TEMPORAL VARIABILITY AND PRE-MORBID
ADJUSTMENT IN SCHIZOPHRENIA
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
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
LIST OF TABLES........................ iv
I. INTRODUCTION................... 1
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
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
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
behavior differing from what would normally be predicted on the basis
of preceding activities.
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
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
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
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-
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
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
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
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.
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
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.
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
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
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-
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
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-
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.
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.
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
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
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
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
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.
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
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
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
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
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
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.
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
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-
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-
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.
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
Pursuit Rotor than any other of the sub-tests. Most subjects showed
a rather smooth increase from occasion to occasion.
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
concealed by a curvilinear relationship. The distributions were found
to be linear in nature.
RELATIVE CHANGES IN SUB-TEST SCORES
FrOM FIRST TO LAST SESSION
Wechaler Memory Scale
Te t I . . .
Test II . . .
Test III . . .
Test IV . . .
TestV . . .
Test VI . . .
Test VII . . .
Pursuit Rotor . . .
Word Association . .
Digit Symbol. . ..
12. 19 14
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.
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.
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
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
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
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
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
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
PERSONAL DATA OF SUBJECTS
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
Phillips Sub-type of
Score Age M( Schizophrenia
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
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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.
Dean, College of Artasad Sciences
Dean, Graduate School
Ch i an