psychology assignment

Clinical Psychology Lightner W i t m e r

D uring the last ten years the l a b o r a t o r y o f psy- chology at the University o f Pennsylvania has conducted, u n d e r m y direction, what I have called " a psychological clinic." Children f r o m the public schools o f Philadelphia a n d adjacent cities have b e e n b r o u g h t to the l a b o r a t o r y b y p a r e n t s or teachers; these children h a d m a d e themselves c o n s p i c u o u s because o f a n inability to progress in school w o r k as rapidly as other children, or because o f m o r a l defects which r e n d e r e d t h e m difficult t o m a n a g e u n d e r o r d i n a r y discipline.

W h e n b r o u g h t to the psychological clinic, such chil- d r e n are given a physical a n d m e n t a l e x a m i n a t i o n ; i f the result o f this e x a m i n a t i o n shows it to be desirable, they are then sent to specialists for the eye or ear, for the nose a n d throat, a n d for n e r v o u s diseases, one or all, as each case m a y require. T h e result o f this c o n j o i n t medical a n d psychological e x a m i n a t i o n is a diagnosis o f the child's m e n t a l a n d physical condition a n d the r e c o m m e n d a t i o n o f a p p r o p r i a t e medical a n d pedagogical t r e a t m e n t . T h e progress o f s o m e o f these children has been followed for a t e r m o f years.

To illustrate the operation o f the psychological clinic, take a recent case sent to the l a b o r a t o r y f r o m a city o f Pennsylvania, n o t far f r o m Philadelphia. T h e child was b r o u g h t b y his parents, on the r e c o m m e n d a t i o n o f the S u p e r i n t e n d e n t o f Schools. E x a m i n a t i o n revealed a b o y ten years o f age, w i t h o u t a p p a r e n t physical defect, w h o h a d spent four years at school, b u t h a d m a d e so little progress t h a t his ignorance o f the p r i n t e d s y m b o l s o f the a l p h a b e t m a d e it necessary to use the illiterate c a r d to test his vision. N o t h i n g in the child's heredity or early history revealed a n y g r o u n d for the suspicion o f degen- eracy, n o r did the child's physical a p p e a r a n c e w a r r a n t this diagnosis. T h e b o y a p p e a r e d to be o f n o r m a l intel- ligence, except for the r e t a r d a t i o n in school work. T h e e x a m i n a t i o n o f the neurologist to w h o m he was sent, Dr. William G. Spiller, c o n f i r m e d the absence o f conspicuous m e n t a l degeneracy a n d o f physical defect. T h e oculist, Dr. William C. Posey, f o u n d n o t h i n g m o r e serious t h a n a slight far-sighted astigmatism, a n d the e x a m i n a t i o n o f Dr. George C. Stout for adenoids, gave the child a clean bill o f health, so far as the nose a n d p h a r y n x were con- cerned. O n the conclusion o f this e x a m i n a t i o n he was, necessarily, r e t u r n e d t o the school f r o m which he c a m e , with the r e c o m m e n d a t i o n to the teacher o f a course o f t r e a t m e n t to develop the child's intelligence. It wilt require at least three m o n t h s ' observation to d e t e r m i n e whether his present pedagogical retardation is based u p o n an arrest o f cerebral d e v e l o p m e n t or is m e r e l y the result o f inad- e q u a t e m e t h o d s o f education. T h i s case is unequivocally one for the psychologist.

M y a t t e n t i o n was first d r a w n to the p h e n o m e n a o f retardation in the year 1889. At that time, while a student o f psychology at the University o f Pennsylvania, I h a d charge o f the English b r a n c h e s in a college p r e p a r a t o r y school o f Philadelphia. I n m y classes at this a c a d e m y I was called u p o n to give instruction in English to a b o y p r e p a r i n g for entrance to college, w h o showed a r e m a r k - able deficiency in the English language. H i s c o m p o s i t i o n s seldom contained a single sentence that h a d been correctly f o r m e d . For e x a m p l e , there was little or n o distinction between the present a n d the past tenses o f verbs; the end- ings o f m a n y words were clipped off, a n d this was es- pecially noticeable in those words in which a final ending distinguished the plural f r o m the singular, or a n adverb f r o m a n adjective. As it s e e m e d doubtful whether he would ever b e able to enter college w i t h o u t special in- struction in English, I was engaged to t u t o r h i m in the English branches.

I h a d n o sooner u n d e r t a k e n this w o r k t h a n I saw the necessity o f beginning with the e l e m e n t s o f language a n d teaching h i m as one would teach a boy, say, in the third grade. Before long I discovered t h a t I m u s t start still fur- ther back. I h a d f o u n d it impossible, t h r o u g h oral a n d written exercises, to fix in his m i n d the e l e m e n t a r y f o r m s o f words as p a r t s o f speech in a sentence. T h i s seemed to be owing to the fact t h a t he h a d verbal deafness. H e was quite able to h e a r even a faint sound, like the ticking o f a watch, b u t he could n o t h e a r the difference in the sound o f such words as grasp a n d grasped. This verbal deafness was associated with, a n d I n o w believe was p r o b - ably caused by, a defect o f articulation. T h u s the b o y ' s written language was a fairly exact replica o f his spoken language; a n d he p r o b a b l y h e a r d the words t h a t others spoke as he h i m s e l f spoke t h e m . I therefore u n d e r t o o k to give h i m a n e l e m e n t a r y training in articulation t o r e m e d y the defects which are ordinarily corrected, t h r o u g h imitation, b y the t i m e a child is three or four years old. I gave practically n o a t t e n t i o n to the subjects required in English for college entrance, spending all m y t i m e on the drill in articulation a n d in perfecting his verbal audition a n d teaching h i m the simplest e l e m e n t s o f writ- ten language. T h e result was a great i m p r o v e m e n t in all his written work, a n d he succeeded in entering the college d e p a r t m e n t o f the University o f Pennsylvania in the fol- lowing year.

In 1894-95, I found h i m as a college student in m y classes at the University o f Pennsylvania. His articulation, his written discourse a n d his verbal audition were very

Editor's note. T h i s is a r e p r i n t o f a n o r i g i n a l a r t i c l e f r o m T h e Psy- chological Clinic, 1 9 0 7 , Vol. 1, p p . 1 - 9 .

248 M a r c h 1996 • A m e r i c a n Psychologist In the public domain

Vol. 51, No. 3, 248-251

deficient for a b o y o f his years. In consequence he was unable to acquire the technical terminology o f m y branch, and I have n o d o u b t that he passed very few exami n at i o n s excepting t h r o u g h the s y m p a t h y o f his instructors w h o overlooked the serious imperfections o f his written work, owing to the fact that he was in other respects a fair stu- dent. W h e n it c a m e to the final examinations for the bachelor's degree, however, he failed and was compelled to repeat m u c h o f the work o f his senior year. He sub- sequently entered and graduated f r o m one o f the profes- sional d e p a r t m e n t s o f the University. His deficiencies in language, I believe, have never been entirely overcome.

I felt very keenly how m u c h this b o y was losing t h r o u g h his speech defect. His school work, his college course, a n d doubtless his professional career were all se- riously h a m p e r e d . I was confident at the time, an d this confidence has been justified by subsequent experience with similar cases, that if he h a d been given adequate instruction in articulation in the early years o f childhood, he could have overcome his defect. With the impro v em en t in articulation there would have come an improved power o f apprehending spoken and written language. T h a t nothing was d o n e for him in the early years, n o r indeed at a n y time, excepting for the b r i e f period o f private in- struction in English and some lessons in elocution, is re- markable, for the speech defect was primarily owing t o an i n j u r y to the head in the second year o f life, an d his father was a physician who might have been expected to appreciate the necessity o f special training in a case o f retardation caused by a brain injury.

T h e second case to attract m y interest was a b o y fourteen years o f age, who was b r o u g h t to the lab o rat o ry o f psychology by his grade teacher. H e was one o f those children o f great interest to the teacher, k n o w n t o the profession as a c h r o n i c bad speller. His teacher, Miss Margaret T. Maguire, now the supervising principal o f a g r a m m a r school o f Philadelphia, was at that t i m e a stu- d e n t o f psychology at the University o f Pennsylvania; she was i m b u e d with the idea that a psychologist should be able, t h r o u g h e x a m i n a t i o n , to ascertain the causes o f a deficiency in spelling and to r e c o m m e n d the appropriate pedagogical t r e a t m e n t for its amelioration or cure.

With this case, in March, 1896, the work o f the psy- chological clinic was begun. At that time I could no t find t h a t the science o f psychology had ever addressed itself to the a s c e r t a i n m e n t o f the causes and t r e a t m e n t o f a deficiency in spelling. Yet here was a simple develop- mental defect o f m e m o r y ; a n d m e m o r y is a mental pro- cess o f which the science o f psychology is supposed to furnish the only authoritative knowledge. It appeared to me that i f psychology was worth anything to me or t o others it should be able to assist the efforts o f a teacher in a retarded case o f this kind.

" T h e final test o f the value o f what is called science is its applicability" are words q u o t e d from the recent ad- dress o f the President o f the A m e r i c a n Association for the A d v a n c e m e n t o f Science. With H u x l e y and President Woodward, I believe that there is no valid distinction between a p u r e science and an applied science. T h e prac-

tical needs o f the a s t r o n o m e r t o eliminate the personal equation f r o m his observations led to the invention o f the chronograph and the chronoscope. Without these two instruments, m o d e r n psychology a n d physiology could n o t possibly have achieved the results o f the last fifty years. I f H e l m h o l t z h ad n o t m a d e the c h r o n o g r a p h an instru- m e n t o f precision in physiology an d psychology; i f Fech- her had n o t lifted a weight to d e t e r m i n e the threshold o f sensory discrimination, the field o f scientific work rep- resented to-day b y clinical psychology could never have been developed. T h e p u r e an d the applied sciences ad- vance in a single front. W h a t retards the progress o f one, retards the progress o f the other; what fosters one, fosters the other. Bu t in the final analysis the progress o f psy- chology, as o f every other science, will be d e t e r m i n e d b y the value a n d a m o u n t o f its co n t ri b u t i o n s t o the advance- m e n t o f the h u m a n race.

T h e absence o f an y principles to guide m e m a d e it necessary to apply m y s e l f directly to the study o f these children, working o u t m y m e t h o d s as I went along. In the spring o f 1896 I saw several o t h er cases o f children suffering fro m the retardation o f some special function, like that o f spelling, or f r o m general retardation, and I u n d e r t o o k the training o f these children for a certain n u m b e r o f hours each week. Since t h at t i m e the psycho- logical clinic has been regularly c o n d u c t e d in c o n n e c t i o n with the l ab o rat o ry o f psychology at the University o f Pennsylvania. T h e study o f these cases has also f o r m e d a regular p art o f the instruction offered to students in child psychology.

In December, 1896, I outlined in an address deliv- ered before the A m eri can Psychological Association a scheme o f practical work in psychology. T h e proposed plan o f organization comprised:

1. T h e investigation o f the p h e n o m e n a o f mental development in school children, as manifested m o r e par- ticularly in mental an d m o ral retardation, b y m e a n s o f the statistical an d clinical methods.

2. A psychological clinic, supplemented b y a training school in the nature o f a hospital school, for the t reatment o f all classes o f children suffering f r o m ret ard ation or physical defects interfering with school progress.

3. T h e offering o f practical work to those engaged in the professions o f teaching an d medicine, an d t o those interested in social work, in the observation an d training o f n o r m a l and retarded children.

4. T h e training o f students for a new p r o f e s s i o n - - that o f the psychological expert, w h o should find his career in co n n ect i o n with the school system, t h r o u g h the ex- a m i n a t i o n an d t r e a t m e n t o f mentally an d morally re- tarded children, or in c o n n e c t i o n with the practice o f medicine.

In the s u m m e r o f 1897 the d e p a r t m e n t o f psychology in the University o f Pennsylvania was able t o p u t the larger p a r t o f this plan into operation. A four weeks' course was given u n d e r the auspices o f the A m e r i c a n Society for the Extension o f University Teaching. In addition to lecture and l a b o r a t o r y courses in ex p eri m en t al an d physiological psychology, a course in child psychology was given to

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demonstrate the various methods o f child psychology, b u t especially the clinical method. T h e psychological clinic was conducted daily, and a training school was in oper- ation in which a n u m b e r o f children were u n d e r the daily instruction o f Miss M a r y E. Marvin. At the clinic, cases were presented o f children suffering from defects o f the eye, the ear, deficiency in m o t o r ability, or in m e m o r y and attention; and in the training school, children were taught t h r o u g h o u t the session o f the S u m m e r School, re- ceiving pedagogical t r e a t m e n t for the cure o f stamm eri n g and other speech defects, for defects o f written language (such as bad spelling), and for m o t o r defects.

F r o m that t i m e until the present I have con t i n u ed the examination and t r e a t m e n t o f children in the psy- chological clinic. T h e n u m b e r o f cases seen each week has been limited, because the means were not at h an d for satisfactorily treating a large n u m b e r o f cases. I felt, also, that before offering to treat these children on a large scale I needed some years o f experience and extensive study, which could only be obtained t h r o u g h the pro- longed observation o f a few cases. Above all, I appreciated the great necessity o f training a group o f students u p o n whose assistance I could rely. T h e t i m e has now c o m e for a wider development o f this work. To further this object and to provide for the adequate publication o f the results that are being obtained in this new field o f psychological investigation, it was d e t e r m i n e d to found this journal, The Psychological Clinic.

My own preparation for the work has been facilitated through m y c o n n e c t i o n as consulting psychologist with the Pennsylvania Training School for Feeble-Minded Children at Elwyn, and a similar c o n n e c t i o n with the Haddonfield Training School a n d Miss Marvin's H o m e School in West Philadelphia.

Clinical psychology is naturally very closely related to medicine. At the very beginning o f m y work I was m u c h encouraged by the appreciation o f the late Provost o f the University o f Pennsylvania, Dr. William Pepper, who at one time proposed to establish a psychological laboratory in connection with the William Pepper Clinical L a b o r a t o r y o f Medicine. At his suggestion, psychology was made an elective branch in what was then the newly organized fourth year o f the course in medicine. At a subsequent reorganization o f the medical course, however, it was found necessary to drop the subject fro m the curriculum.

I also desire to acknowledge m y obligation t o Dr. S. Weir Mitchell for co-operation in the e x a m i n a t i o n o f a n u m b e r o f cases and for his constant interest in this line o f investigation. I have also enjoyed the similar co-oper- ation o f Dr. Charles K. Mills, Dr. William G. Spiller, the late Dr. H a r r i s o n Allen, Dr. Alfred Stengel, Dr. William Campbell Posey, Dr. George C. Stout, and Dr. Joseph Collins, o f New York. Dr. Collins will continue this co- operation as an associate editor o f The Psychological Clinic.

T h e appreciation o f the relation o f psychology to the practice o f medicine in general, and to psychiatry in par- ticular, has been o f slow growth. T h e first intelligent

treatment o f the insane was accorded by Pinel in the latter p art o f the eighteenth century, a c e n t u r y t h at was m a r k e d b y the rapid development o f the science o f psychology, and which b ro u g h t forth the work o f Pereire in teaching oral speech to the deaf, an d the " E m i l e " o f Rousseau. A few medical m e n have had a natural aptitude for psycho- logical analysis. F r o m t h em has c o m e the c h i e f develop- m e n t o f the medical aspects o f p s y c h o l o g y , - - f r o m Seguin and C h a r c o t in France, Carp en t er an d Maudsley in England, and Weir Mitchell in this country. Psychological insight will c a r r y the physician or teacher far o n the r o a d to professional achievement, b u t at the present day the necessity for a m o r e definite acq u ai n t an ce with psycho- logical m e t h o d and facts is strongly felt. It is n o t eworthy that perhaps the m o st p r o m i n e n t n a m e co n n ect ed with psychiatry to-day is that o f Kraepelin, w h o was among the first to seek the training in experimental psychology afforded b y the newly established l a b o r a t o r y at Leipzig.

Although clinical psychology is closely related to medicine, it is quite as closely related to sociology and to pedagogy. T h e school r o o m , the juvenile court, and the streets are a larger l ab o rat o ry o f psychology. An abun- dance o f material for scientific study fails to be utilized, because the interest o f psychologists is elsewhere engaged, and those in constant t o u c h with the actual p h e n o m e n a d o n o t possess the training necessary to m ak e their ex- perience an d observation o f scientific value.

While the field o f clinical psychology is to some ex- tent occupied b y the physician, especially by the psychi- atrist, and while I expect to rely in a great measure u p o n the ed u cat o r an d social worker for the m o r e i m p o r t a n t contributions to this b r a n c h o f psychology, it is neverthe- less t ru e that n o n e o f these has quite the training necessary for this kind o f work. F o r t h at matter, neither has the psychologist, unless he has acquired this training from o t h er sources t h a n the usual course o f instruction in psy- chology. In fact, we must look forward t o the training o f m e n to a new profession which will be exercised m o r e particularly in connection with educational problems, but for which the training o f the psychologist will be a prerequisite.

For this reason n o t a small p art o f the work o f the laboratory o f psychology in the University o f Pennsylvania for the past ten years has b een devoted to the training o f students in child psychology, an d especially in the clinical method. T h e greater n u m b e r o f these students have been actively engaged in the profession o f teaching. I m p o r t a n t contributions to psychology and pedagogy, the publication o f which in the f o r m o f m o n o g r a p h s has already been begun, will serve t o d e m o n s t r a t e t h a t original research o f value can be carried on by those w h o are actively en- gaged in educational or other professional work. T h e r e have been associated in this work o f the l ab o ratory o f psychology, S u p eri n t en d en t Twitmyer, o f Wilmington; S u p eri n t en d en t Bryan, o f Cam d en ; District Superinten- d en t C o r n m a n , o f Philadelphia; Mr. J. M. McCallie, Su- pervising Principal o f the T r e n t o n Schools; Mr. Edward A. H u n t i n g t o n , Principal o f a Special School in Phila- delphia; Miss Clara H. Town, Resident Psychologist at

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the Friends' Asylum for the Insane, and a n u m b e r o f spe- cial teachers for the blind, the deaf, and mentally deficient children. I did n o t venture to begin the publication o f this j o u r n a l until I felt assured o f the assistance o f a n u m - ber o f fellow-workers in clinical psychology as contributors to the journal. As this work has grown up in the neigh- b o r h o o d o f Philadelphia, it is probable that a greater n u m b e r o f students, equipped to c a r r y on the work o f clinical psychology, m a y be f o u n d in this n e i g h b o r h o o d t h a n elsewhere, b u t it is hoped that this j o u r n a l will have a wider influence, and that the co-operation o f those who are developing clinical psychology t h r o u g h o u t the c o u n t r y will be extended the journal.

T h e phraseology o f " c l i n i c a l psychology" and "psy- chological clinic" will doubtless strike m a n y as an o d d juxtaposition o f terms relating to quite disparate subjects. While the t e r m "clinical" has been b o r r o w e d from med- icine, clinical psychology is n o t a medical psychology. I have b o r r o w e d the word "clinical" from medicine, be- cause it is the best t e r m I can find to indicate the character o f the m e t h o d which I d e e m necessary for this work. Words seldom retain their original significance, an d clin- ical medicine, is not what the word i m p l i e s , - - t h e work o f a practicing physician at the bedside o f a patient. T h e t e r m "clinical" implies a m e t h o d , and not a locality. W h e n the clinical m e t h o d in medicine was established on a scientific basis, mainly t h r o u g h the efforts o f Boer- haave at the University o f Leiden, its developmen t cam e in response to a revolt against the philosophical an d di- dactic m e t h o d s that m o r e or less d o m i n a t e d medicine u p to that time. Clinical psychology likewise is a pro t est an t against a psychology that derives psychological and ped- agogical principles f r o m philosophical speculations and against a psychology that applies the results o f l a b o r a t o r y e x p e r i m e n t a t i o n directly to children in the school r o o m .

T h e teacher's interest is and should be directed t o the subjects which comprise the c u r r i c u l u m , and which he wishes to impress u p o n the minds o f the children as- signed to his care. It is not what the child is, b u t what he should be taught, that occupies the center o f his attention. Pedagogy is primarily devoted to mass instruction, that

is, teaching the subjects o f the c u r r i c u l u m to classes o f children without reference t o the individual differences presented b y the m e m b e r s o f a class. T h e clinical psy- chologist is interested p r i m a r i l y in the individual child. As the physician examines his patient an d proposes treat- m en t with a definite purpose in view, namely the patient's cure, so the clinical psychologist ex am i n es a child with a single definite object in v i e w , - - t h e n ex t step in the child's mental an d physical development. It is here t h at the re- lation between science an d practice becomes w orthy o f discrimination. T h e physician m a y have solely in m i n d the cu re o f his patient, b u t i f he is to be m o r e t h a n a m e r e practitioner and to contribute to the advance o f medicine, he will look u p o n his efforts as an experiment, every fea- ture o f which must indeed have a definite p u r p o s e , - - t h e cure o f the p a t i e n t , - - b u t he will study every favorable or unfavorable reaction o f the patient with reference to the patient's previous condition an d the remedial agents he has employed. In the same way the p u rp o se o f the clinical psychologist, as a c o n t r i b u t o r to science, is to discover the relation between cause an d effect in applying the var- ious pedagogical remedies to a child w h o is suffering from general or special retardation.

I would n o t have it t h o u g h t t h at the m e t h o d o f clin- ical psychology is limited necessarily to mentally and morally retarded children. These children are not, prop- erly speaking, ab n o rm al , n o r is the condition o f m a n y o f t h e m to be designated as in an y way pathological. T h e y deviate f r o m the average o f children only in being at a lower stage o f individual development. Clinical psychol- ogy, therefore, does n o t exclude f r o m consideration other types o f children that deviate fro m the a v e r a g e - - f o r ex- ample, the precocious child an d the genius. Indeed, the clinical m e t h o d is applicable even to the so-called n o r m a l child. For the m e t h o d s o f clinical psychology are neces- sarily invoked wherever the status o f an individual m i n d is d e t e r m i n e d b y observation and experiment, and ped- agogical t r e a t m e n t applied to effect a change, i.e., the development o f such individual mind. W h e t h e r the sub- ject be a child or an adult, the examination and t reatment m ay be conducted and their results expressed in the terms o f the clinical method.

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