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1903,' as a characteristic finding in studies of the personality in schizophrenic patients without original mental defect.
The remaining 9 cases presented no definite psychosis, but included a wide range of individual reactions characterized as temperamental idiosyncrasies of the feeble-minded. This phrase includes such mood upheavals as temper tantrums, either as a spoiled child's means of attaining an end, as a sudden tempest of petulance and impatience, or as a sort of getting-square reaction in relation to teasing and similar minor provocations; it embraces panic states over such petty situations as walking alone after dark, or over early bedtime imaginations of ghosts and people under the bed; there is also found an ease of excitability with “flying all to pieces” and confusion when“ somebody hollers at me quick” or “ tells me to hurry up” or there is a crowd around.” These vagaries of behavior are self-contained individual reactions comparable with those observed in the so-called “normal” child of a chronological age corresponding to the "mental age” of these feeble-minded patients. It would be tedious for the reader to follow a discussion of the personal difficulties represented in each of these 9 cases, and I am accordingly presenting only a few of the psychopathological pictures taken at random from case notes made at the time these studies were undertaken. I. J., æt. 19. Male.
The patient was admitted to The Training School in 1913, showing a “mental age,” according to the Binet-Simon test, of 8 years. He was referred to the examiner chiefly because of outbursts of temper in which he“ beats up” the other boys. During the examination the patient reminded one of a lazy, overgrown boy. He answered questions readily, naively confessed his faults while he played with various objects on the table in a childish manner. He was oriented as to place and time. His mood was one of lazy good nature with marked aversion to teasing and implicit faith in his own methods of retaliation. There were no delusions or fancies. (How are your spirits?) “All right, except when I get mad at the boys." (Then what happens ?) "I crack them in the jaw.” (Why do you get mad with them?) “They tease me and throw stones at me.” When asked about his ambitions and interests he replied: “When I get to be 21 I am going to take my foot out of here and buy a gun and a box of bullets and a sword, and I am going on a battleship and be captain of the sailors."
Discussion.-So far as one can judge from the patient's history and mental status, there is no indication of a psychopathic process at the present time. He has always shown marked indolence of
mind and body, which is a constitutional feature, perhaps more responsible than is his mental retardation for his work deficit, which is such a continual source of annoyance. That he should react to teasing by seeking justice with his fists or running away from the school grounds, as he sometimes does, seems quite consistent with his usual methods of getting square with things that irritate him, and certainly is in keeping with his pirate ambitions to buy a gun, box of bullets and a sword.
K. L., æt. 46. Female.
The patient was admitted to The Training School in 1910 with a “mental age,” according to the Binet-Simon scale of 7 years. She was backward in walking and talking, and in early childhood had crying spells and night terrors. As she grew older the family noticed that she was very touchy and easily irritated to the point of screaming and tearing her clothes when crossed in any way. Her assets and interests corresponded to those of a child of 7 years. She is fond of playing with dolls and toys, looking at picture books, dabbling with crayons, and has been trained to do a few simple things about the house. The patient was referred to the examiner because of certain tantrum-like episodes which have stood out since her admission as a great point of differentiation between her and the ordinary feeble-minded individual of her mental age. These attacks come on an average of once in 6 weeks, although she has been as long as 9 months without one. They are frequently associated with gifts or visits from her family. They often come in the morning after the patient has been called for breakfast or is having her hair combed, or perhaps has been asked to pick up scattered playthings. The onset is sudden; the patient screams, kicks, bites, strikes and spits at attendants and others around her. She never uses profane or vulgar language, but sobs loudly that she hates everybody and wishes they were dead. If unrestrained she tears her clothing, stamps her feet, over-turns furniture and destroys anything within reach. The attacks last, on an average, 2 hours, following which she is aggressively penitent and affectionate. It has been found that a change of surroundings such as moving from one cottage to another, will abort these outbursts for periods of several months at a time. The entrance of some unfamiliar person, such as a doctor or the superintendent, will stop an attack instantly.
Mental Status.-When first seen the patient was at the height of one of these episodes, but no sooner did she hear that the physician was on the way up to her room, than she quieted down immediately, so that when the examiner arrived the patient was in the penitent, sobbing stage. She told everything she had done, threw her arms around the attendant's neck, kissed her and begged to be forgiven. She would give no explanation, except: “I guess the devil got into me, he makes me act this way sometimes. I was very naughty, wasn't I?” When seen a week later the patient
remembered all the circumstances of the previous attack, and cooperated to the best of her ability in discussing the matter. She described her mood as “happy except when I am cross.” She said she knew exactly what she was doing during the attack and could stop it if she wanted to. (How do you feel?)
Sometimes I feel like this (patient takes her hand and slaps the air). I do sometimes too. I hit one of the girls in the dining-room when I got mad the other day.” (How do these mad spells come?) “I don't know. I wish I did.” (Are you afraid of anything when you have them?) “No, I am not afraid of anything but thunder and lightning.” (What do these spells mean to you?) “It's a sort of hatred that comes over me. It's bad and wrong." (Can you stop them?) “Yes, if I wanted to.” (Why don't you do it?) “I think I will every time and then when it comes I just don't stop them but let go. I am never going to be bad again."
Discussion.—The nature of the behavior, the periodicity of the outbursts are suggestive of the so-called epileptic equivalent. On the other hand, the patient has a complete realization of what she does and says during an attack, and accurate memory for its details afterwards. Her own mood description and post-tantrum penitence remind one of the temper storms of a spoiled child expressed with the vigor and combativenes of an adult body. It is hard to say how much she is able to control these outbreaks. It is interesting to note that the patient says “I could stop if I wanted to” and promises “to try hard and never do it again”; also that the entrance of a new face, or a change of surroundings, either checks an attack almost instantly if she is in the midst of one, or wards off such explosions for weeks and even as long as 6 to 9 months at a time. Whether this is brought about by distracting her attention from herself, or by virtue of the introduction of a new and unfamiliar element of control, it is impossible to state. One would like to have a fuller record of the patient's constitutional make-up and early environment, and more details of her habits of reaction since admission to the school, in order to study this matter adequately from the standpoint of etiology and readjustment.
M. N., æt. 23. Male.
The patient was admitted to The Training School in 1907, with a mental age of 9 years, according to the Binet-Simon scale. As to his past history he seemed normal until 3 years, except for backwardness in talking. His parents state that he was always easily startled by noises and seemed timid. He was a poor sleeper, afraid of the dark, and had nervous spells at night in which he would wake up and want to be reassured that no one was going to hurt him. His record since admission to The Training School has been that of a faithful and willing worker. He has been trained to do good garden work, showing judgment in planting as to the depth of seeds, etc. He is childishly fond of fairy tales, likes pictures, and draws fairly well. The patient was referred for psychopathological examination because of crying spells and outbursts of temper on the slightest provocation. Frequently at night he becomes panic-stricken, so that the matron of the cottage has to quiet his imaginary fears by turning on the light in his dormitory and reassuring him.
Mental Examination. The patient impressed one as having a frank, open face and manner of address. His replies were prompt, to the point, and accompanied by no evidence of embarrassment. His manners were pleasant and agreeable. He was willing to discuss his emotional outbursts, saying that he has always been easily frightened by sudden noises, and that his panicky states at night were usually inspired by ghost stories, or fears that somebody was under his bed. He said that when the room grew dark and the boys started to tease him he became so worked up that he often fancied that voices were whispering to him. His heart beat faster, cold perspiration broke out over him and he could not be comforted until reassured by careful search that no one was in the dormitory under his bed. He associated his outbursts of irritability and “flying all to pieces" with the delaying of letters from his mother. He spoke with a great deal of feeling of his father who had died since the patient had entered The Training School, saying, “I will show you his picture if you will come to my room." He seemed to realize his lack of control when letters did not come on time, saying that he got so mad he could tear his mother's picture to pieces. The patient could not understand, why, with his strong body, he could not got out and support his mother instead of being an expense to her. He said that at times he brooded over this fact until he burst out crying and then the boys teased him and he got mad.
Discussion.—The patient impresses one as an individual with poor affective control. His “scarey spells” come at night, are in relation to ghost-story teasing by the boys and represent acute panic states which subside quickly with reassurance. It will be remembered that as a child he was afraid of the dark and had
nervous spells” at night. His “moodiness " seems to have a definite causal relation to his home longing, and his behavior at such times in reaction to disappointment and feelings of maternal neglect is an outburst of rage expressed with all the vigor of a husky body of 22 years. Considering the patient in the light of the data we have on him thus far, one would say that he presents a problem of temperamental idiosyncracies in the feeble-minded individual, rather than a psychotic process.
0. P., æt. 27. Male.
The patient was admitted to The Training School in 1912, showing a mental age of 7 years, according to the Binet-Simon scale. He has been definitely hard of hearing since scarlet fever in childhood. Perhaps this accounts in part for the seclusiveness and unsocial tendencies which are described by his parents as always characteristic of the patient. They also state that ever since they could remember the patient has displayed a mania for washing his body and clothing, particularly before and after voiding. Ever since admission to The Training School this impulsive washing has constituted such a problem in his management, that it was necessary to hide the soap from him and to watch him constantly to see that he did not wash even his bed clothes every day. For the last year or two he has not shown this habit as much as formerly. He was referred for examination partly because of this washing mania, and partly because of his variations in mood. At times he seems elated to the point of singing and displaying a great deal of push and go. This phase is usually followed by a “sullen spell” in which he has been so violent as to break windows, and on one occasion he drew a knife at another boy. At work he is described as thorough, attentive, quick and trustworthy, but he gets along best on jobs where he is by himself.
Mental Examination.—There was nothing particularly striking in the patient's general behavior. His deafness is quite marked and probably accounts for some of the misunderstandings which he has with those about him. Nothing could be gathered from the patient as to the basis of his washing habit; he would not speak of the matter voluntarily, and admitted recorded statements about it with embarrassment. (How do you feel?) "I feel happy most of the time.” (And other times?) “Well I get mad; I ain't like I used to be.” (Why do you get mad?) “The boys tease me all the time.” (About what?) (At this point the patient became obviously embarrassed, blushed, fingered his hat, wriggled in his chair and in spite of many approaches to this subject would give no other cause for the teasing except “a lot of things.") (Do you ever have nervous spells?) “Yes, I get excited and worked up when there is a lot of people around. As long as I get jobs by myself I am all right.” (Are you afraid of anything?) “Just things that everybody would be afraid of. I am always afraid I will walk on snakes in the woods. I wouldn't want to go on a long road by myself after dark, and sometimes when I am walking in the daytime and hear a dog running after me I get scared and want to run away.” (Do you ever feel you must do certain things?) (Patient confused and uneasy again.) “I used to-don't wash any more.” (What thing inside you makes you want to do this?) “I don't know, I guess it's a habit.” (Have you ever felt that things around you were not clean?) "No." Further questioning along the line of the dirt phobia failed to bring out any substitutive material.
Discussion. The patient's careful avoidance of his obsessions during an interview, in which he talked freely of other troubles,