I will cite as an example a patient who was twenty years in the asylum. She was always a puzzle to the physicians, for the absurdity of her delusions exceeded anything that the boldest imagination could create.
She was a dressmaker by trade, born in 1845, of very poor family. Her sister early went wrong and was finally lost in the swamp of prostitution. The patient herself led an industrious, respectable, reserved life. She fell ill in 1886 in her 39th year—at the threshold of the age when so many a dream is brought to naught. Her illness consisted in delusions and hallucinations which increased rapidly, and soon became so absurd that no one could understand her wishes and complaints. In 1887 she came to the asylum. In 1888 her statements, so far as the delusions were concerned, were not intelligible. She maintained such monstrous things as that: "At night her spinal marrow had been torn out; pains in the back had been caused by substances that went through the walls and were covered with magnetism." "The monopoly fixed the sorrows which are not in the body and do not fly about in the air." "Excursions are made by breathing in chemistry, and by suffocation regions are destroyed."
In 1892 the patient styled herself the "Bank Note Monopoly, Queen of the Orphans, Proprietress of the Burghölzli Asylum;" she said: "Naples and I must provide the world with macaroni" (Nudel).
In 1896 she became "Germania and Helvetia from exclusively pure butter"; she also said, "I am Noah's Ark, the boat of salvation and respect."
Since then the disease has greatly increased; her last creation is the delusion that she is the "lily red sea monster and the blue one."
These instances will show you how far the incomprehensibility of such pathological formations go. Our patient was for years the classic example of meaningless delusional ideas in dementia præcox; and many hundreds of medical students have received from the demonstration of this case a permanent impression of the sinister power of insanity. But even this case has not withstood the newer technique of psychoanalysis. What the patient says is not at all meaningless; it is full of significance, so that he who has the key can understand without overmuch difficulty.
Time does not allow me to describe the technique by means of which I succeeded in lifting the veil of her secret. I must content myself by giving a few examples to make the strange changes of thought and of speech in this patient clear to you.
She said of herself that she was Socrates. The analysis of this delusion presented the following ideas: Socrates was the wisest man, the man of greatest learning; he was infamously accused, and had to die in prison at the hands of strange men. She was the best dressmaker, but "never unnecessarily cut a thread, and never allowed a piece of material to lie about on the floor." She worked ceaselessly, and now she has been falsely accused, wicked men have shut her up, and she will have to die in the asylum.
Therefore she is Socrates; this is, as you see, simple metaphor, based upon obvious analogy. Take another example: "I am the finest professor and the finest artist in the world."
The analysis furnishes the remarks that she is the best dressmaker and chooses the most beautiful models which show up well and waste little material; she puts on the trimming only where it can be seen. She is a professor, and an artist in her work. She makes the best clothes and calls them absurdly "The Schnecke Museum-clothes." Her customers are only such persons as frequent the Schnecke House and the Museum (the Schnecke House is the aristocratic club. It is near the Museum and the Library, another rendezvous of the aristocratic set of Zürich), for she is the best dressmaker and makes only Schnecke Museum[200] clothing.