Essays In Pastoral Medicine

by Austin O'Malley; James J. Walsh

Paranoia occurs a little more commonly in females than in males. As it is of hereditary origin, it is not surprising to find that the peculiarities are noticed very early in life, though they may not be sufficiently emphasised to attract the attention of any but acute observers, who are brought closely in contact with the patients. Even in childhood, patients who subsequently develop serious forms of paranoia, usually have been shy, backward, inclined not to play readily, irritable, peculiar, precocious, prone to spend much time in study at an age when they ought to be interested mainly in sports, and they are generally old beyond their years. A typical example of this was Friederich Nietzsche, the German philosopher, who died a few years ago in an insane asylum.

Olla Hanssen, Nietzsche's biographer, who carefully collected the family accounts of the philosopher's childhood, said that he did not talk until much later in childhood than is usual. "As a boy he was retiring and solitary in his habits. During his school days he was always interested in books not in sports, in lonely walks not in young companions." A history of this kind will be found in the early career of many queer folk. Very often these old-fashioned traits are a source of pleasure to parents and sometimes even to teachers. During childhood, however, the sports of childhood should satisfy the child, and abnormalities of interest in things outside of childhood's sphere are always suspicious. The growing [{286}] organism needs, first of all, muscular exercise, and after that the freedom of mind that comes with spontaneous play. It may be said, in passing, that the walk of a city child with its maid, when even the child's choice in the matter of where it shall walk is not consulted and the maid's will is constantly imposed, is the worst possible training for spontaneous action or volition in later life.

In the cases that develop early in life it will practically always be found that infantile cerebral disorders of some kind are a prominent feature of the history. The mother's delivery was difficult perhaps, and the child was for some time after birth unconscious, or infantile convulsions occurred. It may be remarked here that a history of convulsions in childhood is now considered by physicians as of serious import for the future nervous and mental life of the child. It has recently been announced, for instance, that so-called idiopathic epilepsy,—that is, epilepsy without some directly immediate cause,—very seldom develops later in life in persons who have not had in childhood convulsive seizures as the result of some extreme irritation. This does not imply that every child that has convulsions will suffer from some serious nervous or mental condition later; but every child whose mental and nervous equilibrium is not stable, because of hereditary elements of weakness, will almost certainly suffer. Injuries to the head in childhood are nearly of as great importance as the actual occurrence of convulsions.

There are usually three stages of paranoia described by authorities in mental diseases. These have been called the prodromal or initial period, which is also, because of the set of symptoms usually most prominent in it, often called the hypochondriacal stage of the disease. The patient occupies himself with his feelings and his sensations. He is concerned very much about the state of his health and is prone to think himself affected by diseases that he reads about or hears described. This set of symptoms, by itself alone, is not an index of enduring mental disturbance, but may be only a manifestation of a passing mental perturbation in sympathy with some slight physical ailment. This state may indeed be nothing more than the result of too persistent introspection. [{287}] Most medical students suffer from a certain amount of hypochondria during their early acquisition of a knowledge of the symptoms of disease.

In the true hypochondriac, however, every bodily sensation, or as it is technically called, somaesthetic sensation, is translated to mean a significant symptom of serious disease. A slight feeling of fatigue becomes to the patient's mind the "tired feeling" of a dangerous constitutional disorder. Any peculiar feeling, such as that of the hand or foot going to sleep, is set down at once as a symptom of a serious nervous disease, or if the patient has heard that in old people numbness of the extremities is a forerunner of apoplexy, he is sure to conclude that apoplexy is threatening in his own case. Subjective sensations of heat and cold set him to taking his temperature and his pulse, and even slight variations in these are magnified into important physical signs of disease.

Very often such slight symptoms as passing lapses of memory are magnified into approaching complete failure of memory, and lassitude becomes a permanent loss of will power, evidently due to disease in the patient's mind, and there begins the persuasion that nothing can overcome it. Morbid introspection becomes, after a time, the favourite occupation, and every slightest sensation or feeling sets up trains of thought that lead to far-reaching conclusions with regard to physical weakness. The patient is apt to be greatly preoccupied with himself, to neglect his duty towards others, to be utterly selfish, to fail to realise how much sympathy is being wasted on him.

Some people never pass beyond this preliminary stage of the mental disorder. Usually, however, after a time the patient misinterprets not only his own sensations, but the actions of other people in his regard; he becomes suspicious and distrustful of everybody around him, sometimes even of his best friends. He is passing on to the second stage of the disease, in which he is sure to feel that he is the object of persecution. Just as he misunderstood his physical symptoms, so he misconstrues the actions of his friends. He is sure that they look at him curiously, that they smile [{288}] ironically. Sometimes he thinks that they wink at one another with regard to him, or make signs behind his back that are meant to be derisive. Even harmless passing observations may be morbidly perverted into severe and inimical criticism of himself and his actions.

The paranoiac is now apt to enter fully upon the second or persecutory stage of his mental disorder. His distress and discomfort he attributes to those around him and he is sure that he is the subject of persecution. At first his persecutors are not very definitely recognised. No particular person is picked out and even no particular set of persons. There is just a vague sense of persecution. A distinguished neurologist once said that no sane person in this world, outside of a novel or a play, has time to make it his business to persecute anyone else. When people come, then, with stories of persecution, either they themselves are not in their right mind and are deluded as to the source of the persecution, or else their persecutor is not in his right mind and the case needs seeing to from the other standpoint.

After a time, longer or shorter in individual cases, the paranoiac begins to recognise definitely who his persecutors are. As a rule, it is not some single individual, but a combination of individuals. Already there is the beginning of the third state of the disease—the grandiose stage of the disease, in which the patient feels an extreme sense of his own importance. It would be derogatory to his self conceit to consider himself the subject of persecution by an individual, and so it is usually some society, or the government, or its officials, or some secret organisation that is persecuting him, and perhaps also persecuting those who are near and dear to him.

Sometimes it is the Odd Fellows, or perhaps the Masons, who are the persecutors. If the newspapers have recently had some account of the disappearance of Morgan years ago, and this subject crops up periodically in the papers, then the Masons become a favourite subject for paranoiacs' delusions of persecutions. Just after the Cronin murder in Chicago, the Clan-na-Gael became an extremely fearsome spectre for paranoiacs who thought themselves persecuted. It is of some [{289}] importance to know, as a rule, what the usual reading matter of a patient is, and what things are likely in his past history to have impressed him, in order to realise what the real source of his delusions of persecutions are.