It will now be necessary to examine the earlier state of Charlotte W. The condition preceding the stupor set in with pre-occupation, slow talk and slight distress. During the time she asked to be given one more chance, she said to the husband she would not see him again. Then followed a day when she was very slow and with moaning said she was going to be put into a dark hole. Again on the next, when speaking more freely, she begged to be saved from the electric chair, and also said, "Don't kill me, make me true to my husband," etc. [Again the connection with real life!] We see here the idea of death and especially an idea pertaining to the rebirth motif in a setting of distress and slowness, as an introduction to the stupor which had in it both of these motifs. We must leave it undecided whether it is accidental or not that the distress was associated with more slowness (i.e., more marked stupor traits) when she spoke of the dark hole than when she spoke of the electric chair or death. But what interests us is that distress and reduction of activity (not sadness and reduction of activity, which seems as a rule to have a different content) are here associated with ideas seen in stupor but formulated as prospective dangers. We know from experience that we often find associated with the fear of dying considerable freedom of action, and we see at times in involution states conditions with freedom of motion and marked anxiety, whereas the
ideas seem to belong to the motif of rebirth; e.g., the fear of being boiled in a tank.[A]
In this connection, however, two other cases should be taken up which show a condition which reminds one somewhat of that we have just discussed, but in which the rebirth motif appeared, not as prospective, but, as in the stupor, as an actual situation. At the same time this situation was not passively accepted but conceived as a dangerous situation. The significant phenomenon in both these conditions was that there was not anxiety with freedom of action but a bewildered uneasiness with marked reduction of activity.
The first case is that of Johanna S., whose history has been given in this chapter. It will be observed that in the fourth period the patient presented two days of typical stupor with the idea that she was dead. We are familiar with this. But this was followed by several days of bewildered uneasiness and slow restlessness, with ideas that she was at the bottom of the deep, dark water and for a time she made attempts at stepping out of the water or swimming motions. All of this was in a general setting of reduction of activity with bewildered uneasiness. In the ideas about being at the bottom of the deep, dark water, we recognize again the re
birth motif, yet the situation is not accepted but attempts are made by the patient to save herself, i.e., the attitude is one in which the situation is taken to be one of danger. It is interesting in this connection that immediately following this state there was one day of ordinary retardation with sadness and ideas of being bad and sick. That is, when the element of anxiety, the uneasiness, disappeared and sadness supervened, the rebirth ideas were no longer present.
In Mary C. (See [Chapter II, Case 7]) we have, unfortunately, not a direct observation, but we have, at any rate, a description from the Observation Pavilion which seems so plain that we should be justified in using it here. The condition we refer to is described as a dazed uneasiness, with ideas of being shut up in a ship, of the ship being closed up so that no one could get out, of the boat having gone down, of the people turning up. We should add here that the condition was not followed by a typical stupor. Essentially it was a retardation, in which only on one occasion was a definite akinesis observed. During this phase she soiled her bed. Perhaps the persistent complaint of inability to take in the environment belonged also more to the retardation of stupor than to that of depression. We have again, therefore, in this initial phase, a similar situation, namely, ideas belonging essentially to the rebirth motif, formulated as of a threatening character if not as actually dangerous.
We can say, therefore, that what characterizes
these three cases, and brings them together, is the fact that all three had ideas belonging to the rebirth motif, but formulated as dangerous situations. Associated with this there was not a typical anxiety with the relative freedom of activity belonging to this state, but an anxiety or distress or uneasiness with traits of stupor reaction, namely, slow movements, lack of contact with the environment, and a dazed facial expression. It would seem that these facts could scarcely be accidental but that they must have a deeper significance. As a discussion of this belongs, however, more into the psychological part of this study, we shall defer it for the present, and be satisfied with pointing out here the clinical facts of observation.
In brief, then, our findings as to the ideational content of the benign stupor are as follows: From the utterances during the incubation period of the psychosis, from the ideas expressed in interruptions of the deep stupor, as well as from the memories of recovered patients, we find an extraordinary paucity and uniformity of autistic thoughts. They are concerned with death, often as a plain delusion of being no longer alive, or with the closely related fancy of rebirth. The rule is a setting of apathy for these ideas, but when they are formulated so as to connect them with the real life and problems of the patient, or when rebirth is represented as a dangerous situation, some affect, usually one of distress, may appear.