The Definition and Diagnosis of Mental Deficiency
- Author:
Cyril Burt, M.A., Psychologist to the London County Council.
- Reference type:
Journal Article
- Record-number:
17193
- Author:
Burt, Cyril
- Year:
1920
- Title:
The Definition and Diagnosis of Mental Deficiency. Part I
- Journal:
Studies in mental inefficiency
- Volume:
1
- Issue:
3
- Pages:
49-54
- Epub-date:
1920/07/15
- Date:
1920/07//
- Short-title:
The Definition and Diagnosis of Mental Deficiency. Part I
- Alternate-journal-name:
Stud Ment Ineffic
- PMCID:
PMC5109058
- Accession-number:
28909949
Note
Burt, Cyril, eng, England, Stud Ment Ineffic. 1920 Jul 15;1(3):49-54.
- URL:
- Author-address:
Psychologist to the London County Council.
- Name-of-database:
PubMed
- Language:
eng
- Copyright:
AMENTIA AS DISTINGUISHED FROM DEMENTIA ————————————-The earlier view that mental deficiency was a fairly definite disease, or at least a clearly marked condition,?like epilepsy or paralysis in the coarser levels of the nervous system has now almost universally teen abandoned. Under the phrase “mental defective” is comprised a strange and ? heterogeneous variety of cases, persons whose mental states differ in essential respects widely from one to another. Some attempt to unify the incongruous meanings of the term is urgently needed. But the conclusions attained must necessarily be tentative.
And if in what follows my suggestions are cast in dogmatic language, without constant qualifications and repeated doubts, this is not from any conviction that a final solution had been reached, but simply from a desire to be brief.
Mental deficiency, sometimes styled “amentia,” is generally contrasted with “dementia” ; and defined to mean absence of mind, as the latter means loss of wind. The demented person is said to have been born with all his mental powers, full and complete, but in later life to have lost tliem, or at least their higher forms; the ament is said to be already, from the very moment of birth, devoid and destitute of these higher mental functions : he has none to lose.
Interpreted thus to signify absence of mind, the phrase mental deficiency embodies two notions, each of which requires precise definition. What is meant by “mind” or “mental”? What is meant by “absence” or “deficiency.
I. The Meaning of “Mental.” ————————-The word “mental” is highly ambiguous. In the writings and discussions of psychologists ;it is used in two senses: first, as the adjective of intelligence, a noun which in English yields no derivative adjective of its own; and secondly, as the adjective of mind. Mind is now employed to denote the whole structural basis underlying conscious processes, whether that basis be conceived as partly immaterial, and resident in the soul, or as simply physical, constituted solely by the nervous system or at least by those higher circuits of its central portion which we loosely call the brain. For the psychologist, therefore, “mind,” and “mental” as the attitude of mind, cover far more than the manifestations of intelligence; they include also the manifestations of character or temperament.
These two aspects of human nature the psychology of popular speech has long recognised. It distinguishes the intellectual aspect from the moral. A reminisaence of the same dichotomy is discernible in thie Mental Deficiency Act of 1913; and the antithesis, if pressed, might seem; to imply two alternative modes of mental defect: intellectual deficiency, on the one hand, and moral deficiency, on the other.
This distinction is not without scientific support. From an analysis of data collected by Dr Webb and by myself, Dr Maxwell Garnett has recently inferred that a widely comprehensive summary of a given personality can be given in terms of an extremely limited number of fundamental factors. Three factors seem relatively independent. Provisionally lie terms them, Ability, Cleverness and Purpose or Will. The miind he depicts by a three-dimensional diagram; and claims that “when a person’s ‘representative point’ in this diagram has been determined, a surprisingly large proportion of his moral as well as his intellectual qualities have also been defined.”* How completely “cleverness as independent “ability” we need not here discuss; but it seems indisputable that in diagnosing mental inadequacy, besides noting defects in cleverness or ability, we are bound, even upon a priori grounds, to look also for defects in purpose or will.
What may be the best nomenclature for distinguishing these alternative conditions is a problem of some difficulty. The Act insists that the defect shall be proved to be innate, or at all events permanent. The words “intellectual” and “moral” in common parlance relate to complex psychological activities, which change with changing surroundings, and which, in the viiew of most authorities, can hardly be identified with elementary capacities inherited at birth. Intellect is largely a matter of ideas, acquired during life-timie; morality is largely ai matter of habits and sentiments absorbed progressively from the social environment and not in any sense innate as such. Provisionally, perhaps, we may, wlTen referring to the more fundamental, hypothetical condition, presumed to exist from birth, . * Proceeding of the Royal Society, Vol. XCVI., 1919, ‘On certain Independent Factors in Mental Measurements,’ p. III. Cf. also British Journal of Psychology Vol. IX, 1919, ‘General Ability, Cleverness, and Purpose.’
speak of defect in Intelligence and in Temperament, and uae the looser phrase, Intellectual Deficiency and Character Detect, to denote the more complex conditions th,at are actually observed, and that must be the resultant of interplay of both in born constitution and post-natal environment.
So-called Deficiency, i.e., Temperamental Instability.
In the whole of mental abnormality there is no problem so perplexing or obscure as the precise nature of what has hitherto been designated moral imbecility. The very phrase is misleading.
To say that average or normal man As born with a moral sense, but that a few are born wanting that moral sense, and so appear morally defective, is to revert to a crude and out-of-date psychology. The foundations of moral character, as Shand and McDougall have taught us, are the hereditary instincts and their correlated emotions; and character-defect, so far as it is congenital, springs usually from too much emotion, rather than from too little will, from primitive instincts that are too strong rather than from some simple moral sense that is too weak. Will and the moral sense, if such terms can be accepted for any scientific purpose whatever, must be recognised as denoting tendencies, far too complex in their nature, and far too late in their emergence, to be hereditary or inborn. Emotions and instincts, however, are admittedly innate; and elsewhere I have given reasons for believing that their excitability and strength depend largely upon a central factor, upon a single fund of energy, which I have termed “general emotionality,” fand that instability in this central factor may occur as a primary and congenital condition.t For persons born with an intensely .emotional endowment perhaps the simplest and commonest designation is “the unstable,” a term that has now found a firm footing-place in psychological works.
The condition, indeed, is a condition of excess rather than deficiency; but, to accord with traditional nomenclature, I have suggested that, for rough practical purposes, those whose inborn instability is so pronounced that they icquire care, supervision, and control for their own protection or for that of others, may perhaps be called “temperamentally defective.”
(b) Intellectual Deficiency, i.e., Deficiency in Intelligence. ————————————————————–The ambiguities contained in the adjective “intellectual” are less dangerous and more (easily discerned than those lurking in the term “moral.” With most persons, it may be admitted, life is not so much an affair of intellect as of intelligence. It entails practical as well as strictly intellectual processes. But to avoid coining some harsh neologism such as “intelligential,” and, at the same time, T *S?ie the admirable discissions in Healy, The Individual Delinquent, Section 372> 11 Moral imbecility ” and Holmes The Conservation of the Child, Chapter X, ” Moral Deviates.” _ . t8rit. Association Annual Reborts, iq 15. 4 General and Specific Factor underlying the Primary Emotions.’ |Child Study, Vol. X, No. 3. pp. 61-79 “The Unstable Child,” to escape the ambiguities of the more common adjective “mental,” I shall use “intellectual” in the broader sense, comprehending under it all processes of the mind, except those connected essentially with character and temperament.
The existence of some central psychological factor, more or less determinfng all such activities, is now iery generally conceded. Efficiency in any type of intellectual work, is due, it is maintained, to inborn capacities of two orders: first, a general ability entering into all mental performances, usually denominated intelligence; and, secondly, one or more specific abilities?affecting only that limited group of processes in which they are immediately concerned.
Defects in these more specific capacities do not in my opinion, form a valid ground for certification. Word-blindness, to take a familiar example, is certainly, in the literal sense, a mental defect; and, in v,iew of the many, it is a condition occurng in a congenital and permanent form. But, since congenital word-blindness does not directly affect general mental efficiency, but is by definition specific and localised, it does not to my mind constitute deficiency, in the technical sense. I have in other articles reported evidence in favour of the existence of “intelligence” as a distinct and all-pervading mental fiactor; and have there defined it as “inborn general intellectual efficiency.” This hypothesis, however, a few authorities, still reject. For them all defects are specific. The only distinction they can countenance is the distinction between those specific defects, on the one hand, that do not entaiil grave social disability?as musical deficiency, or deficiency in the ability to draw?and those, on the other hand, that do.
It is with a defect in this inborn general factor that the psycEologist has usually identified mental deficiency. For him in such a phrase, as in the phrase “mental tests” and in similar contexts, the word “mental” is the adjective of “intelligence.” This usage is somewhat limited. It would, as is evident, wholly exclude (1) cases of moral or temperamental deficiency; (2) cases where the defect is not congenital; and (3) cases, congenital or otherwise, where the defect is specific. Indeed, there are many, magistrates as well as mental experts, who, noting the contrast drawn in the Act between “mental defect” and “vicious propensities,” and between “moral imbecility,” on the one hand, and “idiocy,” feeble-mdndedness and more general forms of imbecility, on the other, have inferred that, in the statute-book as well as in the text-book, mental defect has this stricter connotation, and refers to inadequacy of intelligence alone.
Mental Deficiency as an Administrative Concept ——————————————–I would, however, strongly urge that “mental deficiency” is, at bottom, not a genuine psychological term at all. It marks a legal or administrative category. The ultimate criterion is social inefficiency. Yet not all social inefficiency is proof of mental defect. The social inefficiency must in turn be traceable primarily to some condition of the mind that is either unborn, or, at any rate, emerges early. But the ultimate nature of the primary functions,
which may be thus affected, and which may thus affect efficiency, is very various. They are by no means limited to intelligence alone. Even if we refuse to admit, as a definite and independent type, moral deficiency, or emotional instability, non-intellectual characteristics must still be considered. Temperament and character, bodily health and physical strength, and even the material and social environment to be faced with such equipment, all must be taken into account before the issue of technical “deficiency” can be decided.
In this broader view, however, there aire grave dangers. It is not so safe in practice as it is sound iin theory. Of those obscure psychological activities that underlie social behaviour, and determine character as distinguished from intelligence, too little is known; practicable criteria and trustworthy tests for characterdefect?for its nature, for its degree, for its permanence?are almost non-existent; and patients whose deficiency is purely moral or temperamental need measures quite different, and institutions quite separate, from: those required by the more familiar cases of intellectual detect. Hence, with all this ambiguity of terms and difference of opinions, we should, as I shall presently urge, be particularly chary of describing as mentally defective a person whose intelligence is normal or nearly average.
Finally, the distinction between these two contrasted aspects of the mind? the intellectual and the emotional?is not rigid or complete. The mind functions as a whole. Personality is one. A defect of temperament must inevitably impair intellectual efficiency; a defect of intellect cannot fail to impede the development of character. With dull and lethargic emotions, a low-grade intellect appears, even in tests designed specifically for intelligence, doubly incompetent. And, with a weak and undeveloped intellect, a person of strong emotions amd violent instincts becomes yet more incapable of co-ordinating his impulses and controlling his passions.
With these reservations, then, this is the interpretation I give to the term mental.” I take it to cover those innate and permanent general qualities of the to exclude alike specific capacities, acquired intellectual attainments, and to exclude alike specific capacities, admired intellectual attainments, and acquired peculiarities of character.
II. The Meaning of “Deficiency.” ——————————We have now to define the second termi of the original phrase, the term “deficiency.” Amentia, we have seen, means absence of mind. But absence of mind is, of course, merely relative. No persons are born literally and entirely destitute of mentality. They can be born only with minds less efficient than the majority. How defective, therefore, must a person’s mind appear before lie can he deemed technically “deficient?”
Diagnosis ——–The degree of mental inadequacy is always the crucial question upon which diagnosis turns. It involves a scientific study of the child’s personality, and this ‘in turn, particularly wth temperamental cases, can at times be made, if made at all, only with expert observation in a psychological clinic, or in some school or residential institution that may serve the samie purpose. The results of observation should be sought and recorded systematically according to some pre-conceived plan of psychological functions and conditions. The broaxd headdngs which for this purpose, I find most convenient, may be classified, in popular terms, as follows:
PSYCHOGRAPHIC SCHEME ——————–I. Environment. II. Personality. A. Physical Functions: B. Mental Functions:
Intellect:
Inborn Capacities: (Psychological Abilities).
Specific capacities (attrition, memory, etc.).
General capacity (intelligence).
Acquired Capacities: (Pedagogical Attainments).
Specific attainments (linguistic, arithmetical, manual, etc.).
General attainments (general educational ability).
Temperament.
Inborn tendencies.
Specific instincts and emotions.
General emotionality.
Acquired tendencies.
Specific sentiments and complexes.
General stability of character.
(i) For those accustomed to think in more technical language, I may repeat that “intellect” is used loosely to include psycho-motor as well as cognitive capacities; and temperament to include conative as well as affective capacities.
With the patient’s environment and with his bodily condition, we are not here concerned. Both, however, must influence diagnosis. Among border-line cases, a relatively bright child, incapacitated by some marked physical disability, or situated in hopelessly poor home circumstances, will at times be certified as legally defective, while a slightly duller child, labouring under no such, disadvantages will be passed over as technically normal. Such cases are exceptional; in the sequel I shall have in mind chiefly persons whose environmental and physical conditions are roughly average, recollecting, of course, that along the lower strata of an industrial area average conditions are always a little subnormal. (To be concluded).
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