Essays In Pastoral Medicine

by Austin O'Malley; James J. Walsh

As a rule where the patient has passed through the various stages of paranoia, dementia, with symptoms of imbecility, closes the scene. The paranoia may not always follow the course mapped out for it. Stages may be skipped, several forms of delusions may become prominent in the life of the individual at about the same time. The main feature of the disease is its progressive character, and its diagnosis depends on the queerness exhibited all during the course of life, as well as on the presence of hereditary neurotic influences.

Special Forms of Paranoia.—There are besides the two types described a number of special forms of paranoia, some of which aroused attention first under the form of monomanias, that seem to merit brief treatment by themselves. In their extreme forms they are easy of recognition. Milder types, however, may easily escape classification under the [{293}] head of paranoia, because they are considered to be individual oddities and not due to any physical or mental incapacity. Undoubtedly, however, the study of these peculiar "types," as the French call them, from the standard of the alienist or expert in mental diseases, will serve to make clearer the real significance of many otherwise almost unaccountable actions. There is no doubt, that the consideration of these eccentrics as paranoiacs makes the charitable judgment of many of their acts much easier, and at the same time is of service in managing them. They are likely to be of much less harm to the community and to their friends, when it is realised that they are not to be taken too seriously, but that, on the contrary, there is ample justification for a benevolent combination of interests to keep them from injuring themselves and their friends.

Paranoia Querulans.—One of the most important and familiar forms of the special types of paranoia is what is known scientifically paranoia querulans, that is, the peculiarity of those who insist on going to law whenever there is the slightest pretext. It is pretty generally recognised that a goodly proportion of the civil suits that crowd our law courts are due to the peculiarities of these people who insist on having their rights, or what they think their rights, vindicated for them by a court of justice. There are very peculiar characters in this line, some of whom make themselves very much feared and detested by their neighbours. There are some individuals to whom the slightest injury or show of injury means an immediate appeal to the law.

Not infrequently these patients, for such they are in the highest sense of that word, waste their own substance and even the means of support of wife and children, on their foolish law schemes. When their queerness reaches a certain excessive degree its pathological character is readily recognised. In a less degree paranoia querulans may be a source of very serious discomfort to friends and neighbours without exciting a suspicion of its basis in mental abnormality. Not infrequently such patients become more irrational at times when their physical condition is lower than normal, and a return to their ordinary health makes them [{294}] more amenable to reason and less prone to appeal to expensive litigation.

It is evident that the irrationality of frequent appeals to expensive and bothersome litigation should arouse suspicion. Such patients need to be cared for quite as effectually as those who have tendencies to gamble away their substance or to waste it in the midst of inebriety. Unfortunately it is extremely difficult to frame laws so as to meet such conditions. Severer forms of the affliction are readily recognised and the sufferer is properly restrained. I remember once seeing a patient in Professor Flechsig's clinic in Leipzig, who had been sent to the asylum because of his tendency to go to law on the smallest possible pretext. This patient's incarceration in the asylum was due to a very striking manifestation of his paranoia querulans. He answered an advertisement for a clerk, published by one of the large commercial houses. He found himself one of a row of applicants for the position, and as the member of the firm whose duty it was to engage the clerk was at the moment busy, he had to wait several hours before his application was heard and refused. He tried to secure a warrant for the firm in order to have them indemnify him for the time he had spent while waiting for his application to be heard, at the rate of wages they would have been bound to pay him had he obtained the vacant clerkship; only as they had spoiled a day he claimed a full day's wages.

This patient had been in the asylum several times before because of his tendency to go to law. He always gained in weight while in the asylum, became much more tractable and less querulous as his physical condition improved, and usually after some months could be allowed to leave the institution. He was, however, one of the inept. With the help of asylum influence he usually obtained some occupation more or less suitable, but was not able to retain it for long. When out of a situation he worried about himself, usually did not take proper food, and then soon his litigious peculiarities began to manifest themselves once more in such form that if he could get the money to retain an attorney, or if he could persuade one to take his case on a contingent fee, and he was very ingenious at this, he soon became a veritable nuisance to [{295}] those around him. When in poor health he was never contented unless he had at least one lawsuit on his hands, and only really happy when he had several.

The Gambler Paranoiac.—A form of paranoia that inflicts almost more of human suffering on the friends of the patient than any other is that in which the sufferer is possessed of the idea that he can, by luck or by ingenious combinations, succeed in winning money at gambling. Milder forms of this paranoia are so common that it is the custom not to think of even the severer forms of the gambling mania as a manifestation of irrational mentality. When a man thinks, however, that he can beat a gambler at his own game, or when by long lucubration he comes to the conclusion that he has invented a system by which he can beat a roulette wheel, he is, on this subject at least, as little responsible as the man who thinks that he has discovered perpetual motion.

This form of paranoia inflicts suffering mainly on the near relatives of the patient. There is no doubt that when extreme manifestation of the gambling mania becomes evident, patients should be legally restrained from further foolishness. One difficulty with regard to the proper appreciation of gambling has been an unfortunate tendency to class gambling among the malicious actions. There are many people for whom only two sins seem to have any special importance, drunkenness and gambling. As a rule, there is not the least spirit of malice in the ordinary gambler; not meaning, of course, by this the sharpers, who try to make money at the expense of others, but the man who believes that, somehow, chance and fate are going to conspire to enrich him at the expense of others, though it must be confessed that he does not usually even think of this latter part of the proposition which he accepts so readily.

We have had in recent times so many manifestations of the practical universality of the gambling spirit, the belief by people that brokers and banking concerns are ready to make them rich quick, that we have in it perhaps the best illustration of the partial truth of the proposition that "half the world is off, and the other half not quite on."

The "Phobias."—Sometimes the special form of queerness [{296}] takes on a very harmless aspect. Patients are worried because of the fact that they can not keep themselves clean. They want to wash their hands every time they touch any object that has been handled by others, whether that object seems to be specially dirty or not. Such patients may wear the skin off their hands washing them forty or fifty times a day. They almost absolutely refuse to touch a door-knob, because it is handled by so many people. They will consent to take only perfectly new bills. It is almost amusing to see the efforts they make to avoid shaking hands with people, without giving direct offense. When it comes to shaking hands with their physician, they are apt candidly to declare that he must not ask them to do so, because they can not overcome their feelings as to the possibility of contamination from hands that come in contact with so many patients. This fear of dirt has received the name Misophobia.