Mental deficiency

“ That the definition of the grades of mental deficiency should not vary from one doctor to another, but that one should know what is meant by the word idiot, the word imbecile, and the word feeble-minded. ”

“ Mental defectives, it is argued, unlike the insane and pathological imbeciles, are not a special class of human beings, and they are chiefly distinguished from other normal persons by their low level of general intelligence. The term mental deficiency, as applied to convicts, as well as connoting a mind of inferior capacity, in many cases implies also an unbalanced mind, i.e., a mind whose equilibrium is easily disturbed by the preponderance of extreme degrees of objectionable and dangerous qualities, such as impulsiveness, excitability, passionate temper, &c. ”

“ These inequalities of development may vary to any degree in different subjects. They always produce a want of equilibrium, and this want is the differentiating attribute of the defective child. But to draw a faithful picture we must add yet other traits. According to general opinion, mental deficiency is a disease, and although the idea of disease is very vague, we are inclined to fall in with this general opinion. ”

“ In this complex diathesis which means greater susceptibility to temptations, there is little doubt that mental deficiency is the main factor. Aschaffenburg has well expressed one effect of this particular causal factor: “The weak-minded are generally children of the moment.... The lessons of experience, which serve normal persons as a guide, in later events, soon fade, be cause they cannot be fitted into the existing condition of the ideas. ”

“ Guarding against the propagation of mental deficiency thus seems to be the most direct and hopeful method of attack, while the removal of infecting temptations, and training for greater resistance, should receive hearty, albeit subordinate emphasis. ”

“ With regard to mental deficiency, we think it possible to formulate precise definitions which will enable all competent persons to agree as to the diagnosis of idiocy, imbecility, and feeble-mindedness. ”

“ The deficient are not an anomalous group such as we find with some mental diseases. Except for the comparatively rare cases of traumatic or febrile origin, the deficient individual is a healthy individual so far as his nervous system is concerned, even though his capacity for brain activity is below that of those who socially survive. They are not as a group abnormal in the sense of diseased, but only unusual in the sense of being extreme variations from medium ability in a distribution which is uninterrupted in continuity. ”

“ Bicêtre.—The reader would be wrong to imagine that in these visits to the hospitals we are forgetting the school cases of mental deficiency; we are at the heart of the question. Whether we are dealing with hospital cases or school cases, there are details of organisation which are the same for all, and there are similar mistakes which we must try to avoid. ”

“ In conclusion, it may be said that the important etiological factors in the production of mental disease are heredity, senility, syphilis, arteriosclerosis, somatic diseases, mental deficiency, epilepsy, diseases of the brain and nervous system, alcoholism, drugs, traumatism and mental stress and shocks of various kinds. ”

“ When the general instinctive origin of intellectual deficiency is considered along with the incurability of the condition, we seem to be theoretically justified in assuming that the variation will be slight from one year of life to the next. ”

“ The principle that all mental deficients need not show the same low degree of intellectual ability is clearly recognized in perhaps the most important legal enactment on deficiency which has been passed in recent years, the British Mental Deficiency Act of 1913. ”

“ On the other hand, we find only twenty-one mixed cases in a population where the ill-balanced which have been notified to us amount to forty-four, and the defective to fifty-seven, so that the mixed cases represent only a fifth of the whole, whereas the simple cases form four-fifths. These very different proportions indicate that as a general rule mental instability and mental deficiency are quite distinct. ”

“ In this selection and education of mentally defective children, three positions of Billet and Simon are worthy of consideration. In the first place, it is contended that a physical examination alone can never allow us to dispense with a direct examination of the intelligence, and that "anthropometry, stigmata, and physical appearance must take a second place as means of discovering in school the feeble-minded and the ill-balanced." Again, "mental deficiency and want of balance are peculiar mental conditions which it is often impossible to connect with definite pathological changes." ”

“ It is not difficult to perceive the relation existing between a defective brain weight, paucity of the gyri, deficiency of properly developed cortical cells and such an elementary form of mental aberration as simple imbecility. The subject of the relation between structure and function gains in interest when we leave this domain of simple mental weakness to analyse the relation between structural defects and the positive symptoms of insanity and degeneracy—that is, moral perversion, mental obliquity, delusions, and morbid impulses. ”

“ She has made an admirable start toward a differential diagnosis of special defects in number work, language ability and other mental activities. The degree of special deficiency which results in social failure could be placed upon an objective basis, but the rarity of special deficiencies as compared with general deficiency will make this a slow task. In the meantime we may rely upon the mutual dependence of the organic processes as a point of view which emphasizes the common spread of deficiency to many activities. ”

“ If we disregard the natural antipathy of many people to anything which tends to limit the charming vagueness 13of their mental outlook, we may endeavor to chart this horizon of tested deficiency with something of the definiteness of figures, which shall at the same time indicate a range of error. As soon as our aim comes to be to plot the borderline on a measuring scale of mental ability, we find that the borderline must be so stated that we can deal with either adults or children. Two sorts of limiting regions must be described, one for mature minds and one for immature minds. ”

“ Not only are there no geniuses but the fact can not be too strongly emphasized that even the people who are considered normal ... are not as a rule people of average intelligence....” However, between insanity and genius he finds more kindred spirit.
Tests for Mental Deficiency.—As to tests for mental deficiency, the one commonly meted out to victims in the every-day world is the social-economic one of survival in the competitions of life. The mentally deficient fail. ”

“ If these two forces are lacking in the body to any considerable extent, we have sickness and infirmity and accidents of every kind. If they are lacking in the mind, we find every degree of mental deficiency, every variety of insanity. ”

“ In the hands of an amateur it may perform an analogous service to that of a vision chart in discovering children who require expert examination of their eyes. The danger lies in the novice not knowing his limitations. Few who have had experience with tests can doubt, however, the much greater danger of inadequate diagnosis of mental development on the part of physicians who give opinions about mental deficiency without having had experience with test scales. ”

“ If the diagnosis of conative cases could be determined objectively, it is possible that most forms of social unfitness would be found highly correlated with intellectual deficiency. On the other hand, when the diagnosis of unfitness for school or social life depends merely upon the opinion of experts or teachers, the inaccuracy of the diagnosis may show a wide discrepancy between the so-called conative and intellectual types of deficiency. ”

“ Just as in the case of physical illness, we need to know not merely that the patient is sick, but also why he is sick, what organs are involved, what course the illness will run, and what physical work the patient can safely undertake, so in the case of a retarded child, we need to know the exact degree of intellectual deficiency, what mental functions are chiefly concerned in the defect, whether the deficiency is due to innate endowment, to physical illness, or to faults of education, and what lines of mental activity the child will be able to pursue with reasonable hope of success. ”

“ Of 185 admissions covering a period of three years the principal psychoses represented were dementia praecox, forty-one per cent, constitutional psychopathic inferiority, nineteen per cent, manic-depressive psychoses, eight, mental deficiency, nine, alcoholic psychoses, five, paranoid conditions, four per cent, etc.
Experience has shown that the defective criminal classes are not suitable cases for either penal institutions or hospitals for the insane. ”

“ Patient who accepts mental suggestion of disability as reality. Perverted judgment in severe dementias—as influenced by unreasonable fear, hatred, etc.; in all acute insanities—as manifested in inability of patient to rid himself of his delusions. Absence of judgment in all acute insanities; in later dementias. Limitations in many so-called normal and in all the abnormal. Disorders of Emotion Suggestibility in hysteria. Excitement in mania. Depression in melancholia. Phobias as found in psychasthenia. Deficiency as in the apathy of depression. Perversion in mania, in depression, in catatonia. ”

“ PRACTICAL CONSIDERATIONS CHAPTER II. THE FUNCTIONS OF A SCALE IN DIAGNOSIS A. The Meaning of Intellectual Deficiency. Whatever form the definition of feeble-mindedness may take, in this country at least [3] the concept has become quite firmly established as describing the condition of those who require social guardianship, because, with training, they do not develop enough mentally to live an independent life in society. The feeble-minded are socially deficient because of a failure to develop mentally. ”

“ To be thoroughly objective, of course, one should talk about “feebleness in tested abilities;” but we would then fail to point out the important fact about our present scales that they detect mainly intellectual deficiency, that they do not reach those forms of feeble-mindedness in which the weakness in such traits as stability, ambition, perseverance, self-control, etc., is not great enough to interfere with the brief intellectual processes necessary for passing tests. ”

“ The rapid accumulation of data with psychological tests has made it possible to take our first halting steps in the direction of greater definiteness in diagnosis by a larger use of objective methods. This increase in significance of the concept of deficiency is fruitful at once in estimating the size of the social problem and planning means for undertaking the care of these unfortunates. We can discover something of the error in the previous subjective estimates of the frequency of feeble-mindedness. ”

“ Deficiency is a difference in degree not in kind. Fortunately the tendency to describe the feeble-minded person as if he were a different species from the normal has been definitely attacked by two noteworthy researches, that of Norsworthy (159) and that of Pearson and Jaederholm (164) (167) . In these two investigations mentally deficient children either in special classes or in institutions have been compared with groups of normal children from the same localities on the basis of objective tests. ”

“ The type of behavior disorder, the social reactions, the trends of interests, etc., which psychopathic personalities may show give special features to many cases, e.g., criminal traits, moral deficiency, tramp life, sexual perversions and various temperamental peculiarities. ”

“ The discrimination of mental activities which are predominately emotional and conative from those in which intellect is mainly emphasized is also well recognized by those who have been making broad studies of tests in other fields than that of feeble-mindedness. ”

“ Such work is not only for the mentally disordered and those suffering from mental defect, but for all those who, through mental causes, are unable so to adjust themselves to their environment as to live happy and efficient lives. ”

“ It is a lower degree of the same cause which renders continuous seclusion from society so injurious to both mental and bodily health.”
“Inactivity of intellect and of feeling is a very frequent predisposing cause of every form of nervous disease. For demonstrative evidence of this position, we have only to look at the numerous victims to be found among persons who have no call to exertion in gaining the means of subsistence, and no objects of interest on which to exercise their mental faculties, and who consequently sink into a state of mental sloth and nervous weakness.” ”

“ The effort to work becomes daily more laborious, the task of fixing the attention grows increasingly difficult, thoughts wander, memory fails, the reasoning power is enfeebled; prejudice—the shade of defunct emotion or some past persuasion—takes the place of judgment; physical nerve or brain disturbance may supervene, and the crash will then come suddenly, unexpected by on-lookers, perhaps unperceived by the sufferer himself. This is the history of "worry," or disorder produced by mental disquietude and distraction, occasionally by physical disease. ”

“ While we now know that more than one in five Americans experiences some form of mental illness each year, that many mental disorders are biological, and that they can be treated medically, too many people still believe that mental illness is a personal failure. ”

“ But it is none the less true that always some disorder results from excess or defect, that it influences every function, bodily and mental, and that it constitutes a lowering of the life for the time being. ”

“ One of the most widely believed and most damaging myths is that mental illness is a personal failure, not a physical disease. A recent study shows that the majority of Americans don't believe that mental illness can be accurately diagnosed or treated. ”