‘3 w I II ' L *li' 4 ‘ \ N bl I II | 1‘ ‘ r l p 3 I J! ‘l‘ ‘l . |‘ l‘ ; !L H W H II I M (1 XII“ |' y ( fi 03—: hJCD £>cn THS Simi}arity of Personality Constellations of ‘lcoholics and Lthcr So?octed HOSpittliZCd CrOUps h .. .by PaLrICIa Pol], Duane Cromwell, Doris Spalsbury, and Fldcne Crockett Aw 13355553 L.‘5r“f..F-*;[§',‘§ M:~."r-H(JAN STA} E UNIV; f-Aifl LANSIN(‘:_ MICH «in? .2 4- 'i 1' 8. w.__..—a---I'- _..._- ~— '“fi‘i-TIP M...“ BSTRAC The purpose of this study was to determine the similarity of a per- sonality constellation in alcoholics and other selected groups: manic depressives, manic type; psychoneurotic depressives; and schizophrenics, paranoid type. It was hypothesized that we would find a common perso- nality constellation occurring in the alcoholics and members of the other groups. A sample of one—hundred cases, representing the four diagnostic groups, was obtained from Ypsilanti State Hospital, Ypsilanti, Michigan. The data was gathered through an inventory of personality traits appear- ing in the cases, and the statistical method of pattern analysis was utilized to process the data. The pattern analysis included one-hundred observations, fifty-two variables. six response categories, and four criteria categories. The minimum discrimination level was set at . 60 and the minimum significance level was set at .0001. Cur hypothesis was not supported, in that, a core personality was not found in the alcoholic. In contrast, the other criterion groups pro- vided specific classic personality patterns. Patterns elicited for the alcoholics were clusters of items discriminating the absence of traits. SIMILARITY OP PERSONALITY C ONSTELLATICNS CF ALC CHCLIC S AND OTHER SELECTED HOSPITALIZED GROUPS by Patricia Peil Diane Cromwell Doris Spalsbury Aldene Crockett A RESEARCH REPC RT Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF SOCIAL WORK SCHOOL CF SOCIAL WORK 1967 lid ‘0 AC KNQ-WLEDGMENTS The authors wish to express their appreciation to Dr. Gwen Andrew for her assistance in formulating and interpretating this project. We would also like to thank Jim Clark, Computer Center for his patience, time, and effort; and Alexander P. DuKay, M .D. , Medical Superintendent, and Hans von Brauchitasch, M.D. , Director, Division of Research of Ypsilanti State Hospital for their cooperation in supplying case records and suggestions . ii .1t‘r.". .7. 0 -',,.‘. ‘ ‘s L.. R' ‘f‘9§ )il 4).); . d‘flfiS'an to nymivihl .x'ait‘;1l’.l . . I V. '1 pnlvlmua 01 our : 'iq'mu: 'x' ’1‘? .‘ 1’? I I . a V I); o I D l (i I J! ‘7.- - ,__." ‘X‘ ' ‘l": g "‘ Vi...’ , . 'i? L 'A .. 1’ I 0 u TABLE OF CONTENTS Page Introduction.............. 1 Method................ 3 Instrument Development . . . . 3 Inventory........... 4 Sample............ 6 Data Analysis and Results ..... . 8. Discussion of Results . . . . . . . . . 12 Conclusions.............. 15 Bibliography.............. 16 iii o . . s. “ LIST OF TABLES Table Page 1 Patterns Elicited . . . . . . . 19 2 Discrimination Capacity of Patterns Elicited by Criterion Groups . . . . 21 iv IN TRODUC TICN The increasing presence of alcoholism in our society has evolved into a problem of major concern. During the past twenty years, various dis- ciplines, including physiology, sociology, anthropology, psychology, and psychiatry have attempted to deal with the problem. To date, a clearly defined etiology does not exist. (15, 16, 28) Although there is no known cure for the addictive state, it is agreed by all investigators that total abstinence is required to arrest the progressively disintegrative psychological and physical processes. (1-34) It is estimated that there are 4,589 ,000 individuals in an addictive state labelled alcoholism. (34) The complexity of the impact of the pro- blem of alcoholism presents the greatest difficulty in studying the subject. Preliminary reading from diversified disciplines provided no conclusions as to the etiology, effective prevention, or significantly effective treat- ment. We felt that the psychodynamic theories provide the most compre- hensive and feasible approach to the problem. It is not felt that an extensive review of this literature is necessary here. However, we would like to call attention to the article "Alcoholic Addiction and Personality" by Zwerling and Rosenbaum (34), which pro- vides the most complete review of the interdisciplinary studies, as well as providing a tentative formulation concerning personality and alcohol addiction. This may be summarized as follows: Disruption of the mother-child relationship in the period of depend- ency sets into motion a series of developmental trends evolving into sequences of l. distrustfui withdrawal with attendant experi- ences of isolation and estrangement in addition to persistence of atypical, magical thinking processes, 2. persistent passive- dependent iongings, with resultant distortions in object relation- ships; 3. inevitable frustration in the insatiable omnipotence and dependency demands with resultant impulsive grasping behavior and chronic rage; h. conflicted, ambivalent dependency relationships which must be frequently ruptured, repeatedly establishing the setting for depressive reactions; and 5. con- flicted, ambivalent sexual role-playing with immature modes of sexual behavior. (3h) Zwerling and Rosenbaum suggest that their formulation represents a core personality among alcoholics around which multiple charactero- logical configurations may form. We believe, however, that this personality is present not only among alcoholics, but also among non- alcoholics in other clinical categories. it is our aim to identify the described personality constellation in alcoholics and compare it to that found in three other diagnostic groups. We hypothesize that we will find a common personality configuration occurring in all four groups. METHOD Instrument Development: It was determined that reading a sample of clinical records in a state mental hospital would provide evidence of personality traits. It was felt that data taken from these histories could be analyzed to identify a per- sonality constellation occurring in alcoholics, which could be compared to other emotionally ill patients. It was further decided to compare the alcoholic patient to three other clinical diagnostic categories, including: psychoneurotic depressive; schizophrenia-paranoid type: and manic- depressive, manic type. In order to devise an instrument with which to identify a personality matrix in the alcoholic, the Zwerling and Rosenbaum personality formu- lation was factored into specific symptoms, which we assumed to be typical of the alcoholic personality. These were operationally defined as follows: Dependency - A passive expectation for gratification of physical and emotional needs from others. Depression - A reaction to loss or threatened loss, to failure, discour- agement or disillusionment appearing as a mood disturbance expressed in the form of dejection and self-depreciation, somatic disturbance and repetitive complaints of feeling inferior, hopeless and worthless. Schzoid - A tendency toward emotional withdrawal due to an inability to form meaningful relationships, used as a defense against depression. Hostility - An overt or covert expression of suppressed and introjected hate to a frustrating coersive experience. Sexually immature - A pre-oedipal fixation: the prevalent psycho- se :ual development has not progressed beyond the early anal phase and is reflected in sexual practices and object relationships. Based on the above definitions, the following inventory was developed to collect significant data from case records of both alcoholic patients, and the three clinical diagnostic categories mentioned above. For each of the five symptoms, we identified ten representative indices which we deemed pathological. Since there was no method by which to determine the degree of intensity of a pathological trait, we assumed that if evidence was found in the case records of any representative item on the inventory, it was of sufficient concern to present a problem area to the psychiatrists and therefore could be classified as a pathological symptom. Inve ntoa: Dependency 1. Repeated hospitalization or reliance on external agents for care and security. (jail, AA, etc.) 2. Excessive and constant demands for affection and attention. 3. Financial dependence on spouse if man, or parents if either man or woman. . 4. Fear of being alone or abandoned. (jealousy) S. Prolonged relation with parent of opposite sex, ie. living at home after age 30. 6. Excessive and constant demands for gratification. (alcohol, obesity, smoking) 7. Impulsive behavior - irrational spending, frequent job change, temper tantrum. 8. Immature, childlike, clinging behavior. 9. Preoccupation with death of loved object. 10. Poor identification Depression 11. Attempted or threats of suicide. 12. Self depreciation - expression of inferiority, worthless- ness, and hopelessness. 13. Lack of interest and initiative (people, job, events, self). 14. Somatic complaints. 15. Grandiosity, elation, mood swings. 16. Excessive fatigue. 17. Insomnia. 18. Apathy, indifference. 19 . Guilt - not living up to expectations over past, guilt over past or present behavior. 20. Constant and repeated need for reassurance. Schizoid 21. Use of sleep as a defense. 22. Withdrawal from family, social life and community respon- sibilities. 23. Flight from all anxiety arousing experiences. 24. Inability to evaluate reality situation (fabricate). 25. Hallucination, delusions. 26. Depersonalization, estrangement. 27. Seclusion - impulse to or actual flight. 28 . Frequent disruption of intimate close relationships. 29 . Lack of appropriate affect. 30. Inability to form meaningful relationships. Hostility 31 . Defensiveness - unjustified reaction to real or unreal criticism. 32. Homicidal attempts or threats. 33. Ambivalence toward loved objects. 34. Highly authoratative, takes advantage of people. 35. Rebellious acting out -- inappropriate behavior. 36. Resentment of dependency and hatred of object dependent upon. 37. Use of abusive language and vulgarity. 38. Passive aggressive behavior ( overt compliance with covert resentment). 39. Low frustration tolerance — temper tantrum. 40. Conscious rigidity, withholding. r' -7.- V §exually Immature - 4 1 . Masturbation . 42. Inability to have children with absence of physical reason. 3. Sexual deviant; homosexual, transvestite, etc. 44. Inability to perform intercourse except with certain type of individual, ie . prostitute . 4 S . Promiscuity . 46. Pathological reaction to childbirth. 47. Extended periods of sexual abstinence. 48. Excessive demands for setual intercourse. 49. Voluntary sterilization. 50. Seductive behavior. Sample: In cooperation with Alexander P. DuKay, M .D. , Medical Superinten— dent, and Hans von Brauchitasch, M.D. , Director, Division of Research, of Ypsilanti State Hospital, Ypsilanti, Michigan, one hundred case records were processed, utilizing the above inventory. The sample of cases were obtained in the following manner. Dr. von Brauchitasch made available to the committee a list of cases drawn from the hospital census from January 1, 19 ‘33, through December 31 , 19:35, which had been coded according to diagnostic categories. From this list, one hundred cases were drawn at random. Of these, twenty- five cases represented alcoholics; twenty-five, psychoneurotic depres- sives; twenty—five, schizophrenia-paranoid type; and twenty-five, manic- depressive, manic type. For the purposes of this study, there was no discrimination made with respect to age, set-a, race, length of stay in the hospital, socio-economic or cultural background. The alcoholic -7- group was taken from the diagnostic category of personality trait distur- bance with alcoholism. These patients were hospitalized in a separate alcoholic ward. In the other diagnostic categories, cases with alcoholism were excluded from the study. The total number of cases for this study was arranged according to their primary diagnoses in the following order: Criterion I, Alcoholics; Criterion II, Manic-depressive, manic type; Criterion III, Psychoneurotic depressive; Criterion IV , Schizophrenia, paranoid type. They were serially numbered from one to one hundred, and the respective case records were pulled from the hospital files, from which the clinical infor- mation was obtained. The records were surveyed for evidence of the items listed on the above inventory. If an item was found to be present in the record of a patient, it was recorded. If the item was not present, the specific category was left blank. DATA ANALYSIS AND RESULTS Due to the fact that we were seeking to identify patterns of character traits and not dimensions, we utilized the statistical method of pattern analysis. The information was transferred to IBM cards and was processed on the CDC 3600 Computer at Michigan State University. Cur intent was to determine if patterns existed which would dis- criminate the differences between the alcoholic and the other diagnostic categories. Therefore, the minimum discrimination level was set at sixty per cent. This allowed any pattern to be identified if sixty per cent of the numbers of the total set of cases falling into the pattern were in a given criterion group. If a cluster of traits met this requirement, it qualified as a pattern. It was assumed that if there was a common core personality among our diagnostic groups, there would be no differentiating patterns elicited ie. no patterns will be identified for any criterion groups. It is further assumed that if the alcoholic personality corresponds to any of the four diagnostic categories, we will elicit patterns for the three pathological groups in which the alcoholic cases will be absorbed. As a matter of fact, patterns were elicited from the alcoholic group, Criterion I, but these provided no evidence of a personality constellation common to the alcoholics. The eight patterns which evolved discriminating the alcoholic fnom the other criterion groups dealt with. the abscnno or personality traits. (See table I) The most frequent reason found was the absence of constant and repeated needs for reassurance. This occurred in four of the eight patterns. Lack of appropriate affect and of hallucinations and delusions occurred in three of the eight patterns. In five of the patterns, two traits occur simultan- eously. The maximum number of items occurring in any pattern was three. (See Table I) There were twenty-nine alcoholic cases which fell into the patterns for psychoneurotic depressive (Criterion 3). Seven occurred in the pattern showing the presence of self depreciation in combination with the absence of flight in anxiety arousing experiences. Seven occurred in the pattern with the presence of lack of initiative and the absence of flight from anxiety arousing experiences. Five cases appeared with the presence of somatic complaints and the presence of low frustration tol- erance. Six cases were found in manic-depressive, manic type (Criterion 2). This pattern included the presence of grandiosity, elation and mood swings. There was only one pattern within the schizophrenia, paranoid type criterion in which alcoholic cases appeared. This pattern was the absence of excessive and constant demands. In constrast to the alcoholics, the other three criterion groups pro- vided specific patterns commonly associated with their diagnostic -10- categories. In the manic-depressive group, two patterns were distinguished, the presence of grandiosity, elation and mood swings occurred in sixty- seven per cent of the cases; the absence of hallucinations and delusions, and the presence of lack of appropriate affect were found to occur simultaneously in seventy-eight per cent of the cases. (See Tables I and II) The psychoneurotic depressive type, Criterion 3 , provided the great- est number of patterns, as well as the greatest variety of patterns (See Table I). The discrimination range was from sixty-six to ninty-two per cent within the respective patterns. (See Table II) The pattern of the presence of poor identification, appearing with the absence of the constant and repeated need for reassurance, had the highest level of discrimination; whereas, the presence of attempted or threat of suicide combined with the absence of flight from anxiety arousing experiences, was at the dis- crimination level of sixty-six per cent. Two patterns appeared in twenty- five cases of this criterion. These patterns showed the presence of self depreciation, expressions of inferiority, worthlessness and hopeless- ness, and the presence of low frustration tolerance; and the presence of grandiosity, elation, mood swings, combined with the absence of hall- ucinations and delusions. The patterns in this criterion involved the largest number of cases in the respective patterns, including 309 observations, with an average of 31 observations to a pattern. In the schizophrenic group, there were six patterns with discrimination -11- ranging from sixty-three to eighty-four per cent (See Table I and II). Only one characteristic, the presence of hallucinations and delusions, appeared in more than one pattern. This was observed in a single pattern, involving twenty-two cases, and was combined with the absence of attempted or threat of suicide in twenty-one cases. -12- DI§CU§SION QP RESULTS The above data confirms the complexity of the alcoholic etiology. This study does not identify a symptomatology in alcoholics common to the other diagnostic groups as hypothesized by Zwerling and Rosenbaum (34) . Our objective, to elicit a matrix of personality traits, was also not ful- filled. Therefore, we have been unable to compare such a matrix with the other diagnostic categories. It is, however, pertinent to note that at the .001 significance level, the production of approximately 31 patterns for the alcoholic group were consistent in the absence of responses mentioned above. These patterns were reversed from our original hypothesis concerning the alcoholic group. In contrast to the presence of a personality matrix, an absence of the traits formed the patterns elicited. The percentiles of discrimination show such internal consistency within the alcoholic group that it is felt that serious thought must be given to the variables discriminated, as well as the variables which failed to be included in the patterns. This is, how- ever, beyond the scope of this study. It is recognized that the absence of a specific pattern of symptomatology for all alcoholics does not preclude a variety of subpatterns, and, or a pathology concurrently present in many individuals, labelled "alcoholics" . This is suggested by the frequency in which the alcoholic cases appeared -13- in the psychoneurotic depressive type patterns. It is not known to what degree the above sample is biased. The sampling method used did not consider such factors as length of hospitali- zation and socio-economic or cultural backgrounds. Another possible bias within the sampling may have been due to the exclusion of alcoholics with any gross pathology, and the exclusion of other diagnostic categories in which alcohol was a secondary factor. As the majority of the information was taken from the preliminary history, it is not known to what degree the impact of hospitalization temporarily mobilized the ego defenses, and therefore, tended to contam- inate the responses of the patients. The patients of this study were all hospitalized, and their respective need for, and acceptance of, hospitalization is a variable which is not evaluated in terms of symptomatology. Our patterns of absence of traits tend to support the Sherfey conclusion: " . . . that alcoholism is not a single entity or disease, but a symptom associated with several illnesses or syndromes. " (24) It is noted, however, that the Sherfey study also drew the sample from hospitalized patients in a mental institution. It would seem that this common factor has implications for further analysis into the type of personality utilizing these facilities, and why this method of treat- ment was chosen. From a clinical standpoint, we question the pertinence of the patterns -14- elicited. For example, one pattern included the following items: 11—-an absence of attempted or threat of suicide; 15--an absence of grandiosity, elation and mood swings: 25--an absence of hallucinations and delusions. Clincally, the absence of hallucinations indicates the stage of alcoholism. Delirium tremens may be anticipated as a progressed stage of alcoholism. Grandiosity, elation and mood swings are evident in the active drinking phase and not in the period of abstinence while hospitalized. Likewise, threats of suicide are more commonly found in later phases (11). This is further supported by empirical observations of the research team. -15- CONCLUSIONS The analysis of the data did not support our hypothesis. Evidence of a core personality was not found in the alcoholic. In contrast, the other criterion groups evidenced specific classical personality patterns in each of their respective categories. Specific patterns were elicited for the alcoholic group. These represented clusters of absent traits. Therefore, we cannot conclude that there is a specific personality constellation or symptomatology for the alcoholic. 10. 11. 12. 13. 14. 15. 16. BIBLIOGRAPHY Alexander, Franz, Fundamentals of Psychoanalysis, W. W. Norton & Co. , Inc., 1963 Armstrong , John D. , " The Search for the Alcoholic Personality," The Annals, Jan. 1958 Bolland, John and Sandler, Joseph, The Hampstead Psychoanalytic Index, International Universities Press, Inc. , 1965 Block, Marvin H. , "Alcohol and Alcoholism, " International [ournL April, 1957 Block, Marvin, Alcoholism, John Day Co. , New York, 1962 Bacon, Selden D. , "Alcoholics Do Not Drink," The Apnals, Jan. 19 58 Bleuler, Manfred, " Familial and Personal Background of Chronic Alcoholics," Etiology of Chronic Alcoholism, Charles C. Thomas, 19 55 Diethelm, Oskar, Etiology of Chronic Alcoholism, Charles C. Thomas, 1955 Fenichel, Otto, The Psychoanalytic Theory of Neurosis, W. W. Norton & Co. , 1945 Fleetwood, M. F. , " Biochemical Experimental Investigations of Emotions and Chronic Alcoholism, " Etiology of Chronic Alcoholism, Charles Thomas Company, 19 55 Fox, Ruth, Aspects of Alcoholism, J. B. Lippincott & Company, 1966 Freud, Anna, Normjality and Patholggy in Ciiitldhood, International Universities Press, 1965 Greenberg, Leon, "Intoxication and Alcoholism Physiological Factors, " The Annals, Jan. 1958 Jackson, Joan, "Alcoholism and the Family" The Annals, Jan. 1958 Kant, Fritz, The Treatment of the Alcoholic, Charles C. Thomas, 1954 Keller, Mark, "Alcoholism: Nature and Extent of the Problem," The Annals, Jan. 1958 -15- -17- 17. Keller, Mark and Seeley, John, The Alcohol Language, Alcoholism Research Foundation, University of Toronto Press, 1958 18. McCarthy, Raymond G. , "Alcoholism: Attitudes and Attacks 1775-1935" The Annals, Jan. 1958 19. McGenty, Dennis, Family Relationships Contributing to Alcoholism, National Council on Alcoholism, New York, August, 1965 20. Peltenburg, C. , Casework with Alcoholic Patients, National Council on Alcoholism, Inc. , New York, Jan. 1963 21. Redlich, Frederick C. and Freedman, Daniel, The Theory and Practice of Psychiatry, Basic Books, Inc. , 1966 22. Sapir, Jean V. , " Social Work and Alcoholism," The Annals, Jan. 19 58 23. Sharoff, Robert, “Therapy of Drug Addiction," Current Psychiatric Therapies, Vol. 6, Masserman, J. Ed. , Grune 6. Stratton, New York, 1966, p. 247 24. Sherfey, M. , " Psychopathology and Character Structure in Chronic Alcoholism," Etiology of Chronic Alcoholism, Diethelm, 0. Ed. , Charles Thomas Co. , Springfield, Illinois, 1955 25. Shepherd, Ernest A. , "Current Resources for Therapy, Education and Research," The Annals, Jan. 1958 26. Straus, Robert, " Medical Practice and the Alcoholic," The Annals, Jan. 19 58 27. Trice, Harrison M. , "Alcoholics Anonymous," The Annals, Jan. 1958 28 . Vogel, Sidney, "Psychiatric Treatment of Alcoholism," The Annals, Jan. 1958 29 . Ullman, Albert D. , " Sociocultural Backgrounds of Alcoholism," The Annals, Jan. 1958 30. Wallerstein, Robert, Hospital Treatment of Alcoholism, Basic Books, New York, 1957 -18- 31 . Weiss, Edoardo, The Structure and Dynamics of the Human Mind, Grune & Stratton, Inc. , 1960 32. Whitney, Elizabeth D. , The $911er Sickness, Beacon Press, 1965 33. World Health Organization, Expert Committee on Mental Health (Alcoholism), Report on the Second Session, Oct. 1951 34. Zwerling, I. and Rosenbaum, M. "Alcoholic Addiction and Personality" (Non-Psychiatric Condition), American Handbook of Psychiatry, Silvano Grieti, Ed. , Basic Books, Inc. , New York, 1959 TABLE I PATTERNS ELIC ITED Characterization Criterion Group I (N 25) 8 Patterns Absence of immature, childlike clinging behavior (2 patterns) Absence of poor identification (1 pattern) Absence of attempted or threat of suicide (2 patterns) Absence of grandiosity, elation and mood swings (2 patterns) Absence of need for constant and repeated reassurance (4 patterns) Absence of hallucinations and delusions (3 patterns) Absence of lack of appropriate effect (3 patterns) Criterion Group II (N 25) 2 Patterns f Criterion Group III (N 25) 10 Patterns Presence of grandiosity, elation and mood swings (1 pattern) Absence of hallucinations and delusions (1 pattern) Presence of lack of appropriate effect (1 pattern) Presence of attempted or threat of suicide (2 patterns) Presence of self depreciation, expression of inferiority, worthlessness and helplessness (3 patterns) Presence of lack of interest and self initiative (1 pattern) Presence of somatic complaints (1 pattern) Presence of constant and repeated need for reassurance (1 pattern) Absence of withdrawal from family life, social life and community and responsibilities (3 patterns) Absence of flight from anxiety arousing experiences (5 patterns) Absence of inability to form meaningful relation- ships (1 pattern) Presence of low frustration tolerance and temper tantrums (1 pattern) -19- ‘--.o~. TABLE I (Continued) PATTERNS ELIC ITED Characterization Criterion Group IV (N 25) 6 Patterns Absence of excessive and constant demands for affection and attention (1 pattern) Absence of excessive demands for gratification (1 pattern) Absence of attempted or threat of suicide (1 pattern) Absence of grandiosity, elation and mood swings (1 pattern) Presence of hallucinations and delusions (2 patterns) Presence of lack of appropriate affect (1 pattern) Presence of masturbation (1 pattern) -20- TABLE II DISCRIMINATION CAPACITY OF PATTERNS ELICITED BY CRITERION GROUPS Pattern Number Caseflst in Pattern And Within Criterion Outside Criterion Criterion Group N % N i % Criterion Group I Pattern 1 11 73 4 , 27 2 20 80 5 20 3 2 1 7s 7 ’ 25 4 23 82 5 18 5 23 64 13 , 36 6 . 23 89 3 i 11 7 3 19 9 1 3 ! 9 8 g 18 95 1 ,. 5 9 i __ r i i Criterion Group II 1 1i 5 Pattern 1 25 68 12 32 2 i 18 78 i s 22 Criterion Group III Pattern 1 i 24 67 12 43 2 , 24 92 2 8 3 i 22 7 1 9 29 4 25 71 10 29 5 20 65 11 3 5 6 22 69 10 3 1 7 2 5 69 11 3 1 8 23 89 3 11 9 22 76 7 24 10 22 82 5 28 1 i 1 _ Criterion Group IV i Pattern 1 ’| 14 , 64 8 36 2 11 69 a 5 31 3 22 63 1 13 37 4 i 16 64 9 36 5 2 1 84 4 16 6 16 1 80 4 20 _.. I .- -21-