a new world is a content occurring not infrequently in manic
states, but before the universe can be remolded it must be destroyed.
Before the individual can enjoy new life, a new birth, he must die, and
stupor often marks this death phase of a dominant rebirth fantasy. In
this connection it was not without significance to note that stupors
almost universally recover by way of attenuation of the stupor symptoms,
or in a hypomanic phase where there seems to be an abnormal supply of
energy. Antaeus-like, they rise with fresh vigor from the Earth. They do
not pass into depressions or anxieties.

Rebirth fancies unquestionably, then, contain constructive and
progressive elements, but, as has been stated above, any thinking which
implies a lapse of contact with the environment is, in so far as that
lapse is concerned, regressive, and in consequence rebirth fancies, as
dramatized by the stupor patients, are regressive, just as are the
delusions of death itself.

It is obvious that an acceptance of death implies rather thorough mental
disintegration. Before that takes place there may be some mental
conflict. The instinct of self-preservation may prevent the individual
from welcoming the notion of dissolution, so that this latter idea,
though insistent, is not accepted but reacted to with anxiety; hence we
often meet with onsets of stupor characterized by emotional distress. It
has already been suggested that death may foreshadow another existence.
Often in the psychoses we meet with the idea of eternal union in death
with some loved one whom the vicissitudes and restrictions of this life
prevent from becoming an earthly partner. This fancy is frequently the
basis of elation. Similarly, new life in a religious sense as expressed
in the delusion of translation to Heaven, is a common occasion for
ecstasy. These formulations of the death idea may occur as tentative
solutions of the patient's problems leading to temporary manic episodes
while the psychosis is incubating. It seems that stupor as such appears
only when death and nullity are accepted.

The above are more or less a priori reasons for regarding the stupor as
a regressive reaction. We must now consider the clinical evidence to
support this view. In the first place, we always find that stupor occurs
in an individual who is unhappy and who has found no other solution
than regression for the predicament in which he is. There is nothing
specific in the cause of this unhapp