We see, therefore, that most of the ideas which she thus spoke of retrospectively as having been in her mind during this stupor, and which belonged both to the death and the rebirth motifs were formulated as facts (as in the cases of Henrietta H. and Mary F. above mentioned). It was, moreover, a condition which was accepted without protest. Here again an affect was not associated with these ideas, and when the patient was asked whether she had not been frightened, she said herself, "No, I just lay there." The idea that God told her she would have to die on the cross like Christ, is, in the religious form, like the beckoning of the father with Henrietta H. The only exception to the claim that the ideas were formulated as facts and accepted as inevitable seems to be the statement that she held up her arms to save the ship. This would seem to be, in contradistinction to the rest, a formulation as a more dangerous situation. However, this was isolated and we can do no more than to determine main tendencies. We must expect, especially in such variable conditions as we see in this patient, to find occasional inconsistencies.

In summing up we may say, therefore, that so far as the stupor itself is concerned, the ideas are formulated as a rule:—

  1. As accepted facts (being dead, being in a ship, etc.).
  2. As accepted prospects (going to die).
  3. As the wish to die.

In the first two types the ideas are not associated with affect; in the third, though not associated with affect, they are combined with "impulsive" suicidal attempts.

In order not to tear apart the analysis of Charlotte W. (Case 12) too much, we may begin our study of the intervals and the conditions preceding the stupors with the ideas which this patient produced when the stupor lifted somewhat. We shall see that the ideas are closely related to those mentioned above but formulated differently.

It will be remembered that Charlotte W. had freer intervals when she responded and was less constrained generally, and that it was in these that the ideas above mentioned were gathered. Since they were spoken of in the past tense, we regarded them as not belonging to the actual situation but to the more stuporous period. It seems tempting now to see whether the ideas which are expressed in the present tense are different in character, the general aim being to discover whether any tendencies can be found in regard to the types and formulations of delusions associated with different clinical pictures. We see

that on November 2 the patient, when speaking much more freely than before, said she had felt that she was mesmerized, was dead, and that she had gone to Heaven, ideas which we have taken up above as belonging to the stupor period. In addition to speaking much more freely in these intervals, she showed at times some affect. Thus to the physician whom she called Christ, she said, with tears, "You came to tell me what was right," or again with tears, "I will have to be crucified," or she spoke in a depressed manner about her children, "I can't see them any more," "I must stay here till I die," and she spoke of having to stay here till she picked her eyes and her brains out; or she claimed her husband or her children had to pick them out. Once she exclaimed crossly and with tears, "You are trying to keep me from Jim" (husband). Another idea was not plainly associated with affect. She said she had come back from Heaven, "The wedding ring kept me on Earth." What strikes one about these formulations is that they are, on the one hand, sometimes associated with an affect, and that, on the other hand, they refer much more to her actual life, her marriage, her husband, her children. At least this seems to be a definite tendency. A similar tendency may be seen later: On November 4, while generally stuporous, this suddenly lifted for a short time, and with feeble voice she uttered some depressive ideas. She said she wanted to go to a convent, that it would be better if she were dead, that she

could not do anything right. On November 5 and 6 she said she wanted to go to Jim in Heaven (in contradistinction to the retrospective statements that she had gone to Heaven), and on the 8th, when she had the idea of being in a boat, she said with some anger that she had wanted to get her husband into the boat, but that the doctor kept him out and took his place.

Later there were at times ideas expressed which referred to the actual situation or essentially depressive ideas in a depressive setting. Thus on December 3 she appeared sad, retarded, and spoke of not being able to see her children and that she had done wrong in buying carbolic acid (her suicidal attempt). So far as this case is concerned, therefore, we do find a distinct tendency for the ideas which refer to the more stuporous condition to differ from those which refer to the actual situation in the freer intervals, a difference which we may formulate by saying that, though primitive ideas are expressed, the tendency seems to be to connect them more with actual life, or that the primitive character is lost and the ideas take on a more depressive character with a depressive affect. A few words should be added in regard to the peculiar ideas that she or her husband or her child had to pick out her eyes (or her brain). It is probable that this idea belongs to the motif of sacrifice (the Opfer motiv of Jung) into which we need not enter further, except to say that in this instance it was plainly connected, like

some of the other ideas just spoken of, with the real situation of her life (husband, children).