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Rh with or without definite delusions. The subject is usually poor in mental resource, but proud, vindictive and suspicious. It is eminently a condition which arises spontaneously in certain persons whose mental constitution is of the paranoiac type, i.e. persons who are naturally credulous, mystical and suspicious. The subjects are extraordinarily assiduous in watching the objects of their jealousy, whether husbands, wives or sweethearts. Their conduct in this respect is fertile in producing domestic dispeace and unhappiness, and in the case of unmarried persons in creating complicated or delicate situations. It not infrequently happens, just as in the case of the class of amatory paranoiacs, that delusions of persecution establish themselves, usually directed towards persons who are believed to have secured the affections of the object of jealousy. The disease then follows the ordinary course of the insanity of persecution but usually without hallucinations of the senses. The subjects are highly dangerous and violent. Under the influence of their delusions murder and even mutilation may be resorted to by the male, and poisoning or vitriol-throwing by the female subjects.

4. Litigious Paranoia (paranoia querulans).—The clinical form of litigious paranoia presents uniform characteristic features which are recognized in every civilized community. The basic emotion is vanity, but added to that is a strong element both of acquisitiveness and avarice. Moreover the subjects are, as regards character, persistent, opinionative and stubborn. When these qualities are superadded to a mind of the paranoiac type, which as has been pointed out, is more influenced by the passions or emotions than by ordinary rational considerations, it can readily be appreciated that the subjects are capable of creating difficulties and anxieties which sooner or later may lead to their forcible seclusion in the interests of social order.

It is important to observe that the rights such people lay claim to or the wrongs they complain of may not necessarily be imaginary. But, whether imaginary or real, the statement of their case is always made to rest upon some foundation of fact, and is moreover presented, if not with ability, at any rate with forensic skill and plausibility. As the litigants are persons of one idea, and only capable of seeing one side of the case — their own — and as they are actuated by convictions which preclude feelings of delicacy or diffidence, they ultimately succeed in obtaining a hearing in a court of law under circumstances which would have discouraged any normal individual. Once in the law courts their doom is sealed. Neither the loss of the case nor the payment of heavy expenses have any effect in disheartening the litigant, who carries his suit from court to court until the methods of legal appeal are exhausted. The suit may be raised again and again on some side issue, or some different legal action may be initiated. In spite of the alienation of the sympathy of his relations and the advice of his friends and lawyers the paranoiac continues his futile litigation in the firm belief that he is only defending himself from fraud or seeking to regain his just rights. After exhausting his means and perhaps those of his family and finding himself unable to continue to litigate to the same advantage as formerly, delusions of persecution begin to establish themselves. He accuses the judges of corruption, the lawyers of being in the pay of his enemies and imagines the existence of a conspiracy to prevent him from obtaining justice. One of two things usually happens at this stage. Though well versed in legal procedure he may one day lose self-control and resort to threats of violence. He is then probably arrested and may on examination be found insane and committed to an asylum. Another not uncommon result is that finding himself non-suited in a court of law he commits a technical assault upon, it may be, some high legal functionary, or on some person in a prominent social position, with the object of securing an opportunity of directing public attention to his grievances. The only result is, as in the former instance, his medical certification and incarceration.

Paranoia is generally a hopeless affection from the point of view of recovery. From what has been stated regarding its genesis and slow development it is apparent that no form of ordinary medical treatment can be of the least avail in modifying its symptoms. The best that can be done in the interests of the patients is to place them in surroundings where they can be shielded from influences which aggravate their delusions and in other respects to make their unfortunate lot as pleasant and as easy to endure as possible.

As has been frequently stated, the subjects of most forms of paranoia are liable to commit crime, usually of violence, which may lead to their being tried for assault or murder. The question of their responsibility before the law is therefore one of the first importance (see also Insanity: Law). The famous case of McNaghten, tried in 1843 for the murder of Mr Drummond, private secretary to Sir Robert Peel, is, in this connexion, highly important, for McNaghten was a typical paranoiac labouring under delusions of persecution, and his case formed the basis of the famous delivcrance of the judges in the House of Lords, in the same year, on the general question of criminal responsibility in insanity. Answer 4 of the judges' deliverance contains the foUowing statement of law: If &ldquo; he labours under such partial delusion only and is not in other respects insane we think he must be considered in the same situation as to responsibility as if the facts to which the delusion exists were real. For example, if under the influence of his delusion he supposes another man to be in the act of attempting to take away his life, and he kills that man, as he supposes, in self-defence, he would be exempt from punishment. If his delusion was that the deceased had inflicted a serious injury to his character and fortune, and he killed him in revenge for such supposed injury, he would be liable to punishment.&rdquo;

In considering this deliverance it must be remembered that it was given under the influence of the enormous public interest created by the McNaghten trial. It has also to be remembered that in a criminal court the term responsibility means liability to legal punishment. The dictum laid down in answer 4 is open to several objections, (1) It is based upon the erroneous assumption that a person may be insane on one point and sane on every other. This is a loose popular fallacy for which there is no foundation in clinical medicine. The systematization of a delusion involves, as has been pointed out, the whole personality and affects emotion, intellect and conduct. The human mind is not divided into mutually exclusive compartments, but is one indivisible whole liable to be profoundly modified in its relation to its environment according to the emotional strength of the predominant morbid concepts. (2) It does not take into account the pathological diminution of the power of self-control. The influence of continued delusions of persecution, especially if accompanied by painful hallucinations, undermines the power of self-control and tends ultimately to reduce the subject towards the condition of an automaton which reacts reflexly and blindly to the impulse of the moment. (3) The opinion is further at fault in so far as it assumes that the test of responsibility rests upon the knowledge of right and wrong, which implies the power to do right and to avoid wrong, an assumption which is very far from the truth when applied to the insane. The number of insane criminals who possess no theoretical knowledge of right and wrong is very few indeed, so few that for practical purposes they may be disregarded.

The true paranoiac is a person of an anomalous mental constitution apart from his insanity; although he may to outward appearances be able, on occasion, to converse or to act rationally, the moment he is dominated by his delusions he becomes not partially but wholly insane; when in addition his mind is distracted by ideas of persecution or hallucinations, or both, he becomes potentially capable of committing crime, not because of any inherent vicious propensity but in virtue of his insanity. There is therefore no middle course, from the medical point of view, in respect to the criminal responsibility of the subjects of paranoia; they are all insane wholly, not partially, and should only be dealt with as persons of unsound mind.

See Bianchi, Textbook of Insanity (Eng. trans., 1906); Clouston, Mental Diseases (6th ed.); Krafft-Ebing, Textbook of Insanity (American trans., 1904); Kraepelin, Psychiatrie (6th ed., Leipzig,

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