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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