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I would like to present a case which came to my attention some years ago, and which graphically displays some particular aspects of what I have referred to, more generally, as the “paranoid process” (Meissner, 1977a). In addition, this same case displays some fascinating and unusual variants of the paranoid process which are rarely observed clinically.
The patient was a young man in his mid— thirties, who held a fairly well— paying position as a minor executive in a large accounting firm. His income was quite comfortable and allowed him to enjoy some of the finer things of life. He lived alone and had never married. The patient was brought to our hospital in a piteous state. He was agitated, disorganized, disoriented, and in a state of tremulousness and overwhelming terror. He would sit clutching his head and moaning, muttering almost unintelligibly about his “enemies.” He was utterly terrified of anyone who even looked like a doctor, and would withdraw in a horrified panic, alternately screaming and crying and then pitifully begging the mercy and pity of the physician.
Not much of a coherent story could be gotten from the patient at this point, so he was admitted to the hospital, given a quiet room, and started on moderately high doses of phenothiazines. Over the ensuing few days, he gradually quieted down and became more coherent. As he became less terrified, he was able, little by little, to reconstruct the story of his coming to the hospital. I would like to summarize the reconstruction of his decompensation, which lasted over a period of several days. Where possible, I will present the patient's account in his own words.