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the cause is not quite so clear, and here, furthermore, the ideas are more incorporated into the personality. In the other cases the cause seems quite clear. In Cases I, VII and X the external cause is not so apparent. In fact, the exact cause does not always clearly appear. This, of course, is more like the origin of psychosis.
Thus, Case I seems possibly associated with alcohol (involution ?); Case VII with hypertension, and some organic brain lesion (type not clear); Case X with constitutional inferiority, hypertension and involution—all of which are factors which usually do not produce states of this sort, at least in our experience. Promptly the question is raised as to the relation between these possible causes and the observed state. But it does not seem that we have progressed far enough in etiological investigation, either psychic or organic, to do more than note the associations in these cases and to await the results of therapy. There is no a priori ground for believing that a particular cause is necessary, providing that the soil be right. We could phrase it thus: Any cause on particular soils, or particular causes on any soilalthough this goes somewhat too far, it roughly approximates the truth.
Accordingly it appears that differential diagnosis of psychoneurosis versus psychosis is not always easy; that external and internal causes may produce much the same state; that some psychoneuroses (symptomatically) run a manic-depressive course; that psychoneurotic symptoms may occur as the prodromal signs of dementia præcox; that psychoneurotics not infrequently commit suicide; that many are insane; that such causes as alcohol and arteriosclerosis may operate to produce a syndrome not to be distinguished from psychoneurosis,
THE PATHOLOGY OF CHOICE REACTIONS.
BY FREDERIC LYMAN WELLS AND HERBERT A. STURGES.
(From the Psychological Laboratory of McLean Hospital.)
PAGE 1. Conception of the Problem......
81 II. Correct Reactions of Normal Subjects..
90 III. Correct Reactions of Pathological Subjects Compared with Those of Normal Subjects......
97 IV. False Reactions of Normal Subjects..
ΙΟΙ V. False Reactions of Pathological Subjects Compared with Those
of Normal Subjects.... VI. Pathological Records in Relation to the Clinical Condition of the Case ....
II2 VII. Criticism and Conclusion.
I. CONCEPTION OF THE PROBLEM. To the different situations presented to an organism, human or otherwise, differential reactions must be made if the organism is to survive. Sensory end-organs differentiate and interpret the situation as a stimulus; motor end-organs perform the differential response coordinated by the nervous system. The situation is "discriminated"; the reaction is “chosen.” The choice reaction is a reaction adjusted to a discriminated stimulus. Proper choice reactions in life are implied in proper adaptation thereto.
The question underlying this study was, How are superior quickness and appropriateness in choice reaction processes which can be studied experimentally related to the choice reactions of life which have thus far eluded experimental control? Success, usefulness, happiness, are results of choice reactions called good, well-adapted, correct. Discontent, failure, mental disease, are expressions of bad, ill-adapted, false systems of psychomotor adjustment. This
"The portions of the work for which the authors are severally responsible are as follows: W. supervised the construction of the apparatus, installed same and performed the experiments. S. made practically all measurements and calculations. Tabular material was prepared jointly by S. and W. With suggestions from S. at various points, W. wrote the text substantially as the reader has it.
study is, in the first instance, a comparison of the choice reaction process in normal individuals and in mentally diseased ones. How do laboratory adaptations of those well adjusted to life compare with these reactions in persons thus badly adjusted to life?
In measuring how they compare, there is involved a fundamental source of error in the application of laboratory psychology to actual life. Adjustment in actual life is the expression of a proper balance of instinctive tendencies. The psychoses here considered are from the mental standpoint expressions of a failure of instinctive tendencies to balance (Adolf Meyer). Mental adjustment to actual life is governed by the instinct trends. It is just in their relation to the instincts that laboratory measurements differ most from the test of actual life. Formal complication without limit may be introduced in the laboratory; but the appropriateness of responses is usually a convention, and the instinctive appeal negligible. This investigation provides an answer to the question of how far this balance of instinctive life is reflected on the more superficial psychomotor level with which the present observations deal.
The pathology of choice reactions can be viewed from two angles. One is the direct comparison of normal and pathological individuals suggested above. From another angle, the false reactions of experiment become in themselves a part of the “psychopathology of every-day life.” The data will be presented in both aspects.
The apparatus of the present experiments lays claim to no technical originality, and, if anything, errs on the side of simplicity. Chief stress was laid on the laboratory surroundings. With subjects accustomed to the unfinished aspect of most laboratory appurtenances, these do not greatly matter; but it was felt and is still believed that the effort spent in this direction was compensated in a more favorable attitude of the pathological subjects than had been met with in previous investigations. In the examining room was only such special apparatus as was needed for stimulus and reaction; pains were taken with the finishing of these and with other appurtenances to give the appearance of a well-appointed office.
The stimulus and reaction apparatus designed for these experiments consisted of two exposure screens and a 5-finger reaction key. These pieces are the originals of improved models later supplied to the Carnegie Institute of Technology. The generally used exposure apparatus (here called "fall-screen") carries a frame some 28 inches high by 6 wide, which is moved by gravity against an oil-cylinder past a slit. The stimulus material is carried between guides on this frame, on a strip of heavy paper approximately 3 inches by 284 inches. The frame falls i inch for each exposure, affording 25 exposures per series on a strip. Electric contact is broken during each fall of the frame, and restored when it comes to rest for each exposure.
This apparatus is mechanically most satisfactory; but has the inherent disadvantage that the stimuli, following each other on a single strip, cannot be varied in order. To render this possible, another exposure screen (here called “light-box ") was designed. This is a large box painted black inside, with an aperture in front through which the subject looks. Inside the box, in the rear, is a frame into which an ordinary playing card can be slipped from the outside. On such blank cards is lettered the stimulus material. Under ordinary conditions the material on this card is invisible to the subject (though the card itself is faintly to be made out); but closing the switch lights a concealed tungsten lamp which illuminates it to his vision, and also makes a momentary electric contact to register the stimulation. Single stimuli on each card could, of course, be presented in any order and without interruption to any amount. Otherwise it has been a somewhat less satisfactory instrument than the fall-screen. The fall-screen is the source of the results presented, the light-box figuring but incidentally in the present material.
For reactions with right and left hands, a telegraph key was mounted on each side of both the fall-screen and the light-box. For reactions using all fingers of one hand, a 5-finger key was especially made. Like the other pieces, it was finished in mahogany stain. It was placed on a table at the side of the fall-screen wherever desired. The only visible wiring in the room consisted of three 6-conductor and one 20-conductor Ulesote cables. These cables to the different pieces of apparatus were several feet in length, enabling the pieces to be shifted in the room according to convenience.
These cables are led through an aperture in the wall and immediately to a distributing board, through which any one may be readily connected with any terminal of the recording system. The room containing this distributing board was used as a general shop and storage space, serving further to isolate the examining room from the distractions of the recording apparatus. This was installed in a large ventilated closet leading off of the second room.
Reactions were measured on a 6-pen ribbon recorder, spring driven, which had originally served as a burglar alarm register. The spring motor was stopped and started electrically, giving control from the examining room. The speed decreased considerably as the tension of the spring relaxed, a seconds time-line being employed. This was taken from a Porter electric clock. This circuit was also connected through a relay with a lamp in the examining room, which, not visible to the subject, gave the examiner a rhythm used in the experiments. Pen No. 6 on the recorder, operated by this circuit, also registered the stimuli on the fall-screen. The remaining five pens registered reactions of the five fingers, pens i and 2 those of right and left hands, also the stimuli of the light-box experiments.
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