constantly in these cases, as do the atypical
ideas. In other words, the thought content is definitely correlated with
the clinical picture.

As the clinical pictures show the relationship of stupor to other
psychoses, so there is also a correlation with varying formulations of
the death fancy. We are now in a position to define more narrowly what
death means in stupor. It is an accepted fact, a Nirvana state. When
death means union with God or appears in other religious guise, manic
symptoms tend to develop. When it is unwelcome and appears as "being
killed," we find anxiety symptoms. A patient can conceive of death
variously and have various clinical pictures. A knowledge of the
metamorphoses of ideas and their relationship to other symptoms enables
us to understand such cases, that, without this key, seem confused and
lawless jumbles of symptoms. Such theories tend to justify the view of
essential unity of the manic-depressive group.

It would be instructive at this point to consider another case which
illustrates beautifully how a stupor reaction may crystallize out of
other manic-depressive states when attention has become focused on
personal death. This patient went through four phases while under
observation. First, while showing a perplexed expression but with fair
orientation, she gave utterance to erotic and expansive fancies. She was
restless, somewhat intractable and gave the impression of brooding over
her imaginations rather than luxuriating in them. In other words, her
condition seemed to be more that of absorbed than active mania. Second,
these same ideas, somewhat reduced, continued in an apathetic state
while impulsive symptoms developed: She began to shout like a huckster
to be taken to Heaven and made numerous affectless, suicidal attempts.
Third, came a true stupor and, fourth, a period of recovery when the
stupor symptoms all disappeared but insight into the falsity of her
ideas was lacking.

CASE 19.--_Celia H._ Age: 19. Admitted to the Psychiatric
Institute October 22, 1913.

_F. H._ The father was living; he always drank, and
especially in later years contributed little to the support
of the family. The mother was living and said to be
normal, while a brother was coincidentally insane, with a
recoverable psychosis.

_P. H._ The mother stated that the patient was bright at
school, enjoyed company and going out, had a droll wit, was