THE EMOTIONAL REACTION ON ADMISSION
TO A TUBERCULOSIS HOSPITAL

By
DAVID BERGER.

A THESIS.
Submitted to the School of Graduate Studies of Michigan
State College of Agriculture and Applied Science
in partial fulfillment of the requirements
for the degree of
DOCTOR OB’ PHILOSOEHT

Department of Psychology

1952

THE EMOTIONAL REACTION ON ADMISSION
TO A TUBERCULOSIS HOSPITAL

DAVID BERGER

AN ABSTRACT
Submitted to the School of Graduate Studies of Michi
State College of Agriculture and Applied Science
in partial fulfillment of the requirements
for the degree of
DOCTCR OF PHILOSOPHY
Department of Psychology
Approved

1952

David Berger

The p u r p o s e
emotional

or this research was to investigate the

response

on the part of persons entering a

tuberculosis

treatment facility as patients for the first

time*

psychological instruments were used to

Three

evaluate t h e
Association

reaction; the Rorschach, an original Word
test,

Wechsler B e l l e v u e

and the Digit-Span test taken from the
Intelligence Scale#

An e x p e r i m e n t a l group of forty newly-admitted patients
and a m a t c h e d

control group of forty patients who had been

hospitalized, for at least six months were utilized#
experimental

The

group were seen on the day of their arrival at

the h o s p i t a l and again six weeks later in a retest situation#
The c o n t r o l
interval

group was similarly tested twice with a six-week

b e t w e e n tests.

To analyze the effect of the

admission

e x p e r i e n c e on the tests the difference between the

shifts I n

t h e scores in the two groups from the first to

the s e c o n d

test was calculated#

The m a j o r hypothesis tested was that the Initial
admission

into a tuberculosis hospital would provoke a

stress r e a c t i o n recognizable In the test performance#
study wa-s

considered disparate:

i n v e s t i g a t i o n s of
problem

involved

The

from other psychological

the human response to stress#

First the

a real-life situation involving stress as

compared "fc o the more traditional simulated laboratory
stress

e m p l o y e d i n most other studies#

of s t r e s s

Second the effects

were measured over a period of time rather than

David Berger
simply measuring the immediate response under threat as
done heretofore*
The Rorschach test was examined both atomistically in
terms of the single scores and also In its total
configuration*

Atomistically stress tended to affect the

protocol by; (1) decreasing productivity,
reality testing,

(3) decreasing the breadth of interest,

(4) Increasing reaction time,
whole responses,
responses,

(2) Increasing

(5) increasing the number of

(6) decreasing the number ©f common detail

(7) decreasing inner phantasy,

emotional ccntact Y/ith the environment,
feelings of inferiority,

(8) decreasing

(9) Increasing

(10) increasing evasive defenses,

and (11) decreasing the ability to think in terms of group
standards*

In teims of the configurational analysis it

was shown that the entire Rorschach record reflected the
effect of the stress situation*
The Word Association test was analyzed both in teims
of response time and adequacy of response*

The stress

Involved In the admission situation influenced the response
to the test as evidenced by a delay in reaction time as
well as In a less adequate response*

Disturbance on this

test was reflected both in response to specifically
"loaded" words a3 well as to the ittest In general*
Specificity of disturbance was revealed most clearly by
the reaction time analysis while generality of disturbance

3

David Berger
was best reflected by the adequacy of response type of
analysis*
Tbe Digit-opan t ©31 proved capable of measuring the
3tres3 situation in terms of the three scores obtained.
Stress reduced tbe digit s-forward, tbe digits-back ward,
and tbe total digits scores*
Tbe major hypothesis was considered substaribiated b y
tbe results and it was felt that tbe three tests could b e
considered sensitive to tbe type of stress situation
encountered in this study*

Tbe study was also thought to

have heuristic value in promoting a sample and situation
for future research in the problem of anxiety*

ACKNOWLED GMEN TS
The writer expresses deep gratitude to Dr*
Harold H. Anderson# under whose direction this research
was conducted#

The other members of the Committee:,

Dr# Donald Johnson# Dr* Albert Rabin, and Dr* M* Ray Denny
have made invaluable contributions to the formulation and
direction of this project*

The writer is obligated to

Dr* William Howard, Superintendant of William H» Maybury
Sanatorium, and Dr* Kurt Koster, Director of the Diagnostic
Clinic at Herman Kiefer Hospital for their cooperation and
active assistance in designing this research so that it
could be integrated into their patient service programs*
The staffs at the two medical units were most helpful and
generous in the selection of the sample populations and in
the organization of the testing procedures*

The writer is

indebted to Dr* Alvis W* Caliman who rechecked the Rorschach
scoring and to Dr* Richard Filer and Mr* Robert Sinnett
who assisted in rating the Rorschach protocols*

Finally,

the writer would like to express his sincere appreciation
to all the patients whose inspiration and participation
made the research possible*

TABLE OP CONTENTS
CHAPTER
I

PAG-E
THE NATURE OF THE STUDY........... ..........

1

The Disease Tuberculosis .... .............

1

Tuberculosis and Personality............

2

The Hospitalized Patient and his
Environment.............. ...............
II

THE NATURE OP THE PROBLEM. ............

9

....

13

Purpose of the Study*.....................

13

Experimental Design...........

13

Evaluation of the Design.

16

.......

description of Testing Conditions and
Procedure......................

III

18

Description of the Sample............

21

Description of the Instruments............

28

THEORETICAL ORIENTATION.................... .

32

Theoretical Formulation................

33;>

Applicability of the Three Psychological
Tests.................
Hypotheses
IV

35
....................... 39

ANALYSIS OP THE RORSCHACH AS A MEASURE OP
THE ADMISSION THREAT

.................... .

144-

Comparison of Changes in Rorschach
Responses of the Experimental and Control
Samples........................

kh

CHAPTER

V

PAGE
Interpretation of Rorschach Findings*....•

6l

THE RESULTS OF THE WORD ASSOCIATION TEST....

66

Reaction Time Findings.............. .....

66

Findings Regarding Adequacy of Response..*

7^4-

Interpretative Summary of the Word
Association Test F i n d i n g s * •
' VI

ANALYSIS OF THE DIGIT-SPAN FINDINGS..
Results*.

88

.....

88

9L

Interpretation of Findings..... .
VII

SUMMARY...............................

83

93

Findings Related to the Admission Situation

9^-

Conclusions........................... ....

96

BIBLIOGRAPHY..........................................
APPENDIX A .................................
APPENDIX B ................................

99

1

LIST OF TABLES
TABLE

PAGE
I Matched Characteristics of the Sample..

2lj_

II Summated Characteristics of Experimental and
Control Samples....................

27

III Mean Rorschach Scores In the Four Test
Situations.............

i|l|-

IV Comparison of Change from Test to Retest
Between Experimental and Control Groups...*
V Summary of Rorschach Findings

.........

1±6
60

VI Mean of the Median Reaction Times in the Four
Experimental Settings..........

67

VII Differential Reaction Time to Crucial and
Neutral Words in Test I Experimental Group*

69

VIII Differential Reaction Time to Crucial and
Neutral Words in Test II Experimental Group

7°

IX Differential Reaction Time to Crucial and
Neutral Words in Test I Control Group....... *

71

X Differential Reaction Time to Crucial and
Neutral Words in Test II Control Group...*.

72'

XI Differential Reaction Time of Experimental
and Control Groups in Test I to the Entire
Test................................

75

XII Differential Reaction Time of Experimental
and Control Groups in Test I to the Neutral
Words

......

75

TABLE

PAGE'

.XIII Differential Change in Reaction Time of
Experimental and Control Groups to the

7]+

Entire Test..................... ’.......
XIV Response Adequacy in Experimental and Control
Groups

.....................

XV Difference in Number of "Disturbed* Responses
to Crucial and Neutral Words In Experimental
Group in Test I (Crucial X 2)..............

77

XVIDifference In Number of "Disturbed" Responses
to Crucial and Neutral Words in Experimental
Group in Retest (Crucial X 2

78

•

XVII Differences in the Number of "Disturbed"
Responses to Crucial and Neutral Words in
Control Group in Test I (Crucial X

2),.,0»,

79

XVIII Differences in the Number of "Disturbed"
Responses to Crucial and Neutral Words in
Control Group on Test II (Crucial X 2
XIX. Differences
Responses

in

the

)

8

0

Number of "Disturbed"’

to the Total List of Sixty Words

between the Experimental and Control Groups
in Test I.................... .......
XX. Differences

inthe Number of "Disturbed"

Responses

to theNeutral Words between

8l

the

Experimental and Control Groups on Test I..

82

TABLE

PAGE

XXI Difference in Change in the Number of
"Disturbed*1 Responses between the First
Test and the Retest of the Experimental and
Control Groups for the Entire List of Sixty
Words

•. •. ......

83

XXII Digita-Forward, Digits-Rackward, and Total
Mean Scores of Digit-Span Test*...........

88

XXIII Comparison of Change from Test I to Retest in
Experimental and Control Groups on the
Three Digit-Span Scores....................

89

LIST OP FIGURES
FIGURE

PAGE

1I4.

1

Experimental Procedure

......

2

Shifts in Four Rorschach. Variables from Test
to Retest in the Two Groups.,

5

.........

Shifts in the Mean Reaction Time from Test to.
Retest in the Two Groups......*.......*.**.

J4.

68

Mean Number of "Disturbed” Responses in the
Experimental and Control Groups...........*

5

59

76

Shifts on the Three Indices of the Digit-Span
Test in the Two Groups.............. ......

90

CHAPTER X
INTRODUCTION TO THE PROBLEM
A*

The Disease Tuberculosis

Tuberculosis has plagued man from tbe time of tbe
earliest records of civilization*

Institutional care Is a

ratber recent innovation in the treatment program*
Brompton Hospital for consumptives, in London, established
in tbe second quarter of tbe nineteenth century, was tbe
first such facility*

In 1882, Robert Koch, a little known

German physician, discovered tbe tubercle bacillus*

This

discovery was the cornerstone of tbe modern treatment
program, a3 conducted in contemporary sanatoria*
Tbe disease, tuberculosis, is a chronic recrudescent
disease caused by tbe tubercle bacillus*

Today probably

half a million Americans harbor active infectious processes*
Tbe mortality in tbe United States Is approximately
forty-five thousand persons each year*

In 1900, the

likelihood of anyone in tbe United States dying of
tuberculosis was better than five times as great as it is
today*

Re3t, diet, and hygienic measures have been the

major factors of control*

Drug therapy and mechanical

techniques for restriction of lung motility have been
increasingly helpful and promise to reduce the morbidity
further*

2
Despit© the encouragement offered by the many new
medical developments, a visit to any large diagnostic
center will add a sobering note*

One invariably finds

long waiting lists of persons with diagnostically active
tuberculosis biding their time until bed space is
available for them in the public sanatoria*

This country

now has approximately one hundred thousand beds for
persons with tuberculosis outside of mental and penal
institutions (7 )*

^h® balance between the number of

billets in public insitutions and the demand for them is
as precarious now as it was twenty years ago*

More

thorough case-finding techniques, as well as the pressure
of the increasing population, have placed an added burden
on the available facilities*
To meet this situation, hospital administrators and
public health authorities have urged continued research to
find optimal conditions for the growth of healthy lung
tissue*

Activity has been carried forth in many diverse

areas of the treatment program*
B*

Tuberculosis and Personality

Since ancient times, medical people have recognized
the intimate relation between personality and disease*
With the development of scientific medicine there was a
tendency to reduce the interest in personality and to

3
place the major emphasis on organic processes*

In the

last fifteen years* medicine has once more directed its
attention to the impact of personality on disease*

In

this reawakening* psychic influences were accepted initially
only as precipitating factors*

Gradually* a broader

perspective was developed in the psychosomatic movement
which conceived of the personality of the patient and his
illness: as

alternate views of the same unit*

The symptoms

of tonsillitis were* for example* associated in 1955 by
Weizsacher (i+i5)* with severe emotional crises in the lives
of his clients*

Similar observations were reported by

Booth (8 ) in 1955 in attacks of acute encephalitis and
Parkinson 1s Disease*
The psychoanalytic movement has also contributed to
the understanding of medical problems*

The personality of

patients suffering from colitis* as well as that of
gastric ulcer patients* have been described in detail by
Franz Alexander (2),

He maintained that the physical

complaints were caused by disturbed motor and secretory
function^*

In many cases he related this disturbed

function to emotional conflict resulting from repressed
cravings for love and affection*
The relation between the diseased tuberculous patient
and his personality has been studied over a period of
years*

At the turn of the century* articles began to

appear in the literature discussing the possible
correspondence between tbe disease and certain emotional
symptoms wbicb bad been observed witb some regularity*
In tbe last decade and a half, tbere bas been a marked
increase in tbese articles and in tbe attention accorded
them*

However, much of tbe material Is inconclusive and

tbe inconsistent conclusions make for confusion*
Dr* Canby Robinson (33) laid great stress on tbe
distinction between disease and illness, pointing out
that the former is an abnormal state of tbe body resulting
from a foreign injurious agent, while illness Is a process
in which the individual is prevented from performing
efficiently In his usual everyday activities*

Dr*

Robinson asserted that tbe majority of tuberculous
patients who were ill were ill fundamentally as a sequel
to their disturbed and uncontrolled emotions*

Dr* George

W* Crile (9 ) had documented his observations of patienta
driven to chronic invalidism, and at times, death, by
such emotions as fear, grief, and anxiety.
Shultz (38 ) after analyzing the literature on the
emotions of the tuberculous patients in 19M U

found that

the opinions could be organized into three categoriesr
(1 ) that the toxic condition caused the personality
deviations!

(2) that bodily states are Influenced by

emotions, and vice versa, and;

(3 ) that cultural and

5
soelo-eeonomic conditions adversely influence the lives of
the patients and emotional changes are engendered,
Moorman (26) asserted that after the observer
corrected for the increased psychic energy resulting from
enforced physical rest, there seemed to be a marked
excitation of the mind with increased creativity.

He held

that this greater reactivity Is the product of toxic
elements manufactured by the tubercle bacillus,
Thomson's work (i+S) supported

this general thesis.

He

suggested that the toxic agents may be so potent as to
disrupt the patient’s psychic apparatus and produce mental
aberration,

Jelliffe and Evans (18) formulated the

hypothesis that the tubercular condition irritates the
nerve cells causing a general disharmony in cellular
communication,

Hayes (16) suggested that the centers for

nervous and mental control are invaded by the toxins which
render the patient less effective physically and mentally,
Munroe (28) aligned himself with this view and indicated
that it was likely that those of high literary attainment
sind artistic accomplishment such as Brdnte, Stevenson,
Chopin, and Keats were affected in an exaggerated way by
the bacillus, enabling them to create their masterful
productions.

The extreme position taken under this

geheral formula was to show a relationship between psychosis,
particularly schizophrenia, and tuberculosis (12, 20, 21^),

6
This rather radical position has been subjected to
considerable criticism (25., 55 )•
Shock and Jones (57) disagreed with the above views
and maintained that personality changes would more likely
result from the increased reserve of energy attending
compulsory bed rest*

They rejected the position that the

toxic factor was instrumental in the emotional symptoms*
Muhl (27) studied the reaction to tuberculosis in
women and concluded that they revealed a varied personality
picture including increased sexual drive, impairment of
their ability to evaluate ethical problems, cyclic
emotionality, and dissociative trends*

Strecker, et al

(ipl ^ championed the position that depression and anxiety
are the two most prominent emotional responses exhibited.
They felt that increased sexual drive and the euphoric
trends emphasized in other articles were not accurate
observations*

Shultz (59)

made one of the few

psychometric approaches to the problem by administering
the Bernreuter Personality Inventory to tuberculous
patients*

In comparing his results with the general norms,

he found the patients more neurotic,

more lacking In self

sufficiency and self confidence, more Introverted, more
submissive, and more gregarious*

The ambiguity of such

findings emphasizing the Introverted as well as the
gregarious nature of a population reflects the general

7
state of equivocation in the literature*
Another objective attempt is reported in the paper by
Albee (1)* describing his work with two groups of patients,
one composed of veterans with pulmonary tuberulosis, and
the other composed of veterans with chronic illnesses other
than tuberculosis*

The groups were equated as far as possible

and given the Minnesota Multiphasic Personality Inventory
Test (M.M.P#I.)*

Both groups were found to deviate on each

scale of the M*M*P*I* in the direction of maladjustment,
with the tuberculous group significantly more manic and
feminine*

Wo relationship was found between the degree of

emotional disturbance and the severity of. the tubercular
infection*
Opposed to this latter conclusion were the findings
of Elli 3 and Brown (11)*

They compared the totals of

Rorschach summaries of two groups of hospitalized female
pulmonary tuberculosis patients, thirteen in each group#
The two groups were equated except for their prognoses*
One group was classified as a recovery group and the other
as a declining group#

It was demonstrated that the

declining patients as compared with the recovering
patients were less productive and less creative, enjoyed
less emotional contact with their environment, had
narrower interest patterns and were less conventional in
their thinking as these psychological processes are
measured by the Rorschach*

The authors concluded that

8
mental and emotional factors are related to the cure of
tuberculosis.
Another Rorschach study of pulmonary patients wa 3
conducted by Singeisen (IfO).

He compared tuberculous and

cardiac patients with each other and with normals on the
Rorschach*

His results were as follows:
1.

No difference in number of responses among
the three groups.

2.

No difference in reaction time among the
three groups.

5.

Both tuberculous and cardiac patients had a
high per cent of good form in comparison to
normals.

if.

Both tuberculous and cardiac patients gave
fewer movement responses than normals with
the tuberculous patients lower than the
cardiac.

5.

The frequency of color responses was high for
tuberculous patients and low for cardiac.
The tuberculous patients were felt to be the
extratensive type as a group*

6.

There were no differences on the number of
whole responses for the three groups*

7*

There were no differences between the cardiac
and tuberculous patients in the a m o u n t of

shading although both groups were lower than
the normals*

8,

Both pathological groups were low in their
response to white space.

9*

There were no differences in the animal per
cent for the three groups.

10.

The tuberculous group had the highest number
of anatomy responses.

It seems clear that the studies cited have produced
much conflicting material which invites corroboratory
evidence or refutation.

Thus the investigation of the

problem of the personality of the tuberculous patient and
his reaction to the disease is compatible with the
principle to treat the patient who has the disease, rather
than the disease that has the patient*

It was assumed for

the purpose of this study that the character and attitude
of the patient contribute materially to the severity and
duration of his illness.

The present study purported to

demonstrate that psychology can develop certain concepts
of adjustment and maladjustment which may be meaningful in
the understanding of the tuberculous patients.
C*

The Hospitalised Patient and his
Environment.

We have had considerable opportunity in the gathering

10
of our data to observe the patient on his arrival at the
sanatorium and In his response to treatment*

Many patients

bring with them rather distorted ideas of what the
sanatorium will be like*

Some anticipate a dismal, perhaps

bleak institution with coughing patients suffering all
about them*

Others arrive, bolstered by a spirited health

official, expecting to find a sumptuous hotel*

All feel

the sudden impact of their separation from the community
and react accordingly*

One young married woman, whose

husband preceded her into the sanatorium as a patient,
complained that her reception was B:cold and impersonal”.
Another young married woman spoke of fears of being placed
in a ward "with a lot of old women"*
The first few weeks of sanatorium life are many timea
tearful ones*

Admission to a sanatorium mean 3 to many

patients: that the ranks of the family have closed behind
them, and that they are isolated and abandoned*

Sanatorium

life many times involves an Intrinsic alteration in the
life expectancies of the patient*

On the other hand, some

patients may react to the situation in a positive manner*
Such people usually respond to treatment by maintaining
prolonged hospital pesidence*

One such patient with a

minimal amount of disease elected to be bedfast for
twenty—two months despite his doctor's encouragement to
engage in moderate exercise as early as the sixth month of

IX
his hospital stay*

His family were being maintained

through his disability benefits and he was apparently
perfectly happy to spend his time in a leisurely recovery*
The hospital itself means many things to the patients*
For some, it becomes home^ and the previous life is
reflected upon as an unpleasant interlude*

For others, the

new environment becomes repugnant and highly irritating,
the coughing of fellow patients becomes exasperating, the
institutional food is unattractive, and the routinized life
lacks charm*
Bed rest, another aspect of the treatment situation,
involves considerable readjustment on the part of the
patient*

Rest for the tuberculous patient is only remotely

akin to rest when applied to the tired, healthy individual*
For the tuberculous patient, rest means lying in bed on a
single pillow, physically and emotionally relaxed,
twenty-four hours a day, for a year or more as prescribed
by the attending physician*

This does not imply that the

patient is limited to lying on his back*

The repertoire

of positions is dependent upon the extent of the disease
and the area of the lung or lungs infected*

In general,

though, the patient is encouraged to assume different
positions in order to promote pulmonary drainage*
The patient confined to a bed is obviously completely
dependent for all his needs on the attention of nurses and
staff assistants*

Some people find this situation very

12

threatening*

Their old dependency conflicts are activated,

and generate anxiety*

They complain about their position

and reject the prospect of being treated "like a child"*
Others protest against the hospital and complain about
accommodations, food, or their roommates*

There are also

those patients who seem to have adjusted too well, the
patients who are overimpressed with the need to adhere to
bed rest*

Some patients have to be prodded continually to

take the initiative when the time arrives to leave bed*
They become obsessed with the dangers involved in activity
and virtually refuse to resume a normal life after their
disease has been arrested*.

Under such circumstances they

commonly experience symptoms such as fatigue, cold sweats,
and elevated temperatures*

To such people, leaving the

hospital after a long illness is a fearful experience*
Plans for physical a n d vocational rehabilitation often are
completely rejected by this group*

CHAPTER II
THE NATURE OF THE PROBLEM
A*

Purpose of the study

The purpose of the present study was to determine
some of the characteristics of the emotional response of
tuberculous patients on admission to a sanatorium

To

accomplish this task, material obtained from a battery of
three psychological techniques, the Rorschach, an original
Word Association Test, and the Digit Span Test, has been
employed.
B.

Experimental Design

The design of the experiment entailed the use of an
experimental and a control population.

Both populations

were subjected to a test-retest experience.

A group of

incoming patients (hereafter referred to as the
experimental group) were seen and tested on the day of
their arrival for hospitalization*

Six weeks after the

initial contact with these patients, they were retested#
The control group was composed of a matched group of
long-term hospitalized persons (hereafter referred to as the
control group).

This group was seen In a similar test-retest

situation with a comparable six-week interval between
contacts.

In this manner differences in the test-retest

performance of the experimental group were considered
meaningful only if they were significantly different from
analogous differences in the control group.
The procedure of the experiment is represented
schematically in Figure 1.
Experimental G-roup
Test

Control Group
Test

Rorschach
Word Association
Digit Span

Rorschach
Word Association
Digit Span

w
e
e
k
s

w
e
e
k
s

Retest Rorschach
Word Association
Digit Span

Retest Rorschach
Word Association
Digit Span
Fig. 1.

Experimental Procedure

Treatment for tuberculosis may well be described as a
series of stress situations.

A number of situations

peculiar to the treatment program could presumably have,
been selected for study.

The reaction to prodromal

symptoms, the reaction to a positive diagnosis* the
reaction to periodic X-Ray findings, the reaction to
knowledge that surgical intervention has been recommended,
the reaction to a rehabilitation program, as well as the
reaction to discharge itse3.f are all situations which
involve severe readjustments on the part of persons

hospitalized with tuberculosis*

The admission experience

was ultimately selected because it involved but few of the
complications usually encountered in the other situations*
Typically, the admission situation, in some measure,
interrupts ties with the previous way of life*
Different patients may resist hospitalization for
various periods of time, but the act of arriving and taking
up residence is both sudden and abrupt*
discrete*

It is temporally

It has the "here and now" quality which Gordon

Allport described,
time"* (3, p* 5 5 h )

"as an unanalyzable blend of apace and
Further, since hospitalization

Invariably involves considerable time, the patients were
available for a subsequent reexamination*

A population of

newly hospitalized patients is exposed to a fairly uniform
and constant environment*

Hospital life is highly

ritualized with a minimum of opportunity for novel,
external stimulation*

On the basis of these conditions it

was assumed that changes in test performance over the
six-week Interval In the experimental group should reflect
largely the patient* s adjustment to the hospital and his
efforts to restore his effective communication with the
environment after the original stress response to the
admission experience*

We thus had available a group of

persons who-were experiencing an objective, real-life
situation, who were examined and observed over a span of. time.

16
During the six-week interval between the two teats the
patient's .environment was relatively controlled*

It was

necessary# however# to impose one further limitation on the
sample to insure the constancy of the stress situation*
Only those persons who were being hospitalized for
tuberculosis for the first time were included in the study#
C*

Evaluation of Design

In the present study an attempt was made to
Incorporate features which have been disregarded to some
extent in many clinical studies*

First# the major interest

was with persons in a real life situation#

Rabin made a

plea for experlmentation which offers an opportunity "to
become acquainted with human 'life problems* as
distinguished from those frequently dealt with in the
psychological laboratory"*

(ll*.# p* 11 )

This exhortation

seems to be directed against.the clinician's increasing
reluctance to become involved in man's everyday response
to life*
remarks

Yet many of these same clinicians level derogatory
against the experimental psychologist's efforts to

generalize from the rat to man#

Who can say that the

hiatus between man in the laboratory and man in his
everyday pursuits is less crucial than the gap between the
rat in the experimental box and man in life*

The second

feature in the design which warrants particular attention

17
Is th© effort to measure and to examine sequential citanges
in tLuman behavior over a period of time*

In tills manner#

tlie effects of stress can be measured wit bin an
experimental group as well as between an experimental
population and its control population*
A six-week interval was selected between tbe
test-retest contacts to allow tbe patient ample opportunity
to make some adjustment to bis new environment and to
begin to reconcile bis demands witb tbe limitations of bis
new regimen*

Differences in test performance in tbe

experimental group*s performances could conceivably be due
to one of tbree influences or some combination of them*
First, tbe sbock on entering tbe hospital could produce
deviations on test behavior*

Second, tbe six-week

adjustment interval might serve to reduce tbe intensity
of sbock and in turn be reflected on the tests*

And last,

tbe tests themselves may be somewhat unreliable and yield
differences between tbe two performances*
Tbe first two possibilities were consistent witb the
assumptions underlying tbe study*
tests required control*

Tbe reliability of tbe

Tbe group of long-term hospitalized

patients were utilized for this purpose*

18
D.

Description of Testing Conditions
and Procedure

Contact with incoming patients was established at the
Herman Kiefer Hospital and at the William H* Maybury
Sanatorium*

Both are municipally owned institutions

serving metropolitan Detroit*.

Herman Kiefer Hospital is

located in Detroit proper and serves as the community
facility where most of the contagious diseases are routed
for isolation*

It provides bed space for one thousand

tuberculous patients®

Maybury Sanatorium is the affiliated

installation located approximately twenty two miles out of
Detroit, near Northville, Michigan*

Maybury Sanatorium

accomodates approximately eight hundred and thirty
tuberculous patients*

It Is devoted exclusively to the

treatment of tuberculosis*
Contact with long-term patients was limited to the
population at Maybury Sanatorium since there proved to be
fewer restrictions on the research procedure at that
facility*

Assignment of a patient, in Detroit, to one or

the other hospital is adventitious, being a matter
principally of position on the waiting list and bed space
available at any time*
The waiting list for hospitalization was compiled at
the diagnostic clinic at Herman Kiefer Hospital*

All

positive tuberculous cases discovered in Detroit were

19
processed In this clinic*

If the patient decided to enter

a public treatment facility rather than a private
sanatorium, his name was entered on the list*

Those

patients who were acutely ill were given special
consideration and were usually hospitalized as soon as
possible*
On the day the patient entered the hospital, he was
seen Initially by a medical stenographer who obtained
personal data for the hospital records*

A brief orientation

followed during which the patient was given a mimeographed
form explaining the system of regulations and privileges
which govern the treatment program*
reproduced in Appendix A*

This form is

If medically feasible, the

patient was then referred to the author for the purpose of
testing*
author*

All patients were seen individually by the
The tests were administered on each occasion in

the following sequence; Rorschach, Word Association, and
Digit Span*
to May, 1952.

The testing was conducted from December, 1951*
Every effort was made to indoctrinate the

Incoming population as well as the control group with the
impression that the research was sponsored by the
Institution.

The purpose of the study as described to the

subject was to evaluate the Interests and aptitudes of
tuberculous patients so as to be able to appraise the
services offered by "their* hospital•

Patients were given

20
the option of participating*
cooperate*

All but three elected, to

It was explained to both, the experimental and

control groups that they would have an opportunity to try
some further work a number of weeks after the first test*
All but four subjects cooperated in the retest situation
after they had agreed to the first test*

It was necessary

to discard the records of the four who objected to the
retest*
Testing was carried out at Maybury Sanatorium in an
office reserved for the investigator*

At Herman Kiefer

Hospital, where more crowded conditions prevailed, it was.
necessary to use an office adjoining the nurses 1 office on
the admission floor*

In both situations the testing

program was respected by the staff and a minimum of
interruptions occured*

The examiner wore a white coat, the

conventional attire of the professional staff.
was made to make each patient feel comfortable.
were offered*

An effort
Cigarettes

Patients were encouraged to remove their

facial masks which the medical stenographer had instructed
them to wear in the presence of visitors*

Considerable

time was spent in gaining some insight into the patients
frame of mind and in inspiring a receptive attitude to the
tests.

21
E*

Description of the Sample

The total sample numbers eighty subjects* forty in the
experimental population and forty in the control group*
The subjects for the experimental group were selected as
they entered the hospital and the sanatorium*

Medical

considerations were assiduously honored at all times*
Patients entering treatment who were in acute distress or
who were in any manner non-fsasible for our program were
not seen*

An age range of eighteen through forty-six years

was adhered to*

It was also necessary for the subject to

have an average acquaintance with the English language in
order to be able to respond intelligently to the test
material*

A considerable number of displaced persons and

immigrants from Mexico were admitted during the period when
this sample was being

compiled*

The problem of verbaL

facility and fluency in this group was evaluated during the
preliminary discussion with each prospective subject*

The

disproportionately small representation of Negroes in the
research sample as compared to the hospital population
seemed to be due to two factors.

First* the Negro

population in the Institutions appeared to respond more
slowly to treatment and* as a result, fewer beds for
Negroes were available through discharged cases*

Secondly*

the Negroes as a group seemed to be more acutely ill on
admission and were less apt to be cleared for testing*

After working with a newly admitted patient, a control
subject was selected who had been hopitalized continuously
for at least six months#

The control subject was matched

with an experimental subject on the following six variables!
age, sex, race, marital status, education, and diagnostic
classification#

The diagnostic impressions were those

agreed upon by the medical staff on the Tuesday following
admission#

The classification nomenclature of far advanced,

moderately advanced, and minimal were those adopted from the
Committee on Diagnostic Standards of the American Trudeau
Society, Medical Section, National Tuberculosis
Association (39)#

The standards as described by the

organization are as follows:
Minimal — slight lesions without demonstrable
excavation confined to a small part of one or both lungs#
The total axtent of the lesions, regardless of distribution,
shall not exceed the equivalent of the volume of lung
tissue which lies above the second chondrosternal junction
and the spine of the fourth or body of the fifth thoracic
vertebra on one side#
Moderately Advanced — one or both lungs may be
Involved, but "the extent of the lesions shall not exceed
the following limits; slight disseminated lesions which may
extend through not more than the volume of one lung or the
equivalent in two lungs, dense and confluent lesions which
may extend through not more than the equivalent of one
third of the volume of one lung, total diameter of cavities
less than 1|. eras#
Far Advanced — lesions more extensive than
moderately advanced# (59* p. 53 )
For the control group, the diagnostic impression at
the time of their more recent X-Ray report was utilized

23
rattier than ttie admission diagnosis.

It was believed tbat

this would allow for a more accurate matching with the
experimental partner.

Table I lists the total population

in terms of the six characteristics used In the matching
procedure.

Table II is a summated list of the six

characteristic on which the two samples were matched*
Originally it was Intended to match the two groups
on a. seventh variable* the
patient.

socio-economic status of the

However this proved excessively

complicated in

that it made the matching much more difficult.

The data

available on the vocational adjustment of the patient
population was very sketchy and it was deemed unwise to
classify the members of the samples on this basis.

When

the patients were consulted individually the information
obtained from the male population relative to the degree
of skill

involved In their work was qaite precise.

However*

in discussing

thssituation with the female

population, it was found that a large number were not
gainfully employed and that their appreciation of the
degree of skill Involved in their husbands’ or fathers’
work was highly unreliable.

It was decided to limit the

matching to the six variables illustrated In Tables I
and II in the interest of a much more exact comparison.

TABLE I

MATCHED CHARACTERISTICS OF THE SAMPLE

A
Code Ho*

B

c

D

E

F

Age

Sex

Race

Marital
Status

Education

Diagnostic
Impression

I II

I

II

I

II

I

II

G

I

II

I

II

I II

74
50
77
7

174
150
177
107

21
18
Mi33

23
18
45
33

M
F
M
F

M
F
M
F

W
W
W
w

w
w
w
w

M
S
M
M

M
S
M
M

8
11
12
9

9
11
11
8

Mod
Mod
Min
Min

Mod
Mod
Min
Min

17
48
78
53

117
m
178
153

21
19
18
45

20
19
18
41

F
F
F
F

F
F
F
F

w
w
w
w

w
w
w
w

S
M
S
M

S
M
S
M

12
12
11
6

12
11
11
6

Mod
Mod
Mod
Mod

Mod
Mod
Mod
Mod

20
51
13
k9

120
151
113
149'

41
25
22
33

39
26
23
33

M
M
F
F

M
M
F
F

w
w
N
N

w
w
N
N

W
s
M
Sep

M
S
M
Sep

8
11
11
8

7
10
11
8

Mod
Mod
Far
Far

Mod
Mod
Far
Far

}k
42
33
2

134
1^2
133
102

Mi23
28
45

44
24

F
F
F
M

F
F
F
M

w
w
w
w

w
w
w
w.

M
M
M
Sep

M
M
M
Sep

7
10
12
7

8
11
11
7

Mod
Mod
Far
Far

Mod
Mod
Far
Far

45

TABLE I (Cont'd)

J1

B

D

C

E

F

G

I

11

I

II

1

II

I II

I

II

I

39
3
84
15

139

44

41
28
27
43

M
M
F
M

M
M
F
M

W w
W w

M
M
M
M

M
M
M
M

12
12 '.
10

12
12

8
25
70

30

M M
F F
F F
F F

w w
w w
w. w.

M
M
M
M

9

12
11

10
11
12

w

M
M
M
M

10

M
M
M
F

M
M
M
F

w W
w w
w w
w. w

M
M
M
M

M
M
M
M

12
12

M M
F F
M M
M M

w w
w w
w w
w w

M
M
M

M
M

11
12

S

M
S

F
M
M
M

w w
w w,
¥ w
w w

M
M
M
S

M
M

55
73
79
59
11

52
62

75

105

28

184

25

115

45

108
125
170
155

29
3Q
34
35

30
33
35

173
179
159

35
45

34
44

111

26

32
27

152

2?

25
32
37
21

162
175

54
39

41

141

20

8

108
300
164
165

28

!00
64

65

37
26
23

27
38
29
22

F
M
M
M

w w
w w

W;

M
S

II

I

II

Far
Mod
Min
Mod

Far
Mod
Min
Mod

11

Far
Mod
Mod
Mod

Far
Mod
Mod
Mod

12
12
9
12

Mod
Mod
Mod
Mod

Mod
Far
Mod
Mod

12

11
10
10
12

Far
Far
Mod
Min

Far
Far
Mod
Mod

12
10
12
12

12
11
12
11

Mod
Far
Mod
Mod

Mod
Far
Mod
Mod

7

8
12

8

7

9

fo
vjl

TABLE I (Cont'd.)

B

A

C

I

II

I

II

I

26

126
16J
lot
157

26

27

la

ia

25

35
23

M M
M M
M M
F F

6

?

4
57

36

II

D

E

F

G

I II

I

II

I

11

I

II

W W
W W
w w
w w

M
M
M

M

10
9
9
10

9
10
11
12

Mod
Far
Mod
Mod

Mod
Far
Mod
Mod

M

M
M
M

ft.

Explanation of Tablet
Column C— M-Male, F-Female
D— W-White, N-Negro
E— M-Married
S-Single
Sep-Separated
W-Widowed
F— Education (Highest grade completed)
G— Min-Minimal
Mod-Moderately Advanced
Far-Far Advanced
Sub Column I— Experimental Group
II— Control Group

*

27
TABLE IX
SUMMATED CHARACTERISTICS OF EXPERIMENTAL
AND CONTROL SAMPLES

Population
Experimental
Control
Variables____________ Sample________________ Sample
Male

21

21

Female

19

19

Wbite

58

58

Negro

2

2

31

32:

Married
Single

6

6

Separated

2

2

Widowed

1

0

Average Age

31*10

30*98

Average Education

10*23

10*30

Minimal Findings

ij.

Moderate Findings
Far Advanced Findings

26
10

3
26
11

28
F#

Description or the Instruments
1*

The Rorschach Test.

The Rorschach Test is an instrument developed by the
Swiss Psychiatrist, Hermann Rorschach#
original report in 1921 (3^).
series of ten ink blots#

He published his

The test consists of a

The blots are exposed one at a

time to the subject who is instructed to describe' anything
he may see in the blot#

The responses to each blot, as

well as the subject's elaboration of each response elicited
in an inquiry period, are recorded by the examiner#

It is

the record of the subject's response and the scores
assigned to the responses which comprise the data for
experimental analysis#

The tests were administered and

scored by the Beck method (I}.)#
2*

The Word Association Test

The Word Association Test used in this battery was
developed by the author#

The procedure for administering

the test was identical with the original word association
technique introduced as a clinical tool by Jung (19)«

The

Instructions given to the subject were as follows s.
I am going to read a list of words to you one by one#
As I say each word, I want you to say another word, the
very first one that comes to your mind after you hear my
word# I want you to say your word as quickly as you can#
I shall not repeat any words, so if at any time you are not
sure what my word is, respond to what you think It was.
Now, let's try five practice words# Remember now, each
time X give you a word, you give me the first word that you

29
think of*

Are you ready for the practice wordst

The test was composed of sixty words selected from an
original list of one hundred seventy-eight words taken from
the Thorndike-Lcrge Word List (!{-$)•

The original one

hundred seventy-eight words were all common words, occuring
more often than thirteen times in the tabulation of one
million words*

The list was mimeographed and given to a

group of twenty tuberculous patients with instructions to
assign each word to one of five categories with which they
judged the word to have the highest degree of association
in an emotional sense*

The five categories were:

(1 ) family relation and home life
(2 ) social contacts outside the home
(3 ) health
(I4.) economic situations
(5 ) neutral
The final list of sixty words was composed of five
words assigned to eaeh of the first four categories and
forty words assigned to the neutral area*

The average

agreement on placement of the sixty words selected by the
twenty judges was eighty-eight per cent with a range from
seventy-five per cent to one hundred per cent*

The final

list which was administered in the experiment is presented
in Appendix B*

The twenty words assigned to the first

four categories were considered crucial words*

The areas

they were associated with wwre assumed to represent
dimensions of emotional conflict on entering a sanatorium*
The forty words selected from category five were termed
neutral words*
In the presentation of the words the sequence pursued
the pattern of one crucial word followed by two neutral
words.

The crucial words were staggered through the list

so that one word from a crucial category was presented and
followed by two neutral words, then another word from the
second crucial category followed by two neutral words, etc
The responses were scored in terms of the subject’s
reaction time as well as the adequacy of the response word
Reaction times were calculated by means of a mechanical
stop watch calibrated in tenths of a second*

The watch

was activated just after the stimulus word was spoken and
halted when the subject responded*

The adequacy of the

response was evaluated by means of a scale taken from
Sharp (36)* and abridged*

The response was judged on

this scale as disturbed or non-disturbed and one point
was scored for each disturbed reaction*

The scale is as

follows:
Non-Pisturbed
(1) Equivalent - definition or synonym
(2) Logical «* logical relation to stimulus word

31
Disturbed
(1) Chain - related to previous response
(2) Perseverated - repetition of previous
response
(5) Personal - related to self
(lj_) Indeterminate - relationship not apparent
(5) Multiple - more than one word In response
(6 ) Echo - repetition of stimulus word
3*

The Digit Span Test

The Digit Span Test was taken from the Wechsler
Bellevue Intelligence Scale (i+ii-)•

The subject was

required to repeat a series of progressively longer
digits read to him by the examiner*

In the first section

of the test, the subject simply repeated the digits In
the same order in which the examiner presented them*

In

the second section, the subject was asked to reverse the
order of the digits from the sequence of the examiner’s
presentation*

A digits-forward score, a digits-backward

score, and a total score were calculated*

CHAPTER III
THEORETICAL ORIENTATION
' This chapter deals with the theoretical implications
of the experimental setting*

Each test and its place in

the battery is justified, and a number of hypotheses to be
tested in the evaluation of the obtained data are presented,
A*

Theoretical Formulation

In the discussion in Chapter I the impact of the
admission experience on the composure of many of our
subjects was described.

It was from the observations of

these reactions that a theoretical structure was fabricated
for this research.

One outstanding reaction noted, and

perhaps the most striking, was a tense, fearful
apprehensiveness.

Another manifestation was the apparent

lack of communication between the incoming patients as they
waited their turns to speak with the medical stenographer*
The waiting room always seemed the most unfriendly spot In
the hospital.
It did not seem difficult to empathize with these
people.

The predicament of having to change one’s

established patterns of life is a frightening one.

When

a person is obliged to leave his customary environment and
reestablish himself with an alien group, it Is

33
understandable that lie experience considerable anxiety*
It seems fair to say that a change of this type imposes a
certain degree of fear simply because the newly admitted
patient does not know just what to expect*

In most cases,

life has not demanded such drastic redintegrations of him*
Practiced skills for coping with such situations are
conspicuously absent*

No rehearsals have been possiblej

the situation surrounds him and he is now part of it*

It

was also necessary to realize that regardless of his
plight the patient1s previous life had not been without
satisfactions*

How this new and untried way of life could

yield compensating satisfactions was most perplexing to the
newly arrived patient*
Such a conflict situation offered an opportunity to
deal with anxiety In human beings outside of the laboratory,
a precarious business at best*

It was not only a situation

which Isolated people from their daily pursuits but one
which also posed a severe threat to life Itself*

Many

patients expressed Insidious fears of bodily distortion
and mutilation*

The purpose of this study was to measure

the disorganization of behavior associated with this
situation*
Dr* Beck, in his discussion of personality has
pointed out, "The happenings originating outside of him
(the individual) are in Instances grossly destructive,

3k
such, as disease or accidents*

They affect his functioning

equipment, that is to say they alter the unit personality*
For the individual after suffering damage is
self minus some portion of personality*
new person, a new whole * • •

not the old

He is in fact a

Thus in consequence of the

modifications, there has been a reorganization of the
potentialities that remain available and the result is some­
thing other than the old self*"(i4., p* 5 )
We proposed to measure the response to this type of
"destructive happening"' by means of three verbal tests*
Language being the rich clue to personality it is,

it

seemed justifiable to look for the tension struggle in
the words of the experimental population*

As Murphy

contended in his discu33ion of fear and preoccupations
attending anxiety, and the manner in which such
conditions impinge upon the functioning organism,
the tension is there and it suffices"®

• • •

(29, p* 26i+)

In his discussion of traumatic neuroses and the
conditions which prompt them Fenichel stated*

"XJnmastered

qualities of excitement built up b y hudden overwhelming
events as well as by chronic strain, create very painful
sensations of tension"®

(13* P* 118)

It is this tension

which is presumably responsible for the resultant block
In functional behavior and which impels the individual to
mobilize his energies to meet the crihis situation*

It

35
would follow then, that when an Individual is thus obliged
to focus his energies on an urgent external situation, his
response to standard psychological procedures would be
markedly influenced*
At this point we will refer to a distinction made by
Preud wherein he differentiated anxiety into objective
anxiety and neurotic anxiety.

The objective variety was

considered to be appropriate anxiety, being a sort of
dread of an external danger in a very natural or rational
*
>
manner* Neurotic anxiety, on the other hand, waa
characterized as free-floating anxiety which affixes
itself to any available stimulus object*

The concern here

was primarily with the first type, objective anxiety and
the manner in which it influences behavioral responses*
B.

Applicability of the Three Psychological Tests

Now let us examine the stimulus materials with which
this research was concerned*

First, we encounter in the

Rorschach test perhaps the outstanding contemporary
projective device*

What rationale lies behind the use of

this instrument in this experiment?
First, it must be understood that the Rorschach test
is composed of a series of relatively unstructured field
situations with an infinite potential for eliciting
perceptual experiences*

To enhance this neutral value of

36
tiie stimulus material the verbal instructions are
relatively free of set, allowing the subject to project on
the strength of any 3elf~induced motivational pattern*
There is considerable evidence in the literature to
indicate that the Rorschach test is capable of measuring
radical environmental pressures*

Kimble (22), was

in t eres bed in the effects of a social milieu on the test.
He administered the test twice, one time in the standard
situation and again in a situation with two observers
present*

The two situations were offered in reverse order

to half of the sample population in order to control the
test-reteat factors*

The findings were significant for the

experience balance (the movement and color determinants).
The weight of the color was much more pronounced in the
social situation, while the movement responses were
dominant in the standard testing situation.
Other investigators have attempted to simulate real
life situations in the laboratory and to observe the effect
of the manufactured situation on the Rorschach test.
Williams (i+6 ) employed an artificial stress, situation in an
attempt to determine how it was related to intellectual
control and emotional responsivity*

The intellectual

control factor (F Plus) in the Rorschach test was found to
have a moderately high correlation (r ■ *6l) with efficiency
of performance under stress.

The same measure of control

37
(F Plus) when limited

to the achromatic plates was

correlated mj 2 with the external measure of stability under
stress•
Eichler (10) conducted another experiment to test the
sensitivity of the Rorschach test to a simulated stress
situation*

He utilized a threatening shock situation to

induce anxiety in a n experimental group*

His results were

as follows:

1*

Anxiety increased the number of weighted
shading responses*

2*

Anxiety decreased the number of whole
responses*

5*

Anxiety reduced the number of responses*

Three other signs did not reach a n acceptable level
of confidence but came within limits which would make them
at least suggestive*

They were as followst

1*

Anxiety reduced the number of P responses*

2*

Anxiety increased the number of card
rejections*

5*

Anxiety decreased the number of weighted
color responses*

These findings suggest that the Rorschach te 3t is an
efficacious method for estimating the effect of anxiety on
personality structure*

The test was then a means,

in this

research, for assaying the subject’s response to entering

38
the hospital and for evaluating the extent to which the
subject is disturbed through the influence of objective
anxiety*
The second tool, the Word Association Test, has a
long and exalted history in the development of psychological
techniques*

Galton (15) is accredited With devising the

technique later adopted by Wundt and Freud and perfected
by Jung (19),

In its contemporary application (17) there

has been a trend to use the teat to ferret out areas of
emotional conflict*

Since we were interested in the

conflict generated in a specific situation, it was thought
that this technique should prove productive*

Jung's

rationale for the test adds weight to its selection for
this study.

He

maintained that the association

experiment is merely a section from man* s psychological
experience*

For him, daily life itself could be conceived

of as an elaborate association experiment*

Words are

symbolic representations of action and situations*

It is

obvious that people do not always think or behave precisely
or intelligently*

So in the association experiment,

prolonged reaction times and responses of questionable
quality are to be found where the stimulus excites
emotionally accentuated complexes.

The Word Association

Test employed in this research was designed specifically
to activate areas of presumed conflict*

39
The Digit Span Test, the third instrument employed,
is generally believed to provide a measure of the subject*s
capacity to attend freely to external stimulation*
Rapaport asserts that it may be considered a test of
attention, which he considers to be a function of the
"ego's efficacy in controlling these specifically deployed
emotional and intellectual energies so that their
ideational representatives enter consciousness at appropriate
times only" (32, p* 169)*

Attention, for Rapaport, is the

effortless ability to absorb material and to maintain
contact with reality*

If the individual is plagued with

inappropriate affect or anxiety, this ability is often
markedly hampered*

It could be expected, then, that many

individuals confronted with admission to a tuberculosis
hospital will suffer an appreciable emotional response
which should be communicated via a reduced digit span
performance*
To summarize, it seemed that this battery of tests
should reflect the effects of the admission situation as
it impinged on the personalities of the experimental
population*
C*

Hypotheses

The major hypothesis with which this research is
concerned is that the patient's initial admission into a

1^0

tuberculosis hospital generates an appreciable anxiety
reaction.

To investigate this

hypothesis the three

psychological tests were administered, as described and
their results scrutinized for

evidence of anxiety*

A

number of minor hypotheses w a n e formulated in an effort to
predict the manner in which tti© anxiety would be manifested
on each test.

These hypotheses were consistent with the

theoretical framework present ^<1, with the character of the
tests employed, and with rels-tied findings taken from the
literature.
1.

Hypotheses Dealing with ttxe Rorschach Test
(1) Two judges will be successful in identifying the
first record of the t-wr© protocols taken from the
experimental group aa

the more anxious performance.

(2) Anxiety will be instr\xmental in reducing
productivity.
(3) Anxiety will be instrumental in increasing the
number of card rejections*
(It) Anxiety will be instr*\amental in decreasing the
number of whole responses,
(5) Anxiety will be instrxamental in decreasing the
number of human movement responses.
(6 ) Anxiety will be instr-umental in increasing the
weight of shading responses

(F Sh 5 .05*

(7) Anxiety will be instrumental in decreasing the
weight of color responses. (PC • .05* CF 5 1.0*
C = 1.5).
(8 ) Anxiety will be Instrumental In reducing the per
cent of animal forms.
(9 ) Anxiety will be Instrumental In decreasing the
number of popular responses.
Hypotheses Dealing with the Word Association Test
(1) Anxiety will be Instrumental in prolonging the
reaction time of the crucial words as compared with
the reaction time of the neutral words.
(2) Anxiety will be 'instrumental in increasing the
number of disturbed responses to the crucial words
as compared with the number of disturbed responses,
to the neutral words.
(5) Anxiety will be instrumental in prolonging the
reaction time to the total list of sixty words.
(!}.) Anxiety will be instrumental in Increasing the
number of disturbed responses to the total list of
sixty words.
Hypotheses Dealing with the Digit Span Test
(1) Anxiety will be Instrumental in reducing the Digits

Forward Score.
(2) Anxiety will be instrumental in reducing tbe
Digits Backward Score.
(5) Anxiety will be instrumental in reducing tbe
Total Digits Score.

CHAPTER IV
ANALYSIS OP THE RORSCHACH AS A MEASURE OP
THE ADMISSION THREAT
This chapter is devoted to the presentation of the
results comparing the Rorschach response of the experimental
and control groups.

The comparison of the changes in the

various scoring variables In the two groups is reported,
and the hypotheses In Chapter III which deal with the
Rorschach are evaluated in light of the findings presented.
In the second section of the chapter an interpretation of
the results is made*
A.

Comparison of Changes in Rorschach Responses
of the Experimental and Control Samples*

As stated in Chapter II, the design of the experiment
Involved a test—retest situation for an experimental group
and a control group*

The Intent was to demonstrate any

significant differences between the amount of fluctuation
or change occuring in the two samples from the first test
to the retest*

Table III shows the mean scores on the

various Rorschach variables for the four situations;
Experimental I, Experimental II, Control I, and Control II.
A perusal of Table III gives the general impression of
marked change in the test-retest performance of the

TABLE III
MEAN RORSCHACH SCORES IN THE POUR TEST SITUATIONS
Rorschach
Variable

Mean
Experimental
I

Mean
Experimental
II

R
P Plus %
Number Content
Categories
T/1R

16*87
78.1$

24.20

6.72

8.72

21.57

12.89

k%

47.52

44*oo

2.50

4 .9 2
5.25
19.77

H Plus Hd
W
D

5.52

10.90

75.77

45
1.85
1.12
1.95

1.07
5.52
2.64

Sum V
P
4.95
S
I.25
Cards Rejected**
16

«24

Dd
M
Sum C
Sum I

.94
7.50
1.05

* These are total scores, not means.

1

Mean
Control
I

Mean
Control
II

27*75
75.20

28.20
82062

9.82
15.84

9.62
12.41

46.12
5.22
4.25

48.13
3.95
5.40

22.50

21.20

.95
2.15
5.29
1.20

1.4©

.51
7.28
2 o0Q;

2

2.11

2.14
1.71
•5*

6.85

1.32
0

k3
experimental group and. r e l a t i v e l y m i n o r differences in the
performance of the c o n t r o l g r o u p

o n the two tests*

In order to evaluate the r e l a t i v e stability of the
Rorschach results in tire two g r o u p s
scores for each variable
fashion#

the distribution of

was treated. In the following

Each i n d i v i d u a l s f i r s t

test score was compared

with his retest score and. the s h i f t was recorded as a
difference score*

When the f i r s t

higher than the retest score,

the

t est score was numerically
difference score was

given a negative sign t o

i n d i c a t e a drop In score*

the first teat score w a s

n u m e r i c a l l y lower than the retest

score, the difference s c o r e
score resulted when the

is positive*

two scores

When

A zero difference

happened to be Identical*

In order to teat the s i g n i f i c a n c e between the difference
In the two group difference s c o r e s

fexperimental difference

versus control difference s c o r e s ) t h e correlation between
the two samples had to b e talcen i n t o account*
technique for handling

this w a s

in scores for the two t e s t s f o r
with the difference In s c o r e s
matched companion In t h e

to

compare the difference

e a c h experimental subject

for

the two tests for his

c o n t r o l group.

distribution of differences b e t w e e n
utilized to determine w t w v a l u e s *
summarized in Table I V *

The

This

difference scores was.
This process is

C o l u m n s I I and III in this table

were calculated only t o give t h e reader the direction and

TABLE IV
COMPARISON OP CHANGE PROM TEST TO RETEST BETWEEN EXPERIMENTAL AND CONTROL GROUPS

—

Score

n---- m

F

Plus $
C.C.
T/lR

$

A#
I Plus Hd
F

D

Dd
M
Sum C
Sum y
Sum V
P
S

O.lj.2' (a)
7.42
-0,18
•1.56

7.22 (a)
-2.75
1.98
*8.c5

2.05

•3*58
2.65
*2*28
8.88
o,6o
1.80
1*59
*1.08
-O .lk

2.58
-0.20
Card Reject -15 (b)

7

Ti

13.1?
17.74
3.10
10,53

3.22
}.6o
I4.35
14.50

.001
•001
•001

14,91
6.25

2*35

.025 (c)

4.19

5.07
5.70

4.18
3.16
3.13
1.52

0,20

m

Mean Diff.
Column II v D
t
P
Score Between
Minus
Test & Retest
Column III
In Control Group
- - - - - - - - - - - - - --

Mean Diff,
Score Between
' Test & Retest
_ _ _ _ _ In Exp, Group

R

n

o»8o.
1.15

-0.52
1

0,48
-0,02
-1,12
-0 *4.9
0,09
-0,50
*0,70

-2 (b)

6,00
-10,18
2.15

-7.49
-5*62
1,85
•*5.42
9.40
0,12
1,82
2,71
-1,56

-0,22
3.07

0,50

N 0 t

10,30

1,80

3.5,7
7.94
6,67

.005 (c)

N,S,
1,8, (e)
,001

N.S.
.0005 (cl
,0005 (cl
.0005 (c)

0,68 2.15 .05
2,18
8,60 .0005 (c)
N.S, ,
1.97 1.72
C a 1 c u 1a t e d

U7
magnitude of the change*

These figures were not employed

in the computations for Columns IV through VII since the
latter were based on the mean and variance of the difference
between the difference scores distribution*

It should be

noted that seven of the levels of significance In Column VII
were computed by means of the one-tail test of the null
hypothesis* since directional differences were predicted
for these scores in the hypotheses in Chapter III*
At this point it is expedient to analyze Table IV for
a more detailed inpection of the change in each scoring
variable*
1.

Productivity (R)

R is the total number of associations produced by a
subject in any test period.

Beck (5) conceived of R as an

invoice of the personality’s liberation from disabling
conflict situations as well as an indication of
intelligence.

In this study the mean difference between

the group shifts in the score R is 6,800,

Since the

direction of the shift in R was predicted in Rorschach
hypothesis 2 the one-tail test of the null hypothesis was
used.

The ^t11 for a difference this large is % 2 2 which

is significant at ,005 level.

Thus it is possible to

reject the null hypothesis and accept Rorschach hypothesis;
2 with considerable confidence.

2.
The

Tji© P Plus %

P Plus % is the quotient resulting from the

number of good form responses
number of form responses.

(P Plus) divided by the total

Beck believes that F Plus % is,

"an index of accurate perception, of respect for reality,
an index

of ego strength" (5, p. 20>.

mean difference

between the group

In this study

the

shifts in score is - 10*175

Since P Plus was not Included among the Rorschach hypotheses
the two-tail test of the null hypothesis was used to
determine if there was a significant difference between the
differences in the two groups.

This procedure was employed

with subsequent scores when they were not treated in the
Rorschach hypotheses.

The "t" for a difference this large

is 3*60 which is significant at the *001 level.

It may be

asserted with considerable confidence that there is a
significant difference between the amount of change in
P Plus % in the two groups.
3®

Number of Content Categories

(# C.C.)

The number of content categories on the Rorschach
records is generally accepted as a measure of an individual1
breadth of interest, that is, as an indication of the
versatility of his response to the environment*

A large

number of categories suggests a wide range of Interest or
responsivity while a limited number of categories usually

signifies a narrow intellectual perspective.

In the present

study the mean difference between the group shifts is 2 ,150 .
The number of content categories was not included among the
Rorschach hypotheses.
size is

The "t" for a difference of this

which is significant at the .001 level.

It

may be asserted with considerable confidence that there is
a significant difference between the amount of change in
the number of content categories in the two groups*
I}..

Time of First Response (T/lR)

The time for first response is the time which elapses
from the moment the examiner hands the blot to the subject
until the subject produces a scorable response.

This

measure is generally accepted as an index to the ease with
which the subject reacts to his environment*
study the mean difference between the group;

In the present
shifts is

The time of first response was not included among the
Rorschach hypotheses.

The "t” for a difference of this size

Is lj-.50 which is significant at the .001 level.

It may be

asserted with considerable confidence that there is a.
significant difference between the amount of change In the
number of content categories in the two groups.
5*
The

Animal Per Cent (A#)

animal response is a reaction which refers to

50
any specie of animal*
part of one*

It may be either an entire animal ox*

The A per cent is the quotient of the sum of

whole and part animal responses divided by the total number
of responses in the record*

The A per cent is a measure of

the adaptivity of an individual*

In excess, the A response

reflects stereotypy and is seen frequently in feeble minded
persons*

In the present study the mean difference between

the group shifts was « 5 *625 *

T&e "t” for a difference of

this size is 2*35 which is significant at the *025 level*
Thus it is possible to reject the null hypothesis and to
accept Rorschach hypothesis 8 with considerable confidence*
6*

The Number of Human Responses

The human response is a percept which incorporates
either a whole human form or part of such a form*

Included

in this grouping are the simulated human forms such as
mythological characters, ghosts, religious figures, etc*
The H per cent Is the quotient derived from the ratio of
the sum of the responses involving whole human forms and
segmental human forms, divided by the total number of
responses in the record*

The H response Is

generally

assumed to indicate the capacity of the individual to
accept others and to interact with them*

In the present

study the mean difference between the group shifts was
1*850*

The human response was not included among the

51

Rorschach hypotheses*

The "t" for a difference of this

size Is 1*80 which is not significant*

We have no evidence

that there Is a significant difference between the amount
of change in the H per cent In the two groups*
7*

The Whole Response (W)

The whole response represents a perception on the
part of the subject in which the whole blot area Is utilized*
While the W response may be divided Into a variety of
qualitative subtypes such as the additive and Instant kind,
it is generally conceded to be an indication of intelligence,
and more specifically, synthesizing capacity.

Beck (5)

speaks of W as one measure of functioning intelligence.
In the present study the mean difference between the group
shifts is —3 *14.25 *

Since this difference is In the

direction opposite f r o m that predicted in Rorschach
hypothesis 1+. the null hypothesis must be accepted*
However It is clear that there Is a significant difference
between the amount of change in the number of whole
responses in the two groups*

The two-tailed test of the

null hypothesis yielded a nt n of 5®07 which is significant
at the *001 level.

While Rorschach hypothesis

I4. must be

rejected it may nevertheless be asserted with considerable
confidence that there is a significant difference between
the amount of change In the number of whole responses in

52
tiie two groups*

8*

The Large Detail Response (D)

Tlie D responses are tlie commonly seen details of* the
various blots*

Beck (5) indicates that such responses

represent the subject1s ability to deal with the obvious*
When this type of response is accentuated in a record, it
presumably represents a concrete, practical approach to
life on the part of the subject*

In the present study the

mean difference between the group shifts was 9*i|.00*

The D

response was not included among the Rorschach hypotheses*
The "t” for a difference of this size was 5*70 which is
significant at the *001 level*

It may be asserted with

considerable confidence that there is a significant
difference between the amount of change in the number of D
responses in the two groups*

9*

The Small Detail Response (Dd)

The Dd responses are the less frequently seen details
in the ten blots*

The Dd response is generally accepted as

a measure of the subjectts penchant for dealing with small,
minute, perhaps Inconsequential matters in daily life.

In

the present study the mean difference between the group
shifts w a 3 0*125*

The D d response was not included among

the Rorschach hypotheses*

The ”t" for a difference of

53
this size was 0*20 which, is not significant.

We have no

evidence that there is a significant difference between the
amount of change in the number of Dd responses in the two
groups*
10®

The Movement Response

(M)

The movement response as interpreted by Beck (5) is an
index of the subject*s creativity and inner phantasy life*
Credit for a movement response is most often awarded when
the examinee projects human movement into his response.

It

may also* on rare occasions* be credited in percepts'where
animals are engaging in human-like activities or where
inanimate objects are portrayed in obvious motion.

In the

present study the mean difference between the group shifts
was 1*825*

The ^t* for a difference of this size was 3*57

which is significant at the *0005 level*

Thus it Is possible

to reject the null hypothesis and accept Rorschach hypothesis

5 with considerable confidence.
11*

The Weighted C Response

(Sum C)

The use of color in the response to the ink blots is
an indication of the subject's emotional response to his
environment In Rorschach framework*

The previously described

C or weighted G score (Sum C) Is a composite score of the
subject's total response to color*

The Sum C response for

5k
any record provides a measure of tlie intensity of emotional
responsivity*

Xn the present study the mean difference

between the group shifts was 2 *707 *

The "tw for a

difference of this size was J * S k which Is significant at
the *0005 level*

Thus it Is possible to reject the null

hypothesis and accept Rorschach hypothesis 7 with
considerable confidence*
12*

The Weighted Plat Grey Response

(Sum Y)

The Y response Is a reaction on the part of the
subject to the light and dark features of the blots*

Beck

Interprets this type of psychological reaction as an
Indication of anergic passivity* a feeling in the subject
of passivity in the face of threat.
previously discussed*

The Sum Y score waa

In the present study the mean

difference between the group shifts was —1*562.

The fft w

for a difference of this size was 6*67 which is significant
at the *0005 level*

Thus it Is possible to reject the null

hypothesis and to accept Rorschach hypothesis 6 with
considerable confidence*
15*

The Weighted Vista Response

(Sum V)

The Vista Response Is a type of association to the
blots in which the shading induces a three dimensional
affect*

The perception includes the element of distance*

Beck (5) maintained that the vista response is an

55
Indication of a type of self appraisal and ultimately a
reflection of self inadequacy or feelings of inferiority.
Tiie Sum V again is a composite score of weights assigned to
V, VP, and PV consistent with the color formula outlined
for Sum C.

In the present study the mean difference between

the group shifts was -0.22lj_.

The V response was not included

among the Rorschach hypotheses.

The "t" for a difference of

this size is 2.15 which is significant at the .05 level.
It may be asserted with considerable confidence that there
is a significant difference between the weight of vista
responses in the two groups.
l4 .

The Popular Response

(P)

The popular response is a statistical concept.

P

responses are the most frequent association to the blots*
There are a total of twenty such responses to the ten blots.
As Beck described the concept it may be thought of as,
"the highest common denominator of associatlonal content for
the population"f (5* P* 16).

it is conceded by Rorschach

workers to be a measure of communal thinking, an index to
the individual* s ability to conform to social strictures.
In the present study the mean difference between the group
shifts was 3*075.

The "t" for a difference of this size

was 8.60 which is significant at the .0005 level.

Thus it

is possible to reject the null hypothesis and to accept

Rorschach, hypothesis 9 with considerable confidence*
15*

The White Space or S Response

The S response refers to the type of reaction in which
the examinee utilizes the white ground of the blot plate in
the association*

Such responses are considered to represent

either intellectual perseverance or a negativistlc
orientation*

Xn the present study the mean difference

between these group shifts was 0*500*

The S response was

not included among the Rorschach hypotheses*

The wt B for

a difference of this size was 1*72 which is not significant.
We have no evidence that there is a significant difference
between the amount of change in the number of S responses
in the two groups*
16*

Card Rejections

Under the conditions of the test procedure as outlined
by Beck (I4.) a card is considered to be rejected by the
subject if no scorable response is produced within a twominute time limit.

Card rejections are considered to

reflect malignant personality trends encountered almost
exclusively in psychopathological conditions*

In the

present research the number of card rejections was so
limited that the use of the usual statistical tests was not
warranted*

Hence the mean difference scores for the two

samples are presented in order that the reader may evaluate

57
the trend.

It appears that the shift in tlie experimental

group i 3 much, more pronounced than that in the control
population.
17.

The Configurational Analysis

The Rorschach records were also subjected to a
configurational examination as contrasted to the single
factor analysis already discussed.

In this way an estimate

of the total Rorschach was obtained in keeping with the
clinical use of the test*

Two experienced Rorschach workers

were given the eighty records of the experimental group.
Each individual’s two records were paired and clipped
together*

The two records in each pair were aligned in

random order so that the judges had no clue as to which
was the original and which the retest.

The following

instructions were given to the judges.
There are eighty records here, two different records
from each of forty subjects*
The two records of each
subject have been paired off for your inspection*
The
numbers of the paired records are presented below. You
are to check the number of the record in each pair which
you judge to be the more anxious record of the two*
The question of the reliability of the judgments
between the two raters was answered through a chi square
test of their agreement against chance agreement.

The two

judges were in agreement on thirty three out of forty of
the pairs of records.

The chi square proved significant

beyond the one per cent level.

Til© validity of 'tiie judgments was also treated by a
chi square analysis*

One judge made thirty five correct

judgments out of forty pairs of records.

The second judge

made thirty six correct judgments out of forty pairs of
records*

The chi square for the judge with the poorer

record proved significant beyond the one per cent level*
Thus the null hypothesis is rejected and Rorschach
hypothesis 1 is accepted w i t h considerable confidence*
In summary of this section, eight of the nine
hypotheses dealing with the Rorschach test have been
confirmed and accepted at levels of probability which are
scientifically rigorous*

Figure 2 portrays graphically a

number of the shifts from test to retest*

The difference

between the experimental and control groups was always more
pronounced on the first test*

The single Rorschach hypothesis

found untenable (W) was demonstrated to shift significantly
in the direction opposite from that predicted*

There are

supplementary findings in the Rorschach test which are also
of interest, although they were not among the areas for
investigation included in the experimental hypotheses*
Statistically significant shifts in the experimental
performance beyond that in the control performance were
demonstrated for F Plus

number content categories, time

for first response, D, and Sum V*

Table V presents the

summary of the significance tests performed on the
Rorschach scores*

59

25
22

10

Test

Retest

Test

CONTACTS

Retest
CONTACTS

10

9

8
7

6

5
O

Retest

Test
CONTACTS

5

Test
CONTACTS

Solid Line - Experimental Croup, Broken Line-*- Control Group
Pig* 2.

Shifts in Four Rorschach Variables from Test to
Retest in the Two Groups.

60
TABLE V
SUMMARY OP RORSCHACH FINDINGS

I
Score

II
Type of Teat

IIX
Significant
Shifts
Demonstrated

IV
Level of
SignifIcaace

R
F Plus %
$ C •C *
T/lR

1

X
X
X
X

.0 0 5

2
2
2

A&
H Plus Hd
W
D

1

X

.0 2 5

1

X
X

N.S*
N.S.
.001

Dd
M
Sum C
Sum Y

2
X
X
X

.0 0 0 5
.0 0 0 5
.0 0 0 5

Sum V
P
S
Number of Card
Rejects

2

X
X

*05
.0 0 0 5

2
2
1

1
1

Column II —
—

1

N.S*

N.S.

2
5

.001
.001
*001

X

By Inspection

1 — one—tail test used to confirm
experimental hypothesis*
2 — two-tail test used, to eaplore differences
In Rorschach scores not treated in
experimental hypothesis*
3 - raw number presentation*

6l
B*

Interpretation of Rorschach Findings

Before tlie interpretation of the above findings was
undertaken, a justification for the comparison of two
Rorschach populations with significantly deviant response
totals was indicated#

The traditional criticism of a raw

score procedure is grounded in the position that under the
condition where two populations produce deviant response
totals, any difference in the scoring variables is simply
the reflection of the difference in the response totals#
In an effort to handle this alleged difficulty, many
experimenters have become involved in per cent approaches
as well as far more elaborate and abstruse statistical
manipulations*

While it is doubtful whether such

techniques have achieved the purpose for which >they were
*
intended, it is questionable whether they were really
needed at all#

The traditional position in this problem

makes the assumption that the response total is the
independent variable instigating changes in the other
scoring symbols, as It Itself fluctuates#

The position

taken In this research was that the response total Is in
reality the dependent variable mirroring the dynamic
differences in personality reflected In the independent
approach, determinant and content factors*

Certainly the

evidence points to a differential change in the scoring
variables with a change in R«

If the approach, determinant,

62
and content variables were tlie dependent variables they
have been held to be, it would be expected that the scores
would chan ge directly with change in R»

From, the evidence

provided in this study, it may be seen that in instances
where the response total increases, there is a decrease in
certain scoring variables*

It seemed more parsimonious to

take the view that the response total, as such, was simply
a summary statistic dependent upon the remainder of* the
scoring profile for its character*
In general, the direction of the changes In Rorschach
scores was in accord w ith the commonly accepted sign© of
stress on the Rorschach test*
has

In the present study, stress

(1) significantly reduced the responsivity (R),

(2) increased reality testing (F Plus %),
the breadth of interest
time

(T/lR),

(# C*C,),

(5) decreased

(1|.) Increased reaction

(5) increased the number of whole

comprehensive responses

(W),

(6 ) decreased the number of

common detail responses

(D),

(7 ) decreased the amount of

inner living and creativity (M),

(8 ) decreased the

emotional participation with the environment

(Sum C),

(9 ) increased the dysphoric feelings and prompted feelings
of Inferiority (Sum If «■ Sum V),

(10) Increased the need to

be evasive and concrete In response (A%)* and,

(11) reduced

the ability to think in terms of group standards or mores
(P), as these functions are regarded to be measured on the

63
Rorschach*
One finding was at variance with anxiety signs
demonstrated in other studies.

Elchler (10 ), as previously

reported, found that an artificially induced stress
situation he employed tended to reduce the number of whole
responses given.

Postman and Bruner (31) concluded that

stress affected the individual’s ability to perceive a
complex stimulus in its entirety.

In their study the

perception of whole sentences under a stress condition was
impaired.

In the present study stress facilitated the

perception of whole responses.

At first glance this

appeared to be incompatible with the general findings.
Under more precise inspection the whole responses in the
first test of the experimental group were found to be of
the simplest, undifferentiated type*

They probably

represented the most elementary type of response available*
The exorbitant number of bats, butterflies and animal skins
seen In the anxious situation apparently involved a minimal
effort for the individual, undoubtedly requiring less
psychic energy than that invested in delineating the blot
Into Its common large details*
It seems clear that a stress situation such as used in
this research Is capable of altering the immediate
integration of the personality to the extent that the
perceptual apparatus is severely influenced.

The Rorschach

6k
test may be considered sensitive to this type of threatening
situation#

The response to the Rorschach test under the

impact of the stress was notably consistent with the
Freudian position on anxiety#

Freud postulated that the

consequences of an environmentally perceived threat were
typically behavioral anxiety and defensive measures#

The

response to the Rorschach vividly depicts such defensive
structure in operation#

The impression obtained from the

records is one in which the subjects are responding to an
overwhelming need to avoid the frightening implications of
their situation, to reduce their contact with it in every
feasible manner, and to erect a protective barrier of
inactivity#

In essence this describes the popular Rorschach

term "'constriction1*#

Free communication with environmental

forces is reduced, greater reliance is placed on
intellectual controls, and the direction of critical,
processes is focused on the self*
According to Freud,

the psychological structure of

the individual is geared to the purpose of removing
excitation from the organism#

In the case of fear, the

removal process may be accomplished through physical or
psychological exclusion where either the excitation is
deposed or the organism withdraws from contact*

Many

times withdrawal is the only avenue for dealing with the
situation since other means for discharging the fear

65
stimulus are not available*

When such a situation arises,

action toward the stimulus excitation must be postponed
until the means for coping with it have been differentiated*
During the interval in which experimental actions are
undertaken for handling the excitation, the individual may
be said to experience a tension struggle*,

This

apparently

was the situation for a large number of the experimental
population on entering the hospital*

The Rorschach

portrait of their reaction to the stress situation is
compatible with an interpretation of inhibition and delay
of response*

In order to avoid the experience of danger

which might attend the discharge of tension through
immediate action the subjects commonly resorted to a
general retrenchment of their psychic energies*

CHAPTER V
TEE nESuhTS OF FEE WORD ASSOC-lAT-lOE TEST
The findings obtained fros the Word Association test
are presented in this chapter*

In the first section, the

response to the test was subjected to an analysis on the
basis of the s u b j e c t s reaction times*
section,

Xn the second

the adequacy of the response word was

investigated*

Xn the third section,

an interpretative

summary of the findings is presented.
To review the structure of the test,

it should be

remembered that there were sixty wordsordered
sequence each time the test was given*

in the

same

Of the sixty words,

there were forty neutral words and twenty crucial words*
The crucial words were composed of five words assigned to
each of four threatening areas gleaned from the literature
on the adjustment of tuberculous patients*
areas were family relations,
home,

The four

social relations outside the

economic situations, and health*

The words which

were included on the test as representative of these areas
were selected for this purpose in a pilot study with
in—hospital tuberculous patients*
A,

Reaction Time Findings

The reaction time is a measure of the temporal

67
interval which elapsed between the time the stimulus word
was pronounced by the examiner, and the time the subject
responded with an association*

The median reaction time

was calculated for each word*
Table VI lists the mean of the median reaction times in
the four experimental settings.

The reaction times listed

were determined by averaging the medians of each word group*
It may be seen that in each test situation the speed of
response to the neutral words was more rapid than it was to
the crucial words*

In other terms, the latency of response-

time for the crucial words was greater than that for the
neutral words*

The latency factor waa numerically greatest

in the experimental group’s Initial test experience.

Both

populations profited from the first test in that they
demonstrated more rapid responses on the retest.

Figure 5

graphically represents the shifts in the mean reaction time.
TABLE VI
MEAN OF THE MEDIAN REACTION TIMES IN THE
FOUR EXPERIMENTAL SETTINGS
M e a n

R e a c t i 0 n
Control I

T i m e

Exp. I

Exp * II

Total List

3.07

1*85

1.98

1*77

Crucial Words

3.i}-8

1*90

2.01

1 .8 0

Neutral Words

2*66

1 .8 0

1.95

1-75

Control II

68

Crucial Words

Neutral Words

270

515
Mean

Mean

28 0
Seconds
2L 5

Seconds
210

190

210

175

170
Test

Retes t

Test

Retest

CONTACTS

CONTACTS

Total Idst

Mean

205
175

Retest

Test
CONTACTS

Solid Line «■ Experimental Group, Broken Line c Control Group.
Pig, 3 *

Shifts in the Mean Reaction Time from Test to
Retest in the Two Groups,

69
Table VXI summarizes the response latency to the crucial
and neutral words in test one of the experimental group*
To compute this* the average of the medians of each pair of
neutral words which followed a crucial word was computed*
The mean difference was then the mean of the difference
between the median reaction times of each crucial word and
the average of the median reaction times of the two neutral
words which followed it*

The mean difference was found to

be 0819 which meant that the mean response to the crucial
words was *819 seconds slower than the mean response to the
neutral words*

Since the direction of this shift was

predicted in the Word Association hypotheses the one—tail,
test of the null hypothesis was employed.

In subsequent

situations dealing with comparisons treated in the
hypotheses the same procedure was followed*
difference of this size was
.0005 level*

The ”t" for a

which is significant at the

Thus it is possible to reject the null

hypothesis and to accept Word Association hypothesis 1 with
considerable confidence*
TABLE VII
DIFFERENTIAL REACTION TIME TO CRUCIAL AND NEUTRAL
WORDS IN TEST I EXPERIMENTAL CROUP
Mean Difference
.819

Od

.658

t
5*1*-?

E
.0005

70
Xn Table VIII a summary is made of the mean difference
between the reaction time to the crucial and neutral words
in the retest of the experimental group*

‘
The mean

difference technique described for Table VII was here again
utilized*

The mean difference was 1 * 0 2 signifying a longer

reaction time again,, for the crucial words*

Since this

situation was not included among the Word Association
hypotheses the two-tailed test of the null hypothesis was
used*

This technique was followed with all the subsequent

situations not treated in the Word Association hypotheses*
The "t" for a difference of this size was found to be 2 . 2 7
3t may be asserted

which is significant at the *05 level.

with considerable confidence that the crucial words
required more time for response than the neutral words in
the experimental group’s retest*
TABLE VIII
DIFFERENTIAL REACTION TIME TO CRUCIAL AND NEUTRAL
WORDS IN TEST II EXPERIMENTAL GROUP
Mean Difference
1.02

t

<TD
1.98

P

2.27

*05

In Table IX a summary is made of the mean difference
between the reaction time to the crucial and neutral words
in the first test of th6 control group.

Employing the

71
same mean difference technique, the difference was found
to he *060*

In this situation the crucial words once again

yielded a longer reaction time*

This situation was not

included among the Word Association hypotheses.

The "t"

for a difference of this size was .77 which is not
significant.

We have no evidence that there i3 a real

difference between the reaction time to the crucial and
neutral words in the control group's first test.
TABLE IX
DIFFERENTIAL REACTION TIME TO CRUCIAL AND NEUTRAL
WORDS IN TEST I CONTROL GROUP
Mean Difference
.060

T

C D

t

•514-2

.7 7

In Table X a summary Ismade of
between the reaction times to

Not
Significant

the mean difference

thecrucial

in the retest of the control group*

P

and neutral words

The same mean

difference method was used and the difference obtained was
•0V?> again demonstrating the longer reaction time for the
crucial words.

This situation was not included among the

Word Association hypotheses.

The nt n for a difference of

this this size was .063, which is not significant

We have

no evidence that there is a real difference between the

72reaction time to the crucial and neutral words in the
retest of tiie control group.
TABLE X
DIFFERENTIAL REACTION TIME TO CRUCIAL AND NEUTRAL
WORDS IN TEST II CONTROL GROUP
Mean Difference

<Td

•c4 7

3 .2 8 3

t
.0 6 5

P
Not
Significant

Table XI summarizes the mean difference in the
reaction time of the experimental and control groups in
test I to the entire list of sixty words*

The mean

difference of 1*115 was computed by comparing each
experimental record with the record of the matched control
subject*

The experimental group took an average of 1 . 1 1 5

seconds longer to respond in the first test than the
control group.
1

5

The nt ff for a difference of this size was

which was significant at the . 0 0 0 5 level*

Thus it

is possible to reject the null hypothesis and to accept
Word Association hypothesis 5 with considerable confidence*

73
TABLE XI
differential reaction

time

of e x p e r i m e n t a l a n d

control

GROUPS IN TEST I TO THE ENTIRE 'TEST
Mean Difference
1.115

(P D

t

566

P

.0005

Table XII summarizes the mean difference in the
reaction time of tiie experimental and control groups in
test I to tiie neutral words.

The mean difference was

obtained as described for Table XI®

It was found to be

•712, which, reveals the longer reaction time to the neutral
words in the experimental group as compared to the control
groupo

This situation was not included among the Word

Association hypotheses.

The "t* for a difference of this

size was 1 5 *9 * which was significant at the . 0 0 1 level.

It

may be asserted with great confidence that the experimental
group1s reaction time to the neutral words on the first test
was significantly retarded as compared to the control group*s
reaction time to the neutral words on the first test*
TABLE XII
DIFFERENTIAL REACTION TIME OF EXPERIMENTAL AND CONTROL
GROUPS IN TEST I TO THE NEUTRAL WORDS
t

Mean Difference

.712

.1 3 6

1 3 .9

P
.001

Table XIII summarizes the mean difference in the change
of the reaction time from the first test to the retest in
the two groups to the entire test of sixty words.

These

differences were computed by finding the difference between
each experimental person1s difference and the matched
control person's difference.

The mean inter group difference

was l,06l which indicated that the experimental group had a
mean difference l»06l seconds greater than the control
group.

This situation was not included among the Word

Association hypotheses.

The *t" for a difference of this

size is 1 3 oU2 which is significant at the , 0 0 1 level.

It

may be asserted with great confidence that the experimental
g r o u p s reduction in reaction time from the first to the
second test was significantly greater than the control
group's ""reduction.
TABLE XIII
DIFFERENTIAL CHANGE IN REACTION TIME OF EXPERIMENTAL
AND CONTROL GROUPS TO THE ENTIRE TEST
Mean Difference
1.061

B,

<Td
.609

t
15*1+2

P
.001

Findings Regarding Adequacy of Response

The adequacy of the individual's response to the
stimulus word was evaluated on the previously discussed

75
scale taken from Sharp.

Each, response was scored adequate

or disturbed*
Table XIV reports the mean number of disturbed
reactions in the four experimental settings*

The number of

disturbed responses was calculated for the total list of
words, for the crucial list of words, and for the neutral
list of words*

This table was analyzed in detail as was

the similarly constructed table dealing vL th the reaction
time dimension*
TABLE XIV
RESPONSE ADEQUACY IN EXPERIMENTAL AND CONTROL GROUPS
Mean
Exp. I

Number of
Disturbed Responses
to Total list
2*25
Number of
Disturbed Responses
to Crucial Word3
*75
Number of
Disturbed Responses
to Neutral Words
1 *14-8

Mean
Exp* II

Mean
Control I

Mean
Control II

•
CD
O

Score

1*00

.14-5

*55

•55

•15

.1*8

.65

• 50

Figure I4. graphically represents the mean 'number of
disturbed responses in the experimental and control groups*

76

Crucial Words

Neutral Words

1.50

.85
Mean

Mean

1.25

.70
Number
of .55

Number
of
1.00
Disturbed
.75
Responses
.50

Disturbed.

.1+0

Responses
.25

.10

Test

25

Retest

Test

CONTACTS

.

Retest
CONTACTS

Total List

2 1+0
Mean

2.00

Number
of
1.60
Disturbed
1.20

Responses

.80
.1^0

Test

Retest
CONTACTS

Solid Line » Experimental Group, Broken Line » Control Group.
Pig. 1+.

Mean Number of Disturbed Responses in the
Experimental and Control Groups.

Table XV summarizes the mean difference in the number
of "disturbed" responses to crucial and neutral words to
test I in the experimental group*

The number of disturbed

responses for each crucial word was doubled in order to
control for the greater number of neutral words in the word
list*

The mean difference found was *02 indicating that

there was an average of *02 more disturbed responses to
crucial words than disturbed responses to neutral words®
The "t" for a difference of this size was .l+O* which is not
significant®

Thus we must accept the null hypothesis and

reject Word Association hypothesis 2 since there is no
evidence that there is a real difference between the number
of disturbed responses to crucial words and the number of
disturbed responses to neutral words in test I for the
experimental group*
TABLE XV
DIFFERENCE IN NUMBER OF "DISTURBED" RESPONSES TO CRUCIAL
AND NEUTRAL WORDS IN EXPERIMENTAL QROUP IN TEST I
(CRUCIAL X 2:),
Mean Difference
.02

Vi

2*501

t
.IfO

p
Not
Significant

Table XVI summarizes the mean difference in the number
of "disturbed" responses to the crucial and neutral words

78
to tiie retest in the experimental group*

The number of

disturbed crucial words was again multiplied by two to
adjust for the original difference in frequency*

The mean

difference found was *22, indicating that there was an
average of *22 more disturbed responses to crucial words
than to the neutral words*

This situation was not included

among tbe Word Association hypotheses*

The "t" for a

difference of this size was *905> which is not significant*
We have no evidence that there is a real difference between
the number of disturbed responses to crucial words and
disturbed responses to neutral words in the retest for the
experimental group.
TABLE XVI
DIFFERENCE IN NUMBER OF "DISTURBED" RESPONSES TO CRUCIAL
AND NEUTRAL WORDS IN EXPERIMENTAL GROUP IN RETEST
(CRUCIAL X 2)
t

Mean Difference
*22

1*518

p

*905

Not
Significant

Table XVII presents the mean difference in the number
of "disturbed" responses to the crucial and neutral words
to the first test In the control group*

The number of

disturbed crucial words was doubled in the analysis as
discussed in the description of Tables XV and XVI*

The

79
mean difference found was *08, indicating that there was sn
average of *08 more disturbed responses to crucial words
than to the neutral words*

This situation was. not included

among the Word Association hypotheses*

The "t" for a

difference of this size was *32* which is not significant*
We have no evidence that there is a real difference between
the number of disturbed responses to crucial words and
disturbed responses to neutral words in test I for the
control group*
TABLE XVII
DIFFERENCES IN THE NUMBER OF "DISTURBED1* RESPONSES TO
CRUCIAL AND NEUTRAL WORDS IN CONTROL GROUP IN TEST I
(CRUCIAL X 2)
Mean Difference

*08

(T D

t

1*56

*32

P
Not
Significant

Table XVIII summarizes the mean difference in the
number of "disturbed" responses to the crucial and neutral
words to the retest in the control group*

The number of

disturbed crucial words was adjusted by the formula
described above*

The mean difference found was -**02

indicating that there was an average of *02 more disturbed
responses to the neutral words than to the crucial words*
This situation was not included among the Word Association

8o
hypotheses.

The nt w for a difference of this size was .15?

which is not significant*

We have no evidence that there is

a real difference between the number of disturbed responses
to the crucial words and disturbed responses to neutral
words in the retest for the control group*
TABLE XVIII
DIFFERENCES IN TEE N U M B E R OF "DISTURBED” RESPONSES TO
CRUCIAL AND NEUTRAL WORDS IN CONTROL GROUP ON TEST II
(CRUCIAL X 2}
Mean Difference
-.02

<Td
•7Q1

P

1/

•15?

Not
Significant

Table XIX summarizes the findings re1stive to the
adequacy of response to the total list- of sixty words in
terms of the difference between the experimental and control
groups in test I*

The difference was calculated by comparing

the number of disturbed responses in the record of each
experimental person and the record of the matched control
person*

The mean difference is 1.2?5 indicating that the

experimental group had an average of 1.2?5 more disturbed
responses to the first test than did the control group*

The

"t" for a difference of this size was if*09 which is
significant at the *0005 level*

Thus the null hypothesis

may be rejected and Word Association hypothesis if accepted

j

81
since we have considerable confidence that the experimental
group has significantly more "disturbed1* responses in the
first test performance than the control group©
TABLE XIX
DIFFERENCES IN THE NUMBER OF "DISTURBED"RESPONSES TO THE
TOTAL LIST OF SIXTY WORDS BETWEEN THE EXPERIMENTAL
AND CONTROL CROUPS IN TEST I
Mean Difference
1.275

<n>
1.951

i w 09

.0005

Table XX. summarizes the findings relative to the
adequacy of response to the list of neutral words in terms
of difference between the experimental and control group on
test I.

The differences were obtained by comparing each

experimental record with the matched control record*

The

mean difference is *85, indicating that the experimental
group had an average of ©85 more disturbed responses to the
neutral words In the first test than did the control group*
This situation was not included among the Word Association
hypotheses*

The "t" for a difference of this size was 5*52

which is significant at the *001 level*

It may be asserted

with considerable confidence that the experimental group has
significantly more disturbed responses to the neutral words
in the first test experience than has the control group*

82
TABLE XX
DIFFERENCES XN THE .NUMBER OF "DISTURBED" RESPONSES TO
THE NEUTRAL WORDS BETWEEN THE EXPERIMENTAL AND
CONTROL GROUPS ON TEST I
Mean Difference

C* D

1*6q L|.

.85

t
3.32

P

♦oox

Table XXI summarizes the mean difference in the change
of the number of disturbed responses from the first test to
the retest in the two groups for the entire list of sixtywords*

These differences were obtained by finding the change

in each experimental person* s two records and comparing it
to the analogous change in his matched control*s two records#
The mean difference was *850* which indicated that the
experimental group had a mean difference change in the
number of disturbed responses of *850 greater than the
control group*s change*

This situation was not included

among the Word Association hypotheses*

The "t” for a

difference of this size is 2*60 which is significant at the
•05 level*

It may be asserted with considerable confidence

that the difference between the change in the reaction time
to the whole test in the experimental and control groups is
significant*

83
TABLE XXI
DIFFERENCE IN CHANGE IN THE NUMBER OF "DISTURBED1*1
RESPONSES BETWEEN THE FIRST TEST AND THE RETEST
OF THE EXPERIMENTAL AND CONTROL GROUPS FOR
THE ENTIRE LIST OF SIXTY WORDS

<r d

Mean Difference

.850

C*

2*014-3

P

t

2.60

.05

Interpretative Summary of the Word Association
Test Findings

Hie direction of the findings in terms of the reaction
time factor was in every case consistent with the
theoretical orientation*

Stress invariably

retardation in the response of the subject*

provoked a
The analysis

of the adequacy of the response was not as convincing*
Consonant with the theoretical implications of the
anxiety-producing situation the experimental

group

consistently produced more "disturbed" responses than the
control group*

However when the number of disturbed

responses to the crucial words was compared wLth the number
of disturbed responses to the neutral words no significant
difference was found*

It should be emphasized that while

no significant differences occured on this level of analysis,
the direction of the differences found was with but one
exception suggestive of a trend toward greater disturbance

814.
in reaction to the crucial words.

Tiie one exception resulted

in tiie retest situation of tiie control group, the response
to tiie neutral words required a longer reaction time than
did the crucial words*

Xn general,

then, it may be said

that- the stress has delayed the reaction of the subjects
and influenced the subject in the direction of less adequate
or more "disturbed" responses*

The adequacy of the response

in terms of the proximity of the stimulus word to the stress
situation is far from conclusive.
The evaluation of the efficacy of the crucial—neutral
word dichotomy in demonstrating a stress reaction on the
test produced results of interest.

The Word Association

test as a clinical instrument has been employed under two
distinct theoretical frameworks.

As already mentioned,

Jung was the first to use the test.

He maintained that

there was a specificity of response so that the individual's
tension areas or complexes were reflected in the atypical
response to words which are psychologically related to these
areas*

In this framework, the test could be utilized to

Isolate emotionally laden personality conflicts.

Kephart

and Eoutche.ns (21) disputed Jung* s formulation that "complex*'
words are followed by disturbed responses.

They presented

evidence to show that scores on the association—motor test
are independent of the word list used.

They found subjects

earned fairly consistent scores on two different lists.

85
Further* they emphasized tiie finding that little or no
relationship in disturbance was found on identical words in
two different tests*
The present study provided evidence to support the
contentions of both theories;
of Jung’s position* and*
by Kephart and Houtchens.

(1) the specificity approach

(2) the generalized reaction held
The crucial words were selected

to determine if patients arriving for hospitalization were
sensitive to areas associated with their immediate situation.
In defense of Jung’s position it may be seen that the
experimental group was sufficiently disturbed to respond
with a significantly slower reaction to the crucial words
in both the first and second test situations*

On the other

hand* the analysis of the comparison of the crucial and
neutral words in terms of response adequacy did not prove
significant In any of the four testing situations, while
the comparison of the experimental and control groups’
adequacy of response to the total test was highly significant.
This would lend weight to the Kephart-Houtchens point of
view*

Perhaps the important factor contributing to these two

antagonistic views Is the variable utilized in the analysis.
Jung* s specificity view was confirmed by means of a reaction
time treatment while the Kephart and Houtchens position was
made more credulous by scoring the response on the basis of
Its adequacy*

86
Another finding of some substance waa the apparent
method of defense against stimulus material inimical to the
personality*

The results would strongly suggest that many

times the adequacy of the response was sustained at an
acceptable level at the expense of a delay In reaction time*
Within the limitations of the reliability of the two
methodologies the data indicated that an analysis of the
Word Association test is more profitably made on the basis
of reaction times rather than the system of adequacy of
response used in this research*
One final conclusion seemed warranted by the Word
Association findings* namely, that the type of tension
generated in the experimental situation was manifested as
free floating anxiety*

It was shown that the experimental

group was significantly more distressed in its response to
neutral words in the first test performance than was the
control group in its first test performance*

This was.

demonstrated In terms of both reaction time and adecjiacy of
response.

Thus there is evidence to show that in responding

to an objective external danger,

the human organism;: often

times demonstrate activity which suggests a type of neurotic
or free floating disturbance*

The anxiety becomes

associated with environmental materials not necessarily
closely related to the objective threat*

The distinction

proposed by Freud between objective and neurotic anxiety

87
may well be a purely speculative distinction abstracted
from tbe complexities of tiuman response patterns*

CHAPTER VI
ANALYSIS OF THE DIGIT SPAN FINDINGS
The digit—span test was tiie third test administered to
the two populations*

The digits were pronounced one each

second and an effort was made to avoid any modulation or
variation in voice quality throughout the many series.

The

scores were retained in raw form rather than converted into
weighted scores*
A*

Results

In Table XXII the mean raw scores lor digits forward,
digits backward,

and total performance are presented.

It

may be seen that the experimental group achieved an increment
in their retest over their first test for each of the three
scores*

The eontrol group demonstrated contrasting results

in that they produced only nominal changes from the first
test to the retest,
TABLE XXII
DIGITS FORWARD, DIGITS BACKWARD, AND TOTAL MEAN SCORES OF
DIGIT-SPAN TEST
Exp, I

Exp* II

Cont, I

5*57

6*4 9

6,20

6,22

Digits Backward. i+.OO

5*13

5*05

4.98

11.65

11,22

11,20

Scores
Digits Forward.
Total Score

9*58

Cont, II

89
Figure 5 represents graphically the shifts in the two
groups on the three indices of

the Digit-Span test*

The

difference between the experimental a n d control groups was
always more pronounced on the first test*
Table XXXII summarizes the changes in the three
scores earned by the two research populations on the
Digit-Span test*

On the Digits-Forward test the experimental

group demonstrated a mean increase from test I to the retest
of *87 greater than the control group*

The ”t B for a

difference of this size is I|.*58 which is significant at
the *0005 level*

Thus the null hypothesis may be rejected

and Digit-Span hypothesis 1 may be accepted with considerable
confidence*
TABLE XXIII
COMPARISON OF CHANGE FROM TEST I TO RETEST IN EXPERIMENTAL
AND CONTROL GROUPS ON THE THREE DIGIT-SPAN SCORES
Score

Diff. Mean
Difference

D

t

P

*87

1.20

it.*58

.0005

Digits-Backward

1*25

1*36

5*68

.0005

Total Score

2.12

2*13

6.221

.0005

Digits-Forward

90

5.4-0

6.55

5.10

6.35
Digits
6.15
Forward,
5.95
Score
5.75
5.55

Digits
k . 8o
Backward
4.50
Score
i+.20
3.90
Test

Retest

Test

Retest
CONTACTS

CONTACTS

11.75
11.30
Total

10*85
Score

10*40
9.95
9.50
Test

Retest
CONTACTS

Solid Line * Experimental Group, Broken Line » Control Group.
Fig. 5.

Shifts on the Three Indices of the Digit-Span
Test in the Two Groups.

■■■

f l

On the Digits-Backward test the experimental group
demonstrated a mean increase from test I to the retest of
1*25 greater than the control group.

The "t" for a

difference of this size is 5.68 which is significant at
the .0005 level.

Thus the null hypothesis may be rejected

and Digit-Span hypothesis 2 may be accepted with considerable
confidence.
On the total-digits score the experimental group
demonstrated a mean increase from test I to the retest of
2.12 greater than the control group.

The *rt w' for a

difference of this size Is 6.22 which Is significant at
the .0005 level.

Thus the null hypothesis is rejected and

Digit-Span hypothesis 5 ia accepted with considerable
confidence•
B*

Interpretation of Findings

The direction of the significant changes found in each
case conformed with the theoretical framework employed In the
research.

The experimental group*s performance on the three

scores obtained indicates that the stress situation has
impaired their attention.

It was also shown that the

impairment was more obvious on the Digits—Backward score
than on the Digits-Forward score.

This is further evidence

for the effect of the stress since the Digits-Back ward
score is considered more vulnerable to tension.

Thus the

92
results attest to a deficit in Immediate memory, and a
generalized reduction In efficiency in the experimental
population at the time of admission may be Inferred*
It seemed justifiable to conclude that the Digit-Span
test Is a sensitive tool for measuring the type of anxiety
aroused in this study*

CHAPTER VII
SUMMARY
The purpose of the present investigation was to assay
the emotional reaction to the initial hospitalization of
persons with active tuberculosis*

The Investigation was

conducted by means of three psychological Instruments; the
Rorschach, an original Word Association test, and the
Digit-Span test taken from the Wechsler Bellevue Intelligence
Scale•
An experimental group of forty persons who were newly
admitted patients, and a control group of forty persons who
were hospitalized continuously for at least six months, were
used In the investigation of the admission reaction.

The

experimental group was seen on the day of arrival in the
treatment facility*

The control group was matched

individually with the experimental group on the six
variables; age,

sex, race, education, diagnostic finding*

and marital status*

All tests were conducted indlvldually*

The design of the research involved a test-retest for both
populations with a six-week Interval interposed between
contacts*

The analysis of the data was carried out

primarily by means of the comparison of differences between
the test results from the first test to the retest In the
two groups*

McNemar (25 ) has discussed and justified this

9k
approach to the study of shifts in behavior in two groups
over a period of time,

Preliminary observation of patients’

reaction to hospitalization furnished the basis for the
hypotheses pertinent to this problem*

The major hypothesis

was that the initial admission into a tuberculosis hospital
would provoke a stress reaction recognizable in the test
response*
A*

bindings Related to the Admission Situation

The Rorschach was treated statistically both
atomistically in terms of the single scores, and in ita
entirety by means of an evaluation of the total configuration*
In general, the atomistic changes on the Rorschach related
to stress were;

(1 ) a decrease in

productivity,

(2) increased reality testing,

(5) a decrease In the breadth

of interests,

in reaction time, (5 ) an

(J4.) an Increase

increase in the number of whole comprehensive responses,
(6 ) a decrease In the number of common detail responses,
(7 ) a decrease in Inner phantasy and creativity,

(8 ) a

decrease In emotional participation with the environment,
(9 ) an increase In dysphoric feelings, and feelings of
inferiority,

(10 ) an increase in the need to be evasive

and concrete In response, and

(11) a decrease In the

ability to think in terms of group standards*

It was also

demonstrated that the Rorschach could be used as a measure

95
of total personality adj ustment In tills stress situation*
Two judge 3 were very successful in selecting the first
Rorschach records as the more anxious from the two Rorschach
records of each person in the admission group*
The Word Association test was composed of crucial and
neutral words*

Crucial words were words emotionally related

by in-hospital patients to areas mentioned in the literature
as sources of conflict for tuberculous patients*

Neutral

words were not readily associated with these areas*

The

test results were analyzed in terms of reaction time and
adequacy of response.

The stress, involved in the admission

situation influenced the response to the test as evidenced
by a delay in reaction time and a less adequate response*
The analysis of the differential response to the crucial and
neutral words revealed statistically significant differences
in reaction time.

No significant differences were found

when analysis was made on the basis of response adequacy*
An attempt was made to reconcile the antagonistic views of
the interpretation of the test as promoted by Jung and by
Kephart and Houtchens*

Jung’s specificity of response

point of view was corroborated by an analysis of response
in terms of reaction time*

Generality of response as

sponsored by Kephart and Houtchens* was substantiated by
means of analyzing the adequacy of response*

A further

analysis of the test indicated that the stress situation

itSi

was manifested as free floating anxiety rather than as
objectively fixed anxiety*
The Digit-Span test proved capable of measuring the
stress situation in terms of the three scores obtained*
Stress reduced the digits forward, the digits baclcward, and
the total digit scores.
B*

Conclusions

First, it seemed clear that the three tests have
justified their employment*

Each test has proved capable

of eliciting a differential response in the type of stress
condition utilized in the study*

Aside from minor

discrepancies, the results obtained were consistent with
the theoretical orientation discussed in Chapter XII and
the major hypothesis has been ratified*
The Implications of the present -study for the
treatment of tuberculous patients were quite real*
that patients,

It seemed

on entering the hospital, were

psychologically distressed*

Their ability to behave

integratively and to deal maturely with their situation
was hampered.

They were fearful and unable to mobilize

their best efforts to understand the new environment*
It has been shown that this reaction is a generalised
anxiety pattern in which the tension is affixed to any
convenient environmental object.

Thus, It was plausible

97
for a patient to fear the nurse during his early adjustment
to the hospital even though he had no contact with her
”strepn needle*

It Is fallacious to expect the newly

admitted patient to appreciate the reality of his situation.
Perhaps the more serious indoctrination programs should be
postponed for a month or so until the tension can begin to
dissipate itself*

Ideally, this early adjustment period

would involve as much individualized attention for the
patient as the hospital facilities will permit.

Counseling

and psychotherapy, when medically feasible, should be
undertaken at the earliest possible point in the treatment
program*

The patient should not be called upon to make major

decisions regarding his own treatment or the care of his
family during this period*

His response is apt to be much

more adequate if he is given an opportunity to relieve his
tension before the burden of his own welfare or that of his.
family is imposed upon him*

It would seem that unless the

dominant household and familial conflicts are settled prior
to hospitalization,

the treatment program may be Irreparably

disrupted*
The present study is also thought to have heuristic
value in so far as it describes a sample and a situation
which seemingly may be employed for future research in the
problem of anxiety*

The methodological limitations of

l a b o r a t o r y ” stress have been acknowledged by most reputable

workers.

The possibilities for extending our information

and understanding of the real-life response to stress seems
promising#

BIBLIOGRAPHY
1 Albee, G, W, Psychological Concomitants of Tuberculosis*
Amer, Rev* Tuberculosis, 1914-8, 58 (#6), 650- 661,
2 Alexander, Franz: The Influence of Psychologic Fscfcors
upon Gastro-Intestinal Disturbances i A Symposium#
Psychoanalytic Quarterly, 193^4-* 3* 501-518,
5 Allport, Gordon W, Personality* A Psychological
Interpretation* New York, Henry H clt and Company,.
1937I4. Beck, Samuel, J» Rorschach's Test I*
Grune and Stratton, 19^4-9•
5

Basie Processes#

, Rorschach's Test II, A Variety of
Personality Pictures, New York, Grune and Stratton,
191*9 *

6 Beck, Samuel J., Rabin, Albert I,, Thie 3en, Warren G,,
et al* The Nonaal Personality as Projected into
the Rorschach Test, J, Psychol., 1950* 3°* 214.1- 298,
7 Blakeslee, A, L, The Killer Cornered, Nat'l
Tuberculosis Ass'n Public Affairs Pamphlet No, 156,

8 Booth, Gotthard C,

Paralysis Agitans der Nervenarzt,

1935* 8 , 69.
9 Crile, George W, Studies in Exhaustion,
19l*a» 1*. 150.

Arch, Surg#,

10 Eichler, R, M, Experimental Stress and Alleged Rorschach
Indices of Anxiety, J« Abn, and Soc, Psychol,, 1951*
14-6, 5I44- 355 .
11 Ellis, Robert W,, and Brown, Gladys G,,
The Nature of
Rorschach Responses from Pulmonary Tuberculosis
Patients« J, Clin, Psychol., 1950, (July),
298-300:.
,

12 Fenga, E, Tuberculosis and Dementia Praecox* RIvista
di Pathologia, Nervosa e Mentale, 1935* b5> k-7&~k&3*
13 Fenichel, Otto
The Psychoanalytic Theory of Neurosis,
New York, W, W, Norton and Co., 19^5*

1I4. Foster, A., Benton, A, L#, and Rabin, A# I,

The

100
Internship in Clinical Psychology*
Psychologist, 1952, 7* 11*
15 Galton, P*

Psychometric Experiments*

American
Brain, 1879* 2,

ll}.9«*l62.

16 Hayes, E* W* The Prognosis in Tuberculosis with
Especial Reference to the Psychological Aspects*
Ann* Int. Med., I 93O-I 93I, k> H 85 .
17 Huston, P* E., Shakow, D., and Erickson, M. H. A Study
of Hypnotically Induced Complexes by Means of the
Luria Technique* J* Gent* Psychol., I 93I4-* H * 65~97*
18 Jelliffe, S. E., and Evans, E* Psychotherapy and
Tuberculosis. Amer* Rev* Tuberculosis, 1919**3-9^0,
5, U17.
19 Jung, C* Studies In Word Association* English
Translation, London, Heineman, 1918 *
20 Kallman, P* J. The Genetics of Schizophrenia.
J* J* Augustin, 1938*

New York,

21 Kephart, Newell and Houtchens, H*
The Effect of the
Stimulus Word Used upon Scores in the Association
Motor Test. Amer. J. Psychiatry, 1957* 9^4-* 393~399*
2 2 Kimble, G* A*
Social influences in Rorschach Records.
Jr* Abn. and Soe* Psychol*, 1914-5* I4-O* 89-95*

23 Kopeloff, L. M., Kopeloff, N*, Hinsie, L. E., and
Etchells, J* L* Tuberculosis Bacillemia and
Dementia Praecox.
J* Baet., 1935* 30* l4-9“59*
2J4.

Loewentstien, E. Tuberculosis Bacteria as Cause of
Schizophrenia*
Psychiat.-Neurol* Wehnschr*, 1933-*
33* 379-331.

25 McNemar, Quinn

Psychological Statistics*
John Wiley and Sons, Inc., 1914-9*

26 Moorman, L« J* Tuberculosis and Genius*
U* of Chicago Press;, 1914-0.

27 Muhl, Anita M*.
Approacht

New York,
Chicago,

Tuberculosis from the Psychiatric
A- Follow Up. Psa* Rev*, 1929, l6> 397*

28 Munroe, D* G. M. Psychopathology of Pulmonary
Tuberculosis.
Lancet, 201, 55^~557.

2 9 Murphy,

Gardner Personality : A Biosocial Approach to
Origins and Structure* New York and London, Harper
Brothers, 19ip*7♦

^0 National Tuberculosis Society, Diagnostic Standard «•
Classification of Tuberculosis, 1950 Edition*
31 Postman, L* and Bruner, J. S* Perception under Stress.
Psychol. Rev*, 19l|£* 55# 3 1 I4--5 2 3 .
32L Rapaport, David Diagnostic Psychological Testing. Vol. I*
Chicago, The Year Boole Publisher, Inc., 1914-8 *
33 Robinson, Canby The Patient as a Person.
Commonwealth Fund, 1939*

New York, The

3 I4- Rorschach, H*

Psychodiagnostik Methodik and Ergebnlsse
Eines Wahrnehmungsdiagnostischen Experiments. (3rd Ed.)
Berlin, Huber, 1937*

35 Rothschild, D*, and Sharp, M. L. Frequency of Active
Tuberculosis in Hospital for Mental Diseases with
Special Reference to Schizophrenia* New England J*
Med., 1 9 3 6 , 2 1 I4., 9 2 9 - 9 3 !^
3 6 Sharp, D* L.

Group and -Individual Profiles in the
Association Motor Test. University of Xowa.
Studies in Child Welfare, 1 9 3 8 , 15, 9 7 -I 7 I*

37 Shock, N. W„, and Jones, H . E. Mental Development and
Performance as Related to Physical and Physiological
Factors.
Rev* Educational Research, I 9 I4-I, 11, 551*
3 8 Shultz, I* T.

The Emotions of the Tubercular: A Review
and an Analysis. J* Abn* and Soc* Psychol., 19^2,
11# 551.

39

How Near Normal are Tubercular Patients
in Public Sanatoria* Psychol. Bull., I9J4-I, 3 8 , 557*

I4.0 Singeisen, F* Rorschach befunde be I Chronisch Lungen—
tuberkielosen and Herzkranken. Schweiz Arch* Neurol*
Psychiat., I9 I4.O, I4.5 , 2 3 0 **-2 i4.7 * (Cited in Barker,
R# G*, Wright and Goniek. Adjustment to Physical
Handicap and Illness t. A Survey of the Social
Psychology of Physique and Disability* Soc* Sci*
Res. Council Bull*, I 9 I46 , 55, 121-122.)
lj.0 Strecker, E® A., Braceland, F. J*, and Cordon, B.

102:
Mental Attitudes of Tuberculosis Patients*
Hygiene, 1958, 22, 529*

Mental

J+2 Thompson, B® A®
The Relationship of Tuberculosis to
Nervous and Mental Diseases. Med. J. and Record,
I 929, 129, 690 .
43 Thorndike, E. L. and Lorge, Irving.
The Teachers Word
Book of 30,000 Words. New York, Bureau of
Publications, Teachers College, Columbia University,

19l*lt-.
44 Wechsler, David The Measurement of Adult Intelligence.
Baltimore, The Williams and Wilkins Co., J r d Ed.,
191*4.
45 Weizsacher, Victor Studien Aur Pathogenese*
Georg Thieme Verlag, 1935*

Leipzig,

I4.6 Williams, Meyer An Experimental Study of Intellectual
Control under Stress and Associated Rorschach
Factors. J® Consulting Psychol., 1947* H * 21— 29 .

APPENDIX A
EXERCISE CLASSIFICATION FOR TUBERCULOUS PATIENTS
Bed Rest Stage 0
Full nursing care*

Position in bed, number of pillows,

etc,

to be decided by physician.

No radio, television, reading,

writing,

except by permission of doctor#

or other acitivity,

No smoking*
needs#

May be moved from bed for only the most urgent

Physician may limit visiting to members of the

family as he feels necessary to patient's welfare.
Bed Rest Stage I
Patient may not be out of bed except on physician’s order*
May sit up for bedpan only*
while lying down*

May read and write short letters

No card playing.

No telephone calls

except emergency with permission of doctor. May listen to
radio and view television if assisted in tuning.
Transportation always per stretcher*
and brush teeth.

Wrap sputum cup

supplies for this if necessary).

Wash hands and face

(attendant to set out
Shampoo on order of doctor*

Bed Rest Stage II
Patient may sit up to perform daily personal toilet and for
all meals.

Assist with own bed bath (attendant will always

wash back and may help with washing legs).
on stretcher.

No card playing.

sack at bedside.

Shampoo monthly

Wrap sputum cup and change

May sit up to read or write letters for

short periods only if permitted by doctor®

Transportation

per1 stratciier*

(on table if

Supplies to be within reach

dresser i3 not close enough to bed)*
Bed Rest Stage III
May sit on bedside chair for bedmaking,

barbering, and for

one or two periods up to 20 minutes per day as prescribed by
physician*
back)*

Take own bed bath (attendant to wash and rub

0* T«

(Occupational Therapy) on prescription*

Transportation by wheelchair*
Moderate Exercise Stage I
May walk to bathroom once in morning for bowel movement and
while there may wash face and hands, brush teeth* etc*
bedpan and/or urinal remainder of day and night*
per wheelchair*
in chair*

Use

Transport

Shampoos may be given with patient sitting

0* T*, school work, and rehabilitatation services

on doctor*s permission*
Moderate Exercise Stage II
May walk to bathroom twice daily*
bath (attendant to clean tub)*
night only*

May take tub or shower

Bedpan and/or urinal at

Care of own drinking glass, water bottle*

Transport per wheelchair when leaving ward*
laundry®

Prepare hisi

105
Moderate Exercise Stage III
Bathroom three times daily*
urinal and b e d pan,)
paper sacks*

(Patient to care for his own

Wrap

dispose of sputum cup and

May use phone during hour3 permitted*

Straighten bed*

Church or movie passes if permitted by-

doctor*
Moderate Exercise Stage IV
Bathroom permission.
clinic, 0* T., etc*

Clean tub

himself*

Walk to X-Ray,

May attend church, movies and other

entertainments when issued permit card by physician*
Patient to straighten and make own bed, keep table and
dresser tidy*

May visit other patients with permission,

play cards or other games in solarium*
Exercis e Stage I
Patient may walk to the dining room for meals as prescribed
by the doctor.
Exercise Stage II
May take walking exercise outside the building (inside during
bad weather) as prescribed by physician*

Equivalent time

may be spent in 0* T, Dept, doing craft or similar activity*
Complete responsibility for bed and bedside unit*

APPENDIX B
WORD ASSOCIATION IIST
Practice Words - hat, foot, boat, save, strong*
1*
20
>o
..
5.
6.
7.
8.
9o
10*
11*
12.
13.
l4®
15 *

I

family
barrel
box
party
chalk
copy.
appetite
cover
eagle
income
early
echo
child
far
feather

crowd
* forest
18 . frog

16

doctor
giant
grass
bills
green
hill
household
insect
leaves
dance

..
22 .

19*
20
21

23,*
2ij_.

25.

26

.

27.

28

.

29* mixture
30* moon

31* examination
32. mountain
narrow
debt
post
I I I river
57* home
38. mud
9* round.
o. friend
ij-i. second
42. sheep
hospital
spin
45- stone

li

I

a

46. money
string
suppose
49* marriage
50. swift
51* sword
52. community
53* thick
54® thunder
55® fever
56. valley
57* white
580 expense
open
59
* wave
oO «

hi.