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In the case of stupors the situation is fairly simple, in that the ideational content is extremely limited. As has been seen, it is confined to death and rebirth fancies, other ideas being correlated with secondary symptoms, such as belong to mechanisms of other manic-depressive psychoses.
In fact, in perusing his case material comprising “stupors” in the course of many types of functional insanity, or as a complication of epilepsy or general paralysis, it is evident that in practice he does not follow the discriminative definitions of the earlier portion of his paper.
This, we would say, is probably an example of a more or less automatic intellectual operation occurring when the patient is sufficiently stimulated, although he cannot be raised to the point of spontaneous verbal productivity. As these scattered reports about benign stupors are so unsatisfactory, one naturally turns to text-books. Little more appears in them.
Does not death advance every moment with gigantic strides? Does he not assail the prince in his palace and the peasant in his cottage? Does he not send before him monitors and messengers: acute pains, which wholly absorb the soul; deliriums, which render reason of no avail; deadly stupors, which benumb the brightest and most piercing geniuses?
This pathognomonic symptom of dementia præcox frequently occurs in the onset to malignant stupors. In fact we often find in reviewing such cases that a plain dementia præcox reaction has been in evidence, that a diagnosis has not been made simply because the stupor picture blotted out this earlier psychosis before an opinion was formed.
This defect can only be remedied by looking on every case as a problem in which the origin of each symptom is to be studied and its relation traced to all other symptoms and to the personality as a whole. This is an ambitious task and we do not pretend to any great achievement, merely to a beginning. No better psychoses could be chosen for a preliminary effort than benign stupors.
If this view were correct, it would not be hard to imagine that during the onset of these stupors the tendency to part company with the environment, which ordinarily comes on slowly, might occur with epileptic suddenness and hence liberate convulsive movements.
That partial stupors occur as well-defined psychoses, developing and disappearing without the appearance of deep stupor, we shall attempt to show in the following three typical cases: CASE 6. Rose Sch. Age: 30. Admitted to the Psychiatric Institute August 22, 1907. All were said to be normal.
As will be discussed in a later chapter on the literature, reactions resembling benign stupors occur as a result of toxins, particularly following acute rheumatism. Recently the medical profession has been called on to treat many cases of encephalitis lethargica where similar symptoms are observed.
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.
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