Cleckley’s portrait of the psychopath was fundamentally sympathetic. He was “the forgotten man of psychiatry”: misunderstood, understudied, untreated. Cleckley’s successors, however, seized on the term as a way to understand society’s ills, often highlighting the most extreme and sensational personalities, and the public formed a picture of psychopaths as irredeemably diabolical. Psychopathy acquired a tantalizing aura that attracted prurience and voyeurism, moralizing and stigma. As the field came to understand more about them, Cleckley’s concern for psychopaths transformed into concern about psychopaths.
Cleckley wrote The Mask of Sanity while working as a psychiatrist at a Georgia state hospital, where he observed that about an eighth of his patients fit no existing diagnosis. These patients easily passed mental evaluations. They conversed normally, even pleasantly. By all appearances they were completely sane, and in fact they saw nothing unfit about themselves. But their records told the stories of people who were unable to lead normal lives. Cleckley likened psychopathy to a sort of emotional aphasia. The patient might convincingly mimic sound, but meaning was lost on him. As other researchers would put it later, he “hears the words but not the music.”
Despite the gravity of its topic, The Mask of Sanity is a lively and enjoyable work. This is mostly thanks to Cleckley’s detailed case studies. Cleckley writes with an attentive responsibility to his patients, some of whom he clearly finds endearing. His portraits highlight the individual idiosyncrasies of the psychopathic mind. A military veteran and boxer named Max, for example, is “bright as a dollar, smart as a whip.” Under confinement, Max declares himself to be an artist of unusual talent, sculpting chewed-up bread into religious iconography that he bestows graciously on hospital staff. In return he demands to be let out to buy paints, then a private room to use as a studio, and finally parole. All of these favors are granted; after his release, Max promptly gets into a bar fight and beats his wife. You get the sense that Cleckley finds Max’s scheme as ingenious as it is aesthetically repulsive.
Cleckley’s patients lie, steal, brawl, and sleep around. They cause chaos and disorder, though often without malice. (Says the mother of one patient, “I really think she means to stop doing all these terrible things, but she doesn’t mean it enough to matter.”) Many of them are not especially dangerous. It was the work of Robert Hare, a criminal psychologist, that would indelibly link psychopathy with violence.