DIFFERENCES IN SELF-CONCEPT IDENTIFICATION BY A SCHIZOPHRENIC AND NON-SCH‘IZOPHRENIC : PRISON POPULATION Thesis for the Degree of Ph. ED. MICHIGAN STATE UNIVERSITY BARNEY GREENSPAN 1970 II; III F; LIBRAR y Michigan State niversity This is to certify that the thesis entitled DIFFERL I‘T’TES I“? SELF-CONCEPT IT‘ETTTIFICATION BY A SCEIZOPHREVIC ANT) T‘ON-SOHI'TOPHRQJVIC PRISON POPULATION presented by Barney Greenspan has been accepted towards fulfillment of the requirements for pk D _.__1__n__degree in OIL???» ling, Personnel Services, and Education- al Psvchology 4M5. 2 (MM. / Major/flofessor Date July 31: 1070 I 0-169 ABSTRACT DIFFERENCES IN SELF-CONCEPT IDENTIFICATION BY A SCHIZOPHRENIC AND NON-SCHIZOPHRENIC PRISON POPULATION BY Barney Greenspan Schizophrenics (Scs) have problems, under conditions of ambiguity, in distinguishing between themselves and others. The purpose of this study was to investigate the Sc's use of self-concept information. Since Scs are less aware of their ego boundaries and are more prone toward feelings of disper- sion or diffusion, it was hypothesized that they will be less able to differentiate stereotyped self-concept descriptions than non-Scs. The Counseling Form of the Tennessee Self-Concept Scale (TSCS) was administered to 30 male inmates who had no diagnosed psychOpathology (NSc), 30 Paranoid Schizophrenics (PaSc), and 30 Chronic Undifferentiated SchiZOphrenics (Und). Each g in each diagnostic category was randomly assigned to an experimen- tal or control group. There was an equal number (15) of NSc, PaSc, and Und gs in the experimental and control groups. Two weeks after initial testing, the experimental gs were called individually into a testing room and each g read his own Barney Greenspan profile description. The 45 control gs did not receive any feedback. One week later, all §s were presented with three stereotyped profile descriptions. These include a NSC, PaSc, and an Und profile. Each § was instructed to read all three profile descriptions and to choose which profile best describes him. The analysis of variance indicates that diagnostic cate— gory is related to performance on the profile choice task. The NSC group was most successful (in choosing the description which best describes the diagnostic category to which they belong), followed by the PaSc and Und groups, reSpectively. Across all diagnostic categories, the feedback condition ef- fected a significantly greater amount of success on the task than the no-feedback condition. There was some evidence sup- porting the contention that those Sc gs off medication were more successful compared to those on medication. The effects of medication did not interact with either the diagnostic category or feedback dimensions, nor did the diagnostic cate- gory factor interact with the feedback condition. Finally, no noticeable differences, with reSpect to any finding, were evident between prison and hospital §5- The Sc has difficulty integrating information dealing with his self-concept. While the Sc process in the Und does not com- pensate for the loss of ego boundaries, the adjustment of the PaSc may then be regarded as a positive attempt to offset the disintegration characteristic of the Und. DIFFERENCES IN SELF-CONCEPT IDENTIFICATION BY A SCHIZOPHRENIC AND NON-SCHIZOPHRENIC PRISON POPULATION BY Barney Greenspan A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Counseling, Personnel Services, and Educational Psychology College of Education 1970 ACKNOWLEDGMENTS For their unflagging encouragement and indispensable help, I am indebted to my dissertation committee. Along with Dr. John E. Jordan, who served as chairman, sincerest appre- ciation goes to Dr. James Engelkes, Dr. Fred J. Pesetsky, and Dr. Albert I. Rabin for their suggestions, patience, and enthu- siasm in the undertaking of this thesis. I acknowledge my friends and colleagues, particularly Michael Figler, who have assisted in the completion of this dissertation through discussion, argument, and sometimes challenge. I am most happy to express my thanks to Oliver Terpening, who gave excellent editorial assistance and was a valuable source of ideas, care, and patience. Obviously, this study would have been impossible without the c00peration and candor of the many prisoners who volunteered to be research subjects; I have tried to show my appreciation by respecting their confidence. To my readers, I am grateful to those who make the effort to understand; I hope that in time I shall become more deeply indebted to a few, who will contribute to the further clarifica- tion of the ideas presented. My wife's sensitivity, inspiration, and wise counsel have so influenced all that I do, that I dedicate this, the completed dissertation, to Laurie. ii TABLE OF CONTENTS Page ACKNOWLEDGMENTS. . . . . . . . . . . . . . ii LIST OF TABLES . . . . . . . . . . . . . . v LIST OF APPENDICES O O O O O C O O O O O O 0 Vi Chapter I 0 INTRODUCTION 0 O O O O O O O O O O O 1 Introductory Statement . . . . . . . . 1 Statement of the Problem . . . . . . . 3 Hypotheses . . . . . . . . . . . . 4 II. REVIEW OF THE LITERATURE . . . . . . . . 6 Self-Concept: Theory . . . . . . . . 6 Self-Concept: Research. . . . . . 9 SchiZOphrenia: Self— -Concept Theory. . . . 10 SchiZOphrenia: Self— -Concept Research . . . l7 Schizophrenia: Paranoid Type--Theory . . . 21 SchiZOphrenia: Paranoid Type--Research . . 23 Schizophrenia: Chronic Undifferentiated Type . . . . . . . . . . . . . 24 Criminal Activity. . . . . . 24 Research Demonstrating the Relationship Between Self- -Concept and Behavior Using the Tennessee Self-Concept Scale . . . . 26 I I I O METHODOLOGY 0 O O O O O O O O O O C 2 9 Subjects. . . . . . . . . . . . . 29 Measurement Device . . . . . . . . . 30 Procedures . . . . . . . . . . . . 34 Hypotheses O O O O O O O O O O O 35 Analysis of the Data. . . . . . . . . 37 IV. RESULTS 0 O O O O O O O O O O O O O 39 Summary . . . . . . . . . . . . . 52 iii CHAPTER v. DISCUSSION. LIST OF REFERENCES. APPENDICES Self-Concept: Self-Concept: Retention and Medication Limitations of the Theory . Research. Abstraction resent iv Study. Implications for Future Research. Conclusions. Page 53 53 55 57 58 59 61 61 64 72 Table 1. LIST OF TABLES Summary of Analysis of Variance of Stereo- typed Profile Choices for Non—Schizophrenic, Paranoid SchiZOphrenic, and Chronic Undif- ferentiated SchiZOphrenic Subjects (Diag- nostic Category) Under Feedback or No Feedback Conditions. . . . . . . . . Frequencies and Percentages of Stereotyped Profile Choices for Non—Schizophrenic, Paranoid SchiZOphrenic, and Chronic Undif— ferentiated SchiZOphrenic Subjects Under Feedback or No Feedback Conditions. . . . Proportion and Percentages of Correct Profile Choices for Non-Schizophrenic, Paranoid Schizophrenic, and Chronic Undifferentiated SchiZOphrenic Subjects. . . . . . . . Summary of Analysis of Variance of Stereotyped Profile Choices for Paranoid SchiZOphrenic and Chronic Undifferentiated Schizophrenic Subjects Under Medication or No Medication Conditions. . . . . . . . . . . . PrOportion of Correct Profile Choices for Medicated and Non—Medicated Paranoid Schizo- phrenic and Chronic Undifferentiated Schizo- phrenic Subjects. . . . . . . . . . Proportion and Percentages of Correct Profile Choices for Medicated and Non-Medicated Paranoid Schizophrenic and Chronic Undiffer- entiated SchiZOphrenic Subjects Under Feed~ back or No Feedback Conditions . . . . . Summary of Analysis of Variance of Stereotyped Profile Choices for Schizophrenic Subjects Under Feedback or No Feedback, and Medication or No Medication, Conditions. . . . . . Proportion of Correct Profile Choices for Medicated and Non-Medicated SchiZOphrenic Subjects Under Feedback or No Feedback Conditions. . . . . . . . . . . . V Page 40 41 43 46 47 48 50 51 LIST OF APPENDICES Appendix A. The Counseling Form of the Tennessee Self- Concept Scale (How the Individual Per- ceives Himself). . . . . . . . . A Self-Concept Profile, Derived from the Tennessee Self-Concept Scale, Which Is Characteristic of a Subject with No Diagnosed Psychopathology . . . . . A Self-Concept Profile, Derived from the Tennessee Self-Concept Scale, Which Is Characteristic of a Paranoid Schizo- phrenic Subject. . . . . . . . . A Self-Concept Profile, Derived from the Tennessee Self-Concept Scale, Which Is Characteristic of a Chronic Undiffer- entiated SchiZOphrenic Subject. . . . A Stereotyped Profile Description of a Person with No Diagnosed Psychopathology A Stereotyped Profile Description of a Paranoid Schizophrenic . . . . . . A Stereotyped Profile Description of a Chronic Undifferentiated SchiZOphrenic . Pilot Study 0 O C O O O O O O D 0 Summary of Analysis of Variance of the Total Positive Score on the Tennessee Self-Concept Scale for Non-Schizophrenic, Paranoid Schizophrenic, and Chronic Undifferentiated SchiZOphrenic Subjects . . . . . . vi Page 73 75 76 77 78 79 8O 81 82 CHAPTER I INTRODUCTION Introductory Statement One way in which an individual is given unity is through the self-concept. The young child has no initial way of tell- ing the difference between himself and the world around him. A construct of self is formulated from the data coming to the individual. The environment teaches the child that he is a unit having a certain pattern of attributes. He begins to see the changing world from the standpoint of a constant self. A "psychological homeostasis" adjusts behavior and inter- prets the world in ways that preserve the self-concept. This concept of self, then, serves as a unifying and organizing fac- tor in the behavior of the individual. It keeps molecular bits of behavior in line with perceived general attributes and it preserves itself, sometimes by guiding behavior, sometimes through distorting perceptions of events. Ways of behaving that are consistent with the structure of the self are adopted and inconsistent behaviors are avoided. The individual is well-adjusted when almost all experiences can be assimilated into a consistent relationship with the self. There is psychological disturbance‘when the individual denies significant experiences that cannot be tolerated by the structure of the self. The most shattered and disintegrated personality is schiZOphrenic (Sc). In Sc, thoughts and ideas become distorted, irrational, and bizarre. They are expressed in confused, strange lan- guage, or in nonsensical sounds; or they are not expressed at all and there is only silence. Relationships with other peo— ple are minimized as the person withdraws. Emotions become distorted, exaggerated, confused, and inappropriate. Behavior becomes unconnected, unrelated, disharmonious,and irrational. It is not certain whether Sc is one disorder with dif- ferent types characterized by distinctive symptomatology, or whether there are distinct kinds of disorders grouped together only because they all have in common the general character- iStic of the disintegration of the personality. The prevailing practice is to refer to Sc as a single disorder, and to differentiate types according to the dominant symptom pattern. This is the method followed in the present study. The Sc is characterized by withdrawal from reality, in- difference concerning everyday problems, and a tendency to insulate himself in a world of fantasy. The Sc may often say things which are inconsistent with the emotions expressed, react with indifference to occurrences which usually invoke sorrow in other peOple, coin new words or engage in inappro- priate laughter, withdraw almost completely from group life, complain of being influenced by mysterious powers, or give vent to explosive expressions of resentment and hate. By withdrawing and becoming seclusive the Sc avoids coming into contact with ego-threatening situations. By be- coming apathetic he protects himself against his own fear of failure. By showing indifference to a situation, he precludes the possibility of having to participate in solving the prob- lems which it presents. His delusional ideas insulate him against strong feelings of insecurity, inadequacy, or guilt. His grandiose fantasy compensates for his inadequate and unworthy feelings; his persecutory ideas place the blame of his difficulties and failures on others. The situations and factors that precipitate the Sc reaction are essentially the same that bring on other ego- defensive patterns. They are basically those conditions that are regarded as a serious threat to the individual's feelings of security and adequacy. Sc stems from the individual's inability, whether real or fancied, to satisfy his ego needs and to adjust satisfactorily to the group(s) in which he finds himself. Arieti (1955, p. 43) summed it up in this way: "Sc is a Specific reaction to an extremely severe state of anxiety, originated in childhood, reactivated in later life. This speci- fic reaction occurs when no other solution, no other possibility of adjustment, is any longer available to the individual." Statement of the Problem Ego boundary and ego feeling provide the sense of self as separate from other peOple and the world. This separateness is needed for action to proceed effectively. Ego feeling (Federn, 1952) is related conceptually to ego identity (Erikson, 1959). It is a consistent, conscious, affective awareness of self, both as a psychic and physical entity, and persistent over time. The ego boundary supplies a coherent, stable feeling of selfness and sameness and pro- vides for ego identity. Freeman, Cameron, and McGhie (1958) concluded that schizophrenics (Scs) have problems in differentiating their ego boundary and have difficulty, under conditions of ambi- guity, in distinguishing between themselves and others. In order to help Scs obtain the most benefit from re(habilitation), it is necessary for the therapist to have a clear understanding of how the Sc views himself, and for the Sc to be aware of his own concept of self. To improve treatment methods, however, it is also necessary for thera— pist and patient to be aware of how the Sc uses information about himself. The purpose of this study is to investigate the Sc's use of self-concept information. Since Scs are less aware of their ego boundaries and are more prone toward feelings of dispersion or diffusion, it is hypothesized that they will be less able to differentiate self-concept descriptions than non-Scs. Hypotheses The present study investigated the following hypotheses: H1: Subjects with no diagnosed psychopathology (NSC) will be more successful, in choosing the stereo- typed profile description which best describes the diagnostic category to which they belong, than the Paranoid Schizophrenic (PaSc) group, who in turn will be more successful than the Chronic Un- differentiated SchiZOphrenic (Und) group. Subjects who receive self-concept feedback (regard- less of their diagnostic category) will be more successful as a group, in choosing the appropriate profile, than will the subjects who receive no feedback. Subjects who receive self-concept feedback will be more successful, in choosing the appropriate pro- file, than will the subjects in each of the cor- responding diagnostic categories who receive no feedback. Schizophrenic subjects who are not on medication will be more successful in choosing the appropriate profile than those on medication. The relationship between medication and no medication conditions will be similar for PaSc and Und subjects. Also, this relationship will be similar for subjects in the feedback condition and the no feedback condition. CHAPTER II REVIEW OF THE LITERATURE Self-Concept: Theory The self-concept influences the formation and change of interpersonal response traits in the individual, which often reflect self-cognition (Krech, Krutchfield, & Ballachey, 1962). Self-concept is " . . . those parts of the phenomenal field which the individual has differentiated as definite and fairly stable characteristics of himself (Snygg & Combs, 1948)." In- cluded in the self-concept are the individual's body image, his introjected attitudes, values and other attributes which are felt to be unique and differentiate him from his environ- ment. Self-esteem or self-evaluations include the positive and negative feelings which are ascribed by the individual (Pitts, 1965). Rogers (1954) spoke of psychological tensionwhen the person denies to awareness significant sensory and visceral experiences, which consequently are not organized in the self— concept. Roger's "healthy individual's self-concept" is approximated in Horney's "real self" and Fromm's "true self" when the concept of self is such that all the sensory and visceral experiences of the person are, or may be, assimilated on a symbolic level into a consistent relationship with the concept of the self. To give a person a sense of identity it is necessary that an image of self is created which embodies the more time enduring aspects of the personality. Resolving past experi— ences which were disjointed, isolated, or repressed and con- necting them with present-day events gives the person a sense of continuity. Thus he learns to be proud of things he has done or felt and acquires the habit of discriminating between that which is characteristically his, that which is generally human, and that which is typically somebody else's. The end result is a heightened awareness of self and a sense of con— fidence and well-being (Ruesch, 1961). Identity suggests much of what has been called the self by a variety of persons, be it in the form of a self-concept (Mead, 1934), a self-system (Sullivan, 1953), or in that of fluctuating self-experience described by Schilder (1951) and Federn (1952). Federn called "Erlebnis" the concept of the ego as subjective experience or self-awareness. In discussing libidinal cathexis of the ego in narcis- sism, Hartmann (1950) said it is a self which is being cathected. He advocated the term "self-representation". This self- representation was anticipated by Freud in his references to the ego's "attitudes toward the self". "Ego identity" (Erikson, 1968) is the result of the syn- thesizing function of a child's social reality during succes- sive childhood crises. Identity helps the adolescent contain his postpubertal id and balance his superego, as well as appease his often lofty ego ideal, all in the light of a foreseeable future structured by an ideological world image. Ego identity is the ego's synthesizing power, and self-identity is the integration of the individual's self and role images. Erikson's (1959) ego identity connotes both a persistent sameness within oneself and a persistent sharing of some kind of essential character with others. Federn's (1952) "ego feeling" is a subjective, experi— enced state mediating between the perceived self and the en- vironment. It is the "self-experience" which stands in rela- tion to the continuity of the person in respect to time, space, and causality. Federn (1952) felt that a good sense of re- ality (a Clear differentiation of the self from the rest of the world) is largely predicated upon good "ego boundaries". When ego (or self) boundaries are disturbed, perceptual dis- tortion ensues and the sense of reality is correspondingly disturbed. Under normal circumstances there is no conscious awareness of the self, just as there is no awareness of all other well-functioning parts of the individual. A good sense of reality is predicated upon the lack of intrusion of the self as subject or object. Whenever the immediacy of the relationship of the self to reality is interrupted there is a disturbance in the sense of reality. The concept of ego has the following cores of common meaning as described by Federn and Erikson. The ego is a combination of emergent abilities. Its development occurs through a series of crises which occur whenever the emergent skills and developing powers of a person need to be controlled or elaborated in order for him to be considered a normal mem- ber of the culture. When these crises occur, the equilibrium of the personality is upset. A child's developing ego may be temporarily less differentiated and less well organized, and his relationship to his environment less concordant, until the crisis is resolved. This resolution leaves the ego en- hanced; growth has occurred. At the same time, a Child acquires increasingly diverse types of roles. Each time he successfully resolves a crises or learns to assume a new role, his ego is strengthened because he has internalized a new set of inter- relationships, increased his power of discrimination, and has added to his knowledge of the world and of himself. The mechanism through which the world becomes affec- tively comprehensible and, hence, through which learning is possible, may be "ego feeling at the boundary". This feeling, or cathexis, seems to act at the boundary between the indi- vidual and the environment as the filter through which the affective aspects of the world are sensed, sorted, classified, and ultimately known. Self-Concept: Research With any particular group there are probably certain kinds of descriptions which are more accurate than others, i.e., there are probably stereotyped self-concepts. Forer (1949) reported that students readily rated certain vague 10 generalized statements as highly characteristic of their per- sonalities under the impression that they were true personal- ity sketches. His study did not investigate the possibility that subjects might be able to distinguish "bona fide" de- scriptions from stereotyped descriptions. Sundberg (1955) made blind interpretations of the MMPI profiles of 44 college students and paired them with fake personality descriptions. The students were unable to pick their own personality description except at the chance level. Friends of the subjects likewise failed to pick the ”bona fide" description better than by chance. Analysis of the data and the personality descriptions suggested that acceptable college personality interpretations are short and include vague, double-headed, modal, and favorable statements. The MMPI's of those who Chose their own description and those who rejected it showed no differences except on the Hypomania (Ma) scale. On Ma, the rejectors had an average t score of 64.8 compared with the acceptor mean of 56.4. Sund- berg suggested that the more active, optimistic students identified more readily with the college stereotype, at least as it was represented in the fake descriptions. Schizophrenia: Self-Concept Theory The term "schizophrenia" (Sc) has its origin in the work of the Swiss psychiatrist, Eugen Bleuler. Before Bleuler's introduction of this term, the common designation for these disorders was Kraepelin's "dementia praecox", meaning early ll mental deterioration (implying a disease developing in young peOple, characterized by a process of intellectual and psycho- logical deterioration). Bleuler attempted to define these disorders not in terms of their course but in terms of their primary and secondary symptomatology. The primary defects in Sc are disorders of thinking, feeling, and the relationship to external reality. The secondary results of these defects are delusions, hallucinations, and bizarre associations (Bellak, 1958). A very low self-esteem is one of the characteristics of a Sc and is basic to his pathological communication. It is as though the Sc needs to communicate in ways which involve the use of body posturings and other forms of non-verbal caricature because verbal-symbolic ways are not as yet available to him (Searles, 1965). Perhaps the Sc has a greater need to communi— cate than he has a need for self-esteem. Psychiatric literature does not offer a systematic way of describing the interpersonal behavior of the SC so as to differentiate that behavior from the normal person (Haley, 1963). Whereas normal people work toward a mutual definition of a relationship and maneuver each other toward that end, the Sc seems rather to desperately avoid that goal and work toward the avoidance of any definition of his relationship with another person. The Sc is a person who has suffered severe assaults on his sense of security prior to the development of skill in the 12 use of language, and prior to the formation of a concept of his self, as a personality distinguishable from others (Will, 1961). The Sc is distrustful and resentful of other peOple. During his early fight for emotional survival he begins to develop great interpersonal sensitivity. His partial emo- tional regression and his withdrawal from the outside world is motivated by his fear of repetitional rejection, by his distrust of others, by his own retaliative hostility (which he abhors) and by the deep anxiety promoted by this hatred (Fromm-Reichmann, 1948). Wynne and Singer (1963) stated that an individual's identity is the link between the person and his culture. Sc is seen as the result of a failure to develop a clear and stable ego identity. The classic description of Sc as a gross diagnostic entity, and the specific reaction types which compose it, was made by Bleuler (1950). He distinguished between the I’fundamental" symptoms and the "accessory" symptoms. For Bleuler the fundamental symptoms seemed to reflect most dir- ectly the process of withdrawal. These symptoms include the abandonment of the logic requisite to clear interpersonal communication; an affective disturbance, manifested in the extreme case by apathy; or a complete lack of feeling rather than a dominant euphoria; depression, or even agitation, which has been seen in other psychoses; and an immobilizing ambivalence. 13 It is commonly found that feeling is withdrawn in con- nection with external realities. As a result, the Sc's interests narrow and a growing indifference is found which may extend to personal comforts and needs. Surface displays of feeling are shallow and unrelated to either external cir- cumstances or to conscious mental content; the person is no longer reSponsive to the reality outside him and is instead reacting to the unconscious drives within himself. The lack of concern with his surroundings often causes the Sc to feel very much outside of life, a Spectator rather than a participant, and he begins to lose identity as a per- son. This feeling of depersonalization may be rationalized on grounds that his mind, his body or its various parts, no longer belong to him. He may develop the idea that he is dead altogether or that the world has been destroyed. Bleuler (1950) emphasized that, in contrast to the organic patient, sensation, memory, and orientation are relatively undisturbed in the Sc. He is capable of respond- ing normally to external stimuli even though he may complain that everything seems to be different, a strangeness that is probably attributable to his altered emotional state. Because Scs are more responsive to autistic, internal structures than to external realities, they may not respond appropriately, although they have not lost the capacity. Bleuler (1950) felt that memory functions are intact and in paranoids may be par- ticularly keen. What may appear to be a defect in memory is 14 usually an unconscious reluctance to reproduce a painful past. Federn (1952) stated that "schizophrenia is a state of ego weakness in which there is a failure to cathect the ego and its boundaries adequately." Federn felt impairment of ego boundaries is not only a symptom of Sc, but the basic process of the distrubance during its entire course. Cameron (1963) viewed Sc as resulting from "inadequate ego functioning". He stated that the weak, fragile ego is unsuccessful in its attempt to deny and project the intruding primary process material onto the outside world. What follows are hallucinations, delusional systems, and confusion as to what is actually internal and external. Sullivan (1953) viewed the Sc state as one in which there is a malfunctioning self-system. He felt the self- system developed initially as a secondary dynamism to avoid and to minimize incidents of anxiety. When the self-system is imparied there is a breakthrough of anxiety similar to a primitive panic state. Consciousness becomes flooded by "chaotic thoughts" (similar to Freud's primary process ma— terial) and results in autistic, prototaxic thinking. Wolman (1965) felt that Scs have a negative, devalued self-concept and lowered self—esteem. He stated (1965, p, 995) that: Schizophrenics do not care much for themselves but worry about what other people think of them. In success, they worry; in failure, they blame themselves. They both perceive self-hostility and project it to others. 15 Self—esteem appears to depend upon whether their love is accepted. They may think of themselves as stupid or bad and will lie to cover this apparent fault. They also usually feel that others are superior, smarter, stronger and better, whereas they are gen- erally inferior. Depersonalization is extensive and dramatic in Sc. Ackner (1954) delineated four phenomena which occur most com- monly in depersonalized persons: (a) Feelings of unreality-- in reference to the self, body, external world, or passage of time; (b) these feelings are unpleasant--it is felt that changes are occurring over which the individual has no control. These people become very distressed and fear dying and insan- ity; (c) the feelings are non-delusiona1--the person is aware of the "as if" quality of his feeling of strangeness and un- reality and he realizes the perceived changes have not actually occurred. Reality sense is impaired but reality testing re- mains intact; (d) loss of affective response--the person com- plains of having no feeling, emotion, or pleasure. Cattell (1966) felt that in the overt Sc the depersonal- ization episodes merge with the delusions to the extent where the person is unable to determine reality from fantasy, and may become convinced that he is no longer alive. Jacobson (1954) stated that in Sc the representation of the self is tenuous and unstable. In severe forms of Sc there is a severe disorganization of self-representation with the consequent destruction of the image of the self. Restitution may take the form of a delusion in which the Sc has become another person. 16 Szalita—Pemow (1952) considered the Sc process an attempt to maintain a displaced equilibrium as a defense against acute disintegration and panic. In Sc the self is composed of "small separate islands" disrupting inner com- munications due to discontinuity of experience, originally caused by maternal anxiety. In Acute Schizophrenic Episodes, the person's ego is so engaged in dealing with his internal world in the face of strong disruptive processes, that he can only tenuously deal with external reality. Therefore, his communications are rich in imagery but poor in communicative content. Rabin and King (1958) stated that impairment in Sc thinking is a selective process, being determined by whether or not the task pertains to interpersonal relations. "Gen- erally, with respect to empathic ability, schiZOphrenics do not do as well as normals, though individual differences do exist. Schizophrenics also tend to over-value themselves unconsciously-and similarly dissociate themselves from mental illness (Rabin & King, 1958, p. 255)." The Sc is extremely sensitive to failure and has a strong need to maintain and bolster his self-esteem. "The high level of aSpiration in the face of actual failure is a further indication of the need for restitution at the expense of reality (Rabin & King, 1958, p. 256)." Rabin and Winder (1969) stated that: . . . the phenomenology regarding the self in schizo— phrenia is not simple nor does it permit clear dif- ferentiation from normals and other groups. The evidence of bimodal trends in the self versus l7 ideal-self discrepancy demand utmost caution in draw— ing conclusions based upon group comparisons. The situation with respect to other personality variables is not dissimilar. Schizophrenia: Self-Concept Research Self-esteem or ideal—self congruence measures do not distinguish Scs from normals. Guller (1966) investigated the stability of the self-concept in 84 non—chronic Scs (excluding Paranoids). Self-concept, health-concept, and food-preference questionnaires were administered to Scs and controls, who were equally divided into failure and non-failure groups. Test- retest method with failure or neutral condition immediately preceding the second testing showed Scs (N=42) more variable for self-concept but not for health or food responses. Fail- ure significantly increased self-concept variability for Scs but not for controls. Guller concluded that Scs appear to have a self-concept disorder component which manifests itself through inconsistent self—descriptions. He suggested that some Sc symptomatology may reflect efforts to establish a stable, if unrealistic, concept of self. Several studies (Mark, 1953; Gerard & Siegel, 1950; Freeman & Grayson, 1955; Tietze, 1949) showed that the early home life of the Sc is characterized by much nagging, scolding, and criticism. These studies evolved a picture of a child who is rejected and confused, and learns a pervasive feeling of worthlessness. He fails to develop any self-esteem or sense of personal identity, and detaches himself emotionally 18 in a desperate attempt to avoid further hurt. He is on the way to full-blown Sc. Manasse (1965) explored the effect of the social setting upon the self-regard of Chronic Scs. It was hypothesized that self-regard is related to the degree to which a person is able to meet the demands and expectations of his social setting. Two groups of Scs were compared. Group 1 was hospitalized and Group 2 attended a day treatment center. Hilden's Q-sort pro- cedure was used to obtain a measure of self—regard. Results revealed that the hospitalized group had higher self-regard than the non-hospitalized group. The findings were interpreted as shedding more light on the importance of the situational variable in the development and maintenance of self-regard. Jackson and Carr (1955) studied the empathic ability of 20 female Scs and 20 normal controls (student nurses). The subjects described themselves, an associate, another psychotic, and a normal. The latter two persons were known to each sub- ject for only a brief interview. The empathy ability was based on the discrepancy between the subject's prediction of how "the other" would rate herself on the 40-item scale and how she actually rated herself. The results showed the Scs manifested poorer empathic ability than the controls. How- ever, there were extreme individual differences within the groups. The findings were interpreted by the authors as demonstrating the Sc's general deficiency in the area of psychological closeness and identification with others. 19 Helfand (1956) explored role-taking characteristics in Scs. The autobiography of a former hospital patient was ob- tained, from which an 80-item Q-sort was selected and admin- istered to the subject himself to serve as the criterion. Twenty-five Scs (15 chroniCs and 10 "privileged", i.e., per- mitted freedom of the grounds), 20 normals (functioning mem- bers of the non-hospitalized community), and 19 tuberculous patients sorted the items as if "they were" the person whose autobiography they had read. The similarity between this sorting and that of the criterion was the measure of empathic (role-taking) ability. The results showed that the normal individuals were superior to the chronic Scs in this ability, although privileged Scs demonstrated the highest degree of sensitivity for "the other". Fagan and Guthrie (1959) correlated responses of 20 Sc patients to a Q-sort, including items describing perceptions of self and other people and ways of relating to others. The results showed that the Scs did not perceive themselves as similar to their concept of the normal person. "The schizo- phrenic does know, and will report, that he is different from the stereotypes of normalcy which he apparently shares with non-schiZOphrenics (Fagan & Guthrie, 1959, p. 206)." The authors concluded that Scs do not differ from normals in their conception of the average other, but in their perception of themselves. Chase (1957) measured psychological maladjustment with Q-sort data utilizing concepts of self, ideal self, and the 20 average other person. It was found that only measures con- taining the self-sort could discriminate a group of "adjusted" (50 patients without evidence of psychiatric difficulties who were hospitalized on medical wards) from three groups of "mal- adjusted" (19 psychotics, 20 neurotics, and 17 personality disorders) hospitalized patients. Maladjusted subjects saw themselves as being different from their ideals and from their concept of the average other person, while adjusted subjects did not view themselves as different. Both groups held simi— lar conceptions of the ideal self and of the average other person. Epstein (1955) investigated the manner in which normals evaluated their unrecognized expressive movements, and com- pared their reactions with those of chronic Scs. The results indicated that, unconsciously, the Scs evaluated themselves more highly than normals. However, they were not able to per- ceive similarity in their expressive movements as well as normals. Nickols (1966), employing the Self-Image Rating Scale (a modification of the Waraday-Nickols Scale, used to measure the changes of the self-concept during adolescence), reported that, unlike normal controls, Scs differed significantly from each other but showed a dichotomous departure as a group from the central trend of the control group. The Scs showed extreme self-enhancement and self—depreciation. Using 44 hospitalized Sc women, Kamano (1961) found that the Sc subjects who revealed extreme self-satisfaction (in 21 contrast to those who admitted some dissatisfaction) denied threatening features of themselves to such an extent that they recalled less items reflecting unfavorable personality characteristics from a passage designed to simulate a per- sonality evaluation. This group also revealed greater dis- crepancy between their level of performance and level of aspiration. Schizophrenia: Paranoid Type-~Theory The hallmark of Paranoid Schizophrenia (PaSc) is the presence of hallucinations and delusions in which reality is distorted. Along with these are found thought disturbance and affective alterations which typify Sc in general (Zax & Stricker, 1963). This disorder usually has its onset at a somewhat later age (generally after 30 years) than other forms of Sc. Among its earliest symptoms are ideas of reference, the notion that the remarks and actions of others, despite the fact that they seem to have nothing to do with the PaSc, are made and done with him in mind. While the delusions which develop may become numerous and changeable, they com- monly are cast in a persecutory mold, so that the people around the PaSc are seen as threatening him with physical or material harm. Another form frequently taken by such delusions is grandiosity. Sometimes the grandiose ideas follow from the persecutory feelings as a means of explaining them. Thus, if so many people are going out of their way to make life difficult for one, it must be that one is a 22 particularly important person. As personality disorganization progresses, the delusional beliefs become more far-fetched, eventuating in a complete abandonment of logic. The verbal expressions of PaScs are often inappropriate and at times are neologistic. Hallucinations usually occur in the auditory sphere and are generally accusatory or threatening. For psychoanalytic theory, the core of the PaSc's per- secutory delusions is a conflict over homosexual impulses. This model begins with the experience of a sexual impulse (“I love him") followed by the denial of this impulse ("No, I don't love him"), leading to the counterclaim "I hate him-- he is a homosexual", ending with the re-emergence of the loved person as a dangerous enemy, a persecutory villain (Cameron, 1959). In the Sullivanian model (Sullivan, 1953), the basis of the problem is the Paranoid's deep feeling of inferiority and worthlessness which leads to distortions of reality in an attempt to provide some semblance of self-esteem and inter- personal viability. Cameron (1959) felt the thought processes of the PaSc are a distortion of certain aspects of normal self- referent thinking and feeling. Because of his lack of inter— personal security and his social isolation, the PaSc must face emotional crises alone. Driven by anxiety, he attempts to piece together fragments of his hostile world into some coher- ent system. Ultimately, the "paranoid pseudo-community" is formed (Cameron, 1959), a reconstruction of reality which 23 organizes the actual and projected behavior of the people around him into a "comprehensible" conSpiracy against the Paranoid. This crystallization often takes place with a sudden flash of insight. PaScs may report positive and accepting attitudes toward the self but they are based upon distortions or mis- perceptions in self-appraisal. People who employ projection are unaware that they possess undesirable traits themselves (Sears, 1936); the very purpose of projection is to prevent such insight. Schizophrenia: Paranoid Type-—Research The effect of projection is pointedly illustrated in a study by Friedman (1955). To understand Friedman's results it is necessary to assume, as does Levitt (1967), that a PaSc is likely to distort reality in the interest of improving his self-concept. Friedman's investigation showed that a positive correlation existed between self and ideal concepts among nor- mal people, but no relationship at all among neurotics. Among PaScs, the correlation was almost as high as it was for the normal group. Friedman concluded that the PaSc, by distorting his view of himself or of his environment, is able to estab- lish a relationship between self-concept and ideal concept which resembles that of normal individuals who have no need for such distortion. However, if a PaSc cannot differentiate an ideal (or normal) person (or personality description) from 24 a Sc person (or personality description), then he will not know in what direction to distort reality to improve his self—concept. Schizophrenia: Chronic Undifferentiated Type The Chronic Undifferentiated Type includes persons with Sc symptomatology which does not form a clear pattern and tends to persist. This diagnosis is also often applied to very long-term patients who may once have displayed clearly the symptoms consistent with one of the other subcategories but who, with the passage of time, have "burned out" to the degree that one can no longer distinguish the original symptomatology (Zax & Stricker, 1963). A very affectless disregard typifies these people, and their pattern of thought leaves no doubt as to their being Scs. These people are in what Arieti (1959) called the "pre- terminal stage" of the disorder. The diagnosis is occasionally used for those persons who are floridly Sc, but whose symptoms are not entirely con- sistent with any of the established reaction types. This is one of the most frequently diagnosed of the SC subcategories and, as such, may often provide a "wastebasket" for the reso- lution of difficult differential diagnostic problems. Criminal Activity "Most criminals . . . are not maladjusted mentally, and most psychologically maladjusted persons are not criminals (Vedder, 1954, p. 118)." 25 Crime, according to psychoanalysis, is motivated by many unconscious factors. "Criminal activity is a prolonga- tion of infantile behavior into adulthood (Alexander & Staub, 1931)." Anna Freud (1946) felt aggressive behavior on the part of an adult is caused by a child "identifying with the aggressor", through fear and guilt, and later retaliating .with specific or generalized aggression. According to Adler (1956), the criminal looks for excuses and justification, for extenuating circumstances, and for reasons that "force" him to be a criminal. He stated that criminals evade problems they do not feel strong enough to solve, hide their feelings of inadequacy by developing a superiority complex, and feel they are neglected and look for evidence to confirm this feeling. Healy and Bronner (1936) described the wish for punish- ment of the self or parents as a motive for delinquent behav- ior, in addition to Adlerian concepts such as "masculine protest" and "inferiority feelings". Aichorn (1963) felt the delinquent was an individual still governed by the pleasure principle. Socialization failed with the delinquent because of an "unharmonious home situation and lack of love from parents". 26 Research Demonstrating the Relationship Between Self-Concept and Behavior Using the Tennessee Self-Concept Scale Havener and Izard (1962) hypothesized that PaScs have greater distortion in the perception of self and others than non-PaScs or normals. A PaSc can improve his self-concept provided he knows in what direction to distort reality. Twenty PaScs, 10 Non—PaScs, and 20 normals were given the Berger Scale (items referring to the self and others; used to measure perception of others) and the Tennessee Self-Concept Scale (TSCS--used to measure self-perception). The results showed that PaScs accepted fewer mildly self-derogatory statements about themselves, expressed a greater amount of self- satisfaction, had higher opinions of their personal charac- teristics, and lower opinions of their family relationships than did normals and non-PaScs. The PaScs over-rated them- selves, as compared with the other groups. The authors reasoned that this was evidence of unrealistic self-enhancement and a defense against complete loss of genuinely positive self- related affect and of satisfying interpersonal affective ties. Atchison (1958) found a number of predicted differences, using the Counseling Form of the TSCS, between delinquent and non-delinquent high school boys. All variables except Self- Criticism (defensiveness and openness) and Distribution scores (manner in which a person distributes his answers across available choices) were different in the predicted direction. The delinquents had lower Total Positive (overall level of 27 self-esteem) and higher Variability scores (amount of incon- sistency from one area of self-perception to another). Piety (1958) found that the Total Positive score dis- criminated between psychotics, non-psychotic patients, and non-patient controls at the .005 level. Lefeber (1965) found differences between male juvenile first offenders and repeated offenders. Both of these groups were different (in expected directions) from a control group. Using the Clinical and Research Form of the TSCS he found the highest spike in the offender's profiles to be on the Person- ality Disorder Scale, which he had predicted. The delinquent recidivists obtained the lowest level of personal adjustment and personality integration, the first offenders next, and the non-delinquents the highest level of adjustment. Runyon (1958) investigated racial difference and found no self-concept discrepancies, on the TSCS, of 51 male and female Caucasian college students compared to 59 male and female Negroid college students. Congdon (1959) evaluated the effects of a tranquilizing drug (chlorpromazine) on the self-concept, the ideal self, and the generalized other of chronic Scs. The subjects in this study showed symptomatic and behavioral improvements but no significant change in self-concept, ideal self, or in the generalized other (generalizations from this study, concern— ing the effects of medication, are very limited due to the fact that only the Total Positive and Self—Criticism scores 28 from the TSCS were used). Congdon's conclusions were: (a) In comparison to normals, chronic Scs have self—concepts which are highly positive or highly negative, although the preponderance of them are on the negative side; (b) the chronic Sc's ideal self is significantly lower; and (c) the chronic Sc's concept of the generalized other is more extreme (more positive or more negative). In Chapter III, the methodology is established to mea- sure the ability of Scs to differentiate self—concept descrip- tions. CHAPTER III METHODOLOGY Subjects Sixty male inmates who had been diagnosed (within two months of this study) as schizophrenic (Sc), and 30 male inmates who had no diagnosed psychopathology (NSC), were subjects. The Sc group consisted of 30 Paranoids (PaSc) and 30 Chronic Undifferentiated SchiZOphrenics (Und). Persons with Acute Schizophrenic Episodes were not subjects. Fifteen PaScs and 15 Und were on medication. The Sc group was chosen from the State Prison of Southern Michigan at Jackson (SPSM) and from Ionia State Hospital for the Criminally Insane (ISH). Thirteen PaScs and 10 Und from SPSM, and 17 PaScs and 20 Und from ISH were subjects. The NSC group consisted of nursing aids, clerks, and typists at the Psychiatric Clinic of SPSM. None of the NSC subjects were on medication. All subjects were from 18 through 40 years of age, and had at least a sixth grade reading level (determined by Aver- age Grade Rating scores). No subject was a patient in psycho- therapy for more than two months prior to this study. 29 30 Measurement Device The Counseling Form of the Tennessee Self-Concept Scale was used to measure an individual's self-perception (refer to Appendix A). It consists of 100 standardized statements de- scriptive of the self in five different areas of self—concern, 45 statements being positive and 45 being negative. Ten addi— tional statements, taken from the MMPI Lie Scale, are in- cluded to measure a person's honesty in responding. The Scale is self-administering for either individuals or groups and can be used with subjects age 12 or older and having at least a sixth grade reading level. Most subjects complete the test in 10 to 20 minutes. According to Fitts (1965), the Scale is "applicable to the whole range of psycho- logical adjustment from healthy, well-adjusted people to psy— chotic patients." The areas of self-concern, with reliability data (based on test-retest with 60 college students over a two-week period), measured by the Scale include: 1. Self-Criticism Score (.75): Defensiveness, Openness, and capacity for self-criticism. 2. Positive Scores (.74): (a) "This is what I apf, (b) "This is how I £331 about myself", and (c) "This is what I def. a. Total Positive Score (.92): Overall level of self-esteem. b. Identity (.91): What the individual is as he sees himself. 31 c. Self-Satisfaction (.88): Level of self- satisfaction and acceptance. d. Behavior (.88): Individual's perception of the way he functions. e. Physical Self (.87): View of his body, health, physical appearance, skills, and sexuality. f. Moral-Ethical Self (.80): Moral worth, rela- tionship to God, feelings of being a "good" or "bad" person, and satisfaction with one's re- ligion or lack of it. g. Personal Self (.85): Sense of personal worth, feeling of adequacy as a person, and evaluation of personality apart from body or relationships to others. h. Family Self (.89): Feelings of adequacy, worth, and value as a family member. 1. Social Self (.90): Sense of adequacy and worth in social interaction. Variability Scores (.67): Amount of inconsistency from one area of self-perception to another. Distribution Score (.89): Manner in which a person distributes his answers across the five available choices in responding to the items. Time Score (89): A measure of the time, to the nearest minute, that the subject requires to com- plete the Scale. Little is known as to its meaning or significance. 32 The standardization group from which the norms were develOped was a broad sample of 626 people. The sample in- cluded peOple from various parts of the country, and their ages ranged from 12 to 68 years. There were approximately equal numbers of both sexes, Caucasian and Negroid subjects, repre- sentatives of all social, economic, intellectual and educa— tional levels from the sixth grade through the Ph.D. degree. Fitts (1965) suggested that there is no need to estab- lish separate norms by age, sex, or race. However, the norm group does not reflect the pOpulation as a whole in proportion to its national composition. The norms are over-represented in number of college students, Caucasians, and persons in the 12 to 30 year age bracket. Through various types of profile analyses Fitts (1965) has demonstrated that the distinctive features of individual profiles are still present for most persons a year or more later. By an intercorrelation of scores, Fitts (1965) found that the major dimensions of self-perception (self-esteem, self-criticism, variability, certainty, and conflict) are all relatively independent of each other. Validation procedures: 1. Content Validity: An item was retained in the Scale only if there was unanimous agreement by the judges that it was classified correctly. 2. Discrimination Between Groups: Fitts (1965) stated that personality theory and research suggest that 33 groups which differ on certain psychological dimen- sions should also differ in self-concept. One approach to validity was to determine how the Scale differentiates groups. a. Discrimination on the basis of psychological status: Psychiatric patient groups almost always showed more extreme scores, on practi- cally all variables, than the norm groups. b. Discrimination within patient groups: Fitts (1965) felt if the self-concept is a useful approach in assessing an individual's state of mental health, it should differentiate type of disorder as well as degree of disorder. PaScs are characterized by their use of the projection mechanism which enables them to blame, criticize, and mis- trust others rather than themselves. Therefore, it follows that their profiles showed them to be the lowest of the pa- tient groups on the Self-Criticism score and highest on the Total Positive score (overall level of self-esteem). PaScs have shown an inability to express the self—concern or dis- satisfaction which would be consistent with the rest of their self—perceptions. "Self-evaluation from an external frame of reference is much more variable than from an internal frame of reference (Fitts, 1965)." Fitts speculated that people with psycho- logical disturbances are more focused upon external sources of evaluation. 34 Procedures The Tennessee Self-Concept Scale (TSCS) was administered to all subjects in groups of five to ten persons. Each SPSM group contained NScs, PaScs, and Und while each ISH group consisted of PaScs and Und. Each subject in each diagnostic category was randomly assigned to an experimental or control group. There was an equal number (15) of NSC, PaSc, and Und subjects in the ex— perimental and control groups. Seven PaScs and five Und from SPSM, and eight PaScs and 10 Und from ISH were in the experi— mental group. While none of the NSC subjects were on medication, eight PASC and eight Und subjects in the experimental group, and eight PaSc and eight Und subjects in the control group were on medication. When the hand-scored results of the TSCS were available, a self-concept profile was written for each of the 45 experi- mental subjects (refer to Appendix B). Each description is approximately of equal length and appropriate for a sixth grade reading level (Thorndike & Lorge, 1944). Two weeks after they had taken the TSCS, the experimental subjects were called individually into a testing room in a ran- dom order. Each subject read his own profile description. The 45 control subjects did not receive any feedback. One week after the experimental group received feedback, all subjects in both the experimental and control groups were called individually into a testing room in a random order. 35 Each subject was presented with three stereotyped profile descriptions, one on top of another. These include a NSC, PaSc, and an Und profile (refer to Appendix C). Each description is approximately of equal length and appro- priate for a sixth grade reading level (Thorndike & Lorge, 1944). The order of the stereotyped profiles was randomized across subjects. Each subject was instructed to read all three profile descriptions and to choose which profile best describes him. Six psychotherapists at the Psychiatric Clinic of SPSM achieved one-hundred per cent reliability when they chose the stereotyped profile which best describes a NSC, a PaSc, and an Und. The Sc profiles are derivations of the Pa and Sc scales from the MMPI. A binomial test for each diagnostic category was performed in the pilot study (NSC, PaSc, and Und subjects were instructed to read all three stereotyped profile descriptions and to choose which profile best describes him), and showed that the stereotyped profiles significantly discriminated between diagnostic categories. Also, a binomial test showed that the schizophrenic subjects who were not on medication had a significantly higher frequency of success, in choosing the apprOpriate profile, than did the schiZOphrenics who were on medication (refer to Appendix D). 36 Hypotheses H1: The frequency of success, in choosing the appro- priate profile, will be related to diagnostic category. The NSC group will be the most success- ful, followed by the PaSc group and the Und group, respectively. Hypothesis Derivation--Freeman, Cameron, and McGhie (1958) concluded that Scs have problems in differentiating their ego boundary and have difficulty, under conditions of ambiguity, in distinguishing between themselves and others (refer to Chapter I). Sc is seen (Wynne & Singer, 1963) as the result of a failure to develop a clear and stable ego identity (refer to Chapter II). Scs are characterized by disorientation, loss of contact with reality, and disorganized patterns of thinking and feeling. These traits are more extensive in the Und than in the PaSc. PaScs are more attuned to social stimulation, and exert a greater effort to hold onto their self-concept, than the Und. Instrumentation--A stereotyped profile description of a NSC, PaSc, and an Und (refer to Appendix C). H : The experimental group, with the diagnostic cate- gories pooled, will have a significantly higher frequency of success than will the pooled control group (the Feedback-No Feedback main effect will reach significance). 2 Hypothesis Derivation--Self—concept feedback will enable the individual to feel he has an identity as a person, and a heightened awareness of self is created (refer to Chapter II). Instrumentation--Feedback consisted of a written self- concept profile taken from the individual's Tennessee Self- Concept Scale scores (refer to Appendix B). 37 3: The experimental group will have a significantly higher frequency of success, than will the corres- ponding control group, in each of the diagnostic categories (the Diagnostic Category x Feedback- No Feedback interaction will not reach significance). Hypothesis Derivation--Same as H1 and H2 above. Instrumentation-~Same as H1 and H2 above. H4: The frequency of success, in choosing the appro- priate profile, will be related to medication. The Sc subjects who are not on medication will be more successful than those on medication. The relationship between medication and no medication conditions will be similar for PaSc and Und sub- jects (the Diagnostic Category x Medication-No Medication interaction will not reach significance). Also, this relationship will be similar for sub- jects in the Feedback and the No Feedback condition (the Medication-No Medication x Feedback-No Feedback interaction will not reach significance). Hypothesis Derivation--The pilot study showed that the Sc subjects who were not on medication had a significantly higher frequency of success, in choosing the appropriate pro- file, than did the Scs who were on medication (refer to Pro- cedures section in Chapter III and to Appendix D). above. Instrumentation--Same as H1 and H2 Analysis of the Data The data were analyzed (using the analysis of variance (ANOVA) routine on the Control Data Corporation 3600 computer at the Michigan State University Computer Center) with three different two-way fixed factor analyses of variance for Ber- noulli dependent variables, using the method described by Lunney (1969). 38 Lunney (1969) stated that one of the assumptions under- lying ANOVA is the normal distribution of the dependent mea— sures obtained in each set of subjects treated the same. ANOVA can be used, when the dependent variable is a Bernoulli variable, as a meaningful alternative to chi—square analysis, especially for more complex configurations. Lunney (1969) listed the following restrictions for ANOVA: If the probability of obtaining a "one" as an obser- vation for a subject is between .2 and .8, then at least 20 degrees of freedom for the error term are needed for ANOVA to be apprOpriate. If the probability of obtaining a "one" is more extreme, .l or .9, then at least 40 degrees of freedom for the error term are required to make ANOVA an appropriate statistical technique to be used with Bernoulli values. This study exceeded the 40 degrees of freedom criterion for all analyses that were undertaken. A Newman-Keuls post-hoc paired comparisons test (Winer, 1962) was used in order to further elaborate the locus of the main effects in the ANOVA. A significance level of .05 was used for all analyses in the present study. CHAPTER IV RESULTS The lack of any NSC subjects (gs) on medication, com- bined with unequal cell frequencies for medicated Hs within the Feedback-No Feedback dimension for the PaSc and Und groups, ruled against the utilization of a single three-way fixed factor analysis of variance for the data analysis. Therefore, the data were analyzed using three different two- way fixed factor analyses of variance as listed below: a. Diagnostic Category (NSC, PaSc, Und) x Feedback- No Feedback (Experimental-Control). b. Diagnostic Category x Medication-No Medication. c. Feedback-No Feedback x Medication-No Medication. Hypothesis 1: The frequency of success, in choosing the appropriate profile, will be related to diagnostic category. The NSC group will be the most successful, followed by the PaSc group and the Und group, reSpec— tively. The Diagnostic Category by Feedback—No Feedback (two factor) analysis of variance is shown in Table l. The Diag- nostic Category main effect was highly significant (H;10.300, ggé2/84, p<.OOS). As can be clearly seen in Table 2, the NSC group made 24 correct profile choices, while the PaSc group correctly chose 20 and the Und group made only 9 39 40 mm mmA.H~ Hmuoe mma. em ooe.ea nouns mam. omo. Has. m mmo. xomnemma oznxomnemmm x huomoumu oaumocmmaa oao. mmm.m eem.a H eem.fl xomnemmm OZIxomnemma moo.v oom.oa HHo.~ m ~mo.s suommumo oflumoammfla m m m: mm mm mousom .mcoHpHCCOU xomnpoom oz no xownpmom Hopco Amuommumu oaumocmmflov muoonnsm owcoucmo nuficom emanaucoHoMMHocs oacoucu cam .oflconcmoncom oflocmumm .oflcmucmoNficomncoz How mmoflonu maflwonm oomapowumum mo moccaum> mo wwmwamcd mo >umEESmnu.a mamCB 41 .mmmonucmnmm an ooumowocw one mmowono oucaumoumm¢« ooH om ma ma mm mm me on AdBOB ooa ma om Amy ow m ow m xomnoomm oz can ooa ma ov Amy mm m hm e Mongooom ooa ma hm e mm Am C om m xomnoomm oz ommm OOH ma no a om ANAL ma m xomnooom ooH ma ma m cm M 5m Aoav xomnoomm oz omz ooa ma oo o no H mm Aeav xomnomom w m w m w m w w mcofluflocoo mnomoumo dance on: ommm omz xomnoomm oaumocmmflm .mCOHuflocoo xomnooom oz no xomnpoom Hopes muommnnm Aocav oacmucmoncom concaucmHoMMHCCD UHCOH£U can .Aummmv cacoucmoNflsom owocmumm .Aomzv cacousmoNflsom Icoz How «moowosu oHHmoum omnmuomumum mo va momMDcoonom can Amy mwaocosqonhln.m mqmde 42 appropriate choices. The proportional data (see Table 3) also revealed a similar trend. A Newman-Keuls post-hoc paired comparisons test (Winer, 1962) was undertaken in order to determine the locus of the Diagnostic Category effect. The results showed that the NSC group had a significantly higher mean frequency of correct profile choices as compared to the Und group (p<.01). The PaSc group also had a significantly higher mean frequency of correct choices as compared to the Und group (p<.01). How- ever, there was no significant difference in mean frequency between the NSC and PaSc groups (p>.05). Therefore, Hypothesis 1 was partially confirmed. Al- though the Diagnostic Category effect was highly significant, and the particular diagnostic groups were in the hypothesized order, the NSC group did not significantly differ from the PaSc group with reSpect to the mean frequency of correct pro- file choices. Hypothesis 2: The experimental group, with the diag- nostic categories pooled, will have a significantly higher frequency of success than will the pooled con- trol group (the Feedback—No Feedback main effect will reach significance). Referring again to Table 1, the Feedback-No Feedback effect was highly significant (He6.886, gfel/84, pé.010). Table 2 and Table 3 show that when diagnostic categories were pooled, there were 32 correct profile choices under the Feed- back condition and only 21 for the gs who did not receive any feedback. Viewing the results in another manner, 71% of the 43 om om cm on mm mm on m no om om em H u 8 me ma ma ma II. .II on mm o nv Hm om m mm m no OH x QC m 2 me ma .MH MM on om an mm ov w om NH mm «a x no m w m w a w m w a Hmuoe Us: ommm omz nuomoumu Caumocmmfio .muomflnsm lease oHcmHAEONAsom Cowmaucmummmfipca UHCOHQU Cam .Aommmv oacmucmoNflnom oflocmumm Icoz How moowono mHHmoum uomnuou mo va momwucmonmm can Amy .Aomzv oaconnmoNfisom cofiuuomoum||.m mqmse 44 §s in the feedback group chose the correct stereotyped profile, compared to 47% of the §s in the No-Feedback condition. In summary, the above hypothesis was strongly supported; the Feedback condition was associated with a significantly higher frequency of correct profile choices as compared to the No-Feedback condition. Hypothesis 3: ‘The experimental group will have a signi- ficantly higher frequency of success, than will the cor- responding control group, in each of the diagnostic categories (the Diagnostic Category x Feedback-No Feedback interaction will not reach significance). Table 2 and Table 3 show that the §5 who received feed- back were more successful on the stereotyped profile choice task than those Hs who did not receive feedback. This super- iority of the Feedback condition over the No-Feedback condi- tion held for each diagnostic category when using frequency, proportional, or percentage measures. The lack of a signifi- cant Diagnostic Category x Feedback—No Feedback interaction (Hé.056, g£é2/84, p;.945) attested to the fact that the Feedback-No Feedback relationship was similar for each diag- nostic category. Therefore, Hypothesis 3 was supported; the Feedback con- dition was superior to the No-Feedback condition in a similar manner with respect to each diagnostic group. Hypothesis 4: The frequency of success, in choosing the appropriate profile, will be related to medication. The Sc subjects who are not on medication will be more suc— cessful than those on medication. The relationship be- tween medication and no medication conditions will be similar for PaSc and Und subjects (the Diagnostic Cate- gory x Medication-No Medication interaction will not reach significance). Also, this relationship will be 45 similar for subjects in the Feedback and the No Feedback condition (the Medication-No Medication x Feedback-No Feedback interaction will not reach significance). In order to evaluate the first part of the above hypothe- sis, a two-way analysis of variance (Diagnostic Category by Medication-No Medication) was undertaken. It should be noted that the NSC Hs were deleted from this particular analysis, since there were no NSC Hs on medication during the present study. Table 4 gives the results of this analysis. The Diag— nostic Category effect (based upon the PaSc and Und groups) was highly significant (He9.307, ngl/SG, pe.003). This effect again showed that the PaSc group had a significantly higher frequency of correct profile choices as compared to the Und group. The Medication-No Medication effect was of borderline significance (Hé3.769, gfel/56, p;.057). There were 18 correct profile choices for those Scs off medication, while the medi— cated Scs chose correct profiles only 11 times (see Table 5). Viewed in a different manner, 60% of the Scs off medication chose the apprOpriate profile, as compared to 37% for the Scs on medication (see Table 6). The Diagnostic Category x Medication-No Medication inter- action did not reach significance (§§.O76, erl/56, p§.783). That the relationship between Medication-No Medication groups is similar for the PaSc and Und groups is shown in Table 5. 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