An important "catatonic" symptom is a tendency to sudden, impulsive, unexplainable acts. Such actions occur occasionally in benign stupors and, since we attempt an understanding of the reaction as a whole, an effort should be made to study these phenomena as well. The cases chosen showed persistent, quite affectless, yet very impulsive attempts at self-injury. They characterized the first of the three cases throughout, were present in one stage (the second) of the second patient, while in the last for one day there was behavior which can be similarly interpreted.
Mention has been made of the prominence, approaching universality, of the death idea in stupor. This is a subject to be discussed in length presently, but for the present we may say that there may be a delusion of death with dramatization of that state or a mere abandonment of the mental activities of life. It is but a step from corpse-like behavior to suicidal attempts, psychologically speaking, yet this transition necessarily modifies the clinical picture, since one necessitates inactivity and the other activity. Secondarily, other atypical clinical features appear, as will be seen.
Case 9.—Pearl F. Age: 24. Admitted to the Psychiatric Institute July 26, 1913.
F. H. A paternal aunt was insane. Both parents died long ago; the mother when the patient was a baby; the father when she was a girl. She came to this country when 17. In this country she had generally been a domestic. An older brother and sister were also in America.
P. H. She was described as sociable, good-natured, bright enough, not inclined to be depressed. She had little education. There was no former attack.
Four months before admission, the patient did not menstruate but was said not to have worried about this. A month later she began to show symptoms. She said she did not want to live, had done something wrong but could not or would not say what it was. Again she said a young man was going to sue her, a young Jewish fellow whom she had seen only a few times. She talked of turning on the gas. She also complained that people were looking at her and that the food was poisoned.
The patient after recovery gave the following version of the onset: She had a position on 99th St. for 2½ years. She liked the people there and often went to see them later. Her next position was in the Bronx. She was there for nine months. In the same house lived "Harry." After the work she used to talk to him in the yard and, after she left, she used to think of him and long for him. But she denied, with a very natural attitude, that she worried about him at the beginning of her psychosis. After the position in the Bronx she went to one on 96th St., where she was for four months. In the same house was a girl whom she liked and who was lively. When she left, the patient left too. This was a month before the psychosis began. When she left there, she got word that her employer on 99th St. had developed consumption and had to go out West, but did not worry over this news, she claimed. She looked for another position and had one for two weeks, but felt lonely, did not care to live. Then her sister took her to her home. She thought people were looking at her and were making remarks because she was not working. During this time she had a dream one night in which her dead mother appeared to her (in ordinary street clothes) and said to her that she (the patient) "was going away." She woke up
frightened. She was worried, thought she had not prayed enough for her mother, and asked her sister to pray also and to give money to the poor. She did not recall, or at any rate denied, speaking of the young man suing her.
She was then taken to a private sanatorium, where she was for two months preceding her admission to this hospital. There she was described as quiet, mute, tube-fed, resistive.
When well, the patient said that in this sanatorium she was first spoon-fed, cup-fed, later tube-fed, "I used to be scared of them, they used to put a spoon way down my throat and I had no appetite—I did not like them around me, they were mean to me. They used to let me stand without clothes, used to spite me." "If I did not want to dress myself, they used to hit me." "I used to feel lonesome for home and I imagined my people were there and that my sister passed the place without stopping." She was afraid of the nurses, thinking they wanted to kill her.