The Syphilitic Narcissist

It is common knowledge that brain disorders, injuries, and traumas are sometimes misdiagnosed as mental health problems. But what about "run of the mill" organic medical conditions? Syphilis provides a fascinating glimpse into the convoluted world of differential diagnoses: the art of telling one form of illness from another.
Syphilis is a venereal (sexually transmitted) disease. It has a few stages and involves unpleasant phenomena such as lesions and skin eruptions. Syphilis can go dormant (latent) for years or even decades before it affects the brain in a condition known as general paresis. Brain tissue is gradually destroyed by the tiny organisms that cause syphilis, the spirochetes. This progressive devastation causes mania, dementia, megalomania (delusions of grandeur), and paranoia.

Even when its existence is suspected, syphilis is difficult to diagnose. Most mental health clinicians are unlikely to try to rule it out. Syphilis in its tertiary (brain consuming) phase produces symptoms that are easily misdiagnosed as Bipolar Disorder combined with the Narcissistic and the Paranoid Personality Disorders.

Syphilitic patients in the tertiary stage are often described as brutal, suspicious, delusional, moody, irritable, raging, lacking empathy, grandiose, and demanding. They are indecisive and absorbed in irrelevant detail one moment and irresponsibly and manically impulsive the next. They exhibit disorganized thinking, transient false beliefs, mental rigidity, and obsessive-compulsive repetitive behaviors.

Fritz Redlich, retired Dean of the Yale Department of Psychiatry published "Hitler: Diagnosis of a Destructive Prophet" in 1998. In it, he describes the final stages of general neurosyphilitic paresis:

"... (S)igns and symptoms (include) rapid mental deterioration, psychotic and usually absurdly grandiose behavior..." (p. 231)