Paranoia

During the course of a disease so distressing in its symptoms the patient's suspicions as to the authors of his persecution vary much in indefiniteness. He often never fixes the direct blame upon any individual, but refers to his persecutors as "they" or a "society," or some corporate body such as "lawyers," "priests" or "freemasons." It not infrequently happens that suspicions gradu ally converge upon some individual, or that from an early stage of the disease the patient has fixed the origin of his trouble upon one or two persons. When this takes place the matter is always serious from the point of view of physical danger to the inculpated person.

The persecutory type of the disease may persist for an indefi nite period—even for 20 or 3o years—without any change except for the important fact that remissions in the intensity of the symptoms occur from time to time. These remissions may be so marked as to give rise to the belief that the patient has recovered, but in true paranoia this is hardly ever the case.

2. Ambitious Paranoia.

Af ter a long period of persecution a change in the symptoms may set in, in some cases, and the intensity of the hallucinations may become modified. At the same time delusions of grandeur begin to appear, at first faintly, but gradually they increase in force until they ultimately supplant the delusions of persecution. At the same time the hallucinations of a disagreeable nature fade away and are replaced by auditory hallucinations conformable to the new delusions of grandeur.

The emotional basis of ambitious paranoia is pride, and every phase of human vanity and aspiration is represented in the delusions of the patients. There is, moreover, considerably less logical acumen displayed in the explanations of their beliefs by such patients than in the case of the subjects of persecution. Many of them affect to be the descendants of historical person ages without any regard for accurate genealogical detail. They have no compunction in disowning their natural parents or explaining that they have been "changed in their cradles," in order to account for the fact that they are of exalted or even of royal birth. The sphere of religion affords an endless field for the am bitious paranoiacs, and some of them may even aspire to Divine authority.

A not uncommon form of paranoia, combining both ambition and persecution, is where the subject believes that he is a man of unbounded wealth or power, of the rights to which he is, however, deprived by the machinations of his enemies. They are often so troublesome, threatening and persistent in their deter mination to obtain redress for their imagined wrongs, that they have to be forcibly detained in asylums in the public interest.

On the whole, however, the ambitious paranoiac is not trouble some, but calm, dignified, self-possessed, and reserved on the sub ject of his delusions. He is usually capable of reasoning as

correctly and of performing work as efficiently as ordinary people.

3. Amatory Paranoia.

A distinguishing feature of this form of paranoia is that the subjects are chivalrous and idealistic in their love. Some of them believe that they have been "mystically" married to a person of the opposite sex, usually in a prominent social position. The fact that they may have never spoken to or, perhaps, never seen the person in question is immaterial. The conviction that their love is reciprocated and the relationship understood by the other party is unshakeable, and is usually based upon suppositions that to a normal mind would appear either trivial or wholly unreal. The object of affection, if not mythical or of too exalted a position to be approached, is not infrequently persecuted by the admirer, who takes every opportunity of obtruding the evidences of an ardent adoration.

Closely allied, if not identical with, amatory paranoia, is the form in which jealousy forms the basis of morbid suspicions with or without definite delusions. The subjects are extraor dinarily assiduous in watching the objects of their jealousy.

Their conduct is fertile in producing domestic unhappiness, and in the case of unmarried persons in creating complicated or deli cate situations.

4. Litigious Paranoia (paranoia querulans).—The clinical form of litigious paranoia presents uniform characteristic features which are recognized in every civilized community. It is impor tant to observe that the rights such people lay claim to, or the wrongs they complain of, may not necessarily be imaginary. But, whether imaginary or real, the statement of their case is always made to rest upon some foundation of fact, and is, moreover, presented, if not with ability, at any rate with forensic skill and plausibility. As the litigants are persons of one idea, and only capable of seeing one side of the case—their own—and as they are actuated by convictions which preclude feelings of delicacy or diffidence, they ultimately succeed in obtaining a hearing in a court of law under circumstances which would have discouraged any normal individual. Neither the loss of the case nor the pay ment of heavy expenses has any effect in disheartening the litigant, who carries his suit from court to court until the methods of legal appeal are exhausted. After dissipating his means and, perhaps, those of his family, and finding himself unable to continue to liti gate to the same advantage as formerly, delusions of persecution begin to establish themselves. He accuses the judges of cor ruption, the lawyers of being in the pay of his enemies, and im agines a conspiracy to prevent him from obtaining justice.