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University. MiaOTlms International 300 N ZEEB ROAD. ANN ARBOR. Ml 48106 18 BEDFORD ROW, LONDON WC 1 R 4EJ. ENGLAND 8107375

Owens -Lane , Janice

THE RELATIONSHIP BETWEEN SELF CONCEPT, HOSPITAL ADJUSTMENT, TYPE FAMILY SETTING, AND RACE OF MENTALLY ILL OFFENDERS

The Ohio State University PH.D. 1980

University Microfilms International300 N. Zeeb Road, Ann Arbor,MI 48106

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University Microfilms International 300 N ZS = = SO ANN AR3QR Nil J8106'31 3) 761-4700 THE RELATIONSHIP BETWEEN SELF CONCEPT, HOSPITAL

ADJUSTMENT, TYPE FAMILY SETTING, AND RACE

OF MENTALLY ILL OFFENDERS

DISSERTATION

Presented in Partial Fulfillment of the Requirements for

the Degree Doctor of Philosophy in the Graduate

School of The Ohio State University

By

Janice Owens-Lane, B.A., M.S.W.

* * ★ * ★

The Ohio State University

1980

Reading Committee: Approved By

Andrew Schwebel, Ph.D.

Linda Myers, Ph.D.

John Behling, Ph.D. Adviser Department of Psychology ACKNOWLEDGEMENTS

To undertake the writing of a dissertation requires dedication and perserverance. Several people who I feel very close to have pro­ vided much support and encouragement. Before giving thanks to these individuals, I want to first give thanks to God. I wish to sincerely thank my advisor, Dr, Andrew Schwebel for his time and painstaking effort in supervising this research. My appreciation is extended to

Jean Capuano and Jinunie Phillips of the Ohio Division of Forensic

Psychiatry for their support. Special thanks to Dr. Linda James Myers and Dr. John Behling for serving on my General Exam Committee and

Dissertation Committee. Also special thanks to Patti Watson whose superb typing skills produced this document. And to my husband,

Bernie, whose constant patience and support has been invaluable,

I express my deep appreciation and love.

ii VITA

January 11, 1949...... Bom - Winterhaven, Florida

1971...... B*A., Wilberforce University, Wilber- force, Ohio

1973...... M.S.W., University of Pittsburgh, Pittsburgh, Pennsylvania

1973-1974 ...... Psychiatric Social Worker, Hillsborough County Hospital, Tampa, Florida

1974-1977 ...... Social Worker, Spinal Cord Services, Moss Rehabilitation Hospital, Philadel­ phia, Pennsylvania

1977-1980 ...... Researcher I, Department of Mental Health and Mental Retardation, Division of Forensic Psychiatry, Columbus, Ohio

FIELDS OF STUDY

Major Field: Clinical Psychology

Forensic Psychiatry. Department of Mental Health and Mental Retardation

iii TABLE OF CONTENTS

Page

ACKNOWLEDGEMENTS...... ii

VITA...... iii

LIST OF TABLES...... vii

LIST OF FIGURES ......

CHAPTER

I. INTRODUCTION ...... 1

Hypotheses...... 5

II. SELF CONCEPT ...... 8

Parental Influence on Self Concept...... 8 Others* Influence on Self Concept ...... 11 Self Concept of the Mentally 111...... 14 Self Concept of Prisoners ...... 20

III. LITERATURE REVIEW...... 26

Mentally 111 Population ...... 26 Prison Population ...... 34 Mentally 111 Offender Population...... 39 Issue of Dangerousness...... 47

IV. M E T H O D ...... 53

Participants...... 53 Procedure ...... 53 Instruments...... 55 Tennessee Self Concept Scale...... 56 Katz Adjustment Scale .« ...... 60 Crawford Psychological Adjustment Scale .... 62 Family Contact Interview Index...... 63

iv Page

V. RESULTS...... 65

Hypothesis One...... 66 Hypothesis Two...... 66 Hypothesis Three...... 77 Hypothesis Four ...... 79 Hypothesis F i v e ...... 79 Correlations Between the Tennessee Self Concept Scale and the Crawford Psychological Adjustment Scale ...... 89 Correlations Bet' /een the Tennessee Self Concept Scale and the Katz Adjustment Scales (Subject Rating Scale 1 and Subject Rating Scale 3). . . 94 Correlations Between the Tennessee Self Concept Scale and Age, Education, and the Institution­ al Variables...... 96 Correlations Between the Tennessee Self Concept Scale and the Family Contact Interview Index. . 96 Essay Responses on the Family Contact Inter­ view Index...... 101

VI. DISCUSSION...... 105

Race...... 114 Significant Correlations...... 116 Self Concept and Hospital Adjustment ...... 116 Self Concept, Symptom Discomfort, and Level of Expectations...... 117 Self Concept, Age, Education, and the Institu­ tional Variables...... 119 Self Concept and Family Contacts...... 119 Written Responses on The Family Contact Inter­ view Index...... 120 Problems with Data Collection...... 122 Suggestions for Future Research ...... 123

REFERENCES...... 126

APPENDICES

A. Analysis of Variance Tables...... 136 B. Face-to-Face Interview with Mentally 111 Offenders . 145 C...... Consent Forms...... 148 D. Questionnaires ...... 151

v LIST OF TABLES

age

Means of the Tennessee Self Concept Subscale, Moral- Ethical Self, by Race...... 67

Main Effects and Interactions of Type Family and Race on the Tennessee Self Concept Scale and its Subscales...... » ...... 68

Means of the Crawford Psychological Adjustment Scale (Total Score) by Type Respondent ...... 70

Main Effects and Interactions of Type Respondent, Type Family, and Race on the Crawford Psychological Adjustment Scale ...... 71

Means of Derangement of Thought Process and Physical Behavior (Subscales of the Crawford Adjustment Scale) by Type Respondent ...... 74

Means of Three Crawford Psychological Adjustment Subscales by Type Respondent ...... 75

Main Effects of Type Family and Race on the Katz Adjustment Scale, Symptom Discomfort ...... 78

Main Effects of Type Family and Race on the Katz Adjustment Scale, Level of Expectations for Perfor­ mance of Social Activities ...... 80

Means of Letters per Month Received from Family Members (Question 3 on the Family Contact Interview Index) by Type Family...... 82

Means of Type Letters Received per Month from Family (Question 4 on the Family Contact Interview Index) by Race...... 82

Means of the Number of Family Visits per Month to the Hospital (Question 11 on the Family Contact Interview Index) by Type Family...... 85

vi Table Page

12. Means of Responses to Enjoyment of Family Visits (Question 15 on the Family Contact Interview Index) by Type Family ...... * ...... 85>

13. Means of Responses to the Helpfulness of Family Visits to Adjustment (Question 16 on the Family Contact Interview Index) by Race ...... 88

14. Means of Responses to Family Correspondence (Question 17 on the Family Contact Interview Index) by Race. . . 88

15. Means of Responses to Staff Encouragement of Family Contacts (Question 26 on the Family Contact Interview Index) by Type Family...... 89

16. Correlations Between the Tennessee Self Concept Scale and the Crawford Psychological Adjustment Scale (Social Work Responses in Parentheses, while First Scores are Nurses) ...... 91

17. Correlations Between the Tennessee Self Concept Scale and the Katz Adjustment Scales (Subject Rating 1 and Subject Rating 3)...,...... 95

18. Correlations Between the Tennessee Self Concept Scale, Age, Years of Education, and the Institutional Variables (Total Incarcerations and Total Hospitali­ zations) ...... 97

19. Correlations Between the Family Contact Interview Index and the Tennessee Self Concept Scale ...... 98

20. Main Effect of Type Family on the Tennessee Self Concept Scale and Its Subscales...... 137

21. Main Effect of Race on the Tennessee Self Concept Scale and Its Subscales...... 138

22. Interaction of Type Family and Race on the Tennessee Self Concept Scale and Its Subscales ...... 139

23. Main Effect of Type Family on the Crawford Psychologi­ cal Adjustment Scale ...... 140

24. Main Effect of Race on the Crawford Psychological Adjustment Scale ...... 141

vii Table Page

25. Main Effect of Type Respondent on the Crawford Psychological Adjustment Scale 142

26. Interaction of Type Family and Race on the Crawford Psychological Adjustment Scale ...... 143

27. Interaction of Type Family, Race and Type Respondent on the Crawford Psychological Adjustment Scale .... 144

viii LIST OF FIGURES

Figure Page

1. Channels in which Individuals Can be Committed to a Hospital for the Criminally Insane ...... 42

2. Interaction Between Type Family and Race on the Crawford Adjustment Subscale, Social-Econr-ical- Environmental Competence ...... 72

3. Interaction Between Type Family and Race on the Crawford Adjustment Subscale, Physical Behavior. . . . 76

4. Interaction Between Type Family and Race on Responses to "Like to Receive More Letters from the Family" (Question 7 on the Family Contact Interview Index) . . 83

5. Interaction Between Type Family and Race on Responses to "Do You Write Letters to the Family" (Question 9 of the Family Contact Interview Index) ...... 86

ix CHAPTER 1

INTRODUCTION

For many years psychologists have been interested in the study of

self concex^t. Some of the pioneering studies of self concept were done by Cooley (1902), Mead (1934) and Sullivan (1947). These authors and others view self concept as a central construct in understanding human behavior. More recently, the self concept has become a primary factor

in some exx^lanations of maladjustment and deviant behavior. Numerous

investigations have reported significant correlations between self con­

cept and mental illness (Harrow, Fox, Markus, Stillman, £ Hallowel,

1968; 1969; Karmel, 1969; Ostrauskas, 1977; Tamayo & Raymond, 1977).

Others have noted correlations between self concept and imprisonment

(Cooxjersmith, 1967; Fichtler, Zimmerman, & Moore, 1973; Yelsma 6

Yelsma, 1977). However, studies are unavailable on self concept of the

mentally ill offender^ (often referred to as the criminally insane) .

The mentally ill offender population is perhaps considered the

most deviant group in our society. Yet, very little attention has been

■*"The name mentally ill offender is used by the Ohio Department of Mental Health and Mental Retardation, Office of Community Placement to refer to those people who have been incarcerated and institutionalized at maximum or minimum security mental hospitals. Those who return to the community are referred to as mentally ill ex-offenders. This name is also reflected in the current mental health literature.

1 2 given to understanding their behavior, family life, and hospital adjustment. The investigations of personal and social characteristics of this population have been minimal and largely speculative. Accord- ing to self theorists, knowledge of the self concept can enhance understanding and prediction of human behavior. The importance of this particular study derives from the theoretical and empirical importance of the self concept to the etiology of deviant behavior.

From the extensive investigations on self concept has evolved a proliferation of self theories. Some of the popular proponents of self concept theories are Combs and Snygg (1959), Lecky (1945), Rogers (1951), and Wylie (1961). As is well known, self theorists believe that the

self concept is a frame of reference through which the individual

interacts with others (Fitts, Adams, Radford, Richard, Thomas, &

Thompson, 1971). Further, the self concept comprises all the beliefs the individual holds concerning who he is: i.e., conclusions about his

model or typical life situations (Jourard, 1964). Many of the beliefs

an individual holds about himself have been acquired from significant

others (parents, siblings, spouses). It is primarily through obser­

vations of an individual's behavior that significant others formulate

beliefs which are conveyed to him. The individual in turn adopts

these beliefs. The expectations of significant others are basically

conveyed the sane way. When the individual, however, fails to meet

these expectations, it is anticipated that his self concept will be

2 Many studies use self concept, self esteem, self perception, and self acceptance interchangeably. However, self concept encompasses all of these terms. For this reason the present researcher has adopted self concept. 3 affected.

The self concept is learned through experiences with others.

Although self theorists agree that the self concept is a fairly stable entity, they also agree that as an individual has more contact with significant others, the self concept is continually developing and changing.

A postulate of the present study is that there is a relationship between self concept and type family setting. This postulate is based on the differential demands and expectations theory (Dinitz, Lefton,

Angrist, & Pasamanick, 1961; Freeman & Simmons, 1959) which holds that patients who live with parents differ from those who live with wives in their expectations. Moreover, the parents and wives differ in their denands and expectations of their ex-mental patient relatives

(this theory is discussed in detail in the "Mentally 111" section).

According to Dinitz et al., the wives place greater demands and expec­ tations on their ex-mental patient husbands to display less sick

behavior and make a good adjustment than parents place on their ex­ mental patient sons.

This thinking is advanced in the present study to include self

concept. Some researchers (Jourard, 1964; Sullivan, 1953) contend

that there is a definite relationship between self concept and expecta­

tions of others (parents, wives). The demands and expectations of

wives and parents affect the self concept of their mentally ill

offender husbands and sons. As these mentally ill offenders display

less sick behavior and make a "good adjustment," they are more

accepted and rewarded by their families (wives and parents) and society. Thus, the acceptance by others enhances the self concept.

There are perhaps numerous factors which affect the self con­

cept. However, this study specifically focuses on the relationship between self concept, hospital adjustment, type family setting, and

race of mentally ill offenders. Self concept is defined in this study

as the individual's appraisal, image, and belief about himself. The

definition of adjustment given by Crawford (1968) is used in this

study. He defines adjustment in six behavioral terms or categories.

These are as follows: (1) Social-Economic-Environmental Competence

(ability to modify the environment, money management, work competence)

(2) Derangement of Thought Process (appropriateness of behavior, delu­

sions, memory); (3) Physical Behavior (physical habits, motor activity

fears); (4) Communications (written and verbal); (5) Social Accepta­

bility of Behavior (social acceptability and moderation of behavior);

(6) Management of Hostility (physical and verbal). Type family

setting is dichotomized: families of origin (parental families) and

families of procreation (families with spouses). Race consists of

whites and blacks.

The present study addresses the following questions: What is the

relationship between self concept, hospital adjustment, type family

setting, and race of mentally ill offenders? More specifically, is

there a significant difference in the self concept of hospitalized

mentally ill offenders who will return home with their parents com­

pared to those who will return home with their wives? Is there a sig­

nificant difference in the level of expectations of the tvro groups?

Is there a significant difference in the level of psychopathology of 5 mentally ill offenders who will return to families of origin compared

to those who will return to families of procreation? Is there a sig­

nificant difference in the level of family contacts between the two

groups? Is the hospital adjustment of mentally ill offenders who will

return to families of origin significantly different from the hospital

adjustment of those who will return to families of procreation? is

there a significant difference in the self concept of white and black

mentally ill offenders?

Hypotheses

1. There will ba a significant difference in self concept due

to: type family (families of origin, families of procreation)

and race.

2. There will be a significant difference in the assessment of

mentally ill offenders' hospital adjustment due to: type

family, race, and type respondent (nurses vs. social workers).

3. There will be a significant difference in the level of Symp­

tom Discomfort (psychopathology) due to: type family and

race.

4. There will be a significant difference in the Level of Expec­

tations for Performance of Social Activities (Katz Adjustment

Scale, S3) due to: type family and race.

5. There will be a significant difference in the level of family

contacts (during the patients' hospitalization) due to:

type family and race. 6

My expectations will be somewhat different from those who have conducted similar studies on the mentally ill population (Dinitz et al., 1961; Freeman & Simmons, 1963) because of the dual institutional confinement of mentally ill offenders. First, these individuals come to the attention of the criminal justice system and are labeled offenders. Second, they are diverted from the criminal justice system to the mental health system for psychiatric reasons. Thus, they become products of both systems and are labeled mentally ill offenders.

Since studies are unavailable on self concept and adjustment of this population, this study will draw from two bodies of literature

(mental health and prison, respectively). The goal of the researcher is to do an extensive review of this literature toward the goal of elucidating some of the notions pertaining to self concept, and type

family setting, and illustrating their usefulness in understanding the life of mentally ill offenders.

A review of the Self Concept literature relevant to the present

study is discussed below. There are four topics covered in this liter­ ature. These are as follows; (1) Parental Influence on Self Concept;

(2) Others' Influence on Self Concept; (3) Self Concept of the Mentally

111; (4) Self Concept of Prisoners, Parental influence and others'

influence are developmental factors of self concept. Discussion of

self concept, adjustment and family of the mentally ill and prisoners

draws from the literature on the two populations which encompass the dual institutional experiences of mentally ill offenders. A review of

the literature on the mentally ill offender is dichotomized: Legal

Aspects, and Issue of Dangerousness. While there are numerous studies which have correlated self con­ cept and adjustment of mental patients and prisoners with demographic variables (age, sex, education), few have focused on race. From these few studies controversy has developed over whicli race (black, white) has the highest incidence of psychopathology (DeHoyes & DeHoyes, 1965;

Jaco, I960; Pasamanick, 1963; Taube, 1971). The present study focuses on this issue and includes race as a significant independent variable.

Ilany of the studies discussed in the literature review are cor­ relational studies and are subject to various interpretations. Thus, caution should be taken in reviewing the findings. CHAPTER II

SELF CONCEPT

Parental Influence on Self Concept

The self concept and family has been investigated for many years.

Early studies show that there is a significant relationship between self concept and the parents' influence. Combs and Snygg (1959) main­ tain that the family provides the individual with his early life experiences from which he develops: (1) feelings of adequacy or in­ adequacy, (2) feelings of acceptance or rejection, (3) expectancies of acceptable values, goals and behaviors, and (4) opportunities for identification. It is from parents and significant others that the individual learns and adopts the values which he attaches to his con­ ception of himself.

Sullivan (1947) has given considerable attention to the parents' influence and has pointed out that parents are the source of self concept, particularly the mother figure. He regarded the self as appraisals of the individual which are often made by the parents and others. Besides the positive influence of the parents, there is also the negative influence to be considered. Jourard (1964) suggests that not only do the parents make appraisals of the child, but also place demands and expectations which are at times beyond the real ability of

8 9 the child to conform. Hence, the child will usually not confront or question the parents, but instead question himself. Cassesse and

Benedettini (1973) argue that the parents' behavior, specifically the mother's behavior is "necessary but not sufficient" to account for the child's self concept. Thus, they suggest that the child's self con­ cept is not primarily a source of the mother's influence but the frame­ work of the whole family dynamics and role in which the child functions,

Rosenberg (1965) found a significant correlation between the parent's interest in the child and the child's self concept. The parent's interest was determined by three factors: (1) parent's knowl­ edge of the child's friends, (2) reactions to the child's academic performance, (3) responsiveness to the child at the dinner table.

The findings showed that there was a significant relationship between parental indifference (disinterest) and low self esteem of the child.

The more interest given, the higher the self concept. Thus, Rosenberg concluded that this lack of interest in the child is reflective of the lack of love and perhaps failure of the parent to provide encouragement.

Additional support for the parent's influence upon the child's self concept is provided by George (1970) in his study of the self con­ cept of aspiring and non-aspiring black high school seniors. He ob­ tained Tennessee Self Concept scores from both the adolescents and parents. The findings revealed that aspiring boys had a higher self concept than non-aspiring boys. Further, the aspiring boys' self con­

cepts were significantly correlated with self concepts of both parents.

However, with the non-aspiring boys the relationship was less signifi­

cant with the mother and no relationship reported with the father's 10

self concept. Searles (1970) suggests that students who report more positive climates of home and family relationships are less critical

of themselves and present more positive and consistent self concepts.

The communication between the parent and child has been found to

be significant in the child's self concept as shown in the study by

Reed (1975). The sample consisted of 152 adolescents and their

parents. The Tennessee Self Concept Scale was administered to both

adolescents and parents while the Parent Adolescent Communication

Inventory was administered only to the adolescents. Reed found that

the adolescents' self concepts had a significant (p < .01) effect upon

ttieir perceived communication with the parents. Those adolescents who

had low self concepts perceived communication with their parents as

significantly more non-constructive than those adolescents who had

higher self concepts. The parents’ self concepts had no effect upon

the adolescent's perceived communication with them.

In another investigation of parental influence on the self con­

cept, Coopersmith (1967) reported that persons in retrospect, with high

self-esteem are less likely to perceive the parents as negative or

destructive influences than are persons with medium or low self esteem.

He contends that parental acceptance has an enhancing effect upon the

person's self concept. On the other hand, parental rejection "pre­

sumably results in an impoverished environment and a diminished sense

of personal worthiness" (p. 166).

Some studies (Coopersmith, 1967; Kaplan & Pokorny, 1971; Rosen­

berg, 1965) have attempted to show a significant relationship between

self concept of the child and the broken home (divorce, death of 11 parent(s), separation and other) while others (Angyal, 1967j Harrow et al., 1968) have pointed out that the overprotective and overinvolved parents create fundamental feelings of worthlessness which result in low self concept.

Synthesizing evidence from the literature on parental influence the researcher sees that the parent's behavior is important to the self concept of the child. There are some things the parents can do to enhance the child's self concept, such as conversing with the child often at the dinner table, and taking an interest in the child's friends and academic achievements. On the other hand, parents can unconsciously place tremendous demands and expectations on the child which diminishes the self concept. Not only is the parents' influence important in understanding the child's self concept, but also others’

influence. The latter is discussed in the next section.

Others' Influence on Self Concept

The influence others (people besides parents) have on the self

concept has been a concern of psychologists for many years. For example, Cooley (1902) and Mead (1934) emphasized the effect others have upon the development of the self concept. Specifically, Cooley

contended that an individual learns to perceive self based on how

others perceive him. Mead further expanded on this idea through a

social interactionist position which holds that social interaction is

an integral part of understanding the individual's self concept. In

other words, according to Mead, an individual will think of himself

as he believes significant others think of him. One result of this is 12 that the individual will tend to act the way others desire him to act and in accord with others* expectations.

Sullivan (1953) suggested that to a considerable degree the way a person is treated or judged (expectations) by others will determine the way he views himself. Kinch (1963) is in agreement with Sullivan

(and also Mead), and offers a general theory of self concept which states that "the individual's conception of himself emerges from social interaction and, in turn, guides or influences the behavior of that individual" (p. 481).

Johnson (1952) elaborated on the relationship between the indivi­ dual's concept of himself and the effect his environment has on shaping the self concept. He writes:

Hence an adolescent, if he has already come to a conception of self, may be viewed as having arrived at his conception through such life experiences as afforded him by the atti­ tudes and behaviors of his parents and associ­ ates toward him, and through his interpretation of these attitudes and behaviors. Interactions with individuals in the environment is continu­ ally contributing to modification of the self conception and the conception of others, while at the same time interaction is modified by these conceptions. (p. 783)

Johnson concludes that the self concept is very much affected by one's

experiences and it influences the way in which one approaches, utilizes

and deals with new experiences.

Vargas (1968) further added that childhood experiences unquestion­

ably affect the level of self concept. Hence, individuals with high

self concepts describe positive childhood experiences compared to

those with low self concepts. Similarly, Lynch (1968) found that 13 individuals with high self concepts reported having more pleasurable experiences while individuals with low self concepts reported less life experiences that were pleasurable.

Other studies (Berger, 1952; Frey, 1950; Sheerer, 1949; Stock,

1949) on self concept have shown that not only is the influence of others important to the self concept and an individual's acceptance of himself, but also self acceptance is significantly related to accept­ ance of others. Omwake (1954) in a detailed investigation of self acceptance and acceptance of others used three personality inventories: * The Berger Self-Acceptance and Acceptance of Others Scale; Phillips

Attitudes Toward the Self and Others Questionnaire; and the Index of

Adjustment designed by Bill, Vance and McLean in 1951. These measures

were administered to 113 college students. The findings showed that the

lower the opinion of the self, the lower the opinion of others. Further,

those who rejected themselves also rejected others.

Self concept also affects married relationships. Corsini (1952)

and Kelly (1941) found that happiness in marriage is associated with

similarities of self perceptions of the couples. Happy persons when

given ratings of each other rated themselves and their mates more favor­

ably than did unhappy couples.

In another study, Cohn (1975) investigated self concept, role per­

ceptions and marital satisfaction using a sample of 70 couples. Three

instruments were employed: the Edwards Personal Preference Schedule;

the Maferr Inventories of Masculine and Feminine Values; and the Cantil

Self Anchoring Scale. The results indicated that self concept and role

perception were significantly related to marital satisfaction. The 14 findings supported previous studies.

In summary, the above literature illustrates the influence others have on the self concept. Some studies {Johnson, 1952; Kinch, 1963;

Mead, 1934) discussed how interactions with others affect the self concept. Significant correlations were found between self concept and acceptance of others. Further, studies (Cohn, 1975; Corsini, 1952;

Kelly, 1941) showed that the self concept of married couples affect marital happiness and satisfaction.

After a thorough review of the literature, the present researcher found no studies on type family setting and conditions which are likely to he associated with high and low self concept of mentally ill offenders. However, various ideas have been expressed about other populations (mentally ill and prison) which are pertinent and enhancing to the understanding of family life and self concept of mentally ill offenders. This literature is reviewed below and in the next chapter.

Self Concept of the Mentally 111

During the past 20 years there has been a growing body of research on self concept of the mentally ill. Some studies in this area com­ pare normal subjects with one or more mentally ill populations (Fried­

man, 1955; Hillson,& Worchel, 1957; Jones, 1956; Ostrauskas, 1977;

Tamayo & Raymond, 1977; Zuckerman, Baer, & Monashkin, 1956), while few

studies focus on self concept of mental patients and wives' or parents'

perceptions of them (Harrow, Fox, Markus, Stillman, & Hallowel, 1968,

1969). 15

In an investigation of self concept of psychopathsr Tamayo and

Raymond (1977) used the MMPI to select a sample of 56 adult males, 28 psychopaths selected from a federal maximum security institution, and

28 non psychopaths from a pool of unskilled workers in the community.

The Tennessee Self Concept Scale was administered to all subjects.

The findings showed that the self concept of psychopaths was lower than the self concept of non psychopaths, and that the psychopaths expressed feelings of worthlessness and inadequacy in interactions with their families, close associates and others. They also expressed feelings of being morally worthless and deviant, deriving self satisfaction from being deviant. The psychopaths' sense of personal worth and adequacy

(personal self), however, was comparable to that of the non psycho­ paths. Tamayo and Raymond concluded that inconsistencies in the psycho­ paths' self-concept could be attributed to the "paucity of his fantasy life" (p. 76).

A recent investigation of self concept of mental patients in relation to the parents and others was conducted by Ostrauskas (1977).

Specifically, she focused on the mother-figure and others (fathers, spouses, friends, disliked persons) in the development of the self concept of mental patients and in the process of psychopathology.

The sample consisted of 42 inpatients (maladjusted) admitted to psychi- atric hospitals, and 42 control subjects with no psychiatric histories

(adjusted). Several self measures were used (Osgood, 1957; Snider &

Osgood, 1969) to assess the global generalized self conception ("The way I see myself") and self as perceived with significant others ("The way I see myself with father, spouse, best friend, a disliked person"). 16

The findings were striking. The maladjusted group scored signifi­ cantly higher on the generalized self conception measure (Worth-

Strength dimension)^ than the adjusted group. Further, the self as perceived with the mother was significantly different for the two groups. The maladjusted perceived themselves less favorably than the adjusted. There were no significant differences between the groups in self perceptions when with the fathers, spouses or people they disliked. However, marked differences were revealed in the self as perceived with friends. Specifically, the maladjusted had extremely positive self conceptions compared to the adjusted.

The married patients had a more positive generalized self and self-with-mother than the single, separated and divorced patients.

The self with mother was the "most sensitive indicator of psycho­ pathology" (p. 359). This finding lends support to the notion by

Freeman and Simmons (1958) that sicker patients live with the mothers.

An earlier study on self concept of the mentally ill by Hillson

and Worchel (1957) consisted of a comparison of three groups, a normal population of 47 nursing students, 37 neurotics, and 36 schizophrenic

patients. A 54-item rating inventory was employed, yielding Self and

Ideal Self scores. The findings showed that the neurotic group had

lower self appraisals than the normals and schizophrenics. Further­

more, no significant difference was found between self appraisals of

3 The Worth-Strength dimension is defined by Ostrauskas as scales which provide "direct measures of the individual's capacity to define and view self as a worthy, significant and effective person" (p. 355). 17 schizophrenics compared to normals. There was also no significant dif­ ference reported between the Ideal Self of the neurotics and normals.

However, the schizophrenics had a lower Ideal Self than that of normals and neurotics.

The finding that there was no significant difference between self appraisals (self concepts) of mental patients (schizophrenics) compared with normals in the study by Hillson and Worchel is supported by previous research (Epstein, 1955). Wylie (1961) contends that negative self concept is often found in neurotics but normals and psychotics nave similar self reports. These findings are in contrast to findings of other investigations (Jones, 1956; Tamayo & Raymond, 1977; Tamkin,

1956) .

Other research on self concept of mental patients was advanced by

Harrow, Fox, Markus, Stillman and Hallowel (1968) in their study of

"Changes in adolescents' self-concepts and their parents' perceptions during psychiatric hospitalization." The sample consisted of 3A hos­ pitalized adolescent patients (mean age, 18) and their parents, plus

20 normal control subjects matched by age and education. The Bulter

Haigh Scale (self concept) and a 50-item paper and pencil question­

naire designed by the researchers to measure adjustment were adminis­

tered during two periods of time (1 1/2 weeks after admission and 7 weeks later). Harrow et al. reported that self concepts of the patients were significantly more negative than self concepts of the

20 normals over the two periods. In addition, the parents tended to

view the patients in a relatively negative way. Moreover, the

patients saw themselves as significantly more poorly adjusted than 18 their parents.

Harrow et al. stated that "the patients' views of themselves and their own maladjustment are influenced by the extent of their depres­ sion although the relationship is far from a unitary one. Undoubtedly, this is a reciprocal influence, with the patients' negative self- evaluations also increasing to a limited extent, their own maladjust­ ment" (p. 257).

Beck (1967) espoused the notion that depression often accompanies low self-esteem. Karmel (1969) attempted to test this notion with

80 patients from the New Jersey State Hospital. She found a negative relationship between self esteem and depression— the higher the depres­ sion, the lower the self esteem. Thus, support was provided for

Beck's theory and the postulate of Harrow et al.

Further investigation of self concept by Harrow et al. (1969) was to determine whether the findings of the previous study (1968) were also true of marital families. The subjects were 26 married psychi­ atric patients (9 males, 17 females) hospitalized at the Acute Psychi­ atric Inpatient Division of Vale-New Haven Hospital. Mean age of the subjects was 3 7.5 and educational level 14 years. The patients and wives were administered the Bulter Haigh Self Concept Scale, and a 50

item paper and pencil adjustment test ' ring two periods of tine

(1 1/2 weeks after admission and 7 weeks later). The findings

revealed first that the patients' self image (self concept) and their

spouses' perception of them were both more negative than their own and their spouses' images of the average person. Second, the patients and

their spouses viewed the patient as the most disturbed family member. 19

Third, the patients' self images significantly improved from the first time period to the second, and the spouses' images of the patients also became more positive. However, the spouses still viewed the patients' more negatively than themselves over the two periods of time.

Harrow et al. indicated that the results of the study were con­

sistent with the results from the previous study. Both the married

patients and "patient sons" viewed themselves as the most disturbed

family members. Further, the parents and wives saw improvement

from admission to seven weeks later. Despite the noted improvement,

both parents and wives nevertheless viewed the patients in a negative

way.

Zuckerman, Baer and Monashkin (1956) examined how mental patients'

acceptance of their parents was associated with self acceptance. The

sample consisted of three groups: 60 normal subjects, 30 schizophrenics

and 3 0 patients with various diagnoses (half males and half females in

all groups). The age ranged from 17 to 45 years. A modified version

of the self scale designed by Buss at Larue Hospital in Indiana was

administered to all subjects. The results showed that patients were

less accepting of self than normals. Similarly, patients were less

accepting of others than normals. Moreover, the patients were less

accepting of their mothers and fathers than normals. The females

were more accepting of other people, their mothers and fathers than

male patients.

Zuckerman et al. suggested that the patients generalized from

acceptance of parents to acceptance of others. Arieta (1951) supports 20 this view in his research on schizophrenics. He points out that a

child learns to accept himself as a consequence of his parents’ accept­ ance of him and subsequently generalizes his acceptance to parents.

In summary, there are some studies (Tamayo & Raymond, 1977;

Zuckerman et al., 1956) which show that mental patients have a lower

self concept than normals, while other studies (Hillson & Worchel,

1957; Ostrauskas, 1977) indicate the contrary or no significant dif­

ferences between the groups. Studies (Harrow et al., 1968; 1969)

have shown that mental patients’ self concepts improved from admission

time to several weeks later, and that parents and wives of these

patients noted this improvement. However, they maintained more nega­

tive views of the patients than the patients themselves over the two

X^er iods.

Some researchers (Arieta, 1951; Zuckerman et al., 1956) suggest

that acceptance by the family is an antecedent factor to the patients'

improved self concept and acceptance of others. Evidence from these

studies show that patients who live with their mothers have lower

self concepts than normals with their mothers, and married x’^tients

have a more positive self concept than patients of other marital

statuses. Further, evidence shows a significant correlation between

the patients' depression and level of self esteem.

Self Concept of Prisoners

There are numerous studies on self concept of prisoners. Many

of these studies compare self concept of prison populations with non

prison populations (Coopersmith, 1967; Fichtler, Zimmerman, & Moore, 21

1973; Yelsma & Yelsma, 1977). Evidence from these investigations reveal that the levels of self-esteem of prisoners differ from non prisoners for a variety of reasons, some of which are discussed below.

Yelsma and Yelsma (1977) investigated the relationship between self esteem and type crimes committed. The subjects of the study were

62 inmates (2 females and 60 males) from the Ypsilanti State Forensic

Center and Livingston County Jail in Michigan. Twenty-one of the prisoners were enrolled in one or more psychology courses sponsored by the Corrections Department, and eight were in a work-release- rehabilitation program. Mean age of the prisoners was 26 years. All of the prisoners except 11 had been incarcerated for approximately one year, and had committed one of 12 crimes (total number of different crimes) which were classified into three categories of destructiveness:

(1) crimes destructive only to themselves; (2) crimes directly destruc­ tive to others and themselves; (3) crimes indirectly destructive to others and destructive to themselves. A board of judges which con­

sisted of three prison officials, three lay people, and three "un­

related professional researchers" determined the categories and crimes 4 that fit into the categories. The Coopersmith Self-Esteem Inventory was administered to the subjects. The findings revealed that self esteem of prisoners v;ho committed indirectly destructive crimes to others had significantly higher self esteem scores than prisoners who

4 The categories were derived based on the three judges* decisions regarding the nature of the crimes (direct destructive, indirect des­ tructive) . Direct destructive crimes mostly refer to bodily harm to self or others (violent acts) while indirect destructive crimes include basically property crimes (non-violent acts). 22 committed directly destructive crimes to others. Further, prisoners who committed indirect destructive crimes had higher self esteem scores than those who committed crimes of destruction only to them- selves. There were only slight differences found between prisoners who were in the work-release program and psychology classes and those who were not involved in any activity. The former scored slightly higher than the latter. According to Yelsma and Yelsma, the data sug­ gest that the nature of the crime committed may have important implica­ tions on the prisoner's self esteem.

Conversely, Fitts and Hamner (1969) with the use of the Tennessee

Self Concept Scale found no significant correlation between nature of crimes offenders committed (prisoners) and self concept. Furthermore, there were no significant correlations reported between self concept and age, intelligence, education, sex, race and geographical area that attributed to the differences in self concepts of offenders compared with normal control subjects. They maintain that the offenders see themselves as worthless and inadequate, morally and ethically bad.

In a study of "Race, Commitment to Deviance, and Spoiled Identity,"

Harris (1976) found significant differences in self esteem (identity spoliation) between black and white inmates. The sample consisted of

129 black and 105 white male inmates in Yardville Youth Reception and

Correction Center in Trenton, New Jersey. Four questionnaires were administered, one which focused on "criminal" and "straight" (being a good citizen) commitments, while the other three were psychological well being measures (self esteem, stability of self, and sense of personal control). 23

The findings revealed that white inmates had higher criminal identity scores and significantly lower "straight” identity scores than black inmates. The relationship between self esteen and personal control was stronger for whites than blacks. Differences were also shown between the groups in criminal commitment and spoiled identity.

Goffman (1963) defines spoiled identity as a loss of ego integrity and self derogation. High levels of criminal commitment for blacks increased self esteem (low spoiled identity) while whites, in contrast, showed heightened identity spoliation. Harris postulates that these racial differences in self esteem or identity spoliation can partly be attributed to the American caste-like system. Blacks are seen as non­ members while whites are ascribed members.

In another study of self esteem of prisoners, Fichtler, Zimmerman and floore (1973) compared the self esteem of two prison groups to that of two non-prison groups. The two prison groups were comprised of 60 male newly arrived prisoners and 64 male maximum security prisoners; while the non-prison group included 49 psychology students (24 females and 25 males) and 54 rural church members (28 males and 26 females).

Self esteem of the groups were measured by the Bulter-Haigh self referent scale. The findings showed that the rural church group had the highest self-esteem, the maximum security prisoners had the lowest

self esteem, and the other two groups (newly admitted prisoners and psychology students) fell in between. Fichtler et al. identified time

spent in prison as the critical variable in differentiating the prisoners' levels of self-esteem from that of the non prisoners.

Thus, they concluded that imprisonment produces lower self-esteem. 24

This view supports the contentions presented by Clemmer (1959) and

Cressey (1961).

Heskin, Bolton, Smith and Bannister (1975) examined the relation­ ship between the length of imprisonment served and inmates' attitudes.

The sample consisted of 17 5 inmates and was divided into four groups matched by age and length of imprisonment. All of the inmates were incarcerated for a determinate sentence of ten years and above. The instruments used were thirteen seven-point self concept scales. The findings revealed that men who had been incarcerated for a longer term

(5 years or more) reported a lower self evaluation than those who had been incarcerated a shorter period of time. This finding supports the above research (Fichtler, Zimmerman, & Moore, 1973).

In a previous study of the impact of imprisonment on inmates,

Heskin et al. (1973) reported a significant relationship between hos­ tility (personality correlate) and imprisonment. An increasing level of hostility, especially hostility towards the self was associated with

longer length of imprisonment.

Tittle (1972) also maintains that incarceration has a negative

impact on self esteem. However, he adds that there is an association

between the prisoners' self esteem and nature of their participation

in prison activities. In a study of "Institutional living and self­

esteem, " he found that inmates who participated in prison group activi­

ties or formal group alliances (primary group alliances) with other

inmates had a higher self esteem than non participants. Thus, Tittle

concludes that inmates' primary group affiliations help to alleviate

the problem of low self esteem in prisons. To summarize, the results of several studies show that prisoners' self concepts are lower than the self concepts of normal subjects.

Length of incarceration is seen as a critical variable highly cor­ related with level of self concept. Evidence from one study showed a significant relationship between group affiliation and self concept.

Another study showed significant differences between self concept and criminal commitment between black and white inmates. Because there are few investigations on race and self concept of prisoners, more study is needed in this area. CHAPTER III

LITERATURE REVIEW

Mentally 111 Population

The trend to discharge mental patients from psychiatric hospitals and return them to the community has increased concern about the

social environment in which they are to return. More specifically, there is increased concern about: what family setting is most condu­ cive to helping patients adjust to the community? What family setting enhances the quality of mental patients' lives?

Some researchers (Carpenter & Bourestron, 1976? Dinitz, Lefton,

Angrist, & Pasamanick, 1961; Freeman & Simmons, 1958, 1963; Simmons &

Freeman, 1959) have attempted to answer these two specific questions,

while others have developed ideas which are useful in addressing these

questions (Ferber, Kliger, Zwerling, & Mendelsohn, 1967; Miller, 1967).

Controversy has developed in this literature over which type family

setting (origin, procreation) is most conducive to the patient's

remaining in the community (community tenure) opposed to returning to

the psychiatric hospital (rehospitalization).^ There are some (Dinitz

'’Rehospitalization is viewed as the patient's inability to reinte­ grate into the community, while community tenure in some investigations is a primary indicator of post-hospital adjustment.

26 27

et al., 1961; Freeman fi Simmons, 1958) who argue that patients living with their wives are rehospitalized more often than patients living

with their parents. Conversely, others (Mannino & Shore, 1974; Meyer

& Bogatta, 1959; Miller, 1967) contend that patients who live with

parents are rehospitalized more often than patients who live with

wives. The former work is explored first.

Freeman and Simmons (1958) investigated family settings and per­

formance levels of 209 male patients discharged from psychiatric hos­

pitals and in the community over a one-year period. They reported a

high correlation between level of performance and family setting.

Specifically, patients who lived with their parents were found to

have a lower performance level than patients who lived with their 6 wives.

In contrast, patients who lived with their wives had a higher

rehospitalization rate than patients in parental families. Moreover,

differences in family attitudes, personality and behavior of family

members were reported to be associated with level of performance.

Freeman and Simmons (1958) explained:

Mothers, compared with the wives, are more likely to tolerate deviant performance before the admission of the patient to the hospital, as well as between subsequent readmissions. The person with a low level of interpersonal performance is probably less likely to be hos­ pitalized if living in a parental family, as well as less likely to be rehospitalized if returned to the community in a similar state. (p. 153)

Freeman and Simmons and some other researchers refer to families consisting of a spouse as conjugal families. However, the current literature and this study refer to this type family setting as fami­ lies of procreation. 28

From these findings. Freeman and Simmons advanced that sicker patients cluster in parental families, and healthier patients are in families of procreation.

Over a period of 5 years, Freeman and Simmons had two explanations for these findings: tolerance of deviance, and differential demands and expectations. Tolerance of deviance was coined in the 1958 study

(discussed above) and defined as "continued acceptance of the former patient by significant others even when he fails to perform according to the basic prescription of his age, sex roles as these are defined by society" (p. 148). In a later study (1963), they revised the con­ ceptual model from tolerance of deviance to differential demands and expectations. Specifically, Freeman and Simmons postulated that wives place greater demands and expectations on their ex-mental patient husbands than parents place on their ex-mental patient sons. There­ fore, the ex-mental patient husbands have a higher level of post­ hospital adjustment compared to the ex-nental patient sons.

Dinitz et al. (1961) found support for this conceptual model and other findings by Freeman and Simmons in their eight-month follow-up study of 3 76 female patients discharged from Columbus Psychiatric

Institute. The main focus of the study was to determine the extent to which psychiatric and social attributes were predictive of post-hos­ pital outcome. Additionally, the focus was to determine if married patients tended to be less ill than single, divorced and separated patients prior to and after discharge. The findings showed that psychiatric variables (ward assignment, diagnosis, addiction, release and prognosis at discharge) seemed to be relatively unimportant in 29 post-hospital outcome, while social attributes (family setting, socio­ economic status) were accurate predictors of outcome.

To test the hypothesis that married patients tend to be less

sick than single, divorced and separated patients, an analysis was 7 done using four scales on the MMPI (Sc, D, Pt, Hs) and therapists'

ratings of patients at admission and following discharge. The results

revealed that there was no significant relationship between psychiatric disability, marital status, and type family setting at admission and/ or discharge. Thus the findings failed to support the previous specu­

lation by Freeman and Simmons that the sicker patients are unmarried and live in families of origin. However, a significant relationship was found between type family setting and level of performance (high

level of performance is synonymous with good post hospital outcome

and low level performance with poor outcome), Of the 24 patients in

families of origin, few (8.3%) were rehospitalized and 41% were low performers, while 14% of the 159 patients in families of procreation

were rehospitalized and 21% were low performers. The remaining 85

patients lived either alone or in another living arrangement. Of

these, 16% were rehospitalized, and 41% were low performers. Hence,

these findings support the original findings of Freeman and Simmons

(1958) that patients who live in families of procreation are higher

performers and are rehospitalized more often than patients in families

of origin.

7 The four MMPI Scales mentioned above are as follows: Sc - Schizophrenia, D - Depression, Pt - Psychosthenia, Hs - Hypochon­ driasis. Two additional findings were reported: (A) Married women who returned to families of procreation had a higher performance level than single, separated or divorced women, especially when the care of a child was their role; (B) the patients in families of procreation expected more of themselves than patients in parental families. Thus,

Dinitz et al. support the differential demands and expectations notion

(Freeman & Simmons, 195B), and suggest that patients should perhaps be discouraged from returning to parental families or living arrange­ ments where role replacements (others who take the role of the formerly hospitalized patient in the home) are available. Dinitz et al. used an all female psychiatric population. Thus caution should be taken in generalizing these findings to male psychiatric populations.

In another study of post hospital adjustment of mental patients.

Schooler, Goldberg, Booth, and Cole (1967) followed up 254 patients discharged to the community over a one year period. The purpose of the study was twofold: (1) to assess the post hospital adjustment of schizophrenic patients; (2) to assess the patients' premorbid his­

tory in relation to the post hospital adjustment. The data were col­

lected by social workers through interviews and the use of the Katz

Adjustment Scale with patients and their families. There were

several major findings. Firstly, patients who lived with their wives

were more likely to have jobs and better work performance than patients who lived with their parents. Thus, the former were more

likely to be self supporting than the latter. Secondly, patients with

parents performed at a lower level to socially expected activities

than those with their wives. Thirdly, patients who lived with their 31 wives expected more of themselves in terms of performance than those with their parents. Fourthly, a significant relationship was found between supportiveness of the family and overall functioning of the patients. Specifically, the more supportive the family, the higher the level of functioning. Lastly, parental families were more likely to show contention and disagreement than families consisting of a

spouse.

Schooler et al. concluded that "specific characteristics of the

environment to which the patient is to be discharged are of as great,

if not greater importance than his symptom remission in predicting his

overall functioning after discharge" (p. 995).

This view was further advanced by Mannino and Shore (1974) in

their study, "Family Structure, After Care, and Post Hospital Adjust­

ment." The sample consisted of 41 patients discharged from Spring

Grove State Hospital in Maryland who participated in the Family

Service Community After Care Program over a one year period. The

main focus of this program was to assist patients and their families

in coping with post hospital adjustment. The patients were closely

matched by age, marital status, education, race, diagnosis, and treat­

ment. Individual interviews were conducted by social worh students.

Several instruments were used to assess family structure, after care

success, and post hospital adjustment: (1) three instruments

designed by the interviewer to assess family structure (intactness,

marital status, patients' living situation, position in the family,

domestic activities, and general activity level); (2) a rating scale

developed from the Social Adequacy Rating Scale by Pinchall and 32

Rollins (I960); (3) The Katz Adjustment Scale was used to measure post hospital adjustment. A significant relationship was found between family structure/ post hospital adjustment, and program success.

Mannino and Shore reported that "a major element in positive adjustment after leaving the hospital seem to be the assumption of certain role expectations and responsibilities” (p . 83-84). Speci­ fically, patients who have clear expectations and hold responsible key positions in families seem to function best. They further asserted that post hospital adjustment of patients in families of procreation is better than that of patients in families of origin. Hence, the above findings are in agreement with findings of previous studies

(Dinitz et al., 1961; Freeman & Simmons, 1958; Schooler et al., 1967).

However, another finding showed that patients who returned to families of procreation tend to be rehospitalized more often than patients who returned to parental families. This finding is the reverse of find­ ings from some investigations (Dinitz et al., 1961; Freeman a Simmons,

1958, 1963) and support others (Meyer 6 Bogatta, 1959; Miller, 1967).

Further findings by Mannino and Shore showed that the after care program was more beneficial for patients who were not married, live in families of origin, and occupy a peripheral family position as compared with patients who were married, live in families of procrea­ tion, and occupy a central position (breadwinner) in the family.

Mannino and Shore reported that the latter were less likely to need after care services than the former because they (patients in families of procreation) are perhaps more “capable of utilizing available 33 resources in the family and the community" (p. 83)

Ferber, Kligher, Zwerling, and Mendelsohn (1967) provided support for these findings in an investigation of family structure in relation to psychiatric emergencies. In addition, they found that patients Who lived in families of procreation, in intact families, and occupy central positions tended to have more favorable outcomes (less psychi­ atric admissions) in a psychiatric emergency service when compared with patients living in families of origin, in non-intact families, and occupy peripheral family positions.

Race and Mental Illness

After reviewing the literature on race and mental illness, it is evident that conflicting conclusions have been drawn. Numerous studies on schizophrenia have shown blacks to have a higher rate than whites.

As early as 1939, Faris and Dunham found a higher incidence among blacks compared to whites. Since then, others have supported this finding (DeHoyes & DeHoyes, 1965; Frumkin, 1958; Malzberg, 1963; Taube,

1971; Wilson s Lantz, 1957), while some (Jaco, i960; Pasamanick, 1963) have shown the reverse.

In a more recent study on "Depression and Schizophrenia in Hos­ pitalized Black and White Patients," Sinmon, Fleiss, Gurland, Stiller, and Sharpe (1973) reported findings which contradict previous research

(above studies). The sample consisted of 192 hospitalized psychiatric patients (133 whites, 55 blacks, and four of unknown racial back­ ground) , ranging in age from 20 to 50 years. The patients were scored on 45 scales of psychopathology and assigned to categories which 34 included various schizophrenic and depressive diagnosis. The findings revealed no significant difference in the incidence of schizophrenia between black and white patients. However, blacks were found to have a higher rate of depressive psychopathology than whites.

To summarize, there have been conflicting results in the investi­ gations of the relationship between type family setting and adjustment of mental patients. The finding that mental patients who live in families of procreation make a better adjustment than patients in families of origin is a consistent finding and has some generaliz- ability. Less clear, however, is the relationship between differen­ tial tolerance of deviance or differential demands/expectations and type family setting. Furthermore, there is controversy over the type family setting in which patients are more often rehospitalized. Other controversy involve the incidence of psychopathology among black and white mental patients.

Prison Population

For many years researchers have investigated the effect of imprisonment. Some early studies have attempted to obtain indicators of the impact of institutional stay on inmates (Reckless, 1942, 1955} while others have focused on the attitudes of inmates (Bright, 1951?

Galway, 1948; Sabris, 1951). Bright (1951) studied the attitudes of inmates about imprisonment at the Ohio Penitentiary at Columbus, Ohio.

There were five samples (fifty each) of inmates with different lengths of incarceration: three months, fifteen months, three years, over three years. He found support for several propositions: (1) the 35 longer the time served in prison, the more adverse will be the atti­ tudes of the inmates about imprisonment, as indicated by the responses of the inmates to questions concerning the personnel, the program, and the physical facilities of the prison; (2) better prison programs and facilities lead to better attitudes, as indicated by the responses of inmates to questions concerning the program and facilities; (3) the lower paid, non professional staff members create more impact than do the higher-paid professional staff members, as shown by the inmates' nomination of staff members they like best and of staff who have done something favorable for them.

From these findings Bright concluded that by decreasing length of

incarceration, hiring devoted personnel in supervisory positions and providing better programs, prison administrators can enhance the

impact of the institutional stay on inmates. Consequently, the atti­

tudes of the inmates will change.

Heskin et al. (1975) in another study of attitudes of inmates

found that married inmates had negative attitudes toward work and

their role of "father." They suggest that "these attitudes might be

a consequence of the breakdown of the relationship between prisoners

and their families" (p. 156).

Short term imprisonment of married and unmarried males was inves­

tigated by Sandhu (1963). He reported that inmates who had wives and

children felt that imprisonment was harming them (prisoners), but they

were more optimistic about the future than the unmarried inmates. 36

Effect of Imprisonment on the Family Relationship

There is numerous research on the impact of imprisonment on inmates. However, there are few studies on the effects of imprison­ ment on the prisoners' families. Early research on prisoners' families

(Blackwell, 1959; Bloodgood, 1928) has shown that the effects of the enforced separation of the husband is quite devastating to the family emotionally and financially. Morris (1965) stresses that "if a hus­ band fails in his economic role as the chief family breadwinner, he

is also likely to have problems in all his other social roles. If he

is removed from home and placed in an institution, the effect on the

lives of all the other members of the nuclear family might be assumed to be quite severe" p. 11).

Goffman (1968) points out that the prison establishment destroys

family life of inmates. He asserts:

They create and sustain a particular kind of tension between the home world and the insti­ tution world and use this persistent tension as strategic leverage in the management of men. The recruit, then, comes into the establishment with the conception of himself made possible by certain stable social arrangements in his home world. Upon entrance, he is immediately stripped of the support provided by these arrangements. (p. 267)

Further study of the separation of the prisoner husband from the

family was conducted by Schneller (1975) in his investigation of the

effects of prison life on black families. The sample consisted of

the wives of 93 black inmates who were incarcerated in the District of

Columbia for five years or less. All of the wives were living with

the husbands prior to incarceration. Schneller designed a 15 item 37

Family Change Scale to measure the changes occurring in the family as a result of the husbands' incarceration (scores on the scale ranged from 1-5, with 1 being the lowest score and 5 the highest). This scale consists of three sub-scales: Social-Acceptability-Change Scale,

Economic-Change Scale, and Emotional-Sexual Change Scale. Other instruments used were the Locke-Short-Marital Adjustment Scale (with minor modifications) and two open-ended questions concerned with changes in the family subsequent to the inmate husband's incarcera­ tion. The findings revealed that 76 wives experienced some loss of affection, and 71 indicated sexual frustration. The Emotional-Sexual

Change Scale showed the highest frequency of adverse changes. Economic hardships were reported on the Economic-Change Scale. Some wives received welfare checks, and others were employed while several fami­ lies were forced to beg. On the open ended questions, the majority of the wives reported very negative changes as a result of the incarcera­ tion, such as 32 wives complained of loneliness, 22 complained of nervousness and frequent crying, and 19 complained of depression.

The findings from Schneller's study led him to the conclusion that

"the incarceration of the married offender actually results in his family being punished" (Schneller, 1975, p. 32). Schneller suggests

that unlimited visiting privileges for families (conjugal visiting)

and furlough programs be permitted on a large scale.

Family Contacts with Inmates

Holt and Miller (1972) contended that not only do the families

benefit from visitation programs, but also inmates who participate 38 have less difficulty on parole. They commented that "a strong and consistent positive relationship exists between parole success and maintaining strong family ties while in prison" (p. v.).

This notion was further advanced by Adams and Fischer (1976) in their study of "The Effects of Prison Residents' Community Contacts on

Recidivism Rates." The purpose of the study was to focus on the rela­ tionship between recidivism and the number of contacts inmates had with the community (wives, parents, other relatives and significant others) while in prison. Adams and Fischer postulated that residents with more contacts do not return to prison as often as those with low or no contacts. Contacts with the community was determined by the number of letters and visits by family and significant others prior to release. These letters and visits were considered measures of strength of family and community relationships. Recidivism was defined as return to prison within two years following release. The sample con­

sisted of 124 inmates paroled in 1969 and 197 0. The unmarried inmates

accounted for the largest portion of the population (66%) while only

15% were married, 21% divorced and 2% widowed. The findings showed

that there were 30 (24%) recidivists and 94 (76%) non-recidivists.

The recidivists were compared with the non-recidivists on several

variables: number of letters received from wives, parents and other

relatives, plus overall total letters; number of visits received, plus

overall total of letters. The hypothesis was supported, non-recidivists

received more contacts with family and friends than recidivists.

Adams and Fischer caution that these findings should not be used in

making generalizations about the effectiveness of family contacts in 39 deterring recidivism.

The importance of maintaining the inmate-family relationship has been further emphasized by Pueschel and Moglia (1977). They argue that the correctional system should include the "concept of family planning" in programs for the following reasons:

1. For socialization or rehabilitation to occur, the offender

should be seen as part of a social system of people signifi­

cant to him/her— particularly his/her family.

2. There is a need for offenders to see families as often as

possible because community ties are kept strong by these

visits.

3. After release, family ties continue to be useful resources

for the ex-offender's adjustment to a free society. (p. 375)

In summary, the frequent family contacts are seen by some (Ingram

& Swartsfager, 1973) as effective treatment for prisoners and a way of maintaining close family ties. Others (Adams & Fischer, 1976; Holt &

Miller, 1972) suggest that the contacts increase the likelihood of inmates being paroled and pave the way for a better adjustment in the community.

Mentally 111 Offender Population

In our society, the mentally ill offender, sometimes referred to as the criminally insane, is perhaps considered the most deviant of deviants and carries the double stigma of mental illness and criminal­

ity. A large segment of this population is removed from society and

locked in the back wards of maximum security hospitals. Consequently, 40 this group is a forgotten population. However, many of these mentally ill offenders have been incarcerated, determined incompetent and coimitted to maximum security hospitals for a short time, while others have been hospitalized for long periods of time and discharged back to the community, ill prepared to successfully re-enter family and community life.

Upon discharge from mental hospitals, many of these mentally ill offenders find a difficult transition from maximum and minimum security hospital settings to community life. Some offenders are chronically ill, indigent, and lack vocational or social skills necessary to func­ tion in the community. In addition, many are fearful of re-entering an unfamiliar environment where they lack knowledge, confidence and family support. These are marginal individuals in their mid-thirties, mostly single and with weak family ties (Steadman & Cocozza, 1974).

Beyond this, very little is known about the mentally ill offender either in or out of the institutional setting. Much of the literature that exists deals with legal aspects or the issue of dangerousness.

This literature is reviewed in this section.

Legal Aspects

The legal aspects involving the institutionalization of mentally

ill offenders are highly complex and vary considerably in different states. Most individuals first come to the attention of the criminal justice system, are incarcerated and labeled offenders. Second, they

are diverted from the criminal justice system to the mental health

system for psychiatric reasons. Consequently, they become products of 41 both systems and are labeled mentally ill offenders. The one excep­ tion to this procedure is with the "dangerously mentally ill" patients. They are first admitted to civil mental hospitals and then transferred to hospitals for the criminally insane.

Discussed below are four legal channels in which individuals can be committed to hospitals for the criminally insane and labeled men­ tally ill offenders (see Figure 1). These are listed in order from lowest to highest percentage of cases found in each category.

Adjudication in a Court and Found Not Guilty of Coirtnitting a

Crime by Reason of Insanity (NGRI): The Not Guilty By Reason of

Insanity cases comprise a very small number of cases. Morris (1971) estimates that 2 percent of all the criminal trials involve these type cases, while Steadman and Cocozza (197 4) estimates 4 percent. Although these cases represent a small percentage of individuals committed to hospitals for the criminally insane, research on the NGRI cases reveal lengthy hospitalizations for indefinite periods of time (Lewin, 1968;

Morrow & Peterson, 1966). Prior to 1960 very little was known about these cases. In recent years, however, these NGRI cases have become more visible. Some of the more well known and controversial Not Guilty

By Reason of Insanity cases have been those of Sirhan Sirhan, Jack Ruby, and William Milligan.

There are numerous provocative issues raised by the Hot Guilty By

Reason of Insanity Cases which receive widespread legal, psychiatric, and public attention. For example, one provocative issue is whether individuals determined Not Guilty By Reason of Insanity should be institutionalized indefinitely or whether they have the right to be Ficjure 1: Channels in which individuals can be committed to committed be can individuals which in Channels Ficjure 1: Community Prison optl o teciial isn (tamn & (Steadman 17) p. insane Cocozza, criminally the for hospital a Maximum Hospital Security Community

Mental Civil Hospital Community

42 43 reevaluated in a certain period of time.

Transfer from a Civil Mental Hospital to a Hospital for the

Criminally Insane and Determined as Dangerously Mentally 111: The dangerously mentally ill, like the NGRI cases comprise a small group of mentally ill offenders, approximately 10 percent or less (Steadman

& Cocozza, 1974). The label "dangerously mentally ill" is given to persons transferred from civil psychiatric hospitals to hospitals

for the criminally insane for displaying "dangerous behavior" while in the civil mental hospitals (minimum security hospital).

Determined Incompetent to Stand Trial: The incompetency defen­ dants make up approximately 40 percent of the mentally ill offender population (Steadman & Cocozza). The determination of incompetency is primarily based on psychiatric evaluation and testimony. If the psychiatrists (usually two) determine that the defendant is incompe­

tent to stand trial, a hearing will be scheduled and judicial deter­ mination made. In most cases when the psychiatrists find defendants

incompetent, the court will usually concur (Pfeiffer, Eisenstein, &

Bobbs, 1967). The basic legal question relates to whether the person

is of sound mind to comprehend the court proceedings and charges

agaxnst him or her.

Findings from case studies reveal that approximately 26 percent of

all cases in which competency is questioned result in incompetency

determinations (Steadman & Cocozza). Some criticism of incompetency

hearings has come from researchers (Cooke, 1969; Hess & Thomas, 1963;

Rosenberg & McGarry, 1972) who report inconsistencies in the incompe­

tency proceedings. 44

Transfer from Prison to a Hospital for the Criminally Insane Via

a Psychiatric Evaluations Almost half of the mentally ill offender population falls under this category. First, the person is arrested,

convicted and sentenced. Second, a psychiatric evaluation is made,

usually at the request of the correctional staff, and often because

the staff reports that the inmate is displaying bizarre behavior. The

primary factor which leads to the transfer is the determination of the

need for psychiatric treatment. The transfer procedure from prison

to hospital for the criminally insane varies in different states and

is the least understood of the four channels. Thus, it is with this

procedure that numerous legal problems arise which result in various

court decisions regarding the rights of patients. Some of these court

decisions are discussed below.

Landmark Cases

In recent years there have been landmark court cases involving

the rights of mentally ill offenders. One such case is the Baxstrora v.

Herold case of 1966. Johnnie Baxstrom, a mentally ill convicted felon

had been civilly committed following the expiration of his penal

sentence without a civil hearing or jury review. He petitioned for a

Writ of Habeas Corpus. In a unanimous decision, the U.S. Supreme Court

ruled in favor of Baxstrom, requiring the State of New York to provide

a civil hearing for Baxstrom and other mentally ill offenders involun­

tarily committed to the two New York criminally insane hospitals

following an expired prison sentence. 45

The Supreme Court ruled in favor of Baxstrom for two reasons:

First, the State of New York offered no civil hearings for mentally ill offenders. Second, Baxstrom had not been determined dangerous.

Yet, he was assumed to be dangerous to himself and others without justification.

This precedent setting decision had great impact on the institu­ tional life of all mentally ill offenders confined to New York hospi­ tals for the criminally insane. Rather than provide jury reviews for the mentally ill offenders in the two maximum security hospitals (Danne- mora & Matteawan), the New York Department of Mental Hygiene trans­ ferred 920 males and 47 females to civil mental hospitals. Many of these patients had been hospitalized for long periods of time.

Another landmark case which involves the rights of mentally ill offenders is the 1974 Michigan case of People vs. McQuillan. James

McQuillan was charged with assault-intent to rape and indecent liber­ ties in connection with a sexual attack on a female minor (Benedek &

Farley, 1978). In a local court hearing, McQuillan was adjudicated Not

Guilty By Reason of Insanity. However, the court recommended commit­ ment to the Center for Forensic Psychiatry for a competency evaluation, and as a result, McQuillan was determined conpetent to stand trial.

He was then turned over to the Department of Mental Health, and subse­ quently confined to a state hospital for the criminally insane. After being in the hospital for two years and no decision made about his status, McQuillan filed a Writ of Habeas Corpus.

The case went to the Supreme Court by way of the Local Court of

Appeals. The Supreme Court ruled that McQuillan’s confinement was 46 unconstitutional, and concluded!

Neither due process nor equal protection pro­ hibit a period of temporary statutory deten­ tion for examination and observation of one found not guilty by reason of insanity. How­ ever, upon coirpletion of the examination and observation, due process and equal protection require that a defendant found not guilty by reason of insanity must have the benefit of commitment and release provisions equal to those available to those civilly committed (392 Michigan case).

The Supreme Court decision further directed that reexamination of

patients previously found not guilty by reason of insanity must take

place within sixty days. If determined mentally ill, a civil commit­

ment procedure must be initiated comparable to that used for other

civilly committed patients.

Patients who had been found not guilty by reason of insanity and

confined for indefinite periods of time were affected by this unprece­

dented decision in the McQuillan case. In Michigan, for example, the

Department of Mental Health was required to reevaluate all mentally

ill offenders of this status.

An unprecedented State Court case which has brought much public

attention to patient rights is the Davis v. Watkins decision of 1974.

This is a landmark case in which the U.S. District Court of Ohio ruled

in favor of right-to-treatment for John Davis, and other Lima State

Hospital patients. Further, this court decision was enacted to pro­

tect patients' rights, and consequently requires Lima State Hospital

(hospital for the criminally insane) to develop individual treatment

plans for patients. 47

This landmark case is significant to the present study because the participants in the study were primarily released from Lima State

Hospital as a result of the Davis V. Watkins decision.

In summary, the legal aspects involving the hospitalization of the mentally ill offenders pose numerous problems in the correctional and mental health systems. A major problem is transferring patients from the criminal justice system to the mental health system. In some instances, transferring patients from one facility to another has resulted in violation of patient rights as in the landmark cases of

Baxstrom v. Herold, and People v. McQuillan. The right-to-treatment violation was challenged in the Davis v. Watkins case of Ohio. In the

Baxstrom v. Herold case the issue of dangerousness was very pertinent to the court decision. It is with the issue of dangerousness that the researcher now focuses attention.

Issue of Dangerousness

With the current emphasis in mental health on deinstitutionaliza­ tion and community based programs, the issue of dangerousness is vitally important to the release of mentally ill offenders to the community. The osychiatric decision as to whether the patient is dan­ gerous to himself or others can result in either an indefinite maximum security hospitalization or a short term hospital stay and subsequent return to the community. According to Steadman and Cocozza (1973), the decision to release the mentally ill offenders is perhaps most strongly influenced by their perceived dangerousness and threat to the community. 48

Assessment of Dangerousness

The question is raised: What is "dangerousness" and how can it be determined? While the investigations of dangerousness of mentally ill ex-offenders are minimal and largely speculative, nevertheless, some have addressed the question (Halleck, 1967; Katz & Goldstein,

I960; Rappaport & Lessen, 1965; Rubin, 1972; Shah, 1969; Steadman &

Cocozza, 1972, 1974; Steadman & Keveles, 1974), A review of this literature leads one to conclude that there is a lack of consensus on what ''dangerousness” is and how it is to be measured.

The major problems identified by Katz and Goldstein (1960) are the vagueness of definition, and different uses of dangerousness in both research and legislation. They found a wide range of definitions, most of which focus on crimes committed and suggest a person is dangerous if he or she committed: (1) a crime; (2) a felonious crime; (3) only a crime seen as harmful to the victim; (4) only a violent crime;

(5) violence against oneself; (6) only a crime in which the insanity issue was raised; (7) any combination of the above. Another problem, this identified by Rappaport and Lessen (1965) is the lack of criteria given in research to determine who might be dangerous. Halleck (1967) expresses vehement dissatisfaction with research and psychiatric evaluations of dangerous behavior when he writes:

Research in the area of dangerous behavior (other than generalizations from case material) is practically non-existent. Predictive studies which have examined the probability of recidivism have not focused on the issue of dangerousness. If the psychiatrist or any other behavioral scientist were asked to show proof of his predictive skills, objective data could not be offered. (p. 314) 49

Halleck goes on to conclude that psychiatric evaluation of dangerous behavior lacks empirical substance and is a matter of subjective im­ pression and clinical judgment.

In response to the need for a substantive definition and measure of dangerous behavior, Rubin (1972) labels people as dangerous if they commit an assaultive act against persons which includes: criminal homicide, robbery, aggravated assault, and forcible rape. This defini-

3 tion was employed in the 1974 Baxstrom study (which is discussed later in this chapter).

In the original Baxstrom study, Steadman and Keveles (1972) fol­ lowed 920 males and 47 female patients over a four year period (1966-

1970). These patients were transferred from the two Hew York hospitals for the criminally insane to civil mental hospitals and some were dis­ charged to the community. The results of the four year study showed tliat half of the Baxstrom population remained in civil mental hospi­ tals, 27 percent in the community, 14 percent deceased and three per­ cent in correctional facilities or hospitals for the criminally insane.

In the same study, Steadman and Keveles raised the question:

How could dangerousness of the Baxstrom population be determined?

After exploring many possibilities, they decided to measure dangerous­ ness by behavior that led to arrests and convictions. They found

Q °The 1974 Baxstrom study is one of a series of retrospective studies on mentally ill offenders (Baxstrom population) who were transferred from two Hew York hospitals for the criminally insane to civil mental hospitals as a result of a Supreme Court decision (see Legal Aspects). Some were discharged to the community. 50 that a large number of arrests and convictions were for minor crimes

(i.e., intoxication, disorderly conduct, and vagrancy). Thus, such acts were not considered dangerous behavior.

Further study of dangerousness of the Baxstrom patients (Stead­

man & Cocozza, 1973) focused on the relationship between various indi­

cators of dangerousness and decisions to release patients to the

community. The sample consisted of 176 Baxstrom patients transferred

against psychiatric recommendations from the two criminally insane

institutions in New York (Dannemora & Ilatteawan) to civil mental

hospitals. The indicators of dangerousness were: previous mental

hospitalizations, criminal histories, length of hosi^italization, physi­

cal health, and incidents of hospital assaults. The findings were

striking. All of the indicators of dangerousness proved to be of

minor importance in the decision to release patients to the community.

However, a significant relationship was found between the decision to

release patients to the community and significant others' willingness

to accept the patients.

In another attempt to measure dangerous behavior of the Baxstrom

population, Steadman and Cocozza (1974) refined the measurement of

dangerousness (originally measured dangerousness by behavior that led 9 to arrests and convictions) to include the Legal Dangerousness Scale

and Rubin's definition of dangerousness. As mentioned previously,

q The Legal Dangerousness Scale is a Scale composed of four areas of previous criminal activity: juvenile record, number of previous arrests, conviction of violent crimes, and severity of Baxstrom offense. 51

Rubin defines dangerousness as violent: assaultive behavior against persons. The sample consisted of 98 Baxstrom patients released to the community, 14 of which displayed dangerous behavior. Further findings revealed that two factors were highly related to dangerous behavior: age and Legal Dangerousness Scale Score (LDS). Patients determined dangerous were under 50 years old and had a Legal Dangerousness Score of 5 or more (scores range from 0 to 15, with the lower score indi­ cating non-dangerous behavior and higher score dangerous behavior).

Even with the use of the Legal Dangerousness Scale and the appli­

cation of Rubin's definition of dangerousness, the finding of the 1974

Baxstrom study remained consistent with the previous Baxstrom study

finding that only a snail percentage (15 percent) of the Baxstrom

patients displayed dangerous behavior when released.

Dangerousness as a Factor in Public Acceptance

As a result of the finding in the 1974 study, Steadman and

Cocozza concluded that the release of the criminally insane is less

influenced by dangerousness tnan other factors. As previously men­

tioned, one factor is family or significant others' willingness to

accept the patients after release from the hospital. This view is

supported by labeling theorists (Becker, 1963; Lemert, 1951; Scheff,

1963, 1964, 1966, 1975) and other researchers (Greenley, 1972; Shah,

1969).

The Baxstrom follow-up points out two important things: (1) the

environment that mentally ill offenders return to is vitally important

to their adjustment; (2) a small percentage of this group who return 52 to the community are considered likely to be dangerous. Nonetheless, they are stereotyped by a society that lacks understanding and facts.

Steadman and Cocozza (1974) exemplify this feeling when they write:

Thus, the criminally insane have become stereotyped as infamous assassins; fierce stranglers, black rapists, or decrepit child molesters. Such is not the case. Those people called criminally insane are predominantly non-violent individuals charged with few sex crimes who suffer the fate of many other stereotyped groups— that is, they are seriously handicapped in their apprehension, custody, treatment and community-reintegration by the ignor­ ance and fear of others. (p. 2)

Despite the inherent problems of defining and predicting danger­ ous behavior, it is viewed by mental health professionals as an appropriate reason for differential treatment or perhaps non-treatment, and has public, medical, and legislative support (Steadman 6 Cocozza,

1974).

In summary, the research on dangerousness of mentally ill offend­ ers is minimal and lacks strong empirical evidence. However, it pre­

sents some interesting findings. More longitudinal research is * clearly needed in this area. CHAPTER IV

METHOD

Participants

The participants in this study were 60 mentally ill offender males transferred from Lima State Hospital (maximum security hospi­ tal) to five civil mental hospitals in Ohio. These civil mental hospitals (less restricted hospital settings) are as follows: Central

Ohio Psychiatric Hospital, Dayton Mental Health Center, Longview State

Hospital, Massillon State Hospital, and Western Reserve Psychiatric

Hospital.

The patients ranged in age from 25 to 39 years with a mean age of 29 years. All were diagnosed as schizophrenic and had committed

crimes other than person crimes, such as vagrancy and burglary. They were selected and matched on the basis of the following variables:

type family setting, race, age, education, length of time spent in

the maximum security hospital and civil mental hospitals.

Procedure

The 60 participants were selected from two sources. First,

names of patients were obtained from the office records located at

The Ohio Department of Mental Health and Mental Retardation, Division

53 54 of Forensic Psychiatry. This Division keeps records of patients discharged from Lima State Hospital. The second source was social workers at the five civil mental hospitals. They were contacted

(by letters and telephone calls) and asked to submit names of Lima

State Hospital patients who would be discharged within the next four months. From these sources, two lists of 30 names each were compiled based on the following selection process: (1) patients who were to return home with parents (families of origin) were placed on one list, and those who were to return hone to wives (families of procreation) were placed on the other list} (2) the groups were closely matched by race (15 whites, 15 blacks with parents and wives), age (25-39), edu­ cation (with at least an eighth grade level required)} (3) the patients selected had spent one to five years at the maximum security hospital and from three to nine months at civil mental hospitals}

(4) they had been either notified of discharge or the hospital staff had planned to discharge them within a four month period. The infor­ mation on the status of the patients' discharges was ascertained from the social service departments at the civil mental hospitals. Other pertinent information, such as demographic and institutional data

(incarcerations, hospitalizations, and diagnosis) were obtained from

the patients' charts. Through the authorization of The Department of i-lental Health and Mental Retardation, the charts were made available and reviewed at each hospital.

Individual interviews with patients were arranged by contacts

with nursing staff on the prospective wards and conducted on the wards.

The patients were greeted by the researcher and told the nature of the 55 study (see Appendix B for script). They were further told that their participation was voluntary, and that they were free to leave at any time during the interview if they so desired.

After spending some time to establish rapport, the patients were asked to read and sign two consent forms. The Ohio State University and The Dex^artment of Mental Health and Mental Retardation consent forms (samples of the consent forms are in Appendix C). The patients were then asked if they had any questions or comments. Following the questions and/or comments, if any, the researcher administered three

scales to the patients: The Tennessee Self Concept Scale, Katz

Adjustment Scales (Subject Rating Scales SI and S3), and Family

Contact Interview Index. Each patient interview took approximately one hour.

The head nurses and social workers on each ward were interviewed

and asked to complete the Crawford Psychological Adjustment Scale on

each patient. These scales were returned to the researcher either

face-to-face at the hospitals or mailed.

Instruments

The four instruments used in the present study are discussed

below. In addition to these instruments, the researcher designed a

brief form to collect demographic data, as well as information on

incarcerations and hospitalizations (see Appendix D). 56

Tennessee Self Concept Scale

While numerous instruments have been employed to measure self concept in recent years, many of these instruments are limited in application and poorly standardized. However, the Tennessee Self

Concept Scale (TSCS) was developed by William Fitts (1965) in conjunc­ tion with the Tennessee Department of Mental Health to meet various applications and was well standardized. As a result of this, and the fact that it is multidimensional in its description of the self con­ cept, the Tennessee Self Concept Scale is widely used.

Fitts (1965) believes that the self concept is a central and critical variable in studying and understanding human behavior. He states:

The individual's concept of himself has been demonstrated to be highly influential in much of his behavior and also to be directly related to his general personality and state of mental health. Those people who see themselves as undesirable, worthless, or "bad" tend to act accordingly. Those who have a highly unrealis­ tic concept of self tend to approach life and other peoiile in unrealistic ways. Those who have very deviant self concepts tend to behave in deviant ways. Thus, a knowledge of how an individual perceives himself is useful in attempting to help that individual, or in making evaluations of himself. (p. 1)

With this perspective on self concept, Fitts and associates at the Tennessee Department of Mental Health began to develop a self con­ cept measure. Originally, they compiled a large pool of items from two sources: (1) items developed from several other self concept measures (Balester, 1956; Engel, 1956; Taylor, 1953); (2) items 57 derived from written self descriptions of patients and non-patients.

After the items were edited, seven psychologists were selected as judges to classify the items by a 3 x 5 scheme employed on the score sheet. The 3 x 5 scheme is a phenomenological system developed for classifying self descriptive items by rows (Identity, Self Satisfac­ tion, Behavior), and columns (Physical Self, Moral Ethical Self,

Personal Self, Family Self, Social Self). This unique 3 x 5 scheme has added to the content validity of the Tennessee Self Concept Scale by insuring that the system (used for Row scores and Column scores) i is dependable, and categories are logically meaningful and publically communicable (Fitts, 1965). Moreover, it enhances validation pro­ cedures .

Validation procedures used are of four kinds: content validity, discrimination between groups, correlation with other personality measures, and personality changes under particular conditions. The re-test reliability is in the high 80's, sufficiently large to warrant confidence in individual difference measurement (Bentler, 1972).

The Tennessee Self Concept (TSCS) scale consists of an answer sheet and a test booklet which contains 100 self-descriptive statements to which subjects respond along a five-point scale, describing percep­ tions of themselves. The response alternatives range from completely false (number 1) to completely true (number 5). Of the 100 items, 90 items assess the self concept and 10 assess self criticism. There are several aspects of the self revealed in the Tennessee Self Concept

Scale which receive subscores: Identity, Self-Satisfaction, Behavior,

Physical Self, Moral-Ethical Self, Personal Self, Family Self and 58

Social Self. In addition, other pertinent scores are derived: Total

Positive Score, showing the overall level of self esteem, Variability

Score, showing the amount of consistency over different areas of self perception, and Distribution Score, reflecting the extremity of response style.

On the test booklets and answer sheets, the numbers are not sequentially arranged. Rather, they are matched up horizontally with the correct column on the answer sheet and vertically with the correct number. The subjects respond to every other item. After completing the first page, the subjects repeat the procedure making sure all 100 answers are given. Hence, the subjects need supervision to clarify the procedure and insure the answers are filled out properly. 10 Tiie scale requires at least a sixth grade reading level and can be used with subjects age 12 and higher. The average time it takes to complete the scale is 10 to 20 minutes. As mentioned earlier, the

Tennessee Self Concept Scale has been widely used as a research tool.

The results obtained from previous use of the Tennessee Self Concept

Scale have been impressive and consistent across different popula­ tions as evidenced by research on psychopaths (Tamayo & Raymond, 1977), alcoholics (Gross & Adler, 1970), offenders (Fitts, 1965; Duncan, 1966), and delinquents (Dietche, 1959; Fitts & Hamner, 1969). These studies show uniformly low levels of self esteem as contrasted with controls reflected in the total positive scores.

^There were no problems encountered with the reading level of participants in the present study; all had at minimum an eighth grade reading level. 59

The Scale can be administered to normal or disturbed clients. It is considered a valuable instrument in differentiating normals from psychiatric patients (Number of Deviant Scores Scale). Furthermore, the Tennessee Self Concept Scale serves as a link to bring together many research and clinical findings in further understanding human behavior.

The user can choose between two different forms of the Tennessee

Self Concept Scale: Clinical and Research Form, and Counseling Form.

Both forms use the same test booklet and test items. The difference in the forms lies in the types of scores obtainable and kinds of pro­

files available. While the Counseling Form is quicker and easier to

score since it deals with fewer variables and scores, the Clinical and

Research Form is much more extensive in providing scores and profile data. Because the Clinical and Research Form provides more informa­ tion on the self concept and has a research focus, it was employed in

this study.

The scores used in the present study are as follows:

Identity— The individual describes how he or she perceives him­

self/herself .

Self-Satisfaction— The individual describes how he or she feels

about himself/herself.

Behavior-— The individual's perception of his or her behavior.

Physical Self— The individual's view of his or her physical

appearance.

Moral-Ethical Self— The individual's perception of his or her

moral worth, relation to God, and feelings about religion. 60

Personal Self— The individual’s feelings of adequacy and personal

worth.

Family Self— The individual’s feelings of adequacy and worth as

a family member.

Social Self— The individual's feelings of adequacy and worth in

relation to others in a social situation.

Self-Criticism— The individual's criticisms of himself or herself.

Number of Deviant Score— A measure of psychological disturbance

which is revealed by the number of deviant features on the

Tennessee Self Concept Scale.

While there are scales in the Tennessee Self Concept measure which are indicators of specific types of psychopathology and scores which measure response set, these scores were not used in this study since they do not pertain directly to self concept.

In conclusion, the criteria used in this study to select the self concept measure were: adequate standardization, high reliability and validity, wide use among different groups, and vast information pro­ vided by the instrument. The Tennessee Self Concept Scale met all of these criteria. In addition, it provides more opportunity to study self concept in greater depth and scope.

Katz Adjustment Scales

The current trend in shorter psychiatric hospitalizations or mental patients, and the increase in discharges to the community, has

created a greater need for assessment of both hospital adjustment and

post hospital adjustment. However, in recent years many mental health 61 professionals have focused attention on the post hospital adjustment of psychiatric patients while disregarding the hospital adjustment. This is evidenced by the increased number of instruments developed for assessing post hospital adjustment, and the few available for assessing patient adjustment during the hospitalization.

Assessment of patients * hospital adjustment is essential in making predictions about the post hospital outcome. In addition, this can help determine the type care and treatment patients need upon dis­ charge, thus enhancing the patients' chances of remaining in the com­ munity for longer periods of tine.

Adjustment is a multifaceted dimension (Katz & Lyerly, 1963).

Some traditional measures of adjustment {Community Adjustment Profile, and Distress Checklist) basically assess some parts of it, e.g., psychi­ atric symptomatology or patient treatment. However, there is a widely used multidimensional measure of adjustment which meets this require­ ment, the Katz Adjustment Scales designed by Katz and Lyerly.

The Katz Adjustment Scales have been successfully used in numer­ ous studies (Graham, Lilly, Faolini, Friedman, Knoick, 1974; Hogarty,

Gerard, & Kat2 , 1968; Soskis, & Bowers, 1969; Stewart, Selkirk, a

Sydiaha, 1969). Vestre and Zimmerman (1969) reported on the validity of the Katz Scales and emphasized their usefulness as research tools.

The Katz Adjustment Scales were designed to assess adjustment in

a broad range of mental disorders prior to hospitalization and/or during community follow up. Moreover, these scales were designed to measure adjustment on several levels: patient's symptoms, social behavior, home activities, and free time activities. Information on 62 these characteristics is obtained from both patients and significant

others (relatives and others) with the two types of Katz Scales, the R

(Relative) and S (Subject) Scales. Both of these scales consist of

five forms each. Two of the Subject Rating Scales (Si and S3) are

used in the present study.

The Subject Rating Scale (Si) is a 55 item Symptom Discomfort

measure which describes somatic nood, and psychoneurotic symptoms. It

is a modification of the John Hopkins Distress Checklist designed by

Parloff et al. (1954).

The Level of Expectation Scale (S3) consists of 16 items which

describes the patient's expectations to performance of socially

expected activities. The patient indicates whether he/she expects to

be involved in activities (social activities, self care, home activi­

ties) , "some," "regularly," or "do not expect to be doing."

In conclusion, the Katz Adjustment Scales, Si and S3 were used in

the present study to measure patient symptoms and expectations prior

to discharge from civil mental hospitals. The decision to use these

scales was based primarily on two considerations: wide application

and adequate standardization.

Crawford Psychological Adjustment Scale

The Crawford Psychological Adjustment Scale is one of the few

instruments available to meet the need for both inpatient and out­

patient assessments. This scale was designed by Paul Crawford (1968)

to describe and measure psychological adjustment in behavioral terms.

It is a 25-item instrument derived from a factor analytic procedure. 63

The items are rated by mental health professionals on a five-point scale which ranges from "adequate to inadequate." There are six cate­ gories which are scored. These are as follows: Social-Economic-

Environmental Competence, Derangement of Thought Process, Physical

Behavior, Communication Skills, Social Acceptability, and Management of Hostility.

The normative data were collected from four groups: psychopaths,

Psychotics, Mentally Defectives, and Schizophrenics. These four groups were compared with normals on each behavioral item. This Scale correlates with age, education, and WAIS scores. The estimated reli­ ability is .65 with .93 for internal consistency and interjudge reli­ ability of .59.

In summary, the Crawford Psychological Adjustment scale was used in the present study to measure adjustment of inpatients in behavioral terms. It has been used previously in hospital settings and has shown to be an appropriate and objective measure of hospital adjustment.

Family Contact Interview Index

In addition to the Tennessee Self Concept Scale, Katz Adjustment

Scales (SI and S3), and the Crawford Psychological Adjustment Scale,

a 26 item Family Contact Interview Index has been designed by the

researcher. This Index was developed to obtain quantitative and

qualitative assessments of contacts the patients have with their fami­

lies. Specifically, the questions focus on patients' contacts with

their families as determined bj the number of letters, telephone

calls, and visits. Studies (A-lams 6 Fischer, 1976; Holt & Miller, 1972i Ingram & Swartzfager, 1973) on family contacts with inmates reveal that letters and visits are considered significant measures of strength of family relationships.

The questions on the Family Contact Interview Index were shown to staff persons at The Department of Mental Health and Mental Retardation and The Ohio State University. They agreed the questions are relevant and have face validity. CHAPTER V

RESULTS

The data were analyzed using the Statistical Analysis System

(Barr, Goodnight, Sell, & Helwig, 1976) computer program at the

Instruction and Research Computer Center of The Ohio State University.

To test the five hypotheses, several statistical procedures were utilized. These are as follows! analysis of variance, t-test, Pear­ son product moment coefficient of correlation, and computations by the researcher of the participants' responses to open-ended questions on the Family Contact Interview Index.

Although there are significant main effects (analyses of variance)

in the present study which suggest significant differences between

groups (type family, race, type respondent), the researcher elected to be conservative in the statistical analyses. Because the nature of

the hypotheses of the present study are nondirectional (not predicting

the specific direction of difference), two-tailed t-test values are

used. In utilizing the two-tailed t-tests some true differences

(reflected ir. significant main effects) may have been discounted, thus

diminishing the significant findings of the study. It was felt, how­

ever, that since this is one of the first self concept and adjustment

studies on the mentally ill offender population, it is important to

take a conservative approach. Being conservative lessens the chance

65 66 of a Type I error. To avoid Type I and Type II errors is essential in conducting research. A primary consideration, however, in psychologi­ cal research is to avoid a Type I error over the Type II error (Hays,

1973).

Hypothesis One

There will be a significant difference in self concept due to type family (families of origin, families of procreation) and race.

A 2 x 2 (type family x race) analysis of variance was computed and revealed no significant main effect of type family and race on overall self concept, F(l,56) = .12, F^(l,56) = 1.58, respectively. However, on one Tennessee Self Concept subscale, Moral-Ethical Self, a significant

(£ < .05) main effect was found for race (presented in Table 1). Other subscales of the Tennessee Self Concept Scale (Self criticism. Family

Self, and Social Self) were marginally significant or approached sig­ nificance (£ < .10), while others (Identity, Self Satisfaction, Behav­ ior, Physical Self, Personal Self, and Number of Deviant Score) showed no significant main effects for or interactions between type family and race. A summary of these data are presented in Table 2.

Hypothesis Two

There will be a significant difference in the assessment of mentally ill offenders1 hospital adjustment due to: type family, race, and type respondent (nurses versus social workers).

The results of a 2 x 2 x 2 (type family x race x type respondent) analysis of variance of the Crawford Adjustment Scale yielded no 67

Table 1

Means of the Tennessee Self Concept Subscale,

Moral-Ethical Self, by Race

Race n Means

White 30 49.03a „ b Black 30 42.27

Note. The Tennessee Self Concept Manual (Fitts, 1965) suggests that scores at the mean (50) to one Standard Deviation (+ or -10) from the mean indicate an average level of "moral worth," Scores above this range indicate positive self description while scores below this range indi­ cate diminished self description. The (a) score is significantly .05) higher than the (b) score. 68

Table 2

Main Effects and Interactions of Type Family and

Race on the Tennessee Self Concept Scale

and its Subscales

Tennessee Self Concept Type Type Family Scale df Family* Race* x Race*

Total Self Concept 1 .12 1.58 1.11

Self Criticism 1 .36 2.09 3.35*

Identity 1 .01 2.21 .87

Self Satisfaction 1 .28 1.03 .76

Behavior 1 .30 1.69 2.04

Physical Self 1 .02 1.13 .04

Moral-Ethical Self 1 .40 4.47** 1.44

Personal Self 1 .04 1.76 .32

Family Self 1 .23 1.52 2.97

Social Self 1 1.30 .26 2.79

Humber of Deviant Scores 1 .79 .02 .22

aThe Analysis of Variance F ratios are listed under the variables.

*£ < .10 < .05

Note. Sum of Squares and Mean Squares are presented in Tables 20-22 (Appendix A ). 69 significant main effects or interactions related to type family and race on total hospital adjustment. There was, however, a significant main effect of type of respondent (nurses, social workers) on the assessment of patients’ hospital adjustment, E^(l,56) - 13.43, £ < .01. Applying a more conservative test to determine differences between nurses and

social workers, a two-tailed t-test was computed and showed that the

nurses perceived the patients to be more maladjusted (Crawford Adjust­

ment score), M56) = 1.83, £ < .05, significantly higher than the social

workers (see Table 3). Other significant 2x2x2 (type family x race

x type respondent) analyses of variance results were found on the Craw­

ford Adjustment subscales (presented in Table 4).

Figure 2 shows a statistically significant {£ < .05) interaction

between type family and race on the first Crawford Adjustment sub­

scale, Social-Economical-Environmental Competence. Applying a more

conservative test, two-tailed t-tests were utilized to determine dif­

ferences between the groups and showed no significant differences in

race, t_(56) = 1.09, or type family, t_(56) = 1.04.

As shown in Table 4, type family and race had no significant main

effects on the second adjustment subscale (Derangement of Thought Proc­

ess) . Type respondent, however, had a significant main effect (jo < .01).

Using a more conservative test to determine differences between nurses

and social workers, a two-tailed t-test was computed and revealed that

the nurses rated the patients* Derangement of Thought Process signifi­

cantly higher than the social workers, M56) * 1.70, £ < .05.

While a 2 x 2 x 2 (type family x race x type respondent) analysis

of variance performed on Physical Behavior (third adjustment subscale) Table 3

Means of the Crawford Psychological Adjustment

Scale (Total Score) by Type Respondent

Type Respondent n Means

Nurses’ Responses 60 44.77*

Social Workers' Responses 60 34.45b

Note. Scores on the Crawford Psychological Adjust­ ment Scale range from 0-100. The higher the score, the more increased is the level of maladjustment. aIndicates higher level of maladjustment.

^Indicates lower level of maladjustment. Table 4

Main Effects and Interactions of Type Respondent, Type Family, and Race on

The Crawford Psychological Adjustment Scale

Type Type Type Family Type Respondent x Crawford Adjustment Scale df Respondent5 Family'a Racea x Racea Type Family x Race3

Total Crawford Adjustment 1 13.43*** .33 .02 2. 48 2.03 Score Social-Economical-Environ­ 1 .99 .21 .00 4.54** 2,83 mental Competence Derangement of Thought 1 11.52*** .09 .02 1.02 .54 process Physical Behavior 1 IS.18*** .74 .56 3.24* 3.98 Communications 1 4.yu** ,88 .20 .37 .11 Social Acceptability of 1 7.73*** .15 1.71 2.31 2.56 Behavior Management of Hostility 1 10.96*** .08 .12 .00 .27 a The Analysis of Variance F ratios are listed under each factor.

*n < .10 **£ < .05 ***£ < .01

Note. Sum of Squares and Mean Squares are presented in Tables 23-27 (Appendix A). iue 2 Figure

Level of Social-Economical- Cnvironmental Competence 20 30 10 Note. Scores closer to zero indicate higher indicate zero to closer Scores Note. Social-Economical- the Subscale, on race and Adjustment family Crawford type between Interaction niomna Competence. Environmental 15.23 Origin 12.10 Competence. ee o Social-Economical-Environmental of level Type Family Type 15 (Whites) 11.50 (Blacks) 14.50 Procreation

72 73 yielded no significant main effects of type family and race, a margin­ ally significant interaction (jd < .10) was found between type family and race (see Figure 3). Moreover, type respondent had a significant main effect on Physical Behavior (means presented in Table 5). Apply­ ing a more conservative test, a two-tailed t-test showed that the nurses rated the patients' Physical Behavior significantly higher

(£ < .05) than the social workers.

On the fourth Crawford Adjustment subscale, Communications, there was neither a significant main effect of type family and race nor an interaction. However, a significant main effect was found of type resj>ondent on Communications, F_(l,56) = 4.90, £ < .05. To determine if nurses and social workers significantly differed on this Crawford subscale, .a nore conservative test, a two-tailed t-test was computed and showed no significant difference (see Table 6 for the means).

Another 2x2x2 (type family x race x type respondent) analysis of variance revealed no significant main effects of type family and race on the fifth Crawford Adjustment subscale, Social Acceptability of Behavior. Once again, type respondent had a highly significant main effect (£ < .01). A more conservative analysis (two-tailed t- test), however, showed no significant difference between nurses and social workers, £(56) * 1.39 (see Table 6 for the means) on Social

Acceptability of Behavior.

On the last Crawford Adjustment subscale, Management of Hostility, a 2 x 2 x 2 (type family x race x type respondent) analysis of vari­ ance was performed and showed no significant main effects and no inter­ action of type family and race. There was, however, a significant main 74

Table 5

Means of Derangement of Thought Process and

Physical Behavior (Subscales of the

Crawford Adjustment Scale) by

Type Respondent

Derangement of Physical Type Respondent H Thought Process Behavior a Nurses' Responses GO 12.95* 7.70 b Social Workers' 60 9.72b 4.73 Responses

Note. Scores on the Crawford Psychological Adjustment Scale range from 0-100. The higher the score, the more increased is the level of maladjustment. £ Indicate higher level of Derangement of Thought Process and higher level of Physical Behavior.

^Indicate lower level of Derangement of Thought Process and lower level of Physical Behavior. Table 6

Means of Three Crawford Psychological Adjustment Subscales

by Type Respondent

Social Acceptability Management Type Respondent N Communications of Behavior of Hostility

Nurses * Responses 60 3.68a 3.50a 3.11a

Social Workers' 60 2.78b 2.40b 2, Q5b Responses

Note. Scores on the Crawford Psychological Adjustment Scale range from 0-100. The higher the score, the more increased is the level of maladjustment. aIndicate higher degree of maladjustment.

Indicate lower degree of maladjustment.

w' ■ j Figure 3. Interaction between type family and. race on the and. on race family type between Interaction 3. Figure

Level of Physical Behavior 20 30 10 rwodAjsmn Sbcl, hscl Behavior. Physical Subscale, Adjustment Crawford Note. Scores closer to zero indicate a higher a indicate zero to closer Scores Note. Origin 7.73 5. 47 ee o Ajsmn o Pyia Behavior. Physical of Adjustment of level Type Family Type ’''*5.36 (Whites) .0 (Blacks) 6.30 Procreation

76 77 effect of type respondent on this subscale, F^l,56) * 10.96, £ < .01.

Applying a more conservative test, a two-tailed t-test was used and revealed that the nurses rated the patients' Management of Hostility significantly higher than the social workers, t_<56) = 1.71, £ < .05.

In summary, type family and race had no significant main effects on the total adjustment score or the Crawford Adjustment subscales.

However, there was a significant interaction between type family and race on the first subscale (Social-Economical-Environmental Competence), and a marginally significant interaction on the third subscale (Physi­ cal Behavior). Type respondent had significant main effects on the total adjustment score and five of the six Crawford Adjustment sub­ scales. Applying a more conservative test to determine differences between nurses and social workers on the Crawford Adjustment Scale, two-tailed t-tests showed that the nurses rated perceptions of the patients' total adjustment and on three Crawford Adjustment subscales

(Derangement of Thought Process, Physical Behavior, and Management of

Hostility) were all significantly higher than the social workers.

Hypothesis Three

There will be a significant difference in the level of Symptom Discomfort (psychopathology) due to: type family and race.

A 2 x 2 (type family x race) analysis of variance produced no sig­ nificant main effects of type family and race on Symptom Discomfort

(Katz Adjustment Subject Scale, SI). There was also no significant interaction (see Table 7). The means of the groups are as follows: whites from families of origin (57.47), blacks from families of origin 78

Table 7

Main Effects of Type Family and Race on the Katz

Adjustment Scale, Symptom Discomfort

(N = 60)

Source Sum of Squares df Mean Square F P

Type Family 232.060 1 232.060 1.31 N.S.

Race 117.600 1 117.600 . 66 M.S.

Type Family 166.667 1 166.667 .94 N.S. x Race 79

(56.93), whites from families of procreation (50.20), blacks from fami­ lies of procreation (56.33) (higher scores indicate higher level of psychopathology).

Hypothesis Four

There will be a significant difference in the Level of Expectations for Performance of Social Activities (Katz Adjustment Subject Scale, S3) due to; type family and race.

The results of a 2 x 2 (type family x race) analysis of variance

revealed no significant main effects of type family and race on Level of

Expectations for Performance of Social Activities, and no significant

interaction (see Table 8 ). The means are as follows: whites from fami­

lies of origin (57.40), blacks from families of origin (56.67), whites

from families of procreation (48.27), blacks from families of procrea­

tion (56.66) (higher scores indicate higher Level of Expectation).

Hypothesis Five

There will be a significant difference in the level of family contacts (during the patients1 hospitalization) due to; type family and race.

Individual 2 x 2 (type family x race) analyses were performed on

each question (related to letters, calls, and visits) of the Family

Contact Interview Index (designed by the researcher) to test the hypothe­

sis. Only statistically significant findings are reported below.

In the ANOVA applied to Question 3, "From which family member/

members do you receive letters" (wife, parents, sisters, brothers,

other relatives), a significant main effect was found of type family on

letters received from the sisters (jd < .01). However, using a more 80

Table 8

Main Effects of Type Family and Race on the Katz

Adjustment Scale, Level of Expectations for

Performance of Social Activities

(N = 60)

Source Sum of Squares df Mean Square F P

Type Family 312.817 1 312.817 1.14 N.S. fH CO

Race 220.417 1 220.417 • N.S.

Type Family 312.817 1 312.817 1.14 N.S. x Race 81 conservative test to determine differences on Question 3, a two- tailed t-test showed no significant difference in the number of letters received from the sisters of patients who expect to return to parents compared to those who expect to return to wives, £(56) = .91. The means showing the number of letters received per month are presented in Table 9.

While there was no significant main effect of type family on

Question 4, "The nature of most letters received" (Personal, Social,

Business), a significant main effect, however, was found on race,

F(l,56) = 4.42, £ < .05. Applying the more conservative test to the question of whether white and black patients significantly differed, a two-tailed t-test was computed and showed no significant difference,

£(56) *= 1.48. The means are presented in Table 10.

A 2 x 2 analysis of variance of type family and race on Question

7, "Would you like to receive more letters from the family,” produced

a highly significant interaction, £(1,56) = 7.78, £ < .01 (the inter­

action is depicted in Figure 4). Using a more conservative test to

determine differences on Question 7, two-tailed t-tests were computed

and showed no significant difference in type family, but a highly sig­

nificant difference in race, £(56) = 2.76, £ < .01. That is, white

patients responded more favorably to receiving more letters from

family than black patients. The means are as follows: white patients

(1.30), black patients (1.43). Means closer to one (1) represent more

favorable responses to receiving letters.

On Question 9, "Do you write letters to your family," a highly

significant interaction was found between type family and race, which 82

Table 9

Means of Letters per Month Received front Family Members (Question 3 on the Family Contact Interview index) by Type Family

Type Family n Means

Origin 3 0 1.769

Procreation 30 2.00

Note. The means represent the letters received from the family per month.

aIndicates a lower number of letters received.

Indicates a higher number of letters received.

Table 10

Means of Type Letters Received per Month from Fandly (Question 4 on the Family Contact Interview Index) by Race

Race n Personal Letters

White 3 0 1.7 33

Black 30 1.93b

alndicates a lower number of personal letters.

^Indicates a higher number of personal letters. iue 4 Figure

Level of Responses to "Like to Receive More Letters" 2.0 1.5 1.0 oe Soe eo . rpeet "yes" represent 1.5 below Scores Note. Index). Interview Contact rmteFml" Qeto o h Family the on 7 (Question Letters Family" More the Receive From to "Like to Responses neato ewe Tp aiyadRc on Race and Family Type Between Interaction 1.46 1.46 * 1.26 1.26 ' rgnProcreation Origin ele, hl hs 15o above or 1.5 those while replies, ersn "o replies. "no" represent Type Family Type .0 (Blacks) 1.60 1.00 .3 (Whites) 1.13 1.13

83 84

is presented in Figure 5, F_{1,56) ** 8.64, £ < .01. Applying a more

conservative test to determine differences in the groups, two-tailed t-tests were computed and produced no significant difference in race, hut a significant difference in type family, t_(l,56) = 2.50, jo < .01.

Thus, patients from families of origin indicated they wrote signifi­

cantly more letters than those from families of procreation. The means

are as follows: patients from families of origin, 1 .6 6 ; patients from

families of procreation, 1.73 (means closer to one [1] represent a

more favorable reply to Question 9)*

In terms of questions on family visits, there were several signifi­

cant findings, A 2 x 2 (type family x race) analysis of variance pro­

duced a significant main effect (F_(l,56) = 5. 34, £ < .05) of type

family on the frequency of family visits to the hospital (Question 11)

which suggests that patients who expect to return to families of origin

had a higher number of visits than those who expect to return to fami­

lies of procreation. Applying a more conservative test to determine

if there is a difference in type family, a two-tailed t-test was

computed and showed no significant difference between the groups (see

Table 11 for the means).

A 2 x 2 analysis of variance was performed on Question 15, "Do

you enjoy visits with your family," and yielded a significant main

effect of type family, F_(l,56) » 5.65, jo < .05. This finding suggests

that patients who expect to return to families of procreation enjoyed

the visits more than those who expect to return to families of origin.

Using a more conservative test to determine whether there was dif­

ference in type family on Question 15, a two-tailed t-test was Table 11

Means of the Number of Family Visits per Month to the Hospital (Question 11 on the Family Contact Interview Index) by Type Family

Type Family N Means

Origin 30 2.93a

Procreation 30 2.13b

aIndicates higher number of family visits.

^Indicates lower number of family visits.

Table 12

Means of Responses to Enjoyment of Family Visits (Question 15 on the Family Contact Interview Index) by Type Family

Type Family N Means

Origin 30 1.173

Procreation 30 1 .00b

Note. The Means represent yes-no responses (yes = 1, no = 2). Scores closer to one represent favor­ able responses, while scores closer to two repre­ sent less favorable responses. a Indicate lower level of enjoyment of family visits.

Indicate higher level of enjoyment of family visits. iue : neato BtenTp aiy n ae on Race and Family Type Between Interaction 5: Figure

Level of Responses to "Do You Write Letters to Your Family" .5 .0 .0 Family" (Question 9 of the Family Contact Family the of 9 (Question Family" oe Soe eo . ersn "yes" represent 1.5 below Scores Note. Responses to "Do you Write Letters to the to Letters Write you "Do to Responses 0 Interview index). Interview 1.53 1.53 ' 1.80 rgnProcreation Origin ele, hl hs 15ad above and 1.5 those while replies, ersn "o replies. "no" represent Type Family Type -3 (Blacks) 1-93 .3 (Whites) 1.53

86 87 computed and showed no significant difference between the groups. The means are presented in Table 12.

Results from another 2 x 2 (type family x race) analysis of vari­ ance revealed a significant (£ < .05) main effect of race on Question

16, "Do you feel family visits are helpful to your adjustment,”

_F(1,56) = 4.17, < .05. As shown in Table 13, black patients viewed family visits as more helpful to their adjustment than white patients.

However, a more conservative analysis using a two-tailed t-test showed the difference was not significant.

A 2 x 2 (type family x race) analysis of variance performed on

Question 17, "Does your family correspond with you in other ways”

(besides letters, calls, visits, e.g., through contacts with doctors, social workers, and nurses), yielded a significant main effect on race at the .05 level. Although the means in Table 14 show that blacks had more indirect correspondence than whites, a more conservative analysis (two-tailed t-test) showed no significant difference between blacks and whites.

A 2 x 2 (type family x race) analysis of variance produced a sig­ nificant main effect (FJ1,56) = 4.08, £ < .05) of type family on Ques­ tion 26 ("Does staff encourage family contact with patients) which sug­ gests that patients who expect to return to families of origin feel that staff encourage family contact with patients moreso than those who expect to return to families of procreation. Applying a more con­ servative test to determine difference in type family on Question 26, a two-tailed t-test was computed and revealed no significant dif­ ference. (See Table 15 for the means.) 88

Table 13

Means of Responses to the Helpfulness of Family Visits to Adjustment (Question 16 on the Family Contact Interview Index) by Race

Race N Means

White 30 1 .20a

Black 30 1.03b

Mote. The means represent yes-no responses (yes = 1, no = 2). Scores closer to one represent favorable responses, while scores closer to two represent less favorable responses.

indicates less favorable response to the helpful­ ness of family visits to adjustment.

^Indicates highly favorable response to the helpful­ ness of family visits to adjustment.

Table 14

Means of Responses to Family Correspondence (Question 17 on the Family Contact Interview Index) by Race

Race M Means

White 30 1.47a

Black 30 1.17b

Note. The means represent yes-no responses (yes = 1 no = 2). Scores closer to one represent more favorable responses, while scores closer to two represent less favorable responses.

aindicates less family correspondence.

^Indicates higher level of family correspondence. Table 15

Means of Responses to Staff Encouragement of Family

Contacts (Question 26 on the Family Contact

Interview index) by Type Family

Type Family N Means

Origin 30 1.17a ^ b Procreation 30 1.40

Note. The means represent yes-no responses (yes = 1, no = 2). Scores closer to one represent more favorable responses, while scores closer to two represent less favorable responses.

aIndicates more favorable response to staff encourage ment of family contacts with patients.

Indicates less favorable response to staff encourage ment of family contacts with patients. 90

To summarize, a 2 x 2 {type family x race) analysis of variance vas performed on each item (26 questions) of the Family Contact Inter­

view Index. In the 26 analyses of variance, eight results exceeded the five

percent chance level. By using the more conservative analysis (two-

tailed t-test) to determine differences between groups, the number of

significant results from the analyses of variance were decreased to two.

Correlations between the Tennessee Self Concept Scale, Crawford Adjustment Scale, Katz Adjustment Scales (SI, S3), Family Contact Interview Index, Age, Education, and the Institutional Variables.

Pearson coefficient correlations were utilized to determine the

relationships between self concept, hospital adjustment, Level of

Expectations, Symptom Discomfort (Psychopathology), family contacts, age,

education, and the institutional variables (total incarcerations and

total hospitalizations). Only the statistically significant correla­

tions which relate to the hypotheses will be discussed below.

Correlations Between the Tennessee Self Concept Scale and the Crawford

Psychological Adjustment Scale

Numerous significant correlations were found between overall self

concept, self concept subscales, and hospital adjustment (Crawford

Adjustment Scale ratings from social workers and nurses). The correla­

tions between social workers’ ratings and the patients’ Tennessee Self

Concept scores will be discussed first. All of the correlational data

for nurses and social workers are presented in Table 16.

A significantly negative relationship (£ K .05) was found

between overall self concept and a Crawford Adjustment subscale, Table 16

Correlations Between the Tennessee Self Concept Scale and the Crawford Psychological Adjustment Scale (Social Work Responses in Parentheses, while First Scores are Nurses)

Crawford Adjustment Scale Total Craw­ Social Econ­ Derange­ Social Tennessee Self ford (Hospi­ omical-Environ­ ment of Physi­ Accepta­ Manage­ Concept Scale tal Adjust­ mental Compe­ Thought cal Communi­ bility of ment of ment) tence Process Behavior cations Behavior Hostility

Self Concept .01 .06 .04 .05 -.16 .10 .05 (-.22) (-.16) (-.18) (-.18) (-.22) (-.21) (-.25)* Identity -.10 -.11 -.07 -.05 -.18 -.03 -.11 (-.23) (-.12) (-.20) (-.16) (-.24) (-.16) (-.33)** Self Satisfac­ -.09 -.20 .04 -.06 -.16 -.01 -.02 tion (-.32)* (-.27)* (-.25)* (-.25)* (-.27)* (-.26)* (-.28)* Behavior .OB -.01 .12 .11 -.14 .11 .14 ■ (-.12) (-.07) (-.10) (-.09) (-.14) (-.14) (-.15) Physical Self -.09 -.08 -.13 -.06 -.19 .07 .00 1 rt 1 * (-.29)* (-.32) (-.30)* (-.24) (-.20) (-.16) tbral-Ethical -.09 -.18 -.04 .00 -.18 -.05 .4 Self (-.35) (-.33)** (-.28)* (-.21) (-.27)* (-.32)* (-.29)* Personal Self .11 .03 .16 .16 -.13 .09 .14 (-.22) (-.14) (-.16) (-.18) (-.33)** (-.22) (-.26)* Family Self -.03 -.09 .05 .01 -.09 -.01 -.03 ( .03) ( .03) < .07) ( .05) ( .02) (-.00) (-.16) Social Self .08 -.19 -.02 -.06 -.16 .05 .03 (-.28)* (-.19) (-.24) (-.23) (-.24) (-.19) (-.35)** Self Criticism -.05 -.16 -.07 -.01 .14 .03 .03 (-.11) (-.08) (-.07) (-.16) (-.09) (-.13) (-.08) Number of .19 .26* .15 .14 ,19 -.08 -.22 Deviant Score ( .23) ( .10) ( .22) ( .29)* ( .12) < .01) ( .26)* Note. Higher scores on the Tennessee Self Concept Scale indicate a more positive self description, while higher scores on the Crawford Psychological Adjustment Scale indicate increased maladjustment. £ < .05 **£ < .01

to H* 92

Management of Hostility. The first Tennessee Self Concept subscale.

Identity, correlated significantly with this same Crawford Adjustment subscale, r = -.33, £_ < .01, Thus, higher self esteem is associated with decreased Management of Hostility (the lower the scores on the

Crawford subscales, the higher is the level of adjustment).

The second Tennessee Self Concept subscale. Self Satisfaction, correlated significantly and negatively with the Crawford Adjustment

Scale (total hospital adjustment score), and all of the Crawford sub­

scales at the .05 level: Social-Economical-Environmental Competence, jc = -.27; Derangement of Thought Process, r_ = -.25; Physical Behavior,

_r = -.25; Communications, r_ = -,27; Social Acceptability, r_ = -.26; and Management of Hostility, r_ = -.28. These findings indicate that as satisfaction with oneself is increased, the lower the adjustment

score (higher the level of adjustment).

Physical Self, the fourth Tennessee Self Concept subscale was sig­

nificantly < .05) and negatively correlated with the total Crawford

Adjustment Scale score and two subscales (Derangement of Thought Process,

and Physical Behavior), r_ = -.29, r_ = -.30, r_ - -.30, respectively.

These findings suggest that improved feelings about the physical appearance

is associated with less deranged thoughts and less physical acting out.

Statistically significant correlations were found between Moral-

Ethical Self (the fifth self concept subscale), the total Crawford

Adjustment score and five of the six Crawford subscales. These are

as follows: total Crawford Adjustment score (£ = -.35, £ < .01),

Social-Economical-Environmental Competence (£ = -.33, £ < .01),

Derangement of Thought Process (£ * -.28, £ < .05), Communications 93

(r^ = -.27, ja < .05), Social Acceptability of Behavior (jt = -.32,

£ < .05), Management of Hostility (£ = -*29, £ < .05). Specifically, higher level of hospital adjustment (increased maladjustment) is associated with decreased moral worth.

Significant and negative correlations were found between the

sixth Tennessee Self Concept subscale. Personal Self, and two Crawford

adjustment subscales, Communications (£ < .01), and Management of

Hostility (jo < .05). Thus, higher level of personal worth is associ­

ated with diminished hostility and communication problems.

Another Tennessee Self Concept subscale, Social Self, significant­

ly and negatively correlated with total adjustment on the Crawford

Adjustment Scale (£ = -.28, £ < .05) and a Crawford Adjustment sub­

scale, Management of Hostility (jr = -.35, < ,01). This finding sug­

gests that higher social adequacy is associated with a lower level of

hostility.

The last Tennessee Self Concept subscale, Number of Deviant

Score, significantly and positively correlated with Physical Behavior,

and Management of Hostility (two Crawford Adjustment subscales) at

the .05 level. A higher deviance score is associated with increased

hostility and physical acting out.

On the nurses' ratings of the Crawford Adjustment Scale, there

was only one statistically significant correlation. The Number of

Deviant Score correlated positively and significantly with the Crawford

Adjustment subscale, Social-Economical-Environmental Competence,

r^ = .26, £ < .05. Thus, the more increased is the level of deviance,

the higher the Social-Economical-Environmental Competence score on the 94

Crawford Scale (high Competence score indicates high level of malad­ justment) .

In summary, of the 154 correlations between the total self con­ cept score, Tennessee Self Concept subscales, and Crawford Psychologi­ cal Adjustment Scale, 25 were significant. Twenty-four of these sig­ nificant correlations were from social work ratings, while only one correlation resulted from the nurses* ratings.

Correlations Between the Tennessee Self Concept Scale and the Katz

Adjustment Scales (Subject Rating Scale 1 and Subject Rating Scale 3).

Highly significant and negative correlations were found between the total self concept score and all the subscales of the Tennessee

Self Concept Scale and a measure of Psychopathology, Symptom Discomfort

(Katz Adjustment Scale, Subject Rating Scale 1). Specifically, the higher the level of psychopathology, the more diminished is the self concept. A summary of these data are shown in Table 17.

The relationship between overall self concept and another Katz

Adjustment Scale, Level of Expectations for Performance of Social

Activities (Subject Rating Scale 3) was not significant. Only one significant relationship was found between a Tennessee Self Concept subscale (Behavior) and Level of Expectations for Performance of

Social Activities, r = -.26, jo < .05 (see Table 17). This finding is quite striking and suggests that an increased level of expectation is associated with a decreased level of functioning.

In summary, of the 22 correlations, 12 exceeded the five percent chance level. 95

Table 17

Correlations Between the Tennessee Self Concept Scale

and the Katz Adjustment Scales (Subject

Rating 1 and Subject Rating 3)

______Katz Adjustment Scale Tennessee Self Symptom Discomfort Level of Expectations Concept Scale______(Katz Scale Si) (Katz Scale S3)____

Self Concept -.55** -.19

Identity -.57** -.16

Self Satisfaction -.55** -.13

Behavior -.52** -.26*

Physical Self -.63** -.12

It)ral-Ethical Self -.42** -.23

Personal Self -.45** -.17

Family Self -.49** -.12

Social Self -.56** -.18

Self Criticism .32* .13

Number of Deviant .46** -.16 Scores

*£ < .05 * * £ < .01

Note. Higher self concept scores indicate positive self descrip­ tion. Higher Katz Adjustment Scale scores indicate increased level of psychopathology and increased Level of Expectations. 96

The Tennessee Self Concept Scale Correlated with Age, Education, and the Institutional Variables

There were no significant relationships found between the total

Tennessee Self Concept score or any of the subscales, and age, or either of the institutional variables (total number of incarcerations, total number of hospitalizations). However, a significant (£ < .05) and negative correlation was found between one Tennessee Self Concept subscale, Humber of Deviant Score, and education. Thus, a higher deviance score is associated with lower level of education. These data are shown in Table 18.

Correlations Between the Tennessee Self Concept Scale and the Family

Contact Interview Index

Self concept was found to be significantly related to questions on the Family Contact Interview Index (Table 19 shows the correla­ tions ) .

Statistically significant relationships were found bet’.n m a

Tennessee Self Concept subscale, Family Self, and three questions on

the Family Contact Interview Index: Question 4 ("What is the nature

of most of the letters you receive from your family"), Question 15

("Do you enjoy visits with your family”), and Question 17 ("Does your

family correspond with you in other ways"), £ = -.33, £ < .01;

_r = -.30, £ < .05; r ** .35, £ < .01, respectively. These findings

suggest that as the patients' feelings of adequacy as a family member

are increased, the less enjoyment they receive from family visits. 97

Table 18

Correlations Between the Tennessee Self Concept Scale*

Age, Years of Education, and the Institutional

Variables (Total Incarcerations and Total

Hospitalizations)

Total Total Tennessee Self Years of Incarcer­ Hospital­ Concept Scale Age Education ation ization

Self Concept -.02 .01 -.02 .02

Identity .08 -.07 -.11 .05

Self Satisfaction -.06 .08 -.04 -.02

Behavior -.00 .01 .00 -.02

Physical Self -.11 -.03 -.08 .05

Moral-Ethical Self -.14 .03 -.06 .03

Personal Self -.03 .00 .05 .12

Family Self .22 .03 -.03 -.19

Social Self -.01 .06 -.12 .02

Self Criticism -.17 .02 .09 -.05

Number of Deviant -.12 -.30* -.01 .01 Score

< .05

Note. Higher self concept scores indicate positive self description. Higher scores on age, education, and the institutional vari­ ables indicate increased age and educational levels, plus higher number of incarcerations and hospitalizations. Table 19

Correlations Between the Family Contact Interview Index and the

Tennessee Self Concept Scale

Family Con­ Total Self Physi­ Moral- Per­ Fami­ Self Number tact Inter­ Self Iden­ Satis­ Behav­ cal Ethical sonal ly Social Criti­ Deviant view Index Concept tity faction ior Self Self Self Self Self cism Score

Question 1 -.03 .00 .06 -.09 -.05 .08 .04 -.04 -.04 .10 .09 Question 2 -.10 -.05 .06 -.07 -.07 .04 .03 -.18 .10 .02 -.06 Question 3 -.13 -.15 .22 -.15 -.09 .18 .07 -.15 -.20 .01 -.39** Question 4 -.02 -.06 .12 -.16 -.20 .24 .09 -.33** -.09 .10 -.03 Question 5 .10 -.13 -.13 -.17 -.10 -.01 -.02 -.22 .03 .08 .07 Question 6 -.07 -.12 .07 -.10 -.07 -.03 -.00 -.17 .05 .11 -.02 Question 7 .14 .01 .22 .06 -.00 -.16 .23 .01 .09 .03 .11 Question 8 .12 -.01 .22 .09 .02 .13 .24 -.04 .11 -.02 .08 Question 9 .06 .06 .14 -.03 .04 .10 .14 -.12 .12 -.02 -.08 Question 10 .01 .02 .06 -.07 .08 -.04 -.01 -.00 .02 -.01 -.07 Question 11 -.01 -.03 .05 -.14 .11 -.05 -.05 -.13 -.01 -.03 -.10 Question 12 -.06 -.08 .09 -.05 .14 .19 -.08 -.13 ,06 .15 -.28* Question 13 -.02 .10 -.06 -.13 -.05 -.09 -.06 .09 -.05 .17 .03 Question 14 .05 -.05 .19 ,01 .02 .13 .19 -.20 .18 -.10 -.00 Question 15 .02 -.10 .01 -.02 -.06 ,08 .14 -.30* .05 .17 .12 Question 16 .07 -.11 .13 .01 .04 .09 .17 -.18 .00 .11 .03 Question 17 -.16 -.23 -.04 -.13 -.14 -.02 -.03 -.35** -.04 .12 .07 Question 18 -.27* -.25* -.29* -.26* -.24 -.35** -.22 -.21 -.02 .07 .15 Question 19 -.04 -.16 -.03 .03 -.10 -.01 .09 -.22 -.04 .04 .08 Question 20 .11 .01 .07 .10 .03 .13 .21 -.09 .07 .06 -.04 Question 21 -.04 -.07 -.06 -.06 -.09 -.17 -.12 -.13 -.13 .23 .21 Question 22 -.04 -.12 .12 -.08 -.04 -.04 -.07 -.14 -.17 .14 -.10 Table 19 (Continued)

Family Con- Total Self Physi­ Moral- Per­ Fami­ Self Number of Tact Inter­ Self Iden­ Satis­ Behav­ cal Ethical sonal ly Social Criti­ Deviant view Index Concept tity faction ior Self Self Self Self Self cism Score

Question 23 -.02 -.06 .01 -.06 -.19 .02 .12 -.24 .15 .08 -.02 Question 24 -.12 -.21 -.12 -.10 -.12 -.08 -.11 -.24 -.08 .25* .21 Question 25 .07 -.10 .12 .09 .06 .04 .14 -.02 -.02 -.05 .07 Question 26 .11 .00 .05 .12 -.04 .04 .07 -.15 .00 -.17 .04 aThe precise wording of the questions are in Appendix D.

*£ < .05 **£ < .01 1 0 0

Only one significant relationship (£ < .05) was found between the total self concept score and one question on the Family Contact

Interview Index, Question 18 ("Do you have visits from persons other than your family"). Four Tennessee Self Concept subscales (Identity,

Self Satisfaction, Behavior, and Moral-Ethical Self) correlated sig­ nificantly (£ < .05) and negatively with this same question. These findings suggest that higher self esteem is associated with decreased visits from persons other than family (e.g., friends, ministers, parole officers).

Self Criticism (self concept subscale) significantly (£ < .05) and positively correlated with one response to Question 24, where par­ ticipants rated last call to family as "Personal.” Specifically, increased self criticism is associated with a higher number of per­ sonal calls.

On the last Tennessee Self Concept Subscale, Number of Deviant

Score, there was a significant (£ < .05) and negative relationship found between this same Tennessee Self Concept subscale and Question

12. Specifically, the participants were asked "What family member/ members (wife, parents, sisters, brothers, other relatives) visit you at the hospital." The significant response to this question was

"other relatives." Thus, a higher deviance score is associated with a lower number of visits from other relatives (e.g., cousins, nephew).

In summary, of the 286 correlations between the Tennessee Self

Concept Scale and the Family Contact Interview Index, 11 correlations reached significance (seven at the .05 level and four at the .01 level). 1 0 1

Esaay Responses on the Family Contact Interview Index

The participants (mentally ill offenders) gave essay responses to five open-ended questions on the Family Contact Interview Index

(Question 9, 16, 18, 25, 26). Their responses to these questions are summarized below.

On Question 9 ("Do you write letters to your family, if the answer is "Yes," to whom do you write letters"), 21 of the 30 mentally ill offenders who expect to return home to parents (families of origin) replied "No," while the remaining nine replied "Yes" and indicated they wrote letters to the parents, sisters, and brothers. Of the 30 who expect to return home to the wives (families of procreation), 22 replied "No" to Question 9. Seven of the remaining eight mentally ill offenders indicated they wrote letters to the parents and other rela­ tives, while only one wrote letters to the wife.

When asked, "Do you feel the family visits are helpful to your adjustment" (Question 16), 25 of the 30 mentally ill offenders who

expect to return to families of origin responded "Yes" with a range

of statements to explain the answer (e.g., "Makes me feel good,"

"Moral support," "Feel that somebody cares," "Puts hope in my mind of

getting well"). The remaining five replied "No."

Comparatively, 27 of the 30 who expect to return to families of

procreation responded "Yes" to Question 16, also with a range of

explanations (e.g., "Makes me feel secure," "Helps with questions

that may arise," "Keeping me adjusted to the outside world," "Helpful

in mental alertness, forgiveness"). The remaining three mentally ill 1 0 2 offenders replied "Ho," indicating they feel the visits are not help­ ful to their adjustment. Thus, both groups {origin, procreation) responded similarly (Yes) to Question 16, with a consistent theme of caring.

On Question 18, "Do you have visits from persons other than your family," 20 of the 30 mentally ill offenders who expect to return to families of origin responded "No." The remaining 10 mentally ill offenders responded "Yes." Visits from others included: friends, social workers, and priests.

In comparison, 16 of the 30 mentally ill offenders who expect to return to families of procreation answered "No" to Question 18, while

14 replied "Yes." The visits from others consisted of the same people as above. However, one mentally ill offender who expects to return to a family of procreation received visits from a parole officer. Thus, both mentally ill offenders who expect to return to families of origin and those who expect to return to families of procreation received visits from basically the same people (friends, social workers, priests) other than family.

When asked, "Do you feel the calls (from family) are helpful to your adjustment, if your answer is "Yes" explain in what way are they helpful" (Question 25), 24 of the 30 mentally ill offenders who expect to return to families of origin gave "Yes” answers. Various explana­ tions were given (e.g., "relieves a lot of tension," "1 find my temper to be better," "Lets you know someone else is there besides the doctor,"

"Just to hear their voices makes me feel good"). The remaining six who expect to return to families of origin gave "No" responses to the 103 question.

About the same number, 26 of 30 mentally ill offenders who expect to return to families of procreation answered "Yes" to Question 25, also with various explanations (e.g., "Help me to feel better," "Keep me alert about things that are happening," "Takes away being so

isolated and lonely"). The other four mentally ill offenders replied

"No" to this same question. Hence, both groups (origin, procreation)

responded quite favorably to Question 25, indicating that the calls

are helpful to their adjustment because the calls make them feel

better (common theme).

On the last question of the Family Contact Interview Index, Ques­

tion 26, ("Do you feel the hospital staff encourages family contacts

with patients"), 22 of the 30 mentally ill offenders who expect to

return to families of origin responded "Yes" with a range of state­

ments (e.g., "They try to help people get out," "They want more people

out of here," "Tell mother to come visit me"). The remaining eight

mentally ill offenders replied "No."

Of the 30 who expect to return home to families of procreation,

there were 18 who responded "Yes" to Question 26 and gave a range of

replies (e.g., "It's their job to do such," "Try to get them well and

out of here as quick as possible," "Help make people feel better so

that they can get jobs"). The other 12 mentally ill offenders who

expect to return to families of procreation replied "No" to the Ques­

tion. Although the majority of both groups indicated that staff

encourages family contacts (caring theme prevalent in responses),

mentally ill offenders who expect to return to families of origin 104 responded slightly more favorably to Question 26 than those who expect to return to families of procreation. CHAPTER VJ

DISCUSSION

The present study investigated the relationship between self con­ cept, hosj^ital adjustment, type family setting, and race of mentally ill offenders. The results of the study revealed that of the five hypotheses, four were generally not confirmed and one partly supported.

Hypothesis #1 predicted significant differences between the two type family settings (families of origin, families of procreation) and the two races on self concept (Tennessee Self Concept Scale). There were no significant differences found on the total self concept score.

However, a significant difference was found between blacks and whites on one Tennessee Self Concept subscale, Moral-Ethical Self. Specifi­ cally, black mentally ill offenders scored lower on the moral worth scale than white mentally ill offenders.

Harris (1976) attributes racial differences in individuals' views of self worth to the American caste-like system. He asserts that blacks see themselves and are seen by whites as non-members of this system, while whites are ascribed members. Even in psychiatric hospi­ tals, black mentally ill offenders perceive themselves to be in a custodian or lower position than their white counterparts. Thus, blacks internalize this viewpoint and are expected to score lower on self worth than whites.

105 106

It has been argued in the self concept literature that the self concept is the central construct in understanding human behavior.

Numerous studies have provided evidence that the parents are the source of the self concept (Berger# 1952; Combs & Snygg, 1959; Mead, 1934;

Sullivan, 1974). Some studies (Corsini, 1952; Cohn, 1975; Ostrauskas,

1977) have specifically focused on differences between the self concept and marital status (married, single, widowed, divorced) of individuals.

These studies have shown that married persons have a higher self con­ cept than those living with parents or of another marital status. The present study, however, showed no significant difference in the self concept of mentally ill offenders who expect to return to their parents compared to those who expect to return to their wives.

Significant differences were predicted (Hypothesis #2) between the two type family settings, the two races, and the two type respon­ dents on hospital adjustment (Crawford Psychological Adjustment Scale).

Contrary to expectation, no significant differences were found on the total hospital adjustment score. However, a significant interaction was found on one Crawford Adjustment subscale, Social-Economical-

Environmental Competence (i.e., ability to care for self, handle employment and finances). Although further analyses using the two- tailed t-tests revealed no significant differences between type family and race on this Crawford subscale, the findings, however, suggest that white mentally ill offenders who expect to return to parents had a higher Social-Economical-Environmental Competence score (higher compe­ tence scores indicate increased maladjustment) than white mentally ill offenders who expect to return to wives. Conversely, black mentally 107 ill offenders who expect to return to the wives had a higher Social-

Economic al-Environmental Competence score than blacks who expect to return to parents.

The difference between blacks and whites who expect to return to parents and wives on the Competence scale can perhaps be attributed to subculture differences. Blacks who expect to return to the parents, as well as their parents, expect them to be more competent (self sup­ porting) than whites and their parents. Black parents realize their sons have to strive harder than whites to accomplish goals and conse­ quently push them to be more competent. On the other hand, whites who will return to the wives, as well as their wives, expect them to be more competent than their black counterparts.

Black married males place great value on being competent husbands and providers for their families. During slavery, black men, especially black married men were degraded, stripped of their manhood and labeled incompetent providers. Even today this degradation continues, and black men are still considered by white society as poor providers.

This is evidenced by the Moynihan Report (1965) which indicates that the black family is primarily matriarchal. Thus, black married men find it much harder than their white counterparts to prove their com­ petence to white America and other blacks, including their wives. As a result, many black married men become quite discouraged and perceive themselves to be incompetent.

Although the predicted significant difference between type family and race on total hospital adjustment was not confirmed, a significant difference, however, was found on type respondent (nurses, social 108 workers). The nurses perceived the hospitalized mentally ill offenders to be more poorly adjusted than the social workers. More specifically, the nurses perceived the mentally ill offenders to be more deranged, physical, and hostile than the social workers. The most plausible explanation for this difference is that the nurses, with a medical orientation, work more directly with the patients on the wards and experience them differently than the social workers who are less directly involved with the patients.

While the nurses’ perceptions of the patients* adjustment are per­

haps based primarily on the patients' behavior in response to medica­

tion, the social workers view the patients from basically two perspec­

tives: ward behavior and weekend visitations with the family (inter­

action with other patients and family). Although these two perspec­

tives provide information for the social workers to base their percep­

tions of the patients' adjustment, the information, however, is not

first hand as in the case of the nurses who are with the patients

daily.

The nurses administer medication to patients and observe the

patients' behavior in response to the medication. If the patients

fail to respond to the nursing staffs’ expectations, they are perhaps

not readily recommended for discharge. The social workers largely

depend on the nursing reports of the patients' ward behavior to deter­

mine discharge plans. While the social worker is the team member

responsible for discharge planning, the decision to discharge the

patients is weighed heavily on the nurses' perceptions of the patient's

behavior. 109

It is the present researcher's thinking that if psychiatrists were included as respondents, their responses would perhaps be similar to the nurses'. More specifically, psychiatrists * perceptions of the patients' adjustment would be primarily based on how well the patients respond to medication.

Labeling or societal reaction theorists (Becker, 1963; Lemert,

1951; Scheff, 1966) would go further and suggest that the psychia­ trists would respond more favorably to circumstances unrelated to the

patient's behavior (e.g., admission status, court decision, family

resources, family desire to accept the patients). Specifically,

labeling theorists assert that deviant behavior is less a function of

a person's overt act than an interpretation and definition of that act

by society. One could argue, then, that psychiatrists may overlook

the patient's behavior and primarily base a discharge decision on the

family's willingness to accept the patient and/or society's reaction

to the behavior.

The prediction of Hypothesis #3, that there will be significant

differences between the two type family settings and the two races on

Symptom Discomfort (psychopathology) was not confirmed. Those who

expect to return to parents were not found to be significantly sicker

than those who expect to return to wives. Previous research, however

(Freeman & Simmons, 1958, 1959) suggests that patients who live with

parents are sicker than those who live with wives.

The present study found no significant difference in the level of

psychopathology between blacks and whites. Early studies, however,

have provided conflicting findings which have resulted in a 110 controversy. Some studies (DeHoyes & DeHoyes, 1965; Faris & Dunham,

1939; Freeman, 1958; Wilson & Lantz, 1957) have found a higher level of psychopathology among blacks compared to whites. On the oher hand, others (Jaco, I960; Pasamanick, 1963) have found the reverse. Since the above studies were conducted approximately two decades ago, it is evident that more recent investigation is needed in this area. Perhaps in studies conducted now one might find a change re­ lated to the increase seen in recent years in black consciousness.

Hypothesis #4 predicted significant differences between the two type family settings and the two races on the Level for Performance of Social Activities (Katz Adjustment Scale). While no significant differences were found between type family and race, the means, however, suggest that mentally ill offenders who expect to return to families of procreation, especially whites, had a lower level of expectations than those who expect to return to families of origin.

These findings are contrary to the findings of previous studies

(Dinitz et al., 1961; Freeman & Simmons, 1958, 1959), and fail to support the differential demands and expectations notion. This notion holds that given the role of "husband" and "son," one would expect a mental patient husband and his wife to have significantly higher expectations of his (the patient's) performance than would a patient son and his parents.

The prediction that there will be a significant difference between

the two type family settings and the two races on the level of family

contacts (Hypothesis #5) was partly supported. Differences in

responses to nine of 26 questions on the Family Contact Interview Ill

Index were found to be significant. There were seven main effects and two interactions. The main effect differences related to type family will be discussed first, followed by those main effects related to race and then the interactions.

First, a significant main effect for type family on Question 3

("From which family member/members do you receive letters") was found, suggesting that patients who expect to return to families of pro­ creation received more letters per month than those who expect to return to families of origin. Further, it was found that of the five family members (wife, parents, sister, brother, other relatives), the sister was the family member the patients received most of the letters from. Perhaps the sisters of the patients choose to write letters more often than to visit or call, while other family members perhaps choose the latter over writing letters. Moreover, the sisters per­ haps live quite a distance from the hospitals (in other cities or in another state), and writing letters is the most feasible means of con­ tact with the patients.

Second, type family had significant main effects on two questions related to family visits: Question 11 ("How often does your family visit you at the hospital"), and Question 15 ("Do you enjoy visits with your family"), Although mentally ill offenders who expect to

return to families of origin had a significantly higher number of

visits, those who expect to return to families of procreation, how­

ever, got more enjoyment from the visits. A plausible explanation of

these findings is that parents are more supportive (visit more often)

of their patient sons than wives of their patient husbands. However, 112 patients enjoy visits from their wives more than visits from their parents because of possible sexual involvement with their wives. In some hospitals, the patients and wives are allowed to spend time alone in a special room, thus having sexual contact.

Type family had a significant main effect on the last question of the Family Contact Interview Index ("Does the staff encourage family contact with patients"). Mentally ill offenders who expect to return to families of origin tended to feel that staff encourages family con­ tact with patients moreso than those who expect to return to families of procreation. One possible explanation of this finding is that per­ haps married patients feel that, because of the possibility of sexual contact with their wives in the hospital setting, the staff encourages

less contact with their wives than patient sons with their parents.

Race had significant main effects on several questions of the

Family Contact Interview Index: Question 4 ("What is the nature of

most of the letters you receive from your family"— Personal, Social,

Business), Question 16 ("Do you feel the family visits are helpful to

your adjustment”), and Question 17 ("Does your family correspond with

you in other ways," than letters, calls, and visits). The findings

indicated that blacks, in contrast to whites, received a higher number

of personal letters (i.e., letters which inquire about the patient's

well being) from family, viewed family visits as more helpful to their

adjustment, and had more indirect correspondence (i.e., family con­

tacts with patients through contacts with nurses, social workers).

Thus, family contacts (letters, visits, correspondence) for black

mentally ill offenders exceeded those of their white counterparts on 113 several measures.

Historically, the black family has been a very close and strong unit. The survival of blacks in American society, as evidenced by the above findings, has depended on the closeness and strength of the black family. This closeness is maintained even if one family member is institutionalized.

White patients (from families of origin and procreation) respond­ ed more favorably to receiving more letters from their families than

black patients (from families of origin and procreation). Perhaps, white patients would like to receive more letters from their families

because they are dissatisfied with the amount of letters received com­ pared to blacks who expressed less desire to receive more letters.

The significant interaction between the two type family settings and

the two races on Question 7 ("Would you like to receive more letters

from your family”) suggests that blacks who expect to return to fami­

lies of origin expressed a greater desire to receive more letters

fron family than blacks who expect to return to families of procreation.

On the other hand, whites who expect to return to families of pro­

creation were more desirous of receiving letters than whites who ex­

pect to return to families of origin.

Another significant interaction between the two type family

settings and the two races on Question 9 ("Do you write letters to

your family") revealed that whites who expect to return to families of

procreation indicated they wrote more letters than blacks who expect

to return to families of procreation. In contrast, blacks who expect

to return to families of origin indicated they wrote more letters 114 than whites who expect to return to families of origin. Overall, white and black patients who expect to return to families of origin indicated they wrote significantly more letters than white and black patients who expect to return to families of procreation. A possible explanation

for these differences is that the parents of both white and black patients are perhaps very old and unable to visit as often as the wives. Therefore, the patients wrote more letters to their parents

than to their wives.

Race

Although blacks and whites did not significantly differ in total

self concept, total hospital adjustment, and the Level of Expectations,

it should be understood that the instruments used to compare these

groups are standardized measures primarily based on white Euro-Ameri-

can culture and values. Thus, it is possible that these instruments

are not measuring what they are expected to measure with blacks.

In developing instruments which are used to compare blacks and

whites, many researchers fail to consider the black experience

(impact of slavery), subculture, and social forces which shape the

black family. These social forces are the economy, limited opportu­

nities, and restricted social mobility. According to Billingsley

(1968), black "family life in America is circumscribed by a complex

set of social conditions which shape the family in various ways"

(p. 201). As these social conditions worsen, the more devastating

will be the effect on the black family. 115

with the beginning of the 1980's comes a depressed economy coupled with a higher black unemployment rate. With this high unem­ ployment rate comes a diminished self image and increased criminality and mental illness among blacks, Akbar (1980) suggests that mental illness among blacks result from the oppressive American system which controls and dictates the way blacks are to behave. Moreover, he suggests that many blacks have a need to assimilate into the American way of life which is based on materialism. The reality and self worth of these blacks are determined by the achievement of material goods.

When the avenues for obtaining materialism are no longer available, rtany blacks become displaced. Consequently, the black family steadily disintegrates.

Thus, in reviewing data from studies on the black family, one

should interpret findings from a historical perspective. Jessie

Bernard (1966) argues that nothing conclusive can come from studies on blacks until more knowledge is gained about the black family structure and subculture. The present researcher suggests that in future studies

which focus on differences between blacks and whites, there must be

sensitivity and awareness of the black subculture and values which

exist. In further work in this area, for example, it will be important

to perhaps first develop norms for blacks or to build new instruments

that take the realities of the black experience into account. 116

Significant Correlations

In this section the significant correlations will be discussed.

Self Concept and Hospital Adjustment

The total self concept score and five Tennessee Self Concept sub­

scales (Identity, Self Satisfaction, Moral-Ethical Self, Personal

Self, Social Self) correlated significantly and negatively with a Craw­

ford Adjustment subscale, Management of Hostility. These findings sug­

gest that as the self esteem of mentally ill offenders is enhanced,

the more diminished is their level of hostility. Perhaps as mentally

ill offenders have a greater sense of self worth, their attitude and

behavior toward others changes in a more positive direction.

Self Satisfaction, the second Tennessee Self Concept subscale,

correlated significantly and negatively with the total Crawford Adjust­

ment score and all of the Crawford subscales. These findings indi­

cate that the more satisfied mentally ill offenders are with them­

selves, the less deranged is their thought process and more diminished

is the physical acting out. Moreover, the less communication problems

they experience with others.

Four Tennessee Self Concept subscales (Self Satisfaction, Physi­

cal Self, Moral-Ethical Self, Social Self) all significantly and nega­

tively correlated with the total Crawford Adjustment Scale score. All

of these correlations, taken as a whole, suggests that as mentally ill

offenders become more adjusted to the hospital environment, the more

diminished are the perceptions of themselves (physical, moral, and

social self). Harrow et al. (1968) reported a similar relationship 117 between self concept and maladjustment of patients. Goffman (1968) vehemently argues that the institutional life of inmates diminishes the self worth. Further, Goffman argues that when an inmate enters an institution, he comes in with a conception of himself from the home environment. The institution strips the inmate of his identity and conception of himself, thus the self worth is diminished.

The above significant correlations resulted from social workers’

■atings, while only one significant correlation was found on the nurses' ratings. This significant correlation was found between the

Number of Deviant Score (Tennessee Self Concept subscale) and the first Crawford Adjustment subscale, Social-Economic?1-Environmental

Competence. This finding indicates that the more competent (higher level of adjustment) the nurses perceive the mentally ill offenders to be, the lower the Number of Deviant score.

It is surprising that there was only one significant relationship found on the nurses' ratings. The present researcher expected more significant correlations. However, in view of the nature of the

Crawford Adjustment Scale which is a behavioral rating scale primarily scored on interactions of patients with others, it is not so sur­ prising. As discussed earlier, nurses perhaps base their adjustment ratings on how well the patients respond to medication, and not speci­ fically on how well they interact with others.

Self Ooncept, Symptom Discomfort, and Level of Expectations

The significant and negative correlations found between the total

self concept score and eight Tennessee Self Concept subscales, and 118

Symptom Discomfort (Katz Adjustment Scale) suggest that as the level of psychopathology (Symptom Discomfort) increases, the more diminished

is the self concept. This finding parallels those in previous research on post hospital adjustment (Freeman & Simmons, 1958, 1959) which sug­ gested that sicker patients live with their parents and perform

(activity around the home and community) at a lower level than patients who live with their wives. Thus, one would expect the self

esteem of these patients to differ in ways similar to those found in the present study.

The positive relationships found between two Tennessee Self Con­

cept subscales (Self Criticism and Number of Deviant Score) and Symp­

tom Discomfort indicate that as the level of Symptom Discomfort

increases, the more increased is the criticism of oneself and the

higher the deviance score. Perhaps the sicker patients (higher level

of Symptom Discomfort) are more critical of themselves and have higher

deviance scores. The Number of Deviance Score is a measure of

psychological disturbance. The more increased is the psychological

disturbance, the higher the deviance score.

Although there was no significant relationship between the total

self concept score and another Katz Adjustment Scale, Level of Expec­

tations for Performance of Socially Expected Activities, a significant

and negative relationship, however, was found with this latter scale

and the Tennessee Self Concept subscale, Behavior. The Behavior sub­

scale assesses the way an individual perceives himself and the way he

acts. This finding suggests that the higher the patient's Level of

Expectations for Performance, the more diminished are the patients' 119 perceptions of their behavior and the way they function. Perhaps as the patients began to have greater expectations of themselves and a desire to perform in the home and community, at the same time they may be fearful of not being able to adequately perform to others' expecta­ tions, If this is verified, it could be very useful information to professionals in various treatment settings.

Self Concept, Age, Education, and the Institutional Variables

While there were no significant relationships found between self concept (Tennessee Self Concept Scale or subscales) and age, or either of the institutional variables (total number of incarcerations, total number of hospitalizations), a significant and negative relationship, however, was found between one Tennessee Self Concept subscale (Number of Deviant Score) and education. Thus, mentally ill offenders who have higher deviance scores are poorly educated, Steadman and Cocozza

(1974) have found that many mentally ill offenders are poorly educated and marginal individuals in their mid-thirties.

Self Concept and Family Contacts

Although several significant correlations were found between the

Tennessee Self Concept subscales and the Family Contact Interview

Index, only one significant correlation, however, was found between the total self concept score and an Index item (Question 18, "Do you have visits from persons other than your family"). Four Tennessee

Self Concept subscales (Identity, Self Satisfaction, Behavior, Moral-

Ethical Self) significantly and negatively correlated with this same 120 question on the Family Contact Interview Index. These findings are quite striking and suggest that mentally ill offenders who had visits from persons other than family (e.g., friends, parole officers, mini­ sters) felt less satisfied with themselves and had a diminished self worth. Perhaps these mentally ill offenders feel threatened in some way by visits from persons other than family. It appears, howTever, that visits from friends would be viewed more favorably than visits from professionals who are following their progress.

The significant and positive correlation between Self Criticism

(Tennessee Self Concept subscale) and Question 24 ("What is the nature of most calls you make to your family") suggests that mentally ill offenders who received personal calls (as the last call from family) were highly critical of themselves. Perhaps the family members are critical of their patient relatives. Thus the patients become more critical of themselves.

Written Responses on The Family Contact Interview Index

In terms of the written essay responses on the Family Contact

Interview Index, mentally ill offenders who expect to return to fami­ lies of origin compared to those who expect to return to families of procreation responded similarly on all five essay questions (9, 16,

18, 25, 26). On Question 9, however, nine of 30 mentally ill offenders who expect to return home to the parents indicated they wrote letters to their parents, sisters, and brothers. On the other hand, eight of

30 mentally ill offenders who expect to return home to the wives indicated they wrote letters to family. Seven wrote letters to the 121 parents and other relatives (i.e., nephew, aunt), while only one wrote to the wife. Perhaps mentally ill offenders from families of pro­ creation wrote parents and other relatives more often than the wives because they feel the parents and other family members are more suppor­ tive.

Basically, these five questions asked about letters received, visits, calls, and response to staff encouragement of family contacts with patients. The patients provided favorable essay answers which consistently had a theme of caring. Both groups largely agreed that family visits and calls are helpful to their adjustment, and that hospital staff encourages family contacts with patients.

Caution should be taken in drawing specific conclusions based on the data from the Family Contact Interview Index alone. However, these findings are consistent with findings of other studies which report a significant and positive relationship between family contacts during hospitalization and success in the community (Adams & Fischer,

1976; Holt & Miller, 1D72; Pueschel & Moglia, 1977). Specifically, previous findings have shown that frequent family contacts (letters, calls, visits) enhance the patient/inmate's chance of a good post hospital adjustment. The present study revealed that the more fre­ quent the family contacts with patients, the higher the self concept

score. Moreover, patients not only responded favorably to family con­ tacts, but also felt they were helpful to their adjustment. 122

Summary of Results

In summary, the self concept (total score) of mentally ill offenders who expect to return to families of origin compared to those who expect to return to families of procreation did not significantly differ. Moreover, no significant difference was found between the self concepts of whites and blacks. A significant difference, how­ ever, was found between race on one Tennessee Self Concept subscale,

Moral-Ethical Self. Although mentally ill offenders from the two family settings and the two races showed no significant difference on total hospital adjustment, type respondent (nurses, social workers) had a significant main effect on the assessment of hospital adjustment. Specifically, the nurses perceived the patients to be

significantly more maladjusted than the social workers. The Level of

Expectations and Symptom Discomfort did not significantly differ for type family or race. Some significant differences were found between

type family and race on the Family Contact Interview Index which partly

supported Hypothesis £5.

Problems with Data Collection

The questionnaires were administered to participants face to face

(rather tlian mailing) primarily because of the complexity of the

instructions and the need to determine that the reading level of

mentally ill offenders was adequate for the task which was presented

to them. Additionally, the participation and support of the nurses

and social workers was essential in completing this investigation 123

(see Method Section for details of selection process). Although the face to face interview proved to be the most feasible way of collect­ ing the data, there were several limitations. These are as follows:

1. An enormous amount of time was spent establishing rapport

with hospital social workers and nursing staff to enlist

t he i r suppo rt.

2. Long distance trips to several hospitals all over the State

of Ohio required careful planning and a substantial travel

cost.

3. After the investigator traveled long distances to interview

participants, five refused to be interviewed, thus requiring

additional travel.

While these problems created delays in scheduling and data collec­ tion, the present researcher, however, encourages more research on the mentally ill offender population and, drawing on learnings from this study, provides the following suggestions for future research.

Suggestions for Future Research

After an extensive review of the self concept and adjustment

literature, no studies were available on the mentally ill offender

population. This appears to be one of the first self concept studies on this population. Without the benefit of previous work, directional predictions were not made. Many findings in the present study showed

significant main effects, however, further analyses using two-tailed

t-tests determined no significant differences between groups. In

fact, many of the t-test findings approached significance. Perhaps if 124 a larger sample had been used, more significant results would have been obtained, in any event, the present findings were encouraging and suggest that further investigation may prove fruitful.

The researcher offers several suggestions for future studies on this population. These are as follows:

1. As discussed above, a larger sample size will perhaps provide

a greater chance of detecting differences that do exist.

2. On the Crawford Psychological Adjustment Scale, include

psychiatrists in the type respondent category along with

the nurses and social workers. This will provide another

significant comparison. Perhaps the race of the respondent

should be considered.

3. Conduct longitudinal research to determine if the self con­

cept and level of Symptom Discomfort (psychopathology) of

mentally ill offenders significantly change from the hospi­

tal setting to the home environment, looking at type family

and race. This data can provide mental health professionals

with pertinent information about the patient's hospital

and post hospital adjustment.

4. Include a depression scale in the study. Previous research

on self concept suggests a significant relationship between

the level of depression and self concept.

5. Develop a scale or set of scales which will address the black

subculture. This will perhaps help to explain more clearly

differences between blacks and whites. Include black and white data collectors to see if race of the collectors make a difference in participants' responses.

Obtain information on medication patients take and determine significance to the self concept and adjustment.

If the association between some of the variables examined in this study is verified, design and conduct studies to separate cause and effect.

Obtain financial support from local, state, and federal agencies to help with the data collection cost. Financial support for the present study came from two sources: The

Minority Affairs Award Program and the Graduate Student

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ANALYSIS OF VARIANCE TABLES

136 Table 20

Main Effect of Type Family on the Tennessee Self

Concept Scale and Its Subscales

Tennessee Self Sum of Mean Concept Scale Squares df Square

Total Self Concept 24.067 1 24.067

Self Criticism 41.667 1 41.667

Identity 1.350 1 1.350

Self Satisfaction 45.067 1 45.067

Behavior 53.017 1 58.017

Physical Self 4.267 1 4.267

Moral-Ethical Self ■ 62.017 1 62.017

Personal Self 11.267 1 11.267

Family Self 36.817 1 36.817

Social Self 224.267 1 224.267

Humber of Deviant 135.000 1 135.000 Score 138

Table 21

Main Effect of Race on the Tennessee Self Concept

Scale and Its Subscales

Tennessee Self Sum of Mean Concept Scale Squares df Square

Total Self Concept 308.267 1 308.267

Self Criticism 240.000 1 240.000

Identity 464.817 1 464.817

Self Satisfaction 166.667 1 166.667

Behavior 331.350 1 331.350

Physical Self 209.067 1 209.067

Moral-Ethical Self 686.817 1 686.017

Personal Self 448.267 1 448.267

Family Self 244.017 1 244.017

Social Self 45.067 1 45.067

Humber of Deviant 3.267 1 3.267 Score 139

Table 22

Interaction of Type Family and Race on the Tennessee

Self Concept Scale and Its Subscales

Tennessee Self Sum of Mean Concept Scale Squares df Square

Total Self Concept 216.600 216.600

Self Criticism 385.067 385.067

Identity 133.750 183.750

Self Satisfaction 123.267 123.267

Behavior 400.417 400.417

Physical Self 8.067 8.067

Horal-Ethical Self 220.417 220.417

Personal Self 81.667 81.667

Family Self 476.017 476.017

Social Self 481.667 481.667

Number of Deviant 38.400 38.400 Score 140

Table 2 3

Main Effect of Type Family on the Crawford

Psychological Adjustment Scale

Crawford Psychological Sum of Mean Adjustment Scale Squares df Square

Total Crawford Adjust­ 226.875 1 226.875 ment Score

Social-Economical- 13*333 1 13.333 Environmental Compe­ tence

Derangement of 7. 500 1 7. 500 Thought Process

Physical Behavior 17.633 1 17.633

Communications 9.633 1 9. 633

Social Acceptability . 833 1 .833 of Behavior 1

Management of *533 1 .53 3 Hostility 141

Table 24

Main Effect of Race on the Crawford Psychological

Adjustment Scale

Crawford Psychological Sum of Mean Adjustment Scale Squares df Square

Total Crawford Adjust­ 16.875 1 16.675 ment Score

Social-Economical- .133 .133 Environmental-Compe- tence

Derangement of 1.633 1 1,633 Thought Process

Physical Behavior 13.333 1 13.333

Communications 2.133 2.133

Social Acceptability 9.633 1 9.633 of Behavior

Management of .833 1 .83 3 Hostility Table 25

Main Effect of Type Respondent on the Crawford

Psychological Adjustment Scale

Crawford Psychological Sum of Mean Adjustment Scale Squares df Square

Total Crawford Adjust­ 3193.008 1 3193.008 ment Score

Social-Economical- 17.633 1 17.633 Environmental Compe­ tence

Derangement of 313.633 1 313.633 Thought Process

Physical Behavior 264.033 1 264.033

Communications 24.300 1 24.300

Social Acceptability 36.300 1 36.300 of Behavior

Management of 34.133 34.133 Hostility 143

Table 26

Interaction of Type Family and Race on the Crawford

Psychological Adjustment Scale

Crawford Psychological Sum of Mean Adjustment Scale Squares df Square lotal Crawford Adjust­ 1710.075 1 1710.075 ment Score

Social-Econonical- 282.133 1 282.133 Environmental Compe­ tence

Derangement of 83.333 1 83.333 Thought Process

Physical Behavior 76.800 1 76.800

Communications 4.033 1 4.033

Social Acceptability 12.033 1 12.033 of Behavior

Management of 0 . ooo 1 0.000 Hostility 144

Table 27

Interaction of Type Family, Race and Type Respondent

on the Crawford Psychological Adjustment Scale

Crawford Psychological Sum of Mean Adjustment Scale Squares df Squa re

Total Crawford Adjust­ 492.075 1 492.075 ment Score

Social-Economical- 50.700 1 50.700 Environmental Compe­ tence

Derangement of 14.700 1 14.700 Thought Process

Physical Behavior 70.533 1 70.533

Communications . 533 1 .533

Social Acceptability 12.033 1 12.033 of Behavior

Management of .833 1 .833 Hostility APPENDIX B

FACE-TO-FACE INTERVIEW WITH MENTALLY

ILL OFFENDERS

14 5 146

Interview with Participants

Hello, I'm . I'm a graduate student at The

Ohio State University and a worker at the Department of Mental Health and Mental Retardation. I am conducting research on self concept, hospital adjustment, type family setting, and race of former Lima

State Hospital patients. There is very little known about the Lima

State Hospital population in or out of the institution, and primarily for this reason I am asking for your help. What I would like for you to do is to fill out three questionnaires. The first one is the Tennessee

Self Concept Scale which deals with your thoughts about yourself. The second questionnaire is the Katz Adjustment Scales which consist of two parts. One part asks questions about symptoms you might be experiencing now, and the other part deals with your expectations upon discharge from the hospital. The Family Contact Interview Index, the third questionnaire, asks questions about contacts you have with your family (spouse, parents). The completion of these questionnaires will take approximately one hour of your tine. Another questionnaire, The

Crawford Psychological Adjustment Scale will be administered to the social worker and nurse on your ward. These professionals are asked to fill out this questionnaire which describes your hospital adjust­ ment .

Before I go any further, I want to assure you that your answers

and the information given by the social worker and nurse will remain completely anonymous. I do not want your name on the questionnaires.

If for some reason you decide not to answer certain questions, it is

your choice to omit them. Of course you can terminate participation 147 in this study at any time. Your participation in this study is in no way related to your release from the hospital. If you are willing to participate, I will need two consent forms signed by you. APPENDIX C

CONSENT FORMS

148 149

>

AUTHORIZATION FOR RELEASE OF INFORMATION

The Department of Mental Health and Mental Retardation jt granted my

permission to release to J a n i c e O w ens L a n e ______Department of Mental Health fc Mental Retardation, Employee

Ohio State University Graduate Student (Fuji Ninx ind AddrMt of P»non„ JmMutton, a t A **«cy|

iuch information a* may b* necessary regarding the treatment of:

(Print or Typ* Full of )

Purpose or Need for Disclosure: Study of the Relationship Between Self Concept, Hospital Adjustment, and Type Family Setting of Mentally 111 Offenders.

Specific Information to be Oisdosed: Participants are ashed to correlate three questionnaires. One questionnaire is to be completed by a social worker and nurse. Some information on subjects will be taken from the files at the Department of Mental Health and Mental Retardation, primarily demographic information.

This content to disclose may be revoked by me at any time except to the extent that action has been taken in reliance thereon

Thts consent (unless expressly revoked earlier) expires upon:

______September, I960______(&o*cify D ate EM fit, Of C o n d itio n U c o n Wtiich it Will E *oif« (witriin 9 0 d*yfc|

(SHjnAturc of Ciitni/Pftitnt/Rttidvnl or panon Auihor+zftd I© comcntl

R elat ionth ip: - ______

Date Signed: ______

W itness:______

AUTHORIZATION FOR RELEASE OF INFORMATION nev. a/ta MMaMFt ioss (=1 PROTOCOL NO.

— 1Tt« OHIO STATE UNIVERSITY—

CONSENT FOR PARTICIPATION IN SOCIAL AhC BEHAVIORAL RESEARCH

I consent, to participating in (or my child's participation in) a study entitled A Study of the Relationship Between self Concept, Hospital

Adjustment, and Type Family Setting of Mentally 111 offenders._____

______Janice Qwene Lane______has (Investigator/Project Director or his/her authorized representative) explained the purpose of the study and procedures to be followed. Possible benefits of the study have been described as have alternative procedures, if such procedures are applicable and available.

I acknowledge that I have had the opportunity to obtain additional in­ formation regarding the study and that any questions 2 have raised have been answered to my full satisfaction. Further, I understand that Z am (my child is) free to withdraw consent at any time and to discontinue participation in the study without prejudice to me (my child). The information obtained from am (my child) will remain confidential and anonymous unless I specifically agree otherwise.

Finally, I acknowledge that 1 have read and fully understand the consent form. I have signed it freely and voluntarily and understand a copy is avail­ able upon request.

Datei Signed: (Participant)

(Investigator/Project Director or (Person Authorised to Consent Authorised Representative) for Participant - Zf Required)

PA-02? (2/79) — To b* used only in connection with sociaJ and behavioral re­ search for which an OSt) Mum an Aibjsct Review Cbweitte# has determined that the raaaarch poses no risk to participants. APPENDIX D

QUESTIONNAIRES

151 RECORD INFORMATION

Name of patient_

Race______Age______

Education______D i a g n o s i s ______Total Number of Incareerationa (prison or Jail)

Last crime (charge)______

Total Number of Hospitalizations last Admission Date to civil Mental Hospital_

Reason for Admission to Civil Mental Hospital

D i a g n o s i s ______

Type Living Arrangement______(parents or spouse) KAS BEHAVIOR IHVEKTCRIES S FORKS 2 5 By H a rt Jo H. ju t* 1 iruov Form Mono i tat Si;b irtfiT Period 1 Rater

Name of subject

D ate

Interviewer

Fleaae wait for Instructions before beginning. PLEASE NOTE: Copyrighted materials in this document have not been filmed at the request of the author. They are available for consultation, however, in the author's university library. These consist of pages:

1 and 173-176.

University Microfilms International 300 N. ZEEB RD.. ANN ARBOR Ml 48106 '313l 761 4700 165

TENNESSEE SELF CONCEPT SCALE

by

William H. Fitts, PhD.

Published by

CouriMlor Recordings and Tests

Box 6184 * Acklen Station Nashville, Tennessee 37213 INSTRUCTIONS On Hw top lino of the Mparato antwor ihoot, fill tn your namo end tho othor Information except for tho tfmo Information in tho last thro# box**. You will fill thoio boxot In lator. Writo only on tho anowor sheet. Do not put any marks In thb booklet. Tho statements In thb booklot aro to hoip you describe yourtoH ao you too yourtolf. Please respond to thorn as If you woro describing youraolf to yourself. Do not onrilt any Heml Rood ooch statement carefully) then *elect one of tho five response* listed below. On your answer shoot, put a circle around tho response you chose. If you wont to change an answer after you have circled It, do not erase H but put an _X mark through tho response and then circle the response you Wttfll* When you are roody to start, find the box on your answer sheet marked time started and record the time. When you are finished, record the time finished In the box on your answer sheet marked time finished. As you start, be sure that your answer sheet and thb booklet are lined up evenly so that the Hem numbers match each other. Remember, put a circle around the response number you have chosen for each statement. Completely Mostly Partly fobs Mostly Completely Responses false fa be and true true portly true 1 2 3 4 5 You will find these response numbers repeated at the bottom of eoch page to help you remember them.

* WMtosn K. Ats* 1964 167

d < Item ro g e 1 No.

1, I hove o healthy body ...... 1

3. I am an attractive person...... 3

5. I consider myself a sloppy person...... ®

19 19. I am a decent sort of person ......

21 . I am on honest person ...... 21

23. I am a bad parson ...... 23

37. I am o cheerful person ...... ^

3 9 . lama calm and easy going person ...... 39

41 . I am a nobody ......

55. I have a family that would always help me in any kind of trouble ...... 55

57. I am a member of a happy family...... 57

59. My friends have no confidence in me ...... ^

73. I am a friendly person...... 73

75. I am popular with men ...... 7 5

77. I am not interested in what Other people do ...... ^

91. I do not always tell the truth ...... 91

93. I get angry sometimes ...... 93

Completely Mostly Partly false Mostly Completely Responses- false false and true true partly true 1 2 3 4 5 168

a - I'1 Page 2 Mo.

2. I like to look nice ond neat oil time ......

4. I am full of aches and pains ...... H

6 - I am o sick person ......

20. I am a religious person ......

22. I am a moral failure ......

24. f am a morally weak person...... |

38. I have a lot of self-control ...... H i

40. I am a hateful person ...... H

42. I am losing my mind ...... H

56. I am on important person to my friends and family ...... H

58. I am not loved by my family...... H

60. I feel that my family doesn’t trust me ...... H

74. I am popular with women ...... I

76. I am mod at the whole world ...... I

78. I am hard to be friendly with ...... H

92. Once in a while I think of things too bod to talk about ...... H

94. Sometimes, when I am not feeling well, I am cross ...... I

Completely Mostly Portly false Mostly Completely Responses- false false and true true parti y true I 2 3 4 5 169

D - Icem Poge 3 ko .

7. I am neither too fot nor too thin ......

o 9. I like my looks just the way they are......

] I . I would like to change some parti of my body ......

25 25. I am satisfied with my moral behavior ......

2 7 27. I am satisfied with my relationship to G od ......

29. I ought to go to church more ...... 2 9

43. I am satisfied to be just what I am ......

4 5 4 5 . I am just as nice os I should b e ......

47 47, I despise myself......

61 . I om sotisfied with my family relationships ...... ^

63 63. I understand my family as well os I should ......

65 65. I should trust my family more ......

79. I am as sociable os I want to be ...... 7 9

81 . I try to please others, but I don't overdo it ...... ^

83 83. I am no good at all from a social standpoint ......

95 95. I do not like everyone I know ......

97, Once in o while, I lough at o dirty joke ...... ^

Completely Mostly Partly false Mostly Completely Responses- false false ond true true partly true 1 2 3 4 5 170

Page *

8. I om neither loo tall nor too short ......

10. I don't feel at well at I should ......

12. I should hove more sex oppeol ......

26. I am at religious ot I want to be ......

28. I wish I could be more trustworthy ......

30. I shouldn't tell so many liet ...... *

44. I am as smort as I want to be ......

46. I am not the person I would like to be ......

48. I wish I didn't give up os easily as I do ......

62. I treat my parents as well as I should (Use past tense if parents are not living

64. I am too sensitive to things my family say ......

6 6 . I should love my family more ......

80. I am satisfied with the way I treat other people ......

82. I should be more polite to others ......

84. 1 ought to get olong better with other people ......

96. I gossip a little at times......

98. At times I feel like swearing......

Completely Mostly Partly folse Mostly Completely Responses - false false and true true partly true

2 3 4 5 171

■> «■ I C M Poge 5 Mo.

13. I take good core of my tel f physically ...... 15

15. I try to be careful about my appearance......

17. I often act like I am "all thumb*" ...... 17

31 . I om true to my religion in my everyday life...... 51

33. I try to change when I know ('m doing thing* that are wrong ...... 53

35. I sometimes do very bod things ...... 55

49. I can always take care of myself in any situation......

51 , I take the blame for things without getting mad ...... 51

S3 53 . I do things w ithout thinking about them firs t......

67. I try to play fair with my friends and family......

69. I take a real interest in my family......

71 . I give in to my parents. (Use past tense if parents are not living)...... 71

85. I try to understand the other fellow's point of view ......

87. I get along well with other people ......

89. I do not forgive others easily ......

Q A 99. I would rother win than lose in a game ......

Completely Mostly Partly false Mostly Completely Responses - false false ond true true partly true

1 2 3 4 5 172

I t e s Poge 6 Mo.

14, I feel good most of the time

16. I do poorly in sports and games

18. I am a poor sleeper

32. I do what is right most oF the time

34. I sometimes use unfoir means to get ahead

36. I have trouble doing the things that ore right

50. I solve my problems quite easily

52. I change my mind a lot

54. I try to run away from my problems

68. I do my share of work at home

70. I q1 a rel with my family

72. I do not act like my family thinks I should

86. I see good points in all the people I meet

I. I do not feet at ease with other people

90. I find it hard to tolk with strangers

100. Once in a while I put off until tomorrow what I ought to do today

C om pletely M ostly Portly ffolse Mostly Completely Responses- false false and true true partly true 2 3