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
He was taken to hospital on November 1, 1882, where he was observed to
be immobile and to have little reaction to pin pricks. When a limb was
raised, it fell limply. However, he would leave bed to go to the toilet.
Tube-feeding became necessary, but when the tube was inserted in his
nose, he woke up. He then showed an amnesia not merely for his illness
but for his whole life: he did not know his father, that he was married
or that he had a mother. Towards the end of November, he became limp
again and answered, “I don’t know” to most questions. In December,
however, he improved again and for a few months these variations
occurred. From April, 1883, to May, 1886, he was in deep stupor, almost
absolutely immobile and close to being completely anesthetic even with
strong Faradic currents. Towards the end of this period he walked about
_whenever he thought he was not watched_. He was very cautious about
this and became motionless any time he became aware of observation.
(Gadelius thinks this was not simulation but the expression of an
automatism on the basis of a vague fixed idea.)
This condition persisted apparently for five years more, by the end of
which time the anesthesia had turned into a hyperesthesia. A year later
he began to eat. It was now found that he had an amnesia for his illness
and former life, so that he did not even recognize a needle or pair of
scissors. He knew that he was born in the month of February and retained
some facility in calculation, in speech, walking and usual motions. Then
he regained all his memories and resumed his trade as tailor. He was
discharged in June, 1893, nearly eleven years after admission.
It seems safe to say that elements at least of hysteria appear in this
history, such as the profound retroactive amnesia and appearance of
simulation in the conduct of the patient. Accurate and rapid grasp of
the environment is necessary for such a watch as he kept on the eye of
his attendants. Mental acuity of this grade combined with amnesia looks
more like an hysterical than a manic-depressive process.
Leroy[25] describes a case much like ours which is interesting from a
therapeutic standpoint. The patient was a woman who passed from a severe
depression with hallucinations and anxiety into a long stupor, from
which she recovered completely. There was no negativism and no affect,
although the latter appeared so soon as contact began to be established.
When well she had a complete amnesia for the onset of the psychosis.
Leroy attributed the recovery, in part at least, to the thorough
attention given the patient. Kraepelinian rigidity is seen, however, in
the author’s refusal to regard the case as “circular” because of the
lack of all cyclic symptoms. He takes refuge in the meaningless label
“Mental Confusion.”
Public-domain text, read in full here on John Shaqi.
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