Psychological Reporis, 1979, 4 5 , 431-442. @ Psychological Reports 1979
W O R D ASSOCIATION: CAPACITY OF CHRONIC SCHIZOPHRENICS TO FOLLOW FORMAL SEMANTIC, SYNTACTIC, AND INSTRUCTIONAL RULES
ROY B. MEFFERD, JR.' P~ycbiatricand Prychosomatic Research Laborato~y, Veterans Administration Medical Center, Ha rrston, Texas Summary.-Free word associations with pressure to respond fast were compared for actively psychotic, but tranquil, chronic schizophrenics of two categories and closely matched hospital employees. The stimulus words were homonyms that were equated among other factors for availability of responses in the various response tendencies characterized as idiodynamic sets, e.g., to define or explain the stimulus, or to give a syntactic response. Comprehensive scoring schema included separate semantic-syntactic, grammatical and affective dimensions. Qualitatively, the controls and schizophrenics had similar aberrant or faulting behavior, but the schizophrenics gave significantly more of three kinds of faults: ( 1 ) failure to "play the game or follow the instructions," viz., no response, repeating the stimulus, or giving a multi-word; ( 2 ) mishearing the stimulus, i.e., a distant response to the intended stimulus but that is closely related to a phonetically similar word, and ( 3 ) distant experiential relationships, e.g., PANKNIFE. Expressed on the basis of percentage of scorable responses, the qualitative n a m e of the non-faulted response patterns of the controls and of either paranoid or simple chronic schizophrenics were indistinguishable. Schizophrenics had intact associative structures that appeared to be organized and used in the same way as with the controls.
Following Galton's ( 1880) invention of the word-association test, which he considered provided clues to associative struccure, Jung and Riklin (1904) used it as a diagnostic device. Bleuler (1911) considered associative dysfunction to be a, if not the primary symptom of the schizophrenias, with distant and faulted associates, e.g., no response, repetition of the stimulus, clang, as their major symptom. A prodigious literacure has since developed based on this assertion. Yet, as has been frequently noted by others, non-schizophrenics also give distanc or faulted responses albeit at lower rates than schizophrenics, and with few exceprions, schizophrenics produce many relevant responses. Word association is a versatile and powerful device that can be varied in many ways. It is sensitive to the nature of the instructions, the stimulus words, the situation, the method of adminisrration and the mode of response. Consequently, it is also very difficult to control. The results ate even dependent on enduring associative habits of individuals (Moran, et al., 1964). Unfortunately, much of the literature was developed before anyone realized 'Mail reprint requests to R. B. Mefferd, Jr., Ph.D., Director, Psychiatric and Psychosomatic Research Laboratorv. VA Medical Center. 2002 Holcombe Blvd.. Houston. Texas
432
R. B. MEFFERD, JR.
how very susceptible the task was to so many extraneous influences. Some authors assumed that any kind of fault was a direct reflection of an associative dysfunction. Evidence of blocking behavior (e.g., no response, repetition of the stimulus word, etc.), failure to follow the instructions (e.g., to be fast, to give the first word thought of, to give a single word), and even evidence of game playing (e.g., attempting to deceive the observer, rhyming the responses with the stimulus, naming foods or objects in the room, etc.) have been assumed by some to reflect an associative dysfunction. Slow responses, multiple words, perseverations, and the like have been used, quite appropriately, as diagnostic indicators of psychopathology (Rapaport, 1950). However, it does not follow that any of these are indicators of associative dysfunction. The association process is only one aspect of information processing, and these traditional "faults" may be due to dysfunctions at other points in the total process. The hypothesized associative dysfunction of schizophrenia became questionable in a round-about way. Moran, et al. (1960) found that we were unable to develop equated alternate forms of word association in the traditional way. No matter how carefully the forms were equated on the basis of characteristics of the stimulus words, i.e., nomothetic variables that are independent of the responder, such as frequency of use in printed materials, number of syllables, concreteness, population response frequency or commonality, or of non-specific responding behavior, such as response times, number of multiple word responses evoked, etc., the "equated" forms yielded different inter-form results when administered to other groups. This phenomenon was caused by a robust and enduring individual response habit we characterized as idiodynamic set (Moran, et al., 1964). These sets are virtually independent of population response patterns or commonalities. Only when alternate forms of word-association provided equal availability of responses in the different sets could they be equated (Moran, 1966). This response set relates to major associative categories: (1) paradigmatic in which che stimulus and response are of the same grammatical paradigm (e.g., noun-noun), and ( 2 ) syntagmatic (syntactic) in which the stimulus and response occupy different positions within phrases or sentences (e.g., a sequential noun-verb that echoes syntactic orders). Two idiodynamic sets involve different types of paradigmatic associates: (1) Responses which resemble the denotative organization of a dictionary-defining, categorizing, and classifying; synonyms, exact or loose, and super- or subordinations that are lexical in nature; and ( 2 ) responses which reflect connotative relationships similar to those used in encylopedias-contrasts, logical coordinates, examples. The latter encyclopedic associates attempt to define the domain of the stimulus rather than to provide a precise, pin-point definition. Two sets were clearly syntactic and both have been noted by others: (1)
WORD ASSOCIATIONS OF SCHIZOPHRENICS
433
descriptive, perceptual-referent, iconic predication style described by Jung and Riklin (1904), and ( 2 ) a style described by Piaget (1970) as enactiue, an action-on-referent relationship. The latter might also be described as a sentence completion involving a substantive and a verbal. The fifth idiodynamic set is both paradigmatic-like and iconic-like in that the associates are of the same grammatical form, but they are associated because of experiential contiguity rather than for logical reasons. This relationship ~~R~; or temporal-SLEEPmay be f u n c t i o n a l - ~ ~ ~ ~ E -spatial-PICTURE-WALL; DREAM. This type of associate may reflect a re-encoding of childhood enactiveiconic types of associates into the logical system. If so, this process could be vitally important in the exploration of the syntagmatic-paradigmatic shift (Nelson, 1977). W e noted in 1964 (Moran, et al.) thac the proportions of schizophrenics and controls having each idiodynamic set were about equal. Another relevant point is thac the idiodynamic sets reflect a veneer imposed upon childhood associates or substitutive reorganization of the associative network acquired during the formative years of elementary school (Dufilho, et al., 1969). Much of this change - involves the addition of new associates; but formal education of the written language also appears to result in restructuring of the associative network. For example, the word REAL was already in the associative network of kindergarten children. When the word was introduced into the written language in the third grade, the range of associates increased, but they all remained associates of REAL. This remained the case until the homonym REEL was introduced into the written language in the sixth grade. Abruptly, the associative pattern changed to that of adult norms with about half the responses now being to REEL. A former "strong" association was modified permanently in a short period, even though the word REEL surely must have already been in the vernacular of many of the children. Schizophrenics, despite their psychoticism, exhibited an intact associative structure from day-to-day (Moran, et al., 1964). More significantly, Mefferd (1978) noted that the "sets" exhibited by schizophrenics and controls alike can be manipulated in the same way by tactics such as relaxing or increasing the time pressure, increasing the opportunity for expression of the "set" by the use of homonyms, by using "popular" response instructions, and the like. Thus, schizophrenics appear to possess stable associative structures which reflect the learning processes of elementary school years and vary in essentially the same way as matched adult conuols. The existence of an associative dysfunction per se in schizophrenia remains to be demonstrated unequivocally. A great deal of the supporting data for this conclusion have reasonable alternate explanations-failure to play the game, e.g., to respond; to follow the rules of the game, e.g., to give the first word, to be
434
R. B. MEFFERD, JR.
fast, to give a single word; overt or covert efforts to mislead the observer; a low or vacillating motivational and/or cortical activation level; an habitual shortcutting of analytical processes with guesses, etc. If the brain really processes information serially, a dysfunction at any level should interrupt all subsequent steps. Yet most schizophrenics produce extended series of semantically adequate associates with only erratically appearing faults. What kind of associative dysfunction could be so temperamental: for that matter, what exactly can we use as evidence for associative dysfunction? Both Kraepelin ( 1896) and Bleuler ( 1911 ) emphasized "disconnections of thought" and speech problems as if these resulted from associational faults, without regard to possible syntactic or response organization dysfunction. Failure to delineate the production of speech from the highly specialized word-association task confuses the issue of association. Ordinary speech contains many aids for information processing-redundancy, pauses, connectives, tempo and pitch changes, customary sequencing of both syntactic and phonetic delivery. Thus, powerful predictive expectancies may develop as to what is to come next. The process of producing an associate to a single spoken word is a relatively minor part of the process of speech production and comprehension. In sharp contrast to the production and comprehension of speech, a single, random spoken word provides almost no support for rapid processing of an isolated auditory icon. With word associacion, the individual must produce a single, rapid response from anywhere within his memory system(s) whenever the observer chooses. True, there is some pre-cuing; the individual expects to hear one word and expects that he must focus his attention upon it when spoken. The present report deals with the possible role of failure to utilize formal semantic and syntactic rules in the undeniably aberrant responding in word association by some schizophrenics. Faults are also considered that could result from failure "to play the game" or from an inability or unwillingness to follow the specified rules of the word association. The highly correlated response times and commonalities are not discussed here since both vary significantly becween categories of all three scoring schema considered. Furthermore, they are confounded with some of the categories, e.g., distant responses are defined in terms of commonality, and non-responses are defined in terms of response time.
METHOD Sfib7eci~
Pairs of male veterans ( N = loo), each of the same ethnic group, were individually matched within two percentage points for age, education, verbal intelligence (WAIS; Table l ) , and for auditory acuity. One member of each pair was a hospital employee (e.g., aides, housekeeper, guard, engineer, etc.) who denied having had prior mental or alcohol problems. Half of the chronic schizophrenics in the pairs had a diagnosis of paranoid schizophrenia with delusional problems and half of simple, undifferentiated
435
WORD ASSOCIATIONS OF SCHIZOPHRENICS
TABLE 1 CHARACTERISTICS OF INDIVIDUAL MATCHED SAMPLES* Subjects
Age (Yr. M
u
Education (Yr.) M u
Intelligence ( WAIS Verbal)
M
u
Controls 34.7 8.3 10.9 3.4 78.4 32.5 3.2 77.6 32.1 35.3 10.7 Schizophrenicst 7.4 *Whites, 73; Blacks, 20; Chicanos. 7. t 5 0 Paranoid (and delusional) and 50 simple. undifferentiated schizophrenics, all chronic and psychotic, shortly after re-admission and initiation of therapeutic dosages of uanquilizers. schizophrenia with no recorded paranoid symptoms. Each of the schizophrenics had had his first recorded psychiatric problem before the age of 24, and they had all been hospitalized from 2 to 6 times with the same diagnosis. None had a medical record of alcoholism or of organic brain syndrome. The patients had been re-admitted primarily because they had stopped their medication with a consequent return of psychotic symptoms. They volunteered to complete word associations between 14 and 21 days after therapeutic dosages of tranquilizers had been re-initiated-after they were tranquil, but before the anti-schizophrenic effect had occurred. This latter effect was noted long ago (Mefferd, et al., 1758) but see Charalampous (1978) for recent work. All patients were judged by their psychiatrist to have been actively psychotic at the time of testing. The tranquil chronic patients were deliberately contrasted with active, healthy employees rather than with other patient categories so as to exaggerate any possible evidence of associative dysfunction.
Stimulus word^ The stimulus words were taken from a pool of more than 500 ambiguous words having multiple meanings for which norms from over 1000 subjects were available.' Using these norms the stimulus words were organized into blocks of similar commonalities, frequency of usages (e.g., Thorndike & Locge, 1944, G scale), number of syllables, grammatical forms, numbers of faults elicited and response times. Unfortunately such equating alone fails to control (Moran, et al., 1960) for robust and enduring individualized reswnse sets or habits in free associations. W e characterizd this behavior as idiodynamic set: individuals tend to respond as if they had been given specific instructions, e.g., to define, to give examples or contrasts, to give experiential relationships, to describe or to complete a sentence using the stimulus (Moran, et d.,1764; Mefferd, 1978). These sets will be described in the discussion. A stimulus list that fails to eaualize the ODportunity for each subject to respond in his habitual idiodynamic set severely handicaps the neglected subject (Moran, 1966). This factor is so powerful that a person may "appear" schizophrenic solely because of unavailability of common associates in his set '(Moran, et al... 1964). - . Since almost any word can be described or used in a sentence the emphasis was placed in equating opportunity on the availability of synonyms, examples-contrasts, or common experiential relationships. Thus within each block of words described above, sets of three words were also matched to ensure that there were equally common responses available in the same order within each block for all the idiodvnamic sets to be described. Thirty-two such blocks were located and these were administered sequentially. 'Unpublished norms of this laboratory.
436
R.
B. MEFFERD, JR.
Admini~trdion
The words were given in four series of 24 words each with the instructions: "Say the first word you think of when I say a word-please be as fast as you can as I will be timing you." Then the 24 words were repeated for reproduction, i.e., "This time repeat the word you said the first time" (Rapaport, 1950); immediately after this, the next series of 24 words was administered with the original instructions, and so on. One person tested using the same word order and strong time pressure was maintained. Scoring
The subject's identification and diagnosis code was replaced by a retrievable computerized code, and the response words for all subjects were alphabetized together for each stimulus word. The responses were scored for semantic, grammatical, and affective relationships independently by three experienced scorers according to detailed rules (Mefferd, 1979). The inter-rater reliabilities were between .92 and .95. Finally, all differences between the scorers were resolved in conference. Faults were scored as follows: ( a ) non-responding. i.e., no response in 20 sec. or a repetition of the stimulus word; ( b ) failure to follow directions, e.g., multi-word responses; ( c ) rnisperception of the stimulus, i.e., misheard stimulus (Moon, el d., '1968); ( d ) uncommon parts of speech, e.g., preposition, pronouns, etc.; ( e ) distant relationships of two types of associates-relevant with the aid of a story, i.e., scorable but very idiosyncratic definitions, examples, functional relationships, actions, or descriptions; overspecific subordinations; over-general superordinations, and no apparent relationship w e n with a story. Other faults were scored, e.g., assonances, neologisms, but these occurred very rarely and were all accounted for by no more than two or three subjects. The semantic scoring schema was designed to preserve several factors of importance in associative theory: ( a ) the five paradigmatic and syntactic-semantic categories discussed above, ( b ) directionality (see Asch & Ebenholtz, 1962), e.g.. part-whole vs whole-pan; object-predicate vs predicate-object; noun-verb vs verb-noun; s u b vs superordination, etc.; ( c ) relative precision of the associates' categories, e.g., exact vs loose synonym, or antonym vs contrast, intrinsic vs extrinsic predictions; direct vs indirect action; and transitive vs intransitive verbs; and ( d ) relative concreteness, e.g., physical nouns, active verbs, palpable adjectives vs abstract, passive, non-palpable associates. Grammatical form was scored on the basis of context in the associate-pair. With these ambiguous stimulus words frequently either or both the stimulus and response could have 'been used by the responder indistinguishably as a noun, as a verb, or even as an adjective, e.g., COLD-HEAT, COOL-WARM. High inter-rater reliabiliry was attained by assigning such ambiguous associates to mixed "pigeon-hole" categories, e.g., noun or verb stimulus. Responses elicited by these homonyms were scored to estimate the degree of intrusion of the semantic associative network by the presumably distinct affective associative system (Rapaport, 1950; Koh, et al., 1976). All homonyms had at least one common neutral response available. Many also had at least one common affective response relating to social awareness, aggression, hostility, sex, evaluation, body concern. Especially high The influence inter-rater reliabilities were achieved in scoring these dimensions-.95+. of affective associations was also examined with a Pleasantness-Unpleasantness 3-point scale-+I, 0, -1. The norms for this scale were obtained from ratings made by 126 university psychology students of the 252 stimulus words from which the present words were taken. The score for each word was the algebraic sum of its ratings. These scores correlated at a low positive level of .21, with the G count of Thorndike-Lorge (1944). Another score estimated the degree of personalization with the associative network. The estimated tendencies to limit associates to personal, extrinsic, idiosyncratic, trivial
WORD ASSOCIATIONS OF SCHIZOPHRENICS
437
minor experiences or perceptions, e.g., uncommon associates involving the feel, smell, taste, look, minor function of, etc. Note that these are really categories of low commonality associates.
RESULTSAND D~SCUSSION There were no significant differences between the two categories of schizophrenics, so the results were combined. The various faulted and semantic response categories for the two groups are shown in Fig. 1. Two facts of paramount importance are obvious from this figure: ( 1) the non-schizophrenics had responses in every category of faults, although at about half the rate of the schizophrenics-11.5 vs 23.5%; and ( 2 ) non-faulted response rates, corrected for faults, of all categories in the detailed logical scoring schema were almost identical for the two groups. Directionality was equally irrelevant in both groups. For all practical purposes, the semantic associative patterns were identical for people of this age, education, and intelligence. Of the 11 faults scored (see Scoring above), five were significantly (p.os, t tests) elevated with the schizophrenics: ( a ) , ( b ) , and the distant Functional Relationships of ( e ) . The Unrelated and other distant categories and category ( d ) were not different. The grammatical forms of the stimulus-response associates are shown in Table 2. When the schizophrenics gave relevant responses, which was nearly as often as the controls, there simply was no difference between the means of these variables for the two groups. The groups were also similar relative to the semantic choices made with homonyms where there were common options for responses with either a neutral or an affectively loaded word, i.e., hostile, aggressive, sexual, body concern, etc. The means for all categories of these affective responses were essentially identical for the two groups (Table 3 ) . Further, there was no tendency for either group to personalize the associative net. The relative pleasantness of the stimulus was unrelated to the choice of affective associates as was also noted by Koh, et al. (1976). The .percentages of non-faulted responses for the controls and schizophrenics, respectively, for Concrete, Semi-concrete, and Abstract words were: 39.1 vs 35.4; 27.0 vs 26.6; and 33.9 vs 38.0. The slight shift toward more abstract words by the schizophrenics was not significant. Although they will be considered elsewhere with other variables related to commonality, neither the mean familiarity nor the word length, i.e., the number of syllables, of the stimulus caused differences in these factors in the nonfaulted responses: Thorndike-Lorge frequency, 8.12 vs 8.31; number of syllables, 1.50 vs 1.66, for the controls and schizophrenics, respectively. Koh and associates ( 1 9 7 6 ) , using free-recall of word lists, concluded that part of the recall deficit they report for schizophrenics may be due to inefficiency in utilizing semantic, syntactic, and affective cues for mnemonic encoding and
418
R. B. MEFFERD, JR.
FAULTS
DEFINITION EXAMPLE
SENTENCE COMPLETION
DESCRIP
FUNC TIONAL
FIG. 1. Comparison of faulted and non-faulted WA responses of schizophrenics and matched controls. Each point on the abscissa is a scoring category. The order of the 11 faults from the left are: blank, multi-word, repetition of stimulus, unusual part of speech, misheard stimulus, distant defining, distant example, distant functional, unrelated, extreme superordination, and extreme subordination. The semantic scores, expressed as percentages of non-faulted responses, start with exact synonyms, and proceed through loose synonyms to other meaningful responses at the end. The peaks are exact synonyms, superordinations, contrasts, logical coordinates, part-wholes, functional noun-verb pairs (e.g., NEEDLE-SEW) , action-on a physical object (e.g., BALLS-THROW) , intrinsic predication of stimulus or of response, physical objects related functionally (e.g., KNIFE-FORK). The valleys tend to be of looser more abstract categories.
organization of the list to-be-remembered. They found that this apparent deficit disappeared when the schizophrenic's attention was focused by means of a task
439
WORD ASSOCIATIONS OF SCHIZOPHRENICS
accompanying each word, viz., to rate it for pleasantness. This confirms the report of Mefferd, et al. (1969) in which verbal repetition of the word was the attention focuser. Schizophrenics were able to remember and follow complex instructions that included "Now until I say stop, do not repeat any words that start with the letter I." Further, they were also able to recall words with the instructions "Now repeat all words you hear except those that start with the letter R--do not repeat these, but remember them because I will ask you to repeat them later." Word association is also an attention focuser, but it samples cognitive function at a more complex level than those studies where the task was merely repetition and memory. TABLE 2
GRAMMATICALFORMUSEDBY SUBJECTS TO FORMTHEIR ASSOCIATES STIMULUS-RESPONSE Response
Stimulus (% Non-faulted Responses) Noun Verb Adjective Ambiguous Cont. Schz. Cont. Schz. Cont. Schz. N o r V Nor A Cont. Schz. Cont. Schz. -
-
-
- - -
41.4 40.6 4.6 4.9 Noun ( N ) 4.0 4.1 5.5 5.8 4.3 3.9 0.1 0.1 3.7 2.8 8.1 7.5 0.3 0.4 Verb ( V ) 2.3 2.5 4.9 4.6 0.4 0.3 6.6 6.2 Adjective (A) 1.3 1.6 0.4 0.3 Ambiguous *N or V 1.8 1.6 0.6 0.G 0.4 0.3 4.0 4.4 0.2 0.1 N or A 2.1 2.5 0.1 0.1 0.1 0.1 0.6 0.5 0.6 0.4 *Impossible to determine conclusively whether the subject responded to a noun with a noun, etc. Other ambiguous combinations, V or A, and N or V or A and other parts of speech are not shown, since they varied no more than the examples given here. This ambiguity is due to the ambiguous homonym and homophone words used.
The present study was designed to evaluate the ability of schizophrenics to follow the formal, learned semantic, syntactic, and affective rules. Deliberate sampling procedures designed to exaggerate any tendency for schizophrenics to show an associative dysfunction did not have an impressive impact on their responses. Likewise, two types of chronic schizophrenics did not differ from TABLE 3
PERCENTAGE OF INTRUSION OF AFFECTIVE ASSOCIATIONS INTO ASSOCIATIONAL NET Homonym Meaning Neutral Evaluative Sexual Body Concern Social Aggressive Hostile
Controls
65.4
Schizophrenics
26.2
65.4 26.0
4.3 1.0
4.9 1.6
1.3
1.3 0.0 0.8
1.O 0.2
-
440
R. B. MEFFERD, JR.
each other on any of the variables. Both types combined gave almost as many semantically relevant responses as did the controls-76.5 vs 88.5%. Of course, this difference was statistically significant, but the real question is how could a person with a continuous associative dysfunction produce so many relevant associates in such a reliable fashion? A failure to respond does not infer an associative dysfunction. Such behavior could result from many causes. Faults occurred erratically as if a more basic process had been interrupted momentarily. Yet, not one of the 11 fault categories identified was unique to either type of the schizophrenics and all types occurred in non-schizophrenics also. The mean differences were "generated" by no more than a third of the schizophrenics as was noted by O'Brian and Weingartner (1970). Especially noteworthy was the fact that of the four categories of distant responses, only one was significantly elevated in schizophrenia-Distant Functional Relationships. The kinds of faults that were elevated in some of the schizophrenics could have been due to failure to "play the game" for whatever the reason. Nearly 11% of their responses were simple non-responses or mere repetitions of the stimulus, exactly or with a slight modification. Nearly 3% of their responses were failures to follow the instructions to say. .just one word. These faults were certainly not unique to the schizophrenics. Possible perceptual, mishearing mistakes, which otherwise would have been scored as Distant, accounted for only 2% of the responses. The relevance of an associate-pair may be very real indeed to a person but have no meaning at all to others. For the latter the associate is not distant at all but only persondized or idiosyncratic. Yet, there was no evidence with formal scoring procedures that schizophrenics gave different kinds of low commonality associates than did the controls. Such low commonality responses may represent occasional "leakage" or flashes of more primitive associative structures with origins in perceptual or experiential icons. Conceivably such leakage could be elevated in schizophrenics due to interhemispheric differences in function as suggested by Gur (1978). However, in contrast to what might be expected in this case, the schizophrenics were essentially the same as the controls relative to their management of concrete and abstract associations. It is difficult not to be distracted by the sometimes gross faulting behaviors of some schizophrenics. As was shown here, when certain critical variables ate controlled in subjects (e.g., age, intelligence, ethnic group) and stimulus words (e.g., availability of common responses in the various idiodynamics sets, farniliarity, commonality, etc.) ,most responses given by schizophrenics are indistinguishable from those given by non-schizophrenics. This conclusion is compatible with that of Schwartz (1978) relative to commonalities. Schizophrenics appear co have intact associative structure qna structure that appears to be or-
WORD ASSOCIATIONS OF SCHIZOPHRENICS
44 1
ganized and used in the same way as with non-schizophrenics. However, we observed significant quantitative differences, such as response times, commonalities, and reproductions. These will be treated separately, since they occur in spite of the qualitative similarities noted here, and they appear to have different origins. It is as if there were transient periods during which the associative process becomes inaccessible (Moran, et dl., 1964). REFERENCES
ASCH, S. E.,
The principle of associative symmetry. Proceedings 01 the American Philosophical Society, 1962, 106, 135-163. BLEULER,E. Dementia Praecox oder Gruppe der Schizophrenien. Leipzig und Wien: Franz Deuticke, 1911. BRANFF,D. L., CALLAWAY, E., & NAYLOR,H. Very short-term memory dysfunction in schizophrenia. Avchiver of General Psychiatry, 1977, 34, 25-30. CHARALAMPOUS, K. D. Pharmacotherapy of schizophrenia. In W. E. Fann, I. Karacan. A. D. Pokorny, & R. Williams (Eds.), Phenomenology and tredment o f schizophrenia. New York: Spectrum, 1978. Pp. 467-488. DUFILHO.J. H., MEFFERD,R. B., JR., & WIELAND,B. A. Influences of early formal reading training on commonaliry of word association in children and adults. Journal o f Verbal Learni~gand V e ~ b a lBehavior, 1969, 8, 150-151. GALTON,F. Psychometric experiments. Brain, 1879-1880, 2, 149-162. GUR, R. E. Left hemispheric dysfunction and left hemispheric overactivacion in schizophrenia. Journal o f Abnormal Psychology. 1978, 87, 226-238. JUNG,C. G., & RIKLIN,F. Diagnostische Assoziationstudien. Zeitschrift f i r Psychologie nnd Neurologic, 1904, 3, 193-215. KOH, S. D., KAYTON,L., & P E ~ R S O NR., A. Affective encoding and consequent remembering in schizophrenic young adults. Jorrrnal of Abnormal Psychology, 1976, 85, 156-166. KRAEPELIN.E. Der psychologische Versuch in der Psychiatrie. Psychologie Arbeiten, 1896, 1, 1-91. MEFFERD,R. B., JR. Schizophrenic "thought disturbance" reconsidered. In W . E. Fann, I. Karacan, A. D. Pokorny, & R. Williams (Eds.), Phenomenology and treatment of schizophrenia. New York: Spectrum, 1978. Pp. 203-240. MEFFERD,R. B., JR. Word association: grammatical, semantic, and affective dimensions of associates to homonyms. Psychological Reports, 1979, 45, 359-374. MEFFERD,R. B., JR., LABROSSE,E. H., GAWIBNOWSKI.A. M., & WILLIAMS, R. J. Influence of chlorpromazine on certain biochemical variables of chronic male schizophrenics. Journal of Nervous and Mental Disease, 1958, 127, 167-179. MEFFERD,R. B., JR.. LESTER,J. W., WIELAND.B. A., FALCONER,G. A., & POKORNY, A. D. Influence of distraction of the reproduction of spoken words by schizophrenics. Journal o f Nervous and Mental Disease. 1969, 140, 504-509. MOON, A. F., MEFFERD,R. B., JR.. WIELAND,B. A.. POKORNY.A. D., & FALCONER, G. A. Perceptual dysfunction as a determinant of schizophrenic word associations. Journal of Nervous and Mentlrl Disease, 1968, 146, 80-84. MORAN. L. J. Generality of word association response sets. Psychological Monographs, 1966, 80, No. 4 (Whole No. 612). MORAN, L. J., MEFFERD,R. B., JR., & KIMBLE,J. P., JR. The objective measurement of psychopathology in longitudinal studies. In The Transactions of the Fifth Research Approaches to Mental Illness. Washington, D. C: Veterans Administration, 1960. Vo1. 5. Pp. 106-111. MORAN,L. J.. MEFFERD,R. B., JR., & KIMBLE,J. P., JR. ldiodynamic sets in word associations. Psychological Monographs, 1964, 78, No. 2 (Whole No. 579). & EBENHOLTZ,S. M.
442
R. B. MEFFERD, JR.
NELSON. K. The syntagmatic-paradigmatic shift revisited: a review of research and theory. Psychological Bulletin, 1977, 84, 93-116. O'BRTAN,J. P., & WEINGARTNER,H. Associative structure in chronic schizophrenia. Archives of General Psychiatry, 1970, 22. 136-142. PIAGET,J. Piaget's theory. In P. H. Mussen (Ed.). Carmichael's 'Manual of child psychology'. (3rd ed.) New York: Wiley, 1970. Pp. 50-58. RAPAPORT,D. Diagnostic psychological testing: the theory, stati~tical evaluation and diagnostic application of a battery of tests. Vol. 1 . Chicago: Yearbook Publ.. 1950. SCHWARTZ.S. DO schizophrenics give rare word associations? Schizophrenia Bulletin, 1978, 4, 248-251. THORNDIKE, E. L., & LORGE,I. The teachers' word book o f 30,000 words. N e w York: Columbia Univer., 1944.
Accepted August 6, 1979.
W O R D ASSOCIATION: CAPACITY OF CHRONIC SCHIZOPHRENICS TO FOLLOW FORMAL SEMANTIC, SYNTACTIC, AND INSTRUCTIONAL RULES
ROY B. MEFFERD, JR.' P~ycbiatricand Prychosomatic Research Laborato~y, Veterans Administration Medical Center, Ha rrston, Texas Summary.-Free word associations with pressure to respond fast were compared for actively psychotic, but tranquil, chronic schizophrenics of two categories and closely matched hospital employees. The stimulus words were homonyms that were equated among other factors for availability of responses in the various response tendencies characterized as idiodynamic sets, e.g., to define or explain the stimulus, or to give a syntactic response. Comprehensive scoring schema included separate semantic-syntactic, grammatical and affective dimensions. Qualitatively, the controls and schizophrenics had similar aberrant or faulting behavior, but the schizophrenics gave significantly more of three kinds of faults: ( 1 ) failure to "play the game or follow the instructions," viz., no response, repeating the stimulus, or giving a multi-word; ( 2 ) mishearing the stimulus, i.e., a distant response to the intended stimulus but that is closely related to a phonetically similar word, and ( 3 ) distant experiential relationships, e.g., PANKNIFE. Expressed on the basis of percentage of scorable responses, the qualitative n a m e of the non-faulted response patterns of the controls and of either paranoid or simple chronic schizophrenics were indistinguishable. Schizophrenics had intact associative structures that appeared to be organized and used in the same way as with the controls.
Following Galton's ( 1880) invention of the word-association test, which he considered provided clues to associative struccure, Jung and Riklin (1904) used it as a diagnostic device. Bleuler (1911) considered associative dysfunction to be a, if not the primary symptom of the schizophrenias, with distant and faulted associates, e.g., no response, repetition of the stimulus, clang, as their major symptom. A prodigious literacure has since developed based on this assertion. Yet, as has been frequently noted by others, non-schizophrenics also give distanc or faulted responses albeit at lower rates than schizophrenics, and with few exceprions, schizophrenics produce many relevant responses. Word association is a versatile and powerful device that can be varied in many ways. It is sensitive to the nature of the instructions, the stimulus words, the situation, the method of adminisrration and the mode of response. Consequently, it is also very difficult to control. The results ate even dependent on enduring associative habits of individuals (Moran, et al., 1964). Unfortunately, much of the literature was developed before anyone realized 'Mail reprint requests to R. B. Mefferd, Jr., Ph.D., Director, Psychiatric and Psychosomatic Research Laboratorv. VA Medical Center. 2002 Holcombe Blvd.. Houston. Texas
432
R. B. MEFFERD, JR.
how very susceptible the task was to so many extraneous influences. Some authors assumed that any kind of fault was a direct reflection of an associative dysfunction. Evidence of blocking behavior (e.g., no response, repetition of the stimulus word, etc.), failure to follow the instructions (e.g., to be fast, to give the first word thought of, to give a single word), and even evidence of game playing (e.g., attempting to deceive the observer, rhyming the responses with the stimulus, naming foods or objects in the room, etc.) have been assumed by some to reflect an associative dysfunction. Slow responses, multiple words, perseverations, and the like have been used, quite appropriately, as diagnostic indicators of psychopathology (Rapaport, 1950). However, it does not follow that any of these are indicators of associative dysfunction. The association process is only one aspect of information processing, and these traditional "faults" may be due to dysfunctions at other points in the total process. The hypothesized associative dysfunction of schizophrenia became questionable in a round-about way. Moran, et al. (1960) found that we were unable to develop equated alternate forms of word association in the traditional way. No matter how carefully the forms were equated on the basis of characteristics of the stimulus words, i.e., nomothetic variables that are independent of the responder, such as frequency of use in printed materials, number of syllables, concreteness, population response frequency or commonality, or of non-specific responding behavior, such as response times, number of multiple word responses evoked, etc., the "equated" forms yielded different inter-form results when administered to other groups. This phenomenon was caused by a robust and enduring individual response habit we characterized as idiodynamic set (Moran, et al., 1964). These sets are virtually independent of population response patterns or commonalities. Only when alternate forms of word-association provided equal availability of responses in the different sets could they be equated (Moran, 1966). This response set relates to major associative categories: (1) paradigmatic in which che stimulus and response are of the same grammatical paradigm (e.g., noun-noun), and ( 2 ) syntagmatic (syntactic) in which the stimulus and response occupy different positions within phrases or sentences (e.g., a sequential noun-verb that echoes syntactic orders). Two idiodynamic sets involve different types of paradigmatic associates: (1) Responses which resemble the denotative organization of a dictionary-defining, categorizing, and classifying; synonyms, exact or loose, and super- or subordinations that are lexical in nature; and ( 2 ) responses which reflect connotative relationships similar to those used in encylopedias-contrasts, logical coordinates, examples. The latter encyclopedic associates attempt to define the domain of the stimulus rather than to provide a precise, pin-point definition. Two sets were clearly syntactic and both have been noted by others: (1)
WORD ASSOCIATIONS OF SCHIZOPHRENICS
433
descriptive, perceptual-referent, iconic predication style described by Jung and Riklin (1904), and ( 2 ) a style described by Piaget (1970) as enactiue, an action-on-referent relationship. The latter might also be described as a sentence completion involving a substantive and a verbal. The fifth idiodynamic set is both paradigmatic-like and iconic-like in that the associates are of the same grammatical form, but they are associated because of experiential contiguity rather than for logical reasons. This relationship ~~R~; or temporal-SLEEPmay be f u n c t i o n a l - ~ ~ ~ ~ E -spatial-PICTURE-WALL; DREAM. This type of associate may reflect a re-encoding of childhood enactiveiconic types of associates into the logical system. If so, this process could be vitally important in the exploration of the syntagmatic-paradigmatic shift (Nelson, 1977). W e noted in 1964 (Moran, et al.) thac the proportions of schizophrenics and controls having each idiodynamic set were about equal. Another relevant point is thac the idiodynamic sets reflect a veneer imposed upon childhood associates or substitutive reorganization of the associative network acquired during the formative years of elementary school (Dufilho, et al., 1969). Much of this change - involves the addition of new associates; but formal education of the written language also appears to result in restructuring of the associative network. For example, the word REAL was already in the associative network of kindergarten children. When the word was introduced into the written language in the third grade, the range of associates increased, but they all remained associates of REAL. This remained the case until the homonym REEL was introduced into the written language in the sixth grade. Abruptly, the associative pattern changed to that of adult norms with about half the responses now being to REEL. A former "strong" association was modified permanently in a short period, even though the word REEL surely must have already been in the vernacular of many of the children. Schizophrenics, despite their psychoticism, exhibited an intact associative structure from day-to-day (Moran, et al., 1964). More significantly, Mefferd (1978) noted that the "sets" exhibited by schizophrenics and controls alike can be manipulated in the same way by tactics such as relaxing or increasing the time pressure, increasing the opportunity for expression of the "set" by the use of homonyms, by using "popular" response instructions, and the like. Thus, schizophrenics appear to possess stable associative structures which reflect the learning processes of elementary school years and vary in essentially the same way as matched adult conuols. The existence of an associative dysfunction per se in schizophrenia remains to be demonstrated unequivocally. A great deal of the supporting data for this conclusion have reasonable alternate explanations-failure to play the game, e.g., to respond; to follow the rules of the game, e.g., to give the first word, to be
434
R. B. MEFFERD, JR.
fast, to give a single word; overt or covert efforts to mislead the observer; a low or vacillating motivational and/or cortical activation level; an habitual shortcutting of analytical processes with guesses, etc. If the brain really processes information serially, a dysfunction at any level should interrupt all subsequent steps. Yet most schizophrenics produce extended series of semantically adequate associates with only erratically appearing faults. What kind of associative dysfunction could be so temperamental: for that matter, what exactly can we use as evidence for associative dysfunction? Both Kraepelin ( 1896) and Bleuler ( 1911 ) emphasized "disconnections of thought" and speech problems as if these resulted from associational faults, without regard to possible syntactic or response organization dysfunction. Failure to delineate the production of speech from the highly specialized word-association task confuses the issue of association. Ordinary speech contains many aids for information processing-redundancy, pauses, connectives, tempo and pitch changes, customary sequencing of both syntactic and phonetic delivery. Thus, powerful predictive expectancies may develop as to what is to come next. The process of producing an associate to a single spoken word is a relatively minor part of the process of speech production and comprehension. In sharp contrast to the production and comprehension of speech, a single, random spoken word provides almost no support for rapid processing of an isolated auditory icon. With word associacion, the individual must produce a single, rapid response from anywhere within his memory system(s) whenever the observer chooses. True, there is some pre-cuing; the individual expects to hear one word and expects that he must focus his attention upon it when spoken. The present report deals with the possible role of failure to utilize formal semantic and syntactic rules in the undeniably aberrant responding in word association by some schizophrenics. Faults are also considered that could result from failure "to play the game" or from an inability or unwillingness to follow the specified rules of the word association. The highly correlated response times and commonalities are not discussed here since both vary significantly becween categories of all three scoring schema considered. Furthermore, they are confounded with some of the categories, e.g., distant responses are defined in terms of commonality, and non-responses are defined in terms of response time.
METHOD Sfib7eci~
Pairs of male veterans ( N = loo), each of the same ethnic group, were individually matched within two percentage points for age, education, verbal intelligence (WAIS; Table l ) , and for auditory acuity. One member of each pair was a hospital employee (e.g., aides, housekeeper, guard, engineer, etc.) who denied having had prior mental or alcohol problems. Half of the chronic schizophrenics in the pairs had a diagnosis of paranoid schizophrenia with delusional problems and half of simple, undifferentiated
435
WORD ASSOCIATIONS OF SCHIZOPHRENICS
TABLE 1 CHARACTERISTICS OF INDIVIDUAL MATCHED SAMPLES* Subjects
Age (Yr. M
u
Education (Yr.) M u
Intelligence ( WAIS Verbal)
M
u
Controls 34.7 8.3 10.9 3.4 78.4 32.5 3.2 77.6 32.1 35.3 10.7 Schizophrenicst 7.4 *Whites, 73; Blacks, 20; Chicanos. 7. t 5 0 Paranoid (and delusional) and 50 simple. undifferentiated schizophrenics, all chronic and psychotic, shortly after re-admission and initiation of therapeutic dosages of uanquilizers. schizophrenia with no recorded paranoid symptoms. Each of the schizophrenics had had his first recorded psychiatric problem before the age of 24, and they had all been hospitalized from 2 to 6 times with the same diagnosis. None had a medical record of alcoholism or of organic brain syndrome. The patients had been re-admitted primarily because they had stopped their medication with a consequent return of psychotic symptoms. They volunteered to complete word associations between 14 and 21 days after therapeutic dosages of tranquilizers had been re-initiated-after they were tranquil, but before the anti-schizophrenic effect had occurred. This latter effect was noted long ago (Mefferd, et al., 1758) but see Charalampous (1978) for recent work. All patients were judged by their psychiatrist to have been actively psychotic at the time of testing. The tranquil chronic patients were deliberately contrasted with active, healthy employees rather than with other patient categories so as to exaggerate any possible evidence of associative dysfunction.
Stimulus word^ The stimulus words were taken from a pool of more than 500 ambiguous words having multiple meanings for which norms from over 1000 subjects were available.' Using these norms the stimulus words were organized into blocks of similar commonalities, frequency of usages (e.g., Thorndike & Locge, 1944, G scale), number of syllables, grammatical forms, numbers of faults elicited and response times. Unfortunately such equating alone fails to control (Moran, et al., 1960) for robust and enduring individualized reswnse sets or habits in free associations. W e characterizd this behavior as idiodynamic set: individuals tend to respond as if they had been given specific instructions, e.g., to define, to give examples or contrasts, to give experiential relationships, to describe or to complete a sentence using the stimulus (Moran, et d.,1764; Mefferd, 1978). These sets will be described in the discussion. A stimulus list that fails to eaualize the ODportunity for each subject to respond in his habitual idiodynamic set severely handicaps the neglected subject (Moran, 1966). This factor is so powerful that a person may "appear" schizophrenic solely because of unavailability of common associates in his set '(Moran, et al... 1964). - . Since almost any word can be described or used in a sentence the emphasis was placed in equating opportunity on the availability of synonyms, examples-contrasts, or common experiential relationships. Thus within each block of words described above, sets of three words were also matched to ensure that there were equally common responses available in the same order within each block for all the idiodvnamic sets to be described. Thirty-two such blocks were located and these were administered sequentially. 'Unpublished norms of this laboratory.
436
R.
B. MEFFERD, JR.
Admini~trdion
The words were given in four series of 24 words each with the instructions: "Say the first word you think of when I say a word-please be as fast as you can as I will be timing you." Then the 24 words were repeated for reproduction, i.e., "This time repeat the word you said the first time" (Rapaport, 1950); immediately after this, the next series of 24 words was administered with the original instructions, and so on. One person tested using the same word order and strong time pressure was maintained. Scoring
The subject's identification and diagnosis code was replaced by a retrievable computerized code, and the response words for all subjects were alphabetized together for each stimulus word. The responses were scored for semantic, grammatical, and affective relationships independently by three experienced scorers according to detailed rules (Mefferd, 1979). The inter-rater reliabilities were between .92 and .95. Finally, all differences between the scorers were resolved in conference. Faults were scored as follows: ( a ) non-responding. i.e., no response in 20 sec. or a repetition of the stimulus word; ( b ) failure to follow directions, e.g., multi-word responses; ( c ) rnisperception of the stimulus, i.e., misheard stimulus (Moon, el d., '1968); ( d ) uncommon parts of speech, e.g., preposition, pronouns, etc.; ( e ) distant relationships of two types of associates-relevant with the aid of a story, i.e., scorable but very idiosyncratic definitions, examples, functional relationships, actions, or descriptions; overspecific subordinations; over-general superordinations, and no apparent relationship w e n with a story. Other faults were scored, e.g., assonances, neologisms, but these occurred very rarely and were all accounted for by no more than two or three subjects. The semantic scoring schema was designed to preserve several factors of importance in associative theory: ( a ) the five paradigmatic and syntactic-semantic categories discussed above, ( b ) directionality (see Asch & Ebenholtz, 1962), e.g.. part-whole vs whole-pan; object-predicate vs predicate-object; noun-verb vs verb-noun; s u b vs superordination, etc.; ( c ) relative precision of the associates' categories, e.g., exact vs loose synonym, or antonym vs contrast, intrinsic vs extrinsic predictions; direct vs indirect action; and transitive vs intransitive verbs; and ( d ) relative concreteness, e.g., physical nouns, active verbs, palpable adjectives vs abstract, passive, non-palpable associates. Grammatical form was scored on the basis of context in the associate-pair. With these ambiguous stimulus words frequently either or both the stimulus and response could have 'been used by the responder indistinguishably as a noun, as a verb, or even as an adjective, e.g., COLD-HEAT, COOL-WARM. High inter-rater reliabiliry was attained by assigning such ambiguous associates to mixed "pigeon-hole" categories, e.g., noun or verb stimulus. Responses elicited by these homonyms were scored to estimate the degree of intrusion of the semantic associative network by the presumably distinct affective associative system (Rapaport, 1950; Koh, et al., 1976). All homonyms had at least one common neutral response available. Many also had at least one common affective response relating to social awareness, aggression, hostility, sex, evaluation, body concern. Especially high The influence inter-rater reliabilities were achieved in scoring these dimensions-.95+. of affective associations was also examined with a Pleasantness-Unpleasantness 3-point scale-+I, 0, -1. The norms for this scale were obtained from ratings made by 126 university psychology students of the 252 stimulus words from which the present words were taken. The score for each word was the algebraic sum of its ratings. These scores correlated at a low positive level of .21, with the G count of Thorndike-Lorge (1944). Another score estimated the degree of personalization with the associative network. The estimated tendencies to limit associates to personal, extrinsic, idiosyncratic, trivial
WORD ASSOCIATIONS OF SCHIZOPHRENICS
437
minor experiences or perceptions, e.g., uncommon associates involving the feel, smell, taste, look, minor function of, etc. Note that these are really categories of low commonality associates.
RESULTSAND D~SCUSSION There were no significant differences between the two categories of schizophrenics, so the results were combined. The various faulted and semantic response categories for the two groups are shown in Fig. 1. Two facts of paramount importance are obvious from this figure: ( 1) the non-schizophrenics had responses in every category of faults, although at about half the rate of the schizophrenics-11.5 vs 23.5%; and ( 2 ) non-faulted response rates, corrected for faults, of all categories in the detailed logical scoring schema were almost identical for the two groups. Directionality was equally irrelevant in both groups. For all practical purposes, the semantic associative patterns were identical for people of this age, education, and intelligence. Of the 11 faults scored (see Scoring above), five were significantly (p.os, t tests) elevated with the schizophrenics: ( a ) , ( b ) , and the distant Functional Relationships of ( e ) . The Unrelated and other distant categories and category ( d ) were not different. The grammatical forms of the stimulus-response associates are shown in Table 2. When the schizophrenics gave relevant responses, which was nearly as often as the controls, there simply was no difference between the means of these variables for the two groups. The groups were also similar relative to the semantic choices made with homonyms where there were common options for responses with either a neutral or an affectively loaded word, i.e., hostile, aggressive, sexual, body concern, etc. The means for all categories of these affective responses were essentially identical for the two groups (Table 3 ) . Further, there was no tendency for either group to personalize the associative net. The relative pleasantness of the stimulus was unrelated to the choice of affective associates as was also noted by Koh, et al. (1976). The .percentages of non-faulted responses for the controls and schizophrenics, respectively, for Concrete, Semi-concrete, and Abstract words were: 39.1 vs 35.4; 27.0 vs 26.6; and 33.9 vs 38.0. The slight shift toward more abstract words by the schizophrenics was not significant. Although they will be considered elsewhere with other variables related to commonality, neither the mean familiarity nor the word length, i.e., the number of syllables, of the stimulus caused differences in these factors in the nonfaulted responses: Thorndike-Lorge frequency, 8.12 vs 8.31; number of syllables, 1.50 vs 1.66, for the controls and schizophrenics, respectively. Koh and associates ( 1 9 7 6 ) , using free-recall of word lists, concluded that part of the recall deficit they report for schizophrenics may be due to inefficiency in utilizing semantic, syntactic, and affective cues for mnemonic encoding and
418
R. B. MEFFERD, JR.
FAULTS
DEFINITION EXAMPLE
SENTENCE COMPLETION
DESCRIP
FUNC TIONAL
FIG. 1. Comparison of faulted and non-faulted WA responses of schizophrenics and matched controls. Each point on the abscissa is a scoring category. The order of the 11 faults from the left are: blank, multi-word, repetition of stimulus, unusual part of speech, misheard stimulus, distant defining, distant example, distant functional, unrelated, extreme superordination, and extreme subordination. The semantic scores, expressed as percentages of non-faulted responses, start with exact synonyms, and proceed through loose synonyms to other meaningful responses at the end. The peaks are exact synonyms, superordinations, contrasts, logical coordinates, part-wholes, functional noun-verb pairs (e.g., NEEDLE-SEW) , action-on a physical object (e.g., BALLS-THROW) , intrinsic predication of stimulus or of response, physical objects related functionally (e.g., KNIFE-FORK). The valleys tend to be of looser more abstract categories.
organization of the list to-be-remembered. They found that this apparent deficit disappeared when the schizophrenic's attention was focused by means of a task
439
WORD ASSOCIATIONS OF SCHIZOPHRENICS
accompanying each word, viz., to rate it for pleasantness. This confirms the report of Mefferd, et al. (1969) in which verbal repetition of the word was the attention focuser. Schizophrenics were able to remember and follow complex instructions that included "Now until I say stop, do not repeat any words that start with the letter I." Further, they were also able to recall words with the instructions "Now repeat all words you hear except those that start with the letter R--do not repeat these, but remember them because I will ask you to repeat them later." Word association is also an attention focuser, but it samples cognitive function at a more complex level than those studies where the task was merely repetition and memory. TABLE 2
GRAMMATICALFORMUSEDBY SUBJECTS TO FORMTHEIR ASSOCIATES STIMULUS-RESPONSE Response
Stimulus (% Non-faulted Responses) Noun Verb Adjective Ambiguous Cont. Schz. Cont. Schz. Cont. Schz. N o r V Nor A Cont. Schz. Cont. Schz. -
-
-
- - -
41.4 40.6 4.6 4.9 Noun ( N ) 4.0 4.1 5.5 5.8 4.3 3.9 0.1 0.1 3.7 2.8 8.1 7.5 0.3 0.4 Verb ( V ) 2.3 2.5 4.9 4.6 0.4 0.3 6.6 6.2 Adjective (A) 1.3 1.6 0.4 0.3 Ambiguous *N or V 1.8 1.6 0.6 0.G 0.4 0.3 4.0 4.4 0.2 0.1 N or A 2.1 2.5 0.1 0.1 0.1 0.1 0.6 0.5 0.6 0.4 *Impossible to determine conclusively whether the subject responded to a noun with a noun, etc. Other ambiguous combinations, V or A, and N or V or A and other parts of speech are not shown, since they varied no more than the examples given here. This ambiguity is due to the ambiguous homonym and homophone words used.
The present study was designed to evaluate the ability of schizophrenics to follow the formal, learned semantic, syntactic, and affective rules. Deliberate sampling procedures designed to exaggerate any tendency for schizophrenics to show an associative dysfunction did not have an impressive impact on their responses. Likewise, two types of chronic schizophrenics did not differ from TABLE 3
PERCENTAGE OF INTRUSION OF AFFECTIVE ASSOCIATIONS INTO ASSOCIATIONAL NET Homonym Meaning Neutral Evaluative Sexual Body Concern Social Aggressive Hostile
Controls
65.4
Schizophrenics
26.2
65.4 26.0
4.3 1.0
4.9 1.6
1.3
1.3 0.0 0.8
1.O 0.2
-
440
R. B. MEFFERD, JR.
each other on any of the variables. Both types combined gave almost as many semantically relevant responses as did the controls-76.5 vs 88.5%. Of course, this difference was statistically significant, but the real question is how could a person with a continuous associative dysfunction produce so many relevant associates in such a reliable fashion? A failure to respond does not infer an associative dysfunction. Such behavior could result from many causes. Faults occurred erratically as if a more basic process had been interrupted momentarily. Yet, not one of the 11 fault categories identified was unique to either type of the schizophrenics and all types occurred in non-schizophrenics also. The mean differences were "generated" by no more than a third of the schizophrenics as was noted by O'Brian and Weingartner (1970). Especially noteworthy was the fact that of the four categories of distant responses, only one was significantly elevated in schizophrenia-Distant Functional Relationships. The kinds of faults that were elevated in some of the schizophrenics could have been due to failure to "play the game" for whatever the reason. Nearly 11% of their responses were simple non-responses or mere repetitions of the stimulus, exactly or with a slight modification. Nearly 3% of their responses were failures to follow the instructions to say. .just one word. These faults were certainly not unique to the schizophrenics. Possible perceptual, mishearing mistakes, which otherwise would have been scored as Distant, accounted for only 2% of the responses. The relevance of an associate-pair may be very real indeed to a person but have no meaning at all to others. For the latter the associate is not distant at all but only persondized or idiosyncratic. Yet, there was no evidence with formal scoring procedures that schizophrenics gave different kinds of low commonality associates than did the controls. Such low commonality responses may represent occasional "leakage" or flashes of more primitive associative structures with origins in perceptual or experiential icons. Conceivably such leakage could be elevated in schizophrenics due to interhemispheric differences in function as suggested by Gur (1978). However, in contrast to what might be expected in this case, the schizophrenics were essentially the same as the controls relative to their management of concrete and abstract associations. It is difficult not to be distracted by the sometimes gross faulting behaviors of some schizophrenics. As was shown here, when certain critical variables ate controlled in subjects (e.g., age, intelligence, ethnic group) and stimulus words (e.g., availability of common responses in the various idiodynamics sets, farniliarity, commonality, etc.) ,most responses given by schizophrenics are indistinguishable from those given by non-schizophrenics. This conclusion is compatible with that of Schwartz (1978) relative to commonalities. Schizophrenics appear co have intact associative structure qna structure that appears to be or-
WORD ASSOCIATIONS OF SCHIZOPHRENICS
44 1
ganized and used in the same way as with non-schizophrenics. However, we observed significant quantitative differences, such as response times, commonalities, and reproductions. These will be treated separately, since they occur in spite of the qualitative similarities noted here, and they appear to have different origins. It is as if there were transient periods during which the associative process becomes inaccessible (Moran, et dl., 1964). REFERENCES
ASCH, S. E.,
The principle of associative symmetry. Proceedings 01 the American Philosophical Society, 1962, 106, 135-163. BLEULER,E. Dementia Praecox oder Gruppe der Schizophrenien. Leipzig und Wien: Franz Deuticke, 1911. BRANFF,D. L., CALLAWAY, E., & NAYLOR,H. Very short-term memory dysfunction in schizophrenia. Avchiver of General Psychiatry, 1977, 34, 25-30. CHARALAMPOUS, K. D. Pharmacotherapy of schizophrenia. In W. E. Fann, I. Karacan. A. D. Pokorny, & R. Williams (Eds.), Phenomenology and tredment o f schizophrenia. New York: Spectrum, 1978. Pp. 467-488. DUFILHO.J. H., MEFFERD,R. B., JR., & WIELAND,B. A. Influences of early formal reading training on commonaliry of word association in children and adults. Journal o f Verbal Learni~gand V e ~ b a lBehavior, 1969, 8, 150-151. GALTON,F. Psychometric experiments. Brain, 1879-1880, 2, 149-162. GUR, R. E. Left hemispheric dysfunction and left hemispheric overactivacion in schizophrenia. Journal o f Abnormal Psychology. 1978, 87, 226-238. JUNG,C. G., & RIKLIN,F. Diagnostische Assoziationstudien. Zeitschrift f i r Psychologie nnd Neurologic, 1904, 3, 193-215. KOH, S. D., KAYTON,L., & P E ~ R S O NR., A. Affective encoding and consequent remembering in schizophrenic young adults. Jorrrnal of Abnormal Psychology, 1976, 85, 156-166. KRAEPELIN.E. Der psychologische Versuch in der Psychiatrie. Psychologie Arbeiten, 1896, 1, 1-91. MEFFERD,R. B., JR. Schizophrenic "thought disturbance" reconsidered. In W . E. Fann, I. Karacan, A. D. Pokorny, & R. Williams (Eds.), Phenomenology and treatment of schizophrenia. New York: Spectrum, 1978. Pp. 203-240. MEFFERD,R. B., JR. Word association: grammatical, semantic, and affective dimensions of associates to homonyms. Psychological Reports, 1979, 45, 359-374. MEFFERD,R. B., JR., LABROSSE,E. H., GAWIBNOWSKI.A. M., & WILLIAMS, R. J. Influence of chlorpromazine on certain biochemical variables of chronic male schizophrenics. Journal of Nervous and Mental Disease, 1958, 127, 167-179. MEFFERD,R. B., JR.. LESTER,J. W., WIELAND.B. A., FALCONER,G. A., & POKORNY, A. D. Influence of distraction of the reproduction of spoken words by schizophrenics. Journal o f Nervous and Mental Disease. 1969, 140, 504-509. MOON, A. F., MEFFERD,R. B., JR.. WIELAND,B. A.. POKORNY.A. D., & FALCONER, G. A. Perceptual dysfunction as a determinant of schizophrenic word associations. Journal of Nervous and Mentlrl Disease, 1968, 146, 80-84. MORAN. L. J. Generality of word association response sets. Psychological Monographs, 1966, 80, No. 4 (Whole No. 612). MORAN, L. J., MEFFERD,R. B., JR., & KIMBLE,J. P., JR. The objective measurement of psychopathology in longitudinal studies. In The Transactions of the Fifth Research Approaches to Mental Illness. Washington, D. C: Veterans Administration, 1960. Vo1. 5. Pp. 106-111. MORAN,L. J.. MEFFERD,R. B., JR., & KIMBLE,J. P., JR. ldiodynamic sets in word associations. Psychological Monographs, 1964, 78, No. 2 (Whole No. 579). & EBENHOLTZ,S. M.
442
R. B. MEFFERD, JR.
NELSON. K. The syntagmatic-paradigmatic shift revisited: a review of research and theory. Psychological Bulletin, 1977, 84, 93-116. O'BRTAN,J. P., & WEINGARTNER,H. Associative structure in chronic schizophrenia. Archives of General Psychiatry, 1970, 22. 136-142. PIAGET,J. Piaget's theory. In P. H. Mussen (Ed.). Carmichael's 'Manual of child psychology'. (3rd ed.) New York: Wiley, 1970. Pp. 50-58. RAPAPORT,D. Diagnostic psychological testing: the theory, stati~tical evaluation and diagnostic application of a battery of tests. Vol. 1 . Chicago: Yearbook Publ.. 1950. SCHWARTZ.S. DO schizophrenics give rare word associations? Schizophrenia Bulletin, 1978, 4, 248-251. THORNDIKE, E. L., & LORGE,I. The teachers' word book o f 30,000 words. N e w York: Columbia Univer., 1944.
Accepted August 6, 1979.
