Mental Deficiency
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Book Reviews CS2 Abstracts.
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Tredgold,
M.D., F.R.C.P., F.R.S.(EcL). London. 1929. Bailliere, Tindall, and Cox. Pp. xvi and 535. Price, 25s. net.
This book was originally published in 1908, so that with the present, fifth edition, it attains its majority. Much work has been done, during these twenty-one years, on the subject of mental deficiency, in this and other countries. Since the publication of the fourth edition, two notable events have occurred; there has been the enactment of the amended Mental Deficiency Act, 1927, and the publica- tion of the results of Dr E. O. Lewis’s in- vestigation. It is, therefore, not surprising to learn that the book has been almost re- written.
The book makes a three-fold appeal. To the specialist in mental deficiency, whether he works in an institution, or in some other pos- ition under a local authority, ” Tredgold ” has long been the standard book; and it has fully deserved this position, whether from the point of view of its precise definition, its scholarly tone, or the wealth of its clinical des- criptions. Similar remarks apply in the case of the young graduate who is reading for a diploma in psychological medicine; the present edition will provide him with all that he re- quires under the heading of mental deficiency. The general practitioner meets, not infre- quently, with cases of suspected mental de- ficiency among his patients. He needs a guide to the diagnosis of that condition, and the advice which he should give when he has diag- nosed it; he may be called upon to assist in the certification of such a case. When he turns to the present volume, he will not do so in vain.
But the book has a third, a wider, a social appeal. The whole question of mental defic- iency is being much canvassed. The complex problems which it presents are daily becoming better recognized. The grievous lack of accom- modation for defectives is pressing upon local authorities, and even the urgent clamour for economy is silenced in the presence of so real a need. The situation is more serious than was thought even a year ago. For Dr E. O. Lewis, in the investigation undertaken on be- half of the Joint Mental Deficiency Committee, has estimated the proportion of defectives in this country as, at least, 8 per 1,000, an estim- ate almost twice as large as that suggested by the Royal Commission twenty years prev- iously. Dr Lewis’s finding, as it becomes better known, must occasion much searching of heart and the question at once arises as to whether the estimate indicates a real, or an apparent increase in the incidence of mental deficiency. Dr Tredgold, who regards the higher estimate as being on the conservative side, believes that there has been a real in- crease, and that the figures cannot be explain- ed merely by increased accuracy in ascertain- ment, or by more prolonged longevity among defectives.
This being accepted, the question of treat- ment becomes urgent. Dr Tredgold advances excellent reasons for regarding mental defici- ency as, in the main, an inherited condition. Prevention of propagation among known de- fectives holds the first place in any ameliora- tive measures. Some prominence has recently been given to a demand for sterilization. Dr. Tredgold, in common with most authorities, rejects this plan, holding that its adoption would, ultimately, be productive of more harm than good; and he maintains that segre- gation is the true remedy. The direct cost of this will be large; but the expense will be more than saved in the diminution of the present heavy indirect burden which the defective class occasions to the community. When we look at the photograph, given in the book, of some twenty mentally defective “girl guides,” most of whom appear to be physically attract- ive, we see the dangers to which such girls, with their lessened inhibitory powers, would be exposed were they allowed to be at large. There is another, and a most important con- sideration. It is true that a mentally defective mother may produce normal children. But she has to manage those children; and the physical and mental damage which may be caused to children by such a mother is simply appalling.
The class of ” dull and backward ” child- ren receives consideration. In large towns such children are provided for, with fair ade- quacy, by the institution of Special Schools. But in rural districts these children present a problem which has not, as yet, been solved. Many readers will turn with interest to the able discussion of the moral defective, that be- ing the term now applied to our old friend the ‘ moral imbecile.” It is, of course, well known that Dr Tredgold believes in the ex- istence of this much controverted condition, but he considers it to be relatively rare.
On one somewhat important point we ven- ture to differ from Dr Tredgold, and that is as regards the number of criminal aments. He believes that the proportion of criminals who are mental defectives lies between 10 and 20 Per cent. Most workers in this particular field would regard this estimate as decidedly too high. Dr Tredgold considers that the ex- tension of scientific facilities for the psycho- logical investigation of offenders would be attended by a decrease in the number of crim- inals and the amount of crime. We fear that such extension would have but little effect, unless it were accompanied by the provision ?f rational methods of dealing with offenders after the investigation.
A much needed warning is given against placing undue reliance upon a patient’s ” in- telligence quotient.” The description of Healy’s pictorial completion test (p. 402) Would be improved if it were stated that the subject, in making his selection for the purpose ?f filling the spaces, has the choice of forty different objects and ten blank blocks. The selection, by defectives, of the blank blocks is ?ften most illuminating.
M. Hamblin Smith. Children’s Behaviour and Teachers’ Atti- tudes. By E. K. Wickman (Institute for Child Guidance, New York City). New York. The Commonwealth Fund Division of Publications.
The three previous publications of the Com- monwealth Fund have directed our attention to the individual child presenting difficulty in the school and at home. In this experimental study an attempt is made to answer the ques- tion, ” What constitutes a behaviour prob- lem? ” Xhe focus is shifted from the child himself to the adults interpreting his be- haviour.
The original purpose of the writer was to discover the incidence of behaviour deviations among school children, and to relate the prob- ems of the children to their intellectual and educational characteristics. As the study pro- gressed, however, ” it seemed that the atti- tudes of teachers were fundamental to any study of the behaviour disorders of their pupils.” Whereas in physical and mental dis- orders interpretation only affects treatment; ” attitudes towards behaviour are an integral part of behaviour disorders.” A ” problem ” in terms of behaviour is held to represent, not a certain kind of conduct on the part of an in- dividual, but a relationship in which this par- ticular conduct is inconsistent with the pur- poses of the group : it is, in fact, ” the mal- adjustment between the child and those who seek to regularise his behaviour.” Taking our own illustration from a traditional example we may suppose, on this contention, that the young Spartan who did not steal effectively, was to be regarded as a ” problem child ” in a community where physical courage was given a higher value than honesty.
In order to discover what disparity, if any, exists between the response of the average adult towards the behaviour of children, and the considered estimate of those who are con- cerned with his social adjustment, a compar- ison is made, by means of questionnaire, be- tween teachers’ evaluation of behaviour diffi- culties, and that of professional clinical workers. The results show a striking contrast which appears consistently over a representa- tive number of schools in different commun- ities. To the teacher the problem child is in the main identified as one who is antagonistic to those in authority, violating their standards of social relationships, obstructing the process of teaching, and generally frustrating the easy expression of the grown-up person’s desires. On the other hand, to the Clinician, consider- ing the healthy development of personality, symptoms indicative of social isolation, re- cessiveness and dependency are the more om- inous. The teacher, concerned mainly, appar- ently, with the orderliness of his class room, if he does not overlook them entirely, rates the symptoms of shyness, sensitiveness, de- pendence and unhappiness relatively low in his scale of importance.
If, with the author, we take the teacher as representative of the average adult in a pos- ition of authority over the child, responding emotionally and the Clinician as representative of the response of intelligence, then the im- plications of these results are impressive enough. They are developed by the author in a striking, if somewhat over-simplified way. In a schematic presentation of behaviour prob- lems represented as ” evasions of social re- quirements,” the individual is pictured as faced with certain demands made upon him by the various biological and social groups to which he belongs. Two main methods of evasion are open to him : the method of attack and the method of withdrawal. Obviously, as the writer points out, the types of evasion are not mutually exclusive, but in the process of experiential development the child ” learns to respond characteristically ” in one of these two ways. Attacking methods are evidenced in children by temper tantrums, disobedience, rejection of routine and delinquency; the method of withdrawal, by fearfulness, shy- ness, dependency on routine, and so forth. While the first kind of evasion may develop into ” constructive attacks,” from which the stuff for exploration, industrial exploits and political reform may be developed, from these ranks also are drawn adults with ” psycho- pathic tendencies,” obstructionists and crim- inals. The withdrawing child is pictured, on the other hand, as the potentially creative worker who by means of regressive escapes frequently develops into the neurotic, depend- ent, or functionally insane.
The main thesis of the book is contained in the corollary. If the .results of the experi- ment are reliable, then in our responses to children we are constantly demonstrating the truth of the challenging statement, ” Unto him that hath shall be given, and from him that hath not shall be taken away even that which he hath.” To the grown person the withdrawing type of child is not disturbing; his dependency is flattering, and is therefore nurtured. Resistance, however, is frustrating to our purposes and undermines our self- respect; it is therefore met on its own level with retaliation and the mode of response becomes strengthened and stereotyped.
The author’s deductions and interpretations carry more weight than that somewhat ingen- uous method questionnaire and written answer justify, however refined is the technique em- ployed. The value of the study lies in the en- richment of the material from the wealth of his own experience of human beings in general and of teachers in particular. This is illus- trated by his cautious handling of the sug- gested programme for ” Re-education in Attitudes,” where he acknowledges that ” it is at least as difficult a task to restrain the dis- ciplinary behaviour of adults as it is to modify children’s conduct.” Ideas cannot be effect- ive in action until they have been assimilated into the emotional life of the individual. The young teacher should not only be given oppor- tunities of working side by side with those who are considering the behaviour of children from the point of view of their mental health, but should find help available for the solution of their own personal difficulties in and through the study of their pupils. In the author’s view the time has come for psychiatry to invade the school through the medium of the visiting teacher, the school psychologist, and the physician.
Recent plays and books have been curiously insistent in jogging our ideas on the subject of schools. Extreme and even fantastic as some of these pictures of school life are, their very presence amongst us indicates a certain consciousness of unfulfilled purposes. Since this study was directed particularly to the attitudes of teachers the reader is left a little unsatisfied by the simplicity of the solution offered. Can we solve the relationship between pupil and child by any process of study, though it were directed in such a skilful way as to become ” integrated into the emotional life of the individual ? ” It has been written : ” The teacher is he who, passing through the scholastic Valley of Mara, makes it a well.”* It seems probable that much of the conflict and unhealthiness in the relationship between teacher and pupil is due to lack of real capacity for the art of teaching, and that the psychia- trist and psychologist might in their function of vocational advisers be even more effective than as educators.
S. Clement Brown. *Edvard Yeomans. ” Shackled Youth.” The Nursery Years. By Susan Isaacs, M.A. Routledge Introductions to Modern Know- ledge. No. 1. 6d. net.
This book deals with the mental develop- ment of the child from birth until the age of five years. In the first chapter the author says, ” We have begun by raising some of the everyday practical problems of the everyday parent and as far as the limits of space allow, we shall try to answer them.” This is the key to the whole book.
It supplies a very real need of modern mothers who have broken away from the trad- ition that knowledge of training a child, men- tally and physically, comes instinctively and automatically with its birth, and who wish to study the growth of the child mind with in- telligence. It gives very clear and helpful ex- planations of many problems that often perplex the mothers of young children. Nursery years are those when the foundations of a child’s character are laid, and wrong handling at this stage may affect adversely his whole life; we Welcome therefore this little book, a study of which will save mothers many an anxious hour and will throw light on many phases of child- ren’s mental development that are difficult to understand by simple observation. Wise coun- sel is contained in every one of the ” Don’ts for Parents “to be found at the end of the book.
M. E. S. Aptitude Testing. By Clark L. Hull. Lon- don. Harrap & Co. 1929. 8/6.
The non-mathematician who is concerned with the devising and use of psychological tests will undoubtedly find this book of very great value. Such a worker is almost certain to be acquainted with the elements of statistic- al theory and except for some very brief pre- liminaries this book contains nothing that is to be found in standard texts such as Yule’s Introduction. But much space (almost the whole of Part II and Chapters V and VI in “art I) is devoted to the application of statis- tical methods to the problems of devising, measuring and interpreting psychological tests. This discussion cannot be too highly Praised.
The matter is presented with such abund- ance of simple examples and appropriate dia- grams that much that has hitherto been in the Province of the expert is now made accessible to the novice or amateur.
Part II entitled ” Methods ” is devoted to ^ most complete account of everything that he investigator must do from the moment of deciding to apply a test to the time of finally assifying the tested. Little of this is original )^ork : everyone nowadays is familiar with the S1* steps of test-battery construction “? occupation analysis, choice of a preliminary battery, testing this, choice of a criterion, com- parison of test results with the criterion, and weighting of the competent tests?but it is a great advantage to have a detailed treatment of all these steps set out in one place and pres- ented with the clarity and thoroughness that distinguishes Professor Hull’s writing. More- over, the matter is treated from a strictly practical standpoint, what one may call the ” economics ” of testing are gone into, almost for the first time. The value of a test is judged not on its intrinsic merit but on the relation of its efficiency to its ” real cost.” The efficiency of a test is its ” forecasting value,” the real cost is the aggregate of such things as time and trouble to the investigator, expense and del- icacy of apparatus, and the degree of skill required of the examiner. The cost of a test is obviously greatly increased if only an expert can give it.
The weighing up of all these factors is by no means an easy task but Professor Hull shows by many ingenious examples how much help the appropriate use of statistics can give. This insistence on the usefulness of statistics as a means of solving methodological problems is a most valuable feature of the book. The statistical weapon is relatively new and few people are aware of its range and its potency. The only objection that could be brought against Professor Hull here is that he does not sufficiently warn the inexperienced of its deli- cacy. Statistical manipulations take the in- vestigator further and further from his actual experimental results and the problem of inter- pretation becomes more and more hazardous. Those who do not understand the underlying mathematical assumptions should still be chary of undue elaboration of this technique. The remainder of the book sets out to give an account of the ” fundamental issue involv- ed in aptitude testing ” but this part of the book has less merit than the methodological chapters. It consists of one chapter of theoret- ical considerations and four introductory sur- veys which suggest the compensations text book. Most of these, though interesting in themselves, will be over-familiar to the readers of the statistical chapters. The central theory is dealt with in Chapter VI ” the basic con- stitution of Aptitudes and Tests.” Here again much is introductory. Professor Spearman’s two-factor theory is restated before we meet the author’s own hypothesis?” a strict group factor theory of aptitude determination.” This is somewhat obscurely presented and to it there are a number of theoretical objections which he ignores. Consequently, certain other parts of the book which are based on it cannot be taken as established (e.g., the normal distribu- tion of trait differences, Chapter II; the guid- ing principles in the final composition of test batteries, Chapter VIII).
One survey that is of interest is the account of the experimental examination of ” anatom- ical and other signs of aptitude.” This in- cludes indices, such as blood pressure, urine composition and glandular secretion but atten- tion is also given to claims made by phrenolo- gists, graphologists, handreaders, and the like. As might be expected, the conclusions arrived at by such ” sympathetic magic ” are shown to be groundless, though some investigation shows the possibility of a connection between certain physionomic traits and character. But here, as elsewhere, uncertainty is in- creased by absence of definition. The most serious defect in the book is the failure to define ” aptitude ” and the tendency to apply it at one time to the person, at another to his performance. The sophisticated reader will find it slightly ingenuous to accept at their face value such terms as ” scholastic success,” ” refinement,” ” beauty,” ” vulgarity.” He will also, perhaps, refuse to agree that the genius of Plato is shown by the fact that in 1918 the American Army adopted one of his ideas ! But the merits of the book far outweigh the defects that carping criticism can point out. Not the least of these is Professor Hull’s enviable gift of exposition which gives his work a lucidity rarely found in psychological writings.
P. Holman. The Child’s Conception of the World. By Jean Piaget, D.Sc. Kegan Paul, Trench, Trubner & Co., Ltd. 1929. 12/6 net.
This volume, the third of Piaget’s four books on the mental life of the child, is the result of an investigation into the ideas of children, concerning the origin and nature of the physical world and of thought, dreams and the attributes of consciousness in general. Most of the children studied are between the ages of four and twelve years and the author has elicited many interesting and, indeed, sur- prising theories from them.
The first section of the book deals with the child as a realist. The young child does not distinguish between what is subjective and what is objective and fails to comprehend the internal nature of thought. Until the age of about eleven, thinking is believed to occur ” with the mouth ” or the ears and thought is identified with voice. Thought is also con- fused with the object of thought and is there- fore both with the thinker and in the object. One can touch thought if one thinks of real things. In the same manner, names emanate from and are fundamental parts of the things they signify. Similar beliefs are also held with regard to dreams.
The fact that the child does not make any clear distinction between the self and the ex- ternal world leads to a number of spontaneous beliefs concerning participation between thought and the object of thought, etc., and results in various symbolic actions and mag- ical practices designed to bring about or ward off desired or undesired events. Many inter- esting examples have been collected by the author.
In the second section, the child’s animistic beliefs are discussed. He believes that man is all-powerful and starts with the idea of uni- versal consciousness as a primary assumption which serves to explain the obedience of the physical world. There is a widespread and spontaneous belief that the sun and moon follow us when we move and natural forces are looked upon as big children who are good or ” naughty ” according to their activities. The child is, however, not completely anthrop- omorphic, but endows natural objects with only that degree of consciousness requisite for carrying out their particular duties. For in- stance, the sun would not feel a prick, but it is aware of its own existence and knows that it is moving.
The third section deals with artificialism, i.e., the child’s belief that natural objects are created by human activity. In the early years, when this belief is seen in its most complete form, we find that the sun has been lit by a match, the sky is made by men from ” big slabs of stone,” night is made of black clouds and the river beds were dug out by men. It is interesting to note how explanations given to the child are distorted by their fusion with previous artificialist beliefs. Thus a child who has been told the true nature of clouds, main- tains that they are made of smoke from the chimneys, and that they go down to the sea and take up water, being aware of what they are doing.
The child believes the universe to be gov- erned by moral and social rather than by physical laws and attributes to natural forces ” a moral nature rather than a psychology.” The sun, wind, rain, etc., regulate their activ- ities so as to produce the greatest benefit for man and are compelled thereto either by the will of man or by their own sense of duty. Piaget points out that the proportion of magic and animism in the child’s scheme of things depends upon his egocentricity. Absolute egocentricity implies participation and magic, since the child considers the sun’s movements to depend entirely upon his own, whereas animism results when the child considers the sun to be voluntarily obedient, but as having an independent existence and power of resist- ing his will.
The author is fully aware of the numerous difficulties and pitfalls attendant upon this in- vestigation. He has taken considerable trouble to avoid perseveration, questions containing any suggestion of the answer expected and those which provoke random replies. We are glad to note that he insists on at least a year’s training in this technique before one can assume any degree of validity for one’s find- ings. He is at pains to prevent an appearance ?f over-systematisation and, on the whole, succeeds, though the four phases of artificial- ism which he describes seem somewhat arbit- rary and over-elaborated.
In spite of a certain amount of unnecessary repetition, the book makes very interesting reading and should prove of value to teachers, Parents and others intimately associated with children. Some may, however, be surprised and pained to find how easily the teachings of the adult can be mutilated beyond recognition, how bizarre are the ultimate forms in which they obtain acceptance and with what tenacity the child maintains his own philosophy of life. R. E. Lucas.
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