t
she could not "pay for the beds," etc.

Her mutism and refusal of food she was unable to account
for. She could not talk, her "tongue would not move." As
regards ideas during the more stuporous period, she claimed
that (when quite inactive) she heard voices but did not
recall what they said. But she remembered having dreams at
that time "of fire," "of her dead father and of home."

In a survey of thirty-six consecutive cases of definite stupor, literal
death ideas were found in all but one case. They seem to be commonest
during the period immediately preceding the stupor, as all but five of
these cases spoke of death while the psychosis was incubating. From this
we may deduce that the stupor reaction is consequent on ideas of death,
or, to put it more guardedly, that death ideas and stupor are
consecutive phenomena in the same fundamental process. Two-thirds of
these patients interrupted the stupor symptoms to speak of death or
attempt suicide, which would lead us to suppose that this intimate
relationship still continued. One-quarter gave a retrospective account
of delusions of being dead, being in Heaven, and so on. From this we may
suspect that in many cases there may be a thought content, although the
patient's mind may seem to be a complete blank. It is important to note
that when a retrospective account is gained, the delusions are
practically always of death or something akin to it, such as being in
prison, feeling paralyzed, stiff, and so on.

In the one case of the thirty-six who presented no literal death ideas,
the psychosis was characterized essentially by apathy and mild
confusion, a larval stupor reaction. It began with a fear of fire,
smelling smoke and a conviction that her house would burn down. It is
surely not straining interpretation to suggest that this phobia was
analogous to a death fear. When one considers the incompleteness of
anamneses not taken _ad hoc_ (for these are largely old cases) and that
the rule in stupor is silence, the consistence with which this content
appears is striking.

To exemplify the form in which these delusional thoughts occur we may
cite the following: Henrietta H. (Case 8) said, retrospectively, that
she thought she was dead, that she saw shadows of dead friends laid out
for burial, that she saw scenes from Heaven and earth. Annie K. (Case 5)
claimed to have had the belief that she was going to die, and to have
had vision