THE suggestions here put forward concerning personal (autopsychic) delusions
are based on material of the same sort as that previously analyzed for a
study of somatic and of environmental (allopsychic) delusions. Our
conclusions are also influenced by two analyses of the types of delusion
found in general paresis. Moreover, at a period subsequent to the analysis
presented here, some work on fifth-decade insanities had been completed, and
the delusional features constantly found in the functional cases of insanity
developing at the climacteric, entered to modify our general point of view.
The situation may be summed up as follows:
The accessibility to analysis of the clinical and anatomical data at the
Danvers State Hospital was such as to prompt the use of its card catalogues
for statistical work upon delusions. The more so, because in a period of
enthusiasm over the Wernickean trilogy (autopsyche, allopsyche,
somatopsyche) of conscious phenomena, the Danvers catalogue had attempted to
divide the delusions recorded into the three Wernickean groups. Putting
these clinical data side by side with the anatomical data, we were speedily
able to single out those cases with normal or normal-looking brains and thus
to secure a group approximately composed of functional cases of insanity.
It shortly developed, as to the CONTENT of delusions, that somatic delusions
were exceedingly prone to parallel the conditions found in the trunk-viscera
and other non-nervous tissues of the subjects at autopsy.) A subsequent
study has confirmed this conclusion for the distressing hypochondriacal
delusions found in climacteric insanities, which delusions, however
distressing, are often far less so than the true conditions found at
autopsy. And it may be generally stated that the clinician can get very
valuable points concerning the somatic interiors of his patients by
reasoning back from the contents of their somatic delusions.
But how far can we, as psychiatrists, reason back from the contents of
environmental delusions, e. g. those of persecution, to the actual
conditions of a given patient's environment? In a few cases it seemed that
something like a close correlation did exist between such allopsychic
delusions and the conditions which had surrounded the patient--the delusory
fears of insane merchants ran on commercial ruin, and certain women dealt in
their delusions largely with domestic debacles. But on the whole, we could
NOT say that, as the somatic delusions seemed to grow out of and somewhat
fairly represent the conditions of the some, so the environmental delusions
would appear to grow out of or fairly represent the environment.
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