Occasionally, as a doctor, I am asked to see a patient in the emergency department who is completely mute. They sit motionless, staring around the room. I lift up their arm and it stays in that position. Someone takes a blood test and they don’t even wince. They haven’t eaten or drunk anything for a day or two.
Questions start running through your mind. What’s wrong with them? Would they respond to someone else? Do they have a brain injury? Are they putting it on? And – hardest of all – how am I to know what’s going on if they can’t tell me?Jonathan Rogers, “New Study Reveals The Inner Thoughts of People Mysteriously Frozen by Catatonia” at ScienceAlert (May 25, 2022)
And his biggest question is: Are they even thinking? He and some colleagues decided to try to find out via a large just-published study. Their conclusion?
In one of the largest studies of catatonia psychopathology and phenomenology to date, we studied the catatonic signs recorded in case notes of 1,456 patients with catatonia, examining the phenomenology in a subgroup of 68 patients with available data. Cases were defined on the basis of a minimum of 2 reported catatonic signs and we found that the total number of reported signs had a median of 3 with a maximum of 14. The most commonly reported signs were mutism, immobility/stupor and withdrawal. Excitement was less common, but when it did occur, the same catatonic episode also featured immobility/stupor in approximately half of cases. Cluster analysis generated positive and negative groups of clinical features, while principal component analysis led to the identification of three components, which can broadly be considered as parakinetic features, hypokinetic features and withdrawal. The parakinetic component was associated with women, younger age, neurodevelopmental disorders and longer admission duration; the hypokinetic component was associated with catatonia relapse; the withdrawal component was associated with men and mood disorders.
In terms of the phenomenology, there was a very varied subjective experience of catatonia. Less than half of the patients expressed fear, though a few expressed other forms of distress. Others had potentially meaningful explanations for the catatonia, which ranged from hallucinations to delusions to seemingly non-psychotic rationalisations. Affective and meaningful narrative explanations for catatonia were not mutually exclusive.Dawkins Eleanor, Cruden-Smith Leola, Carter Ben, Amad Ali, Zandi Michael S., Lewis Glyn, David Anthony S., Rogers Jonathan P., Catatonia Psychopathology and Phenomenology in a Large Dataset, Frontiers in Psychiatry, 13, 2022, DOI=10.3389/fpsyt.2022.886662 The paper is open access.
Put simply, when psychiatrists were able to get through to them, it turned out that they were thinking and, in Roger’s view, maybe thinking too much: “It’s not that people with catatonia have no thoughts — it might be that they have too many.” Perhaps their brains cannot handle all that their minds can think…
Some described experiencing overwhelming fear. Some were aware of the pain of staying rigid for so long, but, nonetheless, seemed unable to move. What we found most interesting, though, were those people who had – on one level – a rational explanation for the catatonia. One patient’s notes read:
“I met him kneeling on the floor with his forehead on the floor. He said he had adopted the position to save his life and kept asking to be seen by a neck doctor … He kept talking about his head falling off his neck.”
If you actually believed that your head was at imminent risk of falling off, maybe it wouldn’t be such a bad idea to hold it in place on the floor.
For others, it was voices (hallucinations) that were instructing them to do certain things. One person was being told that his head would explode if he moved – a fairly compelling reason to stay still. Another thought God was telling him not to eat or drink.Jonathan Rogers, “New Study Reveals The Inner Thoughts of People Mysteriously Frozen by Catatonia” at ScienceAlert (May 25, 2022)
Rogers describes the condition — reported to occur in more than 10% of patients with acute psychiatric illnesses — as “stuck halfway between neurology and psychiatry.” Greater awareness of what is going on
You may also wish to read: The “Morality Pill” hormone does not make people “nicer.” After an initial buzz as a “love hormone” we should all be dosed with, oxytocin started to reveal a big down side. Oxytocin can increase cooperation within a group but it also increases hostility to outsiders, research has shown.