e a regression, which is
essentially a withdrawal of interest and energy rather than a fixation
on a false object, then excitement is desirable and interest must be
reawakened. The withdrawal is temporary (inasmuch as the psychosis is
benign), but just as a normal person wakes more readily on a clear
sunshiny day than when it rains, so the more cheering the environment
the more rapid the recovery.

Consequently, although trying to those in charge, persistent attention
should be given the patient. Feeding and hygienic measures probably have
considerable value in this work. As soon as it is at all possible the
patients should be got out of bed and dressed. When up, efforts should
be directed towards making them do something, even if it be something as
simple as pushing a floor polisher. On account of their lack of
enthusiasm the stupor cases are often omitted from the list of those
given occupation and amusement. Even if they go through the motions of
work or play with no sign of interest, such exercise should not be
allowed to lapse. Then, too, the environment should be changed when
practicable. A patient may improve on being moved to another building.

Perhaps the most potent stimulus that we have observed is that of family
visits. In most manic-depressive psychoses visits of relations have a
bad effect. The patients become excited, treat the visitors rudely,
perhaps even assault them, and all their symptoms are aggravated. But
the stupor needs excitement, and an habitual emotional interest is more
apt to arouse him than an artificial one. In another point the situation
differs. As a rule manic-depressive patients have delusional ideas or
attitudes in connection with their nearest of kin, so that contact with
these stirs up the trouble. The stupor regression going beneath the
level of such attachments leaves family relationships relatively
undisturbed. Hence, while the visit of a husband is likely to produce
nothing but vituperation or blows from a manic wife, the stuporous woman
may greet him affectionately and regain thereby some contact with the
world.

So many cases begin recovery in this manner that it cannot be mere
chance. One patient's improvement, for instance, dated definitely from
the day a nurse persuaded her to write a letter home. It is striking,
too, how quickly a patient, while somewhat dull and slow, will brighten
up when allowed to return home. A similar improvement under these
circumstances is ofte