All this was in pitiable and very remarkable contrast to reality. He is a small weakly man of unimposing build, with poorly developed muscles betraying at the first glance the atrophying effect of his studious life. He is unmusical, his voice is weak and he sings out of tune; he is a bad speaker, because of his stutter. For weeks he occupied himself in the asylum with peculiar jumping, and contortions of the body which he called gymnastics, he sang and declaimed. Then he became more quiet and dreamy, often stared thoughtfully in front of him for a long time, now and then sang a love song which, despite its want of musical expression, betrayed a pretty feeling for love’s aspirations. This also was in complete contrast with the dryness and isolation of his normal life. He gradually became accessible for lengthy conversations.
We will break off the history of the disease here, and sum up what is furnished so far by observation of the patient.
In the first illness the delirium broke out unexpectedly, and was followed by a mental disorder with confused ideas and violence which lasted for several weeks. Complete recovery appeared to have taken place. Six years later there was a sudden outbreak of mania, grandiose delusions, bizarre actions, followed by a twilight-stage gradually leading to recovery. Here we again see a typical case of dementia praecox, of the katatonic variety, especially characterised by peculiar movements and actions. In psychiatry the views obtaining at present would regard this as localised cellular disease of some part of the cortex, exhibiting confusional states, delusions of grandeur, peculiar contortions of the muscles, or twilight-states, which taken all together have as little psychological meaning as the bizarre shapes of a drop of lead thrown into water.
This is not my view. It was certainly no accidental freak of the brain-cells that created the dramatic contrasts shown in the second illness. We can see that these contrasts, the so-called grandiose delusions, were very subtly determined by the deficiencies in the patient’s personality. Without doubt, any one of us would naturally regard these deficiencies seriously
