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Above all, we see that retrospectively very little is remembered of what took place during the stupor, even of such obtrusive events as the moving from one ward to another, tube-feeding, physical examination, the presentation at a staff meeting, and the like. Affect: Complete affectlessness is an integral part of the stupor reaction. Modification of the statement will later be mentioned.
Even those reflexes which are only partially under voluntary control, like those of blinking and swallowing, may be in abeyance; for instance, saliva may collect in the mouth because it is not swallowed, and tube-feeding is frequently necessary on account of the failure of the patient to swallow anything that is put into his mouth.
Very often the failure to swallow and anomalous habits of excretion seem to be negativistic in their nature. One thinks at once of the necessity for tube-feeding, which is so common even when patients seem otherwise fairly active. Naturally this form of treatment is necessary only when the patient refuses to swallow.
Inactivity: There is a complete cessation or more or less marked diminution of all spontaneous or reactive movements. This includes such voluntary muscle reflexes as contain a psychic component. Often there is no reaction to pin pricks or feinting motions. The inactivity also often interferes with the taking of food so that spoon-feeding or tube-feeding has to be resorted to.
Tube-feeding became necessary, but when the tube was inserted in his nose, he woke up. He then showed an amnesia not merely for his illness but for his whole life: he did not know his father, that he was married or that he had a mother. Towards the end of November, he became limp again and answered, “I don’t know” to most questions.
This commenced as what seemed to be an act of spite as a part of her resistiveness, for the first time she soiled she seemed to do it deliberately when the nurses insisted that she allow them to put on a dress. Later this explanation no longer held. Tube-feeding too was for the most part necessary, the resistiveness continuing as before.
She also claimed to remember all visits which were made to her by her friends, but it was not specifically determined whether there was a period of less clear recollection or not. However, she remembered the tube-feeding, which occurred only during the more marked stupor. Her desire to be killed, to have her head cut off, she recalled but claimed not to know why she wanted to be killed.
When she began to refuse food and before she was tube-fed regularly, she twice had syncopal attacks and lost considerable flesh which was gradually regained under tube-feeding. After the diarrhea she was habitually constipated. Cyanosis of the extremities seemed to have been present only at first.
If this is not practicable, he should then be spoon-fed, and if this in turn is found to be out of the question, tube-feeding should be resorted to. But this last should never be looked on as a permanent necessity, but only as a method of maintaining the patient’s health until such time as he may be capable of independent taking of nourishment.
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