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
series of cases which showed decisively that this classification was too
rigid.
Since his paper is the foundation for this present study, it should be
reviewed carefully. He first points out that Kraepelin’s “Dementia
præcox” includes much more than it should with its inevitably bad
prognosis. He shows how others have found patients with catatonic
symptom complexes proceed to recovery and speaks of these symptoms
occurring in epilepsy and even in frankly organic conditions, such as
brain tumor, general paralysis, trauma and infections. Kirby’s first
claim is that there are probably fundamentally different catatonic
processes, deteriorating and non-deteriorating. Lack of knowledge has
prevented us from understanding the meaning of the symptoms and hence
making the discrimination. He points out that stupor seems to represent
an attitude of defense, similar to feigned death in animals, and that in
a number of his cases it was clear that the stupor symbolized the death
of the patient. Apparent negativism, he found to be often a consciously
assumed attitude of aversion towards an unpleasant emotional situation.
In cases where there had been no prodromal symptoms pointing definitely
to dementia præcox the outcome was almost always good. To discriminate
the cases with good outlook from those with bad, he discerned no
difference in the stupors themselves, but observed that the mental
make-up and initial symptoms differed sufficiently for diagnosis to be
made. His most important point is, perhaps, that these benign stupors
showed a definite relationship to manic-depressive insanity in that some
patients passed directly from stupor to typical manic excitement, while
in others a “catatonic” attack replaced a depression in a circular
psychosis.
Kirby introduces, then, the idea of stupor being a type of reaction
which can occur either in dementia præcox or in manic-depressive
insanity. The matter cannot be left there, in fact it raises new
problems: what constitutes the reaction? how are the various symptoms
interrelated? are they different in deteriorating and acute cases? what
is the teleological significance of the reaction? if it be an integral
part of the manic-depressive group, how does it affect our conceptions
of what manic-depressive insanity is? More than five years have been
spent in endeavors to answer these questions and the results of the
study are now presented.
Naturally the first point to be settled is: what constitutes the stupor
reaction itself. We can say at the outset that it is seen in the purest
form in benign cases, hence they make up the material of this book. To
discover the symptoms of the disorder one cannot do better than to study
them in their most glaring form in deep stupors, where consistently
recurring phenomena may be assumed to be essential to the reaction.
CASE 1.--_Anna G._ Age: 15. Admitted to the Psychiatric
Institute July 25, 1907.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account