upon older stores and strata of psycho-physic impulsion its ex- haustion may even more completely drain our kinetic resources, if it is too abandoned or prolonged. Play can do just as hard and painful tasks as work, for what we love is done with whole * An Essay on Laughter, 1892, p. 427 et seq. ' See Brandt's Antiquities.
' See Professor Allin's and my Psychology of Tickling, Laughing, and the Comic. Am. Jour, of Psy., vol. ix, p. i et seq.
GROWTH OF MOTOR POWER AND FUNCTION 233 and undivided personality. Work, as too often conceived, is all body and no soul, and makes for duality and not totality. Its constraint is external, mechanical, or it works by fear and not love. Not effort but zestless endeavors is the tragedy of life. Interest and play are one and inseparable as body and soul. Duty itself is not adequately conceived and felt if it is not pleasure, and is generally too feeble and fitful in the young to awaken much energy or duration of action. Play is from within from congenital hereditary impulsion. It is the best of all methods of organizing instincts. Its cathartic or pur- gative function regulates irritability, which may otherwise be drained or vented in wrong directions, exactly as Breuer ^ shows psychic traumata may, if overtense, result in " hysterical convulsions." It is also the best form of self-expression and its advantage is variability, following the impulsion of the idle, perhaps hyperemic, and overnourished centers most ready to act. It involves play illusion and is the great agent of unity and totalization of body and soul, while its social function de- velops solidarity and unison of action between individuals. The dances, feasts, and games of primitive people, wherein they rehearse hunting and war and act and dance out their legends, bring individuals and tribes together.^ Work is menial, cheerless, grinding, regular, and requires more precision and accuracy and, because attended with less ease and pleasure and economy of movement, is more liable to produce erratic habits. Antagonistic as the forms often are, it may be that, as Carr says, we may sometimes so suffuse work with the play spirit, and vice versa, that the present distinction between work and play will vanish, the transition will be less tragic and the activities of youth will be slowly systematized into a whole that better fits his nature and needs; or, if not this, we may at least find the true proportion and system between drudgery and recreation.
The worst product of striving to do things with defective psychic impulsion is fatigue in its common forms, which slows down the pace, multiplies errors and inaccuracies, and develops * Breuer and Freud. Studien iiber Hysterie. Wien, 1895. See especially p.
'See a valuable discussion by H. A. Carr. The Survival Value of Play, Colorado Investigation, November, 1902.
234 THE PSYCHOLOGY OF ADOLESCENCE slovenly habits, ennui, flitting will specters, velleities and caprices, and neurasthenic symptoms generally. It brings rest- lessness, and a tendency to many little heterogeneous, smatter- ing efforts that weaken the will and leave the mind like a piece of well-used blotting-paper, covered with traces and nothing legible. All beginnings are easy, and only as we leave the early stages of proficiency behind and press on in either physical or mental culture and encounter difficulties, do individual differ- ences and the tendency of weak wills to change and turn to something else increase. Perhaps the greatest disparity be- tween men is the power to make a long concentrative, persever- ing effort, for In der Beschrdnkung zeigt sick der Meister. Now no kind or line of culture is complete till it issues in motor habits, and makes a well-knit soul texture that admits concen- tration series in many directions and that can bring all its re- sources to bear at any point. The brain unorganized by train- ing has, to recur to Richter's well-worn aphorism, saltpeter, sul- fur, and charcoal, or all the ingredients of gunpowder, but never makes a grain of it because they never get together. Thus willed action is the language of complete men and the goal of education. When things are mechanized by right habituation, there is still further gain, for not only is the mind freed from further and higher work, but this deepest stratum of motor as- sociation is a plexus that determines not only conduct and character, but even beliefs. The person who deliberates is lost, if the intellect that doubts and weighs alternatives is less com- pletely organized than habits. All will culture is intensive and should safeguard us against the chance influence of life and the insidious danger of great ideas in small and feeble minds. Now fatigue, personal and perhaps racial, is just what arrests in the incomplete and mere memory or noetic stage. It makes weak bodies that command, and not strong ones that obey. It di- vorces knowing and doing, Kennen and Konnen, a separation which the Greeks could not conceive because for them knowl- edge ended in skill or was exemplified in precepts and proverbs that were so clear cut that the pain of violating them was poignant. Ideas must be long worked over till life speaks as with the rifle and not with the shotgun, and still less with the water hose. The purest thought, if true, is only action repressed to be ripened to more practical form. Not only do muscles come GROWTH OF MOTOR POWER AND FUNCTION 235 before mind, will before intelligence, and sound ideas rest on a motor basis, but all really useless knowledge tends to be elim- inated as error or superstition. The roots of play lie close to those of creative imagination and idealism.
The opposite extreme is the factitious and superficial moti- vation of fear, prizes, examinations, artificial and immediate re- wards and penalties, which can only tattoo the mind and body with conventional patterns pricked in, but which lead an unreal life in the soul because they have no depth of soil in nature or heredity. However precious and coherent in itself, all subject- matters thus organized are mere lugs, crimps, and frills. All such culture is spurious, unreal, and parasitic. It may make a scholastic or sophistic mind, but a worm is at the root and, with a dim sense of the vanity of all knowledge that does not be- come a rule of life, some form of pessimism is sure to super- vene in every serious soul. With age a civilization accu- mulates such impedimenta, traditional flotsam and jetsam, and race fatigue proceeds pari passu with its increasing volume. Immediate utilities are better, but yet not so much better than acquisitions that have no other than a school or examina- tion value. If, as Ruskin says, all true work is praise, all true play is love and prayer. Instil into a boy's soul learning which he sees and feels not to have the highest worth and which can not become a part of his active life and increase it, and his freshness, spontaneity, and the fountains of play slowly run dry in him, and his youth fades to early desiccation. The instincts, feelings, intuitions, the work of which is always play, are super- seded by method, grind, and education by instruction which is only an effort to repair the defects of heredity, for which, at its best, it is a vulgar, pinchbeck substitute. The best play is true genius, which always comes thus into the world, and has this way of doing its work, and all the contents of the memory pouches is luggage to be carried rather than the vital strength that carries burdens. Gross well says that children are young because they play, and not vice versa; and he might have added, men grow old because they stop playing, and not conversely, for play is, at bottom, growth, and at the top of the intellectual scale it is the eternal type of research from sheer love of truth. Home, school, church, state, civilization, are measured in one supreme scale of values, viz., whether and how, for they aid in 236 THE PSYCHOLOGY OF ADOLESCENCE bringing youth to its fullest maturity. Even vice, crime, and decline are often only arrest or backsliding or reversion. National and racial decline beginning in eliminating one by one the last and highest styles of development of body and mind, mental stimulus of excessive dosage lowers general nutrition. A psychologist that turns his back on mere subtleties and goes to v^ork in a life of service has here a great opportunity, and should not forget, as Horace Mann said, ''that for all that grows, one former is worth one hundred reformers."
CHAPTER IV DISEASES OF BODY AND MIND Physical and mental ailments and diseases of adolescence a new field of pathology — Neglect of age determination between childish and the better defined diseases of maturity — Mindenverthigkeit — Disparate growth of psychic elements loosens cohesion — Health tables from schools — Prevalent disorders — Death rate and morbidity — Indigestion and changes of appetite — Heart troubles and their psychic effect — Curvatures — Consumption— Stuttering — Eye defects — Chlorosis — Typhoid fever — Nerve signs — Sleep — Catatonia — Hebephrenia — Age of first insanity — Tables — Circular and periodic troubles and epilepsy — Melancholy — Idiocy — Hysteria and sex-psychoses — Anxiety — Impulsiveness — Neurasthenia — Folly of doubt and Grubelsucht — General paralysis — Special views of many authors — Modern concepts and forms of dementia praecox by Wille, Marro, Kraepelin, Trommer, Ilberg, Seglas, Serieux, Serbski, Chris- tian, etc. — Criticisms of Kraepelin — Ten traits in normal youth exaggerated in dementia praecox — Genius and insanity — Some general causes of pre- cocious decay.
Until recent years there has been a remarkable gap in the medical literature and knowledge concerning health and disease during adolescence. Pediatrics, which treats of the diseases of infancy and early childhood and which has lately become a prominent specialty, usually leaves the child at eight or ten, and in the text-books of Heneoch, Stenzl, Spitzner, Burns, Striimpell, and Mobius, or other standard authors or in the files of the special journals devoted to children's diseases, one finds little attention paid to even the early stages of puberty. So too the diseases of senescence and the menopause, although not a specialty, have a copious and valuable literature. A striking illustration of this relative neglect and ignorance by the pro- fession of the morbific peculiarities of pubescent life is seen in the fact that until well within the last decade, writers often in- ferred morbidity from mortality tables and many were thus strangely misled, because early adolescence, while the most healthful period of life, if measured by death rates, which are then lowest, is most prone to many ailments, and is therefore marked by a high percentage of ill health.
238 THE PSYCHOLOGY OF ADOLESCENCE The general reason for this neglect is that medicine has been chiefly concerned with the study and practical treatment of pronounced diseases and has not yet come to rest on the broad basis of biology, which is its natural and scientific foundation. Practitioners too have been occupied, both at home and in hos- pitals, with grave cases and have had little time and less motive to consider preventive medicine or the more general problems of regimen and hygiene, personal, domestic, or public. Per- haps occupation with flagrant symptoms tends to give di- minished interest, if not distaste, for the milder and incipient manifestations of disease which require sharper diagnosis and a higher quality of mind to detect; and this perhaps could only be overcome by some such philosophic device as having physicians insure the health of their patients, be mulcted, if they are ill, and lose caste if they become so by their neglect. Again, dur- ing nearly all its history, medicine has chiefly busied itself with the diseases of adults in whom the same disorders are often ex- pressed by very different symptoms, and which have different prognosis, relations to heredity, treatment, etc. Plato may have had some degree of justification in urging that the ideal doctor must himself not be too well, but must have been schooled by experiences of sickness in his own person to rightly under- stand the diseases of his patients. If this be so, the treatment of adolescents would be hardly less difficult than that of chil- dren, and would be quite as different, because maturity means the obliteration of nearly all traces, physical and mental, of this stage of metamorphosis and transition. Another cause of the hitherto inadequate recognition of the general abnormalities of adolescence is that its sexual and a certain few salient nervous phenomena, which alone have a copious literature, have absorbed attention to the neglect of the other and far more numerous symptom groups peculiar to this age.
The recent advance of interest and knowledge in this latter direction has come for the most part from special studies of large numbers by statistical methods. Some of these researches have concerned health and sickness generally, have selected a group of chronic, acute, or contagious diseases, or else they have spe- cialized upon eye, ear, curvature, circulatory, digestive, or other troubles. In looking over this recent literature one is struck by the following facts: First, that age tables have been too DISEASES OF BODY AND MIND 239 often neglected. Five- and even ten-year periods only instead of single years are sometimes shown, or children are grouped by the class in school which they attend, and the numbers studied are generally far too few to show reliable age proclivi- ties. Secondly, wherever these latter are plotted on a suffi- ciently broad basis of numbers, for almost every trouble grave and slight, there are indications that there is some character- istic modification of the curve at or near puberty, w^hatever the nature of the trouble. These data of age liability are now seen to be so fundamentally important that it can be said with confi- dence that we have no adequate scientific knowledge of any youthful disease, unless this has been presented. It must be recognized that our knowledge of but relatively few of these diseases yet conforms satisfactorily to this criterion. As puberty approaches, most of the diseases to which childhood is most prone, like meningitis, scarlatina, diphtheria, acute bron- chitis, and a number of epidemics decrease, while rheumatism, disorders of bones, muscles, nerves, heart, and circulation in- crease. Goubert ^ concludes that diathesic diseases (as opposed to those like dysentery, typhoid, etc., due to bad hygiene) de- crease, although his tables are based on death rates. Recurrent circular and periodic troubles are especially liable to begin at puberty. The characteristic adult diseases to which youth is now becoming liable, without having ceased to be exposed to those of childhood, are often more simple with less evolved symptoms. Illusions are less systematized than they will be later, when mental phenomena are more complex and more de- veloped. Insanities are more emotional, and Moreau's etat mixte, which is neither health nor sickness, but on or near the border line that separates them, indicates how in this transition stage youth is still exposed to most early diseases, although their assault is with diminished violence, while most adult troubles are beginning to lay hold upon him but can not yet exert their full power. This is, as we shall see later, also the age of incipiency for what Prichard was the first to character- ize as moral insanity, and for the Minderwerthigkeit of Koch, Triiper, and others, a term which designates anomala or anti- nomia of character and conduct which are not normal nor yet insane, but suggest the difficulty and liability of failure to ^ Les maladies des enfants k Paris, 1891, p. 95 et seq.
240 THE PSYCHOLOGY OF ADOLESCENCE pass successfully and completely to the adult stage. Brethean ^ was one of the first to recognize this aspect of these critical years during which the resistance of different parts of the organism to morbid influences varies greatly. The diseases he thought most liable to appear at this stage are chlorosis, anemia, goiter, hysteria, epilepsy, and a peculiar form of chorea. The point of departure for each, if not its cause, he found in the physical changes which characterize sexual evolu- tion, but he thought that many symptoms which do not develop into complete morbid entities had their root in the digestive perturbations peculiar to this age.
That nutritive processes are influenced by climate, seasons, and geographical location, has often been pointed out. Mili- tary statistics show that the size of adults varies greatly in different parts of this country, suggesting thus that growth may also be very sensitive to outer conditions. Such con- siderations led Dr. Bowditch to inquire if the accurate deter- mination of the normal rate of growth of children would not throw light on the nature of the diseases to which they were subject and also guide to proper curative measures. Denti- tion is known to retard growth. Many special cases seem to show that loss of weight or arrest of growth, at the age when it should be most rapid, is a danger-signal of peculiar value be- cause it precedes all others. Loss of weight may precede by months the characteristic cough of consumption, and the advent of other especially constitutional and inherited diseases, and even measles may be thus heralded by some loss of weight. This is an argument for weekly weighings, but it must not be inferred that diminution of growth is always a morbid symp- tom, as this is subject to oscillation the curves and limits of which are not yet sufficiently understood.^ As we know more of adolescence, it will probably be ap- parent that many, if not indeed most of its minor disorders are due to disproportionate development. If increase in height is too rapid and excessive, not only growing pains in the limbs due to failure of the muscles to develop pari passu with the * De la Puberty chez la Femme. Paris, 1865, p. 38.
' See I Fattori della Statura Umana. Arch, di Statistica. Rom., 1877. — Bow- ditch. The Relation between Growth and Disease. Transactions of the Am.
DISEASES OF BODY AND MIND 241 bones, but venous disturbances, particularly varicosities in the legs, now so common, and even aortic disorders may be caused, to say nothing of curvatures and torsions, because young people become self-conscious and perhaps ashamed of their sudden height, and the fully upright posture is hard to maintain. Acro- megalia, or excessive development of the limbs or bones of the face, probably illustrates this same disturbed equilibrium. Some headaches and eye troubles have here their cause. Closely related too, no doubt, are some forms of heterotopy and still more heterochrony or anomalous changes in the direction or order of the various growth stresses. We must probably here too invoke the principle laid down by Roux that different organs and tissues or determinants compete for the available nutritive material in the blood, and some for a time get ahead of others in this internal struggle for survival among the dif- ferent parts or independently variable growth units. If func- tions or tissues that ought to develop at the age of twenty ap- pear at fifteen, or earlier, we have here on a small scale what, if excessive, constitutes, from an evolutionary standpoint, the very interesting body of facts treated in teratology. We shall later see how this principle must be appealed to in genius, in some aspects of insanity and crime as well as in sexual and mental precocity. Its more restricted range is a matter of com- mon observation as seen in children, who are precocious and be- lated in one or many respects.^ We know too from the fact of tachygenesis as described by Cope, and also from the manifold data which already have a rich literature showing how ontogeny often reverses the order of phylogeny, that there is great tempo- rary plasticity and interchange of forces here, the brain and eye — e. g., appearing in the human embryo far earlier than their place in the phyletic sequence. Assuming that our per- sonality is compound and made up of many elements, as Hirt suggests, into which disease, traumata, hypnotism, etc., may partially resolve it, as seen in the phenomena of multiplex personality, we must regard the adolescent stage as especially characterized by either a loosening of the bonds between the manifold factors of our ego, somatic and psychic, or else by a sudden and independent growth of single elements which * Baur, Die korperliche und geistige Friih- und Spatentwickelung. Zeits. f. Schulgesundheitspflege, 1899, p. 707. 17 ^4-2 THE PSYCHOLOGY OF ADOLESCENCE leaves their former associative bonds relatively weakened, or perhaps by both together. The fact that the growth fac- tors are increased, some more and some less, and thus brought into new relations with each other, makes this the most favorable field for the genetic study of character and temperament, whether mental, as seen in the now recognized difference of eye, ear, motor-minded, etc., or emotional and active, as seen in the dominance of different classes of tem- peraments, so apparent in the observation of individual and particularly of peculiar and exceptional children or adults. Thus again, as from so many standpoints, we come to the sug- gestion of ancestral prepotencies struggling with each other for predominance, checking and favoring each other in a way that suggests the Herbart-Taine concepts of collisions and impacts at all angles, with sums of arrest and reenforcements. These perhaps when we understand the laws of heredity we shall find due in part to the mingling of different ancestral stocks, the elements of which are more or less compactly knit together in proportion to the time in which they have been associated in the phylum, as we trace man's ancestral tree backward and downward further toward its earliest roots.
Clouston suggests that the tissues that mature slowly are most liable to be affected by hereditary disease, and others have intimated that growth energy itself may do harm unless rightly distributed and proportioned, so that each determinant gets its full share of this momentum, so that height be not at the expense of weight, or the nervous system left arrested, im- mature, etc. We have seen in Chapter II that boys are more likely than girls to grow unsymmetrically, and there are many cases where even bilateral symmetry, especially of limbs and shoulders, is lost for a time and then regained, as if boys grew first, and most on one side and then on the other. Indeed all the facts that support the doctrine of nascent periods show that for a time growth tends to focalize upon one group of qualities and then upon another, and the newer developments even in brain anatomy suggest, as we saw, a difference between the period of development for the projection system, which reacts through the senses and muscles to the outer world, and the associative functions which combine these capsular and sensory centers with each other into new and higher unities.
DISEASES OF BODY AND MIND 243 Dr. HerteP examined 3,141 boys in 14 schools in Copen- hagen, and found 1,900 healthy, 978 sickly, and 236 uncertain. 18 per cent were sickly on entering school; after two years this number increased to 30 per cent; and just before pu- berty, had reached 40 per cent, when it dropped to 30, where it remained for a few years. Of 1,21 1 girls between the ages of five and sixteen, 640 were healthy, 433 sickly, and the rest not returned. The percentage of sickness for girls rose rapidly from the first to the third school year, from 12 to 32 per cent. From twelve to sixteen sickness increased till the ill outnumbered the well by 10 per cent, except at fourteen, when there was a slight change for the better. At about twelve and one-half years there was a sudden increase of illness due, as he thought, to the im- pending development of adolescence. Before puberty he found scrofulous diseases most common, and after it anemia, nervous- ness, headache, and eye diseases. Hertel says: " We must put aside all illusions and confess that the present generation of young girls is weakly, anemic, and nervous to an extraordinary degree." He scores the ignorance and stupidity of teachers about health, when they are possessed by the demon of education, which is causing an appalling national invalidism as well as juvenile serfdom. The best pupils he thinks are thus often made the slowest and most vacant minded. From thirteen to fifteen great reduction of school work for both sexes, but chiefly for boys, should be insisted on. No one should be allowed to go to school at all without nine hours of sleep and a hearty appe- tite, for even presence in school impairs nutrition, arrests growth, starts neurotic habits, and especially checks the de- velopment of the highest powers, which are the last to unfold. He almost agrees with Dr. Pilger, who had urged that the youth of Germany had degenerated mentally, morally, and physically, and who thought that only a few exceptional boys should be allowed to attend school at all after eighteen. Teachers, he says, are incompetent to judge of the health of pupils and could hardly be trusted for unbiased opinions wxre they competent. All nervous girls need very careful individ- ual study and the greatest degree of consideration at this period.