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At 16 she hired out as a servant for a year and a half, and then did laundry work. When 18 she had an illegitimate child by a co-worker. History of Psychosis: About a year before admission the patient’s sister was burned to death. When the patient heard of this she said that something had come up in her throat. Henceforth she often complained of a lump in her throat, and often bit her nails.
Development of Psychosis: Eight years before admission the patient became nervous, slept badly, but got better. It was claimed that for six years she had been quieter and more sullen than before. Three years before admission the patient had to take a place as janitress, since she needed the money. From the first she had trouble with the tenants and accused everybody of being in league against her.
Dissatisfaction of any kind is the setting in which the psychosis begins and the commonest precipitating factor is some reminder of death. That loss of energy appears with the stupor is evident from the inactivity and apathy, while the thinking disorder can be shown to be the result of the same loss. The different “levels” of the stupor reaction also conform to a theory of regression.
The fact that cases of paresis with delusions were found to have their lesions in the frontal lobe, whereas non-delusional cases showed no such marked lesions, is of interest in the light of the present paper because three cases of senile psychosis were found to have delusions of grandeur and, although they are demonstrably not paretic, they also show mild frontal lobe changes supported by microscopic study.
All the symptoms described seemed to fit what I had observed in Mrs. Wardlaw. "Invariably," the article went on, "it is the result of some toxic substance circulating in the blood. There is a polyneuritis psychosis, known as Korsakoff's syndrome, characterized by disturbances of the memory of recent events and false reminiscences, the patient being restless and disorientated."
It is appropriate that she recalled all of her psychosis fairly well with the exception of the pure stupor, which she remembered only as a time when her mind was a blank. I, pp. 415-458. Hoch, August: “A Study of the Benign Psychoses.” Johns Hopkins Hospital Bulletin, May, 1915, XXVI, 165. A book on “the psychology of manic-depressive insanity” will shortly appear by the editor.
She said, on looking back over her state with impulsive excitement, that she constantly had the idea that she wanted to punish herself, but that she did not know why, and did not think she was sad or worried. Considering only the second phase of the psychosis, this deep stupor showed many interruptions, due not merely to her suicidal efforts but also to her resistiveness.
Renal disease like heart disease is only capable of awakening a latent predisposition or liberating a constitutional psychosis, unless it is merely effecting a species of intoxication. It cannot be doubted that the relation of kidney disorder to mental disorder is worth intensive study, of which the present communication is merely a fragment.
Her orientation throughout was good. The content of her psychosis, in addition to the praying attitude, had a more or less vague religious coloring.
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.