ore than before by constant impulsive
attempts to hurt herself in every conceivable way--by
bumping her head against the wall, putting her head under
the hot water faucet, trying to pound the leg of the
bedstead on her foot, striking herself, pinching her
eyelids, pulling out her hair, trying to pick her radial
artery, throwing herself out of bed, knocking her head
against the bed rail, etc. This was done in silence but
with what appeared a great determination that occasionally
showed itself in her face. She also sometimes scowled and
frowned. With the difficulty in feeding her and the
constant impulsive excitement in which bruises could not
always be avoided (once an extensive cellulitis developed
in the arm which had to be lanced), the patient got weak,
emaciated and exhausted; much of her hair fell out,
although some she pulled out. It should be stated that
during this entire impulsive state she could not be taken
care of in the Institute ward, but was sent to a special
ward in the Manhattan State Hospital, where suicidal
patients are under constant watch. These impulsive attempts
at self-injury lessened only towards the end of the period.
Her laughter, which had been such a prominent trait,
disappeared almost entirely during this entire phase. With
all this, the general resistiveness, as has been stated,
remained towards feeding or any other interference. It was
only in the beginning associated with laughter as in the
previous stage.

Although there were, as a rule, no spontaneous remarks and
no replies, she on one occasion said spontaneously,
probably referring to her unsuccessful attempts to kill
herself: "I can't do it, I have no will." During the same
period she once said: "I don't want to eat, I don't want to
get well, I want to do penance and die."

By _January_, 1915 (i.e., a year after the second phase had
commenced), she began to dress herself and eat, and also
became clean. But she remained for the most part very
inactive, sitting stolidly about all day and still without
interest in her environment. The impulsive attempts at
killing herself disappeared. Although she remained for
months to come still inactive, she gradually began to talk
a little, began to play a lit