should
note, however, that these sporadic exhibitions of mentality are always
associated with brief emotional awakening.

When we turn to examine the fragmentary utterances of stupor patients,
we are surprised by the narrowness and uniformity of the ideational
content. It seems to be confined to thoughts of death or closely related
conceptions. Thirty-five out of thirty-six consecutive cases at one time
or another referred literally to death. It is commonest during the
onset, as all but five of these patients spoke of it during the
incubation of their psychoses. Hence we conclude that death ideas and
stupor are consecutive phenomena in the same fundamental process. As
two-thirds of the series interrupted the stupor to speak of death or to
attempt suicide, we assume that this relationship persists. Only a
quarter gave any retrospective account of these fancies, so we presume
that their psychotic experiences were repressed with recovery.

The usual form in which the idea appears is as a delusion of going to
die or, literally, of being dead. It may appear as being in Heaven or
Hell. A theoretically important group is that which includes the
patients who, in addition, speak of being in situations such as under
the water or underground, which we have mythological and psychological
evidence to believe are formulations of a rebirth fantasy. Not rarely,
preoccupation with death is expressed in sudden impulsive suicidal
attempts.

The affective setting of these different formulations is important. A
delusion of literal death occurs with complete apathy. The wish to die
is apt to appear without the usual accompaniment of sadness or distress
but still with considerable energy when impulsive suicidal attempts are
made. A prospect of death, particularly when there is anticipation of
being killed, is apt in manic-depressive insanity to occur in a setting
of anxiety. Similarly one ordinarily observes fear in the patient who
has delusions of drowning or burial. In the stupor cases, however, this
painful affect seems to be reduced to a mere dazed bewilderment or
feeble exhibitions of a desire for safety, such as the slow swimming
movements of a patient who thought she was under the water. When these
ideas of danger become allied to everyday interests--husband or child
imperiled, etc.--a weak affect in the form of depression is apt to
occur.

Physical symptoms are more common than in any other benign psychosis. Of
these the most ne