iness. At times the factors
producing it are mainly environmental; at others, the problem is
essentially of the patient's own making. Of course almost any type of
functional psychosis may emerge from such a state of dissatisfaction,
but it is important to note that unlike manic states, for instance,
stupors invariably develop from a situation of unhappiness. Quite
frequently the choice of the stupor regression is determined by some
definitely environmental event which suggests death. This often comes as
the actual death of the patient's father (in the case of a woman) or
employer, events which inflate the already existing, although perhaps
unconscious, desire for mutual death. Again, the precipitating factor
may be a situation which adds still another problem and makes the burden
of adaptation intolerable, forcing on him the desire for death. In these
cases the actual psychosis is sometimes ushered in dramatically with a
vision of some dead person (often a woman's father) who beckons, or
there are dream-like experiences of burial, drowning, and so on.

A few cases taken at random from our material exemplify these features
of the unhappiness in which the psychosis appears as a solution with its
development of the death fancy.

Alice R., at the age of 25, was much troubled by worrying over her
financial difficulties and the shame of an illegitimate child.
Retrospectively she stated, "I was so disgusted I went to bed--I just
gave up hope." Shortly before admission she said she was lost and
damned, and to the nurse in the Observation Pavilion she pleaded, "Don't
let me murder myself and the baby."

Caroline DeS. (Case 2) for some time was worried over the engagement of
her favorite brother to a Protestant (herself a Catholic) and the
threatened change of his religion. At his engagement dinner she had a
sudden excitement, crying out, "I hate her--I love you--papa, don't kill
me." This excitement lasted for three weeks, during two of which she was
observed, when she spoke frequently of being killed and going to Heaven.
The conflict was frankly stated in the words, "I love my father but
don't want to die." Then for two weeks she had some fever, was tube-fed,
muttered about being killed or showed some elation, there being
apparently interrupted stuporous, manic and, possibly, anxiety episodes.
Finally she settled down to a year of deep stupor.

Laura A. had for three months poor sleep with depression over her
failure in stu