25. The psychopath as
physician
When first seen by me, he was still in his early forties. From the country
town in which he was practicing medicine an inquiry came concerning his
professional ability. Everyone regarded him as a brilliant man. His patients
loved him, and while he was working regularly, his collections were more
than adequate. It was often impossible to find him, for now and then, in the
classic manner, he lay out in third-rate hotel rooms or in the fields
semiconscious until he could be found and coaxed back home.
This was tolerantly accepted as one of his idiosyncrasies by the rustic folk
he attended. It was inconvenient, but like drought and the boll weevil, what
the devil could one do about it? The community, in which not only social
drinking but even card playing and dances were generally regarded as devices
of Satan, intuitively sensed that the Doc's doings had little or nothing in
common with the proscribed gaieties or frivolities. Although a man known to
drink cocktails for pleasure and even a woman who smoke cigarettes might
have been ostracized, local deacons and town gossips made no concerted
attack on the doctor.
The inquiry about his ability mentioned previously was prompted by the
following incident:
A patient whom he had been attending off and on for several weeks had
noticed that he occasionally seemed glassy-eyed and slightly irrelevant.
Neither she nor her family, however, was prepared for such a bedside manner
as was his on the last visit.
When the door was opened for the doctor, he swung in unsteadily with it,
hanging desperately to the knob, which he apparently hesitated to
relinquish. Breathing hard, he muttered inaudibly for a moment, winked
inanely at three children who had withdrawn to a corner, gave several short,
piercing cheers, and slipped to the floor. Retaining his instrument bag in
one hand, he began, still prone, to crawl toward his patient's room.
Switching his body from side to side, he made slow but spectacular progress,
hesitating every few yards to give a series of hoarse, emphatic grunts or
barks. This pantomime was taken by the family to represent an alligator
slipping through a bog. In this manner he reached the bedside of the
patient.
This man's history shows a great succession of purposeless follies dating
from early manhood. He lost several valuable hospital appointments by lying
out sodden or by bursting in on serious occasions with nonsensical uproar.
He was once forced to relinquish a promising private practice because of the
scandal and indignation which followed an escapade in a brothel where he had
often lain out disconsolately for days at a time.
Accompanied by a friend who was also feeling some influence of drink, he
swaggered into this favorite retreat and bellowed confidently for women.
Congenially disposed in one room, the party of four called for highballs.
For an hour or more only the crash of glasses, scattered oaths, and
occasional thuds were heard. Then suddenly an earnest, piercing scream
brought the proprietress and her servants racing into the chamber. One of
the prostitutes lay prostrate, clasping a towel to her breast, yelling in
agony. Through her wails and sobs she accused the subject of this report of
having, in his injudicious blunderings, bitten off her nipple. An
examination by those present showed that this unhappy dismemberment had, in
fact, taken place. Although both men had at the moment been in bed with her,
the entertainer had no doubt as to which one had done her the injury.
Feeling ran strong for a while, but, by paying a large sum of money as
recompense for the professional disability and personal damage he had
inflicted, the doctor avoided open prosecution. Before a settlement had been
made, the guilty man attempted to persuade his companion to assume
responsibility for the deed. It would be less serious for the other man, he
argued, since his own prominence and professional standing made him a more
vulnerable target for damaging courtroom dramatics and for slander. His
companion, however, declined this opportunity for self-sacrifice with great
firmness.
Less spectacular performances include locking himself in a hotel room alone
where he would drink to stupefaction, arouse the management, break
furniture, telephone his wife that he had decided to kill himself, drink
more, and remain until taken by police or friends who broke open the door.
He also contributed vividly to the liveliness of a dance some years ago. His
older brother, whom he was visiting in a New England town and who was an
officer in a country club where the dance was in progress, remonstrated with
him, urging him to leave because his loud and disorderly behavior, having
already attracted unfavorable attention, was now beginning to cause
consternation. Whooping in indignation, he at once grappled with his elder
on the porch of the club where they stood.
The orchestra having stopped for intermission, a large number of ladies and
gentlemen were strolling on the terrace below. Attracted by frantic
outcries, reiterated curses, and the sound of scuffling above, these
bystanders looked up to see the two brothers whirling dizzily in combat. The
younger man, his strength finally prevailing, got the older against the
banister and seemed about to throw him over. As observers ran to quell the
tumult, our subject, having in his position of vantage breath to spare for
oratory, caused the golf course to echo with his threats and insults.
"You bastard! You goddamned - bastard! You son of a bitch! I'll kill you,
bastard and son of a bitch that you are!" he yelled, pushing his brother
back farther over the banister as the echoes returned his violent words. One
wonders if the brother was observant enough at the moment to note the
two-edged nature of the term with which he was being so loudly reviled.
Rescuers soon interrupted the performance. Our subject could very probably
have thrown his brother over before they came, but his intention apparently
was to make a scene rather than to inflict serious injury.
After one of his longest periods of regular work and apparently satisfactory
adjustment, which lasted nearly a year, he attended the meeting of a
regional medical society in a large city where an exploit brought him to the
notice of local newspapers.
FOUND DRUNK ON HIGH ALTAR OF ST. PHILIP'S
CHURCH
A man listed as Dr. ___ of ____ was arrested yesterday morning and
charged with burglary when he was found asleep on the altar of St.
Philip's Church. Officer J. G. Coates who made the arrest said that a
painter engaged in painting St. Philip's dome found the door to the
church open this morning and called him. Investigation revealed the man
asleep on the altar. The officer quoted Dr. ____ as saying that someone
else had been with him but that he could not remember who.
The doctor
seemed to be eminently rational but could give no adequate reason for
his inopportune presence in such a place. While a charge of burglary had
been placed, according to records at police barracks, a complete
examination of the church property revealed the fact that nothing was
missing.
He proved to the satisfaction of the authorities that he had entered the
church with no intention of stealing or doing any other damage. I am
indeed strongly convinced that this contention was correct. Finding a
man in so preposterous a situation, the newspaper reporters had
mistakenly, but understandably, assumed that some motive such as
burglary must, of plain necessity, be responsible for his presence.
What
his purpose really was, we must admit, is difficult to explain in terms
of ordinary human strivings.
He often swears off drinking and expresses the intention of devoting himself
to constructive and regular occupation but, despite all the serious troubles
that his conduct has brought him, he actually continues as before.
26. The psychopath as
psychiatrist
In the group who show some fundamental characteristics of the typical
psychopath but who make a good or fair superficial adjustment in society are
sometimes found men who hold responsible positions. Lawyers, business
executives, physicians, and engineers who show highly suggestive features of
the disorder have been personally observed.
Perhaps one would think that the psychiatrist,
with good opportunity to observe the psychopath, would eschew all his ways.
I believe, however, that a glimpse can be given of characteristics of the
psychopath in such a person.
Let us first direct our attention to him many years ago when, as an author
of some papers on psychiatric subjects, he attracted the interest of several
inexperienced young physicians then at the beginning of their careers. The
articles, it is true, were marred by grammatical errors and vulgarities in
English a little disillusioning in view of the suave and pretentious style
attempted by the author.
At the time, however, they impressed this little
group of naive admirers as having all the originality that the author so
willingly allowed others to impute to them, and, as a matter of fact,
implied not too subtly himself in every line of his work.
When seen later at a small medical meeting at which no experienced
psychiatrists were present, this author seemed very grand indeed. The actual
ideas expressed in his paper were, to be fair, culled from the primers of
psychiatry and psychology, but he had an authoritative way of making them
seem entirely his own, and marvelous, too. Despite his cool and somewhat
commanding air, he succeeded in giving an impression of deep modesty.
Everything seemed to accentuate his relative youth which, in turn, hinted of
precociousness and of great promise. The effect he had on his audience, most
of whom were general practitioners from small towns, was tremendous.
An opportunity to meet this splendid figure of a
psychiatrist and to sit at his feet during the rest of the evening was
avidly welcomed by several of his new admirers.
Dr. _____, though still in his middle thirties, enjoyed a wide and enviable
reputation in a section of the country where psychiatrists were at the time
almost unknown. After some work at hospitals in a distant state where he was
born, he had come and set up as a specialist in his present habitat. He soon
obtained a small institution in which he began to direct treatment of
psychiatric patients. Reports indicate that it flourished and expanded
greatly.
It was generally agreed that his learning and ability were chiefly
responsible for his rapid rise to local prominence. Ephemeral rumors hinted
that the idolized Dr. ____ made a practice of treating by expensive and
doubtful procedures any patient of means whom he could obtain for as long as
the money lasted and of then dismissing him or sending him promptly to a
state hospital. It was also heard that with female patients he sometimes
suggested, or even insisted on, activities (as therapy) which are
specifically proscribed in the Hippocratic oath. But what physician has not
had similar things said about him? The impressive bearing of the man and his
reiterated and rather eloquent appeals for higher scientific consecration on
the part of his colleagues snuffed out these feeble stirrings of adverse
criticism which were almost universally ascribed to jealousy.
The lion of the evening seemed to put himself out in being gracious to his
young admirers who were indeed nobodies on the fringe of the wonderful field
which he seemed to dominate. His good fellowship was so hearty and yet so
suave that one could scarcely bring himself to see the faint underlying note
of condescension.
The privilege of driving this relatively great personage out to a country
place where hospitality beckoned was seized by one of the young physicians,
In the car an attempt was made to turn the conversation to psychiatric
questions which Dr. ____ had raised in his papers. He made a few stilted
replies but soon drifted from the subject into talk that was hardly more
than pompous gossip.
His companion, fearing that such a learned man
might be talking down to spare him the embarrassment of incomprehension,
kept returning to psychiatry, trying to make it plain that no such
embarrassment would discount the pleasure of hearing the master. Soon the
replies of this alleged master left the young man in serious doubt not only
as to the great one's knowledge, but even as to his interest in the subject.
Dr. _____, in his more popular talks and articles, as well as occasionally
in those directed toward rustic medical groups, often gave psychiatric
interpretations of literature and art. One of his more recent efforts in
this line touched briefly but ambitiously on the works of Marcel Proust.
Being then in the middle of an earnest pilgrimage among the psychopathologic
wonders of Remembrance of Things Past, the fledgling psychiatrist, perhaps
hoping to make a good impression but also eager for enlightenment, ventured
a question on this subject.
The master at this time was calm and alert, but his remarks were so beside
the point that his disciple wavered. Dr. _____ was perfectly self-assured,
in fact politely pontifical, but the more he talked the clearer it became
that he had not read the book at all. It finally became equally clear that
even Proust's name was unfamiliar, and the disquieting suspicion dawned on
his admirer that he had never encountered it except in the excerpt from some
review which he had apparently come upon and used.
He had not been sufficiently interested in what
he plagiarized even to retain the name and was now imputing it to some
imaginary Viennese psychiatrist. He followed this pretension only for a
moment, however, and only as a stepping stone to banalities with which he
was familiar and about which he spoke with such deliberation and assurance
that they almost seemed marvelous.
Never in all this persiflage did he show
the least sign of confusion or timidity. Apparently he felt that he had kept
intact his impressive front. Even at this stage of the acquaintanceship it
was hard to avoid suspicion that any important distinction between such a
front and more substantial things was not in the orbit of his awareness.
With some remark about putting aside these grave and ponderous subjects, he
sang a few lines of a surprisingly obscene ditty, clapped his companion on
the back, and suggested with gusto:
"When their social doings are over, let's
you and I go get us a couple of good frisky chippies!"
Despite the conviviality implicit in this remark
(and no less in his tone), in some way hard to describe he still maintained
the attitude of one who means to insist on his distinct superiority even
while for a moment generously waiving certain restrictions of caste and
allowing his companion a more respectable footing, It was only a
quasi-equality that he offered, however-an indulgence such as an adult might
allow a child who on some special occasion is permitted to sit up and play
that he is grown. The friendship he seemed to offer was at best a morganatic
one.
His discourse during the rest of the drive, especially after he had stopped
on the way for "a couple of quick ones," was coarse and humorless. It seemed
impossible to strike a sincere idea from him on any subject.
On arriving at the host's place, a merry but entirely civilized company was
found drinking highballs, singing around the piano, or talking
enthusiastically in small groups. The singing was in key, and the talking
was not loose or aimless. For the most part the gathering was composed of
people who, though lively, had some interest in general ideas as contrasted
with the trivia of daily life, and a few slowly ingested drinks brought out
humorous and interesting conversation.
The house was not very large or the furnishing
spectacular, but the place, like the men and women present, gave a strong
impression to the newcomer that he was in orderly surroundings, among people
of dignity and good will.
A young, very good-looking married woman who had an amateur but genuine
interest in psychiatric questions and who meant to be polite to the
distinguished stranger, began talking to him with enthusiasm. He soon led
her off into another room. A moment later, on passing through this room, one
of the young physicians was hailed by a feminine voice and, responding,
found the two in a nook, the lady pulling herself away from the doctor with
some effort but with equanimity.
It was plain that his crudely aggressive
overtures were not welcome to her and she urged the other man, who was an
old friend, to join them on the davenport. Apparently trying to start a
conversation, she asked the celebrity about psychoanalysis, a subject on
which he sometimes expounded to lay gatherings in such a way as to give the
erroneous impression that he was a qualified analyst.
"If I could get you out in a car I'd
psychoanalyze you right now," he muttered, low but loud enough to be
overheard, accompanying his words with a confident leer.
The savant had evidently misread the spirit of
the party. The lady rose, smiled quickly at her other companion as if to say
she knew a disagreeable fellow when she saw one, and quietly rejoined a
group.
Dr. _____ now expressed the desire for straight liquor, making strong,
derogatory remarks about highballs and those who drank them. Ordering his
former disciple to come, he strode toward the kitchen. The former disciple,
by this time feeling heavily responsible for the master, made haste to
follow.
In the kitchen Dr. _____ began to order the servants about in profane and
petulant fashion. He had gulped one or two small whiskeys when several men
wandered in looking for ice. One of these, an eager intern, expressed
interest in the important investigative work which Dr. _____ had begun now,
in loud, boastful tones, to announce himself engaged in.
"If you want a job there, son, just lemme
know," he thundered.
Swaggering about, he made an all-embracing
gesture.
"At the ______ Institute I'm it. I'm the big
cheese, I tell you."
No one saw fit to dispute these claims.
He began then a tirade on the subject of his executive ability, his
scientific standing, his knowledge of the stock market, his sexual power,
and his political influence. Having delivered himself of this, he pushed his
audience aside and sauntered back into the sitting room. There he recognized
an old acquaintance, a physician who had formerly been on the resident staff
with him at some hospital but in an inferior capacity.
This man, a newcomer, was talking with the
hostess in the midst of a small group of men and women.
"Why you old son of a bitch!" Dr. ______
shouted. "Come over here and set your goddamned a__ in this chair and
talk to your chief."
It was no time for vacillation. The newcomer and
the young physician who had accompanied Dr. _____ to the party caught each
other's eye and quickly hurried the celebrity to the door. He pulled back at
first but soon came along satisfactorily as both companions sought so
earnestly to cajole him that the words of each were lost to the other.
Turning to his companions just as the door was
gained, he shouted:
"Chippies, did you say?"
On the way to his hotel he began to protest. He
was by no means confused from drink.
"Be goddamned if I go there! What kind of
dirty bastards are you anyway?"
He became insistent - nay, even defiant - about
going where he could obtain women. The new member of the party, who had seen
him through many such episodes and who, to the other escort's relief, kindly
assumed charge of the case, advised that he be humored.
Dr. ____ himself, through an effervescence of obscene threats, muttered
directions to the driver. Expecting to find an ordinary brothel, both of his
companions were surprised to arrive at a large outdoor pavilion where an
orderly dance was going on. Before a definite decision could be reached
about what to do, Dr. _____ was out of the car.
"Luke! Luke!" he yelled imperiously.
A pleasant-looking man appeared.
"You've got to get us a good piece of t___
and get it quick, boy!" he ordered. "We'll wait here and watch 'em dance
by."
The man called Luke, so far as could be learned,
was under serious obligations to Dr. ____ and apparently meant to obey him.
He confided that he had stood by his friend and benefactor in many such
sprees in this town. Luke had pleasant manners and was not drinking.
"God, that's one!" the savant muttered.
"What an ____! Can you get that slut out here, Luke?"
He was far enough away not to be overheard by
the dancers. Luke smiled and shook his head.
"There's one!" the doctor commented again
with enthusiasm.
"She's rutting! That one's rutting! I can
tell it."
His subsequent remarks can hardly be suggested
even in writing on a medical subject.
His two companions left him now in custody of Luke with instructions that he
be brought back to the car when this was possible without violence. Luke had
asked not to be left with sole responsibility.
Some time later the doctor returned. It was difficult to judge whether or
not he had gained all the satisfaction he sought. He made it plain that he
had found a companion but despite his boastful garrulousness did not give
the final details of the encounter. In view of his windy frankness, this
caused doubt as to how far he had succeeded in his aims. Beyond question he
had made considerable progress.
He announced this much loudly, holding up a
finger, sniffing it as he did so, and making a comment of such ingenious
distastefulness that even his brother physicians blenched with revulsion.
The new disciple could not but ruminate about what appraisals of woman and
of human relationships, what attitudes toward basic goals, prevailed beneath
this successful man's ordinarily impressive exterior.
On the road back to his hotel he cursed truculently at other cars. He came
in willingly. While going up on the elevator, he pinched the buttocks of the
girl who ran the machine, apparently oblivious of several passengers. There
was no gaiety or human touch in these actions, only a sullen, derogatory
aggressiveness. He uttered vague challenges and threats emphasizing his
combative prowess and his readiness to fight anyone who might take issue
with him on any question.
On entering his room, he immediately made for a whiskey bottle and began
calling raucously for ice. He became loud and offensive when his companions
sought to excuse themselves, banged the table with his fists, and offered
grandiosely to fight and to fight at once. He was a tall, powerful man and
by no means too drunk to put on a lively and embarrassing scene if crossed.
He cursed the bellboy, who had arrived meanwhile, with such foul oaths it
was incredible that he took them. Pouring himself a quick drink, he called
for careful attention from his companions.
Had he told them about his children? No.
They must see pictures of them. He began to
praise them extravagantly, to extol his love for them it, sickening terms of
pathos, or pseudopathos. He spoke of his plans for their future. His entire
manner began to change, and it was plain that he had determined notions
about keeping all his children what he called pure. A surprisingly
moralistic aspect of this psychiatrist began to appear. Cheap expressions of
sentimentality fairly gushed from him. In a loosely emotional strain he
recited rhymes by Edgar A. Guest about the little ones.
Then he momentarily broke down and blubbered.
Tears ran down his cheeks.
The bellboy had brought ice and Dr. _____ insisted on pouring out drinks,
swaggering about now in his earlier manner. When his companions insisted on
leaving, he promptly announced that he would accompany them. He could not be
persuaded to go to bed and quickly became overbearing when persuasion
continued. Though he had, of course, taken a good deal of whiskey, he seemed
to know perfectly what he was doing.
In fact, he did not really seem drunk in the
ordinary sense of the word. Both of his companions felt that this was not a
person irresponsible for the moment who must be protected and prevented from
doing things he would regret. On the contrary, one was strongly impressed
that this was the man himself.
Going down on the elevator he renewed his practices on the polite girl who
operated it, becoming so annoying to her that his companions had to
interfere. He called a taxi and insisted that all proceed at once to a
brothel. Having had enough experience for one night in trying to be their
brother's keeper, his companions were obdurate.
He drove off, cursing them viciously as
disgraceful specimens of humanity and making derogatory remarks about their
virility.
"What's the matter with him?" asked the
younger.
"Just a queer fellow that way," replied the one who knew him well.
"He's cool and calculating, a good
executive, and a rather pleasant man superficially during the week,
though always a little arrogant. Even when on the job he's not to be
trusted. Every time he gets a chance, he does just about what you've
seen him do tonight. He keeps under wraps of outer dignity at the
hospital and he's careful not to take them off under circumstances which
would cause him to get in serious trouble. He passes as a great
gentleman in polite but unsophisticated circles at home. But the cloak
must be very uncomfortable. Almost every weekend he makes an opportunity
to get it off, and he's always then just the man you saw tonight."
"But won't his reputation suffer from what he did tonight?"
"Probably not. He is a long way from home. Since the town is small, he
evidently assumed that all the people he was thrown with tonight were
country bumpkins who don't count for much and who would be overawed by
him. He judges people only by superficial appearances of wealth and
power, and he is seldom impressed except by gaudy display. He kept up a
good front at the medical meeting. He is exceedingly shrewd, in a
shallow sense, about where and when he behaves naturally. At home he
often goes off into swamps with groups of men far beneath him in his own
estimation and who are apparently flattered to be chosen. The trips are
ostensibly to catch catfish or, in the winter, to shoot ducks; but
actually it's merely to get rowdily drunk, boast and shout inanely, and
sprawl about on the ground or in muddy boats around the camp. He wasn't
drunk tonight. Out in the swamp he often passes through this obscene,
blustering phase in an hour or two and reaches the sodden state that one
might suspect is his goal.
"Sometimes he wants women. It doesn't matter what women or under what
circumstances. Some of the people who know him say that he prefers low,
unprepossessing partners, but it has always seemed to me that there was
no preference at all, and I've seen him often. A beautiful woman means
no more to him than an imbecilic harlot, but on the other hand the
harlot means no more than the beautiful woman.
"Sometimes when the idea of sex is stirring him he gets too drunk to
make much of his opportunities. I'll never forget one incident. It was
about daybreak down in the swamps where we'd been fishing. He'd gone out
on a sexual mission pretty drunk. We found him at a whitewashed shack.
It was time to leave for home so another fellow and I rolled him off a
fat illiterate washerwoman. She must have weighed two hundred pounds!
"'Sakes, Boss,' she muttered, 'he's far gone dis time. Ain't done nuthin'
yet!' It was my last fishing trip with him."
The next morning with fresh sunlight streaming
into the hotel, the youngest member of the group, having finished breakfast,
met Dr. _____ in the lobby. He was emerging from a telephone booth. Tall,
self-assured, clear-eyed, neat as a dandy, and fashionably dressed, he
looked the fine figure of a man.
He spoke affably. With a disarming, boyish smile he made some reference to
the previous evening. His polite expressions and poised tone made clear the
implication that it had been a pleasant occasion and had cemented
friendships. The inconspicuous trace of condescension first noted on meeting
him was now more obvious, but this somehow tended to make his cordiality
seem more precious. He was as sober as a man can be and showed no signs of
hangover. Indeed, as his other companion of the night had said, he must have
been drinking very moderately.
The former admirer of Dr. _____, who was an old friend of the lady whom he
had offered to "psychoanalyze" in a parked car before, stopped at her house
later in the day to say goodbye before leaving the city.
"Come in. I must speak to you," she said.
There was some indignation in her tone but more mischief and merriment.
"What about your friend, the famous psychoanalyst?" she said, relishing,
in all friendliness, the other's discomfiture. She was a person of some
sophistication and poise. Being also pretty, vital, and desirable to
men, she knew well how to take care of herself in ordinary company. She
had been married for several years and gave a strong impression of being
happy and in love with her husband.
"Well," she continued, "I must tell you. You are interested in queer
people."
"Early this morning the cook came and woke me up. 'It's the telephone,'
she said. 'Damn the telephone, Lou!' I told her. 'Don't you know I was
up till all hours last night?' 'Yes'm,' she answered, 'but the gentleman
says you'll speak with him, and it's important business.'
"I picked up the phone, "'Good morning, Mary' said an unfamiliar,
self-assured, masculine voice. I was wondering who it could be - knowing
me well enough to use my first name and still so pompous. Then, just as
I recognized the voice.
"'Mary, this is Doctor _____.' From his tone you'd have judged he
thought I ought to sing for joy!
" 'Yes indeed,' I said. He then baldly suggested that I make a date with
him for this afternoon. He'd come out for me at 4 P.M. or, better still,
he suggested, I could meet him at a drugstore downtown.
"Really, there was something so superior about him, a sort of
indescribably cool insolence, or I don't know what . about his manner, I
mean ..and after last night! . not just the proposition itself . that I
fairly turned white with rage.
"I wanted so much to blast him with scorn that I was at a loss for
words. When you get that mad it's easy to lose your head. The calm and
effective expression of indignation by which ladies in Victorian novels
squelched 'insults' is hard to put into the idiom of today. Trying not
to make myself unnecessarily ridiculous, but trusting the reply would
register as final, I said:
" 'Is that so? Sorry, but I'm afraid I'll have to forego that pleasure.'
"He then insisted, not like a lover or even like one who's making any
decent pretense of being a lover, but coolly, almost arrogantly, like a
fake gentleman who's after a servant girl. I must have succeeded in
making myself a little clearer by this time, for he resigned himself
about this afternoon. But I wasn't done with him.
"He then began to say that he would be back in this city soon, probably
every now and then. He'd like to see me on some of these occasions. He'd
call me when he came. No, perhaps it would be better if he dropped me a
note and let me know when he'd be here. Then I could call him! I was
getting so vexed that I scarcely caught the implication that he didn't
want to telephone and find George here.
"For a moment I couldn't answer. Then I suddenly remembered the way he
announced himself: 'Mary, this is Doctor _____!' The overwhelming
effrontery of the whole farce came over me. It was too much! 'Mary, this
is Doctor _____!' That priceless ass calling me by my first name and
referring to himself as 'Doctor _____!' And under such circumstances!
Why, he probably pictured us having our little bout of 'love' in the
same strain. 'You're so lovely, Mary, do let me take off your pants!'
'Oh, Doctor - (blushing), you're so genteel and handsome!'
"Can you beat it! I ask you as an old friend! The bumptious swine didn't
even have enough delicacy in what he probably thought of as lovemaking
to grant me the intimacy to call him Jack, or Harry, or Percival, or
Happy Hooligan, or whatever else he's named. He's such an indescribable
prig that he probably doesn't even allow himself to think of himself in
terms of a first name.
"I just had time to get out the words which must have come with
something of a lilt:
"'Yes, you just wait until I call you!'
"I'm ashamed to confess they were almost lost in a burst of laughter. It
wasn't ladylike at all the way I laughed. It was belly-shaking laughter.
Homeric laughter. Rabelaisian laughter, maybe. I couldn't stop.
"Lou, the cook, came back in and asked what was the matter. 'I can't
explain,' I told her and went on laughing.
"What sort of people are you psychiatrists anyway?" she now asked in her
spirited, arch way, again enjoying her old friend's discomfiture which
was now almost lost in wonder and amusement. "I bet that bat-house
troubadour went away thinking I had become hysterical with delight at
the opportunity he offered."
"That might not be absurd after all," the friend murmured, remembering
the self-possession and happy assurance with which Dr. _____ had emerged
from the telephone booth that morning.
This case is offered for what it may be worth.
No diagnosis of psychopathic personality has been made.
Occasional news of him over the next few years
indicated that he was still outwardly well adjusted. I believe it likely
that he continues to prosper and I have not the faintest notion that he will
ever reach the wards of a psychiatric hospital except in the capacity of a
physician and executive. He does not really succeed in impressing people of
discernment, though he continues to think he succeeds in this. He impresses
many people who are themselves essentially undiscriminating.
He cannot tell these from others with sounder
judgment and regards himself as a great success socially as well as
financially.
Such a personality shows suggestions of an inner deviation qualitatively
similar to what is found in the fully developed sociopath. The shrewdness is
typical. Unlike others, such as Max, whose cleverness brings only momentary
success in objective dealing with the world, this man's similar cleverness
is applied with enough persistence for him to advance continuously. He
advances financially and, within limits, even professionally. He is a smart
fellow and, in a very superficial sense, has a glib facility in medical
activities. In relations with the public he shows an excellent knack, an
artful sense of showmanship.
For the more fundamental questions that immediately confront a person
interested in psychiatry he apparently has no awareness, and therefore no
concern. The problems of life that make up the chief and underlying interest
for real psychiatrists do not exist for him. He is said to give many of his
patients about what they feel they need. With relatively uncomplex and
emotionally shallow persons his amazing self-confidence is perhaps more
quickly effective than the deeper understanding, with its inevitable lack of
certainties, that another sort of man would bring to his work.
His patients are reported to show improvement that compares favorably with
that shown by most of the patients treated by physicians whose aims are more
serious. We must not forget that pseudoscientific cultists frequently
succeed in relieving psychoneurotic patients of their symptoms by absurd
measures.
These practitioners, if they work in accordance
with the fundamental principles of their craft, have no awareness of the
real problems underlying such symptoms and little or no ability to help
patients understand and deal with these problems. Such a man as this appears
to be similarly limited. If one imagines his attempting pertinent
psychiatric study of a seriously motivated person, of a person whose world
is quite foreign to him, the picture becomes farcical.
This man then, the traits already mentioned notwithstanding, is one who,
unlike the obvious psychopath, succeeds over many years in his outer
adjustment. Granting that the behavior just described is fairly typical and
is persisted in, the conclusion follows that inwardly he is very poorly
adjusted indeed, The quality of happiness he knows and the degree of reality
in which he experiences so much that is major in human relations are such
that, despite his superficial success, he must fail to participate very
richly in life itself.
Let it be pointed out that the drunkenness, immature sex attitudes,
execrable taste, and deceit are not in themselves the basis for suspecting
that this man is affected in some measure with the same disorder that
affects the patients presented previously. Many readers would perhaps
dismiss all this with the thought that our man might be more properly called
a bad fellow and his status left at that. The significant points are these:
His impulse to drink does not seem to be motivated by the hope of shared
gaiety. His attitude in sexual aims is so self-centered as to give the
impression that even when carrying out intercourse with women he is
essentially solitary, isolated in evaluations so immature that what
satisfaction he achieves must be in concepts of a phallic damaging and
despoiling of the female with simultaneous reassurances to puerile concepts
of his own virility.
Such confusing and fragmentary achievement,
common enough in a groping boy of thirteen, is a poor and pathologic
substitute for fulfillment compatible with deep personality integration and
is inadequate for one even remotely as near adult as what is implied by this
man's outer surface.
His lack of taste and judgment in human relationships seems inconsistent
with his opportunity to learn and with his ability to learn in other modes
of knowing where such values and meanings do not enter. His apparent
hypocrisy is probably not a conscious element of behavior. At least he is
unaware of how it would seem to others, even if he assumed all the facts
were known to them.
It has, perhaps, never occurred to him that
there might be people in the world who had other fundamental aims than his
own dominant aim to drop the disguise in which he has acted his part perhaps
not too comfortably during the week, and plunge into what I would call
activity more representative of perverse or disintegrative drives, of aims
at sharp variance with everything his outer self seems to represent.
I am well aware that many basic impulses appear in forms not socially
acceptable, that they might be called immoral, vulgar, or criminal or be
described by other unpleasant words. The person here discussed, when seen
without his mask, seems not to be directed in any consistent and purposive
scheme by these socially unacceptable tendencies but largely to blunder
about at their behest. In his outer front he functions in accordance with
all the proprieties, large and small, but here the reality is thin and
personal participation halfhearted.
He is somewhat like a small boy who succeeds in
maintaining decorum and even in getting a good mark for conduct while in the
schoolroom under teacher's watchful eye. Though he looks attentive, he is
only shrewdly compromising, biding his time to get at what is to him more
important. When the bell rings and he escapes from what he finds to be an
artificial situation, an area of formalities and polite pretenses, he
becomes natural and plays in accordance with what he takes to be the actual
rules and real aims of existence.
The small schoolboy learns eventually to reconcile what the classroom
represented and what he sought in his hours of play. He finds in his work
responsibilities and ways of celebrating much that is compatible, a core at
least, that he can integrate into constructive, self-fulfilling, and, on the
whole, harmonious expression of basic impulses.
In such a man as the one we are considering, little harmony of this sort
appears. Unlike those presented as clinical psychopaths, he has learned to
carry out the formalities rather consistently and appears as actually living
in a constructive and socially adapted pattern. Actually this is a surface
activity, a sort of ritual in which not much of himself enters, For his more
natural and inwardly accepted impulses he has found little reconcilable with
what he gives lip service to. So he must turn to patterns of behavior so
immature and (subjectively) chaotic that they mock and deny all that his
surface affirms.
The outer layers of socially acceptable functioning extend little deeper
into affect than any other exercise empty of all but formality. He has
apparently learned to carry out a lip service in matters that he finds
unreal and tedious and to take pride in how well this is performed. As an
alternative to the barren channels of formality, the inner man finds for the
more valid fulfillment of real impulse only pathways or outlets that sharply
deviate from the surface channels, that cannot in any way be integrated with
them, and that in themselves remain relatively archaic, poorly organized,
undirected toward any mature goal, and socially regressive or self
destructive.
It is confusing to interpret such a personality in terms of bad and good.
From a psychiatric viewpoint, at least, such aspects of a maladjusted human
being cannot be assessed authoritatively.
Years after the incidents recorded in this report, some news of the good
doctor was received which I believe would stand as "Paradox in Paradise." It
was brought to the young psychiatrist who had accompanied Dr. _____ during
the spree just cited by an earnest, middle-aged lady with a strong penchant
for talking about psychology and psychiatry and psychoanalysis, about
anything containing the prefix psyche for that matter.
Striking at once for her hearer's closest
interests, she began to talk about a wonderful lecture she had recently
heard in a distant town at some woman's club or literary society which was
fostering the cause of mental hygiene.
The lecturer was marvelous, she insisted. He stirred up such enthusiasm that
half the ladies present had begun to study psychology. And his subject! He
talked about the queerest people!
They were not exactly insane, but they really
did the most fantastic things! They were even harder to understand than
lunatics themselves! But the lecturer understood them, though he confessed
in all modesty that some points about them were a puzzle even to one of his
own experience. He was a most impressive person - so poised and
authoritative, yet always quiet-spoken.
He was such an intellectual person. A man of
wide and profound culture.
And such a gentleman!
"I declare, I believe half of the women in
our club wished they could exchange roles with his wife! With all that
grasp of psychology, just imagine what a husband he must be!"
She would like to learn more about these people
- psychopathic personalities or psychopaths the doctor had called them. And
the doctor's name. She uttered it in hushed tones of admiration.
