Reactions of chronic schizophrenic patients and college students to facial expressions and geometric forms

REACTIONS OF CHRONIC SCHIZOPHRENIC PATIENTS AND COLLEGE STUDENTS TO FACIAL EXPRESSIONS AND GEOMETRIC FORMS

DONALD E. SPIEGEL, ROBERT M. GERARD, HARRY M. GRAYSON Veterans Administration Neuropsychiatric Hospital, Los Angeles'

AND J. A. GENGERELLI University of Cali jmia, Los Angeles

PROBLEM The major purpose of this investigation was to determine whether chronic

schizophrenic patients are deviant with respect to (a) ability to derive bipolar conceptual dimensions in terms of which sets of concrete materials (such as geometric forms or photographs of facial expressions) may be meaningfully arranged in rank order; (b) ability to rank these sets of materials in terms of a dimension of meaning after the bipolar concepts have been made explicit and anchor points have been provided; (c) their relative ability to perform tasks involving materials depicting the expression of human emotions vs. tasks involving geometric figures; (d) their ad- mission of subjective disturbance for various photographed facial expressions; and (e) their preference for geometric forms vs. photographed expressions as task materials. A secondary purpose was to determine whether the ability of schizophrenic patients to derive conceptual dimensions from sets of concrete materials and to arrange these materials along conceptual dimensions (once these were specified) is related to estimated premorbid level of general intelligence, to current level of intellectual impairment, or to type of schizophrenic reaction.

METHOD Subjects. Twenty-four patients were selected from a ward of the Brentwood

VA Neuropsychiatric Hospital. Each had a staff psychiatric diagnosis of schizo- phrenia of a t least two years duration. These patients ranged in age from 27 to 49 years (median, 41) and had been hospitalized from two to fourteen years (median, 4). The clinical records of only two patients showed evidence of neurological ab- normality. In both instances, prefrontal lobotomy had been performed at least five years prior to the experiment. The vocabulary ages of the patients ranged between 14.3 and 18.6 (median, 16.6) on the Shipley-Institute of Living Scale. The range of their conceptual quotients (CQ) on this scale was between 51 and 96 (median, 73.5). All patients appeared to be in good contact a t the times of testing and ex- perimentation (which were spaced approximately one week apart) and showed will- ingness to cooperate in all phases of the experiment. All patients were receiving some form of tranquilizing drug; none were under treatment with insulin or electroshock.

A non-schizophrenic group was composed of four medical students and eight clinical psychology and experimental psychology trainees (graduate students receiving training in the Veterans Administration Hospitals). These subjects, nine males and three females, ranged in age from 22 to 38 years (median, 26).

The performance of the twenty-four schizophrenic patients on the Shipley- Institute of Living Scale yielded a wide range of scores on the vocabulary scale, the abstract thinking scale, and the conceptual quotient. Ten of the patients had a diagnosis of schizophrenic reaction, paranoid type; the others were diagnosed as schizophrenic reactions of the five other types, viz., catatonic, hebephrenic, mixed, undifferentiated, or simple.

Since it seemed possible that level of performance on certain tasks of the experiment might be related to general intelligence level, to level of ability to think abstractly, or to level of intellectual impairment or deterioration, these relationships were investigated by making the comparisons shown in Table 1. Twelve patients above the grand median vocabulary age were assigned to Group la and compared with twelve patients below the median, Group Ib (which included two lobotomized patients) ; eleven patients above the grand median abstraction age (Group IIa)

'This study was conducted in the Psychophysiological Research Labqratory of the Psychology Service. The assistance of Joel Cantor, Beth Rosenberg, and Charles Ackeris gratefully acknowledged.

REACTIONS OF CHRONIC SCHIZOPHRENIC PATIENTS AND COLLEGE STUDENTS 397

TABLE 1. MEDIAN VALUES FOR VARIOUS GROUPINGS OF THE TWENTY-FOUR CHRONIC SCHIZOPHRENIC PATIENTS USED IN THE STUDY+

Years in Vocabu- Abstrac- Group N Age hospital laryage tionage CQ MA

~~ ______

a High vocabulary aget 12 41 4 17.9 13.0 76 15.5

b Low vocabulary age 12 37 4 15.5 12.0 69 13.5 I

a High abstraction age 11 40 4 16.1 13.6 83 14.9

b Low abstraction age 11 37 4 15.9 11.0 68 12.9

a High CQ 11 40 5 16.1 13.9 83 15.1

b Low CQ 11 40 3 16.1 11.0 66 13.1

a Paranoid 10 40 4 16.1 12.0 73 13.9

b Non-paranoid 10 36 5 15.9 11.0 69 12.9

*Within each of the four major groupings, a is compared with b. t Only Group la (the “bright schizophrenics”) was compared with the “students” (Group V).

rr

IrI

IV

were compared with eleven patients below the median (Group IIb) ; eleven patients whose conceptual quotients were above the grand median (Group IIIa) were compared with eleven patients below the grand median (Group IIIb). Since it seemed possible that paranoid schizophrenics might project more hostility than non-paranoid schizophrenics, and thus see more of the smiling faces as “angry”, ten patients bear- ing a diagnosis of schizophrenic reaction, paranoid type, were assigned to Group IVa and compared with ten patients assigned to Group IVb who formed a non-paranoid group. The lobotomy patients were included only in Group Ib. It should be made clear that only twenty-four patients were involved in this experiment and that patients assigned to Group I (a or b) may also be included in Groups I1 (a or b), 111 (a or b) or I V (a or b), etc. Only group Ia schizophrenic patients-those pre- sumed to be the most intelligent prior to illness, based on vocabulary as an estimate -were compared with the student group (Group V). In order to prevent confusion, Group Ia schizophrenics will henceforth be referred to as the “bright schizophrenics”, and Group V as the “students”.

Materials. The materials consisted of two sets of facial expressions and two sets of geometric figures. Each set could be arranged in rank order along a bipolar conceptual dimension or continuum of meaning.

Set A. Eleven photographs of the face of an adult male with expressions ranging from angry a t one extreme through a neutral expression t o happy at the other extreme. These photographs were selected from the “Frois-Wittman series”@, p. lZe) of an actor in 72 poses?

Set B. Eleven photographs of the face of an adult female with expressions ranging from angry at one extreme through a neutral expression t o happy at the other extreme. These photographs were selected from the recent “Lightfoot series” (2) of 56 posesf

Set C. Fourteen geometric figures beginning with an equilateral t r im le at one extreme, with each succeeding figure becoming less triangular and more circular unt$ a erfect circle is reached at the other extreme. These figures are similar to a set developed by Za&w(?), with the exception that the intervals between figures of the present series were determined mathematically in accordance with Weber’s law, i.e., the area of each succeeding figure was increased by a constant proportion of the area of the preceding figure.‘

*The numbers (furnished by C . H. Stoelting CO., Chicago, Ill.) for the male expressions used in

3The original numbers in criterion order from angry to happy, are: 22, 11,23,21,34, 46, 26,50,

*The radius of the circle was 22.2 mm. The points of the equilateral triangle were circumscribed

set A in criterion order from angry to happy, are: 36, 59, 39, 63, 1,43,50, 68, 71, 70, 72.

48,4, 1.

by the circumference of the circle.

398 DONALD E. SPIEGEL, ROBERT M. GERARD, HARRY M. GRAYSON, J. A. GENGERELLI

Set. D. Fourteen circles ranging in radius from 11.1 mm. at one extreme to 22.2 mm. a t the other extreme. The area of each circle waB obtained by multiplying the area of the preceding circle by the constant 1.055.

The geometric figures (Sets C and D) were centered on white cards three inches square. The figures of all four sets were numbered on the back and encased in plastic covers to prevent defacing.

Procedure. Prior to the experiment a pilot study was done to determine a criterion order for arranging the facial expressions of Sets A and B on a bipolar conceptual dimension from angry to happy. Five clinical psychologists served as the criterion group of “expert judges.” They were instructed to arrange the faces of each set along a dimension from most angry at one extreme to most happy at the other extreme. The rank order of their mean ranks was used as the criterion order for arranging Sets A and B in the main experiment. The criterion order for the geometric series (Sets C and D) was objective, i.e., it was based on the magnitudes of the radii of the figures.

For the experiment all procedures were administered to all subjects in a well- lighted quiet ofice by one experimenter. There were five sections to the experiment, and all subjects performed all sections in the same order. Each of the first two sections is composed of four tasks, each task of a given section involving a different set of stimulus materials. These tasks will be referred to as A, B, C or D, depending upon whether Set A, B, C or D of the stimulus materials is involved. In order to counterbalance for possible effects of learning associated with the sequence in which the tasks were performed, three students (Group V), three patients from Group Ia and three patients from Group Ib were assigned at random to each of four task sequences on the basis of a 4 x 4 Bugelski latin square (ABCD, BADC, CDAB, DCBA). There was no counterbalancing for Groups I1 (a vs. b), I11 (a vs. b) or IV (a vs. b) since these groups were formed by regrouping the data from the twenty four patients in Group I (a and b) .

The procedure and instructions for each of the five sections of the experiment were as follows:

Section 1. S was given a thoroughly shuffled deck of stimulus cards, Set A, B, C or D, depending upon the task sequence to which he had been assigned. The following instruction waa gwen: “I’d like to have you arrange these figures in a single row in what seems to be the best possible order.” After the order produced by S was recorded, E said: “Please tell me why you arranged them in this particular order.” The same procedure was repeated for the three remaining taaks.

Section 2. Each subject was given tasks in the same sequence in which he performed the tasks of section 1. S was given a thoroughly shuffled deck of stimulus cards from which E had removed the polar cards, i.e. the cards of each set which had been assigned extreme ranks by the criterion grou for Sets A (male faces) and B (female faces) the equilateral triangle and the circle for Set 6 and the smallest and largest circles for Set D. $he polar cards, serving as anchor points, were placed on the desk before the subject, approximately thirty inches apart. The instructions for Sets A and B were identical: “This is the most angry face and this is the mo:: happy face. Please arran e the other figures in a single row from most angry to most happy. Instructions for task C: “%us is a triangle and this is a circle. Please arrange the other figures in a single row from a triangle to a circle.” Instructions for task D: “This is a small circle and this is a large circle. Please arrange the other figures in a single row from a small circle t o a large circle.” E gave additional instructions where needed until it was ascertained t.hat S compre- hended the conceptual dimension involved and understood what he waa expected to do?

bThe rank order method used in the fist two sections of the experiment was used by Zaalow(7) in an experiment in which subjects arranged a set of figures along a “continuum” ranging from an equilateral triangle at one pole to a circle at the other. The rationale for the present use of this method is baaed upon the proposition that individuals will tend to agree in their rank ordering of stimulus materials along a dimension of meaning provided the following conditions exiat: (a) the stimulus materials are unambiguously related to a particular conceptual dimension; (b) the individuals are of comparable intelligence; (c) the individuals share a common interpretative frame of refer- ence (e.g.), common stereotypes, common cultural values, (d) the stimulus materials represent dis- criminable differences along a dimension, and (e) the perceptual, cognitive, and affective processes of the individuals are unimpaired by structural or functional disorders.


Section 3. E arranged all four sets of figures in horizontal arallel rows in criterion order along the respective conceptual dimensions and instructed S: (‘Row as you look at these four series, tell me which one you feel is the most difficult t o arrange in proper order. Please try to forget about any trouble you may have had before you got the idea about how they were to be arranged. Just tell me which one of these four you think is most difficult t o arrange in order, once you get the idea. Which one do you think is the easiest series? Now which of these two remaining series is the most difficult? What makes this one seem most difficult of the four? And why do you think this is the easiest of all to arrange?”

Section 4. The geometric series (Sets C and D) were removed from the desk, leaving the two facial expression series (Sets A and B) in criterion order before S. E pointed to the male faces and the female faces and said: “Suppose you were to meet the two people represented here. Do you think you would like this person or this person the best, judging from their various expressions?” The referred series of expressions (male or female) was then thoroughly shuffled and given t o S: ‘Zoo! through this group of faces carefully and pick out the expression you find most appealing, that is, the expression you like best.” After S made a selection, E said: “NOW show me which one you like least or dislike most.’’ The selections were laced about 30 inches a art before S: “Now I would like t o have you try something entirely d igrent from what you dizbe- fore. Arrange the faces from the expression you like best to the expression you like least.” The same procedure was followed for the less-preferred series.

Section 5. S waa asked the following uestions: “Which did you find most interesting to work with, the faces or the geometric figures? Why? Do you find the faces in any way disturbing to you? How about the angry faces-does it bother you at all t o work with them?”

RESULTS Section 1. Deviations between rank values assigned by each subject and median

rank values assigned by the criterion group were computed. The Mann-Whitney U Test(6) was used to compare Groups Ia and Ib, IIa and IIb, IIIa and IIIb, IVa and IVb, Ia and V. Groups Ib and V were not compared since the two groups were not of comparable intelligence level. Differences between the bright schizophrenics (Group Ia) and the students (Group V) were statistically significant at p < .001 for Sets A and C, a t p < .01 for Set B, and at p < .05 for Set D (using 1 tail tests). The rank order of the sum of ranks assigned by the student group was identical for all sets to the rank order of the sum of ranks assigned by the criterion group. It should be noted that whereas the criterion group had been told to arrange the figures along a specific conceptual dimension (e.g., the faces from angry to happy), the students were able to derive these dimensions on the basis of inspection of the materials, being significantly more successful in doing so than the bright schizophrenics. For the various group comparisons among schizophrenics made by regrouping the results, there was no difference between groups which approached statistical significance using the Mann-Whitney U test (Group Ia vs. Group Ib, Group IIa vs. Group IIb, Group 111s vs. Group IIIb, Group IVa vs. Group IVb).

The coefficient of concordance (W) was used to measure within-group agreement for the subjects in the various groups. The extent of agreement among subjects in ranking the figures of each of the four sets was greater than chance in all groups ( p < .OOl). For the various comparison groups (Ia vs. V, Ia vs. Ib, IIa vs. IIb, IIIa vs. IIIb, IVa vs. IVb), F tests were used to determine the significance of the differences in extent of For Sets A, B, and C, the extent of agreement among the students was significantly greater ( p < .05) than the extent of agreement among the bright schizophrenics. Differences between these groups for Set D were not statistically significant. F tests for the other comparison groups were not significant.

Section 8. Since anchor points were provided in Section 2 of the experiment, the data were reranked, deleting the figures a t the poles of each dimension from the ranks. As in section 1, the Mann-Whitney U Test was used. On the triangle-circle continuum (Set C), the students performed significantly better ( p < .O l ) than the bright schizophrenics. The mean rank order of the student group was identical to the mean rank order of the criterion group. The U values for Sets A, B, and D were not statistically significant, the mean rank order assigned by the bright schizo-

6This test of significance waa suggested by Gengerelli. (W may be converted to Xz; therefore F equals X W f ) -

xvdf


phrenic group and by the student group being almost identical to the mean rank order assigned by the criterion group. None of the U values obtained from the various groupings of data comparing schizophrenics was statistically significant (Groups Ia vs. Ib, IIa vs. IIb, IIIa vs. IIIb, IVa vs. IVb). The extent of intragroup agreement on rank ordering each continuum was measured for all groups. For each group on each set of figures, there was a high order of agreement (the values of W ranging from .85 to .99), there being no significant difference between Groups Ia vs. Ib, IIa vs. IIb, IIIa vs. IIIb, IVa vs. IVb, or Ia vs. V.

Section 8. The coefficient of concordance (W) was used to measure the extent of agreement among the subjects within Groups Ia, Ib, and V with regard to the perceived relative levels of difficulty of the four tasks of Section 2. For patient groups Is and Ib, the W’s were not significant, although in each group the triangle-circle series was seen as most difficult, Since these W’s were not significant, and since subjects in Ia and Ib compose the other schizophrenic groups, W’s for IIa, IIb, IIIa, IIIb, IVa and IVb were not computed. For the student group the W was significant ( p < .05), and the perceived relative difficulty of the four tasks decreased in the following order: (1) female faces, (2) male faces, (3) triangle-circle, and (4) small circle-large circle.

Section 4. Nine patients from Group Ia, eight patients from Group Ib, and ten students (Group V) expressed a feeling of liking the female most as a person. Com- parisons of Ia with Ib and Ia with V were not statistically significant, using Fisher’s exact probability test. Each group indicated preference for the more “smiling” faces and aversion for the more “angry” faces of both the male and female series of expressions. There was no significant difference between Groups Ia vs. Ib, or between Ia vs. V in the frequency with which cards 1, or 1 and 2 (the “most angry faces”) were considered least preferred, or in which cards 11, or 10 and 11 (the “most happy faces”) were considered most preferred (using Fisher’s exact probability test). No analyses of the data were made comparing the other schizophrenic groups.

Section 6. Two patients from the bright schizophrenic group, four patients from Group Ib, and five students admitted feeling mildly disturbed by some of the “angry” facial expressions. This difference in frequency of admitted disturbance was not statistically significant. One student, five patients from the bright schizophrenic group, and three patients from Group Ib stated that the geometric forms were more interesting to work with as task materials than the facial expressions. There was no significant difference between groups Ia vs. Ib, or between Ia vs. V, using Fisher’s exact probability test. No analyses of the data were made comparing the other schizophrenic groups.

DISCUSSION Section 1. Four of the bright schizophrenics (Group Ia), 5 Group Ib patients,

and no students arranged each set of figures in rows in approximately the same order in which they had received them. Judging from the explanations given for this behavior, this reflected their interpretation of the instructions to arrange the figures “in the best possible order.” This apparent absence of openness to the most cogent implications of the instructions occurred among patients with vocabulary ages as high as 17 and CQ’s as high as 96 on the Shipley-Institute of Living Scale, This behavior on the part of schizophrenic patients does not seem to be clearly associated with impairment of abstract functioning (as measured by the Shipley-Institute of Living Scale) since according to the norms, CQs above 90 do not suggest presence of intellectual impairment when the vocabulary age is 14 or above, as was the case here.’ It seems that patients who arranged the cards in order without regard to

That this is probably not merely a function of general intelligence level waa supported by the fact that in a pilot study, this behamor did not occur in a group of eight VA patients without any psychiatric diagnosis who were tested as the were recovering from minor surgery and who had been matched for chronological age and Shipley-fmtitute of Living Scale vocabulary age with eight patients from Group Ia.


content did not sense a relationship among the discrete elements making up a set of materials and thus failed to derive the underlying conceptual dimension. It is not clear whether this was entirely a function of a deviant interpretation of the instructions which may have prevented their paying attention to the content of the materials, or whether this behavior was produced by some deviation from normal ability to spontaneously order events or objects meaningfully in terms of a, conceptual scheme. The question arises whether one aspect of the ‘confusion’ often accompany- ing a schizophrenic condition may be associated with some deviation from normal ability to perceive the class or conceptual category to which a series of objects or events belong. Our data suggest that once they have been given (or made aware of) the conceptual scheme or dimension involved, many chronic schizophrenics have no particular difficulty in ordering certain types of materials with respect to it. But when they inspect a set of materials, the discrete elements of which have similar essential properties and vary systematically along a particular conceptual dimension, they fail to grasp this dimension (which seems so immediately apparent to other people). The significance of these findings for rehabilitation and training of schizophrenic patients may be that these individuals may behave less deviantly in certain situations when task instructions are made unusually explicit and concrete. Without such special structuring these individuals may appear to be confused by task demands and unable to perform appropriately. For example a patient may appear unable to make certain perceptual discriminations when the real difficulty is that he does not fully comprehend or grasp the conceptual dimension along which discriminations are to be made. However, with special instructions which provide additional conceptual structuring, he may execute the discrimination task without difficulty.

Section 2. The sensitivity to nuances of facial expression demonstrated by the schizophrenic patients in their veridical ordering of faces from angry to happy and in their verbal descriptions of the expressions was unexpected. There was no evidence from any part of the experiment that either the student group or the patient groups reacted to the facial expressions with either a substantial amount of anxiety (which should have been revealed in their comments or overt behavior) or with a decrement in level of performance (which should have been revealed in a relatively low order of agreement with the criterion group in ranking the facial expressions as compared to ranking the geometric figures). When the instructions were concrete and explicit as in Section 2, the schizophrenics were able to arrange the male and female facial expressions (Sets A and B) and the circles of various diameters (Set D) in order along a specified conceptual dimension. The basis of their difficulty with the triangle-circle materials (Set C ) can only be surmised. This task may be more com- plex perceptually and conceptually in certain ways than the other tasks. It may be that when explicit instructions were given to arrange the figures on a specific continuum, tasks A, B, and D became sufficiently simple that schizophrenic patients (even those with considerable intellectual impairment and relatively low estimated general intelligence) were able to perform the task adequately, but that task C was at a level of complexity which made demands beyond the coping ability of even some of the brighter patients. The difficulty encountered with task C is in agreement with the findings of Zaslom(7) using a similar triangle-circle series and is consistent with the results reported by Cooper who found differences between chronic schizophrenic and non-schizophrenic subjects in perceptual reactivity to various other geometric figures. Consistent with our findings with facial expressions, Levy et u Z ( ~ ) report “essentially complete agreement” among three groups of subjects (mental retardates, college students and acute behavior disorders, half of which were diagnosed as schizophrenic) in their judgments of female faces (photographs from the Lightfoot series used in the present experiment) on a dimension from “happy” to “unhappy.” It would seem that there is wide agreement among adults (whether normal, mentally retarded, or schizophrenic with intellectual impairment) in their perception of facial expressions with respect to a t least some dimensions of meaning. Possibly a series of facial expressions which involve more subtle differences in ex-


pression than the sets of faces now available (and used in the present study and by Levy et al) would provide a more difficult discrimination task and might differ- entiate among groups of different intellectual levels.

Section 4. It would appear that the patients and the students share common values with respect t o preferences and aversions for angry vs. happy facial expressions. Perhaps this reflects acceptance of the social stereotype that angry persons are unlikeable and that happy persons are likeable,

SUMMARY This study explored the perceptual and affective reactivity of graduate students

and chronic schizophrenic subjects to stimulus materials composed of geometric forms and photographed facial expressions.

A group of chronic schizophrenic patients with high vocabulary level was inferior ( p < .Ol) to a group of graduate students in ability (a) to derive the guiding bipolar conceptual dimensions in terms of which four sets of visual configurations could be arranged, and (b) to rank figures in terms of a conceptual dimension ranging from a triangle to a circle, even when anchor points were provided.

The same group of schizophrenic patients did not differ significantly from the student group with respect to (a> their rank ordering of two series of facial expressions from angry to happy and a series of circles from small to large after bipolar concepts and anchor points were provided, (b) preference and aversion for facial expressions, and (c) the frequency with which subjective disturbance to facial expressions was admitted.

The abJity of chronic schizophrenic patients to derive conceptual dimensions or to arrange materials in order along specified conceptual dimensions was un- related to level of intellectual impairment, to estimated premorbid general intelligence level or to type of schizophrenic reaction.

The implications of certain results (summarized in la and 2a, above) for the rehabilitation of schizophrenic patients was discussed. It is conjectured that behavior in certain situations which may seem to an observer to be bizarre, inappro- priate, confused, or associated with loss of perceptual discriminability, may be causally associated in some instances with failure to grasp certain cogent meanings or salient conceptual elements of a situation. The patient may cease to behave in a deviant manner in these situations when he is supplied with certain concrete guide- posts or explicit conceptual dimensions in terms of which he may organize his behavior.

REFERENCES

1.

2.

3.

1. COOPER, R. Objective measures of perception in schizophrenics and normals. J . consult. Psy-

2. LEVY, L., ORR, T. and ROSENZWEIQ, S. Judgments of emotion from facial expressions by college students, mental retardates, and mental hospital patients. J . Pers., 19(io, 88, 342-349.

3. OBGOOD, C. E. Fidelity and reliability. In H. Qurtstler (Ed.). Information theory in Psychology.

4. S C H m s B E m , H. Three dimensions of emotion. f'sych.!. Rev., 1954,61,81-88. 5. SIEGEL, S. Nonparametric statisticsfor the behavioral sciences. New York: McGraw-Hill, 1956. 6. WOODWORTH, R. S. and SCIILOSBERO, H. Experimental psychology. New York: Henry Holt,

7. ZASLOW, R. W. A new approach to the problem of conceptual thinking in schiaophrcr1i:t. J .

chol., 1960, 84, 209-214.

Illinois: The Free Press, 1955. Pp. 374386.

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Reactions of chronic schizophrenic patients and college students to facial expressions and geometric forms