P. H. The patient was said always to have been somewhat seclusive, mingling little with other people; this tendency was so strong that she would leave the room when visitors came. She always slept a great deal. It was stated that she was able to do heavy housework quite well, but never learned cooking.
At 16 she hired out as a servant for a year and a half, and then did laundry work. When 18 she had an illegitimate child by a co-worker.
History of Psychosis: About a year before admission the patient's sister was burned to death. When the patient heard of this she said that something had come up in her throat. Henceforth she often complained of a lump in her throat, and often bit her nails. Two months before admission she suddenly left the laundry, again spoke of the lump in her throat, and claimed to have seen the dead sister. Two weeks later when the family had an anniversary mass for the sister the patient appeared sad, but the following day laughed, said she had seen her "sister beckoning her to come." She also thought she saw her picture "and Heaven was behind it." She also talked of "dead relatives and friends." A reaction of levity in connection with a sister's death is highly suggestive of a malignant psychosis.
Two weeks before admission her mother found her in a stupor, immovable, with her eyes closed. In 24 hours she woke up, began to sing "Rest for the Weary," prayed, then was stuporous again for six hours. When she came out of this, she said she was "going to die," God had told her so and talked of her own funeral arrangements. She again went into a stupor, in which she was sent to the Observation Pavilion.
At the Observation Pavilion she was described as happy, laughing, singing, saying she felt happy, but adding, "I like to be sad too, I am going to Heaven Easter Sunday." She claimed that her sister frequently stood in front of her, and that she knew she wanted her to go with her.
Under Observation: For about three weeks the patient showed a variable stupor. She would lie with a mask-like face inaccessible, cataleptic, drooling saliva, often with her mouth open. When taken up, she was usually perfectly flaccid, but once she let herself slide on the floor after she had stood immobile at the window. Sometimes there was marked resistance to passive motions, especially when attempts were made to open her mouth or eyes, or on one occasion when the examiner tried to open her hand in which she held her handkerchief. Yet when one persisted in urging her to respond there frequently could be elicited more or less marked reactions. Thus repeatedly she could be made to obey some commands, as showing the tongue, etc., even when she would not answer. Once when her eyes were opened, tears rolled down her cheeks—again, she usually reacted to pin pricks by
slight flushing, once she said, "Stop! it hurts." Again, she said, "Leave me alone, I want to sleep."
So far the description of this reaction is that of a benign stupor. There were, however, other symptoms. In the first place, she could sometimes be made to open her eyes and write, although she would not speak. In spite of the penmanship being careless, there were no mistakes. This exhibition of an unhabitual and more difficult intellectual effort when the patient was mute is suggestive of an inconsistency. So was her habit of sometimes singing a hymn, "Rest for the Weary," when no other sign of mental life was given. But, more important than these, she could not infrequently be induced to answer questions and at such times she spoke promptly and with natural affective response.
A number of her replies were of the type to be expected in a benign stupor. In the first place, she spoke of her condition as "going off to sleep" and also as "death," "I was dead all day." "I died three times yesterday," or she merely described it by saying "I go off into states when I lie with my mouth open and eyes closed, and cannot speak or open my eyes." When asked how she got into this condition, she said "My sister died and I think it was on my mind." Again she said she became sad at the anniversary mass of the sister and had been sad ever since. On the other hand, she also stated that when she came home from the mass she first was silly and danced. Spontaneously she spoke of having frequently had visions of her dead sister; once she saw her with wings. In explanation of her singing "Rest for the Weary," she said it was the hymn sung at her father's funeral. An anomalous feature had to do with her description of her feelings. She claimed to have no memory of her stupor periods and yet said of them: "I feel peaceful-like," or "I feel awfully happy and sad together," or "I am sad and contented—I like it that way."
A striking symptom was that, when a sensory examination was made during the first few days during one of the periods when she responded well, she showed glove and stocking anesthesia, also anesthesia of neck and left breast.