On Stupor and Allied States*

American Psychiatry has many sins to answer for. For years it has lagged in its development behind other branches of medicine, blindly groping in darkness for some light, occupying itself with nonessentials, and contributing but little of genuine significance to the subject. Slowly, however, the pall is lifting from the valley and plain revealing a few men who, having outgrown the home of their intellectual childhood have become important figures in the up-building of psychiatry as a science. To this type of men belonged the late Dr. August Hoch, whose last work on “Benign Stupors”* represents his most important contribution, and a distinct development in American Psychiatry. Amid the confused babel of voices that one hears in the prevailing chaos of modern Psychiatry, it is a distinct relief to find a work which makes a definite attempt to reach a nosological delimitation by a careful and logical correlation of the clinical symptoms observed. For as regards diagnosis we are still on very uncertain grounds, largely because we have not developed a singleness of view. Where we do not know the cause of a psychosis, we arrive at the diagnosis on the basis of a given symptomatology, and we call one group of cases paranoia, another praecox, and so on. Where the cause of the particular group of symptoms is known, as in the case of paresis and alcoholic psychoses, the diagnosis is made on the basis of the etiological factor concerned, although the symptomatology may be quite diverse. Where a common symptomatology does not help us to understand the nature and the course of a disease, our diagnosis is made on the basis of prognosis and outcome; and we say that the recoverable psychoses must belong to the manic-depressive group, the malignant types to the dementia praecox group. Certain it is, as was long ago pointed out by Max Muller, that, “An empirical acquaintance with facts rises to a scientific knowledge of facts as soon as the mind