The Mask Of Sanity: An Attempt to Reinterpret the So-Called Psychopathic Personality

The Mask Of Sanity: An Attempt to Reinterpret the So-Called Psychopathic Personality

During a case discussion involving patients in custody recently a colleague made reference to Milton Cleckley’s  “The Mask of Sanity: An Attempt to Reinterpret the So-called Psychopathic Personality.” I’d heard of the book given that it’s considered to be a seminal work and the most influential clinical description of psychopathy in the twentieth century. I had to read it…

Right off, the book starts with a poem – not a poem by an antisocial but perhaps one for an antisocial. The poem is reproduced in many forums including an internet-based Psychology and Mental Health forum. Here it is:

“From chaos shaped, the Bios grows. In bone and viscus broods the Id. And who can say Whence Eros comes? Or chart his troubled way? Nor bearded sage, nor science, yet has shown. How truth or love, when met, is straightly known; Some phrases singing in our dust today. Have taunted logic through man's Odyssey: Yet, strangely, man sometimes will find his own. And even man has felt the arcane flow. Whence brims unchanged the very Attic wine, Where lives that mute and death-eclipsing glow. That held the Lacedaemonian battle line: And this, I think, may make what man is choose. The doom of joy he knows he can but lose.” Cleckley

This book is now in its fifth edition – first published in 1941. Cleckley recalls how the first edition was based primarily on experience with adult male psychopaths hospitalized in a closed institution. During the ensuring decades a much more diverse group of people became available. Female patients, adolescents, people who had never been admitted to a psychiatric hospital, all in large numbers, became available for study and afforded an opportunity to observe the disorder in a very wide range of variety and of degree.

Since the first edition of this book, revisions of the nomenclature have been made by the American Psychiatric Association. The classification of psychopathic personality was changed to that of sociopathic personality in 1958. In 1968 it was changed again to antisocial personality. Like most psychiatrists I continue to think of the people who are the subject of this book as psychopaths and will most often refer to them by this familiar term.

One of the most striking things about this book is born in its seemingly incorruptible America – an era where deals are considered legal contracts by handshakes and man’s word is gold. The government seems to care about its citizens. Here,  lawyers and judges and police officers have a certain amount of sympathy for the patients he’s worked with; they know these people aren’t quite right because they keep committing idiotic crimes that really have no pay-off, but they aren’t legally insane.

What I found most interesting about this book, perhaps it’s just me, the overwhelming sense of paternalism and male chauvinism. While women are mentioned as having jobs, it’s understood that of course they do that until they follow the natural course of life and get married and have children. A case study of one woman was particularly curious. The woman was considered to be a “deviant” and show signs of psychopathology merely because she was a lesbian and had the audacity to say that she did not want to be married. No worries—she was soon “cured” of those two unnatural conditions. Deviant behaviour abounds in this book. There is even a  chapter titled: “Homosexuality and other consistent sexual deviations.” Sure this is written in the early twentieth century but the incredible stereotypes are noteworthy to say the least. Sections deal with The psychopath as businessman, The psychopath as man of the world, The psychopath as gentleman, etc where are fascinating.