er in stupor. In fact, it is
difficult to imagine any one whose critical faculty was functioning
cooperating in a test for catalepsy.

CHAPTER VIII

SPECIAL CASES: RELATIONSHIP OF STUPOR TO OTHER REACTIONS

We have described typical cases of benign stupor and isolated certain
interrelated symptoms which, when they dominate the clinical picture, we
believe establish the diagnosis of stupor, regardless of the severity of
the reaction. These symptoms are apathy, inactivity, a thinking disorder
and, quite as important as these, an absorbing interest in death. It is
typical that the patient contemplates his dissolution with indifference
or, at most, with mild or sporadic anxiety. There seems little reason to
doubt that when these four symptoms occur alone, we are justified in
making a diagnosis of stupor. The next problem is to consider the
meaning and classification of cases where these symptoms occur in
conjunction with others. This naturally introduces the subject of
relationship of stupor to other manic-depressive reactions.

It is probably best to begin with presentation of three such cases.

CASE 16.--_Anna L._ Age: 24. Admitted to the Psychiatric
Institute August 21, 1916.

_F. H._ Maternal grandmother temporarily insane during
illegitimate pregnancy, thereafter a little odd. Mother
high strung and emotional. Father high strung, impulsive
and irritable.

_P. H._ As a child she was quick tempered, quite a spitfire
and given to tantrums. At the age of 14 she became a
vaudeville actress in Cleveland, which was the home of her
childhood. When 17 she married a Jew, although she was
herself a Catholic. Her husband noted that she was fretful,
sensitive, resentful and quick tempered, although apt to
recover quickly from her rages. Previously healthy,
neurotic symptoms began with marriage, taking the form of
stomach trouble and a tendency to fatigue. Shortly after
marriage an abortion was induced. After being married for
two years she had a quarrel and separated from her husband.
They were reconciled later, but in the meantime she had
been having relations with another man. When 20 an
abdominal operation was performed in the hope of relieving
her gastric symptoms, but no improvement occurred. The
patient after recovery stated that she continued to be
nervous, shaky and di