only one of these (the primary sensation) is in the foreground; the others come to awareness not at all or as synæsthesias.

Under these conditions, association would be promptly established between a sound and a color always perceived with it, as well as separately. Such association, while not innate, is governed by innate factors, and not by external experience.

Downey" comments in another paper on expressions in language that counterfeit synæsthesia, but differ therefrom in being inconstant, unsystematic, and having rational associations near the surface. It is not synæsthesia to speak of red war, black looks, weather clear as a bell, clear blue optimism. Sometimes these counterfeit synæsthesias, synopsies secondaires, provoquées of Flournoy, acquire relative constancy. Bleuler mentions how a black and yellow pattern symbolizes Wednesday to him, through the pattern of the travelling bag of an aunt who visited his home on Wednesdays. On the other hand, the English use of blue to denote melancholy is contrary to the commoner associations of the color in life. A synæsthetic origin might be ascribed thereto, as Bleuler seems to think. Bleuler's " observation that the photism of bitter is almost always "dark brown to black" may be the essential determinant of the figure "dark brown taste."

A tendency has been variously observed for numbers to arrange themselves in a definite pattern of visual imagery. Sometimes learned associations, as of the clock-face, appear to govern these. Again, these so-called "number forms " appear to resemble synæsthesias, in that a connection between the ideas is established independently of the will, extending as far back as memory, and constant. Bleuler" speaks of them as "instinctive." Heredity for number forms is postulated by Galton" and for synæsthesia by Calkins." This is good evidence of innateness if the same secondary sensations are inherited. Myers" brings out that this is not always evident with synæsthesia, members of a family disagreeing in the color attaching to a given sound.

Lowie" has connected this general class of phenomena with the facts of pervasiveness in the symbols of myths and legends. He is impressed with the hereditary character of the number forms. Since primitive communities are made up largely of bloodrelatives, symbolic meanings could grow upon numbers in this way. The same naturally applies to the more strictly synæsthetic phenomena.

Both synæsthesias and mechanisms of autistic thinking form associations foreign to the waking consciousness of ordinary life. The associations of synæsthesia, however, are restricted to the more elementary patterns of sensory qualities. They are not adequate to account for the types of symbolism common to mythology, dreams and psychoses. Brown may represent bitter, vanilla may represent green, but the gulf between these associations and such complex symbolisms as snake for phallus, air for male principle, water for female principle, is greater than most imaginations are prepared to leap. And it is only for the synæsthetic type of association that even slight evidence for hereditary transmission is adduced. If such transmission operated on higher levels, evolution would be expected to transmit, in consciousness, useful ideas, such as of mathematical relations, rather than an unconscious full of ideas generally harmful if acted upon. Autistic mechanisms are capable of accounting for the entire body of "archeopathic" symbols on an experiential basis, and there is evidence for but little of it being accounted for in other ways.

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It is a growing conception that a great deal of "higher mental process goes on in the mind of which the main personality is as little aware as it is of many normal organic processes. This thought, below the level of awareness, consists, like the thought of which we are aware, in the association and elaboration of experiences. But, whereas the thought of awareness is, in the normal mind, mainly governed by the logic of experience, that below the level of awareness is quite free from these restrictions and is "autistic" in Bleuler's sense of the term. In this way, associations and symbolisms are formed which are not present to the conscious level of the mind. In the psychoses, these ideas do come to consciousness, dominate it, and give rise to delusions. They also come to the surface in the dream, where they give rise to symbolism that has been amply recorded. The two levels of thought are less distinct in the savage and in childhood than in more developed life. Whatever community exists between psychotic and primitive ideas (how much one sees depends a good deal on the selection of material) is due to regression in modes of thought. There is a regression to modes of thought which more characterize primitive man, but not to special topics of thought. If the topics of thought, the precise ideas associated, do happen

to correspond, this is because the primitive kinds of association (similarity, contiguity) lead in like directions for everyone. The ideas which are associations by similarity for the savage or child are associations by similarity for all. The community appears, not from a transmission of definite ideas through the ages, but because the same associative laws are operating upon the same general class of experiences."

REFERENCES.

1. Goldstein: Arch. f. Psychiat., 1908, 43, 499–500.

2. Ibid., pp. 497-500.

3. Sokolow: Arch. f. Psychiat., 1915, 55, 465.

4. Chvostek: Jahrb. f. Psychiat., 1893, 11, 274, 282.

5. Goldstein: Arch. f. Psychiat., 1908, 43, 497, 498.

6. Sokolow: Arch. f. Psychiat., 1915, 471.

7. Moravcsik: Centralblatt f. Nervenhk. u. Psychiat., 1906, 29, 210, 211. Cf. also Chvostek, op. cit.

8. Liepmann: Arch. f. Psychiat., 1895, 27, 203 ff.

9. Bechterew: Centralblatt f. Nervenhk. u. Psychiat., 1897, 20, 505. 10. Bleuler: Zt. f. Psychol., 1913, 65, 16. Further references by this name only are to this article.

11. Downey: Am. J. Psych., 1911, 22, 528.

12. Bleuler, p. 13.

13. Ibid., p. 12.

14. Pierce: Am. J. Psych., 1907, 18, 341-352.

15. Downey: Am. J. Psych., 1911, 22, 530-535.

16. Myers: Brit. Journ. Psychol., 1911, 4, 231, 232, 235.

17. Ibid., 1914-1915, 7, 115.

18. Ibid., p. 114.

19. Coriat: Journ. Abnorm. Psychol., 1913-1914, 8, 110, III. 20. Bleuler: p. 35.

21. Downey: Journ. Phil. Psych. Sci. Met., 1912, 9, 440–448. 22. Bleuler: p. 28.

23. Ibid., p. 6.

24. Galton: Inquiry Into the Human Faculty, 1883, 118.

25. Calkins: Am. J. Psychol., 1895-1896, 7, 97.

26. Myers: Brit. Journ. Psychol., 1911, 4, 238.

27. Lowie: Am. J. Sociol., 1915, 31, 217-229.

28. Bleuler: Jahrb. f. psa. u. psp. Forsch., 1912, 4, (1), I-39.

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29. 'Because the sleeping mind looks at things in the same. . . . relatively simple, naive way as the waking mind of primitive man" (Silberer). "The stereotypy is due to the uniformity of the fundamental and perennial interests of mankind" (Ernest Jones).

PSYCHOSES IN MENTAL DEFECTS.*

BY ALFRED GORDON, M. D., PHILADELPHIA.

The present series of cases embraces all degrees of mental deficiency except idiocy. There were three imbeciles and 34 individuals with a mental status inferior to normal. Morons constituted the largest majority (24). The psychic disorders as they were manifest in the (37) cases presented themselves under two chief categories. In one, there was a greater or lesser intensification of the pre-existing mental characteristics which formed the basis of the constitutional make-up of the defects. In the other category, there were present psychoses common to all

persons.

Group I.-Fifteen individuals presented during a period of five years at various times marked accentuation of their fundamental defective features in intellectual and moral spheres. A propos of various emotional factors, such as fright and minor accidents, there was present a decided intensification in the deficient mode of feeling and acting, also in the reaction to external stimuli. First of all, there was a definite arrest in intellectual acquisitions. One of the individuals during a process of mental training, which, as is well known, progresses in such cases only by small degrees and in an imperceptible manner, became listless and commenced to forget the slight amount of knowledge of arithmetic which he had acquired after laborious effort during a long period of time. It was also noticed that at times he would exhibit outbursts of violent anger with impulsive acts, by far more intense and more prolonged than prior to the accident. The former timidity became more pronounced; while he used to be very shy and hesitated greatly to face strangers and speak to them, now he isolated himself almost completely and absolutely refused to converse with anyone outside of his immediate relatives. Formerly he showed a certain degree of brutality towards his sisters and brothers. Once, for example, he attacked his older sister with scissors because she refused to hand him quickly a

* Read by title at the Seventy-fourth Annual Meeting of the American Medico-Pyschological Association, Chicago, June 4-7, 1918.

part of her apple. He inflicted an injury to her arm and while the latter bled he stood immovable and laughed. Since the accident, during a period of three months he was unusually violent in his attacks on his relatives, including the parents. Upon the least refusal of gratifying his absurd wishes he attacked mercilessly anyone who happened to be near him; he would pick up heavy objects, such as vases and irons, and throw them, irrespective of consequences. Once he inserted his teeth into his mother's arm with such force that for several minutes it was impossible to remove him, in spite of the fact that the victim kept on screaming from pain. He became so unmanageable during these outbreaks that he had to be kept in bed, under restraint. The condition lasted three months, during which period of time it was impossible to make any progress in the mental training which he had been undergoing prior to the accident. Gradually the condition became ameliorated, the violent impulses became less and less pronounced and the boy returned to his former mental state, which only then made the resumption of his training possible.

In three boys of the same group after slight accidents and in four boys after a fright in addition to an arrest of progress in mental training, there was also an increase in pre-existing tendencies of various character of a serious nature. Sexual perversion, such as fetichism, Sadism, exhibitionism and homosexuality, was quite marked and very frequent police arrests followed. In five cases, in which the mental status of the defective individuals was not wholly understood by the parents, bodily punishment was not infrequently inflicted by the latter when the children have been unable by reason of their deficiency to carry out orders. The result was that an accentuation of the fundamental abnormal characteristics became very conspicuous. Great irritability was the most striking symptom; impulses of the most unusual kind followed. Moreover, in three cases there was a mild, delirious state accompanying each outburst of passion, of anger, or following a violent masturbating act. They soon recovered from the delirium. Very brief periods of confusion were also observed in some of this small group of individuals during their morbid impulses. One girl of 13 was severely punished by her older brother for a trifling offense. Immediately afterwards she was