DELUSIONS 89 



as being due to an overestimation of the self (of a sexual character), 

 and the Freudian conception of paranoia, with its fixed and systema- 

 tized delusions, is that it is a defense reaction of this nature. The 

 s}Tnptoms are due to unconscious elements which act in a fashion some- 

 what similar to, although more powerful than, conscious ideas. These 

 types or cases may be considered to be somewhat different from those 

 of Southard in that they are of an ideational rather than of a sensory 

 type. 



On the other hand, we sometimes find delusions which can not be con- 

 sidered strictly ideational or strictly sensory in character, and it is very 

 likely that many of the so-called ideational cases have certain sensory ele- 

 ments, and on the other hand that certain of the sensory cases have idea- 

 tional elements in them. Such a case, with details learned at a time when 

 the delusion was at its height, is the following; the patient was a woman 

 who had been in love with a young man whom her mother considered 

 to be entirely unsuitable, and because of this kept the man away from 

 the house and, by her insistence, practically compelled the daughter to 

 marry another man who was wealthy and socially more eligible. The 

 man whom she married she did not love and, in fact, very much dis- 

 liked. She bore several children to him, but believed that their rela- 

 tions were not morally right. Because of her ideas and her dislike for 

 her husband she had lacked normal enjoyment in her married life and 

 had frequently longed for death. Eventually she exhibited signs of 

 insanity and was committed to a hospital. She continually said she 

 was dead, that the physician might cut off her finger or her arm or her 

 head without finding a drop of blood. She was not particularly untidy; 

 she could do accustomed things very well; she dressed herself; she 

 walked and talked and in her actions gave a lie to the beliefs which she 

 expressed, but it was impossible to shake her belief either by reference 

 to her acts or in any other manner. She was completely anesthetic and 

 analgesic. This case shows physical signs, namely, anesthesia and 

 analgesia, which may be correlated or believed to be correlated with the 

 delusion, and on the other hand there are elements in the history similar 

 to those which were found in the cases of Burrow and Jones. It was 

 not determinable whether the anesthesia preceded the belief in her non- 

 existence or the reverse. 



A fourth class of delusions is not infrequently encountered. In 

 cases of arteriosclerotic or senile dementias or in a Korsakow's syndrome 

 patients frequently recount their journeys of the night before; they tell 

 how they had been fishing the previous day; they had been brought to 

 this hotel (the hospital) an hour or two ago, or have had visits from 

 friends, when none of these things had occurred. Here the delusion 

 appears to be based upon memory lapses or defects. The patient does 

 not remember the occurrences of yesterday, even those of the same 



