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DIRECTED BY SIGM. FREUD
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VOLUME IV, 1923
FREUD, SIGM.: Certain Neurotic Mechanisms in Jealousy, Paranoia and Homo
Lists of Contents of Vols. I, II & III will be sent on Application
THE INTERNATIONAL PSYCHO-ANALYTICAL PRESS
II Gower Street, London, W.C.I
THE “REALITY-FEELING” IN PHANTASIES
OF THE INSANE
BY HENRY DEVINE.
AMONGST chronic asylum cases are always to be found a number of those who believe themselves to be of exalted or royal birth. In cases of acute confusion or general paralysis in which the higher psychic functions are involved the occurrence of such delusions is readily explicable. In those patients, however, in which no defect of judgment or intelligence on ordinary matters is manifest, and the memory is intact, it is difficult to understand how delusions so manifestly absurd and so devoid of any foundation in fact could be seriously maintained. From the knowledge we have of our mental states it is more or less possible to enter into the feelings of a melancholic. Everyone is apt to feel inadequate, retarded, unworthy or vaguely apprehensive at times; but though it is easy to over-estimate our own importance, it is hard to actually feel the attitude of a person of humble birth and position who believes himself to be (say) the Shah of Persia. The attitude of a patient with a belief of this kind is so inconsistent. His behaviour in the asylum may be that of a normal person; he is quite aware of the actual facts of his past life; he adjusts happily to his environment; employs himself usefully in the garden or elsewhere; exhibits pleasure with little gifts or vexation at some real or imaginary slight—and yet holds tenaciously to fantastic views of his own personality, which are contrary to that common-sense which he is quite able to apply to any subject but his delusions. Unfortunately most paraphrenic patients are unable or unwilling to give any information to enable us to understand how they could have acquired such strange beliefs about themselves; they content themselves with mere assertions as to their imagined position in life and tend to resent any form of question which seems to cast any doubt on the correctness of their statements. I have recently had under my care, however, a case in which it was possible to observe the development of delusions in their earlier stages; and as the whole subject of insane beliefs is so obscure and difficult, I thought it might be of some value to give a brief outline of
Med. Psych. III
this case, and to suggest in what respects it seems to afford us some insight into the processes of delusional formation as a whole, and to indicate some reasons why patients believe in the reality of their phantasies.
The history of the case is briefly as follows: Mr J. is a married man, aged 38. He was the youngest child in a large family and his mother's favourite. The parents belonged to the artisan class and lived in one of the poorer London districts. The father was somewhat addicted to alcohol, but the home was respectable and the children brought up as well as the means of the parents would permit. Mr J. grew up a shy, seclusive, dreamy and clever boy. His studious tendencies enabled him to acquire a good secondary education, and he eventually gained a position in the Civil Service. His industry has enabled him to raise himself above the station in which he was born, and he has achieved a position of moderate comfort. He is happily married and has two nice children.
The first signs of mental disturbance occurred in 1915 when he developed ‘neurasthenia’ attributable to worry and over-work. Some time later he created a good deal of friction in the family by making ridiculous assertions in regard to the morals of his mother-in-law, and subsequently a paranoid attitude developed. As Mr J. himself describes it, “I gained a general impression that people were against me; a kind of excitement was stirred up against me; nasty insinuations, suggestions and remarks were made; there was a sort of under-current when I appeared.” All this time he kept on with his work, but after some trouble with a friend whom he imagined had made reflections of the morals of his (the patient's) mother, he broke down for a time and was sent to hospital. He appeared to recover, however, and resumed his work until shortly before coming under my care. He had then been sleeping badly, had alarmed his wife by muttering to himself and gazing strangely about him, had been sitting about for hours with a vacant expression, and had complained of going into trances and having visions.
The patient was an intelligent and pleasant man who talked freely of his case, but he tended to be solitary and seemed more interested in his own thoughts than anything else. And this was actually the case; he explained that he was constantly disturbed by visions of his past life and he could not concentrate on reading or the ordinary affairs of life because these experiences were so compelling. He did not merely think of the past; the memories came freely and of their own accord and they were not like ordinary thoughts because they were forced into his mind and he could not control them. They were so vivid and real that it was just as if he were at the cinematograph. It was as if he were actually living his past life over again; he felt surrounded by the whole atmosphere of the past—the same sights, smells, voices and feelings. He was vague as to whether these experiences were actually due to external influence or not; he thought it all very strange and inexplicable, and though his memories were very amusing, exciting and interesting, he wished he were not troubled in this way because he could not carry on his work.
When asked whether these memory visions referred to any particular experiences of the past the patient replied in the negative, and asserted that anything which had happened to him might be revived in the manner described. This reply was somewhat disappointing because I had come to believe that hallucinatory experiences were associated with some particular theme or trend, and that they were not general and indifferent in content as the patient told me they were in his case. One day, however, I asked him how far back his memories extended and received the astonishing reply that, while until his illness in 1919, when he was in hospital, he could only remember events in his life from the age of four years, since then, memories had come back to him from the age of two onwards. He then explained, with some hesitation, that the memories that were now coming to him in the form of visions referred to experiences that he had entirely forgotten and which had been obliterated from his mind altogether. The experiences, he said, were of such an extraordinary character that he had hitherto refrained from describing them as he feared they would not be credited and he would be regarded as insane. He had no doubt whatever that the visions actually referred to events in which he had taken part; he felt they were his own experiences; they seemed to belong to himself, as it were, and made everything clear in his past life that he had not previously understood. His personality had been a dual one, he said, and the memories which had been driven from his mind were now being restored.
The nature of these 'memories' may now be briefly described. His first recollection was of being, at the age of two, at Balmoral. A group of persons including King Edward, himself, and his real parents (the Earl and Countess of X–) was being painted in the garden by a famous artist. The patient now remembers that this picture was reproduced in a weekly paper though he did not recognize when he saw it that it included himself. In the next vision he sees himself at Windsor. He was behind a tree with a nurse and King Edward and his parents rode by on horses. The whole experience is so vividly and faithfully reproduced that he can see and actually feel himself stumbling over a branch as he walked forward to watch the distinguished group ride past.
At the age of three the patient now remembers having been through a series of highly dramatic and complex experiences, all of which he can describe with a wealth of detail. He journeyed to Egypt with his parents; met Gordon and was in Khartoum when he was killed (chronologically impossible); travelled over great mountains, sometimes on camels at others on elephants; explored Central Africa; was attacked by fierce hordes of barbarians but escaped; nearly died of thirst in the Sahara, but managed to survive by drinking camel's blood; and eventually after tremendous adventures reached England. The next ‘recollection' is of being handed over to those whom he had always regarded as his real parents until these obliterated “memories' had emerged. He was taken to London by Queen Alexandra in a cab, submitted to a process by his enemies which served to blot out all memory of his past, and handed over to his foster parents.
In addition to these revived ‘experiences' which refer to the life of the patient before the age of four, a mass of 'memories’ have emerged which refer to his life until quite recently. Thus in vision he sees himself in Paris learning to fence under the tuition of the most famous fencing masters in Europe. One of them fences with great fierceness and the patient realises that an attempt is being made upon his life under pretext of giving a lesson. In another 'memory' the patient sees himself killing this man at Osborne. At the age of 14 he ‘remembers' being attacked by three bulls and a woman with a poisoned dagger. He killed the three bulls and made his escape. A wealth of such 'memories' might be given but these will suffice for the present purpose.
As the outcome of these forced ‘memories' the patient now exhibits a delusional attitude similar to that occurring in so many asylum cases. He is hostile to his wife whom he believes to be in league with his enemies to deprive him of his rights, he is repellent and haughty to those around him, he writes letters to cabinet ministers on familiar terms as if they were old friends, and signs himself “Rex Imperator, Swordsman, Aga Khan.” He believes himself to be the son of exalted parents and the heir to the throne. Having been abducted in childhood and been brought up by foster-parents, he is under the impression that from time to time he has been rendered unconscious and taken from his humble home in order to resume his rightful position. During these periods he has been