In the more exaggerated cases the retardation may be complete. Introspection is carried to the degree where the patient tries to take unto himself the responsibility for all the sin in the world. He himself is the arch sinner and he feels himself the subject of punishment by divine wrath in a manner in which no other individual was ever punished. Also the introspection tends to produce various hypochondriacal ideas. The patient may feel that he has contracted some incurable disease and that certain bodily functions have ceased operating. Mental processes become not only retarded and difficult, but actually painful, a symptom which has been termed psychalgia. Suicidal tendencies are also quite frequently present. In extreme conditions the patient may become so retarded in thought and activity that he apparently receives no stimulus from the outer world. He lives in a more or less stuporous state, even requiring that food be administered by tube. =Circular Insanity and Mixed Forms.=—In addition to the conditions in which simply mania or melancholia are manifest there are certain cases which show variations and combinations of these forms. A common type is that in which there is an alternation of the manic and depressed conditions. The patient may pass directly from one state into the other, or there may be an intervening period of lucidity. The term circular insanity has been applied to this type. Other variations are those in which there are recurrences of the manic or depressive attacks often at more or less regular intervals, each recurrence being a practical repetition of the preceding. There is also possible a considerable intermingling of the characteristics of the two types. In the manias may occur difficulty of thinking, passing feelings of depression and even almost stuporous conditions. In depressions there can exist a marked degree of restlessness and activity and a rapidity in the flow of ideas. =Prognosis.=—The outlook for recovery from the individual attack is good. The attack may last from a period of days to one of a number of months and recovery comes with rarely any evidence of mental deterioration. There is a tendency to recurrence of the trouble. In fact recurrence is the rule rather than the exception. In the osteopathic handling of these cases it has been the endeavor to demonstrate that the correction of lesions had a tendency to lessen the duration of the individual attack and reduce the tendency to recurrence. Judging from the experience thus far gained in the observation of cases under treatment during the attack and the comparative few recurrences reported both of these aims have been attained.