stions, while the
orientation which in the preceding manic state had been good became
seriously interfered with. The psychosis bordered on deep stupor for
brief periods when the inactivity seemed to be complete or she lay in
bed with her head raised from the pillow. On the other hand, there were
occasional sudden spells of free activity even with a certain elation.
She could often be persuaded to answer questions or to write, the
slowness of this spoken or written speech varying considerably. Her
replies revealed the fact that she was essentially affectless and that
her intellectual processes were interfered with, even to the extent of
paragraphic writing. We have, therefore, here again features similar to
those of the preceding cases. In addition we must add as important that
this patient said retrospectively that she thought she was dead, that
she saw "shadows from Heaven and Earth," "shadows of dead friends laid
out for burial," all this without any fear. We shall see later that this
is a typical stupor content.

We will here include state 3 of Anna G. (See Chapter I, Case 1) who
after the pronounced stupor was for two months merely dull, somewhat
slowed and markedly apathetic. Although her orientation was not
seriously affected, there was considerable interference with her
intellectual processes, as shown in her wrong answers or her lack of
answers when more difficult questions were asked.

A similar picture was presented in state 2 of Mary D. (See Chapter I,
Case 4.) Here, to be sure, there were more marked stupor features in
that the patient wet and soiled, in addition to occasional spells when
she lay with her head raised. But she spoke and acted fairly freely
(even while soiling). By her replies she showed a considerable
intellectual inefficiency, although, like Anna G., her orientation was
not seriously disturbed. Here again there was complete affectlessness.

This gives us, therefore, five states which may be analyzed for the
symptoms of partial stupor. The pictures of all five are unusually
consistent. There is inactivity, marked but not complete; poverty of
affect without perfect apathy; and a marked interference with the
intellectual processes. The last can be studied better than in the deep
stupors because these partial cases are more or less accessible to
examination. There is a tendency for the patient to think much of death
either in the onset or during the psychosis. Negativism seems much less
promi