German Journal of Psychiatry
On the fourth primordial
delusion in schizophrenia
Corresponding Address :
Y. Sasaki, M.D.
Munechika Hospital, 703, Misonou,
Saijo-cho, Higashi-Hiroshima city,
Hiroshima, 739-0024 Japan.
Tel : ++81(0)824-23-2726
Fax : ++81(0)824-23-3737
On observation of the clinical states of patients, it was noted that
patients with schizophrenia experience pathological consciousness of meaning
(PCM) in primordial delusion. The author tried to classify this phenomenon and
found one delusional symptom.
One patient with schizophrenia showed reconnoitered delusion. Once he
said that there is a feeling of reality which can not be expressed by a word
other than "reconnaissance".
This means that PCM lies at the foundation of his delusion and when he
expresses it in words, we can recognize his delusion.
K. Jaspers 1) described delusional perception as not being considered
interpretations but direct experiences of meaning, while perception itself
remains normal and unchanged. This means that patient experiences PCM directly
with the object (perception) and when he expresses it in words, we can recognize
meaning --> Expression
In a delusional mood, PCM involves the absence of perceiving anything
concrete and it cannot be expressed clearly in words.
PCM --> Linguistic
There are some cases in primary delusion:
A patient experienced the PCM with or without perception of a concrete
object then PCM can or can not be expressed linguistically.
Then, we obtained the next table.
Combination with object
Ability in expression
A : delusional mood
C : intuitive delusion
D : delusional perception
What is B ?
According to the Table, B is
an experience of PCM combined with an object (perception) that can not be
expressed in words.
We call this symptom "pathological mood on phenomenon" in this
meaning --> Expression
This symptom has been incompletely discussed using the term of
"Bedeutungswahn 1) (Jaspers)" or as the first stage of delusional
perception (Conrad). These
discussions are in the context of delusional perception. However, the author
thought that this symptom should be studied separately in its own context.
Pathological mood on
In this symptom, the patient feels an unusual meaning in relation to an
object, while he cannot express it clearly.
Case : one of our outpatients came to the hospital and told me that his
agricultural machine was in good condition. However, he also said that the
machine was always kept in good condition and that there was no special meaning,
such as put-up job by anyone. Thereafter, he left the hospital. The purpose for
consulting me was unclear. However, in this case, it was suggested that he felt
some unusual meaning for the usual conditions of the machine and this unusual
meaning which the patient can not explain clearly caused the patient to seek
Effects of pathological mood
1: If the subject experiences this symptom along with the phenomenon, it
will mask the normal consciousness of the meaning of the phenomenon to some
extent. The normal consciousness of meaning on the phenomenon is thought to be
the "nat¸lichen Selbstverst‰dlichkeit
" of the phenomenon, so it is possible that "Der Verlust der nat¸lichen
(Blankenburg) is based on the pathological mood on phenomenon.
It was suggested that this symptom has an anti-meaning effect.
2: This pathological mood is thought to be able to make the phenomenon
strange to patient and to make the phenomenon an attention-getter.
If the attention-getter is a background-thought and if the patient
experiences it as an auditory sense, the thought can become an auditory
(Nakayasu). If it is an interference idea to the patient in background, the idea
can make the patient feel ambivalent or can cause confused thinking such as lack
of association. This shows that pathological mood on phenomenon can also become
the basis of hallucination and certain negative symptoms.
Pathological mood on phenomenon is not only a peculiar symptom in
schizophrenia but also have some pathological effects that may cause many
symptoms of schizophrenia.
Jaspers K.: Allgemeine Psychopathologie für
studierende Ärzte und Psychologen. Verlag
von Julius Springer, Berlin 1913.
Conrad K.: Die beginnende Schizophrenie - Versuch einer Gestaltanalyse des Wahns.
George Thieme Verlag,
Blankenburg W. : Der Verlust der natürlichen Selbstverständlichkeit. Ferdinand Enke
Nakayasu N :
Symptomatology of schizophrenia. Seiwa syoten, Tokyo 1991 (written in