http://exhibits.library.stonybrook.edu/mfp/files/original/7bd07b6cfa28408a13dfb7a2b134ee43.pdf 7a8e9dcb7ef041dbb63226e8de460992 PDF Text Text �Reprinted from Psychopathology of Communication Grime & Strstton. Inc., 1958 Printed in. (1.5.4. 9 CHANGES IN LANGUAGE DURING ELECTROSHOCK THERAPY By ROBERT L. KAHN, PH.D., I AND MAX FINK, M.D.* Weinstein and his associates have described patterns of symbolic adaptation in patients with cerebral dysfunction.l The main emphasis in their work has been placed on altered language patterns. Their observations have shown the similarity and relationship between various kinds of behavior which were previously regarded as disparate phenomena. Instead of being isolated defects due to focal brain lesions, these phenomena can be understood as unified aspects of an altered pattern of adaptation under the conditions of a diffuse disturbance in brain function. Some of the factors which determine the particular type of adaptation shown include the premorbid personality and the nature of the environmental stresses. This emphasis on language has been shown to be a useful method of study. For example, the presence of certain characteristic changes in language under the influence of amobarbital sodium, such as disorienta— tion for time and place, denial of illness, and reduplication, has been standardized as a diagnostic test of brain disease in neurological patients?! 3 This technique has application in the study of other conditions of altered brain function, as in the somatic therapies. The electroshock population is of interest for two reasons. It is possible in these patients, as it is not in those with neurological diseases, to manipulate experimentally the stimulus causing changes in brain function. Secondly, the mode of action and the psychological changes associated with electroshock treatment remain poorly understood. In a previous study we have shown that a favorable clinical response to electroshock treatment is related to early and persistent manifestations of language changes with amobarbiN RECENT YEARS * Department of Experimental Psychiatry, Hillside Hospital, Glen Oaks, New York. Prepared with assistance from the National Institute of Mental Health, Public Health Service and the Dazian Foundation for Medical Research. 126 �CHANGES IN LANGUAGE DURING ELECTROSHOCK THERAPY 127 tal sodium characteristic of altered brain function} This finding was considered to support the hypothesis advanced by Weinstein and Kahnl’ 5 that the mechanism of therapeutic action of electrically induced convulsions lay in the creation of a condition of altered brain function in which the patient might express his problems in a new symbolic fashion, particularly in the form of denial. The present investigation is a further attempt to test this hypothesis by studying changes in language that occur with treatment. The following questions specifically were studied: 1. Are there characteristic identifiable changes in language which develop in the course of electroshock treatment? 2. Are these changes related to the clinical response? 3. Are these changes related to the degree of alteration of brain function? 4. Does the administration of amobarbital sodium prior to treatment produce any changes in language which have prognostic value for the eventual clinical response to treatment, the development of altered brain function, and the development of language changes during treatment? METHOD Population: Sixty-five consecutive referrals for electroshock treatment at the Hillside Hospital were studied. The Reiter electrostimulator was used on 49 patients, while 16 were treated with the Medcraft. There were 20 men in the series and 45 women and ages ranged from 21 to 68. Each patient was tested prior to treatment and retested during the second week of treatment after having received 4-6 convulsions, and during the third week after having received 7-9 convulsions. On each of these occasions the patient was first tested clinically and then after amobarbital sodium had been administered at the rate of .05 grams per minute until nystagmus, slurred speech, drowsiness, and errors in counting backward were noted.2 The test consisted of a standardized series of questions concerning orientation and awareness of illness. This study is based, however, on the response to only three of the questions used: (1) What is your main trouble? (2) Why did you come to this place? (3) If you could have one wish, what would you wish for? All responses were recorded verbatim. Observations were also made on such nonverbal aspects as smiling, laughing, gestures, and other bodily movements. �128 PSYCHOPATHOLOGY or COMMUNICATION RESULTS Patterns of Language Change Noted Clinically During Treatment In evaluating the changes in language, the original responses to the three questions given clinically prior to treatment were used as the baseline. The evaluation of what constituted a change was based on explicit objective changes in grammar rather than on subjective or interpretative changes as to affect, mood, feeling, pitch, voice quality, etc. In this manner the following types of language change were noted clinically during the course of treatment: (1) alteration in the syntactical use of person, (2) evasion, (3) verbal denial, (4) qualification, (5) change in tense, (6) displacement, (7) stereotyped expressions and cliches, and (8) smiling and laughing. Alteration in the syntactical use of person. Instead of using the first person singular as in the pretreatment period, 28 patients used the second or third person and, occasionally, the first person plural. To the question concerning main trouble such responses were given as, “It’s what they call a depression,” “They told me I was emotionally and mentally sick,” “We’re having a lot of trouble with my mother-in-law,” “My cousin brought me; she said I was nervous,” “What’s your main trouble, or don’t you know?” and “My Mrs. is sick and I would appreciate it if they would let her in here as soon as possible.” The reason for coming to the hospital was variously given as, “My wife brought me,” “My father told me to come here,” or “My doctor said this was a good hospital.” The wish was given as “Perfect health for my family,” “My children, my husband, and all my good friends should be healthy and happy,” and “There should be peace in the world.” Evasion. Evasion in answering the question about their illness was shown by 27 patients. This commonly took the form of answering this question with another, as, “What do you mean by my main trouble?,” “What do you expect me to say?,” “Well, what it it?,” and “What did I say last time?” Other language patterns considered evasive included such responses as, “I don’t know how to tell you,” “I don’t get what you mean,” “Let me think,” “It’s hard to say,” and “I just don’t know how to express it.’ One patient asked the examiner to give her a hint. Verbal denial. Explicit verbal denial of illness was shown by 23 patients. They either said they had no main trouble, were well or else, after giving evasive ‘I don’t know” responses, denied their illness and symptoms when specifically questioned about them. �CHANGES IN LANGUAGE DURING ELECTROSHOCK THERAPY 129 Qualification. Qualification of a response in the direction of less commitment was shown by 19 patients. This language pattern was characterized by the use of such words as “guess,” “kind of,” “sort of,” “think,” “apparently,” “probably,” “possibly,” “might be,” “seem,” “assumed,” 9, and “perhaps. Thus such responses were given as, “I guess I have been jittery,” “I seem to be very much depressed,” “Probably that I’m nervous,” “I suffer from anxieties, apparently,” “Possibly worry about the future,” “I have sort of gotten frightened,” “Mentally upset, I assume,” and “I think I’m a little insecure.” Change in tense. In 18 patients there was a change in tense in describing their illness. In most cases the patient used the past tense: “I was depressed when I came here” or “I had been nervous.” In other cases the patient answered the question about his main trouble by putting it in the future tense as a wish. Displacement. In 20 cases there was a displacement of the complaint to something other than originally given prior to treatment. This was invariably less serious than the original complaint. Sometimes the displacement was in the form of a somatic complaint, as saying the main trouble was “diarrhea,” “headaches,” “pain in the feet,” “I slammed the finger in the door,” and “I’ve got an itch.” In other cases the displacement was to some concrete aspect of the hospital situation, as “My main trouble is getting these treatments,” or “I’m upset because I was transferred to another ward.” Stereotyped expressions and cliches. The use of stereotyped expressions and cliches was shown by 11 patients. They gave such responses as “It seems to me under the proper circumstances I’d be all right,” “ [My trouble is] monetary problems with people that are honorary and sincere,” “That’s the root of the whole thing,” “The only thing certain is death and taxes,” “Learn my lesson and be a good boy,” “To be a person of pep and reliability,” and “I just want to stop being a lazy lout.” One woman responded to a question of her one wish with, “I think I should consult my husband before I make a wish because he’s a lawyer and the father of my children.” Smiling and laughing. In 20 cases the patient was noted to smile or laugh either immediately preceding or following his response to the question concerning his illness. Language Changes Shown with Amobarbital Sodium During Treatment The language patterns after amobarbital sodium during the second �130 PSYCHOPATHOLOGY OF COMMUNICATION and third weeks of treatment were similar to those noted clinically. With the drug, however, the changes appeared earlier in the course of treatment. A given language pattern might be noted in the second week of treatment with the drug, but would not occur clinically until the third week. In addition, the reactions to the drug took more extreme forms, which are described as (l) cryptic responses, and (2) withdrawal reactions. Cryptic responses. These were shown by 23 patients. Responses were classed as cryptic when they had no obvious relevance to the test question or when their meaning was obscure, representing a very personalized expression. Thus one patient, when asked his main trouble, said, “Nightmare of the afternoon of the evening of the nightmare.” Others do the know the didn’t “I such problems—couldn’t as responses gave problems,” “Getting my husband to write down what he does,” or “What could I say—you don’t get the crossword.” Withdrawal reactions. Some pattern of withdrawal was noted in 33 patients. This behavior was characterized by incomplete sentences, incoherent mumbling, neologisms, perseveration, the use of a foreign language by bilingual patients, and delay or failure to respond to the questions. These patients would characteristically lie with their eyes open, would smile or turn their heads when the examiner spoke, and would speak clearly and promptly and in English when asked questions not pertaining to their illness. Other Changes in Language Other changes in language were noted both clinically and with amobarbital sodium in response to the other questions of the test battery but not as a part of this study. There was frequent misnaming of the examiner or reference to him as “Mister.” With the drug those patients who had a “positive reaction,” i.e., one characteristic of altered brain function, showed the characteristic patterns of disorientation for place and time and confabulation described in previous communications. (2) Relation of Language Changes to Clinical Response The evaluation of clinical response to treatment was made independently of this study. The patients were rated by the supervising psychiatrist in charge of the treatments, by the patient’s own therapist and supervising psychiatrist, and by the medical director. On the basis of these ratings the patients were classified into three groups: 28 patients were �CHANGES IN LANGUAGE DURING ELECTROSHOCK THERAPY 13]. considered much improved, no longer showing the symptoms which had brought them into the hospital; 22 patients were rated as moderately improved, showing some symptomatic relief but still showing disturbing features; and 15 were regarded as unimproved, having shown only equivocal or transient changes at best. The ratings were short term evaluations, being made within two months after completion of treatment. For quantitative purposes the language changes shown during both the second and third weeks of treatment have been grouped together as though the patients had been tested only once. If a particular pattern was shown during both periods, the item was scored only once. Altogether, 89 per cent of the patients showed at least one of these patterns of language change clinically during treatment. Such changes were found in all of the much improved patients but in only 73 per cent of the unimproved group. It was apparent that there was a relation between the degree of clinical improvement and the number of changes in language patterns. When the data are analyzed for the patients who showed three or more language pattern changes, there is a significant difference between the groups (table 1). While 68 per cent of the much improved patients showed three or more language changes, only 20 per cent of the unimproved patients showed this degree of language change. Using Chi-square, the over-all difference is significant at better than the 1 per cent level of confidence. TABLE 1.—Relation of Language Changes Shown Clinically to Response to Treatment Three or more * patterns Fewer than three Change No. Much improved Moderately improved Unimproved 28 19 22 7 32 15 68 15 3 20 12 80 65 29 45 per cent 36 55 per cent Total *X’ = 11.26; P < 68 per cent patterns 9 * 32 per cent .01 When each language pattern is analyzed individually (as shown in fig. 1) it becomes apparent that not all patterns discriminated equally �132 PSYCHOPATHOLOGY OF COMMUNICATION between the groups. In all but one case, a greater percentage of the much improved group was most likely to show denial, use of the second or third person, evasion, and displacement of complaint. The only lanmuch the between found difierence which little was on pattern guage improved and unimproved patients was the incidence of smiling and laughing. Analysis of the changes shown by the difierent groups under amytal is shown for the cryptic and withdrawal reactions only in figure 1. While the crytic responses did not vary much with the different groups, the showing of a withdrawal reaction differentiated the three groups significantlyfi‘ occurring in 71 per cent of the much improved, 45 per cent of the moderately improved, and only 20 per cent of the unimproved patients. Relation of Language Changes to Electroencephalographic Response In a previous communication a method of quantitatively evaluating electroencephalographic records was described.6 Criteoria were established for rating records as showing relatively high, middle or low degree of slowing according to five criteria: average per cent time delta waves (waves of six or fewer cycles per second), the highest per cent time delta waves at any one lead, the lowest frequency in the record, the highest amplitude of delta waves, and the longest duration of a burst of delta waves. In the present study, an electroencephalogram was obtained prior to treatment and in the second and third weeks of treatment. Each record was evaluated according to the dichotomy of showing a relatively high degree of delta activity or not, using these criteria. In table 2 the relationship is shown between electroencephalographic slowing and changes in language. Those patients with the highest degree of cerebral dysfunction, having high degree delta in both the second and third weeks of treatment, show a greater number of language changes both clinically and with amobarbital sodium. Using the withdrawal reaction as an index of the drug effect, however, the difference just fails to be statistically significant. Pretreatment Language Patterns The language patterns described in this study were considered as changes only when they occurred after the original pretreatment clinical test which was used as a baseline. Seven patients, however, showed some " X2 = 10.72, significant at better than the 1 per cent level of confidence. �133 CHANGES IN LANGUAGE DURING ELECTROSHOCK THERAPY TABLE 2.—Relation of Language Change to High Degree Delta on the Electroencephalogram During the Second and Third Weeks of Treatment Withdrawal reactions with amobarhital sodium T Change No. Three or more changes clinically Both weeks high Delta Activity One week high Delta Activity No high Delta Activity 25 16 16 8 50 9 56 24 6 25 8 33 = 7.62; P < TX” = 4.87; P < * X2 * 64 per cent 15 60 per cent .05 .10 M form of these language patterns in the initial clinical test. The manifestation of these same patterns by these patients at any other time was accordingly not scored as a change. When given amobarhital sodium prior to treatment, however, 30 patients (or 46 per cent of the total) showed some language change comparable to that noted during treatment. Table 3 shows the relation between such changes at this time and the eventual clinical response. These changes were found in 68 per cent of the much improved patients, in 36 per cent of the moderately improved, and in 20 per cent of the unimproved groups. TABLE 3.—-—Relation of Pretreatment Language Changes with Amobarbital Sodium to Eventual Clinical Response Change No. Much improved Moderately improved Unimproved 28 19 22 8 36 15 3 20 “ X2 = 10.30; P < .01 Change with amobarhital sodium 68 per cent * �134 PSYCHOPATHOLOGY OF COMMUNICATION In table 4 it is demonstrated that the pretreatment change with the drug was also prognostic of the eventual physiological response to treatment as measured by the degree of electroencephalographic slowing. The over-all distribution just falls short of statistical significance, although when those who showed high delta activity in both periods are compared with all the other cases as a group, the difference is significant at the 5 per cent level of confidence. of Pretreatment Changes with Amobarbital Sodium to High Degree EEG Delta Activity During the Second and Third Weeks of Treatment TABLE 4.———Relation Both weeks high Delta Activity One week high Delta Activity No high Delta Activity "‘X2 = 5.27; Change with amobarbital sodium No. Change P < * 64 per cent 25 16 16 6 38 24 8 33 .10 Finally, the initial response to amobarhital sodium was also prognostic of the degree of language change shown clinically and to the manifestation of withdrawal reactions with the drug during treatment (table 5). Between Pretreatment Language Response to Amobarbital Sodium and Clinical Changes and Withdrawal During Treatment TABLE 5.——Relati0n No. Pretreatment Three or more clinical lan* guage patterns barbital sodium = 4.26; P < 'l'X2 = 6.88; P < "‘X2 .05 .01 tions to amobarbital sodium '1‘ 30 18 60 per cent 21 70 per cent 35 11 31 12 34 response to amobarhital sodium N0 pretreatment response to amo- Withdrawal reac- �CHANGES IN LANGUAGE DURING ELECTROSHOCK THERAPY 135 DISCUSSION The relationship of the language changes to the development of altered brain function and to the clinical response is consistent with our original hypothesis concerning the mode of action of electroshock treatment. In 6 studies4’ we have shown that the clinical outcome is related previous to the presence and degree of alteration in cerebral function. Using the “amytal test”2 and the EEG as indices, it has been found that those patients with the earliest and most persistent manifestations of cerebral dysfunction were most likely to have a favorable response. Such physiological changes create the milieu which facilitates behavioral change. The present study, analyzing language patterns, clarifies the nature of the behavioral changes that occur with treatment. The language shown originally (prior to treatment) may be summarized in the statement, “I have this particular illness.” The subject of this sentence answers the question “who,” the predicate refers to “what,” and the verb describes the relationship, including the temporal and intensity aspects. During treatment the subject of the sentence may be modified by changes in the use of person, so that the sentence might read, “You [or he, she, or they] have this particular illness.” Changes in the predicate are shown by such patterns as displacement or evasion. In displacement the sentence might read, “I have some other kind of illness,” while, with evasion, it would be, “I have something, but I don’t know what.” Changes in the verb are shown by denial, qualification, or alteration of tense. In denial the statement would be, “I don’t have this particular illness;” a qualified sentence would read, “I might have this particular illnessg” while with alteration of tense the sentence would be, “I had this particular illness.” Some language patterns modify the sentence as a whole. If the patient smiles, or if he introduces his statement by saying, “The doctors tell me that . . . ,” any part or all of the sentence may be modified. In other reactions, particularly those noted under amytal, the patient avoids giving any meaningful statement at all. In the withdrawal reaction he says nothing or omits part of the sentence. In the use of cliches or cryptic expressions no specific referential meaning can be drawn from the language. It is evident from this analysis that the language changes are not random or bizarre, but form a patterned reorganization of communica- �136 PSYCHOPATHOLOGY OF COMMUNICATION tion characterized by an alteration in the patient’s attitudes to his problems and his illness. The patient either says he is not now and never has been ill, displaces his illness temporally, spatially, or personally, is less committed to his awareness of his illness by the use of qualifications, or avoids the whole problem by evasion and noncommunication. These patterns are comparable to those noted previously by Weinstein and Kahn:l in patients with cerebral disorders, and referred to by these authors as the “language of denial.” Similar language changes have also been described following other somatic therapies. Frank“ 8 reports that lobotomized patients avoid talking about the operation, and he states that “the facility and glibness with which they say ‘well I had an operation for my nerves, I guess’ contain the quality of unconscious denial.” Legault,9 working intensively with post-lobotomy patients, found persistent attitudes of denial. One patient, when asked why she came to see the doctor, said it was her relatives’ idea. Many gave qualified responses, saying they “supposed” they had had an operation. Others doubted that the operation was on the brain, or used an evasive, stereotyped expression as “some nerve in there,” or displaced the procedure as in, “Oh, yes, I went to the hospital and got two black eyes.” When asked about the symtoms that led up to the operation, patients gave such response as, “It seems to have gone.” In studying patients who showed clinical improvement following prolonged coma reactions in insulin coma therapy, we have noted similar changes in language. In a case report10 we noted the appearance of reduplicative phenomena, evasion, verbal denial, displacement, increased use of stereotyped expressions and cliches, cryptic responses, and much smiling and laughing, at a time when clinical improvement was most marked. Since these language changes occur most frequently in patients who are clinically evaluated as improved, may not the language patterns themselves be the critical cues that give a favorable clinical impression? There is traditionally much difficulty in rating patients after treatment. Such evaluations are highly variable because of the lack of suitable objective criteria. While there are other objective cues which can be used, such as the amount of sedation required or the quantity of food eaten, the appearance of these language patterns may constitute an operational basis for clinical evaluation in the psychiatric interview. Not all patients, however, who showed at least three of the language changes were regarded as much improved, and not all of the much im- �CHANGES IN LANGUAGE DURING ELECTROSHOCK THERAPY 137 proved patients showed this degree of change. There may be other aspects of language and communication not covered by this study which are significant. Another explanation is that the use of these language patterns may vary in time or in different situations. On the basis of our previous observations of the “Amytal test” and the electroencephalogram in electroshock patients, we should predict that unimproved patients would show these language changes only transiently, while improved patients would show them persistently. Future work should also be directed toward comparison of language patterns shown when the patient is speaking to a physician with those used when he is with his family or friends. The degree to which members of the patient’s family are made more comfortable by the changed language, and even their inclination to use similar language, may explain the variability in the duration of 11 and Both Kahnl' Weinstein and improvement following treatment. Legault9 have indicated a relationship between the patterns of communication of the patient and those of his family. Finally, our results demonstrate the prognostic usefulness of amobarbital sodium administered prior to treatment. The prognostic value of the drug in the somatic therapies has been noted previously by Hoch12 and others,““14 who felt that patients who became more normal in speech, ideation, and behavior under the influence of barbiturates were most likely to improve with treatment. In the present study the manifestation of a change in language with the drug was related not only to the development of altered brain function and to the clinical outcome, but to the eventual manifestation of these language patterns clinically. On this basis, an operational definition of the goal of electroshock therapy might be described as enduring clinical manifestation of those language patterns which occur initially only with amobarbital sodium. SUMMARY AND CONCLUSIONS consecutive patients referred for electroshock treatment were studied prior to and during the second and third weeks of treatment. Each patient was tested at these times both clinically and with amobarbital sodium with a standard series of questions concerning attitude toward illness. 2. The results showed that characteristic changes in language occurred both clinically and with amobarbital sodium during treatment. These changes were significantly related to the clinical response to treatment 1. Sixty-five �138 PSYCHOPATHOLOGY OF COMMUNICATION M and to the degree of alteration of brain function as measured by the electroencephalogram. 3. The presence of these language patterns with amobarbital sodium prior to treatment was related to the eventual clinical response, the development of altered brain function, and the development of language changes clinically during treatment. 70 a 6050 40 'lo 30 FIG. 1. CLINICAL WITH AMOBARBITAL r-——| I uucu Imovso- Ei Ionmovw Cl ‘ummovso Relation of each language pattern to response to treatment. 4. It is felt that these language changes constitute an operational basis for the evaluation of the clinical response. 5. The results support the hypothesis that the therapeutic mechanism of electroshock treatment is the development of different patterns of symbolic adaptation to the patient’s problems and illness under the conditions of altered brain function. REFERENCES 1. WEINSTEIN, E. A., AND KAHN, R. 2. L.: Denial of Illness: Symbolic and Physiological Aspects. Springfield, III., Charles C. Thomas, 1955. SUGARMAN, L. A., AND LINN, L.: Diagnostic use of amobarhital sodium (“Amytal Sodium”) in organic brain disease. Am. J. Psychiat. —, —, 112: 889-894, 1953. 3. —-~, , AND MALITZ, 5.: Serial administration of the “Amytal test” for brain disease: its diagnostic and prognostic value. Arch. Neurol. & Psychiat. 71 : 217-226, 1954. �CHANGES IN LANGUAGE DURING ELECTROSHOCK THERAPY 139 Relation between altered brain function and denial in electroshock therapy. Arch. Neurol. & Psychiat. KAHN, R. L., FINK, M., AND WEINSTEIN, E. A.: 76: 23-29, 1956. WEINSTEIN, E. A., LINN, L., AND KAHN, R. L.: Psychosis during electroshock therapy: its relation to the theory of shock therapy. Am. J. Psychiat. 109: 22-26, 1952. FINK, M., AND KAHN, R. L.: Quantitative studies of slow wave activity following electroshock, Electroencephalog. Clin. Neurophysiol. 8: 158, 1956. FRANK, J .: Clinical survey and results of 200 cases of prefrontal leucotomy. J. Ment. Sci. 92: 497-508, 1946. —: Some aspects of lobotomy (prefrontal leucotomy) under psychoanalytic scrutiny. Psychiatry 13: 35-42, 1950. LEGAULT, 0.: Denial as a complex process in post lobotomy. Psychiatry 17: 153-161, 1954. 10. KAHN, R. L., GRAUBERT, D., ll. FINK, M.: Delusional reduplication of parts of the body after insulin coma therapy. J. Hillside Hosp. 4: 134-137, 1955. WEINSTEIN, E. A., AND KAHN, R. L.: Personality factors in denial of illness. AND Arch. Neurol. & Psychiat. 69: 355-367, 1953. 12. HOCH, P. H.: The present status of narcodiagnosis and therapy. J. Nerv. Ment. Dis. 103: 248-259, 1946. 13. HARRIS, M. M., Honwn‘z, W. A., AND MILCH, E. A.: Regarding Sodium Amytal as a prognostic aid in insulin and metrozol shock therapy of mental patients (dementia praecox). Am. J. Psychiat. 96: 327, 1939. 14. GOTTLIEB, J. 5., AND HOPE, J. M.: Prognostic value of intravenous administration of Sodium Amytal in cases of schizophrenia. Arch. Neurol. & Psychiat. 46: 86-100, 1941. ��r i , ‘ 4‘ __ W g 1" ' 3 m' 13 1956 ‘ L g 0 cm In meme: mama wrmsnocx mm! Robert L. mm, mm. (1) m m; 3.9. (2) x a 3 E m the Roman Service, Rama 303mm, f 610:: om, In Ion-k Research Assistant (Psychology). (1) (2) Inmmumrtufflmumrdn : um,upon,bymtmavrmmhmmmmeumwmmum l hum). Instant-a We quiz . .____.,_T f 3 32 I m M“ 7 , , , ‘ of Heath, Public Health Service, and tin mm mum :m' W/we‘bé , . 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Album first pom singular is wing and 12mm. , in tho pmtmttmt Warmingtha patient. used the second or third pom and occasionally the first. person plural. to me question anoaming min trouble such reopen.” ward given us ”It's what they call a depress- 10a.”- 17823.64, 28 Whaytoldmlmmfiomuyandmmliuck,‘ We'mhavingalatef trouble with w mflme-lm,“ my cousinbrnght no; she said I was mus,“ mam troublo, er mm mm,“ and my lira. it sick and I tram tppmciato it bar in how u soon a pas-ibis.” thq mum team for coming to the heapiul m anomaly given a W wife hm: no," "W "What‘s 11‘ tamortaldm to m hora! oriwdeow mid mama mumm.‘ will: an: grim as “Part-rat ' The 3.0% mu: for w M13," W alumna.- my Tho husband and anwgoodfm uhauldbelnnlflvandhappy' mfimmaummmm m Md.“ �“”1 ‘ ~5i I LAW Men Wiring m. m M 2. w 1:: 21 patients. rm- with a question, as ”What. do. mm; m Wm momma the queetioh about their tea: the tom of you new by m main trouble?,' “that do you «poet mo; won, what 1:: m,“ and "What «he 1 may last than?“ Gum-1W patterns considered and" included such responses as ”I don't know how to tell you,“ ”I don’t get what you mean," "Let ale think,“ um hard to any,“ ad “I no to m Just don‘t hint. how to expanse 11:." One patient asked the «minor to give her a W. mutwmmammummwzspu an,” Wm W. 1mm. they either math-y had no um «am or an axing evasive “I don't mow” reapeneeo, denied specifically questioned about. him. ' eomltmont the use their illness and a... arm- mention a: a meme in the dimtion a: 1»- m ohm by 19 patients. a: were. as ”31103:," ably, " "possibly,“ ”man. be,“ were given no '1 gun: I have ”pmbably that I'm This lulguago pattern was characterised by ”kind of, “an,“ been ' , “sort at " ”think " “apparentlyfl "prob- “assumed," and “perhape." That such Jittery,” “I seen to he very ream mammaed,“ mom,” “I suffer from emotion, apparently,“ ”Poenbly early about the fume," ”I have sort or! gotten momma,“ upset, I and ”I think I'a a little inseam..." W. ”W ‘ Inlapntiente therewaeaohangein um,” mum» in; their 1111:)“. In most cane the patient used the past tense, as "I wan depressed when I one here” or 'I had been mm.” In other canoe the patient answered the question about his main trmzble by ' 131%(2mg. In 20 cases mung it in the future there no a diamamnt tense as 3 Huh. of the Wt ‘ W to something other than originally given prior to treatment. This was mummy lest Bonan- than the original comm. Sometimes the dilplacamnt was in the tom of a emetic complaint, as laying the main trouble was ”diarrhea," “headaches,“ �WWWWMI—Fr‘ .6. ' ”pm in the tests," “I slams the rings;- in the door,“ stair case: the displacemnt as ‘33: main form»! m to some mores. aspect or the: itch.” In hospital situation, trauma in getting those treatments," or “I'm upset because I to another 7.} and "I‘vs got. an was trans- wand.” Sufism mania and 011mg. Tho use of stereotyped sxpmssim andsliohumaambyupltisntl. Thsygan-uehnnponauunltmtam undo:- the proper circumstance: Igd be alright," with pupils than. are honorary and sinners,“ “The only '1‘0 be thing «mm is “(my tmblo in) monetary "Tut’- the root of the (bath and taxes,“ "Loam my pmblou whole thing,“ lesson and be a good boy,” person a! pep Ind nhtbility,” and “I just want to stop being a hly lent.“ Muhammlpmbdto‘aqusstimothsrmwishuth, 'Imnkllhmaoonsultw a. W. husband borers 8. laugh I make a wish became ho'a a lawn: and the {nth-r or InfiOcaauthopatimtmmtodtoamoor 01m manuly wounding or following his coming xv childish." suspense to the question can- nu 111m". to. language ”zoom um:- ambarbitsl mom during to. mono and tom: units of treatment. were 11min:- to those noted clmenlly. with the drug, haunt, the changes 5mm earlier in the sour» or treatment. A given Imguags pattern might be noted in the second was]: at insistent with tho drug, but. would not occur annually until the third mt. In Audition, the motions to the drug took more extreme forms, which are ascribed cryptic responses and withdrawal remnants. 1. W. u patients. 3031mm” wars class-sdas cmtiswhmthsyhndmobfim relevance to the testqueetion ormthsir 31118 was shown by 23 m obscure, 1'31)an a very momma-d «pr-union. Thu: ms patient, MWMsMntmnble, ma'mghmoftmuumomofmmmgattm naming night-am.” Others gave such msponsoa an to. problem," ”gutting no husband to you duo‘s get. the naturism." '1 MN. know the pmblsm - cm‘t do ma dm mo he does,“ or firm oouu I uy .. �M_W~«W.“hm... ,Wfir—yyw'V‘amn"WW—wzmw. wm-u.www‘wex"w\’murvxl'ww’byum—lam. 7, am....-.. We. .: . ~ . , V . ... 7 or Wham-x“... .3». > my- a. ~u..r-_..L-r.-‘~w flaw. ,‘m,r__ wry", “Tee ‘11ng reaction. 8m pattern or withdrawal was noted in 33 patients. 2. m: behavior we: ohenoteriled by ineomlete egim, pomemtdon, the use or failure to eve-pond of e totem Manage by bilingual patients, and delay to the questions. meet; patiente would cheruoterietioelly lie m1. with their eyes open, would or turn their heed clearly end promptly and in would speak eentencee, incoherent mumbling, mela- when the miner epoke, and Well when asked motions not pertaining to their illness. comm sodium My endwith ambarbitel oom- changes in hnguege were newborn in neponee to the other qua-time of the tut battery but not part of thie more use frequent dimming of the manner, or uteri-mg to hm :- .‘Eflater.’ with the drug these Intimate who had e “punitive reaction,“ my one characteristic characteristic patterns of acclimation for place and time and contebuhtion deeorlbed in preview! communion! (2) . of altered man Motion, showed the the evaluation of clinioel memo to treatment we mede independently of thie may. The Intimate were mted by the supervising peyohietnet in charge of the teammate, the patient‘fl om therapist end eupenieing peydxiatflat, anaby the director. 0:: the beeie of these ratings the petiente were unsealed “eel into three gmpa: W turned, 28 pmenu um widened much which brought then aiming em into the hoepitel; eynptometio 22 improved, no longer showing the petiente were rated as moderately relief, but still ehowing dimming restore" 15 were ragweed ee mmproved, having elbow: on]: equivocal or trmeient and We at beet. me rating: were abort term evaluations, being ude within two loathe after coupletim of them. �PERCENTAGE SHOWING EACH LANGUAGE PATTERN ACCORDING TO RESPONSE TO TREATMENT 70 60 CLINICAL I—————————-‘ WITH AMOBARBITAL l———_I I MUCH IMPROVED El UNIMPROVED I400. IMPROVED �*8. For quantitative purposes the language change: diam during both the mead third week: of tmtaent have been grouped together“ as though the patient: had been tested only once. If e particular pattern we chm during both periods, the the: me scored only wee. ntegether, 895 of the petiente enabled at least one at and then patterns of We manually dining treatment. Such changes were fomdinullthemch mpmvoepauembntinonly7motuuunmpmdm. It as nmt. and the amber [the patients a: chengee who showed mungmgo patterns. three or more leaguege language change. em a.“ is analysed for Wed petm enlyZOSottbeunimpmedpaflenu ienteehmdthmotmnlmgugechangee, this degree of When We- petum changes, there is a signifi- I). ‘gieent differ-wee between the groups (Table shaved clinieel apparent that. there me e relation between the degru of 681 of the much Bung cm! the menu dietdbufidnie lim- mMatbetmtnmth-uwaercmnm. Relatian of. W m 1mm (28) WW MW (22) W (15) 1‘0“!- (65) Chang" W Shawn 3. Wally to Ream“ to Treatment. lie. lo. 5 1 19 685 9 32: 7 )2! 15 681 3 201 12 895 29 ' W 36 551 :2 - 11.25 1! <m Hheneachlengmge pettemiemelyeedmdivimm,um1nfl¢m1, itbecaneeeppemtthetnotenpe‘btem wcmmequmymmw. Infilbntoaeem,emmmtmeftmmmmdpeumuwmmn ’ �Y «my v m. n.“ .-‘ nmxw “gamma. — yawn , v mama-gm m w“... n- ,.—., »1—0” —W -.~.- - V , , n «Fur run...“ .- - . 17,1,» - . , men-1mm, mottheeecmdormmpeum, Wanda-Newt o! ambush; The afly 1111311130 petum on While}: little airtime was found between mmmmmmmdmmamemdmmmum. .Anuymatmmemwmwrmmmup-meumm termerypueandwithdmel mam anlyinrigun 1. mmaypuc reepeneee did mtnrymeh with the afferent groups, the withdml, moving of e mum differentiated the three gmupe eigfifimm: occurring in 711 of the mach Whfldthemdenflhhpmndmdmmzfiottbmnpmdpauwu. x. : mu.“ Mum of In a e to ., vs; mea new M of qumtitafivm Mam electro- Mama pm ducribed (6). emeMgraphic ' a resend: records an m inning relatively high, middle ,a; criteria 62‘ ~ were established low degree for rating of abnonnliia according to five agitating avenge percent. time delta. wee (waves at :11 cycles per mood or lees), the highest percent time delta. mm at my one low. the lowest tremmney lathe moord,thehigheetamplitudeofdelteme, burst. of delta me. mummumote In the present study, an electroencephelogm wee obtained priortotmmntandm the ”Windmirdmk a: treatment. Each ”comm «alum mending to the dichom at showing eliw er m, using the-e axe-Lurk. In Table ality V and changes the relation-hip 2 in animation, Wag show a 1mm. am reletively h1g1 demo at ebnon'e- mm mm abetroonaeplulognphtc linem. Tho: patients with the in Why of high mate; mm: 18 I. greatest degree at cerebral both the «can! I2 a 10.72, thinner:- at mmt, hmge change- both clinicallyxand with Waite]. and“... the mama. mum at! mime-u: at the drug effect. ' m, was the 3m. ran- to be statistically significant. I» end. Wimt 1% better than the ' 11 level or comm. �fl‘rfiwwwme—wmm. . ‘ermmmfimvfimimmw' TABLE Relation of Language Ghana. ’60 High 3 WW (25) OnMunimzé) ‘ lo 315: Ahnamauw (2h) mm withdrawal Motion! with W191}. Seem: i lo. 1 15 as a 50% 6 255 - 15 601 _ 9 5“ ‘ B 335 . Yoa P < 0°, :2 12 Language when they ._._.r,._r. Eloctmmmalom Dunne , m1: < ‘ Both Weeks 31g: 2h: , of Treatment clinical]: lo. may “at on the or Kan changes m._.—r.m~. 2. 83m and Third flecks the , P pat-Mm «termed in that: stuck wan manned afar tho original ’ has? .19 < midsmd a: change: mmmm clinical test which an and u a. baseline. Bum patients, 11mm, .Ihmd can form of than 1mm puttem in the initial 91.1mm test. me minimum or thus same pattern! bythaeepnuenuatmomrtimmmonnnmnatuconduachmgo. mm gum Wits). actual prior to tmtmt, War, 30 patients", at Wot‘flwmu,mmdmhngmgammnbhmmntnommtmh neat. In‘hbh3thonhumbomahmgamhchmguat mamumhm m'mmmeumm mm». Manfmdméfifidmmw pmdpmmnu, thwzyséiutlmnoammynwdwamozmmmd W. . ‘ , par" .— .V �w :u—v-r—wwxv—mww: Relatim of W W3 Pn-tmmt Language Ghangon autumnal Mun with mm and clinical Mona cm. with Ambarbital mu 1 Ho. Knob Impravod (28) Hodomtely MIMI: W 68$ 19 (28) 8 36% 3 W 30 It“ (15) Tom (65) l :3 - 10.30 P< In Tab}. was I; .01 it 1. “infiltrated that the pm-vtmtmnt change with the also prognostic of tho eventual drug Widow anionic to tmtment as mound ouctmcaphalogmmc abnomanw. Tho mun distribution 3m; tall: chart at statistical lawman, although than who my: almonby m. magic. 01' m mlityinboflpeuoda an conpnrodwiflzall’ehsothor crence is significant at th- 51 1m]. 91‘ canfldonoo. Relation of ma mnuam, thaw:- Pwtmmt Languag- Ghanges with manual. Sodium and High Basra Em Abnomliw Drug the Second and Third Weeks of Tmman‘b Both Wuks High One week mmty (25) M Announnw (16) Chung: With Amobarbital Sodium Ho. 1 16 6&1 6 . 38$ ’ la High Abnormality (2h) 8 335 - 5.27 P<olO 1a �many, the initial degru a! Ianguagl clung. I‘hm cunicamand "actions with the drug during twat-ant (km: S). tho m hcpom to 5 . human at Pro-tantalum sodium.an pregnant?“ at to tho Mutation otirithdmnl response to ambarbital Language . NW mm mm: 5041mm . 1': 011mm Chang“ and Withdrawal Remuom 3 Clinical PatternLeague. 03' Hora lo. Pmtmmm Respom to max-mm Sodium (30) In l’ru—treatment Response to Mammal Soditm (35) 18 , 11 :2 aims 9‘00; Withdrawal Reaction! fio Amour-Mu]. Sodium 1 30. i 601 21 705 311 12 3M - 6.38 P<ll°1 x2 _ �'Iwwa‘v-rI—Ku,WM wc-v— ~33- w".— «my. qzwrr * Discussim the relationship or the language changes to the development of sltsred brain function and to the clinicsl reepcnee is cmistent with our original vaethesie cenceming the nude have shown ct action or electmehock treatment. In previous stmnee that the clinical outcome is related to the (hfié) we presence and degree of alter- ”mm test" (2) and the we as indicse, it has been fomd that those patients with the earliest and most persistent Mutations were met likely to have a favorable response. Such physioof cerebral aticn in cerebral function. Using the mm logical changes create the milieu which facilitates behavioral change. present study, analysing language petteme, clezii’ies the nature a: the beheviorel changes that occur with treatment. the language chem criginelly, mic:- tc. treatment, my be amused in the The statement, "I have this particular illness.” The subject or this sentence answers the questicn 'Who,’the predicate refers to What,‘ and the verb describes the relationship, including the femoral and intensity aspects. During treatment the sub- dectoi’thesentencemybenofltiedbycmngesinthemotpereon, eothntthe sentence night read "You (or he, she or they) have this particular illness." Changes in the predicate are shown by such. fiettem as displacement or evasion. In displncs- nent the eentencc night tied “I have ecu other kind of illness," em... with evasion, whet.” Change: in the verb are it would be, "I have something, but I don't m qualification or alteration of tones. In denial the statement would be, “I don‘t have this particular illnessg' a. qualified sentence would read, “I light have this particular illneseg“ while with alteration or tense the sentence would be, "I as this particular illness,” flown by deniel, Sons language psttems- modify the sentence as a whole. " If the patient mice, or 1: n. introduces his etstewent by saying. "no doctors tell me theta...“ any, pert or all of the sentence my be emailed. Other reactions, particularly those noted under mytcl amid giving any meaningful statemt at ell. In the withdrawal reaction w”... �W, wwcww—mw '-—-—'- ..r.-_m..—w., ”fir .,,,,.:.._._‘,._.. r_.‘-“‘1KvW“fiW——r—W‘w‘wwflwmwwi'w ,_,. WWW .Vw—ya-awwmwnmr an... Wpemsaysnoflfingormiupertottlnsen’om. Intheuseotoliohesot cryptic expxessions no specific referential meshing can be dram free the language. or numemm-WumtwmoW-mmom bot rose mourned him, mrzaniutim a of omioeuon Motorised by so alteration in the petient's attitudes to his problems and his illness. The patient either says he is not now and never has ill, displaces his illness temporslly, or parsmslly, in less committed to his or his illness by the use of quelifioeums, or avoids the whole problem by evasion and These pettems en oonpereble to these noted previously by Weinstein end Kahn (1) in patients with cerebral disorders, and who Memo to than as the "m3. w spam use of detain." Sinus: lsngusge mm” Manon. changes have also been described following other emetic therapies. Frank (7,8) reported that lebotonised ptiente avoid talking sheet the operation, end he states that " the teoility and glibness with which they say Well 1 had so operation for nerves, I guess' contain the quality a! moon-:' scion!» q denial." Benoit (9), working mummy with postnlobotouy patients, some ‘ persistent attitudes a: denial. the patient. when asked why she ems to see the doot-or, said it was her, relatives' idea. new game qulii'ied responses, saying they owned the operation was on the brain, or used an evasive, stereotyped «passion as "sou nerve in there,” or aispleoed the procedure es in “oh, yes, I went to the hospital and got one black eyes.“ when asked “suppose“ they had an operation. Others ' about the symptoms that led up to the eperstioo suoh responses were given as ”it seems to have gone." In stucbring patients who showed clinical improvemt following prelooged om reactions in insulin eons thin-em, we have noted sinilsr changes in lengoege. In a ease report (.10) we noted the sppeerenoe of nduplicetive phenomena, evasion, verbal dermal, displacement, incmsed use or stereotype expressions and cliches, eryptio responses and moh mung and laughing at pmemt was most marked. s. time than clinical ile- �wmmmemMMp‘mmm mmmamuwmmmmpmmmum mmmum nugtammmmmr ‘mmumm mmwuumpmmmm MWmm mmammammwmwmm ultimatum awn'mmamhMMuMdemwmm utyotrmdummwdmmpmmwmututamw mmmrormmumummm um. mapm,m,mmummumwmu unwumwwmmammwpflmm mommd'm mummommdhwudmmmm . mmwmsmméhmummt. Wruflmflmumtflnm amewma-wmmmwmmnmm. fathom deflumflmdtfl‘WM’udm-Wm an,uwmmtmmpmmmmg mmwtm.mwpmmmmmupem may, WMWMMWMWWRWM n- wtbpmsnumammmmmuummmorm. mumwtbpmvammyummnmmbnbymmm, mammmmmwmmm,mmmnmmhmwdm duration of tone-mg and ! 1 Wt hmt(9)mmmamumummpmmammam mutant; nmmmrumv Both Hon-ma Km (1, n) and ' ' m.mmquWWde-ob iummmummg mpwmamwmmmm ‘ ’ mmmmmupmmwmm)uomm.mmmz mtmmmmmumgw,mmnmwmurwm i �”mm “mm“..m—wwaww—lw""" , A m. wl’vr-w—w-‘mx'r- :46nnuanco at barbiturates were most likely to 1W0 with treamnt. In the pumt at. chum mmguagowieh‘mdmgm nut-daetenlyto an Mom's a! alum bmn sanction and to the clinics]. but to the av. mmwamum 5mm mutation of then 1mm puttom' clinically. mm. this built, an aparauaml definition at the god of electroshock therapy night be «scribed an enduring On mm museums: of than mm natural which only occur initially with no. humui main. ' �v." 77—79». mm? - , WW. W'm“wu}—r¢ MN '-v" r 0.: navy—w ' , _ , 4 “aw—Ia W.wmv3ww,wmx-. WW,'—-‘W ~01” my iyg‘w 'w-w Hunwyw—m...“ 4.7.» may 1. , GWI saw-an ammunw mums rotomd for!" platteflmck What an tmtasnt. Mmfient’ ammwwmmmmmmu clinicallymdwith m umummww suburbia). BOMflthiltflndu, am: at Mom mooning unwa- mm 1111mm. 2. mo result: :1th that. ahamoteriatia chug“ an language We both 01mm and after gum-mm ”dim during mums. mm ohmgu we. sign“- and 1canfly ”hudtothe chainsaw-panes to tmtmntmdtaflmdegreoufalund mum at maund by thc alwmlogm. 3. Tho presume at then 1mm mam with ambit-him ”(than pain:to tmtmt was directly mum to th- mntml clinical aspen-e, tho Malay-sent bruit: ' otaltendbrainfmcfim. undthadmlomntutlanguagcchmgu clinicallydnring treatment. that than language éhangu What. an opomtim bun m- m mluntim of the clinical 5. the mum: ‘n'mport an hypoflmia that tho thanpeutio or oloctroshoak Mama“. in the develomt of walnut putt-m at symbolic adapt. 1;. It. in $311: mm. mum to the pntiont'u problem and 111m” talcum. am. _ War the conditions a: slum brain .w-wm. __..,‘ ’n’rr' 2-}— �1o “sustain, E. A. and Kuhn, R. L. AW, Springticld, 2. , 1111mm, 8mm, , . W cum: of L. A. and Man, ("mm Sodium") 39am. I maul! Evacuated. mm, 1955. L. : Dwain Us. at Ambaxbitul 6. argma Brain 1n Symbolic and maul, Ann-1m J. meant... $183943?!» 1953.. ”J 3. _____, and mm, Psychintg, E: Serial Administration at the for ”Am/ta]. Test." “mm, MILL. Arch. 217.226, 1951;. 1!. and Yul-match, E. A. s h. mm, R. 1... Pink, cation and x It: Diagnostic and Prognostic Vila, Brain 131mm: a: 3. mm in Ebotroflxock Therapy, 361.31% Between Alum: Bran rm- L114. Arch. ”enrol. G: ' Pageant... in press. 5. Renown, E. It: am: 1., L. and Kuhn, B. Linn.» Kantian be the of Timmy La Psychosis During Electmhock Shock Ehex'npy, Am. J. Paychiatu ' 14. and mm, 3. Lu Quantitative Studies mammm. m. cm 7. Frank, J. I clinical Survey J. fluent. 301., 8. 23! 1;th, 0.: Dani-.1 161. 1994. 10. ram, R. Body at 1956. , 7 (Putnam mom) Under Psychoanalytic u a comma m” in Post know, yummy, u: 1531 1mm 0m 11.: morally. a. 11. Hem-tan, E. A. and Kuhn, R. In: Arch. Activity Founding 354:3. 1950. I... Gmubert, n. and Fink, Am:- - mm o: 200 Cm: or Putnam Macaw, of lobotomy Scrutiny, Psychiatry. 9. (mm). Heumphysiol. g: 158 and Slow wave ”7-508. 13%. Some Aspects I 01‘ mt ' 22-26, 1952. 6. Pink, Burk» mm. a: Pawn»... éi‘ Delusional Redupliaation of Parts at th- mum. Wm, Personality Eastern b; ”Iv-1&7. 1955. 1:: Denial of ’ 355-367, 1953. Inna”, �"fl..- v.w-m,.__wWR—v~.....,1,..e..r.»-w.q.w,__ v7 Koch, P. 313., n. : no Prognostic n W “F" _~—,w .— Mm vunw H.‘ r u-vn ~..»u-,Ww—~wwwwnw~. WVWVWW ,wuwyfl—w ”Maw—v.4. 1911.6: Roma, 3. A. and men, n. 4.: lid in Insulin and Home]. Shock mgammg ‘I‘hompy (was Pmeox), m. a. Paychitt" 2g: 327. 3.939. 11;. ‘swa ant. Status as Memo-1- and Thoupy, J. Harv. Mont, m8 W59; 13. Harris, :4. a... , scum was. as a of Inantal Patients Mm», a. s. and Hop-,4. u. ! Pragmatic van; ,0! 1:11.va amusmum at Mm W]. in ease: of Schisommin, Arch. 3mm}... & Wt.f 5g: 86400. ' 191.1. ' um" , l u, ,, � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Published Works Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Changes in language during electroshock therapy. In P.H. Hoch and J. Zubin (eds.), Psychopathology of Communication. Grune and Stratton, New York, 1958: 126-139. Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-02-01-002-27-002 Date A point or period of time associated with an event in the lifecycle of the resource 1958 Creator An entity primarily responsible for making the resource Kahn, Robert L.; <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a> Subject The topic of the resource Published Works -- Articles and Reviews Relation A related resource The Max Fink Collection Description An account of the resource [preprint] and reprint. Reprint from Psychopathology of Communication Grime & Stratton. Inc., 1958 Rights Information about rights held in and over the resource <a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a> Source A related resource from which the described resource is derived Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York). Language A language of the resource en-US Format The file format, physical medium, or dimensions of the resource application/pdf Publisher An entity responsible for making the resource available Contributor An entity responsible for making contributions to the resource Published