Br. J. soc. clin. Psychol. (1g75),14,pp. 279-290 Printed in Great Brituin
Some Characteristics of Schizophrenics and Their Parents B Y D A V I D A. W I N T E R * Department of Clinical and Educational Psychology, University of Newcastle upon Tyne This study was dcsigned to test four hypotheses: (a)parents of schizophrenics constitute a discrete group amongst thc parents of psychiatric patients with regard to aspects of thcir construing; (b) schizophrenics can bc differentiated from other psychiatric patients by aspects of their construing; (c) thc construing of parents of psychiatric paticnts is rclated to that of their disturbcd childrcn; and ( d ) parents of schizophrenics differ from parents of other psychiatric patients in their personality and attitudes. An expcrimental group of parents of acute schizophrenics and a control group of parents of acute non-schizophrenic psychiatric patients were given a battery of psychological tests, and their hospitalized children completed a shortened battery. There was some confirmation of each hypothesis. Both experimental groups structured supplied, but not their own personal, constructs more abnormally than the corresponding control groups, and showed more deviant sexual identification, though this latter was a function of social class. T h e parents’ structuring of supplied constructs was related to that of their children. Thcre werc also some differences in pcrsonality between thc groups of parents.
The importance of environmental factors in the aetiology of schizophrenia is still in question, but many workers have implicated the schizophrenic’s family as a hotbed of schizogenic environmental influences, Lidz stating that he has ‘seen results of research conducted in many parts of the world, and one thing is clear: there has never been a schizophrenic who came from a stable family - at least we can’t find any’ (Orrill & Boyers, 1972). Family research has, however, tended to be rather poorly designed, in many cases allowing considerable opportunities for the operation of bias, and causal relationships between abnormalities of parents and of their children have been postulated solely on thc basis of ex post facto ‘ crosssectional’ studies. While such studies, with appropriate control groups, are necessary for thc identification of any abnormal characteristics which rcnder the parents of schizophrenics different in kind from parents of other psychiatric patients, and which could not therefore be explained as reactive to the hospitalization of thcir children, research of this type, such as the present study, should be considered as merely descriptive and as suggesting relevant variables, thc causal relationships of which may be examined in subsequent longitudinal studies. Imputations of schizophrenogenic pcrsonality to the parents, particularly the mothers, of schizophrenics abound in the literature (c.g. Arieti, 1959; Lidz et al., 1958a, b), but most of the conclusions on parental personality and attitudes have been reached on the basis of unstandardizcd interviews. Some of the more objectivc work has been carried out on the cognitive styles of such parents, disordered thinking and conceptualization having been demonstrated in thcir responses to object-sorting and other tests (e.g. McConaghy, 1959; Rosman et al., 1964; Phillips
*
Now at Department of Psychology, Claybury Hospital, Woodford Bridge. Essex. 279 S C P 14
19
280
D A V I DA. W I N T E R
et al., 1965; Singer & Wynne, 1965). Lidz (1968) states that parents of schizophrenics tend to show blurring of socially shared, predictive conceptual categories, and vagueness of conceptual boundaries is exemplified in the uncertainty of age, sex and self-non-self distinctions implicit in his descriptions of parental behaviour, such as projection of parental needs on to, or competition with, the child. He feels that the child learns his parents’ systems of categorization but that, whereas in normal families the mother’s construing gives the child the ‘basis of his own’, which he then proceeds to elaborate (Salmon, 1970), the symbiotic nature of the relationship between the schizophrenic and his mother inhibits any such elaboration, so that the child clings to the confusing parental style of categorization. The schizophrenic therefore receives ‘a faulty grounding in the culture’s way of thinking’. From the viewpoint of personal construct theory (Kelly, 1955), such blurring of conceptual categories could be considered a manifestation of a loosely organized system of conventional, socially shared constructs, such as Bannister (1960, 1962, 1963, 1965) maintains is a characteristic of thought-disordered schizophrenics, generated by the style of construing used by their parents. Romney (1969), however, found the relatives of schizophrenics to perform no more abnormally on the Bannister-Fransella Grid Test than those of neurotics and normals when the effects of intelligence were partialled out, but his study can be criticized for its inclusion of siblings, and of parents as old as 85 years (with the attendant possibility of contaminating organic influences) in the groups of relatives as differences between the groups might thus have been obscured. Cooper (1969) could not differentiate between hospitalized schizophrenics and their relatives by means of their scores on the Bannister-Fransella Test; and Muntz & Power (1970) found significantly more parents of thought-disordered schizophrenics than parents of nonthought-disordered patients to be identified as thought-disordered by this test. Liebowitz (1970)has also employed repertory grid techniques with parents of schizophrenics, finding their personal construct systems to be as differentiated as those of normal subjects but that they were unable to make such complex use of the socially shared dimensions of the semantic differential. Using semantic methods, he found self-other discrimination to be lower for the parents of schizophrenics than for normal subjects, and that these parents tended to disagree on their son’s similarity to his father and mother. The present study is primarily concerned with aspects of construing considered pertinent to the assertions of Lidz and others, and is designed to test the general hypotheses that: ( a ) the parents of schizophrenics constitute a discrete group amongst the parents of psychiatric patients with regard to their self-concepts, their conceptions of the disturbed child and their organization of socially shared constructs; (b) schizophrenics can be differentiated from other psychiatric patients on the basis of their self-concepts and their organization of socially shared constructs; (c) the construing of parents of psychiatric patients is related to that of their disturbed children. An additional hypothesis is that ( d )the parents of schizophrenics differ from the parents of other psychiatric patients in their personality and attitudes.
Schizophrenics and Their Parents
28 I
METHOD
A battery of psychological tests was administered to the experimental group of parents of clinically diagnosed schizophrenics and to a control group of parents of hospitalized, non-schizophrenic psychiatric patients, and a shortened battery to their hospitalized children. Subjects Experimental population. (i) The parent sample consisted of 20 parents of schizophrenics. They were all under 65 years of agc, and none were intellectually subnormal or showing overt organic impairment. (ii) The patient sample consisted of 14admissions to psychiatric hospitals who were unequivocally diagnosed as schizophrenic. Their age range was from 19 to 33 years. None were intellectually subnormal or had received E C T in the week prior to testing. All were in the acute phase of their disturbance, so as to minimize the likelihood of contaminating effects of institutionalization. Control population. (i) The parent sample Consisted of 20 parents of non-schizophrenic psychiatric patients. They were all under 65 years of age, and none were intellectually subnormal or showing overt organic impairment. (ii) The patient sample consisted of 14 admissions to psychiatric hospitals who were dcfinitely neither schizophrenic nor organically impaired. Their age range was from 17 to 32 years. None were intellectually subnormal or had received E C T in the wcek prior to testing. All were in the acute phase of their disturbance. One of these patients was not available for testing. T h e corresponding experimental and control samples were matched with regard to age and sex. Table I presents symptomatic descriptions of the patients, based on their most recent psychiatric diagnoses, and includes all the diagnostic categories employed in the latter. Procedure
The parents completed the Mill Hill Vocabulary Scale, a rcpertory grid using elicited constructs and elements, the Bannister-Fransella Grid Test of Schizophrenic Thought Disorder (Bannister & Fransella, 1967), the Eysenck PEN inventory (Eysenck & Eysenck, 197z), and the Hostility and Direction of Hostility Questionnaire (Caine et al., 1967), while the patients completed the first three tests in the battery. Tests were selected as being pertinent to supposed characteristics of the parents of schizophrenics. Tests Elicited constructlelicited element grid. The repertory grid used with the patients included as elements people known to the patient and fitting certain role titles: mother, father, siblings, a man and woman he likes, a man and woman he dislikes, a person he admires, a person in a position of authority, close relatives, and self, ideal self, and social self, these totalling 15. Ten constructs were elicited from each patient using Kelly’s minimum context form of elicitation (Kelly, 1955, vol. I , p. 222) and each element was rated with regard to each construct. The procedure was the same for the parents, except that elements included the patient premorbid and post-onset, and his siblings, these taking the place of the ‘close relative ’ elements of the patients’ grids. Various measures were derived from this grid: Intensity. No differcnce was expected between the patient groups nor between the parent groups in elicited grid Intensity, reflecting the structure of their personal construct systems, as it was hypothesized that any structural abnormalities of construing shown by the schizophrenics and their parents would be circumscribed to their use of socially shared constructs. Intensity scores of parents and their children were expected to be correlated. Sexual identification. The measure of sexual identification used was the difference between the self-same-sex parent clement correlation and self-opposite-sex parent correlation (after conversion to z scores). Confusion of sexual indentification has been thought to characterize families of schizophrenics, and so the schizophrenics and their parents were expected to obtain lower scores than control subjects on this measure ; and scores of parents and their children were expected to be positively Correlated. 19-2
282
D A V I DA. WINTER #
#
#
#
1
#
#
#
#
x #
#
#
x #
#
*
I
Schizophrenics and Their Parents
283
Self-ideal correlation. Evidence on differences in self-regard between psychiatric patients is conflicting (e.g. Wylie, 1971; Geertsma & Reivich, 1972) but it was expected that, with their supposed lack of insight into their condition (or unwillingness to accept the imposition of a psychiatric construction on their experiences), schizophrenics would show a higher self-ideal correlation than would the other patients. A corresponding difference was expected bctwecn the two groups of parents, family workers having tended to emphasize denial of problems by the parents of schizophrenics. Self-patient correlations. Such unconscious processes as projection of parents1 needs on to the child have been thought to operate in schizogenic families, with Lidz regarding projection as a manifestation of the parent’s faulty ego boundaries and of a basic impairment of categorization. Ryle & Breen (1972) argue the value of formulating projective mechanisms in the terms of personal construct theory and examining them by repertory grid measures, and it was thought that projection as described by Lidz could be similarly examined in the present study, particularly in view of the similarities between his framework and that of construct theory. It was expected that parental projcction on to the schizophrenic child might bc reflected in high correlations between ‘ self’ and ‘ patient’ elements in the parents’ grids and that these correlations would therefore be higher for the experimental than for the control parents. Bannister-Fransella Grid Test. This test measures the degree and stability of a person’s structuring of supplied constructs when applying these to people and has been developed as a diagnostic instrument for schizophrenic thought disorder, its Intensity and Consistency measures differentiating thought disordered schizophrenics from the non-thought disordered
Table
2.
Normative data for the Bannister-Framella Grid Test Intensity
Consistency r - - - - - v
Normals (12 = 30) Thought-disordered schizophrenics (n = 30) Non-thought-disordered schizophrenics (n = 30) Depressives (TI = 30) Neurotics (n = 2 0 ) Organics ( n = 20)
Mean
S.D.
Mean
1253
339 369
0.80
728
0.18
0.34 0.39
I 183
390
0‘73
0.34
1115
456 517 524
0.75 0.74 0.73
0.41 0.45 0.47
I383 933
S.D.
Below cut-off points of Intensity 1000 and Consistency 0.49 lie 80 per cent of the thoughtdisordercd schizophrenics and 6.4 pcr cent of the other groups, excluding organics. schizophrenics, other psychiatric patients and normal subjects in its standardization samples, normative data from which are presented in Table 2. The schizophrenics in the present study, although not all were clinically thought disordered, were therefore expected to obtain lower Intensity and Consistency scores than the control patients. Corresponding differences were expected between the groups of parents, and the scores of parents and their children were expected to be positively correlated. Eysenck PENI. Eysenck’s threc orthogonal factors of P, E and N take up a considerable amount of the variance in personality measurement and so the PENI would be expectcd to detect any differences in personality between the parent groups. The expected difference can only be clearly predicted with regard to the P factor, the Eysencks’ (1972) description of the high P scorer resembling descriptions of schizophrenogenic parents in more than its profusion of attributes. fIDEfQ.This test, norms for which arc presented in Table 3, measures various components of hostility. High levels of hostility have been ascribed to the parents of schizophrenics, with the more extrapunitive elements, such as paranoid hostility, emphasized in family studies ( c . g . Alanen, 1958; Lidz et al., 19586). Corresponding differences between the two groups of parents were expected in the present study.
284
D A V I DA. W I N T E R Table 3 . Mean scores of 47 normal subjects in the standardized sample for the HDHQ Hostility Direction Acting-out hostility Criticism of others Paranoid hostility Self-criticism Guilt
Mean
S.D.
13.0
6.2 4’6
0.5
3.6 3’7
2’0
0.8
2.3 I .o
3’7
2‘1
1’2
1’3
RESULTS
These will be considered in relation to the four hypotheses. ( a ) Table 4 summarizes the results obtained with the parents. The parents of schizophrenics obtained significantly lower Bannister-Fransella Intensity scores and lower Consistency scores than the control parents, but the latter difference did not reach statistical significance. They also obtained significantly lower sexual identification scores than the control parents but did not differ in self-regard or in elicited grid Intensity and, though they tended to see fewer similarities between their children and themselves, this difference was not statistically significant. ( b ) Table 5 summarizes the results obtained with the patients. The groups were significantly differentiated by the Consistency measure from the BannisterFransella test, with the schizophrenics obtaining lower scores, but not by the Intensity measure, although the schizophrenics did obtain rather low scores. There was no difference between the groups in their elicited grid Intensity scores but the control patients showed significantly greater self-ideal discrepancy than the schizophrenics and obtained somewhat, but not significantly, higher sexual identification scores. (c) Table 6 gives the product-moment correlation coefficients between the scores of each group of patients and those of their parents (including both parents of some of the patients). Significant positive correlations were obtained between the verbal IQ, Bannister-Fransella Intensity, and sexual identification scores of schizophrenics and of their parents. Such correlations were also found between the scores of control patients and their parents on the Intensity measures from both grids. Allowance for the correlation in verbal I Q did not significantly affect the correlations in Intensity in either group of subjects. x scores from tests of the difference between the correlations in the two groups are also presented, the only significant difference being that the correlation in elicited grid Intensity scores was lower in the ‘schizophrenic’ group. Fisher’s exact probability tests, one of which is presented in Table 7, provided no evidence that parents of patients identified as thought-disordered schizophrenics by the Bannister-Fransella test nor of patients clinically diagnosed as such tended to be similarly identified by the grid test. ( d ) The parents of schizophrenics obtained significantly higher Extraversion scores and somewhat higher Psychoticism and Lie scores on the PEN1 than the
285
Schizophrenics and Their Parents
control parents. No attempt was made to use the Lie scale in its usual 'suppressor' function as Eysenck has yet to provide a cut-off point for the scale above which answers to the inventory can be considered invalid: allowing for the relationships between L and the other PENI measures would in any case (as can be seen from Table 4.Comparison of mean scores of parent groups Parents of schizop hrcnics
r
Agc Verbal IQ Social class 'Elicited grid: Intensity* Scxual identification *Self-Ideal correlation *Self-Pt. premorbid cor. *Self-Pt. post-onset cor. *Ideal-Pt. preni. cor. *Ideal-Pt. post-onset cor. B-F test: Intensity" Consistency* PENI : Psychoticism Extraversion Ncuroticism Lie score HDHQ : I Iostility Direction of hostility Intropunitive hostility Extrapunitive hostility Criticism of others Acting-out hostility Paranoid host i 1i ty Guilt Self-criticism
Mean
s.11.
55'80 96.45 3.20
6-25
0'57 186.13 268.10 250.10 228.35 278. I 5 225'50
0.58 168.80 2.70 12'20
6.75 7.60 16.50 0.40 6.15 10.35 5.20 3.65 1.50 1.55 4.60
*
k
S.D.
t
D.P.
P
tailed
54'75 103'45
6.63 10.03 0.81 0.13 52'37 66.20 51.18 57'79 64'27 86.02
0.52
38 38 38 38
0.6 I
2
0.008
I
28
38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38
0.53 234' I3 270'75 265.00 248.00 266.00 2 I 8.70
0.16 46.80
I 83.00
4'73 0.32 2.41 4.22 2.63 1.50 1.19 1.15 I98
two-
y
Mean
7'04 0.70 0.19 65.10 49.56 53'97 45.10 55'34 62.91
1'59 3'93 4'13 3.68
One- or
Control parents
--+
2.85
0'74 I '90 9'05 7.60 6.35 16.35 2.80 7'05 9'25 4'30 3'65 I '30
2'00
5'05
0'20
44'49 1.52 4'40 4'50 1-76 6.50 8.32 4'44 4'03 2'11
2.55 I .46 0.76 2'23 0.14 0.90 1'20
0.64 0.29 2.65 0.98 I .63 2'39 0.62
1'37 0.08 I '03 0.80
0.84
I .46
1'20 0'00
1'22
0.52
1.41 3'46
1'11
0.50
0.08
I
0.45
2
0'02
I
0'45 0.19 0.24
I
2
0.52
2
0.39
I
0.006 0.17 0.06
I
0'02
2
0'54 0.09
2
I
I I
I
0'47 0.16
I
0'22
I
0.20
I
0'12
I
0.50
I
0.30 0.14 0.3 I
I
I
I
I
Transformcd to normal distribution.
Table 5. Comparison of mean scores of patient groups Schizophrenics
Age Verbal IQ U-F test: Intensity* Consistency" Elicitcd Grid: Intensity Self-idcal correlation* Sexual idcntification
Mean
S.D.
25.36 100.77 0.59 153.14
4.29 14.20 0.24 43.60 0.16 60.13 54.18
0.52
144.93 84.67
*
Control patients S.D.
t
D.F.
P
One- or twotailcd
4.88 10.23 0.17 30.97 0.13 70'37 56.35
0.20
25
0.84
2
0.16
24
0.44
I
0.82
25
0'21
I
1.67 0.76 1'73 1.56
25
0.05
I
25
0.46
2
25 23
0.05
I
0.07
I
* Mean 25.00
101.54 0.66 177'69 0.56 101.38 119.15
Transformcd to normal distribution.
DAVIDA. W I N T E R
286
inspection of the correlations) serve to increase the obtained differences between the groups. There was no difference in total Hostility between the groups of parents, and the tendency for the parents of schizophrenics to obtain higher scores on the extrapunitive, and lower on the intropunitive, components of hostility did not reach statistical significance. Table 6. Correlations between scores of patients and those of their parents Schizophrenic group r Verbal IQ 0'470 B-F test: Intensity 0.554 Consistency 0.148 Elicited grid: Intensity -0.355 Self-ideal cor-0.043 relation Sexual identifica0.430 tion
*
Control group
Diflerence between correlations: Z scores
n
P
r
n
I8
0.03"
0.293
I9
0.2"
0.59
20
0.01~
0.3"
0.648 -0.335
19 19
O.OI*
20
0'45 1'45
20 20
o.zt o.9t
0.541 -0.071
19 19
0.041 0.81.
2.82 0.32
20
0.03"
-0.112
19
0.4"
1.64
t
One-tailcd.
P
0.1"
Two-tailcd.
Table 7. Fisher's probability test of correspondence between Bannister-Fransella test diagnoses of patients and of their parents Patient A
I Thoughtdisordered Parent Non-thoughtdisordered
Thoughtdisordered
Non-thoughtdisordered
2
I0
6
21
8
31
I2
39
P = 0.32.
T h e parents of schizophrenics were of lower verbal IQ and social class than the control parents but correlations between the variables and, where appropriate, analyses of covariance, presented in Tables 8 and 9 respectively, showed that these differences were responsible for neither the difference in Bannister-Fransella Intensity nor that in PEN1 scores. T h e difference in sexual identification between the parent groups was shown, however, to be a function of their difference in social class. DISCUSSION
T h e parents of schizophrenics, as predicted, structured the supplied constructs of the Bannister-Fransella test more loosely than did the control parents, obtaining lower Intensity scores, and more loosely than the normal subjects of the standard-
287
Schizophrenics and Their Parents
ization sample for the test. This result is contrary to Romney's (1969) finding of no significant difference: he also used a Newcastle population, so that an explanat'ion of the conflicting results on the basis of differing diagnostic fashions can be discounted, but his research is subject to the criticisms mentioned above. The difference between the Bannister-Fransella Intensity scores of the groups of parents was obtained, despite the facts that only half the schizophrenic subjects were Table 8. Correlations between parents' test scores and IQ and social class Verbal IQ Class I-ID HQ: Hostility Dircction of hostility Intropunitive hostility Extrapunitivc hostility Acting-out hostility Criticism of others Paranoid hostility Self-criticism Guilt PEN1 : Psychoticism Extraversion Neuroticism Lie scale €3-F test: Intensity Consistency Elicited grid : Intensity Scxual identification Self-regard
Social class
- 0.44 - 0'22
0.05
- 0'22
0.04 - 0.09 -0.16
-0.14 0.19 0.08
-0.31
0'20
- 0.23
0.16
0'01
-0.14
-0.13 0.04
- 0.07
-0.14 0.04
0'20 0'2 I
-0.17 0.18
- 0.03 -0.21
0.15
0.06 0'1 I
0.08
- 0'02
- 0.40 0.14
0.28
Scatterplots suggested that it was permissiblc to combine the scores of both groups of parents in computing these coefficients.
Table 9. Analyses of covariance Source of variance
Adjusted sum of squares
Degrees of freedom
Mean square variance
( a ) For social class and Bannister-Fransclla Intensity scores of parents 1.018 37 0.028 Within groups 0'121 I 0'121 Betwccn groups Total
1.139
F = 4.4
t =
2'1
38 P =
0.05
( b ) For social class and sexual identification scores of parents 16.30 27 0.604 Within groups Between groups 0'1 I I 0'1I 0 Total 16.41 28 F = 0.18 t = 0.42 P = 0.7
288
D A V I DA. W I N T E R
clinically thought-disordered, and that the schizophrenic group was not significantly differentiated from the non-schizophrenic patients by this Intensity measure. T h e patient groups, but not the parent groups, were differentiated as expected by their scores on the Bannister-Fransella Consistency measure and so, contrary to predictions, the groups of patients and their respective parent groups differed on different measures from this grid test. Neither the two groups of parents nor the two groups of patients were differentiated by simple structural features of their personal construct systems, as reflected in the elicited grid Intensity measure, this result being in agreement with previous findings and with the view that organizational processes and features, such as those thought to characterize thought disordered schizophrenics, need not have a uniform distribution throughout an individual’s construct system (Winter, 1971). Little support was provided for the hypotheses regarding differences between the parent groups in the content of their personal construing and any interpretation of the only significant difference between the groups, that in sexual identification, as being a simple function of the difference in the psychiatric conditions of their children was nullified when the lower social class composition of the sample of parents of schizophrenics was taken into account. Contrary to expectations, and to hypotheses of parental projection in the families of schizophrenics (if the measures used can be assumed to relate to projection) the parents of schizophrenics saw no more similarity between themselves and their children than did the control parents : a similar unexpected finding emerged in Liebowitz’s investigation. T h e differences between the groups of patients on the ‘ content of construing’ measures were as expected, the schizophrenics showing higher self-regard and more deviant sexual identification than the control patients. No social class ratings were made on the patients, who were mostly unemployed and living with their parents, but the latter finding might, as with the parents, have been a function of the lower class of the schizophrenic patients. T h e Bannister-Fransella Intensity scores of patients in both groups were, as hypothesized, positively correlated with those of their parents, and to a greater extent than could be explained on the basis of the relationship between Intensity and verbal IQ. This result is consistent with the view that children learn their mode of general organization of conventional constructs from their parents. However, while the scores of the control patients and their parents on the elicited grid Intensity measure were positively correlated, the correlation found with the schizophrenics and their parents was significantly lower and negative and it may be that the schizophrenics tended to react against their parents’ style of personal construing. T h e positive correlation between the sexual identification scores of the schizophrenics and their parents may be interpreted as a result of their common relationship with social class, although, if the primary mediator of social class influences is the family, such an interpretation is not incompatible with one of the child learning its sexual identification from its parental models. Confused sexual identification may be one of the ‘family patterns of the lower classes. . .broadly conducive to schizophrenic personality development ’ (Kohn, 1968). Turning now to the questionnaire results, although the groups of parents
Schizophrenics and Their Parents 289 did not differ in Neuroticism, they were differentiated by Eysenck’s two other major personality dimensions. However, comparison of the scores obtained with the norms suggests that these differences were largely due to the abnormality of the control parents rather than to that of the parents of schizophrenics, although parental personality change could be considered a normal reaction to the psychological disturbance of the child. The direction of the difference in Extraversion provides evidence against the still widely held assumption of a genetic relationship between schizophrenia and introversion and, the control group of patients being mostly neurotics, the lack of a difference in Neuroticism between the parent groups provides evidence against the heritability of a Neuroticism factor orthogonal to Psychoticism. Although there was no difference in total Hostility between the groups, both were rather more hostile than normal, suggesting that parental hostility might be a general response to the child’s disturbance and its attendant problems. As expected, any such reaction tended to be largely intropunitive in the control parents and extrapunitive in the parents of the schizophrenics. Some support is therefore provided for each of the four general hypotheses, but any causal interpretations of the results obtained are inevitably speculative as significant differences and correlations provide no definitive implications regarding causation without further study. More marked differences might have been obtained had the samples been less heterogeneous, with, for example, the experimental group of patients limited to thought-disordered schizophrenics, but this was not possible due to the practical difficulties presented by a family study. The BannisterFransella Grid ‘rest and Eysenck PEN Inventory, having revealed significant differences between the parent groups in the present study, could be useful instruments in future longitudinal research, but it is perhaps more profitable and less artificial to consider the psychiatric patient’s family as a dynamic unit with its own conceptual and fantasy systems than to study the characteristics of particular family members in isolation. It would seem from the present study that the schizophrenic’s family is characterized by an atmosphere of difficulties in the socially shared ways of construing. I wish to express particular thanks to Dr Roger F. Garsidc for his assistance and advice, and to Brian Wijesinghe for his comments on the manuscript. I am also indebted to thc patients and parents who gave up their time to make this research possible. REFERENCES ALANEN, Y. 0. (1958). The mothers of schizophrenic patients. Acta psychiut. nerirol. scund. 33, Suppl. 124. ARIETI,S. (1959). Schizophrenia: the manifest symptomatology, the psychodynamic and formal mechanisms. In S. Arieti (cd.), American Handbook of Psychiatry, vol. I . Ncw York: Basic Books. BANNISTER, D. (1960). Conceptual structure in thought-disordered schizophrenics. J . ment. Sci. 106, 1230-1249. BANNISTER, D. (1962). The nature and measurcrnent of schizophrcnic thought disorder. J. ment. Sci. 108, 825-842. BANNISTER, D. (1963). The genesis of schizophrenic thought disordcr : a scrial invalidation hypothesis. Br. J . Psychiut. 109, 680-686.
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BANNISTER, D. (1965). The genesis of schizophrenic thought disorder: retest of thc serial invalidation hypothesis. Br. J. Psychiat. 111, 377-382. BANNISTER, D. & FRANSELLA, F. (1967). A Grid Test of Schizophrenic Thought Disorder: a Standard Clinical Test. Barnstaple : Psychological Test Publications. CAINE,T. M., FOULDS, G. A. & HOPE,K. (1967). Manual of the Hostility and Direction of Hostility Questionnaire. London : University of London Prcss. COOPER,J. R. (1969). A factor-analytic study of the Grid Test of Schizophrenic Thought Disorder. (Unpublished Dip. Clin. Psychol. dissertation, University of Newcastle.) EYSENCK, S. B. G. & EYSENCK, I-I. J. (1972). The questionnaire measurement of psychoticism. Psychol. M e d . 2, 50-55. GEERTSMA, R. 13. & REIVICH,R. S. (1972). A configurational analysis of self-cognition in psychiatric in-patients. J. nerv. ment. Dis. 155,303-310. KELLY,G. A. (1955). The Psychology of Personal Constructs. New York: Norton. KOHN,M. L. (1968.) Social class and schizophrenia: a critical revicw. In D. Rosenthal & S. S. Kety (cds.), The Transmission of Schizophrenia. Oxford: Pergamon Press. LIDZ,T. (1968). The family, language, and the transmission of schizophrenia. In D. Roscnthal & S. S. Kety (cds.), The Transmission of Schizophrenia. Oxford: I’ergamon Press. LIDZ,T., CORNELISON, A. & TERRY, D. ( 1 9 5 8 ~ )The . intrafamilial environment of the schizophrenic patient. IV. Parental personalities and family interaction. A m . J. Orthopsychiat. 28,764-776. LIDZ,T., CORNELISON, A., TERRY, D. & FLECK, S. (19586). Intrafamilial environment of the schizophrenic patient. VI. The transmission of irrationality. Archs Nezirol. Psychiat. 79,305-316. LIEBOWITZ, G. D. (1970). Conceptual systems in schizogcnic families. (Unpublished Ph.D. thesis, University of Rochester.) MCCONAGHY, N. (1959). The use of an object sorting test in elucidating the hereditary factor in schizophrenia. J. Neurol. Neurosurg. Psychiat. 22, 243-246. M u m z , H. J. & P o r n , R. (1970). Thought disorder in the parents of thought-disordered schizophrcnics. Br. J. Psychiat. 117, 7 0 7 7 0 8 . ORRILL,R. & BOYERS, R. (1972). Schizophrenia, R. D. Laing and the contemporary treatment of psychosis: an interview with D r Theodore Lidz. In R. Boyers & R. Orrill (eds.), Laing and Anti-Psychiatry. Harmondsworth : Penguin Books. PHILLIPS,J. E., JACOBSON, N. & TURNER, W. J. (1965). Conceptual thinking in schizophrenics and their relatives. Br. J. Psychiat. 111, 823-839. ROMNEY, D. (1969). Psychometrically assessed thought disorder in schizophrenic and control patients and in their parents and siblings. Br. J. Psychiat. 115, 999-1002. ROSMAN, B., WILD, C., RICCI,J. & LIDZ,T. (1964). Thought disorders in the parents of schizophrenic patients: a further study utilizing the Object Sorting Test. J . psychiat. Res. 2,211-221.
RYLE,A. & BREEN,D. (1972). Some differcnces in the pcrsonal constructs of neurotic and normal subjects. Br. J. Psychiat. 120,483-489. SALMON, P. (1970). A psychology of personal growth. In D. Bannister (ed.), Perspectiwes in Personal Construct Theory. London : Academic Press. SINGER, M. T. & WYNNE,L. C. (1965). Thought disorder and family relations of schizophrenics. IV. Results and implications. A r c h gen. Psychiat. 12,201-212. WINTER,D. A. (1971). The meaningfulness of pcrsonal and supplied constructs to chronic schizophrenics and normals. (Unpublished B.Sc. dissertation, University of Durham.) WYLIE,R. (1971). The Serf Concept. Lincoln: University of Nebraska Press.
Manuscript received
12
Revised manuscript received
April 1974 20
October I 974
Some Characteristics of Schizophrenics and Their Parents B Y D A V I D A. W I N T E R * Department of Clinical and Educational Psychology, University of Newcastle upon Tyne This study was dcsigned to test four hypotheses: (a)parents of schizophrenics constitute a discrete group amongst thc parents of psychiatric patients with regard to aspects of thcir construing; (b) schizophrenics can bc differentiated from other psychiatric patients by aspects of their construing; (c) thc construing of parents of psychiatric paticnts is rclated to that of their disturbcd childrcn; and ( d ) parents of schizophrenics differ from parents of other psychiatric patients in their personality and attitudes. An expcrimental group of parents of acute schizophrenics and a control group of parents of acute non-schizophrenic psychiatric patients were given a battery of psychological tests, and their hospitalized children completed a shortened battery. There was some confirmation of each hypothesis. Both experimental groups structured supplied, but not their own personal, constructs more abnormally than the corresponding control groups, and showed more deviant sexual identification, though this latter was a function of social class. T h e parents’ structuring of supplied constructs was related to that of their children. Thcre werc also some differences in pcrsonality between thc groups of parents.
The importance of environmental factors in the aetiology of schizophrenia is still in question, but many workers have implicated the schizophrenic’s family as a hotbed of schizogenic environmental influences, Lidz stating that he has ‘seen results of research conducted in many parts of the world, and one thing is clear: there has never been a schizophrenic who came from a stable family - at least we can’t find any’ (Orrill & Boyers, 1972). Family research has, however, tended to be rather poorly designed, in many cases allowing considerable opportunities for the operation of bias, and causal relationships between abnormalities of parents and of their children have been postulated solely on thc basis of ex post facto ‘ crosssectional’ studies. While such studies, with appropriate control groups, are necessary for thc identification of any abnormal characteristics which rcnder the parents of schizophrenics different in kind from parents of other psychiatric patients, and which could not therefore be explained as reactive to the hospitalization of thcir children, research of this type, such as the present study, should be considered as merely descriptive and as suggesting relevant variables, thc causal relationships of which may be examined in subsequent longitudinal studies. Imputations of schizophrenogenic pcrsonality to the parents, particularly the mothers, of schizophrenics abound in the literature (c.g. Arieti, 1959; Lidz et al., 1958a, b), but most of the conclusions on parental personality and attitudes have been reached on the basis of unstandardizcd interviews. Some of the more objectivc work has been carried out on the cognitive styles of such parents, disordered thinking and conceptualization having been demonstrated in thcir responses to object-sorting and other tests (e.g. McConaghy, 1959; Rosman et al., 1964; Phillips
*
Now at Department of Psychology, Claybury Hospital, Woodford Bridge. Essex. 279 S C P 14
19
280
D A V I DA. W I N T E R
et al., 1965; Singer & Wynne, 1965). Lidz (1968) states that parents of schizophrenics tend to show blurring of socially shared, predictive conceptual categories, and vagueness of conceptual boundaries is exemplified in the uncertainty of age, sex and self-non-self distinctions implicit in his descriptions of parental behaviour, such as projection of parental needs on to, or competition with, the child. He feels that the child learns his parents’ systems of categorization but that, whereas in normal families the mother’s construing gives the child the ‘basis of his own’, which he then proceeds to elaborate (Salmon, 1970), the symbiotic nature of the relationship between the schizophrenic and his mother inhibits any such elaboration, so that the child clings to the confusing parental style of categorization. The schizophrenic therefore receives ‘a faulty grounding in the culture’s way of thinking’. From the viewpoint of personal construct theory (Kelly, 1955), such blurring of conceptual categories could be considered a manifestation of a loosely organized system of conventional, socially shared constructs, such as Bannister (1960, 1962, 1963, 1965) maintains is a characteristic of thought-disordered schizophrenics, generated by the style of construing used by their parents. Romney (1969), however, found the relatives of schizophrenics to perform no more abnormally on the Bannister-Fransella Grid Test than those of neurotics and normals when the effects of intelligence were partialled out, but his study can be criticized for its inclusion of siblings, and of parents as old as 85 years (with the attendant possibility of contaminating organic influences) in the groups of relatives as differences between the groups might thus have been obscured. Cooper (1969) could not differentiate between hospitalized schizophrenics and their relatives by means of their scores on the Bannister-Fransella Test; and Muntz & Power (1970) found significantly more parents of thought-disordered schizophrenics than parents of nonthought-disordered patients to be identified as thought-disordered by this test. Liebowitz (1970)has also employed repertory grid techniques with parents of schizophrenics, finding their personal construct systems to be as differentiated as those of normal subjects but that they were unable to make such complex use of the socially shared dimensions of the semantic differential. Using semantic methods, he found self-other discrimination to be lower for the parents of schizophrenics than for normal subjects, and that these parents tended to disagree on their son’s similarity to his father and mother. The present study is primarily concerned with aspects of construing considered pertinent to the assertions of Lidz and others, and is designed to test the general hypotheses that: ( a ) the parents of schizophrenics constitute a discrete group amongst the parents of psychiatric patients with regard to their self-concepts, their conceptions of the disturbed child and their organization of socially shared constructs; (b) schizophrenics can be differentiated from other psychiatric patients on the basis of their self-concepts and their organization of socially shared constructs; (c) the construing of parents of psychiatric patients is related to that of their disturbed children. An additional hypothesis is that ( d )the parents of schizophrenics differ from the parents of other psychiatric patients in their personality and attitudes.
Schizophrenics and Their Parents
28 I
METHOD
A battery of psychological tests was administered to the experimental group of parents of clinically diagnosed schizophrenics and to a control group of parents of hospitalized, non-schizophrenic psychiatric patients, and a shortened battery to their hospitalized children. Subjects Experimental population. (i) The parent sample consisted of 20 parents of schizophrenics. They were all under 65 years of agc, and none were intellectually subnormal or showing overt organic impairment. (ii) The patient sample consisted of 14admissions to psychiatric hospitals who were unequivocally diagnosed as schizophrenic. Their age range was from 19 to 33 years. None were intellectually subnormal or had received E C T in the week prior to testing. All were in the acute phase of their disturbance, so as to minimize the likelihood of contaminating effects of institutionalization. Control population. (i) The parent sample Consisted of 20 parents of non-schizophrenic psychiatric patients. They were all under 65 years of age, and none were intellectually subnormal or showing overt organic impairment. (ii) The patient sample consisted of 14 admissions to psychiatric hospitals who were dcfinitely neither schizophrenic nor organically impaired. Their age range was from 17 to 32 years. None were intellectually subnormal or had received E C T in the wcek prior to testing. All were in the acute phase of their disturbance. One of these patients was not available for testing. T h e corresponding experimental and control samples were matched with regard to age and sex. Table I presents symptomatic descriptions of the patients, based on their most recent psychiatric diagnoses, and includes all the diagnostic categories employed in the latter. Procedure
The parents completed the Mill Hill Vocabulary Scale, a rcpertory grid using elicited constructs and elements, the Bannister-Fransella Grid Test of Schizophrenic Thought Disorder (Bannister & Fransella, 1967), the Eysenck PEN inventory (Eysenck & Eysenck, 197z), and the Hostility and Direction of Hostility Questionnaire (Caine et al., 1967), while the patients completed the first three tests in the battery. Tests were selected as being pertinent to supposed characteristics of the parents of schizophrenics. Tests Elicited constructlelicited element grid. The repertory grid used with the patients included as elements people known to the patient and fitting certain role titles: mother, father, siblings, a man and woman he likes, a man and woman he dislikes, a person he admires, a person in a position of authority, close relatives, and self, ideal self, and social self, these totalling 15. Ten constructs were elicited from each patient using Kelly’s minimum context form of elicitation (Kelly, 1955, vol. I , p. 222) and each element was rated with regard to each construct. The procedure was the same for the parents, except that elements included the patient premorbid and post-onset, and his siblings, these taking the place of the ‘close relative ’ elements of the patients’ grids. Various measures were derived from this grid: Intensity. No differcnce was expected between the patient groups nor between the parent groups in elicited grid Intensity, reflecting the structure of their personal construct systems, as it was hypothesized that any structural abnormalities of construing shown by the schizophrenics and their parents would be circumscribed to their use of socially shared constructs. Intensity scores of parents and their children were expected to be correlated. Sexual identification. The measure of sexual identification used was the difference between the self-same-sex parent clement correlation and self-opposite-sex parent correlation (after conversion to z scores). Confusion of sexual indentification has been thought to characterize families of schizophrenics, and so the schizophrenics and their parents were expected to obtain lower scores than control subjects on this measure ; and scores of parents and their children were expected to be positively Correlated. 19-2
282
D A V I DA. WINTER #
#
#
#
1
#
#
#
#
x #
#
#
x #
#
*
I
Schizophrenics and Their Parents
283
Self-ideal correlation. Evidence on differences in self-regard between psychiatric patients is conflicting (e.g. Wylie, 1971; Geertsma & Reivich, 1972) but it was expected that, with their supposed lack of insight into their condition (or unwillingness to accept the imposition of a psychiatric construction on their experiences), schizophrenics would show a higher self-ideal correlation than would the other patients. A corresponding difference was expected bctwecn the two groups of parents, family workers having tended to emphasize denial of problems by the parents of schizophrenics. Self-patient correlations. Such unconscious processes as projection of parents1 needs on to the child have been thought to operate in schizogenic families, with Lidz regarding projection as a manifestation of the parent’s faulty ego boundaries and of a basic impairment of categorization. Ryle & Breen (1972) argue the value of formulating projective mechanisms in the terms of personal construct theory and examining them by repertory grid measures, and it was thought that projection as described by Lidz could be similarly examined in the present study, particularly in view of the similarities between his framework and that of construct theory. It was expected that parental projcction on to the schizophrenic child might bc reflected in high correlations between ‘ self’ and ‘ patient’ elements in the parents’ grids and that these correlations would therefore be higher for the experimental than for the control parents. Bannister-Fransella Grid Test. This test measures the degree and stability of a person’s structuring of supplied constructs when applying these to people and has been developed as a diagnostic instrument for schizophrenic thought disorder, its Intensity and Consistency measures differentiating thought disordered schizophrenics from the non-thought disordered
Table
2.
Normative data for the Bannister-Framella Grid Test Intensity
Consistency r - - - - - v
Normals (12 = 30) Thought-disordered schizophrenics (n = 30) Non-thought-disordered schizophrenics (n = 30) Depressives (TI = 30) Neurotics (n = 2 0 ) Organics ( n = 20)
Mean
S.D.
Mean
1253
339 369
0.80
728
0.18
0.34 0.39
I 183
390
0‘73
0.34
1115
456 517 524
0.75 0.74 0.73
0.41 0.45 0.47
I383 933
S.D.
Below cut-off points of Intensity 1000 and Consistency 0.49 lie 80 per cent of the thoughtdisordercd schizophrenics and 6.4 pcr cent of the other groups, excluding organics. schizophrenics, other psychiatric patients and normal subjects in its standardization samples, normative data from which are presented in Table 2. The schizophrenics in the present study, although not all were clinically thought disordered, were therefore expected to obtain lower Intensity and Consistency scores than the control patients. Corresponding differences were expected between the groups of parents, and the scores of parents and their children were expected to be positively correlated. Eysenck PENI. Eysenck’s threc orthogonal factors of P, E and N take up a considerable amount of the variance in personality measurement and so the PENI would be expectcd to detect any differences in personality between the parent groups. The expected difference can only be clearly predicted with regard to the P factor, the Eysencks’ (1972) description of the high P scorer resembling descriptions of schizophrenogenic parents in more than its profusion of attributes. fIDEfQ.This test, norms for which arc presented in Table 3, measures various components of hostility. High levels of hostility have been ascribed to the parents of schizophrenics, with the more extrapunitive elements, such as paranoid hostility, emphasized in family studies ( c . g . Alanen, 1958; Lidz et al., 19586). Corresponding differences between the two groups of parents were expected in the present study.
284
D A V I DA. W I N T E R Table 3 . Mean scores of 47 normal subjects in the standardized sample for the HDHQ Hostility Direction Acting-out hostility Criticism of others Paranoid hostility Self-criticism Guilt
Mean
S.D.
13.0
6.2 4’6
0.5
3.6 3’7
2’0
0.8
2.3 I .o
3’7
2‘1
1’2
1’3
RESULTS
These will be considered in relation to the four hypotheses. ( a ) Table 4 summarizes the results obtained with the parents. The parents of schizophrenics obtained significantly lower Bannister-Fransella Intensity scores and lower Consistency scores than the control parents, but the latter difference did not reach statistical significance. They also obtained significantly lower sexual identification scores than the control parents but did not differ in self-regard or in elicited grid Intensity and, though they tended to see fewer similarities between their children and themselves, this difference was not statistically significant. ( b ) Table 5 summarizes the results obtained with the patients. The groups were significantly differentiated by the Consistency measure from the BannisterFransella test, with the schizophrenics obtaining lower scores, but not by the Intensity measure, although the schizophrenics did obtain rather low scores. There was no difference between the groups in their elicited grid Intensity scores but the control patients showed significantly greater self-ideal discrepancy than the schizophrenics and obtained somewhat, but not significantly, higher sexual identification scores. (c) Table 6 gives the product-moment correlation coefficients between the scores of each group of patients and those of their parents (including both parents of some of the patients). Significant positive correlations were obtained between the verbal IQ, Bannister-Fransella Intensity, and sexual identification scores of schizophrenics and of their parents. Such correlations were also found between the scores of control patients and their parents on the Intensity measures from both grids. Allowance for the correlation in verbal I Q did not significantly affect the correlations in Intensity in either group of subjects. x scores from tests of the difference between the correlations in the two groups are also presented, the only significant difference being that the correlation in elicited grid Intensity scores was lower in the ‘schizophrenic’ group. Fisher’s exact probability tests, one of which is presented in Table 7, provided no evidence that parents of patients identified as thought-disordered schizophrenics by the Bannister-Fransella test nor of patients clinically diagnosed as such tended to be similarly identified by the grid test. ( d ) The parents of schizophrenics obtained significantly higher Extraversion scores and somewhat higher Psychoticism and Lie scores on the PEN1 than the
285
Schizophrenics and Their Parents
control parents. No attempt was made to use the Lie scale in its usual 'suppressor' function as Eysenck has yet to provide a cut-off point for the scale above which answers to the inventory can be considered invalid: allowing for the relationships between L and the other PENI measures would in any case (as can be seen from Table 4.Comparison of mean scores of parent groups Parents of schizop hrcnics
r
Agc Verbal IQ Social class 'Elicited grid: Intensity* Scxual identification *Self-Ideal correlation *Self-Pt. premorbid cor. *Self-Pt. post-onset cor. *Ideal-Pt. preni. cor. *Ideal-Pt. post-onset cor. B-F test: Intensity" Consistency* PENI : Psychoticism Extraversion Ncuroticism Lie score HDHQ : I Iostility Direction of hostility Intropunitive hostility Extrapunitive hostility Criticism of others Acting-out hostility Paranoid host i 1i ty Guilt Self-criticism
Mean
s.11.
55'80 96.45 3.20
6-25
0'57 186.13 268.10 250.10 228.35 278. I 5 225'50
0.58 168.80 2.70 12'20
6.75 7.60 16.50 0.40 6.15 10.35 5.20 3.65 1.50 1.55 4.60
*
k
S.D.
t
D.P.
P
tailed
54'75 103'45
6.63 10.03 0.81 0.13 52'37 66.20 51.18 57'79 64'27 86.02
0.52
38 38 38 38
0.6 I
2
0.008
I
28
38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38 38
0.53 234' I3 270'75 265.00 248.00 266.00 2 I 8.70
0.16 46.80
I 83.00
4'73 0.32 2.41 4.22 2.63 1.50 1.19 1.15 I98
two-
y
Mean
7'04 0.70 0.19 65.10 49.56 53'97 45.10 55'34 62.91
1'59 3'93 4'13 3.68
One- or
Control parents
--+
2.85
0'74 I '90 9'05 7.60 6.35 16.35 2.80 7'05 9'25 4'30 3'65 I '30
2'00
5'05
0'20
44'49 1.52 4'40 4'50 1-76 6.50 8.32 4'44 4'03 2'11
2.55 I .46 0.76 2'23 0.14 0.90 1'20
0.64 0.29 2.65 0.98 I .63 2'39 0.62
1'37 0.08 I '03 0.80
0.84
I .46
1'20 0'00
1'22
0.52
1.41 3'46
1'11
0.50
0.08
I
0.45
2
0'02
I
0'45 0.19 0.24
I
2
0.52
2
0.39
I
0.006 0.17 0.06
I
0'02
2
0'54 0.09
2
I
I I
I
0'47 0.16
I
0'22
I
0.20
I
0'12
I
0.50
I
0.30 0.14 0.3 I
I
I
I
I
Transformcd to normal distribution.
Table 5. Comparison of mean scores of patient groups Schizophrenics
Age Verbal IQ U-F test: Intensity* Consistency" Elicitcd Grid: Intensity Self-idcal correlation* Sexual idcntification
Mean
S.D.
25.36 100.77 0.59 153.14
4.29 14.20 0.24 43.60 0.16 60.13 54.18
0.52
144.93 84.67
*
Control patients S.D.
t
D.F.
P
One- or twotailcd
4.88 10.23 0.17 30.97 0.13 70'37 56.35
0.20
25
0.84
2
0.16
24
0.44
I
0.82
25
0'21
I
1.67 0.76 1'73 1.56
25
0.05
I
25
0.46
2
25 23
0.05
I
0.07
I
* Mean 25.00
101.54 0.66 177'69 0.56 101.38 119.15
Transformcd to normal distribution.
DAVIDA. W I N T E R
286
inspection of the correlations) serve to increase the obtained differences between the groups. There was no difference in total Hostility between the groups of parents, and the tendency for the parents of schizophrenics to obtain higher scores on the extrapunitive, and lower on the intropunitive, components of hostility did not reach statistical significance. Table 6. Correlations between scores of patients and those of their parents Schizophrenic group r Verbal IQ 0'470 B-F test: Intensity 0.554 Consistency 0.148 Elicited grid: Intensity -0.355 Self-ideal cor-0.043 relation Sexual identifica0.430 tion
*
Control group
Diflerence between correlations: Z scores
n
P
r
n
I8
0.03"
0.293
I9
0.2"
0.59
20
0.01~
0.3"
0.648 -0.335
19 19
O.OI*
20
0'45 1'45
20 20
o.zt o.9t
0.541 -0.071
19 19
0.041 0.81.
2.82 0.32
20
0.03"
-0.112
19
0.4"
1.64
t
One-tailcd.
P
0.1"
Two-tailcd.
Table 7. Fisher's probability test of correspondence between Bannister-Fransella test diagnoses of patients and of their parents Patient A
I Thoughtdisordered Parent Non-thoughtdisordered
Thoughtdisordered
Non-thoughtdisordered
2
I0
6
21
8
31
I2
39
P = 0.32.
T h e parents of schizophrenics were of lower verbal IQ and social class than the control parents but correlations between the variables and, where appropriate, analyses of covariance, presented in Tables 8 and 9 respectively, showed that these differences were responsible for neither the difference in Bannister-Fransella Intensity nor that in PEN1 scores. T h e difference in sexual identification between the parent groups was shown, however, to be a function of their difference in social class. DISCUSSION
T h e parents of schizophrenics, as predicted, structured the supplied constructs of the Bannister-Fransella test more loosely than did the control parents, obtaining lower Intensity scores, and more loosely than the normal subjects of the standard-
287
Schizophrenics and Their Parents
ization sample for the test. This result is contrary to Romney's (1969) finding of no significant difference: he also used a Newcastle population, so that an explanat'ion of the conflicting results on the basis of differing diagnostic fashions can be discounted, but his research is subject to the criticisms mentioned above. The difference between the Bannister-Fransella Intensity scores of the groups of parents was obtained, despite the facts that only half the schizophrenic subjects were Table 8. Correlations between parents' test scores and IQ and social class Verbal IQ Class I-ID HQ: Hostility Dircction of hostility Intropunitive hostility Extrapunitivc hostility Acting-out hostility Criticism of others Paranoid hostility Self-criticism Guilt PEN1 : Psychoticism Extraversion Neuroticism Lie scale €3-F test: Intensity Consistency Elicited grid : Intensity Scxual identification Self-regard
Social class
- 0.44 - 0'22
0.05
- 0'22
0.04 - 0.09 -0.16
-0.14 0.19 0.08
-0.31
0'20
- 0.23
0.16
0'01
-0.14
-0.13 0.04
- 0.07
-0.14 0.04
0'20 0'2 I
-0.17 0.18
- 0.03 -0.21
0.15
0.06 0'1 I
0.08
- 0'02
- 0.40 0.14
0.28
Scatterplots suggested that it was permissiblc to combine the scores of both groups of parents in computing these coefficients.
Table 9. Analyses of covariance Source of variance
Adjusted sum of squares
Degrees of freedom
Mean square variance
( a ) For social class and Bannister-Fransclla Intensity scores of parents 1.018 37 0.028 Within groups 0'121 I 0'121 Betwccn groups Total
1.139
F = 4.4
t =
2'1
38 P =
0.05
( b ) For social class and sexual identification scores of parents 16.30 27 0.604 Within groups Between groups 0'1 I I 0'1I 0 Total 16.41 28 F = 0.18 t = 0.42 P = 0.7
288
D A V I DA. W I N T E R
clinically thought-disordered, and that the schizophrenic group was not significantly differentiated from the non-schizophrenic patients by this Intensity measure. T h e patient groups, but not the parent groups, were differentiated as expected by their scores on the Bannister-Fransella Consistency measure and so, contrary to predictions, the groups of patients and their respective parent groups differed on different measures from this grid test. Neither the two groups of parents nor the two groups of patients were differentiated by simple structural features of their personal construct systems, as reflected in the elicited grid Intensity measure, this result being in agreement with previous findings and with the view that organizational processes and features, such as those thought to characterize thought disordered schizophrenics, need not have a uniform distribution throughout an individual’s construct system (Winter, 1971). Little support was provided for the hypotheses regarding differences between the parent groups in the content of their personal construing and any interpretation of the only significant difference between the groups, that in sexual identification, as being a simple function of the difference in the psychiatric conditions of their children was nullified when the lower social class composition of the sample of parents of schizophrenics was taken into account. Contrary to expectations, and to hypotheses of parental projection in the families of schizophrenics (if the measures used can be assumed to relate to projection) the parents of schizophrenics saw no more similarity between themselves and their children than did the control parents : a similar unexpected finding emerged in Liebowitz’s investigation. T h e differences between the groups of patients on the ‘ content of construing’ measures were as expected, the schizophrenics showing higher self-regard and more deviant sexual identification than the control patients. No social class ratings were made on the patients, who were mostly unemployed and living with their parents, but the latter finding might, as with the parents, have been a function of the lower class of the schizophrenic patients. T h e Bannister-Fransella Intensity scores of patients in both groups were, as hypothesized, positively correlated with those of their parents, and to a greater extent than could be explained on the basis of the relationship between Intensity and verbal IQ. This result is consistent with the view that children learn their mode of general organization of conventional constructs from their parents. However, while the scores of the control patients and their parents on the elicited grid Intensity measure were positively correlated, the correlation found with the schizophrenics and their parents was significantly lower and negative and it may be that the schizophrenics tended to react against their parents’ style of personal construing. T h e positive correlation between the sexual identification scores of the schizophrenics and their parents may be interpreted as a result of their common relationship with social class, although, if the primary mediator of social class influences is the family, such an interpretation is not incompatible with one of the child learning its sexual identification from its parental models. Confused sexual identification may be one of the ‘family patterns of the lower classes. . .broadly conducive to schizophrenic personality development ’ (Kohn, 1968). Turning now to the questionnaire results, although the groups of parents
Schizophrenics and Their Parents 289 did not differ in Neuroticism, they were differentiated by Eysenck’s two other major personality dimensions. However, comparison of the scores obtained with the norms suggests that these differences were largely due to the abnormality of the control parents rather than to that of the parents of schizophrenics, although parental personality change could be considered a normal reaction to the psychological disturbance of the child. The direction of the difference in Extraversion provides evidence against the still widely held assumption of a genetic relationship between schizophrenia and introversion and, the control group of patients being mostly neurotics, the lack of a difference in Neuroticism between the parent groups provides evidence against the heritability of a Neuroticism factor orthogonal to Psychoticism. Although there was no difference in total Hostility between the groups, both were rather more hostile than normal, suggesting that parental hostility might be a general response to the child’s disturbance and its attendant problems. As expected, any such reaction tended to be largely intropunitive in the control parents and extrapunitive in the parents of the schizophrenics. Some support is therefore provided for each of the four general hypotheses, but any causal interpretations of the results obtained are inevitably speculative as significant differences and correlations provide no definitive implications regarding causation without further study. More marked differences might have been obtained had the samples been less heterogeneous, with, for example, the experimental group of patients limited to thought-disordered schizophrenics, but this was not possible due to the practical difficulties presented by a family study. The BannisterFransella Grid ‘rest and Eysenck PEN Inventory, having revealed significant differences between the parent groups in the present study, could be useful instruments in future longitudinal research, but it is perhaps more profitable and less artificial to consider the psychiatric patient’s family as a dynamic unit with its own conceptual and fantasy systems than to study the characteristics of particular family members in isolation. It would seem from the present study that the schizophrenic’s family is characterized by an atmosphere of difficulties in the socially shared ways of construing. I wish to express particular thanks to Dr Roger F. Garsidc for his assistance and advice, and to Brian Wijesinghe for his comments on the manuscript. I am also indebted to thc patients and parents who gave up their time to make this research possible. REFERENCES ALANEN, Y. 0. (1958). The mothers of schizophrenic patients. Acta psychiut. nerirol. scund. 33, Suppl. 124. ARIETI,S. (1959). Schizophrenia: the manifest symptomatology, the psychodynamic and formal mechanisms. In S. Arieti (cd.), American Handbook of Psychiatry, vol. I . Ncw York: Basic Books. BANNISTER, D. (1960). Conceptual structure in thought-disordered schizophrenics. J . ment. Sci. 106, 1230-1249. BANNISTER, D. (1962). The nature and measurcrnent of schizophrcnic thought disorder. J. ment. Sci. 108, 825-842. BANNISTER, D. (1963). The genesis of schizophrenic thought disordcr : a scrial invalidation hypothesis. Br. J . Psychiut. 109, 680-686.
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BANNISTER, D. (1965). The genesis of schizophrenic thought disorder: retest of thc serial invalidation hypothesis. Br. J. Psychiat. 111, 377-382. BANNISTER, D. & FRANSELLA, F. (1967). A Grid Test of Schizophrenic Thought Disorder: a Standard Clinical Test. Barnstaple : Psychological Test Publications. CAINE,T. M., FOULDS, G. A. & HOPE,K. (1967). Manual of the Hostility and Direction of Hostility Questionnaire. London : University of London Prcss. COOPER,J. R. (1969). A factor-analytic study of the Grid Test of Schizophrenic Thought Disorder. (Unpublished Dip. Clin. Psychol. dissertation, University of Newcastle.) EYSENCK, S. B. G. & EYSENCK, I-I. J. (1972). The questionnaire measurement of psychoticism. Psychol. M e d . 2, 50-55. GEERTSMA, R. 13. & REIVICH,R. S. (1972). A configurational analysis of self-cognition in psychiatric in-patients. J. nerv. ment. Dis. 155,303-310. KELLY,G. A. (1955). The Psychology of Personal Constructs. New York: Norton. KOHN,M. L. (1968.) Social class and schizophrenia: a critical revicw. In D. Rosenthal & S. S. Kety (cds.), The Transmission of Schizophrenia. Oxford: Pergamon Press. LIDZ,T. (1968). The family, language, and the transmission of schizophrenia. In D. Roscnthal & S. S. Kety (cds.), The Transmission of Schizophrenia. Oxford: I’ergamon Press. LIDZ,T., CORNELISON, A. & TERRY, D. ( 1 9 5 8 ~ )The . intrafamilial environment of the schizophrenic patient. IV. Parental personalities and family interaction. A m . J. Orthopsychiat. 28,764-776. LIDZ,T., CORNELISON, A., TERRY, D. & FLECK, S. (19586). Intrafamilial environment of the schizophrenic patient. VI. The transmission of irrationality. Archs Nezirol. Psychiat. 79,305-316. LIEBOWITZ, G. D. (1970). Conceptual systems in schizogcnic families. (Unpublished Ph.D. thesis, University of Rochester.) MCCONAGHY, N. (1959). The use of an object sorting test in elucidating the hereditary factor in schizophrenia. J. Neurol. Neurosurg. Psychiat. 22, 243-246. M u m z , H. J. & P o r n , R. (1970). Thought disorder in the parents of thought-disordered schizophrcnics. Br. J. Psychiat. 117, 7 0 7 7 0 8 . ORRILL,R. & BOYERS, R. (1972). Schizophrenia, R. D. Laing and the contemporary treatment of psychosis: an interview with D r Theodore Lidz. In R. Boyers & R. Orrill (eds.), Laing and Anti-Psychiatry. Harmondsworth : Penguin Books. PHILLIPS,J. E., JACOBSON, N. & TURNER, W. J. (1965). Conceptual thinking in schizophrenics and their relatives. Br. J. Psychiat. 111, 823-839. ROMNEY, D. (1969). Psychometrically assessed thought disorder in schizophrenic and control patients and in their parents and siblings. Br. J. Psychiat. 115, 999-1002. ROSMAN, B., WILD, C., RICCI,J. & LIDZ,T. (1964). Thought disorders in the parents of schizophrenic patients: a further study utilizing the Object Sorting Test. J . psychiat. Res. 2,211-221.
RYLE,A. & BREEN,D. (1972). Some differcnces in the pcrsonal constructs of neurotic and normal subjects. Br. J. Psychiat. 120,483-489. SALMON, P. (1970). A psychology of personal growth. In D. Bannister (ed.), Perspectiwes in Personal Construct Theory. London : Academic Press. SINGER, M. T. & WYNNE,L. C. (1965). Thought disorder and family relations of schizophrenics. IV. Results and implications. A r c h gen. Psychiat. 12,201-212. WINTER,D. A. (1971). The meaningfulness of pcrsonal and supplied constructs to chronic schizophrenics and normals. (Unpublished B.Sc. dissertation, University of Durham.) WYLIE,R. (1971). The Serf Concept. Lincoln: University of Nebraska Press.
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