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DISCUSSION: Dr. David L. Rubinfine questioned the relationship of the content of the clinical vignettes to the formulations in Dr. Frosch's paper. He felt that the ruminations might better be explained on a basis other than that presented by Dr. Frosch. In one of the cases described by Dr. Frosch, Dr. Rubinfine viewed the ruminations as perhaps being partially understandable as the "worrying" of an individual who had been threatened and was correctly frightened. In general, he questioned whether the clinical data were adequate to support the theoretical formulations advanced. He felt that greater attention to formal aspects of the MRS would lead to a better understanding of this altered state of consciousness.
Dr. Harold Blum viewed Dr. Frosch's conceptualizations of the MRS as a useful clinical contribution. He saw the ruminations of the MRS as related to the expression of forbidden wishes and fantasies in a form consistent with psychological phenomena in other altered states of consciousness. The ruminative state occurs in a wide variety of personality types, including the obsessional, the narcissistic, and the depressive. The MRS may be said to be occurring at a time of "sleepy censorship," leading to a new psychic equilibrium. Dr. Blum went on to present excerpts from the Schreber case, to illustrate an instance when the MRS was seen to be just at the frontier between obsessive ruminations and delusional psychosis in a patient with a fragile ego organization. In Schreber's memoirs, obsessive ruminative-like fantasies of being a woman submitting to sexual intercourse were reported as occurring in periods of early morning awakening, just antecedent to Schreber's again falling into his psychosis. Dr. Blum contended that Schreber's MRS recapitulated an earlier altered ego state in both its formal and content aspects.