s view unlikely. One cannot be
anxious and happy at the same instant, although one can alternate in his
feelings; but one can fail to react adequately to a given stimulus when
inhibited by general indifference. In fact it is because apathy is,
properly speaking, not a mood but an absence of it, that it can be
combined with a true affect. It is possible, therefore, to have a
combination of stupor and another manic-depressive reaction, while the
others cannot combine but only alternate.[11]

Finally we must discuss the psychological meaning of cases, such as
those described in Chapter VIII, where we concluded that there were
psychoses resembling stupors superficially. It seemed likely that these
patients were absorbed in their own thoughts, rather than being in a
condition of mental vacuity. It is not difficult to explain the
objective resemblance. All evidence of emotion (apart from subjective
feeling tone which the subject may or may not report) is an expression
of contact with the outer world. There must be externalization of
attention to environment before a mood becomes evident. A moment's
reflection will show this to be true, for no further proof is needed
than the phenomena of dreaming. The attention being given wholly to
fantasies, the subject lies motionless, mute and placid, although
passing through varied autistic experiences. Only when the dream becomes
too vivid, disturbs sleep and re-directs attention to the
environment--only then is emotion objectively betrayed. There is an
appearance of apathy and mental vacuity which the dreamer can soon
declare to be false. He was feeling and thinking intensely. In any
condition, therefore, such as that of perplexity or of an absorbed manic
state, the patient may be objectively in the same condition as a typical
stupor. The histories of the two psychoses differentiate the two
reactions which may be indistinguishable at one interview. The keynote
of one reaction is _indifference_, while that of absorption is
_distraction_, a perversion of attention to an inner, unreal world.

In summary we may recapitulate our hypotheses. Stupor represents,
psychologically speaking, the simplest and completest regression.
Adaptation to the actual environment being abandoned, attention reverts
to earlier interests, giving symptoms of other manic-depressive
reactions in the onset or interruptions, and finally dwindles to
complete indifference. The disappearance of affective impulse leads t