AN ELABORATION OF A STUDY OF
THE SCHIZOP’HRENOGENIC MOTHER
CONCEPT BY MEANS OF THE
THEMATIC APPERCEPTION TEST

Thesls I-or Hm Degree OI DI'I. D.
MICHIGAN STATE UNIVERSITY
Kevin Michael Mitchell

1965,

135515

This is to certify that the

thesis entitled

AN ELABORATION OF A STUDY OF THE
SCH l ZOPHRENOGEN I C MOTHER CONCEPT
BY MEANS OF THE THEMATIC APPERGERTJ'ON

Tgrilented by
Kevin Michael Mitchell

has been accepted towards fulfillment
of the requirements for

ph.D. Psychology
1 degree in.________
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Date November 29, 1965

 

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ABSTRACT

AN ELABORATION OF A STUDY OF
THE SCHIZOPHRENOGENIC MOTHER CONCEPT
BY MEANS OF THE THEMATIC APPERCEPTION TEST

by Kevin Michael Mitchell

The schizophrenogenic mother is seen by several

   
  
   
  
   
   
  
  
  
   
   

.authors as the primary agent in schizophrenia. The essen-
Ii-tial aspect of the concept of the schizophrenogenic mother
_is the notion that, in any situation where the needs of the.
child and the needs of the mother conflict, the mother will
satisfy her needs, but only indirectly, by imposing her
needs and view of reality onto the child in order that the
child's behavior in some way satisfies the mother's needs.
Previous studies have attempted to assess the
concept of the schizophrenogenic mother through interview
'I_g;‘techniques and/or data from psychotherapy. However, control
groups have generally not been used and there has been
little or no attempt to quantify results. Other studies
have used objective psychological test data and/or attitude
fscaling techniques but these strategies make it difficult
II: to differentiate between real and professed attitudes and

0 not enable us to readily see the relationship between

'titudes and behavior.

 

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Kevin Michael Mitchell -

This study employed the TAT, assuming that the

erson whenever their needs conclict. The second hypo—

t I

tthesis to be tested was that the differentiation of mothers
'af,schizophrenics from the mothers of normal gs is comminicable.

fi'r I

Twenty mothers of schizophrenics and twenty

ffihence with the exception of card XVI. Children were

fing matched on the basis of sex, age, level of education, num-
HTS; ber of children in the family and the child's chronological
”3 position among his siblings. In addition, the mothers of

' the two groups of children were matched on age, level of
education and social class.

Each individual story was judged as pathogenic,
TH unscorable or benign by a judge clinically sophisticated

; f ‘in this area and the criteria used were given to a second
Tézfjudge who attempted to make the same categorizations. A

{H'score was then tabulated for each g from the formula:

1"- i

11.“! VI
:m%Pathogenic/Pathogenic + Benign.
‘IIW‘ I

 

 

Kevin Michael Mitchnii-I

 

‘ ‘WThe results led to the following conclusions:

I lsv Mothers of schizophrenics can be significantly H+W
‘ differentiated from mothers of normals by means of ‘fv‘j‘”
the TAT. _ Flt

' 5. Criteria for classification as pathogenic, unscor-
able or benign can be communicated as well as
n formulated. ‘

31 Support for the schizophrenogenic mother concept,
whether as a cause or reaction, is indicated.

  
 
  
  
   
  

A discussion of the research, both from the point
féfifi View of §s and the relative sensitivity of TAT cards
lfgfifii given as well as some suggestions for the treatment of
' the schizophrenic and/or his family. In particular, the
egresent writer suggested some changes in the scoring system

f:"ihich radically changed the scoring system used in the

‘Hjjpresent study.

 

 

AN ELABORATION OF A STUDY OF
THE SCHIZOPHRENOGENIC MOTHER CONCEPT H L,“

BY MEANS OF THE THEMATIC APPERCEPTION TEST . ‘I ‘IIIVI
By ' w

Kevin Michael Mitchell

 

A THESIS I

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

DOCTOR OF PHILOSOPHY

Department of Psychology

1965

 

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ACKNOWLEDGMENTS

The author extends his appreciation to the members

With the preparation and execution of this study but, also; .

vfifor their unswerving demand that he become a psychothera-

 

On a larger scale, I should like to thank my wife,
IRosamond, for her faith and encouragement. She made the

Vieffort worthwhile.

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TABLE OF CONTENTS

Page
I“ NOWIIEMMENTS O o a o o o o o 'n u in o I. g ,I . . . . ii "‘1‘" ;
-sT or TABLES . . . . . . . . . . . . . . . . . . . ivI

§T 0F APPENDICES . 0 I I o O O o O C O o o O I I C 0 V

picer.

 

J I .DUCTION I O o o o o o O o o I o o O o 0 0 o O I 1 ‘

SCUSSION . o o o o o n o o o o o I o o o o o o ' o o 36

ITaLTOGRAPHY . . . . . . . . . . . . . . . . . . . . 65

‘1‘].QPENDIICES I I O N I O O I O O I I I O I I O O I I O I 73

 

 

LIST OF TABLES

Data of subject population of both mothers
and children of experimental and control
groups I I I O O O U I I I I I I O 9 O O

Pathogenic scores attributed by Judges I
and II to individual experimental and
control subjects . . . . . . . . . . . .

Pathogenic.scores calculated for each TAT
card from pathogenic stories attributed
by Judged I and II to experimental and
control subjects . . . . . . . . . . . .

Pathogenic scores attributed to individual
experimental and control subjects under
new scoring system . . . . . . . . . . .

Pathogenic scores calculated for each TAT
card under new scoring system . . . . .

iv

Page

29

32

34

82

83

 

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LIST OF APPENDICES

Page,

General criterion+—pathogenicruneutral
and benign themes used to score.for
schizophrenogenesis in TAT protocols
in Meyer's (1964) study . . . . . . . 73

Pathogenic, unscorable and benign themes
derived during the present study to
score for schizophrenogenesis in TAT ,
protocols . . . . . . . . . . . . . . 77 l
\

Pathogenic, unscorable and benign themes
which comprise the New Scoring System 80

Tables reflecting results of data rescored
under new scoring system . . . . . . 82

 

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INTRODUCTION

   
   
   
  
  
  
   
  
   
 
   
  

‘According to Arieti (1959), Kraepelin was the first
? to structure the concept of dementia praecox as a nosologic
(1 entity. His major criterion for the identification of the
syndrome was progressive deterioration, thus emphasizing the
T .descriptive, rather than dynamic, aspects of the disease.
Although Bleuler (1952), Federn (1952), and Freud
(1925) emphasized a dynamic account of schizophrenia, de-
-1ineating regressive and restitutive aspects of the syn—
drome, considerable controversy still exists concerning the
~precise nature of the schizophrenic process. Some writers
(bender, 1955, 1956; Bergman and Escalona, 1949; Gurevitz,

: ",1954; Kallman, 1946, 1953; Mahler, et a1. 1949; Rabinovitch,

 

1952 and Stierlin, 1959) believe that schizophrenia refers

to an essentially constitutional disorder which is genetically
determined.

Indeed, presenting the obverse of the present writer's
n'hypothesis concerning the concept of the schizophrenogenic
'213~mother, both Gurevitz (1954) and Rabinovitch (1952) insist

‘ jhat the schizophrenic-disturbance is inborn and that the

1

 

 

 

  
   
  
  
  
   
  
  
  
   
  
  
  
  
  
  

*5
,(fi active and represent her response to rejection by the child

17i(who is unable to respond to the mother's affection.

Other writers (Arieti, 1954; Bettelheim, 1956; Fromm-
?Lneichmann, 1948, 1960; Kanner, 1949; Karon, 1963; Klein, 1952,
Ij-1957; Powdermaker, 1952; Rosen, 1953; Searles, 1958 and
fI-Sullivan, 1947, 1953, 1956) clearly designate interpersonal
relationships as both the primary cause and fundamental re;
pository of the schizophrenic process. More orthodox psy-
chOanalytic writers (e.g., Nuberg, 1955) emphasize inter-
personal relationships as a significant causative factor in
schizophrenia but do not rule out constitutional factors
entirely. Bellak's (1958) "multiple—factor theory of schizo-
phrenia" often serves as a model for a partially effective
(compromise between the two positions.

More to the point, however, there seems to be in-
'creasing evidence, much of it based on clinical impression
rather than rigid experimental research, that families of
schizophrenics appear to be different from families of so-
called normal individuals. Furthermore, there seems to be

a sense of increasing assurance among psychotherapists that
1-1schizophrenic patients can respond positively to psycho-

‘*Rtherapy. Consequently, although the status of genetic and

 

 

   
  
  
    
  
 
 
  
  
  
  
  
  
   
 
  
  
  
  
   
 
 

7ochemical factors in the schizophrenic process is far from ‘p a

,cpmpletely delineated, the psychologist as therapist has a

.4
"I‘

7:wide range of meaningful techniques which he can utilize in
«nameleorating the effects of the schizophrenic process in con-

w‘temporary interpersonal relationships regardless of the

-—
,‘v

”petiology of the process. It is the present writer's opinion

H

(”iiithat the psychotherapeutic effort is, and shall remain, of

" :fundamental importance,‘regardless of the nature of the cau-
-flsative factors in the syndrome and that a careful examination
,-ef the interpersonal relationships of the schizophrenic,
especially within his family, seems both appropriate and
:highly necessary. Finally it is the present writer's opin-

. ion, and a basic assumption of this paper, that an investiga-
ftion of interpersonal relationships constitutes the most mean—
ingful avenue for understanding and treating the schizophrenic.
A large number of papers, usually of a theoretical
nature, have concentrated on the kinds of interpersonal re—
?1ationships which are assumed to account, at least in part,
vfor the schizophrenic process. Bleuler (1952), Federn (1952)
i. and Freud (1925) are early writers who conceptualized the

.E :{precess as withdrawl from objects and object relationships.

:5 {Freud (1925) suggested that the break with reality was due

zargither to increasing pressure from the environment or

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increasing pressure from the id. In either event, pressure,
leading to overwhelming anxiety, resulted in the schizo-
phrenic withdrawal. Freud emphasized the regressive aspects
of the syndrome, but he also realized that restitutive
factors play a role as attempts to replace the still exist-
ing, but rejected, world. However, it was left to Federn
(1952) to first suggest the importance of ego boundaries

and ego feelings in schizophrenia.

Later, other writers (Fairbairn, 1954; Fromm-
Reichmann, 1948, 1960; Klien, 1952, 1957; Sullivan, 1947,
1953, 1956) suggested that the schizophrenic withdrawal re-
sulted from early experiences in destructive relationships
with “significant others." Becoming even more specific,
Bettelheim, (1956); Kanner, (1949( and Rosen (1953) believe
that the schizophrenic's "significant others“ were destruc—
tive because, in some way, they threatened his life. While
Johnson, gt;21., (1956) have emphasized the presence of both
discrete and continuous trauma in the early life of the
schizophrenic, Jackson (1957) asserts that the early life
situation of the schizophrenic should not be seen as "trauma"
but rather as “. . . a condition which has been non-
discrete and continuing." (p. 181) More specifically,
Karon (1960) feels that oral trauma, which he con-

i§lsiders fundamental in the genesis of the schizophrenic

 

 

  
  
 
  
  
 
  
  
  
  
 
  
 
 
 
  
 
  
  
 
 
  

 

:1 of the patient's life. It involves the inability of the -»
sdhizophrenic's mother to feed her child without becoming
angry thus causing the feeding situation, per se, to become'
‘ehreatening for the schizophrenic. He adds that "...oral
.(trauma is not one event, but the mother's continuous reaction
y‘( to feeding demands" (p. 481)°

More recently, there has been a greater emphasis on

i specific aspects of the kinds of interpersonal relationships
,that seem to engender a schizophrenic process. For example, ‘ ;
ILArieti (1954), Bateson (1955), Chapman (1960), Flavell (1957),

L and Powdermaker (1952) have commented on the communication

“process in the families of schizophrenics. Arieti (1954)

YR‘and Powdermaker (1952) agree with Sullivan (1953) that the
J~pre-schizophrenic introjects erroneous parental attitudes

about himself and other persons, making these attitudes

‘rhis own. In so far as these attitudes are erroneous and

.lead to inept ways of dealing with his environment, the

‘} child eventually withdraws and the schizophrenic process

firensues. Bateson (1955) qualifies this picture of the

(‘cemmunicative process by suggesting that the child does

“het,receive merely unilateral messages but, rather, double-

  
  
  
   
   
  
  
   
  
  
  
   
   
   
   

.._#%ienvironment.
“((MW Flavell (1957) points out, however, that ". . . a
(current deficit in cognition must be explained in terms of
-iear1y interpersonal disturbances which involved cognitive,
H‘4 as well as emotional, development" (p. 128)° Consequently,
V‘he offers three paradigms which he feels might be useful in
‘ considering such cognitive developments. Flavell suggests
that possibly ". . . only a fragmentary incorporation
of attitudes toward reality take place because of a
$ pervasive atmosphere of parental rejection" (p. 129). Or,
". . . reality attitudes with which the child is presented
tend to be laden with hypocrisy and internal contradiction"
(p. 129). Or, finally, “. . . the parents refuse to tolerate
the child's presocialization autistic ideas and, therefore,
the child must come to accept the parents' reality" (p. 130).
. This last paradigm, in particular, and the first two to some
extent, suggest that the child, in order to literally survive
in his family, must incorporate his parents' reality which,
in turn, means that he must surrender his individuality.
It is the present writer's opinion that there seems
"“‘to be growing support for the notion that a child becomes
’ ’tbachizophrenic within a family or family surrogate and that

'e of the fundamental processes involved is the necessity

 

     
  
  
    
  
   
   
 
  
 

‘ £6: the pro-schizophrenic child, in his particular family,
"Etc accept the imposition of another's distorted reality,
causing him to give up his own evaluative abilities and,
:fconsequently, his individuality. Furthermore, there-is
pilevidence to suggest that this imposition of distorted
reality, which is destructive in nature, occurs largely
' <out of the needs of the schizophrenic's mother. This es-
sentially is the theory of the schizophrenogenic mother
(Fromm-Reichmann, 1960; Karon, 1963) which will serve as
‘ the construct under study in this paper.
At a theoretical level, Powdermaker (1952) sees
the basic etiology in schizophrenia as the pre—schizophrenic's
need to comply with the reality of others versus his need to
own his own perceptions and his own reality. Stierlin (1959)
T speaks of this as ". o . adaptation to a stronger person's
"reality." Dynamically, Stierlin posits that the mother needs
her child as a means of self justification and self confir-
mation, thus putting pressure on the child to experience and
interpret reality as the mother wants it to be. Searles
(1958) sees the schizophrenic illness as ". . °the child's
loving sacrifice of his very individuality for the welfare
Of the mother who is loved genuinely and altruistically"
(p. 570).
These theorists, and others of a similar orientation,
’(‘Jbelieve that a pathological relationship between schizophreno-

Wenic mother and child exists. They do not, however,

. . 111.11.
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suggest a meaningful paradigm for understanding how the
mother's attitudes and feelings become part of the schizo-
phrenic in such a way that his behavior becomes psychically
determined in numerous situations completely different from

‘ familial situations.

 

    
  
  
  
  
  
  
   
    
   
  
  
   
  

Klein (1952, 1957) and Fairbairn (1954) have pro-
vided such a paradigm. While the two theorists disagree on
a number of basic issues, for the present writer's purposes,
they can be examined together for the most part. Essentially,
although both are Freudian analysts, they elaborate on
Sullivan's (1952) basic hypothesis that schizophrenia is the
outcome of destructive interpersonal relationships with
“significant others." The syndrome involves the introjection
of the "significant others" hostile, destructive attitudes
which are then turned toward the self causing an actual
split in the personality.

Klein (1952, 1957) and Fairbairn (1954) argue that
the pathological child carries around with him internalized
objects, specifically, sadistic parental images, which con-
tinuously goad and punish him and which, thereby, determine
his perceptions of himself and his relationships with other
persons. Internalized objects, leading to psychic structural
differentiation, mold the child's psychological life and
determine his behavior. Both theorists, therefore, posit a
psychic reality as distinct from outer reality and affirm

that the difference between normal and pathological individuals,

  
   
 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
   
  
  
  

therefore, is the degree to which phantasies are realisti-
cally dealt with and gratified in relation to the demands

of outer reality.

However, Klein (1952, 1957) sees the infant's
aggression and, to some extent, his and others' reaction to
his aggression as too biologically determined to suit Fair-
bairn (1954). The latter is explicit in viewing the causal
starting point of disturbed development as definitely en-
vironmentalo He believes that ". . . disturbed development
results when the mother does not succeed in making the child
feel she loves him for his own sake and as a person in his
own right." (Guntrip, 1961, p. 330) The dynamic of the
process of repression is aggression felt in the first place
against bad external objects. The schizophrenic ultimately
represses, not impulses or memories, per se, but rather bad
internalized objects. However, since internalized objects
become psychic structures, they can be repressed only by
repressing parts of the ego, resulting in ego splitting.

In summary, both Klein and Fairbairn's paradigm of inter-
nalized objects constituting psychic reality allows us to
see the schizophrenic process as the imposition of another's
distorted reality upon the victim and offers at least a
partial solution to the problem of understanding how maternal
influences early in life determine later behavior.

Fromm-Reichmann (1960); Giffin et a1. (1954); Johnson
et a1. (1956); Karon (1960, 1963); Karon & Rosberg (1958) and
Rosberg & Karon (1958) have contributed extensively to the
concept of the schizophrenogenic mother. For instance,

 

10

   
  
  
   
   
  
  
  
    
  
  
  

Johnson, g£_31. (1956) feel that the schizophrenic child's be-
havior reflects poorly integrated impulses on the part of the
parents. The expression of the symptom through the child

both determines the psychosis in the child and protects the
parent from the same psychosis.

Giffin, gt_al. (1954), in describing the genesis of
anti-social acting out behavior, offer an account which is
applicable to the formulation of the schizophrenic process

being offered here:

Antisocial acting out in a child is unconsciously initi-
ated, fostered and sanctioned by the parents, who vicari-
ously achieve gratification of their own poorly integrated
forbidden impulses through a child's acting out. One or
both of the parents, in addition, unconsciously experi-
ences gratification for their own hostile and destructive
wishes toward the child who is repeatedly destroyed by

his behavior. (p. 669)

Karon (1963) addresses himself most directly to the

concept of the schizophrenogenic mother.

The schizophrenogenic mother feels inadequate and
compensates for her inadequacy by making demands on the
child in terms of her own pathological needs whenever
her needs conflict with his. In many respects, the
underlying problems of the schizophrenogenic mother are
similar to those of the schizophrenic, but she defends
against her anxieties by destroying the child." (p. 29)

The essential aspect of the concept of the schizo-
phrenogenic mother is the notion that, in any situation
where the needs of the child and the needs of the mother
conflict, the mother will satisfy her needs, but only in-
directly, by imposing her needs and View of reality onto the

child in order that the child's behavior in some way satisfies

 

((15.12) (“W

11

:7the mother's needs. This general idea, although not-always

  
    

(filabeled as the concept of the schizophrenogenic mother, has
7 been studied in various ways. Questionnaires, interviews,

5- objective and projective psychological tests, as well as
Li‘psychotherapy with the child and/or mother have all contri-
‘V‘buted in both a theoretical and experimental sense. It is

a major assumption of this paper, however, that the mother
,”;of the schizophrenic is a significant factor in the genesis
of schizophrenic reactions in her child and that the concept
is experimentally valid and experimentally meaningful.

In addition to the writers mentioned above, others
who offer less well systemized approaches or who may not
always specifically express the notion of the schizophreno-
_genic mother, have noted characteristics of the mothers of
.‘ schizophrenic children which, taken as a whole, would seem
y to offer support for such a concept.

Earlier writers (Despert, 1942; Kasania, 1934) have
described the mothers of schizophrenic children as over-

.‘ protective, anxious, and solicitous. Usually, profound re-
:.§3 jection, either overt or covert, was a conspicuous factor in
1%; the mother-child relationship. In a classical study, Tietze
v}, (1949) interviewed mothers of schizophrenics and found that
nearly all such mothers described themselves as nervous,

high strung, shaking inside and always anticipating danger.
:I‘gTietze felt that what was most missing was a kind of intuition

'“'9r empathy between mother and child.

—4.I
‘-

.‘_-.“

 

 

 

 

12

More recent writers, without specifically employing
the term "schizophrenogenic mother" have also cited similar
findings as a result of structured interview techniques and
psychotherapeutic intervention with the schizophrenic and/or
his family. Kaufman, EEJEL' (1957) hypothesized that the
core anxiety of both the parents and schizophrenic child is
fear of annhilation. The parents are unable to recognize “?
that the child has a separate identity, thereby allowing
themselves to displace their own anxiety onto the child and
then controlling this anxiety by controlling the child.

Lu (1962), after intensive interviews with 24 hos-
pitalized schizophrenics and their families, found that in
19 of the 24 cases the parents had expected the pre-schizo-
phrenic, more than his normal sibling, to be both unloved
and yet achieve perfection. Lu also found that in 17 of the
24 cases, the schizophrenic had made greater efforts than
his normal siblings to fulfill these contradictory expec-
tations.

Meyers and Goldfarb (1961) defined their parental
perplexity syndrome as involving ". . . parental passivity,
marked uncertainty, . . . absence of empathy with the child
with resultant diminished awareness of the child's needs,
bewilderment and blandness in the face of socially unaccept-
able or bizarre behavior in the child and a total absence
of forthright parental control" (p. 552). Based on observa-

tions made in the home and open ended interviews, the authors

 

    
  
   
   
  
  
  
  
   
  
  
  
   
  
  
   
    
 
  

-... .
- :-

13

concluded that parental perplexiety confronts the pre—schizo-

(phrenic or schizophrenic child with an absence of positive
reinforcement differentiation that is needed by the develop-
ing ego for the effective integration of clear cut systems
of action.

Some effort has been made to categorize the parents
of schizophrenics. Ekstein, gt_al. (1958) and Reichard and
Tillman (1959), using structured interviews and data from
psychotherapy, have suggested that there are three categories
of parents who usually produce a schizophrenic child:
overtly rejecting mothers, covertly rejecting mothers, and the
schizophrenogenic father. The writers agree that the overtly
rejecting mother can best be described as cold, critical and
insistent that the child meet her needs. They also agree
that the covertly rejecting mothers are infantile, parasitic
and over protective as a reaction formation against hostility
toward the child.

While interview techniques and data from psycho-
itherapy afford a basis for a good deal of informative specu-
lation about the mothers of schizophrenics, these methods do
not provide for adequate control groups. Nor are the data
collected by such methods easily quantifiable, making exact
replication most difficult. In an attempt to deal with
these objections, there has been a large number of studies
utilizing attitude scaling procedures. These techniques,

Whatever their shortcomings in other respects, employ control

 

, 14

 
  
  
  
  
  
  
  
  
   
   
  
  
  
  
  
  
  
  
  
  
  
  
  

groups and are easily quantifiable. In general, the find-
ings support the clinical impression that the parents,
especially the mothers, of schizophrenics differ signifi-
cantly from parents of normal children along certain meaning-.
ful, quantifiable personality dimensions. Divorin and Wyant
(1957) and Mark (1953), while using different terms and the
Fascism and FELS scales respectively, agree that mothers of
schizophrenics foster dependency, and are more domineering
and restrictive. Generally, these mothers emphasized con-
formity and conventionality and allowed the child little
freedom or choice of activity.

The PARI scales have been used by a number of
writers and with similar results. Freeman and Grayson (1955)
found that the greatest difference between mothers of normal
children and mothers of schizophrenic children was reflected
in the Possessive scale. Shepherd and Guthrie (1959) ex-
tracted five factors from the PARI scales which seemed to
best describe the mothers of schizophrenics in their sample.
They were: (1) detached authoritarianism; (2) inadequacy
and inconsistency; (3) pervasive control; (4) sophisticated
denial of inadequate mothering; and (5) annoyance and re-
jection. In a very interesting study, Heilburn (1960) had
normal and schizophrenic daughters answer the PARI "as

their mothers would." He found significantly more deviancy
ascribed by the schizophrenic daughters to their mothers

than by normal daughters to their mothers.

 

 
  
  
  
   
  
  
  
  
  
  
  
  
  
   
   
 
  
  
  
  
  

15

One study merits special consideration. Garmezy, :
§E_a£. (1961) gave a child rearing attitude questionnaire

to 15 hospitalized schizophrenics judged having had a good
premorbid adjustment, 15 hospitalized schizophrenics judged
having had a poor premorbid adjustment and 15 patients from

a general service ward. Each S was asked to answer the
questionnaire as he thought each of his parents would have
answered the questionnaire when the S was between 13 and 14
years of age. In addition to the usual findings that the
schizophrenic Ss, significantly more than the normal Ss,
ascribed attitudes of dominance, over protection and ignoring
of needs to their parents, the authors were also able to
differentiate between good and poor premorbid schizophrenics. 1
There was significantly greater ascription of paternal domi-
nance among good premorbid schizophrenics and significantly
greater ascription of maternal dominance among poor premorbid
schizophrenics. Generally, where the father was seen as

more dominant, the schizophrenic S became disabled in rather
specific situations dealing with self esteem. Where the
mother was seen as more dominant, the schizophrenic S showed
more chronic, pervasive feelings of inadequacy. Whatever
other conclusions may be drawn from the data, it seems ap-
parent that what the father does not do is directly related
to the seriousness of the schizophrenic syndrome in his
offspring. While this paper is concerned only with the

mothers of schizophrenics and not their fathers, it would

 

16

  
  
  
  
  
  
   
 
  
  
  
  
   
  
  
  
  
  
  
   
 
  
  

seem that the father's role is of great importance especially
in ameliorating the destructive influences of the mother.

It would also seem clear that where the mother is more domi—
nant than the father, the schizophrenic child is more
seriously disturbed and hampered than where the father is
more dominant than the mother. Further work, beyond the
scope of this study, will have to be done in this area,
however.

A second consideration, when evaluating differential
parental influence in the genesis of a schizophrenic syn-
drome, should be taken into account. Kohn and Clauson (1956)
found that while schizophrenic Ss, significantly more than 4
normal Ss, saw their mothers' making the major decisions in
the family, this was interpreted differently by male as op-
posed to female schizophrenics. Male schizophrenics, in

this study, were more likely to prefer the dominant mother,
while female schizophrenics were more likely to prefer the
passive father. Consequently, any conclusions about the

role of the mothers of schizophrenics will have to be quali—
fied by both the sex of the schizophrenic child and the role
of his father. However, parsimony, due to the present level
of our knowledge, would seem to suggest that each of the
three factors might best be examined separately.

While objective psychological testing can detect
subtle differences of the kind noted by Garmezy, SE_E£°

(1961) and Kohn and Clauson (1956), for example, only

1

 

17

  
  
  
  
  
  
  
  
  
   
 
  
  
  
  
  
  
  
  
  
   
  
  

projective testing would seem adequate to the task of prob-
ing into dynamic considerations. Furthermore, while objec—
tive testing and attitude scaling techniques lend themselves
readily to the use of control groups and statistical mani-
pulations, these techniques cannot differentiate between
professed and real attitudes, on the one hand, nor can they
account for differences between professed attitudes and
behavior, on the other hand. Consequently, projective tech-
niques have been used to get at the more dynamic, as opposed
to the merely descriptive, aspects of maternal influence on
the schizophrenic process.

The literature on the use of projective techniques
in diagnosing schizophrenia is voluminous but considerations
of space and relevancy preclude a survey of this literature.
To the present writer's best knowledge, however, only one
study using the TAT has attempted to directly assess the
concept of the schizophrenogenic mother (Meyer, 1964). None-
theless, at least two studies, using the Rorschach, have
offered evidence for such a concept. McGhie (1961) found
that mothers of schizophrenics gave Rorschach responses sug-
gesting a diluted schizophrenic process while mothers of
neurotics gave Rorschach responses suggesting a diluted
neurosis.

In a most important study utilizing the Rorschach
and directly related to the assertion that the attitudes and

feelings of mothers of schizophrenics are merely reactions

 

 

18

to the children's illness, Prout and White (1950) concluded
that there is a strong and early identification of such
mothers with their sons and they suggested that this identi-
fication was not simply a result of the sons' illness. In
general, the authors found that the mothers of schizophrenic
Ss, more than mothers of normal children, were not as ag—
gressive or demanding about their own lives, had a lesser
sense of achievement and fewer outlets for self-expression.
The authors felt that these self-attitudes, as reflected in
their Rorschach responses, allowed the mothers of the schizo-
phrenic Ss to intrude in their children's lives, setting up
the kind of demanding, parasitic relationship which the
present writer has referred to as schizophrenogenic.

A persual of the literature suggests that only one
study (Meyer, 1964) uses the TAT in order to evaluate the
concept of the schizophrenogenic mother. Nonetheless, before
discussing this study, it should be noted that the TAT seems
sensitive to schizophrenic processes. Balken (1943) found
that schizophrenic Ss offer fantasies having no apparent
relationship to the pictures. Holt (1958) felt that schizo-
phrenics show over-elaborate symbolism, bizarre or delussional
qualities, arbitrariness, and perseveration more frequently
than normal SS. Lane (1955) found that schizophrenic Ss
showed greater dependence on mother, more feelings of home-
lessness and rejection by parents as themes than normal Ss.

Finally, Rotter (1946) feels that the following are

 

~‘ f' 3 . . "1 1 . V "'1‘. I ' .
v I} u“ . H“ W Hf“ ”w ,- 14..”
w H"

M“ 19

   
   
 
   
  
   
 
  
  
  
   
 
  
  
  
  
  
  
  
  

'tharacteristics of the TAT themes of schizophrenics: u
1.{*(l) direct contradiction; (2) absurdities; (3) loose associa- i
Tfi'tional thinking; and (4) blandness.

‘ In a most interesting study, Goldman and Greenblatt
(1955) were able to show that judges can successfully dif-
fngferentiate between markedly improved and non-improved schizo—
" ‘phrenics on the basis of TAT stories. The authors suggested
that the main point of reference was the degree of withdrawal,
in the stories, from interpersonal relations.

In spite of the fact that some writers (e.g., Eron,
1950; Murstein, 1963) feel that the TAT is inadequate in
differential diagnosis, Dana (1955, 1956), Davison (1953)

and Lane (1955) have demonstrated the ability to differenti~ }
ate significantly between schizophrenic and non—schizophrenic

Ss..

Serious objections have been raised against the

use of the TAT in differential diagnosis, however, Murstein

(1963) points out that no comprehensive TAT scoring system

has won universal acceptance by clinicians although many

have been proposed. One reason, he feels, is that most

qualitative scoring systems depend too much on the originator's
skill, making studies using such scoring systems difficult

to replicate. On the other hand, Murstein suggests that

.5 most quantitative scoring systems are too detailed and com-

:ipplex for popular clinical use.
_JMS

 

311 20

Dana (1955) and Piotrowski (1952) would concur. The

  
  
  
   
 
  
  
  
   
 
  
  
  
  
  
  
  
   

«tatter has pointed out that ". . . those who interpret_TAT

ghetter“ (Piotrowski, 1952, p. 230). Of course, studies
using this scoring approach are difficult to replicate
because the findings too often depend directly upon the

r skill of the particular clinician interpreting the TAT

'J'i stories.

Dana (1955) feels that ". . . use of the TAT as a
formidable diagnostic tool without benefit of formal scoring
has been demonstrated. However, when objective scoring sys—
tems are applied, the TAT has failed to yield clinical
diagnoses, although there has been some differentiation
between normal and abnormal groups." (p. 19)

Consequently, although utilization of the TAT in
'order to probe the more dynamic aspects of schizophrenogenic
‘S relationship between mother and child offers exciting pos-
I_sibilities, attention has to be paid to the way stories-are
5,fl categorized and variables measured so that communicability

' of procedures and results can be maintained. As mentioned
above, only one study (Meyer, 1964) uses the TAT to assess
_the concept of the schizophrenogenic mother. Furthermore,
Meyer addresses himself to the problem of communicating the
?{ {process by which stories are judged so that replication can

.t
he assured. Granted the concerns mentioned above, projective

 

 

 

21

  
  
  
  
  
  
  
  
  
   
 
  
  
  
  
  
  
  

testing would seem most appropriate to evaluate this concept,
;x especially if a communicable, somewhat quantifiable scoring
‘VT system could be evolved. Meyer (1964) presented the TAT to
’ ”mothers of schizophrenic and normal children. He hypothe-
“9_sized that ". . . the mothers of schizophrenics will give
y‘more stories than mothers of normals in which the dominant.
individual takes from a dependent one when their needs con-
'flict" (Thesis Abstract, p. 1). This essentially was the

interpersonal variable measured in each story. It was
assumed to be best labeled as "destructiveness" and the best
single indicator of a schizophrenogenic process.
Each story was judged as pathogenic, neutral or
benign by Judge I, experienced with the concept of the
schizophrenogenic mother. Criteria for each category were
formulated in a very concrete fashion and Judge II, less
experienced with the concept, using these criteria categorized
each of the ES' randomly presented stories as pathogenic,
neutral or benign. A score was tabulated for each s from
the formula: Pathogenic/Pathogenic + Benign.

The results led to the following conclusions:
1. Mothers of schizophrenics can be significantly dif-

ferentiated from mothers of normals by means of

the TAT.
2. Criteria for classification as pathogenic, benign

or neutral can be communicated as well as formulated.
3. Support for the schizophrenogenic mother concept

whether as a cause or reaction, is indicated.
(p. 12, 13) ’

 

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22 ‘15
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"lineate and refine communicable scoring criteria. The first
umhypothesis to be tested is that mothers of schizophrenics,

f bore than mothers of normals, will give TAT themes where the.
xidominant individual will either refuse to meet the needs of
ithe dependent person or take from the dependent person when- H
libever their needs conflict. V

Itshould.be understood that verification of the

’&

~first hypothesis does not necessarily imply that the schizo— W

'; phrenogenic mother is the only or even primary cause of the ‘

. ‘schizophrenic process in her child. Moreover, verification

attitudes and feelings of the schizophrenogenic mother are

i
, ‘ \
of this hypothesis does not refute the contention that the f
l
(
merely reactive to her child's illness. Nevertheless, the i

work of McGhie (1961) and Prout and White (1950) in addition
to the verification of the present writer's first hypothesis
4 would strongly suggest that the projections of the mothers L
Y; of schiz hrenics onto Rorschach and TAT cards reflect per-

‘” sonal pathology rather than mere reactions to their children's
illness. Certainly, while mothers of schizophrenic children

; may become more destructive toward their sick children than

'L «smothers of normal children, for whatever reasons, it would
- m
1

.;3}be.difficult to account for the severity and pervasity of
"Vfithe schizophrenogenic mothers' destructive feelings and

NI .‘

”Evieelings of low self esteem as merely reactive. Moreover,
lw' ‘ ‘fl ‘

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23 y

    
 
  
  
  
 
 
  
 
 
 
 
 
  
  

‘ process of projection, so evident in the test responses
the mothers of schizophrenic children and employing ideas
p‘eference, narcisism and loose associational thinking,
hld scarcely be seen as simply reactive.

‘ Thus, the verification of the first hypothesis will
support the concept of the schizophrenogenic mother and will
'mwfifiker reinforcement to the notion that, regardless of the- .gsgf

tgause, the reactions of the schizophrenogenic mother are

Vdmportant in understanding and treating the schizophrenic

The second hypothesis to be tested is that the~dif-
ferentiation of mothers of schizophrenics from mothers of
(”normal gs is communicable. Thus, further replication and

‘jxefinement of this use of the TAT will be assured.

 

 

  
  
  

 

METHOD

gs were twenty mothers of schizophrenic children and
twenty mothers of normal children. The schizophrenic children
were so judged by at least one psychologist and one psychia-
trist while the normal children were so judged on the basis
of a school report, a report from an unbiased observer and
an interview by the author. If any of the three criteria
used for categorizing the children as normal indicated pa-
thology, the child and, consequently, a potential g, was
discarded. The two groups of children were matched on the
basis of sex, age, level of education, number of children in
the family and, in so far as possible, the child's chrono-
logical position among his siblings. In addition, the
mothers of the two groups of children were matched on age,
level of education, and social class according to the two-
factor system devised by' Hollingshead and Redlich (1958).
Table 1 summarizes the data on the subject population of
both mothers and children of both experimental and control
groups.

The mothers of the schizophrenic children were ob-
tained from a number of different Child Guidance Clinics in
Michigan. Mothers of the normal children were obtained

from P.T.A. groups in Jackson and Lansing, Michigan.

24

 

  

  

 

25

Each g was seen for approximately fifteen minutes
prior to testing in order to allay anxiety, establish mini-
mum rapport, and offer assurances regarding the confidentiality
of the test responses. Each mother in the experimental group
was tested at the particular Child Guidance Clinic where she
had been seen originally. Each mother in the control group
was tested either at the author's office at the Beth Moser
Mental Health Clinic, Jackson, Michigan or in offices pro-
vided for such purposes at Michigan State University.

Mothers in the experimental group were contacted by
the particular clinic worker who had originally seen her for
intake. Experimental gs were told that the purpose of the .
research was to learn more about the kinds of children who fl
are referred to Child Guidance Clinics. The statement of
the purpose was intentionally vague but the worker did
specify that the mother's cooperation would have nothing to
do with her child's disposition. Only those mothers were
used as experimental gs who had never been involved in psy-
chotherapy of any kind and for whose child the particular
clinic had already made specific recommendations.

In order to obtain control §s the author spoke with
a number of P.T.A. groups asking for volunteers. The pur-
pose of the research was not explained but each group was
promised that the author would return and explain the pro-

ject once it had been completed.

 

26

 

Each g was administered the entire TAT sequence ex-
cept card XVI. The author discovered that card XVI elicited
a good deal of anxiety and felt that administering the card
interfered with rapport. Consequently, after approximately
three experimental mothers expressed extreme difficulty with
card XVI, the author decided to discontinue its use. Only
the question, “And what happens next in your story?“ was
used by the author and then only once, if at all, for each g.
No other comments were made by the author during administra-
tion of the cards. At no time did E question g in order to
facilitate the use of the subsequently used scoring system.

The stories were typed on separate sheets of paper, 1
with no identification cues available. They were then pre-
sented in random order to Judge I who, during the first
judgment session, classified all stories as (l) pathogenic,
(2) benign, (3) unscorable (4) can't tell. It should be
noted that, in the present study, the category "Unscorable"
was substituted for "Neutral." Essentially, those themes
scored "Neutral" in Meyer's (1964) study were not neutral
with regard to the concept "pathogenesis." Instead, those
themes so categorized represented stories which could not
be scored either Pathogenic or Benign and, consequently,
it was felt that the term "Unscorable" would better reflect

this meaning.

 

27

This classification was, in part, based upon thematic

  
  
  
  
  
  
  
   
 
  
   
 
  
  
  
  
   
 
  
  
  
  

criteria, for types of stories which were not given by gs in

Meyer's (1964) study but which were given by gs in the present

study, were also used but they followed the same general

rationale. All new criteria consisted of blind clinical

judgments made by Judge I on the basis of the general theory
underlying the criteria enumerated in the previous study.

It should be emphasized that all criteria, in both studies,

were developed by Judge I while judging the stories but

without knowledge of which g gave the story being judged.

Following this, Judge I re-examined all stories ' .
placed in category (4) and reassigned each story so placed
in one of the first three categories. Appendix A indicates
those thematic criteria derived from Meyer's (1964) study.
These thematic criteria and the randomized stories
were then presented to Judge II who followed the same judg-
ment procedure as Judge I except that he had studied the
added, as well as the established, criteria and could make
constant reference to the derived scoring key. Judge II
did not verbalize his criteria for classifying the stories
since he used the previously extrapolated themes.

The general criteria for scoring were two-fold.

If there is an interaction between a dominant and dependent
individual, both with conflicting needs, the story is scor-
able. If not, the story is not scorable. Secondly, if

there is such an interation and if the dominant individual

 

28

 

takes the dependent individual's needs into account, the
story is scored Benign. If the dominant individual either
does not meet the specified needs of the dependent indi-
vidual or meets his own needs at the expense of the de-
pendent individual, the story is scored Pathogenic.

On the basis of the classifications made separately
by Judges I and II, two scores were tabulated for each g
using the formula: P/P+B, where P is the number of stories
judged Pathogenic by a judge and B is the number of stories

judged Benign.

 

 

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30'

 

 

RESULTS

Table II indicates the Pathogenic Scores attributed

  
  
  
  
   
    
   
   
   
  
  
  
  
  
 

by Judges I and II to the experimental and control gs re-
spectively. It can be seen that Judge I attributed a
V“ 1 higher Pathogenic Score to 17 of 20 experimental mothers
J" in comparison to their matched control mothers while
1”‘ Judge II did so for 19 of 20 experimental mothers in com-
parison to their matched control mothers.
l' Use of the Sign Test, a rough, relatively insensi-
fi‘ tive, but non-parametric test, indicated that Judge I was
able to differentiate between the experimental and control
pairs of mothers at the .003 level of significance and
that Judge II was able to differentiate between the experi-
mental and control pairs of mothers at beyond the .001
' .level of significance.
Furthermore, use of the t-test for matched pairs,
a more accurate and more powerful test, indicated that
both Judges I and II were able to differentiate between
' the experimental and control pairs of mothers at beyond
the .001 level of significance. The differences were in
the predicted direction for both Judges, suggesting, first,
' that the scoring system devised by Judge I can be used to

';i significantly differentiate between mothers of schizophrenic

31

 

u-vsr fl vim-Jan:

 

32

"@ fen and mothers of normal children and, second, that-
fa devised scoring system can be communicated to a second

e‘so that he can also significantly differentiate

 

e 2.--Pathogenic scores attributed by Judges I and II to
' individual experimental and control subjects

 

 

 

 

 

Judge I ‘ Judge II
‘Experimental Control Experimental ContrOl
Subject Subject Subject Subject
.68 .36 .80 .38
.78 .59 .94 .68
.86 .58 .85 .75
.56 .29 .69 .25
.67 .67 .67 - .60
.42 .43 .58 .60
.73 .60 .71 .47
.65 .36 .73 .56
.41 .25 .58 .21
.70 .62 .81 .60
.72 .54 .76 .68
.83 .69 .85 .79
.So - .74 .69 .65
.76 .44 .78 .60
.74 .38 .83 .50
.79 .27 .80 .36
.70 .33 .78 .64
.75 .41 .76 .50
.64 .50 .78 .59

.83 .29 .87 .40

 

 

33 '

Table 3 indicates the results of applying the for-

    
  
   
  
  
   
  
   
  
   
   
   
   
 
  

mula: P/P+B to each TAT card across both experimental and
control gs, thus deriving two Pathogenic Scores on each
card for each group by each judge or four Pathogenic Scores,
in all, for each TAT card.
Use of a 2 x 2 contingency table and the exact
test, described by Walker and Lev (1953) under the binomial
test, indicated that Judge I was able to differentiate
between the experimental and control groups' stories pro-
duced to six cards (2, 7BM, 9GF, 12M, 17GF and 18GF) at
beyond the .05 level of significance and to differentiate
between the two groups' stories to three cards (7BM, l7GF
and 18GF) at beyond the .01 level of significance. .3L3
Similarly, again using the same test, Judge II
was able to differentiate between the experimental and :
control groups produced to four cards (7BM, 12M, 18BM f
and 18GF) at beyond the .05 level of significance and to
Idifferentiate between the experimental and control groups'
stories to one card (12M) at beyond the .01 level of
significance.
Finally, it sould be noted that Judge I attributed f
a Pathogenic Score of .64 or higher to 16 experimental
mothers and to only three control mothers. It would
appear that, for Judge I, a Pathogenic score of .64 is
the most economical and efficient cut-off score to best

differentiate between the experimental and control mothers. w

 

 

 

 

 

 

 

34
Table 3.--Pathogenic scores calculated for each TAT card
from pathogenic stories attributed by Judges I and II to
experimental and control subjects
Judge I Judge II
Experimental Control Experimental Control

Card Subjects Subjects Subjects Subjects
1 .83 .64 .87 .75
2 .72 .40 .77 .62
3 BM .91 .50 1.00 .73
3 GF .92 .50 1.00 .67
4 .74 .53 .82 .82
5 .73 .77 .93 .93
6 BM .90 .84 .84 .81
6 GF .47 .58 .50 .50
7 BM .75 .26 .65 .27
7 GF .65 .50 .65 .64
8 .62 .27 .73 .38
8 GF .40 .27 .50 .37
9 BM .67 .57 .88 .67
9 GF .79 .29 .87 .55
10 .05 .16 .06 .16
11 1.00 .78 1.00 .81
12 BC .00 .08 .25 .00
12 F .89 .83 1.00 .87
12 M .71 .37 .93 .43
13 B .33 .60 .67 .44
13 G .33 .25 .25 .17
13 MF .90 .74 1.00 .71
14 .67 .50 .60 .60
15 1.00 .82 1.00 .78
17 BM .50 .37 .44 .43
17 GF .91 .14 1.00 .25
18 BM .68 .44 .83 .53
18 GF‘ .75 .22 .79 .44
19 .67 .40 1.00 .00
20 .50 .43 1.00 .33

 

!

   

 

 

35

'Judge II attributed a Pathogenic Score of .69 or higher to

17 experimental mothers and to only two control mothers.
It would appear that, for Judge II, the most economical
and efficient cut-off score would be .69. These cut-off
scores are similar to those found in Meyer's (1964) study
in which the most efficient cut-off score for Judge I
seemed to be .65 while the most efficient cut-off score

for Judge II seemed to be .57.

 

DISCUSSION

The results cited indicate that mothers of schizo-

  
  
  
  
  
  
  
   
 
  
   
  
   
   
  

phrenic children can be significantly differentiated from
mothers of so-called "normal" children through an analysis
of their stories produced to the TAT. The criteria used as
a basis for this successful differentiation support Karon's
(1963) contention, drawn from clinical experience, that
mothers of schizophrenics seem to be unable to meet the
needs of their schizophrenic children but, instead, use
these children to indirectly meet their own (the mothers')
needs.

The fact that Judge II was also able to significantly
differentiate between the experimental and control mothers
indicates that both the criteria and the process of dif—
ferentiation are communicable, a most important considera-
tion when evaluating the results of studies utilizing data,
derived from projective techniques.

Appendix A includes the criteria used for scoring
stories as Pathogenic, Benign or Neutral in Meyer's (1964)
study and also used in the present study, while Appendix B
includes further criteria devised by Judge I during the

present study.

36

 

 

 

 

37

It should be remembered, however, that verifica-
tion of both hypotheses does not lead to any definite
conclusion about the etiology of schizophrenia nor does
it refute the contention that the attitudes and feelings
of the schizophrenic child's mother are merely reactive
to her child's illness. Nonetheless, the results cited
indicate the validity of the concept of the schizophreno-
genic mother and offer support to the notion that, re—
gardless of cause, the reactions of the schizophreno-
genic mother are important in understanding and treating
the schizophrenic process in her child.

It was noted earlier that Judge I attributed a
higher Pathogenic Score to 17 experimental Se in contrast
to their matched control gs while Judge II attributed a
higher Pathogenic Score to 19 experimental ES in contrast
to their matched control gs. While these results are
highly significant, some explanation should be offered
concerning those pairs of mothers for whom the attributed
Pathogenic Scores were reversed so that the control mother
received a higher Pathogenic Score than her matched ex-
perimental mother.

For only one pair (E6 and C6) both Judge I and
Judge II reversed the Pathogenic Score. In this case both
mothers were Negroes although the present writer is at a
loss to explain why their being Negro would be a factor

in the reversal. However, they were the only Negroes in

38

  
  
  
  
   
 
  
  
  
  
  
  
  
  
  
  
  
   
   
  
  
  
  

the study and, furthermore, while Judge I attributed Patho-
genic Scores of less than .50 to each mother, Judge II
attributed Pathogenic Scores of greater than .50 to each.
Obviously, there is a good deal of fluctuation here and
no doubt further research will have to be done with Negro
Es using this scoring system.

Judge I attributed the same Pathogenic Score of
.67 to a second pair of mothers (E5 and C5). Here, the
question would seem to be why such a relatively high
Pathogenic Score was attributed to a control mother. In
-explaining to E why she was late for her testing appoint-
ment, this control mother stated that her daughter had
quite recently left her husband and had returned home to
her mother with four children, making it very difficult
for E to get away for her appointment with E. It might
be speculated that, at the time of testing, this mother
probably was experiencing a good deal of frustration with
and anger toward her daughter and grandchildren and that
these feelings might very well have been reflected in
some of her stories.

Similarly, Judge I attributed a higher Pathogenic
Score to a third control mother in contrast to her matched
experimental mother (E13 and C13). In this case, toward
the end of testing, the control mother broke down and
cried, saying that some of the cards had reminded her of

the fact that an uncle had died just one week earlier and

 

 

 

 

 

39

that her mother, as a result of this, had been openly wish-
ing for death which had greatly upset E.

In each case, E might have discarded these control
mothers' protocols before judging and substituted two other
Es. However, the results are important in that they lend
further support to Murstein's (1963) contention that tem-
porary mood states contribute to the kinds of stories told
to TAT cards. Furthermore, these results suggest that very
subtle and sophisticated judgments need to made even within
the bounds of the very concrete scoring system used in the
present study. Nonetheless, the present writer will later
suggest further refinements in the scoring system which
negate the Pathogenic Score reversals found with the above
pairs of mothers.

The reader should have a flavor of those stories
told by experimental Es and subsequently scored Pathogenic
by both Judges I and II in order to further understand the
scoring system and some of the dynamic processes reflected
by these Es in their stories. Six such stories follow:

1. Well this seems to be a picture of a woman that is
haunted by something in the background. The lady
seems to be in the background looking over her
shoulder allthe time watching her. So she is very
disturbed and I imagine the look on her face re-
minds me (laughs) of my mother and I . . . my
foster mother and I. Somebody is watching you all
the time . . . peering over your shoulders as if
. . . (Q) Well I don't know what might have hap-
pened between these two. The mother tries to

dominate the girl's life. More or less always
there even if she isn't present.

 

 

 

 

40

This looks like it would be either a mother or a
grandmother. Because of her age, she is living
with them and she knows that they would really
rather wish that she didn't have to live with
them. And the younger woman feels the same way
but there isn't really anything that she can do
about it because she can't stay by herself any-
more.

I don't know. An empty boat, maybe someone was
out fishing and they had a heart attack and may-
be they fell out and drowned. No one knows
they're out there. You should never go fishing
by yourself. I think he just got out there, his
boat is not turned over or nothing . . . He

just had a heart attack and fell out of there and
drowned and now they'll have to get some people
out there and search for him because they'll find
his boat and . . . no telling how far away it
happened. I think he's drowned. Maybe his wife,
when he don't come home pretty soon, gets worried
and it'll probably be morning before they can go
out looking for him. When they find him she'll
be real hurt. Be too bad. I think he's drowned
and . . . there's tragedy in that one too.

This looks like the picnics we used to go on and
everyone eats so much that they're miserable and
lay around after. There's grandfather and all the
uncles and there's my husband (laughs) right there
in the middle . . . right there.

That's . . . looks like another bad dream. That's
a farm house . . . another bad dream and the girl
is going to commit suicide. She's just dreaming
of this of course . . . standing on the bridge.
It's night time but the sun is shining. That's
the way it looks to me . . . that's not the moon.
There's a man waiting for her down below. She
doesn't know what to do. If he catches her she's
doomed and if she throws herself over the bridge
she's doomed. I think she throws herself over
the bridge.

This looks like a family to me and it looks to
me like they're worried about the harvest. She's
praying and the man is working the ground. Just
. . . I don't know . . . that's how it looks.
He's working and they're praying. It looks like

there's been a disaster . . . tornado or something.
She is going to church or school. (Q) How it goes
on? I think she gets sick and dies . . . the

lady's that . . . that's praying.

 

 

  

41

The first two stories, told by experimental Es and
scored Pathogenic by both Judge I and Judge II, reflect
the concept of the "imposition of distorted reality“ very
clearly. In each, one person must force herself on the
other although neither gains anything from the relation-
ship. In fact, the implied needs are for some measure of
independence in the context of mature concern but neither
of these needs are met for either person. In the first
story, especially, the paranoid element, in terms of an
external, evaluating agent, is also quite clear.

The next two stories reflect a second theme: anger
toward men. This was a quite common theme in the stories
told by the experimental Es in contrast to the stories
told by the control Es. The third story is rather stark
in nature but the fourth story is more subtle and, in ad-
dition, reflects a very basic schizophrenogenic theme:
the "poisoned milk fantasy" (Karon, 1958). In this story
the men get fed but the food causes "discomfort" suggesting
that the giver (mother) is unable to feed adequately. The
point is that although she goes through the motions of
feeding, the food is poisoned, in some manner again sug-
gesting that the needs of others are not adequately being
met.

The final two stories reflect a theme which will
be returned to again in another connection. In these two

stcuies the feelings of helplessness and progressive

 

42

deterioration are clearly defined. In the fifth story the
girl is "doomed" whether she is caught or not while in the
last story the family is initially merely "worried" about
the harvest although eventually the woman dies. The
present writer feels it is no coincidence that the woman
"that's praying" dies.

Actually, the notion of a "destructive" relation-
ship between a schizophrenogenic mother and her schizo-
phrenic child needs clarification. While further evidence
will be cited later, the above stories suggest to the
present writer that the mother of a schiZOphrenic child
feels as "destroyed" as her child. She has deep-seated
feelings of helplessness and rage and it is this view of
herself and her world, imposed upon her child in order to
confirm her perceptions and expectations, which seems to
form the basis of the "destructive" schizophrenic process.
In other words, these stories would suggest that the mother
of a schizophrenic child sees herself as a victim in a cold
and ungiving world and, as a result, victimizes her schizo-
‘phrenic child by imposing this distorted perception of the
‘world upon him so that she can confirm this view of reality
by watching her child's destruction. Essentially, she
seems to "act out" her view of the world through her child

‘While attempting to deny this View for herself.

 

-__-._._r_-—r._____._ _

43

The present writer derived separate Pathogenic
Scores for each TAT card for each group of mothers by using
the formula P/P+B. Utilizing the 2 x 2 contingency table,
it was found that on three TAT cards (7BM, 12M, and lBGF)
both Judges I and II attributed relatively more Pathogenic
than Benign stories to the experimental Es in contrast to
the control group of Es. These differences were signifi-
cant at the .05 level and beyond.

Generally, the eXperimental mothers' stories pro-
duced to card 7BM reflected more unresolved conflict themes
between the younger man and an authority figure than the
control mothers' stories. On the other hand, while con-
flict was an important theme for the control mothers on
this card, the younger man was usually seen as being able
to listen to the advice of the older man but also able to
maintain the right to make the final decision himself.
Since both Judges attributed significantly higher Patho-
genic Scores to the experimental in contrast to the control
group of Es, on this card, it would appear that father-son
conflict may be a more important theme in the dynamics of
the schizophrenogenic mother than mothers of "normal"
children and might be one that should be explored more
fully in the treatment of the schizophrenogenic mother
and/or her schizophrenic child. Moreover, this point may
.indicate that for many, the treatment of choice would be

fandly, as opposed to individual, therapy.

 

44

Parenthetically, neither Judge I nor Judge II at-
tributed significantly higher Pathogenic Scores to the
experimental mothers in contrast to the control mothers
on either cards 6BM or 7GF. These cards, implying mother-
son and mother-daughter conflicts respectively, elicited
a large number of Pathogenic themes from both groups of
mothers. At this point in time, it would be impossible
to say whether father-son conflict themes are etiologically
important for the schizophrenogenic relationship between
mother and son, or if they simply represent displacement
and/or generalization from more basic mother-son and
mother-daughter conflict themes. Nonetheless, the explora-
tion of father-son conflict themes in the treatment of a
schiZOphrenogenic mother would seem to be particularly
important because the preponderance of this particular
theme in the experimental group's stories produced to card
7BM seems to clearly differentiate between these mothers
and their matched control mothers.

To pursue this notion further. It had been noted
in the review of the literature cited above that the emo-
tional presence of the father seems to ameliorate the
schizophrenic process in his child. The present writer
would be willing to speculate that, in reality, the father's
emotional presence argues against the perception the
schiZOphrenogenic mother has that the world is a cold and

ungiging place, thus ameliorating her pathology directly

45

and the child's only indirectly. On the other hand, it is
no coincidence that schizophrenogenic mothers marry cold
and ungiving men who, by and large, confirm their view

of the world. Furthermore, I would be willing to speculate
that, at an unconscious level, the schizophrenogenic mother
fears that the father is going to destroy both mother and
schizophrenic child and it is this seemingly genuine con-
cern which forces her to keep the one person (father) who
might help away from the child.

A similar analysis of the stories produced to card
12M would offer support for the above considerations and
also offer further support to the notion that mothers of
schiZOphrenic children see the world as less helpful than
mothers of so-called "normal" children. By and large, the
major difference in the stories produced to this card by
the two groups of mothers revolved around the theme that,
although both groups of mothers preceived the figure lying
on the couch as in need of help, experimental Es, signifi-
cantly more often than control Es, perceived the help as
ultimately failing. This theme obviously is related to
the sense of helplessness discussed above. It also seems
to be related to the "poisoned milk fantasy" mentioned
above because in most of the stories of the experimental

Es help was offered but the helper was not successful.

 

46

It should be pointed out at this time that it seems
to the present writer that what often differentiates the
stories told by the control mothers from the stories told
by the experimental mothers is not so much the amount of
pathology or number of conflict themes in the two sets of
stories as it is the strategy employed by the control
mothers in dealing with the pathology and conflicts they
express in their stories. In this connection, the present
writer feels that a new concept: the "tacked on" story,
which will be discussed later in greater detail, will be of
great value in future considerations about the differences
between schizophrenogenic mothers and the mothers of
"normal" children.

As noted above, Judge I attributed significantly
more Pathogenic stories to the experimental in contrast to
the control mothers on cards 9GF and 17GF while Judge II
did not. As Murstein (1963) has shown, cards 9GF and l7GF,
like card 18GF, generally elicit relatively more depressing
themes than many other cards. This seemed to be the case,
on both cards 9GF and 17GF, for both experimental and con-
trol mothers, but Judge I was able to attribute a signifi-
cantly higher Pathogenic Score to the experimental in con-
trast to the control mothers on these two cards while'
Judge II was not. An analysis of the stories told to cards

9GF and l7GF by both groups suggest that a consideration of

 

47

the "tacked-on" story would aid in making a finer differen-
tiation between stories told by the experimental in contrast
to the control mothers. 1

Before considering the notion of the “tacked-on"
story, however, it might be well to summarize the results
cited above. Both Judges I and II were able to differenti-
ate between the experimental and control pairs of mothers
at beyond the .001 level of significance. Nevertheless,
Judges I and II were able to significantly differentiate
between only five and three pairs of mothers respectively,
all differences being in the predicted direction.

In addition, by applying the formula: P/P+B to
each TAT card across both experimental and control Es and
thus deriving two Pathogenic Scores for each card, attri-
buted by each Judge, it was found that Judge I attributed
a significantly higher Pathogenic Score to the experimental
in contrast to the control group of Es on only six cards
(2, 7BM, 9GF, 12M, l7GF and 18GF). Similarly, Judge II
attributed a significantly higher Pathogenic Score to the
experimental in contrast to the control group Es on only
four cards (7BM, 12M, 18BM and 18GF).

Finally, it should be noted that Judge I attributed
a Pathogenic Score of .64 or higher to 16 experimental
mothers and to only three control mothers. It would ap-
pear that, for Judge I, a Pathogenic Score of .64 is the

nmmt economical and efficient cut-off score to best

 

48

differentiate between the experimental and control mothers.
Judge II attributed a Pathogenic Score of .69 or higher to
17 experimental mothers and to only two control mothers.

It would appear that, for Judge II, the most economical

and efficient cut-off score would be .69. It should be
noted that these cut-off scores are similar to those found
in Meyer's (1964) study in which the most efficient cut-off
score for Judge I seemed to be .65 while the most efficient
cut-off score for Judge II seemed to be .57.

An analysis of the 1200 stories, undertaken by the
present writer after the Judges had completed their scoring,
suggested certain very important and hopefully far-reaching
refinements of the scoring system used in this study. These
further refinements, devised in retrospect by the present
writer, at the conclusion of the study, appear in Appendix C.
Specifically, after the study had been completed the present
writer, with knowledge of which mother had told a particular
story and how each Judge had scored the story, reviewed each
story in order to determine if certain scoring considerations
could further differentiate between the two groups of mothers.
It needs to be made very clear that this was an ad hoc inves-
tigation made after the research had been completed and
probably involves a great deal of scorer bias.

It will be remembered that Judges I and II signifi-
cantly differentiated between only five and three pairs of

Inothers respectively. Furthermore, there was considerable

 

49

overlap among the Pathogenic Scores attributed to the two
groups of mothers by both Judges thereby making the use
of the present scoring system at a clinical level on an
individual basis rather risky.

It was the aforementioned review of each story and
the Judges' scoring which led to the present writer's con-
cept of the "tacked-on" story. Essentially, a "tacked-on"
story is a story told to a TAT card in which the major
portion of the story involves a Pathogenic theme but also
in which the mother literally "tacks on" a Benign ending
either on her own initiative or after the single comment
made by E, "And what happens next in your story?" By and
large, both Judges scored these stories Pathogenic, assuming
that such an unsophisticated, obvious ending does not miti-
gate the Pathogenic theme in the story. However, it is the
present writer's contention that consideration of such a
naive, simple-minded ending does, in fact, help to further
differentiate between the two groups of mothers.

Following are ten stories told by control mothers
and scored either Pathogenic or Unscorable by Judge I and/or
Judge II and subsequently re-scored Benign by the present
writer.

1. This looks like a child has been playing very hard.

He is completely exhausted and has fallen asleep.

(Q) So he . . . Well he wakes up and resumes play-

ing. I . . . wait . . . I don't know. Maybe it's

a child who is quite upset. He has completely

given up for the time at least. It looks like he's

at odds with himself or someone else. Later he gets

himself composed . . . and. . . carries on like he
had been.

50

It looks as if this person has had it . . . just
one of those days. She seems very unhappy . . .
as if she's given up and doesn't know which way
to go. (Q) I don't know really. This doesn't
have to happen. She can help herself. Life goes
on . . . it usually does (laughs).

Well this little boy looks like he's been punished
and sent to his room. I suppose he's been crying
and now is very tired . . . just tired out. I
think he goes to sleep on the floor for a while
but he wakes and goes down to play. I think that
by that time everything will be alright.

Another sad one. It looks like she has just seen
an accident . . . maybe someone close to her and
she's crying very bitterly. Maybe they're dead.

I don't know . . . she seems very sad. (Q) Well
she can't go on like that . . . she goes away . . .
maybe with a relative and begins to feel better.

This is a mother and son. And the son had just
told the mother that he wants to get married.

Now the son is the only support of the mother and
she is quite attached to him. And the son wants
to get married and the mother isn't too pleased
with the girl he has chosen. I don't know if it
would be a difference in religion or nationality
or just what, but the mother, in fact . . . the
mother wouldn't like any girl the boy chose. But
from the expression on the mother's face I think
she will accept it in time but it will take her
quite a time to accept that her son is going to
leave her and that she will be alone. But eventually
grandchildren will come along and she will accept
the daughter-in-law.

Well this looks like a young man talking to his
mother. Maybe he's just told her that he's

going to get married or something and . . . She
doesn't look like she's too happy. But he looks
kind of troubled. Maybe he feels he's just hurt
his mother. She looks like she's just turned away
from him. So . . . I imagine he's probably trying

to think of what to say next . . . like he's just
kind of troubled. Maybe he just wants to say the
right thing . . . and . . . that's about all (Q)

Well . . . they might talk it over and maybe he
might compromise and she'll compromise and they'll
work something out . . . and live happily ever
after (laughs).

 

 

51

7. That's a mother and son and the father has just
died. The mother's reaction is quite different
than . . . the mother accepts that as a part of
life but the son is still questioning why. (Q)
The boy will be alright . . . a questioning look
on his face but he is the type that . . . he'll
find the right answer as to why his father died.

8. This is a husband and wife and the husband has
just said in another two months we have to move
to California and the wife is quite surprised
because she didn't realize this was going to hap-
pen. And she doesn't quite know what to think
about it at the moment. It's such a shock to her.
But I think within time, give her a couple of
weeks, and explain it to the children and she'll
say it's a good move because it will further him
in his own business.

9. This is awful. They all seem to be awful. He's
told her something to upset her or arouse her and
he seemed to sCare her. But . . . I don't know
. . . she should be more scared. He's just told
her something quite shocking maybe. (Q) Well I
think it bothers her for a time but . . . but
I think . . . Well I‘m not sure . . . but it will
be alright. I imagine at the time it sounded
shocking but when they talk it over it will be OK.

10. This looks like a mother trying to explain some-
thing to her daughter. Once again there's a far-
away look in her eyes . . . not much of a response.
She's wandering off and not paying much attention
to what mother is saying. She's probably hearing
. . . not complete indifference . . . but kind of
a melancholia. (Q) I would think that she would
probably turn to mother after all.

It should be noted that some of these stories in-
volve help from another person, but some also imply that
the dependent person helps himself. It is the present
writer's contention, however, that if E allows help of any

kind to occur to the dependent individual in her story pro-

duced to a TAT card, this implies a basic trust in the

 

 

52

world which would be contrary to the View of the world
attributed to the schiZOphrenogenic mother in this study.

A particular kind of "tacked-on" story will be
referred to as the "escape" story by the present writer.
Here, a pathological situation is presented to the depen-
dent individual in the story and demands are made of him
but E allows him to escape and later be reconciled with
the seemingly pathological individual in the story. Again,
it is the present writer's contention that if E can allow
the dependent individual to escape the pathological situa-
tion and not be subsequently harmed, this too implies a
basic trust in the world which would be again contrary to
the view attributed to the schizophrenogenic mother in this
study.

Following are five stories told by control mothers
and scored either Pathogenic or Unscorable by Judge I and/or
Judge II but subsequently re-scored Benign by the present
wirter because these were seen as "escape" stories.

1. Seems to be a son and a mother. Perhaps he's told
her that he's going to get married . . . and she's
saying who is going to visit me. And he seems to
have his mind made up that he's going to get married.
She's saying that you don't care anything about me.
It leaves him in a quandary as to what to do. (Q)
I think he decides to go ahead and get married and
brings his wife to visit his mother.

2. This looks like a little old lady and her son and
they seem to be in a hospital room. Something
seems to be wrong . . . or they could be having a

fight (laughs). (Q) They're waiting for something.
If it's a misunderstanding I don't know if he's

53

grown up enough to leave her alone. Or maybe
they're waiting for some news. I don't know what
the outcome would be. I guess it's a misunder-
standing and he has his hat in his hand . . .
like he intends to go right back out. I think
he's old enough to know that it's better off not
to try to argue right away and he decides to go
off and his mother tries to cool off. Later on
will be time enough to take care of the misunder-
standing. And they do eventually (laughs).

3. This is a mother and a son and they're grieved
over some happening. They don't seem to be much
comfort t each other though. Possibly later they
find their own comfort . . . with someone else.
They each find their own help I mean. Or, maybe
later they come to learn to comfort one another.
(Q) Well the son goes away but after a time he
has second feelings. . . he was never really
hostile but he didn't have a very good feeling
either. Well anyway he eventually has a change
of heart and they patch things up.

4. This looks like a mother and son. It looks as if
he still has his hat and coat . . . he just stopped
by to tell her something. Maybe he has to get a
jobéin a distant town and he stopped by to say
goodbye. He waited so long before telling his
mother because he anticipated this reaction. Well
she's hurt and angry but he goes away anyway.
Later, when he invites her to his new home for a
vacation she forgives him.

5. I think he's trying to talk her into something.

She looks frightened . . . but I can't tell about

what. (Q) If it is . . . She might try to get away.

But I think he hurts her and he's found by the

police . . . no . . . I think she escapes and she

calls the police.

A number of further refinements are listed in Ap-
pendix C, some of which will be discussed in greater detail
below. Tables 4 and 5 in Appendix D indicate the results
the present writer found if those changes in re-scoring

which were mentioned above and which will be further de-

scribed below were incorporated into the original results

54

for Judges I and II. For example, Table 4 indicates the
Pathogenic Scores which might have been attributed to the
experimental and control Es by Judges I and II respectively
if they had incorporated the present writer's new scoring
criteria into their scoring. In addition, Table 5 indi—
cates the Pathogenic Scores which might have been attributed
to the TAT cards if the new scoring system had been used by
Judges I and II.

It will be remembered that, under the scoring sys-
tem used in this study, Judge I and Judge II were able to
significantly differentiate between only five and three pairs
of mothers reSpectively. However, under the new scoring
system, Judge I might have been able to significantly dif-
ferentiate between 15 pairs of mothers. By the same token,
Judge II might have been able to significantly differentiate
between 13 pairs of mothers.

Similarly, it will be remembered that Judges I and II
were able to signifiantly differentiate between the experi-
mental and control groups' stories to only six and four TAT
cards respectively. However, under the new scoring system,
Judge I might have been able to significantly differentiate
between the two groups' stories to 15 cards (1, 2, 3BM, 4,
.6BM, 7GF, 8BM, 9GF, 12F, 12M, 13G, 13MF, 17GF and 18GF).

By the same token Judge II might have been able to signifi-
cantly differentiate between the two groups' stories to 13
cards (1, 2, 3BM, 6BM, 7BM, 8BM, 9GF, 12M, 138, 13MF, 17GF,

18BM and 18GF).

55

A number of other themes, listed in Appendix C,
helped the present writer to further refine the scoring
system used in this study. For example, both Judges I
and II usually scored themes of impotence (e.g., inability
to play the violin), helplessness, lonliness and boredom
as intrapsychic themes and thereby unscorable within the
present scoring system. However, the present writer found
that these themes appeared much more frequently in the
stories of the experimental Es in contrast to the control
Es and re-scoring these as Pathogenic even with no other
person involved in the story contributed greatly to the
further differentiation between the two groups of mothers
illustrated in Tables 4 and 5 in Appendix D. The present
wirter's contention, in these cases, is that these themes
are not merely intrapsychic but, rather, imply a basically
impoverished relationship with the environment so that,
essentially, the world is seen as cold and ungiving which
is the view of the world attributed to the schizophrenogenic
mother in this study.

Further refinements were made by the present writer
and are reflected in the data in Tables 4 and 5 in Appendix
D. On card 2, for example, if the theme involves the young
girl's going away to school to be educated even though this
is against her mother's wishes and the conflict is never
resolved, and this story is scored Benign rather than Patho-

genic, a much finer distinction can be made between

56

experimental and control mothers. Essentially this seems
to be a Benign theme of the "escape" theme which the
majority of the schizophrenogenic mothers do not give.
Instead, they usually allow the conflict to remain unre-
solved by having the girl remain on the farm.

Interestingly, on card 4, both experimental and
control mothers often told stories involving a man and
his mistress. In almost every case, for both groups, the
man is perceived as leaving his mistress but, by and large,
only control mothers perceived him as returning to his
wife. Both Judge I and Judge II scored this theme Patho-
genic, but re-scoring this theme as Benign led to a sharper
differentiation between experimental and control Es on this
card. It may be that, on card 4, the experimental mothers
may have identified with the mistress and perceived the
man as simply leaving while the control mothers may have
identified with the absent wife and, therefore, the man's
returning home could be seen as meeting the needs of the
person to whom it is felt he has a greater obligation.

On card 8BM, while eight control mothers told
stories involving the boy's becoming a doctor, only one
experimental mother did so. Although both Judge I and II
assumed these stories to be intrapsychic because no one
else was involved in the boy's success, and therefore
scored these stories Unscorable, the present writer found

much greater differentiation between experimental and

 

 

57

control Es on this card if these stories were scored Benign.
Again, it is the present writer's contention that success
implies a basic trust in the world and is not merely in-
trapsychic.

On card 138, both Judge I and Judge II scored most
stories produced to this card Unscorable since usually no
one else beside the boy in the barn door was mentioned.
However, if all those stories in which the boy "finds some-
thing to do" are scored Benign and all those stories in
which it is stated that the boy "has nothing to do" are
scored Pathogenic, then card 138 would have significantly
differentiated between the two groups of mothers although
it did not do so under the scoring system used in this
study. The reasoning here is that "finding something to
do" in contrast to "having nothing to do" again implies
having a positive relationship with the world.

In summary, under the new scoring system, found in
Appendix C, Judge I might have significantly differentiated
between 15 pairs of mothers instead of five and Judge II
might have significantly differentiated between 13 pairs
of mothers instead of three. In addition, Judge I might
have been able to significantly differentiate between the
experimental and control groups of mothers on 15 TAT cards
instead of on six cards and, likewise, Judge II might have
been able to significantly differentiate between the experi-

mental and control groups of mothers on 13 TAT cards instead

 

58

of on four cards. Finally, it will be remembered that
Judge I attributed a Pathogenic Score of .64 or higher to
16 experimental mothers and to those control mothers. It
seemed that, for Judge I, a Pathogenic Score of .64 was

the most efficient cut-off score for best differentiating
between experimental and control mothers. Judge II attri—
buted a Pathogenic Score of .69 or higher to 17 experimental
mothers and to two control mothers. It appeared that, for
Judge II, the most efficient cut-off score in order to best
differentiate between the experimental and control mothers
was .69.

However, under the new criteria, Judge I might have
attributed a Pathogenic Score of below .50 to only two
experimental mothers and a Pathogenic Score of above .50
to only one control mother. Likewise, Judge II might have
attributed a Pathogenic Score of below .50 to only one ex-
perimental mother and a Pathogenic Score of above .50 to
only two control mothers.

Earlier, the present writer had suggested that what
often seems to differentiate the stories told by the control
mothers from the stories told by experimental mothers is not
so much the amount of pathology or number of conflict themes
in the two sets of stories as it is the strategy employed by
the control mothers in dealing with the pathology and con—

flicts they express in their stories.

59

It might be argued that the "tacked-on" story and
the "escape" story are examples of a defensive strategy.
The motive for the defensive strategy might be seen as
either the ego's response to the possibility of repressed
hostile impulses breaking through, in a Freudian model, or
the sudden realization that E is in a socially evaluative
situation, in a psycho-social model. While the notion of
defense would seem to account for some of the "tacked-on"
and "escape" stories, it is the present writer's opinion
that the concept of defense does not account for the sharp
differences between experimental and control mothers on
themes suchamslonliness, impotence, and the feeling of im-
pending doom.

Instead, it would seem that the control mother dif-
fers from the experimental mother in this study in her at-
titude toward pathology and conflict rather than in the
nature or amount of conflict each reflects in her stories.
The experimental mother, by and large, seems to see the
world as a cold and ungiving place where, and this is most
important, conflicts are only rarely resolved. On the
other hand, the control mother in this study seems able to
fit conflict into a different scheme whereby some resolu-
tion, for the majority's good, can be reached. It is prob-
ably this relatively optimistic view of the world, in con-
trast to the experimental mother's relatively pessimistic
View of the world, which allows the control mother to add

a "tacked-on" or "escape" ending.

6O

Certainly a number of theoretical models can be
used to explain the above but, regardless of personal
preference, the present writer feels that the overwhelming
tone of the control mothers' stories, in contrast to the
experimental mothers' stories, suggests that the notion
of defense is not broad enough to explain the differences
between the two sets of stories and that, instead, an
explanation involving basic trust on the part of the con-
trol mothers would seem to be more adequate.

The present writer has suggested that the schizo-
phrenogenic mother is as much a victim in her world as her
schizophrenic child. There is no doubt that the schizo—
phrenic child can be treated apart from the rest of his
family and there may be times when this would seem to be
the most appropriate course to follow. However, a number
of considerations would seem to suggest that, as far as
possible, the entire family become involved in the treat-
ment. It would seem apparent that for every schizophrenic
child there is a schizophrenogenic family. This means that,
to one degree or another, all members of the family are
suffering and, furthermore, that possibly if the schizo-
phrenic child, or identified patient, is removed from the
family, another child will be chosen in his place. Family
therapy would, in this instance, both offer help to all per-

sons in the family and serve a prophylactic purpose.

61

Family psychotherapy might also serve additional
purposes. For one thing, the father would be involved
and research cited above would suggest that the father
who is emotionally present seems to serve a positive
function within the family.

Regardless of the kind of psychotherapy utilized,
some issues need be emphasized in the treatment of the
schiZOphrenic and/or his family. The first is the dif-
ference between inside and outside or phantasy and reality.
One of the most fundamental tasks for the therapist in
treating the schizophrenic and/or his family would seem
to be to teach the patients to understand what part of
their perceptions is made up of sensations from the out-
side (the real world) and what part is made up of sensa-
tions from the inside (feelings). It is the present
writer's experience that, regardless of the dynamic causes
of losing this discriminating ability, it must be re-
learned.

A second very important issue would seem to be the
feeling of impotence that both schizophrenogenic mother
and schizophrenic child seem to feel. Here, it is the
present writer's experience that the therapist has to work
most diligently to provide ways for the patient to realize

his effectiveness in interpersonal interactions.

62

The present writer has suggested some therapeutic
implications which might seem pertinent as a result of
the present study. However, these are merely implications,
somewhat removed from the data, and certainly need further

research.

SUMMARY

The schiZOphrenogenic mother is seen by several
authors as the primary agent in schizophrenia, either in
a causal or phenomenal manner. Previous studies have.
attempted to assess the concept of the schizophrenogenic
mother through interview techniques and/or data from psy-
chotherapy. However, control groups have generally not
been used and there has been little or no attempt to
quantify results. Other studies have used objective psy-
chological test data and/or attitude scaling techniques
but these techniques make it difficult to differentiate
between real and professed attitudes and do not enable
us to readily see the relationship between attitudes and
behavior.

This study employs the TAT, assuming that the
schizophrenogenesis will be projected into the stories.
The first hypothesis is that mothers of schizophrenics,
more than mothers of normals, will give TAT themes where
the dominant individual will either refuse to meet the
needs of the dependent person or take from the dependent
person whenever their needs conflict. The second hypo—
thesis to be tested is that the differentiation of
mothers of schizophrenics from the mothers of normal Es
is communicable.

63

 

64

Twenty mothers of schizophrenics and twenty mothers
of normals were administered the entire TAT sequence with
the exception of card XVI. Children were matched on the
basis of sex, age, level of education, number of children
in the family and the child's chronological position among
his siblings. In addition, the mothers of the two groups
of children were matched on age, level of education and
social class.

Each individual story was judged as Pathogenic, Un-
scorable or Benign by a judge clinically sophisticaled in
this area and the criteria used were given to a second
judge who attempted to make the same categorizations. A
score was then tabulated for each E from the formula:
Pathogenic/Pathogenic + Benign.

The results led to the following conclusions:

1. Mothers of schizophrenics can be significantly
differentiated from mothers of normals by means

of the TAT.

2. Criteria for classification as pathogenic, or
benign can be communicated as well as formulated.

3. Support for the schiZOphrenogenic mother concept,
whether as a cause or reaction, is indicated.
A duscussion of the research, both from the point
of View of Es and the relative sensitivity of TAT cards
is given as well as some refinements of the scoring sys-
tem and suggestions for the treatment of the schizophrenic

and/or his family.

 

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7O

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APPENDIX A

 

General Criterion.--This involves an interaction between
a dominant and a dependent individual with conflicting
needs, and the dominant individual takes the dependent
individual's needs into account (benign); or does not

take the dependent individual's needs into account (patho-

genic).

Pathogenic themes

 

1. Murder.
2. Boss driving worker hard.

3. Parents make boy study or practise when he doesn't
want to.

4. Mother supposedly being kind, but not meeting ex-
pressed needs of child.

5. Mother showing particularity for one daughter over
another.

6. Any kind of talking-to as a form of punishment.

7. Mother warning child of all the things that can happen
to him when he grows up.

8. Mother telling child he hasn't worked up to ability.
9. Subordinate who gives someone heck and loses job.
10. Husband gives wife news he is leaving town (or her).
11. Spying on girl friend or being stood up.

12. Monster ready to attack smaller animal (animal=person).

73

13.

14.

15.

l6.

17.

18.
19.
20.

21.

22.

23.
24.
25.
26.
27.
28.

29.

30.
31.

74
Man telling wife something to hurt her, e.g., took
secretary to dinner.
Happy old witch and pretty younger woman.

Mother reading child from Bible to teach her a
lesson.

Woman and evil conscience; devil behind her; etc.

Mother feels what she has said to daughter hasn't
done much good.

Husband interrupts TV show wife is interested in.
Nasty remarks to a subordinate, making her unhappy.
King leading nation to ruin.

Mother doesn't like daughter's (looks, make-up,
attitude, etc.) even though daughter likes it.

Refusal of marriage bid; he's interested, she's
not; etc.

Mother checking up on son (study, etc.).
Destructive witch themes.

Family "ruled" or "dominated."

Husband or father jealous or forbidding.
Woman harming child by punishment.
Suicide attempt to frighten someone.

Man pulling out of extra-marital affair, and she
doesn't want him to.

Losing interest in playing the violin.

Going to the cemetary to scare people.

75

Neutral themes

7.

No interaction between two people, though somewhat
conflicting needs.

One person enjoying himself.

No peOple or living things.

Two people; but no indication of interaction.
Conflict with person's own needs, not other peOple's.
Thinking about a mother who was kind to her.

Wanting to join a dead person--an intrapsychic problem.

Benign themes

1.

10.
ll.
12.

13.

Parents force child to do something (study); he is
unhappy and they change.

Teacher consoling a problem child; helping a gifted
child.

Guides leading animals (llamas) across difficult area.
Reunion of two people--both people pleased.

Person springing a pleasant surprise on another one.
Parent interrupts punishment by another one.

Stopping children from activity in which they would
be likely to get hurt.

Woman trying to console man in trouble.

Father and daughter consoling each other after death
of mother.

Helping people at a disaster.
Son or daughter interested in advice from parent.
Woman working hard for benefit of her children.

Mother thinking about children, and is happy.

14.

15.

16.

17.

18.

19.

76
Accepted proposal or protestation of love, or
evidence of mutual love.

Mother admiring work of children or making some-
thing they will like.

Man heeds woman's wish not to leave.

Any attempt to help with no ulterior motive;
(or comfort).

Prevention of disaster (suicide, murder, etc.).

Mother enlightening child about the birds and the
bees.

APPENDIX B

 

Pathogenic themes

11.
12.

13.

14.

15.
16.
17.
18.

19.

Exploitation.
Talking down to son.

Evil man praying to God for forgiveness but not for-
given.

Alligator poisonous and kills.

Mother putting child out for adoption.
Boy shoots father for beating mother.
Hypnotizing in order to harm.

Drunk mother; boy wants to help but doesn't know
what to do.

Parents lecture and frighten child to be good.
Wife rejects husband.

Separated, leads to suicide.

Minister prays but doesn't help.

Surgery without anesthesia and without emphasis on
helping.

Mother doesn't approve of education of daughter and
father doesn't have time for anything but work.

Woman rejected or shut out.
Scared to call police because they'll think he did it.
Wife pulling husband's hair.
Implication that surgery is doing harm to the patient.

Unhappy over taking care of an unborn child.

77

20.

21.

22.

23.
24.
25.
26.

27.

28.

29.
30.
31.
32.
33.
34.

35.

78
Child must solve family's problems (presumably
because adults don't).
A monster waiting for you in the dark.

Conflict and there is change in the benign direction
but the change occurs on3y after the passage of time.

"No one cares for her."

Dungen themes.

Slave and boss themes.

Doctor or policeman telling man bad news.

One person did something wrong and another person
will go back and tell.

Boss trying to get person to do something he doesn't
what to do.

Father molests daughter.

Ghost laughing at you.

Evil influence claiming a soul.

Quack doctor or hypnotist.

Mother telling daughter she is too old for dolls.
Mother running away from children.

Child sure of parents' needs but parents not sure
of child's needs.

Neutral themes

Thinking about playing the violin.

Being a doctor or becoming a doctor without mentioning
helping anybody.

Performer performing without mentioning the audience.
Insufficient detail.

Lonliness, unless other persons are more directly
involved.

79

Benign themes

10.

ll.

12.
13.
14.

15.

16.

Son is worried and father helps him make a decision
but won't make it for him.

Teacher happy with her children.

Woman looking forward to the work of taking care of an
infant (or a family).

Older couple fond of each other.

A mother, even though it reflects on her, seeking help
for her child at the Child Guidance Clinic.

Father giving approval to son.

Performer making audience happy or audience making
performer happy.

Priest gives last rites to man and man feels relieved
(although man may still die).

Children married or graduated from college and parents

embracing each other and saying what a good job they
have done.

Becoming a surgeon (or missionary) to help people.

‘Wife bringing lunch to husband (although she must wait
until his work is finished).

Family picnic that's fun.
Preparing dinner for family.

Husband wants to help; wife restrains him for his own
good but husband goes anyway and helps.

Child asks for help with the presumption that he'll
get it.

Someone is hurt or frightened by someone and someone

else then offers help where the aggressor is not the
hero of the story.

APPENDIX C

 

Pathogenic themes

1.

10.

ll.

Impotence as a theme where the hero "can't or is
"bored."

"Ignoring" or having "no interest" where it's
specifically stated.

"Despendency" specifically stated.

"Lonliness" whether another person is involved or not.
Man leaves a woman and this is end of the story.
Something is missing and the woman doesn't find it.
"Escape" story with no attempt at reconcilation. Boy
simply leaves mother; no reconciliation or mention of

personal growth.

Specifically stating a wish for a better life without
mentioning any possibility of its being attained.

Specifically stating that there is "nothing between"
two characters.

Not reaching goal specifically stated.

Thinking about suicide with~no mention of the possibility
of help.

Benign themes

 

"Tack on ending" mitigates previous pathogenic themes.

"Escape" story with subsequent reconciliation, or personal
growth.

Person able to help self although others do not.

80

10.

81

Man leaves mistress and returns to wife.

Boy becomes successful doctor by his own efforts and
without mention of anyone helping him, or his helping
anyone.

"Finding something to do" specifically stated.

Getting to the top and having a good feeling although
no one else may be in the story.

Wife dies and is specifically stated that husband and
children "carry on.“

Boy is happy about prospects of going to camp or taking
a trip although no one else is mentioned in the story.

Person feels good after looking out window although no
one else is mentioned in the story; but must feel good
as a result of looking out the window.

APPENDIX D

 

Table 4.--Pathogenic scores attributed to individual experi-
mental and control subjects under new scoring system

 

 

 

 

 

 

 

 

Judge I Judge II
Experimental Control Experimental Control
E Subjects Subjects Subjects Subjects
1 .60 .20 .67 .27
2 .80 .40 .90 .48
3 .83 .48 .77 .63
4 .55 .29 .63 .25
5 .71 .50 .79 .41
6 .41 .26 .48 .29
7 .72 .31 .70 .21
8 .67 .18 .75 .21
9 .43 .14 .56 .13
10 .71 .38 .76 .45
11 .78 .41 .76 .50
12 .81 .63 .86 .72
13 .59 .48 .71 .39
14 .65 .22 .67 .28
15 .56 .16 .62 .17
16 .70 .14 .71 .17
17 .73 .17 .85 .28
18 .71 .16 .73 .17
19 .54 .26 .67 .28
20 .85 .19 .88 .28

 

82

83

Table 5.--Pathogenic scores calculated for each TAT under
new scoring system

 

 

 

 

 

Judge I Judge II
Experimental Control Experimental Control
Card Subjects Subjects Subjects Subjects
1 .84 .50 .93 .43
2 .61 .09 .62 .08
38M .85 .21 .89 .19
3GF .64 .26 .67 .29
4 .66 .34 .67 .44
5 .78 .61 .94 .80
68M .82 .34 .84 .29
6GF .39 .34 .40 .25
78M .62 .18 .63 .07
7GF .67 .34 .65 .44
88M .66 .24 .81 .22
86F .65 .32 .61 .44
98M .50 .45 .81 .50
9GF .72 .26 .79 .33
10 .08 .18 .06 .19
11 .83 .75 .92 .81
128G .19 .12 .31 .00
12F .72 .50 .79 .53
12M .68 .39 .93 .43
138 .50 .21 .65 .07
13G .50 .11 .46 .08
13MF .82 .50 .94 .39
14 .42 .18 .36 .23
15 .82 .54 .86 .58
178M .46 .18 .36 .15
17GF .91 .17 1.00 .08
188M .66 .47 .83 .53
lBGF .72 .18 .79 .32
19 .50 .50 .75 .17
20 .68 .50 1.00 .50

 

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