Benign Stupors: A Study of a New Manic-Depressive Reaction Type. August Hoch
she had no fever. She got up on the tenth day, and then seemed to lose all interest, did not attend to the baby, said she was not strong enough. She sat about, appearing depressed. The mother then took her and the baby to her house. There she sat or walked about, said very little. But she repeatedly came to her mother, said she had something to tell her, or that she had "done something," although she could never be induced to say what. Once she came to her and said, "You are not going to die." She often moaned. Finally, she claimed a neighbor had been saying she was poisoning the baby.
The patient herself gave, after recovery, the onset as follows: When she married she knew her husband was not what he should be, but not that he was so bad as he proved to be. He was a gambler, did not support her, and this caused her much worry. When she became pregnant, eight months after marriage, this increased her worry, and throughout the pregnancy she spoke much to a neighbor about her worries, and said she did not know how she could manage, pay the doctor, and the like, but she did not say much about it to her mother (because the latter would have made such a fuss about it, or would have said, "It serves you right"). Then the childbirth came. This further accentuated her worries. She felt her difficult circumstances, wondered how she could get the necessary money, "I lay there worrying." And she claimed she did not sleep at all. About her statement, mentioned by the mother, that she had done something, she said that she thought she had poisoned the child by giving it fennel tea, and that she thought a neighbor who visited her said she had poisoned it. She was then put to bed again, and one night she had a vision of her father. This frightened her. She thought this meant he had come for her and she wanted to die.
At the Observation Pavilion she was dull, staring, resisting attempts at passive motions.
Under Observation: 1. There was nothing noteworthy in her physical condition, except for a rise of temperature to 100° occasionally during the first month of her admission. For the first four months she was often found lying in bed with her head half raised from the pillow, or standing or sitting about in constrained positions, immobile, frequently she let saliva collect in her mouth. She usually wet and sometimes soiled the bed. Sometimes, when sitting in a constrained position, she let herself gradually slide on the floor. She often began to feed herself when urged, but would not finish, and had to be spoon-fed, as a rule. She was never tube-fed. She was often quite stiff and showed marked resistance. This was manifested either when passive motions were tried, at which times she usually resisted passively, i.e., she became more tense; or when there broke through a more active aggression and she would strike. Above all, the opposition showed itself towards the nurses' attention; in this she also showed either a passive, aimless opposition and stiffness, or a more active one; but even in the latter an open show of angry affect, or plain irritation, though present at times, was by no means constant. When it was present, she would strike quite aimfully; once she struck the nurse and said, "You are the cause of it all," and once, when the nurse tried to give her some milk, she said, in an irritated tone, "I wonder people would not let me alone some time." Again, she bit a patient who tried to hold her. On another occasion she quickly jumped up and pulled the hair of a patient who evidently disturbed her by her noisy shouting. As was stated, she usually wet the bed, resisted being taken to the toilet, or when taken there, would not urinate or defecate, but would do so as soon as she was returned to bed; or she urinated while standing. The same perverse opposition was seen when she would refuse a glass of milk, but grab it when it was taken away and then refuse to let go. She often would grasp the bedclothes or other things and hold on aimlessly.
She rarely spoke, answered almost no questions, complied, as a rule, not even with the simplest commands. To pin pricks she did not react except at times by flushing. But she did not stare, rather looked about, and was at times easily attracted by noises or happenings about her, and would then look in that direction not without some interest. Often there was then an expression of bewilderment. Her mood, however, was, as a rule, apathetic, but at times, as stated, she showed some anger. Once she wept, and a few times she smiled or snickered. As a rule, this happened without appreciable cause. But once, when a cheering remark was made, she smiled; or, when her picture was taken (to show the peculiar constrained attitude with the head raised from the pillow), she laughed loudly.
Although she spoke rarely, she made a few utterances in the first few days. Thus she suddenly said: "I want to see Mr. N.—what I said to him was not right," or "Listen! there are the priests calling," or "You are all faking—it is me that done it—they are all dressing up downstairs," or "I told you she was not able to nurse the baby," or "I have nobody, I am lost—I want to know the truth—my mamma," or she called her sister, "They are dead since last night."
Even during the more stuporous state she could, a few times, be made to write a little. Then she either wrote very slowly and not more than a letter, or if she wrote more, it was remarkably mixed up. Thus when asked to write the date, she wrote, "Jane (mother's name) to me to Chrichst," or when asked to write her name: "Annie take you ktusto."
As to her orientation, nothing could be made out as a rule. At first, however, a few weeks after admission, she spoke correctly of the month as January and spoke of the Island. When at that time she was asked if she had a baby, she said, in an annoyed tone, "I don't know."
2. In the beginning of May, i.e., four months after entrance, her condition changed somewhat, and for two months she presented the following state: She stood about, or walked around slowly, usually with her arms folded. She had a tendency to stand near the door. She had to be assisted in dressing, pushed rather than led to her meals, and urged to eat. For the most part, she would not answer questions, but would either smile in a sneering way, or just walk away, or say, "Oh, don't bother me," or "I don't want to talk," and generally her attitude was rather sulky. Nor was this only towards the physicians but towards the husband, sister and child as well. When on May 17 the sister came, she would not speak to her but said "Go away." The baby she simply pushed away sulkily when it was brought to her. To the husband she said on May 31, "Go away, you stink." In the first part of this period, she presented some bursts of elation, on one occasion turned somersaults, indulged in a few pranks with laughter, or once, when a knock at the door was heard, she called out "Holy gee, cheese it, the cop." But these occurred only in the first part of the period. On June 1 she spoke to the nurse, said, "What is the matter with these people, they must be crazy," asked to go home, and was then by the nurse found to be oriented, and to know the names of people around her. But when she was asked about the baby she would not answer, and questioned whether she was not married, she said "I don't know." Yet when the physician desired to talk to her, she was just the same as before and remained so for two more weeks. Another somewhat isolated occurrence was when on June 18 she spoke a little to the physician, but she sat in a constrained position when taken into the office and answered many questions by "I don't know," namely, those regarding her condition and feelings, the questions about orientation, about her mother's address, and her child's age; but when asked how long she had been married she said correctly "Two years."
At the beginning of July she improved quite rapidly, and on July 5 appeared fairly free and gave a fair retrospective account, with some urging, and it was thought that she smiled somewhat too freely. However, on July 27, she seemed perfectly well, had normal insight, and then gave the second retrospective account, which, together with the first, will now be taken up.
Retrospectively: She claimed to remember things at home, and at both interviews said she recalled being taken to the Observation Pavilion. While there she thought she knew where she was, remembered that she did not talk. She had a feeling she was going to die and said "I thought I would die if I kept still." However, the transfer to this hospital was vague in her mind, as was the entrance on the ward, and she claimed not to have known for quite a while where she was. She added that she used to wonder where she was, how she had gotten here, and how she could get out, and thought the questions which were asked were queer. Individual occurrences, too, specifically inquired into were not recollected, such as an examination in a special room. Of the mixed-up writing at the end of the second week, she had no recollection even when it was shown to her. She did not recall having her picture taken (with eyes open) two months after entrance. Yet a sudden angry outburst ten weeks after admission was remembered. She stated that she struck the patient because the latter annoyed her by her shouting. She had a general recollection of being stiff, having her head raised, and of soiling and