r individual preconceptions. What we have to say is
therefore published not so much to convince as to stimulate further
work. The problem is wider than that of the mere etiology of the stupors
we are considering. Their relationship to manic-depressive insanity is
so intimate that we must tentatively consider this affectless reaction
as belonging to that larger group. A discussion of the basic pathology
of manic-depressive insanity is outside the sphere of this book. The
author, therefore, thinks it advisable to state somewhat dogmatically
his view, as to the etiology of these affective reactions, merely as a
starting point for the argument concerning stupors specifically.

It is our view that the manic-depressive psychoses may be, and probably
are, determined remotely but fundamentally by an inherent neuropsychic
defect, but this physical and constitutional blemish is non-specific.
The actual psychosis is determined by functional, that is,
psychological factors. A predisposed individual exposed to a certain
psychic stress develops a manic-depressive psychosis. Naturally any
physical disease reduces the capacity for normal response to mental
difficulties; hence physical illness may facilitate the production of a
psychosis. But this intercurrent factor is also non-specific.

Such is our view of the etiology of manic-depressive insanity as a
whole. When we approach the study of benign stupors, however, difficult
problems appear. As will be discussed in a later chapter on the
literature, reactions resembling benign stupors occur as a result of
toxins, particularly following acute rheumatism. Recently the medical
profession has been called on to treat many cases of encephalitis
lethargica where similar symptoms are observed. If the resemblance
amounted to identity, we would have to admit that a specific toxin may
produce a specific mental reaction which we have concluded on other
grounds to be psychogenic. As a matter of fact, in two particulars these
reactions show relationship to organic delirium. Knauer reports that in
post-rheumatic stupors illusions are frequent--an ice bag thought to be
a cannon, or a child, etc.--and there are bizarre misinterpretations of
the physical condition, such as lying on glass splinters, animals
crawling on the body, and so on. Such illusions are, in our experience,
not found in stupor, and, on the other hand, are cardinal symptoms of
delirium. Further, Knauer reports that even at the height