Br. J . med. Psycho/. (1976). 49. 73-79 Printed in Great Britain
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Psychological construing and psychological symptoms BY F. M. McPHERSON* A N D ANNABELLE GRAYt Recent theories of emotion (e.g. Schachter, 1964; Lazarus et al., 1970) have emphasized the influence of cognition on the nature and quality of emotional experience and behaviour. Clearly, a person’s emotional response to a stimulus will be influenced b his cognitive appraisal of the stimulus situation, e.g. by whether he construes it as ‘danger us’ or ‘harmless’. However, another possible way in which cognition and emotion interact h een emphasized by Schachter (I-), Valins (1970) and others. They argue that the emoti al experience and behaviour of a person is influenced by how he appraises - interprets, aluates and labels - his own bodily sensations of physiological arousal. This is the topic of the present article. Since James (1884), writers on emotion have distinguished between a person’s experience of emotion, and his awareness of his bodily sensations. When physiologically aroused, a person may perceive and report those physical sensations, usually felt as being localized in specific bodily areas, which typically accompany arousal, e.g. he may be aware of palpitations, breathlessness and a ‘churning’ sensation in the stomach. Emotional states, such as those of being ‘sad’ or ‘angry ’, are on the other hand experienced as more generalized and as on a psychological plane. Schachter,(1%4), Valins (1970) and Bindra (1970) have argued that emotional experiences are secondary constructions which are the outcome of an appraisal process in which a person combines information from his bodily sensations with information derived from his perceptions of other aspects of himself, and of his environment. According to this view, someone who is aware of the bodily sensations of arousal will experience emotion, and will behave emotionally, only to the extent that the sensations are attributed to emotional stimuli. Conversely, regardless of the external situation, he will experience emotion only if he is aware of the somatic sensations of arousal. These points are illustrated in a series of experiments by Schachter and his colleagues, in which physiological changes were produced by drugs. For example, Schachter & Singer (1%2) showed that individuals with identical states of physiological arousal, produced by injections of adrenalin, experienced the emotions of either anger or euphoria, according to whether they construed their current social situation as anger-producing or euphoria-producing. Other individuals who had similarly been injected, but who attributed their bodily sensations to the effect of the drugs, and as unrelated to the emotion-producing situation, experienced no feelings of emotion and reported only bodily sensations. More recent studies have demonstrated that the emotional consequences of environmental threat can be influenced by cognitive factors. Girodo (1973) found that girls who were made anxious by being shown a horrifying film reported less subjective anxiety if they attributed their physiological arousal to the effects of a toxic gas (which actually had no effect) rather than to the film. Other illustrations are provided by Nisbett & Schachter (1966), Valins (1966), Ross et al. (1%9) and Loftis & Ross (1974). These studies appear to show that when a person becomes aware that he is in a state of physiological arousal, he will attempt to explain the state in terms of his current situation. If he finds a ‘psychological’ explanation, e.g. if he construes the situation as ‘anger-producing’, he will interpret and label his condition as the psychological one
i 2
* Department of Psychology, University of Dundee; Hon. Director, Tayside Area Clinical Psychology Department. t Senior Clinical Psychologist, Tayside Area Clinical Psychology Department, Royal Dundee Liff Hospital, Dundee, Scotland.
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of experiencing the appropriate emotion. Identical states of arousal may thus be experienced as different emotions (as ‘joy or sadness, fear or anger’ - Schachter, 1964) according to how the situation is construed. This process appears to involve the reappraisal of the stimulus situation (Nisbett & Schachter, 1966; Valins, 1966) and the categorization and labelling of an experience as emotional will initiate appropriate expressive and instrumental behaviour, such as acting angrily. As Bindra (1970) points out, the process by which someone experiences emotion in himself is similar to that by which he recognizes it in others. The major difference is that in the former the person has access to sensory feedback from his physiological reactions, whereas in the latter he has only the indirect evidence of the other person’s facial expression, posture and communications. In those situations in which a person is aware of bodily sensations for which no psychological explanation can be found, or for which a ‘physical’ explanation is suggested - as in the studies noted above - the person will construe the sensations physically and will not elaborate them into emotional experience. The literature on psychedelic drugs, whose users expect them to have psychological effects, provide interesting illustrations of how physical sensations can be reconstrued as psychological feelings. Thus, Becker (1953) observed that the novice marihuana smoker tended to report only unpleasant physical sensations, such as palpitations, tremor, nausea and hunger. It was only after discussing these symptoms with experienced users that the novice reconstrued his state as the pleasureable one of being ‘high’. Valins (1970) has suggested that differences exist between individuals in the characteristic ways in which they categorize and label their bodily perceptions. In the above studies and illustrations, the people involved obtained clear information from their environment about what and how they should feel. Where few environmental cues are available, individual differences in labelling are likely to show up more predominantly. For example, Bourque & Back (1971) concluded that the way in which a person reports ecstatic and transcendental experiences, e.g. whether as religious or aesthetic, is influenced less by the experiences themselves than by the construct system and terminology available to him. One difference between people which might be important in connexion with emotional experience and expression has been reported by several workers in the context of Personal Construct Theory (Kelly, 1955). A person may describe, and differentiate between, himself and others, or between other people, in terms of ‘psychological’ constructs. These are constructs which refer to aspects of personality, to emotional states or to interpersonal relationships, e.g. ‘ happy-sad ’, ‘friendly-aloof ’, ‘likes me-doesn’t ’. Alternatively, he may employ ‘objective ’ constructs, descriptive of more directly observable, less inferential features such as physical appearance, e.g. ‘tall-short ’, ‘healthy-ill ’. Normal individuals differ considerably in the extent to which they construe ‘psychologically ’ rather than ‘objectively ’, the difference being stable over time and over different construing situations, and being unrelated to intelligence (McPherson &Gray, 1976). People who construe in a predominantly ‘psychological ’ mode differ from those who construe ‘objectively ’ in a variety of ways, for example in having different personal interests (Little, 1968) and in making friends more readily (Duck, 1973). It was suggested above that people experience emotion only to the extent that they find a ‘psychological’ explanation of their bodily arousal, and so interpret their bodily sensations as indicative of emotional experience. From this, it can be predicted that with a given state of arousal, and a given environmental situation, extreme ‘psychological ’ construers will be more likely to find such explanations, and to categorize and label their sensations as ‘emotion ’, than will extreme ‘objective ’ construers, who will tend to report only their physical sensations of arousal. This has not been tested in normals, but a similar prediction can be made about the abnormal arousal and emotions of psychiatric patients. Many psychiatric patients experience symptoms of anxiety, often in addition to other psychological disorders (Foulds, 1965). There are many different anxiety symptoms and there have
Psychological construing and psychological symptoms
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been several attempts to categorize them. One distinction which is commonly made (e.g. Buss, 1962; Foulds, 1966) is between somaticsymptoms, such as sweating, heart palpitations, dry mouth and intestinal distress, and psychological, i.e. cognitive and emotional, symptoms such as worry, apprehension and feelings of anxiety and depression (Hamilton, 1959; Buss, 1962; Foulds, 1965). Patients differ in the sort of symptoms which they report (Buss, 1966) and from the discussion above it can be predicted that these differences are related to the patient’s characteristic modes of construing. Thus, both ‘objective ’ construers and ‘psychological’ construers will be aware of their abnormal physical sensations but whereas the former will report only these sensations and will hence complain only of somatic symptoms, the ‘psychological’ construers will elaborate and interpret these sensations ‘psychologically’, as indicative of emotional distress and symptoms. Thus, on a questionnaire assessing the presence of psychic and somatic symptoms, ‘psychological’ and ‘objective’ construers may be expected to report an equal number of somatic symptoms, but the former may be expected to report significantly more ‘psychic’ or emotional symptoms. Smail(l970) and McPherson (1972) both found that patients who construed ‘psychologically’ and ‘objectively ’ differed, in the predicted direction, in their scores on a psychic-somatic symptom questionnaire, although the method of scoring the questionnaire did not permit the above prediction to be tested directly. The present study will explore the relationship between construing and type of symptom reported, and will employ a revised version of the symptom questionnaire. METHOD
Subjects Forty-two patients were tested. This group comprised every second consecutive patient admitted to a general psychiatric hospital over a six-week period, excluding only those who (i) were aged above 60 or below 18, (ii) had known organic involvement, (iii) scored below 18 on the Mill Hill Synonyms Selection test, or (iv) were untestable or uncooperative. The group included psychotic and neurotic patients, and those with personality disorders, although the majority of patients had had no diagnostic label attached to them at the time of testing. The patient group comprised 21 males and 21 females, with a mean age of 38.4 years (s.D.11.5, range 18-59 years) and a mean Mill Hill Synonyms Selection test score of 27.3 (s.D.5.5, range 18-41).
Measures Two measures were administered, within two or three days of the patient being admitted. ’ Psychic-somatic scale. Each patient completed a 104-item symptom questionnaire (Foulds & Bedford, 1976) developed from the Symptom Sign Inventory (Foulds & Hope, 1968). From the items, two adhocscales were selected. One comprised items referring to symptoms of anxiety or depression which a panel of six psychologists had unanimously agreed were ‘psychic ’, in that the patient reported the presence of distressing or abnormal thoughts or feelings, e.g. ‘Recently I have worried about every little thing’ or ‘Recently, for no good reason, I have had feelings of panic’. The other scale comprised items relating to symptoms of anxiety or depression which the panel agreed were ‘somatic’, in that the patient reported distressing or abnormal bodily sensations or physical conditions, e.g. ‘Recently, I have had pains over my heart or in my chest, or back’, or ‘Recently, I have been breathless or had a pounding of my chest ’. Twenty-six items were thus selected for the ad hoc ‘psychic’ scale and twenty for the ad hoc ‘somatic’ scale. Each item was scored I (symptom present) or 0 (absent) and the items of the two ad hoc scales were intercorrelated over the first 39 subjects tested. After inspection of the matrix of intercorrelations. the scales were reduced to 14 ‘psychic’ and 7 ‘somatic’ items. The retained ‘psychic’ items each had very high correlations (P < 0.005 or less) with at least 6 other ‘psychic‘ items but had no significant correlation with any ‘somatic’ item, whereas the retained“somatic’ items had correlations of similar magnitude with at least 4 other ‘somatic’ items but with no ‘psychic’ item. Thus, the scores of each patient were obtained on scales which both on clinical and statistical grounds appeared to assess the presence of ‘psychic’ and ‘somatic’ symptoms.
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Constnring tusk
Each patient described the most important differences between the people in pairs of photographs. Eight photographs were used, each of single figures, male or female, of various ages and occupations. This method was used because construing photographs is often more acceptable to patients than construing people known to them, and because there is a high correlation between the number of ‘psychological ’ constructs elicited in this way and the number elicited when the same subject construes people known to him, or describes himself (McPherson & Gray, 1976). Eight pairs of photographs were presented and the patients were asked to give the three major differences between the people in the photographs. A total of 24 bi-polar constructs was thus obtained from each patient. These were scored as either ‘psychological’, i.e. referring to the personality, emotions or interpersonal interactions of the people, or as ‘objective’, i.e. referring to their physical features, dress, social status or activities. Two scorers, using detailed criteria, scored theconstructs independently. They agreed on over 95 per cent of the constructs; those about which they disagreed were arbitrarily scored as ‘objective*. RESULTS
The mean number of ‘psychological ’ constructs given by the 42 patients was 8.8 (s.D.5 . I , range 0-19); the mean numbers of psychic and somatic symptoms were, respectively, 6.3 (s.D.3.6, range 0-14) and 1.9 (s.D.1.9, range 0-6). There was no significant difference between male and female patients in the number of ‘psychological’ constructs given, or in the number of psychic and somatic symptoms reported; there were no significant correlations between the construct scores, or the symptom scores, and either the age or the Mill Hill Synonyms test scores of the patients. The relation between ‘psychological ’ construing and the two categories of symptom was tested in two ways. First, product-moment correlations were calculated over all 42 patients between the number of ‘psychological ’ constructs elicited and (i) the number of psychic symptoms and (ii) the number of somatic symptoms reported by each patient. The predictions were that the former correlation would be positive and significant, whereas the latter correlation would be negligible. These predictions were confirmed, the correlations being +0.63 ( P < 0.001) and -0.10 ( N . s . ) respectively. Secondly, the 42 patients were divided into three groups according to the number of ‘psychological‘ constructs used, the cut-off scores being arranged so that approximately one-third of the patients were included in each group. The low group (04 ‘psychological ’ constructs) comprised 13 patients, the medium group (5-9 ‘psychological’ constructs) comprised 15 patients and the high group (10 or more ‘psychological’ constructs) comprised 14 patients. The groups did not differ significantly in age, sex or Mill Hill Synonyms scores. The mean numbers of psychic and somatic symptoms reported by each of the three groups are shown in Table I . Two predictions were tested. The first was that the groups would differ in the number of psychic symptoms reported, with the high group reporting most and the low group reporting least. Inspection of Table I shows that this was the case: analysis of variance showed that the differences were highly significant ( F = 10.01;d.f. = 2.41; P < 0.005;one-tailed test). The second prediction was that there would be no difference between the groups in the number of somatic symptoms reported. Inspection of Table I showed no systematic trend over the three groups in the number of somatic symptoms reported and analysis of variance showed that the groups did not differ significantly (F= 1.47; d.f. = 2, 41; N.s.; two-tailed test). The tendency for those patients who employed most ‘psychological ’ constructs to report most psychic symptoms was not due merely to these patients reporting more symptoms of all types. As shown above, they did not differ from the other patients in their reporting of somatic symptoms. Also, the entire questionnaire from which the Symptom Scale was derived comprised 83 items in addition to the 21 included in the Scale; the three groups did not differ significantly in the number of these other symptoms which they reported.
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Table 1. Number of psychic and somatic symptoms reported by ‘high ’, ‘ medium ’ and ‘low ’ users of ‘psychological ’ constructs Groups High
Medium
Low
10+ 14
5-9 I5
0-4 13
9.14 3.30
5.60 2.87
4.15 2.79
1.71 1.73
1.40 1.88
2.62 2.14
No. ‘Psychological’
Constructs N Psychic symptoms:
Mean S.D.
Somatic symptoms: Mean S.D.
The number of somatic symptoms complained of was relatively small compared to the number of psychic symptoms reported. This reflected both the smaller number of somatic items in the Symptom Scale and their being more specific than the psychic items, i.e. they referred to specific bodily areas. This latter point is particularly important in view of the evidence of the many possible somatic concomitants of anxiety, and the differences between people in the pattern of their somatic reactions (e.g. Lacey, 1950, 1967). In a future study it would be desirable to use a questionnaire specifically designed to assess the full range of possible somatic symptoms of anxiety. DISCUSSION
The results were exactly as predicted. The extent to which patients construed ‘psychologically’ rather than ‘objectively ’ on the photograph description task was positively and significantly correlated with the number of psychic symptoms of anxiety which they reported, but correlated only to a negligible extent with the number of somatic symptoms of which they complained. Those patients who used most psychological constpcts differed from the others in the number of psychic symptoms reported, but not in the number of somatic symptoms reported. The present results, and those of Smail(1970) and McPherson (19721, are compatible with the hypothesis that the characteristic ways in which individuals construe themselves and their situation specifically, the extent to which they describe and interpret events ‘psychologically’ or ‘objectively ’ - influence how they experience and report anxiety. ‘Objective’ construers report only the physical sensations of anxiety and hence complain only of somatic symptoms; ‘psychological’ construers report these sensations, but interpret them psychologically as indicative of emotion, so that they also experience and report the emotional symptoms of anxiety. In other words, the type of anxiety symptom of which a patient complains is influenced by cognitive factors, in particular by the ways in which he appraises and labels his bodily sensations, such as those occurring during states of high arousal. A similar hypothesis has been advanced by McPherson (1973)to explain affective flattening, a disorder in which patients are apparently unable to express emotion or to behave emotionally in situations in which this would be appropriate. McPherson argued that affective flattening can be regarded as a cognitive disorder, resulting from the patient being unable to construe ‘psychologically’. Thus, environmental stimuli are not interpreted ‘emotionally’, and physical sensations of arousal are not interpreted as indicative of emotion. Evidence that affectively flattened patients tend not to construe ‘psychologically’ is provided by Dixon (l968), McPherson et al. (l970a, b), Williams & Quirke (1972) and Bodlakova et al.
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(1974). Likewise, Valins (1970) has proposed that the apparent absence of emotion which is said to be characteristic of psychopaths is due to their failure to utilize their bodily sensations as cues when evaluating emotional situations; some supportive evidence is provided by Valins (1967) and Stern & Kaplan (1967). The present results may have clinical implications. The general differences between people in the extent to which they construe ‘psychologically’ may be reflected not only in their tendency to report psychic or somatic symptoms but also in their response to different types of treatment. Thus, it may be that ‘psychological’ construers are more likely to benefit from ‘psychological’ treatments such as psychotherapy, whereas the more ‘objective ’ construers might be more likely to respond to physical treatments such as drug therapy. An alternative hypothesis is that patients with somatic symptoms might benefit from reconstruing their headaches, back pains, etc., as evidence of emotional distress rather than of physical disorder. Theoretically, the present results support the views of Schachter (1964), Valins (1970) and others regarding the importance of cognitive factors in influencing the nature and extent of emotional experience, and provide further evidence of the heuristic value of the distinction between ‘psychological ’ and ‘objective ’ construing. ACKNOWLEDGEMENTS
Some of the data were collected by Patricia Wright and Lyn Stanley. REFERENCES
BECKER,H. S. (1953). Becoming a marijuana user. Am. J . Sociol. 59, 235-242. BINDRA, D. (1970). Emotion and behaviour theory: current research in historical perspective. In P. Black (ed.). Physiological Correlates of Emotion. New York: Academic Press. B O D L A K O V A HEMSLEY, ,~., D. R. & MUMFORD. S. J. (1974). Psychological variables and flattening of affect. Br. J . rned. Psychol. 47. 227-234. BOURQUE, L. B. & BACK,K. W. (1971). Language, society and subjective experience. Sociometry34, 1-21.
Buss, A. H. (1962). Two anxiety factors in psychiatricpatients.J. abnorm. soc. Psychol.65.426427. BUSS, A. H. (1966). Psychopathology. New York: Wiley. DIXON,P. M. (1968). Reduced emotional responsiveness in schizophrenia. Unpublished Ph.D. thesis. University of London. DUCK,S. W. (1973). PersonalRelationships and Personal Constructs. New York: Wiley. FOULDS.G. A. (1965). Personality and Personal Illness. London: Tavistock. ‘Psychic: somatic’ symptoms FOULDS.C. A. (1%). and hostility. Br. J. soc. d i n . Psychol. 5. 185-189. FOULDS,G. A. & BEDFORD,A. (1976). Manualofthe Delusions, Symptoms and States Questionnaire. (In preparation.) FOULDS,G. A. & HOPE, K. (1968). Manual of the Symptom Sign Inventory. London: University of London Press. GIRODO,M. (1973). Film induced arousal. information search. and the attribution process. J. Person. SOC. Psycho/. 25. 357-360. HAMILTON,M. (1959). The assessment of anxiety states by rating. Br. J. med. Psychol. 32. 50-59. J A M E S . (1884). ~. What isemotion? Mind 9. 188-204.
KELLY,G. A. (1955). The Psychology of Personal Constructs. New York: Norton. LACEY,J. I. (1950). Individual differences in somatic response patterns. 1. romp. physiol. Psychol. 43, 338-350. LACEY,J. I. (1967). Somatic response patterning and stress: some revisions of activation theory. In M. M. Appley and R. R. Turnbell (eds.). Psychological Stress: Issues in Research. New York: Appleton-Century-Crofts. LAZARUS,R. S . , AVERILL, J. R. & OPTON, B. M. (1970). Towards a cognitive theory of emotion. In M. B. Arnold (ed.). Feelings and Emotions. New York: Academic Press. LITTLE, B. R. (1968). Personal Systems Project. Unpublished MS, University of Oxford. LOFTIS,J. & Ross, L. (1974). Effects of misattribution of arousal upon the aquisition and extinction of a conditioned emotional response. J. Person. soc. Psychol. 30,673-682. MCPHERSON,F. M. (1972). ’ Psychological ’ constructs and ‘psychological’ symptoms in schizophrenia. Br. 1. Psychiat. 120, 197-198. MCPHERSON, F. M. (1973). Psychological construing and schizophrenia. Paper presented to B.P.S. Division of Clinical Psychology. Scottish Branch Meeting, Dundee. MCPHERSON,M. F., BARDEN,V. H.,HAY, A. J., JOHNSTONE, D. W. & KUSHNER, A. W. ( 1 9 7 0 ~ ) . Flattening of affect and personal constructs. Br. J. Psychiat. 116. 39-43. MCPHERSON,F. M.. BARDEN,V. & BUCKLEY, F. (1970b). The use of ‘psychological’ constructs by affectively flattened schizophrenics. Br. J. med. Psychol. 43. 291-293. MCPHERSON, F. M. & GRAY,A. (1976). Aspects of ‘psychological ’ construing. (In preparation.)
Psychological construing and psychological symptoms NISBETT,R. E. & SCHACHTER, S. (1966). Cognitive manipulation of pain. J. exp. S O C . Psychol. 2. 227-236. ROSS, L.,RODIN, J . & ZIMBARDO, P. (1969). Toward an attribution therapy: the reduction of fear through induced cognitive emotional misattribution. J. Person. soc. Psychol. 12, 279-288. SCHACHTER, S. (1964). The interaction of cognitive and physiological determinants of emotional state. In L. Berkowitz (ed.), Advances in Experimental Social Psychology. vol. I . New York: Academic Press. SCHACHTER, S. & SINGER, J . E. (1962). Cognitive. social and physiological determinants of emotional state. Psychol. Rev. 69, 379-399. SMAIL,D. J . (1970). Neurotic symptoms, personality
79
and personal constructs. Br. J. Psychiat. 117, 645-648. STERN,R. M. & KAPLAN,B. E. (1967).Galvanic skin response: voluntary control and externalisation. J. psychosom. Res. 10, 349-353. VALINS,S. (1966). Cognitiveeffectsof falseheart-rate feedback. J. Person. S O C . Psycho/. 4, 4-08. VALINS,S. (1%7). Emotionality and information concerning internal reactions. J. Person. soc. Psycho/. 6. 458463. VALINS,S. (1970). The perception and labelling of bodily changes as determinants of emotional behaviour. In P. Black (ed.), Physiological Correlates of Emotion. New York: Academic Press. WILLIAMS, E. & QUIRKE, C. (1972). Psychological construing and schizophrenia. Br. J. med. psychol. 4s. 79-84.
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Psychological construing and psychological symptoms BY F. M. McPHERSON* A N D ANNABELLE GRAYt Recent theories of emotion (e.g. Schachter, 1964; Lazarus et al., 1970) have emphasized the influence of cognition on the nature and quality of emotional experience and behaviour. Clearly, a person’s emotional response to a stimulus will be influenced b his cognitive appraisal of the stimulus situation, e.g. by whether he construes it as ‘danger us’ or ‘harmless’. However, another possible way in which cognition and emotion interact h een emphasized by Schachter (I-), Valins (1970) and others. They argue that the emoti al experience and behaviour of a person is influenced by how he appraises - interprets, aluates and labels - his own bodily sensations of physiological arousal. This is the topic of the present article. Since James (1884), writers on emotion have distinguished between a person’s experience of emotion, and his awareness of his bodily sensations. When physiologically aroused, a person may perceive and report those physical sensations, usually felt as being localized in specific bodily areas, which typically accompany arousal, e.g. he may be aware of palpitations, breathlessness and a ‘churning’ sensation in the stomach. Emotional states, such as those of being ‘sad’ or ‘angry ’, are on the other hand experienced as more generalized and as on a psychological plane. Schachter,(1%4), Valins (1970) and Bindra (1970) have argued that emotional experiences are secondary constructions which are the outcome of an appraisal process in which a person combines information from his bodily sensations with information derived from his perceptions of other aspects of himself, and of his environment. According to this view, someone who is aware of the bodily sensations of arousal will experience emotion, and will behave emotionally, only to the extent that the sensations are attributed to emotional stimuli. Conversely, regardless of the external situation, he will experience emotion only if he is aware of the somatic sensations of arousal. These points are illustrated in a series of experiments by Schachter and his colleagues, in which physiological changes were produced by drugs. For example, Schachter & Singer (1%2) showed that individuals with identical states of physiological arousal, produced by injections of adrenalin, experienced the emotions of either anger or euphoria, according to whether they construed their current social situation as anger-producing or euphoria-producing. Other individuals who had similarly been injected, but who attributed their bodily sensations to the effect of the drugs, and as unrelated to the emotion-producing situation, experienced no feelings of emotion and reported only bodily sensations. More recent studies have demonstrated that the emotional consequences of environmental threat can be influenced by cognitive factors. Girodo (1973) found that girls who were made anxious by being shown a horrifying film reported less subjective anxiety if they attributed their physiological arousal to the effects of a toxic gas (which actually had no effect) rather than to the film. Other illustrations are provided by Nisbett & Schachter (1966), Valins (1966), Ross et al. (1%9) and Loftis & Ross (1974). These studies appear to show that when a person becomes aware that he is in a state of physiological arousal, he will attempt to explain the state in terms of his current situation. If he finds a ‘psychological’ explanation, e.g. if he construes the situation as ‘anger-producing’, he will interpret and label his condition as the psychological one
i 2
* Department of Psychology, University of Dundee; Hon. Director, Tayside Area Clinical Psychology Department. t Senior Clinical Psychologist, Tayside Area Clinical Psychology Department, Royal Dundee Liff Hospital, Dundee, Scotland.
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of experiencing the appropriate emotion. Identical states of arousal may thus be experienced as different emotions (as ‘joy or sadness, fear or anger’ - Schachter, 1964) according to how the situation is construed. This process appears to involve the reappraisal of the stimulus situation (Nisbett & Schachter, 1966; Valins, 1966) and the categorization and labelling of an experience as emotional will initiate appropriate expressive and instrumental behaviour, such as acting angrily. As Bindra (1970) points out, the process by which someone experiences emotion in himself is similar to that by which he recognizes it in others. The major difference is that in the former the person has access to sensory feedback from his physiological reactions, whereas in the latter he has only the indirect evidence of the other person’s facial expression, posture and communications. In those situations in which a person is aware of bodily sensations for which no psychological explanation can be found, or for which a ‘physical’ explanation is suggested - as in the studies noted above - the person will construe the sensations physically and will not elaborate them into emotional experience. The literature on psychedelic drugs, whose users expect them to have psychological effects, provide interesting illustrations of how physical sensations can be reconstrued as psychological feelings. Thus, Becker (1953) observed that the novice marihuana smoker tended to report only unpleasant physical sensations, such as palpitations, tremor, nausea and hunger. It was only after discussing these symptoms with experienced users that the novice reconstrued his state as the pleasureable one of being ‘high’. Valins (1970) has suggested that differences exist between individuals in the characteristic ways in which they categorize and label their bodily perceptions. In the above studies and illustrations, the people involved obtained clear information from their environment about what and how they should feel. Where few environmental cues are available, individual differences in labelling are likely to show up more predominantly. For example, Bourque & Back (1971) concluded that the way in which a person reports ecstatic and transcendental experiences, e.g. whether as religious or aesthetic, is influenced less by the experiences themselves than by the construct system and terminology available to him. One difference between people which might be important in connexion with emotional experience and expression has been reported by several workers in the context of Personal Construct Theory (Kelly, 1955). A person may describe, and differentiate between, himself and others, or between other people, in terms of ‘psychological’ constructs. These are constructs which refer to aspects of personality, to emotional states or to interpersonal relationships, e.g. ‘ happy-sad ’, ‘friendly-aloof ’, ‘likes me-doesn’t ’. Alternatively, he may employ ‘objective ’ constructs, descriptive of more directly observable, less inferential features such as physical appearance, e.g. ‘tall-short ’, ‘healthy-ill ’. Normal individuals differ considerably in the extent to which they construe ‘psychologically ’ rather than ‘objectively ’, the difference being stable over time and over different construing situations, and being unrelated to intelligence (McPherson &Gray, 1976). People who construe in a predominantly ‘psychological ’ mode differ from those who construe ‘objectively ’ in a variety of ways, for example in having different personal interests (Little, 1968) and in making friends more readily (Duck, 1973). It was suggested above that people experience emotion only to the extent that they find a ‘psychological’ explanation of their bodily arousal, and so interpret their bodily sensations as indicative of emotional experience. From this, it can be predicted that with a given state of arousal, and a given environmental situation, extreme ‘psychological ’ construers will be more likely to find such explanations, and to categorize and label their sensations as ‘emotion ’, than will extreme ‘objective ’ construers, who will tend to report only their physical sensations of arousal. This has not been tested in normals, but a similar prediction can be made about the abnormal arousal and emotions of psychiatric patients. Many psychiatric patients experience symptoms of anxiety, often in addition to other psychological disorders (Foulds, 1965). There are many different anxiety symptoms and there have
Psychological construing and psychological symptoms
75
been several attempts to categorize them. One distinction which is commonly made (e.g. Buss, 1962; Foulds, 1966) is between somaticsymptoms, such as sweating, heart palpitations, dry mouth and intestinal distress, and psychological, i.e. cognitive and emotional, symptoms such as worry, apprehension and feelings of anxiety and depression (Hamilton, 1959; Buss, 1962; Foulds, 1965). Patients differ in the sort of symptoms which they report (Buss, 1966) and from the discussion above it can be predicted that these differences are related to the patient’s characteristic modes of construing. Thus, both ‘objective ’ construers and ‘psychological’ construers will be aware of their abnormal physical sensations but whereas the former will report only these sensations and will hence complain only of somatic symptoms, the ‘psychological’ construers will elaborate and interpret these sensations ‘psychologically’, as indicative of emotional distress and symptoms. Thus, on a questionnaire assessing the presence of psychic and somatic symptoms, ‘psychological’ and ‘objective’ construers may be expected to report an equal number of somatic symptoms, but the former may be expected to report significantly more ‘psychic’ or emotional symptoms. Smail(l970) and McPherson (1972) both found that patients who construed ‘psychologically’ and ‘objectively ’ differed, in the predicted direction, in their scores on a psychic-somatic symptom questionnaire, although the method of scoring the questionnaire did not permit the above prediction to be tested directly. The present study will explore the relationship between construing and type of symptom reported, and will employ a revised version of the symptom questionnaire. METHOD
Subjects Forty-two patients were tested. This group comprised every second consecutive patient admitted to a general psychiatric hospital over a six-week period, excluding only those who (i) were aged above 60 or below 18, (ii) had known organic involvement, (iii) scored below 18 on the Mill Hill Synonyms Selection test, or (iv) were untestable or uncooperative. The group included psychotic and neurotic patients, and those with personality disorders, although the majority of patients had had no diagnostic label attached to them at the time of testing. The patient group comprised 21 males and 21 females, with a mean age of 38.4 years (s.D.11.5, range 18-59 years) and a mean Mill Hill Synonyms Selection test score of 27.3 (s.D.5.5, range 18-41).
Measures Two measures were administered, within two or three days of the patient being admitted. ’ Psychic-somatic scale. Each patient completed a 104-item symptom questionnaire (Foulds & Bedford, 1976) developed from the Symptom Sign Inventory (Foulds & Hope, 1968). From the items, two adhocscales were selected. One comprised items referring to symptoms of anxiety or depression which a panel of six psychologists had unanimously agreed were ‘psychic ’, in that the patient reported the presence of distressing or abnormal thoughts or feelings, e.g. ‘Recently I have worried about every little thing’ or ‘Recently, for no good reason, I have had feelings of panic’. The other scale comprised items relating to symptoms of anxiety or depression which the panel agreed were ‘somatic’, in that the patient reported distressing or abnormal bodily sensations or physical conditions, e.g. ‘Recently, I have had pains over my heart or in my chest, or back’, or ‘Recently, I have been breathless or had a pounding of my chest ’. Twenty-six items were thus selected for the ad hoc ‘psychic’ scale and twenty for the ad hoc ‘somatic’ scale. Each item was scored I (symptom present) or 0 (absent) and the items of the two ad hoc scales were intercorrelated over the first 39 subjects tested. After inspection of the matrix of intercorrelations. the scales were reduced to 14 ‘psychic’ and 7 ‘somatic’ items. The retained ‘psychic’ items each had very high correlations (P < 0.005 or less) with at least 6 other ‘psychic‘ items but had no significant correlation with any ‘somatic’ item, whereas the retained“somatic’ items had correlations of similar magnitude with at least 4 other ‘somatic’ items but with no ‘psychic’ item. Thus, the scores of each patient were obtained on scales which both on clinical and statistical grounds appeared to assess the presence of ‘psychic’ and ‘somatic’ symptoms.
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Constnring tusk
Each patient described the most important differences between the people in pairs of photographs. Eight photographs were used, each of single figures, male or female, of various ages and occupations. This method was used because construing photographs is often more acceptable to patients than construing people known to them, and because there is a high correlation between the number of ‘psychological ’ constructs elicited in this way and the number elicited when the same subject construes people known to him, or describes himself (McPherson & Gray, 1976). Eight pairs of photographs were presented and the patients were asked to give the three major differences between the people in the photographs. A total of 24 bi-polar constructs was thus obtained from each patient. These were scored as either ‘psychological’, i.e. referring to the personality, emotions or interpersonal interactions of the people, or as ‘objective’, i.e. referring to their physical features, dress, social status or activities. Two scorers, using detailed criteria, scored theconstructs independently. They agreed on over 95 per cent of the constructs; those about which they disagreed were arbitrarily scored as ‘objective*. RESULTS
The mean number of ‘psychological ’ constructs given by the 42 patients was 8.8 (s.D.5 . I , range 0-19); the mean numbers of psychic and somatic symptoms were, respectively, 6.3 (s.D.3.6, range 0-14) and 1.9 (s.D.1.9, range 0-6). There was no significant difference between male and female patients in the number of ‘psychological’ constructs given, or in the number of psychic and somatic symptoms reported; there were no significant correlations between the construct scores, or the symptom scores, and either the age or the Mill Hill Synonyms test scores of the patients. The relation between ‘psychological ’ construing and the two categories of symptom was tested in two ways. First, product-moment correlations were calculated over all 42 patients between the number of ‘psychological ’ constructs elicited and (i) the number of psychic symptoms and (ii) the number of somatic symptoms reported by each patient. The predictions were that the former correlation would be positive and significant, whereas the latter correlation would be negligible. These predictions were confirmed, the correlations being +0.63 ( P < 0.001) and -0.10 ( N . s . ) respectively. Secondly, the 42 patients were divided into three groups according to the number of ‘psychological‘ constructs used, the cut-off scores being arranged so that approximately one-third of the patients were included in each group. The low group (04 ‘psychological ’ constructs) comprised 13 patients, the medium group (5-9 ‘psychological’ constructs) comprised 15 patients and the high group (10 or more ‘psychological’ constructs) comprised 14 patients. The groups did not differ significantly in age, sex or Mill Hill Synonyms scores. The mean numbers of psychic and somatic symptoms reported by each of the three groups are shown in Table I . Two predictions were tested. The first was that the groups would differ in the number of psychic symptoms reported, with the high group reporting most and the low group reporting least. Inspection of Table I shows that this was the case: analysis of variance showed that the differences were highly significant ( F = 10.01;d.f. = 2.41; P < 0.005;one-tailed test). The second prediction was that there would be no difference between the groups in the number of somatic symptoms reported. Inspection of Table I showed no systematic trend over the three groups in the number of somatic symptoms reported and analysis of variance showed that the groups did not differ significantly (F= 1.47; d.f. = 2, 41; N.s.; two-tailed test). The tendency for those patients who employed most ‘psychological ’ constructs to report most psychic symptoms was not due merely to these patients reporting more symptoms of all types. As shown above, they did not differ from the other patients in their reporting of somatic symptoms. Also, the entire questionnaire from which the Symptom Scale was derived comprised 83 items in addition to the 21 included in the Scale; the three groups did not differ significantly in the number of these other symptoms which they reported.
Psychological construing and psychological symptoms
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Table 1. Number of psychic and somatic symptoms reported by ‘high ’, ‘ medium ’ and ‘low ’ users of ‘psychological ’ constructs Groups High
Medium
Low
10+ 14
5-9 I5
0-4 13
9.14 3.30
5.60 2.87
4.15 2.79
1.71 1.73
1.40 1.88
2.62 2.14
No. ‘Psychological’
Constructs N Psychic symptoms:
Mean S.D.
Somatic symptoms: Mean S.D.
The number of somatic symptoms complained of was relatively small compared to the number of psychic symptoms reported. This reflected both the smaller number of somatic items in the Symptom Scale and their being more specific than the psychic items, i.e. they referred to specific bodily areas. This latter point is particularly important in view of the evidence of the many possible somatic concomitants of anxiety, and the differences between people in the pattern of their somatic reactions (e.g. Lacey, 1950, 1967). In a future study it would be desirable to use a questionnaire specifically designed to assess the full range of possible somatic symptoms of anxiety. DISCUSSION
The results were exactly as predicted. The extent to which patients construed ‘psychologically’ rather than ‘objectively ’ on the photograph description task was positively and significantly correlated with the number of psychic symptoms of anxiety which they reported, but correlated only to a negligible extent with the number of somatic symptoms of which they complained. Those patients who used most psychological constpcts differed from the others in the number of psychic symptoms reported, but not in the number of somatic symptoms reported. The present results, and those of Smail(1970) and McPherson (19721, are compatible with the hypothesis that the characteristic ways in which individuals construe themselves and their situation specifically, the extent to which they describe and interpret events ‘psychologically’ or ‘objectively ’ - influence how they experience and report anxiety. ‘Objective’ construers report only the physical sensations of anxiety and hence complain only of somatic symptoms; ‘psychological’ construers report these sensations, but interpret them psychologically as indicative of emotion, so that they also experience and report the emotional symptoms of anxiety. In other words, the type of anxiety symptom of which a patient complains is influenced by cognitive factors, in particular by the ways in which he appraises and labels his bodily sensations, such as those occurring during states of high arousal. A similar hypothesis has been advanced by McPherson (1973)to explain affective flattening, a disorder in which patients are apparently unable to express emotion or to behave emotionally in situations in which this would be appropriate. McPherson argued that affective flattening can be regarded as a cognitive disorder, resulting from the patient being unable to construe ‘psychologically’. Thus, environmental stimuli are not interpreted ‘emotionally’, and physical sensations of arousal are not interpreted as indicative of emotion. Evidence that affectively flattened patients tend not to construe ‘psychologically’ is provided by Dixon (l968), McPherson et al. (l970a, b), Williams & Quirke (1972) and Bodlakova et al.
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(1974). Likewise, Valins (1970) has proposed that the apparent absence of emotion which is said to be characteristic of psychopaths is due to their failure to utilize their bodily sensations as cues when evaluating emotional situations; some supportive evidence is provided by Valins (1967) and Stern & Kaplan (1967). The present results may have clinical implications. The general differences between people in the extent to which they construe ‘psychologically’ may be reflected not only in their tendency to report psychic or somatic symptoms but also in their response to different types of treatment. Thus, it may be that ‘psychological’ construers are more likely to benefit from ‘psychological’ treatments such as psychotherapy, whereas the more ‘objective ’ construers might be more likely to respond to physical treatments such as drug therapy. An alternative hypothesis is that patients with somatic symptoms might benefit from reconstruing their headaches, back pains, etc., as evidence of emotional distress rather than of physical disorder. Theoretically, the present results support the views of Schachter (1964), Valins (1970) and others regarding the importance of cognitive factors in influencing the nature and extent of emotional experience, and provide further evidence of the heuristic value of the distinction between ‘psychological ’ and ‘objective ’ construing. ACKNOWLEDGEMENTS
Some of the data were collected by Patricia Wright and Lyn Stanley. REFERENCES
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