Appendix 4

Without any training in the diagnosis of the mentally diseased and without any apparatus for exact diagnosis of the mentally defective, I can simply record a number of amateur observations which may be of interest to the specialist interested in the possibilities of studying the pathology of primitive peoples. In the Manu’a Archipelago with a population of a little over two thousand people, I saw one case which would be classed as idiocy, one imbecile, one boy of fourteen who appeared to be both feeble-minded and insane, one man of thirty who showed a well-systematised delusion of grandeur, and one sexual invert who approximated in a greater development of the breasts, mannerism and attitudes of women and a preference for women’s activities, to the norm of the opposite sex. The idiot child was one of seven children; he had a younger brother who had walked for over a year, and the mother declared that there were two years between the children. His legs were shrunken and withered, he had an enormous belly and a large head set very low on his shoulders. He could neither walk nor talk, drooled continually, and had no command over his excretory functions. The imbecile girl lived on another island and I had no opportunity to observe her over any length of time. She was one or two years past puberty and was pregnant at the time that I saw her. She could talk and perform the simple tasks usually performed by children of five or six. She seemed to only half realise her condition and giggled foolishly or stared vacantly when it was mentioned. The fourteen-year-old boy was at the time when I saw him definitely demented, giving an external picture of catatonic dementia præcox. He took those attitudes which were urged upon him, at times, however, becoming violent and unmanageable. The relatives insisted that he had always been stupid but only recently become demented. For this I have only their word as I was only able to observe the boy during a few days. In no one of these three cases of definite mental deficiency was there any family history which threw any light upon the matter. Among the girls whom I studied in detail only one, Sala, discussed in Chapter X, was sufficiently inferior to the general norm of intelligence to approximate to a moron.

I have no training in diagnosing mental illness and no tools for accurately assessing intellectual disability. I can only record a few amateur observations. These may interest specialists studying the possibility of investigating mental disorders among primitive peoples. The Manu’a Archipelago had a population of just over two thousand. There I saw one case that would have been classified as idiocy and one as imbecility. I also saw a fourteen-year-old boy who appeared to have both an intellectual disability and a mental illness. One thirty-year-old man had a well-developed, organized delusion of grandeur. I also observed one sexual invert who approached the female norm in several ways. These included greater breast development, feminine mannerisms and attitudes, and a preference for women’s activities. The child with the most severe intellectual disability was one of seven children. His younger brother had been walking for over a year. Their mother said the children were two years apart. The older boy’s legs were shrunken and withered. He had an enormous belly and a large head set very low on his shoulders. He could neither walk nor talk, drooled constantly, and had no control over his bladder or bowels. The girl classified as having imbecility lived on another island. I had no opportunity to observe her for any length of time. She was one or two years past puberty and was pregnant when I saw her. She could talk and do the simple tasks usually performed by children of five or six. She seemed only partly aware of her pregnancy. When the pregnancy was mentioned, she giggled foolishly or stared blankly. The fourteen-year-old boy was clearly mentally disturbed when I saw him. His outward symptoms resembled catatonic dementia præcox. He adopted the postures people urged him to take, but at times he became violent and unmanageable. His relatives insisted that he had always had low intelligence but had only recently become mentally disturbed. I have only their word for his earlier condition, since I could observe him for only a few days. None of these three clear cases of intellectual disability had a family history that helped explain the condition. Among the girls I studied in detail, only Sala, discussed in Chapter X, had intelligence far enough below average to approach the classification of moron.

The man with the systematised delusion of grandeur was said to be about thirty years of age. Gaunt and emaciated, he looked much older. He believed that he was Tufele, the high chief of another island and the governor of the entire archipelago. The natives conspired against him to rob him of his rank and to exalt an usurper in his stead. He was a member of the Tufele family but only very remotely so that his delusion bore no relation to reality as he would never have had any hope of succeeding to the title. The natives, he said, refused to give him food, mocked him, disallowed his claims, did their best to destroy him, while a few white people were wise enough to recognise his rank. (The natives instructed visitors to address him in the chief’s language because he consented to dance, a weird pathetic version of the usual style, only when so opportuned.) He had no outbreaks of violence, was morose, recessive, only able to work at times and never able to do heavy work or to be trusted to carry through any complicated task. He was treated with universal gentleness and toleration by his relatives and neighbours.

The man with an organized set of delusions about his own greatness was said to be about thirty. Thin and wasted, he looked much older. He believed he was Tufele, the high chief of another island and governor of the entire archipelago. He believed the local people plotted to strip him of his rank and put an impostor in his place. He belonged to the Tufele family, but was only a very distant relative. So his delusion had no basis in reality, since he could never have hoped to inherit the title. The local people, he said, refused to give him food, mocked him, rejected his claims, and tried their best to destroy him. A few white people, however, were wise enough to recognize his rank. (The local people told visitors to address him in the language used for chiefs. This was because he agreed to dance only when asked in that way. His dancing was a strange, pitiful version of the usual style.) He had no violent outbursts and was gloomy and withdrawn. He could work only at times and could never do heavy work or be trusted to complete any complicated task. All his relatives and neighbors treated him with gentleness and tolerance.

From informants I obtained accounts of four cases on Tutuila which sounded like the manic stage of manic depressive insanity. All four of these individuals had been violently destructive, and uncontrollable for a period of time, but had later resumed what the natives considered normal functioning. An old woman who had died some ten years before was said to have compulsively complied with any command that was given her. There was one epileptic boy in Taū, a member of an otherwise normal family of eight children. He fell from a tree during a seizure and died from a fractured skull soon after I came to Manu’a. A little girl of about ten who was paralysed from the waist down was said to be suffering from an overdose of salvarsan and to have been normal until she was five or six years old.

People I spoke with described four cases on Tutuila that sounded like the manic phase of bipolar disorder. All four people had been violently destructive and uncontrollable for a time. But they had later returned to what local people considered normal functioning. An old woman who had died about ten years earlier was said to have compulsively obeyed any command given her. There was one boy with epilepsy in Taū, part of an otherwise normal family of eight children. He fell from a tree during a seizure and died from a fractured skull soon after I arrived in Manu’a. A girl of about ten was paralyzed from the waist down, reportedly because of an overdose of salvarsan. She was said to have been normal until she was five or six years old.

Only two individuals, one a married woman of thirty or so, the other a girl of nineteen, discussed in Chapter X, showed a definite neurasthenic constitution. The married woman was barren and spent a great deal of time explaining her barrenness as need of an operation. The presence of an excellent surgeon at the Samoan hospital during the preceding two years had greatly enhanced the prestige of operations. On Tutuila, near the Naval Station, I encountered several middle-aged women obsessed with operations which they had undergone or were soon to undergo. Whether this vogue of modern surgery, by giving it special point, has added to the amount of apparent neurasthenia or not, it is impossible to say.

Only two individuals showed a clear tendency toward neurasthenia, a condition of nervous exhaustion. One was a married woman of about thirty. The other was a nineteen-year-old girl discussed in Chapter X. The married woman could not have children and spent much time explaining that she needed an operation for her infertility. An excellent surgeon had worked at the Samoan hospital during the previous two years. His presence had greatly increased the prestige of surgery. On Tutuila, near the Naval Station, I met several middle-aged women obsessed with operations they had undergone or would soon undergo. It is impossible to say whether this fashion for modern surgery has increased the apparent amount of neurasthenia by giving it a particular focus.

Of hysterical manifestations, I encountered only one, a girl of fourteen or fifteen with a bad tic in the right side of her face. I only saw her for a few minutes on a journey and was unable to make any investigations. I neither saw nor heard of any cases of hysterical blindness or deafness, nor or any anæsthesias nor paralyses.

I encountered only one case of hysterical symptoms: a girl of fourteen or fifteen. She had a severe tic on the right side of her face. I saw her for only a few minutes while traveling and could not investigate further. I neither saw nor heard of any cases of hysterical blindness, deafness, loss of sensation, or paralysis.

I saw no cases of cretinism. There were a few children who had been blind from birth. Blindness, due to the extremely violent methods used by the native practitioners in the treatment of “Samoan conjunctivitis,” is common.

I saw no cases of cretinism. A few children had been blind from birth. Blindness is common because local healers use extremely violent methods to treat “Samoan conjunctivitis.”

The pathology which is immediately apparent to any visitor in a Samoan village is mainly due to the diseased eyes, elephantiasis, and abscesses and sores of various sorts, but the stigmata of degeneration are almost entirely absent.

Any visitor to a Samoan village immediately notices signs of illness. These mainly involve eye disease, elephantiasis, and various abscesses and sores. But signs of degeneration are almost entirely absent.

There was one albino, a girl of ten, with no albinism in the recorded family history, but as one parent, now dead, had come from another island, this was not at all conclusive data.

There was one girl with albinism, aged ten, with no recorded family history of albinism. But one parent, now dead, had come from another island, so the family history was not at all conclusive.