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
As stated in Chapter V dealing with the ideational content of stupor,
one has to look on the delusions of patients as symptoms subject to
analysis and classification just as truly as the variations in mood or
intellectual processes, in fact they should be subject to the same
correlation as are the mental anomalies which are usually studied,
particularly if we are to understand these psychoses as a whole. Let us,
therefore, consider the death ideas in the three cases studied in this
chapter. We find that, as in the ordinary stupors, there are delusions
of death, also of mutual death (with the father), but there is a
tendency to elaboration so that the death is only part of a larger
Œdipus drama, the rest of which is usually lacking in stupors. Here
it is present. So we have thoughts of the death of the mother or
husband, another rival, considerable preoccupation with Heaven, and also
erotic fancies.
We find in manic-depressive insanity a tendency for more or less
specific ideational contents with different types of the psychoses.[8]
For example, there are religious and erotic fancies or ambitious schemes
dominating the thoughts of manic patients, fears of aggression and
injury met with in anxiety cases, and so on. In stupors, death seems to
be a state of non-existence with other meanings lacking or only hinted
at occasionally. When it tends to be elaborated, it leads over to
formulations suggesting personal attachments and emotional outlet, and
then we are apt to find interruptions of the pure stupor picture. For
example, Charlotte W. (Case 12), whose case has been described, thought
much about being in Heaven and ended with a hypomanic state. Atypical
symptoms appear just as constantly in these cases, as do the atypical
ideas. In other words, the thought content is definitely correlated with
the clinical picture.
As the clinical pictures show the relationship of stupor to other
psychoses, so there is also a correlation with varying formulations of
the death fancy. We are now in a position to define more narrowly what
death means in stupor. It is an accepted fact, a Nirvana state. When
death means union with God or appears in other religious guise, manic
symptoms tend to develop. When it is unwelcome and appears as “being
killed,” we find anxiety symptoms. A patient can conceive of death
variously and have various clinical pictures. A knowledge of the
metamorphoses of ideas and their relationship to other symptoms enables
us to understand such cases, that, without this key, seem confused and
lawless jumbles of symptoms. Such theories tend to justify the view of
essential unity of the manic-depressive group.
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