THE RELATION BETWEEN AGGRESSIVE FANTASY AND OVERT BEHAVIOR

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MTNUCHEN, P a tricia Pittluck, 1923THE RELATION BETWEEN AGGRESSIVE FANTASY AND OVERT BEHAVIOR. Y ale U n iversity, Ph. D ., 1950 P sych ology, clin ica l -

University Microfilms, Inc., Ann Arbor, Michigan

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COPYRIGHT BY PATRICIA PITTLUCK MINUCHIN 1965

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THE RELATION BETWEEN AGGRESSIVE FANTASY AND OVERT BEHAVIOR

By P a tr ic ia P ittlu o k M

A D is s e rta tio n P r e s e n te d t o th e F a c u lty o f th e G ra d u a te S ch o o l o f Y ale U n i v e r s i t y i n C an d id ao y f o r th e D egree o f D o c to r o f P h ilo s o p h y 1950

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The a u th o r is d e e p ly in d e b te d t o D r. Seymour B . S a ra s o n , who s u p e r v is e d t h i s s tu d y and made many h e l p f u l s u g g e s tio n s th r o u g h o u t. She a l s o w is h e s t o th a n k D r. I r v i n L . C h il d , and D r . I r v in g L . J a n i s f o r t h e i r a s s i s t a n c e i n th e p la n n in g o f th e s tu d y an d th e a n a l y s i s o f th e d a t a .

Acknowledgm ent i s a l s o made t o D r. F r e d e r io k W yatt

and th e p s y c h i a t r i c s t a f f o f C u sh in g V e te r a n s ’ A d m in is tr a tio n H o s p i t a l , who g r e a t l y f a c i l i t a t e d th e c o l l e c t i o n o f d a t a .

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DIGEST The s tu d y was d e s ig n e d to i n v e s t i g a t e th e r e l a t i o n b etw een a g g r e s s iv e f a n t a s y and o v e r t b e h a v io r . T his r e l a t i o n s h i p c o u ld be f o r m u la te d i n two w a y s: 1) A g g re s s iv e f a n t a s y i s d i r e c t l y r e l a t e d to b e h a v io r , an d p r o v id e s a c lu e to o v e r t r e s p o n s e ; 2) A g g re s s iv e f a n t a s y i s i n v e r s e l y r e l a t e d t o b e h a v i o r , and p r o v id e s a s u b s t i t u t e f o r o v e r t r e s p o n s e . To t e s t th e s e o p p o sin g f o r m u l a t i o n s , b e h a v i o r a l d a t a w ere r e l a t e d to th e f a n t a s i e s o f 72 n e u r o p s y c h i a t r i c p a t i e n t s . T h e T hem atic A p p e rc e p tio n T e s t was u s e d a s th e m easure o f f a n t a s y . R e p o rts o f s p o n ta n e o u s a g g r e s s iv e b e h a v io r on th e h o s p i t a l w ards p ro v id e d th e b e h a v i o r a l m e a su re . The f i n d i n g s o f th e s tu d y s u p p o r t th e d i r e c t f o r m u l a tio n : More a g g r e s s iv e re s p o n s e s i n f a n t a s y a r e a s s o c i a t e d w ith more b e h a v i o r a l a g g r e s s io n . I t was n o t p o s s i b le to d e m o n s tra te t h i s r e l a t i o n s h i p , h o w e v e r,b y con­ s i d e r i n g e i t h e r th e f r e q u e n c y o r th e c o n te n t o f th e a g g r e s s iv e r e s p o n s e s i n th e m s e lv e s . I t was n e c e s s a r y to c o n s id e r th e s e a g g r e s s iv e r e s p o n s e s i n r e l a t i o n to m o d ify in g m ech an ism s. These m echanism s do n o t a l t e r th e b a s i c a g g r e s s io n o f th e in s tr u m e n ta l a c t s , b u t th e y tem p er th e a g g r e s s iv e im p li­ c a t i o n s . The m echanism s o f m o st u s e i n r e l a t i n g f a n t a s y to b e h a v io r a r e as f o l l o w s : r e j e c t i o n o r d e n i a l o f th e a g g r e s s io n , e x c u s in g o f th e a g g r e s s io n b y p la c e m e n t i n a s o c i a l l y a c c e p ta b le c o n t e x t , n o n -c o m p le t'io n o f a g g r e s s io n p la n n e d by a f a n t a s y c h a r a c t e r , an d d is p la c e m e n t o f th e a g g r e s s io n to non-hum an o b j e c t s . T hese m echanism s a r e c o n s id e r e d to b e m o tiv a te d b y a n x i e ty and d e f e n s iv e i n t h e i r p u rp o s e . By t h e i r u s e , th e a g g r e s s iv e re s p o n s e becom es a com prom ise b etw ee n a g g r e s s iv e im p u ls e s and th e a n x i e t y o p p o sin g t h e i r e x p r e s s io n . I t was fo u n d t h a t th e te n d e n c y to u s e th e s e m echanism s was r e l a t e d t o th e te n d e n c y to a c t o u t . The p a t i e n t s who \ise d more d e fe n s e m echanism s i n p r o p o r ­ t i o n to t h e i r o u tg o in g a g g r e s s iv e f a n t a s i e s te n d e d to a c t o u t l e s s th a n t h e p a t ie n ts .w h o u s e d p r o p o r t i o n a l l y fe w e r such m echanism s. I n a d d i t i o n , p a t i e n t s w ith p r o p o r t i o n a l l y more u n m o d ifie d p r i m i t i v e re s p o n s e s i n f a n t a s y te n d e d to a c t o u t more th a n p a t i e n t s w ith p r o p o r t i o n a l l y fe w e r f a n t a s i e s o f t h i s n a t u r e . U n m o d ified p r i m i t i v e f a n t a s i e s w ere d e f in e d a s th o s e i n s t i g a t e d b y th e h e r o , r e l a t i v e l y v i o l e n t i n n a t u r e , and n o t te m p ered b y a n y o f th e m a jo r d e fe n s e m ech an ism s. P a t i e n t s w ith a h ig h p r o p o r t i o n o f u n m o d ifie d p r i m i t i v e r e s p o n s e s who w ere e x c e p tio n s to th e g e n e r a l f i n d i n g and d id n o t a c t o u t c o u ld be d i s t i n g u i s h e d b y r e l a t i v e l y f r e q u e n t p u n ish m e n t th e m e s. T hese tr e n d s a p p e a r- c l e a r e s t when th e d e f i n i t i o n o f a c t i n g o u t m in im iz e s jo k in g a g g r e s s io n and e m p h asizes a f f e c t i v e e x p r e s s io n . I t a p p e a rs t h a t a g g r e s s iv e r e s p o n s e i s m o st f r u i t f u l l y v iew ed a s a r e s u l t a n t o f two f a c t o r s : a g g r e s s io n and th e a n x i e t y t h a t o p p o ses a g g r e s s io n . The f a n t a s y m e asu re s w h ich p r e d i c t a g g r e s s iv e b e h a v io r a r e p r o b a b ly th o s e w h ich b e s t m easu re th e r e l a t i v e s t r e n g t h o f th e s e two f a c t o r s a s th e y w ould o p e r a t e i n a b e h a v i o r a l s i t u a t i o n . The f i n d i n g s s u g g e s t t h a t th e r e l a t i v e e x t e n t to w hich a n x i e t y a p p ro a c h e s th e s t r e n g t h o f a g g r e s s io n i s a t l e a s t g e n e r a l l y co m p arab le f o r e a c h p a t i e n t i n th e two s i t u a t i o n s ( t e s t f a n t a s y and b e h a v i o r ) . T h e r e f o r e , m e asu re s o f a g g r e s s iv e f a n t a s y c a n p r o v id e d i r e c t c l u e s t o o v e r t a g g r e s s iv e b e h a v i o r , i f th e s e m e asu re s s t r e s s n o t th e a b s o l u t e f r e q u e n c y o f a g g r e s s iv e r e s p o n s e s b u t th e e x t e n t t o w h ich such r e s p o n s e s a r e f r e e fro m m o d i f ic a t io n .

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TABLE OF CONTENTS Page I n tr o d u c t io n • • • • • • • • • • • • • • • • • • • • > •

1

P ro c e d u re • •

. . . . . . . • •

U

S u b je c ts • • • • • • • • • • • • • • • • • • • • •

h

B e h a v io r a l D ata

5

. • • • • •

• ...................................... • • • • • . • •

F a n ta s y D ata • « • • • . R e s u lts

• • * • • • • •

O utg o in g A g g re s s io n

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.............................................. • ? • • •

1 , N e e d -P re s s V a r ia b le s 2 , D efen se M easu res

• • • • 1 3 • • • •

.......................................... • • • • « . . . • • •

• • • • •

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3 , M easu res o f U nm odified A g g re s s iv e R esponse In g o in g A g g re s s io n

17 18 18 22 25 28

D is c u s s io n • • • • • • • . . • • • • • • • • • • • • »

3^

Summary

IfO

•B ib lio g ra p h y

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h3

A ppendix

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INTRODUCTION T h is s tu d y i n v e s t i g a t e s th e r e l a t i o n s h i p b etw een two a s p e c t s o f b e h a v io r? o u t.

r e s p o n s e s w h ich o c c u r i n f a n t a s y an d r e s p o n s e s w hich a r e a c te d

I t w ould be e x p e c te d t h a t th e r e s p o n s e te n d e n c ie s i n th e two s p h e re s

a r e c o n s i s t e n t l y r e l a t e d i n some s p e c i f i a b l e w ay.

The n a tu r e o f t h i s

r e l a t i o n s h i p h a s been u n c l e a r , h ow ever, s in c e th e r e s e a r c h s t u d i e s have s u g g e s te d two o p p o sin g h y p o th e s e s b u t have b een u n a b le t o d e m o n s tra te th e v a l i d i t y o f e i t h e r c o n v i n c in g ly . The tw o h y p o th e s e s a r e a s fo llo w s ? 1) F a n ta s y i s d i r e c t l y r e l a t e d t o b e h a v i o r . A o o o rd in g t o t h i s f o r m u l a t i o n , th e b e h a v io r d e s c r ib e d i n f a n t a s y i s a c lu e t o o v e r t r e s p o n s e .

On th e b a s i s o f g r e a t e r re s p o n s e in

f a n t a s y , one w ould p r e d i c t m ore b e h a v i o r a l e x p r e s s i o n . 2) F a n ta s y i s i n v e r s e l y r e l a t e d t o b e h a v i o r . A c c o rd in g t o t h i s f o r m u l a t i o n , th e b e h a v io r d e s c r ib e d i n fa n ta s y i s a s u b s t itu t e fo r o v e rt re s p o n s e .

On th e b a s i s o f g r e a t e r

re s p o n s e in f a n t a s y , one w ould p r e d i c t l e s s b e h a v i o r a l e x p r e s s i o n .

The r e s e a r c h i n t h e a r e a h a s b e e n r e l a t i v e l y s p a r s e and somewhat in c o n c lu s iv e .

The tw o s t u d i e s w hich h av e h a n d le d th e p ro b lem m o st e x te n ­

s i v e l y a r e th o s e o f S a n fo rd (1 2 ) and Symonds ( 1 6 ) o

S a n f o r d ’ s s tu d y i s

c o n c e rn e d w ith c h i l d r e n , and s u rv e y s th e r e l a t i o n s h i p betvreen m a n if e s t b e h a v io r and a v a r i e t y o f f a n t a s y r e s p o n s e s . c a n t and a r e n o t c o n s i s t e n t i n d i r e c t i o n . f a n t a s i e s o f a group o f a d o l e s c e n t s .

H is f i n d i n g s a r e i n s i g n i f i ­

Symonds i n v e s t i g a t e d th e

On th e b a s i s o f t h i s s tu d y h e r e p o r t s

a g e n e r a l im p r e s s io n t h a t f a n t a s y i s i n v e r s e l y r e l a t e d t o b e h a v io r - t h a t

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" i f a p e r s o n w orks o u t h i s p ro b lem s i n o v e r t b e h a v io r , he d o es n o t f i n d i t n e c e s s a r y t o work them o u t i n f a n t a s y - an d i f he w orks them o u t i n f a n t a s y , h e i s n o t bound t o e x p r e s s them i n r e a l i t y . "

S in c e h i s d a t a a r e

no more s i g n i f i c a n t th a n th o s e o f S a n f o r d , h o w e v e r, th e g e n e r a l i s a t i o n i s q u e s tio n a b le . T hree s t u d i e s have d e a l t w ith s p e c i f i c v a r i a b l e s , a tte m p tin g t o p r e d i c t h y p n o tic b e h a v io r (1 3 , 1 8 ) an d th e s u c c e s s o f o f f i c e r c a n d id a te s ( l l ) on th e b a s i s o f f a n t a s y d a t a .

The f i n d i n g s i n a l l c a s e s have

s u p p o r te d th e d i r e c t h y p o t h e s i s , and th e y a r e o f i n t e r e s t i n r e s p e c t to th e s e s p e c i f i c v a r i a b l e s .

By th e p a r t i c u l a r n a t u r e o f th e b e h a v io r s t u d i e d ,

h o w ev er, th e im p lic a tio n s o f th e r e s u l t s f o r o th e r v a r i a b l e s i s d i f f i c u l t t o d e te r m in e . An u n p u b lis h e d s tu d y b y S e a rs (1 4 ) b e a r s on t h i s g e n e r a l p ro b le m . He was o o n o e rn e d w ith th e f a n t a s y a g g r e s s io n o f c h i l d r e n i n a d o l l p la y s i t u a t i o n , a s com pared w ith t h e p u n is h in g q u a l i t i e s o f e a c h c h i l d ’ s e n ­ v iro n m e n t.

Though h e d id n o t g a th e r a c t u a l b e h a v i o r a l d a t a , he i n f e r s

t h e o r e t i c a l l y t h a t th e c h i l d r e n who a r e m ore a g g r e s s iv e i n f a n t a s y r e s ­ ponse w ould be l e s s a g g r e s s iv e i n b e h a v i o r a l a c t i n g o u t - i . e . , th e in v e r s e h y p o th e s i s .

The f in d i n g s i n t h i s a r e a a r e n o t e s p e c i a l l y s t r o n g , and th e o p in io n s te n d to be c o n f l i c t i n g .

I t seems p o s s i b l e , a c t u a l l y , t h a t th e

h y p o th e s e s a r e n o t m u tu a lly e x c l u s i v e , an d t h a t th e r e l a t i o n s h i p may v a r y w ith th e n a t u r e o f th e u n d e r ly in g d r iv e and t h e a c c e p t a b i l i t y o f re s p o n s e t o th e i n d i v i d u a l and h i s s o c i e t y .

H ow ever, th e b r o a d e r s t u d i e s have n o t

b e e n c o n c lu s iv e w ith r e s p e c t t o a n y v a r i a b l e s - p e rh a p s b e c a u se t h e i r

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b r e a d t h n e c e s s i t a t e d a g ro s s tr e a tm e n t o f any one a r e a - and th e s p e c i f i c s t u d i e s have d e a l t w ith v a r i a b l e s t h a t d id n o t ad v an ce m a t e r i a l l y th e u n d e r s ta n d in g o f g e n e r a l p r i n c i p l e s in v o lv e d . In d e s ig n in g a s tu d y f o r f u r t h e r i n v e s t i g a t i o n o f t h i s p ro b lem , t h e r e f o r e , t h e r e w ere tw o m ain c r i t e r i a :

l ) t o l i m i t th e sco p e o f th e

s tu d y s u f f i c i e n t l y so t h a t th e a r e a c o u ld be th o r o u g h ly e x p lo re d and th e l i k e l i h o o d o f f i n d i n g a r e l a t i o n s h i p m axim ized; 2) t o s e l e c t an a r e a o f s u f f i c i e n t l y c e n t r a l im p o rta n c e s o t h a t th e f i n d i n g s w ould g e n e r a liz e t o s i m i l a r v a r i a b l e s and c o n t r i b u t e t o m ore g e n e r a l p s y c h o lo g ic a l t h e o r y . The g e n e r a l a r e a o f a g g r e s s io n a p p e a re d t o m eet th e s e c r i t e r i a . I t i s a com plex an d u n s e t t l e d a r e a ( 2 , 5 ) b u t s u f f i c i e n t l y l i m i t e d so t h a t i t ca n be e x p lo r e d i n some d e t a i l .

In a d d itio n , i t is a c e n tr a l v a ria b le

i n th e p e r s o n a l i t y o r g a n i z a t i o n o f a n y in d i v i d u a l and i n th e g e n e r a l o r g a n i z a t i o n o f an y c u l t u r e ( 3 , 4 ) .

The r e l a t i o n b etw ee n a g g r e s s iv e f a n ­

t a s y an d o v e r t b e h a v io r i s o f p r a c t i c a l and t h e o r e t i c a l i n t e r e s t i n i t s own r i g h t , a s w e ll a s a n a p p ro a c h t o t h e p ro b lem o f r e l a t i n g f a n t a s y re s p o n s e t o b e h a v i o r a l a c t i n g o u t .

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•4-

FROCEDTJBE

I n g e n e r a l , th e p ro c e d u re in v o lv e d a d m i n i s t r a t i o n o f th e T hem atic A p p e ro e p tio n T e s t t o a g ro u p o f s u b je c t s and th e o b s e r v a tio n o f t h e i r sp o n ta n e o u s a g g r e s s iv e b e h a v io r .

SUBJECTS

The r e s e a r c h was c o n d u c te d a t a v e t e r a n 's h o s p i t a l . w ere w h ite , m ale p a t i e n t s fro m two n e u r o p s y c h ia tr ic w a rd s .

1

The s u b je c t s A ll p a t i e n t s

who had b een on th e s e w ards a t l e a s t two w eek s, a s an a p p ro x im a te minimum, w ere c o n s id e r e d f o r th e s t u d y .

They w ere e x c lu d e d from th e sam p le, how­

e v e r , i f th e y showed any o f th e f o llo w in g c h a r a c t e r i s t i c s :

l ) d u ll i n t e l l i ­

g e n c e , a s in d i c a t e d by army r e c o r d or p r e v io u s t e s t i n g ; 2) age o f 45 o r e b o v e ; 3) f a m i l i a r i t y w ith th e T hem atic A p p e rc e p tio n T e s t; 4 ) s p e c i a l \

s p e e c h d i f f i c u l t y ; 5) e v id e n c e o f o r g a n ic in v o lv e m e n t or p s y c h o s is . Over a f o u r month p e r io d 72 p a t i e n t s w ere s t u d i e d .

2

49 w ere drawn

from th e l a r g e r w ard (Ward L, w ith a p p ro x im a te ly 50 b e d s ) , and 23 w ere draw n from th e s m a lle r w ard (Ward S , w ith a p p ro x im a te ly 25 b ed s)-. c a s e s may be d e s c r ib e d a s f o ll o w s :

The 72

They w ere w h ite , m ale v e t e r a n s of

'World War I I betw een th e a g e s o f 19 and 4 3 , w ith an a v e ra g e age o f 2 8 . They were o f a t l e a s t n o rm al i n t e l l i g e n c e .

They a v e ra g e d a t e n t h g rad e

Thanks a r e e x te n d e d t o th e p s y c h o lo g ic a l and p s y c h i a t r i c s t a f f o f C ushing V e te ra n s A d m in is tr a tio n H o s p i t a l , Fram ingham , M a s s a c h u s e tts , f o r e x c e p tio n a l c o o p e r a tio n an d en co u rag em en t th r o u g h o u t th e c o u rs e o f t h i s s tu d y . 2

S inoe th e h o s p i t a l m a in ta in s s e p a r a t e w ards f o r o rg a n ic and p s y c h o tic c a s e s , . p a t i e n t s w ere seld cm e x c lu d e d on t h i s b a s i s .

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e d u c a tio n , and over 40 p e r c e n t had c o m p lete d h ig h s c h o o l.

They w ere h o s­

p i t a l i z e d f o r n e u r o p s y c h i a t r i c symptoms b u t w ere c o n s id e r e d to have no o rg a n ic c o m p lic a tio n s and t o be n o n - p s y c h o ti c .

F or th e s p e c i a l p u rp o se s

o f th e r e s e a r c h , th e y w ere p a t i e n t s who c o u ld s p e a k w ith norm al e a s e and who had n e v e r b een g iv e n a T hem atic A p p e rc e p tio n T e s t .

They had b een h o s ­

p i t a l i z e d v a r y in g le n g th s o f tim e b u t w ere alw ay s s tu d ie d o n ly a f t e r th e y had become accu sto m ed t o th e h o s p i t a l and w ere f a m i l i a r t o t h e s t a f f .

BEHAI-1ORAL DATA

B e h a v io ra l d a ta a r e b a s e d on ta n e o u s a g g r e s s iv e b e h a v i o r .

o b s e r v a tio n s o f th e p a t i e n t s ' spon­

The n u r s in g s t a f f made th e s e o b s e r v a tio n s

i n th e s e t t i n g o f th e h o s p i t a l w a r d s .

W hile th e p a t i e n t s w ere f r e e to

le a v e th e w ards d u r in g th e d a y , th e y g e n e r a l l y s p e n t c o n s id e r a b le tim e th e re .

The w ard n u r s e s had th e b e s t o p p o r tu n ity t o o b se rv e th e p a t i e n t s

and t o form im p re s s io n s o f t h e i r b e h a v i o r .

They w ere t h e r e f o r e a s k e d to

c o o p e r a te i n th e s tu d y . No p u b lis h e d r a t i n g s c a l e s c o v e re d th e a r e a o f a g g r e s s io n i n t h e r e q u i r e d d e t a i l and two s p e c i a l s c a l e s w ere t h e r e f o r e c o n s tr u c t e d f o r th e u se o f th e n u r s e s .

They w i l l be r e f e r r e d t o a s th e O b s e r v a tio n a l C heck­

l i s t an d th e R atin e; S c a l e .

They a r e re p ro d u c e d i n f u l l i n th e A ppendix

and th e y a r e d is c u s s e d i n d i v i d u a l l y b e lo w .

I n g e n e r a l , th e y l i s t a

v a r i e t y of b e h a v i o r a l r e s p o n s e s w h ich a r e o f te n c o n s id e r e d i n d i c a t i v e o f u n d e r ly in g a g g r e s s iv e d r i v e . s tu d y o f th e l i t e r a t u r e

The re s p o n s e item s vrere s u g g e s te d by a

( e .g ., 2, 9

) &nd w ere sh ap ed by a c o n s i d e r a t i o n

o f th e w ard s i t u a t i o n .

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-6 -

The fo rm a t an d f e a s i b i l i t y o f th e O b s e r v a tio n a l C h e c k l is t were p r e ­ t e s t e d f i r s t on th e p s y c h i a t r i c w ards o f New Haven H o s p i ta l , th e n a t C u sh in g H o s p i t a l .

R e v is io n s w ere made on th e b a s i s o f n u r s e s ' s u g g e s tio n s *

The R a tin g S c a le was p r e t e s t e d a t C ushing H o s p ita l and r e t a i n e d i n a p p r o x i­ m a te ly o r i g i n a l fo rm . The t r a i n i n g o f th e n u r s e s a s o b s e r v e r s began d u rin g th e p r e t e s t p e rio d .

A t t h i s tim e p ro o e d u re was c a r e f u l l y e x p la in e d and each n u r s e was

e n co u ra g ed t o r e p o r t an y d i f f i c u l t y in u s in g th e s c a l e s .

There was no

m e n tio n of th e f a c t t h a t t h i s was a s tu d y on " a g g r e s s i o n ," s in c e i t was d e s i r a b l e t h a t th e n u r s e s be g u id e d by th e d e s c r i p t i o n s on th e s c a l e s r a t h e r th a n by s t e r e o t y p e s .

When th e f i n a l r e v i s i o n s had b een made in th e

s c a l e s , a g e n e r a l m e e tin g was h e ld and e ac h ite m was d is c u s s e d .

The d i s ­

c u s s io n was o r i e n t e d to w ard w ard e .am ples o f th e b e h a v io r d e s c r i b e d .

When

th e s tu d y i t s e l f b e g a n , th e n u r s e s a p p e a re d to have r e l a t i v e l y u n ifo rm u n d e r s ta n d in g o f th e t a s k . I t was i n e v i t a b l e , h o w ev er, t h a t t h e r e sh o u ld be in d i v i d u a l d i f f e r ­ e n c e s among th e n u r s e s a s o b s e r v e r s .

T h is f a c t i s o f some im p o rta n c e ,

s in c e n o t a l l n u r s e s o b se rv e d a l l p a t i e n t s . c o n s ta n t group o f n u r s e s .

E ach ward had a r e l a t i v e l y

A ll p a t i e n t s on a g iv e n w ard w ere o b s e rv e d by

t h i s group and t h e i r a b s o lu te b e h a v io r a l s c o r e s can th u s be d i r e c t l y com­ p a re d .

H ow ever, t h e i r s c o r e s c a n n o t be a s r e a d i l y com pared v /ith th o s e o f

p a t i e n t s o b se rv e d by a d i f f e r e n t g ro u p .

F o r t h i s re a s o n i t was th o u g h t

a d v i s a b l e t o k eep th e d a ta from th e two w ards s e p a r a t e .

The f a c t t h a t th e

n u r s e s in th e two gro u p s a l s o had s l i g h t l y d i f f e r e n t o p Q o r tu n itie s to ob­ s e rv e th e p a t i e n t s s u p p o rte d t h i s a p p ro a c h .^

The d a ta v/ere f i r s t t r e a t e d ,

^The l a r g e r w ard had a f u l l - t i m e n u rs e a t a l l t i m e s . The s m a lle r ward s h a re d a n u rs e w ith a t h i r d w ard d u rin g c e r t a i n h o u rs o f th e d a y .

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t h e r e f o r e , a s i f th e s tu d y had been c o n d u c te d in d e p e n d e n tly on two d i f f e r ­ e n t groups - L and S ,

The two s e t s o f d a ta w ere th e n p o o le d , f o r a m ore

g e n e r a l e s tim a te o f th e t r e n d s . In th e f o llo w in g s e c t i o n s , th e p r o c e d u r e s fo llo w e d in o b ta in in g b e h a v i o r a l m e asu re s w i l l be c o n s id e r e d i n d e t a i l . O b s e r v a tio n a l C h e c k l is t The o b s e r v a ti o n a l c h e c k l i s t was d e s ig n e d f o r r e c o r d in g d e f i n i t e i n s ta n c e s of a g g r e s s iv e b e h a v io r on th e w a r d s .

In o r d e r t o m axim ize th e

n u r s e s ' o p p o r t u n i t i e s t o o b serv e su c h i n s t a n c e s , o n ly a few p a t i e n t s w ere s e l e c t e d f o r o b s e r v a tio n a t an y g iv e n tim e .

U su a lly , t h r e e or f o u r p a t i e n t s

w ere ch o sen on Ward L, and two or t h r e e p a t i e n t s w ere chosen on Ward S . These p a t i e n t s were o b se rv e d f o r a f i v e - d a y p e r i o d .

A t th e b e g in n in g o f

e a c h week th e n u r s e s w ere g iv e n th e names o f th e p a t i e n t s and i n s t r u c t e d t o n o te any b e h a v io r f i t t i n g th e d e s c r i p t i o n s on th e o b s e r v a ti o n a l c h e c k ­ lis t.

(T here a r e 50 item s o f a g g r e s s iv e b e h a v i o r , in v o lv in g p h y s i c a l ,

v e r b a l and p a s s iv e form s and v a r y in g i n i n t e n s i t y and o b j e c t . )

Each n u r s e

on d u ty b etw een se v e n i n th e m o rn in g and 11 a t n i g h t was g iv e n a c h e c k l i s t form f o r each d e s ig n a te d p a t i e n t . one o u t f o r e a c h .

As sh e w en t o f f d u ty each d a y , sh e f i l l e d

She ch eck ed any ite m t h a t she had o b se rv e d t h a t d a y ,

n o te d th e d e g re e o f a n g e r in v o lv e d , th e o b j e c t o f th e a c t i o n , and o th e r m is c e lla n e o u s in f o r m a tio n t h a t was c a l l e d f o r on th e c h e c k l i s t . i n c i d e n t s w ere o b s e rv e d , th e n u r s e m e re ly i n i t i a l e d th e fo rm .’*’

I f no The n u r s e s

I I t i s im p o s s ib le t o acknow ledge f u l l y th e c o n t r i b u t i o n of th e n u r s in g s t a f f . T his ta s k r e p r e s e n t e d an a d d i t i o n to f u l l s c h e d u le s b u t was c a r r i e d o u t w ith c a r e and i n t e r e s t f o r f o u r m o n th s. S p e c ia l th a n k s a r e due to th e M isse s G a r i f o l i , Goodman, L ange, L e o n a rd , M acD onald, M u llig a n an d N u g e n t, who s t a f f e d th e w ards th ro u g h m ost o f th e s t u d y .

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w ere r e q u e s te d n o t t o d is c u s s th e p ro c e d u re or le a v e th e c h e c k l i s t s w here th e y m ig h t be s e e n , s in c e i t was e s s e n t i a l t h a t th e p a t i e n t s behave sp o n ­ ta n e o u s l y .

The n u r s e s w ere c o o p e r a tiv e and c a r e f u l , and no p a t i e n t e v e r

in d i c a t e d in any way t h a t he was aw are o f th e p ro ced u re* .

R a tin g S c a le In h a n d lin g th e r a t i n g s c a l e s , th e n u r s e s w ere n o t l i m i t e d to o b s e r v a tio n s from th e p a s t d ay o r w eek.

They w ere t o b a se t h e i r judgm ents

on a g e n e r a l im p re s s io n o f th e p a t i e n t s in c e h i s a d m is s io n to th e h o s p i t a l * The r a t i n g s c a le was d e s ig n e d p a r t l y a s a s u p p le m e n ta ry d e v ic e .

I t was

f e l t t h a t th e o b s e r v a ti o n a l s c o r e s m ig h t be m is le a d in g i n i n d i v i d u a l c a s e s f o r e i t h e r o f two re a s o n s ?

a p a t i e n t m ig h t have a r e l a t i v e l y low s c o r e ,

ev en th o u g h he was f a i r l y a g g r e s s i v e , b e c a u se he was on th e w ard and u n d e r o b s e r v a tio n l e s s th a n m ost p a t i e n t s - o r he m ig h t have a s p u r io u s ly h ig h o r low s c o re b eca u se h i s b e h a v io r was a t y p i c a l d u r in g th e week he was o b s e rv e d .

The lo n g te rm r a t i n g s were a ch eck to i n d i c a t e w h e th e r an y

p a t i e n t s w ere g r o s s l y m i s p la c e d .

In g e n e r a l, h o w ev er, i t was e x p e c te d

t h a t th e p a t i e n t s who w ere ju d g e d to a o t o u t m o re, by lo n g term r a t i n g s , w ould be o b serv ed t o a c t o u t more d u rin g th e week s a m p le d .

The s tu d y i s

b u i l t on th e p rem ise t h a t t h e r e i s some c o n s is te n c y i n th e te n d e n c y to a c t o u t a g g re s s iv e ly .

I f th e two s e t s o f d a ta w ere n o t in e s s e n t i a l

a g re e m e n t, e i t h e r th e c o n s is te n c y of th e b e h a v io r or th e c o n s is te n c y o f th e o b s e r v a tio n s w ould have to be q u e s tio n e d .

v'Shon th e two s c a l e s w ere

c o r r e l a t e d , ho w ev er, th e y showed s u b s t a n t i a l a g re e m e n t.

P e a rso n r ' s on

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Wards L and S r e s p e c t i v e l y w ere .8 5 and .6 9 .^ The p ro c e d u re i n h a n d lin g th e r a t i n g s c a l e s was a s f o llo w s :

At

th e end o f eac h week e a c h n u r s e was ask ed t o r a t e a g ro u p o f p a t i e n t s , f i l l i n g i n a s e p a r a t e form f o r e a c h o n e.

She w ent th ro u g h th e n in e ite m s ,

re c o rd in g h e r g e n e r a l im p r e s s io n of w h eth er e ac h d e s c r i p t i o n was " v e ry c h a r a c t e r i s t i c , ” ’’somewhat c h a r a c t e r i s t i c , " o r " n o t c h a r a c t e r i s t i c " o f th e p a r t i c u l a r p a t i e n t .

A p a t i e n t was u s u a l l y r a t e d once by each n u r s e

a t th e end o f th e week o f o b s e r v a tio n and a g a in a t th e end o f th e f o llo w ­ in g w eek.

T here w ere i n e v i t a b l e gaps and v a r i a t i o n s i n t h i s sy stem due t o

th e n u r s in g s c h e d u le , b u t e a c h n u rs e r a t e d a s many p a t i e n t s a s p o s s i b le as n e a r t o th e o b s e r v a tio n p e r io d a s p o s s i b l e .

R e lia b ility c o e ffic ie n ts

f o r eac h n u r s e w ere c a l c u l a t e d from f i r s t and seco n d r a t i n g s on th e same p a tie n ts .

T here was a f a i r l y w ide ran g e o f r e l i a b i l i t y

(P e a rs o n r ' s from

.53 to . 8 5 ) , b u t f i v e o f th e e i g h t n u rs e s in v o lv e d had s e l f - c o r r e l a t i o n s of .80 o r h ig h e r and th e g e n e r a l le v e l was c o n s id e r e d s a t i s f a c t o r y .

S c o rin g and O r g a n iz a tio n o f B e h a v io ra l D ata E ach p a t i e n t r e c e iv e d f i v e s c o r e s ,a s e s ti m a t e s o f h is te n d e n c y to a c t o u t a g g re s s iv e ly .

Four o f th e s e s c o r e s m easu re some a s p e c t

o f th e

a g g r e s s io n d i r e c t e d to w a rd th e en v iro n m en t ( o u tg o in g a g g r e s s io n ) .

One

I t w i l l be n o te d t h a t th e c o r r e l a t i o n on Ward L i s somewhat h i g h e r . In g e n e ra l i t i s f e l t t h a t th e d a ta from t h i s w ard a r e somewhat more s t a b l e and d i s c r i m i n a t i n g . I n a d d i t i o n to. t h i s h ig h e r c o r r e l a t i o n , th e l a r g e r ward had b o th a g r e a t e r s p re a d o f o b s e r v a ti o n a l s c o r e s th a n th e s m a lle r ward (0 - 3 0 , com pared t o 0 - 1 2 ), and a g r e a t e r d i s c r i m i n a t i o n a t th e low er end o f th e d i s t r i b u t i o n (o n ly f i v e z e ro s c o r e s o u t o f 49 com pared t o seven z e ro s c o r e s o u t o f 23 on th e s m a lle r w a r d ) . T hese f in d i n g s may stem from v a l i d d i f f e r e n c e s i n th e p a t i e n t s b u t i t seems more p ro b a b le t h a t th e y a r e due t o th e g r e a t e r o p p o r tu n ity t o o b s e r v e , th e s t a b i l i z i n g e f f e c t o f more n u r s e s w o rk in g w ith more p a t i e n t s fo g c o m p a riso n , a n d /o r th e g r e a t e r s e n s i t i v i t y o f th e s t a f f on Ward L . S in c e th e d a ta fro m Ward L a p p e a r more c o n s i s t e n t and more s e n s i t i v e , t h i s w ard i s c o n s id e r e d th e more im p o rta n t one when th e b e h a v io r a l d a ta a r e com pared w ith f a n t a s y .

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sc o re m easures th e a g g r e s s io n d i r e c t e d by th e p a t i e n t to w ard h im s e lf ( in g o in g a g g r e s s io n ) .

Two o f th e s c o r e s m easu re e s s e n t i a l l y th e same

a s p e c t o f o u tg o in g a g g r e s s io n . d e s c rib e d a s t o t a l s c o r e s . 5*

They a r e g ro u p ed to g e th e r and b o th a r e

The o th e r two m e asu re s o f o u tg o in g a g g r e s s io n

a r e r e l a t e d to th e t o t a l s c o r e , b u t a r e r e f in e m e n ts o f th e d e f i n i t i o n o f a c t in g o u t .

They a r e d e s c r ib e d s e p a r a t e l y a s th e a f f e c t s c o r e and th e

o u tb u r s t s c o r e .

E ach m easu re i s d is c u s s e d b r i e f l y b elo w .

A.

**

O u tg o in g A g g re s s io n

T o ta l s c o re s These two s c o r e s in v o lv e th e g r o s s e s t d e f i n i t i o n o f a g g r e s s iv e

a c t in g o u t .

They m easu re th e fr e q u e n c y o f o u tg o in g a g g r e s s iv e r e s p o n s e -

d e fin e d a s any o u tg o in g a c t d e s c r ib e d on th e s c a l e s .

One o f th e s c o r e s

i s o b ta in e d from th e o b s e r v a ti o n a l c h e c k l i s t and th e o th e r is o b ta in e d from th e r a t i n g s c a l e s .

T hese two s c o r e s , i t w i l l be rem em bered, c o r r e l a ­

te d .85 and .69 on Wards L and S r e s p e c t i v e l y .

They w ere d e r iv e d a s

f o llo w s : On th e o b s e r v a ti o n a l c h e c k l i s t a l l o u tg o in g r e s p o n s e s n o te d by a n y n u rs e d u rin g th e week of o b s e r v a tio n w ere ad d ed t o g e t h e r .

S c o re s of f i v e

or more re s p o n s e s p la c e d a p a t i e n t on Ward L in th e u p p er h a l f o f th e g ro u p .

S co res o f t h r e e o r more r e s p o n s e s p la c e d a p a t i e n t on Ward S i n

th e u p p er h a l f o f th e g ro u p . On th e r a t i n g s c a l e th e s c o r in g p ro c e d u re was more c o m p lic a te d . R a tin g s o f " n o t c h a r a c t e r i s t i c " c o u n te d 1; r a t i n g s o f "som ew hat c h a r a c t e r ­ i s t i c " co u n ted 2; r a t i n g s of " v e ry c h a r a c t e r i s t i c " co u n ted 3 .

S in o e t h e r e

w ere seven item s o f o u tg o in g a g g r e s s io n , minimum t o t a l s c o r e was 7 and maximum s c o re was 2 1 .

The t o t a l s o f s e v e r a l n u r s e s who had r a t e d eac h

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p a t i e n t w ere a v e ra g e d f o r an o v e r - a l l s c o r e .^ raw s c o re f o m h o w ev er.

They w ere n o t a v e ra g e d in

S in ce a te n d e n c y t o use d i f f e r e n t p a r t s o f th e

a b s o lu te s c a le c o u ld o b s c u re th e e s s e n t i a l a g ree m en t o f r a t e r s on th e p a t i e n t ’ s r e l a t i v e te n d e n c y t o a c t o u t , th e s c o r e s w ere n o rm a liz e d (T -S c o re s) and a v e ra g e d i n t h a t fo rm .

I|

2.

1

A ffe c t sc o re T h is s c o r e in v o lv e s a more r e f i n e d d e f i n i t i o n o f a g g r e s s iv e a c t i n g

I |

o u t.

I t m easu res th e f r e q u e n c y o f a f f e c t i v e l y to n e d o u tg o in g re s p o n s e -

II |

d e fin e d a s an y o u tg o in g a c t d e s c r ib e d on th e o b s e r v a tio n a l c h e c k l i s t w hioh i s accom panied b y some show o f a n g e r .

In f i l l i n g o u t th e o b s e r v a ti o n a l

c h e c k l i s t , th e n u r s e s re c o r d e d i n c o n n e c tio n w ith eac h re s p o n s e w h e th e r th e p a t i e n t was l ) jo k in g or k id d in g ; 2 ) an n o y ed , i r r i t a t e d , o r s a r c a s t i c ; 3) v e ry a n g r y j o r 4 ) e x tre m e ly a n g ry o r e n ra g e d . For th e only th o s e r e s p o n s e s accom panied by n o t a t i o n s o f

affec t

2, 3, or 4

m e a su re ,

w ere c o u n te d .

The e s s e n t i a l d i f f e r e n c e betw een t h i s m easure and th e t o t a l s c o re fro m th e o b s e r v a ti o n a l c h e c k l i s t s i s t h a t jo k in g - a g g r e s s iv e b e h a v io r h as n o t been in c lu d e d i n th e a f f e c t s c o r e .

S co res o f two or more a f f e c t i v e r e s ­

ponses p la c e d a p a t i e n t on Ward L i n th e u p p er h a l f o f th e g ro u p . |

of one o r more a f f e c t i v e r e s p o n s e s p la c e d a p a t i e n t

on 'Ward

S co res

S i n th e

r ‘v

§:

g

upper h a l f o f th e g ro u p .

| I | § I I

^W ithin e a c h w a r d , i t was d e c id e d t o a v e ra g e th e t o t a l r a t i n g s o f th e same number o f n u r s e s f o r eac h p a t i e n t . The h ig h e s t number c o n s i s t e n t l y a v a i l a b le on Ward L was t h r e e n u r s e s and on Ward S ,tw o n u r s e s , Where f o u r w ere a v a i l a b l e on Ward L, th e n u rs e whose r e r a t e r e l i a b i l i t y was among th e low e s t and who seem ed, in a d d i t i o n , t h e l e a s t m o tiv a te d , was e l im i n a te d . I n th e v e r y few in s ta n c e s w here t h r e e were a v a i l a b l e on Ward S , th e n u r s e w ith th e lo w e s t r e l i a b i l i t y was e l im i n a te d .

| I I i

An a l t e r n a t i v e p ro c e d u re was checked f o r b o th w a r d s . The a v e ra g e was o b ta in e d fro m a l l n u r s e s who had r a t e d a p a t i e n t , r e g a r d l e s s o f num ber. The p la c e m e n t o f p a t i e n t s above o r below th e m edian was com pared w ith th e o r i g i n a l d ic h o to m y . O nly two p a t i e n t s c r o s s e d th e m edian l i n e on Ward and no p a t i e n t s c r o s s e d th e l i n e on Ward S .

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-1 2 -

3.

O u tb u rs t s c o re T h is s c o re in v o lv e s th e m ost com plex m easure o f a g g r e s s iv e a c t in g

o u t and c a n n o t be d e f in e d i n te rm s o f a n y one c r i t e r i o n .

I t i s an a tte m p t

to i s o l a t e th e extrem e group - th e p a t i e n t s who a c t o u t m ost i n t e n s e l y . In a n a ly s in g th e d a t a , t h i s group i s u s u a l l y com pared w ith a l l o th e r p a tie n ts .

In some i n s t a n c e s , ho w ev er, i t i s com pared w ith th e o th e r

ex trem e gro u p - th e p a t i e n t s who a c t o u t l e a s t .

The gro u p s w ere s e le o t e d

as f o llo w s : a ) The o u t b u r s t group The p a t i e n t s i n t h i s group w ere s e l e c t e d on th e b a s is o f in te n s e a c t i n g o u t , d e f in e d a s f o ll o w s :

e i t h e r a n o t a t i o n on th e o b s e r v a tio n a l

c h e c k l i s t t h a t th e p a t i e n t was v e ry a n g ry o r en rag ed

( a f f e c t o f th r e e o r

f o u r ) in c o n n e c tio n w ith some a g g r e s s iv e r e s p o n s e , o r a n o t a t i o n on th e r a t i n g s c a l e t h a t th e in t e n s e b e h a v io r d e s c r ib e d in th e f i r s t item was somewhat o r v e r y c h a r a c t e r i s t i c o f th e p a t i e n t .

(T h is ite m re a d s " a s s a u ltiv e

and b e l l i g e r e n t , p ic k s f i g h t s and s t a r t s t r o u b l e , h as tem p er ta n tr u m s , t h r e a t e n s o t h e r s , s h o u ts , b re a k s o r th ro w s t h i n g s " ) .

T here a r e 19 p a t i e n t s

from Ward L an d seven p a t i e n t s fro m Ward S i n t h i s g ro u p .

b ) The low group The p a t i e n t s i n t h i s g ro u p w ere s e l e c t e d b e c a u se th e y showed l i t t l e or no a g g r e s s iv e a c t in g o u t .

The two e s tim a te s o f t o t a l s c o r e , as w e ll as

th e a f f e c t s c o r e , were below th e m edian f o r th e s e p a t i e n t s , and th e y w ere n e v e r r e p o r t e d t o show o u t b u r s t b e h a v i o r .

T here a r e 16 p a t i e n t s from

Ward L and e i g h t p a t i e n t s from Ward S i n t h i s g ro u p .

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o)

The m id d le group The p a t i e n t s i n t h i s g roup w ere s e l e c t e d by e x c l u s i o n .

They w ere

ju d g ed to a c t p u t more th a n m o st p a t i e n t s by a t l e a s t one d e f i n i t i o n , b u t t h e i r e x p r e s s io n was n e v e r i n t e n s e .

T h a t i s , th e y w ere above th e m edian

i n a t l e a s t one of th e t o t a l s p o r e s or th e a f f e c t s c o r e , b u t no o u tb \ir s t b e h a v io r was e v e r r e p o r t e d . |

T h ere a r e 14 p a t i e n t s fro m Ward L an d e i g h t

p a t i e n t s fro m Ward S i n t h i s g ro u p .

p

B.

In g o in g A g g re s s io n

A g g re s siv e b e h a v io r d i r e c t e d by th e p a t i e n t to w a rd h im s e lf h as b een h an d le d a s a s u p o le m e n ta ry , r a t h e r th a n c e n t r a l , m easu re in t h i s s tu d y . I t was d i f f i c u l t to d e s c r ib e s e l f - d i r e c t e d r e s p o n s e s on th e s c a l e s , s in c e by d e f i n i t i o n many o f th e m o st im p o r ta n t ones may n o t be r e a d i l y o b se rv ­ a b le .

F u rth e rm o re , i t a p p e a re d t h a t th e n u r s e s w ere r a t i n g th e two item s

r e l a t e d t o s e l f - a g g r e s s i o n somewhat p e r f u n c t o r i l y on th e r a t i n g s c a l e . T h e r e f o r e , i t was d e c id e d to u s e a s im p le , o b je c tiv e m e asu re o f in g o in g a g g r e s s io n , d e r iv a b le from th e o b s e r v a ti o n a l c h e c k l i s t .

I f a t l e a s t one

s e l f - d i r e c t e d r e s p o n s e was r e p o r t e d f o r a p a t i e n t on th e o b s e r v a tio n a 1 c h e c k l i s t , he was p la c e d i n th e h ig h in g o i n g - a g g r e s s io n g ro u p .

There a r e

18 p a t i e n t s from Ward L and two p a t i e n t s from Ward S i n t h i s g ro u p .

FANTASY DATA F a n ta s y d a ta a r e b a s e d on r e s p o n s e s i n th e T h em atic A p p e rc e p tio n T e s t (TAT). cussed h e r e .

The n a tu r e o f t h i s t e 3 t i s w e ll known an d w i l l n o t be d i s ­ (See 8 , 9 , 1 0 , 15, 17

).

I t was a d m in is te r e d a c c o rd in g t o

s ta n d a r d p r o c e d u r e , em p lo y in g a l l 20 c a rd s o f th e m ale s e r i e s in th e

R eproduced with perm ission of the copyright owner. Further reproduction prohibited without permission.

c u r r e n t e d i t i o n ( lO ) .

I n a lm o s t a l l c a s e s , th e TAT was g iv e n th e same

week th e p a t i e n t was b e in g o b serv ed on th e w a rd . two s e s s i o n s .

I t was a d m in is te r e d i n

F o u rte e n c a rd s w ere c o v e re d d u r in g th e f i r s t s e s s i o n , an d

th e re m a in in g s i x d u rin g th e second.'*’

The t e s t i n g was in tr o d u c e d w ith

th e g e n e ra l s ta te m e n t t h a t p s y c h o lo g ic a l t e s t s w ere p a r t o f th e s t a f f ’ s a tte m p t to u n d e r s ta n d t h e p a t i e n t ’ s p ro b le m s.

T h ro u g h o u t th e t e s t i n g ,

th e p ro c e d u re s fo llo w e d w ere th o s e o f th e u s u a l c l i n i c a l s i t u a t i o n .

S c o rin g and O r g a n iz a tio n o f F a n ta s y D ata A.

S c o rin g o f F a n ta s y D ata

S c o rin g Scheme Of th e v a r io u s s c o r in g schemes a v a i l a b l e f o r th e TAT, th e a p p ro a c h f i r s t d e s c r ib e d b y M urray (9 ) and e l a b o r a te d by S t e i n (15) and A ron ( l ) a p p e a re d th e m ost u s e f u l .

The r e c e n t a d d i tio n s and r e f in e m e n ts made by

A ron seemed p a r t i c u l a r l y p ro m is in g . f o r u se i n t h i s s tu d y .

These schemes w ere a d a p te d , h o w ev er,

The s c o r in g scheme d e v is e d f o r th e s tu d y s e l e c t e d

o n ly v a r i a b l e s r e l e v a n t t o a g g r e s s io n and e l a b o r a te d th e s e i n d e t a i l . The a r e a was l i m i t e d by th e same re a s o n in g t h a t d i c t a t e d th e l i m i t s of th e stu d y i n g e n e r a l.

I t was f e l t t h a t a b ro ad a p p ro a c h would n e c e s s i t a t e

g ro s s tr e a tm e n t o f i n d i v id u a l a r e a s .

S in c e p re v io u s s tu d ie s had d is c o v e r e d

no r e l i a b l e c o r r e l a t e s f o r a g g r e s s io n th ro u g h t h i s a p p ro a c h , i t seemed a d v is a b le t o d e v e lo p one a r e a in f u l l e r d e t a i l .

S in o e to o n arro w an

a p p ro ac h a l s o m ig h t p ro v e f r u i t l e s s h o w ev er, th e a r e a o f a g g r e s s io n was d e f in e d q u it e b r o a d ly - in c lu d in g th e a g g r e s s iv e a s p e c t s o f v a r i a b l e s

T h is uneven p r o p o r ti o n was a r e s u l t o f th e f a c t t h a t o th e r d a t a , n o t u sed i n t h i s s tu d y , w ere a l s o c o l l e c t e d d u rin g th e second s e s s i o n .

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-1 5 -

c a l l ed b y o th e r names i n th e s ta n d a r d sy stem s (su o h a s "dom inance" o r a c q u is itiv e n e s s " ).

The s c o r in g scheme i s p r e s e n te d in f u l l i n th e

Appendix."*" I n a p p ly in g th e s y s te m s , s c o r e s w ere g iv e n o n ly on th e b a s i s of th e m a n if e s t m a t e r i a l - t h a t i s , th e b e h a v io r o f th e c h a r a c t e r s and th e s ta te m e n ts o f th e s t o r y t e l l e r .

The s c o r in g r u l e s w ere o b je c tiv e and

d i c t a t e d t h a t a v a r i a b l e be s c o r e d e v e ry tim e i t a p p e a re d , u n le s s th e s t o r y t e l l e r was r e p e a t i n g e x a c t l y an i n c i d e n t a l r e a d y d e s c r ib e d an d s c o r e d .

In

a d d i t i o n t o th e v a r i a b l e s n o te d i n th e s c o r in g schem e, th e s c o r e r alw ay s re c o rd e d th e o b j e c t o f a g g r e s s i o n .

1

R e l i a b i l i t y o f th e S c o rin g Scheme

I

B e fo re a p p ly in g th e s c o r in g schem e, a r e l i a b i l i t y s tu d y was c a r r i e d

I.

o u t w ith a n o th e r p s y c h o l o g i s t ^ .

The scheme was d is c u s s e d and t e s t e d d u rin g

I

a p r e li m i n a r y p e r io d u n t i l am biguous e le m e n ts w ere c l a r i f i e d .

I

a b i l i t y s tu d y i t s e l f was c o n d u c te d

The r e l i -

on 90 s t o r i e s , w hich w ere s e l e c t e d a t

5:

$ I

random and s c o re d in d e p e n d e n tly by each r a t e r .

5

n e n t on th e s e s c o r e s a v e ra g e d 8 4 .5 p e r o e n t , i n d i c a t i n g t h a t th e sy stem

I

i s o b j e c t i v e an d com m u n icab le.

The p e r c e n ta g e o f a g r e e -

S c o rin g p r o c e d u r e S ix m onths a f t e r a d m i n i s t r a t i o n , th e 72 p r o to c o l s w ere s c o re d b l i n d l y by th e w r i t e r , i n o r d e r t o e l im i n a te u n c o n sc io u s b ia s o r h a lo e ffe c t.

The m ethod o f b lin d s c o r in g was a s f o llo w s :

The names were

_ _

As p r e s e n te d i n th e A p p e n d ix , th e scheme c o n ta in s some v a r i a b l e s w hich were s c o re d i n th e s t o r i e s b u t n o t a n a ly z e d o r r e p o r te d f o r t h i s s tu d y . 2

.

■

D r, P au l M ussen, whose i n t e r e s t , e f f o r t and e x p e rie n c e p ro v e d i n v a l u a b l e .

Reproduced with perm ission of the copyright owner. Further reproduction prohibited without perm ission.

b lo c k e d o u t on a l l p r o to c o l s and code num bers w ere a s s ig n e d by a n o th e r in d iv id u a l.

T h e r e f o r e , g e n e r a l im p re s s io n s o f th e p a t i e n t s ' b e h a v io r c o u ld

n o t c a r r y o v er t o th e s c o r i n g .

I n a d d i t i o n , th e s t o r i e s o f a l l 72 p a t i e n t s

to any one c a rd w ere h a n d le d t o g e t h e r , r a t h e r th a n s c o r in g th e com p lete r e c o rd o f e a c h p a t i e n t i n s e q u e n c e .

S in c e e a c h s t o r y was d iv o rc e d frcm

th e r e s t o f th e p r o to c o l and was i d e n t i f i a b l e o n ly by code num ber, i t was v i r t u a l l y im p o s s ib le to be in f lu e n c e d by a p a t i e n t 's p re v io u s s c o r e s w h ile r a t i n g a s t o r y . B.

O r g a n iz a tio n o f F a n ta s y D ata

The TAT was s c o re d a c c o r d in g t o th e c a t e g o r i e s o u t l i n e d i n th e s c o r in g schem e.

These c a t e g o r i e s w ere com bined t o form th e b r o a d e r

v a r i a b l e s p r e s e n te d i n T a b le - I .

I n t h i s fo rm , and i n c o m b in a tio n s o f

g r e a t e r c o m p le x ity , th e f a n t a s y m e asu re s w ere r e l a t e d t o b e h a v i o r . E x a c tly w hich m e asu re s w ould p ro v e m o st u s e f u l was d i f f i c u l t to e s tim a te b e f o r e th e y w ere t e s t e d . e x p lo r e d .

A v a r i e t y o f m e asu re s w ere t h e r e f o r e

Some w ere s u g g e s te d by c o n v e n tio n a l p r o c e d u r e s , and some w ere

d ev e lo p e d a s p a r t o f a r e l a t i v e l y new a p p r o a c h .

I n g e n e r a l, th e y w ere

a l l e s tim a te s o f th e s t r e n g t h o f a g g r e s s iv e r e s p o n s e or o f th e s t r e n g t h of th e d e fe n s e a g a i n s t a g g r e s s iv e r e s p o n s e .

I n p r e s e n ti n g th e r e s u l t s , th e

u n d e r ly in g r a t i o n a l e o f th e m e a su re s em ployed in e a c h s e c t i o n w i l l be o u t­ lin e d b r i e f l y .

The m ost f r u i t f u l m e asu re s w i l l be c o n s id e r e d i n somewhat

g re a te r d e t a i l .

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TABLE I

T .A .T . VARIABLES: SYMBOLS AND COMPONENT SCORING CATEGORIES

V a r ia b le s

Symbol

Component S c o rin g C a te g o r ie s

T o ta l A g g re s sio n

TA

A ll a g g r e s s iv e n eed s and p r e s s

T o ta l V e r b a li z a ti o n

TV

L en g th o f p r o to c o l

T o ta l A g g re s siv e Needs

TN

P h y s ic a l , a n t i s o c i a l , v e r b a l c o e r o iv e and p a s s iv e - a g g r e s s iv e o u tg o in g n e e d s ; s u b m is s iv e i n t r a g r e s s i v e and i n t r a g r e s s i v e in g o in g n e e d s ; h a rm a v o id a n c e , i n f a v o id a n c e , b lam escap e and b la m av o id a n ce n eed s

O utgoing A g g re s siv e Needs

ON

P h y s ic a l, a n t is o c i a l , v e rb a l, c o e r c iv e and p a s s iv e - a g g r e s s iv e o u tg o in g n e e d s

A c tiv e O utgoing A g g re s s iv e Needs

AN

P h y s i c a l , a n t i s o c i a l , v e r b a l an d c o e r c iv e o u tg o in g a g g r e s s iv e n eed s

P a s s iv e O utg o in g A g g re s s iv e Needs

PN

P a s s i v e - a g g r e s s iv e o u tg o in g n eed

P h y s ic a l and A n t i s o c i a l A g g re ssiv e Needs (V io le n t a c t i v e n e e d s)

PASN

P h y s ic a l and a n t i s o c i a l o u tg o in g a g g r e s s iv e n eed s

Abasement Needs

ABA

S u b m is s iv e - i n tr a g r e s s iv e and i n t r a g r e s s i v e in g o in g n eed s

A voidance Needs

AV

H arm av o id an ce, in f a v o id a n c e , b la m escap e and b lam av o id an ce

T o ta l P re s s

TP

P r e s s o f p h y s ic a l d a n g e r, d e a t h , p h y s i c a l and m e n ta l a f f l i c t i o n ; p r e s s o f p h y s i c a l , c o e r c iv e , v e r b a l and p a s s iv e - a g g r e s s io n ; p r e s s o f p u n ish m en t and b la m a v o id a n c e ,

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-1 6 b -

TABLE I

(C o n t in u e d )

V a r ia b le s

Symbol

Human P re s s (P re s s from human s o u rc e s )

HP

P re s s o f p h y s ic a l , c o e r c iv e , v e r b a l and p a s s iv e a g g r e s s io n ; p r e s s of p u n ish m en t and b lam av o id an ce

Puni shment

PUN

P r e s s pu n ish m en t

T o ta l D efen ses

TD

R e j e c ti o n , d e n i a l , e x c u s in g , non­ c o m p le tio n , q u a l i f i c a t i o n o f a g g r e s s io n , and rem oval o f a g g r e s s io n t o p a s t o r f u t u r e tim e

M ajor D efen ses

R,D,EX, NCF

R e j e c t i o n , d e n i a l , e x c u s in g and n o n -c o m p le tio n o f f a n t a s i 9 d a c t

D isp la c e m e n t

DISP

D isp la c e m e n t o f a g g r e s s io n t o non­ human o b je c ts

U nm odified P h y s ic a l and A n t i s o c i a l Needs (U nm odified v i o l e n t a c t i v e n e e d s)

•PASN-MD

Component Scoring; C a te g o r ie s

P h y s ic a l and a n t i s o c i a l o u tg o in g a g g r e s s iv e n eed s e x p re s s e d i n f a n t a s y w ith o u t r e j e c t i o n , d e n i a l , e x c u s in g o r n o n -c o m p le tio n o f th e e x p r e s s io n .

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17-

| !

HESULTS

The r e s u l t s a r e p r e s e n te d i n fo u r s e c t i o n s .

The f i r s t th r e e s e c ­

t i o n s , w hich d e s c r ib e th e f in d i n g s r e l e v a n t t o o u tg o in g a g g r e s s io n , a r e o rg a n iz e d i n te rm s o f th e f a n t a s y m e a s u re s .

They r e p r e s e n t th r e e

ap p ro ach es t o m easurem ent w h ich a r e q u a l i t a t i v e l y d i f f e r e n t and w hich a r e n o t e q u a l ly s u c c e s s f u l i n r e l a t i n g f a n t a s y t o a g g r e s s iv e b e h a v io r .

The

m easures i n th e f i r s t s e c t i o n a r e b ased on a c o n s i d e r a t i o n o f a g g r e s s iv e them es a lo n e ,a n d a r e r e f e r r e d t o a s th e n eed - p r e s s v a r i a b l e s .

The

m easures i n t h e seco n d s e c t i o n a r e b ased on a c o n s i d e r a t i o n o f th e mechanisms w h ich m o d ify a g g r e s s i o n . m e a s u re s .

They a r e r e f e r r e d to a s th e d e fe n s e

The m easu res i n th e t h i r d s e c t i o n a r e b a s e d on a c o n s id e r a tio n

o f th e m ost ex trem e a g g r e s s iv e e x p r e s s io n . m easures o f u n m o d ifie d a g g r e s s iv e r e s p o n s e .

They a r e r e f e r r e d t o a s th e The f o u r t h s e c t i o n i s

e s s e n t i a l l y su p p le m e n ta ry , and d e s c r ib e s th e f i n d i n g s r e l e v a n t t o in g o in g a g g r e s s io n . The s i g n i f i c a n c e o f a l l r e l a t i o n s h i p s h a s b een t e s t e d by th e c h i sq u a re te c h n iq u e ( 6 ) .

U n le s s o th e rw is e i n d i c a t e d , th e d a ta have been

d ic h o to m iz e d a t th e m edian p o in t s , w ith Y a te s ' c o r r e c t i o n f o r c o n t i n u i t y em ployed th r o u g h o u t. In a l l th e t a b l e s o f th e f i r s t t h r e e s e c t i o n s , each v a r i a b l e i s p re s e n te d in i t s r e l a t i o n s h i p t o a l l f o u r b e h a v i o r a l m e a s u re s :

th e t o t a l

o b s e r v a tio n a l s c o r e , th e t o t a l r a t i n g s c o r e , th e a f f e o t s c o r e , and th e o u tb u r s t s c o r e .

1

These r e l a t i o n s h i p s were t e s t e d s e p a r a t e l y on each w ard.

I n th e c a s e o f th e o u t b u r s t s c o r e , th e h ig h g ro u p i s c u s to m a r ily com pared w ith th e o th e r two g ro u p s co m b in ed . On o c c a s io n , i t i s com pared w ith th e low group a l o n e .

R eproduced with perm ission of the copyright owner. Further reproduction prohibited without permission.

and a g a in f o r th e com bined w ards , ta b le s .

They a r e p r e s e n te d t h i s way i n a l l

I n g e n e r a l, o n ly th o s e r e l a t i o n s h i p s s i g n i f i c a n t a t th e 15 p e r

c e n t l e v e l s o f c o n fid e n c e o r h ig h e r a r e r e p o r te d i n f u l l i n th e t a b l e s . Some r e l a t i o n s h i p s b etw een t h i s l e v e l and th e 25 p e r c e n t l e v e l a r e re p o rte d , i f th e y s u p p o r t s i g n i f i c a n t f in d in g s w h ich in v o lv e th e same f a n ta s y v a r i a b l e .

Those v a r i a b l e s w hich w ere n o t s i g n i f i c a n t l y r e l a t e d

to any b e h a v io r a l m easure a t th e 15 p e r c e n t l e v e l a r e n o te d below th e ta b le s .

OUTGOING AGGRESSION

1.

N e e d -P re ss V a r ia b le s The m easu res i n t h i s s e c t i o n , w hich e s ti m a t e th e s t r e n g t h of

a g g r e s s iv e r e s p o n s e , w ere d e r iv e d th ro u g h a c o n v e n tio n a l n eed - p r e s s a p p ro a c h .

I n d e v is in g th e s e m e a su re s i t was c o n s id e r e d t h a t th e te n d e n c y

t o a c t o u t m ig h t be r e l a t e d to th e am ount o f f a n t a s i e d a g g r e s s io n , a n d /o r th e r e l a t i v e em phasis on some k in d s o f f a n t a s i e d a g g r e s s io n r a t h e r th a n o th e rs .

T h e re fo re th e v a r i a b l e s in v o lv e a r a t h e r d e t a i l e d breakdow n o f

th e a g g r e s s iv e th e m es.

They c o n s id e r n o t o n ly th e s h e e r number o f su ch

them es, b u t th e a g g r e s s iv e a g e n t (n eed or p r e s s ) , th e n a tu r e o f th e in s tr u m e n ta l a c t ( v i o l e n t , v e r b a l , p a s s i v e , e t c . ) , th e d i r e c t i o n of e x p r e s s io n (o u tg o in g or in g o in g ) and th e fr e q u e n c y o f r e t a l i a t i o n ( p u n is h ­ m ent) . "'"The m ethod o f co m bining w ards f o r a g e n e r a l t e s t o f s i g n i f i c a n c e was as f o llo w s : A ll th e d a ta w ere d ic h o to m iz e d s e p a r a t e l y f o r e a c h w a rd . The o e l l f r e q u e n c ie s o f th e 2 x 2 t a b l e s on each w ard were added to g e th e r when th e s i g n i f i c a n c e o f any g iv e n r e l a t i o n s h i p was t e s t e d f o r com bined w a rd s . T h is c r e a te d one t a b l e f o r th e e n t i r e s a m p le , w ith o u t assu m in g t h a t t h e r e w ere no d i f f e r e n c e s b etw een w a rd s .

Reproduced with perm ission of the copyright owner. Further reproduction prohibited without permission.

-1 9 -

The r e l a t i o n s h i p s o f th e s e v a r i a b l e s t o a g g r e s s iv e b e h a v io r a r e r e p o r te d in T ab le I I .

S e c tio n ti o f th e t a b l e r e p o r t s th o s e f a n ta s y

m easures w hich e s tim a te e i t h e r l ) th e t o t a l num ber o f a g g r e s s iv e th e m e s, or 2) th e e x t e n t t o w hich c e r t a i n a g g r e s s iv e r e s p o n s e s a r e s t r e s s e d . For th e m easu res i n t h i s s e c t i o n , s t r e s s i s d e f in e d by th e p r o p o r ti o n o f th e s e re s p o n s e s (n e e d s ) t o more in o l u s i v e m e a su re s o f a g g r e s s io n .

S e c tio n

b o f th e t a b l e a l s o r e p o r t s m e a su re s w h ich e s tim a te th e e x t e n t t o w hich c e r t a i n a g g r e s s iv e r e s p o n s e s a r e s t r e s s e d .

H e r e , how ever, s t r e s s i s

d e f in e d b y th e p r o p o r tio n o f th e s e r e s p o n s e s (n e e d s ) to m easu res o f p r e s s a lo n e .

S e c tio n _ c does n o t r e p o r t th e r e l a t i o n s h i p s o f new f a n ta s y m e a s u re s ;

i t r e p o r t s th e f in d i n g s when th e s e same m e asu re s a r e t e s t e d in new com­ b in a tio n s a g a i n s t a g g r e s s iv e b e h a v io r .

The e s s e n t i a l f e a t u r e o f t h i s

a p p ro ac h in v o lv e s t r e a t i n g p a t i e n t s who em p h asize c e r t a i n a g g r e s s iv e r e s ­ ponses s e p a r a t e l y from p a t i e n t s who do n o t em p h asize th e s e r e s p o n s e s . W ith in e ac h o f th e s e more homogeneous groups; th e r e l a t i v e s t r e s s on th e s e re s p o n s e s ( d e f in e d by p r o p o r ti o n t o a g g r e s s iv e p r e s s ) i s t e s t e d a g a i n s t b e h a v io r .

F or exam ple - c o n s id e r in g th e v a r i a b l e o f a c t i v e n eed i n p r o ­

p o r ti o n to a l l a g g r e s s iv e n eed :

some p a t i e n t s who a r e above th e m edian

on t h i s p r o p o r ti o n a c t o u t and o th e r s do n o t .

An a tte m p t i s made to

d i f f e r e n t i a t e th e s e p a t i e n t s by t e s t i n g a c t i v e n e e d , i n p r o p o r ti o n t o p r e s s , a g a i n s t b e h a v io r s c o r e s .

1 T able I d e s c r ib e s th e TAT v a r i a b l e s , t h e i r sy m b o ls, and th e b a s ic s c o r in g c a t e g o r i e s o f w hich th e y a r e com posed. T his t a b l e can be u sed a s a r e f e r e n c e in r e a d in g th e v a r i a b l e s in, o th e r t a b l e s .

Reproduced with perm ission of the copyright owner. Further reproduction prohibited without permission.

Reproduced

TABLE I I

TEE RELATION BETWEEN AGGRESSIVE RESPONSES IN FANTASY AND OVERT AGGRESSIVE BEHAVIOR

with permission

A.

The s t r e n g t h o f a g g r e s s iv e re s p o n s e i s e s tim a te d from th e fre q u e n c y and from th e p r o p o r tio n o f c e r t a i n a g g r e s s iv e n eed s t o more in c lu s iv e m easures o f a g g re s s io n

FANTASY VARIABLES

BEHAVIORAL VARIABLES

WARD L TA TV

x 2“ 3 .6 5

In v e r s e pa