the opinion that strong and inappropriate negative attitudes toward psychopaths are commonly aroused in psychiatrists who attempt to deal with them as patients. This is an important point. Such reactions, there is reason to suspect, have tended to distort psychiatric appraisals of the disorder. I am not so rash as to claim total immunity from the subtle bias these patients seem to promote in so many physicians. It is hoped that the earnest wish to avoid this distorting influence will minimize effects of what can be more readily detected in the estimates of others than of one’s self. A strong personal conviction that in the psychopath we are dealing with genuine illness should be of some remedial value, to whatever degree of this prejudice I am, unwittingly, a victim.
When one has the opportunity to follow the career of a typical psychopath, his pattern of behavior appears specific—something not to be confused with the life of an ordinary purposeful criminal or of a cold opportunist who, in pursuit of selfish ends, merely disregards ethical considerations and the rights of others.
This pattern, I believe, differs no less distinctly than the specific and idiomatic thought and verbal expressions of schizophrenia differ from those of the mentally defective and from other psychiatric conditions. Never in faults of logical reasoning, or in verbal confusion or technical delusion, but rather in the sharper reality of behavior, the psychopath seems often to produce something as strange and as obviously pathologic as the following statement taken from the letter of a patient with schizophrenia:
“Financial service senses worries of 35 whirlpools below sound 1846, 45, 44, A.D. Augusta City treasur, Richmond County treasur, United States Treasur of Mississippi River flood area. Gentlemen will you come to… and idenafy none minastrative body that receives the life generated by fourth patented generative below sound. Further arrange financial credit for same. Would like two bedrooms at uptown Hotel and convenient to roof garden. Further what my occupation is you may as well announce me as comforting 35 whirlpools below sound. May you gentlemen have gray eyes and thick bones as the flat sense minastrated are very valuable in idenafying me.”
Even such a relatively simple bit of word-salad stands out at once as indicative of profound and specific disorder within the writer. As in the words of the schizophrenic, so in the behavior of the psychopath there seems to work a positive knack for producing situations which can be accounted for only in terms of psychiatric illness which is unique.
SECTION 2. THE MATERIAL
Part 1. The Disorder in Full Clinical Manifestation
CHAPTER 5. MAX
This patient first came to my attention years ago while I was serving my turn as Officer of the Day in a Veterans Administration psychiatric institution. His wife telephoned to the hospital for assistance, stating that Max had slipped away from her and begun to make trouble again. With considerable urgency and apparent distress she explained that she was bringing him to be admitted as a patient and begged that a car with attendants be sent at once to her aid.
He was found in the custody of the police, against whom he had made some resistance but much more vocal uproar. The resistance actually was only a show of resistance consisting for the most part of dramatically aggressive gestures while he was too securely held to fight and extravagant boasts of his physical prowess and savage temper. His general demeanor in this episode suggested the familiar picture of small boys, held fast by peacemakers, who wax ever more eloquently militant as the possibilities of actual conflict diminish.
He came quietly with the attendants and on arriving at the admission ward was alert, self-assured, and boastful. Extolling his own mettle as a prizefighter, as a salesman, and as general good fellow, he was, nevertheless, friendly and even flattering toward the examining physician and the hospital.
He was far from what could be called drunk. It would, in fact, be stretching a point to say he was “under the influence.” He had been drinking, it is true, but he knew well what he was doing and only by an impracticable flight of fancy could one attribute his behavior primarily to liquor.
At the admitting ward of the hospital accompanying papers promptly revealed that the patient’s desire for treatment arose in consequence of some checks which he had forged in Spartanburg, S. C. He had been arrested and convicted but instead of being sent to jail an agreement was reached whereby he might come to the hospital for psychiatric treatment.
His wife, his attorney, and representatives of a veterans’ organization pointed out that he had frequently been in hospitals for the treatment of mental disorder and maintained that he was not responsible for his misconduct.
He seemed pleased to be at the hospital, was expansive and cordial, a little haughty despite his well-maintained air of camaraderie. Though a small man, only five feet six, he made a rather striking impression. His glance was fresh and arresting. His movements were quick, and he had an air of liveliness vaguely suggestive of a chipmunk. Though preposterously boastful, he did not show any indications of a psychosis.
The hospital records showed that he had been a patient eight years previously for a period of two months. During this time of study he showed no evidence of a psychosis or a psychoneurosis and was discharged with a diagnosis of psychopathic personality. He was found to have tertiary syphilis, but neurologic examination and spinal fluid studies showed no evidence of neurosyphilis.
Though at first cooperative and agreeable on this previous admission, he soon became restless and expressed dissatisfaction with the hospital. He was granted parole, but on his first pass into town he got into an altercation in which words were more prominent than blows and was held by the police for disturbing the peace.
After losing parole he became constantly unruly in petty ways, often insulted the nurses and attendants, and several times egged on mildly psychotic patients to fight each other or to resist the personnel on the ward. On being questioned about this conduct by physicians, he glibly denied all and showed little concern at being accused. Since he was not considered as suffering from a real nervous or mental disorder, and since it was difficult to keep him on any ward except the closely supervised one among actively disturbed patients, he had been discharged.
Records show that he sought hospitalization on other occasions after having been fined a half-dozen or more times for brawling on the streets and for petty frauds. There is every reason to believe, from the evidence of careful reports by the Red Cross and by social service workers, that when his troubles with the civil authorities became too discomforting he sought the shelter of a psychiatric hospital.
Several months previously he had spent six weeks at a Veterans Administration hospital in Maryland after getting into similar trouble with the police in Wilmington, Delaware. He complained at the time of having spells during which he lost his temper and attacked people, often, according to his story, with disastrous results, since, again according to his story, he had at one time been featherweight boxing champion of England.
According to the psychiatric history at the Maryland hospital, he had, in describing these spells, mentioned some points that would suggest epilepsy. As soon as he came to the hospital and was relieved of responsibility for the trouble he had made, the so-called spells ceased. His descriptions of them varied. Sometimes, when particularly expansive, he boasted of superconvulsions lasting as long as ten hours, during which he made window panes rattle and shook slats from the bed. After being in the hospital for several weeks and apparently beginning to grow bored, his talk of spells died down and he seemed to lose interest in the subject. He was discharged after the staff had agreed that the alleged seizures were entirely spurious, and the patient himself had all but admitted it. The diagnosis of psychopathic personality was made.
Between his first visit to the present hospital and his recent return he had been in five other psychiatric institutions,
