Mechanisms in Paranoia: With Report of Case

Sir William Osier stated that “to know medicine is to know syphilis and its manifestations.” A famous neurologist of New York once stated in a lecture on multiple sclerosis that if a neurologist understood this disease, its pathology and manifestations, he would know everything there was to know of neurology. So we can say the same of paranoia. If we understood this enigma of psychiatry we would have a good conception of the psychic forces that govern psychopathology. Hence to understand paranoia is to understand psychiatry.

Heinroth1, in the early part of the 19th century, used the term paranoia to include special types of acute confused thinking (delirium), a trend which has been followed by certain psychiatrists to the present day—as seen, notably, by Ziehen.

The conception of paranoia has been dominated for many years by the description of Magnan in France, von Krafft-Ebing in Austria, and Kraepelin in Germany. These writers have confined themselves to the descriptive phases of the disease. It was not until Freud gave us his conception of paranoia that we began to see the underlying causes of the mechanisms of this enigma of psychiatry.

It is said that true paranoia is a rare disease. The writer has observed many cases in the years that he has spent in the New York State Hospital service; however, at that time he was not acquainted with the dynamic phase of psychiatry and his conception of paranoia was from the Kraepelinian descriptive clinical aspect, that is, that it is a chronic delusional system characterized by systematized delusions of a logical nature, with the absence of hallucinations, no regression in the intellectual field, and subject to a strong emotional reaction. While in Vienna, in 1927, the writer analyzed a case of what he considers true paranoia. The analysis of this unique case lasted four months. It is reported here to demonstrate that the findings simulate findings in schizophrenia, with an absence of