Hervey M. Cleckley

Hervey Milton Cleckley
Born	(1903-09-07)September 7, 1903 Augusta,Georgia,U.S.
Died	January 28, 1984(1984-01-28)(aged 80)
Education	University of Georgia(BS,MD) University of Oxford(BA)
Occupation	Psychiatrist
Known for	Pioneer in the field ofpsychopathy
Notable work	The Mask of Sanity

Hervey Milton Cleckley(September 7, 1903 – January 28, 1984) was an Americanpsychiatristand pioneer in the field ofpsychopathy.His book,The Mask of Sanity,originally published in 1941 and revised in new editions until the 1980s, provided the first clinical description of psychopathy. He defined the term somewhat more broadly than it is understood today, as referring to somebody who behaves in a destructive manner despite lacking overt signs of psychosis or neurosis; this is reflected in the term "mask of sanity", derived from Cleckley's belief that a psychopath can appear normal and even engaging, but that the "mask" conceals amental disorder. By the time of his death, Cleckley was better remembered for a vivid case study of a female patient, published as a book in 1956 and turned into a movie,The Three Faces of Eve,in 1957. His report of the case (re)popularized the diagnosis ofmultiple personality disorderin America.The concept of psychopathy continues to be influential through forming parts of the diagnosis ofantisocial personality disorder,thePsychopathy Checklist,and public perception.

FilmmakerErrol Morris,who tried unsuccessfully to interview Cleckley, said in 2012/13: "He's one of the unsung 20th-century figures. He created two of the enduring myths – I would call them – of the 20th century...These ideas don't originate with Cleckley, but Cleckley popularized them, he built them up, he sold them – almost as a brand."

Life and career

Cleckley was born inAugusta, Georgia,in the Southeastern United States.His parents were William and Cora Cleckley. His younger sister, Connor Cleckley, was schooled for some time in England (e.g.Headington School, Oxford) and later married and widowed byAquilla J. Dyess,the only person ever to be granted America's highest awards for both civilian and militaryheroism(theCarnegie medaland, posthumously afterWorld War II,theMedal of Honor).

Cleckley graduated from theAcademy of Richmond Countyhigh school in 1921, then graduated in 1924summa cum laudewith aBachelor of Sciencedegree from theUniversity of Georgia(UGA) inAthens,where he was a member of the varsityfootballand track and field teams.Cleckley won aRhodes Scholarshipto study atOxford University,England, graduating in 1926 with aBachelor of Arts.

Cleckley then earned hisM.D.from the University of Georgia Medical School (now known as theMedical College of Georgia) in Augusta in 1929. After several years of psychiatric practice in theVeterans Administration,he became professor of psychiatry and neurology at the Medical College of Georgia and, in 1937, the chief of psychiatry and neurology at University Hospital in Augusta. In 1955, Cleckley was appointed clinical professor of psychiatry and neurology at the medical college and became founding chairman of the Department of Psychiatry and Health Behavior. He served as a psychiatric consultant to the Veterans Administration Hospital in Augusta and the US Army Hospital atCamp Gordon.He was a member of the forensic committee of theGroup for the Advancement of Psychiatryand a fellow of theAmerican Board of Psychiatry and Neurologyand the Society forBiological Psychiatry.He also worked in the private practice of psychiatry along with Corbett Thigpen and later also Benjamin Moss, Jere Chambers, and Seaborn McGarity.His first wife was Louise Martin; after her death, he married Emily Sheftall.

Psychopathy

In 1941, Cleckley authored his magnum opusThe Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality.This became a landmark in psychiatriccase studiesand was repeatedly reprinted in subsequent editions. Cleckley revised and expanded the work with each edition published; the second American edition published in 1950 he described as effectively a new book (Cleckley 1988, p.vii).

The Mask of Sanityis distinguished by its central thesis, that thepsychopathexhibits normal function according to standard psychiatric criteria, yet privately engages in destructive behavior. The book was intended to assist with the detection and diagnosis of the elusivepsychopathfor purposes ofpalliationand offered no cure for the condition itself. The idea of a master deceiver secretly possessed of no moral or ethical restraints, yet behaving in public with excellent function, electrified American society and led to heightened interest in both psychological introspection and the detection of hidden psychopaths in society at large, leading to a refinement of the word itself into what was perceived to be a less stigmatizing term, "sociopath".

Military application

In the same year as he publishedThe Mask of SanityduringWorld War II,Cleckley wrote an address warning: "In our present efforts to prepare for national defense no problem which confronts the examining boards for selective service is more pressing or more subtle than that of the so-called psychopathic personality". He argued such soldiers were likely to fail, be disorganized, and be a drain on time and resources. He recommended routinely checking for past encounters withlaw enforcementor drinking alcohol until incapacitated.InThe Mask of Sanity,under a subsection entitled "Not as single spies but in battalions", and further detailed in the appendix, Cleckley describes a survey he and others conducted between 1937 and 1939 at a largefederalVeterans Administration (VA) hospital on the southeastern seaboard, where he worked as one of the psychiatrists for the ex-servicemen who were mainly veterans of World War I. Cleckley critiques the "benign policy" of the VA of not diagnosing more psychopathic personalities due to giving the benefit of the doubt to issues such asneurasthenia,hysteria,psychasthenia,posttraumatic neuroses,orcerebral traumafrom skull injuries andconcussions.He concludes that psychopathic personalities have "records of the utmost folly and misery and idleness over many years" and if considering also the number in every community who are protected by relatives, "theprevalenceof this disorder is seen to be appalling. "

Semantic theory

Cleckley consistently described the hypothesized central deficit in psychopathy as "semantic" (the 'meaning' of things), early on referring to it as a "semanticdementia"or" dysergasia "(a term ofAdolf Meyer's, implying a physiological basis) and later "disorder". He explained that this did not refer to the meaning of life in an abstract sense but to the emotional substrate from which the purposes and loyalties of everyday life are formed and experienced. In using the termsemanticin this broad psychosocial sense, he referred toAlfred Korzybski's theory ofgeneral semantics.However Cleckley also separately employed ananalogyto alanguage disordercalled "semanticaphasia"in explaining the distinction between the appearance of correct functioning on the surface despite an underlying deficit in meaning. This has repeatedly led to the belief that he had suggested the core abnormality is in the use of language, which he has said is a misinterpretation. Today the termsemantic dementiarefers to a specific neurodegenerative disorder involving loss ofsemantic memory,whilesemantic disordercommonly refers tosemantic pragmatic disorderassociated withautism.

Contributors

Cleckley states inThe Mask Of Sanitythat "Dr. Corbett H. Thigpen,my medical associate of many years, has played a major part in the development and the revision of this work ". He also credits his and Thigpen's wives, both called" Louise ", as well as the" constant encouragement, generous help, and the major inspiration that have come from Dr. Sydenstricker to the Department of Neuropsychiatry. "Cleckley also mentions taking inspiration for the structure of his book from a work calledThe Psychology of InsanitybyBernard Hart,an English physician who also published a case study of a multiple personality.

Based on Cleckley's work, but with fundamental changes, from the 1970s the psychologistRobert D. Haredevised an influential "psychopathy checklist"to assess psychopathy primarily in the criminal justice system.

Vitamins

Virgil P. Sydenstricker was a professor of medicine and an internationally recognized specialist inhematologyandnutrition.Articles published with Cleckley were among the first to describe an atypical form ofpellagra(now known as "niacin deficiency" ) which was then endemic in southern states.In 1939 and 1941 they published on the use of nicotinic acid (niacinor vitamin B₃) as a treatment for abnormal mental states and psychiatric disorders.The studies have been erroneously used to justify the use ofmegavitamin therapyin psychiatric disorders such asschizophrenia.

Coma shock therapy

Cleckley practiced the controversial "coma therapy",where psychiatric patients would be repeatedly put intocomasover several weeks through overdoses ofinsulin,metrazolor other drugs. In the wake of sometimes fatal complications, Cleckley published in 1939 and 1941 advising on theoretical grounds theprophylacticadministration of various vitamins,saltsandhormones.In 1951, he also co-published case study research suggesting the use of electronarcosis for various conditions, a form ofdeep sleep therapyinitiated by passing an electric current through the brain, without causing seizures as inelectroconvulsive therapywhich he also used.

Criminal responsibility

In 1952 Cleckley, along with Walter Bromberg a senior psychiatrist andpsychoanalyst[1],published an article on theinsanity defense.They suggested changing the wording of it to: "In your opinion, was the defendant suffering from disease of the mind and if so, was it sufficient to render him unaccountable under the law for the crime charged?" The concept of 'accountability' was intended as an alternative to a narrow definition of 'responsibility' under theM'Naghten ruleswhich requires an absence of moral knowledge of right and wrong, in effect only coveringpsychosis(delusions,hallucinations). They argued that mental illness can involve any part of the mind and that the insanity test should focus on the extent to which the accused's mind overall, due to some inner pathology 'whether obvious or masked', was unable to operate in accord with the law.However, 10 years later, a chapter by Cleckley on "Psychiatry: Science, Art, and Scientism" cautioned others against a common exaggeration of the abilities of psychiatry to diagnose or treat, including in regard to criminal responsibility.In that regard Cleckley expressed his agreement with a critique by Hakeem, yet Hakeem had quoted Cleckley's claims about psychopathy as an example of psychiatrists exaggerating how clear their diagnostic terms are to each other.

Cleckley was a psychiatrist for the prosecution in the 1979 trial of serial killerTed Bundy,the first to be televised nationally in the United States. After interviewing Bundy and reviewing two prior reports, he diagnosed him as a psychopath. At thecompetency hearinga defense psychiatrist also argued that Bundy was a psychopath, however, he concluded that Bundy was not competent to stand trial or represent himself, while Cleckley argued that he was competent.

Multiple personality

In 1956, Cleckley co-authored a bookThe Three Faces of EvewithCorbett H. Thigpen,his partner in private practice and colleague at the Department of Psychiatry at Georgia University. It was based on their patientChris Costner Sizemorewho Thigpen especially had treated over several years. They published a research article on the case in 1954, documenting the sessions and how they came to view it as a case of 'multiple personalities', referencingMorton Prince's earlier controversial case study ofChristine Beauchamp (pseudonym).They also discussed what is meant by 'personality' and identity, noting how it can change even in everyday senses (becoming 'a new person' or 'not himself' etc.).Such a diagnosis had fallen into relative disuse in psychiatry but Thigpen and Cleckley felt they had identified a rare case, though others have questioned the use ofhypnosisand suggestion in creating some if not all of the characterization, and the diagnosis of multiple personality disorder (nowdissociative identity disorder) remains controversial despite, or because of, upsurges in diagnoses in America.

The book also served as the basis for a blockbuster 1957 filmThe Three Faces of EvestarringJoanne Woodward,in whichLee J. Cobbplayed the initial treating psychiatrist and Edwin Jerome the consultant. Both Thigpen and Cleckley received writing credits and reportedly over a million dollars. In the book and film 'Eve' is cured of her alternate personalities, but Sizemore states that she was not free of them until many years later. She also alleges that she was not aware the session reports would be published outside of medical circles, or that she was signing over rights to her life story forever (for $3 for the book rights toMcGraw-Hillwhich sold 2 million copies and $5000 for the visual rights(relatives received $2000)). She fought unsuccessfully to stop the publication of videos of her treatment sessions, but in 1989 successfully sued the film studio20th Century Foxwhen it wanted to make aparodyremake of its film and tried to use a 1956 contract she had signed, without legal representation via Thigpen, to preventSissy SpacekoptioningSizemore's own published book on her life.When Sizemore returned to Augusta for a speaking tour in 1982, neither Thigpen nor Cleckley attended and she did not visit them, though in 2008 she described the diagnosis and treatment of her as courageous.In 1984 Thigpen and Cleckley published a brief communication in an international hypnosis journal cautioning against over-use of the diagnosis of multiple personality disorder.

Pathological sexuality

Cleckley also authored the 1957 bookThe Caricature of Love: A Discussion of Social, Psychiatric, and Literary Manifestations of Pathologic Sexuality.Shortly after it was described by one medical reviewer as "a diatribe againsthomosexualinfluences in our culture and the Freudian doctrines that he believes support these influences. "

See also

• Psychopathy
• Sociopath
• The Mask of Sanity

Further reading

• UGA Rhodes Scholars:1903-1999
• Hervey Cleckley and Corbett Thigpen,Augusta Chronicle, Web posted January 1, 2000
• Summary of the Cleckley-Thigpen Psychiatric Associates Papers at the University of Georgia Hargrett Manuscript CollectionArchived2006-09-11 at theWayback Machine(seems to be missing from there now,citation at WorldCat.Version as it was in 2006at theWayback Machine(archived September 11, 2006))
• Thigpen & Cleckley (1954): A case of multiple personality
• The Mask of Sanity: An Attempt to Reinterpret the So-Called Psychopathic Personality.(St. Louis, MO: C.V. Mosby, 1941). First Edition.
• The Mask of Sanity: An Attempt to Reinterpret the So-Called Psychopathic Personality.(St. Louis, MO: C.V. Mosby, 1988). Fifth Edition.
• "Book Review: Multiple Personality".JAMA.283:2585. 2000.doi:10.1001/jama.283.19.2585.
• "All About Eve",Time,February 18, 1957.
• Without Conscience: The Disturbing World of Psychopaths Among Us(Robert D. Hare,New York: Pocket Books, 1993)