Note 10 — Chapter IX · THE PHYSICAL MANIFESTATIONS OF STUPOR

As a matter of fact, if the views of Clark and MacCurdy[B] be accepted, some reason for these epileptic-like attacks may be imagined. According to them, epilepsy is a disease characterized by a lack of the natural instinctive interest in the environment which is expressed chronically in the deterioration, and episodically in the attacks, the most consistent feature of which is loss of consciousness. Now, in stupor we have an analogous reaction where, although consciousness is not disturbed in the sense in which it is in epilepsy, it is nevertheless considerably affected, inasmuch as contact with the environment is practically non-existent. The coincident thinking disorder is quite similar, both in epileptic dementia and the torpor following seizures and in these benign stupors. MacCurdy has suggested tentatively that the epileptic convulsion may be secondary to a very sudden loss of consciousness which removes a normal inhibition on the muscles, liberating the muscular contractions which constitute the convulsion. If this view were correct, it would not be hard to imagine that during the onset of these stupors the tendency to part company with the environment, which ordinarily comes on slowly, might occur with epileptic suddenness and hence liberate convulsive movements. This is, however, a pure speculation but not fruitless if it serves to draw attention to the analogies existing between the stupor reaction and some of the mental symptoms of epilepsy. These analogies are strong; aside from the obvious clinical differences, the stupor and epileptic reactions are dynamically unlike in that they are the product of different temperaments and precipitated by different situations.