ildish tricks, such as flippancy in answering questions
or the playing of pranks. Such tendencies naturally lead over to frank
hypomanic behavior.

Finally, a peculiar characteristic of the stupor apathy must be
mentioned. This is its tendency to interruptions, when the patient may
return to life, as it were, for a few moments and then relapse. Such
episodes occur mainly in milder cases or towards the end of long, deep
stupors. It is interesting that the occasion for such reappearance of
affect is frequently obvious. We usually observe them in response to
some special stimulus, particularly something that seems to revive a
normal interest. Visits of relatives are particularly common as such
stimuli, in fact recovery can often be traced to the appearance of a
husband, mother or daughter. It is also important to recognize that with
this revived interest, other clinical changes may be manifest, that the
thinking disorder may, for instance, be temporarily lifted. Helen M.,
for example, when visited by her mother was so far awakened as to take
note of her environment, and remembered these visits after recovery like
oases in the blank emptiness of her stupor. She further remembered that
definite ideas were at such a time in her mind that ordinarily was
vacant. She then had delusions of being electrocuted.

In summary, then, we may say that the _sine qua non_ of the stupor
reaction is apathy in all gradations, and that this apathy is as
distinct a mood change as is elation, sorrow or anxiety. Incidental to
this loss of affect there is a dissociation of emotional response
whereby isolated expressions of mood appear without the harmonious
cooperation of the whole personality which seems to be dead. Thirdly,
there tends to be associated with the stupor reaction a tendency to
childish behavior. Finally, the apathy and accompanying stupor symptoms
may be suddenly and momentarily interrupted. An explanation of these
apparently anomalous phenomena will be attempted in the chapter on
Psychology of the Stupor Reaction.

CHAPTER VII

INACTIVITY, NEGATIVISM AND CATALEPSY

1. INACTIVITY. We must now turn our attention to the other cardinal
symptoms of the stupor reaction, and quite the most important one of
these is the inactivity. It is convenient to include under this heading
both the reduction of bodily movement and the diminution or absence of
speech. This inactivity is, of course, related to the apathy which we
have jus