The Mask of Sanity (1941)

The Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality is a book written by American psychiatrist Hervey M. Cleckley, first published in 1941, describing Cleckley's clinical interviews with patients in a locked institution. The text is considered a seminal work and the most influential clinical description of psychopathy in the twentieth century. The basic elements of psychopathy outlined by Cleckley have influenced later discussion and diagnosis.

The title refers to the normal "mask" that conceals the mental disorder of the psychopathic person in Cleckley's conceptualization.

Cleckley describes the psychopathic person as outwardly a perfect mimic 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 to intentionally hide the lack of internal structure, but concludes it hides a serious, yet imprecisely unidentified, semantic neuropsychiatric defect. Six editions of the book were produced in total, the final shortly after his death. An expanded fifth edition of the book had been published in 1976 and was re-released by his heirs in 1988 for non-profit educational use.

History

In the 1800s, Philippe Pinel first used the French term manie sans delire ("mania without delirium") to designate those individuals engaging in deviant behavior but exhibiting no signs of a cognitive disorder such as hallucinations or delusions. 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.

Editions

The first edition was published in 1941, with the subtitle then being 'An attempt to re-interpret' rather than as later 'to clarify'. Cleckley says in the preface that the book "grew out of an old conviction which increased during several years while I sat at staff meetings in a large neuropsychiatric hospital". He added that after commencing full-time teaching duties he found similar patients to be as prevalent in a general hospital, outpatient clinic and the community. In later editions he explains that the basic concepts presented in 1941 were based primarily on "adult male psychopaths hospitalized in a closed institution" for several years. Cleckley had worked for a number of years at a United States Veterans (military) Administration hospital, before taking up full-time teaching responsibilities at the University of Georgia School of Medicine.

The second edition published in 1950, Cleckley has described as a "new and much larger book", based on more diverse clinical observations, feedback and literature reviews. The third edition in 1955 he describes as having fewer changes and additions, but important clarifications to key concepts such as the hypothesis of a core semantic deficit. A fourth edition was published in 1964.

A fifth edition was published in 1976 (ISBN 0801609852) and is generally considered to be the definitive culmination of Cleckley's work. The preface does not specify the changes made. Unlike the first edition it states: "Dr. Corbett H. Thigpen, my medical associate of many years, has played a major part in the development and the revision of this work." Cleckley also states that it could not have been written without the assistance and contributions of Thigpen's wife and his own (first), both called Louise. A sixth edition was published shortly after Cleckley's death in 1984, but is described by others as having minimal substantive changes. Several further years after Cleckley's death, another fifth edition (ISBN 0962151904) was released for non-profit educational use by Emily S. Cleckley, his second wife, naming her as well as Hervey M. Cleckley and copyrighted 1988 to her rather than Mosby as for all prior initial releases (which have been repeat published in various different years).

Description

The Mask of Sanity, fifth edition, presents clinical theories as well as case studies, written in the form of dramatic, novelistic descriptions of 13 individuals, an amalgamation of those he had observed.

Initial outline

The Mask of Sanity begins in Section One, "An Outline of the Problem", by considering the concept of sanity, which Cleckley describes as protean. The first words of the book are a possibly untrue anecdote ending with the line, capitalized and centered in large font, "WHO'S LOONEY NOW?" Cleckley suggests that everyone "behaves at times with something short of complete rationality and good judgment". He notes that many types of people hold beliefs that he and much of society would consider irrational, such as mysticism, pseudoscience, praising of unintelligible or immoral works (e.g. acclaim for the novel Finnegans Wake containing only "erudite gibberish" or for the writing of André Gide on pederasty), and religious faith. He argues, however, that these are personal freedoms and such groups are usually capable of leading useful lives in harmony with others. This he says distinguishes it from psychosis once fully developed and from psychopathy.