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Barrett, W.G. (1943). Folie À Deux—The Psychosis of Association: Alexander Gralnick. Psychiatric Quarterly, XVI, 1942, pp. 230–263.. Psychoanal Q., 12:595.
Psychoanalytic Electronic Publishing: Folie À Deux—The Psychosis of Association: Alexander Gralnick. Psychiatric Quarterly, XVI, 1942, pp. 230–263.

(1943). Psychoanalytic Quarterly, 12:595

Folie À Deux—The Psychosis of Association: Alexander Gralnick. Psychiatric Quarterly, XVI, 1942, pp. 230–263.

William G. Barrett

The history of the term folie à deux is discussed and a definition offered: 'a psychiatric entity characterized by the transference of delusional ideas and/or abnormal behavior from one person to one or more others who have been in close association with the primarily affected patient'. Classification of the entity into one of the four types, 'imposed', 'simultaneous', 'communicated', 'induced', is urged in the hope that understanding of the disease may thus be enlarged. Among the factors most generally observed, close association is described as universal and suggests to the author the synonym 'psychosis of association' for folie à deux. The factor of dominance-submission, which has always received a good deal of attention, is also discussed and it is suggested that when this factor is not obvious 'the person who does the identifying may be considered submissive … unconsciously'. The factors 'relationship', 'prepsychotic personality', 'sex and age', 'type of delusion' and 'homosexuality' are also considered.

As to etiology, the author favors identification, as described by Oberndorf and Deutsch, over the statistically supported arguments pointing towards heredity as the major determinant. The difficulty of distinguishing between heredity and environment is clearly stated. This fact and the fact that the 'family-situation' is one most favorable for the development of identification phenomena, strongly support the identification theory. Imitation and sympathy are considered of etiological significance, particularly 'suggestion … by intermental action and by unconscious imitation'.

'All the reportable cases in the English literature' are reviewed in tabular form. The total number comes to one hundred and three, which includes seven cases observed by the author. Cases involving sisters come to almost forty percent of the total. Husband-wife and mother-child combinations are the next most frequent with about twenty-five percent each. About half the cases are diagnosed dementia præcox, paranoid and about three-quarters are characterized by delusions of persecution. Hallucinations are absent in almost half the cases.

The author explains the high incidence of the disease among women on the basis that in our culture the woman 'is not only dominated, but she is forced to associate with her own sex within the family group because of her restricted opportunities'. Strong identifications are more readily established under these conditions. Similarly, 'the mechanism of identification which stems from specific attitudes and strivings in interpersonal relations, may readily explain the large number of husband-wife combinations'.

There is a bibliography of seventy-six titles.

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Article Citation

Barrett, W.G. (1943). Folie À Deux—The Psychosis of Association. Psychoanal. Q., 12:595

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