An Outline of Abnormal Psychology
- Type:
Book Reviews & Abstracts.
- Author:
William McDougall, F.R.S. Methuen &
Co., Ltd. Demy 8vo., pp. xvi., 572. 1926. 15s. net.
Professional students of Psychology, no less than the very considerable number of the general public which Professor McDougall has made his own, have been waiting for the publication of this book. It was promised in 1923. They expected it to be a useful, and even a necessary, sequel to his ” Outline of Psychology.” In these days of the popularisa- tion of the Abnormal, they wished even more to learn the views of one of the foremost ” pure psychologists ” upon the conflicting theories which pass current under the un- merited name of the New Psychology.
In neither of these expectations have they been disappointed. No system of hormic psychology?such as is McDougall’s?could afford to leave out of account the abnormali- ties of the mind. This volume was therefore needed to complete the former one. On the other hand, it would seem quite impossible to deal with the causes which lie at the root of mental disorders without an adequate dynamic of mental process in general. This McDougall finds in the instincts. His theory has been widely known, and with good reason, since the publication of his ” Social Psychology ” in 1908. It now receives further confirmation from, and at the same time explains many facts which were out of the purview of the original theory . In common with the school of Psychotherapy, which includes so many leading English Psychologists, McDougall, who writes as a Psychologist rather than as a medical practitioner, wages successful war against the mechanical conception of the human mind. Man is no machine. He is a conscious organism in which purpose has its full part to play. He works towards ends at which he aims and is not merely pushed forward passively by natural causes working at his back. And, against deterministic schools even of Psychotherapy, he advances a theory based not merely upon pathological, but upon normal ?and primarily on normal?facts as well. He would have us understand disordered mental processes in terms of the general principles of pure Psychology.
The thirty-four chapters of the volume treat of all the subjects usually dealt with in a work of this kind; all the preceding- ones leading UP to those on Personality and Integration and Disintegration respectively.
It is perhaps unfortunate that McDougall should have made use of the term personality as synonymous with character. Philosophi- cally, they stand for very different things; and McDougall, besides being a psychologist, is well acquainted with Philosophy. Integration of character is understandable, while integra- tion of personality is not. But the usage seems to have become fairly well fixed now in the science. The ” Outline of Abnormal Psychology,” like its predecessor, is not only an interesting book, it is a practical one. It will be of great service to all who wish to under- stand the principles at the basis of the minor, as well as the major, maladaptations of the human mind, and wish to put them to practical account. It will be especially welcomed by those who have the aims of the Association for Mental Welfare at heart. This, perhaps, is no argument in favour of the book, but the book is certainly a sound argument for the aims of the Association.
F. Aveling. Early Mental Disease. (” The Lancet ” Extra Numbers.) By various writers. Pp- 194. Wakely & Son, Ltd., 1926. 12s. Recent events have given rise to additional interest in the subject of early mental disease : so this is a most timely volume. It is a pity? however, that the valuable information which it contains is not rather more concentrated, so that the busy man might familiarise himself with these early symptoms without waste of time. Indeed, it is not so much a matter of ” waste,” it is simply that few people have a sufficiency of leisure to familiarise themselves with even a tithe of the books and articles which pour from the press in only one branch of science ! Then the form of the volume?’ and nearly two hundred pages with double col- umns?is awkward. It is true that the shape conforms to that of some of the weekly jour- nals?which is no commendation. This much by way of complaint. On the other hand, the mere bulk of matter should serve as an answer to those who affirm that in regard to mental disorders comparatively little is known ‘? the inference being apparently that in other Ranches of medicine knowledge of disease and lts treatment is quite satisfactory. Yet a little thought will bring” the realisation that even *n general medicine much treatment is tenta- Ve or palliative.
j- he method adopted by the editor of this v?lume of allocating different topics to separate Writers, although it has resulted in a collection 0 extremely interesting articles, militates also a^ainst compression. This allowance being m^de, much praise may justly be given to those o have contributed. Indeed, it is difficult Well as invidious?to specify particular con- ^butions as most worthy of commendation. erhaps it may be permitted to mention in the j^ction on ” Classification ” the contribution py >r. Mapother on the ” Schizophrenic- paranoid Series “?that is the Dementia Prse- ??x and Delusional Insanity group because it s one of the most difficult problems in the uhole range of mental disorders to deal with, fnd to describe. It is an important group ecaUse jj. incjU(^es cases of mental disorder in Jch the preliminary symptoms are exhibi- .eQ, for the most part, in early adult life, and * which the prognosis is so bad. Also the umber of those who break down in this way th amentat>ly large. Diagnosis is difficult in he early stages : ” transitional cases abound, the relegation of any particular patient, ??> to the category of manic-depressive in- anity Qr dementia praecox, or even to the arger groups of neurosis or psychosis is in any cases a question of personal judgment ano choice.” Dr Mapother does not take an optimistic view of treatment?at any rate, of e measures which have so far been tried proving successful. He is probably right: for those cases in which improvement has taken P ace after treatment, it is very possible that Ul diagnosis has not been correct! Or it may “- merely one of the remissions of symptoms lch are so well known. Prophylaxis may iCrve to prevent the development of an attack), ut, in view of the difficulty of diagnosis, ” it at present quite impossible to say whether ^ ? ? one would ever be justified in claiming 0 ave averted a psychosis.”
s *n.cidentally, it is to be regretted that no Pecial section is devoted to prophylactic mea- Ures. It is doubtful if the community will ;V-Cr ^ Educed to give up its right to marry ^judiciously and to give birth to the next generation of unstable individuals. Still, it would have been as well to emphasise the necessity of doing- something- in this direction if there is to be any appreciable reduction in the numbers of the insane.
There is quite a satisfactory amount of space given to treatment by most of the writers : and there are several appendices devoted chiefly to this. Particularly interesting are those on the “Early Treatment of Mental Dis- order,” by Sir Maurice Craig, and on ” Orga- nised Occupational Therapy,” by Dr D. K. Henderson; while mention must also be made of Dr Millais Culpin’s contribution on the ” Application of Psycho-Analytical Principles.” Dr Henderson remarks : ” I have often been asked whether I found one type of work more suited to a special form of mental disorder than another. The answer is in the negative. Every case is a law unto itself, and with each new patient a different interest has to be found. … The types of work which we have found of most value are raffia-work, cane-work, basket- making, chair-making, rug-weaving, simple joinery, repousse, china-painting, embroidery, the use of the fretsaw for toy-making, and more intricate work, such as batik and bar- bola.” Dr Henderson widens the scope of the term so as to include ” all forms of activity, games, dancing, theatre-going, participation in sports, and crafts of all kinds.”
Despite the criticisms already made, it can be quite freely admitted that this is a valuable book, and one which everyone who is interested in the study of mental disorders should read. Perchance, when a new edition is called for? as it should be?it may be possible to make it more succinct and rather more handy. Hubert Norman.
Report from the Select Committee on Nursing Homes. (Registration.) H.M. Stationery Office, 1926. 4d.
The recommendations of the Select Commit- tee on Nursing Homes (Registration) corre- spond in the main with advanced opinion on the subject. The need for registration is empha- sised, and the exemption of homes with a medical practitioner resident or in actual con- trol at the time is considered impracticable. It is recommended that the inspecting authority should be the County Councils and the County Borough Councils, and that the definition of the term ” Nursing Home ” should be made to include all types of nursing homes, including maternity homes. With provisional exemption 104 mental welfare.
of existing- homes and possibly in special cir- cumstances, the Committee consider that the matron or other person in charge should be a fully qualified nurse, and that the general standard of qualification of the staff should gradually be raised.
The Committee received complaints of very bad conditions in some senile chronic cases, and the position is summarised in the words, ” Elderly and senile patients, practically put away in a cheap home by relations who take little or no further interest in them, suffer great indignities, are very unhappy and too fright- ened to make any complaint.” We quote at length the opinion of the Committee. ” Your Committee have been deeply impressed with the urgent need for registration and supervision in that class of nursing home which caters for the poor senile chronic. It has been stated in evidence that it is impossible adequately to nurse and accommodate, in a private room, a patient under ?5 a week. Unfortunately, there exists a large class of elderly persons who, although they are capable of making some payment, are quite unable to find a weekly sum of this order. Your Committee consider that the general application of registration and in- spection will do much to alleviate the bad con- ditions and sufferings undergone to-day by patients of this class, but they desire strongly to emphasise their opinion that this change cannot be regarded as a cure for these evils, but merely as a palliative. They feel that the problem can only be properly solved by the re-organisation of the Poor Law system, and with regard to the class of patient dealt with in this sub-paragraph, by the provision of proper paying accommodation by local authorities to meet their needs.”
Brain Capacity and Intelligence. By E. Morris Miller. Director State Psychological Clinic, Tasmania. 1926. 2s. 6d. This monograph is published by the Australasian Association of Psychology and Philosophy. The brain measurements were taken during August to October, 1925, according to the methods laid down by the British Association for the Advancement of Science, and by Berry & Porteous in their measurement of Melbourne children. 4,042 schoolboys were examined from varying types of schools. Dr Miller says : ” We found that the medians of cubic capacity of their brains varied in accordance with the de mental levels.” Comparisons are iria between Tasmanian and Victorian childrefl’ and careful statistics made of yearly gr?xV in brain capacity. Table 18 gives a c parison of means of cubic capacities 0 retardates and normals of sub-group of State schoolboys. , Means of Means of Year of Life. Retardates. Normals 8th 9th 10th 11th 12 th 13th 14th 15 th 16th 17 th 1,255 1,274 1,248 1,288 1.275 1,298 1.276 1,322 1,284 1,335 1,307.3 1,336 1,307.6 1,362 1,332 1,377 1,412
” In general terms, it may be affirmed ft”0111 these data relating to groups of schoolboy5 that brain growth shows a positive correS’ pondence with mental growth and pedagogic3 attainment.”
The State Psychological Clinic has, during the last three years, included brain measure’ ments as part of its routine of examinations- From the results, Dr Miller says : ” conclude, then, that small-headedness increase5 considerably as the mental levels decrease, ^ it becomes most marked at the levels of feeble* mindedness, imbecility, and idiocy. As a classi the feeble-minded possess a much smalle1” brain capacity than the border-lines ; and th? border-lines, in their turn, are, as a class, smaller brain capacity than the normals.” An examination of prisoners in Hobart Ga?’ gave evidence to prove that ” this prison pop^’ lation is much smaller-headed than the intel’ lectual and the law-abiding members of the community, and that as the mental levej recedes the numbers of small heads increase- It would be interesting to compare Dr Miller s results with those of Dr Goring which were published in his ” English Convict.”
Dr Miller concludes : ” With such result? as we have attained from the measurement o* brain capacity, and comparing the diagnostic value of these results with other intelligence and performance tests with world-wide recog’ nition, we may claim that the brain capacity record should be utilised along with the other recognised methods in the diagnosis of mental deficiencv.”
An Outline of the Practice of Preventive Medicine. By Sir George Newman. H.M. Stationery Office. 1926. Is. the State of the Public Health. Annual Report of the Chief Medical Officer of the Ministry of Health for the year 1925. H.M. Stationery Office. 1926. 3s. 6d. Education in England and Wales : Being tjle Report of the Board of Education for the School Year 1924-25. H.M. Stationery 0ffice. 3s. 6d.
These three official publications have each ?me reference to the causes of mental disease ^nd defect, to prevention and treatment, Honing and education.
,.r George Newman’s ” Outline ” is a new ltl?n of his 1919 Memorandum, and it is |v?rth while to read in handy form so excel- ^ a summary of the present trend and c llevements of medical practice. He Rurally includes in his survey the latest know- ?C regarding mental defect and disease, and summary of the 44 Provisional articles 1 a national policy in Preventive Medicine ” puts ” Heredity and Race ” in the first place. ? JjJjs Annual Report contains these words : itherto interest in child welfare has centred m?st entirely in the physical well-being of le child. Scientific study of the child has now ?^Un to seek a new direction for investigation, attention 1S being focussed to an increasing ,^ree on the mental health as distinct from , e bodily health. The mental health or lll- tp’1 adults is largely determined by influ- v !~es which are operative in early childhood, j , ‘?he observations on which this conclusion m ased are hardly known except to those who i”ake a special study of the subject. Few, Dn^u ^oca’ authorities have considered the i Nihility of the practical application of cp^ gy to the work of infant welfare nties.” long quotation is given from pj e. .n?tes by Dr David Forsyth, Senior ysician, Evelina Hospital for Children, who tr^??ates strongly the need for psychological ining fQr those working at Child Welfare entres. He says: ” School influences come of?,. ate ? . . It is the first five or six years ea 1 6 t^at are decisive this connection. 1 he i r lest symptoms indicating nervous trouble as we^ as the beginning of a future th,U ^ n^Urosisi are to be sought not later than ls Period. Conversely, a child who has safely passed its sixth year without showing1 any nervous manifestations will hardly develop neurotic trouble in later life.”
In the Board of Education Report, covering the year 1924-25, brief reference is again made to the Committee of the Board which is investi- gating the problem of Mental Deficiency. It is stated that all local authorities are now using the new model schedules prepared by the Board for the ascertainment of defective children, and by these model schedules the number of m.d. (non-notifiable) children was 30,821. No increase in the number of schools can be recorded, there being only 191 schools with accommodation for 16,531.
Among the Vocational Courses for Defec- tive Students over sixteen, there were three for epileptics. We wish that Local Education Authorities in populous areas would explore the possibilities of supporting practical courses for higher-grade feeble-minded persons over 16.
Metropolitan Asylums Board. Annual Report for 1925-26. 5s. Mental Diseases Section (only). Is. Offices of the Board, Victoria Embankment, E.C.4. The Mental Diseases Section of the Annual Report gives, as in previous years, a clear picture of the many differing types of Institu- tions under the Board’s control. At the Caterham Mental Hospital special attention is being paid to records, a convenient record sheet for making six-monthly records of progress on each child and a new system of medical case-records having been adopted. The account given of Darenth Training Colony indicates how much useful industrial work can be accomplished where grading and classification is possible. The value of output for the year ending March 31st, 1926, was <?74,034. The number of inmates that can be accommodated at Darenth is 2,260.
Among the papers contributed by the Board’s staff are those by Dr Kinnier Wilson on the arrangements made by the Board for post- encephalitis cases, and by Dr Stewart on the ” Incidence of Congenital Syphilis in Mental Deficiency,” being a preliminary report of observations made at Leavesden Mental Hospital.
The Board has set aside accommodation at the Northern Hospital, Winchmore Hill, for 50 boys and 50 girls under 16 who are suffering from the effects of encephalitis lethargica. The work is still in an experimental stage. It has been found necessary to exclude cases below three years of age, cases in which diagnosis is doubtful, very slight cases, and completely bed-ridden cases, and also (which is a point of importance to workers among mental defectives), cases in which such mental deteri- oration has followed the original attack of epidemic encephalitis as to reduce the patient to the level of the mental defective. The report states that ” other arrangements exist for their treatment,” but it is only too true that (outside of London) in many areas no adequate accommodation exists.
It is encouraging to read that ” much less difficulty has been encountered than was expected in regard to the cases with inversion of sleep rhythm,” as the patients appear to improve greatly under the conditions of a regulated life. Similarly behaviouristic trouble is less pronounced.”
Dr Stewart’s investigations regarding the incidence of congenital syphilis in mental defi- ciency were made with 800 patients. Steps were taken to exclude those who had been exposed to the risk of acquiring venereal disease. Dr Stewart writes : “In 642 patients the Wassermann reaction was nega- tive, and in 158 positive. Forty-two of the 642 patients represented unequivocal stigmata of congenital syphilis… If the 42 con- genital syphilitics with negative reactions be disregarded, the incidence of syphilis as shown by the Wassermann reaction is 19.75 per cent.
Even when the clinical examples of congenital syphilis with negative Wasserman reactions are excluded, the percentage of positive results appears to be unduly high; certainly much greater than that reported in recent years from other institutions for mental defectives, and I believe the high incidence of congenital syphilis in this hospital can be explained on the basis that a very large proportion of its inmates are low-grade mental defectives with physical infirmity, varying from paralysis of all types to blindness and deaf-mutism.” Previous re- sults of other investigators have shown much disparity, and Dr Stewart believes the explana- tion must be sought in the quality of the material investigated, age and type of case. In drawing any conclusions from Dr Stew- art’s results, care must be taken to keep clearly in mind that Leavesden accommodates unimprovable adults of both sexes, chiefty those suffering- from chronic infirmity, not prI marily due to old age. As Dr Stewart says> the cases are mainly low-grade mental defeC tives with physical infirmity. If generalisation were made from his evidence, an undue pr? minence would be given to syphilis in ^ causation of mental defect.
The Need for Eugenic Reform. By Maj?r Leonard Darwin. John Murray. 1926. l^s- Those who are familiar with Major Darwin ? writings will be particularly glad that the firs really comprehensive text-book of EugenlCS should have been written by him. No one devoted more time and energy to the stud) of the subject in all its aspects, and there few who could bring so sane and impart# a judgment to bear on the data collected, vhi’e still preserving a genuine enthusiasm for the relief of human suffering.
The main criticism which has been levelled at eugenic reformers in the past has been thaj they were basing impossibly idealistic an academic aims on very insecure scientific grounds, that, in fact, they were entirely ?ut of touch with reality. Whatever truth there may have been in this criticism of some eugenists, Major Darwin’s book should remote the subject of Eugenics once and for all fr0lJl the realms of idealistic, academic and some’ what vague propaganda, into those of botn science and practical politics. The author discusses the extent of our present knowledge of the laws of heredity, and the relative in1’ portance of these and other factors in t^e evolution of civilised society. While recog’ nising that much of our knowledge is either incomplete or still debatable, he considers every possible way in which this knowledge* such as it is, might be used to benefit the r&ce in the future. No one who has read these 5^0 odd pages of closely-reasoned argument, hoW ever, will feel disposed to doubt that the science of Eugenics rests on weighty founds tions. On the other hand, it would be ir*1’ possible to accuse the Eugenic programme, outlined in this book by its most distinguished advocate, either by raising exaggerated hopeS of future benefits, or of claiming the exclusiy? attention of reformers. Emphasis is la’? throughout on the impossibility of di5’ tinguishing between, or of weighing the relative importance of environment and heredity aS
Causes of human misery. The two are inextri- cably mixed up. The author in no way tries to minimise the importance of or the necessity tor environmental reforms. They are essential full use is to be made of any improvement which might come about in the race as the Result of eugenic reforms ; they will also he p the eugenic reformer in so far as, by ensuring ?^ore equal opportunity for all, they will render the less fit more easily distinguishable. But ^e author rightly regards it as unlikely that such reforms will ever be neglected in favour of eug”enic reforms to any undesirable extent; their results are immediate, while those of eugenic reforms will be apparent to our great-grand- children at the earliest; they entail fewer and ess drastic immediate sacrifices than do puRfenic reforms ; and last, but not least, they lrnPly a more hopeful view of the human race, ar,d the reformer is essentially an optimist. he book is, in fact, a plea that eugenic reforms should not be entirely neglected in avour of those reforms which will produce ^mediate results, since to do so would mean the expenditure of money on inferior material, r?m which no adequate return could be exPected.
is obvious, therefore, that far from en- ??Ur&ging the crank and the too optimistic Realist, this book is unlikely to appeal to those ^ho expect to find a simple solution of human troubles, or who are looking for immediate and sensational results. There are few conclusions Which the author does not find it necessary to qualify? both among those dealing with the P&st and with the future. Nor will it be more 1 ,ely to appeal to those who attribute the ??lsery of one class to the fault of some other e ass in the community, and who are inclined o deny that any class can be as a whole inferior. And this brings us to the point in e book which seems likely to be the most ?riticised, namely, the contention that success ,n ‘ifc, that is, broadly speaking, economic Recess, is at once the most practical and on ~ whole the least unsatisfactory test of “tness ” or racial desirability.
is impossible in a short review to give any . ecluate summary even of the main conclu- sions of so detailed a work as this. One of , e ?Teat merits of the book lies in the fact at the author has allowed himself no easy generalisations. It is not to be expected, erefore, that we should be able to condense the arguments into any convenient formula, still less that we should find in it a popular slogan. Every aspect of the subject, and especially every practical proposal, is subjected to detailed discussion, and each chapter is followed by a summary of the argument and of the conclusions at which the author has arrived. Readers of this journal will probably be most interested in the conclusions of the author regarding the best methods of eliminating the definitely unfit and the simply inferior stocks. If a sum- mary of the whole is needed it would be to the following effect : The scientific evidence of the possibility of modifying the human race is convincing. All the evidence we possess supports the belief which has been gaining ground recently that at present the inferior stocks are increasing while the superior are decreasing. In any attempt to reverse this process two things must be kept in mind : Firstly, any increase of the population in this country at any rate would probably be disas- trous; and secondly, that it will be better to aim at raising the general level of the “fitness” in the community rather than at producing a small number of supermen. With this aim in view, and taking as a basis for a test of racial desirability the criterion mentioned above, i.e., that of economic success, it would be possible at the present time and with our very limited knowledge to introduce reforms which might reasonably be expected to have important eugenic results in the future. Great sacrifices would certainly have been made, and no imme- diate results could be expected, but if we do not adopt some such measures our civilisation is doomed.
It will be said that this is indeed a gloomy picture, but Major Darwin, if he is not an optimist is still an idealist. He believes that the best among the human race will be wise enough to face these facts, and self-sacrificing enough to take the necessary steps to save their descendants from disaster.
Hester A. Adrian.
The Clinical Study of Mental Disorders By Lt.-Col. J. R. Lord, C.B.E., M.B., M.R.C.P. (Journal of Mental Science Special Number, Aug., 1926). 5/-. Col. T. R. Lord’s Presidential Address to the Royal Medico-Psychological Association, pub- lished as a special number of the Journal of Mental Science, and entitled ” The Clinical Study of Mental Disorders,” gives the reader a most thorough insight into the present posi- tion of the study and practice of psychiatry or psychological medicine.
He begins by reminding us how popular interest in general psychology has developed recently owing to the utilitarian aspect of the newer ideas on that subject, and how this has reacted on psychiatry. He points out the immense scope of modern psychiatry, as set out in the aims of his Association. It is, he says, much more than a mere branch of general medicine, and might well be named medical anthropology. Psychiatry and mental hygiene constitute also a department of Public Health. He emphasises the necessity of psychiatry and general medicine being much more closely asso- ciated than they have been duringf the past fifty years. He urges his Association to make greater effort to attract and keep within its folds psychiatrists of every description and school of thought, and to do more to promote research and the clinical study of mental dis- orders. Research should, he says, include endocrinology, biochemistry, bacteriology, haematoloey, serology, anthropology, eugenics, psychopathology, and experimental, industrial, educational and social psychology. A most useful suggestion he makes is that the Asso- ciation should publish a glossary of terms used in psychology and psychiatry, giving one mean- ing for each term, that of the greatest utility, so that clinicians and others adopting the glossary might all use the terms in exactly the same way.
Colonel Lord pleads earnestly for a properly organised and routine team work in the inves- tigation and treatment of individual cases of mental disorder. He says that this is specially needed for mental patients, in view of the com- plicated nature of the reaction in such cases, and the large number of possible factors that may be operating in vicious circles. He wants this team work everywhere, in the Mental Hospital as well as in the Mental Clinic. In a mental hospital he would not only have a complete staff of consulting specialists, but he would also have each resident medical officer specialise for the time being in some depart- ment of clinical work and give the results of his investigations to a clinical director respon- sible for treatment.
Much of the address is taken up with de- scribing the various trends of thought among1 psychologists, and he pleads for toleration to- ward one another of such workers, particularly so between the physiogenic and psychogenic enthusiasts, pointing out that truth is many- sided. The latter part of the address con- tains plans for examining patients and many practical suggestions. Altogether the address will be found most helpful to a variety _ ?j people concerned with the study of the min” and of health.
M. A. Archdale.
Aphasia and Kindred Disorders of Speech- By Henry Head, M.D., LL.D., F.R.S.; 2 vols. Cambridge University Press. ^”3 3s. It is 28 years since the publication of Bastian’s ” Aphasia and other Speech De- fects,” the most recent English work on the subject which at all approaches the scope of Dr Head’s book. The intervening period has been abundantly fruitful in anatomical, physio- logical and psychological research inspired by the conceptions of biology. Amongst his numerous contributions to knowledge, Dr-. Head’s discovery of epicritic, protopathic and deep sensation alone would have placed him in the front rank of the workers to whom this progress is due. 1
The present book, the product of investiga- tion extending over a period of 40 years, is divided into five parts, four of which are con- tained in vol. 1.
Part I is historical, and in itself would be invaluable. The author agrees with a growing” tendency among psychologists in giving high place among early workers to Gall. As an ardent follower and personal friend of Hugh- lings Jackson, Dr Head’s full account and concise exposition of the latter’s views is of particular interest; so also is the section set- ting out the theories of von Monakow; this includes an explanation of his use of the term diaschisis, and goes further than his published work.
Part II describes Dr Head’s tests for aphasic patients, his conclusions as to the clinical varieties of aphasia, and the effects of the disorder on behaviour and mental capacity. This is the crux of his whole position, and he has here the opportunity of stating his exact point of view in regard to the criticisms ad- j nce<^ since he delivered the Linacre Lecture 9^0. (See, for example, ” the discussion res P^asia,” Brain, Vol. 43.) Variety of ^.sponse in reaction to a number of presenta- m?nS ?^.an identical stimulus is one of the -t striking features of the behaviour of the a*ic, and Dr Head’s serial tests have been ex Co.me^ as an application of the methods of SePerimental psychology to the problems pre- tio* ef’ ^ Physical condition and educa- ted ? atta’nments ?f many of the patients ^ith6* ^ P?ssible to supplement objective tests ?f tl ln^rosPective evidence. The introduction of <<le c^ock, hand and eye tests, etc., as tests full Symk?lic formulation and expression,” is va y .explained. Dr Head’s four clinical Noriet’es of aphasia ? Verbal, Syntactical, themina’ and Semantic?which he recognises to ale ,.exclusion of verbal apraxia and agnosia, is ? la> a&raphia, etc., are already known. He nQlnsistent that these four clinical varieties in Sense correspond to the constituent elements fra S^ee?h and language, any more than the the sa^r’ a c^’na CUP correspond to react*later^als ^ was made. ” The is ‘?n at the moment, however insufficient, ne resh adjustment of the organism to the of conditions ” (p. 536), i.e., an adjustment organism as a whole. Of the 26 cases sistse (^>art V, which constitutes vol. II, con- c0n ?. reports of these), only two were befo 6nita^> an^ neither of these was examined lano.re 0r during the acquisition of speech and irrUaS”e; but in this connection it may not be sj0ne’ant to recall Miss Lucy Fildes’ conclu- word hrtlle result her inquiry into congenital (gr .b”ndness in children of school age one ln’ Vol. 44) that ” Word-blindness is but Spec-^sPect of a more general, yet still in itself tory1 C defect in either the visual or the audi- ^regions or both.”
that re^art^s nominal aphasia, we could wish the ?ni0re tests had been employed eliminating menMi113^ ^actor- Those acquainted with the menta ^ defective may be struck by the ele- semaS .of similarity in the behaviour of the chile]11 ‘u aP^as’c and that of the defective seern ^ when offered a piece of chocolate ing. to ” forget ” his objective while cross- With T”6 u00?’ Comparison is also suggested ciaiiv ? .’s recent researches on apes, espe- Elliot ‘c v’ew ?f the conclusion of Professor that th h’- quoted Dr Head (p- 502)’ e cortical area in which the lesions of the semantic patients occurred, is that most developed in man, as compared with the gorilla. Part II contains a chapter on the effect of the lesions on pictures, drawings, visual imagery and music.
Part III deals with localisation of function. Ur. Head says that ” the material … is in no sense ideal for anatomical localisation ” (p. 469). The number of cases is not large? two only of the nominal variety are quoted as satisfactory in this connection. It is made clear that “orthodox ” views of the represen- tation of motor and sensory elements, sight, hearing, etc., in the cortex are not altogether denied, but ” most so-called ‘ centres ‘ in the nervous system are, strictly speaking, nodal foci where central neural activities undergo intergration and other changes in relation to one another ” (p. 474); they are ” like points on a railway,” and functions are disturbed by a lesion according to their order in the neural hierarchy, and if acquired, their recency of acquisition. ” The more recently acquired aptitudes suffer in a more massive and specific way ” than those gained by the patient earlier in life. The ” schemata ” of a foreign tongue may be almost lost while the use of the verna- cular?in a less severe condition of the dis- order?is comparatively untouched. ” Motor centres form the means by which we are en- abled to interfere at will, with otherwise, auto- matic acts ” (p. 434). Dr Head says cate- gorically that ” the phenomena of aphasia are supposed to discover the motor auditory and visual elements of normal speech. … I have shown that such a position is completely untenable.” He states also that where part of the cortex has been injured or extirpated, re-education is not the result of ” vicarious activity of surrounding centres.”
Part IV analyses the development of lan- guage in the race and in the individual from the point of view of the author as both neurolo- gist and psychologist. Hughlings Jackson’s description of linguistic processes as ” a march of events” is repeatedly quoted; the time- factor is important for the succession of re- actions necessary, let us say, for the utterance of a word or a phrase. ” Consciousness ” is to ” higher ” functions what ” vigilance ” (see p. 536) is to ” lower.” The purposive is the essential aspect in linguistic development. The reason for a patient’s inability to use or understand a word or phrase at one moment, 110 mental welfare.
though he can at the next, is that the necessary nodal foci for the reaction under the previous conditions are disabled or destroyed. Chapter iii of Part IV is devoted to the relation be- tween language and thought. Dr Head differs from Marie (who considered that we think in words), and his views do not contradict but rather support the conclusions of the VVurzburg School and other workers in this field on the purely psychological side.
Ihe publication of the book is in the best traditions of the Cambridge University Press. Alex. W. Gordon Ewing (M.A.Edin.). Industrial Psychology in Great Britain. By Dr C. S. Myers, pp. 16i. Jonathan Cape, Ltd. 1926. 7s. 6d. net.
It goes without saying that nobody is better qualmed in every way to describe the present position of Industrial Psychology in this country than Dr C. S. Myers. For the success which has attended the application of psycho- logical methods to the solution of industrial problems in Great Britain has been due to him more than to any other single person. The book which he has written can, in my opinion, safely challenge comparison with any other treatment of the same general subject that has yet appeared. It is lucid, concise, authorita- tive, packed with information, and at the same time extremely interesting.
The volume opens with an account of how experimental psychology has developed in Great Britain, on the research side, as is well known, chiefly through the activities of the Industrial Fatigue Research Board, and on the more immediately practical side through the National Institute of Industrial Psychology, founded in 1921 by Dr Myers himself. It is at once made evident that the method of approach adopted has been genuinely human- istic, and ” has endeavoured to base its ideals on sound psychology rather than on the super- ficial analogy with a piece of engineering mechanism. It has sought, not to press the worker from behind, but to ease the difficulties which may confront him. It has aimed at removing the obstacles which prevent the worker from giving his best to the work, and it has almost invariably succeeded in increasing output by this method.”
The second chapter deals with the very difficult subject of industrial fatigue. From the immense mass of work which has been d?ne on the problems of fatigue, both in the labora tory and in the workshop, Dr Myers make5 an extraordinarily judicious and successl selection. There is in his discussion, however* a good deal more than a well-chosen accoun of specific researches. There are suggestion5 with regard to the relation of fatigue to in*11 bition and adaptation which, fully developed’ would lead to new and very promising lines o attack. ” If we continue to use (and it lS almost impossible to avoid using) the tern1 ‘ fatigue ‘ in industrial conditions, let uS remember how complex is its character, ho^v ignorant we are of its full nature, and ho^v impossible it is in the intact organism to dis’ tinguish lower from higher fatigue and fatigut; from inhibition, to separate the fatigue 0 explosive ‘ acts ‘ from the fatigue of main* taming ‘ attitudes ‘ or to eliminate the effects of varying interest, of excitement, suggestion and the like.” Following hints of this kind, will perhaps be more fully realised than ha5 been the case in the past that not a little 01 what passes under the name of fatigue is due* not really to diminished capacity to perform a given task, but to diminished capacity to resist the performance of related and competing tasks; and types of experiment based upon thifi notion may prove of the greatest value.
Dr Myers passes on to consider movement study. His illustrations are new and at first hand, and lead him to an investigation of ho^v far and in what ways training in movement Is needed if skilled operations are to be produced’ Two final chapters discuss vocational guidance and vocational selection. Here are considered the importance of the interview an” how it should be arranged; the value of speci^0 tests for vocational aptitudes; how certain tests, e.g., dressmaking tests and engineering tests, have been successfully applied by the National Institute of Industrial Psychology* the different types of vocational test and their relative importance; and the advantages an” dangers of group tests. Every point is excel’ lently illustrated.
The whole book may be most confidently recommended. It demonstrates conclusively that the intelligent and valuable application oI psychology to industrial problems must he based upon a thorough and all-round knowledge of physiology and psychology. Far too often this branch of work has been in the hands o* mental welfare. Ill the engineering or of the ” business ” expert. J- is true that the psychologists who attempt ‘?his work must have the opportunity and the Opacity to assimilate actual working condi- tions. They must ” soak themselves in the 1 e of the tactory by personally engaging in [he work they are studying.” But they must lave their physiological and psychological fining as a background if their work is to , e of any practical usefulness. It is largely ^cause of the constant recognition of this that Industrial Psychology in Great Britain is ^ thoroughly good book, and that the National ^stitute ot industrial Psychology is rapidly advancing to an assured and valuable place ln the industrial life of this country. F. C. Bartlett. oard qF Control, England & Wales, Twelfth Annual Report. H.M. Stationery 0thce, 19:26. 12/6.
1 he relationship between the Central ‘^thority and Local Authorities in English ^ministration is always delicately balanced, each year the Report of the Board of ?ntrol indirectly emphasises the need for ener- ^tic striving by both authorities towards the end?tne adequate protection and control ciei^erS?nS su^erin? irom mental disorder or file introduction of the 12th Annual Report 0lltains these words (pp? 2 & 3) : ” f he ques- a^.n oi accommodation lias given us consider- i(; anxiety. Although there is no evidence to . *?w that tne incidence of insanity is increas- further accommodation is necessary in . ^sequence ot the growth of the population. . actual number ot vacant beds in County lI!tborough Mental Hospitals at the end of 0 Was a,557 : and in view of the fact that _ e average annual growth of the number of a lents tor the last five years has been 2,838, ls essential that steps should be taken imme- lately to secure additional accommodation. j ? ? The absence of sufficient accommo- ion for the care and treatment of mental ^tectives has also given us considerable nxlety, ancj tjie ?uu concurrence of the auH1St^r. of Health, we are pressing local th >1?r*t*es to fulfil their statutory duty under ab? *ental Deficiency Act of providing suit- Ce e anci sufficient accommodation. The suc- Ss this important social measure is seri- ously hampered by the lack of accommoda- tion.”
To those who are working for mental wel- fare in the local areas, the lack of accommoda- tion for the insane is perhaps not so apparent, as urgent cases are usually accommodated (though for slight and incipient and borderland cases there is a lamentable lack of provision), but hundreds of cases of mental defect are known to remain in the community, a menace to themselves and others.
The Report (pp. 56 & 57) states that as re- gards all types of defectives ” the position has not improved during the year under review. It has, in fact, become more acute, as the num- ber of new beds has not kept pace with the number of new cases, and nothing has been done to overtake the arrears… . Out of the 124 Local Authorities under the Mental Deliciency Act, only 17 have at present pro- vided any accommodation, and in no case is the provision adequate to the needs of the population of the particular district. In all, only 5,075 beds have been provided by Local Authorities, and so far only two institutions are sufficiently large to secure proper training and classification.”
Our readers may have heard the argument used by some Local Authorities that it is un- economical and premature to build institutions until the promised legislature is passed con- cerning the Poor Law, which would very prob- ably set free many Poor Law Institutions. But those who argue thus forget that in nearly all cases such Poor Law Buildings are entirely unsuitable and do not allow of classi- fication, nor would they usually have sufficient land attached for a colony of 400 or 500, which the Board give as the minimum number for which adequate grading and an adequate staff can be secured.
Ascertainment (pp. 67, 68) is being carried out more fully, and for the year 1925 the num- bers ascertained were 55,480 or 1.46 per thousand. The Board (p. 68) still continue to think that the ” variation in ascertainment in districts, which merge into one another geo- graphically and in which the populations are racially and industrially the same,” must be due to the difference in method and persistence in the carrying out of this duty. “For the purpose of considering the relative value of these different methods we have taken,” the Report states (p. 69) ” the 21 Authorities 112 Mental welfare, whose ascertainment is highest and the 10 whose ascertainment is lowest, and compared the systems on which they work. We find that, of the 21 Local Authorities with the highest ascertainment, 15 make full use of the Volun- tary Association in their area. In nearly all these instances the Secretary of the Voluntary Association is responsible for ascertainment, and her salary is partly paid, directly or in- directly, by the Local Authority.
The facts disclosed by the answers to our circulars taken in relation to each Local Autho- rity’s success or non-success in ascertainment, leave no doubt as to which methods lead to the best results. They point strongly to the desira- bility of appointing an officer who should be specially trained for the work, or to making use of the services of a Voluntary Associa- tion. If no Voluntary Association exists in f.he district, it is always possible to obtain the help of the Central Association for Mental Welfare to establish one.
Some Local Authorities may prefer to em- ploy Officers of their own, but if they do so they should see that such officers receive ade- quate training either on or before appointment. If sufficient trained Officers are employed this plan may prove quite as efficacious as seeking the help of a Voluntary Association; but it is likely to be more expensive, for one Officer cannot cover a whole County or a large County Borough, whereas the Voluntary Association has generally a body of voluntary workers who can report cases from the particular village, town or suburb in which they live.” (P. 71.) Under the headings of ” Marriage of and Procreation by Mental Defectives ” (p. 63), and ” Supervision ” (p. 71) the Board discuss the general position. They are, of course, unable to get returns for the actual number of births to defective parents throughout the country, and can only get returns for those under statutory supervision. The figures are as follows :?
(P. 64). ” Number of adults and children under Statutory Supervision on 1st Janu- ary, 1926 (calculated on the basis of pro- portions give in Table 1 of Board’s Circu- lar of September, 1925) : Adults. Children under 16. Total. 12,114 3,619 15,733. Number married, 195, or 1.6 per cent, of the adults.
Children of married and unmarried defec’ tives, 275, or 2.3 per cent, of the adults- Without Statutory Supervision both these percentages would probably have been cot1’ siderably greater. Further, by a wiser choice of defectives who can safely be left under supervision, by a wiser choice of homes in which they can suitably be left, and by l{tl’ proved methods and training of the supef’ visors, this percentage could be further diminished.”
They recommend certain measures (p. 65) f?r tightening up the present methods of dealing with mental defectives, one of which, if more fully acted upon, would prevent many * tragedy. ” Regarding lack of parental control leading to sexual irregularities on the part o* a defective as constituting ‘ neglect ‘ and so rendering a defective subject to be dealt with. They go on to say, ” These measures would no doubt tend to decrease the marriages defectives. But we are inclined to think that the law should be altered so as to provide that marriage by a defective when under Order should be void.”
Their views on sterilization do not in the main differ from those set forth by Dr Tred- gold in his pamphlet (recently published by the C.A.M.W.) on Sterilization of Mental DefeC’ tives.” 1
Sterilization can be no substitute for segre’ gation. ” Unrestricted freedom,” the Report states (p. 65), ” in a large number of cases at present under care, would lead to a return to the conditions prevalent before the passing the Mental Deficiency Act. Sterilization would not prevent these persons from leading useless and harmful lives in and out of Poor La^ Institutions, Prisons, Hospitals and Refuges, or from spreading venereal disease.
” As far as immediate expense is concerned) the economic burden to the State is not likely to be lessened by the discharge of the sterilized mental defective. Care in an institution where his limited capacities are made full use of, and where he may be trained for partial indepeU’ dence, is probably the cheaper method of treat’ ment.”
The Board further discuss whether it ‘s desirable to allow sterilization, not as an alter”’ native, but as a complementary measure to segregation. It is evident that they do not feel the number of cases to be very consider- able who are now requiring institutional care and who could safely be returned to the com- munity if procreation were impossible. After reviewing- the matter, they say : ” On the ?ther hand, it is clearly impossible under the Present law and the state of public opinion to Provide institutional care for all our defective Population, even if it were desirable, and the Question arises whether, in cases where per- manent institutional care is now only necessary ln order to prevent the risk of propagation, sterilization followed by return to some f?rm community life on licence under supervision 0r guardianship, might be the most humane and expedient course to adopt.” They con- clude : “We have arrived at no definite con- tusions in regard to this subject, but we may state that we do not consider that sterilization ^vould materially diminish the immediate need ?r increased institutional accommodation, or 9r better provision for the care and supervi- sion of defectives outside institutions. Approval of Occupation Centres as a means supervision and training is again given in lrhe Report (pp. 74-75). Eighty Occupation entres have now (March, 1926) been estab- tshed by Voluntary Associations and three by ?cal Authorities. The number of defectives rePorted as attending on 1st January was 1,157.
Considerable attention is paid to ” Guardian- shlP,” and the Board express their satisfaction : at the M.D. (Amendment) Act, 1925, permits transference of a defective from an institution p guardianship. Reference is made to the guardianship Society, Brighton, and to the guardianship scheme of the C.A.M.W., which ,s month by month adding to the number of Cefectives whom it places.
It is significant that the Board should urge e importance of training and experience in the branch of medical work dealing with defect PP- 85, 86). ” We doubt whether the Act will 3e Worked in a thoroughly efficient manner until each district has a Medical Officer, with special knowledge and experience, whose prin- ClPal work is mental deficiency… ? If the effect of legislation in the future is 0 bring all defectives and insane persons who ?^ed Care and treatment under the existing ‘siting and Statutory Committees of the Local uthorities, the work of those Committees will ,5 greatly increased. A large number both of e defectives and of the insane are at present maintained by the Poor Law Authorities in Poor Law Institutions. There is no doubt that a measure which brought all mental patients under one authority, both locally and centrally, would be beneficial and would render a consis- tent and scientific treatment of the whole ques- tion possible. It would then, we think, be essential that each County or County Borough Council should establish the post of Medical Officer of Mental Health.”
That part of the Board’s Report which deals with Mental Disorders indicates the improve- ments that are steadily being made in the methods of care for the insane. The general desire that practical medicine should keep abreast of discovery is instanced by the sug- gestion that, for purposes of administration and conferences, there should be regional districts, and that such districts should be grouped round a University (p. 8). ” We think it im- portant that the mental hospitals of the country should be in living touch with Univer- sities and the scientific spirit of these seats of learning. By maintaining contact with the Universities much will have been done to secure that our mental hospitals will be in the forefront of scientific progress, and that they will be properly equipped with all that modern science has shown, and may in the future show, is necessary for successfully treating the in- sane.”
The Board further urges (p. 10) that every mental hospital should possess a laboratory ” in which, in aid, and indeed as part, of clinical work, ordinary routine investigations can be carried out.”
Considerable space (pp. 50-56) is devoted to the question of out-patient treatment of mental cases, and interesting reference is made to the fact that historically the separation of the mental from the general hospital was in the interests of the insane, while at the present time it is incumbent that the co-operation of the general hospital should be regained for the benefit of incipient cases. The Board stress the need of in-patient facilities accompanying the out-patient treatment, and point out that the Mental Treatment Bill, had it passed, would have made this possible. They add :
” It would not be right, however, to conclude this section on out-patient treatment without pointing out that in order to secure its com- plete efficiency, the assistance of a Social Worker will ultimately be found an additional necessity. She might, in the light of local experience, be a member of the staff of the general hospital or of the mental hospital or of some voluntary association; but it is essen- tial that she shall act directly under the physi- cian undertaking- the work and that she be specially trained for the performance of her share in it.”
Board of Control, Scotland, Twelfth Annual Report. H.M. Stationery Office. 1926. 2s.
One of the most interesting chapters in this report is concerned with the Early Treatment of Mental Disorders. Reference is made to the first Report of the Board in 1859, from which this quotation is made : ” Adjunct houses in which patients afflicted with certain forms of insanity could be received without the strict legal formalities at present required, would prove a beneficial modification of our asylums and would tend to increase recoveries by inducing patients and their friends to have recourse to treatment before the malady had become confirmed.”
Since 1890, when the Parish Council of Glasgow inaugurated Hospital Wards for the treatment of incipient forms of mental disease and temporary states of mental disorder, some progress in the same direction elsewhere has been made. Striking evidence of the value of such wards has come since 1924 from Glasgow.
In that year, in order to avoid erecting addi- tional asylum accommodation, it was decided, ” with the concurrence of the Board of Health, to open Observation Wards at the General Hospital at Stobhill. Four wards, each accom- modating 20 patients, were then set aside for the treatment of all cases of incipient, tem- porary and unconfirmed mental disorders arising in Glasgow parish.
” The maximum duration of residence, which was formerly limited to six weeks, has been extended to six months. The wards at Stobhill differ in no respect from the other wards of the hospital, and the arrangements are con- ceded by those competent to judge to equal in all respects those of the larger general hospitals.
“It is interesting to note that, in conse- quence of the institution of the Observation Wards, the erection of a third Asylum for the Glasgow District Board of Control has mean- time been avoided, and the advantages which have been gained by the hundreds of patien ^ who, as the result of their treatment in Obsef vation Wards, have not required to erue Asylums, is immense. Through the preventi?n of complete mental breakdown, many have been freed from that anxiety and fear whicl too often clings to patients who have had t? be sent under certificate to an Asylum.
” The value of these Observation Wards 15 shown by the fact that, though they have aval - able only 160 beds, in the course of the ye^r under review, 1,176 patients were admitted 611 were discharged either as recovered ?r improved and 383, or less than 33 per cento required to be certified and sent to Asylurns- Without making any actual recommendation the Board draw attention to the fact that 3 definite post-graduate course in ” mental diS’ orders has been instituted in several Univef’ sities and a diploma in Psychiatry has bee11 established, but the taking of this diploma lS entirely voluntary,” and that ” while a specif diploma is required by Statute from all Medic*1 Officers of Health, no special qualification lS required for a medical man to deal with menta disorder, which presents perhaps the most complicated and most difficult problem of any department in medicine.”
In last year’s Report the Board lamented the need of provision for cases suffering from the effects of encephalitis lethargica. They are now able to report that, ” By an arrangement with the Board of Health, public authorities throughout Scotland have now the opportunity afforded them of sending all cases of encepha’ litis lethargica to Stobhill General Hospital where the excellent Observation Wards to which we have already referred are situated) and where there are facilities for care and treat’ ment and for the investigation of the causa’ factors in this mysterious affection.”
The Board has obtained a recent census ?t the mental defectives in Scotland, and the returns show that there are 12,969 mental defectives throughout the country.
If the number of mentally defective persons in Scotland were calculated on the basis of the Royal Commission’s estimate of four pe^ thousand of the population for England and Wales, the figure for Scotland would be over 19,000 (population 4,891,300).
It is extremely regrettable to read that f0^ economic reasons restrictions have been placed on the number of guardianship cases. The Report states : ” So far as the care and main’ MENTAL WELFARE. 115 rej15006 defectives boarded out with th ^te<^ anc^ unrelated guardians is concerned, r e^e. has, until the present year, been no 1 0OQCti?n *n Grant, an^ no fewer than ‘ ” rate-aided mentally defective persons are e ?Vlded for in private dwellings. As, how- jner’ the total amount of Grant provided for . the estimates of the Board is now fully in ? ‘t has been necessary, owing to the u C^easin?” tendency to place mental defectives a ,er guardianship, to intimate to the several q ?rities concerned that the Government u rant can only be given in cases which might designated as ‘ urgent.’ “
n reference to the adequate protection of ^ ntal defectives in their own homes, the ciaf-r^ state : ” In this connection the Asso- . ‘on for Mental Welfare, which received fQ;-g the past year, a grant of ?700, by J>g, as it were, a liaison between relatives q guardians of defectives and the Parish ^ouncil Authorities, performs a most valuable WiH?Ce’ This work is in its early stages, but an, the progress of years, and as the scope kn act’yities of the Association become better or ^Vn’.’t is hoped that all who do not desire As reHu^e public assistance will appeal to the Ration for Mental Welfare for help and affe a,nCe *n an^ change of circumstances cting the welfare of the mentally defective.”
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