Despite a “casual disregard of primary responsibilities” (p197) “the psychopath presents an important and challenging enigma for which no adequate solution has yet been found.”
“Although I still have no effective treatment to offer for the psychopath (antisocial personality), it has encouraged me to feel that this book has, perhaps, served a useful purpose in making clearer to the families of these patients the grave problems with which they must deal.”
“Apparently many psychiatrists, and many other physicians, have over the years advised relatives of psychopaths to read The Mask of Sanity. The response of these relatives has given me deep satisfaction and has helped me to feel that efforts to pursue this study are not in vain.”
Cleckley, The Mask of Sanity 5th Edition, 1988
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 criticise, reproach, quarrel with, and interfere with him. (p391)
Figures representing authority or respectability naturally irk him…. (p391)
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 humour. 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.
In certain aspects his essential life seems to be a peevish bickering with the inconsequential. (p391)
The lack of aversion to conduct and situations which to the normal person are repulsive is striking and paradoxical in the psychopath. (p392)
Such a superficiality and lack of major incentive or feeling strongly suggest the apparent emotional limitations of the psychopath. (p393)
To the psychopath the basic axioms of life must seem different from what they seem to normal people (and also very different from what they seem to people with severe obsessive disorders) (p394)
Observation of the psychopath makes it increasingly plain, however, that he is not reacting normally to the surroundings that are ordinarily assumed to exist. (p394)
The psychopath has a basic inadequacy of feeling and realisation that prevents him from normally experiencing the major emotions and from reacting adequately to the chief goals of human life. (p394)
What I regard as the psychopath’s lack of insight shows up frequently and very impressively in his apparent assumption that the legal penalties for a crime he has committed do not, or should not, apply to him. (p351)
Usually when a person is legally adjudged incompetent, it is on the basis of his being psychotic. Sometimes, however, a person who is psychotic may be held legally responsible because he is considered as knowing the nature and quality of his criminal deed and that it is wrong. (p422)
The hedonistic and self-centred acts of many psychopaths often go relatively unpunished. Studies by Robins (1966) and Gibbens, Briscoe, and Dell (1968) have shown that a surprisingly large number of psychopathic persons somehow manage to avoid incarceration in spite of the fact that their behaviour may be grossly antisocial. In many cases they are protected by family and friends who may themselves be their victims.
In other cases they may be charming and intelligent enough to talk their way out of prosecution. In any event, their behaviour may be relatively unchecked and unpunished; and therefore very rewarding, persistent, and firmly established. (pp111-112)
UNRESPONSIVENESS IN INTERPERSONAL RELATIONS
The psychopath cannot be depended upon to show the ordinary responsiveness to special consideration or kindness or trust. (p352)
No matter how well he is treated, no matter how long-suffering his family, his friends, the police, hospital attendants, and others may be, he shows no consistent reaction of appreciation except superficial and transparent protestations. Such gestures are exhibited most frequently when he feels they will facilitate some personal aim. (p352)
The ordinary axiom of human existence that one good turn deserves another, a principle sometimes honoured by cannibals and uncommonly callous assassins, has only superficial validity for him although he can cite it with eloquent casuistry when trying to obtain parole, discharge from the hospital, or some other end. (p352)
As in attempting to delineate other aspects of the psychopath, we find ourselves again confronting paradox. Although he can be counted on not to be appreciably swayed in major issues by these basic rules, we often find him attentive in small courtesies and favours, perhaps even habitually generous or quasi-generous when the cost is not decisive.
Occasionally his actions may suggest profound generosity in that large sums are involved or something presumably of real value is sacrificed. Usually, however, these appearances are deceiving. (p352)
In relatively small matters psychopaths sometimes behave so as to appear very considerate, responsive, and obliging. Acquaintances who meet them on grounds where minor issues prevail may find it difficult to believe that they are not highly endowed with gratitude and eager to serve others. Such reactions and intentions, although sometimes ready or even spectacularly facile, do not ever accumulate sufficient force to play a determining part in really important issues. (p352)
Outward social graces come easy to most psychopaths, and many continue, throughout careers disastrous to themselves and for others, to conduct themselves in superficial relations, in handling the trivia of existence, so as to gain admiration and gratitude. In these surface aspects of functioning, the typical psychopath (unlike the classic hypocrite) often seems to act with undesigning spontaneity and to be prompted by motives of excellent quality though of marvellously attenuated substance. (p355)
TRUTHFULNESS
He will lie about any matter, under any circumstances, and often for no good reason. (p342)
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 behaviour, and cannot be accounted for by ordinary motives or incentives. (p342)
Despite the extraordinarily poor judgment demonstrated in behaviour, in the actual living of his life, the psychopath characteristically demonstrates unimpaired (sometimes excellent) judgment in appraising theoretical situations. (p346)
(ie in which he has no personal involvement; well capable of giving a superb lecture on business ethics, yet behaving highly unethically as soon as he leaves the lecture theatre, without remorse)
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. (p346) ……
His subjective experience is so bleached of deep emotion that he is invincibly ignorant of what life means to others. …(p386)
“He is unfamiliar with the primary facts or data of what might be called personal values and is altogether incapable of understanding such matters. (p40)
Having no major values himself, can he be said to realise adequately the nature and quality of the outrages his conduct inflicts upon others? (p386)
The psychopath feels little, if any, guilt. He can commit the most appalling acts, yet view them without remorse. The psychopath has a warped capacity for love. His emotional relationships, when they exist, are meagre, fleeting, and designed to satisfy his own desires.
These last two traits, guiltlessness and lovelessness, conspicuously mark the psychopath as different from other men… (p410)
APPENDIX Standard textbooks did not and still do not make clear to what precise degree the person must be affected to be justifiably placed in this category. With due apologies then to those who would restrict this term, I ask leave to use it for the type of person who is now being considered. Whatever these people may be called, they are not normal. (p452)
If we consider, in addition to these patients (nearly all of whom have records of the utmost folly and misery and idleness over many years and who have had to enter a psychiatric hospital), the vast number of similar people in every community who show the same behaviour pattern in milder form but who are sufficiently protected and supported by relatives to remain at large, the prevalence of this disorder is seen to be appalling.
[ie can appear rational in many situations when he perceives his self-interest is not a factor or may not be under threat; but when his self-interest is threatened (even if it isn’t, just his perception that it may be) and he considers he may not “get his own way”, not unlike a primary school infant, every ability to rationally deliberate issues appears to fly out the window, a matter that neuroscience doesn’t appear to have explained – yet!]
Let us remember that his typical behaviour defeats what appear to be his own aims. Is it not he himself who is most deeply deceived by his apparent normality? Although he deliberately cheats others and is quite conscious of his lies, he appears unable to distinguish adequately between his own pseudo-intentions, pseudo-remorse, pseudo-love, and the genuine responses of a normal person. His monumental lack of insight indicates how little he appreciates the nature of his disorder. (p383)
I think, however, that the roots of this attitude lie deeper, probably in the core of the psychopath’s essential abnormality – perhaps in a lack of emotional components essential to real understanding. (p173)
SUCCESSFUL THERAPY
On the assumption that the psychopath’s behaviour reflects a maladaptive lifestyle that is maintained by reinforcement from family, friends, and associates, Thorne has outlined what he considers to be the requirements of successful therapy with psychopaths.
Hare in 1970 gives this interesting summary of Thorne’s approach: (p445)
These are summarised as follows.
The therapist must have complete control over the financial resources of the psychopath, usually by being made trustee of his accounts.
Relatives and other interested parties must agree not to bail the psychopath out of his difficulties; he must be required to face the consequences of his own behaviour.
The therapist must be very persistent in gradually getting the psychopath to exert some limits and controls over his own behaviour.
The therapist should not protect the psychopath from the legal and social consequences of his actions.
The therapist should make it clear to the psychopath that he understands him thoroughly, knows what to expect, and will be convinced of his good intentions only through actions and not words.
The psychopath must be shown repeatedly that his behaviour is self-defeating.
The therapist should search for a leverage point to stimulate more socially acceptable behaviour. As a last resort, the therapist may have to use money, which he controls, as an incentive.
EBEN Ireland 