nent than in the deep stupors.

A natural criticism is that these cases merely had retarded depressions.
Although this topic will be discussed fully in a later chapter, two
differential characteristics should be mentioned now. First, depression
is a highly emotional state in which the sadness of the patient is as
evident from his facial and vocal expression as from what he says, while
these stupor reactions are by observation and confession states of
indifference. Secondly, there is no such disturbance of the intellectual
processes in depression as is here chronicled. Let the retardation once
be overcome so that the will is exercised and no real defect is
demonstrable. In our experience the cases of apparent depression with
intellectual incapacity are found on closer study to be really stupors
as other symptoms show.

CHAPTER III

SUICIDAL CASES

An important "catatonic" symptom is a tendency to sudden, impulsive,
unexplainable acts. Such actions occur occasionally in benign stupors
and, since we attempt an understanding of the reaction as a whole, an
effort should be made to study these phenomena as well. The cases chosen
showed persistent, quite affectless, yet very impulsive attempts at
self-injury. They characterized the first of the three cases throughout,
were present in one stage (the second) of the second patient, while in
the last for one day there was behavior which can be similarly
interpreted.

Mention has been made of the prominence, approaching universality, of
the death idea in stupor. This is a subject to be discussed in length
presently, but for the present we may say that there may be a delusion
of death with dramatization of that state or a mere abandonment of the
mental activities of life. It is but a step from corpse-like behavior to
suicidal attempts, psychologically speaking, yet this transition
necessarily modifies the clinical picture, since one necessitates
inactivity and the other activity. Secondarily, other atypical clinical
features appear, as will be seen.

CASE 9.--_Pearl F._ Age: 24. Admitted to the Psychiatric
Institute July 26, 1913.

_F. H._ A paternal aunt was insane. Both parents died long
ago; the mother when the patient was a baby; the father
when she was a girl. She came to this country when 17. In
this country she had generally been a domestic. An older
brother and sister were also in America.

_P. H._ She was