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
Naturally we do not see individual cases in which all these stages
appear successively, each sharply defined from its predecessor. To
expect this would be as reasonable as to look for a man whose behavior
was determined wholly by his most recent experience. Any psychologist
knows that every human being behaves in accordance with influences whose
history is recent or represents the habit of a lifetime. At any given
minute our behavior is not simply determined by the immediate situation,
but is the product of many stages in our development. Quite similarly we
should not expect in the psychoses to find evidences of regression to a
given period of the individual’s life appearing exclusively, but rather
we should look for reactions at any given time being determined
preponderantly by the type of mentation characteristic for a given stage
of his development. As a matter of fact, we see in psychoses,
particularly in stupor, more sharply defined regressions to different
levels than we ever see in normal life.
Our psychological hypothesis would be incomplete and probably unsound if
it could not offer as valid explanations for the atypical features in
our stupor reactions as for the typical. The unusual features which one
meets in the benign stupors are ideas or mood reactions occurring
apparently as interruptions to the settled quietude or in more
protracted mild mood reactions, such as vague distress, depression or
incomplete manic symptoms, which have been described in the chapter on
affect. The interruptions are easily explained by the theory of
regression. If stupor represents a complete return to the state of
nothingness, then the descent to the Nirvana or the re-ascent from it
should be characterized by the type of thinking with the appropriate
mood which belongs to less primitive stages of development. A review of
our material seems to indicate that there is a definite relationship
between the type of onset and the character of the succeeding stupor.
For instance, in the cases so far quoted in this book, the onsets
characterized by mere worry and unhappiness and gradual withdrawal of
interest had all of them typical clinical pictures. On the other hand,
of those who began with reactions of definite excitement, anxiety or
psychotic depression, there were interruptions which looked like
miniature manic-depressive psychoses in all but one case. This would
lead one to think that these patients retraced their steps on recovery
or with every lifting of the stupor process, moved slightly upward on
the same path on which they had traveled in the first regression. The
case of Charlotte W. (Case 12), which is fully discussed in the chapter
on Ideational Content, offers excellent examples of these principles.
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