n seen in partially recovered cases of involution
melancholia, in whom a psychological regression similar to that of
stupor takes place. Such experiences make one wonder whether perhaps
these alone of all our insane patients would not recover more quickly at
home than in hospitals, provided nursing care could be given them.

This is a mere suggestion. Before treatment can be rational the nature
of any disease process must be known, and we do not pretend to have done
more as yet than outline the probable mental pathology of the benign
stupors. The next step is to put theory into practice and experiment
widely with various means to see if by appropriate stimulation the
average duration of these psychoses cannot be reduced. It is largely
with the hope of inducing other psychiatrists to carry on such work that
this book is written. There is no other manic-depressive psychosis
which, theoretically, offers such hope of simple psychological measures
being of therapeutic value.

CHAPTER XIV

SUMMARY OF THE STUPOR REACTION

Having discussed in detail the various symptoms and theoretic aspects of
the benign stupors, it may be well to have these observations and
speculations summarized.

It being established that stupors occur as a temporary form of
insanity[12] psychiatry is faced at once with the problem of describing
these conditions accurately in order to ascertain their nosological
position. To this end we first examined typical cases of deep stupor and
found that the clinical picture is made up of the following symptoms: In
the foreground stands _poverty of affect_. The patients are almost
unbelievably apathetic, giving no evidence by speech or action of
interest in themselves or their environment, unmoved even by painful
stimuli. Their faces are wooden masks; their voices as colorless when
words are uttered. In some cases sudden mood reactions break through at
rare intervals. The second cardinal symptom is _inactivity_. As a rule
there is a complete cessation of both spontaneous and reactive movements
and speech. So profound may this inhibition be that swallowing and
blinking of the eyes are often absent. The trouble is not a paralysis,
however, for reflexes without psychic components are unaffected.
Possibly related to the inactivity is the preservation of artificial
positions which is called _catalepsy_, a fairly frequent phenomenon. A
tendency opposite to the inactivity is seen in _negativism_. This
pervers