Comments and Criticisms

To the Editors:

A young American Indian man was found lying in apparent stupor on a couch in the waiting room of the outpatient clinic of a state mental hospital. He carried no identification and was alone. Patients in the waiting room reported seeing him carried in by other young men and laid on the couch. He was admitted as "John Doe". Skull films, EEG, blood and urine chemistry including toxic screening were all normal. As the patient was not entirely stuporous, but would respond to insistent shouted commands, and as he also demonstrated waxy flexibility, a diagnosis of catatonic schizophrenia was made. The patient spent all of his time standing motionless in the middle of the day room of the ward with mucous dripping out of his nose and an expressionless face. All neurologic reflexes were apparently normal. He was occasionally incontinent of urine and feces. At night on shouted commands he could be pushed into bed. For two weeks he remained in this state without eating or drinking. I would bring him special treats and drinks several times a day, but could not urge him to take them. Before resorting to nasogastric intubation, I called the Boston Indian Council and asked them to see him. Thinking that he had regressed to an infantile state, I hoped that by finding the food he ate in early childhood I could persuade him to eat. The Boston Indian Council representatives told me that his childhood food would be fried corn meal mush and instructed me on how to prepare it.

While an attendant pushed the patient into the ward kitchen, I fried corn meal mush and began to feed him by hand. I had tried to feed him many other things before, but he had refused to open his mouth. He did not eat the fried corn meal mush in great quantity, however. This occurred at 12 noon two weeks after his admission. At 3 p.m. he was walking around the ward with normal movements. At 5 p.m. he began to speak normally. At 6 p.m. he walked