And, indeed, I will ask on my own account here, an idle question: which is better—cheap happiness or exalted sufferings? Well, which is better?---Fyodor Dostoevsky ---Notes from Underground Fyodor Dostoevsky ---Notes from Underground Even now, so many years later, all this is somehow a very evil memory. I have many evil memories now, but ... hadn’t I better end my “Notes” here? I believe I made a mistake in beginning to write them, anyway I have felt ashamed all the time I’ve been writing this story; so it’s hardly literature so much as a corrective punishment. Why, to tell long stories, showing how I have spoiled my life through morally rotting in my corner, through lack of fitting environment, through divorce from real life, and rankling spite in my underground world, would certainly not be interesting; a novel needs a hero, and all the traits for an anti-hero are expressly gathered together here, and what matters most, it all produces an unpleasant impression, for we are...
Hope
To be human is to be a miracle of evolution conscious of its own miraculousness — a consciousness beautiful and bittersweet, for we have paid for it with a parallel awareness not only of our fundamental improbability but of our staggering fragility, of how physiologically precarious our survival is and how psychologically vulnerable our sanity. To make that awareness bearable, we have evolved a singular faculty that might just be the crowning miracle of our consciousness: hope.--
Erich Fromm
The interview is a part of a longer psychiatric interview series, produced for the Department of Psychiatry, School of Medicine, by the Motion Picture Division, Theatre Arts Department, University of California, Los Angeles in the year 1961. The young man is identified as patient number 18 .
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Catatonic schizophrenia is serious neurological or psychological condition in which two kinds of behaviors are typically displayed: stupor and motor rigidity or excitement. When people experience rigidity or stupor, they are unable to speak, respond or even move.
Different stories as to who patient 18 was and how his life turned out have emerged since the video became viral. These stories are interwoven from internet derived rumors and comments of those who supposedly knew him. Medical records on patient 18 are few. Below story looks like the most plausible one .
This man was my uncle. I'm not going to give any names, but for those of you who are concerned with how things turned out for him, not well. There's so much to address here. First let me say that he was being treated in this video with meds. Without the medication his mood ranged from complete delusion to catatonic. As for being gay, I don't think he had much of a sex drive at all. With or without meds. As for the idea that he was put here because he was gay by some unloving family, that's ridiculous.I don't have time to say all the things my family tried just to make his existence somewhat peaceful just for his own sake.
My family had a couple of openly homosexual and lesbians in it even back in the sixties and with the exception of my mother's father no one gave a shit. My uncle suffered with meds and even more without. After forty some odd years, most of which he spent in institutions, he took his own life by way of drug overdose. By the way, the comment about the plot twist, he never had a piano was funny because he didn't. His seeming obsession with piano came and went as did obsessions with religion, especially the Catholic Church and government. As far as I know he couldn't play a lick.
He was very ill at his best and a living shell at his worst. I hope that answers some questions because that's all I have to say on the matter. He's been gone since the late eighties and I really hope that other members of my family don't see this video, mostly because of the comments from people that somehow think they understand him better than the people who suffered with him. One last thing, I think people thought that he was talking about sitting or standing effeminately or something. No, he was talking about sitting or standing motionless for hours. Usually not even his facial expression would change but when it did it was usually related to something in his mind only. I really can't begin to tell you all how heartbreaking the whole thing was. He did seem intelligent and with meds he did remind me of a high functioning guy with autism I once met.
Catatonic schizophrenia was historically classified as a distinct subtype of schizophrenia characterized predominantly by prominent psychomotor disturbances. While it is no longer recognized as an independent diagnostic category in the current diagnostic manual (DSM-5), catatonia is now recognized as a specifier that can be applied to various mental health conditions, including schizophrenia, mood disorders, and medical illnesses.
Key Clinical Features
The presentation of catatonia involves a marked decrease, increase, or abnormal regulation of motor activity. Clinicians look for specific diagnostic criteria, of which a patient must typically exhibit three or more:
Catalepsy: Maintaining a rigid posture against gravity for an extended period, often regardless of discomfort.
Waxy Flexibility: Allowing a limb to be manipulated by another person into a position that the patient then holds indefinitely.
Stupor: A complete lack of psychomotor activity; the individual remains actively unresponsive to the environment.
Mutism: Little or no verbal response (provided there is no known physical aphasia).
Negativism: Opposing or failing to respond to instructions or external stimuli without an obvious reason.
Posturing: Spontaneous and active maintenance of a posture against gravity.
Mannerisms: Odd, caricature-like caricatures of normal voluntary actions.
Echolalia: Mimicking another person's vocalizations.
Echopraxia: Mimicking another person's physical movements.
Subtypes of Catatonia Presentation
Clinical presentations generally fall into two primary spectrums:
Hypoactive (Stuporous) Catatonia:
Characterized by immobility, mutism, staring, rigidity, and withdrawal. Patients do not interact with their surroundings and may require intensive nursing care to ensure basic nutrition, hydration, and physical safety.
Hyperactive (Excited) Catatonia:
Characterized by excessive, frenzied, and purposeless motor activity without environmental stimulation. This state carries significant physical risks, including exhaustion, hyperthermia, and cardiovascular collapse.
Differential Diagnosis and Medical Considerations
Because catatonic symptoms can arise from multiple etiologies, comprehensive medical evaluations are crucial to rule out life-threatening conditions:
Neuroleptic Malignant Syndrome (NMS): A potentially fatal adverse reaction to antipsychotic medications featuring autonomic instability, hyperthermia, and extreme rigidity that closely mimics catatonia.
Medical and Neurological Conditions: Encephalitis, autoimmune disorders (such as anti-NMDA receptor encephalitis), metabolic derangements, head trauma, and central nervous system infections can trigger catatonic states.
Management and Treatment
The management of catatonia requires prompt medical and psychiatric intervention:
Pharmacotherapy:
Benzodiazepines:Lorazepam is typically the first-line pharmacological intervention. High doses are often administered intravenously or orally to achieve rapid remission of catatonic symptoms.
Antipsychotics: Must be used with extreme caution or withheld during acute catatonia, particularly if NMS is suspected or if typical antipsychotics could worsen the motor rigidity.
Electroconvulsive Therapy (ECT):
ECT is highly effective for catatonia, especially in treatment-resistant cases, malignant catatonia (which features autonomic instability), or when patients fail to respond adequately to benzodiazepines.
Supportive Care:
Ensuring adequate hydration, nutrition, and prevention of pressure ulcers, deep vein thrombosis, and contractures resulting from immobility.
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