BENIGN STUPORS THE MACMILLAN COMPANY NEW YORK · BOSTON · CHICAGO · DALLAS ATLANTA · SAN FRANCISCO MACMILLAN & CO., Limited LONDON · BOMBAY · CALCUTTA MELBOURNE THE MACMILLAN CO. OF CANADA, Ltd. TORONTO BENIGN STUPORS _A STUDY OF A NEW MANIC-DEPRESSIVE REACTION TYPE_ BY AUGUST HOCH, M.D. LATE DIRECTOR OF THE PSYCHIATRIC INSTITUTE OF THE NEW YORK STATE HOSPITALS, WARD’S ISLAND, NEW YORK. LATE PROFESSOR OF PSYCHIATRY, CORNELL UNIVERSITY MEDICAL COLLEGE, NEW YORK New York THE MACMILLAN COMPANY 1921 _All rights reserved_ PRINTED IN THE UNITED STATES OF AMERICA Copyright, 1921, By THE MACMILLAN COMPANY Set up and printed. Published July, 1921. Press of J. J. Little & Ives Company New York, U. S. A. TO MY FORMER COLLEAGUES IN THE NEW YORK STATE HOSPITAL SERVICE EDITOR’S PREFACE A word should be said as to the origin and history of this book. When the late Dr. Hoch became Director of the Psychiatric Institute of the New York State Hospitals in 1910, he found there an interest in just the kind of psychiatric research which it was his ambition to further. His predecessor, Adolf Meyer, had developed the conception that the psychoses should be looked on as psychobiological reactions rather than rigid nosological entities and had inculcated the habit of scrupulously thorough examination and record of what the patient said and did. Meyer had broken away from the sterile habit of making diagnoses in accordance with the set terms used to label symptoms; and his work and that of his assistants thus led to a collection of valuable material which could serve as a useful starting point for the keen clinical investigation of Hoch. Specifically, attention had already been fixed on the study of the so-called functional psychoses, comprising what are generally termed Dementia Præcox and Manic-Depressive Insanity. An urgent problem in this field was to separate different reaction types in order to discover which were recoverable and which chronic or progressive. In order to understand psychological reactions, interrelation rather than mere coincidence of symptoms must be studied and, to aid in this, free use was made of the fundamental principles of unconscious mentation as exposed in the theories of Freud and his followers.