A Study of Association in Insanity

Part Ii. Association in Insane Subjects.

§1. General Survey of Pathological Material

§2. Classification of Reactions

§3. Non-Specific Reactions; Doubtful Reactions

§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

§5. Order of Preference

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

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

§8. Pathological Reactions from Normal Subjects

§9. Number of Different Words given as Reactions

§10. Co-operation of the Subject

§11. Summary

Acknowledgments

INDEX TO FREQUENCY TABLES AND APPENDIX

THE FREQUENCY TABLES

APPENDIX TO THE FREQUENCY TABLES

PART I.. Association in Normal Subjects.

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.

§ 1. METHOD OF INVESTIGATION.

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

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.

§ 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.

§ 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. These tables will be found at the end of this paper.

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.

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.

§ 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.

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.

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