ses may be interfered with to the extent of a paragraphia, i.e., a
remarkably mixed-up writing in which perseveration (one form of
following the path of least resistance) plays a prominent part. This
same principle is also seen in such reactions as the repetition of the
question or the senseless repetition of a former answer. These phenomena
remind us of what we see in epileptic confusions, in epileptic
deterioration and in arteriosclerotic dementia.

In milder cases difficulties in orientation may be more or less marked;
or there may be incapacity to think out problems, although the
orientation is perfect. The more automatic mental processes may run
smoothly (memory and calculation may be excellent) and there may yet be
a certain shallowness in thinking, a defect of attention (a purely
descriptive term) which is most obvious in the patient's inability to
grasp clearly the drift of what is going on or the meaning of
complicated questions. I am inclined to think that poor results in
retention tests are entirely due to this attention disorder, for we have
no evidence of any fundamental retention defect such as we find in the
totally different organic stupors. From a practical point of view it is
important at this place to call attention to the fact that such mild
changes are particularly seen in end stages. Even when pronounced
negativistic tendencies do not play a prominent role, the patient is
then apt to be silent chiefly as a result of the residual disorder in
the intellectual processes. Still more striking are the conditions which
are on a somewhat higher level and in which the shallowness of the
responses, due to the residual disorder of attention, together with the
last traces of the affectlessness, are apt to create the impression of a
dementia. In such cases the opinion is often held that the patient has
reached a defect stage from which recovery is impossible, whereas a
thorough knowledge of these end stages teaches us that they are not only
recoverable but quite typical for the terminal phases of stupor.

Considering these data, especially those gathered in the end stages, it
would appear that there is no tendency in this intellectual disorder
associated with the stupor reaction for any special side of mental
activity to be most prominently affected. It looks rather as if it were
a question of a general diminution of the capacity to make a mental
effort which in its different intensities accounts for the sympto