tag="{http://www.w3.org/1999/xhtml}a">50

IV. The Interferences with the Intellectual Processes 67 V. The Ideational Content of the Stupor 82 VI. Affect 123 VII. Inactivity, Negativism and Catalepsy 132 VIII. Special Cases: Relationship of Stupor to Other Reactions 149 IX. The Physical Manifestations of Stupor 174 X. Psychological Explanation of the Stupor Reaction 186 XI. Malignant Stupors 205 XII. Diagnosis of Stupor 223 XIII. Treatment of Stupor 229 XIV. Summary of the Stupor Reaction 234 XV. The Literature of Stupor 249 Index 279

BENIGN STUPORS

CHAPTER I
INTRODUCTION AND TYPICAL CASES OF DEEP STUPOR

The fact that psychiatry lags in development and recognition behind other branches of medicine is due in part to the crudity of its clinical methods. The evolution of interest in science is from simple, obvious and tangible problems to more intricate and impalpable researches. Refined laboratory work has been done in psychiatric clinics, particularly along histopathological lines, but clinical studies follow antiquated methods. The internist does not say, "The patient has sugar in his urine, therefore he has diabetes and therefore he will die." He finds a glycosuria and looks for its cause. If this symptom is found to be related to others in such a way as to justify the diagnosis of diabetes, a therapeutic problem arises, that of adjusting the chemistry of the body. The prognosis depends not on the disease but the interreaction of the organism and the morbid process. Both in diagnosis and treatment an individual factor, the patient's metabolism, is of prime importance. Now in psychiatry, although the personality is diseased, this personal factor has been

almost entirely neglected. Text-books furnish us with composite pictures which are called diseases, not with descriptions of reactions brought about by the interplay of personal and environmental factors. Educated people are not satisfied with novels that fail to depict real characters. Clinical psychiatry, however, has been content with the dime-novel type of character delineation. This is all the more disappointing, inasmuch as the study of insanity should contribute largely to our knowledge of everyday life. 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. Every psychiatrist has seen them, although they are wrongly diagnosed as a rule, and they play no small rôle in the world's history. Euripides represents Orestes as having a stupor which is pictured as accurately as any modern psychiatrist could describe an actual case.[1] St. Paul is chronicled as falling to the ground, being thereafter blind and going without food or drink for three days. While apparently unconscious he had a religious vision. St. Catherine of Siena had several unquestionable stupors, which are fairly well

described. In fact the mystics in general seem to have had communion with God and the saints most often when they seemed unconscious to bystanders.[2] The obsession with death, which seems so intimate a part of the stupor reaction, is a fundamental theme in poetry, religion and philosophy. The psychology of this interest is, speaking broadly, the psychology of stupor. So, from a general standpoint, our problem is related to the study of one of the most potent ideas which move the soul of man.

Psychiatrically, stupors have long remained an unsolved riddle. In the century prior to 1872 (See the digest of Dagonet's publication in Chapter XV) French psychiatrists wrote some good descriptions of stupor and offered brilliant, though sketchy generalizations about the condition. Two years later an English psychiatrist (Newington, See Chapter XV) improved on the French work. Little light has been thrown on the subject since then. The researches of the later French School showed that