, in the states where one would
expect anxiety during the onset of stupor or in its interruptions,
manifestation of this anxiety is often reduced to an expression of dazed
bewilderment. In the anxiety states associated with stupor one does not
meet with the restlessness and expressions of fear which would be
expected. Quite similarly, when a manic tendency is present, it occurs
either in little bursts of isolated symptoms of elation (such as smiling
or episodic pranks), or some of the evidences of elation which we would
expect are missing. For instance, Johanna S. (Case 13) terminated her
stupor with a hypomanic state which was natural except for her always
wearing an expressionless face. Sometimes laughter occurs alone and
gives the impression of a shallow affect, raising a suspicion of
dementia praecox. In fact, such evidences of affect as do appear in the
course of the stupor are apt to be isolated, queer and "dissociated." It
does not seem as if the whole personality reacted in the emotion as it
does in the other forms of manic-depressive insanity. For example, we
may think of the resistiveness which is so frequently present when the
patient seems in other respects to be psychically dead. One may recall
the case of Meta S. (Case 15), who, otherwise inert, was occasionally
seen with tears or smiles. Anna G. (Case 1), too, was often seen smiling
or weeping. It was noted once of Charlotte W. (Case 12) that she ceased
answering questions and remained immobile with fixed gaze, but when some
mention was made of her going home she flushed and tears ran down her
cheeks, although no change in the fixedness of her attitude or facial
expression was seen. When Johanna S. was visited by her daughter and was
lying motionless in bed, she slowly extended her hands, apparently tried
to speak, and then her eyes filled with tears. Two days later, at the
end of an interview when she had made a few replies, she settled down
into her usual inactivity and, when further urged to answer, her eyes
filled with tears. Similarly, too, in fairly deep stupor pin pricking
may result in flushing, in tears or an increased pulse rate without the
patient giving any other evidence of the stimulus being felt. These
examples seem to show a larval effort at normal human response which,
failing of complete expression, appeared as single isolated features of
emotion suggesting true dissociation. We should also in this connection
bear in mind the impulsive sui