Paranoia

PARANOIA. - It generically meant madness, mental infirmity, until Boussier de Sauvages (1768), who was the first to reduce it to the concept of a particular form of mental illness. Various authors subsequently concerned themselves with defining it nosographically,

(by courtesy of Msgr. A. P. Frutas)

PARANÀ, ARCHDIOCESE of - New seminary of P. inaugurated in 1950.

considering it predominantly from the semeiological side (French school) or from the pathogenetic side (German school); it is, however, linked to the name of Kraepelin, who understood it as « a psychosis, characterized by the development of a chronic, immutable delusional system, produced by endogenous causes and which evolves while preserving full lucidity of the sensorium and the order of thought, will, and activity ». Alongside this picture, rather rare, are placed the « reactive paranoid syndromes » and the « periodic paranoid syndromes », the latter of which, however, fall within the symptoms of « manic-depressive psychosis », whose course they faithfully follow.

P. and reactive paranoid syndromes have in common the ground on which they arise and develop and which it is more accurate to define as « disposition » rather than paranoid constitution. By this is meant a particular reactivity that predisposes to the onset of the psychosis, under the influence of exceptional external events (paranoid syndromes) or of ordinary life events (Kraepelin's p.); there predominates, in such an anomalous disposition, the overvaluation of one's own personality, the hypertrophy of the Ego, signs that are almost pathognomonic; frequent among such individuals are the « intransigent » types who are often encountered in everyday social coexistence. Diffidence, susceptibility, the perpetual attitude of defense toward one's environment, explain the poor adaptability, the isolation in which they often shut themselves up, the onset of antisocial reactions. A consequence of such an abnormal disposition is the error of judgment regarding the Ego and the external world; logic is furthermore falsified by the passionality that colors events and memories temporarily or in a lasting way.

a) Kraepelin's p. (chronic systematized delusion of the French authors) is almost always characterized by the development of a delusion upon a previous paranoid disposition (the delusion [v.] is, according to classical psychiatry, an erroneous judgment, endowed with irrefutable subjective certainty, against which criticism or experience can do nothing). Important is the perfect integrity of the psychic functions outside the delusional construction, while the delusion itself is lucid, coherent, systematized, logical in its illogicality, and the patient succeeds in elaborating its material to the point of making almost every internal contradiction disappear. The delusion generally arises from external events or affectively experienced facts, which in themselves have nothing pathological; through the deformation that they undergo in the patient's psyche, little by little even events that were previously indifferent or extraneous come to be experienced by him in relation to his own delusion. Hallucinations (v.) are lacking, while « revealing dreams » may appear with a certain frequency, in which the deformation lies only in the interpretation the patient gives of them. The paranoid delusion arises slowly, remains crystallized for a long time, while the intensity of affective participation gradually diminishes.

In relation to the variation of content, the following are distinguished: delusions of grandeur (inventive, reformatory, genealogical form), of jealousy, of persecution, which often combine with the conviction of a harm suffered, while the persecutors may be family members, acquaintances, an entire social class; erotic, in which a platonic love develops toward a person of socially superior status by whom the delusional person feels reciprocated; religious or mystical (it can be included in the form of grandeur); of mission, reform, etc.; of reference, in which events are experienced by the patient in evident relation to his own person (a form placed by Kretschmer in relation to the sensitive personality); querulous-manic, in which the patient believes he is wronged in his true right, makes long petitions to the authorities, continual denunciations, etc.; in this form, in which Bleuler recognizes the « combative paranoid temperament », querulous mania assumes, together with the persecutory delusion, particular medico-legal interest, because it can give rise, given the particular characteristics of the patient, to long and never-concluded judicial disputes, while the persecutory variety can drive the subject to aggressions against his presumed persecutors.

The age at which Kraepelin's p. most frequently develops is around 30-40 years, but the first symptoms may appear as early as the years of youth. It is an affection that does not always require institutionalization; often, however, the antisocial conduct forces security measures and sometimes also limitations of the capacity to act. P. must be kept distinct from « paraphrenia » (Kraepelin) or hallucinatory p. of the French authors, which constitutes a bridge of passage between p. and schizophrenic paranoid syndromes.

b) Reactive paranoid syndromes are always in relation to affectively experienced facts (paranoid reactions), or to particular prolonged affective situations (situational psychoses); they fall, according to Jaspers, within psychogenic reactions: they arise, that is, from external events and depend strictly on them. As an intermediate link between these reactions and p., one can classify abortive p. (Gaupp), mild p. (Fiedmann) and latent p. (Kraepelin), in which the endogenous disposition and external events play a role of almost equal importance: it is a matter of the sudden development of a delusion until then latent or of the birth of an abnormal conviction, from facts that the patient overvalues: in such cases a complete remission, such as to bring the patient back to his previous psychic state, is difficult.

Among the pure reactions are classified forms analogous to querulous mania but which differ from it because, at their origin, there really stands a judicial dispute; often with every dispute a querulous attitude can be renewed: « recurrent querulous delusion » (Kaecke). Also for the delusion of reference a corresponding form can be found among the reactions.

In the group of "situational psychoses," the following are distinguished: "occupational psychosis," that is, delusional developments that arise in certain categories of persons because of environmental working conditions (for example, among governesses, assistants, etc.), in which the contrast between the position occupied and the cultural level or the ideal aspirations of the subject can be brought to light. "Induced psychoses," frequent in individuals who live in contact with a paranoiac, especially if isolated or weak-minded, hysterical, or themselves hypoparanoiacal; in these cases the plausibility of the delusional ideas, the very character of the patient who is driven to make proselytes, the persuasive force by which he is animated, prevail over the critical faculty, especially if defective, of those around him; thus it often happens that, even beyond the social limits of the family, paranoiacs win others over to their convictions and succeed in giving life to sects, parties, societies, etc., in which every member believes blindly in the apparent logicality and truth of the delusional ideas of the leader. "Isolation psychosis," in individuals who by reason of an infirmity or for other motives are isolated from their environment; to this group belongs the persecution delusion of the deaf and, more rarely, of the blind; such a delusion can also be nourished by psychosensory disturbances of the illusory type; in the persecution delusion of prisoners of war, the difference of language creates a state of isolation psychologically analogous to that of the deaf and the blind. "Prisoners' psychosis" can arise either in a reactive form or through the development of a paranoid personality; it is generally of the persecutory type, consecutive to the loss of hope of freedom; Bleuler's "prison complex" is something similar: the patients are convinced, often on the basis of hallucinations, that they have been acquitted, but since the elements of external reality conflict with this conviction, delusional ideas of persecution develop, often with hallucinations. The delusional ideas of degenerates (Birnbaum) are incoherent, illogical delusions, variable in content, proper to criminals, with frequent association of psychosensory disturbances.

All these forms present a better prognosis than Kraepelin's p., since removal from the environment or the cessation of the psychogenic causes almost always exerts a decisive influence on the course of the psychosis, although the anomalous disposition always persists, without which, as a general rule, the psychotic picture would not have occurred.

Sometimes, on the other hand, it happens that, however much one tries to explain the origin of the illness, one finds oneself faced with an incomprehensible fact; it is then necessary to conclude that something new has intervened, a "process" that must have modified the psyche of the patient: one is then in the case of schizophrenia (v.); only in that case ("process") are there true delusional ideas, underivable, incomprehensible, and therefore psychopathologically "primary." On the contrary, when such ideas are comprehensibly derivable, they represent only "secondary delusional ideas" (Wahnhafte Ideen). If the clinical pictures that can fall within paranoid symptoms are considered in the light of these concepts, it will be seen that, depending on how they present themselves to psychopathological analysis, it will be a matter either of a "development," when states of mind, desires, instincts give rise to erroneous or delusion-like ideas in a more or less comprehensible way; or of a "process," when, on the contrary, at the origin of the delusion there are brought to light subjective experiences of the patient that are psychologically underivable (true delusional ideas). Kraepelin's p. is therefore not, according to current concepts of psychopathology, a nosographic entity standing on its own, but constitutes the "development" of a particular disposition, or a schizophrenic "process." Such a concept does not concern, naturally, reactive paranoid syndromes.

Anna Maria Tarantini