Talented Imbeciles
- Author:
Arthur Phillips, Clinic Teacher
The Psychological Clinic, University of Pennsylvania
The differential diagnosis of the type of feeblemindedness known as imbecility is by no means an artisan’s job. No foot rule, scale, or point system has been devised or will ever be devised that will relieve the clinician of long, patient, and discriminating analysis in arriving at a diagnosis. An individual may be diagnosed or classified as an imbecile on the mental scale, on the intellectual scale, or on both. The purpose of this paper is to present three cases in which an analytic diagnosis has been made. Two of these were diagnosed as mentally deficient, one as mentally normal. On the scales of intelligence and intellect, all three are deficient but each of them possesses what may be called a talent, a special aptitude.
The first, Gordon, has a talent for words; the second, Obadiah, has a talent for numerical calculation; and the third, Earl, has a talent for mechanical achievement. All three possess hysterical organisms with a high degree of suggestibility. All three must be rated low on the score of general efficiency, but displayed efficiency in the spheres in which they possess talents. Earl is the only one concerning whom there is hope of adjustment in life. This illustrates a familiar situation, that one who has normal mentality and the possibility of mechanical achievement, though intellectually an imbecile, may fill a place in life while one who is a mental imbecile with a prodigious intellectual talent may fail to do so. Two of these boys, Gordon and Obadiah, will always be custodial cases. Of the two, Obadiah stands on a higher intellectual level. Both of them are superior to Earl, yet Earl’s mechanical talent combined wTith his social conformity gives him a place to stand and a niche to fill in human society.
Gordon, whom Dr Witmer had under his professional care for educational treatment in 1917, was then a boy of ten who stood very near “the zero point in the scale of social efficiency.”1 He was a Low Grade Imbecile on the mental scale. After sixteen months of observation, it appeared that he was incapable of ever being raised to a higher level. He could not be taught to dress himself or to do anything efficient. This was due in part to poor coordination, but was more directly traceable to a lack of perseverant attention to the means to be used to attain a desired end. He lived in “unperceiving, unresponsive detachment from his surroundings.” He had no interest in children. In all practical affairs, he was totally incompetent. There could be no doubt about the diagnosis on the score of mental deficiency.
When considering the intellectual scale, there was reason to pause. Gordon belonged to the Mongoloid type. Physically he showed many of the stigmata of this type of degeneracy. Emotionally he was hysterical, suggestible in the extreme. He was dominated by fear, vacillation and nervous tension. His degenerate nervous organism vibrated like the strings of a harp to the suggestion of every wind. Yet this boy possessed a specific, conspicuous gift for words and tunes. His audito-motor memory amounted to a talent. His mind was a veritable storehouse of verbal images. He not only possessed extreme sensitivity to verbal impressions, but remarkable retentivity. The basis of this power of recall was due to his sheer love of sound which led him to repeat what he heard continuously. After hearing the story of King Alfred and the Cakes, from Baldwin’s Fifty Famous Stories, five or six times, he retold it in 257 words, of which 234 (45 per cent) were from the original. His version after a lapse of three months contained 208 words of which 174 (33 per cent) were from the original, and at the end of nine months, 111 words of which 67 (13 per cent) were from the original.
The intellectual development of this boy had to proceed along the straight line of this one talent. His development, however, was limited in three directions. He was deficient in associability, the ability to link ideas together in logical sequence. His memory span for digits was five; for syllables, ten. Combined with this was the inflexibility of his associations, his inabilty to reverse them or to bring them together under a single category. He was not however totally lacking in the consciousness of meaning. He had a certain comprehension of the meaning of words, the symbols for ideas, and a certain ability to use them. One of his compositions on the Lady of Shallot shows that he was able to throw off the ‘’ tyranny of words’’ and express ideas. His very talent, however, was in the way of intellectual development. His sensitivity to verbal stimuli seemed to make him irresponsive to concrete stimuli except such as were strong enough to compel his attention, as the visual stimuli of movements and sounds which excited his already overcharged auditory area. His intellectual deficiency was certainly not of a primary sort but it was due rather to the fact that an oversensitiveness to auditory stimuli had shut up the lad to a world in which these and no others might be used for his intellectual development. In this world, the development of his talent for expression and his love of literature was the only road upon which he could be expected to stand and go unaided. In this direction, at least, he was not imbecile.
Another interesting case illustrative of the difficulty of a differential diagnosis of imbecility is a boy of six who was brought to the Psychological Clinic in 1918 because of malconformity in behavior.2 He had been dismissed from one of the best of Philadelphia’s special classes because he never obeyed and spent most of his time at school in screaming and yelling. This boy was entirely undisciplined, consistently heedless to all commands, addicted to echolalia, hysterical outbursts and shrieking monologues. Along with this behavior, Obadiah showed other traits which unfitted him for normal association with his kind. He had no consciousness of relationships with people either of his own age or older. He could not dress and take care of himself and never even tried. He never touched anything, not even a toy. He had no play life. This lack of social conformity, inability to care for himself and adapt himself to normal surroundings is the behavior of an imbecile. On the social scale, this is precisely what Obadiah was. At Obadiah’s first visit to the Clinic, Dr Witmer noticed that the boy had a numerical obsession. He was perpetually counting, translating everything into number. At the end of three examinations in a single month, Dr Witmer’s analytic diagnosis described Obadiah as a child of (1) distinctly abnormal behavior, (2) an hysterical organism capable of modification by discipline, (3) a marked numerical obsession, (4) a genuine congenital aptitude for arithmetical processes. Here again, is an imbecile with a talent. This talent involved ‘’considerable persistent analytic concentration of attention, certain specific memories, and within a narrow range, logical association and capacity for synthesis.” It was sufficient to make tentative the diagnosis of High Grade Imbecile. Obadiah’s Intelligence Quotient taken three months later was 92 which placed him well within the limits of normality. An analytic study of the responses showed that the range extended from three to nine years and that his successes above his basal year were attributable to his abnormal numerical ability and his echolalia. In this case, the I.Q. was not decisive one way or the other. It left the case as it stood.
Under orthogenic treatment his behavior improved. Within a week his refusal to obey directions practically disappeared. His hysterical susceptibility under a change in environment turned this recalcitrant child into one who was responsive to authority irrespective of its source. A younger child might command obedience and receive it. In the matter of food habits, he capitulated after a fortnight ‘s struggle. His temper tantrums at meals, especially when the meal was a few minutes late, motivated not by hunger but rather by his passion for promptness and obsession for computation, were soon eliminated. He made some progress in adaptation toward children of his own age. With his teachers, he became very sociable and won their affection on the score of his staunch, independent personality. lie proved to be a boy of something more than a numerical obsession who was perpetually counting and counting. Socially, however, Obadiah will never stand alone. He is now seventeen years of age and is a custodial case.
During the six months this boy was under the professional care of Dr Witmer at his school, his performance level for numerical processes rose rapidly. He had a gift for rapid computation which was far from the mechanical type usually found in such cases. He had never been taught one lesson in arithmetic. He taught himself the elementary processes. Dr Witmer said that he could teach the boy the multiplication tables in a month, but thought it best to put the lid down on all arithmetical work for a time. When the lid was down, Obadiah taught himself. Sometimes with the swift weaving of his nervous fingers, sometimes in silence, his body quiet, his face alone showing nervous tension, this six year old prodigy solved problems in multiplication, division and fractions to an extent that was nothing short of phenomenal. No boy with such an endowment could be classified as imbecile on the intellectual scale. Like Gordon, his one talent assumed not only the hegemony among all other abilities he may have had, but crushed them almost to the point of extinction. His intellectual deficiency grew out of an excess of intellectual quality and achievement in one direction.
The third case3 is that of a boy examined by Dr Witmer in the Psychological Clinic of the University of Pennsylvania, October 31, 1929. This boy, Earl, age eleven years and two months belongs to a class which Dr Witmer designates as mentally normal but intellectually deficient. He is of the conformed type of agreeable and pleasing personality, well liked by his associates. His emotional reactions are variable. On occasions he shows apparent self control and at other times he is nervous and excitable. He is aware of his intellectual deficiencies to the point of sensitiveness. Earl has attended school five years and during that time has not attained first grade proficiency in reading or spelling and scarcely IB proficiency in arithmetic. On the intellectual scale he is a Low Grade Imbecile. The interesting thing about this boy is that he displays intelligence, efficiency, and discrimination in the field of form and mechanical achievement.
Earl was brought to the Clinic by his foster mother because of nervousness and inability to read. He was referred in the first instance by a school teacher in a small town about twenty miles from Philadelphia, and secondly by the Neurological Clinic of the University Hospital where the examining physician suspected him of being mentally deficient and referred him to the Psychological Clinic for a psychological examination.
Earl is being brought up in the home of his mother’s brother. His mother died during the influenza epidemic of 1918 when Earl was two months old. Since that time, he has been in his present home. His foster mother’s interest in him and devotion to him are on a par with that which she shows in the case of her own boy, an only child now in his eleventh year. Earl’s father is living. He is described as a good man but uneducated. He does rough work at a garage. The history states that the birth of this boy was normal. He walked at fifteen months, talked at eighteen months and was clean at two years. He had measles, chicken-pox and diphtheria, all in a light form.
He entered school at six years and at the age of eleven years, two months, he is in the second grade. His foster mother stated that his arithmetic is good but that reading holds him back. He gets good marks in spelling but he cannot recognize the words he has learned to spell when he sees them in print. His school achievement is in striking contrast to that of his foster brother who is making normal progress through the grades. It was probably this contrast between the two boys in academic work that occasioned the bringing of Earl to the Psychological Clinic for examination.
The most striking of his physical features is his sugar loafed head. It is small and comes up to a rounded peak at the top. There is very little forehead and nothing at the back of his head. His head girth is 47.3 cm. His walk is typically microcephalic. In a standing posture, his hands hang forward in Simian fashion and his left shoulder droops considerably. The report of a medical examiner of the Psychological Clinic contains the following observations. There is some lordosis. His abdomen is protruberant and swollen in the umbilical region. His hands are partly cyanosed, moist and cold. His reflexes are exaggerated. His blood pressure is above normal and his heart shows a tendency to a pre-systolic murmur. However he is strong physically and has good muscles. On the day of his examination in the Clinic, he was the picture of apathy. His eyes were dull; he looked “heavy and thick”; he had no interest in his surroundings showing scarcely a sign of lif.e. In a classroom where other boys were moving about and were engaged in spontaneous activity, he sat still as if he did not possess enough vitality to overcome his inertia. He looked as if he would stay put forever. During the course of his examination, he was compliant rather than cooperative. He showed no disposition to converse, offered no side lights on his life, volunteered no information about his interests. This picture is at variance with the picture of his behavior given by his foster mother. She emphasizes his good behavior. He is easily managed and always satisfied. She stresses, however, his nervousness. He is easily disturbed and cries and stammers when he gets excited. His nervousness is shown in the batting of his eye lids, the shrugging of his shoulders, the thumbing of his hands. She was surprised at his behavior in the Clinic, especially at his apparent emotional control in general behavior.
Earl is conformed. He fits well into the household of which he is a member. He runs errands for his foster mother and remembers what he is sent for. Upon inquiry, it was brought out, however, that if the articles were more in number than two or three, he was usually given a list. His conduct in school is excellent, his marks always ranging above 90. Outside of school, he shows keen interest in mechanical things. Without suggestion or help from anyone, he took out the insides of an old clock, rigging it up as a windmill and had it running well.
On the Binet-Simon test, Earl obtained an Intelligence Quotient of 65 which is inferior to 99 per cent of ten year old boys. His basal age is six; his mental age, seven years, four months. His vocabulary score was 17. His only failure at the seven year level was in the “fingers” test. At the eight year level, he failed in the “ball and field” test. The failure here may be construed as an inability to comprehend the directions for this test. For him it became nothing more than a hard directions test. Beyond a preliminary scratch, he made no attempt to solve it, not seeming to know what was required of him. His lack of analytical ability was apparent in his failure to pass the similarities test.
His comprehension and discernment span was obtained by using digits. His audito-vocal was 5 and his reverse, 3. His reverse span places him in the lowest quintile of boys of ten.
The unexpected happened when the formboards were presented. The Witmer Formboard, a test standardized at the four year level, presented no problem. His rate of energy discharge was not speedy. Quantitatively his performance placed him in a quintile superior to 70 per cent and inferior to 10 per cent of boys at the ten year level. His comprehension of the problem was immediate. His distribution of attention was sufficient to cover the whole field of action involved in the test. In solving the Witmer Cylinders, a test standardized at the six year level, he used little trial and error and was able to gauge the heights and circumferences of the cylinders with surprising accuracy. What errors he made, he corrected as he went along. Qualitatively it was an intelligent performance. Quantitatively, on the first trial it was a performance of the upper quintile and on the second trial, of the upper decile. A greater surprise was in store when the Dearborn Formboard was presented. On this test which has been standardized as given in this laboratory at the nine year level and has been known to give trouble occasionally to college students, his performance was deliberate; he looked over the whole board, considered and adopted a method of attack, and without haste and with accuracy made each placement. His first trial on the quantitative scale placed him just inferior to 1 per cent. In the handling of concrete material and in the discrimination of form, Earl had displayed intelligence, efficiency, and superior form discrimination. Dr Witmer’s diagnosis was normal mentality, intellectually a middle grade imbecile, Barr classification, trainable but only slightly educable. He has good judgment, intelligence and efficiency in the mechanical field. The recommendation was educational treatment suited to his personal ability. Dr Witmer directed that the boy be brought to the Clinic for teaching in order to ascertain whether the kind of instruction he has had in the past had been deficient. In accordance with this direction, Earl came to the Clinic Teaching Department, Saturday, November 16, 1929. The Clinic Teacher spent an hour in examining Earl. The school proficiency tests confirmed the ratings already given. He has never learned how to discriminate vowel sounds. He knows nothing of phonic analysis, not even the sounds of the consonants. He has no reading proficiency.
In spelling he writes lias, “his” and red, “rad.” His arithmetic is IB in addition. He has difficulty with subtraction. He is unable to solve the simple problem 9 minus 2 at the board, but when working with concrete material such as blocks he has no difficulty in finding solutions to harder problems. When commanded firmly with a touch of severity to proceed with his reading, lie became sullen, whimpered and shed some tears. He is very sensitive to his inability to read. However the incipient emotional storm was soon laid when a formboard was placed in his hand. His face brightened. He displayed emotionalized attention. In addition to the board already given, he solved Young’s Maze A and C. Maze A was too easy for him. He solved it in the minimum time without error. This test is hardly of any value as a test for children older than nine. It was given merely to make a qualitative observation of the boy’s behavior. In Maze C, after an initial error at the beginning of his solution which caused him to retrace his steps in what some have presumed to be a feminine fashion, he started out using foresight, looking ahead so as to avoid the blind alleys and achieved success. His second performance was better. On his third trial he had mastered the problem. In the Healy Picture Completion Test I, he made seven correct placements and two errors. As he placed the blocks in their proper recesses, he commented on his reason for so doing and showed good comprehension of the situation involved. His mechanical ability was then exploited. His eyes kindled with new light as he told about making aeroplanes, using a saw, hammer and nails. He told with enthusiasm how he was able to make a ferry boat, whereas his cousin who is fifteen years of age did not know until he “learned him.” Asked how he learned, he said he saw a picture in a newspaper. It was suggested that he make a drawing of an aeroplane. He drew with good coordination a cross section of an aeroplane, naming the parts?propeller, wheel, motor, wing, and rudder. He then drew a ferry boat, putting in it a small picture of a business truck. He knew where the engine was located and why there were two pilot houses, stating that the boat could go one way just as well as the other. His interest in mechanical matters is in striking contrast to his lack of interest in the things which ordinarily absorb the attention of a boy of ten or eleven. He had no very definite information about baseball and football. He does not even know the positions. In baseball, he says he prefers to be the batter. His general information about his own locality, his foster father’s employement and the location of his place of business, is good.
On the same day he was used for demonstration purposes by Dr Witmer before a class in the School of Education. It was pointed out to the class that his I.Q. of 65 misrepresents him as far as his intelligence and discrimination in the field of form are concerned. This boy has a personal talent. As distinguished from a social talent, a personal talent may be defined as an excess of one ability over other abilities that the individual possess. It is what is ordinarily called an aptitude. A social talent, on the other hand, is ability in excess of the average ability of those of the individual’s own age. This boy’s personal talent is intelligence, discrimination and efficiency in the field of form.
In making a final diagnosis, a distinction must be made between intellectual imbecility and imbecility on the moral scale, i.e., on the scale of social conformity. According to Barr’s classification, there are three grades of imbeciles on the intellectual scale. The low grade imbecile is trainable but not educable. He cannot be taught to read and write except in a peculiarly mechanical fashion. He rarely gets beyond the first grade in school. A middle grade imbecile is trainable in the manual arts and simplest mental requirements. He usually progresses in school to about the third grade. A high grade imbecile is barely distinguishable from a normal child. He is trainable in both manual and intellectual arts. Some high grade imbeciles get into high school. On the intellectual scale, Earl is diagnosed as a low grade imbecile. He cannot read nor write and will never do so. He cannot add nor subtract well enough to take care of his own money.
On the moral scale, i.e., the scale of social conformity, Earl is diagnosed as of normal mentality. He is socially conformed in the household of which he is a member. He is obedient and trustworthy. He gives promise also of ability to be socially conformed except in reading and writing and in the care of his own money. If he were also socially an imbecile, he would have to be diagnosed as feebleminded and recommended for custodial care. The problem of treatment comes next. The question that arises is one of method, whether it is better to try to eliminate the defects or to train the talents. Theoretically, this question is unsettled. Some educators incline to the view that a child should be given what he does not like and be kept from doing what he does like. If he has artistic ability and does not like arithmetic, give him arithmetic. But this method will not succeed here. Earl does not like reading and arithmetic and he has no ability to do either. He has no trainability in academic things. There is no alternative but to develop his personal talent. The total picture plus the microcephaly precludes educational treatment. He is a case for vocational guidance. The final diagnosis is therefore normal mentality; intellectual competency?a low grade imbecile, type microcephalic; specific ability?intelligence, proficiency and discrimination in the use of forms and tools; endurance?uncertain; motivation?conformed. The recommendation is first, training in the direction of his personal talent and second, reference to the Vocational Guidance Clinic.
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