The most uncommon subtype of schizophrenia is catatonia. Although this kind of mental disorder is the rarest of the schizophrenias, it is perhaps the most disturbing to the people inflicted with the illness, and also to the families and friends who encounter the devastating disorder. Whereas paranoid and unorganized schizophrenia are disorders that effect mainly thought and speech behavior, catatonic schizophrenia not only disables speech and thought processes, but it is also a physically disabling illness. Catatonic schizophrenics experience many of the same symptoms as the other types, especially loosely attached thought and speech patterns and paranoia. Added to these symptoms, catatonic schizophrenics also experience extreme shifts between excited and withdrawn, stuporous motor behavior. These opposing states of physical activity, and the pronounced motor gestures are what characterize catatonic schizophrenia.
In one experiment involving 250 patients, all with catatonic schizophrenia, 110 fall into the predominantly withdrawn class, 67 experience primarily excited symptoms, and 73 are considered mixed between behaving stuporous and excited (Morrison 1973).
The most common state of catatonia, stupor, is characterized by a loss of all animation, and motionless, rigid, unchanging positions. People in a catatonic stupor will become sometimes become mute and stare into space, remaining still for sometimes hours or days, even until the hands and feet become blue and swollen (Carson, et al. 454). Trying to awaken a patient out of a catatonic stupor is virtually useless. Usually he or she will not acknowledge their surroundings, and will not respond to stimuli. Although during the stupor seems to be completely “out there” and unconnected to reality, some patients can even retell the accounts of the stupor and the reason, and what they were thinking at the time. One patient who remained motionless with one hand froze in the air, parallel to the ground, came out of the stupor explaining that the forces of the world were battling on the back of his hand. He was deathly afraid that if he tilted his hand he would give the evil force an unfair advantage (Carson, et al. 454).
Some withdrawn patients are highly susceptible to suggestion and will obey commands or imitate actions, a condition known as echopraxia, or mimic phrases, also known as echolalia. Ordinarily, patients in a catatonic stupor will refuse to comply with even the slightest request and pay no attention to bowel or bladder control. Facial expressions are typically vacant, and skin texture appears waxy.
Schizophrenic patients with catatonia may suddenly switch from states of extreme withdrawn behavior to great excitement. During these episodes, they appear to be under great pressure to be active. Some patients become somewhat aggressive during this state. They tend to talk or shout excitedly and incoherently, pacing back and forth. It is not uncommon for patients to openly indulge in sexual activities, attempt self-mutilation or even suicide. The uncontrollable frenzy of these attacks make such patients dangerous to both themselves and others. Fortunately, these excited episodes are extremely rare and typically only last a few minutes or hours. However, cases have shown that a days’ or weeks’ endurance is not altogether impossible.