The Mask of Sanity. Hervey M. Cleckley

the war he sometimes told interesting stories of having been for a time in the Navy, narrating with vivid and lifelike plausibility action in which he had participated and which led to the destruction of a German submarine off Jamaica or the pursuit of a raiding warship off the coast of Greenland. Again he would talk at length about his experiences transporting airplanes from Miami to Havana, or accidents leading to hospitalization and operation and diverse adventures with nurses, other patients, interns, etc. Once, during a stag-party discussion of venereal disease, he even fabricated an account of having caught one or more of these unenviable maladies and enlightened his listeners about treatments he had received, drugs, dosage, and complications.

      None of these fraudulent stories had a real element of delusion. When really caught in the lie about any of them and confronted with definite proof, he often laughed and passed it off as a sort of joke.

      After these events and many others similar in general but differing in detail, Tom seemed modestly pleased with himself, effortlessly confident of the future. He gave the impression of a young man fresh and unhardened, in no respect brutalized or worn by his past experiences. He seemed, also, a poised fellow, one who would make his decisions not in hot-headed haste but calmly, whether these were prompted by immediate whim or by intentions he had much time to entertain.

      CHAPTER 9. GEORGE

      This man was thirty-three years old at the time I first saw him and admitted him to a psychiatric hospital. He stated that his trouble was “nervousness” but could give no definite idea of what he meant by this word. He was remarkably self-composed, showed no indication of restlessness or anxiety, and could not mention anything that he worried about. He went on to state that his alleged nervousness was caused by “shell shock” during the war. He then proceeded to amplify on this in an outlandish story describing himself as being cast twenty feet into the air by a shell, landing in his descent astride some iron pipes, and lying totally unconscious for sixty days, during all of which he hovered between life and death.

      A physical examination showed George without any evidence of injury or illness. In fact, he was a remarkably strong and active man, six feet in height, 170 pounds in weight. Later, in an athletic meet held on the hospital grounds, he showed himself an exceptional sprinter and broad-jumper, surpassing many able competitors ten years younger than himself in these events. Prolonged observation and psychiatric study brought out no sign or suggestion of a psychosis or a psychoneurosis. Despite his original complaint of “nervousness,” he was at all times calm and without the slightest evidence of abnormal anxiety. He ate and slept well, did not complain of any worries, was free of phobias, compulsions, conversion reactions, tics, and all other ordinary neurotic manifestations.

      Records of this man’s career show that he has been confined in various mental hospitals approximately half the time since he became of age. In addition to periods ranging from a few weeks to six months at federal government institutions in Texas, Tennessee, Mississippi, Georgia, and Florida, he was also frequently sent by the Government to private psychiatric hospitals and invalids’ homes. Between these experiences he spent a good part of his time in the local county jail or in other jails at Birmingham, Montgomery, Mobile, or other towns which he visited. He was taken in sometimes for drunkenness and disorderly conduct, at other times for writing bad checks, petty theft, reckless driving of automobiles, obtaining money under false pretenses, snatching the purse from a prostitute, taking possession of a house whose owners were off on vacation, etc. Extravagant but insincere threats to harm his wife and four children made after taking a few drinks and lunacy charges also accounted for a dozen or so arrests.

      During all the observation at various hospitals mentioned above, as well as at a state mental hospital where George also spent a short time, no technical evidence of a psychosis or a psychoneurosis is mentioned. His wife and friends have repeatedly persuaded local authorities to consider him as mentally deranged and to have him sent to hospitals rather than let him face the various charges brought against him from time to time.

      On other occasions, when refused admission by hospitals that had already studied him more than once and declared him sane, competent, and not in need of psychiatric treatment, friends and relatives have had him arrested, prevailed upon local doctors to sign statements that he is deranged and dangerous, and brought pressure to bear so that hospitals, with the light in which the case was presented, had no choice but to readmit him.

      The doctors involved in such procedures, country practitioners for the most part, never mention technical evidence that would indicate a psychosis or a psychoneurosis as they are described in the textbooks. Such statements as the following are typical:

      “Something is decidedly wrong mentally. I don’t think I have ever come in contact with a man as unreliable as he is. He worries everybody that has fooled with him until they hate him. The County authorities are tired of boarding him as he is not a criminal. (Family Physician.)

      “Everybody who comes in contact with him agrees that he should be confined permanently… very unreliable as to his word of honor. (County Physician.)”

      A physician who owns a private hospital located at a town nearby, in explaining his refusal to accept the patient again, ends by saying “we do not cater to his class.”

      He is described as frequently drinking whiskey to excess and as sometimes taking Veronal, Luminal, Amytal, and bromides to ease himself in the aftermath of a spree. Although there is no record of alcoholic hallucinations, many bizarre and notable actions are described when the patient has had something to drink:

      “On a cold February day he rushed, fully clothed, down to the creek and sprang in. After thrashing about, yelling and cursing to no purpose and creating a senseless commotion, he swam back to land without difficulty. One fine spring evening he is said to have run entirely naked through the streets of the town. He once sat up all night under the house striking matches aimlessly.”

      Generally believed reports indicate that late one night he, with several drinking companions, succeeded in releasing a half-tamed bear from the cage in which it was kept at a filling station to attract trade. A good deal of fright, some civic uproar, and hasty precautionary measures ensued. Assiduous and painstaking effort by a number of local volunteers led to the bear’s relatively uneventful return to his cage. According to available information, the bear was not terribly dangerous but sufficiently so to make a man of anything like ordinary responsibility sharply restrain all impulses to lose him on the outskirts of an unprepared community. The patient denied having been a party to this exploit but the evidence against him is strong.

      In view of this man’s failure to make any effort to conduct himself sensibly through so many years, there is no wonder that many are found to say that he is of unsound mind. He has done no work except for occasional periods when for a week or ten days he would show considerable promise as an automobile salesman, clerk in a grocery store, soda jerker, bootlegger’s assistant, etc. It was not long before, in the language of an elderly uncle often called on to deal with these problems, he proceeded to “launch himself on another pot-valiant and fatuous rigadoon.”

      After studies on his case were completed, and on the basis of his cooperative and technically sane behavior, he was given parole privileges. He promised, of course, not to drink or to break any other rule of good conduct and expressed many fine intentions positively and reassuringly. Six days later he staggered into his ward and attempted to go to bed without being noticed by the attendant. On being found so plainly in his cups, he raged petulantly, first denied any contact with stimulants, and finally, with indignation, admitted having taken one-half glass of beer. His eyes were bloodshot, he could scarcely stand, he spoke in wild, boastful, almost unintelligible accents. A bottle of cheap whiskey was discovered hidden under his mattress.

      According to the custom of the hospital, George was now confined to a closed ward where his superficial sanity stood out arrestingly from the delusional babbling and the blank-faced, staring inertia of his psychotic fellows. He was always intelligent and agreeable, frequently pointing out the obvious inconsistency of his being confined among “insane” people. Pleading important business downtown, he was, after three weeks, given a pass to go out in the care of a hospital attendant for