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
Catalepsy is an important symptom because, although it occurred in
slightly less than a third of our cases, it seems to be a peculiarity of
the stupor reaction found but rarely in other benign psychoses. It seems
never to occur without there being some evidence of mental activity,
and, consequently, we are forced to conclude that it is of mental rather
than of physical origin. Just what it means psychically it is impossible
to state without much more extended observations. We conjecture
tentatively, however, that the retention of fixed positions is in part
merely a phenomenon of perseveration, and in part an acceptance of what
the patient takes to be a command from the examiner, and sometimes a
distorted form of muscular resistiveness.
The intellectual processes suffer more seriously in stupor than in any
other form of manic-depressive insanity. Not only do the deep stupors
betray no evidence of mentation during the acme of the psychosis, but
retrospectively they usually speak of their minds being a blank.
Incompleteness and slowness of intellectual operations are highly
characteristic features of the partial stupors and of the incubation
period of the more profound reactions. The features of this defect are a
difficulty in grasping the nature of the environment, a slowness in
elaborating what impressions are received, with resulting
disorientation, poor performance of any set tests and incomplete memory
for external events when recovery has taken place. At times the thinking
disorder may develop with great suddenness or improve as quickly, and a
tendency to isolated evidences of mental acuity is another example of
the inconsistency which is so highly characteristic of stupor. We should
note, however, that these sporadic exhibitions of mentality are always
associated with brief emotional awakening.
When we turn to examine the fragmentary utterances of stupor patients,
we are surprised by the narrowness and uniformity of the ideational
content. It seems to be confined to thoughts of death or closely related
conceptions. Thirty-five out of thirty-six consecutive cases at one time
or another referred literally to death. It is commonest during the
onset, as all but five of these patients spoke of it during the
incubation of their psychoses. Hence we conclude that death ideas and
stupor are consecutive phenomena in the same fundamental process. As
two-thirds of the series interrupted the stupor to speak of death or to
attempt suicide, we assume that this relationship persists. Only a
quarter gave any retrospective account of these fancies, so we presume
that their psychotic experiences were repressed with recovery.
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