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That would be trauma- induced schizophrenia that would not be attributed to a manic-depressive who was being prescribed lithium. She claimed to have had a hysterectomy although neither childhood molestation nor cancer was claimed as the culprit. Gabriele thought that having advised Rita to go to a gynecologist once a year for a checkup might have brought on this comment.
On the other hand, of those who began with reactions of definite excitement, anxiety or psychotic depression, there were interruptions which looked like miniature manic-depressive psychoses in all but one case.
Adaptation to the actual environment being abandoned, attention reverts to earlier interests, giving symptoms of other manic-depressive reactions in the onset or interruptions, and finally dwindles to complete indifference. The disappearance of affective impulse leads to objective apathy and inactivity, while the intellectual functions fail for lack of emotional power to keep them going.
As a rule manic-depressive patients have delusional ideas or attitudes in connection with their nearest of kin, so that contact with these stirs up the trouble. The stupor regression going beneath the level of such attachments leaves family relationships relatively undisturbed.
Driven to be forever on the go, for one period, in the next they feel like lying down most of the day, with no inclination for any life whatever. The stage of depression may go as far as a melancholia, the stage of stimulation as far as mania. They may simulate manic-depressive or cyclic insanity. Something restrains them, and holds them bound as in a vise in the one cycle.
This hypothesis is welcome, not only because it would account adequately for the fever, but it also tends to accentuate the relationship with other forms of manic-depressive insanity, all of which are marked fundamentally by a pathological emotion.
We believe that the mental symptoms summarized above constitute a specific psychotic type of reaction capable of appearing in any severity from mere lethargy and indifference to profound stupor. Since the prognosis is good, we feel obliged to classify this with the manic-depressive reactions.
"My brother has been lost for over two months now." "I'm sorry," Brent said politely. "My brother was a source of concern to us " "Who is us?" "Why, the family. Who else? We all worried about Charlie. He had fits of depression. Kind of a maniac-depressive." "Manic-depressive," Taber corrected gently. "Yeah, that kind, ah kind of. Well anyhow, he hides from us sometimes and we worry."
The intellectual processes suffer more seriously in stupor than in any other form of manic-depressive insanity. Not only do the deep stupors betray no evidence of mentation during the acme of the psychosis, but retrospectively they usually speak of their minds being a blank.
Psychiatrists are more or less aware of there being typical ideational contents in the different manic-depressive psychoses. For instance, every one is familiar with ideas of wickedness and inadequacy in depression, ideas of violence in anxiety, or expansive and erotic fancies in manic states. Quite similarly we have seen that death is a dominant topic in a stupor.
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