In milder cases difficulties in orientation may be more or less marked; or there may be incapacity to think out problems, although the orientation is perfect. The more automatic mental processes may run smoothly (memory and calculation may be excellent) and there may yet be a certain shallowness in thinking, a defect of attention (a purely descriptive term) which is most obvious in the patient’s inability to grasp clearly the drift of what is going on or the meaning of complicated questions. I am inclined to think that poor results in retention tests are entirely due to this attention disorder, for we have no evidence of any fundamental retention defect such as we find in the totally different organic stupors. From a practical point of view it is important at this place to call attention to the fact that such mild changes are particularly seen in end stages. Even when pronounced negativistic tendencies do not play a prominent rôle, the patient is then apt to be silent chiefly as a result of the residual disorder in the intellectual processes. Still more striking are the conditions which are on a somewhat higher level and in which the shallowness of the responses, due to the residual disorder of attention, together with the last traces of the affectlessness, are apt to create the impression of a dementia. In such cases the opinion is often held that the patient has reached a defect stage from which recovery is impossible, whereas a thorough knowledge of these end stages teaches us that they are not only recoverable but quite typical for the terminal phases of stupor. Considering these data, especially those gathered in the end stages, it would appear that there is no tendency in this intellectual disorder associated with the stupor reaction for any special side of mental activity to be most prominently affected. It looks rather as if it were a question of a general diminution of the capacity to make a mental effort which in its different intensities accounts for the symptoms. FOOTNOTES: [5] See Chapter XV. CHAPTER V THE IDEATIONAL CONTENT OF THE STUPOR _Brief survey of the ideas associated with stupor:_ Having thus described the formal manifestations of the various stupor reactions, it will now be interesting to see what ideas seem to be associated with these reactions. It is, of course, impossible to obtain during a considerable part of the stupor any statement of the patients’ thoughts. We therefore have to depend on their utterances during periods when the inactivity temporarily ceases, or on the retrospective account which the patient gives after the stupor has completely disappeared; and as we shall see, we also may obtain considerable information by studying the ideas which occur in the period preceding the stupor. These last may be autogenous delusions or thoughts about actual events which precipitated the psychosis.