Paranoia is generally a hopeless affection from the point of view of recovery. From what has been stated regarding its genesis and slow development it is apparent that no form of ordinary medical treatment can be of the least avail in modifying its symptoms. The best that can be done in the interests of the patients is to place them in surroundings where they can be shielded from influences which aggravate their delusions and to make their lot as pleasant and as easy to endure as possible.
As has been frequently stated, the subjects of most forms of paranoia are liable to commit crime, usually of violence, which may lead to their being tried for assault or murder. The question of their responsibility before the law is therefore one of the first importance (see also INSANITY : Law). The famous case of McNaghten, tried in 1843 for the murder of Drummond, private secretary to Sir Robert Peel, is, in this connection, highly impor tant, for McNaghten was a typical paranoiac and his case formed the basis of the famous deliverance of the judges in the House of Lords in the same year, on the general question of criminal re sponsibility in insanity in which it was held that such an offender might be regarded as sane, save on one subject, and should, there fore, be held accountable for his acts—a conclusion quite at variance with that of modern medical science.
The true paranoiac is a person of an anomalous mental consti tution apart from his insanity ; although he may, to outward appearances, be able, on occasion, to converse or to act rationally, the moment he is dominated by his delusions he becomes, not partially, but wholly insane ; when, in addition, his mind is dis tracted by ideas of persecution or hallucinations, or both, he becomes potentially capable of committing crime, not because of any inherent vicious propensity but in virtue of his insanity.
There is, therefore, no middle course in respect to the criminal responsibility of paranoiacs ; they are all insane wholly, not par tially, and should only be dealt with as persons of unsound mind. See Bianchi, Textbook of Insanity (Eng. trans., 1906) ; Clouston, Mental Diseases; Krafft-Ebing, Textbook of Insanity (American trans., 1904) ; Kraepelin, Psychiatrie (Leipzig, 1899) ; Magnan, Le Delire chronique (Paris, 189o) ; Stewart Paton, Psychiatry (Philadel phia, 1905) ; Percy Smith, "Paranoia," in foam. of Mental Science, p. 607 (19o4) ; 0. Kant, Beitrage z. Paranoiaforschung, etc. ver gleichende Analyse u. forensischer Ausblick, Ztschr. f. d. ges. Neurol. u. Psychiat., no, 558, bibl. (1927) ; J. Levy-Valensi, La constitution paranoiaque, Progres med., 42, 549 (1927) ; Genil-Perrin, Les para noiaques, bibl. (Paris, 1926) ; M. Nathan, Des idies actuelles sur la paranoia, Presse med., 33, 1,653, bibl. (1925) ; E. Retif, Remarks on the Psychology of Paranoia, Inter. Clin. (1925) ; P. Nayrac, La demence parandiae, bibl. (Paris, 1924) ; E. Kraepeter, Manic-depressive insan ity and Paranoia, bibl. (Edinburgh, 1921). (J. MN.)