The Mask of Sanity. Hervey M. Cleckley

States. They, the same as myself, are perfectly capable mentally and physically to support themselves and should be forced to do so.

      I have begged for parole, trial visit, or any other means to prove myself self-sustaining, but the authorities here seem to take my plea as a joke and make a lot of promises that they have no intention of putting into action.

      I will gladly submit to any physical or mental examination you may deem necessary to assist you in obtaining my release from this place.

      I pray that you will give my earnest request your immediate consideration.

      Please be assured that I hold no malice toward any of the officials here or elsewhere but my only objective in writing you is to gain my freedom and support my children.

      Please let me hear from you personally,

      Yours very respectfully,

      Frank ———.

      The writer of this letter has behind him a formidable record of misadventure.

      Detailed knowledge of Frank’s early life is not available beyond the following facts: The son of a rustic blacksmith, he was raised in a small hamlet near the mountains of north Georgia. No members of his family, so far as can be learned, suffered from nervous or mental disease or made themselves objectionable in the community. He completed the fifth grade in school, where he was considered by no means a dull boy, though often truant. Many of the hours when he was supposed to be in school or working at some necessary chore for his family, he is reported to have spent loitering about a local millpond drowning goats and doing other senseless or uninviting deeds of mischief.

      Before the United States entered World War I Frank had forged his father’s name to a false statement about his age and enlisted in the National Guard. After his discharge from the army he was given vocational training by the government. He was tried at several courses but made no serious effort to complete any of them. In his community he soon made himself a problem, sometimes drinking to excess, often behaving in a rowdy and threatening manner, contracting to buy filling stations, farms, etc., but never living up to his agreements.

      Local ex-service men, believing that he took morphine and that treatment might help his maladjustment, commonly referred to as “nervousness” had him sent to a psychiatric hospital. He remained for a month, then returned to continue in his old ways.

      Now began a series of hospitalizations which extends to the present time. He would be sent first to one place, then to another. He has been treated in state hospitals, in federal hospitals, and in private institutions at the expense of the government. All told, he has been admitted no less than nineteen times to strictly mental hospitals maintained for the purpose of treating psychotic people. Sometimes he remained only three or four weeks, sometimes six months or even eighteen months. Over the years his periods of hospitalization have grown slightly longer and his intervals outside shorter. He has never, during the past fifteen years, been free longer than a few months. While not under the care of psychiatrists he has received considerable attention from the police. His jail sentences number seven at the present reading, including a term of nine months in the Leavenworth Penitentiary (where he was sent for forging a prescription for morphine) but not counting a score or more of overnight or week-end stops in police barracks.

      Despite these preoccupations Frank has found time to marry and have four children and to become ordained as a minister in a small religious sect noted for vigorous evangelical fervor. His martial relations have been most unsatisfactory during the interludes when he was free to be with his family. His wife reports that he curses her and fights with her and it is well established that he seizes any money that is available, hires automobiles, and drives aimlessly about the countryside, often drinking to excess and, according to some reports, occasionally taking morphine.

      At times he has seemed proud of his ecclesiastical title, referring to himself as a pastor and assuming unctuous and haughty airs. He has not, however, occupied himself with whatever ministerial duties he was supposed to fulfill any more consistently than with other work.

      His friends, especially those interested in the American Legion and other service organizations, have obtained many positions for him. He is shrewd, neat in appearance, and an excellent talker. He makes a good impression at first but always shirks his responsibility to such an extent that it is impossible to retain him.

      A few years ago he was given a place at a gasoline filling station and seemed, surprisingly, to show considerable interest in his work for several days. It was then discovered that he had been drawing off all the gasoline he could and taking it to a near-by town where he sold it and bought morphine from dope peddlers, most of which he, in turn, sold at a tremendous profit to local addicts.

      He has been consistently arrogant and aggressive toward his neighbors and acquaintances over trifles. After taking a few drinks he has often threatened others, claimed things that were not his own, and made such a nuisance of himself that local police would be called to deal with him.

      He is boastful and histrionic, more eloquently and aggressively so with a few highballs, and much given to temper tantrums. He frequently threatens to kill himself over some petty vexation and once offered a pistol to his wife, urging her grandiloquently to shoot him. He has never made an attempt, however, to harm himself, though his opportunities have been unlimited.

      He has been reported as having convulsive seizures. These developed when he was refused special attentions by physicians and seemed, according to descriptions of them, plainly and consciously designed toward obtaining various ends. This manifestation has also been noted when he was confined to jail and wanted to be sent to a mental hospital in order to escape charges that had been brought against him. These so-called seizures have been observed several times in this hospital by competent psychiatrists. They did not in any way suggest epilepsy nor were they convincing as possible reactions of true hysteria. The patient is unquestionably conscious and shows that he is behaving intentionally in this way to gain a recognized end. Unlike a conversion phenomenon, the purpose is not concealed from his conscious awareness.57, 77

      Though occasionally confused after heavy drinking (perhaps with the addition of drugs), he has at all other times been entirely rational, alert, shrewd, and free from delusions and hallucinations.

      Early in Frank’s career he was on several occasions given a diagnosis of hysteria, sometimes of both psychopathic personality and hysteria. Once he was given a diagnosis of psychopathic personality with psychotic episodes. There was not, however, any evidence of behavior or symptoms different from what he has shown on other occasions. There is reason to suspect that the real and pressing need to keep this patient hospitalized may have played an important part in his being so classified. The genuinely irrational and incompetent behavior, no doubt, supports the use of such a term as psychosis, despite the lack of any additional symptoms.

      The irrational behavior which has characterized him is not based on a delusional system or on any loss of the good reasoning ability he shows on examination. Some of his most turbulent misconduct has, of course, been while he was intoxicated. At such times he naturally lacked his customary shrewdness and alertness, but one cannot conscientiously call this a psychotic episode beyond and above his well-known inadequacy but rather the manifestation of inebriety. I do not mean to say that this man is normal but only that he has none of the recognized types of mental disorder, episodic or constant. If his drunken and wayward episodes are to be termed psychotic, then his state at other times must be termed psychotic, since it is in his shrewd, technically sane condition that he decides to add the picturesque touches of intoxication which he well knows will bring him to the attention of the police.

      At this hospital, at the state hospitals, and at the other institutions to which Frank was sent in recent years, he has been considered a sane man without psychotic episodes. The symptomatic diagnoses of drug addiction and chronic alcoholism have been added. During all these years he has shown no evidence of deterioration or regression, and today at thirty-eight he is the same clever, alert person he was described as being twenty years ago. Unlike nearly all real morphine addicts he does not show ordinary withdrawal symptoms or other signs of physical illness and acute distress when, after being admitted to the hospital, he is deprived of opportunities to obtain