Retardation Through Neglect in Children of the Rich
The Psychological Clinic Vol. I. No. 6. November 15, 1907. :Author: Lightnee, Witmek.
Mental retardation must not be considered as the equivalent of mental defect. In many cases, doubtless, retardation rests upon a defect of the brain or some other physical defect, the result of heredity, accident or disease, but in some cases the retardation is purely functional and may be a consequence of disuse through neglect. A normal child of six years is possessed of a group of mental and moral qualities characteristic of his age and sex. These qualities change into others through the acquisition of new or the loss of old qualities and through modification due to growth. The normal child of nine years of age differs from the normal child of six. If a child who was entirely normal at the age of six remains in the possession of the same mental and moral qualities when he has reached the age of nine, he presents the condition of retardation. This retardation may involve one or more, possibly the entire group of qualities. A single quality may have a very potent influence upon the course of intellectual development. Thus, the central mental process determining the course of intellectual evolution is attention. The development of concentrated attention results partly from the genetic process alone,? that is, it is a growth from within,?and partly from the environment in the form of school training and home discipline. Through neglect of proper training, the young man of twenty-one may find his poAvers of attention inadequate for the proper fulfillment of the requirements of a college course and more appropriate to a child of eight or ten. He -is suffering from a partial arrest of development, the result of neglect. An arrest in the development of attention will carry with it an arrested development of the intellectual processes.
The children of the rich and especially of the very rich, are as apt to show the results of neglect as are the children of the very poor. According to Dr Nicholas Murray Butler, the child of rich parents is often too seriously handicapped by the effects of home life and school training to profit by the opportunities afforded by the college, into which in Dr Butler’s words, “he is hoisted over the entrance examinations,” through the aid of special coaches and “then left to his own limited and rather dingy resources.” “The rich boy,” he says, “who receives a good education and is trained to be a self-respecting, responsible member of the body politic, might in time share on equal terms the chance of the poor boy to become a man of genuine influence and importance on his own account. Just now, by the neglect or worse of his parents, the very rich boy is apt to be relegated to the limbo of curiosities and too often of decadents.” The responsibility rests primarily, in Dr Butler’s opinion, “upon the folly and indifference of the fathers and the vanity and false pride of the mothers.” But this responsibility is shared by the fashionable private school and the private tutor. With Dr Butler, I believe that the home and school, chiefly through neglect of discipline, permit the minds of many children to remain undeveloped during the formative period. The discipline that is required is not merely that which makes for obedience. It is the discipline of work and strenuous effort, the discipline that trains the memory, the will, the attention, and forms habits of work which permit the children to assume progressively more difficult tasks. The motive that inspires President Butler’s criticism is social, and has in view a high standard of citizenship; he desires the children of the rich to exert an influence upon society and feel a responsibility commensurate with their wealth. The problem of the child psychologist and trainer of individual children is comprehended within somewhat narrower limits. It is training to the highest degree of efficiency and adaptability. Each child receives at birth a brain endowed with possibilities of mental and moral development up to a theoretically assignable limit. Like a field, the brain must be tilled and cultivated to bring forth a rich harvest. Bather like a race horse, it must be nourished and exercised, disciplined and trained, in order to develop all its latent capacities. The better our methods of brain or mind culture, the more efficient will be the product. The community suffers a great loss if brains of unusual capacity, or if brains of even average capacity, are allowed through neglect to arrive at maturity?after which time little can be done?with capacities much below what we have a right to expect from our knowledge of the conditions of heredity and environment.
It is through a study of individual cases that I believe we shall be able to point out the causes of this deficiency, or perhaps I should call it inefficiency, at maturity. The case that I propose to report will present a history of failure, but failure may be as instructive as success, provided the conditions have been carefully studied and the nexus of causes and effects subjected to adequate analysis.
In October of last year a well-known physician invited me to consult with him concerning the appropriate mental and physical treatment to be accorded a puzzling case which had come under his observation. A young man, then twenty-one years of age, had made three successive efforts to pass the entrance examinations of College and had failed. The third and last effort had been made in the summer of 1906, after he had spent a complete year at what is rightly regarded as one of the best coaching schools in this country. His ordinary conversation revealed no trace of mental deficiency, nor would his physical appearance awaken any suspicion of degeneracy. It seemed that a careful mental and physical examination ought to reveal the treatment required to enable him successfully to pass these examinations.
With the physician I made a mental and physical examination extending over several days. Ilis pedagogical history revealed that he had first attended a fashionable school conducted by a woman principal, and that he had then gone to one of the best and most fashionable college preparatory schools in the country, where he had spent four years. Boys’wlio had been in his class at this school were then in the sophomore class of College. Ilis retardation was ascribed to the fact that in 1903 he had suffered severely from grippe, and one lung had become affected. This compelled him to leave school, and to pass the winters of 1903, 1904, and part of 1905 in the South. Here he spent a great part of his time in outdoor life, and was supposed to be preparing for entrance to college under the instruction of private tutors. His tutors were not regarded as very efficient’, either by himself or his father. In the spring of 1901, with this private preparation, he first tried the entrance examinations and failed in all branches except history, in which he obtained and continued to hold two credits. In 1905 he took all the examinations except history, and failed in every branch. In June, 1906, after one year’s attendance at the coaching school, he tried every subject in the spring examination, excepting that for which he had credits, and failed in every branch attempted. In the fall, however, after a complete rest during the summer and with only one week’s review, lie tried tlie examinations in English, algebra and geometry, and succeeded in making a pass mark in the last named subject.
His intelligence appeared to be normal, as revealed in ordinary conversation. If one engaged him in what approached a more serious conversation, he was found to be wofully ignorant, but this would not be considered worthy of special comment by any one who is acquainted with the stock of general information possessed by many young men who are thought to be fitted for college, and by young women who are presumed by the teachers of fashionable schools to be trained for social life. This young man was well able to conduct himself with credit at an afternoon tea.
His memory for names and dates was reported to be very deficient. Thus, his father claimed that he was often unable to give the names of persons with whom he was well acquainted, for example, guests who were staying at his father’s house, although he might bo able to describe their individual characteristics accurately. He had presumably been prepared for three different examinations in Latin, and yet when I asked him what he had read, he was able to tell me little more than ‘’Vergil, Cicero, and Cassar.” He could not name any oration of Cicero ho had read. He said he remembered the oration against Catiline, and that he had read three books of the Aeneid, and all of Caesar’s Commentaries, but he gave me this information only in answer to specific questions, in which I first named what I supposed ho must have studied. At the time I saw him he was reading with his instructor in English, Pope’s Epistle to Dr Arbuthnot, but ho could not tell me anything more about it than that it contained some reference to Addison. This verbal amnesia prepared mo for the discovery that he was deficient in spelling. In a brief dictation I found such words as scpcrale, antisipate, purspirc, and hcven. His writing was poor, unformed, and slow. It bore distinct marks of lack of training. I asked him to write croud, and crowd. He was not certain which was the correct spelling, but inclined to crowd. He spelled correctly ivhich and witch, and knew the proper use of each form. He did not know whether rehaf, relief, or rclcif was correct, but inclined to releaf. I gave him the correct spelling of these words in the morning, and found that he spelled them all correctly in the afternoon. lie said that he remembered them from the drill I had given him in the morning.
His reading showed the same remarkable lack of efficiency and drill as his writing and spelling. He delayed over even very small words. His reading was that of a child in the third school year, devoid of all expression, with frequent substitution of words that were not at all like the words on the page. Thus, he read threshold for shoulder, open for upon, and heel for hill. These errors suggested deficient eye-sight, badly trained attention, and bad tutoring. His articulation in reading was very poor and quite different from that which he employed in conversation. The mental examination had shown easy distraction of attention. I tested this with numerals, calling out groups of five, six, seven, and eight numerals. He never failed in a test of thirty consecutive trials on a group of five numerals, but he often failed on a group of six numerals, and never succeeded in getting a group of eight numerals correctly. I considered the results of this test showed that his memory span was normal, but that attention and interest rapidly flagged. This deficiency of attention was shown in a more striking manner in testing him with a line of verse,?the iambic pentameter of Milton’s “Paradise Lost.” I covered up the printed page and exposed one line at a time for a fraction of a second. The first time I did this he read the line perfectly; in fact, he made no mistakes in the first five lines read, but on the sixth line he made a mistake, and during the entire test he never afterward was able to hold his attention to the task of reading correctly the words of a line. This condition is one that has been called aprosexia, an inability to give sustained, concentrated attention. It is more or less characteristic of the attention of the young child, but school training and the progress of mental development should bring with it a capacity to sustain and concentrate the attention. Aprosexia was first described as a mental symptom associated with adenoids. This young man’s attention was, therefore, one of arrested development, and led immediately to the suspicion of the possible existence of adenoids. The condition of aprosexia, however, is indistinguishable from fatigue. The child whose attention wanders and who loses interest quickly may be the victim of a rapidly generated fatigue which may come from other causes than arrested development or adenoids. In this case, however, adenoids had been present for many years, and had been removed only two years before, when he was nineteen years of age. Following the removal of the adenoids, he grew from three to four inches in height, and his weight increased from one hundred and five to one hundred and forty pounds. At the time of the examination lie was somewhat under weight, his height being five feet eleven inches. He had formerly suffered from ear aches, but not for the last two or three years. Before the removal of the adenoids he was a mouth breather, and much troubled with colds. His digestion was poor, and he complained of stomach phenomena, especially of black spots before the eyes. He slept well. He was fond of exercise and fresh air, and believed that city life caused him to diminish in well being. He said he still had affected tonsils on coming to the city. Knee jerks were normal, or but slightly exaggerated, the right slightly greater than the left. He had good station and gait, though the body was rather poorly balanced on the hips; there was some asymmetry of the trunk and a slight compensatory lateral curvature of the spine. He complained of nervousness, but it was more like the restlessness of ennui. The only marked sign of nervousness was a state of mental confusion, sometimes approaching collapse when he was called upon for any kind of mental test; as for example, to pass an examination. He thought that in this condition he forgot what he knew quite well. He considered himself handicapped in his examinations by his limited vocabulary, his deficiency in spelling, and his lack of facility in writing.
Expert opinion is desirable in almost every case of retardation. In this case it was especially called for, owing to the absence of any pronounced mental or physical symptom indicating a leading cause for retardation. The examination of specialists showed the naso-pharynx to be hyperaemic but free from obstruction, and the tonsils were not much enlarged; no adenoids were recognizable on ordinary examination. There was slight retraction of the ear drums, a catarrhal otitis media non-progressive, caused by adenoids. Hearing for the voice was normal, as shown by the whisper test. For the watch it was reduced to for each ear; there was slightly reduced bone conduction for all forks. Examination of the eyes showed nothing but a slight far-sightedness, for which the constant wearing of glasses was recommended, long enough at least to note the effect. Examination of the heart and other organs gave no indication of defect.
Physically, therefore, he was given what amounted to a clean bill of health. This made a further mental examination all the more necessary. I therefore spent two days in the coaching school, during one of which I observed him at his work in the several class rooms. Even if he had been a clever and hardworking student, he required, in my judgment, at least two or three years’ preparation in order to pass the entrance examinations of any reputable college. His instructors, however, were unanimous in the belief that after a year’s work he could be admitted to College, at least with conditions, if he would only devote himself exclusively to his studies. That his coaches could entertain this belief when the boy was deficient in even the elementals of a common school education came as a startling revelation to me of the ease with which boys, having no real preparation for academic life, can yet be trained to jump the barrier of the entrance examinations.
The instructor of mathematics insisted that his work in this branch was good. He claimed that he knew enough to pass the entrance examinations in algebra and plane geometry, and that if it had not been for stage fright he would have passed both these examinations the previous June; whereas he had failed in both in June and had passed the examination in geometry in September, only after a summer’s rest. The instructor thought him better prepared in algebra than in geometry; he denied that he had observed any noticeable lapses of memory, nor had he observed the attacks of fatigue. The chief complaint was directed to a lack of steadiness in his work and to the distraction of his attention by his family, his sports and his social obligations. The instructor of French was very optimistic. He felt that Elmer (as I shall call him), was able to read French well, but that he had a phonetic difficulty, which he had observed in very many boys. He did not think that Elmer’s case was worse than that of other boys; he felt that he could get him through his examinations in elementary and advanced French on five hours of instruction a week. It is probable that Elmer had made so little progress in French that the instructor failed to observe the limitations of his memory. The hopelessness of endeavoring to get him into college was brought home, to me at least, when it came to his Latin. He had prepared a written exercise which required him to use a number of verbs in the first person. He gave them all in the third person, and seemed quite indifferent when his error was pointed out. Toward the end of the hour I asked the instructor to have him translate a passage from Csesar. His knowledge of the vocabulary appeared to me very deficient, and the evidence of defective memory was conclusive. His Latin instructor did not believe that he could prepare him to pass the entrance examinations in Latin if he kept 011 with all the other work he was then taking at the school. He claimed that Elmer had an ability to translate, but no ability to acquire the exact grammatical forms. I per164: THE PSYCHOLOGICAL CLINIC. ceived from my examination that lie was an exaggerated type of the boy all teachers dread. Such a boy translates a passage fluently and with a quite commendable approximation to its meaning, but he will make a few glaring mistakes that show a faulty knowledge of the grammar. A future participle, let us say, is translated in his flowing, slipshod fashion as a past participle, despite the fact that the sense of the passage as well as the construction suffers. A review of the conjugations of the verbs suggests itself as desirable. Teach him the first conjugation and he learns this satisfactorily; teach him the second and he learns this with apparent ease; teach him the third and then review him on the first, the discovery is made that he has already lost some of this. After he has learned the fourth conjugation, it will be found that he has lost very much of the first and some of the second and third. lie is then taken through all the conjugations again and, depending upon the amount of patience possessed by his teacher, he will receive a more or less protracted drill in the grammar. Finally the task of teaching him the exact grammatical forms- will be given up for the time being, and he is put to translating again, in the hope that his memory, by some happy accident of growth, may overtake his understanding.
This difficulty is either a specific form of amnesia, an inability to establish a memory for the paradigms of a language, or else it is due to faulty methods of education and to deficient attention. It is not an easy matter to prove the existence of a specific form of congenital amnesia verbalis. It would require us to find a boy whom in early years we had attempted to train by aid of the most approved methods and with whom we had, nevertheless, failed. I have under my care at the present time a boy who appears to present this condition; he seems quite unable to acquire the visual forms of language, although he is facile enough in ordinary conversation and has fair intelligence. But in the case of this young man, the matter is not clear, owing to the fact that we have a positive history of inefficient educational methods and of defective training of the attention. The experiment had never been satisfactorily made to determine whether there was in his case a real inability to memorize grammatical forms; he had always pressed on to translation before he had acquired the elements of the grammar.
In his English work the defect of memory, which appears as an amnesia verbalis, was well marked. He could not form a simple sentence. He had practically no knowledge of grammar and it seemed almost impossible to teach him any. He was extremely deficient in spelling, and no amount of training appeared to increase his accuracy. In addition to the lack of memory for spelling, he had a lack of personal conviction that he was right. If he spelled a word correctly, and I asked him, “Are you sure it is right ?” I could always make him uncertain, and this was the case with the most common words. It seemed to me that it would be necessary in teaching him orthography, or indeed any other branch of instruction, to train him into something like self-reliance. He did not offer active resistance; there was no evidence of what is called negativism, but resistance came in the shape of apathy.
This indifference, apathy, or lack of mental energy, was partly temperamental, but it appeared also under conditions that suggested fatigue. On the day that I followed him about from room to room, I observed that he did fairly good work the first period, and held out almost for the entire hour. His teacher was an excellent one, interesting, rapid in the moves that he made to attract the attention, and able to draw a good deal out of a pupil in the way of energy. The second hour, the boy was less alive at the start, and very rapidly lost interest in his work. Before half of the hour was gone, he was mentally inert, apathetic, mechanical in his answers, easily confused, and really indifferent as to whether he was right or wrong, and yet non-resistive, patiently following as well as he could. During the third hour his instructor was again one who was unusually capable of awakening interest and attention, and for a brief period, about fifteen minutes, the boy seemed shaken into life, but soon a condition of mental somnolence, almost of stupor, ensued. The tutor kept on with his work, every bit of it in my opinion worse than useless. At the end of the morning’s work the boy’s face lacked all expression, his eye, lustre. He had the dull, vacant expression of one afflicted with dementia prsecox. It was only when he was about to go, and I spoke to him of his week-end visit to his family, that his face brightened and regained a look of intelligence.
His day’s work at this forcing school consisted of four hours in the morning and two in the afternoon. I resolved upon a decided change of program. In the first place, I cut off the two afternoon hours, leaving him the four hours of the morning only. This cut out two subjects in which he would be required to pass examinations. I felt that we could not afford to take the risk with all six subjects. It also appeared to me that he could not stand a period of one hour. I therefore instructed his tutors to consider a full period’s work as forty-five minutes. The remaining fifteen minutes of each hour were to be devoted to gymnastic work in the gymnasium, light exercises in the school room with the windows open, or to relaxation and rest. If the fifteen minutes in each hour did not suffice to overcome the effects of fatigue, then I advised a further encroachment on the study period; and I gained the father’s consent to have him excused for the day at any time when his condition seemed to unfit him for work. Skilful as these tutors were in the work of cramming knowledge into an unwilling brain, they were incapable of judging when the moment of fatigue arrived, and on subsequent occasions I saw the boy working under conditions which I considered far from hygienic. The afternoon was to be devoted to his physical well-being, and to the preparation of his studies for the next day. There was every reason to believe that the hour and a half which ho professed to spend in preparing his lessons for the next day was perhaps unconsciously wasted. I therefore engaged a young man as tutor in the afternoon. I took a great deal of care in his selection, and mapped out a definite program. My instructions were that Elmer should get his lunch at one o’clock on the completion of the morning’s work and should meet the tutor at two o’clock. The tutor was to go with the boy to his country home, to see that he spent as much of the afternoon as possible in the open air and that he gave two hours during the afternoon to the preparation of his work for the next day. The tutor was to arrange his work to suit the actual conditions; if Elmer was working well, he was to keep him at it; if he appeared to be mentally fatigued, he was to take him for a walk, play tennis, wrestle, box, or engage in whatever exercise suggested itself as desirable. A physical trainer gave him resistive exercises at his country home for a half hour every afternoon. The tutor and physical trainer ^occupied the boy’s time from two until half past five. This gave him plenty of time to rest before dinner, and to dress. In the evening he was left to himself, with the understanding that he would spend an hour in preparation for the next day’s recitations.
The change to this new program was made on the first of November. By the middle of November his instructors noted an improvement in his work, the English instructor in particular observing a marked improvement in attention and ability to grasp ideas. Elmer reported that he no longer experienced the feeling of lassitude and tliat he was mueli less apt to fall into a state of mental confusion.
In two important particulars, the young man refused to co-operate. He would not wear glasses except in the class room ? in the course of a couple of months, he stopped wearing them altogether. He also refused to allow the tutor to go with him to his country home; this appeared to him as too much like having a nurse or keeper. He was a young man already of independent income, and it was important to obtain his hearty co-operation. A compromise, which I regard as in many ways unfortunate, seemed necessary. The tutor, therefore, helped him at the school with his lessons for the next day; this naturally resulted in the study period being more or less of a fixed exercise. I believe also that the tutor failed to carry out my instructions to let the young man off entirely when he was not feeling in good condition. Other difficulties appeared which tended to emphasize certain factors as perhaps the most important in the causation of his- retardation. An admirable glimpse into his mode of life at this time and throughout his entire youth is given in a report to me from the headmaster of the school. “One great difficulty with Elmer’s work is that he has a good many other things to think about. We are to have a football game with next Saturday, and excellent tickets have been scarce. Elmer desired six tickets, and he early became concerned as to whether he was going to get six good ones. He has, therefore, had to spend time visiting the various ticket agencies in town, telephoning to them, and talking over with friends out here the possibility of getting six good tickets. He got them through the kind offices of one of my clerks to-day, but he would have been about as sure of getting them had he not given the matter a moment’s attention. No assurances, however, would convince him of this; he wanted six tickets and he must have them right in hand almost the day that the tickets were issued by the Athletic Association to the original applicants. . Now that he has obtained the tickets, he is obliged to start for 011 the one o’clock train to-morrw, so that he may meet his family and arrange with them for going to the game. The necessary preliminaries to getting the one o’clock train will cause him to miss some of his recitations tomorrow, and he will miss all of those on Friday. His father does not realize how serious an interruption things like this are. Although I have not questioned Elmer about the matter, I presume the tickets are for the use of his family; he certainly cannot be going to take five men friends to the game, and lie lias arrived at the age when he would hardly take five ladies, he would probably prefer to take one and possibly a chaperon. The result is that he has had here a week which is practically worthless, and that is one-thirtietli of his working time before next June. The other boys who are studying here are all going from here Saturday morning with me in a private car; they have not had to take any thought as to how they were to get to , and I do not intend that they shall take any thought as to how they will get back. They have each been provided with a ticket, and although all their tickets were not so good as those of Elmer, some of them were. They will lose but very little work, and the game will come to them as a very enjoyable Saturday outing. It will be nothing more than that; they will have all their work done for Monday before they leave for , and there is not the slightest chance that, barring some entirely unexpected accidents, they will not be ready for work on Monday morning. I mention these things not because I am unwilling that Elmer should accompany his family to the game, but because I want you to realize that the difficulties in Elmer’s work do not every one of them arise from his physical condition or from his backwardness. Admission into College is a businesslike matter, and demands the same devotion that any other successful business enterprise does.” Elmer was one of those young men, and there are many, who find it extremely difficult to get their attention down to work, if there is any cause for emotional excitement. Many young men find it impossible to think of aught else than the coming football game or the social engagement for some future evening. It is only after adult life has been reached that engagements which excite considerable emotional interest cease to have this effect upon the attention. In Elmer, this emotional distractibility of attention was combined with a temperamental tardiness. The tardy boy or adult is one who lets the interest of the moment prevent his looking forward and arranging for the next piece of work on hand. Elmer was supposed to be 011 hand for his lesson in English at nine o’clock, and to work for forty-five minutes, which gave him a fifteen minute intermission before taking up the work of the next period. E1*0111 November 30tli to December 20th, inclusive, there were seventeen working days, which gave him 765 minutes of work. During this period he lost, through absence and lateness, 399 minutes, more than one-half of the time. The following record of these days is an instructive and not uninteresting document:?
Date. Time of Arrival. Record of Recitation. Nov. 30 9.47 Too much Thanksgiving. Dec. 3 9.07 Interested in “The Rivals.” 4 11.30 (30-minute Still interested. Play read aloud. Mistakes period by his of Mrs. Malaprop underlined, and conjectural arrangement.) emendations made in margin. 5 9.23 Writes in class a paragraph headed “My Impressions of Mrs. Malaprop,” in which he confounds that matpon with Lydia Languish and writes about her. G 9.26 (stormy.) Given same subject for outside work. Composition not done?forgotten. Writes in class again on Mis. Malaprop. Forgets entirely what her chief distinction to fame is. When her misuse of words is suggested, says, “Oh, yes.” ” 7 9.02 Recitation satisfactory. ” 8 Absent (train stalled). ” 10 9.15 Composition,poor; misspells afraid, “busy, copy, door, floor, scio, sour, sugar, xvliom. ” 11 9.20 Composition not re-written on account of headache. ” 12 9.10 Work incomplete,?not feeling well. ” 13 Absent (machine breaks down). ” 14 9.15 Good composition. Writes out Browning’s “Incident of French Camp” in his own words. ” 15 Absent. ” 17 Absent. ” 18 9.10 Good composition. Reads “King Robert of Sicily” and writes story of same. ” 19 9.15 Examinations.
20 9.1G Finishes “The Rivals.” Reads unintelligently. The physician who was overlooking the care of Elmer’s health, considered him to be in good condition. He believed that he needed exercise only as all young men need it. He inclined to look upon his difficulty as one entirely due to lack of early training. He told me that he had known a number of sons of the very rich, some of whom had succeeded in getting through college, who had exactly the type of mind possessed by this young man. His fatigue he attributed entirely to the strain that was put upon a mind incapable of endurance through lack of training. This view makes the case all the more interesting and instructive. If his deficient powers of attention and memory were due solely to lack of home and school training, the case becomes a purely psychological and pedagogical one. We have to do with a young man of twenty-one who has the powers of attention of a boy of’ six or seven. If we should ask a boy of this age to attempt the work that we were forcing upon Elmer, he would undoubtedly soon show signs of fatigue and he would manifest this in aprosexia and in periods of mental torpor. Through the study of this case, I am inclined to lay greater stress upon the lack of proper mental training than upon the symptoms of physical deficiency, the adenoids, etc. But I do not feel that I am warranted in excluding the physical factor entirely. Despite the medical opinion, I think there is reason to believe that the boy was physically below par and that he needed outdoor exercise to put him in condition to resist fatigue. I was also very careful of his diet, and insisted upon his eating a satisfactory lunch and taking a sufficient amount of time to it.
Another difficulty, resulting in passive resistance, was the lack of ambition, especially the ambition to excel in intellectual work. He had no real desire to enter college. Life for him was a series of trivial amusements; he did not participate keenly in even his father’s ambition to have him enter College in order that he might become a member of the various social clubs. Neither thought of college as an educational institution. To inspire the youth,?sugar-coat the pill,?college was put before him, in Dr Butler’s words, as “an agreeable country club, where one takes his valet, his polo ponies, liis bull dog, his motor car.” During the Christmas holidays, in an interview with the father, at which time my suggestions for the pedagogical treatment of the case were passed in review, I found occasion to distinguish between getting an education and getting into college. If the father had wished his son educated, I should have recommended an entirely different procedure. I would have outlined a two years’ course at least. lie would havo been kept on elementary language work in English for at least a year before the attempt was made to prepare him for his entrance examinations. This procedure would have ensured an education as well as entrance to college; but it was not for this that my advice had been sought, and I continued to direct my efforts to planning his daily life in such a way as to give him the best possible chance of passing the examinations in enough branches to admit him to college with the least number of conditions.
It was agreed that the boy should take up his residence at the school, where his whole time, his meals, and his sleeping hours, would be under tho supervision of his tutors. With the beginning of tho new year this plan wont into effect, and he entered upon the long pull of the spring months under as favorable conditions as I could obtain for him. Even the distracting interest in his automobile abated, and the machine was shortly afterwards sold. In May, when I again visited the school, I found that all of his tutors felt more hopeful of his ability to pass the examinations. It had proved necessary, however, to give up the attempt to prepare him in Latin, but in English ho was reported to have made great improvement in sentence structure and expression. Ho seemed to have a wider intellectual outlook and greater power of choice in the material used for his compositions. He got more vivid impressions, got them more quickly, and acted upon them with more independence. Without exception, his instructors believed that he would he able to pass the examinations for which he was studying, provided he did not become nervous and lose his head. He appeared to be in excellent physical condition. I feared only that he might approach the examination period in a condition of reduced mental vigor; I dreaded the panic,?almost collapse,? which preceded the previous examination.
The point of view of the psychological trainer and that of the professional coach differ on this important question. The coach is interested in getting as much work out of the boy as he possibly can. As the examination approaches he expects him to sit up late at night and study harder; he arranges extra hours of special coaching; the last week before the examination is a period of great activity. During the examinations, every hour not spent in the examination room is given over to preparation for the next examination. I insisted upon the importance of refraining from this strain upon Elmer’s energy, even to the extent of suggesting that if he fell into a state of fatigue a week or so-before the examinations, he was to be allowed to drop everything and go into the country. I felt it would be safer to risk his taking the examinations without the last finishing touches which the coach always considers so important, than to risk his coming up for the examination overtrained and worn out with anxiety and extra work. I carefully outlined a daily plan to be followed during the examination week, and I strongly advised that he be given no coaching on the days on which he was to take an examination. To accustom him to the ordeal of the examination, he had during the year passed several sets of regular examination papers under conditions approximating those which obtain at the real test.
I saw Elmer again on the first day of the examinations. It appeared to me that despite the care that I had taken to warn his tutors, he approached the examinations in what seemed to be a rather poor physical condition. They all denied this, however, and still believe that he entered upon and passed through the examination period in the best physical state. He did not appear to have the same fear of the examination room, and I observed no sign of panic, no physical collapse. Our work with him during the year had been effective on this point. The result of the examination was a lamentable failure. He passed in only one branch (elementary algebra). In advanced French he got a higher mark than in elementary French, and in English his mark 172 THE PSYCHOLOGICAL CLINIC.
was lower than it had been the year before. To his coaches the reason for this?and perhaps they are right?appeared during the months of April and May in a gradually increasing interest in the construction of a boat. Scarcely a day passed, I was told, that he did not write a letter of instructions, lie left the school on visits to the boat builder; and on one occasion he went to his home from Friday to Monday without even notifying the headmaster of the school that he proposed to go. Instead of working harder as the examinations approached, he made less effort and seemed to care less about succeeding. However this may be, I believe that his instructors erred at the beginning of the year in thinking that he could be made to pass the entrance examinations as the result of a year’s work.
It would not surprise me if my analysis of the interdependent social, psychological, and physical factors involved in this case should provoke entirely opposite conclusions. Viewing this history from the educator’s standpoint, many will find in Elmer only a common type of difficult case, the boy of normal mentality, whose failure is due to lack of interest in his work. This conclusion would overlook the psychological characteristics, which, as I have shown, border on the pathological. Those who arrive at the opposite conclusion, that there existed a congenital mental defect which no amount of training could overcome, would also fail of a right understanding of the case.
In my opinion, the history shows that we have to do with a child, mentally and physically normal at birth, endowed with mediocre but not deficient intellectual capacity,?enough, at least, to enable him to hold his own in school and college. We find this child at the age of twenty-one with insufficiently developed intellect and character. The adenoids were his only physical handicap to normal development. Their tardy removal at the age of nineteen left him with a susceptibility to fatigue, and doubtless also contributed to the mental retardation which he manifested at the age of twenty-one His history would probably have been different had they been removed when he was twelve or thirteen years old. However, the failure to remove them earlier in his career was not the only cause of arrested mental development. I have emphasized as a cardinal mental symptom, the fluctuation of his attention due to inability to sustain and concentrate it. Some fluctuation of the attention is found in every adult normal mind. In Elmer, its pathological character appeared in the extremely short period during which concentrated attention could be sustained. This type of attention, i. e., aproscxia, is not only characteristic of adenoids, but also of the normal child in tlie first years of school life. Elmer’s aprosexia may therefore rest upon the physical basis of the adenoids, or it may be considered a symptom of infantilism,?an arrested mental development due to lack of adequate home and school training. This latter interpretation is supported by the fact that his attention in other respects resembled that of the yet untrained child. He was unable to get his mind down to his work, or to keep it there for any length of time; he continually thought of other things, notably future engagements. If we succeeded in keeping him at a task, a pathological fatigue ensued, from which there was no immediate recovery. An hour or two of work would cause him to fall into a condition that suggested mental stupor. In this condition he appeared to lose clear consciousness and followed a lesson with acquiescence but with no active co-operation. In exaggerated form it became mental confusion, or a lapse of memory, perhaps even of consciousness. In doing a problem in mathematics, he might carry out the work correctly and intelligently up to a certain point, when an entirely wrong number would be set down, despite the fact that the right number stared at him from the page. The error is one which a teacher is apt to attribute to carelessness op “not thinking,” but is probably due to a momentary lapse of consciousness, or at least of memory, and is a phenomenon of fatigue. Another symptom of doubtful import is the amnesia verbalis, which showed itself in the inability to remember the names of persons and places and to acquire an accurate knowledge of orthography and syntax. He could not convey a simple thought in a succession of sentences properly formed and correctly spelled. This condition may rest upon a congenital and incurable defect of the brain; it is found, however, in so many children who are subsequently trained out of it, that I believe we must assume its survival in a boy of twenty-one years to be due to neglect of proper training in the early years of school life.
There is little necessity for hesitation or doubt in forming an opinion as to the cause of his repeated failures to pass the college entrance examinations. These were due to faulty educational methods, or perhaps more correctly to defective educational ideals and insight. The last two failures were each made after a year of the best coaching this country can afford. The instruction, however, was unintelligentlv applied to a case unfitted to profit by it. Instead of attempting to prepare him for college in one year, a course extending over two or three years should have been outlined. I am convinced that at any time after he had passed his fifteenth year he could have been prepared for college in, at the most, three years. Probably it would have been necessary to take liim from his social environment and place liim in a school, perhaps in a camp school, where he wonld have been under constant medical, physical, and educational supervision. His coaches cannot be blamed for failing to appreciate the complex character of the educational problem which presented itself in this case. ]STor can they be expected to educate the parent as well as instruct the boy.
Secondary schools, however, which are supposed to educate their pupils, as well as prepare them for college, must in time be expected to have a professional opinion which will be accepted in these cases as authoritative. Their convictions of what is necessary for the acquisition of proper mental discipline must be expressed even in the face of a rupture with socially powerful and wealthy families. The situation presented by this case is not unique. Two boys for whom I recommended this fall a camp or farm school, both at the critical period of from fourteen to sixteen years, both mentally retarded, and one presenting moral symptoms, are, despite my opinion, the one at a fashionable city preparatory school, the other under a private tutor. The training of such powers of attention as are necessary for intellectual work is the peculiar task of the secondary school. The school, however, cannot adequately fulfil its function unless the child comes to it disciplined to some extent in mind and conduct. In some families, that training of the child’s will, which is to serve him in good stead during his school life, begins as soon as the child is born. In others, the child is turned over to servants, governesses, tutors, and schools that fail to impress upon him the serious nature of school work, with the result that he advances from year to year with no strengthening of the will and attention, no habits of industry, no established ambitions toward an intellectual career. There is reason to believe that a large number of children, without any congenital or acquired physical defect, arrive at maturity with imperfectly developed faculties. This retardation or arrest of development may occur in children as well of very rich as of very poor parents and may in either case result from neglect originating in the exigencies of the parents’ social environment. A child may be provided with expensive tutors, or sent to schools of the highest reputation, but this may not save him from retardation if the home training has failed to establish a mental and moral character that will enable him to profit by these opportunities.
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