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Paranoia from the Perspective of Phenomenological Psychopathology

Abstract and Keywords

This chapter considers the concept of “paranoia” from the perspective of phenomenological psychoptholgy. In so doing, it looks at the contribution of various authors, including Kohut who identifies in the bipolar shame/rabies oscillation a strongly connotative characteristic of the structure of paranoid personality in its potential delirious evolutions. This oscillation, in evolving toward the most stable condition of the “chronic narcissistic anger,” finds its most typical psychopathological expression in paranoid querulomanic delusions. The shame/rabies oscillation can be partially superimposed on the oscillation between the Astenic/Sthenic poles inside which, for Kretschmer, the whole arc of the paranoidal “delirious developments” unfolds. Cargnello suggests that the paranoid condition implies a regime of instability between two opposing polarities: the megalomaniac defense and the persecutory risk. This chapter discusses why, in the opinion of this author, the approach of many in the field, who focus on the behavioral aspects of paranoia, is lacking.

Keywords: psychopathology, phenomenology, paranoia, shame/rabies, persecutory risk, megalomaniac defense, paranoiac imaginary background

Clinical Investigation Raises Questions About Anthropophenomenology

The theme of “complexity” of scientific “object” has been summarized in the concept of “challenge of complexity” by E. Morin (1985). This concept represents a constant challenge to find the more global and the least mutilating possible meaning in front of multiform observable segments of the world. This concept does not belong to a particular theory or to a particular discipline, but is, rather, a general discourse regarding all of science.

The notion of complexity, in this sense, is not the answer to a problem, but is instead “the re-awakening towards a problem: the eruption of an irreducible uncertainty in our knowledge, and the fall of myths of completeness, exhaustiveness, omniscience which, for centuries, like comets, indicated the road of modern science” (Bocchi 1985).

But the positive aspects of the complexity are equally important. These include the growth of a “multidimensional thought” (Morin 1985), which can be described as the awareness that various disciplinary categories are but many aspects of the same reality. These aspects must be distinct but, above all, must be rendered as communicating.

In the face of the perpetual temptation to enclose the world in a pre-established structure, E. Morin, the great expert of epistemological problems, suggests a new approach to knowledge which he calls the “method of complexity”. “The method of complexity [as E. Morin clarifies] asks us to think without ever closing the concepts, without ever breaking the closed spheres, in order to re-establish the articulations between that which is disjointed, forcing ourselves to understand the multidimensionality … ” (Morin 1985: 59).

Unlike the traditional model of scientific knowledge—a neutral and omnipotent model of thought which claims to represent reality as it is—Morin suggests a new profile of knowledge. His model is aware of its own limitations and its temporariness and this new attitude facilitates the discovery of new possibilities and new ways of reading the world.

Psychopathology ought to be located today in the domain of complex science including its specific “challenge of complexity”. Psychopathology is in need of exactly that which E. Morin calls “multidimensional thought” which is an interdisciplinary, methodological attitude, or rather, a trans-disciplinary attitude.

Within this “complex” perspective, the hermeneutic approach (comprehensive-interpretative)—which was originally suggested to psychiatry by Jaspers (1913)—is the only one able to give again freshness and specific originality to psychopathology, after many years of extreme poverty in which the phenomenological approach seemed to have exhausted its task.

At this point, it is important to note that between hermeneutic and phenomenological approaches there is no discontinuity of horizons. In fact, phenomenological philosophy, as a descriptive doctrine of the phenomena of consciousness—phenomena consisting of events sui generis that are “experiences of meanings”—is unavoidable inserted in a hermeneutic horizon (Husserl 1913). “Consciousness,” according to phenomenology, is steeped with meanings and interprets incessantly, because of its vision of the world, all of the things it encounters. Thus as for hermeneutic thought also for phenomenology to know is to interpret.

Our interest is orientated toward the hermeneutic side of psychiatry, which deals with the individual specificity of every clinical history, with the continuity of sense, and with the intrinsic narrative intelligibility of every event, psychopathological or not.

This area of research belongs to a vast hermeneutic horizon and represents a point of intersection of the various points of view of the many other hermeneutic approaches. In such a complex context, psychopathology becomes a meeting area open to other, sometimes very different, methodological perspectives. Those perspectives should be open to narratological analysis as sequential analysis of a text and of its internal coherence, to psychoanalysis as symbolic re-reading and re-narration of a life, as well as to anthropology and phenomenology as an uninterrupted interrogation regarding variety, sense, and project of possible imaginary worlds of human being.

Paranoia and Surroundings: examining Psychopathology through the Clinical Text

The merit of restoring full psychopathological dignity to the concept of paranoia goes to D. Cargnello (1984), who underlined the specific nature of paranoid delusions and the level of grandiosity that distinguishes them.

The concept of paranoid delusion today appears outdated and almost completely unused in clinical diagnosis, as demonstrated by the DSM-III-R (1987) which consigns to nosography the final, probably uncancellable nosographic residue of a psychopathological notion of such complex history and problematic articulation. The DSM-III-R replaces the term “paranoia” (still present in the DSM-III of 1980) with the term “delusional disorder,” characterized by the absence of bizarre aspects. Only in relation to querulous delusion is reference made to the old term “querulous paranoia”.

The DSM IV (1994) completely eradicates the lexical term paranoia for reasons no more clearly motivated than “being theoretically compromised”.

The DSM-V (2014) reinstates the “delusional disorder,” attempting to describe it using specifiers: erotomanic type, grandiose type, jealous type, persecution type, somatic type, mixed type, unspecified type.

The nosographic specifiers distinguish between paranoid personality disorder and delusional disorder with paranoid features. A personality disorder is defined as a mental disorder manifested in maladapted thoughts and behaviors expressed pervasively, inflexibly, and permanently, involving the cognitive, affective, and interpersonal spheres of an individual’s personality. A delusional disorder is instead delineated by the presence of a delusion for at least a month in the absence of marked compromise in the individual’s functioning, with the exception of the impact of the delusion itself and its ramifications. It thus appears to underline a qualitative and quantitative difference: qualitative in that the personological architecture is not considered in subjects with a delusional disorder, while instead the personological architecture pervasively and stably constitutes personality disorders. Quantitative in difference of intensity, which appears to stop at a suspicious and diffident interpretative attitude toward others in paranoid personality disorder, while in delusional disorder it reaches its maximum expression in the creation of erroneous convictions not subject to critical judgment, leading to the altered conception of reality of delusion.

Perhaps under pressure from the need to facilitate diagnosis in order to establish therapies and prognoses, this system often appears to lose the narrative continuity of the individual, explaining any discontinuities in the symptom groupings with the concept of “co-morbidity”. These generic “treatment” categories are not intended to substitute “sense” based categories of indicators, and they should co-exist in clinical practice. In this way it is possible to identify the paranoid dimension, previously an indistinct continuum from normal to pathological, while also avoiding the risk of being led astray by the patient’s own predominant ideas, which in the paranoiac are very striking at first impression and appear to sum up the entire disease, encouraging practitioners to overlook the contexts in which they arise and of which they represent only a superficial manifestation.

Based on the psychopathological ideas of D. Cargnello, who made an extraordinary psychopathological analysis of paranoid delusion (“The Ernst Wagner case”, 1984), we understand that the concept of paranoia represents an absolutely indispensable concept in certain psychoses marked by cold grandiosity and a coherent defensive structuring of the delusional Ego.

We also consider this concept to be of great heuristic value, if we bear in mind that paranoid delusions appear to define an area of transition between common thought and delusional thought, in contrast with truly schizophrenic forms in which the disintegration of the personality, the structural disorders of thought, and autistic apragmatism indicate an almost complete detachment from socially accepted thoughts and behavior.

In its various editions the DSM once again reveals a lack of coherent organization of psychopathological thought, marking the current moment of crisis in psychopathology, after reaching the highest expression of its potential around the 1930s. Tracing the history of the concept of “paranoia” means going back to the origins of psychopathological thought, perceiving it once again in its most vital and essential sense.1

A Brief History of the Concept of Paranoia

In the VI edition of his treatise (1899), Kraepelin defined paranoid delusion as: “The slow development, due to internal causes, of a lasting and unyielding delusional system, which acts while the lucidity and order of thought, of thinking and acting, remain perfectly intact”. It is underlined that the personological structure is always conserved.

French language psychiatry transferred the substance of the Kraepelinian definition into the concept of “chronic systematized delusion,” a cornerstone of French psychiatric culture (De Clérambault 1921; Claude and Montassut 1926; Ey and Pujol 1955; Nacht and Racamier 1958; Racamier 1966). The “chronic systematized delusion” was contrasted against the “paranoid” degeneratively evolving forms of schizophrenia.

In the analysis of the forms of “chronic systematized delusion” by the French school there was a failure, in the view of the present author, to adequately underline the aspect that most typifies paranoia: cold narcissistic grandiosity, which had originally been immediately identified, both in France (Dupré 1919, cited by Ferrio 1970) and in Italy (Tanzi 1923).

Returning to the historical vicissitudes of the concept of “paranoia,” it should be remembered that over the years it referenced semantic areas of psychopathology of variable extension, which are briefly summarized here, all of them having in common the attempt to describe a personological structure.

From the early 1900s some authors in the French and German schools identified as a basis for paranoid delusions a particular personality structure variously labeled as: “abortive paranoia” (Gaupp 1910), “paranoiac character or structure” (Sauget 1955; Schultz 1955; Kranz 1958), “paranoiac constitution” (Dupré 1919; Delmas 1932), “minor paranoia” (Genil-Perrin 1926), and “paranoiac psychopathology” (Kehrer 1951).

All these labels can be unified under a number of character traits summarized as follows: psycho-rigidity, diffidence, excitability and irritability, extreme susceptibility to criticism, aggression and threats, tendency to overestimate personal talents and qualities, propensity toward feelings of envy and jealousy, tendency toward denigration and dissimulation, and fanatical enthusiasm for pure ideologies as long as these provide a totalizing means for interpreting the world.

Duprè (1919), for example, succinctly summarized the paranoiac constitution in three points: 1) hypertrophy of the Ego, pride, feeling of superiority; 2) moody and diffident temperament with a tendency for hostile misinterpretation of the environment and malevolent interpretation of the deeds of others; 3) error of judgment with permanent and implacable dialectical stance toward unilateral, egotistical, biased judgments.

The classic authors who made a decisive contribution to this issue include Kretschmer (1950). He rendered the concept of “paranoiac character” dynamic by establishing relationships between key life-events, and unified through the concept of “paranoiac development,” personality, biography, and delusion.

“At the root of paranoid development,” states Kretschmer, “lies a complex of defeat and a tormented sense of guilt which, over decades of evolution of the personality, leads to the establishment, by way of hypercompensation, of a dense system of thoughts of grandeur, hate, and revenge, an unbounded overestimation of the self paired with a sthenic aggressive conception of life.”2

This now classic approach was recently taken up again with great originality by Kohut (1971, 1978) in terms of “narcissistic pathology”.

It is noteworthy that both Kretschmer and Kohut dedicate time to explicating their model using a character from German Romantic literature (inspired by a real historical figure), Michael Kohlhaas, from a story by Kleist dating back to 1826 and seen as an emblematic example of paranoid litigiousness.

The short story provides an amusing description of the insatiable thirst for revenge of the protagonist, the victim of an unusual narcissistic offense.

Kretschmer sees the behavior of the protagonist as a perfect example of the development of delusions of grandeur. Kohut, in turn, sees in Kleist’s story the best representation in German literature of the theme of narcissistic anger and implacable litigiousness. His article “Thoughts on Narcissism and Narcissistic Anger” (1978: 125) describes it as follows: “Kleist’s novella recounts the destiny of a man who, like Captain Ahab, is trapped in an implacable narcissistic rage. It is the greatest representation in German literature of the motive of revenge, a theme that plays an important part in the national destiny of Germany, whose thirst for revenge after the defeat in 1918 almost arrived at the destruction of the entire western civilization”.

By indicating Kleist as one of the authors who (together with Melville in “Moby Dick”) best represented the most prominent features of narcissistic pathology, Kohut repeatedly underlines the theme of paranoid grandiosity, interpreting it as a specific defensive strategy that he defines as “chronic defensive grandiosity” or “defensive narcissism”.

The present authors in turn also underline how the sphere of paranoid personalities hinges on the counterphobic attitude of systematic opposition and anticipatory vengefulness, all powered by an inexhaustible megalomaniacal drive.

Indeed, ever since the time of Kraepelin, there was a perception of the diagnostic problem of differentiating between paranoid delusions and paraphrenic delusions, in which the fabulatory-megalomaniacal core always emerges centerstage. Kraepelin himself appears to have repeatedly considered the possibility of positioning them very close to the fantastic paraphrenias, sensing the latent megalomaniacal nucleus, often inaccessible to observation, present in this pathology. As will be seen, this issue is not irrelevant from the psychopathological and phenomenological perspective, considering how scarcely the paranoiac imagination has been investigated. In order to discern the paranoiac imagination and its temporality from paraphrenic delusions, Callieri and Maci (2008), who underline particular operative modalities of memory, characterized the paranoiac with temporarily displaced reconstructions, and frequent omissions that impede the natural chaining together of events, despite the evocations of individual elements appearing largely precise and accurate. This probably derives from a wider operation of selective attention that strives for a unitary and exhaustive knowledge of the world, often repetitive but never fleeting. In paraphrenia in this sense a larger role appears to be played by interpretation, with the construction of more ephemeral and fleeting meanings that take different directions from one moment to another.

In summary, in the sphere of chronic psychoses, paranoid delusions appear to lie entirely outside of the schizophrenic range, almost defining a form of transition between common thought and deluded thought. For this reason above all, paranoia represents a crucial node not so much for clinical practice but rather for psychopathological reflection and psychiatric epistemology, lying as it does between common thought and delusion, between personality structure and symptom.

Paranoia between Personality Structure and Symptom

All the authors that have dealt with the issue of paranoia agree in identifying the aspects of tenacious and fanatical combativeness that characterize the personological structure of the paranoiac, to the extent that it has even been called “delusional action” (Serieux and Capgras 1902). Its psychological identikit is defined with great precision by Tanzi (Tanzi and Lugaro 1923). This author, considered by the present author to be undervalued, makes the paranoiac into a sort of champion of idealism, identifying the characteristics of narcissistic grandiosity that locate him, taking into account the necessary historical perspective, within the psychopathological area that today is defined as typical of the “narcissistic personality disorders”.

Tanzi’s identikit is as follows:

Wild independence of character, misanthropy, pride, dogmatism, fanaticism “both in religion and irreligiousness” … The delusions of paranoiacs are not rooted in a defect in intelligence, but rather in the singularity of a character which has essential elements that include marked selfishness, an extremely high opinion of the self, a diffident attitude towards others, an expansive and militant sense of mysticism, a chivalrous spirit of active protection or passive devotion to an amorous ideal, a sensitive intolerance of injustice even when imaginary … and above all a rare tenacity and constancy of driving sentiments that give direction to a tirelessly combative behaviour.

The sensitive aspects that permeate the character of the paranoiac and that trigger his fanatical litigiousness are summed up by Tanzi as:

By reconstructing his past the paranoiac finds traces of continuous, widespread, insuperable insidiousness even in the smallest childhood conflicts, an unjust castigation, a toy that broke as soon as it was purchased, an excessively hot drink, favouritism in the marks awarded at school, in the omission of an invitation ... But over the long term the persecuted becomes in turn the active and obdurate persecutor. He makes unfounded accusations, appeals to courts of law with petitions and denunciations, not obtaining satisfaction he disdains from referring further to the courts that are seen as weak, partial, or corrupted by his persecutors; finally he decides to take justice into his own hands.

(Tanzi and Lugaro 1923: 738, 749, 750).

The characteristic imprint of paranoiac action is that it is essentially social action. Underlying the paranoid delusional experience Tatossian recognizes “the calling into question of the identity of the social role” and tellingly notes that the persecuted paranoiac essentially calls more for the confession of the aggressor rather than the interruption of the aggression, the jealous paranoiac requests more the acknowledgment of guilt by the other rather than his love, and the querulous paranoiac calls for a just sentence rather than financial compensation.

The area of narcissistic pathology was mentioned in relation to the paranoid personality. It is no accident that Kohut himself identifies in “narcissistic rage” the driving element of these vindictive paranoid inclinations. In an article in 1978 Kohut writes:

The most horrific human destructiveness [is found] under the form of ordering and organizing activities in which the destructiveness of the actors is amalgamated with the absolute conviction of their greatness … The need for revenge, to settle an insult, to compensate a damage by any means, and an implacable constriction to pursue all these ends … are the characteristics of narcissistic rage. In narcissistic personalities and paranoiacs, extreme sadism, the adoption of a policy of pre-emptive attack, the need for revenge and the desire to transform a passive experience into an active one are the remedies by which an individual, inclined towards shame, responds to situations that could potentially provoke shame.

(Kohut 1978: 145, 146)

The same author identifies more precisely the problem of narcissistic pathology as an oscillation between shame and rage, and when analysing the concept of “chronic narcissistic rage,” touches on the issue of transition between paranoid personality structure and delusional symptomology. The shame/rage oscillation closely resembles the oscillation between the two asthenic/sthenic poles, within which, according to Kretschmer, the whole range of paranoid delusional developments are arrayed.

B. Callieri and M. Maci confirm the role of shame as the greatest injury within narcissistic vulnerability, and to the narcissistic ideal. Shame, in all its gradations, can be caused by interaction with the other, with his gaze, which may be perceived as directed to the most hidden and least tolerated psychic world, experienced as a sometimes unbearable attack on the individual. Well aware of this experience, Nietzsche wrote “Who is evil? He who wants to shame me” (122).

The theme of shame thus runs through various existential dimensions of paranoia, and can develop through interactions with the other, developing under his gaze; an invasive, intrusive gaze that easily introduces persecutory feelings. As Callieri and De Vincentis showed, the meaning of life and the dynamics of the gaze present spatial peculiarities: through the gaze the other expands, coming to be where it falls, lending the capacity to grasp and violate the most profoundly private sphere. On the other hand, shame can be experienced in the most exclusive relationship with the ideal of the Ego, starting from emotions or thoughts that do not fit easily with the image that we would like to present to ourselves, and be recognized as by others.

As Rossi Monti (2009) underlined with reference to Meissner’s idea, shame, compared to the more circumscribed guilt, assumes a global nature, because it is addressed toward a global image of self, exposed to self-judgment: “From this experience of shame the paranoiac emerges with its inversion into dysphoric anger, in marked irritability and haughty suspiciousness … ”.

According to Kohut, “chronic narcissistic rage” is the expression of the insistence of exercising total and omnipotent control over the subject, in response to an episode of shame, experienced as an uncancellable stain that spoils and undermines a reality experienced narcissistically, in the pure reflection of the self.

Someone who has suffered a narcissistic injury of this type “has no rest until he cancels the offence of the one who dared to oppose, disagree, or even simply outshine the subject”. Narcissistic rage, when it expands and becomes chronic, tends to lead to loss of the limitations inherent to the power of self, which will tend to increasingly attribute its own failings and weaknesses to the malevolence and corruption of external “objects” that do not collaborate. This sets up a self-feeding persecutory cycle that encourages the rage and narcissistic omnipotence. Chronic narcissistic rage is defined by Kohut as “one of the worst torments of the human psyche, both in the initial endogenous and preliminary form of protest and spitefulness, and in the exteriorized form of isolated vengeful acts or carefully planned vendettas”.

To better clarify the words of Kohut it can be added that the argumentative tactic, embraced within “chronic rage,” is constantly at work to anticipate and counterphobically defer the ever looming persecutory anxiety. So much confrontational effort, centered on vengeful action, is much more easily observable compared to the submerged world of the paranoid imagination, which is consequently insufficiently investigated. This explains the reductive (even if appropriate) label of “delusion in action” (Serieux and Capgras 1902).

Sooner or later this type of anticipatory defense will fail in its attempt to maintain sufficient distance between the phobogenic and persecutory figures that he is trying to defend against. It is for this reason that the counterphobic strategy of chronic rage, tirelessly striving to destroy the phobic ghosts that assail the paranoiac world, is in any case always imbued with anxiety and implies a regime of instability between two diametrically opposite poles: megalomaniacal defense and persecutory risk.

For Cargnello the persecutory urgency and megalomaniac urgency are two poles between which the psychopathology of paranoia oscillates. “Persecution and grandiosity usually appear together. They are like a sound and its echo, like an object and its reflected image, like the backwards and forwards of a pendulum … ” (from the play Wahn by E. Wagner, in Cargnello 1984).

This unstable system is implicit in incurable paranoiac vengefulness, an oscillating self-reflecting movement which endlessly presents the two opposite and specular faces of the paranoiac world.

For Callieri and Maci, the megalomaniacal core of the paranoiac, with his quest for ever higher ideals of justice, the pursuit of ambitious and distant political projects, religious faith experienced to its maximum, offers the paranoiac not only the possibility of hiding his experiences of shame, but also of seeking out a social role that compensates him for experiences of inferiority and limitation. The paranoiac’s battle assumes an ever more epic value, against human limitations and the crumbling of his identity if faced with the multitude.

These authors thus consider it no accident to see the manifestation of a delusional drift around forty to forty-five years, a period of life according to Del Pistoia (1985): “In terms of experience of the world, this age brings awareness of a change in horizon after completing ‘life’s journey’ … But it is also above all the age in which future time loses the unending uncertainty it had at twenty years … ”. It is an age of taking stock, which can result in narcissistic injuries or in simpler anxieties of finiteness, including that of mortality which the advancing years present.

Delle Luche (cited by Callieri and Maci) notes: “In the world of the paranoiac there is no place for grey normality, for habit, the common, the anonymous, in final analysis for accepting the human condition of finiteness. He inhabits the totipotent dimension of the unlimited, literally, accepting to position himself outside the world and outside of time, in the universe of fetishistic constructions simultaneously real and imaginary.”

Paranoia between Passion and Reason

Referring to the contradistinction between passion and reason in the paranoiac world, Callieri and Maci deny the possibility of an Aut-Aut logic instead, with these interweaving and interfacing in a constant copresence of ideo-affective aspects. A strong emotional charge is recognized as the primum movens in the history of the development of paranoia. It is followed by a phase in which delusional ideas of explanation or correction are hypothetical in nature, and the delusion appears barely structured, often accompanied by experiences of anxious self-referentiality. A possible evolution thus appears that of structured delusional ideation, in which “everything is explained”. During this transition there is an ever increasing gap between the affective aspect, not acknowledged but suffered and the source of a search for acknowledgment, and the rational aspect, comprising an excessively simple logic in its blinding luminosity while unknowingly always remaining too emotionally polarized.

The contribution of Rossi Monti (2009) on the genesis of the evolutionary stages of paranoiac delusion underline how, after the establishment of the delusion, there can be a maintenance stage of the same, which will become ingrained as a fundamental protective shield around a “secret and timeless emotional strongbox” containing painful and unacknowledged affective elements.

A root of pathos is thus identified in pre-reflective consciousness, which Callieri and Maci, following in the footsteps of Rossi Monti, describe: “It is the sensation of the zone of shadow that surrounds any noetic orientation in the world; and it is from this zone and this time that the proto-nucleus of delusion takes form, which “through interactions” with the external world and with cognitive/intellectual elements, will become the true nucleus of the delusion”. But the noetics of the paranoiac world is unusual: elements of similarity can be identified between the noetics of a scientist and that of a paranoiac, in that “neither looks freely at the world, but instead the facts that come to their knowledge are already perceived in a certain way, and are thus ideational”.

This lens through which knowledge is filtered, limiting the field to certain elements, comprises selective attention and inattention, differentiating the scientist and the paranoiac from the common man. However, the paranoiac, unlike the scientist, has a disowned affective pole, which bends and distorts the observed reality to its need for control and totalitarianism, lending it omnipotent and inhuman features.

The metaphoric area of this regime of antithesis and defensive opposition appears to be effectively described in the words dedicated by Durand (1963) to the so-called “Diurnal Regime of the Imagination” and to its typical “Schizomorphic structures”: “Here the imagination appears marked by a pre-occupation for the recovery of lost power, of a fitness degraded by a fall … Ascension is imagined against falling and light against shadows … Light has the tendency to become a lightning bolt or sword and ascension to trample the defeated adversary.”

Many aspects of the paranoiac imagination and its delusional transformations appears to draw on this register of confrontation and struggle, of fanatical combativeness and absolute and totalizing idealism (Muscatello et al. 1985a).

On the Paranoiac “Imaginary World”

Paranoid delusions, in their thematic multiplicity and their stark and undeniable formal homology, pose a major phenomenological problem. Even the most acute analysts and psychopathologists all appear to align themselves with an approach that could be defined essentially as behavioral, when they delineate the imaginary world of paranoiacs. The authors concentrate mainly on the tenacious and fanatical combativeness of the paranoiac, underlining above all the typical behaviors of querulous mania, implacable intolerance, antagonistic grandiosity, a particular aggressiveness that frequently culminates in unpredictable “escalation to action”. As already seen, the paranoiac has also been convincingly defined by Serieux and Capgras (1902) as “delusion in action”. More recently Racamier (1966) spoke of paranoiacs in terms of “ghostly silence”.

What we do know is that paranoid delusions are those that undergo the longest and most complex incubation. Tanzi states: “As regards the internal elaboration of their delusions, paranoiacs do not usually recount these to anyone, because pride in their beliefs makes them unwilling to reveal their shadows”.

Paranoiacs, in terms of both pathological personality and delusional phenomenology, appears to be distinguished by the unusual aridity of their imaginary world. Is this aridity genuine? Or a dissimilation that draws a curtain of reticence around the imaginary world?

In the face of this enigma there are numerous questions that phenomenologists can and must ask themselves, and there are many paths that they need to follow in order to seek answers. For example, an effort might be made to establish what fantasy is hidden behind the apparent aridity of a querulous manic behavior. It appears likely that there would be a highly articulated imaginary world around the issue of justice, a unique phantom of justice, a particularly radical form of idealization of the law. And one might query: what ascetic and chivalrous dream lies behind an erotomanic delusion? Or what dazzling mythologizing complexity is hidden in the core of a genealogical delusion? And so on …

A phenomenology of inner life should be able to grasp the anthropological aspect of a delusional development with all its latent narrative and communicative possibilities.

However, neither traditional psychiatry nor psychoanalysis have provided answers to any of these questions, though fundamental from a psychopathological phenomenological perspective.

In reality, only an interpretation of the imaginary world and some if its recurrent metaphors could illuminate certain paranoid behaviors (querulous manic and others, including those with “escalation to action”), which so often appear unpredictable and inexplicable.

Cargnello adopts this approach in the analysis of the case of Ernst Wagner, “the paranoiac exterminator,” and manages to open a crack into his megalomaniac imaginary world through an analysis of his drama Wahn (Delusion), which remained unpublished in Italy for many years, only emerging in 1984 as an appendix to Cargnello’s essay. The second act of Wahn in particular allows us to uncover the secret nucleus of the paranoid nature of the author.

As Cargnello specifies, the epiphany of unconfined grandiosity and unlimited power appears when the protagonist of the play, the paranoiac Ludwig, identifies himself with the grandiose historical figure of Nebuchadnezzar and his megalomaniac fantasies of dominion and “Gulliverization” of the world.

Cargnello’s phenomenological analysis insightfully recalls the considerations of E. Canetti (1960) on the relationship between paranoia and power, and focuses very revealingly on the paranoiac imagination of E. Wagner, which provides some access to the background to his exterminatory gesture (Muscatello et. al. 1985b).

The Ernst Wagner Case

On the eve of the First World War an obscure primary school teacher, Ernst Wagner, committed a double atrocity: he stabbed his wife and four young children to death in their sleep, and then went into the town where he had taught a long time previously, Muhlhausen. Here he set a large number of houses on fire and killed nine inhabitants with his pistol while wounding various others more or less seriously.

This massacre was not the result of a sudden madness, but instead the conclusion of a plan for revenge that had gradually been developing over a period of more than ten years. He was convinced that a sin he committed (libidinous deeds with animals) was written on his face and that everybody was aware of his secret unnatural habits. Soon the suspicion of being persecuted, first by some and then by all the inhabitants of the town transformed into certainty and ultimately in fanatical, intransigent conviction. He decided to avenge himself for this.

Quickly recognized as mentally ill and committed for life to a mental asylum, he became the subject of incessant study by a great clinical therapist of the times, Robert Gaupp (1910), who defined him as paranoiac, dedicating much of his research work to the case. Ever since, this famous case has been widely discussed in central European psychiatric treatises, even the most recent.

Ernst Wagner was well-educated and highly intelligent. Above all he had a very high conception of self: a writer since his early years, little by little he ended up proclaiming himself the greatest living German playwright. In his final years there emerged a typical querulous manic delusion, focused on the writer F. Werfel, who he accused of having plagiarized important parts of his work. The dispute even had judicial developments.

Among his works certainly the most outstanding is the play Wahn (Delusion), composed in 1921, but published in a scientific monograph only in 1968. With obvious identification between the author and the main protagonist, the plot traces out the affairs of King Ludwig II of Bavaria, who committed suicide by drowning. It is an extraordinary example of literary “staging” of madness, and the play is a unique document in psychiatric case studies through the ages: it had never previously happened that a person affected by a delusion of persecution and grandeur described, with undeniable precision and depth, another case of delusional persecution and grandeur.

As Cargnello writes, “there is no question that in Ernst Wagner’s work delusion becomes “drama” or rather “tragedy”: no longer merely a clinical manifestation, but an oppressive or even tragic expression of how essentially deficient or distorted interpersonal relations are expressed…. Only exceptionally authentic documents, like those provided by the diary annotations of Strindberg, or the play Wahan by Ernst Wagner give us an idea of what the experience of a delusional existence really means.”

In his essay dedicated to this play, D. Cargnello, in addition to providing an unsurpassable profile of the paranoiac world that we in turn are trying to track down, he also believed he had revealed this passionate interweaving of madness and literature.

The essay can be read and interpreted on at least three levels:

  1. 1) The play Wahn (Delusion), unknown to the public and known only to a narrow circle of specialists and refined experts on the great German tradition of psychopathology, including among others Danilo Cargnello.

  2. 2) The biography of E. Wagner, the paranoid playwright and author of this extraordinary text, which offers a dramatically personal interpretation of the delusional experience of the author reflected in the protagonist of the play, the paranoiac and suicidal Ludwig of Bavaria. The story of E. Wagner is also closely interwoven with the history of psychopathology and in particular with the definition of the concept of “paranoia,” to the point that the term “Gaupp’s Paranoia” is used with reference to Gaupp, a psychiatrist and expert on Wagner, whose case he studied throughout his life.

  3. 3) The third and most important level is D. Cargnello’s illuminating commentary, which attempts to reconstruct, through rare period documents and enthusiastic analyses of the text of the play, a phenomenological profile of paranoia.

There are numerous possible connections between these levels of interpretation, with the text containing multiple metalevels, but certainly the most important is the possibility of seeing the drama of the madness of Ludwig of Bavaria through the eyes and interpretation of the paranoiac Wagner, who serves as a sort of reflecting conscience for the protagonist of the play, the paranoiac Ludwig.

E. Wagner described his work as follows (cited by Cargnello 1984):

The play Delusion could only have been written by me. One who has seen all infernos and horrors…. I too have been to hell, in the centre of the hottest of the fiery pits. For this reason in the play I talk of one who, even if seated high on a throne, is nevertheless a companion in suffering. He lived in equal torment and damnation! Drama of lived experienced? Yes. Drama of destiny? Yes…. I did not write lightly but with seriousness, with bleeding seriousness. Anyone who reads me must know this.

This extraordinary overlap between the author’s world and the world of his character induces Cargnello to speak of a “human document unique in its kind. In it a victim of delusional persecution-grandeur speaks of another victim of persecution-grandeur. A paranoiac describing somebody he considers to be paranoiac!”.

The Wagner/Ludwig reflection represents the prototype for all the reflections and symmetries that emerge within the play. Fundamental among the proliferation of Ludwig’s “doubles” are the specular transpositions of Ludwig/Frederick of Prussia and Ludwig/Nebuchadnezzar, delusional incarnations of two extreme poles, between which the psychological structure of paranoia oscillates: persecutory phase and megalomaniacal phase. “Persecutory delusion and delusion of grandeur,” says a character in the play, “they usually appear together. They are like the sound and its echo, like the object and its reflected image, like the backwards and forwards of a pendulum … ”.

Wagner also adds, through the figure of the psychiatrist in his appearance in the third act, that “the delusion of persecution is the face and the essence/ the delusion of grandeur is the mask and the appearance” (III, 2). Here the author’s phenomenological analysis reveals the modality of the dialectic between persecutory phase and megalomaniacal phase, the hinge of which, binding and keeping the two poles together, according to Cargnello is a profound modification that occurred in the existential structure of the With-Being (Mit-Daisen).

Picking up on Binswanger’s observations described in Schizophrenie (1957), Cargnello sustains that when the world of peers (Mit-Welt), represented in the play by the King of Prussia, becomes oppositional, humiliating, and distressing, then the Being attempts to abandon this world to take refuge in its “own” world (Eigen-Welt) which, in contrast to the lowness of humiliation, rises up to the heights of megalomaniacal grandiosity.

Nevertheless, the attempt to abandon the world of peers is always a failure since, as Heidegger (1927) teaches, the With-Being is an inescapable structure of Being: hiding in a personal world, in terms of both physical isolation and in terms of increasing delusional rigidity and consequent break down of dialogical communication with the Other, is always a case of co-existence, defective as it may be, and it can never be an existence outside of co-existence. Otherwise stated, isolation only exists in reference to those from whom isolation is desired and, precisely on the strength of this relation, the others are in all cases present within the isolation in the defective manner of being at a distance. So, Ludwig/Nebuchadnezzar is such only as a grandiose and solipsistic mask, contrasting with the persecutory dialectic Ludwig/Frederick of Prussia. The grandiose identification only exists in reference to the persecutory anxiety and right from the start this thwarts the aim of the megalomaniacal narcissistic identification of Ludwig with Nebuchadnezzar. It is precisely because Ludwig/Nebuchadnezzar cannot exist without Ludwig/Frederick of Prussia that the persecutory phase and megalomaniacal phase are intrinsically tied to each other, the second as echo and response to the existential intention of the first.

Structured as symmetrical and unstable counterpositions, that dramatize the counterpositions between Ludwig’s two main “doubles,” the persecutory and the megalomaniacal, the text concludes with the suicide of the protagonist, a suicide that expresses the final resolution of the two antagonistic forces in play. This appears to occur at the moment in which megalomania and persecution merge into a single gesture, that of suicide, the only gesture of defeat that can be transformed by megalomaniacal idealization.

As Balzac wrote in “Lost Illusions”, “suicide is the effect of a feeling that might be called, if you like, self esteem in order not to confuse it with the word honour. The day in which a man disdains of himself, the moment in which the reality of life contrasts with his hopes he kills himself, thus rendering homage to the society in the face of which he does not want to remain stripped of his virtues and splendour.”

At an extreme point in his development the defensive position of paranoia, hinged on narcissistic grandeur, can implode into psychosis, through the uncovering of an irremediable loss of self esteem, in the encounter with one’s own Ego irremediably injured in honor, impoverished, and stripped of every illusion. And the moment of the specular encounter with the self is the mortal confrontation with one’s own incurable imperfection. Now the mirror remains the final object. The final medium that reflects a shame and imperfection that can no longer be avoided. So the figure reflected back from the surface of the mirror presents itself as a double or twin that we do not like and do not love and which, symmetrically does not love us. Here appears the image of the twin “enemy” (Girard 1972), and the mirror becomes the medium for a relationship with one’s own Ego charged with violence and death, like the theatre of an implacable duel with our own lookalike-enemy. In this case the specular double inevitably transforms into a “persecutory double”. The poet George Trakl (1919) expressed the latent persecutory nature of the “specular double” and the twin enemy as: “From the illusory void of a mirror, / slow and uncertain, / from darkness and horror / emerges a face: Cain! / Imperceptible rustle of the curtain, / from the window the Moon looks into a void / I remain alone with my assassin”.

This is also the psychotic theme analysed by Otto Rank (1914) in literature and folklore: the autonomization of the specular alter ego. The recurrent theme analyzed by Rank is that of the appearance of a double which can equally be a specular image or shadow, which suddenly becomes autonomous and persecutes the protagonist, establishing a total and unchallenged dominion over him. The story can end in a duel in which protagonist kills the double and finds himself mortally wounded. Or it might happen that the double, as in the novel of the same name by Dostoyevsky, takes over the identity of the protagonist driving him mad, behaving, in the author’s own words, “like a burning mirror”. Or, as in the play Delusion, it happens that the lookalike-enemy, identifiable in the portrait-mirror of the Prince of Prussia that looms in persecution over every scene, drives the protagonist Ludwig to suicide.

The relationship of reflection/identification between Ludwig and Frederick of Prussia, always present on the scene as a large portrait with which Ludwig constantly dialogues, thus presents itself as an implacable struggle between duelling/lookalikes which concludes, as in the mythology of the double, in the suicide of the protagonist. The grandiose paranoiac shell worn like armor by the character Ludwig, expressed in ambitious fantasies of ascension (refuge in his high castles) and of omnipotent control over the world (the delusional transformation into the figure of Nebuchadnezzar, autocrat and warrior), should be considered as the extreme refuge from persecutory dread, the extreme megalomaniacal effort to escape the symmetrical violence of one’s own double.

The operation is delusional and governed by the principle of the instability of the roles, and so does not succeed. It is thrown back hyperbolically amplified onto the protagonist who ends up subjected to the law of “an eye for an eye” advanced and triggered by his own megalomaniacal violence. He becomes, so to speak, the sacrificial victim.

E. Wagner’s play appears to stage the tragic contest of paranoia in the most direct way: that of the unstable reversibility of roles. Ludwig’s encounter with the portrait-mirror of the Prince of Prussia puts into motion an oscillating movement of persecutory dread and megalomaniacal retaliation that culminates in a grandiose fantasy of revenge and destruction of his eternal enemy/persecutor, the Prussian Prince.

The megalomaniacal apex is reached in the delusional creation of another mirror image of the protagonist, that of Nebuchadnezzar, and in the hallucinatory fantasy of dominion over a world governed from above, “Gulliverized” and magically manipulable. As Cargnello writes, “the epiphany of unconfined grandiosity and unlimited power appears when Nebuchadnezzar comes onto the scene (or rather Ludwig disguised as Nebuchadnezzar), transformed by his illusions of grandeur”.3

However, the unstable oscillating game of the two figures of the paranoia, a game of endlessly rising stakes, contains within it, within its definition, a possible exit from its hyperbolic track: the final challenge, the final victory, and the final megalomaniacal disguise to face the persecutory challenge appears to be suicide. We can try asking ourselves why.

Suicide appears to be a sort of short-circuit between the two poles of the reflection: persecuted and persecutor end up reciprocally catching each other, merging into a single entity, that of the suicidal figure, thus repeating the path defined in the mythology of the “double”. As already seen, in the duel with his lookalike the protagonist always finds himself mortally wounded.

In the mythology of the “double” we find a prefiguration of one of the latent psychopathological expressions of paranoia, its suicidal expression.

The Metaphor of the Court of Law in a Case of Querulous Mania

In a case of querulous mania-type paranoia that came under our observation, it was possible to identify the two antagonistic and specular figures of the paranoid world: persecution and grandeur. This patient gave us insight into the surprising imaginary background to a behavior typical of querulous mania (linked to themes of entitlement in the division of a hypothetical inheritance). Only through extended observation was it possible to identify an extensive multifocal delusion of which the querulous mania represented the culminating manifestation.

This case appeared to answer an exquisitely phenomenological question that we had already asked ourselves: what singular phantom of justice is hidden behind the apparent aridity of querulous manic behavior?

The world of patient S. appeared to be organized around a grandiose scenic “metaphor” that shone a beam of light into his internal world and on his structures of meaning. One topos of his imaginary world was the Court of Law.

During one interview the patient S. provided a distressing and visionary image of the court and the rituals celebrated there, depicting a place more metaphysical than real, a context that evoked simultaneously the altar and the gallows. The following is an extract from the transcription of S. referring to the picture he had invented of the court and the trial.

The most important event that can be staged in a courtroom is a trial. In this case the mundane routine work that distinguishes much of the court’s activity is elevated and becomes a rite. It is a rite of roles and opposing strategies: on one side is the counsel for the prosecution, on the other the counsel for the defence.

The scene is awe-inspiring. In the centre of the predella is the court judge, who can transform when required into executioner. Seated to his right are the barristers nominated by the court, dressed in capes and military style headwear. To his left is the court disposed in balconies. Before him, sometimes shielded with a grid, are the accused. There is frequent altercation: the opposite parties spy on each other, study each other’s moves, offend each other. This makes the trial a tense struggle requiring a large room with numerous bolt holes represented by the surrounding rooms and passages. The trial is distinct from other rituals of public life because there is always a guilty party who for justice or destiny, is also always condemned.

What we see is a grandiose counterphobic fantasy, used by S. to subtract himself from the persecutory risk of identification with the guilty party (“who for justice or destiny, is also always condemned”). The patient identified the court as the ideal place for the transfer of both his grandiose vengefulness and his latent persecutory anxiety.

His scenographic reconstruction, which resembles an altarpiece, is dominated by a symmetrical pyramidal structure, the vertex of which is represented by the solemn figure of a judge, “who can transform when required into executioner. Seated to his right are the barristers elected by the court, dressed in capes and military style headwear. To his left is the court disposed in balconies. Before him, sometimes shielded with a grid, are the accused.”

This petrified paranoid scenography is imbued with signs of anxiety and suspicion that compromise its rigorous symmetry. In this room, says S., there are “numerous bolt holes represented by the surrounding rooms and passages”. These passages and escape routes, are the scenographic rendering of the persecutory anxiety of S.4

In reality, in the trial celebrated in this courtroom, de re tua agitur.

The subtle persecutory atmosphere perceived in the courtroom scenography is emblematically summed up in S.’s final words. “The judge can transform when required into executioner” and “the accused, for justice or destiny, is also always condemned”.

The Chance and Destiny evoked by S. as factors that loom indecipherably over the outcome of the trial, also represent the ultimate and most uncontrollable risk to which the two protagonists in the trial are exposed, the judge and the accused. The pair of opposites, by Chance, or Destiny can always invert in polarity: the judge can become the accused, the executioner can transform into the executed. This is the source of the sinister unease that circulates in the court during the enigmatic trial.

There is a symmetrical and reversible relationship between punisher and punished. In reality Chance and Destiny pair the two opposing figures of the courtroom in a sort of “malign symmetry” that implies the possible reversibility of the roles. The two figures that represent the persecutory and megalomaniacal aspects of the paranoid world are fatally bonded together. They are “like a sound and its echo, like an object and its reflected image, like the backwards and forwards of a pendulum … ”, to repeat the words cited by Danilo Cargnello (1984) regarding the Wagner case. Looking closely, the opposing and specular figures of the judge and the accused present the psychopathological theme of the “double” as persecutory lookalike. Within the logic of the “double,” the judge has always also been the accused, and the punisher has always been destined to be punished.

This inescapable truth, beyond any illusionistic play on opposites, is revealed down to the smallest details in a short story by Kafka (“In the Penal Colony” (1919)), which can almost be considered the model parable for paranoiac existence. This story tells of a torture instrument which is also a capital punishment machine. It is designed like a hoeing device and with countless needles it carves the reason for the condemnation into the body of the condemned, before stabbing him to death. The accused only learns toward the end of his torment, like a revelation, the commandment that he has infringed.

At the end of the story the official and custodian of the machine, who is also judge and executioner, condemns himself to its judgment in order to illustrate its exemplary operation. The commandment that the executioner has carved into his back is: “Be just!”.

The conclusion of the Kafkian parable lies in the final description of the lifeless body of the official: “He remained as he had been in life; there was not the minimal sign of the promised redemption; what all the others had found in the machine, the official had not found … ”.

Every expectation of redemption and catharsis that the official, like a paranoiac, invested in the justice system, here finds its definitive failure, a failure that we would define as ontological. As Cargnello underlines, in delusion “the presence no longer develops, it can only turn in and torment itself … without a true tomorrow, without a true future, reduced as it is to an eternal, sterile, and, above all, inauthentic repetition”.

Paranoia: Prognosis or Destiny?

The crucial question we posed is as follows: can the paranoid style of existence, in its repetitiveness, its faithfulness to delusional “truth,” converge with the concept of “destiny”? And how distant (or close) is this word from the lexical meaning of prognostic inevitability?

Anthropo-analytic psychopathology cuts dazzlingly right across all the clinical-nosographic tradition of Kraepelinian memory, the latter fixated on the iron hard and reductive concept of “prognostic destiny,” but in its way paying homage to “destiny” as such, paying its debt to “destiny,” through the key concepts of “anthropological disproportion” (Binswanger), of “disanimating omnipotence” (Racamier 1966), of “failed existence” (Binswanger 1959), as markers of a specific anthropological style.

The Danish philosopher S. Kierkegaard (1844, 1849) anticipated and clarified in an incredible conceptual synthesis the two key concepts underlined above, “disanimating omnipotence” and “anthropological disproportion”. In two extraordinary essays (“The Concept of Anxiety” (1844) and “The Mortal Illness” (1849)), he analyzed the risks faced by a subjectivity enclosed within an abstract omnipotence, in a project of self that provides neither conditioning nor limits. This anthropological disproportion (as Binswanger would put it, 1923) frustrates the Ego, which disappears into the enforced repetition of its own implacable certainties.

Kierkegaard (1849: 244) calls this rigid model of existence, so fixed in its certainties, the “mortal illness”:

The Ego desperately wants to enjoy the satisfaction of being its own self creator, of developing itself, of being itself, it wants to have the glory of this plan … of the sovereign project according to which it has defined itself … and this is precisely the final moment at which a fully intact individual becomes a mirage.

Retracing Kierkegaard’s thesis in his own way, Binswanger states that paranoid existence is one that “holds on anxiously to its singularity,” pursuing it beyond any possible relationship with the other. Striving to live for its own singularity, the existence necessarily fails, or as he writes, “the existence eliminates the ground that gives it substance”.

The risk that these existences lose their way along certain hazardous passages of their anthropological journey in some cases reaches the high probability of a clinical prognosis, and in the view of the authors this determines the unfortunate destiny of paranoia and justifies our hopes for the predictive resources of phenomenological psychopathology.


A special thanks to the psychiatry residents of the School of Bologna, F. Cerrato, R. Emiliani, L. Gammino, P. Lupoli, S.Valente, and E. Volta, who have built, around the theme of paranoia, a passionate “laboratory” of psychopathological thought.


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                                                                                                                            (1) For a detailed critical review of the concept of paranoia and the problems that it raises see Lanteri-Laura, Del Pistoia, and Bel Habib (1985).

                                                                                                                            (2) Hypersensitivity to offenses (the so-called “asthenic pole”) is the common trait, according to Kretschmer, of these personological structures, and this very particular susceptibility stimulates pathologically aggressive reactions (the “sthenic pole”), with diverse clinical expressions (querulous delusion, delusional jealousy, erotomanic delusion). The combination in different proportions of these typological characteristics leads to “delusional sensitivity developments” (self-referential delusions of a persecutory nature) or “grandiose developments” (including the classic querulous delusion).

                                                                                                                            (3) The world of Nebuchadnezzar appears to condense in particular scenic metaphors of power and control. These are: the statue of Fame, which grips a bunch of glittering threads that radiate out over the world; a megaphone that amplifies and spreads the sovereign’s commands everywhere; a movable mirror that like the lens of a telescope allows visual inspection of every corner of the world. The extreme control exercised by these instruments coincides with a sort of miniaturization of the world which renders gigantic the sovereign power of the one who controls it. This is the “Gulliverization” effect implicit in certain visual fantasies of dominion.

                                                                                                                            (4) Following Kafka (“The Trial”, 1935) the trial has also become a literary topos. In one of the chasms of the court building in which the protagonist is to be tried is the studio of the painter Titorelli, specialized in portraits of judges. Here in the eyes of the protagonist Josef K., the Goddess of Justice depicted in a large canvas undergoes a slow metamorphosis, transforming into the Goddess of the Hunt. The trial is thus the place where the Goddess of Justice is deformed by the wildest and most persecutory arbitrariness that transforms her into an enigmatic Goddess of the Hunt.