Experimental Researches

AN ANALYSIS OF THE ASSOCIATIONS OF AN EPILEPTIC 1

[499] Epilepsy is one of the few mental diseases of which the symptomatology is particularly well known and delimited by innumerable clinical and systematic inquiries. Psychiatry has shown that in the epileptic, besides the symptoms of the fit, there is usually a mental degeneration that can be claimed to be specific and therefore of diagnostic value. Here are the principal traits of those epileptics who show degeneration according to the recognized textbooks of psychiatry:

1 Intellect. Mental debility, slowness of mental reactions, fussiness, restriction and impoverishment of ideas combined with poor and stereotyped vocabulary, frequently abnormal preponderance of fantasy.

2. Emotional disposition: Irritability, moodiness, strong egocentricity, exaggeration of all feelings, particularly religious ones.

[500] These attributes comprise what is known as the epileptic character, which, once established, has to be considered a permanent formation. Transitory accentuations of one or the other trait are quite likely, radiating like ripples from occasional fits. It is occasionally possible to make the diagnosis with sufficient certainty by recognizing the epileptic character, even if fits are not known to have occurred. Such cases, however, are on the whole rare. Very frequently the epileptic character is not very obvious, particularly if the fits are infrequent. It would therefore, for practical purposes, be most valuable to find a method of concise formulation of the epileptic degeneration.

[501] Repeated attempts to investigate the permanent epileptic changes by means of experimental methods have recently been made: thus Colucci 2 and Breukink 3 tested by means of the ergograph; Sommer 4 and his pupil Fuhrmann 5 in particular turned their attention towards associations in epileptics. We consider the latter research as particularly suited for a precise formulation of epileptic degeneration.

[502] Fuhrmann reports on an investigation into the associations of two epileptics. The first concerns a patient who was taken ill in his tenth year. The author found that predicates in particular occurred repeatedly and that egocentricity played a prominent part. Not all reactions could be regarded as “associations”; there were also verbal reactions, the content and form of which had no inherent connection with the stimulus-word. Fuhrmann calls these reactions “unconscious.” They appear mainly at the beginning of the test sequence (according to the table given by Fuhrmann). Test sequence I starts with the following reactions:

1. bright	faith
2. dark	health
3. white	arm
4. black	blue
5. red	parents
6. yellow	father
7. green	chair
8. blue	arm

[503] Fuhrmann does not attempt any interpretation. Kraepelin 6 mentioned this observation in the latest edition of his textbook, where he states:

[It seemed] as if these ideas, only released but not produced by the experiment, emerged from permanent general trains of thought. Their contents were mainly related to the illness or else to the patient’s personal circumstances. We may well assume that the frequency of such associations, determined by inner conditions, not by external stimulation, is particularly facilitated by the mental slowness of epileptics, which prevents them from associating quickly and easily with the stimulus-word, as normal people do.

[504] In 1903 I demonstrated the frequent occurrence of such meaningless connections in an imbecile in a state of emotional stupidity in my paper “On Simulated Insanity.” Wehrlin 7 recently expressly referred to these facts, supported by evidence, in his research on associations of imbeciles and idiots. According to our experience these meaningless reactions always occur when the patient is in a state of emotional stupidity, which can, of course, occur in quite a number of mental abnormalities. These “unconscious” reactions are therefore not at all specific for epilepsy.

[505] Let us return to Fuhrmann’s paper. In the first case a repetition of the experiment with the same stimulus-words was carried out after about a month.

[506] The second case concerns a patient who had been ill since he was sixteen. Here the experiment was repeated four times within eight months, and a considerable restriction of the extent of the associations, a striking monotony in the reactions, could be observed. Basing his opinion on the associations of two female idiots, Fuhrmann considers that there is a “marked” difference between epilepsy and idiocy, in that general concepts have no meaning for idiots. Wehrlin’s investigation shows that the idiot is aware of general concepts but these are extremely primitive. Thus the difference may be more subtle than Fuhrmann appears to assume.

[507] Riklin, in his notable paper on “Relieving Epileptic Amnesias by Hypnosis,”8 reports on several association experiments with epileptics. This author deals more with the qualitative aspect of the reactions and arrives at a variety of important findings.

[508] He finds a clinging to the content of a reaction and to the same grammatical form, strong egocentricity, personal constellations, a frequent emotional charge in the content of the reaction, and a paucity of ideas.

[509] These peculiarities are to a great extent nothing but reflections of the epileptic character. Riklin states that it is possible to read the signs of epileptic degeneration from a sequence of associations. In scrutinizing Riklin’s observations, however, it has to be pointed out that: (1) Perseveration of the grammatical form need by no means always be an epileptic symptom. Wehrlin’s paper shows very marked perseveration of grammatical form in imbeciles and idiots. (2) Perseveration of the content occurs also in normal subjects, as I have shown, together with Riklin, in the first contribution of the Diagnostic Association Studies.9 Egocentricity and personal constellation too happen in the normal and in the feeble-minded, as well as feeling-toned reaction-contents. The paucity of ideas is, of course, not characteristic for epilepsy, but for mental deficiency generally, and in a certain sense also for emotional stupidity, where it assumes the special form of “associative vacuum.”

[510] In epilepsy therefore it is a question of the quantity of these symptoms in any given case. It will also have to be considered whether they may perhaps have a more specific quality. I have made it my task to clarify these issues and to attempt to separate what is specific for epileptic associations from the various types of the normal and from congenital mental deficiency. Such an investigation has, of course, to be based on extensive material. The Swiss Asylum for Epileptics in Zurich, with its large numbers of patients, offered a favourable opportunity.

[511] The material comes mainly from this institution, where it was collected by the Medical Superintendent, Dr. Ulrich; some of it came from the Burghölzli Asylum for the Insane. The total number of experimental subjects was 158, the total number of associations 18,277. This extensive material allowed us to form some ideas about associations in epileptics; for this reason Dr. Ulrich and I began a methodical inquiry into this subject which contains so much of interest. In order to comprehend the essence of the abnormalities of epileptic association as fully as possible, I classified the material as follows:

[512] First, I excluded those cases who were not congenitally mentally defective and those who only contracted epilepsy after leaving school, i.e., after puberty.

[513] By doing this I discarded the cases, so frequent among epileptics, that are complicated by congenital mental deficiency. According to Wehrlin’s paper, it seems that imbeciles have a rather characteristic type of association which is mainly marked by the tendency to “define” the stimulus-word. The first records of epileptics showed us association types which from the very beginning revealed the greatest similarity to the imbecile type. In cases of epilepsy complicated by imbecility or by mental degeneration in early youth, the similarity was even greater. In order to find the specific epileptic, it was necessary to eliminate the cases we have mentioned.

[514] For practical reasons the field of inquiry was further divided; in this paper I am analyzing the reactions of a typical case as fully as possible, and in a forthcoming publication Dr. Ulrich is going to discuss the variants of the epileptic types of association.

[515] Before dealing with the observations themselves, I must make a few remarks about the technique of obtaining the associations.

[516] The preparation of the subjects for the experiment is by no means unimportant. One has to consider that as a rule people have no idea what the experiment demands of them; therefore they easily get bewildered. If they become markedly so, this has a distinct influence on the result, as I have repeatedly seen. We therefore introduce the experiment in each case with an instruction: the subject is told that some random word is going to be called out, to which he or she has to answer as quickly as possible with the word or idea that comes to mind without reflection. The instruction is illustrated by a practical example in which the experimenter gives a reasonably complete list of the possible associations. In this way the subject is enabled to select freely from this list the reaction that appeals to him most. The unbiased subject will, of course, choose the type of reaction that is characteristic of him. We take special care that the subject does not make a special effort to respond, if possible, with one word only. If this is, nevertheless, the case, then the characteristic form of the response becomes completely obscured and the reaction-time is considerably shortened. In women it is often necessary to subdue a nascent emotion by talking casually about the experiment. I usually do this by presenting the experiment as a kind of game.

[517] For these experiments a new list of stimulus-words was used. I chose two hundred words; 75 of them denote concrete ideas, 25 denote abstract ideas, 50 of them are adjectives, and 50 are verbs. The sequence is as follows: noun-adjective, noun-verb. They are as mixed as possible so that related stimulus-words do not occur in immediate sequence. No attention was paid to the number of syllables. The stimulus-words were taken from widely varied fields of everyday life, unusual words being avoided as much as possible. Intentionally a number of emotionally charged ideas were interspersed, such as love, to kiss, bliss, friendly, etc., because a particular significance is attached to these words. The reaction-times were checked by a ⅕-second stop-watch.

[518] I have chosen the following case from our material:

M. Joseph. Toolmaker, born 1863, widowed, no children. 19 convictions. No family history of illness admitted. Good at school, completed a three-year apprenticeship with a locksmith. Good testimonials. No major illness during early years, particularly no sign of epilepsy. Married in 1888. In 1893 his wife contracted a psychosis and died soon after in a lunatic asylum. After his wife was taken ill, the formerly stable and industrious patient began wandering about all over Europe. He left every place of employment after a short time, took to drink, travelled aimlessly about, even in forests. During this period there were frequent collisions with the police, mainly for theft. The patient claims amnesia for most of them. In 1893–94 he was three times in lunatic asylums for violent mania transitoria. In 1896 he fractured his skull. In 1896–98 he was again in various lunatic asylums for delirium. In 1898 one-sided twitching, occurring in fits, was noticed. At that time a relatively lucid delirium, with plastic and very stable visions, was observed, and the patient described it with much emotion. The end of 1904 was spent by the patient aimlessly in the mountains eating only poor food. Following a drinking bout, he stole a bicycle. After the theft he wandered aimlessly about and then came into the hands of the police. He was brought in here for observation, which revealed:

Mental deficiency in an epileptic character. Frequent short lapses of consciousness with aura: “Sees black dots, five to six in a row, which are always moving up and down; head feels as if in a clamp or pressed together by screws; chest feels as if a drop were trickling down inside it; there is buzzing in the ears, then fear overcomes him as if he had done something wrong, or he has pains in the back that rise to the head; he has the feeling that he wants to tear everything up, or it is as if a railway engine suddenly rushed towards him.” After this aura he gets giddy, everything is spinning around him and he loses consciousness. The lapses of consciousness were also observed during conversation and particularly while playing cards. Intolerance of alcohol to a high degree.

[519] The associations in this case seemed to me in various respects rather typical for epilepsy, although not all the characteristic symptoms appear in them. This is because each case has its peculiarities, so that here too rather an important role is played by the individual differences between the various reaction-types.

		Secs.
1. coal	hard coal	7.2
2. moderate	eating little	12.0
3. song	to sing, to sing a song	6.2
4. to assume	I assume, what do I assume? several things	23.2
5. pain	because I am ill	4.2
6. rotten	if an apple is rotten, a plant, everything can get rotten	5.8
7. moon	that is the moon in the sky, here we have the moon	3.4
8. to laugh	man laughs	4.2
9. coffee	one drinks it, drinks it every day	4.0
10. wide	this is the width of a distance (accompanied by an explanatory gesture)	6.2
11. air	this is the air, nature’s air, healthy or unhealthy, fresh air is fresh air	2.2
12. to carry (to wear)10	I carry (or wear) something, a burden or fine clothes	5.0

[520] These first twelve reactions already allow some conclusions. Above all it is striking that the subject reacts not with one word but usually with whole sentences. This fact has a certain significance. In my experience, which is supported by the material of more than thirty thousand normal associations, healthy people as a rule tend to react with one word (N.B. after being instructed as explained above). There are exceptions when even educated people may prefer the form of a sentence; Riklin and I quoted such an example in our paper on the associations of healthy people. That subject belongs to the “complex-constellation type,” i.e., to that reaction-type whose associations are at the time of the experiment under the influence of an affect-charged complex of ideas.11 In such cases one recognizes at once the peculiar constellations from the contents of the associations. I refer to this quotation. Among healthy people there is also a type who likes to react with two or more words, though not actually in sentence-form:

[521] The Predicate Type.12 People belonging to this type tend mainly to judge and evaluate the object described by the stimulus-word. This is, of course, done in predicate form; thus the tendency is quite obvious and the use of several words sufficiently explained. Certainly neither of these types can be confused with the reactions that now concern us.

[522] In the pathological field, however, the sentence form is so frequent and occurs so widely that one can hardly recognize in it anything pathognomonic.

[523] An observation (which I cannot, it is true, support at present by figures) has to be mentioned: uneducated mental patients appear to tend more to form sentences than educated ones. Should this observation become confirmed, it would not be difficult to combine it with the fact that uneducated people are more concerned with the meaning of the stimulus-word than are educated ones, as has already repeatedly been stressed in previous papers. Uneducated people at a very low level, who tend to “answer” with something that is as “fitting” as possible and to explain the stimulus-word as well as possible, need more words for it than educated ones, who merely juxtapose words. This tendency to explain becomes most obvious in idiots and imbeciles, who very frequently form whole sentences.13 Our subject shows a preference for sentences which, in the absence of sufficient data, is difficult to understand; it may therefore be inferred that we are faced with some abnormality.

[524] Before dealing with the contents of the reactions we must pay some attention to the reaction-times. These are abnormally long. (The average reaction-time of uneducated subjects is 2.0 sees.) This does not permit us to draw any conclusions at present, because there is no syndrome in which the reaction-time could not be prolonged. As is well known, Aschaffenburg found somewhat extended reaction-times also in manic patients. It may, in any case, not be advisable to investigate the reaction-times found in the association experiment, isolated from the analysis of the association contents, because they depend to a high degree on the momentary contents of consciousness.

[525] Let us now consider the quality of the associations. We notice at once that the subject focuses on the meaning of the stimulus-word; there is an outspoken tendency to clarify and characterize the object denoted by the stimulus-word. Wehrlin described this tendency as particularly characteristic for congenital mental deficiency. Perhaps, however, the strong tendency to explain occurs in every variety of mental defect, and it may be assumed that the feeble-minded converge in some respects towards the congenital mental defective, even if the causes of the two conditions are entirely different. The tendency to explain is so obvious in our case that here too we can without difficulty demonstrate the kind of explanation found by Wehrlin among imbeciles. Reactions such as these can be regarded as “tautological clarifications”:

to assume	I assume
to carry	I carry something
air	this is the air

[526] These can be taken as explanation by “examples”:

moderate	eating little
rotten	if an apple is rotten
wide	this is the width of a distance (with explanatory gesture)

[527] These indicate the main quality or activity:

to laugh	man laughs
coffee	one drinks it

[528] From this we can see no more than a very marked conformity with the explanatory tendency of imbeciles. Moreover, one can even say that the subject is taking pains not to be misunderstood in this respect. Thus he is adding something that confirms and elaborates the explanation in places where there is some doubt whether it is a superficial familiar word-connection, such as in song / to sing, coffee / one drinks it.

song	to sing, to sing a song
coffee	one drinks it, drinks it every day

(Similarly in 4, 11, 12.) These examples show that the subject needs to accentuate his tendency to explain.

[529] Out of the twelve reactions cited, which show a tendency to explain, we find three containing the word “I.” Such reactions belong to the egocentric type. There are egocentric reactions in the normal as well, particularly in subjects with an “egocentric attitude.”14 This attitude can express itself in three different ways:

1. The subject reacts with a number of personal reminiscences.

2. The subject is under the influence of an emotionally charged complex of ideas. He relates almost every stimulus-word to himself (i.e., to the complex) and responds to it as if it were a question concerning the complex (a prototype of paranoia, therefore!).

3. The subject belongs to the predicate type and evaluates the content of the stimulus-word from the personal angle.

[530] In these three types the subject puts himself occasionally into the foreground. Apart from this, egocentric reactions occur as a rule somewhat more frequently in the educated than in the uneducated, but mainly when the subjects are at their ease. For uneducated men we found an average of 1.7 per cent egocentric reactions, for uneducated women only 0.5 per cent. All the more remarkable is the strong predominance of egocentricity here. The cause of it could in the first place be ascribed to mental deficiency. Imbeciles use personal reminiscences relatively often because, owing to their narrow horizon, they have no others available. Wehrlin has given good examples of this. Figures found in our material obtained from imbeciles have shown a fluctuation of the numbers for egocentric reactions between 0 and 2.7 per cent. Among fifteen imbeciles there are no more than nine who show egocentric reactions. It must, however, be mentioned that in Wehrlin’s material 15 there is an imbecile who is distinguished by the fact of having produced no less than 26.5 per cent egccentric reactions. This is quite an unusual result, for special reasons. This imbecile is also different from the other subjects in that he has not an actual tendency to explain, but with each stimulus-word he forms a “schoolroom-type” sentence which often begins with “I”; e.g.,

fall 16	I fall down
to loathe	I loathe rotten fish
head	I have a head
to run	I run swiftly
advice	I ask father’s advice
reward	I deserved the reward

[531] The examples show that, as Wehrlin has already mentioned, this imbecile is mainly trying to formulate correct “schoolroom” sentences, saying “I” in places in which other imbeciles say “one” or “the man.” The description “egocentric” can therefore be applied to this case only with some qualification. As already mentioned, this case is an exception and does not alter the fact that as a rule imbeciles avoid the ego-reference. Egocentric reactions in imbeciles are not much in evidence; on the contrary, the subjects prefer the expressions “one,” “someone,” etc., in order to avoid the “I”-form. Hysteria, too, which has numerous ego-references, prefers the less suspect “one.”

[532] Our case, with his outspoken tendency to explain, also shows a prominence of egocentric reactions, such as we do not find in imbeciles with the same tendency to explain. One can object that R.12, to carry / I carry something, is a “schoolroom” sentence. But one cannot make this objection to 5, pain / because I am ill.

[533] It is strange enough to see the strong egocentric aspect in imbecility; it is even stranger to observe the peculiar way in which the subject words his explanation.

[534] I have already pointed out that in a way the subject accentuates his tendency to explain by repeating his reactions in a confirmatory way, finally adding an attribute. But the subject goes even further; he is not satisfied with a simple reaction, but it evidently gives him special satisfaction to make his explanation more complete.

[535] In R.4, to assume / I assume, what do I assume? Several things, one can virtually see how he is trying to bring something more descriptive into it. He gets into an entirely abnormal excitement with R.11, air / this is the air, nature’s air, healthy or unhealthy, fresh air is fresh air.

[536] The urge to completeness leads to pleonasm in R.10, wide / this is the width of a distance (with explanatory gesture). (See also 6, 7, 12.)

[537] In the reactions 11, fresh air, and 12, fine clothes, the attributes seem to give quite a special emphasis. The effort with which the subject reacts suggests some inadequacy because this display of words goes far beyond what would be necessary to cover the stimulus-word. This fact at once gives the impression of an unnecessary and exaggerated tendency to elaborate. Precisely this trait is absent in the imbecile; he is satisfied with a not too long reaction that appears to him reasonably suitable, but which frequently does not get beyond the most primitive indications and quite undeveloped concepts. Our subject, however, has a strong inclination to accumulate and to elaborate the reactions, occasionally far beyond what is necessary.

[538] The twelve reactions quoted give us reason to suspect feeblemindedness which is specifically tinged by a strong tendency towards egocentricity and elaboration.

[539] Let us now see our patient’s further reactions:

13. plate

dinnerplate—dinnerplate—for dining

The reaction is repeated with emphasis as if in confirmation. As it is not enough, it is further defined; an unnecessary reiteration. Quite similarly constructed, but even more specific, is

14. tired	I am tired—yes, tired—the body is tired	3.0
15. intention	I have the intention—to invent a machine—to draw—to provide—to live properly	13.0

This reaction too is overdone. It contains two explanations by means of definite examples, one of which is a personal constellation (the subject is a toolmaker) and three times qualified.

16. to fly	the bird flies	4.8
17. eye	the eye sees	2.8
18. strong	am strong, that is strong	4.6

Again a clumsy ego-reference followed by a confirmatory but unnecessary sentence.

19. fruit

this is a fruit, a tree-fruit

7.0

The tendency to confirm and complete leads here to the formation of a new word tree-fruit (see also below on this reaction).

20. to create

to work hard means to create

3.6

To work has an emotionally charged attribute.

21. sail

a sail is a sailing boat on the water

6.8

Note the repeated return of the stimulus-word in the reaction. Up to now there were no more than three associations in all in which the stimulus-word did not recur in some form.

22. modest

yes, man is modest when he has learned something

9.0

Yes is an expression standing for a feeling that is about to take the shape of ideas and words (see R.14). Wherever strong feelings, either easily aroused or very intense, are involved (as in hysteria and certain organic brain-lesions), yes and no are frequent. The content of this association points to a train of thought hardly to be found in someone born mentally defective.

23. floor	floor of the room	3.8
24. to whistle	I whistle	3.2
25. purpose	for what purpose? For what purpose are you doing this?	5.6

The reaction is particularly striking because of the repetition of the stimulus-word. Here again we can see that the subject understands the stimulus-word as a question.17

26. hot

it’s too warm, too hot

2.0

Up to now, hardly one of the reactions shows as well as this one the subject’s tendency to confirm and complete the reaction with emphasis. It is as if the subject is each time trying to clarify the meaning of his reaction with special vigour. This emphatic underlining shows up well in the accentuation too warm, too hot.

27. resin	fir resin, the resin grows on the fir-tree, on the pine-tree	3.8
28. to arouse	I arouse—I arouse my friend, he is asleep	8.4

Both reactions are again characterized by great completeness, especially the latter, where the subject even completes the picture by he is asleep.

29. apple

there are various apples

6.6

This reaction can be found extremely frequently in exactly the same form in imbeciles.

30. wicked	one says, who is wicked? so-and-so is wicked, that is a wicked person	6.0
31 case	a brief-case	3.0
32 to drink	I drink lemonade	3.0
33. bed	sleeping—I have the bed for	3.0
34. worthy	that person is worthy to whom him honour is due (sic)	94

This reaction has linguistically miscarried. Epileptic mental deficiency seems to have in common with congenital mental deficiency that the patient is clumsy and arbitrary in the handling of the language. In imbeciles we find many faulty formulations of sentences and also clumsy neologisms. However, in the association experiment one must not simply ascribe linguistic clumsiness to mental deficiency, since there may also be momentary emotional disturbances that interfere with the linguistic expression. We shall come back to this later.

35. danger	I am in danger, in danger of life	4.2
36. to visit	I visit a patient	4.8

The latter reaction may again be an ego-reference.

37. locksmith	I am a locksmith, an artisan	2.8
38. high	the steeple is usually high	4.8
39. hatchet	the hatchet is an axe	3.4
40. to mix	don’t mix yourself up in other people’s affairs	6.2 210

This reaction very much resembles a common phrase. It is the first in this case. As is well known, just such reactions are very common in normal subjects.

41. path	that is a footpath, a field-path	3.2
42. round	it is a sphere, otherwise it is not a sphere, if it is not round	3.8

A reaction very typical of the pedantic fussiness of the subject.18

43. blood

every man has, every animal only good or bad, that is the difference

3.4

In this long-winded reaction we again find similar evaluations to those in R.11. There it was healthy or unhealthy air, here it is good or bad blood. The constellation common to both is apparently the question of health, which is important for the patient. R.5 and R.36 also refer to this complex. The strong predominance of the illness-complex in the associations of the epileptic has also been stressed by Fuhrmann.

44. to let	I let lodgings	6.0
45. cautious	Man, be cautious	4.8
46. merry	I am merry, I am gay	3.6

47. market	the annual fair, that is a market, the fair at Basel only recently took place	7.0
48. to forget	I have forgotten something	5.0
49. drum	the kettle-drum is a drum	3, 2
50. free	I am free—I am free, I am a free citizen, it would be nice if only it were true	4.0

In this reaction, apart from the repeated emphasis on free, the egocentric relation, clothed in the evaluation nice, is noticeable.

51. carriage	a carriage, a team of horses	4.4
52. to eat	I am eating, I am eating a stew	2.4
53. insolence	if a person—there are people who are insolent, insolent in their speech, insolent behaviour	6.8
54. fast	the engine runs fast (probably a constellation arising from his daily work)	3.8
55. fireplace	is a chimney, a factory chimney	2.4
56. to enjoy	I enjoy an evening entertainment, I enjoy pleasure	4.0
57. parson	is a clergyman, a pastor that ought to be a righteous man	2.2

To the reaction, which would be quite sufficient in itself, a feeling-toned evaluation is attached. It resembles R.15: intention to live properly. Are these perhaps indications of a tendency in the epileptic to moralize?

58. easy	what is not easy is difficult	5.0
59. neck	is the neck (points at his neck) every man has a neck	2.8
60. to wish	I wish you luck in the New Year	3.0
61. stone	a marble stone, there are various stones, stone is a product of nature 19	4.6

Imbeciles too are inclined to use abstract nouns of foreign origin (substance, material, article, etc.), which, however, they frequently use in a truly grotesque way.

62. distinguished	the educated man is distinguished	6.2
63. hose	the rubber hose is a hose	4.0
64. to love	I love my neighbour as myself	5.0

This reaction seems to me characteristic for the epileptic: Biblical form, strong emotional charge, and egocentricity. For comparison I assembled the reactions to to love of ten imbeciles chosen at random:

1. friendly

2. to be angry

3. fiancé

4. if one loves someone

5. pleasant

6. I love father

7. if one loves one another

8. if two are fond of each other

9. if one likes someone

10. if one loves someone

With one exception (6), the imbeciles react very impersonally and in a considerably less colourful way than the epileptic.

65. tile	there are grooved tiles in Basel
66. mild	is mild weather, is mild, is warm	2.8

[540] It is hardly necessary to pile up any more examples. The further associations of this case contain nothing fundamentally new.

[541] Some more general clarifications may be useful. It must first be mentioned that the subject made gestures with most reactions (which were indicated each time by a tick on the association form). The gesture expressed, wherever possible, confirmation and completion. Secondly, the stimulus-words were repeated in 30 per cent of the reactions. As I shall demonstrate in a later paper, “The Reaction-time Ratio in the Association Experiment,” the repetition of the stimulus-word in the normal subject is not accidental but has deep reasons, like all the so-called disturbances occurring in the experiment. Apart from these rare cases in normal subjects, in which the stimulus-word is each time quickly repeated in a low voice because of a general self-consciousness, this disturbance mainly occurs only at those points where an emotional charge from the previous reaction perseverates and hinders the following associations. In hysterics I have also seen that the complex-constellating stimulus-word tends to be repeated in a questioning tone.20 These observations teach us that those places where repetitions of the stimulus-word occur are not at all unimportant in normal subjects. For epilepsy, however, other mechanisms may also have to be considered. In this case the first four stimulus-words were repeated, the fourth, to assume, even three times. Then there was nothing repeated until the fifteenth, intention.21 At the beginning a general self-consciousness is likely. In assume perhaps the “difficulty” of the word can have played a part; the same applies to intention. Both, moreover, have extraordinarily long reaction-times (23.2 and 13.0 secs.) which exceed by far those of other reactions. Perhaps then the repetition of the stimulus-word is not simply to be explained by the “difficulty” of the word, but could have been brought about by a perseverating emotional charge. The preceding reaction is I am tired—yes, tired—the body is tired: 3.0; the following reaction-time is 13.0.

[542] Apart from the content, the word yes already points to the existence of a stronger feeling-tone. The subsequent repetition of the stimulus-word appears in 19, fruit. The reaction preceding this is am strong, that is strong: 4.6 (fR-T 7.0).22 21, sail is repeated. Preceding reaction: to work hard means to create: 3.6 (fR-T 6.8). 22, modest is repeated. Preceding reaction: a sail is a sailing boat on the water: 6.8 (fR-T 9.0).

[543] Here we have two stimulus-word repetitions immediately following one another, whereby the reaction-times progressively increase: 3.6—6.8—9.0.

[544] The reaction to sail is a linguistic mishap (in my investigations into reaction-times, linguistic slips have proved to be complex-characteristics). At the near end of the scale is to work hard, an emotionally charged, probably egocentric reaction. The third reaction (22) is yes, man is modest when he has learned something. It is not difficult to see here a relation in the content to to work hard. The assumption that the emotional charge of to work hard has perseverated behind the linguistically disturbed reaction and constellated R.22 is therefore not unlikely.

[545] 47, market is repeated. Preceding reaction: I am merry, I am gay: 3.6 (fR-T 7.0). 51, carriage is repeated. Preceding reaction: I am free—I am a free citizen, it would be nice, if only it were true: 4.0 (fR-T 4.4).

[546] With the exception of the first four reactions most of the other repetitions of stimulus-words coincide with reactions that immediately follow egocentric associations. The reaction-time in these cases is mostly abnormally prolonged. To avoid being unduly long-winded I shall not bring any further evidence for this fact; I can, however, give an assurance that, with only very few exceptions, all the other repetitions of stimulus-words took place near strong emotional charges.

[547] In several reactions a certain linguistic awkwardness was noticed. One is tempted, in analogy with imbecility, to make the epileptic mental defect responsible for these faulty formations. We know, however, another source for slips of the tongue: namely, the strong emotional charge of a complex aroused by the stimulus-word. In my communication on reaction-time in association experiments I shall quote a number of examples from which it can be seen how reactions are influenced in normal subjects by an emotionally charged complex. Apparently quite casual slips of the tongue, which the subject himself hardly notices, prove to be meaningfully determined products of the mixture of two competing ideas.23 Before therefore ascribing the linguistic mishaps to mental defect it is advisable to investigate whether perhaps the mechanism discovered in the normal subject is here too the cause of the incorrect sentence or word-construction. Amongst the associations quoted here, there are three linguistically incorrect ones. I am pairing each of these three associations with the immediately preceding ones (the incorrect construction is given in italics):

18. strong	am vigorous, that is, strong	4.6
19. fruit	(stimulus-word repeated) this is a fruit, a tree-fruit	7.0
20. to create	to work hard means to create	3.6
21. sail	(stimulus-word repeated) a sail is a sailing boat on the water	6.8
33. bed	sleeping—I have the bed for	3.0
34. worthy	(stimulus-word repeated) that person is worthy to whom him honour is due	94

[548] These three faulty constructions have in common:

1. The stimulus-word of the faulty association was each time repeated.

2. Every one of the incorrect reactions has a reaction-time not only higher than that of the preceding reaction but prolonged beyond the average of the others.24

3. Two of the incorrect associations follow emotionally charged reactions: for the third this is at least probable according to the content and the analogy with similar cases.

[549] These observations give us so many starting points for an explanation that we may hardly assume mental deficiency to be the cause of the incorrect constructions.

[550] From these observations we can see that a specific epileptic mechanism can be found neither in the numerous repetitions of the stimulus-word, nor in the faulty constructions of the sentences. It is, however, debatable whether anything specifically epileptic can be seen in the intensity of these otherwise normal processes. Here perhaps the reaction-times, a valuable aid for judging emotional processes, can give us some information.

[551] All time-averages given here are “probable means.”25 The time measurements for the subject give 4.2 seconds as a general probable mean (uneducated normal person: 2.0 secs.). The general reaction-time is thus more than twice as long as that of corresponding normal subjects. This mean, however, is only a “gross” figure; it is composed of several unequal magnitudes. As I shall show in my later publication, reactions complicated by feelings are usually prolonged. If therefore there are many such reactions the general mean may under certain circumstances be strongly influenced. If we now eliminate all those reactions that, according to the criteria already given, are remarkable because of their feeling-toned egocentric contents and also those reactions that immediately follow these, then we obtain 3.8 secs. as a probable mean for all the assumedly uncomplicated reactions, while the probable mean for those eliminated is 4.8 secs.

[552] Thus the feeling-tone makes a difference of 1.0 sec. This state of affairs is not very different from that of the normal. As we have seen in several examples, there is frequently a considerable difference between the times of feeling-toned associations and those of the reactions immediately following them. We therefore investigate separately the time of these two groups. As a mean for the reactions containing a feeling-toned idea we have 3.6 secs., a figure 0.2 secs. lower than the mean for associations not feeling-toned; for the associations immediately following those that are feeling-toned, however, there is a mean of 5.8 secs. This unusually high mean, which exceeds that for the uncomplicated reactions by not less than 2.0 sec, expresses the important fact that the feeling-tone inhibiting the reactions perseverates from the critical reaction and exerts its main influence on the following reaction. Thus the effect of the feeling-tone inhibiting the reaction cannot as a rule be demonstrated in the critical reaction but only in the following reaction. One must therefore assume that in this case the feeling-tone does not properly set in until after the critical reaction, increases very gradually, and then decreases slowly, still inhibiting the following reaction. This state of affairs appears the more remarkable when we remember that the experimenter has to write down the reaction, to read the stop-watch, and to call out the next stimulus-word, and that the writing down of the reaction, which may be rather long, takes most of the time. I also tried to make similar observations about the associations of normal subjects. For this purpose I took the associations of a case of whom I possess a most detailed analysis, so that I was fully informed as to all complex-constellated associations. The probable mean of all associations not complicated by feelings is 1.2 secs. The mean of the feeling-toned reactions is 1.6 secs. The mean of the reactions immediately following the feeling-toned ones is 1.2 secs. This equals the mean of the uncomplicated reactions. If, therefore, in the mentally normal subject the complex-arousing stimulus-word is followed by a reaction-time on average 0.4 secs. longer than that of the immediately following or irrelevant stimulus-word, this only means that in the normal subject the feeling-tone sets in much faster and subsides again incomparably faster than in our epileptic; thus the average reaction-time of the following association is unimpaired in the normal subject, whereas in our epileptic, as we have seen, the reaction-time for the following critical association is unusually prolonged.

[553] This important and interesting peculiarity appears to be of a pathological nature; how far it is typical for epilepsy has to be learned from the further study of our vast material.

[554] There seems to be something characteristic for our case in this phenomenon, because one can also assume the existence of such an enormous emotional process from the quality of the associations. I have repeatedly pointed out the fact that the subject frequently emphasized his reactions with his voice as well as also sometimes with words giving expression to some feeling (e.g., hot / it’s too warm, too hot; tired / I am tired—yes, tired—the body is tired; etc.). This peculiar form of reaction also seems to indicate that the feeling-tone sets in slowly and increases slowly, in this way releasing even more associations in a similar direction. It is most likely that the feeling-tone in the epileptic is of greater intensity than in the normal subject, which again is bound to prolong the feeling-tone. It is, however, difficult to say whether the epileptic’s feeling-tone is necessarily abnormally prolonged.26

[555] In my analytic investigations into the reaction-times of normal subjects I was able to demonstrate the existence of one or more feeling-toned complexes of ideas that constellate a large number of the associations. I have already pointed out that in our epileptic also there exists a complex that constellates many of the associations. It is the complex of the illness. The following associations may be related to this complex:

5. pain	because I am ill	4.2 (fR-T 5.8)
14. tired	I am tired—yes, tired—the body is tired	3.0 (fR-T 13.0 Rr)27
18. strong	am vigorous, that is, strong	4.6 (fR-T 7.0 Rr)
43. blood	every man has, every animal only good or bad, that is the difference	3.4 (fR-T 6.0 Rr)
46. merry	I am merry, I am gay	3.6 (fR-T 7.0 Rr)

A more remote constellation might be:

11. air	this is the air—healthy or unhealthy	2.2 (fR-T 5.0)
36. to visit	I visit a patient	4.8

The reaction following is:

37. locksmith

I am a locksmith, an artisan

2.8

[556] Because of his illness the patient was hospitalized, a fact that made a great impression on him. He feared especially that he might never be discharged, nor be able to work and earn his living any longer. He was also homesick. The following reactions perhaps refer to this aspect of the complex:

20. to create	to work hard means to create	3.6 (fR-T 6.8 Rr)
35. danger	I am in danger, in danger of life	4.2 (fR-T 4.8)
50. free	I am free—I am free, I am a free citizen, it would be nice if only it were true	4.0 (fR-T 4.4 Rr)
60. to wish	I wish you luck in the New Year	3.0 (fR-T 4.6 Rr)

Regarding this last reaction, it must be added that the associations were taken before Christmas—at a time, therefore, when sensitive patients suffer twice as much from hospitalization.

[557] These few examples may suffice to show that quite a number of associations are constellated by a feeling-toned complex. This state of affairs in itself is not at all abnormal, since the associations of normal people are also often constellated by such complexes.

SUMMARY

[558] I. In common with the associations of normal persons:

(a) The patient adapts himself to the meaning of the stimulus-word in the same way as uneducated subjects. Therefore there are no superficial word associations.

(b) The associations are partly constellated by an illness-complex.

II. In common with the associations of imbeciles:

(a) The adaptation to the meaning of the stimulus-word is so intense that a great number of associations has to be understood as “explanation” in the sense of Wehrlin’s paper.

(b) The associations are in sentence-form.

(d) The stimulus-word is frequently repeated.

III. Peculiarities compared with normal and imbecile subjects:

(a) The “explanations” have an extraordinarily clumsy and involved character which is manifest particularly in the confirmation and amplification of the reaction (tendency to completion). The stimulus-word is frequently repeated in the reaction.

(b) The form of the reaction is not stereotyped, apart from the egocentric form that occurs particularly often (31%).

(d) The reaction-times show the greatest variation only after the critical reaction. The abnormally long times are therefore not to be found with particularly difficult words, but in places determined by a perseverating emotional charge. This permits the conclusion that the feeling-tone probably sets in later and lasts longer and is stronger in the epileptic than in the normal subject.

[559] In conclusion I beg to remark that the value of my analysis lies only in the case-material and that therefore I do not dare to draw any general conclusion from it. There are many forms of epilepsy that may have quite different psychological characteristics. Perhaps the fact that my case is complicated by a fracture of the skull sets it apart.

AN ANALYSIS OF THE ASSOCIATIONS OF AN EPILEPTIC1

SUMMARY

AN ANALYSIS OF THE ASSOCIATIONS OF AN EPILEPTIC 1