Manual of the Mental Examination of Aliens, United States Public Health Service (14)

1530. Mental Examination of Aliens. 13 changes incident to the psychosis can not be readily detected. Other types may escape detection, because at the particular time of examination they may not display mental peculiarities, as would be quite possible, for example, in some cases of dementia praecox and manic depressive insanities. Idiots and imbeciles will, as a rule, hardly escape detection by experienced officers. Detection of higher grades of mental defectiveness offers, however, peculiar difficulties. In endeavoring to pick out aliens who may have mental defects, one is guided largely by their appearance, attitude, and conduct. Most experienced examiners agree that very little dependence can be placed upon appearance alone, although idiots and many imbeciles generally present some physical signs which immediately attract attention to their mental condition. The low, narrow forehead, receding chin, closely set eyes, protruding and misshapen ears, and other facial irregularities so often referred to as the "signs of degeneracy" have not the importance formerly supposed. A great many feeble-minded persons on ordinary inspection present no physical signs whatever which would indicate real lack of intelligence. Nevertheless, the examiner should have made close observation of facial expressions, both in normal and abnormal persons, especially as to whether they may be said to be gloomy, sad, anxious, apprehensive, elated, hostile, confused, sleepy, cyanotic, exalted, arrogant, conceited, restless, impatient, etc. An examination of the photographs which appear herewith (Figs, 1-14), may prove interesting and instructive in this connection. It will be of advantage to divide aments, so far as appearance goes, into two general classes. Some are dull, apathetic, slow in their movements, and do not pay the usual attention to their surroundings. These by their air of preoccupation and obvious lack of normal interest in what is going on around them may in some instances excite suspicion as to their mental soundness. Others are overstimulated, always in motion, and their attention is easily aroused, but not held. These would certainly afford no clue to their true mental status on casual inspection. On the contrary, they would often impress one as being unusually bright. Muscular incoordination is also a feature noted not infrequently among aments. [end]