THE MACMILLAN COMPANY
NEW YORK · BOSTON · CHICAGO · DALLAS
ATLANTA · SAN FRANCISCO
MACMILLAN & CO., Limited
LONDON · BOMBAY · CALCUTTA
MELBOURNE
THE MACMILLAN CO. OF CANADA, Ltd.
TORONTO
BY
AUGUST HOCH, M.D.
LATE DIRECTOR OF THE PSYCHIATRIC INSTITUTE OF THENEW YORK STATE HOSPITALS, WARD'S ISLAND, NEWYORK. LATE PROFESSOR OF PSYCHIATRY, CORNELLUNIVERSITY MEDICAL COLLEGE, NEW YORK
New York
THE MACMILLAN COMPANY
1921
All rights reserved
PRINTED IN THE UNITED STATES OF AMERICA
Copyright, 1921,
By THE MACMILLAN COMPANY
Set up and printed. Published July, 1921.
Press of
J. J. Little & Ives Company
New York, U. S. A.
TO
MY FORMER COLLEAGUES
IN THE
NEW YORK STATE HOSPITAL SERVICE
A word should be said as to the origin and historyof this book. When the late Dr. Hoch became Directorof the Psychiatric Institute of the New YorkState Hospitals in 1910, he found there an interestin just the kind of psychiatric research which it washis ambition to further. His predecessor, AdolfMeyer, had developed the conception that thepsychoses should be looked on as psychobiologicalreactions rather than rigid nosological entities andhad inculcated the habit of scrupulously thoroughexamination and record of what the patient said anddid. Meyer had broken away from the sterile habitof making diagnoses in accordance with the set termsused to label symptoms; and his work and that ofhis assistants thus led to a collection of valuablematerial which could serve as a useful starting pointfor the keen clinical investigation of Hoch. Specifically,attention had already been fixed on thestudy of the so-called functional psychoses, comprisingwhat are generally termed Dementia Præcox andManic-Depressive Insanity. An urgent problem inthis field was to separate different reaction types inorder to discover which were recoverable and whichchronic or progressive. In order to understandpsychological reactions, interrelation rather than[viii]mere coincidence of symptoms must be studied and,to aid in this, free use was made of the fundamentalprinciples of unconscious mentation as exposed inthe theories of Freud and his followers.
Almost at the outset it had been discovered thatmany patients presented clinical pictures that wouldnot fit into existing diagnostic pigeon holes. Dr.George H. Kirby, whose skill and industry had madethe most valuable contributions to the archives ofthe Institute, published in 1913 a brief paper inwhich he pointed out, not only that many cases with"catatonic" symptoms recovered, but also that clinicallythe behavior of stupor showed it to be relatedto manic-depressive insanity as well as dementiapræcox. Dr. Hoch took up the problem at this point.Using Dr. Kirby's material and adding to it hisearlier observations as well as current cases, he endeavoredto work out the essentials of the stupor reaction.It was his ambiti