The Mask of Sanity. Hervey M. Cleckley

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These men are studied, found free of recognized mental disorder which might make them unaware of what they are doing, and are sent back out into the world. They are arrested not once but many times. Most of them seldom commit very serious crimes. Only rarely can they be kept for more than a few days. They do not follow any purposive criminal life. They make a nuisance of themselves to the community as a whole and often tragically wreck the lives of those close to them, and all to no discernible end. The police and the courts tire of them. Through various influences they are forced back on the mental hospitals where they take legal action to regain their freedom, only to begin the process again.

      If, as stated in the quotations previously cited, it would be difficult to prove this man incompetent but not insane, it would be far more difficult, by existing definitions of psychiatry, to prove him “insane.” His perfectly rational (superficial) behavior under scrutiny, his freedom from delusions, his shrewdness, his alertness, his convincing plan for a normal, useful life, in short, his plain sanity as this is ordinarily understood, make it all but impossible for a judge or a jury to call him insane. Psychiatrists, familiar with his long record of senseless behavior, are able to see more reason to do so than could be brought out before a court in terms of abstract criteria by which the decision is determined. But according to the accepted standards of psychiatry, his diagnosis carries with it an official and automatic endorsement of the patient as sane and competent. No matter how strongly impressed by real and practical evidence to the contrary, all physicians testifying in such a case must admit that the official technicalities approve this paradox.

      Having won his case in court, the patient was released against medical advice. Frank did not go home but remained in the city where he at once claimed the attention of the police. On being released after a few days in jail he took a room at the best hotel, annoyed other guests by trying to borrow money, sponge on them for a meal, sell them something useless or non-existent, etc. He became at times loudly boastful or rowdy, and eventually fell on the floor drunk. He refused to pay for his room and resisted the management’s attempts to remove him.

      He sought loans under bold-faced pretences, ran up debts without regard to the possibilities of payment, telephoned and wrote to his family threatening suicide unless his demands for money were promptly met. There are indications that he was not inactive during this period in old devices of petty thievery, short-changing, and various types of fraud, sharp practice, and connivance, that exist on the fringe of more or less organized but illegal racketeering found in any city.

      Nothing, however, could be pinned on him by the law that led to his being effectively controlled. In all issues of this sort that arose he had his record as a patient once legally committed and often confined to psychiatric institutions. This record was, in his ingenious hands, of considerable value as insurance against penal restraint.

      After several arrests, the police began to call on the hospital to relieve them of their problems with this man. They were told that nothing could be done since he had been legally removed and the hospital was enjoined by the court not to hold him. Soon afterward the police and various local people began to seek advice on how to deal with him from the attorney who had liberated this man.

      The patient himself soon joined in, coming repeatedly to the attorney’s office or his house, sometimes drunk and always unreasonable, to shout about the injustices of the world, borrow money, evade threatening penalties, and to demand divers preposterous services. The veteran had promised to pay the attorney’s bill with bonus money, but now it appeared that this money had already been squandered. Hoping to collect his fee and, no doubt, from humanitarian impulses, the attorney sought to keep in touch with his client. Those with whom he had run up bills, floated little loans, etc., joined others swindled or defrauded in small matters and took their problems up with the patient’s legal representative. Soon the incessant complaints from annoyed people, the client’s own nagging or uproarious invasions upon him at all hours, and the constant queries of the police drove him to seek relief. The patient being again in jail, the attorney persuaded him to agree to return to the hospital voluntarily and pled with the physician in charge to take him back, confessing himself at fault ever to have released such a scourge on the community and on himself.

      Arrangements were made for readmission. The patient arrived in custody of a policeman. He was still somewhat stimulated from a recent intoxication but, though overbearing and pompous, showed no signs of real drunkenness nor of an officially recognized psychosis.

      Frank took a high-handed manner, swaggered about, finally refused to come back into the hospital, saying that he had no mental disease and that he preferred to return to jail where he would soon be released to carry out important business plans and social activities. He enjoyed the incident, played up his role dramatically, and took a peremptory and haughty tone with everyone.

      Some weeks later after running up big debts, giving several more bad checks, and participating in a series of senseless, bawdy escapades, he was finally returned to the hospital. Three months later he again obtained his discharge on a writ of habeas corpus but not through the same attorney. The story in its broad essentials was repeated.

      Since his last admission, following the exploits just mentioned, he has been true to form. After varying periods on a closed ward parole has been given, he has lost it repeatedly and gone back among “demented” and helpless groups with whom he is, to say the least, not at home. He has continued at all times free from the technical stigmata of psychosis, crafty, intelligent, and superficially cooperative while trying to gain his ends.

      Frank takes advantage of every opportunity to make trouble in the hospital, is rather restless and extremely dissatisfied. He sends frequent letters to women in town to whom he regards himself as paying court. These are written in a neat hand, well spelled and well expressed, and are much better letters than one would look for from a man of his education. They are marked with self-righteousness, extreme egotism, trite sentimentality, and monumental falsehood. His tone is that of a lover who regards his own passion as very high and rare.

      “Only God knows,” he writes, “why I wasn’t left over there among the poppies with my heroic buddies,” falsely describing himself as a captain in charge of 272 men. “My wife never understood me!” he complains in the same letter. What does he expect of her? The question invites meditation.

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