magnified into approaching complete failure of memory, and lassitude
becomes a permanent loss of will power, evidently due to disease in
the patient's mind, and there begins the persuasion that nothing can
overcome it. Morbid introspection becomes, after a time, the favourite
occupation, and every slightest sensation or feeling sets up trains of
thought that lead to far-reaching conclusions with regard to physical
weakness. The patient is apt to be greatly preoccupied with himself,
to neglect his duty towards others, to be utterly selfish, to fail to
realise how much sympathy is being wasted on him.
Some people never pass beyond this preliminary stage of the mental
disorder. Usually, however, after a time the patient misinterprets not
only his own sensations, but the actions of other people in his
regard; he becomes suspicious and distrustful of everybody around him,
sometimes even of his best friends. He is passing on to the second
stage of the disease, in which he is sure to feel that he is the
object of persecution. Just as he misunderstood his physical symptoms,
so he misconstrues the actions of his friends. He is sure that they
look at him curiously, that they smile {288} ironically. Sometimes he
thinks that they wink at one another with regard to him, or make signs
behind his back that are meant to be derisive. Even harmless passing
observations may be morbidly perverted into severe and inimical
criticism of himself and his actions.
The paranoiac is now apt to enter fully upon the second or persecutory
stage of his mental disorder. His distress and discomfort he
attributes to those around him and he is sure that he is the subject
of persecution. At first his persecutors are not very definitely
recognised. No particular person is picked out and even no particular
set of persons. There is just a vague sense of persecution. A
distinguished neurologist once said that no sane person in this world,
outside of a novel or a play, has time to make it his business to
persecute anyone else. When people come, then, with stories of
persecution, either they themselves are not in their right mind and
are deluded as to the source of the persecution, or else their
persecutor is not in his right mind and the case needs seeing to from
the other standpoint.
After a time, longer or shorter in individual cases, the paranoiac
begins to recognise definitely who his persecutors are. As a rule, it
is not some single individual, but a combination of individuals.
Already there is the beginning of the third state of the disease--the
grandiose stage of the disease, in which the patient feels an extreme
sense of his own importance. It would be derogatory to his self
conceit to consider himself the subject of persecution by an
individual, and so it is usually some society, or the government, or
its officials, or some secret organisation that is persecuting him,
and perhaps also persecuting those who are near and dear to him.
Sometimes it is the Odd Fellows, or perhaps the Masons, who are the
persecutors. If the newspapers have recently had some account of the
disappearance of Morgan years ago, and this subject crops up
periodically in the papers, then the Masons become a favourite subject
for paranoiacs' delusions of persecutions. Just after the Cronin
murder in Chicago, the Clan-na-Gael became an extremely fearsome
spectre for paranoiacs who thought themselves persecuted. It is of
some {289} importance to know, as a rule, what the usual reading
matter of a patient is, and what things are likely in his past history
to have impressed him, in order to realise what the real source of his
delusions of persecutions are.
It is curious how rational these patients may be on all other subjects
except the special topic of their delusion. During the past year a
paranoiac has been under observation, who is considered a reasonably
rational individual by those who know him well, who follows his daily
occupation, that of clerk, without intermission and with business
ability, who is a faithful attendant at church, and who is very kind
to his family, but who is sure that he is the subject of persecution
by the Clan-na-Gael. He never belonged to the organisation. He is
not able to give any good reason why he should be persecuted, except
perhaps the fact that, though an Irishman, he never did belong to
them. He is perfectly sure, however, that they are planning to poison
him and his family. He finds peculiar tastes in the tea and the coffee
at times. He throws out these materials and insists on his wife
getting others at another grocery store. He sometimes brings groceries
home from a distance and yet finds that if he ever buys materials a
second time in the same place, they are sure to have been tampered
with in the meantime by emissaries of this secret organisation. He
feels sure that he has seen these secret agents, but he is only able
to give vague descriptions. Not a little of the prejudice against
these organisations is really founded on such morbid suspicions.
Another form that the idea of persecution sometimes takes, in this
second stage, is the delusion that the patient is neglected by those
who should specially care for him or her. A woman insists that she is
neglected by her husband. She may become intensely jealous of him and
make life extremely miserable for him without there being any good
reason for her jealousy. These cases are not nearly so rare as might
be thought. On the other hand, men suspect their wives of
unfaithfulness. This suspicion may go to very serious lengths in
persecution at home, though the man all the time keeps his suspicions
to himself, in order not to make a laughing stock of himself outside
of the house. It is this curious mixture of {290} rationality and
delusion that is the characteristic feature of the disease. It is for
this reason that these conditions were sometimes called monomanias, as
if patients were really disturbed only on one point. As a matter of
fact, however, patients are mentally wrong on a number of points,
though there is some one mental aberration so much more prominent than
other peculiarities that it overshadows the others.
It is not long after the persecutory stage sets in before patients are
apt to become themselves persecutors of others as a result of their
belief that they are being persecuted. The French have a suggestive
expression for this. It is _persecutes persecuteurs_, that is to say,
"persecuted persecutors,"--patients who are trying to repay supposed
persecutors by persecution on their own part. Such patients, of
course, very easily become dangerous. They need to be carefully
watched. As a rule, the persons whom they are prone to select as the
persecutors upon whom they must avenge themselves are absolutely
innocent parties. At times they are even dear and well meaning
friends.
After the persecutory stage in paranoia, comes the third, or so-called
expansive period of the disease. It has been remarked that sometimes
this develops as a sort of logical sequence from the patient's ideas
of persecution. If he has too many enemies and if important secret
organisations are trying to be rid of him, he must be a person of some
importance. As a consequence he evolves for himself a royal or
aristocratic descent, or hints that he is the unacknowledged son of
great personages. In a kingdom royalty is, of course, a dominant idea.
In a republic like our own, he may consider himself to be the
President or the politician to whom the President owes his office.
_Paranoia Religiosa_.--Not infrequently the first hint of their
supposed greatness comes to such patients suddenly in a dream or in a
vision; when their expansiveness takes a religious turn, this is
especially apt to be the case. They may believe themselves to be
especially chosen by the Almighty, a new Messiah or even Christ
Himself, come once more to earth. Such people may retain much of their
rationality on most of the points relating to practical life, and yet
have this {291} hallucination as to their close relationship with the
divinity. Not only may they retain their mental equilibrium on other
points, but they may even give decided manifestations of great genius.
This is, I suppose, one of the most interesting features of this form
of mental disease, but it is well illustrated in the lives of many
modern founders of religious sects, even in our own generation.
Such religious reformers as Mahomet and Swedenborg seem undoubtedly to
have been afflicted with this third stage of expansive paranoia. In
our own day there is no doubt that many of the founders of new
religious sects, many of the heaven-sent apostles or reincarnations of
patriarchs and prophets, the miraculous healers and the like, are
afflicted in this same way. It is useless and entirely contrary to the
known facts to put such people aside as mere imposters. Imposters they
are, but they have imposed on themselves as well as on their
followers. They are sincere as far as they go, and the mental twist
that gives them their power has occurred in the midst of the
manifestation of the intellectual faculties of a highly practical
character and of executive ability, with wonderful capacity for the
direction of complex affairs. A prominent neurologist said, not long
ago, that the most interesting feature of Christian Science is to
contemplate in the study of the movement how near people may come to
insanity and yet retain their faculty to make and handle money and
even accumulate fortunes.
_Paranoia Erotica_.--After the _paranoia religiosa_, the most common
form of the disease is the _paranoia erotica_. There are authorities
in mental diseases who do not hesitate to say that an excess of
religiosity and of erotic sentimentality are more or less
interchangeable. This declaration represents, however, the unconscious
exaggeration of a mind unsympathetic towards religious ideas. But it
must not be lost sight of that the two forms of excesses, erotic and
religious, are more nearly related than would be ordinarily supposed,
and that erotic manifestations may be confidently looked for in
patients who have been afflicted by a too highly wrought religious
sentimentality. St. Theresa seems to have realised this very well and
has touched on the subject in one of her letters.
{292}
Ordinarily erotic paranoia manifests itself by the patient imagining
himself or herself to be beloved by some one of superior station. This
love is of rather a platonic character and the "lover" cranks are
prone to pick out as the object of their attention and annoyance some
young woman rather prominently in the public eye, but whose reputation
is of the very highest. Mary Anderson was the subject of a good deal
of this sort of persecution. At the present moment the well and
favourably known daughter of a great millionaire is the subject of
many such attentions.
These paranoiacs are apt to become dangerous if they are prevented
from paying what they consider suitable attention to the object of
their affection. In hospitals they have to be carefully watched, and
more than one accident has taken place as the result of relaxation of
vigilance on the part of their attendants. If kept from the object of
his affection, delusions of persecution become prominent in the
amorous paranoiac, and he may become a persecutor in turn and thus a
dangerous lunatic. He can not be made to understand that the sending
of flowers and photographs and letters is entirely distasteful to the
chosen one. Fortunately, after a time, in many of these cases, a state
of dementia sets in, and then the patients become mild-mannered
imbeciles whom it is not at all difficult to manage.
As a rule where the patient has passed through the various stages of
paranoia, dementia, with symptoms of imbecility, closes the scene. The
paranoia may not always follow the course mapped out for it. Stages
may be skipped, several forms of delusions may become prominent in the
life of the individual at about the same time. The main feature of the
disease is its progressive character, and its diagnosis depends on the
queerness exhibited all during the course of life, as well as on the
presence of hereditary neurotic influences.
_Special Forms of Paranoia_.--There are besides the two types
described a number of special forms of paranoia, some of which aroused
attention first under the form of monomanias, that seem to merit brief
treatment by themselves. In their extreme forms they are easy of
recognition. Milder types, however, may easily escape classification
under the {293} head of paranoia, because they are considered to be
individual oddities and not due to any physical or mental incapacity.
Undoubtedly, however, the study of these peculiar "types," as the
French call them, from the standard of the alienist or expert in
mental diseases, will serve to make clearer the real significance of
many otherwise almost unaccountable actions. There is no doubt, that
the consideration of these eccentrics as paranoiacs makes the
charitable judgment of many of their acts much easier, and at the same
time is of service in managing them. They are likely to be of much
less harm to the community and to their friends, when it is realised
that they are not to be taken too seriously, but that, on the
contrary, there is ample justification for a benevolent combination of
interests to keep them from injuring themselves and their friends.
_Paranoia Querulans_.--One of the most important and familiar forms of
the special types of paranoia is what is known scientifically
_paranoia querulans_, that is, the peculiarity of those who insist on
going to law whenever there is the slightest pretext. It is pretty
generally recognised that a goodly proportion of the civil suits that
crowd our law courts are due to the peculiarities of these people who
insist on having their rights, or what they think their rights,
vindicated for them by a court of justice. There are very peculiar
characters in this line, some of whom make themselves very much feared
and detested by their neighbours. There are some individuals to whom
the slightest injury or show of injury means an immediate appeal to
the law.
Not infrequently these patients, for such they are in the highest
sense of that word, waste their own substance and even the means of
support of wife and children, on their foolish law schemes. When their
queerness reaches a certain excessive degree its pathological
character is readily recognised. In a less degree _paranoia querulans_
may be a source of very serious discomfort to friends and neighbours
without exciting a suspicion of its basis in mental abnormality. Not
infrequently such patients become more irrational at times when their
physical condition is lower than normal, and a return to their
ordinary health makes them {294} more amenable to reason and less
prone to appeal to expensive litigation.
It is evident that the irrationality of frequent appeals to expensive
and bothersome litigation should arouse suspicion. Such patients need
to be cared for quite as effectually as those who have tendencies to
gamble away their substance or to waste it in the midst of inebriety.
Unfortunately it is extremely difficult to frame laws so as to meet
such conditions. Severer forms of the affliction are readily
recognised and the sufferer is properly restrained. I remember once
seeing a patient in Professor Flechsig's clinic in Leipzig, who had
been sent to the asylum because of his tendency to go to law on the
smallest possible pretext. This patient's incarceration in the asylum
was due to a very striking manifestation of his _paranoia querulans_.
He answered an advertisement for a clerk, published by one of the
large commercial houses. He found himself one of a row of applicants
for the position, and as the member of the firm whose duty it was to
engage the clerk was at the moment busy, he had to wait several hours
before his application was heard and refused. He tried to secure a
warrant for the firm in order to have them indemnify him for the time
he had spent while waiting for his application to be heard, at the
rate of wages they would have been bound to pay him had he obtained
the vacant clerkship; only as they had spoiled a day he claimed a full
day's wages.
This patient had been in the asylum several times before because of
his tendency to go to law. He always gained in weight while in the
asylum, became much more tractable and less querulous as his physical
condition improved, and usually after some months could be allowed to
leave the institution. He was, however, one of the inept. With the
help of asylum influence he usually obtained some occupation more or
less suitable, but was not able to retain it for long. When out of a
situation he worried about himself, usually did not take proper food,
and then soon his litigious peculiarities began to manifest themselves
once more in such form that if he could get the money to retain an
attorney, or if he could persuade one to take his case on a contingent
fee, and he was very ingenious at this, he soon became a veritable
nuisance to {295} those around him. When in poor health he was never
contented unless he had at least one lawsuit on his hands, and only
really happy when he had several.
_The Gambler Paranoiac_.--A form of paranoia that inflicts almost more
of human suffering on the friends of the patient than any other is
that in which the sufferer is possessed of the idea that he can, by
luck or by ingenious combinations, succeed in winning money at
gambling. Milder forms of this paranoia are so common that it is the
custom not to think of even the severer forms of the gambling mania as
a manifestation of irrational mentality. When a man thinks, however,
that he can beat a gambler at his own game, or when by long
lucubration he comes to the conclusion that he has invented a system
by which he can beat a roulette wheel, he is, on this subject at
least, as little responsible as the man who thinks that he has
discovered perpetual motion.
This form of paranoia inflicts suffering mainly on the near relatives
of the patient. There is no doubt that when extreme manifestation of
the gambling mania becomes evident, patients should be legally
restrained from further foolishness. One difficulty with regard to the
proper appreciation of gambling has been an unfortunate tendency to
class gambling among the malicious actions. There are many people for
whom only two sins seem to have any special importance, drunkenness
and gambling. As a rule, there is not the least spirit of malice in
the ordinary gambler; not meaning, of course, by this the sharpers,
who try to make money at the expense of others, but the man who
believes that, somehow, chance and fate are going to conspire to
enrich him at the expense of others, though it must be confessed that
he does not usually even think of this latter part of the proposition
which he accepts so readily.
We have had in recent times so many manifestations of the practical
universality of the gambling spirit, the belief by people that brokers
and banking concerns are ready to make them rich quick, that we have
in it perhaps the best illustration of the partial truth of the
proposition that "half the world is off, and the other half not quite
on."
_The "Phobias."_--Sometimes the special form of queerness {296} takes
on a very harmless aspect. Patients are worried because of the fact
that they can not keep themselves clean. They want to wash their hands
every time they touch any object that has been handled by others,
whether that object seems to be specially dirty or not. Such patients
may wear the skin off their hands washing them forty or fifty times a
day. They almost absolutely refuse to touch a door-knob, because it is
handled by so many people. They will consent to take only perfectly
new bills. It is almost amusing to see the efforts they make to avoid
shaking hands with people, without giving direct offense. When it
comes to shaking hands with their physician, they are apt candidly to
declare that he must not ask them to do so, because they can not
overcome their feelings as to the possibility of contamination from
hands that come in contact with so many patients. This fear of dirt
has received the name Misophobia.
There are a number of other "phobias," and the patient's fears are
manifested at the most peculiar objects. Agoraphobia, for instance, is
the fear of crossing an open place. These patients begin to tremble as
soon as they get away from the line of buildings in a street, in their
way across the square. This trembling becomes actual staggering, with
a sense of oppression over the heart that makes locomotion almost or
quite impossible. Claustrophobia, the opposite of Agoraphobia, is the
fear of narrow places, and prevents some people from going through a
narrow street with high buildings. Many of these "phobias" have a
physical basis in some organic or nervous heart affection.
_The Tramp_.--One of the striking manifestations of paranoia in our
modern life is the tramp. Most people are inclined to consider that
the cause for the wandering life of these unfortunates is rather what
a distinguished physician euphemistically called by the scientific
name, _pigritia indurata_, that is, chronic laziness, than any
pathological condition of mind. Most tramps, however, will be found,
on that close acquaintanceship which alone will justify judgment of
their actions, to have many other peculiarities of mind besides the
shiftlessness which prompts them to wander more or less aimlessly from
place to place. After all, it will hardly be denied that the calm
{297} acceptance of the notion that it is more satisfactory to indulge
in laziness and wander without home or fireside, suffering the many
privations and hardships, especially from the weather which these
creatures do, rather than work and be respected and comfortable among
their fellows, is of itself irrational.
Many of these tramps prove on close acquaintance to be interesting
pathological characters. Various stages of outspoken paranoia will be
found to exist among them. It is not unusual to find that certain
among them have acquired the idea not so uncommon now among large
classes of humanity, that the world is so unjust in its treatment of
the labouring man, that work seems to them almost a persecution that
must be undergone for the sake of the pittance derived from it.
Sometimes there is the actual extrinsic idea of personal persecution
for some fancied wrong done to a large corporation during a strike, or
labour troubles, which they cherish as the reason for which they have
had to give up a fixed habitation, and resign the idea of supporting
themselves honestly and respectably. This persecution stage of
paranoia easily turns to the second phase of this affection as already
described, that in which the fancied victim of persecution becomes in
turn the persecutor. Tramps thus readily give way to even organised
attempts at revenge upon social order, and are led to believe
themselves justified in attempts to burn and otherwise destroy
property because of their enmity towards property holders and
employers generally. Not infrequently the third stage of paranoia, in
which there are delusions of grandeur, may be observed.