s led to a collection of valuable material which could
serve as a useful starting point for the keen clinical investigation of
Hoch. Specifically, attention had already been fixed on the study of the
so-called functional psychoses, comprising what are generally termed
Dementia Praecox and Manic-Depressive Insanity. An urgent problem in
this field was to separate different reaction types in order to discover
which were recoverable and which chronic or progressive. In order to
understand psychological reactions, interrelation rather than mere
coincidence of symptoms must be studied and, to aid in this, free use
was made of the fundamental principles of unconscious mentation as
exposed in the theories of Freud and his followers.

Almost at the outset it had been discovered that many patients presented
clinical pictures that would not fit into existing diagnostic pigeon
holes. Dr. George H. Kirby, whose skill and industry had made the most
valuable contributions to the archives of the Institute, published in
1913 a brief paper in which he pointed out, not only that many cases
with "catatonic" symptoms recovered, but also that clinically the
behavior of stupor showed it to be related to manic-depressive insanity
as well as dementia praecox. Dr. Hoch took up the problem at this point.
Using Dr. Kirby's material and adding to it his earlier observations as
well as current cases, he endeavored to work out the essentials of the
stupor reaction. It was his ambition to describe stupor not only in its
psychiatric bearing but also as a life reaction.

The significance of this task is to be realized only when one considers
the general import of the functional psychoses. They are, biologically,
failures of adaptation. The chronic and deteriorating cases give up the
struggle permanently, while the temporary insanities lay bare the soul
of man as he catches a glimpse of unreality but turns back to face the
world as it is. When one realizes that emotional disturbances are
characteristic of the benign psychoses, it is easy to imagine how much
such studies may ultimately illuminate the problems of normal life.

The technical value of this work to psychiatry is more immediate.
Kraepelin laid the foundations for systematic classification with his
dementia praecox and manic-depressive groups. But the rigidity of the
latter, allegedly descriptive, term has confused the problem of
classifying many benign psychoses. It was Hoch's ambition to pr