ÜBER EXPERIMENTELLE BEINFLUSSUNG DES VORSTELLUNGSVERLAUFS BEI GEISTESKRANKEN, nebst einer Kritik der Assoziationsexperimente an Geistesgesunden, von Dr. Max Levy-Suhl. Leipzig, Verlag v. Johann Ambrosius Barth, 1911. Pp. vi, 142.

It is well known that in various mental diseases patients take up words they overhear and spontaneously associate them with various trains of thoughts in a manner foreign to normal life.

The present work is devoted to a systematic study of this wellknown peculiarity, not only in manias, in connection with which it has been studied heretofore, but in other forms of insanity as well.

The problem which Dr. Levy-Suhl set for himself is as follows: How do patients of different clinical categories react towards certain definite words purposely thrown in their way (Ziehen's Assoziative Reaction auf Zwischenruf)? Furthermore, does the behavior and reaction of patients towards such verbal stimuli present any pathognomic features on the basis of which it might be possible to classify the cases into definite psychological groups? In other words, is a patient's reaction to this kind of stimulus in any way characteristic of his pathological state?

The investigations were undertaken in the patient's usual surroundings, without instruments or other distracting arrangements. For the purpose of the experiment the patient's mutterings were taken down stenographically, and in their midst the reaction word given in a clear tone without previous warning or instruction of any kind. The precaution was taken that there should be no similarity in sound or meaning between the patient's last words and the reaction stimulus. His behavior and the course of his incoherent speech immediately following were carefully noted in shorthand. In some cases it was necessary to start off the patient on the road of speaking to himself by engaging him in some conversation of an indifferent sort. Оссаsionally reaction words were called out within the hearing of patients not engaged in talking to themselves, and the results noted. Here, too, there was no preliminary understanding with the patient or preparation of any kind.

Forty different cases belonging to different clinical categories were thus experimented upon. Without regard to their psychiatric or clinical diagnostic position these cases were classified on the basis of their reaction to the experiments in question. It was found that the cases grouped themselves into four different classes presenting the following characteristic features respectively: First Group. Comprising those whose reactive behavior approaches the normal.

Second Group. Cases characterized by indifferent hyperprosexia. This group comprises the cases whose behavior has necessitated the formulation of such terms in clinical psychiatry as ideational, maniacal, and primary flight of ideas. Levy-Suhl prefers Ziehen's term, hyperprosexia, because it is psychologically more clearly delineated, and also because this term is noncommittal with reference to the diagnostic import of the phenomenon to which it refers. In other words the term is purely descriptive and used as such. Under hyperprosexia Ziehen understands a psychopathic condition in which "hypervigility" is combined with "hypotenacity" of attention. As a result of this condition reaction words are promptly seized upon by the subject and the antecedent flow of ideas as quickly abandoned.

Characteristic features of this class of hyperprosexia are: 1. Complete indifference towards the act of interruption as shown by quick, superficial reactions. In other words the subject is ready to abandon his own thoughts and turns his attention promptly to any verbal stimulus, no matter what the new order of ideas may be. He may react associatively either to the tone or to the new images invoked. The reactions are superficial but prompt, and as a rule show no relation to the subject's former preoccupation.

2. In addition to the formal indifference there is a very marked neutrality towards the content. The associative relations between stimulus and reaction word follow a path unaffected by the feeling tone or the affective character of the former. Thus, even to a word like "seisachtheia," meaningless to the lay ear, the patient reacts the same as to "death" or "shame."

3. The associations proper show no deep relation and no elaboration; they are largely neutral, impersonal, hence verbal forms, plays on words, are predominant.

Third Group. Selective hyperprosexia. Here, in contrast to the second group, the hyperprosexia is selective and presents more or less the marks of an affective elaboration.

1. The heightened ausprechbarkeit, or readiness to react with a flow of words, is concerned with a definite pathological "Totalkonstellation," and the reactions belong to some special groups of images. Those test words which fail to touch in some way the peculiar groups of images to which alone the patient is sensitive at the time are resented as impertinent intrusions or remain entirely unnoticed by him.

2. It follows that, again in contrast with the second group, the meaning of the reaction word is of importance in the shaping of the reaction to which it gives rise.

3. Finally, the associations proper present a more critical and personal character. Their content may be the result of intimate elaboration and peculiarly personal. Superficial verbal associations occur rarely, if at all, while in the second group associations of this class are the rule.

Fourth Group. Hypervigil reaction with contamination and dissociation. Here the subject does not turn away from his flow of thoughts, but the test word or some term associatively awakened by it is taken up and uncritically incorporated in the verbal image series with which the subject happens to be concerned at the moment of the experiment, irrespective of the resulting nonsense. In other words, hypervigility of attention is still present, but no hypotenacity; consequently we deal no longer with hyperprosexia in the strict sense of the term. On the contrary, the condition which confronts us here may be described as a hypertenacity of attention (contaminating or nonsensical hypervigil reaction).

Furthermore, the notion of hyperprosexia is untenable in this group of reactions because the incoherence of the image series. becomes so great that a principle or category of associative relations. in the series of succeeding words is hardly to be recongized any longer; the associative bond from reaction word to the immediately succeeding flow of words is too faint to be recognized.

Associative elaboration, when present or at all discernible, is at any rate more meager than in second group. As in the latter group the associations proper have a superficial character. for the most part, although occasionally reactions of individual. order not unlike those typical of group three may be found here.

A comparison of the clinical and diagnostic features of the forty-four cases studied with the psychopathic characteristics of the four groups into which they have been arranged by means of this psychological test reveals the following facts:

In the first group, besides a case of exhaustion delirium with secondary hyperthymia, on the way to recovery, belong three cases of dementia paralytica.

In the second group eleven cases, ten clinically correlated cases of mania, cyclothymia, periodic mania, and hypomania, and one "case of acute paranoia, passing into mania.”

Closely related to this group (varying in certain psychological respects) stand three cases of hysterical psychosis, one case of post infectious exhaustion, and one case of acute hallucinatory paranoia with post operative delirium.

In the third group there are sixteen cases. These, with one exception, illustrate, clinically, various forms of paranoia. The exception is a case of maniacal exaltation which, strictly speaking,

belongs psychologically somewhere between the second and third group.

The fourth group comprises eight cases: four dementia præcox, three special forms of paranoia, and one dementia paralytica with ideational flights.

It will be thus seen that the psychological divisions correspond closely to certain clinical differentiations. This is undoubtedly the most important result of the present study.

It is not surprising, of course, to find that dementia paralytical does not fall into a single psychological category. In view of its manifold psychopathic clinical forms this would hardly be expected..

On the other hand it is noteworthy how clearly this psychological test differentiates the maniacal stage of paralysis from the mania of functional psychosis in spite of the formal similarity between the two. It appears that this psychological test, applied to all forms of autocheonous ideational flights, may help towards an early differential diagnosis. Further research upon this test should prove not only of scientific value but of great practical interest as well.

J. S. VAN TESLAAR..

BOOKS RECEIVED

THE OUTLINES OF EDUCATIONAL PSYCHOLOGY. By William Henry Pyle, Ph.D. (University of Missouri). Warwick & York, Inc., Baltimore. 1911. $1.25 net. Pp. x, 247.

THE SEXUAL LIFE OF THE CHILD. By Dr. Albert Moll. Translated from the German by Dr. Eden Paul, with an introduction by Edward L. Thorndike. The Macmillan Company, New York, 1912. $1.75. Pp. xii, 339.

THE JOURNAL OF

ABNORMAL

PSYCHOLOGY

OCTOBER-NOVEMBER, 1912

THE MEANING OF IDEAS AS DETERMINED BY UNCONSCIOUS SETTINGS'

I

BY MORTON PRINCE, M.D.

THINK the theory which I shall maintain in this paper will become clearer if, before taking up the main theme, the unconscious settings of ideas, I devote a few pages to a preliminary statement of the psychology of perception and "meaning."

A perception, or, what is in principle the same thing, an idea of an object, although apparently a simple thing, is really, as a rule, a complex affair. Without attempting to enter fully into the psychology of perception (and ideas), and, particularly into the conventional conception of perception as usually expounded in the text-books, a conception which to my mind is inadequate and incomplete,2-it is sufficient for our immediate purposes to point out in a general rough way the following facts concerning perception.

Perception may be regarded both as a process and as a group of conscious elements, some of which are within the focus of attention or awareness, and some of which are outside this focus. As a process it undoubtedly may include much that is entirely unconscious and, therefore, without conscious equivalents, and much that appears in consciousAs a group of conscious elements it is a fusion, amalgamation, or compounding of many elements.

ness.

Read at the meeting of the American Psychopathological Association at Boston, May 29, 1912.

"In that it takes into account only a limited number of the data at our disposal and neglects methods of investigation which afford data essential for the understanding of this psychological process.

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