a delineation of schizophrenic language and thought in a test of imagination

This article was downloaded by: [University of Leeds]On: 28 November 2014, At: 06:27Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

The Journal of Psychology:Interdisciplinary and AppliedPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/vjrl20

A Delineation of SchizophrenicLanguage and Thought in a Testof ImaginationEva Ruth Balken a ba The Otho S. A. Sprague Memorial Institute ,University of Chicago , USAb Division of Psychiatry , University of Chicago , USAPublished online: 02 Jul 2010.

To cite this article: Eva Ruth Balken (1943) A Delineation of Schizophrenic Languageand Thought in a Test of Imagination, The Journal of Psychology: Interdisciplinary andApplied, 16:2, 239-271, DOI: 10.1080/00223980.1943.9917174

To link to this article: http://dx.doi.org/10.1080/00223980.1943.9917174

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

http://www.tandfonline.com/loi/vjrl20

http://www.tandfonline.com/action/showCitFormats?doi=10.1080/00223980.1943.9917174

http://dx.doi.org/10.1080/00223980.1943.9917174

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

http://www.tandfonline.com/page/terms-and-conditions

Published as a separate and in The Journal of Psychology, 1943, 16, 239-271.

A DELINEATION OF SCHIZOPHRENIC LANGUAGE A N D THOUGHT IN A TEST OF IMAGINATION*

T h e Otho 5. A. Sprague Memorial Institute, and the Division of Psychiatry, Unioersity of Chicago

EVA RUTH BALKEN

The present paper is a report on the delineation of schizophrenic language and thought by the application of an experimental technique which was broadly suggested in a critical analysis of Psycho- logical Researches in Schizophrenic Language and Thought and of a methodological and explanatory formulation. These were derived by bringing into apposition pertinent theoretical and empirical psy- chologic and psychiatric knowledge regarding the ego and its object relations (8).

A. METHOD T h e method employed in this study was, as in previous studies,

an adaption in technique and materials of Murray’s Thematfc Apperception Test (27) for the elicitation of phantasies, the materials being limited to the 10 pictures comprising the “neutral” series of Murray’s group of 30.

T h e subjects1 comprised 75 patients at the Cook County Psycho- pathic Hospital. All but five were first admissions and all presented peculiarities of schizophrenic thought. T h e underlying principles in the selection of patients evolved from the author’s critical appraisal of psychological researches in schizophrenic thought ( 3 ) and methodological and explanatory formulation for the investigation of the ‘‘psychological relation.” In the present context, these principles are most aptly described by the following excerpts from Blitzsten’s article on the Psychoanalytic Contributions t o the Conception of Disorder Types :

*Received in the Editorial Office on July 2’0, 1943, and published irnrnedi- ately at Provincetown, Massachusetts. Copyright by The Journal Press.

‘The author wishes to express her aupreciation to Dr. N. Lionel Blitzsten, Capt. Paul Rosenfels, M.D., and Dr. David Slight for their invaluable aid in the selection of the patients.

239

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

240 JOURNAL OF PSYCHOLOGY

His (Freud’s) classification of personality and the mental ills to which it falls heir rests upon the assumption of processes re- ferable to inter-personal relationships. Diagnosis based on these principles is essentially merely the designation of the most likely vantage point in the fluid personality configuration from which to observe the play of forces which is resulting in symptom formation or character disability. Therapy proceeds not with reference to the superficial picture but to an understanding of the deviation of the self as a whole.

Although our knowledge is as yet sorely limited, we are able, daily, to look with new eyes upon ancient phenomena and see more deeply than we had seen before . . . the psychiatric lens facilitates an understanding of the nature of mental disorder and suggests diagnoses which not only classify but offer sotne suggestions for the reconstruction of the disordered personality.

T h e effect upon clinical diagnosis of this interpretation of disorder patterns as dynamic resultant8 of forcer which tend to organize into an approximation of a balance which, for a given individual, we call the normal personality, is to shift the em- phasis from an effort to state what pathological mental picture the patient most nearly represents to an attempt to diagnose or describe the fundamental structure of the patient’s total personality.

The form and content of the elicited phantasies were analyzed in detail on the basis of the principles of language analysis established in previous studies of phantasy ( 5 , 6, 7), the criteria being adapted to and evolving from the contingencies of the interpersonal relations evoked in the experimental situation.

The variables identified through this analysis were then corre- lated one with the other and then validated against the clinically established mechanisms of schizophrenic experience, and not, as is eminently desirable, against the anamnestic and biographical material and the psychiatrist’s formulation of the structure and dynamics of the individual psychosis. For reasons which cannot be elaborated upon in the present context the latter sources of validation were considered both inadequate and unreliable.

The language analysis seeks to answer three questions : “HowPII, “Why?”, and “What?”’ (13).2 In the present experimental con-

‘The author is especially grateful to Dr. N. Lionel Blitzsten for the many stimulating and helpful suggestions regarding the formulation of a theoretical framework for the accommodation of problems in psychodynamics.

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 24 1

figuration the answer to the first is easily attained. T h e technique of eliciting phantasies and the method of validation impose definite restrictions on the extent to which the defenses (Why?) and the content (Wha t? ) may be tangibly delineated and clarified. This may be rather disconcerting to those who have been indoctrinated with the misleading conception that the latent coptent is always manifest in schizophrenic thought, regardless of the configuration of interpersonal relations in which the content .is elicited, and who thus believe that any investigation of schizophrenic thought must yield a field day for conjecture, hypotheses, and interpretations regarding underlying meanings.

B. RESULTS It has been said that emotional participation and sympathetic under-

standing are essential to any penetration into the underlying realities of schizophrenic language and thought. Perhaps an even greater emotional participation and sympathetic understanding should be accorded the investigator in his reports of the results of inquiries with a technique which yields a mass of data even more heterogeneous and descriptively elusive than the patients comprising the experimental group.

T h e verbal productions of one or more of the patients are charac- terized by one or more of the following:8

1. Lack of causal connections. 2.

3.

Lack of qualifying, modifying, and excepting conjunctions, such as “if,” “however,” “but,” and “moreover.”

Juxtaposition of items which overtly are apparently unrelated if analyzed within the context of the patient’s verbal productions, as, for example, in the case of E. H., who, in reaction to the picture

‘A single language symptom may be isolated in the descriptive analysis but it does not provide a valid point of departure for classification or tabulation inasmuch a s its identification depends upon its olace in the confieura- tion of the totality of response. Appeal to guides, lexicons, o r dictionaries is of little aid in classification, inasmuch a s application of such criteria would involve a verbatim. presentation and itemization of the verbal productions of each subject. The’ multiple reference and allusiveness of the manifest content precludes the application of any statistical o r semantic schematization. T h u s any classification which makes claims to scientific objectivity and adherence to the obtained data must perforce bear the stamp of the investigator’s frame-of-reference, ideologies, and idiosyncracies.

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

242 JOURNAL OF PSYCHOLOGY ,

of “a young woman with ner nands squeezed around the throat of another woman half fallen below her” says: “Well, he’s either asking her mother for something or his throat is sore.”

Diffuseness, scattering, and spread of meaning, but each item in the sequence of the verbal productions evoked by some aspect of the interpersonal situation ; including :

( a ) T h e preoccupations of the patient, as, for example, in the case of E. H., whose persistent complaint of having a “sore throat” appeared in the context of all her productions.

( 6 ) Inadvertent gestures and postural changes which might serve as stimuli for ensuing material, as, for example, in the case of A. B., who, upon reversing the picture, noted that she had turned it up on “its bottom” and then talked about “bottoms” and

worry’) and not being able to “sit down on her bottom” because she would “worry” and who, upon gesticulating with her left hand, noted that her “left” hand meant “wrong” and the “right” meant “good things” and then insisted that if she were to relate the “truth” she must “stand” with her “right)’ arm extended.

( c ) Inadvertent gestures and postural changes of the examiner, as well as those which were an integral part of the testing situation, as, for example, in the case of A. B., who, after the examiner had laid down her pencils, said: “Let’s lay down our pencils and stop fighting” and in the case of L. H., who insisted that the examiner’s writing was her writing and that the examiner was a “copy cat.”

( d ) Interpolations by the examiner, as, for example, in the case of H. F., who, when asked “what led up to it?”, amplified‘it with: “Well, what led up to it-well, it could be a number of things- they couid have gone swimming or they could have been taking a bath-what is the proper word for s e x - o r sex relations?”

5. Fragmentation, that is, sentences without subject or object or without either subject or object, verbs standing alone, and nouns alone.

6. Lack of qualifying adjectives and adverbs, other than those involving conative or moralistic implications, such as “good” and “bad” o r “dirty.”

Ellipses in recognizable trains of thought, in which either entire members of the sentence are wanting or members of a cer-

4.

( 1

7.

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 243

tain type are preserved, as, for exampli, in the case. of T. B. who interpolated “of which” at the beginning of every phrase.

8. Absence of similes and analogies and use of inexact substitu- tions, circumlocutions, and neologisms.

9. Poor sentence construction, as, for example, in the case of E. H., who framed nearly all his sentences in this manner: “One every day exercise should.”

10. 1 1. 12. Interminable silences. 13.

Equivalence of all evoked responses. Perseveration, blocking, and endless repetitiousness.

Prevalence of temporal setting in the present or present perfect tense, and lack of verbs with future reference or with past habitual reference.

Prevalence of verbs in mode implying possibility or compul- sive and lack of correlative conjunctions, such as “either-or,” “neither-nor,” and “might be-might not be.”

Lack of identification of the characters in terms of age, sex, names, sibling, parental or filial relations, or attitudes, and of the nature of the interpersonal relations among the characters.

16. T h e absence of adjectives and nouns denoting imagery in all sensoria, such as color, sound, movement.

None of these characteristics, to quote Sullivan, is “exterior to the gamut of ordinary thinking.” One may find parallels in “ordinary” situations where conversation is being submerged by drowsiness or sleep” or boredom and in the verbal reports of dreams, reverie, and hypnagogic imagery. One can find parallels in fiction, myth, and poetry (4) ; many of these characteristics have been utilized as dramatic devices on the stage or on the radio.

And nearly every one of these characteristics has been noted by one or another investigator. White (36) reports that relations usually indicated by “because” and “therefore” are indicated by “and” or “and then” by both the child and the schizophrenic. H e refers to this characteristic as the phenomenon of syncretism and interprets it as the expression of perpetual assimilation to subjective schemes, in which the egocentric tendency replaces adaptation to the external world by assimilation to the self. Cameron (17) and Shl- livan (35) emphasize the interpenetration of personal preoccupations, and the diffuseness and spread of meaning, in which “the accidentals

14.

15.

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

244 $OURNAL OF PSYCHOLOGY

of a situation are dislocated from their place in the total configuration and elevated to focal awareness” and which have led to the labeling of schizophrenic thinking by other investigators as “scattered.” C. Schneider (31 ) gives one of the best descriptions of elliptical thinking in the schizophrenic. A. Schneider (30) comments on the inexact substitutes, circumlocutions, and neologisms, and the faults in word sequence and sentence structure.

T h e restrictions in organization and evaluation imposed by the technique and by the nature of the experimental group become even more obstructive in analyses which transcend mere description as in the foregoing tabulation of the characteristics of the form and content of the elicited phantasies, for it is necessary on the one hand to guard against a systematic exploitation of those aspects of the results that apparently are derived exclusively from the testing situation, and, on the other hand, of those aspects that seemingly are derived exclusively from the interaction between subject and examiner in a testing situation. T h e following account is an attempt to organize the obtained data on the basis of the methodological and explanatory formulation of the “psychological relation” :

T h e schizophrenic patient brings to the experimental situation a great “inner unrest,” which is more or less accentuated by the requirements of the test in the configuration of the dynamics of the interpersonal situation.

T h e totality of the experimental situation is a novel or prob- lematic one and requires an adjustment which cannot be effected exclusively through habitual modes of reaction but which involves the generation of new cognition.

T h e “inner unrest” reactivated and more or less accentuated by the demands of the experimental situation stir the patient to some form of activity.

T h e patient is more or less unaware of the implications of his “inner unrest”-f his anxieties, conflicting strivings, and diversified affects; likewise, he is more or less unaware of himself and of the implications of his inner unrest in relation to the externally prescribed goals and demands of the interpersonal situation.

T h e patient reacts, for the “inner unrest” requires that something must be done in this new situation so as to alleviate the additional tension created thereby. T h e “inner unrest,” in and of itself,

1.

2.

3.

4.

5.

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 245

is so diffuse, transferable, and dissociated that it does not serve as a guide to action; it simply indicates that something must be done, and activates the patient to bring to bear upon the situation items from his repertoire of past experiences. It does not indicate what is to be done.

More or less unaware of his own knowing, let alone of his own knowing in relation to the demands of the external world or in relation to the drives from his own inner experiences, and with his conative tendencies bound by anxiety, affects, and strivings to goals of which he is also more or less unaware, the schizophrenic is un- able to effect the required adjustment through his recall and application of past experience.

7. Anything of any nature-imaginal, sensuous, intraorganic, postural, expressive, perceptual-in the interpersonal environment calls up anything of any nature from the patient’s past experiences. Anything of any nature-internally or externally evoked-is related in a “knowing” or %on-knowing” fashion to anything of any nature.

8. T h e configuration of figure and ground are shifting, vacil- lating, confused, or chaotic and the goaIs of reaction likewise; for the schizophrenic’s conations and affects are not in the service of cognition, but in the service of his own “inner unrest.”

Thus there is’no apprehension of new relations, that is, no relevant apprehension, no generation of new cognition or new learning, and the attempted adjustments do not bring about any alleviation of even those aspects of the “inner unrest” that have been activated or accentuated by the requirements of the test situatioc.

In the above summary an attempt was made to organize the data within the frame-of-reference of the patient. In the presentation of the evidences the approach is largely from the point of view of the participant observer-the examiner.

Only a few patients gave any semblance of a story, an interpretation, a description, or an enumeration in response to the directions. Thus E. P. reacted to the first picture in the series:4

6.

9.

’The presentation of the evidences may be criticiied on the scores ( n ) that the summary and evidences are not apposed in a point-to-point correspondence; ( b ) that the supportive illustrations are not quoted in extenso; and ( c ) that these illustrations are largely from the productions of those patients

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


He looks just the way I feel-that’s all the sensation I get out of the picture. Of course, if I look a t the violin, I can see more in it and if I w a n t to g o on studying this picture it reminds me of a little gir l about, I guess, she’s about seven years of age. T h i s is a little gir l whom I knew-she had been coaxing to take violin lessons a t school. She could get the lessons, but she had no fiddle-no violin. An old friend from out of town when he was visiting the family learned of her desire and told her that he had a good fiddle that no one used and which she could have. He said he would give it to her when she went to visit his home-his home town-they were neighbors. Now I have to stop to think it over in order to make. ’The next morn- ing after she arr ived she got up a t six o’clock to awaken the neighbors to get her fiddle. That’s all that picture would flash into my mind.

These semblances indicate some degree of awareness of the implications of the directions, some degree of relevant apprehension and some degree of maintaining a goal within the direction of the requirements of the situation. However, notwithstanding repetition of directions and other attempts to encourage the patient to maintain his orientations within the configuration of the testing situation, these semblances were obtained only for the first one or two pictures of the series. Responses soon disintegrated into productions in which irrelevant and distractive material suggested by an initial idea in response to the situation itself, or by the suggestive influence of the wider interpersonal situation and also by stimuli from the extensive background of sensuous, emotional, and imaginal material, accumu- lated sufficient dynamic strength to disrupt the trend towards rele- vancy and pertinence of response. Thus : E. P. responded to the third picture in the series :

Well, it could suggest w a r and more sharp featured live

in whom apparently the paranoid mechanisms predominated at the time of examination. These criticisms may be dismissed summarily with the con- tentions ( a ) that the technique employed does not permit B point-to-point apposition of the “I” and “you” variables in the interpersonal situation in question; no attempt is made to appose the interpretative conclusions and the evidences in a point-to-point correspondence; ( b ) that it would be wearisome to quote in extenso the productions of the majority of the patients; and ( c ) that the presentation of excerpts f rom the productions of such patients to a seemingly excessive degree does not imply that such patients constituted the majority of the subjects, since for reasons that need not be elaborated here, the responses of such patients a r e usually more “quotable.”

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 247

ghogts on Flanders Field reminding us that the dead shall not have died in vain. T h e world w a r veterans-who gave their lives-though in recent years it has seemed futile-did not give their lives in vain because they taught us that it is futile and senseless for America to enter the war . (Correcting the examiner)-“That should read ‘be’ instead of ‘is’.’’

These semblances, however, were barren of any direct reflections of the life events of the patient and thus one cannot reconstruct from the verbal productions the determinants of the present schizophrenic episode. They were told as if they were “true” stories, without any awareness of their fictional character ; the narrating was punctuated throughout with an emotional intensity and with an emotional “con- viction” that the patient felt he had told all that was to be told and had complied with the requirements of the situation. T h e absence of any direct reflections of life events even in these “emotional” productions is illustrated in the case of C. K., who had fled the police and denounced himself for having raped a child. T h e most overt response of his anxiety appears in response to the fifth picture in the series:

T h e picture-the picture-appears to be a ‘scene of affectio? or love-probably a home scene-it appears to be either a father and son picture and the picture could illustrate the relationship between father and son or mutual understanding. T h a t is sometimes in life we don’t find. T h e picture could also show that perhaps parent and child may have been through something that brought him closer together. Life is like that-I guess. T h a t is all-I can’t really see this one as clearly as I would like to. (Amplification in response to question:) Prob- ably-probably-something or some misfortune. (Amplification to further question:) I don’t know. Could possibly the loss of someone or some tragic incident in life. This will probably make the relationship to each other more dear. T h a t teaches- that also teaches the lesson for individuals to love and respect their own because-because it may be too late-because it may be too late because of something happening that might-that might take them away from each other. I believe that’s all. (Amplification to still further questioning:) M y vision isn’t so good. Really, I think I’m creative myself. I write songs and things like that.

These semblances of stories, interpretations, descriptions, or enumerations were obtained largely from patients in whom paranoid

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


mechanisms predominated-not including the post-schizophrenic states. They are illustrative of the tendency of the paranoid to divest any situation of power to stir dissociated tendencies and pro-

voke conflict with awareness.” Such patients were likewise wont to temper their refusals of compliance with remarks such as:

( 6

“If I tried something like-then I would-it would drive me - d r i v e everybody nuts around here”;

“. . . everything else would be imaginative and I don’t feel that it should be required of this sort-later should be used as a story”; or

“That would be telling a story-that would be imagination- that would be unthinkable.”

Attempts to encourage the patients who thus had indicated in their response some awareness of the implications of the testing situation, to adhere to the orientation and requirements of the directions were encountered with replies such as: “It doesn’t really mean anything to me. I t didn’t really mean a lot of things to me without effort.” Such replies suggest relevant striving in the direction of goals of which the patient was more or less aware and the disruptions of such strivings by any one of a number of determinants, only one of which, according to Sullivan, is the tendency of the “paranoid” to “divest any situation of power to stir dissociated tendencies and provoke conflict with awareness.”

The majority of the patients, however, regardless of predominant psychodynamic mechanisms, revealed either a complete lack of com- prehensions of the directions and acceptance of the externally imposed goals or varying degrees of inability to maintain throughout their compositions adherence to those aspects of the directions which they had accepted-inasmuch as they coincided with their own desires- and to maintain their goals in accordance with these apprehended aspects. Thus :

E. E. reacted persistently, and with increasing hostility, to each picture with :

“The only things that have a part for me are the things that concern life-health-peace-good will”;

“This too has no thought because it conveys of human instincts. The metaphysicians teach UB that-anything that pertains to matter has no part for me”;

“I’m sure that it has no part in my realization. Anything

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 249

that is part of me-I recognize it immediately and it recognizes me. If I refuse to recognize it then it is not of me”; and

“Has no part with me. I guess that’s the most psychological thing to say concerning a picture like that.”

T h e above illustrations demonstrate the failure of the schizophrenic patient to achieve any degree of successful attainment in the test of imagination. It is possible to infer or conclude from this fact alone a disturbance in imagination, and from this disturbance in imagination may be derived the conclusion of an impairment in the “psychological” or subject-object relation which, theoretically and empirically, has been demonstrated to enter into all relevant apprehension or generation of new cognition and to be amenable to scientific study in the process of imagination. They likewise demonstrate the difficulty of organizing the data in other than a negative fashion.

Further inferential corroboration of a disturbance in the “psychological relation” is obtained from a comparison of the verbal productions of the schizophrenics with those of neurotics evoked by the same technique. This corroboration is likewise of a negative character; that is, certain characteristics of the manifest content of the phantasies of neurotic subjects-a few of which are noted below- are not discernible in the productions of the schizophrenics.

( a ) T h e neurotic subject is aware of the probing implications of the test. It is not uncommon for him immediately to offer in lieu of a newly fabricated story one of an autobiographical or biographical experience of which the picture reminds him.

( h ) T h e neurotic subject is aware of the self-revealing implications of his stories and often verbalizes this awareness in a form such as: “I seem ,to have been talking about myself,” or “The pictures always remind me of something that happened to me.”

( c ) The neurotic subject parries the probing and self-, implications with many devices for the avoidance of any responsibility in the relating of ego-alien material ; for example, he may throw the onus upon the examiner--“You asked me for a story and that’s what I’m giving you.”

( d ) T h e neurotic subject, aware of the probing and self- revealing implications of the test, yet desirous of ventilat-

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


ing some non-ego acceptable material, utilizes the protec- tion of the directions to talk about hostilities, frustrations, desires, jealousies, et cetera. Thus, one child neurotic subject, before relating a tale of intense sibling rivalry, asks: “May I use my imagination here?’’

( e ) T h e neurotic subject makes complimentary or ad- verse remarks regarding his imaginative ability, or regarding his compliance with the directions.

( f ) T h e phantasies of the neurotic subject are often so self-revealing that the pattern-and na ture-of some of the determinants of his neuroses may be reconstructed from them.

(9) T h e neurotic subject, especially in a hospital or clinic atmosphere, is aware of the implications of the task which is set before them even before he has entered the examining room, for he has learned about the test through the grape-vine system.

( h ) T h e neurotic subject evidences some curiosity about the meaning of his participation in the test and its effect upon the future course of his interpersonal relations with psychiatrist, parents or others.

T h e tangibility of mechanisms such as these makes it possible to organize the data obtained with neurotic subjects with reference to the ego’and its defenses against anxiety. Basic to such an organization of data is the assumption of an ego which is not alienated from reality. The intangibility or absence of such mechanisms in the productions of the schizophrenic supports the inferential interpretation of a disturbance of the subject-object relations in the schizophrenic in the direction of an alienation from reality.

Spearman (33), Aveling ( l ) , and Wyatt (37) stress that in conation or striving there must be “more or less awareness” of the pertinence or impertinence of the elicited activity to the interest or end or purpose or objective which is at the time “affectiqg” the individual. Mere relating of items in the cognitive field does not suffice for adaptation or learning. T h e degree of adjustment or learning which an individual exhibits in the case in question is proportioned to the degree of his ability to apprehend a whole act of interlaced

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


relations all fofming parts of a single scheme. T h e whole pattern of relations or inter-relations is what it is and inter-related in the way it is because of the influence upon it of the end entertained. T h e appearance in consciousness of relevant apprehension of the items in the cognitive field is, however, not haphazard, but is itself conditioned by conative tendencies which have the r81e of establishing and maintaining suitable figure-ground configurations for the attainment of clear and determinate cognition and of integrating relations (23).

T h e preceding discussion illustrated that, although the patients were stirred to some form of activity as a part of the interpersonal situation by the test directions, this activity was not relevant to all aspects of the directions and the totality of the activity was not integrated in terms of the dictates of the test. T h e testing situation obviously tended to stir some tendency in the “inner unrest,” but apparently without evoking awareness of the relation of the one to the other and without stirring any one tendency intensely enough to mobilize it relevantly in the direction of the externally dictated goal. T h e dimness and obscureness of the conative tendencies in the direction of the externally imposed goals and their intensity, dis- sipation, transiency, and ambiguity in the direction of multiple, unrelated, dissociated inner amative tendencies or affect or of stimuli suggested haphazardly by the interpersonal situation are evidenced in the following characteristics of the manifest content of the verbal productions and in the attitudes which may be inferred from the content.

T h e interpersonal situation is restricted to those aspects within the range of immediate, central vision. Only three patients attempted to escape from or alter that range. T h e patients remained rooted in their chairs with their gaze fixated upon the examiner, upon the pictures, or upon a vacuum. Details from these fixations were incor- porated o r interpolated or fused with their responses to the test requirements as though they were perceptually real. Even those items of their own compositions that superficially possessed some degree of relevance to the situation were related with a vividness which im- pressed the listener with their perceptual reality for the patient. Thus : A. B. responds to the first picture in the following manner:

Well, that’s a pupil that has failed. That’s Number 1. Are you writing with your left hand or your right hand? That’s a

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


person that’s been trying to learn a very, very hard lesson that’s utterly beyond because I think violin music reaches the highest-he’s trying to learn and he is very, very-utterly beyond him and he has failed and to fail is very, very bitter- I know. Free stuff: Th i s comes from the Harvard Psychological Clinic. Now that child has failed bitterly-believe me-no look -isn’t he a picture of failure; believe me he is the bitterest picture of failure-because he has been given a violin-which I believe is the voice of God-and it’s Number 1. They told me I had a very delicate ego.

And L. H. responds to the same picture in a somewhat similar fashion.

T h a t looks like my brother and he looks like he’s suffering and he looks like they’ve got the place filled with fluffs. And he’s got a violin and those stringed instruments. Well, he’s stuck (and tears the picture from its background) and he’s deep in thought and he’s got his hands like that and he’s got a boil on his face and he’s got . . . his lips look like they’re breaking up and his hands are so stiff-looks like he’s going to fall apart. He looks like he was set on fire. Well, he’s got-he looks like he’s marked with a decimal point, two colons and semicolona. And there’s a line right down here looks like nicotine-from cigarettes-he’s turning all black. Looks like he eat an awful lot of pencils or cigarettes or something (referring to examiner’s pencils and cigarettes). And well-he’s got a great big white sheet over him. Well, he’s-the picture is framed in white and they’ve got scenes in it. White-black and all different colors.6

T o some patients, the apprehension of sensuous or imaginal material was so real that the patients felt impelled to deny the reality. T h e denials were expressed with much emotion, and, in one instance, with panic. Thus: G. H. in reaction to the tenth picture protested frantically :

‘It may be noted that these two patients, A. B. and L. H., were among the three who attempted to escape from or to alter the range of reaction to the interpersonal situation and also they were in an acutely disturbed state a t the time of the examination. A central theme-failure-is discernible in the manifest content of A. B.’s production ; but as developed in the response is obviously more relevant to the inner disturbances of the patient than to the external realities embodied in the test requirements. A central thqne is likewise dimly perceptible in the manifest content of L. H.’s production: this likewise is obviously prompted by the acute suffering of the patient, and its elaboration is suggested haphazardly, fitfully and irrelevantly by accidental features of the perceived or sensed external realities.

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 253

This is a crazy picture. . . . I don’t know anything about- only there’s a man there-well, it isn’t real-it isn’t real-it isn’t-the picture isn’t real.

B. S. reacted to picture M 13 with:

“A gun - a gun - no - no - no - And S. C., having steadily refused to tell a story for the first three

,>

pictures, reacted to the fourth in the series:

Well, I say the story-the picture wasn’t a logical picture- which I think in-think in this particular case it isn’t-, Now the window is opened-it’s light outside-dark in s ido the re are no shades drawn where it’s opened-there’s no reason why it should be dark’in the room and the man’s figure should be black.

Even the very few attempts to validate the content of the repro- ductions in relation to the pictures were made in terms of the perceptual reality of the imaginal and sensuous material conjured by them. Thus, E. H. gave for picture N 7:

I don’t know unless that it would be a shore and these are all cottages and there’s a lot of boats-I can see that-well-boats at the side-there’s water-there seems to be water down there -1’11 see if I’m right; I’ll look it over; -yes.

T h e apprehension of sensuous and imaginal material as though it was perceptually real is a characteristic of schizophrenic language and thought which has been noted previously in psychological investigations of schizophrenia. Bolles (14, 15), for example, notes that the schizophrenic’s reactions are primarily determined by sensory im- pressions, and Rawlings (28) observes that schizophrenics have a “tendency to deal with the concrete even when the abstract is indicated.” Usually, however, the investigators have been content to relate this characteristic to some primary disturbance, such as inability to generalize, inability to categorize, or inability to assume the abstract attitude. Interpretations such as these are largely a function of the methodology. T h e method of Bolles, for example, called for activity on a perceptual-motor-manipulative level, while that of Rawlings predetermined the patient’s responses in the direction of generalizations, abstractions, and interpretations ; and in all psychological investigations, testing or experimentation has been postponed to the

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


point where the schizophrenic episode has waned. or subsided into a phase of “cooperativeness.”

Only the psychoanalytic investigations relate the perceptual reality of apprehended material to the temporal, conative, and affective exigencies of the interpersonal situation. Reference is made to the perceptual reality of imaginal material by Bleuler ( 1 l ) , Storch (34) and others, but the majority of even these also tends to exploit this characteristic, as illustrated in metaphors, object-representations, et cetera, in terms of the concrete attitude. Thus , Storch comments that “while for the normal person the chief criticism of the world of real objects is their independence of him, the general character of the schizophrenic’s experience is that his mental and imaginary experiences have a substantial and concrete nature . . . the world of reality is viewed as a sort of concrete interpenetration.”

Underlying such interpretations are the assumptions of higher and lower orders of thought and of unitary traits-the concrete attitude subserving the lower orders, the abstract attitude the higher orders, and the former unique for schizophrenic thinking. If this characteristic is related to the established facts regarding thinking in the normal and to the temporal, conative, and emotional exigencies of the interpersonal situation in question, it may be interpreted on the one hand as evidence of consensual validation and on the other, to quote Blitzsten, as a manifestation of attempts to cling to reality or of defense against admission of the unreality of inner experience. Many of the illustrations offered jn support of the uniqueness of the concrete attitude for schizophrenic thinking are reminiscent of those offered in the age-old imaged-imageless thought controversy in the study of thought in the normal; and the haphazard, frantic, oscillating grasping at and clinging to one sensory or ideational straw after another are reminiscent of the normal individual’s attempts a t solution of both perceptual-motor and ideational problems. Consensual validation is but another term for the operational or empirical validation which is characteristic of all types and stages of learning. T h e denotations and connotations of this concept, which applies t o normal thinking also, have been adequately envisioned for psychiatry in the discussions of Schilder, Sullivan, and Herold. W h a t is unique for schizophrenic thinking-as reflected in the perceptual reality of sensuous and imaginal material-is not consensual vali-

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 255

dation, but the failure to integrate the material towards an end of which the individual is “more or less aware”-an end which has been externally imposed by the exigencies of the interpersonal situation, but which is only dimly and faintly apprehended because of the diversion created by the intensity of internal exigencies and the fitful control of consensual validation by transient strivings and affects which are agitating the individual.

Correlative with the perceptual reality of imaginal and perceived material is the orientation of the patient’s responses in the present, which is indicated by the prevalence of the present or present perfect tense, the repetitiousness, the perseverations, and the interminability of the schizophrenic’s verbal productions.

All these aspects, like the perceptual reality of sensuous and imaginal material, may be related to the process of consensual validation and interpreted as evidence of the dimness of awareness of inner and outer realities and of the absence of awareness of the relation of goals that have been prompted by multiple, varied, and paradoxical conative tendencies to goals that have been imposed by the exigencies of the interpersonal situation.

Minkowski (27) and Fischer (20) postulate a disturbance in the time relation as a fundamental one in schizophrenic mental activity and refer to it as a disturbance in the “I - here - now” reIation. T h e “I - here - now” relation is reflective of the schizophrenic’s strivings to maintain contact with the outside world, but these very strivings intensify his waning awareness of the distinctions between himself and external realities and lead to the loss of “world-time,’’ a percep- tion of which is dependent upon awareness of external physical and social changes. Blitzsten in his demonstrations of the mechanisms of schizophrenic amnesias elucidates this prevalent tendency in schizophrenic thinking with reference to, among many determinants, the strivings of the schizophrenic to cling to reality and the dimming of discriminations between subject and object--occasioned and intensified by the very striving to cling to reality which has obscured awareness of differences between past, present, and future. A. Koestler, in Dialogue With Death, portrays the intrinsic importance of “I - here - now” relating in a reality oriented ego :

Condemned to death in a Spanish prison upon a date-month, hour, minute, second-undisclosed to him, and afraid of death,

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


but not of dying, he is fearful lest he lose all knowledge of “world-time”-the last refuge of the integrity of his ego in his solitary cell. Consciously, he attempts to thwart the possibility of any such loss by the employment of a number of devices, many of which he had been unaware of in normal circumstances, and is hurled almost into a panic when one of these devices threatens to fail him. Speculating on the subject of time becomes an obsession and the over-awareness of time brings about its annihilation into an endless, unproductive lethargy of now, now, now withal the over-awareness of time serves as a nos- trum for whiling away the never ending “nows” and forestalls that complete annihilation of consciousness which he anticipates from death. The obsession with time saves him from that fate, which he feels is the “main problem of existence for every pris- oner . . . for everyone who exists in unnatural, confined conditions”-“that the outside world increasingly loses its reality for him; it becomes a dream world in which everything is somehow or other possible.”

Carr (18) stresses that the recall of past experiences and the recombination of these past experiences in novel, pertinent ways-the essential requirement of the technique employed in this study-involves a personal reference; that is, the individual must directly or indirectly apprehend himself as the subject or object of experiences ; he must be directly or indirectly aware of his active or passive participation in the experiences reinvoked from the past by the exigencies of the present environmental situation if the past is to be utilized in adjustment of the present-whether that adjustment be on the perceptual-motor or ideational level.

Without this direct or inferential apprehension of the self as subject or object, the schizophrenic does not distinguish between the past and the present and the future, between the real and the unreal -and thus becomes a prey to the inertia of the past, T h e reinvoked terrors of the past have the same reality as the phantasied terrors of the external environment, and these are just as real to the patient as the distorted reality situation. A tension is created between the possible and the real, which the patient attempts to resolve by clinging desperately and without awareness to the present. Still striving to maintain some contact with the world, the inability to distinguish between the possible and the real renders the schizophrenic a hostage to the phantasied demands of the perceived (senses) and perceptually realized imaginal items in the cognitive field.

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


An illustration of the almost total unawareness of the self in relation to the outer world of persons and objects and to inner experiences and thus of an almost complete interpenetration or fusion of subject and object is afforded in the productions of E. E. which are reported verbatim, but without reference to the evocative pictures, inasmuch as his responses are manifestly irrelevant to the content of the pictures:

“The only things that have a part for me are the things that concern life-health-peace-good will.”

“This, too, has no thought because it conveys human instincts. T h e metaphysicians teach us that-anything that pertains to matter has no part for me.”

“I’m sure that it has no part in my realization. Anything that is part of me-I recognize it immediately and it recognizes me. If I refuse to recognize it then it is not of me.”

“No part.” “Has no part with me. I guess that’s the most psychological thing to say concerning a picture like that.”

A changeless, continuous external world does not form the basis for cognized mental activity. It must be broken up into figure and ground-which aspect of the situation shall become figure, which the background depends on the temporal exigencies of the situation and the kind of adjustment demanded from the individual. T h e maintenance and integration of relevant configurations for the attainment of the required end is achieved through neo-cognition as subserved by conation. Conation of which one is more or less aware makes clear and determinat-r makes figure-those items in the cognitive field which are relevant for the objective or purpose which affects the individual ; it dims and obscures those i tems-or relegates to the background-those items which are not pertinent to the whole scheme of inter-laced relatings. Even in normal individuals the course of the maintenance and integration of the configurations may be disrupted by the irruption of discordant conative tendencies and by the suggestive influence of affectively toned experiences which are associated with the tendencies; and often, even in the normal individual, these discordant tendencies and associated affects may posses sufficient dynamic strength as themselves to become goals.

T h e schizophrenic is able to attain some configurations. These, however, are shifting and unrelated and are not maintained or integrated in accordance with either the externally imposed goals or

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

258 J O U R N A L OF PSYCHOLOGY

with any discernible internally imposed goals.6 Thus, in the part- whole configuratings, the patients.react first to the whole or to the parts of the picture, and thev to the parts or to the whole, but never relate the one to the other. T h e whole response is usually a seemingly pertinent generalization such as : “ Jealousy.” T h e part responses are usualIy enumerations such as: “woman - baby - man - woman” interpolated with many interpretations. If the latter are subtracted from both the whole and the part responses, the residue is a string of unrelated responses, each one in and of itself bearing some vague pertinence to the picture, but the whole as well as the parts viewed as perceptual realities.

T h e partial successes suggest some apprehension of the self as a self and of the self in relation to objects. They likewise indicate some awareness of the goal of the strivings. T h e failure to maintain and integrate the configurations in the direction of externally or internally imposed goals is evidence of a disturbance of the psychological relation-f waning awareness of distinctions between self and object-which has been occasioned by the disruptive influence of irrelevant conative tendencies and associated affects.

Waning awareness of the distinction between self and the outer world as revealed in the interaction of patient and examiner may be inferred further from the following characteristics of the patients’ responses :

1. Cliches, morals, platitudes, judgments, axioms. B. S., for example, reacts to the eighth picture thus:

That’s a good family-takes their time-to think things out- a person should have coiiperation and things like that-takes- should never try to give a person too much-good people-good people. A11 I can say about that-which sp,eaks for itself.

The cliches, morals, judgments, et cetera, may be overtly incon- gruous with the stimulus as in the preceding excerpt. They may constitute reproaches of the examiner, who, according to one patient, as “a psychologist should be above human emotions.” O r they may

“Bolles interprets this aspect of schizophrenic language and thought a s an “inability to shift” or “to categorize.’’ Gatewood attributes the shifts of method to a “lack of thought control,” and attributes the decrements i n schizophrenic performance on mental tests to a “loss of the goal idea.”

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 259

serve as rationalizations of refusals, as in the case of L. L., who insisted that “I wouldn’t talk about a person.”

This type of response has been encountered again and again in the administrating of certain tests of intelligence to schizophrenic patients : viz., the absurdities, the interpretation of fables and the interpretation tests in the Stanford-Binet, and as such assumed to be evidence of “inability to generalize” or “to abstract” or “to categorize.” Such an assumption is a tempting refuge for the experimental psychologist, who has been criticized in an article by Lange, a schizophrenic patient, for his sensory-motor approach to the problem of concept-formation on the grounds that such an approach‘ is not adapted to the psychology of the schizophrenic in whom Lange as- sumes ideational activity to be enhanced rather than weakened. It is a tempting refuge for the experimental psychologist for it frees him of the necessity of tortuous exploration of schizophrenic thinking and enables him to be content with superficial confirmation. Basic to conclusions such as “inability to generalize” are the identification of the mode of representation with the objects of thought and the utilization of the performances of “handfuls” of normals as frames- of-reference for determining the falseness or truth of the generalizations. Underlying such conclusions are also the assumptions that generalization is a unitary trait of cognition, that it attains absolute certainty, and that it occurs without consensual validation. From such assumptions evolve the oppositions of generalization and meta- phor which are so prevalent in both the psychological and psychiatric literature on schizophrenic language and thought. Actually the process of generalization has a complicated genetic history and subserves many mental processes ; generalizations never attain any absolute certainty and even their tentative certainty can be validated only empirically, that is, through consensual validation.

T h e fact that tests such as the interpretation of fables involve in and of themselves awareness and relevant evaluation of an interpersonal situation has been overlooked by the majority of psycholo- gists. Actually the phantasies of many schizophrenic patients fairly seethe with generalizations. All of E. E.’s compositions, for example, are merely a string of generalizations around the theme of Personal Identity-without, however, any attempts to validate the generalizations. T h e tendency to respond with cliches, et cetera, is indicative

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


of the fact that the patient’s evaluations of material external to the ego can be shown to represent in the deeper layers judgments concerning the individual’s own personal experience without, however, any awareness as to the source of the judgments or as to their pertinence to the external realities. I t is not surprising, therefore, to find that morals, platitudes, et cetera, prevail in the productions of those patients who have actually accused themselves of some ego-alien phantasied misdemeanor.

T h e failure of the schizophrenic patient to elaborate upon and vindicate his generalizations when called upon to explain them is assumed to be a further proof of an inability to generalize. Again, cognizance is not taken (a) of the fact that such a request merely serves to increase the resistance, since such a request from the examiner as well as the directions implies a threat; ( b ) of the mil- known fact that even with “normals” efforts to articulate either the process or content of generalizations achieve similar results-a sort of stuttering, stammering inchoate mass of concrete, perceptual detail or a pyramiding of further generalizations; or ( c ) of the dynamic strength of disruptive and irrelevant ideas.

2. Reactions to praise, reassurance, encouragement, repetition of directions, or silence from the examiner.

These have been aimed to encourage maintenance of the patient’s strivings in the direction of the requirements of the situation or even in the direction of the patient’s own dim apprehensions and obscure and weak conations. Rut they do not achieve this end, for they are not related by the patient to the requirements of the interpersonal situation nor to his own dim awareness and obscure strivings that accidentally are in the direction of the requirements, but are determined by the conative tendencies and emotions which have been coincidentally invoked.

To this alteration of the interpersonal situation by the examiner the patient responds with intensified emotional apprehension or intensified half-articulated hostilities or with hostile silences. In the case of intensified emotional apprehensions the patient feels that he must make himself understood, responds with endless amplifications by corrections and re-corrections or by repetitions. This need for explaining himself, for justifying himself, is, according to Berze ( lo ) , “different from the normal need for communication.” Such a need

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


in the normal implies awareness of discrimination between self and non-self, whereas in the schizophrenic, according to Berze ( l o ) , it is indicative of “a constant endeavor to abreact.” In the case of intensified hostilities the patient replies with disparaging remarks such as “Can’t you speak English, either?” or with silences that “kill” or with remarks such as “Let’s lay down our pencils and stop fighting.”

3. Interpenetrations of personal preoccupations. T h e phrase “interpenetrations of preoccupations” applies to any material expressed by the patient which is not manifestly related to any phase of the interpersonal situation. T h e productions of the patients are charac- terized by the presence or absence of interpenetrations or by their appearance in forms so subtle and intangible-often being a natural con- tinuation of a trend pertinent to the situation-as almost to escape identification. They are indications of a tendency on the part of the patient to relate everything to himself or to see himself reflected in everything, and are the results of the patient’s failure to distinguish between his awareness of himself and his awareness of objects in his interaction with the examiner, and of the attendant inability of the patient to place himself in another’s place, and of the attendant distorted or altered conception of himself.

When present, the interpenetrations may constitute the whole of the verbal production or appear intermittently. In the former instance the patient may respond initially to one aspect of the test directions or to the wider interpersonal situation and then continue with some personal preoccupation which has been suggested by either his own initial reaction or by some accidental feature of the picture or of wider interpersonal environment. Such interpenetrations of personal preoccupations are illustrative of the fusion of ego and object which has been described at length by Storch (34). Thus, that interpenetration of self and world in which self is absorbed- the sense of separate psychic entity being lost and the self being felt as a dependent part of the external world-and that in which the world is absorbed into the self, all non-ego material being merely qualities or emanations of the self, are illustrated in the productions of L. H. and E. E.:

L. H., a nineteen-year-old girl, who was tested in an acutely disturbed state, seizes anxiously and with aggressive, apprehensive hos-

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

262 J O U R N A L OF PSYCHOLOGY

tility upon every aspect of the sensory situation-including the examiner’s own handwriting-as reflections of herself, and, by implication, accuses the examiner of having robbed her of these essential components of her personality. L. H. reacts to questions and reassurances with an intensification of anxiety and hostility and a further inclusion of all aspects of the test situation as correlates of herself. E. E. who was tested in a reactivated post-schizophrenic state, insists, pompously and pontifically, that he has no Identity- that he is of the world and the world is of him. H e regards the whole testing situation as imposition, as a derogatory reflection upon his own personally-achieved self-esteem ; his manner is kingly and autocratic-he dismisses the request for a story in a few condescending words; he is amazed that the examiner should make such a request and should not understand his condescending refusal and yet is unamazed, since it is not given to mere earthly mortals “to understand God.” Questions, reassurances, flattery, o r persuasions merely elicit derogatory remarks concerning the examiner’s ability as a psychologist-a word which he has quickly interpolated into his already vast polysyllabic vocabulary. His productions are superficially void of demonstrable active anxiety or hostility; yet, despite the immensity of his expressed self-esteem, he has not the courage to terminate or leave the situation to which he is obviously resistant,

T h e patients who do not interpolate personal preoccupations in their productions are obviously among those who have learned to divest any interaction with persons and objects in the external world of power to evoke anxiety with awareness. Yet, obviously they are under the pressure of great anxiety-their responses to the directions are curt and dismissive; they are eager a t every moment to interrupt the process of being tested with endless tales of their own preoccupations, and as soon as the testing equipment has been removed from their vision, they plunge, without pause and without any prelimin- aries, into the relating of preoccupations, which almost invariably are concerned with some love episode. They are not aware of the fictional character of their tales nor of the fact that they may have been offered in compliance with the directions; withal they are also not yet fully convinced of the truth or reality qf the stories, for they continuously seek some reassurance from the examiner in the form of questions such as “Why?” and “Should I?” and react with sus-

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 263

picion to every form of intervention or non-interference on the part of the examiner.

T h e schizophrenic’s failure to refuse to terminate or to comply explicitly with an obviously uncomfortable situation of his own ac- cord, his lack of curiosity about the test and the examiner in and of themselves or in relation to his hospitalization status and other reality factors, and his implicit alignment of the examiner with all other persons in the wider interpersonal environment are further indications of the waning awareness of distinctions between himself and the world of reality as delineated in his interaction with the examiner. These have been analyzed by implication throughout the various discussions and are reflected in many of the characteristics of the schizophrenic’s verbal productions ; for example, the endlessness of his compositions, the endlessness of his silences, the reactions to praise, reassurance, and persuasion, and the repetitiousness of his compositions.

Evidences of anxiety are made tangible in the interpersonal relations created by the technique of this study and may be identified in many forms in the verbal productions of the patient.

In some instances the responses suggest that an already acute anxiety has been accentuated by the need to adjust to the temporal exigencies of a novel interpersonal relation. T h e directions may constitute a threat, for they require that the patient present as imaginative, fictional, and unreal that which he may be accepting or may be striving to accept as real. Thus, one patient responds with:

4.

“If I tried something like-then I would-it would drive me -drive everybody-everybody-nuts around here”; another reacts with: “Everything else would be imaginative and I don’t feel that it should be required of this sort-later should be used as a story”; and a third replies: “That would be telling a story-that would be imagination-that would be unthinkable.”

They may thus suggest suspicion, incredulity, aggressive interference or retaliation from the examiner i f the patient reveals himself -especially i f he gives full rein to expression of his destructive and devastating hostilities.

T h e directions may suggest a thwarting of the patient’s omni- present and pressing desire to present his version of his psychotic

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


dilemma to one and all. T h e need in this direction is so urgent that the patient may tentatively respond with attempted acquiescence. His dilemma infiltrates these attempted acquiescences. Endlessly and repetitiously he presents his “tale”; over and over again he must assure himself that the examiner has recorded his “intangibles” ac- curately, and again and again he must correct his statements and have them read and re-read back to him-lest he be condemned by a permanent record of his own words. Reassurance, encouragement, praise are of PO avail; they merely suggest more thwarting, suspicion, and aggressive interference-and the process repeats itself apparently interminably and is interrupted only at the behest of the examiner. Assurance by the examiner that he will be permitted to tell his version of the psychotic dilemma at the end of the test may temporarily allay anxiety and hostility, but only momentarily, for the patient is not aware of beginnings and ends of time. T h e assurances and efforts to re-orient the patient with regard to present temporal exigencies constitute additional frustrations. T o these frustrations the patient retaliates with mounting hostilities expressed il- lusively and vaguely in criticisms. T h e examiner is often the focus of the criticisms. She may be accused of being a temptress and of having violated all morals in exposing and forcing the patient into a situation of seduction. This reaction appears almost invariably in the patients in whom paranoid mechanisms predominate, especially in those who are in the throes of a “schizophrenic love episode.” T h e latter, as related at the end of the testing session, when pictures, notebook, and pencil have been removed from view, transcends spa- tial, causal, temporal, and other externally realistic boundaries and is surcharged with affect and perplexity. If the examiner comments upon the discrepancies, the patient’s fear and hostilities and suspicions are again accentuated.

T h e interpersonal situation may suggest a tribunal, before which the patient “must” tell his “story” and thereby be condemned or acquitted. T o this implication patients may respond with cliches, morals, and axioms, and with brief, apparently coherent productions despite the ellipses or gaps. This type of reaction is common in those patients who under the pressure of great anxiety and guilt have “given themselves up” to the police and “confessed to a crime” which had been perpetrated only in phantasy. One cannat discern

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 265

any reflections of this “crime” in the manifest content of the verbal productions. Yet the interpersonal situation seemingly provokes anew the anxiety and guilt and the striving toward “confession” and self- justification.

I n some cases the evidences of anxiety are merely reflections of the residuals of conflicts, fears, and hostilities which can always be reinvoked by the accidentals of any interpersonal situation. Such reactivated residuals are characteristic of the post-schizophrenic states. The implications of the interpersonal situation and the reactions thereto are adumbrated in the foregoing descriptions. Thus :

One patient of Irish nativity enters the room saying, “I have my citizenship papers and I’m not insane.” And each picture evokes some comment about “Yankee” or “American-born child” or , “If there’s anything wrong and I’m causing any trou- ble, I’m willing to suffer for it” or, “Sacred Hear t of Jesus-I pray there won’t be any bad pictures.” Another patient reacts to one picture with: “I don’t think if that’s her baby or not. I’ve always been clean that way-I’ve never had anything to do that way with any of my relatives-with my father or with my brother”; and to another with: “I think that God has given me the graves to take all my enemies and put them where they should have been and that . . .” One patient is hurled into a panic by the picture of a boy with a gun and begs to have the gun removed from’his sight. Another responds with irrelevant cliches, morals, critical and Good Samaritan-like comments such as: “Of course you should never jump to conclusions”; or, “That’s a good family-good people-good people-which speaks for itself”; or “Could be a fellow that investigates the wrong people. That’s a fellow that’s deceiving-very deceiving”; or “Outdoor exercise one everyday should.” And still another heaps epithets upon the examiner, from which may be sur- mised that “a psychologist should be above human emotions” or “should not require such things” of him who “transcends all experience.”

I t may be noted that such responses as the foregoing often have a slight pertinence to the pictures or interpersonal situation, in that the personal preoccupations of which they consist almost exclusively have been suggested by some accidental feature of the pictures, directions, or by the examiner’s explanation of his r81e, and that these accidental features are treated as though they were perceptually real.

These manifestations of reactivated residual anxieties appear in an

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


even more vague, illusive, transitory, fitful, detached, and isolated form than the anxiety evidences described for those patients in a schizophrenic episode. For one patient hostility may be so rampant as not to permit or to obscure expressions of fear and anxiety; for another the fears may be rampant; and for still another the anxiety is free-floating and generally ready to attach itself to any incidental feature of the interpersonal situation that may help in the solution of the patient’s pressing problem such as “who she is” or “where she is” or “if she is” or “what she is.” In all such manifestations, anxieties, hostilities, fears and strivings stand in isolation, unrelated one to the other and unrelated to the interpersonal situation. One thus cannot infer the nature of the frustrations, internal or external, which have engendered them, except in so far as it may be assumed that any novel interpersonal situation for such a patient is a changeless continuum, in which there are no similarities and no differences, and thus for each patient is reminiscent of experienced frustrative situations and revokes anew rigidized expressions of reactions to such situations. Assurances and reassurances have a less penetrative thwarting or mitigating effect upon these patients; for apparently, all interpersonal relations are viewed as actually overt aggressive inter- ferences with the patient’s symptoms and peculiarities, and the present situation and many others are regarded as equivocal.

It is interesting to note that anxieties evoked through contact with the external world are more clearly, even though superficially, delineated in the manifest content of the verbal productions than the anxieties which are stirred into being by the affecis and strivings. T o assume that this clearer delineation is indicative of the greater frequency of such anxieties in schizophrenic mental activity is to assume an artifact. T h e clearer delineation of these anxieties is partly a function of the methodology employed in this study-a methodology which requires some adjustment to a certain quantum of reality-and partly a function of the content and verbally ex- pressable possibilities of the anxieties, affects, and conations. T h e content of these anxieties is the accumulations of immediate and mediate acculturations that in the course of the development of the individual were at least dimly, if not intensely, apprehended and attained some degree of verbal articulation and verbal awareness ; whereas the content of anxieties induced by affect and strivings was

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 267

acquired largely through body sentience and, except through asso- ciation with verbalized awareness, they remain forever beyond the reaches of verbal awareness and of verbalization. Thus, the block- ings, which are indications of the pressure of conflicting and in- congruent tendencies, occur partly also from the fact that these tendencies have attained little of verbal awareness and hence of verbal articulation, and neologisms and metaphorical circumlocutions may not be economically analyzed into their effective components because many of the components in these verbal forms likewise have never attained verbal awareness or verbalization.

It is axiomatic that anxiety restricts awareness. A disturbance in awareness of distinctions between self and object may be inferred from the manner in which the patients react to the interpersonal situation in question. They make no discriminations between it and older or currently concomitant situations and hence cannot help but fail to comply or adjust to its requirements. Likewise, the obvious limitations of their language for the expression of their anxieties, affects, and strivings evolve as much from a failure to integrate it knowingly in the direction of or away from goals of which they are more or less aware, as from the inadequacies of all language for direct expression of any phase, of mental activity-for in the normal and in the neurotic, despite the restrictions imposed by the structure and content of language, the “spirit” always manages to “gnaw through language.”

C. CONCLUSION T h e generation of new cognition or learning is expedited by the

availability of items in the individual’s repertoire of past experiences that may be pertinently integrated with the new schema of relations. In many instances, adjustment to a novel situation may be effected through reproductive cognition-immediately, automatically, and with a minimum of awareness. T h e technique employed in this study, however, demands-for effective adjustment-the recombination and reintegration of pertinent past experiences in a novel way and hence calls for considerable neo-cognition or generation of new cognition. I t permits also of responding with reproductive cognition to an appreciable extent-such as, for example, autobiographical or biographical anecdotes-provided that there is more or less awareness

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


of their pertinence to the situation in question. ’The failure of the schizophrenic to react to the demands of the novel interpersonal situation with the generation of new learning, or the pertinent application of old learning-and the implications of this failure for indications of waning awareness of distinctions between self and object, as well as the r6le of anxiety in restricting awareness-have been discussed throughout. It is obvious then that the content of the verbal productions of the schizophrenic patient is derived almost exclusively from reproductive cognition.

T o the schizophrenic patient the external world is a dread undifferentiated infinitude which fitfully, haphazardly, and accidentally calls forth items from the undifferentiated infinitude of past experiences. Many of these items have been mainly and merely “lived” experiences; this is especially true of those items .that pertain to affect and to intra-and-extra body sentience-items that never possessed the qualities of clearness and determinateness and direct or inferential awareness, which reproductive cognition must possess if it is to serve as a basis for the generation of new cognition.’ Many of the items evoked by the undifferentiated infinitude of external reality have been directly or inferentially apprehended or “known” and may or may not have attained the level of verbal awareness and verbal articulation. All types of items tend with the passage of time to become less and less determinate, and with this lessening of determinateness and clearness tend to become more and more equivalent. I n addition, they become fused with late experiences of both the “lived” and directly or inferentially apprehended types. Thus, experiences from all levels of development tend to merge into an undifferentiated mass in which there are neither similarities nor differences.

Activated by an anxiety which may or may not have been accentuated by the circumstances of the new situation, the schizophrenic is stirred to action. But anxiety restricts awareness of distinctions between the self and objects, and affects and strivings in and of themselves do not provide even a very rough guide to action-they indicate that something must be done but not what is to be done. As in the normal, the schizophrenic applies items from his vast repertoire

‘This observation may be paralleled with Cohen’s observation that kina- esthetic imagery predominated in the hallucinatiohs of the more seriously disintegrated schizophrenic patients.

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

EVA RUTH BALKEN 269

of sensuous, somatic, imaginal, and emotional material. But their application is fitful, hit-or-miss, and ineffectve, for without awareness of distinctions between himself and others and without awareness of the ends necessary to alter the situation which is affecting him- and with time but an endless lethargy, having no past, present or future-his utilization of past experiences, both “lived” and “known,” never attains the qualities necessary for the apprehension and integration of new relations. Consequently, anything of any nature from the dread external infinitude can evoke anything of any nature from the equallly dread, internal, undifferentiated infinitude of items indiscriminately fused from all levels of experience. Schizophrenic experience is thus merely relived “lived” experience.*

T h e widely accepted views-as revealed in a critical analysis of Psychological Researches in Schizophrenic Language and Thought- regarding the basic disturbance in schizophrenia may be revised in line with the many evidences presented. T h e evidences are, perhaps, redundant and overlapping and at the same time involve many omis- sions or reservations and qualifications of interpretation. Nevertheless, in relating these evidences one to the other and to other psychological evidence, as well as to the clinically, empirically estabished facts regarding the peculiarities of schizophrenic language and

‘Fleishaker (21) and others characterize this aspect of the content of schizophrenic thought as reflective of a tendency for schizophrenic thinking to run in preformed language patterns. Such a characterization evolves from an isolated consideration of the interpenetration without reference to their place in the total content and without reference to their rBle in the total configuration of the schizophrenic frame-of-reference. I t permits of analysis of the content of schizophrenic thinking in terms of levels of regression; it does not account for the picture of disorganization and disintegration.

I t is reacting without awareness by means of old “lived” and “known” experiences at different levels of development that produces the picture of mental disorganization and disintegration. Additive factors are the inad!- quacies of language for the expression of both “lived” and “known” experiences-cognitive, affective and conative-and its specific limitations for the expression of condensations of “lived” and “known” experiences, as illustrated in neologisms, metaphorical circumlocutions, e t cetera and for the expression of imagery in all sensoria, especially for the expression of imaginal details with body sentience.

T h e predominance of reproductive cognition in schizophrenic thinking, indicative of an anxiety so great as to annihilate awareness of differences between (‘1’’ and “you,” precludes any attempts a t dynamic and economic reconstruction of the mechanisms of schizophrenic thinking from the content of the verbal productions. I t precludes even more any such reconstruction in terms of levels of regression.

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


thought, it becomes apparent that the basic disturbance in schizophrenia is in the “psychological relation,” or in the awareness of distinctions between subject and object, and not an “inability to categorize” or a “regression to prelogical thinking” or the like. From this may be deduced disturbance in the self, since all “knowing” or- iginates in “the awareness of one’s experiences,” the self being “the custodian of awareness” (Sullivan) and “without the self there is no experience” (Herold). T h e eIaboration of implications of evidences in support of this deduction is reserved for a later report.

1,

2.

3.

4.

5.

6.

7.

8.

9. 10.

11.

12.

13.

14.

15.

16.

REFERENCES AVELING, F. P. T h e Psychology of conation and volition. Brit. J.

BALKEN, E. R. Projective techniques for the study of personality: A

. Psychological researches in schizophrenic language and

. T h e language of poetry, schizophrenic experience, and

BALKEN, E. R., & MASERMAN, J. H. T h e language of phantasy. J. of

BALKEN, E. R., & VANDeR VEER, A. H. T h e clinical application of a test of imagination to neurotic children. Amer. J. Orthopgychiat., 1942, l2,

-. T h e interpersonal dynamics of the testing situation. ( I n

BALKEN, E. R. T h e “psychological relation”: A formulation for the

BERGSON, H. Time and Free Will. (6th ed.) Par is : Alcan, 1908. BERZE, J.

BLEULER, E.

PJychol., 1926, 16, 339-353.

critical appraisal. Psychol. BUN., 1942.

thought. 1. of Psychol., 1943, 16, 153-176.

reality. ( In press.)

Psychol., 1940, 10, 75-86.

68-80.

press.)

investigation of schizophrenic experience. (Unpublished.)

Disturbances in psychic activity. Zschr. f. d. ges. Neurol. u. Psychiat., 1932, 142, 720-773.

Storungen der Associationsspannung ein Elementarsymp- tom der Schizophrenien: Eine Hypothese. Allg. Zschr. f. Psychiai.,

BLITZSTEN, N. L. Psychoanalytic Contributions to the Conception of Disorder Types. Amer. J. Pgychol., 1938, SP, 1430-1438.

-. Lectures and Seminars on Schizophrenia. Northwestern University and the Cook County Psychopathic Hospital, Chicago, Illinois.

BOLLES, M. T h e basis of pertinence: A study of the test performance of aments, dements, and normal children. Arch. of Psychol., 1937, No. 212.

BOLLES, M., & GOLDSTEIN, K. Study of the impairment of “abstract be- havior” in schizophrenic patients. Psychiat. Quart., 1938. U, 42-65.

CAMERON, N. Reasoning, regression, and communication in schizophrenics.

1918, 74, 1-21.

Psychol. Monog., 1938, M), 1-33.

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014


17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

Schizophrenic thinking in a problem-solving situation. J. Ment. Sci., 1939, 88, 1-24.

CARR, H. A. New York: Longmans, Green, 1925.

COHEN, L. M. Imagery and its relation to schizophrenic symptoms. J. Ment. Sci., 1938, 64, 284-347.

FISCHER, F. Conceptions of time and space and disorders of thinking in schizophrenics. Zschr. f . d. ges. Neurol. u. Psychiat., 1930, l24,

FLEISHHAKER, H. Disturbances of speech in schizophrenia. Monetschr.

GATEWOOD, L. C. An experimental study of dementia praecox. Psychol.

HEROLD, C. M. Critical analysis of the elements of psychic functions:

ISRAELI, N. Abnormality, Personality, and Time. Lancaster, Pa.: Sci-

LANCE, J. T h e other side of the ideological aspects of schizophrenia.

MINKOWSKI, E. Bergson's conceptions as applied to psychopathology.

MURRAY, H. A. Techniques for a systematic investigation of fantasy.

RAWLINCS, E. T h e intellectual status of patients with paranoid demen-

Psychology: A Study of Mental Activjty.

241-256.

f . Psychiat. u. Neurol., 1930, 77, 1-37.

Monog., 1909, 11, No. 45. Pp. 87.

P a r t I. Pso. Quarf., 1941, 10, 413-544.

ence Press, 1936.

Psychiatry, 1940, 8, 389-393.

J . N e w . I Ment. Dis., 1926, 69, 553-568.

J . of Psychol., 1937, 3, 115-153.

tia praecox. Arch. Neurol V Psychiat., 1921, 5, 283-295. 29. SCHLLDER, P. T h e psychology of schizophrenia. Pso. Rev., 1939, aS,

380-398. 30.

31.

32.

33.

3 4.

35. 36.

37.

SCHNEIDER, A.

SCHNEIDER, C.

Disorders of speech in schizophrenia. Zschr. f . d. ges. NPurol. u. PJychiat., 1927, 108,'491-524.

On the differences of schizophrenic speech and aphasia and on the theory of schizophrenic speech disturbances. ZJchr. f. d. ges. Neurol. u. Psychiat., 1925, 96, 251-274.

. On the general theory of schizophrenic symptom. Zschr. f . d. ges. Neurol. u. Psychiat., 1925, 96, 576-202.

SPEARMAN, C. T h e Nature of Intelligence and the Principles of Cognition. London: Macmillan, 1923.

STORCH, A. T h e primitive archaic forms of inner experiences and thought in schizophrenia. Nerv . I Ment. Dis . Monog., 1924, No. 36.

-, Conceptions of modern psychiatry. Psychiatry, 1940, 3, 1-117. WHITE, W. A. Language of schizophrenia. Arch. Neurol. I Psychiat.,

W Y A ~ ; H. G. T h e Psychology of Intelligence and Will. New York: 1926, 16, 395-413.

Harcourt, Brace, 1931.

T h e Uniaersity of Chicago Clinics 950 East 59 Stree t Chicago, Illinois

Dow

nloa

ded

by [

Uni

vers

ity o

f L

eeds

] at

06:

27 2

8 N

ovem

ber

2014

a delineation of schizophrenic language and thought in a test of imagination

Documents