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A Study of Association in Insanity by Grace Helen Kent

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A STUDY OF ASSOCIATION IN INSANITY

BY

GRACE HELEN KENT, A.M.

AND

A.J. ROSANOFF, M.D.

KINGS PARK STATE HOSPITAL, N.Y.

TABLE OF CONTENTS.

PART I. ASSOCIATION IN NORMAL SUBJECTS.

Sec.1. Method of Investigation

Sec.2. The Normal Standard

Sec.3. The Frequency Tables

Sec.4. Normal Associational Tendencies

Sec.5. Practical Considerations

Sec.6. An Empirical Principle of Normal Association

PART II. ASSOCIATION IN INSANE SUBJECTS.

Sec.1. General Survey of Pathological Material

Sec.2. Classification of Reactions

Sec.3. Non-Specific Reactions; Doubtful Reactions

Sec.4. Individual Reactions; Explanation of Groups and Methods of
Application

Normal Reactions
Pathological Reactions
Derivatives of Stimulus Words
Partial Dissociation
Non-Specific Reactions
Sound Reactions
Word Complements
Particles of Speech
Complete Dissociation
Perseveration
Neologisms
Unclassified Reactions
Normal Reactions
Circumstantial Reactions
Distraction
Incoherent Reactions

Sec.5. Order of Preference

Sec.6. Errors Involved in the Use of Arbitrary Objective Standards

Sec.7. Analysis of Pathological Material
Dementia Praecox
Paranoic Conditions
Epilepsy
General Paresis
Manic-Depressive Insanity
Involutional Melancholia; Alcoholic Dementia; Senile Dementia

Sec.8. Pathological Reactions from Normal Subjects

Sec.9. Number of Different Words given as Reactions

Sec.10. Co-operation of the Subject

Sec.11. Summary

Acknowledgments

INDEX TO FREQUENCY TABLES AND APPENDIX

THE FREQUENCY TABLES

APPENDIX TO THE FREQUENCY TABLES

PART I.

ASSOCIATION IN NORMAL SUBJECTS.

Among the most striking and commonly observed manifestations of
insanity are certain disorders of the flow of utterance which appear
to be dependent upon a derangement of the psychical processes commonly
termed association of ideas. These disorders have to some extent been
made the subject of psychological experimentation, and the object of
this investigation is to continue and extend the study of these
phenomena by an application of the experimental method known as the
association test.

Sec. 1. METHOD OF INVESTIGATION.

In this investigation we have followed a modified form of the method
developed by Sommer,[1] the essential feature of which is the
statistical treatment of results obtained by uniform technique from a
large number of cases.

[Footnote 1: Diagnostik der Geisteskrankheiten, p. 112.]

The stimulus consists of a series of one hundred spoken words, to each
of which the subject is directed to react by the first word which it
makes him think of. In the selection of the stimulus words, sixty-six
of which were taken from the list suggested by Sommer, we have taken
care to avoid such words as are especially liable to call up personal
experiences, and have so arranged the words as to separate any two
which bear an obviously close relation to one another. After much
preliminary experimentation we adopted the following list of words:

01 Table
02 Dark
03 Music
04 Sickness
05 Man
06 Deep
07 Soft
08 Eating
09 Mountain
10 House
11 Black
12 Mutton
13 Comfort
14 Hand
15 Short
16 Fruit
17 Butterfly
18 Smooth
19 Command
20 Chair
21 Sweet
22 Whistle
23 Woman
24 Cold
25 Slow
26 Wish
27 River
28 White
29 Beautiful
30 Window
31 Rough
32 Citizen
33 Foot
34 Spider
35 Needle
36 Red
37 Sleep
38 Anger
39 Carpet
40 Girl
41 High
42 Working
43 Sour
44 Earth
45 Trouble
46 Soldier
47 Cabbage
48 Hard
49 Eagle
50 Stomach

No attempt is made to secure uniformity of external conditions for the
test; the aim has been rather to make it so simple as to render
strictly experimental conditions unnecessary. The test may be made in
any room that is reasonably free from distracting influences; the
subject is seated with his back toward the experimenter, so that he
cannot see the record; he is requested to respond to each stimulus
word by one word, the first word that occurs to him other than the
stimulus word itself, and on no account more than one word. If an
untrained subject reacts by a sentence or phrase, a compound word, or
a different grammatical form of the stimulus word, the reaction is
left unrecorded, and the stimulus word is repeated at the close of the
test.

In this investigation no account is taken of the reaction time. The
reasons for this will be explained later.

The general plan has been first to apply the test to normal persons,
so as to derive empirically a normal standard and to determine, if
possible, the nature and limits of normal variation; and then to apply
it to cases of various forms of insanity and to compare the results
with the normal standard, with a view to determining the nature of
pathological variation.

Sec. 2. THE NORMAL STANDARD.

In order to establish a standard which should fairly represent at
least all the common types of association and which should show the
extent of such variation as might be due to differences in sex,
temperament, education, and environment, we have applied the test to
over one thousand normal subjects.

Among these subjects were persons of both sexes and of ages ranging
from eight years to over eighty years, persons following different
occupations, possessing various degrees of mental capacity and
education, and living in widely separated localities. Many were from
Ireland, and some of these had but recently arrived in this country;
others were from different parts of Europe, but all were able to speak
English with at least fair fluency. Over two hundred of the subjects,
including a few university professors and other highly practiced
observers, were professional men and women or college students. About
five hundred were employed in one or another of the New York State
hospitals for the insane, either as nurses and attendants or as
workers at various trades; the majority of these were persons of
common school education, but the group includes also, on the one hand,
a considerable number of high school graduates; and on the other hand,
a few laborers who were almost or wholly illiterate. Nearly one
hundred and fifty of the subjects were boys and girls of high school
age, pupils of the Ethical Culture School, New York City. The
remaining subjects form a miscellaneous group, consisting largely of
clerks and farmers.

Sec. 3. THE FREQUENCY TABLES.

From the records obtained from these normal subjects, including in all
100,000 reactions, we have compiled a series of tables, one for each
stimulus word, showing all the different reactions given by one
thousand subjects in response to that stimulus word, and the frequency
with which each reaction has occurred. [1] These tables will be found
at the end of this paper.

[Footnote 1: A similar method of treating associations has been used
by Cattell (Mind, Vol. XII, p. 68; Vol. XIV, p. 230), and more
recently by Reinhold (Zeitschr. f. Psychol., Vol. LIV, p. 183), but
for other purposes.]

With the exception of a few distinctive proper names, which are
indicated by initials, we have followed the plan of introducing each
word into the table exactly as it was found in the record. In the
arrangement of the words in each table, we have placed together all
the derivatives of a single root, regardless of the strict
alphabetical order.[1]

[Footnote 1: It should be mentioned that we have discovered a few
errors in these tables. Some of these were made in compiling them from
the records, and were evidently due to the assistant's difficulty of
reading a strange handwriting. Other errors have been found in the
records themselves. Each of the stimulus words _butter_, _tobacco_ and
_king_ appears from the tables to have been repeated by a subject as a
reaction; such a reaction, had it occurred, would not have been
accepted, and it is plain that the experimenter wrote the stimulus
word in the space where the reaction word should have been written.
Still other errors were due to the experimenter's failure to speak
with sufficient distinctness when reading off the stimulus words;
thus, the reaction _barks_ in response to _dark_ indicates that the
stimulus word was probably understood as _dog_; and the reactions
_blue_ and _color_ in response to _bread_ indicate that the stimulus
word was understood as _red_.]

The total number of different words elicited in response to any
stimulus word is limited, varying from two hundred and eighty words in
response to _anger_ to seventy-two words in response to _needle_.
Furthermore, for the great majority of subjects the limits are still
narrower; to take a striking instance, in response to _dark_ eight
hundred subjects gave one or another of the following seven words:
_light, night, black, color, room, bright, gloomy;_ while only two
hundred gave reactions other than these words; and only seventy
subjects, out of the total number of one thousand, gave reactions
which were not given by any other subject.

If any record obtained by this method be examined by referring to the
frequency tables, the reactions contained in it will fall into two
classes: the _common_ reactions, those which are to be found in
the tables, and the _individual_ reactions, those which are not
to be found in the tables. For the sake of accuracy, any reaction word
which is not found in the table in its identical form, but which is a
grammatical variant of a word found there, may be classed as

_doubtful_.

The value of any reaction may be expressed by the figure representing
the percentage of subjects who gave it. Thus the reaction,
_table--chair_, which was given by two hundred and sixty-seven
out of the total of our one thousand subjects, possesses a value of
26.7 per cent. The significance of this value from the clinical
standpoint will be discussed later.

Sec. 4. NORMAL ASSOCIATIONAL TENDENCIES

The normal subjects gave, on the average. 6.8 per cent of individual
reactions, 1.5 per cent of doubtful ones, and 91.7 cent of common
ones. The range of variation was rather wide, a considerable number of
subjects giving no individual reactions at all, while a few gave over
30 per cent.[1]

[Footnote 1: In the study of the reactions furnished by our normal
subjects it was possible to analyze the record of any subject only by
removing it from the mass of material which forms our tables, and
using as the standard of comparison the reactions of the remaining 999
subjects.]

In order to determine the influence of age, sex, and education upon
the tendency to give reactions of various values, we have selected
three groups of subjects for special study: (1) one hundred persons of
collegiate or professional education; (2) one hundred persons of
common school education, employed in one of the State hospitals as
attendants, but not as trained nurses; and (3) seventy-eight children
under sixteen years of age. The reactions given by these subjects have
been classified according to frequency of occurrence into seven
groups: (a) individual reactions (value 0); (b) doubtful reactions
(value +-); (c) reactions given by one other person (value 0.1 per
cent); (d) those given by from two to five others (value 0.2--0.5 per
cent); (e) those given by from six to fifteen others (value 0.6-1.5
per cent); (f) those given by from sixteen to one hundred others
(value 1.6--10.0 per cent); and (g) those given by more than one
hundred others (value over 10.0 per cent). The averages obtained from
these groups of subjects are shown in Table 1, and the figures for men
and women are given separately.

TABLE I

Value of reaction 0 +- 0.1 0.2-0.5 0.6-1.5 1.6-10 >10
Sex Number % % % % % % %
of cases

Persons of M.. 60 9.2 1.8 5.2 9.7 11.0 27.8 85.5
collegiate F... 40 9.5 1.8 8.0 9.8 11.7 28.0 83.4
education Both 100 9.3 1.8 4.7 8.7 11.8 28.2 34.4
Persons of M.. 50 5.8 1.6 8.6 8.3 10.2 81.6 88.7
common school F.. 50 4.6 1.8 8.8 7.1 9.4 82.0 42.1
education Both 100 5.2 1.4 3.5 7.7 9.8 81.8 40.4
School children M... 33 5.9 0.8 4.2 8.7 10.0 28.6 88.5
under 16 Jr. F.. 45 5.0 1.0 4.6 9.8 11.0 80.1 36.7
years of age Both 78 5.7 1.4 4.6 9.8 11.2 29.4 87.4
General average. Both.1000 6.8 1.5

It will be observed that the proportion of individual reactions given
by the subjects of collegiate education is slightly above the general
average for all subjects, while that of each of the other classes is
below the general average. In view, however, of the wide limits of
variation, among the thousand subjects, these deviations from the
general average are no larger than might quite possibly occur by
chance, and the number of cases in each group is so small that the
conclusion that education tends to increase the number of individual
reactions would hardly be justified.

It will be observed also that this comparative study does not show any
considerable differences corresponding to age or sex.

With regard to the type of reaction, it is possible to select groups
of records which present more or less consistently one of the
following special tendencies: (1) the tendency to react by contrasts;
(2) the tendency to react by synonyms or other defining terms; and (3)
the tendency to react by qualifying or specifying terms. How clearly
the selected groups show these tendencies is indicated by Table
II. The majority of records, however, present no such tendency in a
consistent way; nor is there any evidence to show that these
tendencies, when they occur, are to be regarded as manifestations of
permanent mental characteristics, since they might quite possibly be
due to a more or less accidental and transient associational
direction. No further study has as yet been made of these tendencies,
for the reason that they do not appear to possess any pathological
significance.

TABLE II.

Special group values.
_____________________________________
Stimulus Reaction General Contrasting Defining Specifying
word. word. value. group 49 group 73 group 84
| subjects subjects subjects
|----- % No. % No. % No. %

chair........... 26.7 25 51.0 11 15.1 10 11.9
1. Table....{ furniture....... 7.5 0 0 13 17.8 4 4.8
round........... 1.0 1 2.0 0 0 4 4.5
wood............ 7.6 2 4.1 9 12.3 10 11.9

cotton.......... 2.8 0 0 1 1.4 5 6.0
easy............ 3.4 0 0 8 11.0 1 1.2
feathers........ 2.4 0 0 1 1.4 5 6.0
7. Soft.....{ hard............ 36.5 34 69.4 14 19.2 18 21.4
silk............ 1.0 0 0 0 0 2 2.4
sponge.......... 2.2 0 0 0 0 4 4.8

cloth........... 1.7 1 2.0 0 0 3 3.6
color........... 12.9 0 0 20 27.4 6 7.1
11. Black...{ dress........... 2.9 1 2.0 1 1.4 9 10.7
ink............. 1.4 0 0 1 1.4 4 4.8
white........... 33.9 31 63.3 17 23.3 18 21.4

desire.......... 19.7 7 14.3 21 28.8 10 11.9
26. Wish....{ longing......... 1.9 1 2.0 6 8.2 2 2.4
money........... 3.2 0 0 1 1.4 3 3.6

flowers......... 4.2 0 0 1 1.4 7 8.3
girl............ 2.4 0 0 0 0 5 0.0
29. Beau- homely.......... 2.7 3 6.1 0 0 0 0
tiful..{ lovely.......... 6.4 2 4.1 7 9.6 2 2.4
pleasing........ 1.6 0 0 3 4.1 0 0
sky............. 1.6 0 0 0 0 3 3.6
ugly............ 6.6 13 26.5 3 4.1 0 0

court........... 6.4 2 4.1 5 6.8 10 11.9
56. Justice.{ injustice....... 2.6 6 12.2 1 1.4 0 0
right........... 15.7 3 6.1 20 27.4 13 15.5

comfort......... 2.6 0 0 5 6.8 1 1.2
disease......... 0.9 2 4.1 0 0 1 1.2
59. Health..{ good............ 9.4 2 4.1 8 11.0 18 21.4
sickness........ 15.3 23 46.9 6 8.2 1 1.2
strength........ 11.2 2 4.1 12 16.4 4 4.8

arrow........... 1.3 0 0 0 0 2 2.4
fast............ 22.2 0 0 25 34.2 15 17.9
horse........... 2.8 1 2.0 1 1.4 6 7.1
65. Swift...{ quick........... 11.7 1 2.0 22 30.1 2 2.4
run............. 1.9 0 0 0 0 4 4.8
runner.......... 1.3 0 0 0 0 1 1.2
slow............ 19.0 30 61.2 2 2.7 4 4.8
speed........... 2.9 1 2.0 5 6.8 0 0

disagreeable.... 1.0 0 0 2 2.7 0 0
distasteful..... 1.0 0 0 4 5.5 0 0
gall............ 4.2 0 0 2 2.7 8 9.5
76. Bitter..{ medicine........ 3.7 0 0 0 0 3 3.6
quinine......... 2.3 0 0 0 0 6 7.1
sweet........... 30.5 31 63.3 8 11.0 12 14.3
taste........... 6.6 1 2.0 17 23.3 3 3.6

bread........... 20.6 17 34.7 4 5.5 18 21.4

eatable......... 1.2 0 0 9 12.3 0 0
81. Butter..{ food............ 6.3 1 2.0 14 19.2 3 3.6
sweet........... 1.2 0 0 0 0 3 3.6
yellow.......... 8.0 0 0 0 0 18 21.4

gladness........ 4.4 0 0 7 9.6 1 1.2
grief........... 1.8 4 8.2 0 0 0 0
86. Joy.....{ pleasure........ 12.1 1 2.0 13 17.8 7 8.3
sadness......... 1.3 2 4.1 0 0 0 0
sorrow.......... 13.5 23 46.9 2 2.7 2 2.4

Sec. 5. PRACTICAL CONSIDERATIONS.

This method is so simple that it requires but little training on the
part of the experimenter, and but little co-operation on the part of
the subject. It is not to be assumed that every reaction obtained by
it is a true and immediate association to the corresponding stimulus
word; but we have found it sufficient for the purpose of the test if
the subject can be induced to give, in response to each stimulus word,
any one word other than the stimulus word itself. No attempt is made
to determine the exact degree of co-operation in any case.

In the early stages of this investigation the reaction time was
regularly recorded. The results showed remarkable variations, among
both normal and insane subjects. In a series of twenty-five tests,
made more recently upon normal subjects, ninety reactions occupied
more than ten seconds, and fifty-four of the stimulus words elicited a
ten-second response from at least one subject.[1]

[Footnote 1: These tests were made by Dr. F. Lyman Wells, of the
McLean Hospital, Waverley, Mass., and he has kindly furnished these
data.]

It is noteworthy that these extremely long intervals occur in
connection with reactions of widely differing values. That they are by
no means limited to individual reactions is shown in Table III. by a
group of selected reactions, all given by normal subjects.

TABLE III.

Word combination Reaction time Value of
in seconds. reaction.
comfort--happiness 20 5.0%
short--long 11 27.9%
smooth--plane 16 2.3%
woman--lady 40 4.1%
hard--iron 12 2.4%
justice--judge 20 9.1%
memory--thought 20 8.1%
joy--pleasure 18 12.1%

It is apparent, even from a superficial examination of the material,
that the factors which cause variations of reaction time, both in the
normal state and in pathological states, are numerous and complex.

It has been the purpose of this study to establish as far as possible
strictly objective criteria for distinguishing normal from abnormal
associations, and for this reason we have made no attempt to determine
by means of introspection the causes of variations of reaction time.

It would seem that the importance and magnitude of the problem of
association time are such as to demand not merely a crude measurement
of the gross reaction time in a large number of cases, but rather a
special investigation by such exact methods as have been used by
Cattell [1] and others in the analysis of the complex reaction. It
would be impracticable for us to employ such methods in a study so
extensive as this.

[Footnote 1: Mind, Vol. XI, 1886.]

In view of these considerations we discontinued the recording of the
reaction time.

If the association test is to be useful in the study of pathological
conditions, it is of great importance to have a reliable measure of
the associational value of a pair of ideas. Many attempts have been
made to modify and amplify the classical grouping of associations
according to similarity, contrast, contiguity, and sequence, so as to
make it serviceable in differentiating between normal and abnormal
associations.

In this study we attempted to apply Aschaffenburg's [1] classification
of reactions, but without success. Our failure to utilize this system
of classification is assigned to the following considerations: (1)
Distinctions between associations according to logical relations are
extremely difficult to define; in many cases there is room for
difference of opinion as to the proper place for an association, and
thus the application of a logical scheme depends largely upon the
personal equation of the observer; that even experienced observers
cannot, in all cases, agree in placing an association is shown by
Aschaffenburg's criticisms of the opinions of other observers on this
point.[2] (2) Logical distinctions do not bring out clearly the
differences between the reactions of normal subjects and those of
insane subjects; logically, the reaction _bath--ink_, which was given
by a patient, might be placed in the class with the reaction
_bath--water_, although there is an obvious difference between the two
reactions. (3) Many of the reactions given by insane subjects possess
no obvious logical value whatever; but since any combination of ideas
may represent a relationship, either real or imagined, it would be
arbitrary to characterize such a reaction as incoherent.

[Footnote 1: Experimentelle Studien uber Association. Psychologische
Arbeiten, Vol. I, p. 209; Vol. II, p. 1; Vol. IV, p. 235.]

[Footnote 2: Loc. cit, Vol. 1, pp. 226-227.]

The criterion of values which is used in this study is an empirical
one. As has already been explained (p. 8), every word contained in the
frequency tables possesses a value of at least 0.1 per cent, and other
words have a zero value. With the aid of our method the difficulty of
classifying the reactions quoted above is obviated, as it is necessary
only to refer to the table to find their proper values: the value of
the reaction _bath--water_ is 33.9 per cent, while that of the
reaction _bath--ink_ is 0.

Logically the combination _health--wealth_ may be placed in any
one of four classes, as follows:

/ intrinsic / causal dependence
health--wealth / \ coordination
\
\ extrinsic / speech reminiscence
\ sound similarity

But since our table shows this association to have an empirical value
of 7.6 per cent, it becomes immaterial which of its logical relations
is to be considered the strongest. It is mainly important, from our
point of view, to separate reactions possessing an empirical value
from those whose value is zero.

Sec. 6. AN EMPIRICAL PRINCIPLE OF NORMAL ASSOCIATION.

On a general survey of the whole mass of material which forms the
basis of the first part of this study, we are led to observe that
_the one tendency which appears to be almost universal among normal
persons is the tendency to give in response to any stimulus word one
or another of a small group of common reactions_.

It appears from the pathological material now on hand that this
tendency is greatly weakened in some cases of mental disease. Many
patients have given more than 50 per cent of individual reactions.

It should be mentioned that occasionally a presumably normal subject
has given a record very similar to those obtained from patients, in
respect to both the number and the nature of the individual reactions.
A few subjects who gave peculiar reactions were known to possess
significant eccentricities, and for this reason we excluded their
records from the thousand records which furnished the basis for the
frequency tables; we excluded also a few peculiar records obtained
from subjects of whom nothing was known, on the ground that such
records would serve only to make the tables more cumbersome, without
adding anything to their practical value. The total number of records
thus excluded was seventeen.

It will be apparent to anyone who examines the frequency tables that
the reactions obtained from one thousand persons fall short of
exhausting the normal associational possibilities of these stimulus
words. The tables, however, have been found to be sufficiently
inclusive for the practical purpose which they were intended to
serve. Common reactions, whether given by a sane or an insane subject,
may, in the vast majority of instances, safely be regarded as
normal. As to individual reactions, they cannot all be regarded as
abnormal, but they include nearly all those reactions which are worthy
of special analysis in view of their possible pathological
significance. What can be said further of individual reactions,
whether normal or abnormal, will appear in the second part of this
contribution.

PART II.

ASSOCIATION IN INSANE SUBJECTS.

Sec. 1. GENERAL SURVEY OF PATHOLOGICAL MATERIAL.

The pathological material which forms the basis of the present part of
our study consists mainly of two hundred and forty-seven test records
obtained for the most part from patients at the Kings Park State
Hospital.

The different groups from which the cases were selected, together with
the number from each group, are shown in Table I.

TABLE I.

Dementia praecox 108 cases.
Paranoic conditions 33 "
Epilepsy 24 "
General Paresis 32 "
Manic-depressive insanity 32 "
Involuntary melancholia 8 "
Alcoholic psychoses 6 "
Senile dementia 4 "

A comparison of our pathological with our normal material _en
masse_ reveals in the former evidence of a weakening of the normal
tendency to respond by common reactions. This is shown in Table II.

TABLE II.

Common Doubtful Individual
reactions. reactions. reactions.
1,000 normal subject 91.7% 1.5% 6.8%

247 insane subjects 70.7% 2.5% 26.8%

It seems evident from this that pathological significance attaches
mainly to individual reactions, so that our study resolves itself
largely into (1) an analysis and classification of individual
reactions and (2) an attempt to determine what relationship, if any,
exists between the different types of reactions and the different
clinical forms of mental disease.

Sec. 2. CLASSIFICATION OF REACTIONS.

Those who have attempted to use the association test in the study of
insanity have felt the need of a practical classification of
reactions, and have at the same time encountered the difficulty of
establishing definite criteria for distinguishing the different groups
from one another. It is a comparatively simple matter to make these
distinctions in a general way and even to formulate a more or less
comprehensive theoretical classification, but there still remains much
difficulty in practice. We have made repeated attempts to utilize
various systems of classification which involve free play of personal
equation in their application. Although for us the matter is greatly
simplified by the elimination of all the common reactions with the aid
of the frequency tables, we have nevertheless met with no success. The
distinctions made by either of us have on no occasion fully satisfied,
at the second reading, either the one who made them or the other,
while a comparison of the distinctions made by each of us
independently has shown a disagreement to the extent of 20-35 per
cent.

We sought, therefore, to formulate a classification in which the
various groups should be so defined as to obviate the interference of
personal equation in the work of applying it, hoping thus to achieve
greater accuracy. In this we can lay claim to only partial success;
for, in the first place, having satisfactorily defined a number of
groups, we found it necessary in the end to provide a special group
for unclassified reactions, into which falls more than one-third of
the total number of individual reactions; and, in the second place, in
at least two of our groups the play of personal equation has not been
entirely eliminated, so that there is still a possibility of error to
the extent of five per cent of individual reactions, which means
approximately one per cent of the total number of reactions. We have
found, however, that in spite of these shortcomings the classification
here proposed is more serviceable than others which, though more
comprehensive, are at the same time lacking in definiteness.

Our classification consists of the following classes, groups and
subdivisions:

I. _Common reactions._
1. Specific reactions.
2. Non-specific reactions.

II. _Doubtful reactions._

III. _Individual reactions._
1. Normal reactions.
2. Pathological reactions:
A. Derivatives of stimulus words.
B. Partial dissociation:
(a) Non-specific reactions.
(b) Sound reactions:
a. Words.
b. Neologisms.
(c) Word complements.
(d) Particles of speech.
C. Complete dissociation:
(a) Perseveration:
a. Association to preceding stimulus.
b. Association to preceding reaction.
c. Repetition of preceding stimulus.
d. Repetition of previous stimulus.
e. Repetition of preceding reaction.
f. Repetition of previous reaction.
g. Reaction repeated five times (stereotypy).
(b) Neologisms without sound relation.
3. Unclassified.

Sec. 3. NON-SPECIFIC REACTIONS; DOUBTFUL REACTIONS.

*Non-specific Reactions.*--It has already been intimated that common
reactions are in the vast majority of instances to be regarded as
normal. From amongst them, however, a fairly definite group can be
separated out which seems to possess some pathological significance,
namely, the group which we have termed non-specific.

In this group are placed words which are so widely applicable as to
serve as more or less appropriate reactions to almost any of our
stimulus words. That such reactions are in value inferior to the
remaining group of common reactions, which we have termed, in
contradistinction, _specific reactions_, is perhaps sufficiently
obvious; we shall speak later, however, of their occurrence in both
normal and insane cases.

It is not always easy to judge whether or not a given reaction should
be classed as non-specific. A study of our material made with special
reference to this type of reactions has enabled us to select the
following list of words, any of which, occurring in response to any
stimulus word, is classed as a non-specific reaction:

article, articles
bad
beautiful, beauty
fine
good, goodness
great
happiness, happy
large
man
necessary, necessity
nice

object (noun)
people
person
pleasant, pleasantness, pleasing, pleasure
pretty
small
thinking, thought, thoughts
unnecessary
unpleasant
use, used, useful, usefulness, useless, uselessness, uses, using
woman
work

It should be mentioned that some of these words occur as reactions to
one or several stimulus words with such frequency
(_citizen--man_, value 27.8 per cent; _health--good_, value
9.4 per cent) as to acquire in such instances a value as high as that
of strictly specific reactions.

*Doubtful Reactions* have already been defined (p.40): any
reaction word which is not found in the table in its identical form,
but which is a grammatical variant or derivative of a word found
there, is placed in this group.

Sec. 4. INDIVIDUAL REACTIONS; EXPLANATION OF GROUPS AND METHODS OF
APPLICATION.

*Normal Reactions.*--Inasmuch as the frequency tables do not exhaust all
normal possibilities of reaction, a certain number of reactions which
are essentially normal are to be found among the individual reactions.
In order to separate these from the pathological reactions, we have
compiled an appendix to the frequency tables, consisting mainly of
specific definitions of groups of words to be included under each
stimulus word in our list. This appendix will be found at the end of
this paper.

A word of explanation is perhaps due as to the manner in which the
appendix has been compiled. It was developed in a purely empirical
way, the basis being such individual reactions, given by both normal
and insane subjects, as seemed in our judgment to be obviously normal.

It must be acknowledged that the appendix falls short of all that
might be desired. In the first place, its use involves to some slight
extent the play of personal equation, and it therefore constitutes a
source of error; in the second place, it is in some respects too
inclusive while in other respects it is not sufficiently so. However,
the error due to personal equation is slight; the inclusion of certain
"far-fetched" or even frankly pathological reactions may be discounted
by bearing in mind that the general value of this group is not equal
to that of the group of common reactions; and the number of strictly
normal reactions which are not included is after all small. Our
experience has shown us that the appendix constitutes an important aid
in the analysis of individual reactions.

*Pathological Reactions. Derivatives of Stimulus Words.*--We
place here any reaction which is a grammatical variant or derivative
of a stimulus word. The tendency to give such reactions seems to be
dependent upon a suspension or inhibition of the normal process by
which the stimulus word excites the production of a new concept, for
we have here not a production of a new concept but a mere change in
the form of the stimulus word. As examples of such reactions may be
mentioned: _eating--eatables_, _short--shortness_,
_sweet--sweetened_, _quiet--quietness_.

*Partial Dissociation.*--We have employed the term dissociation
to indicate a rupture of that bond--whatever be its nature-which may
be supposed to exist normally between stimulus and reaction and which
causes normal persons to respond in the majority of instances by
common reactions. And we speak of partial dissociation where there is
still an obvious, though weak and superficial, connection. Under this
heading we can differentiate four types:

*Non-specific Reactions* have already been defined; we
distinguish those in this class from those in the class of common
reactions by means of the frequency tables.

*Sound Reactions.*--This type requires no explanation; the main
difficulty is to decide what degree of sound similarity between
stimulus and reaction should be deemed sufficient for placing a
reaction under this heading. The total number of different sounds
used in language articulation is, of course, small, so that any two
words are liable to present considerable chance similarity. Some
time ago we estimated the average degree of sound similarity between
stimulus words and reaction words in a series of one hundred
test records obtained from normal persons; we found that on
the average 14.53 per cent of the sounds of the stimulus words
were reproduced, in the same order, in the reaction word. Our
experience finally led us to adopt the following general rule: A
reaction is to be placed under this heading when fifty per cent of
the sounds of the shorter word of the pair are identical with sounds
of the longer word and are ranged in the same order.

Among sound reactions we occasionally find *neologisms*; for these a
separate heading is provided. Possibly their occurrence may be taken
as an indication of an exaggerated tendency to respond by sound
reactions.

*Word Compliments.*--Here we include any reaction which, added to the
stimulus word, forms a word, a proper name, or a compound word in
common use.

*Particles of Speech.*--Under this heading we include articles,
numerals, pronouns, auxiliary verbs, adverbs of time, place and
degree, conjunctions, prepositions, and interjections.

*Complete Dissociation.*--Here are included reactions which
appear to be entirely unrelated to the corresponding stimulus words;
in the case of such reactions the stimulus words seem to act, as
Aschaffenburg has pointed out, merely as signals for discharge. This
subdivision contains several types of reactions which seem to be
dependent upon the phenomenon of perseveration; it contains also the
rather important type of neologisms.

The phenomenon of *preservation* occurs in cases in which one may
observe an abnormal immobility of attention. To react normally to a
series of stimulus words requires on the part of the subject, in the
first place, a certain alertness in order that he may grasp quickly
and clearly the meaning of each word, and, in the second place, a
prompt shifting of the mind from one reaction to the next. When such
mental mobility is lacking the subject is liable to react not by a
response adjusted to the stimulus word, but either by repeating a
previous stimulus or reaction, or by giving a word associated to the
preceding stimulus or reaction.

The names of the different types of reactions included under the
heading of perseveration are sufficiently descriptive; we shall here
refer only to those which require further definition.

*Association to Preceding Stimulus.*--Here is placed any reaction
that is shown by the frequency tables to be related to the stimulus
preceding the one in question. Seeming or even obvious relationship,
if not established by reference to the frequency tables, is
disregarded. In the tables, however, the combination may not exist in
direct order but only in reverse order, in which case the reaction is
included here. The following examples may serve as illustrations:

_thief--night_
_lion--pocket-book_

_Lion--pocket-book_ is not found in the frequency tables, and is,
therefore, an individual reaction; _thief--pocket-book_, however,
is found there; _pocket-book_ is, therefore, classed in this case
as an association to preceding stimulus.

_table--fork_
_dark--mutton_

_Dark--mutton_ is not found in the frequency tables;
_table--mutton_ is also not found there in the direct order, but
is found in the reverse order, viz.: _mutton--table; mutton_ is,
therefore, classed in this case as an association to preceding
stimulus.

*Association to Preceding Reaction.*--If either the reaction in
question or the preceding reaction happens to be one of the stimulus
words in our list, and a relationship between the two be found to
exist by reference to the frequency tables--whether in direct or in
reverse order--the reaction in question is classed as an association
to preceding reaction. This is illustrated by the following examples:

_eating--table_
_mountain--floor_

_Mountain--floor_ is an individual reaction; _table--floor_

is found in the frequency tables; _floor_ is, therefore, classed
as an association to preceding reaction.

_beautiful--flowers_
_window--red_

_Window--red_ is an individual reaction; _red--flowers_ is
found in the frequency tables; therefore, _red_ is classed as an
association to preceding reaction.

In cases in which neither the reaction in question nor the preceding
reaction happens to be one of our stimulus words, but a relationship
between them may be judged to exist without considerable doubt, the
reaction in question is also classed here. Example:

_priest--father_
_ocean--mother_

_Ocean--mother_ is an individual reaction; neither the word
_father_ nor the word _mother_ is among our stimulus words;
but the association between the words _father_ and _mother_
may be judged to exist without considerable doubt; therefore, in this
case _mother_ is classed as an association to preceding reaction.

In such cases as this personal equation must necessarily come into
play; comparative uniformity of judgment may, however, be attained by
systematically excluding any reaction the relationship of which to the
preceding reaction is subject to any considerable doubt and by placing
any such reaction in the unclassified group.

*Repetition of Previous Stimulus.*--Here we place any reaction
which is a repetition of any previous stimulus from amongst the ten
next preceding, at the same time placing *repetition of preceding
stimulus* under a separate heading.

*Neologisms.*--Here we place the newly coined words, so commonly
given by the insane, excepting such as possess a sound relationship to
the stimulus word, for which, as already stated, a special place in
the classification has been provided.

Neologisms might be divided into three types, as follows: (1) those
which arise from ignorance of language (_comfort--uncomfort,
short--diminiature_); (2) distortions of actual words, apparently
of pathological origin and not due to ignorance (_hungry--foodation,
thief--dissteal_); and (3) those which seem to be without any
meaning whatever (_scack, gehimper, hanrow, dicut_). It is,
however, impossible to draw clear-cut distinctions between these
types, and for this reason we have made no provision in our
classification for such division.

*Unclassified Reactions.*--This group is important, in the first
place, because it is numerically a large one, and in the second place,
because it contains certain fairly definite types of reactions which
are placed here for the sole reason that we have not been able to find
strictly objective criteria for their differentiation from other
types.

It has already been stated that the frequency tables, even together
with the appendix, fail to exhaust all normal possibilities of
association, so that a certain small number of perfectly normal
reactions must fall into the unclassified group. We submit the
following examples:

_music--listen_
_smooth--suave_
_sour--curdled_
_earth--mound_

Another type of reactions found in the unclassified group, though also
normal, yet not obviously so until explained by the subject, is
represented by those which originate from purely personal experiences,
such as the following, given by normal subjects:

_blossom--T....._
_hammer--J....._

The first of these reactions is explained by the subject's acquaintance
with a young lady, Miss T...., who has been nick-named "Blossom," and
the second is explained by the subject's having among her pupils at
school a boy by the name of J.... Hammer.

It would be difficult to estimate the proportion of such reactions in
the unclassified group, but we have gained the general impression that
it is small. An attempt to place them in a separate group could be
made only with the aid of explanations from the subjects; such aid in
the case of insane subjects is generally unreliable. Moreover, to
class these reactions as strictly normal would perhaps be going too
far, since their general value is obviously inferior to that of the
common reactions; and in any case in which they are given in unusually
large numbers they must be regarded as manifestation of a tendency to
depart from the normal to the extent to which they displace common
reactions. The next type of reactions met with in the unclassified
group is characterized by a peculiarly superficial, or non-essential,
or purely _circumstantial_ relationship to the stimulus. Such
reactions, though occasionally given by normal subjects, are more
often given by insane ones, and seem to be somewhat characteristic of
states of mental deterioration which are clinically rather loosely
described as puerilism. We offer the following examples, given by
normal subjects:

_music--town_
_sickness--summer_
_child--unknown_
_house--enter_

Still another type of reactions to be considered in this connection
consists of words which are in no way related to the corresponding
stimulus words, but which arise from _distraction_ of the subject
by surrounding objects, sounds, and the like. In some cases the
experimenter may be able to judge from the direction of the subject's
gaze, from a listening attitude, and so on, that certain reactions are
due to distraction. In other cases, particularly in cases of normal
subjects, the fact that certain reactions are due to distraction may
be determined by questioning the subject on this point immediately
after making the test; In work with insane subjects, as we have
several times had occasion to point out, such aid is generally not
available.

The group of unclassified reactions includes also one more type of
reactions which are of great importance both numerically and
otherwise. These are the *incoherent reactions*, that is to say,
reactions which are determined neither by the stimulus words, nor by
the agency of perseveration, nor by distraction.

Although the occurrence of incoherent reactions is hardly subject to
doubt, yet in no instance is it possible to establish with certainty
that a given reaction is of this type, for in no instance can a
remote, or an imagined, or a merely symbolic relationship between
stimulus and reaction be positively excluded. Some, indeed, would
assert that some such relationship must necessarily exist in every
instance, at least in the domain of the subconscious. This
circumstance necessitates the placing of this type of reactions in the
unclassified group.

In practice it may be found advisable in some cases to analyze the
unclassified reactions with a view to ascertaining to what extent each
of the various types is represented among them. But one here treads on
slippery ground, and one must be continually warned against the danger
of erroneous conclusions.

Sec. 5. ORDER OF PREFERENCE.

After having developed the classification here proposed we found that
there was still considerable room for difference of opinion in the
placing of many reactions, owing to the circumstance that in many
cases a reaction presents features which render it assignable under
any one of two or more headings. To leave the matter of preference in
grouping: to be decided in each case according to the best judgment of
the experimenter would mean introducing again the play of personal
equation, and would thus court failure of all our efforts to
accomplish a standardization of the association test. Therefore, the
necessity of establishing a proper order of preference for guidance in
the application of the classification became to us quite apparent.

In the arrangement of the order of preference we were guided mainly by
two principles, namely: (i) as between two groups of unequal
definition, the one which is more clearly defined and which,
therefore, leaves less play for personal equation is to be preferred;
(2) as between two groups of equal definition, the one which possesses
the greater pathological significance is to be preferred. In
accordance with these principles we have adopted the order of
preference shown in Table III., placing every reaction under the
highest heading on the list under which it may be properly classed.

TABLE III

1. Non-specific (common).
2. Doubtful reactions.
INDIVIDUAL REACTIONS.
3. Sound reactions (neologisms).
4. Neologisms without sound relation.
5. Repetition of preceding reaction.
6. Reaction repeated five times.
7. Repetition of preceding stimulus.
8. Derivatives.
9. Non-specific reactions.
10. Sound reactions (words).
11. Word complements.
12. Particles of speech.
13. Association to preceding stimulus.
14. Association to preceding reaction (by frequency tables).
15. Repetition of previous reaction.
16. Repetition of previous stimulus.
17. Normal (by appendix).
18. Association to preceding reaction (without frequency tables).
19. Unclassified.

Sec. 6. ERRORS INVOLVED IN THE USE OF ARBITRARY OBJECTIVE STANDARDS.

It may readily be seen that such definiteness and uniformity as this
classification possesses results from the introduction of more or less
arbitrary criteria for the differentiation of the various types of
reactions. The question might arise, To what extent do the
distinctions thus made correspond to reality? To consider, for
instance, our rule for the placing of sound reactions (50 per cent of
the sounds of the shorter word to be present, in the same order, in
the other word): when a given reaction (_man--minstrel_) is in
accordance with the rule assigned under the heading of sound
reactions, can it be assumed that sound similarity and not some other
relationship is the determining factor of the association in question?
Or when in, a given instance (_cabbage--cobweb_) the sound
similarity falls somewhat short of the standard required by the rule,
can it be assumed that sound similarity is not, after all, the
determining factor?

Similar questions may, of course, arise in connection with other
subdivisions.

It must, indeed, be conceded that objective methods can reveal but
indirectly and with uncertainty the inner mechanism which produces any
association and that in any given instance it would be impossible to
establish the correctness of grouping in accordance with such

methods. However, to decide that question for any given reaction is
really not necessary in practice, since an error made through wrongly
placing one, two, or three reactions tinder any heading is of no
significance; the types acquire importance only when represented by
large numbers in a record under consideration; and when many reactions
fall tinder a single heading the likelihood of error, as affecting the
record as a whole, is by that fact alone greatly reduced.

The whole question might more profitably be approached from another
point of view: To what extent are the distinctions of this
classification useful? An answer to this question can be found only in
the results.

Sec. 7. ANALYSIS OF PATHOLOGICAL MATERIAL

We present in Table IV, the results of a statistical examination of
the records obtained from certain groups of normal subjects and from
some groups of insane subjects.

The normal groups have been studied for the purpose of determining the
frequency and manner of occurrence among normal subjects of the
various of abnormal reactions. It seemed best for this purpose to
consider separately the records of those subjects who gave an
unusually large number of individual reactions. Fifty-three records
containing fifteen or more individual reactions were found after a
fairly diligent search among our normal test records. In the other
groups of subjects--persons of common school education, persons of
collegiate education, and children--we included no records containing
more than ten individual reactions.

The more striking departures from average normal figures are indicated
in the table by the use of heavy type.

This table reveals associational tendencies as occurring in connection
with the psychoses studied. A better insight into the nature of these
tendencies can be gained by a special analysis of the test of each
clinical group.

DEMENTIA PRAECOX

In this psychosis we find the number of individual reactions far
exceeding not only that of the normal but that of any other psychosis
which we studied. To a corresponding extent we find the number of the
highest type of normal reactions--the common specific
reactions--reduced.

TABLE IV.

TYPES OF REACTION
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA
+--+----+----+--+----+----+--+----+----+--+----+----+---+----+----+--+----+----+--+----+----+---+----+----+---+----+----+
_Common reactions:_ | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Specific reactions................|90|89.8|....|90|89.7|....|91|89.4|....|72|71.4|....|631/2|58.9|....|82|71.3|....|71|63.7|....|78 |71.8|....|80 |71.2|....|
Non-specific reactions............| 4| 4.9|....| 4| 4.1|....| 5| 5.7|....| 3| 4.8|....| 3 | 4.2|....| 4| 4.8|....| 5| 6.0|....|41/2 | 5.3|....|31/2 | 4.6|....|
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
_Doubtful reactions_................| 1| 1.1|....| 1| 0.6|....| 0| 0.7|....| 2| 2.3|....| 2 | 2.5|....| 2| 3.0|....| 3| 3.0|....| 2 | 2.2|....| 2 | 3.0|....|
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
_Individual reactions:_ | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Normal reactions..................| 2| 1.8|41.8| 1| 1.8|35.8| 1| 1.6|42.0| 7| 7.3|33.4| 4 | 4.8|13.9| 3| 3.5|16.3|31/2| 3.4|12.6| 3 | 3.6|17.4|41/2 | 5.3|24.3|
Derivatives of stimulus words.....| 0|0.01| 0.3| 0|0.02| 0.3| 0| 0| 0 | 0|0.04| 0.2| 0 |0.16|0.46| 0|0.10|0.40| 0|0.04|0.15| 0 |0.09|0.45| 0 |0.09|0.43|
Non-specific Reactions............| 0| 0.1| 3.3| 0|0.1 | 1.2| 0|0.2 | 5.3| 0|0.4 | 2.0| 0 |0.6 |1.7 | 0|0.4 |1.7 | 0|0.5 |1.8 | 1 |0.5 |2.4 | 0 |0.3 |1.6 |
Sound reactions (words)...........| 0|0.08| 1.9| 0|0.05| 0.9| 0| 0 | 0 | 0|0.11| 0.5| 0 |1.62|4.7 | 1|1.60|7.4 | 0|0.54|2.0 | 0 |0.22|1.0 | 1 |1.53|7.1 |
Sound reactions (neologisms)......| 0|0.01| 0.3| 0|0.02| 0.3| 0| 0 | 0 | 0| 0 | 0 | 0 |0.07|0.2 | 0|1.0 |4.7 | 0|0.17|0.6 | 0 |0.06|0.3 | 0 |0.03|0.1 |
Word complements..................| 0|0.01| 0.3| 0|0.03| 0.6| 0| 0 | 0 | 0|0.08| 0.3| 0 |0.06|0.2 | 0|0.03|0.1 | 0| 0 | 0 | 0 |0.06|0.3 | 0 |0.10|0.9 |
Particles of speech...............| 0|0.09| 2.2| 0|0.06| 1.2| 0|0.06| 1.6| 0|0.68| 3.1| 0 |1.06|3.1 | 0|0.50|2.2 | 0|1.53|5.3 | 0 |1.22|5.3 | 0 |1.32|6.1 |
Association to preceding stimulus.| 0|0.06| 1.4| 0|0.06| 1.2| 0|0.04| 1.1| 0|0.49| 2.2| 0 |0.92|2.7 | 0|0.60|2.7 | 1|1.04|3.8 | 0 |0.75|3.6 | 0 |0.53|2.5 |
Association to preceding reaction.| 0| 0 | 0 | 0| 0 | 0 | 0|0.04| 1.0| 0|0.09| 0.4| 1 |1.29|3.8 | 0|0.40|2.0 | 1|2.50|9.2 | 1 |3.69|17.7| 0 |0.37|1.7 |
Repetition of preceding stimulus..| 0| 0 | 0 | 0|0.03| 0.6| 0| 0 | 0 | 0| 0 | 0 | 0 |0.06|0.2 | 0| 0 | 0 | 0|0.08|0.3 | 0 | 0 | 0 | 0 | 0 | 0 |
Repetition of previous stimulus...| 0| 0 | 0 | 0|0.01| 0.3| 0| 0 | 0 | 0|0.02| 0.1| 0 |0.12|0.4 | 0|0.10|0.4 | 0|0.29|1.1 | 0 |0.28|1.4 | 0 |0.22|1.0 |
Repetition of preceding reaction..| 0| 0 | 0 | 0|0.03| 0.6| 0|0.02| 0.5| 0|0.08| 0.3| 0 |1.16|3.4 | 0|0.12|0.6 | 0|0.58|2.1 | 0 |2.28|10.9| 0 |0.73|3.6 |
Repetition of previous reaction...| 0|0.21| 4.7| 0|0.31| 6.3| 0|0.23| 5.8| 0|0.92| 4.2| 1 |2.72|7.9 | 1|1.51|7.1 | 3|3.46|12.7| 0 |0.87|4.2 | 0 |0.91|4.2 |
Reaction repeated five times......| 0| 0 | 0 | 0|0.05| 0.9| 0|0.08| 2.1| 0|0.32| 1.5| 0 |1.52|4.4 | 0|1.21|5.5 | 0|4.58|16.8| 0 |1.28|6.1 | 0 |0.81|3.8 |
Neologisms without sound relation.| 0| 0 | 0 | 0| 0 | 0 | 0|0.02| 0.5| 0| 0 | 0 | 0 |1.90|5.5 | 0|0.81|3.7 | 0|0.58|2.1 | 0 |0.09|0.4 | 0 |0.31|1.5 |
Unclassified......................| 2| 1.8|43.4| 2|2.5 |50.3| 1|1.5 |39.4|11|11.1|51.2|11 |16.2|47.2| 5|9.3 |43.5| 6|7.7 |28.5| 5 |5.9 |28.4| 4 |8.6 |40.1|
+--+----+----+--+----+----+--+----+----+--+----+----+---+----+----+--+----+----+--+----+----+---+----+----+---+----+----+
Total individual reactions | 4| 4.2|....| 5|5.1 |....| 9|3.9 |....|21|21.8|....|261/2|34.3|....|10|21.3|....|19|27.2|....|141/2|20.8|....|111/2|21.5|....|
+--+----+----+--+----+----+--+----+----+--+----+----+---+----+----+--+----+----+--+----+----+---+----+----+---+----+----+

86 normal subjects, common school education; records containing not
over 10 individual reactions.

A. Median per cent of all reactions.
B. Average per cent of all reactions.
C. Average per cent of individual reactions.

66 normal subjects, collegiate education; records containing not over
10 individual reactions.

D. Median per cent of all reactions.
E. Average per cent of all reactions.
F. Average per cent of individual reactions.

46 normal subjects, school children; records containing not over 10
individual reactions.

G. Median per cent of all reactions.
H. Average per cent of all reactions.
I. Average per cent of individual reactions.

53 normal subjects; records containing not under 15 individual
reactions.

J. Median per cent of all reactions.
K. Average per cent of all reactions.
L. Average per cent of individual reactions.

108 cases of dementia praecox.

M. Median per cent of all reactions.
N. Average per cent of all reactions.
O. Average per cent of individual reactions.

33 cases of paranoic conditions.

P. Median per cent of all reactions.
Q. Average per cent of all reactions.
R. Average per cent of individual reactions.

24 cases of epilepsy.

S. Median per cent of all reactions.
T. Average per cent of all reactions.
U. Average per cent of individual reactions.

32 cases of general paresis.

V. Median per cent of all reactions.
W. Average per cent of all reactions.
X. Average per cent of individual reactions.

32 cases of manic-depressive insanity.

Y. Median per cent of all reactions.
Z. Average per cent of all reactions.
AA. Average per cent of individual reactions.

While almost every type of individual reactions shows here an increase
over the normal averages, the most striking increases are shown by the
table to be in the groups of unclassified reactions, neologisms, sound
reactions, and some types of perseveration. A further examination of
the individual test records shows that there is no uniformity of
associational tendencies in this clinical group, but that several
tendencies are more or less frequently met with either alone or in
various combinations. Yet some of these tendencies, when appearing at
all prominently, are so highly characteristic of dementia praecox as to
be almost pathognomonic. Among these may be mentioned: (1) the
tendency to give _neologisms_, particularly those of the
senseless type; (2) the tendency to give unclassified reactions
largely of the _incoherent_ type; and (3) the tendency toward
_stereotypy_ manifested chiefly by abnormally frequent
repetitions of the same reaction. Fairly characteristic also is the
occasional tendency to give sound reactions. Again, occasionally one
encounters pronounced _perseveration_, and at least two of our
subjects gave a good many unclassified reactions obviously due to
_distraction_.

It must be noted that not infrequently cases of dementia praecox give
test records that cannot be distinguished from normal. It seems that
the pathological associational tendencies constitute merely a special
group of symptoms, some of which may be expected to be manifest in
cases which have reached a state of advanced mental deterioration, but
may not necessarily be present in the early stages of the disease. On
the other hand there is evidence to show that these tendencies may in
some cases appear among the earliest manifestations. This matter will
be referred to again.

Thus the test records of dementia praecox depart from the normal not
sharply but by a gradual shading off. We find similar gradual
transitions between dementia praecox and other psychoses. For this
work we selected cases in which the diagnoses were established with
reasonable certainty. Whether or not in cases of doubtful clinical
classification this association test may be of aid in determining the
diagnosis, is a question that must for the present remain open.

We submit herewith copies of test records. The numbers which appear
after the reactions indicate in each case the reaction type, in
accordance with Table III. (p. 27); common specific reactions are not
numbered.

CASE No. 4752.--H.J. Neologisms; some unclassified reactions, mostly
incoherent.

Table--meadow.........19
Dark--black...........
Music--sweet..........
Sickness--dead........ 2
Man--manion........... 3
Deep--near............19
Soft--sooner..........19
Eating--formble....... 4
Mountain--gair........ 4
House--temble......... 4
Black--benched........ 4
Mutton--ranched....... 4
Comfort--bumble....... 4
Hand--semble.......... 4
Short--simber......... 4
Fruit--narrow.........13
Butterfly--Ben........19
Smooth--gum...........19
Command--bramble......19
Chair--low............
Sweet--temper.........19
Whistle--bensid....... 4
Woman--hummery........ 4
Cold--gunst........... 4
Slow--bemper.......... 4
Wish--tip.............19
River--gumper......... 4
White--Andes..........19
Beautiful--giinper.... 4
Window--hummer........ 4
Rough--geep........... 4
Citizen--humper....... 4
Foot--zuper........... 4
Spider--gumper........ 4
Needle--himper........ 4
Red--gumper........... 4
Sleep--moop........... 4
Anger--rumble.........19
Carpet--slamper....... 4
Girl--Mnker........... 4
High--bumper.......... 4
Working--gumpip....... 4
Sour--imper........... 4
Earth--gumper......... 4
Trouble--humper....... 4
Soldier--guipper...... 4
Cabbage--phar......... 4
Hard--her.............12
Eagle--damnornott..... 4
Stomach--dumper....... 4
Stem--gumper.......... 4
Lamp--huntenit........ 4
Dream--hungnot........ 4
Yellow--bampir........ 4
Bread--gumper......... 4
Justice--sidnerber.... 4
Boy--eeper............ 4
Light--huntznit....... 4
Health--geeper........ 4
Bible--himpier........ 4
Memory--hummer........19
Sheep--hunner......... 4
Bath--bemnitper....... 4
Cottage--gumper....... 4
Swift--dumper......... 4
Blue--dipper..........19
Hungry--hummer........ 3
Priest--rump..........19
Ocean--himmer......... 4
Head--hiniper......... 4
Stove--gamper......... 4
Long--humble..........19
Religion--gumper...... 4
Whiskey--numper....... 4
Child--himmer......... 4
Bitter--gehimper...... 3
Hammer--gueep......... 4
Thirsty--humper....... 4
City--deeper..........19
Square--bummer........ 4
Butter--bimper........ 3
Doctor--harner........ 4
Loud--harner.......... 4
Thief--himmer......... 4
Lion--humor...........19
Joy--gumpier.......... 4
Bed--hoomer........... 4
Heavy--doomer......... 4
Tobacco--per..........12
Baby--hoomer.......... 4
Moon--gumper.......... 4
Scissors--gumper...... 4
Quiet--humper......... 4
Green--gueet.......... 3
Salt--rummer.......... 4
Street--numper........ 4
King--himper.......... 4
Cheese--guinter....... 4
Blossom--yunger....... 4
Afraid--yunger........ 4

CASE No. 5183.--G. D. Neologisms; numerous unclassified reactions,
mostly incoherent; some sound neologisms.

Table--muss...........19
Dark--gone............19
Music--caffa.......... 4
Sickness--monk........19
Man--boy..............
Deep--lesson..........19
Soft--ness............ 4
Eating--pie............
Mountain--Gus.........19
House--muss...........15
Black--court..........19
Mutton--beef..........
Comfort--ness......... 4
Hand--koy............. 4
Short--ness........... 4
Fruit--dalb........... 4
Butterfly--flack...... 4
Smooth--mess..........19
Command--cork.........19
Chair--ness........... 4
Sweet--Bess...........17
Whistle--toy..........
Woman--girl...........
Cold--cork............15
Slow--mass............19
Wish--veil............ 4
River--mouth..........17
White--cast...........17
Beautiful--ness....... 4
Window--crow..........19
Rough--ratter.........19
Citizen--zide......... 4
Foot--malloy.......... 4
Spider--straw.........19
Needle--cast..........15
Red--Roman............19
Sleep--scack.......... 4
Anger--gois........... 4
Carpet--noise.........13
Girl--call............18
High--hort............ 4
Working--kaffir.......19
Sour--romerscotters... 4
Earth--bell...........19
Trouble--tramine...... 4
Soldier--gas..........19
Cabbage--cor.......... 4
Hard--kalbas.......... 4
Eagle--bell...........15
Stomach--chenic....... 4
Stem--trackstar....... 3
Lamp--loss............19
Dream--melso.......... 4
Yellow--ormondo....... 4
Bread--life...........
Justice--quartz.......19
Boy--nellan........... 4
Light--cor............ 4
Health--hallenbee..... 4
Bible--book...........
Memory--bike..........19
Sheep--armen.......... 4
Bath--cor............. 4
Cottage--callan....... 4
Swift--swar........... 3
Blue--blacksen........ 4
Hungry--scatterbuck... 4
Priest--canon.........17
Ocean--men............19
Head--will............19
Stove--somen.......... 4
Long--lass............19
Religion--cor......... 4
Whiskey--hanrow....... 4
Child--vand........... 4
Bitter--bike..........15
Hammer--hemmel........ 3
Thirsty--cass......... 4
City--cor............. 4
Square--malice........19
Butter--back..........19
Doctor--ness.......... 4
Loud--arman........... 4
Thief--cast...........15
Lion--loss............15
Joy--kaffir...........15
Bed--banrow........... 4
Heavy--cast...........15
Tobacco--colrow....... 4
Baby--boil............19
Moon--padoc........... 4
Scissors--kantow...... 4
Quiet--kilroe......... 4
Green--graft..........10
Salt--semen...........19
Street--pess.......... 4
King--guess...........19
Cheese--tiffer........ 4
Blossom--cad..........19
Afraid--mellows.......19

CASE No. 1500.--D.V. Considerable number of neologisms; stereotypy
manifested partly in a tendency toward frequent repetition of certain
reactions but mainly in a persistent tendency to make use of the
grammatical form of present participle, giving rise to numerous
doubtful reactions.

Table--stand..........
Dark--lonesome........
Music--playing........
Sickness--disease.....
Man--hiding...........19
Deep--unreckless...... 4
Soft--beginning.......19
Eating--plenty........
Mountain--high........
House--standing....... 6
Black--grivelling..... 4
Mutton--plenty........15
Comfort--laying.......19
Hand--disease.........15
Short--writing........13
Fruit--coming.........19
Butterfly--flying.....
Smooth--glimming...... 4
Command--master.......
Chair--standing....... 6
Sweet--sugar..........
Whistle--blowing......
Woman--loving.........
Cold--cellar..........19
Slow--coming..........15
Wish--dreaming........ 2
River--divided........19
White--wall...........
Beautiful--pleasant... 1
Window--breaking...... 2
Rough--tumble.........
Citizen--gentleman....
Foot--sweating........19
Spider--biting........ 2
Needle--stinging...... 2
Red--coloring.........
Sleep--dreaming.......
Anger--widing......... 4
Carpet--cleaning......
Girl--pretty.......... 1
High--degrace......... 4
Working--nobody.......19
Sour--holling......... 4
Earth--disgrace.......19
Trouble--plenty.......
Soldier--shooting.....13
Cabbage--welldebell... 4
Hard--earning......... 4
Eagle--setting........19
Stomach--degrivel..... 4
Stem--biting..........19
Lamp--burning.........
Dream--walking........19
Yellow--blowing.......15
Bread--making.........
Justice--unpossible... 4
Boy--growing.......... 2
Light--stand.......... 6
Health--raising.......19
Bible--teaching....... 2
Memory--together......12
Sheep--weeding........19
Bath--held............19
Cottage--standing..... 2
Swift--incuriossable.. 4
Blue--smooven......... 4
Hungry--uncareless.... 4
Priest--going.........19
Ocean--moving......... 2
Head--setting.........15
Stove--warm...........
Long--slowly.......... 2
Religion--everything..19
Whiskey--burning......
Child--born...........
Bitter--taking........19
Hammer--hitting....... 2
Thirsty--drinking.....
City--welldebell...... 4
Square--taking........15
Butter--soft..........
Doctor--instrument....19
Loud--speaking........ 2
Thief--gitting........ 4
Lion--scared..........17
Joy--playing.......... 2
Bed--laying........... 2
Heavy--raisen......... 4
Tobacco--eating.......19
Baby--born............
Moon--shining.........
Scissors--cutting.....

Quiet--hitting........15
Green--landed.........19
Salt--throwing........19
Street--walking.......
King--tension.........19
Cheese--eating........
Blossom--growing...... 2
Afraid--nobody........

CASE No. 5138.--C.J. Unclassified reactions, mostly incoherent.

Table--tablecloth.....
Dark--forward.........19
Music--instrument.....
Sickness--fluid.......19
Man--hemale........... 4
Deep--steep...........
Soft--hard............
Eating--mountain......19
Mountain--raven.......19
House--shutter........17
Black--blue...........
Mutton--beef..........
Comfort--discomfort...
Hand--wrist...........
Short--tall...........
Fruit--vegetable......
Butterfly--bee........
Smooth--rough.........
Command--orders.......
Chair--sofa...........
Sweet--sour...........
Whistle--fife.........
Woman--girl...........
Cold--warm............
Slow--faster.......... 2
Wish--not............. 2
River--neck...........17
White--blue...........
Beautiful--homely.....
Window--sill..........
Rough--paint..........19
Citizen--pedestrian...19
Foot--rose............19
Spider--towel.........19
Needle--lifter........19
Red--dove.............19
Sleep--coat...........13
Anger--smile..........19
Carpet--gas...........19
Girl--kite............19
High--cow.............19
Working--candy........19
Sour--peach...........17
Earth--balloon........19
Trouble--grass........13
Soldier--brass........17
Cabbage--flea.........19
Hard--cat.............19
Eagle--negro..........10
Stomach--winter.......19
Stem--leaf............
Lamp--cloth...........19
Dream--slumber........
Yellow--pink..........
Bread--glass..........19
Justice--coal.........19
Boy--maid.............
Light--shine..........
Health--pale..........17
Bible--leaf...........
Memory--grief.........19
Sheep--giraffe........19
Bath--soap............
Cottage--scene........19
Swift--slow...........
Blue--piece...........19
Hungry--food..........
Priest--minister......
Ocean--waves..........
Head--black...........
Stove--lid............
Long--short...........
Religion--Christian...
Whiskey--malt.........
Child--baby...........
Bitter--sweet.........
Hammer--nail..........
Thirsty--water........
City--steeple.........19
Square--marble........19
Butter--bread.........
Doctor--aster.........19
Loud--fog.............19
Thief--Mary...........19
Lion--tiger...........
Joy--glad.............
Bed--sheet............
Heavy--light..........
Tobacco--smoke........
Baby--powder..........
Moon--sky.............
Scissors--handle......
Quiet--sing...........19
Green--pink...........
Salt--chimney.........19
Street--block.........
King--crown...........
Cheese--tea...........17
Blossom--leaves.......
Afraid--frighten......

CASE No. 17979.--R.T. Unclassified reactions, mostly incoherent.

Table--full...........19
Dark--coldness........ 2
Music--aeronaut.......19
Sickness--better......
Man--extension........19
Deep--electrician.....19
Soft--harden.......... 2
Eating--stomach.......
Mountain--Lord........19
House--roof...........
Black--darkness.......
Mutton--working.......19
Comfort--ahead........12
Hand--mercury.........19
Short--have...........12
Fruit--flavor.........19
Butterfly--plant......13
Smooth--level.........
Command--obedient.....
Chair--rest...........
Sweet--polish.........19
Whistle--note.........
Woman--comfort........
Cold--pleasant........ 1
Slow--move............
Wish--wealth..........
River--shell..........19
White--change.........19
Beautiful--sat........19
Window--temperature...39
Rough--shell..........15
Citizen--soldier......
Foot--travel..........
Spider--web...........
Needle--point.........
Red--temperature......15
Sleep--rest...........
Anger--temper.........
Carpet--court.........10
Girl--birth...........10
High--dirt............19
Working--ease.........
Sour--bait............ 4
Earth--vexation.......19
Trouble--business.....
Soldier--obedient..... 2
Cabbage--fell.........19
Hard--solid...........
Eagle--government.....19
Stomach--chest........
Stem--wish............19
Lamp--brilliancy......17
Dream--unso........... 4
Yellow--color.........
Bread--crust..........
Justice--truth........
Boy--obedient.........
Light--heart.......... 2
Health--feeling.......
Bible--scripture......
Memory--saying........19
Sheep--wool...........
Bath--get.............19
Cottage--morrell...... 4
Swift--good........... 1
Blue--look............19
Hungry--have..........12
Priest--scripture.....15
Ocean--supply.........19
Head--manager.........17
Stove--shake..........19
Long--journey.........
Religion--thought..... 1
Whiskey--lusk......... 4
Child--wish...........15
Bitter--enmalseladiga. 4
Hammer--efface........19
Thirsty--want.........
City--comforts........15
Square--crown.........19
Butter--flavor........15
Doctor--dram..........19
Loud--temper..........15
Thief--catched........ 2
Lion--crown...........15
Joy--pleasure......... 1
Bed--comforts.........
Heavy--thoughts....... 1
Tobacco--changes......15
Baby--pleasure........ 1
Moon--brilliancy...... 2
Scissors--edge........
Quiet--baptism........19
Green--autumn.........19
Salt--gather..........19
Street--thoroughfare..
King--crown...........
Cheese--flavor........15
Blossom--wood.........17
Afraid--downhearted...17

CASE No. 3307.--G.F. Unclassified reactions, mostly incoherent; slight
tendency to respond by sound reactions.

Table--desk...........
Dark--blue............
Music--stars..........13
Sickness--trees.......19
Man--menace...........10
Deep--soap............19
Soft--excited.........19
Eating--spelling......10
Mountain--marbles.....19
House--train..........19
Black--bed............19
Mutton--button........10
Comfort--steak........13
Hand--flexible........19
Short--umbrella.......17
Fruit--blanket........19
Butterfly--grass......
Smooth--sheet.........19
Command--carpet.......19
Chair--store..........19
Sweet--flower.........
Whistle--linen........19
Woman--water..........19
Cold--coal............
Slow--ferry...........17
Wish--sample..........19
River--shades.........19
Whiter--blue..........
Beautiful--suspender..19
Window--wood..........
Rough--chisel.........19
Citizen--ruler........
Foot--snake...........19
Spider--fly...........
Needle--bird..........13
Red--green............
Sleep--opening........19
Anger--angry..........
Carpet--stitching.....19
Girl--madam...........17
High--ceiling.........
Working--easy.........
Sour--warm............19
Earth--heaven.........
Trouble--astonished...19
Soldier--man.......... 1
Cabbage--carrot.......
Hard--softness........ 2
Eagle--parrot.........
Stomach--mind.........19
Stem--stable..........10
Lamp--oil.............
Dream--awake..........
Yellow--darkness...... 2
Bread--rough..........19
Justice--male.........19
Boy--buoy.............10
Light--standing.......19
Health--very..........12
Bible--ashamed........19
Memory--staring.......19
Sheep--stock..........
Bath--sponge..........
Cottage--house........
Swift--mouse..........19
Blue--fall............19
Hungry--appetite......
Priest--pastor........
Ocean--waves..........
Head--hat.............
Stove--blackening..... 2
Long--garden..........19
Religion--goodness.... 1
Whiskey--Kummell......17
Child--woman.......... 1
Bitter--coughing......19
Hammer--sofa..........19
Thirsty--pillow.......18
City--united..........19
Square--oblong........
Butter--lard..........
Doctor--physician.....
Loud--easy............
Thief--burglar........
Lion--tiger...........
Joy--healthy.......... 2
Bed--thread...........10
Heavy--gloves.........17
Tobacco--cigar........
Baby--hood............11
Moon--stars...........
Scissors--knife.......
Quiet--recollect......17
Green--ring...........19
Salt--pencil..........19

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