Benign Stupors: A Study of a New Manic-Depressive Reaction Type

by August Hoch

The internal relationship among the different ideas associated with stupor: Before we go any further it may be advisable to examine the meaning of such ideas when they arise in other settings than those of the psychoses. If we consider these ideas of death, Heaven, of going under ground, being in water, in a boat, etc., we are impressed with the similarity which they bear to certain mythological

motifs. This is, of course, not the place to enter into this topic more than briefly. We are here concerned with a clinical study, and therefore, among other tasks, with the interrelationship of symptoms, but for that purpose it is necessary to point out how these ideas seen in stupor can be shown to have, not only a connection amongst each other, when viewed as deep-seated human strivings, but also are closely related to, or identical with, ideas found in mythology.

To one's conscious mind death may be not only the dreaded enemy who ends life, but also the friend who brings relief from all conflict, strife and effort. Death may, therefore, well express a shrinking from adaptation and reality, and as such may symbolize one of the most deep-seated yearnings of the human soul. But from time immemorial man has associated with this yearning another one, one which, without the adaptation to reality being made, yet includes a certain attempt at objectivation, the desire for rebirth. We need not enter further into possible symbols for death per se, but it is quite necessary to speak briefly of the symbolic forms in which the striving for rebirth has ever found expression. The reader will find a large material collected in various writings on mythology, for the psychological interpretation of which reference may be made to Jung's "Wandlungen und Symbole der Libido" and Rank's "Mythos von der Geburt des Helden." From them it appears how old are the symbols for rebirth, and how they deal chiefly with

water and earth, and the idea of being surrounded by and enclosed in a small space. Thus we find a sinking into the water of the sea, enclosure in something which swims on or in the water, such as a casket, or a basket, or a fish, or a boat; again, we find descent into the earth. The striving for rebirth might be assumed to have adopted these expressions or symbols on account of the concrete way in which the human mind knows birth to take place. The tendency for concrete expression of abstract notions causes the desire for another existence to appear, first as a rebirth fantasy and then as a return to the mother's body. One thinks of Job's cry, "Naked came I from my mother's womb and naked shall I return thither," as an example of the literal comparison of death with birth. We need only refer to the myths of Moses and the older one of Osiris, and the many myths of the birth of the hero, to call to the mind of the reader the examples which mythology furnishes. There is probably not one of the ideas expressed by these patients which cannot be duplicated in myths. We have, therefore, a right to speak of these ideas as "primitive," and to see in them, not only deep-seated strivings of the human soul, but to recognize in them an essential inner relationship. It is especially this last fact to which at this point we wish to call attention: that without any obvious connection the fantasies of our forefathers recur in the delusions of our stupor cases. We presume that in each case they represent a fulfillment of a primitive human demand. In one of our cases a vision of

Heaven and a conscious longing to be there was followed by a stupor. On recovery the patient compared her condition to that of a butterfly just hatched from a cocoon. No clearer simile of mental rebirth could be given.

Brief survey of the ideas associated with the states preceding the stupor: If we now return to the study of the further occurrence of such ideas in the cases described, we find motifs, similar to those seen in the stupor, in the period which immediately precedes the more definite stupor reaction. Indeed we find the ideas there with greater regularity. In Meta S. (Case 15) the stupor followed upon six days with reduced activity and crying, with self-accusation, but also with entreaties to be allowed to go home and die with her father. At the very onset of her breakdown, the desire for death had also occurred. Anna G. (Case 1) expressed a wish to be with her dead father, and, at the visit of a cousin, she had a vision of the latter's dead mother. A second attack of this same patient began with the idea that the dead father was calling her. Maggie H. (Case 14) saw dead bodies, and during outbursts of greater anxiousness, she thought her husband was going to die. In Caroline De S. (Case 2) the psychosis began with a coarse excitement, with statements about being killed, with entreaties to be shot, with the idea of going to Heaven, again with frequent calling out that she loved her father (who was dead since her ninth year), while immediately before the stupor the condition passed into a muttering state

in which she spoke of being killed. Mary D. (Case 4) began by worrying over the father's death (dead four years before), had visions of the latter beckoning, and she heard voices saying, "You will be dead." Mary F. (Case 3) had a vision of "a person in white," and thought she was going to die. In Henrietta H. (Case 8) the stupor was preceded by nine days of elation, with ideas of shooting and of war, but this had commenced with hearing voices of dead friends, and with ideas that somebody wanted to kill her family. In the case of Annie K. (Case 5) we find before the stupor a state of worry, with reduction of activity, and then a vision of the dead father coming for her. In Charlotte W. (Case 12) the stupor was preceded by a state of preoccupation, with distress and entreaties to be saved, partly from being put into a big hole, partly from the electric chair.

We see, therefore, in the introductory phase of the stupor in almost every case ideas of death, and in one case an idea belonging to the rebirth motif, namely, of being put into a dark hole. In well-observed cases apparently we do not find the stupor reaction without either coincident or preceding ideas of death.

Relation of death and rebirth ideas with affect: In order to investigate the relation of these ideas to the affective condition associated with them, it will be necessary to study not only the abstract ideational content but the special formulation in which the content appears. In looking over the enumera

tion of the ideas given above, it is very clear that these formulations differed considerably from each other. A priori we would say that it is, psychologically, a very different matter whether a person expresses a desire to die, or has the idea that he will die or is dead, or says he will be killed. We associate the first with sadness, the last with fear, while our daily experience does not give us so much information about the delusion of being dead. A vivid expectation of death is usually accompanied by either fear or resignation.