ABSTRACT

Before beginning the discussion of the psychology of the stupor reaction, it will be advisable to quote in some detail a case which illustrates, not merely different phases of stupor, but also other manic-depressive reactions.

Charlotte, W. Age: 30. Admitted to the Psychiatric Institute, October 21, 1905.

F.H. The father was alcoholic and quick-tempered; he died when the patient was a child. The mother was alcoholic and was insane at 40 (a state of excitement from which she recovered). A brother had an attack of insanity in 1915. A maternal uncle died insane.

P.H. The patient was described as jolly, having many friends. She got on well in school and was efficient at her work.

She was married at 23 and got on well with her husband. The latter stated, however, that she masturbated during her first year of married life. The first child was born without trouble.

First Attack at 25: Two or three days after giving birth to a second child her mother burst into the room intoxicated. The patient immediately became much frightened, nervous, and developed a depressive condition with crying, slowness, and inability to do things. During this state she spoke of being bad and told her husband that a man had tried to have intercourse with her before marriage. This attack lasted six months and ended with recovery.

When 29, a year before her admission, she had an abortion performed, and four months later another. Her husband was against this, but she persisted in her intention. Seven months before admission she went to the priest, confessed, and was reproved. It is not clear how she took this reproof, but at any rate no symptoms appeared until three weeks later, after burglars had broken into a nearby church. Then she became unduly frightened, would not stay at home, said she was afraid the burglars would come again and kill “some one in the house”. The patient herself stated later during a fault-finding period, that at that time she was afraid some body would take her honour away, and that she thought burglars had taken her “wedding dress”. “Then,” she added, “I thought I would run away and lead a bad life; but I did not want to bring disgrace to the family”.

The general condition which she presented at this time is described as one of apprehensiveness when at home. For this reason she was for five weeks (it is not clear exactly at what period) sent to her sister, where she was better. About a month before the patient was admitted the husband moved, whereupon she got depressed, complained of inability to apply herself to her work, became slow and inactive, and blamed herself for having had the abortion performed. She began to speak of suicide and was committed because she bought carbolic acid. She later said that while in the Observation Pavilion she imagined her children were cut up.

Under Observation the condition was as follows:

For the first three days the patient, though for the most part not showing any marked mood reaction, was inclined at times to cry, and at such times would complain that this was a terrible place for a person who was not ins ane

On the fourth day the condition changed, and it will be advisable to describe her state in the form of abstracts of each day.

On Oct. 24 the patient began to be preoccupied and to answer slowly. A few days later she became distinctly dull, walked about in an indifferent way or lay in bed immobile. Twice on Oct. 27 she said in a low tone and with slight distress, “Give me one more chance, let me go to him.” But she would not answer questions. At times she lapsed into complete immobility, lying on her back and staring at the ceiling. When the husband came in the afternoon she clung to him and said: “Say good-bye for ever, O my God, save me.” Again, very slowly with long pauses and with moaning, she said: “You are going to put me in a big hole where I will stay for the rest of my life.” On Oct. 28 she was found with depressed expression and spoke in rather low tone, but not with decided slowness as had been the case on the day before. She pleaded about having her soul saved: “Don’t kill me”; “Make me true to my husband”; once, “I have confessed to the wrong man the shame of my life”. Later she said she did not tell the truth about her life before marriage. Again she wanted to be saved from the electric chair. At times she showed a tendency to stare into space and to leave questions unanswered.

From now on a more definite stupor occurred, which is also best described in summaries of the individual notes.

Oct. 29. Lies in bed with fixed gaze, pointing upward with her finger and is very resistive towards any interference. She has to be catheterized.

Oct. 30. Can be spoon-fed but is still catheterized. During the morning she knelt by the bed and would not answer. At the visit she was found in a rather natural position, smiling as the physician approached, saying, “I don’t know how long I have been here”. Then she looked out of the window fixedly. At first she did not answer, but, when the physician asked her whether she knew his name, she laughed and said, “I know your name—I know my name”. Then she would not answer any more questions but remained immobile, with fixed gaze. When her going home was mentioned, however, she flushed, and tears ran down her cheek, though no change in the fixedness of her attitude or in her facial expression was seen.

Nov. 1. Lies flat on her back with her hands elevated. She is markedly resistive.

Nov. 2. Free from muscular tension and more responsive. When asked whether she felt like talking, she said in a whining tone, “No, go away—I have to go through enough”. Then she spoke of not knowing how long the nights and days were, of not having known which way she was going. When asked who the physician was, she whimpered and said, “You came to tell me what was right”. She called him “Christ” and another physician “Jim” [husband’s name]. However, later in the interview, she gave their correct names. When asked about the name of another physician, she said: “He looks like my cousin, he was here, they all came the first night. I did not take notice who it was till I went through these spirits, then I knew it was right.” She paused and added: “My Godmother it was, she is here on earth, somewhere in a convent. Sister C. [who actually was in a convent] she was here too, I could see her”. She said they all came to try to save her. When asked whether she had been asleep, she said: “No, I wasn’t asleep, I was mesmerized, but I am awake now—sometimes I thought I was dead”. (When?) “The time I was going to Heaven.” Again: “I went to Heaven in spirit, I came back again—the wedding ring kept me on earth—I will have to be crucified now”. (Tell me about it.) “Jim will have to pick my eyes out—I think it is him. Oh, it is my little girl.” (Who told you?) “The spirits told me.” Again: “Little birds my children—I can’t see them any more—I must stay here till I die”. (Why?) “The spirits told me—till I pick every one of my eyes out and my brains too.” When asked what day it was, she said, “It must be Good Friday”. (Why?) “Because God told me I must die on the cross as He did.” When asked why she had not spoken the day before, she said that “Jesus Christ in Heaven” had told her she should not tell everything “till all of you had gone, then I could go home with Him, because that is the way we came in, and it was Jim too, all the time”. Finally she said crossly, “Go away now, you are all trying to keep me from Jim” (crying).

Nov. 3. Knelt by bed during night. In the morning she lay in bed staring, resistive; again was markedly cataleptic. She had to be spoon-fed, and was totally unresponsive. In the afternoon she was found staring and resistive. Presently she said with tears: “I am waiting to be put on the cross”.

Nov. 4. Still has to be catheterized. She sits up, staring, with expressionless face, but when asked how she felt she responded and said feebly: “I don’t know how I feel or how I look or how long I have been here or anything”. (What is wrong?) “Oh, I only want to go to a convent the rest of my days”. (Why?) “Oh, I have only said wrong things, I thought I would be better dead, I could not do anything right.” Later she again began to stare.

Nov. 5. During the night she is said to have been restless and wanted to go to church. Today she is found staring, but not resistive. When questioned she sometimes does not answer. She said to the physician, “I should have gone up to Heaven to you and not brought me down here”. She called the physician “Uncle James”. Again she said, “I want to go up to see Jim”. Sometimes she looks indifferent, again somewhat bewildered.

Nov. 6. She eats better, catheterizing is no longer necessary. She is found lying in bed, rigid, staring, resistive, does not answer at first, later appears somewhat distressed, says “I want to go and see Jim”. (Where?) “In Heaven.” She gave the name of the place and of the physician, also the date.

Nov. 8. In the forenoon, after she had presented a rather immobile expression and had answered a few orientation questions correctly, she suddenly beckoned into space, then shook her fist in a threatening manner. When later asked about this, she said: “Jim was down there and I wanted to get him in”. (And?) “You was up here first.” (And?) “I thought we was going down, down, up, up—the boat—you came in here for—to lock Jim out so we wouldn’t let him in.” Later she said, when asked whether anything worried her, “Yes, you are taking Jim’s place”.

Nov. 9. During the night she is reported to have varied between stiffness with mutism and a more relaxed state. Once, the nurse found her with tears, saying, “I want to go down the hall to my sister—to the river”, and a short time later, with fright: “Is that my mother?” Again she said: “Oh dear, I wish this boat would stop—stop it—where are we going?” In the forenoon she was quiet and unresponsive. In the afternoon she said in a somewhat perplexed way, “We were in a ship and we were’ most drowned”. (When was that?) “Day before yesterday it must have been.” Again she said in the same manner: “It was like water. I was going down. I could hear a lot of things.” She claimed this happened “to-day”. “I saw all the people in here, it was all full of water.” “I have been lying here a long time—do you remember the time I was under the ground and it seemed full of water and everyone got drowned and a sharp thing struck me?” “I was out in a ship and I went down there in a coffin.” When asked whether she had been frightened at such times, she said: “No, I didn’t seem to be, I just lay there”. She also said “the water rushed in”, and when asked why she put up her arms, she said, “I did it to save the ship”.

Nov. 10. She is still fairly free. She said that when she was on the ship things looked changed; “the picture over there looked like a saint, the beds looked queer”. (How do things look now?) “All right.” (The picture too?) “The same as when I was going down into a dark hole.” When asked later in the day where she was, she said, “In the Pope’s house, Uncle Edward is it?” but after a short time she added, “It is Ward’s Island, isn’t it?”

Nov. 11. Inactive, inaccessible, but for the most part not rigid.

Nov. 14. Varies between mutism with resistance and more relaxed inactivity. To-day lies in a position repeatedly assumed by her, namely, on her stomach with head raised, resistive towards any interference, immobile face, totally inaccessible.

Nov. 15. Freer. She said: “One day I was in a coffin, that’s the day I went to Heaven”. She also said she used to see “the crucifix hanging there” (on the ceiling)—“not now, but when I was going to Heaven”. (When was that?) “Over in that bed” (her former bed). Later she added, “The place changed so … things used to be coming up and down [dreamily]—that was the day I was coming up on the ship or going down”. She is quite oriented.

Nov. 17. Usually stands about with immobile face, preoccupied, but she eats voluntarily.

Nov. 24. When the husband and sister came a few days ago she said she was glad to see them, embraced them, cried, and is said to have spoken quite freely. To-day she speaks more freely than usually. When asked why she had answered so little, she said she could not bring herself to say anything, though she added spontaneously, “I knew what was said to me”. When shown a picture of her cataleptic attitude with hands raised, she said dreamily, “I guess that must have been the day I went to Heaven, everything seemed strange, things seemed to be going up and down”. (Did you know where you were?) “I guess that was the day I thought I was on the ship.” When the sister spoke to her she seemed depressed; said, “If only I had not done those things I might be saved; if I had only gone to church more”.

Dec. 3. Seems depressed. She weeps some, says she is sad: “There seems to be something over my heart, so I can’t see my little girls”. Again: “I should have told you about it first—I should not have bought it”—(refers to buying carbolic acid). She wrote a natural letter but very slowly.

There followed then a state lasting for six months, during which the patient was rather inactive, preoccupied, even a little tense at times. Sometimes she did not answer; again at the same interview spoke quite promptly. For the most part the emotional reaction was reduced, at other times she appeared a little uneasy, bewildered, or again depressed. She said that sometimes a mist seemed to be over her. Now and then spoke of things looking queer, and she asked, when the room was cleaned, “Why do you move things about? “and she added irrelevantly: “I thought the robbers broke into my house and stole my wedding dress and my children’s dresses” (refers to the condition during the onset of her psychosis). In the beginning of this state, when asked about the stupor, she spoke again of the “ship” and about going “down, down,” but also said that on one occasion she heard beautiful music, was waiting for the last trump and was afraid to move. Morever, she had some ideas referring to the actual situation which were akin to those in the more marked stupor period. Although she admitted she was better, she said on Dec. 8 that she still had queer ideas at times. “I sometimes think the doctor is Uncle Jim” (long dead): She also spoke of other patients looking like dead relatives, and added, “Are all the spirits that are dead over here?” “We never die here, the spirits are here.” But after that date no such ideas recurred, in fact this whole period seems to have been remarkably barren of delusions. Exceptionally isolated ones were noted. Thus, on Jan. 28 it is mentioned that she stated she sometimes felt so lonely, and as though people were against her; and on Feb. 13 she said she felt as though the chair knew what she was talking about. It is also mentioned in January that she wept at times, but this seems not to have been a leading feature at all. In March, when asked why she was not more active and cheerful, her lips began to quiver and she said, “Oh, I thought my children would be cut up in Bellevue. I don’t know why I feel that way about them.” She sometimes cried when her friends left her.

Then followed a week of a rather fault-finding, self-assertive state, during which she demanded to be allowed to go home, saying indignantly that she was not a wicked woman, had done nothing to be kept a prisoner here; she wanted justice because another patient had called her crazy. But in this period also she said that, after the robbery (at home), she felt afraid that her honour would be taken away. When told that her husband had been with her, she said, “Yes, but I was afraid they would get into a fight”. (You mean you were afraid the other man would kill him?) “No, he is not dead.” She further talked of a disagreement she had at that time with her husband, and that she felt then like running away and leading a bad life, but thought of the children. With tears she added: “I would not do anything that is wrong. I have my children to live for”. Quite remarkable was the fact that she then told of various erotic experiences in her life, though with a distinctly moral attitude and minimizing them.

On June 16 another state was initiated with peculiar ideas, the setting of which is not known, as she told them only to the nurses. She said that she was not Mrs. W. but the Queen of England; again, that she was an actress; or again, the wife of a wealthy Mr. B., and that she was going to have a baby. But at night she is said to have been agitated and afraid she was to be executed. She asked to be allowed to go to bed again, then stopped talking, and remained in this mute condition for about a week. She often left her bed and went back again; she usually had a perplexed expression. On one occasion she put tinsel in her hair and saying it was a golden crown.

At the end of that time she became freer and more natural, and remained so for three weeks. She occupied herself somewhat. When asked what had happened in the condition preceding, she said she thought she was a queen, or to be a queen.

Towards the end of this period she had again three more absorbed days, but when examined on the third of these days, got rather talkative, drifting on superficial topics.

Two days later she began to sing at night, kissed everybody, said it was the anniversary of her meeting her husband, but again cried a little. On the following morning she began to sing love songs, with a rather ecstatic mood, and at times stood in an attitude of adoration with her hands raised. This passed over into a more elated state, during which she smiled a good deal, often quite coquettishly; she sang love songs softly; on one occasion she put a mosquito netting over her head like a bridal veil; or she held her fingers in the shape of a ring over a flower pinned to her breast. But even during this state she said little, only once spoke of waiting for her wedding ring, and again, when asked why she had been singing, said, “I was singing to the man I love”. (Why are you so happy?) “Because I am with you” (coquettishly).

This, however, represented the end of the psychosis. She improved rapidly. At first she smiled rather readily, but soon began to occupy herself and made a perfect recovery.

She gave a rather shallow retrospective account about the last phase at first she said it was natural for people to feel happy at times, and that she did not talk more because the inclination was not there. The only point she added later was that she held her fingers in the shape of a ring because she was thinking of her wedding ring.

She was discharged on Oct. 11

The patient was seen again in Sept. 1915. She then stated that she had been perfectly well until 1912, when she had a breakdown after childbirth. (A childbirth in 1910 had led to no disorder.) The attack lasted six months. She slept poorly, lost weight, and felt weak, depressed, “my strength seemed all gone”. In July, 1915, again following a childbirth, she was for about six weeks “despondent, weak, and tired out”.

At the interview she made a very natural, frank impression, and displayed excellent insight.