Paranoia

“ Clinical indications teach us that in paranoia a special use is made of the libido which is withdrawn from its object ... the freed libido in paranoia is thrown back on the ego and serves to magnify it.
Note the fact that there is a necessary relation between the fixed ideal system of the paranoiac and his withdrawal of interest in the outside world. The system gains the function of reality for him in the same measure that, loving not the world nor the things that are in the world, he has rendered our common human world unreal. ”

“ For some length of time I entertained the idea that paranoia also—or the group of cases belonging to paranoia—is a defense psychosis, that is, like hysteria and obsessions it originates from the repression of painful reminiscences, and that the form of its symptoms is determined by the content of the repression. ”

“ Every form of insanity, one may say, has a physiological prototype. Melancholia takes for its model the little depressive attacks of everyday life; mania has its prototype in the unrestrained enthusiasm of the baseball “fan”; and even the various forms of paranoia, the true insanity, have their typical representatives [Pg 92] among normal persons. To bring out this kinship we need no better example than that offered by the delusion of greatness. ”

“ Paranoia may be defined as a progressive psychosis founded on a hereditary basis, characterised by an early hypochondriacal stage, followed by a stage of systematisation of delusions of persecution, which are later transformed into systematised illusions of grandeur. ”

“ The delusions of primary paranoia, without being interfered with by any opposing ideas, control the entire mental life of the patient. The remaining ideas not affected by morbid processes stand in close relation, but not in conflict, with the dominating delusions. ”

“ Cases, on the other hand, in which the primary and dominating disturbance is of the cognitive side of mental life, form a group to which the name paranoia is given, and this includes many, if not the majority of the cases which in England would be labelled "mania." This has four chief sub-groups: acute and chronic simple paranoia, acute and chronic hallucinatory paranoia. ”

“ On the contrary, it not infrequently happens that the mode of life adopted by the paranoiacs is of such a kind as would of itself, because of the hardships involved or the mental trials, deter ordinary people from following it. Paranoia, at least in its severer forms, completely justifies the plea of irresponsibility for actions committed. ”

“ They develop in an emotional soil definitely related to the hopes and fears of the healthy individual and are to be looked upon as a morbid transformation of perfectly normal mechanisms. In addition to this he speaks of an increased self-consciousness, a natural tendency to resistiveness, an undeveloped type of thinking, psychological compensations for the disappointments of life, evidences of developmental inhibitions, improper habits of thought leading to morbid conceptions, etc. He refers to exaggerated self-consciousness as the fundamental basis of paranoia. ”

“ This loss of the conscious self in the universal, this turning away from the empirically known, this demand that an a priori principle be followed to its deadly practical conclusion regardless of the ends to which it leads, is of utmost importance for our study. It is precisely what the paranoiac does after his own fashion. ”

“ So far, I've managed to spend more time free than behind bars. Paranoia is my friend." ”

“ Indeed, in watching the amount of attention a paranoiac bestows upon his grievances, the zest with which he takes up every newly discovered flaw in the law, and the dexterity with which he weaves it into the maze of his delusional system, the idea forces itself upon one’s mind that what the paranoiac least desires is a settlement of his grievances. ”

“ The disease picture, even when it appears, has a certain duration and independence. The whole course of the disease is quite narrowly limited in time, and goes on either to recovery or dementia. 6. No tendency to periodicity of the attacks or the grouping of symptoms. 7. Sanity and insanity are sharply defined, and in striking contrast." In this group he includes mania, melancholia, acute curable dementia and primary [492] hallucinatory delirium. He describes hysteria, neurasthenia, etc., under the psychic degenerations with paranoia and speaks of them as constitutional neuroses. ”

“ Then the metaphorical paralysis of fear is seconded by the simulation of a literal one, extending through the limbs of one side or both; the sufferer reels, feeling one foot fail him—tries to revolve one arm like a windmill, that he may restore his circulation, and that arm for some instants hangs powerless. Presently, with one tremendous concentration of will, his brain shouts down an order to the rebellious member—it stirs with sullen reluctance—it moves an inch—and then it breaks from the prison of its waking nightmare. ”

“ The scenes of horror exhibited around us, naturally awakened such ideas in every thinking breast, and aggravated the deformity of every failing of our lives. It were a lamentable insensibility indeed, not to have had such feelings,—and I think inconsistent with human nature.
Our distressed helpless condition taught us humility and a contempt of ourselves.—The horrors of the night—the prospect of an immediate cruel death—or, as one may say, of being crushed by the Almighty in his anger—filled us with terror. ”

“ And then I realised a growing stress upon me, a feeling as though some huge human magnet was drawing me upward out of my body. The stress grew and grew. I seemed an atom for which monstrous forces were fighting. For one brief, terrible moment sensation came back to me. That feeling of falling headlong which comes in nightmares, that feeling a thousand times intensified, that and a black horror swept across my thoughts in a torrent. ”

“ Or is some shred of nightmare returning ever and again out of the black depths of my sickness? It comes and goes, and every time new doubts—hope it may be a dream, fear it may be reality—come with it. ”

“ The sense of terror which had so nearly brought me to a condition of paralysis had grown considerably less. I do not pretend that fear had altogether vanished, nor that with but a little provocation it would not have returned with all its former force. But, for the moment, certainly, curiosity was to the front. My chief anxiety was not to allow one of my mysterious visitor’s movements, no matter how insignificant, to escape my notice. ”

“ What do you gain for all your worry? Rest and peace of mind? Alas, no! If the worry and effort accomplished anything, I would be the last to deprecate it, but observation and experience have taught me that the more you yield to these demons of vanity and worry, the more relentlessly they harry you. They veritably are demons that seize you by the throat and hang on like grim death until they suffocate and strangle you. ”

“ How mysterious and how profoundly true this transference of emotion was, or, in terms of the present analogy, these invasions of spiritual microbes! For what caused panic to spread through a crowd? Not danger itself, but fear, fear which ran like an electric current through the ranks of its quivering victims. Serenity, therefore, must be equally contagious, and if one could isolate one of those fear-ridden folk for a moment in a ring of men who were not afraid, it could not be doubted that their fearlessness would triumph. ”

“ It haunts my soul when none is nigh:
I hear its whisper in the sigh
Of that complaining wind.
[Pg 16]
And now in death my soul is fain
To tell the tale of fear
That hidden in my breast hath lain
Through many a weary year:
Yet time would fail to utter all—
The evil spells that held me thrall,
And thrust my life from fall to fall,
Thou needest not to hear. ”

“ Although, by these various modes of exciting imaginary fears, there is no direct and outward infliction of bodily suffering, the effect produced on the delicate organization of the brain by such excitements is violent in the extreme. The paroxysms of agitation and terror which they sometimes excite, and which are often spontaneously renewed by darkness and solitude, and by other exciting causes, are of the nature of temporary insanity. ”

“ The absence of personal fear, the consciousness of security as great in the midst of pestilence and storm, as amidst beds of flowers on a summer morning, and the certainty that whatever appeared evil, or was assuredly painful, must eventually issue in a far greater and enduring good—this general feeling and conviction, I say, would gradually lull, and at last put to entire rest, the physical sensations of grief and fear; so that the man would look upon danger without dread,—accept pain without lamentation. ”

“ How graphic the simile, "gnaw my inwards;" it is the perpetual symbol of worry; the poisonous mineral ever biting away the lining of the stomach; just as mice and rats gnaw at the backs of the most precious books and destroy them; aye, as they gnaw during the night-time and drive sleep away from the weary, so does suspicion gnaw with its sharp worrying teeth to the destruction of peace, happiness and joy. ”

“ Alternate hopes and fears distract my mind, My weary soul no rest can find. My busy fancy now presents A gracious scene: my son repents And God recalls his doom. Now to false shame he quits his fears, False courage takes, and madly dares His impious feast resume. Then arms and dying groans resound, And streams of blood gush out around. Alternate hopes and fears distract my mind, My weary soul no rest can find. ”

“ When we have constructed a true psychological pathology, we shall understand clearly why and how it is that fear can turn the hair gray in a single night; that a mother's milk can be poisoned by a moment of terror; that the heart may be paralyzed by a sudden joy or sorrow; that dyspepsia, paralysis, and many other diseases are produced by mental worry and fret and the brain-fag of overwork and anxiety. ”

“ She clasp'd her hands in pangs severe,
And shrieks reveal'd her agony.
And fainting on the earth she lay,
With struggles of convulsive breath,
As if weak life had fled away
In terror at the sight of death. ”

“ Who shall describe the sensation of the poor mortal, as he felt himself falling—falling down—down, a blind mass, through the darkened air? Those who have fallen, or have leaped even from a moderate height, can have no conception of the frenzied terror that took possession of him for a moment. ”

“ There came in answer the whimper of one too frightened to speak. Did you ever, as a child, Doctor, waken with the nightmare, afraid to cry out, afraid to move, tortured by the whimpers wrung out in reasonless terror? ”

“ After the first sight—after that sharp, quivering intake of breath—the gaze of the condemned man shifts about the room. His expression haunts one. You feel that it is both all-seeing and unseeing. The fear of death—a definite emotion—is here portrayed in a fashion that but few have beheld. ”

“ In fear, suppress the palpitation of the heart, the hurrying breath, the trembling of the limbs, the widening of the muscles, the peculiar state of the viscera; in anger, the heaving of the chest, the congestion of the face, the dilatation of the nostrils, the clenching of the teeth, the staccato voice, the impulsive tendencies; in sorrow, get rid of tears, sighs, sobs, suffocation, anguish—what will remain?—a purely intellectual state, pale, colourless, cold. A disembodied emotion is a non-existent one. ”

“ I had planned to sketch with epic calm a few pictures from the life of common, every-day people,—and behold, I must confess that my hand is trembling, my eyes are somehow moist, and the darkness of vain, barren anxiety is upon my soul. ”

“ And I steered, too tired for anxiety, too tired for connected thought. I had moments of grim exultation and then my heart would sink awfully at the thought of that forecastle at the other end of the dark deck, full of fever-stricken men—some of them dying. ”

“ But all along the line it is the same thing—a paralyzing impression upon the centers of life which can produce, through the agency of the nervous system, a vast variety of morbid symptoms in every tissue of the body.
We have very seldom reflected upon the fact that fear runs like a baleful thread through the whole web of our life from beginning to end. We are born into the atmosphere of fear and dread, and the mother who bore us had lived in the same atmosphere for weeks and months before we were born. ”

“ The evils of worry as well as of its frequent associate, anger, have been dwelt upon by writers philosophical, religious, and medical. "Worry," says one author, "is the root of all cowardly passions,—jealousy, fear, the belittling of self, and all the introspective forms of depression are the children of worry." The symptoms and the evil results seem to receive more elaborate and detailed attention than the treatment. ”

“ In this disorder of his nervous and mental condition, with a doubting conscience and a shrinking heart, is it any wonder that the terrors which lay before him at the gap in those bristling walls, should draw near, and, making sudden inroad upon his soul, overwhelm the government of a will worn out by the tortures of an unassured spirit? ”

“ The unmanning feeling of fear, that had not touched a single heart in the extremity of our danger from the storm, was now strongly marked in every face, exaggerated by a horror of we knew not what. Fear is contagious—we huddled together, and peered fearfully around, expecting every moment to see some appalling vision or hear some dreadful sound. ”

“ Thus, in H. O., attacks of recurrent nausea and fear almost prohibiting social intercourse were always due to thoughts of self-disgust hidden in the fringe.
Let us take a concrete case, that of a person who has a pathological fear and who, as we know is often the case, can give no explanation of his viewpoint. The fear may be that of fainting, or of thunderstorms, of a particular disease, say cancer, or of so-called “unreality” attacks, or what not. This so-called “fear” is of course an idea of self or other 355object linked with, or which occasions as a reaction, the strong emotion of fear. ”