Only one publication has come to our attention in which an attempt is made at psychological interpretation of various symptoms in stupor. Vogt[32] derives much from a restriction of the field of consciousness. Only one idea is present at a time, hence there is no inhibition and impulsiveness occurs. Similarly, if the idea appear from without, it, too, is not inhibited, which produces the suggestibility that in turn accounts for catalepsy. Stereotypy and perseveration are other evidences of this narrowness of thought content. Negativism is a state, he says, of perseverated muscular tension. [This would apply only to muscular rigidity.] So far as it
goes, this view seems sound. Of course it leaves the problem at that interesting point, Why the restriction of consciousness?
If stupor be a psychobiological reaction, it should occur, occasionally, in organic conditions just as the deliria of typhoid fever may contain many psychogenic elements. Gnauck[33] reports such a case. The patient, a woman, was poisoned by carbon dioxide. At first there was unconsciousness. Then, as she became clearer, it was apparent that she was clouded and confused. She soiled. Neurological symptoms were indefinite; enlargement of the left pupil, difficult gait and exaggerated tendon reflexes. Months later she was still apathetic, although her inactivity was sometimes interrupted by such silly acts as cutting up her shoes. After five months she recovered with only scattered memories of the early part of her psychosis. What seems like a typical stupor content was recalled, however. She thought she was standing in water and heard bells ringing.
Stupor-like reactions are not infrequent in connection with or following fevers. Bonhoeffer[34] describes a type that follows a febrile Daemmerzustand of a few hours or a day at most. The affect suddenly goes, disorientation sets in. Although outbreaks of anxiety may be intercurrent, the dominant picture is of stupor. Reactions are slowed,
often there is catalepsy. Sometimes there is a retention defect and confabulation to account for the recent past. Again the retention may be good. In the foreground stands a strong tendency to perseveration. This may affect speech to the point of an apparent aphasia or produce paragraphia. Plainly organic aphasia and focal neurological symptoms are sometimes seen.
As Knauer[35] has gone thoroughly into the question of the febrile stupors, the reader is referred to his paper for a digest of the literature on this topic. Mention has already been made in Chapter IX to this publication, where the close resemblance of these rheumatic, to our benign functional, stupors has been noted. Discrimination seems to be possible only on the basis of delirium-like features being added in the organic group.
Footnotes:
[C] This chapter has been written mainly from material in Dr. Hoch's notes which was manifestly incomplete. No claim is made for its exhaustiveness.
The Editor.
[13] Dagonet, M. H.: "De la Stupeur dans les Maladies Mentales et de l'Affection mentale désignée sous le Nom de Stupidité." Annales Medico-Psychologiques, T. VII, 5e Serie, 1872.