Suspicious circumstances

In the British Medical Journal (subscription required) Dalrymple points to a prescient understanding of a particular psychiatric delusion in the work of one of his favorite authors:
Sixteen years before Karl Jaspers described primary delusions in his textbook, General Psychopathology, first published in 1913, the writer and doctor Anton Chekhov (1860-1904) gave an account of such a delusion in “Ward No 6.”…One of the patients in ward 6 is Ivan Dmitritch Gromov.
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Chekhov captures here the preservation, even the sharpening, of the paranoid person’s intellect and powers of reflection. Every small event is infused with sinister meaning: “A policeman walking slowly passed by the windows: that was not for nothing. Here were two men standing still and silent near the house. Why were they silent?” Eventually, Ivan Dmitritch flees the house in the belief that the men who have come to repair the stove are policemen, and he is admitted to ward 6.
Jaspers, who was both psychiatrist and philosopher, gives examples of delusional mood in his General Psychopathology: “Suddenly things seem to mean something quite different. The patient sees people in uniform in the street; they are Spanish soldiers. A patient noticed the waiter in the coffee-house; he skipped past him so quickly and uncannily. A passer-by gave such a penetrating glance, he could be a detective.” Jaspers made no mention of Ivan Dmitritch, however: surely a suspicious circumstance? What can it mean?

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