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A SEMANTIC APPROACH TO PSYCHOLOGICAL NOSOLOGY* LAWRENCE N. SOLOMON

Western Behavioral Sciences Institute L a Jolla, California

PROBLEM Classification systems in science serve the purpose of organizing the subject

matter into meaningfully related groups and of facilitating the scientist’s prediction and control of his variables. It was undoubtedly such considerations that prompted Kraepelin to formulate his original classification of mental disorders. The denotative significance of kraepelin’s original categories have been carefully transmitted from generation to generation of clinical practitioners, in this way enhancing communica- tion between workers in the field of mental health. But recent in~estigationc~) of the communication process has revealed that the “meaning” of any concept is multivariate in nature, and that concepts carry connotative as well as denotative significances. The diagnostic categories in psychology and psychiatry are rich in implication (connotative meaning) and there is every reason to believe that these connotations vary greatly among clinicians and thereby reduce the fidelity of their communication.

Indeed, Korman(2) has recently demonstrated significant inter-group differ- ences in semantic structures and in degree of connotative similarity assigned to diagnostic and therapeutic concepts between psychologists and social workers. He also demonstrated that for psychologists, certain therapeutic concepts tended to cluster semantically into three groups of connotatively equivalent or interchange- able terms. These three groups of terms were: (a) EST, directive psychotherapy,

‘This research was supported in part by a grant from the Sigma Xi-RESA Research Fuqd.

A SEMANTIC APPROACH TO PSYCHOLOGICAL NOSOLOGY 19

and commitment ; (b) uncovering psychotherapy, psychotherapy, and group psycho- therapy; (c) reassurance, supportive psychotherapy, and tranquillizing drugs.

Meehl@- P. 2 6 ) has stated that “. . . the question of what is the most economical language to employ in describing a patient remains open.” It would seem that a first step in answering this question would be to determine in what way the present terminology is being used, what connotative as well as denotative meaning it has for clinicians, and how variations in these meanings make for similarities and differ- ences between concepts. Perhaps in this way a psychological nosology incorporating “clinical intuition” may be evolved.

This study investigated the connotative meanings of various diagnostic categor- ies utilized in psychology and psychiatry, in order to answer the following questions: (a) What are the most commonly agreed upon connotations for the various diag- nostic categories studied? (b) Which terms have the “same” meaning connotatively and therefore form a cluster within semantic space?

METHOD A group of 12 clinical psychologists (mean experience 12.9 years) was asked to

rate 15 diagnostic categories on a series of 20 scales. The 15 diagnostic categories (Table 1) were taken from the MMPI, the Classification of Psychiatric Conditions utilized by the Veterans Administration, and the discussions of psychosis and neurosis in standard texts on abnormal psychology.

TABLE 1. DIAGNOSTIC CONCEPTS USED IN THIS STUDY

Catatonic Schizophrenic Introvert Hypochondriac Hebephrenic Schizophrenic Paranoiac Hypomanic Paranoid Schizophrenic Psychotic Psychasthenic Simple Schizophrenic Neurotic Depressive Extrovert Hysteric Psychopathic Deviate

The 20 scales utilized were those employed by Jenkins, Russell and Suci(’) in their study of the role of language in behavior and represent six dimensions of meaning as isolated by factor analysls (Table 2). This 20 scale instrument is a form of the semantic differential as developed by Osgood, et al.(4) and exhausts the semantic space structured through factor analysis. Twenty seven-point scales were defined by polar opposite adjectives, and the subjects were asked to rate a given concept on these scales by placing a check mark on each scale to indicate the degree of association he felt existed between the adjectives and the concept. Each subject was given 15 sheets, each with the 20 scales on it inthe orderused byJenkins etal. (l), and with a diagnostic category to be rated a t the top. The polarity of the scales was alternated from sheet to sheet and the order of the concepts was random from sub- ject t o subject.

TABLE 2. SEMANTIC DIFFERENTIAL SCALES USED IN THIS STUDY (LISTED BY FACTORS)

Evaluation Potency Activity Tautness Novelty Receptivity

cruel-kind masculine- activq- angular- new-old savory- usual- tasteless timely- feminine passive rounded

untimely hmd-soft calm- curved- unusual colorful- successful- weak-strong excitable straight colorless

unsuccessful slow-f ast wise-foolish

important- unimportant

true-false beautif ul-ugly

good-bad

20 LAWRENCE N. SOLOMON

RESULTS Mean scale ratings were calculated for each concept, summing over subjects.

This generated a concept-by-scale matrix, with mean scale ratings in each cell. A D matrix was then computed, yielding a measure of relationship between each con- cept and every other concept. (D is a measure of distance between concepts within the semantic space structured by the six dimensions of meaning isolated by factor analysis. It is equal to the square root of the sum of the squared differences between any two concepts taken a scale a t a time.)

Table 3 presents the connotative meanings which were found to be consistently associated with certain diagnostic concepts. Consistency is taken as a mean scale rating equal to or less than 2.5 or equal to or more than 5.5. Since 4.0 is the center of the scale and is taken as indicating either equal association to both ends of the scale or the irrelevance of the scale, and further, since the variability over time of the scaling technique has been found to be no more than one ~ca leun i t (~ ) , i t was assumed that mean ratings beyond the limits of 2.5 and 5.5 indicated reliable meanings associated with the concept.

TABLE 3. CONNOTATIVE MEANINGS OF DIAGNOSTIC CONCEPTS.

Catatonic Schizophrenic: passive, unsuccessful, slow Hebephrenic Schizophrenic: unsuccessful, foolish, weak Paranoid Schizophrenic: cruel, excitable Simple Schizophrenic: passive, unsuccessful, foolish, weak, colorless Extrovert: active, colorful Introvert: calm Paranoiac: unusual Psychotic: unsuccessful Neurotic: (no consistent meanings) Hysteric: excitable Hypocondriac: weak Hypomanic: active, excitable, colorful, fast Psychasthenic: (no consistent meanings) Depressive: passive, unsuccessful, colorless, slow Psychopathic Deviate: cruel, active, false

Looking at t,he factor composition of the adjectives in Table 3, it is apparent that four are from scales on the evaluative dimension (cruel, unsuccessful, false, and foolish) ; one is from a scale on the potency dimension (weak) ; six are from scales on the activity dimension (excitable-calm, passive-active, and fast-slow) ; none are from the tautness dimension; one is from a scale on the novelty dimension (unusual) ; and two represent the factor of receptivity (colorful-colorless). The frequency with which consistent distinctions were made on each of these dimensions reveals that 41y0 were made on the activity dimension; 32y0 on the evaluation dimension; 13y0 on the receptivity dimension; 10% on the potency dimension; and 30/, on the novelty dimension.

The clustering of categories revealed by the D matrix reflects these distinctions. Fig. 1 presents a two-dimensional representation of the relationships between clusters of diagnostic concepts. The smaller the D value, the closer together the concepts stand in the six dimensional space defined by the rating instrument. It may be seen from Fig. 1 that there are essentially three clusters of diagnostic labels. Two terms (hysteric and introvert) do not show sufficient relationship to any other concepts to be included in a cluster.

The hypomanic-extrovert cluster shown in Fig. 1 seems to reflect a high energy, high activity grouping, and results from the fact that the major part of consistent connotative meaning assigned to these concepts is in terms of the factor of activity.

The sub-cluster of catatonic schizophrenic-simple schizophrenic depressive (which appears to be a part of a larger cluster) probably represents the low end of the energy-activity dimension, in that these categories all connote low activity, with- drawal, and minimum motor expression.

A SEMANTIC APPROACH TO PSYCHOLOGICAL NOSOLOGY 21

FIG. 1. A TWO-DIMENSIONAL REPRESENTATION OF CLUSTEFCS OF DIAGNOSTIC TERMS.

1-1.. ....\-I

..I-1 ....... l“..‘...i“l

0 V A L U E S

-2.0 0, 111% - - 2.1 lo 2 . 4 ...... 2.5 t o 2.9

The cluster of paranoid schizophrenic-paranoiac-psychopathic deviate seems to hang together because of the common negative evaluation given these terms by the subjects. All three syndromes carry the connotation of “danger to others’’ and a general cruelty in interpersonal relations.

The larger cluster containing neurotic, hypochondriac, psychotic, hebephrenic schizophrenic, etc., defies easy explanation. The only readily interpretable relations are between psychotic and hebephrenic schizophrenic, where the bizarre character- istics of the latter dramatically portray the “insanity” of psychosis; and between neurotic and hypochondriac, where the somatic complainer may compose the bulk of neurotics seen by the clinicians polled.

DISCUSSION The results of this study have indicated how, within a semantic framework of

known composition, a group of practicing clinical psychologists assign connotative meaning to some of the major concepts of their profession. Whereas there appears to be a moderate degree of agreement among the subjects as to the connotations of these terms, for a t least two concepts (neurotic and psychasthenic) there is not sufficient concordance to permit the assumption of consistent meanings. Although the term “psychasthenic” is somewhat out of style today, it is disconcerting to discover that such a popular term as “neurotic” does not display consistent meanings even among a group of well experienced clinicians.

The manner in which the differential scales were used by the subjects reveals that the general picture of the mentally ill person is of one who is negatively evalu- ated, weak and unusual. He may be active or passive, colorful or colorless, depending upon other variables.

The clustering of concepts shown in Fig. 1 leads to some interesting speculations about the basis for the observed intra-group relations. For example, the cluster of paranoid schizophrenic-paranoiac-psychopathic deviate raises some questions about the implicitly perceived psychodynamics of these syndromes. It is possible to specu- late about the relation between psychopathic deviate and paranoid, seeing the former as a defense against the latter. It is also possible to point to the similarity i n

22 LAWRENCE N. SOLOMON

these disorders in terms of the non-incorporation of a superego. For the paranoias, the superego has been introjected, but not incorporated as part of the patient’s personality. The paranoid must therefore project his superego outward in the de- fensive projections so characteristic of this disorder. The psychopatic deviate has not introjected nor incorporated a super-ego, and hence stands apart from it as does the paranoid. A t any rate, these categories have the “same” connotative meaning for the clinicians sampled, and perhaps this clustering may lead to some insight into what the clinician is reacting to in these patients that leads him to feel that they are similar.

It should be emphasized that the subjects in this study were asked to respond to concepts within a semantic frame of reference developed from another sample of the population and related to a different class of concepts. Perhaps the relationships presently reported would be markedly modified if one were to develop a factorized semantic differential based upon the responses of a large population of clinicians to a representative sample of nosological categories, as these are rated on scales exhaust- ing the descriptive language spontaneously employed by these practitioners. Future research may provide an answer to this speculation. The present findings are only suggestive and should be generalized to other populations with extreme caution.

A suggestion for the future validation of findings such as those reported here would be to analyze the confusions in hospital and other diagnoses, with the ex- pectation that there would be most confusion between terms within clusters and least between terms in different and unrelated clusters.

SUMMARY In an effort to determine (a) what are the most commonly agreed upon connota-

tions for a sample of psychodiagnostic concepts, and (b) which of these terms have the “same” meaning and tend to cluster within semantic space, 12 clinical psy- chologists rated 15 concepts on a 20 scale form of the semantic differential. Mean scale ratings for each concept were analyzed to reveal consistent meanings assigned to the terms. An analysis of the relationships between the concepts revealed the presence of three major clusters. The connotations of the terms and the basis for clustering are analyzed and suggestions for further research are presented.

REFERENCES 1. JENKINS, J. J., RUSBELL, W. A. and SUCI, G. J. An atlas of semantic profiles for 360 words.

2. KORMAN M. Implicit personality theories of clinicians as defined by semantic structures.

3. MEEHL, P. E. +he cognitive activity of the clinician. Amer. Psychologist, 1960,16, 19-27. 4. OSOOOD, C. E., SUCI, G. J. and TANNENBAUM, P. H. The measurement oj meaning. Urbana:

Amer. J . Psychol., 1958, 71, 688-699.

J . consult. Psychol. 1960, 2.4, 180-186.

University of Illinois Press, 1957.

CORRECTION The article by Wolkon, G. H. and Haefner, D. P. Change in Ego Strength of Improved and

Unimproved Psvchiatric Patients. J . din. Psychol., 1961, 17, 352-355, contained an error in the 6th line under Results on page 353. This line should read: “length of hospitalization correlated -.33 with persistence, -.37 with goal specificity, and - .40 with interpersonal relations.”