Children with Mental Defects Distinguished from Mentally Defective Children
The Psychological Clinic Copyright, 1913, by Lightner Witmer, Editor. Vol. VII, No. 7 December 15, 1913
- Author:
Lightner Witmer, Ph.D., J
University of Pennsylvania.
A few weeks ago I saw at a college preparatory school a boy eighteen years of age. This school has a four years course, of high school grade. The boy was in the second year of this course, excepting that he was not taking the prescribed foreign languages. He had done so poorly in Latin the year before, that the school authorities had decided it would be inexpedient to attempt to teach him a foreign language. When I asked the head of the educational department to rate the boy, he told me that he was by no means the worst boy in the school, and that every year they had boys of an inferior grade of mentality and scholarship. He could not assign his rank more closely than to say he was among the poorest 25 per cent.
This school is one of the best military academies and preparatory schools which I have ever visited, and has shown its progressive modern spirit by taking into its employ, this year, a trained man as consulting psychologist. The psychologist, who had already tested this boy and most of the other boys in the school, asserted that the closest rating he could give the boy was to place him among the worst 20 per cent.
I think we may therefore assume that this boy is a normal boy. In every other respect than in school progress, his behavior has always been that of a normal boy; and yet four years ago when this boy was first brought to me for examination, he could not read without many gross errors a single sentence in a child’s first reader, such as is employed with children of the first school year. His errors, however, were of a kind which did not show deficient intelligence. He might read a sentence like “I saw the hen,” as “I saw the duck.” He might even read it, “I was the boy.” Intelligent substitutions characterized much of his reading. Where such sub stitutions could not be made, owing to the words being somewhat more difficult, the word which he gave would often have not the slightest resemblance to the word on the printed page, or to any English word. Naturally he was unable to read for himself, for pleasure or profit. He liked being read to by the hour, and enjoyed books of history, etc., such as a boy of his age might be expected to choose for his own reading. During the previous year he had been in the fifth grade, i.e. the fifth school year. At fourteen he should have been in the eighth or at least the seventh school year. His school standing, therefore, showed two or three years of retardation. In fact he had not progressed in reading beyond the first school year, and at fourteen years was at the educational stage of many a child of seven. His spelling was as deficient as his reading. Figures 1 and 2 exhibit the character of his work. The first specimen is a portion of a letter written June 27, 1909, from Nova Scotia, where my summer school was located. He had entered the school June 1st, so that the specimen shows about what he was able to produce in the shape of a letter at the time of his admission to the school. As it is scarcely possible to make out his meaning without knowing what he intended to say, I give this portion of his letter as it should have been written.
“C , Nova Scotia, June 27, ‘09. “My Dear Mother: “Please excuse the blot on the paper. I am going to go in swimming today with Dr Witmer and the two other boys. We have been in before. And will you ask B to get together all the sixth grade school books and send to C , Nova Scotia, in care of Miss R at the Larder Cottage. Please do for your son’s sake. Write soon and tell me how B , J , C , father and yourself are.”
The second specimen was produced July 19th, after a month and a half of training. A number of sentences had been given him to study the day before. He was supposed to have learned the spelling of each word and the position of the words in the sentence. He was given the words at dictation, and also the sentences as units were dictated to him, each word and sentence being given once. One of these sentences was “We are going for nuts when they are ripe.” What he actually put down on the paper is shown in figure 2 on the following page.
I frequently see children?but not usually so old as this boy? who are deficient in written work, the deficiency being due to inade176 THE PSYCHOLOGICAL CLINIC. quate school training. Careful examination showed that the deficiency in this case was due to a language defect, psychologically a defect of memory. The two parts or phases of memory were involved. There was both a weakness in retaining new impressions and a weakness in the recall of impressions which had been received and partially retained. The examination and history of this case clearly demonstrated that we had to do with a case of congenital amnesia, limited however to the language sphere, hence properly called congenital visual asphasia or word blindness.
Further examination revealed an equal amount of articulatory ?aphasia. It was oftentimes very difficult to understand what he said. I thought at first that coming from the South he was showing the effects of imitating his negro caretakers, but in many respects his articulate language was worse than even a negro would employ. Moreover he was word deaf, as well as word blind, and as he had no definite trouble in the motor area, having satisfactory coordination for a boy of his age, and good muscular control, I would assume that the auditory aphasia or word deafness was primary and the articulatory aphasia a resultant.
In other words the case was one of a specific language defect, involving all three of the modes of language,?a general amnesia verbalis, or aphasia. This defect was not associated with any other mental or physical defect, excepting that the boy was somewhat small for his age, although not unusually small; that he had adenoids which were removed with considerable improvement to his health but no noticeable effect upon his language defect; and that he was somewhat lazy or languorous, but probably no more than we have a right to expect of a southern boy,?certainly no more than his older brother has shown, who has succeeded in getting into college. The boy undoubtedly has a neuropathic inheritance, which manifested itself in frequent migrainous headaches, but the tendency to these headaches was overcome through careful hygienic procedure during the two years and three months he remained in my professional care. Our educational problem was exactly similar to that of teaching a boy to sing who happens to have no ear for music. There can be no doubt that there are many otherwise normal persons who are totally tone-deaf. This in technical terms is congenital amusia. It is a mental defect. There is a much larger number of persons who are partially tone-deaf. Fortunately this particular mental defect does not interfere with a successful career in life, excepting that the tone-deaf are necessarily excluded from a musical career. But were society so organized that success in life in every sphere of activity were dependent upon a good enough ear to turn a tune, many persons who are now doing useful work in the world would have to be relegated to the class of imbeciles.
Congenital aphasia is a more serious defect to the individual, because of its social and industrial importance, perhaps also because a certain measure of language development is essential for accurate thinking. I do not believe that a case of congenital aphasia can ever do intellectual work of a high order, but I do believe that congenital aphasics can have useful and successful careers and pass muster as entirely normal persons. Owing to the social and intellectual significance of language, it is important to teach a congenital aphasic to read and write, although it is not of importance to teach a congenital amusic to sing. The latter procedure would be a waste of time and effort; the former procedure is necessary, especially if the child be otherwise intelligent enough to take his place as a fairly efficient adult in society.
Aphasia and amusia were first studied in the adult. They appear as the mental symptoms of a brain lesion, an injury to the local cerebral centres of language and music. Congenital aphasia and amusia, however, must not be supposed necessarily to be caused by a brain lesion, an injury to the child’s brain in the early years of life, at birth, or during uterine life. While it is doubtless true that brain injuries may produce aphasia and amusia in children, and if such injuries occur during uterine life the condition may properly be described as congenital, nevertheless I believe we must consider that congenital aphasia and amusia do not rest upon a pathological condition of the brain, but are indicative of a tendency to biological variation, appearing in the affected children restrictedly as a variation of the functional activities of language and music. Congenital aphasia and amusia are to be explained in biological terms, in somewhat the same manner as we should undertake to explain left-handedness in about two per cent of the race. I have given two examples of congenital mental defects,?congenital amusia and congenital aphasia, the latter serious so far as its consequences are concerned, the former a matter of indifference except as it may interfere with the happiness of the individual in expressing himself through music and song. There is another mental defect of this class, a congenital inability to acquire mathematics. This also is a defect of memory. I have not as yet been able to study individual cases as I have with aphasia. To prove that a child is congenitally defective in mathematics, expert training must be employed and the child must show himself unable to progress except moderately, despite this training. For example, the congenital aphasic with the consideration of whose mental condition I began this paper, was recently examined by me and found to be aphasic still. I was able to demonstrate some considerable reduction in word deafness, but the word blindness appears to be about the same as it was four and a half years ago. The very persevering and intensive methods of education have largely had the result of teaching the boy to read and write, to understand spoken language, and to articulate, despite the persistence of the mental defect. So far as social and intellectual importance is concerned, the mathematical memory stands in my opinion intermediate between the language and musical memories. I have not yet arrived at a fixed conviction as to whether it is of importance to endeavor to train a child lacking mathematical ability in mathematical subjects. I am convinced, however, that the mathematical faculty is sufficiently lacking in many cases, to warrant exempting high school and college pupils from taking these subjects, certainly as they are at present taught.
These three defects are all of them defects of memory and involve one mental function only. There are varieties of mental defects very different from these, some of them of great interest and importance. I pass over such obvious mental defects as sensory and motor defects due to infantile paralysis or other causes, and proceed to a group of mental defects of great interest to the psychologist and educator, affecting those activities which the modern psychologist calls instincts or congenital traits. These are group activities. To designate them, certain names have been employed, such as the sex instinct, curiosity, imitation, obstinacy, vanity, jealousy, conscientiousness, appropriativeness, lying, sociability, shyness, and many others. It is part of our inheritance, it is human, to possess these instincts or congenital traits. We ought to assume that the typical child or adult is possessed of all of them in some degree. In the well-balanced individual, i.e. the normal mind, they probably all serve a valuable orthogenic purpose,?in other words they are mental assets. In other individuals, they represent mental defects, as in the child who lies, or steals, or in the adolescent who indulges himself in what is commonly called “immoral” conduct. Intrinsically, however, they are not mental defects, for it is human, it is normal, for the child of a certain age to lie and steal, and for the adolescent to feel, even to yield to, the promptings of desire. These instincts or traits are present in different individuals in different amounts. Where an instinct becomes excessive, we are in my opinion justified in considering it a defect. The problem of training the child is very often the problem of curbing excessive instincts. Moreover, in the course of individual development, the instincts diminish in intensity of action and are inhibited and controlled by the growth of an intellectual and moral will. Stealing and lying are always mental defects in an otherwise normal child of fourteen to sixteen years, but are not necessarily mental defects in a child of from six to ten years. The unscientific mind inclines to regard certain instincts as good and others as bad. The love of truth is as much an instinct as the love of lying. The love of truth we look upon as an asset, lying as a defect. As a matter of fact, both may be assets and both may be defects. An exaggerated love of truth, over-concientiousness, “the New England conscience,” is a mental defect as much as is excessive lying. Lying often is inspired by the instinct to tell a good story, and those who unduly and too early curb the child’s imagination, even though it overflow at times into direct and palpable lies, may be helping to destroy a valuable asset of the child’s consciousness, one which may later constitute the foundation for a literary or otherwise artistic career. I do not assert that all traits of character must be assets if present in due measure. I do say that we must be extremely careful how we evaluate the instincts. Imitation is an asset of the greatest value, but it is often excessive, especially in children, leading to extreme suggestibility and consequent emotional and intellectual instability. Vanity, which the child is usually asked to eradicate as a fault, is often a mental asset to the child. I have known many children to make their first and most pronounced step forward in consequence of a judicious appeal to their vanity. If I have been able to make my meaning clear, it will be seen that I regard the child, for that matter the adult also, as composed of a number of traits, some of them assets if they favor normal mental development and success in adult life; some of them defects if they provoke retardation, arrested development, delinquency, and crime. There is no so-called normal person who does not possess some defects along with his assets. The type of child in whom I am especially interested and for whom I organized and am directing the work of the Psychological Clinic, is the child who possesses so many and such severe mental defects as seriously to interfere with normal development in the home and in the school, and to prognosticate his arrival at adult age arrested in mental and moral development. Because a child has one or a few mental defects, we must not characterize him as a mentally defective child, any more than we consider a child who has an eye defect, such as astigmatism and hyperopia, as physically defective. Of course he is not physically perfect, nor is any child physically perfect. By the same token, no child is mentally perfect. In fact, the child of perfect mind and body would be a rarer specimen,? shall I say a greater monstrosity??than the idiot, the lunatic, or the criminal.
Undoubtedly there are children whom we can properly designate mentally defective children. The line can not be sharply drawn between children with mental defects and mentally defective children. The defective are those who have so many and such severe mental defects that they are unable to overcome these defects as a result of expert training, and must therefore reach adult age arrested in mental and moral development, industrially incapable of earning even a modest livelihood, and socially a menace oftenCHILDREN WITH MENTAL DEFECTS. 181 times to themselves and their families, and always to society, either by virtue of their own behavior or their retained capacity to reproduce their kind. The feebleminded child is a mentally defective child, but let us avoid supposing that he is feebleminded because he possesses “a mental defect.” This terminology is a relic of an outworn and unanalytic psychology, which looked upon the mind as an undivided entity, a unit. It is unscientific to say that a child has a defective mind. We may say that he has a defective mentality, or that he has defective mental processes, or that he has a large number of mental defects. Where we shall draw the line between the child whom we shall call a normal child with mental defects, and a subnormal or feebleminded child who is mentally defective, is a problem which can not be solved wholly within the realm of psychology. No Binet-Simon tests, nor any other tests, will inform us as to what children we shall consider feebleminded. We define the feebleminded child as a result of social considerations. He is the child who for his own good and for the good of society should be segregated for life. After we have arrived at the social definition of feeblemindedness, we may employ our tests to inform us as to the mental status of a suspected case. A casual glance is all that is needed to assure us of the mental and physical status of some feebleminded children. But there will always be large numbers of children in the border zone between the socially normal child and the socially feebleminded child, and with such children the refinement of clinical methods and the application of intensive methods of observation and training will furnish us with psychological data which will enable us to arrive at a secure social classification. A strictly scientific nomenclature will dispense with the term “mentally defective,” as failing to characterize with sufficient definiteness the class of children under consideration. What characterizes “mentally defective” children is not that they are mentally defective, for other children, in fact all children, are mentally defective, but that they are so defective mentally as to be socially unfit. For the term “mentally defective,” I would therefore propose substituting the term “socially unfit,” or “socially defective.”
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.