The tapping test is ordinarily quite responsive to such changes in condition as are reflected in the behavior here, and its failure to be affected by them in this case is surprising. It may be mentioned that while the patient actually does considerably better with his left hand, he said that it was easier for him to perform with his right, and he also said he thought he did better with it. Though the difference is slight, the preferred hand shows in the

R

36

35

R

34

33

32

FIG. 18.

long run the greater immunity to fatigue, as we are accustomed to find.

CASE X. A man aged 78, retired merchant, some heredity, early history negative. He was successful in business, from which he retired at 63 on account of "nervous prostration." For about five years before admission he was somewhat eccentric and inclined to be ugly toward his family, but about a month before admission his attitude changed and he became very affectionate. This lasted for about three weeks, when one night he performed a number of eccentric actions, finally culminating in a feeble

attempt to kill his wife. When it was suggested that he should come to the hospital he was at first willing, but later became irritated and uncontrollable, and escaped from the house to a pond where he made a weak attempt to drown himself. Here he presents a picture of irritability, a few feeble persecutory delusions, and a tendency to malingering, but with alertness and no marked memory defect. Two experiments were performed about six weeks after admission, the results being as shown in Fig. 18.

The gross rates are distinctly above the normal and there is neither reversal nor favoring of the following hand. The right hand fatigues very little, but there is partial disability in the right arm, due to its once having been broken, so that what we have here may be analogous to the latter part of the fatigue-curve, the higher initial rate that we should have had being lost. The left hand begins at about the same level as the right and fatigues normally. These records thus show no evidence of a motor retardation.

CASE XI. A printer, aged 47, bad heredity; has used a great deal of alcohol. The present attack is the seventh. Between the previous attacks he has cleared up sufficiently to work, but his intemperate habits doubtless help to throw him into the successive depressions. The present condition is characterized by considerable emotional depression with delusions. He is always on the move, though his movements are not especially rapid or efficient. He does not speak, but keeps up a low moaning to himself. However, he understood what was wanted in the experiments with surprisingly little difficulty, and co-operated exceptionally well, seeming, like Case IX, to go at the test as a sort of "substitution." In the ward he wore mitts to keep him from tearing his clothing, which were necessarily removed for the experiments, and the entire time of the pauses he would spend picking at himself unless restrained. Two experiments were performed, the second two days after the first, the fatigue-curves being as shown in Fig. 19. Only one of these curves, that of the right hand in the first experiment, shows an abnormal immunity to fatigue, nor is there sufficient evidence of transference to afford any certain criteria. of motor retardation in these records.

easy-going euphoria, and co-operated with more willingness than zeal. The curve remains somewhat above the performance of normal subjects until half way through the work period, when it drops somewhat below it. Compared with the normal cases, the manic thus show a higher initial rate and a greater susceptibility to fatigue. In the isolated cases in which it was possible to observe the behavior of the test with respect to changes in condition, it seemed also that the more manic states had the higher initial rate with the greater susceptibility to fatigue.

The average curve of the depressed states, on the other hand, shows a very slow initial rate with a slight reversal in the first interval, which then fatigues very gradually through the rest of the work period. The work-curves of the manic and depressed states are thus found to be both in amount and character on opposite sides of the normal.

Franz, using two normal, two depressed, and two manic subjects in various psychological tests, did not find any consistent superiority of the manic performance over the normal; indeed, the manic subjects were apt to be rather inferior to the normal, though not so much so as the depressions. Hutt, however, using the fatigue-curve of the addition test again found the manic performance to be somewhat superior to the normal. On the other hand, while there is in the tapping test observed an increased susceptibility to fatigue, Hutt found that manic cases would gradually increase in rapidity in the same manner as the depressions. There are features in the manic state according to which either of these results can be interpreted. Hutt classes the increased manic efficiency with the increased excitability under stimulation clinically noted in these cases; the abnormally rapid loss in efficiency found in the present experiments corresponds rather to the suspended inhibition of manic cases, leading to the putting forth of greater initial effort, and consequently the more rapid wearing out of the organism. The explanation of the difference probably rests in the character of the experimental task, and the different levels of neural activity which are involved. Objective motor fatigue is generally admitted, while the nature or even the existence of intellectual fatigue is still somewhat in dispute.

Working with the eye movements over a wide range of cases,

Diefendorf and Dodge' found the angular velocity in manic cases distinctly superior to the normal. On the other hand, the simple reaction time, as well as the pursuit reaction, was found to be slightly shorter in the normal than in the manic cases. It may be noted, however, that in these two functions the greater distractibility and inferior attention of the manic cases would operate more to their disadvantage. This perhaps explains why, though the manic states are worse, the "hypomanic" are better than the normal in these two functions; the distractibility would be less here and the attention better. They are, however, not quite so quick in simple reaction.

It is the prevalent clinical opinion that the greater superficial activity in the manic state is to be interpreted not as the greater efficiency of the nervous impulse but as the removal of the inhibitions it ordinarily has to overcome. This fact does not itself justify the secondary interpretation sometimes made that psychic capacity is fundamentally decreased in the manic state just as truly as in the depressed. Every clinician of experience is familiar with cases who make much better superficial impressions, and who in some instances may be actually regarded as more efficient members of society when they are hypomanic than when they are normal. The potentiality of the more efficient reactions is there, but they are normally restrained by inhibitions which the hypomanic condition removes. Thus the taciturn individual who becomes an excellent conversationalist after a few glasses of wine may have the same ideas when normal as when elevated, but in the normal state their expression is inhibited by something that he would probably describe as the thought that the ideas were too trivial to express.

If the essence of the manic state is the removal of inhibitions, it follows as a corollary that maximum efforts must be higher in the manic state than in the normal state. Maximum efforts may not be so easy to obtain, owing to distractibility, nor may the reactions be so well adjusted to the environment, owing to clouded judgment. But the inferiority that manic cases are very apt to show in psychological tests demanding special co-operative effort is probably mainly secondary to the first of these factors. If as

'Brain, Vol. XXXI, Part CXXIII, 1908, pp. 451-489.

good "attention or concentration could be obtained as with the normal state, the maximum performance should be better.

"

It must probably be regarded as a limitation of the German terminology that it uses the word Hemmung to describe both retardation and inhibition. Hoch has indicated this difficulty very clearly in his studies of retardation, especially in his employment of the term resistances instead of inhibitions to describe the process. That psychomotor retardation is the product of excessive inhibition is more than doubtful. Inhibition is opposition, and excessive inhibition is nothing more nor less than a blocking negativism, which is not part of the recognized symptomatology of manic-depressive insanity. This is a difficulty that must be overcome if the strict continuity of the manic and depressed states is to be maintained together with the theory of decreased inhibition in the manic states. We must recognize two factors that may lessen the freedom of a mental or motor reaction-opposition and obstruction. Excess of the former is negativism, excess of the latter is retardation. The crucial question then becomes: Is the manic state a removal of inhibitions or a removal of obstructions? Removal of inhibitions describes the manic state as we know it very well, but excessive inhibitions describes something very different from the retarded state. On the other hand, excess of obstructions describes the retarded state very well, while its relation to the manic state is the same as that of the theory of loss of inhibition. Both viewpoints are compelled to conceive of some process which acts independently upon the primary or the inhibitory impulses, for if they were equally affected the end-effects would remain essentially unchanged. The point is perhaps a minor one, but for the sake of clearness it might be well to examine the objective criteria of obstruction, or resistances, as distinguished from inhibitions, with reference to the more precise analysis of the manic state.

Such phenomena of retardation as appear in the dementia præcox cases observed are objectively differentiated from the depressive ones in that they appear more episodically, almost fortuitously, as it were, affecting one hand and not the other, or only individual series with a single hand, as distinguished from

"Hoch: On Certain Studies with the Ergograph. Journ. Nerv. and Ment. Diseases, XXVIII, 1901, p. 626.