Lecture 17

Abstract

With the summary knowledge of paranoid states that you have acquired so far, I realize that so far you have become acquainted only with certain dominating symptoms; but many others that occur concurrently can also be found only as acute psychoses. However, you will now be able to discover the main features of the vast majority of paranoid states—and so satisfy the requirement which must be fulfilled, with examples, in each psychiatric report, namely that psychotic symptoms which constitute the mental disorder in each specific case must be recorded in precise detail—a requirement that sadly is seldom met in reports of even so-called authorities. I cannot emphasize strongly enough that you have the right to declare a person mentally ill only when you can produce evidence of this by establishing definite psychotic symptoms; only then will you be spared the embarrassment of your opinion being exposed to justified attacks by lay people. The ‘general impression’ [W] sometimes relied on even by better known representatives of our profession, when they fail to elicit definite psychotic symptoms, is no better than everyday parlance and must elicit the deepest suspicion, when used as the basis of diagnosis of a paranoid state. It deserves to be rejected most strongly when, in such cases, the claim is made that we are dealing with a well-known and relatively simple disease state, given the accurate name of paranoia chronica simplex. Then, it is easy to arouse the impression of intentional deception, for both judges and lay people, thereby harming the reputation of the entire alienist profession. If you want to avoid such mistakes, please note that the most obvious self-aggrandizement is far from any grandiose delusion; mistrust and hatred of a few—or many—people is not a persecutory delusion; and paranoid states are mental disorders which are always relatively easy to grasp, detected by very specific psychotic symptoms.