French Chronic Delusional States

   (from 1909)

   In France, there had been a long tradition of regarding delusions as the essence of psychosis, as witnessed in the work of Valentin Magnan. Yet around the time of the First World War, Magnan’s distinction between degenerative and nondegenerative illnesses started to be played down. This compelled a whole reworking of the delusional diagnoses. As well, French psychiatrists were at pains to distance themselves from such German concepts as schizophrenia, which emphasized flattening of affect and other kinds of affective pathology. Delusional states became therefore catalogued on the basis of presumed mechanism (whether hallucinations or delusions were paramount). Pierre Pichot provides a useful explanation of these French diagnostic divergences in an article in Psychological Medicine (1982).

   Chronic nonhallucinatory delusional states: delusional thinking (Le délire d’interprétation) (1909). Paris psychiatrists Sérieux and Capgras in their book Intelligent Insanity: Delusional Thinking (Les folies raisonnantes: le délire d’interprétation), hived these off from the larger block of delusions on the grounds that the absence of hallucinations and the failure to progress to dementia were important diagnostic features. (For details, see PARANOIA.)

   Chronic imaginative psychosis (1910). This second member in the triad of French nondeteriorating delusional disorders, a classification that has survived to the present, was published by Ferdinand-Pierre-Louis-Ernest Dupré (1862–1921), then a staff psychiatrist at the Hôtel-Dieu hospital in Paris, and his student Benjamin Logre, in L’Encéphale under the title "Les délires d’imagination," meaning roughly elaborate confabulations. At a congress in 1910, they suggested "imagination," in the sense of fabrication, as a mechanism alongside hallucinations and interpretative delusions: "The imaginative patient is just as indifferent [as the delusional patient] to sensory impressions and logical demonstrations. . . . Creating fully formed his associations of ideas, the patient transposes upon the exterior world his subjective creations, giving them the character of objectivity. . . . The point of departure of his error is not the notion of an external fact, true or false . . . but a fiction of endogenous origin, a subjective creation. The delusional patient proceeds like a scholar, the imaginative patient like a poet" (L’Encéphale, 1911, p. 211). Many years later, and in apparent ignorance of Dupré’s work, the American Psychiatric Association considered making "pathological lying" an official diagnosis.

   Chronic hallucinatory psychosis (la psychose hallucinatoire chronique) (1911). Psychiatrist Gilbert-Louis-Siméon Ballet (1853–1916), who ran the service for "diffi-cult psychopaths" at the Hôtel-Dieu hospital in Paris, proposed in 1911 in the journal L’Encéphale chronic hallucinatory psychosis combined with delusions as a distinct disease entity caused by heredity. The term was already familiar but, Ballet said, when properly circumscribed (as a singular noun) it represented a nosologically distinct disease. As with the Sérieux and Capgras formulation, Ballet’s disease did not run downhill either, and other mental functions remained intact. The diagnosis was much debated in France, little adopted abroad, yet remains today a familiar construct.

   Mental automatism and the passional psychoses (les psychoses passionnelles) of Gatian de Clérambault (1920). In 1920, Gaétan-Henri Gatian de Clérambault (1872–1934), often referred to as Clérambault rather than by his full last name, long-standing psychiatrist of the psychiatric emergency ward for the city of Paris (L’Infirmerie spéciale of the Prefecture of Police), published two important articles on delusional psychosis: the first, appearing in April in the Bulletin of the Psychiatric Society (Bulletin de la Socíeté Clinique de Médecine Mentale), proposed a possible mechanism for all of the delusional psychoses. Clérambault called it mental automatism and believed it similar to the underlying mechanism driving neurosyphilis, a profoundly organic cause of psychosis that literally took over the brain, producing "automatically" delusions and hallucinations.

   A second article by Clérambault in December 1920 in the same journal introduced a new class of delusional disorders alongside the above-mentioned triad. Clérambault called them "the passional psychoses," meaning those with deep emotional conviction at their core; the psychosis springs fully formed into life, he said. Clérambault included among them erotomania, often called thereafter "Clérambault’s syndrome," often confused with mental automatism as another "Clérambault’s syndrome." (See Erotomania.) Clérambault believed the whole range of these chronic systematized, or well-defined, psychoses to be driven by mental automatism. Both concepts—mental automatism and the passional psychoses—had a large impact on French psychiatry, although Clérambault’s doctrine of mental automatism has not survived, and the passional psychoses are no longer seen as independent entities.