[10] As a matter of fact, if the views of Clark and MacCurdy[B] be accepted, some reason for these epileptic-like attacks may be imagined. According to them, epilepsy is a disease characterized by a lack of the natural instinctive interest in the environment which is expressed chronically in the deterioration, and episodically in the attacks, the most consistent feature of which is loss of consciousness. Now, in stupor we have an analogous reaction where, although consciousness is not disturbed in the sense in which it is in epilepsy, it is nevertheless considerably affected, inasmuch as contact with the environment is practically non-existent. The coincident thinking disorder is quite similar, both in epileptic dementia and the torpor following seizures and in these benign stupors. MacCurdy has suggested tentatively that the epileptic convulsion may be secondary to a very sudden loss of consciousness which removes a normal inhibition on the muscles, liberating the muscular contractions which constitute the convulsion. If this view were correct, it would not be hard to imagine that during the onset of these stupors the tendency to part company with the environment, which ordinarily comes on slowly, might occur with epileptic suddenness and hence liberate convulsive movements. This is, however, a pure speculation but not fruitless if it serves to draw attention to the analogies existing between the stupor reaction and some of the mental symptoms of epilepsy. These analogies are strong; aside from the obvious clinical differences, the stupor and epileptic reactions are dynamically unlike in that they are the product of different temperaments and precipitated by different situations.
[B] Clark, L. Pierce. "Is Essential Epilepsy a Life Reaction Disorder?" Am. Jour. of the Medical Sciences, November, 1910, Vol. CLVIII, No. 5, p. 703. This paper gives a summary of Dr. Clark's theories.
MacCurdy, John T., "A Clinical Study of Epileptic Deterioration." Psychiatric Bulletin, April, 1916.
CHAPTER X
PSYCHOLOGICAL EXPLANATION OF THE STUPOR REACTION
In the previous chapter mention has been made of our view that manic-depressive insanity is a disease fundamentally based on some constitutional defect, presumably physical, but that its symptoms are determined by psychological mechanisms. In accordance with this hypothesis we seek, when studying the different forms of insanity presented in this group, to differentiate between the different types of mental mechanisms observed, and by this analysis to account for the manifestations of the disease on purely psychological lines. If benign stupors belong to this group, then we should be able to find some specific psychology for this type of reaction.
All speech and all conduct, except simple reflex behavior, are presumably determined by ideas. When an individual is not aware of the purpose governing his action, we assume, in psychological study, that an unconscious motive is present, so that in either case the first step in psychological understanding of any normal or abnormal condition is to discover, if possible, what the ideas are that lead to the actions
or utterances observed. In the case of stupors the situation is fairly simple, in that the ideational content is extremely limited. As has been seen, it is confined to death and rebirth fancies, other ideas being correlated with secondary symptoms, such as belong to mechanisms of other manic-depressive psychoses. It is not necessary to repeat the catalogue of the typical stupor ideas, as they have been given in an earlier chapter. Our task is now to consider the significance of these death and rebirth delusions and their meaning for the stupor reaction.
Thoughts concerned with future and new activities require energy for their completion in action and are therefore naturally accompanied by a sense of effort which gives pleasure to an active mind. When the sum of energy is reduced, one observes a reverse tendency called "regression." It is easier to go back over the way we know than to go forward, so the weakened individual tends to direct his attention to earlier actions or situations. To meet a new experience one must think logically and keep his attention on things as they are, rather than imagine things as one would like to have them.
Progressive thinking is therefore adaptive, while regressive thinking is fantastic in type, as well as concerned with the past—a past which in fancy takes on the luster of the Golden Age. Sanity and insanity are, roughly speaking, states where progressive or regressive thinking rule. The essence of a functional psychosis is a flight from reality to a retreat of easeful unreality.