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If these stupors were purely physical in origin, one would expect such explanations as weakness or illness to be offered in accounting for the inactivity. That there is a rather definite type of explanation offered is, we think, distinctly suggestive.
I knew afterwards; when I knew how they waited and expected and talked and grew anxious, and sent down home to see if I was there, and how she But no matter, no matter about that. I used to scoop up a little snow when I woke up from the stupors. The bread was the other side of the fire; I couldn't reach round. Beauty eat it up one day; I saw her. Then the wood was used up.
A mere slowing of thought processes accompanied by subjective feeling of effort is the limit reached in true depression, while it is merely the beginning of the intellectual disorder in stupor, for one meets with retardation symptoms only in the partial stupors.
He thinks stupor usually follows depression or mania and says that “the ‘Confusional Insanity’ of German and American authors is just a lesser degree of stupor.” Omitting his stupors in general paralysis and epilepsy he makes three clinical divisions: melancholic or conscious stupor, which is not a product of delusions, although delusions of death or great wickedness may be present, impulsiveness and fits may be observed; anergic or unconscious stupor, which corresponds roughly to our deep, benign stupor; and secondary stupor after acute mental disease, which resembles our partial stupor.
Secondly, there is no such disturbance of the intellectual processes in depression as is here chronicled. Let the retardation once be overcome so that the will is exercised and no real defect is demonstrable. In our experience the cases of apparent depression with intellectual incapacity are found on closer study to be really stupors as other symptoms show.
The problem is wider than that of the mere etiology of the stupors we are considering. Their relationship to manic-depressive insanity is so intimate that we must tentatively consider this affectless reaction as belonging to that larger group. A discussion of the basic pathology of manic-depressive insanity is outside the sphere of this book.
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.
It seems as though there were, as a pathognomonic sign of the morbid process, a lack of energy and loss of the normal élan vital. We may say, in fact, that the establishment of a specific type of emotional change is justification for classifying all milder stupor reactions with the deep stupors.
We might therefore think that these conditions are mixtures of two organic tendencies, namely, delirium and coma. It is not impossible that resemblances to benign stupor are due to functional elements appearing in the reduced physical state as additions to the organic symptoms. When we consider certain bodily manifestations of these typical stupors, however, fresh difficulties are encountered.
Any such studies should be correlated rigorously with the clinical states before they can have any meaning. Wetzel tested the psychogalvanic reflex in stupors and in normal persons who simulated stupors. He found them different. Only one publication has come to our attention in which an attempt is made at psychological interpretation of various symptoms in stupor.
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