Study of Association in Insanity | Page 6

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.

§ 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 pr?cox 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.

§ 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.

§ 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,