A PROJECTWE STUDY C‘F BYNAMSC FACE-RS LN AUEMPTED SUECEDE Thesis for the Degree of Ph. D. MICHIGAN STATE UNWERSITY ROBERTA BURRAGE VOGEL 1967 LIBRARy THESIS Niciubau state WM University / 3 1293 10456 2677 ll/I/llllllllllll/II/ll/ll////I/I//I//////I///I///I//I This is to certify that the thesis entitled A Projective Study of Dynamic Factors in Attempted Suicide presented by Roberta Burrage Vogel has been accepted towards fulfillment of the '”‘"“‘ ' ' Ph.D. \ ABSTRACT A PROJECTIVE STUDY OF DYNAMIC FACTORS IN ATTEMPTED SUICIDE By Roberta Burrage Vogel Abstract of a Doctoral Thesis Completed Spring Term, 1967. Twenty male depressives who had made a previous sui- cide attempt and 20 male non-suicidal depressives, all in- patients, were compared with regard to the types of responses which they gave to projective cards having hostile, depressive and ambiguous stimulus values. Ten cards were administered along with a personality questionnaire consisting of 5 Minnesota Multiphasic Personality Inventory subscales (De- pression, Hostility, Psychasthenia, Dominance, and Depend— ency) and one subscale from the Edwards Personal Preference Schedule (need-Abasement). A family data questionnaire was administered as a means of surveying some social characteris- tics of the present sample. It was expected that suicide- attempt subjects would give fewer overtly hostile responses to hostile cards, more suicide themes to ambiguous cards, and more pessimistic outcomes to stories. They were also expected to see others as being involved in the thematic hero's misfortunes more frequently than the non-suicidal depressives. jects gave subjects, index of h for one of tions of 51 to ambiguow card. As; nificantly pressive c cide reSpo compared. highex: scc Th tility res Content a; to Predict hOStile re An index c Puted and Suicide-a1 0n the 1m one of the prediCtior Plight Was Predicted, Roberta Burrage VOgel On the projective test, the suicide-attempt sub- jects gave fewer pessimistic responses than the control subjects, contrary to predictions. The group means on an index of hOpelessness-pessimism were significantly different for one of the projective pictures. The frequency distribu- tions of suicidal types of responses given by the two groups to ambiguous stimuli were significantly different for one card. As predicted, the suicide-attempt subjects gave sig- nificantly more overtly suicidal responses than did the de- pressive control group. An index of the overtness of sui- cide responses was computed for each group and the means compared. The suicide attempt group received a significantly higher score than did the depressive control group. The difference in the frequency distributions of hos- tility responses given by the two groups to cards with hostile content approached significance on one of the cards. Contrary to predictions, the suicide-attempt group gave more overtly hostile responses than did the depressive control group. An index of the overtness of hostility responses was com- puted and the means of the two groups compared. Again the suicide-attempt group received significantly higher scores on the index of the overtness of hostility responses, for one of the projective cards. This finding is contrary to predictions. An index of outside involvement in the hero's plight was computed and the two group means compared. As predicted, the suicide attempt group received a significantly Roberta Burrage ngel higher score on the index of outside involvement than the control subjects. The suicide-attempt subjects entertained more sui- cide fantasies in which suicide or a suicide attempt actu- ally takes place. Also, these persons more often saw others as being involved in some way in the occurrence of the hero's misfortunes. It is further suggested that the suicidal de- pressives may experience more conscious hostile fantasies than the depressives who have never made a suicide attempt nor seriously considered suicide as a solution to problems. The suicidal depressives seem to be expressing anger at others through the suicide act. Hopelessness about the future may not be a critical factor in the occurrence of attempted suicide. However, hostility, suicidal fantasies, and the perception of outside involvements do seem to differentiate the groups of subjects in the present sample. There were no significant differences between the means of the two groups of subjects on any of the personality subscales. These findings are inconclusive and the need for further research using such instruments is indicated. Additional findings showed that the social charac- teristics of the suicide attempt group closely resembled those characteristics of other samples of suicide-attempt subjects previously investigated. The mean age for both suicide attempt subjects and non-suicidal depressives was 43.2 rie< wor} the] the rele and vide vmumm Roberta Burrage Vogel 43.3 years. Most of the subjects in both groups were mar- ried, lived at home with their wives and children, and worked at skilled or unskilled jobs. Additional research is indicated as a means of fur- ther investigating the utility of projective materials for the assessment of suicidal intent. Studies to bear out the .relationship found here between hostility, suicidal fantasy, and the occurrence of attempted suicide is also indicated. Follow-up studies using the present sample would pro- vide data about any further suicidal behavior of the subjects. Thesis Committee: Approved:/éé:;%Z:::Cfi§f€::gii;“‘\_‘ Bertram P. Karon, Chairman Committee ’irman John R. Hurley Bill L. Kell Albert I. Rabin Date: JZ§:ld, 1965).. The probability is that the actual number is at least one-fourth to one-third higher than is recorded. Social Characteristics of the Suicidal Person Farberow and Shneidman (1961) noted a number of social factors related to the incidence of suicide and attempted suicide. They found that men commit suicide more often than they attempt it, and they are successful in their attempts more often than women are. Caucasians commit suicide pro- portionately more than any other group. Of those persons who do succeed, the age range within which the highest num- ber occurs is the range from 30-69 years; the modal age is 42. Numerically, more married than unmarried men commit suicide; but the rate for single, separated, and divorced men is considerably higher. Divorced, separated, and widowed men commit suicide as often as they attempt it. Of those persons who do succeed, over 80% have tried or threatened suicide before (Banen, 1954; Farberow & Shneidman, 1961; Stengel, 1964). The person who commits suicide would most likely be male, caucasian, about 42 years old, married, and a skilled or unskilled worker. He would probably have talked about suicide sometime prior to his act or made one or more previous attempts. He would probably live at home with his wife and give as the reason for his act, ill health, depres- sion, or marital difficulties. Theoretical Approaches to Suicide Psychoanalytic theory, as expressed by Alexander (1929), stresses the existence of externally focused destruc- tive tendencies, the original aim of which has been redirected against the self. The fact that external reality puts a check upon the overt expression of hostile wishes makes some re- focusing necessary. Menninger (1933) hypothesizes that sui- cidal individuals maintain a "belief in some kind of future life more endurable than this present life" (1933, p. 18). He also states that the act of suicide may have any of three distinct kinds of elements: the wish to kill, the wish to be killed, and the wish to die. The wish to kill as a basis of suicide is roughly synonymous with the kind of aggression- turned-inward discussed above by Alexander (1929). Addition- ally, Freud has referred to suicides as being disguised mur- ders--the death penalty is self-inflicted as a result of re- pressed hostile wishes directed at others (Menninger, 1933). The wish to be killed refers to the notion that the act of aggression against the self is also one of atonement for guilt or feelings of guilt. The wish to die refers to the instance where the person entertains the conception of death as a going away with a possible future returning. Thus, suicidal behavior, referring to both those attempts which do not actually result in death as well as those which do, is usually interpreted in one of three ways. It may be viewed as the result of an underlying wish to kill, where the individual acts out aggressive and hostile impulses ‘which he is unable to direct against persons in the environ- ment. Consequently, he turns them back upon himself. Sui- cide may also be interpreted as the result of a wish to be killed, where the person feels guilt-ridden because of actual or imagined wrongs he has committed and kills him- self as a means of atoning for the wrongs he feels he has doneu Finally, suicide may be interpreted as the result of the individual's wish to go away and to return at some future time or to be reunited with a dead loved one. In the last two conceptions, the important aspects are the person's inability to tolerate guilt feelings and his wish for a better life. In the first conception, the assumption is that the person is primarily angry at others; and although the act is one of self-inflicted pafln, the basis for it is a desire to cause hurt and pain to someone outside of the self. And in an indirect way, the suicidal act may still serve to achieve this basic aim. Suicide as Revenge Closely related to these views, but not identical, is the idea that suicide is essentially revenge. Hendin (1963) investigated 100 consecutive admissions of suicidal patients to Bellevue Hospital and found that one of the major dynamic factors surrounding these suicide attempts was the perception by the patients of death as retroflex murder or an attempt at revenge brought on by anger at someone else. The notion that suicide is often used by peOple as a means of revenge is not a new one. AnthrOpologists have noted the occurrence of the phenomenon in other cultural groups as .‘well. Malinowski (1929) wrote of his observations of the natives of the Trobriand Islands and how an islander might deal with an insult or injury done him by an enemy by diving Iheadrfirst from a tall tree, to his death. In Japan, commit— 'ting suicide at the doorstep of an enemy is one very often used means of saving face. The Kamikazes were one such example. In Dobuan society, which is extremely hostile in overt be- havior, the natives customarily express anger and resentment by attempting suicide (Hirsh, 1960). Ansbacher and Ansbacher (1956) describe the suicidal act as one which is calculated to attract general attention to the person committing the act. Furthermore, they state that such an attack, supposedly directed only against the self,is really "...an attack against (the) nearest and more distant environment...for the purpose of hurting others" (p. 165-168). Oskow noted that "...(suicidal) behavior is considered to be aggression directed against the self be- cause it is clear that the patient does to himself what...he wants to do to others" (Hirsh, 1960, p. 279). An analysis of such behavior seems to show an inhibi- tion of hostile and angry feelings which prevents their ex- pression outward. The suicidal person seems less able to express such feelings through behavior that affects the en- vironment in a more direct way. At the same time, the need or desire to hurt others or in some way lash out angrily still exists. The answer is to find a way of achieving such an effect while not appearing to have such an aim. Self- inflicted pain seems quite different from pain that is in- flicted upon others. The only other choice would be no ex- pression of the anger at all. Assuming that the individual does possess angry feelings, some indication of their exist- ence should be seen. If the outward expression of anger is inhibited, then the expression of self-directed anger in the form of self-inflicted pain may in some way serve a similar purpose as would outwardly-directed anger or pain inflicted on others. "Suicide may best be understood as an aggressive retaliatory act towards significant figures in the patient's present life...the primary motivating fantasy includes the wish to hurt someone else and the belief that suicide will accomplish this end" (Karon, 1964, p. 207). The act, though directed against the self, is distinctly one which is calculated to affect the environment. "A psychodynamic examination of at- tempted suicide cannot ignore the interpersonal aspects of the act..." (Stengel, 1964, p. 97). Alfred Adler (1958) also noted that "the 'other' is probably never lacking (and) usually it is the one who suffers most by the suicide" (p. 59). Alfred Adler once stressed that the suicidal person usually depends upon strong support from others and tends to be very demanding that others fulfill his wishes. "...The threat of suicide will usually terrorize (the) environment into compliance with (these) wishes...(and if this fails) he may in his rage and in revenge go so far as to attempt or commit suicide. He expects the particular person involved to be shattered by this act, and suffer guilt for not having acceded to his wishes" (Adler, K., 1961, p. 59). K. Adler 'uses this framework as the basis for dealing with the attempted suicide in therapy. He treats the act as a definitely insidi- ous and."vengefu1 device filled with rage" (Adler, K., 1961, 1;. 66). Thus, actual or attempted suicide may be thought of as an act of revenge against those whom the actor sees as not having satisfied some wish (Ansbacher & Ansbacher, 1956; Adler, K., 1961). Furthermore, he seems to accomplish his aim of punishment by inducing in others a feeling of guilt and responsibility for the occurrence of the act (Hirsh, 1960). The Hopelessness Component in Suicide In addition to the suicidal person's inability to tolerate or admit his own destructive tendencies against others, he often consciously feels deSpair and hopelessness. Karon (1964) notes that "the affect of hopelessness is fre- quently present, but is not in itself a necessary or suffi- cient condition for suicide; however, its obverse--a strong hope of attaining an important goal through 1iving--seems to preclude suicide" (p. 207). The perspective of the person who contemplates suicide is so diminished that "the past seems forgotten and the future is unimaginable," only adding to the feeling of gloom and hOpelessness (Klugman, EE_E£" 1965, p. 44). In addition,his "..uview of the present is rigidly confined to a small number of alternative behaviors of which suicide is one" (Klugman, et_al., 1965, p. 44). Yet, the person contemplating suicide may be in- tensely ambivalent about dying, per se. Although he tells others about his intentions, he may also have a genuine wish to die and be rid of his troubles. He often has a rather dinlview of the future, consciously, but because of his ob- *vious ambivalence regarding his own death, an underlying uncertainty about the future may also be present. The Depressive Component in Suicide The person who attempts or commits suicide is almost always depressed, yet the person who feels depressed may or may not consider suicide as a solution to his difficulties. Dorpat and Ripley (1960) studied 114 suicides in the Seattle area and all of these persons had evidence of depression. But, as Hendin (1963) notes, "...many depressed people are just not suicidal...(indicating that) the psychodynamics of depression are not sufficient to exPlain suicide..." (p. 236). Consequently, before depressive symptoms can have any kind of predictive value in relation to suicide, "...they must have an unequivocal meaning and indicate a distinct set of dynamics directed Specifically toward suicide" (Kobler & Stotland, 1964, p. 4). The symptom of depression may have an entirely different dynamic significance for suicidal pa- tients than it has for other patients, who also show depres- sion but who have not made an attempt at suicide. One impor- tant aspect of a study of suicide should be an attempt to differentiate between depressive persons who do try suicide and depressive persons who do not, even though the depressive symptom is none the less evident. The dangerous suicidal person seems to be one who tuas experienced some disappointments and dissatisfactions in Iris life and is angry at others within the environment yet unable to eXpress such anger outwardly. He is often unable 1x3 even verbalize this anger or admit its existence. He feels depression, hopelessness, and despair regarding the outcome of the state he is in and sees suicide as a way out. CHAPTER II HYPOTHESES Relationship of Hostility to Suicide Existing research data have shown that the suicidal individual, here defined as a person who has made at least one actual attempt at taking his life, is often one who has difficulty accepting his own hostile impulses. Farberow (1950) attempted to reconstruct personality characteristics of suicidal subjects through the administration of a series of tests, including the Rosensweig Picture-Frustration (P-F) Test, the Minnesota Multiphasic Personality Inventory (MMPI), and the Make-A-Picture-Story (MAPS) Test. On the MMPI, the suicidal subjects who made serious attempts or threats re- sponded more hostilely than the patients who seemed less serious in their attempts or threats, and control subjects. However, both suicidal attempt groups (with serious and non- serious intent) and the more serious threat group responded to hostility on the Rosensweig P-F test by being less extro- punitive than controls. Additionally, the serious threat and.attempt subjects responded in a more hostile manner, lnentioned suicide as a theme in stories (MAPS) more fre- <;uently, and were less likely to verbalize hostility Openly. Holzberg, Cohen, and Wilk (1951) studied a patient vflu: committed suicide only three days after testing was completed. 10 11 His responses to a variety of personality tests indicated extreme dependency on family, a denial of aggression or ag- gression turned inward, and depressive guilt reactions with regard to relationships with people. Winfield and Sparer (1953), in a study using Rosensweig's P-F Test, found that suicidals and normals did not differ on intrOpunitiveness, but that the suicidal subjects reSponded significantly less extrOpunitively and significantly more impunitively than did the non-suicidal subjects. These results were roughly sup- ported in the study above by Farberow (1950), also using the same test. The present study is a further attempt to investigate the relationship between the expression of hostility and the occurrence (If attempted suicide. Previous research and theory seem to suggest that persons who make suicide attempts tend to react to hostile and aggressive content of test ma- terials by either denying the hostile content or by giving intrOpunitive responses. In the present investigation, pro- jective materials were presented to subjects in the form of a thematic apperception test, as a means of examining this observed relationship between anger or hostility and suicide. Hypothesis I. Suicidal subjects as Opposed to con- trol subjects will be characterized by lessened ability for (avert expression of feelings of anger and hostility. In- stead, they will tend to deny hostility or turn anger and hostility inward. Q __'.____i Hogelessnes Ka‘ of) suicide" H trol subjects ness and des; kind of hopei They Will pr, control subje Ste: eXisting in : warning to 5‘ ply a kind 0: (Jensen & Pe‘ willing to C‘ that they art retms’pectiVt People who Cc 91v en a warnj p. 85)‘ Dor; Suicides inve tne intent , o 12 Hopelessness Aspect of Suicide Karon (1964) has noted that the perception of the patient that there is "...strong hope of attaining an impor- tant goal through living...seems to preclude (the occurrence of) suicide" (p. 207). Hypothesis II. Suicidal subjects as opposed to con- trol subjects will be characterized by feelings of hOpeless- ness and despair. They will be less able to envision any kind of hOpeful solution to their problems at any future time. They will present a more pessimistic outlook on life than the control subjects. Perception of Suicide as a Possible Solution to Problems Stengel (1956), has noted the "social element" existing in suicide attempts. The person tends to give some warning to someone, to move toward others in ways which im- ply a kind of appeal to others as well as a powerful threat (Jensen & Petty, 1958). Suicidal persons thus tend to be willing to communicate in some way, more or less clearly, that they are thinking of killing themselves. "...Careful retrospective inquiry reveals that the large majority of peOple who commit suicidal acts, fatal and non-fatal, have given a warning of their intention to do so" (Stengel, 1964, p. 85). Dorpat and Ripley (1960) found that of 114 actual suicides investigated by them,83% had previously communicated the intent, one-third by previous attempts. Farberow (1950) 13 has observed that the more often suicide is mentioned by a patient, either casually or as a recurring theme, the more cautious one must be with such patients, for these are the ones who might well successfully commit suicide. Hypothesis III. Suicidal subjects as Opposed to con- trol subjects will be more often characterized by the per- ception of suicide as a possible solution to problems. They will consciously engage in ideas of suicide and will be will- ing to communicate such ideas to others. Correlative Personalitnyeasures An attempt will be made to determine through the use of a personality questionnaire, the relationship between suicide and other personality characteristics. These measures will also provide data regarding the role of hostility in attempted suicide, as measured by the questionnaire method. These measures consist of 5 subscales from the Min- nesota Multiphasic Personality Inventory and 1 subscale from the Edwards Personal Preference Schedule. The scales used are intended to measure the characteristics of hostility, depression, dominance, dependency, and guilt or self-abasement. The scales eXpected to differentiate between the sui- cidal and control groups are hostility and a combined measure of depression along with psychasthenia, a scale dealing pri- marily with feelings of blame in conjunction with a kind of irritability and restless agitation. The psychasthenia scale is commonly associated with obsessive-compulsive symptoms, l4 often seen as defensive against underlying anger. Simon and Hales (1949) used the MMPI to assess possible differences between suicidal and non-suicidal subjects. They found that while the depression measure alone was not effective in dif- ferentiating between the two groups used in their investiga- tion, when high scores on the depression scale were combined with high scores on psychasthenia, a significant difference was obtained. Dominance and dependency are not seen as the most crucial variables surrounding the suicidal act, while measures of hostility and anger are expected to be Of much more significance in differentiating between those de- pressed and disturbed persons who do make attempts and those who do not. Hypothesis IV. Suicidal subjects as Opposed to con- trol subjects will receive significantly higher scores on a measure of hostility. Hypothesis V. Suicidal subjects as Opposed to con- trol subjects will receive significantly higher scores on a combined measure Of depression-psychasthenia. Hypothesis VI. Suicidal subjects as opposed to con- trol subjects will receive significantly higher scores on a measure Of self-abasement or guilt, as one index of the tend- ency to turn hostile impulses back upon the self. Social Characteristics and Familnyackground Additional factors which may be Of diagnostic sig- nificance for suicidal as Opposed to non-suicidal subjects 15 may be found in family history and social data. Surveys have shown that in some instances, there were previous cases of suicide in the family of a person who committed suicide (Reitman, 1942). Other research data (Bruhn, 1962) point to the possible significance of the loss through death, deser- tion, or divorce, of one or both parents early in the pa- tient's life. A survey of the social characteristics of the sui- cidal sample used in the present study will be made. These results will be compared with the rates found in previous studies (Farberow & Shneidman, 1961; Stengel, 1964). These and other facts regarding family history may or may not pro- vide some notions about the environmental and experiential correlates involved in the life Of the person who seeks sui- cide as an answer to his problems. CHAPTER III METHOD Subjects: All of the subjects used in the present study were seen while they were in-patients at various treatment cen- ters. A careful examination was made of clinical records and patient lists. All patients in both samples were male caucasians. NO patient was seen whose last hospitalization was continuous for more than one year. In the case of the suicide sample (those who made a suicide attempt), the last hospitalization was almost always precipitated by the sui- cide attempt. The average time interval between the attempt and the administration of the tests was approximately two months, with a range from about four days to seven months. Suicidal patients were selected on the basis of their suicide attempt and an effort was made to select a control group, as comparable as possible with regard to marital status, approxi- mate age, and diagnosis (psychotic vs. non-psychotic). A patient was classified as psychotic if he had been diagnosed psychotic by the physician or diagnostician in charge and,in addition, if he exhibited one or all of the following: irra- tional behaviors which brought him to the attention of others; disorientation with regard to time or place; delusional, with- drawn and preoccupied behavior; and hallucinations. A patient 16 17 was classified as non-psychotic if he had been given a non- psychotic diagnosis by the physician or diagnostician in charge and in addition, exhibited the following: no gross disorientations in time or place, no psychotic delusions or hallucinations, no serious thought impairment. No subject was used who was suspected of having brain damage or mental retardation. The suicidal patients were those who had made an actual suicide attempt. The non-suicidal or control pa— tients were those who had never made a suicide attempt and who reported having no suicidal ideations or serious thoughts about suicide. All the subjects tested had depression as one aspect of the entire symptomatology, Often with de- pression as a major part of the clinical picture (see Appen- dix A). Depression is here defined as the expression and communication of feelings and affects Of dejection, emo- tional depression, despondency, and general unhappiness. One purpose of the present study is the investigation of some possible differential personality variables which may exist between those depressed persons who do attempt sui- cide and those who do not consider suicide as a way out. As previously mentioned, Hendin (1963) Observed that "... many depressed patients are just not suicidal. This alone would emphasize that the psychodynamics of depression are not sufficient to explain suicide..." (p. 236). l8 Suicidal-Attempt Group (I): The suicide group in— cluded persons who made superficial attempts (e.g., slash— ings Of the wrists) as well as those who made very serious attempts (e.g., attempts which may be seen as aborted suc- cessful suicides, such as in the case of one patient who actually hanged himself but was cut down). Stengel (1964) has noted that the motives and causes underlying suicide attempts are in essence the same as those Of suicide (p. 97). Although in some cases of attempted suicide the method used would almost insure death, while in others very little dan- ger to the persons' life is ever present, "...there is reason to believe that the impact they make on other peOple plays a part in the motivation Of all suicidal acts, even if a fatal outcome is felt to be certain" (Stengel, 1964, p. 103). Consequently, no attempt was made to deal sepa- rately with those suicidal acts termed potentially lethal apart from less serious acts of suicide. All subjects who made some kind Of suicide attempt were included in the suicide-attempt group. The suicidal-attempt group (Group I) consisted of men who had expressed feelings of dejection, emotional depression, despondency and general unhappiness and who also had made a recent suicide attempt of some kind, ranging from very serious to more superficial attempts. Group I included both psychotic and non-psychotic patients 19 whose diagnostic and clinical pictures showed depression as part of the entire symptomatology. Group I consisted of 6 subjects diagnosed psychotic and 14 diagnosed neurotic or non-psychotic. The mean age was 43.3 years (range = 18-64 years). In Group I, 13 subjects were married. The total N for Group I = 20 (see Table 1). Control Group (II): This group consisted of men who had expressed feelings of dejection, emotional depres- sion, despondency, and general unhappiness, yet who had never made a suicide attempt and reported having no sui- cidal ideations or serious thoughts about suicide. Group II also included both psychotic and non—psychotic patients whose diagnostic and clinical pictures showed depression as part of the entire symptomatology. Group II consisted of 7 subjects dianosed psychotic and 13 diagnosed neurotic or non-psychotic. The mean age was 43.35 years (range = 25—54 years). In Group II, 14 subjects were married. The total N for Group II = 20 (see Table 1). Table 1. Age, Marital Status, and Diagnosis of Subjects in Groups I and II. Group Age Marital Status Diagnosis ‘Ps - NOn-PSy- Mean Range S M Sep. D W cho¥ic chotic I 43.3) 18-64 3 11 2 3 l 6 14 II 43.35 25-54 1 12 2 5 o 7 i3 20 Instruments Three kinds of data were collected: 1. Projective test data. The attempt was to deter- mine through an indirect method some of the possible dynamic factors in the individual's personality make-up which may be related to the phenomenon of attempted suicide. 2. Personality questionnaire data. The attempt was to investigate other personality characteristics of the sub- jects which may be of relevance to the present study. 3. Family history and socio-economic data were collected as a means of surveying social, environmental, and experiential variables. These data were Obtained from the subjects and supplemented by the clinical case history data. Projective Test A set of ten pictures was devised as a means of investigating particular kinds of conflicts, affects and drives within the personality structure of the subjects. A preliminary set Of 15 pictures was selected for use in the study. Some of these pictures were taken from the Murray (1943) Thematic Apperception Test (TAT), while others were drawn by an artist from instructions as to the desired content. All of the main figures depicted were male, except for one somewhat ambiguous figure which could have been male or female. As far as possible, the scenes pictured were devised in such a way that they might 21 instigate such affect, drive or conflict areas as hostility and anger, depression and suicide. The pictures used in- cluded cards 3BM, 3GF, 20 and 14 of the TAT in the original form. Other TAT cards (18GF, 18BM, 15, 12M, l7GF) were changed so that all the figures were males and so that the picture could be seen as more clearly depicting the desired affect content. The remaining 6 cards were drawn by an artist from written descriptions and changed as needed to suit the purposes of the study. An attempt was made to specify the amount of ambiguity present in the cards and the affective content of the various pictures (Forer, Rabin, Goldstein, and Lesser, 1961). A list of words descriptive of different kinds of affects which the cards might possibly suggest was presented to seven judges, along with the 15 pictures. These judges (advanced graduate students in psychology) independently ranked the words accord- ing to their accuracy in describing the affects depicted in the cards (see Appendix E). Affect words descriptive of hos- tile and angry impulses were anger (and aggression) and homi- cide. Words suggestive of depressive kinds of affects were sadness (and grief), aloneness (loneliness) and suicide. Other words used were anxiety, fatigue, meditation, happiness, curiosity, fear, and restfulness. Twelve words in all were used and ranked by each of the seven judges for each of the 15 cards. The first three ranks and the last three ranks of each judge for each card were used to determine which 22 Table 2. Words Ranked Highest and Lowest with Regard to Their Closeness to the Affective Contents of 10 Thematic Cards. Card Words Ranked highest Words Ranked lowest % of judges % of judges l Aloneness 85.7 Happiness 100 Sadness 85.7 Restfulness 85.7 Suicide 85.7 Curiosity 57.1 2 Sadness 85.7 Happiness 100 Aloneness 71.4 Curiosity 100 Meditation 57.1 Homicide 57.1 3 Anger 85.7 Happiness 100 Fear 85.7 Restfulness 85.7 Homicide 57.1 Suicide 42.9 4 Sadness 100 Happiness 85.7 Aloneness 57.1 Restfulness 71.4 Anxiety 42.9 Curiosity 71.4 5 Homicide 100 Restfulness 71.4 Anger 100 Suicide 57.1 Anxiety 42.9 Happiness 42.9 6 Meditation 71.4 Homicide 85.7 Curiosity 57.1 Restfulness 42.9 Suicide 57.1 Happiness 42.9 7 Anger 100 Restfulness 85.7 Homicide 85.7 Suicide 71.4 Fear 57.1 Happiness 42.9 8 Sadness 100 Happiness 100 Aloneness 85.7 Homicide 71.4 Meditation 57.1 Restfulness 42.9 9 Anger 57.1 Happiness 100 Sadness 42.9 Restfulness 57.1 Suicide 42.9 Homicide 42.9 10 Meditation 85.7 Homicide 71.4 Aloneness 85.7 Happiness 57.1 Restfulness 42.9 Suicide 42.9 23 words were associated most often by more judges to a picture and which kinds Of words were associated least Often with a particular picture. From among the original 15 cards, 10 cards were selected which seemed to come closest to depicting the kinds Of affects and impulses of interest to the present study. The assumption is that such cards should tend to elicit similar kinds of affective responses from the viewer. Table 2 shows the rankings of the twelve affect words for each of the 10 cards, and the percentage of judges ranking them in each category. The cards used were: Card 1: The first card used was card 3BM from the TAT. This pictures a form of a person, sex indistinct, hud- dled on the floor against a couch. On the floor next to the figure is an indistinct object, which could be a gun. Card 1 is highly structured for depressive content (see Table 2), Card 2: This card shows a man sitting in a chair, his face hidden in his hands, his body bent over. Card 2 seems highly structured for depressive content (see Table 2). (Card 3: This card pictures 4 figures, all men. One man in the foreground is standing with his back to the viewer, facing 3 other men, who have hands upraised as though about to attack the man in the foreground. Card 3 is moderately to highly structured for hostile or anger content (see Table 2). 24 Card 4: This card shows a man standing with his head down- cast, his face covered by his right hand. His left arm is outstretched against a door. This card is essentially the same as TAT card 3GP, except that the figure is a man instead of a woman. Card 4 is highly structured for de- pression (see Table 2). Card 5: This card shows a man with his hands squeezed around the throat Of a woman and he seems to be pushing her back against a banister. This card is essentially the same as TAT card 18GF, except that the attacker has been changed to a man instead of being a woman. Card 5 seems highly structured for hostile or anger content (see Table 2). Card 6: This card shows the figure of a man standing on a bridge over water. He appears to be leaning over the rail, while hazy figures of men and a house are in the background. This card is essentially the same as TAT card 17GF, except that the figure on the bridge has been changed to a man. Card 6 is ambiguous with regard to suicide content (see Table 2). Card 7: This card shows three figures, all men. One man is standing in the foreground with his back to the viewer and only the tOp part of his body is visible. The other 2 men are in the rear, one lying on the ground as though he had been knocked down by the other who stands over him with clenched fists, glancing toward the figure in 1;_ w- 25 the foreground. Card 7 is highly structured for hostile or anger content.(see Table 2). Card 8: This card shows the figure of a man standing in a cennetery with head lowered, before one of the tomb- stones. Card 15 of the TAT suggested the content for this picture. Card 8 is highly structured for depressive content (see Table 2). Card 9: This card shows the figure of a man sitting at a table in what seems to be a kitchen, with utensils, stove, and cabinets in the background. He has a vague look on his face, has his head down on the table, and is smoking a cigarette. On a far corner of the table is a knife. Card 9 seems ambiguous for both depressive and suicidal content, and hostile and anger content (see Table 2). Card 10: The last card used in the set was card 14 of the TAT, which shows the silhouette Of a man against a bright window and the rest of the card is black. Card 10 is moderate to highly structured for meditation and alone- ness but ambiguous for suicide content.(see Table 2). Relationship Of the Projective Measures to the Hypotheses: I. Hostility: Hypothesis I: A. Mode of expression of hostility: suicidal subjects will tend to give significantly fewer stories in II.‘ III . 26 which there is Openly hostile or indirectly hostile themes, and significantly more stories with neutral positive, or ambivalent themes to cards on which hos- tility is depicted (cards 3, 5, 7). They will re- ceive significantly lower scores on a measure of overtness of hostility in their responses to cards of hostile content value (see Appendix G). Turning hostility upon the self: the scores received by differentially weighting the kinds of hostility responses given to cards 3, 5, and 7, will be used as an index of the extent to which hostility is not dealt with directly but turned back upon the self. For responses to cards 3, 5, and 7, the suicide- attempt subjects will receive significantly higher scores on a measure of turning of hostility upon the self (see Appendix G). HopelessnesséPessimism:’ Hypothesis II: Suicidal subjects will perceive the outcome of the total number of situations depicted, as being uncer- tain or less favorable significantly more Often than the control subjects. They will receive higher scores on "hOpelessness-pessimism" than the control subjects (see Appendix G). Perception Of Suicidal Content: Hypothesis III: 27 A. Suicide stories: Suicidal subjects will receive sig- nificantly higher scores on a measure of suicide con— tent than will the control subjects. Stories given to cards 1, 2, 4, 6, 8, 9, 10, will be analyzed for re- sponses containing suicide themes (see Appendix G). B. Involvement of Others: Other questions were asked after the stories in an attempt to investigate the subject's perception of the existence of outside involvement in the misfortunes, depression, or sui- cide of the thematic heroes. The suicidal subjects will receive significantly higher scores on a meas- ure of involvement of others, an indirect measure of blame. Higher scores indicate more of a per- ception of outside involvement in the hero's troubles, while lower scores indicate more of a perception of chance factors or personal involvement alone (see Appendix G). Personality Questionnaire A questionnaire was constructed by selecting one subscale from the Edwards Personal Preference Schedule (EPPS) and 5 subscales from the Minnesota Multi-phasic Per— sonality Inventory (MMPI) (see Appendix H). These subscales have been standardized and measures of validity and reli- ability are available. The MMPI scales which were used as a part of this composite were depression (D) in conjunction 28 with psychasthenia (Pt), dominance (DO), hostility (Ho), and dependency (Dy). The EPPS subscale used was need-abasement (Aba). The depression scale (D) or scale 2 of the MMPI was empirically derived to measure degree of symptomatic depres- sion. The mood state associated with the pattern being measured is "characterized generally by pessimism of out- look on life and the future, feelings of hopelessness or worthlessness, slowing Of thought and action, and frequently by preoccupation with death and suicide" (Carkhuff, Barnette, and McCall, 1965, p. 55). Scale items cluster around 5 main symptoms: subjective depression, psychomotor retardation, mental dullness, brooding, and complaints about physical malfunctioning. As a symptom measure, the scale can re- flect any depressive reaction regardless of basic character structure. The psychasthenia scale (Pt) or scale 7 of the MMPI was derived as a means of evaluating the obsessive-compulsive syndrome. The 48 items deal with Obsessive ruminations, rituals, abnormal fears, guilt feelings, and ambivalences. The content does not deal with specific Obsessions as such but more with.the characterological basis underlying the more specific symptoms. The dominance scale (Do) was devised as part of a project investigating political participation, through means of the "peer group nomination technique" (Gough, et a1., 1951). 29 As defined by the dimensions of the scale, the high dominance person is one who is "strong" in "face-to-face personal situ- ations...ab1e to influence others,...to control them,...not readily intimidated or defeated," and he seems to feel secure, safe, and self-confident in such relationships (Gough, eg_al., 1951, p. 213). The person with lower dominance is one who is submissive, unassertive, and easily influenced by others. Also associated with the characteristics Of dominance is a kind of "vigorous Optimism" or feeling of adequacy when per- forming tasks. The hostility scale (Ho) Of the MMPI was devised by using judges to choose items reflecting generalized hostility toward others. The person who scores high on this scale is one who is distrustful of others, "...sees peOple as dis- honest, unsocial, immoral, ugly, and mean, and believes they should be made to suffer for their sins," an attitude indicative of chronic underlying hate and anger (Cook and Medley, 1954, p. 418). The dependency scale (Dy) of the MMPI was rationally derived, by use of 16 judges independently specifying which MMPI items they felt were associated with dependence. The resultant scale consists of 57 items. Reliability coefficients for 100 neuropSychiatric patients was .91 by use of Kuder- Richardson Formula 20. One scale of the Edwards Personal Preference Schedule, the scale for need-abasement (Aba), was used. The items on 30 this scale deal generally with such things as feeling guilty when one does something wrong, accepting blame when things don't go right, feeling that personal pain and misery suf- fered does more good than harm, feeling the need for punish- ment for wrong-doing, feeling the need for confession Of errors, and feeling inferior to others. Relationship of the Personality Measures to the Hypotheses: Scoring Of subjects' responses to the MMPI items is done by using a key which specifies the direction of the re- sponse to be scored for a particular subscale. If a sub- ject's answer to an item corresponds to the direction in- dicated, then he receives a point for that particular item. These points are counted and summed to yield a score for the subscale. I. Hostility: Hypothesis IV: Suicidal subjects will receive a significantly higher score on the measure of hostility than the control sub- jects. II. Depression-Psychasthenia: Hypothesis V: Suicidal subjects will receive a significantly higher score on the combined measure Of depression and psych- asthenia than the control subjects. On the EPPS, each Of the 15 personality variables is paired twice with each of the others. Twenty-eight 31 comparisons are made for each variable. The score received for any one variable indicates the number Of times that the subject has chosen the statement for that particular variable as being more characteristic of himself than the statements for the other variables. III. Need-abasement: Hypothesis VI: Suicidal subjects will receive a significantly higher score on the measure of need-abasement than the control subjects. Familnyata Questionnaire A questionnaire was devised which would provide data regarding the subject's age, marital status, nativity, occu- pation, religion, area of dwelling, and parental separations, divorce, deaths, and illness. Other questions bearing on family health dealt with types of illnesses and their dura- tion and gravity, mental illnesses, suicides in the family, deaths in the family, and the age of the subject at the time. Results obtained on this questionnaire provided data regard- ing the social characteristics and the family background Of the subjects in the presbnt sample. Procedure Subjects were seen individually by the examiner in their respective treatment centers. All subjects were in- patients at some psychiatric installation at the time 32 Of testing. The examiner introduced herself to the subjects as follows: Hello, Mr. . The doctors gave me permission to talk with you today. My name is Roberta Vogel and I'm from Michigan State, conducting a survey. I have a few tests here which I'd like to have you take. One Of them consists Of pictures and is a test of imagination. The others ask questions about your ideas about things and a few questions about your background. The first test is the test of imagination. The subject was usually told that his name was picked at random from the patient list at the hospital and that was why he was being seen. The tests were administered to all subjects by the same examiner and in the same order of presentation. A recording device was set up to record the responses given to the projective cards. It was explained to the subjects that it was easier for the examiner to record his stories than to try to write them verbatim during the testing session. The tests were presented to the subjects in the following order: I. Projective Test II. Personality Questionnaire III. Family Data Questionnaire The projective test was introduced to the subjects in the following manner: 33 This is a story-telling test. I have some pictures here that I'm going to show you, and for each picture, I want you to make up a story. Tell what happened before, and what is happening now. Say what the peOple are feeling and thinking and how it will come out. You can make up any kind of story you please. DO you understand? Well, then, here is the first picture...See how well you can do (Murray, 1943). These additional questions were asked after each story, unless the subject had already indicated the answers to them in his story: 1. Who else might have had a part in his feeling this way or in what happened? 2. How will it turn out in the end? (Good or bad?) 3. What hOpe does he have for the future? The personality questionnaire was then administered using the standard instructions, in a booklet form Of the various scales. Recording of the subjects' responses was done by them in the booklet, instead of on a separate answer sheet. The family data questionnaire was filled out next be the subject and checked by the examiner at the end of 'the testing session. Clarifications of questions were made where the subject felt the question was not clear. Further family and social data were obtained if possible from the cliJiical case folder whenever needed. CHAPTER IV RESULTS Projective Test Data Although it is intended to reduce the scoring to a quantitative scale, these scales are composed of differen- tially weighted categories. The raw data for the projec- tive test are the number of responses scored in these specially-devised content categories. The first category consisted of those reSponses scored for hostility. Five different kinds of responses were possible: overtly hos- tile, indirectly hostile, ambivalently hostile, neutral, and positive affect responses. HOpelessness-pessimism was the second category of which three kinds Of responses were possible: favorable outcomes or unfavorable present and favorable future outcomes, uncertain outcomes, and un- favorable outcomes. The third category, suicide, consisted of four different kinds of responses: no suicide content, overt suicide-act completed, overt suicide-act incomplete, and ambivalent suicide. The last category consisted Of responses scored for outside involvement and three kinds (of responses were possible: no stated involvement or stated personal involvement, external—chance involve- Inents, and external-personal involvements. 34 35 Reliability of the content categories for the pro- jective pictures was obtained by having two judges (one Ph.D. psychologist and one advanced graduate student in clinical psychology) independently score the responses Of a random sample of 10 subjects taken from the total popula- tion of subjects used here. Percent agreement for each of the four main categories, was obtained. Total agreement on all four content categories was 87.7% (see Table 3). Table 3. Percent Agreement of Scoring for the Four Content Categories by Two Judges Using a Random Sample of Subjects (N = 10) Content Total No. Scored Percent Categories Responses the Same Agreement 1. Hostility 30 25 83.3 2. HOpelessness— 140 122 87.1 pessimism 3. Suicide 79 77 97.5 4. Outside 60 47 78.3 involvement ' Total 309 271 87.7 Hostility: Cards judged to have hostile content value (cards 3, 5, and 7) were scored for hostility using the content categories devised. Although it was intended to reduce the categories to a numerical score, it may be of interest to examine by means Of chi square the difference between the groups with regard to the frequency of occurrence of re- sponses in the various content categories. This is a less 36 .huflscwucoo How cOHuOOHHOO m.smunoou moans cmpsmeoo ma mx m o m o m ma HH msouo mz I N o o H AH H msono a s m H m o N HH macho mo.v mm. m m m H a m m H msouo m o m m m OH HH msouo mz . o s m H OH H macho m o>fiuflmom Hmuusoz ucoao>finfim DOOHHUCH some m up Nx muommnsm .Oz thou moauommumo huwaflumom b can .m .m moumo cw couoamoo usoucou oaflumom on» on HH can H mmsouo an sm>Hw noncommom mo soflusnwuumwo mocosvoum .4 magma 37 “sensitive measure but one which may provide data about pos- sible non-linear relationships. Chi squares were computed and these results are reported in Table 4. There was no difference between the two groups on Cards 3 and 7. However, the difference between Groups Iiand II on Card 5 is below the .05 level of significance (X2 = 7.68, 2 degrees of freedom), but in the Opposite direction from that predicted. Further analysis of the frequency distribution of responses to card 5 shows that if, for each group, the amount of Openly hostile reSponses as compared with less Openly hostile responses (indirectly hostile, ambivalent, neutral, and positive affect themes), are com- pared, X2 is again at about the .05 level of significance, and also in the Opposite direction from that predicted (X2 = 3.33, 1 degree of freedom). Subjects in the attempt group tended to give more Openly hostile responses to card 5 than did subjects in the control group (see Table 5). Table 5. Frequency' Distribution of Openly Hostile Responses as Compared to All Other Responses Given by Groups I and II to Card 5. Number Ofpsubjects Openly hostile Indirect or non-hostile Group I 8 12 Group II 2 18 x2 = 3.33a, 1 df p > .05 a 2 X is computed using Yates correction for continuity for X2 with 1 degree of freedom. 38 A more sensitive test may be performed by reducing the categories to a quantitative scale. An index Of overt- ness Of expression of hostility was obtained by differen- tially weighting the types of hostility responses given to the cards. The weighting was derived from an ordering of the responses from more to less Openly hostile, the cate- gories of which are given by Fisher and Hinds (1951). Overtly hostile responses were given a weight of 5; in- direct hostile responses, a weight of 4; ambivalent re- sponses, a weight of 3; and neutral and positive affect responses, weights Of 2 and 1, respectively. A mean score was obtained for each group and t-tests computed to test the significance of the difference between the two means for cards 3, 5, and 7 (see Table 6). Table 6. Significance of the Difference between the Means of the Total Weighted Scores on the Index of Overtness of ExPression of Hostility for Groups I and II Card N0. M1 M2 S.D. t df P 3 3.85 4.00 .379 - 38 NS 5 3.40 2.25 .483 2.38 38 <.05>.01 7 4.55 4.45 .370 - 38 NS There is no significant difference between the two groups in responses given to Cards 3 and 7. However, when the various hostility responses are weighted differentially 39 depending on the overtness of the hostility, the difference between the two groups on card 5 is significant between the .05 and .01 levels of significance (t = 2.38, 38 degrees Of freedom), although again in the opposite direction from that predicted. Group I had a significantly higher score on overtness of expression of hostility, than did Group II. Hypothesis Ia is not supported by these data. An index of turning Of hostility upon the self was Obtained by giving the categories a somewhat different weight. The more overtly hostile responses, overt and in- direct hostile responses, were given weights Of 1; neutral responses, weights of 2; positive affect responses, weights of 3; and ambivalent responses, weights Of 4. This weight- ing of ambivalent, neutral, and positive affect responses given to cards with hostile content value is roughly the same as that used by Fisher and Hinds (1951). A mean score was Obtained for each group and t-tests computed to test the significance of the difference between the groups for cards 3, 5, and 7. Again, there is no significant differ- ence between the two groups on responses given to cards 3 and 7. However, the difference between the two groups on card 5 is significant at less than .01 level of signifi- cance (t.= 2.84, 38 degrees of freedom) on the index of turning of hostility upon the self. These results are in the Opposite direction from that predicted (see Table 7). 40 Table 7. Significance of the Difference between the Means of the Total Weighted Scores on the Index of Turning of Hostility Upon the Self for Cards 3, 5, and 7 Card No. M1 M2 S.D. t df P 3 1.95 2.00 .420 - 38 NS 5 2.15 3.15 .352 2.84 38 <.Ol 7 1.20 1.15 .161 - 38 NS Group II had a significantly higher score on hostility turned against the self than did Group I. Hypothesis Ib is not sup- ported by these data. In all of the above instances in which a significant difference between the two groups was Obtained, Card 5 was the discriminating stimulus. Two main differences between card 5 and cards 3 and 7 are evident. In all three cards, the aggressor or aggressors are male, but only in card 5 is the person against whom the hostility is directed a female. ,Additionally, the content of cards 3 and 7 was perceived only as being hostile, while the content of card 5 is am- biguous in that it may be perceived as depicting either .hostile or positive affects. Card 5 is essentially the same as TAT card 18GF, with the attacker being a man in- stead Of a woman. Iflqpelessnesstpessimism: An index of hOpelessness-pessimism was Obtained by differentially weighting the types of 41 responses given as final outcomes on cards with depressive or ambiguous content value. Responses with favorable out- comes Or unfavorable present but favorable future outcomes were given a weight of 1. Responses with uncertain out- comes were given a weight of 2. And responses with un- favorable outcomes were given a weight of 3. A mean score was obtained for each group for the weighted scores and a t-test computed to test the significance of the difference between the two means for cards 1, 2, 4, 6, 8, 9, and 10. There was no significant difference between the two groups on responses given to cards 1, 2, 6, 8, 9, and 10 (see Table 8). Table 8. Significance Of the Difference between the Means of the Total Weighted Scores on the Index of HOpe- lessness-Pessimism for Cards 1, 2, 4, 6, 8, 9, and 10 Card N0. M1 M2 S.D. t df P 1 1.40 1.55 .228 .66 38 NS 2 1.20 1.35 .173 .87 38 NS 4 1,00 1.40 .152 2.63 38 <.05>.01 6 1.60 1.35 .247 1.01 38 NS 8 1.409 1.15 .187 1.33 38 NS 9 1.20 1.25 .170 .29 38 NS 10 1.10 1.05 .110 .45 38 NS 42 However, for card 4, the two groups did differ significantly on the index of hopelessness-pessimism (t = 2.63, 38 degrees of freedom), at between the .05 and the .01 levels of signifi- cance. Card 4 is essentially the same as TAT card 3GF, except that the figure pictured is a man instead of a woman. It shows a figure standing with his head downcast, his face covered by his right hand, and his left arm is outstretched against a door. Group II received a significantly higher score on hOpelessness-pessimism for card 4 than did Group I. This difference is in the Opposite direction from that pre- dicted. Hypothesis II is not supported by these data. Suicide content: Cards with depressive content value (cards 1, 2, 4, and 8) and cards with ambiguous content values (cards 6, 9, and 10) were scored for suicide content using 4 content categories: overt suicide-completed, overt suicide- incomplete, ambivalent suicide, no suicide content. Although it is intended to reduce the scoring to a quantitative scale, a chi square analysis of the responsesfrequencies for the content categories may provide data about possible non-linear relationships. Chi square was computed and the results are reported in Table 9. There was no significant difference between the two groups on cards 1, 2, 4, 8, 9, and 10. How- ever, on card 6, the two groups differed at between the .05 and .01 levels of significance in the predicted direction 2 (X = 9.28 with 2 degrees of freedom). This card shows the figure of a man standing on a bridge over water. He appears 43 .muHscHucoo HON coHuOOHHOO .moumw mchs pousmfioo mH mxn .muHscHucoo How coHuOOHHOO m.cmnnoou mchs cmusmfioo mH mxm . SH 4 o 0 HH dsouo mz H nmo H NH n o H H msOHo 0H mz I I ma m o 0 HH mnonw SH H m o H anono m mz I I om o o 0 HH msOHU ON 0 o o H msouo m . . HH s N 0 HH msouo HO v N MmN m m m m m H QDOHU 9 m2 I I NH o o H HH msoHo ON o o o H msouo 4 m2 I I mH H o 0 HH msouo ON 0 o o H msouo N nz I I mH H o H HH msOHo , NH o H o H msouo H OOHOHsm OHOHQEOOGH mumHmEOO . a He Nx oz uanm>Hns< Iunm>o IuHm>o muomflnsm oz sumo moHuomoumo ooHOHsm oH can .m .m .m .v .N .H mcuco 0» HH can H mmsouo he co>Ho noncommom OOHOHsm mo sOHuanHumHo aocosvoum .m OHQMB 44 to be leaning over the rail while hazy figures of men and a house are in the background. This card is essentially the same as TAT card 17GF except that the figure is a man instead of a girl. Group I tended to give more responses to card 6 in which suicide was overtly expressed, either as a completed act or as an interrupted act. Cards 6 and 10 (card 14 of Murray's TAT) were further analyzed to test the difference between the two groups with regard to presence or absence of suicide content. This was done by collapsing the four response categories into two: presence of suicide content and absence of suicide content. NO significant difference was obtained on either card 6 or card 10 (see Table 10). Table 10. Frequency of Occurrence of Suicide Responses to the Ambiguous Content of Cards 6 and 10 Card 6 Card 10 Present Absent Present Absent Group I 14 6 8 12 Group II 9 ll 4 16 x2 = 1.64a, df = 1 x2 = 1.08a, df = 1 P = .20 NS P = <.30 NS ax2 is computed using Yates' correction for continuity for X2 with 1 degree of freedom. In order to provide a more sensitive test of significance, re- sponses given to cards 6 and 10 were differentially weighted 45 according to the overtness of the suicide-response, and the means of the two groups were compared. The most overtly sui- cidal responses, where the hero actually commits suicide, were given weights of 4. Overt-suicide responses where the hero changes his mind or is rescued were given weights of 3. Ambivalent suicide responses and no suicide responses were given weights of 2 and 1, respectively. Group I received a significantly higher score on the index of overtness of sui- cide response (see Table 11). Table 11. Significance of the Difference Between the Means of the Total Weighted Scores on the Index of Overtness of Suicide Responses to Cards 6 and 10 Card No. M1 M2 S.D. t df P l 1.10 1.20 .184 .54 38 NS 2 1.00 1.05 .055 .91 38 NS 4 1.00 1.15 .151 .99 38 NS 6 2.40 1.55 .289 2.94 38 <.01 8 1.00 1.00 .000 0.00 38 NS 9 1.35 1.25 .194 .52 38 NS 10 1.50 1.20 .105 1.55 38 >.10 The difference between the means was significant at less than the .01 level of significance for card 6, but only approached significance for card 10, with P greater than .10 (t = 2.94 and 1.55, respectively, with 38 degrees Of freedom). 46 These data tend to support Hypothesis IIIa. Cards 6 and 10 are both cards which were judged to be ambiguous wth regard to suicidal content. Outside Involvement: An index of the perception by the sub- jects of outside involvement in the misfortunes, suicide, or~ depression of the thematic heroes was obtained by differen- tially weighting the different types of responses given by subjects to cards 1, 2, 4, 6, 9, and 10. Card 8 was omitted from this scoring since it is structured in such a way that it would consistently elicit stories dealing with how a per- son handles loss of a loved one, and by nature, would produce stories in which there was external-personal involvements. Stories which suggested no outside involvements or ones which suggested internal involvement only were given weights of 1. Stories containing external factors Of a chance or impersonal nature, like "fate" and "financial difficulty", were given weights Of 2. Stories stating external-personal factors were given weights of 3. A mean score was obtained for each group for the total weighted scores and a t-test computed to test the significance of the difference between the two groups on the index of outside involvement. There was no significant difference between the two groups on cards 1,2, 4, and 9 (see Table 12). However, on both cards 6 and 10, the difference between the two groups was significant at between the .05 and .01 levels Of significance, in the predicted direction (t = 2.24 and 2.60, respectively, with 38 degrees of free- dom). These data tend to support Hypothesis IIIb. 47 Table 12. Significance of the Difference Between the Means of the Total Weighted Scores on the Index of Outside Involvement for cards 1, 2, 4, 6, 9, and 10. Card No. M1 M2 S.D. t df P l 2.45 2.05 .281 1.42 38 NS 2 1.85 1.75 .253 .40 38 NS 4 2.15 2.40 .268 .93 38 NS 6 1.65 1.15 .224 2.24 38 <.05>.01 9 1.75 1.80 .276 .18 38 NS 10 1.55 1.05 .192 2.60 38 <.05>.01 Cards 6 and 10 are different from the other cards scored for outside involvement in several ways. Unlike cards 1, 2, 4, and 9, cards 6 and 10 do not contain clearly de- pressive content. Both cards are ambiguous with regard to suicide content material. Additionally, Group I gave more overt-suicide responses to these cards than did Group II. Group I received a significantly higher score for card 6 on the index of overtness of suicide responses. For card 10, the difference approached significancein the same direction. Twenty-six different analyses were carried out on the projective data, using the mean differences between the two groups on various measures. Of these 26, 3 were sig- nificant between’the .05 and .01 levels and 3 were significant beyond the .01 level. The most extreme finding reached the .002 level of statistical significance. Through the use Of 48 Tukey's method for combining partially dependent significance levels, it was found that the levels Obtained are highly negatively correlated and therefore, this procedure does not lead to a specific combined significance level. How- ever, combining them as if they were independent gives a conservative evaluation in such a case. The probability of obtaining even one difference significant at the .002 level out of 26 tries is itself significant at approximately the .05 level, without taking into account the other sig- nificant findings (which would, of course, increase the over-all significance). Hence, it can be concluded safely that the findings are not an artifact caused by the large number of significances tested. Personality Questionnaire Data Comparisons were made between Groups I and II by obtaining the mean raw scores on the various subscales and computing t-tests for the significance Of the difference between the means. All tests were two-tailed. NO significant difference was found between the two groups on any of the various subscales: Depression, Psychas- thenia, Hostility, Dominance, Dependency and Abasement. Hy- potheses IV, V, and VI were not supported by these data (see Table 13). However, the means for Group I were greater than those for Group II on the relevant variables (D, Pt, Ho, Aba), as stated by Hypotheses IV,V, and VI, although none 49 Table 13. Mean Raw Scores and the Significance Of the Dif- ference between the Means for Suicide-Attempt Group (I) and Control Group (II) on Scales D, Pt, D+Pt, Ho, Do, and Dy of the MMPI, and Scale Aba of the EPPS Groups : - 1 Scales _ D Pt D+Pt HO DO Dy Aba I 28.60 22.80 51.40 24.20 14.05 30.70 15.35 II 27.50 19.20 46.70 22.20 14.55 27.70 13.00 t .43 .98 .80 .67 .36 .78 1.37 NS NS NS NS NS NS NS of these differences reached significance. By using Tukey's method for combining partially dependent significance levels, it was found that the combined significance level was between .15 and .20. Additional Findings Social Data: Percentages were computed for each group on the various categories of re3ponses to the Family Data Questionnaire. So- cial characteristics of the present suicide-attempt sample tended to resemble those of other attempt samples used in previous studies (see Appendix B). Farberow and Shneidman (1961) reported that the per- son who attempts or commits suicide tends to belong to the skilled and semi—skilled or unskilled occupational categories. Table 14 shows the number of subjects falling into the various occupational categories represented. Sixty-five percent Of 50 OOH OOH .ON ON . . . . . . . Hmuoa MMII Mlll Mlll MIII HUOHHHHmGOO chHummaooo msOOGMHHOOmHS O O ON O O AOOHHmecsV chHummsOOO HHO3 Honsuosnum m mN OH m N lemHHHHmIHsmmc meoHummsooo xnos eonmm H HOOHHmeIHEom mm om m O .UOHHmeV OOHummOOOO mocmnp mmcHsomz O m O H O . . HOOHHmeV mGOHummsOOO msHmmOOOHm m OH mH m m . . . . . . . . .chHummsouo OOH>Hom m OH m N H . . . . . . . . . mmHmm one HOOHHOHU N mH mH m m HMHHommsmE w .HMOHGSOOH .HmsOHmmOHOHm HIO HH‘msOHo H msonw HM msouw H msouw mOHHOOOHmo HmsOHummsOOo ocou mOmMUOOOHmm muowflnsm H0 .02 . . mme .mmHuHa HMGOHummsooo HO HHMCOHOOHQ may EOHH smxme muomnnsm HOH.mOHH0moumo can mocou HchHummsOOo .OH OHQMB 51 subjects in the suicide-attempt group (I) were in skilled or unskilled occupations while only 35% held professional or white collar jobs. These percentages are the same for the depressive-control group (II). The largest percentage of subjects in Group I was married (55%), with percentages for widowed, divorced, separated or single men being roughly equal. Farberow and Shneidman found that about 54% of their attempt sample was married. Most of the married subjects in Group I considered their marriages to be successful (77%), while 64.3% Of Group II subjects felt this way. Half of the subjects in Group I were Protestant and half, Catholic, while 70% Of Group II subjects were Protestant and only 25%, Catholic. Most of the Group I subjects (75%)reported owning or buying their homes. Previous surveys (Farberow and Shneidman, 1961) have shown that most males who attempt or commit suicide tend to live in apartment house areas of the city, while only 10% Of the attempts in the present sample reported living in this type of area. The subjects were asked directly about their neighborhood areas so that the figures stated repre- sent their own perceptions of what existed and, therefore, may be somewhat inaccurate in terms Of assessment by so- ciological standards. Over half of Group I subjects (60%) were living at home with their wives or wives and children at the time they attempted suicide. Only 10% lived alone. Seven subjects 52 (35%) in Group I and 4 subjects (20%) in Group II, reported having lost a parent through death, separation, or divorce before the age of 15 years. At the time of testing, 70% of Group I subjects and 80% of Group II subjects had lost either one or both parents through death (see Appendix B). This may be accounted for by the fact that the mean age of subjects in both groups was 43.3 years. The modal age Of subjects in Farberow and Shneidman's sample was 42 years (Farberow & Shneidman, 1961) . There were more somatic complaints reported by Group I subjects, and almost no subject reported previous mental illnesses in the family (2.5%, N = 40). Fifteen per— cent of Group I reported that a family member had once at- tempted or committed suicide, while 30% of Group II subjects reported having had a relative commit suicide or make an at- tempt. Suicide Data--Suicide Attempt Group: Questions pertaining to the occurrence of the suicidal act were asked of the subjects in the suicide-attempt group, at.the end Of the administration of the Family Data Question- naire. Frequencies and percentages of subjects in each re- sponse category were Obtained (see Appendix C). Only 50% of the subjects felt that they really wanted to die at the time of the suicide attempt. Forty percent seemed to feel that they did not really want to die and 10% ‘were undecided. This compares with 36% Of Farberow and Shneidman's sample who reported really wanting to die and 53 40% who expected to be saved. Many subjects (30%) gave as one reason for the attempt psychological depression. Only one subject mentioned guilt feelings. Marital, family, and employment difficulties seemed to be involved in the occur- rence of about 35% of the attempts. These figures are similar to those reported by Farberow and Shneidman (1961). Forty- five percent of the subjects had made previous attempts at suicide. This figure is below that reported in previous sur- veys (Banen, 1954; Farberow & Shneidman, 1961; Stengel, 1964), and may be inaccurate since these data were taken from case history notes which may not have been complete. The most frequent method used was an overdose of drugs with or without alcohol. Overdoses of barbiturates and barbi- turates with alcohol, a more dangerous method, accounted for 35% of this group. Slashing of the wrist and other extremities was used by 35% of the subjects. In Farberow and Shneidman's sample, 54% of subjects took an overdose of barbiturates, while only 12% used cutting of the wrists. Most of the sub- jects (95%) reported that they had not communicated their intent to anyone before the act. However, 25% did leave a note to be found after the act. In Farberow and Shneidman's sample, only 2% of the suicide attempt group, but 35% of the suicide—commit group, left notes. Only one subject in the present sample reported calling for help himself after making the attempt, and 30% were rescued by their wives. Most Of Farberow and Shneidman's attempt subjects were stOpped by someone else (74%) , often their wives. 54 Table 15. Perception of the Effect on Others of the Subject's Death Suicide factors No. (N=20) % Did you feel anyone would be affected by your death? Yes I I I I I I I I I I I I I I I 16 80 NOI I I I I I I I I I I I I I I I 4 20 Total I I I 20 Who would be affected? Wife. I I I I I I I I I I I I I I 8 40 Parents I I I I I I I I I I I I I 7 3S ChildrenI I I I I I I I I I I I I 5 25 SiblingSI I I I I I I I I I I I I l 5 Family, relatives . . . . . . . . 4 20 Totala. . . 25 How would they be affected? Would feel hurt, upset, grief, sadness . . . . . . . . . . . . 8 40 Would feel disgrace . . . . . . . 1 5 Would miss income, support. . . . 4 20 Would miss me . . . . . . . . . . 1 5 They love meI I I I I I I I I I I 1 5 Would be better off . . . . . . . l 5 Totalb. . . 16 Who would be saddest at your death? WifeI I I I I I I I I I I I I I I 8 40 Parents . . . . . . . . . . . . . 6 30 ChildrenI I I I I I I I I I I I I 13 65 Totala. . . 27 aTotals may add up to more than 100% since some sub- jects gave more than one response for the subcategory. bFour subjects gave no response for this subcategory. Percent of subjects is computed on the basis of the total number of subjects in the group. 55 Most subjects in Group I (80%) felt that others would be affected in some way by their death (see Table 15). Close relatives, wife, parents and children, were persons mentioned most Often (by 40%, 35%, and 25%, of the subjects, respectively). Nearly half of the subjects reported feeling that the effect would be that others would feel hurt, sadness, loss, and grief at their death. About 70% of the subjects mentioned an ad- verse effect Of some kind, while only one subject reported feeling that relatives "would be better Off." Most subjects (65%) mentioned children as being most affected, with parents (60%) and wives (40%) being mentioned, also. CHAPTER V DISCUSSION Many of the expectations of the present study were not borne out by the results. However, those that were sup- ported present implications for theory, assessment, and re- search. Theoretical Implications One Obvious component of the depressive picture is the individual's feeling of hOpelessness, of no clear View Of satisfactory future outcomes or goals. Most peOple who attempt suicide are depressed and may also show this kind of hOpeless feeling about the future. However, the results Obtained here suggest that hOpelessness in itself is not enough to cause persons to choose suicide as a way out. HOpelessness may simply be one common component of symp- tomatic depression. Neither the prospect of a better life elsewhere nor the emotional pain of the present life appears to be enough motivation for persons to choose to kill them- selves. The suicide-attempt group tended to be less pes- simistic, rather than more pessimistic, in their responses than the control group of depressives. While these results are only suggestive, they warrant further investigation to~ clarify the relationship between feelings of hOpelessness 56 57 andixm occurrence of attempted suicide. Pessimism.about the fuhne and loss of hOpe may be one component Of symptomatic depression, yet dynamically, may not be one of the most im- Ixutant factors in the individual's decision to make a sui— cide attempt (Hendin, 1963; Kobler & Stotland, 1964). As predicted, the suicide-attempt subjects saw more external kinds of involvements occurring in the plights of the thematic heroes. Importantly enough, the cards on which there was a significant difference were not cards which were judged to contain depressive contents, but ones which seemed of neutral content values. These cards are also ones on which ambiguous suicide content may be found, and on which the suicide-attempt subjects tended to give more overtly suicidal responses. Thus, it may be concluded that the suicide-attempt subjects saw others as being personally in- volved in the occurrence of the suicidal act itself more Often than they considered it to be associated with inter- nal involvements like guilt or personal problems. Addi- tionally, suicide data gathered for the attempt subjects showed that they did feel that others would be affected in some way and most of them saw the effect as being the in- stigation of feelings of loss, sadness, grief, and pain. They know that by their actions they are going to cause hurt and pain to those close to them. Many other writers (Adler, K., 1961; Ansbacher & Ansbacher, 1956; Hendin, 1963; Hirsh, 1960; Karon, 1964; 58 Stengel, 1956) have stressed the social nature of the occur- rence of suicidal behavior. Hendin (1963) found that for the 100 consecutive suicide admissions he studied, one Of the major dynamic factors involved was the patient's per- ception of the act as a means of revenge against others. The notion of the suicidal act as a means of revenge has been suggested by anthropologists studying in other cultures as well (Malinowski, 1929; Hirsh, 1960). Alfred Adler (1958) once noted that the object of the revenge is usually the one who suffers most by the occurrence Of the suicidal act. Sui- cide and attempted suicide would appear, then, to be ex- tremely angry acts, "...aggressive retaliatory (acts)...(with the primary) wish to hurt someone else and the belief that' suicide (or attempted suicide) will accomplish this end" (Karon, 1964, p. 207). The theoretical base used for the present study of the relationship of hostility to attempted suicide was the idea that the suicidal act is actually a hostile or angry act where the anger is turned against the self, though being primarily concerned with hurting others outside the self. The notion is that, due to an inability to handle overt ex- pressions of anger, the individual hurts himself instead. In the scoring Of the projective data, the assumption was that if subjects gave neutral, ambivalent or positive affect themes to cards depicting some form of hostility, then out- ward expression of hostility is inhibited and probably 59 turned back upon the self (Fisher and Hinds, 1951) . Con- trary to expectations, however, those who had attempted sui- cide also responded with more overtly hostile responses to the projective pictures, instead of with ambivalence or the inhibition Of overtly hostile themes. Instead, the control group of depressives seemed to be less able to handle the hostile content of the projective test and gave more ambiva- lent, neutral and positive story themes. It was eXpected that on the personality questionnaire measure, the suicide attempt subjects would give more hostile responses whereas on the projective test, the fantasy material would show an inhibition of hostile themes. The hypothesis that hostile responses would be given by these subjects was originally derived from the Objective measures but it was instead confirmed by the projective data. The term, "turning of hostility upon the self" seems to suggest that the individual is unable to deal with hostility in a direct way and that in the suicidal act, the direction of the anger or hostility has been changed. This further suggests that the individual is now angry at himself and "wants" to hurt himself, primarily. The suicidal act may be thought of, ,however, as a way of attaining retaliation by means of pro- voking guilt, sadness, and feelings Of responsibility in others for the occurrence of the act. Suicide is not hos- tility turned upon the self, as such, but hostility turned against others by means of a tool which causes more conflict, 60 pain, and grief than any other means of expression of anger Even if the person does not succeed, relatives feel If the could. sadness and a kind of responsibility for the act. person does succeed, the act is irreversible for the "other" as well as for the suicide--the "other" can never make repa- rations for whatever wrong he feels he might have done. The suicide attempt is also a means of retaliation which pre- vents the "Other" from striking back, by blocking the ex- pression of his anger. The act itself is a "...vengeful device filled with rage," but rage at others outside of the self (Adler, K., 1961, p. 66). The suicidal act may thus be thought of as a means of expression of rage at others in the individual's life. Instead of being unable to express anger, the subject is able to express it in a very effective and unusual way, though in the process he may also destroy or seriously injure himself. In the present study, the control group of depressive subjects gave significantly more ambivalently hostile re- 3ponses than did the attempt group. This suggests that the depressive demeanor may be associated in some way with anger in both groups; however, the depressives who have not at- tempted suicide may be more correctly seen as being unable to give overt expression to anger. This would support the notion that in depressed persons the most important variable is their angry feelings. Therapeutic intervention with these suicidal persons might more effectively consist of helping 61 them to find different ways of being angry. For the non- suicidal depressives the therapeutic goal might be to pro- vide them with some effective means of releasing anger. Implications for Assessment In the present study, the questionnaire type of in- strument was of little value in the investigation of suicidal behavior. However, the results Obtained from the personality questionnaire may be of questionable relevance in View of the fact that no validity key or validity measures are available for this particular pOpulation. Further research using such instruments is indicated, before the usefulness of this type of data can be ruled out. The use of a projective test seemed effective as a means of assessing dynamic factors of suicide and the serious- ness of suicidal intent. These data suggest that tailor-made projective tests in the form of thematic pictures may be an answer to the problem of assessment. The projective pic- tures used in the present study were chosen because they were structured in such a way that they seemed to elicit certain kinds Of affective-thematic responses to the con- tents depicted. Some Of the cards seemed better able to differentiate between the groups of subjects than others. An attempt was made to control somewhat for the affective content values of the different cards, with regard to cer- tain kinds of conflicts and motives. Card 4 (similar to card 3GF of the TAT) which was highly structured to elicit 62 stories containing depressive themes, seemed to be effective in producing responses which gave evidence of how the two groups might differ with regard to their handling of depres- sion and their feelings about the future. This card was clearly depressive, in content value. Cards 6 and 10 were ambiguous for suicidal types of responses. Suicide may be seen in the cards but the content may also be seen as repre- senting neutral kinds Of situations (curiosity, meditation). The present results suggest that such ambiguous cards are best for determining the danger Of suicide. Card 5 was the only card effective in differentiating between the two groups of subjects on the hostility variable. Cards 3 and 7, also scored for hostility, were highly struc- tured for hostile content and lacking in the ambiguity present in card 5. When the cards were clearly structured to show hostile content, no difference between the two groups was since all of the subjects reacted by giving stories obtained, with hostile themes. The card which did differentiate was one which was somewhat ambiguous with regard to hostile, con- tent value. The scene depicted could be interpreted as con- taining hostile content; yet at the same time, innocuous or positive affective content could also be perceived. This particular card seemed to present affective material which was mid-way between being clearly hostile and clearly posi- tive in content and thus, was maximally effective. The amount of ambiguity present must be such that both kinds of 63 responses can occur. A card which is more clearly hostile in affective content does not permit the subject a choice of responses. In the latter case he could respond in an alter- nate way only by using gross denial of the hostile content depicted. The same principle seemed to be at work in the case of the suicide cards, which were chosen because of their ambiguity with regard to suicidal content value. One of the biggest advantages of the use of a pro- jective method such as the thematic pictures is that it allows for qualitative or content analysis of the data in such a way that reSponses may be dimensionalized. In the present study, both groups gave stories which contained some suicide fantasy material. The important difference was in the type of suicide responses they gave. The sub- jects who had made some previous attempt were more overt about the suicidal intent Of the thematic heroes and gave more stories where the hero actually committed or attempted suicide, or seriously considered it. It is probable that most depressed peOple have at some time thought of killing themselves. However, many Of them, though they have thought of suicide, never make an attempt, while others do. The important difference does not seem to be the presence or absence Of thoughts of suicide but the manner in which the individual thinks of suicide and the kinds of fantasies he has about it. The suicide-attempt group gave more fantasy material in which the hero had serious thoughts and intents 64 of suicide or actually committed suicide. Previous research evidence (Farberow, 1950; Jensen & Petty, 1958; Stengel, 1964) has shown that a patient may be willing to communicate that he has at some time thought of suicide. However, the kinds of fantasies he gives to projective pictures may aid in the assessment Of the danger of actual suicide or the seriousness Of the suicidal intent, and in the making Of clinical deci- sions for treatment of the patient. Responses where the patient's fantasies suggest completed or overt acts of sui- cide seem of more significance for the assessment Of possible future suicidal behavior. Implications for Research The results Obtained in the present study do more to suggest further lines Of research than they do to give clear- cut answers to the question of why a person elects to attempt suicide. It appears that the projective method of psychoé logical testing and evaluation may be especially valuable to the assessment of subjects who are potentially suicidal. These results indicated that overtly hostile fantasy material, as measured by the projective test, was more Often given by the suicide-attempt subjects than by the control subjects. The hypothesis that the expression of overt hos- tility would be inhibited by the attempt subjects was clearly not borne out. Further research concerning hostility and suicide might more apprOpriately be directed toward the vali- dation of this reversed finding, namely, the relationship 65 between overt hostility content in fantasy material and the occurrence of attempted suicide. The present results also support the notion that pro- jective pictures with controlled stimulus values and ambiguity can be most useful to personality research, especially where the aim is the study of specified affects or conflict areas. The amount of ambiguity should be controlled as well as the kinds of stimuli depicted in the cards. In this way, the researcher would be able to Obtain more conclusive results since he would have a clearer notion of the stimulus values Of his projective materials. The need for follow-up data is also indicated, both as a means of providing validity measures Of the projective device used as well as to give some notion about the pre- dictive value of the use of such techniques in suicide re- search. The entire test profiles of those persons who later commit suicide or attempt suicide, if any, might be analyzed for additional variables of importance and ones which may lead to further avenues of research in the area of suicide. Presently, such a study is planned to be carried out at least a year after the first testing as a means of provid- ing answers to questions of test and predictive validity. CHAPTER VI S UMMARY Twenty male depressives who had made a previous sui- cide attempt and 20 male non—suicidal depressives, all in- patients, were compared with regard to the types of responses which they gave to projective cards having hostile, depressive and ambiguous stimulus values. Ten cards were administered along with a personality questionnaire consisting of 5 Minnesota Multiphasic Personality Inventory subscales (De- pression, Hostility, Psychasthenia, Dominance, and Depend- ency) and one'subscale from the Edwards Personal Preference Schedule (need-Abasement). A family data questionnaire was administered as a means of surveying some social characteris- tics of the present sample. It was expected that suicide- attempt subjects would give fewer overtly hostile responses to hostile cards, more suicide themes to ambiguous cards, and more pessimistic outcomes to stories. They were also expected to see others as being involved in the thematic hero's misfortunes more frequently than the non-suicidal depressives. On the projective test, the suicide-attempt sub- jects gave fewer pessimistic responses than the control subjects, contrary to predictions. The group means on an index of hOpelessness-pessimism were significantly different 66 67 for one of the projective pictures. The frequency distribu- tions Of suicidal types of responses given by the two groups to ambiguous stimuli were significantly different for one card. As predicted, the suicide-attempt subjects gave sig- nificantly more overtly suicidal responses than did the de- pressive control group. An index of the overtness of sui- cide reSponses was computed for each group and the means compared. The suicide attempt group received a significantly higher score than did the depressive control group. The difference in the frequency distributions Of hos- tility reSponses given by the two groups to cards with hostile content approached significance on one of the cards. Contrary to predictions, the suicide-attempt group gave more overtly hostile responses than did the depressive control group. An index of the overtness of hostility responses was com- puted and the means Of the two groups compared. Again the suicide-attempt group received significantly higher scores on the index of the overtness of hostility reSponses, for one of the projective cards. This finding is contrary tO predictions. An index of outside involvement in the hero's plight was computed and the two group means compared. As predicted, the suicide attempt group received a significantly higher score on the index of outside involvement than the control subjects. The suicide-attempt subjects entertained more suicide fantasies in which suicide or a suicide attempt actually 68 takes place. Also, these persons more Often saw others as being involved in some way in the occurrence Of the hero's misfortunes. It is further suggested that the suicidal de- pressives may experience more conscious hostile fantasies than the depressives who have never made a suicide attempt nor seriously considered suicide as a solution to problems. The suicidal depressives seem to be expressing anger at others through the suicide act. Hopelessness about the future may not be a critical factor in the occurrence Of attempted suicide. However, hostility, suicidal fantasies, and the perception of outside involvements do seem to differentiate the groups of subjects in the present sample. There were no significant differences between the means of the two groups of subjects on any Of the personality subscales. These findings are inconclusive and the need for further research using such instruments is indicated. Additional findings showed that the social charac- teristics of the suicide attempt group closely resembled those characteristics of other samples of suicide-attempt subjects previously investigated. The mean age for both suicide attempt subjects and non-suicidal depressives was 43.3 years. Most Of the subjects in both groups were mar- ried, lived at home with their wives and children, and worked at skilled or unskilled jobs. Additional research is indicated as a means of fur- ther investigating the utility of projective materials for 69 the assessment Of suicidal intent. Studies to bear out the relationship found here between hostility, suicidal fantasy, and the occurrence of attempted suicide is also indicated. Follow-up studies using the present sample would provide data about any further suicidal behavior of the subjects. APPENDICES APPENDIX A Age, Marital Status, and Diagnosis of Subjects 72 O u oHuoeosmm O OH OH mm OH O OOIOH u mmemm H n oHuoeosmmIcoz H N N HH N H38. OH? I can: cOHmmoummo ..cxm kHOHxsd I z x OH ON OOHmmoummc ..cxm OHGOHSQONHsom I m x mm OH sonmmHmmc ..me aumesm I z x OH OH sonmOHmoc .OHsouso ..sxm humesd I.z x mm OH oHoccHom ..sxm OHconanNHsom I m x ma OH sOHmmOHmmc ..sxm humeGH I z x mv mH OHcOHcO ..sxm OHsmuanNHnom I m x we OH .cxm O>Hmmoumoa I z x mv mH sOHmmOHmoc...sxm aumess I z x mm NH cHosmHmm ..cxm OHcouszNHnom I m x Hm HH .cxm cOHmmoano.I z x HO OH conmOHm c HOHGOHSO ..sxm >UOHxs¢ I z x HO O GOHmmmHmoc ..cxm >HOHxs< I z x mm m EmHHocOOHm .cOHmmmummo ..cxm humesd I z x mm O EmHHonOOHm .OOHmmoumoc ..cxm humesd I z x OO O GOHmmmHmwc ..sxm OHsmucmONHnom I m x on m O>Hmmoumoc .O>HmmoumooIOHcmz I m x me O conmmHm Imp .cOHmmHEmH ..cxm OHGOHQQONHnom I z x mm m EmHHonOOHm .COHmwoumoc ..cxm HHOHxsd I z x mm m cOHmmoummo ..cxm OHuOHsmz I z x OH H 6Huozo>mmum 6Huoaosmm eozuz z o mom 2 m use nomflnsm mHmosmmHo msumum HmuHHmz HON u zv HHS msouo umEouudlmUHOHsm on» SH mUOOnndm HO mHmocmmHo can .msumum HmuHHmz .mmd .OH OHQMB 73 h mH conmOHmoc .OHOOOHOQ ..sxm IEOO OHumEOm .sonmOHmOc EmHHonOOHO .sonmOHmop GOHmmoummc OHuosommm OHuonOmwmIcOZ OHOOHSQONHcOm muchHm ..sxm humesm ..sxm mumecd ..me huOHxnd HOOOHumsuHm ..sxm O>Hmmoumoo sonmoummo ..cxm O>HmmoumooIOHsmz GOHmmOHmoc conmOHmOU ..sxm GOHmmoummc EmHHO£OOHm .cOHmmOHmmc OOHmmOHmoc .cHocmHmm ..cxm OOHmmOHQOc ..sxm mumesd OHGOHanNHSOm ..cxm mumecd ..sxm quchfl OHGOHSQONHsom ..sxm muoncd .cxm O>Hmmonmmo sOHmmOHmmc .cHosmHmm .OHconanNHnom IEOO OHHOEOm .cOHmmOHmoo conmOHmop .OHsouno ..cxm EmHHosOOHm .GOHmmOHmOO cOHmmOHmmo OOHmmOHmoc .cHocmHmm ..sxm EmHHosOOHm .conmOHmmc mucHOHm ..sxm muOch< OHsmnsmoNHsom ..cxm muOHxnd ..me wumesd OHcmusmONHnom ..cxm huOHxGH Q-I DIZZD-IZZOIZD-IZZZZ ZDIZZDIZ OHHOSO>mmum OHuocommmIcozuz mHmocmmHo HHHV msouo Houucoo on» OH muOOnnsm HO mHmocmmHQ cam .msumum HmuHHmz .OOH O ON OH OO O O OOION u moans O O N NH H Hence Om.mO u can: x NO ON x HO OH x OO OH x Om nH x OO OH x OO OH x OO OH x OO OH x Om NH x OO HH x ON OH x NH O x OO O x OO N x OO O x HO O x OO O x OO O x NO N x OO H z a mom 2 m msumuw HmuHHOS OOH pounnsm HON u 2O .NH mHan APPENDIX B Distribution of Other Social Factors for the Subjects 75 Table 18. Distribution of Other Social Factors for the Suicide- Attempt Group (I), and the Control Group (II) . Group I Group II Soc1al factor No.(N=20) % No.(N=20)% Nativity: UISI I I I I I I I I I I I I 17 85 19 95 Other. I I I I I I I I I I I 3 15 l 5 Years in school: Mean years . . . . . . . . . ll.2+ 11.2 Range. 0 o o o o o o o o o o 8-1 6+ 7-16 Occupation: Professional-white collar 7 35 7 35 Skilled-unskilled. . . . . . 13 65 13 65 Mean yearly income . . . . . $5,360 $6,020 Range. 0 o o o o o o o o o o $2'OOO-7'500 $3,800-11, 000 Marital status: Single . . . . . . . . . 3 15 l 5 Married. . . . . . . . . . . ll 55 12 60 Divorced . . . . . . . . . 3 15 5 25 Separated. . . . . . . . . . 2 10 2 10 Widowed. . . . . . . . . . . la 5 0 Mean years in marriage . . . 17.69 17.75 Perceived successfulness of marriagea: Very successful. . . . . . 6 46.2 6 42.9 Successful . . . . . . . . . 4 30.8 3 21.4 Unsuccessful . . . . . . . . 2 15.4 3 21.4 Very unsuccessful. . . . . . 1 7.6 2 14.3 N = 13 N = 14 Religion: Protestant . . . . . . . . . 10 50 14 70 Catholic . . . . . . . . . . 10 50 5 25 Other. . . . . . . . . . . . 0 0 l 5 Dwelling place: Rent . . . . . . . . . . . . 2 10 3 15 Own. . . . . . . . . . . . . 15 75 17 85 Apartment. . . . . . . . . . 3 15 0 0 Type of Neighborhood dwellings: Rent . . . . . . . . . . . . 0 0 l 5 Own. . . . . . . . . . . . . 18 90 19 95 Apartment. . . . . . . . . . 2 10 0 0 aThese figures are computed on the basis of the number of subjects in the group who are presently married. 76 Table 18. Continued , Group I Group II 3°Clal fa°t°r No.(N-ZO) % No.(N-zo) % Subject living with: Alone. . . . . . . . . . . . 2 10 2 10 Parents. . . . . . . . . . . 3 15 2 10 Wife . . . . . . . . . . . . 2 10 3 15 Wife and children. . . . . . 10 50 8 40 Other relatives. . . . . . . 2 10 5 25 Friends. . . . . . . . . . . l 5 0 0 Parental marriages, separations, divorces, death: Married. . . . . . . . . . . 5 25 3 15 Separated. . . . . . . . . . l 5 0 0 Divorced . . . . . . . . . . 0 0 l 5 l deceased . . . . . . . . . 6 30 7 35 2 deceased . . . . . . . . . 8 40 9 45 Mean age at father's death . . . . . . . 25.81 yrst=12) 33.87 yrsJN-lS) Range. 0 o o o o o o o o o o 3 mos-46 yrs. 7-51 yrs. Mean age at mother's death . . . . . . . 30.2 yrsJN=9) 33.24 yrsJN-lO) Range. 0 o o o o o o o o o 0 9-50 yrs. 5 11103-52 yrs. Health data: Present illness: YeSI I I I I I I I I I I I ll 55 7 35 No I I» I I I I I I I I I I 9 45 13 65 Type Of illness: Physical . . . . . . . . . 8 4 Emotional. . . . . . . . . 3 3 Mental illness of parents: Yes. I I I I I I I I I I I 0 0 l 5 No I I I I I I I I I I I I 20 100 19 95 Suicides in the family: Committed. . . . . . . . . l 5 2 10 Attempted. . . . . . . . . 2 10 4 20 No suicides. . . . . . . . 17 85 14 70 Who committed, attempted? Wife . . . . . . . . . . . l 2 Parent . . . . . . . . . . 0 l Sibling. . . . . . . . . . l 2 Other. . . . . . . . . . . l l APPENDIX C Distribution of Suicide Data for the Suicide-Attempt Group (II) IL" A: I 78 Table 19. Distribution of Suicide Data for the Suicide-Attempt Group (II) Suicidal factors No. (N=20) % Seriousness of suicidal action: Really wanted to die . . . . . . . . 10 50 Didn't really want to die. . . . . . 8 40 Undecided. . . . . . . . . . . . . . 2 10 Total . . . 20 Reasons indicated for suicidal act: Psychological depression . . . . . . 6 30 Marital-family problems. . . . . . . 4 20 Employment problems. . . . . . . . . 3 15 Unhappy love affair. . . . . . . . . l 5 Inability to work, no future . . . . 2 10 Loneliness . . . . . . . . . . . . . 2 10 Guilt. . . . . . . . . . . . . . . . 1 5 Delusional involvements. . . . . . . 2 10 Totala. . . 21 Previous attempts: Yes. . . . . . . . . . . . . . . . . 9 45 No . . . . . . . . . . . . . . . . . ll 55 Total . . . 20 Method of attempt: Hanging. . . . . . . . . . . . . . . 2 10 Overdose - barbiturates an alcohol. 4 20 Overdose - other drugs and alcohol . 1 '5 Overdose - barbiturates. . . . . . . 3 15 Overdose - other drugs . . . . . . . 5 25 Slash throat . . . . . . . . . . . . 1 5 Slash wrist, extremities . . . . . . 7 35 Gas. . . . . . . . . . . . . . . . . 2 10 Jumped in front of car . . . . . . . 1 5 Poison . . . . . . . . . . . . . . . l 5 Totala. . . 27 Communication of intent before act: Yes. . . . . . . . . . . . . . . . . l 5 No . . . . . . . . . . . . .7. . . . 19 95 Total . . . 20 Communication of intent after act(note): Yes - to wife. . . . . . . . . . . . 3 15 to other . . . . . . . . . . . 1 5 to anyone. . . . . . . . . . . l 5 No . . . . . . . . . . . . . . . . . 15 75 Total . . . 20 aTotals may add up to more than N=20 since some sub- jects gave more than one response for the subcategory. Table 19. Continued 79 Suicidal factors No. (N=20) % Rescue: Someone stOpped subject. . . . . . . Wife . . . . . . . . . . . . . . . 6 30 Other. . . . . . . . . . . . . . . 9 45 Subject asked for help . . . . . . . l 5 Don't know . . . . . . . . . . . . . 4 20 T tal . . . 20 APPENDIX D Record of Medications Taken by the Subjects at the Time of Testing 81 Table 20. Medication Being Taken by the Subjects at the Time of Testing - Group I Subject Drug name Dosage (mg.) l LibriumI I I I I I I I I I I I I 10' quIdI 2 Mellaril I I I I I I I I I I I I 100' quIdI TOfranil I I I I I I I I I I I I 25' tIiIdI 3 Mellaril I I I I I I I I I I I I 150' tIiIdI 4 Stellazine . . . . . . . . . . . 5, b.1.d. Tofranil . . . . . . . . . . . . 50, t.i.d. 5 Thorazine. . . . . . . . . . . . 50, t.1.d. 6 Thorazine. . . . . . . . . . . . 50, q.i.d. 7 Tofranil . . . . . . . . . . . . 25, q.i.d. LibriumI I I I I I I I I I I I I 25' quIdI 8 Mellaril I I I I I I I I I I I I 100' tIiIdI Tofranil . . . . . . . . . . . . 25, t.i.d. 9 EquanilI I I I I I I I I I I I I 400, quIdI lo LibrimIII I I I I I I I I I I I I 25' tIiIdI ll Mellaril I I I I I I I I I I I I 50' quIdI TOfranj-l I I I I I I I I I I I I 25' tIiIdI 12 ThoraZineI I I I I I I I I I I I 100' quIdI l3 LibriumI I I I I I I I I I I I I 25’ tIiIdI 14 Mellaril I I I I I I I I I I I I 50' quIdI Tofranil . . . . . . . . . . . . 25, q.i.d. 15 ThoraZineI I I I I I I I I I I I 100' quIdI Stellazine . . . . . . . . . . . 5, b.i.d. 16 StellaZine o o o o ' o o o o o o o 2 p to lode l7 LibriumI I I I I I I I I I I I I 50' quIdI TOfranil I I I I I I I I I I I I 25' tIiIdI Table 20. Continued 82 Subject Drug name Dosage (mg.)f 18 19 20 Stellazine Mellaril Librium. Stellazine Librium. 5: 400,’ 25, 5: 25, 83 Table 21. Medication Being Taken by the Subjects at the Time of Testing - Group II Subject Drug name Dosage (mg.) l Librium. . . . . . . . . . . . . 25, q.i.d. 2 Mellaril . . . . . . . . . . . . 50, t.i.d. 3 Mellaril . . . . . . . . . . . . 50, t.i.d. 4 Mellaril . . . . . . . . . . . . 200, q.i.d. Librium. . . . . . . . . . . . . 25, q.i.d. 5 Librium. . . . . . . . . . . . . 10, q.i.d. Tofranil . . . . . . . . . . . . 25, q.i.d. 6 Librium. . . . . . . . . . . . . 25, q.i.d. 7 Thorazine. . . . . . . . . . . . 100, q.i.d. 8 Tofranil . . . . . . . . . . . . 25, q.i.d. Mellaril . . . . . . . . . . . . 50, t.i.d. 9 Mellaril . . . . . . . . . . . . 50, q.i.d. 10 Mellaril . . . . . . . . . . . . 50, t.i.d. 11 Librium. . . . . . . . . . . . . 25, q.i.d. 12 Thorazine. . . . . . . . . . . . 100, t.i.d. l3 Mellaril . . . . . . . . . . . . 100, q.i.d. Prolixian. . . . . . . . . . . . 2.5, b.i.d. l4 Thorazine. . . . . . . . . . . . 100, q.i.d. Librium. . . . . . . . . . . . . 50, t.i.d. 15 Mellaril . . . . . . . . . . . . 50, q.i.d. Benadryl . . . . . . . . . . . . 50, q.i.d. 16 Librium. . . . . . . . . . . . . 25, q.i.d. 17 Mellaril . . . . . . . . . . . . 100, q.i.d. 18 Librium. . . . . . . . . . . . . 25, q.i.d. 19 Librium. . . . . . . . . . . . . 25, q.i.d. 20 StellaZine I I I I I I I I I I I 10’ inIdI APPENDIX E Instructions for Rating the Preliminary Set of 15 Pictures 85 Instructions for Rating the Preliminary Set of 15 Pictures This study is attempting to find out how nouns denoting some emotion (fear, hate) are related to a group of ambiguous pictures. Some of these pictures may be best described in terms of certain kinds of nouns of emotions, i.e., some of them may be seen as showing the kind of emotional or feeling tone implied in words like fear or hate, and so on. We would like you to rate a group of nouns which imply. different emotional tones, using each one of 15 pictures as the basis for your rating. You will be given a sheet of paper on which you will find a list of nouns. Each of these nouns deals with a different kind of feeling tone. You will be asked to study each picture and rank these nouns in terms of whether or not it could be used to describe the emotional tone contained in the picture. Picture #1--At the t0p of the page you will see 12 nouns. Rank these 12 nouns, from 1 to 12, with #1 being the noun most clearly depicting what the feeling tone of the pic- ture is, #2 being the noun which comes next in order of its clearness in depicting the feeling tone of the picture, and so on,‘until‘you have ranked all 12 of the nouns. In case you feel that none of the nouns is the best one to describe the feeling tone of the picture, in the blank next to Other, write in the noun you would think is best. Rank that one along with the rest of the nouns. When you have finished, #1 would be the noun which best describes the feeling tone of the picture, on down to #12 (or #13 if you have written in a noun), which would be the noun least applicable or one which has no rele- vance, to what's happening in the picture. It is not necessary to sign your name. APPENDIX F Test 1. 2. 3. Materials Projective Pictures Personality Scale Family Data Questionnaire and Additional Health Questions The Projective Pictures 88 89 7, “sign J~. .,r_. {film-v“- - 2i 90 Card 3 91 . s. . _ . LU... . ‘ «111. x .u tau. an» my.“ . I 43:214. ‘w . . ,J~.. .u . :14. ”,1: E.- ll )1? i :1 . .. . . :62! 3,294.}: . .\l.IaL.d«,.§. {hiwtli 3:1... :hllilnx £642.!!! gr..§ ,. .mlh... o... (3 cnrd If 92 Cflrd 5’ 93 94 card 1 95 card. 8 96 97 cnr'd 1° PERSONALITY QUESTIONNAIRE DLKISC‘J I OHS This schedule consists of a number of pairs of state” that you may or may not lik e; about w3 s in which you may or may not feel. Look ett he ex& plc helm A I like to talk about myself to otl ere o B I l he to work tows d so: 0 gcsl hot I heJe set for myselfa Which of these two st tenents is more charactei istie of what you like? If you lile "talking about yourself to others” more than you like "working; toward some goal hot 570. have set for yourscli‘,’ the n he: 1t 5 a nut thi 17:: you should choose A over 3.1f you like nv¢rk4s3 tfivard some :fi31 fhil n? n.30ut you self J F’sc you have set for yourself” more than.you like Wzall to others," then you should choose 3 over Ac You no y 13 he both A and 3. In trio case, you would have to choose between the swo and you s1ould choose the one that yo1 like batters If you disl he both A and B, then you should‘ ;hoose the one that you dislike 16330 Some of the pairs of st eteztlents in the schedule have to do w’th your lilwe such as i and B above. Other pairs of statements have to do with how you feel. Look at the cxen1le belowo A I feel depressed when I fail at stmcthiufio B I feel nervou1hen 51virg a talk before a groupu tenents is more characteristic of how you Which of thes two 0 de oed whe11 you; fail at sonath1 feel? If "e einge pro ing” is more charactcr215tic of you tlw n ”h3:113 Icrvous when giving a talk Before a group," then you shole 0110330 A CVO? Bu If B is more charuetcrm istie of you than A, then you should choose 3 over II If both stator nts describe how gou feel. tnen you should choose he one which you Cthink is more oheiacteristLe. If neither statement accurately desexioes how you feel, xten you should choose the one which you consider to be less inocctretea Your c11oiee. in so ch in st911ee, should he in terms of whn; you lih and how you is c.l at the present tinig and has in terns 31 vh1‘ you think you sh ;.)uld like CI low yet. 12111.11}: yer 9231‘:le feel 331:3 i8 HHS a test. lnere are no r13" or Iron: onswers. Tier-r (‘1:I'Lces s Iould be a description of your own personnl likes and salinen lake a 101cc 103 every pair of st2n3.elt3: 63 r36 Skid ”“Y> The pairs of stotezcnts on the following pages are similar to the examples given shove» Re ed each pair of st Wencnts e 3 nick out the one statement that better deser’Les what you Iii: or how you feel. Put a circle around A or 3 s shoxn he} 35 dcuend :f upon w1ich ,; statement setter de er1'cs whew c choose state -1ent A9 p1t a circle are el1oose B, put a circle around.3 ( do cl 0 ll YOU {A1 ); if you 99 a. a... v a - ~ . u. .1 .- 3 C wv :L .f - . s. .. a... up 1.1.. o n... n. 01.... 4.... I: V. T H d C S 7.1 3 r. 1 C l w u . L . i . .11. aw . v.. . . 1 _ .I" st. 0. A 1 . I ”1. m .. . 4L . . C . .. ..... at. n . 3 I S . . C C. “.131 T. I m... “.4 r . .r.“ .e c u I... . n. 2' '1‘ . - ml. \. .3 .. , n...” n... .. U .1; .3 3L 01. w c. :1 .1. (I. 3.1 . I a: . (i .L m x o . .6 >2. .r ... .‘J . Ill. . J 8 .1 x 1 no 3.. m... 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T. w. s .. «t. 1L. 3 a-“ . . v. .. ., .. ~ . .1. .. A». v1.1.3 n1 . .. ”r. . .. . .. 1 . — a o \4 . n D. u . t I .QIA . .Al» .1. I. a. . ¢.— “I. 60 TIA. 1 “1b “In F. pl‘ fik ”(w «‘ou ‘ . .. . r.‘ l‘|u W . Q.) :15 nA\ V\ a) J Ff» DT¢ r . «It .~ . W . I O L. J 3 «4). k D) c 7 3 . .u , »\ a . A... Va . w i L I . . Q l. I. \o O ,0 'n !J u-o‘ F's I C d 14" ’1‘ .J . C ‘H‘ J l l) 4 \) _. . 13 a... C n, .h. 1.1. A... .. _ L . a... .1, f I" .J T. U .. .. . .5 . . , l n. WI...“ I Q 5 .2 .1 .11 P. f... w. . . Ti 3 a” a... I h a... T 3 2 2 7.. .... a. S .l 3 .l .... . .. .. T S r .E C a... ... .3 v. ..... .l H. _ ._ l. n... C a f. i .i I .3 f C 3 o 2.1. ..i j .3 C .1“ a...” A... ..-.. ... .i. I. ...._ i . 4.1.. «(V .7. .«L .. u .1»... Fl.“ 1.- A . ”VJ “I. a)» .. U Mk. ... n. . _ .. - W .l H C .3 .1. C 7:1 F m; h. T. 3 S 3. r... G .3 . .. n-.. n... T w... i .f n... n... .7“ .1 .. .. T 1 “.... f. ..._ on. 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C O f. a.” no «1 6.... ... -..... . . . . . \J b . 1 l 3 .J t ‘ a.“ .. . . «Hal. 0 1U C Al 8 i f, r. e have s l J 4. .1. ‘3 t}: d U? a o in. th. th 0‘1 I bl ll Ci .- :1. all f A I 1.?" n J'- c I i‘ B A I B A .3 A B A 0 0 9 a... 2 1). 1+ 5 are UL) "r" «.— . a v Ins 5 l ' Lu" -‘..i- l )1. b'v a ’I ,- 5.‘ 'I- i 0' I41...\ I -. .L' I *. T J. 15. 17° 18. 1'9 . 20. 210 100 2 I like to pxl~ t:iefigote in 22. groups in thiel; the members have warm and friendly feelings toward one another. I feel gililty when ever have done so- nothing I H IJrAris wrong. 23. I like to analyze the feelings and Lotives of others. I feel depressed by my own inalility to handle 2h» Various °i+th10P I like my fMieufe BO feel sorry for Le “Len_I on S L Cl". 0 I fecl trite‘ W. 1 1 31?? in and :vsili 3 fj‘lt. 2/. the 11 i would if I tricfi to he. ve my mm VOLT.) I like a suede n to do V118 t I I feel depressc o I"), 7NC TT- 2'. to be and i " J- 1L1} (1") Lance ot:3rs :1. «I- X guilt; ‘) r'i ina lllu/ t :E.-:ns I feel uhflb the pgin cue ij‘ry that I heVa 51f» fE‘Pd hos dogs we Lore good than hzrto I ite to Show 3 great 6’11 of affection toward my 17. friends. I feel bette 3 when I 31v: in fld avoid a fight? thai I 'uould ii I t.* mfi to howw my oxm 37:13.? .. I like to move about the 23. esvntry and to live in dizferen 3 If I do sonething thnt is wrong, I feel that I e',1l C‘ Q ) . .‘, n. - j. \311 J.fa Q ‘1 L if “_ "\ {i P. b a. 0' OH (-1? 9 ' W -r l L 4.3”“, an not 012* '2 '4". ism-3a ‘3 iinll '3 4‘ L “'4’ J}-L;.l;. w .f 93- J. v o be punfi..hem I like to st problem e seem as if I getting wfl on \JLV— U} U [.3 A L) H H 33*:3 H4 HM”) eel Ceorv. em 3y my o‘«_ fiwh.licy io Laldle a “-‘ SJ. 1'1 ‘11:]. 01130 ' ’lOUS ike to PC?J nooks and 1333 i. which sex plays Lajor pa?to V‘- . .. .3. . . I 1331 thee I aL inferior , "» " -— 4- s to otners 1n nose reszectsq I feel llke telllej otler F1. peopl 01f when I dlsagree H .I 2,? 1-5, “a ' If). L1 DILCLJO *3, J..— . “.1. ,1- I 11.1.43 bx Silk/1.] .21 5.. .é-‘Cu'u dual of affeetjo toward WV 3%.“). A 'If‘ ~- Limadhuvo T 5 “Ir. ' (~11 (- - v .-— V‘ I? "a". v- a ”gen tnlnin Jo JT)L Id? he, 1 £321 phlt I a3 lore to I: 1-” .. .3. -.,..,. 3“ Lw Lll e ta~1 :lyone eldc. P . e n ‘-.“ - ' 'L 3.1- c L — 1 l "70 \. -)'“&T.J 14116 - A L ‘ . l' r" 3.. . , 0 , eomhezy old he llxe 1h dlffCFC37 place U '1'»: '1 . m1}, “ . . J- . . .4. I CO 5'} ‘L 4.11. 1.1.3,: 3113'; IS _ " ('0’ "' , . wrong? i lCCl “not I "‘1 C‘ ’7 7“,.) s \ .2 A! '3,‘ .0”) J it “1011.4. a” pLL..‘.L.-ll'....1 .L'~.r o 1 .- . I (3 2.1- fit a 300 C)P -r I. " . L ~- 133701.12“ Cue Nib“: 1“ “‘q r S£¥;? J as 3.. «L11 12.31.: SC'tiJll?£5 anvwke- ‘0 U1 h i'. t. I like to i l .ezl that the man n one misezy thct I iraqe suffered ha: SJLG fl: F033 3936 than 1‘}. 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I 4 ’~ ' I.- ’ x “q; ‘2‘ ‘< .q I -l« ‘w tML» 01:0 111 If: 3,“ lf'IT;.:.' was: {Eu-nil”? 91.024 .4 firm? .1.- LLLQU s: L~:,~-d0? v . - 4633 v - W'— If ye": X'q'Tf‘? 1,.“\."j‘~ifj furl ‘1' I 1 f I; ~ ..‘H‘, W'i-m'--m ‘. . - A. . H -( -.'-—--s.~. ‘ U - ‘ ‘ ‘- mu“. YT ¢ . ‘V , .~ ‘3 h} .|_ ~. .0 . m 3 . “Q"! fill; ETC-2‘3 1' m. {JULI 34111” .‘C, _‘_‘;;;3 .. 3. ADDITIONAL HEALTH QUESTIONS Have you ever thought seriously of killing anyone? If so, who? Have you ever thought seriously of killing yourself? If so, why? Have you ever tried before? When? How? Did you tell anyone about it before you tried? If so, who? Why this person? Do you feel anyone would be affected by your death? Who? How? Did you write a note to anyone? If so, to whom? Who stopped you or rescued you? Did you really want to die at the time? Who do you think would feel saddest at your death? 113 APPENDIX G Scoring Procedures for the Projective Test SCORING CATEGORIES FOR THE PROJECTIVE TEST I. Scoring for Hostility (Fisher & Hinds, 1951) -Card 13, 5, and 7. A. Mode of Expression of Hostility l. Qpenly Expressed Hostility: one character says something hostile to or about another, harms, attacks another. a. Intensely hostile: character physically attacks or kills another. b. Moderately hostile: character attacks another entirely verbally. Subject must mention above themes explicitly. Score: sum of a + b. 2. Indirect or Rationalized Hostility: a. Character attacks or harms another and attack seen as accident, for attacked person's own good, unavoidable. Also, a character commits suicide. b. Characters are harmed, attacked, by impersonal forces, e.g., sickness, death due to old age, etc. Subject must mention above themes ex- plicitly. Score: sum of a + b. 3. AmbivalentlygEgpressed Hostility: a. Character is described as attacking or harming another, then the subject directly and openly denies such a hostile theme. Also, the sub- ject spontaneously denies hostile theme, e.g. "He certainly isn't choking her." b. Character is attacked or harmed by impersonal forces or attack is rationalized (category 2 responses above), then immediately denied. Also, the subject spontaneously denies ra- tionalized or indirect hostility, e.g., "He got sick and died. No, he didn't"; or "He committed suicide. No, he didn't." Score: sum of a + b. 115 rm- II. 116 4. Neutral Content: No forms of hostility expressed, no favorable feeling expressed. Score: Total number of neutral stories.‘ 5. Positive or Favorable Feeling Expressed: One character gives affection, positive feeling, or help to another. Score: Total number of positive or favorable stories. Overtness of Hostility: An index of the overtness of expression of hostility was computed by differentially ,__ weighting the different types of responses given to hostile cards. A weight of 5 was given to overtly hostile responses, a weight of 4 to indirect responses, a weight of 3 to ambivalent responses, a weight of 2 to neutral responses and a weight of l to positive affect responses. The mean scores for the two groups were compared. ID)- | Turning Hostility Upon the Self: The assumption here is that if the subject gives neutral, ambivalent, or positive affect themes to the cards which have been judged to involve hostile affects, then he is probably unable to express hostility outwardly, directly, or effectively and probably turns these hostile impulses inward (Fisher & Hinds, 1951). An index of turning of hostility upon the self was computed and a mean score obtained for each group. Responses given to cards with hostile content were weighted differently with more overt responses receiving less weight: Overt and indirect hostility - weight of 1 Neutral content . . . . . . - weight of 2 Positive content. . . . . . - weight of 3 Ambivalent content. . . . . - weight of 4 Scoring for Hopelessness-Pessimism - Cards 1, 2, 4, 6, 8, 9. A. and 10. Outcome of Stories l. Favorable outcome: a. The total outcome of the present situation is favorable; everything works out for the best. A favorable solution to the situation is ob- tained. III. 117 b. The outcome for right now is unfavorable not entirely satisfactory; however, there is hope and in the future things actually do turn out fine. The future outcome is favorable, satis- factory. Score: sum of a + b. 2. Uncertain outcome: The outcome for the present 13 not good, or uncertain the outlook is dim and it is uncertain, whether the future outcome will be favorable or unfavorable. The story is , left with an uncertain outcome so it is unclear f_‘ whether it turns out favorably or unfavorably. Score: The total number of uncertain outcomes. 3. Unfavorable outcomes, unfavorable future out- comes: The outcome for the present is unfavor- able, unsatisfactory. Additionally, there does a not seem to be any hope for any favorable outcome 1. at any future time. Future outcome is also un- *# favorable, unsatisfactory. No hope at any future time expressed. Score: The total number of unfavorable outcomes. B. An index of hopelessness-pessimism was computed by differentially weighting the responses given. Favorable outcomes were weighted l; uncertain out- comes were given weights of 2; and unfavorable out- comes, weights of 3. Scoring for Suicide Content - Cards 1, 2, 4, 6, 8, 9, and 10. A. Suicide content 1. No suicide content present in the story. 2. Overt Suicide-Completed: The subject mentions suicide and the act is carried out in the story with no rescue. Score: Total number of overt-suicide completed. 3. Overt Suicide-Not completed: a. The subject mentions suicide but the story hero doesn't carry it out because he changes his mind or thinks better of it. A 118 b. The subject mentions suicide but the figure is rescued by someone else or the attempt is unsuccessful. Score: The sum of a + b. 4. Ambivalent Suicide: a. The subject mentions suicide but in such a way as to spontaneously deny it, e.g., "He certainly doesn't look as though he is going to jump out of the window." b. The subject mentions suicide but the hero does not make any attempt and it is not clear whether or not he ever will. Also, the subject mentions suicide and is unsure whether the figure carries it out or not. Score: The sum of a + b. B. An_;ndex of the overtness of suicidal responses was obtained by differentially weighting the suicide re- sponses given to the cards depicting depressive and ambiguous contents. Overt suicide responses in which the act is completed were given weights of 4. Overt suicide responses in which the act is incomplete were given wieghts of 3. Ambivalent suicide re- sponses were given weights of 2. Stories in which no suicide responses appeared were given weights of l. A mean score was obtained for each group and these two means compared. IV. Scoring for Outside Involvement - Cards 1, 2, 4, 6, 9, and 10. A. Internal-External Involvements. 1. Internal: a. No outside involvement cited at all. b. Personal faults, problems are cited as reasons for hero's misfortunes. Score: The sum of a + b. 2. External-chance: Uncontrollable circumstances and fate are cited as reasons for the hero's mis- fortunes. This includes such things as "finan- cial troubles," "unemployment," etc. Score: The total number of stories with chance involvement. B. 119 3. Externaljpersonal: a. Indirect: other people are seen as being in- volved in some way in the occurrence of the misfortune but the nature of the involvement is not clear. b. Direct: other people are seen as being in- volved in some way in the occurrence of the misfortune and such involvement is directly expressed. Score: The sum of a + b. An index of outside involvement was obtained by dif- ferentially weighting responses given to depressive and ambiguous content cards, with regard to the kinds of involvements they suggest. External-personal re- sponses were given weights of 3. External-chance responses were given weights of 2. Internal responses (including responses stating no involvements) were given weights of l. A mean score was obtained for each group and these two means compared. APPENDIX H Personality Subscales from the Edwards Personal Preference Schedule (EPPS) and the Minnesota Multiphasic Personality Inventory (MMPI) NEED-ABASEMENT SCALE (Aba) OF THE EDWARDS PERSONAL PREFERENCE SCHEDULE (28 ITEMS)1 l - (46)2 B.3 I feel guilty whenever I have done something I know is wrong. 2 - (47) B. I feel that I should confess the things that I have done that I regard as wrong. 3 - (48) B. When things go wrong for me, I feel that I am more to blame than anyone else. 4 - (49) B. I feel that I am inferior to others in most respects. 5 - (50) B. I feel timid in the presence of other people I regard as my superiors. 6 - (80) A. When things go wrong for me, I feel that I am more to blame than anyone else. 7 - (85) A. If I do somethings that is wrong, I feel that I should be punished for it. 8 - (90) A. I feel that the pain and misery that I have suffered has done me more good than harm. 9 - (95) A. I feel timid in the presence of other peOple I regard as my superiors. lO - (100) A. I feel that I am inferior to others in most respects. ll - (105) A. I feel guilty whenever I have done something I know is wrong. ‘ 12 - (110) A. I feel better when I give in and avoid a fight, than I would if I tried to have my own way. 1A. L. Edwards, Edwards Personal Preference Schedule (New York: Psychological Corporation, 1953). 2Refers to item number on the EPPS. 3Refers to the statement which is scored as need— Abasement. 121 ' ..B'u- 3" {'cm ' OL'I 'm‘:l 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (115) (120) (121) (122) (123) (124) (130) (135) (140) (145) (150) (196) (197) (198) (199) (200) 122 I feel that I should confess the things that I have done that I regard as wrong. I feel timid in the presence of other peOple I regard as my superiors. I feel guilty whenever I have done something I know is wrong. I feel depressed by my own inability to handle various situations. I feel better when I give in and avoid a fight, than I would if I tried to have my own way. I feel depressed by my own inability to handle various situations. I feel that the pain and misery that I have suffered has done me more good than harm. I feel better when I give in and avoid a fight, than I would if I tried to have my own way. If I do something that is wrong, I feel I should be punished for it. I feel depressed by my own inability to handle various situations. I feel that I am inferior to others in most respects. When things go wrong for me, I feel that I am more to blame than anyone else. If I do something that is wrong, I feel that I should be punished for it. I feel that the pain and misery that I have suffered has done me more good than harm. I feel that I should confess the things that I have done that I regard as wrong. I feel that I am inferior to others in most respects. DEPRESSION SCALE (D) OF THE MMPI (60 ITEMS)4 1 - (2)5 I have a good appetite. (F)6 2 - (5) I am easily awakened by noise. (T) 3 - (8) My daily life is full of things that keep me interested. (F) 4 - (9) I am about as able to work as I ever was. (F) 5 - (13) I work under a great deal of tension. (T) 6 - (18) I am very seldom troubled by constipation. (F) 7 - (23) I am troubled by attacks of nausea and vomiting. (in 8 - (30) At times I feel like swearing. (F) 9 — (32) I find it hard to keep my mind on a task or job. CD 10 - (36) I seldom worry about my health. (F) 11 - (39) At times I feel like smashing things. (F) 12 - (41) I have had periods of days, weeks, or months when I couldn't take care of things because I couldn't "get going." (T) 13 - (43) My sleep is fitful and disturbed. (T) 14 - (46) My judgment is better than it ever was. (F) 15 - (51) I am in just as good physical health as most of my friends. (F) 4W. G. Dahlstrom &.G. S. Welsh, An MMPI handboOk (Minneapolis: 6 Univ. of Minn. Press, l960). 5Refers to item number on the MMPI. S. R. Hathaway & J. C. McKinley, Booklet for the Minnesota Multiphasic' Personality Inventory (New York: Psychological Corp., 1943). 6Dahlstrom & Welsh, op. cit. Direction for scoring the scale. 123 16 - (52) 17 - (57) 18 - (58) 19 - (64) 20 - (67) 21 — (80) 22 - (86) 23-- (88) 24 - (89) 25 - (95) 26 - (98) 27 -(104) 28l-(107) 29 -(122) 30 -(130) 31 -(131) 32 - (138) 33 -(142) 34 -(145) 35 -(152) 36 -(153) 124 I prefer to pass by school friends, or peOple I know but have not seen for a long time, unless they speak to me first. (T) I am a good mixer. (F) Everything is turning out just like the prOphets of the Bible said it would. (F) I sometimes keep on at a thing until others lose their patience with me. (F) I wish I could be as happy as others seem to be. (T) I sometimes tease animals. (F) I am certainly lacking in self-confidence. (T) I usually feel that life is worth while. (F) It takes a lot of argument to convince most peOple of the truth. (F) I go to church almost every week. (F) I believe in the second coming of Christ. (F) I don't seem to care what happens to me. (T) I am happy most of the time. (F) I seem to be about as capable and smart as most others around me. (F) I have never vomited blood or coughed up blood. (T) I do not worry about catching diseases. (F) Criticism or scolding hurts me terribly. (T) I certainly feel useless at time. (T) At times I feel like picking a fist fight with someone. (F) Most nights I go to sleep without thoughts or ideas bothering me. (F) During the past few years I have been well most of the time. (F) 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55‘ 56 57 (154) (155) (158) (159) (160) (178) (182) (I89) (191) (193) (207) (208) (233) (236) (241) (242) (248) (259) (263) (270) (271) 125 I have never had a fit or convulsion. (F) I am neither gaining nor losing weight. (F) I cry easily. (T) I cannot understand what I read as well as I used to. (T) I have never felt better in my life than I do now. (F) My memory seems to be all right. (F) I am afraid of losing my mind. (T) I feel weak all over much of the time. (T) Sometimes, when embarrassed, I break out in a sweat which annoys me greatly. (F) I do not have spells of hay fever or asthma. (T) I enjoy many different kinds of play and recrea- tion. (F) I like to flirt. (F) I have at times stood in the way of peOple who were trying to do something, 110t because it amounted to much but because of the principle of the thing. (F) I brood a great deal. (T) I dream frequently about things that are best kept to myself. (F) I believe I am no more nervous than most others. (F) Sometimes without any reason or even when things are going wrong I feel excitedly happy, "on t0p of the world." (F) I have difficulty in starting to do things. (T) I sweat very easily even on cool days. (F) When I leave home I do not worry about whether the door is locked and the windows closed. (F) I do not blame a person for taking advantage of someone who lays himself Open to it. (F) 126 58 — (272) At times I am all full of energy. (F) 59 - (285) Once in a while I laugh at a dirty joke. (F) 60 - (296) I have periods in which I feel unusually cheerful without any special reason. (F) PSYCHASTHENIA SCALE (Pt) OF THE MMPI (48 ITEMS)7 l - (3)8 I wake up fresh and rested most mornings. (F)9 2 - (8) My daily life is full of things that keep me interested. (F) 3 - (10) There seems to be a lump in my throat much of the time. (T) 4 - (15) Once in a while I think of things too bad to talk about. (T) 5 - (22) At times I have fits Of laughing and crying that I cannot control. (T) 6 - (32) I find it hard to keep my mind on a task or job. (T) 7 - (36) I seldom worry about my health. (F) 8 - (41) I have had periods of days, weeks, or months when I couldn't take care of things because I couldn't "get going." (T) 9 - (67) I wish I could be as happy as others seem to be. (T) 10 - (76) Most of the time I feel blue. (T) 11 - (86) I am certainly lacking in self-confidence. (T) 12 - (94) I do many things which I regret afterwards (I re- gret things more or more often than others seem to). (T) 13 -(102) My hardest battles are with myself. (T) 14 -(106) Much of the time I feel as if I have done something wrong or evil. (T) 7 8 Dahlstrom and Welsh, Op. cit. Hathaway and McKinley, Op. cit. Refers to item number on the MMPI. 9 Dahlstrom and Welsh, op.‘cit. Direction of scoring for the scale. 127 15 16 17 18 19 20 21 22 23 24 25 25 27 28 29 30 31 32 33 34 35 (122) (142) (152) (159) (164) (178) (182) (189) (217) (238) (266) (301) (304) (305) (317) (321) (329) (336) (337) (340) (342) 128 I seem to be about as capable and smart as most others around me. (F) I certainly feel useless at times. (T) Most nights I go to sleep without thoughts or ideas bothering me. (F) I cannot understand what I read as well as I used to. (T) I like to study and read about things that I am working at. (F) My memory seems to be all right. (F) I am afraid of losing my mind. (T) I feel weak all over much of the time. (T) I frequently find myself worrying about something. (T) I have periods of such great restlessness that I cannot sit long in a chair. (T) Once a week or oftener I become very excited. (T) Life is a strain for me much Of the time. (T) In school I found it very hard to talk before the class. (T) Even when I am with peOple I feel lonely much of the time. (T) I am more sensitive than most other peOple. (T) I am easily embarrassed. (T) I almost never dream. (F) I easily become impatient with peOple. (T) I feel anxiety about something or someone almost all the time. (T) Sometimes I become so excited that I find it hard to get to sleep. (T) I forget right away what peOple say to me. (T) 36 37 38 39 40 41 42 43 44 45 46 47 48 (343) (344) (346) (349) (351) (352) (353) (356) (357) (358) (359) (360) (361) 129 I usually have to stop and think before I act even in trifling matters. (T) Often I cross the street in order not to meet some- one I see. (T) I have a habit of counting things that are not im- portant such as bulbs on electric signs, and so forth. (T) I have strange and peculiar thoughts. (T) I get anxious and upset when I have to make a short trip away from home. (T) I have been afraid of things or peOple that I knew could not hurt me. (T) I have no dread of going into a room by myself where other peOple have already gathered and are talking. (F) I have more trouble concentrating than others seem to have. (T) I have several times given up doing a thing be- cause I thought too little of my ability. (T) Bad words, Often terrible words, come into my mind and I cannot get rid of them. (T) Sometimes some unimportant thought will run through my mind and bother me for days. (T) Almost every day something happens to frighten me. (T) I am inclined to take things hard. (T) HOSTILITY SCALE (HO) OF THE MMPI (50 ITEMS)10 l - (19)11 When I take a new job, I like to be tipped Off on who should be gotten next to. (T)1 2 - (28) When someone does me a wrong, I feel I should pay him back if I can, just for the principle of the thing. (T) 3 - (52) I prefer to pass by school friends, or peOple I know but have not seen for a long time, unless they speak to me first. (T) 4 - (59) I have Often had to take orders from someone who did not know as much as I did. (T) 5 - (71) 'I think a great many peOple exaggerate their misfortunes in order to gain the sympathy and help of others. (T) 6 - (89) It takes a lot of argument to convince most peOple of the truth. (T) 7 - (93) I think most peOple would lie to get ahead. (T) 8 - (llO) Someone has it in for me. (T) 9 — (117) Most peOple are honest chiefly through fear Of being caught. (T) 10 - (124) J Most peOplewill use somewhat unfair means to gain profit or an advantage rather than to lose it. (T) 11 - (136) I commonly wonder what hidden reason another person may have for doing something nice for me. (T) 10 W. W. COOk& D. M. Medley, PrOposed hostility and parisaic-virtue scales for the MMPI. J. appl. Psychol., 1954, 38, 414-418. 11 Hathaway &chKinley, Op. cittthefers to item number on MMPI. 12 Dahlstrom & welsh, op. cit. .Direction of scoring for the scale. 130 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 (148) (157) (183) (226) (237) (244) (250) (252) (253) (265) (271) (278) (280) (284) (292) (319) (348) (368) 131 It makes me impatient to have people ask my advice or otherwise interrupt me when I am working on something important. (T) I feel that I have Often been punished without cause. (T) I am against giving money to beggars. (T) Some of my family have habits that bother and annoy me very much. (T) My relatives are nearly all in sympathy with me. (F) My way of doing things is apt to be misunder- stood by others. (T) I don't blame anyone for trying to grab every- thing he can get in this world. (T) NO one cares much what happens to you. (T) I can be friendly with peOple who do things which I consider wrong. (F) It is safer to trust nobody. (T) I do not blame a person for taking advantage of someone who lays himself Open to it. (T) I have Often felt that strangers were looking at me critically. (T) Most peOple make friends because friends are likely to be useful to them. (T) I am sure I am being talked about. (T) I am likely not to speak to peOple until they speak to me. (T) Most peOple inwardly dislike putting themselves out to help other peOple. (T) I tend to be on my guard with peOple who are somewhat more friendly than I had expected. (T) I have sometimes stayed away from another per- son because I feared doing or saying something that I might regret afterwards. (T) 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 (383) (386) (394) (399) (406) (410) (411) (426) (436) (438) (447) (455) (458) (469) (485) (504) 132 PeOple Often disappoint me. (T) I like to keep people guessing what I'm going to do next. (T) I frequently ask peOple for advice. (T) I am not easily angered. (F) I have often met peOple who were supposed to be experts who were no better than I. (T) I would certainly enjoy beating a crook at his own game. (T) It makes me feel like a failure when I hear of the success of someone I know well. (T) I have at times had to be rough with peOple who were rude or annoying. (T) PeOple generally demand more respect for their own rights than they are willing to allow for others. (T) There are certain peOple whom I dislike so much that I am inwardly pleased when they are catching it for something they have done. (T) I am often inclined to go out of my way to win a point with someone who has Opposed me. (T) I am quite often not in on the gossip and talk of the group I belong to. (T) The man who had most to do with me when I was a child (such as my father, step-father, etc.) was very strict with me. (T) I have often found peOple jealous of my good ideas, just because they had not thought of them first. (T) When a man is with a woman he is usually think- ing about things related to her sex. (T) I do not try to cover up my poor Opinion or pity of a person so that he won't know how I feel. (T) 46 47 48 49 50 (507) (520) (531) (551) (558) 133 I have frequently worked under peOple who seem to have things arranged so that they get credit for good work but are able to pass Off mistake onto those under them. (T) I strongly defend my own Opinions as a rule. (T) PeOple can pretty easily change me even though I thought that my mind was already made up on a subject. (T) Sometimes I am sure that other peOple can tell what I am thinking. (T) A large number of peOple are guilty Of bad sexual conduct. (T) DOMINANCE SCALE (DO) OF THE MMPI (28 ITEMS)]'3 1 - (32)14 I find it hard to keep my mind on a task or job. (F)15 2 - (61) I have not lived the right kind of life. (F) 3 - (64) I sometimes keep on at a thing until others lose their patience with me. (T) 4 - .(82) I am easily downed in an argument. (F) 5 - (86) I am certainly lacking in self-confidence. (F) 6 - (94) I do many things which I regret afterwards (I regret things more or more often than others seem to). (F) 7 - (186) I frequently notice my hand shakes when I try to do something. (F) 8 - (223) I very much like hunting. (F) 9 - (224) My parents have Often objected to the kind of peOple I went around with. (F) 10 - (229) I should like to belong to several clubs or lodges. (T) 11 - (240) I never worry about my looks. (F) 12 = (249) I believe there is a Devil and a Hell in after- life. (F) 13 - (250) I don't blame anyone for trying to grab every- thing he can get in this world. (F) 13G. S. Welsh & W. G. Dahlstrom, Basic readings on the MMPI_in psychology and medicine. OMinneapolis: Univ; of Minn. Press, 1956). 14Hathaway & McKinley, Op. cit. Refers to item number on the MMPI. 15Dahlstrom & Welsh, Op. cit. Direction of scoring for the scale. 134 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (255) (267) (268) (270) (304) (343) (356) (368) (395) (419) (432) (483) (523) (558) (562) 135 Sometimes at elections I vote for men about whom I know very little. (T) When in a group of peOple I have trouble think- ing of the right things to talk about. (F) Something exciting will almost always pull me out of it when I am feeling low. (F) When I leave home I do not worry about whether the door is locked and the windows closed. (T) In school I found it very hard to talk before the class. (F) I usually have to stop and think before I act even in trifling matters. (F) ._v .v I have more trouble concentrating than others seem to have. (F) I N 9‘4th a: I have sometimes stayed away from another per- son because I feared doing or saying something that I might regret afterwards. '(T) The future is too uncertain for a person to make serious plans. (F) I played hooky from school quite Often as a youngster. (F) I have strong political opinions. (T) Christ performed miracles such as changing water into wine. (F) I practically never blush. (T) A large number of peOple are guilty of bad sexual conduct. (F) The one to whom I was most attached and whom I most admired as a child was a woman (mother, sister, aunt, or other woman). (F) DEPENDENCY SCALE (Dy) OF THE MMPI (57 ITEMS)16 1 - (9)17 I am about as able to work as I ever was. (F)18 2 - (19) When I take a new job, I like to be tipped off on who should be gotten next to. (T) 3 - (21) At times I have very much wanted to leave home. H9 4 - (24) NO one seems to understand me. (T) 5 — (41) I have had periods of days, weeks, or months when I couldn't take care of things because I couldn't "get going." (T) 6 - (63) I have had no difficulty in starting or holding my bowel movement. (T) 7 - (67) I wish I could be as happy as others seem to be. (T) 8 - (70) I used to like drOp-the-handkerchief. (T) 9 - (79) My feelings are not easily hurt. (F) 10 - (82) I am easily downed in an argument. (T) 11 - (86) I am certainly lacking in self-confidence. (T) 12 - (98) I believe in the second coming of Christ. (T) 13 - (100) I have met problems so full of possibilities that I have been unable to make up my mind about them. (T) l4 - (107) I am happy most of the time. (F) 15 - (138) Criticism or scolding hurts me terribly. (T) 16 L. Navran, A rationally derived MMPI scale to measure dependence. J. Consult. Psychol., 1954, 18, 192. l7Hathaway & McKinley, Op. cit. Refers to item . number on the MMPI. 18Dahlstrom & welsh, Op. cit. Direction of scoring for the scale. 136 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 (141) (158) (163) (165) (170) (180) (189) (193) (201) (212) (236) (239) (259) (264) (267) (304) (305) (321) (337) (338) (343) 137 My conduct is largely controlled by the customs of those about me. (T) I cry easily. (T) I do not tire quickly. (F) I like to know some important peOple because it makes me feel important. (T) What others think of me does not bother me. (F) gs I find it hard to make talk when I meet new 4 people. (T) ' I feel weak all over much of the time. (T) I do not have spells of hay fever or asthma. (F) I wish I were not so shy. (T) My people treat me more like a child than a grown-up. (T) I brood a great deal. (T) I have been disappointed in love. (T) I have difficulty in starting to do things. (T) I am entirely self-confident. (F) When in a group of peOple, I have trouble think- ing of the right things to talk about. (T) In school I found it very hard to talk before the class. (T) Even when I am with peOple I feel lonely much of the time. (T) I am easily embarrassed. (T) I feel anxiety about something or someone almost all the time. (T) I have certainly had more than my share of things to worry about. (T) I usually have to stop and think before I act even in trifling matters. (T) 37 . 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 (357) (361) (362) (369) (375) (382) (383) (390) (394) (397) (398) (408) (443) (487) (488) (489) (509) (531) 138 I have several times given up doing a thing because I thought too little of my ability. (T) I am inclined to take things hard. (T) I am more sensitive than most other peOple. (T) Religion gives me no worry. (F) When I am feeling very happy and active, someone who is blue or low will spoil it all. (T) I wish I could get over worrying about things I have said that may have injured other peOple's feelings. (T) PeOple often disappoint me. (T) I have Often felt badly over being misunderstood when trying to keep someone from making a mis- take. (T) I frequently ask people for advice. (T) I have sometimes felt that difficulties were piling up so high that I could not overcome them. (T) I Often think, "I wish I were a child again." (T) I am apt to hide my feelings in some things, to the point that peOple may hurt me without their knowing it. (T) I am apt to pass up something I want to do be- cause others feel that I am not going about it in the right way. (T) I feel like giving up quickly when things go wrong. (T) I pray several times every week. (T) I feel sympathetic towards peOple who tend to hang on to their griefs and troubles. (T) I sometimes find it hard to stick up for my rights because I am so reserved. (T) People can pretty easily change me even though I thought that my mind was already made up on a subject. (T) 139 55 - (549) I shrink from facing a crisis or difficulty. (T) 56 - (554) If I were an artist, I would like to draw chil— dren. (T) 57 - (564) I am apt to pass up something I want to do when others feel that it isn't worth doing. (T) APPENDIX I Raw Scores for the Personality Scales 141 Table 22. Raw Scores for the Personality Scales for Group I Personality Scales Subject Aba D Pt Ho D0 Dy 1 20 27 29 35 10 31 2 14 29 27 29 12 43 3 l9 5 14 20 12 4 30 8 14 20 2O 5 15 23 10 5 23 ll 6 22 33 30 31 10 37 7 18 l4 13 35 16 26 8 8 37 30 30 18 40 9 13 21 20 22 13 24 10 6 24 20 28 14 28 ll 14 23 19 24 15 34 12 19 33 18 16 8 32 13 18 37 35 32 8 38 14 22 28 14 13 18 24 15 l7 16 29 35 17 38 16 18 18 6 20 15 l4 17 15 40 34 35 10 42 18 23 45 34 18 8 43 19 ll 36 34 16 21 32 20 20 39 41 32 5 45 *7: 142 Table 23. Raw Scores for the Personality Scales for Group II Personality Scales Subject Aba D Pt Ho DO Dy 1 15 28 21 26 15 35 2 10 23 3 12 17 ll 3 16 35 23 6 17 24 4 7 22 16 3O 16 27 5 21 29 17 21 13 32 6 13 24 10 ll 15 17 7 8 22 15 38 17 33 8 19 31 l4 14 12 29 9 ll 30 36 21 12 43 10 20 12 31 16 20 ll 16 3 ll 20 9 12 19 39 32 23 ll 36 13 2 24 9 l9 17 10 14 21 43 40 29 6 52 15 9 l8 4 14 19 ll 16 14 33 38 39 10 45 17 ll 31 31 23 13 42 18 20 32 28 25 13 35 l9 19 33 29 37 12 37 20 ll 17 3 14 20 6 BIBLIOGRAPHY Adler, A. Suicide. J. individ. Psychol., 1958, 14, 57-61. Adler, K. Depression in the light of individual psychology. J. individ. Psychol., 1961, 11, 56-67. Alexander, F. Need for punishment and the death instinct. Int. J. Psychoanal., 1929, 10, 256-269. Ansbacher, H. L., & Ansbacher, Rowena R. (eds.). The in- dividual psychology of Alfred Adler. New York: Basic Books, Inc., 1956. Banen, D. M. Suicide by psychotics. J. Nerv. Ment. Dis., 1954, 120, 348-357. Bruhn, J. G. 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