o
objective apathy and inactivity, while the intellectual functions fail
for lack of emotional power to keep them going. The complicated mental
machine lies idle for lack of steam or electricity. The typical
ideational content and many of the symptoms of stupor are to be
explained as expressions of death, for a regression to a Nirvana-like
state can be most easily formulated in such a delusion. Other clinical
conditions may temporarily and superficially resemble stupor on account
of the attention being misdirected and applied to unproductive
imaginations. To employ our metaphor again, in these false stupors the
current is switched to another, invisible machine but not cut off as in
true stupor.

FOOTNOTES:

[11] The reader will note that this view is opposed to that of
Kraepelin, who has written largely on so-called "_mixed conditions_" in
manic-depressive insanity. We believe that careful clinical studies
confirm our opinion and that his classification is based on less
thorough observation and analysis. This subject will be discussed at
greater length in a forthcoming book on "The Psychology of Morbid and
Normal Emotions," by Dr. MacCurdy.

CHAPTER XI

MALIGNANT STUPORS

As we have seen, the benign stupors are characterized by apathy,
inactivity, mutism, a thinking disorder, catalepsy and negativism. All
these symptoms are also found in the stupors occurring in dementia
praecox. In fact this symptom complex has usually been regarded as
occurring only in a malignant setting. There can be no question about
the resemblance of benign to dementia praecox stupors. Even such symptoms
as poverty and dissociation of affect, usually regarded as pathognomonic
of dementia praecox, have been described in the foregoing chapters.
Either recovery in our cases was accidental or there is a distinct
clinical group with a good prognosis. If the latter be true, the
symptoms must follow definite laws; if they did not, we would have to
abandon our principles of psychiatric classification. Naturally, then,
we seek to find the differences between the cases that recover and those
that do not. There is never any difficulty in diagnosis where a stupor
appears as an incident in the course of a recognized case of catatonic
dementia praecox. We shall therefore consider only such clinical pictures
as resemble those described in this book, in that the symptoms on
admission to a hospital or shortly after are those of stupor. It should