[*] Read by title at the Sixth Annual Meeting of the American
Psychopathological Association, New York, N. Y., May 5, 1915.
BY ISADOR H. CORIAT, M. D. First Assistant Visiting Physician for Diseases of the Nervous System Boston City Hospital, Instructor in Neurology, Tufts College Medical School
THE complex construction of a psychoneurosis in an adult, due to the influence exerted by the multiplicity of factors of civilization and cultural advancement, is sometimes so bewildering as to almost defy all attempts at analysis. In children, the organization of a psychoneurosis is usually very simple, almost monosymptomatic, and in children too, we often discover these neuroses in the actual process of making. When adult life is reached, the individual has left behind him all the factors of his childhood life and all the repressed experiences and desires which tend to produce his adult characteristics. Among adults of primitive races however, where the mental organization is far less complex than that of civilized man, certain psychoneurotic disturbances are found, which if analyzed, might disclose the mental mechanisms of these disturbances reduced to their simplest terms.
It has been my good fortune to be able to secure data of this sort, pertaining to certain curious nervous attacks which occur among the primitive races of the Fuegian Archipelago. These facts were supplied me, following along the lines of a questionnaire, by the well known explorer Charles Wellington Furlong, F. R. G. S., who in 1907-1908, was in charge of the first scientific expedition to cross through the heart of Tierra del Fuego. Mr. Furlong's keen powers of observation, have made the data unusually complete. While he had no theory to offer in explanation of the attacks as seen among these primitive tribes, yet it is interesting to note, that certain of the facts corroborate the well-known ideas of sexual repression as elaborated by Freud. The mental organization of these people likewise, seems to substantiate certain psychoanalytic conceptions. For a clear comprehension of these attack, certain preliminary anthropological and geographical data are necessary.
The following data relates to the running amuck or outburst, among the
Yahgan and Ona tribes of the Fuegian Archipelago. This data was obtained in
1907 and 1908 during expeditions through the regions of the Fuegian
Archipelago.
The Yahgans, some forty years ago, numbered perhaps 2,500 but in 1908 had been reduced through contact with civilization and principally through an epidemic of measles to 173. These peoples are canoe Indians and inhabit today the island coasts from Beale Island to the Wollastons inclusive, in the neighborhood of Cape Horn; from about 54 degrees 50' S. Lat. to about 55 degrees 56' S. Lat., making them the southern-most inhabitants of the world. The Ona Indians, a taller and finer race physically, who are foot Indians, occupy the mountain and forest regions of southern Tierra del Fuego from approximately 53 degrees 50' S. Lat. to 55 degrees 3' S. Lat. The Onas formerly occupied the entire northern half of Tierra del Fuego and possibly numbered some 3,000, but through contact and warfare with the whites, who drove them south off the open lands of the north, they have been reduced to about 300. These peoples are of a light cinnamon colored skin, black haired, and of a decided Amerindian type. The Onas are above average stature, the Yahgans below it.
It is not an infrequent occurence for individuals among both the Yahgans and Onas to be subject to sudden outbursts of furor and violence. At such times the individual will generally dash from the wigwam and rush wildly away, and will continue running until nearly or completely exhausted. The one afflicted may dash madly through the woods or sometimes climb up dangerous cliffs. At such times, however, it is the custom of some of the men to follow closely behind to see that harm does not come through injury against trees, stumbling, or falling from the cliffs. However, at such times they rarely touch the afflicted one except to prevent harm, and finally will lead him back to the camp, when the attack is over or when he is exhausted.
While the attack occurs both among men and women, it seems to be more prevalent among men. The individuals in whom these attacks predominate are men in the prime of life, ranging from 25 to 35 years of age. These people are polygamous and as it is the custom for the old men to marry young girls, thus leaving the old women to the younger men, which in many instances causes a scarcity of women, it leaves a somewhat undesirable condition.
In many instances the character of the attack confines itself to the mad rushing away, as above described, at other times attempts to injure or kill others are made. For instance, a rancher of Tierra del Fuego, was in the company of some Onas when suddenly a hatchet whizzed by him, barely missing his head, and buried itself in a log of the Indian shelter. This was the result of an attack which seized upon one of the Onas who was afflicted thus from time to time. The actual outburst in this case was sudden, although it is difficult to tell how long it might have been coming on in the form of brooding, which seems to be a premonitory phase of this condition.
Concerning a personal experience with one of the early phases of an attack, Mr. Furlong states as follows:—"I am fully convinced that one night, while camping alone with Onas in the heart of the Fuegian forests, that my head man Aanakin, who had a good many killings to his credit, was brooding as he sat in his wigwam, which opened towards the fire; he watched me for nearly an hour with an attitude and expression which reminded me of the look a dog takes on sometimes before he snaps. Aanakin I knew to be of a very moody nature but this particular mood was so marked and portended evil so noticeably toward me without any apparent cause, that I decided to do something to break its mental trend. So putting fresh wood on the fire, to make a more brilliant blaze, I walked directly into his wigwam and motioned to one of his two wives, who were lying beside him. There was a passing look of half-anger, half-surprise, but I gave no time for his mind to dwell in the same mood, for simultaneously I produced my note book and pencil and began to make drawings of animals and other things they were familiar with. They like to watch one draw and name the thing, and so I kept them busy for perhaps an hour, and finally had them in gales of laughter. I am quite convinced that I forestalled an attack or a condition akin to it."
It seems that an attack usually begins suddenly. However, an instance is given where an Ona became moody and realized that one of these attacks was coming on and putting his hands together begged to have his wrists and feet bound in order that he would not do himself or others any harm, or that it would not be thought that he meant to kill and consequently be shot in self defence. This would in a way seem to indicate that there was no amnesia for the attack, as the Indian undoubtedly realized what he had done in previous attacks.
The moody state and the realization of what might follow as the attack comes on demonstrates a sense of uneasiness as the premonitory symptom of an attack, which ends in a state of utter exhaustion and sleep. The normal condition is resumed, practically on the awakening from sleep and recovery of strength.
From a description of Donald McMillan the explorer, the Eskimo Piblokto strongly resembles these attacks of the Ona and Yahgan Indians with the exception that Piblokto was particularly prevalent among the women.
How an attack begins is shown by the case of Aanakin, an Ona of Furlong's expedition. A certain form of melancholia, brooding or moodiness, seems to precede many of these attacks, with a realization sometimes that an attack is coming upon them. The Onas not being naturally a quarrelsome people, it may be that this realization and foreboding of the attack accounts for their tendency to run away from their associates, when they have endured the strain as long as they can, thus placing themselves in a position to avoid deliberate attack or injury to those about them.
It was further stated, in answer to the questionnaire—"I cannot give you absolute data regarding laughing or crying in an attack, screaming, yells, foaming at the mouth, biting of tongue, tearing of clothes, although I am of the opinion that any or all of these things may and do occur. As to violent resistance, the case, where the man wished to be bound, would show there was violent resistance, and it is probable that partly for this reason the Onas and Yahgans do not molest the afflicted except to prevent them from harming themselves, preferring to wait until the paroxysm exhausts them. I cannot state positively as to whether the attack is explained by the natives as being due to an evil spirit. While these people are polygamous, though having no religious form of worship, they usually believe when any one has a disease that something has entered them or some one who dislikes them has surreptitiously sent some small animal or an arrow into them. Among the Yahgans the 'Yuccamoosh' (doctors) or magicians proceed to pretend to extract these objects by a form of squeezing and hugging the patient, in the meantime blowing, hissing, etc., to force the object or evil out. I have never known of their doing this, however, to a person suffering from an attack.
"I am unable to supply any direct data as to the relation of love, hunger, sexuality, death of relatives or absent relatives to an attack. On the death of a relative the Yahgans go through incantations in the form of a sort of weird death chant, which they often sing in unison at certain times of the day and night. They paint their faces to show the death to strangers, but they rarely mention the name of the dead, in fact by most it is considered an offence to do so. They say simply 'He is gone,' 'He is no more'; they feel the loss of relatives very keenly and sorrow for them, and sometimes become violent with grief and rage.
"Regarding the primitive type of mental organization among these natives,—despite Darwin's first opinion of them, which was subsequently modified, I consider these people inherently intelligent, though of a very primitive type as far as their culture is concerned, probably the most primitive in this hemisphere, perhaps in the world, as the Onas are today living in the Stone Age. Dr. E. Von Hornbostel of Berlin University, who has collaborated with me in making a special study of my phonographic records of their songs, informs me that these songs are the most primitive American-Indian songs of which they have any record." Of importance for a clear understanding of the mental traits of these Indian tribes, as the source from which these attacks develop, are the study of their dreams, their system of taboos and their myths. So far as could be determined from the data supplied, the dreams of these primitive races strongly resemble the dreams of children, as these aboriginal tribes possess many childlike attributes. In fact up to a certain age the civilized child is really a little savage, with his strong egotism and feelings of rivalry, his taboos, his jealousies and his few or no altruistic tendencies. In the child as in the savage, the wish and the thought are synonymous, both want their desires immediately gratified, although such gratification may be impossible in reality. The dreams of the Yahgan Indians are simple wish fulfilments, without disguise or elaboration, like the dreams of a civilized child.
The Yahgan attitude toward death is the same as that of many primitive races. Any reference to death is strongly tabooed amongst them and to transgress this taboo, exposes the individual to grave danger and severe punishment, even the punishment of the thing tabooed. Thus the person who transgresses this taboo becomes himself taboo by arousing the anger or resentment of other members of the tribe. However, a certain ambivalent tendency seems to be present, for while the word death and the mention of the dead is prohibited, yet they feel deep grief and sorrow for dead relatives. Transgression of the taboo may arouse the other aspect of the ambivalent attitude, (for instance anger instead of sorrow) and it thus becomes a source of danger to the guilty individual and so by contagion and imitation to the community. This ambivalent tendency which leads to taboos is prominent among primitive races as well as in civilized children for instance, in the latter, the taboo of pronouncing certain words which leads to stammering or the taboo of objects possessing a sexual significance in producing kleptomania. As civilization and cultural advancement increase or as the child becomes the adult, the taboo tendency gradually declines, yet under certain conditions it may manifest itself as a psychoneurotic symptom. Since these particular primitive races have no conception of immortality, this taboo cannot be a religious or a moral obligation or prohibition, but a social phenomenon for the benefit of the tribe or for the physical welfare of the individuals comprising the tribe. Freud also has pointed out how the avoidence of the names of the dead because of fear of offence to the living is found among certain South American tribes.
A third factor of importance is a study of their myths. These are the savage's day dreams. The relation between myths and dreams is well known, both having their roots in the unconscious thinking of the race. In the individual this unconscious mental process produces dreams, in the race and society, myths. Only one instance will be cited, the legend of the Yahgan Indians concerning the creation of the first man and woman. When one of the tribe was asked how the first human being came into the world, he replied that a long time ago the first man came down from the sky on a rope and later, the woman followed. Here is a striking instance of how an adult Indian had applied his knowledge of individual births literally to a cosmic process, a genuine creation myth as a form of symbolic thinking. There seems little doubt in this case, that the sky, which to all savages appears like a bowl, represented the uterus and the rope, the umbilical cord. The resemblance of this myth to certain birth and parturition dreams, as encountered in the psychoanalytic investigations of civilized adults, is certainly striking.
How is this mass of material to be interpreted? The mental traits of these people, as shown by an analysis of their taboos, myths and dreams, are very primitive in organization, in fact, according to Mr. Furlong, they represent the most primitive types of culture in the world and are today actually living in the Stone Age. Individuals of such primitive mental traits have not learned to successfully repress their emotions and hence are liable to sudden emotional outbursts. Substitution and repression in civilized races are utilized to cover our complex and multifarious ways of expressing our social wishes and wants. In the savage there is little or no repression and substitution, because his desires are simple and easily satisfied.
These primitive people therefore resemble children, without inhibitions or repressions and hence their attacks of violence and furor as above described are sudden emotional reactions, perhaps hysterical, but without any phenomena of conversion. The relation of the attacks to an unsatisfied sexual craving is shown by the fact that the attacks occur only in young men whose libido remains unsatisfied, because according to tribal custom they are compelled to marry old women, or, in the words of the explorer who lived among these people, "old derelicts." This factor, combined with the observation that the victims of the attacks are free from loss of consciousness and amnesia and the absence of an absolute evidence pointing to foaming at the mouth or biting of the tongue, would seem to indicate that the outburst was hysterical rather than epileptic in nature. It would thus correspond to the Piblokto of the Eskimos as described by Brill. This resemblance was also noted by the explorer in his comparative description of the two disorders.
It seems that the attacks themselves are motivated, not so much by the actual gross sexual as by an ungratified or only partially gratified love which would occur in a man who is compelled by social and tribal custom to marry an old woman. Among the Eskimos this factor is at work in the women, among the Fuegians in the men. Conversion phenomena were absent, because their mental organization is very simple, in the same way that childhood hysteria is free from conversion symptoms or at the most is monosymptomatic.
A. Brill—Piblokto or Hysteria among Peary's Eskimos. Journal of Nervous and Mental Disease, Vol. 40 No. 8—1913.
S. Freud—Totem und Tabu—1913.
E. Kraepelin—Vergleichende Psychiatrie. Centralblatt f. Nervenheilk. U.
Psychiatrie. Bd. XV. July, 1904.
The Ohio State University
THE first case here reported came to the notice of the writer through the attending physician; the second case was reported by the father of the child after the attending physician had failed of satisfactory treatment. The second case is especially interesting and serviceable in connection with the phenomenon of visual space perception.
The first case is that of a boy, nine years of age, healthy, vigorous, who in his play ground and street reactions parallels that of any normal boy of his age. Aside from measles and an occasional disturbance of digestion he has been singularly free from childhood's common diseases. The father and mother are strong Hanoverian Germans holding with puritanic strictness to the dogmas of the Lutheran religious faith. So far as is ascertainable there can be no question of faulty inheritance, at least not so far as the immediate parents and grandparents enter into the problem.
The child upon retiring and usually while still wide awake uttered wild screams of terror. Upon inquiry the child complained of falling and clutched vigorously to the bed clothes and the arms of the parents. Usually the phenomenon disappeared when he was taken out of bed and walked about but reappeared when he lay down. He complained of pain in his eyes, neck and fore- and after-parts of his head. No amount of persuasion dispelled the illusion. It should be emphasized that the illusion occurred in full waking state and rarely as a dream.
An attempt was made to correlate the illusion with the momentum of the day's activity. According to the parents the illusion appeared in aggravated form when the neighborhood boys congregated in a cluster of trees at the edge of the village and when playing "train" in which case the barn-top functioned as the locomotive while a high board fence and an adjoining neighbor's barn functioned as the cars and caboose respectively.
The village physician offered no explanation. He prescribed a hot bath and a "closer supervision of the evening meal." The dilatation of the cutaneous capillaries consequent to the bath lowered the cerebral circulation and to some extent reduced the intensity of the illusion.
The cue to the cure appeared when the child, in expressing his fear, complained because he could not see the parent who sat beside him on the bed. Upon lighting the room the child seemed pacified but still held tightly to anything within reach. As a rule the illusion disappeared within thirty minutes after illumination. It was then suggested that the child be put to bed in a well lighted room. This was done but the phenomenon reappeared although in a less aggravated form. Degree of illumination and intensity of the illusion appeared related. The phenomenon failed to appear at all when a coal oil lamp was placed beside the bed not over two feet from the child's head. For six months the boy went to sleep facing the full glare of the lamp. Gradually the lamp was removed until it occupied a position in the hall. Whenever the illusion recurred the lamp was replaced in its original position.
It is quite probable that the intensity of the visual stimulus (the lamp) deflected the nervous current from the neural processes underlying the illusion and thus changed the direction of attention. Any intense distraction, other than the one employed, would probably have served the same purpose. At the end of a year and a half the phenomenon entirely disappeared.
The second case is that of a six-year-old girl, the daughter of highly educated parents. With reference to this case two interesting phenomena were observed: (a) that of mirror-writing of the common variety and (b) that of ambiguous interpretation of the retinal impressions.
The phenomenon of mirror-writing here observed parallels that of many other cases in which the left-right direction is reversed. These commoner cases take on an added interest when considered in connection with a case of double space inversion. Such a case is on record.[1] The double inversion consists in writing all verbal symbols and digits up side down and backward. In this case the boy had perfect pseudoscopic vision at the beginning of his school work. Stratton, by a system of lenses, artificially produces the same distortions and throws some light on the phenomenon.[2]
[1] G. F. Arps, a Note on a Case of Double Space Inversion. Annals of Ophthalmology, July, 1914, Vol. XXIII, p. 482.
[2] Psychological Review, Vol. IV, pp. 341-360 and 463-481.
It is in the phenomenon of ambiguity in the interpretation of the retinal eye processes that this case finds its value. At the dinner table the child complained of the decrease in size of a number of objects in the room, especially was this true of the apparent size of the father's head. The frequency of the complaint led the father to seek the advice of an occulist who pronounced the child's vision perfect in every way. Over and over again while seated at the dinner table the child would exclaim, "O father how small your head is!"
The explanation of this phenomenon is found in the method employed to dispell the illusion. It was suggested that, at the moment of the appearance of the phenomenon, the child be requested to fixate the end of the father's index finger which was revolved, in the air, to form various geometrical figures. This had the desired effect. Clearly we have here a case of the object altering its apparent size without altering its distance. Under normal conditions a change in size is followed by a corresponding change in the distance. It is probable that we have here inadequate convergence and that the optic axes do not intersect at the object but beyond, so that the axes are more or less parallel. Thus the feeling of convergence is less intense than experience teaches is necessary to perceive the object as such a size and at such a distance. If degree of convergence is a criterion for distance and if distance is a measure for the apparent size of an object then we have the conditions necessary for the appearance of the illusion.
Here we have the retinal image constant for the apparent and the real size of the object (head). Obviously the retinal processes are constant for the two interpretations of magnitude and the ambiguity is due to the concomitant factor of convergence.
The conditions necessary to decrease the real size of an object while still maintaining an unaltered image are produced without artificial means. Wheatstone, a long time ago, arranged his stereoscope so that a negative correlation obtained between the degree of convergence and size of the retinal image.[3]
[3] Philosophical Transactions, 1852.
Very interesting is the fact that Stratton demonstrated by artificial means what was naturally the case in that of the boy reported in the Annals referred to above. Wheatstone demonstrated by artificial means what was naturally the case in that of the girl here reported.
FEEBLE-MINDEDNESS, ITS CAUSES AND CONSEQUENCES. By H. H. Goddard. The
Macmillan Co., N. Y., 1914. 599 pp., illustrated.
Two comprehensive attempts have been made in recent years to study the inheritance of mental abnormality, one in England at the Eugenics Laboratory of the University of London, the other in this country under the leadership, more or less immediate, of the Eugenics Record Office. Both the English and the American school of workers agree that different grades of mental ability, mental defect and insanity are strongly inherited. But the two schools have reached very different conclusions as to the manner of inheritance of mental traits and mental defects. Each school entertains profound disrespect for the scientific methods and conclusions of the other and with the frankness and honesty which devotion to truth demand has freely criticised the other. By this criticism, at the bottom friendly though sometimes caustic, science has undoubtedly profited. The later work of each school begins to show the chastening influence of adverse criticism.
The English school has leaned backward in its devotion to the inductive method of accumulating inheritance data, ostensibly without prejudice for or against any particular theory but in reality with an ill-concealed bias against anything savoring of "Mendelism." The American school recognizing in Mendelism a great advance and an important instrument for the discovery of new truth, has ignored the possibility that other undiscovered laws of heredity may exist and has cast aside as superfluous the valuable biometric tools wrought with much patient toil by Galton and Pearson. It will be the part of wisdom for students of genetics to imitate the hostile attitude of neither school, but to utilize the positive results of both. This is what Dr. Goddard has done in the work under review.
He apparently began studying the inheritance of feeble-mindedness without theoretical prejudice, but with a practical end in view, to discover, if possible, the causes of feeble-mindedness so as to deal intelligently with the inmates of the Vineland (N. J.) institution with which he is connected. Goddard received inspiration and suggestion from the Mendelian principles which dominate the work of the Eugenics Record Office, but has published his observations in detail so that the reader may test by them any theory he likes. This method can not be too highly commended for it gives permanent value to the publication, however much prevailing theories may change. The book contains a detailed study of 327 "cases," each being the family history of a different inmate of the Vineland institution, as made out by trained investigators who visited the homes of the inmates and held interviews with their parents, relatives, friends and neighbors. English criticism of American work of this sort had prepared the reader to expect carelessness of method and inaccuracy in the accumulation of data, but Dr. Goddard is evidently on his guard against this. He goes very fully into the method of obtaining and verifying the data, and in doing so gives a very strong impression that the data are "reliable." His treatment of the data is also cautious but thorough, so that when he works his way to a conclusion it stands firmly established. The conclusions reached are numerous and important, but the one of greatest theoretical interest is this, that feeble-mindedness is inherited as a simple recessive Mendelian unit-character. This conclusion, so far as earlier publications were concerned, might be regarded as insufficiently established, but the evidence presented in this work renders it, I think, beyond question. Goddard was himself apparently considerably surprised at the conclusion reached. He had expected to find different kinds or grades of mental defect independently inherited as units and confesses to leanings toward views of the physiological independence of different mental functions, but his "cases" give him no evidence of such inheritance. He finds only that feeble minds are minds of arrested development in regard to all functions, and that different grades of feeble-mindedness correspond with different stages of normal mental development completely arrested. How different grades may occur in one and the same Mendelian unit is apparently a puzzle to Goddard, who does not attempt its explanation. It is indeed an absurdity to the "pure line" Mendelian, but not to one who appreciates the fact that Mendelian units are subject to quantitative variation sometimes continuous, sometimes discontinuous. An example of the former is found in the hooded pattern of rats,[4] of the latter in albinism and other Mendelizing characters which assume multiple allelomorphic conditions.[5] Pearson has steadfastly refused to admit that albinism in man is a Mendelizing character, because it may assume various forms ranging from colorless to quite heavily pigmented conditions (blondes). We now find that albinism in guinea-pigs shows an even greater range of variation,[6] yet there can be no doubt of its fundamental unity as a Mendelian character, each grade of which is allelomorphic to every other grade and to normal pigmentation.
[4] Castle and Phillips, 1914, Publ. No. 195, Carnegie Inst. of Wash.
[5] Castle and Fish, Amer. Nat., Feb., 1915.
[6] Wright, S. Amer. Nat., March, 1915.
Goddard's findings as regards feeble-mindedness fit in perfectly with this scheme. That Goddard was unaware of it when his conclusions were reached is all the more evidence of their soundness because it shows that they were reached independently. Among albinos every higher grade of pigmentation dominates all the lower grades in inheritance, and so apparently it is with mental development; the higher grades dominate the lower. At every point there appears to be agreement in method of inheritance between albinism and feeble-mindedness. Each is a unit character but showing graded allelomorphic conditions which correspond probably with different stages of arrested development of pigmentation or mentality respectively.
The fact noted by Goddard that the feeble-minded resemble savages, that is backward races of low mentality, has much interest to the student of evolution. It indicates that the evolution of intelligence has occurred by a gradual progressive advancement, stages in which reappear as the higher grades of feeble-mindedness. Of course it is not certain that the ontogenetic stages, at which mental development may be arrested, correspond accurately with earlier phylogenetic stages, but the idea receives considerable support from the observed resemblance between the mentality of morons and that of savage peoples, if the observation may be accepted as accurate. I do not understand however that Goddard makes any claim to first-hand familiarity with the mental life of savages, so that no great emphasis should be laid on the point. But the mere fact that RETROGRESSIVE variation in mentality is GRADED favors the view that its PROGRESSIVE evolution has been gradual, rather than the view that it has arisen by mutation or sudden loss of inhibitors. (Bateson, Davenport).
Goddard points out that a high grade moron may be a useful and self-supporting member of society in some environments (usually rural) whereas he would be quite helpless in the keen competition of urban life. This suggestion leads the reader to wonder whether many peasant and peon populations of the old and new world represent survivals of an older and lower grade of mental evolution than has been attained in the more advanced nations, or whether it is merely lack of opportunity that makes these populations backward. The fact that in every generation great men come from the lower social levels shows that the lower classes are not entirely devoid of capacity; nevertheless it seems probable that a low grade of intelligence would stand a better chance of escaping elimination in the struggle for existence when placed in a simple environment than when placed in a complex one. Consequently, under modern conditions, we might expect a peasant or peon population to average lower in mental capacity than a community more advanced in civilization. Whether the peasant population would equal in average intelligence a band of North American Indians or a tribe of native New Zealanders is very doubtful, for in such peoples natural selection for intelligence was undoubtedly severe because of their intense struggle with nature and with other tribes, unaided by the accumulated knowledge and tools of civilized communities. Among such peoples greater demands were probably made on inborn intelligence than among modern industrial populations.
As regards the CAUSES of feeble-mindedness Goddard's findings are wholly negative, but not less valuable on that account. His case histories statistically studied indicate no causal relation to a number of reputed agencies in the creation of feeble-mindedness, such as alcoholism (which he regards as oftener a symptom than a cause), tuberculosis, sexual immorality, insanity, syphilis, accident and consanguinity. He recognizes HEREDITY as its principal source, i. e. he recognizes feeble-mindedness as a stage of mentality already existing and transmissible by the ordinary mechanism of heredity, but does not attempt further to account for it, either as a survival or as an atavism.
That humanitarian governments by shielding and supporting the moron without putting a limit on his naturally high reproduction will speedily increase this class at the expense of the more intelligent classes of the community is self-evident, if it is admitted that feeble-mindedness is hereditary, as all who have investigated the matter carefully now declare. Goddard shows further that a large percentage (probably more than half) of the alcoholism, pauperism, prostitution, and crime, of the United States are directly traceable to hereditary feeble-mindedness, another strong reason for taking measures to reduce it.
How is this to be done? Goddard has no cure-all to offer but urges first of all that the mental grade of each individual be accurately determined and education and occupation be provided suited to his capacity. This will tend to make the moron a useful and contented member of the community, not a menace to it. Segregation is recommended so far as practicable, but in view of the large number (estimated at 300,000 to 400,000 in the U. S.) Goddard considers segregation of all impracticable. Nevertheless he urges further and energetic efforts in this direction, that as many as possible may be segregated as a safeguard against their reproduction. In individual cases "sterilization wisely and carefully practiced" must be employed to insure non-reproduction.
In this volume there is a pleasing absence of the rant which pervades some eugenic literature. The author has something of importance to contribute to science and he presents his contribution in a sober, dignified manner in keeping with the important character of his contribution. W. E. CASTLE.
CHRISTIANITY: THE SOURCES OF ITS TEACHING AND SYMBOLISM. By J. B. Hannay.
(Francis Griffiths, London; pp. 394).
This is an attempt to expound the symbolism of the Christian religion. It is divided into three main parts: ancient cults (phallism and sun worship); ancient cults in the Old Testament; ancient cults in the New Testament. The author's main thesis can be stated in a sentence: the essential constituents of every religion, and the underlying meaning of its symbolism, are phallicism and sun worship. Of these the former is the more important, more primary, and more wide-spread; the latter is a superimposed layer better adapted to more civilized and educated people, but rarely penetrating into the hearts of the common people to the extent that the former has. "The great branches under which all the religious systems of the past have developed may be classed as based, on the one hand on the consideration of our world and the continuity of life upon it, expressed in Phallic symbolism, and on the other hand, on the Sun as the great giver and sustainer of man, expressed in Solar symbolism." (p. 21). "As the Phallic cult was much the older, it retained its position after the rise of the Solar cult. It required a much higher intelligence to grasp the facts of Solar worship, so it never entered the 'hearts' of the common people as did the Phallic worship, but it had a much more intelligent priesthood, and was the arbiter in all questions of dates, and regulated al) feasts; and, what was more important to the people, fixed the time for payments of debts or interest, and regulated the times of sowing and harvesting, so it became a much more 'official' religion than Phallism." In support of these conclusions the author marshals a huge number of facts, so that the work becomes a veritable encyclopaedia of symbolism.
Now in spite of the fact that the reviewer fully accepts the main thesis of the book, as stated above, and therefore has no prejudice or hostility on the score of the conclusions encunciated being distasteful, his judgment of the book is entirely unfavourable, for the following reasons: In the first place, any presence of the book to be a scientific, and therefore impartial, contribution to knowledge is invalidated by the author's moral bias evident from beginning to end, against religion in general, and Christianity in particular, which he maintains is the most phallic of all religions. His point of view is that of the older rationalists, to whom religion is nothing but an unfortunate instinct for "delight in the miraculous," expressing itself in phallic and sun worship, and fostered by the exploiting tendencies of priests. His desire seems to be, in writing the book, to "show up" religion and, by discrediting it, hasten its end.
In the second place, there is not a single new idea in all its closely packed pages, and therefore no excuse for writing them, since the material here laboriously brought together is easily accessible in other books. It never seems to dawn on the author that pointing out the sexual basis of religion, which countless other writers have already done, is but the beginning of the problem, the starting-point of all sorts of complex riddles. Having dogmatically divided all religious symbols into male and female, he is self-satisfied enough to think that he has explained religion. There is no inkling of the points of view suggested by such words as determinism, significance, genesis, so familiar to the modern psychologist.
Side by side with all this goes a disorderly arrangement and very imperfect powers of criticism. The latter feature is especially marked in the field of etymology, where the author fairly lets himself run wild. The following gem is a typical example (p. 110): "Bacchus became degraded into the God of Wine, and his fetes became drunken orgies, but he was originally the beneficent sun who ripened the fruits, and hence God of Wine, from which, indeed, is derived the English name of all our gods, angels, prophets, or even parsons,—"divines," "dei vini," "Gods of Wine." Jesus was the "True Vine."
The merits of the book are that it may direct the attention of some people to the connection between sex and religion, if there are any who are still unaware of this, and that it possesses a good index that may be useful to readers with limited facilities for looking up particular symbolisms; it is also well illustrated. ERNEST JONES.
LAUGHTER: AN ESSAY ON THE MEANING OF THE COMIC. Henri Bergson. Translated by C. Brereton and F. Rothwell. (Macmillan, London, 1913. Pp. 200).
In this stimulating little book Professor Bergson propounds his theory of the comic, which is shortly to the following effect. Noting first that laughter is purely a human phenomenon, and therefore probably has a social significance, he seeks for this by trying to define what are the essential features of the comical. He reduces the various characteristic features in the main to one, namely, automatism on the part of the comical person or thing. This automatism is of a special kind; especially is it an automatism that is out of place, that occurs at the expense of spontaneity, vitality, and freshness. It may thus be defined as "something mechanical in something living," "a kind of absentmindedness on the part of life." "The comic is that side of a person which reveals his likeness to a thing, that aspect of human events which through its peculiar inelasticity, conveys the impression of pure mechanism, of automatism, of movement without life." "To imitate anyone is to bring out the element of automatism he has allowed to creep into his person. And as this is the very essence of the ludicrous, it is no wonder that imitation gives rise to laughter. "This bald statement of Bergson's conclusion is, in the reviewer's opinion, made very convincing by the delicate analysis he proffers of numerous illustrations.
Up to this point Bergson's theory of the comic fairly well coincides with that of Freud. The latter author, it is true, summarises his conclusions in different language. But the meaning is not very different. For him the feeling of comicality is an "economy of ideational expenditure," and it is evoked by the sight of another person who in a given performance displays either a lack of mental activity or an excess of physical, i.e., who is either stupid or clumsy. Compare this formulation with Bergson's. The latter says that the opposite of the comic is gracefulness, rather than beauty. "It partakes rather of the unsprightly than of the unsightly, of rigidness rather than of ugliness." The replacement of mental by physical activity is insisted on in the following passage: "Any incident is comic that calls our attention to the physical in a person, when it is the moral (i. e. mental) that is concerned." Again, he compares a comical person to "a person embarrassed by his body." His automatism is essentially a lack of mental nimbleness, a formal lack of mental elasticity, a defective capacity for rapid adjustment, in short, a mental laziness. And especially is this defect one of consciousness. The failure is on the part of the higher mental activities, which should be the most alert, and what happens is a relapse into unconscious, automatic modes of functioning, a form of absentmindness. "The comic is that element by which the person unwittingly betrays himself—the involuntary gesture or the unconscious remark. Absentmindedness is always comical. Systematic absentmindedness, like that of Don Quixote, is the most comical thing imaginable . . . . . . . No one can be comical unless there be some aspect of his person of which he is unaware, one side of his nature which he overlooks; on that account alone does he make us laugh."
In substantial agreement on this general conclusion as to mental rigidity and bodily clumsiness, the two views diverge from here. According to Bergson, the comic presupposes "something like a momentary anaesthesia of the heart;" "laughter is incompatible with emotion." For Freud this absence of emotion is much more characteristic of humour than of the comic, two matters that Bergson quite fails to distinguish. Then, whereas Freud explains the subjective side of the comic purely on hedonic principles, Bergson sees in it an important social function. According to him, laughter is one of society's weapons for dealing with tendencies that threaten to diverge from the conventional and accepted norm. It "restrains eccentricity" and "corrects unsociability." "Any individual is comic who automatically goes his own way without troubling himself about getting into touch with the rest of his fellow-beings. It is the part of laughter to reprove his absentmindness and wake him out of his dream . . . . Each member must be ever attentive to his social surroundings; he must model himself on his environment; in short, he must avoid shutting himself up in his own peculiar character as a philosopher in his ivory tower. Therefore society holds suspended over each individual member, if not the threat of correction, at all events the prospect of a snubbing, which, although it is slight, is none the less dreaded. Such must be the function of laughter. . . . It represses separatist tendencies." "Unsociability in the performer and insensibility in the spectator—such, in a word, are the two essential conditions." This interesting theory leaves some questions unanswered. Why, for instance, should onlooking society remain emotionally cold in one case, and merely laugh, and in another case adopt much graver measures? Bergson deals with this point rather imperfectly. It is not the seriousness of the case that decides, for "we now see that the seriousness of the case is of no importance either: whether serious or trifling, it is still capable of making us laugh, provided that care be taken not to arouse our emotions." Nor is it the immoral nature of the deviation from the normal. "The comic character may, strictly speaking, be quite in accord with stern morality. All it has to do is to bring itself into accord with society." "It is the faults of others that make us laugh, provided we add that they make us laugh by reason of their UNSOCIABILITY rather than of their IMMORALITY." The most specific criterion seems, in Bergson's opinion, to be that of vanity. "It might be said that the specific remedy for vanity is laughter, and that the one failing that is essentially laughable is vanity."
We may briefly refer to some other matters dealt with more incidentally; wit, and the relation of the comic to art and to dreams. The discussion of wit is perhaps the weakest part of the book. No analysis is given of the different forms of wit, and the important subject of what may be called its technique is quite passed by. Wit is identified in a superficial manner with the comic in general, the fundamental differences between the two, which Freud has dealt so exhaustively with, being altogether ignored. Bergson gives a more interesting and profitable study of the relation of the comic to art; especially of the nature of comedy as distinct from other forms of drama. According to him, comedy portrays character types rather than individual persons. He repeatedly insists on this point, adding that "it is the ONLY one of all the arts that aims at the general; so that once this objective has been attributed to it, we have said all that it is and all that the rest cannot be." Further, "comedy lies midway between art and life. It is not disinterested as genuine art is. By organizing laughter, comedy accepts social life as a natural environment, it even obeys an impulse of social life. And in this respect it turns its back upon art, which is a breaking away from society and a return to pure nature. "The discussion of the relation of the comic to dreams is, on the other hand, less satisfying. Comic absurdity is stated to be of the same nature as that of dreams. The main point of resemblance seems to be that in both cases there occurs an absence of social contact. In both there is a mental relaxation from the effort of "seeing nothing but what is existent and thinking nothing but what is consistent." This really applies much more to wit than to the comic itself.
As may be expected, the whole book is written in Professor Bergson's pleasing style, and is full of suggestive hints and fresh points of view. The most significant contribution, one which pervades the book throughout, is the view of laughter as a social censor. Even if this hypothesis is substantiated by detailed investigation, however, it cannot rank as a complete theory of laughter, or of the comic, until it is supplemented by some explanation, not given by the author, of the most striking feature of laughter, its capacity for yielding pleasure.
It only remains to say that the translation is literally excellent. ERNEST
JONES.
ADDRESSES AND PAPERS AT THE OPENING OF THE PHIPPS PSYCHIATRIC CLINIC, JOHNS
HOPKINS HOSPITAL. The American Journal of Insanity, Special Number, Vol.
LXIX, No. 5. The Johns Hopkins Press, 1915.
This special number of the American Journal of Insanity contains the exercises and papers delivered at the opening at the Phipps Psychiatric Clinic at the Johns Hopkins Hospital, Baltimore, Md. The contents of the entire volume should prove to be of the greatest interest to all students and lovers of psychiatry. The volume opens with a brief but fitting Introduction by Dr. Adolf Meyer, Director of the Clinic, a man to whom American psychiatry owes so much for the stimulus and inspiration which he has injected into others. This is followed by A Word of Appreciation by Henry D. Harland, President Trustees, The Johns Hopkins Hospital, some brief remarks on The Psychiatric Clinic and the Community by Stewart Paton, the heart-to-heart talk on Specialism in the General Hospital by Sir William Osler, and a short talk on The Purpose of the Psychiatric Clinic by Prof. Adolf Meyer. There then follow a series of fascinating and inspiring papers, as follows: The Sources and Direction of Psychophysical Energy, by William McDougall; Autistic Thinking by E. Bleuler; Personality and Psychosis by August Hoch; The Personal Factor in Association Reactions by Frederic Lyman Wells; A Study of the Neuropathic Inheritance by F. W. Mott; On the Etiology of Pellagra and its Relation to Psychiatry by O. Rossi; Psychic Disturbances Associated with Disorders of the Ductless Glands, by Harvey Cushing; Primitive Mechanisms of Individual Adjustment by Stewart Paton; Demenzprobleme by K. Heilbronner; The Inter-relation of the Biogenetic Psychoses by Ernest Jones; Prognostic Principles in the Biogenetic Psychoses, with Special Reference to the Katatonic Syndrome by George H. Kirby; Anatomical Borderline between the So-called Syphilitic and Metasyphilitic Disorders in the Brain and Spinal Cord by Charles B. Dunlap; and Mental Disorders and Cerebral Lesions Associated with Pernicious Anemia by Albert Moore Barrett. The number is concluded by the penetrating Closing Remarks of Prof. Adolf Meyer.
The papers by Mott, Rossi, Cushing and Heilbronner are of the greatest interest. The discussions by McDougall and Bleuler are fascinating and uplifting. McDougall's paper is a masterpiece. Kirby, Jones and Hoch present us with the modern standpoints in the conception of the psychoses. Throughout the volume one sees the adoption of the broad biological standpoint in mental life. The adoption of the term "biogenetic psychoses" is indicative of the general trend. The adoption of this well-chosen phrase is, I venture to suggest, the product of Dr. Meyer.
The reviewer regrets that the papers do not very well lend themselves for brief reviews. Furthermore, he would not attempt to briefly present the views which have been so lucidly and succinctly expressed by the individual writers.
Prof. Meyer is to be commended for the very splendid program presented at the opening exercises of the Phipps Psychiatric Clinic.
May it be a lasting inspiration for those who drink at the fountain of psychiatry and psychopathology. MEYER SOLOMON.
SLEEP AND SLEEPLESSNESS. By H. Addington Bruce. Pp. IX + 219. Little, Brown & Co., 1915. $1.00 net.
THE MEANING OF DREAMS. By I. H. Coriat. Pp. XIII + 194. Little, Brown &
Co. $1.00 net.
[*] Paper read May 6, 1914, at Albany, New York, before the American
Psychopathological Association.
Copyright 1915 by Richard G. Badger. All rights reserved.
Instructor in Neuropathology, Tufts College Medical School, In Charge Voice
Clinic, Boston State Hospital, Psychopathic Department.
THE object of this paper is to carry the analysis of stutter phenomena deeper than before. In my last year's paper I showed that chronologically the diagnosis of dyslalia mounted step by step from a material external affair, up through the nerves until we came to the basal ganglia. I showed conclusively that it was an involvement that did not exist in any of these places. I further took steps to demonstrate and present evidence that indicated that dyslalia was in its essence some trouble with the personality. I mean by this: that the trouble was located in the nervous system beyond the lower sensory areas of the sensorium; and also above the lower motor areas on the motor side. By the broad term "personality" I mean the total of the activities and interrelations of mental activities that occur above our lower sensory and motor areas. The paper of last year clearly located the trouble vaguely in this region of the personality.
Since that time I have been interested to ascertain just what the nature of this changed personality is. In order to do so, I have carried on an investigation that has reached interesting conclusions. To me it is new truth. It may not be all the truth, but as far as it goes, and as for what it is, it surely is truth and a new finding! This research is an effort to show not only where it is but WHAT IT IS.
The method was as follows: For the purpose of finding out some of the activities going on in the area of collaboration during speech, I asked my stuttering patients two simple questions. I thus found that their methods of collaboration complied to a certain mental type.
Then I carried this same method into the study of normal individuals in the collaboration of their ideas, just before and during speech in order to establish a norm; and to see whether or not it differed from my preliminary test of stuttering cases just mentioned. It did, and therefore I formulated a series of questions in order to pin the type of collaboration down to certain fields of mental action. To make this clear, let me present an outline of these different steps in tabular form.
1. Orientation tests on stutterers. 2. Orientation tests on normal individuals. 3. The research, its objects and methods. 4. Final detailed results.
Let us now pass to a minuter description of each of these procedures and a tabulation of the data that resulted.
By orientation test I mean simply a vague try-out to see just where the problem lies; an initial step to see what further steps are necessary; or in other words enough of an investigation to know where to look next.
The orientation tests consisted in requesting a series of twenty stuttering cases to answer two questions. Following their answers an immediate inspection was made of the content of their consciousness before, during, and after speech. These two questions were as follows:
1. Where do you live? 2. Say after me "The dog ran across the street."
After these questions I asked the patients to state whether there was any picture in the content of consciousness and how long it lasted; also whether that was detailed, intense or weak. I noted the presence of stuttering in relation to the presence or absence of this mental imagery; and also made a note of any other unusual data that happened. The results of the tests indicated above can be summarized as follows:
Of the twenty stutterers examined, ten made no visualization of their homes, some even after a residence of years; one of these twenty visualized home very faintly; two others visualized home clearly but the picture vanished on speaking; seven others visualized home clearly but these had been under treatment.
On repeating the dog statement, ten stutterers made no visualization whatever; one visualized faintly; four visualized well but the picture vanished on speaking; five others reported visualization, and four of these had been under treatment.
At first I did not know but what this was the norm of average visualization methods; so I tried this same series upon a number of normal individuals for comparison; by normal individuals, I mean, at this time, merely anyone who is free from stuttering, and chosen in a haphazard way from the hospital community; for example, one was our executive secretary, another a typewriter, another a telephone operator and so on.
The results of these orientation tests upon normal individuals were as follows:
The normal individuals examined almost without exception visualized clearly before and during speech. Sometimes this visualization was very marked in detail and resulted in emotional responses, such as pleasures, etc.
From the above two sets of figures were thus obtained a fair norm of visualization for ordinary individuals; and in comparison a marked variation from this in stutterers. This data therefore warranted the tentative conclusion that stutterers have a loss or diminished power of visualization. This assertion may seem a little more than is warranted by such meagre data and perhaps would be better revised pending further data into the following: As compared with the normal, stutterers show a weakness in visualization.
These general orientation tests for a norm and its pathological variation were the basis upon which I proceeded on broader lines with a further and more exhaustive investigation with the following points in view:
To what extent is visualization weak?
Is it weaker in the worst cases?
Is it less and less weak as cases appear less severe?
Is it the same for past, present and future memories?
Is visualization equally at fault in all sensory areas of the cortex?
Do cases approach normal visualization processes in proportion as they progress in their cure? and
Lastly, numerous other minor queries presented themselves.
All these questions were answered in the following research, which after thus much orientation found a more complete and final form.
In order to answer these questions I formulated the following series of tests to the number of twenty-four in all, and asked them in series to nineteen stutterers, making almost four hundred tests:
1. Speech:
Say, Today is sunny.
The dog ran across the street.
Submarines will sink all the steamers.
2. Motor:
Do you dance?
Did you ever skate?
Would you sew for a living?
3. General Sensory:
How does a pinch feel?
Did you ever get hurt?
What would you like to do if it was very hot next summer?
4. Hearing: (Eyes closed)
Do you hear anything?
Did you ever hear a rooster crow?
What sounds would you like to hear next summer?
5. Sight: (Eyes closed)
What do you see now?
What did you see yesterday?
What would you like to see next summer?
6. Smell: (Eyes closed) (Pen to nose)
Do you smell anything?
What have you told by smell?
What would you like to smell next summer?
7. Taste: (Eyes closed)
Do you taste anything?
What have you been able to tell by the taste?
What would you like to taste next summer?
8. Muscle Sense: (Eyes closed)
Put one arm up; the other like it.
Put one arm up, down; the other like it.
How would you hold a hand to read from it?
This long series of questions with careful introspection tests upon the content of consciousness constituted then my main research in the field of stuttering. Perhaps further details in explanation of the questions chosen is unnecessary. Three or more questions on introspection were asked at each test.
4. FINAL DETAILED RESULTS are found in the following conclusions as drawn from 1440 answers.
In our average conversation a visual picture is created before we begin utterance. Severe stutterers never visualize at all. In direct proportion that these cases become less severe, does visualization increase in frequency, strength and continuation in consciousness before and during utterance.
When severe stutterers are free from spasms they visualize, and when they stutter they do not visualize.
When mild cases are free from spasms, they visualize, and when they stutter they fail to visualize.
In a word, when visualization is present stuttering is absent; when visualization is absent stuttering is present.
This is true not only of EACH UTTERANCE, in most cases, but is true of severe as well as mild forms as a whole.
Stutterers gain in visualization as they approach cure.
For past, present and future memories: visualization is slightly more frequent for past and future.
Therefore stuttering is an indication of absent or weak visualization either in isolated words, occasional stutterers, mild stutterers or the severest type, either before or during speech, or both.
The slump, then, in personality which I showed last year as the main thing in stuttering as its cause and condition, is thus found by further psychological analysis, to be a slump in the power to consciously visualize.
By personality I mean as mentioned above the composite of collaborative activities that lie between the low sensory repository areas and the low motor expression areas. In other words, personality includes all those collaborative processes that lie between the sensory intake areas and the motor output areas; in a word, any unexpressed use the mind makes of its intake. Conscious visualization is a part of personality processes, then. In my last year's paper([1]) the whole matter was left vague. Here something definite and constant is found. In other words the psychoanalytical method revealed no conscious subconscious cause. Granted there is room here to "interpret" (or create according to Freudian mechanisms) a definite subconscious complex, a step which I could not feel justified in taking; I leave this to better psychoanalysts than I. For me to twist stutter phenomena to comply to a theoretical complex is unscientific to say the least. But the psychological method—as represented by this paper—shows a definite constant cause for all the phenomena of stuttering.
Upon this basis of an involved visualization all the intricate phenomena of stuttering may be explained. Let us take some of these up in detail.
THE START. Visualization processes are a matter of growth through exercise and development and use from the sensory area mostly of the eye. If these processes in their early start and evolution receive a setback through the treatment of people in the environment, such as interruptions of their early speech efforts, constant inattention of those to whom they speak, and persistent refusal by older people to answer questions propounded or the allowing of the little one to ask the same question without hopes of answer for a great number of times, these visualization processes receive a setback. This kind of treatment in the home is one of the chief causes of the slump of visualization processes. Another cause is hearing other stutterers interrupt their own visualization processes as they stutter; and still other minor causes may be almost any psychic trauma; these traumata, such as an operation, an accident or a severe illness, are sufficient to bring to the surface or intensify a growing lack of visualization that has been started by bad environment long before.
THE DEVELOPMENT OF STUTTERING. When the habit of visualization is lessened, the action upon speech is the same as the withdrawal of an inhibiting or regulating reflex arc.
It is thus that visualization processes act like reflex inhibition. When visualization is present a higher inhibition arc is functioning and we have a normal speech as a consequent reflex expression. When and in proportion as visualization is absent this higher inhibition arc is not functioning; and the speech thus uncontrolled flies away in spasms which we call stutter. It should be called an exaggerated or uninhibited speech reflex.
The stutter, then, is merely the externalization of an exaggerated reflex of motor speech, exaggerated through the loss of the inhibitory action of a more or less weakened visualization process.
Not only does this explain the phenomena at large but seems to be a satisfactory explanation for all its intricate, minute details. Some examples may, perhaps, be welcome at this point. I say to two stutterers: "Tell your first name." One of them stutters and the other one does not. On furthering questioning, it is found that the one who did not stutter visualized, and the one who did stutter did not visualize.
CONCRETE: These conditions are also seen when stutterers talk about concrete and abstract matters or when they promulgate some important plea that cannot be visualized. On concrete matters that can be easily visualized the stuttering is gone; and on abstract matters where visualization is hard, the stuttering again appears.
ANGER: In anger, when an intense visual picture is presented and occupies the mind, there is then no stuttering, and also in other similar situations there are periods when the individual is abandoned to some visual concept which acts in the same manner.
SINGING: We all know that stutterers can sing without stuttering. The process here is a similar one; only that there is held up over the speech before utterance an auditory image of a melody in place of the visual image as held in normal speech. This auditory image may be more easily applicable as supplying the needed inhibition reflex arc than the visual because it is nearer to the speech area.
PRAYER: For the same reason prayer is uttered without stuttering when there is faith enough in a God to hold an image of Him during utterance. There may also be other images held during prayer.
FAMILIAR SIGHTS: Familiar sights are less stuttered upon than the detailing of situations that are less familiar and therefore can be less well visualized. This is also true of sights that have been recently seen or that have been repeatedly seen, or that in some other way have been made intense as pictures in the visual field.
AS CURE PROCEEDS: In the process of recovery where visualization is seen to increase as the stutter decreases, there is another illustration where this visualization attitude explains the whole situation. I have taken a severe stutterer and told him a story that could be well pictured, got him to work up the pictures properly by several complicated processes (which we will not consider now) and when he had them well in hand, I have seen him stand up and relate the story from beginning to end with little or no stuttering If at any point he would trip up, the inevitable confession would be that at that point he dropped the picture, or, in other words, the visualization could not be held over in its inhibitory action; and therefore the stutter came. On further request to hold it over that point, the same passage would be again expressed smoothly if he succeeded in holding the picture.
This constancy, this presence and absence of the picture, its presence to make smooth talk and its absence to cause stuttering, is so constant at every turn of the situation, that I would offer it as a new interpretation of all these phenomena. I know of no other interpretation that can EXPLAIN EVERYTHING UNDER ONE HEAD as does this absence, weakness or interruption of visualization processes.
TERMINOLOGY. We have found in our orientation tests that in a vague way the visualization was at fault. We have also found in normal individuals that a marked visualization was an automatic process that preceded speech, and lasted during utterance; and we have found in the long series of stutterers that visualization is entirely absent in severe cases; that it is weak in milder forms; that it is intermittent in most cases, and that on words that are smooth it always appears, and in occasional stutter it is as occasionally absent.
We have also found that the form of visualization common in normal speech is the visualization of eye sensations; that in unusual situations we may have visualizations from other sense areas, such as the ear, taste or smell, but these are the RARE EXCEPTION.
From all this data it would naturally follow that some sort of term is needed to designate this condition. Last year I probed to find such a term without much success.
At present I see no reason why it should not be called an Asthenia; it is surely the weakening of a mental process that is strong in normal individuals. The evidence here presented shows that. I doubt whether there is any marked pathological change, since the individual may be educated out of it; but this does not necessarily follow as proven with my dog in Berlin.[2] As a general designation, then, I should consider Asthenia as apropos.
One objection to this is that the weakness is by this terminology lacking in localization. Our data above has shown us that the location of the trouble is visual; that is, it is situated about a centre of sensory registration that deposits data from the eye; this must naturally then be located somewhere in or near the cuneus. We could therefore add to the terminology this idea of a minute localization and call it a Centre Asthenia.
Some may prefer to carry the matter one step farther and add the name of the centre in which this weakness is located, but I fear if I take this step and complete my terminology by the word "Visual Centre Asthenia," it will, as such, not cover quite all the cases, for I find that sometimes the visualization is absent in other areas as well, and also the holding of an emotion of pleasure or pain and of other dominating mental attitudes that are sometimes visualized would not, therefore, be included. I would therefore retract the broader claim in order to place the term on a conservative basis and call the essence of the lesion simply no more or less than a Centre Asthenia. As well as visual Asthenia, the following terms might be considered as applicable: collaborative centre asthenia; imaginative centre asthenia; visual creative centre asthenia; picture producing centre asthenia. We say neurasthenia when the trouble is not in the nerves as such, so much as it is in the collaborative centres. More of this later. Here in stuttering the trouble is also collaborative, and we can be still more definite than that and say the trouble is with the collaboration of visualization. So if I were forced, however, to choose one term from all these, my choice would be "Visual Centre Asthenia." This indicates a new and rational treatment. But of this later.
SUMMARY: Psychoanalysis reveals stuttering as some vague trouble in the personality[1]. Psychological Analysis shows stuttering is an absent or weak visualization at the time of speech. This new concept of stuttering as faulty visualization may be called Visual Centre Asthenia. This lack or weakness in visualization accounts for all the numerous phenomena of stuttering in severe, medium, or mild cases. A new treatment is indicated.