The so-called querulous paranoia is a form of paranoia which is of practical importance, and which is often misunderstood. It is not the quarrelling and fault-finding that characterises this form of insanity, but the manner of doing it. There are plenty of persons who are always defending with stub born tenacity their actual or supposed rights, without ever being thought mentally unsound. Yet there is a difference between the mentally sound and the unbalanced. The one of sound mind discontinues his case as soon as all appeals have been exhausted, and does not suspect every legal decision of being based on malice, selfishness, bribery, and treachery. In the querulous person of unsound mind there develops a systematic train of ideas of persecution. He believes all his adversaries to be rascals or knaves, the judges to be dishonourable and corruptible, the witnesses to be perjurers. He sends addresses and complaints to high officials, and, receiving no hearing, he becomes insulting ; lie is punished, but continues his insults in spite of sad experience or good advice. Like those insane persons with ideas of persecution already described, the querulous paranoiac believes himself to be the victim of a plot ; his rights are disputed, he has enemies who seek his undoing, but lie will and he must conquer them. He squanders his entire fortune in the " preservation of his interests " ; he writes violent articles to the newspapers ; and he assumes the role of saviour of distressed mankind. If the Court pays no attention to him and his insults, he resents the ignoring of his complaints ; and he will commit penal acts, shoot innocent people, or smash shop windows or mirrors for no other purpose than to get a hearing and again to plead his " rights " in court. In this way the affair is drawn out for years and years.
If the paranoiac finally is placed under the care of a guardian or in an asylum, he finds fresh opportunity for endless complaints and troubles on every occasion. Of course, the alienists are in the plot ; they also are his enemies, and act only from personal motives. Alany pamphlets which have issued from asylums, entitled " Incarcerated Innocently," or " The Modern Vehmic," came from the pens of paranoiacs. They are often cleverly written, and find readers who believe in the writer and in his prejudiced representation (for who is not ready to give credence to evil reports !) ; and these credulous readers wonder how such an " intelligent " man can be put into an asylum. But the fact that these insane persons cut sorry figures in the asylums, and that every alienist would be overjoyed if he could, with good conscience, let these lunatics loose upon the world to commit fresh deeds of foolish ness, should warn the public against false impressions and ugly suspicions. The querulous paranoiac as described is actually sick, for he suffers from the delusion of persecution. That he is everywhere at a disadvantage and is treated unjustly has become a settled fact to him. This belief has become incorrigibly " fixed " in him ; and this differentiates the condition, like all other forms of delusion, from simple misunderstanding, which can always be corrected by the intellect. This idea dominates his thoughts, his feelings,
and his will, and stamps upon his personality the seal of mental disease. These paranoiacs are nearly always dangerous lunatics. What makes them more dangerous is that the untrained mind cannot perceive the kind of sickness from which they suffer. Even judges do not know this type as well as they should.
4. Dementia Prwcox.—This is an important type of mental disease. It is a form of mental breakdown in the young. The French speak of it as " stranded on the rock of puberty," since so many young people go to pieces at that time. This is a disease which fathers and mothers should under stand, for it may at times be avoided by adopting a proper mode of living for their children at the first signs of its outbreak, and thus save them for a life of usefulness. The disease usually begins with mental depression and a mild grade of confusion. The afflicted find it hard to take interest in their books, and there is a tiring of voluntary attention (to be distinguished from the laziness of children) which is present even in their play. The memory becomes impaired, particularly with regard to recent events ; and a certain emotional deterioration begins to take place. Dementia prxcox is a very prevalent type of mental disease. It may be recognised early by experts, and a lifelong dementia and wasted life be avoided.
5. Manic-Depressive Insanity.—This is a prevalent mental disease which corresponds to the disorder which earlier medical authors termed circular insanity. Many authors have also used the terms mania and mel ancholia for this disease. Conditions of depression are often encountered in the insanities. Manic-depressive insanity, however, is an independent disease which has a well-defined course, and which is strictly differentiated from all the other forms of insanity. It is characterised by an afflicting psychic depression, with great loss of self-reliance, alternating with states of excitement. From the psychic grief of the healthy it is distinguished by either absence or insignificance of external cause, or by the force with which the entire mental and psychic life of the affected person is made subject to the condition for weeks and months. For instance, a mentally sound mother who bewails the death of her child will never, deep as her grief may be, become fully the slave of her sorrow ; she is able after a time to console herself, and to master her sentiments. Not so, however, the melancholic. Her train of thoughts is riveted to one single point ; she has no room for other interests ; her entire imagination is obstructed ; her energy relaxes ; and whatever she may experience becomes a new source of grief. A very good example of the transition from the normal to the morbid is presented by home-sickness, which sometimes actually assumes the character of well developed melancholia.