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
Rose Sch. (Case 6) was remarkable, in connection with the present
problem, in her unusually poor answers. She either merely repeated the
questions, or made irrelevant superficial replies, or said she did not
know, this even with very simple questions. When better, too, though not
quite well, she showed striking discrepancies in time relations and
incapacity to correct them. It would seem that in this case there was
something more than an acute interference with the intellectual
processes, such as we are here discussing. As a matter of fact, we have
the statement in the history that the patient herself said she was slow
at learning in school and had not much of an education. A congenital
intellectual defect and the attitude which it creates may, however, as
my experience has repeatedly shown me, very greatly exaggerate an acute
thinking disorder. The case, therefore, while it shows us an
unquestionably acute interference with the intellectual processes, does
not give us useful information about its nature. More information can be
gathered from Mary D. (Case 4). Even toward the end of her marked stupor
some replies were obtained chiefly by making her write. When asked to
write Manhattan State Hospital, she wrote Manhatt Hhospshosh, and for
Ward’s Island, Ww. Iland. Again, instead of writing 90th Street, she
wrote 90theath Street. These are plainly reactions of the path of least
resistance or, in these instances, of perseveration. Of the same nature
are some of her other replies in writing or speaking. After she had been
asked to write her name, she was requested to add her address, or the
name of the hospital; she merely repeated the name. Similarly, when
asked whether she knew the examiner, she said “Yes,” but when urged to
give his name, she gave her own. In the partial stupor at a time when
she knew where she was, knew the names of some people about her, the
year and approximately the date, she made mistakes in calculation and
could not get the point of a test story. Moreover, she failed in
retention tests without there being any evidence of anything like a
marked fundamental retention disorder, such as we find in Korsakoff
psychosis. It seems that these results are best termed defects in
attention, which chiefly interfere with the apprehension of more
difficult tasks. As we shall see later, this seems to be rather
characteristic of these cases. Another point which should be mentioned
is the fact that her reaction to questions which she was unable to
answer (such as matters which referred to her amnesic periods) was
peculiar, inasmuch as she did not only not try to think them out, but
seemed indifferent to her incapacity, simply leaving the question
unanswered. This too, as we shall see later, is characteristic. Laura
A., at a time when she could be made to reply, merely repeated the
question, again a reaction of least resistance. The same patient
sometimes asked, “Where am I?” Mary C. (Case 7) made similar queries.
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