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THE MENTALLY DISEASED
seaside hotel, a young woman went on to a balcony overlooking
a crowded promenade and started throwing chocolates at the
heads of the passers by. Sometimes an outburst of grotesque
behaviour of this kind provides the first indication of insanity
in a person hitherto regarded as normal.
Compulsive Ideas and Delusions
A person suffering from compulsory ideas struggles against
them and in one way or another tries to get rid of them. The
morbid ideas become delusions when the patient accepts them,
ceasing to criticise them or question their validity. Religious
speculation occurs in these cases also, the difference being that
since the morbid idea itself is not now questioned, the brooding
is concerned with its consequences. A patient in this state does
not ruminate about whether he has committed the
unforgivable sin. He is quite sure he has. He does not continually
enquire of himself whether he has been guilty of unworthy
participation in Holy Communion. He has no doubt about it.
He does not wonder whether he is eternally damned. He is
certain of it. The interminable questioning goes on in his mind
as to what may be the results of being in one of these unhappy
situations.
The idea that they have committed the unpardonable sin is
very common among patients with delusions. They live in a state
of anxious suspense. They cannot pray because, as they ask:
‘What’s the use?’ If they read the Bible, they see only passages
that deal with punishment. If they hear a sermon, they
remember only words that can be interpreted as accusations.
Their ‘ideas of sin’ are of the most varied and depressing kind.
One patient believes he has killed his child and hourly awaits
the arrival of the police. Another believes she has caused her
husband’s death and will not allow herself to be convinced that
her idea is absurd.
Self-accusations of this kind often relate to real but trivial
occasions. Something that has been forgotten for many years
is recalled and the patient ascribes to it all his present miseries.
A man suffering from involutional melancholia insisted that he
had committed the unforgivable sin when, as a young man
working in a delicatessen shop he had inadvertently charged a
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