For the study of the interferences with the intellectual processes during stupor reaction, we have two sources of information: The first is derived from the account which the patient is able to give in regard to what he remembers as having taken place around him or in his mind during the stupor period; the second is the direct observation of partial stupor reactions.
1. Information Derived from the Patient's Retrospective Account
We will start with the cases of marked stupor mentioned in Chapter I. Anna G.'s (Case 1) psychosis commenced at home, and under observation lasted with great intensity for five months. She remembered only vaguely the carriage going to the Observation Pavilion, had no recollection of the latter, nor of her transfer to the Manhattan State Hospital and of most of the stay at the Institute ward, including the tube- or spoon-feeding which had to be carried on for four months. She also claimed that she did not know where she was until four or five months after admission. She was amnesic for her delusions and hallucinations. Of Caroline DeS. (Case 2) we have no information. Of Mary F. (Case 3), whose stupor began at home and under observation lasted two years, we find that she had no recollection of coming to the hospital, what ward she came to, who the doctor and nurses were (with whom she became acquainted later), in fact she
claimed that for about a year she did not know where she was. But she remembered having been tube-fed (this took place over a long period). Mary D.'s (Case 4) stupor also commenced at home, and under observation lasted for three months. She had no recollection of going to the Observation Pavilion, of the transfer to Manhattan State Hospital, and of a considerable part of her stay here, including such obtrusive facts as a presentation before a staff meeting, an extensive physical and a blood examination, and she claimed not to have known for a long time where she was. Annie K.'s (Case 5) stupor commenced at home. Although she recalled the last days there and some ideas and events at the Observation Pavilion, the memory of the journey to Ward's Island was vague, as was that of entrance to the ward, and she claimed not to have known where she was for quite a while. Specific occurrences, such as the taking of her picture (with open eyes two months after admission), an examination in a special room, her own mixed-up writing (end of second week) were not remembered. But it is quite interesting that an angry outburst of another patient within this same period, which was evidently not recorded, is clearly remembered.
We shall later show that when the patient comes out of a stupor the condition may be such that, for a time at least, retrospective accounts are difficult to obtain. It must also be remembered that not infrequently the more marked stupors may be followed by milder states, and it is important, if we
wish to determine how much is remembered, not to confuse the two states or not to let the patient confuse them. For example, Mary D. (Case 4), who showed two separate phases, while she claimed not to know of many external facts, also added that she could not understand the questions which were asked. From observation in other cases it seems that in marked stupor any such recollection about the patient's own mental processes would be quite inconsistent. We have to assume, therefore, that this remark referred in reality to the second milder phase, for which, as we shall see, it is indeed quite characteristic. It is not necessary to burden the reader with other cases, all of which consistently gave such accounts.
We see, then, that in the marked stupor the intellectual processes are regularly interfered with, as evidenced by almost complete amnesia for external events and internal thoughts. In other words, this would indicate that the minds of these patients were blank. Inasmuch as direct observation during the stupor adduces little proof of mentation, we may assume that such mental processes as may exist in deepest stupor are of a primitive, larval order.
Before we examine more carefully the milder grades of stupor, it will be necessary to say a few words about the retrospective account which the patient gives of intellectual difficulties during the incubation period of the psychosis. As a matter of fact, we find that these accounts are remarkably uniform. While some patients, to be sure, speak of
a more or less sudden lack of interest or ambition which came over them, others of them speak plainly of a sudden mental loss. Mary. C. (Case 7) claimed she suddenly got mixed up and lost her memory. Laura A. spoke at any rate of suddenly having felt dazed and stunned. Mary D. (Case 4) said she felt she was losing her mind and that she could not understand what she was reading. Maggie H. (Case 14) began to say that her head was getting queer. We see from this that the interferences with the intellectual processes may in the beginning be quite sudden.
In some instances a more detailed retrospective account was taken, which may throw some light upon the interferences with the intellectual processes with which we are now concerned. Emma K., whose case need not be taken up in detail, had a typical marked stupor which lasted for nine months, preceded by a bewildered, restless, resistive state for five days. She was in the Institute ward for the first four months, including the five days above mentioned; later in another ward. When asked what was the first ward which she remembered, she mentioned the one after the Institute ward, and when asked who the first physician was, she mentioned the one in charge of the second ward. However, when taken to the Institute ward, she said it looked familiar, and was able to point to the bed in which she lay, though somewhat tentatively. The same rousing of memory occurred when the first physician, who saw her daily, was pointed out to her. She remembered having