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
2. NEGATIVISM. The next of the cardinal symptoms to be considered is
negativism. This term, which is often loosely used, we would define as
perversity of behavior which seems to express antagonism to the
environment or to the wishes of those about the patient. Naturally it is
only in the minor stupors that we see it in well-developed form as
active opposition and cantankerousness. For example, Harriett C., who
stood about until her feet became edematous, would spit out food when it
was placed in her mouth but would eat if she were left alone with the
food. Josephine G., in a milder state, would turn her back on people.
When more inactive once rolled out of bed and lay on the floor. At this
time also she tried to keep people out of her room. Rarely, patients may
have angry outbursts, as did Annie K. (Case 5) who would strike at the
nurses.
Very often the failure to swallow and anomalous habits of excretion seem
to be negativistic in their nature. One thinks at once of the necessity
for tube-feeding, which is so common even when patients seem otherwise
fairly active. Naturally this form of treatment is necessary only when
the patient refuses to swallow. Quite frequently a refusal to urinate is
met with so that catheterization is necessary, or a patient may never
use the toilet when led to it, but will defecate or urinate so soon as
he leaves it. These latter, like some other perversities, suggest
reactions of a petulant, spoiled child.
By far the commonest manifestation is muscular resistiveness, often
spoken of as “resistiveness.” It was present in thirty-two out of
thirty-seven of our cases. Usually it takes the form of a contraction of
the whole system of voluntary muscles when the patient is touched or the
bed approached. Often it appears only when any passive movement of the
limb is attempted. All muscles of the limb then stiffen, making the
member rigid. Sometimes the negativism is expressed by quite isolated
symptoms, such as stiffness in the jaw muscles alone. One patient showed
no opposition except by holding her urine for two days. Another kept her
eyes constantly directed to the floor. The reaction of another showed
no irregularity except for stiffness in the neck and arms and wetting
herself once after she had been taken to the toilet. One displayed
merely a slight stiffness in her arms. An interesting case was that of
Annie G. (Case 1) who kept one leg sticking out of bed. If this were
pushed in, she would protrude the other. Mary F. (Case 3) sometimes
expressed her antagonism to the environment by slapping other patients.
She spoke only twice in a year and a half, and each time it was when
interfered with. By far the commonest cause of muscular movement in
these inactive cases is resistiveness, and as a rule the inactivity is
interrupted only by negativistic symptoms.
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