as being due to an overestimation of the self (of a sexual character), and the Freudian conception of paranoia, with its fixed and systematized delusions, is that it is a defense reaction of this nature. The symptoms are due to unconscious elements which act in a fashion somewhat 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 considered strictly ideational or strictly sensory in character, and it is very likely that many of the so-called ideational cases have certain sensory elements, and on the other hand that certain of the sensory cases have ideational 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 disliked. She bore several children to him, but believed that their relations 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
