Benign Stupors: A Study of a New Manic-Depressive Reaction Type. August Hoch
monotonous voice, but again often in very theatrical tones, with much, rather slow, gesturing. The following are very representative samples:
"I have been suffering from my own blood, my own blood sent all away from home. I just came from Bellevue. I left here last May (correct) a healthy girl. A sister is a sister—I wonder why shorthand is shorthand, a stenographer is a stenographer (seeing stenographer write)—a kind brother, Bill H.—why H. his wife is a sister-in-law to us, she has four children—four beautiful children—sister-in-laws and brother-in-laws—telephone ringing (telephone did ring)—dear Lord, such a remembrance—remembrance was remembrance, truth was truth—honesty is honesty—policy is policy—if she married him, she is my sister-in-law and he is my brother-in-law—Max knows me—she changed her name to Mrs. R.—two children who are Rosie and Maud, if names were given, names should not be mistaken—they are Julia, Lillian—Rosie and Maud—why should wonders wonder and wonders cease to wonder, why should blunders blunder and blunders still blunder; sleep is one dream and dream means sleep—if move is moving, why not move?" When she accidentally heard the word wine, she said "Guilty wine is not in our house—wine is red and women are women, and women and wine and wine and women and wine and song." Again, "You are not Mr. Kratzberger, Mr. Steinberger, Mr. Einberger—you are not Mr. Horrid or Mr. Storrid—perhaps you are Mr. Johnson or Mr. Thompson—no, you are Dr. C." (correct).
She was quite clear about her environment.
Although the mood was throughout one of elation, on the ninth day in the forenoon she cried at times, wanted to see her mother, and spoke in a depressed strain (content not known). A few hours after that she suddenly became quiet.
2. Then for four days (March 14-17) she was markedly inactive, though at times got out of bed. She looked about in a bewildered manner, did not speak spontaneously, but could with urging be induced to make some replies. She did this now fairly promptly, now quite slowly. Questions were apt to bring on the bewilderment. Thus, when asked where she was, she merely looked more bewildered, finally said "Bellevue—I don't know," and questioned who the doctor was whom she had called by name in her manic state, she said, with some bewilderment, "Your face looks familiar." (Where have you seen me?) "In New York." She claimed to feel all right. There was no real affect. She made the statement that at home she heard voices saying "You will be killed."
3. Henceforth this bewilderment ceased, and for 16 or 17 days she was essentially inactive for the most part, for a short time with a tendency to catalepsy and some resistiveness, and at that time lying with eyes partly closed. As a rule she said nothing spontaneously, but replied to some questions, usually with marked retardation, again more promptly. She constantly denied feeling sad or worried, repeatedly said she felt "better," only on one occasion did she cry a little. When asked to calculate she sometimes did it very slowly, again fairly promptly. The simple calculations were usually done without error, the others with some mistakes. As to her orientation the few answers obtained showed that at times she knew the name of the place and the day, again she gave wrong answers (Bellevue). Once asked on March 23 for the day, she said April. She wrote her name promptly on one occasion, again a sentence slowly but without mistakes. Once during the period she sang at night. Once she suddenly ran down the hall but quickly lapsed into the dull condition.
On April 4, at the end of this period, she suddenly laughed, again ran down the hall, said she had done nothing to be kept on Ward's Island. But she quickly lapsed again into the dull state. Later, on the same day, when the doctor was near, she said, in a natural tone, "Thank God, the truth is coming out." (What do you mean?) "That I have been trusting in a false name and that Miss S. (the nurse) should not nurse me." Then she got suddenly duller, calculated slowly and with some mistakes, 3×17=41, 4×19=56, and when asked to write Manhattan State Hospital she wrote (not very slowly) "Mannahaton Hotspalne."
4. Next day it was noted that she was more stuporous, and she remained so for two weeks, now showing a decided tendency to catalepsy and more resistance than before, though not marked, except in the jaw. She lay often with head raised, sometimes with eyes partly open, or staring in a dull, dreamy way, neither soiling nor drooling, however; a few times she looked up when spoken to sharply. There was no spontaneous speech. Usually she did not answer at all, but a few times a short low response was obtained. Once she wrote slowly a simple addition, put down on paper. When, on one occasion, asked how she felt, she, as before, said, "I feel better."
5. Then, with the exception of a day at the end of the month, when the more stuporous state was again in evidence, she returned to her former condition without catalepsy or resistiveness and without staring, but essentially with inactivity or slowness. She now even dressed herself, answered slowly though not consistently, but she again denied feeling troubled or sad, "I feel better."
On July 7 she got brighter but was still rather slow. She then even began to do some work. She again denied feeling sad.
In a few weeks, while having a temperature of 102° with vomiting and diarrhea, she suddenly got freer. She then said, in answer to questions, that she did not speak because she was not sure whether it would be right, again because she seemed to lose her speech. She did not move because she was tired, had a numb feeling. She said she had not been sad, "but I had different thoughts," "saw shadows on the walls of animals, living people and dead people." She was not frightened, "I just looked at them." People moved so quickly that she thought everything was moved by electricity. She thought her head had been all right.
After a few days she relapsed into a duller state again, but then got quite free and natural in her behavior. On August 28 she gave a retrospective account of her psychosis, a part of which has been embodied in the history. She had insight in so far as she knew she had been mentally ill. She claimed to remember the Observation Pavilion and her coming to the hospital, also the incidents during the manic state, when she heard cannon and thought a war was on, and voices she could not recognize nor understand. Then she became stupid, although neither sad nor happy.
Then, she claimed, she got stupid, but neither sad nor happy. She claimed to have known all along where she was, but felt mixed up at times, her thoughts wandered and she felt confused about the people. She thought she was in everybody's way, thought others wanted to get ahead of her, did not speak because she did not know if it were right or wrong, felt she might cause disturbance if she answered. (It is not clear whether she had complete insight into the morbid nature of these statements.) She also claimed again that all along she "saw shadows on the wall," "scenes from Heaven and Earth," "shadows of dead friends laid out for burial." She had insight into the hallucinatory nature of these visions. Sometimes she thought she was dead also. She claimed that she began to feel better when these shadows stopped appearing in June (the actual time of her improvement).
She was discharged recovered a month later, after having been sent to another ward.
In this case, then, we find that the two months of stupor were ushered in by a brief state in which, in addition to the usual inactivity, there was a certain bewilderment, increased by questions, while the orientation which in the preceding manic state had been good became seriously interfered with. The psychosis bordered on deep stupor for brief periods when the inactivity seemed to be complete or she lay in bed with her head raised from the pillow. On the other hand, there were occasional sudden spells of free activity even with a certain elation. She could often be persuaded to answer questions or to write, the slowness of this spoken or written speech varying considerably. Her replies revealed the fact that she was essentially affectless and that her intellectual processes were interfered with, even to the extent of paragraphic writing. We have, therefore, here again features similar to those of the preceding cases. In addition we must add as important that this patient said retrospectively that she thought she was dead, that she saw "shadows from Heaven and Earth," "shadows of dead friends laid out for burial," all this without any fear. We shall see later that this is a typical stupor content.
We will here include state 3 of Anna G. (See Chapter I, Case 1) who after the pronounced stupor was for two months merely dull, somewhat slowed and markedly apathetic. Although her orientation was not seriously affected, there was considerable interference with her intellectual processes, as shown in her wrong answers or her lack of answers