Incomplete Manifestations or Suggestions of the Disorder

By Hervey Cleckley Extract from "Mask of Sanity"

...all people showing features of [psychopathy] should not be regarded as totally disabled. It is here maintained that this defect, like other psychiatric disorders, appears in every degree of severity and may constitute anything from a personality trait through handicaps of varying magnitude...

...In them, [partial psychopaths] the disorder may be regarded as milder or more limited. The psychopathologic process, the deviation (or the arrest), is, as with the others, a process affecting basic personal reactions; but here it has not altogether dominated the scene. It has not crowded ordinary successful functioning in the outer aspects of work and social relations entirely out of the picture.

Some of these patients I believe are definitely psychopaths but in a milder degree, just as a patient still living satisfactorily in a community may be clearly a schizophrenic but nevertheless able to maintain himself outside the shelter of a psychiatric hospital. Others might not deserve to be called psychopaths but seem to show strong, even if not consistent, tendencies and inner reactions characteristic of the group. They might be compared to the plain and complete manifestations of the psychopath as the schizoid personality might be cormpared to the schizphrenic patient who is obviously psychotic...

...Some patients might more accurately be thought of as showing scattered indications of such a disorder, suggestions of a disturbance central in nature but well contained within an outer capsule of successful behavior much deeper than the merely logical and theoretical rationality of the fully disabled psychopath. In those who consistently support themselves and pass regularly as acceptable members of the social group, we can only be astonished at the difference between such technical outer adjustment and the indications of deeper pathologic features so similar to those found in the complete manifestation of the disorder...

...I believe that in these personalities designated as partially or inwardly affected, a very deep-seated disorder often exists. The true difference between them and the psychopaths who continually go to jails or to psychiatric hospitals is that they keep up a far better and more consistent outward appearance of being normal. This outward appearance may include business or professional careers that continue in a sense successful, and which are truly successful when measured by financial reward or by the casual observer’s opinion of real accomplishment. It must be remembered that even the most severely and obviously disabled psychopath presents a technical appearance of sanity, often one of high intellectual capacities, and not infrequently succeeds in business or professional activities for short periods, sometimes for considerable periods.

I maintain, however, that the actual but concealed pathology in some of the patients now to be described is in a deeper sense also far-reaching and profound. Although they occasionally appear on casual inspection as successful members of the community, as able lawyers, executives, or physicians, they do not, it seems, succeed in the sense of finding satisfaction or fulfillment in their accomplishments. Nor do they when the full story is known, appear to find this in any other ordinary activity. By ordinary activity we do not need to postulate what is considered moral or decent by the average man but may include any type of asocial, or even criminal, activity so long as its motivation can be translated into terms of ordinary human striving, selfish or unselfish.

The chief difference ... lies perhaps in whether the mask or facade of psychobiologic health is extended into superficial material success. I believe that the relative state of this outward appearance is not necessarily consistent with the degree to which the person is really affected by the essential disorder. An analogy is at hand if we compare the catatonic schizophrenic, with his obvious psychosis, to the impressively intelligent paranoid patient who outwardly is much more normal and may even appear better adjusted than the average person. The catatonic schizophrenic is more likely to recover and, despite his appearance, is often less seriously disordered than the paranoiac.

It becomes difficult to imagine how much of the sham and hollowness which cynical commentators have immemorially pointed out in life may come from contact in serious issues with persons affected in some degree by the disorder we are trying to describe. The fake poet who really feels little; the painter who, despite his loftiness, had his eye chiefly on the lucrative fad of his day; the fashionable clergyman who, despite his burning eloquence or his lively castigation of the devil, is primarily concerned with his advancement; the flirt who can readily awaken love but cannot feel love or recognize its absence; parents who, despite smooth convictions that they have only the child’s welfare at heart, actually reject him except as it suits their own petty or selfish aims: all these types, so familiar in literature and in anybody’s experience, may be as they are because of a slight affliction with the personality disorder now under discussion. I believe it probable that many persons outwardly imposing yet actually of insignificant emotional import really are so affected...

They occasionally appear on casual inspection as successful members of the community, as able lawyers, executives, or physicians...