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that the patients have only vague ideas of what you wish them to
tell you. Hallucinations are hard to explain to them, and autistic
thoughts, and phobias, dreams, conflicts, orientation--in short,
dozens of abstract psychiatric concepts not clearly understood or
recognized in relation to any experience they have had. Time is
vague to the aments as it is to young children, giving rise some-
times to misunderstandings. Cause and occasion (post hoc ergo
propter hoc) are confused even more regularly than by normal but
thoughtless people. Family relationships are ill-appreciated. Very
important, and to a degree actually pathognomomic of amentia,
is the typically feeble appreciation of likeness and unlikeness, and
of change of any kind ; as is well realized, judgment of dissimilarity
is t h e one basal intellectual process of mind. Thus the feeble-
minded .do not know that they have become neurotic or psychotic
when folk of normal intelligence often would recognize their condi-
tion. This blindness to change effects diagnosis of every sort, but
that of mental disorder naturally more than others.
Amentia itself in its various well-defined 15 degrees or so is a
diagnosis, and in hospitals at any rate, when present, should always
be added to the diagnostic list as a matter of scientific accuracy as
well as for the benefit of future examiners. The day is all but
passed when it is looked upon as a "disgrace," because now it is
seen to be either purely an accident or else a mental deformity,
congenital or "near-congenital," for which no person is to be
blamed any more than a mother is to be reproached (killed, in some
savage society l) for giving birth to a monstrosity of the somatic
kind.
Oligophrenics, i. e., the feebleminded, are easy game for c e r t a i n
types of hunter, namely those hunting for easy livings--the healers,
the quacks, chiropractors, and such--because from lifetime habit
the aments have been subject to continual suggestion, instruction,
meticulous guidance from without rather than from within their
own cytopenic cortices, their inner understanding of things and
guidance by themselves necessarily failing. They tend to believe
what is told them, to buy "gold bricks" hopefully and with satis-
faction. They buy patent medicine extravagantly and appliances
GEORGE VAN NESS DEARBORN~ M. D.~ F H . D. 531
The reasons for including all of these two dozen factors of an ade-
quate intelligence-examination would require an article--and you
escape it. But after all the main thing is to have them down in
black and white as a refutation that an intelligence test is arbi-
trarily and falsely mechanical. These are all factors in the opinion
as to a person's intelligence and have been so used by me for sev-
eral years in so far as has been expedient or possible in each case.
Here they are :
1. The schooling had by direct-line ancestors. 2. Ages of walk-
ing, talking and reading, when available. 3. Age of the beginning
of schooling, when available. 4. Public or private schools attended.
5. Rural or urban schools ; geographic location, (country). 6. Num-
ber of months in a school year. 7. Grade attained at what age. 8.
Reason for leaving school, (the real reason). 9. Number of times
" l e f t back" (or " j u m p e d " ) and why. 10. Comparison of "smart-
n e s s " with that of his siblings, especially in school. 11. General
mental reaction-time adjusted by the " t y p e " of mentation. 12.
Relative success in arithmetic in school. 13. Reading-ability and
reading-habits. 14. Occupation in general, involving the intellect-
ual grade of the work. 15. Maximum .regular earnings under usual
conditions. 16. If foreign-born, length of time and efficiency in
acquiring English. 17. His own opinion of the relative intelligence.
18. Opinion of his immediate family as to his relative intelligence_,
if available. 19. Binet-Terman questions (VII, 5; VIII, 4; XII, 8;
XIV, 3; XVI, 3) on likeness and unlikeness (in suspected deteriora~
tion). 20. Has fixation of attention been difficult of late? (in sus-
pected deterioration). 21. Have memory and recall been failing of
late? (in suspected deterioration). 22. Re-examination on another
day by the same method (unless it be a performance test). 23.
Intensive method of examination, while keeping the subject's sthe-
neuphoric index high. 24. The studied and intensive use of a com-
pletely standardized and long-used intelligence-scale, preferably
when not contra-indicated, the Binet-Terman (Stanford).
One gets most of this material in a very casual and easy way,
with the expenditure of little time and effort, in so far as it is ob-
tainable at all. Plainly does it mean an intelligence-examination of
534 A M E N T I A I N MEDICAL DIAGNOSIS