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A STUDY OF ASSOCIATION IN INSANITY
A STUDY OF ASSOCIATION IN INSANITY GRACE HELEN KENT AND
A.J. ROSANOFF M.D.
KINGS PARK STATE HOSPITAL N.Y.
TABLE OF CONTENTS.
PART I. ASSOCIATION IN NORMAL SUBJECTS.
Sec.1. Method of Investigation
Sec.2. The Normal Standard
Sec.3. The Frequency Tables
Sec.4. Normal Associational Tendencies
Sec.5. Practical Considerations
Sec.6. An Empirical Principle of Normal Association
PART II. ASSOCIATION IN INSANE SUBJECTS.
Sec.1. General Survey of Pathological Material
Sec.2. Classification of Reactions
Sec.3. Non-Specific Reactions; Doubtful Reactions
Sec.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
Sec.5. Order of Preference
Sec.6. Errors Involved in the Use of Arbitrary Objective Standards
Sec.7. Analysis of Pathological Material
Dementia Praecox
Paranoic Conditions
Epilepsy
General Paresis
Manic-Depressive Insanity
Involutional Melancholia; Alcoholic Dementia; Senile Dementia
Sec.8. Pathological Reactions from Normal Subjects
Sec.9. Number of Different Words given as Reactions
Sec.10. Co-operation of the Subject
Sec.11. Summary
Acknowledgments
INDEX TO FREQUENCY TABLES AND APPENDIX
THE FREQUENCY TABLES
APPENDIX TO THE FREQUENCY TABLES
PART I.
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.
Sec. 1. METHOD OF INVESTIGATION.
In this investigation we have followed a modified form of the method
developed by Sommer[1] the essential feature of which is the
statistical treatment of results obtained by uniform technique from a
large number of cases.
[Footnote 1: Diagnostik der Geisteskrankheiten p. 112.]
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.
Sec. 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.
Sec. 3. THE FREQUENCY TABLES.
From the records obtained from these normal subjects including in all
100000 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. [1] These tables will be found
at the end of this paper.
[Footnote 1: A similar method of treating associations has been used
by Cattell (Mind Vol. XII p. 68; Vol. XIV p. 230) and more
recently by Reinhold (Zeitschr. f. Psychol. Vol. LIV p. 183) but
for other purposes.]
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.[1]
[Footnote 1: It should be mentioned that we have discovered a few
errors in these tables. Some of these were made in compiling them from
the records and were evidently due to the assistant's difficulty of
reading a strange handwriting. Other errors have been found in the
records themselves. Each of the stimulus words _butter_ _tobacco_ and
_king_ appears from the tables to have been repeated by a subject as a
reaction; such a reaction had it occurred would not have been
accepted and it is plain that the experimenter wrote the stimulus
word in the space where the reaction word should have been written.
Still other errors were due to the experimenter's failure to speak
with sufficient distinctness when reading off the stimulus words;
thus the reaction _barks_ in response to _dark_ indicates that the
stimulus word was probably understood as _dog_; and the reactions
_blue_ and _color_ in response to _bread_ indicate that the stimulus
word was understood as _red_.]
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.
Sec. 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.[1]
[Footnote 1: In the study of the reactions furnished by our normal
subjects it was possible to analyze the record of any subject only by
removing it from the mass of material which forms our tables and
using as the standard of comparison the reactions of the remaining 999
subjects.]
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.
TABLE I
Value of reaction 0 +- 0.1 0.2-0.5 0.6-1.5 1.6-10 >10
Sex Number % % % % % % %
of cases
Persons of M.. 60 9.2 1.8 5.2 9.7 11.0 27.8 85.5
collegiate F... 40 9.5 1.8 8.0 9.8 11.7 28.0 83.4
education Both 100 9.3 1.8 4.7 8.7 11.8 28.2 34.4
Persons of M.. 50 5.8 1.6 8.6 8.3 10.2 81.6 88.7
common school F.. 50 4.6 1.8 8.8 7.1 9.4 82.0 42.1
education Both 100 5.2 1.4 3.5 7.7 9.8 81.8 40.4
School children M... 33 5.9 0.8 4.2 8.7 10.0 28.6 88.5
under 16 Jr. F.. 45 5.0 1.0 4.6 9.8 11.0 80.1 36.7
years of age Both 78 5.7 1.4 4.6 9.8 11.2 29.4 87.4
General average. Both.1000 6.8 1.5
It will be observed that the proportion of individual reactions given
by the subjects of collegiate education is slightly above the general
average for all subjects while that of each of the other classes is
below the general average. In view however of the wide limits of
variation among the thousand subjects these deviations from the
general average are no larger than might quite possibly occur by
chance and the number of cases in each group is so small that the
conclusion that education tends to increase the number of individual
reactions would hardly be justified.
It will be observed also that this comparative study does not show any
considerable differences corresponding to age or sex.
With regard to the type of reaction it is possible to select groups
of records which present more or less consistently one of the
following special tendencies: (1) the tendency to react by contrasts;
(2) the tendency to react by synonyms or other defining terms; and (3)
the tendency to react by qualifying or specifying terms. How clearly
the selected groups show these tendencies is indicated by Table
II. The majority of records however present no such tendency in a
consistent way; nor is there any evidence to show that these
tendencies when they occur are to be regarded as manifestations of
permanent mental characteristics since they might quite possibly be
due to a more or less accidental and transient associational
direction. No further study has as yet been made of these tendencies
for the reason that they do not appear to possess any pathological
significance.
TABLE II.
Special group values.
_____________________________________
Stimulus Reaction General Contrasting Defining Specifying
word. word. value. group 49 group 73 group 84
| subjects subjects subjects
|----- % No. % No. % No. %
chair........... 26.7 25 51.0 11 15.1 10 11.9
1. Table....{ furniture....... 7.5 0 0 13 17.8 4 4.8
round........... 1.0 1 2.0 0 0 4 4.5
wood............ 7.6 2 4.1 9 12.3 10 11.9
cotton.......... 2.8 0 0 1 1.4 5 6.0
easy............ 3.4 0 0 8 11.0 1 1.2
feathers........ 2.4 0 0 1 1.4 5 6.0
7. Soft.....{ hard............ 36.5 34 69.4 14 19.2 18 21.4
silk............ 1.0 0 0 0 0 2 2.4
sponge.......... 2.2 0 0 0 0 4 4.8
cloth........... 1.7 1 2.0 0 0 3 3.6
color........... 12.9 0 0 20 27.4 6 7.1
11. Black...{ dress........... 2.9 1 2.0 1 1.4 9 10.7
ink............. 1.4 0 0 1 1.4 4 4.8
white........... 33.9 31 63.3 17 23.3 18 21.4
desire.......... 19.7 7 14.3 21 28.8 10 11.9
26. Wish....{ longing......... 1.9 1 2.0 6 8.2 2 2.4
money........... 3.2 0 0 1 1.4 3 3.6
flowers......... 4.2 0 0 1 1.4 7 8.3
girl............ 2.4 0 0 0 0 5 0.0
29. Beau- homely.......... 2.7 3 6.1 0 0 0 0
tiful..{ lovely.......... 6.4 2 4.1 7 9.6 2 2.4
pleasing........ 1.6 0 0 3 4.1 0 0
sky............. 1.6 0 0 0 0 3 3.6
ugly............ 6.6 13 26.5 3 4.1 0 0
court........... 6.4 2 4.1 5 6.8 10 11.9
56. Justice.{ injustice....... 2.6 6 12.2 1 1.4 0 0
right........... 15.7 3 6.1 20 27.4 13 15.5
comfort......... 2.6 0 0 5 6.8 1 1.2
disease......... 0.9 2 4.1 0 0 1 1.2
59. Health..{ good............ 9.4 2 4.1 8 11.0 18 21.4
sickness........ 15.3 23 46.9 6 8.2 1 1.2
strength........ 11.2 2 4.1 12 16.4 4 4.8
arrow........... 1.3 0 0 0 0 2 2.4
fast............ 22.2 0 0 25 34.2 15 17.9
horse........... 2.8 1 2.0 1 1.4 6 7.1
65. Swift...{ quick........... 11.7 1 2.0 22 30.1 2 2.4
run............. 1.9 0 0 0 0 4 4.8
runner.......... 1.3 0 0 0 0 1 1.2
slow............ 19.0 30 61.2 2 2.7 4 4.8
speed........... 2.9 1 2.0 5 6.8 0 0
disagreeable.... 1.0 0 0 2 2.7 0 0
distasteful..... 1.0 0 0 4 5.5 0 0
gall............ 4.2 0 0 2 2.7 8 9.5
76. Bitter..{ medicine........ 3.7 0 0 0 0 3 3.6
quinine......... 2.3 0 0 0 0 6 7.1
sweet........... 30.5 31 63.3 8 11.0 12 14.3
taste........... 6.6 1 2.0 17 23.3 3 3.6
bread........... 20.6 17 34.7 4 5.5 18 21.4
...
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Unpublished Work 
