The Significance of a Delusion

A young man of twenty—two was referred to me with the statement that he suffered from an obsession. While playing football in college he had broken his nose, and as a result its shape was slightly altered. He then developed the morbid idea that this hardly noticeable deformity gave him a “sour expression” and caused him to look like a “sissy” or “mollycoddle.” This, he said, made him extremely self—conscious, and added that he had observed that other people noticed his appearance and laughed at him because of it. These things gave him so much annoyance that he had appealed to his family for permission to leave college, and when they failed to grant it he ran away and went to work as a laborer. His morbid idea had come on almost immediately after the injury. So far as I could learn he had never shown any definite signs of mental illness prior to that time.

When I first saw the patient he seemed to have considerable insight into his illness, but a Jittle longer acquaintance with him clearly showed that he was suffering from a delusion rather than an obsession, and that his malady was a beginning paranoid dementia precox. In consequence, he remained under my care only a short time, though long enough to furnish some interesting data as to the meaning of his morbid beliefs.

The patient was the only son in a rather prominent and well—to—do family. He had one sister several years older and one four years younger. His father had died some years earlier; his mother was living and had married a second time a few months before his illness broke out.

In school he had been a fair student, though without serious interest in study. An extreme readiness to take offense at real or fancied slights and an overweening conceit tended to make him unpopular with his fellows, and the teachers considered him rather malicious and unruly. He was a fine athlete, however, and the best football player in the school, and his achievements in this sphere well counteracted the tendency to unpopularity