of the normal _elan
vital_.

We may say, in fact, that the establishment of a specific type of
emotional change is justification for classifying all milder stupor
reactions with the deep stupors. In other words, our reason for the
enlargement of the stupor group to include all apathetic reactions
(except those of dementia praecox) is the belief that this dulling of the
emotional response is as specific a type of emotional change as is
anxiety, depression or elation. Perhaps it would be more accurate to say
that this clinical group is founded on the symptom complex which is
built around apathy. There is never any resemblance between apathy and
the mood of elation or anxiety. A discrimination from depression is the
only differentiation worth discussion.

The first point that should be made is that there is a difference
between marked depression and the mood of stupor. In the former we get a
retardation with a feeling of blocking, rather than of an absence of
energy. The expression of the patient is one of dejection, not of
vacancy, which bespeaks a mood of sadness, even when the patient is so
retarded as to be mute and therefore incapable of describing his
emotions. Running through all the stages of stupor, however, there is an
emptiness, an indifference that is in striking contrast to the positive
pain that is felt or expressed by the depressed patient. It may be
objected, of course, that this apathy really represents the final stage
in the emotional blocking of the depressed individual, but the
development of stupor and recovery from it shows an entirely different
type of process. A deep depression recovers by changing the point of
view from a feeling of unworthiness and self-blame to one of normality.
The stuporous case, on the other hand, evidences merely less and less
indifference, and more and more interest in his environment and in
himself as he gets well.

The associated symptoms are no less dissimilar. The difficulty in
thinking which troubles the depressed patient is slight in proportion to
his emotional gloom, and he feels himself to be much more incompetent
intellectually than examination proves him to be. On the other hand, in
the stupor reaction we find that the thinking disorder runs hand in
hand with the apathy and that the intellectual capacity of the patient
is really markedly interfered with, as can be shown by more or less
objective tests. A mere slowing of thought processes accompanied by
subjecti