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
Wernicke, unhampered by classifications of catatonia and
manic-depressive insanity with inelastic boundaries, calls all stupor
reactions akinetic psychoses with varying prognosis. He does not make
Kraepelin’s mistake of confusing the apathy of stupor with the
retardation of depression, stating distinctly that the processes are
different.
Bleuler also has grasped this discrimination. He points out that the
thinking disorder in what he terms “Benommenheit” (dullness)
differentiates such conditions from affectful depression with
retardation. He writes, of course, mainly of dementia præcox,[28] but
makes some remarks germane to our problem. In the first place he denies
the existence of stupor as a clinical entity, except perhaps as the
quintessence of “Benommenheit”, it is the result of total blocking of
mental processes. Consequently, he says, one can observe the external
features of stupor in all akinetic catatonics, in marked depressive
retardation, when there is a lack of interest, affect or will, in
autism, with twilight states, as a result of negativism or, finally,
when numerous hallucinations distract the patient’s attention into a
world of fancy. He notes that in all stupors (with the exception,
perhaps, of “Benommenheit”) the symptoms may disappear with appropriate
psychic stimulation or that some reaction, no matter how larval, may be
observed. He speaks, for instance, of the visits of relatives waking the
patient up.
His only real group is “Benommenheit,” which he separates out as a true
clinical entity. This seems to correspond roughly with our “Partial
Stupors.” It is essentially an affectless, thinking disorder, usually
acute, sometimes chronic, occurring among schizophrenics. He believes
that it is the result of some organic process (intracranial pressure or
toxin). Activity is much reduced or absent; they have poor
understanding, answer slowly or confusedly; their actions are sometimes
as ridiculous as those of people in panic (e.g., throwing a watch out
of the window when the house is on fire); the defect is best seen in
writing, for large elisions are found in sentences. He was able to
analyze only one case and she retained her affect; it was even labile
and marked. One suspects that such a case might, perhaps, not really
find a place in the “Benommenheit” group even as Bleuler himself
describes it.
Public-domain text, read in full here on John Shaqi.
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