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Updated: July 20, 2025
Any large hospital will provide dozens of similar history whose clinical pictures would serve as well as what we have given. The next two cases represent two special types of psychoses: one a chronic manic and the other a definite praecox with recurrent attacks.
It is commonest during the onset, as all but five of these patients spoke of it during the incubation of their psychoses. Hence we conclude that death ideas and stupor are consecutive phenomena in the same fundamental process. As two-thirds of the series interrupted the stupor to speak of death or to attempt suicide, we assume that this relationship persists.
In the psychoses these modes of operation of the psychic apparatus, which are normally suppressed in the waking state, reassert themselves, and then betray their inability to satisfy our wants in the outer world.
Further justification for this grouping is found in the occurrence of the stupor reaction as a phase in many manic-depressive psychoses. A patient may swing from mania to stupor as from mania to depression, and when the partial stupors are recognized as milder forms of the same process, it seems to be a frequent type of reaction. If stupor be a reaction type, its laws must be psychological.
Binswanger states that the mental disorders occurring in acute and chronic nephritis are either toxemic psychoses on uremic bases, or due to arteriosclerosis. In the latter cases, he states that the disease pictures are as a rule characterized by grave disturbances of emotions, chiefly of a depressive character.
It is possible that this lack of a broad psychological view point this example chosen is far from isolated is connected with a specific, and most definitely serious, defect in the book. The treatment of the psychoses is distinctly unsatisfactory.
In some cases it ensues directly on a psychic crisis before any nutritional change can have taken place. Finally, among the symptoms of possible physical origin, epileptoid attacks were described in two of our cases. This is chiefly of interest in that such phenomena are extremely rare in the benign psychoses.
Even if they go through the motions of work or play with no sign of interest, such exercise should not be allowed to lapse. Then, too, the environment should be changed when practicable. A patient may improve on being moved to another building. Perhaps the most potent stimulus that we have observed is that of family visits. In most manic-depressive psychoses visits of relations have a bad effect.
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.
As the clinical pictures show the relationship of stupor to other psychoses, so there is also a correlation with varying formulations of the death fancy. We are now in a position to define more narrowly what death means in stupor. It is an accepted fact, a Nirvana state. When death means union with God or appears in other religious guise, manic symptoms tend to develop.
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