The Borderland Between Feeblemindednesses and Insanity
- Author:
Clara Harbison Town, Ph.D.,
Director of the Department of Clinical Psychology, Lincoln State School and Colony, Lincoln, Illinois.
In discussions concerning the various types of insanity frequent mention is made of borderland cases. Such borderland cases are individuals in whom some psychosis seems to be potentially present though not completely evolved, individuals who on the one hand are not quite normal, and who on the other hand are not quite insane. In discussions concerning the feebleminded conditions mention is also frequently made of borderland cases. These borderland cases are individuals who just miss normality, individuals who are able to read and write and do much work with ability and dexterity but who never reach the intellectual level of their social class, who are always at a disadvantage in their dealings with others.
Cases of insanity occurring in feebleminded individuals are also often reported; but in these cases the insanity is a discrete condition added to the feeblemindedness.
Feeblemindedness and insanity are by definition absolutely distinct conditions, feeblemindedness being the result of defective mental development, and insanity depending upon aberrant mental functioning occurring in an individual of any degree of mental development.
This absolute division between insanity and feeblemindedness is at the present time being carried even into the field of heredity.
We have become accustomed to the thought that the neurotic diathesis is the inherited feature, and that extraneous conditions determine what form of neurosis, psychosis, or defectiveness manifests itself. Another possibility has been suggested, however, by the recently published pedigrees of feebleminded children, epileptics, and insane.1 These pedigrees strongly suggest that similar defects run not only through fraternities, but also through succeoding generations of such families. Epilepsy and feebleminded?C. B. Davenport and David F. Weeks, M.D.: A First Study of Inheritance in Epilepsy. Eugenics Record Ofllce Bulletin No. 4.
Henry II. Goddard, Ph.D.: Heredity of Feeblemindedness. Eugenics Record Office Bulletin No. 1.
Ilenry A. Cotton, M.D.: Some Problems In the Study of Heredity in Mental Diseases. Eugenics Record Office Bulletin No. 8. A. J. Rosanoff, M.D., and Florence I. Orr, B.S.: A Study of Heredity of Insanity in the Light of the Mendelian Theory. Eugenics Record Office Bunetin No. 5. ‘ ness occur frequently in the same families, but insanity is comparatively rare in the families where feeblemindedness predominates. In the light of the Mendelian principles feeblemindedness and epilepsy seem to behave similarly as hereditary factors, and insanity to follow a different course. Dr David F. Weeks2 writes: “It will be seen from the present evidence that epilepsy cannot be considered as a Mendelian factor when considered by itself, but that epilepsy and feeblemindedness are Mendelian factors of the recessive type, in that their germ cells lack the determiner for normality, or are nulliplex in character, while the tainted individuals, such as neurotics, criminals, sex offenders, etc., are simplex, and the normal duplex or simplex in character.” Mr. C. B. Davenport and Dr Weeks3 write: “Three matings (insane with feebleminded or epileptic) yielded 19 offspring of which 15 grew up and are known, of these 9 were normal, 1 epileptic, 4 feebleminded, and 1 neurotic. Here apparently insanity and feeblemindedness are not due to the same missing factors, and so some normal children result.”
In spite of the chasm which is daily growing wider between the scientific conception of feeblemindedness and insanity, there is a group of cases, which it is the aim of this paper to define and which may be considered as occupying the borderland, not between insanity and normality, nor between feeblemindedness and normality, but between insanity and feeblemindedness.
A typical example of this group is a little boy, nine years of age, who was brought some years ago to Professor Witmer for special training. It was my privilege to carry on the training for several months and my opportunities for observation were of the best.
He was a delicate, supersensitive boy, much too childish for his years, and of a confiding, loving nature. He was a marked contrast to that type of feebleminded child whose reactions are prompt and dependable up to a certain level and then cease,?that type whose abilities can be accurately guaged. He on the contrary impressed one as having much more mental ability than he could command. Though quiet and inert most of the time, he would occasionally surprise one by a remark indicating a high degree of intelligence. Though his speech was marred by an infantile stammer of a severe type, he formed complicated sentences and used the longest words without hesitancy. His most striking char2 David Fairchild Weeks, M.D. The Inheritance of Epilepsy. Problems in Eugenics, page 78.
3 C. B. Davenport and David P. Weeks, M.D. A First Study of Inheritance in Epilepsy. Eugenics Record Office Bulletin No. 4, page 10.
acteristic, perhaps, was lack of volitional ability. Left on the porch to play, he was found ten minutes later standing in the identical attitude; on another occasion he was standing with a group ot people on a country road, as an experiment the others walked on without the usual “come on Johnny,” and the hoy stood just where he was, until some one went back for him. He would also sit at table without eating until started by a word of suggestion. The least suggestion was sufficient, but it was absolutely necessary. In regard to some other acts, suggestion did not have so desirable an effect, producing on the contrary marked negativism. Asked to touch his eyes and mouth he would do so; asked to touch his nose his hand would start in the right direction but reach perhaps the cheek or chin, never the nose. When questioned the boy would say that he had been asked to touch his nose, would agree that he had not done so, tears would fill his eyes, but the negativism would persist. When asked to lie down on his back, he would lie on his face. Even the promise of candy did not help him to stand on his toes at command; instead he stood on his heels. When told to touch with his tongue a stick of candy held a little to the right of his mouth, the perverse tongue would twist around toward the left. The child showed real distress, but seemed utterly unable to cope with the situation. This negativism varied from time to time and did not apply to all movements alike.
When directed to make unaccustomed movements, if negative movements did not occur, there was usually an inability to produce the movement from direction or imitation, an apparent lack of volitional motor control. The idea of the movement did not seem to be directly associated with the movement. Each new movement had to be passively performed for him daily, in some instances for weeks, before the volitional control was finally established. That this condition was not the result of mere lack of power of coordination was shown by the fact that very complicated movements were made quite easily at times when the child lost selfconsciousness in action. Though he failed to stand on his toes at command, he was a sure footed climber over rocky hills, and was one day seen carrying, quite successfully, a large rocking chair up a long flight of porch steps because he thought that one of his teachers would like to sit in it.
There was clearly a defect in volition, showing itself in a lack of initiative, negativism, and poor volitional control. An allied condition was a marked echolalia. This was not the echolalia normal to an early stage of language development, that echolalia which occurs on account of the poverty of ideas and vocabulary and which aids in the amassing of both. In language development the boy had long passed the echolalia stage, his vocabulary was large and possible associations were many. His was the echolalia which occurs when the attention span is limited to a very narrow, chiefly sensory sphere, when in consequence, the incoming impressions arouse no apperceptive mass and lead to no reaction other than a verbal expression of themselves,?the mental condition which obtains in the hyper-suggestible state. There was in addition emotional instability. The child would at times become excitable, emotional and cry easily. At all times he was intensely sensitive, but there were periods when this would be greatly increased. He was of a very loving disposition and much more constant that most children. A long separation made no difference, he did not forget one individual for another. Left to himself in a class room with a couple of other children he absorbed much of their instruction; he memorized many little verses by listening to the others recite them. At such times there was no negativism to overcome and achievement was easy.
The inertia, the negativism, the lack of volitional control, the echolalia, and the emotionalism all increased under any excitement, any conditions producing self-consciousness or demanding increased attention. At the close of a summer’s training when the symptoms were much less pronounced, an unusual excitement brought them all back in full force. At such times the initial confusion led to a distinct narrowing of the attention span; the higher apperceptive processes and with them of course volitional control were for the time in abeyance and a state of hyper-suggestibility induced, in which all reactions were either positive or negative responses to sensory impressions, unmodified by apperceptive activity. Echolalia and either negativism or stupid helplessness reasserted themselves. This group of symptoms, inertia coupled with a suggestibility expressing itself in both echolalia and negativism, is of course familiar enough in dementia praecox. It is by no means a complete picture of dementia praecox; and is, moreover, accompanied by such distinctly feebleminded symptoms as extremely defective articulation and infantilism. Children like the one described are in practice included in the feebleminded, not the dementia praecox group.
The symptoms described are, however, clearly dependent upon an aberrant functioning of the will and the emotions, or in other terminology, of the processes of apperception and emotion, which processes at time function normally, and therefore they can scarcely be differentiated from insane symptoms. As they manifest themselves so very early in the child’s life and interfere so gravely with its mental development they are considered developmental defects. Are they developmental defects, or are they insane traits appearing so early as to interfere with the normal progress of the the intellectual life ? In either case they point out the complexity and diversity of the feebleminded condition, and suggest that the study of feeblemindedness from the Mendelian standpoint may prove to require the conception of many unit characters instead of one. Such children do not form a very large percentage of the children at the Lincoln State School and Colony. Among 450 I have found but seven. One of these is a girl of seventeen who has never developed beyond the high grade idiot type, with a mental age of two. She talks much, distinctly, and in well formed sentences, but never in the first person unless much annoyed, when she swears a little. She never speaks to express a desire or a thought and never in response to any environmental condition. Her talk consists entirely of the repetition of sentences which have been addressed to her or spoken in her presence at some time in the past. At times two persons take part in this repeated conversation, the tone of voice and emotional expression of each being reproduced as accurately as are the words. No remark of her own is ever contributed. When addressed she makes no reply, but if one lingers near for a little while, he will hear his words repeated perhaps with a change of a word or two. “There goes a car down the road” was reproduced “There goes a cake down the road”; the command “Say,?1, 2, 3, 4, 5,” was later repeated in full?”Say, 1, 2, 3, 4, 5.” Her thought is altogether autonomous, and is auditory and kinaesthetic in character. None of these seven cases has developed intellectually beyond the age of six years. Such children are little understood in institutions ; they are the despair of their teachers who find it quite impossible to train them by the usual methods. The attempt to do so is soon abandoned and the children placed in a custodial ward where they give little trouble, being allowed to sink into the coveted apathy and inertia.
These cases do not present the usual picture of feeblemindedness, nor do they present such a picture with a later grafting of insanity, neither do they typify the insane child; they present the picture of defective, incomplete development, complicated from the very beginning by an aberrant functioning of certain mental processes still in course of development, which aberrant functioning doubtless interferes greatly with the developmental process.
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