GROUP H. PSYCHOSES DUE TO VI CIOUS OR ABNORMAL BRAIN-ORGANIZA TION (ALWAYS HEREDITARY).
Paranoia.
Definition.—A chronic, inherited, in curable form of insanity, generally pro gressive, characterized principally by hal lucinations and persistent delusions, and rarely terminating in dementia.
The literal meaning of the term para noia is a dislocation or displacement of the mind; the German term is hell. In most cases the intellectual powers are preserved and the affected person may reason with much ness. His conclusions follow logically upon his premises, but as these are wrong the conclusions are likely to be false. The milder forms are generally known as cranks. It has become the fashion to call these persons degenerates, and to class them with geniuses, crim inals, saints, musicians, artists, and an archists. Obviously such an heterogene ous commingling of discordant elements fails to make clear to the ordinary mind what a crank or paranoiac really is.
Development.—The person burdened with an inherited neuropathic tendency usually shows psychical evidences of it in early life. There is in childhood ex centricity, abnormal reserve, morbid pride, at times uncontrollable anger; the child is peculiar, is not like other chil dren. At an early age there may be al ready evidences that the child regards itself as ill-treated by parents or others; its merits are minimized, its faults exag gerated. The other children in the family always get more than their share of praise. This morbid sensitiveness, usually baseless, is often accompanied by excessive precocity. Prizes are gained in school which are, however, generally re garded as entirely inadequate rewards for the tasks accomplished.
After puberty generally, sometimes not until after middle life, the excentrici ties of behavior become more marked. The subject cannot live in peace and amity with anyone for a long time; he develops hallucinations and delusions. These are generally present at some stage of the disease, although its development may stop short of their production.
The hallucinations and delusions dom inate the thought and conduct of the subject. As Krafft-Ebing says: "The paranoiac feels and acts as if his delu sions were true." From the twentieth to the fortieth years the excentricities, hallucinations, and delusions either gradually or by sud den accessions become more marked. The delusions become systematized, as it is termed. That is to say, the delusions assume a regular character, not varying except in increasing intensity and greater specialization. Thus, a subject, fancying himself persecuted by the world in gen eral, will gradually pick out a person whom he regards as his especial perse cutor, to whom, or to whose machina tions he ascribes all his misfortunes, real or imagined.
[The genesis and gradual development of a delusion and hallucinations are beautifully and artistically worked out by Du Maurier in his novel, "Peter Ibbet son." Similarly, but less successful from the stand-point of scientific accuracy, is the genesis of delusions of persecution in "The Statement of Stella Maherly," a novel by F. Anstey. In both of these books the catastrophe, homicide by the leading characters, is the direct conse quence of the domination of the will by hallucinations and delusions. Two char acters stand out prominently in the his tory of the world as examples of para noia; one, the Roman Emperor Caligula, and the other the Czar, Ivan the Fourth, surnamed the Terrible. In the graphic pages of Suetonius one can follow the at first gradual and then more rapid development of the delusions of grandeur and of persecution, together with the sexual excentrieities and the hallucina tions of hearing of the imperial Roman madman. The historical data upon which the paranoiac character of Ivan is based are full and well supported. It is, however, in a romance, "Prince Ser6 bryam," by Count Alexis Tolstoi, trans lated into charming English by Jeremiah Curtin, that the hallucinations, the de lusions of suspicion and persecution, of grandeur, of religious exaltation are traced with the hand of a master. It is strange that the best descriptions of this form of insanity come to us from the hands, not of physicians, but of writers of fiction. GEORGE H. Rolm.] Symptoms. — HALLUCINATIONS. Among hallucinations, those of hearing are most frequent and annoying. They may be simply disturbing noises, but are usually recognized as distinct voices often attributed to particular persons. Rarely the character of the hallucinations is pleasant and agreeable; much more fre quently they are irritating. Thus, in the most frequent form of the auditory hal lucinations the subject hears persons accuse him of dishonesty or other im proper practices, persons call him oppro brious names, or he hears conversations which reflect upon him in various ways. Under the influence of these hallucina tions the patient may make complaint to the suspected person, or invoke the aid of the law to right what the patient con siders wrongs done him. When these measures fail, the patient may take the law into his own hands and endeavor to right the wrongs himself.