disorder in the intellectual processes. Still more striking are the conditions which are on a somewhat higher level and in which the shallowness of the responses, due to the residual disorder of attention, together with the last traces of the affectlessness, are apt to create the impression of a dementia. In such cases the opinion is often held that the patient has reached a defect stage from which recovery is impossible, whereas a thorough knowledge of these end stages teaches us that they are not only recoverable but quite typical for the terminal phases of stupor.
Considering these data, especially those gathered in the end stages, it would appear that there is no tendency in this intellectual disorder associated with the stupor reaction for any special side of mental activity to be most prominently affected. It looks rather as if it were a question of a general diminution of the capacity to make a mental effort which in its different intensities accounts for the symptoms.
Footnotes:
[5] See [Chapter XV].
CHAPTER V
THE IDEATIONAL CONTENT OF THE STUPOR
Brief survey of the ideas associated with stupor: Having thus described the formal manifestations of the various stupor reactions, it will now be interesting to see what ideas seem to be associated with these reactions. It is, of course, impossible to obtain during a considerable part of the stupor any statement of the patients' thoughts. We therefore have to depend on their utterances during periods when the inactivity temporarily ceases, or on the retrospective account which the patient gives after the stupor has completely disappeared; and as we shall see, we also may obtain considerable information by studying the ideas which occur in the period preceding the stupor. These last may be autogenous delusions or thoughts about actual events which precipitated the psychosis.
It is not likely that many observers have a very clear conception about what sort of ideas to expect. We have, as a rule, not been in the habit of paying much attention to the content of delusions, hallucinations, and the like. So far as we could judge, therefore, the ideas expressed might be expected to be fairly multiform, and it was distinctly interesting
to us when we found a marked tendency for the trends of ideas to remain within a certain small compass.[6] It was possible, to state this at once, to show that in by far the majority of cases the same set of ideas returned, and that these ideas had among themselves a definite inner relationship, being concerned with thoughts of "death." In isolated instances other ideas were found as well, and they will have to be discussed later. For the present we shall take up more habitual content.
In addition to the eleven cases already described, it may be well to cite four others which present material now of interest to us.