THE MORBID ''SENSE OF INJURY r 601 



others that it is unreliable until we have heard the " other side 

 of the story/' and that when disputants meet and explanations 

 follow they often find that they have no casus helli. In the ex- 

 amination of the alleged insane for commitment we have constantly 



to separate the real from the imaginary troubles. Mr. F was 



the subject of such examination. He was suffering from heart 

 disease, and thereby compelled to remain at home idle. His wife 

 was supporting the family by keeping boarders, and he began to 

 develop a morbid jealousy of her. He annoyed her by a constant 

 surveillance and suspicion of her every act, which amounted at 

 times to the delusion that she was unfaithful to him, and which 

 culminated one night in an outbreak in which the police figured. 

 It was difficult to separate his real from his imaginary grievances, 

 for his wife had ceased to have any affection for him, though his 

 delusion in regard to her unfaithfulness was unfounded and had 

 been grafted upon his real trouble. Sent to a general hospital, he 

 improved, and was reported " not insane." Circumstances requir- 

 ing a hard struggle for existence, disappointment without apparent 

 cause, coupled with a certain sentimental cast of mind, often pre- 

 vent the correct estimation of the wrongs suffered and the proper 

 relation of undoubted misfortunes. 



In the insane the sense of injury or its analogue — delusions of 

 persecution — appears in numerous shapes. Thus patients are de- 

 frauded, or conspired against, or acted upon by T\dtchcraft, mag- 

 netism, electricity, or poisoned, or preached against, or subjected 

 to disagreeable odors. Sometimes the delusions are but ill-defined 

 and vague. Often it is possible to trace them to their underlying 

 disordered sense impression or the particular environment or to 

 vestiges of outgrown beliefs. They appear in depressed states of 

 melancholia as well as in the exalted states of mania and paranoia. 

 In melancholia they accompany a feeling of worthlessness which 

 is the patient's explanation of his persecution — i. e., he is unworthy 

 of better treatment. In paranoia the patient believes the perse-- 

 cution to be prompted by fear or envy of him, and there is conse- 

 quently a feeling of self-importance — a morbid egotism which is 

 in direct proportion to the magnitude or complexity of the ideas 

 of persecution. Indeed, it is probable that these ideas of perse- 

 cution, acting on a potentially melancholic or a potentially para- 

 noiac mind, whatever these may be, determine the type that these 

 mental diseases take. 



The difference between the " injured " sense in the sane and 

 insane states we must from our view point, without essaying to 

 bridge all the terra incognita which' lies between sanity and insanity, 

 regard as largely but one of degree. And so with the underlying 



