This is a continuation of the article written by Peggy Seo Oba, click here for part 1 and Peggy’s bio

1941, 1964, 1982. The Mask of Sanity by Hervey Cleckley. This book is considered to be such a classic, I have found citations from three editions published that have covered five decades. Dr. Cleckley based much of this book on the male patients at the Veteran’s Administration Hospital in Augusta, Georgia, one of the largest in the country at the time of his writing. He estimated that well over 40% of the patients in the Augusta, Georgia VA’s psychiatric ward fitted the description that he classified as “semantic dementia”, Cleckley describes this as “…a mind or personality so damaged that experiences as a whole cannot be grasped or utilized in its significance or meaning.” Cleckley goes on to say, “…in semantic dementia, the purposiveness, the significance of all life striving and of all subjective experience are affected without obvious damage to the outer appearance of the personality.” “…the persistent maladaptation at the personality level, the inevitable purposelessness of behavior, suggested at times not a lack of purpose so much as a negative purpose. The person despite all his opportunities, his intelligence and his plain lessons of experience, seem to go out of his way to woo misfortune.” The families of the patients in Cleckley’s book are described as “…sound if not superior stock.” even though each of the patients described were alcoholic by nature and abused it constantly throughout their lives.

Cleckley’s Section XXII: Clinical Profile of the patient with semantic dementia is revealing:
“He is usually a very attractive person superficially and makes a strong positive impression when one first meets. him.”
“He is free from…any marked …psychoneurosis.”
“…he has no sense of responsibility whatsoever to others.”
“…appears to have a total disregard for truth…”
“…much of his trouble is his own fault.”
“…he cheats and lies without any apparent compunction.”
“…he continues to show the most execrable judgment about attaining…his own ends.”
“…His inability to learn or profit by experience no matter how chastening his experience may be.”
“…distinguished by egocentricity.”
“…shows no more real evidence of object love.”
“His absolute indifference to the hardships, financial, social, emotional, physical, and others, that he brings upon those for whom he professes love…”
“But mature, wholehearted anger, true or constant indignation, honest, solid grief, sustaining pride, deep joy, despair are never found within this scale.”
“…he does not show anything that could be called woe or despair or serious sorrow.”
“The emotional poverty, the complete lack of stronger or tragic feeling…”
“…lacks the insight to a degree seldom if ever found in other mental disorders.”
“He has absolutely no capacity to see himself as others see him.”
“…he has no ability to know how others feel when they see him or to feel anything comparable himself about the situation.”
“…blaming his troubles on others with the flimsiest of pretexts but with elaborate and and subtle rationalization.”
“…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.”
“…clever statements have been purely verbal, even his expressions without underlying content; an excellent mimicry of insight.”
“…apparently a total lack of insight as a real and moving experience.”
“…uses all the words that would be used by one who understands and who could define all the words, but who is still blind to the meaning.”
“The psychopath shows little of the ordinary responsiveness to special consideration or
kindness.”
“Alcoholic indulgence is very frequently prominent in the psychopath’s life story.”
“…an independent and pre-existing personality maladjustment is primarily causal.”
“…their almost total lack of self imposed restraint.”
“…a striking inability to follow any sort of life plan consistently whether it be regarded as good or evil.”
“…seems to go out of his way to make a failure of life.”
“…he cuts short by some incomprehensible and untempting piece of folly or buffoonery, any activity in which he is succeeding, no matter whether it is crime or honest endeavor.”
“…that some unconscious purpose to fail has been active, some unrecognized drive at social and spiritual self-destruction.”
“He shows no real insight into his condition. There is a persistent tendency to project the source of his troubles to the environment. We see a striking lack of normal and appropriate emotional response, a general flattening or hollowness in affect, such as marked impairment of ordinary judgment that he fails repeatedly to adapt himself in the social group. His record furthermore reveals not one but a series of follies and disasters involving himself and others and brought about for no discernible purpose. We may, therefore, say that he is psychotic, incompetent, and incapable of carrying on the usual activities of life without constant supervision.”
Cleckley goes on to state:
“…it is a different type of psychosis from all those now recognized, and one which differs more widely in its general features from any of those than they differ from one another.”
“The first and most striking difference is…in other psychoses, one finds…a more or less obvious alteration of reasoning processes or of some other demonstrable personality feature. In the psychopath, one…is confronted by with a convincing mask of sanity. All the outward features of this mask are intact; nor can it be displaced or penetrated by questions directed toward
deeper personality levels. …The thought processes retain their normal aspect even if
psychiatrically dissected. One finds…a solid and substantial structural image of the sane and
rational mind.”
“…one usually finds verbal and facial expression, tones of voice and all the other signs we have come to regard as implying conviction and emotion and the normal experiencing of life as we know it …and we assume it to be in others. Only very slowly, and …by intuitive judgment,
does the conviction come upon us that, despite these intact rational processes and their
consistent application in all directions, we are dealing here not with a complete man at all but
with what might be thought of as a subtlely constructed reflex machine which can mimic the
human personality perfectly.”
On treatment, Chapter 25:
“The present writer humbly confesses he has found all true examples of semantic dementia to be very little influenced by therapeutic efforts.”
“…..makes it necessary to place him on wards where patients are closely confined and
supervised…”
“An old physician…suggested that they be carefully gathered from all over the earth, placed on some large habitable island with all the equipment and supplies needed to establish
themselves, and then forgotten by the rest of humanity.”
On occurrence, Chapter 25:
“In this writer’s opinion approximately as many beds as those now occupied by all other
psychotic patients in the nation would scarcely be an exaggerated estimate.

1942. Butler, F.O. ” The Defective Delinquent.” American Journal of Mental Deficiency.

Chesler, A., LaBelle, G.C. and Himwich, H.E. “The Relative Effects of Toxic Doses of Alcohol on Fetal, Newborn and Adult Rats.” Quarterly Journal Studies in Alcohol.

****************************************************************************** 1942. Howard W. Haggard and E.M. Jellinek received a grant from the Rockefeller Foundation to conduct a study that refuted the research that indicated that maternal drinking adversely affected the unborn child. (from Philip Pauly. “How Did the Effects of Alcohol on Reproduction Become Scientifically Uninteresting in the Early Twentieth Century.” Journal of the History of Biology.)
E.M. Jellinek became famous for his work, The Disease Concept of Alcoholism, New Haven: College and University Press, published in 1960. It was the first work that suggested that alcoholism was a disease rather than a matter of personal choice or a flaw of character.

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1944. Crime and the Human Mind by Dr. David Abrahamsen of the Department of Psychiatry, Columbia University. Morningside Heights: Columbia University Press. Dr. Abrahamsen writes in Chapter VI: The Psychology of the Individual Offender: Classification of the psychopathic offender.
“…we have discussed criminals with neurotic characters, including in this group, those persons who are known…as psychopathic personalities. Since this term has been in use for over a hundred years…it is probably impossible to dispense with it…”

“…one is inclined to designate as psychopathic personalities all those persons who do not fit into…other groups.”
“…the term psychopathic personality has been used to mean a certain person who because of deviations and inadequacies in his personality and in his mental make up is neither mentally defective nor psychotic, but has a defect, especially regarding his character or emotions.”
“We…will define a psychopath as an abnormal personality who suffers because his aberrant character or one who because of his abnormalities disturbs society.”
“A psychopath may…show less valuable qualities.”
“…we find among offenders persons with a superior intelligence who are endowed with a capacity to accomplish criminal acts which are not only…well done but also eccentric.”
“…most of them should be classified in the near neurotic or in the neurotic character group.”
“…usually self centered, aggressive and emotionally unstable.”
“…superior attitude…showed little inclination to be corrected.”
“There has been an inclination to include practically all chronic criminals in this group and even to restrict it to the antisocial.”
“The psychopath cannot express love.”
“…earliest childhood…caused trouble by truancy, petty stealing or some other antisocial activity.”
“D.K. Henderson has given this definition: The term psychopathic state is the name given to those individuals who conform to a certain intellectual standard, sometimes high, sometimes approaching the realm of defect…who have…exhibited disorders of conduct of an antisocial or social nature…which have proved difficult to influence by methods of social, penal or mental care and treatment and for whom we have no adequate provision of a preventative or curative nature.”
“It is usually found that the age distribution varies from about fifteen to thirty-five or forty, the peak age being about twenty.”
“…the psychological development extends over a longer period of time (than the normal person).”
“..his instability begins in childhood, reaches a peak in young adulthood and then drops down in the late twenties and early thirties.”
“Partridge wants to change the term psychopath to sociopath…”
In Chapter X, Treatment and Research, Abrahamsen goes onto say about the Neurotic Character: “The offenders with neurotic characters represent the most difficult problem to the psychiatrist and prison authorities.”
“Punishment is without success, except that incarceration protects society…”
“…one may consider the possibility of whether a training program…might be considered. This could only be accomplished by keeping them under a continued disciplined regime in a friendly way.”
“…treat them firmly but at the same time, let them know they are not rejected.”

1947. Developmental Diagnosis: Normal and Abnormal Child Development by Drs. Arnold Gisell and Catherine Amatruda. Dr. Gisell was a professor in the Clinic of Child Development at the Yale School of Medicine. Under the chapter, Amentia of High Grade, Section 4 is titled “Inferior Endowment” and contains the following statements:
“…those individuals who without being definitely defective are nevertheless well below average with respect to developmental status…”
“…border on amentia without being certifiably feebleminded.”
“…a highly diversified category…distinguished (by) three types: (1) borderline dull (2) borderline unstable (3) borderline defective.”
“Borderline dull denotes a mild degree of retardation and a general reduction of performance particularly in the fields of language and adaptive behavior.”
“Borderline unstable denotes a similar inferiority combined with impulsivity, highly changeable and other atypical emotional reactions.”
“Borderline defective. …The behavior is relatively well organized and balanced. In quality and caliber it is defective but not sufficiently so as to warrant a diagnosis of frank amentia.”
Gisell warns, “The foregoing distinctions must rest on clinical impressions rather than on precise objective criteria. They are useful as descriptive diagnoses.” He goes on to elaborate on borderlineunstable: “A borderline unstable child displays unsteadiness and exaggeration in his emotional reactions and atypical deviations in one or more fields of behavior. …Discrepancies and disparities become apparent when his maturity is separately evaluated for the several fields of behavior.”
Gisell goes on to describe four cases:
“…over active, over afraid of men, not interested in toys…touches objects in a gingerly manner…”
“…rapport between himself and the examiner was shallow and variable.”
“…perservative and stereotyped manner…”
“..described as ’stubborn, backward, slow, very jealous, craves an unusual amount of attention’…”
“Screams at about 5 o’clock and refuses to eat supper; moans in bed; wakes at night with weird cries; clings to bottle; refuses cup.”
“…rocked back and forth incessantly…”
“…failure to carry out differential commands…”
“..her amiable personality cast a spell which tended to conceal her fundamental limitations…”
“The somewhat inferior quality of her intelligence and judgment make it necessary to provide good supervision and training throughout adolescence. If she is adequately protected, there is an excellent prospect of her making a satisfactory social and vocational adjustment in adult life.” (Gisell, however, does not follow this case into adulthood.)
Section 5 is titled “Pseudo-Symptomatic Retardation” and contains the following observations:
“There is a type of retardation which is falsely ascribed to such causative factors (unfavorable institutional or home environments), but which in reality a true amentia…”
“He does some thing so well.”
“He understands so much.”
“It is though he were thwarted and as though something were holding him back.”
“He has an excellent disposition.”
“He has more abilities than he likes to use.”
“He seems unhappy.”
“…there are residues of behavior which resemble the normal so much…”
“…the child may show extreme fixations on one toy, or on one pastime…”
“There may be an excessive amount of rocking or mouthing, ofjargoning, of chewing, clicking, respiratory and other mannerisms.”
“…heedlessness to sound or oblivious to persons…”
“…frequently found in association with hyperactivity.”
“…the activity and the bizarre exaggeration are frequently associated with an attractive
countenance and a far-away, wistful expression which builds up an impression of dormant or
obscured normality.”
“Parents go to heroic lengths to re-educate the child and remove the obstructions which they believe are retarding or deflecting the child’s development.”
“…the parents of these children do a lot of ’shopping around’. They try one expedient or one program after another.”
“But the retardation is…organic and symptomatic.”
“…the mental deficiency may be of either high or low grade.”
“..heedlessness to the spoken word and the failure to talk.”
“…slow weight gains.”
“Any progress he makes will be exceedingly slow.”
“School, in the ordinary sense, will be quite beyond him.”
Gisell and Amatruda also noted that “The parents are encouraged to believe that the child will find himself in time.” But they advise, “If you can bring yourself to shaping your child’s need to her needs…your own distress will be reduced. If there is a remote chance that a change will occur, you will be increasing that chance more by these means than by constantly sustained efforts to teach her beyond her capacity to learn.”. Advice often promoted by today’s experts in FAS education.

1950-1972. The 26 page study, “The Effects of Drinking on Offspring: A Historical Survey of American and British Literature.” by Rebecca Warner and Henry l. Rosett. (1975) in The Journal of Studies on Alcohol. cites 14 articles written in this period that warn of the danger of drinking during pregnancy. Copies of these articles are not included in this study. I may include them at a later date if I can obtain them.

1950. The Merck Manual: Eighth Edition. The first six editions of the Merck Manual, starting in 1899, were pharmaceutical references which listed medicinal remedies for specific conditions. Starting with the Sixth Edition in 1934, the Merck Company started to include diagnostic indications but did not include pediatric, psychiatric or psychological sections. Therefore, I have not included the editions prior to 1950.
The Eighth Edition was the first to contain a section on Neuropsychiatric and Psychosomatic conditions, none of which are recognizable as descriptive of FASD behavior.
In modern times, the Merck Manual is considered to be the “medical handbook” for medical and ancillary medical personnel. It is used as a reference, diagnostic and therapeutic guide.