PARANOIA, a chronic mental disease, of which systematized delusions with or without hallucinations of the senses are the prominent characteristics. The delusions may take the form of ideas of persecution or of grandeur and ambition. The disease may begin during adolescence, but the great majority of the sub jects manifest no symptoms of the affection until full adult life.
The prominent and distinguishing symptom of paranoia is the delusion which is gradually organized out of a mass of original but erroneous beliefs or convictions until it forms an integral part of the ordinary mental processes of the subject and becomes fused with his personality. This process is known as "systematization." It is necessary to point out that there is, undoubtedly, what may be called a paranoiac mental constitution, in which delusions may appear without becoming fixed or in which they may never appear. The characteristics of this type of mind are credulity, a tendency to mysticism and a certain aloofness from reality, corn bined, as the case may be, with timidity and suspicion, or with vanity and pride. On such a soil, given the necessary circum stances, a systematized delusional insanity may develop.
The term paranoia appears to have been first applied by R. von Krafft-Ebing in 1879 to all forms of systematized de lusional insanity. The rapid development of clinical study has now resulted in the isolation of a comparatively small group of diseases to which the term is applied and the relegation of other groups resembling it to their proper categories.
Attempts have been made to base a differential diagnosis of paranoia upon the presence or absence of a morbid emotional element in the mind of the subjects, with the object of referring to the group only such cases as manifest a purely intellectual disorder of mind. Though in some cases of the disease the mental symptoms may, at the time of observation, be of a purely intel lectual nature, the further back the history of any case is traced, the greater is the evidence of the influence of preceding emotional disturbances in moulding the intellectual peculiarities. Indeed, it may be said that the fundamental emotions of vanity or pride and of fear or suspicion are the groundwork of the disease. It is frequently ascertained that the patients have always been regarded as "queer." Paranoia is classified for clinical purposes according to the form of delusion which the patients exhibit. Thus there are the Perse
cutory, the Litigious, the Ambitious and the Amatory types.
I. Persecutory Paranoia.—This form is characterized by delusions of persecution with hallucinations of a painful and distressing character. In predisposed persons there is often ob served an anomaly of character dating from early life. The subjects are of a retiring disposition, generally studious, though not brilliant or successful workers. They prefer solitude to the society of their fellows, and are apt to be introspective, self analytical, or given to unusual modes of thought or literary pursuits. Towards the commencement of the insanity the patients become gloomy, preoccupied and irritable. Suspicions regarding the attitude of others take possession of their minds, and they ultimately come to suspect the conduct of their nearest relatives. The conversations of friends are supposed by the patient to be interlarded with phrases which, on examination, he believes to contain hidden meanings, and the newspapers appear to abound in veiled references to him. A stray word, a look, a gesture, a smile, a cough, a shrug of the shoulders on the part of a stranger are apt to be misinterpreted and brooded over. The extraordinary prevalence of this imagined conspiracy may lead the patient to regard himself as a person of great importance, and may result in the formation of delusions of ambition which may wholly supplant the persecutory insanity.
Hallucinations may begin to appear. These, in the great majority of instances, are auditory, and usually commence with indefinite noises in the ears, such as ringing sounds, hissing or whistling. Gradually they assume a more definite form, until isolated words and ultimately formed sentences are distinctly heard. A not uncommon form of verbal hallucination is formu lated in the complaint of the patients that "all their thoughts are read and proclaimed aloud." Though some of the subjects do not develop any other form of hallucination, others suffer from hal lucinations of taste, smell or touch. The misinterpretation of sub jective sensations in these sense organs leads to the formulation of delusions of poisoning or of being subjected to the influence of noxious gases or powders.