The Mask of Sanity – A Clinical Evaluation of Psychopathy

Hervey M. Cleckley, an American psychiatrist, first released his book The Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality, in 1941. The book is based on the interviews he conducted with institutionalized patients. Cleckley uses the ‘mask’ to refer to the psychopath’s ability to conceal their mental disorder. The basic elements he outlined in the book are still relevant in today’s world, and it is considered the most influential description of psychopathy written in the century. There were six editions of the book published, including an expanded fifth edition re-released in 1988 by his family for non-profit educational purposes.

Image: Eversince

The psychiatrist describes a psychopath as having the ability to mimic a normal individual, thus ‘masking’ their true character. They possess an internal chaos that is displayed as repeated destructive behaviour, most often self-destructive. Despite their outward actions, psychopaths can’t feel genuine emotions. The book touches on their ability to tell vivid, fictional stories that they pass off as the truth. Once confronted with a lie the psychopath is quite unphased and tries to pretend it was a joke. The book provides a ‘clinical profile’ of a psychopath, which includes 16 characteristics:

  1. Superficial charm and good intelligence.
  2. Absence of delusions or other signs of irrational thinking.
  3. Absence of nervousness or psychoneurotic manifestations.
  4. Unreliability.
  5. Untruthfulness and insincerity.
  6. Lack of remorse and shame.
  7. Inadequately motivated antisocial behavior.
  8. Poor judgement and failure to learn by experience.
  9. Pathologic egocentricity and an incapacity for love.
  10. General poverty in major affective reactions.
  11. Specific loss of insight
  12. Unresponsiveness in general interpersonal relations.
  13. Fantastic and uninviting behavior, with drink, or sometimes without.
  14. Suicide threats rarely carried out.
  15. Sex life impersonal, trivial and poorly integrated.
  16. Failure to follow any life plan.

Cleckley also tries to find reasons why the disorder occurs, concluding that although life experiences may play a role in the development of a psychopath, that it is not psychodynamic or psychogenic. Their behavior is often a partial, or full, form of social and spiritual suicide. There may also be a subtle defect at the biological level, but the condition is not hereditary.

The author further notes the lack of response by these individuals to treatment, and the difficulty that trying to institutionalise them often presents. He advises that this needs to be changed for the protection of both the individuals, and society on a whole. He observes that neither physical therapy, such as shock therapy, or psychological therapy seems to make much difference, but that the more they are treated the greater the possibility of finding therapy that will help.

Although there have been questions that have arisen from the book’s content, The Mask of Sanity continues to be a reference for those in the profession. The details it provides helps to identify psychopaths, as well as keep more people safe.

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