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
The usual form in which the idea appears is as a delusion of going to
die or, literally, of being dead. It may appear as being in Heaven or
Hell. A theoretically important group is that which includes the
patients who, in addition, speak of being in situations such as under
the water or underground, which we have mythological and psychological
evidence to believe are formulations of a rebirth fantasy. Not rarely,
preoccupation with death is expressed in sudden impulsive suicidal
attempts.
The affective setting of these different formulations is important. A
delusion of literal death occurs with complete apathy. The wish to die
is apt to appear without the usual accompaniment of sadness or distress
but still with considerable energy when impulsive suicidal attempts are
made. A prospect of death, particularly when there is anticipation of
being killed, is apt in manic-depressive insanity to occur in a setting
of anxiety. Similarly one ordinarily observes fear in the patient who
has delusions of drowning or burial. In the stupor cases, however, this
painful affect seems to be reduced to a mere dazed bewilderment or
feeble exhibitions of a desire for safety, such as the slow swimming
movements of a patient who thought she was under the water. When these
ideas of danger become allied to everyday interests--husband or child
imperiled, etc.--a weak affect in the form of depression is apt to
occur.
Physical symptoms are more common than in any other benign psychosis. Of
these the most nearly constant is a low fever, the temperature running
between 99° and 101°. Twenty-eight out of thirty-five cases had this
slight elevation with a tendency for it to occur immediately at the
beginning of marked stupor symptoms. Although the evidence does not
positively exclude any possibility of infection, it speaks distinctly
against this view. A possible explanation is that the low fever is a
secondary symptom. The suprarenal glands may function insufficiently as
a consequence of the emotional poverty, since all emotions which have
been experimentally studied seem to stimulate the production of
adrenalin. Without this normal hormone for the activity of the
sympathetic nervous system, there would be a disturbance of skin and
circulatory reactions that would interfere with the normal heat loss.
Suggestive evidence to support this view comes from the frequency with
which the extremities are cyanotic or cold, the skin greasy, sweating
profuse or absent, and so on. Further observations are necessary to
confirm or disprove this hypothesis, but we feel inclined to accept it
tentatively because it is plausible and consistent with the view that
stupor is essentially a psychogenic type of reaction. Another physical
anomaly, which is presumably of endocrine origin, is the suppression of
the menses. This probably results from lowered nutrition. In some cases
it ensues directly on a psychic crisis before any nutritional change can
have taken place.
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