Mental defectives; their history, treatment, and training

Foreword

The studies herein presented — several of which have appeared from time to time in various journals — have been written in response to many inquiries that have come to me regarding mental defectives.

The result of an experience of almost twenty years in carrying forward principles of treatment and of training, tested, proven and denned — it addresses itself primarily to anxious parents and to earnest teachers, rather than to the scientist. No effort has been spared to render the statistics accurate, and the statements trustworthy, all doubtful data having been unhesitatingly discarded. In endeavoring to emphasize the utter hopelessness of cure, and also the needless waste of energy in attempting to teach an idiot, I have sought to make clear the possibilities that may be attained in the training of the imbecile, the urgent need of preventing the backward child from degenerating into imbecility, and of safeguarding the absolutely irresponsible ammoral imbecile from crime and its penalty.

Some subjects I have not touched upon at all for obvious reasons, nor have I dwelt at any length upon the stigmata of degeneration. Sexual inversion is not a subject to present to the general reader, and researches into both the psychology and pathology of idiocy have yet to gather sufficient data upon which to base dogmatic opinion.

My acknowledgments are due to my immediate associates as well as to many colaborers in the work at large, whose experience has aided me in substantiating theories, in working out basic principles, and in verifying conclusions. In this last my three " boys " have materially contributed, in addition to the aid gladly and efficiently rendered in the preparation of the book; many of the photographs by Jake, the translations by Arthur, and the entire typewriting of the manuscript by Judson, all being an exposition of the main argument — the possibilities to be attained through training.

Martin W. Barr.

Pennsylvania Training School for Feeble-Minded Children, Elwyn, Pa., August i, 1904.

Table Of Contents

Chapter. Page.

I. Synonyms and Definitions 17

II. History 24

Chapter I

synonyms and definitions.

Synonyms.

Through all ages, in many climes, we may trace the close analogy in many tongues, of the various titles of mental defect, thus :

Greek. — Iditas; idios.

Latin. — Amentia; fatuitas; imbecillitas.

Italian. — Idiotismo ; tardivi.

Spanish. — Idiota; idiotismo; tardo.

French. — Idiote; imbecile; les enfants du bon Dieu; les enfants arrieres; demence innee; idiotisme; beganne (Island of Jersey).

Japanese. — Hakuchi.

Scotch. — The daft bairn; the innocent; the feckless.

English. — Idiot; imbecile; backward; feebly-gifted.

American. — Idiot; imbecile; backward; feebly-gifted; feeble-minded.

Definitions.

The terms idiot and imbecile indiscriminately applied for centuries to a despised and neglected class, have naturally, through the mere force of association, become synonymous with and even expressive of opprobrium and reproach. So closely welded has been this association of word and idea, that even the advance of the nineteenth century with all its revelation of true conditions has failed to sunder them. Viewed apart from this association the expressions idiot and imbecile really do indicate certain conditions now, as clearly 2 17

1 8 SYNONYMS AND DEFINITIONS.

as did the words in the original languages from which they are derived, as may be easily seen by comparison.

The word idiot is derived from the Greek cdccozyi;, " a private person," or Wcoq, " peculiar " — i. e., a person devoid of understanding from birth — incapable of holding communication with another, therefore set apart — alone.

The term imbecile is taken from the Latin imbecillis — in and bacillum, as " needing a staff " ; or in vacillo, " tottering," " wanting strength of mind," " weak and feeble " ; expressive of a certain degree of intelligence, but unstable, incapable, irresponsible.

The idiot intelligently sees nothing, feels nothing, hears nothing, does nothing, and knows nothing. He simply lives alone — the solitary one.

The imbecile, on the other hand, is able to see, to understand, and to discriminate in greater or less degree.

Another phase of mental defect either previously unrecognized or else belonging specifically to a later period has developed the term " Backward-child " — one unable to advance rapidly. The differences we note, are of degree not of kind. In reality from the idiot, through the various grades of imbecility, up to the backward and the feebly-gifted there is a regular ascending scale ever-lessening of mental defect.

In America the tendency to draw away from those terms which, however correct in derivation and signification yet preempted and warped through long usage, fail to convey the exact idea apart from one of contumely, has resulted in the adoption of the expression " feeble-minded," covering every form of mental defect ; and of "backward" and "feebly-gifted," for the lesser phases. This for general purposes is more in accord with popular sentiment, although for practical purposes and in scientific classification, the older and more precise terms are still adhered to.

Again the terms idiocy and imbecility are often erroneously considered synonymous with insanity. It is true that certain conditions of idiocy and imbecility do resemble that phase of insanity known as dementia — a reversion to the original mental state of childhood — in reality a form of second childhood. But the states are not identical, although one may lapse into the other. One is defect, the other

DEFINITIONS. 1 9

disease; the imbecile in the former being the counterpart of the dement in the latter, just as the moral imbecile is the analogue of the paranoiac.

Ireland says : " Dementia begins with average intelligence which gradually diminishes ; idiocy begins with a low amount of intelligence, which gradually increases." Spitzka says : " Imbecility is a deficiency of the brain, with permanent impairment of the intellectual faculties," whereas " Insanity is a mental condition, the result of brain disease, affecting the integrity of the mind, characterized by intellectual or emotional disorder."

According to the old Roman law, mental defectives were designated " mente capti," or those deficient in intellect.

Lord Coke's definition is : " An idiot is one who from his nativity, by perpetual infirmity, is non compos mentis."

Blackstone says : " An idiot, or natural fool, is one that hath no understanding from his nativity, and therefore is by law presumed never likely to attain any."

Another legal definition is the following : " He that shall be said to be a sot and idiot from his birth, is such a person who cannot count or number twenty pence, nor tell who was his father or mother, nor how old he is, so as it may appear that he hath no understanding or reason what shall be for his profit or what for his loss ; but, if he have sufficient understanding to know and understand his letters, and to read by teaching or information, then it seems he is not an idiot."

Shakespeare speaks of him as : " One who holds his bauble for his God " ; and, again : " One who tells a tale full of sound and fury, signifying nothing."

Esquirol was the first medical writer who clearly defined the term idiocy, and he restricted its use to congenital mental defect. He says : " Idiocy is not a disease, but a condition in which the intellectual faculties are never manifested; or have never been developed sufficiently to enable the idiot to acquire such an amount of knowledge as persons of his own age, and placed in similar circumstances with himself, are capable of receiving. Idiocy commences with life, or at that age which precedes the development of the intellectual and effective faculties, which are from the first what they are doomed to be during the whole period of existence." He observes further:

20 SYNONYMS AND DEFINITIONS.

" Dementia and idiocy differ essentially. ... A man in a state of dementia is deprived of advantages which he formerly enjoyed. He was a rich man, who has become poor. The idiot, on the contrary, has always been in a state of want and misery." (L'homme en demence est prive des biens dont il jonissait autrefois, c'est un riche devenit pauvre. L 'idiot a toujours ete dans I'infortune et la misere.)

Seguin, in speaking of the idiot, says : " That the will sits, like the lady in Comus, locked up in alabaster." He defines idiocy as : "A specific infirmity of the craniospinal axis, produced by deficiency of nutrition in utero and in neo-nati."

Dr. Howe says : " Without pretending to any scientific accuracy, idiocy may be defined to be that condition of a human being in which, from some morbid cause in the bodily organization, the faculties and sentiments remain dormant or undeveloped, so that the person is incapable of self-guidance and of approaching that degree of knowledge usual with others of his age.

" There are different degrees of idiocy. There is the absolute idiot — the unfortunate creature who has hearing, but seems not to hear; sight, but seems not to see; who never learns to talk; who cannot put on his own clothes or feed himself or do the simplest thing."

" There is the imbecile who cannot take care of himself at all, but can do pretty well under the direction of others. There is the simpleton who thinks he is a man, and who hangs on the skirts of society, the victim of some and the butt of others. ... It may be supposed, from the tenor of our remarks, that we are not much disposed to draw any sharp line of distinction between idiots and other human beings, and still less disposed to deny them the attributes of humanity, and sink them to a level with the brutes. . . . We maintain that they have the germs of human faculties and sentiments, which in most cases may be developed. Indeed, the number of persons left by any society in a state of idiocy, is one test of the degree of advancement of that society in true and Christian civilization. Precise unexceptionable definitions are exceedingly difficult. But we must, at any rate, regard idiocy and imbecility as a condition varying in degree, rather than a disease, and it is concomitant of defective physical organization."

Plate I.

ECHOLALIA.

DEFINITIONS. 21

Again Howe defines mental defectives as : " Pure idiots, fools and simpletons, or imbeciles as they are sometimes called." He goes on to say : " If a boy at ten or twelve years of age (or even six or eight) hears, and does not speak, it is prima facie evidence that his intellect is in an undeveloped state. It furnishes a strong probability of idiocy."

" If he can merely use nouns, — the names of things, — he is probably foolish."

" If he can construct and understand simple sentences, but cannot use or apprehend involved and complicated ones, he is merely a simpleton."

" The ability to use polysyllables would not raise him above the second grade. In using the name of a person or thing the number of syllables does not add much to the complexity of thought or difficulty of utterance."

" A better test is the substitution of pronouns for nouns. A little child, or a fool, would say, for instance, ' Willie want water,' while a simpleton would say, ' I want water.' "

" A simpleton can hardly make a complicated sentence, such as the following : ' Should it be fair to-morrow, and my father consent, I will either come to see you, or send my brother.' The use of the conjunction disjunctive is always difficult for persons of feeble mental organization."

"Idiots of the lowest class are mere organisms, masses of flesh and bone in human shape, in which the brain and nervous system has no command over the system of voluntary muscles ; and which consequently are without power of locomotion, without speech, without any manifestation of intellectual or affective faculties."

" Fools are a higher class of idiots, in whom the brain and nervous system are so far developed as to give partial command of the voluntary muscles ; who have consequently considerable power of locomotion and animal action; partial development of the affective and intellectual faculties, but only the faintest glimmer of reason, and very imperfect speech."

" Simpletons are the highest class of idiots, in whom the harmony between the nervous and muscular system is nearly perfect; who consequently have normal powers of locomotion and animal action;

22 SYNONYMS AND DEFINITIONS.

considerable activity of the perceptive and affective faculties; and reason enough for their simple individual guidance, but not enough for their social relations."

Other definitions read thus :

" Idiocy is the want of a natural or harmonious development of the mental, active and moral powers of a human being, and usually dependent upon some defect or infirmity of his nervous organization." Wilbur.

" Idiocy is that condition of the mind, in which the reflective, and all, or part, of the affective powers, are either entirely wanting, or are manifested to the slightest possible extent." Ray.

" Idiocy is mental deficiency occurring during infancy or the early periods of life." J. Langden Down.

" Idiocy is mental deficiency, or extreme stupidity, depending upon malnutrition or disease of the nervous centers, occurring either before birth or before the evolution of the mental faculties in childhood. Imbecility is generally used to denote a less decided degree of mental incapacity. The term feeble-minded is now much used in the United States of America, both in legal and medical documents, to denote both idiots and imbeciles." Ireland.

" Imbecility is simply weakness of mind, owing to defective mental development, and may be of every degree of deficiency, moral and intellectual; on the one hand, passing by imperceptible gradations into idiocy, and, on the other hand, passing insensibly into ordinary intelligence. There are some individuals in whom a general deficiency of intelligence is accompanied by a singular development of it in a special direction; they manifest, for instance, a surprising memory for details, such as dates, names, numbers, the exact particulars of distant events, which they recall and recount with the greatest ease and accuracy, or display certain remarkable mechanical aptitudes, or exhibit a degree of cunning which might seem inconsistent with their general mental feebleness."

" Idiocy is a defect of mind which is either congenital or due to causes operating during the first few years of life, before there has * been a development of the mental faculties, and may exist in different degrees ; the person affected with it may have the power of articulate speech and manifest a limited degree of intelligence, or he may be

DEFINITIONS.

utterly destitute of any semblance of intelligence and of the power of speech, being little more than a vegetative organism." Maudsley. A definition which I have, in long usage, found most readilv understood, and which I have tried to make inclusive and comprehensive as well as simple and concise, is this : Feeble-mindedness, including idiocy and imbecility, is defect either mental or moral or both, usually associated with certain physical stigmata of degeneration. Although incurable, its lesser forms may be susceptible of amelioration and of modification, just in proportion as they have been superinduced by causes congenital or accidental.