Abstract
A psychopathological investigation has been made of a group of patients seeing or hearing minuscule personalized hallucinations, usually referred to as Lilliputian. These have been assigned to three general groups.
The first are those of very small people or objects, clearly defined in space and engaged in group activity, sometimes related to the patient and sometimes, quite unrelated. These appear to be identified with the classical Lilliputian hallucination described by R. Leroy (1), usually found in toxic or organic states but existing here as a functional feature.
The second group has been described by Angyal (5). They are much more poorly formed, flatly coloured or greyish and usually internalized, though they may come outside and engage in activities outside the patient. They are often identified with body function, either of digestion, as in one of our cases, or the passively appreciated movement of limbs. They are found in quite severely regressed schizophrenic patients who are, however, capable of surprising remissions.
The third group may share some of the passivity phenomena mentioned in the second group but are much more clearly defined, capable of considerable transformations outside and inside the body and sometimes identified with definite people in the environment. They appear to approximate many folklore phenomena, e.g. goblins, incubi, elves, etc., but have not been widely described in psychiatric literature. They were hinted at by Harriman (10), in 1937, who found a number of childhood companions persisting in his psychology students at Bucknell University. Reports of psychoanalytic authors have depicted the development of phantasy figures in the course of treatment.
Psychoanalytic theories of the significance and genesis of minuscule hallucinations are presented. The functions of the phenomena appear to be displacement, multiplication and personalization of the desired phallus or the forces threatening it. In some of our patients, it appears often to be the obtaining of attention and satisfaction, otherwise forbidden to the patient. In others, the persons appeared to be a half conscious dramatization of their own psychic structure, as if the patient, in his efforts towards self-mastery, constructed a model of his own psychic function and difficulties by a process of concretization. The little men are treated as real figures through the mechanism of endo- and ectosomatic hallucinations in the absence of effective insight.