This condition persisted apparently for five years more, by the end of which time the anesthesia had turned into a hyperesthesia. A year later he began to eat. It was now found that he had an amnesia for his illness and former life, so that he did not even recognize a needle or pair of scissors. He knew that he was born in the month of February and retained some facility in calculation, in speech, walking and usual motions. Then he regained all his memories and resumed his trade as tailor. He was discharged in June, 1893, nearly eleven years after admission.
It seems safe to say that elements at least of hysteria appear in this history, such as the profound retroactive amnesia and appearance of simulation in the conduct of the patient. Accurate and rapid grasp of the environment is necessary for such a watch as he kept on the eye of his attendants. Men
tal acuity of this grade combined with amnesia looks more like an hysterical than a manic-depressive process.
Leroy[25] describes a case much like ours which is interesting from a therapeutic standpoint. The patient was a woman who passed from a severe depression with hallucinations and anxiety into a long stupor, from which she recovered completely. There was no negativism and no affect, although the latter appeared so soon as contact began to be established. When well she had a complete amnesia for the onset of the psychosis. Leroy attributed the recovery, in part at least, to the thorough attention given the patient. Kraepelinian rigidity is seen, however, in the author's refusal to regard the case as "circular" because of the lack of all cyclic symptoms. He takes refuge in the meaningless label "Mental Confusion."
An important group of cases is that of the stupors occurring during warfare. Considering stupor as a withdrawal reaction, it is surprising there were so few of them, although partial stupor reactions as functional perpetuation of concussion were very common. The editor saw several typical cases in young children in London who passed into long "sleeps" apparently as a result of the air raids.
Myers[26] has given us the best account of stupors in actual warfare. A typical case was that of a man who was found in a dazed condition and difficult to arouse. He could give little information about himself, could neither read nor write and never spoke voluntarily. A week later his speech was still limited and labored and no account of recent events could be obtained from him. Under hypnosis he was induced to talk of the accident which had precipitated this disorder. He became excited in telling his story, evidently visualizing many of the events. In several successive séances, more data were obtained and a cure effected. Myers points out that in all his cases there was a mental condition which varied from slight depression to actual stupor, all had amnesias of variable extent and all had headaches. The mental content seemed to be confined to thoughts of bombardment, with a tendency for the mind always to wander to this topic. The author thinks that pain is a guardian protecting the patient from too distressing thoughts. An effort to speak would cause pain in the throat of a case of mutism and, sometimes, when a distressing memory was sought after under hypnosis, physical pain would wake the sleeper. His view is that pains tend to preserve the mutism and amnesia, so that there are "inhibitory processes" causing the stupor, which prevent the patient from further suffering. He does
not find either in theory or experience reason to believe that these conditions are the result of either suggestion or "fixed ideas." He thinks it natural that the last symptom of the stupor to disappear should be mutism, as speech and vision are the prime factors in communicating with environment. [As has been noted frequently in this book, mutism is a common residual symptom of the benign stupor.] Myers believes that in nearly every instance mutism follows stupor and is merely an attenuation of the latter process. When deafness is associated with mutism, he thinks it is often due merely to the inattention of the stuporous state.
In this connection we should mention that Gucci[27] points out that stupor patients with mutism of long duration may, when requested, read fluently and then relapse again into complete unreactiveness towards auditory impressions. This, we would say, is probably an example of a more or less automatic intellectual operation occurring when the patient is sufficiently stimulated, although he cannot be raised to the point of spontaneous verbal productivity.
As these scattered reports about benign stupors are so unsatisfactory, one naturally turns to text-books. Little more appears in them. Kraepelin treats stupors occurring in manic-depressive insanity as falling into two groups, the depressive and
manic. The former seems to be nearer to our cases, judging by the statements in his rather sketchy account. He regards stupor as being the most extreme degree of depressive retardation. [This possibility has been discussed in the chapter on Affect.] His description seems perhaps to include cases which we would regard as perplexity states or absorbed manias. Activity is reduced, they lie in bed mute, do not answer, may retract shyly at any approach, but on the other hand may not ward off pin pricks. Sometimes there is catalepsy and lack of will, again there may be aimless resistance to external interference. They hold anything put into their hands, turning it slowly as if ignorant of how to get rid of it. They may sit helpless before food or may allow spoon-feeding. Not rarely they are unclean. As to the mental content, he says they sometimes utter a few words, which give an insight into confused delusions that they are out of the world, that their brains are split, that they are talked about, or that something is going on in the lower part of the body. The affect is indefinite except for a certain bewilderment about their thoughts and an anxious uncertainty towards external interference. Intellectual processes suffer. They are disoriented and do not seem to understand the questions put to them. An answer "That is too complicated" may be made to some simple command. Kraepelin thinks that the disorder is sometimes more in the realm of the will than of thinking, for one patient could do a complicated calculation in the same time as a simple addition. After