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Updated: June 4, 2025
The trouble is not a paralysis, however, for reflexes without psychic components are unaffected. Possibly related to the inactivity is the preservation of artificial positions which is called catalepsy, a fairly frequent phenomenon. A tendency opposite to the inactivity is seen in negativism.
After recovery and during the interruptions the patient explained his mutism, refusal to swallow, his filthiness and general negativism as all occasioned by delusions. He was commanded by God to act thus, the attendants were devils, and so on. He spoke, too, of being under hypnotic influence. In addition there were other delusions such as that he had killed his brother.
But if there has been a hitch anywhere, if the bugbear of negativism has appeared, if he has been scolded or coaxed or repressed too much and there have been tears and struggles, then going to bed is a poor preparation for instant and quiet sleep.
This is followed by the description of a case which he says contains the symptoms typical of the psychosis but in which no pathognomic abnormality is mentioned except negativism a vague term whose meaning varies with the observer. Not unnaturally with such unfamiliarity, the psychosis is a "dispensation of Providence."
We gather from these descriptions that the essentials of the stupor reaction are more or less marked interference with activity, often to the point of complete cessation of spontaneous and reactive motions and speech; interference with the intellectual processes; affectlessness; negativism.
Malignant symptoms are grimacing with prolonged negativism but without essential affect anomaly, decided echopraxia and echolalia and protracted catalepsy. We would agree with this, although command automatisms have not been prominent either in our benign or malignant stupors.
But the force which is acting most strongly in producing this refusal of food is the force of which we have spoken in a previous chapter the force which results in negativism, the force which is in reality the habit of opposition, the love of power, and the desire to attract attention. Here again the refusal of food, if due to this cause, is never the sole manifestation of the fault.
Such patients show inactivity, considerable apathy and wetting and soiling, and with these a whining hypochondria, negativism, and often a rather mawkish sentimental death content without the dramatic anxiety which usually characterizes the involution state. In these cases the diagnosis is bound to be a matter of taste.
Speech then may also be slow and low, but usually shows no change except for the fact that it is diminished in amount. Sometimes awkward positions are assumed and retained, and there may be catalepsy. Negativism: A common symptom is perverse resistiveness.
Frequently wetting and soiling are due to negativism, when the patient has been led to the toilet but relaxes the sphincters so soon as he leaves it. A constant feature is a thinking disorder. On recovery memory is largely a blank even for striking experiences during the psychosis and, when accessible during the stupor to any questioning, a failure of intellectual functions is apparent.
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