Studies in Forensic Psychiatry | Page 5

picture of dementia præcox. According to Raecke's view the
hysterical stupor is closely related to the Ganser twilight syndrome. Stuporous conditions
may introduce the latter, and, vice versa, Ganser complexes may creep into the stupor.
Raecke's stupor, like Ganser's twilight syndrome, frequently develops in criminals
immediately after arrest or as a result of great physical or psychic exertion. Sometimes
the stupor is preceded by convulsions, at other times by a prodromal stage of general
nervousness. In still other cases, unpleasant delusions and elementary hallucinations
precede the stupor, which may follow immediately after this prodromal state or may be
again preceded by a short attack of mania with clouded consciousness. In contrast to the
genuine catatonia, Raecke's stupor as well as Ganser's twilight state, are characterized by
a high grade of impressionability to things in the environment, which may at any time
suddenly cause a complete transition from an apparently deep stupor to normal manner
and behavior. Headaches, vertigo, and various hysterical stigmata are common to both
the hysterical stupor and the Ganser twilight state. At times recovery takes place suddenly,
but as a rule it is gradual and remittent in character. The duration of the disorder differs.
It may last for hours or months, and there generally remains a more or less pronounced
amnesia for the entire period of stupor.
Kutner,[8] in a work on the catatonic states in degenerates, describes this condition at
length. Although recognizing a good many hysterical features in these patients, he prefers
to place these catatonic conditions under the general group of the psychoses of
degeneracy. He does not add anything worthy of note to what Raecke had to say
concerning this mental disorder, but the differentiating points which he advances between
it and the genuine catatonia are of interest and should be mentioned here. Among these he
mentions, first, the development of the disorder upon a grave degenerative basis; second,
the sudden development of the psychosis as the immediate result of a situation strongly

affective in nature, such as a threatening or beginning prolonged imprisonment; third, the
more or less sudden disappearance of the entire symptom-complex upon a change of
environment; and lastly, the lack of secondary dementia. This absence of dementia cannot
be explained by mere assertions that these cases have perhaps not been followed out long
enough. Bonhoeffer kept account of some of these cases for as long as ten years, and in
none of them could he observe any sign of a deteriorating process.
It may, perhaps, be of interest to finally mention here Raecke's fantastic form of
degenerative psychosis, which is nothing more nor less than another attempt at describing
the original Ganser twilight state in a modified form.
It will be seen from the preceding that the disease-pictures described by Reich, Moeli,
Kutner, Ganser, Rish, and others, are so closely related that any attempt at separation
must of necessity be more or less of an artificiality. The question whether this condition,
because of certain isolated hysterical components, deserves to be considered as hysterical
in nature, is by no means solved. The mere presence of physical, so-called hysterical,
stigmata, is not sufficient to call a disorder hysterical. Bonhoeffer, who, in opposition to
such authors as Wilmanns, Birnbaum, Siefert, and others, insists that this so-called
prison-psychotic-complex in its narrower sense is of hysterical nature, does so because he
claims to be able to see in these patients the dominance of a wish factor, namely, the wish
to be considered insane, and consequently to be transferred to an institution for the
insane.
He explains the recovery of these patients upon being transferred to such an institution on
the basis of the fulfillment of this wish. My experience has been that it is very difficult in
most instances to differentiate these acute psychogenetic states from certain hysterical
conditions. Some of them show a good many hysterical symptoms, while in others such
symptoms are absolutely wanting. One of the cases herein reported illustrates this point
especially well. This patient was admitted to our hospital on two occasions, the first time
while awaiting trial on a charge of murder, and the second time soon after conviction and
sentence to life imprisonment. His first attack showed very little, if anything, of a
hysterical nature, while his second attack had so many features of hysteria that it could
hardly be considered anything but a psychosis of an hysterical nature.
CASE I.--E. E., Negro, aged 32 years. One sister insane, a brother is said to be subject to
convulsions. Patient's birth and childhood normal; attended school for three or four years,
where he made normal progress. He entered upon the life of a common laborer when
quite young, and always managed to earn a substantial livelihood for himself and family.
With the exception of typhoid fever at six or