Proximal Spacing to Facial Affect Expressions in Schizophrenia Pratima Srivastava and Manas K. Mandal Schizophrenics (N = 40).
depressives (N = 36),
anxiety neurotics (N = 35).
and nonpatient
controls (N = 60) were asked to walk forward from a distance of 10 feet to a distance comfortable for possible interaction with facial expressions of six affects and a neutral state, depicted in life-sized images. Schizophrenics demandad significantly greater proximal space than other groups to interact with facial affect expressions, especially the nonaroused ones (happy, sad, neutral state). Multiple discriminant analysis of the “comfortable interaction distance” data revealed that schizophrenic persons may be discriminated with moderate accuracy (52.5%)
from other groups.
0 1990 by W. B. Saunders Company.
T
HE STATE OF PATHOLOGY in psychiatric patients is reflected at different socioproximal distances.’ Schizophrenics demand greater socioproximal space, especially during the acute state of illness, than neurotics, depressives, or normals.’ Using a figure placement task, Blumenthal and Meltzoff3 reported that schizophrenics were less accurate than normals in manipulating interpersonal space. Thornton and Gotteheil,4 using a similar technique, found that schizophrenic males overestimated the parental figure distances but not the nonparental figures. Simulating a “live” interpersonal situation, Sommer’ found that schizophrenics chose a close but distorted seating arrangement for interaction. Aronow et aL6 used several interpersonal measures (live situation, figure placement, interpersonal distance scale) and observed no difference on any of these measures between schizophrenics and normals. Little effort has been made to understand how schizophrenics use proximal space during interaction with persons projecting different affects through facial expression. The paucity of research in this area means that no data base exists for determining how schizophrenics use proximal space in real-life situations in which facial affects are expressed in almost any encounter. Indeed, in man’ structuring of microspace is largely determined by the type and nature of affect communications.* The importance of the study in schizophrenia is that the finding may (a) indicate the level of awareness about various affect states and the degree of social withdrawal as reflected in the patient’s proximal behavior, and (b) be effectively used to determine the state of pathology when the patient moves from the chronic stage of illness to nearly remitted stage and to train the patient in social skills. In the present study therefore, we sought to determine (a) whether schizophrenics are capable of using differential proximal space when asked to interact with persons expressing various facial affects, (b) whether schizophrenics are capable of correctly
From the Department of Psychology. Banaras Hindu University, Varanasi. India. Research for this article is based partly on a doctoral dissertation of P. Srivastava. Ph.D., presented to Banaras Hindu Universily. Address reprint requests to Manas K. Mandal. Ph.D., Department of Psychology, Banaras Hindu University, Varanasi 221 005, India. Q 1990 by W.B. Saunders Company. 0010-440X/90/3102-0002$03.00/0 Comprehensive
Psychiatry,
Vol. 3 1, No. 2 (March/April),
1990: pp 119- 124
119
120
SRIVASTAVA
Table 1. Description
Group Nonpatient control (N = 60) Anxiety neurotic (N = 35) Depressive (N = 36) Schizophrenic (N = 40)
AND MANDAL
of Groups Studied by Age, Sex, and Education
Type
Mean Education
Mean Age tvr)
(vr)
Sex
Graduate student
26.10
7.01
20.0
33 M, 27 F
Chronic
25.94
5.89
16.5
20M,
15F
Major
30.08
7.36
16.0
19M,
17F
Unclassified
27.38
6.25
15.0
22M.
18F
labeling the different facial affect expressions, and (c) whether correct labeling of facial affect expressions is a precondition to manipulate proximal space in schizophrenia. METHOD Sample Three groups of psychiatric patients and a nonpatient control group were considered (Table 1). Patients were diagnosed by their treating psychiatrists, and the symptoms in patients were reexamined by the criteria of DSM-III9 All patients had been ill for at least 1 year before testing. Patients (a) who had undergone electroconvulsive shock therapy (ECT) treatment in the last 3 months, (b) with marked intellectual deficiency, and (c) with a concomitant diagnosis of organic brain damage or other general medical condition (e.g., tuberculosis), were excluded. Schizophrenics and depressives were hospitalized for less than 3 months. Patients were all on standard doses of psychotrophic drugs.
Photographs Two photographs (one of a male and one of a female) of facial expressions for each of the six affects, happiness, sadness, fear, anger, surprise, disgust, and a neutral state (2 x 7 = 14) were selected from a series of such photographs developed by Mandal. lo* Each photograph was a front-view full-face expression of an affect posed by an adult Indian subject. Photographs were all correctly recognized by at least 70% of the observers (N = 630), discriminated against a seven-point scale of expressed purity of affect (N = loo), and located on a five-point scale of extremeness of affect expression (N = 50).
Procedure Each subject was required (a) to stand 10 feet away from a life-size facial affect shown on a screen and to step forward as close as possible to that expression to feel comfortable for interaction, and (b) to label the affect with a word that best described the expression. Photographs depicting different facial affects were presented in a random order fixed preexperimentally. The comfortable interaction distance (in feet) between the observer and observed and the number of correct identifications were the dependent measures.
RESULTS
The comfortable interaction distances recorded for two photographs (male and female) of each facial affect were averaged and subjected to a 4 x 7 (group times affect) mixed analysis of variance (unweighted means solution) with repeated measures on affect factor (Table 2). The main effects of group (F = 2.73, df = 3,167, P < .05) and affect (F = 63.59, df= 6,1002, P < .OOl) were significant. *Photographs are available from Microfiche Publications, Document NAPS 04267, P.O. Box 3513, Grand Central Station, NY 10017.
121
PROXIMAL SPACING IN SCHIZOPHRENIA
Table 2. Mean Comfortable Interaction Distance Expressions by Four Groups
(ftl to Seven Facial
Facial Expression Group
Happiness
Sadness
Fear
Anger
Surprise
Disgust
Neutral
Nonpatient control Anxiety neurotic Depressive Schizophrenic
3.71 5.05 5.38 6.47
4.52 6.06 6.28 7.11
8.33 7.13 7.15 7.29
8.23 6.87 7.01 7.97
6.91 6.64 6.97 7.49
8.29 7.20 6.50 7.17
6.02 5.53 6.34 6.47
NOTE. Maximum interaction distance was 10 feet.
Post hoc comparison using Scheffe test revealed that schizophrenics (mean, 7.14 feet) chose significantly greater interpersonal distance than any other group (P < .Ol); the pairwise differences of physical distance among depressives (mean, 6.52 feet), anxiety neurotics (mean 6.35 feet), and nonpatient controls (mean, 6.57 feet) were nonsignificant (P > .05). Facial expressions of happiness (mean, 4.98 feet), sadness (mean, 5.81 feet), and neutral state (mean 6.09 feet) were approached more closely than were facial expressions of surprise (mean, 7.00 feet), disgust (mean, 7.43 feet), fear (mean, 7.59 feet), and anger (mean, 7.63 feet). Scheffe post hoc test confirmed the finding (P -C .05). More important, the two-way (group times affect) interaction also showed significance (F = 10.61, u”= 18,1002, P < .Ol). Groups tended to be more close with the nonaroused facial expressions (happy, sad, neutral state) as compared with aroused facial expressions (fear, anger, disgust). The difference in these two clusters of expressions was greatest for nonpatient controls (P < .OOl) and lowest for schizophrenics (P < .05). Between-group comparisons of approach distance for nonaroused facial affects were all significant (P < .Ol): Nonpatient controls preferred the shortest interpersonal distance, followed by anxiety neurotics, depressives, and schizophrenics. Between-group differences were nonsignificant for aroused affect expressions (P > .05). Multiple discriminant analysis (MDA) of the data (Table 2) showed that 46 of 60 nonpatient controls (76.7%) could be correctly discriminated from their comfortable interaction distance (2 subjects were misclassified as neurotics, 5 as depressives, and 7 as schizophrenics); only 9 of 35 (25.7%) anxiety neurotics could be correctly discriminated (11 subjects were misclassified as controls, 7 as depressives, and 8 as schizophrenics); 20 depressives of 36 (55.6%) could be correctly discriminated (7 subjects were misclassified as controls, 2 as neurotics, and 7 as schizophrenics); and 21 schizophrenics of 40 (52.5%) could be correctly discriminated (5 subjects were misclassified as controls, 3 as neurotics, and 11 as depressives). Table 3 shows the mean correct identification for seven facial expressions by four groups. Data were analyzed with a 4 x 7 (group times affect) mixed analysis of variance (unweighted means solution) with repeated measures on affect factor. The main effects of group (F = 18.29, df = 3,167, P < .OOl) and affect (F = 35.32, df = 6,1002, P -c .OOl) were significant. Scheffe post hoc test yielded significant between-group differences for all (P < .Ol). Nonpatient controls (mean, 11.08) were most accurate in identifying the facial affects, followed by anxiety neurotics (mean, 9.48) depressives (mean, 7.98), and schizophrenics (mean, 6.70). Betweenaffect differences were also significant (Scheffe test: P -E .05). The order of correct
122
SRIVASTAVA Table 3.
Percentage
of Correct Identification by Four Groups
AND MANDAL
for Seven Facial Expressions
Facial Expression Group
Happiness
Sadness
Fear
Anger
Surprise
Disgust
Neutral
Nonpatient control Anxiety neurotic Depressive Schizophrenic
96.7 90.0 94.4 86.2
90.8 87.1 87.5 67.5
46.7 37.1 36.1 23.7
73.3 71.4 70.8 46.2
83.3 71.4 29.2 25.0
93.3 65.7 52.8 41.2
70.0 51.4 27.8 43.7
identification for facial expressions was as follows: happiness (mean, 7.35) sadness (mean, 6.66), anger (mean, 5.25), disgust (mean, 5.06), surprise (mean, 4.18), neutral state (mean, 3.87), and fear (mean, 2.87). Two-way (group times affect) interaction also reached statistical significance (F = 3.04, df = 18,1002, P < .Ol). Patient groups had poor identification for the facial expressions of fear, surprise, and neutral state as compared with other facial expressions, whereas controls were unaffected by the nature of facial expression. The finding was confirmed by Scheffe test (P < .05). The degree of association between proximal spacing and identification accuracy was examined by a 3 (proximal distance: 0 to 40, 41 to 80, 81 to 120 inches) x3 (correct identification for an affect expression: both photographs, one photograph, none) contingency table for each group. Contingency coefficients (C: upper limit ,/m=. 816 ) in d icated that the degree of association was moderate to low [control, C = .20, x2 (4, N = 420) = 17.54, P-c .Ol; depressive, C = .17, x2 (4, N = 280) = 7.48, P > .05; schizophrenic, C = .15, x2 (4, N = 280) = 6.30, P > .05; anxiety neurotic, C = .09, x2 (4, N = 245) = 9.15, P > .05]. DISCUSSION
Results of the study support the earlier notion that schizophrenics demand greater interpersonal distance than depressives, anxiety neurotics, or normals.2Y’1 The finding, however, is not in accord with the findings of other studies that documented (a) a nondifference between schizophrenics and normals in a measure of preference for physical distance,6 and (b) schizophrenics’ preference for seating distance (although distorted) close to the designated person.5 Several issues must be clarified to explain the differences in observation. The first issue is methodological. Whereas earlier studies3-5 required patients to play a passive role by indicating preference, the present study required patients to play an active role by approaching the target person. The method may have minimized the variability in schizophrenics’ judgment for preferred distance. Indeed, the variability of actual performance probably would be less than the variability of the judgment about such performance. The second issue relates to the moderating effect of duration of hospitalization. In the study of Aronow et a1.,6schizophrenic patients were hospitalized for about 6 months. In comparison, the patients in the present study were hospitalized less than 3 months. Tolor and Donnon” reported that patients hospitalized for longer times showed a greater preference for social interaction than patients who were hospitalized briefly. Third, schizophrenics wish to withdraw from social situations either by choosing a close but distorted seating distance’ or by increasing the approach distance, as observed in the present study.
PROXIMAL
SPACING IN SCHIZOPHRENIA
123
Fuiki13 reported that proximal space in schizophrenia is correlated to defense mechanisms against the closeness complex. The present finding further showed that, like other groups, schizophrenics chose consistently greater distances when approaching aroused facial affect expressions (fear, anger, disgust) than when approaching nonaroused facial/affect expressions (happy, sad, neutral state). Indeed, schizophrenics’ demand for greater proximal space was specific to nonaroused affect expressions, the approach distances to which yielded a significant group difference. The group difference was nonsignificant for the approach distances to aroused affect expressions. The finding indicated that schizophrenics showed greatest social withdrawal for the affect expressions (nonaroused) that demand intimate space for interaction. Boucher (1972) reported that schizophrenics showed greater interpersonal attraction toward the designated person when seated at the farther distances (personal and social) as compared with the intimate distance. Schizophrenics were significantly poorer than depressives, neurotics, and normals in identifying the facial affects with verbal labels, a finding confirmed by many investigators.*4*‘5 Affect identification deficit in schizophrenia may result from chronic social withdrawal which reduces the patient’s capacity to recognize and interpret the facial expressions.14 The notion of social-cognitive deficit in schizophrenia14 does not appear to fit well with the present finding since schizophrenics chose differential (and also consistent) proximal distances to interact with facial affects of different arousal (high-low) levels. Therefore, structuring of proximal space in schizophrenia may be dependent essentially on awareness of the nature (aroused-nonaroused) of affect expression and not on the ability to identify facial affect with verbal label. Such a proposition was supported previously by Mandal.16 In summary, (a) schizophrenic’s demand for greater interpersonal space is specific to nonaroused facial affect expressions, e.g., happy, sad, neutral; (b) schizophrenics may be discriminated (with moderate accuracy) from depressives, neurotics, and normals by their comfortable interaction distance; (c) correct labeling of facial affect expression is not a precondition to proximal spacing in schizophrenia. ACKNOWLEDGMENT We thank H.S. Asthana, research worker, Department of Psychology, Banaras Hindu University, for help on quantitative matters.
REFERENCES 1. McGuire M, Polsky R: Sociospatial behavioral relationship among hospitalized psychiatric patients. Psychiatry Res 8:225-236,1983 2. Horowitz MJ: Spatial behaviors and psychopathology. J Nerv Ment Dis 146:24-35,1968 3. Blumenthal R, Meltzoff J: Social schemas and perceptual accuracy in schizophrenia. Br J Sot Clin Psycho16:119-128,1967 4. Thornton CC, Gotteheil E: Social schemata in schizophrenic males. J Abnorm Psycho1 77:192-195, 1971 5. Sommer R: Studies in personal space. Sociometry 22:247-260, 1959 6. Aronow E, Reznikoff M, Tryon WW: The interpersonal distance of process and reactive schizophrenics. J Consult Clin Psycho1 43:94,1975
124
SRIVASTAVA
AND MANDAL
7. Hall ET: Proxemics-The study of man’s spatial relations and boundaries, in Goldston I (ed): Man’s Image in Medicine and Anthropology, Monograph series No. 4. New York, International University Press, 1963 8. Mandal MK, Maitra S: Perception of facial affect and physical proximity. Percept Mot Skills 60~782.1985 9. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington DC., American P, 1980 10. Mandal MK: Decoding of facial emotions, in terms of expressiveness, by schizophrenics and depressives. Psychiatry 50:371-376, 1987 Il. Horowitz MJ, Dull’ DF, Stratton LO: Body buffer zones. Arch Gen Psychiatry 11:651-656, 1964 12. Tolor A, Donnon M: Psychological distance as a function of length of hospitalization. Psycho1 Rep 25:851-855,1969 13. Fuiki S: Psychopathology of psychiatric patients in terms of personal space: A comparative study of schizophrenic, depressive and neurotic patients. Kyushu Neuropsychiatry 29: 181-204, 1983 14. Walker E, Marwit S, Emory E: A cross-sectional study of emotion recognition in schizophrenics. J Abnorm Psycho1 89:428-436,198O 15. Mandal MK, Rai A: Responses to facial emotion and psychopathology. Psychiatry Res 20:317-323, 1987 16. Mandal MK: Judgment of facial affect among depressives and schizophrenics. Br J Clin Psycho1 2587-92. 1986
depressives (N = 36),
anxiety neurotics (N = 35).
and nonpatient
controls (N = 60) were asked to walk forward from a distance of 10 feet to a distance comfortable for possible interaction with facial expressions of six affects and a neutral state, depicted in life-sized images. Schizophrenics demandad significantly greater proximal space than other groups to interact with facial affect expressions, especially the nonaroused ones (happy, sad, neutral state). Multiple discriminant analysis of the “comfortable interaction distance” data revealed that schizophrenic persons may be discriminated with moderate accuracy (52.5%)
from other groups.
0 1990 by W. B. Saunders Company.
T
HE STATE OF PATHOLOGY in psychiatric patients is reflected at different socioproximal distances.’ Schizophrenics demand greater socioproximal space, especially during the acute state of illness, than neurotics, depressives, or normals.’ Using a figure placement task, Blumenthal and Meltzoff3 reported that schizophrenics were less accurate than normals in manipulating interpersonal space. Thornton and Gotteheil,4 using a similar technique, found that schizophrenic males overestimated the parental figure distances but not the nonparental figures. Simulating a “live” interpersonal situation, Sommer’ found that schizophrenics chose a close but distorted seating arrangement for interaction. Aronow et aL6 used several interpersonal measures (live situation, figure placement, interpersonal distance scale) and observed no difference on any of these measures between schizophrenics and normals. Little effort has been made to understand how schizophrenics use proximal space during interaction with persons projecting different affects through facial expression. The paucity of research in this area means that no data base exists for determining how schizophrenics use proximal space in real-life situations in which facial affects are expressed in almost any encounter. Indeed, in man’ structuring of microspace is largely determined by the type and nature of affect communications.* The importance of the study in schizophrenia is that the finding may (a) indicate the level of awareness about various affect states and the degree of social withdrawal as reflected in the patient’s proximal behavior, and (b) be effectively used to determine the state of pathology when the patient moves from the chronic stage of illness to nearly remitted stage and to train the patient in social skills. In the present study therefore, we sought to determine (a) whether schizophrenics are capable of using differential proximal space when asked to interact with persons expressing various facial affects, (b) whether schizophrenics are capable of correctly
From the Department of Psychology. Banaras Hindu University, Varanasi. India. Research for this article is based partly on a doctoral dissertation of P. Srivastava. Ph.D., presented to Banaras Hindu Universily. Address reprint requests to Manas K. Mandal. Ph.D., Department of Psychology, Banaras Hindu University, Varanasi 221 005, India. Q 1990 by W.B. Saunders Company. 0010-440X/90/3102-0002$03.00/0 Comprehensive
Psychiatry,
Vol. 3 1, No. 2 (March/April),
1990: pp 119- 124
119
120
SRIVASTAVA
Table 1. Description
Group Nonpatient control (N = 60) Anxiety neurotic (N = 35) Depressive (N = 36) Schizophrenic (N = 40)
AND MANDAL
of Groups Studied by Age, Sex, and Education
Type
Mean Education
Mean Age tvr)
(vr)
Sex
Graduate student
26.10
7.01
20.0
33 M, 27 F
Chronic
25.94
5.89
16.5
20M,
15F
Major
30.08
7.36
16.0
19M,
17F
Unclassified
27.38
6.25
15.0
22M.
18F
labeling the different facial affect expressions, and (c) whether correct labeling of facial affect expressions is a precondition to manipulate proximal space in schizophrenia. METHOD Sample Three groups of psychiatric patients and a nonpatient control group were considered (Table 1). Patients were diagnosed by their treating psychiatrists, and the symptoms in patients were reexamined by the criteria of DSM-III9 All patients had been ill for at least 1 year before testing. Patients (a) who had undergone electroconvulsive shock therapy (ECT) treatment in the last 3 months, (b) with marked intellectual deficiency, and (c) with a concomitant diagnosis of organic brain damage or other general medical condition (e.g., tuberculosis), were excluded. Schizophrenics and depressives were hospitalized for less than 3 months. Patients were all on standard doses of psychotrophic drugs.
Photographs Two photographs (one of a male and one of a female) of facial expressions for each of the six affects, happiness, sadness, fear, anger, surprise, disgust, and a neutral state (2 x 7 = 14) were selected from a series of such photographs developed by Mandal. lo* Each photograph was a front-view full-face expression of an affect posed by an adult Indian subject. Photographs were all correctly recognized by at least 70% of the observers (N = 630), discriminated against a seven-point scale of expressed purity of affect (N = loo), and located on a five-point scale of extremeness of affect expression (N = 50).
Procedure Each subject was required (a) to stand 10 feet away from a life-size facial affect shown on a screen and to step forward as close as possible to that expression to feel comfortable for interaction, and (b) to label the affect with a word that best described the expression. Photographs depicting different facial affects were presented in a random order fixed preexperimentally. The comfortable interaction distance (in feet) between the observer and observed and the number of correct identifications were the dependent measures.
RESULTS
The comfortable interaction distances recorded for two photographs (male and female) of each facial affect were averaged and subjected to a 4 x 7 (group times affect) mixed analysis of variance (unweighted means solution) with repeated measures on affect factor (Table 2). The main effects of group (F = 2.73, df = 3,167, P < .05) and affect (F = 63.59, df= 6,1002, P < .OOl) were significant. *Photographs are available from Microfiche Publications, Document NAPS 04267, P.O. Box 3513, Grand Central Station, NY 10017.
121
PROXIMAL SPACING IN SCHIZOPHRENIA
Table 2. Mean Comfortable Interaction Distance Expressions by Four Groups
(ftl to Seven Facial
Facial Expression Group
Happiness
Sadness
Fear
Anger
Surprise
Disgust
Neutral
Nonpatient control Anxiety neurotic Depressive Schizophrenic
3.71 5.05 5.38 6.47
4.52 6.06 6.28 7.11
8.33 7.13 7.15 7.29
8.23 6.87 7.01 7.97
6.91 6.64 6.97 7.49
8.29 7.20 6.50 7.17
6.02 5.53 6.34 6.47
NOTE. Maximum interaction distance was 10 feet.
Post hoc comparison using Scheffe test revealed that schizophrenics (mean, 7.14 feet) chose significantly greater interpersonal distance than any other group (P < .Ol); the pairwise differences of physical distance among depressives (mean, 6.52 feet), anxiety neurotics (mean 6.35 feet), and nonpatient controls (mean, 6.57 feet) were nonsignificant (P > .05). Facial expressions of happiness (mean, 4.98 feet), sadness (mean, 5.81 feet), and neutral state (mean 6.09 feet) were approached more closely than were facial expressions of surprise (mean, 7.00 feet), disgust (mean, 7.43 feet), fear (mean, 7.59 feet), and anger (mean, 7.63 feet). Scheffe post hoc test confirmed the finding (P -C .05). More important, the two-way (group times affect) interaction also showed significance (F = 10.61, u”= 18,1002, P < .Ol). Groups tended to be more close with the nonaroused facial expressions (happy, sad, neutral state) as compared with aroused facial expressions (fear, anger, disgust). The difference in these two clusters of expressions was greatest for nonpatient controls (P < .OOl) and lowest for schizophrenics (P < .05). Between-group comparisons of approach distance for nonaroused facial affects were all significant (P < .Ol): Nonpatient controls preferred the shortest interpersonal distance, followed by anxiety neurotics, depressives, and schizophrenics. Between-group differences were nonsignificant for aroused affect expressions (P > .05). Multiple discriminant analysis (MDA) of the data (Table 2) showed that 46 of 60 nonpatient controls (76.7%) could be correctly discriminated from their comfortable interaction distance (2 subjects were misclassified as neurotics, 5 as depressives, and 7 as schizophrenics); only 9 of 35 (25.7%) anxiety neurotics could be correctly discriminated (11 subjects were misclassified as controls, 7 as depressives, and 8 as schizophrenics); 20 depressives of 36 (55.6%) could be correctly discriminated (7 subjects were misclassified as controls, 2 as neurotics, and 7 as schizophrenics); and 21 schizophrenics of 40 (52.5%) could be correctly discriminated (5 subjects were misclassified as controls, 3 as neurotics, and 11 as depressives). Table 3 shows the mean correct identification for seven facial expressions by four groups. Data were analyzed with a 4 x 7 (group times affect) mixed analysis of variance (unweighted means solution) with repeated measures on affect factor. The main effects of group (F = 18.29, df = 3,167, P < .OOl) and affect (F = 35.32, df = 6,1002, P -c .OOl) were significant. Scheffe post hoc test yielded significant between-group differences for all (P < .Ol). Nonpatient controls (mean, 11.08) were most accurate in identifying the facial affects, followed by anxiety neurotics (mean, 9.48) depressives (mean, 7.98), and schizophrenics (mean, 6.70). Betweenaffect differences were also significant (Scheffe test: P -E .05). The order of correct
122
SRIVASTAVA Table 3.
Percentage
of Correct Identification by Four Groups
AND MANDAL
for Seven Facial Expressions
Facial Expression Group
Happiness
Sadness
Fear
Anger
Surprise
Disgust
Neutral
Nonpatient control Anxiety neurotic Depressive Schizophrenic
96.7 90.0 94.4 86.2
90.8 87.1 87.5 67.5
46.7 37.1 36.1 23.7
73.3 71.4 70.8 46.2
83.3 71.4 29.2 25.0
93.3 65.7 52.8 41.2
70.0 51.4 27.8 43.7
identification for facial expressions was as follows: happiness (mean, 7.35) sadness (mean, 6.66), anger (mean, 5.25), disgust (mean, 5.06), surprise (mean, 4.18), neutral state (mean, 3.87), and fear (mean, 2.87). Two-way (group times affect) interaction also reached statistical significance (F = 3.04, df = 18,1002, P < .Ol). Patient groups had poor identification for the facial expressions of fear, surprise, and neutral state as compared with other facial expressions, whereas controls were unaffected by the nature of facial expression. The finding was confirmed by Scheffe test (P < .05). The degree of association between proximal spacing and identification accuracy was examined by a 3 (proximal distance: 0 to 40, 41 to 80, 81 to 120 inches) x3 (correct identification for an affect expression: both photographs, one photograph, none) contingency table for each group. Contingency coefficients (C: upper limit ,/m=. 816 ) in d icated that the degree of association was moderate to low [control, C = .20, x2 (4, N = 420) = 17.54, P-c .Ol; depressive, C = .17, x2 (4, N = 280) = 7.48, P > .05; schizophrenic, C = .15, x2 (4, N = 280) = 6.30, P > .05; anxiety neurotic, C = .09, x2 (4, N = 245) = 9.15, P > .05]. DISCUSSION
Results of the study support the earlier notion that schizophrenics demand greater interpersonal distance than depressives, anxiety neurotics, or normals.2Y’1 The finding, however, is not in accord with the findings of other studies that documented (a) a nondifference between schizophrenics and normals in a measure of preference for physical distance,6 and (b) schizophrenics’ preference for seating distance (although distorted) close to the designated person.5 Several issues must be clarified to explain the differences in observation. The first issue is methodological. Whereas earlier studies3-5 required patients to play a passive role by indicating preference, the present study required patients to play an active role by approaching the target person. The method may have minimized the variability in schizophrenics’ judgment for preferred distance. Indeed, the variability of actual performance probably would be less than the variability of the judgment about such performance. The second issue relates to the moderating effect of duration of hospitalization. In the study of Aronow et a1.,6schizophrenic patients were hospitalized for about 6 months. In comparison, the patients in the present study were hospitalized less than 3 months. Tolor and Donnon” reported that patients hospitalized for longer times showed a greater preference for social interaction than patients who were hospitalized briefly. Third, schizophrenics wish to withdraw from social situations either by choosing a close but distorted seating distance’ or by increasing the approach distance, as observed in the present study.
PROXIMAL
SPACING IN SCHIZOPHRENIA
123
Fuiki13 reported that proximal space in schizophrenia is correlated to defense mechanisms against the closeness complex. The present finding further showed that, like other groups, schizophrenics chose consistently greater distances when approaching aroused facial affect expressions (fear, anger, disgust) than when approaching nonaroused facial/affect expressions (happy, sad, neutral state). Indeed, schizophrenics’ demand for greater proximal space was specific to nonaroused affect expressions, the approach distances to which yielded a significant group difference. The group difference was nonsignificant for the approach distances to aroused affect expressions. The finding indicated that schizophrenics showed greatest social withdrawal for the affect expressions (nonaroused) that demand intimate space for interaction. Boucher (1972) reported that schizophrenics showed greater interpersonal attraction toward the designated person when seated at the farther distances (personal and social) as compared with the intimate distance. Schizophrenics were significantly poorer than depressives, neurotics, and normals in identifying the facial affects with verbal labels, a finding confirmed by many investigators.*4*‘5 Affect identification deficit in schizophrenia may result from chronic social withdrawal which reduces the patient’s capacity to recognize and interpret the facial expressions.14 The notion of social-cognitive deficit in schizophrenia14 does not appear to fit well with the present finding since schizophrenics chose differential (and also consistent) proximal distances to interact with facial affects of different arousal (high-low) levels. Therefore, structuring of proximal space in schizophrenia may be dependent essentially on awareness of the nature (aroused-nonaroused) of affect expression and not on the ability to identify facial affect with verbal label. Such a proposition was supported previously by Mandal.16 In summary, (a) schizophrenic’s demand for greater interpersonal space is specific to nonaroused facial affect expressions, e.g., happy, sad, neutral; (b) schizophrenics may be discriminated (with moderate accuracy) from depressives, neurotics, and normals by their comfortable interaction distance; (c) correct labeling of facial affect expression is not a precondition to proximal spacing in schizophrenia. ACKNOWLEDGMENT We thank H.S. Asthana, research worker, Department of Psychology, Banaras Hindu University, for help on quantitative matters.
REFERENCES 1. McGuire M, Polsky R: Sociospatial behavioral relationship among hospitalized psychiatric patients. Psychiatry Res 8:225-236,1983 2. Horowitz MJ: Spatial behaviors and psychopathology. J Nerv Ment Dis 146:24-35,1968 3. Blumenthal R, Meltzoff J: Social schemas and perceptual accuracy in schizophrenia. Br J Sot Clin Psycho16:119-128,1967 4. Thornton CC, Gotteheil E: Social schemata in schizophrenic males. J Abnorm Psycho1 77:192-195, 1971 5. Sommer R: Studies in personal space. Sociometry 22:247-260, 1959 6. Aronow E, Reznikoff M, Tryon WW: The interpersonal distance of process and reactive schizophrenics. J Consult Clin Psycho1 43:94,1975
124
SRIVASTAVA
AND MANDAL
7. Hall ET: Proxemics-The study of man’s spatial relations and boundaries, in Goldston I (ed): Man’s Image in Medicine and Anthropology, Monograph series No. 4. New York, International University Press, 1963 8. Mandal MK, Maitra S: Perception of facial affect and physical proximity. Percept Mot Skills 60~782.1985 9. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington DC., American P, 1980 10. Mandal MK: Decoding of facial emotions, in terms of expressiveness, by schizophrenics and depressives. Psychiatry 50:371-376, 1987 Il. Horowitz MJ, Dull’ DF, Stratton LO: Body buffer zones. Arch Gen Psychiatry 11:651-656, 1964 12. Tolor A, Donnon M: Psychological distance as a function of length of hospitalization. Psycho1 Rep 25:851-855,1969 13. Fuiki S: Psychopathology of psychiatric patients in terms of personal space: A comparative study of schizophrenic, depressive and neurotic patients. Kyushu Neuropsychiatry 29: 181-204, 1983 14. Walker E, Marwit S, Emory E: A cross-sectional study of emotion recognition in schizophrenics. J Abnorm Psycho1 89:428-436,198O 15. Mandal MK, Rai A: Responses to facial emotion and psychopathology. Psychiatry Res 20:317-323, 1987 16. Mandal MK: Judgment of facial affect among depressives and schizophrenics. Br J Clin Psycho1 2587-92. 1986
