[1] By the time of his death, Cleckley was better remembered for a vivid case study of a female patient, published as a book in 1956 and turned into a movie, The Three Faces of Eve, in 1957.
[11] The Mask of Sanity is distinguished by its central thesis, that the psychopath exhibits normal function according to standard psychiatric criteria, yet privately engages in destructive behavior.
[citation needed] In the same year as he published The Mask of Sanity during World War II, Cleckley wrote an address warning: "In our present efforts to prepare for national defense no problem which confronts the examining boards for selective service is more pressing or more subtle than that of the so-called psychopathic personality".
[12][13] In The Mask of Sanity, under a subsection entitled "Not as single spies but in battalions", and further detailed in the appendix, Cleckley describes a survey he and others conducted between 1937 and 1939 at a large federal Veterans Administration (VA) hospital on the southeastern seaboard, where he worked as one of the psychiatrists for the ex-servicemen who were mainly veterans of World War I. Cleckley critiques the "benign policy" of the VA of not diagnosing more psychopathic personalities 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 that psychopathic personalities have "records of the utmost folly and misery and idleness over many years" and if considering also the number in every community who are protected by relatives, "the prevalence of this disorder is seen to be appalling."
[14] However Cleckley also separately employed an analogy to a language disorder called "semantic aphasia" in explaining the distinction between the appearance of correct functioning on the surface despite an underlying deficit in meaning.
Cleckley states in The Mask Of Sanity that "Dr. Corbett H. Thigpen, my medical associate of many years, has played a major part in the development and the revision of this work".
Cleckley also mentions taking inspiration for the structure of his book from a work called The Psychology of Insanity by Bernard Hart, an English physician who also published a case study of a multiple personality.
In the wake of sometimes fatal complications, Cleckley published in 1939 and 1941 advising on theoretical grounds the prophylactic administration of various vitamins, salts and hormones.
They suggested changing the wording of it to: "In your opinion, was the defendant suffering from disease of the mind and if so, was it sufficient to render him unaccountable under the law for the crime charged?"
The concept of 'accountability' was intended as an alternative to a narrow definition of 'responsibility' under the M'Naghten rules which requires an absence of moral knowledge of right and wrong, in effect only covering psychosis (delusions, hallucinations).
[29][30] In 1956, Cleckley co-authored a book The Three Faces of Eve with Corbett H. Thigpen, his partner in private practice and colleague at the Department of Psychiatry at Georgia University.
[31] Such a diagnosis had fallen into relative disuse in psychiatry but Thigpen and Cleckley felt they had identified a rare case, though others have questioned the use of hypnosis and suggestion in creating some if not all of the characterization.
[32] The book also served as the basis for a blockbuster 1957 film The Three Faces of Eve starring Joanne Woodward, in which Lee J. Cobb played the initial treating psychiatrist and Edwin Jerome the consultant.
[32][34] When Sizemore returned to Augusta for a speaking tour in 1982, neither Thigpen nor Cleckley attended and she did not visit them, though in 2008 she described the diagnosis and treatment of her as courageous.