Benign Stupors: A Study of a New Manic-Depressive Reaction TypeHoch, August
Science
Benign Stupors: A Study of a New Manic-Depressive Reaction Type
Hoch, August
Manic-depressive illness; Stupor
It is rather striking that among all the forty cases only one spoke of
being sick--“I am so sick.” Only one evaded questions with “that was my
illness.” One would expect a priori that these patients would offer some
vague explanations or make complaints of weakness. If these stupors
were purely physical in origin, one would expect such explanations as
weakness or illness to be offered in accounting for the inactivity. That
there is a rather definite type of explanation offered is, we think,
distinctly suggestive. If one tries to correlate and group the death
ideas, one sees that they are all delusions of death or of loss of
energy or complaints of hysterical symptoms that look like sham death.
If the lack of energy complained of be looked upon as lifelessness, one
can conceive of these explanations being variations of one theme,
namely, that of death. In the last chapter it has been shown that a
delusion of dying, being dead, or having been dead is extremely frequent
in the stupor group. It would seem only natural then to regard the
inactivity, in so far as it may be specifically determined, as an
expression of some such delusion.
Psychiatrists are more or less aware of there being typical ideational
contents in the different manic-depressive psychoses. For instance,
every one is familiar with ideas of wickedness and inadequacy in
depression, ideas of violence in anxiety, or expansive and erotic
fancies in manic states. Quite similarly we have seen that death is a
dominant topic in a stupor. Now in addition to these typical ideas we
often hear expressed what we might term non-specific delusions, ideas
that seem to have nothing to do with a peculiar type of reaction which
the patient presents. It is therefore not surprising to find that
inactivity is not consistently ascribed to death or a related delusion.
For instance, Henrietta B. had much talk of higher powers that were
controlling her, also said that it was fear which kept her quiet.
Josephine G. said retrospectively that she had thought she would injure
people if she moved and that if she opened her eyes she would murder the
people around her. Johanna B. was afraid to talk because she fancied she
was in prison. Laura A.: During her stupor was more vague, saying, “I
can’t move, they won’t let me be,” without betraying any suggestion of
whom “they” might be. Finally Mary C. (Case 7) was still more
indefinite, ascribing her immobility merely to fear. When one considers,
however, that these five were the only ones who gave any atypical
explanation of their inactivity among the thirty-seven cases, the
preponderance of the death idea becomes striking.
Public-domain text, read in full here on John Shaqi.
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