The Mask of Sanity
is a book written by Hervey Cleckley, M.D.
Dr. Hervey Milton Cleckley was an American psychiatrist and pioneer in the field of psychopathy. His book, The Mask of Sanity, originally published in 1941, provided the most influential clinical description of psychopathy in the 20th Century...
, first published in 1941, describing the clinical interviews of Cleckley with incarcerated psychopaths. It is considered a seminal work and the most influential clinical description of psychopathy in the 20th century. The basic elements of psychopathy outlined by Cleckley are still relevant today.
The title refers to the normal "mask
A mask is an article normally worn on the face, typically for protection, disguise, performance or entertainment. Masks have been used since antiquity for both ceremonial and practical purposes...
" that conceals the mental disorder of the psychopathic person in Cleckley's conceptualization.
Cleckley describes the psychopathic person as outwardly a perfect mimic
An impressionist or a mimic is a performer whose act consists of imitating the voice and mannerisms of others. The word usually refers to a professional comedian/entertainer who specializes in such performances and has developed a wide repertoire of impressions, including adding to them, often to...
of a normally functioning person, able to mask or disguise the fundamental lack of internal personality structure, an internal chaos that results in repeatedly purposeful destructive behavior, often more self-destructive than destructive to others. Despite the seemingly sincere, intelligent, even charming external presentation, internally the psychopathic person does not have the ability to experience genuine emotions. Cleckley questions whether this mask of sanity is voluntarily assumed intentionally to hide the lack of internal structure, or if the mask hides a serious, but yet unidentified, psychiatric defect.
An expanded edition of the book was published in 1982, after the DSM
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
, the manual used in the United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
for categorizing psychiatric disorders, had changed the name and standards for the classification of psychopathy to antisocial personality disorder
Antisocial personality disorder is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition , as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood...
, incorporating most of Cleckley's 16 characteristics of a psychopath listed below. The original edition of the book is no longer available.
In the 1800s, Philippe Pinel
Philippe Pinel was a French physician who was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy...
first used the French
French is a Romance language spoken as a first language in France, the Romandy region in Switzerland, Wallonia and Brussels in Belgium, Monaco, the regions of Quebec and Acadia in Canada, and by various communities elsewhere. Second-language speakers of French are distributed throughout many parts...
term manie sans delire
("mania without delirium") to designate those individuals engaging in deviant behavior but exhibiting no signs of a cognitive disorder
Most common mental disorders affect cognitive functions, mainly memory processing, perception and problem solving. The most direct cognitive disorders are amnesia, dementia and delirium. Others include anxiety disorders such as phobias, panic disorders, obsessive–compulsive disorder, generalized...
such as hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s or delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
s. Although the meaning of the term has changed through numerous writings on the subject over time, the writing of Cleckley and his use of the label "psychopath" in The Mask of Sanity
brought the term into popular usage.
The first edition of the book was based on Cleckley's clinical observations of adult male hospitalized "psychopaths". Additional experience with expanded populations led to subsequent editions of the book. The Mask of Sanity
, fourth edition, presents the clinical data gathered on an expanded population of subjects, written in the form of dramatic, novelistic descriptions of 13 individuals, an amalgamation of the thousands he has interviewed.
In these vignettes, Cleckley presents a typical psychopath's behavior: for example, the psychopath's ability to tell vivid, lifelike, plausible stories that are completely fraudulent, without evincing any element of delusion. When confronted with a lie, the psychopath is unbothered and can often effortlessly pass it off as a joke. In another typical case history, the psychopath is psychiatrically hospitalized, but because of his constant trouble-making, leaving wards in an uproar, the hospital is finally forced to turn him over to the police. Eventually, the police become so sick of his repeated antics that they try to get him out of their way and hospitalize him again.
Cleckley introduced 16 behavioral characteristics of a psychopath:
- Superficial charm
Superficial charm is "the tendency to be smooth, engaging, charming, slick, and verbally facile."The phrase often appears in lists of attributes of psychopathic personalities, such as in Hervey Cleckley's The Mask of Sanity and Robert Hare's Hare Psychopathy Checklist.Associated expressions are...
and good intelligence
- Absence of delusions and other signs of irrational thinking
- Absence of nervousness or psychoneurotic
Neurosis is a class of functional mental disorders involving distress but neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms. It is also known as psychoneurosis or neurotic disorder, and thus those suffering from it are said to be neurotic...
- Untruthfulness and insincerity
- Lack of remorse
Remorse is an emotional expression of personal regret felt by a person after he or she has committed an act which they deem to be shameful, hurtful, or violent. Remorse is closely allied to guilt and self-directed resentment...
Shame is, variously, an affect, emotion, cognition, state, or condition. The roots of the word shame are thought to derive from an older word meaning to cover; as such, covering oneself, literally or figuratively, is a natural expression of shame....
- Inadequately motivated antisocial behavior
- Poor judgment and failure to learn by experience
- Pathologic egocentricity and incapacity for love
Love is an emotion of strong affection and personal attachment. In philosophical context, love is a virtue representing all of human kindness, compassion, and affection. Love is central to many religions, as in the Christian phrase, "God is love" or Agape in the Canonical gospels...
- General poverty in major affective reactions
- Specific loss of insight
- Unresponsiveness in general interpersonal relations
- Fantastic and uninviting behavior with drink and sometimes without
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
threats rarely carried out
- Sex life
Human sexual activities or human sexual practices or human sexual behavior refers to the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts from time to time, and for a wide variety of reasons...
impersonal, trivial, and poorly integrated
- Failure to follow any life plan.
Some of the criteria have obvious psychodynamic implications, such as a lack of remorse, poor judgment, failure to learn from experience, pathological egocentricity, lack of capacity for love, a general poverty in major affective reactions, and lack of insight into his own condition. Starting in 1972, newer editions of the book reflected a closer alliance with Kernberg's (1984) borderline level of personality
Personality psychology is a branch of psychology that studies personality and individual differences. Its areas of focus include:* Constructing a coherent picture of the individual and his or her major psychological processes...
organization, specifically defining the structural criteria of the psychopath's identity
Identity is a term used to describe a person's conception and expression of their individuality or group affiliations . The term is used more specifically in psychology and sociology, and is given a great deal of attention in social psychology...
integration, defensive operations
In Freudian psychoanalytic theory, defence mechanisms are unconscious psychological strategies brought into play by various entities to cope with reality and to maintain self-image. Healthy persons normally use different defences throughout life...
and reality testing.
Cleckley also introduced the term "semantic dementia" (used today to refer to a medical disorder unconnected to Cleckley's meaning) to refer to the inability of this personality type to "understand the meaning of life as lived by ordinary people". Behind the mask of sanity, the psychopath's "emotional mechanism had collapsed".
In summary, Cleckley clearly distinguishes the psychopath from other disorders such as neurotic alcoholics
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
, psychoneurotics, criminal sex offender
A sex offender is a person who has committed a sex crime. What constitutes a sex crime differs by culture and by legal jurisdiction. Most jurisdictions compile their laws into sections such as traffic, assault, sexual, etc. The majority of convicted sex offenders have convictions for crimes of a...
s and typical criminals. The psychopath does not suffer from any obvious mental disorder. Cleckley characterizes the psychopath as, despite apparent intelligence, seeming to deliberately court failure and disaster for no obvious reason, what Cleckley calls a social and spiritual suicide, or semi-suicide. For example, the classic alcoholic drinks to avoid reality, while the psychopath drinks simply to get into trouble.
Cleckley is very clear that there are important distinctions between the psychopath and the average criminal:
- The psychopath very seldom takes much advantage of what he gains and almost never works consistently toward a goal in crime or anything else, seemingly lacking purpose.
- Criminal ends, though condemned, can usually be understood by the average man. It is not hard to understand why a criminal steals money. However, the psychopath, if he steals or defrauds
In criminal law, a fraud is an intentional deception made for personal gain or to damage another individual; the related adjective is fraudulent. The specific legal definition varies by legal jurisdiction. Fraud is a crime, and also a civil law violation...
, appears to do so for an obscure purpose, sometimes incomprehensibly throwing away much of value for short-term gains.
- The criminal usually spares harm to himself as much as he can and harms others. The psychopath, although he causes sorrow and trouble for others, usually puts himself in a shameful position. His most serious damage to others is often through their concern for him and their futile efforts to help him.
- The typical psychopath, from Cleckley's observations, usually avoids murder or other offenses that lead to lengthy prison sentences. The larger part of the psychopath's antisocial behavior can be interpreted as purposely designed to harm himself. Cleckley adds that most of the people who commit violent and serious crimes fail to show the chief characteristics of a psychopath.
Cleckley states that although a "considerable proportion" of inmates in penal institutions show indications of a psychopathic disorder, only a small proportion of typical psychopaths are likely to be found in an incarcerated environment.
As in his first edition, Cleckley makes no claim to offer an effective treatment for the condition in the 1982 edition.
One reviewer describes the author's viewpoint as presenting a paradox
Similar to Circular reasoning, A paradox is a seemingly true statement or group of statements that lead to a contradiction or a situation which seems to defy logic or intuition...
in that Cleckley's "keen clinical observations" are not integrated into a meaningful psychological model. Cleckley questions the usefulness of psychoanalytic
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
approaches, while at the same time he uses some psychoanalytic explanatory concepts. The rich clinical detail is not developed into a systematic psychological theory.
The label "psychopath" as used by Cleckley had been embraced by popular culture
Popular culture is the totality of ideas, perspectives, attitudes, memes, images and other phenomena that are deemed preferred per an informal consensus within the mainstream of a given culture, especially Western culture of the early to mid 20th century and the emerging global mainstream of the...
, and is often applied to serial killer
A serial killer, as typically defined, is an individual who has murdered three or more people over a period of more than a month, with down time between the murders, and whose motivation for killing is usually based on psychological gratification...
s and other violent criminals, irrespective of whether they qualify (although many serial killers do); for this reason the imprecise popular use had been deplored. Therefore, although in popular culture the term is common, it had little relevance to criminology, forensic psychology
Forensic psychology is the intersection between psychology and the criminal justice system. It involves understanding criminal law in the relevant jurisdictions in order to be able to interact appropriately with judges, attorneys and other legal professionals...
Forensic psychiatry is a sub-speciality of psychiatry and an auxiliar science of criminology. It encompasses the interface between law and psychiatry...
Robert D. Hare, C.M. , is a researcher in the field of criminal psychology. He developed the Psychopathy Checklist and Psychopathy Checklist Revised , used to diagnose cases of psychopathy and also useful in predicting the likelihood of violent behavior...
developed a Psychopathy Checklist based on the psychopath construct
Constructivist epistemology is an epistemological perspective in philosophy about the nature of scientific knowledge. Constructivists maintain that scientific knowledge is constructed by scientists and not discovered from the world. Constructivists claim that the concepts of science are mental...
developed by Cleckley. Later two items were removed from the checklist in order to more clearly represent the structure of a two-factor analysis
Factor analysis is a statistical method used to describe variability among observed, correlated variables in terms of a potentially lower number of unobserved, uncorrelated variables called factors. In other words, it is possible, for example, that variations in three or four observed variables...
The DSM-III committee, in attempting to develop a trait-oriented
In psychology, Trait theory is a major approach to the study of human personality. Trait theorists are primarily interested in the measurement of traits, which can be defined as habitual patterns of behavior, thought, and emotion. According to this perspective, traits are relatively stable over...
basis for the antisocial personality diagnosis, made efforts to combine the work of Lee Robbins's 1966 criteria of behavioral acts with trait items based on the work of Cleckley, as his list of core traits still remains relevant.