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1961 The ffecE ts of Prefrontal Lobotomy on Performance of Delayed Response Problems in Human Psychotic Patients. Arthur Newton Louisiana State University and Agricultural & Mechanical College
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Recommended Citation Newton, Arthur, "The Effects of Prefrontal Lobotomy on Performance of Delayed Response Problems in Human Psychotic Patients." (1961). LSU Historical Dissertations and Theses. 700. https://digitalcommons.lsu.edu/gradschool_disstheses/700
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NEWTON, Arthur, 1928- THE EFFECTS OF PREFRONTAL LOBOTOMY ON PERFORMANCE OF DELAYED RESPONSE PROBLEMS IN HUMAN PSYCHOTIC PATIENTS.
Louisiana State University, Ph.D., 1961 Psychology, clinical
University Microfilms, Inc., Ann Arbor, Michigan THE EFFECTS OF PREFRONTAL LOBOTOMY ON PERFORMANCE OF
DELAYED RESPONSE PROBLEMS IN
HUMAN PSYCHOTIC PATIENTS
A Dissertation
Submitted to the Graduate Faculty of the Louisiana State University and Agricultural and Mechanical College in partial fulfillment of the requirements for the degree of Doctor of Philosophy
in
The Department of Psychology
by Arthur Newton B.S., City College of New York, 1948 M.A., Columbia University, 1956 August, 1961 ACKNOWLEDGMENT
The writer wishes to express his sincere appreciation to Dr. Thomas W. Richards for his valuable suggestions, en couragement, and stimulation throughout the course of the present investigation and preparation of this manuscript.
Thanks are extended to Dr. Brendan A. Maher for his helpful suggestions during the initial phase of the study; to the other members of my committee, Drs. Irwin A. Berg,
George D. Davis, Gregory S. Ferriss, and D. Winfred Tyler for their support and constructive suggestions.
I wish to express my gratitude to Dr. J. A. Sproles and to the other personnel of the Gulfport Veterans Ad ministration Hospital who offered much of their valuable time and made their patients available for this study. TABLE OF CONTENTS
PAGE
TITLE P A G E ...... i
ACKNOWLEDGMENT ...... ii
LIST OF TABLES ...... iv
LIST OF FIGURES ...... v
ABSTRACT ...... vi
INTRODUCTION...... 1
Theoretical Considerations ...... 1 Experimental Background ...... 3 Statement of the Pr o b l e m ...... 8
METHOD ...... 9
Apparatus ...... 9 S u b j e c t s ...... 9 P r o c e d u r e ...... 11 Scores obtained by subjects ...... 13
RESULTS ...... 14
Presentation Score ...... 14 Error Score ...... 14 Reaction T i m e ...... 17
DISCUSSION ...... 18
SUMMARY ...... 21
SELECTED BIBLIOGRAPHY ...... 22
APPENDICES ...... 26
VITA ...... 46 LIST OF TABLES
TABLE PAGE
I Mean, Median and Standard Deviation of Presen
tation Scores for Experimental and Control
Groups in Each Delayed Response Situation • » • • 15
II Mean, Median and Standard Deviation of Error
Scores for Experimental and Control Groups
in Each Task 16 LIST OF FIGURES
FIGURE PAGE
1 Modified apparatus for the H-P Test 10
v ABSTRACT
The aim of the present investigation was to test the hypothesis that psychotic patients with prefrontal lobot- omies show impairment on delayed response problems*
The apparatus employed for these problems was a modi fication of one designed by Pascal and Jenkins* Three de layed response problems of the Hunter-Pascal Concept
Formation Test were selected* It was predicted that the scores on these tests would indicate differences between a lobotomized group of psychotic patients and those without brain damage*
Corn candy was placed in a fixed sequence behind a particular door for one of the problems and the subjects could find the prize behind any one of five doors which could be swung inward from the examiner’s side of the ap paratus. The problems were scored for three indices: pre sentation score, total error score, and reaction time.
All problems were administered individually to eighteen psychotic patients with prefrontal lobotomies and eighteen psychotic patients without brain damage. All subjects were white males between the ages of 29 and 45 years. Reports of electroencephalography, neurological examination, and skull
X-ray were used as criteria to select the subjects. The groups were matched as a whole for IQ and age* Differences between the groups on delayed response were all in the pre-
dieted direction, but none was significant statistically*
An interesting finding was that the lobotomized group ap
peared to be a more heterogeneous one than the control
group* Indeed, the control group was a very homogeneous
one*
Comparisons with other studies and suggestions for
further research are made* INTRODUCTION
There has been a great deal of confusion and disagree ment within the past twenty-five years concerning the corti cal localization of intellectual functions ranging from complete nonspecificity to extreme specificity. Phrenology under Gall and Spurzheim (Boring, 1950) gave to science the suggestion of localization of the various faculties of the mind in different parts of the brain. The central proposi tion of this doctrine maintained that excess in any faculty is correlated with enlargement of a corresponding place in the brain. An excess in a particular faculty would be shown as a- protrusion of the skull in a particular area, whereas a recession in the skull would mean a lack of the faculty. Flourens agreed with the phrenologists that pri mary sensory and motor functions are localized in the brain.
On the contrary, however, he believed that the higher mental functions are not dependent on any particular part of the brain„
Theoretical Considerations
The effects of stimulating the cerebral cortex electri cally lent support to the anatomical or associationism theory of brain functioning. Fritsch and Hitzig found that they could get movement by means of electrical stimulation of a certain region of the anterior portion of the cerebral cortex of the dog. Ferrier supported the notion of fairly exact localization in certain parts of the cerebral cortex.
Nielsen (Meyer, 1961) is the modern exponent of the ana tomical theory. This theory proposes that learning merely consists in the laying down of new pathways in the nervous system between sensory and motor cells.
The Gestalt psychologists based their criticism of the theory of neural connections on the facts of perceptual generalization. They believed that animals and human be ings respond in a specific manner to a range of objects that have only certain relational characteristics in common. For example, a square is seen as a square in almost any setting regardless of its size. Therefore, they implied that per ception is independent of the locus of excitation. Goldstein
(Meyer, op. cit.) defined a perception as a specific pattern of the whole organism. He believed that brain lesions iso lated certain cortical areas from the background of the rest of the central nervous system* Stimulation of such isolated areas is reported to yield abnormal responses. Goldstein believed that isolation caused brain-damaged patients to display concreteness which he regarded essentially as an inability to abstract.
Lashley (Lansdell, 1953; Meyer, I96I), in 1929, ad vanced the hypothesis that any part of the rat’s cortex is as good as another in its contribution to problem solving.
This hypothesis was based on his findings that the rat’s capacity to form or retain maze habits was reduced in pro portion to the amount of cortical tissue removed (mass action) regardless of the locus of the tissue (equipoten- tiality)* Lashleyfs work continues to exercise considerable influence due to the extrapolated hypothesis that the human brain also works in a unitary fashion. On the contrary,
Jacobsen (1935) concluded that a particular intellectual function, presumably recent memory, is specifically located in the frontal lobes* He based this conclusion on his find ings that chimpanzees and monkeys lost the ability to solve delayed response problems following extirpation of the pre frontal areas*
Experimental Background
The delayed reaction problem was first used by Hunter under Carr’s direction, the latter being the first person to think of this type of task (Munn, 1950)* In this problem the subject (S) is presented with a discriminating stimulus, is prevented from responding immediately, the stimulus is withdrawn, and then the S is permitted to respond in the physical absence of the stimulus*
A number of different investigators (Harlow, Meyer, and Settlage, 1951J Meyer, Harlow, and Ades, 1951; Orbach,
1956; Pribram, Mishkin, Rosvold, and Kaplan, 1952; Water house, 1957) have shown that catastrophic impairment of de layed response proficiency is much more readily produced by frontal than by posterior cortical lesions in monkeys and baboons, Pribram, Mishkin, Rosvold, and Kaplan (1952) found that markedly greater alterations in performance on delayed response type tests were produced by dorsolateral resections anterior to the precentral “motor” area than by ventromedial resections of the frontal cortex of baboons,
Rosvold and Delgado (1956) found that impairment on the de layed alternation test resulted from stimulating or destroy ing, electrically, tissue in the head of the caudate nucleus within the frontal lobes of the monkey®s brain, and not from any other structure. The investigation of Dean and Davis
(1959) supported the findings of Rosvold and Delgado. Pour monkey operates with lesions of lateral frontal granular cortex and four operated controls were trained by Mishkin and Pribram (1955) on a series of delayed alternation prob lems. In the classical "left-right” delayed alternation procedure the animals were confronted, after a delay, with two containers which were distinguishable only by their po sitions— one appearing on the left, the other on the right.
The animals were trained to displace alternately two cups arranged one above the other in the ”up-down” alternation procedure. In the ”go-no-go" alternation procedure the ani mals were trained to alternate between displacing and not displacing a single centered cup. The relatively successful performance of th© anterolateral frontal operates on the gO' no-go” procedure suggested that difficulty specific to the 5
"left-right” response choice could not account for frontal operates1 severe impairment on traditional delayed response type tasks. Hence, they concluded that some factor other than, or in addition to, the delay would appear to be of critical importance. In another independent investigation the same investigators (1956) concluded that frontal oper ates’ impairment on traditional delayed response type prob lems is related, not only to the delay, but to some aspect of the predelay cue as well. Furthermore, in a further investigation of the effects of frontal lesions in monkeys the same experimenters concluded that successful performance of frontal operates on delayed response type problems could be examined in terms of the ”distinctiveness" which the pre delay cues had acquired from contiguity with distinctive re sponses and differential reward.
Hunter (1928) conceived of the double alternation temporal maze as a better instrument to measure symbolic ability than the delayed reaction type problem. In the double alternation temporal maze the S is confronted with a
"figure eight” shaped path in a T maze whose arms lead back to the starting position. In order to be successful on this maze S is required to turn right twice at the choice point followed by two left turns in a RRLL sequence.
Hunter (op. cit.) advanced the hypothesis that the abil ity to perform double alternation could be mediated by cumu lative neural effects or a symbolic process. However, he preferred the latter interpretation. Gellerman (1931a) found rhesus monkeys to be superior to rats, cats, and dogs in mastering the maze. Nevertheless, he concluded that the maze was unsuitable for use with monkeys since he was unable to attempt a test of their ability to extend the series be yond the length upon which they were trained* Therefore, he
(1931c) built an apparatus more suitable for the monkeys be cause it was limited to forearm manipulation. With this apparatus he clearly established that the monkeys could ex tend the series beyond that of their training. Leary,
Harlow, Settlage, and Greenwood (1952) tested normal rhesus monkeys, rhesus monkeys with extensive bilateral damage to the frontal association areas, and rhesus monkeys with ex tensive bilateral damage to the posterior association areas on two double alternation experiments. Experiment A con sisted of 150 problems in a RRLLRRLL or LLRRLLRR pattern and experiment B involved a RRLL or LLRR pattern. A different pair of identical stimuli was used for each problem. The results of both experiments showed significant interproblem learning as measured by percentage of errors. The normal monkeys were consistently and usually significantly superior to the frontal operates. On most measures the normal monkeys were superior to the posterior operates, and these in turn were usually superior to the frontal operates.
During the past twenty-five years a considerable number
of human cases were studied following very large cortical lesions including bilateral destruction of the prefrontal areas, hemidecortication, and unilateral removal of the dominant occipital and temporal lobes* Goldstein and
Scheerer (Meyer, I96I) introduced a number of tests for concreteness which generally require the subject to make an abstraction by sorting objects and explaining the principle of sorting, and then to shift to a different method of sort ing, which requires a different principle of abstraction.
On the basis of these tests Goldstein reported that frontal lobe cases manifested greatest impairment of intellectual ability, which he ascribed to a loss of the abstract atti tude. According to Harlow (1952) the data on bilateral de struction of the frontal lobes in man gave no evidence of anything approaching total loss of immediate memory. Landis
(Harlow, 1952), in reporting the results of the Columbia-
Greystone studies, concluded that functions such as the cate gorical attitude or the ability to abstract are not primarily connected with frontal lobe tissue. According to him the really astounding change is the alteration in affect— in emotion— which takes place after the extirpation of the frontal lobe tissue or cutting of frontothalamic fiber tracts, i.e. psychosurgery relieves the patient of intol erable anguish or pain. Hebb (Harlow, op. cit.) concluded that none of the human studies convincingly demonstrated any intellectual loss specifically attributable to loss of frontal lobe tissue, i.e. he meant that the studies were not definitive. According to Harlow (op. cit.), “Either the tests were inadequate, or proper controls were not maintain ed, or the possibility of continued pathologic process after operation was not excluded." (Harlow, op. cit., p. 245)
Other investigators argued that there are no intellectual changes following frontal lobe injuries. Karl and Elvidge
(Meyer, 1961) maintained that the basic loss is lack of motivation, an inability to plan for and to maintain a goal.
Robinson (Meyer, op. cit.) tested and confirmed the hypothe sis that most of the deficits is due to a loss of the capac ity for prolonged attention.
Statement of the Problem
The present investigator was interested in utilizing test situations which would demonstrate difference in per formance between patients with frontal lobotomies and those with no known cortical damage. He chose the delayed reaction problems on the Hunter-Pascal (H-P) Concept Formation Test for this purpose.
The following hypothesis was investigated:
1, Psychotic patients with frontal lobotomies show greater impairment of delayed response than those with no known cortical brain damage. METHOD
Apparatus. Figure 1 shows a diagram of the apparatus used for all the problems. The apparatus is a modification of one designed by Pascal and Jenkins (1959)* It was con structed of 3/8 of an inch plywood and its dimensions are
18 inches long by 15 inches high by 10 inches deep* Five doors equidistant from each other are located at the bottom of the front vertical wall of the apparatus. These doors are 2-1/2 inches long by 3-1/2 inches high and are hinged at the top so that they swing inward to the experimenter’s side of the apparatus. The front vertical wall contains five two-inch square appertures equidistant from each other at a height of 1-1/2 inches from the top of the doors. Ply wood dividers, each 4-1/2 inches square, separates each door on the experimenter’s side. From the experimenter’s side the doors are numbered from one to five beginning on the left. A small 1/4 of an inch-thick wooden block, 1 inch in height, is fastened on each side wall at a distance of 3/4 of an inch from the front vertical wall. Its purpose is to hold one of two pieces of 1/4 of an inch masonite, which is
3 inches high by 18 inches long.
Subjects. A white, male hospital population from the
9 10
□ □□ □□
3UBJE0T«S VIEW
□ □ □ □ □
EXAMINER4 S VIEW
Modified apparatus for the H-P Test. Figure 1» 11
Gulfport Veterans Administration Hospital was used to select the experimental and control groups. All subjects were psy chotic patients. Eighteen Ss with prefrontal lobotomies constituted the experimental group. The control group con sisted of eighteen Ss without any known cortical damage and was chosen by a random procedure. All Ss were between the ages of 29 and 45 years. Reports of electroencephalography, neurological examination and skull X-ray were used as cri teria to rule out cortical damage in S other than the lobot omies of the experimental group. The Full-Range Picture
Vocabulary Test (Ammons, 1948) was used to obtain an IQ estimate for each S. The mean IQs for the experimental and control groups were 74*4 and 84*1, respectively. Mean ages for the two groups were 39*3 and 39.6 years, respectively.
Tests of the difference between mean IQs and ages of the two groups showed no significant differences. Therefore, the two groups as a whole were matched for age and IQ.
Procedure. In each of the problems S Ts task is to find a reward behind a preselected door. The reward used for each trial was one piece of corn candy. S is informed that there are five doors which can be pushed open from his side and he is encouraged to try them. Then he is told that his task is to find the correct door behind which the prize is hidden. E shows S the reward and demonstrates how it can be found. Problems II, III and IV of the Hunter-Pascal Concept
Formation Test were used as follows: 12
Problem II— short delayed reaction. S sees the place ment of the reward behind a predetermined door. A cloth is thrown over the apparatus for approximately 10 seconds, and
S is permitted to search for the reward. A total of ten trials is allowed with each trial consisting of one presen tation. A presentation consists of one discovery of the reward.
Problem III— long delayed reaction. In this task S sees the reward placed behind a predetermined door. Then a cloth is thrown over the apparatus for approximately one minute, and then S is allowed to search for the reward.
Again, ten trials are given.
Problem IV— delayed reaction 3* Here, S is shown a distinctive stimulus, a red checker, in front of the middle door. Then he is turned with his back to the apparatus for approximately 10 seconds. During this delay interval the reward is placed behind one of the end doors (1 or 5) and the checker is placed in front of this same door. Then S is allowed to search fcr the reward. Subsequently, the re ward is placed in a similar manner behind the other end door.
This alternation sequence is continued until S solves or fails to solve the problems with a maximum of ten trials al lowed .
The criterion of success on each problem is a total of three consecutive correct trials (because the probability of 13 this occurring by chance, 1/125, is at the 0.008 level of confidence)•
The treatments x subjects replication experimental de sign was employed in the present investigation. To control for any practice effects the problems were administered to all Ss in a counterbalanced sequence. All were taken off medication approximately 64 hours before testing.
Scores obtained by subjects
Each subject obtained in each of the three delayed re action situations (short, long, and cue) three scores:
1. Presentation score: the number of trials required
to perform successfully three consecutive choices.
2* Error score: the number of errors made in each
trial.
3. Reaction time: the time required for the subject
to make a choice when permitted to do so. RESULTS
Presentation Score
In Table I appear the group means, medians, and sigmas of presentation scores in each of the delayed reaction sit uations* Inspection of the table shows higher mean scores for the lobotomized (experimental) group than the control group in all three conditions which is in the expected di rection, There is a tendency for the brain damaged group to demonstrate greater impairment on delayed response than a non-brain damaged group, A chi square analysis did not reveal any significant group differences for any problem.
Re-examination of Table I illustrates a marked differ ence in sigmas between the experimental and control groups on delayed reaction (short and long). The size of sigma for the control group in the delayed reaction condition, short or long, is small whereas the size of sigma for the experimental group is large. The control group is markedly homogeneous and the experimental group heterogeneous*
% Error Score
In Table II appear the group means, medians, and sigmas of total errors. The results are similar to those obtained with presentation score* The differences between the group means appear larger than those obtained with presentation
14 15
TABLE I
Mean, Median and Standard Deviation of Presentation Scores
for Experimental and Control Groups in Each
Delayed Response Situation
Standard Mean Median Deviation
Short Delay CO
Experimental 5.0 3.5 •
Control 3.1 3.0 0.2
Long Delay
Experimental 4.0 3.1 2.3 CO o Control 3.3 3.1 .
Cue
Experimental 11.9 8.3 5.2
Control4“ ««/\ 1 9,3 7*9n n 7*4 16
TABLE II
Mean, Median and Standard Deviation of Error Scores for
Experimental and Control Groups in Each Task
Standard Delayed Reaction Mean Median Deviation
Short
Experimental 4*8 0*5 8.8
Control 0.1 0.0 0 ol
Long
Experimental 2.7 0.0 7*6
Control 0.3 0.0 1*1
Cue
Experimental 14.8 5.0 17.7
Control 4.2 2.0 6.7 17 score* Again, they are in the expected direction* Higher mean scores were obtained for the lobotomized (experimen tal) group than the control group* The inference may be made that there is a tendency for the lobotomized group to show greater impairment on delayed response than a non- brain damaged group* A chi square test of delayed response gave no evidence of significance in the relationship between error scores and brain damage. The assumption may then be made that the two groups perform the delayed reactions about equally.
Reaction Time
Reaction time (in seconds) in the delayed response sit uation presented the following distribution:
Experimental Control
Two seconds or more 5 1
1.5 to 1*9 seconds 1 1
1,0 to 1*4 seconds 30 34
It is seen that these distributions are very similar. A chi square test showed no significant difference between the groups* DISCUSSION
The results of the present investigation do not support the hypothesis that patients with prefrontal lobot- omies show greater impairment of delayed response than those with no known cortical brain damage. Furthermore, there was no significant difference between the two lengths of delay interval employed* On all tests there were no sig nificant differences between the groups.
Various explanations have been offered by different in vestigators to help account for the delayed response deficit found in their animals with frontal lesions of one sort or another. Jacobsen (1935) attributed the loss of the ability to perform the delayed response problem to surgically pro duced deficits of recent memory. On the contrary, Harlow
(1952) believed that monkeys with frontal lesions suffer a deficit in attending and fixating limited aspects of a test situation and this operates to reduce the effectiveness of the acquisition of complex problems such as the delayed re sponse. Dean and Davis (1959) tested this latter interpre tation in their study by testing their subjects under conditions of food deprivation and minimized distraction.
They found that these factors had no effect on monkeys with caudate lesions. They believe that their caudate operations
18 19
impair memory of recent events, Malmo (1942) believed that
the failure of frontal-operated animals upon delayed re
action problems might be due to their being more liable to
interference from irrelevant stimuli during the delay.
The effects of distraction were minimized in the pres
ent study so that Malmo*s interpretation may help to ac
count for the negative results obtained. If distracting
stimuli had been purposely introduced into this study, then
the two groups may have shown significant differences in
line with the theory. According to Davis* theory, signifi
cant differences should have been found between the two
groups if a factor other than distracting stimuli was oper
ating to reduce effectiveness of performance on delayed
response. However, one word of caution should be mentioned
at this time and that is that the lobotomy operations per
formed on psychotic patients may not involve any destruction
of the caudate nucleus in any way comparable to the caudate
operations performed on monkeys in Davisf study. Thus,
refutation or acceptance of the theory cannot be made. Au
topsies performed on lobotomized psychotics at the time of
their death may help to clear up the confusing picture as
to what cells, bodies, or structures are destroyed. There
fore, the picture with human beings continues to be puzzling with regard to complex functions such as delayed response.
Motivation may be a factor in explaining the negative re
sults obtained, as is probably true when testing any psychotic. 20
As a reward for these adult subjects, candy may not have been most suitable; cigarettes or even cash may have proven to be a more useful substitute. Then, there is the possibility that some patients cannot be motivated for any type of task because they are so much out of contact with reality and their immediate environment.
The author wishes to state that two factors may be operating, jointly, in producing effects on delayed re sponse performance, i.e. distraction and loss of recent memory. SUMMARY
The present investigation attempted to test the hypothesis that human psychotic patients with prefrontal lobotomies show greater impairment of delayed response than those with no known cortical brain damage. The experimental design employed was a treatments x subjects replication de sign. A total of 18 lobotomized and 18 non brain damaged psychotic patients were tested on three problems of the
Hunter Pascal Concept Formation Test. All Ss were white males who met certain criteria for selection on a random basis.
Comparison of the lobotomized patients with the con trols showed consistently that they were less efficient in the delayed reaction situation, although differences from control patients were not of statistical significance.
In terms of the important, general problem regarding the effect of lobotomy as a form of treatment or therapy, the findings in the present study suggest strongly that, whereas lobotomized patients tend to be less efficient than non lobotomized patients in their reactions to a learning situation, they give no signs (within the limitation of these experimental situations) of being better adjusted, more healthy.
21 SELECTED BIBLIOGRAPHY
Ammons, R. B., and Ammons, H. S. The Full-Range Picture Vo cabulary Test. Missoula: Psychological Test Special ists, 1948.
Boring, E. G* A history of experimental psychology. New York: Appleton-Century-Crofts, 1950.
Chow, K. L. Effects of temporal neocortical ablation on visual discrimination learning sets in monkeys. J. comp, physiol. Psychol., 1954, 47. 194-198.
Davis, G. D. Effects of central excitant and depressant drugs on locomotor activity in the monkey. Amer. J. Physiol.. 1957, 188. 619-623.
Davis, G. D. Caudate lesions and spontaneous locomotion in the monkey. Neurology. 1958, 8., 135-139.
Dean, W. H., and Davis, G. D* Behavior changes following caudate lesions in rhesus monkey. J. Neurophysiol.. 1959, 22, 524-537. Edwards, A. L. Experimental design in psychological re search. New York: Rinehart, 1950.
Gellerman, L. W. The double alternation problem Is the behavior of monkeys in a double alternation temporal maze. J. genet. Psychol.. 1931a, 39. 50-72.
Gellerman, L. W. The double alternation problem II: the behavior of children and human adults in a double alternation temporal maze. J. genet. Psychol.. 1931b. 3£, 197-226.
Gellerman, L. W. The double alternation problem III: the behavior of monkeys in a double alternation box ap paratus* J. genet. Psvchol.. 1931c, 39. 359-392.*
Goodglass, H., and Quadfasel, F. A. Language laterality in left-handed aphasics. Brain. 1954, 77. 521-548.
Guilford, J. P. Fundamental statistics in psychology and education. New York: McGraw-Hill, 1950.
22 23
Harlow, H® F. Functional organization of the brain in re lation to mentation and behavior® In The biology of mental health and disease® The twenty-seventh annual conference of the Milbank Memorial Fund* New York: Paul B* Hoeber, 1952, Pp. 244-264®
Harlow, H® F®, Meyer, D, R®, and Settlage, P. H. The ef fects of large cortical lesions on the solution of oddity problems by monkeys. J. comp, physiol* Psychol *. 1951, M , 320-326.
Heilbrun, A® B® Psychological test performance as a func tion of lateral localization of cerebral lesion® J® comp, physiol. Psychol.. 1956, 10-14®
Hunter, W* S® The behavior of racoons in a double alter nation temporal maze® J. genet» Psychol.. 1920, 35. 374-388.
Jacobsen, C® F® Functions of the frontal association areas in primates. Arch® neurol. Psychiat.. 1935, 33. 558- 569.
Kimble, G® A. Principles of general psychology. New York: Ronald Press, 1956®
Landis, C®, and Bolles, M® M* Textbook of abnormal psychol ogy. New York: Macmillan, 1950.
Lansdell, H« C® Effects of brain damage on intelligence in rats. J. comp, physiol. Psychol.. 1953, 46. 46I-464.
Larsen, E® R. A developmental study of performance on the Hunter-Pascal Concept Formation Test. Unpublished Ph.D. Dissertation, Univ. of Tennessee, 1958.
Leary, R® W®, Harlow, H® F., Settlage, P. H®, and Greenwood, D® D. Performance on double alternation problems by normal and brain-injured monkeys. J® comp® physiol® Psychol®. 1952, 576-584.
Lindquist, E® F. Design and analysis of experiments in psychology and education® Boston: Houghton Mifflin, 1953.
MacCorquodale, K. An analysis of certain cues in the de layed response® J. comp, physiol. Psychol». 1947, 40. 239-253® 24
Malmo, R* B. Interference factors in delayed response in monkeys after removal of frontal lobes* J* Neuro- physiol*. 1942, £, 295-308.
McCord, F. The delayed reaction and memory in rats I: length of delay. J. comp, physiol. Psychol.* 1939, 21 , 1-37.
Meyer, D* R. , Harlow, H. F*, and Ades, H. W. Retention of delayed responses and proficiency in oddity problems by monkeys with preoccipital ablations. Amer. J. Psychol.1 1951, ££> 391-396.
Meyer, V. Psychological effects of brain damage. In H. J. Eysenck (Ed.) Handbook of abnormal psychology. New York: Basic Books, 1961, Pp. 529-565.
Mishkin, M. Visual discrimination performance following partial ablations of the temporal lobe II: ventral surface vs hippocampus. J. comp, physiol. Psychol.. 1954, 1Z* 187-193.
Mishkin, M., and Pribram, K. H. Analysis of the effects of frontal lesions in monkey I: variations of de layed alternation. J. comp, physiol» Psychol.. 1955, 48, 492-495.
Mishkin, M . , and Pribram, K, H. Analysis of the effects of frontal lesions in monkey II: variations of de layed response. J. comp, physiol. Psychol., 1956. 4Z, 36-40.
Munn, N. L. Handbook of psychological research on the rat. Boston: Houghton Mifflin, 1950.
Orbach, J* Immediate and chronic disturbances on the de layed response following transection of frontal granular cortex in the monkey. J. comp, physiol. Psychol.. 1956, 49 » 46-51.
Pascal, G. R., Stolorow, L. M., Zabarenko, R. N., and Chambers, C. S* The delayed reaction in mental de fectives. Amer. J. ment. def., 1951, 5^» 152-160.
Pascal, G. R*, and Jenkins, W. 0. The Hunter-Pascal Con cept Formation Test. Unpublished manuscript, Univ. of Tennessee, 1957* 25
Pascal, G. R., and Jenkins, W.O. The Hunter-Pascal Concept Formation Test; an experimental approach to the meas urement of cortical capacity. J. clin. Psychol.. 1959, 1£, 159-163.
Pribram, K. H., Mishkin, M., Rosvold, H. £., and Kaplan, S. J. Effects on delayed response performance of lesions of dorsolateral and ventromedial frontal cortex of baboons. J. comp, physiol. Psychol.. 1952, 4-5. 565- 575.
Pribram, K. H., and Mishkin, M. Simultaneous and successive visual discrimination by monkeys with infer©temporal lesions* J. comp, physiol. Psychol.. 1955, 48. 198- 202. Pribram, K. H., and Mishkin, M. Analysis of the effects of frontal lesions in monkey III: object alternation. J. comp, physiol. Psychol.. 1956, 49. 41-45.
Riopelle, A.J., and Churukian, G. A. The effect of varying the intertrial interval in discrimination learning by normal and brain-operated monkeys. J. comp, physiol. Psychol.. 1958, £1, 119-124.
Rosvold, H. E., and Delgado, J. M. R. The effect on de layed alternation test performance of stimulating or destroying electrically structures within the frontal lobes of the monkey*s brain. J. comp, physiol. Psychol.. 1956, 42., 365-372.
Snedecor, G. W. Statistical Methods. Ames: Iowa State College Press, 1946.
Siegel, S. Non-parametric statistics for the behavioral sciences. New York: McGraw-Hill, 1956.
Waterhouse, I. K. Effects of prefrontal lobotomy on condi tioned fear and food responses in monkeys. J. comp. physiol. Psychol.. 1957, 50« 81-88.
White, R. W. The abnormal personality. New York: Ronald Press, 1956.
Willett, R. A. The effects of psychosurgical procedures on behavior. In H. J. Eysenck (Ed.) Handbook of abnormal psychology. New York: Basic Books, 19^1* Pp. 566-610. APPENDICES 27
APPENDIX A
Presentation scores for an experimental group of psy chotic patients with prefrontal lobotomies and a control group of psychotic patients with no known cortical brain damage on short delayed reaction and long delayed reaction of the H-P Test
Problems Group______Sabjects______Short Delay Long Delay
Experimental: 1 4 8 Prefrontal Lobotomy 2 3 3
3 3 3
4 4 3
5 3 3
6 5 3
7 3 3
8 5 3
9 3 3
10 3 3
11 3 3
12 10 10
13 10 3 14 5 3 15 10 3
16 10 3
17 3 9
18 3 3 28
APPENDIX A Cont'd.
______Problems______Group Subjects Short Delay Long Delay
Control: No 1 4 6 Known Cortical Brain Damage 2 3 3
3 3 3
4 3 3
5 3 3
6 3 5
7 3 3
8 3 3
9 3 3
10 3 3
11 3 3
12 3 3
13 3 3
14 3 3
15 3 3
16 3 3
17 3 3
18 3 3 29 APPENDIX B
Presentation scores for an experimental group of psy chotic patients with prefrontal lobotomies and a control group of psychotic patients with no known cortical brain damage on delayed reaction (cue) of the H-P Test
Groups Subjects Experimental Control
1 8 6
2 8 10
3 8 20
4 8 6
5 12 6
6 6 16
7 8 10
8 8 8
9 8 8
10 8 6
11 8 6
12 20 20
13 20 8
14 8 8
15 20 6
16 20 10
17 20 8
18 16 6 30 APPENDIX C ■M* Mean transformed reaction time scores for an experimen tal group of psychotic patients with prefrontal lobotomies and a control group of psychotic patients with no known cortical brain damage on short delayed reaction and long delayed re action of the H-P Test
Problems Group______Subjects Short Delay Long Delay
Experimental: 1 1.00 1.00 Prefrontal Lobotomy 2 1.00 1.00
3 1.00 1.00
4 1.00 1.00
5 0.67 0.83
6 1.00 0.78
7 1.00 1.00 8 0.90 1.00
9 1.00 1.00 10 1.00 1.00
11 0.50 0.83
12 0.44 0.52
13 0 .68 0.50
14 0.50 0.83
15 0.95 0.67
16 0.95 0.42
17 1.00 0.94
18 0.78 1.00 31 APPENDIX C Cont’d.
Problems Group Subj ects Short Delay Long Delay
Control: No 1 1.00 1.00 Known Cortical Brain Damage 2 1.00 1.00
3 1.00 0.83
4 1.00 1.00
5 1.00 1.00
6 0.50 0.60
7 1.00 1.00
8 1.00 1.00
9 1.00 1.00
10 1.00 1.00
11 1.00 1.00
12 1.00 1.00
13 1.00 0.83
14 1.00 1.00
15 1.00 1.00
16 1.00 1.00
17 1.00 0.83
18 1.00 1.00
^Transformation of the original scores to a reciprocal scale because a J-curve is usually obtained with reaction time scores 32 APPENDIX D
Mean transformed reaction time scores for an experimen tal group of psychotic patients with prefrontal lobotomies and a control group of psychotic patients with no known corti cal brain damage on delayed reaction (cue) of the H-P Test
Group Subj ects______Exp er iment al Control
1 1.00 1.00
2 0.83 1.00
3 0.94 0.80
4 1.00 1.00
5 1.00 0,67
6 0.83 0.57
7 1.00 0.85
8 0.94 1.00
9 1.00 1.00
10 0.94 1.00
11 0.69 1.00
12 0.77 0.32
13 0.87 1.00
14 0.78 1.00
15 0.95 1.00
16 0.80 0.85
17 0.77 1.00
18 0.66 1.00 33 APPENDIX E
Total error scores on short delayed reaction and long delayed reaction of the H—P Test for an experimental group of psychotic patients with prefrontal lobotomies and a con trol group of psychotic patients with no known cortical brain damage
Problems Group______Subjects Short Delay______Long Delay
Experimentalt 1 1 6 Prefrontal Lobotomy 2 0 0
3 0 0
4 1 0
5 0 0
6 4 0
7 0 0
8 1 0
9 0 0
10 0 0
11 0 0
12 14 32
13 24 0
14 1 0
15 10 0
16 3° 0
17 0 10
18 0 0 34 APPENDIX E ContTd.
Problems Group Subjects Short Delay Long Delay
Control: No 1 1 5 Known Cortical Brain Damage 2 0 0
3 0 0
4 0 0
5 0 0
6 0 1
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
IS 0 0
16 0 0
17 0 0
18 0 0 35 APPENDIX F
Total error scores for an experimental group of psy chotic patients with prefrontal lobotomies and a control group of psychotic patients with no known cortical brain damage on delayed reaction (cue) of the H-F Test
Groups Subj ects______Experimental Control
1 6 0
2 4 3
3 2 27
4 8 0
5 11 0
6 0 15
7 1 3
8 2 4
9 2 1
10 4 0
11 8 0
12 39 7
13 41 4
14 1 1
15 40 0
16 40 8
17 53 3
18 4 0 APPENDIX G
Clinical treatment, brief case history, length of hospitalization, and final psychiatric staff diagnosis
I, Lobotomized group of psychotic patients
Date of Bilateral Final Psychiatric Length of Patient Prefrontal Lobotomy Brief Case History Diagnosis Medication Ho spitaiization
Feb, 10, 1950 Anxiety, hostility, Schizophrenic re Thorazine 11 Years hallucinations, de action, hebephrenic lusions, confusion, type, chronic, se bizarre behavior pat v e r e tern, hyperactivity
Oct, 22, 1954 Impulsive, assaultive Schizophrenic re Compazine 7 Years behavior, tension, action, chronic, anxiety; post-lobotomy undiff er enti ated state characterized by type socialization, lack of hostility, withdrawal
Sept. 22, 1954 Divorced, but still Schizophrenic re Stellazine 7 Years believes he is mar action, paranoid ried; hostility, as type, chronic, saultive towards wife, severe oriented to time, place, and person, flattened affect, loss of contact with reality APPENDIX G Cont'd.
Date of Bilateral Final Psychiatric Length of Patient Prefrontal Lobotcmy Brief Case History Diagnosis Medication Hospitalization
Dec. 10, 1952 Hostile, threatening, Schizophrenic re Thorazine 8 Years delusional| post- action, paranoid lobotomy state charac type, chronic, terized by slightly severe easier management, fixed paranoid delu sional system, obses sive thinking
March 14, 1951 Confused, threatening, Schizophrenic re Stellazine 12 Years hallucinated, enure action, paranoid sis, considerable type, chronic, supervision in detail severe assignments
May 11, 1951 Strict stepmother, Schizophrenic re Stellazine 15 Years extremely bashful as action, chronic, Artane a child, superficial, severe, paranoid hyperactive, hostile, type assaultive, auditory hallucinations, ideas of persecution
Jan. 21, 1955 Depression, unpredicta Schizophrenic re Stellazine 7 Years ble behavior, sus action, hebephrenic Thorazine picious, extreme emo type, chronic, se tional flattening and vere OJ inappropriateness, bi - 3 zarre delusional system APPENDIX G Cont'd.
Date of Bilateral Fin*! Psychiatric Length of Patient Prefrontal Lobotomy Brief Case History Diagnosis Medication Hospitalization
8 April 23, 1954 Proposal of marriage Schizophrenic re- Serpasil 6 Years to any young girl, action, hebephrenic regardless of age, type, chronic, confusion, untidy in moderate appearance, restless ness, inappropriate smiling, misidentifies people, delusions, hallucinations
9 February, 1955 Mother in mental Schizophrenic re Thorazine 7 Years hospital, very little action, chronic interest in opposite undifferentiated sex, delusions of type, severe, in persecution, hyper partial remission activity, profanity, assaultiveness, inap propriate affect
10 June 3, 1955 Hyperactive, violent, Schizophrenic re Thorazine 6 Years assaultive, unpre action, undiffer Stellazine dictable behavior, entiated type, flattened affect, active, severe grandiose, with drawal
00 APPENDIX G Cont’d.
Date of Bilateral Final Psychiatric Length of Patient Prefrontal lobotomy Brief Case History Diagnosis Medication Hospitalization
11 March 8, 1954 Repetitive hand washing, Stellazine 7 Years passivity, lacking Schizophrenic Re in spontaneity, loss action, paranoid of drive and initia type, chronic, tive, flattened af moderately severe fect, sexual preoccupation, audi tory hallucinations
12 Sept, 4, 1954 Domineering, nervous Schizophrenic re Stellazine 8 Years mother, jealous of action, paranoid Thorazine younger brothers, type, severe hostile towards ex- wife, auditory hallucinations, de lusions of persecu tion
13 August 31, 1956 Delusions of infi Schizophrenic re Stellazine 4 Years delity against wife, action, chronic, bizarre somatic com undiff erenti ated plaints, mute, with type drawn, negativism
co vO APPENDIX G ContM.
Date of Bilateral Pinal Psychiatric Length of Patient Prefrontal Lobotomy Brief Case History Diagnosis Medication Hospitalization
14 Oct. 23, 1952 Poor social adjust Schizophrenic re Stellazine 9 Years ment, silly, inap action, undiffer propriate affect, entiated type, auditory hallucina severe tions, withdrawn, numerous somatic complaints, bizarre delusions
15 1949 Phobias, paranoid Schizophrenic re Thorazine 12 Years ideation, bizarre action, paranoid behavior, homosexual type, chronic, preoccupation, de severe lusions of persecu tion, auditory hallucinations, grandiosity, distor tion of thinking
16 Jan. 29, 1952 Extreme anxiety, Schizophrenic re Thorazine 9 Years tension, apprehen action, catatonic sion, fear, quiet type, Improved and shy as a child, domineering father, traumatic sexual experience at the age of 12 with older male cousin, depression, auditory hallucinations, withdrawal APPENDIX 6 Cont*d.
Date of Bilateral Final Psychiatric Length of Patient Prefrontal Lobotomy Brief Case History Diagnosis Medication Ho spitalizatibn
17 April 15, 1955 Poor home adjustment, Schizophrenic re- Compazine 6 Years assaultive, restless action, hebephrenic ness, flattened af type, chronic, fect, confusion, severe hallucinations
18 Oct. 12, 1949 Poor social and eco Schizophrenic re- Thorazine 12 Years nomic adjustment, action, hebephrenic marked dissociation type, chronic in ideation, audi tory hallucinations, bizarre delusional system, homicidal tendencies
II, Control group of psychotic patients Final Psychiatric . „ Length of Patient Brief Case History Diagnosis______Medication Hospitalization
1 Many bizarre sensations, somatic com Schizophrenic re- Thorazine 12 Years plaints, emotional flattening, inappro action, mixed type, priate affect, general apathy, auditory chronic, moderate and visual hallucinations APPENDIX 6 ContM.
Final Psychiatric Length of Patient Brief Case History Diagnosis Medication Ho spitalization
Believes ex-wife unfaithful, that last Schizophrenic re- Equanil 1 Year child is not his, extremely depressed over action, undiffer marital situation, delusions of persecution, entiated type, excessive religiosity, hypochondriasis chronic, severe
Withdrawn, seclusive, depersonalization, Schizophrenic re- Stellazine 10 Years bizarre delusional system, auditory hal action, hebephrenic lucinations, ideas of reference, inappro type, chronic, se priate affect vere
Delusions of persecution, homosexual Schizophrenic re- Thorazine 6 Years preoccupation, alcoholism, antisocial action, paranoid type, behavior, auditory hallucinations chronic, severe
Borderline social and economic adjust Schizophrenic re- -- 1 Year ment, developed feeling in back of action, undifferenti head as if it had been frozen in a cer ated type, chronic, tain spot, many somatic complaints, severe auditory hallucinations
Ideas of reference, delusions of perse Schizophrenic re- Thorazine 1 Year cution, extremely hostile, systematized action, undifferenti- Stellazine delusional system involving his boss ated type, chronic, Compazine and a girl, assaultive, grandiose, flat severe, in partial tened affect remission APPENDIX G Cont*d,
Pinal Psychiatric Length of Patient Brief Case History Diagnosis Medication Hospitalization
7 Mute and negativistic early behavior, Schizophrenic re- Stellazine 18 Years shown improvement in recent years, action, catatonic type, withdrawal chronic, severe
8 Sexual preoccupation, believes he Schizophrenic re- Thorazine 11 Years has "female interest,** sex considered action, unclassi ugly, self"conscious, withdrawn, anx fied, severe iety, antisocial behavior
9 Confusion, auditory and visual halluci Schizophrenic re Stellazine 2 Years nations, believed he was hypnotized, action, undiffer flattened affect, autistic thinking, entiated type, psycbomotor retardation chronic, severe
10 Excessive drinking, feelings of some Schizophrenic re Stellazine 6 Years thing crawling up his spine, withdrawal, action, chronic, Thorazine retardation, vague ideas of reference undifferentiated and persecution, flattened affect type
11 Unkempt, childlike in behavior, moderately Mental deficiency, Thorazine 1 Year depressed, fairly well oriented in all moderate, IQ 67 on Stellazine Spheres, reasoning and judgment are im Wechsler-Bellevue paired
12 Suspiciousness, hostility, ideas of castra Schizophrenic re- Thorazine 2 Years tion, inappropriate affect, religiosity, action, undiffer- Stellazine auditory and visual hallucinations entiated type, chronic, severe, in partial remission APPENDIX Cont’d.
Final Psychiatric Length of Patient Brief Case History Diagnosis______Medication Hospitalization
13 Confusion, poor family relationships, Schizophrenic re- Thorazine 2 Tears guilt over mental illness, believes action, undiffer- Stellazine illness due to sickness on both sides entiated type, of family, auditory hallucinations, chronic, severe flattened affect, assaultive and com bative behavior
14 Extremely depressed over father’s death, Schizophrenic re- Stellazine 2 Years feelings of omnipotence, inappropriate action, undiffer- Preludin affect, grandiose ideation entiated type, Vesprin chronic, moderately severe
15 Poor and ?nsecure home environment, Schizophrenic re Thorazine 17 Years parents of low intelligence, required action, hebephrenic Stellazine great deal of supervision in detail type, chronic, se assignments, seclusiveness vere
16 Three suicidal attempts, strong resent Schizophrenic re- Artane 1 Year ment of mother, depressed, obsessional action, schizo Vesprin suicidal ideas, withdrawn affective type, Stellazine chronic, severe
17 Born to frugal, hard working farm owners, Schizophrenic re* Thorazine 11 Years stuttering on father’s side of family action, Unclassi (patient stutters), withdrawn, grandiose fied, chronic, ideation, auditory hallucinations severe
■t* APPENDIX 6 Cont*d.
Final Psychiatric Length of Patient Brief Case History Diagnosis Medication Ho spltalization
18 Hyperactivity, seclusiveness, auditory Schizophrenic re Thorazine 16 Years hallucinations, ideas of reference and action, hebephrenic Artane persecution, bizarre unsystematized de type, chronic, se Compazine lusional system vere
Notes All lobotomy operations were performed at the VA Hospital in New Orleans* All final psy
chiatric diagnoses were made at the VA Hospital in Gulfport, Mississippi. VITA
Arthur Newton was born in New York City on July 8, 1928.
He graduated from Stuyvesant High School in 1944, and then pursued a science curriculum at City College of New York,
where he majored in biology and minored in chemistry. He
received his B.S. degree in June 1948.
Between 1952 and 1954 he served in the Army as an in
structor of laboratory techniques in bacteriology and para sitology, and as a medical laboratory technician.
In July 1954 he entered Columbia University for graduate study in experimental psychology, and received his M.A. de gree in June 1956. He entered Louisiana State University in September 1956 for graduate study in clinical psychology. He received clinical training at the psychology department1s clinic in Baton Rouge,- and at the Gulfport VA Hospital in
Mississippi. At the present time he is completing his train
ing as a VA trainee in the VA Mental Hygiene Clinic in New
Orleans.
46 EXAMINATION AND THESIS RETORT
Candidate: Arthur Newton
Major Field: P sychology
Title of Thesis:
The effects of prefrontal lobotomy Approved: on performance of delayed response problems
at-r t'l/-'* "y A t * in human psychotic patients. M ajor,Professor and Chairman
DeafT of the Graduate School
EXAMINING COMMITTEE:
G).G)
^ . k).
Date of Examination:
June 12, 1961