Gentlemen!

The 38-year-old municipal secretary we examine today has been difficult to motivate, and to bring to the lecture theatre, but eventually he declared his willingness, as he says, to provide a service to science. You see a thriving, seemingly healthy man with impeccable manners and intelligence manifest in his facial expression and speech. Given his situation, the unusual level of general education, which he soon betrays, is explained by the fact that he had studied philology; and, very shortly before his Staatsexamen [W] had to take a different career path for health reasons. There is no sign of formal thought disorder from him. He feels healthy. Nevertheless, the need to detain him here in the clinic, despite his objections is based on the fact that we have reason to fear that, as soon as he is free, he will go to Berlin and seek out the Kaiser; for he feels it his duty and his task to remove from the Kaiser a part of his government. Accordingly, he considers that his being detained here is an injustice and an act of deprivation of liberty. Despite this, you can see how soberly and considerately he passes judgment, from the fact that in no way does he put our behaviour down to ‘bad faith’ [Ed], but suggests a mistake on our part only with the politest warning to us not to approach too closely. I drew his attention to the fact that when he entered the hospital 3 months ago he came voluntarily, and felt ill; therefore as we hear, he was probably well aware of the purpose and provision of the institution. He has to admit that fact, but now vividly regrets having done it, because he is sure that he was wrong to have done so. Rather when he had been ill earlier, he had been nervous, but was now so healthy, so strong, and more efficient in every way than before. On questioning, we still hear that, up to the time of his being detained, he felt completely happy, and did not doubt that the doctors would gradually see the error of their ways. I must acknowledge, moreover, that his general health has been excellent in the last few weeks. During his stay his body weight increased from 63 to 70 kg. He has no doubt that the Kaiser will receive him with open arms. How does he know this? An inner voice tells him. As we see from a piece of paper, this inner voice compares the patient with the daimonion [W] of Socrates, ‘who people have also now declared insane’ as the patient casually remarks. From more detailed characteristics of this voice we learn that it is not localized, has no particular vocal quality, but might include certain words from time to time, and—which is the main thing—is based on divine inspiration. The patient also harbours fears that we doctors are heading towards severe divine punishment because of our delusion. He does not doubt—and this is also evident from his documents—that he is placed in direct communication with God, and receives revelations and enlightenments from Him. He denies hearing voices, as do other mental patients, nor has he ever experienced face-to-face apparitions. I argue with him that, if injustice is being done to him here, this does not lead to the conclusion of a special providence from God. Then he explains that it is quite likely that the thought has been assimilated here, and had in due course been given to him by an evil spirit. He could only regard his time here as probation imposed upon him; he nods approvingly when I remind him of an analogy with other heroes and prophets. As you have already heard, he has no grudge against us doctors, yet is convinced that we believe that we have our duty to do; but he emphasizes the difference between his spiritual concept and our materialistic one, which of course would exclude belief in God and spirits. The patient is confirmed in his belief by an experience from childhood, in which one night, as his grandfather lay seriously ill, he awoke to see a woman clad all in grey, disappearing through a half-open double door. His mother had seen the same phenomenon and could confirm it, and at that very moment his grandfather had died. When we attempt a psychological account of this well-known type of half-wakeful hallucination, he just smiles. He is weighed down, as we have seen, by his writing and, he confirms, with his big plans for the future. As soon as he gets to government, he intends to bless all the world; to install the senior physician with 30,000 Marks as his personal physician; to build a golden bridge over the Rhine near the Niederwald monument as a symbol of peoples’ eternal freedom—the gold represents the purity of the mind—and take the money for this from the Julian Tower. Certainly he carries a whole series of nonsensical fantastic ideas that he is concealing from us.

Gentlemen! Those of you who heard me earlier will remember a very similar case of illness that I presented 1½ years ago. At that time it involved a young 22-year-old mechanic named Sch., who was discharged as recovered after a 4-month stay with us. He also came to the clinic as a voluntary patient, because he thought he was mentally ill. In his opinion he had been ill for about 10 weeks, and this matched details from his acquaintances. At the time of admission his complaints were: a headache; a feeling in his head as though he were drunk; palpitations which occurred during attacks; also dizziness in his head and inability to think, ‘he feels so jaded.’ Objectively: He had a congested face, reddened conjunctiva, and a slight cyanosis, the latter exacerbated by walking around his room. Pulse not accelerated, cardiac findings normal. He was evidently in remission from his illness and presented with no psychotic symptoms, apart from increased need for sleep; but he described with great precision the phenomena of the illness from which he was recovering, and that was the reason I presented him here. However, 14 days later a state of excitement ensued, which, as the patient later stated when his judgment had returned to normal, was a repetition of his earlier state, but at a much lower intensity. This brought about a few sleepless nights, and the state completely subsided in about 8 days. This second burst was also connected with striking vasomotor disturbances, congested face, cyanosis of the extremities, increased perspiration, and increased heart rate. From then on, full insight into the illness quickly returned, so that he could be discharged as recovered after 3 months; and, up to now, 1¼ years after discharge, he has remained in good health and is again active in his previous occupation. We learned from him that his first attack, of 10 weeks duration, began with poor sleep and irritable mood. Then a feeling of anxiety appeared in the cardiac region, lasted for 2 days, and put him in state of fearful agitation, ‘as if he should go into the Oder.’ After about 4 days, this feeling gave place to another mood, ‘the opposite of the previous one,’ such a happy feeling ‘as if the Holy Spirit were within him.’ This was located at the self-same spot as the feeling of anxiety that preceded it. The patient found it difficult to give a more detailed description of this feeling: Sometimes he described it as ‘ramparts in his chest’ [Ed] and sometimes as unusually light, free breathing. At the same time ‘strange thoughts’ [W] came to him and he realized that he had become another person, as he suspected, enlightened by the Holy Spirit. He noticed that he had acquired special abilities, believed that he had invented a machine for perpetual motion; believed that he had the ability to immediately distinguish ‘noble and ignoble people’ [W]; believed that he was able to influence people in the manner of a hypnotist, so that they would do what he wanted; and made a plan to transform his employer’s business into a corporation. At the same time he appreciated that he was not doing well at his work, and that his thoughts were not well focused on the matter; and that those around were making fun of him, declared his plans to be nonsense, or told him they did not understand him. For 3 weeks, these were the only strange thoughts of which he was aware, and then he heard them taken over, and pronounced by a fine female voice; and then the ‘rampart’ [Ed] existed again in his chest. Consciousness of his being inspired by the Holy Spirit now overcame him more clearly. The voice also let him know of the attitude people took towards his plans, whether, for example, they wanted to join the corporation or not. At night, the voice spoke to him, and often continuously disturbed him in his sleep. Once he heard three voices, coming out of his chest, and simultaneously saying good night: two strong voices and one finer voice. After that, he had become tired and went to sleep. An unusual abundance of words came over him; the words presented themselves ‘involuntarily’ [W], and it seemed to him as though the Holy Spirit were speaking ‘out of’ [Ed] him. He preached for hours; on one occasion, he spoke in verse, and finally, a few days before his admission he went home in order to be blessed by the priest of the place, as a court preacher. Through diligent reading of the Bible, he had come to believe that he was one of the two witnesses that appear in the Revelation of John. The patient had told us all this in the clinical presentation a few days after his admission, with full insight into the abnormality of the experiences he described. The second, short-duration attack was also preceded by fear and anxious ideas, the anxiety again being localized in his heart—and the content of the fearful ideas was that he would not come out of here, that he would die here, and his body would be handed over for anatomy, etc. He impetuously demanded his discharge, but could be appeased. Over the next few days he showed only a haughty, demanding manner; he sought to instruct the doctor, but yet remained open to encouragement. He wrote a guide for the physician to examine mentally ill people; spoke of his ‘great abundance of ideas’ [W], his ‘death-defying courage’ [W], and his ability to excel. He retained a certain degree of insight into his sickness and of the vast multitude of thoughts that came to him, even though he did not regard their content as being abnormal. Yet even in this respect insight into illness rapidly returned, and the only complaint, which was lost over the course of the next week, was that so many thoughts came to him. At times of greatest excitement the localized feeling of happiness was again present; however, the patient did not hear a voice during this second attack. Of importance is the fact that this patient grew up with orthodox religious views, as evidenced by letters from his parents, and by the fact that his calling to the priesthood had initially been recognized by them; and moreover there was violent opposition to his being admitted voluntarily into the clinic. We learned later that he had always been somewhat peculiar, and that during his illness, fantastically grandiose ideas had beset him, for instance that he had offered millions to his colleagues. Up to the time of his discharge, his bodyweight had increased from 56 to 65 kg.