The Mask of Sanity. Hervey M. Cleckley

in good condition, but when night came on he refused to go to bed, cursed, and spat at the nurse who tried to advise him. His breath reeked of raw liquor, and a search disclosed a half empty quart bottle in his pocket. The attendant who took him to town denied having allowed him to purchase whiskey and could only surmise in astonishment that the patient must have slipped off for a moment and obtained the bottle while pretending to go to the toilet.

      A few weeks after this incident, the patient’s wife came to town and asked to take him out on a pass, agreeing to assume full responsibility. When she returned him to the hospital it was evident that he had drunk liberally, and the wife confessed herself as having been unable to deal with him.

      The next day a man living near the hospital advised that he had fired a revolver at the patient on being alarmed by his behavior. George, after loitering about the premises boisterous and vaguely threatening, began to fumble at a window as if trying to force his way in. The shot had not been aimed at George but only in his general direction in order to frighten him. This end was satisfactorily achieved, for at the report he made off in a clatter of undignified haste.

      About a month later, on strong promises of good behavior, George was again given parole. Within a few days he climbed over the fence and hired an automobile, which, after racing for a while about the road to no special purpose, he wrecked in the city streets and was taken to jail.

      This cycle of events was repeated several more times. The man was obviously not where he belonged when confined on a closed ward with extremely psychotic patients of the ordinary type. Just as plainly he showed himself unable to remain on an open ward with mildly psychotic patients who succeeded in adapting themselves to a life of limited freedom. Finally, on being kept under close supervision for several weeks following a senseless and troublesome spree, he demanded his discharge in a well-written letter emphasizing his sanity and the inappropriateness of his hospitalization. He was released accordingly.

      Six months later he was sent back to the hospital from his local jail where he had been confined after striking a Negro man with a shovel. He had, as was his wont, been drinking but showed little evidence of being affected by alcohol. The other man was walking peacefully by when our patient engaged him in a dispute about possession of the pavement. “Flown with insolence and [perhaps] with wine”, he found the other’s conciliatory attitude not to his taste, waxed more overbearing, and ended by felling his presumed adversary with a deft blow. He did not on this occasion seem to lose control of himself like a man in a genuine rage who might have struck blow after blow. His deed seemed prompted more by fractiousness and impulses to show off than by violent passion.

      His application for admission was at first refused by the hospital, since only patients suffering from mental disorder in the commonly accepted sense are eligible. His wife and influential friends thereupon invoked higher authorities, who arranged for him to be taken. This time he was again found to be free from all symptoms of recognized mental disorder and was classified as: (1) no nervous or mental disease; (2) psychopathic personality. He did not complain of nervousness as he had at the time of his first admission, but instead insisted that he was a sane and well man and demanded full privileges to come and go as he pleased, saying that the authorities who arranged for him to come to the hospital had promised him this.

      It was plain that George regarded the hospital simply as an expedient by which he might escape the legal consequences of his behavior. After being kept for a few weeks on a closed ward, he was allowed to go out on the grounds alone with the understanding that after a few days he would be discharged as sane and competent. He could not, however, keep out of trouble. On the third day of his freedom he was seen by the guard driving at high speed through the gate in a car belonging to one of the physicians. Chase was offered, and after a lively race he was overtaken about fifteen miles from the hospital, having battered in a fender and knocked off a headlight of the car on the way.

      It is hardly necessary to point out that this man had repeatedly been instructed in the rules to be observed while on parole, that he knew the driving of an automobile by a patient in this hospital to be a serious violation of his trust, not to speak of the theft, or the unauthorized borrowing he proclaimed it to be. When finally caught, he appeared as sane as before, showing no evidence of any episodic loss of his usual reasoning power. He had not been drinking when he took the automobile and, of course, the pursuit was too hot for him to obtain liquor while in flight, though in view of his previously demonstrated ingenuity and dispatch in fulfilling this want, it would scarcely have been surprising to find him properly raddled.

      On his return to the hospital he did not show the slightest sign of remorse over having taken possession of and having succeeded in damaging the car belonging to a physician who had always been particularly kind to him. The owner’s willingness to free him from responsibility for his deed he took as a matter of course, expressing neither gratitude nor satisfaction. In fact, he dismissed the whole matter as insignificant, and his prevailing attitude was that of a man generally ill-used. Some weeks later he was sent home.

      About six months afterward his wife telegraphed the hospital that she could no longer cope with her husband, whom she described as being still in such folly as that already recounted. He did not, however, arrive by the train he boarded. It was subsequently learned that he got off along the way, obtained a few drinks, and made a clamorous nuisance of himself in the station until the police came to cut short his activities.

      A little later he was readmitted following a series of misadventures in no way different from those already mentioned but including a period in the state mental hospital. He was alert and rational and just as he had always been before, except for the presence of a urethral discharge of gonococcic origin. He gave a false account of his activities, saying that he had been working on a farm and had been in no trouble at all. The records showed that he had not turned his hand to make an honest dollar since he left and that a week had seldom passed without his buffoonish or antisocial activities arousing consternation in the neighborhood and bringing him to the attention of the police.

      He was freely communicative and scarcely waited for encouragement to give an explanation of how he came by his gonorrhea. The records show that after causing some commotion in town by maudlin or threatening outbursts on the streets and silly pompous threats about harming his wife, he had been brought in, bedraggled and disconsolate, from a ditch where he lay and confined to jail.

      The jail, George said, was crowded, and the jailor, who knew him to be a good fellow, placed him in a cell on the women’s section of the building. The bars of his cell were about six inches apart and so, according to his story, he was separated from and yet provocatively close to the women prisoners. These, his neighbors, were seven girls ranging in age from fourteen to twenty and awaiting transportation to the women’s reformatory.

      He said that at night, when the lights were out, these girls would disrobe and, coming to the bars, would entice him, calling him “Pretty Boy,” “Country Boy,” and otherwise teasing and challenging him until he began to indulge in sexual intercourse with them between the bars in order to make them leave him alone. He says that he continued this practice with each of them every night during the rest of his sojourn there, the transactions taking place always in the dark and through the separating barrier. From one or all of these women he says he caught the gonorrhea which now troubled him.

      He appeared to be no little proud of this story which, however, is probably no more accurate than his stories of exemplary behavior and hard work or his frequently expressed intentions to conduct himself like a sensible person. During prolonged observation of him in the hospital he showed himself more prone to drift about street corners and bars, to indulge in petty gambling or theft, to cadge and impose on chance acquaintances, or to raise some puerile and futile clamor than to seek intercourse with one woman, much less with many.

      Since this last admission, his story has been the same as before. On recovering from gonorrhea, he was, after being found sane and competent, given freedom of the grounds. He soon left without permission and was found in the hands of the police. Back again on a closed ward he was dissatisfied and with irrefutable arguments pointed out the incongruity of his being assigned to a place among men content to sit all day in silence staring blankly at nothing or who murmured incessantly that their heads were full of gold, radium, and diamonds, that they had no stomachs