s have black hair and straight hair, but one
cannot therefore say that any black and straight haired man is a Mongol.
Fortunately Kahlbaum prevented serious error by leaving the prognosis of
his catatonia open. When Kraepelin included it in his large group of
Dementia praecox, however, it implied that stupor could not be an acute,
recoverable condition.[3] He unquestionably advanced psychiatry greatly
but his scheme was too ambitious to be accurate. Many observers saw
patients, classified as dements according to Kraepelin's formulae,
return, apparently normal, to normal life. Finally Kirby[4] published a
series of cases which showed decisively that this classification was too
rigid.

Since his paper is the foundation for this present study, it should be
reviewed carefully. He first points out that Kraepelin's "Dementia
praecox" includes much more than it should with its inevitably bad
prognosis. He shows how others have found patients with catatonic
symptom complexes proceed to recovery and speaks of these symptoms
occurring in epilepsy and even in frankly organic conditions, such as
brain tumor, general paralysis, trauma and infections. Kirby's first
claim is that there are probably fundamentally different catatonic
processes, deteriorating and non-deteriorating. Lack of knowledge has
prevented us from understanding the meaning of the symptoms and hence
making the discrimination. He points out that stupor seems to represent
an attitude of defense, similar to feigned death in animals, and that in
a number of his cases it was clear that the stupor symbolized the death
of the patient. Apparent negativism, he found to be often a consciously
assumed attitude of aversion towards an unpleasant emotional situation.
In cases where there had been no prodromal symptoms pointing definitely
to dementia praecox the outcome was almost always good. To discriminate
the cases with good outlook from those with bad, he discerned no
difference in the stupors themselves, but observed that the mental
make-up and initial symptoms differed sufficiently for diagnosis to be
made. His most important point is, perhaps, that these benign stupors
showed a definite relationship to manic-depressive insanity in that some
patients passed directly from stupor to typical manic excitement, while
in others a "catatonic" attack replaced a depression in a circular
psychosis.

Kirby introduces, then, the idea of stupor being a type of reaction
which can occu