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CORTICAL ARDUSAL m RUSSIAN RARANom V f 5;};
SCHIZOPHRENICS AS A FUNCTION * _ g_
OF A WORD ASSOCIATION TASK, ‘ ‘ ‘ i ’

Thesis for the Degree of Ph. D; -
MiCHiGAN STATE UNIVERSITY,
DIANE M. SILVERT
1969'

 

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This is to certify that the
thesis entitled

CORTICAL AROUSAL IN RUSSIAN PARANOID
SCHIZOPHRENICS AS A FUNCTION
OF A WORD ASSOCIATION TASK

presented by
Diane M. Silvert
has been accepted towards fulfillment

of the requirements for

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0-169

ABSTRACT

CORTICAL AROUSAL IN RUSSIAN PARANOID
SCHIZOPHRENICS AS A FUNCTION
OF A WORD ASSOCIATION TASK

By

Diane M. Silvert

This investigation examined the relationship between
patterns of cortical arousal and schizophrenia and whether
these patterns of cortical arousal relate to avoidant
thought in the schizophrenic.

Ten words from the Kent-Rosanoff list having cross-
culturally high response commonality were presented as a
single word association task to 25 Russian paranoid schizo-
phrenics and 25 Russian normal controls while the subject
was monitored for arousal by a monopolar EEG hookup.
Patients were selected in order of admission with repres-
entation of both sexes (11 males; 14 females) and two levels
of severity of the disorder resembling the distinction of
process vs. reactive schizophrenia. Although matching was
not possible with the normal subjects, who were recruited
from the hospital staff (8 males; 17 females), correlations

between demographic variables and the dependent measures

proved insignificant. Trials were counterbalanced for word
order and pre-stimulus photic stimulation within groups

defined by diagnosis plus sex. Trials affected by artifact

Diane M. Silvert

were not included in the analyses and only subjects who
showed no signs of EEG abnormality were included in the
study.

Utilizing a Drohocki integrator, EEG recordings were
assessed for degree of cortical arousal by inferring amount
of alpha from the sum of the mean energy content of each
record during each pre—stimulus, latency, and post response
period. Response commonality was scored according to the
percent incidence of the response in a reference sample of
Russian medical students. Differences in EEG activity and
verbal responsivity among the four subject groups (Normal
Males, Normal Females, Schizophrenic Males, and Schizophrenic
Females) were assessed by means of Student's t test and where

test data was taken from the same subject at different times,

by using the correlated 3. Where changes over time were of
interest, regression equations were used.

The hypothesis that schizophrenic and normal subjects
differ in their patterns of electrocortical arousal both at
rest and under conditions of a single word association task
did find support in the data. The EEGs of schizophrenic
subjects, examined with the Drohocki integrator, showed less
alpha in all time periods measured: pre-task; pre-stimulus,
latency period, and post response. Thus schizophrenics as
compared to normals were more highly aroused in all periods
of the experiment. Normals varied more within and between
trials in amount of alpha and Schizophrenic Males, who

were less severely ill, showed greater variability than

Diane M. Silvert

their female counterparts. Within a post response period
equal in length to the preceding latency period almost all
subjects showed electrocortical under—recovery as compared
to their pre-stimulus levels. By contrast the Schizophrenic
Females over—recovered on the average.

The hypothesis that schizophrenic and normal subjects
differ in their verbal responsivity and in the relationship
between verbal behavior and electrocortical indices under
conditions of a word association task received only partial
shpport. Schizophrenics give fewer common responses than
normals, and their uncommon responses are less appropriate
to the stimulus as ranked by ten Russian judges. For the
most part there were no general relationships between
electrocortical arousal and recovery with kind of verbal
response for either normal or schizophrenic subjects; only
Normal Females showed stronger recovery associated with
less common responses.

Additional analysis revealed that the schizophrenics
failed to show adaptation to the experimental situation
both verbally and electrocortically. Schizophrenics showed
a longer mean reaction time which by contrast to the increa—
singly shorter latency among the normals, remained rela-
tively stable through trials. Response commonality scores
showed a similar stability of low commonality for the
schizophrenic subjects whereas the responses for normals

became somewhat more original with time.

Diane M. Silvert

Low commonality and low quality of verbal responses
given in a single word association test, higher electro-
cortical arousal, reduced variability, and a general
failure to habituate, distinguish the schizophrenic from
the normal subjects in most cases. These differences
increase with severity of the disorder. These findings
underline the growing concensus that describes the
schizophrenic as suffering from chronic physiological
hyperreactivity. Notwithstanding the methodological
issues of a somewhat restricted and unmatched sampling,
tde value in considering psychophysiology in diagnosis
agd possible prevention of thought disorder development
is suggested here. The greater severity of disorder
among the females and the relationship between recovery,
tsmmonality, and sex argue for a closer examination of
sex as a variable of importance in the study of schizo-
phrenia. While this study does not offer support for an
anxiety theory of schizophrenia, the absence of any demon-
strable relationship between commonality of response and
degree of physiological arousal is consistent with the
theoretical position espoused by Broen and Storms which
says that behavioral deficit in schizophrenia is the
result of arousal apart from any necessarily defensive

significance of the behavior.

CORTICAL AROUSAL IN RUSSIAN PARANOID
SCHIZOPHRENICS AS A FUNCTION
OF A WORD ASSOCIATION TASK

By
{
Diane M: Silvert

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
Department of Psychology

1969

To Sarnoff, Costia, and Valeria

ii

ACKNOWLEDGMENT

The author wishes to express her most sincere appre—
ciation to Dr. Lucy C. Ferguson, Chairman of her Committee,
for the guidance and encouragement received in the course
of the graduate program as well as during the vicissitudes
of preparation and completion of this research.

Heartfelt thanks are extended to Dr. Clarence L.
Winder, Dr. Lawrence I. O'Kelly, and Dr. Glenn I. Hatton
for their advice and encouragement during the preparation

of this thesis.

iii

TABLE OF CONTENTS

DEDICATION . . . . . . . . . . . . . . . . . . .
ACKNOWLEDGMENTS. . . . . . . . . . . . . . . . .
LIST OF TABLES . . . . . . . . . . . . . . . . .
LIST OF FIGURES. . . . . . . . . . . . . . . . .
LIST OF APPENDICES . . . . . . . . . . . . . . .

Chapter
I. INTRODUCTION . . . . . . . . . . . . . . .

Psychological Deficit in Schizophrenia .

Theoretical Background . .

Emotion and Physiology in Schizophrenia.
Hyporeactivity . . . . . . . . . . . .
Hypereactivity . . . . . .

CNS and ANS Measures in Schizophrenia. .

Electroencephalography and Schizophrenia
General Considerations . . . . . . . .
Parameters of Alpha Blocking . . . . .
EEG and Personality. . . .
Abnormality and EEG in Schizophrenia .
Normality and EEG in Schizophrenia . .
Variability in Cortical Measures . . .

Habituation and Recovery . . .

o

Severity of Disorders and Psychophysiol g

Paranoid vs. Non-Paranoid Subjects in
Studies of Schizophrenia . . . . . . .
Sex Differences in Schizophrenia . . . .
Perception Methodology in Research of
Schizophrenia. . . . .
Soviet Research on Psychophysiology in
Schizophrenics . . . . . . . . . .
Verbal Association in Schizophrenia. . .
Statement of the Problem . . . . . . . .

iv

y

Page
ii
iii
vi
viii
ix

Chapter Page

II 0 METHOD 0 o o o o o o s o o o o o o o o o o o o o o 70

Setting. . . . . . . . . . . . . . . . . . . . . 70
Design . . . . . . . . . . . . . . . . . . . . 72
Measures . . . . . . . . . . . . . . . 72

Physiological Measures . . . . . . . . . . 72

Psychological Measures . . . . . . . . ... . . 7A
Subject Characteristics. . . . . . . . . . . . . 75
Subjects . . . . . . . . . . . . . . . . . . . . 76
Apparatus. . . . . . . . . . . . . . . . . . . 78
Procedure. . . . . . . . . . . . . . . . . . 81
Statistical Treatment of the Data. . . . . . . 83

III 0 RESULTS. 0 O O O O O I O O O O O O I O O O O O O O 106

Subject Characteristics. . . . . . . . . . . 106
Electroencephalographic Findings . . . . . 107

Other Electroencephalographic Findings . . . 109
Verbal Association Findings. . . . . . . . . . 111

IV. DISCUSSION . . . . . . . . . . . . . . . . . . . . 11”

Subject Characteristics. . . . . . . . . . 11M
Electroencephalographic Findings . . . . . . 117
Psychological Findings . . . . . . . . . . . . . 123
Comparisons with the Literature. . . . . . . . 126

V0 SUMMARY OF FINDINGS o o o o o o o o o o o o o o o o 135
“EJB‘ERENCES o o o o o o o o o o o o o o o o o o o o o o o l 39

APPENDICES O O I O O O O O O O O O O O O O O O I O I O O 151

Table

LIST OF TABLES
Page

Student's t and F Statistics Between Groups
Differentiated by Diagnosis and Diagnosis
Plus Sex: MEC/Second by Time Period. . . . . . . 90

Analysis of Variance for Overall Regression and
Multiple Correlation Coefficients for Inde-
pendent Variables Sex, Diagnosis, Trial and
Response Commonality Per Trial With Dependent
Variable Latency Period Length (Reaction Time). . 91

jProduct-Moment Correlations Between Latency

Period Length (Reaction Time) and Variables
Which Reach Significance at p<.05 . . . . . . . . 92

Student's t and F Statistics Between Groups
Differentiated by Diagnosis and Diagnosis
Plus Sex. Latency Period Length (Reaction Time). 93

Analysis of Variance for Overall Regression and
Multiple Correlation Coefficients for Inde-
Pendent Variables Sex, Diagnosis, Time Period,
and Trial With Dependent Variable Pre-Stimulus,
Latency Period, and Post—Response MEG/Second
for Each Trial . . . . . . . . . . . . . . . . . 9“

Analysis of Variance for Overall Regression and
Multiple Correlation Coefficients for Inde-
pendent Variables Sex, Diagnosis, and Time
Period With Dependent Variable Average MEC/
Second for All Ten Trials Averaged . . . . . . . 95

Analysis of Variance for Overall Regression and
Multiple Correlation Coefficients for Inde—
pendent Variables Sex, Diagnosis, and Time
Period With Dependent Variable Pre-Stimulus,
Latency Period, and Post Response MEG/Second
for Each Subject . . . . . . . . . . . . . . . . 96

Product-Moment Correlations Between Pre—Stimulus/

Latency Period MEC/Second (Arousal) and
Variables Which Reach Significance at p<.05 . . . 97

vi

Table . Page

9. Correlated t and D Statistics Between Pre-
Stimulus and Post-Response MEG/Second
for Each Analysis Group Defined by Diagnosis
Plus Sex. . . . . . . . . . . . . . . . . . . . . 98

10. Product-Moment Correlations Between Response
Quality and Response Commonality Which Reach
Significance at p<.05 . . . . . . . . . . . . . . 99

11. Student's E and F Statistics Between Groups
Differentiated by Diagnosis and Diagnosis
Plus Sex: Response Commonality, Response
Quality, and High Response Commonality
Frequency . . . . . . . . . . . . . . . . . . . . 100

12. Analysis of Variance for Overall Regression and
Multiple Correlation Coefficients for Inde-
pendent Variables Sex, Diagnosis, and Time
Period With Dependent Variable Pre-Stimulus,
Latency Period and Post-Response MEG/Second
Associated With High Response Commonality . . . . 101

13. Analysis of Variance for Overall Regression and
' Multiple Correlation Coefficients for Inde-
pendent Variables Sex, Diagnosis, and Time
Period With Dependent Variable Pre-Stimulus,
Latency Period and Post-Response MEC/Second
Associated With Low Response Commonality. . . . . 102

in. One—Way Analysis of Variance for Response
Commonality vs. Trial for Normal and
Schizophrenic Diagnostic Groups . . . . . . . . . 103

15. Product-Moment Correlations Between Response
Commonality, Response Quality and Post-
Response MEG/Second . . . . . . . . . . . . . . . 10A

16. Student's t_and F Statistics Between Groups
Differentiated by Diagnosis, by Sex, and by
Diagnosis Plus Sex: High and Low Response
Commonality Associated With Post-Response/
Latency Period MEG/Second (Recovery). . . . . . . 105

vii

Figure

1.

LIST OF FIGURES

Soviet Working (Preliminary) Scheme of
the Evolution of Schizophrenia (Based
on a long-term investigation of more
than “,500 patients) . . . . . . . . .

Diagram of the Electroencephalographic
Experimental Chambers (Institute of
Psychiatry, Moscow). . . . . . . . .

Diagrammatic Representation of Electrode
Placements: Frontal (F); Pre-Central (PC);
Parietal (P); Temporal (T); Occipital (O);
and Ear Referent (E) . . . . . . . . . . .

Mean MEC/Second Values for Normal and
Schizophrenic Subjects for Each Trial

and for Each Time Period: Pre-Stimulus,
Latency, and Post Response . . . . . . . .

Mean MEG/Second Values for Subgroups
Differentiated by Diagnosis Plus Sex for
Each Trial and for Each Time Period:
Pre—Stimulus, Latency, and Post Response .

viii

Page

85

88

89

LIST OF APPENDICES

Appendix Page

A. Verbal Responses for Each Subject to Each
Word Stimulus. . . . . . . . . . . . . . . . . . 152

B. Most Frequent Responses for Each Word

Stimulus Given by a Reference Sample of

One Hundred Medical Students . . . . . . . . . . 163
C. Patient Admission Data. . . . . . . . . . . . . . 166

VD. Word and Light Stimulus Presentation
Schedules. . . . . . . . . . . . . . . . . . . . 176

E. Names and Transformations of Measures
Calculated for Each Subject. . . . . . . . . . . 178

ix

CHAPTER I

INTRODUCTION

In his review of "Brain Dysfunction in Schizophrenia",
Brackbill (1956) concluded that one of the major sources
of error in research on schizophrenics is the assumption
that schizophrenia is a homogeneous process as diagnosed;
in fact the group labeled "schizophrenic" is a quite
heterogeneous one in composition and in responsivity on
most measures. One source of this wide variability may
be found in the fact that much of the literature is
dominated by subject groups which might be characterized
as chronic as opposed to acute. This may elicit data
relevant only to the "scars" of the dysfunction rather
than to the dysfunction itself. The effects of long term
hospitalization which involve general stimulus depriva-
tion, social isolation, and drug therapy effects are all
special burdens of the chronic patient and are likely
to affect his functioning in a structured research inves-
tigation (Mednick-Schulsinger, 1967). Other reports
fail to take into consideration some measure of severity

and it is significant that recognition of the existence

of subgroups of differing degrees of disturbance has
been a major determinant of increased understanding of
schizophrenia.

The validity of nosological distinctions within
schizophrenia is questionable in that the classification
of paranoid schizophrenia alone remains viable when com—
pared to others. On the average, paranoid schizophrenics
appear less "111" when compared to other schizophrenics.
Assessing a broad spectrum of measures of psychological
functioning Shakow (1962) summarizes findings from
studies carried out at three institutions over a period
of three years and finds the paranoid individual to be
closer to normal subjects in 31 of 58 measurements; the
non-paranoid schizophrenic resembles the normal more
closely than the paranoid in only seven instances, using
measures only where normals were scored at one or the
other extreme of the distribution.

This heterogeneity among persons diagnosed as
"schizophrenic" is responsible for the inconclusive and
conflicting findings in the research literature and testi-
fies to the need for more objective measures in diagnosis
and prognosis of schizophrenia. Venables (1966) concurs
in his criticism of undue reliance upon the Kraepelinian
diagnostic system based primarily on description of mani-
fest behavior. He recommends recognition of distinct
subgroups among schizophrenics based on a broader assess—

ment of patient functioning. The subtlties and complexi-

3

ties of normal and abnormal behavior demand an equally‘
complex assessment procedure and investigations have
frequently been too simplistic, involving a single depen-
dent variable at the expense of assessment of the inter-
action between several relevant measures. The growing
recognition of the importance of affective factors
associated with schizophrenia argues for a wholistic
assessment of the person, both psychological and physio—

logical, if all the relevant factors are to be identified.

Psychological Deficit in Schizophrenia

 

On most measures of behavior schizophrenics perform
more poorly than their normal or nonpsychotic Comparison
groups. Lang and Buss (1965) feel that a sensori-motor
defect underlies this psychological deficit, or perform-
ance decrement, in schizophrenia. In their review of
theories of deficit involving social motivation, drive,
arousal and interference, they conclude that what is
typically observed is a reduction in gggrt_re3ponsivity
suggesting that these findings may be partly the result
of higher initial basal levels which would predict lower
comparative size of response upon stimulation.

The literature shows high agreement with regard to
the apathetic picture characteristic of schizophrenics.
By contrast to manic-depressive psychosis which shows
a major affective involvement, schizophrenia is classified

as a syndrome marked by the loss of affective intensity.

Lange (1939) in his introspective account of
affective aspects of schizophrenia, states that the
actual decrement in affective responsivity is less than
it appears outwardly. Rather the mggg_of affective dis-
charge becomes translated increasingly into ideation.
The stimulus quality of this ideation gives rise to
affective qualities varying from euphoria to deep
depression and additional suppression occurs by a con-
scious attempt to block the affective response from
showing outwardly by further avoidant ideation. Lange
suggest that the extent of cortical dominance in a
patient predicts the amount of this outward "apathy."

He proposes that "the dominant factor underlying the
development of the psychosis is the over-emphasis of

the idealogical aspect of the psychological organization
at the expense of the sensory and motor aspects."

Reaction time studies involving schizophrenic
subjects almost invariably conclude that schizophrenia
is characterized by hyporesponsivity. Rosenthal gg_§1.
(1960) found a correlation of r=.89 (p<.01) between
reaction time and ratings of mental health within
schizophrenic subjects. Even when the experimental
situation is made simple, including foreknowledge of what
the stimulus and the response will be and exact length
of time of preparatory intervals, the schizophrenic sub-
ject consistently responds more slowly than the normal

control. Apparently a schizophrenic is able to take

advantage of this information only for short intervals
of time. Fedio, gt_al. (1961) were concerned with the
relationship between reaction time impairment in
schizophrenia (as measured by releasing a Morse Tele-
grapher Key) and resistance to alpha blocking. Using
twenty schizophrenic subjects and a matched group of
normal subjects they found normals showed significant
improvement in reaction time (p<.005) under conditions
of a preparatory signal, while schizophrenics performed
significantly more slowly (p<.01) than they had initially.
General disturbance in adequacy of overt express—
iveness is noted in most studies involving voluntary,
environmentally reSponsive behavior in the schizophrenic
subject. Where a demand is made for pg! responses, (e.g.,
learning), or self-initiated behavior, (e.g., finger-
tapping), deficit in performance is often not observed

(Shakow, 1962).

Theoretical Background

One theoretical position entertained to explain
schizophrenic deficit is that which presumes an organic,
anatomically demonstrable basis for development of
seriously disturbed psychological functioning. Brackbill
(1956) reviews a number of studies of brain dysfunction
in schizophrenia and comments that the difficulty with
histopathological studies is that it is difficult to get
normal material; in fact most research must rely exclu-

sively on individuals with demonstrated central nervous

(CNS) disease. Even so, if cell loss is the cause of a
progressive disorder characterized by schizophrenic
behavior, then one should expect the longer the illness
the greater the cell loss. Rowland and Mettler (1949)
in comparing a group which had been hospitalized more
than twenty-two months with another hospitalized for
less time, found no difference between the two. However,
methods of counting cells tend to be unreliable and
this alone may account for differing reports in the
literature. Another source of error is the possibility
that various researchers may have misjudged the limits
of normal variation in cell tissue. These authors dise
count the thesis of a specific organic factor in
schizophrenia with the present evidence available.

Biochemical studies for the most part have not
revealed consistent findings. Using a physiological
approach, Hoskins (19A6) suggests that the adrenal
mechanism in the Autonomic Nervous System (ANS) is
altered in its functioning thereby producing a changed
metabolism. The main finding in support of this position
is that schizophrenics show a subnormal response to
stress. Altschule (19N9), however, feels that most
physiological disorders reported are a consequence
rather than a cause of the psychosis.

Much difficulty with the psychological approach
derives from the trouble in differentiating between or-

ganics and schizophrenics, and especially between organic-

 

schizophrenics and funtional schizophrenics. Brackbill
and Fine (1956) using the process-reactive classifica-
tion system, gave the Rorschach to a number of organic,
process and reactive schizophrenic patients. They found
that the organic and process patients could not be dis-
tinguished by their Rorschach responses although reactive
patients showed fewer Rorschach organic signs. Meadow $1
and Funkenstein (1952) categorized fifty-eight schizo—
phrenics according to their ANS pattern and found that
abstract thinking was most deteriorated in the group with

 

the "release" from cortical inhibition pattern. The
group with normal ANS patterns showed holdisturbance in
abstract thinking.

Lang and Buss (1965) in their examination of four
theories of deficit, find support for the psychological
theories of positive and negative drive equivocal but
conclude that research findings involving the covert
responses of ANS and CNS functioning are somewhat more
promising than the usual assessment of overt behavior.

Typically researches have favored either the P031t10n
of hyporeactivity or hypereactivity as characteristic of
schizophrenia. Studies involving motor responses and
some measure of reaction time have generally concluded
in support of the position that hyporeactivity charac-
terizes schizophrenia. By contrast, many investigations
of autonomic variables in recent years have produced

results consistent with the position of hypereactivity.

Lacey (1956) feels that many of the ANS studies which
concluded in support of a hyporeactive picture were pro-
bably affected by the contribution of higher ba§§l_levels
in the schizophrenics as reduced response size would be
anticipated when baselines are already near homeostatic
limits. Then by inference, the finding of greater react-
ivity in acute and/or reactive patients as compared with
chronic and/or process patients suggests that the latter,
who are used most frequently as the schizophrenic subjects
in research, behave from a baseline considerably higher
and therefore closer to homeostatic limits than their
control comparisons (Malmo and Shagass, 1951).

Broen and Storms (1966) suggest that behavioral defi-
cit in schizophrenia is the result of arousal apart from
any necessarily defensive significance of the behavior such
as reduction of anxiety (Mednick, 1958). Their theory
states that the strength of habitual tendencies to reSpond
in a given stimulus situation, normally dependent upon
amount of previous training, interacts multiplicatively
with arousal level to yield response strength. In the case
of competing reSponses reSponse strength is a function of
the differences in response strengths between the dominant
and competing responses. However, the response strength
ceiling may be lower than the product of maximum arousal
and maximum habit strength in which case further increases

in arousal will only facilitate competing responses. This

leads to a decrease in the relative dominance of the.
dominant response with an increasing probability of com-
peting responses, thus creating a deterioration of the
original hierarchical order of response. It is this
disorganization of normal response hierarchies which

seems common to much of schizophrenic behavior.

Emotion and Physiology in Schizophrenia

Physiological responses paralleling the experience of
human emotion include the sympathetically determined behav-
ior of an increase in emptying time of the stomach, inhibition
of paristaltic movement in the GI tract, and augmentation of
blood pressure, pulse rate, and palmar sweating (GSR). Para-
sympathetic expressions of emotional discharge include an
increased frequency of urination, weeping, and a fall in the
pulse rate. Both these branches of the ANS system are acti-
vated simultaneously in emotional experience, but which sub-
system predominates varies according to the individual and
the emotive situation. In his review, Gellhorn (1953) notes
that for the most part, fear experiences seem to be related
to reactions that are primarily sympathetic; hostility, and
anxiety tend to be primarily parasympathetic physiologically.
The "upward discharge" of these ANS experiences, mediated
by the hypothalamus, results in cortical areas which are
affected by a change in the nature of the group potentials
in these areas characterized typically by a lowering of
amplitude and an increase in frequency and irregularity

which may replace the normally larger, slow (8-13 cps),

10

and regular alpha wave configuration. These changes may be
reflected in any or all parts of the cerebral cortex. Like-
wise the downward discharge may involve the whole or part
(for example sympathetic excitation may show an increase in
blood pressure without sign of change in pulse rate) of the

sympathetic or parasympathetic systems.

Autonomic nervous system changes are paralleled by
endocrine changes in the context of emotional excitement.
Thus the basic physiological pattern of the emotional
process seems to involve (l) the autonomic-endocrine
responsivity to the "downward discharge"; (2) the hypo-
thalamic—cortical "upward discharge", representing the
bodily expression of emotion in the first instance and
the feeling tone in the second and involving activation
of the cortex paralleling this subjective experience of

emotion.

Hyporeactivity

 

In his earlier work Gellhorn (19A3) concluded that
schizophrenics showed ANS hyporeactivity, especially
sympathetico-adrenal underexcitability when compared to
normals. In support of this conclusion he refers to
Finkelman and Stephens (1936) who, in studying heat
regulation in schizophrenics after exposure to cold,
found that heat production increased less in schizophrenic
patients than in normals. From studies of systolic and

diastolic blood pressure in schizophrenics, Freeman,

ll

Hoskins, and Sleeper (1932) found these measures low in
patients and this was interpreted as the result of a
diminution in the sympathetically controlled vasomotor
tone. Linton, Hamalink, and Hoskins (193A) suggested

a deficiency in sympathetic response on the basis of the
low score in schizophrenics on the Schneider test which
involved studying cardiovascular fitness or observing
cardiovascular response to changes in posture and moder-
ate exercise. Freeman and Rodnick (19AO) found that if
02 saturated with water vapor is inhaled at an increased
temperature so as to interfere with heat elimination
from the lungs, normals show a much greater increase in
blood pressure, heart rate and respiration amplitude than
do schizophrenics. On the basis of these studies,
researchers concluded in favor of schizophrenics show-
ing a decreased reactivity of sympathetico-adrenal
functioning compared to the vago-insulin system, thus
reflecting a parasympathetic dominance.

Angyal, Freeman, and Hoskins (19A0) in their review
of the Worchester Studies, also concluded that schizo-
phrenics show autonomic hyporeactivity. Employing a
variety of stimulating agents such as dinitrophenol,
thyroid extract, and forced breathing of hot, moist 02,
they found reduced autonomic nervous system responses
predominated in the schizophrenic subjects used. Nystagmic
response to vestibular stimulation, the one CNS variable
studies, was also found to be considerably reduced in

schizophrenics.

12

In his discussion of schizophrenia and shock therapy,
Gellhorn (1953) refers to further evidence in support of
the position that schizophrenics show ANS hyporesponsivity.
Even when showing overt hyperemotional behavior, psycho-
tics show no decisive hyperglycemia (Bowman, §§_§g,, 1929;
Gildea, gt_§l., 1935; Whitehorn 193A). Numerous blood
sugar studies have typically explained the diminished
reactivity of the sympathetico-adrenal systems as a func—
tion of a greater insulin/adrenalin ratio in schizophrenics
when under emotional excitement, but direct experimental
evidence has come only from animal studies. Endocrine
dysfunctions have not been demonstrated to be a prominent

contributor to schizophrenia (Gellhorn, 1953).

Hypereactivity

Over the past ten years an accumulating body of
research findings has concluded in favor of the orthogonal
position: that schizophrenia predicts physiological
hyperarousal characterized by unusually high autonomic
responsivity especially to pain stimuli (Ax, 1967). This
is paralleled by abnormally small and few conditioned
responses.

As early as 1951, Malmo and Shagass pointed out
discrepancies and evidence against the hyporeactivity
hypothesis of schizophrenia. Normal and_greater
reactivity is reported by Altschule and Sulzbach (19fl9)
in their observation of normal vasodilation and increased

vasoconstriction using 002 on acrocyanosis in

 

l3

schizophrenics. Cohen and Patterson (1937) using an
algesimeter as pain stimulus, report the average heart
rate for schizophrenic patients (n - 10) was higher
during a ten minute prestimulation period than heart rates
obtained as a ward procedure in other investigations.
Malmo and Shagass (1951) recorded EMG, heart rate,
blood pressure, and pneumograph data from groups of
chronic schizophrenics, psychoneurotics, acute psychotics,
and nonpatient controls under three different conditions
of stress. Whereas chronics resembled other patients by
showing more tension than controls, the change in tension
in this group was less than the other groups (p<.02lo
Chronic schizophrenics showed more hyporesponsivity than
other groups but during two of the stress conditions, the
EMG for the chronic group was higher than for the con-
trols. Pneumograph data was collected in connection with
a pain stressor and it was found that chronics were
relatively unresponsive especially with higher intensities
of temperature (using as a baseline each subject's initial
prestimulation respiration rate). Deviations in the
direction of decreased amplitude of respiration were more
frequent with chronics, that is, they showed more shallow
breathing than other groups. A higher mean heart rate
was noted in chronics during the pain-stressor test and
this was the only group to show a reliable increase in
heart rate. This suggests high autonomic arousal in

schizophrenics, showing at least normal if not hypernormal

1A

behavior physiologically, despite a reduction in overt
response amplitude.

Reynolds (1962) in his investigation of the somatic
system in chronic schizophrenics hospitalized for a
minimum of three years noted that normals have the lowest
basal levels and show a typical increase under stress,
reactive schizophrenics display a reduced response but
show a higher basal level than normals and process patients
show the highest basal values and least change with stress.
Muscle tension, heart rate, respiration rate, systolic
blood pressure, diastolic blood pressure were measures
recorded under conditions of three mild stressor stimuli:
exercise, a cold pressor test, and a mental arithmetic
task failure with verbal criticism by the experimenter.
Even though half of the schizophrenics (n-l6) were
taking tranquilizers and showed a significantly higher
Manifest Anxiety score than those not taking tranquilizers
and normals, this difference in felt anxiety was not
accompanied by any significant somatic differences among
the groups.

Funkenstein, §t_al,, (1951) noted that as the
psychological picture deteriorates in terms of overt
behavior, the physiological picture also changes. Observ-
ing systolic blood pressure changes from basal values
in post-therapy cases (ECT, insulin, psychotherapy,
spontaneous, or hospital milieu therapies) where there

was behavioral improvement the authors also found a

15

reduction in arousal as indicated by physiological
measures. Conversely, if the patient's psychological
picture did not change, their physiological profile also
did not change. Furthermore, patients with poor prognosis
tended to show a nor-epinephrine like state.

Whatmore and Ellis (1958) studied twenty-one schizo-
phrenics and ten normals with regard to their EMG re-
sponses under conditions of pain versus comfort. While
measures from the leg, forearm, jaw, and the forehand were
taken for a period of thirty minutes during these proced-
ures, subjects were questioned about the way they felt.

In all comparisons schizophrenics showed much higher
residual motor activity than did normals. Further divid—
ing the normals into two groups defined by presence
versus absence of psychogenic symptoms, they found that
the group with symptoms also showed more muscle tension
than the group without.

Ingram (1962) measured respiration (via abdominal
movement), EKG, ballistocardiogram, skin temperature,
skin resistance, blood pressure in a large group of
schizophrenic and non-schizophrenic subjects using the
EEG as a monitor. He was interested in examining the
hypothesis that schizophrenia is a single versus many
diseases. All subjects were submitted to a strict diet
one month prior to the testing session and had been off
drug therapy for a period of at least two months. Degree

of clinical anxiety or emotionality expressed by each

16

patient was rated independently from behavior prior to
testing, during psychological testing and during the poly-
graph recording. An eight-point clinical rating scale
was utilized and results compared to EEG data. Comparing
these findings with a group of non-schizophrenic subjects,
Ingram noted that whereas paranoid schizophrenics showed
a greater respiratory irregularity in depth and rate of
breathing than the other schizophrenic groups (p<.01),
all schizophrenics had higher skin resistance (p<.01) when
compared to non-patients. All schizophrenics showed a
greater fall in skin resistance under stress conditions
other than shock, but paranoids showed a greater respira-
tion rate under stress than all other groups of schizo-
phrenics (p<.Ol). Before drug use, schizophrenics showed
a smaller rise in blood pressure when compared to normals
when nor-epinephrine was administered. Ingram concludes
from this that there are no marked differences among
schizophrenics, either in resting level of ANS activity
or response to stress and drugs; but what few differences
did occur tended to discriminate paranoid schizophrenics
from other groups of schizophrenia. Resting ANS activity
reflected higher arousal in schizophrenics when compared
to non-schizophrenic patients. Reactivity to stress,
too, seemed to be greater among schizophrenics when
observing changes in GSR.

Venables and Wing (1962), like the Ingram study,

used ratings on the ward by the charge nurse of the degree

17

of social withdrawal shown by the subjects in the pretest
period. They found that the increase in physiological
arousal as measured by skin potential response was highly
associated with increased ratings of social withdrawal.

Using a methodology similar to that of Ingram, Ax
§£_al, (1961) were concerned with ANS responses to the
experimental stressors of pain apprehension, a psychodyna-
mic stress interview, and insulin injection. Ten male
chronic schizophrenics were compared to ten male non-
psychotic patients maintaining controls for age, diet,
absence of drug therapy and length of hospitalization.
The instructions were to call "help" when the subject
thought the intensity of the stimulus was becoming "harm-
ful"; the number of "Helps" served as a behavioral index
of stress. Two psychiatrists, one conducting the inter-
view and the other observing the interview through a one-
way mirror made independent ratings immediately after the
interview of the patients' visible degree of emotional
arousal. Applying insulin intravenously, blood samples
were taken fifteen minutes afterward and were analyzed
for amount of epinephrine versus nor-epinephrine
(epinephrine causes a greater rise is systolic blood
pressure, heart rate, ballistocardiogram values, and
respiration rate; nor-epinephrine causes a greater rise
in muscle tension and number of GSR's and produces a

greater fall in heart rate).

18

The expectation of the authors was that chronic
schizophrenics would show more nor-epinephrine kinds of
responses and that the nonpsychotic subjects would show
a predominance of epinephrine—like responses. GSR and
ballistocardiogram measures alone tended to remain stable
and differentiated between the psychotic and nonpsychotic
groups even during resting states, in that the schizo-
phrenics reflected a greater sympathetic arousal and
showed more disturbance by the test situation and a slower
adaptation to it. Whereas nine out of ten nonpsychotics
showed an epinephrine pattern, seven out of ten chronic
schizophrenics showed a nor-epinephrine dominance among
the variables and Ax suggests that perhaps two types of
chronic schizophrenics are included in this sample: The
more hostile and less responsive schizophrenics showing
a nor—epinephrine—like pattern; and the more responsive
schizophrenics showing an epinephrine-like pattern.
Interpreting the physiological data into emotional terms,
it appears that the larger sized group of chronic schizo-
phrenics in this study show an emotional pattern dominated
by experiences of anger as opposed to anxiety. In
support of this interpretation, Gellhorn (1963) finds
that with exercise, active aggressive behavior, and hostile
emotion, more nor-epinephrine is produced in normal sub-
jects. Conversely with the experience of passive, fearful
anxiety, more epinephrine is produced. Thus the finding

of more nor—epinephrine-like physiological behavior in

19

these schizophrenics suggests the interpretation that the
experiential correlate of such findings is an angry state.
With other subjects, Ax (1967) found variables such as
heart rate, diastolic blood pressure and GSR also dis-
criminate well between epinephrine and nor-epinephrine-
like groups. Nor-epinephrine dominated subjects show a
high blood pressure whereas epinephrine-like subjects show
high heart rate and ballistocardiographic index of stroke
force. GSR shows a marked increase in number of responses
during the experience of anger whereas the phenomenologi-
cal experience of fear produces much larger increases in
skin conductance and respiration rate. These findings,
(1) that autonomic responsivity to pain stimuli is often
abnormally high; (2) that conditioned responses are ab-
normally small and few; and (3) that the majority (82 per
cent) of schizophrenics in this sample had a nor-epine-
phrine-like (anger-like) psycho physiological response
pattern to the cold pressor stress in contrast to only

28 per cent of the normals agree well with some findings
of Mednick (1966). Reporting on "high-risk" children,

he finds that they (1) make larger GSR responses to a
loud buzzer; (2) have shorter latency to noxious stimuli;
(3) generalize more; (A) show faster recovery from dis-
crete stimuli; and (5) resist extinction of conditional
GSR longer than do the members of a healthy matched group.
The chief differences here between the findings on the
high-risk children and the findings on chronic adults is

20

the greater responsivity of the high-risk children comp
pared to their matched normals, as compared to the adult
schizophrenic versus healthy adults, and the apparent
readiness of the high-risk children to respond to a con-
ditioning situation. Ax interprets this discrepancy as
one of the major adaptations of the schizophrenic as he
adjusts to his unrewarding environment--that is, he
behaviorally withdraws through time, and in this way
partially succeeds in protecting himself from his over-

sensitivity.

CNS and ANS Measures in Schizophrenia

 

Darrow gt_al.,.(19A2) studied the relationship_
between autonomic nervous system responses and brain
electrical potential data. Examining ten subjects includ-
ing some normal, some improved schizophrenics and "normal"
records from suspected epileptic cases, the investigation
looked at seventy-eight reactions to specific stimuli
while GSR and blood pressure were also measured post-
stimulation. Results for the entire group were that beta
potentials increased while alpha potentials decreased and
GSR increased parallel to beta increase (r=.51) and de-
crease of alpha (r--,5o), A small inverse correlation
(rs-.2") was noted between bloOd pressure and beta wave
incidence. Thus in general it appears that increased
activity of the sympathetic nervous system predicts an

increase in beta and a decrease in alpha potentials.

21

In another study, Darrow (1943) addressed the
problem of determining whether an observed peripheral
event is due to increase of activity in one branch of
the autonomic nervous system or to decrease of activity
in the other. A rise in blood pressure, for example, is
too often assumed a function of increased sympathetic
activity; conversely a fall in blood pressure is generally
interpreted to mean an increase in parasympathetic
activity. Yet, a rise in blood pressure can be due to
a decrease in parasympathetic tone with sympathetic
nervous system activity remaining stable. This oversight
may account for some of the literature which suggests
opposite relationships between blood pressure and other
measures of autonomic nervous system activity. Pulse
rate, like blood pressure, is the resultant of a balance
between the sympathetic and parasympathetic nervous
systems. In addition there tends to be a compensatory
slowing of the heart when there is a rise in blood press-
ure and an acceleration in pulse rate when there is a
fall in blood pressure. Even though hyperglycemia occurs
only with strong emotion in humans, absence of hypergly-
cemia which is a finding often reported in schizophrenics,
may not suggest a defect in the sympathetico-adrenal
function, but may be the consequence of an increased vagal
activity and insulin secretion instead. Thus blood sugar
level is not a simple reflection of autonomic influences

but, too, depends on a balance of opposed autonomic

22

factors. This often overlooked interdependency of
autonomic factors argues for the measurement of CNS
variables as less ambiguous correlates of emotional
experience.

EEG work done at the same lab with the same subjects
that Ax used (1967) suggested that generally measures of
sympathetic activation such as digital vasoconstriction
to pain and epinephrine-like arousal to a cold pressor
test consistently had negative correlations with EEG
amplitude. Thus it appears that low sympathetic arousal
is accompanied by higher amplitude rhythmic activity in
all frequencies of the EEG, whereas psychophysiological
activation (tension and anxiety) are more related to
desynchronization at all frequencies rather than to low
voltage high frequency alone as most of the previous
literature reports. Much of the difficulty with earlier
research has been the lack of sophisticated equipment
but in the Ax study a frequency analyser was used and

so some of this information became manifest.
Electroencephalography and Schizophrenia

General Considerations

A normal waking adult electroencephalogram is com—
posed of alpha and beta waves, some low voltage random
activity, and a small amount of delta waves. Although
records from different parts of the cerebral cortex

show somewhat different patterns, alpha is found in all

23

areas of the cerebral cortex but is produced in greatest
amount in the occipital region.

All electrocortical wave activity is thought to be
a result of the polarization and depolarization of the
neurons. Polarization is generally assumed to arise
either from metabolic oxidation and reduction processes,
from interface (boundary) potentials, or from subliminal
action potentials (Cohn, 1946). Depolarization is attri-
buted to volleys of incoming action potentials of A
sufficient voltage to trigger the stored charge. Although
there is debate as to the exact mechanism responsible for
these potentials, much is known about the conditions which
influence potential differences.

Strauss, et_§l., discuss some physiologic concepts
useful in the interpretation of the EEG (1952). If a
large number of cells under one electrode show a devia-
tion in the same direction from the zero line of potential
at the same moment while the remaining cells show no
deviation, at least not a synchronized deviation, then
a potential will be picked up by the electrode. This
synchronization of the activity of many cells is thought
to be responsible for the origin of brain waves. An
inherent function of the cerebral cortex, it has been
suggested that this synchronization is controlled by a
"pacemaker mechanism" situated probably in the diencephalon,
and may be disturbed by factors such as emotional tension,

sensory stimuli, and concentration. Through hyposynchrony

24

or asynchrony, these activities will tend to suppress
alpha activity, which is the modal wave form for most
normal waking adults.

Wave kinds are defined primarily by frequency, and
alpha, the most prominent frequency range, regardless of
the region of the cortex, is usually defined as those
waves showing eight through twelve cycles per second
(cps). The beta wave range is roughly from thirteen
through thirty cps and amplitudes usually reflect less
than twenty microvolts. Voltage level may vary according
to distance between electrodes and whether monopolar or
bipolar methods are used. A typical bipolar mean occipi-
tal (alpha) voltage is twenty-four millivolts having a
range of 9-48 millivolts; monopolar recordings elicit a
somewhat higher average voltage.

Although alpha may not be seen in the newborn infant,
it gradually appears in increasing incidence until a
constant rhythmic pattern appears by late adolescence.
There are large interindividual differences, but in any
individual the frequency regulation in a sample record is
well maintained within 1/2 wave per second under standard
awake conditions. Waves less than eight cps (theta and
delta) indicate interference with cell metabolic function
and may be evidence of an organic lesion.

The EEG record may be evaluated according to fre-
quency, amplitude, per cent time or amount of time of

certain types of waves, and variability of wave behavior.

25

In normal subjects per cent time alpha, which has been
the most common unit of comparison, varies from 0 to '

about 100 per cent. The blocking of alpha waves--that

is, the cessation of the appearance of alpha correlates
with measures of attention and is preferred by most

researchers as the criterion of electrocortical arousal.

Parameters of Alpha Blocking

 

Adrian and Matthews (1934) confirmed Berger's
observation that the occipital lobes seemed to be the
area where alpha wave behavior was most predominant. In
addition, they demonstrated the alpha wave's responsivity
to light and concluded that the essential condition for
the presence of alpha was the absence of patterned stimuli.
In administering an arithmetic problem to subjects, they
noted that this problem, which required the whole atten-
tion of the individual, abolished the alpha rhythm even
though the eyes remained closed.

Jasper and Cruikshank (1936) studied the effect of
variation in stimulus intensity and duration upon alpha
blocking. They concluded that blocking time (time between
appearance of light and attenuation of alpha wave) varies
inversely with intensity of the light stimulus when dura-
tion is held constant.

Redlich, Callahan, and Mendelson (1946) noted that
the presentation of visual stimuli is not sufficient in
all cases to produce alpha blocking. Of 100 subjects

tested with a standard clinical EEG procedure, twelve of

26

these showed no alpha blocking on eye opening and exposure
to a visual stimulus. In an earlier study, Jasper and
Cruikshank (1937) concluded that the significance of the
alpha blocking appears to be associated with the attention
value or the arousal value of the stimulus for the

organism rather than with the modal or the intensity
attributes of the stimuli as such. Povarinsky gt_§l. (1955)
noted that when direct conditioned stimuli were substituted
by their verbal designations changes immediately appeared
in the EEG similar to those evoked by direct stimuli;

alpha rhythm was depressed and beta rhythm intensified.

In cases where preliminary verbal instruction is used,
there is less alpha than with verbal conditioning
procedures without preparatory verbal stimulation
(Christian, 1960).

One of the few studies that has examined, although
only by eye judgment, the amount of increase post-stimu-
lation of alpha behavior is that by Cruikshank (1937).
Here, using a series of intensity levels of light and
recording the occiput EEG behavior with up to four pairs
of electrodes, data from a selection of five normal stu-
dents showed a variation of increase in per cent alpha
behavior poststimulation between 20 and 40 per cent of
the prestimulation variable. This is reported for the
maximum intensity used, ten millilamberts the amount
of increase in frequency following stimulation decreases

to only one or two per cent at near threshold intensity.

27

The frequently observed finding in schizophrenics'
EEGs of dysrhythmic and/or low amplitude fast activity
is complemented by Jasper's (1936) exploration of normals
using varying degrees of excitation. He reports that a
loss of rhythmic activity occurs with extreme excitation
and an increase in low amplitude fast activity is noted

with the application of a stimulus producing moderate

excitation. These findings with induced moderate excita-

'tion in normals agree with many of the reports reflect-

ing a non-manipulated resting EEG of schizophrenic subjects.
If the subject is experiencing strong emotion, the
amount and amplitude of alpha waves diminishes and an
increased frequency appears (Darrow, e£_al. 1942).
Darrow suggested that alpha may be an important factor
in neurophysiological homeostasis. Low incidence of alpha
may permit an increase of emotion and increased alpha may
act to reduce low voltage fast activity and terminate
excitation. External and internal sources of cortical
excitation are characterized typically by a low voltage
fast EEG, and it is this low potential fast activity which
corresponds to the integrative processes of the cortex.
Sherman and Jost (1942) state that EEG and ANS
measures provide a better index of emotional reactivity
than overt behavior, verbal or other. They conclude that
the best measure of emotional stability is the duration

of the dominant alpha frequency.

28

Jasper (1936) in his application of different levels
of excitation involving the ANS so as to produce feelings
of fear, anxiety, and worry, reported that changes in the
ANS variables predicted marked changes in the frequency
and regularity of brain rhythms. Loss of rhythmic
activity occurred with extreme excitation and an increase
in low amplitude fast activity appeared under circum-
stances of moderate excitation. Loomis gt_al. (1936)
were primarily interested in long term recordings of
normal subjects between seventeen days and seventy-four
years of age with regard to individual variation in the
waking state and characteristic population changes during
sleep. In agreement with Berger (1929) these researchers
found conditions leading to alpha blocking included:

(1) sleep; (2) the attempt to perceive objects; (3) emo-
tional disturbances; and (4) concentrated attention.
Jasper noted that many of his subjects showed relatively
little alpha behavior in the first hour or so of record-
ing, yet when they were apparently accustomed to the
electrodes and the strange surrounds alpha behavior began
to appear. He concluded that this reflected a change in
emotional state of perhaps apprehension or embarrassment
initially to one of greater relaxation and acceptance of
the strange circumstances of the machinery. Asking the
subjects at a given signal to try to imagine themselves
in a terrifying situation also produced consistant alpha

blocking.

29

Cohn (1946) examined patients with histories of
headaches and various forms of emotional disturbance
related to domestic difficulties and interference with
work and compared them to patients who clinically showed
symptoms of vomiting, dizzy spells, and digital tremors.
Although the author does not mention the size of these
two groups, he found that the former group reflects an
EEG pattern characterized by low amplitude, random high
frequency oscillation in all regions of the head. The
second group emitted an EEG pattern characterized by
rhythmic high frequency oscillation (usually 18-22 cps),
predominantly in the frontal and parietal region. This
is a pattern similar to that reported by Finley and
Campbell (1941) in affect disorders of the major psychoses.
Cohn thus concludes that in hyperemotional states two
characteristic types of EEG patterns may be found. He
compares the first pattern, where all regions of the
head showed an equal low amplitude random high frequency
behavior, to the pattern characteristic of the brain when
receiving protracted afferent stimuli. The pattern of
the second group characterized by rhythmicity and high
frequency of wave behavior, is found to be usually stable
and uninfluenced by afferent stimuli of ordinary intensity
when applied to the subject.

In his review of the effects of certain forms of
emotion on the normal EEG, Thiesen (1943) points out that

the major problems in researching the effect of emotional

3O

stimuli upon EEG is the difficulty of producing emotional
reactions in any standard way in the laboratory. Attempt—
ing to resolve this problem, he presented a mixture of
standardized stimuli including verbal and visual forms

of presentation. Using the EEG as a monitor, ten subjects
were examined who gave only normal baseline EEG records
and showed no family history of intracranial pathology

or mental disorder. Both clinical and quantitative
assessments were made of the EEG data, but whereas the
effects of the emotional excitement of the subjects did
not produce clinical discriminations between emotive and
nonemotive stimuli, quantitative assessment of the EEG
record showed a depression of alpha and a decrease in
rhythmic activity associated with onset of emotional
excitement. Conversely increase in non-serial slow acti—
vity and a tendency toward a flatter (high frequency,

low amplitude) record was noted (p<.Ol). Great individual
variation was noted, however, and three of the four most

reactive subjects showed a depgession of fast activity.

 

Thus, change in the direction of a flatter and more desyn—
chronized record was associated with emotion-producing
stimuli, but quantitative assessment was necessary to make
the change visible.

Gastaut gt_§l. (1951) were especially interested in
the relationship between EEG measures of excitability and
clinical measures of "calmness" versus excitability.

"Nervous" subjects showed by contrast to "calm" subjects

31

a dominant rhythm in the upper half of the alpha range,
therefore, of less amplitude. The "nervous" subjects
tended to show a low voltage picture to the "calm" sub-
ject's high voltage alpha of 8-10 cps. No indication
was given of the measures of excitability used for the
psychological comparison, however.

Lange et_al. (1960) selected subjects from a group
of normal persons according to the relative dominance of
beta, alpha, or theta waves. Using an eight-channel EEG
recorder and two frequency analyzers, twenty-four normal
adults, about even for each sex, were tested with the
Rorschach, the Bourdon, Kraepelin, the Passalong, the
Wiggly Blocks, and the Four Pictures Test. EEG's were
examined for mono- versus poly-rhythmia and degree'Of
frequency fluctuation in the rhythm, alpha index, per cent
of fast and slow alpha variance, and the dominant fre-
quency. Subjects were secondarily categorized, without
reference to their EEG records, according to a number of
dimensions related to drive and feelings of self-confid-
ence. Those with little beta and theta and relatively
high alpha tended to show monorhythmic alpha with a
moderately high amplitude, and psychological characteristics
of extensity, activity, self-confidence, and generally an
absence of tension and anxiety. Subjects with a little
theta and alpha but much beta showed a polyrhythmic alpha
record, and psychological characteristics of intensity,
tenseness, anxiety, and unfavorable reactions to feelings

of social insecurity.

32

Test conditions involving some degree of emotional
arousal such as apprehension, startle, or anxiety and
personality dimensions assessing reactivity and tension
predict a depression of alpha and an increase in low
amplitude dysrhythmic wave behavior. This represents

the consensus of the literature to date.

EEG and Personality

 

Some authors report relationships between character
traits and EEG parameters. Lemere (1936) found "good
alpha" in cyclothymic individuals and "poor alpha" in
schizoid subjects. He, as Darrow (1942), suggested that
the capacity to produce a predominance of alpha waves
related in some way to the affective capacity of the
individual. Using a psychoanalytical method to obtain
psychological data, Saul gt_al, (1949) separated seventy
non—psychotic patients into two groups according to high
versus low alpha index. Persons with a high alpha index
were found to be passive, inhibited, and dependent.
Patients with low alpha indexes exhibited a consistent,

well-developed activity orientation and were often

described as frustrated, agressive’ and impgtieht,

Abnormality and EEG in Schizophrenia

Attempting to see if the EEG could differentiate
between psychotics and normals, as well as predict change
clinically, Davis and Davis (1939) examined "alpha index"

in schizophrenics and manic-depressives in comparison to

33

a group of normal subjects. Although the fundamental
pattern of psychotics could not be distinguished from
normal, there appeared to be a large proportion of
patients showing variation outside of the normal range of
variability. These authors were particularly concerned
with variations bordering on CNS pathological indices,
waves resembling brain lesion patterns, epileptic forms,
and sleep wave profiles in the waking and/or cyanotic '
state.

McMahon and Walter (1938) were among the earlier
researchers to address the question of whether schizo-
phrenics showed EEG deviation from normals. Using a two-
channel EEG they examined thirty cases, including eleven
catatonics, three hebephrenics, three chronics of
undifferentiated type, and seven others of equivocal diag-
nostic classification, all of whom had been under hospital
care between three and ten years. They examined the EEG
records for differences with the normal EEG and noted
that eye movements (REM's) and blinking produced artifacts,
which they concluded had probably contributed to findings
of earlier research using the delta index as a measure of
degree of abnormal activity. Even though these artifacts
produced delta waves, they noted that unlike typical CNS
pathological cases, the delta behavior was not localized.
Without reporting statistical data, the authors indicate
that a "certain number of the patients" displayed a true

delta discharge having a focus in the frontal lobe. Two

it

 

34

of the catatonics showed an unusually high incidence of
alpha. On the basis of these observations, the authors
suggest two conclusions: (1) that there is-a variation
within the physiological range and prominence of alpha
rhythm; and (2) that there may be a truly pathological
delta discharge, primarily in the frontal lobes, but
lacking the focal quality of epileptic discharges. They
emphasized that, while neither of these is diagnostic of
schizophrenia, they may be found in a certain incidence
among schizophrenics.

Furthering her interest in classificatory schemes
for EEG in psychiatric disturbance, Pauline Davis (1940)
grouped 132 schizophrenic patients into three EEG cate-
gories: (l) "Norma1,¥ essentially a normal pattern;
(2) "Dysrhythmic,9 resembling patterns of convulsive
disorder patients; and (3) "Choppy,? characterized by
little or no alpha but much low activation of the cortex
by subcortical mechanisms. She found that of the patient
group, more paranoids gave records belonging to the‘hormal"
group. Most of the patients, hOwever, fell into the second

group suggesting the incidence of minimal brain dysfunction
resembling epilepsy. The patients falling into "Choppy,?

a pattern which tends to exclude a high incidence of
alpha, showed some evidence of past or present organic
brain disease. The dysrhythmic patients were more often
catatonics and persons who showed unpredictable behavior

in their clinical histories. Thus, the relatively

35

"healthy" schizophrenics, the undeteriorated paranoids,
showed the healthiest EEG records. However, those patients
undergoing ECT treatment, if they had previously shown a
normal record, became abnormal during and after ECT; if
they had shown a baseline abnormal record, ECT predicted

a worsening EEG record. Stability of the EEG pattern
correlated with clinical stability (Davis makes a distinc-
tion between stability and normality here). Dysrhythmic
patterns, on the other hand, correlated with unstable
behavior.

Walter (1942) studied a group of psychiatric patients,
including six catatonics, sixteen non-catatonic schizo-
phrenics, two manic-depressives (manic phase), and ten
manic-depressives (depressive phase). Using a three-
channel amplifier and Grass ink-writer, standard clinical
EEG records were collected for all subjects, including eye
opening and closing, mental activity, and hyperventilation
procedure. In an attempt to classify the records according
to the broad Spectra of "normal, abnormal, or doubtful" he
found only two schizophrenics that gave records definitely
outside the normal range. Both of these were catatonic
schizophrenics.

Kennard and Levy (1952) found "psychological dete-
rioration" as measured by duration of symptoms predicted
the presence of an abnormal EEG. This finding was used
to support their theory that schizophrenia is a progressive

disorder which ultimately affects all organic systems

36

including the cerebral cortex. However, Barker gt_al.
(1950) in recording the EEG from epileptics during inter-
views which included significant stress materials selected
from the patient's history, found that subcortical EEG
discharges were associated with distress in recall of the
experiences. These authors conclude that these discharges
provide some psycho-social distress warning, therefore
negating the premise that abnormal discharges are to be
taken as evidence only for the existence of an organic
pathological process.

Lindsley (1944) concludes that there are no distinc-
tive abnormalities in the EEG associated with a particular
type of disorder. Generally, findings of definite
abnormality in the EEG of schizophrenics have been incon-
stant and minor (Strauss, gt_al., 1952). Yet while there
are no consistent characteristics of the EEG to clearly
differentiate schizophrenics from normals or other
psychotic patients, a subgroup of schizophrenics do show
a variety of abnormalities--mainly of low amplitude,
irregular, high frequency rhythm variations.

Kiloh and Osselton (1966) suggest two conclusions
about the body of data relating EEG and schizophrenia to
date: (1) no particular EEG pattern can be regarded as
typical of schizophrenia; and (2) in the overall majority
of cases the EEG of the schizophrenics is within normal
limits. Even in cases where there is some evidence of

CNS pathology, the abnormalities are relatively slight

37

in degree. On the other hand, these authors report that
in response to physiological variables schizophrenics
show a wider scatter about the mean of normality than do

controls.

Normality and EEG in Schizophrenia

 

Whereas most of the recent literature would agree
with the first two points here, that there is no typical
pattern and that most schizophrenics show an EEG within
normal limits, there seems to be greater debate about
the schizophrenics range of physiological response to
stimuli including variability of the EEG pattern. Relative
incidence of alpha versus beta waves, alpha blocking, and
conditionability of alpha have all been examined with
regard to this issue.

Davis and Davis (1936) reported a mean alpha index
above 50 per cent on a large group of normal controls and
most other authors conclude in the same general area of
50 or greater per cent time alpha for a normal population.
Yeager and Baldes (1937), using Davis's EEG classification
scheme, reported a high per cent of their schizophrenic
patients showing EEG's of "rare" (0-25 per cent) or "mixed"
(25-50 per cent) alpha incidence in contrast to the higher
level of alpha in manic-depressive and involutional
depressive patients. Additionally the authors collected
a standard EEG from each of seventy adult, primarily male,
organic and nonorganic psychiatric patients, (including

thirty-three schizophrenics, twenty-four of whom were

38

catatonic). Analyzed for per cent time alpha, these
records revealed no significant variations with regard to
abnormality of the EEG among the nonorganic psychotic pa-
tients. Although the beta wave data were of no diagnostic
value, in all cases of the psychotic records beta waves
were found to be more prominent under absence of alpha wave
behavior than they were noted in the records of normals
under similar conditions. Unfortunately, no statistical
data were reported in this study and this is a problem with
many of the earlier reported findings.

Davis and Davis (1937), using their scale of per cent
time alpha in assessing the records of seventy patients diag-
nosed as psychotic, also found that manic-depressive patients
showed a nearly normal distribution interindividually in
terms of per cent time alpha; schizophrenics, however, show
a significant trend toward low incidence of alpha wave
behavior. Further, the clinically quiet and cooperative
patients show a more nearly normal distribution of alpha
wave incidence in comparison to chronic, or disturbed
patients who show a scarcity of prominent alpha waves.

From a total of 3,100 patients, Stevens and
Derbyshire (1958) selected the twenty-one catatonic schizo—
phrenic patients showing the most severe symptom pictures.
Comparing the EEG record before and after administration
of sodium amobarbital the authors noted that those patients
who showed an initial baseline of more than 38 per cent

time alpha showed a fall post medication in alpha per

39

cent time. Those patients showing an initial per cent
time alpha less than 38 per cent, conversely, showed an
increase in alpha post medication. Thus even though

there was wide variation in the patient's behavioral mani-

festation of hyper- as opposed to hypo-activity, the

 

physiological picture was congruent in that all patients
showed a hyperalert state and responded differently to
sodium amobarbital in terms of the degree of internal
arousal. Again, by comparison with normals the schizo—
phrenic subjects in this study showed a low alpha
baseline.

Grinker and Serota (1938) noted that, whereas the
EEG's of normals responded by either a more slow or more
fast range of amplitude upon stimulation by various
stressors, e.g., external cold, electric shock, intra-
venous epinephrine, and emotional disturbance by verbal
provocation, the EEG's of schizophrenics showed no dis-
cernible change upon impact of these stimuli. However,
Grinker and Serota do not note the character of the base-
line EEG in the schizophrenic subjects. If in fact the
schizophrenic initially showed a higher level of physiolo-
gical arousal, one would expect less change with stimuli
which typically produce increased arousal in the EEG
record.

Rubin and Wall (1938b) examined the EEG records of
sixty schizophrenic subjects (no subdiagnostic information
was indicated) and sixty normals, observing whether there

were differences in per cent time alpha, number of alpha

40

bursts, and/or average length of alpha bursts. Using a
monopolar lead from the occipital lobe, they observed a
mean of 38 per cent time alpha for normals as opposed to
34 per cent time alpha for the schizophrenics, thus show-
ing a trend toward a lower incidence of alpha in the
schizophrenic group, but one which did not reach statis-
tical significance. In comparison to other studies
observing per cent time alpha in normals, this normal
group shows an unusually low incidence of alpha.

Jasper, Fitzpatrick, and Solomon (1939) examined
the records of fifty—one epileptics, sixty normals, and
eighty-two schizophrenics (twenty-eight catatonics,
twenty—two hebephrenics, eighteen paranoids, and eight
simple) for per cent time alpha. Using recordings from
frontal, central, parietal, and occipital leads, the
schizophrenics showed about an equal distribution from 0
to 100 per cent alpha, while the majority of normals gave
a per cent time alpha above 50 per cent with a mode at
about 70 per cent for the frontal and central regions and
a mode of 50 per cent for the occipital lobe lead. For
all lead distributions, schizophrenics showed more cases
in the 0-20 per cent class and fewer cases in the 80-100
per cent class than the normal or epileptic subjects.
Thus the schizophrenic records, by contrast to the other
groups were characterized by "flat", higher frequency
activity. Although no quantitative data are reported, it

is mentioned that the paranoid subjects tended to show

41

more cases with higher incidence of alpha than did the
other subgroups of schizophreniCs. At the time of
recording, each patient was assessed for "degree of con-
tact with the environment." There was a contingency a
correlation of .50 between the four classifications, per
cent of degree of contact and the per cent time alpha.
More paranoids were rated in good contact and conversely,
more hebephrenics and catatonics in poorer contact.

These authors used an alpha category extending from 8-15
cps, somewhat higher in the upward range in defining alpha
behavior than other researchers use. Again, schizophrenics
showed a much greater incidence of EEG abnormality, (25
per cent) than normals (8 per cent), but there was no
single specific form of EEG activity which could discrimi-
nate the psychiatric patients from the non-psychiatric
patients and normals.

Davis (1942) again compares the EEG record of
schizophrenics (non-differentiated as to subtype) and
manic-depressive patients. Comparing 129 schizophrenics
with eighty-one manic-depressive subjects, she notes fur-
ther that the schizophrenic group shows more records
characterized by the "B" type pattern whereas the manic-
depressive patients show a prominence of "A" pattern.

She interprets this finding as a reflection that schizo—
phrenics as a group appear to be dominated by internal
overactivity, overstimulation, or lack of organization

within the CNS.

42

Blum (1957) tested the hypothesis that schizo-
phrenics would resemble brain-damaged patients in their
failure to show normal responsiveness of the alpha rhythm
to visual, auditory, and photic stimulation. Twenty—four
normals, twenty schizophrenics on tranquilizers, and
twenty schizophrenics without drug treatment, and twenty
chronic brain syndrome patients subjects were categorized
according to how much responsiveness to the stimuli they
showed (alpha blocking). No differences were noted between
groups with regard to normal resting alpha rhythm, and no
differences between schizophrenic groups were noted.
Normal subjects, however, showed significantly greater
alpha responsiveness (alpha blocking) to stimuli than
schizophrenics (p<.05). Normals showed this same differ-
ence from brain-damaged patients, thus suggesting that
schizophrenics resemble brain-damaged patients in their
lack of brain wave responsiveness to stimulation and
tranquilizer drugs seemed to have no or minimal effect

on this responsivity.

Variability in Cortical Measures

Jasper gt_al. (1939), concurring with the findings
of Davis, also finds wide variation within schizophrenics
on EEG records compared to normals. However, Travis and
Knott (1936), found greater inter-individual differences
among normals in time lapse between the removal of a

light stimulus and the appearance of the potential rhythm

43

(alpha). Yet in the second half of the trial run, it was
noted that there was a general decrease in perseveration
time for individuals as well as for the entire group;
this refers to the process of adaptation. There is some
indication that schizophrenics do not show this same
process, or at least, in the same degree. They seem, by
contrast, to not show this same capacity for adaptation
to stimuli. Hill (1957) criticizes some of these earlier
studies from the point of view of their lack of control
for age; thus some of the variability reported among
schizophrenics may be due to physical factors related to
aging rather than to the disease process itself. In a
somewhat more carefully controlled study, Rubin and Wall
(1938b) found both normals and schizophrenics to show
insignificant variation between groups in per cent time
alpha, number of alpha bursts, and average length of alpha
burst within an experimental session and found only
slightly greater deviation between groups from day to
day. These authors found that normals showed variation
122 times greater between individuals than within the sub-
sequent records of the same individuals.

Acute schizophrenics showed inter—individual
variation forty-five times greater than intra—individual
variation and chronic schizophrenics (also no n_given)
showed an inter-individual variations twenty-seven times

greater than intra-individual variation. While on any

If

 

I.) -‘J‘I h ...'

44

one session the normals were more heterogeneous, the
patients showed much more intra-individual variation from
day to day (p<.05). Thus it appears that schizophrenia
makes individuals more similar to each other.

In Lindsley's review of the literature on "Electro—
encephalography in Personality and the Behavior Disorders"
(1944) he concurs in reporting that, whereas there are
large intgg-individual differences among normals, intgas
individual variability is relatively low.

Shakow (1952) points out that variability becomes a
problem in EEG studies of schizophrenics compared to
normals. Some schizophrenic patients consistently show
coefficients of variation three times that of normals
(Sugarman gt_al., 1964), although the general finding is
that schizophrenics give a coefficient of variation con-
siderably less than that of normals.

More recently, Goldstein, g£_al. (1965), using the
Drohocki technique and taking standard clinical EEG
records from chronic schizophrenics, have found that the
coefficient of variation, figured on the basis of mean
energy content (MEC) of the Drohocki integrator data, is
much less among patients than among normals (p<.001).

In contrast to earlier investigators (Rubin and Wall,
1938b; Lindsley, 1944) these authors found schizophrenics
to be somewhat less variant than normals in Veek to week

‘comparisons.

45

Regardless of the incidence of MEC, neither the
patients nor the normals in the Goldstein gt_al. study
showed any consistent relationship of coefficient of
variation with level of MEC. Thus differences between
coefficients of variation of normals and patients were
independent of their alpha indices (alpha index and MEC
being closely related). Furthermore this low variability
of schizophrenics does not seem to change under different
conditions of recording such as lying down, lying down
with eyes open, closed, or sitting with eyes open. The
authors suggest that this lesser variability in the
records of the schizophrenics is related to a higher
arousal level and absence of periods of drowsiness both
in behavioral and EEG criteria. Length of institutionali—
zation did not seem to be an important factor, as no
differences were noted between patients who had been
hospitalized two as opposed to twenty years. Likewise,
no differences were apparent in a group of inmates studied
some of whom had been incarcerated for two and some for
as long as twenty years. Furthermore, no significant
trend for either age or number of years of illness could
be noted with MEC or coefficient of variation findings.
Thus differences appeared to be due to hyperarousal in
the schizophrenics.

This position is supported by a number of drug
studies relating EEG variability to stimulant

and sedative drugs (Murphree et al., 1962; Goldstein gt

46

31,, 1963a; Pfeiffer gt_al., 1963). These studies noted
that barbiturates and tranquilizers in varying quantities
showed increases in EEG variability as a by-product and
that conversely LSD tended to reduce the coefficient of
variation in normal subjects. Thus it appears that the
coefficient of variation is inversely related to level

of activation of the cortex.

Although early studies which relied primarily upon
clinical assessment of EEG data often reported a differ—
ence in incidence of normal wave behavior in schizophrenics,
examination of EEG parameters in psychiatric subjects has
only regained attention in the last several years. Much
ambiguity still remains in the literature as to the degree
of difference between EEG behavior in schizophrenics and
normals, but the growing consensus is that schizophrenics
show a more dysrhythmic, unusually aroused, cortical state
which increases with chronicity. Reported sex differences
are rare, and this at least reflects the disinterest in
sex as an independent variable by most researchers.
Variability, however, is much lower between schizo—
phrenics than among normals and this may reflect the in—
tensity and consistency of the over-aroused physiological

state of the chronic patient.

Habituation and Recovery

 

Habituation or diminution of response strength over
time, occurs as a result of repeated stimulation of the

same neuronal pathway or when a novel but similar stimulus

47

is introduced (Jus and Jus, 1960). Gastaut and Bert

(1961) report habituation of alpha blocking to occur
fastest when either a weak light or tone stimulus was
applied in normal subjects. And the higher the baseline
alpha level, the faster the habituation. Attempting

to manipulate activation level in fifteen normal subjects
by exposing them repeatedly to a perceptual conflict
situation, Frankenhaeuser gt_§l. (1966) found a progressive
decrease in physiological and subjective indices of
activation as performance improved. As the subjects became
more successful at naming the color of cards in a color-
word task, measures of subjective arousal, skin conduct-
ance, and adrenalin excretions decreased, and this linear
relationship was especially strong between the first two
test trials. The authors concluded that similar and
parallel changes characterize the response patterns for:
these different measures.

As early as 1937, Cohen and Patterson reported
schizophrenics showed a diminished heart rate change over
the course of ten successive pain stimulation trials.
Using an algesimeter and applying it as a pain stimulus
at five—minute intervals and recording via a cardio-
chronograph the heart rate of the subject simultaneously
they examined ten normals and ten schiZOphrenics.

Whereas the schizophrenics tended to maintain their
initial heart rate of eighty beats per minute, the normals

decreased to about seventy-four beats per minute over the

48

ten trials. This was interpreted as a failure for the
patients, on the average, to show adaptation to the pain
stimulus; the schizophrenics showed much variability in
reaction pattern, however. This failure to show habitua-
tion in schizophrenia points out how the experimental
situation itself may induce changes in the particular
phenomenon under investigation. The fact that the average
heart rate during the ten trials was higher than those
heart rates obtained as a regular ward measurement pro-
cedure also suggests that the experimental situation
itself may induce changes in the particular phenomenon
under investigation. Yet even if the experimental situa-
tion may produce an unusual baseline level of the varia-
ble being studied, the failure to show adaptation in the
schizophrenics stands independent of this possible
experimental effect.

Gastaut §t_al. (1951) reported that their "calm"
subjects showed a recuperation time from neuronal post-
excitatory excitability longer than that of the "nervous"
subjects. Most of the earlier findings in psychophysiolo-
gical research of schizophrenics have stated that the
schizophrenic requires a longer recovery period from
autonomic disturbance than does the normal individual
(Williams, 1953; Ax g£_al., 1962). More recent work,
however, has suggested that the assumption of slower
recovery in schizophrenics is not descriptive. Examining

children with "high risk" for schizophrenia, Mednick

49

(1967) has found an unusually gait recovery rate on
measures of GSR. Zahn (1966) has come to a parallel con-
clusion using adult schizophrenics, i.e., schizophrenia
is apparently characterized by faster recovery and failure
to show response habituation. He observed that the GSR
to a repeated noise stimulus dropped less in his schizo-
phrenic subjects than in his normal controls and that the
schizophrenics remained at essentially the same high
general arousal level throughout the experimental period,
whereas in normal subjects the level gradually diminished.

Travis and Knott (1937) examined normals for per-
severation time to twenty words, twenty nonsense words,
and a control ten blank cards, while varying emotionality
of the words and controlling for size and configuration
of the nonsense words by using the same letters as con-
tained in the words. With repeated presentations, words
seemed to lose their arousal value as assessed by EEG
changes, however, meaningful and nonsense words were
associated with longer perseveration times than light
alone.

Thus normal subjects show a parallel between improved
performance through familiarity with the stimulus
materials and a reduced internal arousal level.
Habituation and recovery are altered as a function of
schizophrenia, with less of the former and more of the

latter found among schizophrenic patients.

50

Severity of Disorder and Psychophysiology

A number of studies using physiological variables
in the examination of schizophrenia have noted differences
in the performance of patients diagnosed as acute vs.
chronic, process vs. reactive. To mention just a couple,
Gellhorn (1963) noted that a number of ANS factors indi-
cating sympathetic arousal increased in normal subjects
with overt expression of emotion and decreased in
schiZOphrenic patients when increases in emotionality
were reduced (r=.26; p<.01). He further reports that
metholyl test responses measured in blood pressure changes
discriminate chronics from acutes. However, both groups
looked hyperreactive compared to normals. Shagass and
his colleagues have noted a number of differences regard—
ing sedation threshold, including a difference between
chronic and acute cases of schizophrenia (1958; 1958a).
Shagass tested the hypothesis that individual differences
in drug tolerance may reflect significant aspects of
affect and personality. Using a 0.5 milligram/kg intra-
venous injection of amobarbitol, he noted at what point
speech slurring began to occur in a group of forty-five
non-patients, 308 psychoneurotics, and 350 psychotic
patients. Frontal EEG records were monitored simultaneous-
ly. With a reliability of r=.83 for the total group,
sedation threshold increased with degree of manifest
anxiety in normal and psychoneurotic patients, but the

normals showed a lower sedation threshold than all of the

51

psychoneurotics with the exception of the hysterics.
Acutes had significantly lower thresholds than chronics,
and after one year of illness as defined by hospitaliza—
tion, schizophrenics' thresholds tended to be generally
high.

More recently Gromoll (1961), in his comparison of
process and reactive schizophrenics with regard to level
of cortical activation and arousal, concurred that, while
this difference did not reach significance, the process
rather than the reactive patients manifested evidence of
prolonged electrocortical response to stimulation. Process
patients continued to show fairly high levels of activation
across experimental conditions of rest, visual-auditory
stimulation, auditory stimulation, and auditory-stress.

The growing concensus of psychophysiological research
with schizophrenics is that they tend to be over-aroused,
and this physiological hyperactivity varies with chroni—
city. Performance deficit also varies with chronicity.
These two sources of data support a drive theory of
schizophrenia, wherein schizophrenic deficit may be ex-
plained as the result of the disruptive effects of an
excessively high arousal or generalized drive state.

Paranoid vs. Non-Paranoid Subjects
in Studies of Schizgphrenia

Most studies which have taken into account subcate-
gory differences have reported discrepancies between

paranoid and non-paranoid subjects examined for differences

52

in perception. Venables and Tizard (1956) find that non-
paranoid chronic schizophrenics show faster reaction to
visual than to auditory stimuli, whereas normals and
intact paranoid schizophrenics show the reverse relation-
ship. Johannsen (1961) found paranoid schizophrenics,
non-paranoid schizophrenics, and normals behaved differ-
ently depending upon the presence or absence of the
experimenter in the room when the subject was being
tested. Each subject was required to learn a repetitive
double alternation pattern under conditions of presence
or absence of the experimenter seated beside them and
saying "right" or "wrong" according to the correctness
of their response. Normals showed better performance with
feedback and non-paranoid schizophrenics showed the
reverse. All subjects did equally well under conditions
of non-social feedback and paranoid schizophrenics did
equally well under both conditions. One interpretation
suggested is that, as supposed by Mednick (1965), social
feedback arouses anticipation of censure and thus an
increased drive level among the non—paranoid schizophrenics.
The paranoid subjects' behavior is more puzzling.
Stimulus threshold data (Venables, 1966) indicates
that the more withdrawn the patient (among non-paranoid
schizophrenics), the lower the threshold tended to be
(Venables and Wing, 1962). But among coherent paranoid
patients the relationship between two-flash and two-click

thresholds was as for normals.

53

Ingram (1962) measured several ANS variables under
conditions of rest, stress, and drug administration in
107 male schiZOphrenics and a comparison group of non—
schizophrenic psychiatric patients. Paranoid schizo—
phrenics showed greater respiration rate and irregularity
than others, although there were no other differences
within schizophrenics for any of the other variables
under any of the three test conditions. Autonomically,
paranoids tend to resemble non-paranoid schizophrenics
according to these results. It may be significant that
all patients here were chronic schizophrenics.

Of fifty—eight measurements made over a wide range
of psychological functions, Shakow (1962) found the para—
noid schizophrenics to be nearer the normal in thirty-one
instances as compared to the hebephrenic's seven instances
of similarity to the normals. On twenty measures,
however, paranoid and non-paranoid subjects fell on
either side of the normals. Shakow interpreted these
findings to mean that the paranoid overreacts to the
underlying trend toward disorganization, whereas the non-
paranoid submits to manipulation by his environment more
readily.

In their studies of EEG activity in schizophrenic
and non-psychotic subjects, Goldstein gt_al. (1965) found
catatonic subjects showed least variation when compared
to other subcategories of schizophrenia, subjects incar-

cerated in a state reformatory, and normal controls.

54

This reinforces the point of view which describes schizo-
phrenics as showing physiological hyperarousal, especially
among more severely disturbed schizophrenics.

Ax (1967), in his investigation of the psychophysio—
logy of schizophrenia, found his patients included two
extreme types: fairly intact paranoids who rated low on
disintegration but high on tension and deteriorated
hebephrenics with low tension.

The majority of these studies reinforce the position
that paranoid schizophrenics behave in ways, psychological
and physiological, different from the other members of the
schizophrenic population. An obvious implication for
research is cognizance of this heterogeneity and care in

selection of subjects.

Sex Differences in Schizophrenia

 

Research among psychiatric groups has been almost exclu—
sively with male subjects. The assumption of no difference
between the sexes, even on physiological measures, may
result in a serious oversight. Goldstein, gt_al. (1965)
found at least one sex difference on a measure of arousal
and suggest that ovulation may predict this variation.

Hill (1957) reports that Gastaut finds females show
a higher incidence of a photomyoclonic response (rhythmic
clonis of the periorbital musculature) when exposed to
high intensity light under the influence of metrazol. He
interprets this as susceptibility of subcortical mechanisms

to the production of epileptic-like responses to a light

55

stimulus. Although this reaction is commonly found in
emotionally tense subjects of all descriptions, the
higher incidence in females is noted by comparison to
males, although there are no statistical data reported
for this finding. Visser (1961) examined sex as a possi-
ble source of difference in psychiatric patients versus
normal subjects' susceptibility to alpha conditioning.
Although a high alpha frequency was associated with high
susceptibility to alpha conditioning, there were no sex
nor age differences noted.

Mednick (1967) in his longitudinal, multi-variate
comparison of high—risk to schizophrenia and low-risk
children, noted that among the differences distinguish-
ing the two groups from each other, the female subjects
of the high-risk group appeared to be more highly tense
and nervous, more dysphoric, compulsive, and negative in
their self-evaluation according to the interviewing
psychiatrist. He further found that the girls in the
high-risk group, by contrast to the boys, were positively
related to their sick mothers and were described by their
teachers as being relatively passive and responding with
withdrawal when upset. By contrast, high-risk males
were more often described as aggressive and disturbing
in the class. These findings suggest that the schizo-
phrenia of the mothers affects the females somewhat more

than the male offspring.

56

Rosenthal (1962) has pointed out that the family
members of the same sex as the schizophrenic parent are
more likely to be concordant for schizophrenia. The fact
that schizophrenic women are more fertile than schizo—
phrenic men and that psycho—developmentally mothers
presumably play a greater role in shaping children, would
suggest that females might be expected to fall ill with
schizophrenia at a higher rate than males (Goldfarb, and
Erlenmeyer-Kimling, 1961).

Malzberg, reported by Arieti (1959), gives figures
showing essentially no difference between males and
females in first admission rates up to the year 1950.
Although the rate of admission for diagnoses collectively
subsumed under Dementia Praecox has increased between the
years 1910 and 1950, the proportion between males and
females has remained fairly close (1950: 31.5 males and
31.0 females per 100,000 population).

Although the literature is equivocal as to the
presence of sex differences in per cent time alpha
(Brazier and Finesinger, 1944; and Short 1951, find no
association; Ellis and Last, 1953, do) beta waves are
reported by Mundy-Castle (1951), Ellis and Last (1953),
and Kennard gt_al. (1955) to be in greater incidence in
females than in males. Goldstein (1965) reports a
difference on their measure of electrographic variation

for males and females.

57

Although the findings are sparse, evidence for
behavioral differences on the basis of sex continues to
mount as incorporation of sex as a variable becomes a
more common procedure in research designs.

Perception Methodology in
Research on Schizophrenia

 

 

Although there is little evidence that there is any
true deficit in sensory threshold in the functional dis-
orders (Maher, 1966), schizophrenics do show a difference
from normals when classical refractory phase experimental
methodology is used (Venables, 1968). Using very short
delay intervals (50-500 milliseconds) in order to control
against the possible interference of sex and expectancies,
Venables pursued the suggestion of Lang and Buss (1965)
that because schizophrenics show more checking and
monitoring of their reSponses, one might expect them to
show an exaggerated delay in responding to the second sig-
nal in the refractory phase experiment. Venables reports
a number of concepts and methods in current use in the
study of perception, attention, and memory but notes that
work done in this area has usually excluded abnormal
subjects. He finds that, in general, schizophrenics show
spatial narrowing of the visual field, narrowing of
attention to relevant aspects of the total input, and
temporal narrowing to more immediate aspects of the
stimulus situation. Temporal narrowing is found especi-

ally in states of high cortical arousal. This finding

58

is complemented by Venables' (1966) findings showing
schizophrenics to have a relatively higher two-click
threshold than a two-flash threshold, and Venables con-
cludes that there is some disturbance in normal sensory
modality dominance as a function of schizophrenia.

In light of these results the methodology of
perception seems a fruitful approach to questions of
psychopathology. The primary rationale in studying
sensory processes with regard to psychopathology is that
they may clarify the processes and etiology of malfunc-
tioning of more central processes.

Soviet Research on Psychophysiology
in Schizophrenics

 

In Lynn's review of Russian theory and research on
schizophrenia (1963) the evidence as a whole suggests
two types of schizophrenics: the majority who show a low
sympathetic tone and reactivity; and a minority where
sympathetic tone and reactivity are unusually high.
Breaking down these two groups into sub-diagnostic
categories, it appears that the first group is primarily
composed of catatonics and simple schizophrenics whereas
the smaller group contains acute and agitated patients,
especially paranoid schizophrenics. This observation in
the Soviet Union is congruent with Gellhorn's conclusions
(1957) that high as compared to low sympathetic reactivity
seems to follow lines of severity and chronicity.

Venables' (1960) findings for high and low arousal

59

patterns and Mednick's high and low anxiety (1958)
hypothesis about schizophrenics are also paralleled by
these findings. However, Russian EEG research has
reported patterns typically showing low arousal and
drowsy states characterizing schizophrenia. Rusinov and
Rabinovitch (1958) find a "diversity of the EEG pattern"
(unexplained) which they attribute to the different
clinical forms and stages of the disorder according to

A. Snezhnevsky's schemata (see Figure 1). There are no
studies translated in the western literature comparing
psychiatric patients with normal controls, however.
Russians have used many conditioning approaches in study-
Ing schizophrenics, and with the recent and major exception
of Ax's work, researchers have not generally used these
techniques in the West. The general Russian findings
using conditioning have been that schizophrenics tend to
show slow and retarded reactions.

Much of the Soviet literature shows schizophrenics
unusually sensitive to stimulants, showing behavioral
improvement with small quantities or substantial regression
of behavior produced by large dosages. Venables and
Tizard (1956), and Venables (1960) report similar findings
when observing arousal level changes as a function of
intense stimuli and level of background stimulation. Most
of these findings then can be used to support the inter-
pretation that schizophrenics can only operate efficiently
within a narrower range of arousal than normals

(Venables, 1960).

60

Most of the Soviet literature presumes Pavlov's
concept of "protective inhibition" as subsuming the
phenomena of schizophrenia; however, there is to date
no known physiological evidence verifying this explana-
tory construct. The tendency in the West has been to
use the construct "deficit" to describe the differences
in behavior, both overt and physiological, noted between

schizophrenics and normals.

Verbal Association in Schizophrenia
In his coinage of the term "Schizophrenia", Bleuler
recognized the plurality of the groups of disorders but
defined them together as
characterized by a specific type of alteration
of the thinking, feeling, and relation to the
external world, (Kline, 1952).
The process of normal association, which involves
"integration of thought, completion of logical pursuit
and conceptual integrity," is altered in schizophrenics
by its decreased predictability and often bizarre quality.
Primary disturbances of perception, orientation and
memory do not typically occur, but in more severe cases
emotional and affective expression seem muted if not
absent.
Bleuler described the fundamental symptoms as:
(l) disturbances in association; (2) progressive deteri-
oration of affectivity; and (3) a reliance upon fantasy

as compared to reality--an inclination toward autism.

Disturbance in association may occur in terms of loss of

61

continuity, tangential thinking, concreteness, time
disturbances of verbal production, place disturbances,
etc. Disturbance of affect was seen to occur in dis-
tortion of degree of expressiveness; in severe cases,
affectivity is reduced, in milder cases there may appear
a heightened but often shallow affectivity. (Severity
here is defined in terms of the patient's capability of
functioning independent of hospitalization).

Kretschmer (1934) similarly to Bleuler felt
dissociatibn, or the tendency for mental activity to
occur in isolation, to be one of the main characteristics
of psychotic states. He pointed out that an abnormal
amount of dissociation could produce a schizophrenic
thought disorder characterized by a "fragmentation of
mental activity and a lack of logical relationships
between systems of ideas." The concept of dissociation
is also used to explain inappropriate affect and mainten-
ance of delusional ideas.

Babcock (1930) suggested thought disorder in
schizophrenia is a result of extreme intellectual slow-
ness and based his conclusion primarily upon observations
of reaction time in schizophrenics. Chronics are very
slow, acutes are less slow. However, this explanation
fails to account for the parallel behavioral retardation
noted in depressed patients, thus reducing its power to

distinguish schiZOphrenics from other patient populations.

62

Cameron (1947) holds that schizophrenic thought
disorders are due to overgeneralization of concepts. In
this way, schizophrenics are seen to include a number of
categories at one time. Although there is much in the
literature to support this viewpoint, overinclusion is
not specific to schizophrenic conditions alone.

More recently, Mednick (1958) provides an explana-
tion of the schizophrenic's associational disturbance as
a function of anxiety. Using a Hull-Spence concept of
drive, this learning theory approach proposes that the
random contiguity of irrelevant thoughts with moments of
anxiety predicts the recurrence of irrelevant thoughts
under similar circumstances of high psychophysiological
arousal. As these conditioned avoidant responses help
the individual avoid the arousal stimulus, this will
result in a momentary reduction in arousal level. The
reinforcement value of this reduction in arousal will
reinforce the association between the arousal stimulus
and the avoidant thought, thereby increasing the probar
bility of an avoidant associate response to future stimu-
lation. Through subsequent generalization of stress cues,
irrelevant thinking becomes expanded and gradually
results in a chronic state. Mednick (1967) suggests
that the individual most likely to be susceptible to
this learning of avoidant thought shows extreme hyperh
responsivity, excessive generalization and fast recovery

from autonomic imbalance.

63

Payne and Hewlett (1960) were concerned with deter-
mining whether retardation, overinclusion, or concreteness
are abnormalities specific to schizophrenia or general
characteristics of psychotic patients. Their measures
of overinclusion elicited high scores only among schizo-
phrenics, although retardation was characteristic of all
psychotic patients compared to normal and neurotic con-
trols, and retardation did not discriminate between
schizophrenic and depressive patients. Concreteness
seemed to be almost entirely a product of low general
intelligence. Even though overinclusion discriminated
schizophrenics from other groups, half of the schizo—
phrenics tested were not overinclusive. The authors note
this as indicating the heterogeneity of the schizophrenic
sample and suggest the presence of a specific set of
symptoms; paranoids show more overinclusion than other
patient groups for example.

Johnson §£_§l. (1964) found the responses of psycho-
tic patients to verbal stimuli to be more idiosyncratic
than those of normals. This supports Moran's (1953)
finding that the responses of VA chronic paranoid schizo-
phrenics in a word association test show less meaningful
relationship to the stimulus words than those of non-
psychiatric patients. Although these schizophrenics
could define words about equally well as normals, their

use of them revealed conceptual misunderstanding.

64

Spence and Lair (1964) attempted to test Mednick's
theorizing which deals with abnormal associative inter-
ference in schizophrenics as exhibited in paired-
associate learning. Mednick proposed that early stage
or acute schizophrenics have a heightened susceptibility
to associative interference of this type (1958), but
these authors found both the acute schizophrenic group
and the nonpsychiatric patient controls to show similar
significant interference of extralist words upon presenta-
tion of the experimental list. The major difference
between the groups was that on both experimental, control,
and practice lists the schizophrenics gave a significantly

higher proportion of incorrect overt responses as com-

 

pared to errors of omission. This was interpreted to

say that normals exercise greater control over their

overt behavior, inhibiting inferior or incorrect responses
more.

Kent and Rosanoff (1910) noticed from a massive
survey of verbal association material that the one ten-
dency which appears to be almost universal among normals
is to give a small group of common reactions in response
to many high frequency words in everyday usage. This is
more true for some stimulus words than others. By con—
trast this characteristic is reduced in psychiatric
patients, many of whom were found to give more than 50
per cent of individual responses. The Kent-Rosanoff

frequency tables provide a list of 100 words selected

65

with care taken to avoid words liable to stimulate
intense emotional responses and presented as a single
word association task to 1,000 normals covering a broad
demographic range. The tables include all 100,000
responses for all stimulus words compiled separately.
Comparing the responses of 1,000 normal subjects to
reSponses collected from a group of 247 psychiatric
patients, 147 of whom were diagnosed as having "Dementia
Praecox" or "Paranoic Conditions", incidence of common
responses, responses which occurred at least 1 per cent
of the time, was compared to incidence of individual
responses, responses occuring less than 1 per cent of the
time. Normals gave 92 per cent common responses to the
patients' 71 per cent. There were no notable differences
determined by age or sex although the proportion of
individual reactions given by subjects with a college
education was slightly higher than the average for normal
subjects.

Sommer g§_§l. (1960) studied a group of twenty-
three acute, twenty-six chronic, and twenty-three non-
schizophrenic mental patients using the Kent-Rosanoff word
list and scoring responses according to their frequency
tables. They found that more than 90 per cent of their
subjects most frequent associations were among the three
most frequent associations of the Kent-Rosanoff norms;
apparently commonality of verbal behavior had remained

highly stable over a period of fifty years. Again

66

schizophrenics gave fewer common responses (28 per cent)
than either normals (35 per cent) or the other psychiatric
patients (45 per cent). When asked to rate the common-
ness of their responses, all subjects did equally well.
Thus the schizophrenics not only give more individual
reSponses but they are aware of their individuality as
well.

Babcock (1930) states that the Kent-Rosanoff words
seem to have the quality of a "core language" in that
they consist of words for the most part learned fairly
early in life, they are thus not as likely to be affected
by schizophrenic disturbances as words which occur less
frequently in the language and are learned later in life.
Maltzman g£_al. (1962) were interested in seeing if
common as well as uncommon word associations could be
induced in normals by administering verbal reinforcement
for the appropriate type of response. The group rein-
forced for common responses gave more of them, but.the
groups reinforced for uncommon responses did not give more
than a control group which received no special reinforce-
ment. Apparently normal subjects can learn to give more
common associations but not less common ones. Using a
similar approach with normals compared to schizophrenics,
Wynne (1963) found normals gave more common responses
under instruction whereas schizophrenics did not. There
were no differences in proportion of common responses

elicited under conditions of free association, however.

67

Statement of the Problem

Whereas many studies comparing schizophrenic and
normal subjects have reported an underresponsivity
where behavior is measured overtly, the covert and
internal state of the schizophrenic has been described
variously as tending to show either physiological hypo-
or hyper-arousal. The equivocality of the literature
can be in part assigned to early reliance upon ANS
variables, many of which behave interdependently and
therefore artifactually in response to reduction or
increase in the complementary subsystem. Depending upon
the variable, the size of the measure may or may not
reflect the functioning of that variable alone. GSR has
remained as one enduring exception to this difficulty,
and most recent studies attending to GSR have concluded
in favor of a hyperarousal viewpoint as descriptive of
schizophrenia. EEG research using schizophrenics pro-
vides a closer check on the degree of physiological
arousal in that it lacks the complication of opposing
and interdependent subsystems such as exist within the
autonomic nervous system.

From very early in the history of EEG research
reports of differences in level of arousal as reflected
by level of alpha and beta waves have been noted but
many of these first endeavors suffer from reliance upon
assessment by clinical impression to the exclusion of

quantification or mechanical measurement of wave ‘

68

parameters. Only with the introduction of the Drohocki
integrator has it been possible to mechanically quantify
the energy expenditure of brain wave behavior including
a continuous expression through time of wave energy
changes.

The earlier impressions of higher CNS arousal in
schizophrenics have in recent years gathered increasing
support, contradicting the view of schizophrenia which
contends that these individuals suffer from an under-
active physiology. Not only does it appear that most
schizophrenics experience a continuous state of hyper-
arousal, but there is some evidence to suggest that
chronic individuals show less adaptation to stimuli and
decreased variability through time when compared to less
:everely ill patients and normal controls.

The presence of labile autonomic nervous system
reactivity at the time preceding onset of habitual avoid-
ant thinking is posited by Mednick (1966) as one of the
critical factors responsible for a spiraling reliance
upon avoidant thought finally resulting in a diagnosis
of "schizophrenia". He further posits that reinforcement
of avoidant thought under original conditions of stress
is enhanced by failure to habituate to distressing
stimuli and by faster recovery to pre-stimulus physiolo-
gical baseline.

This study attempts to examine the possibility
that the schizophrenic (paranoid) differs from the non-

schizophrenic in physiological reactivity and that these

69

differences, if confirmed, relate to the presence of
avoidant thought processes in the schizophrenic. If,

as Mednick suggests, there is a relationship between

ANS lability and the development of avoidant thinking,
it may be wondered if adult schizophrenics show evidence
of association between avoidant thinking and electrocor-
tical arousal.

In view of the accumulating body of literature which
suggests the schizophrenic suffers from a chronically
hyperaroused internal state, it is predicted that paranoid
schizophrenics compared to normal controls will show
higher cortical arousal as measured by Mean Energy Content
of the EEG under conditions of rest and performance of a
single word association task.

It is hypothesized that large (alpha) wave activity
will be significantly less among schizophrenics during
resting, pre—stimulus, latency period, and immediate
post-response recordings. By contrast, overt behavioral
indices such as reaction time, response commonality and
response quality are predicted to show deficit of per-
formance as compared to normals. Both overt (behavioral)
and covert (electrophysiological) data will be examined
with reference to theory of thought disorder development

in schizophrenia.

CHAPTER II

METHOD

Setting
An opportunity to work at the Institute of

Psychiatry, located on the grounds of the Kashchenko
Hospital in southeastern Moscow, provided the occasion
for researching this experimental design. Kashchenko
is one of the largest Soviet psychiatric centers with
approximately 2,500 beds and a staff of 2,300. Of the
nearly 200 physicians, about half are qualified psy-
chiatrists and most of the physicians are women.
Although there are no psychiatric aides, patient care
by the many nurses is done with apparent warmth and
concern.

Of the 12,000 yearly admissions to Kashchenko,
nearly 90 per cent are readmissions and the hospital
functions largely as an acute service in that patients
are not usually maintained there longer than a year.
Those who are not among the 80 per cent discharged to
return home are transferred to chronic hospitals.

The present study was conducted at the Psychiatric
Research Institute of the Academy of Medical Sciences of

70

71

the USSR, housed in a building located within the grounds
of the Kashchenko complex. Here Professor A. V. Schnezh—
nevsky, the director, heads a multi-disciplinary staff

in the exclusive research of schizophrenia. The approach
of the institute is thus monoproblematic utilizing a
team effort involving the separate but exchanged efforts
of clinical psychiatrists, psychologists, physiologists,
biochemists, biologists, and neuropathologists. The
clinic involves four laboratories including: (1) Clinical
psychiatry; (2) Abnormal Psychology and Neurophysiology;
(3) General Pathophysiology; and (4) Pathomorphology.

The predominant view of schizophrenia is Pavlovian
in theory and emphasizes description and classification
of the dynamics of the illness. Contrasting with Slu—
tzensky in Leningrad, Schnezhnevsky, whose views are
reflected by the institute's research, assumes schizo-
phrenia to be a unitary disease process without hypo-
thesizing about etiology. Figure 1 depicts the scheme
used to understand the possible routes of development
and course of schizophrenia as conceptualized by Schnezh—
nevsky and his colleagues. Essentially the focus is upon
exploration of whether the person has sterotypic ways of
decompensating in terms of mental and/or higher nervous
activity and how to understand these ways in psychologi-
cal and phenomenological terms.

The Abnormal Psychology and Neurophysiology Lab—
oratory, headed by Dr. C. C. Monakhov, devotes much of

72

its research energies to exploration and discovery of

EEG correlates of schizophrenia. The presence of EEG
machinery and the warm invitation by Dr. Monakhov to
participate with his staff made it possible to undertake
this investigation concurrent with the laboratory's own
research activities. Data was gathered jointly with the
aid of V. G. Puskina, the second most senior member of
the laboratory and assistance for attending and preparing
subjects for the EEG apparatus was made available on

request by the regular research staff.

Design

The original experimental randomized design
included four factors: Sex (2) x Diagnosis (2) x Light
(4) x Time Periods (3). A preliminary analysis proved
Light to be of no influence upon the dependent measures
and so this factor was dropped from further consideration

in the data analysis.
Measures

Pnysiological Measures

The one consistent significant relationship between
EEG pattern and psychological state is that between
electrocortical wave frequency and level of consciousness:
decrease of frequency is associated with somnolence and
inattention and increase of frequency with alertness
and attention (Hill, 1957). For this reason, physiologi-

cal arousal was monitored by means of a standard clinical

73

electroencephalogram integrated for mean energy content
(MEC) in order to infer incidence of alpha waves, a
relatively low frequency large wave, the primary depend nt
variable. As preliminary analysis of lobe data indicated
no significant differences in MEC, the final measure of
arousal utilized MEC data summed over all five lead
pairs. MEC data, noted as blips on the raw integration
record, was used as an equivalent to incidence of alpha
waves; all records were carefully screened to assure
exclusion of any subject with presence of abnormal slow
wave activity, primarily delta waves, which would other-
wise violate the assumption that alpha waves were the
major source of electroencephalograph pen displacement
which, summated, produced integration data. Striking off
equal portions of the record dependent upon the length of
each latency period, this data was examined for pre-
stimulus (PS) alpha/second, latency period (LP) alpha/
second, and post-response (PR) alpha/second for each sub—
ject. Blocking of alpha waves, measured as a significant
(p<.05) drop in MEC, was used as the operational defini-
tion of electrocortical "arousal", while return to back-
ground alpha wave incidence from a preceding state of
arousal defined electrocortical "recovery".

In addition latency period length, summated within
trials using word stimuli alone, and within trials
including variable frequency photic stimulation just
preceding the word stimulus, was analyzed for each sub-

ject and for each trial.

74

Psychological Measures

As the major concern of this work was the investi-
gation of relationship between electrocortical arousal
and recovery and associative behavior, the task for each
subject was to respond with the first association subse-
quent to each of a list of twelve stimulus words. These
were selected from the Kent-Rosanoff word list (1910)
for their tendency to elicit common responses in Ameri-
can normal subjects and for their apparent absence of
emotive acconotation. Goldstein and Jones (1964) note
that persons who give a large number of remote associa-
tions to emotional stimuli also give a large number of
remote associations to neutral stimuli. Thus controlling
against emotionality in stimuli should elicit a clearer
picture of basic disturbance in the association process
of the subject. These words were: table, dark, man,
slow, girl, high, sour, hard, bread, long, black, and
loud (Appendix A). While these words all produce a
single common response 60 per cent of the time or better
among American subjects (Kent and Rosanoff, 1910), the
assumption of cross-cultural similarity in eliciting
common responses was not met for the two words "girl"
and "bread" for the standardization subjects, who were
of Great Russian heritage.

A group of 100 medical students were asked to
respond to each stimulus word with their first response

(Appendix B). Whereas even this limited sample reflected

75

results congruent for American norms for ten of the words,
"girl" and "bread" received a much wider spread of first
response words than did the other words. As a result
data associated with these words were eliminated from
the final analysis. The per cent response given for each
word by the Russian standardization sample was then used
as the commonality score for that response; responses
not given by the standardization sample but produced by
the subject uniquely were accorded a score of "l".
Apparently "bread" connotes "salt" most frequently
as a function of the traditional association of these
two foodstuffs in rural tsarist Russia. At the arrival
of a visitor the wife of the house would respectfully
offer him a fresh loaf of bread upon which rested a small
cup of salt--the symbols of Russian welcome and hospital—
ity. Although "girl" elicited "boy" most often, as in
American norms, "woman" appeared with comparable fre-
quency. Perhaps this is a reflection of the observation
that women seem to maintain girlfriend relationships
more intensively and extensively in Soviet Russia than
in the United States. For example, it is a common sight
to observe two adult women arm in arm on the streets of

Moscow; the same is rare between men and women.

Subject Characteristics
Age, marital status, and socio-economic status was
recorded for each subject. Socio-economic status (SES)

was coded by use of a ranked scale of one through five,

76

from unskilled worker down through professional status.
Each schizophrenic subject was coded as more (1) or

less (2) severe in the degree of disturbance he
demonstrated using the guidelines for describing process
vs. reactive schizophrenics as suggested by Kantor,
Wallner and Winder (1953) and Brown's distinction of

more or less than two years' hospitalization (1960).

Subjects

Twenty-five normal controls and twenty—five patients
hospitalized in the Institute of Psychiatry with a
diagnosis of "paranoid schizophrenia" comprised the sub-
jects of the study. Appendix C contains admission his-
tories of all patients. Approximate counterbalancing
for sex was maintained within diagnostic groups and all
schIZOphrenic subjects were fresh admissions except for
seven who were removed from drug therapy a week before
inclusion in the study. Selection of only patients with
diagnosis of "paranoid schizophrenia" was precipitated
by the observation (Brackbill, 1956; Lang and Buss, 1965;
Venables, 1968) that the diagnostic category of schizo-
phrenia is heterogeneous in its membership. Paranoid
schizophrenics seem distinguishable from other subdiag—
noses in that paranoids are usually less disturbed than
other schizophrenics (Payne and Hewlitt, 1960; Shakow,
1962; Lang and Buss, 1965) and Show fewer differences
from normals on both psychological and physiological

tests (Shakow, 1962; Ingram, 1962). And Johannsen (1963)

77

finds the acute-chronic, process-reactive, and good-
premorbid-poor—premorbid scales all correlating highly;
only the dimension paranoid-non-paranoid remained inde-
pendent of these. This greater similarity of paranoid
schizophrenics to normals on both psychological (Shakow,
1962) and physiological (Ingram, 1962) measures in con-
trast to other subclassifications of schizophrenia
suggests that patient-normal differences, if found for
paranoids, would be of greater value in clarification
of differences between "schizophrenic" and normal status.
That paranoids are often more cooperative and that it is
suggested by at least one researcher that they show a
higher incidence of alpha waves (Jasper, Fitzpatrick,
Solomon, 1939) than other schizophrenics further encour—
aged using patients with this diagnosis.

Males have been the subject sample in most studies
of schiz0phrenia cited in the literature (Schooler, 1963).
The present study attempts to compensate for the omission
of sex as a variable in the literature by inclusion of
groups representing both sexes: eight normal males,
seventeen normal females, fourteen paranoid schizo—
phrenic males, and eleven paranoid schizophrenic females.
Spontaneous order of fresh admission was the main cri-
terion for inclusion in the study and so analysis of the
data by severity was made later. Normal subjects were
recruited from the hospital staff attempting to use
only staff members who were naive about the purpose of

the study at the time of testing.

78

Demographic variables of age, socio-economic
status, marital status, and severity of disorder were
examined by correlation to determine if any subject
characteristics not controlled for homogeneity related
to any of the dependent measures (Appendix F).

The higher age of the schizophrenics and higher
SES of the normals is explained by the difficulty in
obtaining normal—schizophrenic matches on demographic
variables. This was in part due to the difficulty in
communicating the importance of this procedure to the
Soviets who are accustomed to much less concern about
controlling against artifactual influence upon results
due to subject heterogeneity. In addition, schizophrenic
subjects were recruited as they appeared as admissions
and if matches were not available from the research staff
occupying the institute building, the Soviets were
reluctant to seek elsewhere for these; no explanation

was given for this position, however.

Apparatus

 

The experimenter used a twelve-channel electro-
encephalograph built in Leningrad and copied after an
Italian machine; exact specifications were not available.
However, it resembled in most respects Grass twelve-
channel machinery and channel specifications were stan-
dard. Frequency and intensity control apparatus for the
stroboscope adjoined the electroencephalograph machine.

Contact with the subject in the experiment room was

79

maintained with an intercom system operated in the
machinery room. Attached to the electroencephalograph
machine was a Drohocki-like integrator (Drohocki, 1948)
whose output appeared as a series of pulses on each of
the five channels used.

The experimental setting included a suite of three
contiguous rooms separated from each other by thick walls
containing copper shielding (see Figure 2). All doors
were heavily padded to effect sound proofing and two
of these doors separated the subject from the experi-
menter. The test room was entered by passing through a
small anteroom which separated the experimental from the
machinery room.

Recording speed was three centimeters per second
and amplification was set at maximum deflection for a
five microvolt input. Amplification range included fre-
quencies of one-half cycle upward to sixty cycles per
second. Requirements for linearity of response, the
deflection of the pen being directly proportional to
the voltage applied at input to within 10 per cent, and
amplification standards of five microvolts giving a
deflection not less than two millimeters, were met. Noise
level of the machinery was 2.5 microvolts. Calibration
of the electroencephalograph machine was set to have a
fifty microvolt signal produce a six millimeter deflec-
tion in all channels. A preliminary recording was made

to determine whether all electrodes were making good

80

contact and to ensure against artifactual interference
with the recording.

Five channels were used for cortical recording
including frontal, percentral, parietal, temporal, and
occipital areas. One channel recorded onset and termi-
nation of verbal material, and another indicated onset,
frequency, and termination of stroboscope stimuli.

The Drohocki integrator was preset to register a
pulse at the moment when a certain cummulative energy
level (microvolts) had been reached. The frequency of
these deflections is then proportional to the size and
number of the electroencephalograph deflections, and by
summing the number of pulses over a number of successive
time periods, the mean energy for that sum time can be
obtained. As alpha waves, the larger slow wave charac-
teristic of a normal relaxed waking state, was the
implicit criterion of interest in this study, the inte—
grator mean energy was used as a reflection of incidence
of alpha wave behavior.

Electrodes used were silver disks about 0.5 centi-
meters in thickness having a slight depression on the
undersurface for the application of electrode paste. A
two-meter length of insulated wire of multi-strand
copper connected each electrode with a plug. The elec-
trodes were applied with collodian paste, plus a dash
of chloroform to hasten drying, and were removed with

acetone after the test procedure.

81

Recording was monopolar in that each of the cortical
leads situated over the left cerebral hemisphere compared
to a single non-cerebral and presumably neutral electrode
located in the lobe of the left ear (Figure 3). The
frontal electrode was placed centered on the forehead
directly above the left eye. The precentral electrode
placement was three centimeters anterior to the vertex
and three centimeters lateral to the midline of the
skull whereas the temporal parietal area was measured by
placing an electrode in this same position posterior
to the vertex. Electrode placement was at the level of
the upper edge of the pinna of the ear above the auditory
meatus. Occipital electrode placement was 0.5 centi-

meters above the inion.

Procedure

 

The attending nurse or nurses (in the case of
patients) escorted the subject to the EEG laboratory
where he was introduced to the procedure as part of the
admission regimen. Both as a means of establishing
rapport and as an opportunity to observe the subject
clinically, the nurse asked the subject for a brief his-
tory of himself and inquired as to his feelings of the
moment as he was being hooked up to the electroencephal-
ographic apparatus.

This information was later checked and expanded in
conference with the patient's attending psychiatrist.

Each subject was requested to recline on a couch as a

82

supine position elicits greater relaxation and reduces
interference from muscle tension. In the event of any
verbal expression of anxiety on the part of the subject,
he was reassured that the procedure was entirely harmless
and painless, and that it would produce no ill effects.
When the patient had been properly prepared in
the test chamber, all lead pairs were checked on the
oscillograph and integrator machinery for adequacy of
lead attachment and machine functioning. Damping of
the pen was checked by the experimenter to insure wave
input would be neither peaked nor rounded in a distorted
fashion on the subsequent record. Leads (a pair of two
electrodes) were subsequently checked in a trial record-
ing to insure proper electrode contact with the scalp to
insure against any machine failure or difficulties.
After the damping had been checked, and the channels
were matched by connecting each to the same pair of
electrodes adjusting for the degree of amplification
and filtering necessary, survey records were obtained
from the relevant leads. In the event of any unusual
verbal or motor behavior evidenced by the subject during
the recording, a note was made on the record at the time.
If the subject's record gave evidence of sleepiness or
motor potential interference, he was reminded by the
intercom to remain relaxed but awake and this procedure

was maintained throughout the test session. When all

83

adjustments had been completed, the experimental chamber
door was closed and the test session begun.

After an adaptation period of approximately ten min-
utes, a word association task was presented with instructions
to answer with the first response that came to mind upon
presentation of each stimulus word. A list of twelve words
(translated into Russian) with reliable American norms
showing high response commonality—-eliciting a single
response 60 per cent or more of the time—-were presented
counterbalancing for list placement and precedence of strobo-
scopic light, between subjects within each diagnosis (see
Appendix D). These words were later checked with a small
standardization group of 100 medical students to confirm
their cross-cultural high response commonality. Electro-
graphic recording was done concurrently with presentation

of verbal and photic stimuli.

Statistical Treatment of the Data

The following hypotheses were examined by statistical

H : Schizophrenic (Paranoid) and Normal subjects
are the same in their patterns of electro-
cortical arousal, both at rest and under
conditions of a single word association
task. This hypothesis will be tested by

the following measures:

Baseline Mean Energy Content (MEC)
Pre-stimulus (PS) MEC (background)
Latency Period (LP) MEC

Post-response (PR) MEC

Interindividual variability of MEC/second
Electrocortical arousal

Electrocortical recovery

(”WOO-.069)

84

H2: Schizophrenic (Paranoid) and Normal subjects
are the same in their verbal responsivity
under conditions of a word association task
and this does not relate to patterns of
electrocortical arousal. This hypothesis
will be tested by the following measures:

Response Commonality (RC)

Response Quality (RQ)

Verbal Reaction Time (RT)

Cortical Arousal associated with Verbal
Responsivity

. Cortical Recovery associated with Verbal
Responsivity

CLOUD)

(D

Each variable was correlated with all other variables
with the use of a Missing Data Basic Statistics program pro-
cessed by CDC computer to determine whether relationships
existed between subject characteristics and dependent
variables and among the dependent measures themselves.

Student's 2 test was used to examine differences be-
tween subjects and the correlated 3 test was used to examine
differences between data collected from the same subject at
different times. Regression equations were applied to data
where changes over time were of interest. Incidence of high
commonality reSponses for normals vs. schizophrenics was
tested by Chi Square. The presence of unequal n's made
analysis of variance by computer for more than one factor
impracticable. In some cases product-moment was used where
Pearson's point biserial correlation would have been more
appropriate. However, the high relationship between these
two 3's and the availability of only MD BASTAT by product-
moment 3 prompted the consistent use of product-moment 3,

Where questionably significant differences were found,

examination by X2 was done.

85

.Amucmfipma oom.: can»

once no soapmwapmo>ca EsopanOH o co pomomv macoanooufisom mo

conusao>m on» no oEonom Amamsfiefiaosmv wcaxsoz poH>om .H onswam

 

genuine .Hmufi

 

 

 

 

 

 

 

 

 

 

 

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Slilili

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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86

 

 

 

 

 

 

 

 

 

 

 

 

a
H
C
U
A B
d b
C]
’ C] b CF——-
| e

 

 

 

 

 

 

 

 

 

A = Experiment Chamber d = subject couch

B = Anteroom e = electroencephalograph
C = Machinery Chamber f = integrator

a = window g = stroboscopic light

b = door control

c

= stroboscOpic light h = experimenter position

Legend: 1 inch = four feet

Figure 2. Diagram of the Electroencephalographic
Experimental Chambers (Institute of Psychiatry, Moscow).

87

Ear (E)

Referent I
P) ' "l"

o)

 

 

 

 

 

 

 

 

J

Figure 3. Diagrammatic Representation of Electrode
Placements: Frontal (F); Pre-Central (Pc); Parietal (P);
Temporal (T); Occipital (O); and Ear Referent (E).

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88

 

= Normals
-n—- = Schizophrenics

 

Pre-Stimulus Latency Post Response
r
+
' A 5‘ IA\
.- [I \\ I \ ’I \\ A ’F\._/ \\
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I, ‘\ A ’/ \I \ a
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l 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 l 2 3 4 5 6 7 8 9 10
Trial Trial Trial

Figure 4. Mean MEC/Second Values for Normal and.
Schizophrenic Subjects for Each Trial and Each Time Period:
Pre-Stimulus, Latency, and Post Response.

89

 

 

 

 

   

 

 

 

 

~-———-—-- I Pre-Stimulgs MEC/
24" Normal 24 Schiz Second
23.- Females 23 Females ------ - Latency Pegiod NBC.
22._ 22 Second )
21 -- 21 ' “sizes?" “W
200 20
19‘- 19
18- 18
174- / 17
16 .. A / 16
15» / \ 7/ 15
14 4- \/ IA‘\ \ I; ‘\ 14
13 .. \\ ’i \\ ‘— flé/ \\ 13
V N‘ ,
12 «L \ ,' 12
11< ‘---~’ 11
10‘ 10
9 + 9
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5.. 6
5*~ 5
l 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 6 9 10
24-- Normal 24 n Schiz
23‘_ Males {5 0 Males
224- 23 —
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194* 19 -
18¢ 18 -.
17<- 17 -—
16-- 16 ..
IS-A- 15 ..
14-- 14 0
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9? 9 “
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64- 6 4-
5.. 5 a.
a A. : i : : 4. ' 5 P s : : : : i : e 4. t
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10

Figure 5. Mean MEC/Second Values for Subgroups Differentiated by
Diagnosis Plus Sex for Each Trial and for Each Time Period: Pre-
Stimulus, Latency, and Post Response.

9O

.pmme m.nofim3 and; cmpmazoamo ma m peacocficwfim mu m mums;
.zHu: mmamz mason mafia: mmHmEmm
Nazom mm": mmamz HmEAoz mwauc mmamsmm HmEnoz mmmuc wwfigom mmmu: mHMELOZN

momma UmHfiMpuozp mm: mcomanmaaoo HH¢

 

 

H
.m.z .m.z om.o ma.a mmHmEmm m> mmamz "mNHnom
.m.z .m.z mH.o 0H.m mmHMEmm m> mmamz umHmEhoz Ccoomm\omz
Ho. .m.z HH.: mm.H mmanom w> mamshoz mmcoammmlpmom
.m.z Ho. mn.o 05.0 mmHmEmm m> mmamz "mNanom
.m.z mo. 00.0 om.m mmHmEmm m> mmamz “mamshoz uncomm\om2
Ho. .m.z 20.: mm.H mmanom m> mHMEpoz coapmm mocmpmq
.m.z Ho. m©.o om.: mmHmEmm m> mmfimz "mNHnom
.m.z .m.z mm.o mm.m mmHMEmm m> mmamz umHmEpoz Uncomm\omz
Ho. Ho. mw.m mm.m mnanom mb mHmEhoz mSHSEHmemhm
.m.z mo. mm.a mm.m mmHmEmm m> mmamz ”mufinom
.m.z .m.z HH.o om.m mmHmEmm m» mmflmz ”mHmEpoz oncomm\omz
Ho. .m.z mm.m NN.H mmfisom w> mHmEhoz m:«Hmmmm
p m m mm ucomfipmméoo mmnzwmmz
mocmoacacmfim oapmfipmpm 7

 

Hooaemm mafia an accommxomz

”xmw msam mfimocwmfia

new wamocmmfio hp umpmfipsmpmpcfim masons emmzpmm monumfipmpm m yum p m.pcmospmuu.a mqmee

91

 

 

 

mooo.va mm.ou mm.m mm.mm u mammm
mo.va mo.o mm.mm :m.mm mmmoewmma
.m.z mo.o| m>.ma mm.:m a mom
Hoo.va ma.ou om.~ um.mm I Hmfima mom om
um.mm mH.mmm pampmcoo

mocmofimficmam pcmHOfimmmoo pcmaofimmmoo mo acmaOHmmwoo manmfimm>

coapmammmoo Hmfiummm mommm nmmvcmpm scammmmwmm
mm.o u m .pcmHOfimmmoo soapmammmoo magapass
mm: mm.mmozwmam Acmme psonmv Hopes
mm.mmmo: mm: mo.oao:ooom mommm
mooo.ova NN.HH mm.amomna : ma.omoooma Ammme usonmv coammmmwmm
mocmofimacwfim m mmmzcm 2mm: wt mommSUm mo 83m

commmmmwmm Hammm>o mom mocmfimm> mo mfimzfimc<

 

.AmEHa compommmv npwmmq

coammm mocmpmq manmfimm> pcmucmamm spa: Hmame mmm zpfiflmcoEEoo mmcoammm

cam HMHmB .mHmocwMHQ .xmm mmHanmm> ucmvcmamUCH mom mpcmfloammmoo
coaumammmoo maaapasz new mommmmmwmm Hammm>o mom mocmfimm> mo mamaamm¢ll.m mqm<e

92

mcoapmfimmmoo pcmoaMflcme oz

mCOfipmHmmmoo pcmoamacwwm oz

mCOHpmHmmmou unwofiMHmwfim 02

mo. mm.ol
mo. w:.OI
mo. mm.on
mo. 32.0!
mo. H:.on
mo. mm.ou
mo. m:.o

om on spa: vmumaoomm<
ocoomm\omz vOHmmm mocmqu
amm>oommv vcoomm\omz

co«mmm mocmpm4\mmmoammmlumom

apHHmcoeaoo mmmoammm cams

ccoomm\omz mmcoammmlpmom

om on 29H: vmpmfioomm<
ncoomm\omz coammm zocmpmq

om Hm spaz ompmfioomm<
vmoomm\omz omcoammmlpmom

uncomm\omz madnermummm

macaumammmoo pamOHMficwam oz

mcoapmammmoo ammOHMHmem oz

Amaumcv
mmamz Nanom

Amuuov
mmamsmm Nanom

Amumcv
moan: Haemoz

Ammumov
mmHMEmm Haemoz

momumcv
mmamz Hammm>o

Ammumnv
mmamsmm Hammm>o

Ammumov
mNfisom Hammm>o

Ammumuv
mamemoz Hammm>o

 

moCMoamacme

.H PCMEOSIPOSUOHm

mammamm> somfimmasoo

mpomnnsm

 

 

.mo.vn pm mocwofimfimwam nommm sown; mmapmamm> cam
Amsfie compomomv newcmq coammm mocmumq comspmm mcoaumammmoo ucmsozuuosoommll.m mqm<9

93

.umma m.noao3,npflz commasoamo ma m .pcmofimacm«m ma m wmmnz
.aauc moans mason mad-c moHNEom

Nanom “mun mmawz Haemoz «was: mmamsmm anamoz «mmuc nuanom mmmnc mamamoz
.mpmmu cmaamplozu mm: mcomamwnaoo HH<

N

 

 

m
.m.z .m.z mm.m mm.m mmmmEmm m> momma "mumnom
.m.z .m.z mm.o mz.a mmHmEmm m> mmamz "mamsmoz Hammm>o
mo. Ho. mm.: mo.m mumnom m> mmmemoz numemq oommmm mocmpma
.m.z .m.z mm.o mw.m mmmmsmm m> mamas "mumnom
.m.z .m.z mm.o mm.m mmmmEmm m» mummz "mmmsmoz pnwmq + omo:
Ho. Ho. m:.: mm.: muficom m> mamemoz apwcmq uowmmm monopmq
mo. .m.z mm.m mo.m memEmm m> mama: "mumnom
.m.z .m.z ::.H mm.a mmamEmm w> mmamz "mamemoz mcoa< nmoz
mo. mo. mm.: mz.m mNHzom m> mmmemoz numemq oommmm moempmq
u m m mm mcomammano momsmmmz
cosmommmcwmm ompmmpmpm

 

 

Amafie coapomomv cpmcmq cowmmm homopmq “xmm msam mamocwmun
cam mmmocmmma an umpmmpewmmmmma masomc cmozpmm mompmmpapm m new a m.»e¢osumus.= mqm<e

9h

 

ll

 

 

mooo.ovq =H.o m~.o am.m, mummy
.m.z Ho.ou wo.m no.0 -a oommom mafia
mooo.ova mm.ou mm.= om.mm u ammoewmmn
.m.z Ho.o mm.= am.H . , xom
m:.=m, m=.mmm unapueoo

moeaommmcmam aeoaommmooo pammommmmoo mo , pcomommmooo umnwmmm>

coapmaommoo Hwapmom mommm cmmccmum coauummmmm
mm.o u m .mpemmommmmoo compmmmmmoo mmqmpmsz ,
mmam mm.mmmmmmmm memos psonav Haves
:o.m=om mend mm.mmmmmmom momma
mooo.ovg mm.mm om.:mmmmm : mw.mm:mmmm Agave psonmv eoammmmwmm
momMOHMHmwfim m mmmsom cams mu mommsvm no sum

moammmmmmm aammm>o mom mommamm> mo mamaawm<

 

 

.Hwfima comm mom vcooom\omz unconnomrunom

new .ooamom mocmqu .mzasaapmnomm.oanxamw> ucovcmnwo now: Haama can

.uoammm mafia .namocwmaa .xom moanaamm> unoccoamocm mom mucmaoummooo
:oaumflmmmoo maawuasz can scammomwom Hammo>o mom.mocmamm> mo mamaaoc<ua.m mqm<a

95

 

 

 

mo.vq ma.ol sm.HH mm.m~ u woumom mafia
mooo.ovm mm.ou mm.mm mm.~m u ammocmufio
.m.z No.0: mm.HH m:.m I xmm
mooo.ovm mm.~m mm.mm~ meammcoo

monocumacwam pcoaoamumoo ucmuoamumoo mo unmaoamuooo manmdmm>

coaumHommoo Hmapmmm mommm cmmumwum cadmmmmmom
mm.o u m .mumofioammmoo soapmHmmmoo manauasz
mna 5H.~mmmom Hmuoa
mm.mmm= mam mz.mommmm mommm
mooo.ovQ mm.m mm.mu=aa m mm.om=:ma Acmos psonmv coammmmwmm
mocMOHmacme m amazon 2mm: no mmmmSUm mo 83m

scammmmwmm Hammm>o mom mommfimm> mo mummamm<

.ommwmm>< madame cos HH¢ mom unocmw\omz owmmo>¢ magmamm> acoucmqon spas.
\ commmm made new .mumocwmao .xom moanmamm> unoccmqoccH mom mummaoammmoo
soapmammmoo manapazz and commmommmm Hammm>o mom mommamm> mo mnmzamc¢ln.m mam<a

 

 

96

mo.ovm mm.o o:.o Hm.o oommom mama
mooo.ovm m=.ou mm.o m~.~u mmmoewamo
.m.z mo.on mm.o ao.ou. xmm
mooo.ovm -. om.m mm.m meamacoo
mocuommmemmm pcmmommmmoo mammommmmoo mo mammommmwoo «mammma>
soapoaommoo Hmdpmom mommm vmmocopm monummmmmm

o=.o a m .mucmmommmmoo comuammmmoo ommmpmsz

 

and H~.mmm Angus muonav Hopes

mm.m oza oo.mw momma

mooo.ovm mo.mm m~.om m om.omm menus usonmv commmmmwom
oo:doa~acmam m omwsum moo: no mommzvm no How

scammommom Hammo>o mom mocmumm> mo mamzaocd

 

 

.pomnasm comm mom ucooom\om=,

uncommom pmom new .ooamom monopmq .msasaaumuomm mandamo> unoccoaoa and:

cosmom mafia and .mfioocwmao .xom moanoama> pcmccmamocH mom mucouoammooo
ocoauwaommoo oaquuasz cam :onnuomwom Hammo>o mom mocoamo> mo mammawc<1u.p mqm<s

| I "

97

 

Ammo>ooomv ccooom\ou=

Amdlhcv

 

Ho. m».ot commom hocmpwq\omcoamomlpmom mmamz sanom
Aamm>ooomv ocoomm\omz
mo. mm.o ooamom monoqu\oumoouomnpmom
mmumuv
mo. mw.o| om< moamaoh sanom
Amumuv
occupdaommoo pcooauacmam oz moan: Haemoz
Ho. ms.o magnum vasocoomloaoom
mmmnmov
we. mm.o om< amaaaom Haemoz
mmmo>ooomv ucooom\omz
Ho. om.o: coamom ocouaq\om:oamomlouom
mo. m:.ol mafiamsa ommoauom
Aomuuov
mo. m:.o mspoum afiaocooMIoaoom mafia: Hammo>o
Ammo>ooomv vcooom\omz
mo. sm.o commom mucoumq\ommoamomlumom
Ammumuo
mo. H:.o msuoum oflaocoomlodoom moaoaom Hammo>o
om 04 and: ompanooum<
Ho. om.o ocoomm\omz oncogmomnumom
om am spa: ooumfioomm< Ammumov
Ho. mm.o ocoomm\om= uncommomuumom amazon Hammo>o
Amanmuv
occaaaaommoo ucdoamacwam oz «Adamo: Hammo>o
moodoHMszam m pmoaozupozoomm mandamm> conammoaoo

unconnsm

 

 

‘.mo.va ma oceaommmemmm comma nomm3_nmana«ma> new Amausom<v
vcooom\omz uoamom aocoawq\usaaadumlomm cooSpom acouuoaommoo pmoaozupoacommul.m Manda

98

 

Ammnmcv

 

Ho. o>.m oo.~m moan: mason
mom-moo
Ho. oa.a oo.mm| mmaoaom nanom
Ammumov
Ho. m~.m oo.m: mmamz Haemoz
Azaumov ocoowm\omz «accomomlumom
mo. HH.m oo.mm moamamm Haemoz m> usasaapmlomm
mocmoauacwfim _M .m comflmeEoo mmsmaoz

 

 

.xom msam manomwwaa an cocamon odomo mammamc< comm mom ocoomm\omz

.mmcoamoMIpmom ocm msflssapmlomm coosuom wofiumauopm.m com a umpmaomm00||.m mqm<a

 

99

Amduhcv

 

mo. mm.o ammo: nmnom
Amumov
Ho. mm.o mmHoEom macaw
Amumov
Ho. mm.o mafia: Haemoz
Amflumov
Ho. m~.o mmawamm Adamo:
momumcv
Ho. . hm.o moan: Hammo>o
mmmnmcv
Ho. h~.o moawaom Hammo>o
Ammumov
Ho. mo.o mafinom Haomm>o
Ammumuv
Ho. mm.o mamamoz Hammm>o
Amaumov
Ho. mm.o upomunsm Hammm>o
monooHMficwam m newsczlposoomm muoonnsm

 

 

.mo.va um momwofimdmmam noaom moan: muaflocoaaoo
ommoqmom vow mafiaosa uncommon mmmsuom mmoapmaommoo acmaozlvosuomma.oa mqm<e

100

.mommoqmom .mpoonnsm on» no sumo mo gnaw mo mammooomz mwoan on omxmm
mucocsum Havaoma :09 an oocwammo mxmwm on» no momma on» omo momoom mpdawsa

.mucoczpm Hmofioma ooa mo 950mm oomomomom
m an mm>dw no oncoommm on» mo homosommm ammo mom on» 0mm mmmoom zpaamcanooa

.umos m.£oamz spa: cmpmHSoHMo ma » pcdoaMdcwfim mu m amonzm
.aanc moan: mason «Han: maoaom

Nanom mwnc coda: Haemoz “pan: moamamm Haemoz ammu: muaaom ammo: mawamozN

 

 

.mammp omHHMulosp on: mnemamoqaoo HH¢H

hocosdomm apdfiomoaaoo
mo. .m.z mm.~- N».o mumnom.u> ”mnemoz mmeommmm swam
.m.z .m.z Hm.a 3:.H mmamEom m> mmam: ”mufinom
.m.z mo. o:.H um.m mmaoaom m> moan: ”mamamoz
Ho. .m.z ma.m mm.H amazon m> mamamoz zpaaosa onconmomm
.m.z .m.z mm.o NH.H mmamaom m> mafia: «madman
.m.z .m.z am.o mH.H mmaosmm m> moans ”mamamoz
Ho. mo. mo.m mH.m muasom m> mamamoz mpaaocoaaoo omcoamoma
m m m mm
mommoHMHCMHm oaumapmpm Naomfimmqaoo mmsmmmz

 

 

and .muwaosc mmmoammm .hpaaocoaamo oncoommm

hocmsdmmm huuamcoaaoo uncommon swam
-"xom msam mfimOmmMHQ can

ammocmamo ma ommmmuemmmmmmo mmsomo eaozumm mommmmmapm m new » «.meouaumu-.mm mqm<m

 

 

101

.m.z mm.o- mm.o mm.m u commmm mama
mooo.ovm o=.on mm.m mm.» - mmuocmamo
.m.z No.0- mm.m mm.o u mum
mm.m mm.:m meamaeoo
mocmommmcmmm mammommmmoo mammommmmoo mo mammommmmoo omnmmma>
coaumammmoo Hwfipmmm mommm ommocopm moammomwom

m=.o . m “mmemmommmooo commmmmmmoo «madman:

 

mna fiance psonwv Hopoe

om.mm mna Hm.mm>m mommm

mooo.ovq mm.oa Hm.mmm m m>.>mom fiance psonwv moammommom
mocmoHMHmem m ommoom moo: no momozum mo sum

coammmmmmm Hammo>o mom mommamm> no mfimzamc4

 

 

.muaamcoaaoo mucoamom swam nuaz commaoomm< ocooom\omz

oncoommmlpuom cad ooamom .aocopmq .msflzaaumuomm manmdmo> pmmvcoamn spas

oOdmom mafia can .mamocmofia .xom moanmamo> umoocmooocH mom uncoaoammooo
mofiuoammmoo oaowpasz can coammommmm Hammo>o mom «onwamm> mo mummaa:<||.ma mqm<9

 

 

102

 

.m.z mo.ou mm.o am.o n commmm came
mooo.ovm mm.ou :~.m mm.m u mmmomwwmo
.m.z oo.o mm.m mo.o mom
mm.m mm.am peapmcoo

mandommmcwmm mammommmmoo geomommmooo mo mammommmooo omnmmmu>

zofipmaommoo Hmfipmmm momma choomwpm coammommum
mm.o u m .mmeomommmooo commammmmoo mandamus
mum m .mmom memos psogmv mamas
:m.=m mam mo.:nw~ mommm
mooo.ovo mm.m wm.omm m 3H.H=HH Acwoe psonov cadmmomwom
mocwoamdcwfim m omwsdm com: no mommsom ho 85m

. coammmmwmm Haomm>o mom mocmfimo> mo mamaamm<

 

 

.zpfiaocoeaoo uncommom 304 no“: commaoomm< ocoomm\om=

uncommomnumom 0cm commom .aocouoa .msasaaumuomm manuamm> acocmoamn spa;

ooammm made and .mdmocwouo .xmm moanaumm> pcmomoomomH mom mucoHOfimuooo
coauoaommoo oanauasz cad scammomwom Hammo>o mom cocoamm> mo mammawc<nl.ma mam¢s

103

 

Hmuoa

 

 

mm.o cam mm.m madam» magma:

.m.z mm.o mm.o m am.m mammmm coospmm
moamomsqoufinom

.hhMI mm.nm proa

:m.o O:N :O.Hm dedhv CH29H3

HO.VQ Fo.m :O.H m mm.m meHhu C0m390m

 

mocooHMdmwam m ommsom coo: Eoommmm mo moomwma mmmwsvm no 33m

mommamw>
mo oomsom

 

mamemoz

 

 

.mqsomc oaumommMHo cacomnnoudnom can Haemoz
mom Hmame .m> mpaawcoaaoo omcoommm mom oocmdmm> mo mammawc< an:nm:oul.=a mam<a

 

10H

Ammumcv

 

.m.z ma. .m.z ma. moans Nanom

Amumov

.m.z mm.| .m.z mo. moHoSom unnom

Amumov

.m.z ma. .m.z oa. moawz Haemoz

. Amanmov

.m.z ma.| .m.z HH.| mmamaom Haemoz

Ammumov

.m.z mo.| .m.z OH. mufinom Hammm>o

Ammumcv

.m.z om.u .m.z No.1 maoamoz Hammo>o

Amzumcv

.m.z om. .m.z mm. muomnnsm Hmamm>o
moCMoHMHCmHm m pmoBOZIposoomm uCMOHMchHm m ucoEozlposoomm unconnam

mpaamsa uncommon audamcoaaoo omCOQmom .

 

 

.ocooom\umz uncommomlumom cam.
zuaamsa oncoamom .muuamcoaaoo onconmom.cmmzpom mcofipmHommoo pcoaozluosoommnu.mH mqm<e

105

.pmos m.noaoz nuas umumH30HMo ma m.pmmoaMHmmHm mu m amonz
.aau: moans nanom “Han: moamfiom

.m oopmHommoo:

Ndcom «was moan: Haemoz nuauc mmamaom Haemoz mmmum unanom «mmu: mamamozm
.mpmmp omaamulozu om: mmomnmoqeoo HH<H

 

 

.m.2 <2 m>.o <2 moans Nanom ccooom\om2 ooummm mocopwq
.m.2 <2 mm.o <2 mmawaom mason \ommoomomlumom and:
.m.2 <2 NH.H <2 moan: Haemoz ompoHoomm< 2uaamcoeaoo
mo. <2 m=.mn <2 mmamamm Haemoz uncommon sou m> swam:
.m.2 Ho. H:.HI am.m moamamm m> moan: Ammm>ooomv ocoomm\om=
.m.2 Ho. mm.o sm.m moaoamm m> mmamz ”madman ooflmom mommpmq\omcoammmlpmom
.m.2 .m.2 mm.al Hm.H moamamm m> moams "mamsmoz. and: oopmaoomm<
.m.2 Ho. =a.o| mm.m moanom m> mawsmoz muaawmoaaoo oncoqmmm 30A
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CHAPTER III

RESULTS

All raw data, both physiological and psychological,
was coded numerically and analyzed by Missing Data Basic
Statistics (MD BASTAT) in a CDC computer. Appendix E
presents the names and descriptions of these variables
and notes those where transformations were incorporated
in the data analysis. The data was examined for all
subjects summed, for subjects grouped by diagnosis, by
sex, and by sex plus diagnosis. The sum, mean, sum of
squares, standard deviation, sum of squared deviation from
the mean, skewness, and kurtosis were calculated for each
variable and simple correlations with all other variables

were obtained for each of the analysis groups.

§g§1ect Characteristics
The first step in data analysis was to examine varia-
bles where subjects were not matched for correlations with
dependent measures (Appendix F). Although the schizo-
phrenics were older and had predictably lower socio-
economic status than the normals, these measures on the
overall did not correlate meaningfully with the dependent

measures. However age correlates differently with

106

107

electrocortical arousal for females depending upon
diagnosis: the older the normal female, the higher the
arousal level; the older the schizophrenic female, the
lower the arousal. Within schizophrenics presence of
marital history did not relate significantly to Other
measures except to predict a longer latency period length
for the males. There are more female schizophrenics who
are more chronic than the males but this difference does

not reach significance (X2 e .083, 1 df).

Electroencephalographic Findings

Figure H contains mean MEC/second values for all
normal and all schizophrenic subjects, respectively, for
each trial and each time period separately. Figure 5
depicts subgroup mean MEC/second values for each trial
successively and each time period comparatively. (As
there are no differences between the sexes within each
diagnostic category, like-sexed but different diagnostic
groups have been assembled contiguously for purposes of
visual comparison.)

Table 1 presents the data of Figure fl and S in
statistical terms showing schizophrenics to be more highly
aroused at all times during the study. Baseline MEC/
second (Mean MEC/second preceding the onset of the first
stimulus only), PS, LP, and PR MEC/second all discrimi-
nate between normal and schizophrenic subjects with the
latter showing significantly less MEC/second on each

measure .

108

As trials progress, RT decreases (Table 2), and
response commonality decreases through trials for normals
but not for schizophrenics (Table 2). The shorter '
the RT, the higher the initial state of arousal for over-
all females (Table 3). In all t comparisons schizo-
phrenics show longer latency periods and F statistics,
when significant, show schizophrenics to be far more
variable as a group in their latency period length than
are normal subjects (Table N).

Normals show greater variability from trial to trial
summed over time period in the incidence of MEC/second
than do schizophrenics (Table 5); and when all trials are
averaged, normals show greater incidence and greater
variability of MEC/second than do schizophrenics (Table 6).

There is an absence of any significant 2 findings
between groups differentiated by diagnosis and diagnosis
plus sex for the dependent variable ratios PS MEC/second
to LP MEC/second (arousal) and PR MEC/second to LP MEC/
second (recovery). This suggests that the analysis groups
show similar arousal and recovery when proportional data
are considered, i.e., taking into consideration the
subgroup baselines. Thus, with respect to their beginning
incidence of MEC/second, all subjects show a similar
post-stimulus decrease and a PR increase of MEC/second.
Schizophrenic females, however, show a significantly
greater incidence of PR MEC/second, being the only group

to show not only full recovery to average PS alpha levels,

109

but to show overrecovery (Table 9). The other three groups
fail to recover PS levels on the average through all trials.
The higher the arousal, the lower the response
quality and MEC/second recovery. Age predicts arousal
differently for females depending upon their diagnosis:
a positive correlation coefficient of 0.59 for normal
females and a negative value of -0.66 for schizophrenic
females. As in the overall sex findings, schizophrenic
males show a negative relationship between recovery and

arousal and schizophrenic females a positive one.

Other Electroencephalographic Findings

Greater variance is noted among schizophrenic males
when compared to their female counterparts on Baseline,
PS and LP MEC/second. Normal subjects show greater vari-
ance than schizophrenics on PS MEC/second data and normal
females reflect a higher variance of MEC/second behavior
during the latency period from normal males (Table 1).
Significant variation is noted for variables of RC per
trial, diagnosis, and trial alone when related to RT
(Table 2) .

The one significant sex plus diagnosis difference
in variation reveals schizophrenic males have more variable
latency periods than do schizophrenic females.

A finding of lesser strength is noted for time period
(p<.03) in that least MEC/second is noted during the .
latency period. The dependent variable of PS + LP + PR

MEC/second for each subject is found to be related to

110

diagnosis in Table 7. Here where trial is excluded as a
variable, normals again show higher incidence of MEC/
second (p<.03) as well as higher variability in MEC/second
incidence (Table 6).

Reduced PR MEC/second is associated with High RC,
and low LP MEC/second is found with low RC in overall
females, although the latter reflects normal female data
primarily. For males faster reaction time means higher
Response Commonality and a greater incidence of PR MEC/
second, regardless of its commonality. Normal females
also show greater recovery the shorter the reaction time.
There were no significant relationships as a function of
diagnosis alone and examination of data for subgroups
normal males, schizophrenic females, and schizophrenic
males revealed no significant findings.

Analysis of variance of trial against MEC/second
within each time period for all subjects, normal subjects,
and schizophrenics, respectively, was done and found not
significant. The absence of significant F statistics
points out that the incidence of MEC within each time
period (PS, LP, PR) does not vary significantly as a
function of trial within each of these analysis groups.

Significant product-moment correlation coefficients
between arousal and other measures are presented in
Table 8. Although no findings are noted for overall
normals, overall schizophrenics show a positive relation-

ship between arousal and PR MEC/second for both High and

111

Low RC. Overall females are more aroused the lower their
SES and high arousal predicts strong recovery. Overall
males, too, show a similar relationship between SES and
arousal but show an inverse relationship between recovery

and arousal and response quality and arousal.

Verbal Association Findings

 

The original experimental design included light as
a stimulus preceding presentation of the stimulus word
on one-half the trials for each subject. As an attempt
to discover whether a reduced level of background MEC/
second by presence of photic stimulation on some trials
affected Response Commonality, the data was examined by
product-moment correlation for relationship with mean
trial Response Commonality for each of the four diagnostic
subgroups. Although there is no relationship between PS
photic stimulation and Response Commonality, the middle
and the end of the trial series seem to be associated with
an inverse relationship between light and level of MEC/
second, for normals. Light predicted decreased alpha
levels at these points for these subjects.

Subject groups were tested for correlation between
measures of Response Quality and Response Commonality
(Table 10), and apparently there is a consistent and high
relationship between commonality and quality of subject
responses with some decreased relationship noted for

schizophrenic males.

112

In Tables 12 and 13 diagnosis is the source of
significant variance for both F statistics in that normals
show more MEC/second associated with both High and Low
Response Commonality than do schizophrenics and this
stands independently from variables of sex and time period.

Table 14 shows that while normal subjects show a
decrease in Response Commonality over trials, there is no
relationship between trial and Response Commonality for
the schizophrenics.

There are no significant relationships between level
of PR MEC/second and Response Commonality or Response
Quality for any of the subject groups listed in Table 15
although one trend (p<.lO) exists between Response Quality
and PR MEC/second for schizophrenic males. Table 16 takes
into account the specific LP baselines for change in level
of MEC/second PR (recovery). Here student's t and F
statistics show that there are no relationships between
proportional size of recovery and commonality of the
response word to the stimulus word. Greater variation is
found within schizophrenics than normals, females than
males, and schizophrenic females than male schizophrenics.
However, the absence of any differences in variation
between normal males and females and the large variance
of the schizophrenic females suggest that the significant
F comparisons are a result of the schizophrenic females'
variance. Within group comparisons reveal that normal

females alone show greater recovery associated with Low

113

RC responses; thus the further the response word from the
stimulus word (as judged statistically) the greater the
reinforcement value of that word in terms of reduction of

cortical arousal.

.111

 

CHAPTER IV

DISCUSSION

Subject Characteristics

 

Age: Of seventeen possible product-moment correla-
tions with other measures, for normal females there are
three; of nineteen possible findings for schizophrenic
females, two are noted. If chance were operating alone,
there would be an average expectation of somewhat less
than one finding for each group of analyses. These few
findings suggest that age is not an important factor
affecting other measures.

Socio-Economic Status (SES): Out of a possible 136
findings, only eight are noted: chance alone would predict
six of these. As with age, the significant correlations
involving SES are limited in number and possibly affected by
chance. If chance is presumed not a factor, normal females
show greater physiological arousal the lower their SES and
verbal reaction time decreases with increase in SE8 for males.

Marital History: Marital history was assessed among
the schizophrenic subjects as this has been a reliable
objective measure predicting prognosis among hospitalized

schizophrenics (Meehl, 195”). The only significant

llu

115

correlations of note are found between latency period
length (RT) for schizophrenic males and with LP MEC/second
associated with High RC for schizophrenic females.
Presence of marital histbry (including divorced status)

is associated with longer reaction time in the males and
more MEC/second during the latency preceding a High RC
response for females (Table 3).

Severity: There are more females more severely ill
than males in the study sample although this does not
reach significance, and severity also predicts low SES.
Schizophrenic males show greater electrocortical recovery
the more severely ill they are. There is a trend relating
arousal to severity for schizophrenic males (r=.3fl; p<.15).

Despite statistically significant differences in SE8
for all three comparison groups (p<.01) the range of
difference varied between schizophrenics and normals.

Most of the normal males, who are scarce within the
primarily female-run facility, were physicians having com-
pleted their training. Although many of the normal
females tended to be in medically-related positions, there
were fewer who had completed their educational require-
ments and two who were of relatively limited education.
Most of the male schizophrenics had worked and several had
been working immediately prior to hospitalization but most
of the schizophrenic females were either invalid occupa-
tionally or functioning in the most menial of work capa-

cities. Thus the sex differences in SE8 within each

116

diagnostic subgroup reflect somewhat different
origins.

Subject characteristics exclusive of the selective
criteria of sex and diagnosis do not appear to contribute
importantly to the dependent variable data. Patient
selection by order of fresh admission, however, involved
a shortage of female schizophrenics with paranoid sympto-
matology as compared to males. When sufficient numbers
had not occurred spontaneously in the referral population
as the data collection period drew to a close, it was
necessary to recruit five female schizophrenic subjects,
sustained from medication for a period of one week, from
those already hospitalized in another sector of the
Kaschenko Hospital complex. The spontaneous character
of the patient referral pattern suggested a differential
incidence of patient referrals related to sex: fewer but
more severely disturbed females appeared as compared to
males. If this sample is indicative, Soviet females may
be more severely disturbed before they come to the atten-
tion of psychiatric care. Thus if a difference in inci-
dence of schizophrenia among males and females exists,
it does not become reflected in the statistical data egg
s3. (Malzberg, in Arieti, 1959). On the other hand, one
might expect that females would, by their tendency to
occupy occupations of lesser demand and stress than males,
be absorbed in the community more readily than males.

Then for a male and female schizophrenic showing the same

117

degree of dysfunction, the male would be more likely to
be identified and subsequently hospitalized than would
the female. From this hypothesis, Malzberg's first-
admission data giving the picture of equal admission for
both sexes would suggest that the females admitted are
more "sick" than the males; this in turn would predict
an actual greater prOportion of females showing schizo-
phrenic disturbance than males in the overall population.
Mednick reports a complementary finding for differ-
ences in the incidence of schizophrenia as a function of
sex (1967). As compared to males in the still healthy
"high-risk" group, early adolescent females were positively
related to their disturbed mothers, failed to see their
mother's symptoms as strange or abnormal, and gave many
more negative self descriptions on the Adjective Check
List. Teachers described the "high—risk" girls as being
especially passive, as more nervous and prone to with-
drawal as their response to upset. Thus the presently
healthy but "high-risk" females showed more signs of
morbid prognostication than did the males, probably as a
function of their greater susceptibility through identi-

fication with the pathology of the schizophrenic mothers.

Electroencephalographic Findings
Figures 5 and 6 present graphically the raw data of
Table 1 including mean MEC/second values for each trial
and time period for subgroups differentiated by diagnosis

(Figure 5) and diagnosis plus sex (Figure 6). In all time

118

periods, normals have higher MEC/second than do schizo-
phrenic subjects and this includes a baseline measure of
pre-task MEC/second. Arousal, which is a desynchroniza-
tion of alpha waves and an increase in high frequency, low
voltage wave activity is here measured by a decrease in
MEC/second and is greater among schizophrenic subjects
in all phases of the experimental period. Greater PS
variability is found among normals when compared to schizo-
phrenics (p<.Ol) and among male schizophrenics when com—
pared to their female counterparts on Baseline (p<.05), PS
(p<.Ol) and LP (p<.01) measures. Normal females show
greater variability than normal males during latency period
alone (p<.05). This reduced variability of the schizo—
phrenic subjects adds to the growing body of data which
describes schizophrenia as a condition involving reduced
physiological variation (Rubin and Wall, 1938b; Lindsley,
19““; Goldstein, §£_a1., 1965). The significantly lower
variation among schizophrenic females as compared to
males suggests the former are even more "schizophrenic"
in this respect.

Reaction Time (RT): Assessment of reaction time
as a function of sex, diagnosis, trial and RC (per trial)
suggests that trial affects RT (Table 2). The size of
the partial correlation coefficient (r=0.26; p<50005) is
much greater than other significant relationships between
RT and diagnosis (r-0.08; p<e05) and per trial (r-O.15;
p<.001). Trial better than diagnosis or RC per trial

119

accounts for most of the variability here. As trials
progress RT decreases and so does RC as a function of RT.
This varies with diagnosis in that normals show a decrease
through trials whereas schizophrenics remain approximately
the same in their RC scores. Schizophrenics show no
decrease in their comparatively longer RT nor increase in
their low mean RC through time; thus habituation fails
to occur for schizophrenics on both psychological measures
of reaction time and response commonality.

There are no simple relationships between RT and
other variables as a function of diagnosis alone (Table 3).
There are different patterns of relationship between the
Sexes for reaction time. The greater relaxation pre-
stimulus, the longer the RT for females. RT is shorter
when followed by strong recovery associated with High RC
for this group and normal females contribute most to
the finding that females show shorter RT when this period
is characterized by relatively high MEC/second and is
followed by a response of low commonality. Males show a
generally high level of PR MEC/second exclusive of quality
of response when the RT is short in duration. And the
shorter the RT, the higher the commonality of the
succeeding response. This relationship does not appear
for females. The other significant finding is an inverse
relationship between RT and recovery for normal females.

When RT is compared between groups defined by
diagnosis and diagnosis plus sex (Table A), schiZOphrenics

120

show longer and more variable RT compared to normals.
On trials involving word stimuli without a preceding
photic stimulus, schizophrenic males give significantly
longer RT than their female counterparts.

In agreement with the general concensus of schizo-
phrenic behavioral deficit (Rosenthal gt_al,, 1960;
Shakow, 1962; Lang and Buss, 1965) the schizophrenic
subjects of this work also show greater delays in
response, the males somewhat greater than the females,
where word stimulation is used exclusively. There tends
to be a general relationship between strong recovery and
short RT although this is more clearly defined for the
'males than the females in the study. Females also show
more variability in the relationship between RT and RC.
These variables reveal a high inverse correlation for
males (r=-0.53)-

Arousal: Normal subjects show greater variability
in MEC/second from trial to trial and among the three
time periods than do schizophrenics (Tables 5, 6, and 7)
a finding analagous to Goldstein gt_al,'s work (1963a;
1963b; 1965) using the measure "coefficient of variation"
(as measured from Drohocki integrator data. When all trials
are averaged, thus reducing the bias possibly contributed
by subject intertrial correlations, the significance of
trial alone (p<.005) is reduced but not substantially
(p<.03). There are no significant correlation coefficients

relating arousal and other measures for overall normal

121

subjects. But overall schizophrenics show equally signi-
ficant relationships for High and Low RC as associated
with high PR MEC/second. Arousal does not relate to kind
of response for schizophrenics but predicts recovery in
opposite ways for female vs. male schizophrenic subjects:
the greater the arousal, the greater the recovery for
female schizophrenics, the less the recovery for male
schiZOphrenics.

The overall sex findings between arousal and
recovery seem determined primarily by the schizophrenic
subjects' data alone. Age relates inversely to arousal
for females dependent upon diagnosis; the older the nor-
mal female, the higher arousal (r=0.59; p<.02) but for
the schizophrenic female age predicts less arousal
1r=-O.66; p<.05). Organic factors contingent upon
increasing age do not seem then a source of artifactual
contamination to the dependent variables under investiga—
tion. The correlation between SES and arousal for over-
all females reflects the high positive correlation found
for normal females (r-O.72; p<.01); arousal is greater
as SES decreases in status. The higher the arousal, the
lower the quality (and commonality) of response for the
male subjects. There are no relationships between kind
of response and arousal for females.

The incidence of MEC/second within each trial
'period does not vary significantly over the total test
time period of ten trials when examined by a one-way AOV

122

of trial against MEC/second within each trial period for
(either normal or schizophrenic subjects. Where diagnosis
is included with trial and time period, the presence of
a trial effect of variability as a function of time is
found (Tables 5, 6, and 7).

The absence of any differences between diagnostic
groups in proportional reactivity is probably a reflec-
tion of the "law of initial values" (Wilder, 1958). The
lower the initial Baseline MEC/second, the less absolute
change in electrographic activity upon presentation of a
stimulus. This is apparently the case with the present
study: schizophrenics show a significantly lower baseline
MEC/second than do normals and change less in their
absolute levels of MEC/second but show an equal change
proportionally when compared to normals.

Using the raw data of MEC/second comparing PS to
PR levels, Table 9 presents significant differences
within each subgroup. With the exception of schizophrenic
females, all subjects show a higher level of PS as Opposed
to PR MEC/second; these groups then reflect incomplete
recovery to PS levels of MEC/second. A residual arousal
is retained within the time period (determined by RT
immediately following the subject's verbal response.
Schizophrenic females show over-recovery in that immediate
PR MEC/second level is higher than the PS value and this
difference is greater in magnitude than the value for the

other three groups, who show the opposite finding. Not

123

only are schizophrenic females recovered to the initial
level, they are over-recovered by an amount greater than
the under-recovery difference from P8 values in the
remaining three subdiagnostic groups. This phenomenon
only begins to decrease in trend in the latter three
trials of the ten trial sessions (Figure 2) where there
appears to be a convergence of all three time period
values for the schizophrenic females. The lack of fur-
ther trials precludes knowing if this is a random obser-
vance or indication of a trend toward hypoarousal perhaps
as a homeostatic response to an initially hyperaroused

state.

Psychological Findings

As an alternate way of measuring verbal responses,
RQ, or "goodness of fit", was measured by submitting all
non-common responses to a group of ten judges for rating
on a scale of one to seven. Table 10 confirms the
assumption that RC correlates significantly and positively
with RQ. Although all groups showed significant
relationships between these two measures, the schizo-
phrenic males showed a much lower relationship than the
other groups (r-O.58; p<.05). It is also of interest to
note the closeness of the two females subgroups' corre-
lation coefficients with the schizophrenic females
showing the slightly higher figure (r-0.83, p<.Ol) and
the extreme positions of the two male subgroups (normal

males, r-0.935 P<.Ol; schizophrenic males, r-O.58,.p<.05).

129

Even when severely ill, when schizophrenic females give
a high quality response there tends to be little deter-
ioration in the commonality of their verbal productions
even though they may show greater individuality, or less
commonality, on the average in these expressions. The
schizophrenic males by contrast show a much lower degree
of relationship in that adequacy of response more often
fails to predict conformity of response.

' On all three measures of response characteristics-
mean RC, RQ and frequency of common responses, schizo-
phrenics give fewer adequate responses than do normals
(Table 11). No differences dependent upon sex are found
except for the greater variation of RQ among normal males
and greater variability of RC among normals as compared
to schizophrenics. These findings agree well with the
literature which generally supports the notion that
verbal productions of schizophrenics are less conforming
(Kent and Rosanoff, 1910; Sommer gt_al., 1960; Wynne,
1963).

One corollary of Mednick's theory is that avoidant
thinking is precipitated by anxiety and the avoidant
thought allows the individual "psychological removal"
from the source of anxiety. If this is so, then avoidant
associations should be found in connection with greater
reduction in physiological arousal than non-avoidant
responses. However, there is an overall correlation of

r-O.75 (p<.01) between post-response MEC/second for High

125

RC responses and for Low RC responses indicating that it
is the fact of the response rather than its commonality
which is associated with physiological recovery. However,
schizophrenics show less MEC/second associated with both
kinds of response than do normals (Tables 12 and 13).
Commonality of a response does not appear to distinguish
arousal reduction behavior for either diagnostic group.

Time apparently affects RC level. Normals show a
decrease in RC as trials progress through time while
schizophrenics do not change from their initial level of
Low RC (Table 1h). Whereas normal subjects apparently
were able to relax more as time progressed as suggested
by their change in RC towards greater individuality,
schizophrenics retained their same baseline of relatively
low RC. They also failed to show electrocortical
habituation as evidenced by Table 14.

The absolute level of MEC/second incidence PR also
fails to reveal any relationship with RC (Table 15).
This further supports the conclusion that the kind of
verbal response functions independently of the state of
physiological arousal in all subdiagnostic groups. Using
a measure of baseline MEC/second in assessing PR MEC/
second change (recovery) the data in Table 16 is generally
congruent with the preceding measures of association
between verbal response and physiological arousal in that,
with the exception of normal females, there is no

demonstrable relationship or difference in these data to

126

support the suggestion that non-common responses serve

as anxiety reducers. Normal females show one significant
finding which, if not a function of chance (twenty compari-
sons would predict the possibility of one significant
finding; one of twelve comparisons here reaches significance)
would suggest that normal females alone evidence reduction
in level of cortical arousal in association with rela-
tively original verbal responses. Recovery then is

greater for normal females when they produce a low as

opposed to a high commonality response.

Comparisons with the Literature

The general finding of flatter, lower amplitude EEG
records from the schizophrenic subjects concurs with a
growing trend in the literature (Yeager and Baldes, 1937;
Davis, 19h0; Lindsley, lQHH; Stevens and Derbyshire, 1958).
Comparatively less interindividual variability of EEG
records among these schizophrenic subjects agrees with
Rubin and Wall's (1938b) and Lindsley's (199“) observa-
tions of considerably less variability among schizophrenics
than among normals. More recent work using mechanical
rather than manual EEG assessment techniques (Sugarman,
§£_gg,, 196“; Goldstein, g£_al., 1965) continues to con-
clude that schizophrenics are more homogeneous in their
EEG variation than are normals. The schizophrenics
failure to habituate and the relationship between sever-
ity and over-recovery agree well with the observations

on adult schizophrenics by Williams (1953), Ax et a1.

127

(1962), and Mednick's observations in high risk pre-
schizophrenic children (1967). Visser (1961) noted that
number of conditioned responses was found to be low among
patients with symptomatic psychosis and number of condi-
tioned responses correlates positively with the speed of
extinction (p<.001). Thus the better the original learn—
ing, the more quickly extinction occurs. He also noted

a decreased baseline per cent time alpha in the psychotic
subjects tested and found that this predicted less com-
plete learning and a greater period of extinction. To
the extent that the single presentation of the stimuli

in the present study provided an opportunity for some
learning to take place. Visser's comments are in agreement
with the findings of the present study. The schizophrenic
EEG is then more constricted, flat, and consistent in its
quality than that for the normal control. This indicates
that the schizophrenics are hyperaroused rather than the
opposite and the slower and more variable RT noted in the
schizophrenics is not inconsistent with this view.
Deterioration of performance might be anticipated under
conditions of a hyperaroused physiological state pre-
cluding adequate ability to focus even upon the most
simple of assignments such as reaction time tasks.
Gellhorn (1953) notes that electrographic arousal, often
fails to predict behavioral arousal, that is, reduced
reaction time. Altschule (1953) concurs and notes that

the disturbance that appears in all studies of deficit

128

involves the initiation of responses to the selected
stimuli and the inhibition of inapprOpriate responses.
Shakow (1962) postulates that adequate adaptation
to environmental demands requires two kinds of response:
(1) high arousal with a focus on the relevant aspects
of the stimulus situation associated with minimal focus
for irrelevancies; and (2) reduced arousal impact of the
focal stimulus with repetition of exposure, that is,
habituation, both of which the schizophrenic finds diffi-
cult. Whereas schizophrenics may not differ from normals
with regard to evidence of general physiological arousal
(Fedio, 1961), capacity for focalized arousal seems
reduced. Perhaps this failure to develop a focus of
attention relates to the correlative findings of his
difficulty in adapting to the stimulus through time
(Ax, 1967; Mednick, 1966). The findings of this study
then contradict the hypoarousal theory of schizophrenia
and support a description of schizophrenics as electro-
cortically hyperaroused.
Analysis of the quality and commonality of associa-
tions made by the schizophrenic subjects in response to
a single word association task reveal significant
differences according to diagnosis only; there is no
apparent relationship between degree of change in electro—
cortical arousal and kind of response. Thus the corollary
of Mednick's theory, that low commonality responses
would precipitate a reduction in arousal level in persons

dominated by avoidant thinking, was not supported by

129

these data. Rather the arousal level of the schizophrenics
remained relatively stable through trials as did their
typically low RC.

As expected, schizophrenics produced fewer common
responses and had a mean commonality score less than that
for normals; the schizophrenics quality of response was
also found to be inferior as rated by ten judges. This
agrees well with the original Kent-Rosanoff work (1910)
and that of Sommer et_al. (1960) where a lower incidence
of commonality was found to typify schizophrenic by
contrast to normal subjects.

Interference theory offers a somewhat better fit
to these data than anxiety theory. Buss.and Lang (1965)
in their review of "psychological deficit" in schizo-
phrenia, feel that the concepts of arousal and interfer-
ence best fit the research findings to date. But rather
than specify a particular drive state, such as anxiety,
these authors suggest that a generalized drive state,
which can be measured as physiological arousal, predicts
schizophrenia. Schizophrenic deficit is understood as the
result of disruptive effects of an excessively high
arousal state.

Interference theory, used to account for associational
behavior in schizophrenics, contends that the idiosyn-
cracy and inappropriateness of schizophrenic associa-
tions attest to the difficulty these persons have in

maintaining focus for relevant as opposed to irrelevant

130

stimuli, retaining and shifting a set when needed, and

in general, efficiency of performance. As a more broad
explanation including perceptual, motor and cognitive
variables, interference theory provides a means of inte-
grating the wide range of findings often qualitatively
differing but typically concurring in the schizophrenic's
generally reduced capacity for adaptation as to the stimu-
lus situation. The schizophrenic's reduced commonality
'of verbal responses to a single word association task
nonspecific to any variables except diagnosis, may then
be understood as a function of the overall high state of
arousal the schizophrenics displayed during the test
session.

These findings best support a learning theory of
schiZOphrenia espoused by Broen and Storm (1966). They
suggest that the extent to which hierarchical disorgani-
zation will take place is a function of (a) the strength
of dominant and competing responses, (b) the level of
arousal, and (c) the level of response strength ceiling.
With reference to the present study, the level of elec-
trocortical arousal in the schizophrenic sample was, by
comparison to the normal controls, unusually high in
some cases approaching an almost flat integrator record.
This group also gave fewer common verbal responses, thus
suggesting a breakdown of the normal associational pro-
cess. As the theory posits three sources of contributions

to hierarchical disorganization of responsivity, the

131

occasional schizophrenic subject who did not show evidence
of unusual arousal level can be understood in terms of
either the strength of dominant vs. competing responses

or in terms of a low response strength ceiling. As the
Kent and Rosanoff words consist of words learned fairly
early in life and thus are likely to have strong habit
strength in association with a limited number of common
responses, a lowered response strength ceiling offers

the more likely explanation for the presence of irrelevant
responses in the absence of an unusual arousal level.

Examination of the kinds of "errors" (scored as low
response commonality), made by the schizophrenic subjects
reveals further support for the theory of Broen and
Storm (Appendix A). Rather than irrelevant errors show-
ing little if any conceptual relation to the stimulus
word, by far the majority of non-common responses show
conceptual association to the stimulus.

The qualitative correlates of the observed high
arousal level in the schizophrenic subjects are less
easily discerned. Short and Walter (1954) observed that
subjects who had high visual imagery tended to have low
alpha incidence, or high cortical arousal. Employing a
task demanding the subjects recognize several concrete
blocks with grooved patterns by feeling the grooves
and drawing their outlines simultaneously, they noted
that correct answers occured significantly more often

than incorrect ones in subjects who had been previously

132

categorized as low alpha types (0-251). Thus the finding
of low alpha may indicate a higher fantasy preoccupation
than when compared to individuals who show a high incid-
ence of alpha.

Reyher and Marishige (1969) found alpha desynchron-
ization associated with waking dream recall. Compared to
waking visual imagery, this waking dream recall imagery
contained more judged primary process, more kinetic
imagery, more frequent and longer sequences of images,
and was associated with a higher heart rate. This com-
plements Kamiya's work (1968) where low alpha activity
was noted in conjunction with visual imagery in normal
subjects and in subjects under the influence of LSD.
These studies involve normal subjects only.

Eysenck's Introversion—Extroversion Scale was found
to relate to sedation threshold, (Shagass and Kerenyi,
1958a) in that the more introverted the normal subject,
the higher the threshold. By contrast psychotics revealed
an inverse relation between sedation threshold and degree
of impairment of ego functioning in the gross sense of
contact with reality. The lower thresholds among the
psychotics were among the organic psychotic cases; the
higher in the "borderline" group. Expressed anger was
noted to produce marked changes in the sedation threshold
by increasing the threshold. Although the authors
suggest two different kinds of relationships for the

subjects according to psychotic versus non-psychotic

133

status, what apparently holds true for all of the subjects
is a relationship between the degree of physiological
arousal and sedation threshold. Even in the absence of
manifest anxiety, the unusually high threshold for psy-
chotics can be understood in relation to the data for
non-psychotics by suggesting that it is their state of
high physiological arousal that, as with disturbed
psychoneurotic patients, predicts a higher sedation
threshold.

The finding that anger correlates with sedation
threshold is in accordance with Ax's (1967) work showing
schizophrenics have a nor-epinephrine physiological
pattern. Ax (1967) in a multivariate approach to the
study of autonomic nervous system indicators in schizo-
phrenia, concludes that schizophrenics show an unusually
consistent nor-epinephrine-like profile when compared
to normals and nonpsychotic patients. Neurotics, on
the other hand, show a characteristically epinephrine—
like pattern of ANS response. Thus, schizophrenic patients
reflect an autonomic-endocrine picture consistent with
the emotional feeling tones of anger; neurotic subjects
appear to be experiencing intense anxiety and fear
reactions internally.

These scattered findings converge to suggest that
the phenomenology of the low alpha individual is likely
to be accompanied by a higher incidence of fantasy

experience involving visual imagery. To the extent that

134

alpha desynchronization occurs as compared to a baseline
value, this predicts the experience of primary process
material, and in schizophrenics, it is suggested by Ax
(1967) that the affective quality of this fantasy
preoccupation is likely to be anger-ridden rather than

characterized by anxiety.

CHAPTER V

SUMMARY OF FINDINGS

The first hypothesis of this study, that the EEG's
of paranoid schizophrenic subjects do not differ from
those of normal controls, is not supported by the data.
EEG records of the schizophrenic subjects as measured
by mean Baseline MEC/second, PS MEC/second, LP MEC/
second, and PR MEC/second show significantly less large
wave behavior than their normal comparisons for each time
period. Greater variability of MEC/second within each
time period and by trial is associated with normality,
and the male schizophrenic subjects who are also less
severely ill, show greater variability than their female
counterparts.

Schizophrenics show a longer mean RT and, while
normals give an increasingly shorter RT as trials pro-
gress, schizophrenic RT remains relatively stable through
time. The same is noted for RC scores in that they
remain stable among schizophrenics but become somewhat
more original in normals as a function of time. Schizo-
phrenic males have longest RT's, especially in the absence
of preparatory photic stimulation, and short RT predicts

strong recovery for the males.

135

136

Arousal does not relate to kind of verbal response
for either normals or schizophrenics. It does relate
in opposite ways to recovery for schizophrenic subjects
according to sex: high arousal predicts low recovery for
males, strong recovery for females. Age relates ortho-
gonally to arousal for females depending upon diagnosis;
normal females show more arousal the older they get
while older schizophrenic females show somewhat less
arousal compared to younger subjects. Schizophrenic
females alone showed over—recovery as compared to strength
of arousal contrasting with all other subjects' incom-
plete recovery as measured in the immediate PR period.

The second hypothesis receives only partial support
in these findings. Although there are no significant
relationships noted between RC and diagnosis, RQ which
correlates strongly with RC shows a trend relationship
with arousal in that higher arousal predicts lower RQ
for the male subjects alone. There are no relationships
between kind of response and arousal for females or for
diagnostic groups. As anticipated, schizophrenics give
fewer adequate reSponses when compared to normals in
measures of commonality, and quality, verbal productions.
These differences of relationship between RC and other
variables give only partial support to the null hypothesis
of no association between commonality of response and
other measures, and there were no general relationships
noted between PR mean MEC/second or recovery dependent

‘upon diagnosis or sex.

'1'"

137

"Psychological deficit" as measured by overt
behavioral indices (RT, RC) is somewhat greater for the
male schizophrenic subjects in this study and this is
not surprising in view of the male's greater suscepti-
bility to language impairment under stress. However,
the female subjects who are more severly debilitated on
the average, appear to be more highly reactive physiolo-
gically than their male counterparts, and to the extent
that hyperarousal correlates with severity it seems that
physiological measures are the more reliable in pre-
dicting degree of schizophrenic disturbance. Here the
most consistent relationship with severity among schizo-
phrenics is strength of recovery; severity of the schizo-
phrenic condition predicts over-recovery. Higher arousal
and flatter EEG profiles throughout time periods of
measurement and a general failure to habituate either
verbally or physiologically through time reliably dis-
tinguist the normal and schizophrenic subjects from each
other in most cases. This is not to say there is no over-
lap among individuals, however, and to diagnose differ-
entially exclusively on these bases would be in error.

Whereas there is little support for Mednick's
conceptualization of the etiology of thought disorders
as a function of a drive to reduce anxiety, there is
much to underline the growing consensus that describes
the schizophrenic as suffering from chronic physiological

hyperreactivity (Mednick, 1966; Venables, 1968; Ax, 1967),

138

and there is some evidence (Ax, 1967) to suggest that
the phenomenological quality of this hyperaroused state
is anger rather than fear or anxiety.

The value in considering psychophysiology in
diagnosis and possible prevention of thought disorder
development is suggested here. If the usual idea of
learning is modified to include the broader aspects of
physiological adaptation rather than simply verbal or
manipulative changes in behavior and if schiZOphrenia
is viewed involving a deficit in these emotional and
motivational parameters, a more concise understanding
of schizophrenia and therefore an increased probability

of dealing effectively with the schizophrenic process

may be anticipated.

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139

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Shagass, C. and Jones, A. L. A neurophysiological ‘ezt for
psychiatric diagnosis: result in 750 patients. Amer.
J, Psychiat., 1958, 114, 1002—1010.

 

Shagass, C. and Kerenyi, A. B. Neurophysiologic studies of
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a .

 

 

Shakow, D. Segmental set. Arch. Gen. Psychiat., 1962, Q,

Sherman, M. and Jost, H. Frustration reactions of normal
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Short, P. L. The objective study of mental imagery. EEG
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Short, P. L. and Walter, W. G. The relationship between
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Sommer, R., Dewar, R., and Osmond, H. Is there a schizo-
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§_, 665-673-

Spence, Janet T.and Lair, C. V. Associative interference
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Stevens, J. M. and Derbyshire, A. J. Shift along the alert-
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Strauss, H., Ostow, M., and Greenstein, L. Diagnostic
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1952.

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Theisen, John W. Effects of certain forms of emotion on
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150

Travis, L. E. and Knott, J. R. Brain potential studies of
perservation: II perservation time to visually
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APPENDICES

151

APPENDIX A

VERBAL RESPONSES FOR EACH SUBJECT

TO EACH WORD STIMULUS

152

 

F" 7' mm \p-

Subject

\OCDNChUWS'UUMI—J

VERBAL RESPONSES FOR EACH SUBJECT

TO EACH WORD STIMULUS

NORMALS

Room

Bed

Bed

Dark
Chair
Chair
Chair
Chair
Didn't Hear
Chair
Chair
Oaken
Pitcher
Patient
Chair
Chair
Round
Dinner (Table)
Chair
Chair
Chair
Chair
Armchair
Chair
Chair

1.

Table

Subject

153

NF<><£<CHM2UDwOZZF{JRHZEQ'ULTJUOCntb

SCHIZOPHRENICS

Kitchen

Furniture

Round

Clean

Peaceful
Polished

Long

Chair

Different Kinds
Square

Large

Set Out The Tablecloth
Raised

Furniture

Floor

Chair

Worthy

Table (echolalia)
Blue

Bed

Light (in color)
Chair

Couch

The Light is Distrubing
Chair

Subject

H
cnoowqcnULzmumua

p
1...:

thha
amen:

NORMALS

Light (adj.)
Light (adj.)
Fish

Deep (profound)
Night

Grass

Light (adj.)
Pitch Dark
Light (adj.)
Light (adj.)

Light (adj.)
(No Response)

Light (adJ.)

Microscope

Light (adj.)
Light (adj.)
Exceptional
Room

Light (adj.)
Black

Light (adj.)
Light (adj.)
Light (adj.)
Light (adj.)
Night

2.

15“

Dark

Subject

NMNS<CHM§UDV OZSL“ meommuow>

SCHIZOPHRENICS

Night

Dark (echolalia)

Light (prefix to adj.)

Light (adj.)

Catastrophe

Cooked

Sad

Day, light

Dark (prefix to adj.)

Darkness doesn't
depend on me

Night

Unpleasant

Dark (echolalia)

In The Dark It's better

to be afraid of people

Dark (prefix to adj.)

Light (adj.)

Worm

Lightness

Light (adj.)

Light (prefix to adj.)

House

Light (adj.)

Lightness

Light (adj.)

Light (adj.)

Subject

NORMALS

Woman
Woman

Student (masc.)

Tall
Woman

End (noun)

Long

Woman
Woman
Woman
Woman

Woman
Woman

Office

Woman
Woman

Interesting

Tall

Woman
Woman
Woman
Woman
Woman
Woman
Woman

155

MAN

Subject

NNN£<G803=UDVO ZS bemmwmuom>

SCHIZOPHRENICS

 

Tall

Sex

Woman

Good

Music

Tall

Tall

Woman

Could look like a peasant
Tall

Not always pleasant to
be seen as a man

Man (echoalia)

Man is always seeing
woman

Masculine gender
Woman

Woman

Common

Woman

Skeleton

Woman

Strong

Woman

Girl (adolescent)
Not completely

Woman

Subject

HFJHJ
NFJCMOCD~JOWN£mphJH

fOFJHFJFHAPJH
cnocp~aowncny

21
22
23
24
25

NORMALS

Fast
Fast
Fast
To go
Fast
Faster
To go
Fast
Washbasin
Fast
Fast
Fast
Fast
Lake
Fast
Fast
Train
Loud
Fast
Fast
Fast
Fast
Fast
Fast
Fast

A.

156

SLOW

Subject

NF<><£<C1FBUJIJDWOZZVNHIECD'TIJIITJUOtDb

SCHIZOPHRENICS

 

Fast

Time

Fast

Fast

Undoubtedly

Fast

Leaking water
Go By Train
Fast

Fast

Fast, slow, no difference
Slow (echolalia)
Fast

Quiet

Fast

Fast

Slow (echolalia)
Fast

Fast

Fast

Fast

Slow

Fast

Often

Fast

Subject

\OCDNONU'IJ-i'UJMH

FJFJH
IOFJO

PJH
kw

mHHHHH
cnocn~aoun

NNNNN
UT-C’LUNH

NORMALS

Little
Little
High heels
Fellow
Low
Sky
Low
Table
Thick
Little
Low
Man
Tree
Low
Low
Low
Oak
Fellow
Low
Red
Low
Low
Low
Average
Short

5.

157

HIGH

Subject

NKNZ<CHMNDWOZSF$§HQWNUOW>

SCHIZOPHRENICS

 

Man

Increase (noun)
Low

Low

Low

Oak

Man

High Means Increasing
(No Response)
Natural Creation
Guy

Man

Long

Low

Low

Up

Low

Beautiful

Low

Low

Low

Low

No Never

Low

Subject
1

ranHFJFJHFJFJHFJPJH
+4cuccn~aownJruuvracmocn~aounJruuv

N
N

NMN
WED»)

NORMALS

Sweet

Bitter
Sweet
Salty
Sweet
Grapes
Sweet
Sweet
Sweet
Sweet
Sweet
Salty
Sky Blue
Sweet
Sweet
Sweet
Lemon
Sweet
Sweet
Sweet
Sweet
Sweet

Sweet
Sweet
Sweet

6.

158

SOUR

Subject
A

Nr<>< £<CHM$DVOZZF$§HIQHJWUOUJ

SCHIZOPHRENICS

 

"Kvas" (A Sour Russian
Drink)

Taste (noun)

Sweet

Not very

Sweet

Tomato

Milk

Sweet

Greater Sourness

In Milk

Unpleasant

"Kvas I!

Sourness

Bitter

Bitter

Sweet

Work (Job)

Sweet

Watch (wrist)

Dreamlike

Sweet

It's such, it's I
can't know

Sweet

Light Burns

Sweet

Subject

Homooxlmmzwmr—a

rJFHHFJHFHFJH kJH
\ocn~aoun4:uuv

MNNC
WHO

NNIU
U'IJIWJU

NORMALS

(improper
(improper
(improper
(improper
(improper
(improper
Soft
Crude
Soft

Soft

Soft

Soft
Black

7. HARD (Surface)

stimulus
stimulus
stimulus
stimulus
stimulus
stimulus

Photography

Metal
Soft
Nut
Soft
Soft
Soft
Soft
Soft
Soft
Soft
Soft

159

used)
used)
used)
used)
used)
used)

Subject

NP<><£<CIHUJZUDFUOZZ FWHZEQ’IJMUOUJID

SCHIZOPHRENICS

 

Bread

Hardness

Soft

Soft

Soft

Antonym Soft

Sofa

Soft

Hard (echolalia)

I feel very bad

Bread you are
current

Sofa

Brush

Hard (syn.)

Soft

Soft

Sleigh

Soft

Good

Soft

Soft

Stale

Bread

Nothing tastes

Soft

Subject

\DCONQUWEWMH

160

8. LONG

NORMALS

Little
Short
Short
Short
Short
Tree
Short
Short
Short
Short
Short
Short
Pigeon
High Heels
Average
Short
Tall
Short
Short
Short
Short
Short
Short
Short
Short

Subject

Nk<><£<3C*-3U):UD"UOZZF‘NHEQWWUpr

SCHIZOPHRENICS

 

Main Event
Measure
Low
Ruble
Short
Dance
Train
Short
Tall
Thread
Lengthy Poetry
Long (echolalia)
Six

Tall

Low

Short

Sound

Short

Short

Short

Short

Long (echolalia)
Average

Short

Long (echolalia)

(noun)

 

 

 

161

 

9. BLACK
NORMALS SCHIZOPHRENICS
Subject Subject

1 White A Fellow

2 White B Light (noun)

3 Red C White

A Table D Bread

5 White E Brown

6 Grass F Swan

7 Red G Cat

8 White H White

9 White I And So it is black
10 White K Motherly

11 White L Special Light (noun)
12 White M Bread
13 Lake N Suit (clothing)
1“ Disgusting 0 Dark (adj.)

15 Soot P White
16 White Q White
1? Bread R Up
18 White S White
19 Red T Red
20 Red U And White
21 White V And White
22 White W Red
23 White X White

2“ White Y Closed

25 White Z Red

162

 

10. LOUD
NORMALS SCHIZOPHRENICS
Subject Subject

1 Quite (adj.) A Voice

2 Slowly B Sound

3 Quiet (adj.) C Silence

A Loudspeaker D Sound

5 Quite (adj.) E Weak

6 Scream (noun) F Thunder

7 Sound G Thunder

8 Quiet (adj.) H How? Quietly

9 Sound I And so it is loud
10 Weak K Thunder
11 Quiet (adj.) L High Frequence Sound
12 Thunder M Conversation
13 Sun N Sound
In Red 0 Ringing Clear
15 Amplifier P Low
16 Quiet (adj.) Q Weak
17 Sound R Flower
18 Noise S Quiet (adj.)
19 Sound T Quiet (adj.)

20 Quiet (adj.) U White

21 Quiet (adj.) V Whistle (noun)

22 Quiet (adj.) W Mute (adj.)

23 Quiet (adj.) X Weak

24 (No Response) Y Don't Hear Anything
25 Low Z Quiet (adj.)

APPENDIX B

MOST FREQUENT RESPONSES FOR EACH WORD
STIMULUS GIVEN BY A REFERENCE SAMPLE OF

ONE HUNDRED MEDICAL STUDENTS

163

MOST FREQUENT RESPONSES FOR EACH WORD

STIMULUS GIVEN BY A REFERENCE SAMPLE OF

ONE HUNDRED MEDICAL STUDENTS

Table

CERT? 5
To Eat

Legs

Furniture
Dishes

NNMMN

'13.“.

Woman 6
Tall

Handsome

Girl (adoles.)
Interesting

mmzmox

High
Low A

Short
Little
Long
Fellow
Average
Table

NUOUUU O\\JU1

Hard

Soft 5

Hard (Syn.)

Hard
(Difficult)

Table

Sofa

Elastic

Metal

NNN-E‘m \00

164

Dark

Light

Night

(Pitch) Dark
Lightness

Day

Thick

Window

Deep (Profound)
Fearful

Slow
Fast
Loud

To Go
Train
Quiet

To Speak
Airplane

Sour
Sweet
Salty
Bitter
Apple
Lemon

Long
Short
Hair
Little

NNNNUOUU£-'J=O\

NNNNb-E'U'l

 

 

Black
White
Red

Bread
Light

165

10.

Loud
Quiet
Sound
Weak

Low

Voice
Noise
Deaf
Strong
Amplifier
Loudspeaker

NMNNNWWU‘IWGJ

APPENDIX C

PATIENT ADMISSION DATA

166

PATIENT ADMISSION DATA

Patient A. M. L., a 28—year old male, was admitted in

 

January, 1967. After a previous hospitalization in 196A

he was married and has subsequently divorced. He currently
lives with his mother and has worked off and on as a lathe
operator. He arrived at Kaschenko on this occasion against
his will after his mother reported finding several letters

in the home addressed to the Federal Republic of West Ger-
many, the United States of America, and Great Britian com-
plaining of life in the Soviet Union. He complains of
strangers who are plotting against him and who intend to do
him harm. He currently responds adequately to most questions,
although he refuses to state his age and continues to deny
that he is ill. Upon admission he appeared moderately
anxious, was combative with the attendants on several occa—
sions, and showed moderate disorganization of thought process.

Patient B. An unmarried male of 25 years of age, this

 

is B. C.'s first admission. He speaks Openly of his suspi-
cions of people not liking him and shows concern about men
who stop him on the street either drunk or sober asking him
for cigarettes-~feeling that they intend to hurt him in some
way. He states that his neighbors do not like him and wish
to do something to hurt him, although he is aware there is

no evidence for his fears. He does not consider himself 111.

167

168

He has worked as an unskilled factory worker in the past
but has not been employed in the past three months.

Patient C. C. N. is a 50-year old male divorcee.

 

Six months ago he noted "espionage" in that he feels that
his previous wife was a spy and used to spy on him. This
is his first admission and he appeared very anxious to
admission attendants. According to his family he has ex-
hibited delusions of persecution for the past year and
believes he has cancer. He has worked regularly as a taxi
cab driver until date of admission.

Patient D. B. K. is a 67-year old male who has a

 

long history of admissions. At the time of this admission
he appeared talkative and seemed to be in a good mood al—
though he showed no insight into his illness. He has
worked in the past as a ship pilot and in 1956 married for
the first time. In 1958 he began to experience auditory
hallucinations, ideas of reference, and delusions of per-
secution. He describes himself as a "consultant on all
political questions" and has developed his own theory of
the origin of the earth.

Patient E. N. T. is an unmarried male radio engineer.

 

He has not been working in the past several months and this
is his first admission. Since 19A2 he has been developing
his "theory of psychology as a scienCe." He shows little

insignt and describes himself a superior psychologist. The

169

bizarreness of his theory, which he discusses readily,
brought him to the attention of the authorities.

Patient F. A 32-year old married male, A. T. was

 

brought to the hospital by ambulance from the Central
Committee Building where he was delivering his theory of
the universe on the front steps to passersby. In 1958

he began to be interested in cosmonauts and space theory
and since that time has written many letters to various
civic organizations about his ideas. He states that he
is capable of transmitting "biological waves" and that
his sister and brother have tried to kill him on 21 diff—
erent occasions. He has worked in the past as a foreman
in a factory, although relatively calm upon admission, he
speaks readily and at length of his "great discoveries"
and of his disappointment that the Academy of Sciences
has not recognized his work.

Patient G. D. N., a 37-year old married male, has

 

been admitted for the second time. He complains of hearing
noises and male voices in his head. He expresses jealousy

of his wife and feels that she wants to kill him. He also

feels that physical changes are occurring in his hands. He
was a patient in the hospital eight years ago for a period

of three months but he has worked relatively steadily as a

skilled laborer in the interim.

Patient H. D. C., a married male of 28 years of age,

 

was hospitalized for the first time in January, 1967. He

170

first noticed people had a "strange attitude" toward him
shortly before admission. Although he graduated from a
technical institute, he has worked only infrequently.
During the test procedure he expressed concern that some—
one was "following his ideas." His twin brother has also
been hospitalized in the past with a diagnosis of paranoid
schizophrenia.

Patient I. N. B., a married carpenter of “1 years

 

of age, began drinking heavily in 195“. Upon admission in
1961 he complained of hearing voices and expressed multiple
fears. His 1967 admission is his second and he continues
to complain about voices in his head. He is moderately
agitated and refuses to speak about himself or his symptoms
in any detail.

Patient K. L. N., a 32-year old unmarried female,

 

has been ill from the age of 16. She has been admitted to
the hospital several times since and complains primarily
of auditory hallucinations. She hears voices which some-
times threaten her, sees people looking at her who intend
to do something harmful to her. She has worked sporadicly
as a janitoress in a barber shop.

Patient L. M. P. is a 55 Year old female who has

 

been in and out of psychiatric hospitals since 1960. De-
1usions of persecution first appeared when after changing
her apartment she began to speak of neighbors going through

her clothes and "spying on her." People on the street look

171

at her strangely, and try to get her to "join their
organization." She has worked as an unskilled worker in
the past, and is currently living on a pension. She has
never been married.

Patient M. B. K., a 50-year old female, has been

 

ill for ten years. The most recent admission, of several,
was in May, 1967. She complains of insomnia, of hearing
voices which say bad things about her. She has been
married in the past and has two living children. Never
having been able to maintain a job for any length of time,
she is an unskilled worker and is considered an invalid
occupationally.

Patient N. B. K., a 58-year old male married second-

 

ary school teacher. April 1967 was his first admission.
Complaining of "strugglers" he was taken forcibly from a
restaurant. He states that the "strugglers" typically dis-
guise themselves as physicians and are especially to be
found in hospitals. It is interesting that this patient
used to be a private tutor of Litvinov, a former minister
under Khruschev.

Patient 0. This is M. P.'s first admission to the

 

hospital although he hasn't worked actively in his occupa-
tion of taxi driver for the past 2 to 3 years. He denies
any need for being here but openly discusses his notions
of the "false world." Specifically he is concerned about

threatening "voices" which he says have been speaking to

 

172

him since 1955. He feels his behavior is influenced by
"rays" originating in outer space. He is A8 years of age
and has never been married.

Patient P. S. C. was hospitalized in 1963 for a

 

short period of time and this is his second admission. A
36-year old male, he is married with two children. His
speech reflects many delusions of reference including

notions of special calling by the Central Committee. He
suspects his wife of spying upon him and reporting his
movements to an "enemy agent." He has worked as an unskilled
worker all his adult life.

Patient Q. K. G. has had a record of psychiatric dis-

 

turbance since the age of twelve and has been admitted to

the hospital on numerous occasions. He shows disorganization
cf time and place orientation and hears voices directing "his
thoughts." He has never been married and is considered
occupationally invalid having never worked steadily.

Patient R. V. K. has had a history of many previous

 

admissions. He is a 27-year old male who has worked in the
past as an unskilled worker and has never married. Seeing
himself as healthy, he describes everyone around him as
spys and acuses them of persecuting him. Upon admission,
he was in a state of mild excitation for which he was pre-
scribed a tranquilizing drug. Preceding his inclusion in
the study he was kept off drug therapy a period of seven

days.

173

Patient 8. B. C., a 32-year old male, has a history

 

of multiple admissions beginning in 1956. He complains of
persecution by neighbors, voices in his head, and various
somatic complaints not supported by confirmed organic
disease. He is reluctant to answer any questions and is
generally suspicious although not apparently anxious. He
has never been married and has worked only irregularly as
an unskilled laborer.

Patient T. R. T. is a AO-year old female who was

 

admitted most recently in April 1967. She has a history of
many previous admissions and complains of "physical influ—
ences." There are also many references to auditory hallu-
cinations involving the voices of her deceased mother and
current neighbors. She has never been married and is con-
Sidered occupationally invalid.

Patient U. C. B., a A9-year old female, has been ill

 

for more than 15 years. She has a history of several ad-
missions, many for alcoholism. Ideas of reference and
auditory hallucinations, voices warning her of her enemies,
are prominent in her symptom picture. She feels that her
mother wants to kill her by poisoning. A divorcee, she has
two children. She is occupationally an invalid.

Patient V. M. 0. is a 57-year old female who has

 

been ill for many years. Delusions of persecution, ideas
of reference, and some auditory hallucinations characterize

her behavior. She complains about how her boss used to spy

 

174

on her and enlisted co-workers to do the same after work-
ing hours. She has worked as an unskilled worker, is a
divorcee with no children.

Patient W. P. M. is a A6-year old female whose first

 

admission was in 1950. Since that time she has been ad-
mitted many times to the hospital and has complained of
ideas of reference, delusions of persecution and complains
of prejudicial attitudes expressed toward her by strangers.
She is convinced that her neighbors are spying on her.

She is a divorcee with no children and is occupationally
an invalid.

Patient X. 0. K. is a 37-year old female who has

 

been ill since 1957. She has worked as a cloakroom clerk
and manages to give fairly adequate responses upon inquiry.
She shows marked mannerisms in her behavior, no insight,
and delusions of persecution, feeling her relatives are
trying to turn her in to the security police. She has

not been married.

Patient Y. L. S. is a 39-Year old female with a his—

 

tory of many admissions to the hospital. She has worked
as an orderly in a nursery, is currently married with one
living child. She expresses ideas of reference and audi-
tory hallucinations which have an imperative character.
She describes her voices as commanding her to perform non-
sensical compulsive acts about the house. She shows no

insight and shows only mild anxiety at the time of testing.

175

Patient Z. N. B. is a AA—year old female with an

 

extensive history of psychiatric disturbance although this
is only her second admission. She complains about every-
one following her and talking about her and often trying

to grab her and threaten her life. She was described by
her neighbors as reclusive, almost never leaving her apart-
ment except to go to work and never allowing anyone in for
the past year. She had been married, is now divorced, and

has worked in her occupation as a janitoress fairly steadily.

APPENDIX D

WORD AND LIGHT STIMULUS

PRESENTATION SCHEDULES

176

t

\D (I) \1 ON U"!

10
11

12

WORD AND LIGHT STIMULUS

PRESENTATION SCHEDULES

I
Table
1*Dark
l"Man
Slow
2"Girl
2*High
Sour
Hard
Bread
3"Long
Black

3*Loud

SCHEDULES

 

II
1"Table
Dark
Man
l"Slow
Girl
High
2"Sour
2"Hard
3"Bread
Long
3*B1ack

Loud

III

Sour

l"'Hard

l"Bread
Long
2*Black
2"Loud
Table
Dark
Man
3*Slow
Girl

3*High

IV
l"Sour
Hard
Bread
1"Long
Black
Loud
2"Table
2*Dark
3"Man
Slow
3"Girl

High

*Presented with preceding stroboscopic light stimulus.

Note:

:Light
3Light
Light

 

Trials using stimulus words "Girl" and "Bread" were
subsequently eliminated from the data analyses.

Frequency = 10/second
Frequency = 25/second
Frequency = 80/second

177

APPENDIX E

NAMES AND TRANSFORMATION OF MEASURES

CALCULATED FOR EACH SUBJECT

178

NAMES AND TRANSFORMATIONS OF MEASURES

CALCULATED FOR EACH SUBJECT

Baseline MEC/second (I) times 10
Pre—stimulus MEC/second (x)_times 10
Latency Period MEC/second (x) times 10
Post-Response MEC/second (x) times 10
Latency Period Length (seconds)
Severity of Disorder (Schizs Only: l=chronic; 2=acute)
Age (to the nearest tenth of year)
Socio-Economic Status (1 downwards to 5)
Marital Status (Schizs_only) '1=some marital history; 2=none
Response Commonality (x)
Response Quality (x)
Latency Period Length, Trial 1 (SECS) times 10
N H

H H
H N
H II
H H
H II
N I!
H I!
H II

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Pre-Stimulus MEC/second, Trial (f) times 10
H "

1
2
3
u
5
I! H 6
7
8
9
0

Latency Period MEC/second, Trial (I) times 10
fl

1

fl 2

H II 3
H H u
I! u 5
I! ll 6
I! I! 7
II N 8
II II 9
0

n H l

179

 

Post-Response MEC/second,
H

Response Commonality, Trial
II H

H
H

180

Trial 1 (I) times 10
i

I
II
II
H
II
I!
II
N
H

 

2
3
u
5
6
7
8
9
10
1 (I) '
2
3
u
5
6
7 .
8
9
10

Pre-Stimulus/Latency Period MEC/second (fl times 10
Post-Response/Latency Period MEC/second (x) times 10
Pre-Stimulus MEC/second associated with Hi RC times 10
Latency Period MEC/second associated with Hi RC times 10
Post—Response MEC/second associated with Hi RC times 10
Pre-Stimulus MEC/second associated with Lo RC times 10
Latency Period MEC/second associated with Lo RC times 10
Post-Response MEC/second associated with Lo RC times 10

181

 

 

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