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The author starts with a description of a case in which he was able to observe the development of delusions in their early stages. He states that this case throws some light on delusional formation and the belief of these patients in the reality of their phantasies. The patient exhibited memory visions connected with noble birth and associations with the Royal Family. The grandiose delusional attitude developed later from these earlier visions and the patient became a typical paraphrenic. In this case of an intelligent adult the foster-parent phantasy found expression in a delusional form. The difference between the wish-fulfilment foster-parent phantasy of the child or psychoneurotic who enjoys it, although knowing it to be imaginary, and the psychotic, is that the latter knows it to be real. Like the phantasy which is built up from memory images, the foster-parent delusion is probably a massive revival of similar phantasies in childhood. The abnormal character of the phantasy is constituted in the feeling with which it is invested. The difference between phantasy and delusion is important but elusive, and in the case quoted it is just this vague quality of the phantasy which constitutes the difference between insanity and the neurosis. Stress is laid on the non-volitional character of the images in the mind of the psychotic. This patient did not wish to be great, but 'greatness was thrust upon him'. The development of the delusion is compared to the development of an instinct. Delusions symbolize the working of unmoral primitive impulses, and in the case quoted express omnipotence and egoism.
The onset of the delusion often results in a cessation of tension and appears to supply a fundamental need. It is unfortunate that no psychotherapeutic method is able to prevent the development of delusional trends. Examples of the primitive instincts which control the psychotic are found in the hallucinatory personality which overshadows the patient (sadistic im