Showing papers in "Archives of General Psychiatry in 1961"

An inventory for measuring depression

Abstract: The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations." Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15These have been well summarized in a review article by Lorr11on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific

Hypnosis and Related States.

Abstract: Gill and Brenman offered a great service to students of hypnosis in 1947 when they published their comprehensive review of the literature ( Hypnotherapy , International Universities Press, Inc.). Now they extend this service by offering a distillate of their work and thinking over the years. This is not a handbook for the novice, nor is it a guide for learning techniques. It assumes that the reader has some degree of sophistication with hypnotic techniques and some knowledge of psychoanalytic theory. This leads directly to its major weakness. Instead of maintaining the central focus on the phenomena of hypnosis and its appropriate place in the field of the science of human behavior, it puts empirical data about hypnosis into the service of defending the ego psychology of Kris, Hartmann, et al. and at the same time, pays homage to these pioneers for enabling the psychoanalytic theorist to transcend

Americans View Their Mental Health.

Abstract: This is the fourth in the series of ten monographs sponsored by the Joint Commission on Mental Illness and Health and designed to assess the nation's mental health resources and needs from a variety of perspectives. Its focus is the subjective dimension of mental health. Although not all of the monographs have been published so far, the findings and the recommendations of each have been already summed up and interpreted in the Commission's final report which, because of the publicity it has received, may be familiar to many readers. The present volume is based on an interview survey conducted in 1957 with nearly twenty-five hundred individuals selected to provide a probability sample of the country's adult population. It is a product of three social psychologists, all of whom are on the staff of the Survey Research Center at the University of Michigan, one of the few widely recognized

Dreams of Depressed Patients: Characteristic Themes in Manifest Content

Abstract: In a serial study by Beck and Hurvich 2 of the consecutive dreams of patients in psychoanalytic psychotherapy, it was observed that the depressed patients reported a certain class of unpleasant dreams with a notable degree of frequency. A systematic analysis of the data indicated that this class of dreams constituted a significantly higher proportion of the dreams reported by each of the depressed patients than of those reported by a matched group of nondepressed patients. The distinctive characteristic of this class of dreams was that in the manifest content the dreamer was portrayed as being the recipient of a painful experience, such as being disappointed, rejected, or injured. On the basis of the patients' directed associations to these unpleasant dream elements as well as other clinical material, including their free associations, it was felt that these dream themes were an expression of a persistent

Pathology of the Concentration Camp Syndrome: Preliminary Report

Abstract: The Background In 1952 a group of Danish researchers 6 published an extensive report concerning famine disease in German concentration camps, its complications and sequels with special reference to tuberculosis, mental disorders, and social consequences. Their work was mainly based on a medical and social examination of about 1,300 Danes who had survived internment in German concentration camps during World War II. The investigations were made between 1947 and 1951. About 75% of the investigated ex-prisoners stated that they had had, or still had, neurotic symptoms of varying degrees of severity after their repatriation. The vast majority of these were well-known unspecific neurastheniform symptoms. Other mental disorders were rare. The neurastheniform symptoms were uniform. The same complaints were repeated from person to person, although the symptoms varied in intensity and relative importance. The most frequent symptoms found by the Danish authors were restlessness, excessive

Memory functions in endogenous depression before and after electroconvulsive therapy.

Abstract: Several investigations into the ability of an individual to learn new material after electroconvulsive therapy (ECT) have shown that, compared with the pretreatment state, there is impaired function for at least one day after a course of treatment, and that one week or more after the end of the therapy, a return to pretreatment levels or even improvement is observed. 2,7,9,10,12,14-16 The improvement has been ascribed to alleviation of the psychopathologic state with return to normal mental functioning, whereas the initial deterioration is regarded as a direct effect of ECT, to a great extent determined by the energy of the electrical stimulation. 11 The absence of a long-term deterioration in most previous investigations may be due to several facts. Tests with low sensitivity to the influence of ECT or with low reliability may have been used. Furthermore, the adverse effect may be counterbalanced or even outweighed

Amphetamine Addiction and Disturbed Sexuality

Abstract: Among the known results of addiction to amphetamine there is apparently a considerable variation of sexual effects. This is to some degree in contrast with the relative uniformity of other symptoms. However, on closer investigation it may be seen that this variability is more apparent than real, the differences being related to the particular type of sexual organization of the individual addict. A failure to recognize this explains the inconsistent opinions expressed in the literature. One commonly held view is that amphetamine decreases sexual drive. Guttman 1 found no evidence of sexual excitation from amphetamine, while Knapp 2 recorded that 2 of his cases spoke of a decrease in sexual feeling. In contrast Waud 3 observed increased libido during and for a short period after amphetamine inhalation. Similarly Bett, 4 Carr, 5 and Monroe and Drell 6 observed that amphetamine induced erotic sensations and caused

Experimental Analysis of Hysterical Blindness: Operant Conditioning Techniques

Abstract: Introduction The viewpoint adopted for experimental purposes in this study was that the behavior of an organism is generated and maintained chiefly by its consequences on the environment. Over a wide range of conditions, a hungry rat, placed in a so-called "Skinner box," will persist in pressing a bar if, as a consequence of this response, a pellet of food is delivered to it at least some of the time. This exemplifies the principle of reinforcement which is at the core of current behavior theory. Conditioning of this type is termed operant (instrumental) to distinguish it from respondant (classical Pavlovian) conditioning. The probability of a given response in relation to the conditions of reinforcement of that response has been the subject of much study of Skinner, 4 Ferster and Skinner, 2 an others. Recently, controlled experiments conducted with human subjects using cubicles analogous to the

Response specificity. Stimulus-response and individual-response specificity in essential hypertensives.

Abstract: Introduction This paper is the second in a series dealing with the phenomena of physiological response stereotypy in psychosomatic patients. The first paper (Engel, 1960) reported that a group of normal subjects, when presented with several stimuli, will respond with a pattern of physiological responses which are in part a function of the evoking stimulus (stimulus-response or SR specificity), and in part a function of the responding individual (individual-response or IR specificity). In this paper we will extend these results and compare the response patterns of normal subjects to the response patterns of patients with "essential hypertension." The importance of response-specificities for psychosomatic processes has been discussed by Alexander (1950). His theory of specificity—"physiological responses to emotional stimuli . . . vary according to the nature of the precipitating emotional state. . . . Every emotional state has its own physiological syndrome." (p. 68)—seems to acknowledge the existence

Murderous Aggression by Children and Adolescents

Abstract: Murder, its causation and its treatment, is a subject that mankind has debated since the dawn of civilization—since Cain slew Abel. There have been many psychiatric studies on the subject of homicide but, as with studies on death itself, the investigations have tended to be superficial. The study of murder, of death and aggression, may arouse primitive anxiety in those who consider the question deeply. This present study is of children and adolescents who made a murderous attack. A collaborative psychiatric study has been made of each child and of all available relatives. In many psychotic states murder may be committed. The commonest underlying psychosis is paranoid schizophrenia; the psychotic in these cases, though often he understands that he acts against the law, feels justified under the threat of his paranoid fear. The psychotic may try to destroy the unacceptable drives he feels in himself by

Coping behavior under extreme stress; observations of patients with severe poliomyelitis.

Abstract: Introduction The life-threatening impact of severe poliomyelitis has been vividly described both in the scientific literature and in popular reports about polio patients. Here, for instance is a patient's description of his experience in the acute phase of illness. The realization that I was paralyzed came to me with a merciful gradualness. As the extreme lassitude and weakness left by the fever and the pain wore off, the irritations took over. I yearned to change my position, to move ever so slightly onto a cooler spot on the sheet, and I couldn't. My heels itched and I couldn't even move them up and down on the bed. Three weeks ago there had been nothing to any of it—breathing, speaking, eating, evacuating, sleeping. I had accepted my body as if it were myself. If I wanted to eat, I ate—whatever and whenever I liked. If I wanted to

Environmental factors in creative function. A study of gifted children.

Abstract: We are reporting here a psychiatric and psychological study of gifted children, which attempts to elicit significant and relevant factors in family life contributing to functional creativity. Application of the principles of dynamic psychiatry to the area of creative functioning has, in the past, been limited in scope. Kubie's recent book 10 on the subject, for instance, is still basically addressed to the question that has been embarrassing psychiatrists for half a century: Does analysis, in modifying the conflict areas of the personality, quell inner tensions that are necessary to the creative act? Some interest has been expressed in the nature of creativity as an intrapsychic process, but there has been little agreement and no clear formulation. 1,2,7 One implicit assumption that has been shared by many psychologists and psychiatrists working with creativity has been that creative function is a constitutional variable, much as is

The First Five Minutes.

Abstract: An executive of one of the major research foundations recently said: "We are at a critical stage in the history of science. We have learned to recognize problems so complex that no one discipline is able to solve them. At the same time we know very little about how to maintain productive collaborative research among scholars representing divergent disciplines. Out of some two hundred or so interdisciplinary projects with which we are associated I doubt if more than ten or fifteen will be sufficiently productive to reach publication." Two psychiatrists and a linguistic-anthropologist have demonstrated in The First Five Minutes that cross-disciplinary collaboration can be fruitful if certain necessary conditions are met. First, investigators must be concerned with a real problem of common interest. In this case, in the broadest sense of the phrase, the authors wished to know "what actually happened during a part of a tape-recorded interview."

Problems posed by schizophrenic language.

Abstract: Introduction When we have a name for something, we tend automatically to assume the existence of a corresponding reality. Language, as used by schizophrenic patients, becomes identified by the term "schizophrenic language." This term suggests an entity with distinct features, a language differing from ordinary language. Yet when we attempt to characterize this language we find ourselves in the position to recognize and identify, but lack a comprehensive description. "Schizophrenic language" can be correctly designated as both concrete and as abstract; as restricted, impoverished, and as fluid, overideational; as empty of meaning and as overinclusive of meaning; as resembling prelogical thinking and as metaphoric and symbolic. While on an empirical level each of these features can be demonstrated in particular instances, the essential defining characteristic is obscure. We are faced with the paradox that while we recognize schizophrenic language when we see it,

Visual Memory Test: The Simulation of Mental Incompetence

Abstract: Introduction The simulation or exaggeration of behavioral inefficiency referable to presumptive brain injury is a persistent problem in clinical practice. Subjective complaints of excessive fatigability, impairment in memory, difficulty in concentration, and disturbances in work-capacity are always somewhat difficult to evaluate. They are particularly so when questions of compensation for injuries received or a pension are involved in the case. When an individual who is simulating mental incompetence or exaggerating the severity of his behavioral disability following some incident which may have produced brain injury is given a battery of psychological tests, it is reasonable to suppose that his performance will be on a lower level than that which he is actually capable of and that he will attempt to perform in a manner which he believes to be characteristic of a brain-damaged patient. One question which arises in this respect is how successful

Learning Theory and the Symbolic Processes.

Abstract: Mowrer is a leading figure in the area of learning, noted for his imaginative approach to research, as well as a certain daring for venturing out of the relatively safe confines of the Skinner box and tackling some of the more vexing and elusive phenomena of personality and psychopathology In this book he is again concerned with complex behavior and attempts to conceptualize cognitive and symbolic processes, within the framework of his most recent theory of learning (made explicit and fully elaborated in the companion volume, Learning Theory and Behavior ) Since the phenomena dealt with in this book are analyzed with an "eye" to the theory, it may be well to pause and examine Mowrer's position in some detail The author, who for many years has advanced a two-factor theory of learning, now advocates a monistic approach: All learning is basically sign learning and involves the conditioning of emotional

Psychoses Associated with Thyrotoxicosis

Abstract: Patients simultaneously exhibiting symptoms of hyperthyroidism and an overt psychosis have been seen sufficiently frequently in clinical practice to prompt many investigators to inquire into a possible relationship between the 2 sets of symptoms. There has been considerable diversity of opinion expressed on the subject. It is the purpose of this study to reexamine the relationship between these disease processes in the light of data gathered at a large county general hospital. * There will be a consideration of diagnostic and sampling problems, the incidence of the association of the 2 sets of symptoms, the types of psychoses seen in persons with hyperthyroidism, and the nature of the relationship between the 2 processes. Diagnostic and Sampling Problems It would be exceedingly difficult to obtain representative samples of populations with thyrotoxicosis and psychosis because many persons with these diseases do not come to the attention of

Birth order and schizophrenia.

Abstract: The connection between birth order and the incidence of schizophrenia is directly relevant to the problem of the etiology of the disease. 1,11 The absence of any clearly established relationship between the two has been cited as support for the belief that environmental factors play at most a relatively minor role in the disease process. 7 The question of relationship between birth order and schizophrenia has been revived by recently published experimental findings with normals. These studies suggest a relationship between birth order and a primary symptom of schizophrenia, social self-isolation. The work done by Schachter 10 indicates that subjects who are first-born or only children tend to be more affiliative in an anxiety-provoking experimental situation than those who have older siblings. Laterborn subjects when anxious did not particularly wish to be with other people. Schachter saw this tendency to prefer isolation

Season of birth. An epidemiological study in psychiatry.

Abstract: Psychiatric patients have been shown to differ from the normal population in important features of early development. Numerous clinical investigations reviewed by Bowlby 3 have indicated that the development of mental illness may be traceable to conditions and events occurring early in life. Two statistical studies 1,2 have shown a relationship between maternal bereavement during the first few years of life and the subsequent development of psychiatric illness. A number of other statistical studies, summarized later in the present paper, have tested whether psychotic patients differ from the normal population in the distribution of months of birth. One reason why such studies have been done is undoubtedly the ease of collecting the data. Mental hospitals routinely attempt to record the date of birth of every patient; the accurate month of birth is usually obtainable from the patient or a close relative. The monthly

An anxiety scale applicable to verbal samples.

Abstract: In the past several years we have been engaged in developing methods of systematically and objectively scoring small samples of speech obtained in a standardized fashion (Gleser, Gottschalk, and John, 1959; Gottschalk, Gleser, Daniels, and Block, 1958; Gottschalk, Gleser, Magliocco, and D'Zmura, 1961; Gottschalk, Gleser, Springer, Kaplan, Shanon, and Ross, 1960; Gottschalk, Springer, and Gleser, 1961). One important purpose for focusing our attention on verbal behavior has been to develop objective measures of an individual's emotional level or psychological state at any particular time. Such measures would be of great value, for example, in assessing changes in level and lability of emotional response in reaction to psychoactive drugs or psychotherapy, and in determining the relationship of psychological to physiological or biochemical responses in an individual. There are relatively few objective measures of immediate emotional state. Most psychological tests have been

The family in psychotherapy.

Abstract: The territory covered by psychotherapy research has long been a soft and yielding morass and to date it shows no signs of becoming a steady, comfortable place to stand. Under these conditions the practitioner and researcher, to avoid the threat of slowly sinking into oblivion, must constantly keep moving. Under the banner of research trends, I shall report some of these movements in the area which has come to be designated as family therapy. Although the significance of family members in stimulating and maintaining a broad range of pathological states in psychiatric patients has often been cited, such observations appear to have produced but minor additional insights. This position is eloquently summarized by Spiegel and Bell, who wrote: "Up to the present time the area of the psychiatric patient and his family has shown more promise and less achievement than almost any other

Response to auditory stimulation during sleep. Discrimination and arousal as studied with electroencephalography.

Abstract: The ability of man to discriminate between auditory stimuli while asleep is general knowledge. The specificity of this discriminatory ability has, however, never been fully documented. The works of Loomis, Harvey, and Hobart 1 and Liberson 2 have shown that it is possible using electroencephalography to demonstrate the ability of a sleeper to discriminate auditory stimulation to a certain degree. They have also observed that a sleeper often will have EEG changes in response to auditory stimulation, but the subject will continue to sleep. Loomis et al. further observed that the EEG response to auditory stimulation was related to the depth of sleep and to the ambient noise level in the room. No observations were made regarding the EEG response to types of sound. In another publication by Loomis et al. 3 these authors observed not only that arousal to auditory stimulation was

Meprobamate and chlorpromazine in psychotherapy. Some effects on anxiety and hostility of outpatients.

Abstract: The present study had its origin in a nation-wide survey of the use of tranquilizers in Veterans Administration (VA) Mental Hygiene Clinics. 1 The major reason given by physicians for prescribing tranquilizers to patients receiving psychotherapy was the reduction of anxiety and of hostility. The two most frequently prescribed tranquilizer drugs reported were chlorpromazine and meprobamate. The survey also found that therapists reported significantly more improvement in patients with little education who received tranquilizers and psychotherapy than in patients with more education who received similar treatment. We gratefully acknowledge the contributions of the 23 participating Mental Hygiene Clinic staffs and in particular the following investigators who were responsible for the study at their clinics: Louis A. Cibelli, M.D. (Atlanta); Shabse H. Kurland, Ph.D. (Baltimore); Richard W. Boyd, Ph.D. (Boston); Joseph W. House, Ph.D. (Buffalo); Lester W. Savage, M.D., and Henry H. Weiss, Ph.D. (Chicago); Morton

Inhalant-induced convulsions. Significance for the theory of the convulsive therapy process.

Abstract: Despite many years of investigation of the convulsive therapy process, there is still much controversy concerning the importance of the seizure itself. Most studies have concluded that the convulsion is a necessary index of cerebral change essential to clinical behavioral change. 9,10,15,33,39 Some investigators, nevertheless, have assigned significance not to the seizure but to such factors as the psychological meaning of the treatment to the patient, feelings of fear, and the repeated loss of consciousness. 3,4,28 The early studies of Kalinowsky et al. 24 and Pacella et al., 30 demonstrating both clinical and electrographic differences between grand mal and petit mal treatments indicated the significant role of the seizure. The various studies comparing convulsive with subconvulsive treatment demonstrated that techniques culminating in a convulsion were uniformly associated with measurable degrees of neurophysiologic and behavioral change, while subconvulsive techniques were not 15,27,38-40 In recent studies from this laboratory, similar

Adaptive Behavior in Competent Adolescents: Coping with the Anticipation of College

Abstract: Introduction The late adolescent-early adult period involves certain developmental tasks that derive from the emergence of biological sex maturity and the social requirements of adult life in a particular culture. These tasks may be met in many ways; different patterns of coping behavior may get the job done. The accomplishment of each task, and the way in which it is accomplished, may have consequences for the entire adult life of the individual and those close to him. What are the tasks? A list of them may be long or short, depending on the level of specificity utilized. In contemporary American society—and indeed in many industrialized, urban, technologically complex cultures—certain tasks achieve prominence because they are requirements of the transition from being a child to being an adult. Adult roles, responsibilities, and opportunities are sufficiently different from those of childhood in such cultures that a

Enuresis and dreaming. Experimental studies.

Abstract: Relatively little is known concerning the relationship of the enuretics' dreams to the onset of bed-wetting, the depth of sleep during the enuretic episode, or the sleep depth in interim periods. In fact, little is known about any physiological correlation which might serve to increase or decrease bed-wetting. Although the psychological contributions to the etiology of enuresis have long been accepted, there has never been a study of the dreams of an enuretic as they occurred and were collected throughout the night. The purpose of the present investigation is to arrive at a more precise understanding of the interrelationship between dreams, levels of sleep, and bed-wetting. Method In this study a total of 8 boys were studied on 10 nights. There were 2 youths who were studied on 2 nights each. The boys were between ages 5 and 9 and offered no special physical or emotional complaints

The Suicidal Fit: A Psychobiologic Study on Puerto Rican Immigrants

Abstract: Numerous studies have been undertaken in an attempt to arrive at a closer understanding of the phenomenon of suicide and to find some effective means of preventing it. Most of the literature presents statistics which have been interpreted from a psychologic, sociologic, and cultural point of view in an effort to explain why people try to commit suicide. To my mind, however, the important question is not why someone attempts suicide. Rather, I am concerned with the clinical picture of a suicidal person—what goes on in his mind, what psychobiologic process is it that is able to overpower the most vital protective forces of life, the instinct of self-preservation and the fear of death. Objective and Method What is it that precipitates such a complete and paradoxical change in basic human behavior? This study tried to find the answers. Although we used psychiatric

Antisocial and criminal acts induced by "hypnosis". A review of experimental and clinical findings.

Abstract: Between the years 1888 and 1927 Bernheim, Liebault, Binet, Moll, Schilder, and other investigators participated in an ongoing debate concerning the question: Can immoral or criminal acts be induced by hypnosis? 18,21,24,31 Evidence accumulated during recent decades has provided an answer: Some persons who are said to be "hypnotized" can be made to commit acts which are defined by objective observers as dangerous, criminal, or immoral—to steal, 17,37 to violate sexual mores, 26 to injure themselves, to injure others, 33,38 to attempt murder, 29,36 and to commit manslaughter. 31 The problem at hand is not, Can such acts be elicited by "hypnosis," 28 but, Which of the many concrete conditions subsumed under the abstract term hypnosis are instrumental and which irrelevant to producing such behavior? To provide an answer to the latter question, the present paper reviews all pertinent experimental and

Autonomic responses to sleep deprivation.

Abstract: Research in sleep deprivation has in general concentrated on behavioral, psychological, and electroencephalographic measures of functioning. Deficits in psychological test performance, psychotic behavior, and decrease in EEG α-activity have all been described but not fully explained. Williams, Lubin, and Goodnow 7 have attributed both the deterioration in psychological test performance and the perceptual disturbances of sleep deprivation to periodic lapses or brief periods of somnolence in which sensory input is partially or totally blocked. This would imply a gradually decreasing level of activation and this is supported by disappearance of EEG α-activity during periods of unresponsiveness. Malmo, 5 on the other hand, interpreting sleep deprivation within the framework of Hullian theory, has suggested that it produces a state of high arousal or activation and offered autonomic evidence in support. Using continuous polygraph recording he observed an upward shift in the physiology

Low dropout rate in a psychiatric clinic. Special reference to psychotherapy and social class.

Abstract: The dropout rate in the Hutchinson Memorial Psychiatric Resident Clinic of the Tulane University Department of Psychiatry and Neurology is much smaller than any of the rates reported by other psychiatric outpatient clinics. According to Rosenthal and Frank 1 who surveyed the literature and reviewed the statistics of their own and other clinics, the dropout rate for all clinics reporting has been very close to 50%. A dropout patient is defined as one who has discontinued therapy, for whatever reason, before completing 6 treatment sessions. In our clinic the dropout rate is only 6% (Table 1). In view of the reports from other clinics and of the findings in the Phipps Clinic, Rosenthal and Frank had serious doubts about the advisability of doing "insight" therapy in a psychiatric outpatient clinic. If "approximately half of all patients had 5 or fewer hours of therapy" it would