DICES 0F ORGANICITY AS

PERCEPTUAL IN
EACTIVE

RELATED TO PRGCESS A'ND R
SCHIZOPH‘RENIA

Thais Ior the Dear» 00 Ph. D.

MICHIGAN STATE UNIVERSITY

M. McDonough
1958

Joseph

mini!“

This is to certify that the
thesis entitled
Perceptual Indices of Organicity as Related
to Process and Reactive Schizophrenia

presented by

Joseph Manning McDonough

has been accepted towards fulfillment
of the requirements for

Ph.D. degree in Psychology

 

LIBRARY

Michigan Sta.
University

 

PERCEPTUAL INDICES OF ORGANICITY AS RELATED

TO PROCESS AND REACTIVE SCHIZOPHRENIA

by

‘m‘l
Joseph MQNMcDonough

AN ABSTRACT

Submitted to the School for Advanced Graduate Studies of
Michigan State University of Agriculture and
Applied Science in partial fulfillment of

the requirements for the degree of

DOCTOR OF PHILOSOPHY
Department of Psychology

1958

Approved $7: /€&.~3 @M

 

2

JOSEPH M. MCDONOUGH ABSTRACT

The purpose of this experiment was to obtain evidence
about schizophrenia, particularly in relation to possible
organic components. Much theory and some experimental
findings suggested that at least certain schizophrenics
suffer from a disease that is primarily organic in nature,
perhaps of a central nervous system locus. Recent publi-
cations have sought to tie this variety of the disorder
to the concept of process schizophrenia.

The two perceptual tasks chosen to investigate the
problem were critical flicker frequency (off) and the
Archimedes Spiral aftereffect. The selection of these two
tasks was based on the considerable amount of evidence that
brain damaged individuals show gross defects in the per-
ception of both.

Four groups of 29 subjects each were chosen. All sub-
Jects were male veterans under A5 years of age and with
normal visual acuity in at least one eye. The organic
group consisted of cases of known brain damage, as deter-
mined by case history and neurological examination. Twenty
surgical cases from a?:europsychiatric hospital comprised
the normal group. Seventy-six patients with hospital di-
agnoses of schizophrenia, less than one year of current
hospitalization, and no history of head injury were rated
on the Elgin Prognostic Scale by two independent raters

using case history material. A correlation coefficient

3

JOSEPH M. MCDONOUGH ABSTRACT

of .89 was obtained between the two sets of ratings. The

20 patients with the highest Elgin scores were designated as
the process group while the 23 individuals with the lowest
scores made up the reactive group. All 83 subjects were
then given both perceptual tasks.

Relative to cff it was hypothesized that: (1) brain
damaged individuals would have lower cff thresholds than
would normals; (2) process schizophrenics would have lower
cff thresholds than would reactives; and (3) reactives
would show off levels not significantly different from
normals. Hypothesis One was confirmed (.301) but Hypotheses
Two and Three were not. In the latter case, reactives were
significantly higher in off than normals (.35).

Relative to the Archimedes Spiral aftereffect it was
hypothesized that: (A) brain damaged subjects would per-
ceive the effect less often than normals; and (5) process
schizophrenics would not experience the aftereffect as
often as either reactives or normals. Hypothesis Four was
confirmed while Hypothesis Five was not.

A discussion of the results of this investigation
considered the effectiveness of the cff technique in dis-
criminating brain damaged from normal and schizophrenic
individuals, and the relative inability of the spiral
method to do likewise; the possibility that affective com-

ponents of reactive schizophrenia contribute to the

L1,

JOSEPH M. MCDONOUGH ABSTRACT

differences between them and other schizophrenics and
normals; and the belief that process schizophrenia, while
showing some physiological differences from reactive
schizophrenia in other investigations, probably is not due

to defects of a cortical nature.

PERCEPTUAL INDICES OF ORGANICITY AS RELATED

TO PROCESS AND REACTIVE SCHIZOPHRENIA

by

Ml
Joseph M?“McDonough

A THESIS

Submitted to the School for Advanced Graduate Studies of
Michigan State University of Agriculture and
Applied Science in partial fulfillment of

the requirements for the degree of

DOCTOR OF PHILOSOPHY

Department of Psychology

1958

ACKNOWLEDGMENT

The writer is indebted to Drs. M. Ray Denny, S. Howard
Bartley, Alfred Dietze, G. M. Gilbert, Gerald F. King, and
Stewart G. Armitage for their gracious assistance and con-
structive suggestions in connection with this thesis.
Particular thanks are due Dr. Denny, committee chairman,
and Dr. King for their valued contributions to the experi-
mental design; to Dr. Armitage who was instrumental in the
original formulation of the problem; to Dr. Bartley for
the design and construction of the flicker apparatus; and
to Dr. Gilbert who served as chairman during the early
months of this project.

Finally, I would like to thank the staff and patients
of the Veterans Administration Hospitals at Fort Custer
and Dearborn, Michigan for help in the data collecting
phases of the research. Dr. Armitage and his staff at
Fort Custer were extremely encouraging and cooperative

throughout.

TABLE OF CONTENTS

PAGE
ACKNOWLEDGMENTS. . . . . . . . . . . . . . ii
LIST OF TABLES AND FIGURES . . . . . . . . . . iv
INTRODUCTION. . . . . . . . . . . . . . . 1
Critical flicker frequency in brain damaged
individuals . . . 2
Critical flicker frequency with non brain damaged
psychotic patients. . . . 8
The Archimedes Spiral aftereffect with brain
damaged and non brain damaged psychotic
patients . . . . . . . . 12
Organic factors in schizophrenia . . . . . 16
Development of the concepts of process and
reactive schizophrenia . . . . . . . . 23
THE PROBLEM . . . . . . . . . . . . . . . 33
Definitions . . . . . . . . . 35
Purpose of the Investigation. . . . . . . . 36
Hypotheses. . . . . . . . . . . . . . 37
METHODOLOGY . . . . . . . . . . . . . . . 38
Apparatus . . . . . . . . . . . . . . 38
Subjects . . . AO
Classification of schizophrenic patients on a
process reactive continuum . . . . . . . 51
Procedure . . . . . . . . . . . 56
Statistical treatment . . . . . . . . . . SO
RESULTS . . . . . . . . . . . . . . . . 6A
DISCUSSION . . . . . . . . . . . . . . . 75
Brain damages patients and off . . . . . 75
Cff and process and reactive schizophrenia . . . 76
Archimedes Spiral aftereffect . . . . . . . 80
SUMMARY . . . . . . . . . . . . . . . . 81
REFERENCES . . . . . . . . . . . . . . . 8A

APPENDIX . . . .. . . . . . . . . . . . . 96

LIST OF TABLES AND FIGURES

PAGE
TABLE
I. Characteristics of sample. . . . . . . . Al
II. Classification of 76 schizophrenic patients
according to Elgin Prognostic Scale Scores . A3
III. Official hospital diagnosis of schizophrenic
patients rated in this study as process
and reactive . . . . . . . . . . . A8
IV. Kruskal-Wallis H test for mean education level
differences between groups. . . . . . . A8
V. Kruskal—Wallis H test for mean age differences
between groups. . . . . . . . . . . 5O
VT. Mann-Whitney U test for mean age differences
between paired groups . . . . . . . . 50
VII. Individual mean critical flicker frequencies . 65
VIII. Mean critical flicker frequencies for all
groups and Hartley F Max test for homogeneity
of variance. . . . . . . 66
IX. Individual mean cff ranks. . . . . . . . 66
X. Kruskal-Wallis H test for mean Cff differences
between groups. . . . . . . . . . . 67
XI. Mann-Whitney U test for mean cff differences
between paired groups . . . . . . . . 67

XII. Mann-Whitney U test for mean cff differences
between extreme process and reactive subjects 69

XIII. Mann-Whitney U test for mean cff differences
between 10 extreme reactives and 20 normals . 69

XIV. Mann-Whitney U test for mean cff differences
between 10 least extreme reactives and 20
normals . . . . . . . . . . . . . 71

XV. Differentiation of organics from all other
groups on basis of off . . . . . . . . 71

XVI. Individual Archimedes Spiral aftereffect scores 73

Fig. 1. Distribution of Elgin Prognostic Scale averaged
scores for 76 schizophrenic patients . . 5A

INTRODUCTION

The purpose of the present investigation was to obtain
evidence concerning the etiology of schizophrenia, with em-
phasis on a possible relationship between it and central
nervous system pathology. In addition, it was hoped that
further verification of the validity and practicability of
the concepts of process and reactive schizophrenia would
arise out of the study, especially when viewed as the ex-
tremes on a continuum. And finally, it was hoped that addi-
tional meaningful data would come from the investigation
relative to the performance of brain damaged, normal and
schizophrenic subjects with critical flicker frequency and
the Archimedes Spiral aftereffect.

The two perceptual tasks were chosen because of con-
siderable evidence that brain damaged individuals show gross
defects on both. Much theory and some experimental verifi-
cation lend credence to the possibility that at least cer-
tain schizophrenics suffer from a disease that is primarly
organic in nature, and which has perhaps a locus in the
central nervous system. Recent publications have sought
to tie this variety of the disorder to the concept of

process schizophrenia.

Critical Flicker Frequency in Brain Damaged Individuals

 

When a stimulus is presented to the retina in the form
of a pulsating intermittent light, the experience of flicker
occurs to the subject. If the off-on cycles are presented
at an increasingly rapid rate, a point will be reached when
the viewer will report that he sees a steady light. This
subjective point is called the fusion point, and the number
of cycles per second (cps) necessary to produce fusion is
critical flicker frequency (Cff). This phenomenon was
first reported in a publication by Segner in 17AO. Since
that time, more than 1300 publications have appeared on the
subject of flicker or on closely related topics (83).

For some years it has been observed that, in general,
brain damaged persons have significantly lower cff
thresholds than do non—brain injured individuals. Numerous
studies have been carried out in this area, especially in
the decade following World War II, and generally high agree-
ment is found concerning lowered cff for the organic sub-
jects. Phillips (105) noted that the individuals with
cerebral lesions showed lower flicker thresholds than
normal subjects. In a study involving brain injured children,
and using a group of non brain damaged mental defectives
as controls, Werner and Thuma (137) obtained significant
differences in off between the two groups. With pro—
longed exposure in 15 organic subjects, Christian gt El (31)

noted that marked decreases in threshold appeared, while

 

 

osvoa

normal, experimental subjects were not affected. Enzer,
Simonson, and Blankstein (Al) found that organics were much
less liable to perceive the usual phenomenon of a second
and third flicker after the initial cff point had been
reached. Normal subjects did not display this difficulty.
Miles (96,97) found cff defects in cases of multiple
sclerosis, brain trauma and cases suffering from the effects
of cerebral accidents such as aneurysm, occlusion or throm-
bosis. Further evidence of lowered cff in multiple
sclerotic patients has been contributed by Ross and Reitan
(112), and Parsons and Miller (lOA).

A good deal of careful experimentation with brain
damaged subjects using the flicker fusion technique has
been conducted by the group at New York University under the
guidance of Teuber, Bender, and Battersby. Using large
samples of Naval casualties with penetrating gunshot and
shrapnel wounds of the brain, these investigators have
published many articles showing that cff is significantly
lower for these subjects than for normal controls (18,19,
131,132,133).

An interesting contradictory finding in the litera-
ture involves the importance of the frontal lobes in
perception of off, Halstead (5A) reported that lowered
eff is characteristic of patients with frontal lobe
damage. This has not been borne out in subsequent studies

by Battersby, Bender and Teuber (8, 9, 10, 128, 129, 130).

A
When AO frontal penetrations were compared with A0 occipital-
parietal gun shot cases and 60 controls with peripheral
nerve injuries (but without head injury), Teuber 22.2l (68)
discovered that greater deficit appeared in the occipital—
parietal group. For these investigators, one of the crucial
factors seemed to be length of time elapsed since original
damage. Lowered cff did not appear to hold in individ-
uals where frontal damage occurred five or six years prior to
testing. They concluded, that lasting defects in cff
threshold apparently must involve higher brain paths than
frontal areas alone.

Supporting evidence for this position appears to
come from experiments in cff with lobotomized psychiatric
patients. The Columbia-Greystone Project conducted in the
late 19AO‘s and early 1950‘s reported that no lasting de—
fects of any significance were noted in patients who under-
went lobotomy or topectomy of the frontal areas. In some
cases lowered cff occurred post-operatively, but in
general, the effects were transient and explained as due,
in most part, to a dulling or lack of vigilance on the part
of the operatee. Usual recovery of flicker threshold was
accomplished within three months (71, 80, 82, 85,1A9).

Two studies contradict the usual finding of lowered
off in brain damaged subjects. Dean (36), found that
off did not discriminate between the organic and normal

groups. Leiberman, Jlenig, and Hacker (88) were unable to

obtain significant correlations between differing types of
threshold responses and various diagnostic groups (including
brain damaged individuals).

Many investigators have sought to explain the pheno-
menon of critical flicker. In general, two theoretical
approaches have been utilized. The most popular view is
based on the premise that neural events act in a chainlike
manner, over restricted paths in the central nervous system.
On the other hand, a minority of investigators lean toward
a holistic or Gestalt view, where it is assumed that some
sort of collective action takes place in the brain. Pro-
ponents of the latter position include Kohler, Koffka,
Lashley, Goldstein, Kluver, Teuber, and Ogle (20, 21, 101).

Experts are also divided as to the neural locus of
flicker. Is it primarily a retinal phenomenon or does it
occur some time after the original impulse of light stimu-
lates the retina, e.g. in the optic nerve, or in the visual
cortex? Hecht and Verrijp (55) maintain that flicker is
basically a photochemical event, but stress the fact that
the retina is merely the "controlling influence," or the
start of a complex process. Miles (97) on the basis of
his investigations, makes the statement that "Flicker fusion
is a retinal phenomenon in the normal person." Ross (113)
sees cff as a function of the physio-chemical situation
in the single receptor in addition to the total number of

effective receptors in the retina.

For most investigators, however, non retinal factors
are believed to be primary in the experiencing of fusion.
Bartley (6) after numerous experiments, suggests that the
"visual pathways further along are responsible and that the
determination of cff is neural." Halstead (53) believes
that off is not due to any retinal process, but instead
is the result of a fusion mechanism in the brain, probably
the cortex. Simonsen, Enzer, and Blankstein (120) conclude
from their study that a central process is primary in the
perception of flicker,and that fatigue is probably the im-
portant factor. In a subsequent investigation, Werner and
Thuma (137) agree, since brain injured subjects showed
significantly lower cff thresholds than normals, yet no
retinal deficiencies were observed. Bender and Teuber and
their co-workers (17, 19,131, 132) adopt a "field theory,"
similar in many ways to Kohler‘s theory of figural after—
effects (76) where "satiation" or lowered excitation is
postulated as occurring in the occipital brain fields. Ogle
(101) prefers to explain flicker and fusion in phenomeno-
logical terms until such time as considerably more is known
about the neuroanatomy of the brain. It is the opinion of
Landis (83), however, that

in spite of the fact it has entered into such
a wide variety of investigations there is no compre-
hensive theory of flicker. The "general theory" of
Plateau (183A) is as complete as that of any of his
successors. Even such a simple point as whether the
flicker-fusion threshold is dependent on retinal
functional limitations or on limitations imposed by

the central nervous system has never been clearly
answered.

7

In a similar fashion, explanations are quite varied
as to what causes lowered cff thresholds in brain damaged
subjects in particular. Landis and Clausen (8A) hypothesize
that it is the duration of the dark interval which is the
'"link in the chain which is altered by brain damage,"
suggesting that the perception of a steady light persists
only if the dark interval is of short enough duration to
permit a second impulse to reactivate the neural pathway.
Bender, Wortis,and Cramer (21) speculate that brain damaged
patients undergo permanent "disequilibrium in the cortical
field forces. Defects in sensory pathways, or even in
regions outside the sensory pathways proper, lead to a re-
organization and redistribution of the remaining forces.
[but] the new field is no longer as stable as in the normal
state." In a later article, Bender and Teuber (20) suggest
that "intermittence of cerebral activities" is probably
a mechanism which exists even in normal vision, but with
cerebral lesions an "abnormal" intermittence occurs. Klein
and Krech (73) feel that lowered flicker thresholds are due
to the generalized lowering of brain conductivity, which is
permanent, especially in instances of massive damage.

Summarizing the experiments which deal with brain
damage and off, we may say that the overwhelming amount
of evidence indicates that:

1. brain damaged patients have significantly lower

flicker fusion thresholds than do normals.

2. brain damaged patients with frontal lesions ap-
pear to suffer transient lowering only.

3. patients who have undergone psychosurgery (in the
main frontal lobotomies and topectomies) have only
a temporary defect in their post-operative fusion

level.

Critical Flicker Frequency with Non Brain Damaged Psychiatric

 

Patients

Although Cff has been the subject of considerable
scientific investigation for many years, it is only recently
that the technique has been used to any great extent with
persons suffering from psychiatric conditions of a func-
tional or non organic nature. The earliest study involving‘
mental patients and cff was done in 1906 by Wiersma (1A0)
who reported group differences in fusion levels using manics,
paranoids, melancholics and normals. He found that 11 manic
patients had a mean score of 27.7 cycles per second (cps);
l8 paranoids and melancholics, 12.2 cps; and nine normals,
1A,7 cps. It was also noted that manics tended to have
higher scores when in a manic state and lower fusion points
when depressed. A replication of the experiment by
Jones (61,62), some 23 years later, failed to confirm
Wiersma‘s results in that melancholic patients obtained
higher flicker rates than did manics. Ricciuti (109,110)
attempted to differentiate between various diagnostic groups.

His sample consisted of 15 manics, l3 depressives, A2

neurotics, A6 schizophrenics, and 5A normals. Meancflfi?
scores were not significantly different between the groups
with the single exception of normals when compared with
manics. In this latter case, differences at the .05 level
of significance were obtained. In an experiment involving
10 "psychiatric" patients and 10 controls, Klein and Sch-
lesinger (7A) obtained significant differences between the
two groups after they had been divided into "form bound" and
"form labile" by means of the Rorschach. Their hypothesis,
that the ‘"form bound" group would endeavor to "stabilize
the unstable field," was born out, but no attempt to differ-
entiate the groups on the basis of psychiatric diagnosis was
undertaken. Ulett et_al_(l35), with a group of five patients,

I

two of whom showed "symptoms of schizophrenia,' and three

with "depression and anxiety,"

report that two of their sub-
jects underwent increased sensitivity to flicker during
treatment with ACTH. In a second study, Ulett and Gleser
(13A) used a total of 96 individuals divided into three
groups: Group 1 consisted of subjects judged least likely
to develop symptoms of anxiety under stress; Group 2 was
made up of psychiatric patients diagnosed neurotic or
character disorder (i.e. all non psychotic); and Group 3

was a control group consisting of medical students. Groups
1 and 2 were subjected to stress (threat of shock) while

the control group was not. Photic "driving," as recorded

by electroencephalogram, was lowered in response to stress

10
conditions. Psychiatric patients, however, did not return
to higher "driving" on cessation of stress, while the non
patient group did. Ostrow (102) tested 302 psychiatric
patients on their susceptibility to photic driving. His
results showed that 88 per cent of his sample exhibited
susceptibility, but that the clinical diagnosis per se
could not be related to the phenomenon. Bracken and Weid-
man (28), investigated off with 13 schizophrenics and three
depressives, before, during and after shock treatment (elec-
tric and insulin). Results showed that generally higher cff
thresholds were obtained with improvement in the subjects‘
"mental condition." Fifty-eight "healthy" subjects and
51 patients (including 20 schizophrenics, and 11 ideopathic
epileptics) were subjected to a number of experimental
techniques including off by Doust et al (38). Oxygen
levels were found to vary with the rates of stimulation.
Irvine(60) compared 26 paretics with 26 schizophrenics
(matched on age, degree of psychosis, and length of hospital-
ization) and reported a significant difference between the
groups (.01 level). A recent investigation by Ax and
Colley (5) compared 22 brain damaged cases, most of whom
had cortical lesions, with 21 psychiatric cases selected
at random. Included in this latter group were 11 psycho-
neurotics, seven psychotics (five of whom were schizophrenic)
and three character disorders. The sample ranged in age from

22 to 62 years. Flicker score differences, significant

11

at the .01 level, were obtained between the two groups.
Gravely (52) was unable to find differences in cff in
comparisons involving hysterical, anxious, and normal
soldiers. Krugman (78), on the other hand, found that fifty
Air Force anxiety reaction cases differed significantly in
cff from 50 normal controls.

It is apparent from this review of the literature that
many of the studies using mental patients as subjects for
flicker experiments are open to serious methodological crit—
icism. These defects would include the small number of
patients and controls often involved; the frequent com-
bining of psychotic, neurotic and brain damaged individuals
within the same group; and the wide differences in experi-
mental technique. When these are added to the usual dif-
ferences from one study to the next (e.g. dissimilarities
in apparatus, amount of light adaptation, size of test patch,
ages of subjects, intensity of the stimulus, binocular vs.
monocular viewing, etc.), a tremendously complex situation
results. As Granger (51) points out, these differences
make comparisons between studies extremely difficult, if
not impossible, and probably account for some of the con-
tradictory findings.

Of the studies reviewed above, those by Ricciuti (109,
11A) and Irvine (60) appear to be sufficiently well designed

from a methodological standpoint to allow the following

l2

tentative conclusions to be drawn:
1. Schizophrenic patients have significantly higher
cff thresholds than do brain damaged patients.
2. Schizophrenic patients do not appear to differ in

cff thresholds as compared with normal subjects.

The Archimedes Spiral Aftereffect with Brain Damaged and

 

Non Brain Damaged Psychiatric Patients

 

Visual fixation by the subject upon a slowly rotating
Archimedes Spiral produces the illusion of expansion or con-
traction of the disk depending on the direction of rotation.
When the spiral is brought to a sudden stop, the perceiver
experiences an illusion just the reverse of that during
rotation, i.e. a negative after effect. This phenomenon,
sometimes referred to as the Plateau Spiral after effect,
was first described by Plateau in 1850. His findings were
confirmed by Oppel in 1856, Dvorak in 1870, and Bowditch and
Hall some dozen years later (25).

In 19A9, Freeman and Josey (A3) administered the
spiral to 50 normal patients and 85 psychotic patients
from a state institution, the over-all age range for
both groups being 23 to 76 years. Diagnoses in the
psychotic sample included schizophrenia, manic depressive
psychosis, dementia paralytica, epilipsy, cerebral arter-
iosclerosis and Korsakoff‘s syndrome. After being rated
on degree of memory impairment, the patients were given

trials with the rotating spiral. Results suggested to the

investigators that a "strong probability" of correlation
existed between negative after effect and impairment of
memory. Standlee (121) took issue with this explanation.
Using 25 psychotic and 16 normals, he concluded from

his data that memory ability and the ability to experi-

ence the spiral after effect were not related. Working

on Freemafls original assumption however, Price and Deabler
(107) hypothesized that non-organic patients would perceive
the illusion while brain damaged individuals either would
fail to perceive the effect or would experience an incom-
plete effect. Forty adult males employed at the institution
were used as controls, none of whom had a history of organic
injury. The experimental groups consisted of A0 non-
organic mental patients including schizophrenics, manic
depressives and psychoneurotics, and 120 subjects with known
cortical involvement. Diagnoses in this latter group in-
cluded central nervous system syphilis, cerebral vascular
accident, chronic brain syndrome associated with alcoholism,
cerebral arteriosclerosis, post traumatic encephalopthy, and
advanced stages of Parkinson‘s disease. Significant differ-
ences at the .01 level were obtained between normals and
functionally psychotic patients on the one hand, and brain
damaged subjects on the other. Results indicated that
whereas approximately 92.5 per cent of the normals and
psychotics experienced the after effect on every trial, two

per cent of the organics were successful in obtaining

1A
perfect scores in perceiving the illusion. The experimenters
concluded that failure to experience the effect was almost
certainly to be considered an indication of cortical in—
volvement. These findings appear to have set off a rash
of experiments to verify the experiment since the obvious
diagnostic possibilities of the spiral technique were
readily apparent. In a published replication of the experi—
ment Gallese (A8) used known organic cases, mild or suspected
organics, lobotomized schizophremics, and schizophrenics
considered to be free of organic complications. He
found that only 66 per cent of his organics were differ-
entiated from the normal and non lobotomized schizophrenic
group. Lobotomies and the mild organic patients did not
differ from the schizophrenics and normals to any signifi-
cant degree. Aaronson (1) using an epileptic sample,
reported that only 1A of 65 failed to perceive the after
effect. Seeking to corroborate the findings of
Price and Deabler, but with a "carefully matched control
group" on such factors as age, intelligence, and length of
hospitalization, Page et al (103) found that significant
differences between the brain damaged and emotionally dis-
turbed groups did exist. They concluded however, that
Price and Deabler's theoretical implications were supported
by their results, the value of the spiral technique in
diagnosis was less evident due to overlap in the groups.

Davids gt a1 (3A) used the test with 15 cerebral

palsied children, 29 emotionally disturbed non-organic
youngsters, and 15 normals, and found significant dif-
ferences between the groups. Whereas most of the

organics failed to see the after effect, and most of the
normals perceived it, the psychiatric group intended to be
more variable in the response.

Theories as to what occurs in the perception of the
Archimedes Spiral illusion vary. Shapiro (117, 118) feels
that cortical irradiation suffers from additional inhibi-
tory effect due to the brain damage itself Saucer (11A,ll5)
believes that patients undergo varying degrees of loss in
the ability to synthesize and integrate motion perception,
a higher central nervous system function. Bender and
Teuber (l9) prefer a Gestalt field theory for descriptive,
if not explanatory purposes. They propose that in organic
patients, normal resistance to displacement in the cortical
field is weakened, resulting in an "abnormal yielding" to
the stress set up by the perception. Wertheimer and his
co-workers (138,139) suggest that "satiation" (as used in
Kohler's theory of figural after effects) "could be inter-

‘ and therefore the

preted as implying metabolic changes,‘
size of an after effect may be thought of as a measure of
the "metabolic efficiency" of the brain. Gibson (50) hypo-
thesizes that the stimulus for motion is ordinal (i.e.,

the retina responds to adjacent and successive order) and

relational (i.e. the perception of motion is related to and

 

16
cannot be separated from the stable environment within
which it occurs). Several mathematical classes of effective
stimulation may be differentiated. Rotation in any object
such as the Plateau spiral may be described as a type of
"rigid" motion, or motion in which the figure after dis-
placement is identical to the figure prior to displacement.
These classes in Gibson's opinion are in turn "neatly cor-
related with types of physical events . . . which may prove
to be psychophysically correlated with modes of kinetic
experience."

In summary, although theories attempting to explain
the phenomenon vary widely, most experiments involved with
the spiral after effect appear to show that brain damaged
individuals display some degree of difficulty in perceiving
the illusion, while normals and functionally disturbed
patients generally do not have this difficulty. The ability
of the technique to serve as a diagnostic tool however, has
not lived up to the original hopes of Price and Deabler (107)
with subsequent studies unable to reach the heights of '

differential diagnosis reported by these experimentsrs.

Organic Factors in Schizophrenia

Traditionally, all mental aberrations including what
is .now known as schizophrenia were thought to be non-
organic in nature, i.e. due to the work of the devil,
possession of the afflicted soul by evil spirits, et cetera.

However, with the rise of natural science in the 18th and

17
and 19th centuries, more and more emphasis was put into the
attempt to find a physical basis for the disease. Success
on the part of researchers in finding the microorganism
responsible for paresis gave added incentive to investi-
gators and theorists with a materialistic metasystem. The
subsequent achievements of science in the past 50 years, and
their overwhelming effect on the medical arts,continued to
strengthen the position of those who postulate a physical
basis for schizophrenia.

In 1896 Kraepelin (100) formulated the concept of

dementia praecox (a term he borrowed from Morel), charac-

 

terizing the disorder as a metabolic disturbance with an
early onset, a gradual worsening of the patient‘s clinical
condition, and an almost irrevocably poor prognosis. The
disease was usually accompanied by such symptoms as hallu-
cinations, delusions, withdrawal tendencies, bizarre
thought processes, and inappropriate or dull affect. These
symptoms appeared in varying combinations and with varying
degrees of severity. In addition, Kraepelin suggested that
clinical subtypes could be differentiated. These he design-
ated hebephrenic, catatonic, paranoid and simple, each
distinguishable on the basis of its presenting symptom-
atology. Bleuler (22,23,2A), while largely agreeing with
Kraeplein, observed that not all cases appeared to have
early onset and a poor prognosis. Because he believed the

"most important" characteristic of the disease to be the

18

"splitting " of the different psychic functions, he sug-
gested that the name be changed to "schizophrenia." Bleuler
believed it was conceivable that the entire symptomatology
could be psychically determined, but that the functional view
had too many limitations to be regarded very saéiously.
These drawbacks included the usual absence of psychic trauma,
the often present organic symptoms, and the fact that primi-
tive civilizations had as high a rate of the disorder as
did our own society. He concluded therefore(as had Krae-
pelin before him) that "Complete justice to all these
factors [could] only be done by a concept of the disease
which [assumed] the presence of [anatomic or chemical] dis-
turbances of the brain." Even such "dynamically" oriented
theorists as Freud (A2) and Jung (63) postulate an organic
basis for the psychoses. Jung for example, considers
emotional upset as leading to metabolic abnormalities,
which result ultimately in physical damage to the brain.

Numerous researchers feel that brain damage is the
important factor in schizophrenia. Bateman and Papez (7)
state that diseased cells of the thalamus may be at fault,
or that changes in nerve cells of the prefrontal cortex
occur as a result of pathogenic organisms. The latter
finding was based on 70 biopsies of patients with dementia
praecox. Anderson (2), expressing disillusionment with
the Freudian psychodynamic approach to the problem, specu-

lates that failures in interpersonal relations are "brought

19
about by a very specific type of organic brain deficit,"
probably located in the most superficial layers of the
cortex. Lauretta Bender (l5, 16) with a wealth of statis-
tics obtained at Bellevue, believes that "no child can
develop schizophrenia unless predisposed by heredity" with
the most important etiological factors being organic events
such as birth injuries, severe illnesses, accidents and the
like. Bychowski (29) in a discussion of one patient,
hypothesizes that a "dynamic disturbance of the frontal
apparatus" occurs in the schizophrenic, a situation not
unlike that found in certain cases with brain lesions. For
Eickoff (A0), the arrested development of the schizophrenic
child's abstract ability is due to general defects in ac-
quisition of sensation. Again, one case is reported, in
detail. Hoskins (58) in his "Biology of Schizophrenia,"
sees the disease as the product of defective maturation on
both somatic and psychic levels, but concludes that "the
next and most fundamental research in schizophrenia should
be made not in the mental hospitals but in the biology labsg"

From an examination of 1,087 records taken from the
Berlin hospital between 1893 and 1902, Kallman (6A,65)
concludes that "the organic process of schizophrenia in
the brain . . . attacks the cortex most exclusively and
usually leaves the internal parts of the brain intact."

This investigator reports that a "startling correspondence

 

 

between expectation of schizophrenia and mortality from

 

 

2O

tuberculosis [exists]." "This statistical result is so un-

 

equivocal that it excludes all possibilities of coincidence
and can only be interpreted as a genuine gene-coupling of
the tendency to schizophrenia and the heredito-constitutional
susceptibility to tuberculosis infection." He suggests that
the locus of the hereditary weakness may be in the reticulo-
endothelial cells. Landis (79) concurs with Kallman in the
belief that schizophrenia occurs only in individuals pre-
disposed to it through genetic background. Major (89) con-
siders the primary cause of schizophrenia to be in the
altered matabolism of the diencephalic neurons. Neilson
(99) agrees that "the basic pathology must be diencephalic
in location" since schizophrenic symptoms exist prior to

any discoverable cortical signs. He believes that the con-
dition is probably inborn. Roizin at 31 (111) in a discus-
sion of a single case, reported finding considerable demye-
1inization of subcortical white matter. Davis and Davis
(35) compared EEG records of 52 schizophrenic patients with
500 normal controls and were unable to observe and correla-
tion between diagnosis andwave record, although a large
number of the patients showed abnormalities outside the
range of normal variability, and in some respects resembled
closely the patterns of epileptic individuals taken between
seizures. Kennard and Levy (69) found abnormal EEG‘s (often
indicative of brain lesions) significantly more often in the

more severe cases, especially those resembling dementia

21

praecox. Winkelman and Book (1A2) concluded on the basis
of ten autopsies of schizophrenics that gross brain appear-
ance did not differ from normals, but that microscopic evi-
dence did suggest the diagnosis. Dunlap (39), however, was
unable to distinguish schizophrenic from non schizophrenic
brains. Brackbill (26), summarizing the situation, points
out that it seems "fairly well established" that structural
damage appears in some schizophrenics, but that inadequate
investigation of non psychotic subjects make evaluation
difficult.

Some research has attempted to relate physique and
susceptibility to schizophrenia. Kretschmer (76) believed
that the disorder was most prevalent in asthenic or dysplac-
tic body types. Kline and Tenney (75), with 1000 patients
independently rated by Sheldon, discovered a positive cor-
relation between mesomorphs and good prognosis, and a
tendency for endomorphs to have a poor one. However,
Wittman, Sheldon, and Katz (1A7), reported poor prognosis
associated with ectomorphic individuals.

Evidence for organicity in schizophrenia based on
the patient's performance on psychological tests was pre-
sented by Meadow and Funkenstein (92). After classifying
their subjects according to physiological reactivity to
epinephrine and mecholyl, they found a marked parallel
between impairment in abstract thinking and autonomic

nervous system response. The similarity in this respect

22
between brain damaged and schizophrenic subjects suggested
to them the possibility of cortical defect. The relation-
ship between organicity and schizophrenia on the basis of
psychological and physiological measures has also been
reported by other experimenters, whose findings will be
reported in a later section (27, AA,A5,A6,A7,A9,68,70).

In summary, a number of organic correlates for schizo-
phrenia have been found as a result of biological, histo-
logical and genetic studies. Some support for the relation-
ship between constitutional body type and susceptibility to
the disease has also been reported. In addition, differ-
ences in physiological reactivity to drugs, and performance
on psychological tests in a manner similar to that of brain
damaged subjects has been reported by some experimenters
to be present in schizophrenics. However, attempts to find
organic involvement in schizophrenia specifically in the
form of brain damage, have been less successful for the
most part. One difficulty is that many, if not most of
the studies, are inadequately designed from the standpoint
of good experimental methodology, often lacking non
psychoticcontrols. More than a few publications are based
on a sample of one case, while others are merely the clinical
impressions of the investigator arising out of his or her
experience. Brackbill (26) identifies another source of
confusion in his exceptionally fine review of the litera-

ture in this area. While concluding from the evidence that

23

organicity is possible in some types of schizophrenia, he
points out that much of the contradiction in findings prob-
ably can be blamed on the heterogeneity of the concept of

schizophrenia itself.

Development of the Concepts of Process and Reactive

 

Schizophrenia

 

The theorizing which has led to the concepts of
process and reactive schizophrenia is a natural consequence

of numerous studies which have appeared in the literature,

‘-.F-—--"Mm~ry

plus a widespread dissatisfaction with the traditional
Kraepelinian notion of dementia praecox since clinical ex-
perience has not been entirely supportive. Bleuler (22)
recognized that the outcome of the diesase was not irrevoc-
ably poor, noting that almost complete remission was possible
in some instances, especially where a relatively sudden and
late onset occurred. Adolph Meyer (95) suggested that a
psychobiological approach to mental disease was more profit-
able than being bound to the "nosological obsession" of
premature classification. He advocated replacing the term
dementia praecox with schizophrenia, recognizing the trans-
itional forms of the disease, and adopting a conceptual
system which would allow for both constitutional and environ-
mental facts seen as interacting agents.

Excluding the traditional Kraepelinian categories,
the most popular criterion used in experimental studies

for the classification of schizophrenic patients has been

2A
that of prognosis. It has been observed for many years that
some patients have relatively severe, stormy and acute

I

schizophrenic "breaks,' while others develop the disease
at an early age and in an insidious manner. It has been
noted also that a startling correlation appears to exist
between stormy onset and good prognosis, while the patient F“

who undergoes a slow, gradual deterioration is much more

likely to have extremely poor chances of recovery.

 

The following variables have been listed by various

; 3‘:-

investigators as being associated with the poor prognosis '
groups: early insidious onset (33, 67, 86, 98, 1A3,1AA);

asethenic, dysplastic and pyknic body type (33, 77,90,98);

introverted personality prior to illness (33,59,66,67,90,

12A,1A6); inappropriate or dull affect (59,90); unmarried

status (90); absence of precipitating stress (90,12A); and

family history of schizophrenia (33,98).

Good prognosis has been found to be correlated with
the following factors: acute onset (23,33,67,90,98,12A);
precipitating stress (33,67,12A,127); better pre-illness
personality adjustment (59); neurotic and affective features
(33,87,90,9A,98,12A); married status (90); clouded sensorium
(23,59,66,67)s cyclothymic personality (90); catatonic
features (32,125); and short hospitalization (116,122).

Hoch (57) as early as 1921, described a few cases in

.II

which "spontaneous recoveries had occurred. These he

preferred to call "schizophrenic reactions" rather than

25
instances of dementia praecox, since the latter disease was
supposedly immune to remission. Harry Stack Sullivan (125),
writing in 192A, pointed out that at least some cases of
schizophrenia were not without hope of recovery, and that
this pertained to catatonic individuals especially. In 1928
he listed "tentative criteria for malignancy" in schizo-
phrenia,reiterating that not all cases have a poor prognosis

(126). His later formulations conceived of dementia praecox

 

as an "organic, degenerative disease" with insidious onset

 

and poor prognosis, but schizophrenia as primarily a "dis-

 

order of living" with an acute onset due to situational
stress. Prognosis here was seen as good (127).

Langfeldt (86) labeled the two groups "process" and
"schizophreniform." In a longitudinal study of 100 schizo-
phrenics over a period of six to ten years, he found re-
covery rates for the latter group to be much higher. In
later papers, he has preferred to speak of "indefinite"
schizophrenia as having a favorable prognosis, while "defi-

nite" schizophrenia does not (87).

Strecker and Wiley (12A), stated that "good affect"
was the best index of favorable prognosis in schizophrenia,
along with stormy onset and significant precipitating stress.
Strecker et 21 (123) in a more recent paper suggested that
the stormy onset represents "the struggle of the personality
against the acceptance of psychotic material." Cameron (30)

also came to the conclusion that two main groups of early

26
symptoms could be differentiated on the basis of type of
onset. Symptoms of hypoactivity appeared to be correlated
with insidious onset while hyperactivity was more charac-
teristic of the schizophrenic with a shorter pre-illness
history.

Wittman and Steinberg (1A3) studied the records of F“
A3A neuropsychiatric cases of all types. Of the 59 who ;
had histories of school referral problems, 35 were schizo-

phrenic and none were manic depressive. More than 50 per

 

cent of the schizophrenics in their sample had school 7
records, and were described in these as being "shut in"

personality types. The writers concluded that their study

provided objective verification of Meyer‘s concept of the

‘"shut in" personality type, a syndrome quite similar to

Langfeldt‘s "process" schizophrenic. Wittman theorized

that a personality continuum, in the form of a bell shaped

 

distribution, best described the situation. This continuum
ranged from "process" at one extreme to "manic-depressive"
at the other, with the categories "schizophrenic," "normal,"
and "hypomanic and depressive" being intermediate.
Phyllis Wittman (1A6) took 66 adult schizophrenics

who had been examined as children, and compared them to a
randomly selected control group of 66 schizophrenics with
no childhood referral record. She found that her experi-
mental group tended to have an insidious onset and little

or no improvement after shock treatment, while the controls

27
had a somewhat better recovery rate. She concluded that
Meyers concept of the "shut in" personality type did differ-
entiate the process from the schizophreniform and "thus
[had] diagnostic and prognostic significance."

Ausubel (3,A) preferred to label two distinct forms

I

of schizophrenia as "evolutionary" and "reactive,' explaining

them not in terms of possible organic factors, but in terms

a x ad'ffi‘l-‘l’!
'.

of ego deficiencies.

A series of studies has been carried out by Funkenstein

and his co-workers (AA,A5,A6,A7), who have sought to investi-
gate the relationship between physiological reactivity and
prognosis. They found that schizophrenic patients varied
in the degree of autonomic nervous system response when
given epinephrine and mecholyl. After forming seven sub-
groups on the basis of blood pressure and reestablishment
of homeostasis, it was found that subjects who showed
greatest reaction to the drugs had better recovery rates
after shock treatment. Low physiological reactivity was
most often related to little or no improvement after EST.
The writers concluded that their autonomic test was a better
prognostic indicator than the clinical diagnosis of the
patient. Confirmation of the relationship between prognosis
and autonomic reactivity has been reported by Hirschstein
(56) and Geocaris and Kociker (A9).

Experiments by Meadow and Funkenstein (92,93) sought

to investigate the relationship between autonomic reactivity

28
to the adrenergic and cholinergic drugs and the patient‘s
ability to think abstractly. Low reactivity groups were
most impaired when tested on block designs, proverbs, and
sorting tasks. From their findings they speculate that
since "it is well known that an impairment in abstraction

is also associated with organic brain disease,. . . the

similarity of the loss of abstract-ability in these patients
and in those with organic brain disease would suggest a

defect in the cortex."

‘9“ |'. w :3: I

Kantor, Wallner, and Winder (68) were the first to
label the process-reactive dichotomy as such, and study it
experimentally. A sample of 203 schizophrenics was sub-
divided into one of the categories or the other on the basis
of 22 case history criteria. Patients were then designated
as psychotic or non-psychotic according to their Rorschach
responses. Results indicated that individuals classified
as "reactive" from case history material tended to be
called non-psychotic from their Rorschachs. However, cases
judged to be "process" from their histories, tended to have
a greater number of psychotic-like responses on the test.
Kantor concluded from the study that it was legitimate to

classify schizophrenics as being either "process" or "re-

‘ and that there was evidence that the two groups

active,‘
differed as to their "psychological function characteris-
tics." Strong indications of reactive schizophrenia were

felt to be: (1) a "relatively normal" pre—psychotic

29
personality; (2) sudden onset with the presence of logical
precipitating facts; and (3) loss of a clear sensorium. The
process syndrome showed just the opposite characteristics.
Brackbill and Fine (27) administered Rorschachs to schizo-
phrenic patients classified as process and reactive, and to
a third group with "known central nervous system pathology."‘
Although it was impossible to differentiate the process
from the organic group on the basis of Rorschach indices
of brain damage, it was observed that both of these groups
had significantly more individuals with five or more of the
"organic signs" than did the reactive group. Brackbill and
Fine suggest therefore that "the difficulty in differential
diagnosis of some kinds of schizophrenics and organics
results from the involvement of central nervous system
pathology in process schizophrenia."

Devault (37), in an unpublished doctoral dissertation,
sought to link the Kantor findings with those of Funkenstein,
£3.31 (AA,A5,A6,A7). Eighteen process and 18 reactive
schizophrenics were chosen on the basis of pre—psychotic
personality, precipitating stress, type of onset and clin-
ical picture. A control group of 18 normals was used. All
three groups were presented with four pictures (one "neutral"
and three "conflict" situations representing hostility,
dependency and sex). Physiological measures taken on each
patient included base level and amplitude of heart rate,

galvanic skin response changes, and GSR arousal and recovery

 

30
time. An additional stimulus in the form of a loud bell
was preceded by a verbal warning. Devault found that re-
active schizophrenics responded in a fashion similar to
controls in amplitude of GSR and heart rate change, but that
they tended to a slower homeostatic recovery than process or
normal groups. Patients classified as process had lower #1
amplitude of GSR and the other two groups, and mean heart 3
rate changes were all negative and significantly different

from those of normals and reactives. Devault interpreted

 

these results as being "strong evidence for at least two '
polar types [of schizophrenics] with possible intermediate
mixtures."

The belief that schizophrenia may best be conceptu-
alized as being a continuum from "almost complete psycho-
genicity" to "almost complete organicity" at the other
extreme has been expounded by Bellak (13,1A) who considers
most cases as being mixtures of the two components in
varying degrees. Becker (11,12) also adheres to the con-
tinuum position. In recent experiments he criticizes the
usual dichotomous approach on the ground that there is
usually great overlap in the groups, not to mention Bellak's
evidence in favor of multiple causation, after reviewing
3,500 papers on schizophrenia. However, Becker prefers
to view his continuum not in terms of psychogenicity-
organicity, but rather as "levels of personality organi-

zation" with the process syndrome reflecting a "very

31
primitive undifferentiated personality structure, and the
reactive syndrome a more highly organized one." This, he
believes, is a more fruitful point of departure. In his
study, patients were classified by means of a prognostic
scale as being on a process-reactive continuum. Hypothe-

sizing that process schizophrenics would show more re-

“'5'

gressive and immature thinking than would reactives, he i
gave each subject a Rorschach and a proverbs test. Signi- A
ficant relationships between place on the continuum and
Rorschach "genetic" scores were obtained for both male and
female patients, but only for male subjects on the proverbs
task. The feasibility of the continuum approach was given
further support in two recent experiments by King (70).
This investigator was successful in predicting the patiends
autonomic responsiveness according to their relative posi-
tion on the process-reactive continuum. Subjects were rated
on the basis of case history criteria suggested by Kantor
et a1 (68) and, in addition, 22 cases were further rated
with high reliability on the Elgin Prognostic Scale of
Wittman (1AA,1A5). King reported that reactive schizo-
phrenics showed a significantly greater fall in blood pres-
sure level after mecholyl than did the more process patients,
and that a significant rank order correlation existed between
the degree of autonomic response and the subject's position
on the continuum.
The advantages of a classification system based on the

concepts of process andreactive schizophrenia appeared to be

32
be promising enough to this investigator to have encouraged
its use in the present experiment. The concepts seem to
have both practical and theoretical points in their favor,
since as Becker (11) notes, in the clinical situation it
may act as a better guide in treatment programs than tradi-

tional Kraepelinian diagnosis. They have the further

E
advantage of providing a possibly more exact psychiatric :
description than the presently used categories allow. As
far as psychological research is concerned, it may open the
way to additional insights into the etiology of schizo- i

 

phrenia, insights which may now be obscured by the use of

outmoded diagnostic labels in current experimentation.

THE PROBLEM

From the foregohig discussion of the literature,

several conclusions may be drawn with some justification.

If

With regard to critical flicker frequency in brain damaged
individuals, the overwhelming evidence seems to indicate
that brain damaged patients have significantly lower cff
thresholds than to non organic subjects. This has been sub-
stantially the finding with a wide variety of brain damage
diagnoses, and appears to be true of children as well as
adults. Exceptions apparently exist however when the
injury is fairly well confined to the frontal area, including
most cases of psychosurgery. Investigations using the
flicker fusion techniques with psychiatric patients of a
non brain damaged type have been fewer in number, and usually
much inferior to the brain damaged studies both in experi-
mental design and in the selection of experimental subjects.
However, evidence from the better controlled investigations
seems to suggest that in the case of schizophrenics, off is
significantly higher than with organic patients, and that
the former generally show flicker fusion thresholds within
the normal range.

Experiments with the Archimedes Spiral after effect
have been concerned largely with brain damage. Price and

Deabler's study showed extremely wide differences between

3A
brain damaged patients on the one hand and normal and mixed
psychiatric groups on the other (107). Studies subsequent
to this have been considerably less successful in repli-
cating their original findings although most have confirmed
the report that organics are inferior in some measure to

both normal and psychiatric patients in the perception of

 

I?
the after effect (A8,103). There is some evidence also, '
that schizophrenic patients are more variable in their
response than are normals and organics.

For the better part of a century, the search for %

organic correlates for schizophrenia has been of major con-
cern to a number of investigators in many branches of sci-
ence. Biologists, chemists, physiologists, psychologists
and neurologists have all sought to compile evidence that
would point to some specific materialistic factor as being
basic in the etiology of the disease. The results of these
studies have been rather unrewarding in the long run. But
the outstanding successes of 20th century science, especially
in the fields of physics and chemistry, when coupled with
the occasional suggestive finding in schizophrenia, combine
to keep alive the hope that the disorder, in the long run
like all other diseases, will prove to be basically organic
in nature.

Although many of the investigations involving the use
of schizophrenic patients as subjects are poorly designed

and lacking in adequate experimental controls, it is felt

by some (26,108) that the heterogeneity of the concept of
schizophrenia itself is the primary culprit in obscuring

any factors which otherwise might show themselves. As a
result, increasing experimentation has been done in at-
tempting to classify schizophrenics, not in terms of the
traditional Kraepelinian categories, but for example,
according to physiological responsiveness, constitutional
body types, estimate of prognosis, and responses to psycho-
logical tests. One of the most recent suggestions is to
classify patients in terms of a process-reactive dichotomy,
or on a continuum with these categories as end points on a
scale. Actually, this notion has had a rather long history,
and is really an outgrowth of much prior experimentation and
theorizing as to the nature of the disorder. Nevertheless,
recent studies based on a process-reactive formulation of
schizophrenia have resulted in some support for the specu-
lation that process schizophrenia may be of organic etiology,
while reactive forms may be due primarily to psychogenic
factors. If this were true, many of the inconsistent
findings in experiments using groups diagnosed simply as

I

'"schizophrenic,' would be attributable to the heterogeneous

nature of the concept.

Definitions

 

A process schizophrenic, for the purposes of this

 

study, is an individual who has been given a clinical

36
diagnosis of schizophrenia by the hospital staff and who,
on the basis of his Elgin Prognostic Scale score (from a
total of 76 schizophrenics) has been ranked among the top
20 subjects at the "high" end of the continuum. A person
fitting this category could best be described as having an
early and insidious onset of psychosis with an absence of
precipitating stress, an inadequate prepsychotic personality
with a tendency to withdraw from all human contacts, and
presenting clinical symptoms showing a flat or dull affect

and a relative absence of confusion.

A reactive schizophrenic is defined in this study as

 

a person with a hospital diagnosis of schizophrenia and who,
on the basis of his Elgin Score, has been ranked among the
lowest 20 individuals in the entire schizophrenic sample

(N = 76). A typical reactive patient is one with a rela-
tively abrupt and stormy onset of psychosis, usually attri-
butable to a logical and significant stress situation. The
pre illness personality may be described as normal or
neurotic, rather than schizoid, with perhaps some degree

of outgoingness present. The clinical picture is likely

to include severe confusion and many affective components.

Purpose of the Investigation

 

The present study was undertaken in an attempt to:
1. Gain further knowledge concerning the etiology of
schizophrenia with emphasis on a possible relationship be-

tween it and central nervous system pathology.

37
2. Obtain additional evidence for the validity and
practicability of the concepts process and reactive schizo-
phrenia, particularly with regard to a continuum approach.
3. Secure additional data relative to the performance
of brain damaged, normal, and schizophrenic subjects with
critical flicker frequency and the Archimedes Spiral after-
effect, and in particular check on the effectiveness of the

latter as a diagnostic technique in organicity.

Hypotheses

 

The following hypotheses were formulated:

1. Brain damage individuals will have lower mean cff
thresholds than normal controls.

2. Patients rated as process schizophrenics will have
a lower mean cff threshold than will reactive
schizophrenics, and this score will tend to ap-
proach the score of brain damaged subjects, i.e.
fall between reactive and organic patients.

3. Patients rated as reactive schizophrenics will
perceive fusion at levels close to, or not signif-
icantly different from normal subjects.

A. Brain damaged individuals will perceive the after-
effect of the Archimedes Spiral less often than
normal controls.

5. Patients rated as process schizophrenics will not
perceive the spiral aftereffect as often as

normals and reactive schizophrenics.

METHODOLOGY

Apparatus

 

Two pieces of apparatus were used in the experiment.

1. The Archimedes Spiral was made from a cardboard

 

disc, off-white in color, and eight inches in diameter. A
black India ink stripe, one-half inch wide, was painted on
the cardboard so that it made one and three quarter turns
from the center until it tapered completely off the outside
edge of the disc. The spiral was mounted on a Stoelting
color wheel whose speed was calibrated at the beginning of
each morning and afternoon testing session, and set at

100 rpm's. The apparatus permitted rotation in one direction
only. When rotated, an illusion of the disc contracting,

or drawing into the center, was created in the typical
viewer. On stopping the disc suddenly, the "normal" experi-
ence was to perceive the spiral as expanding.

2. Critical Flicker Frequency was produced by means

 

of an episcotister. The apparatus consisted of a rectang-
ular box, 2A inches wide, 16 inches high, and 10 inches deep
which was open at the back permitting the experimenter to
manipulate the necessary controls. It was painted a flat
black color, both inside and out, in order to keep reflected
light at a minimum. A black cardboard shield, 8 x 10-1/2

inches, was mounted on an arm extending 1A-1/2 inches from

39
the front of the box. A "peep-sight," 3/8ths of an inch
wide, was bored in the middle of the cardboard from which
the subject viewed the flickering light monocularly. The
cardboard was wide enough that monocular viewing was assured
even while both of the subject‘s eyes were kept open. The
test patch or target consisted of a circular aperture 5/8ths
of an inch in diameter, cut into the fact of the box. Visual
angle of the target was lag’degrees. The light source was
an ordinary A0 watt frosted bulb which was housed in a small
box inside the apparatus. A small hole was cut in the lamp
housing which allowed a beam of light to escape in the
direction of the test patch. Three pieces of milk glass
were placed between the bulb and the target: one directly
in front of the bulb on the inside of the lamp housing box;
one against the outside of the housing box; and a third
placed immediately behind the target aperture. Intensity of
the test patch was .085 candles per square foot, as measured
by a Macbeth Illuminometer. A shutter panel which could be
raised and lowered over the target aperture, allowed the
experimenter to cut off the stimulus immediately at the end
of each flicker trial.

Power for the episcotister was supplied by a Cenco
Stirrer, a 115 volt, 60 cycle motor (type NS 1-12), built
by the Central Scientific Company of Chicago. A light-
weight, black cardboard disc was mounted on the motor, and

fixed so that it cut across the beam of light at a point

between the front panel of the apparatus and the lamp
housing. Four equal sized sectors were cut in the disc in
a manner to produce a light dark ratio (LDR) of 1.0. An
ordinary automobile speedometer was used to measure the
speed of the spinning disc. This was set to one side of
the motor and driven by a rubber machine belt. Dial illu-
mination was provided by a 7-1/2 watt white bulb, shielded
in such a way that only enough light to read the speedometer
was emitted. Calibration of the speedometer was done by
means of a Strobotac and proved to be linear (1 mph = .5663
cps). The rate of rotation for the disc was controlled
manually by the experimenter by turning a small knob on

tune motor. The speed of the motor at its slowest was 15
mph, at which a very marked flicker was produced. In a two
day session prior to beginning the experiment, a voltage
regulator indicated that voltages were approximately con-
stant during the hours in which the experiment was to be

PUD.

Subjects

Eighty hospitalized male veterans between 19 and A5
years of age made up the sample for this experiment (Table
I). All subjects with extremely poor visual acuity or
structural defects in both eyes were eliminated. However,
patients with defects in one eye only, were retained in the
group. The subjects in all groups were naive as to the

real purpose of the experiment, having been told only that

TABLE I

CHARACTERISTICS OF SAMPLE

A1

 

 

 

Organic Normal Process Reactive

Number of cases 20 20 20 20
Age

Mean 35.20 31.15 26.25 33.60

S.D. 6.56 6.06 2.51 5.68
Education

(grade completed)

Mean 9.85 10.70 10.75 10.85

S.D. 2.76 2.A5 2.20 1.31
Race

Negro 8 8 A 5

White 12 l2 l6 15
Marital Status

Single 8 8 18 7

Married 5 11 1 11

Divorced 7 1 l 2

 

 

A2
they were to undergo two "special eye tests." Occasionally
it was found that a patient who had been accepted for
testing was so incapacitated or in such a confused (i.e.
psychotic) state that he was unable to follow the fairly
complicated instructions. This occurred with four organic
patients, all of whom were eliminated from the experiment.
In the schizophrenic group, although a good percentage
actively hallucinated in the test room, only one proved
to be totally unable to carry out the task as directed.
However, among the A0 schizophrenics whose extreme Elgin
scores qualified them for inclusion in either the process
or reactive group, a total of four were not used in the
experiment. Two patients in the reactive classification
left the hospital before they could be tested. In the
process group, one patient was transferred and the other
was the above mentioned individual who was too confused to
follow the experimental procedure. Selection of the ex-
perimental subjects was continued, however, until a total
of 20 persons was obtained for each of the four groups.

In the case of the process and reactive samples, the next
two ranked patients on either end of the continuum were

substituted for the patients who were dropped (Table II).

Group I. Organics. This group consisted of 20 in-
dividuals with known brain damage, who were chosen on the
basis of their diagnosis (as determined by neurological

findings of the medical staff), their case history material,

TABLE II

CLASSIFICATION OF 76 SCHIZOPHRENIC PATIENTS
ACCORDING TO ELGIN PROGNOSTIC SCALE SCORES

 

 

Rater #1 Rater #2

 

Elgin Elgin Average Score Classification

Patient Score Score for 2 Raters or Disposition
1. HG 17 19 18 Reactive R-l)
2. SV 29 23 26 Reactive R-2)
3. PC 25 29 27 Reactive R-3)
A. PJ 30 26 28 Reactive R-A)
5. KG 28 3o 29 Reactive R-5)
6. HD 32 27 29.5 Reactive R-6)
7. HF 32 29 30.5 Reactive R—7)
8. MJ 3A 27 30.5 Reactive R-8)
9. SJ 28 33 30.5 Reactive R-9)

10. AR 3O 32 31 Reactive R-lO)

ll. KJ 35 27 31 Reactive R-ll)

12. BA 3A 32 33 Reactive R—l2)

13. CL 32 37 3A.5 Reactive R-13)

1A. NR 37 3A 35.5 Reactive R-lA)

l5. HJ 30 A3 36.5 Reactive R-15)

16. RC 39 3A 36.5 (AWOL)

17. DC 33 Al 37 Reactive R—l6)

18. AD 38 37 37.5 Reactive R-l7)

19. GW 37 39 38 Reactive R-l8)

20. PR 39 37 38 Reactive R-l9)

21. FD 28 A8 38 (Discharged)

22. MG A0 37 38.5 Reactive (R-20)

23. CL 38 39 33.5 Middle Group(Not Used)

2 . MI 2 .5 "

25. MG A2 39 Ao.5 "

26. BR A5 37 A1 "

27. UP 39 AA Al.5 "

28. so 36 A7 A1.5 "

29. MJ A6 A0 A3 "

30. CS A1 A6 A3.5 "

31- RJ 55 32 A35 "

32. TL A7 A1 AA "

33. PR AA A5 AA.5 "

3A. BA AA A5 AA.5 "

35. NF 50 A0 A5 "

36. ww A9 A1 A5 "

37. DD 51 A2 A6.5 "

38. UG AA 50 A7 "

39. we A6 A8 A7 "

 

AA

TABLE 11 (continued)

 

fi fi

Rater #1 Rater #2

 

 

Elgin Elgin Average Score Classification
Patient Score Score for 2 Raters or Disposition
A0. WR A5 A9 A7 'Middle Group(Not Used)
A1. IH A7 A8 A7.5 "
A2. BJ A8 A8 A8 "
A3. KB A3 53 A8 "
AA. GJ 55 A3 A9 "
A5. HH A9 A9 A9 "
A6. KS 55 A3 A9 "
A7. BD 55 A5 50 "
A8. HC 52 A8 50 "
A9. FW A9 5A 51.5 "
50. SL 52 53 52.5 "
51. NP 58 A8 53 "
52. KG 5A 53 53.5 "
53. EM 53 55 5LI "
5A. SJ 5o 58 5A "
55. DJ 52 57 5A.5 Process P-2O
56. PJ 56 5A 55 Process P-l9)
57. PL 56 5A 55 Process P-18)
58. LN 52 58 55 Process P- ~17)
59. RW 50 6O 55 Transferred)
60. BD 56 55 55.5 Too confused;
61. WJ 52 59 55.5 Process -16
62. SE 56 57 56.5 Process P- -15)
63. LR 60 55 57.5 Process P-lA
6A. MW 60 56 58 Process P- 13
65. GR 58 58 58 Process P-l2
66. HS 57 59 58 Process P-ll
67. RG 57 61 59 Process P-lO)
68. ZB 63 55 59 Process P-9
69. BK 55 65 60 Process P-8
70. EN 62 58 60 Process P-7
71. DW 61 60 60.5 Process P-6
72. KC 59 62 60.5 Process P-5
73. RL 62 59 60.5 Process P-A
7A. HJ 58 67 62.5 Process P-3
75. MJ 63 6A 63.5 Process P-2
76. LE 61 66 63.5 Process P-l)

 

fi fifi J

A5
and their presenting symptomatology. An effort to control
for age factors (by not considering any individual over A5
for inclusion in any of the groups) severely restricted the
number of brain damaged patients that were available at the
Veterans Administration neuropsychiatric hospital where the
bulk of the experimental data was collected. Over an 11
month period, only 1A patients could qualify for inclusion
in this group. For this reason, the remaining six organic
subjects were taken from the population of a general medical
and surgical (GM & S) hospital of the Veterans Administration.
The organic group ranged in age from 23 to A5 years with a
mean age of 35.2. It consisted of eight Negroes and 12
whites, of whom five were married, seven divorced, and eight
unmarried. Mean educational level was 9.35 years. Diagnoses
included three multiple sclerosis; six brain trauma; four
brain tumor; three Huntington's Chorea; two Parkinson's
disease; one cerebrovascular accident; and one intercranial

infection case.

Group III. "Normal" Controls. This group was made up

 

 

of 20 individuals from two surgical wards of the GM & S
hospital. It included every man in the two wards who was
under A5 years of age and who had neither a history of
emotional difficulties necessitating hospitalization or out
patient treatment, nor a past record of head injury or long
period of unconsciousness. Each patient was a volunteer

since hospital rules required that subjects give their

A6
permission prior to testing. The patients were naive as to
the purposes of the experiment however, since they were told
only that they were to undergo an eye examination which
would be compared with similar examinations done on mental
patients at another VA hospital. Only one patient who was
asked to volunteer, refused. This normal control group
ranged in age from 21 to A3 years with a mean age of 31.15.
It consisted of eight Negroes and 12 whites, of whom 11 were
married, one divorced and eight Single. Mean educational
level was 10.7 years. All patients in the group were
hospitalized for medical-surgical reasons, and diagnoses
included varicose veins, appendicitis, torn cartilage,
hemorrhoids, sacroiliac strain, and post operative foot,
wrist, and hip cases.

The third and fourth groups were made up of patients
diagnosed as schizophrenic. All of these individuals were
chosen from patients assigned to the Acute and Intensive
Treatment Service of the NP hospital. One hundred and sixty-
one schizophrenic case histories were examined. From these,
a total of 76 were chosen on the basis of their having a
case folder with sufficient material to allow rating; no
evidence, either behaviorally or from the record, of any
head injury or long period of unconsciousness; a present
hospitalization of not more than one year; a history free
of repeated hospitalization over the past ten or 12 years

for neuropsychiatric reasons; and definite evidence from

A7
the history of the presence of gross schizophrenic sympto-
matology, e.g. hallucinations, delusions, ideas of reference,
and bizarre behavior. A brief description of the two schizo-

phrenic groups follows.

Group III. Process_Schizophrenics. This group of 20

 

individuals ranged in age from 19 to 36 years with a mean
age of 26.25. It consisted of four Negroes and 16 whites,
of whom only one was married, one divorced, and 18 single.
Mean educational level was 10.75 years. Diagnoses included
16 schizophrenic reactions of the unclassified type, three

paranoid type, and one catatonic type (Table III).

Group IV. Reactive Schizophrenics. These 20 patients

 

ranged in age from 25 to AA years with a mean age of 33.6
years. The group consisted of five Negroes and 15 whites,
of whom 11 were married, two divorced and seven unmarried.
Mean educational level was 10.85 years. Diagnoses included
13 schizophrenic reactions unclassified type, three paranoid
type, two catatonic type, and two schizo-affective type
(Table III).

An examination of the characteristics of the four
groups (Table I) discloses that there were no differences
between the groups in terms of level of education. However,
since variances for the four groups were heterogeneous, a
nonparametric test of significance was in order. The
Kruskal-Wallis H test, using ranked data, was computed and

found to be not Significant (Table IV).

A8

TABLE III

OFFICIAL HOSPITAL DIAGNOSIS OF SCHIZOPHRENIC PATIENTS
RATED IN THIS STUDY AS PROCESS AND REACTIVE

 

 

 

 

 

 

 

 

% of % of
Diagnosis Process Total Reactive Total
Schizophrenic 16 80 13 65
reaction,
unclassified type
Schizophrenic 3 l5 3 l5
reaction,
paranoid type
Schizophrenic l 5 2 10
reaction,
catatonic type
Schizophrenic O O 2 10
reaction,
schizo-affective
type ‘
Total 20 100 20 100
TABLE IV

KRUSKAL-WALLIS H TEST FOR MEAN EDUCATION LEVEL
DIFFERENCES BETWEEN GROUPS

 

 

Organic Normal Process Reactive
Mean grades
completed
(in years) 9.85 10.70 10.75 10.85
Sum of Ranks 700.5 808.5 8A5.0 856.5

 

H(l) = 3.10 (df = 3) Not significant.
(1) H is distributed approximately as Chi Square with df=k-l.

A9

The same test of significance was applied to the mean
ages for the four groups since again it was noted that homo-
geneity of variance was not present. In this case, a very
significant H value was obtained, indicating that the four
groups were different (Table V). A further analysis by
means of another nonparametric technique, the Mann-Whitney
U test, showed significant differences between various com-
binations of the groups when compared two at a time (Table
VI). Process schizophrenics as a group were significantly
younger than each of the other three groups. This finding
may be accounted for in part by the very nature of the con-
cept of process schizophrenia which is typically of "early,
insidious onset." In addition, the selection device used
(i.e. the Elgin Scale) reflects the younger age of process
schizophrenics in Item B (Appendix). The inclusion of older
process schizophrenics in the same sample which would have
tended to equate this age factor, was impossible since
length of current hospitalization was held to a maximum of
one year. The only other Significant difference between
any two groups in terms of mean age level, occurred between
organics and normals (.05 level). This is somewhat harder
to account for. It may possibly be explained as due to the
fact that organic subjects were not restricted to a maximum
of one year's hospitalization Since extreme difficulty was
encountered in obtaining brain damaged patients for the

experiment. In addition, the progressive nature of the

50.

TABLE V

KRUSKAL-WALLIS H TEST FOR MEAN AGE
DIFFERENCES BETWEEN GROUPS

 

 

 

Organic Normal Process Reactive
Mean age
(in years) 35.20 31.15 26.25 33.60
Sum of Ranks 1051.5 782.0 AAA.o

953.5

 

‘7‘

H(1) = 18.A5** (df = 3)
** significant at the .001 level (two tail test)
(1) H is distributed approximately as Chi Square with dfzk-l.

TABLE VI

MANN-WHITNEY U TEST FOR MEAN AGE DIFFERENCES
BETWEEN PAIRED GROUPS

 

 

 

Mean Mean Sum of’ sum of
Age Age Ranks Ranks
lst 2nd lst 2nd
Groups Group Group Group Group U z
Organic vs
Normal 35.20 31.15 A80.0 337.5 272.5 1.96*
Organic vs
Process 35.20 26.25 552.5 265.0 3A5.0 3.93***
Organic vs
Reactive 35.20 33.60 A39.0 381.0 229.0 .78
Normal vs
Process 31.15 26.25 500.5 317.0 293.0 2.52*
Normal vs
Reactive 31.15 33.60 362.5 A53.5 2A7.5 1.29
Process vs
Reactive 26.25 33.60 275.0 5A3.5

335.0

.3.66**

 

* significant at the .05 level two tail test
** significant at the .01 level two tail test
*** significant at the .0001 level (two tail test)

51
pathology in some of the organic cases (e.g. multiple scler-
osis, Huntington's Chorea) meant that patients with such
diseases were generally able to remain out of the hospital
until somewhat later in life. However, as was stated pre-
viously, no subjects in the experiment, including brain
damaged, were allowed to exceed A5 years of age.

Relative to marital status (Table I), it may be noted
that 90 per cent of the process group had never married
while only A0 per cent of the organics and normals, and 35
per cent of the reactive schizophrenics had never married.
Again, the large proportion of single individuals in the
process group is tied closely to the concept itself. This
is reflected in the Elgin Scale in Items A, D, and I (Appen-
dix).

In the organic group, the highest incidence of divorce
(58 per cent of those married) deserves some comment. In
most cases, the divorce took place after the veteran‘s
illness or accident occurred. From this it may be inferred
that the divorce was attributable, at least in part, to

the presence of the disability itself.

Classification of Schizophrenic Patients on a Process-

 

Reactive Continuum

 

As has been mentioned previously, although most inves-
tigators at first conceived of process and reactive schizo-
phrenia as a dichotomy, recent investigations have shown an

inclination toward using a continuum approach. It would

52
appear that the concept of a continuum has a number of ad-
vantages. In the first place, it would seem to best fit
clinical observations since it is rare to find a case of
schizophrenia where the history and symptomatology com-
pletely fall within the usual criteria for one classifi-
cation as opposed to the other. Second, the idea of a
continuum would appear to adapt itself well to a greater
number of theoretical considerations than would a dichtomous
approach. The theory, for example, could be along the lines
of Bellak's (1A) psychogenicity-organicity concept, or a
purely psychological one such as Becker‘s (12), or again
in terms of psychobiological interaction as suggested by
Meyer (95,120). In the third place, the continuum is better
suited for experimental purposes than is the dichotomy.
Because of the relatively crude nature of our measuring
instruments (e.g. the prognostic scales), a great deal of
overlap occurs between the two groups. A continuum permits
the use of many patients who would rightfully fall in the
middle or mixed category. At the same time, it avoids a
‘"forced" choice situation where borderline individuals
must be placed in one group or the other, thereby increasing
the chances of obscuring the results.

After deciding on the use of a process-reactive con—
tinuum in rating our schizophrenics, the next step was to
choose a method of doing so. Becker's (ll) revision of

the Elgin Prognostic Scale was employed to rate the 76

53
schizophrenic patients originally selected. The Elgin Scale

was devised and first used by Wittman (1AA) at the state
hospital of the same name. Becker's revision (see Appendix)
consists of 20 statements, each subdivided into a number of
items describing more or less specifically, the degree to
which the statement is applicable to the person being rated.
Each of these sub items is assigned a numerical value.
Whereas Wittman used only end points to rate each statement,
Becker added the intermediate values in order to "add to the
precision in rating" (11). In the present study, ratings on
each of the 76 patients was done by two advanced clinical
psychology trainees, one of whom was the writer. Prior to
rating, ten case histories were chosen at random from the
rejected cases and rated by each trainee. The results were
compared and discussed in detail and by this means a con-
siderable amount of agreement was reached as to what each
sub item meant subjectively to each rater. Rating then
began on the 76 case histories and was continued for a period
of approximately six months as they became available. The
raters' individual point scores for each subject are shown
in Table II along with the average point score for both
raters combined. A Pearson product moment correlation co-
efficient of .893 was found to exist between the two sets of
ratings. This is significant at the .01 per cent level of
confidence. The 76 cases were then ranked on a continuum,
and the resulting distribution appeared unimodal and easen-

tially normal in shape (Figure 1). The 20 patients

5A

mfimocmogm poem mfimocwopm Boom
mora.ow .owna.mm mmua.om omIH.m: meta.o:_ oqua.mm mmua.om Omua.mm mmna.om omna.ma

 

x x x x x x x x x
x x x x x x x x
x x x x x x x x
x x a x x x x x
x x x x x x x x
x x x a x a x

x x x x x x

x x x x x

x x x x x

x x a x x

x x x a x noonQSm A n x

Benz
a x
A ")

 

 

 

mpcmfipmm oacmgndonanom
we now mopoom eowmpm>< mamom QHDmocwogm QHme mo coaudnfigumfim .H opswam

55

receiving the lowest point totals were then selected as

being most "process,' and in a similar fashion, the 20
patients at the upper end of the distribution were chosen
as being most "reactive" (Table II).

The decision to use Becker‘s modification of the Elgin
Scale was arrived at after a consideration of possible ad-
vantages and disadvantages connected with the instrument.
Disadvantages included certain violations of good scale con-
struction (e.g. different ranges in sub scale numerical
values from item to item), and probably unequal discrimin-
atory ability along the entire length of the scale. Beckers
(11) own criticism (i.e. that the scale is curtailed and not
discriminating enough at the "normal" end), was thought to
be a justified one. However, the advantages seemed to out-
weigh the disadvantages. In the first place, the method of
selection used by Kantor gt gt (68) seemed less appropriate
in a continuum frame of reference. Also, Wittman's original
use of the scale (1AA) showed a very high two-rater reli-
ability of .87. Subsequent validity studies by the same
and other investigators (70, 1A5) showed the scale capable
of predicting prognosis in a large percentage of the cases.
Becker's modification (i.e. a numerical, weighted scale
value for each of the 20 criteria) seemed to offer an even
greater degree of exactness in the ratings, and at the same
time permit a grading along the entire length of the con-

tinuum.

56

Procedure

 

The experiment was conducted in a room nine feet by
12 feet in which the sole illumination came from a 150 watt
bulb directly in the center of the ceiling, 12 feet above
floor level. A heavy canvas "blackout" curtain totally
eliminated all light from the room's only window. All
testing was done by a Single experimenter (the writer) be-
tween the hours of 9:00 A.M. and A:OO P.M. Subjects in all
four groups were tested at various hours of the day in an
effort to randomize the effects of time of day on off.

Both the Archimedes Spiral apparatus and the episco-
tister were placed on a standard size office desk which
served as the experimental table. In the case of the
episcotister, a small wooden stand supported the box,
raising the target aperture to eye level. Each subject was
tested on the Archimedes Spiral first, followed immediately

by the off trials.

Procedure for the administration of the Archimedes

 

Spiral. Each subject was seated at a distance of eight feet
from the face of the spiral, and with the room under ordin-
ary illumination. The experimenter, while pointing to the
spiral, asked the subject to describe the color, shape, and
design of what he saw. This was done in order to get an
additional estimate of the visual acuity and degree of con-
fusion in the patient. The experimenter then proceeded

with the following instructions, after those of Gallese(A8).

57
"This is a Special eye test. Look at the center black spot
and don‘t take your eyes away until I tell you to." After
the disc had been rotating for ten seconds, the experimenter
reminding the subject to keep staring at the center, asked
"What does it appear to be doing?". If the patientb answer
indicated that he saw contraction of the disc, no further
questions were asked. If this did not elicit the correct
response, the experimenter then said, "Does it seem to be
changing in any way?" If this also was unsuccessful in
bringing forth the correct answer, the experimenter asked
the final question. "Does it seem to be getting bigger,
smaller, or going away from you, or coming toward you, or
anything else?" The subject‘s response was then recorded.
At this point, the patient was again reminded to keep his
eyes on the rotating Spiral. At the end of 30 seconds of
rotation the disc was stopped abruptly. The patient was
then asked, "Now what does it appear to be doing?" A
scoring system similar to that of Price and Deabler (107)
was used in recording the subject's response. If his answer
suggested that he perceived the aftereffect, he was given
a score of one. If he did not report the illusion of expan-
sion, a score of zero was recorded. In cases where the
examiner was uncertain as to the subject's answer, a score
of one-half was given for the trial. Four 30 second trials
were administered to each subject with a one minute interval

between each trial. The patient‘s final score was based on

58
all four trials. A point of total of four therefore, would
represent perception of the aftereffect on each trial,
while a score of zero would indicate that he had failed to

perceive the effect on any one of his trials.

Procedure followed ig_obtaining Critical Flicker

 

Frequency. Immediately on completion of his fourth Archi-

 

medes Trial, the patient was asked to take a chair in front
of the episcotister where he could view the flicker target
through the peepsight. The following directions were then
read to him. "This is another special eye test. In order
for you to make a good score on this eye test it is very
important that you follow my instructions carefully. Please
keep your head from moving and do not blink your eyes. Face
the box directly. Look through the peepsight with your best
eye, and keep both eyes open at all times." (The patient
was then checked as to his viewing technique, and this was
corrected if necessary.) "The Spot you see there (experi-
menter points to test patch) is going to flicker off and on.
I am going to turn out the lights in the room and, after
about a minute, you will see the flickering light in front

of you. Stare gt tt steadily ggd don't blink. After a

 

little while the light will no longer appear to be flickering.
Instead, as you stare at it, it will gradually appear to be-
come a steady light. 5g soon gg_tt looks gg thoggh 12.22.22

longer flickering, you say NOW! . . . and I will turn if off.

 

 

Then we will do exactly the same thing over again for a few

59
times. Do you understand? (The main instructions were again
repeated rapidly.) Remember, keep your head still, stare

directly at the light, and don't blink."

 

The overhead light was then turned off and the only
illumination came from the well—shielded 7-1/2 watt bulb in
the rear of the apparatus which permitted dial readings.
After one minute of dark adaptation, the shutter which
covered the target was raised, allowing the subject to view
the test patch. After ascertaining that he saw the flick-
ering light, and that he was holding his head in the correct
position, the experimenter manually increased the speed of
the disc (at approximately one mph per secondl) until the
subject reported the appearance of a steady light. A total
of ten successive ascending trials were taken with about 30
seconds between each trial. In order to control for possible
auditory cues arising from the episcotister, an electric fan,
placed adjacent to the flicker appratus, was used to mask
the sound of the motor. This was done quite effectively by
placing a small piece of cardboard on the fan in such a way
that the blades would strike it, creating a rather loud,
clattering noise. A regular sequence of varied starting
speeds was used. The first trial opened at a dial reading

of 15 mph. The remaining trials began as follows: Trial

#2—-2O mph; #3--25 mph; #A--2O mph; #5--25 mph; #6—-25 mph;

 

1Thus, for example, if the flicker trial was begun at
a dial reading of 20 mph, and the S indicated fusion at a
dial reading of 30 mph, a period of about 10 seconds would

have elapsed.

60
#7-—2o mph; #8--25 mph; #9--15 mph; and #1o--2o mph. In
this way it was hoped that, since a constant rate of accel-
eration was maintained, the patient would be unable to use
subjective time cues in judging fusion without it becoming
known to the examiner. After considerable practice the
experimenter considered himself capable of reading the
speedometer within one-quarter of a mile per hour at the
instant when the subject reported that he perceived a steady
light. In many cases where the examiner was unsure as to
the realibility of the subject‘s reports, additional readings
were given in the following manner, as a check. Various
levels of flicker were set in a random fashion below, above
and at the point of fusion. When the shutter was raised,
revealing the test patch, the subject was instructed to

report immediately whether it was flickering or steady. As

 

many trials were administered as was felt necessary, in
order to obtain an accurate estimate of the individual‘s

fusion threshold.

Statistical Treatment

 

Critical Flicker Frequency. Of the 10 flicker trials

 

on each subject, only the last seven were used in deter-
mining the mean score for each individual. The first three
trials were omitted as practice trials after the observation
that in the majority of cases, subjects used only in

pilot experimentation were unable to report fusion thresholds

61
on initial trials with full accuracy because of the novelty
of the task. On the basis of the last seven trials mean
flicker scores and standard deviations were computed for all
80 patients (Table VII). Generally, it was found that the
subjects were quite reliable in their reporting of fusion
as an examination of the individual S.D.‘s will Show. Only
12 subjects of a total of 80 (i.e. 15 per cent of the entire
sample) had a flicker S.D. exceeding three quarters of a
cycle per second, while only one subject had a S.D. of more
than one cps.

The original design of the experiment called for a
statistical treatment of the data by the analysis of variance
technique. Specifically, an analysis of variance involving
repeated measures on each individual (df =559) was to be
done. However, when mean cff scores and their variances
were computed for each of the diagnostic groups (Table VII),
it was noted that the variances between groups were quite
dissimilar. A Hartley F max test (136) revealed that
\ariances differed significantly between the four groups
Table VIII). Since one of the assumptions of the F test
was not met, namely that of homogeneity of variance, another
method of analyzing the data had to be found. It was de-
cided that a nonparametric technique which did not rest on
the assumption of homogeneous variances between groups,
would be preferable. The Kruskal-Wallis H test (119), a

nonparametric test analogous to the F test for more than

62
two groups, was selected. The H test involved ranking of
all subjects in the sample, regardless of group, according
to their mean flicker scores with a corection for tied
scores applied to the formula. Siegel (119) is of the
opinion that the Kruskal-Wallis test is the most efficient
nonparametric test for more than two independent samples,
with a power efficiency of 95.5 as compared to the most
powerful parametric test, the F test.

In order to get at possible differences in means
between various combinations of the four diagnostic groups
compared two at a time, another nonparametric test of in—
dependent samples was used. The test decided upon was the
Mann-Whitney U test, which like the Kruskal-Wallis, makes
no assumption relative to the homogeneity of the variances
for the two groups involved. The U test requires that the
mean scores for the A0 individuals being compared (1. e. 20
subjects in each of the groups) be ranked, with the person
obtaining the lowest flicker score given the rank of one,
and so on until all A0 are ranked as a single group. A cor-
rection for tied ranks is applied in this case also. Siegel
states that in instances where the Mann-Whitney is used
properly, its power efficiency is close to 95 per cent of
that of the t test, "the most powerful parametric test [for
two groups]. It is therefore an excellent alternative to
the t test, and, of course, it does have the restrictive

assumptions and requirements associated with the t test."

63
He states further that instances have been reported in the
literature in which the U test is superior to its parametric
alternative in rejecting the null hypothesis (119).

To determine the relationship between any schizoph-
renic's rank according to his rating on the Elgin Scale
and his rank on cff, Kendall's tgg or correlation coeffici-
ent was computed. Lastly, the discriminability of cff
scores for the brain damaged group as opposed to the other
three groups was determined and discrimination indices re-
ported in percentages (Table XV). Finally, in view of the
fact that the hypotheses of this investigation were not
based on extremely well established theoretical grounds, it
was decided that all levels of Significance would be deter-

mined on the basis of two tailed tests.

Archimedes Spiral. Individual spiral aftereffect

 

scores were determined on the basis of scoring system devised
by Price and Deabler (107), a method which is comparable to
other recent studies done with this technique (3A,A8).
Individual scores are reported in Table XVI. Chi Square

was used to compare the organics with the other groups.

RESULTS

Critical Flicker Frequency

 

Mean cff scores together with variances for each of
the four groups are summarized in Table VIII. Group means
in cycles per second were as follows: organics 13.20;
normals 16.38; process schizophrenics 16.A3; and reactive
schizophrenics 16.67. However, a Hartley F max test (136)
revealed that variances for the groups could not be consid-
ered homogeneous, thus necessitating the use of nonparametric
tests of significance. The mean cff scores for each individ-
ual were then ranked (Table IX). A Kruskal-Wallis H value,
significant at the .001 level of confidence was obtained,
indicating that the four groups differed in mean flicker
threshold beyond chance expectations (Table X). In order to
discover exactly where the differences existed, Mann—Whitney
U tests were run between all combinations of the groups in
pairs. Table XI summarizes these results. It was found
that the organic group differed very significantly (.0001)
from gt; of the other groups. A significant difference in
flicker fusion mean scores at the .05 level was also found
to exist between normals and reactive Schizophrenics.

Hypothesis 1. Brain damaged individuals will

have lower mean cff thresholds than normal
controls.

 

65

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m>Hpommm mmooogm HmEpoz cacmwpo

 

HmmHQZMDGmmm KMMoHdm HdOHBHmo Z<m2 Q<DQH>HQZH

HH> mum<8

TABLE VIII

MEAN CRITICAL FLICKER FREQUENCIES FOR ALL GROUPS AND
HARTLEY F MAX TEST FOR HOMOGENEITY OF VARIANCE

 

 

Organic Normal Process Reactive
Mean 13.20 16.38 16.A3 16.67
Variance 2.30 .26 .73 .9A
F max 2.3O = 8.81** df h l
77725" ’ 9

 

 

** Significant at the .01 level.

TABLE IX

INDIVIDUAL MEAN CFF RANKS

 

 

Organic Normal Process Reactive

 

1.0 26.0 21.0 16.0
2.0 27.0 23.0 17.0
3.0 28.0 2A.0 37.5
A.o 30.5 25.0 Ao.0
5.0 3A.0 29.0 AA.5
6.0 35.0 30.5 A7.0
7.0 37.5 32.0 50.0
8.0 39.0 33.0 52.0
9.5 A2.0 36.0 53.0
9.5 AA.5 A1.0 57.0
11.0 AA.5 A8.5 58.0
12.0 AA.5 5A.o 62.0
13.0 A8.5 55.5 67.5
1A.o 51.0 61.0 67.5
15.0 55.5 65.0 67.5
18.0 59.0 67.5 70.0
19.0 60.0 73.0 72.0
20.0 6A.0 75.0 77.0
22.0 71.0 76.0 79.0
63.0 7A.0 78.0 80.0
Sum of

Ranks 262.0 915.5 9A7.5 1115.0

 

TABLE X

KRUSKAL-WALLIS H TEST FOR MEAN CFF DIFFERENCES
BETWEEN GROUPS

 

 

 

 

 

 

 

Organic Normal Process Reactive

Mean off 13.20 16.38 16.A3 16.67
Sum of Ranks 262.0 915.5 9A7.5 1115.0
H = 39.01** (df = 3)

** significant at the .001 level.

TABLE XI
MANN-WHITNEY U TEST FOR MEAN CFF DIFFERENCES
BETWEEN PAIRED GROUPS
Mean Mean Sum of Sum of
cff cff Ranks Ranks
lst 2nd lst 2nd
Groups Group Group Group Group U 2

Organic vs

Normal 13.20 16.38 22A.0 596.0 386. 5.03**
Organic vs

Process 13.20 16.A3 225.0 595.0 385. 5.00**
Organic vs

Reactive 13.20 16.67 230.0 590.0 380. A.86**
Normal vs

Process 16.38 16.A3 AO8.5 All.5 201. .0A
Normal vs
Reactive 16.38 16.67 335.5 A8A.5 27A. 2.02*
Process vs
16.A3 16.67 361.0 A59.0 2A9. 1.32

Reactive

 

 

* significant at the .05 level (two tail test)
** significant at the .0001 level (two tail test)

68
Since the mean flicker threshold for organics (13.20)
was Significantly lower than that of the normal control

group (16.38), hypothesis one was confirmed.

Hypothesis 2. Patients rated as process schizo-
phrefiIcs WIll have a lower mean cff threshold
than will reactive schizophrenics, and this score
will tend to approach the score of brain damaged
subjects, i.e. fall between reactive and organic
patients.

 

An examination of Table XI discloses that although the
mean cff threshold for the process group was slightly lower
than that of the reactive group (16.A3 vs 16.67, respec-
tively), the difference was not significant. In order to
determine whether a more rigorous dichotomization would
yield differences between the two schizophrenic groups, the
10 subjects rated as most reactive (i.e. lowest Elgin
scores), were compared with the 10 patients rated most
process (i.e. highest Elgin ratings). Again, no signifi-
cant differences were found to exist between process and
reactives in terms of flicker fusion (Table XII). Thus
hypothesis two which predicts that the process group would
approach the organic group in mean flicker threshold was
not supported by this investigation.

Hypothesis 3. Patients rated as reactive schizo-

phrenics will perceive fusion at levels close to,
or not significantly different from normal subjects.

 

A mean cff threshold for the reactive group of 16.67
proved to be significantly different from the 16.38 average

of the normal individuals at the .05 level of confidence

69

TABLE XII

MANN-WHITNEY U TEST FOR MEAN CFF DIFFERENCES BETWEEN
EXTREMEl PROCESS AND REACTIVE SUBJECTS

 

 

 

Mean Cff Sum of Ranks
10 Extreme 16.56 86.0
Process
10 Extreme
Reactive 17.09 12A.0

 

 

U = 31.0 (nl = 10; n2 = 10)
Not significant

110 highest and 10 lowest scores on Elgin Scale

TABLE XIII

MANN-WHITNEY U T ST FOR MEAN CFF DIFFERENCES BETWEEN
lO EXTREME REACTIVES AND 20 NORMALS

 

Mean Cff Sum of Ranks
10 Extreme 17.09 215.0
Reactives
20 Normals 16.38 250.0

U = A0.0* (nl = 10; n2 = 20)
* significant at the .02 level (two tail test)

110 lowest scores on Elgin Scale.

70
(Table XI), thus contradicting the prediction of hypothesis
three. Following the rationale used in the analysis of
hypothesis 2, a test was done in which the entire normal
group of 20 subjects was compared with the 10 schizophrenic
patients judged to be most reactive on the basis of their
Elgin rating. In this case the difference between the two
groups was even more significant (.O2)(Table XIII). A com-
parison of the remaining 10 reactive patients with the 20
normal subjects did not result in a significant difference
however (Table XIV). This leads to the conclusion that dif-
ferences in Off between the reactives and normals are due to
the 10 reactives with the lowest Elgin scores (i.e. the 10
patients judged to be most reactive). Similar comparisons
involving the 10 most process and the 10 least process sub-
jects versus the 20 normal patients did not result in any

Significant differences between the groups.

Additional Findings Related to cff

In order to determine whether or not a relationship
existed between a schizophrenic subject‘s flicker fusion
rank, and the same individual‘s rank on the Elgin scale,
Kendall's tgg or correlation coefficient was computed. The
resulting correlation of .OA8 indicated that there was
essentially no relationship between the magnitude of a schi-
zophrenic‘s Elgin rank (or position on the process-reactive

continuum) and his ranked flicker Score.

wMI‘flzfi-‘Q . I“ :m'n
Y

71

TABLE XIV

MANN-WHITNEY U TEST FOR MEAN CFF DIFFERENCES BETWEEN
1O LEAST EXTREME REACTIVES AND 20 NORMALS

 

 

 

Mean cff Sum of Ranks
10 Least Extreme 16.2A 171.00
Reactives
2O Normals 16.38 29A.OO

 

 

U = 8A.O (n1 = 10; n2 = 20)
Not significant

10 highest scores among reactives on Elgin Scale.

TABLE XV

DIFFERENTIATION OF ORGANICS FROM ALL OTHER
GROUPS ON BASIS OF CFF

 

 

No. of Organics

 

with off Higher Per Cent
Lowest cff than Column 1 Differentiated
For Normals 15.7A 1 95
For Process 15.03 2 90

For Reactive 1A.28 5 75

 

 

 

.3... .,

72
The ability of Off to discriminate brain damaged from
non brain damaged patients was exceptionally good however.
When compared with normals, organic subjects were success-
fully differentiated by their flicher threshold 95 per cent
of the time, since only one brain damaged individual ob-

tained a higher cff score than that of the lowest normal.

 

 

Somewhat;lessdiscrimination was present in comparisons of g
process and reactive groups with the organics (90 per cent 2
and 75 per cent respectively) (Table XV). i
Archimedes Spiral Aftereffect i

Hypothesis A. Brain damaged individuals will
perceive the aftereffect of the Archimedes
Spiral less often than normal controls.

 

Archimedes Sprial aftereffect scores for all individ-
uals in the experiment are presented in Table XVI.) It will
be noted that with the exception of the organic group, all
subjects in the study (i.e. 2O normals, 2O process and 20
reactive schizophrenics) obtained perfect scores on the
task. When the Organics were compared with any of the other
three groups, a Chi Square value of§9gr7was obtained
(p <:.01). Therefore hypothesis four was confirmed.

Hypothesis 5. Patients rated as process schizo-

phrenics will not perceive the spiral after-

effect as often as normals and reactive schizo-
phrenics.

 

Since all process schizophrenics in the experiment
achieved perfect scores on the Archimedes Spiral, hypothesis

five was not borne out.

TABLE XVI

INDIVIDUAL ARCHIMEDES SPIRAL AFTEREFFECT SCORESl

73

 

 

——

 

 

Organic Normal Process Reactive
Total Total Total Total
Subject Score Subject Score Subject Score Subject Score

01 A N1 A P1 A R1 A
02 A N2 A P2 A R2 A
03 0 N3 A P3 r R3 A
0A 0 NA A PA A RA A
05 1 N5 1) P5 14 R5 A
06 0 N6 A P6 A R6 A
07 A N7 A P7 A R7 A
08 3 N8 A P8 A R8 A
09 A N9 A P9 A R9 A
010 A N10 A P10 A R10 A
011 A N11 A P11 A R11 A
012 0 N12 A P12 A R12 A
013 ‘3 N13 1) P13 1) R13 A
01A 0 N1A A PlA A RlA A
015 A N15 A P15 A R15 A
016 3 N16 14 P16 1) R16 14
017 A N17 A P17 A R17 A
018 A N18 A P18 A R18 A
019 A N19 A P19 A R19 A
020 A N20 14 P20 A R20 A

 

 

1See page 57 for description of scoring method.

The ability of the spiral technique to discriminate

organic subjects from non brain injured individuals was

relatively poor.

Of 20 organics,

perfect scores on the task.

This resulted in a test dis-

only nine failed to obtain

crimination index of only A5 per cent in the present inves-

tigation.

Five of the nine subjects were totally unable

to perceive the effect on any of the four trials. Another

7' " L35 liffl‘dt

7A
organic patient perceived the aftereffect only once in four
trials, while the remaining three individuals not obtaining
perfect scores, had an average of three points out of a
possible four. Eleven brain injured patients (55 per cent)
were able to report the aftereffect on each of the trials

however. An examination of the data revealed no apparent

 

relationship between those patients failing, or almost 57
failing the test (i.e. achieving scores of zero or one) and 5
any particular type of organic diagnosis. The Six patients E
with scores of zero or one included one cerebrovascular i

accident, one brain trauma, one multiple sclerosis, one

Huntington's Chorea, and two cases of brain tumor.

DISCUSSION

Brain Damaged Patients and Cff

 

The results of this experiment on Cff in cases of
known brain damage are in full agreement with most prior
evidence. Only one brain damaged individual obtained a
flicker threshold higher than that of the lowest normal.
This single exception, a patient suffering from the effects
of a gun shot head wound, was the only member of the organic
group whose injury was confined exclusively to the frontal
regions as far as neurological examination could ascertain.
Since most evidence points to the conclusion that frontal

injury, either accidental or deliberate (e.g. psychosurgery),
generally affects cff only temporarily, the frontal locus of
the lesion for this particular subject may even explain the
single exception. In Short, the present experiment provides
additional support for the position that cff isa comparatively
good technique for discriminating brain damaged persons with
gross destruction from normals and schizophrenics. Increased
utilization of Cff in the ordinary hospital setting appears

to be well warranted, a possibility that has been recognized
by Klebanoff (72) and others (5A,81,97). Its potential

seems especially good when a comparison is made with the

relatively poor discriminating ability shown by the usual

paper and pencil tests of organicity (1A8).

 

76

Cff and Process and Reactive Schizophrenia

 

Reactive schizophrenics, while predicted to have cff
thresholds similar to those of normals (in the belief that
no cortical defect is present), actually showed a higher
fusion level than normal patients. This result, although

unexpected, is not entirely incompatible with other research

 

findings. King (70) points out that most evidence from E7
mecholyl studies shows normals and poor prognostic (process) I
groups to have relatively 1mwautonomicresponse levels, é
while good prognostic patients (reactives) respond much E

more strongly to the drugs. He cites other experiments (91,
105,1Al) which corroborate the impression that reactive
schizophrenics have marked physiological reactivity generally
while process subjects do not. In this sense the process
individual resembles more the normal person. King suggests
that "A possible explanation lies in viewing both normals
and process schizophrenics as representing relatively uni-
form, stable adjustments over a period of time" while the
heightened homeostatic response of the reactive patient
reflects the "precipitous nature" of his adjustment.

Another explanation of the cff results with reactive
subjects in this experiment may be offered. Some evidence
from the literature indicates that patients of a manic type
show higher fusion thresholds than do other groups (109,
1A0). In addition, there have been studies which suggest

the possibility of a relationship between manic or affective

77
symptoms and characteristics of schizophrenics with better
prognoses (i.e. reactives) (30,AA, 123).Se1ection of re-
active patients on the basis of affective components in the
clinical picture (Items A, D, G, P, T, of the Elgin Scale)
may account for the significantly higher flicker levels for

reactives as compared with normals. It should be noted also

 

vthat only two of the 76 schizophrenics rated, (sub- ?;
jects R1 and R2, Table VII) carried a hospital diagnosis of F
"schizo-affective." Cff scores for these two individuals

(both of whom were included in the reactive group) were the F”

highest in the entire sample. We may speculate therefore
that a manic component present in the reactive subjects may
have contributed to higher Cff levels attained by this group.
Furthermore, it is possible that the present day concept of
reactive Schizophrenia has much in common with the formerly
popular diagnosis of manic-depressive psychosis.

The experiment failed to reveal differences in cff
between patients rated process and reactive. In considering
possible reasons for this, a number of alternatives suggest
themselves. First, the Elgin Scale may be at fault. But
the fact that other investigators (11,12,70,1AA,1A5) have
found that patients rated process and reactive perform dif-
ferently in experiments would speak in favor of the scale.
Even allowing that certain structural defects were present
in the scale, evidence from the present study suggested

that the scale was functioning to a certain extent. Mean

78
Off scores for the normal, process, and reactive groups
fell on a continuum of ascending order (TableVIII), Although
no differences were found to exist between normals and
process, or between process and reactives, significant dif-
ferences (p <2.05) were obtained between reactives on one

extreme and normals on the other. In addition, when the

 

10 "most" extreme reactive subjects (i.e. those with the ?k
lowest Elgin ratings) were compared with the normals, the

differences were even more significant (p <-.02). Thus, in E

a sense the scale was able to differentiate between two %
groups of schizophrenics: one that differed from normals,

and one that did not.

Lack of differences in Off between the two schizo-
phrenic groups could be due to the fault of the concepts
themselves. Certainly the correlation coefficient of .OA8
between an individual's Elgin rating and his Cff score lends
little support to the process-ractive continuum notion,
assuming of course that Cff itself was not the source of
error. But rejection of the process-reactive classification
leads us back to the alternative of viewing schizophrenia as
a homogeneous entity--already proven an unpromising basis
for research. The paucity of results in schizophrenic
experimentation to date is felt by some to be due to the
very heterogeneity of the concept (26, 108). In addition,
widespread clinical observation plus diversified scientific
investigation further emphasize the inadequacy of any view

of the disease as a homogeneous one.

79
It is readily conceivable that the lack of off dif-

ferences between process and reactive schizophrenics is due
to the flicker phenomenon itself. This view would hold that
process schizophrenia could be an organic (or even cortical)
condition, but with the lesions or structural damage so
slight as to evade detection by such a crude technique as
cff. The ability of flicker to discriminate cases of mild
organicity admittedly has not been well investigated. But
to fall back on the excuse of inadequate instrumentation is
merely to echo one truism of psychological experimentation
generally. Furthermore, cff is relatively speaking one of
the more exact techniques available to psychological
research. In the present experiment, the instrument proved
to be very reliable with only small variations in fusion
level from one trial to the next occurring in any particular
individual.

Perhaps the most parsimonious statement concerning
lack of differences in cff between the two schizophrenic
groups is that process schizophrenia is ggt organic in
nature, at least in the cortical sense. Evidence in favor
of there being some physiological difference between the
two is fairly strong, particularly in those studies having
to do with autonomic reactivity to drugs such as epinephrine
and mecholyl. However, data purporting to Show that schizo-
phrenia is due to a defect of the cortex is less plentiful,
and much reference to this possibility must be put down as

mere speculation.

’WJN'H‘UJHIW "L: “kw-T
._I . l

Archimedes Spiral Aftereffect

 

While it is true the spiral aftereffect discriminated
organics from all other groups in the present study, the
results were somewhat disappointing in light of earlier
experiments utilizing the technique. Price and Deabler (137)

were able to report that approximately 98 per cent of their

 

organic group was correctly identified by failure to per- 77
ceive the aftereffect. Subsequent publications indicated

that a somewhat lower discrimination index was more typical

(3A,38). In the present investigation, however, only A5 per g!)

cent of the brain damaged group was identifiable through
failure to perceive the effect. It is possible that better
control of such variables as age and visual acuity contri-
buted to the wide discrepancy between our results and those
of previous studies. But the fact that only ERRED organics
were used in this study rather than merely cases carrying
an official hospital diagnosis of some sort of organic in—
volvement, should if anything, tend to increase the discrim-
inability of the spiral technique. In light of this, the
findings of Price and Deabler in particular, become even
less understandable. In any event, on the basis of the
present investigation, we must conclude that the Archimedes
Spiral aftereffect appears to offer little or nothing in

the way of a diagnostic aid for the practicing clinician.

SUMMARY

The purpose of this experiment was to obtain evidence
about schizophrenia, particularly in relation to possible
organic components. Considerable theory and a few experi-
ments suggest that at least certain schizophrenics suffer
from a disease that is primarily organic in nature, perhaps

of a central nervous system locus. Recent publications have

WEE MIN" ”’7'"?

sought to tie this variety of the disorder to the concept of
process schizophrenia.

The two perceptual tasks chosen to investigate the
problem were critical flicker frequency (Off) and the Archi-
medes Sprial. The former consisted of a flickerling light
whose rate of presentation was increased gradually to the
point where the viewer reported perceiving a steady light
source. Photic pulse rate at this subjective point is
called the critical flicker frequency. The second task was
one in which the subject steadily fixated a rotating spiral
disc for 30 seconds. 0n sudden stopping of the spiral, the
normal viewer's reaction was to experience the disc as ex-
panding. This phenomenon is referred to as the Archimedes
Spiral aftereffect. The selection of these two tasks was
based on the considerable amount of evidence that brain
damaged individuals show gross defects in the perception

of both.

82

Four groups of 20 subjects each were chosen. A11 sub-
jects were male veterans under A5 years of age and with
normal visual acuity in at least one eye. The organic group
consisted of cases of known brain damage, as determined by
case history and neurological examination. Twenty surgical
cases from a general medical and surgical hospital comprised
the normal group. Seventy-six neuropsychiatric patients
with hospital diagnoses of schizophrenia, less than one year
of current hospitalization, and no history of head injury
were rated on the Elgin Prognostic Scale by two independent
raters using case history material. A correlation coeffici-
ent of.89 was obtained between the two sets of ratings. The
20 patients with the highest Elgin scores were designated as
the process group while the 20 individuals with the lowest
scores made up the reactive group. All 80 subjects were
then given both perceptual tasks.

Relative to Cff it was hypothesized: (1) brain damaged

individuals will have lower cff thresholds than will normals;

(2) process schizophrenics will have lower cff thresholds
than will reactives; and (3) reactives will Show Off levels
not significantly different from normals. Hypothesis One
was confirmed (p <; .0301), but Hypothesis Two and Three
were not. In the last case, reactives were significantly
higher in off than normals (p. <1 .05).

Relative to the Archimedes Spiral aftereffect it was

hypothesized: (A) brain damaged subjects will perceive the

83
effect less often than normals; and (5) process schizo-
phrenics will not experience the aftereffect as often as
either reactives or normals. Hypothesis Four was confirmed
while Hypothesis Five was not.

A discussion of the results of this investigation con-
sidered the effectiveness of the off technique in discrim-
inating brain damaged from normal and schizophrenic
individuals, and the relative inability of the spiral method
to do likewise. Attempts to account for the findings
included the possibility that affective components of
reactive schizophrenia contribute to the differences between
them and other schizophrenics and normals, and the belief
that process schizophrenia, while showing some physiological
differences from reactive schizophrenia in other investi-

gations, probably is not due to defects of a cortical nature.

 

IO.

ll.

12.

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Anderson, Camilla. Organic factors predisposing to
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Ausubel, D. A psychopathological classification of
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Ego development and the personality dis-

 

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‘ wan-“usury“ . .11.,71‘
In

Ax, A. and Colley, W. Temporal acuity of vision,
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Bartley, S. H. Vision. New York: Van Nostrand Co.,19Al.

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Battersby, W. Critical flicker frequency in patients
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The regional gradient of critical flicker
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. . - 9'

APPENDIX
BECKER'S REVISION OF THE ELGIN PROGNOSTIC SCALE

Items A through 0 are rated on the basis of case
history data. Items P through T are rated on the basis
of the presenting clinical symptoms. Item 0 was not used,
however, in the present study because the necessary infor-
mation was not easily ascertainable.

A. Defects of interest versus definite display of interest. I

0. Keen ambitious interest in some of the following: {5‘
home, family, friends, work, sports, arts, pets, i
gardening, social activities, music, dramatics.

2. Moderate degree in several activities including
social gatherings, sports, music, opposite sex,etc.

4. Mild interest in a few things such as job, family,
quiet social gatherings. The interest is barely
sustaining.

6. Withdrawn and indifferent toward life interests
ofewerage individual. No deep interests of any
sort.

B. Insidious versus acute onset.

0. Development over a period of 0-1 months with sudden
dramatic divorcement from more or less commonplace
living.

1. Development over a period of 2-4 months with marked
personality changes from relatively commonplace
living.

2. Development over a period of 5-7 months with
moderate personality changes. May be some accenting
of previous trends, but changes also.

3. Changes have taken place over a period of 8-12
months with noticeable personality modifications,
but primarily an accenting of existing trends.

4. Slow development of symptoms, but possible to detect
personality changes in 2 years prior to onset.

97

Very slow development of symptoms so that final
disorder appears as an exaggeration of already
strongly accentuated personality traits. Indica-
tions even prior to adolescence.

Shut-in personality.

General: The psychotic condition is simply an exagger-

ation of the peculiar type of personality shown all
through childhood. Stormy childhood often with
over-protection and anxiety, a difficult adolescence
characterized by inability to get along with and
mix with other children. Constitutional apparently
rather than the product of specific environment.

Very much as described above.
Moderately the picture described above.

Only mildly this way, but some resemblance to
pattern.

Apparently normal childhood, little evidence of
shyness, unusual difficulty, or else unusual be-
havior is attributable to environmental factors.

Schizothymic versus syntonic personality.

0.

Very sociable, fond of people and social gatherings;
many friends, active in groups and sports, parti-
cipates in life of his community.

Moderately sociable, likes people and social
gatherings, but doesn‘t go far out of way to meet
people.

Midly shy, mildly sociable. Will interact when the
situation presents itself. Prefers association in
family group as a rule.

Moderatly shy, retiring, etc. More concerned with
ideas than people.

Very seclusive, shy, retiring, mixes little with
others. Few if any close friends. Interested in
ideas rather than people. Passive, an onlooker at
life rather than an active participant. Poor

'"Bite on life."

98

Range of interests.

0.

Wide and varied interests, keen bite on life, and
its opportunities, forward and interested in making
adaptation to daily life in many spheres.

Moderate breadth of interest, interested in making
adaptations to daily life, but does not go out of
way to seek new opportunities.

Moderate restriction of interests. Narrow goals,
but some detectable variety of interests within a
narrow orientation.

Inadequate interest in varied problems of life,
rigid, narrow goals or interests, circumscribed
activities because of the narrow range of interests.

Constitutional bias.

0.

Low

A healthy, strong energetic physical and mental
make up that makes the interplay between heredity
and environmental influence during childhood a
satisfactory one.

Suggestions of defects in physical and mental
stamina occasionally observed. Not at all marked.
Perhaps proness to repeated illnesses in childhood.

Regarded from early childhood as different, queer,
or odd; perhaps associated with some real defect
or handicap-physical, such as deformity, or speech
defect, but more often only an imaginary defect of
personality.

energy tone-

Very strong drive, keen active and alert interest
and ambition shown in school, social and work
spheres. Good grasp on life, liked life and had
energy enough to enjoy it. Outgoing and adequate
in meeting life.

Moderately adequate drive, interest, and energy as
described above.

Moderately inadequate energy tone. Tends toward
submissive, passive ractions. Shows some potential
to face lifes problems, but would rather avoid them
than expend the necessary energy.

99

Submissive, inadequate passive reactions, weak grasp
on life, does not go out to meet life‘s problems,
does not participate actively but passively; accepts
his lot without having the energy to help himself.

Asthenic build.

0.

Large, barrel—shaped trunk, with relatively short
legs, and arms; shield-shaped face, short broad
head upon a thick neck, set well down between
shoulders.

Athletic build. Balanced weight, good musculature,
head shape, etc., intermediate to 0 and 4.

Long, slender extremities with nelatively small,
narrow trunk. Egg-shaped face; elongated narrow
head on a tall, slender neck.

Heterosexual contact.

0.

Purposefully contacts the other sex, dates fre-
quently, makes successful effort to be attractive
in manner, dress, accessories, etc., so as to be
popular with girls (boys).

Dates when situation affords. Maybe marries,but
to have difficulties in compatibility. Wants to
interact with other sex, has some techniques but
not completely successful.

If married, apt to divorce or separate. Generally
this is rated as a midpoint between 2 and 4.

Moderate lack of heterosexual contact. Tends to
avoid dates, dances, but has on occasion partici-
pated in same. Might think (he) she would like to
marry someday, but little enthusiasm for it.

No association with the opposite sex. Never had
any dates. Avoides dances and social gatherings
which require the intermingling of boys and girls.

Marked academic interests versus active interest in
sports.

0.

An active interest in sports, participates in
baseball, basketball, tennis, football, or other
sports. A solitary sport such as swimming or
golf is not so important unless the patient plays
or swims with others rather than self.

100
Moderate interests in sports and other interests.
Mild interest in sports, mild interest in study.
Moderate interest in study--without other interests.
Fond of study, worked diligently at school and ex-
cells in this field associated with inadequacy in
sports and social field; a grind without the ambi-

tion or drive in work and play to equal his
achievements as a student.

Careless, indifference versus worrying, self-conscious
type.

0.

Subjectively sensitive, critical of self, pre-
occupied with own conflicts, but shows little of
the extreme, bizarre, unusual, mysterious or
socially unacceptable behavior.

Some concern and preoccupation with difficulties--
a moderate position to 0-4.

Withdrawal and disinterest in social surroundings,
careless of social requirements, given to day-
dreaming, and excentricity, dirty, disheveled ap-
pearance, profane language, unacceptable habits.

Exclusive stubborn traits versus insecurity and
inferiority feelings.

0.

Jl‘UUR)

Timid, lacks self-confidence, feels insecure and
inferior. Very sensitive and critical of self;
feels certain problems in life but participates
and does not accept his lot passively or without
regret and struggle.

Moderately like 0.

Neither timid nor stubborn.

Moderately stubborn.

Complete withdrawal from surroundings and interest,
inadequate in meeting life but stubborn and opin-
ionated, refuses to change, even if suggested, to

achieve a more adequate adjustment. Opinionated
and egocentric.

101

M. Toxity of exhaustion.

0.

History of illness, disease of exhaustion closely
associated with the onset of psychotic symptoms.

Illness present, not severe, but related to onset.
Less severe exhaustion.

Poor health--but not requiring bed.
Fair health-~a little run down.

Excellent health history, health in no sense an
etiologic factor in the development of psychosis.

N. Precipitating conditions (situational reaction).

0.

A strong relationship between onset of symptoms

and situational problems that would require definite
and continued effort to adjust satisfactorily; i.e.
death, failure, loss, interpersonal strife. The
average person would definitely try to flee such

a situation rather than attempt to change it.

Marked stresses related to onset, but not as
severe as 0.

Moderate stresses related to onset such as financial
problems, interpersonal discord, etc., which would
cause considerable worry to the average individual.

Mild stresses that the average person would react
to in some way but which would not usually lead to
a breakdown.

Onset of psychotic symptoms not related to any
disturbance or difficulty in the patient‘s situa-
tion--or a disturbance of such a trivial nature
that it would be ignored or quickly forgotten by
the average person.

0. Duration of psychosis.

\IQW-tme-‘O

Under 2 months
2-4 months
4-6 months
6-8 months

10-12 months

1-2 years
2-3 years
Over 3 years

102

The following scales are rated from the presenting clinical

 

picture:

Inadequate affect versus emotional instability of ap-
propriate affect.

O. Adequate or overly demonstrative affective expres-
sion. This includes appropriate expression and
manic depressive aspects in which there is a
facile display of emotion.

2. Moderately inadequate affect. Tends to be rigid,
dull, or slightly inappropriate. Only moderate
responsiveness to emotional stimulation.

4. Markedly inadequate, inappropriate, rigid, or dull
affect. Emotional life expressed is at odds with
behavior or strikingly inappropriate. Little re-
action to stimulation of any strength.

Hebephrenic symptoms: extreme indifference, complete
divorce between ideas and affect; extreme carelessness
in appearance and reaction with untidiness in some
cases, silly behavior, often silly laughter without
appropriate stimulation.

Not as above.

Mildly as above.
Moderately as above.
Markedly as above.

Very markedly as above.

JEWIUHO

Ideas of influence: Patient feels that someone or some-
thing is directing his actions, thoughts, or speech.
Some outside influence forces him to do things even
against his own will.

(Rate 0-4 as in scale Q)

Physical interpretation of delusions: The patient has
certain feelings (possibly hallucinations) that are

linked up with definite delusional ideas; for instance,
that there is a snake in his stomach, that food passes
right through his body, that someone is passing electrical
currents through his body, that the food he eats is
poisoned, etc.

(Rate 0-4 as in scale Q)

1. m 3“.
.r. an
-

“Fa-Mgr -. “n. ..

T.

103

A typical symptoms: Manic or depressive feature mixed
with the schizophrenic picture. Display of appropriate
affect, over-talkative, distractive, facetious, display
of interest in other patients, desire to help humanity
in general, depression, feeling of sin or guilt,
psychomotor retardation, anxiety, crying.

0. Very markedly atypical picture, shows many of the
above features with considerable strength of affect.

l. Markedly atypical picture.

2. Moderately atypical picture, less intensity of
features shown.

3. Mildly atypical picture, unusual features are
minimal or lacking in intensity.

4. Lacking atypical features.

most. as" ”’UY