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

by August Hoch

Four days before admission she became quite immobile, lay in bed, did not speak, eat or drink. She also had some fever.

The patient herself, when well, described the onset of her psychosis as follows: She knew of no cause except that her brother, some time before the onset (not clear how long), was run over by an automobile and had his foot hurt. She claimed that while still working she lost her ambition, lost her appetite, did not feel like talking to any one; that when she went out with her mother it merely seemed to her that people stared at her. The day before she went to the Observation Pavilion her cousin came to see her, and she thought she saw, standing beside this cousin, the latter's dead mother. She also thought there was a fire, and that her sister was sweeping little babies out of the room. Then, she claimed, she felt afraid (this still on the day before going to the Observation Pavilion) because she had repeated visions of an old woman, a witch. This woman said, "I am your mother, and I gave you to this woman (i.e., patient's real mother) when you were a baby." She also was afraid her mother was "going away."

At the Observation Pavilion she was described as constrained, staring fixedly into space, mute, requiring to be dressed and fed.

Under Observation: 1. For five months the patient presented a marked stupor. She was for the most part very inactive, totally mute, staring vacantly, often not even blinking, so that for a time the conjunctivæ were dry. She did not swallow, but held her saliva; did not react to pin pricks or feinting motions before her eyes. Sometimes she retained her urine, again wet and soiled the bed. Often there was marked catalepsy, and the retention of very awkward positions. As a rule she was quite stiff, offering passive resistance towards any interference. She had to be tube-fed at first. Later she was spoon-fed, and then would swallow, in spite of the fact that during the interval between her feeding she would let saliva collect in her mouth. For a time she had a tendency to hold one leg out of bed, and when it was put back would stick the other out. Sometimes she walked of her own accord to the toilet chair, but on one occasion wet the floor before she got there.

During the first month after admission, this stupor was interrupted for two short periods by a little freer action: she walked to a chair, sat down, smiled a little, fanned herself very naturally when a fan was given to her, though even then did not speak.

There was, as a rule, no emotional reaction, but after some months she several times wept when her mother came, though without speaking. Once when taken to the tub she yelled.

Her physical condition during this stupor was as follows: She menstruated freely on admission, then not again until she was well. Several times she had rises of temperature to 102° or 103° with a high pulse and respiration; again a respiration of 40, with but slight rise of temperature, though the pulse had a tendency to go to 130 and over. She was apt to show marked skin hyperæmia wherever touched. With the fever there was found a leucocytosis of from 11,900 to 15,000, with marked increase of polynuclear leucocytes (89%). She got very emaciated, so that four months after admission she weighed 68 lbs. (height 5' 2").

2. About five months after admission she was often seen smiling, and again weeping, and she began to talk a little to the nurses, though not to the doctors. She also began to eat excessively of her own accord, and rapidly gained weight, so that

by January she weighed 98½ lbs., a gain of 30 lbs. in two months. Yet she continued to be sluggish.

3. For two more months she was apathetic and appeared disinterested, often would not reply, again, at the same interview, she would do so promptly and with natural voice. This condition may be illustrated by the summary of a note made on January 29, 1908, which is representative of that period. It is stated that she sat about apathetically all day, appeared sluggish, but was fairly neat about her appearance and cleanly in her habits. There was at no time any evidence of affect, except when asked by the examiner to put out her tongue so that he could stick a pin in it she blushed and hid her face. When asked whether she worried about anything, she denied this. When questions were asked, she sometimes answered promptly and in normal voice, again simply remained silent in spite of repeated urging. On the whole, it seemed that simple impersonal questions were answered promptly; whereas difficult impersonal questions or questions which referred to her condition were not answered at all. She proved to be oriented. Thus she gave the day of the week, month, year, the name of the hospital, names of the doctors and nurses promptly. She also counted quickly and did a few simple multiplications quickly. But she was silent when asked where the hospital was located, how long she had been here, whether she was here one or six months, how she felt. Questions in regard to the condition she had passed through, or involving difficult calculations, she did not answer. However, some questions regarding her condition asked in such a way that they could be answered by "yes" or "no" were again answered quite promptly. Thus when asked whether her head felt all right she said, "Yes, sir." (Is your memory good?) "Yes." (Have you been sick?) "No, sir." (Are you worried?) "No."