Hervey M. Cleckley (1903–1984)

This book surprised me. It was a detailed description of a woman who seeks help for debilitating headaches and troubling bouts of amnesia and who discovers, with the help of two psychiatrists, she is battling a rare disorder. Her story is told in a non-clinical narrative format that worked for me. I can see how some might not rate this very high because it is an intrinsically difficult subject. Unlike some earlier reviewers, I loved the literary references scattered throughout the text as show more well as the fairly rigorous medical description of her case. Most of the difficult "inside psychiatry" data have been pushed to the end as appendixes, and - this is what surprised me - I was able to follow along with the fairly complicated analyses found here after having read the main text. Some reviewers seemed confused by the Freudian references cited by the authors which, ironically, the authors dutifully submitted as data while explicitly disavowing the Freudian diagnosis; in other words, some reviewers wrongly critiqued the book, their criticism being right in line with the same sceptical viewpoint as expressed by the authors. Finally, I found the denouement to be quite fascinating and powerfully described. I won't forget it (or will I?). show less

Cleckley's book is out of print, so I read a pdf version of a scanned copy made available at http://cassiopaea.org/2011/02/10/the-psychopath-the-mask-of-sanity/
... this online essay is informative if you can handle/ignore the New Age Twilight Zone stuff at the end.

Cleckley provides detailed case histories of psychopaths ... incredible reading if you are interested in stories of dysfunctional people/families.
Medical discussions in Cleckley's book are fascinating from an historical viewpoint show more ... obviously info is dated.

Consider a spectrum of anxiety, with the psychoneurotic at one endpoint and the psychopath at the other:
"People who suffer from personality disorders which cause them to be anxious, restless, unhappy, and obsessed with thoughts they themselves recognize as absurd but who are, in the lay sense, altogether sane have for years been classed as psychoneurotic. They recognize reason in general, often admit that their symptoms arise from emotional conflicts, and are free from delusions and hallucinations.
"....They are often resistant to reasoning but more in the sense of a person with strong prejudices than of one with delusions or with intellectual dilapidation. Sometimes they feel strong fears that they may carry out acts which they dread and which would indeed be tragic or criminal, but they recognize the nature of these acts and do not carry them out. Other acts, all patently senseless but relatively harmless, they do carry out, recognizing the absurdity of feeling that they must do so but becoming anxious if they resist the impulse.
"In general, psychoneurotic people recognize objective reality and try to adapt themselves like most others to the ways of society."
Kindle location 4788-4802

"On the contrary, those called psychopaths are very sharply characterized by the lack of anxiety (remorse, uneasy anticipation, apprehensive scrupulousness, the sense of being under stress or strain) and, less than the average person, show what is widely regarded as basic in the neurotic....
".... the interpretation of the psychopath's behavior as symptomatic 'acting out' against his surroundings, in contrast with the development of anxiety or headache or obsession is, it seems to me, an interesting formulation.... I do not believe that psychopaths should be identified with the psychoneurotic group, for this would imply that they possess full social and legal competency, that they are capable of handling adequately their own affairs, and that they are earnestly seeking relief from unpleasant symptoms.
"There are disorders in which the two diverse types of reaction (developing subjectively unpleasant symptoms versus callously carrying out socially destructive acts) seem to exist in the same symptom. The so-called pyromaniac (and kleptomaniac) often seems motivated by forces similar to the classic obsessive-compulsive patient ....
".... The distinction emphasized by Fenichel between ego-syntonic and ego-alien motivations (compulsive acts of caution versus so-called 'compulsive' antisocial acts) is a fundamental point and brings out a distinction not merely of degree but of quality....."
Kindle 4809-4833

And the bottom line is that psychopaths are BORED:
"If, as we maintain, the big rewards of love, of the hard job well done, of faith kept despite sacrifices, do not enter significantly in the equation, it is not difficult to see that the psychopath is likely to be bored.....
"Apparently blocked from fulfillment at deep levels, the psychopath is not unnaturally pushed toward some sort of divertissement. Even weak impulses, petty and fleeting gratifications, are sufficient to produce in him injudicious, distasteful, and even outlandish misbehavior. Major positive attractions are not present to compete successfully with whims, and the major negative deterrents (hot, persistent shame, profound regret) do not loom ahead to influence him."
Kindle location 7204-7217 show less

I came across this book as a result of a recent fascination of personality disorders. I found the "anti-social type" of particular interest and, absorbing all I could about the subject, I read this book in just a few sittings.
My primary goal was to understand more about the behaviour and thought patterns consistent with individuals afflicted with the disorder reviewed here. I also wanted to learn more about the distinctions from other personality disorders from which this disorder show more contrasts, but is related to.
Almost immediately, the reader's curiosity is satisfied with some 15, or so, personal accounts of the author's dealings with "psychopaths", as Cleckley so liberally, and perhaps callously, refers. These stories were exactly what I was looking for. Later in the book, he describes these patients, as our doctors; businessmen; etc...
It wasn't until the very end of the book that I had any clue this book was written in the 40's. Most of the book read just as "fresh as ever". My only clues were it's description of homosexuality as "sexual psychosis", and the author's occasional less-than-politically-correct terminology and references. Although I enjoyed this book thoroughly, I couldn't help myself from asking why it seemed like the author, sometimes, seemed so unrelenting and, in my opinion, aggressive in his discourse.
Even having learned much from this interesting and very well-written book, I felt the need to explore more resources that could offer an account of the disorder from a more, perhaps sympathetic, point of view: something of a different perspective than the one Cleckley so adequately presents. show less

First published in 1941 and revised numerous times, I read the 5th edition published in 1975.

Whilst updated as time passed, the 5th edition still included the now known to be incorrect hypothesis that homosexuality is a mental disorder. Asides for this the book, although written academically, and as such quite dry, is up to par with the theories of today.

I encoutered mention of this work in Robert D Hare's Without Conscience which noted it was one of the pivotal and first works on show more psychopathology.

It is an interesting book, yet I found the manner in which it is written made the 596 pages feel more like 1,000. I wouldn't recommend it for recreational reading, however if you have an interest in the topic it is quite the seminal work and worthwhile to see where theories and practice came from. show less