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good "attention or concentration could be obtained as with the normal state, the maximum performance should be better.

It must probably be regarded as a limitation of the German terminology that it uses the word Hemmung to describe both retardation and inhibition. Hoch has indicated this difficulty very clearly in his studies of retardation, especially in his employment of the term resistances instead of inhibitions to describe the process. That psychomotor retardation is the product of excessive inhibition is more than doubtful. Inhibition is opposition, and excessive inhibition is nothing more nor less than a blocking negativism, which is not part of the recognized symptomatology of manic-depressive insanity. This is a difficulty that must be overcome if the strict continuity of the manic and depressed states is to be maintained together with the theory of decreased inhibition in the manic states. We must recognize two factors that may lessen the freedom of a mental or motor reaction-opposition and obstruction. Excess of the former is negativism, excess of the latter is retardation. The crucial question then becomes: Is the manic state a removal of inhibitions or a removal of obstructions ? Removal of inhibitions describes the manic state as we know it very well, but excessive inhibitions describes something very different from the retarded state. On the other hand, excess of obstructions describes the retarded state very well, while its relation to the manic state is the same as that of the theory of loss of inhibition. Both viewpoints are compelled to conceive of some process which acts independently upon the primary or the inhibitory impulses, for if they were equally affected the end-effects would remain essentially unchanged. The point is perhaps a minor one, but for the sake of clearness it might be well to examine the objective criteria of obstruction, or resistances, as distinguished from inhibitions, with reference to the more precise analysis of the manic state.

Such phenomena of retardation as appear in the dementia præcox cases observed are objectively differentiated from the depressive ones in that they appear more episodically, almost fortuitously, as it were, affecting one hand and not the other, or only individual series with a single hand, as distinguished from

"Hoch: On Certain Studies with the Ergograph. Journ. Nerv. and Ment. Diseases, XXVIII, 1901, p. 626.

the manic-depressive retardation whose manifestations are more consistent throughout. However, while there have not been observed outside the depressed states instances of the phenomena of retardation which did not seem to have objectively a different origin from those regularly observed within the depressed states, yet the possibility must be granted that the retardation measured in these experiments may be a symptom of many mental diseases, possibly in much the same way as a rise in temperature is a frequent accompaniment of bodily disorders. We do not discard the clinical thermometer because it will not immediately distinguish between the fever of a typhoid and the fever of a pneumonia ; nor need the measurement of retardation lose its clinical significance because it will not serve the purposes of penny-inthe-slot diagnosis.

To briefly recapitulate. The measurement of such elementary functions as are given in the ocular reaction times, the ocular pursuit movements, or the tapping test and the like, affords the most unequivocal criterion of motor retardation that it is at present practicable to obtain. The criteria of motor retardation as illustrated by the tapping test are (a) a lowered absolute rate, (b) a rise in the work-curve where it should normally fall (reversal), (c) a relative gain over the normal in the efficiency of the work that comes later in the experiments (transference). Case I, superficially characterized mainly by fixed ideas, illustrated marked phenomena of retardation under the conditions of the experiment, indicating the existence of a more fundamental psychic disturbance to which the fixed ideas are secondary. Later, this case showed extreme instability of the phenomena of retardation, which markedly decreased through the experiments, a progressive change which the mood tended to parallel. Case II illustrated a pronounced motor retardation, probably without much thinking disorder. Here there were also to be noted characteristic fluctuations as the experimental work progressed. Case III was mainly significant in showing that the phenomena of retardation might appear characteristically in a first attack at the involution period, in giving an especially clear-cut illustration of transference phenomena and further reflecting episodic changes in condition.

Case IV illustrates the effect of an objectively given condition of retardation in accentuating the phenomena of transference and lowered absolute rate. Case V illustrated certain phenomena in retardation in a depression of immediate traumatic antecedents, and with other clinical characters of the traumatic psychosis. In Case VI the characteristic phenomena of manic-depressive retardation appeared in a case showing otherwise many dementia præcox traits, but whose subsequent course was more favorable than is usually to be anticipated in this condition. In Cases VII and VIII a considerable clinical retardation failed to reveal itself in any characteristic way experimentally; in each of these cases the possibility of a general paralysis had been considered. Case IX is a classical involution depression whose deviations from the normal are in the opposite direction from those of the manicdepressive depressions. No retardation is shown and, save for the lowering of the gross rate, the performance resembles that of the manic cases more than that of the typical manic-depressive depressions. The performance is also practically unaffected by considerable fluctuations in the superficial condition. Cases X and XI are presented in this same connection, as agitated depressions not showing retardation ; and affording, with the three previous cases, experimental indication that emotional depression involves retardation no more necessarily than retardation involves emotional depression. Each is seen fundamentally and independent of the other, though either may be secondary to the other.

The cases of dementia præcox and general paralysis show little or nothing of significance, but the manic cases tend to show an increased initial rate and a heightened susceptibility to fatigue, the exact reverse of what is shown by the retarded cases. When the psychological measure can be made sufficiently independent of special factors in co-operation it is probable that the optimum performance of manic states is quite superior to the normal as well as the depressed. Insufficient light exists on this question, however, a satisfactory treatment of which is possible only in the study of a group of circular cases through various periods of depression and excitement. Since the essentially retarded state is almost certainly an over-obstruction, not an overinhibition, of the reaction, the manic state may also perhaps be better interpreted as the loss of normal and teleological obstruction to the primary impulses rather than to the loss of an inhibitory faculty usually exercised by the opposite impulses.




By A. A. BRILL, PH. B., M. D., Clinical Assistant, Department of Psychiatry and Neurology, Columbia

University; Assistant in Mental and Nervous Diseases O.P. D., Bellevue Hospital; Assistant Visiting Physician, Hospital for Nervous Diseases; Former Assistant Physician, Central Islip State Hospital; and Clinic of Psychiatry, Zurich.

He was

A. St., 20 years old, law student and journalist, was admitted to my service in the clinic of psychiatry, Zurich, on January 22, 1908. His friend and colleague stated that patient was a Hungarian journalist who came to Zurich to study law. considered very diligent and brilliant but somewhat eccentric. He seemed to have been depressed for some time, remaining in bed for days, taking very little nourishment, but for the last two days he showed some improvement. He attempted to shoot himself at about 12 noon. He discharged five shots and beyond grazing his shirt, maiming a candle standing near his bed, and a picture of Ibsen on the opposite wall, he did no damage. The reason for the attempted suicide was supposed to be unrequited love. In the beginning of December he made the acquaintance of a lady student with whom he soon became infatuated. His love was not reciprocated so that he became despondent, neglected his work, and uttered pessimistic and gloomy ideas. The informant stated that as soon as the shots were heard he ran into the room and found patient lying in bed in a delirious condition; he was confused, murmured to himself, and asked meaningless questions, repeating, “Where are the white horses?" The last question he also repeatedly put to the physician who was called in soon after the shooting

An anamnesis was also obtained from patient's father about a week later. He denied any psychic abnormalities in the family, but he himself was neuropathic, and it was afterwards learned that one of his daughters was hysterical. He stated that patient


was always somewhat delicate but developed normally. As he grew up he was "indifferent, cold, seclusive, and obdurate, but very bright"; he was always at the head of his class. His teachers referred to him as a prodigy, and his professors predicted a great future for him. At a very early age he manifested a great talent for writing, and since his fifteenth year he had supported himself by journalism. His feuilletons are sought for by the leading Hungarian journals. Due to the divorce of his parents, he had lived apart from them since his fifteenth year; he however kept on corresponding regularly with his father, and even paid him an occasional visit.

On admission patient was exceedingly apathetic, and took absolutely no interest in his surroundings. When addressed he showed some confusion, he seemed to be unable to comprehend the questions, and his answers were monosyllabic and laconic. He did not care what would happen. “Do what you please,” he would say. In appearance he was under-developed and small, his head seemed to be too big for his body, probably due to his long, black hair hanging over his shoulders. The physical examination revealed nothing in particular. In the ward he was quiet and indifferent; he lay on his back motionless, either keeping his eyes shut or staring vacantly into space. He expressed no desires, and when an attempt was made to draw him into conversation he became mute. He took but little nourishment, and this only after much urging. When seen the next morning he was essentially unchanged. The nurse reported that he slept well, but paid absolutely no attention to anything.

The main features were dullness, apathy, and somnolence, and probably hallucinations, as shown by his asking for white horses. This condition continued for four days, after which he gradually became brighter, and at the end of a few days more he was apparently his former self.

He was discharged, on January 31, to go to Vienna with his father. Diagnosis: Schizophrenia.

We have here a precocious youth, slightly burdened by heredity, who, having been disappointed in love, loses his mental equilibrium and merges into Schizophrenia. He makes an unsuccessful attempt at suicide, and later he is delirious and hallucinatory, uttering senseless stereotyped sentences. This is followed by a short

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