It is curious how rational these patients may be on all other subjects except the special topic of their delusion. During the past year a paranoiac has been under observation, who is considered a reasonably rational individual by those who know him well, who follows his daily occupation, that of clerk, without intermission and with business ability, who is a faithful attendant at church, and who is very kind to his family, but who is sure that he is the subject of persecution by the Clan-na-Gael. He never belonged to the organisation. He is not able to give any good reason why he should be persecuted, except perhaps the fact that, though an Irishman, he never did belong to them. He is perfectly sure, however, that they are planning to poison him and his family. He finds peculiar tastes in the tea and the coffee at times. He throws out these materials and insists on his wife getting others at another grocery store. He sometimes brings groceries home from a distance and yet finds that if he ever buys materials a second time in the same place, they are sure to have been tampered with in the meantime by emissaries of this secret organisation. He feels sure that he has seen these secret agents, but he is only able to give vague descriptions. Not a little of the prejudice against these organisations is really founded on such morbid suspicions.
Another form that the idea of persecution sometimes takes, in this second stage, is the delusion that the patient is neglected by those who should specially care for him or her. A woman insists that she is neglected by her husband. She may become intensely jealous of him and make life extremely miserable for him without there being any good reason for her jealousy. These cases are not nearly so rare as might be thought. On the other hand, men suspect their wives of unfaithfulness. This suspicion may go to very serious lengths in persecution at home, though the man all the time keeps his suspicions to himself, in order not to make a laughing stock of himself outside of the house. It is this curious mixture of [{290}] rationality and delusion that is the characteristic feature of the disease. It is for this reason that these conditions were sometimes called monomanias, as if patients were really disturbed only on one point. As a matter of fact, however, patients are mentally wrong on a number of points, though there is some one mental aberration so much more prominent than other peculiarities that it overshadows the others.
It is not long after the persecutory stage sets in before patients are apt to become themselves persecutors of others as a result of their belief that they are being persecuted. The French have a suggestive expression for this. It is persécutés persécuteurs, that is to say, "persecuted persecutors,"—patients who are trying to repay supposed persecutors by persecution on their own part. Such patients, of course, very easily become dangerous. They need to be carefully watched. As a rule, the persons whom they are prone to select as the persecutors upon whom they must avenge themselves are absolutely innocent parties. At times they are even dear and well meaning friends.
After the persecutory stage in paranoia, comes the third, or so-called expansive period of the disease. It has been remarked that sometimes this develops as a sort of logical sequence from the patient's ideas of persecution. If he has too many enemies and if important secret organisations are trying to be rid of him, he must be a person of some importance. As a consequence he evolves for himself a royal or aristocratic descent, or hints that he is the unacknowledged son of great personages. In a kingdom royalty is, of course, a dominant idea. In a republic like our own, he may consider himself to be the President or the politician to whom the President owes his office.
Paranoia Religiosa.—Not infrequently the first hint of their supposed greatness comes to such patients suddenly in a dream or in a vision; when their expansiveness takes a religious turn, this is especially apt to be the case. They may believe themselves to be especially chosen by the Almighty, a new Messiah or even Christ Himself, come once more to earth. Such people may retain much of their rationality on most of the points relating to practical life, and yet have this [{291}] hallucination as to their close relationship with the divinity. Not only may they retain their mental equilibrium on other points, but they may even give decided manifestations of great genius. This is, I suppose, one of the most interesting features of this form of mental disease, but it is well illustrated in the lives of many modern founders of religious sects, even in our own generation.
Such religious reformers as Mahomet and Swedenborg seem undoubtedly to have been afflicted with this third stage of expansive paranoia. In our own day there is no doubt that many of the founders of new religious sects, many of the heaven-sent apostles or reincarnations of patriarchs and prophets, the miraculous healers and the like, are afflicted in this same way. It is useless and entirely contrary to the known facts to put such people aside as mere imposters. Imposters they are, but they have imposed on themselves as well as on their followers. They are sincere as far as they go, and the mental twist that gives them their power has occurred in the midst of the manifestation of the intellectual faculties of a highly practical character and of executive ability, with wonderful capacity for the direction of complex affairs. A prominent neurologist said, not long ago, that the most interesting feature of Christian Science is to contemplate in the study of the movement how near people may come to insanity and yet retain their faculty to make and handle money and even accumulate fortunes.
Paranoia Erotica.—After the paranoia religiosa, the most common form of the disease is the paranoia erotica. There are authorities in mental diseases who do not hesitate to say that an excess of religiosity and of erotic sentimentality are more or less interchangeable. This declaration represents, however, the unconscious exaggeration of a mind unsympathetic towards religious ideas. But it must not be lost sight of that the two forms of excesses, erotic and religious, are more nearly related than would be ordinarily supposed, and that erotic manifestations may be confidently looked for in patients who have been afflicted by a too highly wrought religious sentimentality. St. Theresa seems to have realised this very well and has touched on the subject in one of her letters.
Ordinarily erotic paranoia manifests itself by the patient imagining himself or herself to be beloved by some one of superior station. This love is of rather a platonic character and the "lover" cranks are prone to pick out as the object of their attention and annoyance some young woman rather prominently in the public eye, but whose reputation is of the very highest. Mary Anderson was the subject of a good deal of this sort of persecution. At the present moment the well and favourably known daughter of a great millionaire is the subject of many such attentions.
These paranoiacs are apt to become dangerous if they are prevented from paying what they consider suitable attention to the object of their affection. In hospitals they have to be carefully watched, and more than one accident has taken place as the result of relaxation of vigilance on the part of their attendants. If kept from the object of his affection, delusions of persecution become prominent in the amorous paranoiac, and he may become a persecutor in turn and thus a dangerous lunatic. He can not be made to understand that the sending of flowers and photographs and letters is entirely distasteful to the chosen one. Fortunately, after a time, in many of these cases, a state of dementia sets in, and then the patients become mild-mannered imbeciles whom it is not at all difficult to manage.