<unk> , fifth edition, presents clinical theories as well as case studies, written in the form of dramatic, novelistic descriptions of 13 individuals, an amalgamation of those he had observed. Initial outline<unk>  begins in Section One, "An Outline of the Problem", by considering the concept of<unk> , which Cleckley describes as protean. The first words of the book are a possibly untrue anecdote ending with the line, capitalized and centered in large font, "WHO'S LOONEY NOW?" Cleckley suggests that everyone "behaves at times with something short of complete rationality and good judgment". He notes that many types of people hold beliefs that he and much of society would consider irrational, such as mysticism, pseudoscience, praising of unintelligible or immoral works (e.g. acclaim for the novel Finnegans Wake containing only "erudite gibberish" or for the writing of André Gide on pederasty), and religious faith. He argues, however, that these are personal freedoms and such groups are usually capable of leading useful lives in harmony with others. This he says distinguishes it from psychosis once fully developed and from psychopathy. Classification schemes Cleckley also addresses the confusing traditions of classification in the area of psychopathy, a term he admits is itself confusing and not being used in line with its etymological meaning ('mental sickness'), though adopts it as the most familiar and apparently durable. He considers the terms sociopathic personality and antisocial personality, as adopted by the Diagnostic and Statistical Manual of Mental Disorders; the relationship to the overall category of personality disorder; and the earlier widespread concept of "constitutional psychopathic inferiority", disputing its hereditary assumptions. He states that the main purpose of the book is to bring a few cases before other psychiatrists, and also to raise the profile among the public, to enable better management of psychopaths. He criticizes the 'doctrine of permissiveness', and refers with regret to the lack of prominence of psychopathy in psychiatric textbooks. Prevalence Cleckley argues under a subsection titled "Not as single spies but in battalions" (a phrase appearing in Hamlet), that although reliable statistics are hard to come by, there are various reasons to suspect both psychiatric and prison admission rates are an underestimate, and the incidence of the condition is in his opinion "exceedingly high". He does present some statistics from a survey whereby he and nine other psychiatrists diagnosed 1/8th of patients as having psychopathic personality without any other mental disorder that might explain the condition, and considers that quite a few others classified as alcoholic or drug addicted would actually have qualified too. Their survey is further detailed in the book's appendix, where Cleckley clarifies it took place between 1937 and 1939 at a federal Veterans Administration hospital, located on the Southeastern seaboard, for the care of ex-service men, mainly from World War I. He critiques the 'benign policy' of the VA of not diagnosing more psychopathic personality due to giving the benefit of the doubt to issues such as neurasthenia, hysteria, psychasthenia, posttraumatic neuroses, or cerebral trauma from skull injuries and concussions. He concludes they have "records of the utmost folly and misery and idleness over many years" and if considering the number in every community who are protected by relatives, "the prevalence of this disorder is seen to be appalling." Method Finally, Cleckley asserts that the account provided in his book will accord with the scientific method, as pointed out by Karl Pearson in The Grammar of Science, which he loosely summarizes as: to record observed facts; group them together by correlation as distinguished from other facts; to try to summarize or explain in a way that indicates the significance. He also says his method takes inspiration from that used in an earlier work, The Psychology of Insanity by English physician Bernard Hart (first edition published in 1912 and now open access). Characteristics In Section Two, "The Material", Cleckley presents a typical "full" psychopath's behavior in a series of 15 vignettes (originally nine in the first edition, and all male). For example, the psychopath can typically tell vivid, lifelike, plausible stories that are completely fraudulent, without evincing any element of delusion. When confronted with a lie, the psychopath is unflappable and can often effortlessly pass it off as a joke. In another typical case history, the psychopath is hospitalized for psychiatric treatment but because of his constant trouble-making, leaving wards in an uproar, the hospital is finally forced to turn him over to the police. Eventually, the police become so sick of his repeated antics that they try to hospitalize him again. Also included are six vignettes of "Incomplete manifestations or suggestions of the disorder" in non-patients, such as "The businessman", "The gentleman" or "The physician". Differentiation In Section Three, 'Cataloging the material', Cleckley continues the conceptual outline started in Section One, now termed 'Orientation'. He criticises the tenets of faculty psychology (now known as modularity of mind), arguing that such things as intelligence, morality and emotions are not separate parts in the brain but separate concepts we apply. He believes psychopaths would have been included in the 19th century concepts of 'mania without insanity' by Philippe Pinel and Prichard's moral insanity, but rejects their faculty basis. He notes the confusingly broad literal meaning and practical usage of the terms psychopathic personality or personality disorder, giving the example of the most authoritative textbook of the second quarter of the century, Psychopathic Personalities, by German psychiatrist Eugen Kahn. He rails against the counterculture antihero and gives as an example the novelist Alan Harrington for suggesting a socially necessary role for psychopathy in modern times, calling the idea "perverse and degenerate". He also criticizes Freudian-inspired ideas about antisocial acts being caused by unconscious guilt. He also disagrees with theories of neurotic, emotional or paranoid problems in subtypes of psychopathy, as in his concept there is always a relative or complete lack of this. He says the new DSM "personality disorder, antisocial type" offers an accurate term equivalent to psychopathy which he thinks will also continue as a term for a long time. Psychosis Cleckley then considers how schizophrenia is different from psychopathy, having a defect in theoretical reasoning. He notes that schizoid disorders may appear more similar, and might be more accurately called "masked schizophrenia", which he notes can sometimes be difficult to differentiate from psychopathy. He also notes other 'disguises' of severe personality disorder, such as "cryptic depression" or "pseudoneurotic schizophrenia" or "pseudopsychopathic schizophrenia". He finds the diagnosis of "psychosis with psychopathic personality" unnecessarily confusing. He declares, "There is little point in devoting space to detailed accounts of paranoid or cyclothymic personalities." In the first edition Cleckley described his psychopathic patients as "frankly and unquestionably psychotic", but modified this in later editions. In the fifth edition he describes long ago changing his opinion and now agreeing with the psychiatrist Richard L. Jenkins that this would stretch the definition of psychosis too far. However at various other points it is still suggested that, despite "traditional" classification, the extent of the inner abnormality and associated dysfunction in psychopathy is such that it might be considered a psychosis in many respects. Criminality Cleckley draws important distinctions between the psychopath and non-psychopathic criminal. He states that the psychopath very seldom takes much advantage of any gain, has an obscure or inconsistent purpose, usually puts himself unnecessarily in a shameful position as much as causing trouble for others; and usually does not commit the most serious or violent crimes, but usually does end up harming himself. However, despite the general picture of weak-willed and inconsistent antisocial behavior, he also states, at least in later editions, that some may develop drives towards the most serious or sadistic crimes. He suggests this is a somewhat separate additional pathology but does not explain why or how. Cleckely considers that the concept of delinquency has much in common with his concept of psychopathy, and argues that it could be considered a mild version if it continues for a long time and is generalized. He notes that many respectable mature productive citizens can look back on short periods of unprovoked social misconduct, including such things as property damage, racism, bestiality, voyeurism, rebellion, and promiscuity. On the other hand, he notes prolonged but prescribed behavioral disorder in the case of a woman who remained for some time "irrationally promiscuous and bisexual", but who had plausible psychological reasons for her behavior and was otherwise functional in her work and life. He also notes he no longer considers that homosexuality should be classed as sexual psychopathy, on the grounds that many homosexuals seem to be able to live productive lives in society. He considers that sexual fetishes are not particularly consistent with psychopaths, as the latter tend to have weak drives. He then states that psychopathy can be associated with particular sadistic drives and often be responsible for the most serious sex crimes. Other conditions He distinguishes psychopaths from non-psychopathic alcoholics, who by contrast have a purpose for drinking such as to avoid reality, and may want
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