Psychological Medicine, 1976, 6, 151-158
RESEARCH REPORT
The Biometrics Research Unit of the New York State Department of Mental Hygiene1 The 1955-56 Annual Report of the Department of Research Psychology at the New York State Psychiatric Institute begins by noting that 'Dr. Joseph Zubin, who had been Associate Research Scientist in this department since September, 1938, resigned January 15th, 1956 to become Principal Research Biometrician, heading a new Department [now Unit] of Biometrics Research . . .' While this move soon proved to be a stimulus for the development of significant new avenues of research, it by no means marked a sharp break with previous work. As Zubin has often noted, the late Carney Landis, when he was head of the Department of Research Psychology, actively fostered a variety of biometric studies, and indeed the annual reports of that department had eventually come to contain a separate section devoted to biometrics, in which the work of Zubin and his colleagues figured prominently. Much of this work would serve as the foundation of the new unit's research programme. In particular, an extensive study of prognosis in early and chronic schizophrenia had already been in progress for several years. In addition to interviews, a battery of tests was employed to sample a range of levels in the patients' functioning: psychophysical, psychophysiological, psychomotor, perceptual, behavioural, and conceptual. Efforts to promulgate the biometric approach to the study of psychopathology had for a long time proved disappointing. The area of psychopathology was largely dominated by traditional phenomenological and clinical approaches, and l Note added in press: As froml April 1975, the status of the Biometrics Research Unit has been changed to that of a member of a consortium of units headed by the New York State Psychiatric Institute. At the moment, the internal structure of Biometrics is still as described in this Report; it remains to be seen whether the new status will result in any significant change in the nature of Biometrics Research. Preparation of this report was supported in part by Grant No. MH 22890-02 from the National Institute of Mental Health.
later by psychodynamic theories beginning with Freud. However, there were a number of forces at work which did eventually culminate in the major impact of biometric studies (Zubin, 1973). Such important, if diverse, figures as Pearson, Galton, Kraepelin, and Jaspers all saw the value of quantification as a way of introducing objectivity and sound evaluative techniques into areas heavily dependent on subjectivity. In addition, as the biological, social, and behavioural sciences developed the theories and techniques of their own disciplines and began to apply them to problems in the area of psychopathology in both laboratory and field studies, it became more and more clear that some universal language was required by means of which communication could take place among disciplines. Biometric techniques of classification and measurement held the hope of being able to provide such a language as well as providing a sound basis for truly interdisciplinary research. In recently reviewing the period before the creation of the new department, Zubin commented, 'Apparently . . . the field was just not yet ready for [biometrics]. During the 1930s and on into the 1940s diagnosis was in the doldrums; prognosis was guarded, and the evaluation of therapy mainly negative—hardly any reasons for clinicians to clasp biometrics to their bosom. However, in the 1950s the scene changed. There were so many therapies vying with each other, so many patients in need of treatment, that the great advantage that could be provided by biometric evaluation became clear' (1973, p. 443). In keeping with this, the New York State Commissioner of Mental Hygiene, the late Paul H. Hoch, became interested in establishing a means of evaluating the impact of the major changes that were about to take place in hospital policy and treatment, and the Biometrics Research
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Unit was thus established. Appropriately enough, the interdisciplinary study of prognosis in schizophrenia, already begun, became the unit's first major endeavor. As it turned out, the scientific findings were something less than exhilarating ('This study had taught us that the then currently available clinical tools were neither prognostic nor diagnostic nor reliable nor valid', as Zubin recently summed it up), but the structure of the project set a productive pattern for the Biometrics Research Unit which has continued to the present day. The need became so apparent for the development of better methods and instruments for tapping the various levels of patients' functioning, as well as for gathering comparative data on normal individuals and institutionalized and non-institutionalized populations of many types, that, by the beginning of 1958, when the research grant supporting the prognosis project terminated, Biometrics Research already had several semi-autonomous groups of investigators developing new techniques and theoretical concepts and carrying out research in their own particular areas of interest. These groups were linked, at least initially, by a common interest in studying schizophrenics. Otherwise they developed their own projects and funded their own personnel and equipment needs with research grants from a variety of federal, state, and private agencies; then, as now, the permanent staff directly supported by the New York State Department of Mental Hygiene was small relative to the total number of persons actually working in the unit. Within the first few years of the unit's existence, research projects were actively under way in the development of rating scales and structured interviews (Burdock et al., 1960; Burdock and Hardesty, 1964; Spitzer et al., 1964); the search for dependable prognostic indicators (Zubin et al., 1957; Zubin et al., 1961); evaluation studies in clinics and hospitals (Staudt and Zubin, 1957); pupillography (Hakerem et al., 1964), reaction time and sensory shift studies (Salzinger, 1957; Sutton et al, 1961), and studies on the effects of delayed auditory feedback (Chase et al., 1961; Sutton et al., 1964); studies of the relationship between psychiatric hospitalization and the patients' positions in their immediate social networks (Hammer, 1963-4); formulation of a conditioning model for the interview, leading to
studies on the conditionability and communicability of schizophrenic and normal speech and on the objective measurement of statements of affect (Salzinger and Pisoni, 1958, 1960; Salzinger et al., 1964a, b, 1966); studies of social isolation in the aged (Tec and Granick, 1959-60; Granick and Nahemow, 1961; Bennett and Nahemow, 1965); studies of adolescent friendship patterns of schizophrenics (Kreisman, 1970). Such a listing can only suggest the diversity of the enormous number of individual studies, but it clearly testifies to the broad range of interests already represented in Biometrics Research at this early period. It should also be noted that, although direct intervention was not initially seen as part of the unit's programme, it soon grew naturally out of several lines of basic research. In its earliest form, it involved applied research in operant conditioning (behavior modification) with young hospitalized children (Salzinger et al., 1965)—work which eventually led to the training of parents (Salzinger et al., 1970) and, currently, mental hospital personnel. Along another line, there have been studies of the effects of a systematic home visiting programme for elderly isolated persons in the community (Bennett, 1973) and of other resocialization programmes for the aged (Weiner and Weinstock, 1973). The several years subsequent to this early period saw an expansion of work in almost all the areas mentioned and the inception of two major new ventures. In 1962, a Biometrics Research Training Program in Experimental Psychopathology, funded by the National Institutes of Mental Health and administered through Columbia University, gave explicit recognition and financial support for what had already become an important function of the unit: to provide students with experience and training in the many biometric techniques and approaches encompassed by the Biometrics Research Unit; the training grant itself was phased out about eight years later, but students continue to be affiliated with the unit in various capacities, and much research for doctoral dissertations continues to be carried out in the unit's laboratories or under its auspices. In 1963, a programme was outlined for an International Study of Diagnosis of the Mental Disorders in the United States and the United Kingdom (later called the Cross-National Project).
Research Report: Biometrics Research Unit, New York State Department of Mental Hygiene
The multifaceted nature and increasing size of the unit eventually led to formal organization into individual sections—a kind of federalist structure, as one long-time member of the unit has termed it. Several of these—Anthropology, Behaviour Analysis and Modification (earlier, Verbal Behaviour), Evaluation, Psychophysiology, and Sociology—existed in fact, if not in name, from the beginning. Biostatistics assumed the status of a separate section as it became increasingly occupied with the development of new concepts and techniques in addition simply to providing guidance on the design and analysis of research carried on elsewhere in the unit. The Diagnosis and Psychopathology section grew out of the Cross-National Project's studies of diagnosis, to which most of its effort continues to be devoted. The Gerontology section, established as a distinct entity about five years ago, grew out of the sociological work in ageing that goes back to the unit's earliest years. The newest section, Family and Youth Research, is involved in research on extensive surveys of adolescent drug use, thus focusing on a critical contemporary problem as well as on an age group largely neglected in the unit's earlier work. In a brief space, it is not possible to do justice to the past accomplishments and ongoing investigations of these nine sections, but certainly some details of their research, beyond the work already referred to, are called for. The Anthropology section, directed by Dr. Muriel Hammer, has pursued the development of techniques for specifying the structure of social networks—that is, the nature and degree of connectedness among individuals (Hammer et al, 1969; Hammer and Schaffer, 1975). In part, such work is an essential precursor of any attempt to follow up the earlier finding (Hammer, 1963-4), mentioned above, that patients' positions in their social networks appear to have important implications for the diagnosis and treatment of their psychopathology. While direct evidence is lacking, theoretical consideration has been given to possible interrelationships of psychopathology, diagnosis, and social network structure (Hammer, 1972, 1973). Another major line of investigation has been sociolinguistic and, often in collaboration with the section on Behavior Analysis and Modification, studies have been carried out of the mutual comprehensibility of-
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the speech of pairs of individuals as a function of the degree of interaction between them (Hammer et al, 1969; Salzinger et al., 1970). The Behavior Analysis and Modification section, directed by Dr. Kurt Salzinger, has emphasized study of the variables controlling a wide variety of normal and deviant behaviours. Verbal behaviour is of fundamental interest, as shown by the basic work on normal verbal behaviour (Salzinger and Feldman, 1973), as well as by the early verbal conditioning studies with schizophrenics and normal subjects and the development of techniques for the objective measurement of the comprehensibility or communicability of speech. A theoretical principle, the immediacy hypothesis, has been formulated to encompass a wide diversity of reported findings in the area of schizophrenia (Salzinger, 1971, 1973), and has been supported in a direct test of its applicability to schizophrenics' speech (Salzinger et al., 1970). The Behavior Analysis and Modification section includes a subsection, directed by Dr. Suzanne Salzinger, engaged in developmental studies with preschool children. Again, the emphasis has been on verbal behavior, with studies on its conditionability (Salzinger et al., 1962), on the development of grammar and syntax (Salzinger et al., 1966, 1967), on the relationship between psychophysical judgments and the verbal scale the child employs in making such judgments (Salzinger et al., 1970), and, currently, on the communicability of the speech of an ethnically diverse group of very young children with their peers and their mothers. A recent collaboration with the Anthropology section and with the Institute for Developmental Studies at New York University was focused on the problem of learning disabilities (Deutsch et al, 1974). The Biostatistics section is directed by Dr. Joseph Fleiss, who has explored a wide variety of statistical techniques particularly appropriate to the treatment of the kinds of data frequently obtained by researchers in the areas of psychopathology and mental health (Fleiss, 1973). In addition to its numerous consultative functions within the unit as well as elsewhere, this section has been concerned with the reliability of ratings and the development of valid techniques for measuring agreement among raters (Fleiss, 1970,
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1971; Fleiss and Cohen, 1973), with the identification of homogeneous subgroups in a heterogeneous population (Fleiss and Zubin, 1969; Fleiss et al., 1971; Fleiss, 1972), and with the development of a more satisfactory alternative to analysis of covariance (Fleiss and Tanur, 1973). The Diagnosis and Psychopathology section, directed by Dr. Barry Gurland, makes extensive use of systematic structured interviews (Cooper et al., 1972) adapted for the specific purposes of its various studies and based on interviews and techniques devised by Wing (Wing et al., 1967) in England and by Spitzer (Spitzer et al., 1964) in the Biometrics Research Unit. This section, in collaboration with a team at the Maudsley Hospital in London, has supported a hypothesis that differences in the reported hospitalization rates for schizophrenia and affective illness between the United States and the United Kingdom could be attributed to the labelling practices of the clinicians making the diagnoses, rather than to any differences in observed pathology (Gurland et al., 1970; Kendell et al., 1971; Simon et al., 1971; Sharpe et al., 1974). Subsequent studies of geriatric patients, using instruments especially adapted for the geriatric age range (Gurland et al., in press) have found the analogous result for reported admission rates of organic and functional disorders (Gurland et al., 1973; Copeland et al., 1974). In collaboration with the sections of Gerontology and Sociology, this section is embarking on a cross-national community survey of the elderly. The Evaluation section, directed by Dr. Robert Spitzer, now has to its credit a variety of extensively tested and widely used instruments, for both research and clinical purposes, for the reliable assessment of degree or type of psychopathology (Spitzer et al., 1967; Spitzer et al., 1970; Spitzer and Endicott, 1971; Endicott and Spitzer, 1972a, b). Other major areas of concern have been the delivery of mental health services —for example, a study of brief versus extended hospitalization (Herz et al, 1974); a study of day versus inpatient hospitalization (Herz et al., 1971); the development and application of computer technology for psychiatric diagnosis (Spitzer and Endicott, 1968,1969,1974a, b; Spitzer et al., 1974), and the objectification of the criteria for the various psychiatric diagnoses (Spitzer et al., in press). Family and Youth Research, directed by Dr.
Denise Kandel, has as its major current project an extensive longitudinal survey of interpersonal processes in adolescent drug use which is part of a long-standing interest in adolescent socialization (Kandel and Lesser, 1972). The study is still in progress (Single et al., 1974), but it has already been able to detail the extent to which peers, relative to parents, play a significant role in drug use (Kandel, 1973, 1974a, b; Kandel et al., 1974). The design of the study of drug-use patterns incorporates follow-up for the year beyond high-school graduation. The formation and dissolution of friendships in relation to drug use will also be examined. The work of the Gerontology section, directed by Dr. Ruth Bennett, has followed two principal lines: the study of aged individuals and the study of the social factors affecting them. Social isolation has been a major focus of interest, especially as it relates to an aged person's risk of mental illness, likelihood of being institutionalized, adjustment to an old age home or other site of relocation, and general functioning in a wide variety of settings and situations (Walton et al., 1964). The section encompasses a range from experimental studies of behaviour in restricted settings (Nahemow and Bennett, 1967; Bennett and Nahemow, 1972; Main and Bennett, 1972) to broad survey research aimed at characterizing or evaluating entire institutions or communities in relation to their aged populations (Bennett, 1964). The Psychophysiology section, directed by Dr. Samuel Sutton, consists of laboratories for the study of pupillography, reaction time, vision, audition, and—most recently—evoked potentials. Initially aiming to assess central nervous system functioning in mental patients, particularly schizophrenics, this section has devoted considerable attention to two persistent and fundamental problems plaguing research in this area. One is the search for experimental tasks on which at least some groups of patients would perform 'better' than normals, thus obviating the ubiquitous 'poor motivation' and 'inattentiveness' as the principal factors invoked to explain patients' results relative to those of normal subjects and providing some reasonable assurance that valid psychophysical measures are being obtained. A few such tasks seem to have been found (Zubin et al., 1975).
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The second problem is the identification, pathology (Hammer et al., 1973). Beyond that, through reliable experimental techniques, of it must be emphasized that critical to the nature more meaningful and homogeneous subgroups of the unit is that it occupies a position as neither (diagnostic categories) than have been arrived a department of a larger institution, such as a at on the basis of clinical procedures alone. An university or hospital, nor as an independent initerative strategy is being employed in which a stitute made up of separate departments, but as post hoc data analysis identifies subgroups, something in between. The relationship between within the initial subject samples, differing with the unit and the New York State Psychiatric respect to some criterion measure which is then Institute, where its main offices are located, and used as an independent variable in selecting other institutions such as Brooklyn State groups of subjects for the next experiment. By Hospital, where the unit has continuously gradually refining diagnostic groups through maintained active laboratories for many years, such a sequence of experiments, it is expected is perhaps rather unusual but not without that experimental findings will shed much more precedent. Such an arrangement, with the unit light on specific diagnostic and aetiological having access to local facilities but with the factors associated with well-defined groups of entire system of state facilities also available as the need arises, appears to have fostered patients (Sutton, 1973). This section is studying not only basic sensory great variety and flexibility in choice of research and perceptual functions, but also much more problems and strategies and perhaps should also complex variables such as objectively measured be credited in large measure with the unit's correlates of criterion level and the 'meaning' or continuing problem-centered, rather than disci'value' a stimulus has for a subject (Sutton and pline-centered, outlook. The interdisciplinary Tueting, in press). The various laboratories have studies that have thus arisen constitute another applied their techniques to the study of a wide cohesive force. range of phenomena, including the effects of In a search for integrative principles or intensity and temporal variables on patients and common denominators in the substance of the normal subjects (Zubin and Kietzman, 1966), the unit's research, Zubin has performed a kind of effect of methylphenidate (Ritalin) on hyper- logical factor analysis from which have emerged kinetic children (Prichep, 1974), differences four vectors: (1) descriptive approaches to between diagnostic categories (Zubin et al., psychopathology, including the many systematic 1975), and similarity of responses in twins (Bock, structured interviews, rating scales, and observa1974). tion instruments developed by the unit; (2) Finally, the Sociology section, directed by Dr. behaviour analysis, including the search for David Wilder, has studied the operation of large variables controlling the emission of a wide 'people processing' organizations or institutions, range of behaviours; (3) aetiological approaches, such as schools and mental health facilities. A including the search for developmental, learning, principal aim is to specify the mental health genetic, ecological, and neurophysiological facimplications of guidance and allocation decisions tors in the cause of mental disorders; and (4) as they affect the people being served (Wilder intervention approaches, in both their preventaand Blumner, 1972). Currently, the mental tive and ameliorative aspects, including studies health care delivery system of one county in New of high-risk groups, social structures, and York State is being studied from the perspective methods of resocialization or therapy. The many studies referred to earlier in this report can be of social systems. In all of this diversity, it may seem surprising seen to fall within the scope of these four vectors. that the Biometrics Research Unit retains a high In a brief summary of the unit's accomplishdegree of cohesiveness. In part, this is a reflection ments, perhaps the first area which must be of the fact that Zubin's own work has always mentioned is diagnosis, where the introduction been enormously wide-ranging, as further of new interviewing and rating techniques, the testified to by the diversity of his students and development and application of reliability colleagues, in the unit and elsewhere, in their measures for assessment and diagnostic data, contributions to a recent book on psycho- and the objective indicators of psychopathology
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developed in the unit's behavioural analysis and neurophysiological work all point to much improved diagnostic procedures. While only a beginning has been made in such areas of vital concern as aetiology and prevention, the broad range of objective approaches being continually developed and explored is seen by the unit as the best means of obtaining a better understanding of the circumstances which lead the vulnerable person we call 'mentally ill' to succumb and of what we might do to prevent it. Indeed, much of the unit's work can be viewed as an attempt to accomplish the objective description of the 'circumstances', the 'vulnerability', and the 'illness' itself. On the occasion of the unit's first annual report, Zubin outlined the nature of biometric research in the following way: 'The Biometrician .. . collects his data directly from the individual patient . . . The Biometrician is responsible for determining the need for certain types of data, for designing the experimental procedures for their collection, selection of samples of patients, and evaluation and integration of results. Thus biometric method is independent of the particular disciplines to which it is applied and when new insights into mental disorders are found, be they biochemical, sociological, bacteriological, or psychological, the evaluation of the new techniques will often depend on biometric methodology'. This view is unmistakably wide-ranging, and the diversity which has always characterized Biometrics can be seen to be an essential factor in the continuing vitality of the unit's research. RICHARD S. FELDMAN2 REFERENCES Bennett, R. (1964). The meaning of institutional life. In Geriatric Institutional Management, pp. 68-90. Edited by M. Leeds and H. Shore. Putman: New York. Bennett, R. (1973). Isolation and isolation-reducing programs. Bulletin of the New York Academy of Medicine, 49, 1143-1163. Bennett, R., and Nahemow, L. (1965). The relations between social isolation, socialization and adjustment in residents of a home for aged. In Mental Impairment in the Aged: Proceedings of Institute on Mentally Impaired Aged, pp. 88-105. Edited by M. P. Lawton and F. G. Lawton. Philadelphia Geriatric Center: Philadelphia. Bennett, R., and Nahemow, L. (1972). Socialization and social adjustment in five residential settings for the aged. In Research Planning and Action for the Elderly, pp. 501-513. Edited by D. P. Kent, R. Kastenbaum, and S. Sherwood. Behavioral Publications: New York. "Address for correspondence: Biometrics Research, 722 West 168th Street, New York City, New York 10032, U.S.A.
Bock, F. (1974). Pupillary and Evoked Potential Similarity in Monozygotic and Dizygotic Twins and Siblings. Thesis: City University of New York. Burdock, E. I., and Hardesty, A. S. (1964). A children's behavior diagnostic inventory. Annals of the New York Academy of Sciences, 105, 890-896. Burdock, E. I., Hardesty, A. S., Hakerem, G., and Zubin, J. (1960). A ward behavior rating scale for mental hospital patients. Journal of Clinical Psychology, 16, 246-247. Chase, R. A., Sutton, S., First, D., and Zubin, J. (1961). A developmental study of changes in behavior under delayed auditory feedback. Journal of Genetic Psychology, 99, 101-112. Cooper, J. E., Kendell, R. E., Gurland, B. J., Sharpe, L., Copeland, J. R. M., and Simon, R. (1972). Psychiatric Diagnosis in New York and London: A Comparative Study of Mental Hospital Admissions. Maudsley Monographs No. 20. Oxford University Press: London. Copeland, J. R. M., Kelleher, M. J., Kellett, J. M., Gourlay, A. J., Barron, G., Cowan, D. W., De Gruchy, J., Gurland, B. J., Sharpe, L., Simon, R., Kuriansky, J., and Stiller, P. (1974). Diagnostic differences in psychogeriatric patients in London and New York. Canadian Psychiatric Association Journal, 19,267-271. Deutsch, C , Hammer, M., and Salzinger, S. (1974). Multilevel Approach to Research in Learning. Position paper presented at Conference on Learning Disabilities, National Institutes of Education. Endicott, J., and Spitzer, R. L. (1972a). Current and past psychopathology scales (CAPPS): Rationale, reliability, and validity. Archives of General Psychiatry, 27, 678-687. Endicott, J., and Spitzer, R. L. (1972b). What! Another rating scale? The psychiatric evaluation form. Journal of Nervous and Mental Disease, 154, 88-104. Fleiss, J. L. (1970). Estimating the reliability of interview data. Psychometrika, 35, 143-162. Fleiss, J. L. (1971). Measuring nominal scale agreement among many raters. Psychological Bulletin, 76, 378-382. Fleiss, J. L. (1972). Classification of the depressive disorders by numerical typology. Journal of Psychiatric Research, 9, 141-153. Fleiss, J. L. (1973). Statistical Methods for Rates and Proportions. Wiley: New York. Fleiss, J. L., and Cohen, J. (1973). The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educational and Psychological Measurement, 33, 613-619. Fleiss, J. L., Lawlor, W., Platman, S. R., and Fieve, R. R. (1971). On the use of inverted factor analysis for generating typologies. Journal of Abnormal Psychology, 77, 127-132. Fleiss, J. L., and Tanur, J. M. (1973). The analysis of covariance in psychopathology. In Psychopathology: Contributions from the Social, Behavioral, and Biological Sciences, pp. 509-527. Edited by M. Hammer, K. Salzinger, and S. Sutton. Wiley: New York. Fleiss, J. L., and Zubin, J. (1969). On the methods and theory of clustering. Multivariate Behavioral Research, 4, 235-250. Granick, R., and Nahemow, L. D. (1961). Preadmission isolation as a factor in adjustment to an old age home. In Psychopathology of Aging, pp. 285-302. Edited by P. H. Hoch and J. Zubin. Grune and Stratton: New York. Gurland, B. J., Fleiss, J. L., Cooper, J. E., Sharpe, L., Kendell, R. E., and Roberts, P. (1970). Cross-national study of diagnosis of mental disorders: Hospital diagnoses and hospital patients in New York and London. Comprehensive Psychiatry, 11, 18-25. Gurland, B. J., Fleiss, J. L., Goldberg, K., Sharpe, L., Copeland, J. R. M., Kelleher, M. J., and Kellett, J. M. (In press). The Geriatric Mental State Schedule: A factor analysis. Psychological Medicine.
Research Report: Biometrics Research Unit, New York State Department of Mental Hygiene Gurland, B. J., Kuriansky, J. B., Sharpe, L., Simon, R. J., Stiller, P., and Fleiss, J. L., with Copeland, J. R. M., Kelleher, M. J., Gourlay, A. J., Cowan, D. W., and Barron, G. (1973). A Comparison of the Outcome of Hospitalization of Geriatric Patients in Public Psychiatric Wards in New York and London. Paper read at meeting of Canadian Psychiatric Association. Hakerem, G., Sutton, S., and Zubin, J. (1964). Pupillary reactions to light in schizophrenic patients and normals. Annals of the New York Academy of Sciences, 105, 820-831. Hammer, M. (1963-64). Influence of small social networks as factors on mental hospital admission. Human Organization, 22, 243-251. Hammer, M. (1972). Schizophrenia: Some questions of definition in cultural perspective. In Genetic Factors in 'Schizophrenia', pp. 423-450. Edited by A. R. Kaplan. Thomas: Springfield, 111. Hammer, M. (1973). Psychopathology and the structure of social networks. In Psychopathology: Contributions from the Social, Behavioral, and Biological Sciences, pp. 91-105. Edited by M. Hammer, K. Salzinger, and S. Sutton. Wiley: New York. Hammer, M., Polgar, S., and Salzinger, K. (1969). Speech predictability and social contact patterns in an informal group. Human Organization, 28, 235-242. Hammer, M., Salzinger, K., and Sutton, S. (eds). (1973). Psychopathology: Contributions from the Social, Behavioral' and Biological Sciences. Wiley: New York. Hammer, M., and Schaffer, A. (1975). Interconnectedness and the duration of connections in several small networks. American Ethnologist, 2. Herz, M. I., Endicott, J., and Spitzer, R. L. (1974). A Study of Brief Hospitalization: Initial Results. Paper presented at the American Psychiatric Association Meeting. Herz, M. I., Endicott, J., Spitzer, R. L., and Mesnikoff, A. (1971). Day versus inpatient hospitalization: A controlled study. American Journal of Psychiatry, 127, 1371-1382. Kandel, D. (1973). Adolescent marihuana use: Role of parents and peers. Science, 181, 1067-1070. Kandel, D. (1974a). Interpersonal influences on adolescent illegal drug use. In The Epidemiology of Drug Abuse, pp. 207-240. Edited by E. Josephson and E. Carroll. Winston: Washington, D.C. Kandel, D. (1974b). Inter- and intra-generational influences on adolescent marihuana use. In Generations and Social Change. Edited by V. Bengston and R. Laufer. Special issue of Journal of Social Issues, 30, 107-135. Kandel, D., and Lesser, G. S. (1972). Youth in Two Worlds. Jossey-Bass: San Francisco. Kandel, D., Single, E., Treiman, D., and Faust, R. (1974). Adolescent involvement in illicit drug use: A multiple classification analysis. Paper presented at the American Sociological Association Meeting. Kendell, R. E., Cooper, J. E., Gourlay, A. J., Copeland, J. R. M., Sharpe, L., and Gurland, B. J. (1971). Diagnostic criteria of American and British psychiatrists. Archives of General Psychiatry, 25, 123-130. Kreisman, D. (1970). Social interaction and intimacy in preschizophrenic adolescence. In The Psychopathology of Adolescence, pp. 299-318. Edited by J. Zubin and A. M. Freedman. Grune and Stratton: New York. Main, S., and Bennett, R. (1972). Greeting behavior and social adjustment in aged residents of a nursing home. In Research Planning and Action for the' Elderly, pp. 201-209. Edited by D. P. Kent, R. Kastenbaum, and S. Sherwood. Behavioral Publications: New York. Nahemow, L., and Bennett, R. (1967). Conformity, persuasability and counternormative persuasion. Sociometry, 30, 14-25.
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Prichep, L. S. (1974). Attention and the Auditory Evoked Potential in Hyperkinetic Children Treated with Methylphenidate and in Normal Children. Thesis: City University of New York. Salzinger, K. (1957). Shift in judgment of weights as a function of anchoring stimuli and instructions in early schizophrenics and normals. Journal of Abnormal and Social Psychology, 55,43-49. Salzinger, K. (1971). An hypothesis about schizophrenic behavior. American Journal of Psychotherapy, 25, 601-614. Salzinger, K. (1973). Schizophrenia: Behavioral Aspects. Wiley: New York. Salzinger, K., and Feldman, R. S. (eds). (1973). Studies in Verbal Behavior: An Empirical Approach. Pergamon: New York. Salzinger, K., Feldman, R. S., Cowan, J. E., and Salzinger, S. (1965). Operant conditioning of verbal behavior of two young speech-deficient boys. In Research in Behavior Modification, pp. 82-105. Edited by L. Krasner and L. P. Ullmann. Holt, Rinehart, and Winston: New York. Salzinger, K., Feldman, R. S., and Portnoy, S. (1970). Training parents of brain-injured children in the use of operant conditioning procedures. Behavior Therapy, 1, 4-32. Salzinger, K., Hammer, M., Portnoy, S., and Polgar, S. K. (1970). Verbal behaviour and social distance. Language and Speech, 13, 25-37. Salzinger, K., and Pisoni, S. (1958). Reinforcement of affect responses of schizophrenics during the clinical interview. Journal of Abnormal and Social Psychology, 57, 84-90. Salzinger, K., and Pisoni, S. (1960). Reinforcement of verbal affect responses of normal subjects during the interview. Journal of Abnormal and Social Psychology, 60, 127-130. Salzinger, K., Portnoy, S., and Feldman, R. S. (1964a). Verbal behavior of schizophrenic and normal subjects. Annals of the New York Academy of Sciences, 105, 845-860. Salzinger, K., Portnoy, S., and Feldman, R. S. (1964b). Experimental manipulation of continuous speech in schizophrenic patients. Journal of Abnormal and Social Psychology, 68, 508-516. Salzinger, K., Portnoy, S., and Feldman, R. S. (1966). Verbal behavior in schizophrenics and some comments toward a theory of schizophrenia. In Psychopathology of Schizophrenia, pp. 98-128. Edited by P. H. Hoch and J. Zubin. Grune and Stratton: New York. Salzinger, K., Portnoy, S., Pisoni, D. B., and Feldman, R. S. (1970). The immediacy hypothesis and response-produced stimuli in schizophrenic speech. Journal of Abnormal Psychology, 76, 258-264. Salzinger, S., Salzinger, K., and Hobson, S. (1966). Memory for verbal sequences as a function of their syntactical structure and the age of the recalling child. Journal of Psychology, 64, 79-90. Salzinger, S., Salzinger, K., and Hobson, S. (1967). The effect of syntactical structure on immediate memory for word sequences in middle- and lower-class children. Journal of Psychology, 67, 147-159. Salzinger, S., Salzinger, K., and Patenaude, J. (1970). Effect of verbal response class on shift in the preschool child's judgment of length in response to an anchor stimulus. Developmental Psychology, 2, 49-57. Salzinger, S., Salzinger, K., Portnoy, S., Eckman, J., Bacon, P. M., Deutsch, M., and Zubin, J. (1962). Operant conditioning of continuous speech in young children. Child Development, 33, 683-695. Sharpe, L., Gurland, B. J., Fleiss, J. L., Kendell, R. E., Cooper, J. E., and Copeland, J. R. M. (1974). Some comparisons of American, Canadian, and British psychiatrists in their diagnostic concepts. Canadian Psychiatric Association Journal, 19, 235-245.
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Simon, R. J., Fisher, B., Fleiss, J. L., Gurland, B. J., and Sharpe, L. (1971). Relationship between psychopathology and British- or American-oriented diagnosis. Journal of Abnormal Psychology, 78, 26-29. Single, E., Kandel, D., and Faust, R. (1974). Patterns of multiple drug use in high school. Journal of Health and Social Behavior, 15, 344-357. Spitzer, R. L., and Endicott, J. (1968). DIAGNO: A computer program for psychiatric diagnosis utilizing the differential diagnostic procedure. Archives of General Psychiatry, 18, 746-756. Spitzer, R. L., and Endicott, J. (1969). DIAGNO II: Further developments in a computer program for psychiatric diagnosis. American Journal of Psychiatry, 125, No. 7 Suppl., 12-21. Spitzer, R. L., and Endicott, J. (1971). An integrated group of forms for automated psychiatric case records: A progress report. Archives of General Psychiatry, 24, 540-547. Spitzer, R. L., and Endicott, J. (1974a). Can the computer assist clinicians in diagnosis? American Journal of Psychiatry, 131, 523-530. Spitzer, R. L., and Endicott, J. (1974b). Computer diagnosis in an automated record keeping system: A study of clinical acceptability. In Progress in Mental Health Information Systems: Computer Applications, pp. 73-100. Edited by J. Crawford, D. Morgan, and D. Gianturco. Ballinger: Cambridge, Mass. Spitzer, R. L., Endicott, J., Cohen, J., and Fleiss, J. L. (1974). Constraints on the validity of computer diagnosis. Archives of General Psychiatry, 31, 197-203. Spitzer, R. L., Endicott, J., Fleiss, J. L., and Cohen, J. (1970). The Psychiatric Status Schedule: A technique for evaluating psychopathology and impairment in role functioning. Archives of General Psychiatry, 23, 41-55. Spitzer, R. L., Endicott, J., Robins, E., Kuriansky, J., and Gurland, B. (In press). Preliminary Report of the Reliability of Research Diagnostic CriteriaiR DC) Applied to Psychiatric Case Records. In Prediction in Psychopharmacology. Edited by S. Gershon and R. Beer. Raven: New York. Spitzer, R. L., Fleiss, J. L., Burdock, E. I., and Hardesty, A. S. (1964). The Mental Status Schedule: Rationale, reliability, and validity. Comprehensive Psychiatry, 5, 384395. Spitzer, R. L., Fleiss, J. L., Endicott, J., and Cohen, J. (1967). Mental Status Schedule: Properties of factor-analytically derived scales. Archives of General Psychiatry, 16, 479-493. Staudt, V., and Zubin, J. (1957). A biometric evaluation of the somatotherapies in schizophrenia. Psychological Bulletin, 54, 171-196. Sutton, S. (1973). Fact and artifact in the psychology of schizophrenia. In Psychopathology: Contributions from the
Social, Behavioral, and Biological Sciences, pp. 197-213. Edited by M. Hammer, K. Salzinger, and S. Sutton. Wiley: New York. Sutton, S., Hakerem, G., Portnoy, M., and Zubin, J. (1961). The effect of shift of sensory modality on serial reactiontime: A comparison of schizophrenics and normals. American Journal of Psychology, 74, 224-232. Sutton, S., Roehrig, W. C , and Kramer, J. (1964). Delayed auditory feedback of speech in schizophrenics and normals. Annals of the New York Academy of Sciences, 105, 832-844. Sutton, S., and Tueting, P. (In press). The sensitivity of the evoked potential to psychological variables. In Research in Psychophysiology. Edited by P. H. Venables and M. J . Christie. Wiley: New York. Tec, N., and Granick, R. (1959-60). Social isolation and difficulties in social interaction in residents of a home for aged. Social Problems, 1, llb-Hl. Walton, H., Bennett, R. G., and Nahemow, L. (1964). Psychiatric illness and adjustment in a home for the aged. Annals of the New York Academy of Sciences, 105, 897-918. Weiner, M., and Weinstock, C. (1973). The Effects of a Resocialization Program on Cognitive and Physical Functioning in an Elderly Population. Paper read at meeting of American Psychological Association. Wilder, D., and Blumner, A. S. (1972). Some Sociological Aspects of Student Allocation in Two Racially Mixed Suburban High Schools. Teachers College, Columbia University: New York. Wing, J. K., Birley, J. L. T., Cooper, J. E., Graham, P., and Isaacs, A. D. (1967). Reliability of a procedure for measuring and classifying "present psychiatric state". British Journal of Psychiatry, 113, 499-515. Zubin, J. (1973). The program of the Biometrics Research Unit. Psychiatric Quarterly, 46, 439-448. Zubin, J., Burdock, E. I., Sutton, S., and Cheek, F. (1957). Prognostic indicators in mental illness. Public Health Reports, 72, 592-595. Zubin, J., and Kietzman, M. L. (1966). A cross-cultural approach to classification in schizophrenia and other mental disorders. In Psychopathology of Schizophrenia, pp. 482-514. Edited by P. H. Hoch and J. Zubin. Grune and Stratton: New York. Zubin, J., Salzinger, K., Fleiss, J. L., Gurland, B. J., Spitzer, R. L., Endicott, J., and Sutton, S. (1975). Biometric approach to psychopathology: Abnormal and clinical psychology—statistical, epidemiological, and diagnostic approaches. Annual Review of Psychology, 26, 621-671. Zubin, J., Sutton, S., Salzinger, K., Salzinger, S., Burdock, E. I., and Peretz, D. (1961). A biometric approach to prognosis in schizophrenia. In Comparative Epidemiology of the Mental Disorders, pp. 143-203. Edited by P. H. Hoch and J. Zubin. Grune and Stratton: New York.
RESEARCH REPORT
The Biometrics Research Unit of the New York State Department of Mental Hygiene1 The 1955-56 Annual Report of the Department of Research Psychology at the New York State Psychiatric Institute begins by noting that 'Dr. Joseph Zubin, who had been Associate Research Scientist in this department since September, 1938, resigned January 15th, 1956 to become Principal Research Biometrician, heading a new Department [now Unit] of Biometrics Research . . .' While this move soon proved to be a stimulus for the development of significant new avenues of research, it by no means marked a sharp break with previous work. As Zubin has often noted, the late Carney Landis, when he was head of the Department of Research Psychology, actively fostered a variety of biometric studies, and indeed the annual reports of that department had eventually come to contain a separate section devoted to biometrics, in which the work of Zubin and his colleagues figured prominently. Much of this work would serve as the foundation of the new unit's research programme. In particular, an extensive study of prognosis in early and chronic schizophrenia had already been in progress for several years. In addition to interviews, a battery of tests was employed to sample a range of levels in the patients' functioning: psychophysical, psychophysiological, psychomotor, perceptual, behavioural, and conceptual. Efforts to promulgate the biometric approach to the study of psychopathology had for a long time proved disappointing. The area of psychopathology was largely dominated by traditional phenomenological and clinical approaches, and l Note added in press: As froml April 1975, the status of the Biometrics Research Unit has been changed to that of a member of a consortium of units headed by the New York State Psychiatric Institute. At the moment, the internal structure of Biometrics is still as described in this Report; it remains to be seen whether the new status will result in any significant change in the nature of Biometrics Research. Preparation of this report was supported in part by Grant No. MH 22890-02 from the National Institute of Mental Health.
later by psychodynamic theories beginning with Freud. However, there were a number of forces at work which did eventually culminate in the major impact of biometric studies (Zubin, 1973). Such important, if diverse, figures as Pearson, Galton, Kraepelin, and Jaspers all saw the value of quantification as a way of introducing objectivity and sound evaluative techniques into areas heavily dependent on subjectivity. In addition, as the biological, social, and behavioural sciences developed the theories and techniques of their own disciplines and began to apply them to problems in the area of psychopathology in both laboratory and field studies, it became more and more clear that some universal language was required by means of which communication could take place among disciplines. Biometric techniques of classification and measurement held the hope of being able to provide such a language as well as providing a sound basis for truly interdisciplinary research. In recently reviewing the period before the creation of the new department, Zubin commented, 'Apparently . . . the field was just not yet ready for [biometrics]. During the 1930s and on into the 1940s diagnosis was in the doldrums; prognosis was guarded, and the evaluation of therapy mainly negative—hardly any reasons for clinicians to clasp biometrics to their bosom. However, in the 1950s the scene changed. There were so many therapies vying with each other, so many patients in need of treatment, that the great advantage that could be provided by biometric evaluation became clear' (1973, p. 443). In keeping with this, the New York State Commissioner of Mental Hygiene, the late Paul H. Hoch, became interested in establishing a means of evaluating the impact of the major changes that were about to take place in hospital policy and treatment, and the Biometrics Research
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Unit was thus established. Appropriately enough, the interdisciplinary study of prognosis in schizophrenia, already begun, became the unit's first major endeavor. As it turned out, the scientific findings were something less than exhilarating ('This study had taught us that the then currently available clinical tools were neither prognostic nor diagnostic nor reliable nor valid', as Zubin recently summed it up), but the structure of the project set a productive pattern for the Biometrics Research Unit which has continued to the present day. The need became so apparent for the development of better methods and instruments for tapping the various levels of patients' functioning, as well as for gathering comparative data on normal individuals and institutionalized and non-institutionalized populations of many types, that, by the beginning of 1958, when the research grant supporting the prognosis project terminated, Biometrics Research already had several semi-autonomous groups of investigators developing new techniques and theoretical concepts and carrying out research in their own particular areas of interest. These groups were linked, at least initially, by a common interest in studying schizophrenics. Otherwise they developed their own projects and funded their own personnel and equipment needs with research grants from a variety of federal, state, and private agencies; then, as now, the permanent staff directly supported by the New York State Department of Mental Hygiene was small relative to the total number of persons actually working in the unit. Within the first few years of the unit's existence, research projects were actively under way in the development of rating scales and structured interviews (Burdock et al., 1960; Burdock and Hardesty, 1964; Spitzer et al., 1964); the search for dependable prognostic indicators (Zubin et al., 1957; Zubin et al., 1961); evaluation studies in clinics and hospitals (Staudt and Zubin, 1957); pupillography (Hakerem et al., 1964), reaction time and sensory shift studies (Salzinger, 1957; Sutton et al, 1961), and studies on the effects of delayed auditory feedback (Chase et al., 1961; Sutton et al., 1964); studies of the relationship between psychiatric hospitalization and the patients' positions in their immediate social networks (Hammer, 1963-4); formulation of a conditioning model for the interview, leading to
studies on the conditionability and communicability of schizophrenic and normal speech and on the objective measurement of statements of affect (Salzinger and Pisoni, 1958, 1960; Salzinger et al., 1964a, b, 1966); studies of social isolation in the aged (Tec and Granick, 1959-60; Granick and Nahemow, 1961; Bennett and Nahemow, 1965); studies of adolescent friendship patterns of schizophrenics (Kreisman, 1970). Such a listing can only suggest the diversity of the enormous number of individual studies, but it clearly testifies to the broad range of interests already represented in Biometrics Research at this early period. It should also be noted that, although direct intervention was not initially seen as part of the unit's programme, it soon grew naturally out of several lines of basic research. In its earliest form, it involved applied research in operant conditioning (behavior modification) with young hospitalized children (Salzinger et al., 1965)—work which eventually led to the training of parents (Salzinger et al., 1970) and, currently, mental hospital personnel. Along another line, there have been studies of the effects of a systematic home visiting programme for elderly isolated persons in the community (Bennett, 1973) and of other resocialization programmes for the aged (Weiner and Weinstock, 1973). The several years subsequent to this early period saw an expansion of work in almost all the areas mentioned and the inception of two major new ventures. In 1962, a Biometrics Research Training Program in Experimental Psychopathology, funded by the National Institutes of Mental Health and administered through Columbia University, gave explicit recognition and financial support for what had already become an important function of the unit: to provide students with experience and training in the many biometric techniques and approaches encompassed by the Biometrics Research Unit; the training grant itself was phased out about eight years later, but students continue to be affiliated with the unit in various capacities, and much research for doctoral dissertations continues to be carried out in the unit's laboratories or under its auspices. In 1963, a programme was outlined for an International Study of Diagnosis of the Mental Disorders in the United States and the United Kingdom (later called the Cross-National Project).
Research Report: Biometrics Research Unit, New York State Department of Mental Hygiene
The multifaceted nature and increasing size of the unit eventually led to formal organization into individual sections—a kind of federalist structure, as one long-time member of the unit has termed it. Several of these—Anthropology, Behaviour Analysis and Modification (earlier, Verbal Behaviour), Evaluation, Psychophysiology, and Sociology—existed in fact, if not in name, from the beginning. Biostatistics assumed the status of a separate section as it became increasingly occupied with the development of new concepts and techniques in addition simply to providing guidance on the design and analysis of research carried on elsewhere in the unit. The Diagnosis and Psychopathology section grew out of the Cross-National Project's studies of diagnosis, to which most of its effort continues to be devoted. The Gerontology section, established as a distinct entity about five years ago, grew out of the sociological work in ageing that goes back to the unit's earliest years. The newest section, Family and Youth Research, is involved in research on extensive surveys of adolescent drug use, thus focusing on a critical contemporary problem as well as on an age group largely neglected in the unit's earlier work. In a brief space, it is not possible to do justice to the past accomplishments and ongoing investigations of these nine sections, but certainly some details of their research, beyond the work already referred to, are called for. The Anthropology section, directed by Dr. Muriel Hammer, has pursued the development of techniques for specifying the structure of social networks—that is, the nature and degree of connectedness among individuals (Hammer et al, 1969; Hammer and Schaffer, 1975). In part, such work is an essential precursor of any attempt to follow up the earlier finding (Hammer, 1963-4), mentioned above, that patients' positions in their social networks appear to have important implications for the diagnosis and treatment of their psychopathology. While direct evidence is lacking, theoretical consideration has been given to possible interrelationships of psychopathology, diagnosis, and social network structure (Hammer, 1972, 1973). Another major line of investigation has been sociolinguistic and, often in collaboration with the section on Behavior Analysis and Modification, studies have been carried out of the mutual comprehensibility of-
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the speech of pairs of individuals as a function of the degree of interaction between them (Hammer et al, 1969; Salzinger et al., 1970). The Behavior Analysis and Modification section, directed by Dr. Kurt Salzinger, has emphasized study of the variables controlling a wide variety of normal and deviant behaviours. Verbal behaviour is of fundamental interest, as shown by the basic work on normal verbal behaviour (Salzinger and Feldman, 1973), as well as by the early verbal conditioning studies with schizophrenics and normal subjects and the development of techniques for the objective measurement of the comprehensibility or communicability of speech. A theoretical principle, the immediacy hypothesis, has been formulated to encompass a wide diversity of reported findings in the area of schizophrenia (Salzinger, 1971, 1973), and has been supported in a direct test of its applicability to schizophrenics' speech (Salzinger et al., 1970). The Behavior Analysis and Modification section includes a subsection, directed by Dr. Suzanne Salzinger, engaged in developmental studies with preschool children. Again, the emphasis has been on verbal behavior, with studies on its conditionability (Salzinger et al., 1962), on the development of grammar and syntax (Salzinger et al., 1966, 1967), on the relationship between psychophysical judgments and the verbal scale the child employs in making such judgments (Salzinger et al., 1970), and, currently, on the communicability of the speech of an ethnically diverse group of very young children with their peers and their mothers. A recent collaboration with the Anthropology section and with the Institute for Developmental Studies at New York University was focused on the problem of learning disabilities (Deutsch et al, 1974). The Biostatistics section is directed by Dr. Joseph Fleiss, who has explored a wide variety of statistical techniques particularly appropriate to the treatment of the kinds of data frequently obtained by researchers in the areas of psychopathology and mental health (Fleiss, 1973). In addition to its numerous consultative functions within the unit as well as elsewhere, this section has been concerned with the reliability of ratings and the development of valid techniques for measuring agreement among raters (Fleiss, 1970,
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1971; Fleiss and Cohen, 1973), with the identification of homogeneous subgroups in a heterogeneous population (Fleiss and Zubin, 1969; Fleiss et al., 1971; Fleiss, 1972), and with the development of a more satisfactory alternative to analysis of covariance (Fleiss and Tanur, 1973). The Diagnosis and Psychopathology section, directed by Dr. Barry Gurland, makes extensive use of systematic structured interviews (Cooper et al., 1972) adapted for the specific purposes of its various studies and based on interviews and techniques devised by Wing (Wing et al., 1967) in England and by Spitzer (Spitzer et al., 1964) in the Biometrics Research Unit. This section, in collaboration with a team at the Maudsley Hospital in London, has supported a hypothesis that differences in the reported hospitalization rates for schizophrenia and affective illness between the United States and the United Kingdom could be attributed to the labelling practices of the clinicians making the diagnoses, rather than to any differences in observed pathology (Gurland et al., 1970; Kendell et al., 1971; Simon et al., 1971; Sharpe et al., 1974). Subsequent studies of geriatric patients, using instruments especially adapted for the geriatric age range (Gurland et al., in press) have found the analogous result for reported admission rates of organic and functional disorders (Gurland et al., 1973; Copeland et al., 1974). In collaboration with the sections of Gerontology and Sociology, this section is embarking on a cross-national community survey of the elderly. The Evaluation section, directed by Dr. Robert Spitzer, now has to its credit a variety of extensively tested and widely used instruments, for both research and clinical purposes, for the reliable assessment of degree or type of psychopathology (Spitzer et al., 1967; Spitzer et al., 1970; Spitzer and Endicott, 1971; Endicott and Spitzer, 1972a, b). Other major areas of concern have been the delivery of mental health services —for example, a study of brief versus extended hospitalization (Herz et al, 1974); a study of day versus inpatient hospitalization (Herz et al., 1971); the development and application of computer technology for psychiatric diagnosis (Spitzer and Endicott, 1968,1969,1974a, b; Spitzer et al., 1974), and the objectification of the criteria for the various psychiatric diagnoses (Spitzer et al., in press). Family and Youth Research, directed by Dr.
Denise Kandel, has as its major current project an extensive longitudinal survey of interpersonal processes in adolescent drug use which is part of a long-standing interest in adolescent socialization (Kandel and Lesser, 1972). The study is still in progress (Single et al., 1974), but it has already been able to detail the extent to which peers, relative to parents, play a significant role in drug use (Kandel, 1973, 1974a, b; Kandel et al., 1974). The design of the study of drug-use patterns incorporates follow-up for the year beyond high-school graduation. The formation and dissolution of friendships in relation to drug use will also be examined. The work of the Gerontology section, directed by Dr. Ruth Bennett, has followed two principal lines: the study of aged individuals and the study of the social factors affecting them. Social isolation has been a major focus of interest, especially as it relates to an aged person's risk of mental illness, likelihood of being institutionalized, adjustment to an old age home or other site of relocation, and general functioning in a wide variety of settings and situations (Walton et al., 1964). The section encompasses a range from experimental studies of behaviour in restricted settings (Nahemow and Bennett, 1967; Bennett and Nahemow, 1972; Main and Bennett, 1972) to broad survey research aimed at characterizing or evaluating entire institutions or communities in relation to their aged populations (Bennett, 1964). The Psychophysiology section, directed by Dr. Samuel Sutton, consists of laboratories for the study of pupillography, reaction time, vision, audition, and—most recently—evoked potentials. Initially aiming to assess central nervous system functioning in mental patients, particularly schizophrenics, this section has devoted considerable attention to two persistent and fundamental problems plaguing research in this area. One is the search for experimental tasks on which at least some groups of patients would perform 'better' than normals, thus obviating the ubiquitous 'poor motivation' and 'inattentiveness' as the principal factors invoked to explain patients' results relative to those of normal subjects and providing some reasonable assurance that valid psychophysical measures are being obtained. A few such tasks seem to have been found (Zubin et al., 1975).
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The second problem is the identification, pathology (Hammer et al., 1973). Beyond that, through reliable experimental techniques, of it must be emphasized that critical to the nature more meaningful and homogeneous subgroups of the unit is that it occupies a position as neither (diagnostic categories) than have been arrived a department of a larger institution, such as a at on the basis of clinical procedures alone. An university or hospital, nor as an independent initerative strategy is being employed in which a stitute made up of separate departments, but as post hoc data analysis identifies subgroups, something in between. The relationship between within the initial subject samples, differing with the unit and the New York State Psychiatric respect to some criterion measure which is then Institute, where its main offices are located, and used as an independent variable in selecting other institutions such as Brooklyn State groups of subjects for the next experiment. By Hospital, where the unit has continuously gradually refining diagnostic groups through maintained active laboratories for many years, such a sequence of experiments, it is expected is perhaps rather unusual but not without that experimental findings will shed much more precedent. Such an arrangement, with the unit light on specific diagnostic and aetiological having access to local facilities but with the factors associated with well-defined groups of entire system of state facilities also available as the need arises, appears to have fostered patients (Sutton, 1973). This section is studying not only basic sensory great variety and flexibility in choice of research and perceptual functions, but also much more problems and strategies and perhaps should also complex variables such as objectively measured be credited in large measure with the unit's correlates of criterion level and the 'meaning' or continuing problem-centered, rather than disci'value' a stimulus has for a subject (Sutton and pline-centered, outlook. The interdisciplinary Tueting, in press). The various laboratories have studies that have thus arisen constitute another applied their techniques to the study of a wide cohesive force. range of phenomena, including the effects of In a search for integrative principles or intensity and temporal variables on patients and common denominators in the substance of the normal subjects (Zubin and Kietzman, 1966), the unit's research, Zubin has performed a kind of effect of methylphenidate (Ritalin) on hyper- logical factor analysis from which have emerged kinetic children (Prichep, 1974), differences four vectors: (1) descriptive approaches to between diagnostic categories (Zubin et al., psychopathology, including the many systematic 1975), and similarity of responses in twins (Bock, structured interviews, rating scales, and observa1974). tion instruments developed by the unit; (2) Finally, the Sociology section, directed by Dr. behaviour analysis, including the search for David Wilder, has studied the operation of large variables controlling the emission of a wide 'people processing' organizations or institutions, range of behaviours; (3) aetiological approaches, such as schools and mental health facilities. A including the search for developmental, learning, principal aim is to specify the mental health genetic, ecological, and neurophysiological facimplications of guidance and allocation decisions tors in the cause of mental disorders; and (4) as they affect the people being served (Wilder intervention approaches, in both their preventaand Blumner, 1972). Currently, the mental tive and ameliorative aspects, including studies health care delivery system of one county in New of high-risk groups, social structures, and York State is being studied from the perspective methods of resocialization or therapy. The many studies referred to earlier in this report can be of social systems. In all of this diversity, it may seem surprising seen to fall within the scope of these four vectors. that the Biometrics Research Unit retains a high In a brief summary of the unit's accomplishdegree of cohesiveness. In part, this is a reflection ments, perhaps the first area which must be of the fact that Zubin's own work has always mentioned is diagnosis, where the introduction been enormously wide-ranging, as further of new interviewing and rating techniques, the testified to by the diversity of his students and development and application of reliability colleagues, in the unit and elsewhere, in their measures for assessment and diagnostic data, contributions to a recent book on psycho- and the objective indicators of psychopathology
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developed in the unit's behavioural analysis and neurophysiological work all point to much improved diagnostic procedures. While only a beginning has been made in such areas of vital concern as aetiology and prevention, the broad range of objective approaches being continually developed and explored is seen by the unit as the best means of obtaining a better understanding of the circumstances which lead the vulnerable person we call 'mentally ill' to succumb and of what we might do to prevent it. Indeed, much of the unit's work can be viewed as an attempt to accomplish the objective description of the 'circumstances', the 'vulnerability', and the 'illness' itself. On the occasion of the unit's first annual report, Zubin outlined the nature of biometric research in the following way: 'The Biometrician .. . collects his data directly from the individual patient . . . The Biometrician is responsible for determining the need for certain types of data, for designing the experimental procedures for their collection, selection of samples of patients, and evaluation and integration of results. Thus biometric method is independent of the particular disciplines to which it is applied and when new insights into mental disorders are found, be they biochemical, sociological, bacteriological, or psychological, the evaluation of the new techniques will often depend on biometric methodology'. This view is unmistakably wide-ranging, and the diversity which has always characterized Biometrics can be seen to be an essential factor in the continuing vitality of the unit's research. RICHARD S. FELDMAN2 REFERENCES Bennett, R. (1964). The meaning of institutional life. In Geriatric Institutional Management, pp. 68-90. Edited by M. Leeds and H. Shore. Putman: New York. Bennett, R. (1973). Isolation and isolation-reducing programs. Bulletin of the New York Academy of Medicine, 49, 1143-1163. Bennett, R., and Nahemow, L. (1965). The relations between social isolation, socialization and adjustment in residents of a home for aged. In Mental Impairment in the Aged: Proceedings of Institute on Mentally Impaired Aged, pp. 88-105. Edited by M. P. Lawton and F. G. Lawton. Philadelphia Geriatric Center: Philadelphia. Bennett, R., and Nahemow, L. (1972). Socialization and social adjustment in five residential settings for the aged. In Research Planning and Action for the Elderly, pp. 501-513. Edited by D. P. Kent, R. Kastenbaum, and S. Sherwood. Behavioral Publications: New York. "Address for correspondence: Biometrics Research, 722 West 168th Street, New York City, New York 10032, U.S.A.
Bock, F. (1974). Pupillary and Evoked Potential Similarity in Monozygotic and Dizygotic Twins and Siblings. Thesis: City University of New York. Burdock, E. I., and Hardesty, A. S. (1964). A children's behavior diagnostic inventory. Annals of the New York Academy of Sciences, 105, 890-896. Burdock, E. I., Hardesty, A. S., Hakerem, G., and Zubin, J. (1960). A ward behavior rating scale for mental hospital patients. Journal of Clinical Psychology, 16, 246-247. Chase, R. A., Sutton, S., First, D., and Zubin, J. (1961). A developmental study of changes in behavior under delayed auditory feedback. Journal of Genetic Psychology, 99, 101-112. Cooper, J. E., Kendell, R. E., Gurland, B. J., Sharpe, L., Copeland, J. R. M., and Simon, R. (1972). Psychiatric Diagnosis in New York and London: A Comparative Study of Mental Hospital Admissions. Maudsley Monographs No. 20. Oxford University Press: London. Copeland, J. R. M., Kelleher, M. J., Kellett, J. M., Gourlay, A. J., Barron, G., Cowan, D. W., De Gruchy, J., Gurland, B. J., Sharpe, L., Simon, R., Kuriansky, J., and Stiller, P. (1974). Diagnostic differences in psychogeriatric patients in London and New York. Canadian Psychiatric Association Journal, 19,267-271. Deutsch, C , Hammer, M., and Salzinger, S. (1974). Multilevel Approach to Research in Learning. Position paper presented at Conference on Learning Disabilities, National Institutes of Education. Endicott, J., and Spitzer, R. L. (1972a). Current and past psychopathology scales (CAPPS): Rationale, reliability, and validity. Archives of General Psychiatry, 27, 678-687. Endicott, J., and Spitzer, R. L. (1972b). What! Another rating scale? The psychiatric evaluation form. Journal of Nervous and Mental Disease, 154, 88-104. Fleiss, J. L. (1970). Estimating the reliability of interview data. Psychometrika, 35, 143-162. Fleiss, J. L. (1971). Measuring nominal scale agreement among many raters. Psychological Bulletin, 76, 378-382. Fleiss, J. L. (1972). Classification of the depressive disorders by numerical typology. Journal of Psychiatric Research, 9, 141-153. Fleiss, J. L. (1973). Statistical Methods for Rates and Proportions. Wiley: New York. Fleiss, J. L., and Cohen, J. (1973). The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educational and Psychological Measurement, 33, 613-619. Fleiss, J. L., Lawlor, W., Platman, S. R., and Fieve, R. R. (1971). On the use of inverted factor analysis for generating typologies. Journal of Abnormal Psychology, 77, 127-132. Fleiss, J. L., and Tanur, J. M. (1973). The analysis of covariance in psychopathology. In Psychopathology: Contributions from the Social, Behavioral, and Biological Sciences, pp. 509-527. Edited by M. Hammer, K. Salzinger, and S. Sutton. Wiley: New York. Fleiss, J. L., and Zubin, J. (1969). On the methods and theory of clustering. Multivariate Behavioral Research, 4, 235-250. Granick, R., and Nahemow, L. D. (1961). Preadmission isolation as a factor in adjustment to an old age home. In Psychopathology of Aging, pp. 285-302. Edited by P. H. Hoch and J. Zubin. Grune and Stratton: New York. Gurland, B. J., Fleiss, J. L., Cooper, J. E., Sharpe, L., Kendell, R. E., and Roberts, P. (1970). Cross-national study of diagnosis of mental disorders: Hospital diagnoses and hospital patients in New York and London. Comprehensive Psychiatry, 11, 18-25. Gurland, B. J., Fleiss, J. L., Goldberg, K., Sharpe, L., Copeland, J. R. M., Kelleher, M. J., and Kellett, J. M. (In press). The Geriatric Mental State Schedule: A factor analysis. Psychological Medicine.
Research Report: Biometrics Research Unit, New York State Department of Mental Hygiene Gurland, B. J., Kuriansky, J. B., Sharpe, L., Simon, R. J., Stiller, P., and Fleiss, J. L., with Copeland, J. R. M., Kelleher, M. J., Gourlay, A. J., Cowan, D. W., and Barron, G. (1973). A Comparison of the Outcome of Hospitalization of Geriatric Patients in Public Psychiatric Wards in New York and London. Paper read at meeting of Canadian Psychiatric Association. Hakerem, G., Sutton, S., and Zubin, J. (1964). Pupillary reactions to light in schizophrenic patients and normals. Annals of the New York Academy of Sciences, 105, 820-831. Hammer, M. (1963-64). Influence of small social networks as factors on mental hospital admission. Human Organization, 22, 243-251. Hammer, M. (1972). Schizophrenia: Some questions of definition in cultural perspective. In Genetic Factors in 'Schizophrenia', pp. 423-450. Edited by A. R. Kaplan. Thomas: Springfield, 111. Hammer, M. (1973). Psychopathology and the structure of social networks. In Psychopathology: Contributions from the Social, Behavioral, and Biological Sciences, pp. 91-105. Edited by M. Hammer, K. Salzinger, and S. Sutton. Wiley: New York. Hammer, M., Polgar, S., and Salzinger, K. (1969). Speech predictability and social contact patterns in an informal group. Human Organization, 28, 235-242. Hammer, M., Salzinger, K., and Sutton, S. (eds). (1973). Psychopathology: Contributions from the Social, Behavioral' and Biological Sciences. Wiley: New York. Hammer, M., and Schaffer, A. (1975). Interconnectedness and the duration of connections in several small networks. American Ethnologist, 2. Herz, M. I., Endicott, J., and Spitzer, R. L. (1974). A Study of Brief Hospitalization: Initial Results. Paper presented at the American Psychiatric Association Meeting. Herz, M. I., Endicott, J., Spitzer, R. L., and Mesnikoff, A. (1971). Day versus inpatient hospitalization: A controlled study. American Journal of Psychiatry, 127, 1371-1382. Kandel, D. (1973). Adolescent marihuana use: Role of parents and peers. Science, 181, 1067-1070. Kandel, D. (1974a). Interpersonal influences on adolescent illegal drug use. In The Epidemiology of Drug Abuse, pp. 207-240. Edited by E. Josephson and E. Carroll. Winston: Washington, D.C. Kandel, D. (1974b). Inter- and intra-generational influences on adolescent marihuana use. In Generations and Social Change. Edited by V. Bengston and R. Laufer. Special issue of Journal of Social Issues, 30, 107-135. Kandel, D., and Lesser, G. S. (1972). Youth in Two Worlds. Jossey-Bass: San Francisco. Kandel, D., Single, E., Treiman, D., and Faust, R. (1974). Adolescent involvement in illicit drug use: A multiple classification analysis. Paper presented at the American Sociological Association Meeting. Kendell, R. E., Cooper, J. E., Gourlay, A. J., Copeland, J. R. M., Sharpe, L., and Gurland, B. J. (1971). Diagnostic criteria of American and British psychiatrists. Archives of General Psychiatry, 25, 123-130. Kreisman, D. (1970). Social interaction and intimacy in preschizophrenic adolescence. In The Psychopathology of Adolescence, pp. 299-318. Edited by J. Zubin and A. M. Freedman. Grune and Stratton: New York. Main, S., and Bennett, R. (1972). Greeting behavior and social adjustment in aged residents of a nursing home. In Research Planning and Action for the' Elderly, pp. 201-209. Edited by D. P. Kent, R. Kastenbaum, and S. Sherwood. Behavioral Publications: New York. Nahemow, L., and Bennett, R. (1967). Conformity, persuasability and counternormative persuasion. Sociometry, 30, 14-25.
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Prichep, L. S. (1974). Attention and the Auditory Evoked Potential in Hyperkinetic Children Treated with Methylphenidate and in Normal Children. Thesis: City University of New York. Salzinger, K. (1957). Shift in judgment of weights as a function of anchoring stimuli and instructions in early schizophrenics and normals. Journal of Abnormal and Social Psychology, 55,43-49. Salzinger, K. (1971). An hypothesis about schizophrenic behavior. American Journal of Psychotherapy, 25, 601-614. Salzinger, K. (1973). Schizophrenia: Behavioral Aspects. Wiley: New York. Salzinger, K., and Feldman, R. S. (eds). (1973). Studies in Verbal Behavior: An Empirical Approach. Pergamon: New York. Salzinger, K., Feldman, R. S., Cowan, J. E., and Salzinger, S. (1965). Operant conditioning of verbal behavior of two young speech-deficient boys. In Research in Behavior Modification, pp. 82-105. Edited by L. Krasner and L. P. Ullmann. Holt, Rinehart, and Winston: New York. Salzinger, K., Feldman, R. S., and Portnoy, S. (1970). Training parents of brain-injured children in the use of operant conditioning procedures. Behavior Therapy, 1, 4-32. Salzinger, K., Hammer, M., Portnoy, S., and Polgar, S. K. (1970). Verbal behaviour and social distance. Language and Speech, 13, 25-37. Salzinger, K., and Pisoni, S. (1958). Reinforcement of affect responses of schizophrenics during the clinical interview. Journal of Abnormal and Social Psychology, 57, 84-90. Salzinger, K., and Pisoni, S. (1960). Reinforcement of verbal affect responses of normal subjects during the interview. Journal of Abnormal and Social Psychology, 60, 127-130. Salzinger, K., Portnoy, S., and Feldman, R. S. (1964a). Verbal behavior of schizophrenic and normal subjects. Annals of the New York Academy of Sciences, 105, 845-860. Salzinger, K., Portnoy, S., and Feldman, R. S. (1964b). Experimental manipulation of continuous speech in schizophrenic patients. Journal of Abnormal and Social Psychology, 68, 508-516. Salzinger, K., Portnoy, S., and Feldman, R. S. (1966). Verbal behavior in schizophrenics and some comments toward a theory of schizophrenia. In Psychopathology of Schizophrenia, pp. 98-128. Edited by P. H. Hoch and J. Zubin. Grune and Stratton: New York. Salzinger, K., Portnoy, S., Pisoni, D. B., and Feldman, R. S. (1970). The immediacy hypothesis and response-produced stimuli in schizophrenic speech. Journal of Abnormal Psychology, 76, 258-264. Salzinger, S., Salzinger, K., and Hobson, S. (1966). Memory for verbal sequences as a function of their syntactical structure and the age of the recalling child. Journal of Psychology, 64, 79-90. Salzinger, S., Salzinger, K., and Hobson, S. (1967). The effect of syntactical structure on immediate memory for word sequences in middle- and lower-class children. Journal of Psychology, 67, 147-159. Salzinger, S., Salzinger, K., and Patenaude, J. (1970). Effect of verbal response class on shift in the preschool child's judgment of length in response to an anchor stimulus. Developmental Psychology, 2, 49-57. Salzinger, S., Salzinger, K., Portnoy, S., Eckman, J., Bacon, P. M., Deutsch, M., and Zubin, J. (1962). Operant conditioning of continuous speech in young children. Child Development, 33, 683-695. Sharpe, L., Gurland, B. J., Fleiss, J. L., Kendell, R. E., Cooper, J. E., and Copeland, J. R. M. (1974). Some comparisons of American, Canadian, and British psychiatrists in their diagnostic concepts. Canadian Psychiatric Association Journal, 19, 235-245.
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Simon, R. J., Fisher, B., Fleiss, J. L., Gurland, B. J., and Sharpe, L. (1971). Relationship between psychopathology and British- or American-oriented diagnosis. Journal of Abnormal Psychology, 78, 26-29. Single, E., Kandel, D., and Faust, R. (1974). Patterns of multiple drug use in high school. Journal of Health and Social Behavior, 15, 344-357. Spitzer, R. L., and Endicott, J. (1968). DIAGNO: A computer program for psychiatric diagnosis utilizing the differential diagnostic procedure. Archives of General Psychiatry, 18, 746-756. Spitzer, R. L., and Endicott, J. (1969). DIAGNO II: Further developments in a computer program for psychiatric diagnosis. American Journal of Psychiatry, 125, No. 7 Suppl., 12-21. Spitzer, R. L., and Endicott, J. (1971). An integrated group of forms for automated psychiatric case records: A progress report. Archives of General Psychiatry, 24, 540-547. Spitzer, R. L., and Endicott, J. (1974a). Can the computer assist clinicians in diagnosis? American Journal of Psychiatry, 131, 523-530. Spitzer, R. L., and Endicott, J. (1974b). Computer diagnosis in an automated record keeping system: A study of clinical acceptability. In Progress in Mental Health Information Systems: Computer Applications, pp. 73-100. Edited by J. Crawford, D. Morgan, and D. Gianturco. Ballinger: Cambridge, Mass. Spitzer, R. L., Endicott, J., Cohen, J., and Fleiss, J. L. (1974). Constraints on the validity of computer diagnosis. Archives of General Psychiatry, 31, 197-203. Spitzer, R. L., Endicott, J., Fleiss, J. L., and Cohen, J. (1970). The Psychiatric Status Schedule: A technique for evaluating psychopathology and impairment in role functioning. Archives of General Psychiatry, 23, 41-55. Spitzer, R. L., Endicott, J., Robins, E., Kuriansky, J., and Gurland, B. (In press). Preliminary Report of the Reliability of Research Diagnostic CriteriaiR DC) Applied to Psychiatric Case Records. In Prediction in Psychopharmacology. Edited by S. Gershon and R. Beer. Raven: New York. Spitzer, R. L., Fleiss, J. L., Burdock, E. I., and Hardesty, A. S. (1964). The Mental Status Schedule: Rationale, reliability, and validity. Comprehensive Psychiatry, 5, 384395. Spitzer, R. L., Fleiss, J. L., Endicott, J., and Cohen, J. (1967). Mental Status Schedule: Properties of factor-analytically derived scales. Archives of General Psychiatry, 16, 479-493. Staudt, V., and Zubin, J. (1957). A biometric evaluation of the somatotherapies in schizophrenia. Psychological Bulletin, 54, 171-196. Sutton, S. (1973). Fact and artifact in the psychology of schizophrenia. In Psychopathology: Contributions from the
Social, Behavioral, and Biological Sciences, pp. 197-213. Edited by M. Hammer, K. Salzinger, and S. Sutton. Wiley: New York. Sutton, S., Hakerem, G., Portnoy, M., and Zubin, J. (1961). The effect of shift of sensory modality on serial reactiontime: A comparison of schizophrenics and normals. American Journal of Psychology, 74, 224-232. Sutton, S., Roehrig, W. C , and Kramer, J. (1964). Delayed auditory feedback of speech in schizophrenics and normals. Annals of the New York Academy of Sciences, 105, 832-844. Sutton, S., and Tueting, P. (In press). The sensitivity of the evoked potential to psychological variables. In Research in Psychophysiology. Edited by P. H. Venables and M. J . Christie. Wiley: New York. Tec, N., and Granick, R. (1959-60). Social isolation and difficulties in social interaction in residents of a home for aged. Social Problems, 1, llb-Hl. Walton, H., Bennett, R. G., and Nahemow, L. (1964). Psychiatric illness and adjustment in a home for the aged. Annals of the New York Academy of Sciences, 105, 897-918. Weiner, M., and Weinstock, C. (1973). The Effects of a Resocialization Program on Cognitive and Physical Functioning in an Elderly Population. Paper read at meeting of American Psychological Association. Wilder, D., and Blumner, A. S. (1972). Some Sociological Aspects of Student Allocation in Two Racially Mixed Suburban High Schools. Teachers College, Columbia University: New York. Wing, J. K., Birley, J. L. T., Cooper, J. E., Graham, P., and Isaacs, A. D. (1967). Reliability of a procedure for measuring and classifying "present psychiatric state". British Journal of Psychiatry, 113, 499-515. Zubin, J. (1973). The program of the Biometrics Research Unit. Psychiatric Quarterly, 46, 439-448. Zubin, J., Burdock, E. I., Sutton, S., and Cheek, F. (1957). Prognostic indicators in mental illness. Public Health Reports, 72, 592-595. Zubin, J., and Kietzman, M. L. (1966). A cross-cultural approach to classification in schizophrenia and other mental disorders. In Psychopathology of Schizophrenia, pp. 482-514. Edited by P. H. Hoch and J. Zubin. Grune and Stratton: New York. Zubin, J., Salzinger, K., Fleiss, J. L., Gurland, B. J., Spitzer, R. L., Endicott, J., and Sutton, S. (1975). Biometric approach to psychopathology: Abnormal and clinical psychology—statistical, epidemiological, and diagnostic approaches. Annual Review of Psychology, 26, 621-671. Zubin, J., Sutton, S., Salzinger, K., Salzinger, S., Burdock, E. I., and Peretz, D. (1961). A biometric approach to prognosis in schizophrenia. In Comparative Epidemiology of the Mental Disorders, pp. 143-203. Edited by P. H. Hoch and J. Zubin. Grune and Stratton: New York.
