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B Y G E O R G E S. SPRAGUE~ M. D.
328
T H E FORCE C O N C E P T I N CATATONIA
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330
Not infrequently, these muscular expressions go even a step further in betraying their employment as substitute expressions for
what might otherwise be stated in ideational content or verbal utterance. Action patterns are very often observable which show
ambivalence, as when a patient starts to walk forward, blocks,
walks backward and seems unable to resolve the conflict. The occurrence of episodes of rigidity, in which antagonistic muscles are
simultaneously innervated, is a related phenomenon which expresses conflict in bodily terms instead of in the more usual verbal
form.
In the same individual at different times--as well as in contrasting one patient with another--a varying proportion was found in
the total energy output, between the use of wol:ds, ideas, and language on the one hand and nonverbal muscular innervations on the
other hand. While some patients expressed themselves fluently,
with adequate conversation, and used muscular bodily conduct in
a way closely approximating the usual, others could be arranged
in a series using less and less adequate language production and
depending correspondingly more and more upon the use of nonlanguage muscular innervations, progressively approaching the
completely stuporous reactions. Here we have indications of a
progressive ascendancy of muscular dominance in self-expression
over the use of the customary adult employment of ideational dominance.
Some of the details of symptomatology already referred to in
this paper represented the grosser physical manifestations, which
served to determine the Kraepelinian diagnostic entity of catatonia some decades ago. The case histories studied revealed such
phenomena in by far the greater majority of instances; but, as
might be expected with modern refinements of differential diagnosis, some of the patients in this group were diagnosed without having developed these grosser symptoms. In these cases, it became
important to scrutinize the evidences which lay within the psychic
realm, even before the more crudely obvious phenomena had developed. A state of bewilderment, from the slightest to the most
marked degree, appeared to be generally characteristic. Some patients were too perplexed to carry on coherent conversations or to
express themselves adequately, while others merely voiced differ-
GEORGE S. S P R A G U E , lV[. D.
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332
T H E F O R C E C O N C E P T IN C A T A T O N I A
GEORGE S. S P R A G U E 3 M . D.
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334
T H E FORCE C O N C E P T I N CATATOlqI&
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