Mental Invalids: Being the Morison Lectures
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Book Reviews & Abstracts.
delivered before the Royal College of Physicians of Edinburgh in June, 1925, by C* C. Easterbrook, M.A., M.D., F.R.C.P.E. Edinburgh & London. Oliver & Boyd. Med. 8vo., pp. 86. 5s. net.
Here is one of those valuable books none to? common?which represents the thoughts and work of a lifetime. Can a man offer any- thing of higher value than this to his fellow- men? Is not the world thereby much richer than if the gift took the form of gold and Precious stones? Yet how little is this appre- ciated by many reviewers who fail to dis- tlr*guish such works from mere monographs ?l~ epitomes of other people’s ideas and dismiss them cavalierly with a few words of condem- nation or praise. But to review them seriously ls ?ften impossible because of the small space allotted to the reviewer, and the present is a Case in point.
However, I can at once assure the reader that these lectures by Easterbrook are deserving of direct attention and study, and 0r the small expenditure of 5s. the materials, at lfcast all that really matters, of a large and ^P-to-date work on psychiatry are at hand, those who know Dr Easterbrook personally are not in any doubt as to his sincerity and earnestness of purpose. This is exemplified in t e work before us which treats of that all-im- Pprtant subject, namely, the mind in health and ^sease. Easterbrook’s name should ever be Remembered, for did he not first introduce in these isles the treatment of acute mental disorders by rest, open air, and sunlight? Yet nobody ever speaks of Easterbrook’s treatment as they do of Weir Mitchell’s.
This calls to mind the abiding work of F. A. ‘kins, who taught us how to nurse those Rental patients who have dirty habits, thereby eaning up an(j sweetening our mental insti- tutions. Now add to these two pioneers G. M. v?bertson in regard to nursing the insane, and one arrives at the three modern psychi- rists whose fundamental work for the better are and treatment of the insane ranks with lat of the great pioneers of the early nine- teenth century. How little is this appreciated OWn generation?
Wow the reading of these lectures leaves us both stimulated and thoughtful. The language they are written in is remarkably clear and has the virtue of simplicity despite the con- densation which has been found necessary. Questions are not raised merely to show that they are unanswerable?a miserable practice so common now-a-day in psychiatric works? but really difficult problems (and there are many whenever one contemplates the mind in any relation) are bravely tackled and some answer assayed or solution suggested and, as a rule, very much to the point.
The general viewpoint adopted is dynamic, hormic and not without a spiritual element, but the facts of psychics, chemistry, anatomy, and psychology are never lost sight of and the psychogenic and physiogenic brought in close approximation in their bio- logical significance.
The human being is dealt with as a bio- psychic unit and social creature in the first lecture, which is appropriately entitled ” The Body-Mind.” Lecture II. forms two chapters devoted to the clinical examination of mental invalids and the causation of mental diseases and their prophylaxis respectively. There is much to be said for Easterbrook’s view that there is a real practical advantage in regarding the primary serological factors, not as heredity and stress, but as the nervous constitution, inherited or acquired (pre-disposing) and stress (exciting). He applies the two clinical methods of general medicine to psychiatry, namely : the historical or life-history method, and the observational method. The third lecture deals with classification as based upon not one but many fundamental principles, forming a true nosological or natural classification and one which he has found very serviceable in practice.
There follows what is perhaps the finest lecture and which concludes the series?one on some aspects and methods of curative treat- ment. Here our author is in a dominion peculiarly his own. He is a strong advocate of the psychiatric clinic, and voluntary treat- ment in mental hospitals.
I think I have said sufficient to indicate to readers the extent of the ground covered and, as for the rest, it would be greatly to his advantage to read for himself, promising him with confidence much of the greatest interest and no disappointments.
J. R. Lord. The Language and Thought of the Child. By Jean Piaget, Professor at the University of Neuchatel and at the Institut J.J. Rous- seau, Geneva. Translated by Marjorie Warden. London. Regan Paul. 1926. 10s. 6d.
The volume before us is the first of a com- prehensive series which Professor Piaget has planned on the subject of child thought; the second volume will be entitled Judgment and Reason in the Child, after which an attempt will be made to analyse causality and the function of reality in the child. The material on which the study is based was obtained from children in the Maison des Petits de I’Institut Rousseau. For about a month Professor Piaget and a collaborator took down with context everything that was said by two little boys about six years of age. The material thus obtained was checked by obtaining similar records from a group of about twenty children on the move, the place of the observer this time being fixed. In the Institute, children from four to seven years of age occupy a floor of five rooms, being free to move from one to another doing only as much consecutive work in any one as they like. The place thus provides in the same way as do Dr. Montessori’s classrooms, a laboratory where the natural child may be studied.
Everyone who, from a scientific point of view, has observed the early language of the child has noticed how extraordinarily different it is in nature and purpose from that of the adult. The adult talks so as to communicate with his fellows; this purpose is to be found in the child’s talk, but it can scarcely be said to be the main purpose; at a certain period in his life the child talks straight on, paying little heed to whether anyone is listening to him or not. This kind of talk Professor Piaget calls ego-centric, in contrast to socialised speech, in which there is inter-action between the child and another person. These two main cate- gories are sub-divided and the sub-divisions illustrated amply from the material, and dis- cussed. In the case of the two children first studied, the proportion of ego-centric to other spontaneous forms of language is .47 in the one case and .43 in the other. The material obtained from the twenty children, whose average age was six, was examined in the same way, the co-efficient now obtained being .45. It seems therefore probable that nearly half of the talk of children of about this age is ego- centric.
In the following- chapters Professor Piaget deals with understanding- and verbal explana- tion between children of the same age between the years of six and eight; with some peculari- ties of verbal understanding in the child between the ages of nine and eleven; and with the questions of a child of six, particularly the ” why ” questions. As the author says, the essays are, first and foremost, a collection of facts and documents the bond between the various chapters being, not that of systematic exposition, but of unity of method applied to a diversity of material.
Child thought and child logic are different in kind from adult thought and adult logic- During the early years of life the child is passing slowly and gradually from one plane to the other. That the passage of even a year may make his own earlier ways of thinking quite unintelligible to himself is shown by a concrete example.
Obviously, until Professor Piaget’s work is complete one cannot estimate the value of the contribution he has made to child psychology* but even in this preliminary volume one has not only a storehouse of fresh facts gathered by a trained observer, but suggestions and adumbrations of theories which will un- doubtedly have a tonic effect upon the science. Margaret Drummond.
Mental Life. By B. Edgell, D.Litt., Ph.D- Pp. 275. Methuen. 1926. Price 7s. 6d. This book is designed to provide social workers with a sound textbook on modern psychology, and it succeeds admirably in achieving this aim.
While the treatment of the subject is genetic* it is clear from the outset that the framework of the explanation of the mental life of the individual is based on the psychological prin’ ciples laid down by Ward and elaborated in the writings of Stomt. Fidelity to the teaching of the best English psychologists knits up a series of discussions, which touch controversial problems at many points, into a book which Is systematic in plan and consistent in character. Social workers who are brought into contact with mental defect as well as with social delin- quency, will be glad to note the comprehensive and careful treatment of the nervous system and the useful diagrams connected with it. In e _ chapters on Native Endowment and nyironment, as well as in that on Adolescence, J 1S also evident that the writer is keenly aware of the information and knowledge ed by those brought into relation with ^ver-changing nature of immaturity and The student who follows the distinction rawn between reflex action and impulsive Activity in the chapter on Primitive Values will ^ Prepared to reject Behaviourism and endorse Q cf^?ugaH’s doctrine of Instinct, while being n his guard against the unqualified acceptance 0 his ” neat parallelism between instinctive resP?nse and emotional experience.”
After dealing with Sensation as the basis of j*?g”nition, the fundamental processes of intel- ectual growth are shown to be retentiveness, Vl’ch secures the effects of the past for new vance, and attention, working selectively j.jr?ugh the consciousness of likeness and un- ^eness to a continuously richer integration. e^rning by experience forms the topic of the ?”nth chapter, in which the simpler modifica- 1 of behaviour, such as adaptation and ‘bition and the various methods of acquiring w responses are fully discussed and illus- jr ec*- The development of Ideation is traced ?m the ” acquired meanings ” found in per- id^tUa^ exPer’ence through ” tied ” to ” free ” as. The hallucinatory vividness of the c,?ently discovered ” eidetic ” imagery of 1 tlren is referred to as a possible explanation 0f children’s lies.
hapter ten gives an account of those emo- ^?nal attitudes?Fear, Anger, Sociality, i as*erfulness and Subjection?which play an ^Portant part in the development of the fa ke’ng in his relation to society. The the Pr^m^tive values tend to conflict with ^ahues acquired in the advance to civilised of ^ends to t^ie discussion of current theories ful fG Unconsci?us- All students will be grate- the ?r ^r* ^dgell’s clear distinction between 0f Unc?nscious, considered as the organisation strmean’n?s and values, which is the abiding . c^Ure of the mind, and the sub-con scions, ev c ls ” that portion of the stream of mental niti S,,w^’ch is beyond introspective recog- fion n f referi”in& to Dr Jung’s concep- Co .. tfle racial unconscious as an innate Co^n^1Ve disposition parallel to the innate aiItu lve disposition met with in instinct, the ?r suggests that this may raise more diffi- culties with regard to heredity than it solves. The behaviour of the adolescent in the stress of conflicting- claims is used to distinguish three types of individuals : those who impulsively adopt the opinions of others, those who con- form to group standard morality, and those who are able to take their own way and are probably regarded as outlaws. Yet the latter, by sustaining conflict and playing a lone hand, are able to move forward to the construction of new values which raise the level of group morality.
In dealing with Thought as the process of solving a problem, it is shown that in prac- tical problems thought can succeed through performance?through an analysis and re- synthesis in the world of things comparable to the analysis and re-synthesis involved in the world of ideas. Experiments recorded by Kohler in ” The Mentality of Apes ” and by Julius in ” Mental Life of Monkeys and Apes ” are cited in support of a process, which it is important for the educator to understand. The last three chapters of the book give a straightforward account of the formation of sentiments and the organisation of conduct and character. The teaching of Stout is followed and the further contributions of McDougall somewhat unaccountably ignored?a fact which may account for the somewhat weak treatment of Temperament.
Good diagrams, excellent illustrations drawn from literature, sets of exercises, a list of books recommended for further study, and a careful index enhance the value of a book, which will not only satisfy students preparing for educational or other social work, but also hold the attention of the general reader who desires to understand his own conduct or the behaviour of his fellows.
N. G. R. Taylor.
Behaviorism. By John B. Watson, formerly Professor of Psychology at the Johns Hopkins University. Kegan Paul. 1926. 12s. 6d. The avowed aim of this book is to suggest how the principles of behaviorism can be applied in all branches of psychology, in educa- tion, sociology and ethics.
The author begins with a brief account of the development of the behaviorist point of view, and includes, through reference to primi- tive man, a rapid sketch of the origin of the concept of ” mind.” He then proceeds to illustrate the manner in which the mechanism of the conditioned reflex can be used to explain various kinds of human behaviour. Here foliows a brief outline of the physiology of the nervous system, muscles and glands. This leads up to a theory of instincts as chains of responses, built up by the conditioning” of that original physiological structure by which man is forced to respond in a certain manner to certain stimuli. Further development of the theory leads to the assertion that individual differences in ability or behaviour are entirely due to training, the only differences that are inherited being peculiarities of physiological structure.
In order to prove his theory of instinct, he quotes records of observations made on the earliest behaviour of the child; by studying emotional reactions in young children he con- cludes that there .are only three types of response that can be described as ” innate.” These he classifies as ” fear, rage, and love.” He gives interesting studies of the situations that call out these responses in the first instance, with further experiments and obser- vations on the development of the response in connection with different stimuli and complex social situations.
There follows a discussion of the acquisition of muscular habits, which is explained by the law of frequency, memory being described as the amount of the habit shown to be retained after a given lapse of time. The same prin- ciples are applied to thinking, which is defined as internal speech or ” language habits.”
Here the author makes an advance on earlier presentations of his theory and emphasises the importance in thought of the bodily and visceral muscular systems, in addition to the purely laryngeal muscles. The book finishes with a general discussion of personality, con- sidered as the sum of the habit systems of the individual; this includes some practical con- siderations with regard to the study of per- sonality, its development and diseases.
The illustrations throughout the book seem intended to demonstrate the application of behavioristic principles in everyday life, as well as in the social sciences, but the actual task of analysing the instances given into terms of conditional reflexes is seldom attempted. It thus seems that many of the difficulties of the theory have been evaded, with the result that the arguments intended to demonstrate the possible revolutionary effects of the doctrine, are distinctly uncon- vincing. With regard to the experimental results cited, recent work on learning and memory in animals tends to show that the law of frequency does not adequately fit the facts.
The most significant part of the book is the record of observations on young children, while the emphasis placed on the need for a scientific approach constitutes a useful attack on uncritical anthropomorphism. On the other hand, when the desire to be objective results in an attempt to analyse behaviour entirely m terms of the mechanics of muscles and glands, it becomes unscientific, in that it ignores much relevant material.
Marian Blackett.
Psychological Medicine. A manual on Mental Diseases for practitioners and students. By Sir Maurice Craig, C.B.E-, M.A., M.D. (Cantab.), F.R.C.P. (Lond.)? and Thomas Beaton, O.B.E., M.D-> M.R.C.P. (Lond.) Fourth Edition. Pp* 437. J. & A. Churchill. 1926. 21s. ” In this edition the book has been almost entirely re-written in order to place before the reader the modern views of mental disorder.’ The object of the book is “to lay before the student a short account of the principles and practice of Psychological Medicine.” It is admirably adapted for this purpose, and is certainly up-to-date. But it is more than a mere manual; it is a very interesting work, much of which might be read with advantage by any practitioner. This is partly due to the lucid style, and also to numerous apt refer- ences to illuminating facts gleaned from a wide field of knowledge. The illustrations, many of which are coloured, enhance its value.
There is an excellent exposition of Psychology; we have never read better ex- planations of some ideas, such as Volition and Rationalisation, but in the definition of Sublimation, on page 52, it is not made suffi- ciently clear that Sublimation is not merely a deflection of the interest-flow, but means guiding it into channels of activities, which are socially acceptable and valuable. On page 43 the use of the word ” affection ” in discussing emotion, without explaining that it is not used jn the ordinary sense of the word, may puzzle e student. If the writer did not wish to Use the technical term ” affect ” he could have !ade his meaning- plain by speaking of feeling- ne> or even affective tone, an expression ually used earlier in the same paragraph. An outstanding and valuable feature of the ??k is the attitude to disease, and in par- r’cular to mental disorder, which is approached om many angles. Great importance is ached to minor symptoms in the earlier ^.ag;es. We read that ” More cases of mild ‘s?rder of the mind occur in general practice ? an is commonly imagined, and it is as Jttportant to diagnose and treat mild disturb- nces as more advanced disorders. In many t>ays it is more important… .” The fact at sufferers from mental disorder are not a ass apart from the more normal man will <<0n?e home to the student when he reads that ^e student can study mild forms of mental ^Sorcjer jn Jnmself, ancj wiH find that this kind !ntrospection helps him to comprehend the 0re advanced disorders of others.” As &ards the practitioner, we should like to see .. nted on the top of every doctor’s visiting the aphorism on page 168 : “A case of ? e ancholia should never drift while the doctor re UP his mind what to do.” If he th this book he will get much help from e sections dealing with treatment, ^he section dealing with Psycho-analysis on &e 361 is disappointing. The student may ^ the impression that ” free association ” is e*ercise done by itself, and not a method solving the dream problem. The statement v?Ut assistance in Psycho-analysis from the ^ association experiment is inaccurate. do6 y?r^”assoc’ation test has nothing to ^ith Psycho-analysis, but is a method el k aPProaching the Unconscious Mind 0rated by Jung, not Freud, before is WaS accluainted with Analysis. There itn n? rnention of the Transference, a very sh ant item in Psycho-analysis. These *??ings are the more striking when we lu -*Se that on page 115 there is a terse but tat” an-^ a^equate account of dream interpre- ts n’ -ln whieh the views of Freud and Jung Pectively are rightly differentiated. ?tyell e section on Mental Deficiency describes scar asPects of the condition. But it ancjrcev gives enough help in the diagnosis certification of the feeble-minded, especially the high-grade cases, a duty which any general medical practitioner may be called upon to perform under the Mental Deficiency Act, 1913. This contrasts markedly with many helpful sections, especially the chapter on Malingering, a chapter which any practitioner, however experienced, could read with benefit. Such criticisms as we have made deal with blemishes which might easily be dealt with in the further editions which are sure to be demanded of this informing book.
W. A. Potts.
Children’s Courts. By W. Clarke Hall. George Allen & Unwin, Ltd. 1926. 7s. 6d. A new book by the well-known magistrate of the Shoreditch Children’s Court is very welcome, especially to those who are familiar with his previous work, ” The State and the Child.” The latter appeared nearly nine years ago and it is interesting to note how opinion (including Mr. Clarke Hall’s own) on the subject of juvenile delinquency has advanced since then. One sign of the advance has been the publication of Dr Cyril Burt’s ” The Young Delinquent,” from which many quota- tions are made in the book under review. Readers of this paper will turn with interest to see what is said on the question of the mental examination of delinquent children. It is urged in the summary of conclusions that there should be ” expert medical advice in all serious cases.” It is not sufficient that a mental specialist should be available for the cases that the magistrates suspect of some mental defect. As Mr. Clarke Hall says : “No one without medical knowledge and experience can in all cases diagnose the necessity for a special report. Many children who may seem to a magistrate quite normal are in reality in very urgent need of such an examination, a need which an experienced doctor would at once realise.” But a medical examination necessitates a remand, and the lack of suitable remand homes is a serious obstacle in the way of establishing the exam- ination as a definite feature of our penal system. A room on police premises, such as is provided by a large number of courts, can hardly be considered a suitable place for a child to remain in while a medical examination and the enquiries are being made. And yet, where the total number of cases is very few, it is impossible to arrange for a separate insti- tution. In such places it might be a good plan to make it part of a probation officer’s duty to have a room available at his or her house for a child on remand.
Causes of juvenile delinquency are divided into external and internal, and the Children’s Court is mainly concerned with the former. ” The first and paramount duty of the Juvenile Court is to obtain a complete and exact know- ledge of the child’s environmental conditions.” Then follows ” the further duty of obtaining expert advice on the physical and psycho- logical factors which may have contributed to or … caused delinquency.” The amount of physical defect found among delinquent children is terribly high. No less than 70 per cent, are said to suffer from some bodily weakness or ill-health, and nearly 50 per cent, require medical treatment. As regards mental defect, Mr. Clarke Hall considers that the great majority of juvenile offenders are fairly up to the average in intelligence; in fact, the brightness of many of the children is very striking. Of course, in any consideration of juvenile delinquency it must always be borne in mind what a very small proportion of children who break the law ever come before the Court at all. In 1924 only 311 children were charged at the Old Street Court, while the population served by the Court is over a million, of whom at least 300,000 are children under 16. It is an interesting speculation as to how far this extremely low figure is due to a real decrease in juvenile naughtiness or to a reluctance on the part of the police, parents, and general public to bring a child before a court of law.
With regard to procedure in Children’s Courts, it is urged that legal language and unintelligible questions should be dropped and a reasonable practice made universal. As things are, after hearing a few incomprehen- sible sentences, a child soon loses ” all hope of even partially understanding what on earth it is all about and relapses into a sullen silence which no subsequent explanations can over- come.” If a child denies the charge, it is absurd to ask him to cross-examine the witnesses. He is quite incapable of doing it.
The magistrate should hear what he has to say and then cross-examine the witnesses for him. This is Mr. Clarke Hall’s own proce- dure, and one wishes that magistrates in general would have the wisdom and courage to adopt it. The difficulty is that as long aS the Children’s Court remains a criminal court and the enquiry is a trial, it is almost impos- sible to make the procedure what we should wish it to be. There are in the book son16 drastic proposals regarding special magis* trates for Children’s Courts, the grouping Petty Sessional Divisions round a Central Children’s Court, and the inclusion in the jurisdiction of Children’s Courts of new classes of cases (such as adults charged with offences against children) which raise important issues and require the gravest consideration.
Many proposals which are made f?r improved methods of dealing with young offenders will be heartily welcomed by those who have considered the subject. Birching 15 utterly condemned. No boy has been birched at Old Street for the last six years, and it lS quite clear that the abandonment of the punishment has produced no increase in delin- quency; nor is much use made at Old Street of fines or of recognizances. Nearly all the children are either put on probation (50 per cent, in 1924) or sent to Home Office Schools (28 per cent, in 1924). Part of the success of Probation at Old Street is doubtless due to the admirable staff of Probation Officers who have been appointed by the Home Office to that Court. Mr. Clarke Hall writes strongly against the rigid denominational tests at present imposed on all Probation Officers appointed under the Police Court Mission. To many who would like to become Probation Officers the sectarian test is an insuperable barrier ” as futile as it is harmful.” Nor s Mr. Clarke Hall any admirer of the system by which the Home Office Schools remain under private management. He thinks that earlier licensing, better classification, and better training would result if the schools were under direct State control, and that, if the present system continues, at least much greater powers over the schools should be conferred on the Chief Inspector. Mr. Clarke Hall’s long e” perience as a magistrate, his wide knowledge of the schools, and the high regard in which he is held by all who know his work make his opinions on this, as on all other questions of child welfare, of the greatest weight and value- Clara D. Rackham, J.P-
^lth Compendium and Health Publicity. ^ompiled by T. Crew, F.F.I, and F.I.H. (J^lerk to the Leicestershire Health Insurance Committee). 1926. 7s. 6d.
This book of reference is a guide to social ?rkers in their search for the right associa- n to deal with any special problem of health, yr subjects akin to health. The number of k untary associations in England, as we all fr ?if’ *S so ^ar&e as to excessive, yet each v- society is started with a slightly different c ^Point from its predecessor in the same h ^ Marshalled in one book, the list of a. organisations looks formidable. But jn ,.ls a helpful publication, and its issue i lcates the public interest in maintaining and ti Pr?ving the mental and physical health of e community.
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