Thursday, 5 December 2013

Catatonia, and the Loss of Human Integrity

Yesterday a woman was brought to the ER by her family, because suddenly she "became all rigid". "Rigid", in patients' language, may mean anything from post-mortem rigidity to spastic paralysis to loss of muscle tone (i.e. weakness, but don't ask me why some would describe it as "rigid"). In my typical skepticism — a default position you'll automatically adopt when you work in a scientific environment — I approached the patient to check whether she was truly "rigid" as her family said.

This time the family was right: the patient's whole body was rigid, and although she was completely conscious, she was in a coma-like daze. She lied flatly on her back, eyes staring blankly onto the ceiling, mouth half-open as if in the middle of saying something. She didn't respond adequately to voice or pain stimuli, though she did produce some incomprehensible groans and mild twitching of some facial muscles. She looked like she was in a mental torture deep inside. I tried moving her arms into different positions, and her arms would stay in those positions, even in awkward poses against gravity (such as when I lifted up her left arm above her head to see whether it would drop down on its own). Her head and her legs, on the other hand, resisted any attempts to move them.

After I interviewed her husband to look for recent life stressors (there were plenty and rather significant stressors, according to the hubby) and ordered some blood tests (they all came back normal), so I concluded: this is a classic case of catatonia.

A bit about this condition:
Catatonia is a neuropsychiatric syndrome characterised by psychomotor symptoms, which may include mutism, gegenhalten rigidity, catalepsy ("waxy flexibility"), echolalia, and echopraxia.1 Catatonia may be caused by an organic etiology (diseases, brain injuries, drug side effects) or may be purely psychiatric. The syndrome exists on a spectrum in which it ranges from milder manifestations to life-threatening neuroleptic malignant syndrome.

Historically, catatonia was thought to be a unique manifestation of schizophrenia; however, it is now appreciated to be most commonly associated with affective (mood) disorders2, such as major depressive disorder, bipolar disorder, acute stress disorder, and PTSD.3-4
A catatonic patient often appears emotionless and unresponsive, but he's experiencing real emotional anxiety inside. Now imagine if this happens to the soul instead of the body. You become so depressed that you lose the ability to think, to move, to laugh, to cry, to pray. You experience extreme anxiety, you know or feel that there is something wrong, that you need to do something, but you are unable to express this need. Or, maybe your body does express it, yet in an unexpected and unorganised manner.

Or maybe catatonia IS the current state of man? After the Fall, we lost some of our preternatural gifts, one of them is Integrity. Integrity is when our human appetites and desires being completely submitted to reason; the loss of it leads to Concupiscence, that's when passions are no longer integrated under intellect.

Sin makes us cataleptic: now it is much more difficult for us to react accordingly and to discern properly; we are now less sensitive to God's warnings and callings, and to the sufferings of others; the power of the will has weakened because we tend to follow just about any external stimuli and be stubborn about it. Clearly, it is harder now to recognise good, and to repent and change. Without grace, even these become impossible.

What is sin but the absence or distortion of good? What is sin but catatonia, the soul and the flesh being misaligned in their will and purpose? "The spirit is willing, but the flesh is weak." (cf. Mat 26:41)  Good is a supernatural quality, and yet we must strive for it because it is actually our "normal" state; we are made for good, we are made for health and integrity, we are made for perfection.


Definitions of terms:
  • Mutism = inability to speak.
  • Gegenhalten rigidity = also called "paratonia", a form of hypertonia (excessive muscle tone) with an involuntary variable resistance during passive movement.
  • Catalepsy = muscular rigidity and fixity of posture regardless of external stimuli, as well as decreased sensitivity to pain. Symptoms include: rigid body, rigid limbs, limbs staying in same position when moved ("waxy flexibility", as if the body is made of wax), unresponsiveness, loss of muscle control, and slowing down of bodily functions, such as breathing.
  • Echolalia = immediate and involuntary repetition of words or phrases just spoken by others.
  • Echopraxia = involuntary repetition or imitation of another person's actions.

  1. Daniels J. Catatonia: clinical aspects and neurobiological correlates. J Neuropsychiatry Clin Neurosci 2009; 21:371–380.
  2. Philbrick KL, Rummans TA: Malignant catatonia. J Neuropsychiatry Clin Neurosci 1994; 6:1–13.
  3. Smith JH et al. Catatonic disorder due to a general medical or psychiatric condition. J Neuropsychiatry Clin Neurosci 2012; 24:198-207.
  4. Brasic JR. Catatonia. Medscape Reference 2013. [Online]. Accessed on 2013 Dec 5.

Image: "Soft Construction with Boiled Beans", by Salvador Dali, 1936

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