ing of April.

4. From this stuporous state she emerged during the next
four weeks, the awakening being associated with persistent
efforts to arouse her. She then was, for six or seven
weeks, nearly normal, so far as her mood went, but had a
tendency to cling to some of her ideas and was
overtalkative. Her memory for the earlier phases of the
psychosis was good, as she recalled not only many external
events but most of her false ideas. She said, however, that
her mind had been a blank for the third stage and she
remembered nothing of it. At the end of this time she
cleared up entirely and was discharged as "recovered." She
continued well for some months, during which she was
occasionally examined.

This case gives an excellent example of the relationship of stupor to
other manic-depressive reactions. She begins with an absorbed state,
showing elements of perplexity and mania. With this there are expansive
ideas but, also, statements about losing everything and being in prison,
which suggest abandonment of life. Next, with increasing apathy, she
begins to speak of death and soon makes impulsive suicidal attempts.
Evidently her mind was becoming more and more focused on death and with
this there was an appropriate emotional change. She was either apathetic
or the affect exhibited itself in pure impulsiveness. Then comes the
stupor, when all ideas disappear and mentation is reduced or absent.
When the stupor lifts, the original ideas appear not only in memory but
occasion a wavering insight. It is appropriate that she recalled all of
her psychosis fairly well with the exception of the pure stupor, which
she remembered only as a time when her mind was a blank.

FOOTNOTES:

[7] Hoch, August, and Kirby, George H.: "A Clinical Study of Psychoses
Characterized by Distressed Perplexity." _Archives of Neurology and
Psychiatry_, April, 1919, Vol. I, pp. 415-458.

[8] Hoch, August: "A Study of the Benign Psychoses." _Johns Hopkins
Hospital Bulletin_, May, 1915, XXVI, 165.

A book on "the psychology of manic-depressive insanity" will shortly
appear by the editor.

CHAPTER IX

THE PHYSICAL MANIFESTATIONS OF STUPOR

We must now discuss the most difficult of all the aspects of the stupor
problem. The subject is so involved and the evidence so inconclusive
that observers will probably interpret the phenomena here reported
according to thei