Benign Stupors: A Study of a New Manic-Depressive Reaction Type. August Hoch
disinclination for any mental effort whatever. It is important to note that her attitude towards this disability was usually one of indifference and that, in general, there was no show of affect whatever. Freedom of speech was the last thing for her to regain.
Case 7.—Mary C. Age 26. Single. Admitted to the Psychiatric Institute April 7, 1907.
F. H. The father had repeated attacks of insanity, from which he recovered, but he died in an attack at the age of 60. A sister also had a psychosis, from which she recovered.
P. H. The patient was rather quiet and easily worried. When 14 she had some dizzy spells, with momentary loss of consciousness. After that time she had no such attacks, except after a tooth extraction when about 24.
The patient came to the United States six months before admission. She went to live with a cousin who died a week after she arrived at his house. She worried and said that she brought bad luck. Then she took a position, where she was well liked, but she was not particularly efficient. In this situation she often felt homesick and lonely.
Two weeks before admission an uncle died, which affected her considerably. She spoke of his leaving three children, and would not go to the funeral. Then she thought she was going to die. She felt dizzy, weak, walked with a stooped position, was sleepless. In the midst of this she suddenly felt frightened and walked into her mistress' room, to whom she complained that some one was talking outside but could not tell what was said. She heard shooting. Retrospectively, after recovery the patient said that at that time she suddenly got "mixed up," and that her "memory got bad."
She was taken to a general hospital, where she thought there was a fire, and screamed "Fire!" She was soon transferred to the Observation Pavilion, where she appeared dazed, moving slowly, yet showing a certain restlessness. She spoke of "the boat" being shut up so that no one could go out. Again, she said "The boat went down and all the people keep turning up." Retrospectively the patient stated about this condition that she remembered going to the general hospital but not her stay at the Observation Pavilion. (The trip to the Manhattan State Hospital was again clearer to her.) About the ideas she had at the time, she remembered only that the room seemed to go around, and that after she had come to the Manhattan State Hospital and was clearer, she thought she was in Belfast, was on a ship, and that people were drowning.
Under Observation: On admission she had a temperature of 100°, a coated tongue, suffused conjunctivæ. There were herpes of the lower lip, a general appearance of weariness and exhaustion, a flushed face, trace of albumen in the urine, which was absent on the third day, no leucocytosis, but 41 per cent. lymphocytes.
Then and henceforth she was inactive and very slow in all her movements; she never stirred spontaneously, and had to be pushed to the toilet and to the table; she ate slowly. She did not speak spontaneously, and her replies were very slow in coming. She had to be urged considerably before she would speak and, as a rule, she did not answer. On one occasion she was for a day totally inactive and looked duller. That day and on a few other occasions she wet the bed. There was at times an appearance of dull bewilderment. When, soon after admission, asked whether she felt cheerful or downhearted, she said "downhearted," but this was the only time. Often she answered "I don't know," when asked whether she was worried, and she could never say what she was worried about. Again she directly denied worry. Sometimes she smiled appropriately, and repeatedly, when asked how she felt, said, "I feel better." In answer to questions as to how her head was, she replied several times, "My memory is gone," also "I can't take in my surroundings," or "I don't know where I am," or "I cannot realize where I am." Again, she spoke of being dizzy and once said it was as though the room went round. Sometimes she knew where she was or knew names, again said "I forget," but she always was approximately oriented as to time. There were no special ideas expressed and no hallucinations, except in the very beginning when she still thought at night, when she heard the boats on the East River, that people were being drowned. She later, as stated above, said she thought she was on a boat and people were being drowned.
By June, i.e., two months after admission, she began rhythmical swaying of the body, twisting of the fingers, or pulling out some of her hair. She ascribed this behavior simply to "nervousness."
On July 16, after a visit from her cousin, who said to her that if she worked she would soon get better, she began spontaneously to occupy herself somewhat. She became more active, said she felt stronger and brighter, and that her memory was better. By the beginning of August she was fairly free, but still spoke in a rather low voice, although answering well. Her capacity to calculate also remained poor. When asked about the more inactive state, she said she had been afraid to stir. (What afraid of?) "I didn't know where to go or what to do." Further, she recalled that she had had a numb feeling in her tongue, could not speak quickly, and that her mind had felt confused and "she could not take in things." Further review with her of the earlier period of her psychosis showed that there was a blank for external events and most of the internal events during this time.
She made a perfect recovery and was discharged August 7, 1907, four months after admission.
This case, although very like the last, differs from it in two particulars. For one day her symptoms were sufficiently marked to suggest a deep stupor. Secondly, her intellectual incapacity was not so marked (always approximately oriented for time) and with this there was some subjective appreciation of her defect. Apparently, however, this insight did not cause her any worry. The affectlessness was equally prominent in both of the foregoing cases, the fact that Mary C. (Case 7) once admitted feeling downhearted in response to leading questions, having little significance in the face of her expression, actions and usual denial of worry. It is interesting to note that, during the bulk of her psychosis, her only complaints were of mental hebetude and dizziness. Possibly the latter was merely an expression of her subjective confusion.
Case 8.—Henrietta H. Age: 22. Admitted to the Psychiatric Institute March 6, 1903.
F. H. The father stated that both parents were living and well, also eight brothers and sisters.
P. H. The patient came to this country when she was a baby. She was bright at school and industrious. From the age of 17 on, she worked in a drygoods store and gave satisfaction. About her mental make-up no data were available, except for the statement that she always made a natural impression.
When 21 (February, 1902), without known cause, she broke down and was sent to the Manhattan State Hospital, but was not observed in the Institute ward. She remained in the hospital for three months. It was claimed that the attack came on suddenly two days before she was sent away. She suddenly appeared anxious, said something had happened and became excited. This lasted for about a week, and then she was, as the description says, "depressed and cataleptic." She remained in this condition for about a month, during which time there was a slight rise of temperature. Then she improved gradually and was discharged three months after admission. After recovery from the present attack the patient stated that during the first sickness she had visions of dead friends.
She was perfectly well in the interval.
Six days before admission she suddenly became excited, refused to eat, and began to talk, repeating phrases over and over. Then she became elated and excited.
After recovery the patient described the onset of her psychosis as follows: Six days before admission, after having been perfectly well and without any known cause, she was feverish and vomited, but slept well. Next day she felt nervous, and her thoughts were clear. She constantly thought of dead friends, heard them talking, when she tried to do anything the voices said, "Don't do that." She also thought somebody wanted to harm her people. Soon she started singing and felt happy.
Then she was sent to the Observation Pavilion, where she appeared to be in the same condition which was observed in the Institute.
Under Observation: 1. On admission she was in good physical condition, except for her skin seeming greasy. She presented for nine days the following picture: She was essentially elated, laughing, singing, jumping out of bed, good-natured and tractable, and very talkative. Her productions showed a good deal of sameness and a certain lack