Mutism

MUTISM, or mutacism (from Latin mutus—dumb/mute), is complete silence, muteness, observed in schizophrenia (catatonia) and in hysteria. In schizophrenia, it is a matter of negativism—of inhibition of the speech function along with the inhibition of other functions characteristic of schizophrenia. Patients not only remain silent but also resist examination: they clench their teeth if they need to show their tongue; they squeeze their eyes shut when one wants to examine their pupils; they look away if attention is directed at them; they do not answer greetings, withdraw when approached, hide under the blanket, do not offer their hand, etc. Catatonic stupor is also frequently observed. Sometimes, unexpectedly, the patient correctly pronounces whole phrases, while remaining silent for the greater part of the time. A hysteric suffering from mutism, on the contrary, is fully accessible to the examiner and willingly converses with them using writing. Distinguishing mutism from organic aphasia does not present significant difficulties. In schizophrenia, mutism sometimes unexpectedly disappears, while the rest of the time it is accompanied by general negativism; whereas in hysteria, the disorder is reduced to the absolute loss of only oral speech: the patient not only does not speak, but generally does not produce any sounds at all. At the same time, written speech is fully preserved; Charcot already noted as a characteristic sign of mutism in hysterics that such patients make no attempts to speak, but immediately grab a pen or pencil to answer a posed question, and they answer it quite satisfactorily. Understanding of speech, reading to oneself, etc., are also fully preserved; in a word, all speech functions are preserved with the exception of one—expressive speech. Such a dissociation of speech functions is almost impossible in organic lesions and should therefore immediately lead the examiner to the thought of the presence of a hysterical disorder. In hysteria, the onset of the disease is also characteristic: usually, the patient loses speech suddenly, after a fright or some other emotional shock. The return of speech also usually occurs suddenly, although in the majority of patients it then passes through a more or less prolonged stage of aphonia or stuttering. The pathogenesis of mutism is identical to the pathogenesis of schizophrenia and hysteria (see), as it is only a symptom of schizophrenia or hysteria. Here, the constitution of the patients, emotional shocks, and psychic contagion are of great importance. It should be especially noted that emotions in general have a great influence on speech: when agitated, the voice begins to tremble; when afraid, the "tongue sticks to the larynx," etc. With the appropriate predisposition, such a physiological reaction is simply fixed for an abnormally long period. The treatment of mutism coincides with the treatment of schizophrenia and hysteria. In hysteria, the elimination of the symptom itself by means of hypnosis or suggestion in a masked form does not present particular difficulties in the majority of cases; in schizophrenia, mutism usually disappears along with the disappearance of other symptoms of negativism, although in some cases it may continue for whole years (see Schizophrenia). Distinguishing schizophrenic mutism from hysterical mutism does not usually present great difficulties if one takes into account the usual psychogenic nature of hysteria and the endogenous nature of schizophrenia, as well as the general clinical picture of the disease and all other corresponding symptoms. Lit.: Faybushevich V., A Case of Self-Cure of Hysterical Mutism, Vrach. Gaz., 1927, No. 22; Froschels E., Stummheit bei erhaltenem Hörvermögen, Mitt. d. Gesellsch. f. inn. Med. u. Kinderheilk. in Wien, B. XII, 1913; Mc Dowall C., Mutism in the soldier and its treatment, J. of mental science, v. LXIV, 1918.