' 5

 

 

 

 

A COLE’ARATIVE STUDY
OF
ATTITUDES 0F PARJZI- '33 OF 011anme DIAGNOSED AS PSYCHOTIC

AND CHILDREN DIAGNOSED AS CHARACTER DISORDER
IN A CHILD GUIDANCE CLINIC

by

. Donald Lee Mann

A PROJECT REPORT

Submitted to the School or Social Work,
Michigan State University, in Partial
Fulfillment of the Requirements
for the Degree 0:

MASTER OF SOCIAL LORK

June 1960

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ACKNOWLEDGEMENTS

To those who have guided and helped me with this re-
search I owe a great debt of profound gratitude. My sincere
thanks go to my research committee; Professor Max Bruck,
Ph.D., Chairman, for encouraging me in this undertaking and
giving me the benefit of his ideas and guidance; and Professor
Arnold Gurin for his careful examination of the data and his
many pertinent suggestions.

I wish to express my deep appreciation to the Staff of
the Jackson Child Guidance Clinic, especially to Mr. Henry
Zimmerman, Director, for permission to use the records of the
Clinic; Peter Mitchell, Ph.D., Staff Psychologist, for the
great amount of time he spent in helping to collect the date
end for his continued interest; Mrs. Ruth Nolan, M.S.W.,
Staff Social Worker, for her helpful suggestions and for her
encouragement; and Mrs. Elaine Hautale, Secretary, for her
helpfulness and patience during the time that the records
were in use.

Finally, I wish to thank my wife for her continued
patience throughout the project and also for her sympathetic

encouragement.

ii

ACKNOWLEDGMENTS . .
LIST OF TABLES . .
Chapter
I. INTRODUCTION
II. REVIEW OF THE

III. METHODOLOGY

IV. PRESENTATION AND ANALYSIS OF DATA
V. CONCLUSIONS AND RECOMMENDATIONS

APPENDIX . . . . . .
BIBLIOGRAPHY ‘0 o e 0

LITERATURE

iii

TABLE OF CONTENTS

Page
ii
iv

25
37
86
91
96

LIST OF TABLES

Table Page
1. Age of Children at Time of Referral . . . . . . 38
2. Sex of Children . . . . . . . . . . . . . . . . LO
3. Race of Children . . . . . . . . . . . . . . . ho

a. Number of Children in Family . . . . . . . . . A2

5. Number of Girls in the Families at Time of
Referral of Child . . . . . . . . . . . . . . A3

6. Number of Boys in the Families at Time of
Referral of Child . . . . . . . . . . . . . . L3

7. History of Illegitimate Children in Family . . bk
8. Nationality Background of Child . . . . . . . . #5
9. Sources of Referral . . . . . . . . . . . . . . A6
10. Nature of Referral . . . . . . . . . . . . . . #7
ll. Reasons for Referral of Child . . . . . . . . . 48
12. Age of Mothers at Time of Referral of Child . . 50
13. Age of Fathers at Time of Referral of Child . . 50
1h. Occupation of Mothers at Time of Referral

OfChj-ldoeeeOeeeeeeeeeeeee 52
15. Occupation of Fathers at Time of Referral

Of Child O O O O O O I O O O O O O O O O O O 53
16. Religion of Family at Time of Referral of

Child O O O O O O O O O C O O I O O O O 0 O O 53
17. Educational Level of MOthers at Time of

Referral of Child . . . . . . . . . . . . . . 55

18. Educational Level of Fathers at Time of
ReforraIOfChlld.............. 56

iv

Table
19.

2Q.
21.
22.

23e

2h.
25.
26.

27.
28.
29.
30.

31.

32.
33.
3h.

35.

36.

37.

38.

Parents Child Living With at Time of
Referral..................

Mothers Acceptance of Role as Parent . . . ...
Fathers Acceptance of Role as Parent . . . . .

Marital Status of Natural and Adoptive
Parents...o................

Number of'Years Natural and Adoptive
ParantaMarI'lOd................

Huber of Marriages of Mather, e e e e e e e 0
Number of Marriages of Fathers . . . . . . . .

Number of Separations in Marriage in
Question..................

Number of Desertions in Marriage in Question. .
Marital Adjustment of Mothers . . . . . . . . .
Marital Adjustment of Fathers ... . . . . . . .

Mbthers Acceptance of Respective Role in
Marriage4..................

Fathers Acceptance of Respective Role in
mrriage O 0 O O O O O O 0 O O 0 O O 0 O O 0

Personal Adjustment of the Mothers . . . . ...
Personal Adjustment of the Fathers ... . . ...

Tendency of Mbthers to Exhibit Behavior Similar
to that of the Child Referred .w. . ... . ...

Tendency of Fathers to Exhibit Behavior Shmilar
to that Of the Child Refarred e e e e e e e e

Predominant Attitude of Mbthers Toward Child
Referred.....‘.............

Predominant Attitude of Fathers Toward Child
Referred................,...

Mothers Position on the Control vs. Autonomy
$0810....................

Page

58
60
61

62

63
6h

66
66
69
69

71

72
7b
7b

76

76

78

79

81

vi
Table Page

39. Fathers Position on the Control vs. Autonomy
SOBlOeeeeeeeeeeeeeeeeeeee 81

so. Mothers Position on the Hostility vs. Love
Scal°eeeeeeeeeeeeeeeeeeee 82

Al. Fathers Position on the Hostility vs. Love
Scale . . . . . . . . . . . . . . . . . . . . 32

L2. Comparison of Predominant Attitudes of Both
Parent’eeeeeeeeeeeeeeeeeee 83

A3. Mothers Consistency or Inconsistency in Pre-
dominant Attitude . . . . . . . . . . . . . . 8A

LA. Fathers Consistency or Inconsistency in Pre-
dominant Attitude . . . . . . . . . . . . . . 84

CHAPTER I
INTRODUCTION

The general public hears and reads a great deal about
mental illness and also about crime and delinquency. most of
it borders on the spectacular or sensational. There are also
numerous articles that appear in the non-professional maga-
zines which deal.with growth and behavior of children. On a
professional level much has been published concerning theor-
ies of behavior and etiology of disturbance. Increasingly
more time and energy is being directed to the attempt to
look at some of these problems through systematic research.

Research in the etiology of mental illness and emo-
tional disturbance of children have distinguished, broadly,
between the types of psychopathologies involved in the dis-
orders of psychosis and character disorder. There is consider-
able disagreement and confusion concerning the respective
etiology of these conditions. Many theories have been advanced
and considerable research has been and is being done in these
two areas separately, but there has been little attempt to
compare the two.

Both types of disorders are believed to result from
early damaging parent-child relationships, in which parental
attitudes are an important factor. It is not clear, however,

1

2
what types of parental attitudes contribute toward the devel-
opment of psychoses in the children, and which types contribute
rather toward the development of character disorders. That
was the problem toward which this study was addressed.

This study was undertaken during the writer's student
placement at the Jackson Child Guidance Clinic, where it was
concluded that an exploratory study would be beneficial in
understanding and working with the child, the families, and
the problems they present. It is not a specific agency prob-
lem, but rather a problem within the broader'area of child
development and emotional disturbances.

The Jackson Child Guidance Clinic, located at Jackson,
Michigan, serves the two county areas of Jackson and Hillsdale
Counties. It has been in operation as an independent clinic
since November of 1956 and prior to that time had been opera-
ted as a branch of the Lansing Child Guidance Clinic for approx-
imately two years. Its current staff consists of a Psycholo-
gist as Director, a Staff Psychologist, a Psychiatric Social
Worker, a Staff Psychiatrist, and two full time secretaries.
Financially it is operated by state and county funds and some
individual gifts. Its function is to serve the clientele
from this two-county area concerning evaluation and/or treat-
ment of emotionally disturbed children, ages zero to nineteen,
or until out of high school. Referrals come from doctors,
schools, health and welfare agencies, and parents. many are
referred by the parents at the suggestion of some one person

or agency.

3

The Clinic may be active in any number of ways with
referrals. These include evaluation and referral of children
to other agencies or at the conclusion of the evaluative pro-
cess, the child and family may be accepted for direct clinic
cal services. The Clinic also has a role in educating and
interpreting to the community at large some of the present
knowledge concerning emotional illness and mental health.

The underlying assumption of this study is that there
are basic differences in the attitudes of the parents of the
children exhibiting these respective disturbances and that
these differences in attitudes are contributing factors, in
some measure, to the child’s ultimate pathology and adjustment
to life.

As an outgrowth of these observations two major hypo-
thesis are formulated: (1) Parents of Psychotic children are
characterized by attitudes defined as non-relating; and (2)
‘Parents of Character Disorder Children are characterized by
attitudes defined as withholding and punitive.

The teams used in the hypothesis are defined as follows:

Psychosis:

A severe emotional illness in which there is
a departure from normal patterns of thinking,
feeling and acting. Commonly characterized
by loss of contact with reality, distortion
of perception, regressive behavior and atti-
tudes, diminished control of elementary imp
pulses and desires, abnormal mental content
including delusions and hallucinations.

Chronic and generalized personality deter-
ioration may occur.

 

1Committee on Public Information American Psychiatric
Association, A Psychiatric Glossary (Washington: American
Psychiatric Association,l957f, 55.

A

Non-relating, defined for the purposes of this study,
is a lack of emotional flow between the parents and child
within the parent-child relationships, or the inability of
the parents to allow and foster the expression of feelings
which the child may be experiencing.

Character disorder:

Unhealthy patterns of behavior and emotional
response which are to varying degrees socially
unacceptable or disapproved, accompanied by
minimal outward evidence of anxiety or symp-
toms as ordinarily seen in the neuroses. The
symptoms are ego-syntonic.

Withholding and punitive: these terms are considered
together for the purpose of this study. This indicates an
absence of adequate positive feelings between parent and
child. Expected manifestations of such relationships be-

tween a parent and child are marked hostility and rejection,

with varying amounts of over control.

 

2Committee on Public Infommation American Psychiatric

Association, A Ps chiatric Glossar (Washington: American
Psychiatric AssociatIon, I§57§, 2I.

CHAPTER II
REVIEW OF THE LITERATURE

It should first be stated that there is no one uni-
versally accepted consistent theory concerning the etiology
of the disorder of Psychosis or Character Disorder. Due to
the fact that there are so many unanswered questions concern-
ing them, there are many theories and observations which
appear in the literature. The result is that there is much
repetition, overlapping, and confusion in semantics and pro-
fessional jargon. The writer will attempt, not to cover
this in great detail, but to summarize the predominant think-
ing as it relates to this study.

It is pointed out by Richard 0. Bell that there is a
great need for research to deal with the relation between
parental attitudes and what parents actually dO‘Wlth the
child.3 The literature deals with attitudes of parents as
expressed through the behavior of the parent in the parent-
child relationship.

The published studies relating to the present study
are for the most part not comparative in nature. They deal

'with the two disorders of Psychosis and Character'Disorder

 

3Richard 0. Bell, "Retrospective Attitude Studies of
Parent-Child Relations," Child Development (1958), XXIX,

p. 325.
5

6

separately. In a few studies a comparative study has been
done between one or the other of the disorders of Psychosis
or Character Disorder and other diagnostic scatologies. In
general, published comparative studies dealing with parent-
child relationships or attitudes of parents as they relate to
the psychiatric disorder of the child are very few in number.

The research and literature dealing with the etiolo-
gical factors of these two disorders seems to fall basically
into four categories which are: (1) biological or heredi-
tary; (2) physiological or organic; (3) sociological or cul~
tural; and (A) psychogenic or psychodynamic. Since the study
deals with psychogenic factors in the two disorders of Pay-
chosis and Character Disorder it is the literature in this
area that is of primary importance to the study.

A study that does include both the disorder of Psycho-
sis and Character Disorder was done with a group of adults
by J. E. Oltman‘ and coaworkers. The investigation centered
around the parental deprivation in various psychiatric dis-
orders and a group of normals. Parental deprivation and
broken homes were found to be very similar among schizophren-
ics and the normal control, but it was thought significant
that there was a higher incidence of parental deprivation in
psychoneurotics and psychopathic personalities than in schizo-

phrenics.

 

‘J. E. Oltman, J. J. MCGarry and S. Friedman, "Parana
tel Deprivation and the 'Broken Home' in Dementia Praecox
and Other'uental Disorders," American Journal of Psychiatry

(1952), CVIII, pp. 685-69h.

7
D. L. Gerard and J. Siegels in a study of seventy-

one adult male schizophrenics maintained that their results
supported the hypothesis that the disease is an outgrowth

of the pattern of family relationships and attitudes to
which the patients had been exposed. The parents were char-
acterized by marked maternal over-protectiveness and actual
absence or relative inadequacy of the father.

Trude Tietze6 studied the mothers of twenty-five
schizophrenics and found each to be over-anxious, obsessive,
domineering, and restrictive with the result being that the
child was deprived of usual outlets for aggressive impulses.

Theodore Lids7 and coaworkers have done considerable
work dealing particularly with the father within the family
of the schizophrenic. They stress the important role that
the father plays within a family situation and feel that
within the families of the schizophrenics they have studied,
the fathers have been domineering, rejecting or indifferent
and detached.

Vanya Cuffee8 in comparing a group of adolescents

 

5D. L. Gerard and J. Siegel, "The Family Background of
Schizophrenia," Psychiatric Quarterly (1950), XXIV, pp. L7-73.

6Trude Tietze, "A Study of methers of Schizophrenic
Patients," Psychiatry (1959). III, pp. 55-65.

7Theodore Lidz, Alice R. Cornelison, Stephen Fleck,
and Dorothy Terry, "The Fathers in the Intrafamilial Envir-
onment of the Schizophrenic Patient," Advances in PSYCQ$£f
tr , ed. Rebel Blake Cohen (New York: W. W. Norton & Co.,
I§§9), pp. 180-206.

8Vanya Cuffee, "maternal Over-Protection and Rejec-
tion of Adolescent Schizophrenics," Smith College Studies
in Social Work (October, l957--June, I958), XXVIII, pp. §3~9A.

8
diagnosed as schizophrenics and a second group of non-schizo-
phrenic but emotionally disturbed adolescents found that
maternal overbprotection and/or rejection was present in both
groups, "but it appears more intensely in the mother-child
interpersonal relationships of the schizophrenic adolescents."

9 and co—workers studied parents of schizo-

Jeanne Block
phrenic and neurotic children. They found that some of the
mothers did seem to fall into subtypes. The neurotogenio
mother appeared to be highly tentative, pervaded by guilt and
worry, and in constant need of reassurance. She was in closer
communication with her emotional life and did not markedly
hide her feelings, but because of her submissiveness, uncer-
tainty, and emphasis on relatedness, she seeks for herself
parent figures and the role of a protected child. In con-
trast, the ”schizophrenogenic mother" is characteristically
egocentric. Other people including the child seem to exist
only to serve her own ends and are consequently manipulated
and exploited or ignored. She presents the various interper-
sonal attitudes of distrust, hostility, emotional non-parti-
cipation and deviousness. These are understood as "props"
for her facade of adequacy. The fathers of the neurotic group
appeared to be more conciliatory and to have fewer conflicts
about receiving from others. The "schizophrenogenic fathers"

expressed their hostilities more directly and in general

appeared to be more assertive.

 

9Jeanne Block, Virginia Patterson, Jack Block, and
Don C. Jackson, "A Study of the Parents of Schizophrenic
and Neurotic Children," Psychiatry (1958), XXI, pp. 387-397.

9

10 and her co-workers studying a group of

Beats Rank
psychotic children whom they designated as children with a
typical development, have been impressed with the heredi~
tary and constitutitional role in the etiology of this condi-
tion, but have also emphasized the psychodynamic factors
inherent in the early parent-child relationship. They have
emphasized the emotional climate in which the child's early
object relationships have developed and in which his indivi-
duation has taken place. Three important etiological fac-
tors were classified: (1) a profound disturbance in the
early mother-child relationship; (2) a profound disturbance
in the early father-child relationship;and (3) traumatic
events experienced by the child. In particular, she has
characterized the mothers as being of two groups: (1) the
majority of whom.were either psychotic and had to be hos-
pitalized repeatedly, or (2) were immature, narcissistic
individuals who, although well-adjusted and even quite suc-
cessful and prominent intellectually and socially, were con-
stantly struggling to maintain the image of a fine woman,
wife, and mother. .mOst important in the character and per-
sonalities of these mothers was the absence or paucity of
the important element of genuineness in their maternal feel-
ings, depriving them of spontaneity and tenderness. The

traumatic events she feels center around physical illness,

 

10Beats Rank, "Intensive Study and Treatment of Pre-
school Children Who Show Marked Personality Deviations, or
'Atypical Development' and Their Parents," Emotional Prob-
lems of Early Childhood, ed. Gerald Caplan Thaw York: Basic

DBbks Inc., 1955). pp. t9l-501.

10
separation from or loss of the parents and the birth of sib-
lings. They feel that the father plays an important role in
the development of the disorder and describe him as essentially
a passive person. The view taken regarding the essential
passivity of these fathers, their ineffectual roles, and imp
poverished emotional contributions is that they have both de-
prived their children of healthy emotional resources and
failed to protect them from the negative destructive influ-
ences of their.mothers.

Leon Eisenbergll reported on a study of "The Fathers of
Autistic Children." One hundred cases were used and eighty~
five of the fathers exhibited a tendency to be obsessive, de-
tached and humorless. At home as well as elsewhere they ex-
hibited a lack of feeling for others. The remaining fifteen
fathers were described as warm, giving and devoted.

12.13 has emphasized a characteristic type

Leo‘Kanner
of family constellation in relation to the syndrome of Early
Infantile Autism and feels it to be a unique part of the
syndrome and a basic cause for the development of the autis-

tic ohild. He has described the parents of these children

 

11Leon Eisenberg, "The Fathers of Autistic Children,"
égerican Journal of Orthopsychiatry (1957), XXVII, pp. 715-
2A.

12Leo‘Kanner, "Early Infantile Autism," American
Journal of Orthopsychiatryp(19h9). XIX, pp. Al6-526.

13Leo'Kanner, Child Psychiatry (3rd edition, Charles
C- Thomas. 1957). pp.’739-7u1.

 

11
as characteristically cold and obsessional, sophisticated
and intelligent, and as adjusted to life and to their rela-
tionships in the most impersonal and mechanical manner.
They are dignified, formal and emotionally undemonstrative.
Lacking genuine warmth, they feel repugnance even for physi-
cal contact with their children who are reared in an emo-
tionally refrigerated atmosphere. Many of the fathers
hardly even know their children. He feels that the psycho-
tic state in these children, one of extreme withdrawal,
seemed to represent a turning away from the intolerable,
frustrating, ungiving relationship with parents who could
not adequately meet their emotional needs.

Rudolf Ekateinlk and co-authors express some of their
views concerning the psychogenic origin of this disorder.
They feel that the parents of the schizophrenic fall into
three categories, while the dominant parental relationship
has been characterized as one in.which one parent has been
dominant and the other submdssive and inadequate. They
describe the mother as being overtly or covertly rejecting.
The overtly rejecting mother is seen as being domineering,
aggressive, cold and critical of her child, while the covert-
ly rejecting mother dominates in the form of over-protective-
ness in which "smother love" rather than mother love charac-

terizes her relationship with the child. The writers felt

 

‘U‘Rudolf Ekatein, Keith Bryant and Seymore w.
Friedman, "Childhood Schizophrenia and Allied Conditions,"

Schizo hrenia, ed. Leopold Bellak (New York: Logos Press,
I933). P- 577

12
this subtle form of domination to be more destructive than the
overt type of rejection and domination because it is fraught
with a more malignant type of ambivalence toward the child
and prevents the child from expressing hostility and genuine
emctionality. The third category was the schizophrenogenio
fathers whom.they describe as often being domineering, tyran-
nical in nature, with extreme sadistic attitudes toward their
children which tend to conceal their basic weakness, and ac-
tual ineffectual, unsuccessful modes of adaptation to life.
It is pointed out that this is, of course, the reverse of the
situation in which the mother is dominant and the father
passive, unprotective of the child and ineffectual.' They state
that inherent in the pathologic relationship that these parents
have with their children is their inability to give genuine
love, but rather they offer a pseudo-love.
A psychoanalytic point of view regarding this disease

has been presented by P. Bergman and S. Escalona.15

The role of basic biological considerations in the de-

velopment of the early infantile personality structure

leading to future psychosis, but one based on psycho-

analytic principles, has been set forth by Bergman and

Escalona. In observing unusual sensitivities in very

young children who later became psychotic, these au-

thors postulated the thesis that such unusual sensitiv-

ities could be regarded as being unrelated to the qual-

ity of the ego itself, but were related to something

more primitive and constitutional in the child's make-

up. Bergman and Escalona attempted to conceptualize

the relationship between these unusual early sensiti-

vities to sensory stimulation concomitant with an ex-

cessive vulnerability to emotional hurt, and the occur-
rence of psychosis, on the basis of Freud's theory re-

 

151b1a., (1959). p. 567.

13
garding the organism's protective barrier against over-
whelming and dangerous amounts and Kinds of external
stimuli. They further hypothesized that the infant who
is not sufficiently protected from outer stimuli be-
cause of an abnormally thin protective barrier, or be-
cause cf the failure of maternal protection, may react
to such a situation with premature ego formation. When
this primitive, premature ego breaks down, probably as
the consequence of a trauma, psychotic manifestations
appear.

H. Hartmann and Anna Freud further support this point
of view. Anna Freud feels that failure in the early object
relationships due to maternal rejection should be a suffi-
ciently powerful agent to suppress the innate possibilities
of the ego to develop its normal functions.1

The newer developments in ego psychology have provi-
ded impetus for the heightened psychoanalytic interest in
the theory of schizophrenia.17

- 8

M. S. Mahler1 stresses that symbiotic children should
be thought of as being constitutionally vulnerable and pre-
disposed toward the development of a psychosis. It is the
existence of this constitutional ego defect in the child
which participates in the reaction of the vicious circle of
the pathogenic motherbchild relationship by stimulating the
mother to react to the child in ways that are deleterious to

his attempts to separate and to individuate.

 

1§£2£1-. (1958). pp. 582-583.
l7Ibid.

18M. S. Mahler and B. J. L. Gosliner, "0n Symbiotic
Child Psychosis: Genetic, Dynamic and Restitutive Aspects,"
Ps choanelytic Study_of the Child (New York: International
fi§§Versityfifiress,"I9551, X, pp.‘l95-215.

14
Pack, Rabinovitch and Cramer confirm Bender's viewb
point that there is no uniform pattern of family
dynamics and no typical group of pathological atti-
tudes of mothers to accognt for the child's illness
on a psychogenic basis.

Silvano Aristi stresses the important part that an-
xiety producing factors play in the disease. This could be
caused by any number of things, but primarily arising out
of the interpersonal relationships of the child.20

Considerable work being done at the National Insti-
tute of mental Health deals with psychosis as a family prob-
lem in which there is confusion regarding individual roles
within the family and subsequent breakdown in family rela-
tions. They feel there is a breakdown of the whole family
even though it may give the outward appearance of being an

integrated unit.21'22'23

 

‘19Ekstein, Bryant and Friedman, on; cit.. Pa 579.

20Silvano Arieti, ”Schizophrenia: The Manifest
Symptomotclogy, the Psychodynamic and Formal mechanisms,"
American Handbook of Psychiatry, ed. Silvano Arieti (New
Yin: Basic Books Inc., 195W. I, pp. ics-1.72.

2J'Irving Ryckoff, M.D., Juliana Day, M.D., Lyman c.
Wynne, M.D., Ph.D., "maintenance of Stereotyped Roles in
the Families of Schizophrenics," Reprint from the A.M.A.
Archives of Psychiatry (July, 1959), I, pp. 93-98.

22Lyman C. Wynne, Irving M. Rycxoff, Juliana Day and
Stanley I. Hirsh, "Pseudo-Mutuality in the Family Relations
of Schizophrenics," Reprint from ngchiat y (1958), XXI,
pp. 205-220. '

23Leslie Schaffer, MQD., Lyman C. Wynne, M.D.,
Juliana Day, M.D., Alexander Balperin, M.D., "0n the Nature
and Sources of the Psychiatrist's Experience with the Family
of the Schizophrenic,” Unpublished Paper (Adult Psychiatric
Branch, National Institute of Mental Health, U.S. Department
of Health, Education and Welfare, Bethesda 1h, Haryland),

ppe 2-39 e

 

15

The multiple causation theory is being emphasized by
Bellak, Fabian, Holden and Ackerman.2L

It should be pointed out before the literature is re-
viewed concerned with the area of Character Disorders that
there is a great deal of confusion in terminology. There is
much agreement that the term delinquency is a legal and not
a psychiatric term. However, it was felt that some of the
work that has been done concerning delinquency has perti-
nence and important information and, therefore, has been in-
cluded. '

In 1928 G. E. Partridge,25 the first scientist to
study the early environmental influence on psychopaths,
studied twelve psychopathic delinquents. All the boys were
described as hating their parents and all had been rejected
as young children.

In 1933 Elizabeth‘Knight,26 a social worker, compared
the family backgrounds of nine extremely aggressive chil-
dren with those of nine very submissive children. She
found that the mothers of the aggressive boys rejected them
and the mothers of the submissive boys were over-protective.
An overly punitive atmosphere dominated the homes of the
aggressive boys. 0n the other hand, she termed the homes of

 

2‘Ekstein, Bryant and Friedman, o . cit., p. 56a.

2f'vv’illiadecCord, Joan EcCord, Psychopathy and Delin-
guency (New York: Grune and Stratton,*l955f, p. 59.

26Ibid.

16
the submissive children as being "harmonious."

William Healy's27 clinical studies of individual de-
linquents and August Alchorn's application of psychoanalysis
have contributed greatly to the understanding of this dis-
order.

They established the etiological importance of severe
disruptions in the early lives of these children such
as: separation of child from the parents, loss of
affection for or confidence in the parents, prolonged
absence or death of parents, repeated changes in
foster homes, and institutional life which provides
no opportunity for the development of personal attach-
ments.

Minna Fieldza'in a study of twenty-five aggressive
children in l9h0 found that twenty-three had been rejected
by their parents. She felt that the crucial relationship
was between the mother and child.

In l9h2 B. L. Heller29 studied a group of fifty-two
psychopaths and found that a majority of them had been ne-
glected or rejected as children.

30

Since 1942, Adelaide Johnson, S. Szurek and their

colleagues have published a series of papers in which they

conclude the following: (1) the causes of the child's de-

 

27Eveoleen N. Rexford, "Antisocial Young Children
and Their Families,” Dynamic Psychopathology in Childhogg,
ed. Lucie Jessner and Eleanor Pavenstedt (New York: Grune
and Stratton, 1959), p. 187.

28Minna Field, "maternal Attitudes Found in twenty-
five Cases of Children with Primary Behavior Disorder,"
American Journal of 0rthopsychiatry,(l940), I, pp. 293-311.
29MicCord and McCord, o . cit., p. 60.

3°Rexford, op. cit., p. 188.

17
linquent behavior can be deduced by a study of the family
inter-relationships; (2) the parental neurotic difficulties
are expressed in the child's delinquent behavior; and (3)
the child frequently "acts out" the parent or parents' uncon-
scious anti-social wishes and is aided and abetted in his
activities by the parents.

Robert Linder31

in his intensive study of eight psy-
chopaths states that all had experienced brutal parental
treatment. _

Kate Friedlander32 in l9h7, after examining the re-
cords cf "anti-social characters" found that severe emotional
deprivation precipitated their behavior.

Dr. Friedlander33

further emphasizes the importance
of the early mother-child relationship, the nature of the
oedipal conflicts and the formation of the super-ego and
the group formation in his family.

John Bowlby3h has in his rather extensive work
stressed the role of physical separation from the mother
during the first three years of life and has also emphasized

the frequent history of severe emotional traumatos in the

early part of the life of the anti-social character.

 

31accord and McCord, op. cit., p. 61.
322223... .
33Rexford, loo. cit.

”3.1.9....

18

Patricia L. Guffey35 reported "A Comparative Study of
Sociopathic and Passive-Aggressive Character Disorders,"
and stated that: "The disturbances evident in the parent-
ohild relationships of both groups pervaded the subsequent
relationships pith siblings, marital partners and their
children."

Numerous studies have been reported that have studied
the relationship between rejection and aggression. Examples
of such studies are those reported by: Julie Ann Colety,36

W. W. Nowell,37 David Levy,38 Percival Symonds,39 Schactel

£1

and Levi,“O Harvard Laboratory of Human Development, and

#2 Typical of such studies

#3 In

William Goldfarb and Lawson Lowrey.
is the one reported by the Fels Research Institute.

19k5 this Institute sponsored an extensive analysis of parent-

 

35Pstricia L. Guffey, "A Comparative Study of Socio-
pethic and Passive-Aggressive Character Disorders," Smith
Colle e Studies in Locial Work (October, l957--June, I953),
m1 1. pp. 3-81}.

36Julie Anne Colety, "Family Characteristics of
Sexually Delinquent Girls," Smith College Studies in Social

Work (June, 1955). PP- 39'h0-
37M000rd and MCCOI‘d, Gas 013.. PP. 62-63e
381b1d., p. 63.

 

391bid.

 

holbid., p. 65.
uIbis.

 

 

:-

ZIbi
‘3Ibid., p. 64.

D
s

 

19

child relations which covered a period of two and one half
years in which they observed one-hundred and twenty-four
families. They classified the parents as acceptant, casual
and rejectant. All of the rejecting parents were hostile,
unaffectionate and disapproving. They demonstrated a high
correlation between parental treatment and child behavior.
Children raised in the rejectant environment usually showed
extreme hostility, a "highly emotional non-conformism," and
a marked resistance to adults. Although the rejected child
usually reacted with aggression, some of them adopted other
adjustments such as over-dependence, withdrawal or preco-
cious self-sufficiency. The severity of rejection seemed
to make the difference and they felt that the actively re-
pressed children responded with the most severe symptoms,
the greatest emctionality and the least inner control.

Irving'KaufmsnAh has done considerable study in this
area at the Judge Baker Guidance Center. He describes
three factors found repeatedly in pro-delinquent children:
(1) the specific trauma of losing a parent figure; (2) fixe-
ticns at preganital levels of psychosexual development; and
(3) specific types of ego and super-ego disturbances. 'He
further points out that the loss of the parent may result
from an actual physical separation or from.a lack of or with-
drswal of affection for the child. He further postulates
that this traumatic loss of the parent is responsible for an

 

MIrving'Kauf‘man, "Three Basic Sources for Pro-delin-
quent Character," Nervous Child, (1955), II, pp. 12-15.

20
unresolved depression which he believes is the core of the
delinquent‘s pathology and which the delinquent attempts to

handle by his acting out.
In discussing delinquency, Leo Kannerhs feels that the

parent-child relationship is important along with other fac-
tors. Hs feels that there are different degrees and types of
parental attitudes which incite and invite major disobedience.
He includes in this: (1) excessive restrictions; (2) exces-
sive permissivenesa; (3) inconsistency -- vacillating between
restriction and permissiveness; and (a) parental dissensions --
mother and father'wishing to do different things with regard

to the child.

Various authors and studies have pointed out the emo-
tional deprivation in the infantile period of the Character
Disorder persons. Examples of such authors and studies are
the following: Ralph D. Hebinovitch,"+6 Hyman S. Lippman,"7
Ben‘Karpman,h8 and Laurette Bender,“9 who is typical of such

 

‘5Leo Kanner, Child Psychiatry (3rd Ed., Charles C.
Thomas, 1957), pp. 688-689.

“6Ralph D. Rabinovitch, "Psychogenetic Factors," S15:
posie 0n Child and Juvenile Delinquency, Presented at the
American Orthopsychiatric Association, Chaired and Edited by
Benjamin‘Karpman, M.D. (Psychodynamic Monograph Series, 1959),
p. 11.

h7Hyman S. Lippman, "The Psychopathic Personality in
Childhood," Symposia 0n Child and Juvenile Delinquency, Pre-
sented at the American Orthopsychiatric Association, Chaired
and Edited by Benjamin‘Karpman, M.D. (Psychodynamic Mono-
graph Series, 1959), p. 5.

‘3Ben‘Kerpman, "The Psychopathic Delinquent Child,"
Symposia On Child and Juvenile Delinqueney, Presented at the
American Orthopsychiatric Association (Psychodynamic meno-

graph Series, 1959), p. #7.
”scours and McCord, op. cit., pp. 61-62.

w .7-

 

 

‘VT

 

21
authors. In her clinical work with hundreds of child psy-
chopaths she reported in 1947 that she found all had exper-
ienced emotional deprivation, neglect, or discontinuous
sffectional relationships. She believes that "early emo-
tional starvation, particularly during the first three years,
leads to psychopathy.”

Hervey M. Cleckly5o has recently stated that he has
not regularly encountered any specific type of error in the
parent-child relationship in the early history of his cases.
He further acknowledges, however, the need for scientific
research in this area.

Another approach to the understanding of psychopathy
and delinquency is the attempt to see these disorders related
to distortion in the family and community group structure.
Examples of this approach are: Nathan Ackerman,’l Harry.M.
Shulman,52 Douglas A. Thom,53 and typical of this approach

5b

is that of Sheldon and Eleanor Glueck. They have done con-

siderable research with delinquents and their families. They

 

soHervey M. Cleckly, "Psychopathic States," American
Handbook of Psychiatr , ed. Arieti (New York: Basic Books

Inc., 195917'1, p. 5 .

51Nethan W. Ackerman, The Psychodynamics of Famiiy'
Life (New York: Basic Books,"Inc., 1958), pp.‘23h-2A6.

52Harry M. Shulman, "The Family and Juvenile Delin-
quency,” The Problem of Delinquency ed. Sheldon Glueck
(Boston: Houghton Miffin Company, 1959), pp. 128-136.

53chford, op. cit., pp. 189-191.

 

5‘Sheldon and Eleanor Glueck, “Family Life and Delin-
quency," The Problem of Delinquency, ed. Sheldon Glueck
(Boston: Houghton Niffin Company, 1959), pp. 136-137.

22
report instability and broken homes to be greater in the de-
linquent group. The delinquents were much more the victims
of the indifference or actual hostility of their fathers and
{mothers. The fathers of the delinquents were erratic in dis-
ciplining and resorted more frequently to physical punish-
ment. The mothers were less erratic and more lax in disci-
pline. However, fewer of both parents of the delinquents
were consistent and kindly in their disciplinary practices.

A somewhat different approach was taken by Van Ameron-
gen55 and Schleifer who in 1956 explored the attitudes of
parents toward instinctual gratification and control on the
part of the child. They did a comparative study between a
group of families with children diagnosed as anti-social and
a group of families with children diagnosed as neurotic. The
parents of the anti-social children were predominantly pre-
occupied with whether and how to control his actions. The
mothers indicated their preference for drastic bodily repri-
sels, for“which they showed minimal guilt and anxiety. The
fathers belittled the severity of the child's acts and inter-
preted the anti-social behavior as proof of a desirable mas-
culine self-assertion not to be curbed. The parents of the
neurotic children acknowledge their need for help and the
role that they as parents might be playing in the child's
difficulties. The parents in the anti-social group were much

more controlling in all situations and with all people. Their

 

55Rexford, o . cit., pp. 203-211.

23
mode of control was predominantly negative and active, as
they rejected or criticized the lead of others.

Eveoleen Rexford56 states that after the eleven years
of study and work with the parents of anti-social children
they describe the fathers as predominantly being a passive,
restricted and hostile man who is strongly allied with his
child's behavior, firm in his belief that aggressive beha-
vior of whatever kind or degree is evidence of desirable
masculine self-assertion. They are marked by indulgence
with the boys. The mothers invariably demonstrate the abra-
sive effects upon their own adjustment of the boy's conduct.
They are described as having a sedomaeochistic relationship
with the child. The parents were predominantly negative in
their approach to others, controlling by rejecting, critici-
zing and opposing, which suggests that the child at home
may be constantly confronted with the choice of submission
to parental demands or outright rebellion against them.

It should be said again that there is no one univer-
sally accepted consistent theory concerning the etiology of
either of the disorders of Psychosis or Character Disorder.
There is a great need for scientific research in both dis-
orders end, although the material presented here has been
oriented to the psychogenic point of view, the writer could
not say that this is the universally accepted one. In terms
of research and literature dealing with the etiology of the

 

561bid.. pp. 213-213.

2k
two disorders of Psychosis and Character Disorder, there
seems to be more current interest in the psychoses and par-
ticularly schizophrenia. There seems to be considerable
material in the more current literature, particularly in the
Social Work literature, concerning the treatment of character
disorders, but not dealing specifically with etiology. An
example of such an effort is the recent work by Rainer and

57

Kaufman of the Judge Baker Guidance Clinic in Boston. One
reason for insufficient attention to the problem of Character
Disorder might be the confusion that surrounds the diagnostic
category of Character Disorder. The current trend, however,

is suggestive of increasing interest and concern.

 

57Beatrice Simoox Rainer and Irving'Keufman, M;D..
Character Disorders in Parents of Delinquents (New York:
Family Service Association of America, 1959).

CHAPTER III
METHODOLOGY

Selection of Sample

The cases for the two diagnostic categories were selec-
ted from both cpen and closed cases that were seen at the
Jackson Child Guidance Clinic during a period beginning in
1956 and ending in 1959. All had been active in some way
during that period of time.

Cases either diagnosed as psychotic or character dis-
order, or showing a trend in that direction, were selected.
Open cases were selected because it was easier to obtain
added information on open cases if it was needed. The next
step was to go through both groups, checking case material
in detail and noting those that were clear diagnostically,
those where there seemed to be some question and those that
could not be used. The information on which selection was
based were social histories, psychological and psychiatric
evaluations, and case material from other agencies or hospi-
tals. Cases where the diagnostic classification was in doubt
were ruled out. For example, where there was the possibility
of border-line mental deficiency or any known amount of or-
ganic involvement the cases were excluded. It was also deci-
ded not to use the character disorder cases which are within

the general diagnostic category of Personality Pattern Dis-
25

26
turbance. This decision was made because the clinic staff
regards it difficult with certain cases to distinguish between
the Schizoid personality and a diagnosis of Psychosis. They
stated that they tended not to diagnose a child as being
psychotic unless he or she was quite ill and that the border-
line psychotic children were quite often diagnosed as Schizoid
personality. It was therefore felt that the sample of char-
acter disorder children would be contaminated if this group
were to be included. In addition, cases were screened out
according to the amount of information available in the re-
cord. This meent that each case needed at least a social
history and psychological evaluation with most cases having
also a psychiatric evaluation and other collaterial informa-
tion. It was not necessary but helpful if the child and par-
ents had been seen on a treatment basis. After the initial
screening, the staff psychologist reviewed the cases indica-
ting which he regarded as diagnostically clear out. Follow-
ing these various screening processes fifteen cases of pay-
chotic children and eight cases of character disorder chil-
dren, which had been active cases, were included in the study
group.

Since a larger study group was desirable, cases closed
between 1956 and 1959 were screened. The previously described
criteria and screening process were used. In this way four
cases were added to the psychotic group and eight to the char-
acter disorder group. This brought the final sample to nine-

teen psychotic cases and sixteen character disorder cases

27

which were regarded as diagnostically clear. Eithin this total
sample, seven of the thirty-five children were adopted chil-
dren. One of the adopted children was in the psychotic group
and six were in the character disorder group.

The design of the sample did not make for results
which would prove statistically significant. The sample was
not selected on a probability basis nor'was it large enough,
in relation to the number of characteristics analyzed, to
permit the use of standard statistical tests for significance.
Findings are reported, not as statistically valid conclusions,
but as suggested tendencies which might be useful as leads for

further research.

Schedule
The date was collected with the use of a schedule. It
was divided into four sections: (1) Face Sheet Data on Child;
(2) Face Sheet Data on Parents; (3) Case Record Date on Par-
ents; and (A) Predominant Attitudes of the Parents Toward the
Child.

Collection of Date
The data was collected by the writer with the help and
cooperation of various staff members of the clinic. The
Staff Psychologist, Peter Mitchell, Ph.D., gathered all data
in sections three and four of the schedule. This was done in
an attempt to avoid biases which would have been in operation
if the writer had gathered the data in those two sections.

The psychologist had no prior knowledge of the hypotheses and

28
no operational definitions were established by the writer and
discussed with him prior to his rating the attitudes of the
parents. This again was to avoid bias which could have opera-
ted if the writer would have provided such definitions.

Where the records were deficient or not clear in the
information wanted, various staff members were consulted.

The data were gathered through the use of a schedule
as previously described. The focus of the study was con-
cerned with the predominate attitudes of the parents toward
the child referred to the clinic. These attitudes were ob-
tained through the use of the case material and an attitude
rating scale which the writer.has termed an ”Attitude Circum-
plex." The basic concept and design of the scale was devel-
oped by Earl S. Schaffer of the National Institute of Mental
Health.58

.A duplicate of the attitude scale as it was used in
this study appears on the following page.

The Circumplex consists of two rating scales with the
vertical scale being Autonomy vs. Control and the horizontal
scale being Love vs. Hostility. At the extreme ends of the
Autonomy vs. Control scale are the attitudes of freedom and
possessiveness. Acceptance and its polar opposite, rejection,
are placed on the Love vs. Hostility dimension.

Within each quadrant, there are the various predomi-
nant attitudes with those at the extreme ends of the scales

58Ear1 S. Schaefer, "A Circumplex Model For maternal
Behavior," Reprint from The Journal of Abnormal and Sochgl
Psychology (No. 2; September, 1959), Iii, p. 232.

29
Attitude Circumplex

 

 

Autonomy
Freedom D t'
Detached \ O~6E/N\fi/x emocra 1°
go /
Indifferent§(:x</I ~>( Cooperative
/ 63- \xx
Neglecting 4O
Rejection 2:?“ ’EL'
Hostility 1 1 1 1 1 \ Accepting
__ 3 i I I I
@080 '60 -40 —2.0 20 410 so alo Lave
.430.—
Demanding ‘
Antagonistic 40?‘ Yogi-Eu ent
S
_g£y_
I>< -80-- /Protective Indulgent
A thorita an‘
Bictatorial \f“7£i£ic> Over Protective
Possessive
Control

being divided equally between two quadrants.

The predominant attitudes are defined in the following

way with the help of case examples.

Freedom:

.A parent whose predominant attitude falls

within this category would exhibit or allow the child a

great deal of autonomy and a
or hostility.

the home for three nights and four days.

from the Juvenile Court

cerned because she wasn't attending school.

A case example follows:

very small amount of either love
"Jane was absent from

She was on probation

and the school officials became con-

Her mother said

30
she did not attempt to find out where she was since this
happened quite often and she was not concerned about her."

Democratic: The parent who exhibits this predominant
attitude*would exhibit a tendency to express more autonomy
than they would love. Case example: "The mother has made
several referrals to the clinic and seems to try, but can't
cope with the father when he berates and beats him." A
second case example: "The father insisted on taking her and
has always 'pampered' her by giving in to her wishes and de-
sires.” .

Cooperative: The parent who exhibits this predominant
attitude would exhibit a tendency to express more love than
they would autonomy. Case example: "The father is an amia-
ble, not too effective person who tries to set some limits
for the child and seems reasonable but not too effective in
these efforts."

Accepting: The parent who would have this as the pre-
dominant attitude would rate high on the Love vs. Hostility
scale, but would rate close to zero on the Autonomy vs. Con-
trol scale. They would be accepting of the child but would
be unable to meet his or her needs concerning Autonomy and
Controls. It is impossible to give a case example for this
attitude since there*were no cases in the sample in which,
when rated, this attitude was predominant.

Over-indulgent: The parent who would have this as the
predominant attitude would exhibit a high degree of Love with
a minimal degree of Control.

31

Protective-indulgent: This indicates that the parent
exhibits approximately equal amounts of Love and Control in
relating to the child. Case example: "Barbara and her
mother have both had Polio. The mother has a tendency to
become overbinvolved in protecting her yet tries not to
'spoil' her."

Over—protective: The parent who exhibits this as a
predominant attitude would exhibit a tendency to express a
considerable amount of Control with a small amount of Love.
Case example: The motherflwho nursed her child until he was
eighteen months old.

Possessive: The parent who exhibits this as the pre-
dominant attitude would exhibit a high degree of control with
a minimal amount of either Love or Hostility. This implies
that the parent is unable to accept the child as a separate
individual and rigidly structures the child to a specific
pattern without considering the feelings and needs of the
child. Case example: The mother and father of this girl are
divorced, the children were awarded to the mother at the time
of the divorce, but the girls were also to have visiting pri-
vileges with their father on the weekends. While the children
are visiting the father the mother continually phones to "see
who answers the phone” and drives past the house to "see that
they are there and not getting into trouble."

Authoritarian-dictatorial: This indicates that the
parent exhibits a tendency to express more control than hos-

tility. Case example: ”The mother is extremely rigid and for

32
punishment takes away privileges for months at a time. She
also fines him for minor infractions such as ten cents for
forgetting to turn off the light."

Demanding-antagonistic: The parent who exhibits this
predominant attitude would tend to exhibit more Hostility than
Control in relating to the child. Case example: "The father
is rigid and harsh, has very high scholastic expectations
and becomes very punitive when his son doesn't meet these
expectations. The punitiveness takes the form of verbal
abuse, denying the son a pair of shoes and at the time of
referral wasn't talking to his son.

Rejection: This implies that the parent, consciously
or unconsciously, did not want or like the child. The parent
may ignore the child and have as little to do with the child
as is possible or they may be consistently hostile, unaffec-
tionate and disapproving. The parent who exhibits this as a
predominant attitude exhibits a very high degree of Hostility
and a small amount of Autonomy or Control. Case example:
"Openly hostile to boy, beats him brutally, tells the boy he
is mean and not wanted.

Neglecting: The parent who exhibits this predominant
attitude exhibits a high degree of Hostility with a small or
minimal amount of Autonomy. Case example: "The mother lets
Jerry sleep on the back porch and approves of his wanting to
go to another home.”

Indifferent: This implies that the parent exhibits
approximately equal amounts of Hostility and Freedom in rela-

33
ting to the child. Case example: "The mother at the time of

intake had forgotten many early facts and didn't really seem
to know the child. At the time of the birth of the child the
mother‘wouldn't hold her for a few days."

Detached: The parent who exhibits this predominant
attitude exhibits a high degree of autonomy and a lower degree
of Hostility. Case example: "The.mother has worked regularly
and leaves the children by themselves." A second example:

"The mother seemed unaware of much of son's asocial and homo-
sexual behavior at the time of intake even though by the re-
cords she had been informed of it before coming to the clinic."

Another related aspect of the predominant attitude
study deals with the two rating scales which are the basis of
the Attitude Circumplex. The writer was interested in the
parents rating on the individual scales and how this might
be related to the study. It was decided that each of the two
scales would be divided into four sections. An example would
be as follows:

Hostility Love

 

The divisions for both the Hostility vs. Love scale and the
Autonomy vs. Control would be from -100 to ~Al for section one;
section two would be from -A0 to zero; section three from zero
to LO; and section four from.hl to 100.

On the Hostility vs. Love scale, persons rated in
section one would be considered as being hostile, section two
as predominantly hostile with a small amount of love appearing
at times. Section three would be predominantly love with a

3A
small amount of hostility appearing at times and section
four would be considered as being loving.

The same differentiation was made with respect to the
Control vs. Autonomy scale, with sections one being control,
section two control with some autonomy, section three auto-
nomy with some control and section four autonomy.

In addition to the predominant attitudes of the par-
ents the writer also felt that the factor of consistency or
inconsistency on the part of the parent in maintaining this
predominant attitude would be important to the study. A
rating scale was devised to find out the importance of this
factor in the cases being studied. It consisted merely of
a line scale with consistent and inconsistent being at the
extreme ends in the following fashion:

Con.1 1 .1 2 .1 3 n: ‘__JInccn.
The‘writer was not interested in the predominant attitude of
the parent but rather the consistency or inconsistency which
existed. The rating was again done by the Staff Psychologist.

The persons who were rated as being in section one of
the scale were considered as being consistent in their pre-
dominant attitude. Case example: "Beats children brutally
after they pass infancy."

The persons who were rated as being in section two of
the scale were considered to be predominantly consistent, with
a small amount of inconsistency in their predominant attitude.
Case example: "nether becomes concerned only when pressure

is exerted by the authorities then she becomes very protective."

35

Section three of the scale was considered to be predomp
inantly inconsistent with a small amount of consistency. Case
example: "The father apparently has very little control of
his son or very little interest in him and there are many
contradictions.‘I

The persons who were rated in section four of the scale
were considered as being inconsistent in their predominant
attitude. Case example: "The mother is alternately brutal
and over-protective with the child."

In any attitude rating scale there are inherent weas-
assess and limitations. This is recognized in relation to
this study. Dr. Peter Mitchell collected all data in sections
three and four of the schedule. This included all data con-
cerned with the attitudes of the parents. It is recognized
that since only one person did the rating the study is subject
to criticism for the reason that no reliability test could be
made because of limitations in staff persons available. The
writer did not become involved in the rating of the attitudes
because of the danger of bias. However, even with these
built-in limitations the study is regarded as providing some
information which may give some clues concerning the contri-
buting factors to children diagnosed as psychotic and charac-

ter disorder.

Tabulation
The tabulation of the data was done through the hand-
sorting method. As the information was taken from the sched-

ule it was placed in the various categories for each of the

36
psychotic and character disorder groups. It was then placed

into the tables in the order in which it had been tabulated.

CHAPTER IV
PRESENTATION AND ANALYSIS OF DATA

The presentation and analysis of the data has been di-
vided into four major sections: (1) face sheet data and case
record material on the children; (2) face sheet data on the
parents; (3) case record data and information on the parents;
and (A) data on the predominant attitudes of the parents
toward the child.

The major focus of the study is a comparison of the
predominant attitudes of the parents of psychotic and charac-
ter disorder children. In addition it was felt that other
factors should be considered to see what possible role, if any,
these might play in the two disorders of psychosis and charac-
ter disorder. As the date are presented these factors, where
present, are pointed out. However, since the focus is on the
predominant attitudes of the parents toward the child, as a
contributing factor to the disorders of psychosis and_charac-
ter disorder, the writer's hypothesis should be kept in mind.
The hypothesis is that: (1) parents of psychotic children
can be termed as non-relating in their attitudes toward the
child while (2) parents of children diagnosed as character
disorder can be characterized by attitudes defined as with-
holding and punitive. The writer regarded attitudes as con-

37

38
tributing factors to the disorders, but did not exclude other

factors

Face Sheet and Case Record material 0n Child
With respect to the age of the children it was entici-
pated that there would be a considerable age range and that
the psychotic and character disorder children wouldxnot differ

greatly in this respect.

TABLE 1

AGE OF CHILDREN AT T 2:13 OF REF’RRAL

 

 

 

 

Psychotic Character Disorder
Age in Years Number Per Cent Number Per Cent
5-6 1 5.26 c --
7-8 ‘0 21 e 05 0 .-
9-10 A 21.05 2 12.5
11-12 5 26.31 h 25
13-1A 1 5.26 6 37.5
15-16 A 21.05 3 18.75
17-18 -_9. "' A 6.22
Total 19 100.00 16 100.00
I = 10.78 yrs. M = 13.25 yrs.

 

As can be seen, the range was greater for the psychotic
children than for the character disorder‘children. We see
that the character disorder children tend, as a group, to be
older. This does not support what the writer had previously
anticipated. It is also interesting to note that the psycho-
tic children are fairly evenly distributed throughout the age

range while the character disorders do not present quite the

same picture. As a group, the psychotic children tend to be

39

younger than the character disorder children. This indicates
that the psychotic children are referred at an earlier age and
that the character disorders are referred at an older age.
This might indicate: (1) that the onset of the disorder is

at an earlier age for psychotic children than for character
disorder children; or (2) that the need for help is recognized
sooner in relation to psychotic children than it is for char-
acter disorder children or people may see the behavior of the
character disorder children as normal behavior during the
process of growing up or at least it may be rationalized as
such.

Concerning the sex of the children in the sample the
writer anticipated that there would be.more males than females
in the total sample.

The sex differentiation was about what was expected.
Males were predominant in both categories. This could indi-
cate: (1) that both disorders are more frequently found in
male children than they are in female children; or (2) that
the society and environment within which the female child
lives is more accepting, or at least more lenient, in their
attitudes toward her behavior, whether it be normal or abnor-
mal, than it is toward similar behavior exhibited by male
childre..

Prior to investigating the situation the‘writer expec-
ted that he would have, in addition to white and Negro chil-
dren, possibly some children from other racial backgrounds

because of general clinic population. It was also felt that

LO
about 20% of the character disorder children would be Negro
with the percentage being somewhat lower with the psychotic
children.

TABLE 2
SEX OF CHILDREN

 

 

 

Psychotic Character Disorder
Sex Number Per Cent Number Per Cent
Male 15 78.9L 11 68.75
Female _5_ 21.05 ‘_2 31.22
Total 19 100.00 16 100.00

 

As can be seen in Table 3, there were two racial groups
in the sample. The percentage of Negroes was small in both
groups. This might be accounted for in the following ways:

(1) the proportional distribution of races within the popula—
tion being served by the clinic; or (2) that there is a reflec-

tion of class or socio-economic distinction and differentia-

TABLE 3
RAGE OF CHILDREN

 

 

 

Psychotic Character Disorder
Race number Per Cont’ “Number Per Cent
White 18 94.73 15 93.75
Negro ,_l 2.26 _1 6.22
Total 19 100.00 16 100.00

tion in the cases referred or making use of the clinic. It

would be interesting to see if the addition of a Negro person

L1

’ to the staff of the clinic might have an effect on this
factor. It might be expected to increase the use of the clinic
services by negroes.

It was expected that in general the children diagnosed
as character disorder would be from larger families than those
diagnosed as being psychotic because of the suspected immedi-
ate need gratifying patterns of the parents. An added factor
which was thought might have some importance was the number of
deceased children in the families and their ordinal position
within the family. This, however, was not obtainable from the
records and therefore it was not possible to investigate these
factors in their relationship to the diagnostic categories
under consideration.

The average number of children in the families of the
two categories varied only slightly. There tend to be more
children in the families of the psychotic children than in the
character disorders. The general conclusion drawn from this
is that both tend to have the same number of children in their
families.

In addition to the number of children in these famp
ilies it was thought that examining the sex of the children
in the families might also be helpful in pointing out possible
tendencies. A

Prior to the study the writer anticipated that there
would not be much difference in the number of male and female
children in these two groups.

Tables 5 and 6 indicate a slight difference concerning

#2

TABLE A
NUMBER OF CHILDREN IN FAMIEY

 

 

 

 

 

 

 

 

 

 

 

-—-u— 4 ..—__ a
No. of Psychotic‘_ Character Disorder
Children Number Per Cent Number wPer Cent"
1 l 5.26 l 6.25
2 5 26.31 1 6.25
3 L 21.05 6 37.5
L 2 10.52 1 6.25
5 L 21.05 6 3705
6 1 5.26 --
7 1 5e26 ‘u'
g -- 1 6025
10 ___r 5.26 E;

H I 3.89 Children l,= 3.9L Children

 

the number of boys and girls in the families of these two
groups -- with the families of the psychotic children tend-
ing to have a larger proportion of boys than girls and the
families of character disorder children tending to have a
larger proportion of girls than boys. This difference, how-
ever, seems slight.

When the writer first began this study it was thought
that the factor of illegitimacy should be explored, not only
as it related directly to the group of psychotic children and
the group of character disorder children, but also as it
might involve other children in the family. It was expected
that both the psychotic group and character disorder’group
would have illegitimate children in them.but that the charac-
ter disorder group would tend to have a higher percentage
within it than.would the psychotic group because of the sus-

#3

TABLE 5

NUMBER OF GIRLS IN THE FAMILIES
AT TIME OF REFBRPJXL OF CHILD

WW

 

 

 

 

 

 

 

 

 

 

 

 

Psychotic Character Disorder
Girls FumEEr Per Cent Number Per Cent
0 3 15.52 1 6.25
1 7 36.8h 5 31.25
2 b 21.05 L 25
3 3 15.52 h 25
l} ’- -" 2 12e5
g 1 5e26 'H- --
Total 19 100.00 16 100.00
Hie 1.89 Girls M s 2.06 Girls
TABLE 6
NUMBER 01" BOYS IN THE FAMILIES
AT TREE“ 0F REFERILCLL OF CHILD
====: T W m
Psychotic gharacter Disorder
Boys Number Per Cent Number Per Cent"
0 1 5.26 1 6.25
1 5 26.31 6 37.5
3 l 5.26 2 12.5
5 -- --
6 _l. 2.26 _1 6.25
Total 19 100.00 16 100.00
H.e 2 Boys M.= 1.875 Boys

 

pected immediate need satisfying patterns of the parents. It
was also expected that the same would hold true concerning the

total history of illegitimacy within the families.

LL
Little difference was found concerning illegitimacy
‘within the two groups of psychotic and character disorder
children. However, the records were limited in their infor-
mation on this Point. Therefore no real conclusion can be
drawn. 0n the basis of the limited amount of data obtained,

taowever, there seems to be little difference.

TABLE 7
HISTORY OF ILLEGITIMATE CHILDREN IN FAMILY

 

 

 

Illegitimate Psychotic gharacter Disorder
Children Number 'IPer Cent Number Per Cent
Yes 2 10.52 2 12.5
NO 9 h7.37 5 31.25
Unknown ‘42 h2.10 ‘_2 26.22

Total 19 100.00 16 100.00

Child in Question

Yes 1 5.26 l 6.25

No 10 52-63 6 37-5

Unknown 8 22.10 _2 26.22
Total 19 100.00 16 100.00

 

Table 8 presents the data concerning nationality back-
ground of the child. The term ”American" as used in the
table refers to those cases where this was specifically
stated as the nationality. The category "other" refers to
all those cases where the foreign nationality was reported
by the parent.

The writer expected prior to the study that the chil-

dren of both groups would tend to be native born, but it was

L5
not known what nationality groups they might tend to come

 

 

 

 

 

from.
TABLE 8
NATIONALITY BnCKGROUND OF CHILD
m-m_.-.=mm ...... “”‘w
Psychotic gharacter Disorder
Nationality Number Per Cent Number Per Cent“'
mrioan 1‘ 21e05 3 18e75
Other 3 15.52 --
Unknown '22 62.12 .LZ 81.22
Total 19 100.00 16 100.00
Foreign Born
Yes -- -- -- ~-
No 19 100.00 16 100.00

 

In the same table we see that the records revealed
very little information about nationality. None of the chil-
dren in the sample were foreign born. This may be because of
the nature of the population served at the clinic.

The writer anticipated that the sources of referral
would be primarily the parents and school, including visiting
teachers. For the character disorder group the police and
courts were also regarded as frequent sources of referrals.

As was expected, the parents of both groups were the
most frequent referral sources. The school seems to have play-
ed a minor role in connection with the actual referral of the
children in both the psychotic and character disorder groups.
It is interesting to note that doctors made five (26.31%) of
the referrals of the psychotic children while none of the

referrals of character disorder children came from doctors.

£6

TABLE 9
SOURCES OF REFERRAL

W

 

 

Psychotic Character Disorder
Source dumber 'Per Cent ‘Number Per Cent
School 1 5.26 1 6.25
00“.” '"' ‘"' 2 12. 5
Doctor 5 26.31 -- ~-
Public Health Nurse 1 5.26 -- --
Social Agency -- -- 2 2. 5
Minister -- -- 1 6. 25
‘"Parents .1_2_ 62 .12 5.9. 62.2
Total 19 100.00 16 100.00
I"Parent Making Referral
Mother 12 100.00 9 90.
Father -" '"' 1 10s

 

In conclusion, the predominate referral source appears to he
the parents in both groups with the mother being the parent
that generally makes the referral. The courts do not seem to
refer children to the clinic readily. This could be because
the clinic has been in the community a relatively short period
of time; it could reflect the court's inability to use the
clinic within the community; or it could be that the services
are not needed by the court.

The writer anticipated that the largest percentage of
both groups would he referred after the clinic had been
suggested to them by someone such as a friend, relative,
court or school. Voluntary referrals are those that were
referred because of the recognized need for help, either by

the parents or by some other referral source and they are not

authoritarian in nature. An authoritarian referral is one

. #7
where the child was ordered to come to the clinic with the
threat that other action would be taken if the order were not
heeded. It was expected that there would be a fair percen-

tage of the character disorder group referred in this way.

TABLE 10

NATURE OF REFERRAL

 

 

 

_ Psychotic Character Disorder
Nature of Referral Number Per Cent Number Per Cent
Voluntary 8 £2.10 h 25.
Authoritarian -- -- 2 12.5
At suggestion of
someone ;;_ 21.82 29 62.2
Total 19 100.00 16 100.00

As can be seen from Table 10 the predominant factor
is that the clinic has been suggested by someone. There is
an absence of authoritarian referrals of psychotic children
and it shows a greater frequency for the character disorder
children, but not to the degree that was anticipated. This,
coupled with the comparison of the voluntary referrals of
the two groups, might lead one to suspect that the psychotic
child with his symptoms is more clearly recognized as being
"ill" or ”diseased" than is a character disorder child with
his symptoms.

The reasons for referring the child were examined. It
was anticipated that the character disorder children would be
referred more often for their acting out behavior than would

the psychotic. It was also expected that the psychotic chil-

£8
dren would be referred more often for learning problems and
problems that could be generally termed as "nervous" beha-

vior.

TABLE ll

REASONS FOR REFERRAL OF CHILD
W

 

 

Psychotic Character Disorder
Reason Number Per Cent . Number Per Cent
Learning Problem. 7 21.87 A 10.5
Behavior Problem at
School 6 18.75 - 13 34.21
Behavior Problem at
Home 7 21.87 13 3A.21
Behavior Problem in
Community -- 7 18.52
Speech Difficulty 3 9.37 --
Hearing Difficulty l 3.12 --
Harmful to Self l 3.12 1 3.h2
Nervous Behavior A 12.5 ~-
rears l 3.12 ~-
Incontinent of Bowel
or Bladder 1 3.12 --
Psychosomatic Condition _; 2.12 :3
Total 32 38

 

The data suggest that character disorder children tend to be
referred because of their acting out behavior. This can be
accounted for in terms of the direct effect this behavior has
upon other persons in the child's environment -- while the
psychotic child is referred for reasons that would tend to
involve himself and not create the amount of pressure on other
people in their environment that the character disorder chil-

dren do. This would be especially true away from the familial

environment.

L9

Face Sheet Data on the Parents

Concerning the ages of the parents it was felt that
there would be no major differences and that the fathers
would tend to be slightly older than the mothers.

Table 12 shows that the mothers are comparable in their
average age. There does seem to be a larger range within the
mothers of psychotic children. The average age of 38.12
years would suggest that the mothers of both groups could be
approaching an emotionally stressful period of life and this
would seem to be especially true of the character disorder
group since there is less range within that group. This
factor is pointed out because it is felt that it would have
an effect on the mothers' attitudes toward the children and
the resultant parent-child relationship. This may also be a
period when the mothers begin to strive for vicarious exper-
ience through their children to fulfill some unmet and un-
realized needs, dreams and goals of life.

The fathers of the two groups are older than the
mothers and the fathers of the psychotic children tend to be
older than those of the character disorder children. The
range in ages of the fathers of the psychotic children is
greater than that of the fathers of the character disorders.
It is possible that this age group could be approaching that
period in life when they begin to question if they have accomp
plished all in life that they would have liked to accomplish.

Thus they strive for vicarious experiences through their chil-
dren which, in turn, affects their attitudes toward the

50

TABLE 12
AGE OF MOTHERS AT TIME OF REFERRAL OF CHILD

W

 

 

 

 

Psychotic Character Disorder
Age in Years Number Per Cent fiNumber Per Cent
25-29 2 10.52 1 6.25
30-34 6 31-57 5 31-25
35-39 3 15.52 3 18.75
LO-hh 2 10.52 5 31.25
hS-h9 3 15-52 2 12-5
50-5h 2 10.52 -
55-59 -- --
60-64 l 5.26 --
65-69 :2. :3
Total 19 100.00 16 100.00

M a 38.28 Years H = 38.12 Years

 

TABLE 13
AGE OF FATHERS AT TIME OF REFERRAL OF CHILD

 

 

 

 

Psychotic Character Disorder
Age in Years Number Per Cent Number “Per Cent
25-29 1 5.26 --
30-3h A 21.05 3 18075
35-39 2 10.52 3 18.75
LO-hh 5 26.31 7 £3.75
h5-h9 A 21.05 2 12.5
50-5L 1 5.26 1 6.25
55-59 -- ~-
60‘6L l 5e26 -C'
Total 19 100.00 16 100.00

M 8 1.3.02 Years M e £0.93 Years

 

children and the resultant parent-child relationship. It
could also be that this was Just the time at which the distur-

51
bance of the child was recognized and the parents felt the
need for help.

In terms of occupation the division has been as
follows: (1) for the mothers --"housewifs only'is self- ex-
planatory; (2) "professional” includes persons with a college
degree and who are working in the profession for which they
were trained; (3) "white collar" includes persons working in
office or managerial positions, but do not have the amount of
education that the professional category has; and (A) "blue
collar" includes all unskilled and semi-skilled occupations,
such as factory worker, farmer or domestic work.

It was expected that e larger percentage of the mothers
of the character disorder children would tend to be employed
than of the mothers of the psychotic children. It was also
expected that of those employed the mothers of the character
disorder children would tend to be employed more in the area
of blue collar employment than would the mothers of psychotic
children.

As was expected the mothers of the character disorder
children are employed out of the home to a larger degree but
this does not appear to be significant. This could perhaps
be accounted for in a couple of ways: (1) they need or have
needed to work to support themselves and children more than
the mothers of psychotic children; or (2) they dislike the
staying at home and are unable to fulfill their emotional needs
through the role of wife and mother. A second interesting

point is the presence of professional and white collar occupa-

52

tions within the character disorder group and the absence of
these in the psychotic group. This can be explained partially
by the fact that the one in the professional category and one
of those in the white collar category are mothers of adopted
children. It is known that occupational and educational
levels are factors considered with respect to the eligibility
of a couple to adopt a child, subject of course to the place

they go to adopt the child.

TABLE 1h

OCCUPATION OF MOTHERS AT TIME
OF REFERRAL OF CHILD

 

 

 

 

Ps chotic Character Disorder
Occupation Humfier Per Cent ~Number Per Ccht
Housewife only 15 78.9h 10 62.5
Professional -- 1 6.25
White Collar - 2 12.5
Blue Collar _g, 21.02 ‘_2 18.22
Total 19 100.00 16 100.00

 

It was anticipated that the fathers of the character
disorder children would tend to be employed more in the blue
collar category than would the fathers of the psychotic chil-
dren.

Essentially there was little difference in the occupa-
tions of the two groups of fathers. The above speculation
was refuted by the fact that more fathers of psychotic chil-
dren tended to be employed within the blue collar category.

The professional and white collar categories were about the

53
same except it should be pointed out that the fathers of the

character disorder children.who are in the professional and
white collar categories are all adoptive fathers. This again

could be accounted for in terms of our present day adoption

 

policies.
TABLE 15
OCCUPATION OF FATHERS AT TIME
OF REFERRAL OF CHILD
Psychotic Character Disorder
Occupation Number Per Cent Number Per Cent
Professional 1 5.26 1 6.25
White Collar 2 10.52 2 12.5
Blue Collar 29_ 82.21 52' 81.22
Total 19 100.00 16 100.00

It was expected that there would be more families of

both groups who are Protestant in their religion because of

TABLE 16

RELIGION OF FAMILY AT TIME
OF REFERRAL OF CHILD

 

 

 

 

 

 

 

 

 

 

I—__ v—.‘ M
Psychotic Character Disordg
Religion Nufiber Per Cent Number 'Per Cent
Protestant 10 52.63 12 75.
Catholic 2 10.52 1 6.25
Mixed (Cath. & Prat.) ‘ 21e°5 .-
Unknown _;2 12.22 _2. 18.22
Total 19 100.00 16 100.00

 

the general prominence of Protestants in the total clinic

cases. It was also anticipated that there would be a number

5A
with mixed religion within the home.

The percentage of Protestants within the character dis-
order group was higher than for the psychotic group. There
is a total absence of the Jewish religion. The mixed reli-
gious situations were totally absent from the character dis-
order group. However, there were a few in each group that
were unknown and this might account for some of these differ-
ences. The general conclusion is that in both groups the
Protestant religion dominates.

We will shortly look at the educational (last grade
attended) level of the parents. The terminology used seams
self-explanatory, but it might be said that the Graduate
level refers to the master's and doctoral degree levels.

The writer expected that the educational level of the
parents of the character disorder children would be somewhat
lower than that of the parents of the psychotic children. In
connection with this it was also anticipated that the parents
of the psychotic group would have attended college in a larger
percentage and that they would tend to be predominant at the
graduate level also.

In considering the educational level of the mothers of
the two groups, Table 17 indicates that the writer's previous
thinking was partially true. The mothers of the psychotic
children have attended high school more often. However, 25%
of the mothers of the character disorder children have atten-
ded college and one has participated on the graduate level.
Here again, however, this might be explained in part by the

55

feet that all of the 25% that are in these two categories of
the character disorder children are adoptive mothers. As was
explained with occupations, the factor of education plays a
role in the selection of adoptive parents and it.may be show-
ing up here. In comparing Just the Senior High and Junior
High levels we find that what the writer had previously stated
about the mothers of the psychotic group being of a higher

educational level seems to be true.

TABLE 17

EDUCATIONAL LEVEL OF MOTHERS AT TIME
OF REFERRAL OF CHILD

n
.-

 

 

Psychotic Character Disorder
Educational Level Number Per Cent Number Per Cent
Grade School (0—6) -- --
Senior High (lo-12) l6 8A.21 7 £3.75
College only (l-L) 1 5.26 3 18.75
Graduate (l-completion) 2:. _;

 

Total 19 100.00 16

 

It was anticipated that the educational level of the
fathers of both groups would tend to be somewhat higher than
the educational level of both groups of mothers. However,
within the two groups of fathers it was expected that the
fathers of the character disorders would be of a lower educa-
tional level because of their suspected inability to delay
gratification of immediate needs and thus participate in
long range goal planning.

As can be seen in Table 18, the fathers of the charac-

56
ter disorder children cover a larger range educationally.
However, there is a larger percentage of the fathers of that
group that fall within the grade school and Junior high levels.
Another factor that should be pointed out is that the fathers
of the character disorder children that fall within the
college and graduate levels are all adoptive fathers. This
has been a pattern and, as explained before, can partially be
accounted for on the basis of our current adoption practices,
dependent of course upon where and how the children were
adopted. In general the fathers of the psychotic group do
tend to be of a higher educational level, but that both groups
of fathers tend to be of a lower educational level than do

both groups of mothers.

TABLE 18

EDUCATIONAL LEVEL or FATHERS AT TIME
or REFERRAL or cam:

W

 

 

Psychotic Character Disorder

Educational Level Number ‘Per Cent fiNumber :rer Cen
Grade School (0-6) . 2 10.52 2 12.5
Junior High (7-9) 3 15.52 7 £3.75
Senior High (10-12) 13 68.L2 5 31.25
College only (l-h) 1 5.26 1 6.25
Graduate (l-completion) :: _1’ 6.22

Total 19 100.00 16 100.00

 

Case Record Date 0n Parents
Since the child lives within the family situation where
many interesting forces exert their influence upon him, it was

expected that the parents' marital situation and history would

57
be very relevant.

The environment within which a child lives is thought
to be important. Therefore, it seems important to know with
whom the children were living at the time of referral.
Throughout the body of the study the parent figure or figures
with.whom.the child has lived with the longest period of time
have been used. Therefore, this was not always the parent
figure or figures with whom.he or she was living at the time
of referral. This was done because in several cases the.
child had lived with the step-parent less than a year and in
one instance only three weeks. As the result other data did
not give an accurate picture as to whom the child was current-
ly living with.

Table 19 seems to be self-explanatory. However, it
should be stated that in the categories where it states mother
and father or each separately, the writer is referring to
natural parents. In each case there was one natural parent
in the family except in the cases of the adopted children.

It was anticipated before the study that the persons
with whom the child was living would vary somewhat for the
two groups. That is, it was expected that the character dis-
order children would have been subjected to more separation
and divorce situations and thus a larger percentage of the
children would tend to have step-parents.

Table 19 supports the speculation stated above.

There is a considerable difference between the percentage of

psychotic children living with their natural parents and the

58

TABLE 19
PARENTS CHILD LIVING WITH AT TIME OF REFERRAL

======$ n x 4
tu— ‘ r

 

 

 

 

 

 

 

Psychotic Character Disorder
Parents Number Per Cent Humber *Per Cent"
Mother and Father 12 63.15 2 12.5
Mother 2 10.52 2 12.5
Father -- --
Mother and Stepfather A 21.05 5 31.25
Father and stepmother -- 1 6.25
Adoptive Parents 1 5.26 h 25.
Adoptive Mother and
Stepfather ‘;; _g, 12.2
Total 19 100.00 16 100.00

 

percentage of character disorder children living with their
natural parents. Another point to be mentioned is that of

the seven adoptive children in the total sample, six of them
are in the character disorder group. Many factors may be
operating here, but the factor of separation from the natural
parents is still present and needs to be recognized as a possi-
ble contributing factor. There is a higher percentage of
character disorder children living with step-parents than
there are psychotic children living with step-parents. The
issue that is suggested is whether or not the separation or
divorce of the parents is a primary contributor to the child's
character disorder or is the reel contributing factor the
parents' apparent inability to relate in a warm, healthy and
satisfying way, thus making a primary contribution to both the
unsuccessful marriage or marriages and the child's character

disorder? This factor may also indicate a tendency on the

59

part of the parents of the character disorder children to

act out their feelings. This would tend to support the idea
that they are more openly aggressive and hostile with the
result being that they would tend to be more punitive in their
attitudes in relating to people and particularly to defenseless
children.

In thinking about the total family situation it was
thought that it would be interesting and helpful to Know if
each of the parents accepted their respective roles. The
basic element is meeting the child's needs, both physical and
emotional. The psychologist did the rating on this point
and it is recognized that a clear distinction was hard to
make. However, it is thought that there is enough of a dis-
tinction that can be made to give some idea as.to how the
parents tend to accept or reject their roles as parents.

In this respect "yes" means that they do accept the
role, that they tend to a great degree to provide the basic
physical and emotional needs. The term ”some" indicates that
to a partial degree the parent tries to fulfill these needs.
They are present in the home and are able to accept some de-
gree of responsibility for the raising of the children. The
term "no" means that the parent does not accept to a major
degree the responsibilities of a parent to provide for the
physical and emotional needs of the children.

It was anticipated that the mothers of both groups
‘would tend not to accept their role as mother. The result

*would be that this would affect their'attitudes toward the
children.

60

TABLE 20
MOTHERS ACCEPTANCE OF ROLE AS PARENT

.— -~ --*—”--~ -wk- --”—*-..~-4—_. —-—-——4-———---— --...- ..-.—--.. -~n—--* - .-...-....-..-. .

 

 

 

Payphotic Character Disorder
Acceptance of Role Number Per Cent Number *Per Cent“
Yes 11 57.89 6 3705
Some _§ 52.10 _2 26.25
Total 19 100.00 16 100.00

 

In Table 20 we see that the mothers of the psychotic
group tend to accept their roles and the mothers of the
character disorder group tend, at least to some degree, not
to accept their roles but the difference does not appear to
be significant. This is different than had been anticipated.
It might be that this is really true or it might also be that
the mothers of the character disorder children tend to more
openly express their feelings and rejection of this role,
while the mothers of the psychotic children do not express
their rejection of the role and in fact strive to create for
themselves and others the image of the adequate mother. How-
ever, none of the mothers of the psychotic group and only one
of the character disorder group really rejects their role to
the point that there is no acceptance of the role of mother.

With respect to the fathers of the two groups accepting
their roles, it was anticipated prior to the study that there
would not be much difference between the two groups. It was

further expected that they would tend to some degree not to

61

accept their roles. It was also expected that there would

be little difference on this point between the mothers and

 

 

 

 

 

 

 

 

fathers.
TABLE 21
FATHERS ACCEPTANCE OF ROLE AS PARENT
“fl f" .w W
Psychotic Character Disorder
Acceptance of Role Number Per Cent Number Per Cent
Yes 8 £2.10 A, 25.
No b 21.05 11 68.75
Some _1. 26.85 ‘_1 6.22
Total 19 100.00 16 100.00

 

Table 21 indicates that the fathers tend not to accept
their roles to the degree that the mothers do. In addition
the fathers of the psychotic group, although they tend not
to accept their role as father, do tend to accept it in a
larger proportion than do the fathers of the character dis-
order, but it does not appear to be a significant difference.
This again might be accounted for on the basis that the
fathers of the character disorder children openly express
their non-acceptance of this role and the fathers of the pay-
chotic children do not express this so openly.

The marital status of the natural parents and the
initial set of adoptive parents was thought to be important
to the study. This would give some idea as to the experiences
which the child had been subjected to within the family set-
ting. It was anticipated that there‘would be a higher propor-
tion of the marriages of the parents of the psychotic children

62
still intact than there would be of the parents of the charac-

ter disorder children.

 

 

 

TABLE 22
MARITAL STATUS OF NATURAL AND ADOPTIVE PARENTS
m...
Psychotic Character Disordgg
Married Number Per Cent Number Per Cent
Yes 13 68.1.2 7 1.3.75
No _§, 21.22 _2 26.22
Total 19 100.00 16 100.00

 

Table 22 shows essentially what was anticipated, but
it does not appear to be significant. The marriages of the
parents of the psychotic children tend to be intact in a high-
er percentage than do those of the character disorder group.
Again the question is whether the character disorder child's
problems arise out of the separation from the parent figures
as the result of separation and divorce of the parents or if
their problems and the separation and divorce arise out of
the inability of the parents to foster and tolerate close re-
lationships with people? Another factor in the difference
between the parents of the psychotic and the character disorder
children may be that the parents of the character disorder
children tend to act out their feelings more than do the
parents of the psychotic children.

It was anticipated before the study that little dif-
ference would be found when comparing the parents (natural

and adoptive) of the psychotic children and character dis-

63

order children in terms of the number of years married.

TABLE 23
NUMBER OF YEARS NATURAL.AND ADOPTIVE PARENTS MARRIED

m

 

 

 

Psychotic Character Disorder
Years Married Number Per Cent Number Per Cent‘
0-1 2 10.52 3 18.75
5-9 6 31057 —-
15-19 2 10.52 L 25.
20-2h l 5.26 k 25.
25-29 1 5.26 --
30-34 1 5.26 ~-
35-39 -- ..
1.0-1.1. __]; 2.26 2
Total 19 100.00 16 100.00

M = lt.31. Years ll 8 lb.” Years

 

It was found that there is little difference between
the parents (natural and adoptive) of the psychotic and
character disorder children in terms of numbers of years
married. The range is greater for the parents of the psycho-
tic children than for the parents of the character disorder
children. However, the mean number of years is about the
same.

It was expected that the parents of the psychotic
children would tend to have fewer marriages in their history
than the parents of the character disorder children.

Tables 2L and 25 show that the mothers of both the
psychotic and character disorder children tend to have a wider

range with respect to number of marriages than do the fathers.

6h

TABLE 2L
NUMBER OF MARRIAGES OF MOTHERS

 

 

 

 

 

Psychotic Character Disorder
Number of Marriages Number Per Cent Number Per Cent
2 3 15.52 5 31.25
3 3 15.52 2 12.5
Unknown _5_ 21.02 _2. 18.22
Total 19 100.00 16 100.00
TABLE 25

NUMBER OF MARRIAGES OF FATHERS

 

 

Psychotic Character Disorder

Number of Marriages Number Per Cent Number ‘Per Cedt‘
l 9 h7.37 7 £3.75
2 6 31.57 2 12.5
2 «~- 1 6625
unknown _5. 21.02 _6 27.2
Total 19 100.00 16 100.00

 

There seems to be little difference between the fathers of
the psychotic and character disorder children, while the
mothers of the character disorder group seem to have had a
slightly larger number of marriages than the mothers of the
psychotic group. However, since the records were incomplete
concerning the number of marriages of the parents, these con-
clusions may be questioned in the light of the incomplete

information available.

65

In connection with the marital adjustment and its
effect on the child, it was thought important that informa-
tion be gathered concerning the number of separations that
took place within the marriage in question. The term
”marriage in question" refers to the marriage which involved
the two parent figures that are being used in the sample for
this study.

In conjunction with this it was anticipated before the
study was undertaken that separation would be more prevalent
in the families of the character disorder children than it
would be in the families of the psychotic children because
of their suspected inability to tolerate close relationships.

According to Table 26, separation is present in the
family backgrounds of both the character disorder and pay-
chotic children. It appears that it is more prevalent with-
in the family bachround of the character disorder children,
but it does not appear to be significant. This again might
be accounted for in terms of the possibility that the parents
of the character disorder children tend to act-out their
feelings more than do parents of psychotic children or it may
be that the parents of the psychotic children are able to
tolerate a marriage situation with its close relationships
better than the parents of the character disorder children.

In addition to giving some consideration to separation
within the marriage in question it was felt that desertion
should also be looked at.

In this respect it was felt that the parents of the

66

TABLE 26
NUMBER OF SEPARATIONS IN MARRIAGE IN QUESTION

F.»— '.'—.——— 4. .‘
fil— _:—:_—_ E w

M

 

 

 

Psychotic ggaracter Disorder

No. of Separations Number Per Cent Number Per Cent

None 10 52.63 7 A3.75

1 A 21.05 2 12.5

2 1. 5026 -"'

3 or more -- 3 18.75

Unknown _5 21.02 42 22.

Total 19 100.00 16 100.00

 

character disorder children would tend to desert more often
than parents of the psychotic children.

It was found that the parents of the character disorder
children tend to desert more than do parents of the psychotic
children, but it does not appear to be significant. However,
it should be noted that the records were incomplete in their
information on this point of desertion and this needs to be

considered in drawing any conclusions.

TABLE 27
TWIJBER OF DESERTIONS IN MARRI GE IN QUESTION

 

 

 

Psychotic Character Disordgr

No. of Desertions Number , Per Cent Number Per Cent“
None 7 36.84 5 31.25
1 1 5.26 1 6.25
2 or more 1 5.26 3 18.75

Total 19 100.00 16 100.00

 

67

The difference that has been noted, using the informa-
tion available, the possibilities again arise concerning the
parents of the character disorder children being able to
tolerate close relationships and their possible tendency to
act-out their feelings more than the parents of the psycho-
tic children.

It was felt important to look at the marital adjustment
of the parents within the marriage situation which was being
considered in the study.

Before the study was undertaken it was felt that there
would be an absence of positive (Accepting and Loving) atti-
tudes in the marriages on the parts of the mothers and fathers
of both the psychotic and character disorder children.

The definition of terms are as follows:

Accepting: This implies that the partner (husband or
wife) accepts the spouse for the individual that he or she is
and is able to give warmth and love to the spouse.

Loving: This implies that the partner (husband or wife)
is positive, accepting and warm in his or her attitude toward
the spouse and is able to give of himself or herself for the
welfare of the spouse.

Demanding: This implies that the partner (husband or
wife) requires the spouse to be at his or her command. _

Detached (withdrawn): This is a general attitude of
indifference and the spouse who exhibits this would be with-
drawn and would tend to be non-participating in family activi-

ties.

68

Dependent (infantile): The parent who exhibits this
attitude or adjustment in the.marriage is demanding in terms
of his or her own needs being met and yet mamas little attempt
to make an effort at fulfilling his or her own needs.

Sadistic and Sado~masochisticz This is the spouse
who derives pleasure from inflicting physical or psychologi—
cal pain on others and also present may be the wish that
they will receive in turn some type of pain.

Masochistic: This is the spouse who derives pleasure
from suffering physical or psychological pain.

Rejecting: This implies that the partner, consciously
or unconsciously, does not like orwwant his or her spouse.

He or she is consistently hostile in his or her attitude
toward the spouse and are unaffectionate and disapproving.

Possessive (controlflng): This implies that the partner
(husband orwwife) rigidly structures the spouse to a specific
pattern without considering the feelings and needs of the
spouse.

The study revealed that the mothers of both the pay-
chotic and character disorder groups seem to be more accepting
of the fathers (as spouses) than the fathers are of the
mothers (as spouses). This was especially true of the parents
of the character disorder children. The mothers (as spouses)
of both the psychotic and character disorder groups tend to be
more dependent in their attitudes and relationships than do
the fathers (as spouses) while the fathers (as spouses) tend

to be more detached.

TABLE 28

MARITAL ADJUSTMENT OF MOTHERS

-1 -_ -..- ”...... o... .. .

 

 

 

 

 

Psychotic Character Disorder
Marital Adjustment Number ‘Per Cent TNumber Per Cent
Accepting 9 21.95 5 20.83
LOVing 5 12.19 1 hel6
Demanding 5 12.19 A 16.66
Detached (withdrawn) 5 9.75 1 5.16
Dependent (infantile) 8 19.51 8 33.33
Sadistic a Sade-

masochistic -- l 5.16
Masochistic 2 5.87 1 5.16
Rejecting 3 7.31 1 5.16
Possessive (Controlling) A 9.77 1 5.16
Other _5 2.52 _5 5.16
Total 51 100.00 25 100.00
TABLE 29
MARITAL.ADJUSTfiENT OF FATHERS

g i m

 

 

 

 

 

Psychotic
Marital Adjustment Number Per Cent
Accepting 9 19.15
Loving 5 10.63
Demanding 6 12.76
Detached (withdrawn) 10 21.27
Dependent (infantile) 5 8.51
Sadistic & Sado-
masochistic 2 5.25
Masochistic --
Rejecting A 8.51
Possessive (Controlling) 7 15.89
Other ;:
Total 57 100.00

Character Disorder

 

 

Number Per Cent
A 13-33
1 3.33
2 6.66
6 20.
-5 6.66
12 LO.
3 10.
30 100.00

 

In comparing the mothers (as spouses) in Table 28 of

the psychotic and character disorder children they present

much the same pattern. With the exception that the mothers

(as spouses) of the psychotic children tend to be slightly

70
more loving yet also have a slight tendency to be more re-
jecting and possessive (controlling) than do the mothers (as
spouses) of the character disorder children . The mothers
(as spouses) of the character disorder children seem to be
more demanding and dependent than do the mothers of the pay-
chotic children.

In comparing the fathers (as spouses) the pattern is
different than with the mothers (as spouses). There is a
high degree of detachment in both groups while the fathers
(as spouses) of the character disorder children seem more
rejecting than do the fathers (as spouses) of the psychotic
children.

In thinking of the marital adjustment of the parents
of the psychotic and character disorder children it was
through important to look at their acceptance of their respec-
tive roles in marriage. This was rated by a clinical psycho-
logist. The categories for classification were as follows:
(1) yes, which means that the person does accept his or her
respective role in the marriage; (2) no, which means that the
person does not accept his or her respective role in the mar-
riage and an extreme example would be desertion; and (3)
some, means that they are not totally accepting nor rejecting
of their respective roles as partners in marriage, but are
rather somewhere in between the two extremes. An example
might be the person who passively accepts his or her role
but does not actively participate in this role other than be-
ing physically present and providing the family with finances.

71
It was expected before the study was undertaken that
there would be little difference with respect to the parents'

acceptance of their respective roles as partners in marriage.

TAbLE 30

MOTHERS' ACCEPTAUCB OF RESPECTIVE ROLE IN MARRIAGE

 

 

 

 

v:_A g , -=====,
Psychotic Character Disorder
Acceptance of Role Number Per Cent Number Per Cent
Yes 13 68.h2 6 37.5
No 3 15.52 2 12.5
Some _2 l§.§2 _§ 20.
Total 19 100.00 16 100.00

 

What the writer initially anticipated is not supported
by the data. Significance is indicated when comparing the
mothers of the psychotic and the character disorder children
on the basis of the mothers that do accept their respective
roles in marriage and those who do not, or indicate only
some acceptance of their respective roles in marriage. The
mothers of the psychotic children tend to accept their re-
spective roles in marriage more than do the mothers of the
character disorder children.

The fathers of the psychotic children (Table 31) seen
to accept their respective roles in marriage more than the
fathers of the character disorder children. In comparing the
fathers and the.mothere we see that the mothers (as spouses)
seem to accept their respective roles in marriage more than
do the fathers (as spouses) of both the psychotic and charac-

ter disorder children.

72

TABLE 31

FATHEES' ACCETTAKCE CF RESPECTIVE ECLE 1K HARKIAGE

 

 

 

 

a
- Psychotic gharacter Disorder
Acceptance of hole Number Per Cent humher Per Cent
Yes ll 57.89 3 18.75
Some _5 21.02 _§ 27.2
Total 19 100.00 16 100.00

In terms of the personal adjustment of the parents it
was felt that five classifications should be used: normal;
psychoneurotic; neurotic character disorder; character dis-
order; and psychotic. all of the parents were classified
into these categories by a clinical psychologist. The defi-
nitions of these terms are as follows.

Normal: This is the absence of emotional conflict
which would create clinically observable symptomatology such
as is present in psychoneuroses, neurotic character disorder,
character disorder and psychosis. The personality is inte-
grated and has matured to the point where some degree of
flexability in adaptability exists.

Psychoneurotic disorders:

The chief characteristic of these disorders is 'anxiety'
which may be directly felt and expressed or*which may
be unconsciously and automatically controlled by the
utilization of various psychological defense mechan-
lama (depression, conversion, displacement, etc.). In
contrast to those with psychoses, patients with psy-
choneurotic disorders do not exhibit ross distortion

or falsification of external reality delusions, halluo
cinations, illusions) and they do not present gross

73

disorganization of the personality.

59

Neurotic Character Disorder: In the Neurotic charac-

ter disorder conflict is present and the unconscious impul-

60

see manifest themselves by means of neurotic acting out.
Character Disorder:

Unhealthy patterns of behavior and emotional response
which are to varying degrees socially unacceptable or
disapproved, accompanied by minimal outward evidence
of anxietglor symptoms as ordinarily seen in the
neuroses.

Psychosis:

A severe emotional illness in which there is a depar-
ture from normal patterns of thinking, feeling, and
acting. Commonly characterized by loss of contact
with reality, distortion of perception, regressive
behavior and attitudes, diminished control of ele-
mentary impulses and desires, abnormal mentagzcon-
tent including delusions and hallucinations.

Before the study was undertaken it was expected that
the parents of both the psychotic and character disorder
children would tend to present personal adjustment problems.
That is, they would tend to have emotional problems of their
own.

Table 32 indicates that the.mothers of both the psy-

 

59The Committee on Nomenclature and Statistics of the
American Psychiatric Association, Diagnostic and Statistical
Manual Mental Disorder; (Washington: American Psychiatric
Association, Mental Hospital Service, 1952), p. 31.

 

éoJ. Hc‘V. Hunt, Personality and the Behavior Dis-
Orders (New York), The Ronald Press, l9hh);"ll, p. 932.

 

6100mmittee on Public Information American Psychia-
tric Association, A Psychiatric Glossary (tashington: Amer-
ican Psychiatric AssociatiOn, 1957), p. 21.

621b1e., p. 55.

7h

chotic and character disorder children do have personal ad-

Justment problems. This is also true of the fathers (Table 33)

TABLE 32
PERSONAL ADJUSTMENT OF THE MOTHERS

 

 

 

 

:11: W
, Psychotic Character Disorder
Mothers Fumber Per Cent Number 'Per Cent‘
Normal 7 36.8h 7 £3.75
Psychoneurotic 11 57.89 i 25.
Neurotic Character -
Disorder -- l 6.25
Psychotic 1 5.26 --
Character Disorder ::. _5_ 22.

Total 19 100.00 16 100.00

 

TABLE 33
PERSONAL ADJUSTMENT or may FATHERS

 

 

 

Psychotic Character Disorder
Fathers Number Per Cent ‘fiumber ‘Per Cent"
Normal 10 52.63 L 25.
Psychoneurotic -- l 6.25
-Nsurotic Character ,
Disorder -- --
Psychotic 3 15.52 --
Character Disorder 6 31.52 1; 68.22

Total 19 100.00 16 100.00

 

of the character disorder children but less true of the fa-
thers of the psychotic children. In comparing the fathers
and mothers of the psychotic children we see that the mothers
tend to present personal adjustment problems more often than

do the fathers. The opposite is true of the parents of the

75
character disorder children. That is, the fathers tend to

present personal adjustment problems more often than do the
mothers. This might suggest again that the mothers might
play a major role in the illness of the psychotic children
while the fathers might play a major role in the illness of
the character disorder children.

In examining the parents of the psychotic and charac-
ter disorder children it was thought that it would be impor-
tant to see if there was a tendency for the parents to exhi-
bit behavior similar tc that of the child. A clinical psycho-
logist did the rating to avoid biases which the writer might
have had in examining this factor. An example would be the
impulsive acting out of the character disorder child and the
same trait existing in the parent or parents of that child.
With the psychotic child an example would be the tendency to
withdraw from social contacts and the same trait existing in
the parent or parents of the child. These examples would
fall into the "yes" category and if similar things were
present only in lesser degree or less often than it would
fall into the "some" category, or if this wasn't present at
all it would be in the "no" category.

It was anticipated before the study that the parents
of both the psychotic and character disorder groups would
tend to exhibit behavior similar to that of the child being
referred.

In examining Table 3A it appears that the psychotic

children tend to have a higher percentage of mothers who do

76
present a clear picture of tending to exhibit behavior simi-
lar to their children while the mothers of the character dis-
order children tend to have fewer who present such a clear
picture. ‘Yet more of the mothers of the character disorder
children present some tendency to exhibit behavior similar
to that of their children referred than do the mothers of
the psychotic children.

TABLE 3k

TENDENCY 0F MOTHERS TO EXHIBIT BEHAVIOR
SIMILAR T0 THAT 0]? THE CHILD REFERRED

 

 

 

 

Psychotic Character Disorder
Mother Wimbir Per Cent "Rumber Per Cent
Yes 5 26.31 3 18.75
No 10 52.63 7 £3.75
Some A 21.02 _6_ 22.2
Total 19 100.00 16 100.00
TABLE 35

TENDENCY 0F FATHERS TO EXHIBIT BEHAVIOR
SIMILAR T0 THAT OF THE CHILD REFERRED

 

--—- ~.—.—-—~ m‘n.—~—-*~ “...—.....-” ....— .. -..--.- -.—-——-—-——-—.—- .—..-— ...... ”Moo—.— ~~-“- -

 

 

Psychotic Character Disorder
Father Number 'Per dent ‘Number “Per Cent—
Yes A 21.05 8 50.
Some J 15.22 _5_ 21.22
Total 19 100.00 16 100.00

 

In terms of the fathers (Table 35) we get a much
different picture. It is quite clear that the fathers of the

77
character disorder children tend more to exhibit behavior

similar to that of the child referred than do the fathers of
the psychotic children. It is also interesting to note that
the fathers of the character disorder children tend to ex-
hibit behavior similar to that of the child being referred
more often than do the mothers of the character disorder chil-
dren. This tendency is reversed with respect to the parents
of the psychotic children. That is, the mothers of the psy-
chotic children tend to exhibit behavior similar to that of
the child being referred more than do the fathers of the psy-
chotic children. These factors might suggest that with
respect to the psychotic children the mothers are a larger
factor than the fathers and with the character disorder chil-

dren the fathers are a larger factor than the mothers.

Predominant Attitudes of Parents

The focus of the study was concerned with the predomi-
nant attitudes that the parents exhibit toward the children
in the psychotic and character disorder groups. The hypothe-
ses were as follows: (1) parents of psychotic children are
characterized by attitudes defined as non-relating; and (2)
parents of character disorder children are characterized by
attitudes defined as withholding and punitive. (The defini-
tions of these terms were included in Chapter I, pp. 3 and L)

The predominant attitudes were looked at separately
with respect to the mothers and fathers of the psychotic and

character disorder children. Then the conclusions will be

78
summarized after discussing the factors concerning each separ-

ately.

TABLE 36

PREDOMINANT ATTITUDE 0F MOTHERS
TOWARD CHILD REFERRED

W

 

 

 

Psychotig1;_ Character Disorder
Predominant Attitude Number Per Cent Number Per Cent
Freedom (Autonomy) l 5.26 1 6.25
Democratic l 5.26 1 6.25
Cooperative 2 10.52 1 6.25
Accepting (Love) -- --
Over-Indulgent -- ~—
Protective Indulgent 2 10.52 1 6.25
Over-Protective 3 15.52 1 6.25
Possessive (Control) -- l 6.25
Authoritarian
Dictatorial 1 5.26 1 6.25

Demanding Antagonistic l 5.26 2 12.5
Rejection (Hostility) -- l 6.25
Neglecting 1 5.26 --
Indifferent 3 15.52 2 12.5
Detached _5_ 21.05 _&_ 25.

Total 19 100.00 16 100.00

 

The mothers of both the psychotic and character dis-
order children exhibited a great range within the predominant
attitudes considered in the attitude circumplex. The pre-
dominant attitudc for the mothers of both the psychotic and
character disorder children was "detached." The mothers of
the character disorder children exhibited "demanding antagon-
istic” and "indifferent" as the next most predominant atti-
tude. The mothers of the psychotic children exhibited as
their next most predominant attitudes "indifferent" and "over-

protective." It should be noted that the predominant atti-

79
tudes for the mothers of both the psychotic and character dis-
order groups fall within the hostility-autonomy quadrant. In
addition, it is very difficult to evaluate the predominant
attitudes of the mothers because of the great range exhibited
and the small sample available for the study. However, the

data may reveal some trends and these have been presented.

TABLE 37

PREDOMINANT ATTITUDE 0F FATHERS
TOWARD CHILD REFERRED

 

 

 

 

Psychotic Character Disorder
Predominant Attitudg' Number Per Cent Number Per Cent
Freedom (Autonomy) -- --
Democratic A 21.05 1 6.25
Cooperative 1 5.26 1 6.25
Accepting (Love) -- --
0ver-Indu1gent -- ~-
Protective Indulgent 2 10.52 --
Over-Protective l 5.26 --
Possessive (Control) -- l 6.25
Authoritarian
Dictatorial 1 5.26 l 6.25

Demanding Antagonistic 2 10.52 1 6.25
Rejection (Hostility) -- --
Neglecting -- 2 12.5
Indifferent 6 31.57 8 50.
Detached _g_ 10.22 __;_ 6.25

Total 19 100.00 16 100.00

 

The fathers of both the psychotic and character dis-
order children exhibited the predominant attitude of "indif-
ference." The second most predominant attitude for the
fathers of the character disorder children was "neglecting"
and for the fathers of the psychotic children "democratic."
There was quite a large range within the predominant atti-

tudes considered. However, the range was smaller for

80
fathers than it was for the mothers of both the psychotic and
character disorder children.

In terms of the hypotheses stated for the study, it
appears that the predominant attitudes of the parents of the
psychotic children are within the area previously defined as
non-relating. That is, the predominant attitudes of the
parents of the psychotic children seem to be "indifferent"
and "detached."

The hypothesis relating to the predominant attitudes
of the parents of the character disorder children does not
seem supported by the data. The predominant attitudes for.
the parents of the character disorder children were "indif-
ferent" and "detached." However, the hostility may still be
an important factor, but the difference could be accounted
for by the fact that the parents are not controlling but ra-
ther express autonomy and thus the attitudes of "indifferent"
and "detached." The attitudes of "rejection," ”demanding"
or "dictatorial" which.were felt to be withholding and pun-
itive do not appear as the predominant attitudes for the par-
ents of the character disorder children.

An additional factor which.was thought might be of
some importance was the position on the two rating scales
which each parent obtained when rated. The two scales were
as follows: Control vs. Autonomy and Hostility vs. Love.

It was expected prior to the study that the parents of
the character disorder children would tend to rate higher in
hostility and control than would the parents of the psychotic

children.

81

TABLE 38

MOTHERS POSITION ON THE CONTROL VS. AUTONOMY SCALE

 

 

 

 

 

Psychotic Character Disorder
Control vs. Autonomy Number Per Cent Number Per Cent
Controlling ' 5 26.31 3 18.75
Controlling and Some
Autonomy 2 10.52 A 25.
Autonomy and Some
Controlling 8 A2.10 2 12.5
Autonomy _5’ 21.05 _2_ 55.25
Total 19 100.00 16 100.00
TABLE 39

FATHERS POSITION ON THE CONTROL VS. AUTONOMY SCALE

 

 

 

 

 

W .- m
Psychotic Character Disorder
Control vs. Autonomy Number Per Cent Number Per Cent“
Controlling 2 10.52 2 12.5
Controlling and Some
Autonomy A 21.05 1 6.25
Autonomy and Some
Controlling A 21.05 3 18.75
Autonomy . __2 5,2 .52 2.3 62 .5
Total 19 100.00 16 100.00

 

Tables 38 and 39 indicate that the parents of the
character disorder children tend to exhibit more autonomy
than do the parents of the psychotic children. However, the
parents of both the psychotic and character disorder groups
are rated as tending to express more autonomy than control in
relating to the children. The mothers tend to be more con-

trolling than do the fathers.

82

TABLE LO
MOTHERS POSITION ON THE HOSTILITY VS. LOVE SCALE

 

 

 

m
M T ‘- ‘

 

 

 

 

Hostility vs. Psychotic Character Disorder
Accepting Number Per Cent Number Per Cent
Hostility 3 15.52 A 25.
Hostility and Some Love 7 36.8h 8 50.
Love and Some Hostility 5 26.31 3 18.75
Love _g' 21.05 ‘_; 6.25
Total 19 100.00 16 100.00
TABLE Ll

FATHERS POSITION ON THE HOSTILITY VS. LOVE SCALE

 

 

 

 

Hostility vs. Psychotic Character Disorde;
Accepting; Number Per Cent Ififimber ‘Per CentI
Hostility 6 31.57 12 75.
Hostility and Some Love 5 26.31 2 12.5
Love and Some Hostility 5 26.31 1 6.25
Love ,_3 15.52 ‘_l 6.25
Total 19 100.00 16 100.00

 

Tables Al and 42 indicate that hostility appears to be
a predominant factor with the parents of both the psychotic
and character disorder children. However, it is present more
in the parents of character disorder children than it is in
the parents of psychotic children. The parents of the psycho-
tic children tend to show more love than do the parents of the
character disorder children.

It was stated in the hypothesis that hostility was a
part of the withholding and punitive aspects of the attitudes

of the parents of character disorder children. This seems to

83
be true when examining the ratings on the Hostility vs. Love
Scale.

The writer thought that it would be important to com-
pare the attitudes of the individual set of parents to see
how many of them possessed the same (or like) attitudes and
how many possessed different attitudes toward their child
that was referred.

It was anticipated before the study that the attitudes

of the two parents would be different in most cases.

TABLE L2
COMPARIgOH OF PREDOMINANT ATTITUDES OF BOTH PARENTS

 

 

 

 

Comparison of Psychotic Character Disorder
Attitudes Number Per Cent Number Per Cent

Same 2 10.52 3 18.75

Different ;2_ 82.52 22’ 81.25
Total 19 100.00 16 100.00

 

What the writer anticipated before the study appears
true. Only a small percentage of the parents have the iden-
tical predomdnant attitude toward the individual child. This
is true for the parents of both the psychotic and character
disorder children. This would suggest inconsistency within
the family unit regarding attitudes toward the child.

An added factor which.was thought to be important was
the consistency and inconsistency of the individual parent in
maintaining his or.her predominant attitude toward the child.

It was expected before the study that the parents of

the character disorder children would tend to be more incon-

84
sistent in maintaining their predominant attitudes than the
parents of the psychotic children.

TABLE A}

MOTHERS CONSISTENCY OR INCONSISTENCY
N PREDOMINANT ATTITUDE

 

 

 

 

 

or Psychotic Character Disorder
Inconsistency Number Per Cent Number ‘Per Cent
Consistent h ‘ 21.05 5 31.25
Consistent and some
Inconsistency 2 10.52 A 25.
Inconsistent and some
consistency 10 52.63 2 12.5

Inconsistent ‘_3 15.52 _5 1.2

Total 19 100.00 16 100.00

 

The mothers of the character disorder children tend
to be more consistent in maintaining their predominant atti-
tudes than do the mothers of the psychotic children. The

fathers of the character disorder group tend to be somewhat

TABLE Ah

FA .ERS CONSISTENCY OR INCONSISTENCY
IN PREDOMINANT ATTITUDE

 

 

 

 

 

 

 

 

m W flag—3::
Consistency

or Psychotic Character Disorder
Inconsistengy Number Per Cent Number Per Cent
Consistent 3 15.52 6 37.5
Consistent and some

inconsistency 7 36.8L 3 18.75
Inconsistent and some
consistency A 21.05 A 25.

Inconsistent _5 26.21 ..2 18.25

Total 19 100.00 16 100.00

 

85
more consistent in their predominant attitude than do the
fathers of the psychotic group. The fathers of the psychotic
children seem to be more consistent in their predominant
attitudes than do the mothers of the psychotic children,
while with the character disorder children the matter of con-

sistency and inconsistency of predominant attitudes runs about

the same for the mothers and fathers.

CHAPTER V
CONCLUSIONS AND RECOMEENDATIONS

The underlying assumption of this study was that
there were basic differences in the attitudes of the parents
of the children exhibiting these respective disturbances of
psychosis and character disorder and that these differences
in attitudes were contributing factors, in some measure, to
the child's ultimate pathology and adjustment to life. The
hypotheses were as follows: (1) parents of psychotic chil-
dren are characterized by attitudes defined as non-relating;
and (2) parents of character disorder children are charac-
terized by attitudes defined as withholding and punitive.

The design of the sample did not make for results
which would prove statistically significant. The sample
was not chosen on a probability basis nor was it large enough,
in relation to the number of characteristics analyzed, to
permit the use of standard statistical tests for significance.
Findings are reported, not as statistically valid conclusions,
but as suggested tendencies which might be useful as leads
for further research.

The findings suggest that the parents do play an imp
portant role in the emotional difficulties of the children
in both the Psychotic and Character Disorder groups.

86

87

With respect to the children themselves we find that
the psychotic children are referred to the agency at an
earlier age. This might be due to several factors, but it
may indicate that the parents of the psychotic children tend
to be able to ask for and accept help more easily than do
the parents of the character disorder children. This may
also indicate that a closer relationship between parents and
child exists in the famdly of the psychotic child than in the
families of the character disorder children, or they are more
aware of emotional and feeling difficulties in the families
of the psychotic children than they are in the families of
the character disorder children. A second factor related to
the age of the child at the time of referral is his or her
educational level. The finds were that the character dis-
order children were older and thus at a higher educational
level. This may indicate the added pressure of moving into
new experiences which is felt by the child in scmo way and
parents and school officials should be aware of this. The
probability also exists that the character disorder children
had their problems at an earlier age, but they were not re-
cognized or considered serious enough to need help.

In general the findings were that the character dis-
order children had experienced more family disorganization
than the psychotic children. That is, the families of the
character disorder children had a higher proportion of divorce
and actual physical breakdown present in them than did the
families of the psychotic children. This factor supports

88
the writer's hypothesis that hostility is expressed openly,
more harshly and more freely in the families of the character
disorder children. It might also indicate, although not
necessarily, that within the families of the psychotic chil-
dren the parents or one parent tends to be passive and non-
relating. It could be that they are non—relating because of
over-control of emotion. The writer is also aware that the
lower percentage of family disorganization within the fami-
lies of the psychotic children may simply indicate that the
parents of these children are able to express more positive
feelings to some degree and in general are able to make at
least a different type of adjustment than the parents of the
character disorder children.

In termm of personal adjustment the mothers of the
psychotic children exhibited emotional problems more often
than did the fathers of the psychotic children, while the
fathers of the character disorder children tended to exhibit
emotional problems more often than the mothers of the charac-
ter disorder children. The same situation exists with re-
spect to the parents exhibiting behavior similar to that
exhibited by the child. The mothers of the psychotic chilc
dren exhibited behavior similar to that of the child more often
than did the fathers. Although, in the case of the character
disorder children the fathers showed the tendency to exhibit
behavior similar to that of the child more often than did
the mother.

The findings supported the first hypothesis. The

89
parents of the psychotic children did possess non-relating
attitudes.

The second hypothesis was found to be not supported
by the data. The parents of the character disorder children
were also found to exhibit attitudes which are described as
non-relating. The difference seems to exist in the mmount
of autonomy rather than control which they exhibit in rela-
ting to the child. The hostility was present in the parents
relating to the character disorder children but not the con-
trol that had been expected.

The factor of consistency and inconsistency does seem
to have some significance. The parents of the character dis-
orders seem to be consistent in their attitudes. They seem.to
consistently express hostility and consistently express a
great deal of autonomy toward the child. The parents of the
psychotic children are less consistent and move more from
autonomy to control and hostility to love.

It is hard to evaluate whether the results are in her-
mony with previous investigations since these are so few. It
does seem that the results are in harmony with the separate
investigations that have been undertaken, relating to the atti-
tudes and parent-child relationships which are involved in
these two disorders of psychosis and character disorder in
children.

It is the writer's feeling that a comparative study
of this nature dealing with psychotic, character disorder,

brain damaged and normal children would be of great value.

90
Another possibility exists in only a very few cases from two
or more diagnostic categories and studying them.intensively,
using various.methods and sources of material other than
case records exclusively. Similar comparative studies deal-
ing with various emotional illnesses should be undertaken
which.wou1d lend themselves to statistical tests for signi-

ficance.

APPENDIX
SCHEDULE FOR COLLECTION OF DATA

Face sheet data:
Child:
1. Age , Birthdate

 

2. Sex: M. , F

3. Number of children in family
1) total
2) living
3) decease
h) sex: :u , F

 

m

A. Bank of child in family
1) All living children
(1) only child
(2) l 2,3,A,5,6,7,8,9,10, other
2) All living and non-living children
(1) only child
(2) 1,2,3,A,5,6,7,8,9,10, other

5. Education (grade in school or last grade attended)
1) Kindergarden Il, 2,3,A,5,6,7,8,9,10,1l,12

6. Race: N , N , other

7. Nationality

 

 

1) foreign born: yes , no
8. Referral source
1) School 5) Doctor
2) Court 6) Public HeaIth Nurse
3) Police 7) Social Work Agency
A) Visiting teacher 8) Other
9) Parents TV
(1) Parent maxing referral
a. Mother
be Fathar

c . StepmotEer
d e Stipfa ther
. e Other

 

91

92

9. Nature of referral
1) Voluntary
2) AuthoritarIm
3) At suggestion of wmeone

 

 

A) Other
10. Reason for Referral:
11. Diagnostic category:
Parents:

1. Age (at time of referral)
1) Mother 3) Stepmother
2) Father A) Stepfather

2. Occupation
1) Mother: housewife only

(1) Other: prof. , w

) Father: prof.

3) Stepmother:

(1) Other:

A; Stepfather:

5

a collar

housewife only-
prof. fl, white collar

 

prof.‘ _, white collar
Other
3. Religion:
1) Prot. 3) Jewish
2) Cath. ___ A) Other

, wEite collar

 

A. Nationality
1) Foreign born:

 

yes , no

5. Race: W , N , other
6. Education
1) Mother 3) Stepmother_

2) Father A) Stepfather:
7. Child currently living with:
1) Mother and father
Mother_

3 Father: 6) other

5) Other

, blue collar

ue collar

___, blue collar ___
*, blue collar.___

5) other

 

A) Mother and stepfather“
5) Father and stepmother:

 

8. Marital status of natural parents:
1) Date of marriage
2) Married at time of referral:
3 Separated‘___; date of
I. Desertion _; date of __
5) Divorced ___; date of‘___

 

yes

3 no. yrs. married
, no

93

(1) Parents remarried:
a. Hother , date of
b. Father , date of

9. As parents do they accept their respective roles?
1) Mother: yes ___, no ___, some ___
2) Father: yes ____, no _, some __
3) Stepmother: yes ____, no _____, some __
A) Stepfather: yes‘___, no ___, some‘___
5) Other:

 

Material gained from case record:

1. Familial history of behavior tending to be similar to
that exhibited by child:
1) Mother: yes ___, no ___, some
2) Father: yes _, no _, some _
3) Stepmother: yes _, no ______, some __
A) Stepfather: yes _, no _, some __
5) Other:

 

2. Personal adjustment of parents: (l-normal; 2-psycho-
neurotic; 3-neurotic character disorder; A-character
disorder; 5-psychotic)

1) Mother: 1,2,3,A,5, 3) Stepmother: 1,2,3,A,5
2) Father: 1,2,3,A,5 A) Stepfather: 1,2,3.A.5
5) Other:

 

3. Marital history of parents:
1) Number of marriages:

(1) Mother (2) Father
2) Married prior to marriage in question:
(1) Mother: yes , no (2) Father: yes , no

3) Number of separatIEHs in EEFriage in question‘___
A) Number of desertions:
(1) Mother (2) Father‘___
5) History of IIIegitimate children:
(1) Child in question.___ (2) Other

 

A. Marital adjustment of parents:
Step- Step-
Mother Father mother father Other
Accepting
Loving
Demanding
Detached
(withdrawal)
Dependent
(infantile)
Sada-masochistic
Masochistic
Rejecting _A
Possessive
(controlling)
Other

 

 

”WWW”

 

 

 

 

 

 

91.

5. As a partner in marriage do they accept their respective
roles?
1) Mother: yes _, no _____, some
2) Father: yes ____, no _____, some __
3) Stepmother: yes _, no ______, some __
A) Stepfather: yes _____, no _____, some
5) Other: .

 

Attitudes of Parents:
1 e “Other

EEE§§Ot er‘___ Attitude Circumplex

  
 
 
 
      
  
 
  

 

 

 

 

  
  
  
    

   
 
    

 

 

 

 

 

 

Autonomy
(00
Detached Democratic
Indifferent
Neglecting Cooperative
Rejection
Hostility # r g ; ~{ g ; { Accepting
"00 “50-60-40-830 20 4o 60 80‘ 0 L0"
Demandimg " ~~ ver
Antagonistic .'éoq_ Indulgent
/Protective Indulgent
Authoritarian r
Dictatorial Over Protective
-\Oc)
Possessive
2. Father Control
Stepfatfier Autonomy Ereedom
Other ‘00
""""U€tached Democratic
Indifferent 80*
60--
ooperative
Neglecting 4.0-4)—
Rejection ZCHI
Hostilit , T g g g ,L . “c223?“
"0 ~8o-ao-4o-ao 2.0 40 6080‘ 0
-80....
var
Antagonistic -6CW‘ Protective Indulgent
so—
4 var Protective
1:03.388"
Control
Consistency of predominant attitude.
1. Mother Con. . 1 J 1 , Incon
2. Fathor . 4 j 1 J
. Stepmother p, r g a. .
. StOpf‘thCr , _1 a L 1
5. OLhOr | A s l J

 

 

95

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RIES

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