Volume 14, Number 1 Psychopathology Research June 2004 THE NEWSLETTER OF THE SOCIETY FOR RESEARCH IN PSYCHOPATHOLOGY
President’s Column
Teaching Graduate Psychopathology
Daniel N. Klein State University of New York at Stony Brook hen Craig Neumann Psychology that are often dis- Wreminded me that my cussed informally, but rarely column for the newsletter was addressed in print, such as Editors due shortly, I was in the midst course requirements in doc- of preparing my graduate toral programs, keeping up on Diane C. Gooding, Ph.D. Department of Psychology course in Adult Psycho- the literature, and preparing University of Wisconsin pathology, a course that I’ve CVs. As part of SRP’s mission 1202 W. Johnson Street taught every other year for the is to help train future genera- Madison, WI 53706 608-262-3918, fax: 608-262-4029 past decade. I have also been tions of psychopathologists, E-mail: [email protected] enjoying Roddy Roediger’s and teaching graduate courses Craig S. Neumann, Ph.D. Presidential column this year in psychopathology is one of Department of Psychology in the APS Observer in the ways that many SRP University of North Texas Denton, TX 76203-1280 which he presents his members contribute to this 940-565-3788, fax: 940-565-4682 thoughts on a variety of top- process. It struck me that it E-mail: [email protected] ics related to academic might be of interest to discuss continued on page 2 Members’ Corner
Associational processes in the language disturbances found in schizophrenia
Brendan A. Maher Harvard University he history and evolution ground of how ideas and Tof research in psy- approaches that now seem chopathology and brain sci- obvious came to be estab- ence is often lost in the lished. For an initial glimpse, morass of empirical data. The it seemed The first attempts editors of the Newsletter sug- to study associational gested that it might be worth- processes in psychopathology while to consider the back- continued on page 4
1 PRESIDENT’S COLUMN ing very basic information about genetic — continued from page 1 linkage and association studies, some of the issues involved in teaching approaches to assessing neurotransmitter such a course here in this column. functioning in human subjects, and struc- tural and functional neuroimaging. Psychopathology is a broadly integrative field that draws from all the traditional Another significant challenge is balanc- areas of psychology, newly emerging areas ing the tension between breadth and such as cognitive and affective neuro- depth. Most courses are not long enough science, and other disciplines such as psy- to cover most of the major disorders in chiatry, epidemiology, genetics, and neu- detail, hence tradeoffs and sacrifices are robiology. At the same time, it has inevitable. Students have diverse inter- become increasingly methodologically ests and needs, and these can conflict, diverse, requiring some understanding of even within the same student. For exam- a number of approaches that are often not ple, clinical students require breadth for part of the standard graduate curriculum, their training as practitioners in order to such as neuroimaging, multivariate genetic have a basic understanding of a wide range modeling, and advanced statistical of clinical problems. However, their approaches to analyzing longitudinal data. training as clinical researchers might be While it was never sufficient to teach best furthered by studying a few disorders psychopathology from the perspective of a in greater depth. As most of us probably single discipline (or worse, a single theo- do, I try to strike a compromise, covering retical perspective within a single disci- most of the major disorders, but singling pline), the prerequisites for obtaining even out several for more extensive discussion, a superficial overview of the field have hoping that they will serve as exemplars expanded enormously in the past 20 years. of the kind of work that is being done on a variety of different disorders. Thus, one of major challenges is how to incorporate the necessary background Another facet of the depth versus breadth information in at least some of these areas issue is the degree of emphasis on descrip- into the course, given the time constraints tive psychopathology versus empirical available. In the program at Stony research on pathogenesis and mainte- Brook, students’ knowledge of areas such nance. Ideally, I think that psy- as genetics, neuropsychology, and neuro- chopathology should be taught as two biology varies, and many students require parallel courses; a traditional three-credit some background before they can make didactic course focusing on current theo- sense of current genetic and neurobiologi- ries and research on mechanisms and a cal research in psychopathology. Hence, one- or two-credit course focusing on I have found it necessary to devote four- descriptive psychopathology. The latter five hours early in the course to present- could be part of a diagnostic practicum or
2 clinical grand rounds where students readings. Of course, this depends in large could observe patients with a variety of part on the size of the class and the forms of psychopathology, although a nature of the students. My class usually good set of videotapes might also suffice. consists of about 20 students, so a variety Many clinical programs offer Assessment of formats are possible. However, I am or Intervention sequences that are struc- inclined to teach Psychopathology pri- tured along these lines, but the teaching marily through lectures. Despite the of Psychopathology tends to be more iso- many virtues of class discussions and stu- lated from clinical experience. This is dent presentations, they tend to limit the unfortunate, as clinical observation amount of content that can be covered. remains a rich source of research Psychopathology is a particularly con- hypotheses, and the empirical literature tent-rich course, and I feel obligated to has a much greater impact on students if cover a considerable amount of material, they can connect it to their experiences particularly since one of the goals of the and activities in the clinic. course is to help prepare the clinical graduate students to be competent practi- Most programs offer a separate course on tioners. I feel that graduate students child and adolescent psychopathology. should be immersed in the primary litera- This has the virtue of limiting the ture of their field, so I have never consid- amount of material that we have to know ered using one of the several textbooks or and pack into an already crowded course. edited volumes that might be appropriate However, it raises the question of where for a graduate class. I use the lectures to the boundaries between these areas lie. cover the basic information that I think As it becomes increasingly clear that psy- students should be familiar with (e.g., chopathology rarely appears de novo in clinical presentation and course, and epi- adulthood, the traditional split between demiological, genetic, psychosocial, and child and adult psychopathology appears neurobiological aspects of the disorder), more and more arbitrary. We may be at and use the readings to give them greater the point where it makes more sense to depth in selected areas and approaches. combine child and adult psychopathology Although I assign a few “classic” papers, courses into a single life span sequence, perhaps divided along the lines of inter- especially in the early part of the course nalizing, externalizing, and psychotic dis- dealing with conceptualizations of psy- orders, rather than to offering separate chopathology and research approaches, I courses in child and adult psychopathol- try to assign disorder-specific readings ogy. Unfortunately, there are strong bar- that have been published in the last two riers to change, and the curriculum gener- or three years, and to distribute them ally lags behind the field. among qualitative and quantitative reviews and empirical reports of clinical, Another set of issues concerns the class psychosocial, and biological research. format and the nature of the assigned Finally, a major problem that psycho-
3 pathology instructors face, although it is students, it can influence the research hardly unique to us, is how to keep up questions and directions that they pursue, with the field. Typically, our interests are both in graduate school and during their limited to one or two disorders, and then careers. Finally, it can provide students often to only a subset of the kinds of with a model that they can draw on when research done in that area. Even if we it is time for them to develop their own ignore the ever-growing number of spe- cialty journals, there are over a half-dozen graduate psychopathology and undergrad- first-tier journals in Clinical Psychology uate abnormal psychology courses. and Psychiatry, and a similar number of top-tier general psychology, medical, and MEMBERS’ CORNER
science journals that we must keep tabs — continued from page 1 on. I try to cope with this by skimming the titles and abstracts of articles in the under controlled conditions were con- major journals on a regular basis and ducted at Heidelberg by Aschaffenburg keeping a running list of papers that (1896) , a colleague of Kraepelin. He was strike me as potentially important. My primarily interested in the reaction time approach to book chapters is, unfortu- of associative responses to tachistoscopi- nately, less systematic. I spend two busy cally presented sequences of single noun but rewarding weeks before the start of stimuli, rather than in the content of the class reading through the papers on my responses themselves. Reaction times of list, updating my lecture notes, and patient samples were reported to be choosing the assigned readings. longer than those of normal controls. The content of the responses was classified Attending SRP (and other meetings) is into three basic types, the objective type also useful in trying to stay reasonably up (responds to meaning), the constellation to date. It might also be helpful to find type (responds to emotional connota- some way to share syllabi and reading lists tions) and the predicate type (responds to for Psychopathology related courses and vivid inner images.) No systematic seminars. I have begun to explore attempt seems to have been made to con- whether the SRP website can be used for nect this typology to the clinical phe- this purpose, and would welcome sugges- nomena of psychopathology. The tions. In the meanwhile, if anyone is Kraepelinian approach was employed by interested in getting a copy of the syllabus Jung (Jung and Riklin, 1904) and in that I just finished preparing for my Jung's case led to focus of interest on the course, email me at [email protected]. sunysb.edu. constellation type, and the relation of strong emotion to underlying complexes A good graduate psychopathology course of ideas. His own later work utilized asso- provides students with a framework for ciations in individual cases as an aid to viewing the field. In addition, for some clinical treatment.
4 Bleuler (1911/1950) placed the associa- duce associations that were rarely pro- tion processes as the first of the three duced in a sample of 1000 normal con- simple functions that are disturbed in trols. However, many controls did not schizophrenia. He conceptualized the give a high frequency of normative disturbed overt utterances of the patient responses and even more telling was the as reflections of more basic disturbance of report by Moon et al (1968) that many thought-processes. Hence sequences of schizophrenia patients had hearing and loosely associated phrases or sentences attentional difficulties, and that these would be faithful representations of dis- were responsible for their unusual associa- turbed thinking, not of disturbed speech. tions to the spoken stimulus words. The psychopathologist's task was to When stimulus words were presented understand what the underlying thinking visually, the frequency of unusual associa- disorder was, using interpretation as a tions diminished substantially. tool. For Bleuler the basic thought dis- turbance seems to have been that ele- An additional concern is that single ments of different idea-complexes would responses to verbal stimuli presented to appear in the patient's utterances. "Often the patient do not necessarily tell us what ideas are only partially worked out, and we want to know about the kind of dis- fragments of ideas are connected in an turbances that occur in utterances by the illogical way to constitute a new idea" patient in the natural social habitat. For (Bleuler, 1911/1950. p.9) these reasons researchers became inter- ested in the possibility of the systematic There were two major problems with this analysis of the role of associations in approach. One was that the method of patients' spontaneous utterances. Some of interpretation did not permit controlled the first such studies were reported by quantitative research. The other funda- Julius Laffal (e.g. 1963). Laffal developed mental problem was the assumption that the analysis of "contextual associates" fragmented speech reflected fragmented whereby the investigator seeks to detect thought. That disturbances in utterance the complex of associations that center might arise from malfunction in the nor- around a particular theme word. The mal basic neuropsychological processes technique requires the investigator to that achieve the overt expression of the intended utterance was not considered. select a specific index word and then tab- ulate the frequencies of other words that The word association test rested on this are found in proximity to it in the body of assumption, and made it possible to iden- the utterance. The outcome of the tech- tify associations that were statistically nique was to provide hypotheses about normal from those that were atypical as the implicit connections between ideas well as sometimes bizarre. For example, and the content of utterance but had no Kent and Rosanoff (1910) reported that specific relevance to the general phenom- schizophrenia patients were likely to pro- ena of psychotic utterances.
5 The advent of computer programs McLaughlin, 1966). This, in turn, gener- designed to examine characteristics of ated another question, namely, why was extended language discourse opened up there no associative chaining around sub- the possibility of studying the language of ject nouns.? Was there something signifi- schizophrenia patients on a larger scale cant about the distinction between a sub- than had been feasible before. One of the ject and an object, such as the difference early programs was the General Inquirer, between the activity of a subject and pas- designed to tabulate the content of lan- sivity of an object ? Or was it simply that guage samples (Stone, Dunphy, Smith & object nouns frequently occur at the end Ogilvie, 1966). With two student col- of a sentence or clause and that the sig- leagues the present writer decided to nificant question was, what is happening adopt a different approach to the analysis at the end of a sentence that permit asso- of utterance in schizophrenia. We would ciations to enter into the utterance? begin at the beginning by looking for any One possibility was that as the pre- significant differences in components of dictability of words increases toward the the spontaneous utterances of patients end of a sentence, the attentional who had received a diagnosis of schizo- demands in listening are reduced and the phrenia. We obtained a sample of docu- possibility of intrusions from external or ments written spontaneously by patients internal sources is increased. In the schiz- with a schizophrenia diagnosis. They were ophrenia patient internal intrusions received in response to a request mailed might come from activation of internal to a large number of psychiatric hospitals associations, and their intrusion perhaps across the country. With the General reflected a deficient inhibition. We Inquirer we were able to tabulate a vari- reversed the question to ask "Why don't ety of content categories and syntactic activated associations intrude into normal characteristics, paying particular atten- utterance?" One hypothesis might be that tion to the differences between patients this is due to the effective operation of judged by the hospital to have thought inhibition, and that in TD schizophrenia disorder (TD) and those judged to be patients inhibition is impaired. This free of thought disorder (NTD). The model was presented in Maher (1983). It analysis was post hoc and exploratory. included the deduction that an activated One of the most striking findings was that association might "intrude" into normal the TD documents had a high frequency utterances when it would be compatible of sentences in which the number of with the intended meaning of the utter- noun objects exceeded the number of ance. Neither speaker or listener would noun subjects. Inspection of actual sen- experience it as a disruption. tences that contained several object nouns in one sentence indicated that Schizophrenia patients who are not cur- they often consisted of obvious chains of rently displaying disturbance of utterance associations. (Maher, McKean & might, nonetheless, be more likely to
6 have a higher associative content in their Bleuler, E. (1950) Dementia præcox or the group utterances than controls. To investigate of schizophrenias. New York: International this we recently developed a procedure Universities Press. reminiscent of Laffal's analysis of contex- Jung,C.G. & Riklin, F. (1904) The associations of tual associates. We scan an undisturbed normal subjects. (trans. from Experimentelle utterance word by word, each word being a Untersuchungen über Assoziationen Gesunder). Diagnostische Assoziationenstudien. 1, 3-197 potential source of associational activation. We might expect to find some associates to Kent, H. & Rosanoff, A.J. (1910) A study of asso- ciation in insanity. Journal of Insanity, 67, 326- appear at points where they do not distort 390 the intended utterance. This kind of analy- sis requires a dictionary of normal associa- Laffal, J. (1963) The use of contextual associates in the analysis of free speech. Journal of General tions, and a computer program that scans Psychology. 69, 61-64. each word (the index word), performs a dictionary search to ascertain whether an Maher, B.A.(1983) Toward a tentative theory of schizophrenic utterance. Progress in associate subsequent to the index word Experimental Personality Research. 12, 1-52. appears within the scan range, records it Maher, B.A., McKean, K.O. & McLaughlin, B and calculates a total for the text that has (1966) Studies in psychotic language. In been scanned. In a preliminary pilot study P.J.Stone, D.C.Dunphy, M.S.Smith, & normal utterances of schizophrenia patients D.M.Ogilvie (Eds.) The General Inquirer. received significantly higher association Cambridge, MA: M.I.T.Press. counts than did those of healthy controls. Moon, A.F., Mefferd, R.B., Wieland, B.A., It presents the possibility that analysis of Pokorny, A.D. & Falconer G.A.(1968) utterances in psychometrically-defined Perceptual dysfunction as a determinant of schiz- schizotypes and others at risk for schizo- ophrenic word associations. Journal of Nervous phrenia might enable them to be identified and Mental Disease, 146, 80-84 early, and that we might gain further Stone, P.J., Dunphy, D.C., Smith, M.S. & Ogilvie, insight into the pre-clinical development of D.M. (1966) The General Inquirer. Cambridge, schizophrenia. MA: M.I.T.Press.
Aschaffenburg. G. (1896) Experimentelle Studien über Assoziationen. In. E. Kraepelin (Ed.) Psychologische Arbeiten (Vol.2) Leipzig:Engelmann.