At the Observation Pavilion the patient was described as dull, but brightening up under examination. She made few spontaneous remarks, but in answer to questions said she was melancholy, tired of life, because she was in love with a Gentile fellow who refused to marry her. She also said "I get peculiar thoughts that I am going to die."
Under Observation: The patient's condition lasted for about two years. Much of the time she lay in bed, often with the covers pulled over her, sometimes with her legs drawn up, again in a more natural, comfortable position, or she sat up with her head bowed. She obeyed almost no commands. For months she soiled and wet herself, but never drooled. For a time she refused food consistently, lost flesh and had to be tube-fed. For the most part she said very little and, when one accosted her, she was apt to turn away. A few times, when further urged, she swore at the examiner. There was also persistent marked resistance towards any interference, sometimes merely passive or quite often, especially at first, with wriggling or severe scratching of her own body. There was often with this evidence of irritation or she moaned. Again she was described as quite affectless. One of the most striking features throughout a large part of the course were her suicidal attempts. She would try to strike her head against the iron bedpost, throw herself out of bed, throw herself
about generally, try to strangle herself with the sheets, try to pull out her tongue, all of which seemed to be done with great impulsiveness. Almost her only utterances had to do with death. She said she wanted to die, wanted to drop dead, did not want to live, wanted to kill herself, that she did not eat because she wanted to die. When once she was found tossing about and was asked whether she worried, she said "I know I am going to die." (You mean you will be killed?) "I don't care."
There were a few episodes which still have to be mentioned. Quite early in the course of the stupor, when she was restless, scratching herself and moaning, she once spoke quite freely. She said "Give me that fellow (Harry), I don't care, I can't help it. I must have him, even if it costs me my life." "I would feel happy if I could get him. O God, I love him—I will never get him even if I drop dead, I know I won't get him, the darling" (cries). (What if you did get him?) "I know I would lose him again." Then with shame she claimed she had had sexual relations with him (when well, denied). At the same interview, when the doctor sneezed, she said "Gesundheit." In June, 1914, she was seen smiling at times. But the first was the only episode when she spoke more freely, and the two occasions the only ones when she showed a frank affect.
The improvement commenced in April, 1915. Although still very inactive, she sometimes began to laugh and sing and talk a little to other patients. She also answered a few questions on April 22, 1915. Thus, when asked whether she wanted to go home, she said "No, I want to stay here." (Do you like it here?) "Yes" (smiles), "I can't get no other place; I have got to like it here." She smiled freely. To orientation questions, she knew the place, month, but not the year.
She continued inactive and above all diffident, but improved steadily and, when examined by the writer on November 15, she made a very natural impression and gave the retrospective account of the onset embodied in the history. She was quite frank, thanked the doctor for the interest he took in her case, and said for example, "You know I never thought I would get well. I quite gave up—I am very glad I am well now."
When questioned about her stay here, the patient evidently remembered much. She was able to say which wards she had
been in and approximately how long she had been in each one. She claimed that at first it "seemed strange." "I did not eat, I did not want to eat, I used to tell them to poison me and that I wanted to die, I was disgusted, I thought I would never go home." She also says she felt angry, wanted to kill herself. She bit and scratched "because I was nervous." She remembered talking about Harry, "I said I was in love with him, I thought I wanted to die because I could not have him." She also talked of having been stubborn. Sometimes she felt like running to the river. She also claimed she imagined people were false to her.
In one of the wards she said she thought people were there on her account, were waiting for her death. She did not care for a time whether she died or not. She knew she tried to choke herself occasionally. Asked how she behaved, she first said she was quiet. (Were you not restless?) "I used to get tired and have backache and roll around in bed." She also felt like running away sometimes, wanted to get out of bed and wanted to walk about. (What about going to the river?) "I used to say that." She claimed not to have been mixed up at any time and to remember everything. Remarkable is the fact that she claimed she did not worry at all, "I felt I was lost and would not worry. I used to worry at home and at Dr. M.'s (the private sanatorium) but not here. Here I never worried, I did not care where I went." She said she did not talk because she was bashful in the presence of doctors, sometimes she felt afraid of them, afraid they would kill her, put poison in her food when they fed her. "When my people came, I said I did not want to live, wanted to kill myself. I used to cry." Again asked why she did not talk, she admitted she really did not know. Once she said she was bashful because she soiled her bed. She did not want to go to the closet because she was afraid of the nurse. She denied hearing voices.
In addition to the activity incidental to her attempts at self-injury, this patient showed an unusual degree of resistiveness and with this some affect, for she appeared to be irritated and at times moaned. Still more unusual were the appearances