In The Mask of Sanity, Cleckley devotes a chapter to a case about what was termed Circumscribed Behavior Disorder. Cleckley describes it thusly:-
When behavior disorder is circumscribed, in a child or in an adult, one sometimes feels that symptomatically the patient resembles a psychopath but that a different sort of personality lies behind the manifestation.
The chapter is included among other chapters that are supposed to stand in contrast to psychopathic personality to help us better understand the psychopath, and includes such cases as the psychotic, the psychoneurotic, and the malingerer. One certainly gets the feel that this is 1940s psychiatry really struggling with classifications and groupings, after all, behavioral permissibility seems to be determined by the cultural and legal zeitgeist, and if something is deemed ‘wrong’ culturally, then psychiatrists automatically look at it as a disease or disorder.
This chapter is particularly striking, however. There is absolutely NOTHING wrong with the ‘patient’ in this case, a young woman who had sought help because she feared social repercussions because of her deemed promiscuity. The other chapters all describe behavior or symptoms that now have reputable courses for treatment and therapy (mostly), and while it’s easy to attack the work of Cleckley for the obvious 1940s social climate and prejudices, he wrestles with this patient in the same way that Nietzsche struggled to understand women; if he could just lose the product of his time element from his observations and reasoning, the truth, I think, would have blown him away. You feel like he knows something is wrong in the same way that Mr. Anderson feels that something is wrong in the movie ‘The Matrix’ before he becomes Neo.
The young woman in the case ends up in counseling in her mid twenties. She clearly has a strong and curious sex drive, and she is also thoroughly intelligent, a keen social critic when it comes to cultural mores, and very book smart. She had no desire to form any long lasting relationship with a man (something that unfortunately flagged her as psychologically defective – because of course, sex for sex’s sake is clearly ridiculous). Cleckley interprets this as her not caring who she hurts: If men invest in a series of dates, there is some consensual sexual activity, and then she chooses to move on, the hurt the men suffer is obviously her fault and has nothing to do with their emotional immaturity and possessional attitudes.
In two years, she slept with twenty men. Cleckley notes that she easily experienced vaginal orgasm (wonderful that she had to answer those questions because she’s being screened as sexually dysfunctional), and even so, did not want to stay with any one man. After all, as we know, if women are sexually satisfied, what more could they possibly want out of life? There is never any evidence that she cut and run from relationships, or used sex to steal or blackmail from anyone, only that she ever wanted brief sexual encounters. There was also no guilt felt after sex, which is why Cleckley has connected this apparent disorder to psychopathy in the first place.
Later, the young woman finds an intimate and rewarding relationship with a woman who was fifteen years older and was a part of the faculty with her husband at a local college. This older lady was well read, erudite, and felt a reciprocal attraction; they would together listen to symphonies, read Shakespeare out loud together, and drink and chat well into the night. This progressed into nights spent together in the same bed where they had sex. This happened when the husband was away for research.
While the marital infidelity is enough to make one squeamish, the young woman clearly found everything she wanted in a partner. Who doesn’t want an intellectual, thought-provoking, charming, and sexual guru to spend most of their free time with, especially before the dawn of family and work life? These needs that the young woman experienced would have made herselfish in the sense that she’s trying to figure out the best place for herself in the world, but her culture was against her all the way. In fact, she tells Cleckley how it was okay for little boys to wander off on tree climbing, hiking, or other adventures, but little girls were more restricted, and how boys became airline pilots, surgeons, and generals, but women became wives, and were destined to a life of housework. She fought this all the way and dared to listen to her own drives, dreams, and desires.
While in counseling, Cleckley noted that she was forced to admit that male and female genitalia are better suited to each other and work together to get better “sensual results.” He seems bang on the money – she was forced or defeated to admit something so preposterous. The concluding part to this chapter is disheartening. She’s being made to ‘understand’ that her feelings and drives are mechanisms for avoiding responsibility, in the same way that a child might feign sickness in an effort to avoid school. She is effectively punished for being herself.
I think Cleckley struggled with this case. He knew her observations of 1940s stereotypes were apt, yet her behavior is interpreted heavily by the prevailing morality of the time. One gets the impression that Cleckley’s primary duty for therapy was to encourage cultural assimilation. It wasn’t until 1973 that homosexuality was finally omitted from the American Psychiatric Association’s Diagnostic and Statistical Manual.
There was a disorder here, but it wasn’t Circumscribed Behavior Disorder. It was oppression.