31:--Patient is well oriented, talks in a retarded manner;
questions are answered for the most part correctly; occasionally, only
nearly correct. His memory is good for remote events, but very much
clouded for events which have transpired since the commission of the
crime. Partial insight is present. He realizes that there must have
been something wrong with him. Emotionally not deteriorated. Refuses
to discuss his crime, saying it makes him feel bad; talks in a
childish, affected tone of voice, and undergoes various grimacing
movements; gives frequent evidence of being fully aware of occurrences
in his environment; talks and eats voluntarily and is tidy in habits.
Occasionally laughs in a silly, affected manner. Flexibilitas cerea
and catalepsy entirely disappeared; gained considerably in weight;
continues to show marked tendency to be influenced by occurrences in
his environment. In general, shows a decided improvement in his
condition.

We are dealing here with an individual whose past career is uneventful,
as far as is known. He is charged with murder, and upon being tried for
this develops a mental disorder. The symptomatology of his psychosis
could easily be mistaken for that of catatonic praecox, and, as a matter
of fact, had been so diagnosed by the first observer. In studying the
case more thoroughly, however, it becomes unmistakably evident that we
are not dealing here with a case of catatonia. In the first place, the
immediate relation between the emotional shock of the crime of murder
and the probable punishment for it, and the development of the mental
disorder must be taken into consideration. This is not a mere accidental
relationship. But even if we grant that this point cannot be definitely
decided, the psychogenetic character of this case cannot be doubted when
we remember how the entire symptomatology is absolutely dependent upon
and influenced by occurrences in the patient's environment. He refuses
to eat, a symptom very common in catatonia, but it is indeed a rare
occurrence for a catatonic in the midst of a negativistic stupor and
mutism to say, "I'll drink it," and actually drink voluntarily the
entire contents of the pitcher in order to avoid tube-feeding. He is
untidy in his habits, another common catatonic characteristic, but is it
to be expected that a catatonic, in the height of his disorder, will
abstain from his filthy habits when threatened to be punished for the