olent thinking as opposed to progressive and
energetic mentation. One can look on stupor as being a profound
regression. Effort is abandoned (apathy and inactivity), while the
ideational content expresses a desire for a retreat from the world in
death. It is possible to think of this regression as a return to the
mental habit of the suckling period, when spontaneous effort is at its
minimum. This, too, is the time when petulance and tantrums are frequent
expression of a wish to be left alone, which may account for the
negativism as a consistent symptom of the same regressive progress.

Just as we regress in sleep, to rise refreshed for a new day's duties,
so the stupor case often shows excessive energy in a hypomanic phase
before complete normality is reached. This corresponds again to the
age-old association of the ideas of death and rebirth which we see
together so frequently in stupor. It is the psychology of wiping the
slate clean for a fresh start.

The development and symptoms of stupor furnish evidence in support of
the hypothesis of this type of regression. Dissatisfaction of any kind
is the setting in which the psychosis begins and the commonest
precipitating factor is some reminder of death. That loss of energy
appears with the stupor is evident from the inactivity and apathy, while
the thinking disorder can be shown to be the result of the same loss.
The different "levels" of the stupor reaction also conform to a theory
of regression. First there is mere indifference and quietness; then
appear false ideas when normality is so far abandoned as to mean a loss
of the sense of reality; withdrawal of interest from the environment,
with its consequent centering of self, leads to the next stage--that of
the spoiled child reaction; then follows the exclusion of the world
around in the dramatization of death; finally, in the deepest stupor,
mentation is so far abandoned that we can gather no evidence of even
this delusion being present.

Atypical features in stupor have to do mainly with interruptions,
interludes as it were, of elation, anxiety or perplexity. These are
explicable as awakenings from the nothingness of stupor into
imaginations such as characterize the other manic-depressive psychoses.
When such tendencies are present, the co-existence of the stupor process
may tone down the emotional response or prevent its complete repression
so that insufficient or dissociated affects appear. A combination of the
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