Читать книгу The Mask of Sanity - Hervey M. Cleckley - Страница 13

This patient first came to my attention years ago while I was serving my turn as Officer of the Day in a Veterans Administration psychiatric institution. His wife telephoned to the hospital for assistance, stating that Max had slipped away from her and begun to make trouble again. With considerable urgency and apparent distress she explained that she was bringing him to be admitted as a patient and begged that a car with attendants be sent at once to her aid.

He was found in the custody of the police, against whom he had made some resistance but much more vocal uproar. The resistance actually was only a show of resistance consisting for the most part of dramatically aggressive gestures while he was too securely held to fight and extravagant boasts of his physical prowess and savage temper. His general demeanor in this episode suggested the familiar picture of small boys, held fast by peacemakers, who wax ever more eloquently militant as the possibilities of actual conflict diminish.

He came quietly with the attendants and on arriving at the admission ward was alert, self-assured, and boastful. Extolling his own mettle as a prizefighter, as a salesman, and as general good fellow, he was, nevertheless, friendly and even flattering toward the examining physician and the hospital.

He was far from what could be called drunk. It would, in fact, be stretching a point to say he was “under the influence.” He had been drinking, it is true, but he knew well what he was doing and only by an impracticable flight of fancy could one attribute his behavior primarily to liquor.

At the admitting ward of the hospital accompanying papers promptly revealed that the patient’s desire for treatment arose in consequence of some checks which he had forged in Spartanburg, S. C. He had been arrested and convicted but instead of being sent to jail an agreement was reached whereby he might come to the hospital for psychiatric treatment.

His wife, his attorney, and representatives of a veterans’ organization pointed out that he had frequently been in hospitals for the treatment of mental disorder and maintained that he was not responsible for his misconduct.

He seemed pleased to be at the hospital, was expansive and cordial, a little haughty despite his well-maintained air of camaraderie. Though a small man, only five feet six, he made a rather striking impression. His glance was fresh and arresting. His movements were quick, and he had an air of liveliness vaguely suggestive of a chipmunk. Though preposterously boastful, he did not show any indications of a psychosis.

The hospital records showed that he had been a patient eight years previously for a period of two months. During this time of study he showed no evidence of a psychosis or a psychoneurosis and was discharged with a diagnosis of psychopathic personality. He was found to have tertiary syphilis, but neurologic examination and spinal fluid studies showed no evidence of neurosyphilis.

Though at first cooperative and agreeable on this previous admission, he soon became restless and expressed dissatisfaction with the hospital. He was granted parole, but on his first pass into town he got into an altercation in which words were more prominent than blows and was held by the police for disturbing the peace.

After losing parole he became constantly unruly in petty ways, often insulted the nurses and attendants, and several times egged on mildly psychotic patients to fight each other or to resist the personnel on the ward. On being questioned about this conduct by physicians, he glibly denied all and showed little concern at being accused. Since he was not considered as suffering from a real nervous or mental disorder, and since it was difficult to keep him on any ward except the closely supervised one among actively disturbed patients, he had been discharged.

Records show that he sought hospitalization on other occasions after having been fined a half-dozen or more times for brawling on the streets and for petty frauds. There is every reason to believe, from the evidence of careful reports by the Red Cross and by social service workers, that when his troubles with the civil authorities became too discomforting he sought the shelter of a psychiatric hospital.

Several months previously he had spent six weeks at a Veterans Administration hospital in Maryland after getting into similar trouble with the police in Wilmington, Delaware. He complained at the time of having spells during which he lost his temper and attacked people, often, according to his story, with disastrous results, since, again according to his story, he had at one time been featherweight boxing champion of England.

According to the psychiatric history at the Maryland hospital, he had, in describing these spells, mentioned some points that would suggest epilepsy. As soon as he came to the hospital and was relieved of responsibility for the trouble he had made, the so-called spells ceased. His descriptions of them varied. Sometimes, when particularly expansive, he boasted of superconvulsions lasting as long as ten hours, during which he made window panes rattle and shook slats from the bed. After being in the hospital for several weeks and apparently beginning to grow bored, his talk of spells died down and he seemed to lose interest in the subject. He was discharged after the staff had agreed that the alleged seizures were entirely spurious, and the patient himself had all but admitted it. The diagnosis of psychopathic personality was made.

Between his first visit to the present hospital and his recent return he had been in five other psychiatric institutions, each time following conflicts with the law or pressing difficulties with private persons. In all the records accumulated during these examinations and investigations, no authentic symptom of an orthodox mental disorder is noted. True enough, there are statements by wives and other interested parties about spells and opinions by the laity, such as the following which was quoted by his attorney on one occasion to shield him from the consequences of theft:

I had occasion to be in Dayton, Ohio, recently and talked to the people running the… Loan Company at… Street, having stopped there for about an hour between trains en route for Chicago. I was informed by these gentlemen that he had wheels in his head.

Statements such as the above, opinions that he is “undoubtedly goofy,” that he does not behave like a man in his proper senses, etc., abound in the ponderous stack of letters, medical histories, social service reports, records of court trials, and other material that has accumulated in this man’s wake. One who reads his strange and prolix story, and, even more, one who knows the hero personally is only too ready to fall into the vernacular and agree. Nevertheless, it was equally true on reviewing his record at the time of his new admission that no symptom impressing a psychiatrist had been manifested and that many groups of psychiatrists had, after careful study, continued to find him free of psychosis or psychoneurosis, in other words, sane and responsible for his conduct and even without the mitigating circumstance of a milder mental illness.

Once during this period he had been sent to prison in a southern state for forgeries a little more ambitious than his routine practice. At the instigation of his second and legal wife, who consistently flew to his aid (despite her chagrin at the patient’s having meanwhile consummated two bigamous marriages), well-meaning officers of a veterans’ organization became interested and took up the cudgels.

The patient, wearying sharply of prison, had for some time been talking on all occasions about a blow on the head which he had sustained while in service. This alleged incident, though absent from his military records, had cropped up frequently but not regularly during his hospitalizations. Sometimes the blow, which he had sustained accidentally from the butt of a gun that a companion was breaching, had merely left him dizzy for a moment. Again it had knocked him unconscious for a short period and necessitated several days’ rest in his tent.

Max now became more specific about his wartime injury and explained that he had suffered a severe concussion, lying out stark and unconscious for some eight or nine hours. Attorneys pointed out his many periods of treatment in psychiatric hospitals. The governor soon agreed to parole him into the custody of a federal hospital in Mississippi.

During his present hospitalization he was for several weeks happily adjusted on the admission ward, busy doing small favors for the physician, congenial with all the personnel, helpful and kindly toward psychotic patients. He was alert, quick-witted, nimble with his hands, entirely free from delusions, hallucinations, or any of the broader personality changes found in the ordinary psychoses. He was by no means “nervous,” even in the lay sense, and showed no emotional instability or signs of ungovernable impulse. Rather than an excess of anxiety, he showed the reverse, apparently finding little or nothing in his present situation or in all his past difficulties to cause worry or uneasiness.

As the time passed he began, however, to grow restive. He became somewhat condescending toward the physician, frequently referring to himself as a man of superior education and culture and boasting that he had studied for years at Heidelberg.

Shortly before the time set for him to come before the staff he demanded his discharge. This was denied. He now became involved in frequent altercations with attendants and sometimes fought desultorily with other patients. These fights always started over trifles, and Max’s egotism and fractiousness raised the issue. He never attacked others suddenly or incomprehensibly as does a psychotic person motivated by delusions or prompted by hallucinations. The causes of his quarrels were readily understandable and were always found to be similar to those which move such types as the familiar schoolboy bully. Usually his adversaries were patients also disposed to quarrel. No signs of towering rage appeared or even of impulses too strong to be controlled by a very meager desire to refrain.

He always took care not to challenge an antagonist who might get the upper hand. During this period he talked much of his past glories as a pugilist, describing himself as former featherweight champion of all the army camps in the United States. The desire to show off appeared to be a strong motive behind many of his fights. As will be brought out later, he was indeed, a skillful boxer. These stories were not delusion but the exaggeration and falsifying, sometimes unconscious or half-conscious, that are often seen in sane people and not infrequently in those who are able, intelligent, and highly successful.{§§}

He was often caught sowing the seeds of discontent among other patients whom he encouraged to break rules, to oppose attendants, and to demand discharges. He made small thefts from time to time. This trend culminated in his kicking out an iron grill during the night and leaving the hospital. He took with him two psychotic patients, and numerous others testified that he had tried to persuade them to leave also.

The next afternoon he was returned to the hospital by the police after being arrested in the midst of a brawl that he had caused by cheating at a game of chance in a low dive. He had taken a few beers but was shrewd, alert, and well in command of his body and his faculties.

He now insisted on his discharge from the hospital against advice and was brought before the medical staff. The diagnosis of psychopathic personality was again made. In his demands to be released he arrogantly maintained that he had been pardoned outright by the governor of the state which had imprisoned him, pointed out vehemently that he was sound in mind and body, and expressed strong indignation at being confined unjustly in what he referred to as a “nut house.” It was then pointed out to him that he was not pardoned but merely paroled and told that if discharged at present he would be returned to the penitentiary.

Here his wrath began to subside at once and marvelously. Hastily but with some subtlety, his tone changed, and he began to find points in common with the advice he had been receiving from the staff. He left the room in a cordial frame of mind, tossing friendly and fairly clever quips back at the physicians, nearly all of whom he had known during some of his many admissions to various hospitals.

About ten days later he was pardoned outright by the governor and almost immediately took legal action which got him discharged against medical advice.

Many similar adventures had occupied his time prior to the recent admission. Some of these had resulted in his being sent, as in the episode above, to psychiatric hospitals from which he promptly obtained his release by legal action. Others had led him to jail and to the police barracks dozens of times for charges not sufficiently serious for him to utilize the expedient of psychiatric hospitalization as a means of escape.

A series of troubles had led to his reaching the hospital on this last occasion. As mentioned previously, he had many years ago divorced his first wife and remarried. The second legal spouse continued to play an important part in his career. As the proprietress or Madame of a local brothel generally conceded to be the most orderly and, perhaps in a certain sense, the most respectable institution of its sort in the city, she was constantly embarrassed by the actions of her husband. Though enjoying a good part of the revenue from this ever-lucrative business, Max troubled himself little to maintain the dignity of the house.

In fact, he went out of his way, it seemed, to complicate matters for his wife. If not through his daily and nightly brawls or uproars in various low grogshops, dancehalls, “juke-joints,” etc., then by putting slugs into slot machines or serving as fence in some petty thieving racket, he brought the police in search of him down on the House of Joy which maintained him.

Though satisfactory understandings existed between this institution and the law, policemen suddenly appearing at the door and trooping through the hallways proved anything but conducive to that sense of security and dignity Mrs.——— had long and justly boasted for her house.

Max also, especially after a few drinks, liked to go about the house bragging to clients and to entertainers alike of his prowess in various lines, intruding on parties still at the “downstairs stage” of the night’s activities, minding everybody’s business, and inevitably turning the conversation to his superiorities. Most of the time he was quite amiable in this role—a cordial, but an all too cordial, host under circumstances where people are usually concerned more with definite and perhaps pressing aims of their own than with the glowing reminiscences of another. Occasionally when crossed he became threatening even with clients and, though open strife was usually avoided, hot, wild words and strenuous scenes sometimes followed, with Max exulting in the aftermath by pacing up and down the corridors of the house, shadow-boxing, cursing, crying out his pugilistic titles and victories, and challenging all comers.

No one better than his wife, a woman of experience and good judgment in such matters, realized what an unhappy effect these antics had on her clientele quietly seeking pleasure behind doors before which Max roared and paraded. Naturally she sought to silence him and to lead him off to the quarters they shared. Usually, however, her appearance served merely as a focus for his ire, and the tumult she sought to quell redoubled through her efforts. More than once under such circumstances he pursued her into her room, the wrangle having moved on to open violence, and beat her there to his heart’s content. Mrs.———, a tall and heavy person, gave a casual impression of being twice as large as Max. Furthermore, she was a woman of considerable strength. She often fought back vigorously and, though she seldom succeeded in landing a telling blow that would discourage her marital opponent, her resistance made the fight much more lively and greatly augmented the uproar of thuds, slaps, crashes, oaths, grunts, and honest yells of pain.

Over several years this connubial life had been interrupted frequently by Max’s departure, which he usually took in heat after quarrels such as those described above. Often he left voluntarily with obscene curses at his wife on his lips. Sometimes she called the police to him after he had covered her with minor bruises and abrasions from his practiced fists and had him forcibly ousted. Over the years he spent perhaps two-thirds of his time away, going from city to city, living by his wits, which are sharp indeed. When caught in his minor frauds, which he practiced not only on the public but also on those associated with him in his ventures, he quickly left town; or, if not quick enough, spent a few days in jail, from which he soon obtained release by telling of his imaginary head injury, of his “spells,” or of anything else that occurred to his fertile mind as a means to make people believe he was incompetent because of “shell shock.” When his situation turned out to be more serious, he telegraphed or telephoned to his wife, who at once flew to his aid and usually with some little money at her disposal.

He covered the entire eastern seaboard on these trips and made several expeditions into the Middle West. For a few weeks in Texas he lived well off of money he milked from slot machines by some ingenious device or contraption or maneuver. His inventions of this type are numerous and highly practical. He could, perhaps, make an excellent living indefinitely off such takings if he did not, when drinking, and often when sober, boast too widely of his cleverness or otherwise bring himself to the attention of the police.

It has been mentioned that he had, earlier in his career, but after his second marriage, been wedded to other women bigamously. His wife learned of these episodes and legal action was taken by the deceived women. From these minor troubles he was extricated by his shrewdness, the aid of his wife, and the power of his familiar tactics of claiming incompetency and irresponsibility.

This gambit of moves seems to have gained rather than lost effectiveness by repetition. It has become virtually a joker in the deck, or rather up the sleeve; and it has never failed him yet. One cannot but wonder if the juries, the courts, and other authorities are not overwhelmed by precedent and, seeing that his grounds for impunity have been upheld so often in the past, fail to challenge them adequately. Precedent is, of course, freely admitted to weigh heavily in law. On the other hand, these nonmedical observers seem to weigh seriously the plain facts of the patient’s conduct when they decide that he is not a normal man. Psychiatry, with its clear rules and definitions for the determination of psychosis, has not seemed to be as much concerned with these facts.

The immediate cause of Max’s return to the hospital on this occasion was indirectly connected with a third bigamous marriage which he recently made while off on one of his tours from connubial security. With his new partner he tried his hand again at forgery on a somewhat larger scale than usual. He prospered for a while and, flushed with prosperity and bravado, brought his new bigamous partner home with him on a visit to the brothel where his legal wife was struggling to restore standards which had suffered during his presence.

Quarreling broke out at once, as might well be imagined, between the two wives. Max, still in character, did nothing to pour oil on these sorely troubled waters. In fact, his every move seemed designed to whip up the already lively doings to a crescendo. The dispute culminated in a vigorous and vociferous set-to during which both ladies were pretty thoroughly mauled, furniture broken, and the brothel all but wrecked. Max’s most important personal contribution to the fray was a broken jaw for his legal wife, the Madame of the house.

It is interesting here to note that, despite his continual brawling with both men and women over so many years while drinking or while quite sober, and despite his ferocious threats of violence and his pretty genuine ability as a pugilist, no serious bodily harm had before this come to anyone at his hands. I believe that the substantial injury was unintentional, an act of thoughtless exuberance committed in the heat of a situation eminently and subtly designed to bring out high enthusiasm in such a man as our hero.

Having succeeded in bringing off a scene that even in his career stands out as a little masterpiece, he took the bigamous partner and fled back to the nearby city where his forgeries were in progress. Almost on his arrival detection met him, and hard on its heels came prosecution from home in consequence of the jaw-breaking. To these difficulties charges for his latest bigamy were added. As such disasters began to accumulate about Max, his legal wife, finally aroused, decided for the moment to lend her influence to the punitive forces.

In the court action that followed, the present and third bigamous wife received an adequate sentence to the state penitentiary, and for a while Max’s own fortune seemed none too bright. Wrought upon by his protestations, however, and perhaps influenced as well by the disappearance of her rival from the scene, his old protector, the legal wife, was won over and began to work with her husband. Soon matters were arranged for him to escape the ordinary consequences of his deeds and be sent again to a psychiatric hospital. His last admission, with which this account began, was the result.

Safe in the familiar harbor of a psychiatric hospital, he was for a week or more friendly, cooperative, and apparently content. He was at all times shrewd, somewhat witty on low levels of humor, and entirely free from ideas or behavior suggesting any recognized psychosis.

He became very friendly with me at this period and talked entertainingly and with enthusiasm about his many adventures. He denied all misconduct on his part but admitted that he had often been in trouble because of his wife and others. It was not the denial of a man who is eager to show himself innocent but the casual tossing aside of matters considered irrelevant or bothersome to discuss. After briefly laughing off all his accusations, he at once shifted the subject to his many triumphs and attainments.

Telling of his early life in Vienna, his birthplace, he spoke of his excellent scholarship in the schools, his pre-eminence at sports and of the splendid figure in general he had cut as a youth in that gay and urbane city. In none of these statements did he lay in details such as might be expected of a man developing a delusional trend. No psychiatrist, and few laymen for that matter, would have had the least difficulty in recognizing all this as “tall talk” designed to deceive the listener and to put the talker in a good light. All the patient’s reactions showed that he himself was far from being taken in.

His birth and upbringing in Vienna coincide with the facts as obtained from his army records. His alleged experiences at Heidelberg are recorded many times on his own testimony. He described himself as a distinguished student in that honorable university, referring to Kant and Schopenhauer and several of the Greek philosophers as special subjects of his study. He spoke also of a deep interest in Shakespeare during his student days and sought to give the idea that he was celebrated among his fellows for his knowledge of the Bard.

The shrewdness and agility of his mind were prettily demonstrated in these references to the picturesque and traditional gaieties of student life, to the works of the philosophers and poets. No less vividly and convincingly did he reveal an utter lack of any real acquaintance with all the subjects about which he boasted himself learned.

He knew the names of a half-dozen Shakespearean plays, several catch-penny lines familiar to the man on the streets, a scattering of great names among the philosophers. Not only was he totally ignorant of the systems of thought for which his philosophers are famous but also even of superficial and general facts about their lives and times that any person, however unintellectual, could not fail to remember if he ever had the interest to read of such matters. Of Shakespeare he knew practically nothing beyond the titles that rolled eloquently from his tongue and a few vague and jumbled conceptions that have crept into the ideologies of bootblacks, peasants, and street gamins the world over. Furthermore, he had no interest, as contrasted with knowledge, in any matter that could be called philosophic or poetic. He liked to rattle off his little round of fragmentary quotations, the connections and the connotations of which he realized only in the most superficial sense, to contribute a few pat and shallow saws of his own which he showed that he believed were highly original, iconoclastic, and profound, to boast generally of his wisdom and then go on to descriptions of his other attainments and experiences.

To my surprise, he was several times taken by psychiatrists who studied him briefly and by social service workers as a man of some intellectual stature. His story of Study at Heidelberg, though usually discounted, was, if the implication of the psychiatric histories is correctly read, sometimes taken as true or probably true.

Although my actual contact with Heidelberg is superficial enough, I had no difficulty in demonstrating in the patient a plain lack of acquaintance with the ways of life there. The general plan of study and the physical set-up of the university, matters that would be familiar to anyone who had been an undergraduate there, however briefly and disinterestedly, were unknown to Max. He showed that he had probably passed through the town and that he had heard and still clearly remembered gossip and legend from the streets of Vienna about the university and its customs, but he had no more real understanding of it than a shrewd but unlettered cockney would have of Cambridge.

This phase of his examination provided, in my opinion, a striking example of the ambiguity inherent in our word intelligence, Here was a man of exceptional acumen. His versatile devices to defraud, his mechanical inventions to overcome safeguards which ordinarily protect slot machines and other depositories of cash, and his shrewd practical reasoning in the many difficulties of his career demonstrate beyond question the accuracy, quickness, and subtlety of his practical thinking. His memory is unusually sound; his cleverness at manipulating bits of information so as to appear learned is exceptional. He is not a man to be taken in by the scheming of others, though he himself takes in many. One can truthfully say about him that he is bright as a dollar, smart as a whip, that his mind is like a steel trap, etc.

His ability to plan and execute schemes to provide money for himself, to escape legal consequences, and to give, when desirable, the impression that he is, in the ordinary sense, mentally deranged, could be matched by few, if any, people whom I have known. In such thinking he not only shows objective ingenuity but also remarkable knowledge of other people and their reactions (of psychology in the popular sense) at certain levels, or, perhaps one should say, in certain modes, of personality-reaction. He stands out for the swiftness and accuracy of his thinking at solving puzzles and at playing checkers. At any sort of contest based on a matching of wits he is unlikely to come off second best.

To consider his intelligence (or should one say wisdom?) from another viewpoint, from that of the ordinary man’s idea of what is good sense about working out a successful plan of life on a long-term basis, only the story of his career can speak adequately. Be it noted that the result of his conduct not only brings trouble to others but almost as regularly to himself.

To take still another point of view and consider him on a basis of those values somewhat vaguely implied by “intellectuality,” “culture,” or, in everyday speech, by “depth of mind,” we find an appalling deficiency. These concepts in which meaning or emotional significance are considered along with the mechanically rational, if applied to this man, measure him as very small, or very defective. He not only appears ignorant in such modes of function but stupid as well. He is unfamiliar with the primary facts or data of what might be called personal values and is altogether incapable of understanding such matters. It is impossible for him to take even a slight interest in the tragedy or joy or the striving of humanity as presented in serious literature or art. He is also indifferent to all these matters in life itself. Beauty and ugliness, except in a very superficial sense, goodness, evil, love, horror, and humor, have no actual meaning, no power to move him.

He is, furthermore, lacking in the ability to see that others are moved. It is as though he were colorblind, despite his sharp intelligence, to this aspect of human existence. It cannot be explained to him because there is nothing in his orbit of awareness that can bridge the gap with comparison. He can repeat the words and say glibly that he understands, and there is no way for him to realize that he does not understand.

I believe that this man has sufficient intelligence, in the ordinary sense, to acquire what often passes for learning in such fields as literature and philosophy. If he had more stability and persistence he could easily earn a Ph.D. or an M.D. degree from the average university in this country. If he had this stability and became a doctor of philosophy in literature, the plays of Shakespeare, the novels of Joseph Conrad or of Thomas Hardy, would still have no power to move him. He could remember facts and he could learn to manipulate facts and even to devise rationalizations in such a field with skill comparable to that with which he now out-thinks an opponent at checkers. If, for the sake of theory and speculation, such changes were granted to him, my contention that he would still be without this sort of understanding is, of course, Impossible to prove. It is maintained, however, that this would be clear to all observers who have real interest in such aspects of life, however diverse might be their own formulated opinions on what is good, bad, true, or beautiful about art or about living.

But let us abandon speculation and return to the patient’s conduct. He talked at length of his ability as a fencer, maintaining that he was the best swordsman, or one of the best, at Heidelberg during his student days, and also well-known and feared in Vienna. He spoke of the championship he had won at boxing while in the army, boasting often of a belt which he still possessed symbolizing this achievement. On hearing that I had had a slight experience in amateur boxing, he offered to demonstrate his skill and to give some points. Ostentatiously he insisted that I stand up and, pulling his punches, went through a number of sequences. He did this several times, always choosing a place on the ward where he could be observed by a large group of patients and attendants. He gave every indication of being a practiced boxer. This is borne out also by army records which indicate that he won some small prize as champion of his battalion or regiment.

Even before his presentation at the staff he again became dissatisfied, making complaints against the nurses and attendants, demanding special foods and privileges, bullying other patients, and inciting them to make trouble. At staff meeting the diagnosis of psychopathic personality was reaffirmed.

On failing to get his discharge at once he became even more fretful and unruly and threatened to break out of the hospital. It became difficult to care for him on the ward for well-adjusted patients in which he had been placed, so he was transferred to the closely supervised ward, where he found himself surrounded by actively disturbed and egregiously psychotic companions.

He complained at once of this to his wife, who came to the hospital authorities in tears and with angry protestations, saying that it was an outrage to put her husband with all those crazy men who were violent and combative and who might hurt him. Earlier on the ward she had made the same protest to an attendant, who saltily remarked on the inconsistency of such worries about a husband so well-known for his boasts of might and ferocity and pugilistic skill. She made the matter so sharp an issue that Max, after promising to co-operate, was moved to a quieter ward.

He was now, for a short while, more agreeably disposed. Boastfully he told me that he was, in addition to all his other parts, an artist of remarkable ability. He asked to be given a loaf of bread, stating that he would mold from it creations of great beauty and worth. On getting the bread he broke off a large chunk, placed it in his mouth and began to chew it assiduously, apparently relishing the confusion of his observers. After proceeding for a length of time and with thoroughness that once would have met with favor from advocates of Fletcherism, he at last disgorged the mess from his mouth and with considerable dexterity set about modeling it into the figure of a cross. Soon a human form was added in the customary representation. Rosettes, intertwining leaves, garlands, and an elaborate pedestal followed. The mixture of saliva and chewed bread rapidly hardened.

He now requested a pass to go into town, saying that he must obtain shellac and appropriate paints to complete his creation. He made it plain that he was molding this statuette for me and it was clear that he regarded it as a most flattering favor. Since it was judged unwise to send him out alone he was allowed to go in company of an attendant. He returned with his materials but also with the strong odor of whiskey on his breath.

The whiskey had been obtained in this manner: Pleading a call of nature which, judging by his frantic tone and impressive grimaces, the attendant deemed urgent, he hurriedly sequestered himself in a toilet. After waiting for what seemed like a most liberal interval the attendant went to inquire into the delay. On receiving no response he forced the door only to find that Max had made his escape through a small window near the top of the room, a feat which would have been extremely difficult for an ordinary man.

Guided by a happy instinct, the attendant hurried to a nearby dive where bootleg whiskey was sold and surprised our hero in the midst of his second or third potation. He was drinking to his own cleverness at outwitting the attendant and in loud, imperious tones commanded all present to drink with him and at his expense.

The attendant found him insolent and intractable at first but, with strong moral support from the proprietor and others, led him out, after settling charges for drinks to all, which Max had grandly assumed without a cent in his pockets.

For the rest of the day he was surly and idle except for his efforts to promote quarrels, but on the morrow, extolling again his virtuosity as a sculptor, he settled down and finished his gift to me. It was indeed an uncommon production. The chewed bread had become as hard as baked clay. The whole piece was very skillfully and ingeniously shaped, dry, firm, and as neatly finished as if done by a machine. It was, furthermore, one of the most extravagant, florid, and unprepossessing articles that has ever met my glance. Max presented it with mixed pride and condescension, with an air of triumph and expectancy that seemed to demand expressions of wonder and gratitude beyond reach of the ordinary man. I did my best but felt none too satisfied with my efforts.

Max now asked for daily bread and for a room to be set apart as an atelier where he proposed to work regularly and without distracting influences. In the hope that this activity would keep him out of trouble, all his requests were granted. He immediately demanded full parole also but agreed to wait a short while for this when it was denied.

For a week he worked steadily, his mouth crammed with the doughy mass, his jaws chewing deliberately, his hands nimbly shaping spewed-out hunks of the mess into various neatly finished and exact, but always garish, forms. His coloring of the flowers and garlands and imitation jewels, vivid red, pale purple, sickly pink, always struck a high level of the tawdry blended with the pretentious. The most gaudy atrocities of the dime store must give ground before such art.

He sent messages to the medical director of the hospital, to the supervisor of attendants and the chief nurse, and to many others whom he felt it well to ingratiate, that objets d’art awaited them in his studio. He was visited by these people and by various prominent ladies of the city interested in welfare work and active in helping disabled veterans. To most of these he made presentations as well as moving speeches about his misfortunes, his gifts, and his ambitions. His demands for parole now became more vehement. Many influential citizens begged that he be given this chance to rehabilitate himself. As a matter of fact, he had been reasonably cooperative while at his new work. Parole was granted.

The police brought him back after a few hours. His left hand showed a painful laceration, the result of a severe bite inflicted in retreat by a barroom opponent who had resorted to this vaguely Parthian maneuver after finding Max’s pugilistic skill too great to cope with in the ordinary manner. He showed some evidence of drink but was by no means sodden. Nor did he in any way give the impression of a man sufficiently influenced by liquor to have his judgment appreciably altered or any violent and extraordinary impulses released. In contrast with some of the other patients discussed here, Max, though a ready drinker, never or very rarely drank to the point of confusion. There is no record in all the saga of his being brought in senseless from the highways or fields. At the worst he could scarcely be classed as more than a moderate drinker.

He made no excuses for violating his parole but blamed others in full for the trouble he had started and felt grossly misused by the man he had attacked, by the police, and by the hospital which revoked his parole.

His wife at once pled for restoration of his parole, and a number of other influences supported her. Max reiterated the familiar argument: why deny liberty to a man classed as sane? Parole was restored after a week. Surprisingly, Max got through two days without difficulty but on the third burst into the office of the supervisor of attendants and vehemently demanded that a former attendant, dismissed for incompetence, be reinstated at once. He had brought this man with him into the office. Inspired by a couple of highballs, but by no means drunk, he thundered and swaggered, threatening to use political influences to have the supervisor discharged if all his demands were not met forthwith. He named various political powers which he boasted that he could command. These influences, he very truly pointed out, had lent themselves to his efforts to get out of jail and out of hospitals in the past. He insisted, furthermore, that certain other attendants whom he disliked be discharged. Storming and cursing and threatening, he was removed to a closed ward.

Somewhat disgruntled, he ceased his modeling in postprandial bread and sulked, irritable and aggressive, among his psychotic companions. Soon, however, he became more agreeable and after a few days came swaggering into my office to display a new product of his ingenuity. Borrowing a dollar bill and a pair of scissors, he cut out five rectangles of plain paper identical in size and shape with the bill and poised himself with a faintly prestidigitatorial air.

“Watch this,” he boasted.

As he cut up his models of the bank note and manipulated the pieces, he called for paste to be brought. Then, after a shrewd and tricky rearrangement, he pasted together his fragments.

“Count them,” he ordered in the grand manner.

Not five but six paper models lay on the table, all plainly patched, but all defying the ordinary eye to detect any appreciable loss of substance.

Within a week his wife, after haunting the hospital and begging for his parole, insisting that she needed him at home, that she was in want, etc., succeeded in taking him out in her custody. Late that night local policemen brought him back. After giving his wife what might be called an average beating, he had caused considerable uproar at the bawdy house and fled to another dive where, after trying to get loans from a few idlers, he boasted and quarreled until the police intervened.

He remained then on a closed ward for about a week when, legal charges against him having been dropped, he demanded release against medical advice. Since he was sane and competent in the eyes of law and science, he was discharged.

Two months later local newspapers carried small headlines calling attention to his being taken by federal agents after a protracted investigation in Texas. For weeks patched-up five, ten, and twenty dollar bills circulated in several Texas cities, and Max, decked in flashy finery, drove about in his own car and splurged lavishly on food, drink, and women. The surprising volume of mutilated notes at last caused comment and finally suspicion. After skillful and persistent efforts, the federal agents finally worked out the puzzle and brought it to Max’s feet.

My colleagues and I felt that perhaps our acquaintance with Max had ended. Federal justice is widely regarded as less relenting and less distractible than municipal and state justice. For most lawbreakers this is, indeed, true. Max’s old play, however, had not lost its charm. Some months later he was in a psychiatric hospital and shortly afterward at large.

His career continued. The records show that once, while under a five-year sentence to a state penitentiary, he stressed his former syphilitic infection and boasted so vehemently in his old style that a physician who saw him in prison made a diagnosis of dementia paralytica. No neurologic or serologic findings supported this opinion, which was offered by a general practitioner after one interview. This was enough to start the familiar cycle of prison-to hospital-to-freedom.

Once again, when anxious for shelter, he boasted that he could communicate with ancestors who had died thousands of years ago. His wife joined in and claimed that he had seen monkeys and baboons chasing him. At a general hospital a tentative diagnosis of schizophrenia was offered. Back at another psychiatric hospital he showed no evidence of an orthodox psychosis and after a short time got his discharge.

Again when pressed by a court verdict, he claimed amnesia for a period of two years, during which he had been active at defrauding. A suspicion of hysteria was expressed by some physicians. At the psychiatric hospital he stuck for a while to this story of amnesia but, his vanity being aroused, he recalled in detail all his experiences. It was plain from his manner that he had not suffered from any true amnesia, and he no longer took pains to make any one believe that he had.

A few years later, he was brought to the hospital. This time his wife insisted that his beatings were too much to bear and stated that he had threatened to kill her with an axe, explaining that he could do so with impunity since he was a mentally disabled veteran and that, as she well knew, he had always succeeded in escaping the consequences of any crime. She soon recovered from her fears and asked for his parole. At the insistence of both man and wife, he was discharged after a few weeks.

Be it noted that despite his vigorous threats such as the one just mentioned, Max seldom, if ever tried to do anyone serious physical injury. This fact has especial weight in view of his boasted and pretty satisfactorily demonstrated immunity from penal consequences. Max is not by inclination and has never been a violent or murderous person but in his conflicts with the law has appeared usually in the role of petty bully, sharper, thief, and braggart.

Some months later I, with other psychiatrists, testified at court when efforts were being made to have Max committed by law as “insane.” Several citizens whom he had defrauded and seriously troubled in other ways, finding that he was not vulnerable to fines or sentences in the municipal courts, hoped to obtain relief and protection by getting him into a psychiatric hospital.

The psychiatrists could not avoid admitting that he did not show evidence of anything that is officially classed as a psychosis. I had to agree. In trying to explain briefly and comprehensibly that I believed this man, while not suffering from a psychosis that could be named, or any of the technical symptoms of one, was entirely unsuited to be at large, the sense of futility was oppressive. Max, neat and well-groomed, insouciant, witty, alert and splendidly rational, rose, beaming, to hear again the verdict of freedom.