VULNERABILITY TO EMOTIONAL DISTURBANCES

IN FATHERS OF NEUROTIC AND

PSYCHOTIC CHILDREN

>

BY

MAJOR ABDUR RASHID

PSYCHOLOGIST

ISSB, KOHAT

A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF

THE REQUIREMENTS FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY

TO THE

FACULTY OF PROFESSIONAL PSYCHOLOGY

BAHRIA UNIVERSITY, ISLAMABAD

PAKISTAN

2001

I certify that I have read this dissertation and that in myopinion it is fully adequate, in scope and quality, as adissertation for the degree of Doctor of Philosophy.

Prof. Dr. Miss Farrukh Z AhmadHon. Surgeon CommodoreDirectorInstitute of Professional Psychology -KarachiChairman Dissertation Committee

I certify that I have read this dissertation and that in myopinion it is fully adequate, in scope and quality, as adissertation for the degree of Doctor of Philosophy.

-"£11 <3/v\ -Dr. Mrs. Eva HasanVisiting ProfessorInstitute of Professional Psychology-KarachiMember Dissertation Committee

I certify that I have read this dissertation and that in myopinion it is fully adequate, in scope and quality, as adissertation for the degree of Doctor of Philosophy.

Prof. Masood-UTTftqVisiting ProfessorInstitute of Professional Psychology-KarachiMember Dissertation Committee

II

This dissertation has been approved by the DissertationCommittee and recommended for the award of Ph.D. inProfessional Psychology (Clinical Psychology).

J2 “

Prof. Dr. Miss Farrukh Z AhmadHon. Surgeon CommodoreDeanFaculty of Professional PsychologyBahria University, Islamabad,Pakistan

This dissertation has been accepted for the award of Ph.D.degree.

Director Examination &7Academic Affairs 'Bahria University, Islamabad,Pakistan

IV

ACKNOWLEDGEMENTS

I wish to express my profound appreciation and gratitude to

the chairman of Dissertation Committee Professor. Dr. Miss

Farrukh Z Ahmad under whose guidance this research has

been completed. Her constant encouragement and advice

were source of inspiration for me to complete this project.

My gratitude is also extended to the members of the

Dissertation Committee, Dr. Eva Hasan & Prof Masood-UI-Haq

for their helpful criticism and suggestions.

I am thankful to Miss Saira and Mr. Khalid who helped me in

data collection. I am very grateful to Mr. Zulfiqar and Raja

Khurrum Majeed for the careful typing and computer

assistance.

Respectful thanks are extended to Brig Shafqat Baig who

spared me from my duty for enough time to complete this

research work.

A special mention of thanks to my brothers and sisters

particularly Major Pervaiz Akhtar, Mailk for their moral

support.

Most of all, a special debt of gratitude is owed to my wife, Dr.

Bilqis and children, Umar, Alina and Hamad whose prayers

and patience were a blessing for the author to complete this

dissertation.

V

CONTENTSPage

No.

Acknowledgments iv

List of Tables vi

List of Graphs vii

Abstract viii

Chapter1Introduction

01

Chapter 2Method

70

Chapter 3Results

82

Chapter 4Discussion

100

Chapter 5Conclusion

112

References 114

Appendix A 145

Appendix B 151

VI

LIST OF TABLES

Tables Page No

Level of Anxietyamong Fathersof Normaland Neurotic Children

Table No186

Table No 2 Level of Anxiety among Fathersof Neuroticand Psychotic Children 88

Level of Anxietyamong Fathers ofPsychoticand Normal Children

Table No 390

Levelof Depression among Fathersof Normaland Neurotic Children 92

Table No 4

Table No 5 Levelof Depression among Fathersof Neuroticand Psychotic Children 94

Table No 6 Level of Depression among Fathersof Normaland Psychotic Children 96

Table No 7 Levelof Depression among Fathersof NeuroticandPsychotic Children 98

VII

LIST OF GRAPHS

Graphs PageNo

LevelofAnxietyamong Fathers ofNormaland Neurotic Children

Graph 'A'87

Level of Anxiety among Fathers ofNeuroticand Psychotic Children

Graph 'B'89

Graph 'C' Levelof Anxiety among Fathers ofPsychoticand Normal Children 91

Graph 'D' Level of Depression among Fathersof Normaland Neurotic Children 93

Level of Depression among Fathersof Neuroticand Psychotic Children 95

Graph 'E'

Graph 'F' Level of Depression among Fathersof Normaland Psychotic Children 97

Graph G' Levelof Depression among Fathersof Neuroticand Psychotic Children 99

VIII

ABSTRACT

In the present research the difference of anxiety and

depression level of the fathers of neurotic and psychotic

children was studied.

In order to find out the level of anxiety and depression

among fathers of neurotic and psychotic children, IPAT

anxiety Scale and IPAT Depression Scale were used followed

by an interview to obtain information and history from them.

Three hundred fathers participated in the study.

Hundred fathers had neurotic children, hundred had

psychotic children and hundred had normal children.

A chi-square test was computed for the statistical

analysis of the data.

Hypothesis No 5 when calculated for Statistical

significance on the sample of 100 subjects in each group i.e.

fathers of neurotic and psychotic children rendered a X2 of

3.26 which made it insignificant by the fraction of difference

as the X2 of 3.84 is required to make it significant at the level

of P<.05.

IX

It was then decided to increase the data by 20 subjects

in each group to find out the Statistical significance as

expected the X2 with the increased data was significant at

.05 level.

It was concluded that the fathers of neurotic children

have high sten scores on anxiety and depression than the

fathers of psychotic children. Moreover anxiety sten scores

were higher than the depression sten scores comparatively.

1

CHAPTER1

INTRODUCTION

When a loved one is mentally ill, every member of the

family is affected in some way or the other. Whether the

relative is a son, daughter, sister, brother, parent,

grandparent, or a grand child, they all share the suffering.

They are stunned and bewildered. They hope that the odd

behavior of the patient and his scary talk will end. They are

also hopeful that soon things will be back to normal.

In Pakistan, it is very difficult to detect mental illness

because of lack of awareness and understanding of emotional

disorders. Even if the parents are aware that the children are

suffering from mental disorder they are restrained to admit it

due to the social and cultural stigma. In Pakistan the culture

is basically male oriented, hence the men are responsible for

provision of all the needs, especially those of health and

education of their children. Since families are generally the

responsibilities of fathers, therefore they are more concerned

about the health problems of their families where as the

other needs are looked after by the mothers.

2

It may be noted that parents specially fathers wait for a

few days and then take their ill children to the hospital or

physician for treatment. Parents with psychotic children do

not admit that their child is suffering from psychosis. In the

beginning of emotional disorder the fathers normally take

their children to Spiritual leaders (Pirs) or to the Shrines and

Graves of the holy man (Mazars) as generally advised by the

older people, friends, neighbors etc.

After exhausting all the possibilities they come to the

hospitals and get advice from the psychiatrists and

psychologists. Hence the children are already in the category

of chronic patients.

The parents have lot of questions and queries and their

feelings of despair are quite normal. Many relatives and

friends share their sorrows and concerns but do not actually

share the financial and emotional burden of the fathers.

The feelings of the father are very unique as he feels

tense because it is his child who has fallen mentally ill. A

promising young person, on the threshold of becoming an

adult, suddenly becomes very changed. He begins to feel as

though he has a stranger in his midst. His once happy and

competent son /daughter becomes withdrawn, unkempt, and

3

unable to function. His affectionate, dependable

daughter/son argues, destroys useful household items and

utters sentences that make no sense. He, like other fathers,

wants to protect and nurture his child. When his desire is

thwarted, he feels that he has failed in his duties. He may

blame himself for the failure.

It is a well known fact that other family members may

escape the immediate responsibilities that fall upon the

fathers of the mentally ill children, although, they do share

equally the painful feelings. The brothers and sisters are

bewildered, frightened, and some time ashamed and angry.

Pakistani culture has very close-knit families and the

mentally and physically ill people are accepted by the entire

family. In spite of that, the burden is borne by the father

more than others as they are financially responsible for the

child.

According to Coleman (1976) the general appearance

and clinical picture of the individual suffering from emotional

disturbance is one of dejection, discouragement and sadness.

Typically there is a high level of anxiety and

apprehensiveness, together with mixed activity, lowered self-

confidence, constricted interests and a general loss of

4

initiative. The person usually complains of difficulty in

concentrating, although his actual thought processes are not

slowed down. Often he has difficulty in going to sleep, and

after waking up during the night cannot go back to sleep

easily. In severe cases, the person is unable to work and

prefer to sit, hopelessly staring into space, and able to see

only the dark side of life. The person having anxiety lives in a

relatively constant state of tension, worry and diffused

uneasiness. He is oversensitive to interpersonal relationship

and frequently feels inadequate and depressed. Symptoms

vary from person to person, but typically they include

palpitations, shortness of breath, profuse sweating, faintness

and dizziness, coldness and pallor of the face and

extremities, gastric sensations and an ineffable feeling of

unhealthiness, Lader & Mathews (1970).

5

in this study, the emotional disturbance is operationally

defined as the symptoms of depression and anxiety.

DEFINITION OF KEY TERMS

Depression: An emotional attitude involving a feeling of

inadequacy and hopelessness accompanied by a general

lowering of psychophysical activity.

Anxiety: An emotional attitude involving a feeling of

anticipated future danger accompanied by a symptom of

apprehension and tension. The focus of anticipated danger

may be internal or external.

To summarize, in depression and anxiety following are

the common symptoms:

a) Depressed mood most of the day.

b) Markedly diminished interest.

c) Deep feelings of dejection with associated somatic and

physical symptoms.

d) Hopelessness.

e) Lower level of activity.

f) Poor self-image and suicidal ideation.

g) A feeling of apprehension.

h) Restlessness.

i) Difficulty in concentrating.

6

j) Being easily fatigued.

k) Muscle tension.

I) Sleep disturbance.

Anxiety is part and parcel of human existence. All

people feel it in moderate degrees, and in moderate degrees

it is an adaptive response. According to Stephen M. Paul,

quoted in Scheneck (1990), "Without anxiety, we would

probably all be asleep at our desk", we would also expose our

selves to danger. It is anxiety that compels us to go for

medical checkup, to slow down on a slippery road, to study

for exams, and thus to lead longer and productive lives. But

while most people feel anxiety some of the time, some

people feel anxiety most of the time. For these people it is

not an adaptive response. It is a source of extreme distress,

relievable only by strategies that limit freedom and flexibility.

Anxiety may range from highly adaptive to highly

maladaptive reactions. Adaptive anxiety is appropriate to the

situation and can even enhance efficiency and achievement.

In contrast, maladaptive anxiety is self-defeating, it tends to

interfere with efficiency and achievement. For example,

excessive anxiety can increase errors on various tasks. It can

7

also result in overly cautious behavior, such as delaying

appropriate responses and decision (Eisdorfer, 1977).

One can experience moderate level of anxiety and still

perform effectively. Indeed, under certain circumstances

moderate anxiety can be motivating and constructive. A

study of anticipatory anxiety prior to major surgery

illustrates this point. (Janis, 1971). Patients who has

expressed a moderate degree of anxiety prior to the

operation faired better in their postoperative adjustment

than those who had shown either a very low or a very high

level of preoperative anxiety. This particular investigation

was carried out by means of intensive interviews and

inspection of observational notes made by doctors and

nurses. In a follow-up study, college students who had under

gone major surgery completed questionnaires concerning

their preoperative and postoperative feelings about their

ordeal (Janis, 1971, pp, 96, 97).

These results not only illustrate the disruptive effects of

excessive anticipatory anxiety but also contradict the popular

notion that people who remain extremely calm about an

impending ordeal will be much less disturbed when they

handle the subsequent stress than people who show some

8

anxiety. Indeed, the finding suggest that when people are

exposed to severe stress, those who are not confident about

their invulnerability at the beginning may well be the most

likely to be highly disturbed when they actually under go the

stressful events. Further more, a moderate degree of anxiety

and fear about realistic danger can be constructively

motivating, helping the individual develop effective inner

defenses for coping with the danger (Janis , 1971, p, 71).

Anxiety disorders are characterized either by manifest

anxiety. Until recently, the anxiety disorders were grouped

with the somatoform and dissociative disorders under the

single diagnostic heading of neurosis. This term was coined

in the eighteenth century by a Scottish physician, William

Cullen, to describe a general affliction of the nervous system

that produced "nervous" behavior. Throughout the

nineteenth century, people who were "sane" but

nevertheless engaged in rigid and self-defeating behavior

were labeled neurotic and were thought to be the victims of

some unidentified neurological dysfunction. Then, beginning

around the turn of the century, this biogenic view was

gradually replaced by Freud's psychogenic view. Freud

argued and maintained that neurosis was not due to organic

9

causes but originates in anxiety. As repressed memories and

desires threatened to break through into the conscious mind,

anxiety occurred as a "danger signal" to the ego and neurotic

behavior was either the expression of that anxiety or a

defense against it.

The term neurosis is still widely used in psychodynamic

writings and mental health professionals of many other

theoretical persuasions continue to use it as an indication of

the severity of a psychological disorder, "neurotic" indicating

the milder disturbances and "psychotic" indicating the more

debilitating ones.

In that sense of severity, the anxiety disorders are

"neurotic" conditions. They do not destroy reality contact.

People with anxiety disorders may misinterpret or overreact

to certain stimuli related to their psychological problems, but

in general they see the same world as the rest of the people

and in most cases they still go about their daily rounds,

studying or working, carrying on fairly reasonable

conversation, engaging in relationships with other people

and so on. They may cope poorly, but they cope. Though the

anxiety disorders as a group may not be crippling, they still

represent the single largest mental health problem in the

10

United States (Kessler, McGonagle, Zhao, et al 1994). They

are more common than any other psychological disorder, and

they can lead to more severe disorders, such as depression

and alcoholism. They may also lead to physical disorders such

as heart disease (Barlow, 1988, Wells, Golding & Burnam,

1989).

Gupta (1973) studied 60 Indian college students and

found men to be higher than women by somewhat more than

half a sten.

Men higher in anxiety than women. This has been found

in three other nations. Interestingly enough, these three

nations, Canada, Australia, and New Zealand, would appear

on the surface at least to be similar in many other respects to

the American culture for which the test was initially

developed (Samuel e. Krug 1976).

There are constant fears that the mentally ill person

may hurt himself or others. Suicidal threats or attempts leave

families on edge. Typically reflecting poor self-control. People

with mental illness may direct hostility towards family

members because of jealousy, hypersensitivity to criticism, or

perceived obstruction of desire. Lefley (1987a). Carelessness

with cigarettes, unwillingness to seek medical or dental care,

11

susceptibility to attack by others in the street all add to the

families burden of anxiety.

Psychodynamic Perspective of Anxiety: -

Freud S., (1924) argued that anxiety stemmed not just

from external threats but also from internal ones, in the form

of id impulses attempting to break through into

consciousness. It is this latter type of anxiety that

Psychodynamic theory sees as the root of neurosis. In the

mind of the neurotic, the id is pushing in one direction,

toward the enactment of its sexual or aggressive impulse.

Meanwhile, the ego, knowing that the id impulse is

unacceptable in terms of both reality and the superego's

ideals, is working in the opposite direction, pushing the

impulse back into the unconscious through repression and

other defense mechanisms. This push and counter push goes

on all the time in normal lives and usually works well enough

so that anxiety over the id impulse is never experienced

consciously. In some cases, however, the anxiety is so

intense that it is experienced consciously, with debilitating

results. Or it is kept at away only through the employment of

extremely rigid defense mechanisms. It is these situations

12

that, according to Psychodynamic theory, constitute neurotic

behavior.

In cases where anxiety is experienced chronically and

directly, without elaborate defense, what we see is

generalized anxiety disorder. The cause is repressed, but the

anxiety leaks through. In the panic attack, the cause that is,

the id impulse moves closer to the boundaries of the

conscious mind, resulting in the rapid buildup of anxiety. The

ego responds with desperate efforts at repression, and a

state of maximum conflict ensues. Once the ego regains the

upper hand and the impulse is once again safely repressed,

the attack passes.

The most common areas of worry are family, money,

work, and health (Rapee & Barlow, 1993). Many normal

people worry about such things, but it is the excessiveness

and uncontrollability of the worrying that makes it a disorder.

People with generalized anxiety disorder are continually

waiting for some thing dreadful to happen, either to

themselves or to those they care about, and this subjective

condition spills over into their cognitive and physiological

functioning. They feel restless and irritable, they have

difficulty in concentrating; they tire easily. Typically, they

13

also suffer from chronic muscle tension and insomnia in

response to symptoms, many of them develop secondary

anxiety that is, anxiety about their anxiety fearing that their

condition will cause them to develop ulcers, lose their jobs,

alienate their spouses, and so forth. Most people with

generalized anxiety disorder develop the condition fairly

early in life, many report that they have always felt anxious.

It is a common disorder, affecting as much as four to five

percent of the U.S population, and it is twice as common in

women as in men (Kessler, McGonagle, Zhao, 1994; Rapee,

1991). The rates are similar across a variety of cultures

(Anderson, 1994).

Generalized anxiety disorder sounds as though it might

be the "resting state" of panic disorder, and some

researchers believe that this is the case that these syndromes

are two phases of a single disorder (Barlow, 1988). At the

same time, there are strong grounds for separating them. In

a recent comparison, Noyes and his colleagues found three

major differences between the two syndromes. First, their

symptom profiles differ. The symptoms of generalized

anxiety disorder suggest hyper arousal of the central nervous

system (Insomnia, restlessness, inability to concentrate).

14

Where as the symptoms of panic disorder seem connected to

hyper arousal of the autonomic nervous system (pounding

hearts, rapid breathing, dizziness, nausea). Second,

generalized anxiety disorder usually has a more gradual

onset and a more chronic course than panic disorder. Finally,

when these disorders run in families, they tend to run

separately. First-degree relatives of people with generalized

anxiety disorder are more likely to have generalized anxiety

disorder than panic disorder; first-degree relatives of panic

disorder patients are more likely to have panic disorder than

generalized anxiety disorders (Noyes, woodman, Garvey, et

al., 1992).

Generalized anxiety disorder is relatively common in

U.S society. Surveys suggest that up to 3.8 percent of the

United States population have the symptoms of it in any

given year (APA, 1994, Kessler et al., 1994; Blazer et al.,

1991). Although the disorder may emerge at any age, it most

commonly First appears in childhood or adolescence. Women

diagnosed with it outnumber men 2 to1.

People with generalized anxiety disorder typically feel

restless, keyed up or on edge, are easily fatigued, have

difficulty concentrating, are irritable, experience muscle

15

tension, and have sleep problems. The symptoms last at least

six months (APA, 1994). The majority of people with this

disorder also develop another anxiety disorder, such as a

phobia, at some point in their lives (Roy-Byrne & Katon, W. et

al., 1997; Blazer et al., 1991). Many experience depression as

well (Sherbourne et al., 1996; Kendler et al., 1995, 1992).

Nevertheless, most individuals with this disorder are able,

with some difficulty, to maintain adequate social

relationships and occupational activities.

Pervasive anxiety is often difficult for friends and

relatives to accept. It's unpleasant for them to see a loved

one so anxious and tense, and it's a burden to be continually

reassuring. Sometimes they accuse the anxious person of

"wanting" to worry, "looking" for things to worry about, and

being "happy" only when worrying. These characterizations

are unfair and certainly foreign to the subjective experience

of the sufferers themselves. People with a generalized

anxiety disorder hardly feel happy. They feel that they are in

a constant struggle, always threatened and defending

themselves, and always trying to escape their pain (Roemer

et al., 1995).

16

The general picture of people suffering from

generalized anxiety disorder is that they live in relatively

constant states of tension, worry, and diffuse uneasiness.

Barlow (1988, 1991a, 1991b; Brown et al., 1993) refers to

the fundamental process as one of anxious apprehension,

which is defined as a future-oriented mood state in which a

person attempts to be constantly ready to deal with

upcoming negative events. This mood state is characterized

by high level of negative affect, chronic over arousal, and a

sense of uncontrollability (Barlow, 1991b).

No matter how well things seem to be going, people

with generalized anxiety disorder are apprehensive and

anxious. Their nearly constant worries leave them continually

upset, uneasy, and discouraged. In one study their most

common spheres of worry were found to be family, finances,

work, and personal illness (Sanderson & Barlow, 1990).

Generalized anxiety disorder is a relatively common

condition, with current estimates that it is experienced by

approximately four percent of the population in any one-year

period (Robins & Regier, 1991).

Age of onset is often difficult to determine, with a large

proportion of patients reporting that they remember having

17

been anxious nearly all their lives; many others report a slow

and insidious onset (Barlow, 1988; Rapee & Barlow, 1993).

The most common additional anxiety disorders are

panic disorder with agoraphobia, social phobia, and simple

phobia (Barlow, 1988).

Many of these people show mild depression as well as

chronic anxiety (Barlow, 1988; Brown et al., 1993). This

finding is not unexpected in view of their generally gloomy

outlook on the world.

Many studies have shown that generally anxious people

tend to have their attention drawn towards threat cues when

there is a mixture of threat and non threat cues in the

environment. Non anxious people show, if anything the

opposite bias, tending to have their attention drawn away

from threat cues. (MacLeod & Mathews, 1991; Mathews,

1993; Mineka, 1992).

Across cultures, more women than men suffer

generalized anxiety disorder, panic disorder and phobias

(Amering & Katsching, 1990; Inderbitzen & Hope, 1995).

One study of over 1,000 adolescents found that as early

as age 6, about twice as many girls (6%) as boys (3%)

experience an anxiety disorder (Lewinsohn et al., 1998).

18

Psychologists do not believe that women's higher rates of

anxiety related illness mean that they are mentally "weaker"

than men; instead, some propose that genetic differences are

responsible. (Lewinsohn et al., 1998), and others argue that

women face a combination of psychological and social factors

that tend to make them more susceptible than men to

anxiety disorders.

In addition, women and men seem to respond to

traumatic events in different ways. Women and girls are

more likely than men and boys to develop posttraumatic

stress disorder following a traumatic experience (Breslau et

al., 1991). Women tend to respond to trauma with denial and

avoidance, strategies that facilitate the development of

posttraumatic stress disorder (Curie & Williams, 1996;

Maldonado & Spiegel, 1994), and they are sometimes

encouraged to do so.

Women also tend to face more emotional and

socioeconomic hardships after a trauma than men do

(Garrison et al., 1995). Often women must care for the

emotional needs of others in the same circumstances. They

are less likely than men to have time for themselves, as

19

adequate socioeconomic resources are not available to cope

with a traumatic situation.

Creer and Wing (1974) nearly half of the relatives

thought their health was severely or very severely affected

by having a mentally ill member of the family living at home.

SOME FEATURES OF ANXIETY

PHYSICAL FEATURES OF ANXIETY

Jumpiness, jitteriness

Trembling or shaking of the hands or limbs

Sensations of a tight band around the forehead

Tightness in the pit of the stomach or chest

Heavy perspiration

Sweaty palms

Light-headedness or faintness

Dryness in the mouth or throat

Difficulty talking

Difficulty catching one's breath

Shortness of breath or shallow breathing

Heart pounding or racing

Tremulousness in one's voice

Cold fingers or limbs, Dizziness

Weakness or numbness

20

Difficulty swallowing

A "lump in the throat"

Stiffness of the neck or back

Choking or smothering sensations

Cold, clammy hands

Upset stomach or nausea

Hot or cold spells

Frequent urination

Feeling flushed

Diarrhoea

Feeling irritable or "on edge"

BEHAVIORAL FEATURES OF ANXIETY

Avoidance behavior

Clinging, dependent behavior

Agitated behavior

COGNITIVE FEATURES OF ANXIETY

Worrying about something

A nagging sense of dread or apprehension about the future

Belief that something dreadful is going to happen, with no

clear cause

Preoccupation with bodily sensations

Keen awareness of bodily sensations

21

Feeling threatened by people or events that are normally of

little or no concern

Fear of losing control

Fear of inability to cope with one's problems

Thinking the world is caving in

Thinking things are getting out of hand

Thinking things are swimming by too rapidly to take charge

of them

Worrying about every little thing

Thinking the same disturbing thought over and over

Thinking that one must flee crowded places or else pass out

Finding one's thoughts jumbled or confused

Not being able to shake off nagging thoughts

Thinking that one is going to die, even when one's doctor

finds nothing medically wrong

Worrying that one is going to be left alone

Difficulty concentrating or focusing one's thoughts

Diagnostic Features Of Anxiety DisordersFear and avoidance of places orsituations in which it would bedifficult or embarrassing toescape, or in which help mightbe unavailable in the event of apanic attack or panic typesymptoms.Occurrence of recurrent,unexpected panic attackaccompanied by persistentconcern about them but without

Agoraphobia

Panic Disorder withoutAgoraphobia

22

agoraphobia.Occurrence of recurrent,unexpected panic attacksaccompanied by persistentconcern about them andagoraphobia.Persistent and excessive levelsof anxiety and worry that is nottied to any particular object,situation, or activity.Clinically significant anxietyrelating to exposure to specificobjects or situations, oftenaccompanied by avoidance ofthese stimuli.Clinically significant anxietyrelating to exposure to socialsituations or performancesituations, often accompaniedby avoidance of these situations.Recurrent obsessions and / orcompulsions.The re-experiencing of a highlytraumatic event accompanied byheightened arousal andavoidance of stimuli associatedwith the event.Features similar to those ofposttraumatic stress disorderbut limited to the days andweeks following exposure to thetrauma.

PanicDisorder withAgoraphobia

GeneralizedAnxietyDisorder

Specific Phobia

Social Phobia

Obsessive-CompulsiveDisorderPosttraumaticStressDisorder

AcuteStress Disorder

PSYCHODYNAMIC PERSPECTIVE OF DEPRESSION

The first serious challenge to Kraepelin's biogenic

theory of mood disorder came from Freud and other early

psychoanalytic theorists, who argued that depression was

not a symptom of organic dysfunction but a massive defense

23

mounted by the ego against intrapsychic conflict. In his now-

classic paper "Mourning and Melancholia" (1917/1957) Freud

described depression as a response to loss (real or symbolic),

but one in which the person's sorrow and rage in the face of

that loss are not vented but remain unconscious, thus

weakening the ego. This formulation was actually an

elaboration of a theory put forth by one of Freud's students,

Karl Abraham (1911/1948, 1916/1948). Abraham had

suggested that depression arises when one loses a love

object toward whom one had ambivalent feelings, positive

and negative. In the face of the love object's desertion, the

negative feelings turn to intense anger. At the same time, the

positive feelings give rise to guilt, a feeling that one failed to

behave properly toward the now-lost love object. Because of

this guilt- and also because of early memories in which the

primary love object was symbolically "eaten up," or

incorporated, by the infant the grieving person turns his or

her anger inward rather than outward, thus producing the

self-hatred and despair that is called depression.

There are now many Psychodynamic theories of

depression, yet they do share a certain number of core

assumption (Bemporad, 1998; Strieker, 1983).

24

First it is generally believed that depression is rooted in

some very early defect, often the loss or threatened loss of a

parent (Bowlby, 1973).

Second the primal wound is reactivated by some recent

blow, such as a divorce or job loss. What ever the

precipitating event, the person is plunged back into the

infantile trauma.

Third, a major consequence of this regression is a sense

of helplessness and hopelessness a reflection of what was

the infant's actual powerlessness in the face of harm. Feeling

incapable of controlling his or her world, the depressive

simply withdraws from it.

Fourth, many theorist, while perhaps no longer

regarding anger as the hub of depression, do feel that

ambivalence toward inteijected objects (i.e., love objects

who have been "taken in" to the self) is fundamental to the

depressive emotional quandary.

Fifth, it is widely agreed that loss of self-esteem is a

primary feature of depression.

Otto Fenichel, (1945) described depressive as "love

addicts," trying continually to compensate for their own

depleted self-worth by seeking comfort and reassurance from

25

others. This leads to the sixth common psychodynamic

assumption about depression: that it has a functional role. It

is not just something that people feel but something that

they use, particularly in the form of dependency, in their

relationships with others.

Like most psychodynamic theories, these assumptions

are not fully open to empirical validation, but two claims

have been tested.

First a high level of dependency on others does appear

to characterize some depressed persons, and these highly

dependent people are more likely to become depressed when

they experience social rejections (Nietzel & Harris, 1990).

Second, research has examined the role of parental

loss, though here the results are mixed. There is evidence for

the link. Women who have lost their mothers in childhood

through either death or separation are apparently more likely

to succumb to depression (Harris, Brown & Bifulco, 1990),

and depressed patients who have suffered a serious

childhood loss, particularly separation from a parent are

more likely to attempt suicide (Bron, Strack, & Rudolph.,

1991).

26

A study was conducted in Pakistan by Seema

Cochinwala (1990). It was found that the mean state anxiety

and the mean Galvanic Skin Response of the Father loss in

childhood was significantly high as compared to the mean

state anxiety and mean Galvanic Skin Response of the No

Loss Group under the stressful situation of loss of support,

where as the mean state anxiety and the mean Galvanic Skin

Response of the two groups did not significantly differ under

the stressful situation of no loss of support. The mean state

anxiety and the mean Galvanic Skin Response of the Loss

Group was significantly high under the stressful situation of

loss of support as compared to the stressful situation of no

loss of support, where as the mean state anxiety and the

mean Galvanic Skin Response of the No Loss Group did not

significantly differ under the stressful situation of the loss of

support and under the stressful situation of no loss of

support.

Grief as the psychological process one goes through

following the death of a loved one a process that appears to

be more damaging for men than women (Stroebe & Stroebe,

1983). Although this may be the most common and intense

cause of grieving, many other types of loss will give rise to a

27

similar state. Loss of a favored status or position, separation

or divorce, financial loss, the break up of a romantic affair,

retirement, separation from a friend, absence from home for

the first time, or even the loss of a cherished pet may all give

rise to symptoms of acute grief.

But many researchers now believe that the crucial risk

factor, at least for depression, is not so much parental loss as

poor parenting (Kendler, Neale, Kessler, et al., 1992;

Tennant, 1988). Recent research has focused especially on a

parenting pattern called affectionless control that is, too

much protectiveness combined with too little real care. This

pattern may leave children feeling chronically helpless and

over dependent. When, as adults, they encounter stress, they

are more vulnerable to depression because they feel helpless

(Blatt & Homann., 1992; G. Parker., 1992).

This disorder is one of American society's greatest

mental health problems. Its prevalence in the united state

during any giving month is closed to four percent for men

and six percent for women. The lifetime risk that is, the

percentage of Americans who will experience major

depression at some point in their lives is about 17 percent

(Blazer, Kessler, McGonagle, et al., 1994). Depression is

28

second only to schizophrenia in frequency of first and second

admissions to American mental hospitals. As for the non

hospitalized, private physicians report that as many as 12 to

48 percent of their patients suffer from depression (J.E.

Barrett, Barrett, Oxman, et al., 1988), and those patients are

more debilitated lose more workdays, spend more time in

bed than patients with many chronic medical conditions, such

as diabetes or arthritis (Wells, et al., 1989).

Grave as the situation is, it is getting worse. Each

successive generation born since World War II has shown

higher rates of depression (Burke, Burke, Roe, et al., 1991,

Klerman, 1988). According to some experts, we are

embarking on an "age of depression".

Certain groups with in the population are more

susceptible than others. People who are separated or

divorced show a disproportionately high prevalence of major

depression (Blazer, Kessler, McGonagle, et al., 1994). So do

women. Their risk is one and a half to three times higher than

men's a fact that investigators have tried to explain with

theories ranging from hormonal differences to the changing

social role of women. One promising theory has to do with

29

differences in the way men and women respond to depressed

moods.

According to Susan Nolen-Hoeksema (1987, 1991),

women, when they are "down," tend to ruminate on this,

focusing on the depression, wondering why it is happening

and what it will lead to. Men take the opposite tack: they try

to distract themselves. Since the evidence indicates that

rumination prolongs depression and distraction relieves it,

women are likely to have longer and more serious

depressions.

Adult men and women are equally likely to suffer from

bipolar disorder, which occurs in about 1% of the population

(Bebbington & Ramana, 1995; Jamison, 1993. Lewinsohn et

al., 1995). Similarly the roughly 2 to 3% of all children who

experience periods of depression includes equal numbers of

boys and girls (Angold & Costello, 1993; Lambert et al.,

1994). Around mid puberty, a notable gender difference

begins to emerge; such that about twice as many women as

men experience major depression ( Angold et al ., 1998;

Culbertson, 1997; Ge et al., 1994; Hankin et al., 1998; Nolen-

Hoeksema & Girgus, 1994). This difference in rates of major

depression hold true across many countries, as well among

30

ethnic minorities groups in the United State ( Blazer et al.,

1994; Jones-Webb & Snowden, 1993; kuo, 1984; Magni et al.,

1992; Nguyen & Peterson 1993; Noh et al., 1992; Potter et al

v 1995; Weissman et al., 1993).

It was once thought that susceptibility to mood

disorders also varied with age, the middle aged and the

elderly being the high risk groups. Today it seems that if any

group is most susceptible, it is the young. The peak age at

onset for major depression is now fifteen to nineteen years

for women and twenty five to twenty nine years for men

(Burke, Burke, Regier, et al., 1990), though the disorder may

strike at any age, even in infancy.

The symptom picture differs some what depending on

age group (Harrington, 1993). In depressed infants, the most

striking and alarming sign is failure to eat. In older children,

depression may manifest it self primarily as apathy and

inactivity. Alternatively, it may take the form of severe

separation anxiety, in which the child clings frantically to

parents, refuses to leave them long enough to go to school,

and is haunted by fears of death (or of the parents death). In

adolescents the most prominent symptoms may be sulkiness,

negativism, withdrawal, complaints of not being understood

31

or appreciated and perhaps antisocial behavior and drug

abuse as well (Cantwell, 1982, Goodyer, 1992)—in other

words an exaggeration of normal adolescent problems.

In the elderly, lack of pleasure and motivation,

expressions of hopelessness, and psychomotor retardation or

agitation are common signs, as are delusions and

hallucinations (Brodaty, Peters, Boyce, et al ., 1991).

Further episodes are more likely the more previous

episodes a person has had, the younger the person was when

the first episode struck, the more painful events he or she

has endured recently, the less supportive his or her family

has been, and the more negative cognitions he or she has

(Belsher, and Costello, 1988; Lewinsohn, Roberts, Seeley, et

al., 1995).

The course of recurrent depression varies considerably.

For some people the episodes come in cluster. For others

they are separated by years of normal functioning. As for the

quality of the normal functioning, that too varies. Some

people do return to their premorbid adjustment that is, their

level of functioning prior to the onset of disorder. As for the

others, one study of people who had been symptom-free for

two years found that they still showed serious impairment in

32

job status, income, marital adjustment, social relationships,

and recreational activities (Coryell, Scheftner, Keller, et al.,

1993).

Depression also affects the immune system, leaving its

victims more susceptible to illness (D.L. Evans, Folds, Petitto,

et al., 1992). All of these effects make it difficult for people

coming out of a depressive episode to resume their former

lives. Indeed, some research indicates that the symptoms

and behaviors characteristic of a depressive episode actually

generate stressful life events, which in turn can maintain the

depression and produce a cycle of chronic stress and

impairment (Hammen, 1991; S.M Monroe & Simons, 1991).

So people snap back, but many of them do not snap back

entirely, just as scar tissue is not the same as the original

tissue. Not surprisingly, the longer a depressive episode lasts,

the less likely it is that the person will fully recover (Keller,

Lavori, Mueller, et al., 1992).

If the relationship between anger and illness is

complex, the relationship between depression and illness is

more so. Some studies find that chronic depression is

associated with aberrations in the immune system,

presumably the precursor to illness (Herbert & Cohen, 1993;

33

Weisse, 1992). Yet a review of twenty two studies found that

most reported no immune system differences between

people with major depressive disorders and control subjects

(Stein, Miller & Trestman, 1991).

Moreover a ten years study of a nationally

representative sample of 6,403 women and men found that

those who had depressive symptoms or even clinical

depression were not more likely to develop cancer

(Zonderman, Costa, & McCrae, 1989). To confuse the picture

further, some studies find that depressed men who are

infected with the HIV virus lose certain disease fighting cells

in the immune systems and thus became vulnerable to

infection and AIDS related diseases more quickly than HIV-

infected men who are not depressed (Burack et al., 1993).

Yet other large scale studies have found no links among

depression, psychological distress, immune function, and out

breaks of illness among men with HIV (Lyketsos et al., 1993;

Rabkin etal., 1991).

Some researchers believe that depression is not as

dangerous to health as having a repressive personality style:

denying normal feelings of anxiety, anger or fear and

pretending that everything is fine. Howard Friedman (1991)

34

calls repressors " Phony Type Bs " people who say that

pressure doesn't bother them and who seem unaggressive

but who, just under the surface, actually are competitive,

angry and tense. Other researchers call them "defensive

deniers" (Shedler, Mayman, & Manis, 1993). By whatever

name, they may be at greater risk of serious illness that true

type Bs or even volatile Type As. And there is controversial

evidence from some studies that once deniers contract a

disease, they die sooner, on average, than people who are

able to acknowledge and express their feelings (Burgess,

Morris, & Pettingale, 1988).

Thus the connection between negative emotions and

disease remains elusive. Howard Friedman and Stephanie

Booth-Kewley (1987) summarizing the results of 101studies,

failed to find any significant link between specific emotions

and specific disease. They did find evidence for what they

called a generic, "disease prone personality" in people who

are chronically depressed, angry and hostile, worried and

anxious, but the evidence was not strong.

Perhaps, then the most reasonable conclusion at

present is that extremes of emotional expressions both

denial of negative emotions at constant ventilation of such

35

emotions are probably involved in illness, but they are

unlikely to be the only cause. "Personality may function like

diet," Friedman and Booth-Kewley concluded. "Imbalances

can predispose one to all sorts of diseases." Personality traits

may determine how you react to a stressor or to becoming

sick with anger and belligerence, with resignation, with

denial, with constructive action and these responses affect

the cardiovascular and immune systems in general

(Andersen, Kiecolt-Glaser, & Glaser, 1994).

Unfortunately, depression is very common. In fact, it is

experienced by 21.3% of women and 12.7% of men at some

time during their lives (Kessler et al., 1994). This nearly two-

to-one gender difference in rate of experiencing depression

has been reported in many studies (e.g., Culbertson, 1997),

especially those conducted in wealthy, developed countries,

so it appears to be a real one. Why does it exist? As noted by

Strickland (1992), probably for several reasons.

Situational factors that may contribute to depression in

women include the fact that females have traditionally had

lower status, power, and income than males, must worry

more than males about their personal safety, and are subject

to sexual harassment and assaults much more often than

36

males. In addition, research findings indicate that the

differences in rates of depression may also stem, at least to a

degree, from the fact that females are more willing to admit

to such feelings than males, or from the fact that women are

more likely than men to remember depressive episodes

(Wilhelm, & Parker, 1994).

Another Psychological mechanism that plays a key role

in depression is the negative views that depressed persons

seem to hold about themselves (Beck, 1976; Beck et al.,

1979). Individuals suffering from depression seem to possess

negative self schemas negative conceptions of their own

traits, abilities and behavior. As a result, depressed persons

tend to notice and remember negative information about

themselves, such as criticism from others (Joiner, Alfano, &

Metalsky, 1993). Because of this sensitivity to negative

information, their feelings of worthlessness strengthen and

so does their depression.

Finally, depressed persons are prone to several types of

faulty or distorted thinking (Persad & Polivy, 1993). Since

they often experience negative moods, the kind of mood

dependent memory tends to operate against them.

Specifically, depressed persons tend to notice, store and

37

remember information consistent with their negative moods

negative information (Mason & Graft , 1993; Roediger &

McDermott 1992). They tend to bring unhappy thoughts and

memories to mind, to dwell on them, and to enter new

negative information into memory needless to say, this

pattern set up a self-perpetuating cycle in which the

possibility of escape from depressing thoughts or depression

itself decrease over time.

A dramatic illustration of such effects is provided by

research conducted recently by Watkins and his colleagues

(Watkins et al, 1996). These researchers suggested that the

tendency of depressed person to think negative thoughts is

so strong that it occurs on an unconscious as well as a

conscious level. In other words, depressed persons may tend

to bring negative thoughts and information to mind without

even being aware that they are doing so. To test this

possibility, they also reported that the exposed individuals

who were depressed and persons who were not depressed to

lists of positive words (e.g., admired, optimistic, talented),

neutral words (e.g., dresser, flannel, propane, turtles), or

negative words (e.g., punished, hopeless, failure, rejected).

As each word was shown on a screen, participants in the

38

study were told imagine themselves in a scene that involved

this word. After studying the words in this fashion, the

participants were presented with cue words that were

related to the words they previously studied (e.g., adored for

admired, furniture for dresser and blamed for punished), and

were asked to think of as many associations to these cues as

possible in thirty seconds. The researchers reasoned that

unconscious tendencies for depressed persons to bring

negative information to mind would be shown by a greater

likelihood on their part than on the part of non depressed

persons to remember negative words they had previously

studied in response to the cue words. Moreover, and also as

expected, the opposite was true with respect to positive

words; Non-depressed person remembered more of these

than did depressed persons.

MULTINATIONAL STUDY OF DEPRESSION:-

The results of multinational study show that the rates

of major depression have been rising in the United States and

worldwide (Cross- National Collaborative Group, 1992).

Investigators used similar methods and criteria for

diagnosing depression in nine countries in North America

(United States and Canada), the Caribbean basin (Puerto

39

Rico), Western Europe (Italy, France, Germany), the Middle

east (Lebanon), and Asia and the Pacific Rim (Taiwan and

New Zealand). The investigators in each site first obtained a

random sample of adult household members from a

designated population area. Psychiatric interviews were then

conducted with area residents using the Diagnostic Interview

schedule, a highly structured interview designed to yield DSM

diagnoses. By comparing people born at different times,

investigators were able to show that depression had

increased among successive generations in all sites, although

there were variations in the rate of increase across countries.

In some countries, young people born after 1955 stood about

three times greater likelihood of suffering a major depression

than did their grandparents when they were the same age

(Goleman, 1992d). The greatest increases were found in

Florence, Italy; the least in Christchurch, New Zealand.

No one knows why depression has been on the rise in

many cultures, but speculation centers on social and

environmental changes, such as increasing urbanization and

fragmentation of families, exposure to wars, and increase

incidence of violent crimes, as well as possible exposures to

toxins or infectious agents in the environment that might

40

affect mental as well as physical health (Cross-National

Collaborative Group, 1992). One example is the dramatic

increase in depression that occurred in the period 1950 to

1960 in Beirut, Lebanon. This was a period of chaotic political

and demographic changes in the country. Depression

dropped sharply in the following period, 1960 to 1970 and

time of relative prosperity and stability in the country, but

increased again between 1970 and 1980 during a time of

social upheaval and internal warfare.

Although the rates of major depression in the United

States have also been on the rise, the overall increase masks

important subgroup differences. A review of studies reported

between 1978 and 1987 showed that the rates of depression

appeared to have declined among older people while

increasing among people born since the end of World War II

(the so-called baby boomers) (Klerman & Weissman 1989).

Researchers speculate that baby boomers may be more

susceptible to depression because of factors such a

unfulfilled economic expectations, increased urbanization,

increased relocation from town to town (destroying - works

for social support), and the pressures of adjusting a changing

roles for men and women and women in the home, the

41

marketplace, and society at large (Klerman & Weissman,

1989).

OPTIMISM AND PESSIMISM: -Different ways of thinking are associated with different

emotions. Lonely or depressed people tend to explain

uncontrollable negative events as internal ("It's all my

fault"), stable ("This misery is going to last forever"), and

global ("It's going to affect every thing I do"). Cheerful

people regard the same events as external ("I could not have

done any thing about it"), unstable ("Things will improve")

and limited in impact ("Well, at least the rest of my life is

OK").

Seligman (1991) calls these two characteristic

responses to bad events pessimistic and optimistic

explanatory styles. A pessimistic explanatory Style is

associated with less self esteem, less achievement, more

illness, and slower emotional recovery from trauma. When

researchers followed a sample of people in Florida who had

suffered devastating losses as a result of Hurricane Andrew,

they found that pessimism was a significant predictor of

continued distress six months after the disaster, whereas

loss of resources was not (Carver et al., 1993a). It's not how

42

much you lose, apparently, but how you think about that loss

that makes the most difference to the state of mind.

Pessimists will probably complain that optimism is just

a result of good health or good fortune; it's easy to think

positively when you feel good. But there is growing evidence

that optimism may produce good health as well as reflect it.

In one imaginative study of baseball Hall-of-Famers who had

played between 1900 and 1950, 30 players were rated

according to their explanatory style. A pessimistic r emark

would be internal, stable and global, as in "We didn't win

because my arm is shot, it'll never get better, and it affects

my performance every time." An optimism version would be

external, unstable and specific. "We didn't win because we

got a couple of lousy calls, just bad luck in this game, but we

will be great tomorrow." The optimists were significantly

more likely to have lived well into old age than were the

pessimists (Seligman, 1991).

Another study followed 1,719 men and women with

heart disease who had undergone a procedure to check the

arteries for clogging. Twelve percent of the pessimist people

who doubted they would recover enough to lead normal lives

died with in a year, compared to only five percent of the

43

optimists (Mark, 1994). This difference was not related to

differences in severity of the disease: some of the people

with the mildest heart disease were the most pessimistic.

One reason for the links between pessimism and illness

may have to do with how people cope with stress. When

faced with a problem, such as a risky operation or a serious

continuing struggle with alcoholism, optimists focus on what

they can do about it. They have a higher expectation of being

successful, so they don't give up at the first sign of a setback.

They keep their senses of humor, plan for the future, and

reinterpret the situation in a positive light (Carver, Scheier, &

Weintraub, 1989; Carver et al., 1993a).Note that optimists do

not deny their anxieties, cheerful asserting that "every thing

will be fine". Rather they acknowledge their problems and

illnesses, but have confidence that they will over come them

(Schwartz, 1987). Pessimists, in contrast, may be more likely

to become ill because they give in to negative emotions, or

just give up, instead of acting constructively.

Self defeating thoughts can heighten and perpetuate

anxiety and phobic disorders. When faced with fear evoking

stimuli, the person may think, "1 have got to get out of here"

, or "My heart is going to leap out of my chest"

44

(Meichenbaum and Deffenbacher, 1988). Thoughts like these

intensify autonomic arousal, disrupt planning, magnify the

aversiveness of stimuli, prompt avoidance behavior, and

decrease self efficacy expectancies concerning capacity to

control the situation.

Schwartz and Michelson (1987) found that people with

agoraphobia tend to produce self-defeating thoughts prior to

treatment and more adaptive thoughts during and

immediately following treatment. Those who showed the

most improvement with treatment also made the greatest

shifts from self-defeating to adaptive thoughts.

Research on stress and the onset of depression is

complicated by the fact that depressed people have a

distinctly negative view of themselves and the world around

them (Beck, 1967), and so at least to some extent their

perceptions of stress may result from the cognitive

symptoms of their disorder (Monroe & Simons, 1991). That

is, because of their pessimistic outlook, they may evaluate

events as stressful that an independent evaluator (or a non-

depressed friend) would not. This is why both George Brown

and Bruce Dohrenwend two leading stress researchers have

developed more complex and sophisticated measures of

45

stress that involve either the use of independent evaluators

or of questionnaires with specific narrowly defined stressors

with objectively determined weights. Therefore, both

measures do not rely on the depressed person's appraisal of

an event as stressful. But because relatively few studies have

used these more sophisticated strategies, much of the

research literature on the association of depression and life

stress as assessed by self-report is difficult to evaluate.

In several studies using these sophisticated

measurements of life stress, Brown and Harris (1978, 1989)

have concluded that depression often follows from one or

more severely stressful events, usually involving some loss or

exit from one's social sphere. (Interestingly, events

signifying danger or threat were found more likely to precede

the onset of anxiety disorder [Finlay-Jones & Brown, 1981;

Paykel, 1982]). Indeed, when comparing the incidence of

such stressful events in depressed subjects with that in non

depressed controls, Brown and Harris (1978) estimated that

stressful life events played a causal role in the depression of

about 50 percent of their subjects, in another sophisticated

study, Dohrenwend et al., (1986) found that depressed

patients had more negative life events of three types in the

46

year before the onset of their depression than did

nondepressed controls: physical illness and injury, fateful

loss events, and events that disrupted their social network.

A study by Phifer and Murrell (1986) of a community

sample of older people (ages 55 and over) that did use self-

report measures of stress confirmed that loss events were

associated with the onset of depressive symptoms, and like

the Dohrenwend and colleagues study it also pointed to

health problems and lack of social support as having

depression inducing effects.

Whether mildly stressful events and chronic strains are

also associated with the onset of depression is more

controversial. Using their sophisticated strategies for

assessing life stress, Brown and his colleagues, and

Dohrenwend and his colleagues, have not found minor

stressful events, and only occasionally chronic strains , to be

associated with the onset of clinical depression (

Dohrenwend et al., 1995). However, Bebbington and

colleagues (1988) used Brown's method for measuring life

stress and did find minor events associated with the onset of

both neurotic and endogenous depression. Moreover, from

self-report measures of stress there is also evidence that

47

minor events and chronic strains may be associated with the

onset of depression.

In study of 409 matched pairs of normal and unipolar

depressive subjects, Billings, Cronkite, and Moos (1983)

provided evidence not only of a greater frequency of prior

stressor "events" but also of more chronic sources of

psychosocial strain in the depressed group. Similarly,

Amenson and Lewinsohn, (1981) also found that both major

and minor life events and chronic strains such as marital or

employment problems were predictors of the onset of

depression in a community sample that was followed for a

year. Although these are well conducted studies, their results

should be interpreted with some caution given that subjects

rated stressful events at the follow up period when they were

depressed, and this may have colored their perceptions of

what constituted minor life events and chronic strains. Given

the dozens of studies in this area, it is perhaps best to rely on

findings from a recent review of the literature that concluded

that chronic stressors (such as poverty) and minor events

may be associated with an increase in depressive symptoms

but probably not major depression (Monroe & Simons, 1991).

48

For one subtype of major mood disorder that is not

officially recognized in DSM-IV but is still widely discussed in

the literature endogenous depression there is the strong

implication that it occurs out of the blue, so to speak. If

endogenous depression occurs in the absence of significant

psychosocial antecedents, it must be caused entirely from

within. This idea of endogenous causation is most compatibly

with a strong version of the biomedical model. However,

there is at least some evidence the onset of so called

endogenous depression does not differ substantially from

other forms of depression in terms of the frequency with

which major life events are associated with their onset

(Bebbington et al.,1988). Indeed, problems in defining

exactly what is meant by endogenous depression, as well as

findings that is often associated with precipitating life

events, may be part of the reason why it is not officially

recognized in DSM-IV.

If we take the position and the available research data

seem to justify doing so that some people are constitutionally

more prone than others to develop mood disorders, than it

would seem reasonable to suppose that such high risk

persons would react more intensely to subtle, easily

49

overlooked stressors than would persons less at risk for

these disorders. Unfortunately, no data at present permit us

to evaluate this hypothesis directly. Indeed, a recent critical

review of the literature by (Monroe, & Simons., 1991)

suggest that there is much more evidence for the idea that a

large percentage of the population is at risk for depression if

they are exposed to one or more severe life events.

The more general question of how stress interacts with

various types of vulnerability factors to produce depression.

Psychopathology researchers have long advocated the use of

diathesis stress model for understanding the development of

certain kinds of psychopathology such as schizophrenia and

recently Teasdale., (1988) has called this the vicious cycle of

depression.

There is some recent evidence that when a recovered

depressive patient is in a sad mood the elevations in

dysfunctional beliefs may come back (Mriadna, Persons.,

1988; Mriadna, Persons & Byers, 1990), suggesting that it

may be best to test for vulnerability when people are in a sad

mood. However, more research on this topic is necessary

before strong conclusions can be drawn. In addition tests of

50

the casual hypothesis of Beck's theory regarding the onset of

depression have also provided mixed results.

Depression creates many interpersonal difficulties with

strangers and friends as well as with family members

(Hammen, 1991, 1995).

Harris et al., (1990) had found that women without a

close confiding relationship were more vulnerable to

depression. Since that time many more studies have

supported the idea that people who lack social support are

more vulnerable to depression.

Billings et al., (1983) in a four years prospective study

of 254 adults found that low family support predicted levels

of depression four years latter. In addition, Gotlib & Hammen

(1992) reviewed a considerable amount of research showing

that depressed individuals have smaller and less supportive

social networks. Billings & colleagues (1983) confirmed that

these findings are not just due to a negative reporting bias,

because the findings were confirmed by non depressed

family members. These restricted social networks seem to

precede the onset of depression, and although depressed

persons may have more social contact when their symptoms

remit, their social networks are still more restricted than

51

those of never depressed persons. In addition, Gotlib and

Hammen (1992) review evidence that depressives have

social skill deficits. For example, they seem to speak more

slowly and monotonously and to maintain less eye contact,

they are also poorer than non depressed people at solving

interpersonal problems.

As already, noted, depressed people not only have

interpersonal problems, but their own behavior also seems to

make these problems worse. The behavior of a depressed

individual often places others in the position of providing

sympathy, support, and care. Such positive reinforcement

does not necessarily follow, however depressive behavior

can, and frequently does, elicit negative feelings and

rejection in other people, including strangers, roommates,

and spouses (Coyne, 1976; Gurtman, 1986; Hammen &

Peters, 1977, 1978; Hokanson et al., 1989; Gotlib & Hamman,

1992, for a review).

In fact, merely being around a depressed person may

induce depressed feelings in others (Howes, Hokanson, 8t

Loewenstein, 1985; Strack & Coyne, 1983) and may make a

non depressed person less willing to interact again with the

depressed person. Moreover, such negative reactions are

52

often correctly anticipated by a depressed person (Strack &

Coyne 1983).

Coyne (1976) suggested that the presence or absence

of support may depend on whether a depressed individual is

skillful enough to circumvent or turn to advantage the

negative affect he or she tends to create in other people.

Especially if the other people are prone to guilt feelings, a

depressed person may elicit considerable sympathy and

support, at least over the short term. More commonly, the

ultimate result is probably a downwardly spiraling

relationship from which others finally withdraw, making the

depressed person worse. Indeed this idea is supported by the

findings from several longitudinal studies of college

roommates.

Howe's, Hokanson & Loewenstein (1985) found that the

initially non depressed roommates showed more and more

depressed mood themselves over the course of a year living

with a depressed roommate. Yet these roommates, even as

they were showing more depressed mood themselves, also

showed increasing levels of care taking as their depressed

roommates became more and more dependent (Hokansone

et al., 1989). Hokanson and colleagues 1989 further reported

53

that the depressed roommate reporting reduce (rather than

increase) contact with the non depressed roommate and low

enjoy ability of such contact. Finally, Hokanson, Hummer &

Buttler (1991) found that depressed roommates perceived

more hostility and lower levels of friendliness from their

roommates than did non depressed roommates.

In recent years interpersonal aspects depression have

also been carefully studied in the context of marital and

family relationship. Gotlib & Hammen (1992) have reviewed

evidence that between one third and one half of maritally

distressed couples have at least one partner with clinical

depression. In addition, it is known that marital distress

predicts a poor prognosis for a depressed spouse whose

symptoms have remitted (Hooley & Teasdale 1989). That is, a

person whose depression clears up is likely to relapse if he or

she has an unsatisfying marriage.

There is good evidence that living with a depressed

person is highly stressful indeed, so stressful that it may

make nearly half of non depressed spouses candidates for

psychotherapy (Coyne et al; 1987).

In reviewing the literature on this topic, Gotlib &

Hammen (1992) concluded that depressed people and their

54

spouses tend to perceive their interactions as marked by

tension and hostility. Moreover, these high levels of tension

and hostility do not necessarily seem to remit soon after the

depressed spouse recovers.

There is also evidence that marital distress can lead to

depression as well, because marital distress often precedes a

depressive episode and is frequently identified as a

precipitant of depression and as a reason for seeking

treatment (Gottib & Hammen, 1992) and certainly marital

distress is likely to affect the course of a depressive episode

and the likely hood of relapse. Thus the evidence suggests

both that marital distress can lead to depression, and that

depression can lead to marital distress.

COMMON FEATURES OF DEPRESSION:-

Changes in Emotional States changes in mood (Persistentperiods of feeling down,depressed , sad or blue).Tearfulness or cryingIncreased irritability, jumpiness,or loss of temper.Feeling unmotivated, or havingdifficulty getting going in themorning or even getting out ofbed.Reduced level of socialparticipation or interest in socialactivities.Loss of enjoyment or interest inpleasurable activities.Reduced interest in sex.Failure to respond to praise orrewards.Moving about or talking or

about more slowly than

Changes in Motivation

Changes in Functioning andmoving Motor Behaviour

55

Changes in sleep habits (sleepingtoo much or too little, awakeningearlier than usual and havingtrouble getting back to sleep inearly morning hours—so-calledearly morning awakening ).Changes in appetite (eating toomuch or too little).Change in weight (gaining orlosing weight).Functioning less effectively thanusual at work or school.Difficultythinking clearly.Thinking negatively about oneselfand one's future.Feeling guilty or remorsefulabout past misdeeds. Lack ofself-esteem or feelings ofinadequacy.Thinking of death or suicide.

Cognitive Changes concentrating or

Diagnostic Features of Depressive Disorder

1. Depressed mood duringmost of the day. Can beirritable mood in childrenor adolescents.Greatly reduced sense ofpleasure or interest in oralmost all activities, nearlyevery day for most of theday.A significant loss or gain ofweight (more than 5% ofbody weight in a month)without any attempt todiet, or an increase ordecrease in appetite.Daily (or nearly daily)insomnia or hypersomnia.Excessive agitation orslowing down ofmovementnearly every day.Feelings of fatigue or lossof energy nearly every day.Feelings of worthlessnessor misplaced or excessiveor inappropriate guiltnearly every day.Reduced ability toconcentrate or think

2.

3.

4.

5.

responses

6.

7.

8.

56

clearly or make decisionsnearly every day.Recurrentdeath or suicide without aspecific plan, or occurrenceof a suicidal attempt orspecificcommitting suicide.

thoughts of9.

plan for

COMORBIDITY: MIXED ANXIETY-DEPRESSION:-

Questions regarding whether depression and anxiety

can be differentiated in a reliable and valid way have

received a good deal of attention over the years. Only

recently, however have researchers begun to make

significant advances in understanding the real scope of the

problems. The overlap between measures of depression and

anxiety occurs at all levels of analysis- patients self report,

clinician ratings, diagnosis, and family genetic factors (Clark

& Watson, 1991a, 1991b). That is, persons who rate

themselves high on a scale for symptoms of anxiety also tend

to rate themselves high on a scale for symptoms of

depression, and clinicians rating these same individuals do

the same thing. More over the overlap also occurs at the

diagnostic level.

One recent review of the literature estimated that

approximately half of the patients who receive a diagnosis of

57

a mood disorder also receive a diagnosis of anxiety disorder.

(Clark & Watson, 1991a, 1991b).

Finally there is also considerable evidence from genetic

and family studies of the close relationship between anxiety

and depressive disorders (Clark & Watson, 1991a, 1991b;

Kendler et al., 1992d; Merikengas, 1990, Weissman, 1990).

Much of the evidence has concerned the relationship

between panic disorder and depression (Breier, Charney &

Heninger, 1984, Weissman, 1990), but one recent very large

twin study has also shown that the liability for depression

and generalized anxiety disorder comes from the same

genetic factors, and which disorder develops is a result of

what environmental experiences occur (Kendler et al.,

1992d).

At present the dominant theoretical approach to

understanding the overlap between depressive and anxiety

symptoms is that of Watson, L.A, Clark, and Tellegen ( LA

.Clark and Watson. 1991a, 1991b, L.A Clark et al., 1994,

Tellegen, 1985, Watson et al., 1995a, 1995b.). They have

demonstrated that the substantial overlap between various

measures of anxiety and depression reflects the fact that

most of the measures used tap the broad mood and

58

personality dimension of negative affects, which includes

affective states such as distress, anger, fear, guilt, and worry.

Both depressed and anxious individuals show high

levels of negative affect cannot be distinguished on this

basis. But these researchers have also shown that anxiety

and depression can be distinguished on the basis of a second

dimension of mood and personality known as positive affect,

which include affective states such as excitement, delight,

interest, and pride. Depressed persons tend to be

characterized by low level of positive affect, but the anxious

individuals are not. That is, only depressed individuals show

the signs of fatigue and lack of energy and enthusiasm

characteristic of low positive affect. Clark and Watson have

also shown that anxious, but not depressed people tend to be

characterized by high levels of yet another mood dimension

known as anxious hyper arousal, symptoms of which include

racing heart, trembling, dizziness, and shortness of breath .

This tripartite model of anxiety and depression thus explains

what features for anxiety and depression are common to

both (high negative affect) and what feature are distinct

(Low positive affect for depression and anxious hyper arousal

for anxiety).

59

Beck and D.A Clark have presented evidence that there

is also some discrimin ability of anxiety and depression based

on the kinds of cognitions the patients show (D.A Clark, Beck,

& Beck, 1994a, D.A Clark, steer, & Beck 1994b). For example,

cognitions about loss, failure, and hopelessness are more

common in major depression and dysthymia than in panic

disorder and generalized anxiety disorder.

There are also several features of comorbidity between

anxiety and mood disorders at the diagnostic level that raise

interesting questions about what the common and distinct

causal factors may be. There is usually a sequential

relationship between the symptoms of anxiety and

depression, both within an episode and between episodes.

Alloy and colleagues (1990) proposed an expansion of

the hopelessness model of depression to account for these

and other features of comorbidity. In their helplessness/

hopelessness model they propose that anxiety and anxiety

disorders are characterized by prominent feelings of

helplessness. People with these disorders expect that they

may be helpless in controlling important out comes, but they

also believe that future control might be possible and so are

likely to experience increased arousal and anxiety and an

60

intense scanning of the environment in efforts to gain

control. If the person becomes convinced of his or her

helplessness to control important outcomes, but is still

uncertain about whether the bad outcome will actually occur,

a mixed anxiety depression symptoms is likely to emerge and

finally, if the person is convinced not only of his or her

helplessness, but also becomes certain that bad outcomes

will occur, helplessness becomes hopelessness and

depression sets in.

Alloy and colleagues show how this perspective can

explain certain features of comorbidity between anxiety and

depressive disorder. Some anxiety disorders may be more

associated with depression precisely because the symptoms

of the disorder themselves (e.g., obsessive thoughts and

compulsions, and panic attacks) are so distressing and

seemingly uncontrollable as to create a more certain form of

helplessness, leading to the mixed anxiety/depressive

diagnostic picture.

One important trend in the study of depression is the

increasing evidence of comorbidity of depressive and anxiety

disorders (Alloy, Kelly, Mineka et al., 1990; Klerman, 1990).

The symptomatologies of the two disorders show

61

considerable overlap, the people diagnosed as having one are

likely to meet the diagnostic criteria for the other as well,

either simultaneously or at different times in their lives.

People in these two diagnostic groups also tend to respond to

the same antidepressant drugs (A. J. Fyer, Liebowitz & Klein,

1990), share similar endocrine abnormalities (Heninger,

1990), and have family histories of both anxiety and

depressive disorders (Merikengas, 1990, Weissman, 1990).

These new findings have reignited an old debate over

whether depression and anxiety are in fact two distinct

entities or whether they are some what different

manifestations of the same underlying disorder.

The comorbidity findings have also led to a proposal

that a new category, "mixed anxiety—depression", be

included in future DSMs. This would make the DSM consistent

with the World Health Organizations ICD—10, which has such

a category. More important, it would provide a diagnostic

label for people who have mixed symptoms of anxiety and

depression but who don't meet the DSM-IV criteria for either

disorder alone.

There are many such people, and they may be at risk for

more severe mood and anxiety disorders, especially if they

62

are not given appropriate treatment (Katon & Roy-Byrne,

1991, Zinbarg, Barlow, Liebowitz, et al., 1994). Having no

diagnostic label for them makes appropriate treatment less

likely; and, of course, if these people do represent an

important category of psychopathology, then having no

diagnostic label gives us a false picture of the field.

To understand the concept of comorbidity, the overlap

of the anxiety and depression symptoms is given in the table

on next page.

63

SUMMARY OF SYMPTOMS UNIQUE AND COMMON TO

DEPRESSION AND ANXIETY

Overlap bothSymptoms

Type ofSymptoms

Unique toDepression

Unique toAnxiety

Severe sadness Severe fear andand despairLow positiveaffectPsychomotorretardationAnhedoniaLoss of interest agitationSuicidal acts(and ideation)

Negative affectCryingIrritability

Affectivetension

IncreasedactivityBehavioral

DecreasedactivityLoweredinitiationresponsesDecreased energyBehavioraldisorganizationand performancedeficitsIncreaseddependencyPoor social skills

Behavioral

of

DecreasedsympatheticarousalDecreasedappetiteReduced sexualdesire

Increasedsympatheticarousal

Restless sleepInitial insomniaPanic attack

Somatic

Cognitive HopelessnessPerceived loss and threat

Perceived danger HelplessnessRumination andobsessionsUncertainty

Hyper vigilance Worry(watchfulness) Low self

confidenceNegative selfevaluationSelf-criticismSelf¬preoccupationIndecisivenessPoorconcentration

SOURCE: Adapted from Alloy, Kelly, Mineka & Clements

(1990), P. 507.

64

Automatic Thoughts Associated With Depression And AnxietyCommon Automatic Thoughts Associated with Depression

I'm worthless.1.

I'm not worthy of other people's attention of2.

affection.

I'll never be as good as other people are.3.

I'm a social failure.4.

I don't deserve to be loved.5.

People don't respect me anymore.6.

I will never overcome my problems.7.

I've lost the only friends I've had.8.

Life is not worth living.9.

I'm worse off than they are.10.

There's no one left to help me.11.

12. No one cares whether I live or die.

13. Nothing ever works out for me any more.

I've become physically unattractive.14.

Common Automatic Thoughts Associated With Anxiety

What if I get sick and become an invalid?1.

I am going to be injured.2.

What if no one reaches me in time to help?3.

I might be trapped.4.

65

I am not a healthy person.5.

I'm going to have an accident.6.

Something will happen that will ruin my7.

appearance.

I am going to have a heart attack.8.

Something awful is going to happen.9.

Something will happen to someone I care about.10.

I'm losing my mind.11.

The affects of depression in one family member extend

to children as well. Parental depression puts children at high

risk of many problems, but especially for depression

(Beardslee et al., 1983; Puig-Antich et al., 1989) in addition,

Keller and colleagues (1986) reported a study on 72 children

from families in which at least one parent had a severe (but

not psychotic) mood disorder. They found that the severity

and chronicity of the parents' (especially the mothers')

disorders were uniformly associated with adaptive failure

and psychiatric diagnoses, including depression, among the

children. These are just a handful of the findings in this

extensively researched area (Gotlib and Hammen, 1992).

A skeptic may argue that such studies merely prove

that these disorders are genetically transmitted. However,

66

genetic transmission as a sole explanation becomes less

likely when we consider that there are many studies

documenting negative interactional patterns between

depressed mothers and their children. For example depressed

mothers show more friction and have less playful, mutually

rewarding interactions with their children (Gotlib & Hammen,

1992). So although genetically determined vulnerability may

be involved, psychosocial influences probably play a more

decisive role.

PROBLEM

This study is undertaken in order to investigate the

vulnerability to emotional disturbance in fathers of neurotic

and psychotic children.

It is a well known fact that mental health is as

important if not more than physical health of an individual. In

our society it is very difficult to detect mental illness because

of lack of awareness and understanding in the

symptomotology of emotional disorder hence it is obvious

that when an individual suffers from physical illness in a

family, the family knows about the etiology, symptomotology

and treatment of the physical illness of the individual. More

over they are not disturbed because they are sure it can be

67

treated as it is a curable disease. On the other hand families

specially fathers of patients suffering from emotional

disorders are themselves handicapped because of the lack of

knowledge about the etiology, symptomotology and

treatment of mental illness. It is essential for us to conduct

research on this issue because the awareness, knowledge,

training and specialization in the field of mental health is

very meager in Pakistan. In our country the culture is

basically male oriented, hence the men are responsible for

provision of not only bread and butter but also of all the

needs i.e. health and education of their families.

It becomes the responsibility of a qualified Clinical

Psychologist to disseminate the knowledge and awareness

about the various aspects of mental health in order to

eradicate the basic disturbances of the families. As our

families are normally looked after by the fathers, therefore

they are more concerned about the health problems of their

families.

So many people with severe disturbances live in the

community and receive little or no treatment. Some of these

individuals are indeed dangerous to others. It may also be

noted that in Pakistan mainly the fathers are only looking

68

after the basic needs of their families and children. They are

mostly employed either in the government or non

government institutions, even if they are agriculturist they

are answerable to the community and the people who are in

power.

Hence in case the children misbehave, the fathers are

taken to task by the society and employing agencies. Any

type of character disorder displayed by the children brings

the entire family especially father and grandfather to shame.

As there has been dearth of research in the field of

emotional health in Pakistan, there fore this research can be

a land mark in this barren area of investigation and is most

needed in order to educate the fathers to avoid further

disturbances in the families.

In the light of above theoretical background and

research review for present study, the following hypotheses

were formulated.

HYPOTHESES

1. Fathers of neurotic children will have high anxiety

sten scores than the fathers of normal children.

2. Fathers of psychotic children will have low anxiety

sten scores than the fathers of neurotic children.

69

3. Fathers of normal children will have less anxiety

sten scores than the fathers of psychotic children.

4. Fathers of neurotic children will have high

depression sten scores than the fathers of normal

children.

5. Fathers of psychotic children will have low

depression sten scores than the fathers of

neurotic children.

6. Fathers of normal children will have less

depression sten scores than the fathers of

psychotic children.

70

CHAPTER 2

METHOD

PARTICIPANTS

Fathers of neurotic and psychotic children were

selected from the various psychiatric hospitals and the

Institute of Professional Psychology, Bahria University,

Karachi. Fathers of normal children were selected from the

various educational institutions of Karachi. The age of

children selected ranged from 10 years to 30 years.

A total number of three hundred subjects were selected

for the present study. Out of which hundred fathers from the

group of psychotic children, hundred fathers from the group

of neurotic children and hundred fathers from the group of

normal children were administered the tests.

At this stage it is imperative to give the definitions of

neuroses and psychoses. DSM-II has given a very

comprehensive classification and definition of both

psychoses and neuroses. It has also differentiated the two

disorders very effectively.

71

NEUROSES

Anxiety is the chief characteristic of the neuroses. It

may be felt and expressed directly, or it may be controlled

unconsciously and automatically by the utilization of various

psychological defense mechanisms (depression, conversion,

displacement, etc). In contrast to those with psychoses,

patients with neurotic disorders do not exhibit gross

distortion of external reality (delusions, hallucinations,

illusions) and they do not present gross disorganization

of the personality.

In neurotic disorders, anxiety is a danger signal felt and

perceived by the conscious portion of the personality. It is

produced by a threat from within the personality with or

without stimulation from such external situations as loss of

love, loss of prestige, or threat of injury. Patient attempts to

handle this anxiety results in various types of reactions

discussed below.

ANXIETY REACTION:-

Anxiety is diffused and not restricted to definite

situations or objects, as in the case of phobic reactions. It is

not controlled by any specific psychological defense

mechanism as in other neurotic reactions. This reaction is

72

characterized by anxious expectation and frequently

associated with somatic symptomotology.

DISSOCIATIVE REACTION:-

It represents a type of gross personality

disorganization, the basis of which is a neurotic disturbance,

although the diffuse dissociation seen in some cases may

occasionally appear psychotic. The personality

disorganization may result in aimless running or "freezing".

The repressed impulse giving rise to the anxiety may be

discharged by, or deflected into, various symptomatic

expression, such as depersonalization, dissociated

personality, stupor fugue, amnesia, dream state,

somnambulism etc. These reactions must be differentiated

from schizoid personality, from schizophrenic reaction, and

from analogous symptoms in some other types of neurotic

reactions.

CONVERSION REACTION:-

The impulse causing the anxiety is "Converted" into

functional symptoms in organs or parts of the body, usually

those that are mainly under voluntary control. The symptoms

serve to lessen conscious anxiety and ordinarily are symbolic

of the underlying mental conflict. Such reactions usually

73

meet immediate needs of the patient and are, therefore,

associated with more or less obvious "Secondary gain".

Symptomatic manifestations will be specified as Anesthesia

(Anosmia, Blindness, Deafness), Paralysis (Paresis, Aphonia,

Monoplegia, or Hemiplegia), Dyskinesis (Tic, Tremor,

Posturing, Catalepsy).

PHOBIC REACTION:-

Anxiety of these patients becomes detached from a

specific idea, object, or situation in the daily life and is

displaced to some symbolic idea or situation in the form of a

specific neurotic fear. Commonly observed forms of phobic

reaction include fear of syphilis, dirt, closed places, high

places, open places, animals, etc. The patient attempts to

control his anxiety by avoiding the phobic object or situation.

OBSESSIVE COMPULSIVE REACTION: -In this reaction, anxiety is associated with the

persistence of unwanted ideas and of repetitive impulse to

perform acts, which may be considered morbid by the

patient. The diagnosis will specify the symptomatic

expression of such reactions, as touching, counting,

ceremonials, hand washing or recurring thoughts

(accompanied often by a compulsion to repetitive action).

74

DEPRESSIVE REACTION

The anxiety in this reaction is allayed, and hence

partially relieved, by depression and self-depreciation. The

reaction is precipitated by a current situation, frequently by

some loss sustained by the patient, and is often associated

with a feeling of guilt for past failures. The degree of the

reaction in such cases is dependent upon the intensity of the

patients ambivalent feeling towards his loss (Love,

possession) as well as upon the realistic circumstances of the

loss.

PSYCHOSES:-

An extreme disruption of mental functioning involving

impairment of perceptions, severe alterations of mood,

inability to cope with life situations, and a loss of contact

with reality.

Psychotic disorders are characterized by a varying

degree of personality disintegration and failure to test and

evaluate correctly external reality in various spheres.

Individuals with such disorders fail in their ability to relate

themselves effectively to other people or to their own work,

various psychotic disorders are briefly described below.

INVOLUTIONAL PSYCHOTIC REACTION: -

75

The reaction tends to have a prolonged course and may

be manifested by worry, intractable insomnia, guilt, anxiety,

agitation, delusional ideas and somatic concerns. Some cases

are characterized chiefly by depression and others chiefly by

paranoid ideas. Often there are somatic preoccupations to a

delusional degree.

AFFECTIVE REACTIONS: -These psychotic reactions are characterized by a

primary, severe, disorder of mood, with resultant disturbance

of thought and behavior, in consonance with the affect.

MANIC DEPRESSIVE REACTIONS:-

The psychotic reactions, which fundamentally are

marked by severe mood swings, and a tendency to remission

and recurrence. Various accessory symptoms such as

illusions, delusions and hallucinations may be added to the

fundamental affective alteration.

PSYCHOTIC DEPRESSIVE REACTION: -These patients are severely depressed and manifest

evidence of gross misinterpretation of reality, including, at

times, delusions and hallucinations. This reaction differs

from the manic depressive reaction, depressed type,

principally in (1) absence of history of repeated

76

depressions or of marked cyclothymic mood swings, (2)

frequent presence of environmental precipitating factors.

SCHIZOPHRENIC REACTIONS:-

It represents a group of psychotic reactions

characterized by fundamental disturbances in reality

relationships and concept formations, with affective,

behavioral and intellectual disturbances in varying degrees

and mixtures. The disorders are marked by strong tendency

to retreat from reality, by emotional disharmony,

unpredictable disturbances in stream of thought, regressive

behavior, and in some, by a tendency to "deterioration".

PARANOID REACTIONS:-In this group the cases are classified which shows

persistent delusions, generally persecutory or grandiose,

ordinarily without hallucinations. The emotional responses

and behavior are consistent with the ideas held. Intelligence

is well preserved. The category does not include those

reactions properly classifiable under schizophrenic reaction,

paranoid type.

77

COMPARISON OF PSYCHOSES AND NEUROSES

NEUROSESPSYCHOSES

Gross impairment in reality Reality testing is grossly intact.testing.Grossly disorganized behavior. Behavior does not violate gross

social norms.Markedly incoherent speech The disturbance is relatively

enduring without treatment.Presence of hallucinations Absence of hallucinations,delusions, illusions.Fails to relate with other Can relate with other people.peopleInability to cope with life Can cope with life situations.situationsImpairment of perceptions. No demonstrable organic

etiology.Oriented behavior.Attentive.

delusions, illusions.

Disoriented behavior.Inattentive.

MEASURES

IPAT Anxiety Scale and IPAT Depression Scale were

administered separately in order to find out the level of

depression and anxiety. It is well known that these Scales

are standardized and widely used for research due to the

following reasons.

IPAT ANXIETY SCALE: -

Anxiety is a very common factor in the personality of

the individual. In order to detect the abnormal level of

anxiety most of the psychologists and experts depend on the

technique of depth interview. This technique although very

helpful and necessary is full of subjective biases hence the

diagnosis cannot be based only on this technique. Many

78

people evolve standard interview technique but that is also

not so effective.

In order to make it more scientific the standardized,

reliable and valid questionnaires and scales were constructed

for the measurement of various factors of personality. IPAT

anxiety scale was evolved in 1957 by the Institute for

Personality and Ability Testing.

The scale is brief and applicable to the lowest

educational levels. It can be given to people who belong to

age 15 years and above. It gives accurate estimate of anxiety

level and supplement clinical diagnosis. Moreover the scale

facilitate all kind of screening operations and research. The

central features of scale are worry, tension, low self control,

suspiciousness and emotionality. These features are known

as the trait components of anxiety.

The scores derived from the scale are reliable enough

for research purposes and group comparison. Each question

in the scale has three possible answers, YES, NO &

UNCERTAIN. A further division of pattern is made as covert

and overt anxiety which can be easily obtained from the

scores.

79

IPAT DEPRESSION SCALE:-Depression is one of the most confusing problems faced

by the physicians, psychiatrists and clinical psychologists. It

is difficult to identify any precipitating factor in the person's

immediate surrounding which is responsible for depressive

reactions.

To the practitioners, accurate diagnosis is very essential

for the treatment procedures. In depression and anxiety

most of the symptoms and complaints are common like sleep

disturbance etc. Since the suicidal ideation is mostly present

in depressive disorders, it is important to have a differential

diagnosis at the very initial stages in order to plan the

appropriate psychotherapeutic and medical treatment.

It is this confusion of anxiety and depression symptoms

which creates one of the significant problems in the

treatment of depression. Ayd (1973) reports on 500 patients

later on diagnosed as depressive-who were admitted to a

general hospital with a variety of somatic complaints. On the

average, each patient was seen by three physicians and had

four diagnostic tests performed in addition to the usual given

admission before being referred for psychiatricupon

evaluation.

80

Consequently an instrument was introduced in 1976 to

measure depression. The main aim was to produce

psychometrically sophisticated instrument which could easily

be used to estimate depression in a reliable and valid

manner.

PROCEDURE:-

IPAT anxiety scale and IPAT depression scale were

administered separately with simple instructions to 100

fathers of Neurotic children, 100 fathers of Psychotic children

and 100 fathers of Normal children who were diagnosed

and labeled by the experts in the hospitals and the Institute

of Professional Psychology.

* The fathers of normal children were selected only on

the basis that none of their children suffered from any mental

illness. The fathers were also interviewed in order to

obtain information and history from them.

A chi square test was conducted to determine the

statistical significance of the results.

The hypothesis No 5 when calculated for statistical

significance on the sample of 100 subjects in each group i.e.

fathers of neurotic and psychotic children rendered a X2 of

3.26 which made it insignificant by the fraction of the

82

CHAPTER 3

RESULTS

The aim of this study is to assess the vulnerability of the

fathers of psychotic and neurotic children to depression and

anxiety.

The IPAT anxiety scale and IPAT depression scale were

administered to find out the level of anxiety and depression

in 100 fathers of neurotic children and 100 fathers of

psychotic children. On the other hand 100 fathers of normal

children were assessed as a control group.

The results obtained prove that the hypotheses are

statistically significant. In one of the categories there is a

tendency towards the positive results.

HYPOTHESIS NO 1:-

Fathers of neurotic children will have

high anxiety sten scores than the

fathers of the normal children.

The results of the Statistical analysis are shown

in Table No1and Graph 'A'.

83

The chi square X2 = 63.8, df = 1, P< .001. This

indicates that there is a significant difference in the two

groups. The fathers of neurotic children have high

anxiety scores than the fathers of the normal children.

HYPOTHESIS NO 2:-

Fathers of psychotic children will have

low anxiety sten scores than the

fathers of the neurotic children.

The results of the Statistical analysis are shown in

Table No 2 and Graph 'B\

The chi square X2 = 7.40, df =1, P < .001. This

indicates that there is a significant difference in the two

groups. The fathers of psychotic children have low

anxiety scores than the fathers of the neurotic children.

HYPOTHESIS NO 3:-

Fathers of normal children will have

less anxiety sten scores than the

fathers of the psychotic children.

The results of the statistical analysis are shown in

Table No 3 and Graph C.

The chi square X2 = 30.64, df = 1 P <.001. This

indicates that there is a significant difference in the two

84

groups. The fathers of normal children have less anxiety

scores than the fathers of the psychotic children.

HYPOTHESIS NO 41-

Fathers of neurotic children will have

high depression sten scores than the

fathers of the normal children.

The results of the statistical analysis are shown in

Table No 4 and Graph 'D'.

The chi square X2 = 56.62, df=l, P <.001. This

indicates that there is a significant difference in the two

groups. The fathers of neurotic children have high

depression scores than the fathers of psychotic

children.

HYPOTHESIS NO 5:-

Fathers of psychotic children will have

low depression sten scores than the

fathers of the neurotic children.

The results of the Statistical analysis are shown in

Table No 5 and Graph 'E'.

85

The chi square X2 = 3.26, df = 1, P >.05 this

indicates that the difference between the two group is

statistically insignificant.

The results do show a tendency that the fathers of

neurotic children have higher scores on depression

scale than the fathers of psychotic children.

HYPOTHESIS NO 61-

Fathers of normal children will have

less depression sten scores than the

fathers of the psychotic children.

The results of the statistical analysis are shown in

Table No 6 and Graph 'F\

The chi square X2 = 35.28, df = 1, P <.001. This

indicates that there is a significant difference in the two

groups. The fathers of the normal children have less

depression scores than the fathers of psychotic

children.

86

(TABLE NO 1)

LEVEL OF ANXIETY AMONGFATHERS OF

NORMAL AND NEUROTIC CHILDREN

Neurotic TotalLevels Normal i

High 26 (54.50 Fe) 82 (54.50 Fe) 108!

18 (46.50 Fe)74 (46.50 Fe) 92Low:

200100 100Total

X2 = (Fo-Fei2

FeX2= 63.12

df = 1

Highly significant at .001 level

87

(GRAPH A)

LEVEL OF ANXIETY AMONGFATHERS OF

NORMAL AND NEUROTIC CHILDREN

100

90

80

70

60

50

40

30

20

10

0

Neurotic Normal

88

(TABLE NO 2)

LEVEL OF ANXIETY AMONGFATHERS OF

NEUROTIC AND PSYCHOTIC CHILDREN

Levels Neurotic Psychotic Total

High 82 (73.5 Fe) 65 (73.5 Fe) 147

18 (26.5 Fe) 35 (26.5 Fe) 53Low

200Total 100 100

X2 = (Fo-FeV*

FeX2 = 7.40

df = 1

Highly significant at .001 level

89

(GRAPH B)

LEVEL OF ANXIETY AMONGFATHERS OF

NEUROTIC AND PSYCHOTIC CHILDREN

100

90

80

70

60

50

40

30

20

10

0

Neurotic Psychotic

90

(TABLE NO 3)

LEVEL OF ANXIETY AMONGFATHERS OF

PSYCHOTIC AND NORMAL CHILDREN

Normal Psychotic TotalLevels

65 (45.5 Fe) 91High 26 (45.5 Fe)

35 (54.5 Fe) 10974 (54.5 Fe)Low

200100100Total

X2 = fFo-Fel2Fe

X2 = 30.64

df = 1

Highly significant at .001 level

9!

(GRAPH C)

LEVEL OF ANXIETY AMONGFATHERS OF

PSYCHOTIC AND NORMAL CHILDREN

100

90

80

70

60

50

40

30

20

10

0

Psychotic Normal

92

(TABLE NO 4)

LEVEL OF DEPRESSION AMONGFATHERS OF

NORMAL AND NEUROTIC CHILDREN

Normal Neurotic TotalLevels

81(54.5 Fe) 109High 28(54.5 Fe)

19(45.5 Fe) 9172(45.5 Fe)Low

200100100Total

X2 = fFo-Feÿ2

FeX2 = 56.62

df = 1

Highly significant at .001 level

93

(GRAPH D)

LEVEL OF DEPRESSION AMONGFATHERS OF

NORMAL AND NEUROTIC CHILDREN

100

H90

80

70

60

50

40

30

20

10

0

Neurotic Normal

94

(TABLE NO 5)

LEVEL OF DEPRESSION AMONGFATHERS OF

NEUROTIC AND PSYCHOTIC CHILDREN

Psychotic TotalNeuroticLevels

High 81 (75.5 Fe) 70 (75.5 Fe) 151

30 (24.5 Fe) 4919 (24.5 Fe)Low

200100Total 100

X2 = (Fo-Feÿ2

FeX2 = 3.26

df = 1

Insignificant at .05 level

95

(GRAPH E)

LEVEL OF DEPRESSION AMONGFATHERS OF

NEUROTIC AND PSYCHOTIC CHILDREN

100

90

80

70

60

50

40

30

20

10

0

Neurotic Psychotic

96

(TABLE NO 6)

LEVEL OF DEPRESSION AMONGFATHERS OF

NORMAL AND PSYCHOTIC CHILDREN

Levels Normal \ Psychotic Total

High 28 (47Fe) 70 (47 Fe) 98

fLow 72 (53 Fe) 30 (53 Fe) 102!

200100Total 100

X2 = (Fo-Fe)2

FeX2 = 35.28

df = 1

Highly significant at .001 level

97

(GRAPH F)

LEVEL OF DEPRESSION AMONGFATHERS OF

NORMAL AND PSYCHOTIC CHILDREN

100

90

80

70

60

50

40

30

20

10

0

Psychotic Normal

98

(TABLE NO 7)

LEVEL OF DEPRESSION AMONGFATHERS OF

NEUROTIC AND PSYCHOTIC CHILDREN

Neurotic Psychotic TotalLevels

170High 92(85 Fe) 78(85 Fe)

47(35 Fe) 7028(35 Fe)Low!

i 240120Total 120

X2 = (Fo-Fe)2Fe

X2 = 3.94

df = 1

Significant at .05 level

99

(Graph G)

LEVEL OF DEPRESSION AMONGFATHERS OF

NEUROTIC AND PSYCHOTIC CHILDREN

C120

no

100

90

80

70

60

50

40

30

20

10

0

Neurotic Psychotic

100

CHAPTER 4

DISCUSSION

The purpose of the present study is to find out the

emotional disturbance i.e. depression and anxiety among

fathers of neurotic and psychotic children. The recent

awareness about the mental illnesses has made it imperative

to study the most important risk factor in the fathers of

neurotic and psychotic children.

Fathers are perceived as strict and authoritative as men

are considered more powerful than the women in Pakistan.

The reason is that the father being the head of the family is

responsible to run all the affairs of children i.e. education,

health etc within his own resources. More over in our culture

fathers are supposed to take care and settle all the matters

of young ones. Therefore, if a child in the family suffers

specially from any mental illness all the family members get

involved but financial and emotional burden is mostly borne

by the fathers even when the joint family system is

prevalent.

101

Results obtained indicate that the fathers of neurotic

children have high anxiety sten scores than the fathers of

psychotic children on IPAT anxiety scale. It may be noted

that in overall comparison of the results, anxiety sten scores

are higher than the depression sten scores in fathers of

neurotic children.

Unfortunately in our country generally people are not

well conversant about the mental illness. Even if they are

aware of the illness they are restrained to admit it due to the

social and cultural stigma. These difficulties are multiplied

slowly and gradually. Consequently they become vulnerable

to anxiety and depression.

Results obtained in the present study are corroborated

further by the studies carried out earlier by Gupta (1973),

Samuele, Krug (1976) and Stroebe and Stroebe (1983).

Statistical results of various hypotheses are given in the

previous chapter. This chapter will be devoted to the

discussion of the various hypotheses and their results

separately.

102

HYPOTHESIS NO1 States That:

Fathers of neurotic children will have

high anxiety sten scores than the

fathers of normal children.

This hypothesis is supported by the data and was

highly significant at Pc.001 level.

The results are shown in Table No 1 and Graph 'A'. It is

obvious that the fathers of neurotic children have high

anxiety sten scores than the fathers of normal children.

Similar results have been obtained when compared with the

fathers of psychotic children. Table No 2 and Graph 'B' also

confirm the significance of the hypothesis.

It may be noted that the neurotic children are most

frequently found to be troublesome for the entire family

because they are aggressive in behavior and remain in

conflict with the environment. The father being the head of

the family always faces criticism by the family members,

neighbours and the society. This ultimately becomes a source

of tension and worry for him.

103

It is interesting to note here that the fathers of neurotic

children do feel that home atmosphere is not conducive.

Whenever a son or a daughter misbehaves or creates

problems for the rest of the family, fathers will be held

responsible for it. All the family members especially wife and

children put blame on fathers because of their strict

behavior. He is even blamed for the lack of finances which

are required to sustain the family and provide the basic

needs to the wife and the children. He is also held

responsible for spoiling the future of the children.

Literature review suggests that the most common areas

of worry are, family, money, work and health. Many normal

people worry about such things excessively and develop

mental problems. They also suffer from chronic muscular

tensions and insomnia.

The research studies also indicate that anxiety and

mental illness is not generally accepted by the relatives and

friends. They are bothered and affected badly as these

problems are unpleasant and anxiety producing for them.

104

The constant state of worry makes the parents upsets

and discouraged. Parents of the mentally ill children

generally feel threatened and anticipate future danger

accompanied by insecurity feelings.

Normally people feel that the mothers of mentally ill

children are more anxious but the present study shows that

the fathers of mentally ill children have high anxiety level.

The hypothesis has been significantly proved by the results

because the fathers are facing criticism in the society as well

as at home which is the main source of anxiety for them.

HYPOTHESIS NO 2 States that:

Fathers of psychotic children will have

low anxiety sten scores than the

fathers of neurotic children.

The hypothesis is supported by the data and was

highly significant at P<.001 level.

Table No 2 and Graph 'B' clearly indicates that the

fathers of psychotic children have low anxiety scores

than the fathers of neurotic children.

105

The psychotic children are no doubt seriously ill and

their personality is more disorganized than the neurotic

children. Their reality contact is obviously impaired but they

are not trouble creators and remain withdrawn from the

family members and the society. Fathers of psychotic

children are mentally ready to accept their illness, in most of

the cases they admit their children in the hospital and get a

bit relief from worry and tension. Generally the fathers of

psychotic children do rationalize that it is God's will which

helps them to lessen their anxiety since the illness is obvious

and pronounced.

In our culture belief, system of spiritual healing about

mental illness is so strong that the First preference of the

parents is to consult the spiritual leader for the treatment of

their ill children. By doing so the parents feel protected from

the stigma of madness. This also becomes a source of relief

from worry and tension. In this processes the ill children

become more chronic and the family pressure again compels

the fathers to rush towards the hospital to seek advice from

the psychiatrist.

106

The psychiatrist prescribes anti-psychotic drugs which

helps to control the disorganized and aggressive behavior of

the ill children then fathers feel satisfied till the time patient

remains under the influence of the drug.

HYPOTHESIS NO 3 States that:

Fathers of normal children will have

less anxiety sten scores than the

fathers of psychotic children.

The hypothesis is supported by the data and was

highly significant at Pc.001 level.

According to Table No 3 and Graph 'C', it is quite clear

that the fathers of normal children have less anxiety

scores than the fathers of psychotic children.

Fathers of the normal children have less anxiety scores as

compared to the fathers of neurotic and psychotic children.

There is no doubt that the fathers of normal children do

suffer from anxiety. The literature review also suggests that

the normal people have adaptive anxiety pattern. Adaptive

anxiety is appropriate to the situation and can even enhance

efficiency and achievement. Whereas in contrast maladaptive

107

anxiety is self-defeating as it tends to interfere with

efficiency and achievement.

States That:HYPOTHESIS NO 4

Fathers of neurotic children will

have high depression sten scores

than the fathers of normal

children.

The hypothesis is supported by the data and was

highly significant at Pc.001 level.

In our culture the knowledge and awareness

about mental illness is very meager. It is so unfortunate

that people do not know to whom they should visit for

the treatment of mentally ill children. After exhausting

all the possibilities, they come to the hospital to seek

advice from the psychiatrist but till that time the ill

children are already in the category of chronic patients.

Financial constraints and the ignorance about the mental

illness generate the feelings of helplessness. The fathers

being the head of the family are affected to a large extent.

While facing these difficulties the fathers of neurotic children

108

develop negative thoughts of their own traits and abilities.

Consequently they become hopeless and helpless.

According to Melanie Klein (1954). Neurotic children do

not tolerate reality well, because they can not tolerate

frustration. They seek to protect themselves from reality by

denying. What is most important and decisive for their future

adaptability to reality is the greater or less ease with which

they tolerate those frustrations, which arise out of the

Oedipus situation.

The anxiety sten scores of the fathers of neurotic

children are higher than the depression sten scores. The

reason is quite obvious as mentioned above by Melanie Klein,

the tolerance level of neurotic is less due to which they

create troubles for the family.

The fathers of neurotic children have a long experience

of "Doctor Shopping" and they also try to keep it secret from

others because of the social stigma. When all these efforts go

waste they feel incapacitated, worthless and also fail to face

stress. Hence, whenever they encounter stress they become

109

more vulnerable to depression because they feel helpless. As

the time passes they tend to notice and remember negative

information about themselves. The sensitivity and guilt about

the negative information, their feelings of worthlessness

strengthen.

In Pakistan, the families live in Mohalla's i.e. compact

neighborhood and they are also answerable to the fellow

Bradrimen i.e. (brother hood). When the neurotic child goes

out and creates problems for the others the fathers can not

face it. Consequently anxiety is generated in them.

Most of the people comment that the children are

otherwise alright and there is nothing wrong with them but it

is only due to faulty upbringing that they behave in this

manner. The argument is enough to create perpetual anxiety

in the fathers of the neurotic children.

HYPOTHESIS NO 5 States that:

Fathers of psychotic children will have

low depression sten scores than the

fathers of neurotic children.

no

This hypothesis when calculated for statistical

significance on the sample of 100 subjects in each

group i.e. Neurotic and Psychotic rendered a chi

square x2 = 3.26 in Table No 5 and Graph E which made

it insignificant by a fraction of difference as the chi

square of 3.84 is required to make it significant at the

level of P< .05.

It was then decided to increase the data and compute

the chi square once again to find out the statistical

significance. As expected the chi square with the increased

data was significant at .05 level. Table No 7 and Graph G

represent the significant results.

It is well known that the psychotic children are

seriously ill, have impaired reality contact and disorganized

personality. At the same time they mostly remain under the

drug influence and their aggression and harmfulness is

subdued.

Hence the fathers of psychotic children do not manifest

tension and worries. Inspite of the fact that the overt

manifestation of worry is not visible. They are definitely

Ill

miserable covertly as the children are ill and almost invalid.

The children are not accepted in the society as well.

HYPOTHESIS NO 6 States that:

Fathers of normal children will

have less anxiety sten scores than

the fathers of psychotic children.

This hypothesis is highly significant. As depicted in

Table No 6 and Graph F that it is significant at Pc.001

level.

Fathers of normal children of course have less depression

sten scores because they are not facing such difficulties as

the fathers of psychotic children. The stress which they are

facing in daily routine life is easy to share with friends and

the family members which is a good way of catharsis and

then they feel relaxed. On the other hand the fathers of

psychotic children are deprived of this facility as discussed

earlier as they can not share their feelings and entire burden

is faced by themselves due to social stigma. Hence the

repression ultimately leads to emotional disturbance for

them.

112

CHAPTER 5

CONCLUSION

The statistical analysis of the hypotheses manifests that

the fathers of neurotic children have high anxiety and

depression sten scores than the fathers of psychotic children.

In the overall comparison anxiety sten scores were found

higher than the depression sten scores. It was also found

that the neurotic children generate more anxiety than

depression in the fathers. On the contrary the psychotic

children who mostly remain under the drug influence and

withdrawn from the society are not creating troubles for the

fathers. On IPAT anxiety scale both the groups i.e. fathers of

neurotic and psychotic children Covert Scores were higher

than the Overt Scores.

It may be noted that all the hypotheses were

significant. Out of the six hypotheses only one hypothesis

was significant at Pc.05 level whereas rest of the five

hypotheses were significant at Pc.001 level.

113

RECOMMENDATIONS:-

In the light of the present research work on

vulnerability to emotional disturbances in fathers of neurotic

and psychotic children, the author suggests few

recommendations for future research programme.

1. It is suggested that the number of the participants may

be increased in future research.

2. The gender difference of the children may also be

studied.

3. The number of siblings be also taken into account.

4. The birth order be included in the future studies.

5. Socioeconomic level of the fathers be also determined

and explored.

6. The type of family i.e. joint or nuclear be also included

as a factor for the study.

The diagnosis of the children preferably be done by one

institution which will be possible only from the next year.

114

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Appendix fcA’

Self Analysis Form

commi146

1976 Editioi

SELF ANALYSIS FORM

TODAY’S DATENameMiddle LastFirst

__OTHER FACTS__

(Nearest Year) (Address. Occupation, etc, as instructed)AGESEX

(Write M or F)

Inside this book there are forty statements about how people feel or think at one time or other. There are nt

right or wrong answers. Just pick the one that is really true for you, and mark the a, b, or c answer.

You'll start with the two simple examples below, for practice. Read the first sentence and then put an X in thebox. If you don’t you’d mark the c box. If you enjoy walking once in a while, you’d mark the middle box. Bumark the middle box only if it is impossible for you to decide definitely yes or no. But don’t use it unless yoi

absolutely have to.

:

b1 enjoy walking[a] yes. [b] some times, [c] no

Now do the second example.

1. a c

bI would rather spend an evening:[a] talking to people, [b] uncertain, [c] at a movie

2. a c

Now:Make sure you have put your name, and whatever else the examiner asks, at the top of this page.1.

Please answer every statement. Don’t skip a single one. Your answers will be entirely confidential.2.

Remember, use the middle box only if you cannot possibly decide on a or c.3.

Don't spend time thinking over the statement. Just mark your answer quickly, accordingly to how yofeel about it now.

4.

It will take only ten minutes or so to finish. Hand in the booklet when you’re through, unless told to dotherwise. As soon as you're told, turn the page and begin.

STOP HERE- WAIT FOR SIGNAL

Copy right 1957. 1976 by Raymond B. Cattell All right reserved. Printed in U.S.A. Published by the Institute for Personality anAbility Testing. Inc P.O. Box 188. Champaign, Illinois 61820. Not to be translated or reproduced in whole or in pat, stored inretrieval system, or transmitted in any form or by any means, photo copying, mechanical, electronic, recording , or otherwise, withoiprior permission in writing from the publisher. Printed in U.S.A.

Catalog No. CA 16<

147

My interests, in people and ways to have fun, seem to change quite fast[a] true, [b] in between, [c] false

b1. a c

Even if people think poorly of me I still go on feeling O.K. about myself.[a] true, [b] in between [c]falseI like to be sure that what Em saying is right, before I join in on an argument.[a] yes,[b] in between [c] noI am inclined to let my feelings of jealousy influence my actions[a] sometimes, [b] seldom, [c] neverIf I had my life to live over again Ed:

plan very differently, [b] in between, [c| want it the sameI admire my parents in all important matters.[a] yes, [b] in between [c] noIt’s hard for me to take ‘no’ for an answer, even I know what Em askingis impossible.[a] true, [b] in between, [e] falseI wonder about the honesty of people who are friendly than Ed expect them to be. a[a] true, [b] in between, [c] falseIn getting the children to obey them, my parents (or guardians) were:[a] usually very reasonable, [b] in between, [c] often unreasonable1 need my friends more than they seem to need me .[a] rarely, [b] sometimes, [c] often1 feel sure 1 could “ pull myself together” to deal with an emergency if I had to[a] true, [b] in between. [c| falseAs a child 1 was afraid of the dark.[a] often, [b] sometimes, [c] never

People sometimes tell me that when I get excited, it shows in my voice andManner too obviously.[a] yes, [b] uncertain, [c] noIf people take advantage of my friendliness I :[a] soon forget and forgive, [b] in between, [c] resent it and hold it against them..I get upset when people criticize me even if they really mean to help me.[ajsoon forget and forgive, [b] in between, [c] resent it and hold it against themOften I get angry with people too quickly.[a] true, [b] in between, [c] false1 feel restless as if 1 want something but don’t know what.[a] hardly ever, [b] sometimes, [c] oftenI sometimes doubt whether people Em talking to are really interested in whatEm saying.[ajtrue, [b] uncertain, [c] falseEm hardly ever bothered by such things as tense muscles, upset stomach,

[a] true, [b] in between, [cj falseIn discussions with some people, 1 get so annoyed I can hardly trust myself tospeak.[a] sometimes, [b] rarely, [c] never

b2. a c

b3. a c

fafa

4. b5. &la]

b6. ca

b7. a c

b8. c

b9. a c

10. ba c

b11. a c

12. b ca

13. ba c

b14. a c

15. ba c

16. ba c

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18. ba c

19. ba c

P P20. a

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148

21. I use up more energy than most people in getting things done because Iget tense and nervous.[a] true, [b] uncertain [c] false

22. I make a point of not being absent minded or forgetful of details.[a] true, [b] uncertain , [c] false

23. No matter how difficult and unpleasant the snags and stumbling blocks arcI always stick to my original plan or intentions.[a] yes, [b] in between [c] no

24. I get over-excited and “rattled" in upsetting situations.[a] yes, [b] in between, [c] no

25. 1 sometimes have vivid, true-to-life dreams that disturb my sleep.[a] yes, [b] in between, [c] no

26. I always have enough energy to deal with problems when I’m faced with them.[a] yes, [b] in between, [cj no

27. I have a habit of counting things, such as steps, or bricks in a wall, for noparticular purpose.[a] true, [b] uncertain, [c] false

28. Most people are little odd mentally, but they don’t like admit it.[a] true, [b] uncertain [c] false

29. If I make an embarrassing social mistake I can soon forget it.[a] yes, [bj in between, [c] no

30. I feel grouchy and just don't want to see people.[a] almost never [b] sometimes, [c] very often

31. I can almost feel tears come to my eyes when things go wrong.[a] never [b] very rarely, [c] sometimes

32. Even in the middle of social groups I sometimes feel lonely and worthless.[a] true, [b| in between [c] false

33. I wake in the night and have trouble sleeping again because I’m worryingabout things.[a] often, [b] sometimes, [c| almost never

34. My spirits usually stay high no matter how many troubles I seem to have.[a] true, [b] in between [c] false

35. 1 sometimes get feelings of guilt or regret over unimportant, small matters.[a] yes, [b] in between, [c] no

36. My nerves get on edge so that certain sounds, such as a screechy hinge,are unbearable and give me the shivers.[a] often, [b] sometimes, [c] never

37. Even if something upsets me a lot, I usually calm down again quite quickly.[a| true, [b] uncertain, [c] false

38. I seem to tremble or perspire when I think of a difficult task ahead.[a] yes, [b] in between, [c] no

39. I usually fall asleep quickly, in just a few minutes, when I go to bed.[a] yes, [b] in between, [c] no

40. I sometimes get tense and confused as I think over things I’m concerned about.[a| true, [b] uncertain, [c] false

ba c

ba c

ba c

ba c

ba c

ba c

b ca

ba c

ba c

ba c

ba c

ba c

ba c

b ca

ba c

b ca

ba c

P Pa

ba c

ba c

STOP HERE. BE SURE YOU HAVE ANSWERED EVERY QUESTION.

B

V-

1 AO

B Score (Overt, manifest, sympt.). TOTAL RAWA Score (Covert, indir)

SCORE(A + B)(P. 3 Score)(P.2 score)

TOTAL, STANDARD___STEN SCORE (from table)

Experimental Scales:

Over-Covert Ralio(B ) . C . L. . O Q4• Q3A

Observations:

Diagnostic Summary.

151

Appendix *B’

Personal AssessmentInventory

J

CONFIDENTIAL152

PERSONAL ASSESSMENTINVENTORY

TO DAY’S DATENAME

OTHER INFORMATIONAGESEX

Inside this booklet there are forty statements about how people feel or think at one time oi

another. There are no right or wrong answers. Just pick the one that is really true for you, andmark the a, b, or c answer.

You’ll start with the two simple examples below, for practice. Read the first sentence and then put an X in thebox that tells how you feel about friends. If you enjoy quiet friends, you would put an X in the box. If youprefer lively friends, you'd mark the c box. If you really aren’t sure, you’d mark the middle box. But mark themiddle box only if it is impossible for you to decide definitely yes or no. Don’t use it unless you absolutely haveto.

bI prefer friends who are:[a] quiet, [b] in between, [c] lively.

1. ca

Now try this second example.People say I’m impatient.[a] true, [b] uncertain, [c] false.

b2. ca

Now:Make sure you have put your name, and any other information requested, at the top of this page.Please answer every statement. Don’t skip a single one. Your answers will be entirely confidential.Remember, use the middle box only if you cannot possibly decide on a or c.Don’t spend time thinking over the statements. Just mark your answer quickly, according to how youfeel about it now.

2.3.4.

It will take only ten minutes or so to finish. Hand in the booklet when you’re through, unless told to dootherwise. If you have any questions, ask them now. As soon as you’re told to, tum the page and begin.

STOP HERE-WAIT FOR SIGNAL

Copyrights 1970, 1976 by ihe inslilule for Personality and Ability Testing, Inc. P.O Box 188. Illlinois. All right reserved. Not to betranslated or reproduced in whole or in part, stored in a retrieval system, or transmitted in any form or by any means, photocopying,mechanical, electronic, recording, or otherwise, without prior permission in writing from the publisher. Printed in U.S.A.

Catalog No. PD 471

153

My zest for work is high.[a] nearly always, [b] sometimes, [c| hardly ever

1 worry because 1 don't do much about solving my problems.[a] I often worry', [b] sometimes, [c] I almost never worry about itI get into moods when I feel low' and depressed.] often, [b] occasionally, [c] hardly everI very seldom have moments when life seems lonely and empty.[a] true, [b] uncertain, [c] false,Much of the time 1 feel sluggish and too weary to move.[a] true [b] party true, [c] falseMy mind works quickly and well these days.[a] yes, nearly always, [b] sometimes, [c] hardly everI feel my health is run dow-n and I should see a doctor soon.[a] true, [b] uncertain, [c] falseI have the feeling that most people who know me really and truly like me.[a] true, [b] in between [c] falseI'm not troubled by feelings of guilt.[a] true, I’m not troubled, [b] uncertain , [c] false, 1 am troubledI make up my mind easily and quickly, and seldom have reason to change it.[a] true [b] in between, [c] falseI seem to blame myself for every thing that goes wrong, and I'm alwayscritical of myself.[a] true, most times, [b] true, sometimes, [c] falseIf I’m upset, my muscles twitch and jump.[a] yes. often, [b] occasionally, [c] no1 don't have very many fears of hidden physical dangers.[a] true, [b] partly true, [c] false, I am fearfulI feel life is so pointless and silly that 1 no longer even try to tell peoplehow I feel.

[a] true, [b] in between, [c] falseThere are times when I think I’m no good for anything at all.[a] true, many, [b] in between, [c] false, almost neverI consider myself as able to manage my affairs as most people 1 know.[a] yes, [b] perhaps, [c] noI feel self-confident and relaxed.[a] almost all the time, [b| sometimes, [c] hardly everI feel too depressed and “useless” to want to talk to people.[a] true, [b] in between [c] false1 seldom get so excited that I say things I’m sorry for.[a|true, [b] uncertain, [c] false, I do say thingsIf acquaintances treat me badly and show they dislike me.[a] I tend to get downhearted, [bj in between, [c] it doesn’t upset me a bit

b1. a c

b2. ca

b3. a cn

b4. a c

b5. a c

b6. a c

b7. a c

b8. a c

b9. a c

b10. ca

ba c

12. b ca

b13. a c

b14. ca

15. ba c

16. ba c

17. ba c

18. ba c

19. ba c

20. ba c

CONTINUE ON NEXT PAGE.

154

b21. 1 hardly ever feel sad and gloomy.[a] true, I hardly ever feel sad and gloomy, [bj sometimes I do,[c] false, I’m often very gloomy

22. 1 feel worn out and can’t get enough rest.[a] usually, [b| sometimes, [c] very seldom

23. Sometimes a dark mood of depression comes over me for no reason.[a] true, [b] uncertain, [c] false

24. 1 hardly ever feel under such strain that it’s too much effort to cope with things, a[a] true, I don’t feel under a strain, [b]uncertain, [c]false, 1 do lack energy

to cope25. Every few' days my stomach feels bloated and uncomfortable.

[a] yes, definitely, [b] a little, [c] no, not at all26. I almost never feel that life is a burden.

[a] true, [b] in between [c] false27. Sometimes I feel that my nerves are going to pieces.

[a] true, [b] uncertain, [c] false28. It is easy to chat and joke with a person of the opposite sex.

[a] true, fb] in between [c| false29. I almost never wish 1 wish “out of it all”.

[a] true, I almost never wish that, [b] uncertain, [c] false, I do wish that30. I hardly ever feel that I’ve failed in my duties.

[a|true, I don’t, [b] in between. [c| false, I am troubled by guilt .31. I have fears that no one really loves me.

[a] often, [b] once in a while, [c] not at all32. I dream a lot about frightening events.

[a] yes, often, [b] sometimes, [c] no33. I am confident that I can face and handle most emergencies that come up.

[a] true, always, [b] sometimes, [c] false, I cannot face emergencies34. I get a feeling of tension and have a ringing and buzzing in my ears.

[a] yes, often, [b| sometimes, [c] no, almost never35. I sometimes doubt whether I have been of much use to anyone in my life.

[a] true, [b] uncertain, [c] false36. I rate myself as a happy, contented person in spite of troubles here and there.

[a] true, [b] uncertain, [c] false37. I rarely lie awake at night wondering what will happen because of wrong

things that I’ve done.[a] true, [b] in between, [c] false, I do lie awake

38. I have a weak stomach, and I easily get constipated.[a] true, [b| in between, [c] false

39. I never regret telling people frankly my feelings and ideas.[a] true, [b] uncertain, [c] false

40. If I were called in by my boss. I’d:[a] be afraid I had done [b] in between, [c] make it a chance to ask for

something I want. Something wrong

a c

ba c

& &a

b c

b ca

b ca

ba c

ba c

ba c

& & &fa & fa& fa &

b ca

ba c

ba c

ba c

fa faa

fa fa fafa fa fa

ba c

STOP HERE. BE SURE YOU HAVE ANSWERED EVERY QUESTION.

4

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155Name Sex Date ExaminerAge

BAObservations: Without Correction

FactorWith Correction

Factor

Page 2 Score

Page 3 Score

Total Raw Score

Standard Score

y1

Diagnostic Summary: