eing asked what she
meant, she became quite blocked and the question had to be
repeated several times, when finally the apparently
unrelated statements appeared: "I dreamed my mother
died--they had a quarrel." Who had a quarrel? she was
asked, and replied "My mother and father." Apparently her
thinking about her father coming to life for some one not
her mother stimulated deeply unconscious ideas concerning
the separation of her mother and father, and her taking the
mother's place, and these ideas were sufficiently
revolutionary to upset her capacity of speech for the time
being.

She recovered completely about six and a half months after
her admission.

If we consider together the common features of these three cases, we see
that they resemble stupors only in the presence of inactivity and
apparent apathy. It is true that death appears in the ideational content
but not with that prominence, bordering on exclusiveness, which
characterizes such delusions in the true stupors. These three patients
give one the impression of being absorbed in thoughts that have many
variations. It seems as if they had difficulty in grasping the facts of
the environment, while feeling at the same time the vividness of the
changing internal thoughts, hence a confusion develops which is either
subjective, objective, or both. It is probably the introversion of
attention which gives rise to the apparent apathy, because normal
emotions emerge as part of our contact with reality around us. This lack
of contact with the environment leads also to inactivity. If one's
attention and interest is turned inwards, there can be no evidence of
mental energy exhibited until the patient is roused to contact with the
people or things about him. It is noteworthy that in these cases
emotional expression emerged when the patients were stimulated to some
productiveness in speech.

These conditions really constitute a different psychosis in the
manic-depressive group, essentially they are perplexity states such as
have recently been described by Hoch and Kirby.[7] Not infrequently we
see exhibitions of this tendency in what are otherwise typical stupors.
For example, Mary F. (Case 3) (the third case to be described in the
first chapter), showed for a few days after admission a condition when
she was essentially somewhat restless in a deliberate aimless way. At
the same time she looke