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the subject that aroused D. M. I

never knew, but a remarkable transformation took place. The man

changed over, studied hard, read outside literature and actually

asked for the privilege of working in the laboratory Sundays and

holidays so that he might learn more. When this was known to the

rest of the class, there were bets placed that he would not

“last,” but quite to the surprise of everybody D. M. gained in

momentum as he went along. As a matter of fact, his interest on

the subject grew, and he is now a bacteriologist of good

standing. In fact, his lack of interest in other matters has

helped him, since he has no distracting tastes or pleasures.

 

Thus there are persons of specialized interest and energy, and it

may well be that there is for most of the hypokinetic a line of

work that would act to energize them. The problem, therefore, in

each case is to find the latent ability and interest and to

regard no case as really hopeless. I say this despite the fact

that I believe some cases are hopeless. The pessimistic attitude

on the part of parent or teacher kills effort; the optimistic

attitude fosters energetic effort.

 

6. The irritable hypokinetic. Irritability[1] of a pathological

type as a phase of lowered energy is well known to every

physiologist and in the practical everyday world is seen in the

tired and sick. There are people who from the very start of life

show lowered endurance, who respond to certain stimuli in an

excessive manner and are easily exhausted. This type the

neurologist calls the congenital neurasthenic, and it may be we

are dealing here with some defect in the elimination of fatigue

products. This, however, is only a guess, and the disease factor,

if there is any, is entirely unknown. I do not pretend that the

person I am to describe is entirely representative of this group.

Indeed, no dozen cases would show all the symptoms and

peculiarities of the irritable hypokinetic group.

 

[1] One must take care not to mistake the irritability which is

the characteristic of all living tissue for the irritability here

considered.

 

E. is a man at present thirty years of age. In person he is of

average height, rather slender, with delicate features, somewhat

bald, quick in action and speech. He flushes easily and thus

often has high color, especially when fatigued or excited. This

“vasomotor irritability,” as the physicians call it, is quite

common in this group of people, and in fact in all neurasthenia,

whether acquired or congenital. Though I have described E. as

belonging to the slender type of person, it is necessary to say

that stout, rugged-looking people are often irritable and

hypokinetic.

 

As a child E. “never could stand excitement or strain,” as his

mother says. What is meant is this: that he became overexcited

under almost any circumstances and became profoundly fatigued

afterwards. As we have seen, the intense diffusion of excitement

throughout the whole body is a sign of the childish and inferior

organism; as maturity approaches and throughout childhood

excitability decreases and is better localized. When a noise is

heard an infant jumps, and so do people like E., but the better

controlled merely turn their head and eyes to see what the source

of the noise may be. This lack of control of excitement extended

in E.‘s case to play, entertainment, novelty of any kind, crowds

and especially to the disagreeable excitement of quarrels,

fights, terrifying experiences, etc. Under anger he trembled,

grew pale, and his shouts and screams were beyond control; under

fear he became actually sick, vomited and showed a liability to

syncope of an alarming kind. E. was not the selfish type of the

neurasthenic; he was gentle and kind and ready to share with

everybody, a lovable boy of an intensely sociable nature.

Nevertheless, his high excitability and his quick fatigue made it

necessary to shelter him, for any effort at toughening merely

brought about a “breakdown.”

 

Here we must reemphasize the fundamental importance of the

fatigue reactions. The normal fatigue reaction is to feel weary,

to desire rest and to be able to rest and sleep. The abnormal

reaction, one directly opposed to the well-being of the

individual, is to feel exhausted, to become restless and to find

it difficult to sleep. There are children who thrive on

excitement and exertion; they sleep sounder for it, they

recuperate readily and gain in strength and endurance with every

ordinary burden put upon them. There are others to whom anything

but the least excitement and exertion acts as a poison, making

them restless and exhausted. Not all children who show this

perverse fatigue reaction grow up with it. It may be only a

temporary phase of their lives, but while it lasts it is very

troublesome.

 

In E.‘s case the overexcitable hypokinetic stage lasted until

about the ninth year, and then there was a great improvement,

though he still was of the same general type. He became a fairly

good runner for a short distance, learned to swim, though he

stood the cold water poorly, was clever and graceful as a dancer

and was quite popular. At sixteen he left school to enter

business, because of the straitened means of his family. He

entered into adolescent period later and suffered greatly from

his sixteenth to nineteenth year from, fatigue, hypochondriacal

fears, and had to have a good deal of medical attention at this

time. Sex questions perplexed him, for he became quite passionate

and at the same time had much moral repugnance to illicit

relations. His sexual curiosity was intense, and he read all

manner of books on the subject, went to the burlesque shows on

the sly and almost became obsessed on sex matters.

 

At this stage he made only a mediocre showing in his business

career, though his evident honesty secured him promotion to a

clerk’s position. After his nineteenth year he seemed to gain

again in energy and endurance and was fairly well until his

twenty-eighth year, though he had to nurse his endurance at all

times, developed very regular habits of sleep, diet, etc., and in

this manner got along. Once he had an opportunity to join an

organization which would have paid him a better salary, but the

hours were irregular, and it would have demanded much exertion

and excitement, so he passed it by.

 

In 1917 he joined the army, partly because of patriotic motives,

partly because he was convinced that army life might develop his

endurance and energy. He was sent to an army post in the South

and within two months of his entrance had “broken down.” He was

sleepless, restless, was irritable and “jumpy,” had lost appetite

and the feeling of endurance. Life seemed intolerable, though he

had no desire to do away with himself, for he had no quarrel with

life itself but was disgusted with his inferiority. He was

hospitalized, but this did little good and he was afterwards

discharged as medically unfit.

 

This, of course, hurt his pride, but essentially he was greatly

relieved. He made but slow improvement until through the

munificence of Uncle Sam he was given a new start in life through

the Vocational Reeducation Board. Like many other city men, he

has dreamed of the “chicken farm” as the ideal occupation free

from too much work and yet lucrative. This, of course, is a

mistaken notion, but while learning the work he is happy and is

slowly regaining his energy. What time will bring forth no one

can tell, but this is certain: throughout his life he will have

to rely on good habits, carefully adjusted to his energy, in

order to protect himself from the bankruptcy that so easily comes

on him. A philosophy of life which will help to control his

irritability is necessary, and the intelligent of the hypokinetic

irritable acquire the habits and the philosophy necessary for

their welfare.

 

Any neurologist could cite any number of such cases with varying

traits of character, high intelligence or feebleminded,

controlled in morals or uncontrolled, happily or unhappily

situated, whose central difficulty is an irritable and easily

exhausted store of energy. They are easily excited and excitement

burns them out; that is the long and short of their situation.

Sex, love, hatred, anger, strain, fear in all its forms,

illness,—all these and many other emotions and happenings may

break them down. Such people, and those who care for them, must

not make the mistake of thinking that rough handling,

strenuosity, will cure what is apparently a fixed character.

 

There is an irritable, high-energy type—irritable

hyperkinetic—that is well contrasted with the foregoing. This

explosive personality works by fits and starts but does not wear

out, merely, as it were, settles down to his ordinary pace when

he rests up. He is like a six-day bicycle racer who plugs along

but every now and then sprints like mad for a few laps and then

comes back to a pace that would kill the average rider. I shall

not trouble to cite such a case, but I can think of at least one

man of good attainments who is of this explosive hyperkinetic

type. He responds to every demand with a burst of energy, and his

quota of ordinary activities is simply appalling.

 

Neglecting the further types of energy display for the simple

reason that this quality shades off into every conceivable type

and is also a part of every nature, we turn to the types of

emotional mood display. With these it is necessary to consider

excitability as well, and the most interesting beings are here

our objects of study.

 

I wish first to emphasize my belief that where there is a great

natural variation in excitability and emotionality in

individuals, there is not nearly so much in races as we think,

and that social heredity is tradition and cultural level plays

the more important role in this. My friend and colleague, Dr. A.

Warren Stearns, has made a study which shows that while the

immigrant Italian is excitable and quick to anger and of

revengeful reactions, his American-born descendent has so far

controlled and changed this type of reaction that he does not

especially figure in police records, in murders or assaults. My

own studies of the second and especially the third generation Jew

show there is an almost complete approach to the “American” type

in emotional display, in what is known as poise. This third

generation Jewish-American has dropped all the mannerisms of

excitability in gesture and voice, and his adherence to good form

includes that attitude of nonchalant humor so characteristic of

the American.

 

1. The generally excitable, overemotional type. This type is more

common in the Latin, Hebrew and Celtic races. In some respects it

corresponds to the hypokinetic irritable, but it is not

necessarily hypokinetic. The artistic type of person, so called,

is of this group, but is, of course, talented as well. Talent

need not be present, and there are persons of no artistic ability

whatever who show a generalized, excitable-emotional temperament.

All young children show the main traits of this type, and there

is something essentially simple about all these folk, no matter

how civilized or sophisticated they get to be.

 

A. L., a woman of fifty, belongs to this group. She is a Jewess

and now a widow. All of her life her character and temperament

have been the same, and though her experiences have been varied

she has not in any essential altered. This last is rather

characteristic of the group, for experience has but little effect

on their emotional reactions.

 

A. L. cries very easily and readily, but her tears are easily

dried and her joy is grotesquely childlike. She is readily

frightened, worries without restraint and finds a melancholy

satisfaction in the worst.

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