Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case historiesSouthard, Elmer Ernest
Science
Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case histories
Southard, Elmer Ernest
Neurosyphilis
3. What is the value of grandiose ideas? Ballet distinguishes two
groups of grandiose ideas: (_a_) ideas of self-satisfaction,
including ideas concerning extraordinary capacity, strength,
power, and wealth on the part of the patient; and (_b_) ideas of
ambition; the latter being of a more exact, constant, uniform and
systematizing nature. The more vague and less systematized ideas
of self-satisfaction rest in a phase of contentedness and
optimism; the more definite ideas of pride and ambition are
responsible for striking transformations of personality. General
paresis shows, according to Ballet, these ideas of
self-satisfaction in their most developed form. A certain
variability, absurdity, incoherence, and contradictoriness
characterize these ideas and the patient has little or no insight
into their nature. When such ideas occur at the outset of the
disease, they naturally may be of medicolegal interest. Cotard
explains these ideas of megalomania on the part of paretics on the
ground that they are essentially motor or will disorders and rest
upon a sort of hyperbulia, exhibiting itself in exuberant
activity. Régis has thought that the delusional generosity and
liberality of the paretic, and his willingness to lend his wealth
and talents to social progress, is helpful for diagnosis when
contrasted with the more personal egoism of the victim of
manic-depressive psychosis. The self-satisfaction of the
manic-depressive patient often does not reach a delusional stage,
but remains a mere feeling of pathological well-being or euphoria.
The maniacal patient may compare himself with some great man but
he does not identify himself with him. It must be remembered that
these ideas of self-satisfaction occur also in alcoholism, but
according to Ballet they occur only in the dementing phase of
chronic alcoholism, and have no special diagnostic value. They may
be a clinical stumbling-block for a time in the cases of alcoholic
pseudoparesis. As for the ideas of ambition in which the patients
believe themselves to be princes, emperors, divine messengers, and
the like, these are less characteristic of paretic neurosyphilis
than of delusional psychoses of a non-syphilitic nature. At all
events, such ideas if definite, of long-standing, and systematized
by the patient to form a thorough-going portion of his life, are
not characteristic of neurosyphilis. The victim of paretic
neurosyphilis can as a rule be persuaded out of his delusions, at
least for the time being. These distinctions, it must be added,
are hardly of value in the early cases of any of the psychoses in
question, and cannot be made as a rule in either private or
psychopathic hospital practice. Typical examples of grandiosity,
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