Catatonia: Cillapsed Space-Time

The major psychoses are characterized as primary disturbances in space-time configuration; schizophrenia is seen as a disorder in temporal (left brain) thinking, and manic depressive disease is conceptualized as a dysfunction in spatial (right brain) thinking. An intermediary disorder involving both spatial and temporal thinking is catatonia, a dysvolitional state which presents clinically with catalepsy, waxy flexibility, negativism, mutism, muscular rigidity, and bizarre mannerisms. The catatonic patient attributes special significance to any willed action and dreads the consequences of such action. It is my impression that catatonic stupor results from the patient's creation of the protective fantasy that space and time have collapsed, and his connection with the universe has been severed.

While catatonia is classically viewed as a subgroup of schizophrenia, several authors consider it a separate syndrome with a variety of causes. Affective illness, neurological disorders, and metabolic conditions, as well as toxic and pharmacological agents have all been implicated in the catatonic syndrome.

Arieti's suggestion that there is a close relationship between catatonia and obsessive-compulsive disease and Flor-Henry's conjecture that the obsessive-compulsive syndrome is anatomically dependent on the anterior-thalamic-cingulate gyrus axis raises the possibility that catatonia is a midline limbic dysfunction, rather than a hemispheric disorder. In this connection, Gelenberg notes that catatonia is seen in severe cases of viral encephalitis of the limbic system, and Nielson describes clinical syndromes of akinesia, mutism, and apathy secondary to various lesions of the medial limbic pathway.

We may postulate an Einsteinian model for catatonia by coupling the evidence for limbic dysfunction with Lehmann's hypothesis that the massive inhibition of catatonic stupor is due to excessive cerebral excitation. The catatonic syndrome may then be characterized as a state of mind in w