VOL. 2, NO. 1,1976
on teaching about research in schizophrenia* Mary D. Carpenter
In the summer of 1974 I read with academic interest weekends. For these reasons I felt a textbook was "Teaching About Schizophrenia" by Dr. Ronald O. needed. Maher's Principles of Psychopathology: An ExRieder in the Schizophrenia Bulletin. A year later I had perimental Approach contained more material on schizothe opportunity to teach a related course entitled phrenia research than any other book I examined. Chap"Research in Schizophrenia" during the summer session ters 12 through 15 summarized and discussed many of the Graduate School of Arts and Science at New York studies that examine the familial, biological, and genetic University. I then reread Dr. Rieder's article with greater determinants of schizophrenia as well as studies of definterest although my course approached schizophrenia icits in sensation, perception, learning, language, and from a different perspective. Dr. Rieder's course was thought This book also provided a review of learning designed to inform an educated public about the theory and could be used as an abnormal text as well; subjective experience, diagnosis, and treatment of hence, it was my choice. I supplemented the text with reprints, xeroxed handouts, and articles placed on schizophrenia as well as research in the field. My primary goal, however, was to cover in detail reserve in the library. For those students with greater those topics necessary for students who planned to write interest or time, I provided a list of suggested readings. I their Ph.D. thesis using schizophrenic subjects, although used the reviews of schizophrenia research in the SchizoI was aware that many students who elected this course phrenia Bulletin to bring Maher's 1966 textbook up to did not have this in mind. My secondary goal was to date (Gunderson, Autry, and Mosher 1974 and Mosher teach these students, many of whom planned to be and Gunderson 1973). A topical course outline follows with some of the therapists, to read published studies with a more critical eye. While the material I presented dealt specifically reading assignments that were added to those in the textwith schizophrenics (or their families), I also hoped that book. a deeper understanding of the problems involved in 1. Ethical considerations in research with psychiatric studying this diagnostic group would facilitate research patients. with any other abnormal population. American Psychological Association. Ethical Like Dr. Rieder, I used films, required my students to Principles in the Conduct of Research With Human diagnose case histories, and invited a therapist to talk to Participants. Washington, D.C.: APA, 1973. my class. Many of Dr. Rieder's references were useful to Romano, J. Reflections on informed consent. me although I did not emphasize therapy or the subjecArchives of General Psychiatry, 30:129-135,1974. tive experience of schizophrenia in my class. 2. Theoretical models underlying research. Sixteen students elected to take the course, representReadings from text. ing a wide range of interests and preparation. Most of 3. Diagnosis and subtypes: them were psychology students, though one was studying law, another pharmacology, and another dance • Clinical definitions of schizophrenia vs. a retherapy. Many had a strong background in psychology search diagnosis while others were transferring to psychology from other • Good vs. poor premorbid schizophrenics (procdisciplines and lacked basic courses such as abnormal ess/reactive) psychology or learning theory. Although the majority • Acute vs. chronic had never known a schizophrenic, three were attendants • Paranoid vs. nonparanoid in psychiatric hospitals. Readings included: Serious complications resulted from the facts that Spitzer, R. L ; Endicott, J.; and Robins, E. most of the students had full-time jobs, that the summer Research Diagnostic Criteria for a Selected Group term was relatively short, and that the library closed on of Functional Disorders. 1st ed. Biometrics Research, New York State Department of Mental Hygiene, 722 West 168th Street, New York, N.Y., •Reprint requests should be addressed to the author at 175 Ninth Ave., New York, N.Y. 10011. 1974.
SCHIZOPHRENIA BULLETIN
Bromet, E.; Harrow, M.;and Kasl, S. Premorbid functioning and outcome in schizophrenia and nonschizophrenia. Archives of General Psychiatry, 30:203-207,1974. Gittelman-Klein, R., and Klein, D. F. Premorbid asocial adjustment and prognosis in schizophrenia. Journal of Psychiatric Research, 7:35-53, 1969. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (DSM II) 2d ed. Washington, D.C.: APA, 1968. Strauss, M. E. Behavioral differences between acute and chronic schizophrenics: Course of psychosis, effects of institutionalization or sampling biases? Psychological Bulletin, 79:271-279, 1973. . Ralph, D. E., and McCarthy, J. F. Who are paranoid schizophrenics: A brief comment Psychological Reports, 22:193-194,1968. Depue, R. A., and Woodburn, L. Disappearance of paranoid symptoms with chroniaty. Journal of Abnormal Psychology, 84:84-86,1975. 4. Methodological problems. Daston, P. G. Effects of two phenothiazine drugs on concentrative attention span of chronic schizophrenics. Journal of Clinical Psychology, 15:106-109,1959. 5. Examples of studies in the field: • • •
Experimental Field Survey
Readings included: Mednick, S. A., and McNeil, T. F. Current methodology in research on the etiology of schizophrenia: Serious difficulties which suggest the use of the high-risk groups method. Psychological Bulletin, 70:681-693,1968. Mednick, S. A. Breakdown in individuals at high risk for schizophrenia: Possible predispositional perinatal factors. Mental Hygiene, 54:50-63, 1970. Curran, W. J. Ethical and legal considerations in high risk studies of schizophrenia. Schizophrenia Bulletin, No. 10:74-92, Fall 1974. Blumenthal, R., and Carpenter, M. D. The effects of population density on the overt behavior of mental patients. Journal of Psychiatric Research, 10:89-100,1974. Carpenter, M. D. Sensitivity to syntactic structure: Good vs. poor premorbid schizophrenics. Journal of Abnormal Psychology, 85:41-50,1976.
The course began with one class session on ethical considerations in pursuing research with mental patients, such as informed consent and confidentiality. The ethical principles compiled by the American Psychological Association were xeroxed and handed out to the class. Ethical questions reappeared from time to time during the term. When Mednick's study of high risk children was presented, for example, we also read Curran's (1974) article, "Ethical and Legal Considerations in High Risk Studies of Schizophrenia." The students became conscious of ethical problems when reading not only journals but also the daily newspaper. They realized, some for the first time, that research involves the general public as well as scientists. The next session dealt with theoretical models underlying research, with some emphasis on the psychoanalytic and medical models, which Maher dismisses rather abruptly. I wanted a satisfactory summary article of schizophrenia research based on the psychoanalytic model, but I did not find one. Then several sessions were devoted to the discussion of research diagnoses of schizophrenia. I pointed out how unsatisfactory clinical diagnosis, as defined by the American Psychiatric Association's diagnostic manual (DSM II), has been to researchers. Clinical diagnosis varies from hospital to hospital, from unit to unit in the same hospital, and from therapist to therapist in the same unit Nor do clinical diagnoses appear to define a homogenous population. In frustration, various investigators have struggled to formulate their own definitions of schizophrenia and subtypes. For example, Klein and Davis (1969) compiled a list of symptoms indicative of schizophrenia and divided schizophrenics into childhood asocial, fearful paranoid, and schizoaffective subtypes. Also Salzinger (1973) would prefer to classify patients by the application of a behavioral analysis including such objective data as their performance on certain laboratory tasks (e.g., tapping or rate of conditioning). The Spitzer, Endicott, and Robins (1974) Research Diagnostic Criteria (RDC) were distributed to the class and discussed at some length as a viable classification system. The definitions of the subcategories of acute and chronic schizophrenia presented by the RDC were compared with the common use of the term acute to indicate those recently ill, and the term chronic to indicate those whose illness has been present for a long period of time. Acute according to these investigators defines clear-cut episodes of schizophrenia with symptom remission in between attacks, whereas chronic schizophrenia indicates symptoms more or less continuously present The paranoid subtype was also discussed, and questions were raised about its absence in chronic groups:
VOL.2,NO.1,1976
Does a paranoid schizophrenic recover from his illness, or does his diagnosis change over time? Reference was made to the article by Depue and Woodburn (1975). The newer subdivisions of schizophrenia—process/reactive and the closely related good/poor premorbid—were discussed in detail. Scales measuring these dimensions were xeroxed and distributed in class. The Elgin Scale (Wittman 1941), one of the earliest scales to be used to separate process and reactive patients, was examined first, along with the problems that arise from its use. The Phillips Scale (1953) was then seen as an improvement by the class. Finally, the Gittelman-Klein Scale (Gittelman-Klein and Klein 1969) of asociality, which allows schizophrenics to be classified as good or poor premorbid, was seen to provide certain advantages. This scale, which measures asociality in childhood, and again in adolescence, correlates highly with prognosis. It allows the investigator to classify a much younger schizophrenic population than does the Phillips Scale. After the class became relatively familiar with diagnostic classification, they received case histories (Stone 1943) from which the diagnosis had been deleted. Students were asked to judge on the basis of each history whether schizophrenia was present according to the RDC, and if present, to rate each patient acute or chronic, paranoid or nonparanoid. The patient was also classified as having a good or poor premorbid history based on the Gittelman-Klein Scale of Asociality. Using these instruments, the class showed a very considerable amount of agreement on each diagnosis. I explained to the students that most beginning researchers (as well as more experienced ones if a diagnostic interview is impractical) must select their subjects from the patient population by reading case histories in hospital charts. A further hour was spent on methodological problems specific to this research. Some of the topics covered were medication, sample shrinkage, and the possible confounding of the effects of illness with social class, education, age, or long-term hospitalization. With the preceding as a background, we then examined in detail several experimental, field, and survey studies in schizophrenia. High risk research, especially Mednick's studies, seemed to bring many concepts together for the class. Mednick's approach involved ethics, selecting a research population, behavioral techniques, genetics, and many methodological problems. I also selected several studies in which I was personally involved because I had experienced firsthand the problems that had arisen. This focus allowed me to talk about 1) the difficulties in establishing reliability among raters in a study of an intensive care unit; 2) the issues of reactivity: When raters first entered the unit, they
grossly disturbed the behavior they sought to measure and it was therefore necessary for their appearance to become so commonplace that the patients ceased to react before the data collection could begin; 3) the problem of dropouts in an experimental study: Negative patients who certainly could do the task but would n o t We discussed such routine procedures as consent forms and scheduling patients as well as how much cooperation you can expect from schizophrenics: How soon does fatigue set in? A study currently in process involves interviewing therapists who support chronic schizophrenics in the community. One very cooperative therapist agreed to be interviewed in front of the class. This demonstration gave students a chance to follow a structured interview and to encounter difficulties in compressing the information received into a given format Incidentally, it also gave them a chance to ask questions about therapy with schizophrenics in general since the course seldom dealt with the clinical or therapeutic approach. Limitations of, and generalizations from, all of these studies were discussed at some length. No patients were personally interviewed before this class. Ethical as well as practical considerations ruled out this possibility. Several movies, however, were shown. The New York University Film Library provided films of interviews with simple, paranoid, and catatonic schizophrenics. The Sandoz Drug Company kindly provided a film of a mental hospital in France, Drug Therapy in Psychiatry (Delay et al., no date given). Also a tape was played on which several schizophrenic patients and one manic patient were heard discussing proverbs. The schizophrenics revealed typical concrete approaches to abstract ideas with many tangential answers and idiosyncratic thoughts. I required a paper in place of a final examination. A list of suggested topics was provided, but I encouraged the students to select any aspect of schizophrenic research that interested them. I asked the students to examine critically at least 10 articles in a given area and to outline roughly an experiment that would further the understanding of problems raised by these studies. While considering the direction future research might take, they were to keep in mind all we had discussed earlier in the course. Several class sessions were devoted to the reading of these reports. For many, this activity proved to be the most exciting part of the course. A student would review the literature on his topic and present his ideas for future research while the rest of the class would question him sharply. Who would be in his control groups? Why did he choose chronic subjects? How would he define
SCHIZOPHRENIA BULLETIN
hallucinatory behavior? All students reported this giveand-take to be quite stimulating. Most admitted, however, that this excitement would not have occurred without the previous work. Of course, I asked for and received feedback on the course. A major complaint was the use of a textbook in a graduate seminar. But when I asked for their objections chapter by chapter, most decided the four chapters on schizophrenia were valuable. The earlier chapters reviewing learning theory appeared to have helped a few— and interested others who knew the theory but had never thought of applying it to psychopathology. The only alternative to a textbook suggested was to take up a collection and xerox a number of articles instead of using a text as a basic source. I think I would use the same book again, however, but would designate the first chapters as optional reading. The students also suggested that more time be given to the student reports, and I will plan for this when I teach the course again. From my point of view I feel a great need for more up-to-date films illustrating different diagnostic symptoms. The films shown were old, and those students who were experienced in working with mental patients found them slightly humorous. The antiquated clothes and manners made the schizophrenics appear misleadingly different. Moreover, as one student pointed out, patients were shown lying in the sun when presumably they were on chlorpromazine! Next time I shall try other films. I would be interested in hearing from anyone who teaches, or has taken, a course similar to this one. Comments and suggestions would be most welcome. References Delay, J.; Deniker, P.; Volmat, R.; and Layrie, J. Drug Therapy in. Psychiatry. East Hanover, N. Y.: Sandoz Medical Film Library. No date given. Gunderson, J. G.; Autry, J. H. Ill; and Mosher, L. R. Special report: Schizophrenia, 1974. Schizophrenia
Bulletin, 1 (Experimental issue no. 9):16-54, Summer 1974. Klein, D. F., and Davis, J. M. Diagnosis and Drug Treatment of Psychiatric Disorders. Baltimore: The Williams & Wilkins Company, 1969. Maher, B. A. Principles of Psychopathology: An Experimental Approach. New York: McGraw-Hill, Inc., 1966. Mosher, L. R., and Gunderson, J. G. Special report: Schizophrenia, 1972. Schizophrenia Bulletin, ^Experimental issue no. 7): 12-52, Winter 1973. Phillips, L. Case history data and prognosis in schizophrenia. Journal of Nervous and Mental Disease, 117: 515-525,1953. Salzinger, K. Schizophrenia: Behavioral Aspects. New York: John Wiley & Sons, Inc., 1973. Spitzer, R. L ; Endicott, J.; and Robins, E. Research Diagnostic Criteria for a Selected Group of Functional Disorders. 1st ed. Biometrics Research, New York State Department of Mental Hygiene, 722 West 168th Street, New York, N.Y., 1974. Stone, C. P. Case Histories in Abnormal Psychology. Stanford, Calif.: Stanford University Press, 1943. Wittman, P. A scale for measuring prognosis in schizophrenic patients. Elgin State Hospital Papers, 4:20-33, 1941.
The Author Mary D. Carpenter, Ph.D., is Senior Research Scientist, Community Research Program, New York State Department of Mental Hygiene, and Adjunct Assistant Professor of Psychology, New York University, New York, N.Y.
on teaching about research in schizophrenia* Mary D. Carpenter
In the summer of 1974 I read with academic interest weekends. For these reasons I felt a textbook was "Teaching About Schizophrenia" by Dr. Ronald O. needed. Maher's Principles of Psychopathology: An ExRieder in the Schizophrenia Bulletin. A year later I had perimental Approach contained more material on schizothe opportunity to teach a related course entitled phrenia research than any other book I examined. Chap"Research in Schizophrenia" during the summer session ters 12 through 15 summarized and discussed many of the Graduate School of Arts and Science at New York studies that examine the familial, biological, and genetic University. I then reread Dr. Rieder's article with greater determinants of schizophrenia as well as studies of definterest although my course approached schizophrenia icits in sensation, perception, learning, language, and from a different perspective. Dr. Rieder's course was thought This book also provided a review of learning designed to inform an educated public about the theory and could be used as an abnormal text as well; subjective experience, diagnosis, and treatment of hence, it was my choice. I supplemented the text with reprints, xeroxed handouts, and articles placed on schizophrenia as well as research in the field. My primary goal, however, was to cover in detail reserve in the library. For those students with greater those topics necessary for students who planned to write interest or time, I provided a list of suggested readings. I their Ph.D. thesis using schizophrenic subjects, although used the reviews of schizophrenia research in the SchizoI was aware that many students who elected this course phrenia Bulletin to bring Maher's 1966 textbook up to did not have this in mind. My secondary goal was to date (Gunderson, Autry, and Mosher 1974 and Mosher teach these students, many of whom planned to be and Gunderson 1973). A topical course outline follows with some of the therapists, to read published studies with a more critical eye. While the material I presented dealt specifically reading assignments that were added to those in the textwith schizophrenics (or their families), I also hoped that book. a deeper understanding of the problems involved in 1. Ethical considerations in research with psychiatric studying this diagnostic group would facilitate research patients. with any other abnormal population. American Psychological Association. Ethical Like Dr. Rieder, I used films, required my students to Principles in the Conduct of Research With Human diagnose case histories, and invited a therapist to talk to Participants. Washington, D.C.: APA, 1973. my class. Many of Dr. Rieder's references were useful to Romano, J. Reflections on informed consent. me although I did not emphasize therapy or the subjecArchives of General Psychiatry, 30:129-135,1974. tive experience of schizophrenia in my class. 2. Theoretical models underlying research. Sixteen students elected to take the course, representReadings from text. ing a wide range of interests and preparation. Most of 3. Diagnosis and subtypes: them were psychology students, though one was studying law, another pharmacology, and another dance • Clinical definitions of schizophrenia vs. a retherapy. Many had a strong background in psychology search diagnosis while others were transferring to psychology from other • Good vs. poor premorbid schizophrenics (procdisciplines and lacked basic courses such as abnormal ess/reactive) psychology or learning theory. Although the majority • Acute vs. chronic had never known a schizophrenic, three were attendants • Paranoid vs. nonparanoid in psychiatric hospitals. Readings included: Serious complications resulted from the facts that Spitzer, R. L ; Endicott, J.; and Robins, E. most of the students had full-time jobs, that the summer Research Diagnostic Criteria for a Selected Group term was relatively short, and that the library closed on of Functional Disorders. 1st ed. Biometrics Research, New York State Department of Mental Hygiene, 722 West 168th Street, New York, N.Y., •Reprint requests should be addressed to the author at 175 Ninth Ave., New York, N.Y. 10011. 1974.
SCHIZOPHRENIA BULLETIN
Bromet, E.; Harrow, M.;and Kasl, S. Premorbid functioning and outcome in schizophrenia and nonschizophrenia. Archives of General Psychiatry, 30:203-207,1974. Gittelman-Klein, R., and Klein, D. F. Premorbid asocial adjustment and prognosis in schizophrenia. Journal of Psychiatric Research, 7:35-53, 1969. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (DSM II) 2d ed. Washington, D.C.: APA, 1968. Strauss, M. E. Behavioral differences between acute and chronic schizophrenics: Course of psychosis, effects of institutionalization or sampling biases? Psychological Bulletin, 79:271-279, 1973. . Ralph, D. E., and McCarthy, J. F. Who are paranoid schizophrenics: A brief comment Psychological Reports, 22:193-194,1968. Depue, R. A., and Woodburn, L. Disappearance of paranoid symptoms with chroniaty. Journal of Abnormal Psychology, 84:84-86,1975. 4. Methodological problems. Daston, P. G. Effects of two phenothiazine drugs on concentrative attention span of chronic schizophrenics. Journal of Clinical Psychology, 15:106-109,1959. 5. Examples of studies in the field: • • •
Experimental Field Survey
Readings included: Mednick, S. A., and McNeil, T. F. Current methodology in research on the etiology of schizophrenia: Serious difficulties which suggest the use of the high-risk groups method. Psychological Bulletin, 70:681-693,1968. Mednick, S. A. Breakdown in individuals at high risk for schizophrenia: Possible predispositional perinatal factors. Mental Hygiene, 54:50-63, 1970. Curran, W. J. Ethical and legal considerations in high risk studies of schizophrenia. Schizophrenia Bulletin, No. 10:74-92, Fall 1974. Blumenthal, R., and Carpenter, M. D. The effects of population density on the overt behavior of mental patients. Journal of Psychiatric Research, 10:89-100,1974. Carpenter, M. D. Sensitivity to syntactic structure: Good vs. poor premorbid schizophrenics. Journal of Abnormal Psychology, 85:41-50,1976.
The course began with one class session on ethical considerations in pursuing research with mental patients, such as informed consent and confidentiality. The ethical principles compiled by the American Psychological Association were xeroxed and handed out to the class. Ethical questions reappeared from time to time during the term. When Mednick's study of high risk children was presented, for example, we also read Curran's (1974) article, "Ethical and Legal Considerations in High Risk Studies of Schizophrenia." The students became conscious of ethical problems when reading not only journals but also the daily newspaper. They realized, some for the first time, that research involves the general public as well as scientists. The next session dealt with theoretical models underlying research, with some emphasis on the psychoanalytic and medical models, which Maher dismisses rather abruptly. I wanted a satisfactory summary article of schizophrenia research based on the psychoanalytic model, but I did not find one. Then several sessions were devoted to the discussion of research diagnoses of schizophrenia. I pointed out how unsatisfactory clinical diagnosis, as defined by the American Psychiatric Association's diagnostic manual (DSM II), has been to researchers. Clinical diagnosis varies from hospital to hospital, from unit to unit in the same hospital, and from therapist to therapist in the same unit Nor do clinical diagnoses appear to define a homogenous population. In frustration, various investigators have struggled to formulate their own definitions of schizophrenia and subtypes. For example, Klein and Davis (1969) compiled a list of symptoms indicative of schizophrenia and divided schizophrenics into childhood asocial, fearful paranoid, and schizoaffective subtypes. Also Salzinger (1973) would prefer to classify patients by the application of a behavioral analysis including such objective data as their performance on certain laboratory tasks (e.g., tapping or rate of conditioning). The Spitzer, Endicott, and Robins (1974) Research Diagnostic Criteria (RDC) were distributed to the class and discussed at some length as a viable classification system. The definitions of the subcategories of acute and chronic schizophrenia presented by the RDC were compared with the common use of the term acute to indicate those recently ill, and the term chronic to indicate those whose illness has been present for a long period of time. Acute according to these investigators defines clear-cut episodes of schizophrenia with symptom remission in between attacks, whereas chronic schizophrenia indicates symptoms more or less continuously present The paranoid subtype was also discussed, and questions were raised about its absence in chronic groups:
VOL.2,NO.1,1976
Does a paranoid schizophrenic recover from his illness, or does his diagnosis change over time? Reference was made to the article by Depue and Woodburn (1975). The newer subdivisions of schizophrenia—process/reactive and the closely related good/poor premorbid—were discussed in detail. Scales measuring these dimensions were xeroxed and distributed in class. The Elgin Scale (Wittman 1941), one of the earliest scales to be used to separate process and reactive patients, was examined first, along with the problems that arise from its use. The Phillips Scale (1953) was then seen as an improvement by the class. Finally, the Gittelman-Klein Scale (Gittelman-Klein and Klein 1969) of asociality, which allows schizophrenics to be classified as good or poor premorbid, was seen to provide certain advantages. This scale, which measures asociality in childhood, and again in adolescence, correlates highly with prognosis. It allows the investigator to classify a much younger schizophrenic population than does the Phillips Scale. After the class became relatively familiar with diagnostic classification, they received case histories (Stone 1943) from which the diagnosis had been deleted. Students were asked to judge on the basis of each history whether schizophrenia was present according to the RDC, and if present, to rate each patient acute or chronic, paranoid or nonparanoid. The patient was also classified as having a good or poor premorbid history based on the Gittelman-Klein Scale of Asociality. Using these instruments, the class showed a very considerable amount of agreement on each diagnosis. I explained to the students that most beginning researchers (as well as more experienced ones if a diagnostic interview is impractical) must select their subjects from the patient population by reading case histories in hospital charts. A further hour was spent on methodological problems specific to this research. Some of the topics covered were medication, sample shrinkage, and the possible confounding of the effects of illness with social class, education, age, or long-term hospitalization. With the preceding as a background, we then examined in detail several experimental, field, and survey studies in schizophrenia. High risk research, especially Mednick's studies, seemed to bring many concepts together for the class. Mednick's approach involved ethics, selecting a research population, behavioral techniques, genetics, and many methodological problems. I also selected several studies in which I was personally involved because I had experienced firsthand the problems that had arisen. This focus allowed me to talk about 1) the difficulties in establishing reliability among raters in a study of an intensive care unit; 2) the issues of reactivity: When raters first entered the unit, they
grossly disturbed the behavior they sought to measure and it was therefore necessary for their appearance to become so commonplace that the patients ceased to react before the data collection could begin; 3) the problem of dropouts in an experimental study: Negative patients who certainly could do the task but would n o t We discussed such routine procedures as consent forms and scheduling patients as well as how much cooperation you can expect from schizophrenics: How soon does fatigue set in? A study currently in process involves interviewing therapists who support chronic schizophrenics in the community. One very cooperative therapist agreed to be interviewed in front of the class. This demonstration gave students a chance to follow a structured interview and to encounter difficulties in compressing the information received into a given format Incidentally, it also gave them a chance to ask questions about therapy with schizophrenics in general since the course seldom dealt with the clinical or therapeutic approach. Limitations of, and generalizations from, all of these studies were discussed at some length. No patients were personally interviewed before this class. Ethical as well as practical considerations ruled out this possibility. Several movies, however, were shown. The New York University Film Library provided films of interviews with simple, paranoid, and catatonic schizophrenics. The Sandoz Drug Company kindly provided a film of a mental hospital in France, Drug Therapy in Psychiatry (Delay et al., no date given). Also a tape was played on which several schizophrenic patients and one manic patient were heard discussing proverbs. The schizophrenics revealed typical concrete approaches to abstract ideas with many tangential answers and idiosyncratic thoughts. I required a paper in place of a final examination. A list of suggested topics was provided, but I encouraged the students to select any aspect of schizophrenic research that interested them. I asked the students to examine critically at least 10 articles in a given area and to outline roughly an experiment that would further the understanding of problems raised by these studies. While considering the direction future research might take, they were to keep in mind all we had discussed earlier in the course. Several class sessions were devoted to the reading of these reports. For many, this activity proved to be the most exciting part of the course. A student would review the literature on his topic and present his ideas for future research while the rest of the class would question him sharply. Who would be in his control groups? Why did he choose chronic subjects? How would he define
SCHIZOPHRENIA BULLETIN
hallucinatory behavior? All students reported this giveand-take to be quite stimulating. Most admitted, however, that this excitement would not have occurred without the previous work. Of course, I asked for and received feedback on the course. A major complaint was the use of a textbook in a graduate seminar. But when I asked for their objections chapter by chapter, most decided the four chapters on schizophrenia were valuable. The earlier chapters reviewing learning theory appeared to have helped a few— and interested others who knew the theory but had never thought of applying it to psychopathology. The only alternative to a textbook suggested was to take up a collection and xerox a number of articles instead of using a text as a basic source. I think I would use the same book again, however, but would designate the first chapters as optional reading. The students also suggested that more time be given to the student reports, and I will plan for this when I teach the course again. From my point of view I feel a great need for more up-to-date films illustrating different diagnostic symptoms. The films shown were old, and those students who were experienced in working with mental patients found them slightly humorous. The antiquated clothes and manners made the schizophrenics appear misleadingly different. Moreover, as one student pointed out, patients were shown lying in the sun when presumably they were on chlorpromazine! Next time I shall try other films. I would be interested in hearing from anyone who teaches, or has taken, a course similar to this one. Comments and suggestions would be most welcome. References Delay, J.; Deniker, P.; Volmat, R.; and Layrie, J. Drug Therapy in. Psychiatry. East Hanover, N. Y.: Sandoz Medical Film Library. No date given. Gunderson, J. G.; Autry, J. H. Ill; and Mosher, L. R. Special report: Schizophrenia, 1974. Schizophrenia
Bulletin, 1 (Experimental issue no. 9):16-54, Summer 1974. Klein, D. F., and Davis, J. M. Diagnosis and Drug Treatment of Psychiatric Disorders. Baltimore: The Williams & Wilkins Company, 1969. Maher, B. A. Principles of Psychopathology: An Experimental Approach. New York: McGraw-Hill, Inc., 1966. Mosher, L. R., and Gunderson, J. G. Special report: Schizophrenia, 1972. Schizophrenia Bulletin, ^Experimental issue no. 7): 12-52, Winter 1973. Phillips, L. Case history data and prognosis in schizophrenia. Journal of Nervous and Mental Disease, 117: 515-525,1953. Salzinger, K. Schizophrenia: Behavioral Aspects. New York: John Wiley & Sons, Inc., 1973. Spitzer, R. L ; Endicott, J.; and Robins, E. Research Diagnostic Criteria for a Selected Group of Functional Disorders. 1st ed. Biometrics Research, New York State Department of Mental Hygiene, 722 West 168th Street, New York, N.Y., 1974. Stone, C. P. Case Histories in Abnormal Psychology. Stanford, Calif.: Stanford University Press, 1943. Wittman, P. A scale for measuring prognosis in schizophrenic patients. Elgin State Hospital Papers, 4:20-33, 1941.
The Author Mary D. Carpenter, Ph.D., is Senior Research Scientist, Community Research Program, New York State Department of Mental Hygiene, and Adjunct Assistant Professor of Psychology, New York University, New York, N.Y.
