Differences between good and poor prognosis schizophrenics in defensive behavior, perceptual organization, concept formation, and developmental and social experiences



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This study was undertaken in an effort to gain a clearer understanding of possible relationships among some of the variables already separately established as important in the determining of "good" and "poor" prognosis among schizophrenics. Because of the ever increasing number of studies devoted to single aspects of the behaviors of good and poor prognosis schizophrenics, it was believed that the investigation of a number of these variables within a single sample could be of some merit. Further, the introduction of other measures not previously used in this context was intended to provide additional construct validity for the theoretical approach of separating schizophrenic patients into two prognostic groups. Characteristics under investigation included adequacy of defenses and levels of perceptual and cognitive functioning. In addition, attention was focused on several factors believed to be especially relevant to adequacy of pre- morbid adjustment. These included particular facets of personality organization, developmental experiences, and social and family relationships. A total of 60 subjects (30 males and 30 females) were selected on the basis of an age range of 18 to 45, a WAIS IQ of 80 or above, and a clear-cut undisputed psychiatric diagnosis of schizophrenia. No significant differences were found to exist between experimental groups, or sexes, in age or intelligence. Prognostic ratings were made with the Phillips Scale for Premorbid Adjustment, as applied to case history content. At the outset of the study, it was not known whether ratings made with the criterion measure would yield a continuous or bimodal distribution. After complete test batteries for approximately 30 subjects had been obtained, their social histories examined, and prognostic ratings made, it became clear that, on the basis of results obtained with the criterion instrument, subjects would likely fall into two quite distinct groups. Consequently, for the remainder of subjects selected, an effort was made to control for IQ and sex. The Minnesota-Briggs History Record was used to obtain factual information regarding social-personal experiences during the development period, and resulting personality characteristics. It is a multiple-choice interview schedule comprised of 175 items, from which scores of the following descriptive clusters can be derived: Psychopathic Personality, Schizoid Personality, Neurotic Personality, Hypochondriasis, Achievement, Conflict with Parents, Unstable-unrewarding Home, Sibling Conflict, Broken Parental Home, Parental Socioeconomic Level, Patient's Educational Accomplishment, Patient's Occupational Accomplishment, Lability of Feeling and Emotion, and Avoidance and Isolation from Others. Defensive behavior was examined by two methods. Rorschach records were judged for predominant defense according to the Schafer (1954) system as adapted by procedures developed by Weiss (1956), and Selzer (1956). Comparison of judgments of predominant defense by two independent judges of 27 of the records resulted in 83 per cent agreement. Measures of defense behavior at a more superficially structured level were obtained by use of the Wiener, Carpenter and Carpenter (1956) Sentence Completion test. Responses were scored according to a rationale developed by McGaughran (Rudie and McGaughran, 1961). This scoring system separates responses into two major categories. Defense and No-defense. Under Defense, three subclasses of defenses are included: Intellectualization, Projection and Repression. Within the category. No-defense, are two subcategories for responses reflecting the presence or absence of conflict. A comparison of ratings between two independent judges on 140 responses indicated 76 per cent interjudge agreement. Level of perceptual organization was estimated by analyzing the structural aspects of Rorschach percepts, according to a system developed by Friedman (1953), and modified by Zimet and Fine (1959). The scoring rationale involved the analysis of form-quality of Rorschach responses according to scoring classes designated: Plus-plus, Plus, Mediocre, Vague, Amorphous, Minus, and DW (confabulatory response). Conceptual behavior was examined by means of the Rapaport modification of the GGW Object Sorting test. The rationale for scoring conceptual areas was that developed by McGaughran (1954); sortings are classified into four basic conceptual categories; Closed, Public-open, Privateopen, and Closed-private. Agreement between two judges for 95 separate items yielded 81 per cent agreement as to scoring category. The results of this study indicated that, in comparison with poor prognosis schizophrenics, the good prognosis schizophrenics: (1) have a more highly developed, complex, and effective defense system; (2) display a more mature level of perceptual functioning; and (3) are less socially withdrawn. The findings here seem strongly supportive of the developmental interpretation to prognosis in schizophrenia; the favorability of prognosis of individuals with schizophrenia is closely related to their level of maturation in several areas of functioning. The comparison of the two groups with respect to differences in conceptual behavior failed to support the theoretical position that the performance of poor prognosis schizophrenics resembles that of brain-damaged patients. Several of the positive findings of the present study are in keeping with those reported previously in separate studies with separate samples. The results of this study provide additional support to the conclusion that the application of the good prognosis poor prognosis distinction in research involving schizophrenics serves to reduce some of the within-group variance previously encountered in studying this type of patients.