A Case of Loss of Psycho-Motor Control, Suspected of Malingering
- Author:
Morris S. Viteles, M.A.,
University of Pennsylvania.
An interesting example of the kind and diversity of co-operation which can and should be established between the psj^chologist and psychiatrist is afforded by this report of a case examined at the Psychological Clinic of the University of Pennsylvania in the early part of December. The subject was a Negro, twenty-four years of age, discharged from service in the infantry by reason of physical disability. At the time of the examination he was under the care of the Public Health Service for medical treatment, the specific disability being hysterical attacks characterized by loss of motor control, especially evidenced in a verbal stammer present at all times. He had spent a period of time in an army medical hospital under observation, aiid had been discharged from that hospital as a malingerer. The medical data covering the discharge was very incomplete, being merely a statement of discharge on the grounds of malingering.
The problem presented to us by the Public Health Service was that of rendering an opinion on the question of malingering which had been raised by this discharge from the army hospital. Incidentally, of course, it was also necessary to determine the mental competency of the subject on the so-called general intelligence scale. The early history of the subject shows the absence of all mental and nervous complexes before his entrance into the service. Before starting to work he had completed the first year of the academic course at a Philadelphia high school. He had worked as a driver of an ash cart for a street cleaning concern in this city, and immediately before leaving for the service he had been promoted to the position of street foreman. In the service he had been promoted from private to sergeant and had, moreover, been awarded the Distinguished Service Cross for bravery under fire. He had been wounded twice, both times slightly, and had been severely burned by mustard gas. Shortly after he had been sent to a hospital on this side for treatment for these mustard gas burns he had developed the symptoms of what had been diagnosed as hysteria. Quite suddenly he had developed a marked stammer which under the least excitement rendered him practically speechless.
The object of the preliminary examination, made by the writer, was to establish, first, whether the subject was normal or feebleminded, and secondly to determine whether such symptoms as the gait, the fatigue, the intentional tremor, the stammer, etc., were consciously and intentionally falsified?whether, in other words, there was an actual functional defect in psycho-motor control. The examination was started with the Witmer Cylinder Test, the two trials being completed in 5 mins. 5 sees, and 3 mins. respectively, the performance being, from the point of view of time, about that of a six-year old child. The low level of performance, however, was not due to a low level of competency but rather to inefficiency in control and co-ordination. An attempt was made to draw the subject into conversation while he was engrossed in the task of putting away the cylinders with a view to observing whether the stammer and gait would disappear when consciousness was not directed toward maintaining them. The stammer did not disappear during any part of the examination. When drawn into conversation the subject left off putting away the cylinders. There was not sufficient control over distribution of attention to permit him to do two things at one time. In steadiness and tapping tests the subject showed the same inefficiency in control and co-ordination. As a matter of fact it was necessary to stop these tests after a few minutes because the subject was in imminent danger of a hysterical attack. With the Dearborn Formboard he showed the same inefficiency in response, but did not reveal any absence of the competency necessary to learn to complete the test and to retain what he had learned. Memory span proved to be adequate. A number of other tests helped to establish the truth of the statement made by Dr Witmer that “the mental picture derived m the subject’s examination is the same no matter what test is employed.” S is a young colored man of more than average intelligence. His intellectual level is high for his race and his mental competency is normal, i. e., there is not lack of any mental ability. His defect is solely one in efficiency in control. The examination shows a psychic loss of control.
An examination of speech made by Dr Twitmyer showed the subject to have a true stammer, which, by reason of its consistency and persistence, could not be consciously assumed. He asserted that a stammer such as this young man displayed could not be successfully imitated even by a trained actor.
Like the verbal stammer every performance was a stammering one and warranted the diagnosis given by Dr Witmer of “normal mentality but defective control.” The symptom complex is one of profound hysteria. Malingering is altogether excluded as a con224 THE PSYCHOLOGICAL CLINIC. tributing factor. The young man is, if anything, over ready to co-operate, and his very desire to render a successful performance, in his present physical and mental condition, produces excitability and distractability of attention that destroys the control necessary for successful accomplishment.
The conditions which motivated the physician of the army hospital to discharge the subject as a malingerer are unknown to us. It is of interest to note, however, that the physician of the Public Health Service who brought the young man for examination admitted after the examination that he had doubted the validity of the charge of malingering and expressed himself as in most hearty agreement with our findings.
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