conceptions of mental health held by psychiatric patients

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CONCEPTIONS OF MENTAL HEALTH HELD BY PSYCHIATRIC PATIENTS’ JEANNE M. GIOVANNONI AND LEONARD P. ULLMANN Veterans Administration Hospital, Pal0 Alto, California PROBLEM Nunnally(’) investigated the opinions and attitudes that normal subjects held concerning mental health and mental illness. To measure information he used an opinion questionnaire. To measure attitudes he used the semantic differential. Nunnally(’3 P. 61) found that “the information held by the public is not really ‘bad’ in the sense that the public is not grossly misinformed but the attitudes held by the public are as ‘bad’ as is generally suspected.” In order to determine whether mental patients themselves shared in the general public’s negative attitudes, the responses of psychiatric patients were obtained to the information and attitude measures Nun- nally had used. PROCEDURE The Ss were 35 hospitalized male psychiatric patients from five different wards of a Veterans Administration Neuropsychiatric Hospital. The average age of the group was 37 years, the average educational level was 12.3 grades, and the median length of their current hospitalization had been 17 months. Thirty three of the patients were diagnosed as psychotic, and two had a diagnosis of anxiety reaction. The Ss completed two sets of material. The first was a 50 item questionnaire dealing with opinions about mental health, mental illness, and general information about the field of mental health. Ss were asked to rate each of the items on a seven- point scale as to the degree to which they agreed or disagreed with each statement. This questionnaire was taken verbatim from Nunnally’s(’- P. 24-26) work and had been used by him to measure the level of public information. From this source the means and standard deviations for the responses of a sample of 201 normal subjects were available. In addition, Nunnally presented the responses of 176 “experts” who were 90 psychiatrists, who were members of the Group for the Advancement of Psychiatry, and 86 psychologists, who were diplomates in clinical psychology and in counseling and guidance of ABEPP. The responses of these experts to the 50 items were considered to be the base line to which the relative “correctness” or (‘incorrect- ness” of other subjects’ responses could be compared. The second part of the material completed by the patients was composed of semantic differential scale ratings of six concepts. This technique had been used by Nunnally to measure the attitudes of normals. The six concepts used in this study were “Neurotic Men”, “Average Man”, “Psychiatrist”, “Insane Man”, “Father”, and “Me”. Each of these six concepts was rated by patients on a set of seven-point semantic differential scales. The scales used were : Foolish-wise, intelligent-ignorant, strange-familiar, active-passive, sincere-insincere, predictable-unpredictable, weak- strong, slow-fast, understandable-mysterious, rugged-delicate, warm-cold, clean- dirty, safe-dangerous, relaxed-tense, valuable-worthless, sick-healthy, and good-bad. The instructions, the scales, and the ordering of the scales for each of the concepts were those used by Nunnally‘l. p. 267-269). Data for the average ratings by 250 normals (The Illinois Opinion Panel) were available“, p. 46). As with the question- naire, ratings by patients were compared with those by normals. In addition, patients’ ratings of some of the concepts were compared with their own ratings of other concepts. ‘This paper, from the Behavioral Research Laboratory, Veterans Administration Hospital, Palo Alto, California, was an individual hospital project of the VA’s Psychiatric Evaluation Project, and waa resented at the 42nd Annual Meeting of the Western Psychological Association, San Francisco, Cadrnia, April, 1962. The authors wish to thank Dr. L. Douglas Smith for his help in the collection of data.

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Page 1: Conceptions of mental health held by psychiatric patients

CONCEPTIONS OF MENTAL HEALTH HELD BY PSYCHIATRIC PATIENTS’

JEANNE M. GIOVANNONI AND LEONARD P. ULLMANN

Veterans Administration Hospital, Pal0 Alto, California

PROBLEM Nunnally(’) investigated the opinions and attitudes that normal subjects held

concerning mental health and mental illness. To measure information he used an opinion questionnaire. To measure attitudes he used the semantic differential. Nunnally(’3 P. 61) found that “the information held by the public is not really ‘bad’ in the sense that the public is not grossly misinformed but the attitudes held by the public are as ‘bad’ as is generally suspected.” In order to determine whether mental patients themselves shared in the general public’s negative attitudes, the responses of psychiatric patients were obtained to the information and attitude measures Nun- nally had used.

PROCEDURE The Ss were 35 hospitalized male psychiatric patients from five different wards

of a Veterans Administration Neuropsychiatric Hospital. The average age of the group was 37 years, the average educational level was 12.3 grades, and the median length of their current hospitalization had been 17 months. Thirty three of the patients were diagnosed as psychotic, and two had a diagnosis of anxiety reaction.

The Ss completed two sets of material. The first was a 50 item questionnaire dealing with opinions about mental health, mental illness, and general information about the field of mental health. Ss were asked to rate each of the items on a seven- point scale as to the degree to which they agreed or disagreed with each statement. This questionnaire was taken verbatim from Nunnally’s(’- P. 24-26) work and had been used by him to measure the level of public information. From this source the means and standard deviations for the responses of a sample of 201 normal subjects were available. In addition, Nunnally presented the responses of 176 “experts” who were 90 psychiatrists, who were members of the Group for the Advancement of Psychiatry, and 86 psychologists, who were diplomates in clinical psychology and in counseling and guidance of ABEPP. The responses of these experts to the 50 items were considered to be the base line to which the relative “correctness” or (‘incorrect- ness” of other subjects’ responses could be compared.

The second part of the material completed by the patients was composed of semantic differential scale ratings of six concepts. This technique had been used by Nunnally to measure the attitudes of normals. The six concepts used in this study were “Neurotic Men”, “Average Man”, “Psychiatrist”, “Insane Man”, “Father”, and “Me”. Each of these six concepts was rated by patients on a set of seven-point semantic differential scales. The scales used were : Foolish-wise, intelligent-ignorant, strange-familiar, active-passive, sincere-insincere, predictable-unpredictable, weak- strong, slow-fast, understandable-mysterious, rugged-delicate, warm-cold, clean- dirty, safe-dangerous, relaxed-tense, valuable-worthless, sick-healthy, and good-bad. The instructions, the scales, and the ordering of the scales for each of the concepts were those used by Nunnally‘l. p. 267-269). Data for the average ratings by 250 normals (The Illinois Opinion Panel) were available“, p. 46) . As with the question- naire, ratings by patients were compared with those by normals. In addition, patients’ ratings of some of the concepts were compared with their own ratings of other concepts.

‘This paper, from the Behavioral Research Laboratory, Veterans Administration Hospital, Palo Alto, California, was an individual hospital project of the VA’s Psychiatric Evaluation Project, and waa resented at the 42nd Annual Meeting of the Western Psychological Association, San Francisco, Cadrnia, April, 1962. The authors wish to thank Dr. L. Douglas Smith for his help in the collection of data.

Page 2: Conceptions of mental health held by psychiatric patients

CONCEPTIONS OF MENTAL HEALTH HELD BY PSYCHIATRIC PATIENTS 399

RESULTS Correlations were computed between mean ratings of the 50 items of the in-

formation questionnaire by patients, normals and experts. The correlation between the means of patients’ ratings and the means of normals’ ratings was .73 (critical ratio 6.36). The correlation between the means of patients’ ratings and experts’ ratings was .67 (critical ratio 5.55). The correlation between means of normals’ ratings and means of experts’ ratings was .76 (critical ratio 6.82). All of these cor- relations were significant far beyond the .001 level. The difference between the cor- relations between the patients’ and experts’ ratings and the difference between the normals’ and experts’ ratings was not significant.

The similarities between the patients’ responses and the responses by the 201 normals was reflected in the standard deviations as well as in the means of ratings. The correlation between the standard deviations of the responses to the 50 questions by patients and by normals was .31 which had a critical ratio of 2.20, significant be- yond the .05 level. That is, to a significant extent, when there was higher disagree- ment among patients, there also was higher disagreement among normals.

On 11 of the 50 items there was a significant difference between the means of the patients’ and the normals’ responses. For these 11 items, the means of patients’ ratings and those of normals were compared with the experts, i.e., when the patients and normals disagreed significantly, who was closer to the experts’ opinion on the item? In seven out of the 11 items, the normals’ ratings were found to be closer to the ratings of the experts. A seven to four split is not statistically significant.

Having found no significant difference between patients’ and normals’ informa- tion, a comparison was then made between patients’ attitudes and those of normals through a comparison of their semantic differential ratings of six concepts. Since standard deviations for ratings by normals were not available for the semantic differential as they had been for the information items, a difference between the means of 2.56 of the standard error of the mean of the patient ratings was used as a minimum level of significance. When this was done, there was no significant differ- ence between the mean ratings of patients and the mean ratings of normals for 86 of the 90 ratings.

The product-moment correlations between the means of the patients’ ratings and the means of the normals’ ratings were computed separately for each of the six concepts rated. Each concept had been rated on 15 scales by both groups. The cor- relations between mean ratings by normals and patients for the six concepts were as follows: .56 for “Average Man”, .83 for “Me”, .83 for “Insane Man”, .87 for “Father”, .87 for “Psychiatrist” and .90 for “Neurotic Man”. With an N of 15, the .56 correlation for “Average Man” was significant a t the .05 level. All of the cor- relations for the other five concepts were significant beyond the .001 level. When the 90 concept rating-scale scores were pooled, the correlation between the mean ratings by normals and by patients was .95.

There was a significant difference between patients’ and normals’ ratings on four of the 90 scales. Considering the difference in the patients’ and normals’ situa- tion, these were rather rational points of difference. The patients rated them- selves (“Me”) as less active and less healthy than the normals had rated themselves; the patients rated “Average Man” as less active than the normals rated “Average Man”; and the patients rated “Psychiatrist” as more valuable than the normals rated “Psychiatrist”.

On the 86 scales where there was no significant difference between ratings by patients and normals, the following was found: For the concept “Insane Man”, the ratings were extremely unfavorable. Both groups rated “Insane Man” as dirty, bad, cold, dangerous, unpredictable, worthless, and in fact a halo effect of all things bad emerged. “Neurotic Man” emerged somewhat better, but not nearly so favor- ably as either “Average Man” or as “Me”. “Psychiatrist” and “Father” were generally viewed the most favorably, as being particularly clean, safe, sincere, and valuable creatures.

Page 3: Conceptions of mental health held by psychiatric patients

400 JEANNE M. GIOVANNONI AND LEONARD P. ULLMANN

Within the patient group itself, comparisons were made between patients’ ratings for the concept “Me” and for the concept “Insane Man”. All of the patients’ ratings were in the direction of a much more negative attitude toward “Insane Man” than towards ‘(Me.” A comparison was also made between patients’ ratings of “Me” and of “Average Man”. On only two of the scales was a significant difference found: Patients rated “Me” as less rugged and as less relaxed than they rated “Average Man”. It is interesting to note that normals also had rated (‘Me” as less relaxed and as less rugged than “Average Man”

SUMMARY In this study the opinions and attitudes of 35 hospitalized male psychiatric

patients concerning mental illness were compared with the opinions and attitudes of normal subjects presented by Nunnally(’). The patients’ mean responses to a 50 item questionnaire and a set of semantic diflerential ratings were in s i g d c a n t agree- ment with the mean responses of normals to these instruments. Hospitalized mental patients were found to be no better informed than normals about mental health. Their attitudes toward the mentally ill were found to be as extremely negative as normals’ attitudes toward the mentally ill.

REFERENCES 1. NUNNALLY, J. C., JR. Popular Conceptions of Mental Health. New York: Holt, Rinehart, &

p. 46).

Winston, Inc., 1961.

YOUTH-PARENT RELATIONS OF MATHEMATICALLY-GIFTED ADOLESCENT8

WALLACE A. KENNEDY AND HERMAN WILLCUTT

Florida Slate University

PROBLEM There seems little doubt that the relationship between a potential scientist and

his parents plays an important role in his development. Generally our knowledge of this relationship is in retrospect, as distinguished men of science reminisce about their childhood. Whether these childhood memories are accurate or reflect instead a posthoc reconstruction is of some concern to investigators attempting to establish the determinants of scientific productivity.

Watson(8. 9) , a generation ago and again recently, addressed himself to this problem. Watson contended, both with regard to the literature reviewed and his own data, that the family relationships of children with high potential for creativity and originality were permissive and democratic. This finding is in agreement with the Iowa studies of Lewin“) and Lippitt(6) and the whole tenor of the thirties and forties, when it was felt that the democratic society spreading downward into the home was the best of all possible environments for the incubation of creative in- dividuals. This feeling generalized to the extent that parental strictness and control became almost heretical.

In the post-Sputnik era when the very survival of democracy may well depend upon our ability to produce highly creative, imaginative scientists, we have been forced to recognize that many, if not most, of the great scientists of the world have not been a product of democratic home environments. Looking a t the impressive list of foreign-born American men of science, the American public could well ap- preciate Bob Hope’s quip that the reason the Russians are ahead of us in space is