The Fifteen Months’ Training of A Feebleminded Child
The Psychological Clinic Vol. 1. No. 3. May 15, 1907. :Author: Ligiitnek Wither.
The little ‘girl who is the subject of this psychological sketch came into the world a delicate but normal child. For the first fifteen months of her life, the child developed normally in body and mind. She cut her first tooth at nine months, walked at one year, and in her fifteenth month could say, “papa,” “mamma,” and “kittie.” She was at that time a lovable, bright and active child. Iler sisters and three brothers have always been mentally sound and fairly healthy. Iler parents were intelligent and well-to-do. When-fifteen months old, she passed through eight weeks of severe illness, having in rapid succession, typhoid fever, pleurisy, pneumonia and chicken-pox. Though her life was saved by medical skill and careful nursing, this protracted period of illness reduced her to a Weak, emaciated and helpless infant. The power of voluntary movement was lost for all but the simplest functions; not even the ability to creep remained. Nutrition was seriously impaired, as the condition of her skin witnessed. The development of her mental faculties was abruptly arrested. Physical growth almost ceased. The two following years were marked by epileptoid convulsions, which began during her severe illness. These convulsive attacks affected her health and seemed to prevent mental progress. At the end of two years they became less severe, but had not ceased, when, in her sixth year, she was placed in Miss Marvin’s care for mental and physical training. Some improvement in walking was observed during the fourth and fifth years, and feeble though unsuccessful attempts had been made to talk.
The sixth year of the child’s life found her an idiot of most repulsive appearance. An open mouth was flanked by flabby, puffy cheeks. Above were heavy eyes and a bridgelcss nose, while below ?i weak chin was sore from constant drooling of saliva. The teeth were much decayed and the odor from the nose and moutli was most offensive. Her skin and the boils from which she was never free evidenced impoverished nutrition. Her muscles were weak and her movements uncertain and inco-ordinate. She could not take more than a few steps without falling to the ground, and for days she could neither crawl nor even sit upon the floor. She spent hours whining, or dull and silent, in her mother’3 arms. Her personal liahits were such that she had to be cared for like an infant. Her wants were made known by crying and other simple emotional expressions. The nursing bottle, which she continued to use up to the day that she entered Miss Marvin’s home, seemed to be an absolute necessity for procuring sleep.
No attempt had been made to control her by the force of an external will, much less to develop her own powers of self-control. She was exceedingly stubborn either by virtue of her natural disposition or in consequence of continual indulgence. If she saw any evidence of an intention to thwart her wishes, a violent temper manifested itself. She would dash to the floor any object within reach, stamp her feet, and jabber away unintelligibly, but yet in a most threatening manner. When tears came in the outbursts of rage, they introduced hours of crying and sobbing.- She violently resisted bathing, dressing and all attentions to her personal welfare. When evening came, she was allowed to play around the room until, fatigued,, she fell asleep. She was then undressed without being fully awakened and put to bed. Fortunately, she possessed an affectionate disposition. Her love for her doll, which was shown by her manner of holding and patting it, proved her not devoid of an incipient maternal instinct. It also showed that she possessed to some extent the instinct of play and imitation. She was fond of music and could hum two tunes with moderate success. She observed the moon or a bright light with evident delight. Affection, play, imitation and aesthetic sensibility are powerful aids in the development of even normal children.
Articulate language was restricted to (lie word “mamma,” but even this word was uttered in a way that manifested little comprehension of its meaning. Simple questions like “where is the pretty light ?” “where is the moon ?” were apparently understood, for she would direct her gaze toward the designated object. Her ability to understand language seemed therefore somewhat greater than her facility in employing it. Nevertheless, as the years passed, she gave 110 sign of improvement, in either tho understanding or expression of language. She never babbled, playing articulation, as normal children do; lier nearest approach to such play was a sound in the back of the throat resembling the grunt of a pig. She often jabbered in anger and sometimes in play, but the performance was always very crude and there was no increase in precision of execution. Intellectually she had not progressed beyond the stage of development reached at the time of her first illness, that is to say, she was in mind little more than a year old. As time brought no amelioration in her mental or physical condition, the parents had recourse to the skill of the neurologist. On the advice of Dr S. Weir Mitchell, the child was placed, on December 3, 18 OG, in Mi ss Marvin’s home for defective children, where her training came under my observation as consulting psychologist. It was the opinion of all who saw the child that her condition gave practically no hope of mental improvement. Special training was recommended with the hope that it would render her more amenable to hygienic and other simple requirements of daily life. The day she entered Miss Marvin’s home, without suggestion on the part of any one, she stopped using the nursing bottle which had hitherto been her inseparable companion. The cause of this important but unexpected improvement is not easily explained. Possibly the journey to Philadelphia, the new environment and the intimate association with a personality other than the mother, shocked the child into a sudden manifestation of normal progress. Such phenomena have been observed in normal children. For example, I recall the case of a child of five years, apparently devoid of imagination and imitation, who outdid his companions m fanciful and imitative play on being brought from Boston to live in Philadelphia. It is difficult to believe that the atmosphere ?f Philadelphia is more stimulating to the imagination than that of Boston, and I must, therefore, attribute this long step forward to the influence of the shock of the journey and the new environment. Such shocks seem at other periods of life, notably at adolescence, to usher in unwonted mental habits and attainments.
The first training of the child had as its object the establishment of what may be called the “pedagogical rapport.” The child must obey the will of the instructor or it will become the sport ?f its own caprices. Discipline, guided by tact and knowledge, is, therefore, a necessity with mentally feeble or backward children. ^ lie parent of a defective child moved by sympathy for its condition will commit the. fatal error of indulging it more than the formal child. This excess of tenderness is a serious obstacle in the way of the child’s progress. The feeble-minded child, for the very reason that the usual motives to disciplined behavior are less likely to guide and control its impulses, needs all the more that firmness which develops obedience to the instructor’s will. The love of pleasure and the fear of pain in whatever guise they may present themselves to the mind, are after all the two motives by which every parent or instructor gains the child’s affection, disciplines its will and establishes the “rapport.” Neither motive can be overlooked, nor can too much discretion be shown in the choice of the media through which an appeal is made to the one or the other. The sugar plum and the rod may be preferred by some; the kiss and its denial by others; both sets of alternates appeal to these two primitive emotions. Constant nagging, threatening or slapping should be discouraged, especially with nervous and fretful children, yet when a slap of the hand is needed, it should be hard enough for the pupil to know that the teacher herself is not a creature of wavering purpose. The child should learn to fear punishment and to love the instructor. No child is of such feeble intelligence that it cannot be won and held by affection; but the display of affection, to be effective, must be under the inhibitive guardianship of the reason and judgment. Indiscreet affection will smother with an embrace the small spark of self-control the child may have originally possessed. The mother of a defective child, however, can hardly be held blameworthy if maternal love and personal sensitiveness make her unable to inflict misery upon herself through the firm treatment of her child. The first attempt to control this child demonstrated the effectiveness of a simple pedagogical remedy. In a fit of anger, she took a cup from the drawing-room table, and threw it against the wall. The instructor took her to where the cup lay broken, and, pointing to the pieces, slapped the offending hand. Apparently stunned by the newness of the treatment, she hesitated long enough to show that the cry with which she ran to her mother, who was present, was one of anger and not of pain. At the instructor’s suggestion, the mother exercised sufficient self-control to manifest 110 active sympathy. The result was that the child never again touched with destructive hand an object upon the table. A similarly rapid improvement was shown after her old habit of going to sleep on the floor was broken. When bedtime came she was undressed and put to bed. She cried lustily for a time, intermittently jumping from the bed only to be put back again. Less than a week had passed before she could be undressed, bathed and put to bed without offering any greater resistance than is the natural right of every child.
Her affectionate disposition and love of music were powerful aids in forming habits of obedience. She learned that if she were naughty she would not be sung to or petted. At first the wish to please her instructor was doubtless the result of a selfish interest in what the instructor could do to minister to her comfort or pleasure. But soon this interest changed into a wish to please for the instructor’s sake; then appeared the close conning of the instructor’s face for signs of the displeasure or approval she might have caused. Obedience was then no longer a matter of enforcement. The child obeyed because it could not help carrying out the wish that its awakening powers of observation saw pictured on the teacher’s face. In the spring when the child was advancing in the comprehension of words by leaps that were often surprising, an incident occurred illustrating the power of the teacher to make her will the effective agent in determining the child’s action. The child had been insisting, in her characteristically obstinate fashion, upon having her own way and was spoken to by Miss Marvin in the following words: “Do you know what naughty girls have to do? I want you to go into the house just as fast as your little feet can carry you, and right upstairs to bed.” It was not expected that she would understand, much less obey, the command, and the words were uttered more for the moral effect of a reprimand couched in gesture and tone than to give an order for execution. The child, however, did not wait for the nurse who usually accompanied her, but turned toward the house without a negativing look or gesture, and did as commanded. Complacent affection, on the other hand, yielding to a child’s every whim, defeats itself. Whereas in a short time the instructor had won the child’s interest, obedience and love, the mother had failed to gain any of these, because she herself lacked the determination necessary to awaken in the child’s mind a motive strong enough to dominate its passing fancy and emotion. The mother must have been for the child merely a source of sensuous gratificat]?n, or a willing slave to administer to her wishes and commands. The child did not even notice the mother’s departure, when, after a week, she was left entirely to Miss Marvin’s care, although up this time the mother’s lap had been a haven of refuge for selfindulgence in emotionalism. This rapport which causes the child to form its every action upon the teacher’s word and gesture, conduccs to the unconscious
THE PSYCHOLOGICAL CLINIC.
obedience that is an antecedent condition for gaining concentrated attention. As soon as the attention can he held, it is possible to appeal to imitation. The effort was first made to produce slight modifications in movements already familiar and pleasing to the child. Thus the instructor played with the child’s doll, caressing it and patting it, rocking it and putting it to sleep, singing and talking to it; the child did the same as far as her limitations in natural play permitted. The instructor then emphasized a few simple movements just a little beyond what the child seemed able to perform. She naturally attempted to follow through unreflective imitation, awakened by interest. Thus was the child slowly taught to cross the leg and kick with one or both feet, while she sat upon a chair rocking her doll. Now and again some action would be risked far beyond the child’s powers of muscular coordination but attractive to her fancy. Thus with one leg over the other, the doll would be placed on the swinging foot and lifted up and down, “riding piggy-back,” in nursery parlance. The child was fond of “riding piggy-back” herself, and although she could not treat the doll in this way, the instructor’s action proved a powerful incentive for persistent efforts to attain what was then the impossible.
With the same dependence upon the play instinct, the teacher clapped her hands, shook them up and down, here and there, nodded her head, walked, danced, moved her foot forward and backward. These actions gained the child’s interest, compelled its attention and called forth attempts at imitation. By such means the power of co-ordination was developed and voluntary control over the muscles increased.
Next in order came the employment of imitation to arouse the child to articulate speech. Persistent training of the function of speech began December 9th. The child was fortunately fond of music and liked to be rocked and sung to. She would even try to hum the time herself. Her favorite song,?”Baby, baby, dance my darling baby,” was repeated over and over again. As her interest grew, she tried to sing as well as hum, and her attention was directed to the movement of the lips. In ton days (December 19th), she could say “baby” distinctly, and in three days more (December 22d) she could hum the tune, inserting the word “baby” in its proper place. Soon efforts were directed to the imitation of words and elementary sounds. The circumstances under which she made the first attempt at articulation by the free exercise of her own will arc podagogically suggestive. In the fifth week (January 2d), she was watching an older pupil give as an articulation exercise the sound “ah.” Without suggestion, she imitated him closely, and gave the sound clearly and forcibly, opening her mouth and even assuming the required pose of body with her hands behind her back. But nothing would induce her to repeat the attempt, although efforts were made to this end for several weeks. She understood apparently what was wanted, but obstinacy or sluggishness of will caused her to resist every stimulus. When she finally yielded, she did it as the result of personal choice and desire, presenting thereby the first clear manifestation she had yet given of a voluntary action determined by complex motives. She was being cliided for some mischievous act and was trying to win the instructor over by kisses and caresses. As her efforts seemed unavailing, she stood for a moment as though pondering; her face then brightened into a smile of intelligence; she put her hands behind her back, opened her mouth to the fullest extent, and brought out an “ah” that would have satisfied the most critical articulation teacher. This was the eighth week (January 29tli), six weeks after the first word “baby” had been sung. By the end of the tenth week (February 17th), she could give the phonic elements “m,” “e,” “i,” “all.”
The first word that she used with an adumbration of meaning was the word “more.” This word was wrung from her by its emotional environment. A distasteful medicine was frequently offered her with the inviting supplication “to take just a little more.” She soon learned to point piteously to the bottle, saying “more” with a shake of the head that clearly meant “no.” It is well not to take too much for granted with respect to a child’s deficiency. Miss Marvin always insists upon treating defective children as in many respects normal. She sings to them, talks to them in the language of the adult, tells them stories, and is constantly doing what she feels is lost on them. And yet experience justifies her belief that even the weakest mind is surprisingly affected and unexpectedly improved by some factor selected by the child itself from the normal environment in which ^ is placed.
With the approach of spring, progress became more rapid. She made the very considerable advance of pointing to things she wanted, and toward particular places to which she wished to be taken. Iler table manners improved so much that she was allowed her own cup and saucer, and she was able to pass her plate, asking insistently and intelligently for “more” of what pleased her palate. The improvement in her personal appearance was marked. Drooling had almost ceased; lier mouth and chin were thus kept dry and free from irritation. This was accomplished in part by pointing to her wet dress, appealing to the vanity which she was fortunate enough to possess in the amount due her sex. Her countenance was also losing a little of its blank idiocy of expression. In the fifth month, April, she learned to throw and roll a ball, to snap her fingers, to hunt for hidden objects, and to show how big she was. She could stand firmly on one foot and kick quite high with the other. A curious limitation in motor capacity was shown in an inability to move any part of the body forward and backward. She could shake her head in negation, but not in affirmation; she was also unable to say “good-bye” with her hands, although apparently more difficult movements were repeatedly performed. She now said “cat,” “ball,” “doll” and “hello,” and could imitate the “meow” of a cat and make the difficult sound of clucking. She also one day surprised the family by passing a spoon in the self-assumed response to a request made by someone at the table.
Iler Easter gifts awakened her enthusiasm and appreciation. They were placcd on the breakfast table about her plate. As her gaze wandered from one gift to another her eyes grew large and bright until, clapping her hands with excessive joy, she burst into laughter. An attractive red ball and a doll at first had the largest share of her attention, but the feeding of a toy dog by some one at the table soon absorbed all her interest and awakened successful efforts at imitation.
The sixth month of training, May, found her able to walk without fatigue about as far as a normal child. She learned to climb, impelled by curiosity to grasp things placed out of her reach, and stimulated by pleasure in the unwonted muscular exercise. She was developing sufficient strength and manual dexterity to pick up a chair of light weight and carry it about the room. She spent much time before the mirror, watching the movements of her lips in articulation practice. She could imitate so closely the positions of the lips in speech that looking at her one would think she had normal powers of language. Left alone, she kept up a continuous jabbering, quite unintelligible for the most part, but now and then a group of words clearly enunciated would startle the hearer. Interruptions caused her spontaneous language play to cease abruptly. By means of it, however, she learned most of the words of her favorite song, “Baby, baby, dance my darling baby.”
It would be unfair to Miss Marvin’s pedagogical discernment to give the impression that the child’s improvement was due solely to the skilful appeal made to its mind. From the first, cold and hot baths followed by alcohol rubbing had been given nightly. Her circulation improved under this treatment and the skin became free from sores. At the same time the shock of the baths seemed to have a beneficial mental effect and improved her sleep. Milk at first had formed the greater part of her diet. So fond was she of this that it was necessary to wean her from the bottle to the enjoyment of solid food. A few weeks showed the good result of changing to a varied and nourishing diet. Her flesh became more solid; her cheeks and body grew thinner, but firmer. A severe attack of bronchitis with its consequent treatment served to emphasize the necessity of medical treatment for the reduction of the tonsils and the removal of the adenoid growths which almost filled the naso-pharynx. In the seventh month, June, two operations removed these obstructions. On the day following their final removal, the little girl seemed unusually bright and active. In playing with her, the instructor happened to say the word “boy.” “Boy” the child repeated clearly and distinctly, without a moment’s hesitation. Asked to say it again, she repeated the word many times over and over. If we consider that heretofore not less than two or three months of arduous work had been necessary in order to teach her a new word, one can understand the feeling of the instructor that something like a miracle had been wrought when the child almost with nonchalance successfully essayed a word never before attempted. This marked nn epoch in the child’s career, a position gained and ever afterward maintained in this heroic struggle to overcome the obstructions of disease. On the same day at dinner, when she was about to place her hand upon the tea-pot, she was warned that it was hot. Instantly she repeated “hot” in an inquiring tone of voice. It was now possible to form the habit of keeping the mouth closed and of breathing through the nose. The verbal injunction close your mouth,” combined with firm pressure to hold the lips tightly together, enabled her to comprehend what was desired and forced her to breathe through the nose. Effort in this direction was not relaxed until she could sleep quietly at night with the mouth closed. This not only added to her personal attractiveness but also gave to her mind the freedom of action which so often manifests itself after the removal of naso-pharyngeal obstruction. The distinguished anatomist and medical specialist, the late Dr. Harrison Allen, never wearied of insisting upon the stimulating effect that the removal of adenoid growths exerted upon the mind. He was able during his lifetime to prove himself a benefactor to many children and to justify his belief in the mental reaction that follows these operations. He lias not reported a case in which the mental response was more immediate and pronounced than it was with this little girl.
A month at the seashore during the summer proved a wonderful tonic. Loving the water, she played in the sand at the water’s edge, enjoying the waves as they rolled her over and over. This emotional stimulus and the warm sea air may account for her rapid progress during the summer and autumn months. A factor of greater significance, however, was the child’s constant association for four months with two normal children of her own age. Imitating them, she grew more natural in her play. Thus they inspired her to envy and emulation as they ran up and down stairs. The noise they made was an auxiliary if not the chief fascination. When she found herself unable to run as they did, she bent her energies to outdo them in the production of noise. In this she succeeded, striking each step many times as she slowly descended, and so determined and persistent were her efforts that it was not many weeks before she was able to go up and down stairs with alternate steps. These normal children also taught her to dance, and, through imitation, her carriage and gait manifested improved co-ordination. Many words were added to her vocabulary, among them “Emma,” “Gertrude,” ” Auntie,” “Mary” and “stop.”
The four months following this outing showed a great increase in the power of comprehending what was said to her, and also in the ability to follow directions verbally given. At the end of this period she could, when asked, run and fetch the newspaper, although she might be obliged to remove a book before she could lift the paper from the table. Sho also refused to wear a dress if it was slightly soiled, and instead of fretting during the operation of dressing, she was now anxious to be dressed and would stand comparatively quiet. For this self-denial she rewarded herself by many looks of self-appreciation in the mirror. If thirsty, she could go into the kitchen, take her enp from the nail and ask to have it filled.
Finding herself in the sewing-room, she determined to climb upon a coucli where the pile of garments was highest. As fast as she was pushed from the couch she stopped only long enough to scold and stamp her foot before making another attempt. Hearing the uproar, her nurse went in and asked what the matter was. The child immediately went to the couch and placed a hand on it, pointing with the other to the floor and then to the person who had pushed her off. Through it all she kept up an incessant jabbering. This first attempt at an elaborate pantomime gave promise of a greater advance in language and thought. In the afternoon of the same day she was looking at a picture book, which was taken from her and held between her nurse’s teeth in order to let the child try to pull it away. For a while this only served to tease her, causing her to scold and cry. Suddenly she stopped, looked up into the nurse’s face, and said “ah,” as though she wanted her to do likewise. The nurse followed the child’s suggestion, and as her mouth opened the book naturally fell to tho floor. The child instantly picked it up and ran away as fast as she could.
She could now distinguish between the door bell and the dinner bell. Xo matter how interesting her occupation was, tho sound of the dinner bell caused her to drop everything and start for the dining-room, saying “more,” the word she now used restrictedly for something to cat. ITer appetite was becoming selective, and under the guidance of her improved powers of observation, she refused rice pudding without raisins if she noticed raisins in the portion allotted to others at table. Asked to say her lessons, she would walk over to the wall, place her hands behind her back and repeat all the words she knew. When compelled to stand m a corner as a punishment, she always preferred to choose her ?wn corner. Her persistence in voluntary effort was shown in her first attempt to pick up a pin. Before accomplishing it she worked fifteen minutes without a sign of anger or discouragement. Practice soon gave her facility in this difficult bit of manual coordination. During the fall months she had learned to say “Peeka-boo,” “towel,” “ribbon,” “ring,” “box,” “stew,” “Eddy,” and Hattie,” and while shaking hands she could say “How do you do ?”
She spent Christinas at home. Although she had failed to remember her former life, 011 her return to Miss Marvin’s home, the joy with which she greeted each member of the household bore evidence to the strong impression that the experiences of the preceding year had made upon her memory. Tho beginning of the second year was devoted more particularly to the development of her capacity for persistent concentration of attention and effort. Iler progress was noticeably accelerated and at times a hope was expressed that the child might ultimately attain to normal mentality. Unhappily at the end of the third month of the second year misguided maternal instinct, deeming itself capable of undertaking the further development of this child’s mental life, summoned her home to become the victim of a solicitude which sought to make enervating affection fulfil the office of knowledge and discernment. The task of education appears very simple and even easy to those who see the results obtained by the natural talent and acquired skill of the successful teacher.
What had been done in fifteen months for this still defective child ? The repulsive countenance had been transformed into almost a thing of beauty; curly hair covered a naturally wellshaped head, the mouth was closed, the cheek firm and healthful in appearance, the bridge of the nose was beginning to be noticeable. The dull lifelessness of the eyes and general vacancy of expression alone betrayed the mental deficiency. The irritable infant lying helpless in its mother’s arms was now an active child, revealing the potentialities of a progressive mental existence. The child, absorbed in its own bodily distress, and seeking only selfgratification, had become a favorite of the household through her affectionate and sympathetic disposition. The infant who could barely crawl now walked upstairs with alternate steps and with both arms heavily laden. The speechless child now used connected words, and could say “More tea, “More potatoes,” “I love you,” “I love my baby,” “I love my mamma,” all distinctly articulated. The child, who possessed so little intelligence that her mother’s highest hope had been to see her able to point to what she wanted, could now select with discrimination the clothing she wished to wear, and could execute with precision the details of simple commands verbally given. In the last days she was worrying a visitor for a cornet he had brought with him. The mother said to the child: “Perhaps if you will give the doctor your doll, he will let you have the cornet,”?a verbal suggestion which the child instantly carried out in action. Originally lacking in persistence, her capacity for continued effort was shown when she placed, at the first attempt, one hundred of the smallest pegs used in kindergarten work into the holes of the pegging board. The sport of every passing whim and emotion had now developed a will power capable of resisting its own impulses and of yielding obedience, and had begun to manifest the foreshadowings of a moral sense and a self-respecting personality.
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