a perversity of behavior which
seems to express antagonism to the environment or to the wishes of those
about the patient. In the partial stupors it is seen as active
opposition and cantankerousness. In the more profound conditions it is
represented by muscular resistiveness or rigidity, or refusal to swallow
food when placed in the mouth. Occasionally, too, the patient may even
in a deep stupor retain urine so long that catheterization is necessary.
All the explanations which one may gather from the patients' own
utterances, mainly retrospective, seem to point to negativism expressing
a desire to be left alone. The appearance of perverse behavior in
aimless striking or mere muscular rigidity seems to be an example of
dissociation of affect.

Catalepsy is an important symptom because, although it occurred in
slightly less than a third of our cases, it seems to be a peculiarity of
the stupor reaction found but rarely in other benign psychoses. It seems
never to occur without there being some evidence of mental activity,
and, consequently, we are forced to conclude that it is of mental rather
than of physical origin. Just what it means psychically it is impossible
to state without much more extended observations. We conjecture
tentatively, however, that the retention of fixed positions is in part
merely a phenomenon of perseveration, and in part an acceptance of what
the patient takes to be a command from the examiner, and sometimes a
distorted form of muscular resistiveness.

The intellectual processes suffer more seriously in stupor than in any
other form of manic-depressive insanity. Not only do the deep stupors
betray no evidence of mentation during the acme of the psychosis, but
retrospectively they usually speak of their minds being a blank.
Incompleteness and slowness of intellectual operations are highly
characteristic features of the partial stupors and of the incubation
period of the more profound reactions. The features of this defect are a
difficulty in grasping the nature of the environment, a slowness in
elaborating what impressions are received, with resulting
disorientation, poor performance of any set tests and incomplete memory
for external events when recovery has taken place. At times the thinking
disorder may develop with great suddenness or improve as quickly, and a
tendency to isolated evidences of mental acuity is another example of
the inconsistency which is so highly characteristic of stupor. We