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.

Verrücktheit, paranoia and dementia were interchangeable: all involved exaltations that manifested themselves as delusional selves, as false prophets or seers, and this false estimation was seen as bringing a loss of freedom, a loss of piety. The soul was fallen: paranoia was a loss of liberty, and furthermore a total loss – Heinroth did not believe in partial insanity, nor did he believe in organic disorder. Instead: ‘Air and light are filled with the arrows of evil which men themselves shoot at each other.’ In ways that German psychiatry in particular was to be haunted by, paranoia was no longer even psychosomatic, or dualistic. It was reborn as a kind of insane vanity, the rebel child of Christian idealism, and this break in its historical meaning was to prove decisive and disturbing, for by basing the move towards an intellectual disorder on a prior metaphysical commitment – in this case Christianity – Heinroth had, as it were, politicised the word. Sir Aubrey Lewis exaggerates the subtlety of Heinroth’s descriptive taxonomy of paranoid types: they are all, essentially, ‘playing’ at being Jesus, something that Heinroth would particularly wish to censor. But at the very moment when Heinroth deemed the total knowledge aspired to by his lunatics to be insane, he had himself invoked an explanatory totality – his ‘psychiatry’ – which shared the same ambition as a system of thought. And it is now that one begins to glimpse the possibility that the psychiatry that aspires to total knowledge (many psychiatries are of course heroically sceptical) has precisely the features of paranoid transcendence which the patient who thinks himself Jesus is also trapped by. Paranoia, as hatched by the peculiar fusion of idealism and Christianity which Heinroth represents, is the double, the other, the logic, of the totalising psychiatric project itself. Much European and especially German psychiatric work, from 1820 onwards, could almost be described as two reactions to this ‘rebirth’ of ‘paranoia’: either an attempt to get away from its totalising grip, and reiterate the scepticisms of other positions, or an attempt to carry the project forward, and make urgent the social task of identifying who the paranoiacs are, and why. It must be partly for this reason that the discussion of the word in these later writings gives the feeling almost of embarrassment: here was a nuisance word which, precisely in its enormity, was in danger of being the monster to its idealist Frankenstein inventor.

I exaggerate a little, but not outrageously. In the German writings of Wilhelm Griesinger (1845) and K.L. Kahlbaum (1863), both of whom have a more somaticist approach than Heinroth, there is a clear desire to distinguish between partial and general Verrücktheit, and Kahlbaum makes an important distinction between partial insanity, which includes paranoia and describes a primary disorder that will remain unchanged throughout a lifetime, and general or complex disorders which will pass through four stages, the final one being dementia. Meanwhile, in English psychiatry, whose practice is always accorded Continental respect, the theoretical place of ‘paranoia’ remained dubious, often non-existent. The English retained a commitment to the idea of ‘mania’, and distinctions within the manias, and were not caught up in the residual idealist traps of paranoia/Verrücktheit. In the famous case of Daniel M’Naghten, who had a systematic delusion (or so we are told) that the Tories were trying to destroy his life, and who attempted an assassination of Robert Peel, the word ‘paranoia’ was never used. Instead, and tellingly, M’Naghten was found insane on grounds of homicidal mania. This must be one of the most famous cases of conspiracy theory in the psychiatric and legal literature, and it is interesting that modern psychiatrists such as Henry Rollin take the view that M’Naghten would now have been deemed schizophrenic.

The English writings, up to Henry Maudsley and beyond, and the French writings, especially those of the celebrated J.E. Esquirol on monomania, insisted on the partiality of states of insanity. The French favoured other words for madness, especially délire: but writers in the tradition of Esquirol could delimit monomania as a délire partiel, a chronic state of delusion, often homicidal or erotic, without implying a total impairment of intelligence, affections or volition. Paranoia, in its Heinrothian version, had also been doubted by other German writers for reasons perhaps internal to the arguments themselves, or, as Klaus Doerner in his Madmen and the Bourgeoisie has argued, for reasons to do with mid-century liberal opposition, of which Griesinger’s work is an example, to absolutist states. But – and this is not a line of argument that I have seen elsewhere in discussions of the paranoia question – it is just at this point, around the 1860s, that the question takes on a very interesting aspect.

I have said so far that paranoia in the psychiatric literature is a Christian idealist orphan word, a label to describe a totalising messianic fatuity in persons then deemed insane, which at the same moment elicits an ironic recognition that a psychiatry insistent on citing such conduct would have, weirdly, to share in this totalising enterprise. For Heinroth, there were no partial insanities. Within other European traditions, a marked aversion to this non-partiality is evident, and one could argue that in the pre-Kraepelinian world, i.e. pre-1890, ‘paranoia’ was homeless, without a target, a difficult ghost from the nightmare marriage of psychiatry and Naturphilosophie. The work of Emil Kraepelin, and to a lesser extent Eugen Bleuler, in the last decade of the century, and the development of ideas on dementia praecox and schizophrenia, cleaned up the redundant category that paranoia had become. By the route, especially, of Kraepelin’s dementia paranoides, paranoia was dissolved into the new structure of the ‘schizophrenias’. But something else had happened as well, before this late 19th-century semi-resolution: the important collaboration, at a theoretical level, between ideas on the stages of mental disease, their process, even their procession, and views on degeneration.

In the middle of the 19th century – and even Griesinger, according to Doerner, is touched by this – the French writing on degeneration exerted a powerful influence on Continental psychiatric writing, and, just as importantly, on the social commentary and literature of the age. It is of considerable historical interest that at the time when the ‘paranoid process’ is first mapped out in the French literature – by C.E. Lasègue, 1852, and then J.P. Falret in 1878 – the staging posts in the paranoid journey coincide with B.A. Morel’s religiously-inspired work on degeneration. Thus Falret in 1878 sees delusions of persecution as beginning with a period of incubation, followed by hallucinations of hearing and systematised ideas of persecution, by hallucinations of smell, and then – but not always – by a final, megalomaniac stage of folie de grandeur or délire ambitieux. Thus, as it culminated in the work of Valentin Magnan in the 1890s, the study of progressive, systematised delusions of persecution and grandeur, and of their stages, coincided with degenerationist teleology and hence with therapeutic pessimism. Degenerationist theory – whether riddled with Christian, judgmental categories, as in Morel’s case, or with more secular but equally pessimistic ones, as in Magnan’s case – is the historical are through which a great deal of psychiatric writing and social realist novels of the age (one thinks of Zola’s study of alcoholism in L’Assomoir) must pass. By now there can almost be an interchangeability of words – whether délire, Verrücktheit or ‘paranoia’ – and if the delusions were progressive, then there was little or no way out – only the various stages of degeneration.

As I suggested earlier, the choice within much of the psychiatric writing on paranoia could be seen as consisting either in avoiding the word altogether, tainted as it seemed to be with idealist inexactitude, or following through the task of mapping the paranoid process, and naming names. A historian of the word in the 19th century would surely have to look at Bismarck’s police records, or study the literature on social degeneration in general, to attempt an answer to the question of what social ends this ‘disowned’ word was serving in the culture of everyday life. In the psychiatric literature, one form of naming names is now absolutely clear: paranoids, for a certain, degenerationist-influenced German and French psychiatry, were homosexuals. Or, to be exact, transitional sexual types: men, or women, dreaming (usually) of being something else. If degenerationist psychiatry had not been given Richard Wagner, Ludwig II of Bavaria, and Friedrich Nietzsche, it would have invented them – would have written and composed Parsifal.

This act of recognition is best seen in the compilations of paranoid cases carried out by that terminal figure of one strain of European psychiatry, Richard von Krafft-Ebing. I quote only a couple of cases from his Psychopathia Sexualis (1886), but the use of the category ‘paranoia’ to describe homosexual or trans-sexual cases is now explicit. It should be stressed that Krafft-Ebing (who classed paranoia under ‘psychical degeneration’) also sees it as occurring in those damaged by inheritance, developing on the basis of constitutional neuroses, and that he never saw recovery, only remission.

Take ‘Case 112’ from Psychopathia Sexualis. N, aged 23, single, a pianist, who had masturbated from the age of 15, was received in the asylum at Illenau in 1865. He suffered from fantasies of persecution, and in the early stages of his stay in the asylum, these were accompanied by olfactory hallucinations. Krafft-Ebing records that he, N, alleges that he is ‘dying of magnetically poisoned air and unsatisfied love’. From about August 1872, he declared that he could no longer ‘live among men that drink and smoke’. He insisted that he thought and felt like a woman and that he should be transferred to a female ward. By the end of 1872 N had ‘become’ the Countess V, ‘the dearest friend of the Empress Eugénie’, and remained within that identity until death from tuberculosis in 1874. Krafft-Ebing described this as a case of metamorphosis sexualis paranoica. In Case 161, under the category paranoia religiosa, Krafft-Ebing discusses an example of extreme – and perverse – sexual excitement between M and his daughter, M believing that their progeny would be the ‘Eternal Son’, who would be a bridge between the Old and New Testament’. He was ‘commanded’ to this act, which he deemed divine, and this was the cause for insanity and the ‘insane act’.

As for the extremely influential degenerationist writing of Max Nordau, it surely must be seen in its own terms – as an example of paranoia as a wish, even a dream, come true. In Degeneration, dedicated to the criminologist and psychiatrist Cesare Lombroso, Nordau sees the 20th century as a death rattle, not for civilisation as a whole, but for the various united degenerations which disfigured art and society and which would have to be seen out before a revived, classical, ‘healthy’ world could begin again. He calls society ‘a hospital’, gripped by a black death of degeneration and hysteria:

Our long and sorrowful wandering through the hospital – for as such we have recognised, if not all civilised humanity, at all events the upper stratum of the population of large towns to be – is ended ...

Every city possesses its club for suicides. By the side of this exist clubs for mutual assassination by strangulation, hanging or stabbing. In the place of the present taverns, houses would be found devoted to the service of consumers of ether, chloral, naphtha and hashish. The number of persons suffering from aberrations of taste and smell has become so considerable that it is a lucrative trade to open shops for them where they can swallow in rich vessels all sorts of dirt, and breathe amidst surroundings which do not offend their sense of beauty nor their habits of comfort by the odour of decay and filth. A number of new professions are being formed – that of injectors of morphia and cocaine; of commissioners who, posted at the corners of the streets, offer their arms to persons attacked by agoraphobia, in order to enable them to cross the roads and squares; of companies of men who by vigorous affirmations are charged to tranquillise persons afflicted with the mania of doubt when taken by a fit of nervousness ...

Sexual psychopathy of every nature has become so general and so imperious that manners and laws have adopted themselves accordingly. They appear already in the fashions. Masochists or passivists, who form the majority of men, clothe themselves in a costume which recalls, by colour and cut, feminine apparel. Women who wish to please men of this kind wear men’s dress, an eyeglass, boots with spurs and riding-whip, and only show themselves in the street with a large cigar in their mouths. The demand of persons with the ‘contrary’ sexual sentiment that persons of the same sex can conclude a legal marriage has obtained satisfaction, seeing they have been numerous enough to elect a majority of deputies having the same tendency. Sadists, ‘bestials’, nosophiles and necrophiles etc find legal opportunities to gratify their inclinations. Modesty and restraint are dead superstitions of the past, and appear only as atavism and among the inhabitants of remote villages. The lust of murder is confronted as a disease, and treated by surgical intervention, etc.

The capacity for attention and contemplation has diminished so greatly that instruction at school is at most but two hours a day, and no public amusements, such as theatres, concerts, lectures etc, last more than half an hour. For that matter, in the curriculum of studies, mental education is almost wholly suppressed, and by far the greater part of the time is reserved for bodily exercises; on the stage only representations of unveiled eroticism and bloody homicides, and to this, flock voluntary victims from all the parts, who aspire to the voluptuousness of dying amid the plaudits of delirious spectators.

No wonder Aubrey Lewis, when describing the aversion to the word ‘paranoia’ felt by the English psychiatrist T.S. Clouston, writes that he had, ‘by some undisclosed reasoning’, come to find it ‘obscene’.

Where does that leave Sigmund Freud, and his work on the case, though not of course the person, of Daniel Paul Schreber? Certainly not as an original, in that his account of Schreber’s so-called paranoia as a result of his repressed passive homosexuality might be far more conventional than is supposed. Perhaps Freud was just helping himself resolve something. He hints at this, in a letter to Jung of 18 December 1910: ‘I am unable to judge its objective worth as it was possible with earlier papers, because in working on it I have had to fight off complexes within myself (Fleiss).’ Still, it would not be necessary to see the Vienna Psychoanalytic Society as a home-from-home of homosexual panic to agree that the Schreber case is spectacular, and that Freud, in certain vital respects, has striking things to say about it.

Putting it father too cutely, D.P. Schreber, the son of a notoriously rigid educationalist and social reformer from Leipzig, wanted to be a woman. In figurative terms, he wished to turn into the female figure who is seen ascending into heaven in an entirely conventional painting, called Liebesreigen, by the moderately talented but very successful 19th-century Spanish, artist, Francisco Pradilla. Schreber, who was born in 1861, published an account of his nervous illnesses, the first of these seen out in the Psychiatric Clinic of the University of Leipzig (he returned after this first episode to his post as a judge at the County Court in Leipzig at the end of 1885); and then, falling ‘ill’ again in October 1893, he eventually transferred to the Sonnenstein Asylum in Pirna, near Dresden. He remained at Sonnenstein for almost nine years, and there wrote his Memoirs.

The Memoirs are a famously lucid account of how Schreber was being ‘unmanned’: how his body was turning into that of a woman, and how what he was experiencing (and he indicts the psychiatrist Emil Kraepelin at this point) was neither a delusion nor a hallucination. He was kept alive by rays from the sun, which in turn were manifestations of God: when this power was at its full, he experienced ‘soul-voluptuousness’, which he saw as bordering on the thrill of female sexual enjoyment in intercourse, as some of Krafft-Ebing’s cases had done. When this voluptuousness dispersed, he experienced ‘soul-murder’, at the hands of what he called ‘fleeting – improvised – men’. He sees the nerves of birds as remnants of the souls of human beings who had become blessed, and proposed that when the conversion into a woman was complete in him, the world would be saved. In a fine discussion in the middle of the Memoirs about the dangers of involuntary confinement, he stresses the harmlessness of his insanity. He also says that attacks of bellowing among paranoiacs, ‘to which category I am supposed to belong’, are rare. His sense of persecution often concentrated on one of the first physicians who had treated him, Paul Emil Flechsig.

Schreber combined an idea of redemption with trans-sexualism, and his Memoirs are full of accusations against those who do not understand this. On some occasions, this group of uncomprehending watchers included God himself, who was often seen to behave ignorantly and stupidly. (Freud called some of this ‘a bitter satire on his father’s medical art, in that God knew only how to deal with corpses’.) God would play with Schreber, telling him, for example, to go and defecate, and then arranging for somebody else to be in the lavatory when he got there. But if the process of ‘voluptuousness’ could be completed, Schreber’s soul would pass into a state of purification and bliss, and God would reveal himself to the now feminised Schreber as his lover. Schreber’s soul had educated God into sexuality.

There are dozens of commentaries on the case, and on Freud and Jung’s interest in Schreber’s private or ‘basic’ language. Schreber is seen as having had suppressed homosexual longings for his father and brother: these, are repressed, and the transference of the now hostile feelings is made onto Dr Flechsig, the soul-murderer par excellence. His paranoia was due to his repressed homosexual impulses. As Freud says in his paper ‘On the Mechanism of Paranoia’, the core of the conflict in cases of paranoia among males is a homosexual wishful fantasy of loving a man; at the level of consciousness and speech, this is uttered as a contradiction, i.e. is expressed by a delusion of persecution – ‘I do not love him – I hate him’ – with the implication of being personally attacked. Freud then lists various other contradictory sentences that paranoiacs will offer, against their ‘true’ impulses. He also wished to relate paranoia to a ferocious regression to narcissism.

I would like to bring out two main features of Freud’s account. He has to prove the sexual theory, of course, and to do this, in the case of paranoia, wishes to keep paranoia as an independent clinical entity, at least in his work up to 1914. So Kraepelin’s dementia praecox is played off against paranoia. He also suggests that ‘paraphrenia’ would be a better word than dementia praecox. Now it is important to see what Freud is doing here, in relation to the history of the word ‘paranoia’. At precisely the moment when the sheer generality of the term is bringing it to the point of expulsion – at last – from the main canon of European psychiatric writing, Freud insists on keeping it in view. While Kraepelin in particular was coming to see paranoia as rare and indeed when he was making use of the ‘paraphrenias’ as an expression for systematised delusions and persecutions that did not deteriorate into dementia praecox, Freud faces it. He is not alone: the psychopathological work of Kretschmer and his associates, which was contemporary with Freud’s, took a developmental and, importantly, a relatively optimistic view of the outcome of some paranoias.

But paranoia was, as it were, coming out. It was being rescued from the idealist, pessimistic cultural wasteland to which degeneration theory had condemned it. And Freud makes this wonderfully clear when, in his study of ‘The Mechanism of Paranoia’, he says: ‘The delusional formation, which we take to be the pathological product, is in reality an attempt at recovery, a process of reconstruction.’

Paranoia can now be seen, by making explicit its sexual content, as an imaginative action close to, though not identical with, wishes. Paranoia makes use of projection, and is not at the mercy of the condensing or hysterical mechanism that occurs in dementia praecox. Paranoia is, so to speak, part of the cure: a form of emergence. And Freud, exactly as Heinroth had done, developed a mode of recognition for this, a means of reaching it: the crucial difference was that he did not condemn the paranoiac to the idealist totality, and then the pessimisms, of the tradition whose orphan word he was absolving. For psychoanalysis is itself paranoid: the analyst listens to the patient reconstruct himself; the patient must then suspect and project onto the analyst, while the analyst must learn a her-meneutics of suspicion; the analyst then acquits him by withdrawing his love from the patient, just as paranoiacs are said to do from the world. In biographical terms, by taking up a historical case, that is to say Schreber, Freud may have been freeing himself – of his feelings toward Wilhelm Fliess, or Sandor Ferenczi, or, prophetically, Jung. He was also creating a form of thought that terminates the unhoused wanderings of paranoia as it had been thrown back and forth between the European psychiatric writers of the 19th century. European psychiatry had a word for the newly recognised deviant, one that it did not wish to use particularly, but whose ancient-sounding authority somehow kept it alive: that word is ‘paranoiac’. It had its confusions absolved by the invention of a system of investigation whose exact task was to be as suspicious as any patient in the category could be, and by recognising the supposed sexual basis of paranoia, closing a century of unhappy misrecognitions: we call it ‘psychoanalysis’. Freud did not ‘discover’ the hidden agenda that had come to link paranoia with different visions of the sexual life. It does not even matter that his act of recognition has no therapeutic value in treating, say, the schizophrenias of post-Freudian psychiatry. Perhaps Freud is the final victim of the word, standing alone as his colleagues make off into the schizophrenias, or mythology, or ego-psychology: the last laugh may be on him. He helped the word come out, not as overtly or as pessimistically as Krafft-Ebing (though Krafft-Ebing later changed his mind) but, so to speak, sotto voce and with some optimism. ‘Schreber, who ought to have been made a professor of psychiatry and director of a mental hospital ....’

Freud had not solved anything of particular importance in the context of the 1910s and 1920s, particularly with regard to the ongoing work on the schizophrenias. He used the Schreber case to advance the sexual theory, and perhaps to deal with a private neurosis. For Bleuler especially, the theoretical discussion could reasonably be seen as of no consequence, since paranoia in any pure sense could be deemed rare, while schizophrenia was all too common in the back wards of mental hospitals. Freud was possibly effecting an act of recognition, and at the same time terminating the career of a certain usage for a certain word. The fact of delusional psychoses, the work in the 1930s of Langfeldt on schizophrenias, including paranoid schizophrenia, and the general absorption of the word into the schizophrenias – this remains the important legacy. But, as many writers have commented, ‘paranoia’, as launched on its strange career from Heinroth onwards, had gone. ‘Paranoid’, as Aubrey Lewis suggests, lingered on, but attached to the more powerful psychiatric concept of schizophrenia.

And, of course, it lingers in our own daily speech. The Oxford English Dictionary, interestingly, gives only a few examples, from the second half of the 19th century, many of them American. But, in the Supplement, Volume III, O-Scz, published in 1982, the word is accorded new respect, with additional historical examples from as far back as 1811 and from as recently as 1978. No doubt the reasons are simple: the linguistic side-effects of a drug culture; the fear of crime (one of the examples from a novel called Confess, Fletch of 1976 in the OED Supplement is ‘Even paranoids have enemies’); and no doubt the often strange business of negotiating – particularly American-modern cities. But given how much effort the profession of psychiatry has made to sort out this querulous interloper, either to use it as a throwaway expression for deviants or, perhaps more honourably, to expel it, lay users might follow suit. In certain political contexts, it seems deliberately disabling – to be disallowing that most necessary of civilian attitudes, political suspicion. And it may also be important that when we say, ‘he’s paranoid,’ what we are equally wanting to say is ‘he’s scared’ or ‘he’s malevolent.’ The strange history of the word ‘paranoia’ relates intriguingly to ideas on psychological differences between men and women. Freud commented on the odd relation to paranoia in which his theory placed women, and he noted that paranoia in homosexual women was a possibility: but he also seems to have regarded women as much less prone to this state of mind. Paranoia, with its twisted landscape of persecution and grandeur, conspiracy and jealousy, might well be thought of as a weird conversation between men, or even one way of describing how men talk to themselves. By thinking again, and more sceptically, about what states of mind it is really seeking to describe, users of the word might even discover that what they are trying to say is ‘hello.’

The books mentioned in this piece include:

The Later Papers of Sir Aubrey Lewis. Oxford, 245 pp., 1979, 0 19 712150 0.

Mystical Bedlam: Madness, Anxiety and Healing in 17th-Century England by Michael Macdonald. Cambridge, 323 pp., £27.50, 1 October 1981, 0 521 23170 1.

Madmen and the Bourgeoisie: A Social History of Insanity and Psychiatry by Klaus Doerner, Blackwell, 361 pp., £17.50, 1981, 0 631 10181 0.