A further contribution to delusions of environmental nature was somewhat unexpectedly derived from a piece of work on the general mental symptomatology of general paresis.[4] Dichotomizing the paretics (all autopsied cases) into a group with substantial, i. e., encephalitic, atrophic or sclerotic lesions of the cortex and a group without such gross lesions or else with merely a leptomeningitis, I found the latter (or anatomically mild) group to be characterized by a set of symptoms which were all "contra-environmental," whereas the former (or anatomically severe) did not thus run counter to the environment. The conclusions of that paper, so far as they concern us now, are as follows:—
The "mild" cases showed a group of symptoms which might be termed contra-environmental, viz. allopsychic delusions, sicchasia (refusal of food), resistiveness, violence, destructiveness.
The "severe" cases showed a group of symptoms of a quite different order, affecting personality either to a ruin of its mechanisms in confusion and incoherence, or to mental quietus involved in euphoria, exaltation, or expansiveness.
The most positive results of this orienting study appear to be the unlikelihood of euphoria and allied symptoms in the "mild" or non-atrophic cases and the unlikelihood of certain symptoms, here termed contra-environmental, in the severe or atrophic cases. Perhaps these statistical facts may lay a foundation for a study of the pathogenesis of these symptoms. Meantime the pathogenesis of such symptoms as amnesia and dementia cannot be said to be nearer a structural resolution, as these symptoms appear to be approximately as common in the "mild" as in the "severe" groups.
But in both papers dealing with paresis [2,4] we rest under the suspicion that the delusions are possibly of cerebral manufacture. Of course, a lesion somewhere outside the brain is not unlikely to be projected through the diseased brain, and SOMATIC delusions in the paretic are rather likely to represent something in the viscera.
It was desirable to get back to normal-brain material, to learn how the
INTRINSICALLY NORMAL brain[5] could perhaps produce delusions from a
particular environment. Could a particularly "bad" environment actually
PRODUCE delusions?
By chance, at about this stage in our studies of delusions, some work on fifth-decade insanities[6] was completed. This work seemed to show that the most characteristic (non-coarsely-organic) cases of involutional origin were much given to delusions (each of 24 cases studied), somewhat more so than to the hypochondria and melancholia which we commonly ascribe to the involution period. But this result is equivocal as to the environmental (i. e. allopsychogenic) power to produce delusions, since one could not rid oneself of the suspicion that the delusions were due to the degenerating brain.
To return to our former results with the normal-looking brain:
Case after case of the quasi-environmental group proved to be more essentially personal than environmental, until at last it almost seemed that the environment could seldom be blamed for any important share in the process of false belief. In short, we seemed to show that environment is seldom responsible for the delusions of the insane.
Be that as it may, we secured several lines of attack on the delusions of personality by our study of quasi-environmental delusions. First, we were irresistibly led to a consideration of the emotional (pleasant or unpleasant) character of the delusions. We heaped up a large number of unpleasant delusions in that (quasi-environmental, but actually) personal group. It is interesting to inquire, accordingly, whether our more obviously autopsychic cases will also be possessed of an unpleasant tone. Secondly, we came upon the curious fact that cardiac and various subdiaphragmatic diseases were correlated with unpleasant emotion as expressed in the delusions. It was therefore important to inquire whether similar conditions prevailed in the new group. Thirdly, we found ourselves inquiring whether our patients were victims of what might be termed a spreading inwards of the delusions (egocentripetal) or a spreading outwards thereof (egocentrifugal delusions). But this difference in trend, clear as it often is from the patient's point of view, remains to be defined from the outsider's point of view.