Association Tests in Practical Work for the Insane
- Author:
Claea Harbison Town,
Resident Psychologist, Friends’1 Asylum for the Insane, FranJcford, Pa.
Psychological methods of studying association have been widely used of late to render practical service in the clinical examination of the mentally abnormal. During the last three years we have subjected the various methods to a thorough test in the examination of our patients, with most interesting and, we feel, quite valuable results. The tests have proven useful, not only as a method of securing material for a study of the association processes employed by the insane, but also as a means of uncovering those hidden thoughts and feelings, a knowledge of which is a necessary prerequisite to a sympathetic understanding of the individual mind and therefore to successful therapeutic treatment. Absolutely nothing can be done toward establishing a saner point of view in a mind which has lost its true perspective until the physician actually understands the baffling perplexities which have perverted the onetime normal mind of his patient. Such an understanding has more than once enabled us to build up in our patients’ minds the power of recognizing hallucinatory voices at their true value, and this recognition was followed by a determined and successful effort on their part to overcome the voices by methods of mental discipline suggested by us. It is this adaptibility of association tests to the study of the insane as individuals rather than as insane types that I wish particularly to discuss. There are two general forms of verbal association tests in use by psychologists, each of which is capable of, and has been subjected to, various modifications. The first is the association reaction introduced by Galton, 1879, where a word is called out by the experimenter or presented visually, to which the subject responds as quickly as possible by pronouncing the first word which occurs to him after hearing the stimulus word, the time being recorded by the experimenter. In Galton’s experiments the first two associations were recorded and timed. A long list of such reactions are taken, the numbers varying with the experimenter; for instance Galton took 75-, Jung takes 100 and Scripture 25. The second method secures a series of written words thought of consecutively by the subject after stimulation by a spoken or written word. The length of the series varies with different investigators, some requiring 5 words, others 100 or more. Much has already been written pointing out the value of the association reaction method as an aid in the study of the individual mind. Galton himself writes of his results, “They lay bare the foundations of a man’s thoughts with curious distinctness and exhibit his mental anatomy with more vividness and truth than he would probably care to publish to the world.” Jung has modified the original method both in procedure and in treatment of results, and this modification he believes renders it capable of detecting not only individual thought tendencies but also differences in the accompanying emotional tone. This he accomplishes by interpreting the variations in the association reaction times in terms of emotion. He believes that unusually long reaction times indicate the presence of some emotional complex either directly associated with the stimulus word, to which the response is delayed, or with the immediately preceding stimuli or responses. Sometimes he claims several consecutive reactions are lengthened by the effect of one emotionally-exciting stimulus. His modification of procedure consists in a repetition of the series of reactions Upon its completion, the subject being told to respond as before with the first word of which he thinks, but to give the same word as at first, if possible, A failure to repeat the original response to a word Jung finds indicative of the presence of an emotional complex. Moreover, he finds in his results a correlation between such lapses of memory in the second series and lengthened reaction times in the first. The slight lengthening of the time indicative of an emotional complex is supposed to be beyond the control, and in many instances beyond the knowledge, of the subject.
Jung believes himself able by this combination of association reaction and memory test to detect not only emotional complexes known to the subject, but also such complexes of which the subject himself is quite unconscious but which, nevertheless, according to Jung, Freud and Janet, exert a powerful influence on the mental state of the individual. The conscious realization and actual verbal expression of the submerged emotional complex is thought by Freud to be of great value in the treatment of hysteria and by Jung the effect is believed to be beneficial in cases of dementia prsecox as well. To obtain this conscious realization of the details of the complex, however, the association test must be supplemented by the use of the analytic method of Freud. The association reaction gives the clue which points out that such a complex exists and must be brought to the surface; by the Freud method this is realized. Whether we subscribe to the theory of subconscious mind or not, we cannot but recognize the usefulness of any simple test which will help us to penetrate to the carefully guarded secrets of the conscious mind. In the examination of the insane, especially paranoiacs who wish to conceal their true state of mind, such a means of gaining information, if accurate, cannot be too highly valued.
Our experience in using this method with our patients has convinced us, however, that although the presence of emotion often does cause a lengthening of the reaction time, there are other factors of quite a different type which frequently result in just as pronounced a lengthening. Many of the insane are so absorbed by insistent ideas, delusions, and hallucinations that the stimulus word makes little impression on their conciousness; they are aware of it in a vague sort of way but only react after a long interval. The delay, however, is not due to any mental process awakened by the stimulus but to the effort required to detach themselves from their all-absorbing mental preoccupation. This condition was noted especially in the acute hallucinatory stage of dementia prsecox Other patients have lost all power of concentration, any trivial impression suffices to distract their thought, and such distraction very frequently results in a much delayed reaction. Thus subjective and objective conditions entirely unrelated to the stimulus often produce abnormally long reactions. One patient unwittingly endorsed Jung’s theory by remarking, “When you say anything that refers to my home, my mind seems to be a blank for a few moments.” Others, however, responded very promptly to words which I knew aroused them emotionally and more slowly to those which they evidently received with the utmost indifference. These short times were undoubtedly due to the fact that the stimulus aroused a line of thought intense and near the surface, while the long ones were the result of directly opposite conditions, an uninteresting, non-inspiring stimulus word.
Another form of test, a modification of the second general method described above, has proven much more useful in our work with the insane. This greater success is largely due to its complete freedom from external control or suggestion which makes it an ideal medium for self-expression. This method, which is one used by Doctor Witmer, aims to study the associations of a subject as exASSOCIATION TESTS. 279 pressed in his thought during fifteen consecutive minutes. The subject writes a list of words during this period. lie is told to write as quickly as possible whatever words occur to him, suppressing none and exercising no discrimination. No stimulus word is given to initiate the train of thought, even that being left to the free play of the subject’s imagination. The value of such a list depends in large measure upon the close attention of the experimenter to conditions surrounding the subject as he writes. He must know just what words are suggested by sounds, by objects in the immediate environment, or by any other transient conditions effecting the subject’s consciousness. After the list is complete the experimenter goes over the words with the subject in order to gain all possible light on those associations which may not be clear to him. Such lists furnish rich material for the study of the associative processes, of the quality of thought content, and of fatigue. Our results along these lines will be reported elsewhere ;* here I wish only to emphasize the value of the test for the study of the actual mental content of the individual patient.
For this purpose the words of such a list are arranged in several classes, those suggested by the immediate environment, by personal experience, by subjects of study, by the world environment; names of objects, concepts, proper names, and words without thought content (connectives, etc.), classified simply as parts of speech. Each of these classes is minutely sub-divided, so that after analysis we know exactly what proportion of words were suggested by visible objects, sounds, odors, etc.; what proportion referred to history, botany, etc.; what proportion related to home, social life, etc.; to animals, flowers, food, drink or other world objects; to emotion, religion, art, etc.; the proportion made up of names of self, relatives, noted people or places; the proportion of adjectives, conjunctions, etc. The actual dominance of any distinct line of thought is by this analysis immediately discovered; if a large proportion of words refer to religion, to business, to some personal experience, or to self, light is at once thrown on the mental content. Such lists taken at intervals in the progress of a disease serve to show when certain tendencies of thought are losing their hold and others developing. The list of one patient contained a remarkably large proportion of words pertaining to religion, and also a large number referring to herself. A second list secured after an intermission of some months showed a decline of the religious fervor, while the egoism still remained. *”Experimental Studies in Psychology and Pedagogy,” No. 4, 1909, The Psychological Clinic Press, Philadelphia.
A patient whose mind is much occupied by some idea or group of ideas, is, as a rule, unable to write for so long a period as fifteen minutes without using some words indicative of those ideas. In many instances the patients lapse into sentence form and write fragmentary records of their mental experiences. Patients who are habitually reticent and who divulge nothing even when questioned often lack the control necessary to avoid doing so in the course of such a test. They lose the idea of the purpose of the writing and write for themselves, expressing what they feel. I have had a patient look up while writing her list and say, “I am talking to you now”, and the words she wrote proved to be a personal confession. One patient who was passing through a silent engrossed state in which she said little and appeared to casual observers almost normal, wrote a list which, beginning with her own name and address and the names of several towns in which she had lived, launched out after the first five minutes into the expression of the belief that she had died the previous spring and had been raised from the dead, that since that time she had died and been raised four times, that she is at present engaged in saving souls, that she saved one hundred and seventy on the previous night, that she was the mother of one hundred and twenty-five children, etc. Having written so much she was for quite a while willing to talk and enlarged greatly on all that she had written. It was impossible to gain much information about this patient by the Jung method. Her longest reaction, following one of average length, was that which measured cat?dog, while words which evidently did effect her emotionally met with a more prompt response. Her mind was so engrossed by her thoughts and emotions that words in line with them evoked a quick response, while other words received little attention and resulted in slow reactions.
From another list written by a patient suffering from melancholia one could build up the picture of a hopelessly sad woman who had passed through some great trouble, who was tortured with regret and self-accusation, who believed herself possessed by some evil spirit and destined never again to see her home, who thought herself incapable of affection and yet who, in reality, mourned and longed for her family. There was not a word in the entire list of eighty-two words which did not refer to her own condition or its .cause; and not an idea or delusion of all that persistently haunted her but was expressed therein.
Another woman in a greatly confused, delusional state, wrote a long list in which references to her home, husband and family abounded, and in which she expressed certain peculiar delusions in regard to colors and to sin, betrayed auditory hallucinations by recording what the creaking shoes of a passer-by said to her, and wrote of her own condition and fear of becoming insane.
One woman, reserved, evidently from a fear of the consequence of speaking out, wrote a list of one hundred and seventy-six words in which the name of a certain man appeared forty times, the word man thirteen times and in many other words referred to the same individual. This was the first intimation she had given of the presence of any such complex.
In another list the following group of words appear: “Occult, astrologer, necromancer, clairvoyant, slate, write, pencil, think, Dr Ilyslop, book, dreams, thoughts, mind, reason, art, mind, intellect.” The writer had read Doctor Hyslop’s book and had been greatly impressed with his ideas. She had subsequently tried to develop occult power in herself and had succeeded in receiving mysterious messages on the slate, and also without it in states of passive reverie. She encouraged this state of mind to a greater and greater extent until she reached the point where she would sit up most of the night engrossed by the mysterious thoughts which came to her. Finally she completely lost control of her mind. Many more examples could be quoted, but enough have been presented to demonstrate that in this method lies another means of discovering the actual mental condition of our patients, a means that is often adapted for use in cases where certain mental complications make the Jung method valueless. The Jnng method, on the other hand, can sometimes be used satisfactorily with patients whom it is impossible to induce to write. In using the Jung method with the insane, however, too much significance must not be attached to the length of the reaction. Long reactions due to preoccupation or lack of interest in the stimulus word must be carefully distinguished from those due to the presence of an associated emotional complex.
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