Читать книгу The Mask of Sanity - Hervey M. Cleckley - Страница 19

The following letter was received by an influential senator in Washington and referred by him to the hospital.

Dear Sir:

It is with regret that I find it necessary to seek consideration from higher authority but I have been confined in the Veterans Administration Hospital at ———, ———for two years.

During my period of incarceration here I have tried in every available way to co-operate with the officials, but it seems an impossibility to get any consideration from them towards gaining my freedom.

I was placed here on the recommendation of my sister because she thought I was a drug addict, and she has written some pretty nasty things against me to the officials here.

I can prove to the satisfaction of all concerned that I am not a confirmed drug addict or habitual user of any form of drug sufficiently to warrant continuous confinement. I am not a criminal, nor had I the slightest minor charge of any description against me at the time I came here. The Staff here has rated me less than 10 per cent disabled and discontinued all government compensation; therefore, I believe you will agree with me that any man with a less than 10 per cent disability could not possess a physical or mental disorder sufficient to prevent his having his freedom and making his own livelihood.

I am not even allowed parole privileges of the grounds as a great many of the patients here are. Some are continually violating institutional rules and still retain their parole privileges undisciplined.

I have two children, who need my support and as long as I am kept incarcerated I can’t assist them in any way for I have no means other than my labor to support them,

I hereby humbly request you to intercede in my behalf and demand these officials here to grant my release in order that I may be able to support my children to the best of my ability as is every man’s duty.

There are quite a few men in these institutions that are nothing short of impositions on the government and taxpayers of the United States. They, the same as myself, are perfectly capable mentally and physically to support themselves and should be forced to do so.

I have begged for parole, trial visit, or any other means to prove myself self-sustaining, but the authorities here seem to take my plea as a joke and make a lot of promises that they have no intention of putting into action.

I will gladly submit to any physical or mental examination you may deem necessary to assist you in obtaining my release from this place.

I pray that you will give my earnest request your immediate consideration.

Please be assured that I hold no malice toward any of the officials here or elsewhere but my only objective in writing you is to gain my freedom and support my children.

Please let me hear from you personally,

Yours very respectfully,

Frank ———.

The writer of this letter has behind him a formidable record of misadventure.

Detailed knowledge of Frank’s early life is not available beyond the following facts: The son of a rustic blacksmith, he was raised in a small hamlet near the mountains of north Georgia. No members of his family, so far as can be learned, suffered from nervous or mental disease or made themselves objectionable in the community. He completed the fifth grade in school, where he was considered by no means a dull boy, though often truant. Many of the hours when he was supposed to be in school or working at some necessary chore for his family, he is reported to have spent loitering about a local millpond drowning goats and doing other senseless or uninviting deeds of mischief.

Before the United States entered World War I Frank had forged his father’s name to a false statement about his age and enlisted in the National Guard. After his discharge from the army he was given vocational training by the government. He was tried at several courses but made no serious effort to complete any of them. In his community he soon made himself a problem, sometimes drinking to excess, often behaving in a rowdy and threatening manner, contracting to buy filling stations, farms, etc., but never living up to his agreements.

Local ex-service men, believing that he took morphine and that treatment might help his maladjustment, commonly referred to as “nervousness” had him sent to a psychiatric hospital. He remained for a month, then returned to continue in his old ways.

Now began a series of hospitalizations which extends to the present time. He would be sent first to one place, then to another. He has been treated in state hospitals, in federal hospitals, and in private institutions at the expense of the government. All told, he has been admitted no less than nineteen times to strictly mental hospitals maintained for the purpose of treating psychotic people. Sometimes he remained only three or four weeks, sometimes six months or even eighteen months. Over the years his periods of hospitalization have grown slightly longer and his intervals outside shorter. He has never, during the past fifteen years, been free longer than a few months. While not under the care of psychiatrists he has received considerable attention from the police. His jail sentences number seven at the present reading, including a term of nine months in the Leavenworth Penitentiary (where he was sent for forging a prescription for morphine) but not counting a score or more of overnight or week-end stops in police barracks.

Despite these preoccupations Frank has found time to marry and have four children and to become ordained as a minister in a small religious sect noted for vigorous evangelical fervor. His martial relations have been most unsatisfactory during the interludes when he was free to be with his family. His wife reports that he curses her and fights with her and it is well established that he seizes any money that is available, hires automobiles, and drives aimlessly about the countryside, often drinking to excess and, according to some reports, occasionally taking morphine.

At times he has seemed proud of his ecclesiastical title, referring to himself as a pastor and assuming unctuous and haughty airs. He has not, however, occupied himself with whatever ministerial duties he was supposed to fulfill any more consistently than with other work.

His friends, especially those interested in the American Legion and other service organizations, have obtained many positions for him. He is shrewd, neat in appearance, and an excellent talker. He makes a good impression at first but always shirks his responsibility to such an extent that it is impossible to retain him.

A few years ago he was given a place at a gasoline filling station and seemed, surprisingly, to show considerable interest in his work for several days. It was then discovered that he had been drawing off all the gasoline he could and taking it to a near-by town where he sold it and bought morphine from dope peddlers, most of which he, in turn, sold at a tremendous profit to local addicts.

He has been consistently arrogant and aggressive toward his neighbors and acquaintances over trifles. After taking a few drinks he has often threatened others, claimed things that were not his own, and made such a nuisance of himself that local police would be called to deal with him.

He is boastful and histrionic, more eloquently and aggressively so with a few highballs, and much given to temper tantrums. He frequently threatens to kill himself over some petty vexation and once offered a pistol to his wife, urging her grandiloquently to shoot him. He has never made an attempt, however, to harm himself, though his opportunities have been unlimited.

He has been reported as having convulsive seizures. These developed when he was refused special attentions by physicians and seemed, according to descriptions of them, plainly and consciously designed toward obtaining various ends. This manifestation has also been noted when he was confined to jail and wanted to be sent to a mental hospital in order to escape charges that had been brought against him. These so-called seizures have been observed several times in this hospital by competent psychiatrists. They did not in any way suggest epilepsy nor were they convincing as possible reactions of true hysteria. The patient is unquestionably conscious and shows that he is behaving intentionally in this way to gain a recognized end. Unlike a conversion phenomenon, the purpose is not concealed from his conscious awareness.57, 77

Though occasionally confused after heavy drinking (perhaps with the addition of drugs), he has at all other times been entirely rational, alert, shrewd, and free from delusions and hallucinations.

Early in Frank’s career he was on several occasions given a diagnosis of hysteria, sometimes of both psychopathic personality and hysteria. Once he was given a diagnosis of psychopathic personality with psychotic episodes. There was not, however, any evidence of behavior or symptoms different from what he has shown on other occasions. There is reason to suspect that the real and pressing need to keep this patient hospitalized may have played an important part in his being so classified. The genuinely irrational and incompetent behavior, no doubt, supports the use of such a term as psychosis, despite the lack of any additional symptoms.

The irrational behavior which has characterized him is not based on a delusional system or on any loss of the good reasoning ability he shows on examination. Some of his most turbulent misconduct has, of course, been while he was intoxicated. At such times he naturally lacked his customary shrewdness and alertness, but one cannot conscientiously call this a psychotic episode beyond and above his well-known inadequacy but rather the manifestation of inebriety. I do not mean to say that this man is normal but only that he has none of the recognized types of mental disorder, episodic or constant. If his drunken and wayward episodes are to be termed psychotic, then his state at other times must be termed psychotic, since it is in his shrewd, technically sane condition that he decides to add the picturesque touches of intoxication which he well knows will bring him to the attention of the police.

At this hospital, at the state hospitals, and at the other institutions to which Frank was sent in recent years, he has been considered a sane man without psychotic episodes. The symptomatic diagnoses of drug addiction and chronic alcoholism have been added. During all these years he has shown no evidence of deterioration or regression, and today at thirty-eight he is the same clever, alert person he was described as being twenty years ago. Unlike nearly all real morphine addicts he does not show ordinary withdrawal symptoms or other signs of physical illness and acute distress when, after being admitted to the hospital, he is deprived of opportunities to obtain the drug.

If the reports that he takes morphine have any factual basis, such use must be sporadic. There is little or no evidence that effects of the drug have regularly played any major role in his behavior. It appears that his chief connection with drugs has been through his part in peddling them illicitly.

His career in the hospital has been marked by frequent paroles which are always terminated by his failure to return, returning drunk, or being taken up by the police for petty theft, swindling, and futile and unprovoked disorder. Though ingratiating and outwardly cooperative when he is trying to obtain parole or discharge, he constantly schemes to escape or, surreptitiously, to call upon high authorities to have him released. Once, while helping attendants on the disturbed ward, he succeeded in turning hot water into a tub where a psychotic patient lay in a continuous bath. He did not try to injure the man seriously, merely to hurt him a little as a joke. This is a fair example of the inane, humorless mischief that underlies the pretentious front assumed by this former pastor.

Despite his medico-legal status, which, of course, is technically regarded as constituting sanity, those interested in finding some practical way to protect him and his family and to cope with the ever accumulating problems, succeeded on one occasion in having him committed by the court. Those close to the situation evidently found in his behavior reasons for action more compelling than the abstract criteria which stood in the way of such a step. After being held in the hospital for several months despite his reiterated demands for discharge against medical advice, he called in an attorney.

Frank had in the past always found no difficulty in leaving when it suited his purpose or his whim. In view of his well-demonstrated inability to live in freedom he was now, by means of the legal commitment, kept against his wishes in order to spare his family, the community, and himself the hardships he had brought about before and was sure to bring about again. The attorney for the government, in attempting to resist habeas corpus proceedings, found himself in a familiar dilemma, as the following quotations from his letter will show:

“It is evident that the medical staff at the hospital are using the term insane to convey the meaning of the medical definition of the word rather than the legal definition. In other words, the thought back of the use of the word appears to me to be that it is the opinion of neuropsychiatrists that this man is not suffering from a mental disease as physicians understand the term, that he does not have a psychosis. It does appear, however, that it is their opinion that the state of his mind due to drug addiction and also manifested by his past antisocial behavior is such as to warrant the conclusions that he is incompetent and that he should receive treatment in a hospital for the cure of nervous and mental diseases. To say, however, that he is incompetent but not insane presents a rather inconsistent picture with which to go into court. We may be confronted with such a question as why he needs to be in a hospital for the care of nervous and mental diseases if he has no nervous or mental disease.

“I am inclined to think that the terms insanity and incompetency so far as their legal significance is concerned are used interchangeably and that the important point to be considered, whether you call a man insane or merely admit that he is incompetent, is whether the person is incapable of administering his personal estate in the normal manner of a prudent man and whether there is definite evidence of a more or less prolonged departure from normal behavior as compared with the standards of the community, such as dissipation of funds, unwise purchases, and utter lack of appreciation of values.

“Because of the fact that I anticipate some difficulty in trying to show that the man is incompetent but not insane, I would appreciate an expression of your views on the matter. It occurs to me also that a man ought to be confined who is a menace to others and likely to do harm to others, even though his mental condition may be due in part to inadequate mental development and in part to the use of drugs. He may be just as dangerous to himself or to others as a person suffering from a mental disease and who, according to the purely medical definition of insanity, would be pronounced insane.”

Of course, one might say, why not let these people out of the mental hospitals and leave them to the police? If they are considered responsible for their misdeeds, let them be punished. This, as a matter of fact, is what the average psychiatric hospital is nearly always forced to do, whatever its physicians may think of the wisdom and practicality of such a procedure. These men are studied, found free of recognized mental disorder which might make them unaware of what they are doing, and are sent back out into the world. They are arrested not once but many times. Most of them seldom commit very serious crimes. Only rarely can they be kept for more than a few days. They do not follow any purposive criminal life. They make a nuisance of themselves to the community as a whole and often tragically wreck the lives of those close to them, and all to no discernible end. The police and the courts tire of them. Through various influences they are forced back on the mental hospitals where they take legal action to regain their freedom, only to begin the process again.

If, as stated in the quotations previously cited, it would be difficult to prove this man incompetent but not insane, it would be far more difficult, by existing definitions of psychiatry, to prove him “insane.” His perfectly rational (superficial) behavior under scrutiny, his freedom from delusions, his shrewdness, his alertness, his convincing plan for a normal, useful life, in short, his plain sanity as this is ordinarily understood, make it all but impossible for a judge or a jury to call him insane. Psychiatrists, familiar with his long record of senseless behavior, are able to see more reason to do so than could be brought out before a court in terms of abstract criteria by which the decision is determined. But according to the accepted standards of psychiatry, his diagnosis carries with it an official and automatic endorsement of the patient as sane and competent. No matter how strongly impressed by real and practical evidence to the contrary, all physicians testifying in such a case must admit that the official technicalities approve this paradox.

Having won his case in court, the patient was released against medical advice. Frank did not go home but remained in the city where he at once claimed the attention of the police. On being released after a few days in jail he took a room at the best hotel, annoyed other guests by trying to borrow money, sponge on them for a meal, sell them something useless or non-existent, etc. He became at times loudly boastful or rowdy, and eventually fell on the floor drunk. He refused to pay for his room and resisted the management’s attempts to remove him.

He sought loans under bold-faced pretences, ran up debts without regard to the possibilities of payment, telephoned and wrote to his family threatening suicide unless his demands for money were promptly met. There are indications that he was not inactive during this period in old devices of petty thievery, short-changing, and various types of fraud, sharp practice, and connivance, that exist on the fringe of more or less organized but illegal racketeering found in any city.

Nothing, however, could be pinned on him by the law that led to his being effectively controlled. In all issues of this sort that arose he had his record as a patient once legally committed and often confined to psychiatric institutions. This record was, in his ingenious hands, of considerable value as insurance against penal restraint.

After several arrests, the police began to call on the hospital to relieve them of their problems with this man. They were told that nothing could be done since he had been legally removed and the hospital was enjoined by the court not to hold him. Soon afterward the police and various local people began to seek advice on how to deal with him from the attorney who had liberated this man.

The patient himself soon joined in, coming repeatedly to the attorney’s office or his house, sometimes drunk and always unreasonable, to shout about the injustices of the world, borrow money, evade threatening penalties, and to demand divers preposterous services. The veteran had promised to pay the attorney’s bill with bonus money, but now it appeared that this money had already been squandered. Hoping to collect his fee and, no doubt, from humanitarian impulses, the attorney sought to keep in touch with his client. Those with whom he had run up bills, floated little loans, etc., joined others swindled or defrauded in small matters and took their problems up with the patient’s legal representative. Soon the incessant complaints from annoyed people, the client’s own nagging or uproarious invasions upon him at all hours, and the constant queries of the police drove him to seek relief. The patient being again in jail, the attorney persuaded him to agree to return to the hospital voluntarily and pled with the physician in charge to take him back, confessing himself at fault ever to have released such a scourge on the community and on himself.

Arrangements were made for readmission. The patient arrived in custody of a policeman. He was still somewhat stimulated from a recent intoxication but, though overbearing and pompous, showed no signs of real drunkenness nor of an officially recognized psychosis.

Frank took a high-handed manner, swaggered about, finally refused to come back into the hospital, saying that he had no mental disease and that he preferred to return to jail where he would soon be released to carry out important business plans and social activities. He enjoyed the incident, played up his role dramatically, and took a peremptory and haughty tone with everyone.

Some weeks later after running up big debts, giving several more bad checks, and participating in a series of senseless, bawdy escapades, he was finally returned to the hospital. Three months later he again obtained his discharge on a writ of habeas corpus but not through the same attorney. The story in its broad essentials was repeated.

Since his last admission, following the exploits just mentioned, he has been true to form. After varying periods on a closed ward parole has been given, he has lost it repeatedly and gone back among “demented” and helpless groups with whom he is, to say the least, not at home. He has continued at all times free from the technical stigmata of psychosis, crafty, intelligent, and superficially cooperative while trying to gain his ends.

Frank takes advantage of every opportunity to make trouble in the hospital, is rather restless and extremely dissatisfied. He sends frequent letters to women in town to whom he regards himself as paying court. These are written in a neat hand, well spelled and well expressed, and are much better letters than one would look for from a man of his education. They are marked with self-righteousness, extreme egotism, trite sentimentality, and monumental falsehood. His tone is that of a lover who regards his own passion as very high and rare.

“Only God knows,” he writes, “why I wasn’t left over there among the poppies with my heroic buddies,” falsely describing himself as a captain in charge of 272 men. “My wife never understood me!” he complains in the same letter. What does he expect of her? The question invites meditation.