Some Mechanisms of Paranoia

Of the numerous and widely diversified clinical conditions which the psychologist and psychiatrist are called upon to investigate, perhaps no single one presents more difficult problems than does paranoia. Though by this time we have arrived at a satisfactory insight into the grosser symptoms of this disorder, we are apparently still far from anything approaching a deeper, more lucid understanding of the subtler motivation at work in the disease; and there remains some considerable amount of scientific debate with regard to the precise aetiology.

The purpose of this paper is to offer a few speculations on certain mechanisms which are prominent in paranoia, as well as to accord some attention to various theories of its causation. The time seems ripe, in any case, for a reconsideration of the Freudian theory of paranoia. I shall proceed on the assumption that the classical symptoms of this psychosis are so familiar both to psychologists and to psychiatrists that no reference to them, or description of them, is either desirable or necessary.

After all this time, there can be no doubt in the mind of any trained investigator that Emil Kraepelin was abundantly justified, as Freud points out, “in taking the step of separating off a large part of what hitherto had been called paranoia and merging it, together with catatonia and certain other varieties of disease, into a new clinical unit” ( Collected Papers, Vol.  III, p.  462). Here, as in so many other matters, Kraepelin has evinced his remarkable skill in nosology. For while it is true that aetiologically and phenomenologically the two disease-entities—i.e., paranoia and schizophrenia—possess some points in common, each one nevertheless has enough distinctive features of its own to demand nosological independence.

According to the Freudian viewpoint, paranoia represents, essentially, the individual's striving towards the repression of homosexual tendencies which the ego is unprepared to acknowledge or entertain. Ferenczi, inde