Is Michael Neve paranoid?

Michael Neve

‘Havelock Ellis has sent me the sixth volume of his studies, Sex in Relation to Society,’ Freud wrote to Jung, in late April 1910. ‘Unfortunately my receptivity is consumed by my nine analyses. But I shall set it aside for the holidays along with the wonderful Schreber.’ Freud is here referring to the famous case of Daniel Paul Schreber, whose Memoirs of his nervous illness had appeared in 1903, and constitute one of the most celebrated case-studies of paranoia in the literature. The letter of 1910 to Jung goes on: ‘Schreber, who ought to have been made a professor of psychiatry and director of a mental hospital ...’

‘Paranoia.’ ‘He’s paranoid.’ ‘The student movement took such a paranoid view of Nixon.’ ‘Nixon was a paranoid.’ ‘Don’t be so paranoid.’ ‘You’re so oversensitive, Neve, so paranoid.’

‘Paranoia’, as a word, has gone far into popular usage. In some ways, astonishingly so, since its place in the history of medical psychiatric terms has never been easy or comfortable. One could even suggest – or suspect, and this is an article of suspicion rather than truth – that it is one of the mass of crumb-like words which have been swept off the table of medical usage onto the floor of lay usage, to drive out and imperialise other available words (‘suspicion’, ‘fear’, ‘nit-picking’, ‘scared’, ‘quarrelsome’), and that trained psychiatrists from about 1870 or 1880 onwards were quite happy to see it go, so unclear had its meaning and purpose become. ‘Throw paranoia to the dogs, we’ll none of it.’ Well, we certainly have it now. Or to be correct, it has us.

Can we understand why? I will ‘invent’ some possibilities, as a way of bringing attention to the literature on it that does exist, and, slightly fantastically, adding a little to it. I am paranoid about the word ‘paranoia’, and the previous researches of, above all, Sir Aubrey Lewis have helped me indulge my fear. Lewis’s famous paper, ‘Paranoia and Paranoid: A Historical Perspective’, provides a framework around which some further historical speculations can be built.

‘Paranoia’ is a simple word which has nonetheless become historically complex. From the Greek para, ‘beside’, and noos, ‘mind’, it indicates, as far as one can tell, the state of being beside, or out, of one’s mind. I put in the qualification because the use allegedly made of it by Hippocrates was not accepted by Galen as genuine. But the closest one can get to the ancient meaning, from sporadic appearances in literature and drama, is that of ‘out of mind’ or ‘against one’s mind’. But it is also likely that paranoia’s hazy relationship to a variety of states of mind – a catch-all word as well as a simple one – was also present in Antiquity. Delirium, senility, foolishness, idiosyncratic thinking: Aubrey Lewis has suggested that it may have been used in these ways as well.

From the Ancients right through to the Enlightenment, paranoia has an undiscovered history. For reasons that can only be guessed at, it does not seem to have been a commonly used word, and Lewis suggests that its resurfacing in the 18th century, especially in the taxonomical work of Boissier de Sauvages, is ‘practically a rebirth’. Certainly it doesn’t appear in the striking list of words for mad states reproduced in Michael Macdonald’s Mystical Bedlam, a study of 17th-century English sources. Instead we have ‘mad’, ‘lunatic’, ‘melancholy’, ‘stubborn’, ‘suspicious’, ‘fancies and conceits’, ‘frightening dreams’. This disappearance of the Classical connection is intriguing, and paranoia’s reappearance in the classificatory writings of the 18th century may be related to the sheer proliferation of Classical expressions that this taxonomic project required and generated.

Whatever the history, de Sauvages in his Nosologia Methodica of 1763 gave paranoia as the Greek equivalent of amentia: ‘Amentia, Graecis paranoia; Latinis dementia, fatuitas, vecordia; Gallis imbécillité, bêtise, niaiserie, démence’. Two important Enlightenment systematists, R.A. Vogel and William Cullen, made a different decision: in their systems paranoia was enlarged by making it part of the vesaniae, which included mania and melancholia; in Cullen’s system, a disorder of the class vesaniae would involve a lesion of the faculty of judgment, dependent to an unclear extent on excitement, or collapse, within the nervous system. Thus – and it was an important feature of this late 18th-century position – the vesaniae or insanities were part of the neuroses, part of the organically-based disorders, centring on the nervous system.

Importantly too, at least in Cullen’s system, the vesaniae did not include ‘hallucinations’ or ‘false appetities’ (one such false appetite was nymphomania). Thus paranoia was included within the vesaniae, but without hallucination and without any additional complication – such as delusions or an idea of personal jeopardy – given to the word’s meaning. At the end of the 18th century, paranoia remains close to dementia or loss of reason, and is organically-based, as neurotic – in the 18th-century, not the 20th-century, sense of that last word. At this point, in received accounts of the word, a villain is wheeled on: the German psychiatrist Johann Christian Heinroth (1773-1843). Heinroth is a complex and disturbing figure in the history of psychiatry. He was influenced by Christian pietism, idealist philosophy, particularly that of Schelling, the work of John Brown, the former pupil of Cullen who attempted to relate all diseases to states of over or under-excitation of the nervous system, and the example of English mad-doctors, for whose empirical method Heinroth had considerable respect: William Perfect (1737-1809) and Thomas Arnold (1742-1816) particularly. (He, called William Perfect the ‘Nestor of English practitioners’.) Why then, the villainy? The answer is that, against the grain of the Enlightenment tradition which preceded him, Heinroth wished to restate, in a fairly extreme form, the view that insanity was a punishment for sin. The soul of man, when healthy, was both near God and sane: the falling away from God, into sin, was itself insanity. Madness was Hell. And this made insanity into a disease of the intellect – or the soul – that had no neurotic, organic foundation, which was the opposite of what Scottish Enlightenment writers had suggested. Heinroth makes interchangeable the concept of Verrücktheit, craziness, with Dementia. And ‘dementia’ appears interchangeably with ‘paranoia’, as part of the second genus of the first order of mental disturbances. The influence of Brunonian ideas of over or under-excitation is manifest here: the first order is the exaltations; the second the depressions; and the third order is mixtures of the first two. Drawing on the medical model of his Edinburgh teacher William Cullen, John Brown, the founder of the Brunonian school, had fashioned a theory of diseases according to which all disease sprang from the nervous system being either too active or not active enough. Disease was, as it were, a manifestation of the body’s inability to maintain an equilibrium between the double tension of over or under-excitement. Heinroth makes explicit use of this model and extends it into explanations for the possible bodily manifestations of insanity. But the crucial point to stress is that paranoia, in his and other German idealist psychiatric writing, had now taken up its place as a disorder of the intellect, with explicit theological underpinnings. Within the genus ‘dementia’ or ‘paranoia’, Heinroth had four species: Ecnoia, where a patient is insane in judgment and broods on a single object or project; Paraphrosyne, where a patient imagines breaking through to a complete system of knowledge, or being the messenger of the world’s end, a transcendent figure; Moria, which involved proud, vain ideas of personal worth – Heinroth quotes examples from Thomas Arnold; and Paranoia Catholica, which is a fusion of the main forms of dementia.

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