"Here's another: Simply meaning that Kahn is not a Jew at all but simply an
Ur.
"So you see I have not altogether forgotten some of the topics of our meeting."
If our claims be allowed we should be able to make some deductions of value to psychiatric theory. The first is an explanation of scattering of thought. We find that, in all our cases showing constructive delusions, the utterance of these highly elaborated fancies is not accompanied by scattering. On the other hand it is an every day experience that a dementia praecox patient may show no scattering when conversing on indifferent subjects but that his train of thought loses logical sequence when he launches into his ideas. These findings may be reconciled by studying the reaction with types of ideas such as the last patient showed. In his intervals he was (and is) continually busy with delusional thoughts but of a constructive character, but was never scattered as long as these were alone present. As soon, however, as an attack commenced and cruder ideas appeared he became scattered. Where were these crude ideas in the intervals? They were represented in his constructive delusions it is true, but in their native form they did not appear. The cruder fancies must therefore have been in the unconscious during his intervals. Now actual verbatim records show with him that these crude ideas did not come to expression in logical sequence but that each appeared in response to an idea previously in his consciousness which was a distorted formulation of the crude fancy next to appear. His utterances during these attacks would have a logical sequence if they were translated into terms of the underlying crude ideas. The scattering, therefore, was due to the fact that his utterances were a mixture of crude and elaborated fancies. Had they been entirely one or the other there would have been no scattering. During his intervals he dealt with objective fancies and was logical. As these fancies, however, could be easily demonstrated to be derived from the unconscious crude ones, which appeared during his attacks, we are safe in assuming that one factor at least in the production of an attack was the lifting of some inhibition which kept the cruder ideas from entering consciousness except in a form in which they could be objectively viewed and so logically arranged. Scattering of thought therefore arises from the intermittent action of this censor or from an incomplete abolition of the inhibition allowing varying formulations of the crude ideas to gain expression which have no logic surface connection. If entirely done away with, of course, the latent ideas appearing in perfect crudity would have a logical connection. The content of consciousness is what is within the sphere of introspection. We can therefore say that the praecox who is scattered really does not know his own ideas. This is, of course, an every day experience for those who examine such patients. A suitable case left to himself will give expression to a limited number of delusions which he does not correlate. A few suggestive questions, however, will educe a mass of delusions, which when pieced together demonstrate the logical unconscious ideas that give rise to them. If such a patient be asked "What are your ideas?" he can give no reply. Ask him, however, if any one is mistreating him and you will start a train of thought in which one fancied insult leads to another or to delusions which do not represent mistreatment at all. On the other hand approach a patient with constructive delusions with the same question as to his ideas and he will produce a theory of the universe, often with a chronological account of how these ideas developed. He is insane in that his fancies do not reach an outlet in action being an end in themselves; but he is sane in so far as he keeps his ideas within the range of introspection and has not allowed them to become autonomous. The inferences from this to the laws of normal association are obvious.
The second point is really a historical one. Psychiatrists are often asked, "Was Joan of Arc crazy?" "Was Saint Louis a dementia praecox?" In an endeavor to answer such questions wise books have been written detailing the "psychoses" of historic or religious leaders. There is probably not a single delusion expressed by any one of the patients whose cases have just been recited that is not duplicated or paralleled by the belief of savants of a few centuries ago or the uneducated of to-day. The last patient said "All nature is artificial, man made it all. All the world would disappear, if man lost the power of reproducing. The reproduction of nature by man is founded on faith—constant reiteration and association with a thing will produce that thing." Is this not analogous to the working hypothesis of the alchemists? The more sincere among them sought salvation for their souls. To gain this they worked with metals to which they ascribed abstract or moral qualities. Their metallurgy was primarily symbolic, yet they seriously hoped for results by working with symbols. And to what extent of absurdity and crudity did they go? Many of their metallurgic terms were sexual processes. Their "prima materia" was called by the name of many of the secretions or excretions of the body. A whole school—the Seminalists—adhered to the view that the great original substance was semen. Other thought it was hermaphroditic. Paraceleus spoke of the birth of monsters as a result of sodomy. A natural history[4] written three centuries ago tells of semen being carried by wind. Notoriously there was no limit either to the absurdity or crudity of these conceptions. Were these men—the wisest of their time—insane? Here again we may quote the last patient—"Insanity," he says, "is the elemental human mind left to itself, unimproved by other minds." The last is the important phrase. What minds were there to improve those of the alchemists? What critic was there to tell Joan of Arc that visions and voices were pathological? That was the regulation form of inspiration in her day. Comparative mythology like a comparison of mysticism, alchemy, rosicrucianism and masonry shows that the human mind left to itself will formulate similar ideas. These ideas, however, are modified by the advance of learning as time goes on. The individual whose critical faculty allows him to maintain an idea incompatible with the knowledge of his age and his fellows is insane.
[4] The Historie of Foure-Footed Beastes, by Edward Topsell, London, 1607.
Our last point is a corollary to the claim we have just made. It has been the sport of iconoclasts for many years to discount all religious beliefs as psychopathic. This is not the forum where the problem of science versus religion may be discussed but these cases have certain features which should warn us to be wary of such generalizations. We have seen that religious formulations have been used to embody crude fancies. That does not preclude the possibility of the formulations having an actual basis. A flag may gain its importance to a given individual because it symbolizes for him his native land but that does not prove that the flag has not an existence of itself. This, however, is a matter of logic and not of psychiatry. Let us now grant that all religious formulations have an unconscious origin. But there still remains a wide gulf between patients such as we have been describing and the devout church-goers. The former show in their productions how their religious ideas arise, their egocentric quality is patent, they manifestly are but thin cloaks for selfish wishes. The latter, however, never in consciousness connect their religious formulations with their subjective creations. To the true believer his God is as objective a reality as is the electron of the physicist. Finally, real religious faith has a pragmatic value. Granting it be only a theory it nevertheless produces results in conduct. This is in sharpest contrast to religious delusions. They never lead to sustained effort, they bring with them no social potentiality. They exist for the comfort of the patient alone.
To sum up: We have endeavored to establish the claim that delusions in dementia praecox which takes the form of objective speculations rather than subjective experiences are an evidence of a milder psychotic reaction and hence warrant a prognosis of chronicity rather than deterioration. From the cases presented we argue that scattering of thought arises from a failure to formulate underlying fancies in an objective way; that the insanity of ideas depends not on themselves but on the critical judgment of the age which produces them, and lastly that there are essential psychological differences between creeds and religious delusions.
SOCRATES IN THE LIGHT OF MODERN PSYCHOPATHOLOGY
BY MORRIS J. KARPAS, M. D.
Assistant Resident Alienist, Psychopathic Department of Bellevue Hospital of
New York