A PSYCHOLOGICAL EVALUATION OF CERTAIN ASPECTS OF ELECTRO-CONVULSIVE THERAPY

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A PSYCHOLOGICAL EVALUATION OF CERTAIN ASPECTS OP ELECTRO— CONVULSIVE THERAPY

Dissertation Prsssntsd in Partial Fulfillment of the Requirements for the D e g r e e Doctor of Philosophy in the Graduate School of The Ohio State Unlversity

BP H. Robert Albrecht, B. A. The Ohio State University 1951

a

eraowiaqmrs

The writer le grateful to the administrative officials and to the medical staff of the Chlllicothe Veterans Administration Hospital.

He is especially indebted to Dr. H.A. Rock and to the

Shock Team headed by Dr. CI.W. Mockbee for their excellent cooper­ ation in the selection and; handling of patients employed in this 1 mr estimation. The writer is especially grateful to Dr. Ranald M. Wolfe, Chief of the Clinical Psychology Service in the Veterans Administration Hospital for his kind assistance In both the admin­ istrative and academic aspects of this study.

Dr. M.H. Cordon's

contributions toward the statistical analysis of the data cannot be given sufficient praise. Acknowledgments are also given to Miss Smith and to Hiss Henderson of the Clinical Psychology Service for their efforts in making this manuscript presentable in its final form. My fellow trainees, William N. Bowen and Charles T. Baker, who acted as raters must be thanked for their heln and understanding. Sepeclal acknowledgment is given to Dr. II. A. Durea, Professor of Psychology, at The Ohio State University, for his kind and thoughtful assistance throughout the investigation.

Without his

direction, this research undoubtedly would not have been oosslble.

(i)

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TABLE OF CONTENTS PAGE I N T R O D U C T I O N ............................

1

HISTORY AND PRESENT STATUS OF EST

9

Historical Developments

. . .

. . . . . . . .

9

M o d e m Shock Methods . . . . . . . . . .

11

Recent Practices • • • .................

13

Theories Concerning the Operation of EST

19

Organic Theories

...........

20

Psychoanalytic Theories ...........

21

Psychological Theories

22

...........

STATHJENTS CONCERNING THE PROBLEM

. . .

25

METHOD AND PROCEDURE ...................

30

Description of the Scoring System

• • •

30

Reliability of the Scoring System

. . .

37

Subjects « • • # # • * • • • • • • • # •

U3

Experimental Groups

U+

. . . . . . . . . .

Preparation of Subjects

. . . . . . . .

U9

E q u i p m e n t ............. ................

U9

Interview Procedure

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

U9

Experimental Sample

•

50

STATISTICAL METHODS

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

52

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

55

DISCUSSION ..............................

66

RESULTS

(ID

CHAPTER VIII.

PA(Z SUMNARY AND C O N C L U S I O N S ............................ 73 B I B L I O G R A P H Y ....................................... 79 A F P T S N D I X ........................................... 83

(iii)

TABLES AND FIGURES TITLE Table I* Table I I •

DESCRIPTION

PAGE

Agreement Between Raters for Identification of Thought Units

39

Agreement Between Raters for Efficiency Index Determination • • • • . • • • • • • • •

LO

Table III*

Distribution of Global Ratings by Judges . • • 1*1

Table IV.

Agreement Between Judges in Assigning Global Ratings • • • • • • . * • • • • • • .

. l»2

Agreement of Judges' Global Ratings Com­ pared with Chance Expectancy • • • • • • • .

*1*2

Table V.

Table VI.

Graphic Representation of Experimental Conditions

1|7

Table VII.

Ages and Diagnoses of Subjects . . . . . . .

Table VIII.

Slope Values Representing Trends of Scores for Each Experimental G r o u p .......... . . .

Table IX.

.U8 56

Trends Occurring Within Each Interview

S e r i e s .............................

....

57

Table X.

Statistical Tests of the Significance of Differences Between Scores From Each Ex­ .................. 5 3 perimental Situation

Fig. 1.

Average Number of Thought Units Produced During Each Interview . . • • • • • • • • • • 5 9

Fig. 2.

Efficiency Index Values for Each Interview • • 60

Fig. 3»

Global Rating Scores for Each Interview

(iv)

• • * 61

Although this investigation was conducted with the permission and assistance of the Veterans Administration, the methods employ-’ ed and results expressed do not necessarily represent the policies or attitudes of that organisation.

(t )

CH1PTHR I IMTEODPCTlOy I.

IWTROIXrCTOBT RBMABE8

The literature dealing with behavior disorder* and conditions of maladjustment contains many references to a group of therapeutic methods i

which are desettbed as "shock treatments".

Of these various, but re­

lated techniques, electroshock therapy* has received the most attention from Investigators and theorists In the field of psychology and psychiatry. Prior to the advent of the surgical techniques such as the orefrontal lobotomy, X5T was one of the more recent of the "shock therapies"•

The recency of the development of this method, together

with the relative ease of Its administration, are factors which have influenced Its popularity. The basic technique of X5T was first utilised with human subjects by Cerlettl in 1933*

However, as will be pointed out, there vers numer­

ous antecedent methods which paralleled Cerlettl's technique.

The

introduction of 2ST was well received and was ranldly followed by numerous Investigations dealing with its nature and practical application. Its theoretical foundations and empirical considerations have been discussed widely, but as yet there has been no general agreement as to either the theoretical or the practical basis for this method of treatment.

Although there have been several systematic and searching

reviews of the literature dealing with BBT, disagreement persists. •Hereinafter, electroshock therapy, or as it Is often referred to, electroconvulslve therapy, will be aborevlated BBT to conform to general practice employed by writers in the field. (1)

(22, UO, U3).

It appears that one of the outstanding conclusions derived

from such reviews of the literature is that t|he general area of EST research still has many unsettled problems. O'Kelly (20) suanarlses these general conclusions when he states, "Modern shock therapies have been empirical in nature, and there is no acceptable theoretical explanation to account for their effect"• opinion Is wide-spread.

(5, 21, 23, Uo).

This

"uch of the seemingly dis­

ordered structure surrounding EST can be attributed to the development and growth of the technique itself, which was a startling new method that was received enthusiastically by workers representing diverse theoretical viewpoints.

Many of these workers regarded EST as a "cure"

for behavior disorders, and, as such, it was subjected to investigations which represented various theoretical viewpoihts.

The conclusions of

these investigations, of course, have been equally diverse. Despite the Initial hope that EST would be a "cure", it became evident that shock therapy in itself was a "pflychosiSMnodifying agent" (1*0).

This realisation led to the investigation of relationships between

EST and other factors, proximate and remote.

Among these relationships

was that of the correlation between EST and psychotherapy* As is true within the general field of 3$T, investigators have expressed various theories and attitudes concsming the relationship between EST and psychotherapy. ment.

On some points there is relative agree­

On others, the viewpoints are etartlingly disparate.

The point

on which there seems to be the legist disagreentent is that of the merits of EST as an agent with which to augment, or render possible, the under­ taking of some form of psychotherapy.

However, disagreement exists as

to the psychotherapy which should be provided and, more importantly,

(2 )

there art even more opinions as to when psychotherapy should bs eon‘ductsd.

Kailnowsky (21)., for example, reviews soae of the opinions

expressed by others and summarises then Into several rather specific attitude-categoriesi vis, psychotherapy should not be undertaken con­ currently with BBT; pemissive, reassuring psychotherapy should be given; deep-level psychotherapy should be administered upon tem i n atlon of 2ST; psychotherapy aust be a concomitant of 1STI

Krainee (23)

feels that psychotherapy should be concomitant with 1ST and that whenever possible contacts with the n o m a l environment should be maintained. Bennett (3) feels that therapy should accompany 1ST because of the In­ crease In accessibility during treatment.

Myereon (2?) , however,

found that B T alone achieved results comparable with combined B T psychotherapy for certain ambulatory patients. Wilcox (IQ) believes that the amnesias which accompany 1ST obviate the possibilities for deep psychotherapy.

This point of view has been

taken by others but the foundations for such belief rest on the nature and the functioning of the "amnesias'', the nature of which has been challenged by the work of Janls (20) , Bub in (34), and others (23, 43) who have shown that memory Is not a unidimensional factor during 1ST but that selective elements are important. Krai nee (23) and Wilcox (43) are among the writers who have sug­ gested that some of the benefits observed from B T may be attributable to concomitant factors.

These authors suggest that the attitudes of the

physician and his staff may be of importance.

Wilcox describes how

these attitudes may help to reorder perceptual relationships so as to (3)

Influence remission rates.

He says, "Patients who have responded to

any intensive therapy become interesting peoole to the Psychiatrists, and. If they subsequently relanse, they are given renewpd special attention".

Thus, the patients are Perceived as treatable, the method

as a Tjositlve one vhlch permits approach to a problem situation which was previously regarded as essentially Insoluble. not be dismissed too lightly.

This point should

It seems possible for research workers

to be enthusiastic about new techniques and to noseess attitudes which influence interpersonal relationships.

This

Hathaway (1?) who expresses the possibility

point is hinted by that much of thebenefits

of therapy may be ascribed to the personality of the therapist.

Thus,

it may be that psychotherapy, broadly conceived, Is basic In the attain­ ing of benefits from JEST.

Bowen (4), in discussing material drawn

from Interviews with patients undergoing 1ST, cites examples of sub­ jective feelings emphasising the importance of the ascribed feelingtone of the melieu in which the Patient finds himself and the Influences of the personnel administering EST, Briefly then, there are differing opinions as to when Psychotherapy should be held and as to its merits.

Kalinovsky, after summarising the

views of others, states that in his opinion psychotherapy should depend upon individual factors*

"In some eases psychotherapy should follow

shock treatments; in other? , it would be superfluous; and, in still others, it may be contraindicated." Many of the statements are subjective

in nature although some of

the authors attempt to "explain" them on theoretical or analogical bases. Therefore, the proolem which is herein undertaken is an attempt to (*>

explore some aspects of the relationship between the administration of EST and the time of c o n d u c t i n g Individual Psychotherapy. ii . AOTBCgnmrs

or

the present ^TtosLiy

The following Is essentially an anecdotal description of some of the events which have culminated in the present Investigation. The Investigation Is an outgrowth of an Interest in Individual psychotherapy as practiced in a practical hospital situation.

Within

the hospital situation the employment of EST as a psychiatric procedure is frequently brought to the attention of the clinical psychologist. There are requests made by various Intramural departments for evalua­ tion of patients who are considered suitable candidates for EST, and other referrals for specific evaluations for the effects of recent or contemporary E T .

At other times an evaluation of the total effects

of a particular EST program may be desired. The writer w*>s in immediate contact with several such systematic attempts at the evaluation of the results and benefits of EST.

Some

of these Investigations were conducted by the medical staff, others by psychological personnel, and still others were organized as combined programs.

One such investigation was conducted by Durea* who inter­

viewed the possible conduct of a systematic program of investigation. He emphasizes the merits of the interview technique as an indicator of

• "Clinical-psychological Impressions for Psychotherapy with Patients Undergoing Ileetroehock; A Report and Recommended Program".

Unjmibllshed

report on file at Chillicothe Veterans Administration Rosoital, 19^8* (5)

shift* In therapeutic accessibility and as a predictor of adjustment. ,He outlined a program of Investigatlon which would focus upon individual psychotherapy. Shortly thereafter, the present investigator. Influenced by that report, undertook a preliminary survey of some of the effects of 1ST as reflected in the Interview situation. between » T

Many conditions of relationship

and the Interview were Investigated In order to evaluate

the effects of psychotherapy. were Interviewed:

Subjects having undergone 1-75 shocks

subjects were seen on the day of the administration

of SST and on the day following Its administration; patients were inter­ viewed prior to undergoing a treatment series so that their attitude* concerning the contemplated treatment might be elicited; patients were seen in the recovery ward within a few minutes following the application of SST; and other variables were considered.

From this survey, a

specific program of free research or exploratory work was undertaken In an effort to evolve a fixed experimental design which would provide the setting for an investigation. A definite program was arranged which included the testing of various methods of obtaining electrically recorded interviews and the effects of physical surroundings upon the therapeutic Interview. Several different techniques for eliciting free associations and sub­ jective attitudes were tested.

The result of this program was the

refinement of many aspects of the interviewing technique. At this time, Bowen (*0 undertook an exploratory investigation of some of the relationships between SST and psychotherapy.

He Interviewed

a number of subject* prior to, during, and following a series of SST (6)

treatments.

So

m

of his specific conclusions relating to the effects

of EST upon psychotherapy were;

psychotherapy, rather than EST, may

provide the means for problem-solving and consequent improvement; psychotherapy and XST can be conducted In any combination of temporal circumstances; Individual reactions to 1ST are of greater importance than are universal reaction*- .

Trom this exploration, the relationship

between these two therapies was seen more clearly, but the relative benefits of the various combinations were not clear.

That is to say,

Bowen's work did not provide any comparison between the respective merits of psychotherapy conducted prior to, during, or following IS®, but only was able to say that Psychotherapy was possible at any of these times. The present investigator, seeking to explore more fully these temporal relationships between XST and psychotherapy, presented the general problem to the hospital medical staff for suggestion? concern­ ing its theoretical and empirical aspects.

As a result of this

presentation, several specific questions concerning the utility of a problem such as this were raised.

These were:

What are the possibil­

ities of determining signs for the optimal point, for termination of XSTT Could prediction be made as to eventual disposition of a patient uoon termination of B5TT

What are the merits of adjunctive theraoiesT

It was realised that the probability of answering each of these specific questions in one experimental investigation was remote. However, It was considered possible to derive some generalizations concerning these questions from an investigation of the relationship

(7)

between 1ST And the time of conducting psychotherapy.

The specific

manner for the setting of this Investigation Is described In Chapter IV, Method and Procedure.

(6)

CHAPTER II HISTORY ASP PRESENT STATUS OP EST I.

HI 3 TO HI CAL DEVELOPMENTS

Am Stainbrook (40) points out, artificial methods of Inducing comatose and convulsive states as cures for psychiatric illnesses have been employed for a relatively short period.

There have been

numerous historical predecessors to these present methods.

Some of

the earlier techniques resembled the present methods in that the In­ dividual was forced into a sudden or dramatic change of physical con­ dition with the anticipated result of modifying his psychological be­ havior.

However, many of these methods are only apparent homologies

to present practices!

the philosophical considerations and nractlcal

purposes have often been quite different from those which are behind present techniques. "Torture cures" such as branding, ducking, flagellation, and other forms of physical Insult were undertaken with the aim of changing the individual*s behavior.

The nature and purpose of these "cures" reflect­

ed the cultural and religious-philosophical attitudes of the ti^es. These "cures" were often drastic despite the alleged enlightened or benevolent attitudes of the healers.

Tear was a component of these

methods as was the induction of physical and physiological shock. Other practices 3uch as blood-letting and the use of pharmaceutical agents were observed and it was also known that behavioral changes often occurred as consequences Af illness or injury.

Thus, the general frame­

work of behavioral changes as relating to physical changes was well known, although the assumptions relating to the nature of these (9)

relationship* were sometime* unclear. • Stainbrook remarks that shortly after the invention of the

*

Leyden Jar In 179£ there appeared the first attempt at treating mental disorders with electricity.

Cerlettl (9 )• In telling of his own de­

velopment of SST. mentioned several historical references to the use of electrical current in the treatment of maladjustment.

He cites one ac­

count of a method dating from at least 96 A.D. in which a live torpedo fish was placed ta the skull as a cure for headaches and other ailments. Cerlettl, apparently Impressed by the implications of this nrocedure, sought information from zoologists and learned that the torpedo fish Is capable of generating approximately 20— 25 volts.

The treatment, he

felt, was not exactly the same as his method although it certainly Is of historical significance. Some of the reviewers of the historical literature object to refering to these earlier methods as being related or similar to nresent techniques.

Kalinowsky and Hoch (22) regard these early cure* as In­

stances of deliberately producing anxiety and fear In a conscious subject, whereas In the more modern techniques, the subject Is uncon­ scious and unaware of the treatment.

This objection implies some con­

scious-unconscious dualism related to the success of the therany. Stainbrook feels that perhaps the only continuity between ancient and modern shock therapies is the similarity of the motivation to display aggression against the patient.

Rils inspection of the frustration re­

sulting from being unable to cope with the situation is of eenecial interest in connection with these various reviews of t .e historical "non-antecedents'1 of present treatment, which are the very tortures (10)

which war* the basis for th* Pinal—lad reaction against inhumanitarian4 t reatment. II.

H O P P E METHODS

Modern usage of shock therapy dates from 1928 when Sakel began using insulin-produced hypoglycemic states for the treatment of abnormal mental conditions.

By 1933* he was treating schisophrenic subjects with

this method and, although Sakel is generally recognized as the leading figure In the development of the method, others had all ready claimed cures by the method. Many investigations have been undertaken concerning the usage of insulin therapy (40, 43).

Of particular significance for this paper is

the frequently encountered statement that psychotherapy is of utmost importance during the employment of insulin treatment (23)* In 1934, ton Meduna began producing convulsions by us* of a camphor derivative, the drug known as metrasol or cardiazol.

Von Meduna

had been influenced by the assumption that dementia praecox and epilepsy were Incompatible.

Stainbrook (40) asserts that von Meduna was in error

concerning this assumption, and therefore the rationale for this treat­ ment method was false. However, metrasol therapy has been employed widely and with some success.

Its usage has been less wide-spread since the development of

SST because of the intense fear reaction which occurs before the onset of the convulsion and because of fractures and other complications which accompany the convulsions. The development of XST as a method reached J is fruition in 193

(11)

Cerlettlfs description of the development of BBT affords some insight into the background of the method.

He had been conducting experiments

on doge while Investigating specific brain areas as correlates of enilepsy. In 1936

wae employing insulin coaa therapy and metrasol as

cures for schizophrenia.

He thought that the same results might be

obtained by the use of electricity, so he again turned to experimental animals.

By 1937 he was more certain that the method held promise and

was vorking with pigs to determine the effects of dosage regulation. Shortly thereafter, he successfully treated the first case, an adult male schizophrenic, and XST soon became recognized as a method. this Initial work many modifications and techniques have arisen.

From Cerlettl,

differing from these proponents of modified techniques, feels that the basic treatment is the element which is Important.

He has chosen to

refer to the operation of the method as a "terror defense reaction" and claims that it is of biological significance.

The patient has vide-

spread fear of the treatment despite the fact that he is unconscious dur­ ing the convulsive state. Other shock therapies have followed the introduction of XST. these aret

Among

pictrotoxln, carbon dioxide stimulation, prolonged sleep,

refrigeration, "psychological shock", and even the variations of the lobotomy technique are considered as shock methods. It is felt that nearly all of these therapies have been influenced by the evolution of the disease entity approach to osychlatry, and the Kraepllnlan attempt at ordering behavior abnormalities system.

into a taxonomic

The identification of dementia praecox as a specific condition,

(12)

or disease led to the search for a specific cure.

The von Meduna method

of combating schisophrenia with an alleged antagonist is evidence of this approach.

All the methods are empirical.

EST was developed in an

attempt to provide something which resembled metrasol or insulin.

The

entire picture has developed into one of empiricism and attempts at ex­ planatory theorising.

As O'Kelly and others (5, 16, 20, 23, 29, h0, U3)

point out, there are no adequate theoretical assumptions concerning SST. Agreement does exist upon the "facilitation" afforded by the treat­ ment; however, attempts at explaining this facilitation are as diverse as are the theories• III.

RECENT PRACTICES

The ease of its application is one factor which has enhanced the clinical value of EST.

The method of administration is easier than the

Intravenous injections necessary for insulin or metrasol and the immediate loss of consciousness is helpful in regulating the patient (22). cidence of fractures Is less than encountered in metrasol,

The in­

(23), and other

practical considerations such as the duration of treatment, the amnesia for the shock, relatively simple training of personnel, and other factors have all helped make EST a popular method. Debate concerning contraindications for EST was formerly encounter­ ed but it has been found possible to utilise it under many circumstances. Wilcox (1*0) mentions that it can be safely administered to aged patients, in cases of advanced pregnancy, where organic complications exist, and even with some types of cardiac involvements. The course of treatment has been fairly well agreed upon, although some writers state that variations should be undertaken whenever specific (13)

results are desired. It is felt that manic hyperac*ivity may be ter*

minuted b> a short. Intensive series of XST.

Fifteen to twenty

treatments constitute the usual series, and some authors feel that this entire series must be given desoite evidences of improvement follow­ ing

early treatments (**0, 43). Failure for a patient to improve after a course of EST is not

usually taken as a sign that improvement is not possible.

Some writers

object to this practice of continuing treatment without adequate evalu­ ation and feel that it may result in permanent irreversible cortical changes.

There are instances of patients having received over two

hundred XST treatments, although the effects of such prolonged treat­ ment are not clearly known. (2 3 * 31)* The spacing of treatments is also of importance.

It is moat often

utilized on a three-times-a-week basis in the institutional situation. However, some insist on more frequent applications.

This may involve

as many as four treatments daily during the early stages of treatment with some reduction following the onset of desired changes (40, 43). Further modifications of XST include variations of dosage intensity and the duration of application.

Wilcox has pointed out the effects of

various modifications of the electrical current and states that various wave patterns result in differences in convulsions.

These modifications

usually reflect theoretical differences between their proponents:

those

utilizing dramatic intensive therapy generally ascribe to a theory of ranid change and a need for organic and psychological confusion, vkereas those utilizing "soft" shock base their belief on the facilitating effects or stimulation resulting from the treatment (22, 40, 43). (14)

In addition to the actual modifications of tha technique( SST is often compared vith other therapies or agents.

Specific pharmaceutical

agents are administered to modify or lessen the convulsion.

The use of

curare for example, makes it possible to administer treatment to patients who might otherwise suffer fractures or compressions (4-3). XST is often combined with insulin therapy following the failure of a course of treatment.

Further, 1ST is often followed successfully by additional

courses of treatment, insulin shock therapy, combination treatments, and lobotomy (40).

Psychotherapy is also combined with 1ST.

Selection of Patients,

There are varying degrees of consideration given

to the criteria for undertaking XST although some authors have mentioned that such criteria should be applied (22).

In general, it is felt that

considerations such as age, severity of condition, duration of illness, onset, pre-psychotic level of adjustment, and other considerations should be applied.

Usually, however, shock is administered on the basis of diag­

nostic categories rather than on dynamic considerations.

This practice has

developed from rough empiricism and shows many evidences of fallibility. This approach has provided literature with many numerical compar­ isons between improvement rates for the various diagnostic categories. There is agreement between mathors as to the relative Improvement rates although the exact degree of improvement may differ from enlng.

Whatever the reason, this erarve

of production Is different in its productivity than the thought unit curves for the other groups.

As such, it Is of significance.

The

other two measures for this group represent what night be termed "peychologlcal straight llnesM .

They do not fluctuate significantly

during the course of therapy nor are they greatly Influenced by the amount of talk. group 1 .

Shock group.

general improvement during the course of

Interview series Is noted on all characteristics•

The first half of

this series is significantly different from the last for each measure­ ment:

all slopes changing from positive to negative.

The similarity

of these findings to those mentioned earlier In regard to formal psychological testing Is remarkable.

As the cumulative effects of

shock treatment are noted, the measures decline.

Despite this last

half decrement, final performance may be at a level above the Initial point. group I I .

Post Shock.

These group I people, following the termin­

ation of shock, demonstrate a reversal of curves for the quality of communication and for global rating. does not return to the previous level.

The amount of talk, however, The reversal In curve trends

oeaurs approxlmatsly two weeks after the termination of ® T and Is quite dramatic.

Vote that the differences between the first and last halves

of this Intsrvlew series are significant at ths .05 and .001 levels of confidence.

This trend is similar to that found by Stone (h2) on his

woric with th« "cognitive function* following termination of SST. group III.

Post Shock.

In contrast to its companion Group II,

this experimental situation shows downward trsnds that bsooms more aeesntsd with ths passing of tins. Thus, In summary, it oan be sssn that under conditions when no SST Is administered, no significant differences occur for factors other than amount of talk*

During the course of shook, although these results hare

been drawn ffom the period Including only the twelfth treatment, the scores show a significant decline as shock orogreeees.

It may be

postulated that further SST would result in a still greater decrement of performance.

T o H e w i n g shock, those people who hare not had previous

psychotherapy, tend to show declines in performance.

Those nereons who

have had psychotherapy during SST demonstrate a rapid overall improvement upon termination of SST.

Thus it seems dgnifleant that therapy conducted

during SST may be reflected in later behavior or at least facilitate later performance, learning studies.

nils finding is similar to that demonstrated by the (34, 44) II.

M H W M M » t O a P TRSNDS

The previous descriptions tell relatively little about the exact nature of the differences between the various experimental situations. The statistical procedure utilised to compare between-group differences permit systesiatic comparison between these experimental situations. I — II.

There are no important trends between the characteristics

during and nost SST. in group II) Improve.

All curves of values excepting one (thought units Thus, while the general trends are positive, they

are not significantly different from one another.

(68)

I - III.

All characteristics show a Pronounced difference favoring

the combination of XST and "Psychotherapy overmychotherapy begun follow­ ing EST.

Better quality of Ideational production and Improved amenability

for therapy enhances the possibilities for psychotherapy during XST rather than waiting until the course has been concluded. It Is worthwhile to note that Qroup III does not compare favorably with any of the other groups.

This does not Indicate thrt eventual

Improvement might not have been possible.

It does however reflect the

conditions which were noticeable during the four weeks following termination of XST. I - IV.

Shock therapy does appear to enhance the possibilities

for psychotherapy. IX - III.

This comparison is perhaps the most fruitful and

slgnlfleant of any.

Rie results are much In keeping with those obtained

by the Investigators who have conducted the various learning experiments In the field of XST. later.

The situation provided during shock Is reflected

On two of the three variables. Qroup II scores are significantly

better than Qroup III.

Bae Implication Is that this situation Is of

definite therapeutic Importance.

The quality and the significance of

communication show true differences between these groups. II - IT.

Therapy continued after the cessation of XST Is of

greater benefit than no therapy. III - IT.

Psychotherapy conducted without XST may result in

greater, short-time benefits than therapy begun following the termina­ tion of XST when there has been no previous therapy undertaken.

(19)

III. *•

UTILITY or THS S C O M NO METHODS

Thought Unit Count.

It seems that the thought unit count by

itself does not appear to be a valuable measure of change.

However,

when It Is considered together with the other measures, it may be of significance.

It did certainly seem that the amount of talk Is an

Important variable In the practical situation when Previously mute patients began talking or bbhsr patients cease to be verbally product­ ive.

VIthin the framework of this study, the amount of talk itself

does not seem to be mf great significance. The thought unit count Produced by three of these groups parallels that reported by Bugental (£) who etates, "The average one-hour inter­ view, it has been found, ylelde well in excess of 350 of these units". The results of this study seem to indicate that the Group IT subjects were more ideatlonally productive than Bugental*s. b.

Efficiency Index and Global H atings.

The other measures tend

to show indications of relationship although there is no systematic confirmation of this feeling.

The fact that they vary together is

oosltively related to the results of an Informal non-systematic follow-up of these patients six months after the termination of the final Interviews. It was shown that!

for Group II, four patients had left the hospital

and the other two had freedom of the grounds; three of the Group III subjects had returned home while the others were on closed wards; the Group IT subjects were divided in the same manner as Group III.

How­

ever, all Group III and XT subjeets who had remained in the hospital had received at least one additional course of X3T and two subjects from each group had also received insulin shock therapy. (?a>

Thus, the measured

superiority of Group II over the other groups seems to hare been reflected in subsequent clinical disposition. IT. A.

IMPLTCATI0H8

Shock does increase therapeutic amenability.

ftiere is a rapid

initial rise in accessibility which is followed by a decline.

This

would indicate that the length of the BST course, or at least the spacing of treatments, might be modified.

Such a modification would

involve the administration of fewer BSTs following the attainment of the initial benefits resultant from improved accessibility.

Thus,

therapy might progress further without being hindered by those factors which would seem to impede "movement".

This hypothesis needs further

systematic testing but it is felt that It is fairly well substantiated by the results of this investigation. B.

It is possibls to make a rather precise definition of the temporal

relationships affording the maximum benefits of combining BST and psychotherapy.

It is apparent that psychotherapy is possible during

BST, is less efficacious when begun after termination of 1ST, and shows the best possible results when conducted before, during, and subsequent to BST. C.

By generalisation, any therapy adjunctive to BST is of greater

value than BST alone.

These conclusions are remarkably similar to

those of Babin (3*0 who found that new learnings were possible close to the time of 1ST. 2).

Prediction of prognosis is possible within a period of two weeks

subsequsnt to the termination of 1ST.

This is the point at which the

curves for Group II and III show the greatest inflection.

.

( £

CHAPTER Till SUMMARY AMD CONCLU3IOHS This study was conduotsd In order to investigate sons of ths offsets of rarious temporal relationships between electroshoclc therapy and individual psychotherapy.

Of particular Interest were the c h a n g e

in oharaeteristics of psychotherapeutic interviews conducted under differing conditions of 1ST. this investigation were:

Some of the practical implications of

What combinations of S3? and individual

psyohotherapy would be moot efflcaciouoT ation of XS? be developed:

Could criteria for termin­

Could predictions for prognosis follow­

ing termination of S3? bft madsT The Method Of Interview Analysis Three scoring methods wore utilised in order to analyse mater­ ial produced during interview situations.

These were the Thought

Unit index, a measure of ideational productivity; the Efficiency Index, an indication of the quality of verbal materials; and the Global Sating, which indicated the subjects accessibility for psycho­ therapy. Reliability studies were conducted In order to determine the utility of these scoring methods.

It was found that trained

Judges were able to satisfactorily identify the scoring variables. The degree of concurrence between Judges ratings exceeded chance expectancy for all three scoring measures.

Thus, it was concluded

that the method of analysis was a statistically reliable measuring device.

(73)

Subjects The subject* ueed In this investlgation were sale veterans of World War II who were hospitalized at a Veterans Administration Neuro­ psychiatric Hospital.

The subjects were selected on the baeie of the

following criteria: 1.

All subjects were diagnosed as psychotic without evidence

of organic brain damage.

Certain diagnostic groups were sordluded be­

cause of evidence that there are differential reactions to 1ST dis­ played by various nsyehiatrlc classification groups. All subjects in this study were diagnosed as schbsouhrenlc reaction. 2.

Patients with relatively short periods of hosoitalizatlon

were utilized. 3.

No subjects had received previous 1ST or other shock therapy

within six months of the time of this investigation. h.

Patients who spoke a language other than English were

excluded. 5.

Subjects were free to decide whether or not they wished to

enter into a series of psychotherapeutic interviews. Experimental Variables Pour experimental situations were constituted.

In these sit­

uations the interview procedure remained constant while differing conditions of EST were employed.

One group of subjects was seen for

psychotheraoeutlc interviews while they were being given EST.

Another

experimental situation Involved the same subjects seen for a series of psychotherapeutic Interviews following the termination of EST.

A

third group of subjects had concluded EST treatments but had not re— (7*0

ceived previous individual psychotherapy.

The final group, in sons

measures a control for the other three, had not received 159 during this period of Investigation. Procedure The material produced during these experimental interviews was electrically recorded and typescripts were prepared.

The Interview

series consisted of 3O-mis0.te periods held three times a week until a total of 12 sessions was reached.

The typescripts were scored for

each of the three scoring measures and statistical comparisons were made between various experimental groups. Besults The scoring characteristics derived from interviews conducted during EST showed improvement for the entire series.

However,

statistically significant differences exist between the first and last half of the series. An initial improvement was followed by a decline in performance:

nils difference was beyond the .001 level of con­

fidence for a combination of all three measures. This same group of people seen n o s t - M T showed continued over­ all Improvement in Efficiency Index and Global Ratings. talk, however, declined.

Amount of

The trends for Efficiency Index and Global

Rating Scores showed an initial decline followed by a rapid lnrorovement during the last half of the Interview series:

these differences

were significant at the .05 and .001 levels of confidence.

The amount

of talk did not show significant variations between the first and last halves of the Interview series. Those subjects seen for Interviews following EST but who had (75)

not had previous psychotherapy demonstrated dacllnea In all measures for tha entlra Interview aarlas.

This daclina was mora

promounced during tha laat alz Interviews. 800raa from subjects who had no 1S T ahowad overall dacllnaa In Thought Units and Xfflelaney Index. alightly.

Global Hating aeoraa improved

Tha aaount of talk dlalnlahad ranIdly during tha flrat

alx Interviews and incraaaad brjf; an erjual amount during tha laat half of tha aarlaa. level of confldanea.

Thia dlffaranea waa algnlflcnnt at tha .001 Tha othar two maaauraa did not ylald statia—

tleally algnlficant tranda. Statlatleal eoapariaona batwaan tha various experimental altuatlona Indicated tha following dlffarancaa batwaan tha altuatlona. Characterlatlea of Interviews conductad during

do not

dlffar from charactariatics obtained from the same subjects follow­ ing tha termination of shook. Intarrlawa conductad with subjects undergoing XST dlffar significantly from those conductad with subjects haring terminated XST without haring had prerious psychotherapy.

Tha combined scores

Indicate this dlffaranea Is significant at the .001 laral of eonfIdanca. Thought Unit count and Xfflelaney Index values ahowad statistically Important differences for those individuals u£dergoing XST as contrasted with those subjects who had not received shock.

However, Global HatInga for these two grouna did not show

any Important differences. Psychotherapy conductad during XST la of Importance In tha I* P*y c ho therapeutic situations.

(76)

T is Is indicated by an .01

level of confidence between the scores obtained from those subjects who had terminated EST and had previous psychotherapy and the group of subjects having terminated 1ST without previous psychotherapy. There were no statistically significant differences between the interview characteristics of subjects having terminated XST with previous psychotherapy and those subjects not having XST. The declines in functioning for those individuals having terminated XST without previous psychotherapy do not differ from the decline of performance shown by individuals without EST. Conclusions 1. .M T 2.

Increases the possibilities for therapeutic accessibility.

During the course of XST, there is a rapid initial rise In

accessibility which Is followed by a decline.

This would indicate

that it would be most beneficial to attempt psychotherapy during the initial stage of XST treatment. 3.

It is possible to profitably conduct individual psychotherapy

during the course of X8T.

However, far more beneficial results can be

obtained if individual psychotherapy Is conducted during the course of XST and is followed by further psychotherapy following the termination of shock treatment. U.

If the lnaugeratlon of individual psychotherapy is delayed un­

til the termination of EST, the possibilities for initial success are less favorable than, when psychotherapy has been conducted during EST.

(77)

5.

Psychotherapy conducted ae an adjunct to EST is of greater

benefit than 1ST alone.

By generalisation, it is believed that any

fora of therany adjunctive to EST is beneficial. 6-

It is possible to predict the relative benefits of XST

within a period of two weeks subsequent to the termination of shock treatments.

(78)

BIBLIOGRAPHY 1.

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2.

Barry, J. R . , "An Investigation of the Relationships Between Adjustment Level and Oharaetsristles of Tsrhal Reactions Toward Self and World". Unpublished Ph.D. dissertation, Bie Ohio Stats University. 1949-

3.

Bennett, A. X . , "The Role of Psychotherapy in Xlectroshock Therapy". A m . J. Psychiatry, 105 (1948), PP- 392-393-

4.

Bowen, V . V. , An Xrploratory Study of Xlectroshock Therapy with Reference to Psycholherapy. UnpublieFed M.A. thesis. The Ohio State --------------------P nlver' s U / riW -

5.

Braatoy, J . , "Indications for Shock Treatnent in Psychiatry". A m . J. Psychiatry, 104 (1946) pp. 573-575-

6-

Bugental, J. P. T . , An I orestleation of the Relationship of the Conceptual Matrix to~lhe~belf-Concept . Unpublished Ph.D. dissertation, the UElo State University, 1948.

7.

Burke, C. J . , "Computation of the Level of Significance in the F-Test". Psychol. Bull. , 48, (Sept., 1951), PP- 392-397-

6.

Calvert, Janes J., Verbal Behavior as a Prediotor of Personality Syndrones. Unpublished Ph.D. thesis. The Ohio State University, 19**9-

9.

Cerlettl, U. , "Old and Xew Information About Xlsctroshock". A m . J. Psychiatry.10? (August, 1950), pp. 87-94.

1C.

Committee on Therapy of The Croup for the Advancement of Psychiatry, "Shock Therapy, Report Xo. 1". Psychoson. Med. . 10, (1948), pp. 55-56-

11.

Dollard, John and Mower, 0. Hubert, "A Method of Measuring Tension in Written Documents". J. Ab. and Soc. Psych. . 42 (1947), pp. 3-32.

12.

Duncan, C. P., "Tbs Tstroactire Xffect of Xlectroshock or Learning". J. Compar. Physio. Psychology, 42 (1949), PP- 32-49-

13.

Xrikeen, 0. W. , Porter, P. B. , and Stone, C. . "Learning Ability In Rats Cl von Ueotrocoarrulsive Shocks in Late Infancy". J. Compar. Physiol. Psychology, 41 (1948) pp. 144-154.

14.

Penichel, 0., The Psychoanalytic Theory of Xeurosie. Wiley, 1949. PP. 548-69.

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Xew York*

15.

Froseh, J. and Inpastato, S., "The Effects of Shock Treatment on the Xgo". Psychanal. Qaar. . 17 (1948), pp. 226-236.

16*

Gordon, H. L. , "fifty Shock Therapy Bieorles", Mil. Surgeon. 103 (1948) . pp. 397-401. »

17-

Hathaway, S., "Clinical Methodei Psychotherapy", Annual Her. Psych., 2. 1951. pp. 259-280.

16.

Hunt, J. McT., "The Problem of Measuring the Results of Psychotherapy". Psychological Service Center Journal, 1 (Dec, 1949). pp. 1 2 2 -1 3 5 ~

19.

Huston, P.E. and Shakov, D. , "Learning Capacity In Schizophrenia". A m . J. Psychiatry. 105 (1949), pp. 881-888.

20.

Janls, I. L . , "Memory Loss Following Electric Convulsive Treatments". J. Person. , 17, (1948), pp. 29-32.

21.

Xalinoslqr, L. B. , "Shock Treatment As of Today". Dig, of Neurol. and Psychiatry. Institute of Living, 1£, (1949), p. 296*

22.

and Hoch, P. H . , Shock Treatments and Other Somatic Procedures In Psychiatry. Hew T ork : Prune & Strait on, 19**9.

23*

Krainee, 8. H . , The Therapy of the NcuroAcs and Psychoses, Philadelphia: Lee 4 FeblgerT"1935’, pp. **84—566-

24.

Lindquist, I. F. , Statistical Analysis in Educational Research, Bomton: Houghton Mifflin Company, 1940, pp. 4 6 - 5 ^

25*

Lowenhaoh, H. and Steinbrook, 3., "Observation on Mental Patients After Zleetroshock". Am. J. Psychiatry, 98 (1942), p. 828.

26*

Millet, J. A. P., and Mosse, X. P., "On Certain Psychological Aspects of Xlectroshock Therapy". Psychosom. Med. . 6. (1947). pp. 226-236*

27.

Myerson, A., "Borderline Cases Treated by Electric Shock". Am. J. Psychlat., 100, (1943), pp. 355-357*

26.

Xatimaal Bureau of Standards. Tables of the Binomial Probability Pis trdbution. Washington, D.C.1 Government Printing Of rice, January 27* 1950 *

29.

O'lolly, L. I. , Introduction to Psychopat hoi pgr. Prentice Hall, 1^49, p p . 6^5— 661*

30

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New York:

Pearson, E . , Tables of the Incomplete Beta-Tunction. Blonetrlka Office, 1934.

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London:

31.

Perlson, J . t "Psychologic Studios on a Patient Who Received 248 Xleetrie Shock Treatments". Arch. Heurol. A Psychiatry, 54, (1945) . pp. 409-411.

32.

Rickies, S. X., "Xlectroshock Therapy". (1947). PP. 52-55.

33.

Hodnick, B. H . , "The Bffoct of Metrazol Shock Upon Habit Syotoms" J. Abnorm. Soc. Psychol. . 37. (1942), pp. 560—565-

34.

Rubin, H . , The Differential Bffocts of Blectric Shock Therapy on reho'tic ^Patltntf TatTon' o TTornxVl — —1flVWd fti.DV, -------ll»»#rtatlon, — Ltaralnc Aaooc ^■ychotic rrorsITy t ).95Q The Ohio dtate Univi

35*

Scherer, I. V., "Correlates of Improvement with Blectroconvulsive Therapy", Psychological Serrice Center Journal, 1 (Bee., 1949)* pp. 109—121.

36.

Shaw, P. J.,"The Role of Reward in Pe; chotherapy", A m . Psychologist. 4, pp. 177-179-

37.

Shoben, B. J. , "Psychotherapy as a Problen In Learning Theory", Psych. Bull. , 46 (8ept. , 1949) . PP- 366“392.

38.

Smith, L. H. , Hastings, D. W. and Hughes, J., "Immediate and Follow-up Results of Xlectroshock Therapy". Am. J. Psychiatry, 1 0 0 , (1943), 351-354.

Am. J. Psychiatry, 104.

39*

Stelnbrook, X. J . , "The Rorschach Description of Immediate PostConvulsive Mental Functions", Character of Pars., 12, (1944), pp. 302-322.

40.

"Shock Therapy: Psychologic Theory and Research ” , Psychol. 'Rill. . 43, (1946). pp. 31-60.

41.

and Lowenbach, H. , "Writing and Drawing of Psychotic Individuals After Xlectrleally Induced Convulsions". J. Herv. A Mont. P is. . 99. (April, 1944), pp. 382-388.

42.

Stone, C* S. , "Losses and Gains in Cognitive Function as Related to XIeotro— Convulsive Shocks". J. Ab. and Soc. Psych., 42, (April. 1947), P P - 206-214.

43.

Wilcox, Ph H. , "Shock Therapy" Chap. 30 in Progress in Beurology and Psychiatry, X.A. Spiegel, Xd. , Hew York: Orune S“ Stratton, 1^49, pu. 499-528.

44.

Worohel, P., and Barcieco, J. C . , Jr., "Xlectroshock Convulsions and Memory: the Interval Between Learning and Shock". J. Abnorm. Soc. Psych. , 4 5 . (1950), pp. 85-99.

(81)

Zubin, J., "Objaetiro Studlaa of Diaordarad Paraona” . Chaptar 20 In Mathoda of Paychology, Andrava , T. , Id. , Vow Torkt Wllay, 19^8.

(82)

Appendix 1

iMsraooTioas

poi r a t p s

I. DIT13IOB or KATMRIAL INTO THOUQHT UHITH 1)

Head, the entire typescript in order to familiarise yourself with

the content.

Through auoh reading it ie possible to recognise eoae of

the distinctive speech habits or patterns of the subject.

This is of

importance in analysing the material. 2)

Punctuation:

transcriber.

The protocol is punctuated as it sounded to the

Pauses or hesitations in speech fcre indicated by a

series of dots.

However* it is difficult to estimate the exact length

of time between two speeches.

The presence of a capitalised word after

a Series of dashes indicates that the transcriber felt that a new ver­ bal production had started.

This, however, may not necessarily be re­

lated to the beginning of a new thought unit.

The punctuation, as it

exists on the typescript, may or may not follow the rules of grammar ...or even of the psychological determination of thought units. 3)

Head a smaller unit for meaning.

When reading this smaller unit

it is well to bear in mind the possibilities of "rewriting" material which mi|d*t be distorted. h)

Take a topic, line, or similar unit and divide it into thought units.

It is to be remembered that, for the purpose at hand, a thought unit le an idea which can stand alone or an Independent clause.

However,

because of the nature of the verbal productlone of these individuals, idea content does not always follow the rules of grammar.

Therefore,

the thought unit is to be regarded as much a psychological unit as a pure grammatical function.

Inferences need to be drawn in many

instances.

However, whenever It is possible, thought unit division

should be as much on an explicit level as possible. II. 1)

3CTLN3 JOB THOUGHT UNIT DIVISION

SUPPLY MISSING V0BD3 AND IDIAS.

It Is oftsn necessary to

add words In ordsr to complete a thought unit or to anhanca tha meaning. Bumpiest (8ha said)

"Please alstar, plaasa mister,

don't hit hla no sora"/.

Hara tha words sha

said hara baan added. I was 4*7 days AWOL. / And u h

oolorad saetlon

/...and uh wall, I had about $80.00/.

Hara

it is necessary to supply tha idea that tha veteran was in a colored saotlon. 2)

M f R X T S WHXN NXCNS8AHT.

Spaaehas ara to ba rawrlttsn whan

FAHBNYHNTIGAL COMMENTS.

thasa ara not to ba eountad as

necessary. 3)

thought units excepting whan they ara an Integral part of tha mater— lal or whan they ara tha only natarlal alieitad batwaan two tharaplst spaaehas. B e amplest that's right

I don't know You see

Wall

Let's sea

I guess

Oh wall

as I said

or something.

and everything

and so forth ate

However, whsn e o M t a t t such as these ara tha only production, thay ara count ad aa thought unlta. 4)

QCJH8TI0HS AHD AHSlfgBS.

whan a raaponaa is to a question,

if It la ona In which tha aaawar la followed by a alapla elaborating atataaant, it la counted aa a single thought unit* Xxaaplesi *Tt

You find that rl£it now you ara able to talk to peoplet

Y:

Yea, I carry on a conversation./

Thia la alapla elaboration. Howewer, whan tha anawar bring* up now aaterial or goea beyond sl^»le elaboration, tha anawar ia a thought unit and tha renalnder la handled aa neoeaaary. Xnaplat Ti

Have you had a feeling that perhape I'd forgotten about youT

▼: 5)

Hot exactly/... .1 aaw you outdoors there today./

QPOTATIOHS:

whan tha subject ia quoting another paraon, it ia

handled aa a single thought unit.

This is because ha perceives tha

other Individual'a atataaants aa a single psychological entity. Xxaaplai And she'd day, "You little devil. If you don't aend your ways you'll grow up to be ona of tha worst... worst little devils that Ood aver walked tha face of tha earth. You're Just a roughneck, that's all”/. *Y equals therapist; ▼ equals veteran.

Us 1

However, when the individual quotes hlnself, it is handled la th« usual way. Sxaaple: I said, "get out of tho ear" you know./ no food./ 6)

"You're

I don't tako that shit froa nobody."/

SXRIXS AXD P A B 1 L U X I S M B i

whsn a sari os is regarded as a

continuous psychological unit slthar bacausa of tha individual's par* eeptlon of tha events or bacausa of cosuson usage, it Is regarded aa a singla thought unit.

However, when a a arias is composed of ltaas

which sirs discrete, thay ara handled aa separata units.

Sxanples t She h a d baan aarrlsd and dlvoroed and had a little kid a n d

I don't know./

This is all

ona distinct unit bacausa it Is a dascrlption of t h a woman as aha exists. Thara's Stanley that's on tha Vorth Side/ and t h a n thara's Joseph, ha's studying auaie;/ and Walter;/ and Dorothy;/ and XIisabeth;/ and thara's ay sister who waa eoaalttad to a state institution,/ she's a hypochondriac;/....and thara's ay sister Stella,/ she's autrriad and has 3 children,/...." (Mora of same follows).

In

this long series th* subject la describing his family but tha ltaas are discrata enough to ba considered aa individual units.

'SO

Compound subjects or coapound -sorbs which Indicate parallel ideas ara usually count ad aa a single thou^&t unit. Sxaaploa t Bay and I uaad to go out thara./ They oaaa by train and bus./ Ha rltehed (raachad) down and picked It up./ 7)

OOHRXCTIOHS:

whan a rapid, apontanaoue corraction la aada

it doaa not Indlcata a naad for aora than a single thought unit. Hxanple t Ha'a froa Tennessee— *Weat Virginia./

Ona thought

unit. But whan tha corractlona rapraaant wacillation or doubt* thay ahould ba handlad aa aaparata thought unita. Hxanplat Wall I told ona of than..../ did I tall hlaT/ I didn't tall him/....or did It/ I told hint/ 1 said that if thay didn't traat aa right I'd eaeape./ 8)

7RA0MXHT8t contlnnoualy addltlre fraguanta ara frequently

ancountarad.

Tha aubjact repeats tha aana lneonplata natarlal but

adda aoaathlng with aach rapatltlon.

Thaaa ahould ba traatad aa a

alngla unit. Scaaplai Wall It....wall It Just....well tha aaaorlaa Just cona back./ This is only dona whan tha aubjact finally says aonathing which

appears to bo directly the result of the fragments In the repetitions ante rial.

When an individual elicits a group of fra^ientary state—

aents and then produces a coaplete thought unit which does BOT appear to be the product of these fragments, all the fragmentary material is counted as one thought unit, the remainder aa necessary. If the individual repeats a coaplete thought unit over and over again without adding to It, each complete. Independent Idea is counted as a thought unit. ■samples I made a bench in OT. / Down at OT I made a bench./ I aade a bench...... down at OT./ When speech fragments are the only production between two therapist speeches, they are counted as a single thought unit.

The

same Is true when there is a large group of fra^ents between two of the subject's speeches, i.e., they exist as an "island" between two coaplete speeches and are not related to the thought units on either side. ■samplet I still remember that../...well...1...why It was quite a../ my hands are sweating more than they used to./ Many fragments are handled according to the rules concerning the supplying of missing words and ideas. ■samples Well...well...1'd....I wrote a card to my girl friend/ ....dated........ /. .1 been acquainted with her during

the i u « » r Months./

I think It waa laat year. ../...

. .a n a a w .../ or did I go laat yearT/ or waa It tha year before?/ Othara ara not ao claar In neaning but ara recognlseable aa 1n— conplata ldaaa. ■ranpleai At flrat It waa pretty.../ at all./

I didn't want har

I didn't want har to taaeh aa typing./

Thay wouldn't understand and I'd ba laid off again/......anything happan a n d

/».uh. .wall. ..

I want to try ay baat to gat back In tha offlea at Allagheny Staal./ 9)

®CffTI0¥8i

apaclflc raquasta eonearnlng cigarettes,

aatehaa * and alallar aaoklng aatarlala ara not to ba tabulatad aa thought units.

nils la baeauaa of tha rastrlctlons placad upon thaaa

subjects which aada It Impossible for thaa to carry aatehaa.

Othar

"asides” auch as tits, waathar, data, ate. ara to ba tabulatad. hi.

800HXM0

won

arncigNCT

Of OOMMPHICATIOJ Thia la aa attempt to evaluate soaa aspects of tha subject's ability to eoaaunlcate.

Specifically, for thia study. It ia an eval­

uation of how wall tha subject's ideas hold together.

Thera ara two

factors which ara scored: tha flrat la a tabulation of lrrelevancles, tha second ia a tabulation of tha apaaeh fragments. A n irrelevancy consists of a thought unit which ia osychologically

d o r i a a t f r o * th o p r t e t d l a g u n i t , w h o th o r t h a t p r o c o d ln c « a l t m a * p r o d u c t o f o l th o r th o n u b jo e t o r th o t h e r a p i s t . S — aples

T h i a l o a a o x a a p l e o f a TV w h ic h i a d o r i a a t f r o * th o l a s t th o u g h t u n i t o f th o t h e r a p i s t . ▼i a a d I w a n te d t o f i n d o a t i f 70a t h i n k X e o u ld r o t a r a h o a o . T* Sow do 70a f o o l a b o u t i t ? ▼« W e l l , l l f o h o r o i n Tt I t i s

o o a o tla o o h o t . .

o o a e tla s o h o t ,

V« a n d I ' d

l i k o t o 000 a y r o l a t l o n o .

Bcanplot

I r r o lo r a a t to ova la a o d la to o ta to a o a t. c o t t l a c a a r r l o d , / 70a c o t d i s a p p o i n t e d . / I l o a r a o d how t o d a a o o P o o . / B o w e ro r, w hoa th o s u b jo o t o l l e i t o a n i r r o l o r a a t o t a t o a o a t a a d e o a t l a a o o a l o n e t h o new t r a i a o f t h o u c h t » t h e r e l o a o f a r t h o r p o a a l t 7 . k a q p lo i D i d X r o a d t h a t i a t h o B l b l o T / X d o a ' t kaow a h o ro X ro a d i t . /

...

a h ...

X d o a 't t h in k X

ro a d i t l a th o B i b l e / . . . . b u t . . w a l l . ..1

ro a d i t . /

X w ro te a a o th o r p o o t o a rd t o a a o th o r a n ro o / X f o r e o t h o r — a o / . . w a l l . . . t h o o a o t h a t w aa h e l p l a c D r . H ookboo w i t h o h o c k t r e a t m e n t s , / 70a kaow h o r a a a o , d o n ' t p o u t / . I w a a to d t o c o t o o h a r o h

ta a d a ^ /.. ( t i e . ) H o r* t h t r t * n w h ie h i s

o n l y tw o M t t t a a d l a c s h i f t s .

fo llo w e d by r « l a t « d M t t r i s l .

*he f i f t t

th e re fo re , i t

is

is

on#

sc o red a s a

s in g le irro lo ra n o y . I t i s to ho a o ts d t h a t i t

i s p s s s i h l s f o r a s o r t so o f th o u g h t

u n i ts to h a re ao p s y c h o lo g ic a l e o a t la a i t y .

n u k Mem i n u m W H W Ii

v u t

s*Am a n v i m a n u c b sim.

P u t a s o ro s ig n o a oaoh o f th o f r s g n s n ta r y sp e e c h e s

w h ic h h a s h o o a b r o u g h t o u t b y t h o A i r i s i o a o f t h o u g h t u n i t s . p o a a lis o d boc au s o i t

is

T h is i s

ia A io a tiro o f a r o l a t lr o l y p o o r a b i l i t y

to

s u s ta in a lo g io a l o o a ro rs a tlo a . 0001* teb » m n i

in) z n o s . amd xbookd s » IT.

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AUTOBI0 W A P H Y I, S. lobert Albrecht, « u bora in Toledo, Ohio, February 29. 1920.

I rocoirod ay secondary oehool oduoatloa

la tho public school* of tho city of Toledo, Ohio.

Kjr under­

graduate training was obtaiaod at Rie Ohio Btato Uhirersity, froa which I rocoirod tho degree Bachelor of Arts in 194£. During the scholastic years 1942-43* X *aa a aoabor of the United States Karal Reserrs, Class V-7*

Froa 1943 to

1946 X *erred on actlro duty in tho Araod Forces. Xn 1946* X enrolled in the graduate school of Vhe Ohio State Unirersity and in 1947. X was accepted in the Veterans Adainistration Training Program for Clinical Psychologists.

I held the position of Psychological Intern

while ooapleting the requirements for th# degree Doctor of Rillosophy.