Idiocy

IDIOCY, IDIOCY (from the Greek idio-tes-ignorant, uninformed), is characterized by almost complete absence of mental functions and belongs to the group of diseases which Kraepelin named 'oligophrenia'. Oligophrenia includes forms of underdevelopment (of both the psyche and the entire organism) caused either by congenital deficiency or by diseases that affected the nervous system in early age. Oligophrenia, in particular I., is characterized by absence of active process and progression; the underdevelopment is caused either by persistent deficiency of the nervous system or by persistent residues of early processes (scars, etc.). Depending on the degree of mental deficiency, oligophrenia is divided into three types: profound-idiocy, medium-imbecility, and mild-moronicity. The boundaries between these degrees are more or less arbitrary. Idiocy in turn is divided into profound and less profound. In profound idiots, speech does not develop at all; they only produce indistinct sounds and with difficulty understand others' speech. Their attention is not drawn to anything: they do not follow moving objects, do not listen to sounds, and do not use protective movements when attempts are made to cause them pain. They have markedly reduced sensitivity, and defects of hearing, smell, etc. are very common. In the areas of smell and taste, perversions are often observed; they do not distinguish between edible and inedible substances, eat feces, drink urine; it is interesting that this is sometimes associated with sexual excitement. Elementary sexual excitations sometimes appear in them very early; they masturbate frantically in front of everyone and fly into extreme rage if interfered with in this. The delay in development in the intellectual sphere concerns associative activity, formation of concepts, judgments, and for the most part also mechanical memory; however, in the latter there can also be a sharp exception. Thus, one idiot remembered for 30 years all the dates of funerals in his village. This kind of partial giftedness was also observed in relation to art. Thus, the 18th-century artist Gottfried Mind, who had the nickname 'Katzen-Rafael' and whose paintings depicting animals brought him great fame, was otherwise an oligophrenic. Some idiots are distinguished by a certain musicality; they listen to gramophones, etc., for hours. The affective sphere is extremely poor: they do not cry or laugh; facial expression is dull and meaningless; however, affects of anger with a tendency to bite can be observed in them, and sometimes they bite themselves, inflicting various injuries on themselves. Drives are not regulated by intellect, hence the tendency to antisocial actions (exhibitionism, arson, theft, etc.). Such actions are observed particularly often because idiots, as suggestible subjects, have great imitativeness, as a result of which they can be easily led astray. A large contingent of vagrants, prostitutes is recruited from such subjects. Motor activity of idiots deserves special attention. They begin to walk late. Movements are mostly monotonous, automatic; often rhythmic swaying of the entire body is observed, bearing the name 'idiot movements.' Movements are awkward, there is no grace in them, there is no automatic adaptation of the strength and form of movement to motor tasks ('amyostatic symptom-complex' of Homburger), which is explained in part by striatal, in part by associative disorders; often paralyses (most often in the form of hemiplegia- in connection with transferred childhood cerebral paralysis), convulsive seizures are observed. Growth is often below normal. Brain weight is usually below normal, reaching 550-600 g, but along with this there are also cases of I. with normal weight. Very often there are abnormalities of the skeleton, such as scapula scaphoidea and other deformities: incorrect shape and position of teeth, ears, asymmetrical coloring of the iris, high palate, abnormal hair distribution. In very many, changes in the endocrine system are observed (according to Szondi, in 33% of all oligophrenics), primarily deficiency of the sex glands, thyroid and pituitary, as well as hyperplasia of the thymus gland; in many, especially those with endocrine disorders, underdevelopment of the capillary system is noted (horizontal arrangement of loops, nodes, strangeness of form, etc.). In less profound idiots, some ability for perception is observed, presence of passive attention. They recognize their close ones, show elementary attachment to them, one can establish some contact with them, they grasp simple questions, understand the purpose of the simplest things encountered in domestic life, but still the total stock of such representations is extremely limited. Ability to speech, though delayed, does appear; however, they often throughout life cannot form sentences (use agrammatisms, telegraphic style, speak of themselves in the third person). They do not learn to write or read. Their mood is usually cheerful. They are good-natured, trusting, more rarely quarrelsome, irritable (especially under the influence of alcohol); they need constant supervision, guidance. The more dangerous ones should be kept in the work departments of psychiatric colonies in the countryside. Psychoses often arise on the basis of I. Psychotic reactions are more elementary than in other oligophrenics, manifesting in the form of flashes of depression passing into excitement; these flashes have some similarity with epileptic ones. Reactions of the 'short circuit' type are often observed. As for psychoses, almost all kinds are encountered here, but usually they have certain peculiarities. Thus, instead of elevated mood, melancholy, fear and malice are more common. A separate form is the 'added hebephrenia' developing on the basis of oligophrenia (Propfhebephrenie). Congenital idiocy-see Amaurotic family idiocy.