(Parte 3 de 7)

Riverrun, past Eve and Adarn's, from swerve of shore to bend of bay, brings us by a commodius vicus of recirculation back to Howth Castle and Environs.

Sir Tristram, violer d'amores, fr'over the short sea, had passencore rearrived from

North Armorica on this side the scraggy isthmus of Europe Minor to wielderfight his penisolate war: nor had topsawyer's rocks by the stream Oconee exaggerated themselse to Laurens County's gorgios while they went doublin their mumper all the time: nor avoice from afire bellowsed mishe mishe to tauftauf thuartpeatrick: not yet, though venissoon after, had a kidscad buttened a bland old isaac: not yet, though all's fair in vanessy, were sosie sesthers wroth with twone nathandjoe. Rot a peck of pa's malt had Jhem or Shen brewed by arclight and rory end to the regginbrow was to be seen ringsome on the aquaface.

The fall bababadalgharaghtakamminarronnkonnbronntonnerronntuonnthunntrovarrhoun awnskawntoohoohoordenenthurnukl) of a once wallstrait oldparr is retaled early in bed and later on life down through all christian minstrelsy. The great fall of the offwall entailed at such short notice the pftjschute of Finnegan, erse solid man, that the humptyhillhead of humself prumptly sends an unquiring one well to the west in quest of his tumptytumtoes: and their upturnpikepointandplace is at the knock out in the park where oranges have been laid to rust upon the green since devlinsfirst loved livvy.

The adventurous reader will, I promise, find any of the other 627 pages equally illuminating. It is not for me to say dogmatically that Finnegan's Wake is a volume devoid of meaning. Nor could I with certainty make such a pronouncement about the chaotic verbal productions of the patient on the back ward of an old time state hospital.

Ezra Pound's continued eminence as a poet and the almost worshipful admiration with which some scholars acclaim Finnegan's Wake are likely to evoke wonder from the man of ordinary tastes and reactions if he gives these matters serious consideration.

Graduates of our universities and successful businessmen join others to contribute testimonials announcing the prevention of hydrophobia and the healing of cancer, diphtheria, tuberculosis, wens, and broken legs, as well

8 THE MASK OF SANITY as the renting of rooms and the raising of salaries, by groups who reportedly work through "the formless, omnipresent God-substance" and by other metaphysical methods. One group publishes several magazines which are eagerly read in almost every town in the United States. Nearly two hundred centers are listed where "prosperity bank drills" and respiratory rituals are advocated. Leaders solemnly write, "the physical body radiates an energy that can at times be seen as a light or aura surrounding the physical, especially about the heads of those who think much about Spirit."81

The following are typical testimonial letters, and these are but three among many hundreds:286

I wrote to you somewhat over a week ago asking for your prayers. My trouble was appendicitis, and it ssemed that an operation was unavoidable. However, I had faith in the indwelling, healing Christ and decided to get in touch with you. Well, as you might expect, the healing that has taken place borders on the so-called miraculous. I spent an hour each day alone with God, and I claimed my rightful inheritance as a child of God. Naturally the adverse condition had to disappear with the advent of the powerful flow of Christ-Life consciously directed towards this illness.

salary but[etc.]. I should probably not have had sufficient faith and courage to trust

You will be interested to know that just about the time when my prosperity-bank period was up I went to work in a new position, which not only pays a substantially higher Him had it not been for the Truth literature.

Thank you for your beautiful and effective ministry. I have had five big demonstrations of prosperity since I had this particular prosperity bank. Last week brought final settlement of a debt owed me for about seven years.

Not a few citizens of our country read, apparently with conviction, material such as that published by the director of the Institute of Mental Physics, who is announced as the reincarnation of a Tibetan Lama. This leader reports, furthermore, that he has witnessed an eastern sage grow an orange tree from his palm and, on another occasion, die and rise in a new body, leaving the old one behind. Many other equally improbable feats of thaumaturgy are described in eye-witness accounts.70

The casual observer has been known to dismiss what many call superstition as the fruit of ignorance. Nevertheless, beliefs and practices of this sort are far from rare among the most learned in all generations. A fairly recent ambassador to the United States, generally recognized as a distinguished

AN OUTLINE OF THE PROBLEM 9 scholar, died (according to the press) under the care of a practitioner of Christian Science.

Even a doctor of medicine has written a book in which he attests to the cure of acute inflammatory diseases and other disorders by similar methods. But let him speak directly:264

At the time of my examination she was showing definite signs of another attack

At another time I examined a girl upon whom I had operated for recurrent mastoiditis. Absent treatments stopped her trouble in two days. To one who had never seen anything of the kind before, the rapidity with which the inflammation disappeared would have seemed almost a piece of magic.

A third case is that of a woman who carried a bad heart for years. About a year ago she experienced an acute attack accompanied by pain, nausea, and bloating caused by gas. Her daughter telephoned to a practitioner of spiritual healing and explained the trouble to her. The reply was that an immediate treatment would be given. In ten minutes the trouble was gone, and there has been no serious recurrence since.

The more one considers such convictions and the sort of people who hold them, the more impressive becomes the old saying attributed 301 to Artemus Ward and indicating that our troubles arise not so much from ignorance as from knowing so much that is not so. Hundreds of other examples like those mentioned are available to demonstrate that many persons of high ability and superior education sincerely cherish beliefs which seem to have little more real support from fact or reason than the ordinary textbook delusion. Such beliefs are held as persistently by respected persons and influential groups, despite evidence to the contrary, as by psychotic patients who are segregated in hospitals.

Let it be understood that I am not advancing an opinion that those who are persuaded by prophets that the world will end next Thursday or that those who appeal to faith healers to protect a child from the effects of meningitis should be pronounced as clinically psychotic and forcibly committed to hospitals. Despite the similarity between the way such beliefs are adopted and the way a schizoid or paranoid patient arrives at his delusions, and despite the similar lack of evidence for considering either true, people such as those now under discussion are usually capable of leading useful lives in harmony with the community and sometimes of benefit to society. Few things, in my opinion, are more basic than the necessity for men to allow each other freedom to believe or not to believe, however sacred, or however false, different creeds may be held by different groups. Convictions that the world is flat, that one must not begin a job on

10 THE MASK OF SANITY

Friday, or that Mr. Arthur Bell of Mankind United193 is omnipotent are apparently held by some in reverent identity with the deepest religious attitudes of which they are capable. In this basic sense, each man's religion, as contrasted with the dogma or illusion in which he may frame it, his basic attitude and emotional response to whatever meaning and purpose he has been able to find in his living, deserves respect and consideration. The Methodist, the Mormon, and the Catholic, as well as the man who cannot accept any literal creed as a final statement of these issues, can honor and value, in a fundamentally religious sense, the valid reverence and the ultimate subjective aims of a good Mohammedan. This is possible without the ability to share his pleasant convictions about the likelihood of houris in paradise.

2 Traditions that obscure our subject

Raising general questions about personality disorder, we have briefly considered (1) persons suffering from illnesses that progress to major mental disability and (2) the numerous citizens of our nation, many of them able and well educated, who hold beliefs generally regarded as unsupported by evidence and considered by many as irrational or even fantastic. Aside from these groups and aside from all types of patients recognized as psychotic, there remains for our consideration a large body of people who are incapable of leading normal lives and whose behavior causes great distress in every community.

This group, plainly marked off from the psychotic by current psychiatric standards, does not find a categorical haven among the psychoneurotic, who are distinguished by many medical characteristics from the people to be discussed in this volume. They are also distinguished practically by their ability to adjust without major difficulties in the social group.

Who, then, are these relatively unclassified people? And what is the nature of their disorder? The pages which follow will be devoted to an attempt to answer these questions. The answers are not easy to formulate. The very name by which such patients are informally referred to in mental hospitals or elsewhere among psychiatrists is in itself confusing. Every physician is familiar with the term psychopath, by which these people are most commonly designated.50 Despite the plain etymologic inference of a sick mind or of mental sickness, this term is ordinarily used to indicate those who are considered free from psychosis and even from psychoneurosis. The definitions of psychopath found in medical dictionaries are not consistent nor do they regularly accord with the

In a 1952 revision of the psychiatric nomenclature14 the term psychopathic personality was officially replaced by sociopathic Personality. Subsequently the informal term, sociopath, was often used along with the older and more familiar psychopath to designate a large group of seriously disabled people, listed with other dissimilar groups under the heading personality disorder.62 Still another change in the official terminology was made in 1968 when the designation sociopathic personality was replaced by personality disorder, antisocial type.15 In referring to these people now formally classified by the term antisocial personality, I shall continue to use also the more familiar and apparently more durable term, psychopath. The diagnostic category, personality disorder, officially includes a wide variety of maladjusted people who cannot by the criteria of psychiatry be classed with the psychotic, the psychoneurotic, or the mentally defective. Until fairly recent years, it was by no means uncommon for the report of a detailed psychiatric examination made on a patient in a state or federal institution to end with this diagnostic conclusion: 1. No nervous or mental disease 2. Psychopathic personality

Traditionally the psychopath (antisocial personality) has been placed in general diagnostic categories containing many other disorders, deviations, abnormalities or deficiencies, most of which have little or no resemblance to his actual condition. From the category personality disorder, as last defined in 1968, a number of these dissimilar and apparently unrelated psychiatric conditions have been removed. It is not likely however that all the confusion promoted by the older classifications will subside promptly.

In the early decades of our century a large group of abnormalities, mental deficiency, various brain and body malformations and developmental defects, sexual perversions, delinquent behavior patterns, chronically mild schizoid disorders, were all classed as constitutional psychopathic inferiority.123

* Stedman's Medical Dictionary (1972): "Psychopath: The subject of a psychoneurosis. One who is of apparently sound mind in the ordinary affairs of life but who is dominated by some abnormal sexual, criminal or passional instinct."

Dorland's Illustrated Medical Dictionary (1974): "Psychopath: a person who has an antisocial personality. sexual p., an individual whose sexual behavior is manifestly antisocial and criminal."

Blakiston's New Gould Medical Dictionary (1949) gives: "A morally irrespsonsible person: one who continually comes in conflict with accepted behavior and the law."

Curran and Mallinson- (1944) say: "The only conclusion that seems warrantable is that some time or other and by some reputable authority the term psychopathic per. sonality has been used to designate every conceivable type of abnormal character."

12 THE MASK OF SANITY

After the ordinary mental defectives and most of the cases with demonstrable brain damage or developmental anomalies were distinguished, a considerable residue of diverse conditions remained under the old classification.

As time passed and psychiatric study continued, an increasing number of observers felt that the term constitutional was scarcely justified for some of the several disorders listed in the categories just menioned. Eventually the term was officially discarded in our country and psychopathic personality was adopted, not only for the type of patient to be discussed in this volume but for a good many others easily distinguished from him in life but only with difficulty in the nomenclature.

Some time after the period during which it was generally assumed, by the physician as well as by the clergyman, that abnormal behavior resulted from devil possession or the influence of witches, it became customary to ascribe all or nearly all mental disorder to bad heredity. Even in the early part of the present century this practice was popular.210 Before relatively recent developments in psychopathology and before any real attempt had been made to understand the meaning and purpose of symptomatology, the invocation of inborn deficiency or "hereditary taint" was, it would seem, grasped largely for the want of any other hypothesis.

Another factor contributing to the popularity of belief in hereditary causation lies, perhaps, in the fact that families of patients in state hospitals were investigated and all deviations recorded. Most of these histories revealed aberrant behavior, if not in a parent or grandparent, at least in some great uncle or distant cousin. It is surprising that some investigators gave such little consideration to the fact that few men stopped on the street could account for all relatives and antecedents without also disclosing one or more kinsmen whose behavior would attract psychiatric attention.* This is not to say that there is no reasonable likelihood of inborn deficiencies playing a part, perhaps a major part, in the development of the psychopath. It is to say that one is not justified in assuming such factors until real evidence of them is produced. If such evidence is produced, these factors must be weighed along with all others for which there may be evidence and not glibly assumed to be a full and final explanation.

(Parte 3 de 7)

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