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

by August Hoch

that this "stupor" was liable to constant interruption, either spontaneously or as a result of questioning, which always produced a mood reaction. She was apathetic only so long as she was left alone. In other words, whenever an effort was made to test what seemed to be apathy, the evidences of it disappeared.

The third case to be considered is somewhat like that of the first, Anna L. (Case 16), in that with the inactivity and apathy there was a coincident subjective perplexity. The apathy, however, was less marked than in the case of Annie L.

Case 18.—Catherine M. Age: 24. Admitted to the Psychiatric Institute November 10, 1913.

F. H. Information as to the family is confined to the two parents. The mother, who was frequently seen, seemed to be a natural, sensible woman. The father, on the other hand, had been alcoholic all his life, had had two convulsions while drinking, and had little respect from any member of the family, including the patient.

P. H. The patient was said always to have been healthy, from a physical standpoint, although never robust. She got on well at school, and then worked first as a stock girl and later as clerk in a department store, where her work was efficient and she advanced steadily. As a child she played freely with other girls but little with boys. As she grew older she moved about socially a little more, made the acquaintance of men as well as of girls, but never cared much for the former and had no love affairs until she met her husband. She was never demonstrative but always rather quiet and modest. Occasionally she spoke of thinking that people talked about her, but the informant doubted if she brooded over this, because she was not of a worrying disposition. Considering the ideas which appeared in her psychosis, it is striking that in her normal life she was rather

antagonistic towards her father on account of his alcoholism and the crudity of his speech and manners.

When she met her husband she liked him from the first, although she at no time became really demonstrative. They were engaged for a year, during which time she agreed to a postponement of three months for the marriage, which was suggested by her mother. For some time before this event she was working harder than usual and seemed a bit worn out. She ceased working a month before marriage and improved physically, although she became rather nervous, that is, she was more easily startled, an accentuation of what had been a characteristic for some years. Her husband stated that at this time she became fearful of the approaching marriage relations and asked him to be kind to her in this respect. She was married a year before admission. For two and a half months she refused intercourse and visited her mother's home a great deal. She finally submitted. She was quite frigid but became pregnant at once. Her abnormality then became apparent. She kept the fact of her pregnancy to herself for several months and then when she told her mother wanted to have an abortion performed. Neurotic symptoms appeared. She became sensitive with her husband, correcting his grammar, and cried easily. She also began to be anxious about the approaching childbirth, and with this became more religious.

For the first few days after the delivery, she was fussy with the nurse so that two in succession had to be discharged. On the fifth day she woke up and seeing a nurse lying on the couch beside her bed thought the latter was colored. On the seventh day she had a dream in which she thought she "nearly died in childbirth." Then she began to talk of dying for her baby or of having two babies, of dying herself and rising again after Easter Sunday. She became antagonistic to her husband and with this excited and confused so that she was taken to the Observation Pavilion.

On admission she looked pale and exhausted, had a slight temporary fever and a coated tongue. Her orientation was usually vague but sometimes she gave fair answers. Her verbal productions were rather fragmentary and with the exception of some repetitions there did not seem to be any special topics which dominated her train of thought.

For some days the great weakness and the slight fever continued, and then, as it gradually cleared up, there came a change in her mental condition that settled into the state which characterized the rest of her psychosis. She talked less and was often quite inactive, frequently lying with her eyes closed for long periods, or sat or stood about. Such movements as she made were slow and languid. Her expression was either blank, absorbed, or gave the appearance of peculiar appealing perplexity. This last was not infrequently associated with a rather sheepish smile. She was never resistive and always ate and slept well. With the exception of a few times she did not soil herself. The most interesting feature of her mood reaction was that in a general setting of a slight perplexity there appeared at times and evidently associated with definite ideas, changes in her emotional state. Sometimes this was a matter of distress or of mild ecstasy, sometimes she became markedly blocked. There was at no time any frank elation, but often an appropriate smile, that is, appropriate to the situation and to the thought to which she was giving expression at the time. Then, rarely, there were sudden bursts of peculiar conduct, such as throwing herself on the floor or running down the hall. When questioned as to her motive for these acts, she would flush, look perplexed and apparently be unable to explain them.