of an insulting character, while others are compelled to listen
to regular dialogues carried on by unknown voices concerning
themselves. A not uncommon form of verbal hallucination is
formulated in the complaint of the patients that " all their
thoughts are read and proclaimed aloud." Even more than the
enforced hstening to verbal hallucinations this " thought reading
" distresses the patient and often leads him to acts of violence,
for the privacy of his inmost thoughts is, he believes, desecrated,
and he often feels helpless and desperate at a condition from
which there is no possible escape.
Though some of the subjects do not develop any other form of hallucination, it is unfortunately the lot of others to suSer, in addition, from hallucinations of taste, smell or touch. The misinterpretation of subjective sensations in these sense organs leads to the formulation of delusions of poisoning, of being subjected to the influence of noxious gases or powders, or of being acted on by agencies such as electricity. Such are the persons who take their food to chemists for analysis; who complain to the police that people are acting upon them injuriously; who hermetically seal every crevice that admits air to their bedrooms to prevent the entrance of poisonous fumes; or who place glass castors between the feet of their beds and the floor with the object of insulating electric currents. Such patients obtain little sleep; some of them indeed remain awake all night — for the symptoms are usually worse at night — and have to be content with such snatches of sleep as they are able to obtain at odd times during the day. It is obvious that a person tormented and distracted in the way described may at any moment lose self-control and become a danger to the community. But perhaps the most distressing and most distracting of all hallucinations are those which for want of a better name are termed " sexual." The subjects of these hallucinations, both male and female, under the belief that improper liberties are taken with them, are more clamant and threatening than any other class of paranoiac.
During the course of a disease so distressing in its symptoms the patient's suspicions as to the authors of his persecution vary much in indefiniteness. He often never fixes the direct blame upon any individual, but refers to his persecutors as "they" or a "society, " or some corporate body such as "lawyers, " "priests" or "Freemasons." It not infrequently happens however, that suspicions gradually converge upon some individual or that from an early stage of the disease the patient has, generally under the influence of hallucinations, fixed the origin of his trouble upon one or two persons. When this takes place the matter is always serious from the point of view of physical danger to the inculpated person, especially if the patient is of a violent or vindictive disposition.
The persecutor type of the disease may persist for an indefinite period — even for twenty or thirty years — without any change except for the important fact that remissions in the intensity of the symptoms occur from time to time. These remissions may be so marked as to give rise to the belief that the patient has recovered, but in true paranoia this is hardly ever the case, and sooner or later the persecution begins again in all its former intensity.
2. Ambitious Paranoia. — After a long period of persecution a change in the symptoms may set in, in some cases, and the intensity of the hallucinations may become modified. At the same time delusions of grandeur begin to appear, at first faintly, but gradually they increase in force until they ultimately supplant the delusions of persecution. At the same time the hallucinations of a disagreeable nature fade away and are replaced by auditory hallucinations conformable to the new delusions of grandeur. Undoubtedly, however, this form of paranoia may commence, so far as can be observed, with delusions of grandeur, in which case there is seldom or never a transformation of the personality or of the delusions from grandeur to persecution, although delusions of persecution may engraft themselves or run side by side with the predominant ambitious delusions.
The emotional basis of ambitious paranoia is pride, and every
phase of human vanity and aspiration is represented in the delusions of the patients. There is moreover considerably less logical acumen displayed in the explanations of their behefs by such patients than in the case of the subjects of persecution. Many of them affect to be the descendants of historical personages without any regard for accurate genealogical detail. They have no compunction in disowning their natural parents or explaining that they have been " changed in their cradles " in order to account for the fact that they are of exalted or even of royal birth. Dominated by such beliefs paranoiacs have been known to travel all over the world in search of confirmation of their delusions. It is people of this kind who drop into the ears of confiding strangers vague hints as to their exalted origin and kindred, and who make desperate and occasionally alarming attempts to force their way into the presence of princes and rulers. The sphere of religion affords an endless field for the ambitious paranoiacs and some of them may even aspire to divine authority, but as a rule the true paranoiac does not lose touch with earth. The more extravagant delusions of persons who caU themselves by divine names and assume omnipotent attributes are usually found in patients who have passed through acute attacks of insanity such as mania or dementia praecox and are mentally enfeebled.
A not uncommon form of paranoia combining both ambition and persecution is where the subject believes that he is a man of unbounded wealth or power, of the rights to which he is, however, deprived by the machinations of his enemies. These patients frequently obtain the knowledge on which they base their delusions through auditory hallucinations. They are often so troublesome, threatening and persistent in their determination to obtain redress for their imagined wrongs, that they have to be forcibly detained in asylums in the public interest.
On the whole, however, the ambitious paranoiac is not troublesome, but calm, dignified, self-possessed, and reserved on the subject of his delusions. He is usually capable of reasoning as correctly and of performing work as efficiently as ordinary people. Many of them, however, while living in society are liable to give expression to their delusions under the influence of excitement, or to behave so strangely and unconventionaOy on unsuitable occasions as to render their seclusion either necessary or highly desirable.
3. Amatory Paranoia. — A distinguishing feature of this form of paranoia is that the subjects are chivalrous and ideahstic in their love. Some of them believe that they have been " mystically " married to a person of the opposite sex usually in a prominent social position. The fact that they may have never spoken to or perhaps never seen the person in question is immaterial. The conviction that their love is reciprocated and the relationship understood by the other party is unshakable, and is usually based upon suppositions that to a normal mind would appear either trivial or whoUy unreal. The object of affection, if not mythical or of too exalted a position to be approached, is not infrequently persecuted by the admirer, who takes every opportunity of obtruding personally or by letter the evidences of an ardent adoration. The situation thus created can easily become complicated and embarrassing before it is realized that the persistent wooer is insane.
The failure of their schemes or repeated repulses may, in the case of some patients, originate delusions of persecution directed, not against the object of affection, but against those who are supposed to have conspired to prevent the success of the patient's desires. Under the influence of these delusions of persecution the patient may lose self-control and resort to violence against his supposed persecutors.
The subjects of this form of paranoia are in the majority of instances unmarried women well advanced in years who have led irreproachable lives, or men of a romantic disposition who have lived their mental lives more in the realm of chimeras than in the region of real facts. The delusions in this form of paranoia are never accompanied by hallucinations.
Closely allied, if not identical with amatory paranoia, is the form in which jealousy forms the basis of morbid suspicions
