The Paraphrenic's Inaccessibility1

The root words of paraphrenia, meaning beside or beyond mind do not disclose beside or beyond whose mind, but discarding for the moment the formal history and meaning of the term with its close relation to paranoia and schizophrenia or dementia praecox, we know that it can be applied accurately in its latent meaning to a disturbance of personality which lies beyond the mind or understanding of the psychiatrist—although not nearly so much as it did before the illuminating work of Kraepelin, Freud and Jung. The patient often has at least a partial insight into his condition. The physician has not enough insight to cure him. He may be able to transform some of the symptoms into those less troublesome, to solve a few conflicts, and make several hours less unhappy for the patient, but he does not cure him in the same sense that he cures a psychoneurotic. The physician may also make to his own satisfaction many plausible interpretations of the patient's symptoms, but unless these are accepted by the latter and effect his release from them, they do not fulfill their function of curing. The term paraphrenic includes a connotation of the physician's unconscious revenge against the patient becauses he could accomplish for the latter so much less than he attempted.

Some paraphrenics effect an automatic self-cure in a selected environment by returning to their own norm after reaching the limit of regression and then reversing the process.

We are now classifying psychoneurotics and normals together quite easily. No one feels hopeless if he is called neurotic, but the term paraphrenic carries with it a sense of incurability. Still, because there are so many signs of immense energy stored away in the nature of paraphrenics, we are tempted again and again to continue our search and speculation, to keep on working with them, in and out of their several kinds of attacks, even though we find after all our efforts that the patient continues to be locked up behind his inaccessibility.