University of Southern California Dissertations and Theses

A Projective Look At The Educational History Of Adult Mental Patients

(USC Thesis Other)

A Projective Look At The Educational History Of Adult Mental Patients

PDF

Download

Open document

Flip pages

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content This dissertation has been microfilmed exactly as received 6 6 -1 1 ,5 9 4 SUSSMAN, Edward, 1911- A PROJECTIVE LOOK AT THE EDUCATIONAL HISTORY OF ADULT MENTAL PATIENTS. U niversity of Southern California, Ph.D ., 1966 Education, general University Microfilms, Inc., Ann Arbor, Michigan A PROJECTIVE LOOK AT THE EDUCATIONAL HISTORY OF ADULT MENTAL PATIENTS by Edward Sussman A D i s s e r t a t i o n P re s e n te d to th e FACULTY OF THE SCHOOL OF EDUCATION UNIVERSITY OF SOUTHERN CALIFORNIA In P a r t i a l F u lf i llm e n t o f th e R eq u irem en ts f o r th e D egree DOCTOR OF EDUCATION Ju n e 1966 This dissertation, written under the direction of the Chairman of the candidate’s Guidance Committee and approved by all members of the Committee, has been presented to and accepted by the Faculty of the School of Education in partial fulfillment of the requirements for the degree of Doctor of Education. Date.......................................-1966 Guidance Com m ittee Chairman IL i'W ' ACKNOWLEDGMENTS My th a n k s a r e due to th e fo llo w in g in d iv id u a ls and a g e n c ie s . To George Abe, M .D ., S u p e rin te n d e n t and M ed ical D ir e c to r o f th e M e tro p o lita n S ta te H o s p ita l, N orw alk, C a lif o r n i a , and T re n t E. B e sse n t, P h .D ., C h ief P s y c h o lo g is t o f t h a t h o s p i t a l , f o r h av in g g ra n te d p e rm is s io n f o r t h i s stu d y to b e u n d e rta k e n . To th e S ta te D epartm ent o f Hy g ie n e , S acram ento, C a lif o r n i a , f o r h av in g aw arded me a C a re e r D evelopm ent S c h o la rs h ip f o r one y e a r, w hich ex p e d ite d th e co m p letio n o f t h i s w ork. To M rs. E d ith C o le, R .N ., D ir e c to r o f N u rsin g E d u c a tio n , M e tro p o lita n S ta te H o s p ita l, f o r h av in g h e lp e d make a v a ila b le to me a p o o l o f n u rs in g s e r v ic e s p e rs o n n e l to f u l f i l l " c o n tr o l" sam pling re q u ire m e n ts . To W ilmer C ouzens, P h .D ., G lenn W rig h t, P h .D ., H arry R o s e n th a l, P h .D ., f o r h av in g g iv e n o f t h e i r tim e u n s t i n t i n g l y to p erfo rm th e r o l e o f ju d g e s f o r t h i s r e s e a r c h . To my w ife , Ruth W. Sussman, f o r h e r e n c o u ra g e m ent. And f i n a l l y , to th e r e s id e n ts o f M e tro p o lita n S ta te H o s p ita l, from whose num bers, in d iv id u a ls v o lu n te e re d to be th e h o s p it a li z e d sa m p lin g . TABLE OF. CONTENTS C h ap ter Page 1 I . THE PROBLEM Some T h e o r e tic a l C o n s id e ra tio n s R esearch R egarding th e S ch iz o p h re n o g en ic M other and O th er Fam ily C h a r a c t e r i s t ic s C o n clu sio n s from th e L i t e r a t u r e The P re s e n t Staidy M ajor H y p o th esis and R e la te d Q u estio n s T e s tin g M a te r ia l Used D e f in itio n s Some Very R ecen t F in d in g s D e lim ita tio n s o f th e Study O rg a n iz a tio n o f th e Study I I . REVIEW OF IMPORTANT RELATED LITERATURE . . . 22 D e f i c i t Theory S tu d ie s Symptoms o r B eh av io r P a tte r n S tu d ie s Case H is to ry o r L o n g itu d in a l S tu d ie s A C h a lle n g in g Study C o n clu sio n s I I I . SUBJECTS, SOURCES OF DATA, AND M ETHODS S e le c tio n o f Sample The Q u e stio n o f Sample S iz e A d m in is tra tio n o f T e s t M a te r ia l E v a lu a tio n o f th e In s tru m e n ts Used A C o n c rete Sample o f th e J u d g e 's Task The Check L i s t C hoice T echnique V a lid ity and R e l i a b i l i t y o f T e s ts Employed R e search R egarding TAT and S en ten ce C om pletion V a lid ity and R e l i a b i l i t y IV . ANALYSIS OF THE RESEARCH FINDINGS....................... 61 T a b u la tio n and P ro c e ssin g o f th e Raw D ata The H ypotheses and th e E x p erim e n tal OF PROCEDURE 43 R e s u lt s : G en eral a a XL C h ap ter Page The H ypotheses and th 8 E x p erim en tal R e s u lts : D e ta il Summary o f E x p erim e n ta l R e s u lts R e s u lts in R e la tio n to P u rp o ses o f th e S tudy V. SU M M A RY , CONCLUSIONS, AND RECOM M ENDATIONS . . 89 Summary C o n clu sio n s Recomm endations f o r F u rth e r Study BIBLIOGRAPHY............................................................ 110 iii LIST OF TABLES T ab le Page 1 . A n a ly sis o f V a ria n c e , Q u estio n 1: A n x iety in S chool S itu a tio n s ............................ 67 2 . A n a ly s is o f V a ria n c e , Q u estio n 2: D ep ressio n in S chool S itu a tio n s ........................ 69 3 . A n a ly s is o f V a ria n c e , Q u estio n 3: F e e lin g o f I s o l a t i o n in S chool S itu a t io n s . 71 4 . A n a ly s is o f V a ria n c e , Q u estio n 4 : P e rc e p tio n o f T each ers a s R e je c tin g , H o s tile , D om ineering, o r O v e rp ro te c tin g P a re n t F i g u r e s ................................ 73 5 . A n a ly sis o f V a ria n c e , Q u e stio n 5: F e e lin g s o f Inadequacy R egarding S chool A c h ie v e m e n t........................................... 75 6 . A n a ly s is o f V a ria n c e , Q u estio n 6: Poor Academic M o tiv a tio n ................... 76 7 . A n a ly sis o f V a ria n c e , Q u estio n 7: F e e lin g s o f A g g ressio n in School S i t u a t i o n s ...................................................... . . . 78 8 . A n a ly s is o f V a ria n c e , Q u estio n 8: F a n ta sy and Lack o f C o n c e n tra tio n in S chool .............................................. 80 9 . A n a ly sis o f V a ria n c e , Q u estio n 9: S ex u al A djustm ent P r o b l e m s ................................. 82 1 0 . A n a ly sis o f V a ria n c e , Q u estio n 10: D is lik e o f S chool .......................................... 84 1 1 . Mean R a tin g s and D iffe re n c e s Between th e Mean R a tin g s , P a t i e n t and C o n tro l G roups, Q u e stio n s 1 - 1 0 ............................................................. 87 iv CHAPTER I THE PROBLEM I t i s s e l f e v id e n t t h a t sc h o o l i s th e p la c e in w hich m ost a d u lts have s p e n t a s i g n i f i c a n t p o r tio n o f t h e i r e a r ly y e a r s . T hus, in th e fo rm a tiv e y e a r s , th e e d u c a tio n a l system i s an im p o rta n t en v iro n m en t, p e rh a p s second o n ly to t h a t o f th e fa m ily . The r e s e a r c h done w ith re g a rd to th e im p act o f th e sc h o o l m ilie u on p e r s o n a lity developm ent i s th u s f a r v ery s m a ll. A ttem p ts to e v a lu a te th e e f f e c t o f th e e d u c a tio n a l system on th o s e who in l a t e r l i f e e x p e rie n c e d m en tal b re a k downs a r e e s p e c i a lly ru d im e n ta ry . T h is stu d y d e a ls w ith s c h iz o p h re n ia , th e m ost p r e v a le n t ty p e o f m e n tal i l l n e s s . Some T h e o r e tic a l C o n s id e ra tio n s T hat th e r e a re many and d iv e rs e th e o r ie s w hich claim to a c co u n t f o r th e e tio lo g y and developm ent o f s c h iz o p h re n ia i s a w id ely known f a c t . Even a sim p le p e r u s in g o f two com prehensive su rv e y s o f th e f i e l d , one by B e lia k (1 9 5 8 ), th e o th e r by Jack so n (1 9 6 0 ), r e v e a ls num erous fram es o f r e f e r e n c e . T hese, o f c o u rs e , in c lu d e o r g a n ic , n e u r o - p h y s io lo g ic a l, p h y s io lo g ic a l and b io c h e m ic a l 1 p o in ts o f v ie w , a s w e ll a s th e p s y c h o lo g ic a l a p p ro a c h . W e have b een co n c ern ed h e r e in o n ly w ith c e r t a i n p ro m in e n t f u n c tio n a l i n t e r p r e t a t i o n s . B le u le r (1934) was dmong th e f i r s t to p o s tu l a t e p sy c h o g e n ic f a c t o r s . He was in f lu e n c e d by th e n o tio n s o f a s s o c i a t io n p sy ch o lo g y a s w e ll a s by F r e u d 's e a r l y w ork. He a t t r i b u t e d th e s o - c a l l e d " s p l i t " betw een i n t e l l e c t and a f f e c t in th e s c h iz o p h re n ic to th e lo o s e n in g o f a s s o c ia t i o n s in th e th in k in g p r o c e s s e s . In c o n t r a d i s t i n c t i o n to K ra e p e lin , he d e n ie d t h a t t h i s " s p l i t , " w hich seems to g iv e th e im p re s s io n o f d e m e n tia , was th e same a s th e " tr u e " d em en tia se en in some o r g a n ic s . R a th e r, r e d u c tio n in w hat h e term ed " a s s o c i a tio n te n s io n " was th e re a s o n f o r im p a ir m ent in memory, p e r c e p tio n , o r i e n t a t i o n , and s e n s a ti o n , in th e s c h iz o p h r e n ic . From th e F re u d ia n p s y c h o a n a ly tic p o in t o f v iew , s c h iz o p h re n ia i s lo o k ed upon a s a r e g r e s s io n to i n f a n t i l e l e v e l s o f f u n c tio n in g . E s p e c ia lly em phasized i s th e r e t u r n to th e s o - c a l le d n a r c i s s i s t i c s ta g e , when p resu m ab ly th e human o rg an ism i s unaw are o f th e s e p a r a tio n o f th e s e l f from th e " n o t s e l f , " and l i b i d o i s l a r g e ly i n t e r n a l l y d i r e c t e d . F e n ic h e l (1945) m a in ta in e d t h a t i n s c h iz o p h re n ia th e r e i s a c o lla p s e o f r e a l i t y t e s t i n g , t h a t fu n d a m e n ta l f u n c tio n o f th e eg o . T h is am ounts to a s e v e re d is r u p tio n o f th e p e r s o n a l i t y . I t can lik e w is e be i n t e r p r e t e d a s a r e t u r n to th e tim e when th e ego was n o t y e t e s ta b lis h e d o r had j u s t begun to be e s ta b li s h e d . W ith in t h i s fram ew ork, an A c h ille s ' h e e l a c tin g o f te n a s a p r e c i p i t a t i n g f a c t o r i s s tro n g c o n f l i c t and am b iv alen ce in p sy c h o se x u a l i d e n t i f i c a t i o n . Jung (1936) c r e a te d th e c o n c ep t o f au to ch th o n o u s th in k in g a s a b a s is f o r th e u n d e rs ta n d in g o f s c h iz o p h re n ia . By t h i s he r e f e r r e d to g ro u p s o f id e a s c lo s e ly a s s o c ia te d w ith d is tu r b in g em o tio n a l e x p e rie n c e s . T hese id e a s became removed from c o n s c io u sn e ss and m a in ta in e d a more o r l e s s in d e p e n d e n t e x is te n c e . A c u r r e n t em o tio n a l im p act resem b lin g th e o r ig i n a l may b e s e v e r e ly f e l t by an i n d iv i d u a l. When t h i s o c c u rs , r e l a t e d id e a c l u s t e r s e r u p t in to aw are n e s s . T hese i n t e r f e r e w ith norm al th in k in g and i n t e l l e c t u a l f u n c tio n in g . Meyer (1910, 1912) d e c la re d t h a t th e c a u se s o f s c h iz o p h re n ia w ere to b e found in a f a u l t y s o c i a l a d j u s t m ent to l i f e ' s dem ands. I t was m ost l i k e l y to o c c u r in in d iv id u a ls who have d ev elo p ed a s " te n s e , w ithdraw n, o r s h u t in p e r s o n s ." In such in d iv id u a ls , th in k in g i s c h a r a c te r iz e d by a u t i s t i c f a n t a s i e s and a m b itio n s , w ith i n a d e q u a te ac h iev e m en t. The a c tu a l g ro s s symptoms a r e seen a s an o u tg ro w th o f f a u l t y liv i n g h a b i t s . T hese o f c o u rse o cc u r in n o rm als a s w e ll, to a l e s s e r d e g re e . Cameron (1947, 1951, 1963) d ev elo p ed and c a r r ie d f a r t h e r a v ie w p o in t w hich has some o f i t s r o o ts in M e y er's ap p ro a c h . He d ev elo p ed th e id e a o f f a u lty h a b i t fo rm a tio n in to w hat he r e f e r s to a s s o c ia l d i s a r t i c u l a t i o n . T h is i s th e param ount c o n d itio n in s c h iz o p h re n ia . By t h i s , h e means t h a t b ec a u se o f th e c u m u lativ e re p la c e m e n t o f norm al com m unication by p r i v a t e f a n ta s y , s c h iz o p h re n ic s have been u n a b le to e s t a b l i s h th em selv es f irm ly in th e c u l t u r a l p a t t e r n . A d e f ic ie n c y in r o le - ta k in g s k i l l s h as been a r e l a t e d co n seq u en ce. Cameron makes no s e p a r a tio n betw een th in k in g and lan g u ag e b e h a v io r. In th e d e v e lo p in g c h i l d , lan g u ag e o r g a n iz a tio n i s d ete rm in e d by th e en v iro n m e n t. Out o f lan g u ag e p r o g re s s io n , th in k in g becom es in c r e a s in g ly s o c i a l iz e d . To m a in ta in th o u g h t and lan g u ag e a t a le v e l n e c e s s a ry f o r a d e q u a te com m unication, c o n tin u o u s re in fo rc e m e n t i s r e q u ir e d . T hus, s c h iz o p h re n ia i s a c o n d itio n r e s u l t i n g from th e crow ding o u t by fa n ta s y o f s o c ia li z e d communica t i o n . In th e p r o c e s s , t h i s v e ry fa n ta s y i t s e l f te n d s to become d e c re a s in g ly r e l a t e d to , and in flu e n c e d by, p r e v a i l in g s o c ia l p a t t e r n s . S u lliv a n (1953, 1956) lik e w is e lo o k ed upon s c h iz o p h re n ia a s a d is o r d e r i n p e rs o n a l l i v i n g . He p la c e d s tro n g em phasis on in te r p e r s o n a l, fa m ily r e l a t i o n s h i p s . In t h i s c o n te x t, he s t r e s s e d th o s e e a r ly i n t e r a c t i o n s betw een th e c h ild and th e a d u lts im p o rta n t to h is p h y s ic a l and e m o tio n a l w e ll b e in g . Out o f th e s e e n c o u n te rs th e " s e l f sy stem " d e v e lo p s . The l a t t e r i s c o n s tru c te d from r e f l e c t e d p e r s o n a l a p p r a i s a l s . Thus, i t i s lo o k ed upon a s an em er g e n t sy stem , th e s e l f sy stem , w hich though n e v e r f u l l y e n com passing th e p e r s o n a lity , r e p r e s e n ts th o s e en d u rin g p a t te r n s o f s o c ia l i n t e r a c t i o n w hich e lim in a te a n x ie ty , i . e . , m a in ta in o n e 's s e l f sy stem . Thus i n s c h iz o p h re n ia th e s e l f system i s p o o rly d e v e lo p e d . Under heavy em o tio n a l s t r e s s , i t c e a s e s to m a in ta in i t s f u n c tio n a l u n ity w ith th e p e r s o n a l i t y . The in d iv id u a l i s lik e w is e u n a b le to e x p e rie n c e o th e r p eo p le w ith o u t in te n s e a n x ie ty . In r e c e n t y e a r s , e s p e c i a lly in European p s y c h ia tr y , b u t in c r e a s in g ly to o in th e U n ite d S t a t e s , a q u a s i- p h ilo s o p h ic a l, e x i s t e n t i a l v ie w p o in t h a s been a p p lie d to th e problem o f s c h iz o p h re n ia . S e v e ra l e x i s t e n t i a l th e r a p i s t s o f re p u te p o in t up th e fo llo w in g c o n c e p ts in t h e i r ap p ro ach to th e p ro b lem . 1 . S to rc k (1947, 1959) se e s th e b a s ic d is tu rb a n c e a s a lo s s o f a se n se o f p e rs o n a l e x is te n c e . 2 . B insw anger (1 9 4 5 ), from an u n u s u a lly d e t a il e d stu d y on a s in g le c a s e , em phasizes t h a t th e p a t i e n t was a t te m p tin g to com pensate f o r a f e e lin g o f a lo s s o f b e in g , th ro u g h d i s t o r t e d c o n c e p ts and d e lu s io n s . 3 . F ra n k l (1955) r e f e r s to id e a s o f r e f e r e n c e and a l i e n in f lu e n c e a s ’’e x i s t e n t i a l p a s s i v iz in g ’’ and " th e e x p e r ie n c e o f p u re o b j e c t n e s s .” In s c h iz o p h r e n ia , th e ego i s s a i d to be a f f e c t e d b o th "qua c o n s c io u s n e s s and qua re s p o n s i b i l i t y . " Thus th e s c h iz o p h re n ic e x p e rie n c e s h im s e lf a s / so lim ite d i n h i s f u l l h u m a n ity , t h a t h e can no lo n g e r f e e l h im s e lf as r e a l l y e x i s t e n t . 4 . Duss (1948) c o n te n d s t h a t h e r p a t i e n t had b e come s c h iz o p h re n ic b e c a u se o f t e s t i n g to th e l i m i t th e t h e s i s o f t o t a l r e s p o n s i b i l i t y in a w o rld w ith o u t norm s o r v a l u e s . B oth Cameron an d S u lliv a n have p la c e d m ore em phasis on t h e im p o rta n ce o f s o c i o - c u l t u r a l i n t e r a c t i o n m a tric e s in th e e tio lo g y o f s c h iz o p h re n ia th a n d id c l a s s i c a l F re u d ia n - ism , w hich was more b i o l o g i c a l l y o r ie n te d . P erh ap s th e e x i s t e n t i a l i s t s , p a r t i c u l a r l y i n th e w r i tin g s o f D uss, have gone f a r t h e s t o f a l l i n t h i s d i r e c t i o n . E s p e c ia lly b ro a d and a lm o st a l l - i n c l u s i v e i s th e id e a t h a t th e p a t i e n t b e came s c h iz o p h re n ic "b e c a u se o f t e s t i n g to th e l i m i t th e t h e s i s o f t o t a l r e s p o n s i b i l i t y i n a w o rld w ith o u t norms o r v a l u e s ." B ut even in th e l a t t e r c o n te n tio n i t i s f e l t t h a t t h e r e i s a n e e d f o r m ore c o n c re te d e s c r ip tio n and d e l i m i t a t i o n , i f h y p o th e se s and v a r ia b l e s t h a t le n d th e m se lv e s to t e s t i n g and r e s e a r c h a r e to be g ra s p e d . I t i s s i m i l a r l y f e l t t h a t C am eron's c o n c e p t o f s o c i a l d i s a r t i c u l a t i o n i s to o g lo b a l. D i s a r t i c u l a t i o n from w hat s o c i a l m ilie u ? What a r e i t s p a ra m e te rs and how does one d e s c r ib e i t so t h a t i t becomes more p a lp a b le ? Cameron w ent p e rh a p s f a r t h e s t o f a l l th e th e o r e t i c i a n s when he s ta t e d t h a t th in k in g ca n n o t be s e p a ra te d from lan g u ag e b e h a v io r. Thus i t i s f e l t t h a t th e im p act o f th e sc h o o l en v iro n m en t c a n n o t be d e n ie d a p la c e , in i t s own r i g h t , as a p o t e n t i a l e t i o l o g i c a l m a trix f o r s c h iz o p h re n ia . The is s u e t h a t i s h e re r a i s e d i s , in o th e r w ords: i s i t n o t q u ite p o s s ib le , t h a t en v iro n m en ts o th e r th an th e fa m ily , qua fa m ily , o r th e presum ed s c h iz o - p h ren o g en ic m o th er, qua sc h iz o p h re n o g e n ic m o th er, m ight c o n ta in im p o rta n t c o n tr ib u to r y f a c t o r s in th e e tio lo g y o f s c h iz o p h re n ia ? R esearch R eg ard in g th e S ch izo p h ren o g en ic M other and O th er Fam ily 'C h a r a c te r is tic s R egarding th e c o n c e p t o f th e " sc h iz o p h re n o g e n ic " m o th er, some r e c e n t r e s e a r c h c a s ts c o n s id e ra b le d o u b t on t h i s s in g l e , m ost w id e ly a c c e p te d p s y c h o lo g ic a l e t i o l o g i c a l f a c t o r in sc h iz o p h re n ia .'* ’ As th e term has been u se d , th e m others o f s c h iz o p h re n ic s a re c o n s id e re d to have been o v e r- p r o te c tiv e and som etim es r e j e c t i n g , d o m in eerin g and ag g r e s s i v e . The f a t h e r has u s u a lly been d e s c rib e d a s weak, su b m issiv e , i n d i f f e r e n t , n e g lig e n t o r p a s s iv e . Two s tu d ie s ■ 1 -T h e word " sc h iz o p h re n o g e n ic " was c o in e d by F. Fromm Reichmann (1 9 4 8 ). The l a b e l h a s r a r e l y been a p p lie d to th e f a t h e r . c o n t r a d ic t th e a fo re m e n tio n e d id e a . P o in te d up in them as w e ll, i s th e in c o n s is te n c y t h a t c h a r a c te r iz e s r e s e a r c h l i t e r a t u r e on th e fa m ily en v iro n m en t and s c h iz o p h re n ia . H o tc h k iss (1 9 5 5 ), stu d y in g th e m o th ers o f s c h iz o p h re n ic p a t i e n t s a t th e M a ssa c h u se tts M ental H e a lth C e n te r, found t h a t o n ly th r e e had th e c h a r a c t e r i s t i c s o f th e " s c h iz o p h re n o g e n ic " m o th e r. He su g g e ste d t h a t th e c o n c e p t, r a t h e r th a n r e p r e s e n tin g a co m p o site p i c t u r e o f m o th ers o f s c h iz o p h re n ic p a t i e n t s , was p ro b a b ly d e riv e d from th e m ost g la r in g exam ples o f b e h a v io r o f a few . S tu d y in g th e f a t h e r ty p e t h a t a lle g e d ly goes w ith th e sc h iz o p h re n o g e n ic m o th er, a s d e s c rib e d above, F razee (1953) co n clu d ed t h a t "Many o f th e f a t h e r s w ere s e v e re ly c r u e l and r e j e c t i n g and th e r e was no su p p o rt f o r th e e x p e c ta tio n s o f th e p a s s iv e , i n e f f e c t u a l f a th e r g e n e r a lly assum ed in th e l i t e r a t u r e . " She had s tu d ie d th e re c o rd s o f tw en ty -tw o c h ild r e n who, when in s c h o o l, had been r e f e r r e d to th e I n s t i t u t e o f J u v e n ile R esearch in C h ica g o . They s u b se q u e n tly had become s c h iz o p h re n ic . Sanua (1961) in re v ie w in g p e r t i n e n t r e s e a rc h s tr o n g ly s u g g e s ts t h a t th e r e s u l t s o f b o th th e F ra zee and H o tc h k iss s tu d ie s may be due to th e f a c t t h a t th e f a m ilie s o f th e p a t i e n t s in v o lv e d w ere la r g e ly from th e w orking c l a s s . In e a r l i e r s tu d i e s , and in Fromm- R eichm ann's i n i t i a l c o n c e p tu a liz a tio n o f th e " s c h iz o p h re n o g e n ic " m o th er, p a t i e n t s were from m iddle and u p p er 9 c l a s s f a m il ie s . Sanua c i t e s a few s t u d i e s , in t h i s re g a rd , t h a t a tte m p te d to c o n tr o l on s o c i a l c l a s s a n d /o r e t h n ic i ty and r e l i g i o n . *1. B a rrab e e and Von M ering (1953) s tu d ie d s ix t y - n in e s c h iz o p h r e n ic s , m ale and fe m a le , o f P r o te s ta n t, Je w ish , I r i s h and I t a l i a n f a m il ie s . The a u th o rs were m ainly i n t e r e s t e d in th e w h ite P r o t e s t a n t , or. "Y ankee," f a m ily . (a) In th e w h ite P r o t e s t a n t fa m ily p o s itiv e a f f e c t i o n i s p r e s e n t b u t th e r e i s a pronounced tendency n o t to d is p la y i t . (b) S ib lin g s in such f a m ilie s seem to com pete s tr o n g ly f o r p a r e n t a l a f f e c t i o n . (c) The c h i l d seems s a t i s f i e d w ith i n d i r e c t sam ples o f lo v e r a t h e r th a n e x p e c tin g i t more d i r e c t l y . (d) The w h ite P r o te s ta n t m other may w ithdraw lo v e as a way o f p u n is h in g m oral t r a n s g r e s s io n s . (The a u th o rs co n ten d t h a t t h i s d i f f e r s from th e b e h a v io r o f Jew ish m o th ers o f s c h iz o p h re n ic p a t i e n t s . ) C h ild re n in such f a m ilie s have a h ig h d eg ree o f g u i l t and s tro n g f e e lin g s o f in a d eq u ac y . (e) The w h ite P r o te s ta n t f a th e r i s n o t domi n a n t. He u s e s l i t t l e p h y s ic a l p u n ish m en t. A w eakness in th e B arab ee, Von W ehring .stu d y i s , o f c o u rs e , th e f a i l u r e to c o n tro l f o r s o c ia l c l a s s f a c t o r s . 10 M eyers and R o b e rts (1959) c o n tr o lle d a d e q u a te ly f o r s o c i a l c l a s s , b u t n o t f o r e t h n i c i t y and r e l i g i o n . They d iv id e d t h e i r p o p u la tio n sam p lin g s a c c o rd in g to th e o p e ra t i o n a l s o c ia l c la s s in d e x f i r s t d ev elo p ed by A. B. H ol- lin g s h e a d (1 9 5 8 ). T hese c l a s s e s th e y d e s c rib e b r i e f l y as fo llo w s : 1 . C la ss I c o n ta in e d 3 p e r c e n t o f th e g r e a t e r New Haven p o p u la tio n . I t i s composed o f th e v e ry w e a lth i e s t f a m il ie s , w ith m ost o f th e le a d e r s in th e com m unity's b u s in e s s and p r o f e s s io n a l p u r s u i t s . A lm ost a l l G e n tile f a m ilie s in t h i s group a r e l i s t e d in th e New Haven S o c ia l D ir e c to r y . Few Je w ish f a m ilie s w ith th e same p o s it io n a r e so l i s t e d . 2 . C la ss I I — a lm o st a l l in t h i s c la s s a r e c o lle g e g r a d u a te s ; th e y h o ld h ig h m a n a g e ria l p o s it i o n s , o r a r e en gag ed in th e le s s e r - r a n k in g p r o f e s s io n s . These f a m ilie s , co m p risin g 9 p e r c e n t o f th e com munity, a r e r e l a t i v e l y w e ll- to - d o , b u t l i t t l e o f th e w e a lth i s s u b s t a n t i a l l y i n h e r it e d o r a c q u ire d . About 5 p e r c e n t o f th e s e a r e l i s t e d in th e New Haven S o c ia l D ir e c to r y . 3 . C la ss I I I - - 2 1 p e r c e n t o f th e community p o p u la t i o n f a l l i n t h i s c l a s s . I t in c lu d e s th e v a s t m a jo rity o f s m a ll p r o p r i e t o r s , w h ite - c o lla r , o f f i c e , and s a le s w o rk ers, and a c o n s id e ra b le number o f s k i l l e d m anual w o rk e rs . T h e ir s o c i a l l i f e te n d s to b e c o n c e n tra te d in th e fa m ily , th e c h u rc h , and th e lo d g e . 4 . C la s s I V - - th is group c o n s i s t s m a in ly o f sem i s k i l l e d f a c to ry w o rk ers. The group co m p rises 49 p e r c e n t o f th e community p o p u la tio n . S o c ia l l i f e i s c e n te re d in th e n eig h b o rh o o d , th e fa m ily , th e u n io n , and p u b lic p la c e s . 5 . C la s s V—t h i s group i s com prised overw helm ingly o f s e m i- s k ille d fa c to ry w o rk e rs and u n s k ille d la b o r e r s . M ost o f th e a d u l ts in t h i s group h av e n o t com pleted p u b lic s c h o o l. T h is gro u p co m p rises 18 p e r c e n t o f th e p o p u la t i o n and o n ly a sm a ll m in o rity b e lo n g to community i n s t i t u t i o n s . T h e ir s o c ia l l i f e ta k es p la c e in th e fa m ily f l a t , on th e s t r e e t , o r in a n eig h b o rh o o d s o c ia l ag en cy . T h e ir stu d y had as i t s g o a l th e q u e s tio n o f fin d in g o u t w h eth er s o c i a l and psychodynam ic f a c t o r s in th e developm ent o f s c h iz o p h re n ia w ere r e l a t e d to a p a t i e n t 's p o s it io n i n th e s o c ia l c l a s s s t r u c t u r e o f Am erican s o c ie ty . C o n tra s tin g m id d le and lo w e r-c la s s f a m ilie s e s p e c i a lly , th e a u th o rs found th e fo llo w in g v a r ia b le s more p r e v a le n t i n th e fa m i l i e s o f C lass V p a t i e n t s , when com pared to f a m ilie s o f C la ss I I I p a t i e n t s : (a) g e n e r a l d is o r g a n iz a tio n o f th e home; (b) la c k o f p a r e n ta l a f f e c t i o n , g u id an ce and c o n t r o l; (c) i s o l a t i o n o f th e f a th e r from th e fa m ily ; (d) heavy r e s p o n s i b i l i t y o f th e m other in th e fa m ily ; (e ) re s p o n s i b i l i t y o f s i b l in g s in th e c h i ld - r e a r i n g p r o c e s s ; and ( f ) h a rs h b u t in c o n s is te n t p u n ish m en t. 12 C o n c lu sio n s from th e L i t e r a t u r e Sanua sum m arizes from th e a fo re m e n tio n e d s tu d ie s a s w e ll a s from s e v e r a l o f h i s own in w hich he c o n t r o l l e d f o r s o c i a l c l a s s , e t h n i c i t y , and r e l i g i o n , t h a t I t i s n o t s u r p r is in g t h a t v e ry l i t t l e ag reem en t was found among a l l o f th e s tu d ie s w hich t r i e d to f in d a common p a t t e r n among s c h iz o p h re n ic f a m i l i e s . The p a t t e r n s w hich w ere found in many e a r ly s tu d ie s w ere u n q u e s tio n a b ly in f lu e n c e d by th e norm s o f th e c l a s s o r c u l t u r e o f w hich th e p a t i e n t was a member, and th e s e norm s may, in tu r n , have a f f e c t e d th e n a tu r e o f an y p a th o lo g ic r e l a t i o n s h i p w hich s u b s e q u e n tly d e v e lo p ed in th e f a m ily . (Sanua, 1965:58) T h u s, th e r e i s e v id e n c e in d ic a t in g t h a t m ilie u s b ro a d e r th a n , and a p a r t from s t r i c t l y i n t e r n a l fa m ily r e l a t i o n s h i p s , i . e . , s o c i a l c l a s s , e t h n i c i t y , r e l i g i o n , may have an im p o rta n t b e a rin g on th e shape and s u b s ta n c e o f f a m i l i a l dynam ics in r e l a t i o n to th e e t io lo g y o f s c h iz o p h r e n ia . Why n o t th e n th e sc h o o l? F o r no one would q u e s t i o n i t s p ro fo u n d im p a c t and in f lu e n c e on th e e a r ly sh a p in g o f p e r s o n a l i t y . The P re s e n t S tudy An e x p lo ra to ry a tte m p t h as been made in t h i s r e s e a r c h to e s t a b l i s h : 1 . W hether o r n o t a d u lt s c h iz o p h re n ic s had p e r c e iv e d , and i n t e r a c t e d w ith , t h e i r e a r l i e r S chool e n v iro n m ent in a q u a l i t a t i v e l y d i f f e r e n t way from n o rm al a d u l t s . The p r e d i c t i o n was t h a t th e y so d id . T h is p r e d ic ti o n from th e b ro ad t h e o r e t i c a l fram es o f r e f e r e n c e r e g a rd in g th e 13 * n a tu r e o f s c h iz o p h re n ia in w hich c o n te x t c e r t a i n a s p e c ts o f b e h a v io r and th in k in g w ould show m e a su ra b le d if f e r e n c e s b e f o r e th e a c tu a l o n s e t o f p sy c h o se s. 2 . Ten im p o rta n t dynam ic o r a t t i t u d i n a l f o c i were c o n s id e re d . Each a t t i t u d e was s t a t e d as a q u e s tio n which ask ed "D id th e s c h iz o p h re n ic s d i f f e r from th e n o rm als in a s i g n i f i c a n t way?" I t was a g a in p r e d ic te d t h a t th e y w ould. The r e s e a r c h was c a r r i e d o u t by means o f th e p ro j e c t i v e e x a m in a tio n o f s c h iz o p h re n ic in d iv id u a ls now no lo n g e r a c t i v e l y p s y c h o tic , c o n tr a s te d w ith a sam ple o f norm al i n d iv id u a ls , and c o m p a ra tiv e ly e v a lu a tin g t h e i r r e a c t i o n s . In t h i s way, i t was f e l t t h a t some p ro g re s s in th e u n d e rs ta n d in g o f th e s c h iz o p h re n ic and h i s e d u c a tio n a l h i s t o r y c o u ld be made. However, i t was n o t in te n d e d t h a t t h i s stu d y a tte m p t to u n ta n g le e t i o l o g i c a l o r c a u s a l i t y f a c t o r s . R a th e r, i t was b e lie v e d th e stu d y m ight make a c o n tr ib u tio n tow ard an u n d e rs ta n d in g o f th e dynam ic r e la t i o n s h i p betw een a d u lt m e n tal p a t i e n t s and a s p e c ts o f th e sc h o o l en v iro n m e n t. M ajor H y p o th esis and R e la te d Q u e stio n s The m ajor h y p o th e s is p o s tu la te d t h a t th e r e was a m easu rab le and s i g n i f i c a n t d if f e r e n c e betw een th e dynam ics o f h o s p it a li z e d a d u l ts and n o rm als, when c o n fro n te d w ith , and i n t e r a c t i n g w ith , r e p r e s e n ta ti v e s o f sc h o o l l i f e situ -: a t i o n s . A gain, from t h e o r e t i c a l c o n s id e r a tio n s re g a rd in g 14 th e n a tu r e o f s c h iz o p h re n ia , i t was b e lie v e d th e p a t i e n t p o p u la tio n would ev id en ce n o te d ly p o o re r human r e l a t i o n s h ip s th a n th e n o rm a ls, as r e f l e c t e d in t h e i r p e r c e p tio n s o f th e sc h o o l m ilie u * « In c o n n e c tio n w ith th e m ajo r h y p o th e s is , human r e l a t i o n s h i p s w ere t r a n s l a t e d in to th e fo llo w in g d im ensions f o r w hich answ ers w ere so u g h t: 1 . Were th e h o s p ita liz e d in d iv id u a ls s i g n i f i c a n t l y more an x io u s in sc h o o l th a n th e c o n tr o ls ? 2 . Were th e h o s p it a li z e d in d iv id u a ls s i g n i f i c a n t l y more d e p re s se d in sc h o o l th a n th e norm als? 3 . Did th e y ten d to f e e l more is o l a te d from t h e i r p e e rs and te a c h e rs th an th e norm als? 4 . Did th e y p e rc e iv e te a c h e r s to be r e j e c t i n g , h o s t i l e , d o m in eerin g , o r o v e r - p r o te c tin g m others o r f a t h e r s , more th a n th e n orm als d id ? 5 . Did th e y have m ore' f e e l in g s o f in ad eq u acy re g a rd in g th e p o s s i b i l i t y o f sc h o o l achievem ent th a n th e n orm als ? 6 . Were th e y more p o o rly m o tiv a te d , f e e l in g sc h o o l was an im posed c h o re , w ith o u t r e a l m eaning in term s o f t h e i r l i f e ’ s g o a ls , th a n w ith th e norm als? 7 . Did th e h o s p it a li z e d in d iv id u a ls e x p e rie n c e more w ra th , a n g e r, h o s t i l i t y , in th e sc h o o l en v iro n m en t, w h eth er e x p re sse d open o r n o t, th a n th e norm als? 15 8 . Were th e s c h iz o p h re n ic s more p re o c c u p ie d w ith f a n ta s y , m aking i t d i f f i c u l t to pay a t t e n t i o n o r to con c e n t r a t e , when compared w ith th e n o rm als? 9. Was p sy c h o sex u a l i d e n t i f i c a t i o n and h e te r o se x u a l s o c ia li z a t i o n more o f a problem f o r th e h o s p it a li z e d a d u lts th an f o r th e norm als? 10. Was sch o o l more s tr o n g ly d is l ik e d by th e h o s p it a li z e d in d iv id u a ls , p r a c t i c a l l y a n y th in g and e v e ry th in g ab o u t i t , th a n by th e norm als? T e s tin g M a te r ia l Used For th e p u rp o se o f t e s t i n g th e h y p o th e s is , and ob ta in in g answ ers to th e q u e s tio n s r e l a t e d to i t , two m o d ifi c a tio n s o f s ta n d a rd p r o je c tiv e t e s t s were c r e a te d and u se d . 1. An E d u c a tio n a l H is to ry S en ten ce C om pletion T e s t. The fo llo w in g a r e a few sam ple in co m p le te s e n te n c e s , in th e o rd e r in w hich th e y a p p e a r, o f a t o t a l o f tw en ty - e ig h t such s e n te n c e s . 1 . My te a c h e rs w ere . . . 3 . S tu d y in g a r ith m e tic and m athem atics . . . 8 . The women te a c h e rs I had . . . 14. The a r t c l a s s . . . 2 2 . The one th in g I can remember ab o u t sc h o o l . . . 2 . A b r i e f E d u c a tio n a l H is to ry Them atic A ppercep tio n T e s t. T h is was composed o f n in e p ic tu r e s o f classro o m and sc h o o l l i f e sc e n e s, p lu s th e b la n k c a rd o f th e s ta n d a rd TAT, making te n p la t e s in a l l . The n in e p ic tu r e s w ere tak en from v a rio u s m agazine p h o to g rap h s and e n la rg e d to th e 16 s iz e o f th e s ta n d a rd TAT p i c t u r e s . Both h o s p i t a l i z e d i n d iv id u a ls and n o rm als w ere ask ed to respond t o th e s e i n a m anner s im ila r to th e i n s t r u c t i o n s u se d in t h e s ta n d a rd a d m in is tr a tio n o f th e 1?AT. D e f in itio n s F or th e p u rp o se s o f t h i s s tu d y , dynam ics i s d e fin e d a s th e a t t i t u d e s o f h o s p i t a l i z e d s c h iz o p h r e n ic s and o f n o rm a ls , a s e x p re s s e d in th e re s p o n s e s to t h e two t e s t i n g d e v ic e s em ployed, to w ard s v a r io u s a s p e c ts o f sch o o l l i f e . T hese re s p o n s e s a r e a n a ly z e d as r e v e a lin g t h e i r p e rc e p tio n s --h o w sc h o o l a p p e a re d to them . 0 F o r th e p u rp o se s o f t h i s s tu d y , a s c h iz o p h r e n ic i s d e f in e d a s an in d iv id u a l so d ia g n o se d by th e h o s p i t a l s t a f f . F or th e p u rp o se s o f t h i s s tu d y , a n o rm a l s u b j e c t i s d e fin e d a s anyone whose h i s t o r y d o es n o t in c lu d e any h o s p i t a l i z a t i o n f o r m e n ta l i l l n e s s . Some V ery R ecen t F in d in g s A few s tu d i e s in r e c e n t y e a r s , though n o t done from an e s s e n t i a l l y dynam ic p o in t o f view , h a v e p o in te d up some i s s u e s w ith r e g a r d to th e s c h o o l y ears a n d l a t e r l i f e s c h iz o p h re n ic b reak d o w n s. Bower e t a l . (1960) and Bower (1960) drew th e fo llo w in g c o n c lu s io n s : 17 1 . P re -s c h iz o p h re n ic s te n d ed to be le s s w e ll lik e d by c la s s m a te s , were l e s s i n t e r e s t e d in t h e i r e n v iro n m en t, and p a id m arkedly l e s s a t t e n t i o n to th e oppo s i t e se x , th a n d id a c o n tr o l g ro u p . 2 . T here was l i t t l e d if f e r e n c e betw een th e two g ro u p s w ith r e s p e c t to o v e r t h o s t i l i t y , b u t th e s c h iz o p h re n ic s w ere more su b m issiv e , more h e s i t a n t , and l e s s sp o n tan eo u s in t h e i r b e h a v io r. 3 . The s c h iz o p h re n ic s w ere more an x io u s and d e p re sse d th a n th e c o n tr o ls . 4 . T h e •s c h iz o p h re n ic s f a i l e d s i g n i f i c a n t l y in com parison to th e c o n tr o l group in E n g lis h , s o c ia l s tu d ie s and m a th e m a tic s. T h e ir h ig h sc h o o l g ra d e -p o in t a v e ra g e was 2 .0 4 com pared w ith 2 .4 8 f o r th e c o n t r o ls . T h is d if f e r e n c e i s i n s u f f i c i e n t to re a c h a s i g n i f i c a n t d i f f e r ence l e v e l . 5 . They showed l e s s i n t e r e s t in s p o r ts and d ra m a tic s and d id l e s s w e ll in p h y s ic a l e d u c a tio n . Warnken (1958) drew th e fo llo w in g c o n c lu s io n s : 1 . Lower sch o o l m arks w ere o b ta in e d by th e s c h iz o p h re n ic s a t th e p rim a ry , in te r m e d ia te , and ju n io r h ig h sch o o l l e v e l s , to a s i g n i f i c a n t d e g re e . However, s i g n i f i c a n t d if f e r e n c e s w ere n o t found a t th e h ig h sc h o o l l e v e l . 2 . A lthough c o r r e la tio n s betw een i n t e l l i g e n c e t e s t s c o re s and academ ic g rad e a v e ra g e s w ere h ig h e r f o r th e c o n tr o ls a t a l l sch o o l l e v e l s , th ey w ere n o t 18 s i g n i f i c a n t l y s o . 3. More s c h iz o p h re n ic s dropped o u t o f sc h o o l, w ere r e ta r d e d , were in s p e c ia l c l a s s e s , and w ere a b s e n t w ith a g r e a t e r fre q u e n c y . 4 . S ig n if i c a n tl y few er s c h iz o p h re n ic s p a r t i c i p a te d in e x t r a - c u r r i c u l a r a c t i v i t i e s o f a l l k in d s e x c e p t th e g le e c lu b . C e rta in d e f i n i t i v e s ta te m e n ts made by W arnken, w ith a l l due r e s p e c t to th e many p o s i t i v e a s p e c ts o f h is p io n e e rin g w ork, a re open to d o u b t. Among th e s e a r e th e f o llo w in g : 1. B e tte r g ra d e s w ere o b ta in e d by th e s c h iz o p h re n ic s when com pared w ith th e c o n t r o l s , in non-academ ic s u b je c ts (m u sic, a r t , p h y s ic a l e d u c a tio n ) . (The Bower e t a l . stu d y found t h e i r p erfo rm an ce p o o re r in th e s e sub j e c t s . ) W amken a t t r i b u t e d t h i s ach iev em en t to b e h a v io r t h a t was l e s s d is r u p tiv e to c lassro o m m anagem ent, r a t h e r th a n to g r e a t e r s k i l l in th e s e a r e a s . T h is would s c a r c e ly a p p e a r to b e an ad eq u ate e x p la n a tio n o f th e f in d in g s . 2 . Wamken p o s tu la te d t h a t judgm ent and u n d e r s ta n d in g w ere v a r ia b le s o f m ajo r p r o p o rtio n in th e e tio lo g y o f s c h iz o p h re n ia . He th e n e q u a te d th e low er in t e l l i g e n c e t e s t sc o re s o f th e s c h iz o p h re n ic s w ith p o o re r judgm ent and u n d e rs ta n d in g . (W echsler s c o re a v e ra g e s : s c h iz o p h re n ic s 1 0 2 .3 , n orm als 1 0 8 .8 .) These d e f i c i t s , a c c o rd in g to 19 W am ken, make th e c r i s i s o f ev ery d a y l i v i n g i n t o l e r a b l e f o r some i n d i v i d u a l s . T hus, th e y a r e p re d is p o s e d to r e g r e s s io n and a p s y c h o tic b r e a k . I t i s u n w a rra n te d to assum e t h a t th e W e ch sler- B e lle v u e i s an a d e q u a te m easure o f such com plex f u n c tio n s a s ju d g m en t and u n d e r s ta n d in g . B ut even i f one a c c e p te d such an a s su m p tio n , i t i s d o u b tf u l t h a t a d if f e r e n c e o f a few p o in ts in a v e ra g e s c o re s w ould b e o f su ch c r i t i c a l im p o rta n ce in c o p in g w ith th e p ro b lem s o f ev ery d ay l i v i n g . P erh ap s even more im p o rta n t a r e th e v a r i a b le s n o t even m en tio n ed by W am ken, t h a t may be d e c is iv e when a few p o in ts o f d if f e r e n c e in s c o re a r e o b ta in e d . F or exam ple: who t e s t e d whom, an d w hat w ere th e e f f e c t s o f d i f f e r e n t r a p p o r t c o n d itio n s such as mood, p h y s ic a l s t a t u s , th e q u a l i t y o f th e c la ssro o m s u rro u n d in g s , e t c e te r a ? A stu d y by W ittm an and S te in b e rg (1945) r a i s e s w arning s ig n a ls r e g a r d in g th e I . Q . , s c h iz o p h re n ia , and r e f e r r a l f o r e v a lu a tio n . C o n cern in g a group in whic h th e_ I.Q . ra n g e was from 123 to 163, th e y d is c o v e re d t h a t 50 p e r c e n t o f th e r e f e r r a l s had been f o r r e t a r d a t i o n o r s u s p e c te d m e n tal d e f ic ie n c y . In a r e l a t e d stu d y by Knehr (1 9 6 2 ), tw e n ty -f iv e s c h iz o p h re n ic s and a m atched c o n t r o l group o f tw e n ty -f iv e norm als w ere s tu d i e d . A b a t t e r y o f t e s t s to m easure th e b a s ic c o g n itiv e d im en sio n s p o s tu l a te d by Spearm an was u s e d . 20 When com pared, th e p a t i e n t s e v id en ce d l i t t l e o r no im p a ir m en t.1 None o f th e o b se rv ed d if f e r e n c e s reac h ed a s a t i s f a c to r y l e v e l o f s ig n if ic a n c e . The a u th o r h y p o th e siz e d t h a t th e a p p a re n t in c o n s is te n c y betw een th e in f e r e n c e ab o u t a b i l i t y made from p sy c h o p ath o lo g y and th e o b serv ed p e r form ance on e x p e rim e n ta l t e s t s i s a t t r i b u t a b l e to m o tiv a t i o n a l f a c t o r s . He f u r t h e r p o s tu la te d t h a t in some p r e v io u s r e p o r ts i t i s l i k e l y t h a t th e c o n ta m in a tin g f a c t o r o f c e r e b r a l damage may ac co u n t f o r th e im p airm en t p r e sumed to be a r e s u l t o f s c h iz o p h re n ia . D e lim ita tio n s o f th e S tudy In t h i s s tu d y , a lim ite d sam ple o f i n s t i t u t i o n a l iz e d m e n ta lly i l l a d u l ts was s tu d ie d re g a rd in g t h e i r c u r r e n t p e r c e p tio n s o f th e sch o o l en v iro n m en t, alo n g c e r t a i n a t t i t u d i n a l d im e n s io n s . No m a te r ia l a b o u t t h e i r a c tu a l sc h o o l l i f e c a r e e r s i s in c lu d e d . These p e r c e p tio n s were com pared w ith th o se o f a s im ila r ly lim ite d sam pling o f norm al a d u l t s . O rg a n iz a tio n o f th e S tudy The rem ain d er o f t h i s d i s s e r t a t i o n i s o rg a n iz e d as fo llo w s : C h a p ter I I i s a rev iew o f r e l a t e d l i t e r a t u r e . C h a p te r I I I c o n ta in s a d is c u s s io n o f th e s u b je c ts , sam p lin g , and m ethods o f p ro c e d u re . C h a p ter IV c o n ta in s an a n a ly s is o f th e r e s e a r c h f in d in g s and t h e i r im p l ic a tio n s . C h a p te r V c o n s i s t s o f th e summary and c o n c lu s io n s . CHAPTER IX REVIEW OF IMPORTANT RELATED LITERATURE The p r e s e n t stu d y d e a l t e x c lu s iv e ly w ith a s p e c ts o f m en tal h e a lth s t a t u s in r e l a t i o n to th e sch o o l m ilie u . T h e re fo re o n ly s tu d ie s in w hich some f a c e t o f th e ed u c a t i o n a l sy stem was g iv e n e x p l i c i t c o n s id e r a tio n a re i n c lu d e d in t h i s c h a p te r . From th e s ta n d p o in t o f t h e i r b a s ic o r i e n t a t i o n , su ch s tu d ie s group th em selv es e s s e n t i a l l y i n to fo u r k i n d s . I t m ust be n o te d , how ever, t h a t some f e a tu r e s o f a few su ch s tu d ie s a re by no means c o m p le te ly encom passed by th e one g ro u p in g . The fo u r g ro u p s a re as fo llo w s : 1 . D e f ic i t th e o ry s t u d i e s . --T h is ty p e o f stu d y i s b a s e d on th e h y p o th e s is t h a t s c h iz o p h re n ic s , when com pared w ith n o rm als, w i l l be found d e f i c i e n t in c e r t a i n b a s ic a b i l i t i e s . The a re a s in w hich th e y a r e d e f i c i e n t a r e presum ed to b e o f some e t i o l o g i c a l s ig n i f ic a n c e . In t h i s ty p e o f r e s e a r c h th e r e has been a s e a rc h to f in d s i g n i f i c a n t d if f e r e n c e s , e i t h e r b e fo re o r even d u rin g th e p sy c h o t i c p e r io d , betw een s c h iz o p h re n ic s and n o rm a ls, along c e r t a i n p erfo rm an ce d im ensions such as I .Q ., g rad e p o in t a v e ra g e , c o u rs e s in w hich th e b e s t g ra d e s w ere a c h ie v e d , e t c e t e r a . Some d e f i c i t th e o ry s tu d ie s a ls o in c o r p o r a te a 22 23 co m p ariso n o f m e n ta l h e a l th a t t i t u d e s i n th e sc h o o l co n t e x t . 2 . Symptom or. b e h a v io r p a t t e r n s t u d i e s . - - I n su ch s tu d i e s an a tte m p t i s made to d is c o v e r i f c e r t a i n symptoms o r b e h a v io r p a t t e r n s a r e s i g n i f i c a n t l y d i f f e r e n t in n o rm a ls and th o s e who l a t e r become s c h iz o p h r e n ic s . In one such s tu d y , i t was co n c lu d ed t h a t c e r t a i n b e h a v io r p a t t e r n s w ere p r e d i c t i v e o f l a t e r m e n ta l i l l n e s s . 3 . C ase h i s t o r y o r l o n g it u d in a l s t u d i e s . 4 . C h a lle n g in g s t u d i e s . - - I n t h i s ty p e o f r e s e a r c h th e c o n c lu s io n c h a lle n g e s a lr e a d y a c c e p te d n o tio n s ' r e g a rd in g th e e tio lo g y o f s c h iz o p h r e n ia , from w hich i t i s f e l t o v e r g e n e r a liz a tio n s have been draw n. D e f i c i t T heory S tu d ie s B ecause i t i s a w id e ly know, f a i r l y r e c e n t s tu d y , b r i e f l y d e a l t w ith in C h a p te r I , th e Bower e t a l . r e s e a r c h m e r its more d e t a i l e d e x a m in a tio n . The fo llo w in g i s s t a t e d i n i t s o p en in g c h a p te r re g a rd in g th e r o l e o f th e sc h o o l and m e n ta l h e a lth : The p r e s e n t co n c ern o f th e p u b lic sc h o o l f o r th e e d u c a tio n o f a lm o s t e v e ry c h i l d h a s in h e r e n t in i t v a s t p o t e n t i a l f o r p r e v e n tin g o r re d u c in g th e number o f p e rs o n s w ith m in o r, m o d e ra te, o r s e r io u s e m o tio n a l d is tu r b a n c e . C h ild re n a t te n d s c h o o l f o r th e g r e a t e r p a r t o f a day f o r 10 to 12 y e a rs o f th e m ost fo rm a tiv e p e r io d o f l i f e . They a r e o b se rv e d by te a c h e r s and p r i n c i p a l s who h av e had p r o f e s s io n a l e d u c a tio n in th e g ro w th and dev elo p m en t o f c h ild r e n ; . . . th e r e i s c o n t in u ity to o b s e rv a tio n s th ro u g h c u m u la tiv e re c o r d s and p r o f e s s io n a l com m unication . . . th e te a c h e r i s 24 u se d t o , and e x p e c ts a wide v a r i e t y o f norm al b e h a v io r; he i s s e n s i t i v e to and can le a r n to re c o g n iz e e a r ly th e s ig n s in c h ild r e n who may need some h le p w ith em o tio n a l p ro b le m s. I t i s no d i s t o r t i o n o f th e s c h o o l's r o le to pay a t t e n t i o n to such f a c t o r s s in c e th e s e may be th e m ajor c a u se s o f th e i n a b i l i t y o f th e c h ild to le a r n o r to make th e sc h o o l a d j u s t m ents n e c e s s a ry to l e a r n . (Bower e t a l . , 1960:12) T here were th r e e m ajor h y p o th e ses in th e s tu d y . 1 . H igh sc h o o l s tu d e n ts who l a t e r became s c h iz o p h re n ic w ere s i g n i f i c a n t l y d i f f e r e n t from a c o n tro l group in th e m anner in w hich th e y a re p e rc e iv e d by sc h o o l s t a f f s and in c e r t a i n p h a se s o f t h e i r sc h o o l r e c o r d s . 2 . The sc h o o l s t a f f and sc h o o l re c o rd s c o n ta in s u f f i c i e n t r e le v a n t d a ta on s tu d e n ts who have l e f t sch o o l w ith in f iv e o r l e s s y e a rs to a s s e s s a d e q u a te ly t h e i r s c h o o l m en tal h e a lth . 3. The d e v e lo p in g sc h iz o p h re n ic i s r e a d ily re c o g n iz a b le d u rin g h is h ig h sc h o o l y e a rs and i s p e rc e iv e d by th e sc h o o l s t a f f a s h av in g more em o tio n a l problem s th an o t h e r s . M e th o d o lo g ic a lly , t h i s stu d y p ro cee d ed as fo llo w s : 1. The e x p e rim e n ta l group c o n s is te d o f f o r ty - f o u r p a t i e n t s a t th e V e te ra n s A d m in is tra tio n H o s p ita l in P alo A lto . They had a l l a tte n d e d a C a lif o r n ia h ig h sc h o o l fo r a t l e a s t one y e a r . They h ad a l l been born a f t e r Ja n u ary 1, 1932. No o rg a n ic o r c e n t r a l n erv o u s system problem s w ere e v id e n t in any o f them . The d ia g n o s is f o r each was s c h iz o p h r e n ia . 25 2 . A t th e tim e o f th e s tu d y , th e y ra n g e d in age from n in e te e n to tw e n ty -s ix y e a r s , w ith a m edian age o f tw e n ty - th r e e . 3 . The c o n tr o l group was s e le c te d a s fo llo w s : one o f th e two r e s e a r c h in v e s tig a to r s v i s i t e d th e sch o o l o f an e x p e rim e n ta l s u b je c t. He had mem orized th e name o f th e p a t i e n t . Under th e g u is e o f ch o o sin g two s tu d e n ts random ly, he p ic k e d th e p a t i e n t and a c o n t r o l. The n e x t name a f t e r th e e x p e rim e n ta l s tu d e n t in th e y e a r book o r c l a s s l i s t was u s u a lly s e le c te d f o r th e l a t t e r g ro u p . R uled o u t w ere names in d ic a tin g a r a c i a l d if f e r e n c e , o r in tim a tin g th e p o s s i b i l i t y o f b lo o d r e l a t i o n s h i p . I n t e r view s o f th e h ig h sc h o o l s t a f f w ere cond u cted by th e second in v e s t i g a t o r who knew n e i t h e r th e name o f th e e x p e rim e n ta l o r c o n tr o l in d iv i d u a l. L a te r on in th e r e s e a r c h , th e p o s s i b i l i t y o f m en tal i l l n e s s in any o f th e c o n tr o ls was checked o u t by a r e l a t e d s t a t e ag en cy . An e ig h te e n -ite m , f iv e - p o in t b e h a v io r r a t i n g s c a le d ev elo p ed by th e V e te ra n s A d m in is tra tio n and th e C a lif o r n ia S ta te D epartm ent o f E d u ca tio n was u sed to s tr u c t u r e th e in te rv ie w s . Two g e n e ra l q u e s tio n s w ere added to th e e ig h te e n , making a t o t a l o f tw enty q u e s tio n s in a l l . A sam ple o f q u e s tio n s i s a s fo llo w s : 1. D egree to w hich th e in d iv id u a l was lik e d by o th e r s . . 4 . D egree to w hich th e in d iv i d u a l showed an i n t e r e s t in th e e n v iro n m e n t. 6 . D egree to w hich th e in d iv i d u a l p a r t i c i p a t e d in group a c t i v i t i e s . 8 . D egree to w hich th e in d iv id u a l showed i n t e r e s t i n th e o p p o s ite s e x . 1 3 . D egree to w hich th e in d iv id u a l ev id e n c e d m a n ife s t a n x ie ty . 1 4 . A r a t i n g o f th e in d iv id u a l a lo n g a d e p re s s e d - c h e e r f u l co n tin u u m . 1 9 . A r a t i n g o f th e i n d i v i d u a l 's o v e r - a l l sch o o l a d ju s tm e n t. 2 0 . A ,r a tin g o f th e i n d i v i d u a l 's m e n ta l h e a lth . I n a lm o st a l l c a s e s , sc h o o l s t a f f in te rv ie w e e s w ere shown p i c t u r e s o f .b o th c o n tr o l group and e x p e rim e n ta l i n d i v i d u a l s , in a m atch in g ap p ro a c h , and ask ed "What i s th e f i r s t th in g t h a t comes to y o u r mind a b o u t each o f th e b o y s?" The in te rv ie w e e was th e n en co u rag ed to c o n tin u e in a f r e e - a s s o c i a t i v e way u n t i l no more a s s o c ia tio n s were e l i c i t e d . P r i o r i t y was g iv e n to f a c u l t y members who knew b o th b o y s. In t h i s r e g a r d , th e r e s e a r c h e r s commented as f o llo w s : I n a lm o st a l l c a s e s s t a f f members w ere a v a ila b le who rem em bered th e bo y s in c l a s s , a s c o u n s e lo r s , o r as members o f a t h l e t i c team s. In some c a s e s th e boys had made l i t t l e im p re s s io n on th e s t a f f beyond th e fa c e s th e y h ad rem em bered. (Bower e t a l . , 1960) 27 C e rta in sc h o o l in fo rm a tio n was in c lu d e d a s p a r t o f th e c l i n i c a l d a t a . 1,. G ra d u a tio n . (T his m eant th e number o f g ra d u a te s i n each g r o u p .) 2 . C o u rse o f s tu d y p u rs u e d . 3 . The s t u d e n t s 1 b e s t s u b j e c t s . (T his m eant sub j e c t s i n w hich th e y a c h ie v e d th e h ig h e s t g r a d e .) 4 . Subj e c ts f a i l e d . 5 . O v e r - a ll g ra d e p a t t e r n . 6 . G rade p o in t a v e ra g e . 7 . A tte n d a n ce r e c o r d . 8 . E x t r a - c u r r i c u l a r a c t i v i t i e s . 9 . I .Q . s c o re . Three p s y c h o lo g is ts w ith d o c to r a te s who had worked w ith h o s p i t a l i z e d s c h iz o p h re n ic s f o r a t l e a s t f iv e y e a rs were a sk e d to r a t e s u b je c ts u sin g th e t o t a l m a t e r ia l . In th e s e r a t i n g s , th e y to o k a p o s it io n on two is s u e s : (1) R a te th e s u b je c ts i n each group from m ost l i k e l y to l e a s t l i k e l y to r e q u ir e h o s p i t a l i z a t i o n , and (2) Make a r a tin g o f your o v e r - a l l .im p re ssio n o f each s u b j e c t 's e m o tio n a l a d ju s tm e n t. Bower e t a l . drew th e fo llo w in g summary c o n c lu sio n s : T h is s tu d y co n firm ed i t s b a s ic h y p o th e s is t h a t h ig h sc h o o l s tu d e n ts who l a t e r became s c h iz o p h re n ic w ere s i g n i f i c a n t l y d i f f e r e n t from o th e r s tu d e n ts . In m ost o f th e c a s e s , members o f th e sc h o o l s t a f f w ere 28 aw are o f th e d if f e r e n c e s betw een th e p r e - s c h iz o p h re n ic c h i ld and h i s c la s s m a te s , b u t o n ly i n a sm a ll number o f c a s e s w ere such d if f e r e n c e s c o n s id e re d s i g n i f i c a n t . The p r e - s c h iz o p h re n ic group was n o t c o n s id e re d by th e f a c u l ty to have had ma.ior sch o o l' p ro b le m s, b u t t n e i r d if f e r e n c e s from o th e r s tu d e n ts w ere s u f f i c i e n t l y m arked to be n o te d and rem em bered by te a c h e r s , c o u n s e lo r s , d e a n s , and a d m i n i s t r a t o r s . . . . N ever th e le s s a l i t t l e more th an h a l f o f th e in d iv id u a ls in th e p re - s c h iz o p h re n ic group w ere judged by th e sc h o o l s t a f f to h av e a t l e a s t a v e ra g e m en tal h e a lth . ( I t a l i c s m in e .) . . . on th e o th e r h an d , so seldom d id th e sc h o o l p e rs o n n e l f e e l t h a t a p r e - s c h iz o p h re n ic c h ild showed b e t t e r th a n a v e ra g e m en tal h e a lth t h a t one can s t a t e w ith some v a l i d i t y t h a t th e p e r c e p tio n on th e p a r t o f such p e rs o n n e l o f an a d o l e s c e n t's m e n ta l h e a lth as b e in g above a v e ra g e augurs w e ll f o r th e f u tu r e o f th e m e n tal h e a lth o f th e s tu d e n t. O 'N eal and Robins-*- (1958) a ls o found in a 30 y e a r fo llo w -u p t h a t a c o n tr o l group whose members were p ic k e d on th e b a s is o f no s t r i k i n g d i f f i c u l t i e s in sc h o o l m a n ife s te d no m ajo r p e r s o n a lity d is tu rb a n c e s o r m e n ta l i l l n e s s as a d u l t s . (Bower, e t a l ., 1 9 6 0 :3 8 -3 9 ) Two im m ediate q u e s tio n s one m ig h t a sk s e r io u s ly o f t h i s r e s e a r c h a r e th e fo llo w in g : 1 . Why were n o t such c o n c e p ts a s a v e ra g e m en tal h e a lth anyw here d e fin e d and a t l e a s t an a tte m p t made to do a p i l o t stu d y on th e d e f i n i t io n ? 2 . I s th e r e e v id e n c e s u b s t a n t i a t i n g a c c e p ta b le v a l i d i t y and r e l i a b i l i t y in th e m ethod o f f r e e a s s o c ia tio n from w hich d a ta b a s ic to th e e n t i r e outcom e was a c c e p te d a t fa c e v a lu e ? W am k en 's work (1958), a ls o b r i e f l y to u ch ed upon i n 1 Reviewed and c r it i q u e d on p . 34 in t h i s c h a p te r . 29 C h ap ter I , seems e q u a lly to m e r it f u r th e r c o n s id e r a tio n . In t h i s s tu d y , the. e d u c a tio n a l h i s t o r y o f 116 m ale v e te r a n s c h iz o p h re n ic s was s tu d ie d ; d if f e r e n c e s betw een th e p a t i e n t s and 116 random ly s e le c te d c o n tr o ls m atched f o r age w ere exam ined. A ll th e d a ta w ere o b ta in e d from cumu l a t i v e sc h o o l re c o rd s in th e M in n eap o lis p u b lic sch o o l sy ste m . N ot u n lik e th e Bower e t a l . stu d y (1 9 6 0 ), Warnken found many d e f i c i t d if f e r e n c e s such a s av era g e I .Q ., g ra d e p o in t a v e ra g e a t c e r t a i n g ra d e l e v e ls , e t c e t e r a . These le d him to co n clu d e t h a t th e c lu e to th e s c h iz o p h re n ic p ro c e s s l i e s in th e i n f e r i o r s o c ia l and i n t e l l e c t u a l e q u ip m ent o f th e s c h iz o p h re n ic . The n a t u r a l , though n o t i n e v i t a b l e , co n c o m itan t to i n f e r i o r i t y i s re p e a te d f a i l u r e . S u b se q u e n tly , th e p ro c e s s w hich began in r e p e a te d f a i l u r e c u lm in a te s in a le a rn e d w ith d raw al from in te r p e r s o n a l r e l a t i o n s h i p s . C e rta in g la r in g c o n tr a d ic tio n s in a d d itio n to th e ones m en tio n ed in C h a p te r I , how ever, w hich W arnken, i t i s f e l t , e x p la in s "away" b u t does n o t e x p la in , seem to sta n d o u t. A co u p le o f sam ples o f th e s e a re th e fo llo w in g : 1 . A group o f s c h iz o p h re n ic s (n o t in th e main e x p e rim e n ta l group) was m atched w ith a group o f norm als ( s im ila r ly n o t in th e main c o n tr o l g ro u p ) f o r : (a) A m erican C o u n c il on E d u ca tio n s c o re s , 30 (b) h ig h sc h o o l from w hich g ra d u a te d , and (c) d a te g ra d u a te d . These s c h iz o p h re n ic s sc o re d s i g n i f i c a n t l y h ig h e r in h ig h sc h o o l ra n k th an d id th e n o rm a ls. Warnken r e l a t e s t h i s fin d in g to d i f f e r e n t m o tiv a tio n s f o r p r e - s c h iz o p h re n ic s u b j e c t s ; b u t no s u b s ta n tiv e e x p la n a tio n o f th e l a t t e r i s u n d e rta k e n . 2 . M ajor s o c io lo g ic a l f in d in g s , e n t i r e l y ig n o re d as to t h e i r in f lu e n c e on o th e r f in d in g s , w ere as fo llo w s : (a) F a th e rs o f s c h iz o p h re n ic s w ere s i g n i f i c a n tly more o f te n em ployed in th e low er o c c u p a tio n a l l e v e l s and w ere more o f te n unem ployed. Would t h i s f a c t , one c o u ld a s k , n o t r e l a t e to th e I.Q . s c o re s a t t a i n e d on th e W e c h sle r-B e lle v u e , p a r t i c u l a r l y to th e many v e r b a l sub t e s t s , b ecau se o f th e low er c u l t u r a l le v e l o f th e home? (b) More p a r e n ts o f s c h iz o p h re n ic s were fo re ig n b o m ; would t h i s n o t ca u se a p o t e n t i a l l y s im ila r a r t i f a c t ? Symptoms o r B eh av io r P a tte r n S tu d ie s B irre n (1944) s tu d ie d a group o f t h i r t y - e i g h t s c h iz o p h re n ic s who had been seen e a r l i e r by th e C hicago P u b lic S chools Bureau o f C h ild G uidance. He com pared them w ith f i f t y - t h r e e n o n -s c h iz o p h re n ic s who had b een seen by th e same ag en cy . He found t h a t th e p re - s c h iz o p h re n ic s ev id en ced more symptoms t h a t co u ld be g e n e r a liz e d u n d er th e 31 h ead in g o f "w ithdraw n" th a n th e n o n - s c h iz o p h re n ic s . He a ls o found no sc h o o l le a d e r s among th e p re -s c h iz o p h re n ic group com pared w ith n in e in th e c o n tr o l g ro u p . An I.Q . com parison r e v e a le d 8 8 .7 as th e av erag e, o f th e m e n ta lly i l l group when in s c h o o l, and 99.7 a s th e av e ra g e I.Q . o f th e c o n tr o l g ro u p . No comment re g a rd in g th e s ig n if ic a n c e o f th e a v e ra g e s i s made by th e a u th o r . In a d d itio n , sc h o o l r e t a r d a t i o n , s e c lu s iv e n e s s , l i s t l e s s n e s s and p o o r p e e r r e l a t i o n s h i p s w ere num bered among th e c h a r a c t e r i s t i c s o f th e m e n ta lly i l l . However, when B irre n d is c u s s e d th e s t a t i s t i c a l fin d in g s r e l a t e d to c e r t a i n d im en sio n s o f h is s tu d y , he co n clu d ed in th e fo llo w in g v e i n . R egarding g ra d e le v e l ach iev em en t d if f e r e n c e s , no s i g n i f i c a n t fin d in g s w ere o b ta in e d . R egarding r e f e r r a l f o r backw ardness o r r e t a r d a t i o n , a chance o rd e r o f c o r r e l a t i o n was o b ta in e d . The r e s u l t s o f com paring th e sc h o o l p s y c h o lo g is t's recommenda tio n s f o r members o f b o th g ro u p s w ere s im ila r ly i n s i g n i f i c a n t. H is f i n a l d is c u s s io n s t a t e d : I t i s e v id e n t t h a t c h ild r e n who w i l l l a t e r develop a m e n ta l d is e a s e o f s u f f i c i e n t s e rio u s n e s s to r e q u ir e h o s p i t a l i z a t i o n do n o t d i f f e r g r e a t ly as a group from o th e r c h ild r e n a t th e sc h o o l ages when th e y w ere exam ined by th e B ureau o f C h ild S tu d y . (B irre n , 1944:95) W ittm an and S te in b e rg (1945) s e le c te d f i f t y - n i n e , c a s e s from th e f i l e s o f th e Cook County P sy ch o p a th ic H o s p ita l, and E lg in S ta te H o s p ita l, b o th in I l l i n o i s . The 32 in d iv id u a ls had been r e f e r r e d to th e C hicago P u b lic S ch o o ls B ureau o f C h ild G uidance in t h e i r p u b lic sc h o o l y e a r s . Two h undred c h i ld r e n w ere random ly s e le c te d from th e same f i l e s a s th e c o n t r o l g ro u p . They fo u n d t h a t m ore th a n 50 p e r c e n t o f th e p a t i e n t s had been d e s c r ib e d d u rin g t h e i r sc h o o l y e a r s as h a v in g a " s h u t - i n 1 1 p e r s o n a l i t y . D e s c rip tiv e e x p r e s s io n s u s e d by th e p s y c h o lo g is ts in t h e i r r e p o r t s w e re : dream y, l i s t l e s s , p o o r a t t e n t i o n , la c k o f c o n c e n tr a tio n , o v e r - s e n s i t i v e , a p a t h e t i c , w ith d raw n , slow b u t w ith good i n t e l l i g e n c e , in d e c is iv e and l e t h a r g i c . F ra z e e (1945) s tu d ie d tw e n ty - th r e e male c h ild r e n who l a t e r becam e s c h iz o p h r e n ic . She com pared them w ith tw e n ty -th r e e who d id n o t become m e n ta lly i l l . E ach o f th o s e in b o th groups had been r e f e r r e d to a c h i ld g u id an ce c l i n i c when i n p u b lic sc h o o l. R eg ard in g th e k in d s o f p r e s e n tin g p ro b le m s, F ra zee fo u n d l i t t l e d if f e r e n c e betw een t h e g ro u p s. An e q u a l number i n b o th g ro u p s had e v id e n c e d e x c e s s iv e ly e x c i t a b l e b e h a v io r and d e s t r u c t iv e a g g r e s s iv e n e s s . C lassroom b e h a v io r p ro b lem s w ere s i m i l a r ly eq u a l i n fre q u e n c y . She c o n c lu d ed t h a t a l a r g e r number o f th e s c h iz o p h re n ic s were r e ta r d e d i n s c h o o l, p ro n e to e x c e s s iv e d ay dream ing, and i s o l a t e d th e m se lv e s from o th e r c h i ld r e n . A ccording t o h e r , n o n e in th e s c h iz o p h r e n ic group i n t e r a c te d n o rm a lly w ith o th e r c h i l d r e n . W ittm an and Huffman (1948) made a c o m p a ra tiv e s tu d y 3 3 o f d ev elo p m en tal a d ju stm e n t and p e r s o n a lity c h a r a c t e r i s t i c s o f p s y c h o tic , p sy c h o n e u ro tic and n o rm ally a d ju s te d te e n ag e y o u th s . They u se d th e B e ll A djustm ent T e s t and th e E lg in D evelopm ental H is to ry a s o b je c tiv e m easuring d e v ic e s . They co n clu d ed t h a t th e p s y c h o tic group had n o t been m arkedly d i f f e r e n t i a t e d from th e o th e r g ro u p s by th e s e in s tr u m e n ts . M ost p e r t i n e n t in term s o f sc h o o l l i f e d im en sio n s w ere th e s c o re s on th e E lg in D evelopm ental H is to r y . T h is in v e n to ry p u r p o rts to m easure d i r e c t l y e a r ly sc h o o l l i f e a d ju stm e n t and ac h iev e m e n t. S co res ob ta in e d were such t h a t no p s y c h o tic d ip p e d below th e av e ra g e ra n g e . In b o th c a te g o r ie s , in f a c t , th o s e o f sc h o o l ad ju s tm e n t and ach iev e m en t, th e s c h iz o p h r e n ic s ' s c o re s w ere c lo s e r to th e s c o re s o f th e c o n tr o ls th a n w ere th e s c o re s o f d e lin q u e n ts o f b o th s e x e s . Andrew and Lockwood (1954) u n d e rto o k th e fo llo w in g s tu d y . School te a c h e rs r a te d a random ly s e le c te d sam ple o f 10 p e r c e n t o f th e 8 ,5 0 0 c h ild r e n in th e B a ttl e C reek, M ich ig an , p u b lic sc h o o l sy stem . They made t h e i r r a tin g s alo n g th e fo llo w in g d im e n sio n s: 1 . O v e ra ll e m o tio n a l a d ju s tm e n t. 2 . S o c ia l m a tu r ity . 3 . Tendency tow ard a g g re s s iv e b e h a v io r. 4 . Tendency tow ard d e p re s s io n . 5 . E x tr o v e r s io n - - in tr o v e r s io n . 34 6 . E m o tio n al s e c u r i t y . 7 . M otor c o n tr o l and s t a b i l i t y . 8 . Im p u ls iv e n e s s . 9 . E m o tio n al i r r i t a b i l i t y . 1 0 . S ch o o l a c h ie v e m e n t. 1 1 . S chool c o n d u c t. R a tin g s w ere made a lo n g a f i v e - p o i n t s c a l e . The r e s u l t s found 81 p e r c e n t w e ll - a d ju s te d , 19 p e r c e n t p o o rly a d j u s te d . Two p e r c e n t o f th e 19 p e r c e n t w ere c o n s id e re d s e v e r e ly m a la d ju s te d . However, th e r e w ere no s i g n i f i c a n t d if f e r e n c e s found betw een th e g ra d e s o f th e w e ll and p o o rly a d ju s te d . No s c h iz o p h r e n ic , o r p r e s c h iz o p h re n ic c h i ld r e n , as su c h , w ere i d e n t i f i e d . O 'N eal and R obins (1958) made a 3 0 -y e a r fo llo w -u p stu d y o f 115 c h i ld r e n , aged se v e n te e n o r l e s s , who had been r e f e r r e d d u rin g t h e i r s c h o o l y e a rs to th e M u n ic ip al P sy c h i a t r i c C lin ic in S t . L o u is b e c a u se o f o b v io u s b e h a v io r p ro b le m s . They com pared t h i s g roup w ith a c o n tr o l group o f t h i r t y - f i v e c h ild r e n o b ta in e d from th e re c o r d s o f th e S t. L o u is p u b lic s c h o o ls . I n d iv id u a ls in th e l a t t e r group w ere r e q u ir e d to have shown no o b v io u s p ro b lem s such a s r e p e a tin g a g ra d e , e x c e s s iv e a b s e n c e , o r a s ta y a t a c o r r e c t i o n a l i n s t i t u t i o n . The t o t a l o f 150 in d iv id u a ls w ere a d m in is te re d a tw o -a n d -a -h a lf h o u r q u e s tio n n a ir e in w hich th e f i r s t p a r t d e a l t w ith s o c i a l s k i l l s and a d ju s tm e n t. The seco n d p a r t o f th e q u e s tio n n a i r e was e s s e n t i a l l y a m e d ic a l p s y c h i a t r i c symptom re v ie w . The a u th o rs co n c lu d ed t h a t th e co m p ariso n o f th e r a t e o f p s y c h i a t r i c d is e a s e in a g roup o f e x - p a t i e n t s o f a c h i l d r e n 's p s y c h i a t r i c c l i n i c w ith t h a t in a group o f norm al c o n tr o ls i n d i c a t e s t h a t th e problem s f o r w hich c h ild r e n w ere se e n a r e f r e q u e n tly th e symptoms o f s e r io u s l i f e l o n g , p s y c h i a t r i c d is e a s e . However, some o f th e v e r y d a ta th e m s e lv e s , i t w ould seem to t h i s r e v ie w e r, c o m p le te ly b e l i e any such d e f i n i t i v e c o n c lu s io n s and a r e r e p l e t e w ith im p o rta n t, b u t ig n o re d , p a ra d o x e s . For in s t a n c e , com paring th e e x is te n c e o f n e u r o tic d ia g n o s is in th e e x p e rim e n ta l g ro u p o f 115 c h ild r e n w ith th e t h i r t y - f i v e in th e c o n tr o l g ro u p , th e p e rc e n ta g e s a r e 27 p e r c e n t and 23 p e r c e n t r e s p e c t i v e l y . N ot o n ly i s th e a c t u a l d i f f e r e n c e s m a ll, b u t i t would n o t be s t a t i s t i c a l l y s i g n i f i c a n t . In th e p s y c h o tic su b g ro u p , two o f th e t o t a l o f e ig h te e n so d ia g n o se d w ere a d m itte d ly th e r e s u l t o f c h ro n ic b r a i n dam age, and two o th e r s a r e in c lu d e d , even though th e r e was no ag reem en t among th e p s y c h i a t r i s t s . Thus, th e l a t t e r were c l a s s i f i e d a s u n d ia g n o sed p s y c h o s is . T h is , th e n , le a v e s u s w ith f o u r te e n c l e a r - c u t c a s e s in th e 115 g ro u p in g , a s com pared w ith th r e e p sy c h o se s in th e con t r o l group o f t h i r t y - f i v e . But i f th e c o n t r o l g ro u p had 36 been m u ltip lie d by 3 .3 so t h a t one group n u m e ric a lly e q u a le d th e o t h e r , th e r e s u l t w ould be 1 0 . How s i g n i f i c a n t 10 com pared w ith 14 i s , o u t o f a t o t a l o f 1 1 5 ,' i s c o m p le te ly u n to u c h e d . F u rth e r s t i l l , i f one exam ines th e fre q u e n c y o f o c c u rre n c e o f th e te n c o m p la in ts f o r w hich th e p a t i e n t group h ad been r e f e r r e d , one o b se rv e s g r o s s ly p a r a d o x ic a l r e s u l t s . These te n r e f e r r a l c o m p la in ts w ere: t h e f t , d e s t r u c t i o n o f p r o p e r ty , tru a n c y , i n c o r r i g i b i l i t y , ru n n in g away, f i g h t i n g , le a r n in g d i f f i c u l t i e s , s e x u a l b e h a v io r, ta n tru m s , n e u r o tic t r a i t s . T aking a t o t a l o f th e p e r c e n ta g e s g iv e n by th e a u th o rs f o r each r e f e r r i n g c o m p la in t, i f w ould seem th e n e u r o tic group exceeded th e p s y c h o tic group by 276 to 2 0 6 . Y et th e authors^ s i n g l e o u t o n ly two r e f e r r i n g c o m p la in ts t h a t w ere h ig h in a group t h a t became p s y c h o tic to p o s t u l a t e p r e d i c t i v e s ig n i f ic a n c e , nam ely ru n n in g away and tr u a n c y . S in ce t h e i r stu d y su g g e ste d to them t h a t p sy c h o ses o c c u rre d more f r e q u e n tly among th e c h ild r e n o f lo w er s o c io econom ic s t a t u s , and n e u ro s e s among th o s e b e t t e r s it u a t e d e c o n o m ic a lly , th e y m ight w e ll h av e ask ed w h eth er th e s e two c o m p la in ts were r e f l e c t i o n s o f s o c i a l c l a s s b e h a v io r p a t t e r n s , r a t h e r th a n p r e c u r s o r s o f a d u l t p s y c h o s e s . Even more p a r a d o x ic a l w ere th e d a ta from th e group in w hich no p s y c h i a t r i c d is e a s e was c u r r e n t l y fo u n d . T h e ir 37 t o t a l o f r e f e r r a l p e rc e n ta g e s f o r th e e n t i r e te n c o m p la in ts i s p r a c t i c a l l y e q u a l to th a t o f th e p s y c h o tic g ro u p s, th e f ig u r e b e in g 201. And i f we com bine th e f ig u r e w ith th e r e f e r r a l p e rc e n ta g e f o r th e g ro u p fo r which, th e p s y c h i a t r i s t s c o u ld n o t a g re e as to d ia g n o s is , th e t o t a l i s 300. Thus th e u n d iag n o sed group and th e group w ith no p s y c h i a t r i c d is e a s e had a combined r e f e r r a l t o t a l s u b s t a n tia lly i n ex cess o f th e group th a t becam e p s y c h o tic ! Two more p o in ts should b e made i n c o n n e c tio n w ith t h i s r e s e a r c h . I f we combine th e p e rc e n ta g e s o f th e e n t i r e n o n -s c h iz o p h re n ic p o p u la tio n re g a rd in g th e s o - c a lle d p r e d i c t i v e c o m p la in ts , nam ely tru a n c y and ru n n in g away, th e t o t a l i s h ig h e r th a n f o r th e p s y c h o tic g ro u p . And no m en tio n i s made a t a l l o f the f a c t th a t re g a rd in g one v ery im p o rta n t co m p la in t i n sch o o l, nam ely le a r n in g p ro b lem s, th e n e u r o tic s exceeded th e psycho t i c s by 7 to 1. Case H is to ry o r L o n g itu d in a l S tu d ie s F rie d la n d e r (1945) used th e case h is to r y m ethod in stu d y in g th e e a r l i e r l i v e s o f tw e n ty -se v e n s c h iz o p h re n ic s . H er stu d y d id n o t make u se o f an y c o n tro l gro u p . A ccording to h er f in d in g s , d a ta from th e C hicago I n s t i t u t e o f Ju v e n i l e R esearch showed t h a t 30 p e r c e n t o f th e s c h iz o p h re n ic s w ere r e f e r r e d f o r p o o r school w o rk . L ic h te n b e rg (1957) s tu d ie d two young a d u lt s c h iz o p h re n ic s lo n g it u d in a l ly in some d e t a i l . He found t h a t b o th 38 in d iv id u a ls had made e x c e ll e n t academ ic re c o rd s in p u b lic and h ig h s c h o o l. One o f th e two g ra d u a te d from p u b lic sc h o o l a t th e age o f tw e lv e . Both had been a c t iv e ly en - gaged in e x t r a - c u r r i c u l a r a c t i v i t i e s , and one was a member o f th e h ig h sc h o o l v a r s i t y f o o t b a l l team . Among th e h o b b ie s th e y p u rsu e d w ere m aking model a i r p la n e s , r a i s i n g t r o p i c a l f i s h and l i s t e n i n g to good m u sic. He s t a te d in h is summary: Does t h i s mean t h a t th e y had to o much ach iev em en t o r i s i t s e m a n tic a lly i n c o r r e c t to c a l l t h e i r su c c e ss tr u e ach iev em en t? W e b s te r's C o lle g ia te D ic tio n a ry d e f in e s ach iev em en t as som ething acco m p lish ed by " v a lo r , b o ld n e s s , o r p ra is e w o rth y e x e r t i o n ." The ev id e n ce in th e s e c a s e s s u g g e s ts t h a t such p o s i t i v e u s e f u l m o tiv a tio n was n o t th e dom inant f a c t o r . (L ic h te n b e rg , 1957:368) He g o es on to p o s tu l a t e t h a t a c t u a l l y a r i g i d p a t t e r n o f com pliance w ith th e i m p l i c i t demands o f t h e i r f a m ilie s e x i s t e d . Through t h i s th ey had a c h ie v e d co n v e n tio n a l s u c c e s s . But w hat th e y f a i l e d to a c h ie v e , a c c o rd in g to L ic h te n b e rg , would have been more d e s ir a b le from a m e n ta l h e a lth s ta n d p o in t. From h is p o in t o f view , t h i s would have m eant su c c e s s in b ein g s e l f c o n fid e n t and a p p r o p r ia te ly r e b e l l i o u s . I t would have m eant t h a t th ey had become p e rso n s in t h e i r own r i g h t , a b le to e x p e rie n c e w ith r e l a t i v e eq u an im ity th e co n seq u en ces o f t h e i r own b e h a v io r and d e c i s i o n s . A C h a lle n g in g Study M ic h a e l, M o rris and S o ro k e r (1957) c h a lle n g e d th e p r e v a le n t id e a t h a t th e m a jo rity o f s c h iz o p h re n ic p a t i e n t s h ad s o - c a l le d ahy, w ith d raw n , i n t r o v e r s i v e p r e - p s y c h o tic p e r s o n a l i t i e s . T h e ir s u b je c ts w ere 606 random ly s e le c te d c a s e s from th e f i l e s o f th e D a lla s , T ex as, C h ild G uidance C l i n i c . A ll th e in d iv i d u a ls had been r e f e r r e d to t h a t agency e i t h e r in t h e i r grammar o r h ig h sc h o o l y e a r s . T h e ir c l i n i c r e c o r d s a l l in c lu d e d a co m p reh en siv e s o c i a l h i s t o r y , one o r more p s y c h o lo g ic a l e x a m in a tio n s , in c lu d in g th e S ta n fo rd B in e t I n t e l l i g e n c e S c a le , and a p s y c h ia tr i c \ in te r v ie w . C a se s -in -w h ic h p h y s ic a l c o n d itio n s m ig h t have b lu r r e d th e c l i n i c a l p i c t u r e w ere e n t i r e l y e x c lu d e d from th e s tu d y . The a u th o rs made an in d e p e n d e n t c l a s s i f i c a t i o n i n to th r e e c a te g o r ie s o f ev ery o n e in th e g ro u p . 1 . I n t e r n a l r e a c to r s o r i n t r o v e r t s . 2 . E x te r n a l r e a c t o r s o r e x t r o v e r t s . 3 . M ixed r e a c t o r s o r a m b iv e rts . As a r e s u l t , th e r e w ere th e n 104 i n t r o v e r t s , 268 e x t r o v e r t s , and 174 a m b iv e rts . (S ix ty c a s e s o f th e o r i g i n a l 606 had been r u le d o u t b ec au se o f p h y s ic a l c o n d i t i o n s .) They th e n ch eck ed th e s u b je c ts a g a in s t th e f i l e s o f a l l th e Texas S ta te m e n ta l I n s t i t u t i o n s , in c lu d in g s t a t e h o s p i t a l s , V e te ra n A d m in is tra tio n i n s t a l l a t i o n s , and th e D a lla s C ity H o s p ita l. Summaries w ere o b ta in e d f o r a l l th o s e c a s e s who 40 had b ee n , o r s t i l l w ere, in any o f th e s e i n s t i t u t i o n s . W hile o n ly ten, o u t o f th e e n t i r e p o p u la tio n w ere d iag n o sed as s c h iz o p h re n ic , th e a u th o rs n o te d t h a t one came from th e i n t r o v e r t c l a s s i f i c a t i o n , s ix from th e a m b iv e rt, and th r e e from th e e x t r o v e r t . The a u th o rs d id draw th e fo llo w in g c o n c lu s io n : The r e s u l t s p o in t to th e c o n c lu s io n t h a t th e r e i s n o t an a d e q u a te j u s t i f i c a t i o n f o r th e a s s e r tio n t h a t c h ild r e n who m ig h t be c l a s s i f i e d a s i n t r o v e r t s a r e more l i k e l y to develop s c h iz o p h re n ia (th an c h ild r e n who a re e x tr o v e r ts o r a m b iv e rts ) o r t h a t a la r g e p r o p o rtio n o f s c h iz o p h re n ic s have p r e - p s y c h o tic p e r s o n a l i t i e s . (M ich ael, e t a l . , 1957: 337) However, th ey u n d e rsc o re c e r t a i n c a u tio n s , among w hich th e fo llo w in g w ere s tr e s s e d : 1. S in ce th e stu d y in c lu d e d o n ly c h ild r e n who had been r e f e r r e d to th e c l i n i c , th e p o p u la tio n sam pling m ight w e ll have been a t y p i c a l , o r i n s u f f i c i e n t l y c r o s s - s e c t io n a l . 2 . I t may w e ll be t h a t a m b iv e rts and e x tr o v e r ts d evelop symptoms w hich so o b v io u sly annoy o th e r p e o p le , t h a t a t t e n t i o n to th e problem i s more r e a d i ly evoked, and l a r g e r p r o p o rtio n s o f th e s e a r e r e f e r r e d to th e c l i n i c . In th e c a se o f i n t r o v e r t s , on th e o th e r hand, th e p o s s i b i l i t y m ight w e ll be t h a t t h e i r problem s a r e to a g r e a t e x te n t i n t e r n a l i z e d and on a fa n ta s y and th o u g h t l e v e l . Thus, outw ard b e h a v io r may w e ll rem ain la r g e ly conform ing and a c c e p ta b le , so t h a t few er e a r ly r e f e r r a l s o f such c h ild r e n a re made. C o n clu sio n s W hat, i f a n y th in g , o f a d e f i n i t i v e n a tu r e , can one co n clu d e from th e s e s tu d ie s ? F o r i t would seem t h a t : 1 . R egarding d e f i c i t th e o ry n o tio n s , such m ajor s tu d ie s a s th e Bower e t a l . (1960) and th e Warnken (1958) stu d y c o n t r a d ic t each o th e r in s e v e r a l ways,. F u rth e r th an t h a t , w ith in th e Warnken stu d y th e r e a re c o n tr a d ic tio n s h e r e in c i t e d t h a t a r e co m p ellin g in n a tu r e . 2 . The L ic h te n b e rg stu d y , a lth o u g h o n ly o f two c a s e s , c a n n o t be d is m is s e d , i t i s f e l t , m erely b ecau se o f th e sm all sam p lin g , f o r i t p o in ts to two in d iv id u a ls i n t e l l e c t u a l l y s u p e rio r , who seem ingly p o sse sse d more th an a d e q u a te s o c i a l , a t h l e t i c and hobby i n t e r e s t s k i l l s , who a ls o became s c h iz o p h re n ic . The p a t i e n t p o p u la tio n o f th e M enninger C lin ic , The I n s t i t u t e f o r L iv in g , and o th e r ex p e n s iv e tre a tm e n t a g e n c ie s , s im ila r ly a re composed o f in d iv id u a ls w ith h ig h I . Q . 's , many o f whom have been h ig h ly s u c c e s s fu l p r o f e s s io n a ls , w orkers in th e a r t s , dftd b u s in e s s w o rld . 3 . A r e p e t i t i v e e r r o r made in s e v e r a l o f th e s tu d ie s i s h ig h lig h te d in th e Warnken (1958) s tu d y . T here i s no j u s t i f i c a t i o n f o r assum ing t h a t b ecau se th e d i f f e r ence betw een th e av erag e I.Q . o f th e p a t i e n t s and norm als i s a t a s i g n i f i c a n t le v e l o f d if f e r e n c e re g a rd in g th e 42 number o b ta in e d ( i . e . , a v e ra g e I.Q . o f 105 com pared to a v e ra g e I .Q . o f 110) t h a t t h i s t r a n s l a t e s i t s e l f in to a r e a l - l i f e d if f e r e n c e in ju d g m e n t, u n d e rs ta n d in g , th e a b i l i t y to s o lv e p ro b lem s o f ev ery d ay liv i n g , e t c e te r a . 4 . The symptom and b e h a v io r p a t t e r n s t u d i e s seem lik e w is e c o n t r a d ic to r y , and th e many p arad o x es i n th e m ost s p e c ta c u la r and r e c e n t o f th e s e , nam ely th e O 'N e a l and R obins stu d y (1958) make i t l e s s th an p r e d ic tiv e a s th e a u th o rs presum e i t to b e . B ut more im p o rta n t, p e rh a p s , th a n th e a f o r e m e n tio n e d , i s th e f a c t t h a t none o f th e s tu d ie s a tte m p te d to t r e a t th e sc h o o l en v iro n m en t in a dynam ic w ay. I t i s hoped t h a t t h i s s tu d y , a l b e i t e x p lo r a to r y in n a t u r e , w i l l h av e c o n tr ib u te d to w ard s a b e g in n in g i n th a t d i r e c t i o n , a s i s s u g g e s te d in C h a p te r I . CHAPTER III SUBJECTS, SOURCES OF DATA, AND M ETHODS OF PROCEDURE S in c e th e p u rp o se o f t h i s stu d y was to d e te rm in e th e e x te n t to w hich th e sc h o o l en v iro n m en t m ig h t have been in v o lv e d d y n a m ic a lly w ith a d u l t m e n tal p a t i e n t s , two g ro u p s w ere em ployed. T hese w ere a h o s p i t a li z e d group' o f s c h iz o p h re n ic s and a n o rm al g ro u p . The h o s p i t a l group c o n s is te d o f tw e n ty -f iv e m ale a d u lts s e l e c te d from two w ards h o u sin g 180 m e n ta lly i l l a d u l t s , a t M e tro p o lita n S ta te H o s p ita l, N orw alk, C a l i f o r n i a . The n o rm al group c o n s is te d o f tw en ty - f i v e m ale p s y c h i a t r i c te c h n ic ia n t r a i n e e s a t th e same h o s p i t a l . S e le c tio n o f Sample 1 . A ll o f th e h o s p i t a l i z e d group w ere c o n s id e re d to be in " f a i r " to "good" re m is s io n , and w ere no lo n g e r in a s t a t e o f a c tu a l g ro s s p s y c h o s is , in th e o p in io n o f th e w ard team p r o f e s s io n a l s t a f f . 2 . Members o f th e h o s p i t a li z e d and c o n tr o l g ro u p s w ere a c c e p te d on th e b a s is o f t h e i r w illin g n e s s to p a r t i c i p a t e . 3 . A ll p a r t i c i p a n t s w ere below th e age o f 43 44 t h i r t y - s e v e n . The s e l e c t i o n o f t h i r t y - s i x y e a rs as th e u p p e r age l i m i t was q u i t e a r b i t r a r y . The g u id in g th o u g h t th e r e i n was t h a t to o many y e a rs away from h ig h s c h o o l, and to o .o ld an a g e , m ig h t make memory lo s s e s a c o n ta m in a tin g f a c t o r . 4 . The y o u n g e s t age l i m i t was in h e r e n t in th e h o s p i t a l s i t u a t i o n f o r b o th g r o u p s . •No one u n d er s ix te e n y e a r s o f ag e i s a c c e p ta b le f o r h o s p i t a l i z a t i o n . No one u n d e r e ig h te e n y e a rs o f age can be em ployed as a p s y c h i a t r i c te c h n ic ia n t r a i n e e . 5 . E very p e rso n in b o th g ro u p s was a h ig h sc h o o l g r a d u a te . F o rty h o s p i t a l i z e d in d iv id u a ls v o lu n te e r e d f o r th e s tu d y . F iv e w ere e lim in a te d b ec au se th e w ard s t a f f s tr o n g ly s u s p e c te d o rg a n ic c o m p lic a tio n s . The tw e n ty -f iv e u se d in th e m a jo r stu d y w ere s e le c te d by p ic k in g names o u t o f a h a t . The re m a in in g te n w ere u sed in th e p i l o t s tu d y . T h i r t y - s i x n o rm als v o lu n te e re d from among th e p s y c h i a t r i c te c h n ic ia n t r a i n e e s . A gain, tw e n ty -f iv e w ere s e le c te d f o r th e m ajor stu d y by p ic k in g names o u t o f a h a t o f th e re m a in in g e le v e n , te n w ere s i m i l a r l y ch o sen f o r th e p i l o t s tu d y . The Q u e stio n o f Sample S iz e F or s e v e r a l r e a s o n s , th e sam ple s iz e in t h i s stu d y was lim ite d to tw e n ty -f iv e f o r each o f th e g ro u p s . T his 45 number was in d e p e n d e n t o f th e te n u se d in ea c h group f o r th e p i l o t s tu d y . 1 . Two t e s t s w ere a d m in is te re d to a t o t a l o f s e v e n ty i n d i v i d u a l s . T hese w ere an E d u c a tio n a l H is to ry S en te n ce C om pletion t e s t , and an E d u c a tio n a l H is to ry T hem atic A p p e rc e p tio n t e s t . The l a t t e r , w hich has. to be a d m in is te re d in d i v i d u a l l y , to o k o n e -a n d -o n e -h a lf to tw o- a n d - o n e - h a lf h o u rs to a d m in is te r . I f g iv e n to a l a r g e r p o p u la tio n , i t i s f e l t i t w ould have been to o tim e - consum ing in r e l a t i o n to th e presum ed g a in in v a l i d i t y and r e l i a b i l i t y . 2 . T here i s u n f o r tu n a te ly a n -e x tre m e ly h ig h r a t e o f tu rn o v e r in em ploym ent among th e p s y c h i a t r i c te c h n ic ia n t r a i n e e s in even a s s h o r t a p e rio d a s two m onths. T hus, to in c r e a s e th e s iz e o f th e norm al sam pling would have p r e s e n te d an a d d i tio n a l p r a c t i c a l p ro b lem . 3 . The r e s u l t s o f th e p i l o t s tu d y , u s in g a sam ple o f o n ly te n in e a c h g ro u p , r e s u l t e d in w hat a r e c o n s id e re d to be good f in d in g s ; u s in g a n a ly s is o f v a r ia n c e m ethods, th e t e s t d a ta s i g n i f i c a n t l y d is c r im in a te d betw een th e h o s p i t a l i z e d and th e n o rm als ( P c . 0 1 ) . F u rth e rm o re , u s in g E b e l1s fo rm u la f o r com bined ju d g e r a t e r r e l i a b i l i t y , a r e s u l t a n t c o e f f i c i e n t o f .683 was o b ta in e d , in d ic a t in g s u b s t a n t i a l ag reem en t among th e r a t e r s . 46 A d m in is tra tio n o f T e s t M a te r ia l The E d u c a tio n a l H is to ry S en te n ce C om pletion T e s t and th e E d u c a tio n a l H is to ry T hem atic A p p ercep tio n T e s t w ere a d m in is te re d to b o th g ro u p s . The E d u c a tio n a l H is to ry S entence C om pletion -T est was a d m in is te re d to groups o f f i v e , and th e T hem atic A p p ercep tio n T e s t in d iv i d u a ll y . The l a t t e r was a d m in is te re d a f t e r th e fo llo w in g i n s t r u c tio n s w ere g iv e n : I am a s k in g you to im agine you a re a w r ite r who has been r e q u e s te d to w r ite some s t o r i e s f o r a maga z in e , b a s e d on te n p l a t e s I am g o in g to show you. I w ill show you th e s e p i c tu r e s one a t a tim e . Remember now, you a r e a w r i t e r who w ill make up a s d ra m a tic a s to r y a s you c a n . Try to in c lu d e in y o u r s to r y w hat i s happening in th e p i c t u r e , who a r e th e p eo p le in i t , w hat t h e i r f e e l in g s and th o u g h ts ab o u t one a n o th e r may b e, and how th e s to r y w i l l end. The l a s t p l a t e I w ill' show you i s b la n k . Make up a s to r y o u t o f your im a g in a tio n w h ile you a r e lo o k in g a t i t , j u s t l i k e you do f o r th e o th e r n in e . W rite your th o u g h ts down as th e y come in to y o u r m ind. Do you u n d e rsta n d ? Are th e r e any q u e s tio n s ? E v a lu a tio n o f th e T e s t M a te r ia l The com bined t e s t p r o to c o ls w ere su b m itte d to th r e e ju d g e s who w ere c l i n i c a l p s y c h o lo g is ts w ith d o c to r a t e s . They had a b s o lu te ly no know ledge o f whose m a te r ia l th e y were e v a lu a tin g . Each ju d g e s tu d ie d each c a se a s a w hole. They w ere ask ed to ju d g e th e m a te r ia l in a check l i s t c h o ic e manner w ith th e fo llo w in g typed i n s t r u c t i o n s : P le a s e g iv e by th e in d ic a te d s ig n y o u r o p in io n re g a rd in g th e p re s e n c e o r ab sen ce o f th e te n a t t i tu d e s ( l i s t e d in C h ap ter I ) in each o f th e f i f t y p r o to c o ls . P re s e n t: V; a b s e n t: X; n o t c e r t a i n : ? 47 P le a s e t r y to u s e th e t h i r d c a te g o ry a s s p a rin g ly as you a r e a b le to do so . A C o n c re te Sample o f th e J u d g e d Task The fo llo w in g i s a sam ple o f th e t e s t p r o to c o l m a te r ia l th e ju d g e s w ere ask ed to r a t e , a s d e s c rib e d in th e im m ed ia te ly p re c e d in g s e c ti o n . A nswers to a few s e n te n c e c o m p letio n q u e s tio n s r e a d as fo llo w s : 1 . My te a c h e r s w e r e ......................................................... (m o stly women, th o u g h I d id have some men t e a c h e r s ) . 3 . S tu d y in g a r ith m e tic and m ath em atics . . . . . . . . . . . . (was a b o re and m e re ly busy w o rk ). 8 . The women te a c h e rs I had ...................................... (were somehow a b o o n , ta u g h t w ith a m is sio n to te a c h , h e ld me o u t a s a d is t in g u is h e d s t u d e n t ) . 1 4 . The a r t c l a s s . . . ............................................... (was e n jo y a b le . You co u ld l o a f and daw dle, f e e l s a t i s f i e d to o , even w ith no t a l e n t l i k e m e). 2 2 . The one th in g I can remember ab o u t sc h o o l ..................................... ( i s to w alk to sc h o o l a t 7 :0 0 A .M ., lo a d s o f b o o k s, o r th e way hom e--an i n t e r v a l o f tim e i n a busy d a y ) . S e v e r a l o f th e E d u c a tio n a l H is to ry T hem atic A p p e rc e p tio n " s t o r i e s ” o f th e same in d iv id u a l w ere as fo llo w s : C ard I . A New York p r o g r e s s iv e sc h o o l . . . th e scen e i s m o b ility , th e m o tto i s "group and r e g r o u p ," tw e n ty -f iv e b r i g h t 3 rd g r a d e r s le a r n th e equipm ent f o r a m id tw e n tie th C entury l i f e , a t l e a s t w hat t h e i r w ell-m e an in g e ld e r s r e g a r d as r e le v a n t o r e s s e n t i a l . The d e s k s a re n o t n a ile d to th e f l o o r , as o f o ld , b u t move and movement i s th e e x p e rie n c e o f th e c h i l d . The A m erican In d ia n i s u n d er d i s c u s s io n i n a S o c ia l S tu d ie s u n i t ; th e te a c h e r , n o t in o u r im m ediate v ie w , moves around th e c l a s s , s p e a k in g , q u e s tio n in g , d e m o n stra tin g from a l l • 48 d i f f e r e n t a n g le s . Jo h n W ilb e r t, s e a te d r i g h t in th e lo w er c e n te r o f o u r v iew , becom es t i r e d o f m oving t h i s way and t h a t . He d i d n 't c a re i f In d ia n s u se d c o m s to c k s f o r w eaving m a ts , he was c o n te n t to f a c e f r o n t , from r e l i e f o f tu r n in g . Jam ie, j u s t to h i s r i g h t , was e a tin g som eth in g on h i s f in g e r , t h i s annoyed J o h n n ie , a s d id J e n n i f e r 's in c e s s a n t e a g e rn e s s to f u r n is h th e c o r r e c t an sw ers to th e ways o f co rn s to c k w eaving and su c h . She s a t s t r a i g h t up i n h e r c h a i r , as i f she had a broom h a n d le in h e r b a c k , j u s t th r e e s e a t s r i g h t o f J o h n n ie . To J e n n if e r i t was l i k e e a tin g a l l o f h e r p e a s . . . Mummy lik e d i t . The te a c h e r was young, u n fu rro w ed by y e a rs o f e x p e rie n c e , f r e s h in h e r w ays, and a c t u a l l y , th ough sup p o sed th e ro a d to t h a t com placency to be ab h o red , q u i t e s a t i s f i e d . She saw th e e a g e r f a c e s , as she lo o k e d h e re a n d 't h e r e , and g e n e r a liz e d from th e s e im p re s s io n s a keen e a r n e s tn e s s , c u r i o s i t y , even th e e j a c u l a to r y jo y s o f illu m in a tio n on b e h a lf o f th e c l a s s . She knew t h a t she knew how to te a c h . Jam ie lo o k e d a t th e te a c h e r now and th e n . He w ondered i f sh e had a c o ld to o . . . w hat h e r s would t a s t e l i k e . He had se e n an In d ia n o n ce , w ith, o n ly a f e a t h e r and a p ie c e o f d e e r s k in o v e r h i s p e n ie ; th e la d y In d ia n s had b ig brown bags on t h e i r c h e s ts and no c l o t h s . (Jam ie drew a p i c t u r e o f such an In d ia n la d y and drew in w ith a d o t t e d - l i n e lo n g cu rv ed l i n e s , r e p r e s e n tin g (p e e, pu) from th e brown b a g s .) C ard 4 . Among h i s fe llo w c l a s s m a te s, Jo n a th a n i s th e m ost d e l i c a t e , f r a g i l e i t seem s, c h i ld , even th e s m a lle s t and s l i g h t e s t g i r l a p p e a rs r o b u s t in co m p ariso n , and s u b t l e l y jo in e d w ith h i s a n g u la r lim b s, aw kw ardness o f movement accom panies h i s n e c e s s a r i l y slo w ly ram b lin g arra n g em en t o f tru n k and lim b s . H is com plexion i s c l e a r , he may have to w ear g l a s s e s , a d o c to r t o l d him . He i s m ost s e n s i t i v e , a s th e m orning g lo r y to th e g lim p se o f dawn, to h u r t , to d e je c tio n w ith in a b l u r r y eyed c o n fu s io n , a lth o u g h in tim e s o f norm alcy he b o b b le s u n d e l ib e r a te ly in a f l u i d w o rld o f d e l i g h t . C ard 6 . M r. S te w a rt had g r a d u a lly come upon h is m is s io n : to b r in g th e w o rld o f s c ie n c e to J u n io r h ig h sc h o o l s tu d e n ts . These boys and g i r l s l i k e t h e i r s c ie n c e c l a s s and te a c h e r . They le a r n th e c a u se s o f th in g s - th in g s t h a t th e y can do - ac c o m p lish 49 acco m p lish w ith t h e i r own hands and m inds. To Mr. S te w a rt, s c ie n c e i s o m n ip o ten t and a b so rb s a l l o f h is M e ssia n ic i n s t i n c t . The s tu d e n ts a ls o e x p e r i ence t h i s pow er, in a budding form , and g a in in s e lf - e s te e m w ith grow ing c o m p e te n c ie s. Tom and E ric see pathw ays o p ening o n to c o n firm a tio n in w hat th ey l a t e r w i l l know as a v a s t econom ic m achine. The g i r l s do n o t know why s c ie n c e p le a s e s them , g ra sp i t u n q u e s tio n in g ly . The boys in w ard ly c o n fu se d ly wonder why th e g i r l s o f f e r so keen c o m p e titio n , r u t h l e s s l y i t som etim es seems to them . C ard 7 . K athy knows t h e . r i g h t answ er and s tr u g g le s w ith n erv o u s energy to be re c o g n iz e d . N early a l l o f th e c h ild r e n p u t t h e i r hands up f o r t h i s q u e s tio n - a l l h o ping t h a t h e o r she w i l l b e g iv e n a chance to r e c i t e th e c o r r e c t answ er v i c t o r i o u s l y . She f e e l s t h a t th e te a c h e r won1t c a l l on h e r , f o r i t happens r a th e r r a r e l y . T h is h u r ts h e r , she o f te n has known th e r i g h t answ er when some o th e r c h ild has b lu n d e re d i t . The te a c h e r i s d e lig h te d w ith th e e a g e r re sp o n se o f h i s s tu d e n ts , b u t i s unaw are o f how t h i s m o tiv a tio n h as come in to b e in g , unaw are o f w hat i t r e a l l y i s . He i s unaw are o f th e im p lic a tio n s f o r such an e a g e rn e ss f o r a p p ro v a l o r need f o r su c c e s s - c a r ie d to such an ex trem e a s to cau se c o n tin u o u s d is a p p o in tm en t and f e e l in g s o f d e je c tio n on th e p a r t o f some c h ild r e n . He i s unaw are o f th e dynam ic o f th e le a r n in g p ro c e s s and o f a l l t h a t i s le a rn e d - in th e se n se o f modes o f em o tio n al - th o u g h t re sp o n se to o n e 's l i f e and w o rld . He f e e l s t h a t he i s a su c c e ss a t h is jo b . T here i s l i t t l e , i f any, com m unity o r group problem s o lv in g in h is c l a s s , r a th e r c h ild r e n com pete f o r th e s p o t - l i g h t . C ard 9 . M iss Owen, th e l i b r a r i a n , o c c a s io n a lly re a d s to th e c h ild r e n , from some book o r o th e r she ju d g ed e s p e c i a lly good o r e n t e r t a i n i n g . The c h ild re n had seen o r re a d th e "F iv e C h in ese B ro th e rs " b e f o r e , and en jo y ed i t , "so why n o t? " B i lly (W ide-eyed b lo n d boy in th e f r o n t ) had seen a p i c t u r e o f a Chinaman w ith a long cu rv ed sw ord. He was n o t p ay in g to o much a t t e n t i o n to M iss Owen, b u t th o u g h t o f f iv e C hinese b r o t h e r 's h ead s se v e re d w ith a long curved sw ord. H is ey es g o t .b i g . Suzy, to B i l l y 's l e f t , l i s t e n e d to th e s to r y o u t o f a se n se o f d u ty , and when th u s l i s t e n i n g w ith a tr a c e o f s e l f - r i g h t e o u s n e s s in h e r f e e l i n g s . Edward, up and betw een Suzy and B i l ly , th o ro u g h ly en jo y ed th e p a r t ab o u t th e Chinaman s le g s s tr e t c h in g to th e bottom o f th e s e a , 50 th e re b y to a v e r t d i s a s t e r , b u t even m ore, th e Chinaman who c o u ld j u s t n o t b e cooked in th e oven. W ith th e same d e g re e o f s i m p l i c i t y , M iss Owen th o u g h t t h a t , in th e C h in ese b r o t h e r s ' m ira c u lo u s e sc a p e from d e a th , sh e was s t i r r i n g th e d e p th s o f c h ild h o o d im a g in a tio n . F or s o o th , sh e b u t m essed on th e s u r f a c e . The Check L i s t C hoice T echnique G u ilfo rd (1950) s t a t e s t h a t " C h e c k - lis t i n s t r u m ents a r e r e l a t i v e l y new and w ould seem 'to be grow ing in f a v o r ." Among th e arg u m en ts in fa v o r o f t h i s m ethod a r e th e f o llo w in g : 1 . T here i s s i m p lic ity o f a d m in is t r a tio n . 2 . Minimum d is c r im in a tio n i s r e q u ir e d from th e r a t e r s in term s o f q u a n t i t a t i v e ju d g m en t. 3 . S c o rin g i s v e ry e a s y , e s p e c i a l l y w here ite m s a r e m erely r a t e d 1 o r 0 . 4 . I t s m ost u s e f u l a p p l ic a t io n i s to v e ry com plex v a r i a b l e s . The c h e c k - l i s t ty p e o f in s tru m e n t can be a d a p te d to th e a sse ss m e n t o f a u n iq u e v a r i a b l e su ch as a s in g l e t r a i t o f p e r s o n a l i t y . Among th e w eak n esses in t h i s m ethod, G u ilfo rd u n d e rs c o re s th e f o llo w in g : 1 . The p ro c e d u re o f m e re ly ch e ck in g th e re s p o n s e s t h a t a p p ly i s open to re s p o n s e b i a s . 2 . I t w ould be much b e t t e r to r e q u ir e th e r a t e r to check one way, i f th e ite m a p p l i e s , and a n o th e r way i f i t does n o t r a t h e r th a n a llo w th r e e c h o ic e s . 3 . However, s in c e th e r e i s o f te n r e s i s t a n c e to th e fo rc e d -c h o ic e ty p e o f ite m , i t i s p ro b a b ly b e s t in p r a c t i c e to allo w th e u se o f a d o u b tf u l, o r " I d o n ’ t know.” c a te g o ry , u rg in g t h a t i t b e u sed v e ry s p a r in g ly . 4 . Not a l l re s p o n s e b ia s e s w i l l b e removed by th e l a t t e r , b u t i t w i l l be h e lp f u l in a v o id in g a la r g e "does n o t ap p ly " c a te g o r y , w hich co u ld h av e many d i f f e r e n t m ean in g s. G u ilfo rd f u r t h e r ta k e s th e p o s itio n t h a t r e q u ir in g one o r tw o, o r t h r e e , re s p o n s e s to ev e ry s ta te m e n t, w i l l a ls o h elp s o lv e th e s c o rin g p ro b lem . T hat i s to sa y , e v e ry re sp o n se sh o u ld have a w e ig h t. T his does n o t p r e c lu d e th e u s e o f w e ig h ts lim ite d to 1 and 0 , such a s was done in t h i s s tu d y . V a li d ity and R e l i a b i l i t y o f In s tru m e n ts Employed No g e n e r a liz e d o r a b s t r a c t s ta te m e n t r e g a rd in g th e v a l i d i t y and r e l i a b i l i t y o f th e S en te n ce C om pletion T e s t and th e T hem atic A p p e rc e p tio n T e st p e r se can be m ade. F re q u e n tly , in th e r e s e a r c h s tu d ie s in w hich th e s e t e s t s have been u s e d , th e v a r ia b le s com pared d i f f e r e d . In d ep en d e n t c r i t e r i a em ployed have seldom b een th e sam e. P a r t i c u l a r l y in th e c a s e o f th e S en ten ce C om pletion T e s t, b u t a ls o w ith th e T hem atic A p p ercep tio n T e s t, d i f f e r e n t v e r s io n s o f th e t e s t have been in v o lv e d . Not in f r e q u e n tly 52 th e s c o rin g m ethods have been d i s s i m il a r . Four k in d s o f v a l i d i t y were r e f e r r e d to in th e te c h n ic a l recom m endations r e p o r t o f th e A m erican Psycho l o g i c a l A s s o c ia tio n Com mittee on P sy c h o lo g ic a l T e s ts (1 9 5 4 ). These w ere as fo llo w s : 1 . C o n ten t v a l i d i t y . 2 . P r e d ic tiv e v a l i d i t y . 3. C o n c u r r e n t .v a lid i ty . 4. C o n s tru c t v a l i d i t y . In t h i s s tu d y , i t i s f e l t t h a t th e c o n d itio n s f o r b o th ad e q u ate c o n te n t and c o n s tr u c t v a l i d i t y have been m et. R egarding c o n te n t v a l i d i t y , o b v io u sly b o th th e E d u c a tio n a l H is to ry S en ten ce C om pletion T e s t and th e E d u c a tio n a l H is to ry T hem atic A p p ercep tio n T e st sam ple th e a t t i t u d e s o f two g ro u p s o f in d iv id u a ls i n t e r a c t i n g p e r c e p tu a lly w ith a c la s s o f s i t u a t i o n s , nam ely sc h o o l s i t u a t i o n s . T h is i s a b a s ic a s p e c t o f t h i s s tu d y . A ccep tin g M u r s te in 's (1960) d e f i n i t i o n o f c o n s tr u c t v a l i d i t y f o r p u rp o se s o f t h i s s tu d y , i t i s f e l t t h a t c o n d itio n s f o r th e l a t t e r have a ls o been m et. M u rste in d e f in e s c o n s tr u c t v a l i d i t y a s th e p s y c h o lo g ic a l t r a i t o r c h a r a c t e r i s t i c w hich i s n o t o p e ra t i o n a l l y d e fin e d , b u t, a s a c o n s tr u c t i s presum ed to a c co u n t f o r th e b e h a v io r o b serv ed on th e t e s t . H ere i t i s n o t th e t e s t s c o re o r even th e c r i t e r i o n e v a lu a tio n w hich i s o f p rim ary i n t e r e s t , b u t r a t h e r th e t r a i t o r p e r s o n a lity 53 q u a l i t y a c c o u n tin g fo r th e s e o v e r t m a n if e s ta tio n s . In t h i s r e s e a r c h , th re e ju d g e s w ere asked to mark a ch eck l i s t from th e p r o to c o l m a te r ia l a s to w h eth er te n a t t i t u d i n a l d im en sio n s w ere p r e s e n t, a b s e n t, o r u n c e r t a in . These a t t i t u d i n a l d im en sio n s w ere, nam ely: 1 . A n x ie ty in a sc h o o l c o n te x t. 2. D ep ressio n i n a sc h o o l c o n te x t. 3. R e la tio n s h ip s w ith p e e r s and te a c h e rs in a sch o o l c o n te x t. 4 . P e rc e p tio n s o f te a c h e rs as r e j e c t i n g , h o s t i l e , d o m in eerin g , o r o v e r-p ro te c tin g p a r e n t f i g u r e s . 5 . F e e lin g s o f in a d eq u acy re g a rd in g sc h o o l ac h iev e m e n t. 6 . M o tiv a tio n to w ard s c h o o l. 7 . A nger and h o s t i l i t y i n th e sc h o o l en v iro n m en t. 8 . F a n ta s y in sc h o o l as i t r e l a t e d to b e in g a b le to pay a t t e n t i o n and c o n c e n tr a te i n th e c la ssro o m . 9. P sy ch o sex u al i d e n t i f i c a t i o n and h e te ro s e x u a l s o c i a l i z a t i o n . 1 0 . L ik in g or d i s l i k i n g sc h o o l from a g e n e ra liz e d v ie w p o in t. The a fo re m e n tio n e d te n d im en sio n s can be c o n s id e re d e q u iv a le n t to w h a t, in M u r s te in 's d e f i n i t i o n , i s m eant by a t r a i t o r p e r s o n a lity q u a l i t y . 54 Rese a r c h R eg ard in g TAT an d Sente n c e C om pletion V a l i d i t y and R e l i a b i l i t y In th e l i g h t o f th e d is c u s s io n in th e p re v io u s s e c tio n , i t can be s a id o f th e la r g e r e s e a r c h l i t e r a t u r e in w hich th e TAT and S e n te n c e C o m p letio n t e s t s w ere u s e d , t h a t l i t t l e i f any o f i t h a s s p e c i f i c a p p l ic a tio n to th e n e e d s o f th e p r e s e n t s tu d y . However, some a s p e c ts o f a s tu d y in v o lv in g th e v a l i d i t y and r e l i a b i l i t y o f th e TAT, by H enry and F a r le y (1 9 5 9 ), m e r it c o n s id e r a tio n h e r e . In t h i s s tu d y , w hich was a m o d ifie d m a tch in g e x p e rim e n t, e x p e rie n c e d c l i n i c i a n s a tte m p te d to I d e n t i f y a g ro u p o f s u b je c ts by TAT a n a ly s e s . T h ere w ere t h i r t y - s i x i n d iv i d u a ls i n th e g ro u p . They w ere a l l norm al a d o le s c e n t s , b o m in th e same y e a r , from a s in g l e s c h o o l, and a t th e same g ra d e l e v e l . In s o c i a l o r i g i n , th e y came from g e n e r a lly th e same so c io -e co n o m ic l e v e l , liv e d In a s in g le com m unity, and p a r t i c i p a t e d in o v e rla p p in g s o c i a l and r e c r e a t i o n a l g ro u p s . None o f th e c l i n i c a l p s y c h o lo g is ts h ad any in fo rm a tio n a b o u t th e s e y o u th s e x c e p t age and se x . The TAT a n a ly s is was t r e a t e d a s a b a s is f o r p r e d i c t i o n and m atched a g a in s t id e a s r e f e r r i n g to a p a r t i c u l a r a r e a o f p e r s o n a li t y f u n c tio n in g . A summary o f th e s e a r e a s i s a s f o llo w s : 55 I . S o c ia l I n t e r a c t i o n A. P e e rs (1) D egree o f p a r t i c i p a t i o n ( i . e . , i s o l a t e , a c tiv e p a r t i c i p a n t , s o c i a l s u c c e s s , e t c e t e r a ) . (2) N atu re o f p a r t i c i p a t i o n ( i . e . , le a d e r , f o llo w e r , d e p e n d ab le , co n fo rm in g , r e b e l l i n g , e t c e t e r a ) . (3) Q u a lity o f r e l a t i o n to p e e rs ( i . e . , group w arm /cool tow ard him , w arm /cool f e e lin g tow ard o th e r s , t r u s t e d / n o t tr u s t e d , e t c e te r a ) . B. Fam ily (1) F e e lin g s tow ard m other and o th e r fam ily r e l a t i o n s h i p s ( s ib lin g s i t u a t i o n , a t t i t u d e tow ard f a t h e r , e t c e t e r a ) . , C. S o c ia l R e la tio n to Community I I . C h a r a c te r i s t i c s o f th e S e lf A. M en tal F u n c tio n in g (1) I.Q . ( p o te n ti a l f u n c tio n in g , p r e s e n t l e v e l, sc h o o l work ac h iev e m en t, e t c e t e r a ) . (2) M ental ap p ro ach and o r g a n iz a tio n (judgm ent o f l e v e l o f o r g a n iz a tio n and q u a l i t a t i v e e la b o r a tio n s , e t c e t e r a ) . (3) M o tiv a tio n a l f a c t o r s (a m b itio n , energy 56 in v e s tm e n t, e t c e t e r a ) . B. Im a g in a tio n (1) Q u a lity o f im a g in a tio n and c r e a t i v i t y . V , (2) F a n ta sy a s an e s c a p e . (3) N atu re o f f a n ta s y ( g e n e r a l, o m n ip o te n t, e t c e t e r a ) . C. P a tte r n s o f E m o tio n al A d ju stm en t (1) B a sic e m o tio n a l a t t i t u d e ( a c t i v e / p a s s i v e ) . (2) A ccep tan ce o f im p u lses ( a c c e p t / r e j e c t , im p o rta n t/u n im p o rta n t, e t c e t e r a ) . (3) A n x iety (p re s e n c e and d e g re e , o r a b se n c e , form ta k e n , s o u rc e o f p rim a ry f o c u s ) . D. M echanism s o f D efense E. E m o tio n al R e a c tiv it y ( i n t r o v e r s i o n /e x t r o - v e r s io n , p r e o c c u p a tio n , e t c e t e r a ) . F . S ex u al A d ju stm en t (1) A n x iety and g e n e r a l a d ju s tm e n t. (2) R ole ( s o c i a l / p h a l l i c , a g g r e s s iv e /p a s s iv e , am ount o f i n t e r e s t , p a r t i c i p a t i o n , e t c e t e r a ) . The a u th o rs u s e d a n a ly s is o f v a r ia n c e te c h n iq u e s and in one o f th e a r e a s e s p e c i a l ly p e r t i n e n t to th e p r e s e n t stu d y th e r e l a t i o n s h i p betw een TAT c l i n i c a l ju d g m en ts and c r i t e r i a w ere a t a h ig h c o n fid e n c e l e v e l (P * = ^ .0 1 ). C r i t e r i a w ere o b je c tiv e t e s t s c o re s and sum m aries o f 57 o b s e rv a tio n s 'a n d in te rv ie w s w ith th e s u b j e c t s , te a c h e r s , and f a m i l i e s . T hese w ere i n t e r p r e t e d by c l i n i c i a n s who had n o t a d m in is te re d th e t e s t s o r co n d u c ted th e i n t e r v i e w s . P a ir in g s o f th e ju d g e s y ie ld e d c o r r e l a t i o n c o e f f i c i e n t s t h a t ra n g e d from .380 to .5 1 6 . A nother r e c e n t stu d y by L ip s h e r (1962) h as some s im ila r v a lu e in r e l a t i o n to th e p r e s e n t r e s e a r c h . T h ree g roups o f s u b je c ts each co m p o sed .o f n in e in d iv id u a ls w ere u se d . One group o f s u b je c ts was composed o f s c h iz o p h r e n ic s . A second group was com posed o f n e u r o t i c s . The t h i r d g r o u p 's members w ere a l l c o n s id e re d to b e n o rm al. T hree t e s t s , th e M in n eso ta M u ltip h a s ic P e r s o n a lity In v e n - . t o r y , th e R o rsc h ach , and th e TAT w ere a d m in is te r e d . T h ree groups o f ju d g e s w ere u s e d , tw elv e in each g ro u p . Each group w as a t a d i f f e r e n t l e v e l o f e x p e rie n c e and e d u c a tio n in th e f i e l d o f c l i n i c a l p sy c h o lo g y . One g roup c o n s is te d o f f i r s t - y e a r g ra d u a te s tu d e n ts . The second g r o u p 's mem b e rs w ere a l l ad v an ced beyond th e f i r s t y e a r o f g ra d u a te w ork. The t h i r d g roup was composed o f tw elv e c l i n i c a l p s y c h o lo g is ts w ith c o n s id e r a b le p o s td o c to r a l e x p e rie n c e . T h e ir ju d g m en t ta s k c o n s is te d o f r a t i n g th e t e s t m a te r ia l alo n g te n p e r s o n a lity d im en sio n s su ch as h o s t i l i t y , a n x ie ty , g u a rd e d n e ss, im p u ls iv e n e s s , e t c e t e r a . The h y p o th e s is t h a t e x p e rie n c e would be u n r e la te d to con s is te n c y and a c c u ra c y o f ju d g m en t, o r to th e m atching o f 58 s u b j e c t s ' p r o to c o ls , was u p h e ld . However, th e ju d g e s w ith a m o d erate to ex trem e amount o f e x p e rie n c e w ere more a c c u r a t e (P“ < . .0 0 1 ) and m ore s u c c e s s f u l i n t h e i r m a tch in g o f p r o to c o ls th a n w ere th e n a iv e ju d g e s (P-<i .01 and P - c .05 r e s p e c t i v e l y ) . B o th th e s e r e s e a r c h e s have some s i m i l a r i t y to th e p r e s e n t s tu d y . L e t i t be assum ed fo r th e moment, by way o f co m p ariso n w ith t h e Henry a n d F a rle y (1959) r e s e a r c h , t h a t s c h iz o p h re n ia a n d norm alcy a re th e c r i t e r i a w ith w hich we a r e lin k in g o u r ju d g e s ' r a t i n g s o f th e E d u c a tio n a l H is to r y S e n te n c e C om pletion T e s t and t h e E d u c a tio n a l H is to ry T h em a tic -A p p erce p tio n T e s t re s p o n s e s . Then, as th e p i l o t s tu d y has d e m o n s tra te d , a h ig h c o n fid e n c e le v e l h a s been a c h ie v e d (P-=C .01) i n d is c r im in a tin g b etw een th e h o s p i t a l i z e d and th e norm al sa m p le s. R eg ard in g i n t e r r a t e r r e l i a b i l i t y , a s im ila r ly ad e q u a te le v e l h a s been a c h ie v e d ( .6 8 3 ) . The co n g ru en ce w ith th e L ip s h e r stu d y seem s c l e a r . For in th e p r e s e n t stu d y , to o , a t t i t u d e d im e n sio n s (in c lu d in g f e e lin g s some o f w hich a r e i d e n t i c a l w ith th e L ip s h e r r o s t e r ) were r a t e d by ju d g e s w ith th e aim o f d e te rm in in g w h eth e r they d is t i n g u i s h e d one p o p u la tio n from a n o th e r o r n o t. R eg ard in g s t u d i e s in v o lv in g th e S en ten ce C om pletion T e s t . R o th e r and W illerm an (1947) a p p lie d th e Spearm an- Brown e q u iv a le n t h a lv e s fo rm u la to a v a l i d i t y stu d y o f th e 59 S en te n ce C om pletion T e s t . Two h u n d red e n l i s t e d men w ere u se d a s s u b je c ts and th r e e c a te g o r ie s o f re s p o n s e s w ere s c o re d : (1) c o n f l i c t o r u n h e a lth y re s p o n s e s ; (2) p o s i t i v e o r h e a lth y r e s p o n s e s ; (3) n e u t r a l re s p o n s e s . They r e p o r te d a c o r r e l a t i o n o f .3 5 . Rhode (1947) com pared th e re s p o n s e s o f one hundred n in th - g r a d e s tu d e n ts to a S en te n ce C om pletion T e s t w ith d a ta o b ta in e d by p e r s o n a l in te r v ie w , th e r a t i n g s o f fo u r te a c h e r s , in fo rm a tio n from g u id a n c e c o u n s e lo r s , and cum ula t i v e c a rd r e c o r d s . C o r r e la tio n s w ere o b ta in e d alo n g t h i r t y - f o u r d im en sio n s o f p e r s o n a l i t y such a s a g g r e s s io n , c o n f l i c t , e m o tio n a lity , p essim ism , ego i d e a l , a c h iev e m e n t, e t c e t e r a . R e s u lts ra n g e d from c o r r e l a t i o n s o f .30 to .95 w ith an a v e ra g e p e r s o n a l i t y ite m c o r r e l a t i o n o f .78 f o r g i r l s , .82 f o r th e b o y s. B o rg a tta (1961) o b ta in e d c o r r e l a t i o n s betw een S en ten ce C om pletion m a t e r i a l , th e G u ilfo rd Zimmerman P e r s o n a li t y S u rv e y , th e T h u rsto n e Tem peram ent S c h e d u le , th e Edwards P e rs o n a l P re fe re n c e S u rv ey , and th e C a t e l l S ix te e n P e r s o n a li ty F a c to r Q u e s tio n n a ir e . He co n c lu d ed re g a rd in g th e c o n s tr u c t v a l i d i t y o f th e MAST (Make a S en ten ce T e s t) t h a t " In g e n e r a l, th e r e s u l t s o f t h i s r e g r e s s i o n ap p ro ach m ust b e deemed more th a n j u s t e n c o u ra g in g ." R eg ard in g r e l i a b i l i t y , m ost o f th e e v id e n c e su p p o r t s th e g e n e r a l c o n c lu s io n t h a t th e t e s t - r e t e s t 60 r e l i a b i l i t y o f th e TAT and s e n te n c e c o m p le tio n m ethod i s low , f a r below le v e ls o f r e l i a b i l i t y demanded by co n s t r u c t o r s o f t e s t s o f m en tal a b i l i t y , s o c i a l a t t i t u d e s , e t c e t e r a . However, th e r e i s some e v id e n c e t h a t , re g a rd in g th e T h erm atic A p p ercep tio n T e st a lo n e , h ig h e r t e s t - r e t e s t r e l i a b i l i t y may be o b ta in e d when th e p i c tu r e s u sed u n am biguously r e p r e s e n t a p a r t i c u l a r c o n te n t a r e a . Kagan (1959) r e p o r ts , f o r exam ple, t h a t o n ly two o f e ig h t v a r i a b le s showed s t a t i s t i c a l l y s i g n i f i c a n t t e s t - r e t e s t r e l i a b i l i t y o v er th e c o u rse o f a s ix - y e a r p e r io d , b u t in d ic a t e s t h a t th e s e two s ta b le v a r ia b le s w ere e l i c i t e d p r im a r ily by p i c t u r e s w hich unam bigously p o rtra y e d them . S e v e ra l such s t u d i e s , t h a t i s to sa y , in w hich th e p i c t u r e s u sed u n am biguously r e p r e s e n te d a p a r t i c u l a r c o n te n t a r e a , s im i l a r l y r e s u l t e d in low , b u t n e v e r th e le s s s i g n i f i c a n t , t e s t - r e t e s t r e l i a b i l i t y r e s u l t s (Morgan, 1953; L indzey and Hanmann, 1955; L indzey and Herman, 1955; H anley, 1955; K rum bholtz and F a rq u a r, 1957; H aber and A lp e r t, 1 9 5 8 ). C e r ta in ly th e n , our own r e s e a r c h was enhanced in term s o f r e l i a b i l i t y by th e f a c t t h a t o u r E d u c a tio n a l H is to ry T h erm atic A p p e rc e p tio n T e s t was com posed, e x c e p t f o r th e in c lu s io n o f th e b la n k c a rd from th e o rth o d o x TAT s e t , o f n in e p ic tu r e s u n m ista k a b ly c o n ta in in g c o n te n t in a sc h o o l s e t t i n g . CHAPTER IV ANALYSIS OF THE RESEARCH FINDINGS - T a b u la tio n and P ro c e s s in g o f th e Raw D ata The s e l e c t i o n o f th e two g ro u p s (h ere r e f e r r e d to f o r b r e v ity a s th e p a t i e n t and c o n tr o l g ro u p s ), th e n a t u r e o f th e in s tru m e n ts a d m in is te r e d , and th e ty p e o f ju d g e s u s e d , have been d is c u s s e d in C h a p ter I I I . The raw d a ta o b ta in e d by th e p ro c e d u re s th e r e d e s c rib e d c o n s is te d o f one s h e e t f o r each s u b je c t, c o n ta in in g t h i r t y r a t i n g s - - one from ea c h ju d g e on each o f th e te n q u e s tio n s . S in ce th e te n q u e s tio n s w ere n o t c o n s id e re d to form a co m p o site s c a le g iv in g r i s e to a s c a le s c o re , th e y w ere a n a ly z e d s e p a r a t e ly . In ea ch c a s e th e m ajor c o n s id e r a tio n was w h eth e r th e ju d g e s ' r a t i n g s showed t h a t th e q u e s tio n co n c e rn e d was h ig h ly r e le v a n t to a d i s t i n c t i o n betw een th e s c h iz o p h re n ic p a t i e n t s and th e norm al o r c o n tr o l g ro u p . A seco n d c o n s id e r a tio n was w h eth e r th e o b ta in e d d if f e r e n c e was in the" p r e d ic te d d i r e c t i o n . T h ir d ly , th e d e g re e o f ag reem en t among th e r a t e r s was o f i n t e r e s t , e s p e c i a lly i n view o f th e f a c t t h a t no r a t e r knew, in s c o rin g a g iv en p r o to c o l, to w hich o f th e two g ro u p s th e s u b je c t b e lo n g e d . The ju d g e s ( r a t e r s ) w ere asked to mark each 61 62 q u e s tio n f o r ea ch s u b je c t by i n d ic a t in g w h eth er th e r e l e v a n t a t t i t u d e was p r e s e n t o r a b s e n t. They w ere a ls o g iv e n a t h i r d c h o ic e , " n o t c e r t a i n , " b u t ask ed to u se t h i s as s p a r in g ly a s th e y w ere a b l e . When t h e i r ch eck l i s t s w ere r e tu r n e d to th e i n v e s t i g a t o r i t was found t h a t t h i s .-"not c e r t a i n " re s p o n s e had b een u se d in o n ly v e ry few i n s t a n c e s . I t seem ed more c o n s e r v a tiv e to c o n s id e r t h a t , i f a ju d g e w ere u n a b le to s t a t e p o s i t i v e l y t h a t an a t t i t u d e was p r e s e n t , th e " n o t c e r t a i n " re s p o n s e was ta n tam o u n t to m arking i t a b s e n t. T hese few " n o t c e r t a i n " re s p o n s e s w ere th e r e f o r e com bined w ith th e " a b s e n t" r e s p o n s e s . ; In c o n v e rtin g th e check l i s t m ark in g s to s c o fe s w hich co u ld th e n be p ro c e s s e d by e l e c t r o n i c c o m p u ters, " p r e s e n t" was a s s ig n e d a v a lu e o f 1, w h ile " a b s e n t" and " n o t c e r t a i n " w ere g iv e n a v a lu e o f 0 . Each o f th e f i f t y p r o to c o ls th u s c o n s is te d o f a s e t o f t h i r t y b in a ry s c o r e s , w hich w ere th e n punched in to IBM c a rd s and p ro c e s s e d a t th e H e a lth S c ie n c e s Com puting F a c i l i t y , U n iv e r s ity o f C a lif o r n i a a t Los A n g ele s, u s in g program B M D X66. T h is program p erfo rm ed an a n a ly s is o f v a r ia n c e on e a c h o f th e te n q u e s tio n s in d e p e n d e n tly , s e p a r a tin g th e so u rc e s o f v a r ia n c e in su ch a way t h a t (a) a norm al two-way a n a ly s is o f v a r ia n c e c o u ld be r e p o r te d , and (b ) a c o e f f i c i e n t o f r a t e r r e l i a b i l i t y c o u ld be c a l c u l a t e d . These r e s u l t s a r e d is c u s s e d b elo w . The 63 means and d if f e r e n c e s betw een th e means o f th e p a t i e n t and c o n t r o l g ro u p s, to g e th e r w ith o v e r a ll m eans and m edians to f a c i l i t a t e a p p r a i s a l s o f th e e f f e c t i v e n e s s o f th e v a r io u s q u e s tio n s , a r e a ls o p r e s e n te d . The c o e f f i c i e n t s o f r a t e r r e l i a b i l i t y were c a lc u l a t e d by a fo rm u la o f E b e l 's , a s re p o rte d b y G u ilfo rd (1 9 5 4 ). T h is fo rm u la , in G u i lf o r d 's n o t a t i o n , i s : V - V *kk = _ ! ____" , vp w here k d e n o te s th e num ber o f r a t e r s ( ju d g e s ) , Vp d e n o te s th e v a r ia n c e due to p e rso n s ( s u b j e c t s ) , and V0 d e n o te s th e e r r o r v a r ia n c e o r " r e s i d u a l" v a r ia n c e . The H ypotheses and th e E x p e rim e n ta l R e s u l t s ; G e n e ra l E ach o f th e te n q u e s tio n s posed in C h ap ter 1 con ta in e d a r e s e a r c h h y p o th e s is in i m p l i c i t fo rm . S in c e in each c a se th e r e le v a n t s t a t i s t i c a l t e s t in v o lv e d com paring th e means o f th e p a t i e n t and c o n t r o l g ro u p s , th e d i r e c t i o n o f th e d if f e r e n c e b e in g p r e d i c t e d , th e se t e n t e s t s w ere " o n e - t a i l e d , 1 1 and to ea c h q u e s tio n c o rre sp o n d s a p a i r o f h y p o th e s e s . Each such p a i r c o n s i s t s o f a n u l l h y p o th e s is (H0 ) and an a l t e r n a t e , d i r e c t i o n a l h y p o th e s is (Ha ) . As alw ay s, when s e v e r a l ju d g e s r a t e each s u b j e c t , th e r e was th e e x p e c ta tio n t h a t t h e i r i n s t r u c t i o n s an d 64 p r o f e s s io n a l e x p e r tis e w ould be ad e q u ate to e n s u re an a c c e p ta b le le v e l o f a g reem en t. The e x te n t to w hich t h i s was a c h ie v e d fo r ea ch q u e s tio n may be d eterm in ed in th r e e ways from th e a n a ly tic r e s u l t s . I f th e F - r a t i o f o r th e so u rce o f v a ria n c e la b e le d " R a te rs " i s n o t s i g n i f i c a n t , th e n th e means o f th e th r e e ju d g es u se d in t h i s stu d y w ere n o t v e ry d i f f e r e n t . T h is im p lie s t h a t no r a t e r had an overw helm ing ten d en cy to se e a t t i t u d e s a s " p r e s e n t" w h ile th e o th e r s found them " a b s e n t" o r v ic e v e r s a . S econdly, th e v ery sm all F - r a t i o s o b ta in e d f o r th e so u rce la b e le d " I n t e r a c t i o n " show t h a t th e r e was v e ry l i t t l e , i f an y , c o r r e l a t i o n betw een group membership and in d iv id u a l ju d g e s --n o n e had a g r e a t p r o c l i v i t y f o r id e n tif y in g sub j e c t s in d is c r im in a te ly as s c h iz o p h re n ic o r as n o rm al. T h ird ly , th e c o e f f i c i e n t o f r a t e r r e l i a b i l i t y shows th e g e n e ra l l e v e l o f agreem ent a t ta i n e d by th e ju d g e s on each q u e s tio n . As w ill be se e n , in g e n e ra l, th e d is c r im in a tio n betw een th e two g ro u p s ( a b i l i t y o f th e ju d g e s to a s s ig n s u b je c ts c o r r e c t ly to one o r th e o th e r group on th e b a s is o f t h e i r p r o to c o ls ) was e x c e ll e n t; r a t e r b ia s o f th e f i r s t s o r t was r a r e ; th e i n t e r a c t i o n e f f e c t was i n s i g n i f i c a n t in a l l b u t one q u e s tio n , and th e c o e f f i c ie n t s o f r a t e r r e l i a b i l i t y w ere s i g n i f i c a n t l y la rg e on a l l b u t one q u e s tio n . The H ypotheses and th e E x p erim e n tal R e s u lts : D“ g a i l H : The te n main h y p o th e se s concerned th e s ig n if ic a n c e 65 o f th e d if f e r e n c e s betw een th e p a t i e n t and c o n tr o l groups on each q u e s tio n . As n o te d ab o v e, each o f th e te n q u e s tio n s gave r i s e to a n u l l and an a l t e r n a t e h y p o th e s is . Each q u e s tio n a lg o gave r i s e to th r e e s u b s id ia r y h y p o th e s e s . The f i r s t two w ere n o n - d ir e c ti o n a l, b ein g co n cern ed o n ly w ith th e m agnitude o f th e c o rre sp o n d in g v a r ia n c e s and n o t w ith w hich o f a s e t o f means was th e l a r g e s t . The l a s t h y p o th e s is co n cern ed th e m agnitude o f th e c o e f f i c i e n t o f r a t e r r e l i a b i l i t y , w hich can o n ly be ze ro o r p o s i t i v e . In a l l c a s e s , th e .05 le v e l o f s ig n if ic a n c e was ta k e n as th e minimum c r i t e r i o n f o r th e r e j e c t i o n o f a n u l l h y p o th e s i s . These h y p o th e se s were i d e n t i c a l f o r each q u e s tio n , so th e y a r e h e re s t a t e d once in o p e r a tio n a l ( t e s t a b l e ) form ; th e r e s u l t s f o r ea ch q u e s tio n w i l l th e n b e d is c u s s e d u n d e r h e a d in g s r e f e r r i n g to th e so u rc e s o f v a r ia n c e named in th e accom panying t a b l e s . S ource H y p o th esis Groups H q : T here i s no d if f e r e n c e betw een th e mean r a ti n g s o f th e p a t i e n t and c o n tr o l g ro u p s . Ha : The mean r a t i n g o f th e p a t i e n t group ex ceed s t h a t o f th e c o n tr o l g ro u p . R a te rs H Q: The means o f th e th r e e r a t e r s (ju d g e s) do n o t d i f f e r . 66 S ource H y p o th esis I n t e r a c t i o n HQ: T here i s no i n t e r a c t i o n betw een th e r a t e r s and th e g ro u p s . R e l i a b i l i t y H Q: The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y w i l l e q u a l zero (th e v a r ia n c e r a t i o Ve /Vp w i l l eq u a l 1 .0 ) . S in c e th e u s u a l ta b le o f v a lu e s o f th e F - r a tio g iv e s o n ly h a l f o f th e F - d i s t r i b u t i o n , th a t f o r v a lu e s o f F g r e a t e r th a n u n ity , th e t e s t o f t h i s h y p o th e s is w ill c o n s is t o f d e te rm in in g th e s ig n if ic a n c e o r o th e rw is e o f 1 th e in v e rs e r a t i o . In t h i s l a t t e r c a s e , th e n u m erato r h as 49 d eg rees o f freedom and th e d en o m in ato r 98. The n e a r e s t ta b u la r v a lu e i s t h a t f o r 50 d e g re e s o f freedom in th e n um erator and 100 in th e d en o m in ato r. H ere th e F - r a t i o m ust a t t a i n 1 .4 8 f o r th e .05 l e v e l o f s ig n if ic a n c e and 1 .7 3 f o r th e .01 l e v e l . I n te r p o la t io n shows t h a t th e s e v a lu e s a re u n changed f o r th e c a se o f (4 9 ,9 8 ) d e g re e s o f freedom , and th e y th e r e f o r e c o n s ti t u t e th e c r i t e r i a f o r ju d g in g th e co e f f i c i e n t s o f r a t e r r e l i a b i l i t y . Q u estio n No. 1 . —Were th e h o s p it a li z e d in d iv id u a ls s i g n i f i c a n t l y more an x io u s in sch o o l th a n th e c o n tro ls ? "hfhere V p and Vg a r e n o t r e p o r te d , F may be c a lc u l a t e d by ta k in g th e r e c ip r o c a l o f ( 1 - r ^ ) . TABLE 1 ANALYSIS OF VARIANCE, QUESTION 1: ANXIETY IN SCHOOL SITUATIONS Source SS DF M S F P Groups 6.8267 1 6.8267 34.04 .001 R a te rs 0.6533 2 0.3267 1.63 NS* I n te r a c tio n 0.0133 2 0.0067 - NS Between C e lls 7.4933 5 1.4987 W ith in C e lls 28.8800 144 0.2006 T o ta l 36.3733 149 < R a te r r e l i a b i l i t y .677 *In a l l te n o f th e s e ta b le s "NS" d e n o tes " n o t s i g n i f i c a n t a t th e 5 p e r c e n t l e v e l . " Where an F - r a ti o ap p ro ach es th e 5 p e r c e n t le v e l , b u t does n o t q u ite a t t a i n i t , a fo o tn o te w i l l in d ic a te t h i s . 68 (As d e s c rib e d in C h ap ter I I I , t h i s was deduced from th e ju d g e s ' r a t i n g s o f th e com bined p r o to c o l m a t e r i a l .) H ere th e a n a ly s is o f v a r ia n c e , T able 1 , fo"~ th e "G roups" so u rc e o f v a r ia n c e , shows t h a t th e n u l l hypo th e s i s may be r e j e c t e d a t beyond th e .001 le v e l o f s i g n i f i c a n c e . T ab le 11 shows t h a t th e mean r a t i n g f o r th e p a t i e n t group was h ig h e r th a n t h a t f o r_ th e c o n tr o l g ro u p . The a l t e r n a t e h y p o th e s is Ha was th e r e f o r e a c c e p te d . N e ith e r th e F - r a ti o f o r th e r a t e r s n o r t h a t fo r r a te r - g r o u p i n t e r a c t i o n was s i g n i f i c a n t . The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was .677; th e c o rre sp o n d in g F - r a t i o was 3 .1 0 , w e ll above th e v a lu e r e q u ire d f o r th e .01 le v e l o f c o n fid e n c e . Q u estio n No. 1 may th e r e f o r e b e answ ered in the a f f i r m a t i v e . Q u estio n No. 2 . --W ere th e h o s p it a li z e d in d iv id u a ls s i g n i f i c a n t l y more d e p re sse d in sc h o o l th a n th e norm als? The F - r a t i o f o r "G roups" in T ab le 2 shows th a t th e n u l l h y p o th e s is may be r e j e c t e d a t beyond th e .0 0 1 le v e l o f s ig n i f ic a n c e . T ab le 11 shows t h a t th e mean r a t i n g f o r th e p a t i e n t group was h ig h e r th a n t h a t f o r th e c o n tr o l g ro u p . The a l t e r n a t e h y p o th e s is Ha was th e r e f o r e a c c e p te d . N e ith e r th e F - r a ti o f o r r a t e r s n o r t h a t f o r r a t e r - group i n t e r a c t i o n was s i g n i f i c a n t . The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was .699; th e TABLE 2 ANALYSIS OF VARIANCE, QUESTION 2: : DEPRESSION IN SCHOOL SITUATIONS Source SS DF M S F P Groups 4.1667 1 4.1667 21.30 .001 R a te rs 1.0800 2 0.5400 2 .7 6 NS I n te r a c tio n 0.2533 2 0.1267 - N S Between C e lls 5.5000 5 1.1000 W ithin C e lls 28.1600 144 0.1956 T o ta l 33.6600 149 R a te r r e l i a b i l i t y .699 O N v O 70 — i c o rre sp o n d in g F - r a t i o was 3 .3 2 , w e ll beyond th e v a lu e r e q u ir e d f o r th e .01 l e v e l o f c o n fid e n c e . Q u estio n No. 2 may th e r e f o r e be answ ered i n th e a f f i r m a t i v e . Q u estio n No. 3 . — D id th e h o s p i t a l i z e d in d iv id u a ls te n d to f e e l more i s o l a t e d from t h e i r p e e rs and te a c h e rs th a n th e norm als? The F - r a ti o f o r "G roups'’ in T able 3 shows t h a t th e n u l l h y p o th e s is may be r e j e c t e d a t beyond th e .001 le v e l o f s ig n i f ic a n c e . T able 11 shows t h a t th e mean r a t i n g f o r th e p a t i e n t group was h ig h e r th an t h a t f o r th e c o n tr o l g ro u p . The a l t e r n a t e h y p o th e s is Ha was th e r e f o r e a c c e p te d . The F - r a t i o f o r r a t e r s was n o t s i g n i f i c a n t . T hat f o r r a te r - g r o u p i n t e r a c t i o n was n o t s i g n i f i c a n t , b u t ap p ro ach ed i t , s in c e i t re a c h e d th e .06 l e v e l . The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was .5 2 1 ; th e c o rre sp o n d in g F - r a t i o was 2 .0 9 , low er th a n on th e p r e ced in g q u e s tio n s , b u t s t i l l beyond th e v a lu e r e q u ir e d f o r th e .01 l e v e l o f c o n fid e n c e . Q u estio n No. 3 may th e r e f o r e be answ ered in th e a f f ir m a tiv e . Q u e stio n No. 4 . - -D id th e h o s p i t a l i z e d in d iv id u a ls p e rc e iv e te a c h e rs to be r e j e c t i n g , h o s t i l e , d o m in eerin g , o r o v e r - p r o te c tin g m o th ers o r f a t h e r s , more th an th e n orm als d id ? TABLE 3 ANALYSIS OF VARIANCE, QUESTION 3: FEELING OF ISOLATION IN SCHOOL SITUATIONS Source SS DF M S F P Groups 8.6400 1 8.6400 48.76 .001 R a te rs 0.7600 2 0.3800 2 .1 4 NS I n te r a c tio n 1.0800 2 0.5400 3.05 NS* Between C e lls 10.4800 5 2.0960 W ith in C e lls 25.5200 144 0.1772 T o ta l 36.000 149 R a te r r e l i a b i l i t y .521 * S ig n if ic a n t a t th e 6 p e r c e n t l e v e l . 72 The F - r a t i o f o r "G roups'1 in T ab le 4 shows t h a t th e n u ll h y p o th e s is may be r e je c te d a t beyond th e .001 l e v e l . T ab le 11 shows t h a t th e mean r a t i n g f o r th e p a t i e n t group was h ig h e r th a n t h a t f o r th e c o n tr o l g ro u p . The a l t e r n a t i v e h y p o th e s is Ha was th e r e f o r e a c c e p te d . Both th e F - r a t i o f o r r a t e r s and t h a t f o r r a t e r - group i n t e r a c t i o n w ere s i g n i f i c a n t a t th e .05 l e v e l , though n e i t h e r re a c h e d th e .01 l e v e l . T h is was th e only q u e s tio n f o r w hich e i t h e r o f th e s e so u rc e s o f v a r ia n c e was s i g n i f i c a n t , a lth o u g h on th r e e o th e r q u e s tio n s one o r th e o th e r la y betw een th e .10 and th e .05 p r o b a b i l i t y v a lu e s . The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was .3 9 8 , a r a t h e r low v a lu e , r e f l e c t i n g in p a r t th e p o o re r i n t e r r a t e r ag reem en t and in p a r t th e la r g e r r a te r - g r o u p i n t e r a c tio n in d ic a te d by th e a n a ly s is o f v a r ia n c e . The c o r r e sponding F - r a t i o was 1 .6 6 , w hich i s s i g n i f i c a n t a t th e .05 l e v e l , though i t does n o t re a c h th e .01 l e v e l . Q u estio n No. 4 may th e r e f o r e s t i l l be answ ered in th e a f f ir m a tiv e , s in c e d is c rim in a tio n -b e tw e e n th e p a t i e n t and c o n tr o l g ro u p s was s i g n i f i c a n t a t th e .001 l e v e l , b u t agreem ent among th e r a t e r s was n o tic e a b ly p o o re r th a n on th e p re c e d in g q u e s tio n s - - p o s s ib ly due to th e com posite n a tu re o f th e q u e s tio n . Q u estio n No. 5 . --D id th e h o s p it a li z e d in d iv id u a ls have more f e e lin g s o f in ad eq u acy re g a rd in g sch o o l TABLE 4 ANALYSIS OF VARIANCE, QUESTION 4 : PERCEPTION OF TEACHERS AS REJECTING, HOSTILE, DOMINEERING, OR OVERPROTECTING PARENT FIGURES S ource SS DF M S F P Groups 8.1667 1 8.1667 44.82 .001 R a te rs 1.2133 2 0.6067 3 .3 3 .05 I n te r a c tio n 1.2133 2 0.6067 3 .3 3 .05 Between C e lls 10.5933 5 2.1187 W ith in C e lls 26.2400 144 0.1822 T o ta l 36.8333 149 Rater reliability .398 ac h iev em en t th a n th e norm als? The F - r a tio fo r. "G roups'1 in T ab le 5 shows t h a t th e n u l l h y p o th e s is may b e r e j e c t e d a t beyond th e .001- le v e l o f s ig n if ic a n c e . T a b le 11 shows t h a t th e mean r a t i n g f o r t h e p a t i e n t group was h ig h e r th a n t h a t f o r th e c o n tr o l p g ro u p . The a l t e r n a t e h y p o th e s is Ha was th e r e f o r e a c c e p te d . N e ith e r th e F - r a t i o f o r r a t e r s n o r t h a t f o r r a t e r - g ro u p i n t e r a c t i o n was s i g n i f i c a n t . The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was .5 8 2 ; th e c o rre s p o n d in g F - r a ti o was 2 .3 9 , w e ll beyond th e v a lu e r e q u ir e d f o r th e .01 le v e l o f c o n fid e n c e . Q u e stio n No. 5 may th e r e f o r e be answ ered in th e a f f i r m a t i v e . Q u e stio n No. 6 . —Were th e h o s p it a li z e d in d iv id u a ls m ore p o o rly m o tiv a te d , f e e lin g sc h o o l was an im posed c h o re , w ith o u t r e a l m eaning i n term s o f t h e i r l i f e ' s g o a ls , when com pared w ith th e n o rm als? The F - r a ti o f o r "G roups" in T ab le 6 shows t h a t th e n u l l h y p o th e s is may b e r e je c te d a t beyond th e .001 le v e l o f s ig n i f ic a n c e . T a b le 11 shows t h a t th e mean r a t i n g f o r th e p a t i e n t group was h ig h e r th a n t h a t f o r th e c o n tr o l g ro u p . The a l t e r n a t e h y p o th e s is Ha was th e r e f o r e a c c e p te d . The F - r a tio f o r r a t e r s was n o t s i g n i f i c a n t , b u t ap p ro ach ed i t , sin c e i t a t ta i n e d th e ,07 l e v e l . T h at f o r TABLE 5 ANALYSIS OF VARIANCE, QUESTION 5: FEELINGS OF INADEQUACY REGARDING SCHOOL ACHIEVEMENT Source SS DF M S F P Groups 6.0000 1 6.0000 2 8.20 .001 R a te rs 0.5200 2 ‘ 0.2600 1.22 NS I n te r a c tio n 0.2800 2 0.1400 - NS Between C e lls 6.8000 5 1.3600 W ith in C e lls 30.6400 144 0.2128 i T o ta l 37.4400 149 Rater reliability .582 TABLE 6 ANALYSIS OF VARIANCE, QUESTION 6: POOR ACADEMIC MOTIVATION ■ Source SS DF M S F P Groups 4.8600 1 4.8600 23.02 .0 0 1 . R a te rs 1.2133 2 0.6067 2.87 . NS* I n te r a c tio n 1.0000 2 0.5000 2.37 NS Between C e lls 7.0733 5 1.4147 W ith in C e lls 30.4000 144 0.2111 T o ta l 37.4733 149 R a te r r e l i a b i l i t y .276 * S ig n if ic a n t a t th e 7 p e r c e n t l e v e l. 77 r a te r - g r o u p i n t e r a c t i o n was n o t s i g n i f i c a n t . The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was .2 7 6 , th e lo w e s t v a lu e o b ta in e d f o r any o f th e te n q u e s tio n s . The c o rre sp o n d in g F - r a ti o was 1 .'3 8 . In t h i s c a s e , th e r e f o r e , th e n u l l h y p o th e s is r e l a t i n g to th e r a t e r r e l i a b i l i t y c o e f f i c i e n t c o u ld n o t b e r e j e c t e d : th e o b ta in e d v a lu e i s n o t s i g n i f i c a n t l y g r e a t e r th a n z e ro . The re a s o n f o r t h i s , in term s o f s t a t i s t i c a l r e s u l t s , was t h a t on t h i s q u e s tio n a r e l a t i v e l y sm a ll v a r ia n c e among th e s u b je c ts was ob ta in e d sim u lta n e o u sly w ith a r e l a t i v e l y la r g e e r r o r ( r e s id u a l) v a r ia n c e . A gain, i t m ight be s p e c u la te d t h a t Q u e stio n No. 6 was c o m p o site , r e s u l t i n g in some co n fu sio n on th e p a r t o f th e r a t e r s . N e v e rth e le s s , d is c r im in a tio n betw een th e p a t i e n t and c o n tr o l g ro u p s was s i g n i f i c a n t beyond th e .001 l e v e l . Q u e stio n No. 6 may th e r e f o r e b e answ ered in th e a ffirm a t i v e , b u t w ith some r e s e r v a t i o n s . Q u e stio n No. 7 . --D id th e h o s p it a li z e d in d iv id u a ls e x p e rie n c e m ore w ra th , a n g e r, h o s t i l i t y , w h eth er e x p re sse d o p en ly o r n o t, th an th e norm als? The F - r a t i o f o r "G roups'1 in T ab le 7 shows t h a t th e n u l l h y p o th e s is may be r e j e c t e d a t beyond th e .001 le v e l o f s ig n i f ic a n c e . T ab le 11 shows t h a t th e mean r a t i n g f o r th e p a t i e n t gro u p was h ig h e r th a n t h a t f o r th e c o n tr o l g ro u p . The a l t e r n a t i v e h y p o th e s is Ha was th e r e f o r e TABLE 7 ANALYSIS OF VARIANCE, QUESTION 7: FEELINGS OF AGGRESSION IN SCHOOL SITUATIONS Source SS DF M S F P Groups 6.0000 1 R a te rs 0.4933 2 I n te r a c tio n 0.7600 2 Between C e lls 7.2533 5 W ithin C e lls 30.2400 144 T o ta l 37.4933 149 6.0000 28.57 .001 0.2467 1.17 NS 0.3800 1 .8 1 NS 1.4507 0.2100 Rater reliability .639 I a c c e p te d . N e ith e r th e F - r a t i o f o r r a t e r s n o r t h a t f o r r a t e r - g ro u p i n t e r a c t i o n was s i g n i f i c a n t . The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was .6 3 9 ; th e c o rre sp o n d in g F - r a ti o was 2 .7 7 , w e ll beyond th e v a lu e r e q u ir e d fo r t h e .01 l e v e l o f c o n fid e n c e . Q u e stio n No. 7 may th e r e f o r e be answ ered in th e a f f i r m a t i v e . Q u e stio n No. 8 . - -Were th e h o s p it a li z e d in d iv id u a ls m ore p re o c c u p ie d w ith f a n ta s y , m aking i t d i f f i c u l t to pay a t t e n t i o n o r to c o n c e n tra te , when com pared w ith th e norm als? The F - r a t i o f o r "G roups" in T ab le 8 shows t h a t th e n u l l h y p o th e s is may b e r e je c te d a t beyond th e .001 le v e l o f s i g n i f i c a n c e . T ab le 11 shows t h a t th e mean r a t i n g f o r th e p a t i e n t g ro u p was h ig h e r th a n t h a t f o r th e c o n tr o l g ro u p . The a l t e r n a t e h y p o th e s is Ha was th e r e f o r e a c c e p te d . N e ith e r th e F - r a t i o f o r r a t e r s n o r t h a t f o r r a t e r - g roup i n t e r a c t i o n was s i g n i f i c a n t , a lth o u g h t h a t f o r r a t e r s ap p ro ach ed s ig n if ic a n c e , b e in g a t th e ,06 l e v e l , in d ic a tin g some ten d en cy tow ard r a te r - g r o u p b i a s . T his q u e s tio n too i s co m p o site, in th e sen se t h a t one m ight answ er "yes" to one p a r t o f i t b u t "no" to a n o th e r . The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y i s a ls o r e l a t i v e l y lo w , being .4 4 7 ; th e c o rre sp o n d in g F - r a t i o i s TABLE 8 ANALYSIS OF VARIANCE, QUESTION 8: FANTASY AND LACK OF CONCENTRATION IN SCHOOL Source SS DF M S F P Groups 6.8267 1 6.8267 37.47 .001 R a te rs 1.0800 2 0.5400 2.9 6 NS* I n te r a c tio n 0.4133 2 0.2067 1.13 N S Between C e lls 8.3200 ■ 5 1.6640 W ith in C e lls 26.2400 144 0.1822 • T o ta l 34.5600 149 R a te r r e l i a b i l i t y .447 * S ig n if ic a n t a t th e 6 p e r c e n t l e v e l. o o o 81 1 .8 1 , w hich i s s l i g h t l y g r e a t e r th an th e v a lu e r e q u ir e d f o r th e .01 l e v e l o f c o n fid e n c e . Q u estio n No. 8 may th e r e f o r e be answ ered in th e a f f ir m a tiv e . Q u estio n No. 9 . —Was p sy c h o se x u a l i d e n t i f i c a t i o n and h e te ro s e x u a l s o c i a l i z a t i o n a problem f o r th e h o s p i t a l iz e d .in d iv id u a ls when com pared w ith th e n o rm als? The F - r a t i o f o r "G roups" in T ab le 9 shows t h a t th e n u l l h y p o th e s is may b e r e j e c t e d a t beyond th e .001 le v e l o f s ig n i f ic a n c e . T ab le 11 shows t h a t th e mean r a t i n g f o r th e p a t i e n t group was h ig h e r th a n t h a t f o r th e c o n tr o l g ro u p . The a l t e r n a t e h y p o th e s is Ha was th e r e f o r e a c c e p te d . N e ith e r th e F - r a t i o f o r r a t e r s n o r t h a t f o r r a t e r - group i n t e r a c t i o n was s i g n i f i c a n t . On t h i s q u e s tio n , as on th e n e x t, b o th were l e s s th a n 1 .0 ; t h i s happened o n ly on th e s e two q u e s tio n s . The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was .610; th e c o rre sp o n d in g F - r a t i o was 2 .5 6 , w e ll beyond th e v a lu e r e q u ire d f o r th e .01 le v e l o f c o n fid e n c e . Q u estio n No. 9 may th e r e f o r e b e answ ered in th e a f f i r m a t i v e . Q u estio n No. 1 0 . --Was sc h o o l s tr o n g ly d is l i k e d by th e h o s p it a li z e d in d iv i d u a ls , p r a c t i c a l l y a n y th in g and e v e ry th in g ab o u t i t , when com pared w ith th e norm als? The F - r a t i o f o r "G roups" in T ab le 10 shows t h a t TABLE 9 ANALYSIS OF VARIANCE, QUESTION 9: SEXUAL ADJUSTMENT PROBLEMS Source SS DF M S F P Groups 7.7067 1 7.7067 38.96 .001 R a te rs 0.0933 2 0.0467 - NS I n te r a c tio n 0.0933 2 0.0467 * NS Between C e lls 7.8933 5 I 1.5787 W ith in C e lls 28.4800 144 0.1978 T o ta l 36.3733 149 R a te r r e l i a b i l i t y .610 o o ro 83 th e n u ll h y p o th e s is may be r e j e c t e d a t beyond th e .001 l e v e l o f s i g n i f i c a n c e . T ab le 11 shows t h a t th e mean r a t i n g f o r th e p a t i e n t group was h ig h e r th a n t h a t f o r th e c o n tr o l g r o u p .' The a l t e r n a t e h y p o th e s is Iia was th e r e f o r e a c c e p te d . N e ith e r th e F - r a t i o f o r r a t e r s n o r t h a t f o r r a t e r - g ro u p i n t e r a c t i o n was s i g n i f i c a n t . In d e e d , a s on Q u estio n No. 9 (b u t on none o f th e o t h e r s ) , b o th w ere l e s s th a n 1 .0 . The c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was .8 0 8 ; th e c o rre sp o n d in g F - r a t i o was 5 .2 2 , f a r beyond th e v a lu e r e q u ir e d f o r th e .01 le v e l o f c o n fid e n c e . T hese h ig h v a lu e s w ere m ainly due to th e f a c t t h a t th e e r r o r ( r e s id u a l ) v a r ia n c e was e x c e p tio n a lly s m a ll. Q u e stio n No. 10 may th e r e f o r e be answ ered in th e a f f i r m a t i v e . Summary o f E x p e rim e n ta l R e s u lts In te rm s o f r a t e r ag ree m en t, mean d if f e r e n c e s among r a t e r s , and r a te r - g r o u p i n t e r a c t i o n , th e s i x b e s t q u e s tio n s w ere num bers 1 , 2 , 5 , 7 , 9, and 10. In none o f th e s e d id th e v a r ia n c e f o r r a t e r s o r t h a t f o r i n t e r a c t i o n ap p ro ach s ig n i f ic a n c e a t th e .05 l e v e l , w h ile th e c o e f f i c i e n t s o f r a t e r r e l i a b i l i t y (th e In d ex o f ag reem en t u s e d ) w ere betw een .582 and .8 0 8 . The v a lu e o f r ^ r e q u ir e d f o r th e .001 l e v e l o f c o n fid e n c e i s a p p ro x im a te ly TABLE 10 ANALYSES OF VARIANCE, QUESTION 10: DISLIKE OF SCHOOL Source SS DF M S F p Groups 3.5267 1 3.5267 2 3.34 .001 R a te rs 0.2800 2 0.1400 - NS I n te r a c tio n 0.1733 2 0.0867 X NS Between C e lls 3.9800 5 0.7960 W ith in C e lls 21.7600 144 0.1511 • T o ta l 25.7400 149 R a te r r e l i a b i l i t y .808 0 3 - P " 85 .5 3 5 , so t h a t a l l s ix o f th e s e q u e s tio n s w ere h ig h ly s a t i s f a c t o r y in t h i s r e s p e c t . Two o th e r q u e s tio n s w ere f a i r l y s a t i s f a c t o r y in th e s e th r e e r e s p e c t s , nam ely numbers 3 and 8 . In n e i t h e r c a se w ere th e r a t e r o r i n t e r a c t i o n v a r ia n c e s s i g n i f i c a n t , n o r th e c o e f f i c i e n t s o f r a t e r r e l i a b i l i t y i n s i g n i f i c a n t . In b o th c a s e s , th e s e c o e f f i c i e n t s w ere somewhat low er (.5 2 1 and .4 4 7 ), though b o th exceeded .4 2 2 , th e v a lu e r e q u ir e d f o r th e .01 le v e l o f c o n fid e n c e . A lso , in Ques tio n 8 th e r a t e r d if f e r e n c e s re a c h e d th e .06 l e v e l , w h ile in Q u e stio n 3 th e r a te r - g r o u p i n t e r a c t i o n re a c h e d th e .06 l e v e l . T here was th e r e f o r e some in d ic a t io n o f r a t e r d i s agreem ent w ith r e s p e c t to th e s e two q u e s tio n s , though i t d id n o t re a c h s i g n i f i c a n t p r o p o r tio n s . The two rem ain in g q u e s tio n s , num bers 4 and 6, w ere le s s s a t i s f a c t o r y . In Q u e stio n 4 , b o th th e d if f e r e n c e s among th e r a t e r s and th e r a te r - g r o u p i n t e r a c t i o n a t ta i n e d th e .05 l e v e l , w h ile th e c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was .3 9 8 , s t i l l s i g n i f i c a n t l y g r e a t e r th a n z e ro , b u t o n ly a t th e .05 le v e l o f c o n fid e n c e . F or Q u estio n 6, th e F- r a t i o s f o r r a t e r s and r a te r - g r o u p i n t e r a c t i o n w ere n o t s i g n i f i c a n t , th e form er re a c h in g th e .07 le v e l and th e l a t t e r ly in g betw een .09 and .1 0 , b u t th e c o e f f i c i e n t o f r a t e r r e l i a b i l i t y was o n ly .2 7 6 , w hich f a l l s s h o r t o f .324, th e v a lu e r e q u ir e d f o r th e .05 le v e l o f c o n fid e n c e . T h is 86 was th e o n ly q u e s tio n f o r w hich th e n u l l h y p o th e s is (r kk=0) c o u ld n o t be r e j e c t e d , though r a t e r ag reem en t on th r e e o th e r q u e s tio n s was somewhat u n s a t i s f a c to r y , a s n o te d ab o v e. None o f th e s e e v a lu a tio n s o f th e te n q u e s tio n s in term s o f th e v a r io u s a s p e c ts o f r a t e r ag reem en t, how ever, can d e t r a c t from th e m ajo r c o n s id e r a tio n : on ev ery s in g le q u e s tio n d is c r im in a tio n betw een th e p a t i e n t and c o n tr o l g ro u p s was h ig h ly e f f e c t i v e , ly in g in a l l c a s e s beyond th e .001 le v e l o f s ig n i f ic a n c e . The mean r a t i n g s a r e p r e s e n te d in T ab le 1 1 . T hese r e s u l t s s u g g e s t t h a t a l l te n q u e s tio n s a r e h ig h ly p e r t i n e n t to th e d is c r im in a tio n b e tw een a d u l t s c h iz o p h re n ic s and a d u lt n orm als on th e b a s is o f th e E d u c a tio n a l H is to ry C om pletion T e s t and th e Edu c a tio n a l H is to ry T hem atic A p p erce p tio n T e s t r e s u l t s , when r a te d by q u a l i f i e d c l i n i c a l p s y c h o lo g is ts in th e manner u se d in th e p r e s e n t s tu d y . R e s u lts in R e la tio n to P u rp o ses o f th e Study The p u rp o se o f t h i s stu d y was n o t so much to develop a d ia g n o s tic in s tru m e n t a s to make p ro g re s s in th e u n d e rs ta n d in g o f th e s c h iz o p h re n ic and h is e d u c a tio n a l h is t o r y (C h ap ter I ) . F or d ia g n o s tic p u rp o s e s , e s p e c i a lly in d e a lin g w ith in d iv id u a ls r a t h e r th a n g ro u p s, fo u r o f th e q u e s tio n , a s n o te d ab o v e, would a p p e ar to r e q u ir e some s im p lif ic a tio n o r f u r t h e r c l a r i f i c a t i o n , in o rd e r to TABLE 11 M EA N RATINGS A N D DIFFERENCES BETW EEN THE M EA N RATINGS, PATIENT A N D CONTROL GROUPS, QUESTIONS 1-10 Q u estio n Number Topic C o n tro l Group P a tie n t Group D iffe re n c e b e tween Means 1 A nxiety .3733 .8000 .4267 2 D epression .1733 .5067 .3333 3 F e e lin g s o f i s o l a t i o n .3600 .8400 .4800 4 T eachers as h o s t i l e .3333 .8000 .4667 5 S c h o la s tic inadequacy .3200 .7200 .4000 6 Poor m o tiv a tio n .3067 .6667 .3600 7 F e e lin g s o f h o s t i l i t y .2933 .6933 .4000 8 F an tasy .1467 .5733 .4267 9 S exual m alad ju stm en t .1867 .6400 .4533 10 D is lik e o f sch o o l .0667 .3733 .3067 Mean .2560 . .6613 .4053 Median 1 i .3000 .6667 .4133 o o in c r e a s e t h e i r r e l i a b i l i t y . The m ajo r h y p o th e s is p o s tu l a te d t h a t th e r e was a m e a s u ra b le , s i g n i f i c a n t d if f e r e n c e betw een th e dynam ics o f h o s p i t a l i z e d a d u l ts and n o rm als when c o n fro n te d w ith , and i n t e r a c t i n g w ith , r e p r e s e n ta ti o n s o f sc h o o l l i f e s i t u a t i o n s (C h ap ter I ) . T h is h y p o th e s is was em bodied in te n s p e c i f i c q u e s tio n s r e l a t i n g to a t t i t u d e s tow ard v a r io u s a s p e c ts o f sc h o o l l i f e . Each o f th e te n q u e s tio n s r e v e a le d a m e a su ra b le , h ig h ly s i g n i f i c a n t d if f e r e n c e betw een th e dynam ics o f th e sam ple o f h o s p i t a l i z e d a d u l t s c h iz o p h r e n ic s and th o s e o f th e c o n t r o l sam p le, and ev e ry d i f f e r e n c e was in th e p r e d ic te d d i r e c t i o n , nam ely, t h a t th e c o rre sp o n d in g t r a i t o r a t t i t u d e was more o f te n found p r e s e n t in th e p r o to c o ls o f th e p a t i e n t group th a n in th o s e o f th e n o rm a ls . CHAPTER V SUM M ARY, CONCLUSIONS, A N D RECOMMENDATIONS. t Summary The p r e s e n t stu d y was u n d e rta k e n b e c a u se v e ry l i t t l e r e s e a r c h h as been done to d a te on th e d ia g n o s tic o r p r e d i c t i v e p o s s i b i l i t i e s a r i s i n g from th e re s p o n s e s to th e sc h o o l en v iro n m en t on th e p a r t o f p e rs o n s who l a t e r e x p e rie n c e m e n ta l b reak d o w n s. For m ost p e o p le , sc h o o l i s , in t h e i r fo rm a tiv e y e a r s , second o n ly to th e fa m ily i n i t s e f f e c t on p e rs o n a l i t y d ev elo p m en t. A t th e same tim e , th e sc h o o l e n v iro n m ent p ro v id e s a w ide v a r i e t y o f s i t u a t i o n s and problem s to w hich th e s tu d e n t m ust r e a c t , and h is re s p o n s e s may p ro v id e c lu e s to th e k in d o f p e rso n he w i l l l a t e r becom e. P a re n ts who a r e e d u c a tio n a lly and m e n ta lly e q u ip p e d , and s u f f i c i e n t l y m o tiv a te d , to re c o g n iz e and d e a l w ith s ig n s o f f u tu r e m a la d ju stm e n t, c o n s t i t u t e a s e l f - h e a lin g segm ent o f th e p o p u la tio n . The p r e s e n t co n cern i s w ith th e d is tu r b e d c h i l d o r a d o le s c e n t whose p a r e n ts a r e n o t s u f f i c i e n t l y a l e r t to r e f e r him to a c o u n s e lo r o r t h e r a p i s t . For th e c h ild r e n o f su ch p a r e n t s , th e sc h o o l i s th e m ost l i k e l y agency f o r th e d e te c tio n o f f u tu r e 89 90 p ro b le m s. As th e O 'N eal and R obins (1958) stu d y , d e s c rib e d in C h a p te r I I , te n d e d to show, i t does n o t a p p e ar to s u f f i c e to r e l y on ju v e n ile b e h a v io r-p ro b le m r e f e r r a l s . W hether one a d h e re s to th e " d e f i c i t th e o ry " o r r e l i e s on the. o b s e rv a tio n o f symptoms and sym ptom atic b e h a v io r p a t t e r n s , i t i s p r im a r ily th e te a c h e r and th e sc h o o l p s y c h o lo g is t who a r e in a p o s it io n to re c o g n iz e any e a r ly in d ic a t io n s w hich may be p r e s e n t . I t becomes im p o r ta n t th e r e f o r e to a sk w hat th o s e i n d ic a t io n s a r e . W hat, i f a n y th in g , d is t in g u is h e s c h ild r e n who may a t a l a t e r d a te become m e n ta lly i l l from th o s e who w i l l n o t? S in ce th e p r e s e n t stu d y fo c u se d on one ty p e o f m e n tal d is o r d e r , s c h iz o p h re n ia , th e q u e s tio n becam e: i s th e d e v e lo p in g s c h iz o p h re n ic d i s t in g u is h a b le from o th e r s tu d e n ts in th e sc h o o l s i t u a t i o n , and, i f s o , how? I t sh o u ld be n o te d t h a t th e em phasis th ro u g h o u t t h i s stu d y i s on p r e d ic tio n ; no s p e c u la tio n a s to e tio lo g y i s made. W hether th e im p act o f sc h o o l e x p e rie n c e s h as e i t h e r a c a u s a tiv e e f f e c t , o r m erely an i n t e n s if y in g e f f e c t on p r e - e x i s t i n g te n d e n c ie s , i s q u i t e o u ts id e th e scope o f t h i s r e s e a r c h . S e v e ra l s tu d ie s w ere d is c u s s e d in C h ap ter I I ab o v e. Of th e s e , one o f th e m ost in t e r e s t i n g , was t h a t o f Bower e t a l . (1 9 6 0 ), w hich ask ed e s s e n t i a l l y th e same q u e s tio n . The m ethod o f g a th e r in g d a ta a b o u t th e p re s c h iz o p h re n ic and n o n -p re s c h iz o p h re n ic s u b je c ts w as, how ever, open to 91 some c r i t i c i s m , o r a t l e a s t d o u b ts ; members o f th e sc h o o l s t a f f w ere in te rv ie w e d , u s in g a f r e e - a s s o c i a t i o n r e c a l l te c h n iq u e . Q u ite a p a r t from th e q u e s tio n o f r e l i a b i l i t y (th e te a c h e r may have known th e s tu d e n t f o r a s in g l e y e a r e i g h t o r more y e a rs a g o ), su ch m a te r ia l does n o t le n d i t s e l f to s ta n d a r d iz e d , o b je c tiv e s c o rin g te c h n iq u e s . The T hem atic A p p e rc e p tio n T e s t and S en ten ce C om pletion T e s t s , w h ile s t i l l p r o j e c t i v e in n a t u r e , do p o s s e s s t r a d i t i o n a l s ta n d a r d iz e d s c o rin g m ethods, and a r e a t l e a s t sem i o b je c ti v e a s f a r a s i n t e r p r e t a t i o n i s c o n c e rn e d . T hese t e s t s w ere th e r e f o r e ad o p ted f o r th e p u rp o se s o f th e p r e s e n t r e s e a r c h , b u t m o d ifie d so as to r e f e r to th e su b j e c t s ' p e r c e p tio n s o f sc h o o l s i t u a t i o n s . Of th e s tu d i e s r e p o r te d in C h ap ter I I , th o s e w hich have th e m ost b e a rin g on th e t r a i t s and a t t i t u d e s i n v e s t i g a te d in th e p r e s e n t r e s e a r c h may b e b r i e f l y sum m arized a t t h i s p o i n t . Bower e t a l . (1960) co n c lu d ed t h a t h ig h sc h o o l s tu d e n ts who l a t e r became s c h iz o p h re n ic w ere s i g n i f i c a n t l y d i f f e r e n t from o th e r s t u d e n t s . Members o f th e sc h o o l s t a f f w ere aw are o f th e s e d if f e r e n c e s in m ost o f th e c a s e s , b u t d id n o t c o n s id e r t h a t th e y c o n s t it u t e d m ajo r sc h o o l p ro b le m s. Some o f th e t r a i t s on w hich th e s tu d e n ts w ere r a te d and com pared w ith a c o n tr o l group w ere: b e in g lik e d by o th e r s tu d e n ts , i n t e r e s t in e n v iro n m e n t, p a r t i c i p a t i o n 92 in group a c t i v i t i e s , i n t e r e s t in o p p o s ite s e x , m a n ife s t a n x ie ty , and c h e e r fu ln e s s v s . d e p r e s s io n . Q u e stio n s 1, 2 , 3 , and 9 o f th e p r e s e n t stu d y ( a n x ie ty , d e p r e s s io n , f e e l in g s o f i s o l a t i o n , and p ro b lem s o f s e x u a l i d e n t i f i c a t io n ) r e l a t e to some o f th e s e c o n c lu s io n s . W arnken (1958) found many " d e f i c i t d i f f e r e n c e s " ; th e p r e s c h iz o p h r e n ic s had a low er a v e ra g e I .Q ., a low er g ra d e p o in t a v e ra g e a t c e r t a i n g ra d e l e v e l s , and so on. T h is le d him to b e lie v e t h a t th e c lu e to th e s c h iz o p h re n ic p ro c e s s l i e s in s o c i a l and i n t e l l e c t u a l i n f e r i o r i t y , w hich le a d s to r e p e a te d f a i l u r e and u lti m a t e ly to w ith d ra w a l. Q u e stio n s 5 and 6 o f th e p r e s e n t i n v e s t i g a t i o n ( f e e lin g s o f s c h o la s t ic in a d eq u ac y , p o o r academ ic m o tiv a tio n ) r e f e r to th e s e and s im ila r c o n c lu s io n s . Andrew and Lockwood (1954) found no s i g n i f i c a n t d i f f e r e n c e s , in a la rg e random sam p le, betw een th e g ra d e s o f th o s e found p o o rly a d ju s te d and th o s e r a t e d w e ll- a d ju s te d . No p re s c h iz o p h re n ic i d e n t i f i c a t i o n s w ere made a s su ch , b u t among th e d im en sio n s on w hich th e s tu d e n ts w ere r a t e d w ere: ten d en cy tow ard a g g r e s s iv e b e h a v io r and e m o tio n a l i r r i t a b i l i t y . Q u e stio n 7 o f th e p r e s e n t stu d y ( f e e lin g s o f w ra th , a n g e r, o r h o s t i l i t y ) r e f e r s to b o th o f th e s e o b v io u s ly o v e rla p p in g t r a i t s . The q u e s tio n o f in tr o v e r s io n - e x t r o v e r s i o n was con s id e re d in s e v e r a l s tu d i e s , in c lu d in g t h a t o f Andrew and Lockwood j u s t m en tio n ed , b u t was ta k e n up in g r e a t e r d e t a i l by M ichael e t a l . (1 9 5 7 ). W orking w ith a la r g e sam ple, random ly drawn from th e f i l e s o f a C h ild G uidance C lin ic , th e y i d e n t i f i e d a p p ro x im a te ly o n e - f i f t h a s i n t r o v e r t s , o n e - h a lf a s e x t r o v e r ts , and th e rem ain d er as a m b iv e rts . Only 2 p e r c e n t w ere d ia g n o sed a s s c h iz o p h re n ic s (te n c a s e s o u t o f 546 in a l l ) , b u t o n ly one o f th e s e came from th e i n t r o v e r t c l a s s i f i c a t i o n . T h e ir popu l a t i o n was presum ably n o t n o rm al, b e in g composed e n t i r e l y o f r e f e r r e d c h ild r e n , and th e number o f s c h iz o p h re n ic s i d e n t i f i e d was v e ry s m a ll. However, th e y co n clu d ed t h a t t h e i r r e s u l t s a t l e a s t d id n o t s u p p o rt th e common b e l i e f t h a t i n t r o v e r t s a r e more l i k e l y to d ev elo p s c h iz o p h re n ia th a n o t h e r s . They p o in te d o u t, on th e o th e r hand, t h a t th e q u i e t i n t r o v e r t may e sca p e a t t e n t i o n , w h ile th e more o b s tre p e ro u s e x tr o v e r ts and a m b iv e rts a r e more l i k e l y to annoy p e o p le and be r e f e r r e d to a g u id a n ce c l i n i c . (They com posed, a f t e r a l l , f o u r - f i f t h s o f th e sa m p le.) In th e p r e s e n t s tu d y , i t was f e l t t h a t some o f th e c h a r a c t e r i s t i c t r a i t s o f th o se w ith i n t r o v e r t i v e te n d e n c ie s m ight more p r o fib a b ly be r a t e d s e p a r a te ly , r a t h e r th an by means o f a p erh ap s s p e c io u s ly sim ple in tr o v e r s io n - e x tr o v e r s io n s c a le . Thus, f o r exam ple, Q u estio n 3 s t r e s s e s f e e lin g s o f i s o l a ti o n , Q u e stio n 8 p re o c c u p a tio n w ith f a n ta s y ( a t th e ex pen se o f a t t e n t i o n to th e e n v iro n m e n t), and Q u e stio n 10 94 d i s l i k e o f school (which may in d ic a t e r e j e c t i o n o f s o c ia l a c t i v i t y , among o th e r th in g s ) . L ich ten b erg (1957) s tu d ie d two young a d u l t sc h iz o p h re n ic s in g r e a t d e p th . He concluded t h a t i t i s p o s s ib le f o r young p eo p le w ith th e s e te n d e n c ie s to make good g ra d e s , e t c e te r a , and even to p a r t i c i p a t e in e x t r a - c u r r i c u l a r a c t i v i t i e s , w h ile in r e a l i t y m erely com plying r i g i d l y w ith what t h e i r p a r e n ts e x p e c t o f them. In o th e r w ords, they tnay be m erely f o r m a l i s t i c a l l y fo llo w in g an imposed s e t o f r u l e s . I t m ight be h e a l t h i e r fo r them to develop more sen se o f s e l f , to a s s e r t t h e i r own needs more, even i f t h a t im p lie s r e b e l l i o n . By r i g i d l y fo llo w in g somebody e l s e 's r u l e s , they f a i l e d to become p e rso n s in t h e i r own r i g h t , making t h e i r own d e c is io n s and a c c e p tin g a l l the im p lic a tio n s and consequences o f doing so . I t was f e l t t h a t t h i s id e a had c o n s id e ra b le re le v a n c e to th e way in which a s tu d e n t p e rc e iv e s h i s te a c h e r s . I f , as Q uestion 4 a s k s, he sees them as a u t h o r i t a r i a n p a r e n t f i g u r e s , e i t h e r a s h o s t i l e and r e j e c t i n g o r as dom ineering and o v e r- p r o t e c t i v e , then he may be p r o je c tin g onto them th e c h a r a c t e r i s t i c s o f h is own p a r e n ts ; he may be d i s t o r t i n g t h e i r r e a l r e l a t i o n s h i p to him in te rm s o f th e in a d eq u ate p a r e n t - c h ild r e l a t i o n s h i p o b ta in e d a t home. N a tu r a lly , th e te n q u e s tio n s posed in th e p re s e n t in v e s tig a tio n d id n o t a r i s e s o le ly o u t o f th e above 95 m entioned s o u rc e s , and th e r e i s n o t a o n e -to -o n e c o r respondence betw een them and th e r e s e a r c h f in d in g s d i s cu ssed in C hapter I I ; i t seemed d e s i r a b l e , however, to augment and ex ten d th e r e s e a r c h h y p o th eses t e s t e d in t h i s stu d y in th e l i g h t o f th e c o n c lu sio n s t h a t were reach ed in o th e r exp erim en ts in t h i s a r e a , e s p e c i a lly where th ey were t e n t a t i v e o r where o th e r ex p erim en ts le d to c o n tra ry f in d in g s . In some c a s e s , th e t r a i t s which appeared b o th r e a d i ly o b se rv a b le by te a c h e rs and i n d ic a t iv e o f f u tu r e se v ere d is tu rb a n c e , seemed to c a l l f o r r e d e f i n i t i o n and c l a r i f i c a t i o n . O th e rs, n o ta b ly th e i n t r o v e r s i o n - e x t r o v e rs io n continuum , seemed to r e q u ir e a more c o n c re te (though le s s d i r e c t ) approach, and t h i s le d to th e form u l a t i o n o f q u e s tio n s which covered o nly p o r tio n s o f th e g e n e ra l a re a under d e b a te . These p a r t i a l b u t more c o n c re te q u e s tio n s would, i t was hoped, le a d to more c l e a r - c u t r e s u l t s . Some o f th e q u e s tio n s asked were th e r e f o r e a m p lifie d so as to cover two o r th r e e i n t e r r e l a t e d phen omena (fo r exam ple, Q u estio n 7 m entioned "w rath , a n g e r, o r h o s t i l i t y " ) w h ile o th e rs were broken down in to two o r more d is t in g u is h a b le components (fo r exam ple, Q u estio n s 5 and 6, which r e f e r r e d s e p a r a te ly to f e e l in g s o f s c h o la s t ic inadequacy and to poor academ ic m o tiv a tio n ) . A s e t o f te n a p p a re n tly sim ple and d i r e c t , and, 96 i t was hoped, e a s i l y an sw erab le q u e s tio n s , was th u s a r r iv e d a t . As th e r e s u l t s showed (C hapter IV ), a l l te n d is c rim in a te d between th e p a t i e n t s and th e norm als v e ry s i g n i f i c a n t l y . F u r th e r , o nly fo u r o f th e te n f e l l to any e x te n t s h o r t o f th e g o a l o f in e q u iv o c a lity , as evin ced by a s iz a b le ( i f n o t s i g n i f i c a n t ) r a te r - g r o u p i n t e r a c t i o n e f f e c t o r a low in d ex o f i n t e r - r a t e r agreem ent. These shortcom ings were f o r th e m ost p a r t s t a t i s t i c a l l y i n s i g n i f i c a n t , and a r e more in d i c a t i v e o f a need f o r re p h ra s in g o r f o r c l e a r e r d e f i n i t i o n s o f th e terras u se d , th an o f a s e rio u s re d u c tio n o f d is c r im in a tin g pow er. Such im prove m ents a r e d e s ir a b le p r i n c i p a l l y where d e c is io n s in th e c a se o f in d iv id u a l s tu d e n ts may be in flu e n c e d by c o n s id e r a tio n o f th e s e and s im ila r t r a i t s . The te n q u e s tio n s a r r iv e d a t as d e s c rib e d above were th e n posed as p o s s ib ly form ing a co re o r n u c le u s o f d i f f e r e n t i a t i n g t r a i t s which m ight prove to be o f u se in th e p ro c e s s o f d e c is io n m aking. In o rd e r to d is c o v e r w hether th e y were in d e ed p r e d i c t i v e , and th e r e f o r e r e l e v a n t, th e two p r o j e c t i v e t e s t s which were used in t h i s stu d y were adopted f o r th e re a so n s a lre a d y b r i e f l y d i s c u ssed , b u t m o d ified in such a way a s to p r e s e rv e t h e i r o r i g i n a l e f f e c t i v e n e s s , w h ile s la n tin g th e c o n te n t s tim u li in th e d i r e c t i o n o f sc h o o l e x p e rie n c e s and r e l a t e d f e e l i n g s . 97 The E d u c a tio n a l H is to ry Them atic A p p ercep tio n T e st and th e E d u c a tio n a l H is to ry C om pletion T e st were ad m in is te r e d , a f t e r a sm a lle r p i l o t stu d y , to two groups o f tw e n ty - f iv e s u b je c ts e a c h . One group c o n s is te d o f h o s p i t a l i z e d s c h iz o p h re n ic s , th e o th e r r e p r e s e n te d th e norm al p o p u la tio n . The s e l e c t i o n o f th e sam ples and th e ad m in is t r a t i o n o f th e t e s t s a r e d e s c rib e d in C hapter I I I above. On the b a s i s o f th e p r o to c o ls so o b ta in e d , th r e e e x p e r i enced p s y c h o lo g is ts , a c tin g as ju d g e s , responded to th e l i s t of te n q u e s tio n s . They d id n o t know which s u b je c ts belonged i n which g r o u p . Each q u e s tio n r e f e r r e d to a c e r t a i n a t t i t u d e o r t r a i t , and th e ju d g e s m erely in d ic a te d w h eth er, from a given s u b j e c t 's p r o to c o l, i t was p r e s e n t o r a b s e n t. A th ir d c h o ic e , " n o t c e r t a i n , " was a v a ila b le to them, b u t they w ere asked to u se i t as s p a rin g ly as p o s s i b le . (See C h ap ter IV a b o v e .) In th e r e s u l t i n g check l i s t s , th is t h i r d ch o ice was used so seldom t h a t i t was d ecid ed to give i t th e same sc o re v a lu e as th e " a b s e n t" re s p o n s e s , nam ely z e ro . The " p re s e n t" resp o n se was given a sco re v a lu e o f 1. S ince each o f th e t r a i t s o r a t t i t u d e s , i f marked " p r e s e n t," i s b e lie v e d to be in d ic a t i v e o f s c h iz o p h re n ic te n d e n c ie s , th e p a t i e n t group.w as ex p ected to re c e iv e th e g r e a t e r number o f 1 sc o re s on each q u e s tio n , and such p ro v ed to be th e c a s e . However, no " t o t a l s c o r e ," based on com bining a l l te n q u e s tio n s , was used, s in c e too l i t t l e i s known about th e c o n jo in t oc c u rre n c e o f th e s e t r a i t s in g ro u p s. The r e s u lt in g d a ta were s tu d ie d , tr e a t i n g each q u e s tio n s e p a r a te ly , by A n aly sis o f V ariance te c h n iq u e s, g iv in g r i s e to F - r a t i o s fo r Groups, f o r R a te rs (ju d g e s ), and f o r R ater-G roup i n t e r a c t i o n s . C o e ff ic ie n ts o f r a t e r r e l i a b i l i t y (agreem ent) were a ls o computed fo r each ques tio n , as a measure o f c l a r i t y and adequacy of d e f i n i t i o n . The te n dim ensions or t r a i t s r e l a t i n g to th e school environm ent, and re g a rd in g which th e q u e s tio n s in v e s tig a te d and c o n tra s te d th e members o f th e two groups, w ere: 1. A n x ie ty . 2. D epression. 3. F e e lin g s o f i s o l a t i o n . 4 . P e rc e p tio n o f te a c h e rs as r e j e c t i n g , h o s t i l e , dom ineering o r o v e rp r o te c tiv e p a r e n ts . 5 . F e e lin g s o f s c h o la s tic inadequacy. 6. Poor academic m o tiv a tio n . 7. F e e lin g s o f w rath, anger or h o s t i l i t y . 8 . P reo ccu p atio n w ith fa n ta s y a t th e expense o f a t t e n t i o n and c o n c e n tra tio n . 9. Problems o f psychosexual i d e n t i f i c a t i o n and h e te ro s e x u a l s o c i a l i z a t i o n . 10. D is lik e o f sch o o l. 99 On every^ one o f th e s e te n q u e s tio n s th e s c h iz o p h re n ic group d if f e r e d from th e norm als in th e p r e d ic te d d ir e c t i o n a t o r beyond th e .001 le v e l o f s ig n i f ic a n c e . A s i g n i f i c a n t d if f e r e n c e ( a t th e .05 le v e l) among th e ju d g es was found o n ly on Q uestion 4, though th e r e was a ls o some d isa g re em e n t on Q u estio n s 6 and 8 ( a t the .07 and .06 le v e ls r e s p e c t i v e l y ) . R a ter-g ro u p i n t e r a c t i o n was s i g n i f i c a n t ( a t th e .05 le v e l) on Q uestion 4, b u t on no o th e r q u e s tio n , though i t approached s ig n if ic a n c e on Q uestion 3 ( a t th e .06 le v e l) . The n u l l h y p o th e sis as to r a t e r agreem ent (r^ k = 0) was r e je c te d a t th e .05 l e v e l , or beyond, on a l l q u e s tio n s e x c e p t Q uestion 6. Q u estio n s 4 and 8 were r a t h e r weak in th e degree o f agreem ent a t t a i n e d , alth o u g h s t i l l s t a t i s t i c a l l y a c c e p ta b le . Agreement on th e rem aining q u e s tio n s m ight be d e s c rib e d as ran g in g from f a i r to e x c e l l e n t . The p rece d in g comments on th e r e s u l t s o f th e a n a ly s i s a r e based on T ables 1 through 1 0 --each t a b le r e f e r s to th e c o rre sp o n d in g ly numbered q u e s tio n . A lso, th e r e s u l t s a re d isc u sse d q u e s tio n by q u e s tio n in C hapter IV, pages 6 6 f f . In sum m arizing th e s e r e s u l t s , i t i s ab u n d an tly c l e a r t h a t d is c r im in a tio n between th e sc h iz o p h re n ic and norm al groups was e x c e lle n t f o r a l l te n q u e s tio n s , and 100 t h a t th e d i r e c t i o n a l hypo th eses te s te d were s u b s ta n tia te d w ith o u t r e s e r v a tio n in th e ca se o f e ig h t o f them, and w ith some s l i g h t r e s e r v a tio n s in th e case o f Q u estio n s 4 and 6, which m ight be removed by more e x p l i c i t d e f i n i t i o n s . C onclusions Table 11 (in C hapter IV) p r e s e n ts th e mean r a tin g s o f th e two groups f o r each o f th e q u e s tio n s . A h ig h e r sc o re on any q u e s tio n means t h a t th a t a t t i t u d e o r t r a i t was more o fte n marked " p r e s e n t." I d e a lly , th e n , norm als should sc o re zero and sc h iz o p h re n ic s 1 .0 . N a tu ra lly , t h i s d id n o t o ccu r, b u t i t i s rem arkable how h ig h th e p a t i e n t g ro u p 's means were on many o f th e q u e s tio n s , and how sharp th e c o n t r a s t was on a l l te n . The p ro to c o ls o f th e p a t i e n t group were o b ta in ed from s u b je c ts c u r r e n tly h o s p ita liz e d w ith a d ia g n o s is of sc h iz o p h re n ia . They were a l l a t th e tim e in " f a i r ” to "good" rem issio n and were no lo n g e r in a s t a t e o f a c tu a l g ro ss p s y c h o s is . N e v e rth e le s s, t h e i r re sp o n se s may have r e f l e c t e d t h e i r more r e c e n t developm ent; d uring th e tim e they a c tu a l ly were a t school th ey may, o f c o u rse , n o t have d if f e r e d so sh a rp ly from t h e i r fello w s tu d e n ts . I t seems f a i r , however, to conclude t h a t a s tu d e n t who e x h i b i t s 4 _any o f th e above t r a i t s to a marked degree in h is resp o n se s to school s i t u a t i o n s may be a developing sc h iz o p h re n ic . As was to be ex p ected , th e same t r a i t s c 101 viere a lso found among some o f th e normal group; t h e i r p o s s e s s io n i s th e r e f o r e n o t c o n c lu siv e . They a r e , r a t h e r , c lu e s which should a l e r t th e te a c h e r o r o th e r o b se rv e r to th e p o s s i b i l i t y o f a p re sc h iz o p h re n ic c o n d itio n . Four o f th e t r a i t s were r a r e r than th e o th e rs among th e c o n tr o l group. These were numbers 2, 8, 9, and 1 0 --a n x ie ty , p re o c c u p a tio n w ith fa n ta s y , problem s o f psychosexual i d e n t i f i c a t i o n , h e te ro se x u a l s o c i a l i z a t i o n , and d i s l i k e o f sc h o o l. The last-nam ed was, in f a c t , r e l a t i v e l y r a r e among the p a t i e n t group to o , b u t when i t i s observed, i t may be c o n sid ered a f a i r l y s i g n i f i c a n t i n d ic a t o r . Problems o f psychosexual i d e n t i f i c a t i o n and h e te ro s e x u a l s o c ia li z a t io n a ls o appeared to c o n s titu t e a u s e f u l in d ic a to r because they were r a th e r r a r e among th e c o n tro ls b u t r a t h e r common among th e p a t i e n t g ro u p . The c o n tr a s t was n o t so c l e a r in th e case o f th e o th e r two t r a i t s which were r e l a t i v e l y r a r e among th e norm als. At th e o th e r end o f th e s c a le f e l l numbers 1 and 3, a n x ie ty in school s it u a ti o n s and, s u r p r is in g ly , f e e lin g s of i s o l a t i o n ( i . e . , from p e e rs and te a c h e r s ) . These were th e most f re q u e n tly p re s e n t t r a i t s among th e c o n tro l group. However, f e e lin g s o f i s o l a t i o n were a lso th e most f r e q u e n tly p r e s e n t o f a l l th e t r a i t s in the p a t i e n t group p r o to c o ls , and gave r i s e to th e la r g e s t o f th e d if fe re n c e s between c o n tro l and p a t i e n t group means. N e v e rth e le s s, 102 fo r th e purposes o f p r e d ic tio n in th e case o f in d iv id u a l s tu d e n ts , th e se would appear to be th e l e a s t u s e fu l o f th e t r a i t s , sin c e th e p r e s e n t a n a ly s is was based sim ply on t h e i r p resen ce o r absence, w ith no measure o f i n t e n s i t y . Numbers 4, 5, 6, and 7 --p e rc e p tio n o f te a c h e rs as r e j e c t i n g , h o s t i l e , dom ineering o r o v e r-p ro te c tin g p a r e n ts , f e e lin g s o f s c h o la s tic inadequacy, po o r academic m o tiv a tio n , and f e e lin g s o f h o s t i l i t y in school s i t u - a t i o n s - - f a l l between th e two ex trem es. W hile common among the p a t i e n t s , th ey a re n o t ra r e among th e norm als. None, taken alo n e , forms a b a s is fo r c l e a r - c u t p r e d ic tio n on an in d iv id u a l b a s i s . The q u e s tio n o f th e r e l a t i v e u s e fu ln e s s o f th e ten t r a i t s o r symptoms f o r p r e d ic tio n in the ca se o f i n d i v i duals i s n o t e n t i r e l y p ro p e r or r e le v a n t. No im p o rta n t d e c is io n s are recommended on t h i s b a s is . The b a s ic q u es tio n o f th is stu d y was: a re th e re any d e te c ta b le d i f f e r ences between p re sc h iz o p h re n ic and o th e r s tu d e n ts in th e school s i t u a t i o n , and, i f so, w hat a re some o f them? Ten were su g g ested , and a l l o f them ap p ear in d ic a t iv e on a s t a t i s t i c a l b a s i s . Like many psychom etric r e s u l t s , how e v e r, th o se o b ta in e d by th e p r e s e n t study can only be a p p lie d w ith g r e a t c a u tio n to i n d i v i d u a l s . There a re very probably o th e r dim ensions in which th e two groups d i f f e r s i g n i f i c a n t l y . Many stu d e n ts who 103 e x h ib it th e s e t r a i t s presum ably do n o t l a t e r become s c h iz o p h re n ic ; th e r e s u l t s o f th e p re s e n t stu d y tend n e v e rth e le s s to in d ic a te t h a t th o se who do so a re more l i k e l y to be developing sc h iz o p h re n ic s than th o se who do n o t. Recommendations fo r F u rth e r Study The main d i f f i c u l t y o f in v e s tig a tin g a q u e s tio n such as t h a t asked h e re i s : even i f i t were p r a c t i c a l to t e s t a la rg e random sample o f s tu d e n ts by any in te n s iv e method, one would have to w a it perhaps te n or f i f t e e n y e a rs b e fo re adequate m a te r ia l f o r making com parisons became a v a ila b le . That i s , i f one lim ite d h im se lf to th o se who were h o s p ita liz e d fo r sc h iz o p h re n ia p r i o r to th e age of t h i r t y , say, one would s t i l l have long to w ait b e fo re one knew which form er s tu d e n ts in f a c t d id plater become members o f th e p a t i e n t group. Even th en , t h e i r number would be sm a ll. A ttem pts to e n la rg e the o r i g i n a l sample so as to in c re a s e th e u ltim a te s iz e o f th e p a t i e n t group do n o t seem p r a c t i c a l w ith to d a y ’s d ia g n o s tic to o ls , due to th e tim e re q u ire d to t e s t every in d iv id u a l a d e q u a te ly . The only a l t e r n a t i v e seems to be th a t adopted h e re : to s e l e c t o n e’ s p a t i e n t group from th o se p r e s e n tly h o s p i t a l i z e d , and to atte m p t to study r e tr o s p e c tiv e ly how they f e l t about school when they were th e r e - - o r , as in the above-m entioned study o f Bower e t a l . (1960), to depend on th e r e c a l l o f t h e i r form er teachers,, The l a t t e r seems le s s 104 r e l i a b l e , y e t-- p ro v id in g the te a c h e rs one in te rv ie w s do n o t know th e purpose o r n a tu re o f the r e s e a r c h —i s f re e o f th e only im p o rta n t o b je c tio n to th e p r e s e n t study: pos s i b l e b ia s in th e resp o n se s o f th e p a t ie n t s r e s u lt in g from t h e i r p r e s e n t d is tu rb e d c o n d itio n . The f i r s t and c h ie f recommendation i s th e re fo r e to combine th e se two r e tr o s p e c tiv e te c h n iq u e s. N e c e ssa rily , a tim e l i m i t must be s e le c te d , and w ith some c a re : b oth th e p a t i e n t s and t h e i r form er te a c h e rs , coaches, coun s e l o r s , e t c e te r a , must be a b le to remember w ith re a s o n a b le accuracy what th e p a t i e n t s were lik e in t h e i r school y e a r s . I f th e h igh sch o o l le v e l i s chosen, th e age of tw e n ty -fiv e o r t h i r t y su g g e sts i t s e l f as th e upper l im it to th e p a t i e n t s ' ag e s. Then, i f both th e p a t i e n t s and t h e i r form er te a c h e rs can be in te rv ie w e d , th e p a t i e n t s ' p ro to c o ls can be to some e x te n t v a lid a te d a g a in s t th e te a c h e rs ' d e s c r ip tio n s . To av o id b ia sin g th e l a t t e r , a f r e e - a s s o c ia t io n type o f in te rv ie w may be b e t t e r than a q u e s tio n n a ire o r t r a i t check l i s t . The second recommendation has to do w ith th e p r a c t i c a l u s e fu ln e s s o f th e r e s u l t s . I f a l i s t o f d i s tin g u is h in g c h a r a c t e r i s t i c s i s s u c c e s s fu lly e s ta b lis h e d , such as th a t o f th e p r e s e n t r e s e a rc h , no doubt somewhat s im ila r r e s u l t s w ill be found: no t r a i t i s lik e ly to be u n iq u e ly p o sse sse d by th e p re s c h iz o p h re n ic s . This means 105 t h a t In d iv id u a l p r e d ic tio n i s u n r e lia b le . The d e te c tio n o f one o r more of th e t r a i t s in a g iv en s tu d e n t i s no g u a ra n te e th a t he w i l l in f u tu r e have a m ental breakdown. A t b e s t, he i s somewhat more lik e ly to do so than th e s t u d e n t in whom such t r a i t s a re n o t observ ed . T h e ir o b se rv a t i o n should a l e r t th e te a c h e r, and, i f f u r th e r c lu e s a re fo rth c o m in g , r e f e r r a l may be in o rd e r. But p s y c h o lo g is ts ' lo a d s are heavy and p a re n ts r e l u c t a n t . The r e l i a b i l i t y of t h e p r e d ic tio n m ight be in c re a s e d in v a rio u s ways, which would then reduce th e number o f cases r e f e r r e d , and tend to lim it r e f e r r a l to the in d iv id u a ls who are most in need o f a s s is ta n c e . Two main tech n iq u es f o r th is purpose would b e: to e s t a b l i s h degrees o f in te n s it y fo r each t r a i t s e p a r a te ly , and to stu d y the r e la tio n s h i p o f the p o sse ssio n o f more th a n one o f the d is tin g u is h in g t r a i t s to subsequent m ental i l l n e s s . In the f i r s t case, d e te c tio n o f the t r a i t as sim ply " p r e s e n t” would be follow ed by o b se rv a tio n to de term in e i t s s tre n g th and i t s p e rv a s iv e n e s s . I s i t s l i g h t , m oderate, o r very n o tic e a b le ? Does i t apply to only one a r e a or s i t u a t i o n , o r to s e v e r a l, or does i t perm eate n e a r ly a l l o f the s tu d e n t's r e l a t i o n s h i p s w ith th e school environm ent? In th e second case, in v e s tig a tio n m ight re v e a l t h a t , w h ile p o sse ssio n of any one of th e t r a i t s i s somewhat 106 in d i c a t i v e , p r e d i c t a b i l i t y i s much g r e a te r i f c e r t a in groups o f t r a i t s a r e c o n jo in tly p r e s e n t (and even more so i f each is v e ry m arked). I f , th en , th o se who have th e o p p o rtu n ity to ob se rv e th e s tu d e n t in a school s it u a ti o n had (a) a sim ple l i s t o f d is tin g u is h in g t r a i t s o f p o t e n t i a l f u tu re sc h iz o p h re n ic s , (b) a sim ple system o f r a tin g each acco rd in g to i t s s tr e n g th , p e rv a s iv e n e s s , e t c e te r a , and (c) a knowledge o f c e r t a in t r a i t groupings which a re mo^e r e l i a b l e as i n d i c a to r s than any o f th e t r a i t s co n sid ered s in g ly , they would be in a b e t t e r p o s itio n to d ecid e which in d iv id u a ls e sp e c i a l l y w arran ted f u r th e r concern o r rem edial a c t i o n . F i r s t , of c o u rse , hypotheses had to be form ulated and te s te d , so th a t a t l e a s t a p re lim in a ry l i s t of d i s tin g u is h in g c h a r a c t e r i s t i c s , o b se rv a b le in a school en v ironm ent, could be e s ta b lis h e d . I t i s f e l t th a t th e p r e s e n t r e s e a r c h has c o n trib u te d s u b s t a n tia lly to t h i s i n i t i a l p ro c e s s,' and i s to some e x te n t supported by p r e v i ous s tu d ie s such as t h a t o f Bower e t a l . (1960) and, In c e r t a i n r e s p e c ts t h a t o f Warnken (1958). So l i t t l e has been done in t h i s a re a in th e way of q u a n t ita tiv e re s e a rc h t h a t i t may be f e l t d e s ir a b le to add to th e p re s e n t s tu d y 's l i s t o f p o s s ib le p r e d ic tiv e - d ia g n o s tic symptoms in some f u tu r e re s e a rc h ; on th e o th e r hand, th e h ig h ly s i g n i f i c a n t d iffe re n c e s achieved (Tables 1 through 10, C hapter IV) 107 su g g e st t h a t th e te n a t t i t u d e s or b eh a v io r p a t te r n s con s id e re d p ro v id e a n u cleu s o f im p o rta n t i n d i c a t o r s , and th a t in c re a s in g t h e i r d is c rim in a tin g power, s in g ly or c o n jo in t ly , and u sin g th e v a l id a t in g te c h n iq u e s d e s c rib e d above, a re th e n e x t o rd e r o f b u s in e s s . These two o b je c ti v e s - - adding to th e l i s t , and im proving i t s v a l i d i t y and r e l i a - b i l i t y - - m i g h t w e ll be combined in f u tu r e s tu d ie s . The f i n a l recommendation i s t h i s : t h a t u t i l i t y be k e p t in mind in a l l re s e a rc h in t h i s a r e a . The school p s y c h o lo g is t i s presum ably equipped, when a s tu d e n t i s r e f e r r e d to him, to make a d ia g n o s is . Such r e f e r r a l s a r e , however, i n i t i a t e d by o th e r members o f th e school s t a f f - - te a c h e rs , coaches, c o u n s e lo rs . How a re th e se p e o p le, busy as th e y a r e , to be equipped to make d e c is io n s about i n d i v i dual s tu d e n ts? The s tu d e n t who r e f e r s h im s e lf, o r whose p a re n ts r e f e r him, to a c o u n selo r o r t h e r a p i s t c o n s titu t e s a s e l f cu rin g segment o f t h e ’p o p u la tio n . The o th e rs a re th e r e a l concern o f r e s e a rc h o f t h i s ty p e , though o f co u rse no study w i l l l i m i t i t s e l f j u s t to th e s e . The p r a c t i c a l c o n s id e ra tio n s a r e , however: who f i r s t d e te c ts th e sig n s o f f u tu r e m ental i l l n e s s ? How do they do so? How can th e y , by f u r t h e r o b se rv a tio n and r e f l e c t i o n , e s t a b l i s h some s o r t o f p r i o r i t y , however rough, so a s to ta k e rem ed ial a c tio n only in th o se ca se s which e x h ib it sig n s o f r e a l l y needing i t ? 108 In s h o r t, sin c e supposedly rem edial a c tio n may i t s e l f be d is tu r b in g , and sin c e c a s e -lo a d s a re so heavy, how can th e te a c h e r be a s s i s t e d in c l a s s i f y in g stu d e n ts in t h i s r e sp e c t? And how can th e technique be ren d ered more v a lid and r e l i a b l e , w h ile s t i l l being k e p t s u f f i c i e n t l y c le a r and sim ple f o r a busy te a c h e r to u se i t ? BIBLIOGRAPHY BIBLIOGRAPHY Ackerman, N athan. Psychodynamics o f Family L i f e . New York: B a sic Books', I n c ., 1950. Andrew, Gwenn, and Lockwood, H ild a .’ "T e a c h e rs1 E v alu a tio n s of th e M ental H ealth S ta tu s of T h e ir P u p ils ," Jo u rn al o f E d u c a tio n a l R e sea rc h . XLVII (A p ril, 1954), 631-5. A r i e t i , Sylvano. . The I n t e r p r e t a t i o n of S c h iz o p h re n ia . New York: R obert B runner, I n c . , 1955. B e lia k , L. S ch iz o p h re n ia , A Review of th e Syndrome. New York: Logos P r e s s T ^ I W . ------------------- ------------ ________ . Contemporary European P s y c h ia tr y . New York: Grove P re s s , 1961. ■ - _____ , and A bt, L aurence. P ro je c tiv e P sychology. New ” Y ork: Knopf, 1950. B irre n , James E. "P sy ch o lo g ical Exam inations of C hildreir Who L ater Became P s y c h o tic ," Jo u rn a l o f Abnormal and S o c ia l Psychology (January, 194'4), 84-95. B le u le r, Eugene. Dementia Praecox or the Group of S ch izo p h ren ias . New Y ork: I n te r n a tio n a l U n iv e r s itie s P re ss, B o rg a tta , Edgar F.- "Make a Sentence T est: An Approach to O bjective Scoring o f Sentence C om pletion," G enetic Psychology Monograph, LXIII (1961), 3-65. Bower, E li M. "E v alu atin g E d u ca tio n al E xperiences f o r the Promotion o f M ental H e a lth ," The P sy c h o lo g ist i n th e S chool, e d i te d by E l i M. BowerT Sacram ento, C a li- f o r n i a : C a lif o r n ia S ta te Departm ent o f E d u c a tio n , 1958. . E a rly I d e n t i f i c a t i o n o f E m otionally Handicapped C h ild re n . S p r in g f ie ld , 111.: Thomas, i9 6 0 . 110 Ill Bower, E l i M e ta l. High School S tu d e n ts Who L a te r Became S c h iz o p h re n ic . A B u lle tin P repared by th e C a lif o r n i a S ta te D epartm ent o f E d u c a tio n , V ol. XXIX, No. 8. Sacram ento, C a lif o r n ia , A ugust 1960. Bowman, K. M. "A Study o f th e P re -p s y c h o tic P e r s o n a lity i n C e rta in P sy c h o se s,1 7 American J o u rn a l o f O rth o p s y c h i a t r y , IV (1934), 473-98. B usw ell, M a rg a re t. "The R e la tio n s h ip Between th e S o c ia l S tr u c tu r e o f th e Classroom and th e Academic S uccess o f th e P u p i l s ," J o u r n a l of E x p erim en tal E d u c a tio n , XXII (Septem ber, 1953), 37-52. Cameron, Norman A. The Psychology o f th e B ehavior D is o rd e rs . B oston: Houghton M if f lin C o., 1947. ________ . P e r s o n a lity Development and P sychopathology: A Dynamic A pproach. B o sto n : Houghton, M if f lin Co., 1963. ________ , and M agaret, Ann. B ehavior P a th o lo g y . B oston: Houghton, M if f lin C o., 1931*". C aplan, G e ra ld . M ental H ea lth C o n s u lta tio n in S c h o o ls . The Elem ents o£ a Community M ental h e a lth Program . New York: N ilbank Memorial Fund, 1956. C lancy, Norah, and S m itle r , F a ith . "A Study o f E m o tio n ally D istu rb e d C h ild re n in S anta B arbara County S c h o o ls ," C a lif o r n ia Jo u rn a l o f E d u c a tio n a l R esearch, IV (November, 1958), 269-78. 1 D r i s c o ll , G e rtru d e . How to Study th e B ehavior o f C h ild re n . New Y ork: T eachers C o lle g e , Columbia U n i v e r s i t y , 1954. F e n ic h e l, O tto . The P sy c h o a n a ly tic Theory o f N e u r o s is . New York: W. W. N orton and Company, I n c ., 1945. Fenton, Norman. Mental Hygiene in School Practice. Palo Alto: Stanford University Press, 1948. F ra z e e , Helen E. C h ild re n Who L a te r Became S c h iz o p h re n ic . Smith C o lleg e S tu d ie s in S o c ia l WorkV V ol. XXIII (F ebruary, 1953),' pp. 125-49. F reud, Sigmund. A G en eral I n tro d u c tio n to P s y c h o a n a ly s is . New York: L iv e r ig h t P u b lish in g C o., 1955. 112 F rie d la n d e r, D orothea. " P e rs o n a lity Development of Twenty-Seven C h ild ren Who L a te r Became P s y c h o tic ," Jo u rn a l o f Abnormal and S o c ia l Psychology, XL (Ju ly , 1945), 330-5. ; G ilb e r t, Gustave M. "A Survey o f R e fe rr a l Problems in M e tro p o lita n C hild Guidance C l i n i c s ," J o u rn a l of C lin ic a l P sychology, X III (January, 1958), 37-42. G laz er, N athan. "Trends in M ental D is o rd e r," in M ental H ealth and M ental D is o rd e r, e d ite d by A rnold Rose. New York: W. W. Norton and Company, I n c ., 1955. G lid e r, M argaret C. L. Community M ental H ea lth : A School C entered Program . S p r in g f ie ld , 1 1 1 .: C h a rles Thomas P u b lis h e r s , 195 9. G lid w e ll, J . C ., and o th e r s . "B ehavior Symptoms in C h ild ren and Degree o f S ic k n e s s ," American Jo u rn a l of P s y c h ia tr y , CXIV (May, 1958), 447-53. G ross, C ecily F. " In tra ju d g e C onsistency in R atings o f Abnormal and S o c ia l P sychology," Jo u rn a l o f Abnormal and S o c ia l P sychology, LXII, No. 3 (May, 1961), . 605-9. Henry, W. E. The A nalyses o f F an tasy , th e Them atic Apper c e p tio n T e st in th e Study o f P e r s o n a lity . New York: John W iley and Sons, 1956. , and F a rle y , Ja n e . "A Study in th e V a lid a tio n . o£ th e Thematic A pperception T e s t," Jo u rn a l o f P ro j e c t i v e T echniques, XXIII (1959), 383-907 H o llin g sh ead , A. B ., and R ed lich , F. C; S o c ia l S t r a t i f i - c a tio n and P s y c h ia try . New York: John W iley and B o ris’ ; ' 19537 -------------- H olsap p le, James, and Mate, F lorence R. Sentence Comple tio n : A P r o je c tiv e Method f o r th e Study o f P erso n a l i t y . S p rin g f ie ld , 11 1 .: Thomas Company, 1954. H orow itz, Miriam J . "A Study o f C lin ic ia n s ' Judgments from P ro je c tiv e P r o to c o ls ," Jo u rn a l o f C o n su ltin g Psychology, XXVI (1962), 2 5 1 ^ Howard, K. I . " V a lid ity o f P r o je c tiv e In s tru m e n ts ," Jo u rn a l o f C l in ic a l P sychology, X VIII, No. 18 (1962), 183-8. 113 H u n ter, Elwood C. "Changes in T each ers' A ttitu d e s Toward C h ild r e n 's B ehavior, Jo u rn a l o f M ental H ygiene, XLI (January, 1957), 3-11. Ja ck so n , Don. The E tio lo g y o f Schizophr e n i a . New York: . . j i i i i nJ l W n i i i m > « iim B asic Books, I960. ! J e n k in s , R. L ., and Glickman, S y lv ia . "Common Syndromes in C hild P s y c h ia tr y ," American J o u rn a l of O rtho p s y c h ia tr y , I I (1944), 244-53. Jung, C arl G ustav. The Psychology o f Dementia P raeco x . New York and W ashington: Nervous and M ental D isease P u b lish in g Co., 1936. Kagan, J . "The S t a b i l i t y o f TAT F antasy and Stim ulus A m biguity." Jo u rn a l o f C onsulting Psychology, XXIII (1959), 2 6 6 -T n , and L e ss e r, R. ( e d s .) . Contemporary Issu e s in Thematic A pperception M ethod." New York: Greene and S t r a tto 'n ," 1962 7 ------------------- i and Moss, H. A. " S t a b i l i t y and V a lid ity of Achievement F a n ta s ie s ," Jo u rn a l o f Abnormal and S o c ia l ■ P sychology, LVIII (1959), 357-63. K aplan, L o u is. M ental H e a lth and Human R e la tio n s in Edu c a tio n . New York: H arper and b r o th e r s , 1959. K le in , Donald C ., and Ross, Ann. "K in d erg arten E n try : A Study o f Role T r a n s itio n ," in O rth o p sy c h ia try and th e S chool, e d ite d by M orris Krugman. New York: American O rth o p s y c h ia tric A s s o c ia tio n , 1958. Rnehr, C harles A. "T hinking Impediment in A cute Schizo p h r e n ia ," Jo u rn a l o f Psychology, L I I I (1962), 15-28. L ic h te n b e rg , Joseph D. "P ro g n o stic Im p lic a tio n s of th e I n a b i l i t y to T o le ra te F a ilu r e in S ch izo p h ren ic P a t i e n t s , ” P s y c h ia tr y , XX (November, 1957), 365-71. L id z, Theodore. "S ch izo p h ren ia and th e F am ily ," P sy ch i a t r y , XXI (February, 1958), 21-7. L indzey, G. "Them atic A pperception T e s t: I n t e r p r e t i v e Assumptions and R e lated E m p irical E v id en ce," Psychology B u l l e t i n , XLIX (1952), 1-25. 114 L i t t l e , IC . B ., and Schneidman, E. "The V a lid ity o f Thematic P r o je c tiv e Technique I n t e r p r e t a t i o n s , " J o u rn a l o f P e r s o n a l i t y , XXIII (1955), 235-94. M eyers, j . K ., and R o b e rts, B. H. Fam ily and C la ss Dynamics in M ental I l l n e s s . New York: John W iley and Sons, 1959. M ich ael, Carmen M., M o rris, Don P ., and S o ro k er, E le a n o r. "Follow -up S tu d ie s o f Shy Withdrawn C h ild re n . R e la tiv e In cid en ce o f S c h iz o p h re n ia ," American J o u r n a l o f O rth o p s y c h ia try , XXVII (A p ril, 1957), 531-7. M i l l e r , Alan D. The Role o f th e School System in a M ental H e a lth Program"! E d ite d by M orris Krugman. New York: American O rth o p s y c h ia tr ic A s s o c ia tio n , 1953. M itc h e ll, J . A. "A Study o f T e a c h e rs' and M ental Hygien- i s t s R atin g s o f C e rta in B ehavior Problem s o f C h ild r e n ," Jo u rn a l o f E d u catio n R esearch , XXXVI (December, 1964) ----------------------------------------------- M urray, H. A. Them atic A pperception T e s t M anual. Cambridge, M a ss.: H arvard U n iv e r s ity P re s s , 1943. , e t a l . E x p lo ra tio n s in P e r s o n a l i t y . New York: Oxford U n iv e rs ity P r e s s , 1938. M u rste in , B ernard. Theory and R esearch in P r o je c tiv e T echniques. New York: John W iley and Sons, 1963. N eubauer, P e te r, and B e lle r , Emanuel K. " D i f f e r e n t i a l C o n trib u tio n s o f th e E d u cato r and C lin ic ia n in D iag n o s i s , " in O rth o p s y c h ia try and th e S c h o o l. E d ite d by M o rris Krugman. New Y ork: American O rth o p s y c h ia tric A s s o c ia tio n , 1958. O 'N eal, P a t r i c i a , and R obbins, Lee N. "The R e la tio n o f Childhood B ehavior Problems to A dult P s y c h ia tr ic S ta tu s : A 30-Year Follow-Up Study o f 150 S u b je c ts ," American J o u rn a l o f P s y c h ia tr y , CXIV (May, 1958), 961— 9. ' . "C hildhood P a tte r n s P r e d ic tiv e o f A dult S chizo- p h r e n ia : A 30-Year Follow-Up S tu d y ," American J o u rn a l o f P s y c h ia tr y , CXV (November, 1958), 335-91. Rhode, Amanda R. The S entence C om pletion Method: I t s D iag n o stic and~~Clinical A p p lic a tio n to M ental D is^ o r d e r s . IS lew York: Ronald P re ss Go . , 1947 , 115 Sam uels, H. "The V a li d ity o f P e r s o n a lity T r a it R a tin g s Based on P r o je c ti v e T ec h n iq u es," P s y c h o lo g ic a l Mono g ra p h , LXVI, No. 5 (1952). Sanua, V ic to r D. " S o c ia l D is o rg a n iz a tio n in F a m ilie s of S ch iz o p h re n ics B elonging to V arious E th n o -R e lig io u s G roups," P s y c h ia try D ig est (November, 1965). S tevenson, I a n . " I s th e Human P e r s o n a lity More P l a s t i c in In fan cy and C hildhood?" American J o u r n a l of P s y c h i a t r y , CXIV (August, 1957)7"T5T-£)T" S to u f f e r , George A. W. "B ehavior Problems o f C h ild re n as I d e n t i f i e d by T o d ay 's T eachers and Compared w ith Those R eported by E. K. Wickman," Jo u rn al o f E d u c a tio n a l R e sea rc h , XLVIII (Jan u ary , 1955), 3 2 1 -3 1 . S u lliv a n , H arry S tac k . The I n te r p e r s o n a l Theory o f Psy c h ia tr y . New York: W. W. Norton, 1953. C l i n i c a l S tu d ie s in P s y c h ia tr y . New York: W. W. Norton",' W5W.--------------------- • --- . Schizophr e n i a as Human P ro c ess. New York: W . W. Nor to n , 1962. Ullm an, C h a rles A. I d e n t i f i c a t i o n of M a la d ju ste d School C h ild re n . Monograph No. 7 . W ashington, D.' C. : U.S. P u b lic W ealth S e rv ic e , 1952. W all, W illiam D. E d u catio n and M ental H e a lth . New York: Columbia U n iv e rs ity P re s s , 1955. Warnken, R obert G. "The E d u c a tio n a l Background o f Male S ch iz o p h re n ic P a t i e n t s , " U npublished D o cto ral D is s e r t a t i o n , U n iv e rs ity o f M innesota, 1958. W ittman, Mary P h y l l i s , and Huffman, A rth u r V. "A Coin-i - p a r a tiv e Study o f D evelopm ental A djustm ent and P e r s o n a lity C h a r a c te r i s tic s o f P s y c h o tic s , P sycho n e u r o tic , D elin q u en t and Normally A d ju ste d Teen-Age Y o u th s," J o u rn a l o f G en etic Psychology, LXVI (Ju n e. 1945), 1 6 7 ^ 7 ----------------------- *-^ ________ , and S te in b e rg , D. L o u is. "A S tudy o f Prodrom al F a c to rs in M ental I l l n e s s w ith S p e c ia l R eference to S c h iz o p h re n ia ," American J o u rn a l of P s y c h ia tr y , C (May, 1944), 811-6. 116 W ittman, P h y l l i s . "D ia g n o stic and P ro g n o stic S ig n ific a n c e o f th e S h u t-In P e r s o n a lity Type as a Prodrom al F acto r in S c h iz o p h re n ia ," Jo u rn a l o f C l in ic a l P sychology, IV (A p ril, 1948), 211-7T.

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

An Experimental Study Of The Effect Of Anxiety And Stress On The Group Intelligence Test Performance Of Elementary School Children

PDF

A Factor Analysis Of Some Hypothesized Abilities Of Six-Year-Old Children

PDF

Validity Concomitants Of Various Scoring Procedures Which Attenuate The Effects Of Response Sets And Chance

PDF

An Assessment Of Effects Of A Large, County Wide, Public School Program Of Special Training Classes On Trainable Retarded Children

PDF

Differential Abilities In Normal And Retarded Children At Mental Age Six

PDF

An Empirical Study Comparing Various Methods Of Achievement Expectancy Bymeans Of Mental Ability

PDF

An Investigation Of Two Language, Two Memory, And Two Perceptual Abilities In Retardates Of Mental Age Four

PDF

An Evaluation Of Orientation Programs In Seven Selected Small Liberal Arts Colleges, Using Student Satisfaction Criteria

PDF

Development And Analysis Of Some Tactual Measures Of Intelligence For Adolescent And Adult Blind

PDF

Predicting Success In The Study Of Descriptive Linguistics

PDF

The Relationship Of Creative Thinking Abilities To School Achievement

PDF

Rigidity In Children'S Problem Solving, With Emphasis On The Einstellung Phenomenon

PDF

A Problem-Centered Approach To Introductory Psychology

PDF

The effect of noise on intellectual performance as related to personality and social factors in upper division high school students

PDF

Lullabies Of The Western Hemisphere

PDF

Legal Problems In The Conduct Of School Elections

PDF

An Investigation Of Selected Ability, Aptitude, Interest, And Personalitycharacteristics Relevant To Success In High School Geometry

PDF

Dissent And Agreement Regarding The High School Counselor'S Role

PDF

The Prediction Of General And Differential Achievement In Two Samples Of Junior College Students

PDF

A Study Of Pupil Participation In A Church-Related School

Asset Metadata

Creator Sussman, Edward (author)

Core Title A Projective Look At The Educational History Of Adult Mental Patients

Degree Doctor of Philosophy

Degree Program Education

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Education, general,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Meyers, Charles Edward (committee chair), Lefever, David Welty (committee member), Martin, David W. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-223184

Unique identifier UC11360056

Identifier 6611594.pdf (filename),usctheses-c18-223184 (legacy record id)

Legacy Identifier 6611594.pdf

Dmrecord 223184

Document Type Dissertation

Rights Sussman, Edward

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA