seen him, and then even recalled the fact that he had thrown a light into her eyes, but remembered nothing else. This observation would seem to show that with some often repeated or very marked mental stimuli (throwing electric light into her eyes) a vague impression may be left, so that it may at least be possible to bring about a recollection with assistance, whereas spontaneous memory is impossible. In another instance, the patient was confronted with a physician who had seen a good deal of her. She said that he looked familiar to her, but she was unable to say where she had seen him. Here then again evidence that a certain vague impression was made by a repeated stimulus.
Another feature should here be mentioned, namely, that isolated facts may be remembered when the rest is blank. We have seen above that Annie K. (Case 5), while very vague about most occurrences, recalled a sudden angry outburst in detail. Another patient, though the period of the stupor was a blank, recalled some visits of her mother. At these times, as she claimed, she thought she was to be electrocuted and told her mother so, "Then it would drop out of my mind again." These facts are very interesting. We can scarcely account for such phenomena in any other way than by assuming that certain influences may temporarily lift the patient out of the deepest stupor. In spite of the fact that stupors often last for one or two years almost without change, a fact which would argue that the stupor reaction is a remarkably set, stable state,
we see in sudden episodes of elation that this is not the case, and other experiences point in the same direction. A similar observation was made on a case of typical stupor with marked reduction of activity and dullness. A rather cumbersome electrical apparatus (for the purpose of getting a good light for pupil examination) was brought to her bedside. Whereas before, she had been totally unresponsive, she suddenly wakened up, asked whether "those things" would blow up the place, and whether she was to be electrocuted. During this anxious state she responded promptly to commands, but after a short time relapsed into her totally inactive condition. We have, of course, similar experiences when we try to get stuporous patients to eat, who, after much coaxing may, for a short time, be made to feed themselves, only to relapse into the state of inactivity.
Such variations are paralleled, as we shall later show, by a suddenly pronounced deepening of the thinking disorder. We have already seen that the onset may be quite sudden. All this indicates that, in spite of a certain stability, sudden changes are not uncommon. Finally, we know that, in spite of the fact that stupor is an essentially affectless reaction, certain influences may produce smiles or tears, or, above all, angry outbursts, which again can hardly be interpreted otherwise than by assuming that those influences have temporarily produced a change in the clinical picture, in the sense of lifting the patient out of the depth of the stupor. All these
facts suggest that inconsistencies in recollection are correlated with changes in the clinical picture.
As is to be expected, the cases with partial stupors remember much more of what externally and internally happened during their psychoses. Rose Sch. (Case 6), who had a partial stupor during which she answered questions but showed a great difficulty in thinking, said retrospectively that she felt mixed up and could not remember. Although she recalled with details the Observation Pavilion and her transfer, she was not clear about their time relations (how long in the Observation Pavilion, how long in the first ward). Mary C. (Case 7), whose activity was not entirely interfered with and who showed some thinking disorder, said retrospectively that she could not take in things. Henrietta H. (Case 8), who had a partial stupor, claimed to have known all along where she was, but that she felt mixed up, that her thoughts wandered and that she felt confused about people. In the cases where a partial stupor was preceded by a marked one, such as in phase 2 of Anna G. (Case 1) and phase 2 of Mary D. (Case 4), we have no retrospective account regarding the partial stupor, because emphasis in the analysis was naturally laid on the period comprising the most marked disorder. However, we can gather from the few cases at our disposal that the patients retrospectively lay stress chiefly on their inability to understand the situation.
We finally have to consider the group of suicidal cases. We have information only in regard to two
cases, namely, Margaret C. (Case 10) and Pearl F. (Case 9). In both of these, we find that a good many things that happened during the period under consideration were remembered, as were also the patients' own actions. In Rosie K. (Case 11) we have at least the evidence that she remembered her own impulses, namely, that she refused food because she wanted to die. In other words, in these partial stupors with impulsive suicidal tendencies the interference with the intellectual processes seems to be moderate, and memory for external events not markedly affected.
2. Information Derived from Direct Observation
The evidence can best be presented by considering the details of some cases.