Now it was precisely the cases with autopsychic delusions, as well as with
profound disorder of personality in general, that showed the brunt of the
destructive paretic process in the frontal region. The other
not-so-autopsychic cases did not show this frontal brunt, but were less
markedly diseased at death and had a more diffuse process.
Our genetic hint from paresis, therefore, inclines us to the conception that
this disorder of the believing process is more frontal than parietal, more
of the anterior association area than of the posterior association area of
the brain. And if we can trust our intuitions so far, the perverted
believing process is thus more a motor than a sensory process, more a
disorder of expression than a disorder of impression, more a perversion of
the WILL TO BELIEVE than a matter of the rationality of a particular credo.
Again we may appear to burst through from an undergrowth of statistics into
the clear field of truism. False beliefs are more practical than
theoretical, more a matter of practical conduct than of passive experience,
more a change of reagent than a reaction to change. The man on the street or
even many a leading neurologist would perhaps accept this formula as his
own.
Certainly in general the least satisfactory of these chapters on the nature
of delusions was the chapter on environmental effects,[3] and this perhaps
because the results seemed so nearly negative.
A further contribution to delusions of environmental nature was somewhat
unexpectedly derived from a piece of work on the general mental
symptomatology of general paresis.[4] Dichotomizing the paretics (all
autopsied cases) into a group with substantial, i. e., encephalitic,
atrophic or sclerotic lesions of the cortex and a group without such gross
lesions or else with merely a leptomeningitis, I found the latter (or
anatomically mild) group to be characterized by a set of symptoms which were
all "contra-environmental," whereas the former (or anatomically severe) did
not thus run counter to the environment. The conclusions of that paper, so
far as they concern us now, are as follows:--
The "mild" cases showed a group of symptoms which might be termed
contra-environmental, viz. allopsychic delusions, sicchasia (refusal of
food), resistiveness, violence, destructiveness.
The "severe" cases showed a group of symptoms of a quite different order,
affecting personality either to a ruin of its mechanisms in confusion and
incoherence, or to mental quietus involved in euphoria, exaltation, or
expansiveness.
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