tes. There
are also many psychoses where complete stupor is never developed. This
gives us our justification for speaking of the _stupor reaction_, which
consists of these symptoms (or most of them) no matter in how slight a
degree they may be present. The analogy to mania and hypomania is
compelling. The latter is merely a dilution of the former. Both are
forms of the manic reaction. We consequently regard stupor and partial
stupor as different degrees of the same psychotic process which we term
the stupor reaction. To understand it the symptoms should be separately
analyzed and then correlated.

The most fundamental characteristic of the stupor symptoms is the change
in affect which can be summed up in one word--apathy. It is fundamental
because it seems as if the symptoms built around apathy constitute the
stupor reaction. The emotional poverty is evidenced by a lack of
feeling, loss of energy and an absence of the normal urge of living.
This is quite different from the emotional blocking of the retarded
depression, for in the latter the patient shows either by speech or
facial expression a definite suffering. The tendency to reduction of
affect produces two effects on such emotions as internal ideas or
environmental events may stimulate. Exhibitions of emotion are either
reduced or dissociated. For instance, anxiety is frequently diminished
to an expression of dazed bewilderment; or, isolated and partial
exhibitions of mood occur, as when laughter, tears or blushing are seen
as quite isolated symptoms. This latter--the dissociation of
affect--seems to occur only in stupor and dementia praecox. It should be
noted, however, that inappropriateness of affect is never observed in a
true benign stupor. A final peculiarity is the tendency to interruption
of the apathetic habit, when the patient may return to life, as it were,
for a few moments and then relapse.

Closely related to the apathy, and probably merely an expression of it,
is the inactivity which is both muscular and mental. It exists in all
gradations from that of flaccidity of voluntary muscles, with relaxation
of the sphincters, and from states where there is complete absence of
any evidence of mentation to conditions of mere physical and psychic
slowness. After recovery the stupor patient frequently speaks of having
felt dead, paralyzed or drugged.

By far the commonest cause of emotional expression or interruption in
the inactivity is negativism. This is