The latter two are
exceptionally
pronounced here.
Adorno-T-Authoritarian-Personality-Harper-Bros-1950
Unexpectedly, during the trip she had to change plans.
This stumped her completely.
She just sat down with her baby in the waiting room at the airport, quite lost and not able to ask for information nor to make arrangements for herself.
She did not improve much after she had joined her husband.
In going shopping, for in- stance, she would stand before the grocery shelves, unable to think of things to buy.
The patient was very alarmed and depressed about her condition.
In the hospital she kept repeating her complaints over and over, and said she feared she was going crazy and that she could not be helped.
The husband reported that the patient had changed in other respects too. Whereas she had been sexually rather frigid before the delivery, she all of a sudden became very passionate.
flospitalization and psychotherapy seemed to do little good. So the patient was discharged and brought in by her husband at intervals for electric shock treatments. After very few treatments the patient felt normal and both she and her husband felt that she was now less inhibited, warmer, and able to enjoy herself more.
At the present time the psychological meanings and effects of shock treat- ments are not sufficiently understood to permit theorizing concerning its role in this case. Its evaluation is rendered the more difficult by the fact that the patient had received and was receiving psychotherapy. The doctors' and husband's acceptance of her newly awakened sensuality may have helped
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the patient to accept this part ofherself, and this may have been an important factor in her improvement.
Another case of the same general type was a 24-year-old mother of two children. She too had an episode of depersonalization and forgetfulness fol- lowing the birth of the first child. This woman could have been taken for a naive high school girl. Her usual submissive and conventional "good girl" be- havior occasionally alternated with outbursts of anger and spite. She was a very dependent person with no ideas and opinions of her own and without interests outside of the domestic sphere. When her husband's support was withdrawn (because of illness) just after she had her second child, she suf- fered a paranoid schizophrenic episode, became afraid someone would harm her and the children, that her husband or relatives would take one of her daughters out and not bring her back.
Still another case was that of a girl who had always been a particularly con- scientious worker and who was completely submissive to her rigid, unsym- pathetic parents and aggressive older sister, without ever becoming aware of any resentment. When this girl was promoted to a job of considerable re- sponsibility she developed extreme headaches and entered a state of depres- sion and anxiety, in which she accused herself of being bad, thought people were looking at her, and feared she would lose her mind.
This girl and several other high-scoring women suffered, during the acute stages of their illness, from a mood disturbance which could only be de- scribed as "agitated depression. " (In some cases this was accompanied by suicidal ideas. ) These depressions, however, were different from those seen in the patients who were subject to periodic neurotic depressions. They were often accompanied by somewhat bizarre ideas and in general showed schizoid qualities. For this reason they were sometimes labeled schizo-affective reactions.
Few of these cases had the slightest idea of or interest in current issues and were very unsure of the few ideas they could voice during the interviews. Their ideologies about outgroups were meager, less elaborated, and even more naive and stereotyped than those of less disturbed high-scoring subjects. Their rejection of outgroups-in the abstract at least-was extremely strong, leading to very high prejudice scores and often to emotionally charged re- sponses during interviews such as "You wouldn't want to have a black baby, would you? " This is an expression of their particular ego weakness, necessitat- ing special efforts at creating and maintaining countercathexes.
2. THE LOW SCORERS
The pattern formed by the symptoms in List B of Category VII is dif- ferent. The unacceptable impulses-although not all conscious nor undis- guised-are more ego-assimilated and are perceived as part of the self. The
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low-scoring patients generally came to the Clinic with a particular psycho- logical problem they wanted to solve. They complained of certain conflicts or anxieties about some more or less definite idea or situation or were consciously dissatisfied with their sex role. Many of these are character neuroses. The "evil" was not sought outside but in the self. Elsewhere in the present volume it has been shown that high scorers on E are typically extrapunitive, while low scorers are intrapunitive. Intrapunitiveness has been understood as a sign of a strict but internalized superego and probably also of a somewhat masochistic character structure. The psychologically ill low scorers seem to show this tendency in exaggerated form: in (neurotic) depression, suicidal ideas, inferiority, and guilt feelings.
Their greater acceptance of their instinctual and fantasy lives and their relative independence from conventional restrictions give great variety, in- dividuality, and even bizarreness to the pathological ideas and behavior of these patients.
In some ways many of these patients (although by no means all of them) behaved in a way that is opposite to the cultural norm for their sex. Some of the men were shy, timid, passive, and dependent and had some interests more often found in women. Some of the women were aggressive, less inter- ested in home and family than in some occupational achievement. Homo- sexuality and sexual perversions were more freely admitted, and conflicts about such impulses were often quite conscious and undisguised. (This does not mean that the low scorers have more homosexual tendencies. There are probably just as many if not many more high scorers with such impulses. But in the latter case, these impulses and fantasies are strongly disguised and re- pressed. )
a. Low-scoRING MEN. The low scorers on E presented such a variety of complaints and clinical pictures that it is almost impossible to fit them into a few "types. " While some had psychoses or classical neuroses with anxiety- hysterical and compulsive symptoms, many cases presented character dis- orders which had come to the fore or were accentuated because of situational factors. An example of this type was a very dependent man, married to a more aggressive woman to whom he was very much attached and. sexually attracted. The relationship, always problematic, had become intolerable since the wife had a second child whom she rejected. The Clinic suggested foster-home placement for the child. The patient could not accept this nor could he decide to leave his famliy.
Broadly speaking, the low-scoring men were generally unaggressive, nur- turant, often somewhat withdrawn and inhibited socially. They came to the Clinic with depressions and conscious anxieties relating to problems of sex, work, or general adjustment. In contrast to the high-scoring men, the prob- lems as stated by these patients referred directly to their relationships to others. During the war a few of them suffered acute conflict about the prob-
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lem of participation, leading, in'a few cases, to self-inflicted injuries to avoid the draft, in others to conscientious objection. This was not primarily because of fear of physical injury or death but because of ideological reasons and a horror of being forced to kill.
An illustrative case is that of a young man of college age who had been in a camp for conscientious objectors. He was short and slight. His manner and speech betrayed much tension and self-consciousness. He was very unsure of himself and suffered somewhat from compulsive doubt and indecision. He had well-formed opinions about some subjects-such as the problems of minorities and pacifism-but in most areas he was quite uncertain, mentioning one opinion and then retreating when challenged by the interviewer, saying "I really don't know much about it yet-I have to read a lot more. " He was
keenly interested in politics and concerned about social progress. He realized that his occupational choice-to counsel people about their personal problems -stemmed from awareness of his own inner struggles and from his own desire to be helped.
The patient voluntarily sought help because of restlessness, anxiety, occa- sional depression, and inability to concentrate. He also had severe feelings of inadequacy, stage-fright, social anxiety, and several fears-of the dark, of physical injury, and of graveyards and mental institutions.
The patient's father was of lower-class origin with a grade-school educa- tion, who became a carpenter, then a farmer and minister in a fundamentalist church. He was a stern, dominating and punitive man with narrow, funda- mentalist and puritanical ideas, who made the children work hard on the farm and dealt out severe corporal punishment. The mother, a church singer, would have liked to push the father into a higher ministerial position. She was ashamed of her husband's fire and brimstone sermons and his denuncia- tion of vices he himself possessed. Though not punitive herself, she did not actively take the children's part. She tried to appease the father by con- formity to his demands, and she tried to influence the children to do the same. There was much discord between the parents which was painful to the patient. He usually sided with the mother, who had made him her special confidant. Although he had been close to his mother in his earlier life, the patient was, at the time of the interview, rather critical of her.
The patient had one brother, several years his senior, with whom he was never close but whom he liked and respected and wanted to know better. He was quite close, however, to his twin brother, taller, stronger, and more ag- gressive than the patient, and admired him for his poise and school achieve- ment. The patient let his brother play the socially aggressive role and also let the brother go ahead in football while the patient remained in the back- ground, doing the chores on the farm. The brother submitted to the father, did not resist the corporal punishment and, so far, remained a conformist. The patient, on the other hand, always resisted the father's punishment to
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some extent, though often in fantasy only; he felt the father was doing him a wrong, often broke the father's rules, and finally tried to break completely with the parental ideology with regard to religion, mores, and politics. This process caused the patient a great deal of conscious anxiety and conflict. The core of the neurosis was undoubtedly the partly repressed hostility against the father, complicated by the relationship to the twin brother.
The following are excerpts from the first psychiatric interviews of low- scoring men:
The patient says that since childhood he has been somewhat withdrawn, making very few social contacts, remaining in his room for days at a time. Never has had any particular interests, heroes, or ideals other than the vague feeling that he should somehow get a good job and become a respectable member of society. But
he "loses interest and becomes bored with a job as soon as he finds out that he can handle it. " He has had a variety of positions from laborer to personnel interviewer. When the job becomes intolerable, feelings of anxiety and frustration are at their height. He will feel very dissatisfied with himself as well as with the job and then
try to change jobs. He shot off the middle finger of one hand "in a hysterical effort 2 to escape the draft. " He feels that psychotherapy is his "last chance" to straighten out and settle down mentally.
The patient complained of acute anxiety, depression, suicidal thoughts, and present inability to work or make decisions. He said the problem worrying him was whether he was a homosexual and if so, how could he make a happy adjust- ment to it? While in the army, the patient had formed a strong attachment to a homosexual man of his own age who, for a long time, encouraged and courted, then suddenly rejected him. When the relationship had become very strained, the patient was very angry and thought of killing the friend, but instead made a suicide attempt, wounding himself quite severely with a gun.
The patient suffers from feelings of depression, primarily in reaction to receiv- ing a letter from his girl friend stating that she had married someone else. They had been friends on a purely platonic basis, sharing intellectual interests. Also he feels bitter and hopeless about his recent transfer from a public service camp to a government camp where he has no opportunity for constructive activity. He feels the C. O. camps should provide more public service, not be there merely for pur- poses of detention.
There were two cases with hysterical symptoms: One pianist, with a his- tory of various mild hysterical conversion symptoms while in the service, who complained of numbness and partial loss of function of the right index finger; one student who suffered from anxiety nightmares and fainting spells, particularly during examination times. The fainting spells had first appeared in situations in which he had felt attacked by his very aggressive, brutal father.
Finally, there were a few low-scoring men with mild cases of schizo- phrenia. Actually, their E scores were in the low end of the low middle quar- tile. But interviews revealed that timidity had inhibited the questionnaire
? PSYCHOLOGICAL ILL HEALTH AND POTENTIAL FASCISM 955
responses in one case in which? the subject was really strongly opposed to prejudice. This patient had always been a seclusive, somewhat compulsive, obviously schizoid person. Although all his relationships were weak and ego- centric, he gave a history of having been somewhat closer to his mother than to his father, whom he described as particularly puritanical, stern, and co- ercive. He expressed much hatred for his father, but there was evidence that some of these sentiments were actually expressions of unconscious fantasies of homosexual submission to the father. While an officer in the army, he suffered from feelings of jealousy regarding his wife, hopelessness and rest- lessness, finally ending in a schizophrenic episode in which he imagined that a number of his subordinates were criticizing his work and were spying on him and talking about him. He became so angry he wanted to kill these individuals. In spite of these tendencies towards projection, the parent was strongly intrapunitive, as shown by the ideas just cited as well as by his responses to the questionnaire and projective items.
The other schizophrenic from the low middle quartile, a young seaman, c:laimed that he experienced sexual satisfaction only when he deliberately miled his trousers. He reported various bizarre fantasies, usually of sadistic actions directed against women. He imagined that his shipmates knew about his secret sexual practice and that they looked down on him and rejected him for it. He sought help voluntarily.
In the projections of this and the previous case, both intrapunitive char- tcters, the superego seems to play a different role than it does in the charac- teristic projections of the high scorers, where the self is seen as the virtuous :me, the "others" as the representatives of the id. While undoubtedly the two psychotic caseS" just cited projected some of their repressed impulses, e. g. , homosexual and sadistic ones, onto their environment, they did this to a ;mailer degree than did the high scorers. In addition, they projected their Jwn superego strivings onto the environment, feeling that others-more or less justifiably-rejected and punished them.
). Low-scoRING WoMEN. It was brought out in Section D that a great nany of the low-scoring women were classified as "mixed neurosis. " This s partly due to the fact that in the classification scheme used, no separate :ategory was available for neurotic depression, one of the main complaints Jf our low-scoring group. Also, the diagnosis of mixed neurosis was usually ~esorted to in the case of character disorders. These also were prevalent tmong the low-scoring women.
The following excerpts from the first psychiatric interviews are typical of :he low-quartile women. Feelings of depression were given as main com- Jlaints by low-scoring patients with a great variety of other problems. Even :he one schizophrenic scoring in the low quartile complained of the charac- :eristic depression and feelings of inadequacy. The prevalence of passivity md orality is also to be noted.
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Main concern is "that I have failed repeatedly with everything I do. " Com- plains of lack of self-confidence in her abilities and in her work. States "I have built up such a resentment toward myself that I am afraid I will commit suicide. "
Several of these women, suffering from depression, felt that their symptom was related to their difficult relationship to their mothers. One young woman said she felt "a great deal of hatred" for her mother and got sleepy and irritable whenever her mother was around.
She is depressed, with loss of appetite, lassitude, and suicidal thoughts, wants to lie down all the time, requires an abnormal amount of sleep-fifteen to sixteen hours-but without gaining a feeling of vitality afterwards.
Another woman stated that she felt "things are too hard"-she'd rather go to bed. Felt depressed, weak, irritable.
In two women, the central problem was their conscious struggle with homosexual impulses. One young girl with strong intellectual interests had had a violent crush on a female teacher during adolescence. Later she formed crushes on men.
She is aware of some homosexual tendencies. She has a strong desire for friend- ship and love relationships. Depending on the satisfaction and frustration of this need, she alternates between periods of elation and depression.
The other had crying spells, the desire to sleep all the time, and also suf- fered from vomiting and cramps.
Some of the women sought help mainly because they felt they were harm- ing their children by their neurotic behavior. All of these were rather active women with interests outside the home, and with a great desire for achieve- ment and for playing a more or less masculine role.
One woman had married an invalid man whom she admired for his intel- lectual talents. She worked to support him and their child, waiting on her husband hand and foot when at home. She continually drove herself to under- take too much, felt nervous, did not sleep well, and felt she "wasn't a decent mother. " She often got spells of excessive eating, followed. by depression. Formerly she had had the same "spells" of drinking.
Another case is that of a married woman about 30 years of age who had one child of a previous marriage. She had felt extremely depressed and unable to work since she discovered that she was pregnant again. She did not want the baby because it would mean giving up a career she had just started with much satisfaction, but could not think of offering it for adoption because her husband very much wanted a child. She wanted to have help so that she would either be able to accept the child or decide to give it up. She said, "I bitterly resent having been born a female. " From her history, it appeared that she had always actively competed with boys or men. As a kindergarten child she picked fights with little boys-"I liked to beat them to a pulp to show them who was really something. " She was married twice previously,
? PSYCHOLOGICAL ILL HEALTH AND POTENTIAL FASCISM 957
each time to a brilliant and successful man with whom she would compete bitterly. These marriages were unsuccessful. At the time of her treatment, she was happily married to a more passive man who admired her and encour- aged her professional ambitions. The patient was a serious, sensitive, tense person who was uncomfortable and shy in groups and preferred to be or work alone. Asked about her early life, she described herself as a thoroughly undisciplined, nonconforming child, who in spite of very high intelligence could not do well in school because she got bored and refused to do work she disliked. She did not get along with other children, and preferred to do art work by herself. In later childhood she wanted to be a cowgirl. In adoles- cence she went through a very rebellious period, then took art training and became a radical. She was talented and had had some success in various artistic fields. She was interested in modern experimental art forms and in the repre- sentation of psychological moods. She was politically left-wing but felt she could not be of great use to any political movement because of her shyness and inability to function in groups or to approach people. She described herself and her history with much psychological perceptiveness, frankness, and insight. In spite of this, psychotherapy was difficult because everything was told in a very intellectualized fashion. Instead of letting herself feel the appropriate emotions, the patient usually managed to keep quite aloof, care- fully choosing her words to describe her early environment and history.
The patient had had previous periods of depression, each time when some- thing blocked her professional ambitions. The last episode was very severe: She became afraid there was a man in the house who could harm her, and she developed such a loathing for herself that she felt her skin was covered with repulsive fish scales.
The history revealed that she was the only child of two rather neurotic people, who in her early childhood gave the girl a good deal of freedom and individual attention. In spite of this, she often felt lonely and "left out. " Through the circumstance of the parents' separation when the patient was 5, the patient came to feel that her mother had caused the beloved father much suffering and was responsible for the separation. She began to feel great dis- gust for and hostility towards her mother, who became the prototype for her image of the "shallow, pretty, exploiting woman. " Her professional interests and activities were based on identification with her professionally successful father, and perhaps also her stepmother.
It is not necessary for our purpose to go into a detailed discussion of the dynamics of this woman's personality and development. The case was pre- sented merely as a description of one type of female patient found among the low scorers. Though too extreme to be representative, the case has many characteristics typical of a whole group of low-scoring women, usually polit- ical radicals or militant liberals: the masculine identification (which is un- usually strong here), the competition with men and striving for professional
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achievement, the rejection of femininity and inability to accept the role of mother.
The latter two are exceptionally pronounced here. In most of o low-scoring women there were strong feminine identifications also whic were in conflict with the "masculine" strivings. In contrast to the hig scoring women, there is-as with low-scoring women generally-little con pulsiveness, less constriction, greater richness of fantasy life-here express in artistic and other professional fields-introversion (here particular strong), and concern with ideas and inner experience. The patient tried handle her conflicts by seeking rational explanations (therapy) and by subl mations.
In a few of the low-scoring women anxiety symptoms predominated. these cases, feelings of inadequacy were quite prominent and there w anxiety and shyness in certain social situations. One woman felt so unea: in groups that she frequently broke into a sweat. She was also jealous of h husband's interest in other women and afraid she might retaliate by having affair, as she did once before. Another patient, an unmarried woman wl was embarrassed in social situations, had developed tremors whenever s had to hold a cup or stemmed glass, or when filling out application blanl After having fallen down the stairs at a party where she was very uncomfo: able, she developed a panic of going down stairs. Also, the patient thoug she was always attracted by the wrong men-usually very neurotic m< One very inhibited young girl came to the Clinic because she was afraid l former enuresis might return. She thought she would use the symptom avoid social engagements, of which she was somewhat afraid. She felt ve guilty about her adolescent sexual interests. She had night terrors aboUI
half hour after going to sleep, in which she saw something coming down her-sometimes a net, sometimes a swarm of bugs. Sometimes an abstr: shape of a person would crawl into her bed. She would scream and jump < of bed. One case was of a more phobic character. The girl had had an anir phobia. When seen at the Clinic she was in a ''confused anxious state," afr of entering graduate school, particularly of going to see her graduate : visor. She could not bring herself to go to him and discuss her work. ~ felt that she had not accomplished much. She was also worried because : did not feel warmly towards anyone, because she felt rather hostile-parti' larly toward her mother.
There was one case with obsessive-compulsive symptoms, a woman " a previous depressive episode. At the time of her treatment she was unablt do her (clerical) work for fear she might write down something that wo embarrass her or damage someone else. The trouble began at 17 when feared to write down "dam" or "damn. " (Swearing was severely condem1 by her strict father, whom she reported she hated. ) Years later, after she r about rape in the papers she began to worry about the word "rape. " Now was afraid of writing down something pertaining to her current employ
? PSYCHOLOGICAL ILL HEALTH AND POTENTIAL FASCISM 959
raping or attacking her. She was never certain whether she had not by chance inserted these ideas into a letter, or into other products of her typing work. For the last few years she had found that sedatives and alcohol would relieve her condition.
One of the low-scoring women was classified as a paranoid schizophrenic. Yet her complaints, except for a few bizarre ideas, were similar to the ones reported by other low-scoring women suffering primarily from depression. The patient described with much insight her extreme sensitivity to other people's reactions, her concern lest she be rejected by others, her early feel- ings of insecurity and of being unwanted. She said her illness started with nervousness, indecision, and fears "of not being able to keep a job, that I might harm people, of dying of a cerebral hemorrhage (her mother had died in this way); afraid I was going to die and none knew about it or cared. " When first interviewed she complained of being depressed and la"cking in the ability to concentrate on her work. She was afraid people were "question- ing her motives" and had tried to read her mind by saying things to elicit her reactions. She felt a change in the attitude of her family towards her. She had been weak and tired, attributing this to a drug which she believed was used in the food at the previous hospital. She said "there is a barrier between me and other people erected by myself. Last week I felt closer to people. "
Finally, there were two cases who were referred by physicians to whom they had turned because of physical symptoms. In one case the main com- plaint was a headache and "hypersensitivity to light, necessitating wearing of dark glasses. " The other case complained mainly of dismenorrhea, also of nausea and of muscular pains simulating her mother's arthritis. Both cases traced their symptoms to accidents. Although little material on these patients was available, it seemed very likely that they were cases of conversion hysteria.
3. THE ''MIDDLES"
Most of the data just presented pertain only to patients receiving E scores within the high or low quartiles. We have, of course, collected some data on "middle scorers. " First, there were the questionnaire data, including responses to Projective Questions, and second, the psychiatric diagnoses and Minnesota Multiphasic scores. These indicated that, on the whole, "low middles" re- sembled the low scorers more, the "high middles" showed more resemblance to the high scorers.
In addition, several clinical case studies were made of patients with middle scores. In these cases one could clearly discern both "high" and "low" per- sonality trends and, sometimes, curious inconsistencies in ideology and be- havior. This was true of some of our most disturbed patients. Most of the psychotic patients made middle scores-a few were "low middles," but most of them made high middle scores. Some explanations of this trend have been
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advanced in Section D above; it seemed to be related in these patients to ego weakness and unconcern with social reality. There were, of course, people with middle scores who were relatively little disturbed, but we have very little information concerning them.
The total sample of Clinic subjects contained 27 cases diagnosed as psy- chotic. Of these, 70 per cent (19 cases) made scores in the middle quartiles. This percentage is considerably greater than chance (which would be so per cent) and is significant at the 5 per cent level. However, little weight can be given this result because of the small number of cases.
The clinical case studies also indicate that many of the most disturbed patients tended to make middle rather than extreme scores. In these cases it can often be shown that the over-all personality picture is either "high" or "low" but that the neurotic or psychotic processes lead to certain contra- dictory opinions, or attitudes that are the opposite.
An example of such a picture is a schizophrenic man, a strongly intrapuni- tive person, thoroughly opposed to any kind of prejudice against minorities, usually a pacifist (and believer in a vague humanitarianism) who at certain times expressed marked chauvinism and destructive ideas directed against other nations. He developed these ideas when control of his own homosexu- ality and hostility was threatening to collapse. Another case is that of a man with a strongly paranoid character who had the most outspoken fascist ideology. This man's character structure and his scores on the F and PEC scales revealed that in most respects this man was very much like our high- scoring subjects. Great hostility and fear of his father had prevented genuine identifications. But the subject spent all his efforts in a fruitless attempt to prove to himself and the world that he was more powerful, capable, intelli- gent, and virtuous than his father. This manifested itself, among other ways, in continual though unrealistic and unsuccessful strivings for positions of power, in a grandiose conception of himself, in a verbose manner of speech and continual orientation toward making an impression on others. In many ways this man could be described as a psychopathic character. Still, he made only a low-middle score on E. Interviews revealed that this was related to a certain opposition to the father's prejudiced ideology, although in other areas this subject had very conventional values. Also, the mild opposition to preju- dice seemed to rest on a certain amount of identification with deprived groups. For instance, he considered the differences between whites and Negroes to be primarily due to a difference in education; in fact he would like to solve all problems in the area of group relations by giving educa- tional opportunities to all. He also considers the basis for all his own failures to be his lack of a college education due to the fact that his father lost his money just when the patient was of college age. Needless to say, this subject's ideology differed qualitatively from that of low-middle subjects whose
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characters were more typical of low scorers. These differences, however, were revealed only in the interview.
H. CONCLUSIONS
In this concluding section we shall discuss the problem of the relationship between ethnocentrism and psychological ill health in the light of the find- ings just reported. First, however, it will be necessary to make a statement about the degree to which conclusions drawn on the basis of findings from the Langley Porter Clinic group can be generalized. In our description of the sample (Section B) we have defined the Langley Porter Clinic population as a group coming mainly from the urban lower middle-class and, on the average, somewhat younger and slightly more educated and more intelligent than the general population, and more cooperative than average. In these respects Langley Porter Clinic patients are probably similar to patient groups from other psychiatric clinics in large American cities. Within the limits set by our selection procedure, the sample studied was thought to be fairly rep- resentative of the Clinic population as a whole, although an exact comparison with the clinic population at large could not be made for want of available data. Results of the present investigation which were found to be statistically significant probably hold for similar clinic groups. A question then arises as to how representative these clinic groups are of the psychologically dis- turbed (neurotic-psychotic) population as a whole. This question cannot be answered, because no one knows just what this population is like. There are countless individuals who have severe psychological disturbances but never come to the attention of clinics or private psychiatrists. On the other hand, a public clinic such as the one described probably covers a wider range of clinical pictures and social backgrounds than any other agency, certainly a much wider one than could be found among patients going to private ther- apists and institutions.
As far as the statistical significance of most of the results is concerned, much is left to be desired. The scope of the investigation did not permit the use of many more than 120 subjects. For many of our comparisons this group had to be divided into many small subgroups. Taken one by one, most of the numerical results therefore are not statistically significant, nor otherwise impressive. Whatever value there is in the present investigation lies more in the consistency of all of our findings with one another and with the findings of the study as a whole.
Now an attempt will be made to bring our findings to bear on several questions regarding the relationships between ethnocentrism and psycho- logical ill health. All of the following questions have been raised in connection with the research findings reported in this book: (1) Are people with rela-
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tively severe psychological disturbances on the average more or less preju- diced than "normal" people? (2) Are people making extreme (high or low) scores on the E scale also extreme on the dimension of mental health-mental illness? (3) Are high or low scorers prone to develop certain specific kinds of psychological disturbances? (4) Did the study of neurotic and psychotic subjects lead to new hypotheses about the character structure and its possible genetic sources in high and low scorers? (5) Is there any evidence that one of the two groups, at the opposite extremes of the E scale, was more severely disturbed than the other? Is there a relationship between ethnocentrism and psychosis?
1. Are people with relatively severe psychological disturbances on the average more or less prejudiced than "normal" people? When the average ethnocentrism scores of the Langley Porter men and women were compared with scores obtained by averaging all other groups, the Clinic group turned out to be slightly, but not significantly, less prejudiced than average. The scores showed a wide range and great variability, indicating that the group contained subjects of greatly varying ideologies and personalities. If one would like to generalize to a wider group of psychologically disturbed people, the Langley Porter Clinic mean is probably too low. As we have shown, the Clinic group was younger, somewhat more educated, intelligent, and cooperative than average. All these selective factors are known to show slight negative correlations with ethnocentrism. On these and other grounds it seems reasonable to assume that a large group of disturbed persons taken at random from the general population would on the average make prejudice scores similar to those of a group of nondisturbed people.
2. Are people making extreme (high or low) scores on the E scale also extreme on the dimension of mental health-mental illness? Most of the dy- namic formulations in this book have been derived from comparisons of subjects scoring in the high and low quartiles. An objection to this procedure has been that perhaps high and low scorers are both deviant groups, that they are "marginal and neurotic," and that "normal people" in our society are "middles," that is, mildly in agreement with the stereotypes prevalent in our culture. In order to answer the above question conclusively one would first have to establish a reliable measure of degree of psychological disturbance. This could then be correlated with ethnocentrism in a large group of subjects. No such measure was available for the present investigation. However, there were some indications that the subjects receiving middle scores on E were at least as disturbed-if not more so-than the patients making extreme scores. This statement is based on some clinical case studies of neurotic and psychotic middle scorers and on the finding that 70 per cent of our psychotic subjects scored in the middle quartiles.
3? Are high or low scorers prone to develop certain specific kinds of psy- chological disturbances? On the whole our data seem to show that the clinical
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pictures of subjects in the high quartile resemble each other and differ system- atically from the clinical pictures shown by patients from the low quartile. These trends cannot be completely described in terms of the conventional psychiatric classifications as they were used at Langley Porter Clinic. In these terms, the trends were partially expressed in a predominance of "mixed neurosis" with "depressive and anxiety features" in low-scoring women, of "anxiety states" in high-scoring women. The relationships were less marked in the men. However, clinically defined similarities among high-scoring cases, on the one hand, and low-scoring cases, on the other, cut across the lines drawn by these diagnostic classifications. There are high as well as low scorers in each of the major psychiatric categories (e. g. , schizophrenia, manic-depressive psychosis, anxiety state, hysteria, obsessive-compulsive, and "mixed neurosis"). It cannot be decided here whether this is due to the essentially nondynamic nature of the classification system or to the way in which the classifications were applied by the physicians. Probably both factors are responsible. More detailed study of the complaints as described by the patients in a first psychiatric interview revealed the following differ- ences in clinical pictures of high and low scorers.
The subjects scoring high on ethnocentrism usually displayed very little awareness of their own feelings and psychological problems. What is more, they tended to resist psychological explanations and to suppress emotion. Their complaints were very often devoid of any psychological content. The most common symptoms in both men and women were vague anxiety or physical signs of anxiety and rage. The more disturbed patients suffered from feelings of depersonalization, lack of interest, and depressed affect of a more schizoid type. Very many high-scoring men and women came to the Clinic with somatic complaints-some of them psychosomatic symptoms which could be understood as expressions of suppressed affects such as fear or rage. They were inclined to dwell at length on these symptoms to the exclusion of other problems. Some showed pathological fear of sickness, physical injury, or death.
The most frequent physical complaints of the high-scoring men in our group were stomach ulcers and physical expressions, such as tremors, sweat- ing, etc. , of tension and anxiety. Some of the cases had markedly compulsive characters, others appeared to be more "phobic" or to have characters built around defenses against passive homosexuality. In some of these cases fears of being injured or attacked, or other paranoid trends, were part of the pic- ture. Other types of cases were primarily psychopathic (one of these had admitted sexual exposure to a child) and still others were overt homosexuals. All of them, except for one case of simple schizophrenia, showed to some extent the "toughness" and masculine fa~_;ade together with various signs of extreme castration anxiety and underlying passivity. The majority of the high-scoring women complained of irritability, anxiety or hyperven-
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tilation symptoms; many also had temper outbursts or attacks of trem- bling, screaming, or fainting (probably equivalents of attacks of rage) and fear of dying during such an attack. When one of these cases was stUdied in detail, it was found that her attacks of panic, trembling, fainting, and screaming were expressions of extreme rage precipitated by an incident earlier in the day but suppressed at the time. There was one case of hysterical conversion in a woman with a very rigid character, and there were several very infantile schizoid cases with different features such as agitated depres- sion, depersonalization, and paranoid fears. All of these women, however, resembled each other in the following ways: their main problems seemed to center around the inability to express strong hostilities directed against some member of their family; their personalities were rigid and very constricted; most of them had marked compulsive traits. Rigidity of personality and the tendency to use countercathective defenses seem to be characteristic of both high-scoring? men and high-scoring women.
The low scorers were found to exhibit a wide variety of clinical pictures and complaints. They were much more familiar with themselves, more aware and accepting of emotional experiences and problems. The complaints of low-scoring patients very rarely consisted of vague anxiety or physical symptoms? alone. If anxiety without content appeared at all, the patient also reported being concerned about other problems. Usually, the patients stated their problems in terms of specific impulses, fears, or adjustment difficulties. The most common single symptom characteristic of low-scoring men and women was neurotic depression with feelings of inadequacy. Most of these patients had inhibitions in some area-sexual, work, social-and felt uneasy in group situations.
Summarizing these findings, then, one might say that some statistical rela- tionship was found for the women between high E score and the classification "anxiety state," on the one hand, low E score and a classification which was labeled "mixed neurosis" (which probably should have been called "neurotic depression"), on the other. It became clear, however, that ethnocentrism was much more strongly related to certain very general personality trends which cut across the lines drawn by the psychiatric classifications. It has therefore been impossible to speak of symptoms or "types of disturbance" without some reference to the personality syndromes in which they oc- curred. These personality syndromes will be discussed more fully, more interpretatively in the following section.
4? Did the study of neurotic and psychotic subjects lead to new hypoth- eses about the character structure and its possible genetic sources in high and low scorers? All the important variables in which high- and low-scoring patients differed, were identical with those found to differentiate high and low scorers in groups of people who were relatively little disturbed. In the
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disturbed group, however, these characteristics were seen in more exagger- ated form. In the first student group studied by the questionnaire and clinical techniques, Frenkel-Brunswik and Sanford (38) found that the high-scoring women more often mentioned health problems, in spite of the fact that their health histories appeared to be quite similar to those of the low scorers. These few, often casual, remarks about health were related to certain themes in the T. A. T. stories, where many characters suffered mutilating injuries and acci- dents. On the basis of these data, a tentative interpretation was made to the effect that high-scoring women characteristically show concern about their physical well-being because they are unconsciously afraid of being hurt as a punishment for strong hostile impulses. This hypothesis was confirmed and extended by the data furnished by the Clinic group. In the Langley Porter Clinic women, references to physical symptoms were not confined to a few more or less casual remarks but often formed the most emphasized part of the patient's statement of complaint. Intensive study of several cases sup- ported the hypothesis, developed on the basis of earlier findings (Chapter XII), that the tendency to focus on one's physical condition in this par- ticular way not only expresses strong unconscious (castration) anxiety but also represents the way in which a person with a very constricted ego defends himself against becoming aware of large areas of his emotional life.
Similarly, some of the "normal" subjects in the over-all sample of the study mentioned tendencies towards depressed feelings. The data on the low- scoring Clinic patients confirmed the hypothesis that tendencies toward feelings of inferiority and guilt and depression were consistent with a type of character structure found commonly in low scorers and would appear to some degree under conditions of inner or outer stress. In the "normal" sub- jects, however, these tendencies appeared to be relatively mild, while some of the Clinic patients were incapacitated by them.
Thus, the material from the Clinic group supported and, in some instances shed additional light upon, the dynamic hypotheses advanced in Chapters IX through XIII. Also, our data strongly bore out our hypothesis that the rela- tionships between ethnocentrism and personality variables would be essen- tially the same for "normal" and for psychologically disturbed groups, but that some of these personality trends would, in the disturbed group, appear in pathological forms and degrees.
Taking the evidence from the various techniques with which our group was studied, and recalling major conclusions from earlier chapters, we can make the following general formulation regarding the character structure of high and low scorers.
The high scorers have rigid, constricted personalities, as shown by their stereotyped, conventionalized thinking and acting and their violent and categorical rejection of everything reminding them of their own repressed
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impulses. Their egos appear to be not only very constricted but also quite undifferentiated: their range of experience, emotionally and intellectually, is narrow. It is as if they can experience only the one conventionally correct attitude or emotion in any given situation. Everything else is suppressed or denied, or if another impulse breaks through, it is experienced as something which is completely incompatible with the conception of the self, and which suddenly overwhelms the ego. In part, this high degree of ego-alienness probably derives from the fact that the impulses emerging from repression are so primitive and, especially in the women, so very hostile. Compare, for example, the ways in which two high-scoring women on the one hand, and one low-scoring woman, on the other, expressed their ambivalence towards their children. The two high-scoring women had "spells" of excitement, trembling, and various physical manifestations which they did not recognize as expressions of rage. One woman actually choked her children during such attacks, the other had had the impulse but could control it. Both tried to convince the interviewer and themselves that they "really" loved their chil- dren. The low-scoring woman was quite aware of rejecting her child, of her habitual impatience and inability to give enough love to the child. She recog- nized the effects of her behavior on the child, tried to make up for it at times and hoped that after therapy she would be able to be a better mother. The high-scoring mothers were not able to admit any deviation from the conven- tional idea that a mother, unless she is utterly depraved, can feel anything but tenderness and devotion for her children. In these, and in all of the other cases of high scorers, it seemed as if the person's ego had usually been able to keep the unacceptable impulses completely out of consciousness, by means of countercathexes, and that this prevented modifications of the impulse, such as channelization into milder and more adult forms, sublimations and the like.
The husband reported that the patient had changed in other respects too. Whereas she had been sexually rather frigid before the delivery, she all of a sudden became very passionate.
flospitalization and psychotherapy seemed to do little good. So the patient was discharged and brought in by her husband at intervals for electric shock treatments. After very few treatments the patient felt normal and both she and her husband felt that she was now less inhibited, warmer, and able to enjoy herself more.
At the present time the psychological meanings and effects of shock treat- ments are not sufficiently understood to permit theorizing concerning its role in this case. Its evaluation is rendered the more difficult by the fact that the patient had received and was receiving psychotherapy. The doctors' and husband's acceptance of her newly awakened sensuality may have helped
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the patient to accept this part ofherself, and this may have been an important factor in her improvement.
Another case of the same general type was a 24-year-old mother of two children. She too had an episode of depersonalization and forgetfulness fol- lowing the birth of the first child. This woman could have been taken for a naive high school girl. Her usual submissive and conventional "good girl" be- havior occasionally alternated with outbursts of anger and spite. She was a very dependent person with no ideas and opinions of her own and without interests outside of the domestic sphere. When her husband's support was withdrawn (because of illness) just after she had her second child, she suf- fered a paranoid schizophrenic episode, became afraid someone would harm her and the children, that her husband or relatives would take one of her daughters out and not bring her back.
Still another case was that of a girl who had always been a particularly con- scientious worker and who was completely submissive to her rigid, unsym- pathetic parents and aggressive older sister, without ever becoming aware of any resentment. When this girl was promoted to a job of considerable re- sponsibility she developed extreme headaches and entered a state of depres- sion and anxiety, in which she accused herself of being bad, thought people were looking at her, and feared she would lose her mind.
This girl and several other high-scoring women suffered, during the acute stages of their illness, from a mood disturbance which could only be de- scribed as "agitated depression. " (In some cases this was accompanied by suicidal ideas. ) These depressions, however, were different from those seen in the patients who were subject to periodic neurotic depressions. They were often accompanied by somewhat bizarre ideas and in general showed schizoid qualities. For this reason they were sometimes labeled schizo-affective reactions.
Few of these cases had the slightest idea of or interest in current issues and were very unsure of the few ideas they could voice during the interviews. Their ideologies about outgroups were meager, less elaborated, and even more naive and stereotyped than those of less disturbed high-scoring subjects. Their rejection of outgroups-in the abstract at least-was extremely strong, leading to very high prejudice scores and often to emotionally charged re- sponses during interviews such as "You wouldn't want to have a black baby, would you? " This is an expression of their particular ego weakness, necessitat- ing special efforts at creating and maintaining countercathexes.
2. THE LOW SCORERS
The pattern formed by the symptoms in List B of Category VII is dif- ferent. The unacceptable impulses-although not all conscious nor undis- guised-are more ego-assimilated and are perceived as part of the self. The
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low-scoring patients generally came to the Clinic with a particular psycho- logical problem they wanted to solve. They complained of certain conflicts or anxieties about some more or less definite idea or situation or were consciously dissatisfied with their sex role. Many of these are character neuroses. The "evil" was not sought outside but in the self. Elsewhere in the present volume it has been shown that high scorers on E are typically extrapunitive, while low scorers are intrapunitive. Intrapunitiveness has been understood as a sign of a strict but internalized superego and probably also of a somewhat masochistic character structure. The psychologically ill low scorers seem to show this tendency in exaggerated form: in (neurotic) depression, suicidal ideas, inferiority, and guilt feelings.
Their greater acceptance of their instinctual and fantasy lives and their relative independence from conventional restrictions give great variety, in- dividuality, and even bizarreness to the pathological ideas and behavior of these patients.
In some ways many of these patients (although by no means all of them) behaved in a way that is opposite to the cultural norm for their sex. Some of the men were shy, timid, passive, and dependent and had some interests more often found in women. Some of the women were aggressive, less inter- ested in home and family than in some occupational achievement. Homo- sexuality and sexual perversions were more freely admitted, and conflicts about such impulses were often quite conscious and undisguised. (This does not mean that the low scorers have more homosexual tendencies. There are probably just as many if not many more high scorers with such impulses. But in the latter case, these impulses and fantasies are strongly disguised and re- pressed. )
a. Low-scoRING MEN. The low scorers on E presented such a variety of complaints and clinical pictures that it is almost impossible to fit them into a few "types. " While some had psychoses or classical neuroses with anxiety- hysterical and compulsive symptoms, many cases presented character dis- orders which had come to the fore or were accentuated because of situational factors. An example of this type was a very dependent man, married to a more aggressive woman to whom he was very much attached and. sexually attracted. The relationship, always problematic, had become intolerable since the wife had a second child whom she rejected. The Clinic suggested foster-home placement for the child. The patient could not accept this nor could he decide to leave his famliy.
Broadly speaking, the low-scoring men were generally unaggressive, nur- turant, often somewhat withdrawn and inhibited socially. They came to the Clinic with depressions and conscious anxieties relating to problems of sex, work, or general adjustment. In contrast to the high-scoring men, the prob- lems as stated by these patients referred directly to their relationships to others. During the war a few of them suffered acute conflict about the prob-
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lem of participation, leading, in'a few cases, to self-inflicted injuries to avoid the draft, in others to conscientious objection. This was not primarily because of fear of physical injury or death but because of ideological reasons and a horror of being forced to kill.
An illustrative case is that of a young man of college age who had been in a camp for conscientious objectors. He was short and slight. His manner and speech betrayed much tension and self-consciousness. He was very unsure of himself and suffered somewhat from compulsive doubt and indecision. He had well-formed opinions about some subjects-such as the problems of minorities and pacifism-but in most areas he was quite uncertain, mentioning one opinion and then retreating when challenged by the interviewer, saying "I really don't know much about it yet-I have to read a lot more. " He was
keenly interested in politics and concerned about social progress. He realized that his occupational choice-to counsel people about their personal problems -stemmed from awareness of his own inner struggles and from his own desire to be helped.
The patient voluntarily sought help because of restlessness, anxiety, occa- sional depression, and inability to concentrate. He also had severe feelings of inadequacy, stage-fright, social anxiety, and several fears-of the dark, of physical injury, and of graveyards and mental institutions.
The patient's father was of lower-class origin with a grade-school educa- tion, who became a carpenter, then a farmer and minister in a fundamentalist church. He was a stern, dominating and punitive man with narrow, funda- mentalist and puritanical ideas, who made the children work hard on the farm and dealt out severe corporal punishment. The mother, a church singer, would have liked to push the father into a higher ministerial position. She was ashamed of her husband's fire and brimstone sermons and his denuncia- tion of vices he himself possessed. Though not punitive herself, she did not actively take the children's part. She tried to appease the father by con- formity to his demands, and she tried to influence the children to do the same. There was much discord between the parents which was painful to the patient. He usually sided with the mother, who had made him her special confidant. Although he had been close to his mother in his earlier life, the patient was, at the time of the interview, rather critical of her.
The patient had one brother, several years his senior, with whom he was never close but whom he liked and respected and wanted to know better. He was quite close, however, to his twin brother, taller, stronger, and more ag- gressive than the patient, and admired him for his poise and school achieve- ment. The patient let his brother play the socially aggressive role and also let the brother go ahead in football while the patient remained in the back- ground, doing the chores on the farm. The brother submitted to the father, did not resist the corporal punishment and, so far, remained a conformist. The patient, on the other hand, always resisted the father's punishment to
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some extent, though often in fantasy only; he felt the father was doing him a wrong, often broke the father's rules, and finally tried to break completely with the parental ideology with regard to religion, mores, and politics. This process caused the patient a great deal of conscious anxiety and conflict. The core of the neurosis was undoubtedly the partly repressed hostility against the father, complicated by the relationship to the twin brother.
The following are excerpts from the first psychiatric interviews of low- scoring men:
The patient says that since childhood he has been somewhat withdrawn, making very few social contacts, remaining in his room for days at a time. Never has had any particular interests, heroes, or ideals other than the vague feeling that he should somehow get a good job and become a respectable member of society. But
he "loses interest and becomes bored with a job as soon as he finds out that he can handle it. " He has had a variety of positions from laborer to personnel interviewer. When the job becomes intolerable, feelings of anxiety and frustration are at their height. He will feel very dissatisfied with himself as well as with the job and then
try to change jobs. He shot off the middle finger of one hand "in a hysterical effort 2 to escape the draft. " He feels that psychotherapy is his "last chance" to straighten out and settle down mentally.
The patient complained of acute anxiety, depression, suicidal thoughts, and present inability to work or make decisions. He said the problem worrying him was whether he was a homosexual and if so, how could he make a happy adjust- ment to it? While in the army, the patient had formed a strong attachment to a homosexual man of his own age who, for a long time, encouraged and courted, then suddenly rejected him. When the relationship had become very strained, the patient was very angry and thought of killing the friend, but instead made a suicide attempt, wounding himself quite severely with a gun.
The patient suffers from feelings of depression, primarily in reaction to receiv- ing a letter from his girl friend stating that she had married someone else. They had been friends on a purely platonic basis, sharing intellectual interests. Also he feels bitter and hopeless about his recent transfer from a public service camp to a government camp where he has no opportunity for constructive activity. He feels the C. O. camps should provide more public service, not be there merely for pur- poses of detention.
There were two cases with hysterical symptoms: One pianist, with a his- tory of various mild hysterical conversion symptoms while in the service, who complained of numbness and partial loss of function of the right index finger; one student who suffered from anxiety nightmares and fainting spells, particularly during examination times. The fainting spells had first appeared in situations in which he had felt attacked by his very aggressive, brutal father.
Finally, there were a few low-scoring men with mild cases of schizo- phrenia. Actually, their E scores were in the low end of the low middle quar- tile. But interviews revealed that timidity had inhibited the questionnaire
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responses in one case in which? the subject was really strongly opposed to prejudice. This patient had always been a seclusive, somewhat compulsive, obviously schizoid person. Although all his relationships were weak and ego- centric, he gave a history of having been somewhat closer to his mother than to his father, whom he described as particularly puritanical, stern, and co- ercive. He expressed much hatred for his father, but there was evidence that some of these sentiments were actually expressions of unconscious fantasies of homosexual submission to the father. While an officer in the army, he suffered from feelings of jealousy regarding his wife, hopelessness and rest- lessness, finally ending in a schizophrenic episode in which he imagined that a number of his subordinates were criticizing his work and were spying on him and talking about him. He became so angry he wanted to kill these individuals. In spite of these tendencies towards projection, the parent was strongly intrapunitive, as shown by the ideas just cited as well as by his responses to the questionnaire and projective items.
The other schizophrenic from the low middle quartile, a young seaman, c:laimed that he experienced sexual satisfaction only when he deliberately miled his trousers. He reported various bizarre fantasies, usually of sadistic actions directed against women. He imagined that his shipmates knew about his secret sexual practice and that they looked down on him and rejected him for it. He sought help voluntarily.
In the projections of this and the previous case, both intrapunitive char- tcters, the superego seems to play a different role than it does in the charac- teristic projections of the high scorers, where the self is seen as the virtuous :me, the "others" as the representatives of the id. While undoubtedly the two psychotic caseS" just cited projected some of their repressed impulses, e. g. , homosexual and sadistic ones, onto their environment, they did this to a ;mailer degree than did the high scorers. In addition, they projected their Jwn superego strivings onto the environment, feeling that others-more or less justifiably-rejected and punished them.
). Low-scoRING WoMEN. It was brought out in Section D that a great nany of the low-scoring women were classified as "mixed neurosis. " This s partly due to the fact that in the classification scheme used, no separate :ategory was available for neurotic depression, one of the main complaints Jf our low-scoring group. Also, the diagnosis of mixed neurosis was usually ~esorted to in the case of character disorders. These also were prevalent tmong the low-scoring women.
The following excerpts from the first psychiatric interviews are typical of :he low-quartile women. Feelings of depression were given as main com- Jlaints by low-scoring patients with a great variety of other problems. Even :he one schizophrenic scoring in the low quartile complained of the charac- :eristic depression and feelings of inadequacy. The prevalence of passivity md orality is also to be noted.
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Main concern is "that I have failed repeatedly with everything I do. " Com- plains of lack of self-confidence in her abilities and in her work. States "I have built up such a resentment toward myself that I am afraid I will commit suicide. "
Several of these women, suffering from depression, felt that their symptom was related to their difficult relationship to their mothers. One young woman said she felt "a great deal of hatred" for her mother and got sleepy and irritable whenever her mother was around.
She is depressed, with loss of appetite, lassitude, and suicidal thoughts, wants to lie down all the time, requires an abnormal amount of sleep-fifteen to sixteen hours-but without gaining a feeling of vitality afterwards.
Another woman stated that she felt "things are too hard"-she'd rather go to bed. Felt depressed, weak, irritable.
In two women, the central problem was their conscious struggle with homosexual impulses. One young girl with strong intellectual interests had had a violent crush on a female teacher during adolescence. Later she formed crushes on men.
She is aware of some homosexual tendencies. She has a strong desire for friend- ship and love relationships. Depending on the satisfaction and frustration of this need, she alternates between periods of elation and depression.
The other had crying spells, the desire to sleep all the time, and also suf- fered from vomiting and cramps.
Some of the women sought help mainly because they felt they were harm- ing their children by their neurotic behavior. All of these were rather active women with interests outside the home, and with a great desire for achieve- ment and for playing a more or less masculine role.
One woman had married an invalid man whom she admired for his intel- lectual talents. She worked to support him and their child, waiting on her husband hand and foot when at home. She continually drove herself to under- take too much, felt nervous, did not sleep well, and felt she "wasn't a decent mother. " She often got spells of excessive eating, followed. by depression. Formerly she had had the same "spells" of drinking.
Another case is that of a married woman about 30 years of age who had one child of a previous marriage. She had felt extremely depressed and unable to work since she discovered that she was pregnant again. She did not want the baby because it would mean giving up a career she had just started with much satisfaction, but could not think of offering it for adoption because her husband very much wanted a child. She wanted to have help so that she would either be able to accept the child or decide to give it up. She said, "I bitterly resent having been born a female. " From her history, it appeared that she had always actively competed with boys or men. As a kindergarten child she picked fights with little boys-"I liked to beat them to a pulp to show them who was really something. " She was married twice previously,
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each time to a brilliant and successful man with whom she would compete bitterly. These marriages were unsuccessful. At the time of her treatment, she was happily married to a more passive man who admired her and encour- aged her professional ambitions. The patient was a serious, sensitive, tense person who was uncomfortable and shy in groups and preferred to be or work alone. Asked about her early life, she described herself as a thoroughly undisciplined, nonconforming child, who in spite of very high intelligence could not do well in school because she got bored and refused to do work she disliked. She did not get along with other children, and preferred to do art work by herself. In later childhood she wanted to be a cowgirl. In adoles- cence she went through a very rebellious period, then took art training and became a radical. She was talented and had had some success in various artistic fields. She was interested in modern experimental art forms and in the repre- sentation of psychological moods. She was politically left-wing but felt she could not be of great use to any political movement because of her shyness and inability to function in groups or to approach people. She described herself and her history with much psychological perceptiveness, frankness, and insight. In spite of this, psychotherapy was difficult because everything was told in a very intellectualized fashion. Instead of letting herself feel the appropriate emotions, the patient usually managed to keep quite aloof, care- fully choosing her words to describe her early environment and history.
The patient had had previous periods of depression, each time when some- thing blocked her professional ambitions. The last episode was very severe: She became afraid there was a man in the house who could harm her, and she developed such a loathing for herself that she felt her skin was covered with repulsive fish scales.
The history revealed that she was the only child of two rather neurotic people, who in her early childhood gave the girl a good deal of freedom and individual attention. In spite of this, she often felt lonely and "left out. " Through the circumstance of the parents' separation when the patient was 5, the patient came to feel that her mother had caused the beloved father much suffering and was responsible for the separation. She began to feel great dis- gust for and hostility towards her mother, who became the prototype for her image of the "shallow, pretty, exploiting woman. " Her professional interests and activities were based on identification with her professionally successful father, and perhaps also her stepmother.
It is not necessary for our purpose to go into a detailed discussion of the dynamics of this woman's personality and development. The case was pre- sented merely as a description of one type of female patient found among the low scorers. Though too extreme to be representative, the case has many characteristics typical of a whole group of low-scoring women, usually polit- ical radicals or militant liberals: the masculine identification (which is un- usually strong here), the competition with men and striving for professional
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achievement, the rejection of femininity and inability to accept the role of mother.
The latter two are exceptionally pronounced here. In most of o low-scoring women there were strong feminine identifications also whic were in conflict with the "masculine" strivings. In contrast to the hig scoring women, there is-as with low-scoring women generally-little con pulsiveness, less constriction, greater richness of fantasy life-here express in artistic and other professional fields-introversion (here particular strong), and concern with ideas and inner experience. The patient tried handle her conflicts by seeking rational explanations (therapy) and by subl mations.
In a few of the low-scoring women anxiety symptoms predominated. these cases, feelings of inadequacy were quite prominent and there w anxiety and shyness in certain social situations. One woman felt so unea: in groups that she frequently broke into a sweat. She was also jealous of h husband's interest in other women and afraid she might retaliate by having affair, as she did once before. Another patient, an unmarried woman wl was embarrassed in social situations, had developed tremors whenever s had to hold a cup or stemmed glass, or when filling out application blanl After having fallen down the stairs at a party where she was very uncomfo: able, she developed a panic of going down stairs. Also, the patient thoug she was always attracted by the wrong men-usually very neurotic m< One very inhibited young girl came to the Clinic because she was afraid l former enuresis might return. She thought she would use the symptom avoid social engagements, of which she was somewhat afraid. She felt ve guilty about her adolescent sexual interests. She had night terrors aboUI
half hour after going to sleep, in which she saw something coming down her-sometimes a net, sometimes a swarm of bugs. Sometimes an abstr: shape of a person would crawl into her bed. She would scream and jump < of bed. One case was of a more phobic character. The girl had had an anir phobia. When seen at the Clinic she was in a ''confused anxious state," afr of entering graduate school, particularly of going to see her graduate : visor. She could not bring herself to go to him and discuss her work. ~ felt that she had not accomplished much. She was also worried because : did not feel warmly towards anyone, because she felt rather hostile-parti' larly toward her mother.
There was one case with obsessive-compulsive symptoms, a woman " a previous depressive episode. At the time of her treatment she was unablt do her (clerical) work for fear she might write down something that wo embarrass her or damage someone else. The trouble began at 17 when feared to write down "dam" or "damn. " (Swearing was severely condem1 by her strict father, whom she reported she hated. ) Years later, after she r about rape in the papers she began to worry about the word "rape. " Now was afraid of writing down something pertaining to her current employ
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raping or attacking her. She was never certain whether she had not by chance inserted these ideas into a letter, or into other products of her typing work. For the last few years she had found that sedatives and alcohol would relieve her condition.
One of the low-scoring women was classified as a paranoid schizophrenic. Yet her complaints, except for a few bizarre ideas, were similar to the ones reported by other low-scoring women suffering primarily from depression. The patient described with much insight her extreme sensitivity to other people's reactions, her concern lest she be rejected by others, her early feel- ings of insecurity and of being unwanted. She said her illness started with nervousness, indecision, and fears "of not being able to keep a job, that I might harm people, of dying of a cerebral hemorrhage (her mother had died in this way); afraid I was going to die and none knew about it or cared. " When first interviewed she complained of being depressed and la"cking in the ability to concentrate on her work. She was afraid people were "question- ing her motives" and had tried to read her mind by saying things to elicit her reactions. She felt a change in the attitude of her family towards her. She had been weak and tired, attributing this to a drug which she believed was used in the food at the previous hospital. She said "there is a barrier between me and other people erected by myself. Last week I felt closer to people. "
Finally, there were two cases who were referred by physicians to whom they had turned because of physical symptoms. In one case the main com- plaint was a headache and "hypersensitivity to light, necessitating wearing of dark glasses. " The other case complained mainly of dismenorrhea, also of nausea and of muscular pains simulating her mother's arthritis. Both cases traced their symptoms to accidents. Although little material on these patients was available, it seemed very likely that they were cases of conversion hysteria.
3. THE ''MIDDLES"
Most of the data just presented pertain only to patients receiving E scores within the high or low quartiles. We have, of course, collected some data on "middle scorers. " First, there were the questionnaire data, including responses to Projective Questions, and second, the psychiatric diagnoses and Minnesota Multiphasic scores. These indicated that, on the whole, "low middles" re- sembled the low scorers more, the "high middles" showed more resemblance to the high scorers.
In addition, several clinical case studies were made of patients with middle scores. In these cases one could clearly discern both "high" and "low" per- sonality trends and, sometimes, curious inconsistencies in ideology and be- havior. This was true of some of our most disturbed patients. Most of the psychotic patients made middle scores-a few were "low middles," but most of them made high middle scores. Some explanations of this trend have been
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advanced in Section D above; it seemed to be related in these patients to ego weakness and unconcern with social reality. There were, of course, people with middle scores who were relatively little disturbed, but we have very little information concerning them.
The total sample of Clinic subjects contained 27 cases diagnosed as psy- chotic. Of these, 70 per cent (19 cases) made scores in the middle quartiles. This percentage is considerably greater than chance (which would be so per cent) and is significant at the 5 per cent level. However, little weight can be given this result because of the small number of cases.
The clinical case studies also indicate that many of the most disturbed patients tended to make middle rather than extreme scores. In these cases it can often be shown that the over-all personality picture is either "high" or "low" but that the neurotic or psychotic processes lead to certain contra- dictory opinions, or attitudes that are the opposite.
An example of such a picture is a schizophrenic man, a strongly intrapuni- tive person, thoroughly opposed to any kind of prejudice against minorities, usually a pacifist (and believer in a vague humanitarianism) who at certain times expressed marked chauvinism and destructive ideas directed against other nations. He developed these ideas when control of his own homosexu- ality and hostility was threatening to collapse. Another case is that of a man with a strongly paranoid character who had the most outspoken fascist ideology. This man's character structure and his scores on the F and PEC scales revealed that in most respects this man was very much like our high- scoring subjects. Great hostility and fear of his father had prevented genuine identifications. But the subject spent all his efforts in a fruitless attempt to prove to himself and the world that he was more powerful, capable, intelli- gent, and virtuous than his father. This manifested itself, among other ways, in continual though unrealistic and unsuccessful strivings for positions of power, in a grandiose conception of himself, in a verbose manner of speech and continual orientation toward making an impression on others. In many ways this man could be described as a psychopathic character. Still, he made only a low-middle score on E. Interviews revealed that this was related to a certain opposition to the father's prejudiced ideology, although in other areas this subject had very conventional values. Also, the mild opposition to preju- dice seemed to rest on a certain amount of identification with deprived groups. For instance, he considered the differences between whites and Negroes to be primarily due to a difference in education; in fact he would like to solve all problems in the area of group relations by giving educa- tional opportunities to all. He also considers the basis for all his own failures to be his lack of a college education due to the fact that his father lost his money just when the patient was of college age. Needless to say, this subject's ideology differed qualitatively from that of low-middle subjects whose
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characters were more typical of low scorers. These differences, however, were revealed only in the interview.
H. CONCLUSIONS
In this concluding section we shall discuss the problem of the relationship between ethnocentrism and psychological ill health in the light of the find- ings just reported. First, however, it will be necessary to make a statement about the degree to which conclusions drawn on the basis of findings from the Langley Porter Clinic group can be generalized. In our description of the sample (Section B) we have defined the Langley Porter Clinic population as a group coming mainly from the urban lower middle-class and, on the average, somewhat younger and slightly more educated and more intelligent than the general population, and more cooperative than average. In these respects Langley Porter Clinic patients are probably similar to patient groups from other psychiatric clinics in large American cities. Within the limits set by our selection procedure, the sample studied was thought to be fairly rep- resentative of the Clinic population as a whole, although an exact comparison with the clinic population at large could not be made for want of available data. Results of the present investigation which were found to be statistically significant probably hold for similar clinic groups. A question then arises as to how representative these clinic groups are of the psychologically dis- turbed (neurotic-psychotic) population as a whole. This question cannot be answered, because no one knows just what this population is like. There are countless individuals who have severe psychological disturbances but never come to the attention of clinics or private psychiatrists. On the other hand, a public clinic such as the one described probably covers a wider range of clinical pictures and social backgrounds than any other agency, certainly a much wider one than could be found among patients going to private ther- apists and institutions.
As far as the statistical significance of most of the results is concerned, much is left to be desired. The scope of the investigation did not permit the use of many more than 120 subjects. For many of our comparisons this group had to be divided into many small subgroups. Taken one by one, most of the numerical results therefore are not statistically significant, nor otherwise impressive. Whatever value there is in the present investigation lies more in the consistency of all of our findings with one another and with the findings of the study as a whole.
Now an attempt will be made to bring our findings to bear on several questions regarding the relationships between ethnocentrism and psycho- logical ill health. All of the following questions have been raised in connection with the research findings reported in this book: (1) Are people with rela-
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tively severe psychological disturbances on the average more or less preju- diced than "normal" people? (2) Are people making extreme (high or low) scores on the E scale also extreme on the dimension of mental health-mental illness? (3) Are high or low scorers prone to develop certain specific kinds of psychological disturbances? (4) Did the study of neurotic and psychotic subjects lead to new hypotheses about the character structure and its possible genetic sources in high and low scorers? (5) Is there any evidence that one of the two groups, at the opposite extremes of the E scale, was more severely disturbed than the other? Is there a relationship between ethnocentrism and psychosis?
1. Are people with relatively severe psychological disturbances on the average more or less prejudiced than "normal" people? When the average ethnocentrism scores of the Langley Porter men and women were compared with scores obtained by averaging all other groups, the Clinic group turned out to be slightly, but not significantly, less prejudiced than average. The scores showed a wide range and great variability, indicating that the group contained subjects of greatly varying ideologies and personalities. If one would like to generalize to a wider group of psychologically disturbed people, the Langley Porter Clinic mean is probably too low. As we have shown, the Clinic group was younger, somewhat more educated, intelligent, and cooperative than average. All these selective factors are known to show slight negative correlations with ethnocentrism. On these and other grounds it seems reasonable to assume that a large group of disturbed persons taken at random from the general population would on the average make prejudice scores similar to those of a group of nondisturbed people.
2. Are people making extreme (high or low) scores on the E scale also extreme on the dimension of mental health-mental illness? Most of the dy- namic formulations in this book have been derived from comparisons of subjects scoring in the high and low quartiles. An objection to this procedure has been that perhaps high and low scorers are both deviant groups, that they are "marginal and neurotic," and that "normal people" in our society are "middles," that is, mildly in agreement with the stereotypes prevalent in our culture. In order to answer the above question conclusively one would first have to establish a reliable measure of degree of psychological disturbance. This could then be correlated with ethnocentrism in a large group of subjects. No such measure was available for the present investigation. However, there were some indications that the subjects receiving middle scores on E were at least as disturbed-if not more so-than the patients making extreme scores. This statement is based on some clinical case studies of neurotic and psychotic middle scorers and on the finding that 70 per cent of our psychotic subjects scored in the middle quartiles.
3? Are high or low scorers prone to develop certain specific kinds of psy- chological disturbances? On the whole our data seem to show that the clinical
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pictures of subjects in the high quartile resemble each other and differ system- atically from the clinical pictures shown by patients from the low quartile. These trends cannot be completely described in terms of the conventional psychiatric classifications as they were used at Langley Porter Clinic. In these terms, the trends were partially expressed in a predominance of "mixed neurosis" with "depressive and anxiety features" in low-scoring women, of "anxiety states" in high-scoring women. The relationships were less marked in the men. However, clinically defined similarities among high-scoring cases, on the one hand, and low-scoring cases, on the other, cut across the lines drawn by these diagnostic classifications. There are high as well as low scorers in each of the major psychiatric categories (e. g. , schizophrenia, manic-depressive psychosis, anxiety state, hysteria, obsessive-compulsive, and "mixed neurosis"). It cannot be decided here whether this is due to the essentially nondynamic nature of the classification system or to the way in which the classifications were applied by the physicians. Probably both factors are responsible. More detailed study of the complaints as described by the patients in a first psychiatric interview revealed the following differ- ences in clinical pictures of high and low scorers.
The subjects scoring high on ethnocentrism usually displayed very little awareness of their own feelings and psychological problems. What is more, they tended to resist psychological explanations and to suppress emotion. Their complaints were very often devoid of any psychological content. The most common symptoms in both men and women were vague anxiety or physical signs of anxiety and rage. The more disturbed patients suffered from feelings of depersonalization, lack of interest, and depressed affect of a more schizoid type. Very many high-scoring men and women came to the Clinic with somatic complaints-some of them psychosomatic symptoms which could be understood as expressions of suppressed affects such as fear or rage. They were inclined to dwell at length on these symptoms to the exclusion of other problems. Some showed pathological fear of sickness, physical injury, or death.
The most frequent physical complaints of the high-scoring men in our group were stomach ulcers and physical expressions, such as tremors, sweat- ing, etc. , of tension and anxiety. Some of the cases had markedly compulsive characters, others appeared to be more "phobic" or to have characters built around defenses against passive homosexuality. In some of these cases fears of being injured or attacked, or other paranoid trends, were part of the pic- ture. Other types of cases were primarily psychopathic (one of these had admitted sexual exposure to a child) and still others were overt homosexuals. All of them, except for one case of simple schizophrenia, showed to some extent the "toughness" and masculine fa~_;ade together with various signs of extreme castration anxiety and underlying passivity. The majority of the high-scoring women complained of irritability, anxiety or hyperven-
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tilation symptoms; many also had temper outbursts or attacks of trem- bling, screaming, or fainting (probably equivalents of attacks of rage) and fear of dying during such an attack. When one of these cases was stUdied in detail, it was found that her attacks of panic, trembling, fainting, and screaming were expressions of extreme rage precipitated by an incident earlier in the day but suppressed at the time. There was one case of hysterical conversion in a woman with a very rigid character, and there were several very infantile schizoid cases with different features such as agitated depres- sion, depersonalization, and paranoid fears. All of these women, however, resembled each other in the following ways: their main problems seemed to center around the inability to express strong hostilities directed against some member of their family; their personalities were rigid and very constricted; most of them had marked compulsive traits. Rigidity of personality and the tendency to use countercathective defenses seem to be characteristic of both high-scoring? men and high-scoring women.
The low scorers were found to exhibit a wide variety of clinical pictures and complaints. They were much more familiar with themselves, more aware and accepting of emotional experiences and problems. The complaints of low-scoring patients very rarely consisted of vague anxiety or physical symptoms? alone. If anxiety without content appeared at all, the patient also reported being concerned about other problems. Usually, the patients stated their problems in terms of specific impulses, fears, or adjustment difficulties. The most common single symptom characteristic of low-scoring men and women was neurotic depression with feelings of inadequacy. Most of these patients had inhibitions in some area-sexual, work, social-and felt uneasy in group situations.
Summarizing these findings, then, one might say that some statistical rela- tionship was found for the women between high E score and the classification "anxiety state," on the one hand, low E score and a classification which was labeled "mixed neurosis" (which probably should have been called "neurotic depression"), on the other. It became clear, however, that ethnocentrism was much more strongly related to certain very general personality trends which cut across the lines drawn by the psychiatric classifications. It has therefore been impossible to speak of symptoms or "types of disturbance" without some reference to the personality syndromes in which they oc- curred. These personality syndromes will be discussed more fully, more interpretatively in the following section.
4? Did the study of neurotic and psychotic subjects lead to new hypoth- eses about the character structure and its possible genetic sources in high and low scorers? All the important variables in which high- and low-scoring patients differed, were identical with those found to differentiate high and low scorers in groups of people who were relatively little disturbed. In the
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disturbed group, however, these characteristics were seen in more exagger- ated form. In the first student group studied by the questionnaire and clinical techniques, Frenkel-Brunswik and Sanford (38) found that the high-scoring women more often mentioned health problems, in spite of the fact that their health histories appeared to be quite similar to those of the low scorers. These few, often casual, remarks about health were related to certain themes in the T. A. T. stories, where many characters suffered mutilating injuries and acci- dents. On the basis of these data, a tentative interpretation was made to the effect that high-scoring women characteristically show concern about their physical well-being because they are unconsciously afraid of being hurt as a punishment for strong hostile impulses. This hypothesis was confirmed and extended by the data furnished by the Clinic group. In the Langley Porter Clinic women, references to physical symptoms were not confined to a few more or less casual remarks but often formed the most emphasized part of the patient's statement of complaint. Intensive study of several cases sup- ported the hypothesis, developed on the basis of earlier findings (Chapter XII), that the tendency to focus on one's physical condition in this par- ticular way not only expresses strong unconscious (castration) anxiety but also represents the way in which a person with a very constricted ego defends himself against becoming aware of large areas of his emotional life.
Similarly, some of the "normal" subjects in the over-all sample of the study mentioned tendencies towards depressed feelings. The data on the low- scoring Clinic patients confirmed the hypothesis that tendencies toward feelings of inferiority and guilt and depression were consistent with a type of character structure found commonly in low scorers and would appear to some degree under conditions of inner or outer stress. In the "normal" sub- jects, however, these tendencies appeared to be relatively mild, while some of the Clinic patients were incapacitated by them.
Thus, the material from the Clinic group supported and, in some instances shed additional light upon, the dynamic hypotheses advanced in Chapters IX through XIII. Also, our data strongly bore out our hypothesis that the rela- tionships between ethnocentrism and personality variables would be essen- tially the same for "normal" and for psychologically disturbed groups, but that some of these personality trends would, in the disturbed group, appear in pathological forms and degrees.
Taking the evidence from the various techniques with which our group was studied, and recalling major conclusions from earlier chapters, we can make the following general formulation regarding the character structure of high and low scorers.
The high scorers have rigid, constricted personalities, as shown by their stereotyped, conventionalized thinking and acting and their violent and categorical rejection of everything reminding them of their own repressed
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impulses. Their egos appear to be not only very constricted but also quite undifferentiated: their range of experience, emotionally and intellectually, is narrow. It is as if they can experience only the one conventionally correct attitude or emotion in any given situation. Everything else is suppressed or denied, or if another impulse breaks through, it is experienced as something which is completely incompatible with the conception of the self, and which suddenly overwhelms the ego. In part, this high degree of ego-alienness probably derives from the fact that the impulses emerging from repression are so primitive and, especially in the women, so very hostile. Compare, for example, the ways in which two high-scoring women on the one hand, and one low-scoring woman, on the other, expressed their ambivalence towards their children. The two high-scoring women had "spells" of excitement, trembling, and various physical manifestations which they did not recognize as expressions of rage. One woman actually choked her children during such attacks, the other had had the impulse but could control it. Both tried to convince the interviewer and themselves that they "really" loved their chil- dren. The low-scoring woman was quite aware of rejecting her child, of her habitual impatience and inability to give enough love to the child. She recog- nized the effects of her behavior on the child, tried to make up for it at times and hoped that after therapy she would be able to be a better mother. The high-scoring mothers were not able to admit any deviation from the conven- tional idea that a mother, unless she is utterly depraved, can feel anything but tenderness and devotion for her children. In these, and in all of the other cases of high scorers, it seemed as if the person's ego had usually been able to keep the unacceptable impulses completely out of consciousness, by means of countercathexes, and that this prevented modifications of the impulse, such as channelization into milder and more adult forms, sublimations and the like.
