Title: Temporal variability and pre-morbid adjustment in schizophrenia
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Title: Temporal variability and pre-morbid adjustment in schizophrenia
Physical Description: iv, 48, 1 leaves : illus. ; 28 cm.
Language: English
Creator: Humphries, Charles Creighton, 1924-
Publication Date: 1960
Copyright Date: 1960
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Subject: Schizophrenia   ( lcsh )
Psychology thesis Ph. D   ( lcsh )
Dissertations, Academic -- Psychology -- UF   ( lcsh )
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
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Thesis: Thesis - University of Florida.
Bibliography: Bibliography: leaves 42-47.
Additional Physical Form: Also available on World Wide Web
General Note: Manuscript copy.
General Note: Vita.
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Volume ID: VID00001
Source Institution: University of Florida
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Resource Identifier: alephbibnum - 000554324
oclc - 13398603
notis - ACX9161

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TEMPORAL VARIABILITY AND PRE-MORBID

ADJUSTMENT IN SCHIZOPHRENIA












By
CHARLES C. HUMPHRIES


A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF
THE UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY











UNIVERSITY OF FLORIDA
June, 1960














ACKNOWLEDGED N' S

The author extends his gratitude to Dr. James C. Dixon and the

other members of his committee, to Dr. Martin J. Brennan of the

Psychology Service of Lenwood Hospital, VAH, Augusta, Georgia; and

to Mr. Julian C. Davis of the Psychology Department of the Florida

State Hospital at Chattahoochee, Florida.













TABLE OF CONTENTS


Page

ACKNOWLEDGMENTS..................... ii

LIST OF TABLES........................ iv

Chapter

I. INTRODUCTION................... 1

The Problem
Temporal Variability
Two Kinds of Schizophrenia
The Phillips Scale
The Problem Restated

II. SUBJECTS . ....... .. .. .. . 15

III. PROCEDURE .................. . 20

IV. RESULTS AND CONCLUSIONS . . . . . 28

V. SUMMARY ................... ... 31

APPENDIX I. THE PHILLIPS SCALE . . . . .. 35

APPENDIX II. PERSONAL DATA OF SUBJECTS .... 38

REFERENCES ................... ...... 42

BIOGRAPHICAL SKETCH ................... 48













LIST OF TABLES


Table Page

1. Relationships between Control Variable and
Phillips Scale Scores ..................... 16

2. Correlations of Phillips Scale Scores and Test
Variability .................. ... ........ 29

3. Relative changes in Sub-test Scores from First
to Last Session........................... 30













CHAPTER I

INTRODUCTION

The Problem

Variability has long been noted as an outstanding characteristic

in the test performance of schizophrenics. This study seeks to deter-

mine if variation in test performance over a period of time is related

to level of pre-morbid adjustment in schizophrenics.

Specifically, this study seeks to test the hypothesis that indivi-

duals who have had a good pre-morbid adjustment will show more tem-

poral variability than those individuals who have had a poor pre-morbid

adjustment. Fluctuations in attention and motivation would seem more

likely to occur in those still in the acute storm and stress of recent

conflicts than in those who have long since reorganized and stabilized

themselves, even though on a psychotic basis.

A certain amount of variability appears in the normal organ-

ism, and has been found to occur as a matter of course in many sub-

human animals. Actually, variability in the sense of adaptibility is

felt by some to be a necessary part of evolutionary progress (Lepley,

1954) and should be examined as a lawful variable in itself. However,

this study is concerned primarily with pathological variability, which

may be defined as an inconsistency greater than normally expected or

1







2

behavior differing from what would normally be predicted on the basis

of preceding activities.

Temporal Variability

Temporal variability has been observed in the gross behavior

of schizophrenics. Studies (Gjessing and his associates, 1938; Rice,

1944; and Richter, 1938) have show explicitly repeated cycles of ab-

normal and normal behavior with a sharp transition from one phase to

another, the cycles ranging from two days to forty days in length.

More subtle temporal variability, perhaps not observable in overt be-

havior, has been shown to occur in psychological testing and is often

used as an aid in differential diagnosis. Temporal variability can

manifest itself in a short period of time over the course of a single

testing session, causing striking irregularities between tasks, and

in sub-test scores. It can show itself in the erratic and seemingly

paradoxical answering of difficult questions while missing easy ones.

Temporal variability can also be shown in the performance of

the same tasks over a period of time, when results are often highly

inconsistent with what would be expected on the basis of learning and

familiarity with material.

Research interest in variability and mental aberration was

shown early in the history of psychological testing, although interest

failed to continue. Pressey (1918) studied differences in test perfor-

mance between psychotics (in his sample, cases of dementia praecox







3

and chronic alcoholism) and primary mental detectives, both groups

having obtained scores in the mental defective range on the Yerkes

Point Scale. He found that the psychotics showed a consistently

greater total variation from the average normal individual of the

same age and that there was more individual variation from the aver-

age for the psychotics.

In a study following up this first, Pressey and Cole (1918)

examined the value of irregularity on a psychological examination as

an indicator of deterioration. Again the Yerkes Point Scale was used

on a sample of 158 feeble-minded patients and 67 cases of dementia

praecox and chronic alcoholism grading from 8 to 12 years of Mental

Age. They found the increasing order of irregularity to be the feeble-

minded patients, the cases of dementia praecox and the alcoholics.

However, the mean variation at each Mental Age was large, rendering

the irregularity on the total scale of little value. Certain of the tests

were more differential with respect to irregularity, giving results that

were much more meaningful statistically. They concluded that ir-

regularity could be caused by poor cooperation, illiteracy, malinger-

ing, psychotic disturbance of a temporary nature, or by deterioration

alone.

Curtis (1918) set out to obtain norms for the Yerkes Point Scale

but incidentally obtained variability scores for the various categories

of individuals whom she tested. She found chronic alcoholics to be






4

most variable, with schizophrenics second most variable. She stated

that this result seemed contrary to popular opinion of the day. but

that the schizophrenics were individuals who had recently become

patients; that if they had been psychotics of long standing their vari-

ability would have been greater.

Hunt (1936) tested schizophrenics, organic, and normal with

the same tests at intervals over a period of time and found that the

schizophrenics had the highest rate of variability. He stated that high

variability has been one of the most consistently demonstrated charac-

teristics of the performance of schizophrenics and cites as an illustra-

tion the work of Gatewood (1909). Gatewood obtained performances on

the same tests successively through a period of several weeks and

found schizophrenics who would achieve a score three times their

initial score and the next session would obtain scores only half their

initial score. Hunt's theory was that the high variability is due to the

lack of governabilityy" by which he meant the ability of individuals to

apply themselves to what they are doing and not to be distracted by

their own private responses.

Another similar study (Keehn, 1957) found greater variability

in schizophrenic test responses. He tested four chronic schizophrenics

from 13 to 15 times with the Bender-Gestalt test and the Block Design

sub-test from the Wechsler-Bellevue. Testing at intervals of about

four days, he found that two of the patients improved on the Bender-






5

Gestalt over the period of time, reaching normal levels or above.

However, the other two became poorer in their performance on the

Bender-Gestalt. All four improved on accuracy on the Block Design

Test, but not on time scores. The Bender-Gestalt scores fluctuated

widely, and Keehn felt that better scores could have been obtained

if the patients had been tested in several short periods, since in

every case, a patient's best possible performance substantially ex-

ceeded his best actual performance. Keehn felt that it was not the

Bender-Gestalt material that caused the fluctuations but the inability

of the patients to apply themselves consistently to the material over

the whole testing period. Similar results were obtained on the Block

Design Test, but they were not so marked, and general improvement

outweighed score fluctuations. All fluctuations occurred without treat-

ment or apparent change in the patient's overall behavior.

A study with similar findings, although incidental to the main

purpose, was that of Rosenthal and Imber (1958). They administered

mephenesin daily for two weeks to a group of patients including ambu-

latory schizophrenics, and also administered the Bender-Gestalt five

times over the period. They found that repeated administration of the

Bender-Gestalt had resulted in a generally improved performance,

but learning curves varied widely, some patients ending up worse than

they started.






6

Wolf (1957) used the test-retest method on 72 schizophrenics

and 72 non-schiaophrenies to determine if there was impairment of

particular functions. He equated them for age, intelligence, and

education and tested them twice, a month apart. He found that the

schizophrenics had greater variability than the non-schieophrenics

and also did less well as a group. There was no difference in the

amount of variability from test to test so he concluded that schizo-

phremia does net affect stability of performance in specific areas of

functioaing.

Armstrong (1952) studied the coasisteacy of longitudinal per-

formance on the Graham-Kendall Memory-for-Designs Test, and

showed that while schieopkrenics scored much better on total score

than organic with whomn they were compared, they were far more

erratic, showing much greater inter-test variability. It was his belief

that the lesser motivation of the sehlophrenics to improve their per-

formances accounted for the difference between the groups.

Rappaport (1953) tested groups of organic and sehiaephreaics

with the same tests repeatedly over a period of more than a month.

He attempted to relate the level of intellectual functioning with what

he called "behavioral accessibility, the degree to which the indivi-

dual is able to respoed to selected environmental stimuli. Also, he

attempted to ascertain the relative variability of aeceesibility in the

two groups.







7

He found that the relative variance of organic and schizo-

phrenics from day to day was not significantly different, considering

the group as a whole. However, the temporal variability of each

schizophrenic from performance to performance was significantly

greater than that of each of the organic, at the 1% level of confi-

dence. This suggests that the behavioral accessibility of the schizo-

phrenic varies widely from day to day, and his behavior and perform-

ance on various tasks do likewise. The individual behavior patterns

were grossly irregular, but in gathering data for groups as a whole,

the patterns were cancelled out by the superimposing of curves in

grouping the data. He concluded that the intellectual functioning of

psychotic patients does appear to be dependent upon behavioral ac-

cessibility and that the varying manifest intelligence of schizophrenics

is especially highly related and in direct proportion to their accessi-

bility at the time of testing.

Two Kinds of Schizophrenia

Certainly the bulk of the evidence seems to indicate that

schizophrenics show great temporal variability. However, these

studies treat schizophrenics as a fairly homogeneous group. There

is a current hypothesis (though not really new) that there are two sub-

groups of schizophrenia which can be differentiated, and that these

sub-groups can be shown to have considerable differences.






8

This hypothesis can be found, stated either implicitly or ex-

plicitly in the psychiatric and psychological literature since the time

of Bleuler (1950). He recognized that mome individuals appeared to

recover from dementia praecox in opposition to Kraepelin's notion of

aen-recoverability (1913), and felt that there was something operat-

ing that made necessary further criteria for the diagnosis. Many

others have divided schizophreaia into two sub-types and have suggested

many names for the dichotomy, e. g., process-reactive, chronic-

episodie, typieal-atypical, evolutionary-reactive, true-s chiophreni-

form, etc. Bellak (1944) sums it up in his statement that there is

apparently a syndrome that distinguishes itself from the classical

dementia praecox by an atypical pre-psychotic personality. Its onset

is not insidious; there is often a precipitating factor; It does not take

place in the presence of a clear sensorium; many of the phenomena

can be well understood and dealt with in terms of psychological dynamics;

and the outcome is relatively good. He terms this syndrome schiso-

phreaia and leaves the term "dementia praecox" to a possibly mere

somatically determined disorder. Meyer (1906) also made it a point

to distinguish the categories, and Sullivan (1928) and Laagfeldt (1937)

considered it well worth writing about. The inaereace based on these

observations has usually been that there is a schisophreniform psy-

chosis which develops fairly suddenly and in response to relevant stress

which does not follow the classical course, and that many cases of







9

so-called typical schizophrenia are so classified mistakenly.

Actually, however, there was very little definitive research

on the problem until Kantor, Wallner, and Winder (1953) explicitly

formulated the concepts and separated a group of schizophrenics into

"process" and "reactive" types from the case histories. They found

their separation to be reliable and demonstrated certain test differ-

ences between the two groups. The authors felt that their results

supported the view that the diagnostic category of schizophrenia can

be legitimately elaborated to include the classifications "reactive"

and "process. "

Following up their work, Brackbill and Fine (1956) conjectured

that perhaps process schisophrenics have organic complications while

the reactive group does not, which would help explain the great vari-

ability found in studies in this field. They studied three groups of sub-

jects; two groups diagnosed process and reactive by the same criteria

as Kantor, Wallner, and Winder (1953), and a third group of demon-

strated organic brain damaged individuals. They found that the organic

and process schizophrenics were quite similar with regard to certain

test responses, and were different from the group judged to be reactive

schizophrenics. They suggested that the difficulty in the differential

diagnosis of some schizophrenia and organicity is the result of central

nervous system pathology in process schizophrenia.








10

Continuing along the same line, Becker (1956) used the Elgin

Prognostic Scale to evaluate case records of 24 male and 24 female

schizophrenics in terms of the process-reactive continuum, assum-

ing the scale to be a measure of the level of personality organiza-

tion reached. He found lower genetic level scores in the process

type for both males and females, but results were more definite for

the males. He found a significant difference between males and

females on the Elgin Prognostic Scale, indicating that the process

and reactive types of schizophrenia may be manifested differently

in males and females.

In another study (Kantor and Winder, 1959) the authors depart

from the usual process-reactive dichotomy and assume a theoretical

formulation that there is a continuum of stages of personality develop-

ment and that each of these steps must be dealt with in order to suc-

cessfully cope with the next stage. The malignancy of the schizophrenic

reaction will depend primarily upon the developmental stage at which

overwhelming anxiety and psychological trauma occur. These five

stages have been patterned after the five integrative modes suggested

by Sullivan (1947), i. e., the empathic, the prototaxic, the parataxic,

the autistic and the syntaxic. The authors state that schizophrenia

developed in the syntaxic mode of development tends to be the least

malignant, and indeed suggest that it is the only mildly malignant re-

action of all of the modes, and that it is an appropriate reaction to







11

accidental severe stress, with minimal chances of repetition of break-

down. This appears to correspond to the concept of the reactive

schizophrenic, while all four of the other stages reflect varying

degrees of the process type.

Zimet and Fine (1959) relate the process-reactive concept

also to levels of personality organization. Using Werner's (1948)

concept of ontogenetic development from amorphous and undifferen-

tiated perceptions to increasing differentiation and hierarchic inte-

grations, they examined the same population as that used in Kantor,

Wallner, and Winder's study (1953). They found very significant

differences between the groups in level of perceptual development.

Becker (1959) further discusses the process and reactive

syndrome in schizophrenia as end-points of a continuum of illness and

at the same time as reflecting levels of personality organization.

This, he states, opens up a number of research strategies which

offer promise of increasing knowledge about schizophrenia.

The Phillips Scale

Phillips (1953) studied case history data of a number of schizo-

phrenic patients and noted that there were constant and consistent

differences between those who remitted following electroconvulsive

treatment and those who did not. By categorizing the data, he obtained

a rating scale which measured three aspects of the individual; pre-

morbid adjustment in the social and sexual fields, possible precipitating







12

factors; and signs of the disorder. This covered the general area of

the case history variables studied by Kantor, Wallaer, and Winder

(1953); and, usiag the scale, he was able to differentiate these patients

who could be expected to remit following electroconvulsive therapy and

these who were not likely to remit. Prediction was accurate in a cross-

validation study.

He found that nearly all of his predictive power came from the

scale which measured pre-morbid history. This scale deals with (a)

recent sexual adjustment, (b) the social aspects of sexual life during

and immediately beyond adolescence, (c) social aspects of the recent

seal life, (d) the past history of personal relations, and (e) recent

adjustment in social relations. Chi-square for the combination of

these factors against remission was 15.4, which is significant at the

S001 level of confidence. This scale is used in the present experiment.

The Phillips Scale, particularly the section dealing with pre-

morbid sexual and social history, has been utilled by several experi-

meaters who have found significant differences between schiuophrenaca

who were found to have good pre-morbid histories compared with

those who were found to have poor pre-morbid histories. In the first

place, Phillips found a striking difference in remission rates. Bleke

(1955) used the scale and demonstrated a significant difference between

the two grasps on adequacy of behavior under stress, although the two

groups scored the same as each ether and as a greup of normals under







13

reward conditions. Harris (1957) discovered a difference between the

two groups on size-estimation of pictures reflecting child-mother re-

lationships. Farina and Webb (1956) found that, although there was

only a slight relationship between Phillips Scale scores and a patient's

ability to remain out of the hospital on an early trial visit, the re-

lationship between the scores and the patient's later hospital status

was significant. Rosenthal (1959) studied concordance and discord-

ance of schizophrenia in identical twins and found that in discordant

twins (one of whom has schizophrenia and one of whom had not) the one

that has escaped the disease had a more favorable Phillips Scale score

than the one who had become schizophrenic, in every single case.

The dichotomy of good and poor pre-morbid adjustment types

of schizophrenia is not known for certain to be isomorphic with the

"process-reactive" dichotomy, but there are certainly many likenesses

apparent in the notion of bad pre-morbid adjustment in process schizo-

phrenia. If comparability is assumed, it would seem that the Phillips

Scale would be of great value in differentiating the two groups whose

differences in variability are being investigated.

Rodnick and Garmesy (1957) also report that evidence from the

laboratory suggests that the Phillips Scale is a reliable instrument as

well as a valid predictor. They state that a high inter-rater reliability

has been found when senior clinicians are compared with each other as

well as untrained graduate students. In addition, they report that pre-







14

morbid adjustment ratings derived by intensive interviews with pa-

tients, and from information supplied from case history data, have

tended to be markedly similar.

Garmezy and Rodnick (1959) admit that the observation that

schizophrenic patients are a heterogeneous lot is not an uncommon

one. However, they do not concur completely with the notion that

there is a real dichotomy or that the "process" schizophrenics are

necessarily organic and the "reactive" schizophrenics necessarily

psychogenic in origin. They do recommend that the use of certain

factors of pre-morbid adjustment in testing ichirophrenic patients

will strongly tend to reduce their heterogeneity, however, and illus-

trate this point with a number of experiments (Alvarez, 1957; Bleke,

1955; Englehardt, 1959; Farina, 1958; Garmezy. 1957; Zahn. 1959.)

They noted that in many of them, the heterogeneity of variance would

have masked real differences if separation on the basis of good and

poor pre-morbid adjustment had not been made, by use oi the Phillips

Scale. Again, differences reflecting a wide range of pre-morbid

antecedents were found.

The Problem Restated

To restate the hypothesis, schizophrenics who are shown to

have good pre-rorbid adjustment on the Phillips Scale will have more

temporal variability on psychological testing than will schizophrenics

who are shown to have a poor pre-morbid adjustment.













CHAPTER II

SUBJECTS

The subjects used in this study were 44 patients of the Florida

State Hospital at Chattahoochee, Florida, and 16 patients of the Len-

wood Veteran's Administration Hospital at Augusta, Georgia, making

a total of 60 subjects.

In order to reduce variability from sources other than those

desired, certain controls were placed on the subjects to be chosen.

All had been diagnosed as schizophrenic by staff diagnosis, and none

had been hospitalized more than a total of five years, although for

some the time since first hospitalization exceeded five years. At

least a modicum of contact with the environment was required, since

it was necessary that the patient be able to attend to the task. No pa-

tient less than 19 years of age nor older than 35 was used in the study,

since there appear to be few age differences in ability to do tasks in

this range. This restriction penalizes those in the younger group some-

what, however, since marriage is a positive factor in obtaining a favor-

able Phillips Scale score. All were males, so that sex differences

could not contribute to the variability. All of the patients were seen

at intervals of the same length of time (two weeks + one day) so that

changes in performance would be equal so far as retention and famili-









arity factors were concerned.

Three other sources of possible variation, age, intelligence,

and sub-type diagnosis were investigated to determine their influence.

Age and intelligence were correlated directly with Phillips Scale scores

and were found to be non-significant. (See Table 1. ) There were six

different types of schizophrenia. The means of the Phillips Scale

scores of each of the sub-types were computed. The highest and lowest

of the means were tested for significance of the difference between

them and the difference was found to be insignificant. (See also

Table 1.) This being the case, then, none of the other means could

possibly be significantly different, and it is concluded that sub-type

was not a confounding source of variation.


TABLE 1


RELATIONSHIPS BETWEEN CONTROL VARIABLES
AND PHILLIPS SCALE SCORES




Categories r t

Age vs. Phillips Scale Score -.22 1.69
MO vs. Phillips Scale Score -. 17 1. 31
Mean of SRSA mean of SRP vs. Phillips Scale Scores 1. 14



While no direct measure of intelligence was made, the Wechsler

Memory Scale, one test of the experimental battery, is designed to be







17

compared directly with the Wechsler Bellevue, Form 1. Wechsler

(1945), in the manual of the Wechsler Memory Scale states, "...

a method was arrived at which equated the memory scores against

the weighted scores of the Full Scale. The method is essentially

empirical and was arrived at by plotting the mean memory scores

for different ages against the weighted scores of the Bellevue Scale

(age group 20-24 years) and then trying out various constants which

would keep the IQ for any age group equivalent to the mean IQ of that

age group. The advantages of the Memory Scale are its relatively

satisfactory standardization, the fact that an allowance is made for

memory variations with age and the fact that memory quotients so

obtained are directly comparable to the subject's intelligence quotient. "

Thus, the Memory Scale was felt by the investigator to be fairly in-

dicative of the functioning level of the intelligence of the patient.

Complete data regarding the patients and their ages, MQ's

and diagnoses may be found in Appendix II.

The problem of tranquilizers and other drugs and their effects

on variability is so complex as to almost defy logical determination.

Certainly it can be stated that these agents bring about considerable

changes in overt behavior, and seem to reduce over-activity to a

great extent. It is the ordinary practice to administer larger and

larger amounts of drugs to patients whose behavior becomes more







18

and more erratic to bring this behavior more into normal range, and

this might possibly reduce also the variability which is shown on

psychological testing. It also appears possible that drugs, in making

schizophrenics' behavior closer together (toward normal) may thus

mask true differences which could be shown to exist if both groups had

not been pushed toward the normal. On the other hand, it might very

well be true that the ataractics cover over the behavior symptoms only,

and that psychological tests still reveal the basic irregularities in the

personality picture.

Most of the patients used in this study were on tranquilizers

throughout the six weeks that were required to complete the study and,

of course, the effects of these are unknown. There has been some re-

search done in connection with the effects of various drugs and tran-

quilisers on psychological test performances and the conclusion dra. n

are most inconsistent. Some (Good, Sterling, Holtaman, 1958) find no

change in test performance of schizophrenics with or without tran-

quilizers even with startling changes in overt behavior. Others

(Kovitz, Carter, and Addison, 1955) find that tranquilizers have a

facilitating effect on schizophrenic test performance; others (Lehmann

and Hanrahan, 1954) find it inhibits some tests; still others (Shaten,

Rockmore and Funk, 1956) find that tranquilizers inhibit some types of

tests, facilitate others and have no effect upon others. The same con-

fusion is found in the use of tranquilizers and drugs on normals and







19

their test performances; some increase, some decrease, some do

both, some do neither. At the very least it appears there is no clear-

cut relationship between the use of tranquilizers and their effect on psy-

chological test performance, although the impression is gained that

the technique of examining for the effect of the tranquilizer is one

factor in obtaining differences. Nevertheless, the conclusions of this

study must be made with the reservation that the effect of tranquilizers

on test variability was an uncontrolled variable.













CHAPTER III

PROCEDURE

The same set of psychological tested was presented individually

to the 60 schizophrenic patients every two weeks for a period of six

weeks, making a total of four presentations altogether. The tests in-

cluded the Wechsler Memory Scale, the Pursuit Rotor test, the Word

Association test and the Digit Symbol test. These tests were chosen

because of brevity, ease of scoring, previous standardization, diver-

sity of mental function examined, and a good likelihood of sensitivity

of temporal variations in effort, attention, motivation and transitory

psychotic disturbances. This design was arranged to examine the de-

gree to which the subjects varied in their responses on the various

tests from time to time throughout the period of the study.

Previous to testing, each patient had been rated for pre-morbid

adjustment using the Phillips Scale (see Appendix I). Any source of

information was utilized in filling out the rating scale, although most

information was obtained from the regular case folder. Any material

found in the cafe folder was examined for pertinent information, in-

cluding social histories, psychiatric examinations and notes, corres-

pondence and reports from other hospitals, agencies, and institutions.

On three of the patients special interviews were done by the psychiatrist

20






21

in charge of the patient at the request of the investigator to obtain ad-

ditional sexual and social information so that the Phillips Scale ratings

could be completed.

When case history data were too scanty to rate at least four of

the five sub-scales of the Phillips Scale, the case was discarded. How-

ever, if at least four of the five scales could be rated, the fifth scale

was prorated. If enough information was present to make it obvious

that the patient could not have been rated below a certain point on the

scale or above a certain point on the scale and yet the exact point was

indeterminate, a range estimate was made and the midpoint of the range

was used as the rating on that scale. Half scores were rounded off to

the next highest full digit score. Even with these allowances, most of

the case histories were unusable and were discarded. No more than

four cases having the same Phillips Scale score were used, and some

of the possible Phillips Scale scores were not obtained. However, the

majority of the scores have two cases, and the distribution of the cases

is roughly equal from high to low scores.

Inter-rater reliability was determined by having another staff

psychologist at the Florida State Hospital rate ten of the same cases

independent of the investigator. A Pearson product-moment correla-

tion was obtained for the two ratings, which was 96. All other raLings

were made by the investigator alone for the Chattahoochee cases. The

ratings of the Augusta cases were made by the staff psychologists of







22

that hospital after careful and detailed instruction in the use of the

scale by tho investigator.

Each subject was tested individually. At the first session, he

was asked if he would like to take part in a scientific experiment which

might be of some benefit in obtaining information about people who are

troubled with nervousness. If he assented to the testing, he was told,

"This test procedure requires that you come back several times for

further testing, approximately on the same day of the week each time.

At each of these sessions you will receive several different types of

tests. I would like for you to do your best each time. Are there any

questions ? Then let us begin with the first test. They will be fairly

short. If he refused testing, he was allowed to return to his ward.

If the patient requested more information about the testing, he was

told that it was entirely voluntary and would be in no way connected

with his relationship to the hospital or his treatment. This was suffi-

cient to dispel most suspicions. Only one patient refused to continue

testing after completing the first session, although many were lost

because of administrative action of one kind or another--furloughs,

transfers, referrals to medical and surgical wards, etc.

Testing was begun by the administration of the Wechsler Memory

Scale. The VWechsler Memory Scale is composed of seven sub-tests,

each measuring some aspect of memory. Test 1, called Personal and






23

Current Information, is composed of six simple questions. It is scored

by summing up the total number of correct answers. Test II, Orienta-

tion, asks five questions about the date and the place, and is scored by

summing up the total number of correct answers. Test III, labelled

Mental Control, consists of three sub-items, counting backwards from

20 to 1, repeating the alphabet, and counting by threes. It is scored

by giving two points for each sub-item done correctly, adding a point

if it were done in a certain time limit, taking away a point from each

sub-item if one error were made on that sub-item. These three sub-

tests discriminate very little or not at all between subjects of normal

or even near-normal intelligence and mental condition but many of the

patients used in the present investigation do not fall into either of these

categories.

Test IV, Logical Memory, consists of two memory passages

which are read to the subject and then he is asked to repeat as many of

the ideas as he can. The subject's score is the average of the number

of ideas which he produces correctly on both passages. The test is

intended to measure immediate recall of logical material. Test V is

the Memory Span for digits backward and forward, and the score is

simply the number of digits recalled. Test VI is a test of Visual Re-

production which requires the subject to draw from memory geometric

figures exposed for a period of 10 seconds. Scoring is based upon the

number of correct elements included in the reproduction of each of the







24

three figures. The Ilnal test, Test VII, called Associate Learning,

consists of 10 paired associates, some easy and some hard, which

the subject is required to learn in three trials. The score is the sum

of the hard associates recalled and half the easy associates.

The tests were all administered according to the directions in

the manual for the Memory Scale, with the exception of minor changes

due to present conditions. For example, the question, "Who is the

mayor of this city: was changed to, "Who is mayor of your home

town?" since the patients in this hospital come from all over the state.

After the Memory Scale was completed, the patient was told,

"Fine, and now let us try something a little different. He was asked

to stand in front of the Koerth Pursuit Rotor, and given the following

directions, similar to those of Huston and Shakow (1948), "On this

device you show your ability to learn a new movement. Hold the

pointer like this. The subject is shown that the pointer handle is held

in the hand with the palm downward and the fingers around the handle

and not touching the metal point. Directions are continued, "With the

wrist and pointer in a straight line, your body erect and well balanced,

keep the pointer on the target as it turns around. If you let the pointer

get off the target, catch up with the target again, moving the pointer

steadily until you get on it. At first, you may not be able to keep the

pointer on the target well, but as you continue, your hand and eye will

begin to work together and you will improve much if you do your best.







25

Your score will be higher the more you make contact with the target.

Let the other hand rest lightly on the edge of the turntable box. If you

relax between tries you will do better. When I say 'Ready, place the

pointer on the target and follow it as best you can until I say 'Stop. '"

Five trials were given, with a maximum of twenty seconds per trial

possible, and the score was the average of the five trials in seconds as

measured by a chronoscope. The Pursuit Rotor was set automatically

to run for about twenty seconds, switch off for about ten seconds and

repeat.

The Word Association Test was administered next. The words

used were taken from the list compiled by Rappaport in Volume II of

Diagnostic Psychological Testing (1946). Fifty of the words were used,

omitting those of obvious sexual content, because with a psychotic popu-

lation the words would have contributed little and would have complicated

rapport. The following directions were given, "I am going to read to you

a series of words, one by one. I want you to respond to each word with

one other word. It does not make any difference what your word will be,

but it should be the very first word that comes to your mind after you

hear my word. I want you to be just as fast as you can because I will

time you. When people take this test, they have a tendency not to hear

some of the words I call out. I want you to resist this tendency; I am

not supposed to repeat the words. The words and the reaction time to

the nearest second were recorded and scores were obtained by count-






26

responses on the first test for the same stimulus word.

When that was completed, the Digit Symbol sub-test from the

Wechaler-Bellevue Test of Adult Intelligence, Form I, was admin-

istered according to the standard directions. The score was the total

number correctly completed, and half scores for one of the symbols

which could be reversed. Afterwards, the subject was thanked and

told that he would be asked to come back in the near future and take

some more tests.

As was noted previously, the same set of tests was given four

times. It was expected that scores would show a gradual increase as

the testing continued, but this would be a constant factor and would not

bias the final comparisons. However, each time the subjects were not

certain that the same tests would be given each time or when they

might be called again; this probably helped hold down the effects of

between-sessions practicing for the subjects.

The data were treated by calculating a mean and standard devia-

tion for all scores on each of the tests, including all seven of the sub-

tests of the Wechsler Memory Scale separately. Then each of the raw

test scores vas converted in deviation scores, or a-scores. These

scores were then summated for each of the cases and their means com-

puted. Then the differences between each a-score and the mean of the

sz-Ecrc were obtained, squared, sunmmated and divided by the mean

to yield the actual variance of each case, that is, the composite vari-







27

ability of each case. Frequency distributions were plotted to deter-

mine linearity of the relationship between variability and Phillips

Scale scores for each of the tests including the sub-tests of the

Wechsler Memory Scale, and for all of the tests combined. Then a

Pearson Product-Moment Correlation of each of the sub-tests and

the Phillips Scale scores and for all of the tests combined and the

Phillips Scale scores were carried out. Finally, the null hypothesis

was assumed, and all correlations tested for significance.













CHAPTER IV

RESULTS AND CONCLUSIONS

The hypothesis studied in this investigation was that schizo-

phrenics who had a good pre-morbid adjustment would show more

variability than schizophrenics who had a poor pre-morbid adjustment

on the basis that their conflicts and struggles to solve their difficulties

would affect their test performance differentially from time to time.

This hypothesis, in the main, was not substantiated by the data.

Only one of the eleven correlations between test variability and Phillips

Scale scores was found to be of significance (see Table 2). This test

was the Pursuit Rotor test, a test of visual-motor coordination.

The Pursuit Rotor also led the group of tests very greatly in

amount of increase from time to time as a result of practice, and a

high variability score on this test was almost entirely the result of a

large increase in time spent on the target as testing progressed (see

Table 3). This result suggests that one difference between reactive

and process schizophrenics is that the reactive are able to improve

significantly their performance on a psycho-motor test of this type,

while the process schizophrenics can not. However, these findings are

of little significance for the purpose of this investigation, since there

was really no more genuine variability or erratic performance on the

28







29

Pursuit Rotor than any other of the sub-tests. Most subjects showed

a rather smooth increase from occasion to occasion.


TABLE 2

CORRELATIONS OF PHILLIPS SCALE SCORES
AND TEST VARIABILITY



Test Variability r t


WMS Test 1 30.38 .14 1.08
Test 2 38.63 .12 .92
Test 3 36.79 -.19 1.46
STest 4 41.10 .04 .31
Test 5 33.22 -.10 .75
Test 6 29.73 -.10 .77
"Test 7 48.63 .14 1.08
Pursuit Rotor ... 79.07 -. 36 2.74*
Word Association 13.69 .18 1.36
Digit Symbol ... 18.46 .26 2.02
All Combined ... 369.70 .1I 1.46


*Significant at 1% level of confidence.


All other sub-tests, and also all tests taken together show no

relationship between variability and Phillips Scale scores. The null

hypothesis could not be rejected for any of the other tests. Apparently

all the subjects, at least with regard to variability of behavior on psy-

chological testing, have been drawn from the same population.

All distributions were plotted and examined to see if the rela-

tionship between variability and Phillips Scale score might have been







30

concealed by a curvilinear relationship. The distributions were found

to be linear in nature.


TABLE 3

RELATIVE CHANGES IN SUB-TEST SCORES
FrOM FIRST TO LAST SESSION


Test



Wechaler Memory Scale
Te t I . . .
Test II . . .
Test III . . .
Test IV . . .
TestV . . .
Test VI . . .
Test VII . . .
Pursuit Rotor . . .
Word Association . .
Digit Symbol. . ..


Mean Scores

Sessions
1

4.82 4
4.20 4
5.25 5
5.53 6
9.55 9
8.33 8
12. 19 14
231.72 466
19
31.24 35


It is concluded then, that no matter what the pre-morbid adjustment

of the individual has been, his variability on psychological tests does not

differ significantly from that of other schizophrenics. Schisophrenica

who have had a good pre-morbid adjustment have been shown in other

studies to be different in certain ways from those with poor pre-morbid

adjustment. Apparently one of the ways in which they differ least is that

of symptomatology, and prognostic estimates based upon variability of

performance would be no better than chance.


Percent
of
Change


2

.95
.23
.93
.97
.67
.50
.23
.07
.30
.30


3

5.02
4.07
5.67
7.72
9.60
9.17
15.98
574.43
18.02
35.03


5.03
4.18
6.07
8.96
10.35
9.92
17.13
672.80
17.90
38.23


+04 %
-.5 %
+16 %
+62 %
+08 %
+19 %
+41 S
+190%
-07 %
+22 %













CHAPTER V

SUMMARY

High variability has been one of the most consistently demon-

strated characteristics of the performance of schizophrenics. This

present experiment proposed that the amount of variation in test per-

formance is related to the level of pre-morbid adjustment in schizo-

phrenia, the individual with a good pre-morbid adjustment showing

more temporal variability than the individual with poor pre-morbid

adjustment. The basis for this hypothesis was that persons who pre-

sumably have only recently been stricken with schizophrenia are still

in the midst of strain and strife that will affect their test performance

adversely from time to time, while the persons who have long ago

reorganized on a psychotic basis will not show this storm of conflict

and will not have their test performance disrupted in the same way,

but their divergencies from normality will be fairly constant.

Many experimenters have compared the temporal variability of

schizophrenics with normals and other nosological groups and the find-

ings have essentially confirmed the fact that temporal variability in

psychological testing is greater in schizophrenics than in any other

group. These experiments have assumed that schizophrenics are a

fairly homogeneous group, however, and this may not be the case.






32

There may be two or more types of schizophrenia which have differing

antecedents, prognosis, etc., or perhaps a continuum of malignancy

in schizophrenia with other demonstrable concomitants. This is not

a new concept, but little experimental work had been done to examine it

until fairly recently. For the last six or seven years, however, many

investigators, using primarily case histories but other criteria also,

have separated schizophrenics into groups, and have demonstrated

significant differences between these groups. These differences have

been found to be in responses to protective tests, to level or personali-

ty organization reached, to the developmental stage at which psycho-

logical trauma occurred, and in many other areas.

One method of separating schizophrenics is on the basis of pre-

morbid adjustment, and the Phillips Scale is used in this investigation

to separate them. The Phillips Scale was developed to aid in the pre-

diction of the individuals who could be expected to profit from electro-

convulsiv.- therapy, but was found to have great usefulness in separat-

ing schizophrenics for various other types of measure. While the

scale actually has three parts, only the part involving pre-morbid ad-

justment was utilized, since it contributed the greatest part of the pre-

dictive power. This scale measures (a) recent sexual adjustment,

(b) the social aspects of sexual life during and immediately beyond

adolescence, (c) social aspects of the recent sexual life, (d) the past






33

history of personal relations, and (e) recent adjustment in social re-

lations. Subsequent investigators have found the Phillips Scale to be

both reliable and valid.

Subjects used in this study were 60 male schizophrenics, 44

from the Florida State Hospital at Chattahoochee, Florida, and 16 from

Lenwood Veterans Administration Hospital at Augusta, Georgia. All

were between 19 and 35 years of age and none had been hospitalized

for more than 5 years. Age, intelligence and sub-type of schizophrenia

were shown by computation not to be confounding sources of variation.

Most of the patients were on drugs and the effects of these on variability

is not known for certain, since results of investigations on the effects of

drugs on psychological test performance are, at best, contradictory.

Previous to testing, each patthnt was rated for pre-morbid

adjustment on the Phillips Scale, principally from case histories.

Inter-rater reliability was determined by having another staff psycho-

logist rate 10 of the cases independently and the correlation between

ratings was .96.

The same set of psychological tests, the Wechsler Memory

Scale, the Pursuit Rotor test, the Word Association Test, and the

Digit Symbol test were presented individually to the 60 subjects every

two weeks for a period of six weeks, making a total of four presenta-

tions altogether. The design of this experiment was arranged to






34

examine the degree to which the subjects varied in their responses to

the tests from time to time.

All raw scores were converted to deviation scores, and vari-

ances were computed from them. All of the seven sub-tests of the

Wechsler Memory Scale, and each of the other tests used were corre-

lated with Phillips Scale scores. Also the total variability for each

case on all the tests combined was correlated with Phillips Scale

scores.

With the exception of the Pursuit Rotor, all correlations be-

tween variability and pre-morbid adjustment ratings were not signif-

icant. The Pursuit Rotor indicated that schizophrenics of good pre-

morbid adjustment varied more than the schizophrenics who had a

poor pre-morbid adjustment. This seems to have been due to the

relatively large increases in scores made by the good pre-morbid

adjustment schizophrenics, while the poor pre-morbid adjustment

schizophrenics did not tend to make large increases.

It may be concluded from these results that the high temporal

variability found in schlsophrenics is not a function of pre-morbid

adjustment.

































APPENDICES












APPENDIX I


PIIILLIPS SCALE

Part I

A. Recent Sexual Adustmnent

1. Stable heterosexual relationship and marriage ..... .0
2. Continued heterosexual relationship and marriage, but
unable to establish a home . . . . . . .. 1
3. Continued heterosexual relationship and marriage broken
by permanent separation . . . . . . . 2
4. (a) Continued heterosexual relationship and marriage,
but low sex drive ...... . . . . . . 3
(b) Continued heterosexual relationship with deep
emotional meaning, but emotionally unable to
develop it into marriage . . . . . . . 3
5. (a) Casual but continued heterosexual relationships,
"affairs" but nothing more . . . . .... .4
(b) Homosexual relationships, with lack of or chronic
failure in heterosexual relationships. ..... .4
6. (a) Occasional casual heterosexual or homosexual
relationships with no deep emotional bond ..... 5
(b) Solitary masturbation, not active attempt at
heterosexual or homosexual relationships ..... 5
7. No sexual Interest in either men or women . . . . 6

B. Social Aspects oi Sexual Life During Adolescence and
immediately Beyond

1. Showed healthy interest in opposite sex a "steady"
during adolescence .............. .... 0
2. Started going out with opposite sex regularly in
adolescence . . . . . . . . .. .....
3. Always mixed closely with boys and girls . . ... .2
4. Consistent deep interest in same sex attachments with
restricted or no interest in opposite sex . . . 3
5. (a) Casual same sex attachments with inadequate
attempts at adjustment to going out with opposite
sex . . . ... . . . . . . . . 4
(b) Casual contacts with boys and girls ........ 4









6. (a) Casual contacts with same sex, lack of interest in
opposite sex .............. ........ 5
(b) Occasional contacts with opposite sex . . . . 6
7. No desire to be with boys or girls; never went out with
opposite sex . . . . . . . . ... . . 6

C. (30 years of age and up) Social Aspects of Recent Sexual Life

1. Married and has children, living as a family unit . 0
2. Married, has children, unable to establish or keep a
home ........................... 1
3. Has been married, had children, but permanently
separated .. . .. . . .. . .. . . 2
4. (a) Married, but considerable martial discord. . . 3
(b) Single, has had engagement or deep heterosexual
relationships, but emotionally unable to carry
it through to marriage. . . . . . . . 3
5. Single, with short engagements or relationships with
opposite sex which do not appear to have much
emotional depth, i.e., "affairs" . . . . . 4
6. (a) Single, has gone out with a few of opposite sex,
but without other indications of a continuous
interest in them ................... 5
(b) Single, consistent deep interest in same sex
attachments, no interest in opposite sex . . . 5
7. (a) Single, occasional same sex contacts, no interest
in opposite sex ................... 6
(b) Single, interest in neither men nor women . . . 6

C. (Below 30 years of age) Social Aspects of Recent Sexual Life

1. Married, living as a family unit, with or without children 0
2. (a) Married with or without children, unable to
establish and keep a home. . . . . . ... 1
(b) Single, engaged or in a deep heterosexual relation-
ship leading toward marriage. . . . . . 1
3. Single, has had engagement or deep heterosexual
relationship, but emotionally unable to carry
it through to marriage. . . . . . . . . 2
4. Single, consistent deep interest in same sex attach-
ments, with restricted or lack of interest in
opposite sex ...................... 3
5. Single, casual same sex relationships with restricted
interest in opposite sex ................ 4









6. Single, has gone out with a few of opposite sex but without
other indications of a continuous interest in them. .. 5
7. (a) Single, never interested in or associated with men or
women ...................... ... 6
(b) Antisocial . . . . . . . . . . . 6

D. Personal Relations: History

1. Always had close friends, didn't habitually play leading
role . . . . . . . . . . . . .. 1
2. From adolescence on had a few close friends . . ... 3
3. From adolescence on had a few casual friends. ..... . 3
4. From adolescence on stopped having friends . . . 4
5. (a) No intimate friends alter childhood . . . . . 5
(b) Casual but never any deep intimate mutual friend-
ships . . . . . . . . . . . . 5
6. Never worried about boys or girls; no desire to be with
them ................... ....... .6

E. Recent Pro-Morbid Adjustments in Personal Relations

1. Habitually mixed with others, but not a leader . . .. 1
2. .Mixed only vith a close friend or group of friends . .. 3
3. No close friends; very few friends; never quite accepted
by thcrn.......................... 4
4. Quiet; aloof; reclusive; preferred to be by self . . . 5
5. Antisocial . . .. . . . . .. . . . . 6












APPENDIX II

PERSONAL DATA OF SUBJECTS

Part II


Phillips Sub-type of
Score Age Mc Schizophrenia


5 27 66.5 SRC

5 33 112 SRP

6 26 100 SRC

6 25 72 SRP

7 35 96 SRP

7 29 93.5 SRP

8 32 91 SRSA

8 26 121 SRP

9 21 83.5 SRU

9 28 76.5 SRP

9 28 104 SRS

10 26 103 SRP

10 30 66 SRP

10 24 105 SRU

11 30 97 SRC











Phillips .t,-r. p- .Ai
Score Ags MCN Echizophrenma


62

122

59

64

122

89.5

74

105.5

86

93

65

83

79.5

52

86

60

59

98

48

62


SRP

SRP

SRC

SRC

SRP

SRC

SRU

SRU

SRU

SRU

SRH

SRP

SRS

SRC

5RP

SRU

SRC

SRC

SRC

SRH











Phillips Sub-type of
Score Age M( Schizophrenia


73

72

61

105

62

89

76.5

84

82

110

92

51

107

108

109

48

52

122

95

93.5


SRU

SRU

SRH

SRU

SRU

SRC

SRP

SRP

SRU

SRSA

SRC

SRU

SRS

SRP

SRSA

SRP

SRS

SRP

SRS

SRP










Phillips Sub-type of
Score Age MQ Schizophrenia

27 22 74 SRP

28 21 114 SRP

28 29 66.5 SRU

29 20 48 SRSA

29 26 75 SRC


Schisuphrenic

Schizophrenic

Schisephrenic

Schizophrenic

Schi ophrenic

Schizophrenic


Reaction.

Reaction,

Reaction,

Reaction,

Reaction,

Reaction,


Catatonic Type

Paranoid Type

Hebephrenic Type

Simple Type

Undifferentiated Type

Schiso-affective Type


SRC

SRP

SRH

SRS

SRU

SRSA












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sions of schizophrenia. J. nerv. ment. Die., 1959, 129, 435-441.












BIOGRAPHICAL SKETCH

Charles C. Humphries was born in Miami, Florida, on August 23,

1924. He graduated from South Broward High School at Hollywood,

Florida, in 1941, and entered the Armed Services on April 20, 1943,

where he served until December 3, 1945. He enrolled at the University

of Florida in September, 1946, and obtained a Bachelor of Science

degree in September, 1949, and a Master of Arts degree in 1956.













This dissertation was prepared under the direction of the

chairman of the candidate's supervisory committee and has been

approved by all members of that committee. It was submitted to

the Dean of the College of Arts and Sciences and to the Graduate

Council, and was approved as partial fulfillment of the require-

ments for the degree of Doctor of Philosophy.



June, 1960



Dean, College of Artasad Sciences





Dean, Graduate School

Supervisory Committee:



Ch i an










r 9




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