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Other cases may exhibit megalomania, where the patient is
convinced he has extraordinary powers

There can be false ideas that can be divided into several
sub-groups, as follows:

[A] False thoughts of being pursued – the patient feels
that various people are trying to harm him or even kill him.

[B] Illusory thoughts about other people’s attitude – the
patient thinks that the people around him are mocking him
behind his back.

[C] Delusions of unfaithfulness – the patient is obses-
sively jealous of his/her spouse, suspects the spouse of un-
faithfulness or of planning to leave and forbids the spouse to
have any social life, all based on utterly insignificant details.

[D] Delusions of being loved – the patient believes that a
particular person loves him. The imagined admirer is often a
famous or powerful person [such as his treating physician].

[E] Delusions of grandeur – the patient believes himself
to be a prophet or Mashiach.

[F] Hearing “inner voices” – illusions of threatening ele-
ments [this sensation is expressed through sight, touch and
smell].

[G] In acute cases: extremely disturbed thinking, sudden
outbursts of anger, suspicion, anxiety and fear.

As the disease progresses the patient develops a rich, fab-
ricated worldview in which a particular group – the secret
police or the government, for example – are making numer-
ous attempts to harm him.

Paranoid schizophrenics tend to exhibit hostility to their
environment, cutting off social contact and in extreme cases
they are liable to be very dangerous to those around them
because they are liable to respond violently to any perceived
threat.

Similarly, alongside their delusional thinking schizo-
phrenics also suffer from perceptive and emotional irreg-
ularities: colors and sounds change and the body appears

214 1 Medical-Halachic Responsa of Rav Zilberstein