Journal of Abnormal Psychology 1978, Vol. 87, No. 5, 505-513
Differences in MMPI Scores of Black and White Compulsive Heroin Users W. E. Penk
W. A. Woodward
Veterans Administration Hospital, Dallas, Texas
Southern Methodist University
R. Robinowitz
J. L. Hess
Veterans Administration Hospital, Dallas, Texas
Kansas State University
The question of racial bias in the Minnesota Multiphasic Personality Inventory (MMPI) was investigated by comparing responses of black and white compulsive heroin users on both empirically derived validity and clinical scales and intuitively constructed content scales. In both univariate and multivariate analyses of variance and covariance of individual scales and overall profiles, black heroin users (n = 2 52) differed significantly from white heroin users (»= 120), the direction of differences opposite to that reported for blacks in previous studies of normal and psychiatric samples. Blacks scored significantly lower on six clinical scales (Infrequency, Depression, Psychopathic Deviate, Psychasthenia, Schizophrenia, and Social Introversion) when profile validity and the covariates age, intelligence, and socioeconomic status were both controlled and uncontrolled. On content scales, whites displayed greater personality disturbance in Social Maladjustment and Family Problems, whereas blacks obtained higher scores on Feminine Interests and Phobias. The results show that methodologically the question of a black bias in the MMPI awaits additional information about the interaction of ethnicity with clinical samples; substantively, the results refute the assumption of personality trait communality among compulsive heroin users and suggest that ethnicity is an influential subject background characteristic by which subgroups of heroin users might be identified. A debate has flared about the suitability of the Minnesota Multiphasic Personality Inventory (MMPI) for minority ethnic groups, Hokanson and Calden (1960) first suggested a need for developing norms "appropriate" for minorities after finding that black, male This ^earch was conducted with funds furnished by the Medical Research Service, Veterans Administration Hospital, Dallas, Texas. The authors wish to thank the following people who contributed to this project: Robert Tucker, who introduced us to the problem of assessing compulsive heroin users; Isham Kimbell, who encouraged our research; Harold Gilberstadt, who computer scored the MM'PIs used in this study; T. A. Van Hoose, C. £5 i^Sct^ i?S±^ and M. Korman, who provided his thoughtful suggestions during the writing of the manuscript. Requests for reprints should be sent to W. E. Penk, Research Psychologist, Psychology Service, VA Hospital, Dallas, Texas 75216.
tuberculosis patients in a Veterans Administration (VA) hospital scored higher than whites on the MMPI. Miller, Wertz, and Counts (1961) immediately parried the proposal by demonstrating that differences in treatment settings were stronger than differences in race. Now, after 20 years and 20 studies, the question of a black bias in the MMpJ h
t b
answered
considering
_ , , . . . , ,! . . , Gynther's (Note 1) renewed call in 1977 for black MMPI norms and Marks's (Marks, Bertelson, & May, Note 2) contention that , , , .. . , HpmnnsfratpH a black blas flas n0t been demonstrated. The debate has focused on the question, JJOW can a test developed with "contrasted
Coups'" methods using adult, white Minnesotans of the 1930s serve as the standard for interpreting scores of individuals assessed in , ,„„,-, ^ - 1 1 c the 1970s—particularly persons of minority ethnic groups such as blacks? Should clini-
Copyright 1978 by the American Psychological Association, Inc. 0021-843X/78/8705-0505$00.75
SOS
506
PENK, WOODWARD, ROBINOWITZ, AND HESS
cians compare clients of the current generation on a test "norm-referenced" in 1939 with 724 people waiting while relatives and friends were being seen in the University of Minnesota University Hospital, with 265 high school graduates seeking precollege guidance in the University of Minnesota Testing Bureau, and with 265 skilled workers from Work Projects Administration jobs in Minneapolis? The specific question of a black bias from white norms is but one example of the general principle confronting psychologists "not to interpret an obtained score with reference to a set of norms that is inappropriate for the individual tested or for the purposes of the testing" (American Psychological Association, 1974, p. 70). Gynther (1972) has championed the position that MMPI norms should be developed for blacks, basing his argument on two types of black-white comparisons. He has shown, first, that normal blacks, compared with normal whites, score consistently higher on MMPI scales Infrequency (F), Psychopathic Deviate (Pd), and Hypomania (Ma). Gynther stated that such elevations do not indicate personality disorder but, rather, are a sign of cultural alienation associated with the black minority experience of living in a white majority culture (e.g., Harrison & Kass, 1967; McDonald & Gynther, 1962, 1963). Second, Gynther has shown that maladjustment measured by the MMPI is greater for black than for white psychiatric samples—but his evidence is not consistent (cf. Gynther, 1972, p. 398; Gynther, Altman, &Warbin, 1973). Findings by other investigators studying black-white MMPI differences among abnormal groups have similarly been inconclusive (e.g., Costello, Fine, & Blau, 1973; Costello, Tiffany, & Gier, 1972; Cowan, Watkins, & Davis, 1975; Davis & Jones, 1974; Elion & Magargee, 1975; Watkins, Cowan, & Davis, 1977; Marks et al., Note 2). Such potentially confounding background characteristics as education and socioeconomic status (SES) have not always been controlled, and when controls have been introduced, it has not been clear whether samples were rendered unrepresentative for the popu-
lation to which conclusions were generalized (cf. Meehl, 1970). In fact, investigators testing the question in field settings have yet to face the reality that ethnic subgroups within a particular clinical sample may be disproportionately attracted to treatment settings. There are now, in addition, two new lines of research findings complicating the question of ethnic bias in personality assessment. First, results from tests not regarded as culturally biased have shown that certain clinical samples of blacks—particularly those from lower educational and SES levels—evidence greater maladjustment; the findings make intuitive sense, considering deprivation deleteriously affects personality development (cf. Warheit, Holzer, & Arey, 1975). Second, blacks actually appear better adjusted than whites in at least one clinical sample—compulsive heroin users. Earlier studies based on interviews have suggested that black drug users evidence less psychopathology than white drug users (cf. Chein, Gerard, & Lee, 1964; Nail, Gunderson, & Arthur, 1974). Previous MMPI studies show that black heroin users either do not differ or do not score lower than white heroin users (e.g., Gilbert & Lombardi, 1967; Hill, Haertzen, & Glaser, 1960; Penk & Robinowitz, 1974). The present study was undertaken to examine the generality of these findings. The purpose was to assess the question of a black bias in the MMPI by comparing black and white compulsive heroin users. Method Subjects Two samples of subjects were drawn from a data pool of male veterans consecutively admitted to a drug dependence treatment program (DDTP) of a VA general medical and surgical hospital. Between 1972 and 1976, 263 black and 124 white heroin users were routinely evaluated by white examiners in group assessment sessions (Jernigan, 1975) the day after beginning a methadone treatment program. Race was classified from each subject's selfdescription on a biographical inventory item. Criteria for subject selection were the following: First, only volunteers for treatment were included.1 1 Previous research has shown that the volunteernonvolunteer dimension in admission status should
BLACK-WHITE MMPI DIFFERENCES Second, only heroin users admitted for the first time to the local DDTP were selected (in order to avoid unknown effects of differential treatment experience). Third, both a larger sample of subjects who completed the first day's quota of tests (i.e., a biographical inventory, a drug history questionnaire, and the MM'PI, Form R) and a smaller subgroup who on the second day completed the Progressive Matrices (PM 1938; Raven, 1941), measuring intellectual (IQ) functioning, were included. Attrition rates ran somewhat higher for blacks, but not significantly: 3% refused testing (4 white and 11 black); 8.33% (21 of 252) blacks, compared with 6.33% (8 of 120) whites, produced "invalid" MMPI profiles (defined as Lie (L) > T score 70, F > 90, and/or Defensiveness (K) > 70). Of those completing the MMPI, 33.73% (84 of 252) blacks, compared with 21.66% (26 of 120) whites, did not complete the IQ test and/or did not specify SES data—'blacks more than whites did not give father's occupation, the SES measure. Data were analyzed first for all MMPIs disregarding profile validity or covariates and second for the subgroup of MMPIs with valid profiles and covariates. Since results were similar under all possible separate and combined comparisons, the findings are presented simply for (a) uncontrolled groups, in which covariates and profile validity were allowed to vary, and for (b) controlled groups, in which both covariates and profile validity were controlled. Blacks did not differ from whites on potentially confounding variables. Compulsive heroin use refers to the average of 3.4 years of reported heroin use, users injecting an average of three "papers" a day (about one and a half grams of "street" heroin). Estimates of duration and dosage are assessed rigorously before admission to treatment through screening interviews and laboratory tests (partly because methadone is hazardous for persons inexperienced in opiate use and partly because Federal Drug Administration regulations require evidence of at least 2 years of daily, intravenous heroin use
be controlled. As a consequence, those heroin users sent to the local DDTP shortly before military discharge (i.e., the one kind of "nonvolunteer") were omitted from the present analysis; these findings will be discussed in a separate paper examining a replication of previous volunteer-nonvolunteer findings among black subjects. The presently available sample size of 18 black nonvolunteers was not sufficiently large to permit the multivariate analysis of covariance design with 13 dependent MMPI variables. Black-white nonvolunteer comparisons will be made when sample size permits. Results of a multivariate analysis of variance performed for both volunteers and nonvolunteers combined (179 whites and 281 blacks) yields a significant Wilk's A = .929, F(13, 446) = 2.64, p < .001; black volunteers and nonvolunteers averaged lower on overall MMPI profile than white volunteer and nonvolunteer compulsive heroin users.
507
before methadone can be prescribed). Beginning methadone dosage averaged 35 mg, usually in 25mg units with 10 mg available as needed. Heroin duration was shorter than reported in other studies, presumably because multiple-admission users, who are older and who report longer heroin use, were not included for study. Means for relevant subject characteristics were: for age, 27.96 years; for education, 11.75 years; for Wechsler Adult Intelligence Scale equivalency, 102.68 (using Burke's, 1972, Raven norms); and for SES, lower middle class, or 4.05 of a 7-point scale rating father's occupation. Group differences increased but were controlled when analysis of covariance (ANCOVA) was performed for the subgroups: Whites were slightly younger (28.20 vs. 30.95), slightly lower in SES (3.98 vs. 4.95), and somewhat brighter (107.83 vs. 98.66).
Procedures Admission MMPI responses were scored for validity and clinical scales (Hathaway & McKinley, 1951) and for content scales (Wiggins, 1966), the measures are listed in Tables 1 and 2. Content scales were compared to determine whether ethnic differences occur for intuitively derived scales. (Some think that content scales are more stable and less situationally bound to treatment settings of subjects' origins than are empirically derived clinical jcales developed through "contrasted-groups" methods [e.g., Mezzich, Damarin, & Erickson, 1974]).
General Experimental Tactics The hypothesis was tested that black heroin users score lower on the MMPI than do white heroin users, contrary to findings among psychiatric patients. If the MMPI is not biased, then black heroin users should score significantly lower than whites (of. Nail et al., 1974). If the MMPI is biased, however, then black heroin users should score higher (or possibly the two groups would not differ significantly, given, hypothetically, that whites were more disturbed than blacks). Samples were analyzed first with and then without controls. A general question was asked first, Do consecutively admitted blacks and whites differ on the MMPIs? Multivariate analysis of variance (MANOVA) and univariate analysis of variance (ANOVA) were performed with race as the main effect (Cohen & Burns, Note 3); neither MMPI validity scale scores nor covariates were controlled. Then a second, more specific question was asked, Can black-white differences be eliminated by controlling statistically both nonracial covariates (age, IQ, and SES) and MMPI profile validity? Multivariate analysis of covariance (MANCOVA) and univariate analysis of covariance (ANCOVA) were performed (Cohen & Burns, Note 3) for the smaller subset (i.e., 223 of 372, or 60%), who completed both the SES item and the IQ test along with the
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PBNK, WOODWARD, ROBINOWITZ, AND HESS
MMPI. Age, SES, and IQ were selected as covariates because they have been found to bias sampling in ethnic studies (cf. Marks et al., Note 2, on covariates and Costello et al., 1972, on validity). Race effects on MMPI scores were analyzed after linear adjustments were made for covariates. (Tables of beta weights and significance levels for each covariate with adjusted cell means are available upon request.) A third question was addressed implicitly by this design, What are the practical and theoretical consequences of these findings with regard to heroin addiction? By asking whether personalities of compulsive heroin users differ as a function of ethnicity, one indirectly questions, for example, the pertinence of the predisposing, "addiction-prone" personality issue (cf. Platt & Labate, 1976). 2
Results The hypothesis is supported. Black heroin users score significantly lower on the MMPI than white heroin users. Blacks score lower on empirically developed clinical scales and intuitively derived content scales. Blacks score lower both for experimentally and statistically controlled and uncontrolled comparisons. Means and standard deviations (i.e., /sT-corrected raw scores of groups with and without control for profile validity and covariates) are presented in Tables 1 (the clinical scales) and 2 (the content scales). Clinical Scale Comparisons The extent to which blacks score lower than whites is reflected in a MANOVA performed to determine whether group MMPI profiles differ in overall analysis. Wilk's lambda for this MANOVA was significant, A = .988, ^(13, 358) =3.88, p< .00001. Blacks scored significantly lower on 7 of 13 scales—Depression ( D ) , Hysteria (Hy),Pd, Masculinity-Femininity (Mf), Psychasthenia (Pt), Schizophrenia (Sc), and Social Introversion (Si)—and higher on L and K in ANOVA comparisons when neither validity nor covariates were controlled (see Table 1, columns 3-6). White heroin users elevated five scales above T score 70: D, Pd, Pt, Sc, and Ma; blacks elevated three: D, Pd, and Sc. Although both groups registered moderate distress with depression and nervousness (high D) for persons who are irritable and hostile (high Pd) and socially alienated
(high Sc), whites evidenced even more pronounced personal difficulties, as well as excessive worry and overideational rumination (higher Pt), along with hyperactivity and tenseness (higher If a). Blacks also scored lower than whites when validity and covariates were controlled (Table 1, columns 7-10). MANCOVA yields a significant difference, Wilk's A = .870, F(13, 206) =2.36, p< .006. The introduction of statistical control of covariates and profile selection criteria does not alter the relationship between group means, unlike previous black-white psychiatric comparisons (e.g., Costello et al., 1972). MMPI scores average lower when invalid profiles are removed and covariates are controlled, but blacks still scored significantly lower on 6 of 13 scales in ANCOVA comparisons, F, D, Pd, Pt, Sc, and Si (see Table 1, columns 710). Removal of invalid profiles sharpens group differences: Whites elevated D, Pd, Pt, Sc, and Ma, whereas blacks elevated only Pd. Blacks registered higher negativism and social nonconformity (Pd), whereas whites evidenced appreciably more difficulty, express social nonconformity, along with more pronounced pessimism (higher D), anxiety (higher Pt), social alienation (higher Sc), and excitability and restlessness (higher Ma). Content Scale Comparisons These results, though similar, are not as clear-cut. Blacks tended to score lower than whites on content scales. Wilk's A from the MANOVA is .669, F(13, 337) = 12.82, p < .00001. Blacks scored lower than whites in S of 13 ANOVA comparisons, Social Maladjustment, Depression, Poor Morale, Family 2 Only two of five possible comparisons are presented in this study. Three comparisons resulting in identical findings were omitted in the hopes of simplifying the presentation: (a) the total sample of black versus white volunteers and nonvolunteers combined (see Footnote 1 for an overall MANOVA); (b) black and white volunteer subjects with only profile validity controlled; and (c) black and white volunteer subjects with only the covariates controlled (but not profile validity). Blacks scored significantly lower than whites in all comparisons.
BLACK-WHITE MMPI DIFFERENCES Problems, and Hostility, and higher on three scales, Feminine Interests, Religious Fundamentalism, and Phobias. The groups did not differ significantly on Authority Conflict,
509
Psychoticism, Organicity, Hypomania, or Poor Health (see Table 2; columns 2-6). Comparisons are similar when controlling covariates and profile validity (Table 2, col-
Table 1 Means, Standard Deviations, A NOVA, and ANCOVA F Ratios of Clinical Scales for Uncontrolled and Controlled Black- White Compulsive Heroin Groups Uncontrolled MMPI scale
Controlled
White"
Black"
F
P
White"
Black"
F
P
3.06 1.80
3.83 2.26
10.63
.001
2.98 1.91
3.75 1,99
3.60
.059
12.51 7.44
10.81 8.29
3.43
.065
11.61 5.90
8.72 5.86
13.70
.000
11.20 4.52
12.28 4.79
4.29
.039
11.15 4.34
12,61 4,51
2.43
.120
18.92 6.35
18.60 6.58
.19
.656
18.53 6.29
18.07 6.25
2.53
.113
27.63 6.37
25.39 6.47
9.93
.002
27.47 5.88
24,70 6.34
14.64
.000
25.93 5.83
24.44 6.61
4.47
.035
25.36 5.91
24,09 6.33
3.50
.063
31.06 4.59
28.92 4.67
17.28
.001
30.95 4.50
29.20 4,43
7.79
.005
26.40 4.61
25.35 4.88
3.88
.049
26.83 4.57
25.11 5.16
.82
.377
13.43 4.69
12.59 5.32
2.13
.145
13.20 4.17
11.71 4.74
3.45
.065
34.02 8.12
31.72 7.66
7.02
.008
33.77 7.79
30.77 7.31
11.05
.001
36.71 11.32
34.23 11.08
4.05
.045
35.95 10.65
32.29 9.72
9.72
.002
25.53 5.30
24.62 4.71
2.80
.095
25.36 5.45
24.50 4.64
.83
.365
32.32 10.75
29.06 8,56
9.96
,002
32.06 10.54
27.98 8.35
12.93
.000
Lie
M SD Infrequency M SD Defensiveness
M SD H ypochondriasis
M SD Depression M SD Hysteria M
SD Psychopathic deviate M SD Masculinity-Femininity
M SD Paranoia M SD Psychasthenia
M SD Schizophrenia M SD Hypomania
M SD Social Introversion
M SD
Note. Means are J£-corrected raw scores. Controlled- means groups in which covariates were controlled and in which only "valid" MMPI profiles were used (see Results section). • » - 120. b n = 252. •«- 87. d n - 136.
510
PENK, WOODWARD, ROBINOWITZ, AND HESS
Table 2
Means, Standard Deviations, ANOVA, and ANCOVA F Ratios of Content Scales for Uncontrolled and Controlled Black-White Compulsive Heroin Groups Controlled11
Uncontrolled Whiteb
Black0
F
P
Whited
Black"
F
P
12.53 6.45
10.02 4.96
16 22
.001
12.37 6.42
9.20 4.57
17.04
.000
14.97 7.47
12.54 6.36
1(U1
.002
15.19
12.04 6.23
12.99
.000
9.18 3.32
11.27 3.28
31 6S
.001
8.98 3.18
11.07 3.31
21.51
.000
11.91 5.94
10.28 5.59
6 37
,012
12.08 5.97
10.15 5.46
4.64
.032
4.96 2.81
5 91
' 2.44
10 75 10J5
.001
5.06 2.94
5.89 2.47
2.08
.150
14.54 3.45
14.53 3.25
' UI
.969
3.39
14.71 2.89
.04
.849
14.92 8.38
15.02 8.66
' U1
.913
14.70 7.66
13.57 7.11
.36
.552
12.05 7.16
10 78
' 7.38
2 38 "8
.124
'i5
9.70 6.91
7.64
.006
8.17 3.10
2'85
22 30
.000
7.98 2.93
6.39 2.69
9.68
.002
Hostility M SD
13.03 5.34
11.78 4.65
S 18
.024
12.87
11.57 4.60
3.11
.080
Phobias M SD
7.37 4.07
424
13 26
.000
6.80 3.80
9.11 4.30
8.82
.003
Content scales" Social Maladjustment M SD Depression M SD Feminine Interests M SD Poor Morale M SD Religious Fundamentalism M SD Authority Conflict M SD Psychoticism M SD Organicity M SD Family Problems M SD
'
,
'
„
'
'
'
'
Hypomania M SD
15.58 4.13
14 67
' 4.27
57 3357
.060
14.52 4.25
1.52
.219
Poor Health M SD
•ts
10.29 4.95
10.11 5.20
>uy
.760
10.35 4.56
9.74 5.03
1.80
.180
'
Note. Means are raw scores. Controlled means groups in which covariates were controlled and in which only "valid" MMPI profiles were used (see Results section). a Definitions of content scales are given in the text. Sample sizes for content scales are somewhat smaller than for clinical scales because 28 subjects did not complete all of the items between statements 399 and 566 of MMPI, Form R, in which content scales items were clustered. » » = 118. ° n = 233. d » = 86. >n = 131.
BLACK-WHITE MMPI DIFFERENCES
umns 7-10). Wilk's A from the MANCOVA is significant, A = .633, F(13, 212) = 8.91, p < .0001, groups differing in mean profiles. White heroin users scored significantly higher on Social Maladjustment, Depression, Poor Morale, Organicity, Family Problems, and Hostility; blacks scored significantly higher on Feminine Interests and Phobias. Whites expressed greater interpersonal difficulties on content scales (noting content scales above 60 are considered "elevated," as clinical scales above 70 are considered "elevated," Wiggins, 1966). High Social Maladjustment (equivalent to T score 63) suggests shyness, reticence, and self-consciousness (cf. Si). Higher Family Problems (near 67) indicates unpleasant, unloving, and disturbed parental home life (correlating with emotional immaturity; Wiggins, Goldberg, & Appel'baum, 1971). Blacks scored significantly higher on scales reflecting intrapersonal difficulties. Higher Feminine Interests (averaging near 56) may reflect a set to endorse many socially sanctioned interests; higher scores may indicate a desire to be more "cultured" (Wiggins, 1966). Higher Phobias (near 57) suggests more neuroticlike fears (although the community climate for blacks may be more dangerous). Whites, then, scored higher on two content scales traditionally indicating maladjustment (i.e., Social Maladjustment and Family Problems, Wiggins, 1966, p. 27). Only one of the two scales on which blacks scored higher (i.e., Phobias) is considered a classical indicator of maladjustment. Discussion What then are the practical implications of these findings? A call for "renorming" the MMPI has gradually grown over the last 20 years, since investigators have increasingly noticed that minority group members systematically average five or so T score points higher on several MMPI scales than do majority group members. This call was based on differences similar in magnitude to black-white differences in this study, except that now whites have scored higher. Should one follow historical precedence and ask that
511
the MMPI be renormed for white heroin users or should one conclude that the white heroin user is more maladjusted? Probably neither, yet. It is tempting to conclude that MMPI elevations by whites indicate greater maladjustment. Although our clinical observations support this point, nevertheless there are other explanations which must first be ruled out. For one thing, whites may have expressed vulnerabilities more readily to white examiners than may blacks. Or, whites may more readily have adopted an "impression management" stance in a VA hospital, finding it easier to project a "sick-role" that was thought to be demanded by the VA as an institution representative of the majority culture. Such speculations must be ruled out based on external criteria and behavioral correlates of elevated MMPI scores before concluding whites are more maladjusted. For the present, clinicians must continue to establish local norms for tests along with behavioral referents for their treatment settings. The issue of black-white MMPI differences, however, has not been answered; rather, more questions have been raised by finding that black-white MMPI differences vary as a function of clinical groups studied. Further, the black-white MMPI content scale differences have weakened any claim that the empirical, contrasted-groups method of clinical scale construction provides an ethnic bias. The issue of ethnic differences is shown now to be more difficult to untangle than originally supposed. The question cannot be answered simply by comparing one kind of clinical sample from one kind of treatment setting; the issue must be studied as an interaction of clinical groups, clinical settings, and ethnicity, as suggested many years ago (Miller et al., 1961). Minority (and majority) groups use treatment settings and services so selectively that studies conducted in field settings are vulnerable to sampling biases from differential utilization. We still have much to learn about parameters in sampling before we can say a test is biased.
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PENK, WOODWARD, ROB1NOWITZ, AND HESS
The findings have implications for research and program evaluation; studies of treatment effectiveness might be biased if ethnic differences are not controlled or assessed. These findings also have implications for treatment programming. White heroin users display more social maladjustment, generally—that is, more conflicts with parents, those in authority, and prevailing cultural values. Black heroin users, beset more with personal fears and neuroticlike concerns over passivity, are seen as striving to actualize potentials, as struggling to reach goals valued by the majority culture (cf. "feminine interests" apparently regarded as representative of successful enculturation). These ethnic differences may require different nuances in treatment: for whites, increased family therapy with regard to interpersonal difficulties; for blacks, more education, particularly of skills for "making it" in the mainstream. What are the theoretical implications? These results contraindicate the notion that one kind of personality is addiction prone. Although a theory of heroin addiction cannot be generated from the limited aspects of personality operationalized by the MMPI, we have demonstrated at least one criterion by which any theoretical formulation must be assessed, that is, any theory of addiction must be sufficiently complex to account for variety in personality traits and types and for variety in levels of adjustment. Theory construction must await several developments in the study of addiction behavior—for example, the charting of life span changes, identifying a variety of personality types associated with compulsive heroin use, understanding the role of drugs for the person, and the interaction of personality variables with cognitive, social, and environmental variables. As investigators begin to discern such heterogeneity in personality, the identification of ethnicity as one significant subject parameter serves at least as one dimension for locating uniformity and order in a complex picture. Reference Notes 1. Gynther, M. D. Ethnicity and personality: Recent findings. Paper presented at the 12th An-
nual MMPI Symposium, St. Petersberg, Florida, February 3, 1977. 2. Marks, P. A., Bertelson, A. D., & May, G. D. Race and MMPI: Some new findings and considerations. Manuscript submitted for publication, 1977. 3. Cohen, E., & Burns, P. SSPS update for CDC users: MANOVA and MANCOVA, a preliminary edition. Manuscript in preparation, Vogelback Computer Center, Northwestern University, May, 1976.
References American Psychological Association. Revised standards for educational and psychological tests. Washington, D.C.: Author, 1974. Burke, H. R. Raven's progressive matrices: validity, reliability, and norms. The Journal of Psychology, 1972, 82, 253-257. Chein, I., Gerard, D. L., Lee, R. S., & Rosenfield, E. The road to H: Narcotics, delinquency, and social policy. New York: Bask Books, 1964. Costello, R. M., Fine, H. J., & Blau, B. I. Racial comparisons on the Minnesota Multiphasic Personality Inventory. Journal of Clinical Psychology, 1973, 29, 63-65. Costello, R. M., Tiffany, D. W., & Gier, R. H. Methodological issues and racial (black-white) comparisons on the MMPI. Journal of Consulting and Clinical Psychology, 1972, 38, 161H168. Cowan, M. A., Watkins, B. A., & Davis, W. E. Level of education, diagnosis, and race-related differences in MMiPI performance. Journal of Clinical Psychology, 197S, 31, 442-444. Davis, W. E., & Jones, M. H. Negro versus Caucasian psychological test performance revisted. Journal of Consulting and Clinical Psychology, 1974, 42, 675-679. Elion, V. H., & Megargee, E. I. Validity of the MM'PI Pd scale among black males. Journal of Consulting and Clinical Psychology, 1975, 43, 166172. Gilbert, J. G., & Lombardi, D. N. Personality characteristics of young male narcotic addicts. Journal of Consulting Psychology, 1967, 31, 536-538. Gynther, M. D. White norms and black MMPIs: A prescription for discrimination? Psychological Bulletin, 1972, 78, 386-402. Gynther, M. D., Altman, H., & Warbin, R. W. Behavioral correlates for the MMPI 4-9/9-4 code types: A case of the emperor's new clothes? Journal of Consulting and Clinical Psychology, 1973, 40, 259-263. Harrison, R. H,, & Kass, E. H. Differences between Negro and white pregnant women on the MMPI. Journal of Consulting Psychology, 1967, 31, 454463. Hathaway, S. R., & McKinley, J. C. The Minnesota Multiphasic Personality Inventory. New York: Psychological Corporation, 1951. Hill, H. E., Haertzen, C. A., & Glaser, R. Personality characteristics of narcotic addicts as indi-
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cated by the MMPI. Journal of General PsyNail, R. L., Gunderson, E., & Arthur, R. J. Blackwhite differences in social background and milichology, 1960, 62, 127-139. Hokanson, J. E., & Calden, G. Negro-white differtary drug abuse patterns. American Journal of ences on the MMPI. Journal of Clinical PsycholPsychiatry, 1974,131,1097-11102. Penk, W. E., & Robinowitz, R. MMPI differences ogy, 1960,16, 32-33. Jernigan, A. J. The use of group tests in clinical of black and white drug abusers. JSAS Catalog settings. In P. McReynolds (Ed.), Advances in of Selected Documents in Psychology, 1974, 4, 50. psychological assessment (Vol. 3). San Francisco: (Abstract) Jossey-Bass, 1975. Platt, J. J., & Labate, C. Heroin addiction. New McDonald, R. L., & Gynther, M. D. MMPI norms York: Wiley, 1976. for southern adolescent Negroes. Journal of So- Raven, J. C. Standarization of progressive macial Psychology, 1962, 58, 277-282. trices, 1938. British Journal of Medical PsycholMcDonald, R. L., & Gynther, M. D. MMPI differogy, 194il, 19, 137-150. ences associated with sex, race, and class in two • Warheit, G., Holzer, C., & Arey, S. Race and menadolescent samples. Journal of Consulting Psytal illness: An epidemiological update. Journal of Health and Social Behavior, 1975, 16, 243-256. chology, 1963, 27, 112-116. Meehl, P. E. Nuisance variables and the ex post Watkins, B. A., Cowan, M. A., & Davis, W. E. facto design. In M. Radner & S. Winokur (Eds.), Differential diagnosis imbalance as a race-related Analysis of theories and methods of physics and phenomenon. Journal of Clinical Psychology, 1977, 33, 267-268. psychology (Vol. 4). Minneapolis: University of Minnesota Press, 1970. Wiggins, J. S. Substantive dimensions of self-report in the MMPI item pool. Psychological MonoMezzioh, J. E., Damarin, F. L., & Erickson, J. R. graphs, 1966, 50(22, Whole No. 630). Comparative validity of strategies and indices for differential diagnosis of depressive states from Wiggins, J. S., Goldberg, L. R., & Appelbauin, M. MMPI content scales: Interpretative norms other psychiatric conditions using the MMPI and correlations with other scales. Journal of Journal of Consulting and Clinical Psychology, Consulting and Clinical Psychology, 1971, 37, 1974, 42, 691-698. 403-410. Miller, C., Wertz, C., & Counts, S. Racial differences on the MMPI. Journal of Clinical Psychology, 1961,17, 159-160. Received January 30, 1978 •
Differences in MMPI Scores of Black and White Compulsive Heroin Users W. E. Penk
W. A. Woodward
Veterans Administration Hospital, Dallas, Texas
Southern Methodist University
R. Robinowitz
J. L. Hess
Veterans Administration Hospital, Dallas, Texas
Kansas State University
The question of racial bias in the Minnesota Multiphasic Personality Inventory (MMPI) was investigated by comparing responses of black and white compulsive heroin users on both empirically derived validity and clinical scales and intuitively constructed content scales. In both univariate and multivariate analyses of variance and covariance of individual scales and overall profiles, black heroin users (n = 2 52) differed significantly from white heroin users (»= 120), the direction of differences opposite to that reported for blacks in previous studies of normal and psychiatric samples. Blacks scored significantly lower on six clinical scales (Infrequency, Depression, Psychopathic Deviate, Psychasthenia, Schizophrenia, and Social Introversion) when profile validity and the covariates age, intelligence, and socioeconomic status were both controlled and uncontrolled. On content scales, whites displayed greater personality disturbance in Social Maladjustment and Family Problems, whereas blacks obtained higher scores on Feminine Interests and Phobias. The results show that methodologically the question of a black bias in the MMPI awaits additional information about the interaction of ethnicity with clinical samples; substantively, the results refute the assumption of personality trait communality among compulsive heroin users and suggest that ethnicity is an influential subject background characteristic by which subgroups of heroin users might be identified. A debate has flared about the suitability of the Minnesota Multiphasic Personality Inventory (MMPI) for minority ethnic groups, Hokanson and Calden (1960) first suggested a need for developing norms "appropriate" for minorities after finding that black, male This ^earch was conducted with funds furnished by the Medical Research Service, Veterans Administration Hospital, Dallas, Texas. The authors wish to thank the following people who contributed to this project: Robert Tucker, who introduced us to the problem of assessing compulsive heroin users; Isham Kimbell, who encouraged our research; Harold Gilberstadt, who computer scored the MM'PIs used in this study; T. A. Van Hoose, C. £5 i^Sct^ i?S±^ and M. Korman, who provided his thoughtful suggestions during the writing of the manuscript. Requests for reprints should be sent to W. E. Penk, Research Psychologist, Psychology Service, VA Hospital, Dallas, Texas 75216.
tuberculosis patients in a Veterans Administration (VA) hospital scored higher than whites on the MMPI. Miller, Wertz, and Counts (1961) immediately parried the proposal by demonstrating that differences in treatment settings were stronger than differences in race. Now, after 20 years and 20 studies, the question of a black bias in the MMpJ h
t b
answered
considering
_ , , . . . , ,! . . , Gynther's (Note 1) renewed call in 1977 for black MMPI norms and Marks's (Marks, Bertelson, & May, Note 2) contention that , , , .. . , HpmnnsfratpH a black blas flas n0t been demonstrated. The debate has focused on the question, JJOW can a test developed with "contrasted
Coups'" methods using adult, white Minnesotans of the 1930s serve as the standard for interpreting scores of individuals assessed in , ,„„,-, ^ - 1 1 c the 1970s—particularly persons of minority ethnic groups such as blacks? Should clini-
Copyright 1978 by the American Psychological Association, Inc. 0021-843X/78/8705-0505$00.75
SOS
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PENK, WOODWARD, ROBINOWITZ, AND HESS
cians compare clients of the current generation on a test "norm-referenced" in 1939 with 724 people waiting while relatives and friends were being seen in the University of Minnesota University Hospital, with 265 high school graduates seeking precollege guidance in the University of Minnesota Testing Bureau, and with 265 skilled workers from Work Projects Administration jobs in Minneapolis? The specific question of a black bias from white norms is but one example of the general principle confronting psychologists "not to interpret an obtained score with reference to a set of norms that is inappropriate for the individual tested or for the purposes of the testing" (American Psychological Association, 1974, p. 70). Gynther (1972) has championed the position that MMPI norms should be developed for blacks, basing his argument on two types of black-white comparisons. He has shown, first, that normal blacks, compared with normal whites, score consistently higher on MMPI scales Infrequency (F), Psychopathic Deviate (Pd), and Hypomania (Ma). Gynther stated that such elevations do not indicate personality disorder but, rather, are a sign of cultural alienation associated with the black minority experience of living in a white majority culture (e.g., Harrison & Kass, 1967; McDonald & Gynther, 1962, 1963). Second, Gynther has shown that maladjustment measured by the MMPI is greater for black than for white psychiatric samples—but his evidence is not consistent (cf. Gynther, 1972, p. 398; Gynther, Altman, &Warbin, 1973). Findings by other investigators studying black-white MMPI differences among abnormal groups have similarly been inconclusive (e.g., Costello, Fine, & Blau, 1973; Costello, Tiffany, & Gier, 1972; Cowan, Watkins, & Davis, 1975; Davis & Jones, 1974; Elion & Magargee, 1975; Watkins, Cowan, & Davis, 1977; Marks et al., Note 2). Such potentially confounding background characteristics as education and socioeconomic status (SES) have not always been controlled, and when controls have been introduced, it has not been clear whether samples were rendered unrepresentative for the popu-
lation to which conclusions were generalized (cf. Meehl, 1970). In fact, investigators testing the question in field settings have yet to face the reality that ethnic subgroups within a particular clinical sample may be disproportionately attracted to treatment settings. There are now, in addition, two new lines of research findings complicating the question of ethnic bias in personality assessment. First, results from tests not regarded as culturally biased have shown that certain clinical samples of blacks—particularly those from lower educational and SES levels—evidence greater maladjustment; the findings make intuitive sense, considering deprivation deleteriously affects personality development (cf. Warheit, Holzer, & Arey, 1975). Second, blacks actually appear better adjusted than whites in at least one clinical sample—compulsive heroin users. Earlier studies based on interviews have suggested that black drug users evidence less psychopathology than white drug users (cf. Chein, Gerard, & Lee, 1964; Nail, Gunderson, & Arthur, 1974). Previous MMPI studies show that black heroin users either do not differ or do not score lower than white heroin users (e.g., Gilbert & Lombardi, 1967; Hill, Haertzen, & Glaser, 1960; Penk & Robinowitz, 1974). The present study was undertaken to examine the generality of these findings. The purpose was to assess the question of a black bias in the MMPI by comparing black and white compulsive heroin users. Method Subjects Two samples of subjects were drawn from a data pool of male veterans consecutively admitted to a drug dependence treatment program (DDTP) of a VA general medical and surgical hospital. Between 1972 and 1976, 263 black and 124 white heroin users were routinely evaluated by white examiners in group assessment sessions (Jernigan, 1975) the day after beginning a methadone treatment program. Race was classified from each subject's selfdescription on a biographical inventory item. Criteria for subject selection were the following: First, only volunteers for treatment were included.1 1 Previous research has shown that the volunteernonvolunteer dimension in admission status should
BLACK-WHITE MMPI DIFFERENCES Second, only heroin users admitted for the first time to the local DDTP were selected (in order to avoid unknown effects of differential treatment experience). Third, both a larger sample of subjects who completed the first day's quota of tests (i.e., a biographical inventory, a drug history questionnaire, and the MM'PI, Form R) and a smaller subgroup who on the second day completed the Progressive Matrices (PM 1938; Raven, 1941), measuring intellectual (IQ) functioning, were included. Attrition rates ran somewhat higher for blacks, but not significantly: 3% refused testing (4 white and 11 black); 8.33% (21 of 252) blacks, compared with 6.33% (8 of 120) whites, produced "invalid" MMPI profiles (defined as Lie (L) > T score 70, F > 90, and/or Defensiveness (K) > 70). Of those completing the MMPI, 33.73% (84 of 252) blacks, compared with 21.66% (26 of 120) whites, did not complete the IQ test and/or did not specify SES data—'blacks more than whites did not give father's occupation, the SES measure. Data were analyzed first for all MMPIs disregarding profile validity or covariates and second for the subgroup of MMPIs with valid profiles and covariates. Since results were similar under all possible separate and combined comparisons, the findings are presented simply for (a) uncontrolled groups, in which covariates and profile validity were allowed to vary, and for (b) controlled groups, in which both covariates and profile validity were controlled. Blacks did not differ from whites on potentially confounding variables. Compulsive heroin use refers to the average of 3.4 years of reported heroin use, users injecting an average of three "papers" a day (about one and a half grams of "street" heroin). Estimates of duration and dosage are assessed rigorously before admission to treatment through screening interviews and laboratory tests (partly because methadone is hazardous for persons inexperienced in opiate use and partly because Federal Drug Administration regulations require evidence of at least 2 years of daily, intravenous heroin use
be controlled. As a consequence, those heroin users sent to the local DDTP shortly before military discharge (i.e., the one kind of "nonvolunteer") were omitted from the present analysis; these findings will be discussed in a separate paper examining a replication of previous volunteer-nonvolunteer findings among black subjects. The presently available sample size of 18 black nonvolunteers was not sufficiently large to permit the multivariate analysis of covariance design with 13 dependent MMPI variables. Black-white nonvolunteer comparisons will be made when sample size permits. Results of a multivariate analysis of variance performed for both volunteers and nonvolunteers combined (179 whites and 281 blacks) yields a significant Wilk's A = .929, F(13, 446) = 2.64, p < .001; black volunteers and nonvolunteers averaged lower on overall MMPI profile than white volunteer and nonvolunteer compulsive heroin users.
507
before methadone can be prescribed). Beginning methadone dosage averaged 35 mg, usually in 25mg units with 10 mg available as needed. Heroin duration was shorter than reported in other studies, presumably because multiple-admission users, who are older and who report longer heroin use, were not included for study. Means for relevant subject characteristics were: for age, 27.96 years; for education, 11.75 years; for Wechsler Adult Intelligence Scale equivalency, 102.68 (using Burke's, 1972, Raven norms); and for SES, lower middle class, or 4.05 of a 7-point scale rating father's occupation. Group differences increased but were controlled when analysis of covariance (ANCOVA) was performed for the subgroups: Whites were slightly younger (28.20 vs. 30.95), slightly lower in SES (3.98 vs. 4.95), and somewhat brighter (107.83 vs. 98.66).
Procedures Admission MMPI responses were scored for validity and clinical scales (Hathaway & McKinley, 1951) and for content scales (Wiggins, 1966), the measures are listed in Tables 1 and 2. Content scales were compared to determine whether ethnic differences occur for intuitively derived scales. (Some think that content scales are more stable and less situationally bound to treatment settings of subjects' origins than are empirically derived clinical jcales developed through "contrasted-groups" methods [e.g., Mezzich, Damarin, & Erickson, 1974]).
General Experimental Tactics The hypothesis was tested that black heroin users score lower on the MMPI than do white heroin users, contrary to findings among psychiatric patients. If the MMPI is not biased, then black heroin users should score significantly lower than whites (of. Nail et al., 1974). If the MMPI is biased, however, then black heroin users should score higher (or possibly the two groups would not differ significantly, given, hypothetically, that whites were more disturbed than blacks). Samples were analyzed first with and then without controls. A general question was asked first, Do consecutively admitted blacks and whites differ on the MMPIs? Multivariate analysis of variance (MANOVA) and univariate analysis of variance (ANOVA) were performed with race as the main effect (Cohen & Burns, Note 3); neither MMPI validity scale scores nor covariates were controlled. Then a second, more specific question was asked, Can black-white differences be eliminated by controlling statistically both nonracial covariates (age, IQ, and SES) and MMPI profile validity? Multivariate analysis of covariance (MANCOVA) and univariate analysis of covariance (ANCOVA) were performed (Cohen & Burns, Note 3) for the smaller subset (i.e., 223 of 372, or 60%), who completed both the SES item and the IQ test along with the
508
PBNK, WOODWARD, ROBINOWITZ, AND HESS
MMPI. Age, SES, and IQ were selected as covariates because they have been found to bias sampling in ethnic studies (cf. Marks et al., Note 2, on covariates and Costello et al., 1972, on validity). Race effects on MMPI scores were analyzed after linear adjustments were made for covariates. (Tables of beta weights and significance levels for each covariate with adjusted cell means are available upon request.) A third question was addressed implicitly by this design, What are the practical and theoretical consequences of these findings with regard to heroin addiction? By asking whether personalities of compulsive heroin users differ as a function of ethnicity, one indirectly questions, for example, the pertinence of the predisposing, "addiction-prone" personality issue (cf. Platt & Labate, 1976). 2
Results The hypothesis is supported. Black heroin users score significantly lower on the MMPI than white heroin users. Blacks score lower on empirically developed clinical scales and intuitively derived content scales. Blacks score lower both for experimentally and statistically controlled and uncontrolled comparisons. Means and standard deviations (i.e., /sT-corrected raw scores of groups with and without control for profile validity and covariates) are presented in Tables 1 (the clinical scales) and 2 (the content scales). Clinical Scale Comparisons The extent to which blacks score lower than whites is reflected in a MANOVA performed to determine whether group MMPI profiles differ in overall analysis. Wilk's lambda for this MANOVA was significant, A = .988, ^(13, 358) =3.88, p< .00001. Blacks scored significantly lower on 7 of 13 scales—Depression ( D ) , Hysteria (Hy),Pd, Masculinity-Femininity (Mf), Psychasthenia (Pt), Schizophrenia (Sc), and Social Introversion (Si)—and higher on L and K in ANOVA comparisons when neither validity nor covariates were controlled (see Table 1, columns 3-6). White heroin users elevated five scales above T score 70: D, Pd, Pt, Sc, and Ma; blacks elevated three: D, Pd, and Sc. Although both groups registered moderate distress with depression and nervousness (high D) for persons who are irritable and hostile (high Pd) and socially alienated
(high Sc), whites evidenced even more pronounced personal difficulties, as well as excessive worry and overideational rumination (higher Pt), along with hyperactivity and tenseness (higher If a). Blacks also scored lower than whites when validity and covariates were controlled (Table 1, columns 7-10). MANCOVA yields a significant difference, Wilk's A = .870, F(13, 206) =2.36, p< .006. The introduction of statistical control of covariates and profile selection criteria does not alter the relationship between group means, unlike previous black-white psychiatric comparisons (e.g., Costello et al., 1972). MMPI scores average lower when invalid profiles are removed and covariates are controlled, but blacks still scored significantly lower on 6 of 13 scales in ANCOVA comparisons, F, D, Pd, Pt, Sc, and Si (see Table 1, columns 710). Removal of invalid profiles sharpens group differences: Whites elevated D, Pd, Pt, Sc, and Ma, whereas blacks elevated only Pd. Blacks registered higher negativism and social nonconformity (Pd), whereas whites evidenced appreciably more difficulty, express social nonconformity, along with more pronounced pessimism (higher D), anxiety (higher Pt), social alienation (higher Sc), and excitability and restlessness (higher Ma). Content Scale Comparisons These results, though similar, are not as clear-cut. Blacks tended to score lower than whites on content scales. Wilk's A from the MANOVA is .669, F(13, 337) = 12.82, p < .00001. Blacks scored lower than whites in S of 13 ANOVA comparisons, Social Maladjustment, Depression, Poor Morale, Family 2 Only two of five possible comparisons are presented in this study. Three comparisons resulting in identical findings were omitted in the hopes of simplifying the presentation: (a) the total sample of black versus white volunteers and nonvolunteers combined (see Footnote 1 for an overall MANOVA); (b) black and white volunteer subjects with only profile validity controlled; and (c) black and white volunteer subjects with only the covariates controlled (but not profile validity). Blacks scored significantly lower than whites in all comparisons.
BLACK-WHITE MMPI DIFFERENCES Problems, and Hostility, and higher on three scales, Feminine Interests, Religious Fundamentalism, and Phobias. The groups did not differ significantly on Authority Conflict,
509
Psychoticism, Organicity, Hypomania, or Poor Health (see Table 2; columns 2-6). Comparisons are similar when controlling covariates and profile validity (Table 2, col-
Table 1 Means, Standard Deviations, A NOVA, and ANCOVA F Ratios of Clinical Scales for Uncontrolled and Controlled Black- White Compulsive Heroin Groups Uncontrolled MMPI scale
Controlled
White"
Black"
F
P
White"
Black"
F
P
3.06 1.80
3.83 2.26
10.63
.001
2.98 1.91
3.75 1,99
3.60
.059
12.51 7.44
10.81 8.29
3.43
.065
11.61 5.90
8.72 5.86
13.70
.000
11.20 4.52
12.28 4.79
4.29
.039
11.15 4.34
12,61 4,51
2.43
.120
18.92 6.35
18.60 6.58
.19
.656
18.53 6.29
18.07 6.25
2.53
.113
27.63 6.37
25.39 6.47
9.93
.002
27.47 5.88
24,70 6.34
14.64
.000
25.93 5.83
24.44 6.61
4.47
.035
25.36 5.91
24,09 6.33
3.50
.063
31.06 4.59
28.92 4.67
17.28
.001
30.95 4.50
29.20 4,43
7.79
.005
26.40 4.61
25.35 4.88
3.88
.049
26.83 4.57
25.11 5.16
.82
.377
13.43 4.69
12.59 5.32
2.13
.145
13.20 4.17
11.71 4.74
3.45
.065
34.02 8.12
31.72 7.66
7.02
.008
33.77 7.79
30.77 7.31
11.05
.001
36.71 11.32
34.23 11.08
4.05
.045
35.95 10.65
32.29 9.72
9.72
.002
25.53 5.30
24.62 4.71
2.80
.095
25.36 5.45
24.50 4.64
.83
.365
32.32 10.75
29.06 8,56
9.96
,002
32.06 10.54
27.98 8.35
12.93
.000
Lie
M SD Infrequency M SD Defensiveness
M SD H ypochondriasis
M SD Depression M SD Hysteria M
SD Psychopathic deviate M SD Masculinity-Femininity
M SD Paranoia M SD Psychasthenia
M SD Schizophrenia M SD Hypomania
M SD Social Introversion
M SD
Note. Means are J£-corrected raw scores. Controlled- means groups in which covariates were controlled and in which only "valid" MMPI profiles were used (see Results section). • » - 120. b n = 252. •«- 87. d n - 136.
510
PENK, WOODWARD, ROBINOWITZ, AND HESS
Table 2
Means, Standard Deviations, ANOVA, and ANCOVA F Ratios of Content Scales for Uncontrolled and Controlled Black-White Compulsive Heroin Groups Controlled11
Uncontrolled Whiteb
Black0
F
P
Whited
Black"
F
P
12.53 6.45
10.02 4.96
16 22
.001
12.37 6.42
9.20 4.57
17.04
.000
14.97 7.47
12.54 6.36
1(U1
.002
15.19
12.04 6.23
12.99
.000
9.18 3.32
11.27 3.28
31 6S
.001
8.98 3.18
11.07 3.31
21.51
.000
11.91 5.94
10.28 5.59
6 37
,012
12.08 5.97
10.15 5.46
4.64
.032
4.96 2.81
5 91
' 2.44
10 75 10J5
.001
5.06 2.94
5.89 2.47
2.08
.150
14.54 3.45
14.53 3.25
' UI
.969
3.39
14.71 2.89
.04
.849
14.92 8.38
15.02 8.66
' U1
.913
14.70 7.66
13.57 7.11
.36
.552
12.05 7.16
10 78
' 7.38
2 38 "8
.124
'i5
9.70 6.91
7.64
.006
8.17 3.10
2'85
22 30
.000
7.98 2.93
6.39 2.69
9.68
.002
Hostility M SD
13.03 5.34
11.78 4.65
S 18
.024
12.87
11.57 4.60
3.11
.080
Phobias M SD
7.37 4.07
424
13 26
.000
6.80 3.80
9.11 4.30
8.82
.003
Content scales" Social Maladjustment M SD Depression M SD Feminine Interests M SD Poor Morale M SD Religious Fundamentalism M SD Authority Conflict M SD Psychoticism M SD Organicity M SD Family Problems M SD
'
,
'
„
'
'
'
'
Hypomania M SD
15.58 4.13
14 67
' 4.27
57 3357
.060
14.52 4.25
1.52
.219
Poor Health M SD
•ts
10.29 4.95
10.11 5.20
>uy
.760
10.35 4.56
9.74 5.03
1.80
.180
'
Note. Means are raw scores. Controlled means groups in which covariates were controlled and in which only "valid" MMPI profiles were used (see Results section). a Definitions of content scales are given in the text. Sample sizes for content scales are somewhat smaller than for clinical scales because 28 subjects did not complete all of the items between statements 399 and 566 of MMPI, Form R, in which content scales items were clustered. » » = 118. ° n = 233. d » = 86. >n = 131.
BLACK-WHITE MMPI DIFFERENCES
umns 7-10). Wilk's A from the MANCOVA is significant, A = .633, F(13, 212) = 8.91, p < .0001, groups differing in mean profiles. White heroin users scored significantly higher on Social Maladjustment, Depression, Poor Morale, Organicity, Family Problems, and Hostility; blacks scored significantly higher on Feminine Interests and Phobias. Whites expressed greater interpersonal difficulties on content scales (noting content scales above 60 are considered "elevated," as clinical scales above 70 are considered "elevated," Wiggins, 1966). High Social Maladjustment (equivalent to T score 63) suggests shyness, reticence, and self-consciousness (cf. Si). Higher Family Problems (near 67) indicates unpleasant, unloving, and disturbed parental home life (correlating with emotional immaturity; Wiggins, Goldberg, & Appel'baum, 1971). Blacks scored significantly higher on scales reflecting intrapersonal difficulties. Higher Feminine Interests (averaging near 56) may reflect a set to endorse many socially sanctioned interests; higher scores may indicate a desire to be more "cultured" (Wiggins, 1966). Higher Phobias (near 57) suggests more neuroticlike fears (although the community climate for blacks may be more dangerous). Whites, then, scored higher on two content scales traditionally indicating maladjustment (i.e., Social Maladjustment and Family Problems, Wiggins, 1966, p. 27). Only one of the two scales on which blacks scored higher (i.e., Phobias) is considered a classical indicator of maladjustment. Discussion What then are the practical implications of these findings? A call for "renorming" the MMPI has gradually grown over the last 20 years, since investigators have increasingly noticed that minority group members systematically average five or so T score points higher on several MMPI scales than do majority group members. This call was based on differences similar in magnitude to black-white differences in this study, except that now whites have scored higher. Should one follow historical precedence and ask that
511
the MMPI be renormed for white heroin users or should one conclude that the white heroin user is more maladjusted? Probably neither, yet. It is tempting to conclude that MMPI elevations by whites indicate greater maladjustment. Although our clinical observations support this point, nevertheless there are other explanations which must first be ruled out. For one thing, whites may have expressed vulnerabilities more readily to white examiners than may blacks. Or, whites may more readily have adopted an "impression management" stance in a VA hospital, finding it easier to project a "sick-role" that was thought to be demanded by the VA as an institution representative of the majority culture. Such speculations must be ruled out based on external criteria and behavioral correlates of elevated MMPI scores before concluding whites are more maladjusted. For the present, clinicians must continue to establish local norms for tests along with behavioral referents for their treatment settings. The issue of black-white MMPI differences, however, has not been answered; rather, more questions have been raised by finding that black-white MMPI differences vary as a function of clinical groups studied. Further, the black-white MMPI content scale differences have weakened any claim that the empirical, contrasted-groups method of clinical scale construction provides an ethnic bias. The issue of ethnic differences is shown now to be more difficult to untangle than originally supposed. The question cannot be answered simply by comparing one kind of clinical sample from one kind of treatment setting; the issue must be studied as an interaction of clinical groups, clinical settings, and ethnicity, as suggested many years ago (Miller et al., 1961). Minority (and majority) groups use treatment settings and services so selectively that studies conducted in field settings are vulnerable to sampling biases from differential utilization. We still have much to learn about parameters in sampling before we can say a test is biased.
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PENK, WOODWARD, ROB1NOWITZ, AND HESS
The findings have implications for research and program evaluation; studies of treatment effectiveness might be biased if ethnic differences are not controlled or assessed. These findings also have implications for treatment programming. White heroin users display more social maladjustment, generally—that is, more conflicts with parents, those in authority, and prevailing cultural values. Black heroin users, beset more with personal fears and neuroticlike concerns over passivity, are seen as striving to actualize potentials, as struggling to reach goals valued by the majority culture (cf. "feminine interests" apparently regarded as representative of successful enculturation). These ethnic differences may require different nuances in treatment: for whites, increased family therapy with regard to interpersonal difficulties; for blacks, more education, particularly of skills for "making it" in the mainstream. What are the theoretical implications? These results contraindicate the notion that one kind of personality is addiction prone. Although a theory of heroin addiction cannot be generated from the limited aspects of personality operationalized by the MMPI, we have demonstrated at least one criterion by which any theoretical formulation must be assessed, that is, any theory of addiction must be sufficiently complex to account for variety in personality traits and types and for variety in levels of adjustment. Theory construction must await several developments in the study of addiction behavior—for example, the charting of life span changes, identifying a variety of personality types associated with compulsive heroin use, understanding the role of drugs for the person, and the interaction of personality variables with cognitive, social, and environmental variables. As investigators begin to discern such heterogeneity in personality, the identification of ethnicity as one significant subject parameter serves at least as one dimension for locating uniformity and order in a complex picture. Reference Notes 1. Gynther, M. D. Ethnicity and personality: Recent findings. Paper presented at the 12th An-
nual MMPI Symposium, St. Petersberg, Florida, February 3, 1977. 2. Marks, P. A., Bertelson, A. D., & May, G. D. Race and MMPI: Some new findings and considerations. Manuscript submitted for publication, 1977. 3. Cohen, E., & Burns, P. SSPS update for CDC users: MANOVA and MANCOVA, a preliminary edition. Manuscript in preparation, Vogelback Computer Center, Northwestern University, May, 1976.
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