Presidential Address Margaret Singer (1973)

8/7/2019 Presidential Address Margaret Singer (1973)

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Psychosomatic M edicineJOURNAL OF TH E AMERICA N PSYCHOSOMATIC SOCIETY

Presidential Address—

Engagement-Involvement: A CentralPhenomenon in Psychophysiological Research

MARGARET THALER SINGER, P H D

Experience indicates that there will bea continuing use of interviewing and ob-servational methods for assessing thepsychological status of persons in studiesusing concurrent physiological measures.I shall briefly re view asp ects of the historyof such work, and selectively focus uponc er ta in s tu die s u sin g i n t e r v i e w -observational techniques and relate thework of several research groups. Espe-cially here, I want to again call attentionto a transactional phenomenon, which Iterm engagement-involvement (1-12). Iho pe in so doing to encou rage further ef-forts toward defining and studying its par-ameters. When semantic differences arereconciled, it appears that a num ber of re-searchers have been studying similar pro-perties in transactional behavior.

Based upon my own years of work ininterdisciplinary research, and from thewritings of others, my first speculation isthat each person appears to have at anygiven moment an estimatable level of en-gagement to nonengagement with his fel-

Presented at the American Psychosomatic Society,Annual Meeting, April 7,1973, Denver, Colorado.

Received for publication August 30, 1973.

low man, his surroundings, and his innerself and on a longer term basis has whatmight be termed his preferred level of en-gagement. Persons, seem to show detecta-ble short-term changes in their level ofengagement-involvement (of which alert-ing, activation, affect, and changes in res-ponsiveness are integral components).These short-term changes in engagement-involvement are shown both in outwardbehavior with other persons, events, andsurroundings and in the level of respon-siveness to inner states, memories, andideas. These short-term features can berated in particular settings and at specifictime periods for attempted correlationswith certain physiological indices. At thesame time, we need to try to predict whatis a person's general preferred level of en-

gagement with the inner and outer stimuliimpinging upon him. The more rapidlyc ha ng in g le ve ls of e n g a g e m e n t -involvement might be termed the currentresponses, whereas longer term qualities,the person's predictable average range,might be called his preferred style ofengagement-involvement.

Engagement-involvement is difficult todefine succinctly, because it always oc-curs in a transactional context, a context

Psychosomatic M edic ine V ol. 36, No. 1 (Jan.-Feb. 1974) 1Copyright ® 1974 by the American Psychosomatic Society, Inc.

Published by American Elsevier Publishing Company, Inc.





PRESIDENTIAL ADDRESS

chophysiological and psychosomatic re-search because it permits one to try toquantify the cost of behavior one notes ina person's current transacting. Add itional-ly, the concept forces a rater to avoid fo-cusing too narrowly or too exclusivelyupon intraphysic features, traits, and atti-tudes which are not currently activated or

"turned on" responses to the presentscene. For example, a rater attempting toassess psychological behavior for possiblecorrelation with concurrent physiologicalmeasurements can be led astray and over-rate certain behaviors such as handw ring-ing, grimacing, nervous laughter, jitteryways, as signs of current "anxiety" withan implied "c ost" to the individua l, whilein actuality, these may be habitual, stylis-tic features of certain persons not accom-panied by any special changes in levelsof physiological output, for there is no

new, current engagement-involvement.For some persons, such behaviors are asingrained and automatic as regionals pe ec h a cc en ts . R atin g e n g a g e m e n t -involvement permits a rater to focus uponcurrent changes and levels rather thanpaying undue or incorrect heed to habi-tual features, which need to be rated forother purposes in studies where, I believe,long term physiological indices are beingmeasured. But for attempted correlationsbetween the interview-observational as-sessment of behavior in relation to certain

rapidly-changing physiological indices,the concept of engagement-involvementseems a more useful way of rating thestate of a person.

HISTORY OF THE CONCEPT

The early 1950s was a period of rapidrefinement in physiological monitoringand biochemical methods and the begin-ning of increasingly more sophisticated

studies of psychological and physiologicalinteractions. Until then the subject whocame into a laboratory experiment was re-garded as an entity who responded tochanges in physical and environmentalstimuli such as heat, pain, cold, or noise,with neither the personality of the experi-menter nor the setting considered as vital

parts of the conditions with which thesubject had to deal. The subject was notseen as a transacting, but as a reacting en-tity, and only his responses to the con-trolled stimuli were given heed. His reac-tions to the experimenter or the settingwere not considered as serious param etersof study. The subject was viewed ahistori-cally. Regard was not given to what wasgoing on in his life prior to coming intothe laboratory. He could have come fromparticipating in a car accident, a quietchurch service, or a happ y ho ur at the lo-

cal pub. Neither was heed given to wherethe subject was going in his life. Was hepreparing for crucial examinations, worry-ing about a close relative, or on his wayto a vacation? Only in the past twentyyears have subjects in psychophysiologi-cal studies been viewed as having histor-ies, futures, and most of all as personswho are transacting with their surround-ings at the very moments physiologicalmeasurements are being made.

Time limits our review of the many

studies done by members of this societyand others in which variations in one ormore aspects of laboratory procedureswere studied in hum ans (29-55). Here wecan mention only a few studies whichcentrally focus upon the engagementaspects of transactions.

ENGAGEMENT EM A T R A N S A C T I O N

In the early 1950s Reiser and his col-

leagues at the Walter Reed Army Institute

Psychosomatic Medicine Vol. 36, No. 1 (Jan.-Feb. 1974)



MARGARET THALER SINGER, PhD

of Research began to explore some of thediscrepancies that existed in the psy-chophys io logica l l i t e ra ture (1 ,2 ,5 ,6 ,9,12,56—59,79). "While some of the dis-crepancies may be explained by the factthat the psychological and physiologi-cal techniques used have varied consider-ably from one laboratory to another, it is

our thesis that much of the disagreementmay stem from meth odolo gical difficultiesthat are introduced when man studiesman" (1). They felt that physiologicalchanges recorded in a laboratory couldbest be understood within the context ofthe subject's responses to the totality ofthe experimental situation (laboratory, in-struments, and the examiner himself),rather than as mere responses to specificmanipulations and stimuli to which thesubject was exposed (5). Reiser wished toeva luate sys tema tically t he m u l t i p l epsychological aspects of the experimentalsituation and to explore their relation-ships to concomitant cardiovascular phen-omena. Thus Reiser, Weiner, Thaler-Singer, and others, in a series of studiesmanipulated the laboratory interactionsbetween subjects and examiners in orderto explore how transactions between thesepersons related to concurrent psycho-logical and physiological responses (1,5,6,9—11,56—59).

They conclude d that "differences in the

experimenter-subject relationships m ay al-ter the total meaning of the experimentalsituatio n so that different psych ologicaland physiological mechanisms or re-sponses are evoked by an otherwise iden-tical test procedure. 'Small' variations intechnique, personnel, mannerisms, etc.,which may seem unimportant and irrele-vant may lead to suprisingly largechanges in what actually transpires duringan experiment. The findings strongly sup-

port the concept that the circulatory mea-surements reflect respon ses to these inter-personal transactions as well as responsesto more obvious or standard stimuli"(5,1,56).

Reiser, Weiner, and Singer continuedthese studies with normal men and wo-men and with hypertensive, peptic ulcer,

and other patient groups. Integrated phy-siological and magnetic sound tape re-cordings permitted separate evaluation ofthe physiological and psychological phen -omena during laboratory interview andtask transactions (5). They c onclud ed thatthe cardiovascular responses noted amongvarious clinical and normal groups wererelated to the interaction of subject andexaminer, rather than to the content of thecommunication or the intended nature ofthe stressful stimulus per se. They foundthat the responses are initially related tothe task of communicating something inresponse to the examiner's request. Fail-ures to perceive or engage in the task cor-related with an absence of brisk physiolo-gical responses. If, in addition, the com-munication of the material requested (fan-tasies in response to viewing a card) leadsto "anxiety" or more specific emotionalinvolvement with the examiner, further,more specific physiological changes oc-cur. The initial or "task" responses(prompt rise in pulse rate, systolic and

diastolic blood pressure) appear to pre-cede and be a prere quisite for further indi-vidual m obilization of the system. The oc-currence of these later exaggerated orindividual physiological changes are re-lated to an exaggerated or specific emo-tional interchange with the examiner (in-fluenced by the nature of the thoughts,but through interaction with the examin-er) (5).

Thus these studies laid the groundwork





for speculating that the transactional qual-ities between the subject and examinerwere influential in determining the pat-terns of physiological and psychologicalresponses which occurred during labora-tory experiments and that most crucialwas whether the subject became involvedwith his own thoughts or became in-

volved with the examiner. This concept ofinvolvement differed appreciably from thethen current terms, relating and interact-ing, nor was it solely related to specificcontents of affect states such as anxiety,anger, or depression. Rather, involvementreferred to phenomena falling among thedomain of behaviors which include arou-sal, alerting, and engagement. Singer (6)wrote, "We concluded that the extent andpatterning of engagement and nonengage-ment or involvement and noninvolve-ment , whichever terms might be pre-

ferred, between these subjects and theexaminer paralleled physiological respon-sivity." Subsequently Hardyck, Singer,and Harris (10) continued studies alongthe same lines with both normotensiveand hyp ertensive p ersons. Ratings of tran-sient changes in engagement-involvementduring a life history interview were correl-ated through a predictive process withchanges in blood pressure levels. Estima-tions of the degree of involvement withthe interviewer or with the subject's own

associations during the selected periodssignificantly paralleled changes in bloodpressure. Involvement was defined as aquality of directness, intensity, and imm e-diacy in the transactional pattern shownby the subject. While ratings of involve-ment, thus defined, significantly p redictedblood p ressure levels, examination of spe-cific affects did not reveal any apparentrelation with blood pressure.

These findings were similar to ones re-

ported by Innes, Millar, and Valentine (60)who found no consistent patterns on acontent analysis of interview data com-pared with a sampling of blood pressureevery thirty seconds during an interview.They commented: "The significance ofany given event, whether internal or exter-nal, physical or physiological, is highly

individual or idiosyncratic in nature andcannot be readily equated with factorscomm on to all subjects and exerting simi-lar and predeterminable effects." Theyfurther reported: "It could not be estab-lished that the emotions of rage, anger,and fear (during an interview) were posi-tively correlated with pressor responses. . . overt displays of anxiety or anger dur-ing the interview were not clearly pressorin effect; and depressive themes (such asthe discussion of bereavement), whichmight be expected to produce some lower-

ing of values, were not in any way consis-tent in their effect" (60). They concludedthat pressor responses occurred (a) withnovel or "alerting" stimuli; (b) when thesubject talked about herself, about her ill-ness or about her husband; (c) when thesubject's verbal outpu t increased. Thus forthese several research group s who stud iedcardiovascular responses during contin-uous physiological monitoring, efforts tomatch specific affect qualities in portionsof interviews with specific physiological

patternings were futile, as theory wouldpredict from a transactional viewpointwhich would say that the amount ofengagement-involvement and not the con-tent of the communication per se wouldbe the crucial variable. Each of these re-search groups, however, found similarcardiovascular patterns under behavior,which they labeled as alerting, engage-ment, and involvement.

These several studies emphasized the





need to attend to the new, freshly turned-on quality of the engagement, involve-ment, or alerting behavior and cautionedagainst efforts solely to rate affect tone,personality styles, or so-called defenses.Hardyck , Singer, and Harris (10) desc ribeda laboratory transaction in w hich an inter-viewer engaged a subject in a life history

interview during a continuous physiologi-cal monitoring procedure. They said thatthe interviewer's role was "that of subtlydirecting and encouraging the subjectspontaneously to move toward what ap-pears to be his natural mode and level ofinvolvement. The subject's own potential-ities thu s determ ine the extent and patternof responses. In a deliberately stressful in-terview, the interviewer tries to take con-trol and become the stimulus for a largeresponse. Paradoxically, he may be a lesssuccessful elicitor than the subject him-

self, because his intrusions and his han-dling of the situation may instead h elp thesubject avoid or curb his natural p otentialpatterns and levels of emotional and phy-siological functioning. This reasoning isbased on the widely held assum ption thatthe responses m ade by individu als in ever-yday spontaneously lived situations arerelatively individualistic and run a widegamut of intensity. The stress interviewertakes a stimulus-response view of the ini-tiating of affective response as if the outerworld determines the strength of the re-

sponse." A transactional model says thatit is only partially external and that inter-nal and external become interwoven.

Recently Williams and his colleagues(61-66) have systematically extended thethesis offered b y We iner, Singer, and Reis-er (5) and Singer (10) and have exploredthe influence of aspects of transactionalbehavior on diastolic blood pres sure. Wil-liams and his colleagues initially studied

four variables: the novelty of the interviewsituation, the personal nature of the con-tent of the interview, the direction of thesubject's attention during the interview,and the amou nt and nature of the interper-sonal interaction occurring during the in-terview. They used a counterbalanced pre-sentation of two types of interview, a

word association test and the telling ofstories to TAT cards. They conclude d thatneither the novelty of talking about the to-pics of their interview with a stranger forthe first time, nor the content per se wereas important determinants of diastolicblood pressure as were the direction of asubject's attention during the interviewand the extent of the interperson al interac-tion in which he engaged. They con-cluded w ith Singer (6) that it is the " . . .transactional involvement with otherpeople, rather than the sheer content of

wha t peo ple talk about in interviews . . .that is the relevant variable for correlationwith concomitant physiological behav-ior." Williams, et al., went on to remark,"Perha ps co ntent plays a role in either fa-cilitating or hindering such transactionalinvolvemen t (63)." Williams has ex tendedhis exploration of "transactional physiolo-gy" and the impact of the direction of at-tention in a subject upon the forearmblood flow (64-66).

Rosenman, Friedman, and Jenkins and

their colleagues in describing the behaviorof Type A and Type B persons in relationto patterns of cardiovascular functioningappear to be dealing with what we wouldconsider the extent and intensity ofengagem ent-involvement these persons ty-pically display (15-20).

The preceding research primarily in-volved blood pressure, pulse and cardiov-ascular responses. Yet work in the psy-choendocrine area also appears to either





directly or indirectly be dealing with thissame problem of trying to estimate the ex-tent of current engagement-involvementin a transaction and how such correlatewith endocrine measurements.

INVOLVEMENT, DISTRESS,

ENGAGEMENT, AND

ENDOCRINE MEASURES

Studies seeking correlates betweenpsychological responses and endocrinelevels again show similar findings.Periods of excitement, engagement, andinvolvement seem to correlate with briskincreases in adrenocorticosteroid levels.Mason's review of research on thepituitary-adrenal cortical system prior to1955 indicates the early researchers de-scribed the conditions which seemed toaccompany marked increases in corticos-

teroid measu rements in animals as periodsof "exciteme nt," "general ex citement," or"nervous excitement," or even the excite-ment of one animal observing others fight-ing (67). Mason summarized by saying,"While the system appears to respond toa wide variety of events and psychologicalstimuli, there do appear to be some con di-tions which tend to elicit responses of un-usual intensity. The element of novelty,uncertainty, or unpredictability appearsespecially striking. The anticipation of, or

waiting for something previously experi-enced as unpleasant are often associatedwith 17-OHCS responses larger than thoseassociated w ith the unpleasan t experienceitself. It appears that the element of 'in-volvement ' of ' t rying' in si tuations inwhich the animal must master a difficulttask in order to forestall aversive stimuli. . . (and) si tua t ion s in w hic h long-established rules are suddenly changed,and the behavior which previously was

effective no longer accomplishes masteryof the task at hand, may lead to disor-ganized behavioral patterns which arelikely to be associated with unusually in-tense 17-OHCS elevations" (67).

By 1956 the biochemical methods per-mitted great advances in human studies,but again it seems to us that the findings

suggest that attempts to pinpo int specificemotions with adrenocortical responsesare no better than the results of trying totie cardiovascular responses to specificemotions. It seems that various ratings ofnew, fresh, alerted, engagement, involve-ment, excitement, or distress appear thestates which parallel the biochemical in-dices, much as they paralleled certaincardiovascular reactions.

Price, Thaler-Singer, a nd Maso n (3) suc-cessfully predicted from inferred behavi-oral levels of what they termed "distress-

involvement" to the levels of plasma 17-OHCS in preoperative patients. Theywrote: "It is suggested that the pituitary-adrenocortical system may be associatedwith a number of emotional states, whichseem to have a common component ofemotional involvement. This componentmay be a relatively broad, undifferentiatedstate underlying or accompanying a num-ber of emotions" (3). This group had ini-tially tried to rate "anx iety" in presurgerypatients, but changed to rating "distress-

involvement" for this term "was a truerreflection of what was being measured"(3). At the same time that Price, Thaler-Singer, and Mason (3) at the Walter ReedArmy Institute of Research were using theterm "distress-involvement," a group atMichael Reese led by Dr. David Hamburg(68,70) had adopted the term "distress"for use in their psycho endoc rine research.Both groups and later others (69,71) foundthat adrenocortical functioning a n d





psychological behaviors appeared morepredictably related to levels of immediate,alerted, engaged states than to narrowlydefined specific emotions.

In his extensive review, Mason (67)cites hund reds of psychoendocrine studiesin which countless stressful situationswere studied . Neither any particular stress

per se, nor any specific emotional contentappeared as good predictors of 17-OHCSoutput as did ratings of the intensity ofa domain of behaviors which can be var-iously labeled as excitement-engagement-involvement.

After his monumental review of psy-cho end ocrin e research , Mason (67) offereda formulation which links together thestress research of Selye and myriads ofothers. Mason's seminal questions were:"Does the widely occurring pituitary-adrenal cortical response, then, reflect a'general adaptive' or 'non-specific' endo-crine response to many different noxiousstimuli or does it reflect a specific re-sponse to a single type of stimulus(psychologica l) which these v a r i o u sunpleasant situations share in common?Should the main conclusions drawn fromSelye's observations have been simplythat the pituitary-adrenal cortical systemresponds sensitively to the ubiquitouspsychological influences in many 'differ-ent' laboratory situatio ns?" (67).

PSYCHIATRIC PATIENTS

Between 1944 and 1955, many studiesassumed that schizophrenic patients pos-sibly had chro nic abnormalities in adrenalcortical function (67). Only when Bliss andhis coworkers (72) demonstrated no evi-dence of unpaired adrenal cortical func-tioning in schizophrenic patients was thisnotion laid to rest. Mason comm ented that

the early studies did not consider thepossibility of "close relationships betweenchanges in emotional or affective statesand adrenal cortical hormone levels inschizophrenic patients" (67). To this wewould add that the earlier studies appar-ently sampled series of patients with lowlevels of engagement-involvement, per-

sons doing little brisk attending and re-sponding in transactions.

More recently the work of Sachar(73-75) has been especially noteworthy indemonstrating that 17-OHCS levels do notreflect the type or severity of the ps ych oticprocesses per se, but rather the degree ofemotional distress and the effectiveness ofpro tect ive psychological d e f e n s e s—whether the defenses be normal, neurotic,or psychotic. Especially in Sachar's workwe again see the theme of the extent ofexcitement (as the early animal research-ers termed it), or the extent of involve-ment or engagement with the currentscene which appears to parallel adreno-cortical measurements. Sachar uses theterms "turmoil, psychological distress,emotional arousal, acute psychotic disor-ganization, and the psychoendrocinologyof ego disintegration" to try to convey thedimensions he and his colleagues findparallel brisk rises in adrenal cortical ster-oid levels (73-75).

OTHER ENDOCRINE SYSTEMS

Greene (21), in what is perhaps the firstresearch to provide evidence of a relation-ship between th e type of psychologic reac-tion and the extent of change in growthhormone secretion, studied patients un-dergoing cardiac catherization. Greeneand his colleagues use among other rat-ings a simple and ingenious measure ofengagement, they noted "the extent of ini-





tiation an d perp etuation of talk with card-iologists and nurses, speaking sentencesrather than words." Each patient was as-signe d to one of four behav ioral categoriescalled "anxious-engaged, anxious-not en-gaged, depressed, and calm." The calmand depressed patients showed no signifi-cant increases in plasma level of either

growth hormone or cortisol. Anxious-engaged patients showed elevations ofcortisol but no elevation of growth hor-mone. Anxious-not engaged patientsshowed elevations of both growth hor-mone and cortisol. In describing their ef-forts to rate the behavior they observedGreene et al. referred to the wo rk of Price,Thaler-Singer, and Mason (3) and re-marked, "Their report suggests that theywrestled, muc h as we have, with the ques-tion of ho w to label the states of em otionaldistress along with the interpersonal com-

ponent."

OVERVIEW

A number of studies were reviewed inwhich primarily cardiovascular and psy-choendocrine measures were correlatedwith behavioral ratings. While there wereseman tic differences am ong the behavioraldescriptions, the commonalities suggestedthat the recency, extent, and degree of

engagement-involvement with the sur-round ings or with one's inner self seem edto parallel important ch anges in these tworather rapidly responding physiologicalsystems. The researchers whose work wascited offered terms such as excitement, at-tention, turmoil, involvement, distress,engagement, and ego disintegration to de-scribe the behavior they found to parallelphysiological increments. We believe thecommon feature which these terms shareis a focus upon the extent of recently al-

erted, activated, and committed transac-tional engagement-involvement a personshows . Some studies followed normal per-sons in ordinary situations, others fol-lowed the course of physiological re-sponses over periods of unusual stress.Under the latter circumstances the termsdistress, discomfort, or anxiousness were

appended to the descriptions of theengagement-involvement. All told we be-lieve the level of newly or recently activ-ated a n d intensely c o m m i t t e dengagement-involvement behavior wascentral in demonstrating relationships be-tween transactional behavior and the lev-els of cardiovascular or psychoendocrineresponses.

Each of the researchers wrestled withthe problems of estimating the extent ofcurrent engagement-involvement (as wewould term it) while being aware of both

the length of time the seem ingly stressfulouter or inner conditions had been pres-ent, and the general long-term persona lityfeatures seen in each subject. Further eachof the writers commented upon the prob-lem of separating seemingly en during per-sonality features from current responses,and unraveling their interactions. That is,und er various g uises, the trait versus state,personality versus symptomatic changesin behavior, issues arose for each of theseresearchers. Also most of them introduce deither coping mechanisms, psychologicaldefenses, or related constructs wh ich theyhypothesize individuals use to meet thestressful vicissitudes of daily living. Herethe idea we offer is that it is possible toconsider, as we did earlier, that in at-tempting these types of predictive ratingsin psychophysiological studies an empha-sis should be placed on transactionally or-iented views such as : What is this pers on'sseeming preferred level of engagement-involvement in which he rather typically





indulges? And in relation to that, what ish is c ur re nt lev el of e n g a g e m e n t -involvement? At what cost to him is hetransacting? These questions permit a ra-ter to consider whatever he wishes aboutcoping techniqu es, but permits the estima-tion of longer term, relatively stylisticmodes of engagement in order to better

judge how the present transactional be-havior relates to this supposed ly more en-during, stylistic approach to transactions.Additionally a rating can be made of theseeming cost to the person for his transact-ing.

S T A T E S A N D

ENGAGEMENT-INVOLVEMENT

For a moment here, I would like to brief-

ly talk about some general states of beingand th e co ncep t of e n g a g e m e n t -

involvement. This may help to give morecontext to the prediction process.

There appear to be in individuals aboutfive general states of being, with their ac-c om pa ny in g le vels of e n g a g e m e n t -involvement as their central phenomena.First is the ordinary, cruising level, orbackground condition of being each per-son typically shows. This is his preferredor characteristic level of engagement-involvement which can be detected whenheed is given stylistic rather than purely

content features of his behavior. Secondlythere are those brief alertings or arousalswhich occur frequently in any day withtheir accompanying recovery or "spring-back" periods. Thirdly there are the moresustained high levels of engagement-involvement which may occur over greatparts of each day for certain persons andoccasionally for almost all persons.Fourthly there are those periods of briefwithdrawals and divertissements whichseem to follow alerted states. These recov-

ery or spring-back periods are almost un-explored aspects of transactional behaviorand d eserve study, for they may permit usto tap into the process of how homeostasisproceeds. Fifthly there are mo re su stainedwithdrawals. These include what Engel(24—26,28) terms periods of conservation-withdra wal. These are those relatively im-mobile, quiescent, unresponsive periodsof rest and restitution, "those shorter orlonger episodes of unresponsiveness andarrest of activity at times or unde r circum -stances where interaction with the envi-ronment has become impossible or unav-ailable" (28). There is need to considerthese states of being in order to judge cur-rent behavior on a time dimension. Oneasks from what state is this person comingand to what state is he moving when anattempt is made to estimate his level ofengagement-involvement at any point in

time.It is well to make clear here that raters

mak e predictions for clearly specified tim eperiods in an effort to see what, if any,correlations there are between behavioraland physiological, for example cortisol,levels. Usually a designated block of timeis selected for an overall estimation(35,10,21,34,71,77). For exam ple, in inter-viewing and observing persons the morn-ing of day one prior to surgery, raters tryto estimate the general l e v e l of

engagement-involvement, how turned oneither to his life problems, the presentcrises, and so forth, is this person at thisparticular period of time (3,71). However,it is possible to try to predictively followeven brief shifts in level of involvementduring continuously monitored interviews(5,6,10,21). For example where bloodpressure, heart rate, BCG, or other meas-ures are followed, raters attempt to pin-point brief ups and downs in levels ofengagement-involvement.

10 Psychosomatic Medicine Vol. 36, No. 1 (Jan.-Feb. 1974)




Raters need learning periods duringwhich they closely follow a series of di-verse personalities over a period of timewith open kno wledge of for examp le mon-itored blood pressure, to learn to makebetter observations and subsequ ently moreappropriate predictions about the interrel-ationships between behavior and physiol-ogical patterns in order to free themselvesfrom a vast mythology of misleading con-structs learned from various personalitytheories. Much of the literature is basedupon over-simplified stimulus-responseand fixed energy systems conceptualiza-tions of organisms, whereas the need inpsychophysiological research is to reasonin systems terms, to consider processes,durations, transactions, and movementsacross phases.

The process of estimating any person'sstate of engagement-involvement through

interview-observational technique s beginswith this conceptualization. As was de-scribed elsewhere in detail (5,10), we viewthe laboratory transactions b etween an ex-perimen ter and subject as an e xperimentalprototype of what may occur a number oftimes in the daily life of an individual.One person is asked by another to dosomething, to reply, to converse, to assistin some way. At least three discernibleranges of physiological (cardiovascularwill be used here for illustrative p urposes)

response forms are seen in laboratory sit-uations which seem to parallel the ex-tent of engagement-involvement shownby the subject. A type of engagement-involvement is seen in a majority of per-sons when they are asked to do a task forand with another person in a laboratory.Their average involvement is reflected ina certain amount of immediate cardiovas-cular response probably representing arange of average alerting, attending, andbecoming committed in this type of tran-

saction. This we label a "task" level re-sponse (5). The person has made an aver-age effort to comply with the experimen-ter's request, shows an ordinary committ-ment to the implied interpersonal contextand is engaging and involving himself in-to an expected range of responsivenessand effort. Such a person has alerted suffi-ciently, has committed his attention andinvested himself to a level which appearsaverage or ordinary for mee ting the gener-al task demands and relat ionship de-ma nds of the situation. He is not intensiv-ely nor extensively involved, inwardly oroutwardly, during the designated timespan. He is making only an average, ex-pected level of investment in the currenttransaction . Or secondly, raters may deemthe person not to be engaging, investing,responding, becoming committed in thetransaction even up to the ordinary level

such as a person just previously describedwou ld show . Rather this person, either be-cause of long-term personality style andcharacter traits, or recently-impo sed moodtones, or other conditions, gives indica-tion of a very minor ex tent of engagem ent-involvement. Low levels of engagement-involvement are often seen in personswhose character and other personalitytraits are patterned in ways which permitthem to remain chronically insulated.They seem especially underresponsive totaking up and responding in transactionsin adequately committed ways to the in-tensions or implicit expectations of others.These persons seem impaired in their ca-pacity to respond to implied obligationsto others, and thus often display low lev-els of gen uine eng ageme nt-involvement inlaboratory situations even though theymay respond in other situations. However,a certain segment of hypertensive patientswho seem to have ordinary to exemplarycharacter traits, almost being overobli-

Psychosomatic Medicine Vol. 36, No. 1 (Jan.-Feb. 1974) 11




gated to respo nd to the intention s of othersand to the demand aspects of situations,seem to function at an over-primed, fixedlevel and sh ow little variation in the qual-i ty or extent of thei r engagement-involvem ent unle ss their rather taut, fixedstate of being is upset by the acts of othersor si tuational exigencies. Additionally

certain persons with rather low moodtones and flat ways of relating to otherst end to show l ess than averageengagement-involvement in transactions.These persons would not be consideredclinically depressed usually, but insteadflat, emotionally dulled, and unenthusedabout life in general at the time.

The third broad level of engagement-involvement is shown by persons whoduring observation periods appear to behighly engaged, involved, turned on, in-vested, distressed, alerted, committed,who are paying a high price for thatperiod of transacting. Not only do thesepersons seem turn ed on in the present set-ting, but they seem vividly to connect upto memories from their past. Recollectionsare experienced with considerable emo-tional charge. It is as if they have partiallystepped back into some of the emotionswh ich were part of the remembered scene.Recall for them is not a neutral listing offacts, but a partial, mom entary, vivid reex-periencing of certain of the feelings and

intensity of the original experiences. Cer-tain individuals not only indicate throughtheir behavior in the present scene thatthey are vividly reliving bits of their past,but give clues that they may have beeninvolvement-prone across time. They de-scribe themselves as responders; theycreate the impression that they often feelpressu red by work, people, their inner lifeand that they experience many thingswith marked intensity. Their historiesseem filled with frequent, vividly experi-

enced episodes, be these positive or nega-tive in nature. They seem to play harder,feel the good and the bad, remember howthey felt, and show the effect of the mem-ory more than average.

The foregoing are in marked contrast tothe interview behavior of persons display-ing very low engagement-involvement.

The latter persons recount episodes fromtheir past which an interviewer expectsfrom the content to be accompanied byemotions (bad accidents, remarkableachievements, periods of what sound liketimes of great stress, pressure, or passion,or ones of love, fun, and seeming pleas-ure) in very matter-of-fact ways. Whenglimmerings of affect about the episodebeing described show, they seem to befrom a narrow band of emotion. One findswithin this group of minimally involved,both the under and overly verbal. The tal-

kative, obsessional, impersonal citing ofdetails occurs as well as an und er talkativ-eness, which may lead an interviewer tofeel he has to drag each statement out ofa subject. Regardless of whether he is ver-bose or laconic, a person showing onlyminimal to modest amounts of currentengagem ent-involvement seem s to recou ntpast events in uncharged ways and withlittle apparen t personal cost. The contentsof memory are seemingly available, butthe accompanying emotional side-tonesare minimal—usually from a constrictedrange and with a rather fixed quality tothat affect which emerges. Thus an inter-viewer senses the person is neither exten-sively engaging and involving himself in-wardly with his own past nor outwardlyin the current transaction with the inter-viewer and the shared task they are doing.

Lest the above passages be misinter-p re te d to m ea n th at e s t i m a t i n gengagement-involvement is synonymouswith sheer personality diagnosis, we want

12 Psychosomatic Med icine V ol . 36 , No. 1 (Jan.-Feb. 1974)




to reiterate that a rater must evaluate aperson as he senses and experiences himat a designated point in time, especiallyfocusing upon how much he is engaging,investing, and at what cost, regardless ofwhat personality labels or diagnosesmight be considered.

COSTS OFA D A P T A T I O N O V E R T I M E

Trends in psychoendocrine researchsuggest that following and assessing be-havioral processes in chronically stressfulperiods needs much study. Mason (67)was especially careful to call attention tothe need to note whether threats wereacute or chronic in natur e. We wish to em-phas ize this poin t also, and to suggest ef-forts be made to more carefully concep-tualize chronic stresses in order to explore

the hypothesis that possibly patternsamong physiological systems may be cor-related across time periods with patternsof individual behavior. Specified "pat-terns of 'cost' " may be detected on a psy-choen docrine level in relation to differentbehavioral patterns over various extendedperiods of time. The use of the conceptof patterns, existing at both an endocrineand behavioral level, rather than studyingseparate paired resp onses at the two levelsmight help us to better explore psycho-physiological transactions. Additionally

thinking of personality patterns as chronicadaptations might assist our speculationsand research. For example certain person-ality styles may be more costly to givenpersons than other styles might be. For in-stance, given certain genetic propensities,the particular vicissitudes of one person'slife, plus the way his personality unfoldsand is molded by experiences, that personmay develop habitual personal styles oftransacting which are very costly given

his physiological propensities whereascertain other personality features mighthave helped him weather life changeswith more equanimity and less personalcost.

To emphasize an idea mentioned ear-lier, I feel we need to study the phasesafter periods of intense engagement-

involvement subside. How long does ittake a person, by what methods, and atwhat cost, to spring back or return to hisaverage level of being? This may not bethe best wording for the phenomena, buteach of us is familiar with the experiencesof recovering from both brief and ex-tended periods of intense engagement-involvem ent, be they difficult mo men ts atthe office, intensely engaging sportsevents, or any of a variety of turned-onperiods. How does a person unwind, re-cover, rejuvenate after any episode of in-

tense, committed engagement?As we become better able to specify

central, core behavioral processes whichseemingly underlie and l ink a number ofacts, attitudes, traits, moods, etc., whichon superficial viewing seem diverse andunrelated if we view only their contentsand not their form, but which on inspec-tion appear to share common properties,we no doubt will come closer to definingthe relationships between transactionalbehavior and the body support of such be-

havior. Eventually we may be able to bet-ter formulate ho w to study to what extentsand in what ways does the body adapt toone's personality and in what ways doesthe body mold and influence personalityacross time.

To date research has been burdenedwith a legacy of disparate psychologicaltheories about how to view behavior.Many of the hypothetical constructs, anumber of which have become reifiedover t ime, wh ich these theo ries offer, blind

Psychosomatic Medicine Vol. 36, No. 1 (Jan.-Feb. 1974) 13




and divert us from seeing and formulatingwha t may be comm on prop erties of a mul-titude of acts, which at a surface level ap-pear dissimilar. In actuality these may behan dled by the body as one, albeit compli-cated program. If we can sort out andstudy process-type behavioral dimensionsas longer term physiological parameters

become possible to follow, we may findwe can avoid falling back upon outmodedemotional and social terms which are notsufficiently process-focused. For example,testosterone (76-78) may relate less to ag-gression and fighting in humans but moreto sustaining long-term endurance and tosupporting short-term bursts of brief, buthigh-inten sity motor behavior. Aggressionand fighting are specific, relatively occa-sional acts, which no doubt are merelyvivid examples of a broader category ofprocesses with which testosterone is in-

volved.

As we view more directly the intensity,direction, and duration of behavioral acts,seek common formal properties among di-verse behaviors, and so mew hat divest actsof their specific contents in order to seewhat commonalities exist among certainsets of acts, we may be surprised to seehow distracting and diverting studying

certain contents of behavior has been.Perhaps if in psychophysiological re-

search, we can phrase our conceptualiza-tions of how to rate transactional behaviormore in terms of systems, in terms of ex-tents of engagement-involvement, and interms of specified durations, of where aperson is moving across a number of pro-cesses of adaptation, we can perhap s cometo see more clearly how we work. Or asDuffy (42) said, "Perhaps when we for-mulate our questions better, Nature willbe more obliging in her answers."

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Documents

Presidential Address Margaret Singer (1973)