. So, too, it was possible for
ideas unrelated to the stupor picture, such as those of lovers, to occur
sporadically. Finally, since activity must imply some contact with
environment, the first of these cases at least showed less interference
with the intelligence than is usual. In general, one may conclude that
any aberration from the pure type of stupor tends to allow other
impurities to appear.

CHAPTER IV

THE INTERFERENCES WITH THE INTELLECTUAL PROCESSES

This is one of the most interesting and important of the stupor
symptoms. We are accustomed to think of the functional psychoses having
symptoms to do with emotions and ideas in the main, and, conversely,
that disorientation, etc., observed in such cases is merely the result
of distraction, poor attention or cooperation. But in stupor the deficit
in understanding, incapacity to solve simple problems and failure of
memory seem deep-rooted and fundamental symptoms. So far is this true
that Bleuler[5] looks on "schizophrenic" cases with this symptom of
"Benommenheit" as organic in etiology. It may be said at the outset that
we do not share this view for many reasons. One at least may now be
stated as it seems to be final. In benign stupor purely mental stimuli
may change the whole clinical picture abruptly and with this produce a
change in the intellectual functioning such as we never see in organic
dementias or clouded states. We find it more satisfactory to attempt a
correlation of this with the other symptoms on a purely functional
basis, as will be explained later.

For the study of the interferences with the intellectual processes
during stupor reaction, we have two sources of information: The first is
derived from the account which the patient is able to give in regard to
what he remembers as having taken place around him or in his mind during
the stupor period; the second is the direct observation of partial
stupor reactions.

1. Information Derived from the Patient's Retrospective Account

We will start with the cases of marked stupor mentioned in Chapter I.
Anna G.'s (Case 1) psychosis commenced at home, and under observation
lasted with great intensity for five months. She remembered only vaguely
the carriage going to the Observation Pavilion, had no recollection of
the latter, nor of her transfer to the Manhattan State Hospital and of
most of the stay at the Institute ward, including the tube- or
spoon-feeding which had to be carried on fo