In the various experiments recorded of extirpation of the hemispheres, the phenomena now well known by the phrases 'psychic-blindness,' 'psychic-deafness,' etc., appear. These phrases are contrasted with ' cortical ' blindness, deafness, etc. In the former, the animal loses all his sense of the meaning, associations, value, of what he sees and hears. He still sees and hears, and he still has reactions appropriate to sight and hearing; but he does not show the reactions peculiar to what he has learned, in all his life, about what he sees and hears. After certain operations upon his brain the dog sees a whip, but is no longer afraid of it; sees food, but no longer moves forward to secure it; hears a voice, but no longer recognizes it. What psychologists mean by ' apperception ' — the tinder- standmg of a thing, as opposed to the mere seeing or hear- ing of it — this is gone. The thing seen or heard is no longer a co-ordinated thing, built up of memories, varied sensations, motor dynamogenies, and pleasures or pains; but it is a bare, worthless stimulus to reflex or suggestive reaction.
Lack of co-ordination } Then lack of attention, lack of persistence, of effort, of volition! ' Exactly,' says the brainless pigeon, 'that is what I lack.' Attention, effort, volition — these are the motor correlatives of the co-ordi- nations of memories with present sensations, the motor correlatives of association, of apperception. Lack on one side, the sensory, then a fortiori lack on the other, the motor. The motor it is, exactly, which holds the sensory elements together. The creature shows, in fact, no com- plex activity, no curiosity, no constancy of attention, no 402 The Origin of Volition.
persistence in his undertakings — indeed, no undertakings, no adaptation to new conditions. He lacks all means of taking care of himself, and perishes of hunger with food under his nose.
Now substitute men for dogs and pigeons, and substi- tute disease or drugs for the operator, and you have, in cases of varying clearness, cases of general progressive aboulia in man; all those cases in which consciousness subsides into the depths of mere vague feltness, so to speak, of sensations coming in and movements made upon them. Two typical instances may be cited, the two for which we have exact observations. One of these is the rather obscure phenomenon of 'Jacksonian re-evolution,' and the other is the fact, equally obscure until very recently, of hysteria.
By ' re-evolution ' is meant gradual recovery from a swoon or fit of such a gross character that the mental faculties had given way, and the patient had become all but unconscious. It is evident that in such cases, in which the recovery is comparatively slow, tests may be applied at intervals to discover the order in which the various functions return; this order will evidently repre- sent the inverse order of their loss in the fit, and so the original order of their development.
A recent case reported by Pick,^ furnishes perhaps the most careful and detailed observations yet made on the re-evolution of the function of speech — a function which, by reason of its complexity, lends itself to recovery by stages. Four stages were found in this epileptic patient's recovery from complete unconsciousness: first, no response whatever to words spoken or written; second, 1 Archiv fiir Psychiatrie, XXII., heft 3, pp. 25 ff.
special Evidence. 403 the parrot-like repetition of words heard (an imitative condition called ccJiolalia; the man could strike a match only when he saw some one else strike one); third, a dazed sort of reply by counter-questions; and fourth, intelligent speech with voluntary forming of sentences.
The evidence from such cases as this as to the place of volition in the evolution scale is self-evident. The first form of response, echolalia, is simple verbal imitation, i.e., sensori-motor suggestion from a brain-level below the cortex. It involves no extended associations. The next stage represents, I think, a groping of the man after coherence, agreement, co-ordination; just as the child gets dissatisfied with his simple imitations, has a sense of dawn- ing capacity to identify, compare, and select, of a tendency to be a willing being; and gropes toward the next stage of development. Then comes the recovery of the centres and their connections. The man's associative channels open up and the currents flow in and out. He remembers his word-meanings, compares them, feels the proper energies tingle in lip and tongue in co-ordinate movement, and so reaches voluntary speech again. In short, volition in speech has come back on the basis of simple imitation, through a period of tentative trial and effort to co-ordinate movements. Could there be a reconstruction in plainer terms of the child's attainment of voluntary speech through imitations, tentative and then repeated; or a plainer demonstration that the normal way of volition is through imitation } The other case — the general phenomena of hysteria in their varied combinations — may be spoken of only in a general way, since the quotation of observations would be too lengthy. As an authority, I appeal, as I have 404 The Origin of Volition, already done, to Prof. Pierre Janet, whose works ^ are more psychological than those of most professed alienists, and who, unlike many of the rest, is aware that there are philosophical problems in the world, no less than medical. At the end of a recent discussion of ' Defi- nitions of Hysteria,' he concludes by himself defining hysteria thus: ^ "A disease especially characterized by mental symptoms of which the principal are enfeeblement of the faculty of mental synthesis; retraction of the field of consciousness; the disappearance of a certain num- ber of elementary phenomena — called stigmata — from consciousness and from personal perception; a tendency to the permanent and complete division of personality; the formation of many independent groups of phenomena; the co-existence of these systems with each other or their alteration by each other, giving rise to crises, somnam- bulisms, subconscious actions, and finally, through the defect of synthesis, the formation of certain parasitic ideas whose development is so complete and independent that they break up all normal control of consciousness and manifest themselves in various troubles of a physical and accidental sort."
From this definition and from the description of the phenomena by Charcot and other writers, we may say that the outstanding psychological characteristics of such mental degeneracy are: (i) ' enfeeblement of the faculty of psychic synthesis'; (2) loss of control and direction of the mental life; (3) the breaking up of the material of ^ AutomatistJie psychologique, Etats Mentals des I/ysierigues (2 vols.), Quelqiies Definitions Recentes de V Hyst'erie in Arch, de Neurologie^ Juin et Juillet, 1893.
2 See pp. 49, 50 of the paper cited last in the preceding note.
special Evidence. 405 personality, and the possible formation of several inde- pendent psychic groups, either successive or existing together; (4) an enormous development of the tendency to imitation; (5) the growth of mental suggestibility, tend- ing to the complete dominion of controlling ideas and im- perative movements, all of which are summed up in the last characteristic; (6) general and progressive aboulia.
Here, again, we note at once, that with enfeeblement of mental synthesis goes increased suggestibility, which takes the form, whenever possible, of direct imitation. And, further, we find the process of re-evolution striving to do its proper work in the tendency of the separate groups of psychic facts to get themselves the appearance to personality by partial synthesis. As James puts it, they 'tend to personal form.* What is this but the reverse way of mental growth, whose terms are simple suggestion, — sensori-motor and ideo-motor, — imitation, synthesis, which last, in its various stages, illustrates the growing success of effort, and the growing independence of the one great synthesis whose pre-eminence stands for stable personality and intelligent volition } The absence of effort in certain cases is shown in the fact that the patients are often unable to learn any new movements, although they can perform, in response to a suggestion, those which have become habits,^ — just the condition of the child before its first * persistent ' imita- tions.
A further remarkable confirmation of the distinction 1 Janet (^Aui. psy., p. 64) calls this condition, on the memory side, 'antero- grade amnesia' — an unfortunate phrase. It is simply, as far as action is concerned, general ' apraxia,' or the inability to effect the synthesis necessary for a movement, through failure of some of the memories which go into the synthesis.
4o6 The Origin of Volition.
between voluntary and involuntary imitation is seen in the phenomena of unconscious writing, from which the hypoth- esis of ' secondary personality ' gets some support. The anaesthetic hands of certain blind-folded patients respond in writing appropriately, either in lines of habit, or by imitative repetition. Not only are the movements here involuntary; they are also quite unconscious.^ And the view that the attention and the co-ordination which it effects are the real vehicle of volition is shown in the negative 2 fact, that as soon as the patients are allowed to see the limbs in question, which they know to be paralytic, no response whatever from these limbs can be secured. This belongs to the theory of ' control ' taken up in a later connection. ^ Furthermore, the anaes- thetic hand, hidden behind a screen, will imitate the movements made by the patient voluntarily with the un-anaesthetic hand, giving what may be called acquired 'accompanying movements.'* And yet again, the anaes- thetic hand traces out, when a pencil is put into it, and it is left undisturbed, mental pictures as they exist in the subconsciousness of the owner of the hand, what I have called, in the case of the child, simple * tracery-imitation.' The development of this tendency under the law of habit accounts, by the way, for all the 'intelligent' results of planchette writing.
1 See Binet and Fere, Arch, de Phys., iSyy, II., pp. 339 ff., and Binet, Les Alterations de la Personalite.
2 Negative, i.e., to the other remarkable case of patients who cannot move the limbs unless they do see them. In the cases now cited, voluntary move- ment is impossible, and the incapacity is extended by suggestion to the invol- untary movements of the organ upon which the attention is fixed. For the other, contrasted, cases see the reference given in the next note.
3 See Chap. XV., § 4, below.
* Binet and Fere, loc. cit., 340-345.
Jl special Evidence. 407 Cases of congenital mental defect, of which idiocy and imbecility are the extremes, teach us about the same thing. Weak-minded children are notably different from other children in two things: the difference in the character of their early movements, and the difference in their abilit)^ to learn new movements. In regard to the first point: their movements are abrupt, undisciplined, isolated from the rest of the organic happenings, jerky, and essentially unaccountable. The normal child gets disciplined by his first experiences, and his movements show the subduing and regulating effects of all kinds of suggestion. But the child which we call, in varying degrees, * natural,' is not so; much that we mean by acquired nervous inhibition is wanting, and the character of the movements becomes at once an index of the mental state. He imitates well, but repeats his imitations without modification. He lacks voluntary power both for action and for control.
This characteristic leads at once to the second: the child fails to learn. He progresses as far as the natural growth of the organism carries him. All his senses may be perfect; his vegetative processes normal; his reflexes good; his native reactive couples responsive. This means, in general, that he grows well, up to the simple, imitative stage; then he stops! Stops where, in the reverse pivcess of luileaming, the hysteric and hypnotic patients stop! He gets a few useful associations drilled into him by force of habit. He may come to do the simpler things which he sees others do, and make the simpler word sounds which others make. But he does not initiate anything, does not learn by his own effort. He is like the brainless pigeon. Idiots are generally very imitative. Imbeciles are lower still; if they get any form in the sounds they emit, it is only what Seglas calls ' reflex echolalia.'
4o8 The Origin of Volition.
I think this indicates very fairly, in these poor defec- tives, about the condition of things which we have found in cases of hysterical and cataleptic degeneracy. Here is the same lack of mental synthesis, so-called mental blind- ness, deafness, dumbness,^ the exaggeration of unruly movements, inability to acquire anything new, excessive imitation, general suggestibility. The idiot lacks the * third-level ' co-ordination, just as all the rest do. Volun- tary inhibition is gone, and a measure of involuntary inhibition, also. Attention is weakened, vacillating, in- constant. Heredity defect has done, in this case, what disease has done in the other cases, i.e., drawn a sharp line between action which is imitative and simple, and action which is still imitative, but complex, — the latter alone being persistent, effortful, acquisitive, voluntary. These poor creatures have mental images, and make responses to them, but they are unable, in Janet's phrase, (V ejfectuer la synthese?
Passing now to what I have designated partial aboulia, we have to consider the decay or destruction of particular motor functions, asking whether, if we apply the law that the order of loss is the inverse of that of development, we find evidence for our theory of the rise of volition. This examination can best be made in connection with complex functions or acquisitions, and speech and handwriting at 1 The expression 'mental dumbness' was suggested first by the present writer for the inabiUty to speak intelligently, as opposed to the mere ability to imitate sounds. See the article, * Internal Speech and Song,' F/iilos. Review, II., 1893, p. 389. See also, below, Chap. XIV., § i.
2 The characteristics of the idiot's movements are given by Guicciardi, Zeitsch. fur Psychologic, IV., p. 154, as, in order, progressive inco-ordination of voluntary movement, loss of voluntary movement, increased imitation.
1 special Evidence. 409 once suggest themselves. I accordingly have to cite evi- dence from aphasia and agraphia. Other functions which do not involve so clearly the complex co-ordinations learned by voluntary effort may also be cited in their place as we proceed.
It may be well to give, at the outset, the general result of the detailed examination of cases of such troubles. The order of acquisition of the elements of speech and hand- writing is this: first, in the stage of suggestive reaction before the rise of conscious imitation, we find hearing of sounds with some very simple associations, also suggestive adaptation of movements of the tongue, hands, etc., under the direct stimulus of associations, pleasures and pains, etc.; second, in the stage of simple imitation, we find full recognition of objects and musical tunes, some slight power of song in individual children, imperfect articula- tion, increasing co-ordination of movements, though still without effort or volition; third, in the epoch of persistent imitation, we find full understanding of speech, the rapid acquisition of co-ordinated movements in speaking and writing, and also visual sign interpretation which leads on to the ability to read.
On the side of disease, therefore, we would expect, if the acquisition proceeds by stages so well marked, that at least the same three great types of function would be reasonably independent in their loss. That is, we should find that the highest type of function, revealed in volition and conscious synthesis, would in some cases be lost alone, and that to its loss might then be added that of the func- tion which corresponds to sensation and simple imitative adaptation, but which does not show intelligence and con- scious selection. Finally, in the most fundamental derange- 4IO The Origin of Volition.
ment of all, even the degree of acquisition represented by- direct imitation and reflex speech should be impaired along with the two higher kinds.
Our expectations are so clearly fulfilled in current inter- pretations of defects in the active life, that the very nomenclature of the subject gives us words for these very distinctions. Loss of the first type is called, as we have seen, psychic blindness, deafness, etc., according as one sense or another is affected, issuing in associative or higher sensory aphasia. The term dyslogia has been ap- plied to this state by Seglas. It has equal application to various functions, but applies especially to speech. The second stage has had, if not equally general recognition, equally happy characterization by the same author, who calls defects of speech of this general nature dysphasia. It is aphasia of the sensory or motor type, due to the loss of a specific kind of sensory or motor memory through a lesion in a specific centre. Finally, the greatest defect of speech is dyslalia^ or aphasia due to lesions in the lower centres.
We may now, before going into more detail, draw up a table showing these functions, and the corresponding defects of the three great classes described, using the terms current for the function of speech, but bearing in mind the general application of the divisions themselves to complex motor acquisitions in general. See Table X.
The main point in discussion — the origin of Volition — is isolated in the question as to the distinction between dyslogia and dysphasia. The question is this: Do we find that whenever the mind is impaired to the degree designated, in respect of special acts, by the phrase am- nesia, — the loss of some function demanding spontaspecial Evidence.
neous co-ordinated memories, and action in view of such co-ordinated memories, — that voluntary acquisitions are then impaired, while purely sensori-motor actions remain? In other words, do these kinds of aphasia — speaking of speech in particular — show a functional line between per- sistent effort and simple imitation?
In support of the truthfulness of the exhibit made in the table — as far as pathology goes — I may make certain observations: — Among the numerous schematic diagrams which have been proposed to illustrate aphasia in its different forms, that of Lichtheim has had most recognition. ^ It is not my purpose to add to these constructions, which have rep- resented, in part at least, the individual interpretations of the particular writers. The * motor square ' which has been found serviceable in the preceding sections, presents a modification of Lichtheim's scheme in the one direction in which current psychology finds some of its most impor- tant problems; and it thus enables us to bring the prob- lems of aphasia into connection with general psychological theory. Lichtheim's diagram, Fig. XVII. a., gives no means of distinguishing between the centre of muscular sensa- tions and memories, the kinaesthetic centre, on one side, and the true motor centre, the innervation centre, on the other side; but includes both, under the one symbol M. In my 'motor square' diagram. Fig. XVII. b., these two possibly distinct areas, and perfectly distinct functions, are distinguished, thus making it possible to represent, dia- grammatically, a distinction current in psychology. The distinction is required in the interjDretation of cases of aphasia. Lichtheim himself admits this, and constructs 1 Brain, Part XXVIII., January, 1S85, p. 436 (his Fig. i).
special Evidence.
an awkward supplement to his diagram when he comes to interpret certain individual cases. ^ If my 'motor square' be squeezed together, so that the opposite corners, mc and vip, coincide, it then becomes identical with Lichtheim's. The isolation of vip, however, is required by all the evi- dence now accumulated, which goes to show that move- ments may be stimulated directly from the sensory centres {sg\ sight, hearing, etc.), or directly from the higher come mi a. Scheme of Lichtheim.
FIG. XVII.
b. Motor Square ordinating centre {cc) — supposing it to exist, as all the diagrams, interpreting the facts functionally, represent — without necessary stimulation of the kina^sthetic cortical movement centre i^jtc). This class of cases, now very generally accepted, has no separate recognition, I think, in any of the schemes except my * motor square.'
Interpreting the ' motor square ' in terms of the three great functional classes of motor acquisitions, we may say 2 My use of this diagram, before I saw Lichtheim's, in class-room demon- stration of the ' motor ' problems in psychology, has proved it so convenient that I have ventured to print it in my text-books. Most of the diagrams proposed by others are intended to illustrate the different sensory areas which contribute to speech (Charcot's, Kussmaul's in Storungen der Sprache, p. 182, etc.); these centres are all bunched in Lichtheim's and mine, the purpose being to illustrate types of motor disturbance, rather than particular local lesions.
414 '^^^ Origin of Volition.
that aboulia, and the equivalent dyslogia, result from some disturbance in cc, or its connections, whereby the co-ordi- nating centre (Lichtheim's Begriffscentrimi, B) is cut off, either (i), from the motor discharge centre mp, for the particular function in question, or (2), from the centres from which the stimulus or material of co-ordination comes. All the varieties of amnesia fall under (2), in as far as the particular memory pictures whose absence constitutes the amnesia observed, are necessary to the concentration of attention by which the voluntary performance of the action in question is brought about. That is, it is possible that a particular case of inability to perform an act of speech may be due, apart from injury to cc, to a lesion which breaks any of the three connections cc, mp; cc, sg, mp; or cc, mc, mp. The other case (i) includes instances in which the failure to speak is due to lack of ability to get the attention fixed upon anything which would represent the movement itself apart from both kinaesthetic impressions and special sense memories. Such cases would involve a doctrine of innervation sensations and memories due to the condition of the motor discharge centre itself.^ The two other cases of possible lesion in this highest region, involving aboulia only, represent respectively sen- sory amnesic aphasia of the several kinds known as visual, auditory, etc., and motor amnesic aphasia. It is evident that a break in the line cc, sg would accomplish both of these; that is, the patient would be unable to speak volun- 1 So Waller's region {Brain, XIV., p. 179, and XV., pp. 380 ff.), which is called by him the ' locus ' of subjective as well as objective fatigue, would, if cut off from its connection with the co-ordinating centre, produce aphasia, even when the kinaesthetic sensation series were all intact. This possibility, whatever we may think of its probability, it is impossible to represent on Lichtheim's or any other of the earlier diagrams.
special Evidence, 415 tarily, however he might preserve all his special centres, both sensory and motor. This is the case where a patient is unable to speak or write spontaneously, although he can repeat or write words which he hears or sees, written or printed (using the line mc, mp). It is possible, however, since the symbol sg represents the various sensory seats taken together, that a function like speech might in some cases not be impaired when a particular connection cc, sg is cut, since the attention might be stimulated by a discharge from an alternative sensory seat. This gives its validity to the distinction between the so-called types of speech, as auditory, visual, motor, etc.
It is evident, therefore, that a certain very important class of functions would be left to a man of such partial aboulia. First, he might be able to perform a voluntary function when his attention was supplied with some in- direct stimulus: so the cases in which voluntary movement is possible only when the eyes are open. Or, second, he might be able to perform other voluntary co-ordinations in which the particular class of memories now cut off are not essential elements; and third, he might be able to per- form, reflexly or by suggestion, imitation, etc., functions which he could not perform voluntarily.
All of these deductions respecting aboulic patients are securely established by pathological facts. The last men- tioned is the critical distinction, and some cases illustrat- ing it may be cited, from a great number available. They are selected with two especial points in view: first, as showing the fact of conscious simple imitation in patients to whom all persistent effortful reactions had become im- possible; and, second, as showing the inability of such patients to learn again the function which is lost, without 41 6 The Origin of Volitio7t.
resorting to a painstaking repetition by imitation of a new kind of motor association. By this means such a patient may train his attention over again upon a new class of memory images.
1. Case of Pick already cited. ^ This man was able to strike a match only when he saw the proper movements of another (pp. 764 and 76Z). He echoed words he heard, and he even repeated with the questioning inflection ques- tions addressed to himself (pp. 568-569 and 771-773); but he had lost all spontaneous speech. Pick interprets the case (p. 774) as one of 'transcortical word-deafness' de- scribed by Lichtheim and Wernicke, which arises from a lesion of the line BM in Lichtheim's diagram, or of the line cc, sg in my ' motor square.' It is a case of verbal amnesic aphasia, or dyslogia. It involves aboulia, but not dysphasia.
2. Case of Pitres,^ showing agraphia, in which ' tracery imitation ' remained. This case also shows the possible mutual isolation of speech and writing, inasmuch as there was no aphasia. Here we have a lesion of the tract cc, sg (Lichtheim's BM) for writing movements only, the lesion not extending to the corresponding tracts for speech movements.