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
them but would even stick out her tongue to have a pin stuck in it.
The relationship of catalepsy to resistiveness is interesting but
unfortunately complicated and unclear. In only one of our cases was
catalepsy definitely present without resistiveness, and in one other a
“tendency to catalepsy” was noted without muscular rigidity being
observed. In this latter case, when the catalepsy became unquestionable,
resistiveness also appeared. It is one thing to note this coexistence
and another to explain it adequately. All that we can offer are mere
speculations as to the real meaning of the association of these
phenomena. It may be that the tension of muscles that occurs when
resistiveness is present gives the idea to the patient of holding the
position. There would be two possible explanations for this. We might
think there is a dissociation of consciousness, like that of hysteria,
where the feeling of tenseness in the muscles that comes from the
resistance to gravity is not discriminated from the resistance to the
movements made by the examiner. On the other hand, there might be a
similar dissociation where the perception of contraction in the
antagonistic muscles is interpreted as the action of the examiner in
placing the limb in a given position. This latter view would seem, on
the face of it, ridiculous, inasmuch as its presumes the existence of
two directly opposed tendencies, namely, those of opposition to the will
of the physician and compliance with it. But ambivalent tendencies are
frequently present in psychopathic states, and moreover we find
occasionally some evidence in the behavior of the patient to
substantiate this view. For example, at one stage of the stupor of Annie
G. (Case 1), her arm could be moved without resistance. Then the elbow
would catch and at this moment the position would be maintained. Such
observation is highly suggestive of the resistance being signal for the
catalepsy. In Isabella M. the catalepsy appeared when resistance to
passive movements also developed. On the other hand, when the resistance
became extreme, the catalepsy was reduced, and vice versa. This makes
one think of two tendencies: suggestibility on the one hand, and
opposition on the other. We might presume that when both are present and
equally strong, stiffness with passive movements results as a kind of
compromise, but when there is a greater development of one, the other is
inhibited.
Such speculations remind one strongly of the psychology of conversion
hysteria and of hypnotism. In some cases of stupor hysterical symptoms
are quite definitely present. For instance, Celia G. began her psychosis
with hysterical convulsions which would terminate with short periods of
stupor. Later the stupor became persistent and during this stage she had
catalepsy (and restiveness as well) in her left arm only. On recovery
from her stupor she complained of stiffness in her hands, which
examination proved to be a purely hysterical difficulty.
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