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Full text of "Report of program activities : National Institute of Mental Health. Division of Intramural Research Programs"

AWJAI. REPORT 



NADONAI, INSIITUIES OF HEALTH 



NATIONAL INSTITUTE OF MEOTAl HEALtI 






mm. 



Library, Ac^u.. Unit 

National Institutes of Health 

Building 10 

Be&esda, Maryland 20014 



U-^ NATIONAL INSTITUTE OF MENTAL IffiALTH ^ 
Annual Report for the Calendar Year 1957 
TABLE OF CONTMTS 



SUMMARIES: 

Basic Research 

Biometrics 

Clinical Investigations 

Community Seiyices 

Professional -Services 
PQblications and Reports 
Research Grants and Fellowships 
Training and Standards 

PROJECTS s £asa 

C^^rtiraX Invas tigations. 

Office of the Dire^ctor of Clinical Investigations 

Budget Fheet 
M-D(C) 1 The Analysis of the Psychotherapeutic iVocess, 

Particularly the Psychoanalytic Process 1 

M-D(C) 2 Development of an Ego Integration Conceptual System 

for Studying PsychotheraRjr ^ 

M.D(C) 3 Establishment of a Near Zero Level of Fhjrsical 

Stimulation and of Action Possibilities and its 

Effects on Mind and Brain ■'Activity 7 

Adult Psychiatry Branch 

Budget Sheet 
M.AP(C) 1 The Study and Treatment of Schizophrenia as a Family 

Problem "^1 

M-AP(C) 2 Investigation of the Character Structure in the 

Alcoholic Patient 15 

M-AP(C) 3 A Study of Clinical and Experimental Depersonalization: 
The Effects of Psychotomimetic Drugs on Psycho- 
logical Processes 17 
-M-AP(C) 4 A Study of Tranquilizing Drugs: The Effects of a 
Tranquili«ing Drug on Fsychodynamic and Social 
Process 20 
M-AP(C) 5 FVoblems of Psychoanalytic Research with Schisophrenics 24 
M-AP(C) 6 Family Relations in Schizophrenia 2? 
M-aP(C) 7 Perceptual Impairment in Psychogenic l^iental Disorder 32 
K-AP(C) 8 Linguistic Study of Emotionsl Expression 35 
M-AP(C) 9 Social Mobility and the I^aiieu of the Psychiatric 

Hospital 36 

M-AP(C) 10 Psychiatric Research in a Clinical Setting: Integrating 
Research and Treatment in the Role of the Clinical 
Investigator 39 

- 1 - 



Adult Psychiatry Branch, Continued Page 

iyl-AP(C) 11 Selected Aspects of the Social Structure of a Clinical 

Research Program in the Mental Health Fields Problems 
Posed by the Variety of Roles Built into the Social 
Structure ^ 

M-AP(C ) 12 The Nat^l^al History of a Hospital Case Presentation hZ 






M.CR(C) 
M-CR(C) 


1 
2 


M-.CR(C) 


3 


M-CR(C) 


4 


M-CR(C) 


5 


M-CR(C) 


6 


M-CR(C) 


7 


i^CR(C) 
M^CR(C) 


8 
9 


M-CR(C) 


10 



Child Research Branch 

Budget Sheet 

Milieu Therapy ^5 

Studies in Psychopathology of the Hyperaggressive 

Child ^ 

Technical Problems in Individual Psychotherapy 

with HTperaggressive Children 53 

Studies in Learning Disabilities in Hyperaggressive 

Children 51 

Studies in Life Space Interview Strategy and 

Techniques 61 

Studies of Change in Hyperaggressive Children 

During the Course of Residential Treatment 65 

Interaction Patterns of Nprraal and Hyperaggressive 

Children 68 

Research on Anger in Interpersonal Situations 70 

Staff Values Concerning Therapeutic Inteirventions 

with Hyperaggressive Children 73 

A Study of Behavior Reporting by Child Care 

Workers 15 

Laboratory of Psychology— Section of the Chief 

Budget Sheet 
M-P-C(C) 1 Administration of Laboratory of Psychology ( A Joint 

Operation of the Clinical Investigations and 

Basic Research Programs) 77 

M-P-C(C) 2 The Analysis of the Psychotherapeutic Process: The 

Cumulative Information Derived Prom Repeated 

Viewing of Complex Material 80 

M-.P-.C(C) 3 Psychology of Schizophrenia 82 

M-P-C(C) h Linguistic Study of Emotional Expression 84 

M-P-C(C) 5 Judgment of Facial Expression from Short Sequences 

of Motion Picture Film 86 

M-P-C(C) 6 Interaction Patterns of Normal and Hyperaggressive 

Children 88 

M-P-C(C) 7 Studies of Dimensionality of Psychological Variables 90 
M-P-C(C) 8 The Self-Concept and Body Image as Related to Disease 

Susceptibility and Organ Choice 92 

M-P-C(C) 9 Precocious Puberty and Pseudohermaphroditism 9^ 

]y^P-C(C) 10 Study of Intractable Pain 96 

M-P-C(C) 11 Drug Study 98 

M-P-C(C) 12 Schizophrenic Illness In a Set of Idential 

Quadruplets 99 

M-P-C(C) 13 Responsivity Patterns in Schizophrenics 101 



Laboratory of Psychology — Child Development Section SSJSS. 

Budget Sheet 

iy[-F-D(C) 1 The Preparation of Procedures for Observing and 
Recording Infant Behaviors and Mother- Child 
Interactions in Testing Situations for Use in a 
Study of Infant Development 103 

M-P-D(C) 2 Standardization of the California Infant Scale of 

Mental Development 105 

M-P-D(C) 3 Long-Term Sxperisacf-s With Methyltestosterone as 

a GrOTrbh Stimulanx. in Short Iramatux-e Ecys IC? 

M-P-D(C) k Relationship of Jfeternal Behavior to the Subsequent 
Social, Emotional, and Intellectual Development 
of Children 109 

M-F-D(C) 5 Develcpraent of a Theory of the Role of Parental 

Behaviors in the Utiology of Personality Structure 

and Psych ops thology 112 

M-P-D(C) 6 Organization of Maternal Behavior and .'.ttitudes 

Witliin ; 'wo' Di^uensioilal Space llij- 

M-P-D(C) 7 Dsvelopnient of a Maternal Behavior Ivesesrch Instrument 116 

M-P-D(C) 8 Origins of Zmotional Dependency in 3arly Childhood: 

An Experimental Frograra 118 

M-P-D(C) 9 The Effects of Depr!.vation and Satiation on Social 

Reinforcers 120 

M-P-D(C) 10 .A Screening Test for Selecting Parents on the Basis 
of Their Attitudes Tof/rard Children: Fteletions 
Between Attitudes Expressed During the Lying-in 
Period and I^ater Behavior With the One-month Old 
Infant 123 

M-F-D(C) 11 Early Infant Personality Characteristics: Studiss 

of Crality, -activity, and Sensitivity in Neonates 125 

M-P-D(C) 12 Further Studies of the Conditioning of Vocal Behavior 

in the Huifian Infant 12? 

M-P-D(C) 13 The Chick's Preference for Some Visual Properties 

of Water 129 

M-P-D(C) 1^1- Increasing Social Vocalizations in the Infant by 
Means cf an ."dult's Social Response (foriTierly: 
The Pf.fect of Social "{einforcetnent Upon Social 
Behavior in the Human Infant; The Effects Upon 
Vocal Behavior.) 132 

t!t-P-D(C) 15 A Follow-Up Studji- of Social Responsiveness in a 

Group of Institutional Babies 13^ 

M-P-D(C) 16 The Differential Responsiveness of Infants to 

FarAHiar and Unfamiliar Fersjons 136 

H.P-D(C) 1? The Effect of a Strange Environment Upon the 

Behavior of Infants 138 



- 3 



Laboratoiy of Psychology— Section on Personality 



Page 



Budget Sheet 

M-P-P(C) 1 Coininunication of Value Systems Between Therapist and 

Schizophrenic Patients 1^0 

M-P-P(C) 2 Natxire and Stability of Psychiatric Nurses Concepts 

of Their Roles 1^2 

M.P-P(C) 3 Evaluation of the NIH Research Associates Training 

Program 1^4 

M.P-P(C) 4 Attitude Changes in Nurse Trainees Subsequent to 

Psychiatric Training 1^6 

M-P-P(C) 5 The Process of Change and the Communication of Value 

Systems in Psychoanalytic Therapy^'- 148 

M-P-P(C) 6 Development of an %o=.Integration Conceptual System 

for Studying Psychotherapy 150 

M-P~P(C) 7 Patterns of Responses on Psychodia gnostic Tests Yielded 
by Patients Suffering from Various Psychosomatic 
Diseases 153 

M-P.P(C) 8 Development of Objective Measures of "Mental Health" 155 

M-P=P(C) 9 An Analysis of Interpersonal Communication Patterns 
Within Families of 'Schizophrenics and Non-Schizo- 
phrenics in Quasi- Experimental Group Situations 157 

M-P"P(C) 10 Value ^hanges in Psychiatric Nursing Trainees 159 

M-P-P(C) 11 Validation of Specificity Theory of Psychosomatic 

Disease l6l 

M-P-P(C) 12 Processes of Acceptance of Social Influence 163 

Laboratorj"- of Clinical Science-=Office of the Chief 

Budget Sheet 
M=CS.OC(C) 1 Biological Studies in Schizophrenia 166 

M-.CS=OC(C) 2 Comparison of the Excretion Patterns of Metabolites 

of Aromatic Amino Acids by Normal Subjects and 

ScM.zophrenic Patients 169 

M-CS-OC(C) 3 Study of the Metabolites of Epinephrine and 

Norepinephrine in Human Body Fluids 171 

]yt=CS=OC(C) k Studies of the Interrelationships of the Nei^rous and 

Circulatory Systems 173 

Laboratory of Clinical Science^^Section on Medicine 

Budget Sheet 

M=.CS-xM(C) 1 Behavioral and Biochemical Correlates of the Electro- 
encephalogram (EEG) in Schizophrenic Patients 176 

M>CS-M(C) 2 Qualitative Intraspecies Variations in Human Serum 

Cholinesterase 180 

M=CS=M(C) 3 Effect of i^ferphine and Nalorphine on Plasma 

%dr-o= cortisone Levels 182 

M-CS-M(C) h An Evaluation of Certain Reported Biochemical Differ- 
ences Between Schizophrenia and Non- psychotic 
Subjects 184 



k 



Laboratoi'y of Clinical Science— Section on Medicine, Continued. Pa^e 

M-CS-M(C) 5 The Relationship Between Endogenous Antidiuretic 

Hormone Activity and ACTH Release in Man 186 

M-CS-M(C) 6 Morphine Suppression of Pitressin-induced ACTH 

Release in Man 1S9 

Laboratorj'- of Clinical Science — Section on Phj-siolog;^ 

Budget Sheet 

]4.CS-P(C) 1 An Attempt to Differentiate Between the Thinking 
Disorder Found in Schizophrenics and That Found 
in Patients with the Diagnosis of Chronic Brain 
Sjmdrome 191 

M-CS-P(C) 2 The Effects of a Vari«?ty of Centrally Acting -rugs 
on Intellectual Mot or ^ and Perceptual Behavior 
in Normal Subjects 192 

M-CS-P(C) 3 Studies on the Effects of Various Centrally 

Acting Drugs in the Rat 195 

M-CS-P(C) h A Comparison of the Effects of Chlorpromazine and 
Secobarbital on Intellectual, Motor and 
Perceptual Behavior in Schizoplirenic Patients 197 

M-CS=P(C) 5 Behavior-ally and Pharmacologically Induced Effects 

on the Electrical -^ctivity of the Brain 199 

Laboratory of Clinical Science— Section on Psychiatry 

Budget Sheet 

M-CS-Ps(C) 1 Correlation of Psychiatric Evaluation in-th 

Neiirophjrsicological, Psychological and Socio- 
logical Evaluation in the '"'ged 203 

M-CS-Ps(C) 2 Psychiatric Evaluation of Normal Control 

Volunteers 20? 

M-CS-Ps(C) 3 Psychological Variables and Cerebral Physiology 210 

M-CS-.Ps(C) iJ- Correlation of Psychiatric Evaluations and Their 
Physiological Correlates of the Effects of 
1- Epinephrine in a Normal Control and a 
Schizophrenic Population 213 

M-CS-Ps(C) 5 Psychiatric Investigations in the Biological Study 

of Schizophrenic Subjects 215 

Socio- environmental Studies, Social Studies in Therapeutic Settings 

Budget Sheet 

M-S-T(C) 1 Social Life of the Mental Hospital Patient 21? 

M-S-T(C) 2 The Relationship Between the Value System of the 
Mental Patient and His -Mjiistment to Hospital 
Life 220 

M-S-T(C) 3 Development of Objective Measures of "^^^ental Health" 222 

M-S-T(C) 4 Construction of Measures of Affectional and 

Authority Relationships of Parents and Children 

in the Families of Schizophrenics and Normals 223 

= 5 ^ 



Socio- environmental Studies=~Social Studies in 

Therapeutic Settings, Continued Page 

M-S-T(C) 5 Evaluation of the NIH Research Associates' 

Training Program 224 

M-S-T(C) 6 Sbcploratory Study of the Mental Hospital as a 

Social System 225 

M-S-T(C) 7 Psychiatric Research in a Clinical Settings 

Integrating Research and Treatment in the Role 

of the Clinical Investigator 22? 

M-S-T(C) 8 Changes in the Social Behavior of Child Patients 

Associated with •'-'ifferences in Treatment Setting 229 

M-S-T(C) 9 Selected Aspects of the Social Structure of a 

Clinical Research Program in the Mental Health 
Field; Problems Posed by the Variety of Roles 
Built into the Social Structure 231 

M-S-T(C) 10 A Fhenomenological Study of Child-Patient Behavior 232 

M-S-T(C) 11 A Study of the Structure of a Therapeutic Milieu in 
a Psychiatric Ward — Its Impact on the Patients and 
the Patients* Response to it 23^ 



Baeic Research 

Laboratory of Neurophysiology— C-eneral Neurophysiology 



^ ioy 



Budget Sheet 
M-NP-GW 1 Measurement of Local Circulation in the Brain 236 

M-NP-GN 2 Effects of Drugs on Specific Ionic Conductance 23? 
M-NP-GN 3 Measurement of Soma-Dendritic Membrane Current 238 
M-NP-GN ^■ Studies on Role of Superficial Neurons "Dendritic 

Reactions" in Spreading Cortical Depression 2^1 

M-NP-GN 5 Effect of Curare on the "Dendritic" ^Reaction 2^3 

M-NP-GN 6 Tests of Certain Drugs on Specific Electrical 

Reactions in the Brains of Animals 2^6 

M-NP-GN 7 Activity Cycles and Interaction Between Callosal 

and Direct Cortical Reactions, and to Determine 

Regions of Chief Activity of Each 2^7 

M-NP-GN 8 Measurement of pH Changes in the Cortex During 

Spreading Cortical Depression 2^8 

Laboratory of Netorophysiology— Section on Cortical Integration 

Budget Sheet 
M-1^]P-CI 1 Analysis of the Electrical Activity of the Brain of 

Unanesthetized Monkeys 250 

M-NP-CI 2 Mapping the Behavior Elicitable by Electrical 

Stimulation of the Brain 252 



Laboratory of Neurophysiology— Limbic Integration and Behavior 



£ag£ 



Budget Sheet 
M-NP-LI 1 Studies on Localization of Function in Limbic System 
M-MP-LI 2 Studies on the Limbic System 

Laboratory of Neurochemistry 



M-NC-PC 1 

M-NC-PC 2 

M-NC-PC 3 

M-NC~PC k 

M»MC-PC 5 

M-NCPC 6 

M-NC-PC 7 

M-NC-PC 8 

M-NC-PC 9 



Budget Sheet 

Structure of Transition-Metal Complexes 

Physical Chemical Studies on Synthetic Poljrribonucleo- 

tides 
The Formation of a New Helical Complex Between 

Polyinosinic Acid and Polyadenylic Acid 
Computation of Helical Transforms for Synthetic 

Polypeptides 
Physical Properties of Ribonucleic Acids 
Frictional Properties of Cesoxjrribonucleic Acid in 

Solution 
Structiire of a Complex Formed Between Polyadenylic 

Acid and Polyinosinic Acid 
DeterTiiination of the Structure of Collagen 



Investigation of the 
Acid Complexes 



tructure of teroid Amino 



Laboratory of Cellular Pharmacology 



Budget Sheet 

Methionine Activating Enzyme in Rabbit Liver 
Studies on Methionine Activating Enz3me of Yeast 
Study of Methionine Synthesis by Enzym&tlc Transmethyla- 
tion from Betaine o:- Diraethylthetin 
Metabolism of S-Adenosyl"L.hom.ocysteine (ASR) 
Amino Acid Analogue Studies of Protein Synthesis 
The Conversion of Phenylalanine to Tyrosine 
Hormonal Regulation and Protein Synthesis 
Studies on the Cofactor Required for the EnZvTuatic 

Conversion of Phenylalanine to Tyrosine 
Clinical Studies on Phenylketonuria 
Biossmthesis of Noradrenalin 
Sulfate Metabolism in Chlorella 

The Enzymatic Mechanism of Generation of the MetVQrl 
Group of Methionirje From One Carbon Compounds Such 
as Forma.ldehyde 
Amino Acid Uptake ay Escherichia coll 

Amino Acid Incorporation and Protein Synthesis in Liver 
Metabolism of ' .-ictive Methionine" in Yeast 



M-CF 


1 


M-CP 


2 


M-CP 


3 


M=CP 


t^ 


M-CP 


5 


M-CP 


6 


M-CP 


7 


M-CP 


8 


M-CP 


9 


M-CP 10 


M-CP 


11 


M-CP 


12 


M-CP 


13 


M-CP Ik 


M-CP 


15 



260 
262 



266 

268 

271 

27^ 
277 

280 

282 
285 

288 



290 
292 

29ii. 
296 
298 
300 

302 

30^^ 
306 
308 
310 



312 
31^ 
315 
317 



Addiction Research Center Page 

Budget Sheet 

ti-AR 1(C) Addictive Liabilities of New Analgesics 318 
M-AR. 2 (C) Acute and Chronic Intoxication i-n.th Drugs Other 

than Analgesics, Barbiturates or Alcohol 323 

;4-AR . 3 Chronic Intoxication T-iith Barbitiorates and Alcohol 326 

M-AR 4 Biochemistry of Addiction 329 

M-AR 5 Neuroplis'siology and Neuropharmacology of Addiction 331 

M-AR 6 Psychological Studies of Addiction 335 

Laboratory of Clinical Science — Section on '-'erebral Metabolism 

Budget Shee-5- 

.I-CS-CM 1 Studies on :.e Circulation and Metabolism of the 
Human Brain, I. .-.ge Changes in Cerebral Blood 
Flaw and Metabolism. II. Effects of Anxiety and 
Emotional States on Cerebral Circulation and 
Metabolism 3^0 

M-CS-CM 2 Rapid Continuous Measurement of Leg Blood Flow and 

Metabolism ty^ Means of Radioactive Sodium 3^ 

li-Co-CH 3 Measurement of ^-ocal Circulation in the Brain 3^ 

M-CS-CH k The >?echanism of Action of ThjToxine and Its 

Relation to Cerebral Metabolism 350 

J^CS-C I 5 Chromatographic Studies in Intermediatry I%tabolism 

Related to Diseases of the Nervous System 353 

M-CS-CK 6 Determination of the Spinal Fluid Levels of 

T -Aminobutyric Acid and the Lnzyme Responsible 
for Its Formation, Glutamic Decarboxylase, in 
Normal Subjects and in Patients vlth Mental and 
Neurological Disease 357 

!^CS-CM 7 Copper Dynamics in NoriKal and Schisophi-enic Serum 359 

Laborator-y of Clinical Science — Section on Drug Evaluation 

Budget Sheet 
M-CS-DE 1 Detertoination of Cerebral Blooi Tlcn-r and rfetabolism 
in Brain Disease by Means of the Inert Gas 
Technique Utilizing Krypton 35 361 

Laboratory rT Clinical Science— Section on Biochemistry 

Budget Sheet 
M-CS-3 1 ractionation of Brain Constituents. Isolation and 

Identification of Antigen Responsible for Praiuc- 

tion of Allergic Sncephaloticrelitis 364 

M-CS-B 2 Iir; lunological Studies on .Allergic Encephalomyelitis 363 
M-CS-B 3 Biochemical Studies on Brain, Blood, and Spinal Fluid 

c' Encephalotnyelitic /uiimals 371 

iy^CS-B 4 Antl'iuretic Effects of LSD in Normal and 

Sc' Izophrenic Subjects 37'^ 

M-CS-B 5 xMeta'tolisra of Radioactive Histidine in Schizophrenics 

and formal Humans 377 



- fi - 



V 



Laboratory of Clinical science — Section on Fharraacology Pag e 

Budget Sheet 

M-CS-Fh 1 Biochemical Factors Involved in the Action of 
Drugs. I. Studies on the Development of 
Tolerance to Narcotic Drugs and the Action of 
Narcotic Drug Antagonists 379 

M-CS-Ph 2 The 'Tiyslological Disposition and Metabolic Fats of 

Drugs Affecting the Nervous System 3S2 

M-CS-Ph 3 Cellular Kschanisms in the Metabolism of Drugs 385 

I-aboratory of Psychology — Section on Aging 

Budget Sheet 
M-P-A 1 A.ge Differences in the Behavior of the Hats learning 

and Transfer, and "sychomotor Behavior 388 

M-P-A 2 Age Changes in Time and Intensity "'elations in Hmaan 

Sensation, Perception, and Response 390 

M-F-A 3 '"^ge Changes in Mental and Ferceotual Abilities and 

Personality Structure 392 

M-F-A. k Cj'tological and Cytochemical Changes in the Nervous 

System as a Function of iVgei .in Investigation of 

Submicroscopic Morphology Employing the Light and 

Electron Microscopes 395 

M-P-A 5 Age Changes in Brain Electrolytes in the Rat 393 

M-P-A 6 Metabolis-n of Nei'vc-us Tissue ~s s Function of Age 402 
M-P-A 7 The Kctabolism of Neuropharniacological Agents as a 

Function of Age ^05 

M-P-A 8 The Effects of Hypoglycemia, Anoxi?-, and Drugs on the 

Phosphocreatine Content of ^-ist Brain in ini".als of 

Different Ages ^07 

M-P-A 9 The Effect of Age on the Distribution of Glucose 

Between Blood and Bi'ain ^08 

M-P-A 10 Components of Cellular "tructure as s Function of Age ii-lO 
M-P-A 11 Preparation of a Handbook of the Beha\n.or3l Aspects 

of Agj.ng iil2 

M-P-A 12 Electrophysiologic Correlates of ""ensatlon and 

Perception 414 

Laboratory of Psychology— Section on Animal Behavior 

Budget Sheet 

ItP-B 1 The /analysis of the Relationship Beta.'een ^.motional 
Behavior and Certain Cortical and Subcortical 
Structures in the Subhutnan Primate Brain '(•15 

M-P-B 2 The Analysis of the Relationships Between Problem- 
solving Behavior as Demonstrated in the Delayed 
Response and Discrimination Tasks and Certain 
Cctical and Subcortical Structures in the Subhuman 
Primate Brain 41? 

M-P-B 3 The Effects of Brain Lesions and Immediate Post- 
operative Experience on Dominance Behavior in 
Primates 420 

- 9 - 



M-P-B 
M-P-B 


5 
6 


M-P-B 
M-P-B 


7 
8 



Laboratory of Psychology--Section on Animal Behavior, Continued Page 

M-F-3 k- Further Analysis of the Continuous- Performance 

Technique as a Research Tool and Diagnostic Device 

in Assessing the Effects of Drugs and Brain Pathology 423 

Defining an Extrageniculostriate System, in Vision 42? 

A Comparative Study in Friiiates on the Effects of 

Temporal Lobe Damage on Visually Guided Behavior kjO 

Histological Ajialysis of Brain Lesions in Primates ^32 

Electroencephalographic Correlates of Sustained 

Attentive Behavior in Man ^3^ 

M-P-B 9 Electrical Activity in Temporal Cortex During 

Visual-discrimination Learning and Performance ^36 

Laboratory of Psychology— Section on Perception and Learning 

Budget Sheet 
M-P-L 1 Effects of Lysergic Acid Diethylamide (L3D-25) on 

Visual Functions 438 

M-P-L 2 Test of the Satiation Theory of Perception 441 

M-P-L 3 Electrical Recording of SJyemoveraents 443 

M-P-L 4 Visual Discriminative Processes in the Pigeon 445 

M-P-L 5 Individual Differences in Normal Perceptual Processes 449 
M-P-L 6 Environmental and Genetic Modification of Biological 

Systems 452 

Laboratory of Socio-environmental Studies— Office of the Chief 

Budget Sheet 
M-S-C 1 Analysis of Theoretical and Methodologicsl Issues in the 

Sociology of Mental Health and Illness 458 

M-S-C 2 The Impact of Mental Illness Upon the Family 461 

M-S-C 3 The Adaptation of the Mental Patient to His Family Upon 

Return from Hospitalization 464 

Laboratory of Socio-environmental Studies — Social Developmental and 
Family Studies 

Budget Sheet 
M-S-D 1 The Formation of Children's Peer Relationships 466 

M-S-D 2 Adult Leadership in Children's Groups: A Study of 
Leader's Sensitivity and Functioning in Relation 
to the Social-cultural Composition of the Group 470 
M-S-D 3 The Validity of Retrospective Data on Parent-Child 

Relationships 47^3 

M-S-D 4 Life-styles in Aging 475 

M-S-D 5 The Identification of Self in Identical Quadruplets: 
A Special Case of the Problems of Sibling Rivalry 
and of Multiple Status 478 



- 10 - 



Laboratory of Socio-environmental Studies — Social Developmental Pag'e 
and Family Studies, Continued 

M-S-D 6 The "X" Family as Seen by the Community kSO 

M-S-D 7 Exploratory Study of I'fethodol ogy for /.ssessing Inter- 
personal Relationships Within the Family ^+82 

Laboratory of Socio-environmental Studies — Community and Population 
Studies 

Budget Sheet 
M-S-P 1 A Comparison of the Social Relationships of Children 

in the Middle ^snd Lovrer Socio-economic -'trata ^85 

M-S-P 2 Exploratory Study of the 'Ir-e of Local Community 

Resources for Handling Mental Health Problems 487 

M-S-P 3 Pre-hospital Social Factors, Treatment i>T.th the 

Tranquilizing Drugs, and Behavior as Prognosticators 

of Successful Release from a Mental Hospital ii-89 

M-S-P k A Twin Family Study of Mental Deficiency 491 

M-S-P 5 Social Mobility and the Milieu of the Psychiatric 

Hospital 494 



- 11 - 



Annual Report of the Basic Research Program, NIMH-NINDB 



January 1 to December 31., 1957 



IlSrTRODUCTION 

There are relatively few resources around the world for basic 
research in the mental and neurological field. Problems that need 
solution are staggering,. The present overdemand for medical ser- 
vices cannot be diminished except through fundamental advancement 
of concepts., With few resources and lamense problems we need to 
make especially effective use of what is available » How to do 
this? Simply stated, it is by giving encouragement and stimulation 
to the most creative scientists interested in fundamental problems 
in this field and by providing that support by which they can be 
most effective. 

Unfortunately, there is no simple recipe for achieving this 
goal. Something' worthwhile may be accomplished, nevertheless, by 
setting forth new and compelling reasons why it is desirable to 
pursue research basic to neurology and psychiatry. And it may 
also be helpful to make even a preliminary enquiry into what is 
the nature of scientific creativity. 

All of the old reasons for exaiainiag the functions of the 
nervous system still exist. Among the laost important of these 
has traditionally been the desire to know on the part of those 
involved in research— pure intellectual curiosity. The nervous 
system is concerned with those things that Keaini the most in 
hvfflfian life. Man's o>s/n cariosity absut himself as a perceivings 
thinking being cam only be satisfied by pursuing the aaatomy, 
physiology, biocheirdstry, pharmacology, psychology, sociology 
and allied disciplines relating to the brain. Always there has 
been a pressing need to know in order to solve clinical problems . 
This reason has generally been uppermost in the minds of those 
who have provided support for research. 

THE IIRGEICY OF BRAIN RESEARCH 

It needs to be emphasized that the braiia is aa instrument 
for social as well as physiological integration. The peoples 
of all nations are in need, rather suddenly, of the means to 
understand and cope with a myriad of problems relating to 



For this Annual Report the Laboratory Chiefs have provided 
cqmprehensive statements of research progress during the year. 
In the following paragraphs I have attempted the exploration of 
some longramge issues that may be important to our ultimate 
best achievement. 



perception p memory and emotion and to learn how to become more 
constructively adaptive as interdependent individuals. Social 
and technological revolutions are hurtling us, as one of the 
authors of the recent Gaither Report succinctly remarked, 
"right into the mouth of Hell." It remains to be seen whether 
we can find ways to maintain freedom where it exists and to 
establish it where it is lacking. In the meantime , some kind 
of world government under law is called for to forestall a 
global catastrophe that now seems so probable. The shield of 
our republic will depend more and more upon the creativity of 
human social thinking and less and less upon direct inst|"umentali- 
ties of war. The latter can only provide a gap of time within 
which certain crucial social adaptations must take place. 

At the root of the matter are as yet unsolved problems relat- 
ing to the perception of actions and of shibboleths, the trans- 
lation of ideas, the momentum of traditional concepts 3 the 
adhesive behavior of groups j the communication of ideals and goals. 
Many scientists have confidence that these problems can be solved, 
given time and effort. Our country is presently buying time; we 
can undoubtedly improve our effort . Ignorance of basic mechanisms 
acts as a handicap to current attempts to meet these problems. 
There may be short cuts, but few are evident. We have to learn 
how signals enter the nervous system, how they are distorted by 
concurrent and antecedent events, how they relate to mechanisms 
of reward and punishment and emotional expression, how learning 
occurs, and what are the limitations of our ■mnemonic and 
behavioral response systems. These mechanisms have their 
anatomical, physiological, chemical, psychological and socio- 
logical manifestations. What more interesting or important 
labor than to be involved in the unravelling of these mysteries? 

There are bases for optimism in relation to finding solutions 
to these difficult problems; 

lo Creative thinking will undoubtedly be more and more 
deliberately cultivated within the government , In the past, 
creativity has not been favored in relation to social or 
political action; instead, the emphasis has been on stability 
and continuity of the familiar » Creative talent for several 
hundred years has had to find individual, usually unsupported, 
expression through music, literature, art and science. Recently, 
and with spectacular results, creativity in scientific endeavors 
has been supported by governments and industry to the enormous 
material advantage of mankind. The object of this lesson 
appears too clear to be missed in relation to man's psychological 
and sociological needs. A more creative approach to governmental 
issues will invite answers to these problems; one can already 
discern the trends. Leadership in government will hopefully 
become less like steering the car of a Juggernaut and more like 
deliberating the most advantageous moves in chess. 



' 



- 3 - 



2. Progress in fields basic to sociology, psychiatry 
and neurology is rapid. There is a natural tendency, at any 
given moment , to imagine that science is in a pretty comfortable 
state; the directions are obvious for a great deal of work to be 
done just to clear up "loose ends." Nevertheless, a glance over 
one's shoulder just a few years back elicits a rather giddy sense 
of speed of events in any branch of science. Physicists have 
in the last year had to throw away three of the most fundamental 
principles of the universe. Although less spectacular, revolu- 
tionary changes are also taking place within the psychological, 
neurological and sociological sciences. Twice in the past year 
the Basic Research Program has been asked to prepare reviews 
concerning recent advances in areas of our interest ; it has been 
genuinely surprising to take notice of the speed of overall 
conceptual growth. Furthermore, discoveries among complementary 
disciplines now appear to dovetail in ways that could not have 
been anticipated even three or four years ago. Resources of the 
National Institutes of Health and of a number of other governmental 
and private agencies have played an important part in the achieve- 
ment of these advances . 

3„ Progress in these fields will be even more rapid if 
we deliberately cultivate the best oppoi'tunities for creative 
contributions . The most favorable utilization of creative talent 
is not a trivial issue. It needs to be thoroughly and thought- 
fully examined. Albert Einstein wrote: "It is, in fact^ nothing 
short of a miracle that the modern methods of instruction have 
not yet entirely strangled the holy curiosity of inquiry; for 
this delicate little plants aside from stimulations stands mainly 
in need of freedom; without this it goes to wreck and ruin without 
fail. It is a very grave mistake to think that the enjoyment of 
seeing and searching can be promoted by means of coercion and a 
sense of duty." The most fruitful achievements by creative persons 
apparently require three things: personal mastery of a province of 
science, personal discipline and personal freedom. All three 
factors need to be of a high order. 

4. The brain is a very incompletely exploited instrument 
for survival"! The nervous system is an evolutionary product that 
has played its role in human development and survival just as have 
teeth and claws. But we can expect from it much more constructive 
and creative possibilities. An adequate utilization of present 
knowledge in areas of our greatest national need has not been 
attempted in any systematic way. As further insight emerges, v/e 
can expect to better understand human capabilities and limitations 
in perception, memory and communication and to learn ways of 
engaging reward-punishment and emotional mechanisms along rela- 
tively more constructive channels. 

As Professor Percy W. Bridgman, the eminent physicist at 
Harvard, has been careful to point out, all knowledge of the 
universe is dependent upon the level of understanding of 



4 - 



neurophysiology and psychology; this is essential for the inter- 
pretation of sense data and for certain logical, mathematical 
and verbal operations that are involved, many times in a limiting 
way, in the formation of concepts of physics. It was in an 
analysis of comparable instrumental operations involved in the 
measurement of length and time that Einstein discovered certain 
non-common-sense aspects of the universe which form the basis of 
special relativity. As we learn more about human perceptual and 
conceptual processes, we will gain insight not only into ourselves 
but into more general features of the physical world as well. 

We consider that the public need for basic knowledge in all 
fields relating to the nervous system is one of the most urgent 
and worthwhile as well as fascinating areas of scientific 
endeavor. Warren Weaver, Vice-President of the Rockefeller 
Foundation, recently said "in the realm of human behavior 
including all those social, economic, and political aspects of 
individual, group and mass actions which constitute the social 
sciences , . . progress in understanding, and eventually in 
controlling, these phenomena is just as sure to occur as is 
progress in understanding the cell. We must not be impatient 
or critical — surely not contemptuous — of the tentative and 
fragmentary nature of the successes to date . . . the first 
exciting invasions into the world of the mind and behavior." 

We would welcome an objective disinterested examination of 
the dimensions of these issues; the urgency of our national 
need for new basic knowledge relating to the brain and its 
activities; the potential value of current research; the ultimate 
promise of basic research in this field to public problems; and 
a consideration of all of these evaluated findings in relation to 
the total research endeavor being supported by the Federal 
Government . 



CREATIVITY 



Problems that resist solution may be insoluble, yet, if you 
will believe the history of science, it is more likely that the 
means of solution being attempted are inadequate. Certainly, in 
the absence of fresh insight, sheer devotion is powerless to do 
more than refine what is already known. It takes a creative 
person to turn aside from established schemes of consciousness and 
to seek out that which can lead to something more fundamental. 
Occasionally the entire framework in which a problem is presented 
needs to be creatively reformulated, A theory can be tested by 
experience, but there is no direct path from experience to the 
setting up of a theory. 



A more adequate understanding of nature cannot be achieved in 
the abstract; it must be brought about through the consideration 
of materials with which the scientist is already familiar. Even 
the most gifted and energetic person must have achieved a certain 
mastery in the field of his pretended accomplishm.ents , He must 
have a keen sense of what needs to be done to solve a given 
problem and a sufficient skill to do that. He needs not only 
carry out a program of thought and action at the limits of con- 
ception , but he must follow through by communicating in a clear 
way his new level of understaniding. His scientific achievements 
in the end represent only a better approximation— the end can 
never be a statement of finality. 

Highly creative ability in any field of endeavor is so 
relatively rare and little understood that it is usually suspect. 
Every new step in the development of an. idea is likely to seem 
alien and eccentric. One who would be creative must deliberately 
encourage the imaginative manipulation of ideas that have only 
tenuous credentials. Yet the mechanism of creative scientific 
accomplishment are not under any satisfactory degree of voluntary 
control. It requires from the scientist a thorough understanding 
of the problem, discipline and hard work, but also something more 
than that: creativity cannot be squeezed out as paste is extruded 
from a tube. It needs the exercise or "release" of some nimble 
elements of com.binatory play of imagery in a form that usually 
precedes logical construction into words or symbols. Moreover, 
and this is a feature of the greatest importance, the process is 
easily disturbed or put off. Even too urgent a desire to arrive 
quickly at logically connected ideas may foreshorten a conceptual 
advancement in the making. Because of this, discipline of the 
creative process should largely arise within the individual, or 
be provided by example. 

There is another feature of creativity which is less clearly 
appreciated, that of nonconformity. As Ben Shahn has recently 
written: "Without nonconformity we would have had no Bill of 
Rights nor Magna Carta, no public education system, no nation 
upon this continent, no continent, no science at all, no 
philosophy, and considerably fewer religions. All this is 
pretty obvious. But it seems to be less obvious. But it seems 
to be less obvious that to create anything at all in any field, 
and especially anything of outstanding worth, requires non- 
conformity, or a want of satisfaction with things as they are. 
The creative person-=the nonconf ormist==may be in profound 
disagreement with the present way of things, or he may simply 
wish to add his views, to render a personal account of matters... 

"Yet, when it comes to the matter of just what kind of non- 
conf oiinity shall be encouraged, liberality of view recedes. 
There seems to be no exact place where nonconformity can be 



fitted in: it must not be admitted into the university curriculum— 
that would produce chaos « In politics it is certainly inadvisable— 
at least for the time being. It cannot be practiced in journalism.., 
In scieace -- least of all, alas I" Shahn goes on to conclude that 
"The degree of nonconformity present— and tolerated--in a society 
might be looked upon as a symptom of its state of health." 

Important scientific achievements thus seem to depend upon 
the fruitful combination of a group of essentially positive 
factors; some of these relate to the competence, self-discipline 
and nimble imaginativeness of the scientist himself and others 
concern his surroundings. Research in laboratories of the Federal 
Government will surely progress in the sense of advancing the 
frontier. And the rate of advancement inay be speeded up somewhat 
by administrative hustling or by providing additional money or 
personnel in a given field. But saltatory advancement of concepts— 
the kinds of change in point-of-view that may alter the entire 
character and direction of scientific pursuit, the kinds of advance- 
ment that may cut short years of striving--these are not likely to 
occur except where circumstances are especially favorable for 
creativity. In the long run, the reputation and credit of any 
laboratory will depend upon a few advances of this sort far more 
than upon the extension of studies that now seem entirely familiar. 

AN INHERITANCE 

A year ago when invited to participate in the Basic Research 
Program of NIMH-NII'fDB, I already had a high regard for the 
individual scientists in the Program and for their overall endeavor. 
The group, recruited and led by Dr. Seymour S. Kety, was widely 
recognized throughout the United States and abroad as performing 
outstanding research across most of the frontier of complementary 
disciplines relating to the nervous system. All this had been 
accomplished within five years. Despite Dr. Kety's heavy commit- 
ments to purely administrative efforts, he continued to pursue 
research; he perfected his theoretical treatment of blood-tissue 
exchange, e:?Jtended his pioneering studies on human cerebral cir- 
culation and metabolism, and demonstrated a new method for 
determining local cerebral blood flow simultaneously in 
individual regions of the brain. 

It is understandable that after such achievements, simply 
maintaining the Program xn being could pall for Dr. Kety. Moreover, 
he needed to be relatively more free to accelerate his own labora- 
tory research. He would also then be able to provide immediate 
leadership for a group that would undertake a broad-scale investiga= 
tion of the "biology of schizophrenia." For these several reasons, 
Dr. Kety asked for replacement in his job and thereby established 
a precedent for rotation of this administrative office. 



7 - 



Before accepting so large a responsibility, it was natural 
to take a deliberate and hard look at the Basic Research Program. 
Close examination satisfied me and associates to whom I appealed 
for advice that the excellent reputation of the Program was 
entirely deserved. In addition to a feeling of satisfaction as 
regards the purposes and character of the Program, I also felt 
a strong conviction that the United States Government should be 
supported by its citizen-scientists in every way they are able. 
Dr. Kety's invitation to join the Basic Research Program was not 
only flattering in one sense, it was also an opportunity for 
dedication to an important cause. Having completed a "Freshman 
Year" in this job, I can say without qualification that my regard 
for the Program and for Dr. Kety's contributions has risen still 
higher. I can scarcely measure the agreeableness that stems 
from respecting and liking every scientist in the Program: this 
is a continuing reflection of Dr. Kety's wise recruitment. 

GENERAL COMMENTARY 



During the last year we continued trying to recruit a 
Laboratory Chief for Neurochemistry . In succession, two very 
excellent men were invited. Each was keenly interested in joining 
the Basic Research Program, even though it would mean no increase 
in salary. When it came down to particulars, however, we did not 
have enough space. Each was willing to come at a sacrifice of 
their present considerable space, believing that some of this 
deficiency could be made up by the central and collaborative 
facilities of the National Institutes of Health. But neither 
could establish even skeletal programs within the number of modules 
we had available. Space discussions occupied us for months, but 
no adequate adjustment or construction possibilities appeared. 
The same contingency proved critical in relation to recruiting a 
Chief for the Section on Perception and Learning in the Laboratory 
of Psychology. Finally, we had an opportunity to develop the 
important area of auditory physiology and psychology, but again, 
space limitations were critical. It is gratifying to know that 
we could build with strength and that our Program is competitive 
on equal or even disadvantageous terms, but it is also obvious 
that space is our most precious commodity. 

Limbic Integration . By taking advantage of Dr. Kety's fore- 
si ^jht^d^pTanMrn^TorTa Section on Brainstem Mechanisms which had 
never been activated, we werg fortunate to be able to invite 
Professor Paul D. MacLean of Yale University to join the Program. 
Dr. MacLean 's interests in psychosomatic mechanisms and his 
brilliant studies concerning the anatomy, physiology, chemistry 
and behavioral aspects of the phylogenetically older parts of the 
brain have attracted world-wide respect. At the time of our 



invitation Dr. MacLean was on leave of absence from his 
university, spending a year of study in ZUrich. He brings 
with him not only his own exceptional talents and the tradi- 
tions of Professor Fulton's laboratory at Yale, but also the 
rewarding influence of recent visits to many of Europe's 
finest laboratories. The new section headed by Dr. MacLean 
is called the Section on Limbic Integration and Behavior. It 
is jointly identified with the Laboratory of Psychology and 
the Laboratory of Neurophysiology. 

Graduate Students . The Laboratory Chiefs agreed that we 
should restrict the acceptance of graduate students to the 
best possible candidates throughout the nation instead of 
favoring scholars of the Potomac Basic. We now encourage 
suitable graduate students from any part of the country who 
wish to do thesis work in our laboratories. They may find 
this advantageous by reason of the opportunities to work 
with particular scientists, have access to special facilities 
and the interdisciplinary setting of the Basic Research Program 
and at the same time discharge their military obligation. The 
local preceptor would undertake the special responsibility of 
supervising the candidate's thesis and may if mutually agreeable 
become a member of the Doctoral Committee at the candidate's 
home university. The university faculty advisor would at the 
same time become a Consultant to the Basic Research Program 
and would participate in planning and supervising the thesis 
work here. The first graduate candidate participating in this 
plan is Dr, Stanley Glauser, a medical doctor now completing 
his thesis for a Ph.D. in Chemistry from the University of 
Pennsylvania. His local preceptor is Dr. Alexander Rich, Chief 
of the Section on Physical Chemistry. His faculty advisor is 
Professor Philip George, Research Professor in Biophysical 
Chemistry, University of Pennsylvania. 

Research Associates . A Research Associates Program designed 
nearly two years ago was launched last July. The purpose is to 
provide two years of combined preceptor and didactic training 
in basic research to outstanding men .vho have completed an 
internship and who wish to continue in academic medicine. The 
didactic training is intended to supplement and extend in a 
more penetrating way the exposure to basic biomedical science 
provided in medical school. Four of the National Institutes of 
Health are participating in this Program. Seven out of the 
first class of fourteen Research Associates are being supported 
by the Basic Research Program j NIMH-=NINDB. Scientists in the 
Institute of Mental Health are making a study of the aspirations 
and creativity of the Research Associates and of the impact of 
this training program on their career development . 



- 9 



Visiting Scientists . The primary objective of the Visiting 
Scientist program is to provide a mechanism for cross- 
fertilization of ideas and for collaboration between our 
Institutes and Universities elsewhere in this country and 
abroad. During the calendar year, we have enjoyed the associ- 
ation and profited from the scientific skill of some eighteen 
individuals participating in the Visiting Scientist program. 
Six came to the Basic Research Program from England, three from 
the United States (one of these was from Puerto Rico) , two from 
Japan, and one each from Australia, Canada, Denmark, Germany, 
Hungary, India, Korea, and Switzerland. Six of the eighteen 
are senior scientists. We are fortunate that by mutual agreement 
four of the eighteen are imjnigrating to fill Civil Service posi- 
tions in the Basic Research Program. One of the four received 
his papers during the year and has already transferred to 
permanent status v/ith us. 

We are very pleased that Professor H. W. Magoun of the 
University of California at Los Angeles chose to join the 
Intramural Research Program of NIMH as a Visiting Scientist during 
his sabbatical leave. He pursued research v^ith Dr. John Lilly, 
Chief of the Section on Cortical Integration, and with 
Dr. Edward Evarts, Chief of the Section on Physiology , in the 
Clinical Program of Dr. Kety's Laboratory of Clinical Science. 
With Dr. Evarts, Dr. Magoun demonstrated that the recruiting 
response in cortex is modified by alerting reactions on the 
part of the animal. With Dr. Lilly, Dr. Magoun examined 
behavioral stop-start mechanisms in subcortical structures, 
mechanisms apparently related to pleasure, fear and sexual 
excitement. Dr. Magoun also attended courses in the History of 
Medicine at The Johns Hopkins University and Hospital and gave 
a few seminars and lectures at various universities on the 
Atlantic Seaboard. He was responsible for initiating the 
Anglo-American Symposium on the History and Philosophy of 
Knowledge of the Brain and its Fianctions which was held in 
London, July 15-17 under the sponsorship of the Wellcome 
Historical Medical Library with the cooperation of the 
National Hospital, Queen Square, and the Maudsley Hospital. 
This was reported as being the most successful and interesting 
international meeting of last summ.er. We would like to 
encourage the practice of other notable scientists as well 
taking sabbatical leave here at the National Institutes of 
Health . 



ROBERT B. LIVINGSTON, M.I>. 



Q 



a 



The Basic Research Prograni, NIMH-NIUDB, includes 
the following laboratories which are combined with Clinical 
Investigations; 

Laboratory of Psychology 
Laboratory of Clinical Sciences 
Laboratory of Socio-environmental Studies 
The c^ummaries for these laboratories on the following 
pages include only those Sections in the Basic Research 
Program. 

The overall summary for these laboratories is 
included under Clinical Investigations, pp., 33-56 



- 10 - 

Laboratory of Psychologr 
David Shakow, Chief 

SectioB on Aging 

This has been an active year for members of the Section on Aging and 
the specific research findings of the present year will assist considerably in 
outlining long-range research programs in aging* As in the past, research 
effort has been divided among projects employing animals and studies of the 
normal human subject* The work of Dr* Jack Botwinick and his associates 
indicates that there is evidence for a chjinge in inhibitory processes and 
control functions that are involved in motor, perceptual, and mental abilities. 
This is an extension of previous experimental and conceptual work of the la,bora- 
tory. Analysis of the data on over 59 human subjects with a broad range of 
psychological de asurements is now in process of statistical analysis = It is 
expected that these results will be available for publication in the spring of 
19^8, Dr. Alfred Weiss who also participated in the studies of human aging 
is concerned, xfith three areas: click perception, dual chjinnel auditory per- 
ception, and delayed auditory speech feedback. Only the click perception 
data has been analyzed thus far. The data on click perception indicates 
something of the nature of the perceptual deficit which can occur in some older 
individuals * Older individi.i3.1s have increasing difficulty as the number of 
clicks increases, However, response time does not differ for two age groups, 
suggesting that the relationship between response time and perceptual ability, 
or accuj.-"acy, is more complex than previously realized. As an outgrowth of a 
study on age changes in retina,l potentials, a licro-electrode study of retinal 
and optic tract potentials of the cat's eye in response to light was carried 
out in collaboration with Dr. Robert Gohn of the ^-aval Kedical Center by 
Dr. Weiss » The results of this studjr are now being anal /zed. In another 
collaborative study wi'th Dr. Gonan Kornetsky of the Clinical Sciences 
Laboratory, it was found that chlorpromazine was irjithout effect on delayed 
speech feedback while secobarbital markedly increased susceptibility of the 
subject to speech disruption with this method. 

Dr. Edward Jerome has been studying age changes in rat activity, rate 
of learning, and ability to transfer in a series of ten, escape choice problems 
employing light aversion as the drive. Preliminary analyses of the yet incom- 
plete results indicate that, although the older animals were somewhat slower 
than the young ones, the txro age groups did not differ with respect to reaction 
to obstruction, type of errors, learning rate, nor ability to transfer. These 
results can be interpreted as impugning the hypothesis that impairment of 
learning ability and flexibility of behavior are necessary concomitants of 
a decay of biological organization with increased longevity of the organism. 
They are, on the other hand, consistent V7ith the hypothesis that when apparent 
impairment of these functions is observed in human beings, or does occur in 
animals, it is due to experiential factors, e.g., absence of recent relevant 
practice, low motivation, accumulation or strengthening of sources of inter- 
ference, or lack of familiarity i-jith the test situation in general or in 
particular. These preliminary investigations are being extended. 



- 11 - 

Section on Aging (Cont'd ) 

Dr^ iiugene Streicher has continued his studies of age differences in 
calcium of the brain. In all age groups ^ from one month to two and a half 
years, the calcium content of the rat brain is varj variable. The two halves 
of tha saiiie brain often differ by 100 percent or more in calcium content. 
However, the values for the txjo halves of the same brain are more closely 
related to each other in the tissues of old rats than in young animals regard- 
less of the level observed^ On the basis of relatively few observations, it 
appears that the magnesium content of the brain is somewhat diminished in 
animals over two and a half years of age. i'rom measurements on the magnesium 
content of brain from rats of different ages, it appears likely that, in 
contrast to the reports of other investigators, the magnesium content of the 
myelin sheath is relatively low. 

Dr. rtilliain Bondareff has continued his studies of age changes in 
nervous tissues of rats. His electron microscope studies of spinal ganglia 
from aged rats conventionally fixed vjith osmiiom tetroxide, have resulted in 
the demonstration that the genesis of the lipofuchsin (the so-called senility 
pigment) is not directly related to possible age changes in mitochondria. 
This work which has been published in the Journal of Gerontology emphasizes 
that pigment originates in the c:,,i:oplasm of old nerve cells in association with 
vacuoles of su':Tdcroscopic siae and it is suggested that this process is 
associated with age changes in the golgi complex. In an attempt to further 
investigate the process of pigment particulates, tissues fixed by freezing and 
drying have been investigated. These investigations are currently being 
continued and some progress has already been made in the application of these 
methods to the study of submicroscopic cellular changes of aging nerve cells. 

Hr, Joel G-arbus has extended his studies reported last year on the 
oxidative phosphoiylation of fortified brain homogenates to include studies 
using other brain particulate fractions . A preparative procedure was developed 
for the isolation of cellular particulates of high metabolic activity and 
stability. Oxidative phosphorylation, measured in mitochondrial fractions 
prepared by these methods show no decline '.fith age in central nervous system 
preparations from aged rats. These activities are measured under ideal in 
vitro conditions, xxhich may not pertain in vivo . It is therefore proposed to 
make similar measurements using less than optiraum conditions, such as anoxia, 
limited substrate, etc., reproducing a. less favorable cell environment which 
may be a factor in senescence. Collaborative studies undertaken last year with 
Dr. Eugene u'einbach of the rational Institute of Allergy and. Infectious 
Diseases vri.ll be continued to study other aspects of cellular metabolism and 
aging. 

The Section on Aging has continued to act as a coordination center of 
the research pro ;:ram on human aging in the KIMIL At present this pro.loct is in 
the stage of analysis of data. Kr. Samuel Greenhouse and i-Ir. Donald Ilorrison 
are now actively developing high speed computer metliods to intercorrelate the 
many variables from the different laboratories concerning changes in personality, 
cognitive and perceptual abilities, and physiological factors, in normally aging 
individuals « 



= 12 - 

Section on Perception and Learning 

During the year Dr. Carlson's studies of the effects of LSD on the absolute 
visual threshold have been completed » The findings in man indicate a central 
effect of this drug in that the photopic threshold was raised significantly more 
than the scotopic threshold o Brightness vision in man undoubtedly depends to 
a great extent upon the cortex^ and presently available evidence suggests that 
cone vision depends more on the complete integrity of cortical functioning than 
does rod vision. The presiuned hallucinogenic effects of LSD were not found with 
the normal subjects used here. Psychotic and nexxrotic patients have shown evi- 
dence of an elevated visual threshold^ however j, so that this effect of LSD may 
constitute another point of similarity between the effects of the drug in normal 
htmians and the manifestations of more naturally occurring psychological impair- 
ment.. The absolute visual threshold was found to be raised more strikingly in 
the pigeon, although the effect is probably mediated subcortically in this animal. 
Another very interesting finding with LSD in the pigeon is an improvement in 
performance in a conditional visual discrimination task. The reason for this 
effect is not clear at the present time^ but it may have a possible parallel in 
himian perf ormaixce . Under certain conditions normal subjects with LSD, anxious 
or tense subjects^ and some schizophrenic patients seem to be better able to 
maintain directed attention aoad interest in what usually is a simple and tedious 
task for a normal subject. One effect of LSD may be to render the subject less 
susceptible to outside distractions and at the same time less able to integrate 
accessory cues into a xmitary perception. Partly for this reason, the effects 
of LSD are being investigated on more complex perceptual tasks such as size- 
const^ajacy and visual illusions. 

Dro Carlson has also continued his study of the Kohler theory of 
satiation in relation to neural processes associated with perception with a 
view towards using the methods developed for the st\3dy of basic processes of 
attention and short-term memory. He has also continued on the difficult technical 
problem of recording eye-movements electrically. The problem at present breaks 
down into three stages s (l) To work out the technical problems^, which is the 
stage in which the work is concentrated. (2) To work out the methodology measur- 
ing psychological variables by means of eye -movement recording. (3) To apply 
the methodology to specific problems in the percepttial-attentional realm. It 
is in relation to the last that this technique may offer us a method of attain- 
ing an objective indication of what the subject perceives and where and how he 
directs his attention. With increasing interest in studies involving attention, 
such a technique would be most useful. 

Dr. Carlson has finally made arrangements for obtaining students as 
a normal control population. Some of these subjects are being tested intensively 
both as a comparison group for results obtained with patients and as an experi- 
mental group for investigating normal relationships among basic psychological 
processes. An example of the latter is an investigation of the extent to which 
personality J, emotional, and motivational variables are related to the perfor- 
mance aspects of behavior rather than to the perceptual process itself. Another 



= 13 = 

:aon and liiearning (Cont'd ) 

avenue of inquiry concerns behavioral experimental distinctions between those 
perceptual processes which may depend more directly upon neural structure in- 
dependent of experience and those which depend to a greater extent upon develop- 
ment through experience and upon the general psychological state of the individual. 
These and other researches with this normal pop\;ilation have just recently been 
initiated^ but experience thus fax indicates that this program shoiild prove to 
be a workable and successfvil operation » 

Dro Blough's studies of techniques for the experimental analysis of 
instrtmiental behavior in the pigeon have been further developed and refined. 
These techniques are proving especially valuable and efficient in the study 
of the basic processes involved in the stimulus control of behavior and in the 
stiid^ of certain responses which would be difficvilt to explore with more traditional 
methods. For example^ the pigeon has been successfully trained to stand still 
for food reward, a response which promises to be particTolarly useful in assess- 
ing effects of the treinquilizing drugs o Chlorpromazine was fotmd to increase 
the ability of the pigeon to staxid stiH, whereas pentobarbital reduced this 
ability o In nany respects pentobarbital, though not a tranquilizer, has effects 
which are difficult to distinguish behaviorly from those of the tranq.uilizing 
drugs. This emphasis on exploratory work with drugs^ however, is now being 
shifted more toward elucidation of the behavioral principles themselves which 
imderlie stiaxulus discrimination and stimulus generalization. 

Most of the physical construction and equipment procurement for Dr. 
Calhoun's Rockville Faorm Project has been achieved, and initiation of the 
first pilot studies should be possible by the end of this year. This project 
will enable more comprehensive controlled study of the environmental and genetic 
modification of biological systems o Some provocative findings are emerging from 
present studies in this area. Analysis of two field studies of mice and shrews 
living in woodJ.ands revealed that the several species forming the community 
express a social hierarchy in their utilization of space. The more dominant 
species enjoy greater home ranges, but within each range the individual members 
of each species maximize distance from other individuals. Behavior of the rat 
in aa activity alley shows a negative escponential relationship between frequency 
and duration of the 'behavior j, and the frequency with which trips are terminated 
from a starting point is inversely proportional to distance. It is not known 
yet to what extent principles describing the utilization of space through time 
by small mammals wiU be generalizable to man, but the movsnent of an animal 
within its own home range have been fotmd to describe the distribution of church 
members about a church, and the emotional past history of a rat appears to alter 
its utilization of space and time. Initial studies have suggested the possibility 
that emotional conditioning processes may affect space-time utilization through 
function of the retictilar activating system of the brain stem. This and other 
physiological hypotheses will be further explored in rglation to variables of 
environmental structure and social organization. 



» lij. „ 

SECTIOW ON MTMAL BEMVIOR 

In general^ this yeax's activities have concentrated on specifjring more 
precisely the behavioral deficits following brain damage, delineating 
more exactly the anatomical systems related to cognitive behavior, and 
developing automatic-testing devices for use in these problems o We 
have been unable to pursue that part of our program concerning the emo- 
tional and motivational aspects of behavior as actively as intended be- 
cause of lack of funds and personnel o 

The study involving the effects of frontal-lobe damage on delayed- 
response type tests in chimpanzees has been completed except for the 
last stages of anatomical analysis. The results of this study indi- 
cate that chimpanzee performance like that of monkeys is impaired fol- 
lowing frontal-lobe damage. Unlike monkeys, however, they are able to 
recover from these effects and after several months of training regain 
their preoperative performance level. Thus, at the end-point of their 
training the effects of frontal-lobe damage in chimpanzees resembles 
that in man where no consistent effects of frontal-lobe damage on prob- 
lem-solving behavior have been demonstrated. This study has served a 
valuable purpose in clearing up some discrepancies in the literatiore, 
and in demonstrating the important point that in the highly developed 
brain, the effect of damage in a particular area may be less than in 
the more primitive brain. 

The work on the effects of brain lesions on social behavior in primates 
m8.y be summarized as follows s Unlike the findings in monkeys, social 
dominance in chimpanzees appears to be unaffected by temporal- lobe le- 
sions. Further, frontal, lobe lesions in chimpanzees produce a tempor- 
ary decrease in dominance. This finding is compatible with the sub- 
duing effects in the famous ehimpanzeesj, Becky and Lucy^ but is in the 
opposite direction to the effects of such lesions on social behavior 
in monkeys (i.e., increased dominance) described by Rosvold and Erody. 
In monkeys our studies show that hippocampal lesions do not affect 
social dominaneej this is an unexpected finding, since lesions in the 
amygdala^, wMeh is anatcsmically and fmietionally closely related to 
the hippocampus, produce striking decreases in dominance. The studies 
on the interrelation between postoperative escperience and brain lesions 
in determining postoperative change suggest that postoperative experi- 
ence can determine this effect to some extent; this research area, which 
is of considerable theoretical ijmportance, unfortunately cannot be pur- 
sued at present. 

A numb.er of cent rally ■= acting drugs have been investigated with the con- 
tinuous performance technique; ehlorpromazine, L.S.Do;, meperidine, 
several barbitui-ates, meprobamate, benzactyzine and d- amphetamine . The 
results siiggest that agents which appear to depress activity in the 
brain- stem reticular system will impair performance on the C.P.T. Tlaese 



- 15 - 

Section on Aalinal Beliavlor (Continued) 

data a,ppear to mesh nicely with the results of our epilepsy studies: 
those patients in whom the focus of abnormality is presxmably in the 
brain-stem region perform more poorly on this test than other patients 
in whom the pathology, althoiigh equally great, is confined to cortical 
structures. Other tests of "brain- damage" that have been used have 
failed to differentiate the cortical from the non-cortical subgroups. 

The new, improved version of the C.P.T. has recently been delivered 
to us and should provide great flexibility in investigating the para- 
meters of the task. In addition, it will make possible precise study 
of clinical ictal and subclinical ictal phenomena (recorded electro- 
graphically as hypersynchrony) in relation to the mainteneuice of vigil- 
ant or attentive behavior. The instrument hs,s aroused interest among 
other investigators by virtue of its versatility and capacity to elicit 
and measure behavior that covild not be handled so efficiently previous- 
ly. 

The study of the role of inferotemporal neocortex in visually guided 
behavior is being approached in a variety of ways. Attempts to de- 
lineate the anatomical connections betvreen the inferotemporal region 
and the primary visu^ system have finally met with at least tentative 
success. After removing the temporal lobe in one hemisphere eind the 
occipital lobe in the other, monkeys were trained to discriminate 
visual stimvili. The corpus callosum was then cut in these animals and 
they were re-trained on the same visual discrimination. Marked impair- 
ment in re-learning was found, siiggesting callossal transection had in- 
terrupted long association tracts, running presumably from the intact 
occipital lobe through the corpus callosum to the opposite intact tem- 
poral lobe. The lack of impairment following various control opera- 
tions demonstrates that the deficit in the escperimental animals was 
specific to their particular combination of lesions. Final evaluation 
of these results must await replication of the experiment axid histo- 
logical examination of the lesions. This positive finding is of par- 
ticular interest in view of the consistently negative findings that 
have been obtained in animals with subcortical damage. Thus, neither 
the pulvinar nucleus in the thalamus, nor the superior colliculus ap- 
pear to serve as an essential relay station between the inferotemporal 
region and the primary visual system. How it appears, on the basis of 
preliminary resixlts from monkeys with combined ptilvinar and collicular 
lesions, that the two structvires in combination are not the essential 
relay stations. At the moment then, cortical- cortical connections ap- 
pear to be implicated. 

The finding that teiaporal-lobe damage produces visual impaiirment in 
monkeys would be of greater theoretical interest if similar resuJLts 
could be obtained in man. Unfortunately, there is little evidence to 



Section on Anipjal Behavior (Continued) 

support 2h an extension of the animal data. A reasonable 
explanation for this discrepancy has been gleaned from recent 
work on chimpanzees. It wa.s foiand that bilaterally symmetri- 
cal inferotemporal lesions produced impairment of visual dis- 
crimination in chimpanzees which had shown no impairment after 
only a unilateral removal. The negative evidence in human pa- 
tients may be due simply to the fact that temporal -lobe path- 
ology in man is rarely, if ever, bilateral and symmetrical. 
Recent work with monkeys, however, has demonstrated that even 
imilateral damage may produce impairment if vision is limited 
to the field opposite the lesion. On the basis of these re- 
stilts an experiment has been planned to test for possible 
differences between tachistoscopic recognition in the left 
and right visual fields in patients with left or right tem- 
poral-lobe pathology = 

The evidence which has been accumulated so far supports the 
notion that the inferotemporal region constitutes -s^ link 
in the chain of cerebral structures serving vision . The 
study of the neural activity of this region should provide 
important information on the sequence of cerebral events in- 
tervening between stimulus reception at the cortex and the 
motor response. Experiments are therefore being planned in 
which the inferotemporal cortex will be electrically stimu- 
lated or recorded from during the learning and performance 
of visiial discriminations. Evidence for disruption in per- 
formance following stimulation or changes in electrical 
activity during learning would bring us one step closer to 
an understanding of the neural processes underlying vision 
and perhaps other modalities as well. 

An important discovery has been that subcortical structures, 
such as the head of the caudate nucleus and the splenium of 
the cojrpus callosvim, are involved in performance on delayed- 
resp-yife- -type problems = Several points have been raised by 
these findings, (l) What anatomical relationships exist 
to account for these findings? Anatomical studies are \mder 
way to answer this question. (2) Are these effects in fact 
similar to those apparent in animaJ-s with frontal lesions? 
Studies are under way comparing anmals with caudate lesions 
and frontal lesions on a variety of t .'rsc (3) What other 
subcortical structiires may be involved? Studies are under 
way in which animals are being tested after lesions in other 
subcortical structures, (h) What functional relationship 
could exist between the frontal cortex and the head of the 
caudate nucleus to account for their similar effects? 
Evoked potential studies are planned to answer this question. 



SuiTimary Report of Laboratory of Biophysics 
Calendar Year 19?7 

Kenneth S . Cole 3, Chief 

The Laboratory has continued its efforts to understand the nature and 
the implications of the ion movements fundamental to the initiation and propa- 
gation of a nerve impulse and it has made substantial progress ^ 

The squid giant axon, which first allowed the direct measurement of the 
ionic currents through a nerve membrane^ remains the most useful source of 
experimental information. The continuing improvements of techniques and 
equipment have resulted in data on this a:con that more closel;:/ approach the 
ideals of accuracy^ reproducibility and significance than heretofore « The 
transient and steady state ion current flows after an abrupt change of the 
potential difference across the membrane are determined much more by the values 
of the initial and final potentials than by the difference between them^ For 
an initial h3rnerpolari2ation depending upon the axon and its condition, these 
currents approach maxima which are determined only hy the final potential 
and correspond to the rather surprisingly high peak conductances of 200 m mho/cm 
for both sodium and potassium: 

Further investigation of the effects of external calcium and magnesium 
ions added further et/idence of the qualitative similarity of the actions of 
these ions. A decrease of either ion concentration tends to increase the 
membrane excitability by allowing sodium current flow at a reduced depolari- 
zation^ and in spite of the opposing increase of potassium conductance and 
more easily evoked sodiom inactivation» In procaine the potassium conductance 
and sodium inactivation changed slightly in the directions instability^ but 
the decrease of sodiura conductance and the increase of depolarization required 
to achieve it accounted for the net stabilizing effect and suggest that 
procaine not only reduces the number of available paths for sodium ions but 
also increases the difficulty of opening each path^ 

Not only do the speeds of the sodium and potassium processes increase by 
a factor of three for a ten degree centigrade temperature rise as previously 
reported, but the peak conductances of both of these ions also increase bj 
about sixty percent,. In addition to confirming a preliminary report that the 
squid axon action potential is almost identical in artificial sea waters 
containing either the normal sodiura ion concentration or the same concentration 
of lithiiim ion, it was found that none of the ion conductance characteristics 
are probably changed bj more tlian twenty percent by this substitution^ Both 
the temperature and the lithium effects Iwrite explanation in terms of non- 
specific physical processes rather than chemical reactions, A complete analysis 
of the many records of the ion currejits has been delayed by the need for a 
critical examination of several methods, including those originally used hy 
Hodgkin and Htixley, for the separation and empirical representation of the 
sodiiira and potassium components ct 

An investigation of some characteristics of a lobster giant axon has 
been completed. The changes of the resting and action potentials produced 
by alterations of the normally occurring external cations, and by some 
organic solvents, are compared and contrasted with those found in the squid 
and other axons in forthcoming reports. The disparities between the activi- 
ties of synthetic anti-cholinesterases on the enzyme and on frog nerve were 



- 18 - 
Summary Report of Laboratory of Biophysics (cont'd.) 

found to include the optical isomers of one compound before the work turned 
to the more critical experiments on a single node. Some progress was made 
towards the determination of ionic conductances of a single node before the 
project was suspended. 

Recalculations of the Hodgkin-Huxley equations for the squid axon on an 
IBM 70U have shown that mistakes in earlier computations were not of physio- 
logical importance although they had been the source of some theoretical 
difficulties. The new analog computation program has begun with a systematic 
examination of sin^jlified Hodgkin-Huxley equations in which one or more 
variables are held constant. One result is that either a constant potassium 
conductance or a constant sodium inactivation produces a plateau in the 
recovery of the action potential rather similar to that of heart muscle cells.. 
An investigation of passive iron wire models of nerve activity resulted in 
the first quantitative theory of one such system. 



2 - 



- 19 - 
LABORATORY OF NEUROANATOMICAL SCIENCES 



"William F. Windle, Chief 



The Laboratory of Neuroanatomical Sciences occupies space in 
D Wing of the Clinical Center and the East Wing of Building 9. In 
addition, certain research projects have facilities m Puerto Rico. There 
have been no changes in the regular professional staff during 1957. 



Section on Development and Regeneration 

This report of the activities of the Section on Development and 
Regeneration will be divided for convenience into work in the Bethesda and 
the Puerto Rican laboratories. Professional personnel at Bethesda are: 
Lloyd Guth^ Richard L. Sidman, Irene Miale, Kenneth M. Wolf and 
William F. Windle, Chief. Harry H. Wilcox^, of the University of 
Tennessee, is a consultant. Those working in San Juan, P. R. , are: 
C. J. Bailey, J. A. Ranck, S. A. Altmann. Marisa I. R. Ramirez de 
Arellano and Max Ramirez de Arellano are consultants. C. A, Pfeiffer, 
J. G. Frontera and W, Stiehl of the University of Puerto Rico Medical 
School, are collaborators. 

Projects at Bethesda: Histological studies of the spinal cords 
of cats, paraplegic for 1-2 years, have been continued. Regenerative 
activities of central nerve fibers which succeeded in traversing the site 
of the transection under the influence of such agents as piromen were 
blocked by encroachment of massive scars which apparently were formed 
from the pia mater, dura mater and surrounding tissues. Vascularity of 
the site of transection increased with time and the adventitial sheaths of 
the vessels provided routes for regeneration into both the rostral and 
caudal portions of the spinal cord by nerve fibers, principally from the 
spinal nerve roots. Anatomical confirmation of successful regeneration 
of central fibers of the mammalian spinal cord has been published by 
scientists m another laboratory and plans are being formulated for 
collaborative experiments with monkeys in our laboratories late m 1957 
or early in 1958. 

Dr. Guth has continued investigations of neuron specificities. 
He has succeeded in restoring motor function to the rat's diaphragm by 
anastomosing the central end of the cut vagus with the distal end of the 
cut phrenic nerves, demonstrating that visceral motor fibers can take over 
the function of somatic motor neurons. Dr. Sidman has carried out 
experiments by other techniques to explore trophic properties of nerve 
fibers. In the adult newt, the epidermis plays a special role in limb 
regeneration but this is not under nervous control. Motor nerve fibers 
regenerating into the limb do not enter the epidermis. 



Z0-- 



Studies of development of intrinsic brain structure in the human 
embryo have been confined principally to assembling and correlating 
information from the literature. Dr. Guth has translated Ramon y Cajal' s 
classic^ but now almost inaccessible monograph^ entitled: "Etudes Sur la 
Neurogenese de Quelques Vertebres". It is expected that his translation 
will be published next year. 

Studies of the process of aging in the nervous system, have been 
continued, mainly by Dr. Wilcox, working on contract with the University 
of Tennessee School of Medicine, In well-controlled material from the 
brains of guinea pigs between birth and extreme old age, he has found 
that the process of aging involves a decrease in interneuronal substance 
(neuropil). During the year a conference on the Process of Aging m the 
Nervous System was held at Bethesda, the proceedings of which are being 
edited for publication. 

i 

A tissue culture laboratory in Building 9 for Dr. Sidman' s use 
has been under construction for the past year and now is nearly ready for 
operation. In the meantime, Dr. Sidman has devoted his energies to 
other types of work, notably, stiidy of the structure and chemiistry of 
photoreceptor cells in several species but especially the squid. Dr. Feder 
of NIAID, Laboratory of Clinical Investigations has collaborated. Details 
of their study of fine structure and histochemistry of visual elements are 
presented m their annual report. 

Studies of effects of reserpine and other drugs on monkeys and 
chimpanzees which produce states resembling parkinsonism in man are 
being terminated. Results of an attempt to abolish the hypokinesia, 
rigidity and tremor in monkeys by alcohol injection of the globus pallidus 
were reported at the First International Neurological Congress in 
Brussels in July by Drs. Feringa and Windle. The tremor and rigidity 
was abolished transiently on the contralateral side but returned within 
24 hours in chronically reserpinized monkeys. Perhaps the most 
significant observation resulting from research in this area is that 
obtained from histological study of the brains of African green monkeys 
kept on minimal daily doses of reserpine (0. 2-0, 6 mg/kg) for over 18 
months. In contrast with control of material^ neurons of various brain 
stem nuclear groups and cerebral cortex (but not cerebellum) show a high 
incidence of vacuolation in nucleus as well as cytoplasm. The contents 
of the vacuoles have not been identified. The significance of the observation 
IS unproved, but it would appear that continuous administration of the drug 
reserpine, in doses comparable to those in common use in human 
subjects, may not be without adverse effects on the cytological structure of the 
primate nervous system. 

Other activities of the scientists in the Bethesda component of this 
section pertain to interpretation of function of neural elements by techniques 
of histochemistry and fluorescent microscopy. An investigation of the 
development of the blood-bram barrier has begun (see annual report by Wolf). 



--21 



Projects at San Juan: During 1957 two groups of laboratories were 
established at San Juan^, Puerto Rico, one adjacent to the Medical School 
of the University of Puerto Rico and one on the grounds of the U. S. 
Public Health Service Clinic, Facilities on the small island, known as 
Cayo Santiago, where a free-ranging colony of about 250 Macaca mulatta 
monkeys is located, were renovated, A caged colony of 3 5 breeding 
females in the San Juan laboratories, and one of about the sanae size in 
Bethesda have been established. These several facilities provide for 
studies of adverse factors in the perinatal period of monkeys which may 
lead to neurological and psychological deficits in the offspring. Pilot 
studies have been carried out in guinea pigs and cats. 

The principle topic of research at present is asphyxia neonatorum 
in relation to neurological and psychological deficits in the offspring of 
monkeys. Before summarizing this work, a number of other topics, 
touched upon during the year, are noteworthy, (a) Dr. Ranck and others 
have been standardizing procedures for a neurological examination of the 
monkey from birth to maturity. This became necessary when it was 
found that no standard procedure existed, (b) Certain adverse effects of 
hormonal imbalance during gestation have been investigated m the cat by 
Dr. Windle. Dr. Pfeiffer is studying endocrine organs of monkeys 
subjected to various degrees of anoxia or asphyxia, (c) Anthropometric 
studies are being carried out in the free-ranging monkeys on Cayo Santiago 
as well as on specimens in caged colonies. This part of the work will 
soon be taken over by Dr. James A. Gavan of the Medical College of the 
State of South Carolina on a collaborative basis, (d) An opportunity 
presented itself to study hemolytic anemia during pregnancy of one monkey 
in the caged colony. The fetus of this animal was dead at delivery and 
the mother went into eclampsia with convulsions and urinary shutdown. 
This appears to be the only reported example of this condition m a primate 
other than man. 

One of the main objectives of the project m Puerto Rico is to 
relate episodes of asphyxiation at birth to possible deficits in learning 
ability and behavior patterns after birth. Dr. Bailey has completed a 
study of learning in guinea pigs 1-2 years old, half of which were asphyxiated 
and resuscitated at birth. He succeeded in demonstrating that ability to 
perform m certain mazes was impaired even after the animals had attained 
adu].t st3,ges. In this same group of animals Dr. Marisa Ramirez de 
Arellano carried out studies of the electrical activity of the brain. She 
established the characteristics of EEC's in the normal animal at different 
ages and found that abnormalities manifested themselves in some of the 
asphyxiated guinea pigs. All the guinea pigs of this group have been killed 
by the perfusion fixation technique and the brains are being prepared for 
histological study. 



-2; 



A two-year study of behavior and social organization was begun 
on Cayo Santiago in June 1956 by Stuart A, Altmann (see his annual 
report)o The free ranging colony of monkeys provides a unique 
opportunity in the new world to make controlled observations^ not only 
of adults but also of newborn and infant monkeys. These observations 
will help interpret the behavior of controls as well as asphyxiated 
infant and young monkeys of the caged colonies. 

The feasibility of breeding monkeys in caged colonies has been 
thoroughly established^ To date 24 timed pregnancies have been obtained 
in the caged colonies , which numbered only 24 females at the end of 
January and has gradually increased to 70, 

The main endeavor since establishment of caged colonies of 
monkeys^ beginning the end of January 1957, has been to study acute 
effects of asphyxia neonatorum induced near the end of gestation in 
cesarean section delivered animals or within a few days after birth in 
vaginally delivered animals. This^ in a sense, has been an exploratory 
investigation. To date^ the principle results have been as follows. 
Survival time after asphyxiation appears to vary inversely with age of the 
subject. At the end of gestation (164-168 days) monkeys were readily 
resuscitated after 13 or 14 minutes of asphyxiation By 7 weeks of age 
the maximum tinne of survival in an atmosphere of nitrogen was less than 
4 minutes All infant monkeys subjected to experimental asphyxia 
neonatorum exhibited marked neurological deficits after resuscitation. The 
acute effects were impairment or cessation of respiratory activities, impair- 
ment of the establishment of consciousness, blocking of sensory functions, 
blocking of reflexes _, depression of the rate of the heart beat with 
abnormalities in the EKG , blocking of visceral functions. Recovery of 
many of these functions occurred gradually with time However^ all 
animals remained unnaturally guiet and presented acute nursing and care 
problems^ inasmuch as they lost the ability to suck. By 24 hours after 
resuscitation^ most of them improved to such a degree that the investigators 
expressed optimism for eventual recovery However, by 36 to 48 hours ;, 
the condition of those which were most severely asphyxiated deteriorated 
markedly; muscle fasciculation_, nasal regurgitation ^ impaired motor and 
sensory functions . somnolence^ visceral disturbances ^ status epilepticus^ 
and respiratory arrest were encountered- 

Most of these young animals were killed at different ages for 
histological studies. Some of them are still living and being used for 
psychological studies together with randomly chosen babies delivered by 
similar techniques. Sections of the brains of 6 monkeys have been 
examined. These were animals killed between 2 hours and 6 days after 
resuscitation. They have been compared with similar sections from control 



- 23- 



brains. Extensive cell changes are evident in the brains of all the 
experimental animals. The only animal which showed petechial cerebral 
hemorrhages was the one which exhibited status epilepticus. In 5 others 
the principal abnormality appeared to be neuronal lysis. This was found 
throughout, but the changes were more marked in the cerebellum^ dentate 
nucleus and certain centers of the brain stem than m the cerebral cortex 
or basal ganglia. The damage was diffuse rather than focal. It was of 
such a nature that, had the animals lived for 6 months or more, it might 
have been difficult to ascertain with certainty that structural abnormalities 
existed. Such changes after asphyxiation at birth have not been reported 
in any primate. 



Section on Experimental Neuropathology 

The professional personnel of the Section on Experimental 
Neuropathology consists of Helen J. Ramsey and Jan Cammermeyer, Chief. 

The main objective of the section has been to reveal factors 
concerned with development of the myelopathies. Research activities 
have been directed towards three aims: 

(1) To develop a procedure which permits an estimation of volume 
of the spinal cord on the basis of the animal's size and then to conclude 
whether the spinal cord is affected m a given experimental situation. 
Another procedure attempts to predict the size which the spinal cord will 
attain after several nnonths of growth of the animal. Such information is 
needed for an evaluation of long term experiments. In the course of these 
studies sex, age and species have been found to be the factors influencing 
the size of the spinal cord. 

(2) To study the distribution of extradural fat. This study has 
been almost completed by Dr. Ramsey in several species of animals of 
different age. Although certain specific patterns have been established 
in the distribution of fat, the amount of fat is quite variable. This would 
seem to be another factor of importance for the proper functioning of 
the spinal cord, 

(3) To perfect histological techniques for the purpose of 
establishing standard conditions of microscopical investigations of 
experimental myelopathy. After having critically surveyed the technical 
procedure, the investigators are now in position to evaluate properly 
subtle changes of neurons, myelin and glia and to dismiss as not 
significant certain other changes usually encountered in microscopical 
material, such as variability in the staining of neurons, the size of 



glia and appearance of myelin. The emphasis has been placed on 
formulation of standard procedures for examination Ui >be spinal cord in 
animals because only when such formulation is completed ib '^ne able to 
correlate moderate functional neurological dysfunctions with subtit, ^^norpho- 
logical changes. This will be necessary before an attack can be directed 
against the problems concerned with the development of myelopathies, 



Section on Functional Neuroanatomy 

Professional personnel of the Section on Functional Neuroanatomy 
are; Leo C. Massopust, Richard Gacek and Grant L Rasmussen, Chief, 
This section concerns itself primarily with nervous pathways and 
connections of the brain and spinal cord, 

The origin and termination of the medial longitudinal fasciculus in 
the brain stem and spinal cord by means of axonal and terminal 
degeneration methods have been studied by Drs, Massopust and Rasmussen. 
The termination of spinal components of this tract, consisting chiefly of 
vestibulospinal fibers, has been more definitely localized to cell groups of 
the spinal gray matter, m the brain stem the medial longitudinal 
fasciculus has been found to send some of its fibers beyond the midbrain 
to the subthalamic region 

Studies on the auditory afferent and efferent systems have been 
continued by Dr Rasmussen, with the cochlear nucleus receiving 
particular attention during the past year. The experimental anatomical 
findings indicate that the dorsal cochlear nucleus plays an important role 
in control over cochlear nerve afferents received by the ventral cochlear 
nucleus. The vast majority of cochlear nerve fibers ter^ninate m the 
ventral nucleus while the dorsal cochlear nucleus receives predominantly 
short and long efferent or feed back connections from different parts of 
the central nervous system. 

Mr, Robert Boord, a graduate student of the University of 
Maryland, worked during the summer on a problem dealing with the 
innervation of the chinchilla inner ear: This study will be completed at 
the University of Maryland and NIH during the coming year. 

The efficaciousness of the synaptic stain developed by Dr 
Rasmussen has been further explored and tested on various synapses m 
different regions of the central nervous system. It has proven to be 
specific for demonstration of a "granular synaptic substance" in 
practically all endings in the young as well as the adult animal. The 
clarity and completeness of staining is a virtue taken advantage of in 
present studies of interneuronal relationships by the experimental method 
of Wallerian degeneration. Disappearance of synapses related to neurons 



-25 - 



damaged can be noted and the relative number of synaptic connections 
playing upon a single nerve cell that originates from different anatomical 
and functional sources may be determined. In studies of normal material 
dealing with the maturing terminals of young kittens ^ this technique shows 
that synapses make their appearance much earlier than previously noted , 
a finding which correlates more nearly with behavior studies of the young. 

Dr. Chaco of India, guest of this section during one month of 
the summer, employed the synaptic stain successfully to a problem 
dealing with synaptic endings of the spinal cord of lower vertebrates. 



Section on Neurocytology 

The professional personnel of the Section on Neurocytology are: 
Milton Wo Brightman, R, Wayne Albers and Sanford L, Palay, Chief. 
Dr, Samuel McGee-Russell , Birkbeck College, University of London, 
spent the year with this section as a Visiting Scientist. Dr. Jean Gruner, 
University of Strasbourg, was a guest m the laboratory for a two-month 
period, January to March, The principle objective is to conduct research 
into the fine structure of the nervous system, histochemistry and neuro- 
secretion. 

A laboratory for studying fine structure by means of electron 
microscopy has been activated during the past year with the installation 
of an electron microscope and associated equipment. Investigation of the 
structure of synapses and neuron-glia interrelations m the brains of fish 
and mammals is m progress. Dr. Palay attended an international 
symposium on the structure and function of the neuron held in Caracas, 
Venezuela, at which he presented a paper on the ultrastructure of the 
synaptic junction. 

DrSo Brightman and Albers have studied the distribution of true 
and pseudocholmesterase activity in the central nervous systems of cats 
and rats. The perikarya of neurosecretory neurons contain true 
cholinesterase activity whereas their endings in the neurohypophysis do 
not. Pseudocholinesterase activity occurs in the glial cells of the cat's 
spinal cord whereas in spinal cord and brain of the rat, activity is 
confined to the vascular endothelium. This observation may be related 
to the locus of the blood-brain barrier and may be helpful in an 
analysis of myelogenesis. 

Drs. Albers and Brightman have also completed an interesting 
study of dilute alcohol extracts obtained from frozen sections of the 
neurohypophysis of the rat. These extracts contain a proteina.ceous 
material which is present in large amounts in the neurohypophysis of 



.26 - 



hydrated rats but is absent from the glands of animals given restricted 
amounts of water for several days. When this material was assayed, the 
investigators found that practically all of the antidiuretic hormonal 
activity of the neurohypophysis was in this fraction. Since it has been 
known for several years that the neurohypophysial hormonal activities 
can be isolated in small molecules (octapeptides) , this work demonstrates 
that the active natural hormones are not secreted as small molecules but 
are m fact associated with a protein. 

Dr. Albers, in association with Dr, Brady of the Laboratory of 
Neurochemistry, has been studying the localization of glutamic 
decarboxylase m the nervous system. This enzyme is absent from white 
matter^ the neurohypophysis and the pineal gland, but is high in certain 
areas of the gray matter. The reaction which this enzyme catalyzes results iiji| 
the production of y -amino butyric acid, which is an inhibitor of synaptic 
transmission. The localization of this enzyme is therefore of undoubted 
importance in an analysis of cerebral metabolism and function. 



# 



- 27 - 
Laboratory of Neurochemistry 
Robert B, Livingstorij Acting Chief 



During the past year^ efforts to recruit a chief 
for this laboratory were continued. We identified success- 
ively two distinguished investigators each of whom could 
mount a most impressive and fruitful program of research in 
this field. Each was greatly attracted to the Basic Research 
Program. The only handicap v/as lack of sufficient space. 
Each was willing to give up much of the luxury of space 
where they were in favor of the values of interdisciplinary 
transaction available hereo But if they came here they 
would have to amputate too much of what they want to do 
and are prepared to dOj in order to be accommodated within 
the space we have available. We considered a number of 
alternate plans for re-arrangement of space available to 
the Basic Research Program as a whole, in order to make 
this key recruitment possible. We tried to win back space 
which historically had been "loaned" outside the Basic 
Research Program. In every case^ we failed. Each of the 
scientists concerned would have been content to join the 
Progranij, do as much as possible with the space presently 
available and await the construction of new space,, provided 
only that we could indicate that such construction would 
probably take place witLiin a few years. There are clearly 
many uncertainties in such contingency. Therefore j the 
matter was dropped for the time being. Until more space 
becomes available^ it will not be possible to establish 
the one or two additional Sections and bring to the Labora- 
tory the overall leadership needed to fulfill our research 
objectives in Neurochemistry. 

Meanwhile 5, the two already established Sections 
have continued to deiaonstrate that they are capable of 
pursuing important issues profitably. The Section on 
Physical Chemistry under the leadership of Dr. Alexander 
Rich, has made significant advances in the determination 
of the shape and dimensions of several families of large 
molecules. These are variously concerned with cell re- 
plication and grovi/thj the "coding" of amino acids along 
protein strands, the control of protein conjugating 
systems by metallic ions, the binding of key metallic 
ions to protein complexes, and the structure al role of 
certain protein-steroid complexes relating to myelin. 
The Section has already received wide recognition for its 
investigations concerning the structure of collagen, DNA 
and RNA and for its comparative studies of natural and 
synthetic polynucleotides. The key to many problems 



28 



of importance to an uuderstartdirig of the nervous system 

will be found by exaiiilaing the shape and activity-configuation 

of these molecules o 

The Section on Lipid Cheir^istryj led by Dr., Roscoe Brady, 

has completed a year of accOiaplishiEent in relation to our 
understanding of lipid formation and structure, and of the 
mechanisms of action of certain niirible eleraents concerned 
with the initiation and inhi'bition of the nerve action 
potential. Sphingosine synthesis has now been accounted 
for, the mechanisn of incorporation of glucose and galactose 
into cerebrosides has been shown and a further advance 
has been made toward defining the nature, origin and dis- 
position of myelin. Gai;;;i.ia-amno butyric acid has recently' 
caused quite a stir among neurophysioiogists and neurochemists 
as an example of a synaptic inhibitor coiTiparable to the 
synaptic excitants such as epinephrine asid nor~epinepyrine. 
The Section has contributed toward knowledge of both the 
source and fate of this compound within the brain. By 
combining talents with the Section on Special Senses in 
the Laboratory of Neurophysiology , Dr. Brady has found that 
compounds releasing free radicals, and cozipcunds interfering 
with certain redox potential nechanisas within the squid 
axoii may provide an avenue of approach for the ultimate 
chemical analjrsis of the ZLechscrlsms governing the nerve 
action potential. 

Summarjr reports prepared by the Section Chiefs 
follow: 



Section on Physical Chemistry 

A. Rich, Chief 29. 

One of the main activities of the Physical Chemistry 
Section consists of studying the properties and physical structure 
of ribonucleic acid. This substance, an elongated polymeric mole- 
cule composed of a sequence of nucleotide units, has been shown to 
be of fundamental importance in the economy of the cell. It is 
found in the microsomal particles which are the site of protein 
synthesis. It is believed that the RNA in these particles somehow 
determines the sequence of amino acids in the protein to be syn- 
thesized. Thus, the RNA has an important function in transmitting 
information, i.e., concerning amino acid sequences, from one poly- 
meric species (nucleic acids) to another (proteins). In addition 
to this, another function of prime importance is the transmission 
of genetic information. Thus, it has been shown that RNA can act 
as a carrier of genetic material in several RNA-containing viruses. 
In this role, the RNA acts as a carrier of information from one 
nucleic acid molecule to a large number of nucleic acid molecules 
in the daughter viruses. In this respect, RNA shares this ability 
with deoxyribosenucleic acid (DNA) which is the main carrier of 
genetic information. 

In view of the participation of RNA in these two fundamental 
cellular processes, the Section on Physical Chemistry is studying 
the molecular architecture of the RNA molecule in the hope of 
elucidating its molecular structure in order to obtain an under- 
standing of the molecular mechanisms behind these activities. In 
this regard, it is quite possible that the role of this molecule 
is even more significant in nervous tissue than in other tissues 
since an essential activity associated with nervous tissue is 
information transfer. How this is accomplished on the molecular 
level in nervous tissue is of course unknown at the present time. 
However, fragmentary information is available which suggests that 
the nucleic acids play an essential role in this activity. 

The Section on Physical Chemistry has been studying the 
synthetic polyribonucleotides. These are molecules composed of 
the same linear array of nucleotide subunits as is found in the 
naturally occurring nucleic acids. However, they can be prepared 
enzymatically and, what is most significant, the sequence of 
nucleotide bases can be controlled during the polymerization. 
Thus, it is possible to prepare not only a nucleic acid-like mole- 
cule which has all four of the constituent nucleotides found in 
naturally occurring RNA, but it is also possible to prepare nucleo- 
tide pol5rmers which contain only one nucleotide. This is of funda- 
mental importance in terms of elucidating the structure of the 
molecule since it superimposes a degree of simplicity on the mole- 
cule which is not found in nature. This simplicity permits us to 
study the conf igurational details of the molecule in a form which 
is simplified to a point where we can solve the problem. 



-30 - 

About a year and a half ago, we discovered that two of the 
synthetic polyribonucleotides, polyadenylic acid and polyuridylic 
acid, would combine together to form a two-stranded helix in 
which the uracil and adenine residues are hydrogen bonded to each 
other with a specific set of hydrogen bonds. These are, in fact, 
the same type of hydrogen bonds which hold together the two- 
stranded helical DNA molecule. This discovery attracted a great 
deal of interest because it showed how intimate was the relation- 
ship between DNA and RNA. As was noted above, both of these 
molecules have the ability to transmit genetic information, and 
this discovery has led to the tentative conclusion that both 
molecules carry out this function, using the same molecular 
mechanism, i.e. separation into two single strands with the 
formation of a complementary strand to yield two identical mole- 
cules. 

During the last year, we made a series of additional dis- 
coveries. Among the first of these was the discovery that it is 
possible to make a three-stranded nucleic acid. Thus, when the 
two-stranded polyadenylic acid plus polyuridylic acid is put into 
a solution with an additional molecule of polyuridylic acid and 
small amounts of magnesium ions, it will combine to form a three- 
stranded molecule. This three-stranded molecule was discovered 
by a spectrophotometric and ultracentrifuge investigation. More 
recently, a detailed X-ray diffraction pattern has been obtained 
from which we will be able to work out the details of the molecu- 
lar arrangement of the three chains. This is the first time that 
a three-stranded nucleic acid molecule was discovered, and it may 
be significant in pointing out the manner in which nucleic acid 
molecules function. One of the probable reactions of the DNA 
molecule is that it aids in the specific synthesis of an RNA 
molecule. By doing this, it transfers information, i.e., nucleo- 
tide sequence from one polymeric species to another. It is 
possible that this is accomplished by forming a single-stranded 
RNA molecule which is wrapped around a two-stranded DNA molecule. 
Accordingly, the discovery of three-stranded nucleic acids seems 
of potential importance. 

Further investigations concerning other polynucleotide 
interactions have been carried out, and several have been dis- 
covered. Among the first of these was a combination involving 
polyadenylic acid with polyinosinic acid. Polyinosinic acid is 
closely rela1;ed to polyguanylic acid and as such is of importance 
in our understanding of the naturally occurring nucleic acids. 
It was found that polyadenylic acid and polyinosinic acid would 
combine together to form a two-stranded helical molecule. It 
was also found that an additional strand of polyinosinic acid 
could join the two-stranded complex to form a three-stranded 
complex, polyadenylic acid plus 2 polyinosinic acid. This is, 
of course, similar to the system polyadenylic acid plus 2 poly- 
uridylic acido 



-31 - 

Another discovery was made concerning the interaction of 
polyinosinic acid and polycytidylic acid. These two molecules 
will combine to form a two-stranded helical arrangement. It is 
interesting to note that this two-stranded molecule will not 
form a three-stranded one in contrast to the two systems men- 
tioned above. The most interesting feature of this combination 
is that it has an X-ray diffraction pattern which is very simi- 
lar to that which is found in naturally occurring RNA. Accord- 
ingly, by working out its structure, we should learn something 
about the configuration of RNA when it is extracted from cells. 

Another discovery was made concerning the structure of 
polyinosinic acid itself. It has been found that this molecule 
exists as a three-stranded helical structure with a cyclic 
system of hydrogen bonds holding together the three strands. 
Although this structure is quite interesting, it is difficult 
to relate it to the configuration of the naturally occurring 
nucleic acids . 

If we assess the total amount of information known about 
the configuration of the synthetic polyribonucleotides, we find 
that we have deduced a total of eight different structures which 
will form from these polynucleotides. These provide an adequate 
basic set of information from which we hope to go on to deduce 
the configuration of RNA in cellular systems. 

While studying the synthetic polyribonucleotides, we have 
not neglected to study naturally occurring RNA itself. Thus, a 
study was carried out of methods of extracting RNA from muscle 
tissue in order to obtain it in an undegraded form. In addition, 
studies were made of the effects of metal ions on the stability 
and sedimentation properties of naturally occurring RNA. These 
have shown that metal ions in small quantities are able to 
stabilize naturally occurring RNA probably by serving as sites 
which bind together the negatively charged phosphate groups and 
thereby decrease the amount of internal electrostatic repulsion 
energy in these molecules. 

Another aspect of the program of the physical chemistry 
section has been the study of the structure of protein mole- 
cules. As in previous years, we have continued to work on the 
structure of collagen, the major fibrous protein in the animal 
kingdom. Refinements have been carried out on the molecular 
structure proposal made two years ago. This proposal has now 
been accepted quite generally by the scientific community as 
providing a basis for the structure of collagen. Studies have 
been made concerning the interaction of different collagen 
chains with each other and the effect of various amino acids 
side chains on the stability of the molecule. A recent addi- 
tion has been the study of elastin, a closely related protein 



-32 - 

which provides the elastin components of blood vessels and con- 
nective tissues. Preliminary studies of this molecule indicate 
that it has a structure similar to a somewhat degraded collagen 
molecule. 

An investigation has been carried out on the coordination 
of the porphyrin group to the protein part of cytochrome C. 
This has been done by making a thermodynamic study of the bind- 
ing of various small molecules such as azide or cyanide to the 
iron atom in cytochrome C. From this, information may be obtained 
concerning the amino acid side chains which are of importance 
in holding the heme group to the protein. 

Further work has been carried out on the interesting inter- 
action between steroid molecules and amino acids or peptides. 
These interact to form a helical structure with a diameter of 
40 A. Studies have been carried out on the number of amino acids 
which will interact with the steroid (sodium desoxycholate) . It 
has been found that a large variety of amino acids and peptides 
will interact. All of these form the same helical structure 
although there is some modification of the helix as a function of 
different amino acids. Further studies are being carried out on 
this complex to ascertain the molecular configuration of the 
steroid molecule. Steroids play an important part in the struc- 
ture of the myelin and fatty components of nervous tissues and 
it is hoped that these studies will provide some understanding 
of the modes of packing steroid molecules together. This may 
lead to an understanding of the unique role which steroids play 
in the nervous system. 



Section on Lipid Chemistry 

R. 0. Brady, Chief 33. 

The primary goal of this section is to elucidate the path- 
way of synthesis and metabolic fate of the complex lipids of the 
nervous system. This problem has been approached by investigating 
the formation of several of these components using enzyme systems 
obtained from brain tissue. The distinguishing characteristic of 
the major portion of neural lipids is the presence of the long 
chain dihydroxyamine, sphingosine, which forms the basic structural 
unit of these complex lipids. Accordingly, an elaboration of the 
enzymatic mechanism of sphingosine synthesis is of paramount 
importance for understanding the formation of these lipids. We 
have succeeded in demonstrating for the first time the enzymatic 
synthesis of sphingosine (NINDB-NCl) and have characterized the 
enzjrrae system and identified the cofactors required for this 
process. That the reaction is exceedingly complicated is indi- 
cated by the observation that at least eleven non-enzymatic 
components are required for the final step in this process. These 
findings are of considerable interest since a relative insuffi- 
ciency of any one of these materials could potentially interfere 
with the formation of myelin. Furthermore, in the course of these 
investigations J the pathway of formation of long chain fatty 
aldehydes has been discovered. These latter materials constitute 
the characteristic moieties of another group of cerebral lipids 
called plasmalogens. 

Perhaps the most representative of the complex cerebral 
lipids are cerebrosides . These compounds are composed of an 
extra-ordinarily long chain fatty acid in an amide linkage with 
the amino group of sphingosine. A third portion of these compounds 
is a molecule of either glucose or galactose joined with the 
primary alcoholic group of sphingosine by a glycosidic bond. We 
have succeeded in demonstrating for the first time the enzymatic 
incorporation of glucose or galactose into cerebrosides (NINDB- 
NC4) . The enzyme system obtained from brain tissue has been 
characterized and the specific uridine nucleotide cofactors 
required for this synthesis have been identified. Of particular 
interest was the identification of the pathway of incorporation of 
galactose into cerebrosides. The experiments performed in this 
series of investigations indicated that in contrast with the 
mechanism of formation of uridine diphosphate glucose from glucose- 
1-phosphate and uridine triphosphate, an analogous enzyme for the 
formation of uridine diphosphate galactose was absent in brain 
tissue. The formation of the appropriate galactose nucleotide from 
galactose- 1-phosphate occurred only in the presence of catalytic 
amounts of uridine diphosphate glucose which indicates the presence 
of a novel transferring enzyme in brain tissue called galactose- 1- 
phosphate uridyl transferase. It should be indicated .Jiere that when 
glucose is employed as substrate, it is actually incorporated into 
cerebrosides as galactose confirming the presence of the enzyme 
uridine diphosphate galactose epimerase in these preparations. 



Sii--"-^':!: . 

In addition to the fact that cerebrosides are important 
constituents of the myelin sheath, there are several disease states 
associated with an overabundance of such compounds, particularly 
Gaucher 's disease or Tay-Sachs' disease. In the latter condition 
related materials called gangliosides accumulate in pathologic 
quantities in the brain. We are at present investigating the 
metabolism of cerebrosides using tritiated galactocerebrosides in 
these studies. Furthermore, we are exploring the effect of certain 
antimetabolites such as deoxyglucose and deoxygalactose on cerebro- 
side formation. 

Since cerebrosides contain long chain fatty acids as well as 
sphingosine and a sugar molecule, we wish to investigate the incor- 
poration of fatty acids into ceramides (sphingosine-fatty acid) or 
cerebrosides (NINDB-NC5) . A search for the appropriate tissue 
source and enzyme system will be initiated shortly. 

Another important class of cerebral lipids under investiga- 
tion in this laboratory consists of inositol lipids. These 
materials are particularly interesting because they have been found 
to exhibit the highest rate of metabolic turnover of all of the 
cerebral lipids. We have demonstrated for the first time the 
enzymatic incorporation of inositol into this type of lipid and 
have identified the particular cytidine nucleotide cofactor required 
for this process (NINDB-NC7) . This process was investigated with 
the use of tritiated inositol and in the course of these investiga- 
tions several new techniques for the handling and radioactive assay 
of tritiated compounds have been developed (NINDB-NC8) . Of partic- 
ular interest in this regard was the innovation of the use of 
silica counting vials which improved the low level counting of 
tritiated samples immensely. Another technique developed here was 
the extraction of lyophylized tissue samples with an appropriate 
solvent system for direct radio-assays of tissue specimens. These 
techniques proved to be particularly feasible for the study of 
metabolism of meprobamate, a tranquilizing agent currently in wide 
use (NINDB-NC9) . 

The availability of liquid scintillation counting techniques 
suggested a method which has been successfully employed for the 
ultra-micro determination of the enzyme glutamic decarboxylase 
(NINDB-NC2) . This enzjnne catalyzes the formation of y-amino butyric 
acid, a compound found to exert striking neurophysiological effects. 
We have succeeded in identifying three particular regions where this 
enzyme is predominantly found in the central nervous system. Thepe 
areas comprise the reticular formation of the midbrain, the optic 
sensory area of the cortex, and the nucleus proprius of the dorsal 
horn of the spinal cord. Such a distribution where a localized 
production of 7-amino butyric acid can occur may be of considerable 
significance for mediating certain control mechanisms character- 
istically exhibited by nuclei such as are found in the reticular 
formation. This project is continuing by investigating the meta- 
bolic fate of Y-amino butyric acid produced by the decarboxylase 
reaction. It undergoes transamination to form succinic semialde- 
hyde which is subsequently oxidized. The enzymes catalyzing these 
reactions have been demonstrated and an assessment of the quantita- 
tive importance of this alternate pathway of cerebral metabolism 
will be undertaken. 



- 35 - 

The investigations of neurohumoral agents led us to the 
observation that under certain conditions, compounds such as 
serotonin which contain an aromatic benzene ring are not necessarily 
formed via the 7-carbon sedoheptulose-diphosphate pathway. Accord- 
ingly, we wish to try to identify alternate enzymatic routes for 
aromatic ring formation (NINDB-NC6) . These experiments are 
pertinent because of the finding that compounds such as benzoquinone 
capable of giving rise to free radicals have a profound effect on 
the conduction of nerve impulses. This observation was made in the 
course of experiments on the intra-axonal injection of enzymes and 
other biologically active materials (NINDB-rNCS) . These investiga- 
tions also revealed that the application of compounds having 
sufficiently high oxidation potential cause drastic changes in the 
conduction properties of the squid giant axon. The results seem to 
indicate that the axon membrane is normally in a reduced state, a 
condition known to require energy obtained through metabolic reac- 
tions, and that the appropriate alteration of this condition permits 
the investigator to predetermine any number of repetitive responses 
to a single stimulus that is desired. It appears that a delicately 
balanced equilibrium is obtained between the oxidizing agent and 
the reduced axon membrane which can be destroyed by the agent or by 
allowing the nerve to fire repetitively until it has exhausted its 
metabolic energy source. Some striking recent observations have 
been obtained in this laboratory with regard to the ability of brain 
extracts to reduce exogenous triphosphopyridine nucleotide in the 
absence of added substrate. Taken together, these investigations 
suggest certain experiments which should be undertaken which may 
help to clarify the mechanism of production of the resting potential 
of a nerve fiber and ultimately, the nature of the metabolic 
processes responsible for the phenomenon of excitability. 



tcjmifcdty.i' 



ADDICTION RESEARCH CENTER 
Dr Harris Isbell. Chief 



I. ADMINISTRATIVE 

Throughout the year the administrative unit of the Addiction 
Research Center (ARC) continued to conserve the time of the prof- 
essional staff by efficient handling of purchasing, filing, personnel 
record keeping, etc. The typing of manuscripts has constituted an 
especially heavy load during the current year and the editing and 
bibliographic checking by the administrative staff contributed 
greatly to smooth preparation of manuscripts and reports. As 
experience was gained, property accounting, now delegated to the 
ARC instead of the hospital, proceeded satisfactorily. 

The additional subprof essional employees who came on duty during 
last fiscal year or in the first part of the current fiscal year 
are now well trained and oriented in their jobs, We were disappoin- 
ted that request for special awards to the psychiatric aides was not 
granted. We intend to write another recommendation for a special 
award for this group in the very near future. 

We have experienced difficulty in obtaining professional 
personnel but have succeeded in recruiting a neuropharmacologist , 
Dr. William R Martin, who will come on duty on 1 December 1957. 
Dr. Martin will initiate a program of studies of the effects of 
acute and chronic intoxication with various drugs on the activities 
of single neurons. Studies of this nature are basic to complete 
understanding of the addiction process. 

Space of the ARC has now become inadequate. The animal house, 
which is a temporary structure, is very crowded and can barely house 
all of the animals needed. It does not have floor drains, is not 
sanitary, and should be replaced as soon as possible The addition 
of a neuropharmacologist means that crowding in the animal building 
will be further intensified It is hoped that the hospital will 
make an additional ward available to us. This would permit us to 
convert one of the present wards to additional office and laboratory 
space . 

II. ADDICTIVE PROPERTIES OF NEW ANALGESICS 

This is a technological project which is carried on for the 
protection of the public, As new analgesic drugs are developed 
that are likely to come into clinical use they are referred to the 
ARC by the Committee on Drug Addiction and Narcotics of the National 
Research Council, After the addictive potentialities of these. new 



Page 2 

- 37 - 

drugs have been determined, by methods previously described, the 
findings are referred to the Committee on Drug Addiction and 
Narcotics, NRC, who in turn informs the Section on Addiction- 
Producing Drugs, World Health Organization. These bodies advise 
the United States Government and the United Nations concerning 
appropriate legal action regarding control of these drugs at 
national and international levels. 

It is now hoped that in the future most drugs can be tested in 
animals. Currently, initial tests of addictive properties of new 
agents are carried out by the Department of Pharmacology, University 
of Michigan, using monkeys. All drugs are referred to this unit 
prior to being tested by the ARC. It seems very likely, however, 
that at sometime in the future some unit of the government (Public 
Health Service or Food and Drug Administration) may have to take 
over this animal-testing program. 

During the year five new analgesics were tested. Three of 
these had sufficient addiction liability to justify placing them 
under the controls of the Harrison Narcotic Act. D-propoxyphene, 
-though possessing some addiction liability, was judged not to be 
sufficeintly dangerous to require control by the narcotic law. 
No decision has been made in the case of the fifth. 

The demethylated congener of morphine (normorphine) was 
especially interesting. This drug, which is one of the metabolic 
products of morphine in the body, has been presumed to be rela- 
tively inert on the basis of animal tests. Axelrod and his 
collaborators at the NIMH have shown that ability of the liver to 
demethylate morphine declines during experimental addiction in 
male rats. Axelrod felt that this change might be a model of 
effects on receptors within the central nervous system and might 
lead to a theory of tolerance. For this reason, normorphine was 
reinvestigated at the ARC. 

In single dose, normorphine is less potent than is morphine 
in inducing behavioral changes in man. In repeated dose, however, 
normorphine has accumulative effects and is more potent than 
morphine. For this reason, the dose cannot be elevated as rapidly 
as the dose of morphine. Tolerance to the sedative effects of 
normorphine appear to develop more slowly than does tolerance to 
the sedative effects of morphine. Normorphine completely suppressed 
symptoms of abstinence from morphine. Following withdrawal of 
normorphine after direct addiction (or after substitution for mor- 
phine) J abstinence appeared slowly and was quite mild as compared 
with abstinence from morphine. 

Although normorphine has definite addictive properties, its 
addiction liability is the least of any potent drug in the morphine 



38 - 



Page 3 



"■to 



series. If normorphine is a good analgesic, it will represent 

a considerable advance toward the goal of a nonaddicting analgesic. 

During the coming year this project will be continued, as 
it must be, in order to protect the public. Primary emphasis 
will be placed on demethylated derivatives of morphine and 
meperidine. 

III. CHRONIC BARBITURATE AND ALCOHOLIC INTOXICATIONS 

A. Substitution of Alcohol for Barbiturates . The project 
on equivalence of chronic alcoholic and barbiturate intoxications 
was completed during the year. Alcohol was substituted for 
barbiturates in a sufficient number of chronically intoxicated 
dogs to warrant the following statements: in sufficient dose, 
alcohol reduces the nember of seizures after withdrawal of 
barbiturates, but does not eliminate them entirely. Alcohol 
suppresses the barbiturate withdrawal delirium completely. 
Following withdrawal of alcohol after substitution for barbiturates, 
convulsions were observed in occasional dogs and delirium in the 
majority of the animals. These findings indicate that chronic 
intoxication with alcohol and barbiturates are partially but not 
totally equivalent. 

B. Substitution of Chlorpromazine for Barbiturates . 
Chlorpromazine did not suppress abstinence from barbiturates 
in dogs . 

C. Meprobamate . Special studies were carried out on 
chronic meprobamate intoxication. Patients who entered the 
hospital with histories of taking large amounts of meprobamate 
were maintained on their accustomed dose of meprobamate while 
opiates were withdrawn. After allowing a week for recovery 
from abstinence from opiates meprobamate was abruptly withdrawn. 
A convulsion occurred in one of 3 patients and an abnormal EEG 
was observed in another patient. 

Five dogs were chronically intoxicated with meprobamate. 
The doige was increased as tolerance permitted to 5-6 grams 
daily, divided into two or three doses. One of the dogs died 
during the period of chronic intoxication. Following abrupt 
withdrawal of meprobamate all 4 surviving dogs had severe ab- 
stinence. All 4 had seizures and bizarre behavior, and 3 of the 
4 dogs died after repeated seizures ("status epilepticus") . 
These findings show that meprobamate can cause a type of addiction 
similar to that caused by barbiturates or alcohol. 



Page 4 - 39 - 

During the coming year we hope to test the equivalence of 
intoxication with paraldehyde, chloral, meprobamate, doriden 
and barbiturates , 

IV„ BIOCHEMISTRY OF ADDICTION 

The biochemical unit shifted from clinical biochemistry 
into the field of drug metabolism during the year. Methodolo- 
gical problems in this area are particularly difficult because 
of the relatively low doses of analgesic drugs given human 
subjects, and because of the high incidence of interference by 
the various foodstuff and other drugs often ingested by the 
subjects. A great deal of progress was made in developing 
paper chromatographic methods for isolation of drugs from 
body fluids. Methods for quantitative determination of morphine 
and normorphine were developed. The normorphine method has 
been particularly troublesome since the solubility of normorphine 
in organic solvents is less than the solubility of morphine. 
Quinine appeared to have no effect on the conjugation of morphine, 
Less normorphine is conjugated than is the case with morphine. 
This last finding may explain the difference in the length of 
action and addictiveness of morphine and normorphine. 

Addiction to and withdrawal from analgesics and barbiturates 
had no significant effect on the excretion of 5-hydroxyindol- 
eacetic acid. 

During the coming year we hope to complete a project on 
comparison of the metabolism of morphine and normorphine, and 
to determine the changes in excretion of epinephrine and 
norepinephrine during cycles of addiction. We also hope that 
another chemist can be obtained to initiate a study on the 
effects of addiction on enzymological processes at the cellular 
level. 

V. NEUROPHYSIOLOGY AND NEUROPHARMACOLOGY OF ADDICTION 

Studies on changes in electroconvulsive thresholds during 
addiction to and withdrawal from barbiturates in cats were 
hampered by a number of technical difficulties. Although 
seizure thresholds are elevated and variable during addiction 
to barbiturates J elevations were also noted in control cats that 
were receiving no barbiutrates , Apparently, repeated electro- 
stimulation causes some change (perhaps anatomical) leading to 
elevation in the seizure threshold. No consistent change was 
seen in seizure threshold after withdrawal of barbiturates. 
Cats addicted to barbiturates had fewer spontaneous seizures if 



Page 5 - ko - 

stimulated on a regular schedule after withdrawal of the bar- 
biturates . 

Following withdrawal of barbiturates after chronic adminis- 
tration, one spinal dog had grand mal seizures above the level 
of the transection but no seizures below. This finding indicates 
that the barbiturate abstinence syndrome is mediated at levels 
above the spinal cord. 

During the coming year we hope to continue the project on 
seizure thresholds during addiction to barbiturates, using 
electroencephalographic changes instead of clinical seizures 
as the end point. We also hope to begin experiments with 
animals with chronically implanted electrodes, in the hope of 
obtaining information on changes at various levels of the nervous 
system during morphine and barbiturate addictions. It may be 
possible to begin studies on the relationship of systems sub- 
serving synthesis and destruction of acetylcholine in relation 
to addiction to barbiturates. It is also hoped that studies on 
the effects of acute and chronic intoxication with various drugs 
on the activities of single neurons can be initiated by Dr. Martin. 

VI. PSYCHOLOGY OF ADDICTION 

Physician addicts show less elevation on the Pd (psycho- 
pathic deviate) scale of the MMP 1 than do either nonphysician 
White or Negro addicts. Physician addicts are higher than normal 
on the neurotic scales. Unfortunately MMPP 1 profiles on non- 
addict physicians are not available and must be obtained before 
this study can be interpreted properly. We hope to obtain control 
profiles on a sample of Army physicians. 

A great deal of progress was made in the construction of 
psychological tests for differentiating between the subjective 
effects of various classes of drugs. Questions which differentiate 
between the effects of a marihuana-like drug, LSD, morphine, 
pentobrbital, and amphetamine have been assembled. A general 
inventory is to be constructed from these items and tested more 
throughly during the coming year on a number of classes of drugs. 
It is hoped that these inventories will provide quantitative in- 
dices of the effects of the drugs which addicts regard as pleasant 
("euphoria") so that a more exact statement on relative addictive- 
ness of different agents can be made. 

Studies on the effects of drugs on conditioned inhibition of 
a feeding response in rats (pain-anxiety) were continued. It was 
found that different types of drugs produce specific patterns of 



Page 6 -kl- 

unconditioned bar-pressing, time-action rates, and conditioned 
inhibition of feeding responses. It was also found that very 
exact control of the strength of the auditory stimulus used is 
essential to this particular method. The studies indicate 
that morphine abolishes anxiety in anticipation of a painful 
stimulus . 

A number of studies on the effects of drugs on "mental 
set" were completed. In this work visual-hand reaction time 
is determined under two conditions: (1) when various fore- 
periods (warning periods) are administered in a regular order, 
and (2) when foreperiods are administered in an irregular 
fashion. It is known that in "normal" subjects curves obtained 
with the regular and irregular procedures are well separated. 
In schizophrenic subjects, the curves cross, indicating a dis- 
turbance in ability to profit from the regularization of the 
foreperiods. This test was administered in random balanced 
order to 10 former addicts who received morphine, pentobarbital, 
LSD, placebo, and amphetamine. Amphetamine and placebo. had 
little effect on reaction time or on mental set; morphine and 
pentobarbital slowed reaction time but did not impair mental 
set; LSD slowed reaction time, but did not cause any statisti- 
cally significant impairment of mental set (crossing of regular 
and irregular curves) in spite of the presence of marked per- 
ceptual distortion, hallucination, and depersonalization. These 
findings indicate that LSD is possible only indirectly related to 
the natural psychosis, schizophrenia. 

During the coming year we hope to complete the study on 
physician addicts, to develop the inventory for measuring 
subjective effects of drugs further, to investigate the 
significance of drug-produced internal changes in controlling 
animal behavior, and to begin studies of the effects of drugs 
and addictions on discrimination. 



LABORATORY OF NEUROPHYSIOLOGY 
Wade H. Marshall, Chief 



The productivity of the Laboratory of Neurophysiology 
continues at a high level and xs in the van of some crucial 
arguments, . One of the most important current questions is 
the participation of soma and dendritic membrane in activa- 
tion of the efferent axons. Nearly 20 years ago it was 
recognized that sufficient depolarization of the dendrites, 
or other components, of a neuron could cause the cell body 
to discharge without actual complete depolarization of 
said component structures. It was further recognized that 
sustained depolarization of these structures might result 
in repetitive firing of the cell body and axon. However, 
physiology of the neural network has been slow to sufficiently 
divorce itself from axonology . This is to say that the 
compulsion to fit CNS ganglion physiology into "the existing 
framework of knowledge" (which was largely axonology) has 
acted as a conservative brake on advancement . During the 
past several years great progress has been made toward 
liberating thinking from the simple axonology concepts. 
This has been particularly true of the dendritic components 
of the neuron. During the past 2 or 3 years it has been 
quite vociferously argued that the dendritic membrane is 
entirely passive. It has further been argued that all 
synaptically covered parts of the neuron membrane are 
passive and electrically inexcitable (that is they are 
somehow not capable of complete all-or-none regeneratively 
propagated discharges) and that the polarization modula- 
tion of these parts of the neuron is entirely accomplished 
by neurochemical means. Whether or not the latter point 
is correct is not completely proven. But the best evidence 
so far obtained for the passive nature of the soma-dendritic 
membrane has been developed during this year by Dr. W. H. 
Freygang working on the lateral geniculate nucleus of the 
cat. Using very small pipette electrodes, excellent 
electrical technics, and superb mathematicax analysis, 
he has developed strong evidence that only a very small 
area of the neuron soma is electrically excitable. All 
other parts of the neuron react passively, acting as sinks 
of current which causes activation of the low threshold 
axon hillock region. This experiment depends on placing 
the microelectrode very close to the active membrane so 
that it measures the IR drop due to the total membrane current 
at that locus . The only decernible reservation about this 
experiment devolves on the inevitable Heisenberg uncertainty 
principle. Has the electrode, because it is so near the membrane 
rendered that locus inexcitable? There are many reasons to 
discard this objection. This experiment is the best and probably 
the only valid evidence for the electrical inexcitabiiity of the 
soma-dendritic membrane in the mammalian CNS. So far as it is 



possible to accurately judge current events this paper constitutes 
a revolution and a major breakthrough. 

Tests of this theory on the motor neuron (anterior horn 
cell") done in collaboration with Dr , Karl Frank have more clearly 
substantiated it Very recently a concentric pair of electrodes 
have been used to record simultaneously from inside and just 
outside the anterior horn cell This has likewise confirmed 

Dr. Freygang s observations on the lateral geniculate, 

'xsrit'Lul aB^f^ J-I nonoqxnioo i)i£s 

Drs, Tasaki and Spyropoulos, in the Section on Special 
Senses, have made an important advance in axonology . They have 
found that when the squid nerve is clamped, i e an attempt is 
made to fix an imposed potential difference across the membrane; 
that the membrane does not respond uniformly but that erratic 
patches contribute the current and that these patches have the 
characteristics of local all-or-none reactions. This fact indi- 
cates that the normal membrane as a whole is not clamped but 
that only the electrodes are clamped. This demands re-evalua- 
tion of the basic Na-K exchange theory because obviously the 
current measured and the apparent resistance change are not 
properties of the total membrane undergoing a smooth continuous 
function, but are instead the more or less chance resultant of 
reactions in random patches on the membrane. This change in 
current flow and pat I .em of same as a function of the imposed 
voltage is now regarded primarily as an increase in total area 
of active patches Again the inevitable Heisenberg uncertainty 
principle must be considered Has the placement of electrodes 
inside the squid nerve and other items such as dissection of the 
nerve, produced significant local changes in patches of membrane? 
However, Dr . Tasaki has acquired considerable collaborative 
evidence in recent years from the single node of toad A fibers 
and his two stable state experiments All these items suggest 
that the normal axon membrane does not exhibit partial states 
in its reactions except transiently In the case of the squid 
nerve under voltage clamp the membrane resistance changes only 
under the active patches and this current has heretofore been 
considered to be uniformly conducted by the entire membrane If 
the sodium current is not a uniform function of membrane voltage, 
for instance, the Hodgkin-Huxley theory must be modified, 

Drs. Spyropoulos and Tasaki are investigating active 
chemical processes to account for the action potential They 
have used the methods of intracellular injection into the squid 
nerve and also the single node preparation. In their hands 
these methods are exquisitely sensitive tools for study of ■■ - >■ 
many biochemical problems. Their thesis is that the action '^^■^^ 
potential as well as the recovery process probably involves 
biochemical events and that the ion exchange is not merely a 
passive result of a regeneratively propagated action current 



-hk _ 

They have made very substantial progress in this direction and 
we can look forward to decisive and comprehensive conclusions 
during the coming year. 

Drso Tasaki and Spyropoulos have also determined that the 
Bekesy potential is generated in the stria vascularis and not 
by the brain cells of the ear „ This confirms or perhaps, is 
concurrent with similar studies done at Institute for the Deaf 
at St o Louis, Mo The source is not in the hair cells 

Recently Drs. Tasaki and Chang have gone to Dr. Pomerat's 
famous tissue culture laboratory at Galveston. They are making 
an intensive investigation of electrical reactions in cultured 
CNS cells. 

The program of the laboratory has been considerably 
broadened and strengthened by the recruitment of Dr. Paul MacLean 
(Section on Limbic Integration and Behavior) . His broad 
general knowledge in several fields and his work on the limbic 
system well fills a gap in the program. Dr. MacLean is setting 
up his laboratory and has already underway a valuable project 
concerned with use of genetically and chemically induced sub- 
cortical lesions in rats. 

The Section on Cortical Integration has continued work on 
the remarkably successful chronic monkey technic , Stop stimulus 
and start stimulus regions have been partially mapped and work on 
this aspect is continuing. Regions concerned with pleasurable 
and compulsive activity are being clarified as well as regions 
concerned with negative emotions and pain, anxiety, and fright. 
The importance of such work for problems of mental health needs 
no elaboration. 

A new technic for implanting of electrodes has been 
developed and successfully used on the monkey and the porpoise. 
The latter animal (2 preparations) has shown learning processes 
faster than the monkey by an order of magnitude. Considering 
the fact that the porpoise possesses one of the most elaborately 
developed of the mammalian brains, this fact constitutes a very 
interesting observation. 

Work is continuing on a practical method of portraying 
and analyzing activity from 256 electrodes. The section enjoyed 
the opportunity of collaborating with Dr. H. Magoun for a few 
months . 

It is gratifying to note that Dr. Lilly is one who is 
actively engaged in chronic electrode work in primates and that 
he is deeply conscious of medical and social responsibility 
involved. He is not encouraging brash clinical work and is 
attempting to do constructive work to encourage only conservative, 
well considered activity in that direction. 



- ^5- 

The Section on the Spinal Cord has continued with elegant 
work. It is to be remembered that this laboratory by virtue of 
its technical excellence was the first to demonstrate that an 
accurate intracellular record of antidromic activation showed 
two components o Dr. Frank's consultation and collaboration 
with Dr. Freygang has been particularly valuable and gratifying. 
This has j.ed to important comparisons of records taken from 
within the cell and just external to it by means of a double 
concentric electrode system. 

They have discovered a "remote" inhibition process which 
operates without any detectable change in the polarization of 
the cell membrane as measured by intracellular electrodes. This 
laboratory is "tooling up" for transmission of neurochemical 
agents through their pipettes. 

Work has been continued on spreading cortical depression o 
It has been determined that neuronal reactivity of the superficial 
layer of the cortex is not necessary for this phenomenon. This 
is a curious result because while spreading depression is a 
dendritic like reaction in the sense that it is completely graded, 
a fully developed reaction probably represents the most complete 
depolarization the dendrite ever undergoes. 

A new technic for study of the superficial cortical 
electrical reactions has been developed which permits much 
more accurate experiments, and which also permits accurate 
observations in drug experiments in face of extreme changes 
in blood pressure and which also eliminates other artifacts 
such as spreading cortical depression. 



_ 46 - 

LABORATORY OF CLINICAL SCIENCE 
Seymour S. Kety, Chief 



The Section on Pharmacology under Julius Axelrod 
has continued its studies on the fate, metabolism, and 
mechanism of action of drugs which act on the nervous system 
with several notable achievements in the past year. In 
collaboration with Schmid and Tomkins of NIAMD, he has found 
enzymatic mechanisms in the synthesis of N-glucuronides and 
in the formation of bilirubin glucuronide, leading to the 
elucidation of a biochemical lesion in congenital non- 
obstructivOj non-hemolytic jaundice. He has added 
significantly to knowledge concerning the metabolism of 
epinephrine by elucidating the enzymatic process involved 
in the o-methylation of catecholSj characterizing its 
requirements and demonstrating it in a number of organs 
including the brain o He has shown that this process plays 
a key role in the metabolism of epinephz'ine and norepinephrine 
in vivo . In collaboration with Agranoff of NINDB^ a method 
for the estimation of meprobamate in body fluids was 
developed and applied to a study of the disposition in man 
of this widely used ataractic agent . 

The Section on Biochemistry under Marian Kies, in 
collaboration with Alvord of Baylor and Roboz of Georgetown 
medical schools, has for several years been concerned with 
a better characterization of the materials in brain tissue 
responsible for experimental allergic encephalomyelitis. 
In the past year they have further purified their active 
preparation, obtaining a protein fraction with a ten-fold 
increase in activity, A collagen-like material was also 
isolated from brain, characterized and found to have moderate 
activity . 

The Section on Cerebral Metabolism under Louis 
Sokoloff has, as part of a cooperative study on aging, made 
a substantial contribution to the physiology of aging in 
their finding in over 50 normal elderly men that a decrease 
in cerebral blood flow is not a concomitant of the aging 
process. The decrease which has often been found by previous 
investigators appears to be limited to those with evidence 
of gross mental changes. These findings are about to be 
extended in studies at St, Elizabeths Hospital by Lassen and 
Lane with a modification of the technique which employs 
radioactive krypton as the tracer gas. The section has 
continued its development of techniques for measurement of 
blood flow continuously and locally and their application to 
physiological and clinical problems. The studies by Sokoloff , 
in collaboration with Kaufman of the Laboratory of Cellular 
Pharmacologys on the mechanism of action of thyroxine continue 
to produce promising and significant results, indicating an 
important effect of thyroxine on protein synthesis. 



- h7 - 

Public Health Service 

National Institute of Mental Health 

Laboratory of Socio-environmental Studies 

STATEIv^lNT OF FROGFJIM (DBJECTIVES AND . 

SIM^iARY OF OPERATIONS DURING 1957 

The research goal of the Laboratory is the investigation of 
the ways in which social processes bear upon the production- and 
course of psychic disturbances. Included with this goal is a wide 
range of research areas; the nature and distribution of mental 
illness and behavioral pathologies, social and cultural variations 
in defining and treating behavioral disturbances, social and 
cultural patterns influencing personality development, interpersonal 
processes within the faraily, and social processes in the treatment 
setting of the mental hospital. This range of interests is repre- 
sented in the current projects of the Laboratory'", 

With the growing., recognition of the importance of social 
a%),ects of illness and with the realization that relationships between 
social and medical or biological factors are more complicated than 
has been assmued, there has been an intensification of research 
interests and efforts in conceptual and methodological issues and 
in ,c6llab oration across disciplinary lines, 

* 

. , During 1957, the organization of. the Laboratory has been 
coEf-leted with the staffing of the Section on Social Studies in 
Therapeutic Settings, 

Social Developmental and Family Studies 

Research in this Section,, under the direction of Dr, I-Iarian 
Radke Yarrow, is devoted to systematic study of socialization 
influences at various stages of individual development. The greatest 
enphasis is ;:f)on the period of childhood, but critical developmental 
periods or shifts in social roles in adult life, such as in old age, 
are also considered. 

The assiinptions that personality is significantly shaped by 
the social interactions in which the individual participation from 
infancy on through life, and that adult outcome bears a significant 
relation to early experiences are readily accepted, though research 
knowledge has not succeeded in defining precisely these relationships 
or in explaining the processes by which antecedent conditions affect 
siiisequent behavior. Advances toward this knowledge rest partly on 
refinements in methodology as well as on systematic investigation of" 
research hypotheses. 



- kS - 

Some of the efforts of the Section are directed toward method- 
ological problems . Several scientists have begun work on techniques 
for obtaining more detailed and, hopefully, more valid data on the 
child's social learning environments. One such approach is the 
development of techniques for the study of the family in its natural 
setting, malting use of direct observational data. Tliat this is a 
very difficult problem is reflected in the scant research which has 
been done thus far in the field. A second project concerns the 
investigation of processes of recollection and reporting of earlier 
childhood and family conditions. Much of cujrrent research concerning 
relationships between early experience and later development rests on 
retrospective data; an understanding of memory changes is lacking. 
This factor is believed to be of particular significance in investigat- 
ing retrospectively such problems as family relationships in the 
childhood of schizophrenics, where the recall of past events may be 
markedly modified by the subsequent developments. 

In the investigation of family and societal influences upon 
the child, seldom has research given consideration to the level of 
the child's perceptual and cognitive understanding of the experiences 
to which he is exposed. That is, what are the developmental stages 
in children's sensitivities to and discriminations in interpersonal 
relationships? A project has been carried out which is concerned with 
the child's sensitivities to the personality, characteristics and 
motives of the persons with whom he interacts, and his modes of causal 
thinlcing about interpersonal relationships. Much of the analysis of 
these data has been completed during the past year and reporting of 
findings has begiin. 

Attention to the interplay of social and biological factors 
in developmen-".- has been part of the focus of two of the projects of 
this Section^ one, a study of family and community influences in the 
development of identical quadruplets, and the second, a study of social 
characteristics and problems of old age. Both projects were undertaken 
collaboratively with other disciplines. In both, data collection has 
been completed. The interrelationships between social and physiological 
conditions is demonstrated in the study of human aging, in a relation- 
ship occurring between various behavioral indices in the aged and the 
subjects' combined status on raeasi-ires of O2 consumption and environ- 
mental impoverishments. 

The work of the next year will be devoted to the completion of 
the just preceding projects and to the expansion of the methodological 
studies described above. 

Community and Population Studies 

This section, directed by Dr. Melvin Kohn, studies the relation- 
ship between broader aspects of the social order and mental health or 
illness. The long range program includes: (l) research on social 
factors in the etiology of mental illness and behavior pathologies; 



(2.) studies of th^. prc^ess-^.s by whi:;h mental illness is recognized 
or defined ar,d the channels th.roi5.gh whi'?h it is brought to treatment 
(whether by ,foriua,l "therapeutis agents or other means) j and (3) studies 
of GoiDi?i".ni ty crga.nizationj social strnjt'are; and cultural dynam.i?.3 
basi.-; to these aims. 

Much o.f what ve should like to ac">JomplJsh .i,n the ,fir.3t two 
areas is -jn.attainabls at presf-n* .for la?k of basi'" knoxjledge. For 
example^ in tb'j: research dCiie by Kohn and Clausen on social factors 
i.n the de'^elopment of schi3ophren1a_B .vt became appa-^ent that further 
progress awaj.ted a fii!',.ler unders^tanding of the relati 'nshlp between 
social class and family structure in the normal populationo Thpreforej 
for the i.TEmed.iate future., much of the sect.ion's work will ha'^" to be 
.focused on problems o.f basi.j in^Dortance to social psychology. Before 
we can discover too much abcu*- social favvto-'S in the etiology of 
schizophrr.nia we .shall have to study,., for e^xample.,-, sc-ial -mriation 
in child-rearing practices and pf-^snna].ity development, Basic to 
our ijnderst/anding of the pro:e?59s by which mental illne.BS is defined 
and dealt with is research on th; processas by whi.ch de'."is.tion .from 
sub-cultural norms is handled. For the present, the third aspect of 
the long-=range program is the most important. 

Following a study that showed a relationship be^-ween 30':..io= 
economic status, parental authority beh.av.iory and schizophrenia 3 
ef. forts have been directed toward securing a more ad.equate knowledge 
of the stru.cturing of family relationships in .middle and workd,ng class 
families „ The fieldwork on this s'*udy is now eoBiplete,- as is the 
first portion of data analysis, a coirparison of the values of parents 
in the two social classes. It was found that mi.ddle class parents 
are more la,k6ly to attach primajrj'" value to self=control_„ considerationj 
curiosity,, and. .happiness | working class parents to obedience ,, neatness 
and cleanliness. It was al.so found that the parent's values are very 
directly related to the ways th.at they ra.ise their children. 

In line witii the Section's .interest .in the processes by which 
mental illness is recogn.ized or de.fined and the .-.bannels through which 
it is brought to treatment. Dr. Stephen Boggs has been developing a 
study of cultural differences in the ways that community resources 
(formal and informal) are utilized by people witJi problems. He has 
conducted prelimi.nary fieldwork and i.s now i.n process of developing 
a systematic research design for th.e investigation. 

A third, -study has been undertaken to ascerta.in the relationship 
between social background and dnag therapy for prognosis among 
functionally psyciiotic patients, Dr, E;rwin Linn has been abstracting 
the re,levant data from^ Saint Elizabeths Hospital records to be able to 
determine whether or not prcgnosi.3 is improved with drug therapy .-. s..nd 
to what extent patients of varying social backgrounds react differ- 
entially to drugs. 



-5C - 

There follow summary statements of the objectives of each 
of the projects to which appreciable amounts of staff time were 
allotted during 1957. 

Office of the Chief 
■t-ro.iect lio. H-S-C-1 

Title: Analysis of Theoretical and Methodological- "ssues in the 
Sociology of Mental Health and Illness 

Project Staff: John A. Clausen 

To exp line current research within the Laboratory and within 
the larger t'i.ld, searching for theoretical convergences and for 
problematic issues in empirical findings, especially bearing upon 
the relationship between social structure and personality develop- 
ment. 

Iroject Ko. M-S-G-2 

Title: The Impact of Mental Illness upon the Family 

rt-oject Staff: John A. Clausen, Leila C. Deasy, Harriet S. Murphy, 
Eleanor E. Carroll 

To study the effects upon the family of the father's or 
mother's mental illness, by focusing on a limited number of hypotheses 
and questions raised by an earlier study within the following areas: 
(l) the effects of mental illness upon the personal relationships with- 
in the family and the family organization, (2) the family's understand- 
ing and perspectives of the illness, and (3) the social implications of 
the illness. Fajnilies under study are to include both parental and 
conjugal families of schizophrenic patients. 

rro.ject No. M-S-C-3 

Title: The Adaptation of the Mental Patient to his Family Upon 
Return from Hospitalization 

Project Staff: John A. Clausen, Leila C. Deasy, Harriet S. Murphy 

To study the rehabilitation process following the patient's 
discharge from a mental hospital, in terms of two interdependent sets 
of dimensions: (a) the patient's progi-ess toward mental health, and 
(b) the changing structure and functioning of the family of the patient. 



- 51" 

Social Developmental and Family Studies 
Project Mo. M-S-D-1 

Title: The Formation of Children's Peer Relationships 
Project Staff: Marian R. Yarrow, John D. Campbell 

To investigate the process by which children form impressions 
of each other and develop patterns of interactions in social situ- 
ations, '^o .".udy the effects of developmental, personality and social 
factors or .his process. 

Pro.iect No. M-3-D-2 

Title: Adult Leadership in Children's Groups: A ^tudy of leader's 
Sensitivity and Functioning in Relation to the Social- 
Cultural Composition of the Group 

Project Staff: Marian R. Yarrow, John D. Campbell 

To study the adult leader's role in children's groups, assessing; 
(a) congruencies and diacreoancies in leader's .nd children's per- 
,, ceptions "i interperijonal processes in the -roup, (b) bases and con- 
sequence;, of discrepancie;j between leader '>:■ and children's perceptions, 
and (c) leader','' '^ehavior and sensitivities regarding the individual 
child and the group in relation to the social class and racial cora- 
position of the group. 

Project Mo. M-S-D-3 

Title: The Validity of Retrospective Data on Parent-Child Relationships 

Project Staff: Marian R. Yarrow, John D. Campbell. 

'To study the extent to which valid information about early 
aspects of a child's development and parent-child relationships can 
be obtained from parents' retrospective reports. Specifically: (l). 
To assess the nature of differences between earlier events and parents ' 
recollection of such events. (2) To determine how retrospection is 
influenced by such factors as the time interval between events and recall, 
intervening events, and the current social-jjsycho logical situation. 

Project Mo. M-S-D-/i^ 

Title: Life-styles in Aging 

Project Staff: Marian R. Yarrow, Olive U. Quinn, E. Grant Youmans 

This project is part of a larger research on the functioning of 
physically healthy aged persons, which brings the perspectives and 



-52--- 

raeasurement of physiology, psychiatry, psychology and sociology, 
both singly and in combination, to the examination of the problems 
and factors in aging. The primary objective of this part of the 
total research is to exaraine relationships between the demands and 
supports of the aged person's social environment and his functioning 
— as it is defined in terms of the organization of his daily behavior, 
his planning for the future, his attitudes toward himself and his 
relationships with others. Environment is assessed in terms of (l) the 
social expectations and stereotypes imposed upon old age, and (2) the 
impact of common changes or crises of old age, such as retirement from 
employiuent, family losses, and social isolations. 

A second research objective is the investigation of inter- 
relationships between the social psychological variables described 
above and physiological, psychiatric, perceptual and cognitive data. 

Project No. M-J-D-5 

Title: The Identification of 3elf in Identical Quadruplets: A 

Special Case of the Problems of Jibling Rivalry and of Multiple 
otatus 

Jrroject jtaff; Olive W. Quinn 

To analyze (l) interactional patterns, and (2) incompatible 
statuses in a group of mentally ill identical quadruplets, in an effort 
to understand the inaividual's struggle to establish a uefinltion of 
self in relatioii to the group. This problem is seen within the frame- 
work of stresses arising from or exaggerated by the fact of multiple 
birth. 

Project No. K-iS-J-b 

Title: The "A" Family as Seen by the Com:nunity 

Project Staff: Olive U. Quinn, Leila C. Deasy 

This is one part of a larger study of the "X" family from the 
points of vle\-i of various disciplines, with the intent of deriving or 
exaiviplifying hypotheses regarding nature-nurture contributions to the 
aevelopaent of schizophrenia. In this regard, the influences of the 
faiiiily on the community and of the comjiunity on the family comprise an 
area of information essential to a full unaerstanding of how mental 
illness in the "X" quadruplets developed. 

Project lio. K-S-D-7 

Title: Exploratory Stuuy of Methodology for Assessing Interpersonal 
Relationships within the Faraily 

Project Staff: Marian R. Yarrow, Thomas L. Gillette 



-5J- 

To develop techniques of inveiitigating interpersonal re- 
lationiihipa within the family, in the natural family setting. 



Com,fiunity and i-opulation Studies , 
irro.iect IJo. M-:i-P-l 

Title: A Comparison of the Social Relationships of Children in the 
Middle and Lower Socio-economic iStrata 

i-roject Staff: Melvin L. Kohn, John A. Clausen, Eleanor E. Carroll 

To ascertain whether or not there are consistent and patterned 
difference'^' between the social relationships of children from the 
middle and lower socio-economic strata of urban society. 

rro.iect No. M-S-1--2 ^ 

Title: Exploratory Study of the Use of Local Community Resources 
for Handling Mental Health Irdblems 

Project Staff: Stephen T. Boggs 

To evolve and test hypotheses about the utilization of formal 
agencies and informal resources (family, friends, associates and 
strangers) by people v/ith personal problems j the social -factors in the 
community affecting this utilization j and the consequence^ of various 
ways of handling problems for the subsequent career of the individual. 

Iro.iect Ho. M-o-l:-3 

Title: rt'e-hospital Social Factors, Treatment with the Tranquilizing 
Drugs, and Behavior as trognosticators of Successful Release 
from a Mental Hospital 

Project Staff: Erwin L. Linn 

To determine the relationship between (a) the patient's pre- 
hospital social background, (b) his course of treatment in the hospital 
(with particular interest in reserpine and chlor promazine) and (c) his 
behavior while in the hospital and the duration of hospitalization and 
probability of readmission, for functionally psychotic patients. Among 
the questions to be asked are the following: 

1. Are patients treated with chlorpromazine or reserpine more likely to 
be released during the first year of hospitalization and more likely to 
remain out of the hospital one year after release than a comparable group 
of patients admitted to the hospital before the use of tranquiliaing 
drugs? 

2. Have the tranquilizing drugs increased the probability of release of 
patients not treated with drugs because of the generally "calmer" 



atnos]..here of the hospital durin^ the current j^eriod of drU(j therapy? 
3. To what extent do patients of varyin,^ social backi^rounds react 
differentially to the drugsV 

JrToject lio, Ii-S-l-'-/i 

Title: A Twin Fauiily Study of hental Deficiency 

Iroject Staff: Dr. Franz J. Kallmann, Dr. Gordon Allen 

To assess the frequency with which mental subnormality can 
clearly be ascribed to non^^enetic factors and to elucidate the inter- 
action of genetic constitution with environmental causes of sub- 
noririality. Also to develop better methods for the collection and 
interpretation of twin data in medical research. 

Iroject Ho. M-S-P-5 ' 

Title: Social Mobility and the Milieu of the Psychiatric Hospital 

Iroject Staff: Leslie Schaffer, Leila C. Doasy 

The study is an attempt to exi;ilore the relevance and impli- 
cations of some theoretical work by Harold Lasswell concerning social 
structure aiid social nobility - particularly his notion that there is 
a significant negative relationship between the extent to which a group 
achieves solidarity and hijjh morale and the incidence of mobility 
ar.ion^ its members. It is hopped to clarify in theoretical terms a 
particular perspective concerning the value context of the psychiatric 
hospital and, in particular, some of the problems concerning respect 
as a value. Among other questions is whether there is a significant 
difference between the incidence and intensity of vertical mobility 
in a psychiatric setting as compared with conventional medical and 
surgical settin^^s. 



55 - 



PHS-NIH 
NIMH"=STD 
Individual Project Report 
Calendar Year 1957 



Kesearch isranch 3 

Section on Technical Development. 
Bethesda, Maryland 



During the past yearj, the functions of the Section on Technical 
Development have been qixLte varied. Included are consultation on the 
instrumentation problems of laboratory personnel^, design and development 
work on these problems <, construction^ repair and maintenance ^ internal 
operation^ and administrative activi.ties» 

In the area of design and development., several items of equipment 
have been built as the result of a request by an investigator* Some of 
thesej to be listed here_, are potentially of widespread interest. For 
the Laboratory of Psychology^ a device for putting discriminations on 
magnetic tape, and during playback^ having these filtered from the sound 
system and used to give a visual indication, A system for communication, 
stimulation, and recording from mthin a sound-proofed room to an outer 
roomo For the Laboratory of Neuroanatomical Sciences, a device for 
photoelectrdcally counting urine drops and reinjecting an equal amount 
of saline solution into the animal. For the Laboratory of Biophysics, 
numerous high impedance amplifiers^ power supplies, data boards and 
control circuitry to aid them in preparing for the annual trip to the 
Marine Biological Laboratory in Woods Hole, Massachusetts. For the 
Director of Basic Research, a slave scope assembly to facilitate photogra- 
phy of an observed waveform on an oscilloscope. For the Laboratory of 
Neurochemistry, an "Automatic Sample Changer and Ptadiation Register" for 
the sequential counting of blood samples for predetermined amounts of 
time. For the Laboratory of Neurophysiology, a technique for mounting 
and using thermistors in measuring the temperature of the cortex. 

The Section on Technical Development has been engaged in repair 
and maintenance to the limi^ that staffing idll permit. Responsibility 
is naturally assumed for all equipment built by this facility, or modified 
by this facility. Repair of commercial equipment is undertaken when an 
economic saving can be effected. 

Assistance is often asked for and given in the form of consultation. 
First the feasibility of a problem is determined and then the mechanics 
are worked outo This may take the form of the proper commercially avail- 
able item to purchase, or it may result in a project best done by this 
Section, or a combination of the two. The result of consultation may 
also be a set of specifications that will be sent out on bido 

Internal activities include projects considered worthwhile by the 
Section which are pursued further on the initiative of the Section Chief, 
One such project is a miniaturized high voltage supply, powered by an 



_ ^5 - Research Branch 

Section on Technical DevelopmentL 
Bethesda, Maryland 



air jet. This will be described further in a later report. Another 
activity was the expansion of the Technical Development facilities which 
carried over into the first part of this year. Stocks were rearranged 
for better accessibility and work areas were made more efficient by the 
installation of power distribution panels at each position. Files were 
expanded to inclade the year's newest electronic equipment pertaining 
to medical research and continue to be available to investigators desiring 
to use them. Stock requisitions and equipment loans were continued to 
provide components and instruments to laboratory personnel on a minimal 
delay basJs. The procurement of supplies extends well beyond the Section's 
own needs in order to forestall long delays when an investigator needs a 
component quickly. 



- 57 - 

LABORATORY OF CELLULAR PHARMACOLOGY 
Giulio L, Cantoni, Chief 



During the year 1957 the Laboratory of Cellular Pharmacology 
has continued its favorable development. The Laboratory has not 
yet reached its maximum potential size and there has been considerable 
difficulty in the recruitment of technical and supportive personnel , 
From the standpoint of professional personnel the year has seen 
relatively little change, Drs . B, Levenberg and G. Jamieson have 
joined the staff of the Laboratory as Commissioned Officer and 
Visiting Scientist respectively, while Dr. J. Durell has gone to 
the Department of Psychiatry at Yale University on a Training Grant 
from the National Institute of Mental Health. On the other hand 
several vacancies at the technical level have not been filled and 
cannot be filled because of lack of applicants. While the reasons 
for these recruitment difficulties are probably beyond the scope of 
this report they are pointed out, in the hope that some action may 
be possible to remedy this unfortunate situation. 

Very little progress has been made as yet towards the estab- 
lishment of a Section on the biology and biochemistry of medicinal 
plants. Developments in this area depend on the construction of a 
greenhouse facility which is in the planning stage. It is hoped that 
progress will be more rapid in the next year so as to allow us to 
proceed vigorously in the development of a program on alkaloid synthesis 
and plant biochemistry, since these areas are of great interest to a 
balanced program in cellular pharmacology. 

The scientific efforts of the Laboratory have continued to 
center along three main lines: 

1. Studies on biological methylation, 

2. Studies on amino acid metabolism, 

3. Studies on comparative biochemistry. 

It has been pointed out in earlier reports that these three 
broad areas have been selected because of their central importance 
in basic biochemical research and because of their special relevance 
to problems of cellular and neuro pharmacology. Since the Laboratory 
is a relatively small and tightly knit research group, we favor close 
and frequent exchange at the intellectual as well as at the technical 
level between the various staff members. The development of an 
atmosphere of mutual interchange has been facilitated also by the 
fact that the chosen areas of study represent different facets of 
a broad, continuous research spectrum rather than exploration into 
entirely separate fields. It will be seen from the detailed analysis 
below that many of the projects are listed as belonging to more than 
one of these three areas . 



- 58 - 

Biological methylation; As has been pointed out in earlier 
reports"^ the wide biological significance of transmethylation reactions 
is reflected in the universal distribution of methylated compounds 
in great variety and at all levels of biological organization. 
The central role played by the amino acid methionine in transmethyla- 
tion reactions has been emphasized in recent years by a series of 
discoveries from this Laboratory and others throughout the world. 
Transmethylation reactions are involved or play a part in the bio- 
synthesis of substances of particular interest to neuropharmacology 
such as the neurohormones, the alkaloids and some of the vitamins 
and steroids. 

It has been recognized that transmethylation reactions 
in particular, and transalkylation reactions in general, have some 
features which may be considered of general interest in energy 
metabolism and possibly cellular transport mechanisms. This might 
be of particular relevance to basic research in neurology since 
cellular transport mechanisms play such a key role in mechanism of 
conduction and transmission of the nervous impulse. While Projects 
1, 2, 3, 4, 11, 12 and 15 contribute particularly to this general 
area they also contribute to other important areas of biochemical 
research. For instance Dr. Durell and Cantoni's studies on the 
synthesis of methionine by enzymatic transmethylation are of parti- 
cular interest to students of protein chemistry since the purified 
homocysteine thetin methylpherase has been found to undergo a 
sulfhydryl dependent polymerization reaction which is essentially 
without precedent but which is potentially of very great significance 
in our understanding of the cytochemical architecture of the cell. 

Amino acid metabolism : A study of the intermediary metabolism 
of amino acids and of proteins offers great possibilities for contri^ 
butions at the basic level of biochemical research and for the 
development of a program on cellular regulatory mechanisms. It 
has become increasingly clear in recent years that many among the 
physiological cellular regulators such as neuro hormones, polypeptide 
hormones, and plant hormones are derived directly from amino acids. 
Studies on the metabolism of amino acid are also related to com- 
parative biochemistry because one of the characteristic features 
of mammalian metabolism as opposed to the metabolism of lower species 
is the relative inability of the mammal to synthesize amino acids. 
Finally, studies in the areas of amino acid metabolism are of 
particular interest to mental health since in nvimerous mental and 
neurological diseases there is evidence of derangement in the 
metabolism of amino acids. It is particularly noteworthy, in "t;his 
connection, to emphasize the important contributions of Dr. Kaufman's 
studies on aromatic hydroxy lation reactions. These studies have 
lead to the discovery that a hitherto unrecognized cofactor is 
involved in the conversion of phenylalanine to tyrosine. Much progress 
has been made towards the elucidation of the structure and function 
of this cofactor and it is of interest to note that progress at the basi( 
level has been paralleled by increased interest in the biochemical 



- 59 - 

etiology of the disease oligophrenia phenylpyruvica, a disease which is 
characterized by a genetically determined inability to metabolize 
phenylalanine. Dr. Kaufman's important contributions have advanced 
our understanding of the disease and contributed greatly to the general 
area of neurochemistry . 

Another area of research which relates, in part at least, to 
amino acid metabolism is protein synthesis. In the course of the 
last year the Laboratory has developed a major interest in this rela- 
tively new area of research, and is gradually attempting to find its 
own experimental approach to it. 

At the present time it appears possible to make a fruitful 
beginning at an enzymatic level by studying systematically the various 
steps which are postulated to occur between free amino acids and a 
completed biologically-active protein. In reality only the very 
initial phases of this complex sequence of reactions can be visualized 
and studied in detail and it is hoped that as progress is made the 
next steps will become clearer. The overall problem is a most diffi- 
cult and challenging one, for proteins are the most complex and fragile 
polymers known in nature. The problem of protein synthesis is in- 
timately related to the problems of protein structure, of biosynthesis 
and function of the nucleic acids, and less directly to the challenge 
of biochemical genetics, chemical morphology and biological evolution. 

Although practically all of the work of the Laboratory deals 
with amino acid metabolism in general, Projects 5, 8, 7, 8, 9, 10, 
,13 and 14 contribute more directly and specifically to this field. 

Comparative biochemistry : As was pointed out in earlier reports, 
the relationship of comparative biochemistry to cellular pharmacology 
is one of the foundations of the scientific philosophy of this 
Laboratory. A research program in comparative biochemistry can be 
developed favourably through a long term general interest supplemented 
with intermittent specific contributions. 

Thus implications for comparative biochemistry constitute a 
recurring, albeit minor, theme in many of the projects which can be 
specifically classified as contributing to the problem of protein 
synthesis, aromatic hydroxy lations , enzymatic transmethylation, etc. 
More directly pertinent to comparative biochemistry are Dr. Mudd's 
studies on the MAE in yeast and Dr. Jamieson's studies of sulphate 
utilization in Chlorella as are Dr. Kaufman's studies on the metabolism 
and enzymology of phenylalanine in man. 



1 



BIOMETRICS BRANCH 
ANNUAL REPORT FOR CALENDAR YEAR 1957 

General 



The Biometrics Branch has made continuing progress in each phase of 
its program which consists of the following activities; (a) collecting, 
processing, and analyzing data on the extent of the problem of the mental 
disorders , particularly with regard to patients under treatment in mental 
hospitals , in outpatient psychiatric clinics , in general hospitals with 
psychiatric services, and in public and private institutions for mental 
defectives and epileptics; (b) providing consultative services to State 
research bureaus on the organization of statistical services on the design 
of follow-up, evaluative and other special studies; and (c) providing con- 
sultative services on design of experiments, analysis of experimental data, 
development of mathematical models to the other Branches and laboratories 
of the Institute, particularly to personnel engaged in basic and clinical 
researcho 

During the year a reorganization of the Branch was carried out in 
line with recommendations made in the recent Manpower Utilization Study 
of the Branch's activities. The Current Reports Section was subdivided 
into three separate sections so that the Branch now consists of the follow- 
ing: Hospital Studies Section, Outpatient Studies Section, Consultation 
Section, Section on Applied and Mathematical Statistics, and Community 
Studies Section, 

The Branch has made considerable progress in the collection of data 
on patients under treatment in mental hospitals and clinics , Nevertheless , 
the task of collecting data on the fate of patients admitted to such faci- 
lities remains an extremely difficult task because of the lack of certain 
essential knowledge on the etiology and epidemiology of the mental disorders 
and the absence of instruments that can be used in comparable fashion from 
institution to institution to determine severity of illness and to characterize 
the psychologic status, the degree of psychiatric disability, social and 
familial adjustment and physical condition of patients at various intervals 
following onset of disease. As more new therapeutic programs (drugs, use 
of day and night hospitals, half way houses, open hospitals, etc) and 
treatment facilities are introduced into hospital and community programs, 
the task of obtaining data on people under treatment becomes increasingly 
difficult and complex, and data derived from separate treatment facilities, 
such as public mental hospitals and clinics and psychiatric services in 
general hospitals, become increasingly difficult to interpret. It has become 
quite apparent that state mental health and state mental hospital authorities 
must develop statistical reporting programs that will coordinate basic data 
on patients tinder treatment in all known psychiatric treatment facilities 
in their jurisdictions and will include appropriate follow-up data 
on the various classes of patients. The Branch has been working with states 
to iB^rove reporting within public mental hospitals and clinics. This job 



- 2 - 

is far from complete and we plan to continue our work with states to improve 
hospital and clinic reporting, to de-rolop nrethods that will reflect changes 
resulting from new treatment programs and concepts. In addition we will 
intensify our efforts to devise methods for collecting coordinated data on 
patients under treatment in all psychiatric facilities within defined 
geographical areas c 

The Branch is also taking step$ to program certain of its operations 
for the IBM electronic computer „ The availability of this machine will 
make it possible to produce more quickly certain data on patients under 
treatment in psychiatric facilities and to permit more detailed and rapid 
analysis of certain types of data involving computation of decrement tables, 
rates, correlation coefficients and other types of coniputations , 

The services of the Section on Applied and Ifethematical Statistics 
continue to be in increasing demand by the investigators in the basic 
laboratory and clinical research programs of the National Institute of 
Mental Health. Tlirough a'n arrangemeirt iiltli 'the "oicnetrics Branch' of tEe 
National Institute of Neurological Diseases and Blindness, this section 
also proviies similar services for the scientists of that Institute. 
This section has carried out its own research activities developing several 
new techniques in multivariate analysis which are helpful in the analysis 
of profile data and in the analysis of variation c The Section intends to 
provide liaison services between investigators in laboratories and branches 
of NIH who plan to collect extensive data and personnel in NIH developing 
programs for the electronic calculator scheduled to start operating at NIH 
during 1958<, This section is also contemplating the possibility of initiat- 
ing investigations into mathematical biology and information theory becs.use 
of the significance of such research in various aspects of tha raeistal hef.lth 
field o 

The Coramurxity Studies Section has not, as yet, been activated due to 
difficulty in recruiting a staffs particularly a person to direct its acti- 
vities o Active attempts will continue to recruit appropriate personnel for 
this important aspect of the Branch's activities, 

A problem that makes the achievement of results in the biometrics 
field slow is the shortage of well-qualified personnel to fill positions 
both in the National Institute of Mental Health and in the field. Not 
all states have bureaus of statistical research within state departments 
of mental hospitals and mental health, and only a few of the states with 
these departments have well-trained people. To improve this situation 
at least two things are needed. First, directors of state mental hospital 
and health programs must be willing to give strong support to the develop- 
ment of adequate statistical research programs. Second, they must be 
willing to pay salaries at a sufficiently high level to attract well- 
trained and imaginative people into the field. Third, steps must be taken 
to increase the pool of trained analytic and mathematical statisticians 
to fill the increasing need for such personnel in action and research 
programs in the mental health field. The NIH has taken steps to attempt 
to alleviate the shortage, starting a grant program designed to develop 
training centers for biometricians throughout the Nation and for giving 
fellowship support to promising students. 



- 3 - 

The major part of the Branch has been separated from the National 
Institutes of Health reservation for somewhat more than two years. Although 
the office space in the Perpetual Building is satisfactory, there are still 
many problems involved in developing an efficient office arrangement because 
of the separation of the offices over three floors of the building and the 
fact that even on the same floor all offices are not contiguous. The staff 
in the Perpetual Building feels keenly the separation from the Institute 
because of the lack of frequent contact with the professional and other 
personnel in the various branches of the Institute and the lack of contact 
with personnel in the other Institutes on the NIH reservation. The Chief 
of the Branch spends a fair amount of his time traveling between T-6 and 
the Perpetual Building to attend executive staff and other meetings on 
projects in which the Biometrics Branch has a definite interest. The 
Branch hopes sincerely that steps can be taken in the not too distant 
future to bring it back onto the NIH reservation. 

The reports of the individual sections follow; 



HOSPITAL STUDIES SECTION 

During the year the Hospital Studies Section continued its work in 
further developing the Model Reporting Area for Mental Hospital Statistics, 
carrying out cooperative studies with individual hospitals and state mental 
hospital systems on methodology of cohort studies and developed new tech- 
niques needed to gather information which would permit more meaningful 
analyses of trends in the movement of mental hospital populations. 

Seventh Annual Meeting of Mental Hospital Statisticians . The 18 
states in the Model Reporting Area held their 7th Annual Conference in 
Washington, D, C, in May 1957, The conference concentrated on interstate 
comparisons of cohort studies giving probabilities of first significant 
release during the first 12 months following admission, re-evaluation of 
basic definitions of patient movement terms, and the need for more specific 
annual and monthly data on the movement of patient populations in mental 
hospitals. 

Cohort Studies , Implementing a recommendation of the 1956 meeting, 
11 states completed cohort studies in which groups of first admissions in 
specified age, sex, and diagnostic groups (schizophrenia and mental disorders 
of the senium) were followed during each of the first 12 months of hos- 
pitalization to determine probabilities of release, death, or retention. 
The data showed considerable variation among states in release, death, and 
retention rates for each category of patients. A committee reviewed these 
findings during a meeting in January 1957 and developed a list of factors 
which might account for these differences, such as screening facilities 
in the community, legal requirements, administrative policies, type of 
patient admitted ana severity of illness. The committee recommended that 
these cohort data be published including data from each state that might 
make it possible to partial out the effect of some of these variables and 



- K - 

emphasizing the problems inherent in interstate comparisons of mental hospital 
datao The Conference approved the recommendations of the committee and the 
Section staff is now preparing these data for publication. 

It is significant that eleven states have now carried out these 
studies when as recently as five years ago no valid measures of mental 
hospital release rates were available on a statewide basis. 

The Biometrics Branch has continued to work with the Warren State 
Hospital, Warren, Pennsylvania. Data are being obtained that will make 
it possible to analyze the experience of cohorts of first admissions to 
this hospital during the period 1916-55, not only by age, sex, and diagnosis 
but also by such variables as urban-rural residence, occupation, marital 
status, therapies, etc, and to determine readmission rates to the hospital 
after specified periods of time following release by these variables. It 
is expected that some analysis of the data for the period around 1950 will 
be completed within the next few months . 

The Branch continued its cooperative study with the Department of 
Mental Hygiene of the State of Virginia of first admissions to state 
mental hospitals of that state over the period 1952-55. Cohorts of 
released patients will also be studied to determine probabilities of 
return to the hospital within a specified number of months after release. 
In order to obtain a~more adequate base for computing such probabilities, 
a search of the death certificates in the Virginia Department of Health is 
being carried. out for all patients released alive from the hospitals. This 
will also permit the computation of death rates within specified periods 
of time after admission regsirdless of whether the patient died in the 
hospital or outside of the hospital. Preliminary analyses have indicated 
some very interesting differences between the various age, sex, and racial 
groups. 

Another cooperative study with the California State Department of 
Mental Hygiene on the ejqserience of first admissions to the Pacific State 
Hospital during the five-year period, 194-9 to 1953, was completed during 
the year. The study was the first cohort study ever conducted on patients 
admitted to institutions for the mentally deficient. The findings indicate 
that thdre were striking differences in release rates by age, I.Q., and 
diagnosis. For patients with I.Q. under 20 only 1% were released within 
4- years following admission, whereas for patients with I.Q. of 70 or over, 
12% were released within 4- years. Among patients in the age groups 14.- 
17 years, 60-70^ were released in the first 4- years, while among those 
under 5 years of age, only 12^ were released. Patients with diagnoses 
of undifferentiated or familial mental deficiency had release rates of 
55-60^, while those with diagnoses of mongolism and developmental cranial 
anomaly had release rates as low as 10-15^ but had high death rates of 
27-28^, A paper Incorporating the methodology and results of this study 
was prepared cooperatively by the Biometrics Branch and personnel from the 
Pacific State Hospital and was presented at the annual meeting of the 
American Association for Mental Deficiency in May 1957. The results of 
this study fiave served as a starting point for a more Intensive research 



- 5 - 

project on the factors influencing the prognosis in mentally deficient 
patients admitted to Pacific State Hospital. The National Institute of 
Mental Health is supporting this research through a special grant. 

Trends in Public Mental Hospital Populations . A study was carried 
out in which the movement of patient populations in public mental hospitals 
in 1956 was compared to what would have been expected on the basis of 
the trend over the period 194-5-1955. While the analysis of the gross 
data indicated that the number of resident patients in public mental 
hospitals of the nation at the end of 1956 was lower than would have 
been expected on the basis of the trend in the period 194-5^1955, data 
needed to assess the factors responsible for this decrease were not 
available. The gross hospital data on the movement of patients must 
be made specific for such basic variables as age, sex, diagnosis, and 
length of hospitalization, etc., and state mental hospital systems 
have, with minor exceptions, never developed techniques to produce 
such tabulations. The section developed a method to solve this problem 
using data at Saint Elizabeths Hospital to determine release ana death 
rates among groups of patients according to such variables as age, sex, 
diagnosis, length of stay, marital status, race, and type of commitment. 
It is planned to work with several other states to develop similar analyses 
so that more adequate interpretation of interstate comparisons of trends 
in mental hospital population movement can be made. Indeed, this studjr 
emphasized that obtaining the facts necessary to quantify the impact of 
tranquilizing drugs and such other therapies and programs as mav be 
developed in the future on the mental hospital requires the revision 
of existing statistical systems in mental hospitals to provide appropriate 
intrahospital data. But equally as important, programs must be developed 
which will coordinate data on utilization of all community treatment 
facilities so that the role played by the mental hospital can be studied 
in relation to that played by these other community facilities in the 
treatment and rehabilitation of the mentally ill. 

Monthly Reporting . Monthly reporting of gross public mental 
hospital population movement by the states in the Model Reporting Area 
was begun in December 1956 to obtain mental hospital population move- 
ment data on a more highly current basis and to see whether striking changes 
are occurring, to consider the effect of seasonal variation in the analysis 
of changes in the movement of these populations. Examination of the data 
collected during the first 10 months Indicates considerable variation in 
the movement of these populations from one month to the next and also 
considerable variation among states. However, until data have been 
accumulated for more than one year it will not be possible to determine 
what proportion of the change from one month to the next is due to 
seasonal variation and what proportion is due to other factors . Such 
information will begin to emerge during early 1958. 

Mortality Studies . Tabulations of the niunber of deaths occurring 
in public mental hospitals in 1955 were made available to the Biometrics 
Branch by age, sex, mental disorder, and cause of death by 17 states in 
the Model Reporting Area. An analysis of the data is presently under way, 
using the IBM 65O computer, to determine age and cause specific death rates, 



- 6 - 

percentage distributions of deaths by cause and the ratio of hospital 
deaths and death rates to deaths and death rates in the general popula- 
tion. Preliminary findings indicate a marked variability in the distri- 
bution of causes of death between the various age, sex, and mental 
diagnostic groups and considerable variation by state. However, certain 
patterns do emerge. Deaths due to arteriosclerotic and degenerative 
heart disease account for the greatest percentage of all deaths, with 
deaths from pneumonia the next highest. As would be expected, over 3/5 
of all deaths occurred in the age group 65 years and over. The death 
rates in the mental hospitals are higher than the corresponding rates 
in the general population. 

In addition to studying the death experience of the mental hos- 
pitals of the 17 states, this study provided valuable experience in the 
programming of vital statistics calculations on the IBM 650. This ex- 
perience will be particularly useful in programming data for the pre- 
paration of the annual census of patients in mental institutions. 

The Third Midwest Conference on >fental Health Statistics . This 
conference was held at Lansing, Michigan, in October 1957, Much of the 
discussion centered around a refinement of interstate comparisons of 
gross data on mental hospitals ana institutions for the mentally deficient 
in the Midwest. In addition, the following were among the topics dis- 
cussed; analysis of mental hospital population data; measures of effective- 
ness of hospital programs; recommendations for consideration by the 
Committee on Definitions of the Model Reporting Area and reports of 
research projects in the various states. These meetings are an outgroT^h 
of the annual meetings of the Model Reporting Area and since representatives 
from midwestern states who are not members of the Model Reporting Area are 
also invited, interest in sound statistical procedures in mental hospitals 
has been stimulated in these states 



CONSULTATION SECTION 

The objectives of the Consultation Section are to establish 
efficient records systems, to promote use of comparable terminology and 
definition, and to facilitate data reporting and data analysis. Imple- 
mentation involves providing consultative services in setting up a records 
and reports system or reorganization of out-moded and ciimbersome records 
systems . 

By furnishing advice and assistance in research design and data 
analysis, the Section not only aids in procuring much needed information 
but stimulates other states to engage in research by establishing working 
models, methodological techniques, and, occasionally, resources. 

The following states requested and received consultative services 
regarding improvement of their central office, mental hospital, or out- 
patient psychiatric clinic records systems or on matters regarding research 
design, program evaluation, and data analysis: Delaware, Florida, Georgia, 
Kentucky, Maine, Jfessachusetts, Michigan, and Ohio. 



- 7 - 

Specific examples of assistance furnished by the Section upon request 
of state or local mantal health agencies or facilities are briefly presented 
be lows 

The Institute in Jackson Memorial Hospital, Florida, and the clinic 
attached to Tampa General Hospital, Florida, requested assistance on develop- 
ing methods to furnish the Biometrics Branch with the data requested annually. 
The problem stemmed from the fact that the out-patient psychiatric clinics 
were part of a generalized medical care program and the record systems used 
in these clinics were part of the total hospital record system. A plan was 
devised for incorporating a form for psychiatric clinic data into the basic 
record system. 

Assistance was given to the superintendent and staff of South Florida 
State Hospital with regard to setting up a records and report system. The 
request was unique inasmuch as it was tendered by the superintendent before 
the official opening of the hospital. Consultation in this case was parti- 
cularly satisfying since discussions regarding a records system were 
unencumbered by an existing records system. 

At the request of the superintendent of Plneland Hospital and Train- 
ing Center, Maine, a school for the mentally retarded, their ciur-rent records 
and reports system was reviewed. The superintendent was Interested in 
establishing an IBM machine punched card system to be used for administra- 
tive and research purposes, A statistical system utilizing an IBM key punch 
and card count sorter with schedules, coding and punching instructions was 
provided for his use. 

Consultation services were also provided to the Kentucky Department 
of Mental Health and the hospitals they supervise in the revision of its 
records and reports system. This reorganization was to a large degree 
prompted by their desire to qualify for admittance to the Model Reporting 
Area. This state has applied for admission to the Area. 

Several projects on the evaluation of drug therapy in the hospital 
setting and' in a home care program were reviewed with the Clinical Director 
of the Delawai^e State Hospital and members of his staff. Suggestions 
regarding use of cohort methods in analysis of follow-up data were made. 
Discussions were also centered about the use of concurrent and historical 
controls in clinical trials. A form was designed to be used In a visible 
file register to guide follow-up of patients and to present. Information 
rapidly on the status of patients in the project. 

The Chief of the Research Section of the Michigan Department of'"'"'^ 
Jfehtal Health requested- advice on' t'hfe collection: and analysis of research 
data on patients under' treatment in the... hospitals and clinics of that ' 
state.'- Among the studies- .that .were reviewed v/ers ones on rates' of first 
jadmission to their hospitals and another on the evaluationbf the' public 
^alth nursing' services to t'he families of hospitalized, mental patient 
and to the patients themselve^s wheja ihey are released to the community. 

Consultative service was requested; by the Georgia Departm&nt of 
Health in relation ..to the evaluation -of "two ■■programs. .One program' 
Involved public health nursing services to families of the mentally llx; 



the other program pertained to general hospitals providing diagnostic and 
treatment facilities for the mentally ill. The fornEr program had been 
in operation for several years. The problem was to devise forms and set 
up procedures which would enable them to collect certain basic data that 
would enable them to ascertain to what degree such services were being 
utilized as con^Dared to an optimiim utilization. Reasons for low utilization 
in given areas could then be investigated. Modifications in the existing 
methods of collecting data and in maintenance procedures were made which 
would permit the above requested administrative information to be readily 
collected. Further recommendations were made concerning the collection 
of individual patient and family data for research purposes. 

So as to insure some built-in evaluation techniques into the other 
program, the state department of health requested consultation in the 
planning stage in order to include items which might indicate the degree 
to which the program objectives were being met. Briefly stated, these 
objectives were to reduce the number of patients going to the state mental 
hospital from counties participating in the program, to return such patients 
to the community more quickly than could the state mental hospital and 
decrease the number of readmissions. Since randomized controls which would 
permit direct evaluation of these objectives was not feasible, several other 
approaches in analyzing the accomplishments of the program were suggested. 
These measures would throw some light on shifts in patterns of hospitali- 
zation for communities with and without such mental health facilities. 
Some revisions in the data forms and data collection procedures were made. 
Models for data presentation and analysis were also presented. 

The Chief of the S'ection is also supervising a contract study being 
done by the Harvard School of Public Health for the Biometrics Branch. 
This study will determine probabilities of release and return using two 
different points in time ("significant" release or return and "standard" 
release or return) for cohorts of admissions in the years 1900, 194-0, and 
1950. The follow-up period is limited to five years after admission and 
will consider such variables as age, sex, mental diagnosis, education, 
marital status, etc. 

The 1900 cohort has been coded and punched and some preliminary 
analyses have been made by age, sex, and type of admission (first and 
readmission) for l) entry hospital, 2) legal status, 3) marital status, 
4.)birthplace , 5) occupation, 6) education, 7) usual type of household, 
8) place from which admitted, 9) in hospital during year preceding admission, 
10) cause of death. A detailed cross -tabiolation by age, sex, diagnosis, 
and type of admission was also made. These analyses formed the basis for 
determining how to group certain variables and which cross -tabulations 
would be practicable for the more detailed analysis. 

The Section also reviewed the records system of the Ohio Depart- 
ment of Mental Hygiene and Correction. As part of this review, data 
on first admissions during the years 194-8-1952 are being correlated with 
pertinent 1950 census information enabling the computation of admission 
rates by such factors as age, sex, color, marital status, education, 
occupation, resident (urban-rural, metropolitan-non-metropolitan, county), 



mental diagnosis, etc. Proximity to state mental hospital facilities 
and the effect of other mental hospital facilities on admissions to 
state -operated hospitals is being considered. A portion of the find- 
ings will be presented in a regional research conference to be held in 
Ohio early next year. Subsequently, data involving discharge and 
readmission will be analyzed. 



OUTPATIENT STUDIES SECTION 

Activities in this year have concentrated on the analysis of the 
data being reported in the annual statistical reports from out-patient 
psychiatric clinics and providing assistance in extending reporting of 
information on patients to an increased proportion of the clinics in 
all states, furthering the standardizing of definitions, putting into 
effect the plan that is to provide the National Institute of Mental Health 
for research study, duplicate standard punch cards that include data on 
each terminated patient, and on the development of a plan for a special 
study on the socio-economic characteristics of clinic patients in I960. 

A conqjrehensive analysis of data on clinic characteristics and the 
number and type of clinic staff and man-hours reported by 95 percent of the 
1,234- clinics in 195^-55 was completed and is being published in December 
1957 as a Public Health Monograph. 

"A Manual on Recordkeeping and Statistical Reporting for Mental 
Health Clinics" has been published and is being made available to Regional 
offices, states, and clinics, 

A resToms of the xjorkshop on "Concepts in Mental Health Reporting" 
at the annual meeting of the Aisrican Orthopsychiatric Association was 
published in the Journal of the Association and reprints made available 
for distribution to the states by the National Institute of Mental Health. 

The subcommittee on Reporting of Diagnostic Classification for 
Children attended by representatives of the American Psychiatric Associa- 
tion Committee on Nomenclature and Statistics, American Orthopsychiatric 
Association, and several other child guidance clinic representatives and 
representatives of the Children's Bureau and other branches of the National 
Institute of Mental Health met on September 12-13 to discuss problems on 
reporting diagnoses for children. 

Data on the patients and services they received in outpatient psy- 
chiatric clinics for about 380 clinics were reported for the year ended 
June 30, 1955. The reporting clinics, comprising about one-third of the 
total number of clinics in the country, do not represent a probability 
sample of all clinics and generalization from the findings cannot be 
made to the total clinic patient population in the nation. These first 
reports on the charactieristics of patients and their services, however, 
provide within this important limitation some preliminary information on 
patients. Briefly summarized, some of these data show the following; 



- 10 - 

1. Of each 10 patients terminated during the year, 3 received 
diagnosis and treatment, U received diagnosis only, and 2 had received 
other services only, that is, only an application interview, partial evalua- 
tion, psychological testing, etc. 

2. The bulk of the terminated patients - about 8 of each 10 - left 
clinic service after less than 10 interviews with a professional staff 
member. More than 2 in 10 had only one interview, and almost U in 10 had 
2 to /+ interviews . 

3. When the patient was an adult, most interviews were with the 
patient; only 1 in each 10 interviews was with a spouse or other person 
about the patient. When the patient was a child, only half the inter- 
views were with the child patient; U in each 10 were with the parent or 
parent substitute, and 1 in 10 was with some other significant person 
about the patient. 

U. Not quite a fovirth of the terminated patients, either because 
they came for services other than diagnosis and treatment or because they 
did not continued their visits, were iindiagnosed when terminated. For 
children with a psychiatric disorder, transient situational personality 
disorder was the most frequent diagnosis - 36 percent. Personality 
disorders (21^); mental deficiency (18^); and Psychoneurotic disorders 
(13^) also comprised fairly large groups. Among the patients 18 years 
and over with psychiatric disorder, personality disorders (29^); psycho- 
neurotic disorders (28^), and psychotic disorders (24-^), were most 
prevalent. 

5. The 1955 data on patients made possible for the first time an 
estimate on total patients using outpatient psychiatric clinic facilities. 
On the basis of the number of clinic patients served per man-hour of pro- 
fessional staff time in the reporting clinics and earlier reports on 
man-hours of service in all clinics, it has been estimated that 197,000 
patients under 18 years of age and 166,000 patients 18 years of age and 
over used clinic service sometime during the year ended June 30, 1955, 
in continental United States. These very rough estimates provide a 
clinic usage rate of 355 for each 100,000 pop\ilation under 18 years of age 
and 155 for each 100,000 population 18 and over. 

Data on patients for the year ended June 30, 1956, were reported 
for almost 500 clinics --about 100 more than reported for 1955, and these 
represent about two-fifths of the 1,294- clinics in the United States in 
1956. These reports are being processed for tabulation and analysis. Of 
the reporting clinics , 237 also prepared special tables that provide 
additional detailed information on some items and cross tabulations of 
other data that will make possible a more complete analysis of the data 
for 1956. 



- 11 - 

The uniform duplicate punch card plan designed to provide data 
on each terminated clinic patient to NIMH to facilitate national research 
was put into effect. Thirty-six states with punch card procedures are 
participating in the program. Approximately 100,000 cards, that is, data 
for 100,000 patients terminated during the year ended June 30, 1957, in 
4.77 clinics will be received by NIMH during the last quarter of 1957. 
Plans are being made for taking national samples of patients with selected 
characteristics for special analysis. Plans are being considered for 
additional studies to be made in cooperation with the states in order to 
obtain further information on these patients. Present plans include the 
submission of duplicate standard punch cards again in I960. 

Plans are being developed for the collection of information on 
socio-economic characteristics of patients admitted to clinics for a 
specified period in i960 to be related to the population census in I960. 
To date 20 States have indicated an interest in participating in such 
a study and additional states are expected to indicate interest; 5 have 
reported that they cannot participate. Some of the socio-economic charac- 
teristics of patients for which information may be collected are education, 
employment status, occupation, income, mobility, urban-rural (and census 
tract) residence, marital status, nativity, family size and composition, 
housing, etc. The data will provide rates of admission from the various 
socio-economic groups as well as relationships between socio-economic 
characteristics and diagnosis, outcome after treatment, services received, 
number of interviews, etc. 

SECTION ON APPLIED AMD MATHEMATICAL STATISTICS 

During the year the section has continued to assist and consult 
with investigators on statistical, mathematical, and biometrical problems 
arising in various investigations carried out by the laboratory and 
clinical scientists at NIMH as well as scientists who are working in 
mental health problems outside NIMH. These services provide the scientists 
with the most efficient and valid statistical techniques available in the 
design and analysis of data. The section has been consulted on a large 
variety of subjects including experiments on the effects of various drugs 
on psychiatric and sociological functions in animals and in man 5 investi- 
gations in electrical conductivity, sections and resections, and vascularity 
of nerve tissue; studies in reaction time; continuous performance tests 
on various groups of people; surveys on interactive patterns among socio- 
economic groups and among the emotionally disturbed; and continuous con- 
sultation has been provided to the multidisciplinary aging project. 

The section has developed new techniques in mathematical statistics 
especially in multivariate analysis which are helpful in the analysis of 
profile data and in the analysis of variation. Advice has been provided 
to various committees with regard to grants, surveys, and proposals in 
the field of mental health. The Section has also reviewed manuscripts 
arising within the Institute and has served as referee on papers submitted 
for publication in statistical journals . 



- 12 - 

The section proposes to continue consultations with these investi- 
gators already begun and to continue to aid the Psychopharmacology Service 
Center to obtain definitive evaluations of new drug therapies in mental 
illness. Next year we intend also to provide liaison services between 
investigators in the laboratories and branches of NIMH who plan to 
collect extensive bodies of data and the machine programmers of the 
electronic calculator which has been procured for NIH. The section is 
also contemplating the possibility of initiating investigations in 
mathematical biology and information theory because of the significance 
of such research in various aspects of the field of mental health. 

In addition to providing a variety of statistical and mathematical 
services to research and clinical investigators of NIMH, this section has 
also been called into consultation by investigators outside NIMH working in 
mental health. These services include consultations in the design of 
experiments, the analysis of data, and mathematical models underlying 
the data. The section has served on and provided advice to various com- 
mittees in NIMH as well as reviewing and refereeing papers in the dis- 
ciplines involved in mental health. 

Some examples of the investigations in which this section has par- 
ticipated by providing consultations in design and analyzing data are: 

1. Experiments on the effects of various drugs on psychological 
functions in ani m als and man. 

2. Experiments on the effects of certain nerve sections and 
resections , 

3. Studies of various social and psychological relations in 
socio-economic groups. 

4-. Studies on a maternal attitude test. 

5. Ecological investigations in animals. 

6. Investigations of blood vessel density in various spinal 
neur-al regions . 

7. Studies in the methodology of behavioral observations. 

8. Reaction time experiments in normal controls. 

9. Experiments on the effect of tranquilizing drugs on 
certain psychological and biochemical functions. 

10. Comparison of brain damaged with normal groups on 
Continuous Performance Tests. 

11. Leadership studies in childrens camps. 

12. Survey on job satisfaction at NIH. 

13. Studies on the interactive patterns of emotionally dis- 
turbed children. 



- 13 - 
14., Investigations on electrical conductivity of nerve tissue, 

ACTIVITIES OF THE CHIEF OF THE BRANCH 

During the year, the Chief of the Branch engaged in certain activi- 
ties that might be noted. He was invited to lecture to the students and 
faculty of the Department of Public Health of Yale University and to 
conduct a seminar on problems of research in the epidemiology of mental 
disorders o He was also invited to participate as a member of a study 
group convened by the World Health Organization in Geneva from November 4- 
to 8 to consider problems of the use of ataractics and hallucinogenic drugs 
in psychiatry. While in Europe he was also invited to lecture at the 
Institute of Psychiatry of the University of London at the Maudsley Hos- 
pital on the collection of data on the mentally ill in the United States, 
geographical variations in the availability of psychiatric personnel and 
facilities, and the other activities in which the Biometrics Branch has 
been engaged. 

He also participated in the following conferences? l) A con- 
ference on patterns of patient care called by the Joint Commission on 
^fental Illness and Mental Health, Boston, March, 1957, 2) Conference 
on coordinating community resources in psychiatric after-care sponsored 
by Pennsylvania Mental Health, Inc, Philadelphia, April 1957, 3) 
Conference on research in mental health sponsored by the Florida Con- 
ference on Training and Research in ^fental Health, April 1957, 

The Chief of the Branch has been designated to provide liaison 
between the National Institute of Mental Health and the Epidemiologic 
Intelligence Service Training Program at the Communicable Disease 
Center in Atlanta, Georgia, In this connection he presented a paper 
at the ^fe.y conference of the EIS and lectured to a training class of 
EIS officers during August 1957 on problems of research in the epi- 
demiology of mental disorders. The NIMH is supporting this training 
program, and it is hoped that through our active participation we will 
attract some of the trainees into epidemiologic research on the mental 
disorders. 

The Chief was also asked to confer with the personnel responsible 
for the mental health training and research program being implemented 
by the Southern Regional Educational Board. In this connection he 
reviewed types of data that are available on the prevalence of mental 
disorder and distribution of personnel and facilities in the seventeen 
states that are members of the Board and made recommendations concern- 
ing the development of adequate statistical services within the state 
mental health programs of that region, the training of medical record 
librarians, and the need for extensive studies within the states of 
that area to throw greater light on regional differences in the utiliza- 
tion of psychiatric facilities. 



- 1^ - 

The Chief of the Branch provides liaison between two special grants 
being carried out in the California State Department of Mental Hygiene 
and the NIMH. The first project, a study of suitability of out-patients 
for treatment was completed in 1957 and a report has now been published on 
this study by the California Department of Mental Hygiene. This report 
has been issued as Research Report Number 1 of the California State Depart- 
ment of Mental Hygiene,* The second project is being carried out at the 
Pacific State Hospital at Pomona, California. This project includes both 
an extensive research program investigating individual, familial, and 
commiinity factors related to admission to and release from the institution, 
and evaluating the effect of specific treatment and rehabilitation programs 
within the hospital on the prevention of disability and the training of 
patients for community employment. In addition, this project is being 
used as a training center to attract into the field of mental retardation 
high caliber research personnel in psychology, psychiatry, biometry, 
sociology, and epidemiology. 

Both the Branch Chief and the Chief of the Section on Applied and 
Mathematical Statistics serve on the Psychopharraacology Advisory Committee. 

A list of the publications of the Branch follows. 



^Sampson, H., Ross, D., Engle B., Livson, F., A Study of Suitability for 
Out-patient Clinic Treatment of State Mental Hospital Admissions. State of 
California, Department of Mental Hygiene. Research Report No. 1, 1957. 



Publications of the Branch 

Bahn, A. K., and Norman, V. B,, Outpatient Psychiatric Clinics In the 

United States: Characteristics and Professional Staff, 195/k-55. Public 
Health Monograph No. U9 . Due December 30, 1957. 

Bahn, A. K., and Norman, V. B., Outpatient Psychiatric Clinics in the 

United States: Characteristics and Professional Staff, 1954--55. Resume 
in Public Health Reports , December 194-7. 

Geisser, S., The Distribution of the Ratios of Certain Quadratic Forms in 
Time Series. Annals of Mathematical Statistics , Volume 28, Number 3, 
pp. 724.-30, September 1957. 

Geisser, S., A Note on McQuitty's Index of Concomitance. Journal of 
Educational and Psychological Measurement . In press. 

Geisser, S., and Greenhouse, S. W., An Extension of Box's Results on the 
Use of the F Distribution in Multivariate Analysis. Submitted to the 
Annals of Mathematical Statistics . 

Halperin, M. , and Greenhouse, S. W. , Note on Multiple Comparisons for 
Adjusted ^feans in the Analysis of Covariance. Biometrika. In press. 

Hill, J. H., and Greenhouse, S. W. , Analysis of Plasma Proteins by 
Turbldimetry: An Unsuccessful Aid in Cancer Diagnosis. Journal of 
the National Cancer Institute . Volume 18, Niimber 2, February 1957. 

Hospital Studies Section, Mental Health Statistics, Current Reports: 
Patients in Public Hospitals for the Care of the Mentally 111, 1956 
and 1957. Series MHB-H-3. 

Hospital Studies Section, Jfental Health Statistics, Current Reports: 

Patients in Public Institutions for Mental Defectives and Epileptics. 
Series MHB-I-2, 1955. Series MHB-I-3, 1956. 

Hospital Studies Section, Mental Patient Data for Fiscal Year 1956. 
Public Health Reports , Volume 72, Number 1, January 1957, 

Hospital Studies Section, Patients in Mental Institutions, 1953, Part III: 
Private Hospitals for the Mentally 111 and General Hospitals with 
Psychiatric Facilities. PHS Publication No. 495, Part III. 

Hospital Studies Section, Patients in Mental Institutions, 1953, Part IV: 

Private Institutions for Ifental Defectives and Epileptics. PHS Publication 
No. 495, Part IV. 

Hospital Studies Section, Patients in >fental Institutions, 1954, Part I: 
Public Institutions for Mental Defectives and Epileptics. PHS Publi- 
cation No. 523, Part I. 

- 15 - 



- 16 - 

Hospital Studies Section, Patients in Mental Institutions, 1954-, Part II: 
Public Hospitals for the I^ntally 111. PHS Publication No. 523, Part II. 

Hospital Studies Section, Patients in Mental Institutions, 195A, Part III; 
Private Hospitals for the tontally 111 and General Hospitals with 
Psychiatric Facilities. PHS Publication No. 523, Part III. 

Hospital Studies Section, Patients in Mental Institutions, 1954-, Part IV: 

Private Institutions for Mental Defectives and Epileptics. PHS Publication 
No. 523, Part IV. 

Hospital Studies Section, Progress in Reporting Ifental Hospital Statistics. 
Public Health Reports , Volume 72, Number 9, September 1957. 

Kramer, M. , Problems of Research on thf Population Dynamics and Therapeutic 
Effectiveness of >fental Hospitals. Chapter IX, pp. 145-172, in The 
Patient and the >fental Hospital. Greenblatt, et al., editors. Free 
Press, Glencoe, 111., 1957. 

Kramer, M. , Statistical Studies of Mental Hospital Populations. Chapter 
8, pp. 68-83, in I^ntal Health and the World Community. Prof, F. 
Brockington, Editor. World Federation for lyfental Health, 19 Manchester 
Street, London W. 1., 1957. 

Kramer, M. ; Person, P. H.; Tarjan, G.; Morgan, R.; Wright, 3., A Method 
for Determination of Probabilities of Stay, Release, and Death for 
Patients Admitted to a Hospital for the Mentally Deficient: — the 
Experiences of Pacific State Hospital Dincing the Period 19^8-1952. 
American Joirrnal of Mental Deficiency , Volume 62, Nvmiber 3, pp. 4-81-4.95, 
1957. 

Kramer, M. , and Pollack, E. S., Problems in the Interpretation of Trends 
in the Movement of Mental Hospital Populations. Presented at the annual 
meeting of the American Public Health Association, November 15, 1957. 

Kroll, B. H., and Goldstein, H., Methods of Increasing Ifeil Response. 
Journal of Marketing . VoIuhb XXII, Number 1, July 1957. 

Outpatient Studies Section, A Manual on Recordkeeping and Statistical 
Reporting for Ifental Health Clinics. PHS Publication No, 539. 

Pasamanick, B., and Kramer, M. , Designs for Scientific Studies to Estimate 
Need for Beds for Psychiatric Inpatient TreatnKnt Facilities for Children. 
Chapter 6 in Psychiatric Inpatient Treatment of Children. American 
Psychiatric Association, Washington, 1957. 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Biometrics 



BUDGET SHEET 



Total: $329,253 
Directs $316,478 

Reimbursements ! $12 , 775 



Axmual Report - 1957 
Clinical Investigations 
Ifeitional Institute of Mental Health 



Previous assnual reports have described in considerable 
detail the rationale for the current organization of the 
Clinical Investigations program. Our research efforts 'have 
been directed on the one hand towaird improvenjents in treat- 
meat methods for a variety of psychiatric disorders, and on 
the other toward making contributions to a better iinderstand- 
ing of the factors which influence normal personality develop- 
meat and behavior,, Certais studies from each of the branches 
and laboratories were described in order to indicate the scope 
of their research, ajsd particularly the areas in which collab- 
oration between several disciplines was involved. 

In the four asd. one -half years since the first ward was 
opened to patients^ the general areas of interest of each 
research group have grad'^oally beea defined » These axe still 
subject to change, depending as they do upon developments in 

the field, on the Eatiire of the Clinical Center setting^ ajad 
on the special skills of the staff. Nevertheless, all the 
branches have by EOt^' decided upon one or m&i'e major projects 
to which they have committed their resources. The mala 
portion of this r-sport is devoted to descriptions by their 
chiefs of the aetivitiss of the branches asd laboratories. 

Duriag the past year we have bees fortunate in the 
appoiatments of outstanding investigators to fill the two 
major sta^f vacaacies. Iia September Dr. Joel Elkes reported 
as Chief of the Clinical leuropharmaso.los'' Research Cemter, 
which is being developed isa eollaboration with St. Elizabeths 
Hospital. Dr. Elkes v&s Profsssor of Experimeffl'bal Psychiatry 
at the University of Birmingham^ Eagland;, where he initiated 
a remarkably well-iategratsd program of psychiatric research 
ramging from the psychological to the aaaatcaiaical bases of 
behavior. At t&e end of Deeerober at the teirroisatiom of his 
fellowship at the Center for Advamced Study in the Bskavioral 
Sciences^ Dr. David. Baffiburg will, come as Chief of the Adtilt 
Psychiatry Branch. Frier to Ms fellowship. Dr. Haiuiburg had 
served as Asisociate Director of the lastitute for Psychosomatic 
&a& Psyckiatrls Research asd Training of Michael Reese Hospital. 
Both Dr. Elkes aad Dr. Hambirg have made sigslficasit coatribu- 
tions in their ispesial fields j is addition;, they are particularly 
interested and essperiesc^d in the problems of int-ardisciplinary 
researchi asd, fi'Ea.H^p they are ususually ccaapeteat admin- 
istrators wfe-3 have dem-Dsstrat^d their ability to achieve a high 
standard of research sophistication while at the same time 
naitttaiaiag a sensitive aad effective clinical opsration. 



-2- 



Although it will obviously take at least two or three 
years for Drs„ Hamburg and Elkes to build their branches to a 
state of maximum efficiency, there are many immediate ad- 
vantages which result from their arrival. They bring to the 
group of laboratory and branch chiefs who are responsible for 
the development of the Clinical Investigations program the 
much-needed resources and the unique points of view gained 
from their wide clinical and general research experience. 
Further, it is now possible for the first time to make long- 
term commitments of the clinical facilities which it will be 
their responsibility to operate. This will open the way to 
a whole range of studies within the clinical branches them- 
selves and in collaboration with others, which have hitherto 
been held in abeyance or pursued on a more or less intensive 
pilot basis „ 

In a sense, we can say that the first phase in the or- 
ganization of Clinical Investigations is nearing successful 
completion. We now have within the group strong representa- 
tion of the various disciplines which we conceive to be neces- 
sary for the further development of theories of behavior and of 
personality development,, Although later we should like to see 
our clinical facilities expanded to include a small therapeutic 
community- type hospital and a child institute, we already have 
in the Clinical Center and in St. Elizabeths Hospital access to 
reasonable flexible facilities which will enable us to set up 
many situations for critical study » We are at last nearly 
ready to essay an answer to the question of how best to organ- 
ize and utilize these personal, professional, material, and 
structural resources. 

It should be made clear that we recognize, that there 
are areas of autonomy for each of the behavioral sciences, and 
we assume that certain advances will be possible only after 
further progress in the individual disciplines. But in any 
review of this total field it does appear that the areas be- 
tween disciplines have been relatively neglected, and our 
unique resources for collaborative studies impose upon us a 
responsibility to pursue them where there is reason to believe 
that they might be profitable. Even a cursory scanning of the 
reports which follow will indicate that up to the present time 
we have, at best, carried out some multidisciplinary rather 
than interdisciplinary research - that is, in some studies 
representatives of various disciplines working side by side 
have collected data in certain experimental situations. This 
I regard as a step in the right direction, and I believe that 
we have done about as well as could be expected. In the early 
life of most groups there is first the formation of a number 



-3- 



of sub-groups. Not only do the members of these sub-groups 
tend to identify strongly with each other, but there is often 
a tendency to exclude those vho do not share their point of 
view. With varying intensity this has occurred among our 
branches and laboratories. To some degree the breaking down 
of these barriers will reflect the success the group of lab- 
oratory chiefs achieve in finding some common ground. 

Circumstances related to the necessity of starting a 
clinical operation before some of its key personnel were ap- 
pointed have resulted in two types of administrative organi- 
zation within Clinical Investigations = Some of the branches 
contain representatives of various disciplines: Child Research, 
Clinical Sciences, and the Clinical Neuropharmacology Research 
Center, Others are largely unidisciplinary: Adult Psychiatry, 
Psychology, and Socio-Environmental Studies, The advantages of 
the unidisciplinary type of organization are that it facilitates 
strong identification with one's own discipline; evaluation of 
proposed projects or of work in progress is apt to be more 
sound; observations made in one area of the group's concern 
are readily correlated with data gathered in others. A poten- 
tial problem of this type of organization, however, is that it 
may foster a relative lack of that type of commitment which is 
absolutely essential in a clinical project where treatment 
responsibilities are assumed in order to afford research 
opportunities. 

The multidisciplined branch does not have this problem 
of commitment to the project; and since all of the investigators 
are responsible to the same chief, the organizational lines for 
efficient operation are clear. This may make for the earlier 
effectiveness of such a group. On the other hand there is a 
definite tendency to in-group formation with the resulting loss 
of contact with others in the larger operation who are similarly 
engaged. Sometimes in the interest of promoting mutual good- 
will potentially productive differences are ignored; each 
discipline becomes too "understanding" of the others; the 
special competences of each tend to become blurred; and the 
level of performance may sink to the lowest common denominator 
in a setting where a pseudo-equality becomes a goal. 

I do not believe that such problems as these can be 
legislated out of existence by adopting a particular pattern 
of organization. A continuing alertness to their development 



-k- 



is essential to their resolution, and our ultimate success 
will depend on our frankness and our willingness to face them 
when they do arise. But these are matters for the future. 
The current status of our work is reported in the following 
pages by the chiefs who are responsible for the development 
of the studies in which we are engaged. 



Robert A. Cohen, M. D. 

Director of Clinical Investigations 

National Institute of Mental Health 



-5- 



Adult Psychiatry Branch 

Section on Ward 3-W 

Dr„ Lymaji C. Vfynne 



For the Adult Psychiatry Section working on Ward 3-W, 
the past year has on the whole been transitional; it has in- 
volved the rounding off of previous phases of research and 
the planning of a new program which will be both more focused 
in research objectives and more varied and expansive in the 
approaches used to reach these objectives. The program of 
this ward, viewed in over-all perspective since the opening 
of the Clinical Center, has now completed a rather distinct 
evolutionary stage. The program began with a rather large 
number of psychiatrists using the ward individually for 
quite numerous and heterogeneous projects. This permitted 
a considerable variety of fruitful pilot studies, but a shift 
to a more consolidated program seemed to have three major ad- 
vantages: those studies which are continued can then have a 
larger and more adequate sample of patient material, more 
focused staff participation permits a more inclusive and 
thorough penetration into questions which are particularly 
significant; and the clinical operation of the ward can be 
more readily integrated with the research. 

Arising out of ongoing research on this ward has been 
a heightened conviction that a crucially strategic area for 
increasing our understanding of mental disorder lies in the 
examination of family relationships. This conviction is in 
accord with general clinical and statistical studies from a 
half-dozen countries which have repeatedly confirmed the find- 
ing that schizophrenics emerge almost exclusively from severely 
disturbed homes — a finding which provides perhaps the most con- 
sistent lead concerning etiology that has been found in any 
kind of investigation of schizophrenia. In addition, early 
familial experience has long been accepted as a pivotal factor 
in determining personality development and deviation. However, 
it is only recently that the details of how this generalization 
applies to the genesis of schizophrenia has begun to be sub- 
jected to systematic research scrutiny. 

Research in this section has led to a preliminary speci- 
fication of the nature of these familial influences in the 
development of schizophrenia. This research has progressed from 
clinical observations and an intensive pilot study of five 



-6- 



families of schizophrenics to the formulation of a series of 
hypotheses which can be summarized as follows: 

1. The parents of potential schizophrenics have 
had serious difficulties in their own person- 
ality development in achieving a sense of 
personal identity — that is, a self-concept in 
which they can clearly differentiate themselves 
from others and which they can maintain over 
time in a variety of relationships. Clinical 
observations indicate that difficulties in 
identity formation and threats to one's sense 
of identity prevoke intense anxiety and strenu- 
ous efforts to reduce the impact of such anxiety. 

2. One way of dealing with such personality strain 
is for the person to seize upon an interpersonal 
relation that can have the continuity that per- 
sonal identity lacks. Obviously, the parent- 
child attachment offers an opportunity for such 
a relation during the child's growing years, 
especially if the child is relatively passive 
and malleable for "constitutional" reasons. 

The need to maintain such a relation in a parti- 
cular form acquires all the emotional intensity 
that is ordinarily associated with the mainten- 
ance of personal integrity and identity. 

3. Such relations, like all others, become structured 
through interactional processes into par' icular 
complementary or reciprocal roles. In relations 
of the quality and intensity described, deviations 
from expected roles have come to represent a threat 
of explosive anger and recrimination. 

l^.» The intense need for a sense of relatedness, to- 
gether with the threat of its disruption, leads to 
a particular kind of relationship in which open 
recognition of even ordinary, inevitable divergence 
from expected roles is strenuously avoided. The 
resultant quality of relatedness has been summar- 
ized in the concept of pseudo-mutuality. Pseudo- 
mutuality involves a characteristic dilemma: di- 
vergence from expected roles is perceived as lead- 
ing to disruption of the needed relation, but if 
divergence is avoided, new ingredients that would 
permit growth of the relation and of the individ- 
uals' personalities are excluded. 



-7- 



5. In the families of potential schizophrenics, it 
is hypothesized that pseudo-mutuality of an 
especially intense and enduring form character- 
izes the acknowledged family relations » Legal 
members of the family may be psychologically 
excluded from the internally acknowledged family 
role structure as it is perceived by the rest of 
the family who are involved in pseudo-mutual 
relations. However, the resultant quarrels and 
schism between the acknowledged family and the 
ostracized legal family member may be highly 
functional for the organization of the family 

as a whole as seen by an outside observer, who 
can regard the scapegoat ing of someone as essen- 
tial to the continuity of the pseudo-mutuality 
in the rest of the family. In other instances, 
other persons or events outside the family may 
be scapegoated as a way of avoiding recognition 
of internal family divergence. In still other 
instances, legal outsiders, such as hospital 
personnel, may be psychologically incorporated 
into the family pseudo-mutuality and role 
structure in order to facilitate its maintenance 
for a time, 

6. In addition, in the families of potential schizo- 
phrenics, it is hypothesized that the intensity of 
the necessity of maintaining pseudo-mutuality has 
led to the development of a particular variety of 
shared, family mechanisms by which deviations from 
the family role structure are delusionally re- 
interpreted or excluded from open recognition. 
Further, the effectiveness of these mechanisms is 
enhanced by a pervasive familial subculture of 
myths, legends, and ideology which stress the dire 
consequences of openly recognized divergence from 
a relatively limited number of fixed, engulfing 
family roles. ■'"- -ji-'.,': 

7. In the families of schizophrenics these shared 
mechanisms act at a primitive level in preventing 
the articulation and selection of any meanings 
that might enable the individual family member to 
differentiate himself from the family role structure. 
It is hypothesized that the resultant patterns of 
interpersonal perception and communication become a 
part of the offspring' s personality structure and 
involve a kind of fragmentation and confusion of 



-8- 



experience and thought which is a central feature 
of schizophrenia. Also the offspring ha? come 
to develop only those ego skills which have been 
■" valued within the special constrictions of the 
family role structure, leading to a personality 
impoverishment that becomes clearly apparent when 
the offspring needs to assume extra- familial adult 
roles. 

8. Further, it is hypothesized that different family 
members will occupy different positions or roles 
within the family social organization, leading to 
differing consequences for the personality develop- 
ment of the offspring, (This hypothesis has been 
confirmed by a detailed examination of very exten- 
sive material on a family in which the offsprings 
are monozygotic quadruplet schizophrenics.) 

In the planning of further empirical research in this 
section, these hypotheses have served as a fruitful focal point. 
The section planning has been interdisciplinary, with the parti- 
cipation of psychiatrists, social workers, nurses, sociologists, 
and psychologists. More recently, a committee consisting of Dr. 
Lyman C. Wynne of Adult Psychiatry as Chairman, with Dr. Joseph 
Handlon of Psychology and Dr. Leonard Pearlin of Socio-Environ- 
mental Studies, has been working out a specific research plan for 
consideration by the total staff which will be taking part in the 
ward program. 

The intent in this research is to examine three especially 
significant unsettled problems: (l) The degree of constancy of 
familial disturbance in schizophrenia in relation to such variables 
as: type of schizophrenia, age and type of onset, family social 
class, and kind of family constellation; (2) The degree of 
specificity that some aspects of family disturbance may have for 
schizophrenia, or for varieties of schizophrenia, compared to the 
generality of some other features of family disturbance which may 
also occur normally or in other disorders; (3) The question of 
the extent to which the family disturbance is a primary factor in 
the development of schizophrenia or, alternatively, a secondary 
consequence of the individual's pathology. 

The implementation of this long-range program is at present 
planned along two main lines: (l) Intensive studies on Ward 3-W 
of the family relations of schizophrenics and, in comparison 
studies, of neurotics. Current plans include the trial, in 
a variety of settings, of a group therapy approach to each 



-9- 



family as a whole, the use of quasi-experimental family group 
test procedures, and the detailed evaluation of the extent to 
which features of family interaction carry over to the in- 
dividual family member's relations with others, especially in 
observed ward behavior; (2) Extensive studies, off the ward, 
of a larger and more varied sample of families, including 
"normals", in order to check specific items in statistical 
comparisons. Such work, interdisciplinary but with a sociol- 
ogic emphasis, has been usefully considered in over-all 
planning, even though it will not be operationally practicable 
to proceed with it until the more intensive studies have been 
advanced. 

In September 1957, Dr. Chsirles Savage departed for a 
year' s leave of absence, after having completed a number of 
papers on his studies of psychodynamic processes in the 
therapy of schizophrenics, especially the effects when ther- 
apy is conducted in a research setting and when the patient 
receives psychotomimetic and tranquillizing drugs. 

Despite the emphasis upon family studies for the future, 
certain investigations which have continued to seem valuable 
and which do not use separate inpatient material are to be 
extended; a study of the extent to which social mobility of 
various professional groups contributes to difficulties in 
interdisciplinary collaboration; a study of role conflicts in 
the clinical investigator arising from the difficulties of 
integrating research and therapy values; the development and 
clarification of the role of psychiatric ward administrator; 
the linguistic study of emotional expression; and the effects 
of certain perceptual and imaginative impairments upon learn- 
ing capacity, for example, in reading. 



-10- 



Adult Psychiatry Branch 
Section on Ward 3-E 
Dr. L. Murray Bowen 



General Statement 

The work of the section is devoted almost entirely to 
cne project, the title of which is "The Study and Treatment of 
Schizophrenia as a Family Problem." It is anticipated at a 
later stage of development that there will be several projects 
in the section. 

This project was started thirty- eight months ago to bring 
normal family members into a living situation in the Clinical 
Center with hospitalized schizophrenic patients. This was con- 
sidered a potentially rewarding area for study. It is well known 
that there is a vigorous emotional process when a psychotic 
patient is in living contact with his family. A theoretical 
plan had been worked out which, it was hoped, would make it pos- 
sible for the families to live in the hospital setting for in- 
definite periods, and also for it to be a practical and possible 
venture in the Clinical Center, The intensity and specific 
characteristics of the intense emotional conflict between the 
family members had not been anticipated in the plan. Clinical 
experience was that the conflict between family members could 
transfer itself into a conflict between staff members. This 
transfer took place in the context of ordinary treatment rela- 
tionships between staff and family members. Changes in both 
the theoretical formulation and in the treatment approach were 
made during the first two years. The changes went toward find- 
ing families in which the tendency to transfer their problems to 
others would be less, and in developing concepts and techniques 
to help the staff to work with the families without becoming in- 
volved in the family problems. The immediate motivation for the 
change was to make the clinical operation into one that was 
liveable and operable both for families and for staff and that 
also seemed to offer some hope for treatment successes. While 
these changes were empirical and made in service of the clinical 
situation, they had also a direct bearing on the theoretical 
formulation. By the end of the second year, the ward operation 
seemed to have reached a controllable and workable level. No 
further changes have seemed indicated since that time. The plan 
includes fathers, mothers, and patients as the minimal family 
group for study. Schizophrenia in the patient is regarded as 
a symptom manifestation of an active process that involves the 
entire family, and the family therefore treated as a unit. 



-11- 



A characteristic of the operation has been the diffi- 
culty in making accurate predictions of the project course. 
For instance, each year there has been an impression that 
the project staff had reached a workable capacity to deal 
objectively with the emotional problems of these families. 
Each time staff again encountered an unexpected situation 
which required further resolution. One error in predication 
seems to have come from the application of criteria from in- 
dividual psychotherapy to the work with the more intense and 
involved family group problem. Another error has been the 
lack of experience with family groups and the fact that it has 
not yet been possible to follow a family through to completion 
of treatment. 

The year 1956 ended with a fairly stabilized clinical 
operation. There were no upsets between staff and families 
that could not be understood and controlled within a few days. 
This stabilized period was seen more as a calm period between 
crises than the beginning of a sustained controlled clinical 
operation. 

Developments and Trends in 1957 

The year 1957 is seen as a transition year for the pro- 
ject. This was the first year in which there were no major 
changes in either the hypothesis or treatment operation. The 
more stabilized clinical operation, which began in 1956, con- 
tinued throughout 1957, The clinical operation was much more 
able to "run itself." Clinical problems required less time 
and a corresponding increase in staff time was devoted to ef- 
forts to more accurately structure and define the research 
problems. 

The first efforts to perceive the family as a unit 
began as a clinical necessity. When a staff member related 
individually to a family member, it could be the point at 
which the family problem could become transferred to an intra- 
staff problem. It is believed that "family unit" concept made 
it possible for staff to see the family in a different way than 
would have been possible observing fathers and mothers and 
patients. The presence of the family group in a setting where 
they could be observed constantly provided a source of detailed 
objective data that would be hard to obtain in any other setting. 
Many promising observations were marked "for future study" and 
passed over during the early stages when the main effort went to 
stabilizing the clinical operation. Early in 1957, when there 
was more time for research efforts, some of these areas were 



■12- 



selected for detailed study. The effort was not successful. 
The details seemed out of place in the absence of more pre- 
cise overall concepts » The effort was then directed to a 
more detailed thinking through of the overall project. This 
resulted in four papers written during the year. The result 
of this has been far from satisfactoryo Another effort is 
now being made to define some of the more specific observa- 
tions. 

Progress in 1957 

The changes in the project have the characteristics of 
a growth process in which it is difficult to describe a change 
as belonging to one period. Some patterns do stand out. There 
are three principal areas of activity and interest, all inter- 
dependent. This includes relationships within the family group, 
relationships between family and staff, and relationships within 
the staff. An interference in one area has a potential of show- 
ing almost immediately in all three areas. Interference in 
staff- family relationships seriously threatened the project 
during the first year. There was careful structuring of the 
conditions under which staff members would relate to family 
members the second year. This brought enough control over 
staff-family relationships to stabilize the clinical operation 
and to make possible more accurate observations in the intra- 
fajnily area. The focus of research observations during the 
second year was on relationship patterns between family members. 
The third year the main changes have been in intrastaff rela- 
tionships, A year ago very strict structuring was still 
necessary to prevent staff-family relationships from involving 
the operation in an undefinable emotional turmoil. As the 
staff began to understand itself better, the structure becajne 
more of a natural process than a necessary set of rules. 

The staff effort to understand intrastaff relationships 
has been accompanied by a much clearer perspective of the 
family as a unit. There was a beginning perception that the 
family unit had group characteristics just as the individual 
has individual characteristics. The evolution in the staff 
seemed to permit enough detachment from the individual to see 
the family. 

The concept of the family as a unit may be one of the 
more important concepts in the project. There are events in 
the family when the activity, the intentions, or even the at- 
titude in one member can set up changes in another member. 



-13- 



An exsimple is the mother who developed physical illnesses in 
response to a change in her daughter. When one's interest and 
focus is on the individual, there is a much greater tendency 
to see the family in relationship to that individual than to 
see family relationships as a phenomenon. The development of 
psychotherapy for the family group was also developed as a 
clinical necessity but it appears to have some advantages over 
individual psychotherapy that are worth exploring. 

Another major clinical change in 1957 was developed to 
deal with a clinical problem. The interchange between psychic 
and somatic problems is intense in these families. Over a 
year ago the project assigned itself the task of combining 
psychotherapy and general medical care within a single physi- 
cian. This has brought into focus a number of problems pre- 
viously missed when psychic and somatic problems were divided 
between two physicians. To handle the anxiety situation, the 
^ysician who operates the two areas has gone in the direction 
of structuring medical practice in a psychotherapy frame of 
reference. This area has presented a number of promising 
clues for further study. 

The following outline by Dr, Warren Brodey illustrates 
concretely some aspects of the narcissistic relationships and 
reality testing observed during the study of these families. 

Family- Staff Mechanisms 

1, The staff and family by the nature of this study 
maintain close proximity. It is necessary for 
family and staff to negotiate with one another 
in dealing responsibility with such situations 
as, obtaining a pass to leave the unit, periodic 
physical examination, passing food at the dinner 
table, etc. These families were chosen because 
of the primitive intensity of their intra family 
relationships. It has been found that this in- 
tensity readily spills over into family-staff 
relationships, and that even simple negotiations 
frequently break down in an atmosphere of intense 
family-staff emotions. This capacity to evoke 
powerful responses in others is historically a 
characteristic of these families. 



-14- 



2. Examination of this process of evocation in the 
family-staff relationship indicates a specific- 
ity in the positions that are assumed by the 
staff members in relation to the family. These 
positions, when compared to the intra family roles, 
are seen as "stand-in" positions — the drama being 
reenacted is tradition for each family, and has 
been called the family nythology. This mythology 
has a control axis or leit motif along which all 
the parts are played, i.e., good-evil, powerful- 
weak, praised-criticised, competent-incompetent, 
sick-well, etc. Autonomous stimuli from staff 
members or other extra familial figures are re- 
sponded to in terms of this central axis- -the de- 
gree to which this occurs is directly related to 
the degree of lack of coincidence of the stimulus 
with expectation and the level of anxiety that 
prevails. The process of putting the autonomous 
stimuli or the person emjtting them into line, is 
called polarization. 

3. Examination of this process of polarization indi- 
cates that the family responds so as to reinforce 
the possibility of getting in return a response 
closer to its own projected expectation. This is 
accomplished by the fragmentation of the total 
reality into accurately perceived parts, and then 
utilizing for response these accurately presented 
parts, without reference to their relationship to 
the whole or each other, i.e., with altered per- 
spective. Thus a statement is responded to in 
terms of its symbolic meaning without reference 
to its reality component, as a long term general- 
ization with reference to its immediate intent, 
etc. The staff member who responds to the frag- 
ment is pulled toward the sixis of orientation of 
the family member. The alteration of perspective 
in the staff member is a subtle process. It is 
often effective in altering the orientation of 
the staff member in the direction of the family 
nythology, particularly as it is made clear that 
this is the only way to obtain or maintain rela- 
tionship. 



-15- 



4. The concept of circular causality if found use- 
ful in considering the effect of the above noted 
process, in the creation of an altered reality. 
Thus conflict {A) in the family evokes the 
response in the staff (B) which is closely re- 
lated to the DQTthological expectation of (a). 
The response in the staff (B) then reinforces 
the validity of the projection of the conflict 
(a). This process of creating an altered reality 
which is valid in fact, as well as in keeping 
with the family n^rthology, is called the process 
of externalization, 

Intrafamily Mechanisms 

1, Each family has a specific set of family roles. 
These roles are not specific to the individual 
family members though one member may habitually 
play a particular role. Family members can trade 
roles with each other provided that the constella- 
tion of roles remains unchanged, 

2. The roles can most obviously be described in terms 
of the central axis or leit motif of the family. 
Each role embodies a major extreme position such 
that persons interacting from these positions will 
reenact the issues of the central conflict, 

3« Grossly at least, the issues of these central con- 
flicts embodied in the family mythology are readily 
related to the major deep and highly energized un- 
conscious conflicts in each family member. But 
the conflicts highlighted in the central axis, the 
leit motif, and the major roles are those conflicts 
which in addition to being in each individual, in- 
terlock between important individuals. 

4. The major structure of these families can be viewed 
as the result of a process of externalization, 
similar to that observed in the families' relation- 
ships to staff. One can observe the same evocation, 
polarization, and fragmentation of reality occurring 
within the family as was seen in staff-family rela- 
tionships. In observing the family in ordinary 
operation it is harder to be aware of the external- 
ization process for it is so pervasive. In the 
families, externalization is facilitated by marriage 
choice, child-rearing practices, etc. Though ongoing 
process of externalization is not as readily seen - the 



-16- 



previous findings point up that the externali- 
zation of internal conflicts has taken place. 
Also, when an individual family member, perhaps 
through his therapeutic work, makes an effort 
to introduce into the family relationships as- 
pects of himself which do not coincide with the 
image projected from other fajnlly members, then 
the processes which maintain externalization are 
observed to become more evident. 

Considering the above observations the intense 
close relationships apparently between family 
members can be seen as relationships based on 
the cathexis of that part of the other family 
member which coincides with the projections 
from self and is essentially then not removed 
from self except to acted out mirror reflections. 
The term narcissistic relationships seem specif- 
ically descriptive of this phenomena, 

5. In practice this system of narcissistic relation- 
ship is maintained by the suppression of recog- 
nition for relationship purposes, of autonomous 
behavior which does not coincide with the family 
nythology. Each family member is related to by 
the others in terms of the part of this person 
symmetrical with the role in which he is cast. 

It is considered that autonomous behavior other 
than than symmetrical as noted above is not given 
a negative relationship value, but rather has no 
relationship value, 

6. There is observed a strict, iron-clad rigidity 
about these families. It is considered that this 
is related to the need to suppress spontaneity but 
more specifically in these families. An important 
characteristic is the single-minded pursuit of 
concrete reality and corollary abhorence of ir- 
rationality. It is considered that this inability 
to directly deal with irrationality has much to do 
with the effort to alter reality to make the ir- 
rational rational, and when this fails, to project 
and externalize this conflict setting up the role 
in the family iiythology of the irrational one, the 
other family roles then being reinforced as the 
super rational ones. The role of the irrational 



-17- 



one is habitually occupied by the family member 
who manifests the psychotic symptomatology. It 
has been observed that the processes clinically 
manifest in the symptomatology called schizo- 
phrenia are an accurate caricature of the same 
processes which are covert within the family. 



-18- 

Child Reseaxch Branch 
Fritz Redl, Ph.D. 



Creation and Operation of a New Research F?icility 

A considerable amoimt of staff work during 1957 went into the 
planning and opening of the new Children's Treatment Residence and 
into the exploitation for research of unique observational possi- 
bilities that offer themselves only during such periods of transi- 
tion from one setting to another. While in terms of the research 
projects reported on in the annual report of 1956, this heavy re- 
focussing of research effort during 1957 constitutes somewhat of 
a detour, for the long range objectives of the research at the Child 
Research Branch it probably constitutes one of the most Important 
moves forward. 

The purposes served by the Residence are: 

1. To make possible the collection of research data on child 
patients when they have reached a level of recovery that 
makes their treatment in a closed hospital ward setting 
Inadvisable, \rtille they are not yet ready for full return 
to life in the open community. 

2. To explore the nature of the therapeutic milieu , including 
social structure and staff roles, that are required during 
this phase of treatment and to compeire it with the nature 
of environment most conducive to treatment in the earlier 
phases in a closed ward setting. 

3. To create concepts \rh±ch will enable us to describe the 
movement of patients into an improved state of mental health 
in terms as specific as one is now able to use for the des- 
cription of their pathology while still more fully in the 
grip of "mental disease." 

The Research Operations which were carried out in 1957 and 
\rtiich were closely related to the opening of our new research facili- 
ty, the Residence, were the following: 

1. Study of a group of "Normal Controls" - matched in I.Q., age, 
social background, and racial distribution with our patient 
group, while exposed to a week's life in the residence. 
Narrative recordings by staff and participant observers as 
well as more rigorously planned recordings by trained ob- 
servers using systematic observation techniques, were used 
as methods in this study. 



-19- 



2. Study of a group of children of nvirsery school age with 
symptoms of aggressive acting out during eight weeks on 
4-East, after the patients had been moved into the resi- 
dence. These children were exposed to a planned siimnier- 
nursery school program -t^ile under study and the material 
gathered on them should peirait comparison with similar 
behavioral expressions observed during two very differ- 
ent developmental phases. 

3. Study of child patients on 1<-East - eight children of aji 
age range around eight years, brought in for the purpose 
of a temporary stay on the ward for differential diagnosis, 
for a limited period of observation, ^fith two objectives 
in mind: 

a. widening the clinical data on children with similar 
symptoms by studying a larger number for shorter peri- 
ods of time I ajid 

b. selection of a group of new long-range child patients 
with a high degree of homogeneity in a number of variables, 
to be chosen on a more thorough basis than the usual fonns 
of direct intake into the ward would otherwise allow. 

Operation 1. and 2. were discontinued after the end of the sum- 
mer; operation 3. will continue for the rest of the year. 

The exploitation of the data gained during this period and com- 
parisons with data gained on previous control normals, as well as on 
our long-range patient group, is now being worked on but is not yet 
at a stage of completion tdiich makes a detailed report possible. 

Abstract of selected research activities as contained in the 
Project Reports for 1957° 

Individual Ttieareipy and Psychopathology 

While two children have been without a therapist since July 1957 > 
intensive recording has been done on the other four, who are being 
seen four hours a week in individual therapy. While much of this is 
still in the process of ongoing data collection, the materials avail- 
able now for the development of hypotheses of the children's pathology, 
as well as for the basic trends in problems of technique, are being 
worked on by the therapists, their consTiltants, and other research 
staff. Comparisons of later phases with data produced in earlier 
stretches of therapy, organized collation of therapy data with obser- 
vations gained from other sources, including the more strictly de- 
signed research projects, and with data gained about the pre-histoiy 
of the children, are among the tasks on which part of the effort of 
research staff is being focussed at this time. 



-20- 

Tentative findings: 
Psychopathology : 

1. Hyperaggressive children display a ja,thology ¥111011 combines 
aspects from childhood neuroses and psychoses to constitute 
a special syndrome. Although individual children differ in 
aspects of this syndrome, in all cases there are profound 
ego disturbances centering around problems of impulse con- 
trol, and particularly around the control of aggression. The 
ego disturbances are reflected in conceptual lacks, learning 
difficxilties, disturbances in conceptions of space and time, 
low tolerance for frustration, hyper -distract iMlity hy en- 
vironmental props, readiness for contagion, pai-anoid-like 
suspiciousness and projections. Despite these features, the 
children being studied here differ in many features from 
psychotic children. In particular, they do not show the 
autistic behavior and fantasies of the latter, they are gen- 
erally in communication with the environment, and under spe- 
cial circumstances they show marked ego-intactness. 

2. In all cases oral themes seem to play a major part in the 
underlying fantasies of these children. The children seem 
to interpret experiences via orally incorporative or des- 
tructive modes. Even material that seems initially to be 
predominantly phallic in tone, can be readily seen as a de- 
velopmental phenomenon superimposed on an anlage of primary 
oral concerns. 

3- Related to the above, one finds in these children intense 
anxiety over the possibility of dependency, and intense de- 
fenses erected against both behavioral and fantasy expres- 
sions of dependency. With progress these defenses seem to 
(diminish both in behavior and in fantasy productions. 

k. All of the children show severe problems in the formation of 
a sense of identity. These problems seem related to the ab- 
sence of or failure of figures who might serve as transmitters 
of cultural or subc\iltural values. In all cases there is ab- 
sence of a father, failure of the father to fulfill a role 
that might provide a source for social identification, or in- 
adequacy of the father as communicated to the child through 
the mother's perceptions. With all children the opportunity 
for establishing any relationship (even an anti -social one) 
with a social order seemed lacking. 



-21- 
Problems of Technique ;"-;!fr;j; 

1. Foremost among these is the broad observation that, contrary 
to beliefs popular in the field, individual psychotherapy 
with the hyperaggressive child is more like than unlike psy- 
chotherapy with other categories of disturbed children. As 
in all cases where ego development is weak or distorted, 
there is, especially in the early phases of treatment, great- 
er necessity for the therapist to function as an aiixiliary 
ego for the patient than is true in more classical neurotic 
cases; this , however, is no more than a difference in em- 
phasis, since it is well kno\m that child therapy always 
requires that the therapist play a partially educational 
role more than does adult therapy, by virtus of the fact 
that no child's ego is fully formed. 

2. A second impression is that the therapeutic process, while 
similar in course, is more prolonged than is the case with 
other kinds of children. 

3. Third, while limit setting plays an important role in all 
child therapy, it becomes partictilarly significant in treat- 
ing children vfhose most crucial problems lie in the area of 
control, fear of loss of control, and distrust of the adult's 
dependability and integrity in controlling both himiself and 
the child. Since fear of seduction (in both the narrow sexu- 
al meaning and the broader sense of seduction to Impulsivity 
of any kind) plays a major role in the psychodynamics of 
these children and seductive experiences often figure promi- 
nently in their history, it becomes a vital problem for the 
therapist to avoid confusing the wish to demonstrate his bene- 
volent intent %-rt.th seduction. Particularly in the earlier, 
more disorganized phase of therapy (which may be prolonged 
for many months and even a year or more), it may be a dis- 
quieting e:cperience for the therapist to find himself re- 
sponded to as though he were a dangerously hostile figure, 
and it is easy to become unxri.ttingly seductive in the effort 
to correct this projection. 

k. Many countertransference problems also have become apparent 
in this project. While the particular content of the counter- 
transference will no doubt vary \-ri.th the personality of each 
therapist, all those participating here have had to deal with 
feelings aroused by the need to meet such explosive barrages 
of raw destructiveness and with those aroused by the under- 
lying oral demandingness of such children, whose own fantasy 
certainly seems to be one of eating up the therapist. 



-22.- 

5- Impressions axe beginning to emerge as to specific interpre- 
tive techniques. In the earliest ph ases of treatment, \dien 
these children communicate largely through gross motor be- 
havior and acting out, it seems necessary to accompany the 
traditional resistance interpretations with fairly concrete 
behavioral responses to the child; it is as thou^ actions 
speak loudly while words at best mean little or, at worst, 
signify oral sadistic attack to this kind of child. later, 
as the child moves into a phase of more symbolic communica- 
tion, the interpretations also seem to need to shift; at 
this phase communication seems best to be achieved by cor- 
responding symbolic gestures on the part of the therapist, 
much as one answers a schizophrenic child's fantasy communi- 
cations within the framework of his own fantasy rather than 
by interpretive translation. It seems only to be in the more 
advanced phases of therapy, as the child becomes able to ver- 
balize directly about himself, that the weight of the inter- 
pretive effort can be shifted to direct discussion of the 
child's problems and their origins and remain effective. 
While all three levels of communication are present through- 
out therapy, there is a difference in their relative useful- 
ness at various phases. 

Milieu Therapy 

Under this heading are summarized a variety of research activities. 
The "level" on which research is carried on in this specific aspect 
varies all the way from naturalistic styles of data collection, the 
production or or^nized research data as part of projects with a special 
design and focused on limited variables and the development of con- 
cepts to the formulation of theories and hypotheses preparatory to 
later more rigorous selection of variables. Without going into detail 
the following highlights may be given special emphasis: 

Tentative findings: 

Concept of Milieu smd Breakdown of Vajiables 

1. It is possible to isolate about thirteen to fifteen distinct 
and relatively independently researchable sub-units of the 
milieu which seem to have behavioral impacts on the cMldren 
under study. 

2. At least seven quite distinct meanings are customarily in- 
voked when the adjective "therapeutic" is attached to the 
milieu concept, each one of them relevant in its own right, 
but in need of sharp separation for the utilization in an 
organized research approach. 



-23- 

3. A considerable list of properties of games, materials, props, 
tools involved in activities such as arts emd crafts, etc., 
can be isolated as of clinically distinct importance, and the 
therapeutic variation of these factors can be described in a 
considerable amount of detail. Effects of some technic[ues of 
employing such activities and of handling child behavior dar- 
ing the process can be distiactly seen as differing in their 
effect on the children from others, so that the groundwork 
for a more organized pharraacopaea mentioned as one of our ob- 
jectives, can be seen to emerge. Such factors as have been 
Isolated by now can be described in sufficient detail and 
precision to make them teachable to others and approachable 
in sharper research design in later studies. 

k. Techniques for the clinically geared observation of surface 
behavior on the spot can be developed so that they avoid the 
traditional gap between obser^-uble surface data on the one 
hand and depth-psychological dynamics on the other more suc- 
cessfully than in the past. 

Life Space Interview 

Copious material collected for the piirpose of exploring eind 
struct\iring this technique, described in 1956, has been added to. 
A preliminary fonmilation of basic theory and technicaJL principles 
were submitted for discussion to professional groups at the 1957 
Orthopsychiatric Conference; parts of this are in the process of 
publication in the American Journal of Orthopsychiatry. 

Tentative findings: 

1. Bie variety of purposes for which treatment staff uses Life 
Space Interview techniques can be ordered around the follow- 
ing sub -goals which emerge most frequently in in-patient 
treatment of children with aggressive disturbances: 

a. Clinical Exploitation of Life Events, under vihich dis- 
tinct categories have been temporarily singled out under 
the following labels: (l) reality-rub -in, (2) symptom 
estrangement, (3) revitalization of numb value areas, 
(k) new tool interpretation, (5) manipulation of the 
bo\uidaries of the self. 



-2/r- 

b. Emotional First Aid on the Spot with subcategories 

temporarily classified under the following code labels: 
(l) drain-off of frustration annoyance, (2) communica- 
tion mainteimnce in moments of relationship decay, (3) 
support for the management of panic, fury and guilt, 
(k) regulation of behavioral and social traffic, (5) 
umpire functions in decision crises and in cases of 
loaded transactions. 

2. In terms of exploration of Criteria for the indications 
or contraindications of holding Life Space Interviews in 
a given situation, and of the choice of a specific tech- 
nique, the following 6 subcategories of areas of major 
relevance have emerged: 

a. central theme -relevance 

b. ego proximity and issue clarity 

c. role compatability 

d. mood manageability 

e. timing 

f. Impact of terrain and props. ■' ■ 

3. On the basis of preliminary work a number of similarities 
were found between techniques employed by interviewer in 
Life Space and in Play Therapy Interviews. Among the dif- 
ferences in the techniques employed in the two types of 
interviews were the following: 

a. As expected, play is used less frequently in Life 
Space Intei*views. 

b. Techniques of control were used more frequently by 
Life Space Interviewers. 

c. While there were no differences in the amoiint or spe- 
cific techniques of interpretation used in the two 
types of interviews, there were differences in the 
direction of interpretation: In Play Therapy Inter- 
views interpretations were directed more frequently 
toward impulse, whereas in Life Space Interviews in- 
terpretations aimed relatively more frequently toward 
resistance and defense. 

Learning Dibourbances 

The major objective of the research on Learning Disturbances 
carried on at the Child Research Branch is to arrive at a sharper 
differential diagnosis between those disturbances of learning which 
are intimately linked -up with the basic pathology of the children 
and those which are a result of previous learning failixres or of im- 
portant behavioral or cognitive learning blocks. 



-25- 

In order to isolate the variables that go into the success or 
failxrre of a specific learning task and •sdaich make a given learning 
sitiiation either destructive or supportive for the learning process, 
our study focused especially on the problem of motivating the children 
toward learning activities, of exploriixg the type of "situational in- 
gredients" at work and of assessing the nature of certain specific 
leaming disturbances that seem to occur with frequency in the type 
of hyperaggressive child patient under study here. School records 
distributed over a 27 month period were sampled, rated in terms of ^ 
variables involved, and later reliability was checked by use of judges 
not connected with IHIMH. Chajiges in school behavior of 6 children 
were studied by comparing ratings for two halves of the sample by 
time. ClinicaJ. analyses were undertaken on the learning problems of 
each child and on special sources for anxiety in both, children and 
staff, with respect to the learning situation. With the new group 
of child patients on 4-East, methods are being developed on the basis 
of the previous studies and are focusing aroimd the following: 

1. Planned variations of school program to provide examples 
of behavior in different settings (individual, group; 
formal, informal), with different materials (verbal, 
manual -manipulative, etc.), and different content. 

2. Participajit and non -participant observation. 

3. Analysis of observations to isolate variables and to devel- 
op systematic methods of describing the variables. 

Tentative findings: 

1. A behavior Rating Scale, which can be used reliably in 
judging school incidents for adjustive behavior, was developed. 

2. Over the period of 27 months the children changed significant- 
ly in the direction of better school adjustment. 

3. Categories for describing clinical factors accounting for 
school behavior and behavioral change were developed, and 
it was demonstrated that they could be used reliably in 
judging school incidents. ISae clinical factors in the 
learning situation cam be subsumed under three major 
categories : 

a. Self (self picture; inner pressures and forces; infan- 
tile needs and frustrations) 

b. Relationships (to adults; to peers) 

c. School (subject matter, methods, material; teacher 
personality. 



Behavioral Measurements and the Assessment of Change 

An Important part of our research effort has always been geared 
in the direction of better methods for observing and describing child 
behavior and toward the development of categories of recording that 
would make it possible to catch the clinically relevant issues of 
"change." Several studies in that line were reported previously. Dur- 
ing 1957 several additional methods were tried. Among the studies 
undertaken during this year are the following: 

1. Systematic observations in a variety of settings and coding 

of individual interactive behavior during two treatment phases. 

2. Systematic observations done on a control group of children, 
matched for age, I.Q., race, socio-economic status. 

3. Categorization derived for detailed descriptions contained 
in clinicaJ. records and case conference materials. 

U. Periodic interviews and collections of clinical incidents 
from Child Care Staff. 

5- Exploratory interviews with child care and therapy staff 
directed at staff's concept of change and improvement g ^r i f^ 
matched with their actual statements about observed func- 
tioning of their patients. 

Tentative Findings: 

Among them is one, especially, that makes it possible to list 
"findings" gained so far, as a result of investigations by means 
of the Leary-Ossorio technique ;diich were made in two series, a 
year and a half apart, and from idiich the following suggest themselves: 

1. Changes in b eh avior interaction patterns. From the inves- 
tigation of two series of observations made a year and a 
half apart, the following major conclusions can be drawn: 

a. The interpersonal behavior of the children has changed 
considerably in the course of treatment. 

b. Over the period there is a decrease in inappropriate 
behavior toward peers. Most children show a trend 
toward more friendly peer relationships. 



-g7- 

c. Changes in relations with adults are much more marked 
than changes in relations with peers. Hostility to- 
ward adults decreases considerably. Particularly there 
is a decline in hostile -dominant Isehavior and an in- 
crease in friendly -passive behavior toward adults, with 
a major increase in trusting, dependent expressions. 
Inappropriate behavior also decreases considerably. The 
distinction between behavior toward peers and behavior 
toward adults gets sharpened. 

d. The behavior that the children evoke from others shows 
corresponding changes. Children are less hostile than 
they were in response to a particTilar child. Adults 
show an increase in the proportion of friendly, giving, 
supportive behavior with the children. 

e. Different behavioral settings produce different quali- 
ties of interpersonal behavior. 

f . There is an interaction between person and situation 
that goes beyond what either contribute independently 
to ovir ability to predict behavior. That is, althou^ 
there axe generalizations, settings also operate differ- 
entially for different children. 

g. The effects of settings differ in the two phases. Ten- 
tatively, it would seem that in the later phase of treat- 
ment the situation comes to play a greater role as a de- 
terminant of behavior than it did previously. 

h. Changes in interpersonal behavior appear more readily in 
some settings than in others. 

i. A paper on some of these findings was presented at nation- 
al meetings and is in process of publication. Data analy- 
sis is near completion and another paper is being worked on. 

2. Concepts of Improvement: 

a. Formulations of clinically relevant concepts of improve- 
ment are xindergoing continuous change as onxr study pro- 
ceeds, and temporary findings axe as yet too volatile 
to be reported this year. 

b. A pilot study for the collection of data on the staff's 
concept of improvement as related to our present child 
patients is in a state of partial completion. Preliminary 
impressions indicate that the children have improved in a 
number of areas. Especially, hostile interactions between 
children have decreased and acceptance by the children of 
staff interventions has gone up. Other details about im- 
provements are too varied from child to child or require 
too much background data to be summarized here. 



Next Step Plans 

The activities reported oa here s.re ?iot really to be considered 
as a nimber of research projects with relatively independent objectives. 
They are, with some exceptions, more is, t!he :aature of a research pro- 
gram rather than a sequence of projects o 

During the next years it is intended: 

1. To bring to a state of closui-e those phases of the program 
and to finish up -those studies ^±dch ai'e i^, the nature of 
relatively limited "project type" investigations and to 
publish them in form of a paper or article for a scientific 
journal during 1958 or 1959 » 

2. To pull out of the larger material such sections as can be 
reasonably closed out as independently reportable findings 
and to publish them as articles cr books. Among these, 
some will be on the level of articles in scientific periodi- 
cals or books on therapy techniques directed primarily to- 
ward the research field. Others, by the very nature of the 
program will combine research findings with directives to 

be used for staff traini??^ or for application by practition- 
ers in the field of Psychiatric In-Ifetieat Trea-bment of 
children, and will be addressed to ee.ch of the disciplines 
involved in psychiatric Residentisl Ttierapy. 

3. In order to fulfill the major objective of the research 
program, namely the study of the t.veatment process during 
its full duration from hospitalisation back to reinstate- 
ment into normal comnroriity functiorrLag, several groups of 
children with similar pathology i^^Lll be taken through their 
full course of therapy. TH-iis is a condi.tioa sine qua noa 
for coming closer to the task of creating diagnostic con- 
cepts which will either verifj' our hypothesis tJaat these 
child patients constitute a specific nosological entity. 

If the findings should cjiae out in terms of e preference 
to maintain them as if a ''borderline" category, to fill this 
category with enough specific content to make prescriptions 
and predictions more reJJ-able aad to separate them more 
sharply from borderline cases of other types. We plan to 
use the next years for the completion of this task. 



-29- 

CLINICAL NEUROPHAEMACOLOGY KESEAECH CEMER CLINICAL INVESTIGATIONS, 
NATIONAL INSTITUTE OF MENTAL HEALTH MD SAINT ELIZABETHS HOSPITAL, 

Joel Elkes, M.Do 

The Clinical Neuroptiaimacology Research Center, now in the pro- 
cess of being established as a Joint project between the National. In- 
stitute of Mental Health and Saint Elizabeths Hospital, is a Clinical 
Laboratory intended primarily for the study of the action, and the 
mode of action, of drugs on mental function in man, with special, re- 
ference to their bearing on problems of mental disorder. 

The location of the Center at Saint Elizabeths Hospital was 
thought appropriate for a number of reasons. In the first place, it 
was felt from the outset that such a program would gain greatly by 
being initiated and maintained in a large modern mental hospital, 
where abxindant and varied clinical material would make for the con- 
duct of controlled large scale trials of pharmocotherapeutic agents, 
as well as the ready selection of suiitable case material for special 
intensive investigation of individual conditions and syndromes. 
Furthermore, it was thought desirable to expose the investigators 
working in the field to the, in many ways unique, phenomena present- 
ed by mental illness in a mental hospital; and thus familiarize them 
with the special research problems presented by a mental hospital 
population. Equally, it was hoped that the contact of the clinical 
staff of the Hospital with scientists working amongst them would make 
for a more ready appreciation of the role of each in a common research 
program. The Saint Elizabeths setting, with its long tradition of 
clinical care and teaching, and its high standard of resident staff 
therefore seemed to provide a unique opportxmity for the pursuit of 
such collaborative research into the biology of mental illness. Its 
location within the Washington area, and within ready access of the 
Clinical Center will, make for ready interaction between it, and the 
resources and special services of the Clinical Center. Essentially, 
therefore, the functions of the CNPRC" and the work of other labora- 
tories at the Clinical Center are envisaged as complementary and in- 
terdependent. It is, in fact, plajmed that a number of long range 
programs will be conducted with the active and sustained collabora- 
tion of the laboratories of Clinical Science, Psychology, Adult Psy- 
chiatry, Socio Environmental Studies; the Biometrics Branch of NIMH; 
and the Psychopharmacology Service Center. The full yield of the 
scheme of necessity hinges on the degree and the intimacy of this 
interaction. 

A further featiore ^ich, with increasing experience, may grow 
in importance may be the steady defixiition and growth of methodologi- 
cal tools specially adapted for the study of large mental hospital 
populations and their interaction with the community. It is hoped that, 
in time, coiirses in Research Method in these special fields will emerge 



-30- 

as a direct outcome of collaborative studies between CHPRC, Saint 
Elizabeths, and. the appropriate laboratories of KIH. 

For the present, three broad Sections are envisioned for the 
CHPRC. These are the sections of Clinical Psychiatry, Chemical Phar- 
macology and Behavioral Sciences. Only the broadest indications of 
the programs of each can be given at the present stage. 

1. SECTION OF CLIHICAL PSYCHIATRY 

One of the early functions of the Section of Psychiatry will be 
a systematic survey of the existing population of Saint Elizabeths 
Hospital, with special reference to the assessment of the impact of 
pharmocotherapies on the existing services of the Hospital. It is 
common knowledge that the immediate management and treatment of the 
acutely ill patient has been altered. Large groups of chronic pa- 
tients heretofore secluded in the continuous treatment wards of the 
hospital have been mobilized, and new categories of patients, with 
special needs of their own, may well be emerging. Also, such reha- 
bilitative measures as have been empirically achieved have increased 
and made more urgent the contacts between the mentaJ. hospital and 
the commimity. Acciorate figures in all these respects, however, are 
not readily available at present. Nor has the impact of the new 
therapies on staff attitudes and staff skills and on the emergence 
of novel responsibilities for ward personnel been systematically as- 
sessed. In conjunction with the Laboratory of Socio-Environmental 
Studies, the Psychological Laboratory, and the Biometrics Branch of 
NIME, it is hoped to give early thought to the design of a series of 
documents aimed at answering certain specific questions relating to 
these various areas; to test and recalibrate these in different 
therapeutic settings of the hospital; and, in the light of experi- 
ence, adopt some dociunents \&Lch would with reasonable accuracy 
measure subjective and objective change in the patient and the en- 
vironment within which he functions. It is hoped to reduce these 
data to a statistically manageable form, and to apply them to wider 
populations than the one for which they were originally intended. 

The design of the above documents will proceed pari passu with 
the design and calibration of documents used in a study of the placebo 
response, and the systematic trial of new agents. It is hoped that 
these studies will be conducted in conjunction with the Psychopharma- 
cology Service Center. 

A further function of the Section will be to determine and classi- 
fy the mental and somatic responses to established and new dr-ugs in 
relation to the nature of the individual illness, the phases and the 
changing patterns of the course of an illness and the genetic back- 
ground of the individual patient. Relatively little is known of the 
relation of drug reactivity patterns, in either mental or metabolic 



-31" 

terms, to genetic factors. It is intended to single out a few selected 
syndromes^ such as the depressive syndrome^ certain phasic mental dis- 
orders, and stable schizophrenic states., for intensive clinical, psy- 
chophysiological and metabolic studies.. "Hiese will be conducted in a 
metabolic ward and will, aim at establishing correlates between clini- 
cal, somatic, biochemical and endocrine responses to graded doses of 
individual drugs and metabolites | and by the use of suitable techniques 
(including animal techniques - see below) at defining the relationship 
between biochemical events in tissue fluids, and intra-cerebral events. 
•The interplay between the nervous, and the endocrine systems may be 
particularly relevant in this context; and may perhaps, in time, con- 
tribute to a definition of prognostic indicators in the choice of indi- 
vidual drugs for particular syndratnes. Furthermore, it is hoped that 
drugs discrimlnately used may lead to the recognition of pharmacologi- 
cal and biochemical cleavage planes between syndromes bearing a super- 
ficial clinical resemblancei and thus contribute to a clearer classi- 
fication of the phenomena of mental disorder than has been possible on 
clinical grounds alone. 

2. SECTION OF CHEMEGM. FHABMACOLOGY 

The activities of the Section will be closely related to both 
the functions of the Section of Psychiatry and the Section of Beha- 
vioral Sciences. In the clinical field, this Section will be responsi- 
ble for the conduct of hiunan studies in intermediate metabolism, and 
the establishment of the biochemical correlates of drug reactivity 
patterns in the individual patient. Also, using tracer techniques, an 
attempt will be made at a clearer recognition of the relationship of 
systemic biochemical events to events within the central nervous sys- 
tem. The precise metabolic pathways affected by selected drug, and 
the metabolic fate of drugs will also be studied. 

In the experimental field it is intended to carry further the 
examination of the effects of drugs en enzymatic processes concerned 
in the synthesis, storage and release of neurohumoral agents within 
the brain, with special reference to the possible existence of three 
types of drug receptors related, respectively to a naturally occur- 
ring choline ester, catecholamine, and indole. It is hoped that 
attention will be directed toward the effect of drugs on the opera- 
tion of hormonal mechanisms, within and outside the central nervous 
system, with special reference to pituitary function; and, at a more 
cellular level, to an examination of drug effects on carbohydrate and 
nucleotide metabolism in the central nervous system. The fluorimetric 
and tracer methods used in these studies wi3J. be intimately related 
to pairallel pharmalogical and electrophysicologieal studies in the 
Section of Behavioral Sciences. 



-32- 

3- SECTION OF BEHAVIORAL SCIENCES 

The work of the Section of Behavioral Sciences will be closely- 
related to the work of the other Sections, and also to some studies 
currently in progress in the laboratories of Clinical Science and 
Psychology at the Clinical Center. In the human psychological studies, 
particular attention will be paid to the processes of attention, 'set', 
sensory discrimination, and learning in the schizophrenic and depressed 
patient in various phases of illness, and the effects of drugs upon 
these processes. An attempt will also be made to establish objective 
measiores for those aspects of thought disorder \diich are characteristic 
of the schizophrenic syndrome, and which are measurably affected by 
drugs. Somatic measures will center on vaa:ious aspects of autonomic 
and fine motor function, and the spontaneous and induced electrical 
activity of the brain. 

These studies will be linked to studies of the effect of drugs 
on the function of sensory pathways in the experimental animal, with 
special reference to the coding and transformation of information 
along various levels of integration within a sensory pathway. Micro - 
electrode techniques will be used in these studies, emd an attempt 
will be made to link concepts of modem information theory to data 
obtained in physiological eind pharmacological experiment. The opera- 
tion of highly patterned inhibitory fields operating within the central 
nervous system may be relevant in this context. The capacity of the 
brain as an information-storing, matching and predicting organ is dis- 
turbed in certain stress states, in drug induced states, and in schizo- 
phrenia. These disturbances may have their chemical corollaries. It 
may, therefore, be appropriate to carry out these studies in a hospital 
setting where clinical disttirbances in the hajidling of sensory informa- 
tion, though not uncommon, have not so far received the experimental 
scmitiny they merit. 

A further aspect which it is hoped to pursue in this Section is 
the systematic study of the electrophysiological equivalents of learn- 
ing in the normal animal, and in animals subjected to either anatomi- 
cal or biochemical lesion. Techniques in this regard, though still 
at an early stage of development, promise well, and may gain by being 
linked to the techniques used in the studies in the sensory physiology 
field. 



-33- 

lABORATORY OF CLINICAL SCIEHCE 
Seymour S. Kety 

The area of interest of the Laboratory of Clinical Science lies 
in the application of the biological sciences to the problem of mental 
disease. The individual sections of which the laboratory is com- 
posed, representative of the various biological disciplines, work 
freely within this broad field concentrating upon certain clinical 
or basic studies which they pursue independently or in collabora- 
tion with each other or with other laboratories and institutes. 
In July of this year a second ward was placed under the direction 
of this laboratory, making possible the initiation of a long-range 
multidisciplinary program of studies in the biological aspects of 
schizophrenia. Since this is expected to be the central program of 
the laboratory for the next several years, some discussion of its 
historical backgroimd and methodological approach seems warranted. 

Biological Aspects of Schizophrenia 

There is a long history of theories and findings which postu- 
late or purport to demonstrate characteristic biological changes 
which operate at a fundamental level in this important field of 
neuropathology, where definite pathological change in the brains 
of schizophrenics was reported by Alzheimer in 1897 and by Mott in 
1920. More carefully controlled studies by Dunlap in 192U and Conn, 
ten years later, failed to reveal significant changes from the normal, 
so that at the present time there is no pathological change general- 
ly accepted as characteristic of this disease. More cogent has been 
the evidence acquired by studies of its genetic aspects. Studies by 
Kallmann of a large population of schizophrenics had shown a high 
incidence of mental illness in their immediate families, an inci- 
dence which increased progressively with consanguinity, making it 
compatible with but by no means proof of the genetic factor. Studies 
on uniovular and biovular twins by Luxemberger in I928, Rosanoff in 
193^^ Ballmann in 19^6, and more recently. Slater in 1953 have shown 
a concordance rate in the imiovular twins varying from 60 to 86 per 
cent, with a concordance rate in the biovular twins identical with 
that in siblings, which is about 10 to ik per cent. Although none 
of these studies is free of important methodological defects which 
would tend to exaggerate the concordance rate in uniovular twins, 
the close agreement in the concordance rates by several investiga- 
tors using somewhat different approaches and studying patients in 
different coiintries strongly suggests an important genetic element 
in at least a large fraction of schizophrenics o 



-34- 

In the field of electrophysiology, as eaxly as 19U1 Finley 
reported a higher incidence of elect roencephalographic abnormali- 
ties in schizophrenia (28 per cent as compared with 7 per cent in 
normals). A series of reliable investigators have confirmed this 
high incidence with frequencies rajiging from 23 to 60 per cent in 
this disease. These findings are compatible with the reports by 
Heath and by Sem-Jacobsen of pajT'oxysmal spiking activity in deeper 
cerebral structures in a large percentage of schizophrenics. The 
electroencephalographic evidence has formed the basis for the cur- 
rent project by Evarts, McDonald, Pollin, Snyder, and Butler on 
behavioral and biochemical correlates of the electroencephalogram 
in schizophrenia, \diere preliminary studies have revealed at least 
one positive correlation with biochemical changes in the blood. 

Although there has been some emphasis on the endocrinologic 
changes in schizophrenia in the past, there is little confirmed evi- 
dence of endocrine disturbance in this disease which cannot readily 
be explained as being secondary to the anxiety and stress vhich 
characterize this condition. The same comment is true of circula- 
tory changes. In his current project in this area. Garden has foiind 
little cardiovascxxlar deviation except for a diminished ballistocardiogram. 

There has been much speculation concerning distvirbances in the 
circulation and energetics of the brain in schizophrenia. The Section 
on Cerebral Metabolism and the Section on Psychiatry have confirmed 
and extended previous work in this field in showing that although 
there may be a correlation between certain mental states emd cere- 
bral oxygen consumption, there is no abnormality either in circiila- 
tion or total oxygen consumption of the brain in schizophrenia. 

Much of the biologicsLL work and many of the findings have been 
in the field of biochemistry as related to schizophrenia. There is 
some agreement in the literature of some disturbance in carbohydrate 
metabolism, i.e. a reduced glucose tolerance and an increased insulin 
tolerance, although to ■vdiat extent this is primary is in doubt. 

Many of the biochemical studies in the recent past have concen- 
trated on various aspects of protein and amino acid metabolism. Gjes- 
sing in Norway first showed -a correlation between nitrogen balance and 
the mental chemges of periodic catatonia. More recently, there have 
been reports of altered excretion patterns of amino acid and phenolic 
amines in schizophrenia by Williams and by McGeer and their respective 
associates, findings which have not generally been confirmed. One 
major program of the laboratory is a systematic examination of the 
metabolism of certain amino acids (e.g. phenylalanine, tyrosine, tryp- 
tophane, histidine, glutamine) in normal man and in patients suffering 
from schizophrenia. 



-35- 

There are at the present time three hypotheses^ widely held, if 
poorly supported, for a significant biochemical mechanism in the patho- 
genesis of schizophrenia. Iliese involve, respectively, epinephrine, 
ceruloplasmin, and serotonin. The epinephrine hypothesis postulates a 
disordered metabolism of this hormone in schizojiirenia with the produc- 
tion of toxic schizophrenogenic substances » It is based upon the un- 
confirmed finding of Osmond, Smythies, and Hoffer of hallucinogenic 
properties in adrenochrome and adrenolutin, and on the finding by Leach 
and Heath of a more rapid oxidation of adrenaline in vitro by schizo- 
phrenic serum. McDonald and the Section on Medicine have confirmed the 
latter finding but have shown further that it is related to and probably 
explained by the low levels of ascorbic acid usually found in unselected 
schizophrenics. Since there is no evidence for the formation of adreno- 
chrome or adrenolutin in vivo in normal or schizophrenic man, a project 
is under way in the laboratory which is studying the effects and fate of 
this important hormone in these two popislations . 

An elevation in the copper -containing globulin, ceruloplasmin, in 
the serum of schizophrenics was first reported in 1955 "by Ozek in Ger- 
many, and in 1956, Leach and Heath demonstrated that it was the impor- 
tant enzyme in the in vitro oxidation of epinephrine. In 1957 Akerfeldt, 
in Sweden, applied the dimethyl -paraphenylenediamine test for cerulo- 
plasmin to schizophrenic serum and showed that the positive reaction 
was related both to an increased ceruloplasmin and a decreased ascorbic 
acid. In the past year, McDonald and his associates in the Section on 
Medicine have shown further that ceruloplasmin is not characteristically 
high in schizophrenia, and that the positive Akerfeldt test in this di- 
sease is more the resxilt of a low ascorbic acid v±iich is probably on a 
dietary basis, since he was able to demonstrate normal levels of this 
vitamin and a negative Akerfeldt test in schizophrenic patients at the 
Clinical Center kept on an adeq.\iate normal diet. This interest in cerulo- 
plasmin has prompted the initiation of a project by Hansen in the Sec- 
tion on Cerebral Metabolism on copper metabolism in normals and schizo- 
phrenics. An outgrowth of the ceruloplasmin hypothesis has been the 
reported isolation by the group under Heath of a substance, taraxein, 
reported to be an altered form of ceruloplasmin which they find capable 
of producing certain of the manifestations of schizophrenia on injection 
into prisoner volunteers. Bobbins aoad Smith, on the other hand, have 
been unable to confirm these findings. The laboratory awaits better 
characterization of this substance and more reproducible techniques for 
its production before attempting to eval\mte these reports. Interest 
has also been aroused in the laboratory by the preliminary report of 
Winters of the ability of small doses of schizophrenic serum to pro- 
duce behavioral chaages in the rat. A discussion has been arranged 
with Winters for the purpose of working out some eollabozative vali- 
dation of these findings. 



-36- 

The hypothesis that an abnonnality in the metabolism of seronto- 
nin occurs in schizophrenia stems from the discovery by Hofmann in 19^3 
of the hallucinogenic properties of lysergic acid diethylamide and the 
demonstration by Gaddum and Woolley, independently, of an anteigonism 
between this substance and serotonin. Rirther support has been found 
in the demonstration by Udenfriend, of the National Heart Institute, 
of the presence of enzymes for the formation and destruction of sero- 
tonin in various parts of the brain, the isolation by Homing of the 
NationaJ. Heart Institute of dimethyl -serontonin from the cohaba bean, 
and the demonstration by Isbell, of the NB4H Addiction Research Center, 
that dimethyl-serontonin possesses hallucinogenic properties. This 
hypothesis is compatible with findings of Brodie's group in the Nation- 
al Heart Institute of a release of brain serontonin on the administra- 
tion of reserpine and the behavioral effects reported in animals and 
man of the administration of marsalid which increases the brain sero- 
tonin content. The only evidence at hand, however^ for an actual dis- 
turbance in serotoain metabolism in schizophrenics is the finding by 
Zeller that such patients fail to show the normal increase in 5- 
hydroxyindoleacetic acid which he has found to follow the administra- 
tion of tryptophane. Several projects contemplated or initiated as 
peurt of the amino acid metabolism program of the laboratory propose 
to test the metabolism of tryptophane and serotonin in schizophrenic 
patients . 

Even a casual review of the literature reveals no dearth of 
positive findings in schizophrenia from every biological discipline. 
On the other hand, it is extremely difficult to find any T^rtiich have 
been confirmed by others or for which there is evidence that they are 
characteristic of a si^iificant proportion of schizophrenics and fun- 
damental to the process rather than being completely secondary to the 
disease or to present methods of its treatment. TSiere appeatr to be 
at least two factors operating to produce this unfortunate state of 
affairs, in addition to the emotional domination and tendency to re- 
port preliminary results quiclsly and widely which seem to character- 
ize research in those diseases which constitute important national 
problems. The diagnosis of schizophrenia, being entirely phencmeno- 
logical and clinical and without etiological bases, is apt to include 
a number of different diseases with a common symptomatology. This 
would introduce major sampling errors in studies on relatively small 
samples, especially idaoee limited to a population at a single institu- 
tion as practically all of lihese studies have been, and might help to 
explain the extremely large variability in biological data obtained 
on "schizophrenics" and the infrequency with wfeich these are confirmed 
by subsequent investigators. Perhaps a more important factor has been 
the general fall\ire to control the impoirtant non-disease variables, 
which are either secoaadary symptomatic featxzres of the disease or 
which £ire associated with the chronic hospitalization to which most 
of the patients are subjected. Dae "controls" for most of the 
studies in schizophrenia have been hospital or laboratory staff under 
normal conditions of life. 



-37- 

We feel, nevertheless, that this is a particularly propitious 
time for a major effort in this field, hopefixLly avoiding or, at 
least, attempting to minimize some of the methodological pitfalls 
to which previous studies have been subject. The recent twin studies 
of Kallmann and Slater, confirming and extending those of previous 
workers, strongly suggest an important role for biological factors 
in the etiology of many types of schizophrenia. In the past two 
decades the field of intermediary metabolism has been largely xra-it- 
ten and a wealth of basic information made available on possible 
biochemical mechanisms which have been studied only partially in 
normal man and practically not at all in schizophrenia. There are, 
furthemiore, certain new techniques which were not available to 
previous studies: chromatography for the separation of large num- 
bers of constituents, various techniques of spectrophotometry v.Gi- 
lizing ultraviolet, infrared, or fluorescence for the sensitive 
detection and quantification of chemical substances, and the use 
of isotopic techniques for the tracing of metabolic pathways in man. 

Dr. Perlin and the Section on Psychiatry has given considerable 
attention to the problem of selection of patients, in an effort to 
minimize the incidental and non-disease variables in the sample and 
to maximize within the sample the incidence of those fonns of the 
disease in which genetics and biological factors operate signifi- 
cantly. These patients are housed in the Clinical Center and main- 
tained under optimal dietary and therapeutic care in conditions 
which tend to provide a normal amotmt of activity, and with appro- 
priate psychotherapy designed to minimize the disturbance snc- the 
anxiety associated with the institutionalization and with tlie obser- 
vations themselves. The schizophrenic group is controlled by means 
of a population of normal individuals, maintained as much as possi- 
ble under similar conditions of diet, activity, and management. 

These two controlled populations offer to the members of the 
laboratory and to other interested investigators a unique opportu- 
nity to test various hypotheses relating to schizophrenia and to 
correlate their findings with those of others in different fields 
who have studied the same population. Reference has already been 
made to some of the specific projects now under way or being initia- 
ted which include studies on electroencephalographic changes, the 
effects and fate of epinephrine, blood levels and metabolism of 
glutathione, copper, ceruloplasmin, and ascorbic acid, and the meta- 
bolism of such amino acids as tryptophane, histidine, glutamine, and 
tyrosine . 



-38- 

KESEARCH OF THE SECTIONS 

The Section on Psychiatry under Seymour Perlin has concerned 
itself with psychiatric variables and their correlations with hio- 
logical measirrements o In the past year an interesting relationship 
has "been discovered between cerebral oxygen utilization and certain 
personality traits or the psychological state of the individual at 
the time of the procediire. These studies are being extended to de- 
termine whether the relationship is maintained. A careful psychia- 
tric study by Pollin and Perlin of normal volunteers has elucidated 
a very high incidence of significant psychopathology which was high- 
ly and inversely correlated with the extent to which external factors 
operated in the volunteering process o This represents a contribution 
of considerable significance in clinical investigation on volunteer 
populations. Reference has already been made to the excellent theo- 
retical study and practical achievement in the problem of selection, 
of an adequate population for biological research in schizophrenia. 

The Section on Physiology under Edward Evarts has continued its 
program of studies related to the correlations between drug action, 
behavior, and electrophysiology. By meajis of chronically implanted 
electrodes in trained, conscious animals, clear-cut differences be- 
tween the cortical effects of hypnotic and ataractic drugs have been 
demonstrated. The absence of cortical depression by the latter group 
may help to explain the selective behavioral effects of these drugs. 
Clinical psychological studies by Kornetsky on a number of centrally 
acting drugs have revealed significant effects on intellect^^al, motor, 
and perceptiial skills by meprobamate in normal subjects. In schizo- 
phrenic patients single therapeutic doses of chlorpromazine or seco- 
barbital produced similar impairment of intellectual, motor, and per- 
ceptual functioning, but during chronic administration of these agents, 
the deficits associated with chlorpromazine disappeared. 

One of the major interests of the Section on Medicine, headed by 
Roger McDonald, has been the interrelationship between the nervous and 
endocrine systems as Indicated by the hypothalamico-hypophysial sys- 
tem. In the past year McDonald has evaluated a widely held concept 
that pitressin is the neurohormone which directly stimulates ACTH re- 
lease from the anterior pituitary gland. In a series of crucial ex- 
periments he has shown that pitressin and ACTH release can occur inde- 
pendently of each other and that morphine, which acts on the central 
nervous system, effectively blocks the ACTH release associated with 
pitressin, thus demonstrating that the pitressin effect is not a direct 
one upon the anterior pituitary gland. The studies of McDonald and 
this section on many of the biochemical dist'urbances thought to be 
associated with schizophrenia, highlighting nutritional factors as 
their probable cause j have already been mentioned. They have brought 
a new and critical approach to the field of the biology of schizo- 
phrenia, an approach much needed lest this Important interest be 
stifled in its very reawakening by overenthusiastic and undercritical 
conclusions. 



-39- 

Laboratory of Psychology 
Dr„ David Shakow 



As has been pointed out in previous annual reports, 
the program of the Laboratory, despite having certain clear- 
cut areas of activity such as is represented by the separate 
Sections, is best viewed as a whole and in mutual context „ 
I shall therefore combine the report on the activities of 
the seven Sections which comprise the Laboratory without mak- 
ing a distinction as to source of support — Clinical Investi- 
gations or Basic Researcho I shall concern nyself first with 
reports on the status of various studies and then consider 
other material of relevance as an annual report o 

Although there are still four important programs which 
have not reached the stage where they may be considered as , 
actually launched, the rest of the work of Laboratory in this 
fourth year of activity is well under wayo This, despite the 
fact that two Section Chiefs, those in Personality, and in 
Learning and Perception, have not as yet been appointed,, It 
appears, however, that the first problem will be solved as 
of the middle of next year, and various plans are afoot to 
solve the secondc In the meantime, the Acting Chiefs of the 
two sections have worked most conscientiously at their tasks 
of keeping the administrative machinery going. 

Although some work has already started, the major 
program in relation to schizophrenia is still to be worked 
out. With respect to the research to be carried out on wards 
3-V/ and 3-E some preliminary planning is in progress but 
largely it awaits the coming of the new Chief of the Adult 
Psychiatry Brancho We are most anxiously awaiting this de- 
velopment since it will afford us an opportunity to deal with 
more molar and social aspects of schizophrenia — a necessary 
complement to other kinds of schizophrenia research we are 
carrying on and planning. Since this summer we have been 
carrying out a series of studies on wards 4--W and 2-W, but 
these have been considered largely pilot projects to develop 
methodology and refine our concepts. The principles for the 
selection of patients and controls on these wards having been 
established, we are now ready to enter with a more definitive 
program. The schizophrenia program to be carried out at 
St, Elizabeths Hospital is in part awaiting the completion 
of the construction which is going on there at the present 
time and the period of basic relation-building which 
Dr, Elkes is now in process of carrying out in this new 
set-up. By the beginning of the next year it is hoped that 
a program of research utilizing this unusual facility will 
have been formulated. 



-^0- 



Although minor sub-projects have been carried out, the 
central Psychotherapy Sound-Movie Program has suffered serious 
delays over a three-year period because of the slowness with 
which construction of both the room and projector equipment 
has proceeded. However, it looks as if the major construction 
work will shortly be over and with the coming of Dr. Bergman 
plans have already been laid for actually carrying through a 
full psychoanalytic psychotherapy. The problem of freeing more 
time for this study for the two major investigators now becomes 
acute. 

In presenting the present programs, I plan in general to 
follow the organization of last year's report; that is, to pre- 
sent the work of the various sections separately in order that 
the stage of development they have reached and what they are 
engaged in will be clear. It is important, however, that the 
section reports should be presented in the context of the general 
program of the Laboratory because there is a certain kind of 
artificial separation which derives from the section organization. 

The general goal of the Laboratory, stated in its broad- 
est terms, is the study of psychological function - both normal 
and pathological - in the context of specific behaviors or in 
more generalized structures of personality. In many instances 
these functions are studied explicitly in relation to nervous 
and other somatic systems. In other instances they are studied 
independently and with only an implicit acceptance of such re- 
lationships, either because these relationships are not immedi- 
ately relevant, or are not presently available for study. This 
broad but focal concern with psychological function is approach- 
ed through various avenues, each of which contributes to the 
total picture. These approaches may be roughly designated as 
the study of the developmental, aging, mature, and pathological 
aspects of the organism. The last is considered both with re- 
spect to the character of the pathology and with respect to 
efforts at its modification, whether through individual psycho- 
logical, psychosocial or physiological means. 

Against this background I shall first consider the work 
of the three sections of the Laboratory in the Clinical Investi- 
gations area: Child Development, Personality, and Section of 
the Chief. 



-a- 



Child Development 



The Section on Child Development has continued its re- 
searches along the general pattern set in previous years, an 
emphasis on the study of basic processes and developmental 
aspects of behavior in infants and young children. Several 
studies have been carried through to completion, and new ones 
have been initiated. The five senior members of the staff 
all continue in the program. One psychologist at the Ph.D. 
level. Dr. Yvonne Brackbill, was added to the staff in August, 
to assist Dr. Gewirtz with his studies on infant learning. 
Dr. Belinda Straight, as a guest investigator, has continued 
cooperative work with Dr. Bell in the study of one-month old 
infants and their mothers. 

Research in the section is directed toward evaluating 
the inherent, maturational and environmental determiners of 
personality and development in infancy and the persistence of 
early emotional and behavior patterns, as they relate to mental 
health. At present several fundamental methodological and pro- 
cedural studies are under way. Some of these studies are con- 
cerned with devising tools for use in a more general longitudi- 
nal study of personality development. The children selected 
for study are presumably normal, although some selections of 
subjects are made on the basis of specific conditions that 
could affect mental health. For example, in addition to 
babies in normal homes, we are studying infants living in in- 
stitutions and infants whose parents have contrasting and 
possibly psychopathogenic personalities or attitudes toward 
child rearing practices. One group of studies is concerned 
with available data from the Berkeley Growth Study, in which 
characteristics of the mothers' personality are related to the 
personality and development of the children (on whom records 
are available from birth to 18 or 25 years). Significant re- 
lations from this study are utilized in devising tests and 
procedures for further studies of infant development. 

The researches of Dr„ Gewirtz are concerned with the 
etiology and conditions of dependency and attention-getting 
behavior, an area of importance because it is an aspect of the 
central problem of how social learning takes place. Working 
with nursery school children he has experimentally observed this 
behavior under conditions of social reinforcers (approval), and 
their effect in situations of satiation and deprivation, and 
has demonstrated significant relationships, (l) Brief social 
isolation (equated to a condition of deprivation of all social 
reinforcers) increased reliably the reinforcing power (i.e., 
the importance) of adult approval for children (aged 4-0 to 
5-6) as a positive function of the degree to which they typically 



-42- 



sought such approval in other settings; and older children 
in this age range were affected to g, greater extent than were 
younger children. (2) In children aged 6-6 to 9-0, it was 
found that brief social isolation (deprivation) enhanced the 
effectiveness of social reinforcers representing approval and 
social contact relative to a control condition (no treatment); 
and that a brief condition of satiation for approval and social 
contact decreased the effectiveness of those social reinforcers 
relative to the control condition. Dr„ Gewirtz's current program, 
with Dr, Brackbill, is directed toward observations of infants 
under one year of age. 

Methods are being explored with very young children 
which reduce to relatively simple terms the complexities of 
the behavior which characterize emotional dependence in later 
childhood and which would relate those behaviors to critical 
aspects of myriad environmental conditions to which young 
children are typically subject. A series of prototype experi- 
ments with human infants in a highly controlled institutional 
setting represents the core of the experimental program. 
Initially, these experiments will attempt to relate effects 
in the child's pattern of emotional dependence to variations 
in selected aspects of the caretaking process. At first, the 
reinforcing aspects of caretaking and adult responsiveness to 
the child are employed as variables; and the range of adult 
responses which can function as reinforcers for the young child's 
behavior will be explored. Selected stimulus events associated 
with the caretaker are being set into a variety of contingencies 
with different responses emitted by the child. After some of 
the more common reinforcers which are provided by adult re- 
sponses are determined, selected stimulus events (e.g., the 
attention of a caretaker) involved in or attached to the care- 
taking person may be set into a vaflety of contingencies with 
these reinforcing aspects of the caretaking process; and 
selected aspects of this process may be made contingent upon 
different responses emitted by the child. 

Dr. Rheingold is carrying out a series of studies on 
social responsiveness in infants. Her work has been with 
children in institutions, with re-tests in their homes of 
children originally observed in institutions, and with compari- 
sons between behavior in their homes and in a strange place of 
the same children. In a monograph now published, she demonstrat- 
ed increasing social responsiveness in institutional babies who 
were given individualized maternal care, and she (together with 
Dr. Gewirtz) has just completed a study in which she was able 
to increase vocalizations in three-month old babies by positive 
social reinforcement. 



-43- 



In a pilot study of a few infants living in their own 
homes, Dr„ Rheingold has tested the developmental changes in 
social responsiveness to known persons and to strangers, and 
compared the difference of the infants' behavior In their 
own homes and in a strange testing room. She has found evi- 
dence of significant differences and plans to extend these 
studies to a larger population. Data are now being analyzed 
of observations made by Dr„ Rheingold and Dr, Bayley who 
re-visited at 21 months of age infants first studied at 
6 months while living in an institution. Half of these in- 
fants had had an 8-weeks experience of special care-taking 
by a single person. The follow-up study was carried out to 
look for any evidences of long-term effects of the special- 
ized care. Some slight differences of manner of social re- 
sponsiveness are suggested, 

Dr, Bell is conducting studies of early phases of mother- 
child interactions on samples selected on the basis of the 
mother's expressed attitudes toward children and child-rearing 
(the PARI). Motion picture records of the infants are made of 
standardized situations at 3 days of age, and of the mother- 
child pairs at one month of age. Ratings of the mothers' be- 
havior are being compared with their responses on the Parental 
Attitude Research Instrument; the characteristics of the infants 
are being rated at three days and at one month of age. Consist- 
ency of the infants' behaviors, as well as patterns of mother- 
child interaction relevant to the maternal attitudes are being 
studied. The data having been collected, they are now in 
process of analysis by a variety of methods. The general 
approach used appears to have provided quite rich data on the 
nature of the early child-mother relationship. 

In addition to the PARI, a questionnaire-rating scale 
filled out by the mother to express her attitudes to child- 
rearing (described in earlier annual repolrts — which, by 
the way, has received extensive use over the country), 
Drs, Schaefer, Bell and Bayley have prepared for publication 
two Maternal Behavior Research Instruments, which were de- 
veloped for quantifying descriptive material from the case 
files of the Berkeley Growth Study, One of these instruments 
is based on material derived from interviews with the mother 
about child-rearing and development which is carried out by a 
sophisticated child clinician; the other is based on direct 
observations of child-mother interactions in a relatively 
standard situation, Dr, Schaefer has utilized this and other 
material in applying fsctor analyses and Guttman' s radex methods 
to the intercorrelations of maternal behavior scores, and has 
concerned himself with developing, around the resulting pattern 
of maternal traits, a theory of certain aspects of personality 



-kU- 



organization: the two factors of autonomy- control, and love- 
hostility form the frsune in which the traits are organized in 
a circumplex. 

DrSo Bayley and Schaefer are carrying on a series of 
studies of the Berkeley Growth Study material in which the 
^^aternal personality scores are being correlated with other 
parental data and with the children's scores. Findings so far 
show patterns of relationship of maternal traits to socio- 
economic status, to children' s happiness and activity and to 
children's intelligenve scores, which if corroborated by fur- 
ther study would have important implication for child-rearing, 

A few of the findings might be mentioned here: Corre- 
lations between the maternal traits and socio-economic status 
show the higher status mothers to grant more autonomy to their 
children, to be more cooperative in the testing situation, and 
more equalitarian in their interactions with their children. 
Lower-status mothers tend, on the other hand ttJ-oii-iaintain close 
contact with and to be more intrusive, irritable, punitive and 
ignoring of their children. When compared with characteristics 
of the children, those children whose mothers grant autonomy 
are equalitarian and cooperating, express affection, tend to 
have below-average intelligence scores as infants but to earn 
increasingly higher "IQs" to about six years and remain high 
through 18 years. In contrast, those children whose mothers 
are punitive, irritable and ignoring tend to have high scores 
as infants but to develop slowly with even lower "IQs" to about 
6 years, after which age they remain low. In both of the above 
sets of comparisons the relations are much stronger for the 
mothers of boys, than the mothers of girls. Among personality 
ratings of the children, cooperative, equalitarian, affection- 
ate mothers tend to have babies who are happy, calm (unexcitable) 
and "positive", while the irritable, punitive mothers tend to 
have infants who are rated as more active. The same relations 
tend to hold for the boys after they are as old as 8 years, in 
ratings related to their socially responsive, cooperative and 
intellectually efficient behaviors in these variables the boys 
who score high tend to have cooperative , equalitarian, affection- 
ate mothers who had close contact with their babies. The boys 
who rated low more often had mothers who were punitive, irrit- 
able and ignoring. Further study is necessary to clarify the 
nature of these relationships. 

As part of a program for studying development in infancy, 
Drs, Bayley and Schaefer have been trying out on infants and 
successively revising, methods of recording and rating both 
maternal and infant behavior observed during the infant develop- 
ment tests. In connection with this program Dr„ Bayley is 



-is- 



preparing her California First Year Mental Scale, for a thorough 
revision and restandardization. This revision is being under- 
taken as a necessary preliminary to the infant study because 
currently available tests for infants are out of date, inade- 
quately standardized and procedures and scoring poorly defined. 
It is planned to correct these inadequacies and to expand the 
test to include emotional and attitudinal scores that will per- 
mit a more comprehensive evaluation of the infant as observed 
in the test situation. 

Theories of the early formation of personality, both of 
emotional adjustment and intellectual development are based on 
rather general studies with very little experimental work under 
specifically controlled conditions. The primary research efforts 
of this section are directed on the one hand toward identifying 
more or less specific environmental conditions that can influence 
the course of development, and on the other hand toward studying 
in infants their developing capacities to learn, and the stabil- 
ity of both learned (or conditioned) behaviors and of matura- 
tional trends in response tendencies. Once these are better 
understood it will be possible to state more explicitly the 
determining factors in the dynamics of personality formation. 

The personnel and program of the section are utilizing 
to the fullest extent the facilities available to it. It is-- 
at present necessary (both for lack of facilities and by demands 
of the research designs) to make a large proportion of the ob- 
servations in facilities outside of the NIMH, in hospitals, 
well-baby clinics, orphanages, and in the infants' own homes. 
For certain of the studies it would be desirable to have 
accomodations either in the Clinical Center or in a separate 
building, for housing normal, healthy infants who could be made 
available for continuous study over periods of a few days to 
several months, and either with their mothers or on a "Foster 
care" basis. It is hoped that such a facility with the augment- 
ed staff and caretaking personnel it would entail will be con- 
sidered seriously as an important aid to the Child Development 
research progi*am. 



Personality Section 

The program outlined in previous annual reports of this 
Section has necessarily undergone some modification with the 
resignation of two of the four investigators of the Section, 
The remaining two investigators have continued their studies 
of the process of change in attitudes, value systems and per- 
sonality. The central focus of the Section continues to be 
the development, testing and extension of current personality 
theory. More specifically, the major effort of this Section is 



-46- 



the application of personality and social influence theory to 
the problems of modification of attitudes, value systems and 
behavior. 

The ward milieu studies dealing with preferred nursing 
roles have been completed this yearo In line with the develop- 
ing program on ward 3-W stdflies will be undertaken to analyze 
the nature of relationships existing among the hospitalized 
schizophrenic and his parents. Although investigation of 
psychosomatic disease came to a temporary halt with the re- 
signation of Dr, Iflund, it is planned that some studies in 
this area will be con*4nued by Dr. Handlon, 

In planning the future directions of the Section, an 
effort has been made to select personnel who will be able to 
work closely with the Adult Psychiatry Branch in research and 
case evaluation. Drs, Handlon and Waldman, who came on duty 
in September, give promise of fulfilling this goal. They are 
already actively engaged in planning collaborative research 
programs with psychiatrists, sociologists and members of other 
disciplines active on the Adult Psychiatry and Clinical Scieaees 
wards. 

In the ward milieu studies we have to date been concerned 
with one important aspect of ward milieu, namely, the nursing 
role as it relates to the treatment of schizophrenia. In this 
setting efforts have been made to introduce predetermined ward 
philosophies on the experimental basis. Under these conditions, 
it is necessary for the experimenter (the ward administrator) 
to communicate his concepts to the nursing staff and to help 
them accept and apply them in order that the desired experimental 
condition be achieved. The problems inherent in this mode of 
research have offered a very practical and real-life situation 
in which to investigate conditions affecting attitude change. 
Over a period of two years data have been gathered concerning 
the impact of five unique ward pilosophies on the psychiatrists 
and nursing personnel. It has been found that psychiatrists and 
nurses show consistently different concepts of the preferred 
psychiatric nursing role and this offers a basic problem for 
collaboration. It was further noted that although nurses may 
show attempts at modification of their nursing concepts in the 
direction of the new ward philosophy, these changes are unstable 
and disappear over time. It was concluded that the less accept- 
able a ward administrator's philosophy was to nurses initially, 
the less it was finally accepted by them even after as much as 
21 months of exposure to it. These studies have not as yet 
been extended to measuring the effect of a given ward milieu on 
patients inasmuch as the desired ward atmospheres, i,e„, the 



-47- 



experimental conditions have not been achieved. Other studies 
of the development of psychiatric nursing attitudes were under- 
taken with nurse trainees, graduate nurses and experienced 
psychiatric nurses « It is clear that with the greater crystal- 
lication of the nurse's identity as a professional individual, 
her amenability to roles quite deviant from her own preferred 
nursing role becomes progressively reduced. 

It is anticipated that this Section will become increas- 
ingly involved with ward studies particularly as the contemplated 
studies of patient-family interactions get under way. Efforts 
will be made to investigate the premorbid and postmorbid patterns 
of interpersonal communication unique to families having a 
schizophrenic member. It is planned that carefully controlled 
studies will be made using a variety of techniques including the 
quasi-groups technique where unknown to the subjects, the process 
and substance of interpersonal communication can be systematical- 
ly manipulated. 

Two major investigations have been conducted in the area 
of psychotherapy. One involves research regarding moment-to- 
moment changes in the ego organizations of patients in the course 
of psychotherapy. Current work is mainly concerned with the in- 
vestigation of a speech disruption measure adapted from Mahl in 
its relation to these ego states. Currently attempts are being 
made to determine the influence of rate of speech on the incidence 
of such speech disruptions. The continuing aim of this investi- 
gation is to use these and other measure to define shifts in a 
patient's ego state. The second investigation in the area of 
psychotherapy relates to the communication of therapist's values 
and preferences for types of content and emotional expression in 
the course of therapy. This was investigated in the treatment 
of two schizophrenic patients. This particular study was com- 
pleted in its writing stage this year. It has, however, given 
impetus to a broader program of study. It is planned that some 
of the implications regarding values and expectations of patient- 
therapist pairs will be the basis of a program of research re- 
garding "drop-outs" from therapy. It is becoming increasingly 
evident that a sizeable proportion of the total number of patients 
referred for psychotherapy drop out of treatment without benefit 
during the initial phases of therapy. These patients are describ- 
ed in sociological terms as coming predominently from the lower 
socio-economic groups. It is hypothesized that with further 
analysis of these individuals, it will be found that an important 
variable affecting drop-out rate is the nature and degree of dis- 
^^repancy between therapist's and patient's values and role ex- 
pectations. It is proposed that a study of the psychological 
variables resulting in such communication failures will be in- 
vestigated. The next step of the proposed program would be the 



-4-8- 



utilizatlon of the identified variables in treatment and in 
quasi-treatment groups in order to facilitate communication 
and the adaptation of the psychotherapy situation to the 
special needs of this large group of patients. Such a 
program would have both theoretical and practical signifi- 
cance. 

Another aspect of the "values" studies is a two year 
study regarding the communication of "moral" values in the 
course of psychoanalytic treatment which is being brought 
to a close. This may provide data related to the question 
of whether the intensive analytic relationship affects the 
moral values of a patient in the direction of those held by I 
the therapist. An analysis of the pattern of change in moral 
values of each of the four patients studied will be under- 
taken, 

Dr, Handlon plans to investigate the relationships 
among physiological states, individual personality structure 
and susceptibility to the various psychosomatic diseases in 
a program tentatively planned with Dr, Hamburg. 

To date there have been but few attempts to develop 
instruments that permit the simple and economic assessment of 
the mental health of large segments of the population. Dr. 
Handlon is collaborating with members of the Socio-environ- 
mental Laboratory in the attempt to apply the Guttman Scalogram 
technique to the development of valid and reliable measures of 
"mental health". 

The Section is also occupied with a research project 
which may perhaps be classified most appropriately as "service 
research", but which carries much wider implications. This 
involves the evaluation of the NIH Research Associates Training 
Program. The project touches on a very basic administrative 
question: How best to facilitate optimal interaction between 
the inherent capacities of the investigator and the stimuli 
provided by the setting to promote creative productivity. 
This project may develop into such scope that it may be neces- 
sary to bring in researchers on a contract basis or to assign 
investigators full time to this particular project. 



Section of the Chief 

The major areas of research in this section are 
schizophrenia , psychotherapy, and the psychological aspects 
of physical illness. In many respects the activities of this 
section overlap with those of the Section on Personality. 



-49- 



It is our expectation that when the Chief of the Personality- 
Section is appointed, some reorganization of the two sections 
will take place looking towards further integration of the 
activities of the two groups. 

At the present time the members of the section who are 
concerned with the problem of schizophrenia are Drs, Rosenthal 
and Zahn in addition to the Chief. One continuing study by 
Dr. Shakow involves the analysis of a large body of already 
existing experimental data on the psychology of schizophrenia 
as a basis for the development of theory in this field. Dur- 
ing the year some progress was made on the analysis of this 
material. In part this was used for a paper presented at the 
Second International Congress of Psychiatry in Zurich. It is 
hoped that eventually this work will result in several mono- 
graphs on the psychology of schizophrenia. 

The major group of studies consists of four parts and 
will involve the members of this section who are working in 
schizophrenia as well as members of other sections working in 
this general area. It is essentially the over-all program in 
relation to Clinical Center wards and St. Elizabeths wards 
which is being planned as described in the introductory re- 
marks to this report. Many of the studies will be carried out 
concurrently and collaboratively with other Laboratories of the 
Institute. 

One series of studies deals with responsivity patterns 
in schizophrenics. For this Dr. Rosenthal has the major respons- 
ibility. Patients are being studied '£pr their responses at both 
the autonomic and molar behavioral levels when confronted with a 
variety of orienting situations. This is in part an outgrowth 
of previous studies on reaction time and on response to other 
forms of simple stimulation which have indicated the existence 
of deficits in schizophrenic patients. For a preliminary study 
a group of 13 schizophrenic patients selected on the basis of 
alpha patterns have been under study since July 1957, The ex- 
periment is still in process but the analysis of the material 
should be begun shortly, 

A second series of studies in which Dr. Shakow is par- 
ticularly interested and which will be carried out with Drs. 
Rosenthal and Zahn might be terms "capacity" studies, A con- 
siderable variety of psychological functions have in previous 
studies been found to normalize themselves under conditions 
of either repetition or optimal conditions of cooperation. 
There are however some functions in which such a tendency to- 
wards normalization does not appear to exist at least in the 



■50- 



contexts in which they have been studied thus far. This 
persisting pathology appears particularly prominent in sit- 
uations where speed of response is called for by the environ- 
ment . It is the purpose of the planned series of studies to 
find out whether with repeated exposure to the same task over 
a long period of time and with the setting of optimal conditions 
for performance it is possible to achieve the same normalization 
as is found in the other group of psychological functions. Some 
preliminary studies have already been started in this area on 
our wards here but mainly they are awaiting the development of 
the wards at St, Elizabeths, 

Still another group of studies, as yet not clearly de- 
lineated, involve affective situations where attitudes of 
acceptance or rejection by the environment enter prominently. 
These derive in many respects from studies carried out by 
Garmezy and Rodnick at Duke, dealing with patients having good 
or poor prognosis, and should help to make more understandable 
the incongruence between cognitive and affective functions as 
characteristic of this type of patient, 

A fourth group of studies subsumed under this general 
program are the family and social studies now in process of 
planning to be carried out by members of the Section on 
Personality in association with the Adult Psychiatry Branch. 
(See Project No, M-P-P-(C)-9) 

Dr, Rosenthal has carried the administrative responsibil- 
ity for the general aspects of the scientific investigation of 
a group of identical quadruplet girls who have been under study 
by investigators from various laboratories for a period of 
several years. A large amount of data in different areas have 
been accumulated. The integration and evaluation of these data 
are to begin on a formal basis shortly. The psychological material 
is in process of analysis by Drs, Rosenthal, Parloff and Waldman at 
the present time. 

The psychotherapy activities of the section center around 
Project No. M-D(C) 1, and as far as this section is concerned is 
being carried by Drs, Dittmann, Shakow and Bergman, Both methodo- 
logical studies aimed at making the substantive attack on the 
problem easier and a systematic theoretidal exposition of the 
area as a field for research are included. 

During the year Dr, Dittmann has been involved in two major 
studies having to do with the micro-analysis of the complex data 
of non-verbal communication provided by the special technique of 
sound-movies which we are using. In one project Dr, Dittmannand 



-51- 



Dr. Lyman l.^nne of the Adult Psychiatry Branch have attempted 
to find ways of coding speech in order to identify disturbances 
which may be used as an index of psychological disturbance. 
Pitch, stress, and juncture patterns were first studied with 
the conclusion that these microlinguistic phenomena were too 
closely related to the syntax of language to be carriers of 
emotional communication. The next attempt was to work with 
hesitations and breaks in speech » Although they could be coded 
with fairly high reliability these qualities did not seem tO' be 
related solely to anxiety, but to other, irrelevant factors. 
During the present year a third set of phenomena were worked 
with, the so-called "paralinguistic" phenomena. These include 
changes in duration, loudness, pitch, intensity, articulation, 
and vocalization as applied to unit of speech larger than the 
morpheme. Preliminary study indicates that these phenomena can 
be coded fairly rapidly and offer promise of eventual useful- 
ness for dealing with one of the non-verbal communication 
channels. 

Another study being carried out by Dr. Dittmann has to do 
with the judgment of facial expression from short sequences of 
motion picture film. A previous technique of showing short 
series of prints from motion pictures was abandoned as being 
too artificial. The present technique involves showing short 
sequences of film of about three seconds in length through ? 
motion picture projector to the judges. Considerable reliabil- 
ity has been obtained across judges, A pilot study was run to 
test whether these scores could be related to other variables. 
Using sequences of film of a patient following either leading 
responses or confrontations by the therapist facial expressions 
showed greater relatedness and calm following leading responses 
and greater discomfort and apprehension following confrontations. 
Judgments based on speech with meaning filtered out and on con- 
tent alone showed trends in the same direction. The technique 
appears to hold promise as a method of studying emotional com- 
munication as mediated by visual cues. Reliability on a very 
limited sample is high and the judgments can be related to other 
variables. If this method holds up it may give us a beginning 
towards the analysis of the visual communication channel. 

During the last year Dr. Shakow did some additional pre- 
liminary work on the project dealing with the information to be 
derived from the repeated viewing of complex'- material. The 
purpose of the study was to determine what additional relevant 
information necessary for the understanding of various aspects 
of the therapeutic process could be derived from successive 
viewing of a film from a psychotherapy session and whether there 
were major differences in the additional information derived as 
between active and passive analytic approaches to the data. 



•52- 



Due to some lindtations of apparatus and press of time much 
"less than the desirable amount of study could be carried out. 
However, with the acquisition of our new projector it ought to 
be possible to carry this project out with greater facility. 
It is therefore being planned for the next year. 

Another area of research is an psychological factors 
related to physical disease that is being carried out by 
Dr, Kendig in association with various of the other Institutes 
and with some outside agencies „ Her major project is on the 
self-concept and body-image as related to disease suscepti- 
bility and organ choice. In this study she is exploring the 
attitudinal factors insofar as they affect health and longevity. 
She is particularly interested in early childhood attitudes 
which may be instrumental in determining the nature of the self- 
concept and the body-image, especially in relation to suscepti- 
bility to illness, organ choice, course and outcome of disease. 
At first Dr, Kendig used an extensive series of self-concept 
tests and a variety of projective techniques on a group of 
physically ill patients. However, these proved unsatisfacgory 
since they seemed mainly to reflect the present self-concept 
and body-image as unfavorably modified by years of illness. 
It therefore seemed necessary for her to develop an elaborate 
detailed questionnaire or interview schedule which would dis- 
close the attitudes towards the self and the body inculcated in 
early childhood, explicitly by direct instruction and implicitly 
by the emotional climate of the home and family reactions to 
illness. During the past year such an instrument has been de- 
vised and pre-tested on two patient groups and on one group of 
normal controls. The scales are now being drawn up so the data 
can be coded and treated quantitatively. In the course of the 
current year the expected coding of the interview schedule 
which has already passed through a number of forms will be com- 
pleted and a weighted scoring system devised. It will then be 
used with groups of patients in five of the other Institutes 
and with normal control groups. 

Partly in relation to this study and partly as an out- 
growth of her association with the other Institutes at the 
Clinical Center Dr, Kendig has become involved in a study of 
intractable (phantom) pain with Dr, John Van Buren of NINDB 
and on precocious puberty and pseudo-hermaphroditism with 
Dr, Roy Hertz of the National Cancer Institute, Both of these 
studies throw light on the body- image and the self-concept and 
therefore contribute to her major project. She is also seeing 
a group of patients who are being studied for the effects of 
various drugs by Dr, Conan Kornetsky, Again in these patients 
she is interested in problems of body- image and self-concept. 



■53- 



There are a few other studies going on in the Section 
which are not directly related to these three major areas. 
One is a further development of the study which Dr„ Dittmann 
has been carrying out with Dr. Wells Goodrich on interaction 
patterns of normal and hyperaggressive children, a project 
reported upon last year. Their work during the present year 
has been chiefly concerned with further reliability studies 
of the methods developed. In this connection Dr. Dittmann 
has undertaken a study of dimensionality of psychological 
variables using non-metric techniques. This is an attempt to 
deal with certain problems in ordering data derived from per- 
sonality material. 

Dr. Paul Bergman, who has recently arrived and who is 
to participate as therapist in the psychotherapy sound-movie 
project, will also undertake a program of research of his own. 
These are of course only in the planning stage at present. 
They are to be along the lines of the relation between the 
effects of psycho somimetic drugs and psychotherapy, and on 
the interaction of other adjuvants and psychotherapy. 

In closing this summary of the work of the Laboratory 
of Psychology I should like to point up succinctly and without 
elaboration a few tentative but important generalizations which 
derive from the preparation of the reports of the several 
Sections, These refer to common trends which appear independent- 
ly despite the diverse approaches to the study of psychological 
functions by different methods and with different subject matters. 

The first of these is a methodological point — that of 
the value of the comparative method. It is through the com- 
parative approach that we become impressed with the tremendous 
potentialities which lie in the interaction of the complicated 
psyche of the human (and its associated nervous system) with a 
stimulative complex social environment. We get an inkling of 
what such an interaction does for the full development and exer- 
cise of the organism's capacities. This picture is made even 
more vivid when we see these same principles reflected in lesser 
degrees in lower orders of animals, in the aged, in psychoses, etc. 

Thus, we see in the report of the Aging group evidences 
for the potentiality of the organism for maintaining a high level 
of psychological function despite some biological decline. The 
difference between younger and aged rats is in many respects 
small or even non-existent. Also, this time in human subjects, 
similar scores are obtained in a variety of functions when the 
aged come from active rather than from limited institutional 
environments. 



-5V 



In the report of the Section on Animal Behavior we find 
that even when the human organism is damaged physically in an 
important part of its brain, the potentiality for recovery is 
great. Thus after frontal lobe damage monkeys seem to be 
permanently affected in delayed- response type tests, chimpan- 
zees are also impaired but are able to recover with retraining; 
in man there does not seem to be any consistent damaging effect 
on problem- solving behavior. We also see a similar phenomenon 
in studies we have made of schizophrenics where optimal environ- 
mental pressure frequently brings patients close to capacity 
levels which are not far from the normal „ We find it at another 
level in Dr. Calhoun's report of the importance of social 
factors in space utilization by mice and shrews living in wood- 
lands. And we may have similar data from Dr. Kendig' s studies 
soon in still another area — physical disease and organ choice 
as related to the self-concept and the body image. 

All of these studies seem to be leading in the direction 
of saying that despite the genetic factors which may be playing 
a role in either normality or pathology, the human organism has 
a tremendous range of potentiality which neither psychosis, nor 
age, nor brain damage can more than partially stay in its course 
if a social environment is provided which is sufficiently rich 
and appropriate to make demands on its potentialities. It is 
in this context that our developmental studies in handicapped, 
normal and superior subjects (both animal and human) become so 
important, for it is there that we can ask ourselves the im- 
portant question: What is the process by which these potenti- 
alities are most effectively built up for optimal use, for re- 
sistance to destroying factors, and for recovery from such 
destroying factors? 



-55- 



Laboratory of Socio-environmental Studies 
Dr. Marian Radke Yarrow 



The research goal of the Laboratory is the investi- 
gation of the ways in which social processes bear upon the 
production and course of psychic disturbances. Included 
with this goal is a wide range of research areas: the 
nature and distribution of mental illness and behavioral 
pathologies, social and cultural variations in defining 
and treating behavioral disturbances, social and cultural 
patterns influencing personality development, interpersonal 
processes within the family, and social processes in the 
treatment setting of the mental hospital. This range of 
interests is represented in the current projects of the 
Laboratory o 

With the growing recognition of the importance of 
social aspects of illness and with the realization that re- 
lationships between social and medical or biological factors 
are more complicated than has been assumed, there has been 
an intensification of research interests and efforts in 
conceptual and methodological issues and in collaboration 
across disciplinary lines. 

During 1957, the organization of the Laboratory has 
been completed with the staffing of the Section on Social 
Studies in Therapeutic Settings. 



Social Studies in Therapeutic Settings 

In recent years there has been an increasing recog- 
nition of the therapeutic significance of the mental patient' s 
social environment. The mental hospital is more than simply 
an auxiliary setting within which therapy goes on; it is a 
relatively long-term and all-encompassing life experience 
which, by virtue of the special nature of mental illness, 
necessarily has therapeutic consequences. This fact has led 
to an interest in studies of interaction among patients and 
between patients and staff, social role definitions of patients 
and staff, lines of communication and patterns of decision- 
making in the hospital, values, norms, and behavior of adminis- 
trators, physicians, nurses, attendants, and patients, and 
various other aspects of hospital structure which appear to 
have consequences for the course of mental illness. 



■56- 



In 1957s for the first time, the Clinical Investiga- 
tions Branch undertook to support the operation of such studies 
through its budget o This decision was followed by a period of 
active recruitment of social scientists who were motivated and 
equipped to cope with the problems in this field o This has 
been accomplished successfullyo Since five of the seven pro- 
fessionals (including one Visiting Scientist) have entered 
this Section within the past two or three months, the general 
section program is still in its early stages of development. 
Dr„ Morris Rosenberg has recently assumed direction of this 
Sectiono 

Active planning is currently under way for the collabo- 
rative research witn other units of the Clinical Investigations 
Brancho Mr, Turk and Mr„ Lefcowitz are currently developing 
plans for research designed to form an integral part of the 
Neuropharmacological Program at Sto Elizabeths Hospital c 
Dr, Pearlin and Dro Rosenberg are collaborating with members 
of the Adult Psychiatry Branch and the Laboratory of Psychology 
in the development of a research program in Ward 3-West of the 
Clinical Centero Dr, Wallin is currently working with the 
psychiatric group in Ward 3-East of tne Clinical Center in 
the intensive study of families of schizophrenics arid is using 
this information for the development of scales about parent- 
child relationships associated with the development of schizo- 
phrenia o Such collaborative undertakings, to which a large 
part of the staff time is likely to be devoted, are pursued in 
the faith that the pooling of skills and perspectives from 
different fields will pro^ilde fruitful insights and valuable 
data bearing on the therapeutic process, 

MPo Perry j, in his work at the Clinical Center, has 
provided a detailed demonstration of how the objective 
positions of staff members in the ward structure influence 
their attitudes and behavior toward the patients. These 
studies are scheduled for completion this year. 

During the past year Dr, Goffman has continued his 
intensive investigation of the social life of the mental 
hospital patient at St, Elizabeths Hospital, Using partici- 
pant observation J unstructured interviews ^ and case record 
sampling, he has succeeded in specifying some of the thera- 
peutic implications of the pattern of involuntary incarcer- 
ation and stigmatization which characterizes life in the 
mental hospital. 



PUBLICATIONS NOT RELATED TO A SPECIFIC PROJECT 



Ader, R, and Clink, D„ W„ Effect of chlorpromazine on the acquisi- 
tion and extinction of an avoidance response in the rat. 
J„ Pharmacolo & Exper, Therap, 121 ; 1957 (In press). 

Bayley, N.s National Parent-Teacher Quiz Program - Questions and 
Answers, Nat'l Parent-Teacher . 51, #5, 28. Jan. 1957. 

Bayley, N.: On the Growth of Intelligence, Translated into Japanese 
and reprinted in Americana . A monthly J, of Humanities, Social 
Sciences, and Natural Sciences, _2, #11, Nov. 1956. 

Bayley, N.: A new look at the curve of intelligence, Proc. of 
1956 Invitational Conf. on Testing Problems . New York: 
Educ. Testing Service . 11-25, 1957. 

Bayley, N,: Data on the growth of intelligence between 16 and 21 
years as measured by the Wechsler-Bellevue Scale, J. Genet . 
Psychol , , 90, 3-15, 1957. 

Bayley, N,: Predicting children,! s Intelligence, Nat'l Parent- 
Teacher . In press. 

Carlson, 7,R,: Effect of lysergic acid diethylamide (LSD-25) on 
the absolute visual threshold. J. Comp. Physiol, Psychol . 
Submitted for publication, 

Dittmann, A.T,, and Moore, H.C.: Disturbance in dreams as related 
to peyotism among the Navaho. American Anthropologist . 59 . 
6^-64.9, 1957. 

Dittmann, A. T,: Review of Harry Stack Sullivan's Clinical 

Studies in Psychiatry , Contemp. Psychol .. 2, 127-129, 1957, 

Glasner, P.J., and Rosenthal, D,: Parental diagnosis of stutter- 
ing in young children, J. Speech & Hearing Disorders . 22 . 
288-295, 1957, 

Handlon, J. H., and George, F.H.: Language for perceptual analysis. 
Psychol. Rev .. 6^, U-25, 1957, 

Handlon, JoH,; Personality changes following alteration of 
external genitalia in female pseudohermaphroditism, 
Psychosm. Med , . 1957. In press, (with I.K.Rosenwald and 
I, M .Rosenthal ) . 



- 51 - 



-2- 

Publications (Cont'd) 



Kelmanj H„C„, and Parloff, MoB„: Interrelations among three 
criteria of improvement in group therapy: Comfort, 
affectiveness, and self awareness. Jo Abn, & Soc . 
Psychol o 5^, 281-2S8, May, 1957. 

Kendig, I,V.: The Un-Merry Widow. Book Review, Cont. Psychol . 
In press, 

Kety, S„S.: The implications of psychopharmacology to the 
etiology and treatment of mental illness. Ann, N.Y. 
Acado Sci,, 66: 836-8^0, 1957, 

Kety, S,So: Recent studies in psychopharmacology, A,M,A. 
Arch, Neurol, and Fsychiat., 77: 278-279, 1957. 

Kety, S.S,: The cerebral circulation in man. Triangle, 2.' 
47-52, 1957, 

Kety, S.S,: The general metabolism of the brain in vivo . 
The Metabolism of the Nervous S'/'stem , edited by 
D. Richter, Pergamon Press, London, 1957 (In press), 

Kety, S.S,: Determinants of tissue oxygen tension. Fed. Proc, 
16: 666-670, 1957. 

Rheingold, H.: The modification of social responsiveness in 
institutional babies. Mono. Soc. Res, Child Develop . 
21, Serial No, 63, #2, 1956, 

Rosenthal, D.: Drug research design in a psychiatric out- 
patient setting. Proc, of Conf. on Evaluation of 
Pharmacotherapy in Mental Illness . In press, 

Rosvold, H.E,, Mirsky, A.F., Sarason, I., Bransome, E,D,, 

and Beck, L,H,: A continuous performance test of brain 
damage. J, Consult. Psychol . . _^, 34-3-350, 1956. 

Sternberg, R,, Chapman, J., and Shakow, D. The problem of 
intrusions on privacy in psychotherapy research. 
Psychiatry . In press. 

Streicher, E. Biochemical investigation of the aging nervous 
system. In press. 



58 - 



-3- 

Publications (Cont'd) 



Streicher, E. The neurobiological research program of the 
Section on Aging of the National Institute of Mental 
Health. Proceeding of the Conference on the Process of 
Aging in the Nervous .System, Bethesda, January 30, 
February 1, 1957. 

Sokoloff, L., Perlin, S., Kornetsky, C., and Kety, 3,3.: 

The effects of d- lysergic acid diethylamide on cerebral 
circulation and over-all metabolism. Ann. N.Y. Acad. 
Sci., 66, 4.68-^77, 1957. 

Schaefer, E.S., and Bell, R.Q.: Patterns of attitudes toward 
childrearing and the family. J. Abnorm. See. Psychol .. 
5U, B, 3S1-395, 1957. 

Schaefer, E.S. and Bell, R.Q.: Development of a maternal 

attitude research instrument. Child Develop . In press. 

Waldman, M.: The application of developmental theory to problems 
of social adaptation, (with L. Phillips and 3. Kaden) 
In press. 



- 59 - 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Clinical Investigations 



BUDGET SHEET 

Estimated Obligations for FY 19*^8 
Total: $^61,389 
Direct: $353,652 

Reinibiarsements: $107,737 



Project: Neuropharmacology Research Center 



ANNUAL REPORT 

f SERVICES BRAT 

January 1, 1957 - December 31, 1957 



COMMUNITY SERVICES BRANCH, NIMH 



INTRODUCTION 

States and Territories have been receiving Federal men- 
tal health grants-in-aid and technical assistance for ten years. 
A major objective has been to help them establish sound adminis- 
trative organizations at State level and to provide a well-trained 
multidisciplinary staff for leadership. This was essential to 
bring more direction to the scattered and often ineffective efforts 
in community mental health programs and to insure continuity of pro- 
gram. As a results most States and Territories now have a profes- 
sional staff developing a program aimed at public education, preven- 
tions treatments, and rehabilitation. An increasing amount of train- 
ing and research is being built into these programs. 

The recent broad-based legislation for State grants-in-aid 
to localities for community mental health services to California, 
Connecticut 5 Florida, Minnesota, New Jersey, New York, and Vetmont, 
follows many of the concepts included in the "Program Guide" 
issued by the Public Health Service in 1954, This type of legis- 
lation seems to be setting a pattern for other States to follow. 
Implied in these new programs are more organized efforts by State 
administration to meet the demands of the public for preventive 
and corrective services in the mental health field x^hich are equal 
in quality and scope to general medical services. It recognizes 
that institutional care of the mentally ill has been designed 
chiefly for committed patients and does not meet the major needs of 
early treatment and prevention. The growing emphasis on comrni^nity 
services is likely to continue at a rapid pace, greatly increasing 
the demand for trained personnel, coordination of medical and so- 
cial services, insurance coverage j, and for research on the effec- 
tiveness of programs. 

State programs were developed by constant teamwork of com- 
munity. State, and Public Health Service staff, based on the fol- 
lowing assumptions; 

Poor social adjustment and mental illness is 
widespread, involving especially children, young 
adult males, middle-aged females and the aged of 
both sexes; 

Syroptom complexes have many causes based on 
imiltiple etiological factorSj even perhaps in an 

individual cases 



The public is inclined to view mental illness in all 
ages as a single disease with a "mystical or unnatural" 
cause. Methods of dealing with the mentally ill are 
largely responsible for the lack of public understanding; 

The public is increasingly concerned with the threat 
of mental illness, and is extremely interested in preven- 
tion. It is interested in utilizing all available know- 
ledge in prevention and treatment programs even though 
scientific knowledge is limited at present; 

There are so many social and economic implications 
in mental health and illness that the mobilization of 
family and community resources are essential for an ef- 
fective mental health program. With more involvement of 
citizens in educational, preventive, and treatment pro- 
grams, they would gain a better understanding of the na- 
ture of mental illness and of the components of mental 
health and would be in a better position to support re- 
search, training and services. 

Current research findings and improved treatment 
techniques tend to increase rather than decrease the 
need for more professional staff and organization; and 
finally. 

More effective and complete coverage of preventive, 
treatment and rehabilitative services would be a tremend- 
ous factor in preserving the manpower pool of the nation, 
in addition to cutting down the morbidity and cost of men- 
tal illness. 

The increasing interest in healthy psychological develop- 
ment of the child at home and in the school, and his ultimate 
performance as an adult in a job and as a parent, has made the 
public acutely aware of the need for corrective services. Be- 
sides the general mental health services ordinarily provided, 
there is increasing demand by organized groups for special ser- 
vices to meet needs for particular areas of distress, i.e., alco- 
holism, drug addiction, and juvenile delinquency. Maintaining an 
organization which can integrate staff activity to provide all of 
these special services and at the same time utilize scarce profes- 
sional staff most effectively is a challenge to community, State 
and Federal Governments. There is the danger that States, as well 
as the Public Health Service, may respond to special areas in mental 
health programs at the expense of a comprehensive approach, thereby 
weakening the organizational structure which has been built so pa- 
tiently in many States during the past ten years. In effect. 
State leadership responsibility could be scattered again, as it 
was in 1947. 



Another problem is the frequent conflict about who will 
be responsible for the total mental health program in States. 
One group demands a Department of Mental Health with Cabinet 
status, another expects the Health Department to become respon- 
sible, and a third group advocates that mental hospitals be 
given total responsibility. At this time there is insufficient 
evidence that any one of these ways of organizing State mental 
health services is the best for all of the States and Territor- 
ies, Time and experience should help solve the problem and the 
Public Health Service should advise caution despite the need for 
stronger and more centralized leadership in some States. In any 
event, there is little doubt about the need for hospital and 
community programs to coordinate their efforts in serving people. 

The more serious test of whether or not State and com- 
munity programs will continue to develop in a healthy fashion 
is still to come. Almost half the States and Territories have 
considerable dependence on Federal grants for their continued 
existence. Most of the other States use grants very effec- 
tively in testing new methods and evaluating the effectiveness 
of their programs, which generally would be impossible on State 
resources. The morale and pace-setting value of grants is ex- 
tremely important for all States and Territories. With so many 
pressures for categorical health programs in States, leadership 
is inclined to stay with those programs that are national in 
scope. 

The shortage of personnel is still serious but not dis- 
couraging even though turnover is very great. The Public 
Health Service regional office staff are more permanent than 
many of the State program staffs and in many instances they 
are depended upon to lend continuity to State programs. With 
State leadership staff struggling to hold on to its gains and 
to meet the increasing demands of the public for program 
coverage throughout the State, there is great need for the 
Public Health Service to continue technical assistance, es- 
pecially for assessing community needs, introducing new meth- 
ods, developing new areas of service, and in program evalua* 
tion. 

If the Public Health Service and the States are to 
participate effectively in preserving the manpower pool of 
the nations, so essential to national defenses more suitable 
and widespread community mental health services, acceptable 
to the public, m^ast be provided. Practically every profes- 
sional person in his lifetime will face a serious social or 
psychiatric problem, either in himself or his family, which 
will partially or completely incapacitate him in his work 
for a significant length of time. This time could be short- 
ened if there were convenient and acceptable mental health 
facilities available which were equal, for example, to the 



-4- 

facilities available for physical disabilities. When physical 
illness or injury strikes it is usually recognized quickly and 
facilities acceptable to the family are usually waiting to 
serve. With mental disorders, it is often the reverse. 

The Community Services Branch plans to assist States in 
holding on to the gains made in community programs by providing 
mental health consultants in every regional office to give sup- 
port to State staffs, and assist in getting wider coverage of 
services to all parts of the State. Specialists in special pro- 
gram areas from within and outside the Public Health Service 
will be provided to States to help them incorporate the latest 
practices into their programs. Through technical assistance, 
conferences will be held with State and community staff for the 
exchange of knowledge and program development in new areas, es- 
pecially in the field of alcoholism, drug addiction, school 
mental health, and aging. 

The Public Health Service will cooperate with the State 
mental health authorities in conducting orientation conferences 
to acquaint the staff of national. State, and local mental 
health associations with public mental health programs. These 
conferences should encourage voluntary and public organizations 
to work together on common objectives and probably will result 
also in increased support of official programs by citizen 
groups. 

The staff will work with individuals, groups, organiza- 
tions, and institutions who are interested in new approaches 
for prevention^ treatment, and rehabilitation of the mentally 
ill. Besides providing consultation, in some cases, the devel- 
opment of projects will be encouraged. More effort will be 
given to improving hospital administration and treatment pro- 
grams. This will be done by providing expert consultants to 
hospitals, supporting conferences for the exchange of ideas, 
special studies to improve operating procedures, demonstra- 
tions, and small grants to hospital staff members in Isolated 
areas so that they may spend time learning of new procedures in 
more modem treatment centers. 

Demonstrations will be continued in the aftercare of drug 
addicts, mental health activities in a county school system, and 
health education in a State mental health department. 

Branch staff at the Study Center will continue to study, 
at close range, one county in Maryland, to keep abreast of com- 
munity organization and dynamics, and their influence on new 
mental health serviceso These studies are important for devel- 
oping in Branch staff a progressively deeper and sharper under- 
standing of community mental health services, which is so essen- 
tial for the staff role as consultants to States and local pro- 
grams. 



An effort will be made to assist States in transmit- 
ting their training needs to universitieso At present, 
universities tend to emphasize training for clinical ser- 
viceSo State and local mental health staffs need training 
in working with groups and community organizations in the 
consultation process,, training techniques, administration, 
and research design. Only by communicating their needs to 
the training institutions can the universities begin to 
meet the demands of modern mental health programs. 

In order to keep abreast of developments in the men- 
tal health field and maintain a leadership role^ staff will 
continue to participate in inservice training, in national 
and regional conferencesj and some will have special as- 
signments to States. Staff will also participate in the 
Public Health Service graduate training program. Next 
year. Dr. Alan Miller mil return from a year's study in 
England^ His special knowledge of the open hospital and 
how it is integrated in the community will be utilized 
widely by the Branch. A m.ore complete analysis of State 
program activities will be made, including scope of pro- 
grams, methods used, effectiveness, cost, legislation, and 
program activities common to all communities. This infor- 
mation is essential for redefining the role the Public 
Health Ser\?ic8 should piay in the expansion of community 
mental health ser\'lces throughout the nation. The States 
have already laid the foundation. 



FEDERAL LEG ISLATION AND APPROPRIATIONS 

No major Federal legislation directly affecting 

the operations of the Coxsmunxtj Services Branch was enact- 
ed during the year. The appiopriations for grants to 
States for community ir-ental health services was continued 
at $4j000i,000s as in the previous year., but Guam was added 
to the States and Territories lAiich share in the grants. 

For the first times appropriations ($2,000,000) 
were made available for mental health project grants 
(Title Vg Piiblic Law 911) ., covering the fiscal year end- 
iEg June SOj 1958. 

The total operating budget of the Branch for staff 
, and admiaistration for fiscal year 1958 was $1,116,450, 

slightly more than a year before. 



BRANCH STAFFING 

There were 62 professional staff members, plus sup- 
porting secretarial staffg employed in the Branch at the 



end of 1957. Recruiting additional staff for the Branch was a 
major, time-consuming activity but was more successful in 1957 
than in previous years. Despite the acute shortage of mental 
health staff, 19 new professional employees were added to the 
staff. Three professional employees left the staff leaving a 
net gain of 15 employees. Ths three staff members who left the 
Branch were psychiatrists, who are most difficult to recruit. 

In central office, a public health physician was employed 
as a specialist on alcoholism. For part of the year a new psy- 
chiatrist worked on industrial mental health before her transfer 
to a regional office. Also, an administrative assistant was re- 
cruited. 

The regional offices filled positions for two psychiatrists, 
two clinical psychologists, two psychiatric social workers and one 
mental health nurse, helping to complete the mental health teams 
in the regional offices. 

At the Mental Health Study Center, Dr. Alan D. Miller 
was transferred to England for advanced study and research. 
Dr. Stanley F, Yolles, formerly the Associate Director is the 
present Director. In addition, a clinical psychologist was re- 
cruited. 

The two new demonstrations launched during the year (the 
New York City Drug Addiction Project and the Volusia County- 
Florida School Mental Health Project) were able to recruit a 
full staff ccmpleiment (six social workers in New York City, a 
psychologist and nurse in Volusia County). During part of the 
year, the staff member conducting the demonstration on mental 
health education in Ohio was reassigned to work on the Asian flu 
program. 

As in previous years, the Community Services Branch contin- 
ued to be responsible for staffing the mental health clinic at the 
D,C. Juvenile Court on a reimbursable basis, A psychologist was 
recruited but the position of psychiatrist remains vacant. Plans 
are bsiitg considered for the eventual transfer of responsibility 
for the clinic to the District of Columbia, 

During ths year, t>:.i?o psychiatrists on the staff completed 
training in public health. A staffing innovation in 1957 was the 
"Career Davslopment" plan. The purpose of this plan is to employ 
young, promising, fully-traiaed professional people and provide 
them with an opportunity to obtain a broader or higher level of ex- 
perience in order to prepare them to fill the regular positions in 
the Branch. I'toder this plan, a social worker was added to the re- 
gional office staff and .assigned to work as the State- level social 
work consultant in tb,s Arizona mental health program. 

By ths end of 1957 there ^jrere only ten professional posi- 
tions vacant and definite prospects or commitments for over half 



of the positions. It seems quite likely that in 1958 almost 
all of the Branch positions will be filled. 

In 1958s, orientation of new staff will continue to be 
an important activity. With the completion of the period of 
rapid growth and expansion, 1958 should see a period of con- 
solidation and, alsoj, the consideration of new ways in which 
a larger staff can work together effectively. 

In the Spring of 1957 9 most of the central office 
staff of the Branch moved from the National Institutes of 
Health grounds in Bethesda to Silver Springy Maryland. The 
Hospital Consultation Service of the Branch remained on the 
Institute reservation. Branch staff recognize the critical 
space shortage at the National Institutes of Health reserva- 
tion and also that the physical space a\7ailable in Silver 
Spring is superior to the Branch space previously occupied on 
the reservation. Howeverj the physical separation of the Hos- 
pital Consultation staff from the rest of central office staff 
tends to retard the development of a fully integrated Branch 
program, despite the strenuous efforts that have been made to 
maintain lines of communication. Similarly, the staff at 
Silver Spring have lost many of the benefits of the easily ac- 
cessible contacts with staff in other parts of the National 
Institute of Mental Health, 



DEVELOPMENTS IN STATE COMMUNITY MENTAL HEALTH PROGRAMS 

The major function of the Community Services Branch is 
to improves extend^ and strengthen State and local community 
mental health services and mental hospital services. Federal 
grants to States, irental health project grants, consultation, 
technical assistance projects, field demonstrations are some 
of the ways that are used to achieve this objective. A com- 
prehensive program including prevention, clinic and hospital 
services has been the goal. Of course, progress or lack of 
progress in individual States and localities result from a 
complex of factors and forces but the Federal program for men- 
tal health services has proved to have significant impact in 
moving programs ahead. 

Plans submitted by States to the Public Health Service 
show that on the T.'jholej State programs for community mental 
health services continued to expand in 1957, moving toward 
meeting the many large areas of unmet needs. Although some 
States have suffered set-backs, by and large^ the coverage and 
quality of State and local mental health programs are improv- 
ing. More clinics have been establishedo Efforts are being 
made to do more mental health education and to provide consul- 
tation to other programs and agencies. In some States, it has 
been possible to develop and expand a program of training sti- 



-8- 

pends and research. Stronger ties are developing between commun- 
ity and hospital programs. Nationwide, increasing attention is 
being given to specialized mental health services for particular 
groups, such as alcoholics, aged, mentally retarded^ and patients 
released from mental hospitalSo The regional mental health con- 
sultants have had a continuing and important role in working with 
States on these developmentSo 

Organization 

Relatively few changes in organization resulted from 
State legislation in 1957. West Virginia was the only State 
that had a major reorganization. The community mental health 
program was transferred from the Department of Health to the new- 
ly created Department of Mental Health which is responsible also 
for the mental hospitals, the State Training School for the Re- 
tarded and the Alcoholism program. Connecticut abolished its 
Mental Health Council replacing it with a Mental Health Board and 
gave the Commissioner of Mental Health more authority to direct 
the program. Idaho changed the size and membership of its Board 
of Health, and Missouri created a five member State Mental Health 
Commission responsible for appointing the Director of the Division 
of Mental Diseases in the Department of Public Health and Welfare. 

Divergent organizational changes were made in relation to 
alcoholism programs, Texas and Utah set up new independent alco- 
holism agencies. However, two States (California and Indiana) 
abolished their Alcoholism Commissions and integrated the alco- 
holism program into the existing public health departments. 
Illinois created a Division of Alcoholism in its Department of 
Public Welfare and Washington established an alcoholism program 
within its State Department of Institutions, 

State Grants-in-aid to Localities 

Probably the most f^ir-reaching development in 1957 was the 
legislative action in four States (California, Minnesota, New Jersey, 
Vermont) which followed the pattern of Connecticut and New York in 
providing State grants-in-aid to localities for community mental 
health services. 

This type of legislation is highly significant in its im- 
pact on the future development cf community mental health programs. 
At the local levels theavailability of State matching funds makes 
it possible for more e - eumil ' ^fcees co initiate .qew programs of commun- 
ity mental health services. Where ^ ^ aob^ itc Qsarh already complete- 
ly supporting mental health services. State matching funds release 
local funds which can be used to expand and improve existing services. 

At the State level, the legislation indicates the acceptance 
by the State of responsibility for helping to finance local mental 
health services on a continuing basis. State appropriations for com- 
munity mental health may be expected to increase. An eventual devel- 



-9- 

opment of local services throughout the State is implied. 
Also State funds act as a binder in bringing closer working 
relationships of State and local mental health staffs. 

The use of Federal grant~in->aid funds is also af- 
fected. Part of Federal grants are now being used to init- 
iate mental health clinics in communities. With, the avail- 
ability of State funds for this purpose,, Federal funds can 
be used increasingly for demonstrations of new types of ser- 
vices, pilot projects, training and research. 

According to the Minnesota mental health authority, 
"The recent session of the Legislature enacted the Community 
Mental Health Act which provides basically for state match- 
ing of local funds so that the communities can develop their 
own local mental health services. Within four years we ex- 
pect to liquidate the state financed clinics in favor of 
this community operationo This new program is an example of 
the use of the demonstration technique. The existing state 
clinics were established several years ago and their ser- 
vices expanded by the use of Federal funds. They have dem- 
onstrated their value and the communities are now willing 
to share in this cost." 

Using a different approach to the development of lo- 
cal community mental health services j three Midwestern 
States (Iowa, Kansas and South Dakota) authorised their 
counties to levy taxes or appropriate funds to support lo- 
cal community mental health centers or clinics. 

Funds 

According to the plans submitted by States to the 
Public Health Service for the fiscal year ending June 30, 
1957, States budgeted $45.4 million of Federal, State, local, 
and private funds for community mental health services, 76 
percent more than a year before. Excluding New York State 
which accounted for $14.1 million of the total increase of 
$19,5 million, funds budgeted by the States increased by 28 
percent. The largest gro^irth was in mental health clinical 
services which rose from $18.1 million in 1956 to $37.8 
million in 1957. 

Of the $45.4 million budgeted in 1957 the large majori- 
ity (83,3 percent) was for clinical services. Of the remaind- 
er, 4.4 percent ($2,0 million) was budgeted for the State men- 
tal health program administrative unit, 2,9 percent ($1.3 mil- 
lion) for the control of alcoholism,, 2,0 percent ($0.9 million) 
for trainings '^"^ percent ($0,7 million) for research, and the 
rest for other types of services. Federal funds ($4 million) 
constituted only 8,6 percent of the total funds budgeted, 

4 



-10- 

State and local community mental health programs have 
expanded tremendously following the availability of Federal 
grant-in-aid funds beginning in fiscal year 1948. In 1948, 
$3 million of Federal funds were available and $2,4 million of 
State and local funds. In fiscal year 19575 Federal funds had 
been raised slightly to $4 million but State and local funds 
had skyrocketed to $41,4 million. 

Preliminary tabulations for fiscal year 1958 indicate 
a continued increase in funds budgeted by State Mental Health 
Authorities for community mental health services. Available 
data for 45 States reveal that 34 States have more funds avail- 
able in 1958 than in 1957 and 11 States have less funds. For 
the 45 States combinedj 20% more funds were budgeted in 1958 
than a year before. New York State, which alone spends about half 
of the total funds budgeted In the nation, reported a tremendous 
increase of $6,4 million between 1957 and 1958, Other States re- 
porting large increases included Alabama (747,), Delaware (537,), 
Louisiana (307,), Ohio (407,), Oregon (837,), West Virginia (1217,), 
and Wyoming (847,), States reporting decreases included Kentucky 
(107,), New Mexico (187,), Washington (157,), and Puerto Rico (427,). 

Three States (Colorado^ Washington, Wyoming) for the 
first time in 1957 voted specific State appropriations for com- 
munity mental health services, thus joining the large majority 
of States which already have identified mental health appropria- 
tions. Such action by a State legislature is concrete recogni- 
tion of the State's responsibility for community mental health 
services, and usually sets a precedent for additional and more 
adequate appropriations in future years. 

Staffing 

The development of strong State-level mental health teams 
to provide leadership in the States has been a long-time objec- 
tive of the Branch, The Branch has especially encouraged a basic 
State level team which includes representatives from the four men- 
tal health disciplines of psychiatry, clinical psychology, psy- 
chiatric social work and mental health nursing. During 1957, 
States slowly expanded their State-level mental health staff. 
At the end of the year^ 12 States and Territories had State-level 
teams representing the four disciplines, 18 States had teams re- 
presenting three disciplineSs and 24 States had representatives 
of only one or two disciplines. In some States, only part-time 
services of staff were available. 

As of December Ij 19575 there were State level psycholo- 
gists carrying administrative or consultative responsibilities in 
community m.ental health programs in 29 States, psychiatric social 
workers in 40 States and mental health nurses in 27 States, Three 
States (Californiaj Marylandj New Hampshire) passed laws on cer- 
tification of psychologists. Several States (Califomias Georgia, 



-11- 

Pennsylvania^ Texas) are developing regional staffs of psy- 
chiatric social worker consultants who serve several coun- 
ties within a State» Several States have increased State- 
level nursing positions (e.g., Florida, Kentucky, Massachusetts, 
New Yorkj, North Carolina). Vacancies for personnel in State 
and local positions continue to increase faster than such 
personnel are being trained. 

Heavy turnover in the top-level State staff continued 
to plague mental health programs. Almost one- third of the 
States and Territories had changes during 1957 in the direc- 
tors or commissioners of community mental health programs 
(Colorado, Connecticut, District of Columbia, Georgia, Idaho, 
Indiana, Kentucky, Missouri, North Dakota, New York, Ohio, 
Pennsylvania, Puerto Rico, Utah, Virginia, Virgin Islands, 
West Virginia), Without attempting to evaluate whether the 
staff changes strengthened or weakened State leadership, the 
fact of change alone interrupts the continuity of program. 
Also the high "mortality rate" in these top jobs tends to 
deter many high caliber, career-minded people from seeking 
positions in State service. 

Mental Health Education and Consultation 

All States have programs of mental health education 
and consultation for lay and professional groups and agencies. 
To brief general practitioners in the diagnosis and treatment 
of mental disorders as well as in referral processes, 
Nebraska is using Federal funds to develop a special film 
for this purpose. Federal funds are also being used in a 
Bridgeport, Connecticut mental health clinic to experiment 
with the employment of a psychiatric social worker in a posi- 
tion called "Educational Director." 

Local Services 

New local mental health centers or clinics continue 
to be organized (e.g., Alabama, Illinois, Massachusetts, 
New Hampshire, New York, Ohio, Tennessee) but sparsely set- 
tled areas have great difficulty in recruiting staff. Clinic 
services are especially scanty in large areas in the South, 
Southwestern, and Mountain regions of the country. According 
to the Oregon Public Health Service plan, "The most vociferous 
demands in'the field of mental health are for increased mental 
health clinical services for both adults and children." Some 
States are using traveling clinics, some are trying to organ- 
ize multi-county clinics^ and others are trying to provide 
mental health consultation services Oiere no direct treatment 
facilities are available. 

To meet the need in rural areas, Florida has evolved a 
new kind of mental health staff person called a "mental health 
worker." These "mental health workers" (whose background may 



-12- 

have been in nursing-, teaching or social v/ork) are stationed in 
the rural countieso They refer people to the clinics in the 
urban counties and try to carry out the recommendations made by 
the clinics in conjunction with community agencies. They also 
conduct a program of mental health education and community or- 
ganization. The program of the "mental health v/orker" has re- 
ceived strong legislative support in Florida, and the idea may 
spread to other States even though the effectiveness of the plan 
has not been established^ Alabama, for example, has indicated 
that it is seriously considering initiating such a program in 
1958. 

Mental Retardation 

State legislatures showed high interest in mental retar- 
dation, Idaho and Minnesota made it mandatory for local school 
districts to provide instruction for handicapped children. State 
funds were appropriated for the establishment of a diagnostic 
and training center for the mentally retarded at the University 
of Washington. The Delaware legislature authorized the establish- 
ment of day centers for children with an I.Q, of less than 35, 
who are living with their families. New York is making a State- 
wide census of mentally retarded children and will be developing 
plans for a State research institution on mental retardation. 
Massachusetts received a new appropriation of $150,000 for com- 
munity nurseries for retarded children. 

Examples of mental retardation projects, which are sup- 
ported by Federal grant-in-aid funds, include the multidisci- 
pline training program of the New York Medical College at the 
clinic for the mentally retarded of the Flower-Fifth Avenue 
(New York City) Hospital, and the day care program for young 
mentally retarded adults of the Retarded Children's Aid Agency 
of Chicago, In many States (e.g,, Arizona, Nevada, Oklahoma, 
Rhode Island) State mental health staff have been actively in- 
volved in the establishment and development of nex7 clinics for 
the mentally retarded which are supported through Children's 
Bureau grants. 

State and Local Surveys 

Surveys of State or local mental health needs and resour- 
ces are another indication of the stir and ferment on mental 
health. The American Psychiatric Association completed surveys 
of Iowa and OhiOo State-wide surveys are planned or underway in 
Michigan, Hei-j Hampshire and Nevada. Los Angeles, California, and 
Montgomery County, Maryland^ are examples of the more numerous 
local communities in the midst of a survey. 

Training and Research 

Training and research were being stepped up through the 
action of State legislatures. The Iowa legislature set up a new 



.13- 

fund for training and research at the Psychopathic Hospital. 
The appropriation for Florida's Council on Mental Health 
Training and Research was raised to $363^000 for the current 
biennium as compared with $250^000 in the previous period. 
Texas will be organizing a new community hospital for train™ 
ing and research in mental illness, to be located near the 
Texas Medical Center in Houston. In 1958a Illinois will be 
opening its new training and research centerj the Illinois 
Psychiatric Institute in Chicago, Louisiana appointed a new 
Director of Training and Research and got its new training 
program in operations after making agreements for the train- 
ing of mental health personnel with Louisiana State Univer- 
sity, Tulane University and two State hospitals. The Medi- 
cal Center at the University of North Dakota was directed by 
the State legislature to encourage the training of psychia- 
tric personnel for staffing the mental health agencies of 
the State and training stipends were provided. 

Alabama made its first effort to attract mental health 
trainees to the State when it set up a training unit in 
Birmingham, Massachusetts has set up a project for training 
community mental health staff. A curriculum is planned for 
public health nursesg school psychologists and school social 
workers, AlsOs by offering second-year fellows in child 
psychiatry, part-time experience in the mental health center 
programg the Massachusetts Department of Mental Health hopes 
to interest more of them in the community mental health field. 
Under the Division of Community Mental Health Services in 
New Yorkj about 50 stipends are being awarded to mental health 
trainees J about 45 stipends to employees of the mental hospi- 
tal program, Indiana will be using about $50,000 of its 
Federal grant-in-aid for training stipends. 

Sparked by a consultation request from a State, a 
staff member of Region II., with the cooperation of staff in 
other regions, conducted an informal survey of the educa- 
tional leave policies for psychiatric nurses in State mental 
health programs in June, 1957. The survey revealed a paucity 
of State financial support for the professional training of 
psychiatric nurses. Of the 44 States reviewed, only 12 had 
State funds available for training stipends. These 12 
States were; California, Florida, Illinois, Kentucky, 
Louisiana, Michigan, Minnesota, New York, Ohio, Pennsylvania, 
South Carolina, and Virginia, The level of training sup- 
ported by the States varied and raiaged from single courses 
to training for the Master's degree. Without exception, 
everyone of the 12 States expected the trainee to accept 
State employment for a specified period in return for the 
financial aid provided during training, 

A second staff member in central office supplemented 
this survey with a narrative report which included a discus- 
sion of the problems resulting from the frequently inadequate 



-14- 

amount of the stipend and from the requirement for obligated 
State employment in return for the training stipend. 

In the area of research a program of research in alco- 
holism was established at the College of Medicine of Ohio 
State University. The California Department issued its first 
research report on a study which found that there are few pa- 
tients arriving at the State mental hospitals who could be 
cared for better in an outpatient clinic. The General Bacon 
Health Center in Delaware is working on a study of the rela- 
tionship between behavioral adjustment and the emotional a- 
rousal pattern in children. The Michigan Department is con- 
ducting an analysis of the characteristics of audiences par- 
ticipating in mental health education programs. Minnesota 
is supporting a study of the reasons for the breakdown of re- 
covered or partially recovered mental patients. New York is 
studying schizophrenic children in outpatient settings. 

In its official plan submitted to the Public Health 
Service, Connecticut reported that 5 "A grant of Federal funds 
was made in 1956-57 to a psychiatric clinic for children in 
Bridgeport to enable its staff to do a preliminary survey and 
evaluation of some of the work done in that clinic over a 
five-year period. As a result of this preliminary survey, 
the clinic expects to undertake some more intensive research 
activities in the coming year supported by funds from other 



During the year a member of the Region V staff issued 
a compilation of mental health research conducted or support- 
ed by State mental health agencies in that region during 
1956-1957. Of the 122 research projects reported, 467o were 
biological, 337, clinical, and 21% were psycho-social. Four- 
teen of the projects were in mental retardation and five were 
on aging, . 

Needs 

Although progress is being made on many fronts, the 
States report many gaps and inadequacies in over-all commun- 
ity mental health services. In the plans submitted to the 
National Institute of Mental Health, State after State indi- 
cates the need to set up more mental health seirvices for peo- 
ple living in geographical areas now without ser-s/ices. States 
are seriously concerned with the need for more treatment and 
rehabilitation services, mental health education, consultation 
to community agencies, training opportunities for mental health 
staff, and research and evaluation. Over and over again States 
report that the bottlenecks are inadequate funds for community 
mental health services, shortages of professional mental health 
personnel, and low salaries. 



-15-» 

MENTAL HOSPITALS 

Mental Health Project Grants 

A major effort of the Hospital Consultation Service 
of the Branch has been in providing staff services to the 
new Mental Health Project Grants program. Legislation es- 
tablishing this program was passed by Congress (Public Law 
911) in 1956o This legislation was based upon the recog-"" 
nized need for encouraging effective ways to improve pro- 
grams for the care of the mentally ill, for experimenting 
with new methods of care,, and for helping isolated hospi- 
tals to demonstrate the feasibility of methods already suc- 
cessfully in use elsewhere. It was believed that, in many 
instancesj the secondary gains to the institution because 
of the stimulation of working on a project would in itself 
improve the quality of care in that institution. When 
Public Law 911 was passedj no appropriation was made, How- 
everj steps were taken to establish the groundwork for the 
grants program. A Review Committee was established with a 
membership of thirteen outstanding professional persons 
from the field of psychiatry, clinical psychology, psychi- 
atric nursing, psychiatric social work, sociology and 
hospital administration. Applications were received be- 
ginning in January 1957 in anticipation of the availability 
of funds. The response to the announcement of the grants 
program was enthusiastic and immediate. Two million dol- 
lars were made available for grants during fiscal year 
ending June 30, 1958. 

The Review Committee has met three times during 
1957 and has considered 137 applications. Applications 
have been received from 34 States and three Territories, 
including States in every region of the country. Organ- 
izations submitting applications have included State de- 
partments of mental health. State hospitals. State insti- 
tutions for the mentally retarded, private hospitals, 
clinics, universities, residential treatment centers for 
children, rehabilitation centers, and professional organ- 
izations. 

To date A4 projects totalling $1, 385,306 have been 
approved by the National Advisory Mental Health Council. 
Examples of the initial projects which are just now get- 
ting underway are; 

1, Demonstration of a day hospital service in a 
child gujidance center setting. 

2, Demonstration of a special group program for 
acting-out children in a residential treat- 
ment home for children. 



-16- 

3. Demonstration of a day hospital program for psy- 
chotic children. as part of the state hospital unit 
for psychotic children. 

4. Utilization of a public health nursing service in 
the supervision of convalescent psychiatric patients. 

5. Coordination of community services to facilitate 
the hospitalization of patients. 

6. A study of preadmission services and alternatives 
to hospitalization. 

7. Establishment of aftercare services and the coor- 
dination of community services in a rural area. 

8. A study of the various techniques for the care 
and treatment of chronic psychotic patients. 

9. The improvement of medical records in a large 
state hospital. 

10. The provision of comprehensive psychiatric ser- 
vices in a geographically isolated area with max- 
imum utilization of local facilities. 

11. A project to develop ways and means to sustaining 
the geriatric patient extramurally and cut down, 

if possible, the admission of the nonpsychotic geriatric 
patients to the public mental hospital. 

12. A study of the language and communication problems 
of mentally retarded children. 

13. Demonstration of a psychiatric rehabilitative ser- 
vice for young inmates of a county jail. 

14. An evaluation of treatment methods for schizophren- 
ic patients selected from chronic wards of a state 

hospital. 

15. A demonstration project which would set up a suici- 
dal referral service in a large urban area. 

16. A study of the role of practical nurses as a possible 
solution to the problem of the shortage of nurses in 

state hospitals. 

It can be seen that the approved projects cover a wide 
range of problems in intramural and extramural care. 

In the course of the review and approval of the projects, 
the Review Committee has been working on guide lines for the pro- 
gram. Early in 1958 the Committee plans to review the progress 



-17- 

of the program and to see if there are uncovered areas which are 
in need of further stimulation and development. 

As in many new programs, the working out of relationships 
has been an important factor in the initiation of this program. 
This had included the clarification of the responsibilities be- 
tween headquarters and regional office staff. Some questions 
have come up concerning the confidentiality of grant applications 
and the role of the State mental health authority in relation to 
applications from voluntary agencies. Efforts have been made to 
interpret the basic features of the Mental Health Project Grants 
program. 

Headquarters and regional office staff have received nu- 
merous requests for consultation concerning the program. The 
staff members and members of the Review Committee have made site 
visits and have given consultation. Applicants have indicated 
that these consultations have been most helpful in clarifying 
the potentialities of their own program as well as stimulating 
the development of better patient services. 

Currently approved projects will require over $1,200,000 
of grants in order to continue in fiscal year 1959, Unless ad- 
ditional funds are available, very few new projects can be added 
during fiscal year 1959. The staff will make visits to the 
approved projects and will be available to help project direc- 
tors in their recruitment of personnel and in their working out 
of the projects. 

Hospital Consultation 

The year 1957 has seen an acceleration in the amount of 
consultation given to State hospital programs. The regional 
office consultants as well as the staff of the Hospital Consul- 
tation Service have been active in this area. The Hospital Con- 
sultation staff have visited 36 states to meet with hospital 
and other mental health personnel and to visit mental health 
facilities. Through these visits new program ideas are being 
communicated widely. The content of these consultation visits 
covered a wide variety of subjects and some new patterns in the 
care of mental patients seem to be spreading rapidly. 

Several States attempted to modernize their laws in re- 
gard to the commitment, detention and care and treatment of 
the mentally ill (e.g., California, Colorado, Kansas, Minnesota, 
Montana, North Dakota, Texas), Alaska enacted a comprehensive 
mental health act following the framework of the Alaska Mental 
Health Enabling Act passed by the Congress. 

Of special interest was the 1957 legislative action in 
seven States (Connecticut, Maine, Minnesota, New Hampshire, 
Oregon, Rhode Island, West Virginia) which ratified the Inter- 
state Compact on Mental Health, Together with Massachusetts, 
New Jersey, and New York which ratified the Compact in 1956, 



-18- 

ten States are now participating in the inter-State agreement 
which was first issued in 1955. The Compact makes the patient's 
welfare the cardinal consideration in deciding whether he shall 
be kept in one State or sent to another. The prompt action of 
the ten States suggests that the Compact meets a long recognized 
need and also that inter-State agreements may be a useful admin- 
istrative device for helping to solve other problems of providing 
mental health services. 

The establishment of psychiatric facilities in general 
hospitals seems to be a definite trend. For example, Georgia 
asked for help in developing its program for establishing such 
units and using them as screening centers for patients prior 
to admission to the state hospital. The State plans to reimburse 
the local hospitals for the care of the patients. 

The philosophy of the "open hospital" is receiving wide- 
spread attention. This philosophy implies the creation of a 
therapeutic milieu, greater patient freedom, a different concep- 
tualization of the status of the patient with, in turn, differ- 
ences in the staff-patient relationships, a fuller integration 
of the hospital into the community, and a broader , use of commun- 
ity resources. Most hospitals are trying to achieve this goal 
one step at a time. Mental Health Project Grants are being used 
by a few hospitals for this purpose. 

Many hospitals are asking for help on how to achieve im- 
provements in patient care with "what they have at hand now" and 
without either extensive building programs or recruitment of 
hard-to-get professional personnel. 

Several States are taking action to provide special care 
and treatment for emotionally disturbed or psychotic children. 
The Minnesota and Virginia legislatures authorized the establish- 
ment of resident treatment centers for emotionally disturbed child- 
ren while Nevada and Washington will be establishing special treat- 
ment facilities for children as part of the State hospital program. 

Interest and activity in mental retardation continued at a 
high level, Arkansas, Nebraska, Texas, and Wisconsin authorized 
the construction of new institutions for care and treatment of the 
mentally retarded. 

Aftercare facilities and programs are becoming increasingly 
important. These are being developed as a part of hospital programs 
and as a part of community programs administered by voluntary or pub- 
lic agencies. Two conferences on aftercare were held as Technical 
Assistance Projects and involved participation of regional and head- 
quarters staff. Three regional conferences were held with the Of- 
fice of Vocational Rehabilitation and mental hospital personnel on 
the rehabilitation of the mental patient. These were held in Re- 
gions rv, V and VI, Another conference in California enabled the 



-19- 

hospital and aftercare staff to meet together. All of these 
conferences have contributed to the better understanding be- 
tween the intramural and extramural programs and better com- 
munications in the interests of patients. 

The half-way house as a method of care is receiving 
widespread attention and interest. As in any new development, 
there is much experimentation and considerable variation in 
the various programs. Some see the half-way house as meeting 
a need for an interim facility which avoids the dependent se- 
curity of a hospital ward and yet offers an individualized as 
well as a group program. It is possible that in some commun- 
ities the already established facilities^ such as the YWCA 
and the YMCA, may provide this kind of opportunity fot the 
discharged patient. Some hospitals are setting up rehabili- 
tation wards that provide interim care to the patient and as- 
sist him in his integration back into the community. Patient 
clubs or social therapeutic clubs are becoming more widespread 
and are another assist to the patient in his resocialization. 

The interest in the development of half-way houses and 
patient clubs is very closely related to the growth in scope 
and importance of the volunteer movement. Volunteers are an 
important factor in the closer working together of hospitals 
and communities. Volunteers are being used in many roles in 
working with the institutionalized patients and are sponsor- 
ing some community efforts such as ex-patient clubs and half- 
way houses. A conference on the work of volunteers with men- 
tally ill patients is to be held in June 1958 under the spon- 
sorship of the American Psychiatric Association and four other 
national organizations. This conference is being supported by 
a grant from the National Institute of Mental Health. Four 
preparatory commissions are gathering material to be used as 
the basis of the conference. This conference will consider 
the present status and purposes of volunteer programs for the 
treatment, care, and rehabilitation of the mentally ill; the 
delineation of the functions of volunteers; the unique pro- 
grams in the field of community rehabilitation services; and 
the existing administrative patterns and personnel policies 
governing the operation of volunteer programs. Problems of 
recruitment and training of volunteers will also be considered. 

The care of the aged in nursing homes and in mental 
hospitals is getting increased attention nationwide. Crowding 
in other community facilities often makes the State hospital 
the only place for the disabled old person. In some States, 
county homes are used for this purpose. Visits have been made 
by staff to the county homes in two Mid-Western states and a 
workshop is to be held in December 1957, with nursing home 
operators in another State, Branch staff are participating 
in the planning of a national conference of nursing home 



-20- 

operators in February 1958, which is being sponsored by the Bureau 
of State Services, Public Health Service. 

The community care of the mentally ill and the early dis- 
charge of patients from State hospitals together with treatment 
in the community in lieu of hospitalization have many implica- 
tions for other community health and welfare programs. Consul- 
tation has been provided to national and State agencies on ways 
of coordinating services of hospitals, public health and welfare 
agencies. Community workers such as public health nurses and 
welfare workers are key figures in providing care for the pa- 
tient and his family. Many efforts are being made to familiar- 
ize these workers with the problems of the mentally ill, and to 
interest them in expanding their services to this group. There 
are also indications of the need for change in agency policies 
which may exclude a person from service by reason of his mental 
illness. Conferences have been held with personnel in the Bureau 
of Public Assistance and Old Age and Survivor's Insurance to 
point up some of these questions. The fact that the American Pub- 
lic Welfare Association devoted part of its "Round Table" to a 
consideration of the problems of mental health and mental illness, 
is a very encouraging indication of the interest of welfare admin- 
istrators in this area. 

The upgrading of the existing staff through staff develop- 
ment activities and the use of the psychiatric hospital as a train- 
ing resource Ihave important implications for improvement of patient 
care. The Hospital Consultation Service staff have contributed to 
a number of different kinds of staff development efforts, including 
regional meetings, summer institutes, hospital staff seminars and 
staff consultations. Special consultation was given to one State 
concerning the development of its hospitals as training centers. 

It has not yet been possible to work out adequate informa- 
tion collection procedures in order to answer the requests for in- 
formation on such subjects as State commitment laws. State licens- 
ing laws for private mental hospitals, architectural plans, trends 
in aftercare programs and personnel standards. It is hoped that 
during the coming year further progress can be made in the collec- 
tion and analysis of such data. 

One of the needs voiced by many States is for small amounts 
of money with which they could initiate a variety of developmental 
projects. Such money could be used for consultation, for staff de- 
velopment, for sending staff teams to visit other hospitals, or for 
experimental purposes. It may be that this need can be met through 
the Mental Health Projectv Grants Program; if not, ways need to be 
found to assist States in this kind of effort. 



SPECIAL AREAS OF MENTAL HEALTH 



Alcoholism D 

u 



Branch activities relating to alcoholism during the past 



-21- 
year have expanded in two important respects. The first is 
the increased amount of service given by the regional mental 
health staffs to program developments relating to alcoholism. 
The rising number of requests for such services reflects a 
growing awareness of the relatedness of alcoholism to the 
broad field of mental health problems. Regional staff were 
being asked to meet the following kinds of requests: planning 
for and participating in State or regional institutes on alco- 
holism; development of more effective treatment and rehabili- 
tative measures in State mental hospiitals and mental health 
clinics; consideration of alcoholism in relation to tuberculo- 
sis, diabetes and other chronic diseases; problems of alcohol- 
ism in industry; consideration of excessive drinking among 
Indians. Regional mental health staff also consulted with 
other regional staff of the Public Health Service and of the 
Department (such as the Office of Vocational Rehabilitation) 
on problems of alcoholism. 

There are currently 37 official State alcoholism pro- 
grams in operation, with others in various stages of organi- 
zation. A commonly cited factor relating to these programs 
is that they have relied entirely on State initiative rather 
than on Federal support. The desirability of effecting more 
formal working relation between these presently independent 
programs on alcoholism and the Federal-State operations per- 
taining to other public health activities, is a matter now 
receiving attention on both State and Federal levels. Re- 
gardless of the natute of such a relationship, it is practical- 
ly inevitable that the participation of the regional mental 
health staffs will continue to grow in significance. 

The return of Dr. Paul H. Stevenson to active duty 
as Concultant on Alcoholism marks the second advance during 
the year in the Branch's activities relating to alcoholism. 
This event provides for more effective consultation services 
to and through the regional office staffs and also for the 
reactivation of certain headquarters activities. Most impor- 
tant will be the renewal of active liaison relations with the 
major organizations operating on the national scene in the 
field of alcoholism, and the maintenance of rosters and current 
summaries of State and local programs and facilities, thus 
serving again as a clearing house for information. In addition, 
through the procurement of the recent annual issues of the 
Classified Abstract Arthive of the Alcohol Literature, the 
Institute is now one of the limited number of depositories of 
this service in the country. This archive will be kept cur- 
rent, and arrangements made to make it available to a wide 
circle of research workers and program staff working in the 
field. 

In March 1958, the National Institute of Mental Health 
and the Bureau of State Services, Public Health Service, will 
jointly sponsor an ad hoc conference of about 25 national ex- 



-22- 

perts in the field of alcoholism. They will be asked for their 
suggestions on the future role and program of the Public Health 
Service in regard to alcoholism. 

Industrial Mental Health 

At the 1956 Conference of the State and Territorial Mental 
Health Authorities with the Surgeon General, the mental health 
authorities requested that the National Institute of Mental Health 
make available information dealing with mental health in industry. 
For several months in 1957, a Branch psychiatrist was assigned to 
work in central office on mental health in industry. This staff 
member prepared the publication, "A Review of Mental Health in 
Industry" which contained a review of the literature, a bibliog- 
raphy of some 150 titles, a description of several programs in 
large companies, and a list of films on human relations in indus- 
try. The review of the literature covered recent history, func- 
tions of the psychologist and psychiatrist, relationships of men- 
tal health programs to general industrial health programs, atti- 
tudes of management and labor, and training and research. The 
special problems presented to industry by absenteeism, accidents, 
alcoholism, and the elderly worker were also considered. The re- 
view found that the participation of public health agencies in the 
industrial mental health field has been limited and fragmentary 
and suggested the need for development and expansion of the total 
field of mental health in industry. 

Mental Retardation 

A member of the central office staff was the joint author 
with Dr. Seymour B. Sarason of a major report (in press) on mental 
retardation. The report entitled, "Psychological and Cultural 
Problems in Mental Subnormality, A Review of Research," was spon- 
sored by the National Association for Retarded Children under a 
National Institutes of Health grant. 

The report points out that the bulk of cases of intellec- 
tual deficit are identified and become problems during the span 
of years children normally attend school. Therefore, reported 
prevalence of retardation in the population reaches its highest 
point at age 14-16. These children and adolescents who have been 
labelled retarded leave the school system and merge successfully 
into the adult population because their post- school life places 
different kinds of intellectual demands upon them. There is no 
present reason to assume either organic or hereditary etiology in 
most of these individuals; rather, they suffer from learning defi- 
cits often introduced by the subcultural patterns of living and 
child rearing characteristic of the groups into which they were 
bom. The report urgently recommends research on the nature of 
the intellectual processes learned in the «srious sectors of our 
population, on better means of identifying learning deficits at 



-23- 

the preschool level so that corrective action may be taken be- 
fore it is too late, and on the intellectual requirements of so- 
cial living outside of the school situation. 

Narcotic Addiction Demonstration 

A Demonstration Center to work with drug-addicted pa- 
tients discharged from the Lexington Hospital was launched by 
the Community Services Branch during the year. The Center was 
set up in New York City in an attempt to prevent relapse among 
discharged drug addicts by helping them utilize the facilities 
of community health and welfare agencies and by providing con- 
sultation to the agencies so that they will better be able to 
meet the needs of former addicts. The program of the Center 
is based on the general premise that an increased use of com- 
munity resources will help to rehabilitate narcotic addicts. 
Experience has shown that there are obstacles both in the pa- 
tient and in the community that interfere with the full use of 
community services for this group. 

A staff of six psychiatric social workers has been em- 
ployed and arrangements have been made for part-time psychia- 
tric consultation. The Center staff have been contacting com- 
munity agencies and, somewhat surprisingly, have found that 
agencies are willing to cooperate with the Center and to pro- 
vide service to selected addicts. In many instances, this 
has involved a reversal of previous agency practice. 

The Center will also be continuing a previous project 
of the Bureau of Medical Services, Pwblic Health Service, to 
maintain contact with a sample of drug addicts, without at- 
tempting treatment intervention, in order to find out about 
re-addiction rates after discharge. In addition, a study is 
being planned of the social and psychological factors that 
distinguish those who successfully discontinue taking drugs 
from those who become re-addicted. 

School Mental Health 

The number of school mental health activities of the 
Community Services Branch increased in 1957 in response to 
greater interest in this area by the States and the greater 
emphasis given these programs by our staff. The year 1957 
is the first time the Branch has had a full-time consultant 
working in this special area. The provision of a full-time 
consultant in this field enabled the Branch to work more 
closely with other Branches of the Institute also involved 
in mental health in education activities and to provide in- 
creased consultation to national organizations. States, and 
teacher-training colleges. 

Colorado, Mississippig Idaho^ Missouri, and South 
Dakota, were among the States which utilized Branch staff 



-24- 

to develop joint conferences of State mental health and education 
personnel on school mental health program development. Region III 
reviewed the school mentalhealth activities of its States as a 
part of a regional study of school health programs. Seventeen 
Southern States under the Southern Regional Education Board ini- 
tiated a project to increase the utilization and training of school 
psychologists. Considerable effort was expended on establishing 
closer liaison with the Office of Education, Department of Health, 
Education, and Welfare, and the National Education Association* 

During 1957, the Branch, in cooperation with the Florida 
State Department of Health and Education initiated a school mental 
health demonstration in Volusia County, Daytona Beach, Florida. 
Two members of Branch staff, a clinical psychologist and mental 
health nurse, were assigned to this county to study the present 
and potential local health department's school system teamwork 
on the screening and local management of minor emotional problems 
in school children. It is anticipated this fetudy will help to 
formulate the elements of a basic school mental health program 
that can be adapted and field tested for use in other rural coun- 
ties. 



TECHNICAL ASSISTANCE PROJECTS 

Technical assistance projects were initiated in 1955. 
These projects are special conferences focussed on a particular 
mental health problem of a State. They are designed to assist 
the States in building their mental health programs and are seen 
as an extension of the consultation and technical assistance now 
provided to the States through the professional staff of the Com- 
munity Services Branch. They have been particularly valuable in 
helping States explore and develop new mental health program areas. 

In 1957 there were 12 technical assistance projects carried 
out as a joint endeavor by the States, Regional Offices, and the 
Branch, at a total cost of approximately $45,000. This represents 
an average cost per project of approximately $3,700. Generally, 
at least one outstanding national consultant is employed to par- 
ticipate in the project. The following is a listing Ijy title of 
the projects carried out this year: 

California - "Coordinating Treatment Services for 
Mental Patients in California" 

Colorado - "Development of Better Social Services — 
Family, Patient, Hospital, Conmiunlty" 

Colorado - "Mental Health Through Coordinated 
Efforts of Education, Mental Health 
and Public Health Personnel" 



•25- 



Connecticut 



Iowa 



Mississippi 



Missouri 



New York 



Pennsylvania 
South Dakota 
Texas 

Utah 



"Applications of Management Theory 
to Administrative Psychiatry" 

"Rehabilitation and Post-Hospital 
Care for the Mentally 111" 

"The Schools the Childj and Mental 
Health" 

"Leadership Training for Community 
Mental Health Promotion" 

"In-Patient Psychiatric Units for 
Children - A Program Designed to 
Prepare the Child for Return to 
the Community" 

"Conference of Community Mental 
Health Clinics" 

"Leadership Training for Mental 
Health" 

"Maximum Utilization of Community 
Agencies in Treating Emotionally 
Disturbed Children" 

"Development of Collaboration be- 
tween State Agencies to Promote 
Better Mental Health Programs" 



CONFERENCES OF CHIEF STATE PSYCHOLOGISTS. SOCIAL WORKERS. 

AND NURSES 

As in previous years s Branch staff helped to sponsor and 
plan conferences for top State- level community mental health 
staff in each of three disciplines: psychology, social work, and 
nursing. These conferences provide an opportunity for the State 
staff in one discipline to exchange ideas and information on pro- 
gram developments in the various States. The meetings of the 
chief State psychologists focussed on the need for psychologists 
to have training in consultation and administration. The social 
workers' meetings discussed the philosophys methods, and tech- 
niques of mental health consultation. At the nurses meeting, re- 
source books, containing mental health materials and publications 
of special interest to State- level nursing consultants, were dis- 
tributed. Several members of university nursing faculty, who 
were present at the meeting, requested copies for their use in 
teaching. The shortage of mental health nurses was a major sub- 
ject of discussion. 



-26- 

ORIENTATION COURSES FOR COMMUNITY MENTAL HEALTH 
STATE PROGRAM DIRECTORS 

In accordance with recommendations made by the 1956 Conference 
of State and Territorial Mental Health Authorities, the Community Ser- 
vices Branch has assigned two staff members to be responsible for de- 
veloping a course of instruction and orientation on community mental 
health programs for State-level mental health staff. Following comple- 
tion of a preliminary plan for such a course, an advisory committee will 
be established, including representation from the Community Services 
Advisory Committee, members of the National Institute of Mental Health 
staff at headquarters and regional offices, and consultants outside of 
the Public Health Service. 

It is anticipated that an initial pilot course will be given for 
the States in three regions where the problems are fairly similar. Em- 
phasis in the course will be placed on program planning, coordination 
of coiranunity agency activities, and administration. Experienced people 
from State mental health program staffs, as well as others, will be 
drafted as faculty members to discuss and present aspects of these prob- 
lems. 

It is planned to have this first course early in 1958; a second 
course in another area of the country is planned for the Spring of 
1958. Later courses may provide more intensive training in special 
areas, such as administration. Vhere possible, such subsequent units 
will probably be arranged through contracts with appropriate university 
graduate departments, schools of public health, graduate schools of so- 
cial work, etc. 



REPORT ON FEDERAL MENTAL HEALTH ACTIVITIES FOR CHILDREN 

At the request of the Joint Commission on Mental Illness and 
Health, a statement was prepared on the impact of Federal mental health 
activities on services for children. Although the statement focussed 
primarily on activities of the National Institute of Mental Health, the 
review revealed the tremendous range of activities and the substantial 
investment of the Federal government in the mental health of children. 
A surprising number of Federal agencies are active in this field, includ- 
ing the Cooperative Extension Service of the Department of Agriculture, 
Department of Defense, Bureau of Public Assistance, Office of Education, 
Children's Bureau, Department of Justice, and many programs of the Public 
Health Service. 

Within the Community Services B ranch j , activities directly related 
to children included the following: (a) About 10% of the time of region- 
al consultants was devoted to school mental health, (b) a psychiatrist 
is assigned full-time to work on school mental health, (c) a school men- 
tal health demonstration has been launched in Volusia County, Florida, 
(d) four of the twelve technical assistance projects conducted in 1957 



-27- 

were directly concerned with children, (e) Federal grants-in-aid 
for conmunity mental health services have helped State programs 
grow from $2.4 million of State and local funds budgeted in fis- 
cal year 1948 to $41 million in 1957. Federal grants have been 
an important factor in the tremendous spurt in the number of 
outpatient psychiatric clinics established since 1946. Prelim- 
inary tabulations reveal that 72% of the persons served in out- 
patient psychiatric clinics were under 18 years of age. Feder- 
al funds have been used in many States for "growing edge" ac- 
tivities for pilot projects, experimental services, demonstra- 
tions, and research. A frequent pattern is the use of Federal 
funds to demonstrate a new mental health service which, after 
the success of the demonstration, is taken over and supported 
by State and local funds, (f) under the National Health Pro- 
ject Grants program (Title V), eight projects totalling 
$278,000 (October, 1957) were approved which were concerned 
with children. 



CONSULTATION ON RESEARCH AND EVALUATION 

Increasingly, as programs in State mental health agen- 
cies expand and develop, requests are made for consultation ser- 
vices relating to program research and evaluation. With the 
pioneering stage passed, interest has turned to justification 
of existing programs and increased evidence that services are 
actually accomplishing the results for which they are intended. 

To supplement resources in the regional offices, during 
the past year a Section on Program Research and Evaluation with- 
in the Community Services Branch was established in central of- 
fice. Two staff members are presently serving in that capacity. 
Regional consultants can request assistance from this Section 
as occasions and problems warrant. Also through this Section, 
the various technical research resources in the many laborator- 
ies and branches at the National Institute of Mental Health may 
be made available to the regional offices and State mental health 
programs. 

As an illustration of the activities of this Section, at 
the request of the mental health consultants in Region VIII, 
the two staff members of the Section participated in a meeting 
held in Utah to consider possible research studies relating to 
the establishment of new communities. This meeting was spon- 
sored by the Bureau of Mental Health of the Utah Department of 
Public Health and included representatives from the Departments 
of Psychology, Sociology, and Anthropology in the three State 
universities -- namely, the University of Utah, Brigham Young 
University, and Utah State University, This planning group is 
interested in a large-scale, long-term study of three new 
towns being built near the Utah-Arizona border in connection 
with the construction and use of the Grand Canyon Dam, Also, 



-28- 

a fourth town similarly related to the Flaming Gorge Dam on the 
Utah-Wyoming border may be included. Any such studies would be 
multi-disciplinary and would involve all three universities. 

Questions were raised and discussed with reference to 
Public Health Service research grants, administrative problems 
within the universityj collaboration, research design and grant 
procedures. 



THE MENTAL HEALTH STUDY CENTER 

The Mental Health Study Center, a field station of the 
Community Services Branch in Prince Georges County, is a clin- 
ical unit whose general function and purpose is to provide a 
setting in which studies can be conducted on various aspects 
of community mental health. It functions in four major areas, 
operation; (1) a research program ranging from studies on the 
structure, function, and operation of mental health units to 
epidemiological studies of problems in community mental health; 
(2) a mental health consultation service for Prince Georges 
County service agencies concerning family problems and commun- 
ity mental health activities; (3) a limited all-purpose psychi- 
atric outpatient service restricted to residents of Prince 
Georges County; and (4) in addition, the Center engages in 
training activities for various professional personnel. The 
staff of the Center are also called upon from time to time to 
act as consultants outside of the County, 

Epidemiological Study of Reading Disability 

This project is now in its fourth year. It is a product 
of the basic interest in the problem of locating emotionally 
disturbed and maladjusted individuals in the community and in 
identifying some of the psychological and sociological factors 
associated with such maladjustment. As a resident mental health 
research team that also offers service in the county, the staff 
became aware that one major concern, in the schools, in the 
homes, and in the courts, was the apparent high frequency and 
ubiquity of serious reading problems among children. The staff 
recognized that this community problem was remarkably suitable 
for epidemiologic inquiry, Reading disability is a definable 
phenomena. Accurate and complete case finding, one of the mqre 
difficult problems in epidemiologic studies of mental disorders, 
is an approachable goal. It is possible to know with reasonable 
accuracy how many children have serious disabilities, to know 
where these children live, and if only crudely at first, who 
they are and how they live. It is also possible to know these 
things about average readers and good readers. 

In spite of the fact that this phenomena is defined in 
educational termSj it is almost certainly of great mental health 
relevance. The syndrome of reading disability is clearly a 



-29- 

final common pathway Tdiich may have many origins. Reading 
is a basic and highly valued communication skill and a dis- 
ability in this area, whatever its origins, limits the in- 
dividual's capacity in many areas. As with so many chronic 
disorders, the consequences reduce the probability of its 
correction and may, in fact, lead to its entrenchment and 
even enhancement. The staff are interested in exploring 
and documenting this apparent destructive potential. It is 
the impression of the staff that such a disorder, together 
with its sources, constitutes an important reservoir of 
psychopathology from which a variety of disorders may e- 
merge. Should this be demonstrated, the presence of read- 
ing disability in an individual or an unexpectedly high in- 
cidence of reading disability in a family or neighborhood 
or community could serve as a flag calling attention to the 
need for more intensive examination^ This may be, in short, 
something like a "coliform count" for a public health 
screening device for mental health problems. The staff ap- 
proach to the problem is a multi-dimensional one; some of 
the areas of interest are described below: 

a. A profile of reading performance by school dis- 
trict will be completed during the first half of 1958 based 
on data collected over the past three years. Earlier inter- 
im studies have demonstrated the reliable performance of 
most school districts as well as increasingly reliable differ- 
ences between discreet geographical and sociological units 

in the county. The profile will provide a basis for the 
study of the meaning and significance of these differences 
as well as offer some clues to the nature and direction of 
performance changes in specific localities and in the county 
as a ^ole. 

b. A series of longitudinal studies based on three 
years of data from 1954 to 1957 v;ill be completed during the 
winter of 1957-58, These studies provide a crude sampling 
of children along a broad spectrxim of reading achievement 
and covering grades one through nine. They describe, with- 
in sampling limits, a picture of the range and variability 
of reading achievement over these grades. The three stud- 
ies have provided a good estimate of the reliability of the 
data-collecting instruments including the "reading quotient," 
a statistic that permits comparison of reading achievement of 
children at different age levels. They will also permit the 
evaluation of impact of agej, sex, and certain psychological 
and socio-cultural forces on achievement. 

These longitudinal studies will also serve as pilot 
projects for a Cohort Study of the entire sixth grade school 
population of 1954-55 (approximately 5,000 children), to be 
started during 1958, This study is planned first as a test 



-30- 

of the hypothesis that reading disability identified early can 
act as an indicator of psychopathology. In addition to collect- 
ing data on the total school careers of this group, information 
will be gathered from the Health Department, the Courts, Welfare 
Department, and other community sources. Second, and perhaps 
more importantly, the study will allow the development of methods 
for the effective and meaningful handling of large amounts of in- 
dividual .mental health data. 

c. The clinical study of the first group of boys with 
reading disability and of their parents was completed during 
1957 and a second group has been in treatment for eight months. 
These intensive studies of families seen in collaborative group 
therapy have contributed heavily to staff understanding of the 
intra-personal, familial, and cultural dynamics that appear to 
be so significant in this syndrome. One of the methods of deal- 
ing with the problem may be collaborative group therapy, a by- 
product of the research operation. 

d. Current plans, in addition to the Cohort Study, 
call for the completion of the survey of individual and family 
life, originally planned for 1957 and postponed. This survey 
will seek to examine the social matrix in tAich the syndrome 
appears through surveys of individual and family life in sever- 
al of the communities pinpointed as high and low incidence a- 
reas by the demographic study. 

Post -Hospital Project 

This project, begun in 1955, is a survey of a group of 
mental hospital patients returning to their homes in Prince 
Georges County, It was felt that people who had experienced 
hospitalization could contribute to the understanding of ad- 
justments during the post-hospital period. This information 
could be useful in planning for service programs for the post- 
hospital patient. 

During the twelve-month period of August 1955 through 
July 1956, 77 patients returned to the county. Forty-six of 
the 77 were interviewed; 24 had moved, 4 were not available 
for interview and 3 refused interview. Patients were inter- 
viewed once after they had been at home for approximately six 
months. Information was obtained about their experiences since 
returning home and from whom, if anyone, they had looked for help 
in the family, neighborhood, or from professional resources. In- 
terviewing began in January 1956 and was completed in March 1957. 

A preliminary analysis of the data calls attention to two 
facts. First, the total number of patients returning to this com- 
munity was numerically less than had been expected. Secondly, pet- 
haps similar to many communities, staff had anticipated a total 
post-hospital population composed primarily of psychotics and were 



-31- 

surprised at the large number of patients with an alcoholic 
or non-piaychotic diagnosis. It would seem logical, there- 
fore, that one of the first practical steps in planning a 
followup program would be to review carefully with the hos- 
pital the y^riety of patients admitted and discharged. 

Other significant activities and projects of the Study 
Center include; 

1. A pilot project aimed at trying out brief family- 
oriented service. The procedure being tested is to offer 
families a series of three family group therapy conferences 
after the usual diagnostic evaluation has been completed. 
The goal in this approach is facilitating communication with- 
in the family. 

2. A followup study has been initiated of patients 
seen for diagnostic services only and then referred to other 
community agencies. 

3. A study and evaluation of general clinical pro- 
cedures has been initiated. The traditionai 'technique of 
an intake interview followed by a psychiatric diagnostic 
session, followed by a psychological evaluation, followed 
by a staff conference will be under review as will be the 
voluminous dictation, recording and transcription of each 
step of the diagnostic and treatment process. 

4. The Center continues to work on the development 
of a way of classifying and filing the varied kinds of data 
about the county in which it works - its social structure 
and forces, its sub-cultures and neighborhoods, and agencies, 
A detailed cross-indexed classification was completed in 
July 1957. 

5. The record system project, begun in fiscal year 
1952, had as its objective the design of an integrated set 
of mental health clinic records, including a coding system 
for IBM cards. After this record-keeping system had been in 
operation for five years, the Center staff, this year, com- 
pletely revised all of the recording methods in use after 
evaluation was made of each item on each form as to its ap- 
plicability, practicability of completion and usefulness. 
Together with the Biometrics Branch, Center staff plan to 
analyze the five years of data acctimulated on IBM cards. 



WORK WITH REGIONA L. MTIONA L, AND IH TERNATIOmL ORGANIZATIONS 

Continued efforts have been made to develop program 
relatedness with national and international official and vol- 
untary agencies. This type of relationship is particularly 



-32- 

iraportant in a preventive mental health program. Mental health 
programs rather uniquely demand the close working relationship 
of many individuals, groups, and agencies. 

The following are some examples of how the Branch has 
been working with both national and international official 
and voluntary agencies in further developing mental health 
services to people: (1) Joint planning was initiated with 
the UoSo Department of Agriculture in an effort to take ad- 
vantage of their interest, and ongoing activities related to 
mental health. This agency has a tremendous potential for 
preventive mental health, particularly in rural areas, (2) 
A staff member of the Branch represented the National Insti- 
tute of Mental Health at the Third Pan American Congress of 
Social Service in San Juan, Puerto Rico. (3) Regional of- 
fice staff have participated actively in the deliberations of 
the National Social Welfare Assembly regional meetings. These 
meetings cover a wide range of activities including services 
to the aging, juvenile delinquencyj and mental retardation, 
(4) Two staff members participated in the 1957 National Asso- 
ciation for Mental Health Assembly as leaders of workshops on 
rehabilitation of the mentally ill, and the relationship of 
the community and the hospital in the care and treatment of 
the mentally ill, (5) Both regional and central office staff 
participated in the 1957 National Health Forxim which was de- 
voted to mental health. Regional and central office staff 
were also active in professional organizations such as The 
American Psychiatric Association, National League for Nursing, 
American Psychological Association, National Association of 
Social Workers, etc. 

Working relationships with the Office of Vocational Re- 
habilitation, Children's Bureau, Public Assistance, and the 
Office of Education have been greatly strengthened through nu- 
merous joint activities. For example, the Branch co-sponsored 
with the Office of Vocational Rehabilitation a series of re- 
gional conferences throughout the United States on the rehabil- 
itation of the mentally ill. 

The regional offices concerned (Atlanta, Charlottesville, 
Dallas, and New York) continue to work with the Southern Region- 
al Program in Mental Health Training and Research of the Southern 
Regional Education Board, which, with a grant from the National 
Institute of Mental Health, was successful during the year in em- 
ploying a mental health staff. Southern Regional Education 
Board's Council on Psychological Resources in the South has re- 
sulted in the first regional program to train school psycholo- 
gists. Likewise the regional offices in the Western part of 
the country (Dallas, Denver, San Francisco) continued their work 
with the Western Interstate Commission on Higher Education to es- 
tablish a Western Regional Council on Mental Health Training and 
Research, which received during the year a grant from National 
Institute of Mental Health to establish, operate and staff the; 



-33- 

above council. The New York Regional Office continued its 
cooperative work with the Northeast States Governments Con- 
ference on Mental Health. 

As in previous years, many of the regional offices had 
a meeting of the State program staff in their regions gener- 
ally to exchange information and experience about program 
problems and developments. In Region V a regional meeting was 
held which was focussed on the single subject of mental health 
education. 



COMMUNITY SERVICES COMMITTEE 

Recruitment and training of community mental health 
staff were the major subjects discussed in the two day meet- 
ing in March 1957 of the Community Services Committee of the 
National Advisory Mental Health Council. The Committee dis- 
cussion was centered about the problem of; (a) how to in- 
crease the supply of persons enrolled in professional schools, 
and (b) how the people in the training centers could be 
channeled into community mental health programs. 

Among the suggestions made were the following: (1) A 
more intensive, aggressive, and better organized recruitment 
program is needed, beginning with the high school student, 

(2) If part of the medical residency took place in a commun- 
ity agency rather than in a hospital, the interest of stu- 
dents in entering community services might be stimulated, 

(3) A study was prpposed to determine the motivational fac- 
tors which lead an individual to select either private prac- 
tice, work in a mental hospital or in community mental health 
services. (4) Community work needs to be made more attrac- 
tive through such devices as career plans, inservice train- 
ing, providing maximum responsibility and professional free- 
dom to staff. (5) Special project funds are needed to encour- 
age State hospitals to orient themselves community-wise. (6) 
Mental health associations should be encouraged to emphasize 
preventive services and community mental health programs as 
well as the mental hospital programs. (7) Increased utili- 
zation should be made of public health nurses in community 
mental health programs. 

In addition, the Committee took formal action in unan- 
imously approving the recommendation made at the 1956 confer- 
ence of the State and Territorial Mental Health Authorities 
that the National Institute of Mental Health provide courses 
of instruction for orientation of State- level staff on commun- 
ity mental health programs. 



I -34- 

ANNUAL CONFERENCE OF THE SURGEON GENERAL WITH THE STATE AND 
TERRITORIAL MENTAL HEALTH AUTHORITIES 

Preceeding the formal Conference of the Surgeon General 
with the State and Territorial Mental Health Authorities, the se- 
cond annual two-day "Technical Session" was held for community 
mental health program directors. These informal meetings provide 
an opportunity for program directors from all parts of the country 
to exchange information and experiences about program developments 
and activities. The manpower problem - recruitment, inservice 
training, retention of staff - was the major subject discussed in 
the meetings but other subjects discussed included research. 
State-level program planning and regional programs for sparsely 
settled areas. 

At the formal Conference on November 5;, 1957, the Mental 
\ Health Authorities passed thirteen recommendations. Three of the 

■j recommendations were concerned with training. The first asked 

; for Public Health Service grants of training funds on a matching 

I basis to the Mental Health Authorities to support interstate 

training centers for professional training in mental health. The 
second encouraged the training of more personnel for community 
i mental health programs by providing more funds for training grants 

i to operating agencies that are carrying on community laental health 

I programs. The third asked for liberal stipends to general prac- 

I titioners and non-psychiatric specialists for periods of three to 

! six months of intensive training in mental health, 

I 

i Two recommendations requested increased Federal grant-in- 

! aid funds for community mental health services. Surprisingly, 

\ these recommendations were submitted by New York and California, 

I both large, high- income States that contribute more in taxes 

I than they get back from a Federal grant, 

! 

I Two recommendations were concerned with meetings of men- 

' tal health staff. One asked the National Institute of Mental 

Health to set up a series of regional conferences for State men- 
tal health staff and the second asked for a continuation of the 
1 annual meetings of community mental health program directors usu- 

) ally held in conjunction with the annual Conference of the State 

1 and Territorial Mental H&alth Authorities Td.th the Surgeon General. 



I 
I 

I 

1 

f 



Additional recommendations requested that (a) Hill-Burton 
funds be extended for use in the construction and equipping of men- 
tal health facilities established for cooperative ^se by several 
States, (b) the Public Health Service explore with the National 
Association of Mental Health possible plans for providing orien- 
tation for executive secretaries of State mental health associ- 
ations on the Federal and State community mental health programs, 
(c) a study be conducted of the present structure of mental health 
clinics, (d) exploration be made of the possibility of notifying 
the mental health authorities of Federal grants in the mental 



-35- 

health field made by agencies other than the Public Health 
Service, in the Department of Health, Education, and Welfare, 
(e) the Public Health Service prepare and publish a monthly 
Mental Health Digest. As a recommendation to themselves, 
the Conference endorsed the principle of establishing after- 
care programs for released mental hospital patients. 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Cotnrniinity Services Branch 



BUDGET SHEET 

Estimated Obligations for FY 1958 
Total: $1,367,667 
Direct: $l,31''J-,600 

Reimbiir sements : $53 » 067 



ANNUAL REPORT OF PROFESSIONAL SERVICES BRANCH, NIMH 

CALENDAR YEAR 1957 

The Professional Services Branch continued to fulfill its function 
in the fields of program planning, program development, the administra- 
tion of special grants, budget review, specialized assignments with re- 
spect to program problems faced by the Institute, and the provision of 
consultation within the Institute to other governmental and non- 
governmental groups. 

The major activity of the Branch continues to be research and 
development in program areas and problems. Special grants are used in 
this connection to extend, temporarily, the facilities of the Institute. 
Analysis of the state of knowledge and programs of action, consultation 
with other groups or agencies concerned with the same problem, and feed- 
back of new knowledge and understandings, especially to State mental 
health programs, also constitute important parts of this activity. These 
areas form an over-all pattern, as indicated in the outline and stsmmaries 
which follow. 

Studies Concerned with the Prevention or Reduction of Disability in 
Pathologic or Deviant Populations 

Rehab i 1 i ta t ion 

Progress continues on two large-scale studies of psychiatric re- 
habilitation and a third project has been initiated. The Boston State 
Hospital Pilot Study of Rehabilitation and Rehabilitation Personnel is 
in the final stage of analysis of data. Dr. Ralph Notman, Principal 
Investigator, and Dr. Richard H. Williams of the Professional Services 
Branch, are assuming joint responsibility for preparation of a major 
report to be published in book form. The study of the post-hospital 
experience of mental patients is currently in full operation with four 
more years of committed support. Dr. Ozzie Simmons and his staff at 
the Harvard School of Public Health have published several papers based 
on the study, A study of the adjustment patterns of married patients 
admitted to a mental hospital for the first time, during hospitaliza- 
tion and the post-hospital period, has been initiated in the Department 
of Mental Hygiene in California. Drs. John Clausen, Morton Kramer and 
Williams are acting as liaison. 

Feedback activities from the rehabilitation studies have in- 
creased markedly during the past year. Drs. Notman, Simmons and 
Williams have consulted with the staffs of several State hospitals and 
State mental health programs and have participated in regional con- 
ferences on psychiatric rehabilitation sponsored jointly by the OVR 
and the NIMH. A book has appeared. The Patient and the Mental Hospital 
(Milton Greenblatt, M.D., Daniel J. Levinson, Ph.D., and Richard H. 
Williams, Ph.D., Editors), which summarizes current research on the 
social and psychological aspects of treatment and rehabilitation. 
Dr. Williams is serving as Chairman of an Advisory Committee at the 



Massachusetts Mental Health Center (Boston Psychopathic Hospital) which 
is concerned with a group of studies on rehabilitation, alternatives to 
hospitalization and the relation between drug and milieu therapies. He 
also serves on a Panel on Patterns of Patient Care, for the Joint Com- 
mission on Mental Illness and Health, and prepared an analytical sum- 
mary of the deliberations of this group. 

Mental Retardation 

Concern for the mentally retarded throughout the country has been 
greater during the past year than previously. The amount of research 
and program development has increased markedly with much improvement of 
both the quality and quantity. 

Activities within the NIMH staff and special grants made in this 
area have played an important stimulating role. 

The American Association for Mental Deficiency project on Techni- 
cal Planning in Mental Retardation has been working on many problem areas. 
The primary ones this past year have been: reorganization of the American 
Journal of Mental Deficiency ; development of an abstracting service which 
has been appearing regularly in the Journal ; publication of review articles 
(the NIMH supported survey of the etiology of mental retardation done by 
Drs. Masland, Satason and Gladwin will be published in the spring of 1958). 
Dr. Leonard J. Duhl is serving as the Associate Editor for Medicine for 
the Journal . 

Conferences have been held with medical school deans and heads of 
the departments of psychology and psychiatry to discuss the inclusion of 
teaching of mental retardation in medical schools. It is believed that 
it should be incorporated along with the general program of child develop- 
ment, rather than as a special entity and specialty. 

A basic revision of the presently existing nomenclature is in 
process. This nomenclature will fit the standard American Medical 
Association version. The revision is being made in cooperation with the 
American Psychiatric Association committee, the NINDB as well as other 
Government organizations. 

Institution-university cooperation studies are being made to de- 
termine how to improve the working relationships between these two groups. 
Institutions offer a wealth of subjects for research purposes; the uni- 
versities can both actively participate in research and offer much to im- 
prove the institution. 

The grant to the National Association for Retarded Children on 
the etiology of mental retardation is being prepared for publication. 
One version will appear in the Genetic Psychology Monographs and the 
other in the American Medical Association Journal of the Diseases of 



children . They are both being reprinted in the American Journal of 
Mental Deficiency and will subsequently be circulated by NARC and various 
Government agencies. This survey has already had a marked impact on 
researchers. 

The third special grant in this field to the pacific State Hospital, 
to study the factors involved in institucionalization of the mentally re- 
tardedj has begun. In addition to doing cohort studies of the population, 
attempts will be made to develop m.easures of Individual change. This 
grant has also allowed for the development of the Pacific State Hospital 
as a center for research in mental re tarda Si on. Major cooperative re- 
lationships have developed with University of California at Lcs Angeles, 
California Institute of Technology and the University of Southern 
California. Various departments such as bio-statistios^ public health, 
psychology, psychiatry and chemistry have become Involved, Various 
groups of graduate students have been brought into the program. In addi- 
tion, many persons not previously interested have been attracted both 
to the hospital and to work with the retarded themselves. This project 
ably demonstrates how effects of a research project car. spread beyond 
the research itself, 

Cooperatio!!. has continued with other agencies in Governmentj 
especially the Office of Education. Dr. Duhl has continued to consult 
on m.ental retardation, and served as a member of the Office of Education's 
Research Advisory Board. The Pvesearch Advisory Board is responsible for 
evaluation of research projects in ed^acation and has given special em- 
phasis to mental retardation. 

Drug Addiction 

A major study of drug addiction among m-inors at New York University 
is in its terminal year of support, M'ach has been learned about the cir- 
c'jmstances under which young people become drug users, the way they are 
initiated, and the kind of people they are. There has been basic clari- 
fication of the delinquency-drug use relationship. We now know the social 
psychology of drug addiction quite well, even though we cannot control 
all contributive forces in this field, as we cannot in other problem areas. 

There is still concern about this field. The Professional Services 
Branch is currently exploring the possibility of developing; (1) a 
sophisticated doc^jment on the measures necessary, in terms of commuriity 
action, to reduce and control addiction, and, (2) a small-scale demonstra- 
tion effort, aimed at the reduction of drug addiction in a part of a large 
city, with another part of the same city used as a control area. Such a 
formulation, based upon the research done in the last six years, plus a 
demonstration, could well lead to similar efforts, on a large scale, vjith 
local and/or State financing. It is now felt that basic social science 
research should be followed by action research. 



4 - 



Juvenile Delinquency 

Three special grant projects in delinquency research have been 
under \<iay during 1957, with Dr. Raymond Gould as the Branch liaison per- 
son. The first, at the Thorn Clinic in Boston, involves an intensive 
diagnostic study of hyperaggressive, uncontrollable boys and their 
families as preparatory to a larger study ivhich is to include both in- 
tensive diagnostic study and intensive investigation of the treatment 
process over a period of several years. The special grant covered che 
pilot phase of the project, with the understanding that the investi- 
gators would apply for a regular grant for the next phase. The appli- 
cation for the regular grant was approved in June of 1957 and the 
investigators are moving into this phase of the study in December of 
1957. At the same time they are completing the analysis and the re- 
porting of the pilot phase. The project is already supplying methodo- 
logical innovations in the content analysis of interview materials and 
a deepened understanding of the dynamics of the problem of the hyper- 
aggressive child and his family, with valuable clues regarding effec- 
tive treatment. 

The second project, at the South Shore Guidance Cenier in 
Quincy, Massachusetts, has concentrated in its pilot phase on develop- 
ing a typology of a sample of 50 delinquents who came to the juvenile 
court in 1957. The tjrpology is designed so as to be relevant for treat- 
ment purposes. A first draft of the analysis of the pilot phase has 
just been submitted to NIMH. The study has included the design of an 
extensive schedule for accomplishing the social and psychiatric diag- 
nostic study and has involved reliability checks on the observations 
of the psychiatrist by one or more other psychiatrists. It has also 
included a specification of the ideal treatment, the recommended 
treatment, and the actual treatment or disposition prescribed by the 
court, x^7ith predictions regarding the probability of recidivism in each 
instance. This group is planning to apply for a continuation grant 
of several years' duration early in January 1958. This project will 
involve enlarging the sample so as to permit more refined analysis and 
a program of intensive treatment where appropriate, and intensive 
follow-up of the sample so as to test the predictions and deepen the 
diagnostic understanding of the cases. 

The third project, with Dr. Lippitt and Dr. Withey at the 
University of Michigan, is in its pilot phase, using a social- 
psychological approach to develop a clinically meaningful typology of 
delinquents, with a focus on the social situation of the child as well 
as on significant attributes of the child and his family. They are 
also conducting pilot investigations of significant agencies in the 
community, such as police, juvenile court, social agencies, and schools. 
Application for an expansion of this project will be submitted in the 
spring of 1958, 



- 5 - 



Dr. Gould has been active as a consultant in delinquency research 
during the year, and has an article on the present state of delinquency 
control and research in the December 1957 issue of Federal Probation . 

Other Areas 

Consideration is being given to the promotion of research and 
development activities in other areas, under this general heading, in- 
cluding alcoholism, sex deviancy, suicide, family disorganization and 
the problems of gifted children. No actual work has as yet been under- 
taken in these areas. 

Studies of Fundamental Processes Affecting the Mental Heaich o£ Popu - 
lations of Entire Communities ( Local , State and National ) 

Communication of Mental Health Concepts 

A major study in this field, at the University of Illinois, has 
shown what the population thinks about mental health problems, how 
these beliefs compare with those of the experts, and v^hat is being said 
about the theory of mental illness in the mass media. The project has 
terminal support, and is currently addressing itself to experimental 
studies of change phenomena in this area, as well as to an analysis 
of the factors determining how mental health information is secured, 
screened and transformed by the media. The demographic factors are 
pretty well understood. The final results should be useable tools for 
those who want to achieve specific mental health education objectives. 

Child - Rearing Practices and Beliefs - The Parental Role 

The Illinois studies on communication highlighted a specific 
problem area--education concerning child rearing or rather the fac- 
tors responsible for parent behavior with respect to their children. 
There had been many studies of what kinds of problems children showed 
as a consequence of particular parent behaviors and child-rearing 
practices. One of the most definitive was an extensive study by 
Robert Sears at Harvard with regular research grant support. It be- 
came increasingly clear, however, that little was kno^^m about the 
total set of factors that determine parent behavior. The interaction 
of parent personality structure, beliefs, concepts and hypotheses 
about child development, value structure and goals for the child, 
sub-cultural influences, etc., had not been explored for all parents 
and only in a limited way for those who have produced children needing 
clinical attention. In short, vjhat is the total set of influences that 
determine parent behavior? Which of the influences are raanipulable by 
non-clinical methods? l-Jhat is the natural history of parent role de- 
velopment? The emphasis here is on basic understanding of hov7 a role 
is developed in our culture. The answers should help greatly to deal 
with the more applied problem of parent education. This study is 
being supported on a five-year basis starting in April 1957. The 
principal investigators are Robert Sears and VJilbur Schram at 
Stanford University. 



6 - 



Aging 

Progress continues on the study of Psychological and Sociological 
Factors in Successful Aging on a special grant to the University of 
Chicago, being undertaken in Kansas City. Dr. Williams provides the 
NIMH liaison. Excellent relations have been established with a panel 
of about 150 persons between the ages of 50 and 70, with all of whom 
the staff has conducted four intensive interviews to date. A compara- 
tive study has been made of a group of people in their 80' s. 

A special grant to the University of California Institute of 
Industrial Relations was recently approved to complete a study of 
social and psychological aspects of retirement, with Dr. Else Frenkel- 
Brunswik as Principal Investigator. Dr. Williams has effected liaison 
between this project and the Kansas City study. 

Papers have been presented to scientific meetings by members 
of the staff of the Kansas City study and Dr. Williams prepared a paper 
for the 4th International Congress of Gerontology. Dr. Williams is 
currently preparing a chapter on "Changing Status, Roles and Relation- 
ships" for the Handbook on Social Gerontology being prepared by the 
Inter-University Training Project in Social Gerontology, financed 
jointly by the NIMH and the NHI. Materials will be drawn from the 
Kansas City and California studies as well as from the multi- 
disciplinary study being conducted at NIH. Dr. Williams also is main- 
taining liaison with the Center for Aging Research at NIH. 

Community Decision Making 

The staff of the Professional Services Branch has felt it would 
be valuable to make an analysis of factors in decision-making processes 
which may affect the mental health of comraunities. Approval was given 
by the Executive Staff to develop a project in this area, and a pro- 
posal was submitted for consideration by the National Advisory Mental 
Health Council in November. The Council was divided in its opinion of 
the proposal, and the majority felt that the time was not ripe for the 
particular proposal presented. It was therefore disapproved. However, 
it was clear from the discussion that the Council felt research and 
development in this area vjould be important, and undoubtedly further 
explorations of this field will be made. 

The Utilization of Space 

The Branch has had a continued interest in the physical and 
social environment as it relates to mental health. An informal group 
of consultants from varied disciplines has met regularly to discuss 
this problem. They have, as part of their discussions, aided in the 
formulation of several projects. An interesting concept has been de- 
veloped called population potential, which states that a community 
closer to centers of population density will react quite differently 



from communities at some distance from major population densities. Using 
this concept and the mathematical formulations associated with the pre- 
liminary xi?ork has shown, that the prevalence of alcoholism, for example, 
is greater nearer the centers of population potential than in areas dis- 
tant from it. Work with city planners has led to their ability to utilize 
a new dimension in consideration o^ plans being made for connriunities. 
Dr. Duhl has been asked to speak at both the City Manager's Association 
and the American Municipal Association on topics related to mental health. 
The interest seems to lie less in concern about mental health clinics 
and facilities and more with problems of the general iinpacf. on the pro- 
motion of health of a population. The general importance of human 
ecology is being recognized. It is becoming evident how difficult it 
is to deal with a specific problem vjithout considering the multiple 
factors involved in the community. 

Other Areas 

Some consideration has been given to problems of creativity, but 
no systematic v/ork has yet been started. The Branch also hopes to under- 
take a basic study of the logistics of mental health services in the 
future. 

Studies of Fundamental Processes Affecting the Mental Health of Specific 
Populations in Organizational Settings 

Mental Health in the School 

The school is repeatedly alleged to be the community structure 
next to the home that plays a dominant role in determining the mental 
health, character, and personality structure of children. In spite of 
this repeated assertion no careful studies have been made o£ the mental 
health influences of the schools. Nearly all of the studies to date 
have dealt with efforts to identify disturbed children in the school 
at any one moment with little effort to show the school's etiological 
relationship. These studies have been valuable as ways of shovjing the 
treatment problem faced by the school, the ccmxiuatty, or the home; but 
they have not dealt with the day-to-day psychological et-ents of the 
classroom and school in such a manner as to give a clear understanding 
of how the school can play a constructive role in the promotion of 
mental health and prevention of mental illness while maintaining its 
social mission as a teaching institution . 

The thinking that led to the formulation grew out of the con- 
siderations over the last two years of an NIMH ad hoc Committee on 
School Mental Health and of the work in this area of the Professional 
Services Branch. The basic idea-~that the psychological events of the 
school and classroom can be directly observed and studied--is a new 
departure in school mental health. The validity of the formulation 
has been checked with outstanding child psychologists. 



The relationship of the events studied to educational and achieve- 
ment indices must be a matter of concern since the school's socially 
designated function is education. The primary concern here, however, 
is with the nature of the psychological events and their relationship 
to educational outcome. If they are functionally related, the degree 
to which one set of variables should be manipulated to affect the 
other becomes a value judgment which is not determined by research but 
which may be made by those responsible in the light of research find- 
ings. In other words, research in this area is not directed toward 
arriving at value judgments- -rather providing a well docijmented basis 
for them. 

The National Advisory Mental Health Council at its meeting in 
November approved a grant to the Bank Street College of Education for 
five years of support to pursue research along these lines. 

Preliminary exploration has started to develop a project con- 
cerned with mental health in college settings. 

Mental Health in Work Groups 

In our highly competitive and expanding economy the work situa- 
tion is particularly important for mental health, both as a source of 
support and of health as well as a source of pathology in some instances. 
Dr. Rajmiond Gould is the Branch liaison with projects in this area. The 
National Advisory Mental Health Council approved the initiation of pro- 
gram development in this area in June of 1957 and authorized support 
for a project of Dr. Chris Argyris of the Department of Industrial 
Administration at Yale University. In this project he proposes to in- 
vestigate the observation that the needs of the individual worker tend 
to be in conflict with the needs and policies of the work organisation. 
In this connection he proposes to conceptualize and develop measures 
for optimum mental health of the worker (involving a constructive com- 
parison between worker needs and organization needs) as opposed to 
maximum mental health for the worker (in disregard of organizational 
needs). Argyris has now completed over 60 interviews with management 
and workers in a silver manufacturing plant and has prepared a state- 
ment of his study design which was approved with enthusiasm by an 
ad hoc advisory group on November 29. 

An application from Drs. French, Kahn, and Mann at the University 
of Michigan was approved at the November meeting of the National Ad- 
visory Mental Health Council. In this project the investigators propose 
to develop their theory of the dynamics of work organizations, V7ith a 
more intensive focus on the mental health aspects of these dynamics. 
They expect to be assisted in this research by Dr. A. T. M. Wilson, 
industrial psychiatrist of the Tavistock Clinic in England. This de- 
velopmental phase is to be followed by the submission of applications 
for specific projects to test hypotheses related to the theory. 



- 9 - 

Studies of the Mental Health Aspects of Traumatic or Stressful Events 
in Various Populations 

Disasters 

The Institute's interest in disasters grew out of early (1949) 
inquiry by the FCDA concerning the management of populations in event 
of attack. The Professional Services Branch staff prepared extensive 
documents on this subject at that time. Later the NRC Committee on Dis- 
aster Studies asked for support of some of its work by the Institute. 
Since it was felt that behavior under extreme circumstances is related 
to personality and mental health status, the Council made a grant for 
the partial support of their work. Recently (1957) this grant was re- 
newed. There has been serious consideration of staff representacicn 
in the disaster and extreme circumstance area as part of the Community 
Research Facility Plans. 

Epidemics 

There has been no real program development work in the epidemic 
field. The PHS was requested in the summer of 1957 by the Army Chemical 
Corps to make a study, primarily of industrial reaction, of the impact 
of the anticipated Asian influenza epidemic. The Service felt that any 
study made should not be limited to industrial production offices but 
should encompass as many aspects of community reaction as possible. 
The participation of the NiMH was requested. Several staff members par- 
ticipated in the planning of the over-all study which is being administered 
by the Behavioral Studies Section, Public Health Education Branch, BSS. 
Field studies in selected communities before, during, and after the epi- 
demic period are being conducted. Various aspects of community planning 
and reaction to the epidemic at various stages are being measured. The 
NIMH is helping in three ways: (1) Personal services funds equal to 
one man year at the GS-11 have been transferred to the study to help with 
field work and data analysis of temporary employees; (2) One social 
scientist is on detail to the project; (3) A grant was made to support 
the field interviewing work by National Analysts, Inc. The work in this 
area has had to be done quickly and without a large amount of preliminary 
study. It is congruent with the Institute's interest in reaction of 
populations to conditions of threat. 

Urban Relocation 

A study has recently begun of the impact of urban renewal and re- 
location in relation to slum clearnace, under the direction of Dr. Erich 
Lindemann at Harvard. This study, like all studies of human behavior 
under stress, should highlight some of the mental and emotional components 
of ecological and social change generally. 

Accident Prevention 

The Department, and PHS became highly interested in accident pre- 
vention in early 1956. NIMH participation in the program of the Service 
was requested. One PSB staff member was assigned responsibility in this 



- 10 - 



area. The Service has centered its Accident Prevention Program in 
the Division of Special Health Services, BSS. The Institute is supply- 
ing one staff member to the Accident Prevention Program, Dr. Bernard 
Fox, a psychologist specifically recruited for the. work and tscbnically 
a member of the PSB. A special grant has also been developed to support 
a forthcoming conference on research on accident prevention with em- 
phasis upon the possible contribution of the behavioral and social 
sciences. Regular research grant support of accident prevention studies 
by NIMH and other parts of the NIH has been encouraged. Tnare is cur- 
rently some concern being expressed over the basic relevance of soEe 
kinds of accident prevention research to the NIMH program. 

Establishment of Research Settings 

Carefully established and planned research settings for studies 
of human populations, in which basic demographic data are well known 
and samples of the population may be systematically draxTO; can facili- 
tate a variety of studies of special problem areas. Also, results can 
more readily be made cumulative, and the interrelations of problems 
more thoroughly understood. 

The Community Research Facility Plans, which the NIMH have been 
developing, would be of much value in relation to most, if not all, of 
the specific areas discussed above. 

The California State Department of Health is interested in the 
establishment of a "community population laboratory" in the Oakland bay 
area. It is possible that the NIMH will wish to assist in the effort, 
in collaboration with other Institutes, and to utilize this laboratory 
for special studies in the fields of aging, alcohol, and possibly others. 

Conclusions 

All of these areas are being approached from the general perspec- 
tive of operations research. There is another, and more fundamental 
element which they have in common. All of them are tendlag to broaden 
the basic conceptions of public mental health by analysis of the inter- 
personal and societal matrices within which each problem occurs. An 
understanding of these matrices is proving to be basic both to an ^under- 
standing of the nature of the problem and to the development of methods 
for its solution. 



- 11 - 



Several of the studies are explicitly concerned with alterations 
in social circumstances which go far to overcome other deficits, inclu- 
ding deficits of a physiological nature. There is a growing body of 
evidence that this approach to problems of mental illness and health 
is both feasible and highly worthwhile. 

One of the major efforts in future years should be to consoli- 
date gains made to date, and to explore the interrelated and cumulative 
aspects of the findings as they are made. It is to be suggested, as 
a major recommendation, that new areas not be explored at the expense 
of following through on work already begun. 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Professional Services Branch 



BUDGET SHEET 



Estimated Obligations for FY 1958 
Totals $157,055 
Directs $150,961 

Reimbursements s $6 , 09^ 



Project included: Community '^tudy Project 



PUBLICATIONS AND REPORTS SECTION 

NATIONAL INSTITUTE OF MENTAL HEALTH 

Annual Report 
Calendar Year 1957 



During calendar year 19579 raore than diaring previous years j the 
information and public education activities of NIMH's P & R were weighted 
in the direction of interpreting and presenting the findings of funda- 
mental research in the basic medical sciences that contribute to the 
field of mental healtho A niajority of the major radio and TV programs 
and magazine and newspaper articles which P & R prepared ^ or otherwise 
cooperated and participated in, irere on mental health research subjects 
rather than on needs and services or interpretation of basic mental 
health subject-matter. The same trend was noticeable in some of the 
special events sponsored by P & R during 1957 and in consultative and 
other types of assistance provided to other branches of the Institute and 
to outside organizations during the yearo 

In part, this trend was a reflection of the Institute's generally 
increased research programs, particularly intramurallyj, as well as of 
NIH's intensified concentration on research accomplishmentSs as evidenced 
by the almost exclusively research character of the weekly report and the 
call for special reports dealing 'with various phases of reseai°ch develop- 
ments. As a consequence, there have been more demands on P & R staff 
for studying and keeping abteadB of research developments in a wide 
spectruni of- technical areas j and of actively seeking out new developments 
in theccourse of preparing articlesj reportsj speeches^ and responses to 
inquiries. To meet these demands as well as increasing demands on the 
Director for professional and lay presentations on mental health research, 
P & R has had the responsibility not only for handling this material 
accurately and comprehensively but also for presenting it with a keen eye 
to the broad policies, as well as the public relations problems that 
might be involved. 

In part the trend during 1957 '^^s a conscious effort on the part 
of P & R to stress mental health research increasingly during the past 
year or two. Work done during past years., and the increasingly effective 
activities of the mental health voluntariesj have awakened public interest 
in, and understanding of, mental health problems to the point where the 
Institute no longer needs to devote major effort to stimulate inclusion 
of mental health material in the mass media. The major task now is to 
direct and channelize existing interest and to stimulate attention to 
neglected areas. This P & R has attempted to do during 1957« 

Another important trend in P & R's activities was the greatly 
increased number of special jobs and special events performed and sponsored 
by P & R in a partnership role (rather than in an assisting or independent 
role) with other branches of the Institute. The over-all number of such 
special jobs greatly increased during 1957= So did the amo-ont of con-^ 
sultation to and work with outside organizations. Some of tliis special 
work was done on request. Much of it vras actively solicited and performed 
by P & R in recognition of the essential role of public information and 
education in the over=all goals and objectives of the Institute and its 
program. 



Work in 

A large part of NIMH's activity during 1957 'was devoted to such key 
areas as psychopharmacologyc, agings mental retardation, and rehabilitation 
of the mentally illo Much of the work done ty P & R, as an integral part 
of over=»all Institute work;, can be described most conveniently under such 
subject headingso 

P sychopharma c ology 

All of the mass media and the general public were intensely concerned 
with the tranquilizers, the energizers, and other phases of psychopharmacology 
during 1957o The year had scarcely opened before NIMH ijas barraged by press 
and magazine inquiries stimulated by unfavorable publicity about the Institute's 
psychopharmacology program, P & R spent considerable time in handling these 
inquiries, preparing special reports j and otherwise counteracting the adverse 
results of a public attack on the Institute's program in this fieldo 

To help counteract the effects of this publicityj and to withdraw the 
Institute from the strategically poor defensive position in which it had 
been placed, P & R arranged with Jules Billard for placement of a major and 
authoritative positive statement of NIl'IH's position on psychopharmacological 
agentso This appeared, as the lead interview^article by the Director in the 
June 21, 1957 issue of Uo Se NEWS AND WORLD REPORT. The article, entitled 
What You Ought To Know About Tranquil izers 9 met with immediate and unqualified 
approval by the psychiatric profession, the medical professions special 
interest groups, and the general public, and the Institute was unifonnly 
congratulated on its firm stand in the field of psychopharmacology. Uo So 
NEWS AND WORLD REPORT , generously supplied several thousand reprints to 
satisfy requests for copies of the article received from all parts of the 
country. It is of interest that Dto Allman, President of the American 
Medical Association, quoted from the U<. S« NEWS piece in his art.icle on 
tranquilizers that appeared in AMERICAN WEEKLY late in 1957 «. 

Another major article on The Tranquiliz er Question was a piece with 
that title by Frank Bello in the May 1957 FORTUNE magazine. Based in large 
part on information supplied by the Institute's Psychopharmacology Service 
Center, through arrangements made ty P cS: R, this was a comprehensive article 
on the subject of psychopharmacologyc P & R made arrangem.ents to procure 
reprints and has been using this piece 5 along with the U. S« NEWS piece, as 
a regular part, of its informational materials. 

A number of important press articles on psychopharmacology, prepared 
with assistance from P & R, appeared during 1957<> The more important of 
these included several articles in a series on mental health by Howard 
Whitman in the COLE NEWSPAPER SYNDICATE, several by Selig Greenberg in his 
series on New Horiz ons in Medicine in the PROVIDENCE JOURNAL-BULLETIN , a 
SCOPE piece on the NIMH program of clinical research on anti-depressive 
drugs, a NEW YORK TIMES piece on tranquilizers by John Finney, and a lead 
article on the 'Psychopharmacology Service Center in SCOPE WEEKLY. In 
addition, information on psychopharmacology was provided to writers from 
the AAA magazine, REPORTER, CHEMICAL AND ENGINEERING NEWS 5, PHYSICIANS 
MAGAZINE, READEife DIGEST, CAPITOL TD-ffiS, WASHINGTON POST, GANNETT NEWSPAPERS, 
N. Y. DAILY NEWS, WORLD-WIDE NEWS, NEA SYNDICATE, NEWARK EVENING NEWS, 
SCIENCE SERVICE, and INS. 



Three major TV shows j in which P cS: R had an important role in 
selecting topics and making arrangements, were devoted to psychopharma- 
cology. One, the American Association for the Advancement of Science 
hour-long NEW FROOTIER program, appeared on the CBS-TV Network at the 
very close of 195^1 the Chief of NIMH^s Psychopharmacology Service Center 
was guest panelist on the section of the program dealing with the biological 
scienceso Arrangements were made for the Chief of the Center to give a 
medical exposition of tranquilizers on Howard Whitman's special half -hour 
program on tranquilizers produced as pairt of a national hook=up NBC-TV 
HOlylE shoWo Toward the end of the year arrangements were again made for 
Dr. Cole to appear on TV — this time the McCaffrey CELEBRITY PARADE 
(WMAL-TV) in a discussion of tranquilizers and tensions., 

In addition^ P & R provided information and arranged for consul- 
tation to an independent film maker who is currently preparing a medical 
fil::n on tranquilizers addressed to the general physicianj and assisted 
Editorial Research Associates on their new pamphlet on psychophamiacologyo 
During the year, the Chief of P & R served as a member of the Committee of 
Editors in a Working Conference on the Status and Improvement of Clinical 
Drug Evaluation Reports sponsored jointly by the Institute's Psychopharma- 
cology Service Center and the American Psychiatric Associationo 

Gerontology Conference 

P & R's major activity in the field of aging for 1957 was complete 
coverage and handling of the press relations and publicity program for the 
Tenth Annual Scientific Meeting of the Gerontological Society held in 
Cleveland on October 31 - November Eg 1957«. Carried out by P & R staff at 
the request of the Chief of NIMH's Section on Aging, who was Program 
Chairman for the meeting, this was a highly successful and extremely 
important undertaking which increased P & R's prestige with NIMH and out- 
side scientists in the field of agingj as well as NIMH prestige for its 
leadership in this field. Preliminary to the meeting^ contact was made 
with and publicity materials distributed to 22 editors of metropolitan 
newspapers with large national circulations j 22 selected science writers 
with a known interest in gerontology;, program managers of all the principal 
radio and TV stations in Clevelandj and the CBSg NBC, and \^ESTINGHOUSE 
radio and TV Public Service departments* T'wo advance press releases, one 
a general anno\incement and the other on a special synposium of European 
gerontologists, were sent to 200 large dailies plus some professional 
journals. The K,Y. THESj the NeY, JOURNAL-AMERICAN, and AP sent reporters 
from headquarters? INS and UP were covered by the Cleveland bureaus. In 
addition, requests for all releases and papers were received from SCIENCE 
SERVICE; Roland Berg, Medical Editor of LOOK; the Managing Editor of MEDICAL 
NEWS; Earl Ubell of the N,Y, HERALD=TRIBUNE; Tom Henry of the WASHINGTON 
STAR; the editor of the PITTSBURGH STOI-TELEGRJill; Robert P. Goldman of PARADE; 
Ray Bruner, Science Editor of the TOLEDO BLADE; free=lance -writers; Richard 
C. Bostwick of Sl'IITHj KLINE and FRENCH; and Fred Freed of CBSo 

As part of the press coverage, condensations of the major papers to 
be delivered at the Conference were prepared and these were made available 
at the press room, along with suggested leads, biographical sketches of 
the principal speakers, photographs, and printed programs. P & R staff 
members were in Cleveland for the meeting, set up the press room, and took 
care of all public relations for the Conference o Three days ahead of the 



meeting a staff member went out to do advance publicity xd-th the managing 
editors of the three Cleveland papers, the three id.re services, and the tiro 
radio stations and one TV station which had expressed interest in interview 
programs with gerontologists attending the meeting. In addition, P & R had 
an NIMH exhibit at the Gerontology meetingo 

Immediate results of P & R's publicity work at the Gerontology 
Conference included: 

1) Two radio interviews with gerontologists on Cleveland's VGAR and 
KYWo 

2) One TV interview with Dto BourHere of France on WJW. 

3) Advance stories in No ./T. TIMES and other papers. 

k) Daily stories in N. Y. TIMES and over AP and INS. AP stories 

were carried on front pages from N. Y. HERALD TRIBUNE to SEATTLE 
TIMES, from Great Falls (Mont,) LEADER to Louisville (Ky.) TIMES, 
from Ithaca (NeYo) JOURNAL to Idaho Falls POST-REGISTER, and many 
others, both large and small. INS coverage was also widespread. 

5) Daily stories by medical xjriters in CLEVELAND PLAIN DEALER, and 
daily feature stories xd.th pictures in CLEVELAND PRESS. Also 
publicity in CLEVELAND NEWS. 

6) Round-up article by WORLD WIDE NEWS in November 20 issue of 
SCOPE WEEKLY. 

In addition to these immediate res'iiltsj, various featiire articles will 
no doubt result from this public relations work. Two of the reporters who 
covered the meetings write columns related to gerontology, and many of the 
free-lance and magazine writers who requested materials will probably use 
them as source data for future articleso 

Other Work on Aging 

Mental Health of the Elderly , a new pamphlet prepared by P & R, was 
issued describing NIMH's varied activities in the field of aging. It was 
also translated into French and Italian, and copies (including those in 
English) were sent to Italy for display and distribution at the Inter- 
national Gerontology meeting. GPO has reported relatively high sales of 
this pamphlet (a total of I5OO being sold in the 3 months from June to 
September) , and a second edition was run off in 1957. 

As part of its assistance in the press room at the annual meeting of 
the American Psychiatric Association in May, P & R staff prepared press 
announcements on papers delivered by NIMH personnel on their research in 
aging, and arranged for a press conference with two of these scientists. 
This activity resulted in a n\amber of press articles on NIMH research on 
aging and mention, of this work on 3 network radio programs. Several months 
after the meeting,. P & R wrote an article on the research work of one of 
these scientists for Tom Henry in the WASHINGTON STAR, During the year, 
information on aging was also given to Fishbein of WORLD-WIDE NEWS, to 
Beach of U. S. NEWS AND WORLD REPORT, and to Cassels of UP. 



- 5 - 

Another major informational event in the field of aging was the Johnsi 
Hopkins FILE 7 TV show, in the fall of 1957, devoted to the sociological 
and psychological aspects of aging, with the Chief of KIMH's Section on 
Aging as guest speaker, P & R worked with the script writer and helped 
make arrangements for this program. 

Mental Retardation 

During the year, P & R was called upon to assist in revitalizing the 
JOURNAL ON MENTAL DEFICIENCY, published by the American Association of Mental 
Deficiency, the principal professional organization in the field of mental 
retardation. At the request of a member of NIMH's Professional Services 
Branch who had become Medical Editor of the J0I3RNAL, a P & R staff member was 
assigned to develop magazine policy, to set standards for manuscripts, to 
develop editorial guidelines and procedures, and to get the JOURNAL operating on 
a journalistically professional basiso A major policy statement, prepared 
by this P & R staff member, was adopted by the JOURNAL, as were the editorial 
guidelines. She also edited a nijmber of highly technical professional 
articles in order to provide the Medical Editor and other JOURI\!AL staff with 
prototypes and practical guides. 

At the close of the year, P & R worked closely with the National 
Association for Retarded Children, the principal voluntary in this fieldji, 
in preparing releases and other advance publicity as well as in making 
arrangements for a special meeting and press conference (held in New York 
City in January 1958) in connection mth release of two major reports on 
research on mental retardation, prepared under the sponsorship of NARC 
with the aid of a grant from NIMH and NINDB. Firm relations were established 
•with the information, publicity and executive directors of NARC, and P & R 
plans to work closely -with that organization in planning appropriate joint 
activities. 

During 1957s WGAY, a local radio station, carried a taped interview 
on retardation with the Professional Services Branch specialist on this 
subject. P & R also prepared a number of speech materials for top level 
speakers on retardation diiring the year, and assisted a writer from the 
N.Y. DAILY NEWS with a story on patients in hospitals for the mentally deficient. 

Mental Health of Children 

P & R prepared three speeches dealing with mental health of children 
diu'ing 1957» one for the Director of NIMH on Services and Programs for Mothers 
and Children (delivered at the annual American Public Health Association 
meeting in Cleveland) , and two for the NIMH specialist on school mental health 
(delivered at the National Education Association Centennial Convention and 
Syracuse University's Second Annual Conference on Secondary Education). 
P & R is assisting this school mental health specialist on a regular basis, 
collecting pertinent research data for his use, evaluating the usefulness of 
such material, and advising him of its potentialities for articles in various 
types of outlets. P & R -will prepare some of these articles and provide 
editorial assistance on all of them. 

P & R prepared a statement for and assisted in an open house, held hj 
NBlH's Residential ,Tj?eatment Center for emotionally disturbed children, for 
members of Montgomery County citizens' associations. Also coincident with 



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the opening of the Center, a series of still pictures showing normal controls 
were taken for subsequent public relations and other informational uses» 
Some of these pictures were used for an INS story. MEDICAL NEWS carried a 
major picture story on the Treatment Center and the January 1958 issue of 
HARPERS carried an excellent major article on the work of NIMH's Child 
Research Branch; P & R assisted with both of these articles o In addition, 
information was provided to LOOK for a major article on emotionally dis- 
t\irbed children, and to Eve Edstrom of the WASHINGTON POST on treatment 
facilities for such children. 

Arrangements' were made for NIMH's Chief of the Section on Child 
Development to discuss IQ testing on ABC-TV's OPEN HEARING, a Network 
program. P & R wrote 3 articles in collaboration with this Section Chief 5 
(l) a guest column on IQ testing for Jane Eads AP column, (2) a 3>000 word 
story on adopted children for CHILDREN magazine, and (3) an article on 
predicting children's intelligence for the NATIONAL PARENT -TEACHER magazine. 
Information on IQ testing was also provided for a WASHINGTON DAILY NEWS 
story. 

P & R helped with arrangements for an article on normal children 
in the February 1957 issue of BETTER HOMES AND GARDENS, and for a pro- 
spective article on child rearing being prepared by a free-lance writer. 
In addition, a statement was prepared for the Director's signature on the 
new PIEIRE THE PELICAN series of child-rearing leaflets for parents, 
produced by the Louisiana Mental Health Association. 

A number of the large meetings at which P & R exhibited and dis- 
played materials during 1957 were held by organizations directly interested 
in or vitally concerned ^with the mental health of children. These in- 
cluded the biennial meeting of the American Association of School 
Administrators (17,000 registered attendants), the American Orthopsychiatric 
Association annual meeting (5>000), the 12th Annual Conference of the 
.'association for Supervision and Ciirriculum Development of the National 
Education Association (3»000), the American Academy of Pediatrics (1,000), 
the NEA annual convention (20,000), and the New York Congress of Parents 
and Teachers (7,000). 

Treatment and Rehabilitation of the Mentally 111 

As part of its emphasis on rehabilitation of mental patients during 
Mental Health Week in 1957> P & R prepared a 4-minute 15-second tape record- 
ing of the Director of the Institute on the subject of The Healing Community , 
dealing vilth. the role of the community in helping the former mental patient 
make a successful adjustment. P & R offered to transcribe this talk onto 
blank tapes sent in by any individual or organization. Though the tape was 
not available until shortly before the Week, some 20 requests for the tape 
were received from radio stations and mental health associations o It is 
planned to continue this type of activity, with promotional assistance from 
the National Association for Mental Health and the Mental Health Materials 
Center. 

In this same general area, P & R prepared an outline for a speech 
given by the Director at an APA Mental Hospital Administration session, 
and drafted a progress report on NDIH's program of Mental Health Projects 



Grants, which are awarded for studies and demonstrations of improved methods 
of patient treatment and careo 

Information was provided to the NBC-TV Public Affairs Department for 
a documentary on mental hospitals, and to Howard Miitman for a half -hour 
program on rehabilitation on the N3C=TV HOME shoWo Writers for TIMEj READER'S 
DIGEST, COSMOPOLITAN;, and INS were helped with stories on day=and night-care 
programs, rehabilitation of the mentally illj identifying and receiving help 
for the emotionally disturbed;, commitment procedures, and resident patient 
populations. 

Research 

Research, both intramixral and extramuralj was emphasized wherever 
appropriate in P & R's work during 19570 The research interest is apparent 
in many of the activities already described, and Dd.ll be integrated into the 
discussion of activities in subsequent sections of this report. This section 
describes some of the more important P & R projects which are of primary 
relevance to basic research and which do not lend themselves to treatment 
under special subject headings. 

Starting in July, the Institute Director's Weekly Report, prepared 
by P & R, was heavily weighted in the direction of research. In the preparation 
of research items for these reports, P & R has received excellent cooperation 
from ND'IH's research programs^ a staff member has been invited by the Director 
of Basic Research to sit in on staff meetings. In all, "^S items were included 
in NH-IH's weekly reports to NIH from July 1 to December 31, 1957; of these, 53, 
or more than txiro-thirds , were incorporated into the NIH reports to the Surgeon 
General. This material proved to be extremely helpful in preparation of 
Research Highlights of 1957 which, as in past years, iiras prepared ty P & R. 

P cS: R prepared a number of releases and research papers delivered by 
NBIH staff at professional meetingSj, wrote a speech for the Director on 
Current T rends in Psychiatric Research for a Regional Research Conference 
of the Araerican Psychiatric Association^ and assisted the American Psychological 
Association in planning a press reception for a foreign world-renowned neuro- 
physiologist. 

During I957 the script for the proposed NDIH fiLii on Mental Health 
Research was completed and the project approved for production. The film ^ras 
planned as a public relations tool to acquaint the general public with the 
nature and scope of mental health research, and thereby to help dispel some 
of the prejudices against psychiatry and the field of mental health, as well 
as to help relieve some of the ingrained pessimism about the ability to treat 
mental illness successfully. 

P & R arranged for an NIMH researcher to discuss the physical effects 
of emotions on the ASK-=.IT=BASKET WTOP=TV program, and for the Director to 
discuss mental health research in the SCIENCE SERVICE series of taped radio 
prograras. K3C=TV was given information for a documentary on stress. 

In addition to research articles mentioned in other parts of this 
report, P & R assisted in arrangements and information for the '^-article 
series on alcoholism written by Cassels for UP. Information on research 
grants and intramural research projects was provided to free-lance writers 
and writers from MODERN l^IEDICINE, TIME, LIFE, READErIs DIGEST, SCOPE, PAGEANT, 



SCIEOTIFIC AMERICAN, U. So NEWS AND WORLD REPORT, FORTUNE, N« Yo TBIES, 

N. Y. DAILY NEWS, SCRIPPS-=HOWARD, SCIENCE SERVICE, WASHINGTON POST, MEDICAL 

NEWS, and IKSo 

Work With Voluntaries and Oth er Organiza tions 

As in past years, P & R worked very closely with the National Asso- 
ciation for Mental Health in planning and carrying out public information 
and education programs, both in connection vrxth Mental Health Week and in 
connection xiTith year-round activitieso In addition, assistance and con- 
sultation were provided to an increasingly larger number of other organiza- 
tions, such as State and local mental health associations , voluntary and 
professional associations in the field of mental retardation, and a wide 
variety of civic, service, and quasi-governmental groups with a primary or 
ancillary interest inj, and concern with,, problems of mental health and 
mental illness. 

Mental Health Week 

During the first week in May, NIMH and NAMH jointly sponsored the 
9th annual celebration of Mental Health Week. With the theme "The Mentally 
111 Can Come Back," the Week xras focussed on what citizens and communities 
can do to promote the full recovery and rehabilitation of the ex-mental 
patiento During 1957j "the Advertising Council again ran messages supporting 
celebration of the Week in the May-June issue of their RADIO-TV BULLETIN. 

P & R prepared special Mental Health Week kitsj each containing a 
careful selection of program, publicity^ information, and educational 
materials to be used in celebrating Mental Health Week and in planning 
long-range mental health activitieso These kits were mailed out to some 
600 mental health voluntaries, civic and service organizations, mental 
health agencies, and other interested groupso Selected publicity materials 
were sent to science writers and others in a position to promote the over- 
all goals of the Week. Included in the kits were a new version of a 
Mental Health Fact Sheet prepared for the occasion by P & Rg and announce- 
ments of the tape recording of the Director's talk on The Healing Community . 
Additional requests for kits and for extra copies of certain materials in 
the kits were received prior to the Week and subsequentlyo 

The Mental Health Week kit, in the past year- or two, has developed 
into an important program item, apart from its use in connection with the 
Week. Kits are requested throughout the year by local and State mental 
health agencies and organizations for use in planning and conducting 
program activities. As an example, the Bureau of Community Mental Health 
Services, New Jersey Department of Institutions and Agencies j has requested 
kits to assist them in developing community mental health education as a 
first step in setting up the County Mental Health Boards required iinder the 
newly enacted Community Mental Health Services Act of the State of New 
Jersey. 

A number of radio and TV programs and magazine and press articles 
during Mental Health Week were a direct or indirect result of P & R 
activities. In addition, P & R prepared two speeches for use during Mental 
Health Week (one delivered by the Director and another by an Assistant 
Secretary of DHEW), and the Presidential Message and Proclamation for 
Mental Health Week. 



Work With NAME 

NBffl worked with and assisted the Advertising Cottncil and the NAMH in 
the Advertising Council's major year-roiind mental health education campaign 
which was launched in 1957<> P & R can claim a good share of the credit for 
the fact that this campaign was developedj, since P cS: R established the con- 
tact with the Ad Council in 1952^ built up relations and cooperation with 
the Ad Council Program Consultant and other staff during the past six years, 
and assisted in establishing relations between NAMH and the Ad Councilo In 
connection with the Ad Council's distribution of How To Deal With Your Tensions 
as part of the general mental health campaign, P <§: R arranged for a foreword 
by the Director of NIMH, and is assisting in distributing the booklets 

P cS: R continued its periodic consultation with the public relations 
and educational directors of HAMH in order to plan joint programs and provide 
distribution of each other's materials o P & R prepared the message from the 
President to the Annual Meeting of NAIfflo NAFEg in turn, has promoted dis= 
tribution of two new P & R publications? Facts A bout Mental Health and Mental 
Illness , and the Barbiturates leaflet <, At the end of the year, P & R was 
planning joint publication, with NAlfflg of a series of leaflets and folding- 
card exhibits for teen=>age audiences describing the work of mental health 
professional personnel and the kinds of training and experience such people 
must haveo At the end of the year, alsoj, P & R was planning cooperative 
public relations with a newly appointed special liaison representative of 
NAI^Ho Contemplated activities include preparation of a series of charts 
and leaflets interpreting NH'IH activities to State mental health associa=- 
tions, and cooperation mth NAMH field representatives and regional groups 
of mental health organizationso 

Work With Other Orga nizations 

During the year^, P & R provided consultation to an official of the 
Southern Regional Education Board engaged in preparation of a special report 
on the work of that organizationo Assistance was given to the General 
Federation of Women's Clubs on a popular pamphlet being prepared by the 
Federation on what mental health means to the individual and the family. 
Consultation and other help was given Editorial Research Associates on 
their new pamphlet on psychophaiTOacology, 

A speech was -written for delivery by a Government official at the 
Rhode Island State Mental Health Associations greetings were sent for the 
Director of NIIIH to a meeting of the Louisiana Mental Health Association, 
forewords were Tjritten for two pamphlets published by the Westchester 
(Ne Ye) Mental Health Association, assistance and advice were provided 
an official of the Oregon Mental Health Association;, and a series of film 
previews were arranged for a teachers' workshop conducted by the Washington 
School of Psychiatryo 

Mental health materials prepared by P & R received wide acceptance 
and use by key organizations o The Canadian Broadcasting Company purchased 
8 prints of Preface To A Life for a nationwide telecast o The Bureau of 
Health Education of the American Medical Association requested copies of 
a packet of NIMH educational materials for use in their health education 
programo The Mental Health Materials Center included copies of P & R's 



= 10 = 

Reference Guide Noo 3> Introductory Readings in Mental Health, in their kits 
which go to 2500 individuals and organizations active in h\:unan relations work. 
Two State Health Departments purchased 15s 000 copies of What Is Mental Illness , 
the popular leaflet prepared by P & R<, 6,500 copies of Careers in Psychiatric 
Social Work and 1^500 copies of Mental Hea lth of the Elderly were sold by the 
Government Printing Office from June to September 1957£> and 3*000 copies of 
Barbiturates As Addicting Drugs were sold between September and Decembero 

Exhibits and literature displays were sent to meetings of a vrlde 
variety of voluntary and other organizations which play a key role in promoting 
mental healths These organizations included the American Academy of Occupa- 
tional Medicine, the National League for Nursing, the National Conference of 
Social Workers, the National Education Association, the American Personnel and 
Guidance Association, the Cleveland Health Museuia, a number of county mental 
health associations, and the National Health Councilo This activity has been 
a major phase of P & R's public relations and educational work for 1957* 

Other Activities 

Many of the activities already described=-speeches5, articles, radio 
and TV programs, exhibits, special events, and consultations—are directly 
related to public relations work for NII-IH as an institution. The press 
releases, annoioncements, and answers to public inquiries are' also integral 
to P & R's public relations work for the Institute, In addition to these 
activities, P & R vjrote and provided still pictures for an article entitled 
Report from NB'2I Xirhich appeared in the October 1957 issue of STATE OF MIND, 
the monthly magazine published by CIBA for the general practitioner. 

P & R staff also assisted a number of the scientists at KDIH in 
organizing, formulating, and presenting their scientific data. In addition 
to the Weekly Reports and the Research Highlights for 1957> P & R also 
prepared the Director's Budget Testimony and the short=form annual report, 
as well as supervising preparation of the long"=form annual report, 

P & R, at the request of the Chief of the Training Branch, wrote a 
comprehensive historical analysis of NI^iH's training programs which is to 
be included in the Institute's report on training being prepared at the 
request of Congresso 

Recognizing its responsibilities for developing competent personnel 
in the field of mental health information and public relations, P & R for 
the first time established a position for, and recruited an Information 
Traineso A comprehensive training prograra, including evaluation, was 
planned and scheduled with NIMH Branch Chiefs, the Office of Research 
Information of NIH, and the Special Assistant for Information to the Surgeon 
Generalo Under supervision, the trainee developed a new system for cata- 
loguing and controlling distribution of publications. This system has been 
put into effect with gratifying results. 

The number of public inquiries answered during 1957 was e:ctremely 
high. An estiniated 1800 letters of more than routine difficulty, including 
about 50 Congressional letters were sent out (based on actual count of 
891, including 2^■ Congressional, from July 1 to December 3I) , Replies to 
Congressional letters require knowledge of NIMH policy, considerable 
original research in gathering data for the reply, and a keen sense of 



- 11 - 

public relations in presenting the materials 

Approximately 2^114 telephone inquiries were haxidled from July to 
December 1957= 

A total of 83s 0^7 pieces of literature were distributed in answer 
to 8,3^2 requests during 1957 <> This was about two and one^half times the 
volume handled in 195° I the nuraber of separate requests also rose hy about 
50 percent. Over 300 clearance papers were handled by P cS; Rj and 1133 
film bookings were made during 19570 

Rew Publications and Other Materials 

Two new pamphlets and two new leaflets were issued in 1957o One 
pamphlet. Facts About Mental Health and M ental IllnesS s, was prepared for 
Mental Health Week and has proved to be so useful that P & R plans to 
reissue it from year to year^ bringing the figures up to date each time« 
Mental Health of the Elderly ^ the other pamphlet, was prepared as an 
extended printed version of the original NDffl exhibit of the same titleo 
This publication, which describes the comprehensive activities of NIMH 
in the field of aging, was also issued in French and Italian for use at 
the International Gerontology Congress in Italy, 

What Is Mental Illness?, the NUffi leaflet which was distributed in 
large quantities in its pre-publication edition, was received from GPO 
early in 1957° Large quantities of this leaflet have been distributed, 
15jOOO copies being sold by GPO to two State health departments in a 
single weeko The other new leaflet , entitled Barbiturates As Addicting 
Drugs , has filled an urgent need and met with unqualified approval. The 
Food and Drug Administration requested IjOOO copies for use in their 
District OfficeSj and the GPOj which reported 3sOOO copies sold between 
September and December 1957> went back to press for a second edition of 
2,000= 

Reference Guides Nos<> 1 and 6, Mental Health For Parent and Child 
and Advanced Readings in Mental Health were revised, as was the Current 
Reading List of mental health pamphlets, reprints, and reports available 
from P & Ro 

Mental Health Memo Noo I9 the first issue of a proposed series of 
digests of significant program activities designed as a means of communi- 
cation for operating agencies throughout the coiintry, was prepared and 
sent to some 550 individuals and organizations, including State Mental 
Health and Mental Hospital Authorities and NIMH regional staff. 

Copy xjas prepared for an abridged statement of Institute fxuictions 
to be entitled National Institute of Mental Health~=A Summary Statements 
This will be issued as a leaflet to be sent in response to inquiries 
from students and others who do not need a fully detailed description of 
NIMHo 

In addition to new NDIH publications, P cS: R purchased distri- 
bution stocks of 29 new reprints dxiring 1957<> These covered such varied 
subjects as narcotics addiction, delinquency, psychiatric terminology, 
treatment of the mentally ill, family mental health, child guidance, 



■ s 



- 12 - 

scientific developments, legal problems in mental illness, tranquilizing 
drugs, communication of mental health concepts, and mental retardation. 

Prints of three new films were purchased during 1957^ The Kid 
Brother , and To Your Health , new films on alcoholism; and The Human Side , 
a film on voliinteer programs in mental hospitals o 

The Public Relations of Mental Health Education 

The special nature of the mental health field, with its attendant 
difficulties in communicating information that conflicts with existing 
attitudes, and the special role of the NIMH as a leader in mental health 
research, training, and service programs, have posed unique problems for 
P & R, In meeting its responsibilities, P & R has attempted to develop 
its information and public relations activities so that they help promote 
the goals of mental health education., Similarly, educational projects 
are carefully planned so that they constitute good public relations for 
mental health in generalo 

During 1957j P & R was involved in a number of activities intimately 
related to these public relations aspects of mental health educationo The 
Chief of P & R participated in a panel on mass comm\ani cat ions at the 
National Health Council's National Health Forum (held in Cincinnati in 
March) which was devoted to the subject of Better Mental Health, The 
presentation, in addition to being published in the National Health Council's 
official report of the 1957 National Health Forum, was published as an 
article entitled Mass Communications and Health in the August 1957 issue 
of the New Jersey PUBLIC HEALTH NEWS. Copies of this article were procured 
by the California State Department of Health for distribution to all State 
health educators, to all health educators in training, to mental health 
service personnel, and to reference libraries for public health personnel. 
The spring issue of MENTAL HIGIENE, the professional quarterly ptiblished 
by NAMH, also quoted excerpts from this presentation. 

P & R assisted in the preparation and review of the series of five 
articles on psychiatry and psychology today, carried in LIFE starting 
xd-th the January 5s 1957 issue. In addition to providing information and 
materials for the articles, P & R was instrumental in guiding their 
development and general approach, both through direct review and thorough 
communications xjith the two APA's, who were given major responsibility 
for review by LIFE, 

In May of 1957 the Chief of P & R participated as discussant in 
a sjnnpositun on Public Awareness and Problems in Mental Health at the 12th 
Annual Conference of Public Opinion Research held in Washington, D, C, 
by the American Association for Public Opinion Research. P & R also 
pai^ticipated3in!pr6viding"':"consultatiori:i'to the program" director and' other 
officials of the Educational ITV Genter~,i".AnncArbor,.-ivIichigan5 Hho'are 1;," 
planning' aesifeiries of mental health proEr,aihs.v::In:"additiDh, P & R partici- 
pated in consultation mth researchers from the University of Illj.nois 
Institute of Coiiiiaunications Research who are conducting a special study 
of coiiiiTiunications of mental health concepts under a grant ii-om IvIMK, 



13 - 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Publications and Reports 



BDDGET SHEET 



Estimated Obligations for PY 19^8 
Totals $176,229 
Directs $169,391 

Reimbursement s s $6 , 838 



RESEARCH GRAMS AND FELLOWSHIPS BRANCH 



Annual Report for Calendar Year 1957 



The continuing and rapid growth of the research grants pro= 
gram made 1957 a year of sigaificaat deirelopaient and reassessment 
in Branch operations « Reaffirmation in the fiscal 1958 "budget of 
last year's strong Congressional support for research in mental 
health, again testified to a steadily gro"td,ng social concern over 
problems related to mental ill-health, as well as to an increasing 
public recognition of research as a vital national resource. 



I, PROGRAM GROWTH AKD DEVELOPMEJNTt THE ADfffNISTRATIVE PICTURE 



Throughout the year the steadily joDunting volume of grant 
applications was to necessitate a series of modifications in pro- 
gram administration. A glance at the following comparative figures 
on new grant applications furnishes a rough index to the growth of 
the program.. ScclMing applications relating to previously conanitted 
funds (i.e. continuation and supplement applications), the number of 
grant applications received has risen from 260 in 1955? "to 457 in 1956, 
and reached 683 in 1957. Kuaibers of research grant applications which 
were approved rose from I30 in 1955 to 2^2 in 1956, reaching 292 in 
1957. 



It is apparent at a glance that the volume of work necessi= 
tated by the review and approval operation has very materially 
expanded in the last two years » Concurrently, the staff of the 
Branch has increasingly been called upon to provide advisory and 
consultative services to grantees, prospective applicants, and to 
university departments in the behavioral, medical, and biological 
sciences. Difficulties arising from an acute shortage of staff at 
the outset of the year were conrpoTonded by the loss of staff time in 
providing repeated and lengthy information statements for budget 
justification and other administrative purposes. IM certainty as 
to 1958 appropriations iar^jeded Branch planning for many months . It 



" 2 



has Tseen difficult for Bramcfe staff msmters to ^ma.ertal£e the aeces- 
saxy degree of stimulatioa, of special areas of i^searcl^ in whida the 
Institute ha-s a priniary interest. While it has "been a eontimsiBg 
problem this year to meet o?©rall demaads for service ^ jnembers of 
the staff ha-eie teen hard pressed as ¥©11 t© fiBd tiaae to keep abreast 
of recent i^searda developsnents ia the m0.ti-disciplined fields ^ieh 
mjderlie research in mental health. ^ 

A loss of e2q)erie3aced BrasGh staff -was ©ceasioaed in April, 
1957 with the transfer of the Mental Health Stiidy Section to the 
Division of Eeseareh Grants » So hea-vy had the task of reviewing the 
increased voltnne of research grant applications become that a sister 
Study Section to the Mental Health StusSy Section^ the new Behavioral 
Sciences Study Section, was established at this tii^. 

Some of the new staff positions established this year to meet 
the increase in work- load have been filled - - including those of a 
Program Analyst, a new Executive Secretary of the Msntal Health Small 
Grants Committee, and an Executive Secretary of the Mental Health 
Career Investigator Selection Consoittee, together with the new 
con5)lement of the Psychopharmacology Service Center, Other positions 
are as yet still vacant. It has proven difficulty as is true in msny 
scientific fields today, to locate well-ijaalified applicants. Even 
tdien qualified people are hired, a losag period of training and ex- 
perience in the Braach is necessary before new staff reach their full 
work value within the Bi^mch setting. Sds problem offers n© hope of 
iiffinediate solution. 

To help in the training of new staff si^a&ers brou^t on during 
1957^ an orientation series of "discussioa-cpaestion-aaswer" sessions 
have been held at intervals, individual background orieatatioa folders 
have been prepared, and, through the medium of week3y staff meetings 
and roiEfcine circulation of information materials to all staff stembers, 
a strong effort has been made to establish that aecassary inter- 
comniuni cation without which few work gro-i^s fimetion successfully. 
Furttier effort in this area included a major reorganizstioa and con- 
solidation of Branch files to ensure the iaaasdiate availability of 
baekgrouad inforaettion to all staff membei's. 

Sse gx»5rth is the volume of applications for research grants 
has very markedly Increased the number of individual eansultatioas 
with i®searda inviastigators, A eoasiderabla shar^e of such consulta- 
tion is eoadmeted by smil, but :m^' personal later^ews have been held 
by the staff is. ^thesda as well as at eoafereaces and professional 
meetings. Diaring 1957, staff sasmbers partieipated ia a variety of eoa- 
fereaces, ineli^ding the Conference on Research in ^ntal Health held in 



3 " 



JacksoHTiUep Florida^ ia April, arf. tie Soutliexn Regional Miaeatioa 
Board's Coafei^ace on Jfental Health Research, in the South j, held in 
Williams'burgj, Virginia in August^ 1957l amMal aad 3Pggional sneetiags 
©f such professioaal groups as the AsBSleaa PsycMatrie Association., 
Anaricaa Psychologieal Associatios,;, ete» Branch staff also visited 
SQWB fifteen to tireaty -fflaivsrsity deparfansats in the "biological aai 
behavioral seienees as advisors aad eoas'ultaa.ts on researeh programs. 



Analysis of Program Meeds 

nihe jMieious distrilmtioa of grant fsasds carries with it sosse 
reqiairement that those respoasiTble for the program work from a soxmS. 
basis of Ifflowing "where jou are^ where jon are ^ing^ and how you can 
best get there." 5to acquire such a platfoam for operating necessitates 
a eontinuing program aaalysiB. Xaereasisglgr^ ale©;, the Branch has been 
called v^n to famish analytic inforaation on the grants program - - 
to the Sti^ Sections^ the national Advisory Sfental Health Cotmcil;, 
branches ©f the Public Health Ser^ee^ other goveiament agencies aM. 
the public. To a greater extent than in the past both the Council and 
Study Sections have turned to the Braadi for infonnation on policy, on 
program dii^etion and planning. 

In an effort to n^et both internal and external derasnds for 
ps^grajE aaalysig^ the Branch this year tools a number ©f steps to 
develop long-range aiethcsds of adasiaistrativB i^view and critical 
examination. A part of this new activity has been dirgcted toward 
the establisha^at of a sou^ and workable basis for "categorizing" 
grants. Since the spring of 1957 a largB part of -ae tiim of one 
staff lEember has been spent In the devBlopaaent of a system of gx-ant 
analysis^ ia ■which defined and standardised processes of content 
analysis will be combined %-jlth medianieal sorting procedurss to per- 
mit of rapid seleetion. It is hoped that the successful estaMisfeEent 
of the grants category system will facilitate not only the sort ©f 
program analysis which concerns itself chiefly with how srada s^seareh 
was^ or was x»t^ s'i^parfced (in terms of atEabers of applications^ 
aaiDunts of nsney^ distribution by fiscal years^ areas of stMyj, etc.), 
but may later assist in iaterprsting comtrtbutions to scientific 
toowledge^ 

Still a fm°ther armmm of program aasljsis was e^lor^ by an- 
other staff mamber in a detailed stody of the ©vbesII role of program 
evaluation within the Branch, based ia lar^ measure on an historical 
analysis of rslated earlier e^erlenee. Siis study indicated the seed 
for, and feasibility ©f, pi^paring analytic iBviews ©a subject areas 
©f tte x^search grants program, an overall historical review of the ad- 
Mnist^tivie development ©f the program, aad additioMil information 
articles iaterpr^ting the program to scientific audiences. 



k - 



While lack of staff tisie this year has limited the preparation 
of analytic stiadies, several short reviews of special aspects of the 
program were ■unfiertaken, including a statistical analysis of the 
i*esearch fellowships program^ a backgroimd paper (for use hy the Study 
Sections and Council) considering fluid funds in the award of research 
grants^ and a more substantial review of the Small Grant Program. 
With an aim of determining the availability and nature of grant sirp- 
port in mental health and related disciplines from foundations and 
professional organizations, the Branch this year also has prepared a 
sxir7ey=guestionnairej, presently in process of clearance^ which will 
be circulated to some seven hundred private organizations. 



The anall Grant Frogi^m 

Ihe year 1957 slso produced a serious review* of the Stoll 
Grant Program. Initiated by the Natiosial Institutes of Health on 
an across-the-board basis in March, 1956, the program had been planned 
as a new method of research support in which the usual deadlines 
would be waived. Maximum awards imder the Small Girant Program are 
$2,000 plus indirect costs. It was hoped that the program would pro- 
vide support for such pvirposes as small-scale pilot studies, modest 
assistance to young investigators, assistance for minor iresearch needs, 
etc. 

In the late fall of 1957, a general assessment of the Small 
Grant Program was undertaken in all the National Institutes of Health. 
While the Program has been less successful in other Institutes, 
K.I.M.H. has found it to be a workable and desirable means of granting 
funds in a flexible and rapid manner for certain types of limited re- 
search needs. 

From September, I956, to October, I957, the Mental Health 
Small Grant Committee reviewed 2^9 applications and approved 112 - - 
a 45 per cent approval rate. AluBDst ninety per cent of the applica- 
tions approved constituted awards to research investigators who had 
not had px^vious s^sp^tort from this Institute . More than half of the 
approved c.X'i.ixcations eoiild be classified as "escploratory and pilot 
gt".aiies." Sixty- four per cent of the applicants were psychologists, 
13 per cent psychiatrists, with sizable minorities from sociologists 
Bz^ anthropologists. 

At its Hovember, I957 meeting, the national Advisory Ifental 
fealth Council eadorsed continuation of the Small Grant Program in 
this Institute at the same level of fiaaaacial support. 



*See ±a this eoaaection "Report of the Jfental Health Small Grant 
Oojmuittee, N.I.M.He, to the National Advisory Ifental Health Council," 
October 22, 1957. 



5 - 



Program Grants aad Flioi d Fuada 

The gtaestion of haw piibHc Svm&s for research may loost pro- 
diictivelj amd equaMy "he distribxited is a coatinuiBg concern to 
grast-giving agencies. Since its iaeeption in 19h^^ the Public Health 
Serriee program of research graats has Iseea based on the sigiport of 
projects axA programs. This year, as in earlier years j the query was 
again rsdsad in the National Mvisoiy Ifeatal Health Ctoyncil as to 
whether siuppleasental si^port for tSiose research needs which did not 
fit into the usual research project or progiBm, mi^t be given through 
luaag) mm. "block grants" to institutions or deparbmsnts^ which cotjld 
then distribute the funds as ■Siey saw fit aapag departments or in- 
vestigators e 

As a result^ the whole subject of fluid funds amd program 
grants was cojriprehensi-^Tely aired this year^ in cosmiiittee discussion, 
administra>tive consultation^ and at tha Council aad Stxsdy Section 
meetings. In a final revieW;, the Cotmcil recommended that increased 
eniphasis continue to be given to the award of long-term program 
grants to investigators of established eoarpetence in the plaiming and 
direction of a program of researdi. Applications for such program 
si;5)porti, the Ooraacil felt^ should be prepared within the context of 
the present N^I.H, grant program aad shoiild be evaluated primailly 
on -^.he capabilities of the investigator (together with project-site 
visits to review all such applications) j-uther than on the detailed 
specifications of projects to be pijrsued, Sie Council suggested that 
■ttie staff of the National Institute of Jfental Eealt-h encourage the 
submission of applications for progrsm grants whenever it is deemed 
appropriate . 



II. THE SUBSTANCE OF THE BESEARCH GRAM?S PROGRM 



Underlying the seesningly heterogeneous nature of the basic and 
applied research supported in the extraBSoral program of the National 
Institute of Jfental Health Is a aeeeesarily eoa^tx^hensive view of the 
etiology 5 prevention and treatment of mental illness. While ti^saiendous 
strides have been taken in twentieth eeat"a3:y reaeareh in the biological 
aM behaviosBl sciencesj, our knowledgja of the fundamental processes of 
B3aa's functioning in his environcKnt is stiH ve2:y fragmentary. Occa- 
sionally^ a researcher's "serendipii^'% that original "gift of finding 
agreeable things not solicit for" amy bring long-needed "break-throughs" 
where least easpeeteds Jfeanwhile, long-tesm invBStments in the proven 
investigator J, in interdisciplinary team rgseardb.^ and in projects for 
the ij^rovejEent of methodology and quantification continue to add slowly 
to our knowledge. 



QSie scope of the researcli stjpporfced in aieatal health crosses 
through many fields of specialization — psychiatry^ psychology, 
sociology;, anthropology and other social sciences., in addition to 
such "biological sciences as neuroanaton^Tj! neusrophysiology;, "bio- 
chemistry^ neurochemistry aad genetics. As the meiiber aiid variety 
of research grants in these areas preclude any comprehensive suinmary 
of the research, the following remarks vill attempt cnly to highlight 
some of the research areas. 



Basic and Methodological Research 

From the early beginning of the research grants program, the 
National Institute of Mental Health has "believed strongly in the 
sxipporfc of "basic research — defined once as "research where the 
primaiy aim of the investigator is a fuller understanding of the 
su"bject under study rather than a practical application thereof." 
This year a very substantial share of the research grants program 
was invested in the support of basic research studies. 

Daring 1957 grant strpport was awarded for a nimber of re- 
search studies dealing with the functioning and structvire of the 
brain. Through the use of iirplanted electrodes in an animal brain, 
one investigator hopes to locate neural systems concerned with 
basic drives - - hunger, thirst, sex, etc. — a research study of 
great potential significance to a neurophysiologieal landerstanding 
of behavior. Another jresearch project approved this year seeks to 
provide new data on "behavior as related to chronic stimulation of 
cerebral structures. The investigator, who carries out much of his 
escperimentation with a monkey colony at Yale Ifeiversity, utilizes 
an ingenious, transistor-like brain stimulator the size of a 
cigarette pack. 

Explorations of brain chemistry in asaimals provide further 
clues to the sources of behavior, N.I.M.H. research- siipported in- 
vestigators at the University of California are examining brain 
enzymes in relation to the adaptive problem?" sol'vlng ability of the 
animal. It has already been demonstrated that h^tb adaptable 
animals, those capable of variability in attempting to solve a 
problem, have a higher level of activity in one of their brain 
enzymgs - - diolinestera.se - - than do those less adaptive animals, 
mors rigid in their "behavior whsn faced with a problem. Another 
graatee, foKnerly a U.S. Public Health Service fellow, emplojs "both 
chemical and electrical stimulation of tha local brain areas in rats 
together with electroencephalograph recordings, in a further effort 
to understand the action of neural centers concerned with primary- 
drive "behavior (sexual, maternal, etc.). 

One of our more important needs in psychosomatic medicine is 



7 



a widened understanding of the relation of "behavior and physiological 
processes, such as hlood pressure, heart rate, muscle potential and 
other processes controlled "by the autonomic nervous system. Modern, 
polygraphic equipment offers many new tools for measuring and record- 
ing performance in the autonomic nervous system, termed "by some "the 
voice of the -unconscious." The Institute, for several years, has 
supported a series of electrophysiological studies of the autonomic 
nervous system as a mechanism underlying hyperkinetic behavior. 

It has long been of theoretical interest whether some persons 
show the effect of stress mainly through the increased activity of 
one physiological system, as, for example the cardiovascular, while 
others reveal the effect of stress primarily in a different functional 
system, such as the gastro-intestinal or skeletal -motor . A research 
grant, awarded by the Institute this year, provides for further system- 
atic study of the specificity of physiological reactions to stress. 
Still another research project utilizes electrical stimulation of the 
skin in psychophysical studies on man and in parallel electrophysiolog- 
ical work on the cat brain, studying space-time interactions in the 
somesthetic system. 

As yet we have only begun to understand relationships between 
man's early learning experience and his later behavior. An N.I.M.H. 
grant- supported study with birds and animals on "imprinting --" an 
extremely rapid form of learning, which takes place during the early 
life of many organisms --is helping to verify and extend some of the 
original findings on imprinting. Other research projects with monkeys 
and other animals attempt to clarify the role of fearful experiences 
with other individuals upon subsequent social behavior, and also in- 
vestigate the permanency of physiological and psychological effects 
produced by handling (or gentling) in infancy. 

In a world made only too conscious of radioactivity, timely 
research on the behavioral effects of x-irradiation on animals before 
birth is being currently supported at the University of Tennessee and 
the University of South Dakota. 

As tools for testing and measurement are improved and other 
methodological advances made, new roadways of knowledge may open to 
the research investigator. One substantial "program grant" at the 
University of Washington supports long-term research in the mathematical 
analysis of patterns of personal data - investigating such problems 
as methods for research on diagnoses, factor analysis, and ways of 
improving psychological tests. This year several additional grants 
were made in the area of psychometric theory -- including one grant 
for the preparation of a handbook of contemporary measurement theory. 

A substantial amount of basic research in psychopharmacology 



has received grant support this year -- in part as the result of direct 
program stimulation by the Psychopharmacology Service Center, and is 
elaborated on elsewhere in this report. 



Reseaxch in Social Problem Areas 

Increasingly, in the last decade American society has come to 
recognize the mental health implications of a number of "social problem 
areas" -- among them juvenile delinquency, aging, drug addiction, 
alcoholism, and mental retardation. Together with the developing 
sense of public responsibility for better solutions to these problems 
which affect so many of society's members, there has grown an in- 
creasing demand on state and national agencies to assist in support- 
ing reseaarch in these areas. Last year's Annual Report documented 
the Congressional interest in fostering research in these social problem 
areas and pointed in detail to the growth of such research supported 
by N.I.M.H. 

Ihxring 1957 the Institute has continued to encourage the sub- 
mission of well-designed projects, both in basic and applied research 
relating to the special areas of social concern. Among the more size- 
able awards made this year is a grant given jointly with the National- 
Heart Institute to establish an Aging Research Center at Duke University. 
The Duke program has been especially designed to promote an inter- 
disciplinary research approach to the multiform, problems involved in 
the process of aging. 

A variety of other research projects in aging, juvenile delin- 
quency, drug addiction and other problem areas reflect an increasing 
interest on the part of research investigators throughout the country 
to work in areas of direct social concern. Considerable progress in 
stimulating research in psychopharmacology has, of course, been 
fostered in the Psychopharmacology Service Center, as is reported 
sub se quently . 



Other Areas of Research 

While the number of grazit applications has increased during the 
last three years at a near geometric rate, much of the overall pattern 
of grant support has remained relatively stable . An exception, of 
course, has been the publicly spotlighted area of the tranquilizing 
drugs. But side by side with the growing interest in special social 
problem areas, there moves a steady volume of applications for research 
into such psychological processes and functions as intelligence, 
learning, perception, attitudes, emotional states and their inter- 
relations, as well as a large body of research directly dealing with 
the etiology and treatment of mental illness. 



studies of the causes of severe mental disorders, such as 
schizophrenia, are exploring both genetic and environmental factors. 
Biochemical approaches, such as research on the metabolism of indole 
derivatives in schizophrenics, attempt further to establish the eti- 
ology of the disease. 

Treatment studies continue to range throughout group psycho- 
therapy, psychoanalysis, shock therapy, drug therapy, "milieu" or 
social setting therapy and a variety of rehabilitation programs. In 
the face of the recognized nationwide shortage of hospital attendants 
for the mentally ill, the Institute this year awarded a grant to the 
American Psychiatric Association to support a working conference on 
volunteer services for psychiatric patients. 

History offers long documentation to the thesis that man acts 
according to his perception of his environment. Among research studies 
to enlarge oixr understanding of the basic featxires of perception, is a 
"program grant" to Clark University. Other studies are exploring the 
judgemental processes involved in perceiving other people. 

Both in 1956 and again in 1957 "the National Advisory Mental 
Health Council, conscious of what one leading American medical historian 
has referred to as a mistaken modern tendency "to limit the definition 
of research to the experimental process," recommended further support of 
scholarly research. The Council has also encouraged grant support of 
research projects in the history and socio-cultural aspects of psychiatry 
and, more broadly, of medicine. 

Several current mental health research projects may also con- 
tribute to the great American talent hunt today, through supporting 
projects for a more systematic analysis of aptitudes. Diiring 1957 the 
Institute participated in an inter- agency grant award to set up a new 
study on identifying, developing and utilizing h\jman talents, to be 
based on a sample of over one million American high school students. 



III. THE PSYCHOPHARMACOLOGY RESEARCH PROGRAM 



The revival of psychopharmacology, an old science with a new name 
and with renewed promise of help for the thousands of mentally ill pa- 
tients throughout the country, led to the establishment in late 1956 
of the Psychopharmacology Service Center. During its first year the 
Center has had to struggle with, and learn to adjust to, the many 
administrative problems and growing pains experienced by any young 
organization. It came into being at a time when the "tranquilizing 



- 10 - 



drugs" had caught the attention of the whole American public. Medicines 
for the mind and drugs for the soul were — and still are -- not only 
the target of cartoons and quips, but also a source of deep concern 
to scientists, physicians, and all those responsible for research funds 
and a subject of serious editoriaJ. comment by the press and other 
thinking laymen. With such an urgent and pervading interest in its 
work, the staff of the Center was plunged precipitously into almost 
daily crises calling for immediate action and decision. But meanwhile, 
in this atmosphere of subdued uproar the staff felt impelled to proceed 
deliberately and soberly with a program leading to its ultimate goal. 
This goal can perhaps best be stated as the promotion, stimulation, and 
support of research and related activities that will result in increased 
■understanding of the psychopharmacological agents and their role in the 
treatment of psychiatric patients. And clearly, from this greater under- 
standing may come the possibility of freeing those with mental illness, 
whether serious, debilitating and continuous or slight, bothersome, and 
transient, to live more creative, interesting, and happier lives. 

Psychopharmacology Service Center Staff 
Activities and Program Developments 

At its inception the Center was staffed with two professional 
persons; at the end of the year there are five professional persons, 
plus supporting semi-professional, secretarial, and clerical personnel, 
amounting to a total of thirteen. Staff has not been easy to come by, 
and much time of those who first came to the Center has been spent in 
recruiting and other personnel chores. 

Soon after its formation, a Psychopharmacology Advisory Com- 
mittee was selected and appointed. This committee, made up of leading 
scientists in psychiatry, psychology, sociology, neurophysiology, and 
pharmacology is responsible for guiding the staff on general policy 
and planning. It also serves as a review committee for grant applica- 
tions in psychopharmacology. The staff and the committee have been 
working through a period of definition of functions, especially in the 
matter of review functions. After trying several different procedures, 
it has now been decided that most of the applications for grants in 
psychopharmacology will be reviewed by this committee, with related 
basic studies reviewed by the relevant Study Sections. 



C onference and Meetings 

As part of its effort to facilitate and stim\ilate sound research, 
the Center held two conferences in 1957- On January 1^+ and 15, in 
collaboration with the American Psychiatric Association, it called 
together a group of prominent clinical investigators and editors of 



11 



scientific joiirnals to discuss problems in the reporting of psychiatric 
drug studies. The major purpose was to consider ways in which the 
reports of clinical drug evaluations could he made more informative 
and useful. The conference resulted in a series of concrete and 
specific recommendations on reporting of data ahout patient selection, 
evaluation of change, treatment setting, and toxicity reactions. In 
addition, the editors recommended that as one means of handling the 
flood of psychopharmacological papers a newsletter-type of journal "be 
published, containing brief summaries of current research, analytic 
review articles, euid bibliographies. An article describing the con- 
ference entitled "Recommendations for Reporting Studies of Psychiatric 
Drugs" appeared in the July 1957 issue of Public Health Reports . 

Later in the year, on September 19 and 20, the Center organized 
a working group on anti-depressive or "energizing" drugs. Because 
the tranquilizing drugs appear to be of only limited value for patients 
who are depressed, withdrawn, or markedly inactive, several new drugs 
with potential anti-depressive or stimulant properties are being tried. 
The staff of the Center deemed it wise to meet at a time when research 
on these drugs was just beginning, with a group of investigators who 
have done, or might be interested in doing, such research to exchange 
views and information and to lay plans for future research. One 
result of the meeting was the conclusion that problems of research 
with cases of regressed and withdrawn schizophrenia are quite different 
from research on depression. Even though the same drugs may turn out 
to be effective for both groups, the patient populations are, in fact, 
not at all alike and demand research planning designed for the specific 
group under study. The animated discussion and large amount of new 
information gleaned by the Center's staff and all those present 
demonstrated the value of such working groups as one fruitful approach 
to stimulating good research. 



Informational Activities 

As another approach to research facilitation and stimulation and 
as stated in the Research Grants and Fellowships Branch Annual Report 
for the Calendar Year 1956, one of the functions of the Psychopharmacology 
Service Center is to "serve as a clearinghouse of information." During 
the past year the Center has collected, organized, and catalogued about 
2,500 articles and reports, both published and unpublished, on psycho- 
pharmacology. A coding system has been developed to permit easy and 
accTirate identification and retrieval of the documents, and most of 
them have been coded. For over 500 of the more important articles, 
300-word abstracts have been written so as to provide investigators 
with concise, well-organized, and readable summaries of research in 



- 12 - 



which they are interested. It was originally planned to follow the 
recommendation of the editors attending the conference on reporting 
of psychiatric drug studies hy starting a newsletter or abstract 
journal to serve as one vehicle for the rapid commimication of in- 
formation ahout research activities in psychopharmacology. However, 
as this notion was explored in more detail, it became evident that 
administrative considerations militated against the Psychopharmacology 
Service Center itself handling the publication. The present proposal 
is to solve this aspect of the communication problem by grant support. 
Now that investigators know of the existence of the information 
clearinghouse, many requests for information have been received and 
answered. These requests have ranged from specific questions about 
use of drugs with certain kinds of patients to general inquiries 
about all research that has been done in broad areas of psychopharma- 
cology. Although much of the scientific information activity of the 
Center has revolved around the accijmulation and dissemination of 
written research reports and the preparation of reference lists and 
bibliographies, all members of the staff have engaged in providing 
information by attending scientific meetings, presenting papers, taking 
part in discussions of psychopharmacology both at scientific conventions 
and with visitors in the office, answering many telephone inquiries 
received every day from scientists and administrators both within and 
outside the government, appearing on television programs, and being 
interviewed by newspaper and magazine writers. Finally, in line with 
the request of the 83rd Congress, a comprehensive status report has 
been written, describing in detail the developments in psychopharma- 
cology during the past year. 



Interactions with Drug Companies 

Throughout the year the staff has been meeting and corresponding 
with representatives from many of the drug companies. At the spring 
meeting of the Physiological Society a presentation was made to a 
relatively small group of drug company representatives to describe to 
them the purposes and activities of the Center. A more extensive 
report was given in October to the American Drug Manufacturers 
Association. Relevant here also is the fact that the executive 
secretary of the American Drug Manufacturers Association is a member 
of the Psychopharmacology Advisory Committee. Relations with the 
drug companies have been cordial and mutually satisfactory. The 
companies have shown a sincere willingness to give information (some 
of it confidential and handled in a strictly confidential manner by 
the Center's staff) about their drugs, both new and old, and they have 
cooperated whole-heartedly with the information clearinghouse. The 
Center, in turn, has sent much general infonaation about psychopharma- 
cology to persons doing research in the drug companies. It has had 



13 



many sessions with driig company representatives to discuss their 
research problems and to consult with them on techniques and 
methodology, particularly on problems of screening drugs for 
behavioral effects and designing of clinical studies. These 
discussions illustrate one important facet of the Center's work. 
The drug companies do not need financial support, but they often 
do want good objective evaliiations and advice. Since much of the 
psychopharmacological research is done under drug company auspices, 
the Center, through its consulting service, can indirectly but very 
significantly contribute to the development of better research and, 
thus, to better Tinders tanding of the drugs. 

Research in Psychopharmacology 

The core and raison d'etre of the Psychopharmacology Service 
Center program is stimulation and support of research. During the 
fiscal year 195T;> ^2 new grants in psychopharmacology were awarded, 
totaling $73^ J 291. These grants range in content from basic 
pharmacological and physiological studies through research on the 
effects of drugs on animals and normal human behavior, to clinical 
studies of drug effectiveness in psychiatric patients. In terms of 
amount of support they vary from small, pilot one -year studies of 
about $2,000 to five-year support of a major and extensive research 
program on the psychopharmacology of schizophrenia totaling more than 
$500,000. 

The National Institute of Mental Health has for several years 
been supporting substantial work in psychopharmacology through its 
regular research grants program. This work and emphasis are contin- 
uing, with the added impetus of additional fionds specifically ear- 
marked by the Congress for both preclinical and clinical research 
in psychopharmacology. Although continuing to push basic research, 
the staff of the Center and its Advisory Committee have, during the 
past year, channeled considerable effort into the stimulation of soimd, 
we 11 -controlled clinical studies, and several new grants have been 
awarded for such research. 

One carefully controlled clinical study in a large state 
hospital system is testing the effects of four phenothiazine drugs on 
chronic schizophrenic patients. Dosage is individualized and is at 
the high upper limit to yield needed information about dosage and 
dosage schedules for fut\ire use of drugs in hospital settings. The 
research is designed to answer the question of whether or not patients 
treated with drugs improve, as compared with untreated patients, in 
their social adjustment within the hospital and also to obtain con- 
clusive data on the number of patients who improve enough to leave 
the hospital. A complementary investigation is studying the effects 



- ll^ - 



of five phenothiazine drugs on newly admitted, rather than chronic, 
patients. Four of the drugs are the same as those being used in the 
study of chronic patients, thus allowing a good basis for coordinated 
and comparative results on these two groups. 

Another investigation on acutely ill patients is evaluating 
the effectiveness of both chixpromazine and reserpine. In addition 
to increasing knowledge about the comparative value of these two 
drugs, this study should extend the generality of the findings about 
tranquilizing drugs and the applicability of their use. These 
studies will make possible sound conclusions about drug effectiveness 
and, also important, will provide information on the best designs to 
use in future research in hospital settings. 

Preliminary observations of res\ilts with tranquilizing drugs 
indicate that some patients respond and others do not What accounts 
for this difference? In order to discriminate more clearly the 
differences and thus to predict more accurately the effectiveness 
of drugs, a study is underway in which patients will be given several 
perceptual tests before they begin drug therapy and these tests will 
be correlated with results of the treatment This study may well also 
point up clues leading to better understanding of the mechanisms of 
drug action in the nervous system. 

Ifeny clinical studies have indicated, in a general way, that 
drugs are of great benefit to hospitalized psychiatric patients, but 
there has been little research on outpatients . With the release of 
patients from mental hospitals after drug therapy it is essential to 
know if these patients are able to take their places as active pro- 
ductive members of society. Consequently^ research is being supported 
to evaluate cMorpromazine and promazine for use with chronic schizo- 
phrenic patients treated in a clinic, rather than a hospital. The 
study is assessing the psychological changes accompanying drug therapy 
and the patient's social adjustment in the community. Moreover, it is 
not basing its conclusions on observations for only a few mont]:s,but 
is planning to follow the patients ' progress for several years . 

Closely related to the question of outpatient drug treatment, 
is the question of how long to continue drug therapy with chronic 
patients after their overt symptoms have subsided and they have been 
released from the hospital. Is it necessary to continue the drugs 
in the same way that diabetic patients must keep on taking insulin 
and epileptic patients anticonvulsant medication? Should the drugs 
be gradually reduced, or should they be replaced by placebos? A well- 
planned study in which neither the psychiatrist, psychologist, and 
social worker nor the patients know which kind of treatment is being 
used is attempting to answer these important questions. 



15 



With the tremendous increase in the number of new psycho- 
pharmacological agents it is vital that they receive careful pre- 
liminary clinical screening soon after they become available One 
of the studies is being supported specifically to subject new drugs 
to rigorous testing. Along with the clinical trials, work is being 
done on animals to observe any toxic effects after long-term admin- 
istration and also to obtain data on the possible sites and modes of 
action of new compounds. 

It is a truism that the effects of a drug are not produced 
just by the drug but by the interaction of the drug with the system 
in which it is used. This is even more true of psychopharmacological 
agents, where the interactions extend into complex personality and 
social variables. One study currently receiving support is comparing 
drug effectiveness with patients who are merely given custodial care 
with patients who are receiving intensive social therapy from psychi- 
atrists, nurses, and other personnel. An interesting by-product of 
this study will test the hypothesis that intensive social therapy 
may be just as effective as drug therapy. 

Not only are the social variables in drug action in need of 
study, but it is essential to investigate the psychodynamlc and 
personality changes that appear with drug therapy. Therefore, a 
study has begun in which the patients receiving drugs are also being 
given intensive psychotherapeutic interviews or are undergoing 
psychoanalysis . 

In such a broad field as psychopharmacology, how shall the 
many important variables be determined? One investigator is attempt- 
ing to delineate these variables by analyzing the relations between 
environmental variables and the effects of drugs . Both animal and 
human subjects are being used, and a wide variety of measures and 
techniques employed. As specific reproducible results are found in 
animals, crucial experiments will be adapted for human beings to 
learn the generality of the results. 

Several researches on drug toxicity are under way. One is 
working on psychomotor dysf xmctions , such as parkinsonism, that occur 
with use of tranquilizing drugs. Another is looking into the effects 
of chlorpromazine and reserpine on the reticuloendothial system to pin 
down the clinical observation that patients on protracted drug treat- 
ment seem more susceptible to infections and are less predictable in their 
response to antibiotic therapy. Indirectly related to studies of toxicity, 
but with definite implications, is a study of the effects of drugs on 
the psychological development of young animals. The significance of 
this research for the question of using drugs with children is obvious. 

In addition to stimulating research and providing support for 



- 16 



clinical and toxicological studies, the Center has during the year 
encouraged many studies of basic research on animals and of the 
effects of drugs on the performance of normal human beings . 

Plans for the Coming Year 

In the process of reviewing applications for research grants ;, 
making surveys of past and current research, and consulting on 
research designs, the staff and its Advisory Committee have become 
increasingly aware that there are no good instruments for assessing 
the psychological and social changes that take place with drug 
therapy. This is particularly true in studies of drug effectiveness 
with neurotic patients or psychiatric patients who are not hospital- 
ized. Two recently awarded research grants will be concerned with 
this problem as it involves hospitalized patients. In addition, to 
meet this need the staff, together with a subcommittee, is devoting 
considerable effort to the construction of a valid, reliable rating scale 
for use primarily in outpatients . This undertaking exemplifies one of 
the practical and significant ways in which staff activity can augment 
research being done imder grant support. 

Although there is no lack of preclinical research in psycho- 
pharmacology, there is a need for compilation and organization of the 
data and theories to learn where psychopharmacology has been and where 
it is going. A recently-begun staff project will be the preparation 
of extensive and definitive working papers to serve as a basis for 
program planning and stimulation of research. One of the papers will 
emphasize the pharmacological and physiological research; the other 
will be primarily focused on behavioral techniques with animals. 

The informational activities of the Center will undoubtedly 
have to be expanded and extended if the demands of investigators are 
to be met, and explorations into ways in which the publication problem 
can be solved will be continued. Hopefully, the foreign literature 
will also be included in the collection and will be translated and 
abstracted. 

The success of the first two conferences has led to plans for 
additional meetings. Now under consideration is one meeting to discuss 
problems of chronic drug administration, including toxic and with- 
drawal effects. The other will probably be organized around the topic 
of behavioral testing of drugs. 

Finally, now that at least some of its staff and administrative 
problems appear to be resolved, the Psychopharmacology Service Center 
can concentrate more fully on its primary function of research stimu- 
lation, planning, and accomplishment. 



17 - 



Specific plans are being considered for the organization of 
single or cooperative studies in the following areas: 

1. The testing of nev drugs in chronic schizophrenic populations. 

2. The evaluation of newer "energizing" drugs in depression. 

3. Drug studies in neurotic outpatients. 

h-. Drug effectiveness in "both schizophrenic children and 
children with serious behavior disorders. 

It is probable that work will be under way in most of these 
areas before the end of the current (1958) fiscal year. 



IV. RESEARCH TRAIIOiWG; CAREER INVESTIGATOR GRANTS AMD THE 
FELLOWSHIPS PROGRAM 



Present day shortages of scientific personnel and the spread- 
ing range of professional disciplines Involved in mental health 
research have accentuated the need for training assistance. Research 
training activities of the Branch as represented by both the Career 
Investigator grants and the research fellowships program constitute 
a vital share of Branch activity. This year, with the addition of 
a full-time Branch staff member for fellowships and Career Investigator 
grants, a greater degree of planning and program evaluation has been 
made possible in these programs. 

The Career Investigator Grant Program . Started in 195^ as a new form 
of research support designed to assist in the opening of research 
careers to qualified young psychiatrists and scientists in related 
disciplines, the Career Investigator program has supported seventeen 
investigators to date. All but three are psychiatrists. The program, 
which aims to enable a limited number of highly qualified young men 
or women to spend from three to five years in full-time research and 
further development of research skills, manifests considerable stability 
by this time. 

It is significant, that in the shifting psychiatric world -- 
where financial rewards for private practice far outweigh any fellow- 
ship or training stipend, there have been no resignations from amongst 
the psychiatrist Career Investigators. 

In December, 1957 past and present Career Investigators to- 
gether with members of the Selection Committee gathered together in 
a three -day meeting at Arden House in Harriman, New York for a gen- 
eral discussion of the program. The role of the research psychiatrist 



18 



is a relatively new one in many university settings, and a share of 
the discussion vas concerned with the professional future of the 
research psychiatrist. Stressed by many of those participating in 
the program was the value to the Career Investigator of a strongly 
organized university department able to offer research guidance. 
The discussions also emphasized the validity of the three to five- 
year research training program in terms of the growth of an investi- 
gator's research abilities. As a whole, the meeting provided a 
valuable opportunity for the interchange of scientific ideas among 
this select cadre of research investigators. 

The Research Fellowships Program . During fiscal year, 1957? $6^7,000 
was earmarked for mental health research fellowships . The Mental 
Health Fellowships Board reviewed 206 applications and made ik'J 
awards. Applications in this lively program range over a wide 
variety of the behavioral and biological disciplines related directly 
and indirectly to mental health. 

IFb^llowships supported by N.I.M. H. are available to the 
scientist whose experience has matured him to train for leadership 
in mental health research, to the post-doctoral candidate preparing 
for a research career, to the pre-doctoral student whose endowment 
recommends him for emphasis on research training, and finally (an 
innovation of fiscal 1957) to the medical student whose aptitude 
justifies a year or two of application to the techniques of the basic 
sciences as an extension of his training for medical work. More than 
two million dollars has been invested in over 600 mental health 
research fellowships during the period from 19'<-7 through 1957- 

Research work in progress by N. I.M. H. fellows extends to a 
variety of areas, including the problems of aging, mental retardation, 
psychopharmacology, neurophysiology and techniques of clinical psychi- 
atry. This year's applications also numbered several studies submitted 
by educators which deal with adjustment problems in high school and 
college students. 

While the fellowships program has repeatedly proven its value 
as a sound investment in research training, the administration of the 
program has been somewhat hampered by the overall volume of fellowship 
applications received at N. I.E. It has been difficult in the past 
to provide that individualized attention to fellowship applicants which 
might pay dividends in more responsible and selective faculty guidance. 
With the addition this year of a full-time Branch staff member to work 
with the fellowships and Career Investigator programs, it is hoped this 
recognized problem may reach better solution. 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Research Grants and Fellovfshlps Branch 



BUDGET SHEET 

Estimated Obligations for FT IQ'^S 
Total: $328,353 
Direct: $199,307 

Reimbursements : $129 , O^t-S 



TRAINING AND STANDARDS BRANCH 
Annual Report For Calendar Year 1957 

! 

During the past year one of the serious problems confronting the over- 
I all field of mental health is that of manpower. Because of the expanding in- 
terest of the country as a whole in the field of mental health opportunities 
for staff appointments are increasing at a rate far greater than the capacity 
of the training centers to prepare professional people. The staff of the 
Training Branch have been deeply involved in this problem. In additions 
attention has been focused upon improving and extending the quality of 
psychiatric education. Continued emphasis and support have also been directed 
toward training large numbers of clinical personnel for the reason that it is 
from this group that we get our people for leadership positions in teaching, 
research, public service and administration, and for community mental health 
programs at State and local levels. This does not imply that the Training 
Branch has neglected giving stimulus to the development of more adequate train- 
ing opportunities in the area of research The staff are expending consider- 
able effort in this latter direction and it is anticipated in the next several 
years more attention and conceivably more grant support will be expended in 
the direction of developing basic sciences programs in human behavior. A 
number of medical schools are engaged in a study of the development of a basic 
sciences department of human behavior at this time. 

Aside from the needs for personnel for clinical therapeutic activities 
is the need for stimulating the development of community mental health 
personnel for administrative leadership at the State and local community 
level. These administrative leaders are in extremely short supply and consid- 
erable stimulus must be given to the training centers to have them focus their 



. 2 - 
attention upon the preparation of such professional persons. In the field 
of mental health the educational centers are experimenting with various types 
of training programs that will prepare a mental health leader analogous to 
the general public health officer to deal with the problems of prevention of 
mental illness and the promotion of mental health. 

In connection with these activities, the staff of the Training Branch 
carry on extensive consultation with presidents and deans of universities , 
medical schools, graduate schools and schools of public health as well as 
with department heads in psychiatry, psychology , social work and nursing. 
Frequently the staff have been called in consultation or have been used as 
resource personnel in the broad field of mental health education. The 
number of project site visits approximated 300 made by the staff during the 
past year. 

Grants have been made during the past year for the purpose of im- 
proving and extending the psychiatric aspects of training of the medical 
and nursing student . These people represent a first line of defense so to 
speak and it is desirous from a preventive point of view that they be 
adequately prepared to deal with emotional problems encountered in their 
respective spheres of activity. 

During the past year traineeships were awaurded departments of 
psychiatry in medical schools for the purpose of providing additional 
clinical experience in psychiatry or experience in psychiatric research 
for the medical student. It is anticipated that more physicians will be 
recruited into the specialized area of psychiatry, A total of 290 such 
traineeships were awarded. 

As indicated above there continues an excessive demand for leader- 
ship people in teaching, research, public service and administration, and 



- 3 - 
in community mental health activities. These people come from the programs 
of clinical training. For this reason the greatest percentage of the funds 
available for training have gone into the preparation of as large numbers 
of psychiatrists, psychologists „ social workers, and nurses as is possible. 
During the past year frequent consultation has been given to a number of 
schools of education concerned with the preparation of the classroom 
teacher. These schools have been interested in incorporating material from 
the field of the behavioral sciences, including psychiatry, psychology, and 
social sciences into the training of the classroom teacher that will be 
useful to her in dealing with emotional problems encountered in the growing 
and developing child in the classroom setting. It is anticipated that 
several of these institutions will apply to the Institute in the near future 
for support of programs of an experimental nature to work out the content 
and the methods for presenting this material in these training programs. 
Special attention continues to be devoted to encouraging the development 
of training programs concerned with mental retardation and juvenile 
delinquency. Some small encouraging progress can be reported in these latter 
areas . 

A large number of training centers, widely scattered throughout the 
country, appear to have increasing interest in these conditions. We cannot 
report the same kind of interest in the training of personnel to work in the 
area of alcoholism. It has been a difficult assignment to arouse interest 
in training personnel for this health problem. 

In a number of medical schools there appeared during the past year 
a considerable interest in developing a closer teaching liaison between the 
departments of psychiatry and the pre=clinical or basic sciences departments. 



_ 4 - 
This Interest seems more intense from the pre-clinlcal departments of 
pharmacology and physiology „ A number of medical schools are experimenting 
with conjoint teaching activities Involving the department of psychiatry and 
one or more of the pre-clinlcal departments- It is anticipated that the 
Institute will receive in the future requests to support the further elabora- 
tion of these conjoint experimental teaching activities » 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Training and Standards Branch 



BUDGET SHEET 

Estimated Obl.igat3iQng f«?r .lY 19'i8 
Total: $i+10,081 
Direct: $278,823 

Reimbursements: $131,258 



Project included: Training Activities 



Mj 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Clinical Investigations 
Office of the Director 



BUDGET SHEET 



Estj.mated Obligations for FY IQ'^S 
Total: $221,9'^5 
Direct: $170,533 

Reimbursements : $51 ,^12 

Projects included: I^D(C) 1 through M-D(C) 3 



I 



Serial No. M-D(C) 1 

1. Clinical Investigations 

2. Office of the Director 
3" Bethesda, Maryland 



PHS-WIH 

IndividuaJ. Project Report 

Calendar Year 1957 



Part A. 



Project Title ; The Analysis of the Psychotherapeutic Process, Particularly 
the Psychoanalytic Process 

Principal Investigator ; Robert A. Cohen 

Other Investigators ; David Shakow, Allen Dittman, Morris Parloff , Paul 
Bergman, Mabel Cohen 

Cooperating Units ; Laboratory of Psychology 

MEm Years ; 

Professional: 0.25 
Project Description ; 

Objective ; To conduct an intensive study of the psychoanalytic process 

Methods Eniployed ; \ 

1. Data Collection ; Natiiralistic recording by motion pictxires and 

stereophonic souad of portions and of complete courses of 
psychoanalytic (and in some cases of other psychotherapeutic) 
treatments of adults and children with a variety of emotional 
disorders. 

2. Data Analysis ; Methods will be developed to organize the exten- 

sive material which will be gathered by a variety of partial, 
total and cimiulative exposxire techniques; to divide it 
into units which on the one hand accurately reflect the 
nature of the exceedingly complex interactions between pa- 
tient and therapist, and on the other are sufficiently 
specific and manipulatable to permit an orderly and mean- 
ingful analysis of the therapeutic process. 

For the past 2 years two training and supervising 
analysts have studied very intensively a short series of 
therapeutic intearvlews; first using a typescript alone, 
then the sound recording and finally the sound motion pic- 
ture. These studies were carried out independently at the 
beginning, but they are now being combined in order to set 
up categories for the individual elements which must be 
rated in order to study the therapeutic process. 

= 1 - 



Serial No. M-D(C) 1;, page 2 

Project Descrlptioo, (coEtlEued) ; 

Patient Material ; 

Up to the present time the material used has been collected at 
the University of Illinois where another research group is work= 
ing toward the same goalo 

Our ow7a phj^sical set-up has finally been completed, and an ex- 
perienced therapist has begun a trial series of single inter- 
views with a variety of patients and with several normal controls o 
In the coming year it is anticipated that it will be possible to 
embark on a motion picture recording of a regular psychoanalytic 
therapy. 

Ifejor Find!.n gs; 

None as yet. Much methodological research must be done before sub- 
stantive theoretica.1 contributions can be madeo 

SignifieaEce ; 

This is cum of a series of studies of the psychotherapeutic process; 
The Process of Change and the Communication of Value Systems in Psy- 
choaoalytic Therapy M=P-P(C) 5^ Linguistic Study of Easotional Ex- 
pression M-P=G(C) 4| Judgment of Facial Expression fi-om Short Se= 
quenees of Motion Pictiara Film M"P-C(C) 5; Analysis of the Psycho- 
therapeutic Process; The Cumulative Information Derived from 
Repeated Viewing of Complex Material M-P-C(C) 2j Development of 
an Ego -Integration Conceptual System for Studying Psychotherapy 
M-P-P(C} 6. 

Despite the fact that psychotherapy is the major therapeutic device 
in psychiatric treatment., our understaxiding of it as a procass is 
still very limited » One reason for this is that previously data 
could be secTored only by the therapist; his reportdng was limi,ted 
both by the fact that he was a participant as well as an obsen/er 
in the process and also by the human impossibility of reporting 
completely -wb&t had tr8s:is,piredo In the therapeutic situation;, the 
relationship is exceedingly complex^, and this is all the more true 
since much of the communieation occurs at an implicit le^-^elo Hence, 
much of the significant data was not even available to anyone out- 
side the rala.tlonship which it was proposed to study. The soui-id 
motion pictxire pro'vldes for the first time a sizable and signifi- 
cant amount of objective data hitherto \inobtainablej what is 
equally important is that this data is collected in a form suit- 
able to multiple and repeated analyses. 

This series of studies nmy make many contributions methodologically, 
it will be possible to study the psychoanalytic process scientifi- 
cally to a far greater degree than has heretofore been pcfssible. 
Theoretically it is expected that it will make available new and 
highly significant data - data which is gathered in a mere or less 
naturalistic asttixjLg but which is as objective as those usually 
obtained in laboratory experiments. 

Beyond the direct contribution to a better understanding of the 
psychotherapy process itself, it will aid in the establishment of 



Serial Ko. M-D(C) 1, page 3 

Project Desci-iption (continued) ; 

Significance (continued) ; 

the scientific bases of psychoanalytic theory. It is safe to 
say that psychoanalysis is one of the central socio -psychologi- 
cal sciences. It deals with man, born with his drives and abili- 
ties, with his slow adjustment to social life through family train- 
ing. While it deals with the same kind of data social sciences 
deal with, it also provides information on the subjective aspects 
of the activity of those parts of the central nervous system which 
have recently attracted so much attention, viz. the limbic system 
and the reticular activating system. Psychoanalysis should be 
able to make fundamental contributions to the understanding of 
education in its broadest sense. 

Proposed Coxrrse of Project ; 

It is expected that this program wiU continue for many years. 



Part B. included; No. 



o 

J 



Serial No. M-D-(C)-2 

Office of Director 
Clinical Investigations 
Bethesda 

PHS-NIH 
Individual Project Eeport 
Calendar Year 1957 

Project Title: Development of an Ego Integration Conceptual 
System for Studying Psychotherapy 

Principal Investigators: D. ¥ells Goodrich, M.D. 

Donald S. Boomer, Ph.D. 

Other Investigators: None 

Cooperating Units: Section on Personality, lahoratory of Psychology 

Laboratory of Clinical Sciences 
Eniployee Health Service, NIH 
Community Psychn.atric Clinic, Roekville, Md. 
Washington Institute of Mental Hygiene 

Man Years (calendar year 1957) ' Patient Days (calendar year 195?) : 

Total: 2.00 Outpatients: k2 patient days 

Professional: 1.00 
Other: 1.00 

P ROJECT DE SGPJPTION; 

Objectivas; (l) Long-tei^i: To develop a theoretical model and 

observational tools for the purpose of generating and testing 
a network of hypotheses about the conditions of personality 
change, (2) Immediate: To organize a loose set of clinical- 
theoretical ideas and observations into a coherent model, as 
indicated above, and to determine the feasibility of observing 
certain critical changes in patient behavior during psycho- 
therapeutic sessions . 

¥e are concerned with the moment-to-mament le^?■el of ego 
integration in the patient in his dealings with the therapist. 
¥e have conceptualized and hope to be able to identify in action 
four patterns of ego integration among which patients are presumed 
to shift duj^ing a therapy session. These have been carefully 
spelled out, but for the purpose of this report brief descriptive 
simimaries must suffice: 



- ^ 



" '' "* M-r)-(c)-2 

page 2 

Defended (F ) - The patient is controlling anxiety by his 
custorasiry means, and is functioning at his characteristic 
level, Involimtarily reveal Ing from time to time, the ego- 
distorting aspects of his defensive fiinctioning. 
PartiaXLy defended (P ) - Similar to F but less stable and 
comfortable. Patient displeiys some readiness to move 
toward a suspension of his defenses, with concomitant 
premonitory anxiety. 

Self observing (o) - The widely-described "split ego" 
state in which the patient is monitoring his own behavior 
and considering simultaneously, or in rapid alternation, 
his feelings, his behavior, and his defenses. 
Deccaiipensated (c ) - The overwhelmed ego: Anxiety is so 
high as to submerge defenses, disrupt some or all ego 
functions and interfere with interpersonal and task- 
directed functioning. This may be a clear open panic 
state or a transitory disturbance, virtua3-ly unnoticeable 
unless reported by the patient. 

Methods Itaploye d; In order to provide data on personality change dviring 
psychotherapy, from two to six patients are maintained in outpatient 
psychotherapy continually. The senior investigator is responsible 
for maintaining professional relationships with the referring and 
collaborating eigencies (see "cooperating units"), for supervising 
the diagnostic screening procedures (psychiatric interviews, psycho- 
logical tests, physical examinations and laboratory tests), and for 
supervising the psychotherapeutic treatment and incidental medical 
care provided to the patients while they are subjects. Psychiatric 
supervision of psychotherapy is carried out by means of individugil 
conferences with the project's therapists (i.e., psychiatrists and 
psychologists who donate time to the project) and by use of the 
one-way vision screen vhen this is indicated to clarify a clinical 
problem. 

During the first few weeks of psychotherapy, and periodically 
thereafter, each patient's major resistances axe formulated both 
in general clinical terms and in terms of specific inter^/iew 
behavior. Particular attention is directed to formulating major 
current transference resistances, since the reseeirch model focuses 
upon the process of patients' attaining conscious insight into 
transference experiences. All interviews are recorded for 
behavioral analysis, according to the methods outlined in Project 
Ho. M-P-P-(G)-6 (Section on Personality, Laboratory of Psychology). 



- 5 - 



" 3 " M-D-(c)-2 

page 3 

Interview transcripts are also coded into phases according to 

whether the patient's statements demonstrate a blatant resistance 

state (f) or one of the other ego states (P, C, or O). It may 

then be possible to explore relationships between the clinical 

course of therapy, specific ego state phases during interviews H 

and the profile of statisticeuLly measurable behaviors. |;i 

Ilirough this integration of clinlceil case studies with 
the statistically-controlled behavior measures, we hope to be 
able to define shifts in the patient's ego state. Subsequently, 
it may also be possible in a more detailed theoretical manner to 
relate ovir concept of ego state to more general concepts of ego 
psychology. 

Patient Material ; Patients are selected according to the following 
criteria: (l) Ages 17 to 40; (2) approximately half women and 
half men; (3) absence of psychotic or "borderline" type of 
psychopathology; (U) absence of social or family problems or 
of severe acting-out tendencies; and (5) likelihood of demon- 
strating in a short time some definite changes under the influence 
of psychotherapy. A total of seven patients have been studied 
to date; the addition of from two to four more patients d-uring 
the coming yesir is contemplated. 

Significance to HIMH Research ; The systematic Investigation of relevant 
aspects of psychotherapy is a salient part of the program of NIMH. 
This project may contribute directly to this effort with substemtive 
findings or indirectly with methodologlC€LL and conceptual develop- 
ments which can be utilized in other parallel investigations. 

Proposed Course of the Project ; Biis work, as ciirrently envisaged, will 
continue throughout this yeax and weH beyond. Some csirefully 
controlled definitive work will be carried out d-uring this yeso* 
with regard to the incidence of speech disruptions and the correlates 
of high and low incidence. Bie broader conceptual-theoretical work 
of formtilatlng a model will also continue along the lines outlined j 

above. 



- 6 - 



Serial No. M-D-(C) 3 



1 . Office of the Director 
3 Location: Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



[irt A. 



Project Title: Establishment of a Near Zero Level of Physical 

Stimulation and of Action Possibilities and its 
Effects on Mind and Brain Activity. 

Principal Investigator: John C. Lilly. 

Other Investigators: Thelma W. Galkin and Jay T. Shurley. 

Cooperating Units: None. 

Man Years: Patient Days: None 

Total: .99 1/3 
Professional: .49 1/3 
Other : . 50 

Project Description: 

Objectives: 

1. To make a survey of the literature on individuals who 
were exposed to environments in which the physical stimuli 
were at a minimal level. 

2. To devise an environment producing minimum possible 
levels of stimuli in terms of light, sound, gravitational 
effects, movement, temperature changes, pressures on the 
skin, etc. 

3. To observe the effect of this environment on monkeys 
and human subjects. 

4. To obtain fundamental base line data on brain activity 
and mind activity during a state of minimal inputs to the 
brain from the environment. 

5. To interest professional psychiatric and psychoanalytic 
personnel in serving as subjects to obtain professional 
evaluations of and maximum meaning from this type of experiment 

6. To write a book detailing our findings in the literature 
on autobiographical accounts as well as experimental results 
found by others. 

Methods Employed: 

1. Library research. 

2. Communication with persons who have been exposed to 
minimally stimulating environments, i.e., American Speleo- 
logical Society, Arctic Institute. 



- 7 - 



Serial No. M-D-(C) 3 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



page 2 



A. (continued) 



3. Experimental methods have been under development for the ' 
last 4 years. The present approach is to suspend the subject i 
in quiet water,* in the dark at such a temperature as to be 
neither warm or cool (about 34.5°C) with a breathing mask 
which gives minimal stimulation The mask has been the major 
problem: underwater masks from the Navy Experimental Diving 
Unit, the Army Engineers, and Chemical Warfare have been 
found to have too high unit pressures on small areas of the 
face, leading to (1) pressure stimuli and (2) eventual local 
anoxemic pain. Therefore, a program of mask development has ! 
been undertaken: Model #7 is almost completely satisfactory. 
Preliminary designs for a quiet, pressure-balanced respirator 
are being done . j 

i 

Major Findings: To date, many examples have been found in the, 
literature of individuals isolated in boats or in the polar 
regions or in prison, but the factors of threat to life, cold,' 
hunger, thirst, sun, etc. make it difficult to attribute the 
effects solely to reduction of the ordinary levels of stimulat a 

The results of experiments done on volunteers show the followii;; 

1. Any remaining continuous stimulus becomes extremely 
irritating and leads the subject to terminate the experiment. 

2. Patterns of activity resulting from previous stimuli 
slowly die out in the tank — the "half -life" seems to be about I 
1/2 to 1 hour. : 

3. A powerful tension may develop in an interval as short as I 
2 hours . 

4. One experience of the first stages of visual hallucinatory 
phenomena has been experienced. 

5. At emersion, the subject's appreciation of clock time 
was changed so that he felt as if the day was started afresh. 

An additional subject has been trained and is about to start 
his own series of observations on himself. 



* Tank devised and its use loaned by Physical Biology 
NIAMD, Dr. Heinz Specht . 



- 8 - 



Serial No. M-D- (C) 3 

page 3 
PHS-NIH 
Individual Project Report 
Calendar Year 1957 



(dontinued) 



Significance to Mental Health Research: An evaluation of the 
significance of the literature on normal individuals who have 
been exposed to extreme environments. 

This project will provide baseline data on effects of short- 
term isolation from the usual levels of stimulation. Since 
the work is essentially exploratory, we will be in a better 
position to evaluate its significance after satisfactory 
apparatus allows better experiments. 

This work may allow us to more sharply distinguish between 
I the effects on a normal person of purely voluntary isolation 

from physical stimuli and that of the involuntary isolation 
, experienced by the mentally ill person; no systematic exami- 
I nation of such effects has yet been made; it may be that 

certain experiences in these circumstances are fundamental 
and characteristic for both the normal and the mentally ill 
person--the major differences may be due to attitudinal 
variables only. If so, the results may add to our basic 
understanding of causal factors in mental illness. 

A truly surprising amount of interest has been aroused 
in scientific and non-scientific circles over the reports 
on this project. During this year interest has been expressed 
in this project by two groups, one is the submarine warfare 
' group with the Navy and the other is the "Far Side" project 

group of the U S. Air Force who are interested from the stand- 
point: (1) isolation of a man in a space ship, (2) the effect of 
weightlessness upon his mental functions. Several laboratories 
have expressed enough interest to warrant their starting similar 
projects: University of Utah, Mayo Clinic, Holloman Air Force 
Base, Fort Ord (Human Resources Board). 

Proposed Course of Project: 1. To foster the development of 
a new tank more suitable for these experiments. 

2. Continue the search of the literature. 

3. To collect data from more subjects. 

4. To continue to reduce the stimuli. 

art B included Yes x No 



- 9 



Serial No. M-D- (C) 3 

page 4 
PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part B: Honors, Awards, and Publications 

Publications other than abstracts from this project: 

Lilly, John C Some thoughts on brain-mind, and on restraint 
and isolation of mentally healthy subjects. (Comments on 
"Biological Roots of Psychiatry" by Clemens E. Benda) 
J. of the Phila. Psychiatric Hospital, 2:16-20, 1957. 



10 - 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Clinical Investigations 
Adult Psychiatry Branch 



BUDGET SHEET 



Estimated Obligations for FY 1958 
Total: $757,^10 
Direct: $170,065 

Reimbursements: $587,3^5 



Projects included: M-AP(C) 1 through M.AP(C) 12 



1 



Serial No. M-AP(C)- i 
1. Adult Psychiatry Branch 

a, 

3. Bethesda^ Maryland 



PHS-MH 

Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: The Study and Treatment of Schizophrenia 
as a S^mily Problem 

Principal Investigator: Murray Bowen, M. D. 

Other Investigators 5 Robert Dysinger, M. Doj, Warren Mo Brodey, M. D., 

Betty Basaaaania, M.SoW. 

Cooperating Units: None 

Man Years (calendax year 1957 ): Patient Days (calendar year 1957): 

Total: k 2^950 days 

Professional: 3 
Other: 1 

Project Description: 

The project was started 38 months agOo The first two years there 
were major changes in the hypothesis aad in the treatment approach to 
schizophrenia. This is the first year there has not been a major change 
to include in the axsnual rsport. To staraBarize briefly^ the first year 
was devoted to the study of mother® smd patients » The second yes^ was 
devoted to the study of fsaailies with fathers ;, to a redefinition of the 
hypothesis, sod to effort® to develop a psychotherapy of the family as 
a unit. The third year went to refinement of the psychotherapy and an 
effort to define some of tha concepts and to write about experiences 
that had been hurriedly pagssd over in the emotional turmoil of the first 
two years. When the project was starfesdj, there was no previous litera- 
ttire or experience to use as a gaide., There was am intellecttiaL convic- 
tion that this area could be profitable. The only blueprint, for an 
operation that would make it possible for noraaal family members to con- 
tinue to live in the high anxie^ aad for staff to work with the pro- 
jectp was a theoretical anticipation of probleiiES along the -m^ and some 
ideas about possible solutions o Maajy deeisioas that affected the entire 
coTirse were fortuitous ones to deal with the emotional emergency of the 
moment. Such was the decision to pat the entire family together into a 
family tmit p^ch©th@rapy» Originally conceived as an emergency Measure 
to control uncontrolled ©motion, it opened up a n©w area of observations, 
techniques a^id cos^cepts. 



- 11 - 



Serial No» M"AP|'C)~l page 2 
Project Description ( continued); 

Objective ; 

The immediate research objective is to attempt to define in more 
detail some of the mauj promising clinical findings that were by-passed 
in the emotional emergency of the early stages » The therapy objective 
is further development and refinement of family unit psychotherapy. A 
therapy objective to reach a more predictable and efficient means of 
therapy is a crucial part of the project. 

Method ; 

Small complete family gro^ips which include at least father, mother 
and schisophrenic patient are hospitalized. The hospital setting permits 
around the clock observation of the family group. The daily family-staff 
group meetings serve as a means of fort&er cheek emd understanding of the 
emotional processes within the group, of the emotional conflict between 
staff and families^ of the e2E,oti03ml process i^thin the family, and as a 
means of psychotherapeutic comzsKtaication to the family. An inpatient 
operation is much more difficult to operate than an outpatient operation 
but the added information and observation is considered essential. On 
the other hand, there is evidence that outpatient psychotheraj^ caa be 
more productive thae in the inpatieat operation. Several outpatient 
studies have been carried out in order to observe variations and refine- 
ments in family psychotherapy. It is possible to try such variations 
as the use of one therapist with one or more families i or two or more 
therapists with one or more families. 

Patient Ifeterial; 

Four family groups participated in the 1957 operation. The first 
was a mother and datighter connected with the project since November 195^ • 
They lived together on the ward into May 1957 at which time they were dis- 
charged from the project. They now live at the family home in another 
state. The second was a mother and daughter who lived constantly on the 
ward from November 195^;) until discharged to outpatient status on 
October 7, 1957- They live in a nearby city. The third was a family of 
father, mother, patient, and normal siisling admitted in December 1955 and 
still active in the project. The normal sibling has been away at school 
most of the year. The family is currently disrupted by the mother's 
3 month "business leave" to their home in another state. The fourth is 
a father, mother, patient, normal sibling family admitted in Atigust I956. 
The family group has been present the entire year except for the normal 
sibling's absence at school for six months. This family may terminate 
project participation January 1, 1958. An outpatient family of father, 
mother, and psychotic teen age daughter have been seen as outpatients 
since early November 1957 • The four inpatient families axe the same 
referred to in the I956 report. 

- 12 - 



Serial NOo M"AP(C)-1 page 3 
Project Description: (continued) 

It is expected that 2 new inpatient families will be admitted by- 
December 1957^ that new families will be admitted as vacancies occur 
in the ward, and that some outpatient families may be started in I958. 

Major Findings ; 

1. The clinical facts reported in the 1956 annual report, which coxild 
be classed as Intrafamily Reaction Patterns are still as prominent and 
pertinent as a year ago. These are part of many such observations awaiting 
more careful definition and incorporation into papers. There is a new 
series of observations to suggest that the psychotic symptom in the patient 
is an outward escpression of a regressed impulse in a parent. 

2. A new class of prominent clinical findings might be classed as 
"Family Group Reaction Patterns". The families all present a group picture 
of helplessness and inadequacy. They deal with many life problems as bur- 
dens to be endured rather than problems to be solved. Therapeutic emphasis 
is directed at this helplessness. When either parent is able to become 
active in solving such a problem, the emotional adjustment of the entire 
family changes. The schizophrenic patients have responded favorably to 
actions by parents that popular concept would call traranatic. This sug- 
gests that it is not traumatic action bpt passive lack of action that is 
incapacitating to patients. 

Significance to Mental Health Research; 

It may be that the broader perception of psychological processes pro- 
vided when the family is seen as a unit, may be a major contribution from 
this project. A medical orientation to help the patient places the fact 
of a parent's activities in regard to the patient in a completely different 
perspective than when the orientation is toward helping the family unit. 
When the project staff is able to achieve a family unit orientation, the 
investigator has the experience of observing what appears to be a new 
psychological phenomenon. If it is possible to clarify some of the pro- 
fusion of clinical facts observable from this perspective, this might be- 
come the basis for a different view of inteirpersonal processes. 

Proposed Course of Project; 

1. Complete the evaluation and organization of data already secured. 

2. Continue the inpatient operation with 3 to 4 complete small families 
using the same theoretical orientation and treatment approach as 

a year ago. 

3. Build up an outpatient sejrvice for variation and development of 
therapy techniques and to coaiplement the inpatient service. 

k. Maie an effort to define and conceptualize some of the major 

clinical findings by-passed in the effort to establish the project. 

5. Seek help from other disciplines in the further effort to concep- 
ttialize and validate findings. 



Part B included; Yes 



13 



Serial Noo M°AP(C)°l page k 



PHS-NIH 
Individual Project Report 

Calendar Year 1957 

Part B: Honors^ Awaxds^ and Riblications 

Publications other than abstracts from this projects Hone 

Honors and Awards relating to this projects 

1. "Study and Treatment of Five Hospitalised Family Groups each with a 
Psychotic Member", Invitation to present paper about project to 
Section on Intrafamily Relationships o 

2o "Family Participation in Schizophrenia", Murray Bowen^ M. !>„, Invitation 
to speak to Psychiatric Staffs Phipps Clinic, Johns Hopkins University, 
Baltimore^ March 12^ 1957" 

3« "A Psychological, Formulation of Schizophrenia"'^ Murray Bowen^ M. D.^ 
Invitation to speak at a panel discussion on the Etiology of Sehizo- 
phrenia., American Psychiatric Association^, Chicago,, Illinois_, May 15^ 
1957 o This has been elaborated iEto a chapter of a ■book, "St'odies in 
Schizophrenia" t<3 be published in the Spring of 1958. 

h. "Family Participation in Schizophrenia" j, Murray Bowen, M. Do, Presented 
at the Meeting of the Ameritsaa Psychiatric Association, Chicago^ Illinois, 
May 15, 1957. 

5. "The Action Dialogue" in an Intense Relationship; A Study of a Schizo- 

phrenic Girl and her Mother", Robert Dysinger, M. D., Presented at the 
Meeting of the American Psychiatric Association^ Chicago, Illinois, 
May 15, 1957. 

6. Invitation to speak at the Zurich Conference = not accepted. 

7. "Schi3£ophrenia and the Family", Murray Bowen, M. D,, Invitation to 

present paper about project at lowa-Kebraska Psychiatric Meeting, 
University of Iowa, Iowa City, Iowa-, October 26, 1957. 

8. "A Working Approach to Schizophrenia and the Family", Murray Bowen, M. D., 
Invitation to present paper on working research concepts at a research 
seminar, Yale University, New Haven, Connecticut, October 31p 1957. 

9. Group for the Advamcement of Psychiatry, Family Committee, Murray Bowen, M. D., 
April 5j 6, 7, 1957. Invitation to meet with Family Committee. 

November 7, 8, 9, 10, 1957, Murray Bowea, M. D., Invitation to become per- 
manent member GAP Family Committee <. 



14 



Serial No. M-AP(C)-2 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: Investigation of the Character Structxire 
in the Alcoholic Patient 

Principal Investigator: Murray Bowen, M. D. 

Other Investigators: None 

Cooperating Units: None 

Man Years (calendar year 1957): Patient Days (calendar year 1957): 

Total: 120 hours 
Professional: 120 hours 
Other: None 

Project Description: 

This is a detailed psychotherapeutic study of addictive character 
(alcohol and drug addiction) patients. Five patients have been studied 
in about six years. 

Objective : 

Treatment of the addictive patient with a modification of psychoanalytic 
technique and a study of the character structure of the patient as revealed 
in the transference relationship. 

Method: 

Psychotherapeutic treatment using a specific modification of technique 
based on psychoanalytic theory. The addictive personality is seen as one of 
the clearest examples of fixation at the oral passive stage of psychosexual 
development. According to the theory, the relationships of a child at this 
age centers about the child in the oral receiving role ajid the parent in the 
oral giving role. In experience it is very difficult to get a workable trans- 
ference relationship with addictive patients. The modification in technique 
involves an oral giving attitude on the part of the therapist and the symbolic 
oral giving of the therapeutic hour to the point of establishment of a workable 
transference which is then resolved in the usual way. 

Patient Material : 

One patient is currently in the study. She was dischaxged to outpatient 
status in July 1957. 



15 



Serial No. M-AP(C)-2 page 2 

Project Description (continued): 

Major Findings : 

Treatment goes satisfactorily both in terms of treatment response and 
in terms of content material. Indications are that much of the perverse 
sexuality content is a defense against oral passivity. 

Significemce to Mental HeaJLth Research : >^ •^■^•' 

It is hoped that this study may eventually maie some contribution to 
understanding the relationship of orsJ. passivity to other very infantile 
clinical problems. 

Proposed Course of Project ; 

Continue with this one patient and make a report at the termination of 
her treatment. It is proposed to keep the side interest in this problem 
for its contribution in the understanding of the oral passive component in 
schizophrenia and other infantile character problems. 



.yvJLi Hj. 



Part B Included: No 



- 16 - 



Serial Wo. M-AF(C)-3 

lo Adult Psychiatry Branch 

2. 

3. Bethesda^ Maryland 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Fart A. 



Project Title : A S'budy of Clinical and Experimental DepersonsQ-ization : 
The Effects of Psychotomimetic Drugs on Psychological Processes 

Principal lD.vestigator : Charles Savage ;, M»Do 

Other Investigators: Juliana Day, M.D. 

Cooperating Units; Margaret Toohey, Research Assistant? Nursing Personnel 
on Ward S-West 

Man Years (calendar year 1957 )s Patient Days (calendar year 1957)-° 

Total? .5 

Professional ; .2 500 

Other; .3 

Project Description; 

Objectives ; 

To stu(Sy artificially induced psychoses and delineate their 
relation to schizophrenic processes and depersonalization^ and 
their effect on th'S therapeutic process., 

Methods En i pl oyed; 

Psychotomimetic agents such as LSD, mescaline, are given to 
patients in psychotherapy and to voliinteer subjects. Their verbal 
prccaictions before., daring, and after are recorded, compared and 

analysed o 

M a.jor Findings; 

A. 1957--Praliminsry trial with one psj'-chotomimetic agent 
produced an effect more similar to a natural psychosis by creating 
a disturbance of thought processes with relatively little visual 
disturbaiic© in contrast to the effects of LSD and mescaline . 

B. Data collected from 1955 to 1957 on a single patient in 
intsnsix>-a individusJ. therapy who received LSD and reserpine and 



- 17 - 



Serial Wo. M-AP(c)-3 page 2 



Majoi- Findings (eoatinued); 



other dr\igs over a long period of time ajialyzed for their effects on 
psychotherapy. Findings: Under the influence of LSD the memories of 
childhood experiences sind emotions which came to the fore were fre- 
quently too highly charged to be effectively dealt with in psychotherapy. 

Significance to Mental Health ; 

A. Drugs which are psychotomimetic are useful adjuncts to the study 
of natiiral psychoses. 

B. The value of LSD in psychotherapy still remains debatable. 

Proposed Course of Project ; 

Further review of data from study "B" with a view to publication. 
Paper to be concerned with the psychodynamic effects of both LSD and 
reserpine in the long-term intensive psychotherapy of a single patient. 



Part B included Yes / X / No / / 



18 



Serial No. M-.AP(C)-3 page 



Part B ; Honors, Awards, and Publications 

Publications other than abstracts from this project; 



Honors and Awards relating to this project: 

"lysergic Acid Diethylamide and Schizophrenia, " by Charles 
Savage, M.D. Presented by Dr. Savage at the Association ox 
Former Internes and Residents of Freedmens Hospital, June 6, 
1957. 



- 19 - 



PHS»NIH 
Individual Pi'oject Report 
Calendar Year 1957 



Serial Wo, M-AP(g)-^ 

1. Adult Psychiatry Branch 

3. Eethes'iaj Jferylajad 



Part A. 



Project Title: A Study of Tranquilising Drugs; The Effects of a Tran- 
quiliaing Drug on Psychodynsmic and Social Process 

Principal Investigator: Charles Savage., M«D. 

Other Irr/estigators : J\iliana Day^ M.D.^ lyman. G« Mtynxxs, McD.^ 
Leslie Schaffer^ M.D., and Harold A. Greeterg, M.D. 

Cooperating Units: Margavet L. Toohey, Research Assistants Nursing 
Personnel on Ward 3-West 



Man Yeaxs (calendar year 1957): 



Total: 


1.5 


Professional : 


.8 


Other: 


.7 



Patient Ds,ys (calendar year 1957): 
1725 



Project Description: 

Objectives : 

An intensive study to assess the effe-st of tra^i^uilizing drugs 
on the therapeutic process. 

Methods Employed ; 

A. 1955-56. Four regressed patients who had been studied and 
treated intensively for a year's time -jjlthout tranquilizing drugs 
were selected. They had all px'oven x'esistgixtt to psychotherapy and 
intensive nursing cai'e. Their daily livingj, their relations with 
others and the resection to the therapist a]J. hs3. haA carefxil 
scrutiny. Gross behavioral observations were recorded as well as 
i-atings. Contpsi'ison of therapy vrith asid without resei-pine were 
Double blind controls were used. 



B. 1956-57. A fifth patient ■\irs.s ar^Aad to this study who, in 
contrast^ was a borderline neurotic^ who '(ms highly verbal and active 
in psychotherapy. This patient '3 therapy had been under observation 
for over a year 'vTith a S3.ngle therapist ;, in pasri with LSD (see project 
on psychotciEDlnistic drugs ) . T?f70 period:^ of reserpine administration 
with differing doss^e we:«?e alternated with periods of placebos and 



20 



Serial KOo M-AP(c)-4 page 2: 



Methods Employed (continued); 



phenoTDarbital administration. Control periods vithout reserpine were 
increased over the earlier study frcm two weeks to a month as previous 
findings indicated a long lag in reserpine effect. 

C« 1957° Two of the patients in study "A" were given clinical 
trials with ehlorpromazine and with Trilafon. 

Major Findings ; 

Further study of data from "A"; With reserpine, patients were more 
friendly and less preoccupied and showed greater self-control and social 
conformity. Delusional material was less frequently expressed in waking 
life and appeared in dreams. Individual psychotherapy was a more agree- 
able collaboration but sensitive topics were still avoided. Reserpine 
had a dramatic effect in a therapeutic milieu affecting favorably not only 
the patient but the patient- staff interactions. It did not facilitate 
psychotherapy within this sample of patients. Its effect did not last 
after reserpine was discontinued stnd could also be reversed by severe 
environmental stress. 

Findings from study "B": Analysis of behavior charts and psycho- 
therapeutic interviews showed no significant beneficial shift during 
reserpine periods. In this patient there was an increased preoccupation 
with the need for mothering and support during the period of reserpine 
administration. The patient's periods of greatest curiosity and re- 
sponsibility were when no drug was administered. 

From study "C"; The clinical trial with ehlorpromazine was for 
too short a period to dracw conclusions and was replaced by Trilafon 
because of ehlorpromazine 's undesirable side effects. Neither patient 
showed striking changes with Trilafon, one showed little or no behavioral 
change, the other, who had had Parkinsonism with reserpine had no such 
effect with Trilafon. On maximum doses of Trilafon she was less anxious 
and more self- controlled than when on no drug. 

Significance to Mental Health; 

Both studies "A" and "B" are limited by number of patients and by 
diagnostic category and conclusions must be viewed with caution. In the 
first study reserpine aids in increasing the psychotic 's self-control 
and social conformity and in both studies reserpine appears to strengthen 
the patient's repression of conflict, but apparently not facilitate 
psychotherapy. 



- 21 



Serial No. M°AP(c)-^ page 3 



Proposed Course of Project: 



Further review of data from study "B" with a view to publication. 
Paper to be concerned with the psychody^namic effects of both LSD and 
resei'pine in the long-term intensive psychotherapy of a single patient. 



Part B included Yes [^TJ No l~~~f 



- 22 



I 



Serial No. M-AP(c)2^+__pageJ+ 

Part B ; Honors, Avraxds, and Publications 

Publications other than abstracts from this project: 

Savage, C. and Day, J., "The Effects of Reserpine on 
Psychodynamic and Sociail Processes . " Presented by 
Dr. Savage in May 1957 at the Annual Meeting of the 
APA. Accepted for publication in the A.M. A. Archives 
of Neurology and Psychiatry. 



Honors and awards relating to this project: 



- 23 - 

ikljll: 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Serial No. M-AP(C)-5 
1. Adult Psychiatry Branch 
2. 
3. Bethesda, Maryland 



Part A. 



Total: 


1.15 


Professional : 


.75 


Other: 


.h 



Project Title : Problems of Psychoanalytic Research with Schizophrenics 

Principal InvestigatCT? : Charles Savage, M.D. 

Other Investigators: Juliana Day, M.D., Harold A. Greenberg, M.D., 
Leslie Schaffer, M.D., Jordan Scher, M.D., layman C. Wynne, M.D., 
Stewart Perry 

Cooperating Units: Nursing Personnel of 3-West 

Man Years (calendar year 1957) •' Patient Days (calendar year 1957): 



1000 



Project Description: 
Objectives ; 

1. To study alterations in psychoanalytic technique which 
are iarposed by the research setting. 

2. To study the application of psyehoanaljrfcic techniques 
to the therapy of schizophrenics. 

3. To study the emotional problems of the therapist brought 
about by the intensity of the psychotherapeutic relationship with 
the schizophrenic. 

Ifethods Employed : 

Tape recordings of psychoanalytic therapy, staff review and 
discussions of recordings. 

Patient Material : 

Hospitalized schizophrenics. 

Maj or Findings ; 

The transference psychosis which develops in the course of the 
analysis of hospitalized schizophrenics tends to become diffuse and 



Zk - 



Serial No. M-AP(c)-5 ps^e 2 



Major Findings (continued): 



projected to other members of the staff, and thus converted into a 
formidable resistance. If the staff responds to the transference 
distortions as realities, the patient loses the opportunity to learn 
the nat\are of the distortion and to develop more appropriate patterns 
of reactivity. Close cooperation of the analyst with the rest of the 
staff is essential to the handling of the diffusion of transference. 

Customary focus in psychotherapy is on the problems of the schizo- 
phrenic patient. Yet equaJ. attention should be paid to the problems of 
the analyst who is treating him. The analyst's understanding of his own 
countertransference to his schizophrenic patient leads to an iinderstanding 
of the patient's productions in analysis and the ability to respond to 
them appropriately. By identifying with the patient, the analyst is able 
to understand and communicate with the patient. This process of identifi- 
cation is fraught with anxiety because the analyst experiences the patient's 
problems as his own and the anxiety associated with them. In addition, the 
very fact of conducting analysis in a research hospital complicates the 
transference picture and renders difficult the adherence to a rigid psycho- 
anaJyiJic technique. 

Significance to Mental Health ; 

Psychoanalytically oriented therapy is regarded as a major research 
tool for the understanding of the schizophrenic process. That which en- 
hances our capacity to use these techniques effectively has both research 
and therapeutic application. 

Proposed Course of Project ; 

Because Dr. Savage has departed for a year's leave of absence, his 
focal interest in this area of inquiry will be missing, but attention 
to these problems will continue as part of several projects, especially 
the studies of the family relations of schizophrenics. 



Part B included Yes /IT/ No / 7 



25 - 



Serial No. M°AP(c)-3i page 3 

Part B ; Honors^ Awards and Publications 

Publications other than abstracts from, this project: 

Savage, C, "The Diffusion of the Transference -Psychos is 
in the Treatment of Schizophrenia. " Accepted for publi- 
cation in Psychiatry^ 1957 • 



Honors and Awards relating to this project: 

Savage, C, "Parazneters and Interminable Analysis." 
Presented at the American Psychoanalyi^ic Association 
Meeting in Chicago, Illinois, May 195?. 

Savage, C, 'Ifethodology . " Presented at the Annual 
Meeting St. Elizabeths Hospital, May h, 1957. 

Savage, C, "The Problems of the Analyst in the 
Psychotherapy of Schisophrenia . " Presented at the 
Second International Congress in Psychiatry, Zurich, 
Switzerland, September 1957 • 

Savage, C, 'tProblems of Class ic8.1 Analysis in the 
Treatment of Schizophrenia. " Clinical paper for the 
Washington Psychoanalytic Institute. To be presented 
at the Moiint Sion Hospital in San Stsrancisco in December 
1957^ San Francisco, California. 



- 26 - 



Serial No. M°AP(c)-6 

1, Mult Psychiatiy Ba^aaefe 

2. 

3. Bethesda, Jfesyland 



PES=NIH 
IDadividual Project Report 
Calendar Yeai- 195t" 



Part A. 



Project Title: Family Relations in Schizophrenia 

Principal lanrsstigator : Igrmsm Go "■^Tme, M.D.j Jijliaaa Dsgr, M.D.., 
Leslie Schaffer^, M.D,, and Stanley Hirseh, M.S.W. 

Other Investigators: Harold Greenbex'-g, M.D., Kursiag Personnel on Ward 

3 West, Morris B. Parloff, Ph.D., Joseph H, Haffidlon, Ph.D., Donald S. 
Boomer, Ph.D., Marvin Waldasaa, Ha.D., Morris Rosenherg, Ph.D., 
Leonard I. Peaxlin, Ph.D.j I. M. Ryckoff, M.D., Gonsultamt. 

Cooperating Units: The methods aad conceptualization of this project acrs 
different from those of aay other PHS project. The general subject 
matter, family relationshixjs of schizophrenics, is similar to project 

M-AP(C)-1, which, howeTsr, solely uses group methods to sttiSy the 
families that generally live on the ward. The present project differs 
"by its use of dat^ from indi-^iduaJ. faadly members as well as ob serra- 
tion of interaction among the family meaibers. As each project develops 
further, it is probable that the eliiaisal material and hypotheses frcan 
ea^h will ccm^lement one another so that caj!^a5:'atiYe discussion showld 
be increasiagly fruitfal. 

OBie of the families being st^2.di@d in this project is also involved 
in project M=-^)-5l in the present st'ddy, this family has been considered 
intensively from the stisadpoiat of the dynseuics of the family os-ganisa- 
tion as a whole, partierjd.aa'2^ in relation to the general hypotheses of 
this project. 

Man Years (calendar yeaj? 1957): Patient D@^b (eeJLendas' year 1957): 

Total: 3.0 

Professional: 2.25 lk6o 

Other: .75 

Project Iteseription: 

Ob jectJTes ; This project is parfc of a long-range program of which 
the central goal is to examine the part that the family setting 
has in the genesis, form, and course of schizophrenic illness, 
!Riis reseas-ch has progressed from intensive pilot studies of a 
small number of fasEilies of schizophrenics to the fommlation 



- 27 - 



Serial Ko. M-AP(c)-6 page 2 

Objectives (continued) ; 

of a series of preliminaiv hypabbeses, which, in turn, have stinm- 
lated ciirrent planning of further eE^irical research that will 
include a critical evaliiation, modification, and esqjansion of these 
hypotheses « 

Ifethods Employed ; 

(1) Data collection . Data was collected "by tape-recorded 
psychiatric interviews with the patient, pa:rents and other sig- 
nificaat relatives and friends. This included intensive psycho- 
therapy with the patient, and interviews with parents TAich 
centered on their participation in the therapy of the patient 
and which sometimes eventuated in psychotherapy. Collated data 
was collected frcsn ward administrator and nursing personnel re- 
garding interaction of the patient with ward personnel and of the 
parents with the ward staff and with the patient. 

(2) Analysis of Data . Chief methods of analyzing the data used 
ttnis far include the use of the psychoanalytic viewpoint to examine 
the dynamics of the individ\ial relationships, and modified role 
theory as hasis for analyzisag the family system of interrelationships. 

Patient IJateria l; 

Patient material has consisted thus far of young recently ill 
schizophrenics with both parents available for outpatient interviews. 
Five families have been st-adied thus far. 

Total to Date 

number of Patients 7 

(Hospitalized) 
Number of parents 9 

(Oat-Patiants) 

Major Findiags; 

The starting point in the series of hypotheses now formulated was 
an examination of the qaality of interpersonal relations in the faaiilies 
of certain schizophrenics. According to this conceptualization, the 
acknowledged relations in these families in the prre-psyehotic phase have 
a quality of intense and endurijag pseudo-jjutuality. Pseudo-asutaelity 
involves a sense of relation which hiisges upon fitting in with what are 
assumed to be the expectations of othersj inversely, the sense of rela- 
tion is exE<erieneed as possible only by excluding recognition of azs^ 
divergence from this fitting together, or coarj^leiasntarity, of reciprocal 
expectations . 



28 - 



Serial No. M-ig(c) °6 page 3 



Ma j or Fteaiags ( c ont inued ) ; 



Pseudo=inut'a£il conrplemeiitazs'ity is contrasted with mutual and non- 
mutual forms of ccmplementa3.'ity. !Eiis differentiation involves a new 
extension of role theory which was a 'by-product of this work. 

In the families of cer-baln schizophrenics, it is hypothesized 
pseudo-mutuality takes an especially intense and enduring form in 
which the family memlsera strive for a sense of relation "by trying to 
fit into the family role struetare. The social oi'ganization in these 
families is shaped by a pervasive familial subeulture of myths, legends, 
and iSeologs,'' which stress the dis-e consequences of evenly recognized 
divergence frcaa a relatively limited number of fixed, engulfing family 
roles. 

The shared, familial effox'ts to exclude from open recognition any 
evidences of non-ccarplementarity within the pseudo-matoal relation 
become group mechanisms that help perpetuate the pseiido-mutuality. 
la the families of schisophrenics these mechanisms act at a primitive 
level in preventing the articulation and selection of any meanings that 
might enable the indixd-dual family member to differentiate himself from 
the family role structure. 

It is hypothesized that the resultant patteiTis of interpersonal 
perception and coairoanicstion, after haviiag become a part of the 
offspring's personality structure, ixr^olve a kind of fragmentation 
and confusion of esqserience and thought which is a central feature of 
schizophrenia . 

Furfcher, it is hypothesised that different family members will 
occupy diffe2*ent positions or roles within the family social organiza- 
tion, le.9ding to differing consequences for the personality development 
of the offspring. This hypothesis has been confirmed by a detailed 
examination of very extensive material on a family in which the off- 
spring are monozygotic quadEorgilet schizophrenics. 

Significa nce to Mental Health Research; 

Severely aisturbed family reD^tdons have been coxisistently found 
in the background of schisophrenic: x»sacti<Dns, Q]his is a very iiEportant 
lead being examined in this project, par-&ieularly in tei'ias of three 
major unsettled problSiass (l) the particular characteristics cxf such 
familial disturbance in schiscpbreniai (2) the degree of specificity 
that various aspects of such distuj^bance may have for schizophrenia, 
or varieties of schizophi'enis, cDaipared to the generality of other 
aspects of family distur'banee which may also occur normally or in other 
disorders J (3) the question of whether the family disturbance is a pri- 
mary factor in the iSBvelopmeiit of schizophrenia ox a secondary consequence 
of the individual's patholDgj"'. 



29 - 



Serial No. M"AP(C)-6 page k 



Proposed Course of Project ; 



Having eonrpleted a phase of exploration of the clinical problem and 
the formulation of preliminary hypotheses, it is now planned to proceed 
with a major shift and e^qoansion of this project, along three main lines: 

(1) Coanparisons of the family relations of schizqphreaics with non- 
schizophrenics (a) initially in a time-limited (several months) pilot 
study with hospitalized neurotic patients and their outpatient families, 
(b) later, in studies of normal families, families of medical patients 
of other Institutes, and families of various neurotic subgroups, varied 
by diagnosis, social class, and faznily constellation. 

(2) After an initial pilot congorison study with neurotics, extension 
of the range of observations for the families of schizophrenics both in 
terms of such variables as social class and family constellation, but also 
in terms of the variety of schizophrenia and type of onset. The question 
of differential effects upon schizophrenic and non- schizophrenic siblings 
is especially important in family studies. 

(3) Extension of techniques for specifying meaningful features of 
both the individual psychopathology and its family setting, by trying 
out a variety of approaches such as group therapy with an entire family, 
including the patient; quasi- experimental group situations for the analysis 
of inteirpersonal communication patterns within families (see project 
M-P-P-(c)-9), analysis of the place of the family in the wider ciilture 

and society, and improved techniques for comparing those behavior patterns 
found in intra-f amilial interaction with those carried over into psycho- 
therapy and the wai'd setting. 

These changes necessa:-:ily involve other prospective changes: an 
enlarged patient and family sample, at first with hospitalized patients, 
later with others as well; a marked incirease in interdisciplinary 
collaboration; a reorganization of the wajrd clinical operation. 



Part B included Yes £YJ No /~~7 



- 30 



Serial Wo. M°AP(c)-6 p age 5 

Part B ; Honors, Awax-ds, and Publications 

Publications other than abstracts from this project: 

V^mne, L.C., Ryckoff, loM., Day, J., and Hii'sch, S.I., 
"Pseudo-Mituality in the Family Relations of Schizophrenics," 
Accepted for publication in Psychiatry . 

Eyckoff, I.M,, Day, J., and Vftmne, L.C., 'family Role 
Structure and Schizophrenia. " Presented at the Annual 
Jfeeting of the Saint Elizabeth's Medical Society, 
Washington, D. C, May 1957 and accepted for publication 
as a chapter in book reporting proceedings of this ineeting. 



Honors and Awards relating to this project: 

Wynne, L.C., Day, J,, Hirsch, S.I., and Ryckoff, I.M., 
'family Relations of Schizophrenics: Some Working hypotheses." 
Presented in a synrposium on "OSie Family Emrironment of Schizo- 
phrenic Patients, " chaired by J. Delay, Second International 
Congress for Psychiatry, Zurich, Switzerland, September *»-, 1957- 

\^rnne, L.C., Day, J., Hirsch, S,I., and Ryckoff, I.M., 
"The Family Relations of a Set of Schizophrenic Monozygotic 
Quadruplets . " Presented at Second International Congress 
for Psychiatry, Zurich, Switzerland, September 2, 1957j and 
at a Research Seminar, Department of Psychiatry, Yale 
University School of Medicine, December 3f 1957 • 



„ 31 



PHS-NIH 
Individizal Project Report 
Calendax Year 1957 



Serial Ko. M-AF(C)--7 

1. Adult Psychiatry Branch 
■ 2. 

3. Bethesda, Maryland 



Part A. 



Project Title: Perceptual Impairsnent in Psychogejaic Mental Disorder 

Principal Investigator: lyman C. Wynne, M.D. 

Other Investigators: Leslie H. Farber, M.D. and Irving M. Eyckoff, M.D. 

Cooperating Units: None 

Man Years (calendar year 1957): Patient Days (calendar year 1957) i 

a?otal: .2 

Professional: .1 
Other : .1 

Project Description: 

Objectives ; 

(1) To delineate the quality of an imaginative inrpairjment in 
certain neurotic and psychotic patients in their ability to perceive 
content and create meaning. (Following general usage, perception 
includes, in addition to the processes of conduction and sensation, 
the process in which a person attributes significance or msaning to 
a stimulus situation,) 

(2) To examine and evaluate some of the iinplications for 
personality functioning and for psychotherapeutic processes arising 
frcm this inipairnent . More specifically, to study the details of 
the imaginative isrpairment associated with difficulties in reading, 
arithmetic, and social skills, especially, hew such difficulties 
relate to the development of anxiety, to past learning failiire, and 
to the manner or style in which an individual brings about a sense 
of relatedness to others. 

Methods Employed : 

Research interviews were conducted with psychiatric patients 
and "normal" subjects, focusing on the measoixigs with these patients 
perceived with a variety of subject matter, media, and situations. 
Some of these interviews have dealt with the person's interpretation 
of particular passages which he has read, of television prograais 
and movies and of recorded material which is played over a speaker. 



- 32 " 



Serial No. M-AP(C)-7 page 2 

Methods En^loyed (continued) ; 

Others have dealt with the person's problems in dealing with common 
arithmetic problems and the use of maps^ as occxirring both in his 
ordinary life and in the interview situation. A session was conducted 
of a mother coaching her children with their reading. All of these 
interviews have been tape recorded and transcribed. Several have now 
been observed through a one-way mirror and partially photographed with 
sound film. Subsequently, the movies have been shown to one of the 
patients and her interpretation of her own appearance discussed in a 
further interview. Four of the patients have been also seen in psycho- 
analytic psychotherapy, so that information from this source covild be 
added to the research interviews. 

Patient Material ; 

TVo inpatients (continued as outpatients in 1957) sn.6. two private 
patients of Drs. Farber and Ryckoff . Tao "normal" mothers and their 
children (not patients). 

Major Findings ; 

(1) A description has been derived of the quality of an unex- 
pectedly extensive incapacity of these patients to perceive and deal 
with content, both in and out of the psychotherapeutic situation. 
Such massive difficulties with content may be overlooked vinless 
specific inquiry is made in which the patient's stylistic devices 

do not succeed in disguising the failure to derive meaning 
imaginatively . 

(2) In the usual situation of psychotherapy, the extent of the 
patient's capacity to perceive content may be obscvire. The therapist 
is apt to believe the patient's diffictilty in dealixig with content 
arises from anxiety, instead of consi&SPing the aaxiety as ai'ising 
from an inability to distinguish content. In this project data are 
being examined which strongly suggest that an impaired capacity to 
perceive, understand, and communicate commonly exists independent of 
the Impairment produced by ongoing defenses against anxiety, and fre- 
quently leads to rather than results from, anxiety. One area of 
fxinctioning in which this diffictilty is especially prominent is in 
reading difficulties of both adults and children. 

(3) Wot only does transference and relationship influence per- 
ceptiveness, but also, and to a greater degree, perceptiveness 
determines what can go into relationships. A narrow or inflexible 
perceptual style will markedly interfere with the development of 
mutuality in relationships. 



33 - 



Serial Ko. 



tfeijor Findings (continued) ; 

(k) The form whicti the imaginative irngpairment takes depends greatly 
upon the characteristics of individual essperiences in learning situations. 
The quality of perceptiveness and ccamnunication is markedly impaired in 
each psychiatric disorder and will vary in quality depending upon both 
the general characteristics of the disorder and the specific character- 
istics of the individual personality. 

Significance to Mental Health Research ; 

It is believed that the meehaaisms being studied in detail in this 
project plays a signifieaat part in the learning failures widely reported 
in schools and by parents today^ especially upon reading. In present-day 
psychiatric theory anxiety is widely regarded as the central problem in 
psychogenic mental disorders. Any evidence which challenges or calls for 
a modification of this viewpoint clesrly is relevant to a great deal of 
current thinking about the nature of these disorders and their treatment. 
This work is an exploration of neglected dimensions in psychiatric theory. 

Proposed Course of Project ; 

Current activity in this project is b®ing directed toward review of 
past research data and writing of the material in a series of short 
papers each focused on a particular aspect of the work. One such paper 
was presented by Dr. Wynne in discussion at a meeting of the Washington 
Psychoanalybic Society, February 1957 • It is expected that this review 
and writing process will contintae through at least six months of the 
ccaning year. During the discussion of the material for this p'orpose 
new ideas have been emerging which it is planned to examine in farther 
research after the writing has been done. 



Part B included Yes A°~7 No /" '^7 



3^ - 



Serial No, M-AP(c)-8 
1. Adult Psychiatry Branch 
2. 
3. Bethesda, Maryland 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: Linguistic Study of Emotional Expression 

Principal Investigator: Allen T. Dittmann, Ph.D. 

Other Investigators: lyman C. Vtynne, M.D. 

Cooperating Units: Laboratory of Psychology 

Man Years (calendar year 1957): Patient Days (calendar year 1957): 

Total: .1 

Professional: .1 
Other: 

Project Description: 

See Individual Project Report, laboratory of Psychology, Serial No. 
M-P-C-(C)-1^. 



- 35 - 



Serial Uo. M-/\?(c)"9 

1. Ad-alt Psychiatry Branch, 

2. 

3. Bethesda^ tJaryland 



PHS-i^HH 
Xxidividiial Project Report 
Calendar Year 1957 



Part A. 



Project Title : Social Mobility and the Milieu of the Psychiatric Hospital 

Principal Investigator: Leslie Schaffex", M.D. and Leila Calhoun Beasy^ Ph.D. 

Other Investigators j ITone 

Cooperating Units: Laboratory of Socio-environmental Studies 

Lfen Years (calendar year 1957) = Patient Days (calendar year 1957): 

KTone 



Total: 


.h 


Professional : 


.2 


Other : 


,2 



Project Description: 

Objectives : 

Tiie study is an atteiJipt to explore the relevance and implica- 
tions of some theoretical vrork "by Harold Lasswell concerning social 
structure and social mobility - particularly his notion that there 
is a significant negative relationship between the e::tent to which 
a group achieves solidarity and high morale and the incidence of 
mobility siaong its members « It is hoped to clarify in theoretical 
terras a ps-rticular perspective concez-ning the value context of the 
psychiatric hospital and, in particular ;, some of the r^roblens con- 
cerning respect 8,s a value. Among other questions one is whether 
tliere is a significant difference between the incidence and intensit;/' 
of vertical mobility in a psychiatric setting as coropared with con- 
ventional medical and svirgical settings. 

Methods Employed : 

A preliminary snxvey of professional, and other personnel in 
lilMH. and tv?o other Institutes has been followed up by the collec- 
tion of additional, data in (a) a private psychoana].j'"fcic hospital 
and (b) a university department of psychiatry « In addition, the 
superintendents of two other hospitals have agreed to allow us to 
gather data in their institutions. Data from a random sejrtple of 
1_,0S7 iBsdical students has been secured throtJigh the cooperation of 
KORC who have promised us access to the original protocols. 



JO 



Serial No. M-AP(c)-9 page 2 



Major Findings : 



Statistical analysis of the preli^nlna.ry date has shown a well-marked 
gradient of achieved vei*tlcal mobilii^ across the professions studied. 
The highest degree of vertical mohilitv occiirs in the newer professions 
adjacent to psychiatry — i.e.j, psychology and the social sciences j the 
least mobile popuj,£.tioa is found in physicians in internal, medicine. 
Psychiatrists fall midnfay hetrreen these two groups. The further data 
referred to above is in the process of being collected, coded and trans- 
lated on to IBM cards. 

Significance to Mental Health Research; 

It is suggested that some staff csiaflicts, both ijx rtssearch and in 
clinical psychiatric settings may be explained in terms of vertical 
social mobility in the pa:rbieipants . The notion has long been held that 
the provision of respect for the patient in a mental hospital is a crucial 
ingredient in a therapeutic milieu. It has also repeatedly been suggested 
that all Mnds of collaborative efforts may be expected to flourish in an 
atmosphere of mutual respect. It has been suggested in this study that in 
hvunan groups which are characterised by the pssjriicipatlon of highly upwardly 
mobile persons the value of respect is ioipl^.citly conceived as a competitive 
valxie and one that is likely to be in decidedly short supply. 

Proposed Course of Project ; 

(1) To continue to code and sneJ^yze additionad data, 

(2) Clarification of the theor.'y. Ixl a sense this study may be under- 
stood as an effort to explore the utility of a theoretical perspective 
elaborated by Lass^^ell and Kapl^in for the s^imdj^ of politica3. events. 

(3) An abstract concer-T-ing sorsB aspects of the \-^ark has been sub- 
mitted for the 1958 Ann'j£il Meeting of the Americas, Psychiatric Association. 



Part B included Yds fXl JIo 



37 _ 



Seri^a NOo M-iff(C)-c 



Part B ; Honors, Mexds^ and Publications 

Publications other than abstracts from this project: 



Honors and Awards relating to this project: 

Scha£fer, L. and Deasy^ L C.^ "Deference j, Social Mobility 
axid Conflict in Psychiatric Settings, " Presented at the 
Section on the Sociology of Science, itoericsn Sociological 
Society, August 1957^ and also in a lecture given at the 
V. A. Hospitaly Salt lalc® City 3, Utah, September 1957. M 
esjpanded version of this paper is presently in preparation 
for publication. 



- 3i 



Serial No. M-AP(c)-10 

1, Adult Psychiatiy Branch 
2. 

3. Bethesda, iVfea-yland 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: Psychiatric Research in a Clinical Setting: Integrating 
Research and TreatiBsnt in the Role of the Clinical Investigator 

Principal Investigator: Stewart E. Perry 

Other Investigators: I^nnan C. Wynne, M.D. 

Coc^rating Units: Laboratory of Socio^environmental Steadies 

Msai Years (calendar year 1957 )s Patient Days (calendar year 1957): 

Total: .2 

Professional: .2 None 

Other: 

Project Description: 

See Individual Project Report^, Laboratory of Socio-environmental 
Studies;, Serial No. M-S-T(C)-7. 



- 39 = 



Serial KOo M~ig(C )-ll 

1. Mult Psychiatry Braxtch 

2. 

3. Bethesda,, Jferyland 



PHS-OTH 
Individual Project Report 
Calendar Yean' 1957 



Part A. 



Project Titl© ; Selected Aspects of the Social Staract-iir® of a Clinical 
Research Program in the Mental Health Field: Pro"bleJBS Posed hy the 
Variety of Roles Built into the Social Strueture 

Principal Ijwestigator : Stewart E. Perry 

Other Investigators: None 

Cooperating Units: Child Research Branch 

tfatn Years (calendai' year 1957)5 Patient Days (calendar year 1957): 

Total: 1/6 

Professional: l/6 kO 

Other: 

Project Description: 

Objectives ; 

To explore the consequences for a clinical research progrsan 
of the variety of roles which characterize itj special en^hasis 
win be placed on examining the prohlems of integrating the various 

administrative J research;, and clinical roles and statuses. 

Methods Bnployed : 

Participant observation in a psychiatric research programi 
interviews with staff xaembersj recording of group conferences, 
search of extant riscords and xHgmoranday rigsearch and clinical; 
and review of li^terature in XDsdical sociolo^ and the sociology 
of knowledge and science. 

Major Findings : 

Preliminary iss^ressions include the following probiesas as 
consequences of the role variety in psychiatric clinical research 
programs: (l) Basre often appears to be a discrepancy between the 
hamaa relations techniques earphasised in administrative roles and 
those effi^hs^sized in psychotherapeutic roles==for exanrplej, psycho-- 
therapeutic roles enjshasiz.® techniques of indirection in the 



40 



Serial KOo M-AP(c)-ll p age 2. 



Major Findings (continued) ; 



e:q)ression of views to another, while administrative techniques enrphasize 
directive expression of viexfs, (2) There seems to be some discrepancy 
between the pattern of integration of non-ioedical roles in a conventional 
hospital organization and the pattern of integration of such roles in a 
research (iteration— for exaagjle, in some instances functions performed by 
doctors assy be transferred to non-doctors (e.g.j, nurses, scientists, etc.) 
and statuses ordinarily reserved to the doctor may also be occupied by 
non-medical personnel. (3) Differences in the definitions of science, 
method, and Imowledge in psychiatry appear to be related to role differ- 
ences and to engender problems in scientific ccsmmmication— for exaaiple, 
soane research techniques are derogated or valued in relation to the staff 
member's role, {h) The staff member's interpretation of crises in the 
patient's hospitalisation — such as suicidal attezapts, acute onset of 
muteness, etc. — tends to vary with his role and function. 

Significance to tfental Health Research ; 

This project explores the operational difficulties which are inherent 
in psychiatric research, treatment, aad adiainistration. Insofar as such 
difficulties can be isolated and specified, it is possible that steps 
be talsen to minimize their interference with organizational goals in 
mental health work. 

Proposed Course of Project ; 

Mditioaal exploratory work is planned for the purpose of formu- 
lating more explicit hypotheses and theories. 



Part B included Yes /~~7 No fTJ 



- kl ~ 



iliifl 



Serial No„ M-AP(C)-12 
1. Adult Ps;5)'«hiatry Bra^ich 
2. 
3. Bethesda, Maryland 



PHS-HIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: The Natural History of a Hospital Case Presentation 

Principal Investigator: Stewart Ea Perry 

Other Investigators: Hone 

Cooperating Units: None 

Man Yesxs (calendar year 1957): Patient Days (calendar year 1957) 

Total : 1/6 

Professional: I/6 None 

Other: 

Project Description: 

Objectives : 

Taking as a starting point a hospital case presentation of a 
psychiatric patient^, to describe the social context of the theory 
of behavior explicit and implicit in the case presentation; to 
note the potential influences of this social context upon the 
theoryi to note the social control in^lieations of the theoretical 
perspective on patient behavior which is held hj -ward staff j to 
explore the influence on patient behavior of this theoretical per- 
spective and of the social organization of the ward. 

tethods Employed : 

Participant observation of the case cojaferences and in the 
general psychiatric research program^ interviews with psychiatric 
workers who hsA contact with the subject patient j search of extant 
records on the patient,, 

?fe,jor Findings : 

This case stvidy indicated the following general conclusions: 
(1) Intellectual products (such as research reports) in a human 
behavior research progrsm may be systesaatieally s^budied as items 
of social, behavior themselves, (2) A theory of patient behavior, 
explained psychodynamically, may offer clues to the hospital 



42 - 



Serial Wo. M-AP(g)-12 page 



Major Findings (continued) : 



social organization within which the patient is treated. (3) Responses 
of personnel to a research theory may also provide clues to the hospital 
organization, (i)-) As a 'by-product of the study, it appeared ths/fc a re- 
view of psychiatric theory would indicate a need for explicit development 
of propositions about the social control of patient behavior. 

Significance to Mental Health Research ; 

Psychiatric theories^ lUse all theories in social sciencsj, evolve 
in a social context which may influence their development and their 
applicability; as such the theories may implicitly as well as explicitly 
describe the social structure of psychiatric treatment. To explore such 
influences and in^lieit descriptions is to add a further dimension to 
the explanation of patient behavior. 

Proposed Course of Project ; 

This project has been terminated with the publication of a paper 
reporting findings in detail. 



Part B included Yes /IT/ Ko /"" / 



1^3 - 



Serial No, M-ig(c)-12 page 3 

Part B ; Honors^ Awards, and Publications 

Publications other than abstracts from this project: 

Perry, Stewart E. and Shea, Gertrude K., "Social Controls 
and Psychiatric Theory in a Ward Setting, " Psychiatry , 20 : 
221-21^7 (1957). __ 



Honors and Awards relating to this project: 



hh 



i 



NATIONAL INSTITUTE OF MENTAL HEAI.TH 



Clinical Investigations 
Child Research Branch 



BUDGET SHEET 



?gtipiated oUi^Mti-ong fgr,,FT, 1S'?S 

Total: $J^3,863 
Direct: $179,939 

Reimbur s ement s : $263 , 92^ 



Projects included: ]y^CR(C) 1 through M-CR(C) 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Serial No. M-CR(C)-1 

1. Child Research Branch 

2. 

3. Bethesda, Maryland 



'art A. 



Project Title: Milieu Therapy 

Principal Investigators: F. Redl, Ph. D., J. Noshpitz, M.D. 

Other Investigators: C. Faegre, B.A., S. Crawfort, M.S.W., E. Citrin, M.S.W. 
J. Vernick, M.S. W., E. Maeda, O.T.R. 



Patient Days (calendar year 1957) 
850 



Cooperating Units: None 

Man Years (calendar year 1957): 
Total: 5 1/2 

Professional: 3 
Other: 2 1/2 

Project Description: 

Objectives : 

Over-all Goal : To subject the various facets of milieu to an intensive 
as well as extensive scrutiny as to their properties and nature, and to 
arrive at a breakdown of this global concept into manageable and yet clini- 
cally relevant subunits. To study the precise impact of the subunits as 
well as the structure of the whole on the child patients as well as on the 
staff, to arrive at criteria for assessment of the specific psychological 
ingredients of milieu parts for the purpose of clinical prescription as 
well as prediction of milieu effects. 

Sub-Tasks ; Concept formation--creation of workable constructs for the 
differentiation of clinically relevant variables involved in milieu-effects, 
theory formation related to the impact of milieu-findings on the model of 
personality. 

Pharmacopaea of games and other child-patient activities--so as to 
create a useable manual for the prediction of their effects, and describe 
the variations of ingredients necessary for their adaptation to a variety 
of different pathologies and of different phases in treatment. 

Analysis of all other milieu-aspects that can be clearly distinguished 
as variables in their own right, so as to make them more accessible to the 
process of therapeutic manipulation and to arrive at safer criteria for 
prediction of effects. 

Methods Employed ; 

(1) With the aim of preparing for a pharmacopaea of activity ingredients 
as well as of other milieu variables, a thorough analysis is being made of the 
records of actual in-game behavior of the child patients over an extended 



- 45 - 



Part A. M-CRCO-l, page 2 

period and during different phases of their therapeutic development. En- 
vironmental stimuli involved in sub-facets of any given program or activ- 
ity unit are being analysed as to their nature and potential effect on the 
children;, and this is then compared with the actual events recorded by 
staff o On the basis of this analysis materials are being prepared relating 
to indications and eounter-indications in the selection of program activ- 
ities as well as for the choice of methods and techniques. 

(2) The assessment of social structure, institutional atmosphere and 
distribution of staff roles as well as impact of staff behavior and atti- 
tudes is being pursued by a variety of methods simultaneously. The ac- 
cumulation of sharply focused and detail-rich descriptions of actual situa- 
tions of interaction of children and staff under varying circumstances, 
will still have to constitute the major method employed^ since this field 
is as yet so poor in actual naturalistic and well described data. In 
isolated areas more rigorous methods are being employed on sub phases which 
lend themselves to such techniques, as for instances Critical Incident 
technique, controlled observations by trained investigators, Ossorio-Leary 
system of behavioral observation^ and others. On isolated hypotheses 
systematic analyses of historical materials and records on special inci- 
dents are pursued-^such as, for instance, an analysis of the relationship 
between incidents reported on the child patients, and staffing patterns 

at the time of the incident^ etc. 

(3) Data from other studies are being used to define and clarify in- 
formation on the impact of various aspects of the milieu on various facets 

of behavior. For example, CR-4 deals in part with the effects of school 
milieu factors on school performance, CR=5 is concerned in part with 
milieu effects (times space^ props, etc.) on the technique, strategy, and 

results of Life Space Interviews^ CR-6 studies the effects of various 

settings on interpersonal behavior and changes in such behavior. 

Findings ; 

This is a long range project, and major findings on the nature of the 
milieu ©oncept and its clinical facets cannot be expected to emerge as yet. 

However s among the part-findings one could trace in the process of on- 
going research the following may be listed; 



It is possible to isolate about 13-15 distinct and relatively 

indepemdently researchable subunits of the milieu which seem to be at work 
in the produetiom of behavioral impacts on the children under study. 



At least 7 quite distinct meanings are customarily invoked when 
the adjective "therapeutic" is attached to the milieu concept, each one 
of" them relevant in its own right, but in need of sharp separation for 

the utilisation in an organized research approach. 



A considerable list of properties of games, materials, props, 
tools involved in activities such as arts and crafts, etc., can be well 
isolated as of clinically distinct importance, and the therapeutic 
variation of these factors can be described to a considerable amount of 

^ h6 = 



'art A , M-CR(C)-1, page 3 

detail o Effects of some techniques of employing such activities and of 
handling child behavior during the process can be distinctly seen as dif- 
fering in their effect on the children from others, so that the ground- 
work for a more organized pharmacopaea mentioned as one of oxuc objectives, 
can be seen to emerge „ Such factors isolated by now can be described 
in sufficient detail and with sufficient precision to make them teachable 
to others and approachable in sharper research design in later studies. 



Techniques for the clinically geared observation of surface be- 
havior on the spot can be developed and sharpened up so that they avoid 
the traditional gap between observable surface data on the one, and depth- 
psychological dynamics on the other hand more successfully than has been 
possible in the past„ 

(5) A milieu design which is well adapted to meet the children's 
problems in the earlier phases of their pathology, may, by this very fact, 
become detrimental or at least non-supportive toward later phases of re- 
covery and on the move toward fuller mental health. The differences be- 
tween the clinical characteristics of a social structure on a hospital 
ward as compared to that of a family style setting can be described with 
somewhat more detail though a really thorough analysis of residential 
versus institutional versus family style milieu design will have to wait 
for further data and explorations. Beginnings of such comparative data be- 
came possible with the move of 6 of Our child patients from the Ward into 
the newly created Residence building, and through a trial run on a group of 
normal controls in that residence before the child patients were moved in. 

Patient Material ; Nb. Average Stay (Days) 

Children 6 365 

7 75 

10 25 

Major Findings ; 

This project is exploratory at present. 

Significance to NIMH Research ; 

The worthwhileness of this project lies in the fact that the clinical 
techniques of residential therapy for use with hyper aggressive children are 
as yet in a developmental phase in the field of child psychiatry. The 
current clinical design in a number of respects is unique within the field. 

Proposed Course of the Project ; 

This project will continue indefinitely as part of the program of the 
Laboratory with new areas being developed as time permits. The addition 
of a "Halfway House" outside the Clinical Center has already broadened the 
scope to include less disturbed children and later phases of treatment. 

Part B included Yes X No 



Serial No M-CR(C)-1, page 4 
PHS-NIH 
Individual Project Report 
Calendar Year 1957 

Part B; Honors, Awards, and Publications 

Publications other than abstracts from this project: 

Bloch, D. A., & Silber, E. The Role of the Administrator in Relation to 
Individual Psychotherapy in a Residential Treatment Setting. American 
Journal of Orthopsychiatry . Vol. 27, No. 1, 69-74, January, 1957. 



Honors and Awards relating to this project: 



48 - 



Serial No. M"CR(C)-2 

1 . Child Research Branch 
PHS-NIH 2o 

Individual Project Report 3. Bethesda, Maryland 
Calendar Year 1957 



Part A« 



Project Title: Studies in Psychopathology of the Hyperaggressive Child 

Principal Investigators: J. Noshpitz^ Mo Dos Bo Sweet, Ph„D. 

Other Investigators; Ho Raushg PhoDo, Ho Kitchener, MoSoWo, H. Perry^ AoB= 
Po Spielmanj MoD.j So Berman, MoDo, Ro Lourie, Mo Do 

Cooperating Units : None 

Man Years (calendar year 1957): Patient Days (calendar year 1957): 

4 650 



Professional: 2 1/2 
Oth®r 11/2 

Project Description: 

Objectives ; 

To synthesize clinical and research observations made over a long 
period in such a way as to formulate hypotheses about the etiology;, 
personality assets and psychopath© logy of hyperaggressive children o 
Special attention is directed toward the testing of a hypothesis that a 
specific group of child patients £,■ currently included under the label of 
borderline cases actually constitute a nosological entity in its own 
right and differ significantly from patients of the disease entities 
which they are usually listed as being borderline tOo 

Methods Employed ; 

lo Historical material from parents, schools^ physicians, courtSj 
social agencies J, is being organised systematically toward a full de- 
velopmental description,, 

2o Material from nursing, psychotherapy, schools social service, 
life space interview notes^ and results from special researches are being 
organised and collated with each other and with biographical material ^ 
for each child. 

Patient Material : 



Children 



No^ 


Average Sta. 


6 


365 


7 


75 


10 


25 


6 


6 



= k9 



Part Ao Serial No, M-CR(C)-2, page;!' 



Only tentative findings can be reported at this timej since data collec- 
tion on the later phases of the children's individual therapy, their behavior 
in the residences as well as in public school, is still in process. However, 
temporary summarization has been accomplished on the material available up to 
the present on two of the cases, and clinical studies are in process for the 
other fouro These studies are directed toward a synthesizing of data gained 
in psychotherapy as well as in the other aspects of the research project, such 
as previous history, school, ward and residence behavior, and so forth. Among 
the tentative findings the following have emerged with eoough clarity to be 
reported at this point; 

(1) Kyperaggressive children form a pathology which combines aspects 
from childhood neuroses and psychoses to constitute a special syndrome. Al- 
though individual children differ in aspects of this syndrome, in all cases 
there are profound ego disturbances centering around problems of impulse 
controls and particularly around the control of aggression. The ego distur- 
bances are reflected in conceptual lacks, learning diff iculties, disturbances 
in conceptions of space and time, low tolerance for frustration, hyperdis tract' 
ibility by environmental props, readiness for contagion, paranoid-like suspi- 
ciousness and projections. Despite these features, the children being studied 
here differ in many features from psychotic children as described in the literat 
ture. In particular, they do not show the autistic behavior and fantasies of 
the latter, they are generally in communication with the environments and 
under special circumstances they show marked ego-=intactnessc 

(2) In all cases oral themes seem to play a major part in the under- 
lying fantasies of these children. The children se«m to interpret experi- 
ences via orally incorporative or destructive modes. Even material that 
seems initially to be predominantly phallic in tone, can be readily seen 

as a developmental phenomenon super-imposed on a rfauBsdation of primary oral 
concerns . , 

(3) Related to the abovej, one finds in these children intense anxiety over 
the possibility of dependency, and intense defenses erected against both 
behavioral and fantasy expressions of dependency. With progress these 
defenses seem to diminish both in behavior and in fantasy productions. 

(4) All of the children show severe problems in the formation of a 
sense of identity » These problems seem related to the absence of or 
failure of- figures who might serve as transmitters of cultural or subcul- 
tural values. In all cases there is absence of a father, failure of the 
father to fulfill a role ChaL might provide a source for social identifica- 
tion, or inadequacy of the father as communicated to the child through the 
mother's perceptions. With all children the opportunity for establishing any 
relationship (even an anti=social one) with a social order seemed lacking „ 

Significance to NIMH Research ; 

Although a few detailed clinical case studies of individual children 
exist in the literature, this Laboratory's facilities permit comparative 

- 50 = 



1^ 

II 



Part A. Serial No. M-CR(C)-2,page 3 

study o£ six similar children and hopefully may clarify some of the common 
elements seen in the personality disturbance of these children. 

Proposed Course of the Project ; 

(1) Continuation of data collection of the present patient group in 
the residence setting, and follow up data gathering after their return home 
or their placement, 

(2) Gathering of similar data-^but with methods improved by our 
previous experienee--on the new inpatients on 4 East, and comparison of 
findings on a larger number of child patients followed through several 
phases of their treatment. 



Fart B included Yes X No, 



~ 51 - 



Serial No,, M=CR(C)-2j page 4 

PHS-NIH 
Individual Project Report 
Calendar Year 1957 

Part B: Honors, AwardSj and Publications 

Publications other than abstracts from this project: 

Siegels L. Case Study of a 13-Year Old Fire-Setter: A Catalyst in the 
Growing-Pains of a New Residential Treatment Unit. American Journal 
of Orthopsychiatry j, Vol, 27 , No, 2, 396-410, ^ril, 1957, 



Honors and Awards relating to this project; 



- 52 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Serial No. M=CRCC)-3 

1 c Child Research Branch 

2. 

3c Bethesda 



Part A. 



Project Title: Technical Problems in Individual Psychotherapy with 
Hyperaggressive Children « 

Principal Investigator: B. Sweet, Ph„D.s H. Kitchener, MoS.W. 

Investigators: Fo Redl, PhoD. ^ Bansanaj Ph. Do, S. Berman, M.D. 
Ro Louries M.D. 



erating Units: None 



Man Years (calendar year 1957): 
Total: 3 1/4 

Professional: 1 3/4 
Other: 11/2 



Patient Days (calendar year 1957) 
375 



Project Description: 

Objectives ; 

To define a variety of therapeutic principles and techniques which 
seem to be particularly Indicated for hyperaggressive children within 
the setting of intensive individual psychotherapy. To explore a variety 
of therapeutic issues which arise when psychotherapy is undertaken in 
conjunction with intensive residential treatment; these include choice 
of play materials at various stages of treatment, handling of trans- 
ference and counters-transference problems peculiar to this situation, 
the eliciting and utilization of fantasy material, the handling of 
¥arious forms of resistance, etc. Problems of locating and identifying 
transference phenomena in the life space and communicating them to the 
therapist will be explored. The types of transference phenomena 
observable at various stages of treatment are being recorded. 

Methods Employed; 

In the course of seeing six children three to four interviews per 
week for two or more years, experiences are recorded around specific 
issues. For example, during the past year experience has been gained 
in handling various forms of resistance to coming to the therapy play- 
room. This has included experimenting with various policies and roles 
(for therapist and for life space personnel) set up to deal with this 
resistance. 



Patient Material; 



Children 



No, 
6 



Average Stay (Days) 
365 



53 - 



Part A. M-CR(C)-3ipage 2 

Major Findings ; 

(1) Foremost among these is the broad observation that, contrary to 
beliefs popular in the field, individual psychotherapy with the hyper- 
aggressive child is more like than unlike psychotherapy with other cate- 
gories of disturbed children. As in all cases where ego development is 
weak or distorted, there is, especially in the early phases of treatment, 
greater necessity for the therapist to function as an auxiliary ego for 
the patient than is true in more classical neurotic cases; this, however, 
is no more than a difference in emphasis, since it is well known that 
child therapy always requires that the therapist play a partially educa- 
tional role more than does adult therapy, by virtue of the fact that no 
child's ego is fully formed. 

(2) A second impression is that the therapeutic process, while 
similar in course, is more prolonged than is the case with other kinds 
of children, 

(3) Third, while limit setting plays an important role in all child 
therapy, it becomes particularly significant in treating children whose 
most crucial problems lie in the area of control, fear of loss of control, 
and distrust of the adult's dependability and integrity in controlling 
both himself and the child. Since fear of seduction (in both the narrow 
sexual meaning and the broader sense of seduction to impulsivity of any 
kind) plays a major role in the psychodynamics of these children and 
seductive experiences often figure prominently in their history, it 
becomes a vital problem for the therapist to avoid confusing the wish 

to demonstrate his benevolent intent with seduction. Particularly in 
the earlier, more disorganized phase of therapy (which may be prolonged 
for many months and even a year or more), it may be a disquieting ex- 
perience for the therapist to find himself responded to as though he 
were a dangerously hostile figure, and it is easy to become unwittingly 
seductive in the effort to correct this projection. 

(4) Many counter -transference problems also have become apparent 
in this project. While the particular content of the counter -trans- 
ference will no doubt vary with the personality of each therapist, all 
those participating here have had to deal with feelings aroused by the 
need to meet such explosive barrages of raw destructiveness and with 
those aroused by the underlying oral demandingness of such children, 
whose own fantasy certainly seems to be one of eating up the therapist. 

(5) Impressions are beginning to emerge as to specific interpre- 
tive techniques. In the earliest phases of treatment, when these 
children communicate largely through gross motor behavior and acting 
out, it seems necessary to accompany the traditional resistance inter- 
pretations with fairly concrete behavioral responses to the child; it is 
as though actions speak loudly while words at best mean little or, at 
worst, signify oral sadistic attack to this kind of child. Later, as 
the child moves into a phase of more symbolic communication, the inter- 
pretations also seem to need to shift; at this phase communication seems 
best to be achieved by corresponding symbolic gestures on the part of 

- 5^ - 



Part A. M-CR(C)-3, page 3 

the therapists much as one answers a schizophrenic child's fantasy communi- 
cations within the framework of his own fantasy rather than by interpretive 
translation. It seems only to be in the more advanced phases of therapy, 
as the child becomes able to verbalize directly about himself, that the 
weight of the interpretive effort can be shifted to direct discussion of 
the child's problems and their origins and remain effective. While all 
three levels of communication are present throughout therapy, there does 
seem to be some difference in their relative usefulness at various phases. 

While it is premature to state findings about the effectiveness of 
therapy before it is completedj it is our impression thus far that psycho- 
therapy is possible with such children, at least within the context of 
residential treatment. Issues such as the use of the ward milieu 
(see CR(C)=1) and the use of the life space interview (see CR(C) -5) in 
handling problems of therapy and resistance to therapy within a residential 
setting are being investigated. If impressions as to the possibilities of 
psychotherapy with such children were to stand up with the passage of time 
it would be a most significant finding in view of the widespread doubt 
within the field. 

Significance to NIMH Research : 

Since these children are rather infrequently given prolonged intensive 
psychotherapy in the communityj exploratory observations of the type 
described above are indicated at this stage of our knowledge. Hopefullyj 
such experiences may be helpful to other clinicians who are beginning to 
treat delinquents with the recently developed community support. 

Proposed Course of the Project ; 

This area of inquiry is part of the on-going program of the 
Laboratory. 



Part B included Yes X No. 



55 



Serial No. M-CR(C)-3, page 4 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part B ; Honors, Awards, and Publications 

Publications other than abstracts from this project: 

Gordon, G., 6e Siegel, L. The Evolution of a Program of Individual 
Psychotherapy for Children with Aggressive Acting-Out Disorders in 
a New Residential Treatment Unit. American Journal of Ortnopsychiatry . 
Vol. 27, Noo 1, 59-68, January, 1957. 



Honors and Awards relating to this project; 



56 - 



PHS-WIH 
Individual Project Report 
Calendar Year 1957 



Serial No. M-CR(C)-4 

1. Child Research Branch 

3o Bethesda, Maryland 



Part A, 



Project Title; Studies in Learning Disabilities in Hyperaggressive Children 
Principal Investigator: R. Newman, Ph=D,, So Jacobson, M.A. 
Other Investigators: Jo Glaser, B.Ao, C. Faegre, B.Ao 
Cooperating Units: None 



Patient Days (calendar year 1957): 
537 



Man Years (calendar year 1957): 
Totals 2 1/2 

Professional: 2 
Other: 1/2 

Project Description: 

Objectives ; 

To investigate the nature of the learning disturbances of hyperag- 
gressive ehildren and to develop techniques for their assessment as well 

as for their cure. 

More specifically: To arrive at a sharper differential diagnosis 
between those disturbances of learning or school behavior which are 
intimately linked with the basic pathology of the children and those 
which are a secondary result of learning failure or behavioral learning 
resistances or motivational blocks. 

To isolate the variables that go into making a specific learning 
sit^iation eg© supportive enough so that motivation for learning can 
develop and learning process can unfold and to isolate those variables 
which can be expected to be toxic or at least non-supportive to the ego 

tasks involved in the learning process. 

To produce instruments as well as develop techniques which can 
be applied beyond the experimental setting and beyond the group of children 

on whom the study is being done. 

Methods Employed ; 

One of the studies focused especially on (1) the problems of moti- 
vating ehildreti to maintain interest in learning projects, (2) the 
type of play equipment and activity choice that is needed in relation to 
the degree of regression or developmental lag exhibited by the child, 

(3) the relationship of certain specific learning deficits which appear 

commonly in' the hyperaggressive childj such as inability or unwillingness 

to subtract, the fear of reading, etc., and other aspects of psychopathology. 



57 - 



Part A . M-CR(C)-4, page 2 

such as anxiety laden fantasies, etCo (4) To observe and explore the various 
intervention techniques needed in order to deal effectively with the child's 
problem in learning as well as with his behavioral manifestations during the 
learning process. 

Besides the actual experimentation carried on with our child patients in 
relation to above named objectives, various sources of records were used in 
measurements for school participation. School records, sampled over a period 
of 27 monthSj were rated on this measure, rater reliability being checked by 
use of judges not connected with NIMH. Changes in the school behavior of the 
six children were studied by comparing ratings for two halves of the sample 
by time. 

A modification of the Critical Incident Technique was used to develop 
categories of factors affecting school adjustment. School incidents for 
each child were classified into these categories, after rater reliability 
was checked. 

Clinical analyses were undertaken on the learning problems of each child, 
and on special sources of anxiety in both children and teaching staff with 
respect to the learning situation. 

With the new group of child patients on 4 East, methods utilized focus 
around the following: 

1„ Planned variations of school program to provide example-^ 

of behavior in different settings (individual, group; formal, in- 
formal); with different materials (verbal, manual -^manipulative, etc.) 
and different content. 

2. Participant and non-participant observation. 

3. Analysis of observations to isolate variables and to develop ! 
systematic methods of describing the variables. 

Patient Material ; 

No. Average Stay (Days) 
Children Male 6 365 

Children Male 7 75 

Major Findings ; 

1. A behavior Rating Scale, which can be used reliably in judging 
school incidents for adjustive behavior, was developed. 

2o Over the period of 27 months the children changed significantly 

in the direction of better school adjustment. 

3. Categories for describing clinical factors accounting for school 
behavior and behavioral change were developed, and it was demonstrated 
that they could be used reliably in judging school incidents. The clinical I 
factors in the learning situation can be subsumed under three major 

categories: 

- 58 - ! 



Part A. M-CR(C)=4, page 3 

1. Self (self picture; inner pressures and forces; infantile 
needs and frustrations) 

2= Relationships (to adults; to peers) 

3. School (subject matter, methods^ material; teacher personality) 

Patient Material ; No . Average Stay (Days) 

Children Male 6 365 

Significance to NIMH Research ; 

1, The instruments developed here can be used in other studies of 
learning disturbances with other groups of children. 

1„ The juxtaposition of a therapeutic school program to intensive 
residential treatment and psychotherapy is perhaps unique in the field 
and presents unusual opportunities for sifting out those therapeutic 
issues which are best dealt with in school and those which are common to 

all three settings. 

Proposed Course of the Project ; 

Further investigation^ refinement, and broadening of these methods, 
their collation with other data from school and from other sources. 



Part B included Yes X No. 



59 - 



Serial No. M-CR(C)-'!i, page 4 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part B ; Honors, Awards, and Publications 
Publications other than abstracts from this project: 



Honors and Awards relating to this project: 

Newman, R, G. A Study of the Difficulties of Hyper-aggressive, Emotionally 
Disturbed Children in Adjusting to School and in Deriving Satisfying 
Learning Experiences from School. Ph.D. Thesis, University of Maryland, 
June, 1957. 



60 



Serial No. M-CR(C)-5 

lo Child Research Branch 
PHS-NIH 2, 

Individual Project Report 3. Bethesda 
Calendar Year 1957 



art A. 



Project Title: Studies in Life Space Interview Strategy and Techniques 

Principal Investigator: F. Redl, Ph.D., H, Kitchenerj MoS.W. 

Other Investigators: A.T. DittmanRj Ph.D., J. Noshpitz^ M.D., H.L.Raush, Pi^.D 
P.M. Spielman, M.D., J. Vernick, M.S.W, 

Cooperating Units: None 

Man Years (calendar year 1957): Patient Days (calendar year 1957); 

420 



Total 

Professional 

Other 


1 3/4 

1 1/4 

1/2 


Project Description: 




Ob|ectives: 





Psychiatric In-Patient treatment of children necessitates the use of 
interview techniques not only during specifically designed Therapy Sessions 
of the child with his doctor, it becomes important to add interviews carried 
on by other adults in the hospital or residential setting^ in high proximity 

to the events of the day. 

We designated this type of interview by the term Life Space Interview 
and approached our study of this technique with the following objectives 
in mind : 

(1) To explore the variety of situations that suggest the use of 
Life Space Interviewing as a therapeutic measure. 

(2) To subject the technical problems that emerge in this type of 
work to am orgarsized scrutiny as to the in^>act of the setting^ the issue, 
the objectives of a given interventiori, the specific pathology of the 

child as well as other factors in the surrounding milieu. 

(3) To collect well recorded illustrative samples for all those 
aspects from the sum total of life space interviews recordec^ and to 



Work toward a well documented technique of Life Space Interview- 
ing similar to the rigorous concept of technique that has been developed 
over the years in the more well known style of psychiatric interview 
therapy in the office setting. 

Methods employed ; 

Over 500 records of Life Space Interviews at varying phases of the 



- 61 



Part Ao M-CR(C)-5, page 2 

therapy of our child patients have been gathered. Some of these have been 
recorded post-sltuatlonally by the interviewer, others have been recorded 
by means of stimulated recall — the Interviewer reporting to a trained 
researcher following the episode. 

Through individual exploration and group discussion of these materials 
categories have been devised which shall be used as basis for the coding of 
Interview materials, and part of the material has been coded. 

Using Interview notes, a preliminary empirical analysis was made com- 
paring Interviewer techniques In Life Space Interviews with Interviewer 
techniques in Play Therapy Interviews. Interviewer techniques were coded 
Into 25 categories under seven major headings. 

Data collection as well as conceptual exploitation of the data so 
far gained for the development of a theory and technique of the Life Space 
Interview has been continued in both settings, the Ward as well as the 
Residence. 

Patient Material : No. Average Stay (Days) 

Children Male 7 ^5 

6 365 

Major Findings ; 

Miong the preliminary findings, presented at the National Conference 
for Orthopsychiatry in 1957 are the following: 

(1) The variety of purposes for which treatment staff uses Life 
Space Interview techniques can be ordered around the following sub-goals 
which seem to emerge most frequently in in-patient treatment of children 
with aggressive disturbances: 

A) Clinical Exploitation of Life Events, under which categories 
distinct from each other are temporarily singled out under the 
following labels: (1) reallty-rub-in, (2) symptom estrangement, 
(3) revltalizatlon of numb value areas, (4) new tool interpre- 
tation, (5) manipulation of the boundaries of the self. 

3) Emotional First Aid on the Spot with subcategories ten^orarily 
classified under the following code labels: (1) drain-off of 
frustration annoyance (2) communication maintenance in moments 
of relationship decay, (3) support for the management of panic, 
fury and guilt, (4) regulation of behavioral and social traffic, 
(5) umpire functions in decision crises and in cases of loaded 
transactions . 

(2) In terms of exploration of Criteria for the indications or counter- 
indications of holding Life Space Interviews in a given situation, and of 
the choice of a specific technique, the following 6 sub-categories of areas 
of major relevance have emerged: (1) central theme-relevance, (2) ego 
proximity and issue clarity, (3) role compatability, (4) mood manageability, 

(5) timing (6) iitpact of terrain and props. ... 

- 62 - 



A. M-CR(C)-5, page 3 

(3) On the basis of preliminary work a number of similarities were found 
between techniques employed by interviewer in Life Space and in Play Therapy 
Interviews. Among the differences in the techniques employed in the two types 
of interviews were the following: (I) as expected, play is used less frequently 
i)jt Life Space Interviewer r; (2) techniques of control were used more frequently 
by Life Space Interviewers; (3) while there were no differences in the amount 
or specific techniques of interpretation used in the two types of interviews, 
there were differences in the direction of interpretation: In Play Therapy 
Interviews interpretations were directed more frequently toward impulse, whereas 
in Life Space Interviews interpretatioms aimed relatively more frequently 
toward resistance and defense. 

All these findings are based on the first few years with our special 
group of child patients and in the earlier phases of their individual and 
milieu therapy , Expansion of data collection as well as concept-reformula- 
tion is of course contemplated bsfore more final conclusions can be drawn « 
The abundance of rather untraditional tkEminology for labelling our tempo- 
rary findings and categories must be understood out of the fact that this is 
quite a new field of exploration, and that more static technical terminology 
has not yet been developed o In part, it also constitutes the conviction on 
the side of the investigators that a premature forcing of newly emerging 
concepts into all too rigidly technical terms might lead into a premature 
theory-freeze which we are eager to avoid. 

Significance to NIMH Research ; 



life space interview is a relatively unexplored psychotherapeutic 
technique which holds considerable promise for future employment in treat- 
ment institutions if it can be further developed. 

Proposed Course of the Project : 

This is a continued project. 



Part B included Yes X No, 



63 = 



Serial No. M-CR(C)-5, page 4 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 

Part 6: Honors, Awards, and Publications 

Publications other than abstracts from this project: 

Redl, Fo Strategy and Techniques of the Life Space Interview. American 
Journal of Orthopsychiatry , (in press), 1957. 



Honors and Awards relating to this project: 



6k - 



Serial NOo M-CR(C)=6 

1 . Child Research Branch 
PHS-NIH 2, 

Individual Project Report 3. Bethesda, Maryland 
Calendar Year 1957 



Part Ao 



Project Title; Studies of Change in Hyperaggressive Children During the 
Course of Residential Treatment 

Principal Investigator: Ho RaMsh, PhoD 

Other Investigators: F, Redl, PhoD.s Bo Sweet, PhoD,, T. Taylor^ MoAo, 
Ao Dittmannj, PhcDo 

Cooperating Units? None 

Man Years (calendar year 1957): Patient Days (calendar Year 1957): 
Total: 2 1/2 170 

Professionals 1 1/2 
Other : 1 

Project Descriptions 

iectivess 



To develop concepts of improvement that are clinically relevant and 
sophistieatea, but go beyond the listing of dropped out pathology o We hope 
to arrive at descriptions of the functioning of the intact ego and of other 
personality characteristics commonly associated with a state of Mental Healtho 
We aim at descriptions as specific and as sharply focused as concepts for the 
description of pathology o 



To develop methods for the assessment of change in behavior 
patterns of children in a wide variety of aspects as well as settings and 
situations such as children would be expecfeed to be exposed to in in-patient 

residential therapy. 



To develop critssxa for the differentiation of change in general, 
as compared to the assessment of therapeutic movement as a result of exposure 
to treatment, and 



Assess the actual changes that occurred in these particular child 

patients during the various phases of their therapy o 



Existing recordings of all phases of the patient's therapy and 
life eaq^erieioices were studied and compared in order to find where traceable 

patterns of change can be seen to emerge. 

(2) A series of studies was undertaken with the special purpose of 
foeusing on various aspects of change: 

- 65 - 



Part A o M-CRCC)-6s page 2 

(a) Systematic observations in a variety of settings and coding 

of individual interactive behavior d«iring two treatment phases. 

(B) Systematis observations done on a control group of children, 
for age, IQs racSs so©io=®e0nomie status c 



Categorisation derived from detailed descriptions contained 
in clinical secords and case conference materials., 



Periodic interviews and collections of clinical incidents 
from Child Care Staff o 

(«) Eaqjloratory interviews with child care and therapy staff 
directed at staff's concept of ishange and improvement and matched 
with their actual statements about observed functioning of their 



Patient Material ; 

No^ Average Stay (Days) 

Children Male (patient) 6 365 

Children Male (control) 6 6 

Major Findings ; 



5s in behavior interaction patterns. From the investigation 
of two series of observations made a year and a half apart, the following 
major conclusions can be drawn; 

(a) The interpersonal behavior of the children has changed con- 
siderably in the course of treaiSmento 

(hi Over the period there is a decrease in inappropriate behavior 
toward peers » Most children show a trend toward more friendly peer 
relati©! 



(e) Changes in relations with adults are much more marked than 
(gh&nges in relations with peers o Hostility toward adults decreases 
considerably o Particularly, there is a decline in hostile^dominant 
beh&vior and an increase in friendly^passive behavior toward adultSj 
with a major increase in trusting;, dependent expressions., Inappro- 
priate behavior also decreases considerably. The distinetion between 
behavior toward peers and behavior toward adult® gets sharpened „ 



behavior that the children evoke from others shows 
corresponding changes. Children are less hostile than they were in 
response to a particular child. Adults show an increase in the pro- 
portion of friendly, giving, supportive behavior with the children. 

(e)- Different behavioral settings produce different qualities 

of interpersonal behavior o 

CI) There is an interaction between person and situation that goes 

^ 66 ^ 



Part A, M"CR(G)-6s, page 3 

beyond what either contribute independently to our ability to predict 

behavior o That is, although there are generalizations, settings also 
operate differentially for different children. 



The effects of settings differ in the two phases. Tenta- 
tively, it would seem that in the later phase of treatment the situa- 
tion comes to play a greater role as a determinant of behavior than 
it did previously o 



Changes in interpersonal behavior appear more readily in 
some settings than in others. 

(i) A paper on some of these findings was presented at national 
meetings and is in process of publication. Data analysis is near 
completion and another paper is being worked on. 

(2) Concepts of Improvement » 

(a) Formulations of a sharpened up and clinically relevant con- 
cept of improvement are undergoing continuous change as our study 
proceeds, and temporary findings are as yet too volatile to be 
reported this year. 



A siilot study for the collection of data on the staff's 
concept of improvement as related to our present child patients is 
in a state of partial completion. Preliminary impressions from the 
data indicated that the children have improved in a number of areas. 
Especially, hostile interactions between children have decreased 
and acceptance by the children of staff interventions has gone up. 
Other details about improvements are too varied from child to child 
or require too much background data to be summarized here. 

Significance to NIMH Research ; 

With some modification findings and methods should be applicable to 
other settings s Adult psychiatric in-patient settings^ school situationSj 
etc„ The area of change and -improvement is critical for psychiatric and 
psychological research in generals 

Propose d Goairse of Project; 

St ion aiad write-up. 



(2) Completion of coding and analysis of control data; further 

observations of patient grQ)ep in new residence. 

(3) Completion of p^er. 
Farther work toward development of categorization scheme. 



Part B included Yes No X 

„ 67 - 



Serial No. M-CR(C)-7 

1 . Child Research Branch 
PHS-NIH 2. 

Individual Project Report 3o Bethesda,, Maryland 
Calendar Year 1957 

Part A . 

Project Title: Interaction Patterns of Normal and Hyperaggressive Children 

Principal Investigator; Allen T. Dittmann, PhoD. (Psychology), 
D«Wo Goodrich, M«Do (Psychology) 

Other Investigators: None 

Cooperating Units: None 

Man Years (calendar year 1957): Patient Days (calendar year 1957): 

None None 

Project Description: 

Objectives ; 

(a) To develop methods of studying interaction patterns of children in a 

treatment wardo (b) to compare interaction patterns of normal and disturbed 

children in the same setting. 

Methods Employed ; 

Short sample observations were taken of groups of children in specific 
situations on the ward and in the field, situations selected for their con= 

duclveness to nurturing and limit-setting adult behavior. Observations 
were recorded on tape by intensive interviewing of the observer: the 
recordings form the basic data of the research. These protocols were coded 
for interactions between children and interactions involving children and 

adul ts . 

Patient Material ; No. Average Stay (Days) 

None this year. 

Major Findings ; 

Patterns of interaction of the two groups showed differences such as 
might be expected; Less inappropriate behaviorj less overt aggression 
among the normals, more real leadership; greater dependency based on 
trust toward adults. Adult behavior toward the children includes greater 
freedom with the normals in expressing affection setting limits, while 
with the disturbed children adults are more caution in their expressions. 

Significance to NIMH Research: 

The method can be used in descriptive studies where group differences 

- 68 - 



Part A, M-CR(C)-7, page 2 

are the focus., The method's disadvantages were clearly shovm by the ex" 
perienee of this study: Recalling everything that goes on with six 
children in even a very short observation is impossible, even with in- 
tensive interviewing of the observer. Since the data for this study were 
collected the observational method has been refined to get more complete 
information on one child in one observation, so that sequences of inter- 
action can be followed. See M-CR(C)-6, 

Proposed Course of Project ; 

A paper is in preparation. 



Part B included Yes No X 



„ 69 » 



Serial No, M-CR(C)-8 

1. Child Research Branch 

2, 

3. Bethesda, Maryland 



PHS-NIH 
Individual Project Report 
Calendar Ydar 1957 
Part A , 

Project Title; Research on Anger in Interpersonal Situations 

Principal Investigator; Do Kaplanj MoS«Wo (resigned 9/21/56)o 
DoWo Goodrichj MoDo (Psychology), 



Investigators; To Taylor, M,Aos F, Redl, PhoD. 

Cooperating Units : None 

Man Years (calendar year 1957); Patient Days (calendar year 1957): 

Nome None 

Project Description; 

Objectives ; 

To explore descriptive concepts for analysis of anger episodes in inter- 
personal situations within this residential treatment center ■ This study 
proposed to develop a theoretical model including categories to describe the 
various phases of an anger episode. 



Approximately 300 anger episodes have been collected by non-partici- 
pant and participant observers » A preliminary analysis of these has led 
to development of a model for the anger sequence in interpersonal situations. 

Patient Material; No, Average Stay (Days) 

None this year 

Major Fimdiifflgs ; 

With the aim of developing a schema for the analysis of provocative 
techniques used in anger episodes, some 50 incidents were examined in detail, 
and preliminary attempts at codings were made, A total of 15 over-all head" 
ings and 53 sufo=sategorie8 of provocative techniques were described, and 

examples were given. 

Significance to NIMH Research ; 

One of the major forms which symptomotology takes in hyper aggressive 
children is outbursts of aggression against others. By means of this study 

- 70 - 



Part_A^ M-CR(C)-8, page 2 

an important aspect of the psychopathology of many delinquent children may be 
clarified. 

Proposed Course of the Project ; 

A paper has been published and the project is discontinued. 



Part B included Yes X No. 



- 71 



Serial No. M-CR(C)-8,page 3 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part B ; Honors, Awards, and Publications 

Publications other than abstracts from this project: 

Kaplan, Do, & Goodrich;, GoWo A Formulation £or Interpersonal Anger, 
American Journal of Orthopsychiatry , Vol. 27, No. 2, 387-395, April, 1957 



Honors and Awards relating to this project; 



- ?2 - 



Serial No. M-CR(C)-9 

1. Child Research Branch 
PHS-NIH 2. 

Individual Project Report 3. Bethesda, Maryland 
Calendar Year 1957 

Part A. 

Project Title: Staff Values Concerning Therapeutic Interventions with 
Hyperaggressive Children. 

Principal Investigators: D. S. Boomer, Ph.D. (transferred to Laboratory of 
Psychology), D. W. Goodrich, M. D. (Psychology) 

Other Investigators: None 

Cooperating Units : None 

Man Years (calendar year 1957): Patient Days (calendar year 1957): 



Project Description: 

Objectives ; 

To survey the matrix of common assumptions and therapeutic values which 
underlie the therapeutic behavior of the staff of Children's Unit, NIMH. 
To formulate these generalizations in such a way as to maximize their use- 
fulness for research and training. 

Methods Employed ; 

The technique utilized was the so-called "critical incident" method. 
Each staff member was regularly interviewed by one of the investigators 
over a 3-month period, to elicit accounts of actual therapeutic inter- 
ventions with children, engaged in or witnessed by the staff member. The 
incidents thus collected were then categorized with regard to natural 
dimensions which emerged from the data. 

Patient Material : No. Average Stay (Days) 

None this year 

Major Findings : 

^proximately 240 critical incidents were collected and categorized. 
The final groupings are 38 in number, distributed among four superordi- 
nate headings : 

A. Promoting personality change by helping child to learn to view 
his own behavior evaluatively . 

B= Promoting ego growth. 

- 73 - 



Part A. M-CR(C)-9, page 2 

G. Supporting existing ego controls, 

D. Managing one's own conduct as a staff person. 

An interim report has been prepared presenting these categories 
together with a selection of critical incidents illustrative of each. 
A paper was presented at the American Orthopsychiatric Association. 

Significance to NIMH Research : 

(1) The clinical staff of the Children's Service has been furnished 
with our findings to make use of as they see fit, in research, or train- 
ing of new personnel . 

(2) Our method has been demonstrated, and shared with other NIMH 
investigators. This method, adapted from an industrial psychology 
tool, seems to be a useful way of formulating concepts concerning a 
complicated clinical operation. 

Proposed Course of the Project ; 

Publication of material. 



Part B included. Yes No X 



74 - 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Serial No. M-CR(C)-10 

1 . Child Research JBzanoh 

2. 

3. Bethesda, Maryland 



a t A. 

Project Title: A Study of behavior Reporting by Child Care Workers 
Principal Investigators: B. Iflund, Ph.D., D. W. Goodrich, M.D. (Psychology) 
Other Investigators: None 
Cooperating Units: None 



Man Years (calendar year 1957) 


Project Description: 



Patient Days (calendar year 1957); 




Objectives : 

To determine (1) the consensus of expectations by the staff concerning 
what should be included in the daily descriptive notes made by counselors 
on patients" overt behavior; (2) the extent to which such expectations 
are met subjectively; and (3) the extent to which these notes in reality 

actually achieve these expectations. 

Methods Employed : 

Eleven child care workers and twelve clinicians ranked seventeen 
categories of items whose frequency of occurrence in a large sample of 
behavior notes had actually been determined. Rankings were obtained 
which revealed the subjective judgment of the child care workers and 
clinicians concerning what is contained within the notes as well as 
rankings which reflect what would be most desirable to be in the notes. A 
comparison between what is expected and what is believed to be present was 
used as a measure of satisfaction or dissatisfaction. Since actual fre- 
quencies are also available one can determine further the extent of aware- 
ness of what is in the notes on the part of those reading them (the clini- 
cians) and those writing them (the child care workers). 



Patient Material : 



None this year 



No, 



Average Stay (Days) 



Tests of concordance within each group showed the ai^ount of agreement 
to be significant at better than the .01 level. Thus we are justified in 
considering the combined results of each group. 



75 - 



1 

Part A, M-CR(C)-10, page 2 

Correlations were determined between the following variables: Actual 
rank order of frequency, the clinician's "Ideal" order, child care workers' 
"ideal" order, clinicians' concept of what is in the notes, and child care 
workers' concept of what is in the notes. Eight of the ten correlations 
carried out were significant. 

Factor analysis of the above correlations yielded two factors which 
account for the major portion of the variance. One of the factors is 
defined by the clinician's ideal; the other factor by both what the 
clinicians and child care workers think is actually present. In reality 
the notes themselves have equal loadings of both factors. 

Significance to NIMH Research : 

The statistically significant results obtained seem to suggest that 
further studies of the perception of adults in this setting may be 
profitably carried out in relation to the behavior reports of the staff. 

Proposed Course of the Project : 

Publication of the paper 



Part B included Yes No X 



- 76 



NATIONAL INSTITUTE OF MENTjil HEALTH 



Clinical Investigations 
Laboratory of Psychology— Section of the Chief 



BUDGET SHEET 



Estimated O hiigations for Fy 19*^8 
Total: $250,971 
Direct: $110,9^1 

Reimbursements: $li»-0,030 



Projects included: M-P-C(C) 1 through M-P-C(C) 13 



Serial Wo. M-P-G-(c)-l 

1. Laboratory of Psychology 

2. Section of the Chief 

3 . Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: Administration of Laboratory of Psychology 

(a Joint Operation of the Clinical Investiga- 
tions and Basic Research Programs) 

Principal Investigator: David Shakow 

Other Investigators: None 

Cooperating Units : None 

Patient Days : none 



Man Years : 




Total : 


1.70 


Professional 


: .70 


Other : 


1.00 



Project Description: 

Objectives: A. To achieve an administrative structure which 
vill provide the optimum of communication with (l) Chief of 
the Laboratory;, (2) among members of a section, (3) within the 
Laboratory as a whole, (h) and with other investigators and 
units in NIMH and other Institutes ; and at the same time result 
in the' least interference with the objectives and time for 
research of individual investigators. 

B. To complete organization of Laboratory. 

Methods Employed: A. To achieve optimal administrative 
structure: Organization into a 'reasonable number of sections, 
conduct individual conferences with investigators, hold the 
minimal necessary number of meetings with individual section 
chiefs and with the group of Section Chiefs in the Laboratory 
as a whole. 

B. To complete the organization: Recruitment of 
additional personnel. 



- 77 



Serial JSo. M-P^C-(C)-1 
Page 2. 
Part A: Project Description (Cont'd) 

Major Findings : 

1. Personnel by Sections (Professional): 

Clinical Investigations Program 

Section of the Chief 

Shako-w, David (Chief) 

*Bergnian; Paul 

Dittmann, Allen 

Kendig, Isabelle 

Rosenthal^ David 
■5^ahn; Theodore 

Section on Child Development 
Bayley, Nancy (Chief) 
Bell, Richard Q. 
Gewirtz, Jacob L. 
Rheingold, Harriet 
Schaeferj Earl S. 

Section on Personality 

Parloff, Morris (Acting Chief) 

Boomer. Donald 
*Handlon, Joseph 
**Kelman, Herbert 
^VJaldman, Marvin 

Basic Research Program 

Section on Aging 

Birren;, James (Chief) 

Bondareff, William 

Botwinick, Jack 

Jerome; Edward A. 

Streicher, Eugene 

Weiss ; Alfred 

*Kay, Harry (Visiting Scientist) 

Section on Animal Behavior 
Rosvold; H. Enger (Chief) 
Mishkin, Mortimer 
Mirsky, Allen 

*B&ttig; Karl (Visiting Scientist) 
*Bush, Elinore (WIMH Fellow) 

- 78 - 



Serial No. M-F-C-(C)-1 

Page 3 • 

Part A: Project Description (Cont'd) 

Major Findings (Cont'd) 

2. Program of conferences held by Chief of Laboratory 

3. New Section -- Limbic Integration -- jointly with Labora- 
tory of Neurophysiology^ iras organized with Dr. Paul MacLean 
as Chief. 

Proposed Course of the Project: 

1. Continuation of attempt to recruit Section Chiefs for 
Section on Personality^ and Perception and Learning. Although 
for the Section on Perception and Learning serious negotiations 
were under V7ay last spring and summer with a very prominent psy- 
chologist for this position, his decision was finally in the 
negative because of space limitations — we could offer him so 
much less than he already had in his university laboratory. ¥e 
appear now to be more fortunate in relation to the Chiefship 

of the Section on Personality. Negotiations are tinder way with 
a very promising person and it seems likely that we shall be 
able to make the final arrangements early next year for a 
reporting date sometime during the summer of 1958. 

2. Because of certain present limitations in our own Clinical 
Center facilities , in some areas of our research, notably Child 
Development; it has been necessary to attempt to find settings 
outside this building. Some arrangements have already been made 
and othei's are in process of being made to find satisfactory 
settings in the Washington area for carrying out the planned 
resea^rches . The hope is that the Clinical Center will eventu- 
ally be able to furnish some of these facilities. 

3. The coming year should see more involvement of the members 
of the Laboratory in collaborative projects with the Adult 
Psychiatry Branch, the Laboratory of Clinical Science, and the 
Clinical Neuropharmacologlcal Research Center at St. Elizabeth's. 



Part B included: No. 



79 



Serial No. M-P-C-(C)-2 

1. Laboratory of Psychology 

2. Section of the Chief 

3. Bethesda 



PHS-WIH 
Individual Project Report 
Calendar Year I957 



Part A. 



Project Title: The Analysis of the Psychotherapeutic Process: 

The cumulative information derived from repeated 
viewing of complex material. 

Principal Investigator: David Shakow 

Other Investigators : None 

Cooperating Units : None 

Man Years : Patient Days : None 

Total: 1.0 

Professional 1.0 

Other: .0 

Project Description: 

Objectives : To determine what additional relevant information 
necessary for the understanding of the therapeutic process is 
derived from successive viewings of a film of a psychotherapy 
session^ and whether there are major differences between 
active and passive analytic approaches to data of this type. 
(Such a study is important because a major problem arises as 
to how complex data of this kind best lends itself to significant 
analysis. ) 

Methods Employed : The film for one psychotherapeutic session is 
divided into four sections. Eeh section is viewed repeatedly 
(15 times) under one of four sets of conditions: active attitude/ 
once per day; active attitudes/all 15 in one day successively; 
passive, free-floating attention/once per day; passive free- 
floating attention/all 15 in one day successively. This pilot 
experiment is being carried out as a preparation for deteirmining 
the design of the analytic process to be followed in the major 
project on the analysis of the therapeutic process. The 
experimenter dictates into a recorder as much as he can 



80 - 



Serial No. M-P-C-(c)-2, page 2 

Part A (Cont'd) 

Methods Employe d (Cont'd) 

both during the running of the film and immediately afterwards 
with regard to content process, relationship, cues for all of 
these, etc . , and a comparison is subsequently made of the kinds 
of material which is added at successive viewings . 

Major Findings : No findings as yet. The study is in its 
early stages. Apparatus problems developed which limited the a- 
mount of data collected. 

Significance to the Program of Mental Health Research : This 
is one of a series of studies directed at solving certain 
methodological problems in earr;ji,ng out research in the field 
of psychotherapy. The importance of this general area for 
research is considered in Project Description Sheet M-D-(C) 1, 
titled, "The Analysis of the Psychotherapeutic Process, 
particularly the Psychoanalytic Process." 

Proposed Course of Project : Depending upon the results from 
tne completion of the first experiment, further experiments 
will be set up with additional subjects and with more rigorous 
design and categorizations. The acquisition of a new projector 
should make possible the prosecution of this project with 
greater facility. 



Part B included: No 



- 81 - 



Serial No. M-F-C-(C) 3 

1. Laboratory of Psychology 

2. Section of the Chief 

3. Bethesda 



PHS-EEH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: Psychology of Schizophrenia 

Principal Investigator: David Shakow 

Other Investigators: David Rosenthal; Theodora Zahn, Joseph 
Handlon, Marvin Waldman 



Cooperating Units : None 



Man Years: 




Total : 


1-5 


Professional: 


.5 


Other : 


1.0 



Patient Days : None 



Project Description: 

Objectives : To bring together a large body of experiinental 
data on schizophrenia collected over many years into a series 
of monographs developing a theory of the psychology of schizo- 
phrenia. A detailed analysis of the body of experimental data 
already available and of new data to be gathered on our wards 
here and at St. Elizabeth's (see Project Description M-P-C-(c) ] 
will be carried out to test certain hypotheses as to the 
importance of difficulties during the period of preparation 
for response in schizophrenics. 

Methods Employed : In relation to the already accumulated 
material; ranging in complexity from studies of the latent 
time of the patellar tendon reflex to studies of social 
response; the usual methods of sta-oistical analysis will be 
utilized. Some new developments deriving fi-om studies of 
PhillipS; Rodnick and Garmezy regarding good and poor prognosis^ 
and certain other studies on "reactive" as opposed to "process" 
schizophrenics will be utilized for 'further differentiation of 
the material. Several related studies are being carried out 
on senescent and brain damaged subjects and they will be used 
in this study for control purposes. 

Patient Material : For this particular study no patient material 
will be required. The data are already collected. 

- 82 - 



Serial No. M-P-C-(c) 3, page 2 

Fart A (Cont'd ) 

Major Findings : Some of the major findings from this material 
have already been reported hy the proponent and his former 
colleagues in an extensive series of papers on the psychology 
of schizophrenia. The present project is directed at working 
up as yet unpublished material and reworking the total 
material in the context of a more carefully delineated theory. 

Significance to Mental Health Research ; Despite the fact 
that schizophrenia is the major disease group of mental dis- 
orders and accounts for half the occupied beds in mental 
hospitals; little advance has been made in dealing with this 
problem. A major defect undoubtedly has been in the relatively 
unestablished theories proposed to account for this complex 
of disorders. It is hoped i:hat the proposed study will con- 
tribute to an understanding of the underlying factors. 

Proposed Course of Project : Continuation of analysis of 
material and tying it in with experimental findings of 
current experimental studies. 



Part B Included: No. 



- 83 - 



Serial No. M-P"C-(C)-U 

1. Laboratory of Psychology 

2. Section of the Chief 

3. Bet>iesda 



PHS-EIH 

Individual Project Report 

Calenda.r Year 19.57 



Part A. 



Project Title : Linguistic Study of Emotional Expression 

Principal Investigator: Allen T. Dittmann 

Other Investigators : Lyman C. Wynne 

Cooperating Units : Adixlt Psychiatry Branch 

Man Years (calendar year 1957) ; Patient Days (calendar year 

1957) : 
Total t A 
Professional: .2 
Other: ,2 

Project Description: 

Objectives ; This project is an attempt to find ways of coding 
speech in order to identify disturbances which may be used as an 
index for psychological di st'orbance . 

Mg.thods Employed : Techniques of linguistic analysis developed by 
x'i'ager and Smith as applied to psychotherapeutic interviews. 

Major Fin dings: (a) Pitch, stress and junct'^ara patterns. These 
can be coded with high reliability^ but do not in themselves re- 
late to outside judgments of distiabaace. Judgoients of inappropri- 
ateness of juncture patterns could be related to disturbance, but 
the relationship was not strong enough, to make this a useful source 
for indi-vidual prediction. Subseq,uent attempts to make judgments 
of appropriateness of entire phrases based on the configuration 
of pitchy stress, junetxire all t&icen together, proved not to be 
relstes^ble to disturbance. This finding leads us to believe that 
the meager positive resiilts from appropriateness of juncture 
patterns alone were the resiilt of capitalization on chance. Our 
conclusion is that these inicro].ingaistic phenomena are too closely 
related to the sysitax of language to be carriers of emccional com- 
munications. 

(b) Eesitations and "breaks" in speech. These can be coded 
with fairly high reliability, but psychologic^?,! states other 
than dist\irbanee or anxiety affect these phe.aomena. It is 
impossible to differentiate, for example, betffean anxiety 
e;nd meditative reflection using these codings. It. may be 
that other systems, based partly on content, will do this job 

- Sh - 



Serial No. M-P-C- (C)-i)-page 2 
Part A. Project Description Sheet (cont'd.) 

better. See, for example, the project, "Development of an Ego- 
Integration Conceptual Ss^stem for Studying Psychotherapy", of 
Goodrich and Boomer in the Section on Personality of this 
laboratory. 

(c) Dixring the year of this report we have been trying to 
develop in a more systematic way the vocal phenomena of speech 
other than those mentioned above, the "pexalinguistic" phenomena. 
These include changes in duration, loudness, pitch, intensity, 
articulation, and vocalization as applied to units of speech 
larger than the morpheme. Preliminary trials indicate that the 
paralinguistic phenomena can be coded fairly rapidly, and that 
a good deal of work is neeessaury to spell out the criteria for 
coding completely enough that objective measuremen-cs can be made. 

Significance of the program to tfental Health resegjch ; This 
p^ojec^ is part of the program devoted to determining ways of 
measuring non-verbal comm'onication channels. If successful, 
it will sharpen our ability to use interview data more com- 
pletely in the analysis of psychotherapy. 

Proposed course of th e project ; To continue the deve3.opment of 
these teehniqLues unxil we find that we have objective measure- 
ment techniq.ues or that linguistic technig.ue8 ai'e not the way 
to get at vocal communicative phenomena. 



Part B included Yes £J Wo [Tl 



- 85 - 



Serial No. M-P-C-(C)-5 
1. Laboratory of Psychology 
2o Section of the Chief 
3. Bethesda 



PHS-KIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: Judgment of facial expression from short sequences 
of motion picture film 

Principal Investigator: Allen To Dittmann 

Other Investigators : none 

Cooperating Units : none 

Man Years (calendar year 1957): Patient Days (calendar year 

1957): 
Total: 1.2 
Professional: .6 
Other: .6 

Project Description: 

Objectives ; To develop techniques of judging emotion from motion 
pictvires so that these may be used for sequence ajialysis of thera- 
peutic interviews. This project is related to Linguistic Study of 
Emotional Expression. 

Methods Employed ; IXiring the year of this report the technique of 
showing short series of prints from motion pictures was abandoned 
as being artificial, even though it was a far simpler method of 
presenting data to judges than the one finally evolved. The pres- 
ent technique involves showing short sequences of film through a 
motion pictxire projector to judges ;, sequences about three seconds 
in length. Judges make their responses by checking a list of 17 
categories of emotional tone, and final scores are derived from 
this list. Reliability of pooled scores of three independent judges 
was .85 for 2k items, 

A pilot study was run to test whether these scores could 
be related to other variables. Using sequences of film of a 
patient following leading responses and confrontations by the 
therapist in one interview, judgments of facial expression showed 
greater relatedness and calm following leading responses and 
greater discomfort and apprehension following confrontations. 
Judgments based on speech with meaning filtered out 3uad on content 
alone showed trends in the same direction, but the relative un- 
reliability of these judgments for these data meant that the 
differences were not significant, 

- 86 - 



Serial No. M-P-C-(C)-5-page 2 
Part A. (Project Description Sheet cont'd.) 

Major findings ; This technique definitely holds promise as a 
method of getting at emotional communication as mediated by- 
visual cues. Reliability on a very limited sample is high, and 
the judgments can be related to other variables. 

Significance of the program to the Institute : Here is a tech- 
nique for measuring nonverbal communication which appears to 
work. While it is not simple to carry out (motion pictures 
must be used as the basis for judgment), this method, or rather 
those which are developed from it, may find wide use in analysis 
of interviews and other situations where films are available. 

Proposed course of the project : The preliminary findings are 
based on very limited material, and further work is iznder way 
enlarging the scope to Include many patients in many different 
stages of psychotherapy. At each stage in the development, 
reliability tests will be run, and pilot studies similar to the 
one cited above carried out. 



Part B included Yes [J No [Tf 



- 87 



Serial Ko. M-P-C-(C)-6 

1. La.boratorjr of Psychology 

2. Section of the GMef 

3. Bethesda 



PHS-NIE 
Individual Project Report 
Calendar Year 19.57 



Part Ao 



Project Title : Interaction patterns of Normal and Hyperaggressive 
Children 

Principal Investigator: All.en T<, Dittraann 

Other Investigators ; B. Wells Goodrich 

Cooperating Units ; Child Research Brascch 

Man Years (calendar year 1957)" Paxient Dsys (calendar year 

1957) t 
Total : . 3 
Professional i .2 
Other ; o 1 

Project Dasftription : 

Objectives : (a) To develop roethodjs of studying intersection 
patterns of children in a treataient setting, (b) To compsjre 
interaction patterns of normal and disturbed children in the 
same setting. 

Methods Emp3-oye d; Short sample observations of chi.ldren in 
situations selected to represent daily life experiences. Obser- 
vations were recorded, and the recordings tormsd the basic data 
of the research. Protocols were coded for interactions bet-^reen 
children and interactions involving children and adiilts. 

Patient Material : None during the year oovered by this report. 

Major Fin dij^s; Patterns of interaction of the nomial ajid h;yT)er- 
aggressive children differed as laight be expected: normals showed 
less inappropriate behavior, less overt aggression, more real 
leadership, greater dependency based on t.rust t-Xj/ard ad^iJits. 
Adait behavior was not so clear Ijr e^zpected: more i'reedoai with 
normals in exprassing affection, setting limits, while with 
the disturbed children they were more cautious in all their ex- 
pressions. Extensive studies of reliability of the observa- 
tional method itself aiid of the eodj.ng systeiii used here showed 
that the methods were repeatabis by the ssme people at dif- 
ferent times and by different people a'l; the saas? tims, thiis 

=. 88 - 



Serial No. M-P-C- (C)-6-page 2 
Part A. Project Description Sheet (cont'd.) 

lending greater credibility to the findings. During the year 
covered by this report the work has been chiefly concerned with 
reliability studies. 

The initial methodological paper is complete, and the sub- 
stantive findings are in the process of being written. 



Part B included Yes [J No /xT" 



- 89 - 



Serie,! Ko., M-P-C-(C)-7 

1. Laboratorj"- of Psychology 

2. Sect?: on of the Chief 

3. Bethesda 



TES-KLE 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title? Studies of diasensionality of psychological 
variables 

Pi'incipal Investigator: Allen To Dittmann 

Other Investigators : Efone 

Cooperating Units : None 

Man Yeai's (calendar year 1957) = Patient De-ys (calendar year 

1957) s 
Total ', . 5 
Fx'of essionel : . 1 
Other: .4 

Project Description: 

Objectives ; To investigate systems of psychological ^rariables 
for their dimensional structure, using no2i-metric tecbBiques, 

Meth ods employed : Methods developed by W. L. Hays and the late 
J. E. Benri.ett under the general theory of Co Gooiabs pre usedo 
Systems investigated are the Freediaan-Leary-Ossorio system of 
Interpersonal Mechanisms and the" Schasfer Circumplex of 2hild- 
I'earing attit-ideso Leary has concludad that the Interpersonal 
Mechanisms form a ti-ro-dimensions.! schene, and has applied plan 
trigonometric manipiJia"i:;ions of indivlduai profiles based en the 
sj'-stem to handJ.e group datao Schatfer has said that the beha'/lors 
concomzltant with child-rearing attitudes can be cast in t-^ro 
dimeasions , and finds similarities with the c'-imsnsions proposed 
by Lesry. 

Major Findings; Non-metric ansJ-ysis of these two systeias sho\fs 
tha'c ar. lea&t three dimensions Eiust be posxted. to accovjit for 
the beha\':loi"3 which they piarport tc organa.E« into oxily two 
dimei'Osions. The end-points of these dtinenisions have not been 
worked out as yet, but the indications of preliminary vork a^'s 
that they do not coincide with those s-aggested by the authors 
of tne systems o 

Sigpificaiice of the program to Mental Health ggs esrch i The 
systeai of interpersorisi mech2;nism£ is in iise in tvo studies in 

- 90 - 



Serial No.M-P-C-(G)-7-page 2 
Part A. Project Description Sheet (cont'd.) 

the institute (in the Laboratory of Socio-Enviromnental Studies and 
the Child Research Branch), and theoretical analysis of its properties 
will give information on how it nsay be most profitably used aad on 
what are its limitations. The Scha^er cireumplex will be used in 
organizing data of a different kind in the Section on Child Develop- 
ment, and can also profit fi-om data from a number of different kinds. 

Proposed course of the project : To complete the s^alysis in order 
to find end-points of the dimensions, and to publish the results. 



Parr. B included Yes ^ No /x/ 



91 - 



M~P-C-(C)-8 
lo Laboratory/' of Psycholoar 

2. Section of the CMef 

3. Betkesda 



PaS"NIH 
lacUvidoal Project Report 
Calendar Year 1957 



Part A. 



Project Title: Tlae Self -concept and Body Image as Related to 
Disease Susceptibility and Organ Choice 

Px'inoipal Investigators Isabelle V. Ke?idig 

Ot-iier Investigators: None 

Cooperating Units: National Institute of Arthritis and Mstaboiic 

Diseases 

Meja Tears (calendar year 1957) : Patient Days (caiendajj' year 

1957} s 
Total : . 5^' 6 

Prof a 8 3 i onsl : .53 
Other: .05 

Project Description: 

Objectives; To explore attit'iidiaal factors affecting health sjQd 
lo.agevlty. Mors specifically;, to invss'cigats thcsc attitudes in- 
culcated in e:5i'ly childhood -#hich are inj-trtiiaental ia determxiiag 
the 2::iat-are of the self-concept and the body injage er-peelaliy in 
relation to susceptibility to illness ^ orgarx choica, coi-rse and 
OTiticome of disease. 

Mgth..ods Employed ; E:rfcensive use of self-concept tests and a 
variety of prcjectiva techniques, inolitdiag the Ror^chach^ Di*aw~ 
a-Persoa and Four Picture tests ;, with patients proved unsatis- 
factory, the results reflecting o:aly the j^resent self-coacept exid 
boo;/ image as unfavorably modified by yeai-:"3 of il^jsest^. It seeased 
necessary J, therefore, to develop a der-ailsd q,uestion??aire or in- 
terview schedixle which woald «iisciOi3e the attitudes toward the 
self and the body inculcated in early chiWhood, explicitly by 
dirac'c instrtiction g=nd Impli-iitl;;/' thi-ou^ ti;,e emotional climate 
of the home and faMly reactions to iljjiess, which aigiit bear a 
relation to subsequent cdsease susceptibility. Boring the pss's 
year such as inatr'ujsisnt has been dsTeloped a;ad pretesr^ed on t¥0 
putient gro^i,ps &nd one gi-oup of 'normal' coatrola. Scales are 
now being ii^mm sc that tte dtta cpji ba codec', and treated 
quantitati'/ely. 

- 92 - 



Serial Wo. M~P-C-(C)-8~page 2 
Part A. Project Description Sheet (cont'd.) 

Patient Material ; The two patient groups used for pre-testing the 
interview schad^JLLe have consisted of a number of rheiijmatoid 
arthritics from KIAMD and a smaller niimber of patients from KflKDB 
referred for study because of intractable pain. In addition, the 
instrument has been administered to 'normal' controls involved 
in drug studies. 

Major Findings ; There are no substantive findings to report at 
this time as the emphasis to date has been upon the development 
of an appropriate methodology. 

Significance of the progrstm to Mental Health research ; To the 
extent to which the results of this study may thra^jf light on the 
part which beliefs and attitudes to the self and to the body 
play in relation to subsequent health suad to longevity;, it should 
have value in forr^rarding the work of the various Institutes in 
which it is carried on. It should also tie in with studies in 
progress in the Laboratory of Psychology, specifically in the 
fields of child development and gerontology. In these areas it 
will be significant to trace the rise, modification and deteri- 
oration of the self-concept over time in its effect upon re- 
sistance to disease. 

Proposed Course of Project ; Before the close of the current year 
it is expected that the coding of the Interview Schediole, which 
has already passed through a number of forms, will be completed 
and a weighted scoring system devised. It will then be used with 
groups of patients in NCI, NHI and KLAID as well as in NIAMD and 
NINDB. The next step will be to secure matched control groups, 
the Peace Church 'normals' being largely imsuitable because of 
the age factor. 

A subsidiary project has been in the ways since spring, viz. 
to compsjT'e the physical status of a group of Princlpia College 
students, raised in the Christian Science faith, with a matched 
group of students from a deaomins,tional college of similar stand- 
ing, to all of whom medical examinations were given by a Sfa-'iy 
team during the Second World War. Permission for access to the 
reports on these exagu.nations has already bean granted ty the 
Navy and the project is now under consideration by the Christian 
Science Mother Chtjreh in Boston. This study should afford a 
crucial test of the extent to wblch affinmtlvs attit'ades to 
hesilth inculcated in childhood contribute to subsequent re- 
sistance tc disease. 



Part B included Yes f^ No /^ 

- 93 - 



Serial No. M-P-C-(C)-9 

1. Laboratory of Psycholo^ 

2. Section of the CSaief 
3» Bethesda 



PHS-WIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title : Precocious Puberty and Pseudohermaphroditism 

Principal. Investigator: Roy Hertz, M. D. 

Other Investigators; Isabelle V. Kendlg 

Cooperating Units s National C9,ncer Institute 

Man Years (calendar year 1957) s Patient Mys (calendar year 

1957) s 
Total: .08 3 

Professional: .03 
Other: .05 

Project Descriptions 

Objectives : From the standpoint of the second investigator ;, the 
objective of this study is to evaluate the psychological effects 
of precocious puberty and pseudohermaphroditism on personality 
variables^ particularly upon the self concept and the body image. 

Methods Employed; Administration and analysis of the stsmdard 
intelligence and projective tests. 

Patient Material: All present out-patients a-nd all newly ad- 
mitted patients to the NCI suffering from precocious puberty and 
pseudohermaphroditism^, an estimated 15 a yesir. 

Major Findings : The group of patients seen to date (5) is still 
too small to waxrant any statement in re findings. 

Significance of the progr-am to Mental Health research : Besides 
throwing light on general personality variables in such a group 
of patients^ the study should contribute significantly to our 
understanding of the bearing of such pathology on the self con- 
cept and the body image. 



9h ~ 



Serial Wo. M-P-C-(C) -9-page 2 
Part A. Project Description Sheet (cont'd.) 

Proposed Course of Project ; To continue to see new patients 
with these diagnoses and to re -evaluate from tiwe to time those 
already seen until an n is built up of sufficient size to 
warrant conclusions about the group as a whole. 



Part B included Yes /V No /xj 



95 - 



Serial Wo, M-P-C-(C)-10 
lo Laboratory of Psychology 
2o Section of the Chief 
3. Bethesda 



PES-NIE 
Individual Project Report 
Calendar Year 1957 



Part A, 



Project Title: Study of Intractable Pain 

Principal Investigator: John M« Van Buren, M.D. 

Other Investigators; Isabelle V. Kenaig 

Cooperating Units : National Institute of Neurological Diseases 

and Blindness 

Man Years (calendar year 1957) = Patient Days (calendar year 

1957) : 

Total; .06 2 

Prof e s ■5 io^oal ; a Gl 
Other: .05 

Broject Description: 

Objectives ; From the standpoint of the second investigator, the 
objectives in this study are to uncover developmental attitudes 
to the self and to the boc'y image which may be related to the 
patient's present condition and perhaps enable a differentiation 
to be s&ade between those suffering orgs^nic- pain and those with 
psychological (phantom) pain. 

Methods Employed ; Data on early attitudes tc the self and the 
boi!ly and family attitudes to illness are being obtained through 
the use of the Interview Schediiie. 

Patient iyte.terial ; Patients included in the study of intractable 
pain being carried on by the principal investigator. 

Major Findiiigs; As only k persons to date have been seen in 
this stuc^Yj, there are no findings to report. 

Sigroificance of t.he progran to Mental Health X'eseareh: The 
problem of intractable pain is of s;i:'eat interest i.ii medicine. 
If attitudixml factors are found to play an important role, 
particularly in connection with phantom pain, a new appx-oach 
to treatsQsnt may be suggesT.ed. 

- 96 - 



Serial No. M-P-C-(C) -10-page ? 
Part A. Project Description Sheet (Cont'd,) 

Proposed Course of Project ; To carry it on until a sufficiently- 
large group of patients has been seen to Justify drawing con- 
clusions re the psychological variables involved. 



Part B included Yes [J No jTJ 



- 97 - 



Serial No. M-P-C-(C)-11 

1. Laboratory of Psychology 

2. Section of the Chief 

3. Bethesda 



PHS-NIH 
Individxial Project Report 
Calendar Year 1957 



Part A. 



Project Title: Drug Study 

Principal Investigator*. Conan Kornetsky 

Other Investigators: Isahelle V. Kendig 

Cooperating Ifeits: Laboratory of Clinical Science, HIMH 

Man Years (calendar year 1957) : Patient Days (calendar year 

1957) : 
Total: .25 10 

Professional: .2 
Others .05 

Project Description: 

See Serial No. .M-CS-P-(C)-2 



Part B included Yes [J No [Tf 



98 - 



Serial Wo. M-P-C-(C)-12 

!• Laboratoiy of Psychology 

2. Section of the Chief 

3. Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



JtSLl w Ao 



Project Title i Schizophrenic illness in a set of identical 
qioadruplets 

Principal Investigator: David Rosenthal 

Other Investigators; Numerous NIMH investigators and personnel 

ftom other NIH institutes 

Cooperating Units s None 

Man Years (calendar year 195?) '• Patient Days (calendar year 

1957); 
Total; 2.6 ]Li^50 

Professional ; . 5 
Other; 2.1 

Project Description: 

Objectives ; To determine factors related to the development of 
schizophrenia in a set of identical quadruplets and to evaluate 
factors which lead to differences in their psychopathology. 

Jfethodg employed ; Interviews of the quadraplsts , their relatives, 
and members of their home comrau.nity. Ohser-trations of the quads 
and their parents. Biochemiealj, physiological, and psychological 

tests. 

Patient I^feiterial ; A set of 27 year old Identical quadruplet 
girls. 

Major Findings; A large amount of data of different kinds has 
been accumsjilated. The integration and evaluation of these data 
will begin oa a mors formal basis very shortly. 

Significance of the progiram to Ment al Health research ; It is 
hoped that this intensive analysis will ILUminate the process 
of sehizophrenJ.c development, especially with regard to genetic 
faetors, social iisolation, parental behavior, family life pat- 
tern, maturation of self -concept , and other related concepts. 



99 - 



Serial No, M-P-C-(C)-12-page 8| 
Part A. Project Description Sheet (cont'd.) 

Proposed Coarse of the Project ; Data collection will teraiinate 
at the end of this year, and the formal integration and evalua- 
tion of findings will follow. 



Part B included Yes [J. No /x7 



- 100 - 



Serial Nc, M-P-C-(C)-13 

1. Laboratory of PsycliolOQr 

2. Section of the Chief 

3. Bethesda 



Individiial Project Heport 
Calendar Year 1957" 

Part _A. 

Project Title i Eesponsivity Patterns ia Schiaopferenics 

Principal Investigator i I^vid Rosent^l 

Otker Investigators; David Simkowj, William G, Lawlor (visiting 

scientist);, Tiieodore P. Zahn, Blaacfee Sweet 

Cooperating Units ; Clinical Sciences Laboratory (Ward 2-W) and 

St. Elizabeths Hospit'al 

Man Years (calendar year 1957) : Patient Days (calendar year 

1957): 
Total: 2.15 ^5 

Prof e ssional ; 1.4 
Other: ,75 

Project Description: 

Objectives ; Schizophrenics of various types are toeing studied 
with regard to how they respond at both the aiatonomic and molar 
behavioral levels when confronted by neutral^, meaningfuJ., and 

performance -de.manding stimuli. The concepts &f set and arousal 
are central in planning the pro-am of stiidies, both with regard 
to the tests and procedures used and the Ejeas^ares taken. In the 
endj, it Is hoped to elucidate the respomeivity patterns of 
various kinds of schizophreioics insofar as these may be influ- 
enced by externally induced psychological factors and by in-= 
ternal factors. With regard to internal factors^, we hope in ,•'' 
time to relate the phenomena here studied to studies of reticu- 
lar activating and limbic systems in schizophrenics. 

Methods Employed: Tests administered to date include: orienting 
(to light stnd tonej under amytalj, an^hetamiae ^ and chlorpromazlne ) | 
conditioning j reaction time; intelligence tests (WAIS and Pro- 
gressive Matrices); Wisconsin Card Sorting Test^ Rorschach; 
adaptation to blocking of alpha; discrimination of size differ- 
ences; word-color test; and subjective pr.obability tests. Even- 
tually;, when ssuDpling will have become w3.der;, tests will be in- 
tercorreiated to examine whether broad coastellations of response 
patterns sure present among schlsophreriics . 

- 101 - 



Serial Nc. M-P-C-(C) -13-page 2 
Part A. Project Description Sheet (cont'd.) 

Patient Material ; One group of 13 saMzcphrenic patients having 
high, middle, and low percent time alpha in their electroencepha- 
lograms has been under study since Jiily, 1957« A set of identical 
quadruplets with varying degrees of severity of schizophrenic 
symptomatology is also being studied. Till now, all patients have 
been Clinical Center patients, but plans have been in the making 
to include St. Elizabeths Hospital patients next year. 

Major Findings : Data are now in process of being evaluated. 

Significance of the program to Mental Health research ; ¥e hope 
to study the possibilities that ; 

1. Subgroups of schizophrenics can be differentiated 
according to their autonomic and molar behavior patterns. 

2. These patterns can be related to schizophrenic 
symptomatology. 

3. The subgroups caxi be differentiated according to 
genotypical background and/or family relationship constellations. 

k. The pattern differences can be conceptualized as 
involving varying kinds of defect in "arousability". 

5« Arousability defects are related to disturbances 
in the functioning of the reticular activating and/or limbic 
systems. 

Proposed Course of the Project ; We plan to evaluate the findings 
and to follow the best leads. Some tests and experiments may be 
modified and new ones will be planned on the basis of oiir initial 
findings . 



Part B included Yes £J No Jx/ 



- 102 - 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Clinical Investigations 
Laboratory of Psychology — Child Development Section 



BUDGET SHEET 



Estimated Obligations for FY 19S8 
Total: $121,198 
Direct: $89,956 

Reimbiirsements : $31 ,2^4-2 



Projects included: M-P-D(C) 1 through M-P-D(C) 17 



Serial No. M-P-D-(C)-1 
lo laboratory of Psychology 
PHS-NIH 2. Child Development Section 

Individual Project Beport 3« Bethesda 
Calendar Year 1957 

Part A. 

Project Title : The preparation of procedures for observing and record- 
ing infant behaviors and mother-child interactions in testing situations 
for use in a stxidy of infant development. A pilot study. 

Principal Investigator; KEincy Bayley 

Other Investigators: Earl S. Schaefer 

Cooperating Units: None 

Ifen Years: Patient Days: 

Total : .82 5 

Professional: .40 

Other: ck2 

Objectives ; In preparing for a developmental study that is oriented 
toward finding significant variables in shaping personality structure, 
and rates of behavior development^ it is necessary first to devise 
methods of observing, recording and evalviating the behavior of infants 
and their mothers during short testing -observation periods. The 
objective of this project is to devise and test a set of methods and 
recording procedures for such use* 

Methods employe d; Mothers and their young infants are visited in 
their homes ■vrtiere developmental and social tests are given the in- 
fants. At intervals each mother and child pair is brought into the 
Clinical Center for the same tests, at lAiidi time motion picture and 
tape recordings are made of the testing sequences. An earlier attempt 
to give these tests in a ■well -baby clinic proved tmsatisfactory, and 
has now been dropped. A veiriety of methods of recording the procedures 
is being experimented with. Eating scales, adjective check lists, 
running accounts, coded records of responses made by observers during 
tests, and qualitative descriptive notes as veil as the motion pictures 
are being tried out and checked for reliability, validity, and adequacy 
for purposes of interpretation. 

Major Findings ; This sttxdy is still in the stage of developing the 
•tools of observation and recording, althou^ several fojans now being 
tried are promising. None of them is at p3:«sent ready for general vse. 

Significance to the program of mental health research ; Findings from 
other research indicate that the emotional health of infants and young 
children are affected by the emotional climate and characteristic 



103 



Serial No, M-P-D-(c)-l-page 2 

Bart A continued ; 

Significance to the program of mental health research continued : int er - 
action patterns between children and significant adults. These emotional 
climates appear, furtheimore, to affect significantly the course of behavior 
development « Mach more information is needed on the ways in ■^rfiich these 
interactions occur, and on the extent of their effectiveness in determin- 
ing mental health or disease. Careful observation in natxiral settings, with 
later evaluation of the same diildren is one of the best ways to discover the 
important variables. 

Proposed Course of Project ; Although this project was initiated as part of 
a projected developmental stiody of infants^ the direction of interest of 
the members of the section is now shifted toward smaller, more intensive 
studies of infant behavior. Some of the foims developed here will be used 
in the mental test standardization. Others will be utilized as appropriate 
study conditions are instituted. 



i 



il 



Part B. included Yes l~~J No /X / 



- 104 - 



Serial No, M-P-D-(C)-2 
Laboratory of Psychology 
PHS-ETIH Child Development Section 

Individual Project Report Bethesda 

Calendar Year 1957 



Part A. 



Pro.ject Title : Standardization of the California Infant Scale of 
Mental Development 

Principal nixvestigator: Nancy Bayley 

Other Investigators: IVbrjorie Po Honzik and Dorothy Ho Eichom, 
University of California, Berkeley. 

Cooperating Units: None 

Man Years : * Patient Days : 

Total: .55 None 

Prof e s sional : . 25 

Other: o30 

Project Description : Objectives: To revise and prepare for re- 
standardizing the California First Year Ifental Scale to be extended 
through two years and re -named the California ^ntaJ. Scale of Infant 
Development. T!he normative testing to be done by or under the im- 
mediate supervision of Drs. Marjorie P. Honzik and Dorothy H. Eichom. 
The revision of the scale should fill a serious gap in the current 
status of developonental tests for infants. The infant sceiles now in 
use in this coiontry were all standardized on data obtained 20 to 30 
years ago on small samples of infants us\ially from a geographically, 
culturally and often socioeconomically restricted source. Because 
of these inadequacies of sampling, we have no assurance that the age 
norms in ajiy of them are representative of infants in the country 
generally. The revision should be standardized by testing repre- 
sentative samples from a variety of geographical areas. 

Aside from the sampling, however, cvirrent theories about the 
nature of the developmental processes caH for inclusion in the scale 
of a wider range of behaviors in order to render the evaluations of 
a child's status more meaningful. 

tfethods employed: The original mental scale has been gone over item 
by item to make the procedural directions more clear; new items have 
been added for trial; new record forms and work sheets are being 
developed that wiU both increase the ease of administering and re- 
cording and allow for fuller descriptions of the infants' responses. 
An additional foim has been devised for recording the child's 
emotional^ attitxidinal, energy output and goetl'^directed behaviors. 
These wiH be analyzed for age and developmental trends and for the 
relation of individual differences to scores of mental functioning. 



- 105 



Serial No. M-P-D-(C) 2-page 2 

Part A, Continued 

Methods employed continued : Tentative revisions are tried out on a few 
infants and further revisions are then made. When satisfactory forms 
have been devised a program of testing will be instituted according to 
a statistical design that will insure good noiraative data. 

Ma..1or findings ; This project is now at the stage of selecting the items 
to be observed and developing the test form. A few infants have been 
tested for the purpose of discovering ways to improve the testing instru- 
ment. 

Significance to the program of mental health ; There is need for a 
really good objectively scorable well -standardized test of mental 
functioning in infants that covers the age span between birth and two 
years. This is of primary importance to basic research that is 
directed toward early detection of such conditions as mental deficiency 
and emotional disturbances. A good test would function as a basic tool 
in studies of environmental deprivation and the effects of emotional 
trauma on the infant's development and personality adjustment. 

Proposed course of project : The testing procedures and record forms 
are now almost reaxiy for putting into final form. The next step will 
be to organize the testing program. This is now in the preliminary 
planning stage. 

It is probable that such a normative testing program will be tied 
into the large study of infant development that is being carried out 
in NBTDB. In that program it is planned that 13-15 cooperating institu- 
tions will, over a period of eleven years, measure the development of 
some 35^000 children, starting vath pregnancies, and continuing with 
the children xintil they are 5 years old. In this program well-standard- 
ized developmental tests are needed. It appears now that the pro- 
cesses of standardizing the two-year mental scale can be integrated 
with this program, in such a way that a standardization sub -sample can 
be derived from this total population. This in return would furnish 
standard test scores to the entire popxilation, vAiich would be tested 
less frequently. 



i^rt B included Yes / / No TO 



106 



Serial No. M-P-D-(C)-3 
Laboratory of Psychology 
PHS-NIH Child Development Section 

Individual Project Eeport Bethesda 
Calendar Year 1957 



Part A. 



Project Title ; Long-term experiences with methyltestosterone as a 
growth stimulant in short immature boyso 

Principal Investigator: Kancy Bayley 

Other Investigators: Gilbert S. Gordon and H. Lisser, XJhiversity of 
California MsdicaJ. School, San Etrancisco, California 

Cooperating Units : None 

Man Years; Patient Days: 

Total: .30 None 

Professional: <.15 

Other : .15 

Project Description ; Objectives : To investigate the effects of oral 
administration of methyltestosterone on the growth and pubertal develop- 
ment of small iimoature boys. 

tfethods eniployed; Accumulated clinical records, including serisil measure- 
ments of height, skeletal X-rays and treatment dosages of 100 boys, 
patients of Drs. Lisser and Gordon, were studied. Growth curves of 
height, and annual increments were plotted on Bayley 's curves. Sseletal 
ages were read from the X-rays and pre -treatment height -predictions made 
on 62 of the boys, using the Bayley -PLnneau tables. Subsequent height 
predictions, after treatment weare possible from later X-rays of 36 of 
the boys. It was possible to compaxe the predictions with eventual 
ad;xlt stature for 20 boys v*.ose growth was completed. The effect of 
methyltestosterone on growth were found to be most effectively evaluated 
by grouping the boys according to age at maximum growth. 
Major findings : Staall doses (5 to 20 mg. ) of methyltestosterone ware 
found to result in immediate spurts of rapid growth in most instances. 
Compared with pre -treatment predictions, both post -treatment predictions 
and actual adult statures were found to be, with few exceptions, at or 
above the expected growth without treatment. Btew disturbing side-effects 
were noted. 

Significance to the program of mental health research ; Staall boys, -iitio 
are retarded in puberal development, have been found to have emotional 
problems related to their small size, lack of strength, and immaturity. 
If growth can be stimulated at the normal age for such growth without 
physical damage, these boys may be helped to regain status and thus re- 
duce their emotional problems. 
Proposed course of project : Qonrpleted and published » 

Part B included Yes / 1 / No /"7 



107 



Serial Ho. M-P-D-(C)-3 page 2 
PES-NIH ... 

Individual Project Beport 
Calendar Year 1957 

tB: Biblications 

"1"" 

1 cations other than abstracts from this project: 

Bayley^ Nancy^ Gordon, S. G., & Xlsser^ H« Long term experience vlth 
Mstbyltestosterone as a growth stimulant in short inonature boys* 
Pediatric Clinics of North America, Ihiladelphia, W. B. Saunders Co«, 
1957 > pages ai9-tt25. 



801 



Serial No. M-P-D-(c)-Ii. 
Laborato3ry of Psycholoar 
PHS-NIH Child Development Section 

Individual Project Report Bethesda 

Calendar Year 1957 



Bart A. 



Project Title; Bslationship of maternal behavior to the subsequent 
social, emotional, and intellectual development of children* 

Principal Investigators: Hancy Bayley and Earl So Schaefer 

Other Investigators: None 

Cooperating Iftiits: None 

Man Years: I^tient Days: 

Tcftal: 082 None 

Rrofessional : o^l-O 

Other: ckS. 

Project Description : Objectives : Recent theories of the effects of 
maternal behavior upon personality development of children have 
shifted from an emphasis upon such variables as age of weaning and 
toilet tiraining to variables 'stiich stress social and emotional be- 
haviors of the mother with the child. In another project data 
collected by Bayley in the Berkeley Growth Study have been utilized 
in developing a method for quantifying notes on behavior observation 
of mother-child interactions of children under 3 years and of un- 
structured interviews of the mothers ^en the children were approxi- 
mately 10 years old. The objective of this project is to st-udy the 
relationship between these maternal behavior variables and the 
intellectual, social, and emotional behavior data on children ^ich 
were collected by Ifency Bayley over a period of twenty -one years. 
Some of the analyses will test current theories of the influence of 
the mother upon the development of the child ^ile other analyses 
win escplore the data in an effort to develop new hypotheses ^ich 
can be tested in future studies. 

Msthods eH^loyed : Mich of the data on the children was recorded in 
quantified form, e.g., intelligence scores, ratings of behavior in 
the test situation at various ages, tests of interests and attitudes, 
and many others which were collected over a period of 21 years. 
Other records on the children consist of unstructured notes on test 
behavior, notes on interviews, projective test materials, etc. Qae 
phase of the project is to develop a method of quantifying personality 
concepts from the available data. A rating scale is being developed 
to quantify notes on test behavior between the child's age of 11 to 
180 It is Qften necessary to group other scores « Appropriate 
statistical techniques to analyze reliability consistency through 
time, and the relationships of the various variables with one 
another and with maternal behavior must be selected and statistical 



109 



Serial Wo, M-.P-D-(C)-i(- page 2 

I^xt Ac continued; 

Methods employed continued ; analyses of the material must be done. The 
data are being organized to permit the application ot IBM techniques in 
order to facilitate the analysis of this comprehensive and unique set of 
longitudinal data.. 

Ma.i or Finding s ; All results of these data indicate differences between 
the relation of maternal behavior to personality development of boys 
and personality development of girls « Jfetemal behavior is consistently 
more highly related to intellectual and personality development of boys 
than girls <, This finding may be relevant to the process of identifi- 
cation in males and females <, Another finding is that upper socio- 
economic groups tend to show more positive behavior toward their children. 
This may help in interpreting differences in incidence of mental health 
problems among socioeconomic groups. Internal behavior is significantly 
related to the intellectual development of males but not of females. 
Mothers ^o are Cooperative^ Equalitarian , and Escpress Affection for 
their children most often have sons ^o consistently improve in intelli- 
gence throu^ the first 6 or 8 years ;, and then remain stable, vftiile the 
opposite is true for mothers who are FUnitive, Irritable and Ignoring. 
Maternal behaviors which are approved by mental health specialists are 
related to the happiness, calmness ;, and positive behavior of their 
children between 10 months and three years of age. It was found that 
behavior ratings of children of this age level largely define two di- 
mensions—Happiness vs. Unhappiness and Activity vs. I^ssivity. The 
child's activity between 10 months and three years is more consistent 
than the child's happiness, though neither characteristic is highly con- 
sistent. 

Maternal behavior variables are significantly related to the rated 
behavior of boys in the test situation between thiree and nine years of 
age. The pattern of relationship of maternal behavior with the rated 
behavior of girls is less clear. Internal behavior is also signifi- 
cantly related to the test behavior of boys between 11 years ajid l8 years. 
Analysis of these data on the girls is incomplete. Eeliable ratings of 
adolescent behavior in the test situation were obtained from the rating 
scale \dilch was developed. 

Correlations among the maternal behavior variables ^ich are re- 
ported in another project revealed two primary dimensions of Love vs. 
Hostility and Autonomy for the Child vs. Control. An Investigation of 
the consistency of maternal characteristics between the two age levels 
revealed relatively high consistency of the love vs. HDstility dimension 
but low consistency of the Autonomy vs. Control dimension. This result 
was meaningful in that the child's needs for a'sxt.onomy vary from total 
dependence at birth to relatively complete independence as an adiilt 
•(rfiile his needs for positive relationships are relatively consistent 
through time. The detailed information on Intelligence and person- 
ality ^Ich is available on this group over a 

- 110 » 



Serial No, M-P-D-(C)-4 page 3 

Bart A continued ; 

Major bindings continued ; period of 21 years has resulted in other 
findings -^ich are relevant to hypotheses of the influence of 
environmental variables upon developments Intensive study of these 
results and their interpretation is necessary before their signifi- 
cance can be determined- 

Significance to the program of mental health research ; Since most 
of the theories of family influence upon personality development have 
been developed from clinical and retrospective studies^ the oppor- 
ttmity to test them developmentally should assist materially in 
eval\iating these theories » The data on social and emotional inter- 
actions of mothers with their children from both observations and 
interviews are xmique since most data on maternal behavior are from 
structured interviews with no opportunity to check their validity. 
The results of this study are highly relevant to the theories of 
Sullivan, Eraram^ and Homey ^ich are currently influential among 
psychiatrists and psychologists and should be valuable in testing 
those theories. Data about personality and intellectxial development 
^ich are valuable to personality theory and to the mental health 
movement may be obtained.. 

Proposed course of pro.ject ; Rirther investigations on the interre- 
lationships of these data will be madeo The data will be prepared 
for IBM analysis and the results will be interpreted and reported. 



Part B included Yes J^ No /FJ 



111 



Serial No. M-P-D-(C)-5 
1. Laboratoiy of Psychology 
PHS-NIH 2. C3aild Developnent Section 

Individual Project Report 3» Bethesda 
Calendar Year 1957 



rt A« 



Project Title ; Development of a theory of the role of parental 
behaviors in the etiology of personsility structure and psycho- 
pathology. 

Principal Investigator: Ikrl S<, Schaefer 

Other Investigators: None 

Cooperating Units: Hone 

l&n Years: Patient Days: 

Total: .37 None 

Professional! .20 

Other: .17 

Project Description : Objectives : The purpose this research is to 
develop a systematic theory of the effects of social influences upon 
personality development and to develop a theory of the relationship 
of the major diagnostic categories to one another and to the healthy 
personality. As systematic theory would enable one to integrate 
personality research, both clinical and experimental, into a common 
conceptual scheme in which the various findings would be relevant to 
one another. A theory would guide futiare research designs as well as 
assisting in interpreting previous results. 

tfethods Bnployed : Through an important advance in statistical theory, 
Guttman's circuraplex theory, a new way of investigating the inter- 
relationship of personality variables became available. The circum- 
plex method, idiich is a seaxch for a law of neighboring and a law of 
polar opposites in a set of correlations, permitted a parsimonious 
ordering of a set of maternal behavior concepts ^ich had been 
developed by Schaefer, Bell, and Bayley in a previous project in this 
laboratory. This parsimonious ordering of maternal behavior concepts 
was fo\3nd to apply to other published data and to other concepts 
\4iich have been used to describe maternal behavior, i^otheses were 
developed concerning the types of personality structures \Ailch. might 
be developed from the accumulative effective of the different maternal 
behaviors. Predictions were made and the predictions were verified 
from enrpirical data. Proposed work on the theory is to apply the 
theory as it exists to further published data, to amplify or modify 
the theory as indicated by these data, and to plan additional studies 
;|;\dxich would test the theory^- 



- 112 - 



Serial Wo, M-P"D-(c)-5~page 2 

Fart A« continued : 

Ife.Tor Findings ; Two major dimensions of maternal behavior have been 
isolated --Love vs. Hostility and Autonomy for the Child vs. Control. 
A prediction was made that Love and Autonomy wo'old result in a 
normal personality adjustment ^ Love and Control in a more inhibited 
neurotic personaJLity^ Hostility and Control in a more schzoid person- 
ality, and Hostility and Autonomy in a more psychopathic, delinquent 
personality. This prediction specified the relationship between the 
various diagnostic types and the normal personality. The prediction 
was substantially verified by intercorrelations of the scales of the 
Minnesota Multiphasic Personality Inventory i^iich were developed to 
differentiate the diagnostic categories. Additional verification was 
found in published data from the comprehensive assessment data of the 
Institute of Personality Assessment Research and in several compre- 
hensive behavior rating studies on Nursery school children, pre- 
adolescents, and young adults. The findings were related to Freudian 
theory, to data on psychotherapeutic success, to learning theory, sind 
to the literature on experimental neurosis in ajaimals. 

Significance to the program of mental health research : Current 
psychiatric theories of Sullivan, Frcram and Homey stress the effect 
of environmental factors upon personality development. The develop- 
ment of a systematic theory of the nature of these social environmental 
factors and of their effect upon personality development Tri.ll organize, 
amplify, and clarify these theories. This theory will permit the 
integration of available data and the development of improved research 
designs for future studies of the effects of the social environment 
upon personality development. The conceptual scheme also simplifies 
the problem of communication mental health concepts since it organizes 
an extremely complex phenomenological field into an ordered and parsi- 
monious set of concepts. 

Proposed course of project : A paper entitled "A theory of personality 
development, personality structure, and psychopathology" is in pre- 
paration and will be sent to Behavioral Science . Further data will 
be obtained from published studies and further tests of the theory 
will be made in new research designs. 



I^rt B included Yes l~~J Wo /X / 



113 



PHS-NIH 

Individual Project Report 

Calendar Year 1957 



Serial Wo. M-P-D-(c)-6 

1. Laboratoiy of Psychology 

2. Child Development Section 
3o Bethesda 



I^rt A. 



Pro.iect Title : Organization of ]yfe,temal Behavior and Attitudes Within 
a Two nimensional Space. 

Principal Investigator: Earl S. Schaefer 

Other Investigators: None 

Cooperating Units: None 



Man Years: 

Total: .37 

Professional: .20 

Other: .17 



I^tient Days; 
None 



Pro.iect Description : Cto.iectives: Qae of the major goals of science is 
to order an apparently complex phenomenological field into a parsi- 
monious, ordered set of concepts. Previous researches in this laboratory 
by Schaefer, Bellj, and Bayley have developed a Parental Attitude Research 
Instrument and a Maternal Behavior Research Instrument with which to con- 
ceptualize and quantify parental attitudes and behaviors. lepers on 
these research instruments are now ready for publication. The purpose 
of this research is to study the Interrelationships of the concepts 
\Aiich are measxired by these research instruments in order to be able to 
develop efficient research designs, to assist in interpreting research 
results, and in order to be able to develop a comprehensive theoiy of 
the effects of maternal behavior upon the personality adjustment of 
children . 

tfethods Bmployed ; Quantified data on maternal attitudes and behavior 
were intercorrelated, and the methods of factor analysis and Guttman's 
radex analysis were used to discover a simple nomological network within 
the concepts. 

Major Findings Both methods revealed two major dimensions of both 
maternal attitudes and behavior \*iich were labelled Love vs. Hostility 
and Autonomy vs. Control. These two dimensions included most of the 
common factor variance of maternal behavior with the child. The dis- 
covery of this order among the maternal behavior concepts was general- 
ized -ahen it was fovmd that other published data on maternal behavior 
could also be organized by this two dimensional scheme. 
Significance to the program of mental health research : Recent studies 
of personality development in psychiatry, sociology, and psychology have 
emphasized the great importance of the family and^ of the mother. 



11^ » 



Serial No. M-P-D-(C)-6-page 2 

Part A, continued : 

Significance to the program of mental health research continued ; 
Although there is some concensus about the important variables, due to 
different teiminologies and to the apparent complexity of the data, no 
organized conceptual scheme vAiich could integrate this research has 
been available. It appears this two dimensional organization of 
maternal behavior vdiich we are developing would make it possible to 
integrate many of these researches. 

Proposed Course of Project : Ripers on this organization of maternal, 
behavior and attitudes are being prepared. Rirther confimation and 
amplification of the conceptual scheme will be attempted in conjttnction 
with other projects and from other published data. 



P&rfc B included Yes 7 7 No ^J 



- 115 - 



Serial No. -M-P-D-(C)-7 
1. Laboratory of Psychology 
PiB-NIH 2* Child Developnent Section 

Individiml Project Bsport 3, Bethesda 

Calendar Year I957 

Fart A . 

Project Title: Development of a Maternal Behavior Research ]jastrument . 

j Principal niivestigators : Earl S. Schaefer, Richard Q. Bell and 

! Nancy Bayley. 

Other Investigators: None 

Cooperating Units: None 

Man Years: Ifeitient Days: 

Total: .67 None 

Prof e s sional : . kO 

Other: .27 

Project Description : Objectives ; The pui^pose of this research was to 
develop a conceptual scheme and a method ofguantifying maternal behavior 
I both from behavior observations and interviews. In order to be able to 
test theories of the effects of maternal behavior upon personality 
development of children it was necessary to organize two sets of data 
that had been collected by Dr. Bayley at the Institute of Child Welfare 
at Berkeley. 

Lfethods Biiployed : The set of concepts vftiich had been developed by 
Schaefer and Bell in the project which developed the I^rental Attitude 
Research Instrument were revised and attional concepts were added. 
Several trait-actions or specific behaviors were specified \daich de- 
fined each of the abstract concepts. Each of the trait-actions were 
rated on a seven point scale by each of the three judges for each case. 
^ combining the several trait actions vftiich defined each abstract 
concept and by combining the ratings of the three judges reliable 
scores on the maternal behavior concepts were obtained. This method 
was applied to sets of ten to twenty observations on each of 56 mothers 
on ^ftiom notes had been written from the child's age of one month to 
three years and to 3^ sets of one to two interviews with the mothers at 
the child's age of approximately ten years. 

Major Findings ; The method insulted in reliable ratings of maternal 
behavior from both behavior observations and from inteiviews. It was 
possible to define the abstract general concepts with specific be- 
haviors of mothers and to get agreement between judges from un- 
structiired written behavior observations and interviews ;diich had not 
been collected with this conceptual scheme in mind. 



^ 116 



Serial No. M-P-D-(c)-7-page 2 
Part A. continued: 



I 



Significance to the program of mental health research : Clinical re- 
ports have emphasized the contribution of the mother to the personality • 
development of the child yet few attempts have been made exactly to 
define or to quantify the concepts used. Many longitudinal studies of 
personality development have collected unstructvired observations and 
interviews with mothers but no method has been available with •vrtiich to ' 
quantify these data in terms of social -interaction concepts. The 
development of this rating scale will permit quantification of ton- 
structured observations, interviews and clinical descriptions of mother-; 
child interaction and will assist in testing theories of maternal influ-i, 
ence upon personality development. 

Proposed Course of Project : A paper on this project has been prepared 
and is being submitted to Child Development . The method will be used 
in future research. Project completed. 



I^rb B included Yes /""T " No jTJ 



- 117 



Serial No. M-P-D-(C)-8 
Laboratory of Psychology 
PHS-WIH Child Developnent Section 

Individiial Project Beport Bethesda 
Calendar Year 1957 



Part A. 



Project Title: Origins of Bnotional Dependency in Early Childhood: 
An Experimental Program. 

Principal Investigator: Jacob L. Gewirtz 

Other Investigators: None 

Cooperating IMits: None 

Man Years: rfe,tient Days 

Total: I0O7 None 

Professional: .'+5 

Other: ,62 

Project Description: Objectives ; To enauguiate a program of research 
in infants and young children on the basic acquisition processes under- 
lying 'emotional dependence'. It is intended to focus particularly 
upon children's behaviors like those employed to gain such positive 
social responses from adults as their attention, affection, approval, 
nearness, and caresses, and upon the earliest environmental conditions 
under v4iich they develop. 

Methods employed : Proceeding both from simple learning and performance 
concepts and from such theories as are available for tracing the early 
developnent of emotionsil dependence, it is intended to analyze the 
apparent complexities of that behavior class into skeletal terms, so 
that they may be related in a simple manner to the fundamental mechan- 
isms operating in the developing child. 

Methods are being explored with very young children vdiich reduce 
to relatively simple terms the complexities of the behavior \ftiich 
characterize emotional dependence in later childhood and \daich wo\ild 
relate those behaviors to critical aspects of myriad environmentsil 
conditions to \jhich young children are typically subject. A series of 
prototype essperiments with human infants in a highly controlled insti- 
tutional setting represents the core of the experimental program. 
Initially, these experiments will attempt to relate effects in the 
child's pattern of emotional dependence to variations in selected as- 
pects of the caretaking process, analyzed in terms of learning con- 
tingencies. At first, the reinforcing aspects of caretaking and adult 
responsiveness to the child are employed as variablesj and the range of 
adult responses which can function as reinforcers for the young child's 
beliavior will be explored. Selected stimulus events associated with the 
caxetaker are being set into a variety of contingencies with different 
responses emitted by the child. In addition, the attempt will be made 

- lis - 



Serial No. M-P-D-(C)-8 page 2. 

Part A. continued : 

Methods employed continued : to determine if environmental change or 
novel stimuli as, for example, noises or lights, within and without 
the caretaking process, can function to reinforce the child's be- 
havior. 

After soma of the more common reinforcers vAiich are provided by 
adult responses are deteimined, selected stimulus events (e.g., the 
attention of a caretaker) involved in or attached to the caretaking 
person may be set into a variety of contingencies with these rein- 
forcing aspects of the cai^taking process; and selected aspects of this 
process may be made contingent upon different responses emitted by the 
child. 

Majog findings: While this project is in its initial phase, some recent 
reseaxch (with Dr. H. Eheingold) suggests that a vocal response in 
three -month old infants can be conditioned through use of axi adult's 
complex social response as reinforcing stimulus. 
Significance to the prop;ram of mental health research: While it is 
probable that an understanding of the processes underlying emotional 
dependence will be critical to the understanding of a substantial 
portion of the social behavior both of children and adults, potentially 
useful to the theory of child rearing as well as to therapeutics, almost 
nothing is known either about the dimensionality or the antecedents of 
that behavior class. This research program constitutes a beginning in 
the direction of gathering such information under highly controlled con- 
ditions. 

Proposed course of project ; The "tooling -up" phase of the research 
program may requii« another six months before it will be fully under 
way. At that time equipment should be available to study a single 
. infant at any one time. The project will require a population of in- 
fants, ajid the search for such a source is now going on. Suitable ex- 
perimental techniques ai^ now being devised. 



Part B. included: Yes [J No f^ 



119 - 



PHS-NIH 
Individual Project Eeport 
Calendar Year 1957 



Serial No. M-P-D".(C)-9 
1. Laboratory of Psychology 
2o Child Development Section 
3. Bethesda 



lirt A. 



Project Title; 
Beinforcers 



The Effects of Deprivation and Satiation on Social 



Principal Investigator: Jacob Lo GevriLrtz 
Other Investigators: None 
Cooperating Units: None 



Man Years: 

Total: 1.11 
Prof e s sional : . U9 
Other: .62 



Patient Days: 
None 



Project Description: Objectives : Events ^ich are the "goals" of human 
social behavior are termed "social reinforcers," More specifically, a 
social reinforcer is defined as a social stimulus event \Aiich, if made 
contingent upon behavior, can systematically affect its output. It is 
generally assumed that social reinforcers (e.g., attention, approval, 
affection) have developed importance for people through a history of 
conditioning. 

Deprivation inrplies a period of unavailability of a given rein- 
forcer \diich re stilts in an increase in behaviors for it; satiation im- 
plies a period of availability of a reinforcer sufficient to effect a 
decrease in behaviors for it. Thus deprivation and satiation represent 
two statements of a single concept, a dimension characterized by the 
relative supply of a given reinforcer in the recent histoiy of the 
organism which determines the incidence of behaviors for that rein- 
forcer. Laws relating long -and short-term social deprivation as an 
empirically defined dimension to certain basic characteristics of social 
behaviors would have considerable integrative value (d.f. , e.g.. Spitz, 
Bowlby, and others )» But first the experimental operations of depri- 
vation and its inverse, satiation, must be implemented in social terms. 

Social reinforcers may be supplied and deprived in a variety of 
ways, and it is important to discover their responsiveness to many of 
these ways. It would be especially inrportant, for example, to imple- 
ment the deprivation of a single social reinforcer, rather than of all 
such reinforcers (as, for example, is acccanplished through social 
isolation in these studies). iUrther, it is essential to Jare some 
asstirance that social reinforcers are more or less homogeneous in this 
regard. 



- 120 



Serial No. M-P-D-(C) -9-page 2 

I^rt A. continued : 

^fethods employed and Ma.ior Findings to date : (l) Brief social iso- 
lation (equated to a condition of deprivation of all social rein- 
forcers) increased reliably the reinforcing power (i.e., the importance) 
of adult approval for children (aged 4~0 to 5-6) as a positive function 
of the degree to ^ich they typically sought such approval in other 
settings; and older children in this age range were affected to a 
greater extent than were younger children. (2) In children aged 6-6 
to 9-0^ it was found that brief social isolation (deprivation) enhanced 
the effectiveness of social reinforcers representing approval and 
social contact relative to a control condition (no treatment); and that 
a brief condition of satiation for approval and social contact decreased 
the effectiveness of those social reinforcers relative to the control 
condition. 

Significance to the program of mental health research : This project is 
a beginning attenrpt to gain an imderstanding of some classes of short - 
and long-term conditions constituting social deprivation, a concept of 
importance particularly in the child health literature. At the sams 
time it would provide additional understanding of the social rein- 
forcers (social goals) important for children, and possibly an under- 
standing as well of the conditions under -vAiich they develop. 

Proposed Course of Project : This is a program of research: a number 
of studies axe being published, and as additional studies axe completed, 
new ones will be begun. As relevant variables are isolated, it is 
intended that they be investigated paretmetrically -rfiere possible. 



Bart B. included Yes /xj Ho [ / 



- 121 - 



Serial No. M-P-D-(C)-9 page 3 

PHS-NIH 

Individxial Project Report 

Calendar Yeeir 1957 

Bart B ; Honors, Awards, and Publications 

Publications other than abstracts from this project : 

Q?he effects of deprivation and satiation on behaviors for social 
reinforcers. (with D. M. Baer) American Psychologist, 1957^ 12, ^MDl. 

The effect of brief social deprivation on behaviors for a social 
reinforcer. (With D. M. Baer) Journal of Abnormal and Social 
Psychology, in press. 

A note on the similar effects of low social availability and depri- 
vation on young children's behavior. (With Baer and Roth) Child 
Development , in press. 



- 122 - 



PHS-NIH 

ladivldual Project Beport 

Calendar Year 1957 



Serial Ho. M-P-D-(C)-10 

1. Laboratory of Psychology 

2. Child Development Section 

3. Bethesda 



Bart A. 



Project Title: A screening test for selecting parents on the basis 
of their attitudes toward children: relations between attit\ides 
expressed during the lying-in period and later behavior with the one- 
month old infant. 

Principal Investigator: Richard Q. Bell 

Other Investigators: Belinda Straight (Guest Investigator) 

Cooperating Units: None 



Man Years: 

Total : 1 .21 

Professional: .57 
Other: .64 



Patient Days: 
3h 



Project Description: Objectives ; To test the hypothesis that atti- 
tudes toward child i^aring practices expressed by mothers during the 
lying-in period are related to behavior with their infants at a later 
point in time. 

tfethods Employed: Primiparous mothers are assigned to a sub-group 
having a characteristic attitude pattern on the beisis of responses to 
a self -reporting attitude questionnaire administered during the lying-in 
period. The existence of such sub-groups was established by statistical 
procedures carried out in project NIMH 114(c) 1955* ^e mother's be- 
havior with her infant at the time of a one -month follow-up is rated on 
a variety of scales developed in project NIMH 11d(C) 1955* Similarity 
of mothers on the basis of such scales should be greater within sub- 
groups than between sub-groups if the parental attitude questionnaire 
is related to actual interaction with infants in any ccanprehensive 
way involving a variety of behavior. It is not necesseay that there 
be direct correspondence between ^at the mother says on the attitude 
questionnaire and how she behaves with the infant. 

Major Findings: The data gathering stage has been completed, but data 
Einalysis will require a major portion of the coming year. It is the 
impression of the investigators that the one-month follow-up examination 
used in this study provides relatively rich data on the natvae of the 
mother-infant relationship. It was possible to identify five mother- 
infant relationships \diich seemed incipiently pathological. This^ sug- 
gested to the investigators that a future stxidy might be designed 
specifically to test the adequacy of a first and second line mass^ 
screening approach, an initial ^screening during the lying-in period. 



- 123 - 



I 



Serial No. M-P-D-(C) 10 page 2 

Part A. continued. ., ^^j^,,, 

Ma.ior TWrifi-ti^g s mn-h-i mie>ri ? followed by a more intensive screening in 
the follow-vtp examination at one month. This type of sttaiy woxild re- 
quire sampling a much more extensive population than the study i 
currently underway idiich sanrpled only from specified statistical sub- | 
groups. 

Significance to the program of mental health research; If psychologicall| 
useful suh-groups can Ije identified it will simplify statistical operatic j 
involved in screening any population of young parents for those likely to 
form pathological relationships with their children. A one month foUov-il) 
examination could be \ised as a second-line of screening to reduce the I 
margin of error in the initial screening. The present study is an initia 
attempt to test out such screening operations on a limited scale with 
selected sub-grovtps from a larger population. 

Proposed Co\3rse of Project; Calendar year 1958 will be spent in analyz- , 
ing data now collected, and if viseful resvilts emerge sufficiently early 
it should be possible to resvme screening and follow-ttp procedures to 
focvis on any leads which emerge. 



Part B inclTaded Yes £J Ifo ^ 



- 12ij- - 



PHS-NIH 
Individual Project Report 
Calendar Year 1^7 



Serial No. M-P-D-(C)-11 
Laboratory of Psychology- 
Child DevelopmentSection 
Bethesda 



Part A. 



Project Title: Early Infant Personality Characteristics; 
orality, activity, and sensitivity in neonates. 

Principal Investigator: Richard Q. Bell 

Other Investigatoi-s : None 

Cooperating Units : None 



Stvidies of 



Man Years: 

[Dotal: .97 

Professional: .33 

Other: .6k 



Patient Days; 
None 



Project Description: Objectives : The objective of this project is to 
obtain some precise measures of infant characteristics in the immediate 
post-natal period. These characteristics will be vised to test the hypo- 
thesis that infant types exist prior to exposure to maternal care. 
Methods Employed: Ifotion pictvire records have been made of 31 infants 
96 hoturs old from Tdiich estimates are being made of cutaneous and kines- 
thetic sensitivity, auditory sensitivity, visual sensitivity, depth and 
amount of sleep, strength and muscle tone, reaction to fnxstration, 
feeding characteristics, nature of crying, and appearance. Measurements 
of feeding characteristics are based on an apparatus which when filmed 
in -oae reveals i^te, rhythm, and vacuum created in sucking. Other 
variables are estimated by rating infant behavior directly. Precision 
is achieved by repeated viewing of the films and making direct compari- 
sons between babies. Film records have also made it possible to detect 
and evalixate the effects of any deviation £rom standard circumstances 
or test administration at the time observations are being made. 
Major Findings : Although reliable rating of infants at this age has 
been diffictilt to achieve in other studies, use of the film technique 
has made it possible so far to achieve reliable measures of five of the 
variables rated xip to date. No findings will be available vmtil the 
remaining ratings are completed. 

Significance to the program of mental health research : Research on the 
effects of parent behavior on the emotional adjustment of children is 
handicapped by the fact that different children provoke different be- 
havior from their parents as well as react differently to their parents. 
Att^Dpts by other studies to identify congenital patterns in infants 
have'led to confusing results since very little consistency on individual 
measures has emerged over time. The present study will attempt to 
identify congenital infant types, and test the notion that infants will 



125 - 



Serial No, M-P-D-(C)-11 page 2 

Part A. continued* 

Significance to the program of mental health research continued; at 
later points in time fall into the same generic tjrpes even thou^ Hie 
basis of their being grouped has changed due to metamorphic growth 
processes* Thus consistency of pattern may be demonstrable in spite 
of lack of consistency in individvial measures correlated over different 
time periods. 

Proposed course of project; The ratings should be completed during 
this calendar year and some information on vhether clxisters or types 
e:d.st should be ascertainable soon thereafter. During calendar year 
1958 these data will be related to observations made on the same in- 
fants at one month. This project serves an independent purpose in 
studying congenital patterns in infants as well as providing control 
data for a related study NIMH— P-3(C) \riiich compares mother-Infant 
interaction in mothers grouped into one of five groups based on an 
attitude questionnaire. Dils project provides data on vhether the in- 
fants bom to the mothers in the jM.ve grovgps differ significantly prior 
to leaving the maternity hospital. 



Part B included Yes / / Kb /TJ 

- 126 - 



Serial No. M-P-D-(C)-12 

1. Laboratory of Psychology 

2. Child Development Section 

3. Bethesda 



PHS-WIH 

Individual Project Report 

Calendar Year I957 



Fart A« 



GOC 



Project Title: Further Studies of the Conditioning of Vocal 
,.f,~ Behavior in the Human Infant. 

Principal Investigator: Harriet L. Rheingold 

Other Investigators: None 

Cooperating Units : None 

Man Years (calendar year 1957) > Patient Days (calendar year 

1957) : 
Total: .05 
Professional: .05 
Other : 

Project Description: 

Objectives : The results of the first study suggest that the 
social vocalizations of three -month-old infants were conditioned 
(i.e. increased) by means of a social reinforcer. Several ques- 
tions were raised and require further study before the results 
can be unequivocally attributed to the experimental procedures. 
The first of these asks to what extent the stimulating properties 
of the reinforcer might have been responsible for the increase 
rather than its having been made contingent upon the child's 
vocalizing. The second asks whether home babies woxild respond 
similarly to the original institutional subjects. The third 
asks questions about the effect of different schedules and their 
use over longer periods of time. 

Methods Employed : Both home and institutional babies will be 
used. Intensive studies will be made of a few children, now 
that a result has been demonstrated in large groups of infants. 
To test the stimulating properties of the reinforcer, the re- 
inforcer will be administered at regular intervals (e.g. 10" 
apart) but never directly after a vocalization. To further 
test the possibility that operant conditioning did occiir in 
the original experiment, some work should be done with different 



- 127 



Serial No. M-P-D-(C)-12, page 2 

Part A. Project Description Sheet (cont'd.) 

schedules, with both fixed and variable ratios, with recon- 
ditioning after extinction, with continuing conditioning until 
certain predetermined rates of vocalizing are obtained. 

Major Findings ; These studies are in the planning stage. 

Significance of the program to MenteuL Health research ; If con- 
ditioning of any behavior can be obtained in the three -month-old 
hiunsin infsmt, we have learned an important fact about human 
learning. If, further, social behavior proves to be modifiable 
by environmental response, specifically a social response, we 
are closer to accounting for early differences in sociability. 
Finally, since the social behavior here studied is vocal, we 
may obtain clues to the later use of speech for social and 
perhaps other purposes. 

Proposed coiirse of the project ; The study will be begun in the 
next month or two. ' ■ — '^" 



^a^Q-i-i 



j.^-::.";-i.v. ^li*z.- 'j'^^.i.- 



Part B included Yes £J No /x7 



- 128 - 



Serial No, M»P-D-(C)-13 

1. Laboratory of Psychology 

2. CTnild Development Section 

3. Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: The Chick.' b Preference for Some Visvial Properties 
of Water. 

Principal Investigator: Harriet Lo Rheingcld 

Other Investigators; Dr. Eckhard H. HesSj, Department of Psychology, 
University of Chi sag: . 

Cooperating Unite; None 

Man Years : Patient Days : 

Total; .20 None 

Professional : ,10 

Other ; ,10 

Project Description: Objectives: The chick discovers and drinks 
water ver-y soon after ha-oching, "On tiie ass'osrption that water must 
possess some sharacteristie or pattern of characteriscics which 
draws the chick to itj, we set out to asalyze t-he "attractiveness" 
of water "s visxjal properties. The questions asked were: What are 
the visual properties of water which attract the naive chick? To 
what extent are these changed as the chick acquires experience with 
water? 

Methods Employed : Kewly-liatched chicks were presented with an array 
of six stimuli;, namely waber and five other siibstaaces,, each of which 
possessed some 5 but not aH, of the visual attributes of water. The 
subjects were 100 White Rock ehiclcs. Seventy- two of these, having 
no experience with food or water, were tested at the age of three 
days. Twenty-ei^t ■%rere control chicks also tested at the age of 
three daysp but these had been given food and water from the time of 
hatching. All animals were t-ested again foijr days 3,ater^ both 
experimental and control an.t!Bals having had access to food and water 
in the interval, except for 1.2 hoinrs of ^■ratev deprivation just prior 
to the tes-So 

Major Findings : The distributions of responses given hy experimental 
and control euiimals at both ages were sii^ilar. The order of stimuli 
for chicks three days old was mercury, plastie_, blue water, water, 
metal, and red water. Ejcperience with i^ater did not alter the 

- 129 - 



Serial No. M-P-D-(C)-13 page 2 
Part A. Project Description (cont'd.) 

position of mercury as first "choice" and of water as foiorth. 
It seems proTjatle that attractiveness to the chick lies in a 
comhination of a "bright reflecting surface and the movement of the 
stimulus . 

Significemce to Mental Health Research: Some investigators "believe 
that "behavior may "be released "by stimuli which are prepotent for 
the species, i.e., that certain stim\xLi are "innately releasing." 
While this principle may "be truer for lower-order species, it may 
also account for some of the "behavior of other species, e.g. the 
human infant. The present study demonstrates a method "by which 
this principle can "be tested. 

Proposed Course of Project: This study was executed in I955 at the 
University of CJhicago. It was prepared for pu'blication at NIH in 
1956, and in 1957 i't was accepted for pu'blication by the Journal of 
Comparative and Physiological Psychology. 



Part B included Yes /T/ No / :: / 



- 130 - 



Serial No. M-P-D-(C)-13-page 3 
PHS-NIH 
IndividueLL Project Report 
Calendar Year 1957 

Part B ; Honors, Awards, and Publications 

Publications other than abstracts from this project : 

Rheingold, Harriet and Hess, Eckhaiti. The Chick's Preference for Some 
Visvial Properties of Water. Accepted for publication by the Journal of 
Conrpsirative and HiysiologicaJ. Psychology. 



- 131 - 



Serial No. M-P-D-(C)-lll- 
,.-,-> 1 . Laboratory of Psychology 
'"-''"'' "~ 2. Child Development Section 

3. Bethesda ,.:,: ^ . ^ 

p . ... Individual Project Report - -■.:■-,.._.- 
,:T..., , -r. Calendar Year 1957 

Part A . 

Project Title : Increasing Social Vocalizations in the Infant by 
Means of an AdixLt's Social Response (formerly: Ttie effect of 
social reinforcement upon social behavior in the hvanan infant: 
the effects upon vocal behavior.) -^ ^^r- 

Principal Investigator: Harriet L. Rheingold ,q r■,e.c,,•^cfo'3:^ 

Other 3Javestig^tP?§.: Jg,c9b,,ii. Gevirtz -•■-* 

Cooperating Units: None 

Patient Days: 
2 



Man Years: 




Ibtal: 


.90 


Professional : 


.ko 


Other : 


.50 



Project Description: Objectives : Vocalizations are a prominent 
component of the response three-month-old infants give to an adult. 
In turn, adults often respond to -Uiese vocalizations. If the 
advilt's responses are made contingent upon the infant's vocalizing, 
thus functioning as a social reinforcer, will the infant increase 
his rate of vocalizing? 

Methods Employed : Twenty-two three-month-old infants were studied 
in two separate experiments. In one experiment 11 babies were 
reinforced by one experimenter; in the other, 11 different babies 
were reinforced by another experimenter. 

The basic unit of measure was the nimber of discrete vocali- 
zations produced by an infant during three-minute periods. Vocal- 
izations were coimted for nine three-minute periods distributed 
throughout a day. 

In the baseline condition, the first two days, E leaned over 
the baby and looked at him with an expressionless face. Uilder 
conditioning , the next two days, E reinforced vocalizations by 
simulteineously smiling cluclcing, and lightly pressing the infant's 
abdomen. During the last tx<ro days, extinction, E retvirned to the 
expressionless face of the baseline condition, and made no response 
to the infant's vocalizations. 

Major Findings : By means of the social reinforcer the number of 
vocalizations was raised from the baseline mean of 13 to a mean 
of 2k.Qf an increase of 86.5^« Removing the reinforcer depressed 

- 132 - 



Serial No. M-P-D-(C)-lU page 2 

Part A. Project Description (cont'd.) 

the rate until "by the second day of extinction it was close to the 
level of baseline performance. The results suggest that (a) verhal 
"behavior produced by three -month-old babies in a^ aocial situation 
can be very quickly broii^t under control and ^t) eui everyday 
complex of acts, typical of a mother's social behavior can function 
as a reinforcer. • " 

Significance for Mental Health Research ; This is part of a larger 
inquiry into how different components of mothering influence the 
development of social behavior in the human infeint. 

Proposed C!o\irse of Study: The study has been completed sind the 
data analyzed. It was reported at the 1957 American Psychological 
Association meetings eind now is being prepared for publication. 



Part B included Yes £J_ No ^ 



' 133 - 



Serial No. M-P-D-(C)-15 

5scr •?I-(5)-fr-^-M .oW Xst-x^v. j.. Laboratory of Psychology 

2. C3iild Development Section 
3 • Bethesda 

PHS-KIH 
Individnal Project Report 
Calendar Year I957 

Project Title: A Follow-Up Study of Social Responsiveness in a 
Group of Institutional BaMes. 

Principal Investigator: Harriet L. Rheingold 

Other Investigators: Nancy Bayley 

Cooperating Units : None 

Man Years : Patient Days : 

Qbtal: A6 None 

Professional: .20 

Other: .26 

Project Description: Objectives : Eight experimental infants, as 
a result of special mothering, showed a marked Increase in social 
responsiveness with little, if any, significant increase in in- 
tellect\3al performance. One year after termination of treatment 
both experimental and control babies were tested to discover if 
the experimental babies showed any persisting effects of treatment. 

Methods Employed ; Fifteen children were located and examined 
in their own homes by the second investi^tor who did not know 
the children's experimental status. All but one of the children 
had left the institution for their own or adoptive homes. They 
were given the Cattell Infant Intelligence Scale and a specially 
constructed test of social responsiveness. Incidental informa- 
tion was obtained on the mother and the home. 

Major Findings ; The babies were found to be living in a great 
variety of different life situations. The "intellectual" per- 
formance of both groups was practically identiceil . The experi- 
mental subjects, however, were more responsive ("Hhen positive 
and "negative" reactions were given equal weights) than the 
control subjects (£ at the .1 level). Especially interesting 
were the marked ne^tive responses shown by two experimental sub- 
jects. 

Significance for Mental Health Research ; Generally it is assumed 
early ejcperience will affect later behavior. This study seeks to 

„ 132+ . 



Serial No. M-P-D-(0)-15 page 2 

Part A. Project Description (cont'd.) 

discover the extent to vhich this assxanption may "be accepted in the 
case where social behavior vas modified in the sixth, seventh, and 
ei^th months of life and then assessed one year later. 

Proposed Course of Project : The data have "been analyzed. The study 
will be written up for publication. 



Part B included Yes £J No ^ 



' 135 - 



Serial Wo. M-P-D-(C)-l6 

1. Laboratory of Psychology 

2. Child Development Section 

3. Bethesda 



PHB-MIH 

Individiial Project Report 

Calendar Year I957 



Part A. 



Project Title: The Differential Responsiveness of Infants to 
Familiar and Unfamiliar Persons. 

Principal Investigator: Harriet L. Rheingold 

Other Investigators: None 

Cooperating Units: None 

Man Years : Patient Days : 

Total: .38 None 

Professional: .I5 

Other: .23 

Project Description: Objectives : It was predicted that infants 
responsive to the social overtures of a person iJith whom they 
were familiar, .; . -n though this person had performed fevf, if any, 
caretaking acts for them, than they would be to a person totally 
strange . 

Methods Employed : In order to test the proposition the re- 
sponses of '+0 institutionalized infants, k to 10 months of age, 
were obtained to three different persons. The first v/as the 
person in charge of the floor who had some contact with all the 
babies but who did not routinely perform caretalcing services for 
them. The second was an unfamiliar person who \Tore the same 
distinctive garb as the first person. The third person had never 
been seen by any of the babies before the day of testing. In 
garb she did not resemble the first person but instead the class 
of persons who regularly cared for the babies. The order in 
which the three persons presented themselves to the babies was 
systematically varied. 

Major Findings : The infants appeared to be most responsive to 
the third person, the stranger. Tvro possible explanations are 
being explored. One is tliat the stranger possessed greatest 
novelty value. The -second is that the response to the stranger 
represents a response which has generalized from the infants' 
experiences with caretakers who, in general, were constantly 

- 136 - 



Serial No. M-P-D-(C)-l6 page i 
Part A. Project Description (cont'd.) 

changing persons (volunteers). 

A more detailed analysis is now in process. Contemplated are 
studies of the contribution each subtest makes to the total score; 
of the extent to which subtest scores cast light upon the mechan- 
isms responsible for the differences in response to the three 
persons; of the ratio of positive to "negative" responses accorded 
each person; of number of vocalizations made by the infant in re- ■ 
sponse to each person; of changes in response with age. Responses : 
can be compared with those given a constant caretaker (obtained froit 
an earlier study). 

Significance for Mental Health Research ; This study is part of a 
larger program which seeks to explore the development of socia- 
bility in the infant. It is assumed that early manifestations of 
social behavior influence later behavior and that social behavior 
is central to an understanding of personality. i 

Proposed Course of Project ; The data have been gathered and are 
being analyzed. 



Part B included 



Yes fj_ No ^ 



- 137 - 



Serial No. M-P-D-(C)-1T 

1. Laboraix)ry of Psychology 

2. C!hild Development Section 

3. Bethesda 



PHS-NIH 
Indlvidioal Project Report 
Calendar Year I957 



Part A. 



Project Title: The Effect of a Strange Environment upon the Behavior 
of Infants. 

Principal Investigator: Harriet L. Rheingold 

Other Investi^tors : None 

Cooperating Units : None 

Man Years: Patient Days: 

Tbtal: .55 I8 

Professional: ,30 

Other : , 25 

Project Description: Objectives : It is predicted that infants, 
even in the first few months of life, are sensitive to changes in 
both the physical and hi;raan components Of their environment. This 
stvidy seeks to discover the kinds of behavior which are affected 
by change, the degree to which they are affected by sittiations 
reinging from minimal to maximal change, individTial differences in 
reactions eind the relationships between these variables and the 
infant's age. 

Methods Employed: Severeil related studies are planned, using 
home and institutional babies, in situations which involve differ- 
ent kinds and aaaounts of change. The first pilot study is being 
carried out on twins, who are examined at monthly intervals both 
in their home and in the Clinical Center, usually on successive 
days, the order of place of examination being alternated regularly. 

Major Findings : By the fifth month of age the babies began to 
give a more restricted performance at the Clinical Center on the 
tests used, that is, on tests of social responsiveness to the 
mother and to a stranger, and on tests of developmental progress. 
At present the twins are eight months of age. 

Significance for Ifental Health Research; The general problem is 
the charting of the gro-v/ing awareness of, and sensitivity to, the 
environment in the human infant. The problem caai be attacked by 
measuring his responses to changes in his environment. The term 



- 138 - 



Serial Kb. M-P-D-(C)-1T page 2 

Part A. Project Description (cont'd.) 

"environment" is conceived "broadly and includes l)oth people and things. 
Some changes may produce an acceleration of growth, some may inhibit 
it. In another sense, change may he viewed as frustrating, and the 
alternations in "behavior as modes of defense. 

Proposed Course of Project; The twins will "be examined monthly 
•until they are twelve months old. After the resvilts are analyzed, 
a more definitive study will he set vp. 



Part B included Yes £J No Jx/ 



- 139 - 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Clinical Investigations 
Laboratory of Psychology — Section on Personality 



BUDGET SHEET 



ggtlmated Qbligatigns fpr,n:.,19'?8 
Total: $92,675 
Direct: $69,597 

Reimbursements : $23 , 078 



Projects included! M-P-P(C) 1 through ^^.P-P(C) 12 



Serial No. m-P-P°(C)°1 

lo Laboratory of Psychology 
2o Section on Personality 
3e Bethesda 



PHS-NIH 

Individiial Project Report 

Calendar Year I957 



Part A. 



Project Title: Communication of Value Systems Between Therapist and 
Schizophrenic Patients 

Principal Investigator; Itorris Be Parloff^ Ph^Ds 

Other Investigators; Norman Goldstein^ MeDa^ Boris Iflxindj, Ph^D. 

Cooperating Ifoits: None 

Man Years (calendar year 1957: Patient Days (calendar year 1957): 
Total: ..68 None 

Professional: *20 
Other: .H8 

Project Description: 

Ob.lectives; To devise techniques for the study of the process by which 
the schizophrenic patient learns the therapist's value system re^ 
garding therapy, and by which the therapist learns the patient's 
values.. 

Methods •p^rrplnypd; Topics introduced by schizophrenic patients in daily 
psychotherapy sessions were recorded by observers and presented to 
the i)atient and therapist at the end of each session s. Topics were 
independently rank ordered by therapist and patient regarding im» 
portaace for therapy s. Each participant also predicted the sortings 
of the other « Changes in understanding and convergence of values 
over time was compared for inrproved and unimproved patient* 

Patient Material ; The study focusses on two paranoid schizophrenic 
cases treated individually by the same therapist over a period of 
approximately two years » One patient recovered » 

Major Findings : 

1* The therapists values regarding the ingrartance of content for 
psychotherapy is communicated to the patient*. 

2» Acceptance by the patient of the therapist* s values varies 

consistently with such factors as day of the week and therapist's 
responses and activity level « 



l^i-O 



Serial No. M-P°P-(c)-l-Page 2 

Part A. Project Description (Coat'd) 

3. A positive relationship was foimd laetween the therapist's mode 
of response to a topic ("approving" or "disapproving") and the 
rate at which the patient subsequently introduced the topic. 

k» Although the patient's choice of topics appeared to he con- 
sistent with the therapist's expressed values, the patient's 
own evaluation of these topics in some instances, moved quite 
independently . 

5. A patient's verbal "behavior may appear to be superficially 
compliant to the unconsciously expressed expectations of the 
therapist, without the patient having internalized such 
therapist-values . 

Significance to the Program of Mental Health Research : Basic to the 
understanding of psychotherapeutic treatment of schizophrenia is 
the tinderstaading of the interrelationships between therapist 
and patient. It is this relationship that provides the con- 
ditions which permit the patient to learn that it is safe to 
give up his defenses and to learn more adaptive ways of re- 
lating. The above technique permits the study of the factors 
influencing the learning process which occurs in theraiy. 



Part B included - No 



1. Laboratory of Psychology 
2;. Section on Personality 
3i. Betliesda 



Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: Nature and Stability of Psychiatric Nurses Concepts of 
Their Roles 

Principal Investigator; Morris B* Parloff^ Ph*D» 

Other Investigators; Charlotte Schwartz, M.A. , TAn* G» Jenkins^ M.-D^ 

Cooperating Iftiits; Adult Psychiatry Branch, Socio^Environmental Studies, 

and Laboratory of Clinical Sciences 

Man Years (calendar year 1957)' Patient Days (calendar year 195*/); 
Total: *88 None 

Professional; =20 
Others «68 

Project Description: 

iK 

Objectives ; 

1« To develop an instrument for measuring nursing role concepts* 
2. To describe the "Ideal Nursing" concepts of psychiatric nvirses 
at NIMH and to compare them with (a) "Ideal Nursing" concepts 
of varying degrees of psychiatric training and (b) other re= ill 

lated professions® views of the '"Ideal Nursing" concept e^g^, '' 

administrative psychiatrists # psychotherapists, attendants etc. 
3 c. To investigate the relationship between initial nursing^role f 

concepts of staff members and (a) professional ident if i cations # 

(b) nature and extent of training^ and (c) experience*. 

U, To study the relationship between nature and extent of changes ' 
in nursing role concepts and (a) the initial discrepancy be- 
tween the "prescribed" role and the individual's own role 
concept^ (b) time of exposxire to prescribed philosophy^ 

(c) professional identification, and (d) trainiag and experi- 
ence. 

Methods Employed; A 60 item Q^ssatple was devised<» This Q-^deck 
consists of statements describing attitMes and behaviors of 
psychiatric nursing personnel in dealing with psychotic patients. 
These were sorted periodically by all staff members of the Adtalt 
Psychiatry Branchj. NIMHo The attitudes of staff members on each 
ward were ccmpared with the '"nursing role" concept of the ward 
administrator. Data were obtained from 23 psychotherapists^ 

- 1^1-2 =- I 



Serial No. M°P-P-^(C)-2 - Page 2 

Part A, Project Description (Cont'd) 

5 ward administrators (psychiatrists) an experimental grot^ of 19 
psychiatric nvjrses and a control group of 19 psychiatric niirses. 
The study covers a period of two years during which each of the 
five administrators attempted to establish different treatment 
philosophies on wards treating chronic schizophrenic patients. 

^fel.1or Findings ; 

1. Psychiatrists and nurses showed consistently different con- 
cepts of the preferred psychiatric nursing role. 

2. Nurses initially show small but statistically significant 
modification of their nursing concepts in the direction of 
the new ward philosophyi however, these changes were unstable 
and disappeared in time. 

3. The less acceptible a ward administrator's philosophy was to 
nurses initially, the less it was finally accepted by them even 
after 21 months of exposure to it. 

Significsmce to the Program of Ifental Health Research ; The ward 

administrator who wishes to conduct research regarding the natxire 
and effectiveness of a given "ward milieu" philosophy is dependent 
on the nursing staff for the faithful implementation of his ideas. 
This raised basic questions regarding the processes of accomplishing 
the goals of communication and acceptance by the nurses of the ex- 
perimental philosophy. Our findings suggest that in selecting a 
ward staff, attention should be paid to the fact that (l) Training 
differences between psychiatrists and nurses may result in basic 
differences in expectation regarding nursing roles, and (2) The 
nvirses' concept of her position may effectively limit the kinds 
of ward atmosphere that may be established. 

ProTX>sed Course of Pro.lect ; Project has been completed and paper is 
heing prepared for presentation at the Annual Meeting of the 
American Psychiatric Association in San Francisco, May 1958. 



Part B included = No 



Serial No. M°P-P°(C) 

1. Laboratory of Psychology 

2, Section on Personality 
3e Bethesda 



PHS-HIH 
Individual Project Report 
Calendar Year 1957 



Part A» 



Project Title; Evaluation of the HIH Research Associates Training Program 

Principal Investigator; bforris B« Parloff, Ph,D«, Herman Turk, M.A. 

Other Investigators; Donald S. Boomer, Ph.Do, Allen To Dittmann, Ph.D., 

Joseph Ho Handlon, Ph.D., James Kincannon and 
Marvin Waldman, Ph.D. 

Cooperating IMits; laboratory of Socio-Environmental Stvidies 

Man Years (calendar year 1957) J Patient Days (calendar year 1957): 
Total: .85 None 

Professional: .31 
Other: .511^ 

Project Description; 

Ob.lectives ; To prove data permitting the directors of the Research 
Associate Program to evaluate: 

a) The extent to which the program meets the goal of communicating 
basic research philosophy and techniques to the medically trained 
investigator. 

b) The reactions and recommendations of trainees currently in the 
program. 

Methods Enrployed ; 

1« Open<=end and structured interviews at regular intervals with 
the entire Research Associate group on individual career 
aspirations and reactions to the Program. 

2. Analysis of background data on the Research Associates to pro- 
vide a framework for 1. above. 

Mft^^n-r TJHwfU^ripfg? Cannot be reported as yet. 

Significance to the Program of Mental Health Research : One of the 
basic problems of any research organization concerns the question 
of selection of personnel and provision of the appropriate setting 
to enhance the research capacity of the individual. This study 

. m.14. „ 



Serial No. M~P-F-(C)«3 - Page 2 

Part A. Project Description (Cont'd) 

may provide some preliminary notions concerning the nature of the 
intricate relationships "between l) the capacities of the investi- 
gator-trainee, and 2) the attributes of the training setting in 
assisting the Investigator to utilize his potentialities creatively. 

Proposed Coxnrse of Pro.lect ; Periodic data collection will extend over 
a period of about two years. A preliminary report will be made on 
or about November 13, 1957* 



Part B included - No 



- 1^5 



Serial Ko= 

1. Laboratory of Psychology 
2« Section oa Personality 
3o Bethesda 



PHS-ISIH 
Individual Project Report 
Calendar Year I957 



Part A, 



Project Title; Attitude Changes in Nurse Trainees Subsequent to 
Psychiatric Training 

Principal Investigator; Morris B<, Parloff, Ph.D. 

Other Investigators; Donald S. Boomer, Ph.D., Marvin Adland, M.D, 

Cooperating Ifeits; Chestnut Lodge, Rockville, Maryland 

Man Years (calendar year 1957) s Patient Days (calendar year 1957): 
Total: ,58 None 

Professional; .30 
Other;. 28 

Project Description; 

Objectives ; 

1. To determine the "nurse-patient" attitude of nurse trainees 
prior to and following three months of psychiatric training o 

2. To investigate the relationships among personality variable®, 
conditions of training and nattore and extent of changes sub- 
seijuent to training. 

3« To determine the relationship between "suceess" in psychiatric 
field work and personality and attitude measures. 

Methods Employed ; Before and after a 3 month field work placement at 
Chestnut Lodge, 62 nurse trainees described their concepts of 
"Ideal Nxjrsing" of psychotic patients, con5)leted the Welsh Anxiety 
and Repressions Scales, the Fascism Scale, and the Leary Inters 
personeQ. Checklist. The staff nurses were similarly tested. The 
nature of changes will be related to the personality measures 
available. Each student is graded on theory and practice. These 
grades will be related to (a) degree to which the students* final 
attitude approximates that of the staff nurses' and (b) the degree 
of authoritarianism, "Anxiety and Repression", 

tfetjor F iadtogg; 

1, Nurses scoring high on the Fascism scale have significantly 
less "permissive"' attitudes toward psychotic patients than do 
nurses low on the Fascism scale. 

» li^6 - 



Serial No. M-P-P-(C)-t^ - Page 2 
Part A. Project Description (Cont'd) 

2» In the course of the training progrMn, students^ personeility 
(as measured by the above instruments) show the following 
changes: significant decrease in "repression", a tendency to 
be less anxious, and significantly less authoritarian in their 
general attitudes. 

3. Nursing Role Concepts are altered generally in the direction 
desired by the training staff with the exception that trainees 
reveal a significantly increased emphasis on "Riysical Care". 
This latter finding may be interpreted as a response to covert 
training or an anxious reaffirmation of basic nursing concepts. 

k. Nurses who subsequent to training decided to enter psychiatric 
nursing revecJ. a significant increase in emphasis on "Qnotlonal 
Care" of the patients. This change is not found in nurses not 
desiring a psychiatric nursing placanent. 

5» No relationship was found between personality measures and 
success as measured by grades received. 

Significance to the Program of Mental Health Research ; Information 
regarding the selection and training of nursing personnel is of 
importance to NIMH in view of the heavy emphasis placed on the 
establishment of a therapeutic ward milieu to facilitate treat- 
ment of schizophrenic patients. Since the nurse is expected to 
play a critical role in this program, information which would 
facilitate appropriate selection and subsequent training would 
be useful. 

Proposed Course of Pro.iect ; These and other findings have been 
prepared for publication. A paper also is to be read at the 
American Psychiatric Association Annual Meeting in May 1958 • 



Part B included = No 



- 1^4-7 - 



Serial No. M«»P-P-(C)-3 

S.<^ Laboratory of Psychology 

2« Section on Personality 
3o Bethesda 



Part A. 



Project Title: The Process of Change and the Conmnmication of Value 
^sterns in Psychoasmlyfcie Therapy 

Principal Investigator: Morris B, Parloff, PhaD,, Seymour Perlin, M.D, 

Other Investigators: None 

Cooperating Units: Laboratory of Clinical Sciences 

Meua Years (calendar jrear 1957) J l^tient Days (calendar year 1957)5 

Total: .US 1 in°patient = 30 patient days 

Professional: ,20 3 outpatients = 30 patient days 
Other: .28 

Project Description: 

Ob.lectives: To study the nature and direction of change in: 

1) VaQ.ue systems of the analysand, analyst and control analyst. 

2) Perceptions of self and each other during the period of 
psychoanalysis (approximately 2 years). 

3) Psychodynamics of the analysand. 

Methods Tgrnployed ; Data collection techniques include two Q-sorts that 
are administered to all participants periodically during the 
treatment period. One Q-sort is descriptive of "Moral Values" 
and the other descrihes attitudes and "behavior ranging from 
normal to pathological. A "battery of psychological tests are 
administered at six month intervals to each of the patients. 

Patient Material ; Three psychoneurotic outpatients and one ambulatory 
schizophrenic patient "began trealanent with Dr. S. Perlin approxi- 
mately l8 months ago and have continued to date. Each case is 
imder the supervision of a different "control" analyst. These 
nine individuals are the subjects of the study. 

Ma.ior Findings ; No detailed analysis of the data has "been xjndertaken 
since material is still "being collected. 

Significance to the IFtogram of Me ntal He alt h Research ; This study is 

^■■■■iMIMliwiJiiilB.ii.lwiiiiiLii luMl ii i M . ii >wi i i i w wfil iiii n pi W i i M m" iii 1 IT n T r w rrnfmifii i i ii iii' iii T nfnnnrTTtnT r i in"Ti'-T~iM i i i rrTT~~'^~^^--~ ' * 

consistent with the NIMH general interest in psychotherapy for it 
attempts to investigate some aspects of the psychotherapeutic 
I'process and the natere of changes effected in patients whose 
-treatanent is carried through to "eoi^Ietioa'" . One focus of this 



I'^S 



Serial No. M-P-P-(C)-5 - Page 2 
Part A. Project Description (Cont'd) 

study takes up the popularly raised question that since effective 
therapy is an "attitude change** and "influence" procedure, the 
patient in addition to "being assisted to modify his pathological 
perceptions may he influenced to take on the moral values of the 
therapist. Another area of significance to HIMH is the emphasis 
on descrihing the nature of the changes in the patients' personality 
over a period of extended intensive therapy. 

Proposed Course of the Pro.ject ; The final rete sting of patients is 
currently underway. The data will be analyzed and presented for 
publication. 



I^t B included - No 



- li^9' 



Serial No, M"P-P-»(C)-6 

Laboratory of Psychology 

Section on Personality 
Bethesda 



ras-KiH 

Individual Project Report 
Calendar Year 1957 



Part A, 



Project Title: Development of an Ego-Integration Conceptual System 

for Studying Psychotherapy 

Principal Investigators; Donald Se Boomer^ PhoD*^ D» Wells Goodrich, McD, 
Other Investigators: 



Cooperating Units: Community PsycMatric Clinic in Rockville^ Mi», 

Washington Mental Health Clinic, Laboratory of 
Clinical Sciences, and Section on Personality Theory 

Man Years (calendar year 1957): Patient Days (calendar year 1957) J 
Total: 1.72 Outpatients - 42 patient days 

Professional: «80 
Other: .92 

Project Description: 

Ob.lectives : (l) Lomg-term: To develop a theoretical model and observa- 
tional tools for the purpose of generating and testing a network 
of hypotheses about the conditions of personality change. 
(2) Immediate: To organize a loose set of clinical-theoretical 
ideas and observations into a coherent model, as indicated above, 
and to determine the feasibility of observing certain critical 
changes in patient behavior during psychotherapeutic sessions » 

We are concerned with the moment->to=moment level of ego° 
integration in the patient in his dealings with the therapist* 
We have conceptualized and hope to be able to identify in action 
■ four pattern® of ego integration smong •atoieh patients are pre° 
simied to shift during a therapy session* These have been carefully 
spelled out, but for the purpose of this report, brief descriptive 
summaries must swffiees 

Defended (f.) - The patient is controlling anxiety by his 
customary means, and is functioning at his characteristic 
level, involuataz'ily revealing frcm time to time, the ego- 
distorting aspects of his defensive fusietioning. 
Partially defend ed (^_»)^ - Similar to f «, but less stable 
and ccanfortableo Patient displays some readiness to move 
toward a suspension of hi® defenses, with eeneciBitant pre° 
monitory an3d,aty<, 

- 150 - 



Serial No, M"P-P-(C)-6 - Page 2 

Part A, Project Description (Cont'd) 

Self observing (o.) - The widely-described "split ego" state 
in which the patient is monitoring his own behavior and 
considering simultaneously, or in rapid alternation, hie 
feelings, his behavior and his defenses. 

Decompensated (co) - The overwhelmed ego: Anxiety is so high 
as to submerge defenses, disrupt some or all ego functions, i 
and interfere with interpersonal and task-directed functioning. ] 
This may be a clear open panic state or a transitory disturbance^! 
virtually unnoticeable unless reported by the patient. 

Methods Enroloved; The investigators function together as a therapist- 
observer team, utilizing a one=way observation screen and a tape 
recorder for monitoring and recording the content of the inter- 
views. Each investigator functions periodically as observer for 
the other's psychotherapy. In addition to the content of the hour, 
the observer's amplifying description of non-verbal events is 
electrically recorded. 

These records provide a basis for regular discussion aimed 
at refining our concepts and operations. In addition to the 
theoretical work, we are exploring a set of verbal measures which 
we hope to use in the context of the ego-state model. 

Our effort at present is primarily focused on two such measures: 
(l) Speech disruptions, and (2) The interpersonal locus of the 
patient's productions, gauged at the manifest level. 

The speech disruption measure, adapted from tfahl, is a simple 
count of the incidence of a set of specified disruptions in speech, 
such as stutter, superfluous repetition, tongue-slip and the like. 
We are attempting to determine what effect rate of speech has on 
the incidence of these speech disruptions. 

The interpersonal measure we are developing consists of a 
set of clearly defined categories for characterising what or whom 
the patient is talking about, along a scale which ranges from 
things and abstractions through Increasingly intense personal 
relationships to the relationship with the therapist. 

It is our aim to use these measures, together with others 
yet to be developed, to define shifts in the patient^s ego state. 

Patient Matfirifti i Two female psychoneurotic outpatients are currently 
serving as ovcc subjects. One is being seen twice weekly by 
Dr. Boomer; the. father four times weekly by Dr. Goodrich. Briefer 
courses of therapy have been completed with three other patients. 
We conten5)late the addition of from three to five more patients 
during the coming year. 

- 151 - 



Serial lo<, M-P-F°-(C)-6 °> Page 3 
Part A. Project Descriptioa 



Sigyilficance to the Prograa: of Mental Health Eeseareh; The syste= 
matie inyestigation of relevaiet aspects of psyefeotlierapy is a 
salient part of the program of KIMH. This project may con- 
tribute to this effort directly with suibstantive findings or 
indirectly with methodological SEd conceptiual developnents 
which caii "be utilized ia other parallel investigations. 

Proposed Course of the Pro.lect ; This work, as currently envisaged, 
will continue throughout this year and well beyond. Some 

carefully controlled def iaitive work will be carried out 
during this year with regard to the incidence of speech- 
disruptions and the correlates of high and low incidence o The 
broader conceptual=t&eoretieal work of formxilating a model will 
also continue along the lines outlined above o 



Part B included - No 



152 - ,; 



Serial No. M°?-P-(c)-7 

lo Laboratory of Psychology 
2c Section on Personality 
3o Bethesda 



PHS=EH 

Individual Pl'-oject Seport 

Calendar Year 1957 



Part A, 



Project Title; Patterns of Responses on Psychodiagnostic Tests 

Yielded by Patients Suffering from Various .r-;vycho- 
somatic Diseases 

Principal Investigator; Joseph Ho Handloa^ PhoD. 

Other Investigators; Hone 

Cooperating IJiits: Hone 

Man Yeeor's (cs^ei-'.ds.r year 1937)? Patient Days (calendar year 1957): 
Total: .19 None 

Professional: «11 
Other: .08 

Project Description: 

ffl?.1ggUYgg; 

a. General: To study the rsletionsMps "betvyeen Indiifidoal personality 
struct'ore ar^d susceptibility to the various psycl-j.oscEatic diseases. 

b. Specific: Prelisnins^rjf to fur-S'ier study of this ■pi^o'blanD.^ a coarplete 
survey is to be made of the results of pra\rious studies relating 
patterns of responses oii psychodiagi2>ostic tests to specific 
psychoscaiatic diseases. 

Methods Enmloy ^d; It T>rill first be necessaxy to review ojrlta ex- 
haxxstively the findiiigs of isrevious ia^-estigators wio fcave 
attempted to relate vario'^is issychoscrastic iiJjaesses with specific 
responses on psychodiag^ostie tests. Af^feer a OHTetcl. eoiKpiiation 
of such resxilts, caaimon p5,ttsms -wilJ. be looked for. If such 
cammunE.:Ilties are fo^iad^ an atteiapt will be weAe to relate this 
with what is known about personality dj'nsmLcsi and sucli res'olts 
will serve as a base for further refineaient of diagnostic work, 
partici-Larly in relationship with preventative medicfjie. 

Sianificapce to the Il:or^-.as^.oT.¥jsr.:t!s2^JB&&2^Ui..BQS.QSXd^ It is hoped 
that the results of tb-is studs'- tirill shed some light on the 
etiology, general dyui^a^sdcE of, aad the appropi:'iate therapeutic 
interventions necessary for psychosomatic illness. It is also 
hoped that more refined diagnostic methods snay be discovered 

- 153 - 



Serial No. M-P-P-(C)-7 - Page 2 

Part A. Project Description (Cont^d) 

which vill make for more accuracy in the early discovery of the 
disease, as veil as the specifying of personality types vho 
wovild be likely to fall victim of such illnesses vith an eye 
to preventing such an occurence. 

Proposed Coiirse of the Pro.lect : An exhaustive search of previous 
studies which have used a variety of techniques upon a variety 
of disease entities will precede an analysis of the consistent 
patterns fo\md in such stiidies. If such patterns are found and 
diagnostic instruments can he refined, further empirical vali- 
dation of such findings will he attempted. 



Part B. included - No. 



- 154 - 



Serial UOc M-?-P--{G)~8 

1. Laboratory of Psycb.ology 
2o Sactioa on Personality 
3. Bethesda 



PHS-MIH 
Individual Project fieport 
Calendar Year 1957 



art A. 



Project Title: Development of Objective Measxires of "Mental Health"* 

Principal Investigators; Joseph H.. Handlonj, PfaoDo, Morris Rosenberg^ PkoD,^ 

Leonard Pearlin^ Ph»D« 

Other Investigators: None 

Cooperating IMits: laboratory of Socio-EnirirorEaeatal Studies 

Man Years (calendar year 1957)? Patient Days (calendar year 1957): 
Total: »kO Hone 

Professional: .11 
Other: .29 

Project Description: 

Ob.leetives ; 

1« General: To develop techniques for the economic evalxxation of 

"mental health" of large samples of subjects* 
2, Specific: To apply the Guttrran Scalogram Technique in the develop- 
ment of valid and reliable measvires of "mental health", 

^fe-|j ^9d Emploved ; An analysis will be made of questionnaire items of more 
or less loiown validity and reliability. In order to reduce the 
manber of items administered to the respondent, the Guttaian method 
of scalogram analysis will be employed to evaluate various existing 
personality scales of several well laioim questionnaires. Using 
those protocols which are at the present time available to us, the 
items will be processed to see if they lend themselves to the scalo- 
gram analysis. If a variety of items are found to scale, they will 
he further validated on selected samples of individuals^ aiid results 
compared with other clinical tasts. 

Major Findings ; No findings to report as yet. Project has just begun. 

^^;S3^S^S^m,.^.,:^JS2^^^.2lJ^^^MSi^m^M§^QU^ if -the socio- 
environmental ijifluence of a coramuiaity iipoti the mentaJ. health 
of individuals living ^rlthin tliat ccfinamnity is to be stuiLied with 
any adequacj!-, it will be necessary to develop techniques that lend 
themselves to such a study. So far there bave been few attea^ts 

- 155 - 



Serial No„ M-P-P-(C)-8 - Page 2 
Part Ae Project Description (Cont'd) 

to develop methods by which large segments or tlie popiolation can 
be sampled and eval>J!at6d* If suc'3 siethods can be devised, it 
will mean that much important information heretofore not 
available to investigstors who are interested in stiadying in an 
objective fashion cOTmimity health problems will now be available, 

Prppq sed Course ._of .. tl),e„Stafflbr t After a statistical analysis of the 
data now available at KIMH, the resialts will determine whether 
such previously used meastires lend themselves to scalogram 
analysis. If satisfactory scales can be derived^ they will be 
checked out on other saatples which, will be made available for 
this purpose. It is proposed that other questionnaires having 
to do Tri.th psychic health as well as disease will be evaltiated 
as well. The advisability of the development of new scales 
will also be considered. 



Part B included ■= No 



- 156 - 



Serial No. M-?°?-(c)°9 

1, Laboratory of Psychology 
2o Sactiom on Personality 
3o Bethesda 



IHS-KIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: An Analysis of Interpersonal Communication Patterns 
Within Faaiilies of ScMzophrenics and Non-Schiso- 
phrenics in Quasi -Eacperimental Group Situations 

Principal Investigator: Joseph H. Handlon, Ph,D« 

Other Investigators: Morris B« Parloff, Ph.D., Donald S. Boomer, Ph.D., 

Marvin Waldman, Ph.D., liyman Wynne, M.D. 

Cooperating Units: Adult Psychiatry Branch, Laboratory of Socio- 

Environmental Studies 

Man Years (calendar year 1957): Patieat Days (calendar year 1957): 
Total: .30 None 

Professional: .22 
Other: .08 

Project Description: 

Objectives : There is evidence to suggest that there may be inter- 
personal coiinaunieation patterns ^hich are \jniquc to fianiliss one 
of whose members is a schizophrenic . It will be the ptiirpose of 
this study to attenrpt to demonstrate these assumed differences 
in structured, quasi^escperimental group situations which lend 
themsel^'es readily to objective obser\?atiDnal and measurement 
techniques. 

Method Emrployed ; Making use of previous studies, techniques will be 
developed which will permit accurate meas'orss of interpersonal 
comfflunication patterns in an observed group situation. At the 
present stage of planning se\'eral tec"anij^ues sroggest themselves, 
including the use of quasi-groaps where, Tsaknowi to the subjects, 
interpersonal cosnmunication caa be maaiptilated systematicallj' by 
the experimenter. The advantage of such obsei"/ational methods of 
evaluating intra-faaiily behavior is that it lends itself to 
objective, reliable measures suitable for coagyarative studies, 
while at the same time preserving in large measure the natural 
group dynamics. Both faaiilies of schizophrejaics as well as 
control groups of various normal and non=i?cliizophraaic psycJiii«» 
atric entities will be studied, Belatiojaship® be-fcween the 
findings in the cxTperimenial gro;^ sitae. tioa and l) discovered 

- 157 - 



Serial No. M-P-P-(C)-9 - Page 2 

Part A. Project Description (Cont'd) 

patterns on diagnostic tests of personality; 2) personality 
dynamics as gleaned from individual and/or group psychotherapy; 
and 3) vhere appropriate, ward behavior will "be examined, 

%P![}f^i''rK*i M' *^r ?*-"gT-«" "^ Mftn+Al TTRftlth Bffaf*ftrf^hi If it is the 
case that the intra-family dynamics play a crucial role in the 
course of schizophrenia, then a careful study of these dynamics 
under controlled conditions would seem to be profitable. It 
will be particularly important to determine whether such 
consistent intra-family communication patterns as are found 
are really unique to families of schizophrenics, or whether 
they are to be found in non-schizophrenic families as well. 
If found in both schizophrenic and non-schizophrenic, is 
there a difference in degree? A correlative question is that 
of whether such patterns as may be fovind are a result of having 
a mentally disturbed member in the family, or whether they are 
an important contributing factor in the actual development of 
schizophrenia . 

Pro-poged Course of Pro^iect ; After an exhaustive review of the various 
techniques which have been emplojred in the experimental study of 
group processes, appropriate methods will be tried out in pilot 
studies with a variety of groups. Once techniques have been 
perfected, use will be mside of the families of schizophrenics 
and others who are in-patients at NIH as well as normal groups. 
Findings will then be correlated with other psychologically 
relevant material gleaned frcan diagnostic tests, group and 
individual therapy, and ward behavior. 



Part B included - No 



- 158 - 



Serial No. M-P-P«(c)"10 

1. Laboratory of Psychology 
2» Section on PersoneuLity 
3. Bethesda 

PHS-NIH 
Individual Project Report 
Calendar Year 1957 

Part__A^ 

Project Title: Value Ciianges in Psychiatric Nursing Trainees 

Principal Investigator: Herbert C. Kelman, Ph,D. 

Other Investigators: Donald S. Boomer, Ph.D. 

Cooperating Iftiits: None 

Man Years (calendar year 1957): Patient Days (calendar year 1957): 
Total: ,63 None 

Professional: .17 
Other: *h6 

Project Description: 

Objectives ; The purpose of this project is to study some of the 
factors that are related to changes in attitudes, values, and 
role conceptions on the part of student nurses undergoing 
psychiatric trainings Of particular interest are those values 
which relate to patient care and sensitivity to the patient's 
needs, as well as to sensitivity in interpersonal relations in 
general. Specifically, the project will be concerned with the 
effects on value change of (l) certain specified personality 
predispositions of the student nurses, and (2) variations in 
the training method employed. In measuring the effects of the 
training, the study will focus not only on amoxmt of change, 
but also on level of change: an attempt will be made to measxrre 
changes in public attitudes, in behavior, and in general values 4 
This study represents an integration and elaboration of two 
previous studies reported in 1955: NIMH 118(C) and NIMH 128(C). 

Methods Employed : As presently planned, the study will involve 
experimental manipulation of one part of the training program^ 
and informa.1 observation of the training program in generals 
In order to measure relevant personality predispositions, a 
variety of techniques will probably be used* These may in- 
clude standard personality tests, interviews, and special 
laboratory sitioations (probably of a guasi-group nature ) . Both 
the variations in the training procedure and the personality 

- 159 - 



Proposed CouTb.- . 

the resignation of ur. 



Part B included - NO 



r:|^^«-^i<-,^' 



r*i« 



w«- 






T^'^^mm 






re: a«^^ 



isfU^- ■■■ 






?^:ci, 



S ■: 






>ryp<;XjT!0'Sj' i"'*" '''■"* 



;.^,. ^Tts' 'uiQjs^'i 



.^."r:rT%;r, 



- 160 - 



Serial No, M-?-?-(C)-U 

1. Laboratory of Psychology 

2. Section on Personality 

3. Bethesda 



PHS-NIH 

Individual Project Report 

Calendar Year 1957 



Part A. 



Project Title: Validation of Specificity Theory of Psychosomatic Disease 

Principal Investigator: Herbert C. Kelman, Franz Alexander, Morris Stein 

Other Investigators: None 

Cooperating Iftiits: None 

Man Years (calendar year 1957) t Patient Days (calendar year 1957) J 
Total: .25 None 

Professional: .17 
Other: .08 

Project Description: 

Objectives : 

1» To validate hypotheses about specific personality dynamics^ 
life hi story _, and onset situations related to each of seven 
psychosomatic syndromes* 

2, To develop methods for such validation and determine the effects 
of degree of psychiatric sophistication on results obtained. 

Methods Employed : Detailed checklists were filled out after reading 
of transcribed ananuiesic interviews with psychosoraatic patients, 
from which all medical information had been deleted. From those, 
diagnoses will be derived and checked against presenting sjrmptoms. 

Subjects Used : Two groups of judges completed the checklist — a 
group of secretaries, unacquainted with psychiatric concepts and 
the specific hypotheses; and a group of gradi'vate students in 
psychology, who in addition were infortTtied of the specific 
hypotheses. Diagnoses made by a groiap of psychoanalysts ^ who 
read the some case riiaterial but did not use the checklist are 
available for comparison.. 

Major Findings : (l) In general, the study shows that it is possible 
to isolate factors in a patien-c^s life history and personality 
dynamics which are related to the specific psychosomatic syndrome 
which he develops. (2) The data support three of the six personality 

- 161 - 



Serial IJo, M'P"P-'(C)-11 - Page 2 

Part A. Project Description (Cont'd) 

and life history patterns which were studied: patients \^o develop 
peptic ulcer, "bronchial asthma and thyrotoxicosis tend to be 
characterized by the psychological patterns which the investi- 
gators hypothesized* The patterns for neurodermatitis and essential 
hypertension tended in the hypothesized direction but were not 
statistically significant. The hypotheses in the case of tilcerative 
colitis were clearly not supported. 

Significance to the Program of Mental Health Reseerch ; Trea-tanent of 

psychosomatic patients depends on an understanding of the personality 
and conflicts of the patient. This study aims to get some indication 
of the validity of certain hypotheses about specific syndromes. The 
methodological part of the study should give some information on 
the reliability of various ways of collecting relevant data. 

Proposed Coiorse of the Project ; This project has been terminated due 
to the resignation of Dr, Kelman. 



Part B included - No 



- 162 - 



Serial No. M-»P»P-(C)~12 

1. Laboratory of Psychology 

2. Section on Personality 

3. Bethesda 



PHS-NIH 

Individual Project Report 

Calendar Year 1957 



Part A* 



Project Title: Processes of Acceptance of Social Influence 

Principal Investigator: Herbert C. Kelman 

Other Investigators: None 

Cooperating llhits: None 

Man Years (calendar year 1957): Patient Days (calendar year 1957): 
Total: »50 None 

Professional: .17 
Other: ,33 

Project Description: 

Objectives : To distinguish three processes wherehy influence is 
accepted — con^pliance, identification, and internalization 
and to show that these are produced by different motivational 
conditions and have different subsequent histories. 

Methods Employed : Several different tape recorded communications 
were used xo create different perceptions of the comrauni- 
cator's power and different motivations for acceptance of 
influence. The effects of these on an area of social attitudes 
were measured through repeated questionnaires. 

Subject Used : College students 

Major Findings ; Attitudes accepted through compliance (communicator 
has means-control) tend to be expressed only under conditions 
of surveillance by the communicator. Attitudes accepted throvigh 
identification (comnunioator is attractive) tend to be expressed 
only under conditions of salience of the communicator. Attitudes 
accepted through internalization (communicator is trustworthy) 
tend to be expressed regardless of sturveillsuace or salience of 
the communicator. 

Sipilflcance to the Program of tfental Health Research : The thera- 
peutic sitxaation can be regarded as a situation of social inter- 
action and the therapeutic process as a product of social influence. 

- 163 - 



Serial No, M-P-P-(C)-12 - Page 2 

Part A. Project Description (Cont'd) 

It is through these interpersonal relationships that the patient 
is able to modify his values, attitudes, and role expectations. 
Therefore, the development of a general theory of social inter- 
action and inf Ivience should increase oiur understanding of the 
therapeutic process. The present study can contribute to our 
understanding of the conditions mxder which therapeutic chwiges 
will be lasting and integrated with the patient's values and the 
conditions under which they will be superficial and of short 
duration. In addition, it can be useful for the development of 
programs of public education on mental health. 

Proposed Course of the Project ; A detailed report of the study and 
of the theory underlying it has been written. This report will 
be revised and expanded for publication as a monograph. This 
project has been terminated due to the resignation of Dr. Kelman. 



Part B included - Yes 



- 16k - 



Serial No. M-P-P-(C)-12 «■ Page 3 

Part B: Honors, Awards, and Publications 

Publications other than abstracts from this project: 

Kelman, Herbert C, Social Influence aad Personal Beliefs; A Theoretical 
and Experimental Appi'oach to the Sta dy of Bet.ayior Chgjage 'fTo be 
published by Wiley and Sons, Inc., New i'lbrk 

Kelman, Herbert C. "Three Processes of Acceptance of Social Influence: 
Compliance, Identification and Internalization" Sociometry (In press) 

Honors and Awards relating to this project: 

Awarded the $1,000 Socio-Psychological Prize of the American Association 
for the Advancement of Science, New York City, December, 195^ for his 
essay entitled, "Compliance, Identification, and Internalization: A 
Theoretical and Experimental Approach to the Study of Social Influence," 



- 165 - 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Clinical Investigations 
Laboratory of Clinical Science— Office of the Chief 



BUDGET SHEET 



Estimated Obligations for FY IQ'^S 
Total: $151, 8U9 
Direct: $107,067 

Reimbiirsements : $^4- , 782 



Projects included: M-CS-OC(C) 1 through ^^CS-OC(C) k 



Serial Wo. M-CS-0C(C)-1 

1. Laboratory of Clinical Science 

2. Office of the Chief 

3. Bethesda; Maryland 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: Biological Studies in Schizophrenia 

Principal Investigator: Sejinour S. Kety 

Other Investigators: See individual projects. 

Cooperating Units: See individual projects in the Laboratory 
of Clinical Science , NIMH^ as follows: Office of the 
Chief, Serial Wos. M-CS-0C(C)-2^ 3, and h; Section on 
Medicine, Serial Wos. M-CS-M(C)-1 and h; Section on 
Psychiatry, Serial Nos. M-CS-Ps(c)-2 and k; Section on 
Cerebral Metabolism, Serial Nos. M-CS-CM-1, 5, 6, and 7; 
Section on Drug Evaluation, Serial Wo. M-CS-DE-1; and 
Section on Biochemistry, Serial No. M-CS-B-4 and 5- 

Man Year (calendar year 1957): Patients Days (calendar year 1957): 

Total: 3-5 See individual projects. 

Professional: 2-5 
Other: 1.0 

Project Description: 

Objectives : To direct and coordinate a multidisci- 
plinary program of biochemical; pharmacological,, and physiological 
studies in schizophrenia and their correlation with psychological 
and psychiatric aspects of the disease . 

a. Studies on amino acid raetaaolism 

b. Studies on the fate and effects of epinephrine 

c. Evaluation of reported biological abnormalities 

Methods Employed : Selected populations of schizophrenics 
and normal controls have been esteblished and are maintained 
under controlled conditions of normal diet, activity and 
management. Three general techniques are employed for studies of 
a particular substance in both populations: l) examination of its 
blood level or urinary excrL-tion and their correlation with 
psychological and psychiatric observations; 2) examination of the 
psychological, biochemical, and physiological effects of the 



- 16^ 



o - 



Serial No M-CS-0C(C)-1 , page 2 



Project Description (continued): 

administration of measured amounts of the substance to 
permit assessments of differences in the handling or effects of 
the substance in the two groups j and 3) the administration of 
radioactively tagged substances and examination of blood levels 
and ujTinary output of all radioactive products to permit qualita- 
tive and roughly quantitative estimates of its various metabolic 
pathways . 

Major Findings : The program, is relatively recent in 
its inception. Criteria for the selection of patients have been 
established and the sample drai^m up from an examination of several 
thousand state hospital charts. Techniques have been adapted for 
the effective fractionation of metabolic products in blood and 
urine, and animal experiments are in progress to permit determina- 
tion of safe doses of particular radioactive compounds in man. 
Specific findings are reported in the component projects. 

Significance to Mental Health Research : Many positive 
findings relating to biological abnormalities in schizophrenia 
have not been subjected to well controlled and critical evalua- 
tion. There are num.erous reasons which suggest abnormalities 
in the metabolism of amino acids or certain amines as essen- 
tial factors in some forms of schizophrenia. This program 
offers a means of evaluating such h^.-potheses . 

Proposed Course of Project : The program is plan_ned 
for several years' duration. 



Part B included: Yes 



- 167 



Serial No,, M-CS-OC(C) -1 , pag.a 3 

PliS NIH 
Individual Project Report 
Calendar Year 1957 

Part B: Honors. Awards and Publications 

Publications other than abstracts from this project: 

Sokoloff, L , Perlin S., Kornetsky. C.^ and Kety, S.S,: 
The effects of d-lysergic acid diethylamide on cerebral 
circulation and over-all metabolism, Ann. N,Y. Acad. 
Sci., 66: 468-477 1957. 

Kety, S.S-: The implications of psychopharmacology to 
the etiology and treatment of mental illness. Ann. 
N.Y. Acad. Sci . 66: 836-840. 1957,, 

Kety. 3 S.: Recent studies in psychopharmacology. A.M. A. 
Arch. Neurol, and Psychiat . , 77. 278-279. 1957. 

Kety. 3.S.: The cerebral circulation in man. Triangle. 
3: 47-52, 1957 

Kety, 3,S,: The general metabolism of the brain in^ vivo . 
The Metabolism of the Nervous System ,, edited by D. Richter 
Pergamon Press. London IS 57 (In press) . 

Kety. S,S . Determinants of tissue oxygen tension. 
Fed. Proc . . 16' 666-670. 1?57 . 



Honors and awards relating to this project: 
Dr Seymour S. Kety 

Elected to the Council of the International Collegium 

of Psychopharmacology . 
Elected to membership in American Psychopathological 

Society . 
Appointment to Committee on Research in Dementia Praecox. 

Supreme Council 33° Scottish Rite. Northern Masonic 

Jurisdiction , 
Presented Eastman Memorial Lecture on "Biological Aspects 

of Schizophrenia". University of Rochester, Dec, 1957 
Address to the Harvey Tercentenary Congress, London. 

June 1957. 



- 168 - 



Serial No. M-CS-0C(C)-2 

1. Laboratory of Clinical Science 

2. Office of the Chief 

3. Bethesda, Maryland 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A, 



Project Title Comparison of the Excretion Patterns of 

Metabolites of Aromatic Amino Acids by Normal Subects and 
Schizophrenic Patients 

Principal Investigator: Elwood H» LaBrosse 

Other Investigators: Jay D. Mann 

Cooperating Units: None 

Man Years (calendar year 1957): Patient Days (calendar year 1957): 

Total: 0.50 94 

Professional: 0.25 
Other: 0.25 

Project Description: 

Objectives: Numerous investigators have described 
quantitative differences in the excretion of urinary 
phenolic acids between normals and schizophrenic patients. 
In many cases these studies have been so incompletely 
reported that they could not be repeated in exactly the 
same manner or they had insufficient numbers or inadequate 
controls. Because of the close biochemical relationship of 
the neurohumors, such as epinephrine and norepinephrine and 
of such compounds as serotonin; to the aromatic amino acids, 
the metabolism of the latter is important in mental function-- 
this has been clearly shown in phenylpyruvic oligophrenia in 
which a disturbance in the hydroxylation of phenylalanine to 
tyrosine is consistently associated with mental deficiency. 
The objective of this investigation will be to establish 
whether there is a significant difference in the metabolism 
of aromatic amino acids by normals and by schizophrenic 
patients. If a difference actually is found to be present ^ 
it will then be possible to set up further experiments 
which will elucidate the biological relationship between 
metabolism and schizophrenia. 



169 " 



Serial No. M-CS-0C(C)--2 , page 2 

Project Description (continued),,: 

Methods Employed : The rormal subjects and schizophrenic 
patients will be given identical diets in addition, following 
a double-blind technique; half of each group will be given 
a loading dose of phenylalanine, tyrosine or tryptophane. 
Urine specimens will be collected over known time periods 
and replicate portions of each urine specimen will be 
analyzed using quantitative paper chromatographic methods 
to analyze numerous urinary metabolites of the aromatic 
amino acids. These data will be analyzed statistically to 
determine whether there is a significant difference in the 
excretion of these metabolites between the normals and the 
schizophrenics . 

Major Findings: This project is just getting started 
and no major findings have yet been obtained. 

Significance to Mental Health Research : If a 
significant difference between normals and schizophrenic 
patients were found, it would be a major breakthrough in 
the understanding of mental illness and would provide a 
point of entry for elucidation of the biochemical factors 
in mental illness and thereby lead to a more rationa.1 and 
effective therapy. 

Proposed Course of Project: To begin the loading 
experiment as soo«a as equipment , supplies, and technical 
assistance can be obtained. To combine with or extend this 
study to include administration of C-^ -labeled amino acids. 



Part B included: No 



170 - 



Serial No, M-CS-0C(C)-3 

1 . Laboratory of Clinical Science 

2. Office of the Chief 

3. Bethesda,. Maryland 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A, 



Project Title: Study of the Metabolites of Epinephrine and 
Norepinephrine in Human Body Fluids 

Principal Investigator: Elwood H. LaBrosse 

Other Investigators: Seymour S Kety, Julius Axelrod 

Cooperating Units: None 

Man Years (calendar year 1957) . Patient Days (calendar year 1957) 

Total: 0,50 15 

Professional: 0.25 
Other: 0„25 

Project Description: 

Objectives: To investigate the metabolites of 
epinephrine and norepinephrine in the urine and in the 
blood in the approach to studies of the in vivo metabolism 
of these important neurohumors in normal~~and mentally ill 
subjects. 

Methods Employed: Treatment of the urine with 
P-glucuronidase j followed by extraction and paper chroma- 
tography of the extracts were used in the search for these 
metabolites. This study will be greatly facilitated when 
the tritium labeled epinephrine becomes available, at which 
time the total radioactivity in the urine and the relative 
amounts in various constituents will be determined. 

Major Findings: This project has just begun and 
there are no significant findings to report at this time. 

Significance to Mental Health Research : Both 
epinephrine and norepinephrine are well known as neuro- 
humors and have been found in the brain as well as in the 
peripheral nervous system, Because of this fact an under- 
standing of their metabolism would facilitate an evaluation 
of their role in normal function of the nervous system and 
in mental disease. 

- 171 - 



Serial No. M-CS-0C(C)-3; page 2 

Project Description (continued): 

Proposed Course of Project : It is planned to 
continue this investigation and to study the labeled 
metabolites after the intravenous injection of tritium 
labeled epinephrine. 



Part B included: No 



- 172 - 



Serial No, M-CS"Of;(C)-U 
Iffl Lab,, of Clinical ScieM 
2., Office of the Chief 
5» Bethesda, Mi* 



PHS-KIH 
Individual Project Report 
Calendar Year 1957 



Part A« 

Project Title: Studies of the interrelationships of the nervous aad circul= 
atory systems. 

Principal Investigator; P,V* Csirdon, Jr„, M<.Do 

Other Investigators: So Kety^, M*D<,^ L« Sokoloff, M,D*, E* Labrosse, M,D,, 

Wc Pollin, MftD», Ri Butler^ M»Dt^ Wa Goodrich, M,D*, 
R* Gordon, MaD*, and C» Kometsky, Ph>rD» 

Cooperating Units: Clinical Investigations, HIMH; Lab, of Cellular Pjjysiologi 

and Metabolism, KHI 

Man Years (Calendar year 1957) Patient Days (calendar year 1957) 
Total: 2 1/5 70 

Professional s 1 
Other 1 1/5 

Project Description: 

Objectives: 1. To clarify the nature of the changes which occur in the 

circulatory system in association with changes in various 
parameters of central nervous system function such as 
attitudes, feeling states, modes of interpersonal reaction, 
and psychomotor performance » 

2o To develop and standardize reproducible, simple, and non^ 
traumatic methods for the assessment of such circulatory 
changes » 

Methods Employed: Circulatory changes are assessed by the following methods: 
Pulse rate, blood pressure (ausculatory or direct arterial measurement), . 
ballistocardiograph, impedence plethysmography i 

More studies this year involved comparison between groins (i.-,e« normf^l 
vs, schizophrenic patients) rather thaxi meastirement of changes in the same \ 
individual. Four preliminary studies of the effects of infusing epin= 
ephrine into normal and schizophrenic subjects have been done in collabor" 
ation with six other investigators in the laboratory^ One psychoneurotic 
out-patient was studied immediately before and after therapeutic interviews 
for 17 weeks (Dr« Goodrich)... The number of normal subjects in whom plasma 
unesterified fatty acid (UFA) was measured before and after a sham 

- 173 - 



Serial Noo M''GS-OC(C>APage 2 

tramttatic procedure was e3cpanded to 18 (Dr. Gordon) » The circulatory 
effects of amphetiffiKiae^ phenobarbital^ and mepro'bamate were studied 
in normal subjects (Dr, Kometsky)^ Comparison of the ia^edence plethysmo^ 
graph and Ha2'+ methods of estiaaatisg leg blood flow was coEpleted (Dro 
Sokoloff)c. Induction of circulatory changes with structured interviews 
has been abandoned for the time being because of the data-reduction problem 
and the resignation of the participating psychiatrist (Dr. J,M. Scher), 

Patient Material; Patients oa i^-W and 2-W of the Clinical Center* 

Major Finding: (Findings enumerated include results of analyzirag some data 
collected in 1956)» 

As a group, schizophrenic men tend to have sHjaller brilistocardiographs 
than do normal men. Other eiroalatory variables studied are not different. 
Within the schizophrenic sasssplep variables studied have not beea foimd 
so far to correlate with behavioral ^ EEG, or biochemical sub -groupings <, 

In the studies of the acute affects of a variety of centrally acting 
drugs, chlorpromazine si^ific^jtly increased pulse rate aad meproTbamate 
decreased ballistocardiograph ajaplitude. 

On the basis of comparison with the Na^^ clearaace method, the 
impedence plethysmograph is not a good method for estimating relative 
change in liiab blood flow. 

Acute anxiety usDially causes an increase in plasma UFA* 

Significance to Jfeatal Health Research; Problems to which these studies may 
prove pertinent include; tranquilising drugs, anxiety states^ schizophrenia, 
neurocirculatory asthenia, essential hypertension, and coronary heart disease. 

Proposed Course of Projects Continue studies of the types reported on the 
same relatively" saall aaid flescible scale. 



'I* 



Part B included; Yes 



= 17ij- - 



Ml: 



Serial No-- M-CS»OC(G)-i^; Bage 

Part B » 

Publications: Cardon, P*V*j Jr« "Psychic factors in hypertensive heart 
disease b" "Psychic factors in coronary heart disease," 
Chapters in Encyclopedia of Cardiology > Ed, A«, A* Luisada, 
Philadelphia, Blackiston, (in press) 7 i 



- 175 - 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Clinical Investigations 
Laboratory of Clinical Science — Section on Medicine 



BUDGET SHEET 



Estimated Obla-ggtipng fgr , n 19'?? 

Total: $172,05^ 
Direct: $56,31^ 

Reimbiirsements : $115 . 7^0 



Projects included! M»CS-M(C) 1 through M-CS-M(C) 6 



II !i 

1. 1 



Serial No. M-CS-M(C)- 1 

1. Lab. of Clinical Science 

2. Section on Medicine 
5o Bethesda, Md. 



PHS-rHH 
Individual Project Report 
Calendar Year 1957 



Part A, 



Project Title: Behavioral and biochemical correlates of the electroenceph- 
alogram (EEG) in schizophrenic patients* 

Principal Investigators; Roger K. McDonald, M,D,^ William Pollin, M,D, 

Frederick Snyderj, lUL^^ Robert R, Butler, M»D, 
and Edward V, Evarts, M,D. 

Other Investigators 2 Bonnie Peacock 

Cooperating Units: None 

Man Years (calendar year 1957) Patient Days (calendar year 1957): 
Total s 5/6 751 

Professional: 1/2 
Other: l/5 

Project Description: 

Objectives: A variety of biochemical studies in schizophrenic patients 
have yielded data whose mean does not differ significantly from the 
mean of a normal population, but vhose variability exceeds that of 
the normal population. So far^ few attempts to determine the rela- 
tionship between these variable biochemical data and behavioral or 
biological processes have been made^ The present project represents 
a preliminary effort to determine the degree to which one form of 
biological activity (the EEG) may be related to a number of bio- 
chemical and behavioral measures. 

Methods Employed: (A) Patient Selection : Approximately 150 white male 
schizophrenic patients between the ages of 20 and iK) were selected 
from the population of the Springfield and Spring Grove State Hospitals. 
Care was taken to exclude any patients with organic brain disease or 
mental deficiency. Tracings of occipital electrical alpha activity were 
obtained in these patients. The EEG records were divided into three 
groups according to whether they showed high, low, or intermediate 
aasounts of alpha activity, A number of patients in each of these 
categories was admitted to the Clinical Center, All patients who were 
selected for admission to the Clinical Center were evaluated clinically. 
Only those patients with clearly schizophrenic disorders were admitted. 
These patients had been hospitalized for one or more years « 



176 



Serial No. M-CS»M(C)-1 Page 2 

EEG Studies ; Patients were exanined electroencephalographically 
at the time of admission aad at weekly intervals thereaftero Records vrere 
analyzed with respect to per cent alpha so that a quantitative score describ- 
int amount of alpha would be available for correlation with behavioral and 
biochemical variables. Studies of photic activation of the EEG were also 
carried out, 

(C) Pharmacologic and Electromyographic Studies ; The attempt was made to 
test the hypothesis that the percentage of alx^ha activity is a reflection of 
the degree of arousal of the organism by measuring several physiological 
indices which are reputed to be correlated with the level of anxiety j, i.e, 
the sedation threshold and surface muscle activity. The sedation threshold 
is obtained by determining the amount of intravenous sodium amytal which is 
necessary to produce the specific electroencephalographic change associated 
with the effect of barbiturates on cortical rhythms, Muscle activity was 
measured by siorface electromyographic methods from the various parts of the 
body to provide an objective indication of tension in individual subjects. 

(D) Behavioral Studies ; Patients were seen for recorded, observed evalu- 
ation interviews shortly after their admission. Their EEG characteristics 
were unknown to the evaluating psychiatrists at that time. Data obtained 
were used for final confirmation of the diagnosis of schizophrenia, and 

for the purpose of making independent rankings of 19 personality variables 
which^ on the basis of prior work, were thought likely to relate to per 
cent alpha., These rankings fell into five major categories t Ego 
intactness^ reality contact^ reality distortion^ affects and activity. Two 
hypothesised profiles using these rankings were constructed. These profiles 
were based on work from the literature, and were designed to differentiate 
the high from the low alpha. Predictions were made as to which of the two 
categories each patient would be in. After coniparison of the EEG character- 
istics and psychiatric findings, patients were re-evaluated„ Continuing 
ward obseiryations were made by psychiatric and nursing personnel. A modi- 
fied version of the Lohr scale, and various additional experimental 
techniques were employed for rating ward behavior. 

(E) Biochemical Studies « The laboratory methods employed in this study 
are described under the project entitled, ^ Evaluation of Certain Reported 
Biochemical Differences Between Schisophrenic and I^on -psychotic Subjects . 

Major Findings ; 



Correlations Between EEG and Behavior . The relationship between 
psychiatric rankings and behavioral ratings, on the one hand, and per cent 
alpha on the other was not statistically significant. Re-eveduation after 
coarparison of EEG and psychological data has led to a reformulation of the 
hypothesised clinical picture %>*i,ich may be related to high or low alpha 
characteristics , 



177 



Serial No. M-CS-M(C)-1 Page 5 

No consistent relationship was found between the percentage alpha and the 
sedation thresholds of the patient groi^j, nor could the latter measure be 
correlated with psychiatric judgments concerning apparent anxiety in the sub- 
jects » The results were in keeping with previous provocative reports that in 
schizophrenics there is no clear-cut relationship between the sedation 
threshold and behaviorally manifest anxiety ^s, as there is in neurotic patients 
or normal controls a Neither was there a consistent relationship between a 
global measure of muscle tension and the alpha index,, The data suggest^ 
however, that there may be such a relationship with muscle tension in certain 
area^ of the body, notably the forehead and periorbital muscles <, This 
possibility is still being escplorede, 

(B) Correlations Between EEG and Biochemical Measures » Of the variety of 
biochemical measures which was carried out, only red blood cell glutathione (GSH) 
was significantly correlated with per cent alpha in the schizophrenic patients. 
The mean GSH was 76.6 mgo in patients with high alpha and 65oO mg,^ in patients 
with low alphas 

Initial observations suggesting differences in blood levels of ascorbic 
acid between the high and low alpha groups appeared to be the result of 
differences in dietary intake of ascorbic acid. Evidence for this belief 
rests on the complete similarity of blood levels of ascorbic acid in the two 
groups following an ascorbic acid loaxiing-deprivation experiments 

Adrenaline oxidation, which has been shown to be a function of ascorbic 
acid and copper levels in the blood, did not differ in the two groups. Like- 
wise, serum oxidation of paraphenylenediamine, which is a function of 
serum copper, did not differ in the two groups. 

Significance to Mental Health Research; 

(a) Biochemical Findings . The positive correlations between blood gluta- 
thione and per cent alpha is of considerable interest in view of the obser- 
vations of some previoxis investigators that blood glutathione is depressed 
in certain forms of mental illness » The present study does not demonstrate 
such differences between normals and schizophrenics taken as a group, but 
does indicate that there is a suggestive relationship between blood glutathione 
and at least one measure of central nervous system activity. 

(B) Behavicjjjl F indl^gs . Thus far, no significsiit clinical correlates of 
' high or low alpha characteristics have been established. 



178 - 



Serial No. M-CS-M(C)-1 Page 
Proposed Coxirse of Project: 

(a) B iochemical . The small size of the present sample vould make ■ 
it mandatory that the observations on blood glutathione and EEG be 
extended to more schizophrenic patients. In addition, studies will 

be carried out to determine the relation of blood glutathione to the 
EEG in a normal population, 

(b) Behavioral . High aad low alpha schizophrenic patient groups at 
two nearby State Hospitals will be psychiatrically evaluated, without 
knowledge of which EEG groxaping each patient belongs to. On the basis 
of the study of the present patient groiip, predictions as to EEG 
characteristics will be made to test the significance of suggested 
clinical correlates of alpha per cent. 



Part B included; No 

- 179 - 



Serial No. M-CS-M(C)-2 

1, Lab. of Clinical Science 
2o Section on Medicine 
rf 5« Bethesda, Md, 

»r 

PHS-MIH 

>X Individual Project Report 

Calendar Year 1957 

Part A. 

Project Title; Qualitative intraspecies variations in human serum 
cholinestersise , 

Principal Investigator; Franklin T. Evans, McD* 

Other Investigators; Roger K« McDonald and Raymond Wo Patrick 

Cooperating Units; Kone 

Man Years (calendar year 1957) Patient Days (calendar year 1957) 
Total; 1 60 

Professional: 5/12 
Other; 7/12 

i 

' Project Description; 

Objectives; To examine the possibility that qualitative differences 
in serTmi cholines t erase exist between different human 
subjects, 

Miethods Employed; The rate of hydrolysis of B-carbonaphthoxycholine and 
B^naphthyl acetate by human serum^ and the effect of calcixm and 
magnesium ions on this rate have been studied by the colorimetric method 
of Ravin, Tsou and Seligmanc The rate of hydrolysis of acetylcholine 
by human seron has been studied by the colorimetric method of de la 
Huerga^ et al. 

Method for studying individual variation in human senmi cholin - 
esterase . Various concentrations of calciiim and magnesium, with and 
without eserine, were added to the sera of a group of patients, and the 
resultant hydrolytic activity of the sera was determined individually* 

Patient Material; Normal male and female volunteers and schizophrenic males. 

Major Findings; Presently avsiilable data do not justify definite conclusions 
regarding intraspecies variations of cholinesterase at this time. The 
preliminary findings do suggest that further investigation of the effect 
of calcium and magnesium on cholinesteraise is warranted. 



- 180 - 



Serial No. M-CS-M(C)-2 Page 2 



Significance to Jfental Health Research: Although the physiologic substrate 
of serum cholinesterase is at present uhknovn, recent evidence has shovn 
that inhibition by the serum-type cholinesterase in isolated brain 
preparations restilts in a so-called arousal response on electroencephale-ij 
gram. In addition^ a nxmber of psychotomimetic drugs are known to j 
inhibit this enzyme. These facts suggest that a more careful exploratio! 
of the nature of this enzyme may ultimately clarify its possible role ia ;i 
central nervous system activity. ! 



Part B inclxided: No 



181 



Serial No. M-CS-M(C)-5 
■ M .oH iBri:-.: 2.. Lab. of Clinical Science 

2a Section on Medicine 
3= Bethesda, M. 

1 PHS-NIH 

Individual Project Report 
C-lendar Year 1957 
I 
f rt A . 

Project Title: Effect of morphine and nalorphine on plasna hydrocortisone levels. 

Principal Investigator; Roger K. McDonald, M»Do 

Other Investigators: Franklin To Evans ^ M,D„, Raymond W=, Patrick, and 

Virginia K, Weise 

Cooperating Units: None 

Man Years (calendar year 1957) Patient Days (calendar year 1957) 
Total: 1 1/6 128 

Professional: 2/5 
Other: 1/2 

Project Description: 

Objectives: To determine whether raoi'phine and nalline suppress ACTH 
release in man.. 

Laboratory Methods ; Plasma hydrocortisone concentrations vere determined 
by the method of Peterson et al . 

Methods Earployed: The hourly plasma hydrocortisone levels from 8 a.m. to 
1 p.ffio were determined on a group of normal subjects on one day follow- 
ing placebo injections, on another day following morphine injections, 
aad on a third day following nalorphine. The second design employed 
in this study consisted of determining the effect of morphine on the 
large rise in plasma hydrocortisone concentration which characteristically 
occurs between k a.m. and 8 a.m. In this design a group of normal 
subjects received on one night oral pentobarbital and at 3 a.m. a 
subcutaneous injection of morphine sulfate. At 6 a.m., 7 a.m., and 8 a.m. 
fasting blood saanples were drawn for a conrparison of plasma hydrocortisone 
levels with levels on other mornings when either nembutal or placebos were 
given at the scheduled times. 

Patient Material: Normal male and female volimteers were used exclusively « 

Major Findings: In the first part of the study both morphine and nalorphine 
produced a significant depression of the plasma hydrocortisone level 
which occurred at 11 a.m. aad continued through 1 p.m. In the second 
part of the study morphine blocked the mondng rise in plasma hydrocortisone 
concentration . 



182 



Serial No. M-CS-M(C)-5 Page 2 



Significance to Mental Health Research: These observations indicate that 
morphine and nalline suppress significantly the release of ACTH by the 
anterior pitxiitary gland. Since the c.ction of morphine and nalline 
is most likely on the central nervous system it woiild appear that the 
normal control of ACTH release in man is under central nervous system 
control <. 

Proposed Course of Project: The present approach has provided an 
answer to the question of the Interrelationship between morphine, 
nalorphine administration and ACTH release. The project will not 
be continued unless new approaches become apparent. 



Part B included: No 



- 133 - 



Serial No, M-CS-M(C)-iv 

1, Lab, of Clinical Science 

2. Section on Medicine 
5o Bethesda, Mi. 



PHS-WIH 
Individual Project Report 
Calendar Year I957 



Part A. 



Project Titles An evaluation of certain reported biochemical differences 
between schizophrenic and non-psychotic subjects. 

Principal Investigator: Roger Ko McDonald, M.D. 

Other Investigators; Virginia K^ Weise, Franklin T. Evans, M.D., and Raymond 

W. Patrick 

Cooperating Units: Springfield State Hospital, Sykesville, Mi, 

Stc Elizabeths Hospital, Washington, D.C. 

Man Years (calendar year 1957) Patient Days (calendar year 1957) 

Total: 1 1/U 255 

Professional: 2/5 
Other: 7/12 

Project Description: 

Objectives: To determine the plasma copper and ascorbic acid levels, the 
red blood cell reduced glutathione levels and the oxidizing capacity of 
serum and plasma for W-W dimethyl para-phenylenediamine (DPP), p-phenyl- 
enediamine and adrenaline in schizophrenic and non-psychotic subjects. 
These various parameters have been reported to be abnormal in schizophrenic 
patients , 

Methods Employed: Laboratory methods included copper analysis by the method 
of Cubler et al , , ascorbic acid analysis by the method of Roe, red blood 
cell glutathione determination by the method of Grunert and Phillips and 
the serum oxidation of DPP by the method of Akerfeldt, of p-phenylenediamine 
by the method of Aijood and of adrenaline using the method of Leach et al . 

Patient Material: Schizophrenic patients were studied at the Clinical Center, 
St, Elizabeths Hospital and Springfield State Hospital, Normal male and 
female volunteer subjects were used as controls. 

Major Findings: No significant difference was foimd between the serum copper 
and red blood cell glutathione values and the serum oxidation rates for 
DPP and p-phenylenediamine for schizophrenic and control subjects. The 
serum ascorbic acid levels were lower in the schizophrenic group^but this 
was shown to be a dietary phenomenon. Adrenaline oxidation was more 
rapidly oxidized by plasma from schizophrenic subjects, but this was 
shown to correlate highly with the plasma ascorbic acid levels. The 
latter observation suggests that abnormally high dye and aidrenaline oxi- 
dation rates found in schizophrenics are simply a result of low plasma 
ascorbic acid levels resulting from low dietary intake, 

~ 13k ~ 



Serial No. M-CS-M(C)-lt Page 2 



Significance to Mental Health Research: This study falls into the over-all 
laboratory approach to biological studies in the psychoses. It is hoped 
that this approach will be of aid in better understanding the complex 
phenomena of mental disease. 

Proposed Course of Project: Certain aspects of this project are continu- 
ing to provide a more critical evaluation of "peripheral" biochemical 
findings and central nervous system function. 



Part B included: No 



135 - 



Serial No. M-CS-M(c)- 5 
(, , 1. Lab. of Cliniccu Science 

' 2. Section on Medicine 

3. Bethesda, M. 

ri/^rrv^^ri r-^ ?- -Orel's- 

• •" ~ PHS-NIH 

Individual Project Report 
Calendar Year 1957 

Pi -t A . 

'reject Title: The relationship betvfeen endogenous antidiuretic hormone 
activity and ACTH release in n:.ri. 

'rincipal Investigator: Roger K. McDonald^ M.D, 

)ther Investigators: Henry N. Wagner, Jr., M,D. and Virginia K» Weise 

Jooperating Units: Laboratory of Kidney and Electrolite Metabolism, Ifiil 

Ian Years (calendar year 1957) Patient Days (calendar year 1957): 
Total: 5 A 150 

Professional : 5/12 
Other: 1/3 

'roject Description: 

Objectives: To determine if the endogenous release of antidiuretic hormone 
causes ACTH release. 

Methods Employed: 

Laboratory Methods : 1. Determination of plasma hydrocortisone 

concentration by the method of Peterson et al. 

2. Urine osmolality determined by freezing point 
depression. 

Method of studying interrelationship of antidiuretic hormone and ACTH 
release . 

Stimxili used for production of either antidiuretic hormone or ACTH 
release consisted of water deprivation, intravenous injection of hyper- 
tonic saline, intravenous injection of insulin and nicotine, intra- 
muscTJlar injection of mecholyl and hand immersion in ice water. At 
appropriate intervals urine and blood were collected for analysis of 
plasma hydrocortisone concentrations and antidiuretic hormone activity. 



- 186 



Serial No. M-CS-M(C)-5 Page 2 
Patient Material: Normal male and female volunteers. 



Major Findings: The experiments demonstrate that antidiuretic hormone and 
ACTH release can occur independently of each other and therefore 
antidiuretic hormone is not the neurohormone causing ACTH release. 

Significance to Mental Health Research: The ACTH release associated with 
various stress is a study of this problem pertinent to the inter- 
relationship between stress and bodily function. This study disproves 
one of the current hypotheses employed in explaining the relationship 
between the central nervous system and endocrine control. 

Proposed Course of Project: This particular project has provided the answer 
to the problem examined and is not being studied further. 



Part B included: Yes 



- 187 - 



Serial No. M-CS-M(C)-5 Page 5 



Part B. 



Piiblications . 

McDonald, R.K., Wagner, H. N., and Weise, V.K« The relationship between 
endogenous antidiuretic hormone activity and ACTH release in man. 
Proc. Soc. Exper. Biol. & Med., 96: 1957^ (in press). 



Other Publications. 

Ader, R. and Clink, D.W. Effect of chlorpromazine on the acquisition and 
extinction of an avoidance response in the rat. J. Pharmacol. & Exper. 
Therap, 121: ll^-lU8, I957, 



- IE 



Serial No. M-CS-M(C)-6 

1. Lab. of Clinical Science 
2„ Section on l"iedicine 
PHS-KIH 3. Bethesda, Md. 
Individual Project Report 
Calendar Year 1957 



: 3,rt A . 

fj Project Title: Morphine suppression of pitressin-induced ACTS release in man. 

Principal Investigator; Roger K^ McDonald, M.D» 

Other Investigators: Virginia K. V7eise, Raymond W. Patrick, and Franklin T, 

Evans, M,D. 

Cooperating Units: None. 

fj Man Years (calendar year 1957) Patient Days (calendar year 1957) 
Total: 2 110 

Professional: 2/5 
Other: 1 1/5 

Project Description: 

Objectives: Pitressin (vasopressin) has been postulated to be the neuro- 
hormone responsible for directly stimulating ACTH release from the 
anterior pituitary gland. In addition to causing ACTH release the 
intravenous administration of pitressin in human subjects is accompanied 
by unpleasant subjective symptoms which, in themselves, could be suffi- 
ciently stressful to cause ACTH release. This study is designed 
to determine whether pitressin-induced ACTH release in man can be 
suppressed by morphine, a drug which has knovm central nervous system 
action. 

Methods Employed: Plasma hydrocortisone concentrations were determined by 
the method of Peterson et al. The levels obtained were assumed to be 
an indication of ACTH activity. 

Patient Material ; Normal volunteer subjects were employed in this study. 

Major Findings ; In normal human subjects the ACJTH release resiolting from 
the intravenous injection of pitressin is significantly reduced by 
morphine premedication. Morphine has no suppressive effect on adreno- 
cortical responsiveness to intravenoxisly administered ACTH. 

Significance to Mental Health Research ; This study provides further evidence 
against the hypothesis that antidiuretic hormone acts directly on the 
anterior pitxiitary gland to produce ACTH release. It is part of the over- 
all program for evaluating hypothalami co -hypophysial interrelationship 
which is concerned with the individual's adaptation to frequently changing 
life situations. 



- 189 - 



Serial No. M-CS-M(C)-6 Page Jj 

Proposed Course of Project ; No direct continuation of this project is 
contemplated at the present time. 



Part B included; No 



190 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Clinical Investigations 
Laboratory of Clinical Science — Section on Physiology 



BUDGET SHEET 



gsUtnated oi?lieat3„ong for n 19'?8 

Total: $196,226 
Direct: $69,^6? 

Reimbiirsements : $126 , 759 



Projects included: l^CS-P(C) 1 through ]^CS-P(C) 5 



Serial No. M-CS-P(C)-1 

1. Laboratory of Clinical Science 

2. Section on Physiology 

3. Bethesda, m. 



PES-1«H 

Indivldvial Project Report 

Calendar Year I957 



Prt A. 



Project Title: An attempt to differentiate between the thinking disorder found 
in schizophrenics and that found in patients vith the diagnosis 
of chronic brain syndrome. 

Principal Investigator; Irwin Feinber'g, M<,D. 

Dther Investigators: Edward V. Evarts, M.D. 

Cooperating Units: St. Elizabeths Hospital, Washington, D,C. 

to Years (calendar year 1957): Patient Days (calendar year I957): 
Total: 2/3 -'^■z 

Professionals S/5 

Other: None 

'reject Description: 

Objectives: 1. To characterize more precisely the nature of the think J ng 
disorder found in schizophrenia, 

2. To devise a test which will distinguish the thinking of 
schizophrenics from that of patients with chronic brain 
syndroffie. 

Methods Employed: Our starting hypothesis is that schizophrenics may have a 
selective difficulty in recognizing relationships and that, in a test com- 
paring the ability to recognize identities and relationships, organics may 
perform equally poorly on both but that schizophrenics will be significantly 
worse on the latter. oxts,uxxAcaaT,xy 

^^^IT'K^^^^^'^' P^*ien*s hospitalized in the William A, White Building of 
St, Elizabeths Hospital with the diagnosis of schizophrenia and those in 
other buildings >rith the diagnosis of chronic brain syndrome. 

Major Findings: None at present. 

Si^iflcance to Mental Health Research: A more accurate description of this 

i^n*" T^^J\°^ *^! ^^°^^^ P^^^^^^ '"^^ ^^ ^^ ^^ ^ tl^e Assessment of 
induced raodel-psychoses and of the effect of various treatment procedures. 

^SlS^ff °K ^^°J^^*V ^^^^*i"g ^11 b« started shortly in an attempt to 
evaluate the above hypothesis. The literature in the field is beinTreviewed. 



B included: NOo 



■191 



Serial No, M-CS-P(C)-2 

1, Lab, of Clinical Scienii 
2e Section on Physiology ; 
5= Betbesdaj, Md. 



PHS=NIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Titles The effects of a variety of centrally acting drugs on intellectual 
motor, and perceptual behavior in normal subjects., 

Principal Investigators Conaa Kornetsky^ PhoD« 

Other Investigators: Thomas Vates^ Mt.D,, Mary Lee Geisser^ end Edith Karnmen I 

Man Years (calendar year 1957)° Patient Days (calendar year 1957)° ' 
Totals 1 1/3 650 

Professional; l/5 

Other; 1 i 

i 

Project Description; 

Objectives; 1, To determine what differences may exist in the psychological 

effects of opiates, tranguilizing drugs, barbiturates, psychoto-]j 
mimetics, and alcohol » 

2 a To study the individxial differences in subject response to drugs 

Methods Employed; During the past year we have altered the procedure eniployed 
in measuring the psychological effects of dsrugs such that instead of em- 
ploying a number of separate pieces of apparatus we now use a single multiple ' 
stimulus -response apparatiis. This allows the measurement of a variety of , 
types of behavior involving the same motor response on the part of the I 
subject* This multiple stimulus-response apparatus was developed by Michael 
Davis, formerly of Technical Development, with the collaboration of Dr« James 
Birren, Section on Aging, Laboratory of Psychology, and Conaa Kometsky, 
Laboratory of Clinical Science, Three measures of behavior have been used 
this past year; Simple motor response, choice reaction time, and a simple 
learning task. 

One eacperiment has been con!i)leted this year and another is in 
progress* The completed experiment compared the effects of 800 and 1600 
mg=, of meprobamate, 60 and 120 mg. of phenobarbital, and 5 and 15 mg, of { 

d-anrphetaraine ,. 

The second experiment which is stiH in progress conipared the 
effects of chlorpromazine, dextro-amphetamine^ pentobarbital, benactyzine, 
and alcohol in normal subjects. The pxirpose of this experiment was primeirily 
to test the hypothesis that individuals whose performance was most impaired 
by depressant drugs would have the greatest facilitation after stimulant 
drugs. In order to obtain facilitation after dextro=amphetamine this drug 
was administered after 48 to 72 hours of sleep deprivation^. 

- 192 » 



Serial No.. M-CS-P(C)-2 Page 2 

In both of these studies Dr« Allen Mirsky of the Section on 
Animal Behavior^ Laboratory of Psychology, determined the effects of the 
drugs on the "continuous performance test,-." (See Dr^ Mirsky* s report for 
details )« Dr.. Philippe Garden of the Laboratory of Clinical Science studied 
the subjects employed in the first study o, He compared the effects of the 
varioiis drugs on a number of physiological indices,, (See Dr, Caxdon's report 
for details)= Dr, Virgil Carlson of the Section on Perception and Learning, 
Laboratory of Psychology, has been testing all subjects of the second study 
on a suggestion test and a variety of perceptual tasks, (See Dr.. Carlson's 
report for details), Dr^ Isabella Kendig of the Laboratory of Psychology has 
interviewed all subjects prior to the start of the experiment in an attempt 
to see if relationships exist between health and health attitudes and 
response to drxigs, (See Dr., Kendig' s report for details )« Dr* Darab Dastur 
of the Section on Cerebral Metabolism, Laboratory of Clinical Science, has 
collected urine during the sleep deprivation part of the experiment to 
determine if sleep deprivation changes the constituents of the urine « 

Major Findings: In the first study engjloylng meprobamate, phenobaxbital and 
dextro-aatphet amine, only I6OO mgm, of meprobamate catused significant impairment 
of functioning on all three parameters of the multiple stimulus -response appeiratus* 
Eight hundred m@n„ of meprobamate reduced the rate of learning but did not affect 
performance on simple motor response or choice reaction timeo Phenobarbital 
did not si^ificantly affect performance on ar^r of the procedures Dextro- 
anphetaffiine did not facilitate performance j on the contrary, it produced a 
slight though statistically insigiificant impairment of performance. 

In the second escperimeat, l4 subjects have been studied. The data will 
not be analyzed imtil I8 to 20 subjects have been completed,. 

Significance to Jfental Health Research; This project will give information on 
the relative effects on performance in normal man of a vsiriety of drugs that 
are used in the treatment of mental illness =. In the early studies^, it was 
found that those subjects who were most affected by one drug were very likely 
to be the same subjects who were most affected by other drugs » If this 
finding is confirmed, an attempt can be made to relate this to such variables 
as personality and the physiology of the individual. Such studies may give us 
a basic understanding of the important non-dxug variables in an individual's 
response to drugs <. 

Proposed Course of the Project; 

1. The present study will be completed early in 1958 after which 
further studies on individual differences in drug response will 
be carried out and the relationship of these responses to the 
response of the individual to psychological and physiological 
stress will be determined^ 

2o The effects of smaller doses of the drugs will be studied in an 
attempt to siscertain minimal effective dose. 



Part B included; Yes, - 193 



Serial No. M-CS-P(c)-2 Page 5 

P rt B, 

Publications : 

1. Koraetsky, C. Relation of physiological and psychological effects 
UMT-Ifs" 1%^^,^^*^^-^^^* A.M.A. Arch. LLl. I PsycSatf 

Honors: Dr. Conen Kometsky was elected to membership in the American 
Society for Pharmacology and Experimental Therapeutics. 



- 19^ - 



I 



Serial Wo. M-CS»P(C)-5 

1, Latoo of Clinical Science 
2o Section on Physiology 
5. Bethesda, M. 



PHS-HIH 
Individual Project Report 
Calendar Year 1957 



et A 

Project Title; Studies on the effects of various centrally acting drugs 
in the rat. 

Principal Investigator; Conan Kometsky^ PhoD, and Joseph Cochin, MeD,, :!''. 

Other Investigators 2 Michael Malainud*aRd Straty Economon 

Cooperating Units; Laboratory of Chemistry, NIAMD 

Man Years (calendar year 1957) s Patient Days (calendar year 1957): 

Total; 5/6 None 

Professional 1/3 
Other; 1/2 

Project Description; 

Objectives; 1» To study the effects of various centrally acting drugs 
on siinple motor behavior in the rat. 

2, To determine the degree to which individual differences 
in the extent of response to drugs may be partially 
independent of the drug being studied, 

3, To study tolerance to various centrally acting drugs. 

Methods Employed: The primary dependent variable used in these experiments 
is the time it takes the rat to swim a cireiilar pathway 13 feet in length. 
Two experiments comparing the effects of chronic administration of mor- 
phine on swimming time to an analgesic measure of morphine effects have 
been corapletedc. Two methods of determining analgesic effects have been 
used; tail flick response to thermal radiation and the hot plate method. 
A third and preliminary experiment has been started to study tolerance of 
the rat to LSD. 

Major Findings; The morphine stisdies suggest that tolerance to the be- 
havioral effects of morphine lasts longer than tolerance to the anal- 
gesic effects. The preliminary LSD experiments suggest that tolerance 
to LSD in the rat does not develop so rapidly or to so great a degree 
as does tolerance to LSD in man. Also, it is not clear at the present 
time whether or not complete tolerance to LSD ever appears in the rat, 

"Sunmer students 



19-5 - 



Serial No. M-CS-P(C)-5 page 2 

Significance to Mental Healtti Research; 

1« These studies will help us understand the course of the development 
of tolerance to variovis drugs used in the treatment of the mentally 

2, A more basic problem but one that may have far more significance 
to the problems of mental disease is that of individual differences 
in response to drugs. If animals that are most affected by one drug 
are also the same animals that are most affected by other drugs, it 
will indicate that there is something present in the animal that 
determines the relative effects of drugs independent of the drug. If 
physiological mechanisms can be elucidated that contribute to the 
extent of drug effect it will contribute to an vsnderstanding of the 
important variables in human response to drugs. 

Proposed Course of Project; The effects of a variety of drugs on the swimming 
procedure will be studied. If it is found that animals who are 
relatively most affected by one drug are relatively most affected by 
other drugs, an attempt will be made to elucidate the iniportant 
variables contributing to individual responsivity to drugs. 



Part B included; No 



- 196 - 



Serial No» M-CS-P(C)-lv 

lo Lab, of Clinical Science 
2o Section on Physiology 
5o Bethesda, Md.. 



PHS»NIH 
Individual Project Report 
Calendar Year 1957 



]irt A 



Project Title; A comparison of the effects of chlorpromazine and secobarbital 
on intellectual^ motor and perceptual behavior in schizo- 
phrenic patients* 

! 

'Principal Investigator; Conan Kometsky^ Ph»D<, 

Other Investigators; Ronald Wynne^ MaSe^ Edward Vo Evarts, M«De^ and John 

M, Petit ^ M^D^ 

Cooperating Units s St» Elizabeths Hospital^ Washington j, D«C» 

Man Years (calendar year 1957): Patient Days (calendar year 1957) s 
Total; 1 1/6 885 

Professional; 1/2 
Other; 2/5 

Project Description; 

Objectives; To compare the effects of both acute and chronic administration 
of chlorpromazine and secobarbital on a variety of behavioral measures 
in schizophrenic patients. 

Methods Employed; Acute Study - Twelve schizophrenic patients with a minimum 
of one year of hospitalization were selected frcan the population of the 
William iU White Building at Sto Elizabeths Hospitals On separate days 
each subject received 100 aad 200 mgm, of secobarbital, 100 and 200 mgm. 
of chlorpromazine^ and a placebo « Each dose of each drug was repeated 
once^ so that each subject had a total of 10 testing days. All drugs 
were admnistered in identical capsules and the "double -blind" procedure 
weis used throu^out* Ninety minutes after drug administration j, subjects 
were tested on a variety of motor, intellectual and perceptual tests. 

Chronic Study = A week after the coH^letion of the acute study, 
subjects were placed on a two=week regime of chlorpromazine, secobarbital, 
or placebo. All subjects received each drug for two weeks *, A balanced 
design was used« During the first week on each drug, subjects received 
100 mgm. twice a day, while during the second week subjects received 
200 mgm. twice a day. Testing was done ©a the fifth day of each week. 
The same behavioral measures used in the acute study were used in the 
chronic study. 



197 



Serial Bo^ M-CS-P(C)-it Page 2 

Major Findings s Acute StxKly = The restjlts indicate that the effects of 
eMLorpromazine aud secobarbital on perfonaance in schi'^ophrenics are 
not sigDififfiantly different from the effects of these drugs on per- 
formsnce in normal subjects o That is^ both 200 m^^ of secobarbital 
aad 20D m@no of chlorpromasine inspair intellectual^ perceptual and 
motor functioning in both normal and schizophrenic populations. In 
the studies on normal subjects 100 m^« of chlorpromazine also signi- 
ficantly affected performance on these same testsj in the schizophrenic 
population^ however^ 100 rngm, of chlorpromasine caused a sli^t but 
statistically insignificant decrement in performance level. 

Chronic Study » In the chronic study neither 100 nor 200 mgm. of 
chlorproma:zine caused siggiificant in^airment in performance^ where- 
as the 200 mgm<, dose of secobarbital did cause significant impairment 
of perl'ormanceo 

Research; 
SigQifieanee to Mental Health/ Since drugs are one of the primary methods 
used in the treatment of the mentally ill^ it is importajat to know to 
what degree these drugs do or do not iiopair psychological functioning. 
Drugs which lead to amelioration of a patient's psychotic syu^itoms 
but catise significant impairment of mental ftmctions may not be the 
therapy of choice in certain groups of psychiatric patients. 

Proposed Course of the Projects In 1958 this project will make use of 
operaat conditioning procedures in the study of the effects of drugs 

ia schisophrenic patients. It is hoped that the use of operant con- 
ditioMng procedures will allow the studies of learning and perception 
in patients ifeo otherwise would not cooperate enough so that meaning- 
ful results could be obtained» These techniques may prove useful in 
evaluating the efficacy of traaquiliziag drugs in this population. 



Part B included; lo 



198 ~ 



Serial No. M-CS-P(C)-5 

1. Lab. of Clinical Science 

2. Section on Physiology 
5d Bethesda, Mi. 



PHS-NIH 

Individual Project Report 

Calendar Year 1957 



Prt A. 



Project Titles Behaviorally and pharmacologically induced effects on the 
electrical activity of the "brain. 

Principal Investigators; Edward V. Evarts, M»D, and Corwin Fleming, M.D. 

Other Investigators; Mortimer MLshkin, M.D, and Bonnie Peacock 

Cooperating Units; Section on Animal Behavior, Lab. of Psychology, NIMH 

Man Years (calendar year 1957): Patient Days (calendar year 1957); 
Total; 1 5/6 
Professional; 5/6 
Other; 1 

Project Description; 

Objectives; In the previous annual report (1956) from this section, two 
separate neurophysiological projects were outlined, one dealing with neuro- 
pharmacolosr and one dealing with the excitability of primary and diffuse 
thalamo-cortical projection systems. These two areas of investigation 
have been combined in the present project. The purpose of this project 
is to correlate a variety of behavioral and electrophysiological 
observations. Studies of the effects of pharmacological agents on 
behavioral and electrophysiological events are also in progress. 

Methods Employed; MDSt of the studies on this project have been carried 
out in cats with chronically implanted electrodes. The loci of place- 
ment of the stimulating and recording electrodes depends upon the 
particular phase of neural activity ^ander investigation. 

Major Findings; 

(l) Studies of the characteristics of cortical recruiting responses 
in unanesthetized cats were begun in 1955 in collaboration with 
Dr. H. W, Magoun. These studies have been completed. It was found 
that well -developed cortical recruiting responses could be evoked 
in awake cats by stimulation of the intralaminar nuclei. Stimu- 
lation of the brain stem reticular formation reduced the amplitude 
of the recruiting responses in these preparations! novel auditory 
stimuli had a similsir effect. With repeated presentation, a 
given auditory stimulus ceased to affect recruiting responses 
("habituation")* Repeated stimulation of the brain stem reticular 
formation, however, consistently reduced the amplitude of 
recruiting responses. 



199 



Serial No, M-CS-P(C)-5 Page 2 

(2) Previous studies carried out in collaboration with Dr. Arnold 
Schoolman and Dr, Wade H. Marshall demonstrated that pentobarbital 
has marked effects on the excitability cycle of the primary cortical 
response to lateral geniculate radiation stimulation. This effect 
of pentobarbital consists of a marked increase in the initial sub- 
normality of the test response. Further studies have now shown that 
ethyl ether has a similar effect. In contrast, chlorpromazine and 
reserpine do not exert this depressant effect on the early phase of 
the cortical excitability cycle. 

(3) A series of observations concerning the electrophysiological effects 
of metabolites of epinephrine and norepinephrine has been carried 
out. In anesthetized cats, metanephrine and normetanephrine were 
tested on 

(a) the transcallosal response 

(b) the cortical response to retinal photic stimuli 

In unanesthetized cats with chronically iniplanted electrodes, obser- 
vations were made on the effects of the two substances on 

(c) recruiting responses 

(d) the cortical response to geniculate radiation stimulation 

(e) the cortical response to retinal photic stimuli. 

Large doses of the two substances were without effect on any of these 
forms of electrical activity. , 

{h) Studies aimed at analysis of electrophysiological correlates of condi- 
tioning have recently been vindertaken in collaboration with Dr. Mishkin. 
In an initial phase of this study, cats with chronically implanted 
electrodes were subjected to repeated photic stimuli. In three cats 
that were exposed to 3,000 flashes (600/day for 5 days), no decrease 
in the aniplitude of the primary cortical response weis observed. On 
the contrary, there was a statistically significant increase in the 
amplitude of the responses over this period. Subsequent studies 
will analyze the effects of a conditioning procedure in which the 
light flash will be paired with a painfral shock. 



200 



Serial No. M-CS-P(C)-5 Page 5 

Significance to Mental Health Research: The four general findings which 
have been described may be divided into two groups: 

1. The electrophysiological studies have shown rapid habituation to the 
effect of an auditory stimulus on recruiting responses, but have failed 
to show any decrease in the primary cortical response to a repeatedly 
presented flashy These observations are related to the problem of 
central electrophysiological changes in association with learning, and 
may be regarded as generally relevant to basic problems of mental 
function. 

2, The pharmacological studies have demonstrated a clear end striking 
difference between the cortical effects of barbiturates and ether 
on the one hand;, and chlorpromazine and reserpine on the other » The 
absence of cortical depression by chlorpromazine and reserpine may 
in part explain the selective behavioral effects of these drugs « 

Proposed Course of Project: The project will continue along the lines indicated 
above* During the coming year emphasis will be placed on studies of the 
electrophysiological correlates of learning and conditioning. 



Part B included: Yes 



lOl = 



Serial No. M-CS-P(C)-5 Page k 



Part B< 



Publications 

1. Evarts, E.V. and Magovin^ H,W* Some characteristics of cortical 
recruiting responses in unanesthetized cats. Science, 12^ ; 11^7- 
111^3, 1957. 

2. Evarts, E,V. Neurophysiological correlates of pharmacologically 
induced behavioral disturbrnces . Research Publications of the 
Association for Research in Nervous and Mental Diseases , 1956, 
(in press). 

3. Evarts, E»V, Contributions of neuropharmacological studies to 
our present concept of a possible chemical basis for psychosis. 
Proceedings of the Symposium on Chemical Concepts of Psychosis , 
2nd International Congress of Psychiatry, Zurich, Switzerland, 
1957> (in press). 



2C2 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Clinical Investigations 
Laboratory of Clinical Science — Section on Psychiatry 



BUDGET SHEET 



Estimated Obligations for FY 19*^8 
Total: $220,722 
Direct: $83,673 

Reimbursements: $137,0^9 



Projects included: M-CS-Ps(C) 1 through M-CS-Ps(C) 5 



Serial No. M=>CS-Ps(C)-l 

1. Laboratory of Clinical Science 
FHS-HIH 2o Section on Psychiatry 

Individual Project Report 3» Bethesda^ Maryland 
Calendar Year 1957 



Part A. 



Project Title: Correlation of Psychiatric Evaluation with Neurophys- 
iological, Psychological and Sociological Evaluation in the Aged» 

Principal Investigators: Seymour Ferliaj Mo D. and Robert U. B-itler^ M= D, 

Other Investigators: None 

Cooperating Units: Section on Cerebral Mstabolism^ Laboratory of Clinical 
Science, National Institute of Mental Health. Serial No. M-CS-CM-1 

Man Years (calendar year 1957): Patient Days (calendar year 1957) ^ 
Total: it. 5 

Professional: 1 755 

Other: 3-5 

Project Description: 

Objectives ; (a) To select suitable saniples of "noriaal-a,';:ed" vol- 
unteers and Chronic Brain Syndrome patients for nultidisci- 
plin-ary study, (b) To psychiatrieally evaluate and characterize 
ttie selected subjects in terms of: diagnosis, psychopath- 
ology and modes of adaptationo (c) To correlate psychiatric 
evaluation vith physical status^ neurophyeiologic (including 
cerebral ffletabolism and eleetroeneephalograpliic measurements) 
status^ and psychological and sociological status o (d) To 
define (through a, b aad c) criteria for the subgroups desig- 
nated "normal" aged^ "senile factor" aged, and chronic 
brain syndrom'; » 

Methods ; Each subject will be interviewed for two 2-hour recorded 
and observed sessions; the first (Interview A) being an 
unstructured psychiatric interview^ the seccad (interview B), 
a structured interview which includes a loental status ex- 
axaination and inquiry regarding apparent age-relevant 
concepts, 53iere is systeraatic rotation in roles of inter- 
viewer and obseirver. 

In addition., rating methods will be adapted for use by the 
interviewer, observer, and other psychiatrists for indepen- 
dent assessment. 

Independent and concensus ratings, quantified on a seven-point 
scale tdierever feasible, will be made in the following ten 

categories: (a) Diagnoses, (b) "Age Relevant" SynsptGSJS, 



^03 



^^« "^^ Serial Number M-CS-Ps(c)"l I 

Project Description: (Csntiaued) 

(c) Mental Status, (d) Affective State, (a) PsyeMatric Sya^toms, 
(f } Separation Respoase, (g) Concept Evaluation (Disordered Tiiae 
Sensej Constriction of Future^ Age ChaBge Attitudesj Death 
Concern; Disturbed Body Ismge), (h) Maternal Attitude Scale, 
(i) Psy^hodyaamic Formaation, and (j) Intei-view Behavior Scale. 

Patient Material ; 

Major Findi23g3; Adaptational modes in the aged have "been derived from ! 
the psyxshiatric characterisation aiid differentiation of emerging j 
subgroups within the fifty- seven aged volunteers studied, j 

I 

Investigations of neurophysiological variables; e.go, cerebral :' 
metabolism, in ttie conmmiity aged failed to disclose any simple '• 
relationships with psychiatric status (ineludiag cognitive defects] 
Bie relationship of reduced cerebraa metabolism to the diagnosed 
of chromic brain syndrons was confirmed.. I 

i 
A group which has been designated as the "Senile Factor Group," i 
reveals definitive cognitive losses but no alterations is cerebral;' 
metabolism. !Siis may be a coisposite syndrome, a consequence of 
both organic and psychosocial alterationso and is distinct from i 
the Chronic Brain Syndrome, mis syndrome m.j correlate with ' 
psychological tests for "orgaaicity. " This m.j represent an ! 
early stage of the Chronic Brain S^-ndrome. ' 

Investigations of the effects of psychosocial disruptions or 
losses demonstrates that the personal meaning or psychological 
significance, of such are more important than the incidence or 
nature of these stresses per se. In general, the adaptive or^ 
maladaptive function of personality variables or psych©pathologica' 
features varied with the psychological significance of certain 
events in the aging experience (e.g., losses; cognitive deficits: 
forced retirement and the like). 

The adaptive use of psychopathology, -fee use of activity, the 
counterphobic attitude, and the function of denial versus 
insight into the aging essperience, axe among the adaptatiosaal 
modes identified, to the other hand, maladaptation is seen in 
depression, paranoid isolation, identity loss and «ie like. 

While the representativeness of the saa^sle cannot be claimed a 
variety ©f psychiatric, psyeh©s©oial and other aspects of 
these populations are escplieitly ehajraeterized and thus available ' 
for purposes of comparison. '' 

Significance to Me ntal Health Research; Hi® strueturi^ of problems ' 
for research in geriatric psychiatry receives nuch. ©f its is^tus \ 
in the s©atext ef iBie evar«=iacreasiag niaaibers ©f aged in -feis 
country. Bie ©Ider pers« himself has been aagiected resea^-ch-wis 
and there has been miah faulty extrapolation of data from o-^er ag 

10^ 



Page Biree Serial Number M=CS"Ps(c)-l 

Significance to Mental Health Research : (Continued) 

periods. The study of the normal aged hr.s been especially neglected. 
The sesLTch for adequate evaluation in the aged has its historic roots 
in the inability to fully understand psychological symptoms on the 
basis of neuropathologies! changes. The question as to which are 
the important parameters for investigation eiaphasizes the need for 
a multidiscipline approach. Psychiatric diagnoses run the gaimat and 
may vary from one dealijag with the individual's personality make-up 
to defined neurotic syraptomatology to organicity; e.g., chronic 
brain syndrome with arteriosclerosis. Thus the possibility of 
correlating data with other disciplines is present. A few examples 
of the theoretical questions posed by one discipline against the 
data provided by another discipline are as follows: (l) Does the 
slowing of reaxition time postulated by the psychologist as a sine qua 
noa of aging correlate selectively with depression as evaluated by 
the psychiatrist? (2) Does the diagnosis of chronic brain syndrome 
with arteriosclerosis formulated as a syndrome by the psychiatrist 
correlate with evidence of change as measured by the neurophysiologist 
and internist? (3) Are assumptions regarding sequence of changes in 
cerebral blood flow and metabolism as meastired by the neurophysi- 
ologist supported by changes in intelligence, perception, etc., as 
measured by the psychologist and psychiatrist? Follow-up studies, 
if undertaiien, can deal with the predictive value of such matex'ial. 

Proposed Cetirse o f Project; The study of the subgroup of hospitalized 
Chronic Brain Syndrome patients will be continued. 



I Part B included Yes 

! - 2G5 



Serial I©, M-CS-Ps(C)-l Page k 

mS-NIH 

ladividual Project Report 

Calendar Year 1957 

Fstrt B: Honors, Awards, and Publications 

Publications other than abstracts from this praject: 

Perlin, S. and Butler, Ro Correlation of Psychiatric Evaluation with 
Neurophysiolegic, Psychologic, and Sociologic Evaluation in a Group 
©f Normal Aged, (in preparation) 

Perlin, S. Psychiatric Aspects ©f Senile Nervous Diseases. Summary 
of Fourth International Gerontological Congress, Merano, Italy, 
July, 1957. (To be published) 

Perlin, S., Pollin, W. and Butler, Ro The Experimental Subject: I. The 
Psychiatric Evaluation and Selection of a Volunteer Population. 
(Submitted for publication) 



Honors and Awards relating to this project: 

Butler, R. and Perlin, S. Depressive Reactions in the Aged. Presented 
at 113th Meeting, American Psychiatric Association, Chicago, 
May, 1957. 



206 - 



Serial No. M-CS-Ps(C)-2 

1, Laboratory of Clinical Science 
PHS-NIH 2. Section on Psychiatry 

IndivicLual Project Report 3« Bethesda, Maryland 

Calendar Year 1957 

Part A. 

Project Title: Psychiatric Evaluation of Nornal Control Volunteers. 

Principal Investigators: William Pollin, M. D,, and Seymotir Perlin, M.D. 

Other Investigators: None 

Cooperating Units: None 

Man Years (Calendar year 1957): Patient Days (Calendar year 1957): 
Total: 1.20 

Professional: »50 85 

Other: .70 

Project Description: 

Objectives ; (a) To study the methodology of evaluating normal 
control volunteers, (b) By means of psychiatric evaluation^ 
to describe the psychodynamLcs of all normal control volimteers 
admitted to the Laboratory of Clinical Science for participation 
in other projects, (c) To provide data for use in 
(l) setting up criteria for selection of normal control 
volunteers; and (2) interpretation of the resxilts of projects 
in which they participate, (d) To indicate in vhat vays 
extension of this investigation into the area of correlation 
between psychological and physiological variables in normal 
controls can be made* (e) To study the motivation of normal 
control volunteers to enter a research hospital and the 
relationship between motivation and psychopathology. 

Methods Employed; Each normal control is routinely seen for a 
psychiatric evaluation interview^ Following this interview, 
the interviewer as well as the interviewee provide independent 
ratings of a variety of categories of affect and psychological 
functioning, quantified on a 7-point scale. In addition, 
interview behavior is rated by the psychiatrist-. Interviews 
are recorded and available for later independent analysis and 
evaluation. During their stay on the ward, subjects are seen 
before and after certain investigative procedures for brief, 
recorded procedure-oriented interviews. 

Patient I'laterial : To date, (10/17/57) ^9 subjects have been so 
evaluated. 

Major Findings ; 

1. Psychiatric evaluation of a group of 29 volunteer research 
subjects demonstrated the presence of significant psycho- 
pathology in 15. In 11 of the 29 subjects psychiatric 
diagnoses were made. 

- 207 - 



Page Two Serial NOo M<=CS=Ps(C)"2 



There ■^ras an inverse relationship in this volunteer group 
between the presence of psycbopatJiology and the extent to 
which environissental influenees contributed to servl,ng as a 
volunteer o "-- '- - 

3o Kie incidence of psychopathclogy in a subgroup whose 
volxinteer status was largely due to thair draft status 
was 28^j in a second gubgroup whose volunteer status con- 
formed with sociO'Oultiiral tr^sdition^ 3^^$ in a third sub- 
group where neither of these factors were operative^ 100^, 

ko The volunteer group showed considerable differences in the 
motivations involved in volunteering^ in the ability of 
its members to accommodate to stress, in defense mechanisms i 
employed^ and in the tendency to somatieize anxiety, 

5o These differences^ and the relationship between volunteering 
and psyehopathology have clsxified a number of questions 
pertinent to the selection of ^folimteer groups^ and the 
interpretation of results obtained from them. 

Signific ance to Mental Health Research; Normal control volunteers 
constitute one of the major subject groups used in psychiatric 
and psychological resear'Ch= Until very recently^ little 
attention has been given to setting up ci'lteria for the 
selection of such groups^ other t-hsa att'Smpts at exclusion of 
individuals shoTd.rjg gross psyehopathology » SLniilarly^ there 
has been little work done en psychiatric evaluation of normal 
controls or with the application of data obtained from such 
evaluation to the interpretation cf data obtained by other 
discipline So Findings thus far msJse possible a more meaning- 
ful use of volunteer Sj, and clarify some problems of one of the 
basic elements in personslity,-@ad pfychophys5.ological research; ! 
the subjects employedo . " .. _ i 

' ' ' ■ I 

Proposed Course of Projects Eva3.Tu,ation of all normal control 

volunteers admitted t© the laboratory of Clinical Science wards, 

I 
will continue » 



Part B included^ 



--^'^^:'%rt 



Page Three Serial No. M-CS-Ps(C)-2 

PHS-HIH 
Individual Project Report 
Calendar Year 1957 



Part B ; Honors, Asrards, and Publications 

Publications other than abstracts from this project: 

1. Pollin, W, and Perlin S^ Psychiatric evaluation of 

"norinal control" ^'olunteers. Am. J, Psychiato (in Press) 



Honors and Awards relating to this project: 

1« Perlin, S,, Pollin, W. and Butler, Re N. The experimental 
subject: I. The psychiatric evaluation and selection of a 
volunteer population. Presented at Divisional Coiaference, 
American Psychiatric Association, New York, New York, 
November, 1957 • 



- 209 - 



PHS-NIH 1. Laboratory of Clinical Science 

Individual Project Report 2. Section on P^ychiatcj!: : 
Calendar Year 1957 3. Bethesda, ifeyland- '- -- •- 

s, no ii'j'Vjsa niia-s.ti-^. 01 - S x ^ ~ bbZs^^ 

Project Title; ^ Psychological Variables and Cereljr.i^ .phy§iqi.ogy^ ..;. 

/ Principal Investi^al^drs: ' Seymoxir Perliri/ M» D. and^illiam Pollin.M.D. 

Other Investigators J Conan Kornetsky/ M.. D,, Louis Sokoloff, M, D« 

and Seymoxir S. Kety, M. D. 



Cooperating; Units; None , _^ 



u., ,.^^»^^ ,.'fm ^ «--.^ ?. *-.jt!r o.* 



Man Years (calendar year 1957); Patient Days (calendar year 1957) 
Total; >66 

Professional; .33 26 

Other: ,33 

Project Description; 

Objectives ; To determine -vrhether there is a demonstrable relation- 
ship between levels of cerebral blood flow and/or oxygen uptake, 
on the one hand and basic personality structure and/or 
psychological state at time of the procedure, on the other.. To 
characterize such a relationship, if one exists. 

Methods Employe d; Normal Control Volunteer subjects are routinely 
seen for psychiatric evaluation on admission. They are also 
seen at intervals before and after the CBF procedure, by the 
psychiatrist, for a brief procedure-oriented interview. 
Psychological measurements, including MMPI, Rorschach and GSR 
recording during procedure, are done. Cerebral blood flow and 
metsibolism are measured by Nitrous Oxide technique of Kety and 
Schmidt. Four participant -observers make independent and con- 
sensus ratings of subjects behavior and adaptation during pro- 
cedure. When current second series of subjects is completed, 
these independently amassed data will be inspected for possible 
correlations and to determine if certain relationships between 
personality and cerebral metabolism indicated by the study of 
first series of subject is further supported. 

Patient Material ; Males - 5 x 2 - 10 

Females - 6 x 2 - 12 

Patients served on a variety of projects 

Major Findings ; In the first group of subjects, studied by similar 
techniques, there appeared to be an inverse relationship between 
low normal levels of cerebral O2 uptake and the presence of 
psychopathology« There was also a direct relationship between 
level of CMIO2 and responsivity during the procedxire. The cxirrent 
subject population is being investigated to determine if these 
previous findings can be verified^ 

- 210 - 



P&ge Two Serial No. M-CS-Ps(C)-3 

Patient Material ; 

Males - ^ X 2 - 10 Patients served on a 

Females - 6 x 2 - 12 variety of projects 



Significance to Mental Health Research ; Results of this study should 
help to clarify the relationship between personality factors, the 
stress of certain investigative procedures and the results of such 
procedures. They may also indicate a relationship between certain 
aspects of cerebral metabolism and personality variables. 



Proposed Course of Project ; The present second series of subjects will 
be completed and data then analyzed. 



Part B included Yes 

r- 211 



Serial Ho. M»CS-Ps(C)-3 Page 3 



mS-HIH 
Individual Project Report 
Calendar Year I957 



Fart B ; Honors, Awards, and Publications 
Riblications other than abstracts from this project: 



Honors and Awards relating to this project: 

Presented at (l) Peripatetic Club, February 1, 1957; and (2) Public 
Health Service Clinical Society, April 27, 1957; under title 
"Psychological Variables and Cerebral Functions in a Volunteer 
Population: Preliminary Report." 



212 



Serial No. M-CS-Ps(C)A 
1. Laboratory of Clinical Science 
PHS-NIH 2. Section on Psychiatry 

Individiial Project Report 3. Bethesda, Maryland 
Calendar Year I957 



Part A. 



ft"oject Title: Correlation of Psyckiatrie Evaluations and Their Ibysi- 
ological Correlates of tlie Effects of 1-Epinepkrine in a Normal 
Control and A Schizophrenic Population. 

Principal Investigators: Rohert H. Butler, M. D. and William Pollin, M. D. 

Other Investigators: None 

Cooperating Units: Section on Cerebral Metabolism 

Section, General Haysiology 

Man Years (calendar year 1957): Patient Days (calendar year 1957): 
Total: olO . 

Professional: .50 None 

Other: ,(iO 

Project Description: 

Objectives ; (l) To determine if there is any difference in psy- 
chiatric response to a high level of circulating epinephrine 
between a group of chronic schizophrenics and a group of 
control volimteerso (2) To study the effects of a high 
level of circulating epiiiephrine upon the schizophrenic dis- 
order. (3) To investigate possible correlations between 
psychiatric response to high levels of epinephrine and 
concurrently obtained metabolic and psychophysiological data. 

Methods ; Each experimental subject receives 1-Epinephrine, stan- 
dardized according to body weight, infused intervenously at 
0.30 micrograms per kilogram per minute. An aliquot of 
tagged tritiated epinephrine is included in the infusion. 
Experimental conditions are standardized and studies of 
control and schizophrenic subjects are interdigitated. Two 
psychiatrists participate, one as an interviewer and the 
other as an observer-auditor. The psychiatric observations 
proceed continuously from the time the patient is informed 
of the procedure shortly before it begins through a post- 
study evaluation period. The procedural period consists of 
a randomized sequence of drug and saline infusion concerning 
which the peirticlpating psychiatri&ts remain blind. The 
subject also is uninformed as to idiat substance is being 
infused. During cBjch infusion period an interview of approx- 
imately twenty minutes duration is conducted. The interview 
includes a portion of the time devoted to xmstructured 
productions by the subject, a standardized symptom check list, 
brief tests of mental function, and, in the case of the 

" 213 - 



^^e Two Serial No. M-CS-Ps(C)-l^ 

schizophrenic popaatioH, specific questions pointed at each | 
subject •s most prominent psychotic features of conflict. The 
interviews will he recorded for further and independent analyai, 

The observer-auditor employs a scale devised for use in rating 
subjects with respect to changes in affect, mental organization 
and activity in each of the periods, and in assessing their 
attitude toward the procedure. In addition, he writes con- 
tinuous descriptive notes and includes data concerning the 
interaction between the interviewer and the subject. Observa- 
tions are made through a one-way mirror. 

Physiological, metabolic, psychophysiological and EEG data 1 
sure collected simultaneously. 

Patient Material ; A group of chronic schizophrenic patients 

admitted here from a state hospital, as well as a group of j 
resident control volunteers. I 

-- 

Significance to Msntal Health Research ; Bie role of epinephrine 

in anxiety has been suspected for some time and the possibility;! 

that epinephrine ©r one of its metallolites is ©f Importance i 

in the pathogenesis of schizophrenia is under current com- 1 

sideratlon. Studies of the psychological and physiological i 

effects of epinephrine may contribute t© knowledge of the I 
physiology of affects and/or the physiology of schizophrenia. 

Proposed Course ; Trial studies are now being conducted on both I 
control and schizophrenic subjects. The series itself will 
shortly begin. 



Part B included No 

- 214 - 



PHS-NIH 
Individual Project Report 
Calendar Year I957 



Serial No. M-CS-Ps(C)-.5 

1. Laboratory of Clinical Science 

2. Section on Psychiatry 

3. Bethesda, Maryland 



Part A. 



Project Title: 



Psychiatric Investigations in the Biological Study of 
Schizophrenic Subjects. 



Principal Investigator: Seymour Berlin, M. D. 

Other Investigators: William Pollin, M. D.; Robert Butler, M. D.j 



A. Russell Lee. M. D. 



Cooperating Units: 



Man Years (calendar year 1957): 
Total: 1.2 
Professional: 2.5 
Other: 3.7 



Patient Days (calendar year 1957); 
735 



Project Description: (l) Criteria for the Selection of a Small Group 
of Schizophrenic Patients for Biological Studies. (2) Character- 
ization (via interview) of a Schizophrenic Population. (3) Ward 
Observations of Schizejihrenic Subjects, (k) Organization of a 
Ward for Biologic Studies in Schizophrenia. . 

Objectives: 

(1) a. To critically explore schizophrenic subject selection 
criteria coi^atible with the theoretical and methodological approach 
of the multidisciplinary team. b. T® present a design for se- 
lection, which attempts to increase the probability of the ex- 
pression (qualitative and/or quantitative) of a biological defect. 

c. To detail the application of the design in a current NIMH project. 

(2) To characterize, in detail, relevant personality features and 
adaptations of a normal control and a schizophrenic population 
admitted for psychophysiological studies in schizophrenia. To this 
end, to develop interview techniques, and rating scales, •jdiich 
will be applicable to both groups. Within the schizophrenic 
group, to determine if there exist certain patterns of disease, 

or symptom clusters, ^ich, though possibly independent of 
currently accepted diagnostic groupings, show significant 
correlations with organic groupings. 

(3) a. To observe the behavior of schizophrenic subjects in a re- 
search setting for correlation with psychiatric interview pre- 
dictions and psychological test findings, b. To characterize the 
experimental situation, and investigate the perception and 
response of control and schizophrenic subjects to the experimental 
situation. This is an attempt to control for situational 
variables extrinsic to the schizophrenic disorder. 



Bt^ 



.211 



^^« Two Serial Humber M-CS-Ps(C)-5 

Project Description: (Continued) 

(k) ihc overall objective is to develop a psychiatric ward milieu suited 
to the requirements of biological studies. Complicated by this goal, 
but in many ways crucial to its achievement, is the more limited ob- 
jective of providing a desirable standard of psychiatric care for the 
patients participating in such studies. 

Methods; 

(1) In attempting to establish criteria compatible with the theoretical 
and methodological approach of the raultidisciplinary team, the following 
issues were delineated: (A) Group horaogeneityj e.g., age, sex, duration 
of hospitalization, exclusion of known organic factors, (b) !Qie biasing 
of the sample: An atten^t to increase the probability of the expression 
(qualitative and/or gxiantitative) of a biological defect. Concepts 
utilized: Multiple versus single etiology, "genetic," familial, "process," 
etc. (C) Generalizations and statistics related to the sm^J^sairole. 

(D) The "normal control." " ^ — 

The following committee was consulted as regards the issues raised; 
Dr. Seymour Kety (Biology); Dr. Gordon Allen (Genetics); Dr. Saniael 
Greenhouse (Statistics). 

(2) Clinical experience and literature search have provided a number of 
alternative interview- and rating scale approaches, which are cvirrently 
being tested. 

(3) Observation by ward personnel and the investigator. Use of several 
scales devised to record and quantify particularly changes in affect, 
mental orgajiization and activity observed in the ward and in the ex- 
perimental situation. 

(i^) In the process of administering the ward there are many vinusual 
problems related to the research goals. Through such pragmatic and 
empirical experience ward policies, modes of interaction with patients, 
and distinguishing characteristics of tiie ward milieu are gradually 
being shaped and defined. 

Patient Material ; 
Major Findings: None 

Significance to Mental Health Research: The selection, evaluation and 
ward observations of schizophrenic subjects are essential aspects of 
biological studies in schizophrenia. (Such factors are, in themselves, 
areas for research.) 

Proposed course: At present, plans call for the admission of ll^ 
schizophrenic subjects and ik "normal control" volunteers for long-term 
biological studies. 



Part B included No 

- 216 - 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Basic Research 
Laboratory of Nevirophysiology 
General Neurophysiology 



BUDGET SHEET 



Estimatgcl Obligations fgr fl 19^g 

Total? $li^O,ivOO 
Direct: $107,876 

Reimbursements: $32, 524' 



Projects included! M-NP-GN 1 through Jt-NP-GN 8 



Serial No. M-NP-GN-1 
1 . Laboratory or Meurophysiology 
2.. General Neurophysiology 
3. Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A, 



Project Title: Measurement of Local Circulation in the Brain 

Principal Investigator: D. Hansen 

Other Investigators: L. Sokoloff and W. Freygang 

Cooperating Units: Laboratory of Clinical Science, Section on 

Cerebral Metabolism, M-CS-CM-3 

Man Years : 

Total : . 5 
Professional: .5 
Other: 

Project Description: See M-CS-CM-3 



- 236 - 



Serial No . M--NF-<:'N-2 

1 o Laboratory of Neurophysiology 

2» General Neurophysiology 

3. Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A 



Project Title: Effects of drugs on specific ionic conductance. 

Principal Investigator : W« H» Freygang, Jr. I 

Other Investigator: None 

Cooperating Units: This work is being done with Dr. A. M. Shanes ij 

of the Institute of Arthritis and Metabolic 
Diseases and Dr. H, Grundfest of the Departmen 
of Neurology,, Columbia University, New York 



Man Years : 

Total: .15 
Professional 
Other : 



Patient Days : None 



15" 



Project Description: ' 

Objectives: It is possible to analyze the components of j 
membrane permeability into those which are specific for i 
different ion species « A new afiderstaading of the mechanism:! 
of the nerve impulse has been achieved with this approach. 
The effects of many neurologically potent drugs need to be 
studied in the light of this new information in order to 
define clearly their mode of action. 

Methods Employed: The technique employed provides a con- 
trolled voltage across the membrane of a squid giant axon. 
Changes in the flow of ionic current across the membrane hav< 
been measured. The drugs are applied extra-cellularly . 
Cocaine and veratrine have been studied. 

Major Findings: A prominent effect of cocaine is a reduc- 
tion in the influx of sodium ions daring activity of the axo • 

i 
Significance to Mental Health Research: The study should ! 
supply information of fundamental neuropharraacological 
importance . 

Proposed Course of Project: Analysis of data. 

Part B included Yes No x 



237 



Serial No. M-NP-GN-3 



1, Laboratory of Neurophysiology 

2, General Neurophysiology 

3, Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A, 



Project Title: Measurement of Soma -Dendritic Membrane Current. 

Principal Investigator: W. H. Freygang , Jr. 

Other Investigator: H. Wiener 

Cooperating Units: None. 

Man Years : Patient Days : None , 

Total: 1 80 
Professional: .80 
Other: 1 .00 

Project Description: 

Objectives: To determine the role of the dendrites aud cell 
bodies in the process of transmitting electrically coded 
information in the central nervous system. 

Methods Employed: As the dendrites and cell bodies carry 
signals, there is a flow of current across their membranes. 
It has been proven both by mathematical means and by an 
electrical analogue of a neuron that the electric poterjtial 
outside the cellj, but very close to it, is directly related 
to the flow of membrane current » The extracellular potentials 
are recorded from very fine glass pipettes placed close to 
a single neuron and the time course of the membrane curresiit 
is calculated from the recordings „ 

Major Findings: It is apparent that the iatracellular 
recording technique does not show whether the site of 
recording can produce all-or-none electrically induced 
activity or not, for the electrical signs of all-or~none 
activity can spread in a relatively undistorted form to 
the recording site. The time course of the membrane current 
from the dendrites and cell bodies, however, shows that these 
parts of the neuron do not respond to electrical excitation. 
Therefore, they must be activated primarily by chemical 
transmitter substances that do not induce all-or-none propa- 
gating electrical activity. 

Significance to Mental Health Research: This new technical 
approach combined with the finding that the dendrites and cell 
bodies are not excited electrically makes it possible to in- 
vestigate the chemically excitable soma-derjidritic membrane 

- 238 - 



Serial No. M-NP-GN-3 
page 2 
PHS-NIH 
Individual Project Report 
Calendar Year 1957 

Part A. (continued) 

with a clearer understanding and possibly a powerful new tool. 

Proposed Course of Project. Because the anterior horn cells of 
the spinal cord are large and can be impaled easily, much intra- 
cellular data have been obtained from them. Also, they have the 
additional advantage that they respond synaptically to stimula- 
tion of several easily accessible pathways. For these reasons 
it seems probable that the nature of synaptic excitation can be 
studied more profitably with these nerve cells rather than those 
of the lateral geniculate nucleus which have been studied in 
this project. 

Part B included Yes x No 



- 239 



Serial No. M~NP-GN-3 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 

Part B : Honors, Awards, and Publications 

Publications other than abstracts from this project: 

Freygang, W. Ho, Jr., An analysis of extracellular potentials from 
single neurons in the lateral geniculate nucleus of the cat. J, 
Gen. Physiol., In press. 



Honors and Awards relating to this project 
None. 



240 



Serial No, M-NP-GN-4 

1„ Laboratory oi Neurophysiology 

2. General Neurophysiology 

3. Be the s da 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



5rt A. 



Project Title: Studies on Role of Superficial Neurons "Dendritic 

Reactions" in Spreading Cortical Depression, 

Principal Investigator: Wade H. Marshall 

Other Investigators: W. Ho Freygang, Jr. 

Cooperating Units: None. 

Man Years Patier.t Days: None 

Total: o90 
Prof ess J-OB^l : =30 
Other: .60 

Project Description: 

Objectives: To determine relation of reactivity of superficial 
elements of cortex to spreading cortical depression ±v. cat and 
monkey o The reactivity of superficial elements is typically 
recorded electrically as a surface negative wave. This reaction 
has been rather loosely designated as the dendritic response. 
Spreading cortical depression car, be obtained in cat and moBicey 
only by pathological manipulation, that is by prolonged exposure 
to room air_, cooling the surface of tbe cortex, treating the 
surface with tyrodes containing excess potassium, etc. The 
latter two methods have been extensively employed in this labora- 
tory. The effect of these manipulations oia the "dendritic" 
response was determined. 

Methods Employed: The "dendritic" reaction was evoked by direct 
stimulation and by stiaiulation of the callosal systemo The 
surface of the arachnoid membrane was exposed to excess potassium 
or cooled to the level at which spreading depression can be 
evoked . 

Major Findings: It was found that producing conditions under 
which spreading depression can be evoked resulted ia severe 
reduction in the "dendritic" response. This reaction is re- 
versible. These experiments clearly showed that neuron activity 
of J at least, the first layer of tb.e cortex is r-ot necessary for 
evocation and propagatiorA of sprea.ding depression. This is a 
curious result since it is knows that the upper third of the 
cortex is dominant in the spreading depression reaction. 

„ 241 - 



Serial No. M-NP-GN-4 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. (continued) 



Conversely, the rabbit and other smooth brain corticies are very 
susceptible to spreading depression and it occurs in these cases 
with no specific pathological manipulation and with the "dendritic" 
response intact. 

Significance to Mental Health Research: Further progress in 
fundamental physiology of the brain. 

Proposed Course of Project: Various aspects will be continued 
indefinitely. 

Part B Included: Yes No x 



- 242 



Serial No. M-NP-GN-5 

1 . La,boratory of Neurophysiology 

2 General Neurophysiology 

3. Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A, 



Project Title: Effect of Curare on the "Dendritic" Reaction 

Principal Investigator; Wade H. Marshall 

Other Investigators: J. Brinley^ E. Kandel, S. Lerner, 

T Bak 

Cooperating Units. None 

Man Years 

Total » 1.70 Patient Days: None 

Professional: .60 
Other: 1.10 

Project Description: 

Objectives- To test the published claim that large 
doses of curare transiently block the synaptic reactions 
allegedly involved in the "dendritic" reaction. 

Methods Employed: It was soon found that the great 
fall in systemic blood pressure resulting from injections 
of large doses of curare (3 to 10 mg/K) led to various 
artifacts, depending on type of electrodes employed 
and methods of suspending same With spring-loaded 
electrodes the fall of capillary pressure may result in 
collapse of the capillary wall under pressure of the 
electrode, this being followed by reduction or extinction 
of the reaction. With fixed electrodes the brain shrinks 
away from, them as the blood pressure falls resulting in 
less effective stimulation and recording^ thus giving 
the appearance of a reduction of response. In any case 
with spring loaded or fixed electrodes spreading cortica,l 
depression often occurred after the injection of curare. 
Hence we developed a new method of stimulation and 
recording which eliminates the a,bove and other artifacts 
from the direct cortical response (dendritic) and 
callosal reactions. This consisted essentially of a 
system of reversible pore electrodes mounted ±n a constant 
pressure device^ the pressure being enough to secure good 
contact without collapsing capillaries even at very low 
systemic blood pressure. This system also permitted the 



243 



Serial No. M-NP~GN-5 f 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. (continued) 



electrodes to follow the surface as the brain 
volume increased or decreased This technique is 
absolutely essential for reliable results in those 
kinds of experiments. 

Major Findings. We found that large doses of curare 
do not block the direct cortical (dendritic) response 
when the above artifacts including spreading cortical 
depression are eliminated. 

Significance to Mental Health Research: This new 
technical approach is a useful advance in techniques for 
experimentation on the brain. It is currently of some 
value to determine validity of the claim that curare 
blocks synaptic conduction in dendritic systems of 
the cortex. 

Proposed Course of Project: Project Concluded 

Part B Included Yes x No 



Serial No. M-NP-GN-5 

P?£e 3 
PHS-NIH 

Individual Project Report 

Calendar Year 1957 

Part B Honors^ Awards^ and Publications 

Publications other than abstracts from this project- 

Proponents of the above argument have been notified of 
our results. We may eventually publish this but since 
it is a negative result we wish to give the other 
laboratory time to recheck their findings. 

Honors and Awards relating to this project! 

Lecture at University of Washington Medical School and 
University of Wisconsin Medical School dealing with these 
kinds of experimental problems. 



- Zti5 



Serial No. M-NP-GN-6 

1. Laboratory of Neurophysiology 

2. General Neurophysiology 

3. Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



t A. 



Project Title: Tests of Certain Drugs on Specific Electrical 

Reactions in the Brains of Animals 

Principal Investigator: Wade Ho Marshall 

Other Investigators: E. Evarts, E.Kandel, J. Brinley, and S„ Lerner 

Cooperating Units: Laboratory of Clinical Sciences 

Laboratory of Clinical Biochemistry 
Heart Institute 

Man Years Patient Days: None 

Total: .90 
Professional: .40 
Other: .50 

Project Description: 

Objectives: To further analyze neuron activity with the aid 
of specific drugs which may have specific roles in synaptic 
transmission^ including those which are currently alleged 
to be demonstrable. 

Methods Employed: Precise electrical technics are employed to 
test effects of drugs on the direct cortical and callosal re- 
actions (the "dendritic" reactions)^ and on other systems such 
as the specific sensory, recruiting and augmenting reactions o 

Major Findings: We have failed to see any specific action of 
adrenalin or serotonin when injected I„V. or in the carotid 
artery in the cat or monkey. Gamma amino butyric acid applied 
topically on the surface of the arachnoid membrane very quickly 
(order of 1 sec) produces a dramatic reversal of phase of the 
surface negative "dendritic" reaction. Isotonic KCl similarly 
applied produces a sufficiently similar reversal so we currently 
conclude that the drug blocks the superficial elements unmasking 
surface positive recorded elements from slightly deeper structures, 
Quanido butyric acid topically applied seems to act oppositely 
to gamma amino butyric. It enhances the "dendritic" reactions. 

Significance to Mental Health Research: Contributes to knowledge 
of physiology of the brain. 

Proposed Course of Project: Continue indefinitely. 

Part B Included: Yes No x 

- Zk6 - 



Serial No. M-NP-GN-7 

1. Laboratory of Neurophysiology 

2. General Neurophysiology 
3o Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: Activity Cycles and Interaction Between Callosal 

and Direct Cortical Reactions, and to Determine 
Regions of Chief Activity of Each. 

Principal Investigator: Wade Ho Marshall 

Other Investigators; E. Kandel, J. Brinley, S„ Lerner 

Cooperating Units: None 

Man Years: Patient Days: None 

Total: 1.50 
Professional: .50 
Other: 1.00 

Project Description: 

Objectives: To get better data on interaction and activity 
cycles in the callosal, direct cortical response and other 
systems. 

Methods Employed: Cats, monkeys and rabbits are used 
employing techniques developed in the course of the curare 
experiments and described in Project No. M-NP-GN-5. 

Major Findings: This work is now in progress, no major 
findings to report at this time,, 

Significance to Mental Health Research: None 

Proposed Course of Project: Continued indefinitely. 

Part B. Included Yes No X 



- 2k-7 - 



Serial No, M-NP-GN-8 

1. Laboratory of Neurophysiology 

2= General Neurophysiology 

3o Bethesda. 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A, 



Project Title: Measurement of pH Changes in the Cortex During 

Spreading Cortical Depression 

Principal Investigator: Wade H. Marshall 

Other Investigators- J„ Brinley, S, Lerner, T. Bak 

Cooperating Units: Department of Physiology, University of 

California, Los Angeles. National Heart 
Institute, Laboratory of Technical 
Development 

Man Years- Patient Days: None 

Total- 1.20 
Professional- .20 
Other- 1.00 

Project Description: 

Objectives: To determine if a specific type of glass pH 
electrode could be used to estimate changes in pH during 
a wave of spreading cortical depression as has been 
reported by a laboratory at University of California, Los 
Angeles. 

Methods Employed: Using electrodes kindly supplied by 
Dr Ralph Sonnenschein, University of California, Los 
Angeles. We repeated their experiments with our methods 
of recording spreading cortical depression. 

Major Findings. We found the Los Angeles laboratory to 
be in error, the difficulty lies in a very subtle and 
ea.sily made error of interpreting the "D.C." shift 
accompanying sprea.ding cortical depression. 

Significance to Mental Health Research: Improved techniques 
for experiments on the brain. 

Proposed Course of Project: Will continue with other and 
similar types of electrodes in collaboration with Dr , 
Murray Eden of the National Heart Institute. 

»art B. Included Yes X No 



Serial No, M-NP-GN-8, pege 2 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part B ; Honors, Awards, and Publications 

Publications other than abstracts from this project: 

Since this finding is negative, it will not be published at 
present. The Los Angeles laboratory has been informed of 
our decision. 



- 2^9 



NATIONAL INSTITDTE OF MENTAL HEALTH 



Basic Research 
Laboratory of Neurophysiology 
Section on Cortical Integration 



BUDGET SHEET 

Estimated Obligations for FY IQ-^S 
Total: $68,893 
Direct: $52,933 

Reimbxir sement s t $15 , 960 



Projects included: M-NP-CI 1 and M-NP-CI 2 






4M0ITit4 



oae^c- 



K.7.. 



Serial No. M-NP-CI-1 

1. Laboratory of NeurophysTology 

2. Section on Cortical Integration 

3. Location: Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



[irt A. 



Pwoject Title: Analysis of the Electrical Activity of the Brain of 

Unanesthetized Monkeys. 

Principal Investigator: John C. Lilly 

Other Investigators: Robert R. Cox 

Cooperating Units: Swarthmore College and National Science Foundation 

Man Years Patient Days: None , 

Total: 1.08 1/3 
Professional: .33 1/3 
Other: .75 

Project Description: 

Objectives: 1. Analyze origins, courses, and relations of 
figures in the electrical activity in the brain of unanesthetized 
monkeys. 

2. To correlate this activity with behavior and physiological 
and psychological states. 

3. To analyze the electrical activity which occurs concurrently 
with locally stimulated "reward" and "punishment" systems within 
the brain itself. 

Methods Employed: 1. Using implanted electrodes of a new design 
(see Project #2) it is intended to pick up the electrical 
activity from 256 points simultaneously within the substance of 
the brain of the unanesthetized monkey and relate this to the 
activities of the monkey. Development of a system for recording 
from 256 electrodes simultaneously was initiated 4 years ago 
with the electrical engineering department of Swarthmore College. 
Two National Science Foundation grants supported the two-year 
development which was completed last summer. It has been found 
this year that the prototype which was developed under these 
auspices is not quite simple enough in terms of ease of control 
to be immediately useful in long term studies. These circuits 
are being currently revised, a new type of simplified electronic 
switch has been developed recently. An 18-channel tape recorder 
was developed, delivered,, and modified to record the switched 
outputs of 16 times 16 input channels. 



-250=. 



Serial No 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 

Part A. (continued) 

Major Findings: 1. Technical: the problem of electronic 
switches at low level has been continued to be attacked on 
this project. It is extremely difficult to obtain a switch 
which will operate rapidly enough and quietly enough in the i 
electrical sense to give us the necessary information from 
the brain. Several forms of switches have been developed, 
tested and found to be inadequate. Currently a new model has 
been produced in a 25-channel prototype to be tested on 
animals. 

2. Physiological: no physiological results have been obtained 
on this project during the last year. Previous work on the I 
project with a 25-channel instrument showed that the electrica 
activity of the brain contains "figures" which start moving 
and die away in characteristic fashions which vary with states 
of excitement, drowsing, and sleep, with evoked responses, ^ 
voluntary movements and epileptic seizures. These results | 
have shown that 25-channels are not numerous enough and that I 
the old recording system was not fast enough to adequately 
record the type of figures which occur when the animal is 
awake. These figures are very small and extremely rapid; 
the new 25-channel switch is presumably fast enough, combined 
with the tape recorder, to record and later reproduce these 
figures in a slowed down fashion. ' 

Significance to Mental Health Research: Since the activity oJ 
the brain is the basis of all thought, emotion, and action it 
is necessary to investigate and understand this activity in as 
many ways as possible. Electrical methods have the advantage li 
of high speed and local specificity, i.e. are closest to the 
very rapid action to the nerve cell groups themselves. Since i 
the brain is a three dimensional, extremely complex, inter- 
related network of such groups of nerve cells it is necessary 
to observe simultaneously many loci at once in order to 
appreciate how this extremely complex "computor" operates. 
Since this is basic exploratory work it is hard to say what 
its significance will be in the future. These new methods 
are the first ones with a great enough ability to begin to 
record the large amounts of information needed to understand 
the complexities of the brain's action. 

Proposed Course of Project: To further develop and use the 
25-channel prototype of the 256-channel instrument and then 
to further develop the 256-channel instrument which is progre 
simultaneously . 

Part B included Yes No x 

- 251 - 



Serial No. M-NP-CI-2 

1 . Laboratory of Neurophysiology 

2. Section on Cortical Integration 

3. Location: Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



b A. 

Project Title: Mapping the Behavior Elicitable by Electrical 

Stimulation of the Brain. 

Principal Investigator: John C. Lilly. 

Other Investigators: Alice M. Miller, Robert R Cox, 

Horace W, Magoun, Felix Strumwasser . 

Cooperating Units; Marineland Research Laboratory, Marineland, Florida 

Man Years : Patient Days : None 

Total: 2.57 1/3 
Professional: .57 1/3 
Other: 2.00 

Project Description: 

Objectives: 1. Define and investigate those regions of the 
monkey brain which are of importance in terms of eliciting 
(1) specific somatic movements; (2) extreme emotional states, 
and (3) those which function as powerful motivational sub- 
strates: (a) various types of pleasure including sexual 
activities, (b) various types of punishment including pain, 
fear, etc. These studies are an extension of the previous 
work by Hess ; Ranson and Magoun ; Magoun and co-workers ; Jasper ; 
Olds and Milner; Delgado. Roberts and Miller; etc. 

2. To continue development of the technical methods necessary 
to explore such things in the brain, safely and with relatively 
minimal injury due to mechanical insertion of electrodes and to 
the passage of electrical currents through the brain. 

3. To investigate these systems in larger brained animals than 
the monkey such as the chimpanzee and the porpoise. The por- 
poise is an animal of choice because it is available through 
the Marineland Research Laboratories in Marineland, Florida; 
its brain is equal to and larger than the human and it has been 
demonstrated recently by Rose and Kruger that it contains, in 
an enlarged fashion, all of those nuclei which are considered 
to be characteristic of the human. 

Methods Employed: 1. A simplified method of implantation of 
electrodes and electrode arrays into the brain through the skull 
and skin of unanesthetized monkeys has been developed on this 



252 



Serial No. M-NP-CI-2, page 2 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. (continued) 



project within the last year. This method consists of 
hammering small guides into the skull in the stereotaxic 
instrument. Later these guides can be located through the 
intact skin and the electrodes inserted at will in a monkey 
or other animal. Such guides have been completed and inserted' 
and used in monkeys and another type has been inserted and > 
used in porpoises. j 

2. Records are taken of observations on the behavior during ! 
stimulation. 

3. Operant testing methods. (B. F. Skinner) by 'animal start" 
and "animal stop" stimulation methods of all areas stimulated I; 
in order to find (a) those areas which function as "animal ! 
start" areas, in other words, reward, i.e. pleasure and 
compulsivlB activity and (b) those areas which function as 
"animal stop" areas, i.e., punishment areas. j 

4. Testing interactions between the stimulation and other j 
ongoing behavior such as eating, spontaneous muscular activitils, 
naturally evoked emotional states, interactions with the 
observers, etc. 

Major Findings: 1. Our confirmation of the finding of Sch'afer! 
von Bechterew, Ferrier, Sanderson, etc. continues, i.e. that eel 
and every small area of the unanesthetized macaque cerebral cc- 
tex can cause a specific movement of relatively small groups c 
muscles and hence all of cortex is sensorimotor. (It v/as j 
learned this year that Sch'afer, in eliciting the post central Ij 
motor map, was not using anesthesia contrary to implications 
in the published account.) 

2. A system in the brain has been found which causes a clinics 
state which resembles "fright", extreme anxiety, or terror; it 
has been demonstrated that this state is unpleasant to the 
animal by showing that he can be taught to act to stop the 
stimululation and that once learned the reaction to stop the 
stimulus is not lost or forgotten as easily as that to stop 
a peripheral pain stimulus. This observation has been borne 
out in several animals who havve been trained to avoid stimu- 
lation in this system at very low levels of current. If the 
animal is prevented from shutting the current off and it is 
allowed to rise to higher values, it is found that a high- 
priority, urgent escape pattern takes place in which the 
animal cannot function in the learned pattern but is forced 
to function in a violent multiple escape set of actions and 
shows extreme defensive reactions if any threatening object 1 
is brought near him. During this state vocalization seems to 



- 253 - 



Serial No. M-NP-CI-2 , page 3 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



(continued) 



be impossible; further back in the pain systems vocalization 
is easily elicitable and is part of the pattern of responses 
to pain 5 both centrally and peripherally. This observation 
has been suggestively borne out by work on humans by Wilhelm 
Sem-Jacobsen in Oslo, though his localization is not so good 
as ours; i.e. he has not been able to recover the brain. From 
his x-rays of the position of his electrodes in the midplane 
in relation to the base of the skull it is presumed that he 
was in the same system. The patient reports extreme terror 
which he cannot control and which does not have any of the 
aspects of a quasi-emotion or pseudaf fective state or sham 
fright that one might expect from results using epinephrine 
and norepinephrine. This system apparently does excite a 
primary emotion rather than merely the outward expression of 
such an emotion. 

3. Continuation of the work on reward systems (Olds and Milner) . 
We have mapped these systems in several monkeys. Stimulated 

in these zones an animal acts so as to start an electrical 
stimulus in his own brain. We have continued Olds' demon- 
strations that this kind of system operates as a powerful 
motive to learning new and difficult tasks, we have found 
that once the animal is taught this reaction, the learned 
pattern can be shifted from one output to another quite 
easily by the animal. He performs 3 times per second by hand, 
2 per second by tongue, and 1 per second by foot; however, 
he very much prefers to use the hand. We have continued to 
try to force the monkey to vocalize to obtain this reward and 
find that it is not as pov/erful as the other outputs, in fact 
it requires a combined social situation plus the electrical 
stimulation so far; we are not sure we will not find some 
area which will give vocalization as an adequate output. 

4. In two animals we have found a system which causes erection 
of the penis. This seems to be an additional part of a system 
recently described by MacLean. We have found that erection of 
the penis can be caused by stimulation of parts of the fornix 
and of the septal nuclei by electrical stim.uli . MacLean demon- 
strated that erection can be aroused by chemical stimulation 

of the hippocampus from which the fornix originates. This 
system is unique in our experience in that it is both positively 
and negatively reinforcing, not simultaneously but sequentially 
in time. The animal will push a lever to start his own erections 
about once per minute and will stay awake 24 hours a day to 
continue this kind of activity. On the other hand, if we start 
the stimulus every 30 seconds he will shut off approximately 



- 25k 



Serial No. M-NP-CI-B, page h 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. (continued) 



1 



every other one and will allow them to come through about 
once per minute . 

5. Another very small system is being investigated in which 
the animal appears to have its "battery drained" when ; 
stimulated in this region. All of his spontaneous activity 
decreases, he becomes relatively unresponsive through not j 
comatose or unconscious and if allowed to be alone will | 
go to sleep, this apparently is very closely related to 
Hess' so-called "sleep area". 

6. Technical Developemnt : a new method of implanting 
electrodes which consists of hammering guides into the skull ; 
has very much simplified these problems. In the older i 
system we implanted buttons in the skull which allowed up i 
to 44 electrodes to be moved in and out of the brain, mapping 
up to 30-40 points along each electrode track; it was found j 
that the skin broke down around such buttons after several | 
months of use. In the new system each electrode penetrates 
the skin independently; intact skin is left between electrode 
So far there is some reaction at the point at which the elec- 
trode penetrates the skin but it is not nearly so severe as 
it was around the button. We now can map about 30-40 points 
along each electrode track from the top of the brain to the 
base of the skull in a much simpler fashion and yet be able 
to restore the animal to a colony or his cage without any 
leads showing from the top of the head. This system has 
also been developed for use on the porpoise; it was demon- i 
strated 2 years ago that it is practically impossible to 
anesthetize the porpoise without using a respirator. With 
the new technique local anesthesia is introduced into the 
head to the skin down to the bone and the guide pounded 

in with porpoise suspended in the restraint system in water. , 
The pain was sufficiently small so that the porpoise showed 
very little if any reaction to this procedure; he gave a 
small startle response at the first hammering apparently due 
to the sound and the sense of pressure but after that he 
calmed down and allowed us to keep on going without much 
trouble . 

7. We have found that in two porpoises that (a) the reward 
and punishment systems exist and (b) that the urgency of 
these systems for the porpoise is comparable to that for the 
monkey 5 (c) that the porpoise learns very much more rapidly 
than the monkey to either turn the stimulus on or to turn 
the stimulus off, (d) that the porpoise in contrast to the i 
monkey learns very rapidly with an assist from the observer 
on the proper way to push the trigger^ and (e) that during , 



255 



Serial, No. M-NP-CI-2 . page 



PHS-NIH 
Individiial Project Report 
Calendar Year 1957 

A. (continued) 

stimulation of a reward system in the porpoise he becomes 
extremely loquacious and covers a vast repertory of sounds 
apparently seeking some way of communicating with the 
observer in the fashion in which the porpoise will corajnuni- 
cate with his own species. 

Significance to Mental Health Research: These various regions of 
the brain which are so fundamental to behavior and the subjjective 
life, are of fundamental importance to an understanding of those 
factors which maintain mental health and maintain mental illness. 
Studies upon the rat brain by Olds and Milnerj on the cat brain 
by Hess, Delgado, Roberts and Miller, and Ranson and Magoun have 
finally given us powerful tools for the investigation of that whicb 
is urgent and of highest priority when active within the brain ; 
substance. These rewards and punishments and emotional elici- \ 
tations are more powerful than any other way which we and others 1 
have been able to employ to change the behavior of animals; 
apparently these methods and these states exert more powerful 
effects than food, pain, and Sex itself. Means have now been 
found for quickly inducing and as quickly removing profound 
mental changes in monkeys and in porpoises. In the rat, cat, 
monkey (chimapnzee) . human, porpoise series, we have a spectrum 
of brain sizes in which we might expect there to be a spectrum 
of physiological determinants of behavior which can be elicited 
by small areas of intense activity elicited by electrical stimu- 
lation; it is important to investigate brains larger than the 
human before approaching the human in order to find out if the 
urgency and priority of these built-in emotional patterns 
exists in the larger brain and whether the larger brain can 
exert control over such patterns. Such methods ultimately 
should be applied to the human and currently are by several 
investigators. These show that the expected urgency of both 
the rev/ard and punishment systems is of the order of intensity 
which is importaat to mental health research. 

Proposed Course of Project: To continue such investigations 
of the electrical stimulation of behkvior and of learning and 
eventually to relate the results to elici table and spontaneous 
electrical activity in the various regions of the brain. To 
continue the work on the monkey, to expand the work to the 
chimpanzee, and to continue the work on the porpoise. At some 
time in the future we lorsee that we will have progressed far 
enough in technical matters to apply these methods to the human. 

; B included Yes x No 



- 256 



Serial No. M-NP-CI-2 , page 6 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part B: Honors, Awards, and Publications 



Publications other than abstracts from this project: None 



Honors and Awards relating to this project: 

John C. Lilly: Invitation to serve as Secretary of the First 
Conference on the Use of Depth Electrodes in the Human. 
Georgetown Medical School, 10-13 June 1957. 



- 257 - 



Report on Conference on the Use of Depth Electrodes 

page 

in Human Patients 

John C. Lilly, Secretary to Conference 
Section on Cortical Integration 
Laboratory of Neurophysiology 
Research Branch 
National Institute of Mental Health 



Organization of a conference on the use of depth electrodes 
in human patients which was supported under the auspices of the 
National Institute of Mental Health and the National Institute of 
Neurological Diseases and Blindness through Georgetown University 
Medical School; Dr, Francis M. Forster kindly consented to arrange 
for Georgetown to sponsor such a conference June 10-13, 1957. 
Dr. Desmond O'Doherty carried out the technical details of housing, 
organization of space, arranging for banquet, meals, etc. The 
Conference was attended by these principal investigators: 
M. Baldwin, R. G. Bickford, J. V. Brady, M. A. B. Brazier, 
W. P. Chapman, G. E. Chatrian, J. M. R. Delgado, H. W. Dodge, Jr., 
R. Galambos, H. Hamlin, R. G. Heath, W. J. H. Nauta, J. Olds, 
H. Patton, C. W. Sem-Jacobsen, E. A. Spiegel, A. Torkildsen, 
J. M. Van Buren. It was found to be of considerable value in 
mutual education among the participants as to (1) technical 
results, (2) indications for future research, (3) possible 
therapeutic values, (4) the dangers in employing such methods 
on the human, (5) improvement of methods in the future, (6) plans 
for a future conference, (7) methods of increasing the accuracy 
of localization within the human brain of the sites stimulated 
and recorded from. 

Significance of this conference seems to be that there 
are a sufficient number of people working on the human brain with 
implanted electrodes and the results are sufficiently important 
at the present time to warrant interest on the part of the 
National Institute of Mental Health. It looks as though, with 
the methods devised up to the present time., that such methods 
are going to become relatively popular whether this is warranted 
therapeutically at present or not. It looks as if it is important 
to encourage publication and discussion and not to allow ethical 
judgments to drive people "underground", i.e. to prevent publi- 
cations and full exchange between investigators. This field 
seems to be acquiring a respectability and a set of ethics which 
are acceptable to most of the medical profession and to m_ost 
scientific investigators in the field. 

It is generally agreed that indications for use of depth 
electrodes in a given patient are (1) cases of epilepsy without 
obvious lesions in the cortex and who are not am^enable to drug 
treatment: for exploratory searching for deep foci of pathological 

- 238 - 



page 3 

activity, (2) meatally ill cases in which there is a threat 
of removal of the frontal lobes in order to render them more 
amenable to custodial care , (the depth electrodes are very 
much less damaging, and exploratory investigation of such 
patients may show a more powerful therapeutic intervention 
can be brought about by electrical stimulation of local regions 
rather than sacrifice of such important areas of the brain) , 
(3) those cases of severe neurological disease in which some 
sort of intervention is needed, such as in Parkinsonism, to 
prevent an irreversible clinical course by removal of foci 
such as those which occur in the globus pallidus; the investi- 
gation by electrical stimulation of such cases is warranted 
in view of the definite therapeutic advantage of such inter- 
vention as has been demonstrated by several neurosurgeons. 
These three justifications were brought out intensively at 
the conference and discussed at great length. The dangers 
of such intervention were brought out very strongly by the 
neurosurgeons present and improved methods were emphasized 
and the accounts of at least one death due to the employment 
of improper technical procedures was reported. The results 
on animals which were highlighted at the conference tentatively 
suggested to some of those present that eventually extremely 
powerful changes presumably can be brought about by electrical 
and chemical stimulation within the human brain, not only in 
cases of mental illness but presumably in psychosomatic ill- 
ness also. These are some of the speculations which were 
exchanged at the conference in addition to the solid results 
which were presented. 

A Steering Committee was set up with Desmond O'Doherty, 
Chairman, John C. Lilly, Secretary , and members as follows: 
R. G. Bickfordj M. A. B. Brazier, J. D. French, R. G. Heath, 
C. W. Sem-Jacobsen and E. A. Spiegel. 

Dr. J. D. French suggested a second conference be held 
at the new University of California Seminar Site at Lake 
Arrowhead, California, near Los Angeles. 



259 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Basic Research 
Laboratory of Neurophysiology- 
Limbic Integration and Behavior 



BUDGET SHEET 

Total J $144, 86i^ 
Directs $111,307 

Reimbursements s $335557 



Projects includedJ M_nP-LI 1 and M-NP-LI 2 



i 



Serial No. M-NP-LI-1 

1. Laboratory of Neurophysiology 

2. Limbic Integration and 

Behavior 

3. Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. 



Project Title: Studies on Localization of Function in Limbic 

System 
I . Effects of Biochemically Induced Lesions 

Principal Investigator: Paul D. MacLean, M.D. 

Other Investigators: Richard E. Coggeshall, M.D. 

Cooperating Units* None 



Patient Days: None 



Man Years 

Total: 1.0 
Professional: 0.6 
Other: 0.4 

Project Description: 

Objectives: Lesions of the mammillary bodies and other 
subcortical structures of the limbic system are known 
to occur in association with Vitamin B deficiency. The 
administration of acetyl pyridine, an antimetabolite of 
nicotinamide, has been reported to result in acute 
neuronal degeneration in the archicortex (hippocampus) , 
but not the neocortex; the supraoptic nuclei also undergo 
degeneration. The foregoing findings suggest a means 
of inducing lesions throughout integral parts of the 
limbic system for the purpose of studying behavioral 
changes. As selective damage of neurons throughout 
discrete cerebral structures is not possible to obtain 
by other methods, this investigation is being undertaken 
to evaluate the possibilities of this kind of an approach 
in studies on functional localization . 

Methods Employed: (1) Mice and rats are being used 
in the initial studies. The first series of experiments 
are concerned with controlling the variety and extent 
of lesions induced by Vitamin B, deficiency and the 
administration of acetyl pyridine. The brains of 
treated animals are being compared histologically with 
those of controls. In addition to the conventional 
staining of cells and fibers, the Nauta silver stain 



- 260 



Serial No. M-NP-LI-1 

page 2 
PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part A. (continued) 



will be used for tracing fibers of degeneration. 
(2) If it proves possible to obtain reproducible 
lesions, a study will be made of the effects of these 
lesions on the behavior of animals in a variety of 
psychological tests, including conditioned avoidance 
and delayed response tests. 

Major Findings- Serial sections have been cut and 
stained on brains of control animals, as well as of 
a group of mice that were maintained on a Vitamin B 
deficient diet for one month. No lesions were found 
in the brains of the experimental group. Another 
group of animals that is being fed another variety 
of Vitamin B deficient diet is awaiting study. The 
brains of a number of acetyl pyridine treated rats 
is in the process of being sectioned, stained, and 
examined. 

Significance to Mental Health Research: There already 
exists evidence that the structures under investigation 
are concerned in emotional and memory processes. Besides 
adding to basic knowledge needed in regard to localization 
of function in the limbic system, the present investigation 
has the potentiality of yielding information that will 
be useful to neuropharmacological investigations concerned 
with the differential action of drugs on nervous centers. 
It also has unique possibilities for contributing to the 
knowledge of anatomical connections of the limbic system. 

Proposed Course of Project: If the results on mice and 
rats prove promising, the investigation will be extended 
to include observations on squirrel monkeys. 

Part B included Yes No x 



- 261 - 



Serial No. M-NP-LI-2 

1. Laboratory of Neurophysiology 

2. Limbic Integration and 

Behavior 

3. Bethesda 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Ftrt A. 



Project Title: Studies on the Limbic System 

Principal Investigator. Paul D. MacLean, M.D. 

Other Investigator: None 

Cooperating Units: None 

Man Years: Patient Days: None 

Total: 0o2 
Professional: 0.1 
Other: 0.1 

Project Description: 

Objectives: During the period when the new section on Limbic 
Integration and Behavior is waiting to move into its full 
complement of space, part of the principal investigator's 
time is being devoted to completing six papers for publication. 
These papers , which deal with experimental work that was 
performed in the Departments of Physiology and Psychiatry at 
the Yale University School of Medicine, are as follows: 

1. Effects of hippocampal seizures on conditioned 
avoidance behavior. (with DrSo J.R. Stevens and C. Kim) 

2. Behavioral changes associated with chemical and 
electrical stimulation of the caudate nucleus. (with Dr. 
J.R. Stevens) 

3. EEG and behavioral changes following chemical and 
electrical stimulation of posterior cingulate gyrus, (with 
Dr.lttLockhart) 

4. Effects of neuropharmacological agents on bioelectrical 
activity of limbic system. I. Reserpine and drugs of related 
interest. (with Dr. C. Kim) 

5. Effects of neuropharmacological agents on bioelectrical 
activity of limbic system. II. Ether, nitrous oxide, and carbon 
dioxide. (with Dr. C. Kim) 



262 



Serial No. M-NP~-LI"2 ^^..^ -? 



Indi vidua,! Project Report 
Calendar Year 1957 



Part A. (coB-tixiued) 



6. Propagation, of hippocampal seizures in unrestrained 

aad wa.ki:ag animals, (with Dr. C. Kim) 

Major ,FiB.dingS'; (1) Animals trained ±n a. shuttle box to 
avoid a shock following the sound of a huzzer fail to resposd 
t.o the conditioried stimul-as during propagaT/i::=g hippocaTrpal 
seizures,, but in the majority of iastasic-es will quickly direct! 
their ©scape upon receiving the unconditioned stim-ulus. (2) 
Either chfri^ical or electrical stimulation of the head of the 
caudate nucleus interferes with the performa.nce of an an.im_al 
trained in conditioned avoidance. i3) Chemical stimulation of 
the cortex just above the posterior ciogwlate gyrus may result 
in spontaji:!.eous or easily induced penile 'Erections in male cats, 
(4) The administration of reserpirve to ca.ts in a dose of one 
mg, per kg, results in distinctive electroencephalographic 
changes tha.t can be localized to parts of the hippoca.mpiis aad ; 
hypothalamus. (5) Except for the extended tiirje course,, the ' 
elect.roencepha.logra.phic picture associated with reserpine has 
many similarities to that observed during the induction and 
recovery stages of ether anesthesia. 16) The pattern of 
propagation of electrically induced hippocajEpal sei.zures in 
unrest,ra..ined a.n.d waking animals conforms to aB.d co.af irms what 
has been found in acute prepa.rations. 

Signif ica.'jce to Mental Health Research: E.xperiii;eatation duri.j 
the past two decades has yielded evidence that allows one to j 
infer a dichotomy in the function of the phylogenetically old 

(limbic) a.ad new cortex. This dichotomy has important 
implicatiojLS for neurology a.?:.d psychiatry because it bears ob 
the distinctive attrib-'ites of emotiona.l a,nd intellectual 
behavior. The papers in prepa.ration shed further light on 
functional _, electroencephalographies and chemical distiactiom 
between the "old" and "new" coreex. 

Proposed Coxixse of Projects Completio,n within the near fut'Eix^ 

Part B included Yes X Mo 






263 






Serial No. M-NP-LI-2 ^ page 3 

PHS-NIH 
Individual Project Report 
Calendar Year 1957 

i.r t B ; Honors, Awards., and Publications 

Publications other than abstracts from this project: 

MacLean^ PoD, , Chemical and electrical stimulation of hippoca,mpus 
in unrestrained animals. Part I. Methods and EEG findings. Arch . 
Neurol, and Psychiat . , 1957, 78, 113-127. 

MacLean^ P.D. „ Chemical and electrical stimulation of hippocampus 
in unrestrained animals. Part II „ Behavioral findings. Arch. Neurol . 
and Psychiat . , 1957, 78, 128-142. 

MacLean, P.D.;, Visceral functions of the nervous system. Ann . Rev . 
Physiol "., 1957, 1^, 397-416. ~ 

Flanigan, S. , Gabrieli, E. „ and MacLean, P.D. _, Cerebral changes 
revealed by radioautography with S35_iabeled i-Methionine. Arch . 
Neurol, and Psychiat . , 1957^ 77, 558-594. 

MacLean, P.D.,, Rosner „ B. , and Robinson, F. , Pyriform responses to 
electrical stimulation of olfactory fila, bulb, and tract. Am. J. 
Physiol o , 1957, 189, 395-400. 

Paasonea, M.D. „ MacLean, P.Do , and Giarmin, N.J., 5-Hydroxytryptamine 
(serotonin, enteramine) content of structures of the limbic system. 
J. Neurochem. , 1957, 1^, 326-333c 

MacLean, P.D,, "Psychosomatics", Handbook of Physiology. (in press) 

MacLean, P.D,, The limbic system from the standpoint of self- 
preservation and the preservation of the species. Transactions of 
"La Semaine Neurophysiologique de la Salpetriere - 1956. "(in press) 

Flynn, J.P, , Kim, C, and MacLean, PoD., Effects of hippocampal 
seizures on conditioned cardiac and respiratory responses. In: 
Symposium on Braio Stimulation, University of Texas Press. (in press) 

Honors and Awards Relating to this Projects 

1. Senior Postdoctoral Fellowship from the National Science 
Foundation, (Affiliated with the Physiological Institute, University 
of Zurich) 

2. Invitation to become Associate Editor of Psychosomatic Medicine. 

3. Invitation to speak at the Neurological Clinic, University of 
Freiburg, Freiburg, Germany. 

4. Invitation to speak to the neurological and neurosurgical groups 
at the University of Graz, Graz, Austria. 



Serial No, M-NP-LI-2 , page ^■ 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Part B (continued) 



5. Invitation to be a discussant at the Ciba Conference on 
"Neurological Basis of Behavior" (in commemoration of the 

birth in 1857 of Sir Charles Sherrington) London^ July 2-4^, 1957. 

6. Invitation to write a review on the limbic system for 
Physiological Reviews. 

7. Invitation to serve as a member of the Selection Commit te of 
the National Institute of Mental Health. 



265 



I 

k 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Basic Research 
Laboratory of Neurochemistry 



BUDGET SHEET 



E,?-'--iiDqt,$(^ Ohnrat^w-? for ^ iQ^s 
Total! $97 5,008 
Directs $74,536 

Reimbursements I $22,ii72 



Projects includeds M-NC-PC 1 through I4.NC-PC 9 



! Serial No, iHN&PCr-l 

1, Neurochemistry 

2, Physical Chemistry 

3, Bethesdaj Md. 

PHS-NIH 

Individual Project Report 

Calendar Year 1957 

I'oject Title: Structure of Transition-Metal Complexes 

^incipal Investigator: Gary Felsenfeld 

)her Investigators: Leslie E. Orgel 

;ioperating Units: None 

In Years 
Total: 1/4 
Professional: 1/4 
Other: 

Poject Description: 

' Objectives : To study by theoretical methods the unusual configurations 
of certain transition-metal complexes. 

Methods Employed: The quantum-mechanical method known as the crystal- 
I field theory was employed, 

i Major Findings: It has been shown in a previous investigation by 

G. Felsenfeld that the unusual flattened tetrahedral configura- 
tion of the complex ion CuCl.~ can be explained theoretically. 
The present research has extended the study to a consideration of 
complexes of nickel, and it has been shown that for a complex 
ion of the form NiCl."^ an elongated tetrahedral configuration is 
to be expected. The amount of distortion has been predicted, 

ij Significance to Mental Health Research : The role of metal ions in 
'i biological systems depends upon the directional properties of the 

bonds they form. The understanding of the activity of the metal- 
containing enzj^esjof ceruloplasmin,and of cerebrocuprein all 
depend upon a knowledge of the stereochemistry of the metal ion 
involved. Theoretical studies permit us to predict the behavior 
of such ions under varying conditions. 

Proposed Course of Project : Calculations will be extended and refined 
to take into account further energy terms. In collaboration with 
D. R. Davies, X-ray diffraction studies of nickel chloride 
complexes will be undertaken to verify the predictions of the 

theoretical study. 

tB Included Yes X No 



iU_ 



- 266 - 



Serial No. M-JtuiC-PC-^l 
page 2 
PHS-NIH 
Individual Project Report 
Calendar Year 1957 

B: Honors, Awards, and Publications 

ublications other than abstracts from this project: 

Felsenfeld, G. and Orgel, L» E.^ "Jahn- Teller Distortions of 
Tetrahedral Transition-Metal Complexes". In preparation. 

onors and Awards relating to this project. None. 



- 26? - 



Serial No. M-NC-PC-2 

1. Neurochemistry 

2. Physical Chemistry 

3. Bethesda, Md. 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



; A. 



Project Title: Physical Chemical Studies on Synthetic Polyribo- 
nucleotides . 

Principal Investigator : Gary Felsenfeld 

)ther Investigators: Alexander Rich, David R. Davies 

Cooperating Units: None 

Ian Years 

Total: 1-1/2 
Professional: 1-1/4 
Other: 1/4 

'roject Description: 

Objectives : To study behavior of various synthetic polyribonucleo- 
tides . 

Methods Employed ; The synthetic polynucleotides have been examined 

spectrophotometricallyp and with the ultracentrifuge. Theoret- 
ical techniques have been applied for discussing the statilptics 
of interaction of the polymers. 

Major Findings: The study of the interaction between polyadenylic 

acid (poly A) and polyuridylic acid (poly U) has been continued. 
A new three-stranded molecule, involving two strands of poly U 
for each strand of poly A has been discovered using techniques 
like those which led to the discovery of the two-stranded 
molecules. This three-stranded molecule may be related to a 
structure (as yet undetected) involving a single ribonucleic 
acid (RNA) strand wrapped about a two-stranded desoxyribo- 
nucleic acid (DNA) , and is therefore of considerable interest 
with relation to problems of nucleic acid synthesis. 

The dependence of the formation of multiple-stranded 
structures on concentration of small ions has also been studied. 
It is found that small amounts of divalent cation (Mg*^ . Mn , 
etc.) are sufficient to cause formation of the two-stranded 
complex, whereas large excesses of cation concentration -are 
required for addition of the third strand. The dependence of 
two-stranded polynucleotide stabilization upon ion concentra- 
tion closely resembles that found for DNA. 



- 268 - 



Serial No. M-NC-PC-2: 

page 2 



Part A (Continued) 



Theoretical studies have also been carried out to 
determine whether the observed experimental data for forma 
tion of two-stranded complexes can be explained either on 
basis of a rapidly reversible or an irreversible process, 
has been shown by means of these studies that only a systej 
involving highly labile bonds between the two strands can 
account for the data. This suggests that two-stranded DM' 
also capable of a very rapid dissociation reaction, a consd 
eration of great importance for proposed mechanisms of DNA 
replication, which involve separation of the two strands s 
part of the process. 

Significance to Mental Health Research ; These synthetic polymei, 
are models of RNA and DNA, and provide a means of studyingt 
reactions of the nucleic acids under well-defined chemica.' 
conditions . 



Proposed Course of Project : Continued combined theoretical andj 
experimental studies will be undertaken to determine the 
mechanism of interaction between poly A and poly U, and 
between other polynucleotides. 



Part B Included 



Yes X 



No 



- 269 - 



'■ Serial No, M-NC-PC-2 

page 3 

PHS-NIH 
Individual Project Report 
Calendar Year 1957 

]art_B: Honors, Awards, and Publications 

'I Publications other than abstracts from this project: 

Felsenfeld, G.j, Davies, D. R. , and Rich A., Formation of a Three- 
Stranded Polynucleotide Molecule. J. Am, Chem. Soc . 79; 2023; 
1957. 

Felsenfeld, G. and Rich, A. j Studies on the Formation and Two- and 
Three- Stranded Polyribonucleotides, Biochim. et Biophys. Acta 
in press . 

Felsenfeld, G. , Theoretical Studies on the Interaction of 'Synthetic 
Polyribonucleotides, in preparation. 

Honors and Awards relating to this project: None. 



- 270 - 



Serial No. MilTC-PCSS 

1. Neurocheraistry 

2. Physical Chemistry 



Bethesda, Md. 



PHS-NIH 

Individual Project Report 

Calendar Year 1957 



^' 



PDject Title: The Formation of a New Helical Complex between 
Polyinosinic Acid and Polyadenylic Acid. 

PiLncipal Investigator: David R. Davies 

J1ier Investigators: Alexander Rich 

Uoperating Units: None 

Ma Years 

Total: 1/2 
Professional: 1/2 
Other: 

Pi) j act Description: 

Objectives : To define the conditions under which these synthetic poly- 
nucleotides interact, and to discover the nature of the complex 
formed. 

Methods Employed : Ultra-violet absorption and ultracentrifugation 
techniques have been employed to examine the conditions under 
which the complex forms. X-ray diffraction methods were used to 
investigate the structure of the complex„ 

Major Findings ; It has been discovered that polyinosinic acid and 
polycytidylic acid will combine rapidly in solution to form a 
helical molecule. X-ray diffraction photographs show that, 
contrary to expectation, this molecule is dissimilar to that 
formed when polyadenylic acid and polyuridylic acid react together, 
The structure, in fact, appears to be very similar to that of 
natural ribonucleic acid (RNA) . One implication of this finding 
is that the RNA molecule exists in an even-stranded helical 
configuration, at least under the conditions used for X-ray 
diffraction studies. It is to be expected that the elucidation 
of the structure of this molecule will throw considerable light 
on the RNA structure which is at present undetermined. 

The reaction takes place rapidly in the presence of 0.1 M 
sodium chloride o It is inhibited by the absence of sodium 
chloride and by the presence of 1.0 M sodium chloride. Ultra- 
I centrifuge studies show that the complex sediments much faster 
than either of the separate polymers. 



- 271 



Serial No. ■lfe3SC-l'C-3 

page 2 



Project Description (Continued): 



Significance to Mental Health Research : An understanding of the roll 
played by RNA in cellular metabolism is basic to our understandi( 
of cell differentiation and function. RNA is involved in protei 
synthesis and most current hypotheses about protein synthesis 
invoke the use of RNA as the template on which the amino acids n 
ordered. Knowledge of the structure of RNA is therefore importai 
since this will clarify our understanding of the manner in whicj 
it can act as such a template. The structure of natural RNA ±s' 
difficult to obtain directly, whereas much clearer information 
concerning the configurations of molecules of this type has bee 
obtained from studies such as this on the synthetic polyribonucei 
tides. 

Proposed Course of Project : Further work will be carried out to oblii 
better X-ray diffraction patterns of this complex with a view 1; 
elucidating its structure. Further investigations will also b«j 
undertaken to define the condition under which the complex is ills' 
stable. ! 



Part B Included Yes X No 



''' - L 



Serial No. H^lJC-PCr^. 
pa^e 3 

PHS-NIH 

Individual Project Report 

Calendar Year 1957 

t ; B: Honors, Awards, and Publications 

>ublications other than abstracts from this project: 

Davies, D. R. and Rich, A., The Formation of Helical Complex between 
Polyinosinic Acid and Polycytidylic Acid. Submitted to J.A.C.S. 

lonors and Awards relating to this project: None. 



1^22. 



Serial No. M-NC-PC-4 

1. Neurochemistry 

2. Physical Chemistry 

3. Bethesda, Md. 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



rt A. 



Project Title: Computation of helical Transforms for Synthetic 

Polypeptides o 

Principal Investigator: David R. Davies 

Other Investigators: Alexander Rich 

Cooperating Units: None 

Man Years 

Total : 1/2 
Professional: 1/2 
Other: None 

Project Description: 

Objectives : To study various proposed helical polypeptide models by 
means of the helical transform computation. 

Methods Employed : The helical transform computation yields a theo- 
retical X-ray diffraction pattern for proposed molecular 
structures. Use of this technique provides a basis for 
comparison with the observed diffraction data. 

Major Findings : The a-helix is of considerable importance since it 
is now generally believed to be the basic structural unit, not 
only of the synthetic polypeptides and the fibrous proteins, 
but also of many globular proteins. It was therefore consid- 
ered interesting to examine the diffraction patterns of other 
helices (notably, the 7r-helix) to see whether they were 
markedly different from those of the a-helix. A careful 
examination shows that for the synthetic polypeptides, a 
clear distinction can be made in favor of the ct-helix. How- 
ever, this investigation demonstrates that such a clear 
distinction cannot be made for the natural fibrous proteins. 

Further computing programs have also been developed for 
rapid calculation of interatomic distance and angles in 
helical molecules. 



12^^^ 



Serial No. M-NC-PC-4 | 

page 2 



Part A. (Continued) 



Significance to Mental Health Research ; This investigation has 
led to further understanding of the relation between the 
configurations assumed by proteins and their X-ray diffrac- 
tion patterns. 

Proposed Course of Project: This project has been completed. 



Part B Included 



Yes X 



No 



- 275 - 



Serial No. M-NC-PC-4 

page 3 

PHS-NIH 

Individual Project Report 

Calendar Year 1957 

Part B: Honors, Awards, and Publications 

'I 

Publications other than abstracts from this project: 

Davies, D. R. and Rich, A,, Structure Factor Calculations for Some 
Helical Polypeptide Models, Submitted to Acta Crystallographica. 

Honors and Awards relating to this project: None. 



- 276 - 



I 



I 



Serial No» M-NC-PC-5 

1. Neurochemistry 

2. Physical Chemistry 

3. Bethesda, Md. 

PHS-NIH 
Individual Project Report 
Calendar Year 1957 

t A . 

Project Title: Physical Properties of Ribonucleic Acids 

Principal Investigator: Dan F. Bradley 

Other Investigators: Jean Johnson 

Cooperating Units: None 

Man Years 

Total: 3/4 
Professional: 1/2 
Other: 1/4 

Project Description: 

Objectives ; Much attention has been focussed in recent years on 
ribonucleic acids (RNA) because they seem to be intimately 
associated with in vivo protein synthesis. Their function 
in this process rests upon the fact that they are linear, 
unbranched polymers, presumably varying from one to another 
both in polymer length and rigidity. For several years we 
have been acciimulating evidence as to how these properties 
change spontaneously in samples of RNA during and subsequent 
to isolation from organisms. These studies lead to better 
understanding of the structure of native RNA and how it can 
be isolated for study with a minimum of alteration. This 
work is also relevant to the paradox of the apparent J^ vivo 
stability and _in vitro lability of nucleic acids and the 
problem of stabilizing these genetic materials against radia- 
tion damage. 

Methods Employed : Ultracentrifugationj, ultraviolet spectrophoto- 
metry, column chromatography J, electrophoresis, viscosity. 

Major Findings : Two major avenues of approach have been followed. 
One has been the careful study of the relative lability of a 
particularly promising RNA in aqueous solutions as a function 
of ionic environment. The addition of small amounts of 
divalent cations to RNA solutions in ion-fi^ee water lowers 
the optical absorption of the RNA (an indication of increasing 
polymer rigidity) as well as retards the fa.ll of sedimentation 
coefficient upon standing at moderately elevated temperatures. 
Monovalent cations perform the same stabilizing functions but 
I at much higher concentrations suggesting that they interact less 
strongly with the RNA because of their lower ionic charge. 

- 277 - 



Serial No. M-NC-PC-S 
page 2 

1_A (Continued) 

At temperatures approaching 100°, the ion-RNA complexes 
begin to dissociate as indicated by increased optical absorp- 
tion. Under these conditions j the monomer-monomer linkages 
in RNA are ruptured by polycations so that under these condi- 
tions RNA is labilized by divalent cations. 

Another avenue followed has been the isolation of RNA 
from a source (rabbit muscle) which provides unusually 
difficult isolation problems » This work was carrieG. out in 
collaboration with Dr, E. Mihalyi and Miss Irene Knoller of 
the National Heart Institute. As is true will all RNAs 
studied to date, the product was heterogeneous,, having a 
distribution of chain lengths and flexibilities. Most inter- 
estingly, application of normal isolation procedures resulted 
in removal of a non-random fraction. Therefore the mean 
values of the properties of RNAs isolated by different methods 
varied because part of the RNA was discarded, although 
normally, this variation would be ascribed to alterations of 
the RNA during isolation. Such changes were also observed. 
Further, it was discovered that the chromatographic technique 
we developed for separating RNA into various chain lengths is 
also suitable for separating RNA from protein contaminants. 

Significance to Mental Health Research : This study is part of a 

long-term group effort to discover the mechanisms of protein 
synthesis and genetic transfer. 

Proposed Course of Project ; There is recent evidence that cerebral 

RNA varies with mental state. We intend to isolate ribo- 
jiucle6protein particles from animal brain and see whether 
they are in any way different from the corresponding protein- 
synthesizing particles found in liver. 

We are also interested in searching for methods to 
separate low molecular weight RNAs to investigate their 
optical properties, their binding of cations, and their 
binding to other nucleic acids. 



tB Included Yes X No 



- 278 



Serial No. M-NC-PC-5 

page 3 

PHS-NIH 
Individual Project Report 
Calendar Year 1957 

rt B: Honors, Awards, and Publications 

Publications other than abstracts from this project: 

Mihalyi, E. , Bradley, D. F. , and Knoller, I. Physical and Chemical 
Properties of the RNA Contaminant of Rabbit Muscle Myosin Prepara- 
tions." J. Am. Chem. Soc . ^ in press. 

Honors and Awards relating to this project: None, 



- ^'^Q 



Serial No. M-NC-PC-6 

1. Neurocheraistry 

2. Physical Chemistry 

3. Bethesdaj Md. 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



'rt A. 



Project Title: Frictional Properties of Desoxyribonucleic Acid in 

Solution. 

Principal Investigator: Dan F. Bradley 

Other Investigators: None 

Cooperating Units: None 

Man Years: 

Total : 1/2 
Professional: 1/2 
Other : 

Project Description: 

Objectives: Desoxyribonucleic acid (DNA) has been shown to carry 
genetic information. As DNA is a linear j unbranched polymer 
consisting of four different monomer units, this genetic infor- 
mation is presumably coded along '^h'b polymer chain by varia- 
tions in the sequence of monomers. It follows that a longer 
polymer chain can code a larger amount of genetic information. 
A great deal of effort has been expended to measure the chain 
length of DNA m solution either by light scattering or by 
frictional methods. The latter methods which measure the 
rate at which DNA molecules move through a solution under 
different applied forces do not agree with the former 
methods. In the present study the relationships between the 
frictional properties and the polymer length of DNA are 
reexamined. 

Methods Employed : A careful survey of the literature on experi- 
' mental determinations of the chain length of DNA revealed 
that a heretofore unobserved simple relationship existed 
between the chainlength (or molecular weight, M) of DNA and 
the velocity with which it moves in a centrifugal field 
(sedimentation coefficient, S) , i.e. M a S^-'^^. This was 
significant because heretofore an additional frictional 
measurement (such as viscosity or diffusion) was believed 
to be necessary to calculate M from S. data. Upon further 
examination of the data, however, it became apparent that 
the equations used to extrapolate the observed S data to the 



280 - 



Serial No. M-NC-PC-6 

page 2 



Part A= (Continue( 



theoretically meaningful state of infinite dilution were 
neither theoretically justifiable in themselves nor even 
fit the experimental S data in the measured concentration 
range. A theory was developed to explain the observed 
variation of S at finite concentrations and provide a 
satisfactory extrapolation to infinite dilution. 

Major Findings ; The theory developed accounts for the observed 
decrease in sedimentation rate at finite concentrations in; 
terms of a reverse flow of solvent, required by conservatid 
of volume conditions. The DNA actually flows faster rela-' 
tive to solvent than as measured by a stationary observer. 
The theory thus includes terms for the volume of DNA, the 
amount of solvent which it carries along with it, and the 
degree to which it is permeable to the solvent. DNA is a 
relatively rigid polymer and wanders through, oi' "occupies 
thousands of times its own molecular voluiiie. Hence its 
permeability to solvent molecules is unusually high, a fac) 
which increases the frictional drag on the molecule and malijs 
the relation between chain length and frictional properti; 
obscure. 

When observed S-concentration data were fitted to th 
theoretical expression, a remarkably good fit was ■■achieved 

The values of the parameters for volume, hydration, permea 
bility, and S at zero concentration (S.) are of reasonable 
magnitudes, while the volume "occupied" agree within a few, 
percent of the value calculated from viscosity data- The] 
values of S„ and volume occupied may be combined with any 
the existing theories to calculate molecular chain lengths) 
without resort to any additional frictional measurement. 

Significance to Mental Health Research ; This study is part of a 
long-term group effort to discover the mechanisms of proten 
synthesis and genetic transfer. 

Proposed Course of Project ; Molecular sizes may be calculated fioa 

S vs. concentration data using existing theories. However' 
these theories treat only limiting cases of complete perme- 
bility or impermeability, whereas DNA is approximately haJ- 
way between these extremes. An effort is toeing made to 
develope a theory which will treat this intermediate case.' 
One reason why this case has not been treated previously 2\ 
that prior to the theory discussed above there was no mettfd 
for estimating permeability of highly extended polymer i 
molecules. The theory applies generally to all such molecll« 
and we hope to extend its application to other cases such is 
RNA, synthetic polynucleotides, and nucleoproteins , 

Part B Included Yes No X 



» 281- 



Serial No. M-NC-PC-7 

1. Neurochemistry 

2. Physical Chemistry 

3. Bethesda, Md. 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



art A, 



Project Title" Structure of a Complex Formed Between Polyadenylic 

Acid and Polyinosinic Acid. 

Principal Investigator: Alexander Rich 

Other Investigators: None 

Cooperating Units: None 

Man Years 

Total: 1/4 
Professional: 1/4 
Other: 

Project Description: 

Objectives : To discover the configuration assumed by the synthetic 
polyribonucleotides polyadenylic acid and polyinosinic when 
they combine together to form a helical complex. 

Methods Employed : Principal methods in this investigation are 

those of X-ray diffraction. Ancillary methods include spec- 
trophotometric studies, ultracentrifugal studies j and 
titration curves. 

Major Findings : It has been discovered that in dilute aqueous salt 
solutions, polyadenylic acid will combine with polyinosinic 
acid to form a two-stranded helical complex. In addition, 
it has been found that this two-stranded helical complex will 
take on a third polyinosinic acid molecule to form a three- 
stranded helical complex. This reaction is controlled by 
the ionic conditions of the environment. Thus, in solutions 
with a salt concentration less than 10 "^ M, no reaction occurs 
at all. In solutions which are 0.1 M in NaCl, the reaction 
occurs very rapidly, resulting in the formation of the three- 
stranded complex within four minutes. If the salt concentra- 
tion is reduced, however, to 0.01 M, then the reaction 
proceeds more slowly, and one can clearly differentiate the 
initial formation of the 1:1 complex of polyadenylic acid 
and polyinosinic acid followed by the subsequent addition of 
a polyinosinic acid molecule to form a final complex which is 
2:1 with two polyinosinic acid molecules and one polyadenylic 
acid molecule. 



- 232 - 



Serial No, 



I-NC-PC-7 

page 2 



Part A. (Continue( 



An X-ray diffraction photograph has been obtained of 
of the 1:1 complex which clearly shows that it is a helical 
molecule with a pitch of 38.8 A. These molecules are parall 
to each other and packed together in a hexagonal array. Won 
has been done in the elucidation of the structure of the twc 
stranded complex. At the present time, it is believed that 
this complex forms by having the two purine bases hydrogen ' 
bonded together and the base pairs packed together helicallj! 
with the ribose phosphate chains on the outside of the t 
molecule. 



Significance to Mental Health Research : Ribonucleic acid is a 
molecule found in all nervous tissues and is currently 
believed to be an essential ingredient for the synthesis of 
protein. The synthetic polyribonucleotides are molecules 
which have the same ribose phosphate backbone as is found 
ribonucleic acid itself, and by studying the configuration 
potentialities inherent in these synthetic polymers, we ca: 
determine the conf igurational possibilities which are opJen 
RNA itself. In this way, we hope to elucidate the fundamenij 
mechanisms of protein synthesis, a mechanism which will be 
applicable to these protein synthetic activities within 
nervous tissue as well as in other tissues. 



Proposed Course of Project : This work v/ill be continued by 

carefully studying the diffraction patterns produced by the] 
various models of the type described above. In addition^ 
the models will be built for the three-stranded helical 
complex. 



Part B Included 



Yes X 



No 



- 283 - 



Serial No. M-NC-PC-7 

i page 3 

! PHS-NIH 

Individual Project Report 
Calendar Year 1957 

lirtB: Honors, Awards, and Publications 

Publications other than abstracts from this project: 

Rich, Alexander, The Formation of Two- and Three- Stranded Helical 
Molecules by Polyadenylic Acid and Polyinosinic Acid, Nature, 
(In press) . 

Honors and Awards relating to this project: None. 



284 - 



Serial No. M-NC-PC-8 

1. Neurochemistry 

2. Physical Chemistry 

3. Bethesda, Md. 



'PHS-NIH 
Individual Project Report 
Calendar Year 1957 



>art A. 



Project Title: Determination of the Structure of Collagen 

Principal Investigator: Alexander Rich 

Other Investigators: F.H.C. Crick 

Cooperating Units: None 

Man Years 

Total : 1/4 
Professional: 1/4 
Other : 

Project Description: 

Objectives : To determine the configuration of collagen and 
related proteins. 

Methods Employed : Principal method used in this investigation is 

that of X-ray diffraction. Diffraction patterns are obtained 
from stretched samples of collagen or tendon or of elastin. 
These diffraction patterns are then analyzed, using a 
computer for calculating the diffraction patterns expected 
from various helical structures. 

Major Findings : Two years ago, these investigators proposed a 

model for the structure of collagen. This proposal has been 
accepted in the intervening two years by all of the investi- 
■"gators working in the collagen field. At the present time, 
we are expanding the work on collagen to work out various 
fine features in the structure of the molecule. Thus, we 
have been spending a great deal of time on the configuration 
and position of the various amino acid side chains which are 
known to exist in the collagen molecule. In addition, we 
have found several hydrogen bonded side chain linkages which 
are believed to be of importance in the lateral stabiliza- 
tion of the molecules when they are parallel to each other. 
Among other things, these investigations proved useful in 
understanding the mechanisms of tanning. In the tanning 
process, metal ions are introduced between the parallel 
collagen molecules and by complexing onto amino acid side 
chains from adjoining molecules, the neighboring units are 
firmly held together so that they can no longer separate. 
This results in a tanned collagen fiber. 



- 285 - 



Serial No, 



M-NC-PC-8 

page 2 



Part A. (Continued) 



In addition, some work has been done on stretched 
elastin fibers. Elastin is a protein which has an amino 
acid composition somewhat similar to collagen, but has a 
structure which has not been determined as yet. For varioi 
reasons }, we have felt that the elastin molecule has a 
degenerate collagen structure, and attempts have been made 
to re-orient elastin so as to demonstrate its close relatic- 
ship with collagen. A certain measure of success has been 
achieved along these lines. 

■ ■ j 

Significance to Mental Health Research : Collagen is the major 
tensile element which is found in the animal kingdom. In 
addition to being spread through all the phylla, it is 
equally well distributed through all the tissues of the 
body, including the nervous system. There, collagen is 
found in the fibrous wrappings around nerves as well as inii 
the fibrous covering of blood vessels in the central nervoii 
system. Through a fundamental understanding of the config- 
uration of collagen molecule, we hope to better understand 
the role which it plays in holding tissues together. 

Proposed Course of Project : This work will be continued along 
lines described above. 



Part B Included 



Yes X 



No 



- 286 - 



Serial No. M-NC-PC-8 
page 3 
PHS-NIH 
Individual Project Report 
Calendar Year 1957 

'art B : Honors, Awards, and Publications 

Publications other than abstracts from this project: 

^ Rich, Alexander and Crick, FoH.C, The Structure of 

I Collagen. A chapter in a book on Advances in Collagen 

Research. To be published by Pergamon Press, London, England, 

Honors and Awards relating to this project: 

An invitation to present the opening paper at an International 
Conference on Collagen and Gelatin, held in Cambridge, England 
July 1 through 7, 1957. 



- 287 



Serial No. M-NC-PC-9 

1. Neurochemistry 

2. Physical Chemistry 

3. Bethesda, Md. 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



.rt A. 



Project Title: Investigation of the Structure of Steroid Amino Acid 

Complexes . 

Principal Investigator: Alexander Rich 

Other Investigators: David M. Blow 

Cooperating Units: None 

Man Years 

Total : 1/2 
Professional: 1/2 
Other : 

Project Description: 

Objectives ; To determine the structure of the molecular complexes 
which form between desoxycholic acid and various amino acids 
and polypeptides. 

Methods Employed : The principal tool used in this investigation 
is X-ray diffraction. Other subsidiary tools are spectro- 
photometric analyses, viscosity studies, freezing point 
depression, and pycnometry. 

Major Findings : We have discovered that a steroid moleculej 

sodium desoxycholatOj will form a series of helical com- 
plexes in the presence of a variety of amino acids or poly- 
peptides. X-ray diffraction studies of these complexes show 
a remarkably detailed and precise organization of the flat 
steroid molecule and the amino acid residues o The crystallo- 
graphic investigation has shown that these molecules form a 
complex with a diameter of approximately 40 A. Thus, it is 
quite likely that the flat steroid molecules lie adjacent 
to each other with amino acids between themo This state- 
ment is supported by the finding that additional amino acids 
added to the complex are usually located on the periphery of 
the complex. 

A series of investigations has been carried out to 
determine the stoichiometry of the interaction between the 
steroid and amino acid. These have shown that the optimum 
j ratio is one steroid molecule to one amino acid. The 
I complex will continue to form if there is an excess of amino 



- 288 - 



Part A (Continued) 



Serial No. M-NC-PC-9 
page 2 



acids, however, as, for example, going up to a mole ratic 
of 3 or 4 to 1. In the presence of additional steroids, 
however, the complex failed to form. Thus, if there are 
more than two steroid molecules per amino acid, no compl( 
forms at alio This effect can be shown very markedly in 
viscosity study of these complexes in solution. 

Eight amino acids and five peptides have been stud:;d 
thus far. It has been shown that all of them will interj|| 
with a steroid, either through a marked increase in the 
viscosity of solution or by the production of a character 
istic X-ray diffraction photograph. 

Significance to Mental Health Research : A large component in ji« 
nervous system are the steroid molecules which are found 
largely in the myelin. Very little is known regarding tlJ 
structural role which these flat molecules play in 
organizing the myelin sheath. The purpose of this study le 
to show how the closely related steroid molecule, sodium 
desoxycholate, interacts with amino acids in the hope tht 
it will throw some light on the role which steroids playin 
the nervous system. 

Proposed Course of Project : Studies will be continued along t3 
lines described above until the complete structure analylis 
has been worked out . .' 



Part B Included 



Yes 



No 



- 289 - 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Basic Research 
Laboratory of Cellular Pharmacology 



BUDGET SHEET 



te^imatga o^UgatiPns for n 195B. 
Totali $358,362 
Directs $2759350 

Reimbursements s $83 , 012 



Projects included: M-CP 1 through M=CP 15 



Serial No. M - CP 1 

Laboratory of Cellular Pharma- 
cology 
Room 2D-14, Building 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



ii_A. 



Project Title : Methionine Activating Enzyme in Rabbit Liver 

Principal Investigator : Giulio L. Cantonij M. D, 

Man Years 

Total: 1-1/3 
Professional: 1/3 
Other : 1 

Project Description : 

Objectives : 

Mammals, plants and fungi and presumably other phyla 
utilize the methyl group of methionine for biological 
methylations o As a result of recent work on the mechanism 
of transmethylation reactions, it has been established that 
in reality activation of methionine is a prerequisite to 
the transfer of its methyl group. Biologically the activa- 
tion reaction is catalyzed by an enzyme found in yeast and 
in the liver of numerous mammalian species. In this reaction, 
adenosine triphosphate plays an essential role; specifically 
adenosine triphosphate fulfills a dual function inasmuch as 
it serves a) directly or indirectly as a donor source of its 
adenosine moiety, which is incorporated in "active methionine", 
and b) as an energy source, since it has been calculated that 
the methyl-sulf onium bond in "active methionine" is roughly 
equivalent to the pyrophosphate bond in adenosine triphosphate. 

Major Findings : 

Repeated efforts were directed toward the separation 
of the activity of the methionine activating enzyme into 
two or more protein fractions. All these attempts were 
unifoi-mly negative. Furthermore attempts at recombination 
of protein fractions from rabbit liver with protein fractions 
obtained in the course of purification of the methionine 
activating enzyme from yeast (Project M - CP 2) were likewise 



- 290 



Part A. (Continued) 



Serial No. M - CP 1 

page 2 



negative. While evidence of this kind is not compelling, all 
indications suggest that the formation of S-adenosylmethionine 
from methionine and ATP is catalyzed by a single protein moiety. 

Significance to Mental Health Research : 

This project is part of a larger study of biological 
methylations. The role of transmethylation reactions of 
biogenesis of neuro-hormones such as acetylcholine and 
epinephrine, metabolites important in neuro-muscular functions 
like creatine and anserine and of pharmacologically active 
agents like bufotenine, mescaline and many other alkaloids 
clearly indicates that this broad area of research is of 
significance to basic research in neurology and mental health. 



Part B included 



Yes /"7 



No /W 



- 291 - 



Serial No. M - CP 2 

Laboratory of Cellular Pharma- 
cology 
Room 2D-39, Building 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



tA_. 

Project Title ; Studies on Methionine Activating Enzyme of Yeast. 

Principal Investigator : S. Harvey Mudd, M. D. 

Man Years 

Total: 1-2/3 
Professional; 2/3 
Other: 1 

Project Description : 

Objectives : 

The objectives of the project have been outlined in a previous 
annual report. Briefly; these are to further elucidate the detailed 
mechanism of the enzymatically catalyzed formation of S-adenosyl- 
methionine, the compound which serves as a biological donor of 
labile methyl groups and of certain aliphatic carbon chains. 

Major Findings : 

The methionine activating enzyme has been extracted from 
bakers' yeast and purified 250-fold from this extract by one method 
and 200-fold by a second method. The properties of the enzyme in 
regard to stability, pH effects, substrate specificity for methionine 
and adenosine triphosphate, and the effect of various inhibitors 
have been studied. Cof actor requirements for both a monovalent and 
divalent cation have been demonstrated and the specificity of these 
requirements investigated. The stoichiometry of the reaction and 
the reaction products have been studied. By use of P labelled 
adenosine triphosphate the method of breakdown of this substance has 
been clarified. An important negative finding has been the failure 
of the enzymatic activity to fractionate into two or more protein 
moieties during extensive purification. 

Significance to Mental Health Research : 

' This project is part of a larger study on biological methylations, 
the significance of which to mental health has been discussed else- 
where. In addition, the purification of this enzyme from yeast 

- 292 - 



Part A. (Continued) Serial No. M - CP 2 

page 2 



allows detailed comparison with the previously purified analogous! 
liver enzyme, a comparison which is especially important from thd 
viewpoint of comparative biochemistry. 



Part B. 



Mudd, S. H., and Cantoni, G. L. 

"Activation of Methionine for Transmethylation III. 

The Methionine Activating Enzyme of Baker's Yeast" 

J. Biol. Chem . , in press 

Mudd, S. H., and Cantoni, G. L. 

"Selenomethionine in Enzymatic Transmethylations" 
Nature, in press 



it 



- 293 - 



Serial No. M - CP 3 

Laboratory of Cellular Pharma- 
cology 
Room 2D-14, Building 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Project Title : Study of methionine synthesis by enzymatic 
j transmethylation from betaine or dimethylthetin. 

Principal Investigator : Jack Durell, M. D. 

Other Investigators ; Qiulio L. Cantoni, M. D. 

Man Years 

Total: 1-1/2 
Professional: 5/6 
Other : 2/3 

Project Description ; 

Objectives : 

To study the mechanism of the enzymatic transfer of alkyl 
groups from "onium" poles and the energetics of such reactions; 
to investigate whether two enzymes are involved to characterize 
their properties and substrate specificities. 

Major Findings : 

As reported in 1956 homocysteine-thetin-methylpherase, 
HTMP, has been purified to the point where it appears to 
be almost pure. The purified enzyme undergoes an interesting 
and novel polymerization reaction which can be reversed with 
[ a variety of sulphydryl compounds. The kinetics and mechanism 
' of this reversible polymerization reaction has been investigated 
in detail by biochemical and physicochemical means, in part in 
collaboration with Dr. R. Steiner of NMRI . 

With the purified enzyme it has been possible to measure 
by direct calorimetry the enthalpy change in the methyl transfer 
reaction from dimethylthetin. The ^H was found to be -12000, 
indicating a very large change in the standard free energy of 
the reaction. This aspect of the work was carried out in 
collaboration with Professor Julian Sturtevant of Yale 
University. 



- 29-^ - 



Part A. (Continued) Serial No. M - CP 3 

page 2 



Interesting though preliminary results on the relationship 
of HTMP to the enzyme catalyzing the synthesis of methionine 
from betaine and homocysteine were obtained and will be pursued 
further . 

Significance to Mental Health Research : 

This project is part of a larger study on biological 
methylations. As is well known, "onium" compounds have 
profound pharmacological effects upon the nervous system 
and it has been suggested that they may play a role in the 
conduction and transmission of the nervous impulse. Knowledge 
of mechanisms of synthesis and degradation of such compounds 
as well as the energetics of such reactions might therefore 
contribute to our understanding of nervous tissue function. 



Part B. 



Durell, J., Anderson, D.G., and Cantoni, G.L. 

"The Synthesis of Methionine by Enzymic Transmethylation 

I. Purification and Properties of Thetin Homocysteine Methylpherasj" 
Biochim. and Biophys . Acta , in press ! 

Durell, J. and Sturtevant, J.M. 

"The Synthesis of Methionine by Enzymic Transmethylation 

II. Enthalpy Change in the Methyl-Transfer from Dimethylacetotheti 
Biochim. and Biophys. Acta, in press 



- 295 - 



Serial No, M - CP 4 

Laboratory of Cellular Pharma- 
cology 
Room 2D-08, Building 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



_A. 

Project Title : Metabolism of S-Adenosyl-L-homocysteine (ASR) . 

Principal Investigator : Gabriel de la Haba, Ph.D. 

Man Years 

Total: 1-2/3 
Professional: 2/3 
Other: 1 

Project Description : 

Objectives : 

This project is a continuation of last year's finding on the 
enzymatic synthesis of ASR by way of condensation of L-homocysteine 
and adenosine. 

Methods Employed : 

The enzyme involved has been purified about eighty-fold from 
rat liver by conventional methods of protein fractionation. The 
product of the reaction has been characterized chemically and 
enzymatically . 

Major Findings : 

It has been found that the enzymatic reaction between adenosine 
and L-homocysteine is very specific for both of the above-mentioned 
reactants; no other purine or pyrimidine nucleoside will substitute 
for adenosine, and no mercaptan other than L-homocysteine will react. 
Of interest also is the fact that the equilibrium of this reaction 
has been found to lie very far in the direction of condensation; the 
hydrolysis of ASR is however readily obtained with the same enzyme 
if both the products of the reaction are trapped enzymatically (a) 
adenosine with its specific deaminase, and (b) L-homocysteine with 
the enzyme homocysteine-thetin methylpherase which has been purified 
and studied extensively in this laboratory. 

Chemical methylation of ASR to yield S-adenosyl-L-methionine 
was performed and enzymatic studies on the product undertaken. It 
I has been found that in the chemical methylation only half of the 
S-adenosyl-L-methionine formed is active in the enzymatic 

- 296 - 



Part A . (Continued) Serial No. M - CP 4 

page 2 

methylation of guanidoacetic acid to yield creatine. It appears 
that two stereoisomers of the sulfonium group are obtained upon 
methylation oi ASR in agreement with organic chemical methylations 
of simpler thioethers. Further study of this finding is con- 
templated. 

Significance to Mental Health Research : 

I 
I 

This study is a part of the general problem of transmethylation 
reactions under investigation in this laboratory. ASR is a product' 
of the transfer of methyl groups from active methionine to a number 
of acceptors such as guanidoacetic acid, nicotinamide, etc. It 
would appear that investigations on its fate — and as here describee 
its biosynthesis — may add to our knowledge of the general problem c 
sulfur metabolism, sulfonium metabolism, and methyl transfer reactin 
metabolic processes which are acquiring increasing significance in , 
neurochemistry . 

Proposed Course of Project : j 

This project will be continued especially in conjunction with 
Project M - CP 12. 

Part B included Yes /~7 No /5c7 i 



oo^ 



Serial No, M - CP 5 

Laboratory of Cellular Pharma- 
cology 
Room 2D-39, Building 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



] t A . 

Project Title : Amino acid analogue studies of protein synthesis. 

Principal Investigator : Michael Yarmolinsky 

Man Years 

Total: 2/3 
Professional: 2/3 
Other : 

Project Description : 

Objectives : 

(1) Selective inhibition of the capacity of pancreas tissue 
slices for the net synthesis of specific proteins by use 
of appropriate amino acid analogues „ 

(2) Investigation of the transfer of activated amino acid to 
its first acceptor prior to incorporation into protein 
in vitro. 

Methods Employed : 

(1) Pigeon pancreas slices v/ere incubated in a nutrient 
medium. Increases in amylase activity following homogeni- 
zation of the tissue slice in its incubation m-edium were in- 
vestigated under various conditions. The initial amylase 
levels before incubation were determined by a method pre- 
viously developed in this laboratory. 

(2) Cell-free preparations of rat liver and of yeast were 
studied by measuring incorporations of radioactive pyro- 
phosphate or adenylic acid into adenosine triphosphates 
in the presence and absence of amino acids. 

Major Findings : 

(1) In contrast to previous reports, but consistent with recent 
analyses of amylase composition j, methionine was found to 



-■ 293 



Part A . (Continued) Serial No. M - CP 5 

~ ~ page 2 

stimulate slightly the synthesis of amylase by pigeon panre 
slices. Ethionine showed a questionable inhibition. Try]- 
tazan can to a certain extent replace or spare the utili- 
zation of tryptaphan for amylase synthesis. 

(2) The report of an alanine-dependant , ribonuclease-inhibite( 
adenylic acid incorporation into adenosine triphosphate b; 
extracts of rat liver was not confirmed. Nor was it 
possible to demonstrate in yeast extracts an amino acid 
dependant incorporation of adenylic acid into ATP. 



The sulfonic acid analogue of alanine is not activated. 
Significance to Mental Health Research: 



i 



For growth and regeneration nerve tissue depends on the procesiefs 
of protein synthesis which is the subject of these investigations.! 

Prop osed Course of Research : 

Owing to the extreme variability of the pigeon pancreas experii 
ments, this aspect of the work has been discontinued. The work i 
with cell-free systems will be continued in the coming year. 

Part B included Yes /"7" No /x7 



- 299 - 



Serial No, M - CP 6 

Laboratory of Cellular Pharma- 
cology 
Section on Cellular Regulatory 

Mechanisms 
Room 2D-04, Building 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Toject Title : The Conversion of Phenylalanine to Tyrosine. 

fincipal Investigator : Seymour Kaufman, Ph.D. 

they Investigators : Bruce Levenberg, Ph.D. 

an Years 
Total; 1-2/3 
Professional: 2/3 
Other : 1 

roject Description : 

Objectives : 

Almost nothing is known about the mechanism of biological hydroxy- 
lation reactions. For many compounds, including steroids and some 
drugs, hydroxy lation is on the normal pathway of metabolism. For the 
essential amino acid, phenylalanine, hydroxylation to tyrosine re- 
presents a preliminary step prior to its complete oxidation via 
(ultimately) the citric acid cycle. 

Methods Employed : 

The methods employed in the problem are those of (classical) enzym- 
ology. For the separation and purification of the individual enzymes, 
such techniques as salt fract^ionation, organic solvent fractionation 
and selective adsorption and elution from gels have been employed. 
Spectrophotometric and chemical assays have been used to follow the 
course of the reaction. 

Major Findings : 

From kinetic studies previously carried out on this system, indi- 
cations were obtained for the participation of another cofactor in this 
reaction, in addition to TPNH. This cofactor has now been isolated from 



300 - 



Part A. (Continued) Serial No. M ^ CP 6 

=,- ■ page 2 

boiled extracts of rat liver. It has been shown that the lag periocii 
the reaction which has previously been reported, can be eliminated 
bv a short anaerobic incubation of TPNH with the cofactor in the pr«.e 
of the highly purified sheep enzyme. These results suggest that thtfe 
is an interaction between TPNH and the cofactor and that this re- 
action is catalyzed by the sheep enzyme as shown in the reaction (1, 

TPNH + H"^ + X ^ ^ TPN"^ + XHg i 

In the subsequent reactions in what must obviously be a complex 
seauence this reduced cofactor may be oxidized by molecular oxygen i 
to form the primary hydroxy lating agent. The rat enzyme probably I 
participates in these later reactions involving the actual hydroxy-: 
lation of phenylalanine. 

Significance to Mental Health Research : 

It is known that this reaction, the conversion of phenylalanine, 
to tvrosine, is at least partially blocked in the disease oligophreiij 
phenylpyruvica. One of the characteristics of this disease is a 
severe impairment in mental ability. With an increased understandi^. 
of the nature of the reactions catalyzed by the 2 enzymes which are| 
involved in this conversion of phenylalanine to tyrosine, it should^ 
be possible to delineate more precisely the nature of the biochemicjl 
abnormality of this disease. I 

Proposed Course of Project : 

The work on the purification of the enzymes will be continued, 
mainly to explore the possibility that more than 2 enzymes are in- 
volved The detailed mechanism of the reaction should be more 
amenable to study when larger amounts of the purified enzymes and 
the new cofactor become available. 

Part B included Yes fj No /x7 



- 301 - 



Serial No. M '■■.. CP 7 

Laboratory^o]f~CeTlular Pharma- 
cology 
Section on Cellular Regulatory 

Mechanisms 
Room 2D-04, Building 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Proj ect Title : Hormonal Regulation and Protein Synthesis. 

Principal Investigator : Seymour Kaufman, Ph<,D. 

Other Investigators ; Louis Sokoloff, M.. D. 

Coopera ting Jnits : M - CS - CM ~ 4 

Man Yea:'S 
T^talT"- 
Prof essional: ~ 

Other : - 

Project Descriptioa : 

Objectives : 

Only recently methods have become available for studying 
protein synthesis in_ vitro . Utilizing these methods, it has 
been elearl2/ demonstrated that protein synthesis is coupled 
to energy-yielding reactions in the cell. The mechanism of 
the synthesis and of this coupling are unknown,, The objec- 
tives of this study are three-fold „ (a) Investigate in 
general the mechanism of protein synthesis, (b) Attempt to 
elucidate the nature of the coupling of the energy supply 
and the synthetic reaction. More specifically, this system 
v/ould seem to offer the possibility of investigating the 
question of whether or not different energy-yielding reactions 
are geared to specific synthetic reactions. Thus it is now 
known that during oxidation of substrates with molecular oxygen, 
energy is tapped from the hydrogen carrier system at three 
separate sites . It would be of great interest to know if the 
energy liberated at these three sites is equally available 
for all synthetic reactions. (c) To investigate the possible 
hormonal regulation of protein synthesis. 



- 302 - 



Part A . (Continued) Serial No. M - CP 7 

page 2 

Major Findings : 

During this year, the course of the problem has paralleled 
closely the work described in Project M - CS - CM - 4. 

Part B included Yes /T No /3c7 



303 - 



Serial No « M - CP 8 

Laboratory of Cellular Pharma- 
cology 
Section on Cellular Regulatory 

Mechanisms 
Room 2D-04, Building 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



Project Title : Studies on the Cofactor Required for the Enzymatic 

Conversion of Phenylalanine to Tyrosine. 

Principal Investigator : Seymour Kaufman, Ph.D. 

Man Years 

Total: 1-2/3 
Professional: 2/3 
Other: 1 

Project Description : ) 

) See previous project 
Objectives : ) 

I Methods Employed : 

The cofactor has been purified from boiled extracts of rat 
liver by a combination of procedures including: Organic solvent 
fractionation, ion exchange chromatography and partition chroma- 
tography on silica gel columns. 

Major Findings : 

Enzymatic assays for the cofactor have been developed which can 
detect ^ quantities of the material in natural materials. Using these 
assays, many tissues have been examined as possible starting ma- 
terials for large scale isolation attempts. So far, activity has 
been detected only in liver and adrenal tissue. Of the livers 
tested (beef, sheep, rabbit, monkey, rat) rat liver has the highest 
activity. The cofactor has been isolated from this source by a 
procedure which leads to about 1000 fold purification. Extensive 
tests for specific chemical groups have been carried out and from 
the results of these tests, as well as from some of its physical 
properties, it can be concluded that the cofactor is an unstable 
heterocyclic organic base which contains 20-30 per cent nitrogen. 

Significance to Mental Health Research : 

There is good evidence that the conversion of phenylalanine 

I I to tyrosine is at least partially blocked in the disease, 

' oligophrenia phenylpyruvica . With the realization that at least 

- 30^4- - 



Part A . (Continued) Serial No. M - CP 8 

page 2 

2 enzymes are involved in this conversion, experiments have been 
reported which attempt to specify whether both or only a single 
enzyme is missing or blocked in the disease. The finding that a 
non-protein cof actor is also involved in this conversion raises 
the possibility that it is the cofactor which is missing in the 
disease . 

Proposed Course of Project : 

The purification and the studies of the structure of the 
cofactor will be continued. In addition, the possibility that 
it is the cofactor which is missing in oligophrenia phenylpyruvica 
will be investigated. 



Part B. 



Kaufman, Seymour 

"A New Cofactor Required for the Enzymatic Conversion of 

phenylalanine to Tyrosine" 

J. Biol. Chem. , in press 



« 305 - 



Serial No. M - CP 9 

Laboratory of Cellular Pharma- 
cology 
Section on Cellular Regulatory 

Mechanisms 
Room 2D-04, Building 10 



PHS - NIH 
Individual Project Report 
Calendar Year 1957 



tA. 
Project Title : Clinical Studies on Phenylketonuria. 

,, Principal Investigator: Seymour Kaufman, Ph.D. 

1 ~~~ ~ 

Man Years 
Total: 2/3 
Professional: 1/3 
Other: 1/3 

Project Description : 

Objectives : 

It has been established that in this disease there is at least 
a partial block in the conversion of phenylalanine to tyrosine. 
In vivo studies have shown that in phenylketonuria only one of 
tEe 2 enzymes which are known to participate in this enzymatic 
system is missing. The possibility exists, however, that it is 
not an enzyme which is missing but rather a coenzyme v/hich is 
required for the activity of this enzyme. Experiments will be 
carried out to test the possibility that it is the cofactor 
which is missing in the disease. If it is actually an enzyme 
lack, the studies on the mechanism of the normal enzymatic con- 
version of phenylalanine to tyrosine should allow for a better 
understanding of the nature of the metabolic lesion. 

Methods Employed : 

Liver biopsy samples from children with oligophrenia 
phenylpyruvica, as well as from normal controls from the same 
age group will be tested for the conversion of phenylalanine to 
tyrosine (see Project M - CP 6 for details). 

Major Findings : 

I The assay system previously used for the work on animal tissues 
I has been modified so that it is applicable to small (about 1 g.) 



306 - 



Pa rt A . (Continued) Serial No. M - CP 9 

page 2 



amounts of liver tissue. High activity has been obtained with ' 
2 normal human liver samples. It has been possible to show that 
the cof actor, isolated from rat liver (see Project M - CP 8) can 
stimulate the human liver system 3-6 fold. 

Significance to Mental Health Research : 

s j 

A precise delineation of the metabolic block in this disease jj 
may help our understanding of the relationship if the metabolism' 
of phenylalanine and tyrosine to normal brain development and 
function. 

Proposed Coxirse of Project : 

Several additional normal samples of human liver will be chei'si 
for activity and then the studies on the oligophrenic liver sampai 
will be carried out. 

Part B included Yes /"^ No /5E7 



- 307 - 



Serial No. M n. CP 10 

Laboratory^^ofi^T^Trular Pharma- 
' cology 

Room 2D-08, Building 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



A. 

Project Title : Biosynthesis of Noradrenalin 

Principal Investigator : Bruce Levenberg, Ph„D, 

Man Years 
Total: 1/3 
Professional: 1/3 
Other: - 

Project Description ; 

Objectives : 

This investigation is concerned with the mode of biosynthesis 
of the suprarenal hormone, noradrenalin. Evidence from tracer 
studies has indicated that a possible pathway of formation of this 
substance is from dihydroxyphenylalanine (DOPA) via hydroxytyramine 
(DOPA-amine) „ Research will be directed toward obtaining enzymatic 
evidence for such a series of reactions in cell free preparations of 
adrenal tissue. It will be of particular interest to make a detailed 
study of the postulated hydroxylation step between DOPA-amine and 
noradrenalin and to ascertain the nature of the enzymatic and cofactor 
requirements of such a system. 

Methods Employed : 

A simple and rapid chemical method has been devised for the 
estimation of small quantities of noradrenalin in tissue extracts in 
the presence of considerably larger amounts of DOPA-amine. Other 
methods are being perfected which will enable one to follow the course 
of the conversion of trace amounts of isotopically-labeled DOPA 
to noradrenalin in crude as well as in more purified enzyme prepa- ,1: .: 
rations. 

Major Findings : 

Much of the time devoted to this investigation during the past 
several weeks has been spent on development of routine and re- 
liable methods of assay. Thus, no major biochemical findings can 
be reported at this time . 

! 

- 308 - 



Part A. (Continued) Serial No. M - CP 10 

— — page 2 

Sign ificance to Mental Health Research : 

Adrenalin and noradrenalin, the major suprarenal medullary - 
sympathomimetic agents, have been detected in considerable quantitle 
in brain as well as in all types of adrenergic nerve tissue. The 
Physiological and pharmacological actions of these hormones have 
become the subject of an almost overwhelming number of studies, 
but surprisingly little has been definitely established regarding 
the enzymatic mechanisms which the body employs in the biogenesis 
of the catechol amines from tyrosine. Much in the way of mteres-.i 
biochemical reactions lies therein, and it is hoped that informal c 
gained from this investigation will make a contribution in that 
direction. 

Proposed Course of Research : | 

Since this is a new project, it is difficult to chart its coirs 
until specific findings are made. However, should the hydroxylase 
step be successfully demonstrated, purification of the enzyme coil- 
ponents and a study of the intimate mechanism of the reaction ar 
planned. 

Part B included Yes fj No /x7 



- 309 - 



Serial No„ M - CP 11 

Laboratory of Cellular Pharma- 
cology 
Room 2D-41, Building ,10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



' >roject Title : Sulfate Metabolism in Chlorella 

>ri ncipal Investigator : Graham Ao Jamiesonj Ph.D. 

Ian Years 

Total: 1/2 
' Professional: 1/2 

! Other: - 

i 

'roject Description: 



Objectives : 

It has been suggested (Schiffj Thesis, Pennsylvania, 1956) that in 
the sulfur metabolism of Chlorella pyrenoidosa active methionine is 
formed without the intermediation of methionine. It was necessary to 
confirm these results (i) since the activation of methionine is the 
only known mechanism for the formation of active methionine, and (ii) 
as an attempt to clarify the role of the adenosine-homocysteine con- 
denzing enzyme isolated from rat liver since adenosyl homocysteine 
was a possible intermediate. 

Methods Employed : 

After the addition of carrier, active methionine was isolated by 
paper electrophoresis and chromatography from Chlorella cells which 
had been incubated with S^^-sulfate and methyl-C '^-methionine, 
respectively, of equal specific activity and the radioactivity of 
the product determined. 

Major Findings : 

It has been found that methionine is incorporated into active 
methionine by Chlorella eight to ten times more effectively than is 
sulfate suggesting that the pathway in this species is substantially 
similar to that in yeast and in the rat. A possible explanation for 
Schiff's erroneous results lies in the fact that the specific activities 
of his substrates were not carefully controlled and hence an apparent 



- 310 



Part A. (Continued) Serial No. M- CP 11 

page 2 

non-incorporation of methionine as shown by radioautography was 
actually a dilution effect when compared with carrier-free sulfate 

Si gnificance to Mental Health Research : 

The importance of onium compounds and of methyl transfer read o 
in the metabolism of nerve tissue is well known. Because of the 
unusual mode of active methionine formation postulated by Schiff :; 
was imperative to clarify these findings in the hope of revealing 
new interrelationships between thioether and sulfonium compounds iid 
of understanding the biochemical basis of methyl group transfer. : 

Pr oposed Course of Research : ! 

In view of our negative findings this project will not be con 
tinued. 

■ ■ i 

Part B included Yes /~7 No /x7 | 



- 311 - 



Serial No. M - CP 12 

Laboratory of Cellular Pharma- 
cology 
Room 2D-08, Building 10 



PHS-NIH 
Individual Project Report 
Calendar Year 1957 



r- 



Project Title : The enzymatic mechanism of generation of the meth3?j. 
" ~ group of methionine from one carbon compounds such 
as formaldehyde o 

Principal Investigators : Graham A. Jamieson, Ph.D., and 

r— Gabriel de la Haba, Ph.D. 

ilan Years 
Total: 1/3 
Professional: 1/3 
Other: - 

Project Description : 

Objectives : 

To investigate the enzymatic mechanism of generation of the 
methyl group of methionine from formaldehyde. Recent investi- 
I gations by other workers on the enzymatic reactions of formaldehyde 
f or the beta carbon of serine, implicate a tetrahydrof olic complex 
I such as a hydroxymethyl derivative as a metabolic intermediate. 
It is well known that formaldehyde, formate, or the beta carbon, 
of serine are converted to the methyl group of methionine (and 
i that homocysteine is required for the generation of methionine 
I from formate). The intimate details of this pathway, however, 
i are unknown . 

If a hydroxymethyl derivative of tetrahydrof olic acid Is an 
t intermediate, it is proposed that in a condensation with homocysteine — 
I analogous to the reaction between adenosine and homocysteine de- 
! scribed in Project No, M - CP 4 — would result in a thioetherj, 

which upon subsequent reductive cleavage would yield methionine.' 

Such a postulated mechanism is under investigation. 

Methods Employed : 

To facilitate the detection of the above postulated iner- 
mediate, radioactive formaldehyde and C-^'* carboxyl labelled 
homocysteine will be employed. To determine the extent of 
conversion of the formaldehyde to the methyl group of methionine 
the latter will be degraded to release specifically the methyl 
group as methyl iodide. 

- 312 - 



Part A, (Continued) Serial No. M - CP 12 

page 2 

Major Findings : 

This project is at the moment being initiated and as yet no | 
vpc,ults have been obtained^ As a first step conditions for maximi 
reaction between tetrahydrof olic acid and formaldehyde were es- 
tablished and the complex isolated virtually free of f ormaldehyde| 

Significance to Mental Health : 

This oroiect is part of the broad problem of methyl group 
transfer under investigation in this laboratory. For discussion n 
the significance to neurochemistry refer to a previous report 
(M - CP 4). 

Part B included Yes fj No /x7