severe obsessive disorder he often finds indications of a distaste for life as it is ordinarily lived, a nauseous rejection of what is normally most appealing, and an attitude toward the world that finds in our chief sources of joy the equivalent of decay and filth. These observations are interesting and extraordinarily articulate. They seem to elucidate from an independent viewpoint other and important aspects of what has elsewhere been presented as confusion of love and hate.209

  It is impossible to give briefly an adequate account of what Straus brings out. Its relation to our subject is of interest. The psychopath does not seem to share the obsessive patient’s specific pathologic evaluations, but he also reacts to the milieu of human life as if it had been altered in its essential qualities. The alteration in the psychopath is by no means similar to what Straus depicts. The obsessive patient according to Straus spends his life desperately trying to avoid what he finds so disgusting and horrible. The psychopath looks as if he were reacting to what is trivial by showing that he just doesn’t give a damn. Having no major goals or incentives, he may be prompted by simple tedium to acts of folly or crime. Such prompting is not opposed by ordinary compunction or concern for consequences.

  The psychopath certainly does not seem to be warding off anything similar to what the obsessive patient solemnly seeks to ward off with disgust. He may, however, be flouting something very different in an unrecognized or poorly recognized mockery or travesty whereby he demonstrates that he is not emotionally involved.

  The lack of aversion to conduct and situations which to the normal person are repulsive is striking and paradoxical in the psychopath. This is no impressive than the disgust Straus finds in obsessive patients. It might in fact be regarded as an equally basic alteration of the normal reaction but an alteration toward the other extreme. The opposite reactions of depression and manic euphoria have been interpreted as diverse responses to an identical inner pathologic situation.79 The prude and the pathologically wanton often seem to be influenced chiefly by the same misconception of sexuality as being intrinsically ignoble and, to the female, degrading. So, too, the active life rejection believed by Straus to underlie obsession and the indifference to major human values underlying the psychopath’s life scheme may themselves be thought of as profoundly pathologic reactions in opposite directions.

  A world not by any means identical but with some vivid features of both these underlying situations can be found in Huysmans’ Against the Grain42 and in Jean-Paul Sartre’s Nausea.252 In the satirical novels of Evelyn Waugh, also, an atmosphere difficult to describe sometimes develops—an atmosphere that may give the reader awareness of attitudes and evaluations genuinely illustrative of deeply distorted or inadequate reactions to life.290,293

  In none of this fiction does one find evidence of the obsessive patient’s reaction to what he scrupulously rejects as if it were filth. The leading characters depicted therein show a peculiar cynicism which is more conscious and directed and purposive than the behavior of the psychopath. But none of the characters presented show even an approximate awareness of what is most valid and meaningful and natural in human beings. A negative response to life itself, an aversion at levels more basic than ordinary morals or the infraconscious foundations of taste and incentive, is conveyed subtly and impressively.

  It is difficult to illustrate by incident, by the expressed attitude of the characters depicted, or by any clearly implied evaluation of the authors the specific quality of what is evoked in these novels as the essence of an unhappy, mutilated, and trivial universe in which all the characters exist. The sense of pathology pervades to levels so deep that rational scrutiny cannot reach and meet the fundamental implications; nor can inquiry satisfactorily demonstrate its precise source. If the actual world and main’s biologic scope were only that conveyed in these interesting works, it would perhaps be less difficult to account for obsessive illness and for the psychopath’s career as reasonable reactions to a situation where no course is possible except one profoundly pathologic in one way or another.

  Thoughtful contemplation of what is depicted in these works of fiction suggests a world as fundamentally
altered as what Straus presents as the world of the obsessive patient. In the effective and terse implication of general emotional incapacity in these characters, the authors succeed in evoking awareness of a sort of quasi-life restricted within a range of staggering superficiality. This, rather than those aspects of the works that apparently brought them popularity, may deserve high literary appraisal as concise and valuable communications of something that is by no means easy to convey in direct language. Such a superficiality and lack of major incentive or feeling strongly suggest the apparent emotional limitations of the psychopath.

  In his discussion of what arouses disgust in his obsessive patients, Straus brings out memorable points. Not by literal falsification of objective facts but by seeing and feeling the facts in a pathologic mode is the world altered. He says:270

  Curls on a head look lovely and attractive, but the same hair found in the soup is disgusting; perhaps we should like to cut one of these curls as a souvenir, but we should be disgusted to collect the hair left in a comb. Saliva spit out is disgusting, an expression of our contempt, but on fresh lips and tongue the saliva is not disgusting. Separation from the integrity of the living organism turns the physiognomy from delight to disgust. This transition indicates a transition from life to death; it signifies decay. Disgust is directed more against decay, the process of decomposition, than against the dead. A skeleton, a mummy, may be frightening, even horrible, but not as disgusting as a cadaver which has just been brought from a river to the morgue.