Abstract
The scrutiny of this small group of patients, presenting a serious deterioration of insidious onset, reveals as outstanding factors the constitutional inadequacy of the individual patient and the unfavorable external factors which conditioned and frustrated him.
Two of the patients developed pulmonary tuberculosis, but the clinical picture and course in these 2 patients were not markedly different from those of the other 7 patients. One may say that in this group the physical examination revealed no adequate cause for the onset of the deterioration.
The clinical picture and course of the mental disorder in this group may be outlined as follows: The patient in adolescence or early adult life, without any adequate explanation in the way of physical illness or drastic change in the environment, begins to show a striking loss of sociability, initiative, interest and personal care. The course is as a rule steadily downwards, ending in a parasitic existence at a very low level.
With the abeyance of the superior functions, with the loss of social response, of spontaneity, and of interest, there occur, perhaps as release phenomena, reactions of a lower neurological level—meaningless smiling and laughter, explosive outbursts of anger, occasional autoerotism, mannerisms and grimaces, automatic movements. Memory may be retained to a surprising extent; incoherence is frequently noted but the patient is uncommunicative.
There is no special manifestation of basic urges, of underlying preoccupations, of repressed and dissociated factors. There seems to be a lack of vital energy associated with the egoistic as with the more complex social trends. The condition is one of defect rather than of conflict. In the comparative absence of tension, or turmoil, of compensatory strivings or phantasies, the clinical picture makes the impression of self-abandonment, of surrender, of acceptance of life at a lower automatic level. This surrender may be further evidence of the constitutional defect of vitality of the organism already indicated in childhood and made more manifest in face of the demands of the independent, mature, social life. The challenge of life to these underprivileged, poorly conditioned, and frustrated individuals is beyond their capacity. While others with somewhat different endowment react with hysterical or compulsive evasions, with affective slumps or sprees, with imaginative phantasies or regressive dramatisations, this group differently endowed reacts to the challenge with a simple surrender.
If we continue to retain these patients within the hospitable group of schizophrenia, it may be legitimate to characterize their special type of reaction as schizophrenic "surrender." In the further analysis of the conditions of this "surrender" the inadequacy or abiotrophy of component systems of the organism requires to be investigated and evaluated.
