The ego-maniac must of necessity immensely over-estimate his own importance and the significance of all his actions, for he is only engrossed with himself, and but little or not at all with external things. He is therefore not in a position to comprehend his relation to other men and the universe, and to appreciate properly the part he has to play in the aggregate of social institutions. There might at this juncture be an inclination to confound ego-mania with megalomania, but there is a characteristic difference between the two states. Megalomania, it is true, is itself, like its clinical complement, the delusion of persecution, occasioned by morbid processes within the organism obliging consciousness perpetually to be attending to its own somatic ‘Ego.’ More especially the unnaturally increased bio-chemical activity of the organs gives rise to the pleasantly extravagant presentations of megalomania, while retarded or morbidly aberrant activity gives rise to the painful presentations of the delusion of persecution.[247] In megalomania, however, as in the delusion of persecution, the patient is constantly engrossed with the external world and with men; in ego-mania, on the contrary, he almost completely withdraws himself from them. In the systematically elaborated delirium of the megalomaniac and persecution-maniac, the ‘not-I’ plays the most prominent part. The patient accounts for the importance his ‘Ego’ obtains in his own eyes by the invention of a grand social position universally recognised, or by the inexorable hostility of powerful persons, or groups of persons. He is Pope, or Emperor, and his persecutors are the chief men in the State, or great social powers, the police, the clergy, etc. His delirium, in consequence, takes account of the State and society; he admits their importance, and attaches the greatest value, in one case, to the homage, in the other to the enmity, of his neighbours. The ego-maniac, on the contrary, does not regard it as necessary to dream of himself as occupying some invented social position. He does not require the world or its appreciation to justify in his own eyes himself as the sole object of his own interest. He does not see the world at all. Other people simply do not exist for him. The whole ‘non-Ego’ appears in his consciousness merely as a vague shadow or a thin cloud. The idea does not even occur to him that he is something out of the common, that he is superior to other people, and for this reason either admired or hated; he is alone in the world; more than that, he alone is the world and everything else, men, animals, things are unimportant accessories, not worth thinking about.