Gentlemen!

An overview of elementary symptoms occurring during paranoid states allows us to make the following distinctions: First, we found several changes in content of consciousness, namely delusions and delusional judgments, expressed within an unbroken train of conscious activity, in so far as they were in a logical form, preserving attentiveness and memory, and in their moment-by-moment adaptability to any given situation. However, the intactness of these faculties in no way prevents the remaining content of consciousness appearing to have disintegrated, to a degree, into fragments a fact to which we gave the name ‘sejunction’ [Ed], in other words, the detachment of individual components one from another. Such components initially form tight-knit structures, as complete experiences, but their sejunction is shown by the fact that memories that flatly contradict each other can coexist. The sejunction hypothesis then led us to a closer understanding of certain symptoms of activation, first, of manifestations of disturbed conscious activity itself, then of autochthonous ideas and obsessions [1], and then of hallucinations and delusions of relatedness and reference. Explanatory delusions, which took up much of our discussion, could then be likened to normal expressions of conscious activity, in contrast to the aforementioned primary psychotic symptoms. We then came to recognize subsequent corrections of the content of consciousness as conditions essential for the so-called systematization, itself related closely to explanatory delusions. We also found amongst these corrections a process, which we viewed as normal conscious activity reacting against ‘false intruders’ [Ed]; and we also saw psychotic symptoms in various types of memory falsification, seemingly quite aberrant in themselves, yet appearing to stand in regular relationship with existing disturbances of the content of consciousness, such that their occurrence depended on the extent of changed content. Amongst such psychotic symptoms we distinguished at least three different points of origin, all emerging in part as a reaction of intact conscious activity to alterations of content of consciousness. These included explanatory delusions and subsequent corrections, either of which occurred as a direct consequence of sejunction; the latter included contradictory contents of consciousness in many old cases, and additive and subtractive ways in which memory can be falsified. Lastly, there were excitatory processes arising out of the sejunctive processes: these included hallucinations, delusion of relatedness, and retrospective delusion of relatedness, and finally autochthonous ideas.

The following is a typical example of an aberrant overvalued idea: A 61-year-old person of independent means, who was recently presented to you, gives, as reason for his being admitted, the ‘hounding’ to which he had been exposed outside the institution. Inside the institution he is completely free of such annoyances, and feels so well that he is already in his fourth year here, and intends to stay. Several attempts to discharge him have failed because, repeatedly, the same harassments have led to police intervention and internment. Originally it was a certain gentleman, known to him only by name, who lived in his neighbourhood and who he therefore often encountered on the street. He came to believe that this gentleman stopped and waited for him, standing as though counting windows of a house. He therefore crossed to the other side of the street but noticed next time how the same gentleman, at the same spot, was talking to an acquaintance, no doubt about him [Ed], of which fact he was convinced, without being able to hear what was said. He therefore went close to the two men and said, ‘Do you perhaps want something from me?’ He then went home and observed that the men followed him and remained standing in front of his house. Having reached his home he then went to the window and waved his stick, calling out to them ‘Come right up! I’ll give you what for!’ A similar encounter on another occasion led to the two men actually following him to his home, who then found out his name, and laid complaints with the police. That event led to the patient’s initial admission. I took him into the clinic soon after, and established that the patient’s delusion of reference was directed solely against one of these two, a master carpenter; and I then asked him: ‘How did this gentleman come to harass you?’ The answer was quite typical. He could think only as follows: The gentleman in question was the brother of a close friend, who 6 years ago had been, like himself, a regular guest of a particular wine merchant. The patient himself had been interested in this businessman’s daughter for years, and had even proposed to her, but had then broken off the engagement, because he had been told that her father was in financial difficulties. As the master carpenter had spoken to the other gentleman about him, he had probably said, ‘There goes the scoundrel who left the girl in the lurch’. Detailed investigation and observation of the patient failed to find any kind of psychotic symptoms, other than his continuing to insist on the accuracy of these allegations. Therefore he was discharged, at his own request, after a few weeks, but was soon readmitted; and this was repeated a second time. Since then he no longer tries any more. The harassment that the patient was exposed to when outside the institution occurred far more frequently on the two further occasions than before; also, other people were involved, as well as the police. However everything always came back to the one master carpenter who, meanwhile, had served up the old story to other people, and notified the police of his observations of mental illness. Nowhere in the institution has anyone observed even a hint of a delusion or any other sign of mental illness in this patient.