ion well outside the self? 55. Specific loss of insight In a special sense the psychopath lacks insight to a degree seldom, if ever, found in any but the most seriously disturbed psychotic patients. In a superficial sense, in that he can say he is in a psychiatric hospital because of his unacceptable and strange conduct, and by all other such criteria, his insight is intact. His insight is of course not affected at all with the type of impairment seen in the schizophrenic patient, who may not recognize the fact that others regard him as mentally ill but may insist that he is the Grand Lama and now in Tibet. Yet in a very important sense, in the sense of realistic evaluation, the psychopath lacks insight more consistently than some schizophrenic patients. He has absolutely no capacity to see himself as others see him. It is perhaps more accurate to say that he has no ability to know how others feel when they see him or to experience subjectively anything comparable about the situation. All of the values, all of the major affect concerning his status, are unappreciated by him. This is almost astonishing in view of the psychopath's perfect orientation, his ability and willingness to reason or to go through the forms of reasoning, and his perfect freedom from delusions and other signs of an ordinary psychosis. Usually, instead of facing facts that would ordinarily lead to insight, he projects, blaming his troubles on others with the flimsiest of pretext but with elaborate and subtle rationalization. Occasionally, however, he will perfunctorily admit himself to blame for everything and analyze his case from what seems to be almost a psychiatric viewpoint, but we can see that his conclusions have little actual significance for him. Some of these patients mentioned spoke fluently of the psychopathic personality, quoted the literature, and suggested this diagnosis for themselves. Soon this apparent CATALOGING THE MATERIAL 351 insight was seen to be not merely imperfect but a consistent and thorough artifact. Perhaps it was less a voluntary deception than a simulation in which the simulator himself fails to realize his lack of emotional grasp or that he is simulating or what he is simulating. The patient seems to have little or no ability to feel the significance of his situation, to experience the real emotions of regret or shame or determination to improve, or to realize that this is lacking. His clever statements have been hardly more than verbal reflexes; even his facial expressions are without the underlying content they imply. This is not insight but an excellent mimicry of insight. No sincere intention can spring from his conclusions because no affective conviction is there to move him. Such a deficiency of insight is harder to comprehend than the schizophrenic's deficiency, for it exists in the full presence of what are often assumed to be the qualities by which insight is gained. Yet the psychopath shows not only a deficiency but apparently a total absence of self-appraisal as a real and moving experience. Here is the spectacle of a person who uses all the words that would be used by someone who understands, and who could define all the words but who still is blind to the meaning. Such a clinical picture is more baffling to me than any of the symptoms of schizophrenia, on which attempts have been made to throw some light by psychopathologic theories. Here we have a patient who fulfills all the ordinary theoretical criteria of a \"sound mind,\" and yet with this apparently sound mind is more incomprehensible than the psychotic patient. What I regard as the psychopath's lack of insight shows up frequently and very impressively in his apparent assumption that the legal penalties for a crime he has committed do not, or should not, apply to him. This astonishing defect in realization often seems genuine, as the patient protests in surprise against the idea that prison might be anticipated for him, as for others under similar circumstances. He frequently reacts to such an idea as if to something unexpected and totally inappropriate. This characteristic has already been mentioned in Chapter 18, Gregory. Some observers believe that what the psychopath expresses about himself and his situation constitutes insight and merits such a term. I cannot agree with this opinion. The chief and most valid connotations of the word disappear in such an application. Profoundly psychotic patients whose gross lack of insight would be admitted by all sometimes express opinions which, if fully meant and appreciated, would indicate an insight that is plainly not there. A few brief examples may help: A young man with a very active manic psychosis was interviewed some years ago. He whistled, shouted, winked, expressed the belief that he controlled the movements of the sun by his glance, sang snatches of bawdy 352 THE MASK OF SANITY songs, announced himself as a \"sort of Messiah,\" and laid claim to the sexual vigor of seven bulls. Leaping about in a hospital shirt he had torn almost to shreds, he found exposed wires at a place on the wall from which he had torn the electric fixtures. Seizing and releasing them and seizing them again, he got good jolts of the city current, which he relished, apparently interpreting the sensation as a manifestation of his own vitality. When asked if he felt anything was wrong with him mentally, he shouted in glee, \"Sure, Doc, I'm crazy as a coot! I'm nuts I tell you. Crazier than anybody you ever saw!\" Another patient on a closed ward, a man badly disabled for years by obvious schizophrenia, often shouted out to the passerby, \"Simple case of dementia praecox, Doc, simple case of dementia praecox,\" pointing to himself several times. Despite the chance diagnostic accuracy of what he said, this patient, like the one just mentioned, had little grasp of his situation and almost no real appreciation of his disorder and its meaning. Another manic patient not only spoke words that correctly indicated a good deal about his situation but even hammered out with a metal object he had obtained these letters in deep gashes in the wood door: \"Bug house nutty.\" Indications of serious impairment of insight abound in the psychopath's reactions after his failures have been undeniably demonstrated or his antisocial acts detected. The persistent tendency to ask for recommendations from those they have every reason to know cannot furnish anything but a negative report fatal to their plans has been illustrated. Such decisions in highly intelligent people can hardly mean less than that something crucial is absent from the realization of their status. The calm assurance with which they report a successful rehabilitation in the midst of egregious and immediate maladjustment often does not seem so much a real effort to deceive as an indication that the patient himself is greatly deceived. Despite his awareness of major facts, the pivotal significance of these facts seems not to be in his evaluations. After a peculiarly overt and spectacular succession of failures, thefts, truancies, falsehoods, and expulsion from school, a young man had to be sent home to a distant state by his aunt and uncle with whom he had been staying. They had taken him in the hope that he might do better in another environment. His parents, after years of struggle, had found no solution. All the details of his recent failure and disaster were factually known to him and had been discussed with his aunt and uncle. They made no effort to deceive him about why he had to be sent home. The physician to whom he wrote the letter which follows had also been frank with him. The letter was mailed a couple of days after he returned in what to another person could not have seemed less than total failure and disgrace. CATALOGING THE MATERIAL 353

The Mask of Sanity

Presenting case studies of schizophrenic patients, Laing aims to make madness and the process of going mad comprehensible. He also offers an existential analysis of personal alienation.

The Divided Self, An Existential Study in Sanity and Madness

ion well outside the self? 55. Specific loss of insight In a special sense the psychopath lacks insight to a degree seldom, if ever, found in any but the most seriously disturbed psychotic patients. In a superficial sense, in that he can say he is in a psychiatric hospital because of his unacceptable and strange conduct, and by all other such criteria, his insight is intact. His insight is of course not affected at all with the type of impairment seen in the schizophrenic patient, who may not recognize the fact that others regard him as mentally ill but may insist that he is the Grand Lama and now in Tibet. Yet in a very important sense, in the sense of realistic evaluation, the psychopath lacks insight more consistently than some schizophrenic patients. He has absolutely no capacity to see himself as others see him. It is perhaps more accurate to say that he has no ability to know how others feel when they see him or to experience subjectively anything comparable about the situation. All of the values, all of the major affect concerning his status, are unappreciated by him. This is almost astonishing in view of the psychopath's perfect orientation, his ability and willingness to reason or to go through the forms of reasoning, and his perfect freedom from delusions and other signs of an ordinary psychosis. Usually, instead of facing facts that would ordinarily lead to insight, he projects, blaming his troubles on others with the flimsiest of pretext but with elaborate and subtle rationalization. Occasionally, however, he will perfunctorily admit himself to blame for everything and analyze his case from what seems to be almost a psychiatric viewpoint, but we can see that his conclusions have little actual significance for him. Some of these patients mentioned spoke fluently of the psychopathic personality, quoted the literature, and suggested this diagnosis for themselves. Soon this apparent CATALOGING THE MATERIAL 351 insight was seen to be not merely imperfect but a consistent and thorough artifact. Perhaps it was less a voluntary deception than a simulation in which the simulator himself fails to realize his lack of emotional grasp or that he is simulating or what he is simulating. The patient seems to have little or no ability to feel the significance of his situation, to experience the real emotions of regret or shame or determination to improve, or to realize that this is lacking. His clever statements have been hardly more than verbal reflexes; even his facial expressions are without the underlying content they imply. This is not insight but an excellent mimicry of insight. No sincere intention can spring from his conclusions because no affective conviction is there to move him. Such a deficiency of insight is harder to comprehend than the schizophrenic's deficiency, for it exists in the full presence of what are often assumed to be the qualities by which insight is gained. Yet the psychopath shows not only a deficiency but apparently a total absence of self-appraisal as a real and moving experience. Here is the spectacle of a person who uses all the words that would be used by someone who understands, and who could define all the words but who still is blind to the meaning. Such a clinical picture is more baffling to me than any of the symptoms of schizophrenia, on which attempts have been made to throw some light by psychopathologic theories. Here we have a patient who fulfills all the ordinary theoretical criteria of a "sound mind," and yet with this apparently sound mind is more incomprehensible than the psychotic patient. What I regard as the psychopath's lack of insight shows up frequently and very impressively in his apparent assumption that the legal penalties for a crime he has committed do not, or should not, apply to him. This astonishing defect in realization often seems genuine, as the patient protests in surprise against the idea that prison might be anticipated for him, as for others under similar circumstances. He frequently reacts to such an idea as if to something unexpected and totally inappropriate. This characteristic has already been mentioned in Chapter 18, Gregory. Some observers believe that what the psychopath expresses about himself and his situation constitutes insight and merits such a term. I cannot agree with this opinion. The chief and most valid connotations of the word disappear in such an application. Profoundly psychotic patients whose gross lack of insight would be admitted by all sometimes express opinions which, if fully meant and appreciated, would indicate an insight that is plainly not there. A few brief examples may help: A young man with a very active manic psychosis was interviewed some years ago. He whistled, shouted, winked, expressed the belief that he controlled the movements of the sun by his glance, sang snatches of bawdy 352 THE MASK OF SANITY songs, announced himself as a "sort of Messiah," and laid claim to the sexual vigor of seven bulls. Leaping about in a hospital shirt he had torn almost to shreds, he found exposed wires at a place on the wall from which he had torn the electric fixtures. Seizing and releasing them and seizing them again, he got good jolts of the city current, which he relished, apparently interpreting the sensation as a manifestation of his own vitality. When asked if he felt anything was wrong with him mentally, he shouted in glee, "Sure, Doc, I'm crazy as a coot! I'm nuts I tell you. Crazier than anybody you ever saw!" Another patient on a closed ward, a man badly disabled for years by obvious schizophrenia, often shouted out to the passerby, "Simple case of dementia praecox, Doc, simple case of dementia praecox," pointing to himself several times. Despite the chance diagnostic accuracy of what he said, this patient, like the one just mentioned, had little grasp of his situation and almost no real appreciation of his disorder and its meaning. Another manic patient not only spoke words that correctly indicated a good deal about his situation but even hammered out with a metal object he had obtained these letters in deep gashes in the wood door: "Bug house nutty." Indications of serious impairment of insight abound in the psychopath's reactions after his failures have been undeniably demonstrated or his antisocial acts detected. The persistent tendency to ask for recommendations from those they have every reason to know cannot furnish anything but a negative report fatal to their plans has been illustrated. Such decisions in highly intelligent people can hardly mean less than that something crucial is absent from the realization of their status. The calm assurance with which they report a successful rehabilitation in the midst of egregious and immediate maladjustment often does not seem so much a real effort to deceive as an indication that the patient himself is greatly deceived. Despite his awareness of major facts, the pivotal significance of these facts seems not to be in his evaluations. After a peculiarly overt and spectacular succession of failures, thefts, truancies, falsehoods, and expulsion from school, a young man had to be sent home to a distant state by his aunt and uncle with whom he had been staying. They had taken him in the hope that he might do better in another environment. His parents, after years of struggle, had found no solution. All the details of his recent failure and disaster were factually known to him and had been discussed with his aunt and uncle. They made no effort to deceive him about why he had to be sent home. The physician to whom he wrote the letter which follows had also been frank with him. The letter was mailed a couple of days after he returned in what to another person could not have seemed less than total failure and disgrace. CATALOGING THE MATERIAL 353

http://zpatbp.com/images/docs/TheMaskofSanityHerveyCleckley.pdf

The Mask of Sanity: An Attempt to Clarify Some Issues about the So-called Psychopathic Personality

This article endeavors to replace the sociology of professions with the more comprehensive and timely sociology of expertise. It suggests that we need to distinguish between experts and expertise as requiring two distinct modes of analysis that are not reducible to one another. It analyzes expertise as a network linking together agents, devices, concepts, and institutional and spatial arrangements. It also suggests rethinking how abstraction and power were analyzed in the sociology of professions. The utility of this approach is demonstrated by using it to explain the recent precipitous rise in autism diagnoses. This article shows that autism remained a rare disorder until the deinstitutionalization of mental retardation created a new institutional matrix within which a new set of actors—the parents of children with autism in alliance with psychologists and therapists—were able to forge an alternative network of expertise.

/pdf/for-a-sociology-of-expertise-the-social-origins-of-the-4c3hbiixdj.pdf

For a Sociology of Expertise: The Social Origins of the Autism Epidemic

Engineering and construction projects are dependent on two fundamental elements: (1) the ability to plan and manage the technical components of the project such as the tasks and resources; and (2) the ability of the project participants to effectively develop into a high performance team. Historically, the industry has focused extensively on optimizing the project management processes associated with the former element. In this focus, organizations have emphasized the ability to develop the optimum plan, allocate resources efficiently, and utilize control functions to ensure that the project stays on schedule and within budget. Although this has been effective, this engineering focus has reached the point of diminishing results. Specifically, the engineering approach to project management has neglected to recognize the importance of the participants to the success of the overall project. Rather, the engineering approach has favored the development of an optimum plan as the path to effective project management. In this paper, the engineering-based approach to project success is reconfigured to reemphasize the need to develop high performing teams by recognizing the importance of the project network. This recognition is formalized in the social network model of construction that integrates classic project management concepts with social science variables to enhance the focus on knowledge sharing as the foundation for achieving high performance teams and project results.

/pdf/social-network-model-of-construction-v35753ozi1.pdf

Social Network Model of Construction

The Sociometry Reader

Fads and Fallacies in the Name of Science

Meaning and Content of Sexual Perversions

Among the cognoscenti, a proper goof ball is a green heart and a red bullet. The green heart is a triangular tablet containing dextro-amphetamine and amobarbital. The red bullet is a capsule of secobarbital. This is the story of an intelligent, verbal, 37-year-old woman addicted to goof balls. Neither her first nor her last name begins with 0, so I will call her that. You might think-at least I thought-that if you mix a sedative and stimulant, you will get a mildly stimulating or a mildly depressing effect depending on which drug is dominant. If they are pharmacologically balanced, you ought to get no effect. They should neutralize each other. So I thought. I was wrong. And so is much of the current literature which generally gives only a cursory look at this curious addiction. Some use the phrase “goof ball” to identify only the barbiturate. Most texts simplify it this way. If a patient takes barbiturates to sleep, then he’ll soon depend on them. He will develop anxiety and keep clamoring for barbiturates. If he takes amphetamine for that tired feeling, he’ll soon need it to stay awake. If he takes it to overcome the effects of barbiturates, he will be clamped on the circumference of a vicious cyclehe must have barbiturates to sleep; he must have amphetamine to prevent excessive sleepiness resulting from the barbiturates; then the amphetamine makes him tense so he needs barbiturates and so on. Nyswander( 1) wrote in 1959 that “addiction to Benzedrine and Dexedrine seems to have considerably lessened in the past 5 years.” The standard Noyes-Kolb text (2), on the other hand, says that in the last few years there has been a great increase in barbiturate addiction. The popular writer, R. S. de Ropp(3), tells us that: “Barbiturates are obtained in the black market under such names as red birds or yellow jackets, known collectively as goof balls. Those who become addicted to barbiturates are worse off than the mor-

Henry A. Davidson

Papers

The Sociometry Reader

Fads and Fallacies in the Name of Science

Meaning and Content of Sexual Perversions

Confessions of a goof ball addict.

Who Are the Guilty