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It is stupor as a clinical entity, as a separate psychosis, that he regards as one form of the catatonic, and therefore of the dementia præcox, reaction. Kirby, George H.: “The Catatonic Syndrome and Its Relation to Manic-Depressive Insanity.” Jour. of Nervous and Mental Disease, Vol. 40, No. 11, 1913.
Such theories tend to justify the view of essential unity of the manic-depressive group. It would be instructive at this point to consider another case which illustrates beautifully how a stupor reaction may crystallize out of other manic-depressive states when attention has become focused on personal death. This patient went through four phases while under observation.
Wernicke, unhampered by classifications of catatonia and manic-depressive insanity with inelastic boundaries, calls all stupor reactions akinetic psychoses with varying prognosis. He does not make Kraepelin’s mistake of confusing the apathy of stupor with the retardation of depression, stating distinctly that the processes are different. Bleuler also has grasped this discrimination.
In the form of cyclic insanity known as the manic-depressive psychosis, mania alternates with depression, as if the personality were dominated wholly in turn by one or the other of these two instincts of the ego. There is a good deal of evidence that behind them is a corresponding fluctuation in the amount the thyroid secretes into the blood.
Adolf Meyer was one of the first to protest and offered categories of “Allied to Manic-Depressive Insanity” or “Allied to Dementia Præcox,” as tentative diagnostic classifications to include the doubtful cases. Difficulties with stupor furnish an excellent example of the confusion which results from the adoption of rigid terminology.
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?
Kraepelin treats stupors occurring in manic-depressive insanity as falling into two groups, the depressive and manic. The former seems to be nearer to our cases, judging by the statements in his rather sketchy account. Activity is reduced, they lie in bed mute, do not answer, may retract shyly at any approach, but on the other hand may not ward off pin pricks.
Many of these states seem to be hysterical rather than manic-depressive stupors, but so far as the unconsciousness goes, there is probably as much psychological as symptomatic resemblance between the two types of reaction. Kraepelin recognizes, of course, the occurrence of stupor symptoms or states in the course of manic-depressive psychoses.
Naturally any physical disease reduces the capacity for normal response to mental difficulties; hence physical illness may facilitate the production of a psychosis. But this intercurrent factor is also non-specific. Such is our view of the etiology of manic-depressive insanity as a whole. When we approach the study of benign stupors, however, difficult problems appear.
Let us, therefore, consider the death ideas in the three cases studied in this chapter. Here it is present. So we have thoughts of the death of the mother or husband, another rival, considerable preoccupation with Heaven, and also erotic fancies. We find in manic-depressive insanity a tendency for more or less specific ideational contents with different types of the psychoses.
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