The Mask of Sanity

5th edition; Written By

Hervey Cleckley

Presented Here By

Bonnie M. Wells

Discussion of Psychopathy Traits

More often than not, the typical psychopath will seem particularly agreeable and make a distinctly positive impression when he is first encountered. Alert and friendly in his attitude, he is easy to talk with and seems to have a good many genuine interests. There is nothing at all odd or queer about him, and in every respect he tends to embody the concept of a well-adjusted, happy person. Nor does he, on the other hand, seem to be artificially exerting himself like one who is covering up or who wants to sell you a bill of goods. He would seldom be confused with the professional backslapper or someone who is trying to ingratiate himself for a concealed purpose. Signs of affectation or excessive affability are not characteristic. He looks like the real thing.

Very often indications of good sense and sound reasoning will emerge and one is likely to feel soon after meeting him that this normal and pleasant person is also one with high abilities. Psychometric tests also very frequently show him of superior intelligence. More than the average person, he is likely to seem free from social or emotional impediments, from the minor distortions, peculiarities, and awkwardnesses so common even among the successful. Such superficial characteristics are not universal in this group but they are very common.

Here the typical psychopath contrasts sharply with the schizoid personality or the patient with masked or latent schizophrenia. No matter how free from delusions and other overt signs of psychosis the schizoid person may be, he is likely to show specific peculiarities in his outer aspect. Usually there are signs of tension, withdrawal, and subtle oddities of manner and reaction. These may appear to be indications of unrevealed brilliance, perhaps even eccentricities of genius, but they are likely to complicate and cool easy social relations and to promote restraint. Although the psychopath's inner emotional deviations and deficiencies may be comparable with the inner status of the masked schizophrenic, he outwardly shows nothing brittle or strange. Everything about him is likely to suggest desirable and superior human qualities, a robust mental health.

The so-called psychopath is ordinarily free from signs or symptoms traditionally regarded as evidence of a psychosis. He does not hear voices. Genuine delusions cannot be demonstrated. There is no valid depression, consistent pathologic elevation of mood, or irresistible pressure of activity. Outer perceptual reality is accurately recognized; social values and generally accredited personal standards are accepted verbally. Excellent logical reasoning is maintained and, in theory, the patient can foresee the consequences of injudicious or antisocial acts, outline acceptable or admirable plans of life, and ably criticize in words his former mistakes. The results of direct psychiatric examination disclose nothing pathologic - nothing that would indicate incompetency or that would arouse suspicion that such a man could not lead a successful and happy life.

Not only is the psychopath rational and his thinking free of delusions, but he also appears to react with normal emotions. His ambitions are discussed with what appears to be healthy enthusiasm. His convictions impress even the skeptical observer as firm and binding. He seems to respond with adequate feelings to another's interest in him and, as he discusses his wife, his children, or his parents, he is likely to be judged a man of warm human responses, capable of full devotion and loyalty.

There are usually no symptoms to suggest a psychoneurosis in the clinical sense. In fact, the psychopath is nearly always free from minor reactions popularly regarded as "neurotic" or as constituting "nervousness." The chief criteria whereby such diagnoses as hysteria, obsessive-compulsive disorder, anxiety state, or "neurasthenia" might be made do not apply to him. It is highly typical for him not only to escape the abnormal anxiety and tension fundamentally characteristic of this whole diagnostic group but also to show a relative immunity from such anxiety and worry as might be judged normal or appropriate in disturbing situations. Regularly we find in him extraordinary poise rather than jitteriness or worry, a smooth sense of physical well-being instead of uneasy preoccupation with bodily functions. Even under concrete circumstances that would for the ordinary person cause embarrassment, confusion, acute insecurity, or visible agitation, his relative serenity is likely to be noteworthy.

It is true he may become vexed and restless when held in jails or psychiatric hospitals. This impatience seems related to his inability to realize the need or justification for his being restrained. What tension or uneasiness of this sort he may show seems provoked entirely by external circumstances, never by feelings of guilt, remorse, or intrapersonal insecurity. Within himself he appears almost as incapable of anxiety as of profound remorse.

Though the psychopath is likely to give an early impression of being a thoroughly reliable person, it will soon be found that on many occasions he shows no sense of responsibility whatsoever. No matter how binding the obligation, how urgent the circumstances, or how important the matter, this holds true. Furthermore, the question of whether or not he is to be confronted with his failure or his disloyalty and called to account for it appears to have little effect on his attitude.

If such failures occurred uniformly and immediately, others would soon learn not to rely upon psychopaths or to be surprised at their conduct. It is, however, characteristic for them during some periods to show up regularly at work, to meet their financial obligations, to ignore an opportunity to steal. They may apply their excellent abilities in business or in study for a week, for months, or even for a year or more and thereby gain potential security, win a scholarship, be acclaimed top salesman or elected president of a social club or perhaps of a school honor society. Not all checks given by psychopaths bounce; not all promises are uniformly ignored. They do not necessarily land in jail every day (or every month) or seek to cheat someone else during every transaction. If so, it would be much simpler to deal with them. This transiently (but often convincingly) demonstrated ability to succeed in business and in all objective affairs makes failures more disturbing to those about them.

Furthermore, it cannot be predicted how long effective and socially acceptable conduct will prevail or precisely when (or in what manner) dishonest, outlandish, or disastrously irresponsible acts or failures to act will occur. These seem to have little or no relation to objective stress, to cyclic periods, or to major alterations of mood or outlook. What is at stake for the patient, for his family, or for anybody else is not a regularly determining factor. At the crest of success in his work he may forge a small check, indulge in petty thievery, or simply not come to the office. After a period of gracious and apparently happy relations with his family he may pick a quarrel with his wife, cuff her up a bit, drive her from the house, and then throw a glass of iced tea in the face of his 3-year-old son. For the initiation of such outbursts he does not, it seems, need any great anger. Moderate vexation usually suffices.

The psychopath's unreliability and his disregard for obligations and for consequences are manifested in both trivial and serious matters, are masked by demonstrations of conforming behavior, and cannot be accounted for by ordinary motives or incentives. Although it can be confidently predicted that his failures and disloyalties will continue, it is impossible to time them and to take satisfactory precautions against their effect. Here, it might be said, is not even a consistency in inconsistency but an inconsistency in inconsistency.

The psychopath shows a remarkable disregard for truth and is to be trusted no more in his accounts of the past than in his promises for the future or his statement of present intentions. He gives the impression that he is incapable of ever attaining realistic comprehension of an attitude in other people which causes them to value truth and cherish truthfulness in themselves.

Typically he is at ease and unpretentious in making a serious promise or in (falsely) exculpating himself from accusations, whether grave or trivial. His simplest statement in such matters carries special powers of conviction. Overemphasis, obvious glibness, and other traditional signs of the clever liar do not usually show in his words or in his manner. Whether there is reasonable chance for him to get away with the fraud or whether certain and easily foreseen detection is at hand, he is apparently unperturbed and does the same impressive job. Candor and trustworthiness seem implicit in him at such times. During the most solemn perjuries he has no difficulty at all in looking anyone tranquilly in the eyes. Although he will lie about any matter, under any circumstances, and often for no good reason, he may, on the contrary, sometimes own up to his errors (usually when detection is certain) and appear to be facing the consequences with singular honesty, fortitude, and manliness.

It is indeed difficult to express how thoroughly straightforward some typical psychopaths can appear. They are disarming not only to those unfamiliar with such patients but often to people who know well from experience their convincing outer aspect of honesty. A saying current among psychiatric residents, secretaries, medical associates, and others familiar with what goes on in my office may illustrate this point. The saying is in substance that excellent evidence for the diagnosis of psychopathic personality can be found in my own response to newcomers who seek to borrow money or cash checks. It is rather generally believed that only psychopaths are successful and that in typical scams success is inevitable. Although I argue that some exaggeration has perhaps colored this story and overemphasized the infallibility of my reaction as a test, I must admit there is much truth in the matter. Even after so many years of special interest in the subject, I am forced to confess that fairly often observers have had the opportunity to make a snap diagnosis from my response to this sort of appeal and see it gain full confirmation in subsequent events. I might add that no such loan has ever been repaid and that all such checks have bounced.

After being caught in shameful and gross falsehoods, after repeatedly violating his most earnest pledges, he finds it easy, when another occasion arises, to speak of his word of honor, his honor as a gentleman, and he shows surprise and vexation when commitments on such a basis do not immediately settle the issue.

The conception of living up to his word seems, in fact, to be regarded as little more than a phrase sometimes useful to avoid unpleasantness or to gain other ends. How inadequate such ends may be to account for the psychopath's neglect of truth can be shown in a brief example:

In a letter to his wife, at last seeking divorce and in another city, one patient set down dignified, fair appraisals of the situation and referred to sensible plans he had outlined for her security. He then added that specified insurance policies and annuities providing for the three children (including their tuition at college) had been mailed under separate cover and would, if she had not already received them, soon be in her hands. He had not taken even the first step to obtain insurance or to make any other provision, and, once he had made these statements in his letter, he apparently gave the matter no further thought.

The psychopath apparently cannot accept substantial blame for the various misfortunes which befall him and which he brings down upon others, usually he denies emphatically all responsibility and directly accuses others as responsible, but often he will go through an idle ritual of saying that much of his trouble is his own fault. When the latter course is adopted, subsequent events indicate that it is empty of sincerity-a hollow and casual form as little felt as the literal implications of "your humble and obedient servant" are actually felt by a person who closes a letter with such a phrase. Although his behavior shows reactions of this sort to be perfunctory, this is seldom apparent in his manner. This is exceedingly deceptive and is very likely to promote confidence and deep trust. More detailed questioning about just what he blames himself for and why may show that a serious attitude is not only absent but altogether inconceivable to him. If this fails, his own actions will soon clarify the issue.

Whether judged in the light of his conduct, of his attitude, or of material elicited in psychiatric examination, he shows almost no sense of shame. His career is always full of exploits, any one of which would wither even the more callous representatives of the ordinary man. Yet he does not, despite his able protestations, show the slightest evidence of major humiliation or regret. This is true of matters pertaining to his personal and selfish pride and to esthetic standards that he avows as well as to moral or humanitarian matters. If Santayana is correct in saying that "perhaps the true dignity of man is his ability to despise himself," the psychopath is without a means to acquire true dignity.

Not only is the psychopath undependable, but also in more active ways he cheats, deserts, annoys, brawls, fails, and lies without any apparent compunction. He will commit theft, forgery, adultery, fraud, and other deeds for astonishingly small stakes and under much greater risks of being discovered than will the ordinary scoundrel. He will, in fact, commit such deeds in the absence of any apparent goal at all.

Yet we do not find the regularity and specificity in his behavior that is apparent in what is often called compulsive stealing or other socially destructive actions carried out under extraordinary pressures which the subject, in varying degrees, struggles against. Such activities, and all disorder distinguished by some as impulse neurosis,14 as we have mentioned, probably have important features in common with the psychopath's disorder. In contrast, his antisocial and self-defeating deeds are not circumscribed (as, for example, in pyromania and kleptomania), and he shows little or no evidence of the conscious conflict or the subsequent regret that are not regularly absent in these other manifestations. Again the comparison Of a circumscribed dissociation typical of hysteria with the general ego disintegration of schizophrenia may be usefully cited.

Objective stimuli (value of the object, specific conscious need) are, as in compulsive (or impulsive) stealing, inadequate to account for the psychopath's acts. Evidence of any vividly felt urge symbolizing a disguised but specifically channelized, instinctive drive is not readily available in the psychopath's wide range of inappropriate and self-defeating behavior. Two incidents in typical cases are offered:

1. An 18-year-old boy often stole objects for which he had some use, but stealing was not a dominant feature in his almost universally manifested maladjustment. Drifting one day into church, he chose to remain after services and speak personally with the clergyman. As might be expected, he made a profound impression and, spontaneously professing conversion, brought justifiable pride to his counselor. Although disappointed because this new religious attitude did not curtail the boy in his flagrant truancy, his desultory cheating in examinations, and his lying, the clergyman worked hopefully and assiduously with him. On one occasion, after hanging around juke joints and street corners until 3 A.M., he explained his tardiness to his parents in a vivid account of having been injured while wrestling at the school gymnasium. He had, he explained to them, spit up blood and so was taken in an ambulance to the hospital emergency room, where he was treated by the family physician. He gave realistic detail about difficulties in locating the physician, the spirit of emergency prevailing, and techniques of treatment. This story was elaborated despite his knowledge that the next day he was, in the company of his father, going to visit this very physician (for a previously made appointment) and that all he said would be proved untrue.

Despite repeated and versatile acts inconsistent with the boy's profession of religion, the patient clergyman, naturally impressed with one who seemed so sincere and whose stated attitudes were so admirable, did not lose hope and at times even became quite optimistic. This optimism was particularly shaken after the discovery that his convert had, during communion, succeeded in stealing one of the small glass goblets used in the ceremony.

2. Stealing was a very minor feature of this lady's career, a few details of which were cited in Chapter 12, Anna. While on parole for the afternoon from a private psychiatric institution, she accepted the hospitality of an old friend who had planned tea and sandwiches for several rather demure women whose common interest centered on Sunday school activities. While accompanying her hostess on a preparatory visit to a large grocery store, the patient, as if by whim, slipped into her ample handbag a bottle of vitamin tablets, a package of cream cheese, and a tin of anchovy paste. On arriving at the house (prior to the gathering), she presented all but the vitamin tablets to her hostess as a contribution to the party. She was a woman of considerable wealth and had funds with her. She apparently realized that her theft might be detected and would almost surely be suspected. In carrying out the act she behaved with what can perhaps best be called moderate caution. Apparently she was not strongly influenced by fears of being caught. Nor, on the other hand, did she seem to be seeking purposively but unconsciously any specific thrill, masochistic or otherwise, that might arise in this event. Nothing about her reactions to this and scores of similar acts ever suggested an irresistible force compelling her on against her judgment and will.

Despite his excellent rational powers, the psychopath continues to show the most execrable judgment about attaining what one might presume to be his ends. He throws away excellent opportunities to make money, to achieve a rapprochement with his wife, to be dismissed from the hospital, or to gain other ends that he has sometimes spent considerable effort toward gaining. It might be said that he cares little about financial success and little about regaining his wife, but it is difficult indeed to say that he is not extremely fain to get out of the psychiatric hospital where he has been locked up for months with other patients whom he regards as "lunatics" and who are, indeed, not desirable associates for the average man or for him. Be it noted again that the psychopath appears as unwilling to remain in a psychiatric hospital and as impatient to regain his freedom as would be the normal man. I have not in these patients ever found reliable evidence that unconsciously they seek and enjoy as punishment such confinement.

This exercise of execrable judgment is not particularly modified by experience, however chastening his experiences may be. Few more impressive examples of this could be offered from the records of humanity than the familiar one of the psychopath who, in full possession of his rational faculties, has gone through the almost indescribably distasteful confinement of many months with delusional and disturbed psychotic patients and, after fretting and counting the days until the time of his release, proceeds at once to get drunk and create disorder which he thoroughly understands will cause him to be returned without delay to the detested wards. It is my opinion that no punishment is likely to make the psychopath change his ways. Punishment is not, of course, regarded as an appropriate measure in medical treatment. It is, however, often considered and administered by legal authorities. And it must be remembered that at present the law deals with these patients more frequently than physicians deal with them.

Despite the extraordinarily poor judgment demonstrated in behavior, in the actual living of his life, the psychopath characteristically demonstrates unimpaired (sometimes excellent) judgment in appraising theoretical situations. In complex matters of judgment involving ethical, emotional, and other evaluational factors, in contrast with matters requiring only (or chiefly) intellectual reasoning ability, he also shows no evidence of a defect. So long as the test is verbal or otherwise abstract, so long as he is not a direct participant, he shows that he knows his way about. He can offer wise decisions not only for others in life situations but also for himself so long as he is asked what he would do (or should do, or is going to do). When the test of action comes to him we soon find ample evidence of his deficiency.

The psychopath is always distinguished by egocentricity. This is usually of a degree not seen in ordinary people and often is little short of astonishing. How obviously this quality will be expressed in vanity or self-esteem will vary with the shrewdness of the subject and with his other complexities. Deeper probing will always reveal a selfcenteredness that is apparently unmodifiable and all but complete. This can perhaps be best expressed by stating that it is an incapacity for object love and that this incapacity (in my experience with well-marked psychopaths) appears to be absolute.

Terms in use for what we experience as "emotion" contain much ambiguity, and their referential accuracy is limited. This contributes to confusion and paradox which are difficult to avoid in attempts to convey concepts about such a matter.

Continued on page 2

Bonnie M. Wells

This page posted: December 2007 // BMW