INTELLIGENCE AND PSYCHOSIS

Abstract according to diagnosis of 102 psychotic cases examined by the Stanford intelligence scale: par. 1-11. Retests: par. 12-13. Scattering: of tests: par. 14-20. Technical considerations and criticisms of detail: par. 25-34. Incidents: par. 35-42. Cases dominated by volitional disturbance: par. 43-51. Cases with IQ above 1.00: par. 52-74. "Intelligence" as ideational capacity, distinguished from capacities for dealing with concrete things, or adjustments to other personalities: par. 75-87. Interrelations of intelligence, psychosis, happiness and general adaptation: par. 88.

1. This study is based upon examination in 102 cases of mental disease. The observations cover a period between September, 1916, and July, 1917, and from February, 1919, to April, 1919. The number examined represents approximately the cases in McLean Hospital within these periods from whom the necessary cooperation was obtainable. The percentage of admissions thus susceptible to examination was about 60. The material is not otherwise selected, and comprises various psychoses in both men and women, in order as they came to the attention of the examiner.

2. Studies using the Yerkes adolescent scale in a similar sort of material have been reported by Pressey^1,9 and by Curtis.² Pressey compared groups of alcoholic and dementia præcox cases with feeble-minded of corresponding mental ages. Curtis employs data from various psychoses, also from the feeble-minded, but is more concerned with questions of "scattering" than with absolute mental ages. The results of both investigations coincide with the present at their points of contact. The present material does not contain alcoholic cases, nor does feeble-minded material enter save incidentally. Both Pressey and Curtis find more "scattering" ering" in the psychotic than in the feeble-minded. Pressey finds mental ages generally below normal, his groups averaging between 10 and 11 years. Curtis seems to have found the higher scores with special frequency under the diagnosis of psychopathic personality.

3. In the present material, the majority of cases were examined within a short interval after admission. There are a few chronic cases who had been in the hospital for long periods; otherwise, the examinations do not represent special relation to the course of the psychosis, except as indicated in the retests.

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4. Chronological ages of the present subjects range from i6 to 75 years. The IQ thus represents mental age divided by 16. In observing relationships of individual tests in the scale, frequent use is made of the mental age figure as such. As representing "age" its significance is conventional only. It is not to be presumed that psychotic individuals of a given mental age mentally resemble normal, feebleminded or other psychotic individuals of like mental age, otherwise than is implicit in the specific tests performed.

5. The above table abstracts the material according to diagnostic groups, giving data upon age, sex and IQ.

6. Reductions of IQ in this material are subject to various interpretations. Apathy and negativism in schizophrenia, thinking difficulty in manic-depressive depressions, distractibility in excitements, memory and attention failures in organic conditions, are factors able to account for reduced IQ in the respective psychoses. None of them in necessarily present in any psychosis to such a degree as to markedly reduce the IQ. There is no case in the material of the Kraepelinian paranoia in which, so far as discernible, IQ would be unaffected; but it appears unaffected in the "paranoid conditions" observed.

7. Reduction of IQ is greatest in the organic cases, and frequently not evident in the manic-depressive or schizophrenic groups. There is ample demonstration that reduction of "intelligence" to subnormal is not a necessary accompaniment of grave mental disorder. The organic are the only defined groups showing no IQ's above 1.00. In these cases alone does intelligence defect show definite association with the psychosis. Yet the highest IQ obtained in these groups (.96) was associated with judgment defect and delusions (persistent, not delirious) of unusual social gravity.

8. Among the present psychoses, little diagnostic importance attaches to the IQ. In some manic-depressive conditions, reduced IQ (associated with "scattering," cf. par. 14) may indicate superposed organic involvement not otherwise apparent, with consequent modification of the prognosis.

9. In central tendency of IQ, the non-organic groups are similarly affected. This is in accord with Pressey's¹ experience, though there was greater reduction in his material. Over half the present IQ's are above the level below which independent adjustment is for reasons of intelligence no longer possible. A few are considerably above the normal level. Certain psychoses develop along lines imperfectly or not at all reached by measures of "intelligence."

10. The age standards of the vocabulary test, which correlate well with "mental age" in normal adolescents, do not preserve this relationship in the present material. As derived from par. 5, the distribution of IQ's is as follows:

.20 .30 .40 .50 .60 .70 .80 .90 1.00 1.10

No. cases. 1 1 4 7 5 17 19 28 16 4

The highest year group in which the vocabularly test (not made in one case) is passed, distributes as follows:

Year Group less than VIII-VIII. X. XII. XIV. XVI. XVIII.

No. cases. 1 3 3 24 19 19 49

The vocabulary test appears least affected of all functions in the scale. "Superior adult" ability in vocabulary is associated with deficiency in remaining aspects of intelligence down to the upper limits of feeble-mindedness.

11. Four cases in the material have IQ's of the "superior adult" level. In repeating digits forward this level is reached by 25 cases. Though to a less degree than vocabulary, this somewhat formal ability is relatively spared by the incidence of psychosis. Repeating digits backwards approximates more closely to the general intelligence distribution, superior adult ability being reached by 13 cases, and average adult by 16.

12. Retests indicate a sphere of usefulness for the scale in quantitative demonstration of progressively lost or recovered functions. Both are illustrated in the following abstract of material on this point.

13. Clinical examination of mental cases properly involves some formal tests of the same general character as find place in the intelligence scales. These formal tests are ordinarily crude, without other standard than the examiner's little organized impressions. Over such procedure the scales offer improvement, not less because they may be entrusted to persons specially trained therefor, to the release of physicians for more specific responsibilities. Where circumstances do not justify full scale examination, certain abridgments have been found useful, while preserving the standard character.

14. A practically convenient criterion of "scatter" is the number of tests failed below and passed above the mental age of the individual. In the findings of Curtis,² by the "variation total" of the Yerkes adolescent scale, "scatter" is greater among feeble-minded than normal, and greater among psychotics than feeble-minded. Among the psychoses, the dementia præcox group records more "scatter" than the manic-depressive, and the syphilitic psychoses (only organic group represented) more

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"scatter" than the dementia præcox , though the difference are small. The present material is in harmony with these results, average "scatter" in different psychoses being as follows:

Manic-depressive depression... 5.9 Whole manic-depressive group. 5.7 Constitutional psychopathy ... 5.6 Dementia præcox......... 6.2 General paralysis............ 7.8 Whole organic group.......... 7.6

15. A more elaborate measure of "scatter" is proposed by Pressey,’ which aims to weigh the scattered tests according to their "scatter" than the dementia preæcox, though the differences are amount of displacement from the mental age. The manicdepressive depressed, dementia præecox and general paralysis groups of the present material were thus compared, with the following results:

Weighted. "Scatter." (Months.) Av. m.v. Manic-depressive depressed .................. 22.7 6.7 Dementia præcox ........................ 25.4 13.7 General paralysis ........................... 31.0 12.3

15a. The greatest number of scattered tests observed in an individual was 15, yielding a weighted score of 58, in an acute drug psychosis. Three subjects showed no "scatter," one a paranoid condition of normal mental age, the second a deteriorated dementia præcox, the third, exceptionally, a deteriorated general paralytic ( Case 8, par. 12).

16. With such exceptions as are noted below, reduction of IQ does not select special test functions according to diagnostic group. Various tests, however, do not have the same difficulty for the psychotic, as for a normal person of given mental age. Data on this point have been examined for all tests made over 25 times. Comparisons are based on the percentage of times a test was made where there was a failure below the mental age of the subject, and the per cent of subjects having mental age above that of the test, who fail therein.

17. Tests failed by no one below mental age are: Comprehension, 3d degree ( VIII-3), stamps total value (IX-a2) and the vocabulary tests. Other tests very seldom failed below mental age are: Comprehension, 4th degree (X-5), makes change (IX-3), Healy-A ( Xa3), abstract words ( XII-2), dissected sentences (XII-4). Tests showing marked tendency to fail below mental age are: Weights, serial arrangement (IX-2), rhymes (IX-6), enclosed boxes (XVI-4). Outstanding positions of difficulty for the psychotic subjects belong to: Designs (X-3), reading and report (X-4) and Ball and field superior plan (XII-3).

18. The following tests above year VIII are never passed by a subject having mental age below their year-group: All nine-year tests except making change; all ten-year tests save vocabulary, comprehension, 4th degree, and 60 words. Tests passed above age with relative infrequency are: Fables score 4 (XII-5), comprehension, 4th degree (X-5), makes change (IX-3), stamps total value (IX-a2), ball and field superior plan (XII-3). frequency of passing above mental age is, as previously indicated, most marked in the vocabulary and formal memory tests.

19. Examination of "scatter" on single tests according to diagnosis is made for the manic-depressive depressed, dementia præcox and organic groups. Absurdities (X-2), designs (X-3), reading and report (X-4), which are never passed above age, are failed with similar frequency in the three groups. The superior plan of ball and field (XII-3) fails below age over twice as often in the dementia præcox group as in the manic-depressive or organic. In the repetition of five and six digits backwards (XII-6, XVI-5), the manic-depressive and organic groups togather record nine failures below age and two passes above; the dementia præcox group records one failure below age and eight passes above. In the repetition of six and seven digits forward (X-aI, XIV-aI) the manic-depressive and organic groups record 13 failures below mental age to none by the dementia præcox group. Other differential features are not indicated.

20. If all regular tests of a year group are made, alternate tests, even though made, do not figure in the IQ; but in statements of "scatter," alternate tests are included irrespective of whether or not they figure in the IQ.

21. The 1916-17 data were recorded upon the published"record booklets." Recording on the booklet is desirable while the tests are being learned, but superfluous after familiarity with the tests is acquired, a single letter-size sheet being suitable for record of data practically significant in scoring. It is necessary to have at hand a single copy of the record booklet for various references. Most of the 1919 data were recorded upon a single sheet form.

22. The record booklet classifies the tests by the ages to which they attach. The single sheet of present reference classifies them according to topics. This presentation of the tests effects some saving of time and distributes failures and successes fairly evenly through the examination. Among the disadvantages are that evaluating is less simple, and a basal year less readily fixed. It is indicated that the most desirable record, form for such a scale is one that occupies a single letter-size sheet, lists the tests thereon by year groups, uses a homogeneous system of numbering the tests, and gives the homologous tests (as of vocabulary, pictures and figures backward) the same position in the year groups where they occur.

23. The minimum range of testing sanctioned by Terman⁴ is all passed but one at the lower limit and all failed but one at the upper. The uniform range of the present material is from a basal year in which all tests are passed, to an upper limit in which one test only is passed. The basal year is the highest year within and below which there are no failures. The material contains ains cases of failures below years where all tests were passed. All passes above age and failures below it are thus not necessarily reached, resulting errors being left to compensate.

24. The median number of tests necessary to cover the employed loyed range of testing is 35. In a random group of 30 cases in the material of the Massachusetts School for Feeble-minded, kindly furnished by Dr. Mateer, the median number of tests made is 45. A greater range appears to have been prescribed. There is also less scope for testing in the present material, as the basal years come nearer the upper limit. The M. S. F. 30 cases contain no basal year above 8; the distribution of basal years in the present material is as follows:

Basal year ...... 3—3 4 5 6 7 8 9 10 12 14

No.cases ....... 1 0 2 1 6 9 18 27 19 12 7

25. Certain experience with particular tests will be recorded. Some criticisms of detail are of factors inherent in the scale, others arise from the present application thereof to a use for which it was not constructed. The Stanford scale is primarily adapted for children, and the higher level tests for older, brighter children rather than for normal or inferior adults.

26. In their present connection, certain comprehension items are objectionable in the childishness of their phraseology and the situations they present. These advantages are somewhat offset by phrasing in the third person ("What should a man (or boy) do"), etc. The situation may also be changed to one more in harmony with adult life ("If you are to meet someone"), etc.

27. The objection of incongruity with the adult mind appearsalso in the sentence memory tests, encountered most frequently in X-a2 and XVI-a1. If the tests are of sufficient significance, standardization may be attempted or more adult types of sentence, examples (difficult) of which are quoted in the appendix (D). Similar objection exists to the item, "I asked my teacher," etc.

28. The ball and field situation is incongruous for most adults, especially women. Much more satisfactory service has been obtained through a presentation which supposes that a soldier is sent by his commanding officer to hunt for a pair of field glasses, packet of papers, or other object of military value, lost in the field.

29. The use of the silver dollar in VII-a1 is doubtfully applicable to eastern conditions. In test IX-3 it is convenient to make the object of purchase postage stamps instead of candy. Knowledge of the date (IX-i) has evident limitations in the case of persons living under hospital conditions.

29a. There is a difference between the child and adult mind which puts the adult at a disadvantage in the pictures test (111-3, etc.). A just ground for scoring interpretation higher in a scale for adolescents is that the children who gave interpretations are brighter than those who give descriptions, but there are grave difficulties in the way of maintaining that interpretation is itself the higher form of response. The adult is not so free to use his imagination as is the child, and thus produces less readily an interpretation which, however reasonable, he knows to be imaginary. The issue of interpretation may be clearly raised, while specific interpretation is declined. In these cases full credit is allowable. The direction, "Explain this picture," did not work intelligibly with the present material. The question, "What does (or might) this picture represent?" is useful in eliciting good interpretation from those able to give it.

30. Most of the absurdities (X-2) might have been paraphrased from the "Ruthless Rhymes for Heartless Homes." Their sadistic note is disturbing to some depressed patients. The same feature is present in the problems of fact (XIV-4). An observed and legitimate deduction for the "queer visitors" is that of marriage after a pregnancy not so legitimate.

31. The 6o-word test (X-6) does not lend itself well to adult reaction types. It might be advantageous to uniformity substitute the Healy-A (X-a3).

32. The item 8. 1o in the clock test (XIV-6) is objectionable since reversal places the hour hand exactly at 2.00. The item should read 8.08. (Cf. appendix, B).

33. The items for repeating seven digits (XIV-aI) each contain a digit repeated twice. The third item for repeating eight digits (XVIII-3) contains a digit repeated twice; the other two items do not. It is not clear from Terman's manual whether the commingling of these items was intentional or fortuitous. According to work of Ranschburg's⁵ and other related experience, repetition of digits should change the difficulty of the series. Objection has been made to number-sequences occurring in the items for repetition of digits. In the appendix (A) are quoted number series believed to avoid them.

34. In the ingenuity test (XVIII-6), it is recommended that quarts be substituted for pints in the presentation, as the more common and natural of the two units to work with. Many subjecets make the change of their own accord. The situation still suffers from incongruity for adults, with their less plastic imaginations. Trial has been made with a situation using medicines, where more precise measurement is naturally called for. The test is extremely subject to coaching; a series of alternate problems is quoted in the appendix (E). (In formulating the solutions of these problems, very considerable practice was experienced.)

35. Among depressed patients there is a tendency to give good responses with accompanying assurance that they are insufficient, and request that they be not recorded. This is part of the selfdepreciation symptomatic of the psychosis. The responses, when correct, are recorded as such.

36. The scoring of the induction test requires correctness of both the sixth response and the governing rule. Two cases occur where all responses were correct, but the governing rule was not satisfactorily produced ("I simply guess from the way things were multiplying that you keep on multiplying"); the other case produced the rule satisfactorily on leading question only. Two other cases gave the governing rule unexceptionably, but failed in the multiplication of 16 by 2.

37. To the ball and field test, a depressed patient, drawing an unsystematic response, said, "I suppose some people would have some system, but I wouldn’t." The failure may be from thinking difficulty, or the self-depreciation described in par. 35. On retest after improvement, the superior plan was produced (Case 3, par. 12).

38. Another patient described a superior plan of reaction to the ball and field test, but actually drew an inferior one. This patient (IQ .95) had delusions of exceptional fixity, that he was responsible for the condition of other patients, and for various more remote terrestrial evils. This attitude of vicarious accountability irradiated into an otherwise correct interpretation of the Colonial Home picture; "and the dog is responsible for it in some way."

39. Effect of psychosis in producing specifically perverted responses is most conspicuous in the judgments of dementia præcox. A case so developing, not at the time clinically diagnosed as such, interpreted the Dutch Home, Canoe, Post Office and Colonial Home pictures respectively as follows: "A child who has been punished; cruel to the cat, maybe." "A man kidnapping a girl has hired two Indians to help him." "Reading about some murder-perhaps five men gossiping about the woman walking to her house....something disgusting....they think they’re very witty." "A woman who has been kidnapped crying because she can’t go back to her home."

40. The scale gives scope for perseveration to be shown, as (wood and coal) "burning"; (apple and peach) "they’ll burn all right." .... "round." Other apparent instances, shown in a case of general paralysis, are: (Plumbing) "tinner’s utensil "; (outward) " tinner's utensil, used in all sorts of ways." (Quake) "is generally used to crack the earth"; (civil) "is generally used to crack the earth"; (treasury) "is generally used by people who understand it." (Broken something) "return it and have it fixed"; (danger of being late) "hurry up and fix it as quick as I could." (Opinion of unknown person) "leave them alone." (Important undertaking) "let him have his own judgment."

41. In a depressed patient, self-depreciatory trends cropped out in such responses to the vocabulary test as (majesty) "Noble— I am not noble"; (conscientious) "true—I have not been true." A related attitude appears in this patient’s response to (broken something): "Go and acknowledge it." It is unfortunate that the religious doctrines of repentence and absolution are so easily perverted in this direction. The ethical standard reflected occurs oftener than it should in normal life.

42. ^Piscatorial occasionally acquires an ecclesiastical meaning (Episcopalian) overdetermined, no doubt, by an unconscious i_xθύζ. A case of drug psychosis surpassed the normal expectation in classifying book, teacher and newspaper as "all well read." "A white man riding on a horse too small for him" affords an ingenious escape from the expected interpretation of the Indian's remark. A manic disciple of Anaxagoras would respond to the vocabulary test only when formulated, "what do people mean by....?"

43. If a busy executive is asked to undergo an intelligence examination he will not always comply; no "credits" will be earned, but to infer corresponding intelligence defect is absurd. Delusional motives or instability of feeling may cause psychotic cases to similarly decline or obstruct examination, when it is clear that good records would be made otherwise. In all cases, the "intelligence" factor in the performance is underlain by that of voluntary co-operation, secured through good-will or self-interest. Volitional as well as intellectual disturbances are capable of reducing the IQ. The defects of adjustment are equally real in either case, but they have different causes, which, outside the sphere of the tests, have different effects.

44. It is well observed that dementia præcox is characterized by the failure of conduct to maintain its level with the intellect; it is a volitional disorder rather than an intellectual one. But it is only through conduct of some sort (as speaking) that intellect is manifested. The disorder attacks first the more fundamental, instinctive, "real," types of conduct, and leaves relatively untouched the more conventional "laboratory" type of reactions. Particularly does this apply to the language mechanism, through which any degree of intellect is to be manifested. Hence the high IQ in grave dementia præcox cases. Ultimately this type of behavior also may be deeply involved. The appearance is then that of dementia, of the stuporous or scattered type. What is actually observed is a conduct disorder, in which the status of the intellect is not clear. There is reason to regard it as much better preserved than in the organic dementias.

45. Case 10, the dementia præcox case of IQ .24, par. 5, lowest observed in this material, is considered in this light. Peculiarities of make-up characteristic of dementia præcox are not recorded in this case, but the course of the psychosis has been typical. He was admitted in August, 1912, and the examination dates September 9, 1916. His condition was stabilized at this time, and there has been substantially no change since.

46. Clinical notes of the time the examination was made record that the patient has been somewhat quieter than previously; is good in working voluntarily on the ward; sweeps and polishes the floor every morning. Eats and sleeps well. Walks about making gymnastic motions, whistling, singing, turning rapidly in the opposite direction; looks over the paper and smokes, talking and laughing to himself. The "mental age" in the scale is three years ten months, notable difference existing between the present picture and that of a normal person of this age.

47. General notes of the examination read: "Much blocked, especially in language responses. Co-operation of the main personality seems willing. Is deferential to examiner and assists his work in various ways." Characteristic of the examination as detailed, is that the patient shows he has the information called for, but manifests it in an abnormal way. The former criterion governs in the assignment of the present credits. Performance in the tests is shown in table on page 30.

Of 26 subsequent tests recorded, all are failed except the vocabulary tests of years VIII and X.

In the vocabulary test, much scattered talk would be added to the definatory words upon which the item was passed. Scattered talk was also produced to items failed, this tendency decreasing as the words grew more difficult. It consisted largely of stereotyped phrases as: "Quantity of representation of things that have use"; "material that it is"; "there is quite a difference according to the uses of it." "Use and uses that it is" "it’s according to the quantity of the use and uses of the speech of it."

No. Nature of test. Pass or fail. III. 1. Points to parts of body.—, total. 6. Repeats seven syllables. - Ar. Repeats three digits. - IV. 2. Discrimination of forms. + 2. Names colors. 3. Æsthetic comparison. - 4. Definitions, use or better. + 5. Patience. Ar. Age. VI. 1. Right and left. 2. Mutilated pictures. 3. Counts 13 pennies. 4. Comprehension 2d. deg. + 5. Coins. +, total 6. Repeats 16 to i8 syllables. - Cf. 111-6. 2. Names familiar objects. + 3. Picture enumeration. - 5. Gives last name. + 3. Counts four pennies. + 4. Copies square. + 5. Comprehension, 1st. deg. - 6. Repeats four digits. - AI. Repeats 12 to 13 syllables. - V. i. Comparison of weights. + Remarks. Other performance indicates this due to motor blocking. Points to objects called for. Produces nothing relevant. Shows written address, points to last name. Language blocking is against correct response. Do. Points, amid scattered talk, to each form without error; "Quite a resemblance." Covers all with four fingers and holds up this number. Well and carefully done. Only irrelevant talk. Cf. 111-6. Tips them a little with forefinger, and points with unintelligible mumbling. Red is called "dull red," showing superior discrimination. Shuts eyes, produces irrelevant talk. Chair, "convenience" (points). Horse, "creature"; fork, "implement"; table "furnishing"; doll and pencil, failure. Shows how pieces were taken apart, but will not move them. Indicates both hands. Points ("optic"). Points without naming to mouth, nose, arms. Names arms on urging. Counts properly, finally says "thir -thir- thirteen." Amid scattered talk, produces successively "umbrella," "sprinkler, telephone, telegraph, fire department"; "automobile or wait till next car comes."

Among the responses upon which items were credited correct, are the following:

Eyelash, particle of hair.

Health, condition, muscles, body.

Mellow, condition of food or drink, taste, whiskey.

Lecture, classified as a sermon or any such thing, a speech.

Treasury, place where they have quantity of money, bank.

Reception, hostess, gentleman of the house.

Skill, (goes through movements of shadow boxing).

Insure, insurance policy, endowment.

Repose, quiet.

Shrewd, furthering of his interest.

Charter, certificate, diploma.

Conscientious, faithful, kind.

Swaddle, some kind of clothing.

Philanthropy, cheerful giver, philanthropist.

Flaunt, flag to the breeze.

48. Similar features appear in a retest of the psychopathic case with IQ .36 in par. 5 ( Case 7, par. 12). In the retest, 27 months later, the IQ is .28. This case is a woman aged 29 and 32 at the respective tests, who has always been deficient, deterioratation to lower level now supervening. Along with her mental age at retest of four years six months, she is able to write a clear though childish hand, and to read as indicated in the examination. She appears to read very light stories, and to look at pictures for amusement. Her chief occupation is writing, in which she produces scattered material, with stereotypies. (Test material she wrote as: "The dogs runs afters the cats"; "Sees the littles boys"; "We are goings have a fimes in the countrys.") She is very neat about her room, spends much time in cleaning and keeping everything in order. ( At retest, seeing the examiner resting note-paper upon his knee, she spontaneously cleared a table stacked with papers, and smilingly placed it for the examiner to write on.)

49. In the examination the patient made no verbal responses, except, in a scarcely audible whisper, a wrong statement of her age. Normal responses were obtained where language was not needed, as in III-I, pointing to parts of body. Otherwise, the correct information was either written by the patient, or identified from a number of alternatives written by the examiner. Among the tests passed in this way were giving sex, last name, fingers on hands, naming colors, figures forward up to and including five digits.

50. These cases illustrate the disharmony between normal and psychotic mental age of which note has been already made. They also show how knowledge needed to pass a test may be present, and at the same time not capable of manifestation in the conventional test response. Whether such test performance be regarded as "passing" is a matter of casuistry; but the recognition of such phenomena is of service in comprehending the present situation between intellectual, affective and volitional elements of test reaction.

51. In the cases just recorded, the level of adaptation is in various ways above the level of "intelligence," or above the level of adaptation regularly associated with the IQ shown. Knife and fork are not defined, but they are used; skill is not defined, but is ready to be demonstrated. It is not purposed to discuss whether one can use a fork without "knowing" what a fork is; but it is wholly possible to know a fork for the essential purpose of direct action ; while, for aphasic or catatonic reasons, this knowledge is not to be represented in conventional verbal terms. In the two present instances, the difficulty is regarded as essentially volitional. The ability to deal with the thing and the corresponding idea are intact save for this particular means of verbal communication.

52. Brief account is given of individual cases in which IQ above 1.00 was observed. When the present material began to be gathered, IQ 1.00 was supposed to represent normal adult intelligence. Terman's estimate to this effect is originally based on results with 32 high school pupils 16 to 20 years old, and 32 "moderately successful business men." It is believed that such material yields an IQ higher than the normal average. Terman's civil service eligibles probably represent a more average human group, and their median IQ is .89. Those in the present material having IQ over 1.00 make the impression of ideational capacity distinctly superior to average.

53. The IQ's over 1.00 in this material are regarded as distinctly above the average, those above 1.10 as conspicuously above it. The causes which brought them to hospital supervision operated without clearly affecting superior functioning in the "intelligence" reached by the scale. All recorded abnormalities of real behavior are compatible with adequate normal adult responses in the tests.

54. Account of the following cases briefly recites sex, age, education, attainments, personality, precipitating cause, psychotic picture, conduct during test, and scattering:

Group of Manic-Depressive Depressions.

55. Case 11.—Man, aged 23. School progress normal, three years college, has not worked independently. Seclusive personality. Psychosis precipitated by erotic tangle. Delusions showing greatly reduced judgment; depressed, apprehensive, reticent. Reaction to test superficially normal. Failed below age: President and king, repeats seven digits, repeats 28 syllables. Passed above age: Vocabulary 75 words, thought of passage heard. IQ. 04.

56. Case 12.—Woman, 57. One year high school. Housekeeping. Capable in activities, conscientious, faithful, religious. Reserved in manner, but made friends easily, willing to do more than required of her. Three previous attacks. Psychosis without definite precipitating cause. Depressed, feeling fatigued, without special delusions. Practically recovered at time of test, in which behavior was normal. Failed below age: President and king, difference between abstract words, enclosed boxes. Passed above age: Vocabulary 75 words, repeats eight digits, seven digits backwards. IQ 1.05. (While scarcely influenced by the psychosis, the IQ is interesting in view of the patient's limited educational opportunities and status.)

57. Case 13.—Man, 59. High school education. Minor executive position. A plodder, methodical, reticent, insignificant social, political or recreational interests. First attack, precipitated by failure of expected advancement. Clear, feeble somatic delusions, some motor agitation. Normal attitude towards tests, save as distracted by own depression. Failed below age: Ball and field superior plan. Passed above age: Vocabulary 75 words, repeats eight digits, seven digits backwards. IQ. 03.

58. Case 14.—Man, 24. Delicate as a child, various operations. Two years college, working independently to defray expenses. Not athletic, probably overconscientious in school work. Liked by companions. Second attack, precipitated by fatigue of intensive training course. Clinically retarded, considerable thinking difficulty, some inadequacy and selfreproach, without other disturbance in consciousness. Attitude towards tests normal, somewhat slow in speech. Failed below age: Designs, ball and field superior plan, repeats 28 syllables. Passed above age: Vocabulary 75 words, Binet's paper cutting, repeats eight digits. IQ 1.07. (Makes a social impression distinctly better than average.)

59. Casa 15.—Man, 54. Three years high school. Fairly successful in independent business. Somewhat sensitive, opinionated, not a good mixer. Little alcohol, tobacco freely; considerable mechanical ingenuity. Second attack, without definite precipitating cause, preceded by slight failure of memory and judgment. Melancholy and agitated behavior in experiment. Failed below age: Reading and report, president and king, problems of fact, enclosed boxes, 28 syllables. Passed above age: Vocabulary 75 words, Binet's paper cutting, repeats eight digits, seven digits backwards. IQ 1.05. (The amount of scattering lends color to suspicions of arteriosclerotic involvement.)

MANIC DEPREsSIVE EXCITEMENT.

Case 16.—Man, 18. One year of college. Has not worked independently. Lilcable, not secretive, enjoys athletics and social activities, easy-going, follower rather than leader, popular. Precipitating factors unknown. Mild initial depression followed by characteristic hypomanic irresponsibility. Overactivity and diminished judgment. Desired examination, had foreknowledge of some tests. Failed below age: Fables score 8, repeats 28 syllables. Passed above age: Vocabulary 75 words, repeats eight digits, seven digits backwards. IQ 1.o7.

DEPRESSION WITH PSYCHOPATHY.

61. Case 17.—Man, 43. part of year high school. Has worked in minor clerical positions, not sustaining responsibilities of social station. Not athletic, no alcohol or tobacco. Probably third attack, without definite precipitating cause. Suicidal attempts. Depression considerably moderated at test, complained of thinking difficulty, co-operation especially willing and with effort. Failed below age: Six digits backwards, physical relations. Passed above age: Vocabulary 75 words, thought of passage heard. IQ 1.04.

MIXED PHASE.

62. Case 18.-Woman, 41. High school, religioustraining school. Religious worker. Constitutionally "nervous"; takes things hard; is a follower; enjoys sociability in moderation. Third attack, precipitated by bereavement. Oriented, flighty, labile, depressive ideas, erotic trends. In test fairly normal appearance, over-anxiety for correctness of response. Failed below age: Six digits backwards, 28 syllables. Passed above age: Vocabulary 75 words, Binet's paper cutting, thought of passage heard. IQ 1.07.

DEMENTIA PLECOX Gaoup.

63. Case 19.—Woman, 53, college graduate, successful in scientific profession. Much physical disease preceding, but no definite precipitating cause. Marked delusional development. Gradual weakening of judgment and conduct. Examination about nine years after admission. Throughout the test talked ramblingly on other subjects, stacked up papers before the examiner, directing his attention to them. Correct responses often the only indication that stimulus had been attended to or perceived; such responses promptly given, even in advanced tests. The test record is in great contrast to the behavior disorder. Failed below age: Designs, ball and field superior plan, president and king, 28 syllables. Passed above age: Vocabulary 75 words, Binet's paper cutting, repeats eight digits, seven digits backwards. IQ 1.08. (A trace of negativism appeared in the ingenuity test, where the condition of filling a certain vessel first was insistently disregarded. About six months previously the patient had undergone the Yerkes adolescent point scale with a score of 87.)

64. Case 20 —Man, 24. College graduate. At school shy, overreligious, egoistic, masturbation-complex, over-conscientious. Psychosis precipitated possibly by erotic tangle. Mannerisms, delusion formation and hallucination. Owing to continual attempts at self-injury, was confined in restraint sheet at time of test. Full co-operation in test. Answers came slowly, as though enunciated with effort. Failed below age: Fables score 8, difference of abstract words. Passed above age: None, necessarily. IQ 1.12. (Patient's responsiveness has considerably diminished since this examination.)

65. Case 21.—Man, 31. Three years of college. Minor clerical occupation. "Different" as a boy. Did not join in boyish sports, no mechanical or business ability. Reticent, kindly, religious interests and activities. No definite precipitating cause. Overactivity, impulsive acts, ideas of reference, special mission. In test, co-operation rather intense, some stilting of speech, continued picking at clothes, otherwise normal appearance. Failed below age: Enclosed boxes. Passed above age: Vocabulary 75 words, thought of passage heard. IQ 1.07.

66. Case 22.—Man, 27. College graduate and professional study. Clerical work. Good academic record; not popular, shy, retiring, devoted to family, sensitive, opinionated. No definite precipitating cause. Suspicious, ideas of reference, lack of insight. Normal co-operation in test. Failed below age: Ball and field superior plan, enclosed boxes. Passed above age: None, necessarily. All superior adult tests passed. IQ 1.17, second highest in the material.

67. Case 23.—Woman, 45. One year college. Very good in school work. Housekeeper. Retiring, no men friends, reticent, very conscientious. Breakdown after remission from original onset, without known precipitating cause. Erotic delusions and hallucinations in foreground. Conduct normal during test, save for free expression of delusions without insight. Failed below age: Designs, induction, enclosed boxes, 28 syllables. Passed above age: Vocabulary 75 words, repeats eight digits, thought of passage heard. IQ 1.04.

68. Case 24.—Man, 28. Two years college. Capable in business. More reserved than other members of family, good student, did not always get on well with teachers. Symptoms date from attack of rheumatic fever. Increasing "opposite-mindedness" and irritability. General persecutory ideas, not elaborated. Test co-operation seemed perfunctory, but good technical criticism was made. No insight into mental trouble. Failed below age: Designs, ball and field superior plan, 28 syllables. Passed above age: None, necessarily. IQ 1.13.

69. Case 25.—Man, college graduate, professional study. Has not worked independently. Close student, no outside interests, sensitive, not good mixer, worries. Psychosis without apparent precipitating cause. Some erotic trends. In test, co-operation willing, rather listless. Asked if first ingenuity problem heard before, replied characteristically,"I wouldn't be surprised if someone had told me a long while ago—I have heard similar problems." Test passed by satisfactory performance in parts b and c. Failed below age: Ball and field superior plan, reversed clock, fables score 8, enclosed boxes, 28 syllables. Passed above age: Vocabulary 75 words, Binet's paper cutting, thought of passage heard, seven digits backwards, ingenuity. IQ 1.07.

INEBRIETY.

70. Case 06.—Man, 35. College course, not graduating. Clerk and salesman, considered good at latter. Few interests, fond of athletics. Alcohol to excess, hospital care therefor. Diminished sense of responsibility and appreciation of others’ help. Normal attitude in test. Failed below. age: Reading and report, arithmetical reasoning, repeats seven digits, six digits backwards, 28 syllables. Passed above age: Vocabulary 75 words, Binet's paper cutting, ingenuity. IQ 1.04. (Alcohol appears to have cut into the memory.)

PARANOID GROUP.

71. Case 27.—Woman, 53. High school graduate, happily married. Argumentative, markedly social, a leader, egoistical. Slowly developing paranoid ideas, chiefly relating to husband. In test pleasant manner, but keyed up, interrupting to elaborate on paranoid ideas. Failed below age: Arithmetical reasoning, enclosed boxes. Passed above age: Vocabulary 75 words, thought of passage heard. IQ 1.04.

72. Case 28.—Woman, 50. High school graduate, capable business woman. Oversensitive, good organizer. Psychosis precipitated by physicalinjury. Systematic delusional ideas of a religious nature. Otherwise normal behavior. Test attitude normal. Failed below age: None. Passed above age: None. IQ 1.00+. (Patient made rapid and complete recovery.)

CONSTITUTIONAL PSYCHOPATHIES.

73. Case 29.—Woman, 29. Limited education. Tantrums in childhood, instability of emotion and conduct. Preoccupation with erotic subjects. Test attitude high strung, apologizing for fancied deficiencies on ground of limited education. Failed below age: Problems of fact, reversed clock, fables score 8, six digits backwards, 28 syllables. Passed above age: Vocabulary 75 words, Binet's paper cutting, repeats eight digits, thought of passage heard, ingenuity. IQ 1.07.

74. Case 30.—Man, 21. Last year high school. No independent work. Sensitive, self-centered, not making friends easily, not athletic. Very imaginative, wrote stories of morbid content. Hospital care owing to depressive episodes with suicidal attempts. At time of test, was not under hospital care, constitutional psychopathy being the essential psychotic feature. Normal co-operation, strongly motivated for best record. Failed below age: Ball and field superior plan, problems of fact. Passed above age: None, necessarily. All "superior adult" tests passed. IQ 1.18, highest in the material. (Has since committed suicide.)

75. It is possible to conceive the intelligence here measured, in less empirical terms than those of the scale itself. The Yerkes and Stanford scales deal essentially, the army Alpha almost wholly, with information and ideational capacity-ability to deal with ideas, as contrasted with ability to deal with concrete things, or make adjustments to other persons. "It probably requires more intelligence to tell what one ought to do in a situation which has to be imagined than to do the right thing when the real situa- tion is encountered." Such formulation makes ability to deal with ideas (and the words which are their conventional symbols) the governing factor in intelligence, to which capacity in the sphere of "real" action is subordinate. This formulation is necessary to the conception of "intelligence" as measured in the scale. It is inconsistent with a conception of intelligence as determining general adaptation.

76. If test failure is presumed upon such basis, e. g., failure to speak a response although it can be written, the test is made a criterion not of intelligence, but of general adaptation. It may without practical difficulty be inferred that failure of conventional reaction means some notable failure of adaptation, but not so that conventional passing means sustained adaptation. Witness the schizophrenic whose confinement in a restraint sheet does not restrain him from an IQ of 1.12, or the psychoneurotic who passes every "superior adult" test and proceeds to commit suicide. Tests governed by ideational capacity are not accountable for the subject's reaction outside the sphere of dealing with ideas.

77. The present dementia præcox and manic-depressive cases, accompanied by generally little and often no clear reduction of "intelligence," accordingly appear as failures of adjustment not essentially in the sphere of ideas, nor of things, but in the more instinctive and affective adaptations to other members of society. For dementia præcox there is a mass of other evidence to this effect. For the manic-depressive psychoses, the balance of the same probability is considerable. Intellectual impairment is secondary to affective and volitional. In the organic dementias ideational capacity also suffers primarily. As such, it drags down the others with it in large degree. But there is no reason to consider the primary deterioration as confined to the intellectual sphere.

78. It appears that the Stanford scale and its congeners use- fully measure certain qualities included in capacity for dealing with ideas, and thereto the name "intelligence" is not unjustly applicable. Similar intelligence quotients appear in extremely differing personalities, and normal ones in the presence of grave mental imbalance. While essential in some degree, "intelligence" is neither the sole nor the chief factor in practical mental adjustment.

79. The factors in mental adjustment are capacities for dealing with men, with things, and with ideas. Intelligence scales deal with the last of these. It need not be further defined. Accomplishments in one of these classes are found to be positively related to accomplishments in the other classes. This might be because capacities for dealing with men, things and ideas are forms of an underlying common capacity.^6,7 It is certainly also because any superior capacity in one class, as such, favors the development and deployment of existing capacities in the other classes.

80. One with high degree of manual skill may thus become the best of mechanics; but with this unsupported, he continues as such. Executive, rather than ideational, capacity unites with such mechanical ability to fit him as industrial foreman or superintendent. Lacking executive but having superior ideational capacity, favors his development rather as an ingenious artificer or inventor. Conspicuous lack of social capacity renders his remaining abilities liable to exploitation by others. Excelling in both social and ideational capacity, he becomes a head of his organization.

81. For practical measurements of ideational capacity, the situation is generally satisfactory. For purposes involving not too delicate measurements through extreme ranges, the Stanford scale used in these observations is suited. For intelligence levels likely to concern industrial problems of personnel selection, the army Alpha test and the "signal corps test of mental alertness" have had wide application. The now available instruments of measuring "intelligence" appear not inadequate to any practical demand upon them that can be foreseen.

82. Ability to deal with things includes motor and mechanical accomplishments, in so far as they are not governed by judgment of, or influence upon, the minds and actions of other persons. Thus, the housepainter or carpenter needs ability to deal with things; the artist in painting or sculpture, a co-ordinate ability plus capacity for dealing with ideas. The mechanic deals with things; the inventor with things and ideas; the great engineer, with things little, ideas considerably and men most essentially of all.

83. In the sphere of dealing with things, practical concern is usually with what degree of some specialized ability a person possesses. The field has been extensively covered in the development of the "trade tests." This material is of recent growth, and less generally known than intelligence tests. It is not apparent that the problems involved are more difficult than those successfully dealt with in the measurement of ideational capacity.

84. Ability to deal with men, positive adjustments to other personalities, social-executive capacities, are summed up in the capacity for influencing and directing the conduct of others. It is in practice more an expression of inborn character and less a product of special training than abilities concerning things or ideas. It is, however, susceptible of education, perhaps in the same order as the other two. Abilities concerning things and ideas are chiefly of conscious knowledge, or habitual automatisms. Ability to deal with men is equally or more governed by unconscious factors.

85. In the sphere of dealing with men, the experimental situation is less satisfactory. Various methods of approach are exemplified in the work on the association experiment, and studies by G. G. Fernald, Myerson and Downey. The chief difficulty is to make the experimental reactions share in the unconscious determination which affects the actual ones. Chief practical reliance is still placed upon analysis of previous conduct, and the judgment of competent authority upon the social impression made.

86. The bankruptcy of former faculty psychology had for underlying cause the fact that judgment between hedonism and utilitarianism differs from judgment of commercial prospect, and these two from judgment in a love affair. As was experimentally developed in Scott's work on suggestibility, the manifestation of mental faculties differs according to the setting in which they are exercised. Chief settings here distinguished concern the fields of ideas, objects and other personalities. Capacities in these fields are faculties underlying the "faculties" in their previous conception. The main social significance of psychology has been attained through achievements concerning ideational capacity as such. Equal mastery is to be foreseen in the field of dealing with things as such. Substantial invasion of the third field will be longer delayed.

87. The relative contributions to success in life of the three classes of ability are fairly clear. First, almost by definition, come the abilities to deal with other personalities. As human evolution consists largely of processes that make for higher social organization, their importance tends to increase. Second have long been the ideational capacities, the more valued servants of the volitional abilities implicit in the first class. The value of the ideational capacities has recently undergone a relative depreciation, and the manual skills, abilities to deal "with things" have correspondingly gained. The abnormal world situation is one to foster such a development.

88. Elementary relations of intelligence, psychosis, happiness and general adaptation are briefly reviewed in conclusion. Due weighting of psychological and ethical factors indicates that general adaptation is to be conceived essentially in terms of outward achievement, not inner contentment. Intelligence is favorable to general adaptation in their present conceptions. Intelligence is without marked relation to the development of psychosis. Intelligence, except as volitionally supported, is negatively related to happiness ("He that increaseth knowledge increaseth sorrow"). Psychosis is by definition a breakdown of general adaptation. happiness is a subordinate factor in general adaptation, whose importance depends on the extent to which aspirations are volitionally supported. The relation between happiness and psychosis is of all degrees, varying with some uniformity according to the psychosis, but not admitting of simple statement.