Benign Stupors: A Study of a New Manic-Depressive Reaction TypeHoch, August
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Benign Stupors: A Study of a New Manic-Depressive Reaction Type
Hoch, August
Manic-depressive illness; Stupor
Dagonet says stupor results from various causes, such as exhaustion, or
emotional and intellectual factors. Clinically it varies in kind and
degree according to the situation in which it develops. When it develops
during normal mental health, it disappears when its cause does. In
insanity it appears in the course of a psychosis of some duration, of
which it seems a part, an exaggeration of some symptom of the general
condition. Evidently he views stupor as a type of reaction: as a more or
less complete suspension of the operation of intellectual faculties, a
more or less sudden subtraction of nervous forces. This reaction can
result from a fright or the memory of it, a brain lesion or trauma, the
action of narcotics, exhausting fevers, excessive grief, the terrors of
alcoholic hallucinations, epileptic seizures, profound anemia and
nervous exhaustion consequent on sexual excess. He is careful to say
that both symptoms and treatment vary with the varied etiologies.
He credits Pinel with being the first to call attention to stupor. This
author claimed that some persons with extreme sensibility could be so
upset by any violent emotion as to have their faculties suspended or
obliterated. He noted, too, that stupors frequently terminated in manic
phases of 20 to 30 days’ duration. Pinel also emphasized the apathy of
these cases. Esquirol called stupor “acute dementia,” a term which
persisted in French literature for a long time. He described an
interesting circular case where alternations between mania and typical
stupor took place. He mentions too the dangerous, impulsive tendencies
of many patients. Georget emphasized the fact which Pinel had also
noted, that retrospectively the stupor patient says his mind was a blank
during the attack. In 1835 Etoc-Demazy published on the subject. He
regarded stupor not as a separate form of insanity but a complication
ensuing on monomania or mania. He recognized the partial as well as
complete stupor. He thought the condition was due to cerebral edema, as
did other writers of that period. Dagonet remarks about this last--a
lesson not learned in fifty years by the profession--that demonstrable
edema does _not_ produce the typical symptoms of stupor. Baillarger in
1843 (Annales Médico-psychologiques) was the first whose ambition to
simplify psychiatric types led to denial of a separate kind of reaction.
He claimed that stupor was not a form of insanity but an extension of a
“délire mélancholique.” As Dagonet remarks, every symptom by which he
characterizes stupor is a psychiatric symptom and insanity can consist
just as well in the diminution as the perversion or exaltation of normal
faculties. Some of Baillarger’s cases had false ideas, some apparently
none at all. Dagonet thinks this justifies two types, one a dream-like
state and another where no ideas are present, although he admits one may
be an exaggeration of the other. Brierre de Boismont (Annales
Médico-psychologique, 1851, p.
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