But in addition to the above statements the patient also began to make others of a definite dementia præcox type. About ten days after admission she said, "What any one says goes right
through my brain," or she talked of being hypnotized. "The typewriting machine turned my eyes—three or four girls turned my eyes—they look at me and get their chance, their left eye—turning me into images. I want to be the way I was born—turn my body! look how their bodies are turned before they die," or "Take it if you get it—he got the name out—I was over there to death—himself to death—of, you know—you played out—she is played out." ... This while she snickered between the sentences. As early as four weeks after admission she had begun to giggle or laugh, often in an empty fashion, and a transition from the more constrained stuporous state, with interruptions of laughter, to an indifferent silly, muttering to herself was gradual.
In 1909 she was described as not talking, standing around, showing no interest in anything, muttering. The only response obtained was "I don't know." In December, 1911, she was transferred to another hospital as a case of deteriorated dementia præcox.
To Recapitulate: We have here a young woman who for a year had indefinite mental symptoms and suddenly developed a stupor. This was atypical in that she sang and wrote when otherwise apparently deeply stuporous. When persuaded to talk, her utterances, even as early as ten days after admission, were of a malignant type and with such statements she giggled. This last is apparently a highly important sign. Quite frequently in our cases the first signal of a dementia præcox reaction has been giggling in a setting of what was apparently a typical benign stupor.
As has frequently been stated, symptoms of benign stupor are closely interrelated. Consequently the reaction is, when benign, a consistent one. We do not find free speech with profound apathy and in
activity, nor do we expect to meet with unimpaired intellectual functions when other evidences of deep stupor are present. The inconsistency of mental operations which characterize dementia præcox, however—the "splitting" tendency which Bleuler has emphasized in his term "schizophrenia"—is just that added factor which may produce disproportionate developments of the various stupor symptoms in the dementia præcox type of that reaction. Examples of this have been given in the two cases just quoted. The history of the following patient shows this tendency more prominently.
Case 22.—Nellie H. Age: 20. Admitted to the Psychiatric Institute June 11, 1907.
F. H. The father had repeated depressions; he died of typhus fever. The mother was living.
P. H. The brother of the patient stated that she was like other girls, and very good at school. At 16 she became quieter, less energetic. She came to America at 17. After arriving here she has seemed low spirited, cranky and faultfinding. She often complained of indefinite stomach trouble and headaches; when at home she often had a cloth around her head. The informant recalled that she said, "I wish I could get sick for a long time and get either cured or die." However, she worked. For one and a half years prior to admission her "crankiness" is said to have become much worse. She complained continually of being tired; quarreled much with her mother; said she did not have enough to eat. It is also stated that she was constantly afraid of losing her job.
History of Psychosis: For six months before admission she said frequently that her boss was giving her hints that he liked her. (She did not know him socially at all.) Six days before admission she came home, saying the boss had told her he had no more work for her. Nevertheless, she went back next day and was again sent home. At home she sat gazing. Next day again