Judgment is the act by which the mind determines the relationship between two or more representations.

When the relationship is imaginary the judgment arrives at a false conclusion. This becomes a delusion when it is in obvious conflict with evidence.

False ideas which patients often entertain concerning their own condition, believing their health to be perfect when in reality it is seriously affected, are to be attributed to impaired judgment [lack of insight]. This lack of appreciation of their own condition is not always absolute, and though in general it may be truly said that mental disease often does not recognize itself, it must, however, be acknowledged that sometimes, chiefly at the onset of the psychoses, the patients are conscious of pathological changes taking place in them.1

Some apply to the physician of their own accord, or even request to be committed. A sufferer from a recurrent psychosis, treated several times at the Clermont Hospital, had at the beginning of his attacks such perfect realization of his state that he would request by telegram to have attendants sent after him.

General Properties Of Delusions

The sum of a patient's delusions constitutes a delusional system.

Such a system may consist of purely imaginary ideas, or of ideas based upon facts improperly interpreted.

In the latter case we have false interpretations. When false interpretations involve occurrences of the past they are termed retrospective falsifications.

1 Pick. Ueber Krankheitsbewusstsein in psychischen Krankheiten. Arch. f. Psychiat., Vol. XIII. - Heilbronner. Ueber Krankheitseinsicht. Allg. Zeitsch. f. Psychiat., Vol. LIV., No. 4.

Sometimes a delusional state follows a dream, is confounded with it, and presents all the characteristics of it (dream delirium); this occurs in many infectious and toxic psychoses.

Almost always delusions are multiple. Even in those cases which are sometimes designated by the term monomania, the primary morbid idea entails a certain number of secondary morbid ideas which result from it. In some cases different delusional conceptions coexist without there being any connection between them, in others they are grouped so as to form a more or less logical whole possessing greater or less plausibility. In the first instance the delusions are said to be incoherent, in the second systematized.

Whether systematized or not, delusions, like hallucinations, generally harmonize with the emotional tone. This harmony disappears when the pathological process becomes abated in intensity, as the patient either enters upon his convalescence or lapses into mental deterioration. In dements the delusions often affect neither the emotions nor the reactions. A patient may claim that he is an emperor and yet consent to sweep the hall; or one may believe himself to have lost his stomach and still eat with a hearty appetite.

Three great categories of delusions are usually distinguished:

Melancholy ideas;

Ideas of persecution;

Ideas of grandeur.

We shall limit ourselves here to a brief sketch of these, reserving the details for consideration in connection with the affections in which the delusions occur.