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Case 24, age 45, represents a progressing recovery from a mild depression. Clinically, it may be regarded as certain that the depression was less on the second of the two experimental days; they were two weeks apart. In general the reaction times are also shorter on the second day, but a more noticeable change is that the false reactions, 23 on the first day, the greatest number but one observed for any single experiment, diminished in the second experiment to seven.
Case 71, age 20, is of marked constitutional neuroticism associated with psychotic episodes whose diagnostic interpretation is not wholly clear. Like 75, he is a rather critical case for an inquiry like the present, his condition being one continued maladaptation, without observed change during the period of the experiments, and without likelihood of reaching a normal adjustment to life. Three experiments were made at intervals of about a month. The first two have slow speed and many falsities, the third is fairly quick with no falsities. Notes on the third experiment are lacking, but it is safe to say that the long times in the first two as such are not significant for present purposes. They are associated with unusual clumsiness on the motor side of his adjustment to the experimental task. Thus, contrary to instructions, he fingered unsystematically in series 10 and 50, this compelling him to work by sight. This inefficiency is of a "motor” rather than a "psychomotor" level.
About 18 months later this case voluntarily presented himself for further examination, saying he had not really tried in the previous tests, and now wished to establish his sound mental condition. He manifested much concern over their outcome. Reaction speed was greater in series 10 and 50, slower in series 110 and 100, than in the previous experiment. There were also six false reactions in this fourth experiment as opposed to none in the third. The gain in 10 and 50 is fully accounted for in that the subject now fingers systematically, according to instructions. Though the notes of the third day are not found, it seems probable that the greater speeds of the third day are also due to improvements of this kind. The gains are not correlative to change in the psychotic constitution of the patient; they represent more willing cooperation, better adjustments of strictly motor character, or both.
VII. CRITICISM AND CONCLUSION.
Dementia præcox and manic-depressive psychoses show certain types of reaction to the environment. Certain individuals react in these ways because their adaptive capacity is not equal to the demands the environment puts upon it. When this capacity is strained to the breaking point, the psychosis is precipitated. Dementia præcox seems to be precipitated chiefly by the sexual adjustments called for upon attaining maturity in the presence of incapacity for making them. A definite type of predisposition to this reaction has been made out—the “shut-in personality.” The manic-depressive psychosis represents more temporary withdrawals from reality. Sometimes, as in cases here studied, psychopathic defect is evident when the patient is “normal” for him. In other cases, no psychopathic traits have been found except in the definitely psychotic periods. In the dementia præcox group, and in the present manic-depressive cases, we have to deal with individuals whose maladaptation to life is constitutional.
There are two sides to the question of demonstrating this maladaptation at the psychomotor, laboratory, conventional level. If it is so demonstrable, we shall expect to find it most marked during periods of actual psychosis, where the present study has looked for it. Finding psychomotor deficiency here, the logical progress of the investigation would take up manic-depressive psychoses during periods of recovery, prospective dementia præcox cases before onset, or during remission.
Failing to find such psychomotor deficiency, the most reasonable interpretation is that the factors (instinctive, emotional, volitional) upon which psychosis or sanity depends, are essentially dissociated from the superficial psychomotor capacities represented in these experiments. (It is possible to suppose a sort of compensatory relation between the two, but the conjecture cannot here be profitably discussed.)
Independence and dissociation of the functions governing vital adaptation from those governing psychomotor adaptations is the chief indication of the present results. Their inter-relationship should have shown itself most clearly in a greater tendency of the psychopathic cases to false reaction. The contrary was found, and cases of the more serious maladjustment, dementia præcox, actually showed the fewer false reactions.
While the psychomotor adaptations of the pathological cases, as a group, take longer time than those of the normal, a simpler explanation of this is indicated than that of constitutional difference between the two groups. If this difference in the two groups is one of constitution, it ought to persist with relative independence of the patient's immediate clinical status. The evidence we have points in the opposite direction. The psychomotor adjustments are too dependent on symptomatic and incidental factors of the condition to be regarded as the expression of constitutional tendencies. Both reaction time and false reaction contribute data on this topic. Of the dementia præcox cases, 75 was much more broker. down mentally than 71, but 75 was emotionally calm, while 71 was agitated. The result that 71 was quicker but made more false reactions than 75, is easier to reconcile with the immediate -motional factor. In case 16, a period of clinically subsiding excitement corresponds generally to a shortening of reaction time and great reduction of false reactions. The change is best interpreted as a lessened distractibility. In case 79, false reactions increase with the state of excitement, and are eliminated with its subsidence. In case 24, they decrease markedly with a subsidence of depression. The rule is improvement with the subsidence of superficial symptoms, such as would themselves cause a poorer performance. An exception is shown in case 26, where better performance is shown in a somewhat greater excitement. Thus the changes in the pathological groups appear to result from factors secondary to the psychosis. When these factors disappear, the psychopathic constitution of the cases does not differentiate their experimental performance from the normal.
From the standpoint of the experiments it is not a fortunate circumstance that such practise as there is in the experiments generally coincides with periods of improvement. The meager control data point to considerable variation from day to day in the normal, not consistently in either direction. This is true for both speed and false reactions. Consistent improvement in the performance of pathological cases associated with improvement in clinical status seems better explained by this than by practise effects, especially when the experimental days are far apart.
That these pathological groups are not constitutionally differentiated from the normal on the psychomotor level, is the most certain result of this study; the departures from the normal which are seen may, with reasonable probability, be related to symptomatic features of the disorders. In formulating results beyond this, one is hampered by insufficiency of data. Many things were found, and are stated in their appropriate sections, but they require substantiation from further work before assuming general validity.
Among these may be recalled the singular separation of the normal from the pathological groups found in the statements of natural fact (series 100) and the greater difficulty experienced in the pathological group with incorrect statements of both natural and mathematical fact. The greater tendency of normal individuals to spontaneous correction of false reactions might also be mentioned because of the more natural and unconventional character of this response.
It has been postulated that a false reaction is as such a more pathological performance than a slow one. But it has clearly not the same sort of pathology that is concerned in the manic-depressive and dementia præcox psychoses. It originates on a more superficial level. The false reaction results from an incidental disturbance of mental processes, and the susceptibility to false reactions is a measure of constitutional liability to such disturbances. It has been shown that this is a different constitutional character from that which makes for certain functional psychoses. It has been difficult to acquire knowledge as to the positive meaning of susceptibility to false reaction because no satisfactory measure of individual difference in it has existed. Under ordinary conditions of experiment one does not get enough false reactions to serve as a basis for comparison. They deserve consideration in other rôles than as a disturbing element in studying the time of correct reactions. To study them in and for themselves one should have conditions more favorable for their occurrence, the usual experiment being designed to favor correct reactions.
One means of bringing out more false reactions is to increase the complexity of the reaction patterns. This is the effect in the use of the typewriter, though that instrument has obvious limitations on account of different individual capacities due to special practise. Comparable to increasing the complexity of the reaction patterns is diminishing the differences in the stimuli to be distinguished, approaching the border-line where misperception becomes a greater factor in the false reaction than maladjustment of the psychomotor mechanism.
The greater space in this study has been given to reaction time, because the nature of the experiments was such as to yield more material on it. Item for item, the tendency to false reactions is the more suggestive. There are very few situations in practical life where anything depends on the small amount of individual difference that exists in reaction time. There is usually time enough to pull the right lever; the important thing is to pull it in the right direction, or not to get hold of the wrong one. The opinion must be reiterated that the facility of time measurements has led to their playing a part in psychology disproportionate to their value for the study of the mind, while measurements of correctness in choice have had too little attention. The present study in the pathology of choice reactions results in delimiting the problem in reference to the psychoses. The pathological features seen in the choice reactions of psychotics are secondary to incidental symptoms. The problem is to be approached for its relation to normal psychology; to the "psychopathology of every-day life.” With this it has as many points of contact as there are systematic choice reaction processes in the conduct of civilized life, and these are without number.