William
- Author:
Helen E. Pennypacker and Genevieve McD. Murphy,
Clinic Teacher, University of Pennsylvania
When we first saw William, he had come to us for his first hour of diagnostic teaching. He appeared to be a sturdy ten year old, tall for his age and well developed physically. Added to the attractiveness of his blond good looks, was the fact that he was well groomed, quite evidently the recipient of all of his adoring mother’s care and attention. He bore himself very quietly and shyly, in marked contrast to his mother’s vivacious conversation and eager manner. When spoken to, he answered in low voiced, slow monosyllables of “ye-es” or “no.” Mrs. M. told us that William was her only child. He was born September 10, 1916, under normal conditions and was a healthy intelligent baby. At two and a half years, however, he was very ill with a disease that the doctors diagnosed as diphtheria although the State Department of Health reported negative cultures. William walked at eleven months and talked at twelve months, but after his illness, he had to learn to talk all over again and was extremely backward. At the present time, his speech is infantile although he has had extensive corrective training in a speech class of the public schools. Friends of the family say that Mrs. M. fosters this tendency by talking “baby talk” to him and by not forcing him to depend upon himself a great deal more than he does at present.
This picture of dependency is an interesting one because as it unfolded, it definitely had two contributing factors. Undoubtedly, the mother’s affection as lavished upon the boy, served to undermine any desire that he might have felt, if he had had obstacles to confront and overcome for himself, to be self sufficient and aggressive. What the chief factor was, however, developed as we studied the boy.
William’s auditory memory span was five and his visual memory span was seven. On the Stanford Revision of the Binet-Simon Scale, his Intelligence Quotient was 77. He was in the third grade in school, upper half. His proficiency in reading and spelling was up to the level of his grade when only mechanical processes were involved. He could analyze words into their component parts but showed no comprehension of what he read. For example, he was given very simple commands to read, such as,?’’ Clap your hands,’’ “Fold your arms,” “Hop to the blackboard,” etc. No amount of instruction on our part could make him understand that he was to carry out these commands. In the same way, he knew the fundamental processes in arithmetic for the 3 B grade but he seemed , unable to organize and use his knowledge in the solution of even the simplest problems.
It was learned that the school principal considered William a very interesting problem. He had observed the boy since his first appearance in the school and reported that at one time William’s coordination had been very poor, that in trying to run he would often fall. He also said that William seemed to be “in a daze” and that he marveled that William was able to go to and from school unaccompanied.
Thus far in his development, William had been no active conduct problem. He was docile, obedient, unobtrusive and well mannered. All his virtues were negative. When he was sent to the store, he always took a note and his mother never held him responsible for any accuracy in getting the proper change or the right article. Play interests and normal contacts with other children were also lacking.
This is the picture, then, that we had of William when he came for diagnostic teaching. The ostensible reason for bringing him was to discover whether individual teaching would aid him with his arithmetic. Actually, we found ourselves confronted with the more serious problem of discovering whether the boy was edueable or merely trainable and to what degree. Also, what was tthe cause of his mental retardation? Was his infantilism superficial or did it permeate his whole mental and emotional structure ? What was the prognosis for his future development and the recommendation for his treatment? In clinic teaching, we found William very amenable. He followed directions …. but they had to be very explicit. For example, it was not sufficient to tell him to sit down, he had to be told where to sit each day. In conversation, he never passed the stage of being monosyllabic. It was not that he seemed repressed or unwilling to talk but rather that he actually had nothing to say. His manner was always smiling, eager to please. To the casual observer, William’s hesitancy to take any action on his own initiative would have appeared to be mere bashfulness, but it was so consistent and he was so unproductive of any of the natural buoy280 THE PSYCHOLOGICAL CLINIC ancy and aggressiveness that goes with the picture of the normal ten year old that we finally concluded that he had not the spirits nor the ideas to motivate him to action. With all his appearance of normal boyhood, he lacked the fire to make him live. We were given an illustration of the fact that when he had an idea he could express it on the day after he received a Wasserman Test at the hospital. He then told everyone whom he met in the clinic with his slow, babyish lisp that… . the bad doctor stuck a needle in my arm …. and he hurted me …. and I’m not going back any more.” Each time he told the story, he took off his coat, rolled up his sleeves and pointed to the place on his arm. He seemed unable to remember which arm had been hurt, so showed either one indiscriminately. His mother was astonished that he showed so much concern at the hurt for recently he had walked for a whole day with a bad limp but had insisted that his foot did not hurt when he was questioned. When bedtime came, his mother found that he had rubbed a large and painful blister on his heel. In discussing this occurrence, we could not credit William with unusual bravery, for there was no occasion for his suffering if he had had intelligence enough to associate the limp with a need for help. It is barely possible that he felt no pain. Our eight hours of intensive clinic teaching verified the tentative diagnosis that William was trainable but not educable. He could read words but did not comprehend them. He could name and count numbers and in a mechanical way, could add, subtract, and multiply. We spent six lessons teaching him that five pennies have the same value as a nickel. Part of the drill was spent in teaching him to make change. He was able to do this as long as the five pennies were before him, but otherwise showed no understanding of the problem. What was the cause of this lack of life in an apparently healthy boy? A thorough physical examination gave him a clear slate. Psychologically speaking on the basis of the clinical teaching, we would say no more than that lie failed to show any sign of educability due to a weakness of associations which make the link between the concrete and the abstract. He could draw no conclusions nor form abstract concepts. It remained for the neuro-psychiatric examination to trace the condition to its cause. It seems that when William had “diptheria” he also showed a marked tendency to sleep a great deal. His retardation and abnormality also dated from that time. It was in 1918, that epidemic encephalitis was prevalent. The history of prolonged sleep at the time of his illness as well as a slight muscular incoordination and tremor, the infantilism and the vacant stare characteristic of William, marked him as a victim of the sequellae of epidemic encephalitis. The case was diagnosed as one of mental arrest due to this disease. In a great number of cases, the base of the brain is affected and a Parkinsonian complex arises. This was a case of cortical encephalitis.
The prognosis for William’s future condition was unfavorable as far as improvement was concerned. He would always need supervision and direction; he would never be independent mentally or socially. He had reached his maximum development educationally and so it was recommended that he be placed in an institution or means be provided at home for his training in some very simple manual work that would keep him occupied. Thus, we passed on from a child who looked normal, who apparently had physical equipment to succeed in life but who inreality was only a physical specimen with his mental abilities irremediably impaired …. no energy, intelligence, motivation.
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