http://exhibits.library.stonybrook.edu/mfp/files/original/0a74924969c48b97fad064f4d827441c.pdf e33e0604bf1a53d201e8e551507b5084 PDF Text Text Founded in 1887 by G. STANuIY HALL OFFPRINTED FROM THE AMERICAN JOURNAL OF PSYCHOLOGY EDITED BY KARL M. DALLENBACH UNIVERSITY OF TEXAS AND M. E. BITTERMAN BRYN MAWR COLLEGE E. B. NEWMAN HARVARD UNIVERSITY WITH THE COOPERATION OF E. G. BORING, Harvard University; W. K. ESTES, Indiana University; J. P. GUILFORD, University of Southern California; HARRY HBLSON, University of Texas; E. R. HILGARD, Stanford University; FRANCIS W. IRWIN, University of Pennsylvania; G. L. KREEZER, Washington University; D. G. MARQUIS, Social Science Research Council; GEORGE A. MILLER, Harvard University; W. B. PILLSBURY, University of Michigan; LEO PosTMAN, University of California; W. C. H. PRENTICE, Swarthmore College; T. A. RYAN, Cornell University. THE ROLE OF SET IN THE PERCEPTION OF ‘SIMULTANEOUS TACTILE STIMULI By HYMAN KORIN and MAX FINK, Glenn Oaks, Long Island September, 1959, Vol. LXXII pp. 384—392 Published b The American Journal of Psychology. Department of sychology, University of Texas, Austin. Tex. �Founded in 1887 by G. STANLEY HALL OFFPRINTED FROM THE AMERICAN JOURNAL OF PSYCHOLOGY EDITED BY KARL M. DALLENBACH UNIVERSITY OF TEXAS AND M. E. BITTERMAN BRYN MAWR COLLEGE E. B. NEWMAN HARVARD UNIVERSITY WITH THE COOPERATION OF E. G. BORING, Harvard University; W. K. ESTES, Indiana University; j. P. University of Southern California; HARRY HELSON, University of Texas; E. R. HILGARD, Stanford University; FRANCIS W. IRWIN, University of Pennsylvania; G. L. KREEZER, Washington University; D. G. MARQUIS, Social Science Research Council; GEORGE A. MILLER, Harvard University; W. B. PILLSBURY, University of Michigan; LEO POSTMAN, University of California; W. C. H. PRENTICE, Swarthmore College; T. A. RYAN, Cornell University. GUILFORD, THE ROLE OF SET IN THE PERCEPTION OF SIMULTANEOUS TACTILE STIMULI By HYMAN KORIN and MAX FINK, Glenn Oaks, Long Island September, 1959, Vol. LXXII pp. 384-392 Published by The American Journal of Psychology, Department of Psychology. University of Texas, Austin, Tex. �THE ROLE OF SET IN THE PERCEPTION OF SIMULTANEOUS TACTILE STIMULI By HYMAN KORIN and MAX FINK, Glenn Oaks, Long Island The influential role of ‘mental set’ in determining a subject’s response to a perceptual task has been well documented.] In studies of the perception of simultaneous, tactile stimuli, various patterns of response have been observed which seemed to be the result of a set induced by suggestion. This investigation was undertaken to determine the relation between different conditions of ‘set’ and the frequency and type of perceptual error elicited in tests with simultaneous, tactile stimuli. Recently the advantages of the simultaneous stimulation of different body-parts in tests of tactile perception have been stressed.2 Simultaneous stimulation may elicit perceptual errors under conditions in which successive single stimulations are correctly perceived. When two stimuli are applied to body-parts at the same time, only one stimulus may be reported —an error referred to as 'extinction’; or one stimulus may be perceived correctly and the other mislocalized—an error called 'displacement.’ Occasionally, if a single stimulus is interspersed in the testing-sequence, it may be reported correctly, but an additional, extraneous stimulus may also be reported—an error of ‘confabulation.’ Such errors of extinction, displacement, and confabulation are significantly increased in patients with brain dysfunction. When errors of extinction and displacement occur, they are elicited in a consistent pattern. Thus, on stimulation of the hand and face, the stimulus to the face is usually reported correctly, while that to the hand is mislocalized or not reported. By testing various combinations of bodyparts, an ‘order of dominance’ may be determined in which stimuli to the face and genital areas are most often perceived and those to the hand are for publication September 23, 1958. From the Department of Experimental Psychiatry, Hillside Hospital, Glenn Oaks, Long Island, New York and aided in part by Grant M-927, National Institute of Health, US. Public Health Service. 1]. J. Gibson, A critical review of the concept of set in contemporary experimental psychology, Pryc/aol. 32111., 38, 1941, 781—817; Robert Leeper, Cognitive processes, in S. S. Stevens (ed), Handbook of Evperimeoto] Psychology, 1951, 730-757. 2M. B. Bender, Disorder: in Perception, 1952; M. B. Bender, M. A. Green, and Max Fink, Patterns of perceptual organization with simultaneous stimuli, A.M.A. Arc/a. Neural. é Put/riot, 72, 1954, 233-255; Fink, Green and Bender, The facehand test as a diagnostic sign of organic mental syndrome, Neurol., 2, 1952, 46-58. * Received 384 �SIMULTANEOUS TACTILE STIMULI 385 least often perceived. Between these extremes, stimuli to the shoulder, foot, buttock, breast, back, thigh and abdomen are perceived in a gradient.3 Theories involving factors of rostral dominance,‘ maturation,“ inattention,6 and inherent body-image,7 have been advanced to explain the organization of these perceptual patterns, but no one theory has adequately explained all the facts. We have ascribed significance to the relative intensity of the stimuli and the thresholdvalue in the frequency and the pattern of the 'extinction’ error, when electrical stimuli are applied at threshold and suprathreshold intensities.8 The present study was undertaken to assess the relation between ‘set’ induced by suggestion and errors of 'confabulation’ and 'displacement.’ The specific problem studied is whether an 'inquiry’ into the testing pro— cedure is significantly related to the frequency and type of these errors. Since these errors are most prominent in $5 with cerebral dysfunction, patients undergoing convulsive and subconvulsive therapies were studied. Subjects. The 55 were 61 consecutive psychotic patients referred for electroconvulsive therapy. Their ages ranged between 21—67 yr., mean age being 46 yr. Thirtyseven of them received convulsive therapy; 14 first received subconvulsive therapy and then convulsive therapy; and 10 received subconvulsive therapy alone. The 55 were selected for convulsive or subconvulsive treatment on a random basis by the supervising psychiatrist. Procedure. Two model S-4B Grass square-wave stimulators were synchronized to deliver either single or simultaneous electrical stimuli. An isolation unit was connected with each stimulator to eliminate artifacts and the Output was visually monitored by an oscilloscope. A switch-box was inserted in the circuit to permit independent selection of the various parts of the body. The active and indifferent electrodes for each part were small 3fig-in. steel disks, placed l-in. apart and secured with tape. Bentonite electrode paste was rubbed into the skin of each area before the electrodes were applied. The patient was placed on a couch in a relaxed and supine position. To alleviate undue anxiety, the nature of the testing was described. It was emphasized that a slight tap-like sensation would be felt. The electrodes were then placed on (a) the dorsum of the hands, (b) the mandibular area of both cheeks, and (c) the medial aspect of the calves of the legs. aBender, Green, and Fink, op. .cit., 253-255. 4R. Cohn, On certain aspects of the sensory organization of the human brain: I. A study in rostral dominance as determined by ipsilateral simultaneous stimulation, ]. new. mem‘. Dis., 113, 1951, 471-484; II. A study in rostral dominance in chil1, 1951, 110-122. Neurol., dren, 5 Louis Linn, Some developmental aspects of the body image, Int. ]. Pryc/ooanol., 36, 1955, 1-7. 6Macdonald Critchley, The phenomenon of tactile inattention with specific references to pariental lesions, Brain, 72, 1949, 538-561. 7Bender, op. cit., 77-88. 8 Hyman Korin and Max Fink, Role of stimulus intensity in perception of simultaneous electrical cutaneous stimuli, I. Hillside H0511, 6, 1957, 241-250 �386 KORIN AND FINK Thresholds for the various body-parts were first determined. At a frequency of 0.3 cycles per sec. and a pulse-duration of 50 m.sec., the voltage was increased in uniform increments of 5 v. to the hands and 1 v. to the cheeks every 6.7 sec. (2 pulses) until 5 perceived 100% of the stimulations. After a 10-sec. interval, voltages were decreased until the sensation was no longer reported. After another 10sec. interval, voltages were increased by 1 v. every 6 sec. until the patient again reported 100% of the stimulations. This reading was considered the minimal voltage required to produce threshold-sensation. After thresholds were determined, testing with a random series of 4 single and 6 double simultaneous stimulations followed. The body parts tested were the right hand and left cheek (heterologous stimulation) and the right cheek and the left cheek (homologous stimulation). Stimuli were applied either simultaneously or to one part singly, in a mixed order, for 10 trials. The order of presentation of the heterologous and homologous stimulation was alternated. Failure to report the interspersed single stimuli served as an index that the perceptual threshold had changed. At such times the threshold was again determined, and the 10 test-trials were repeated. Threshold changes, however, occurred infrequently during testing. The patients were tested in two groups: an ‘inquiry' group and a 'no-inqury’ group. The ‘inquiry’ group, consisting of 24 convulsive and 9 subconvulsive 55, was asked the question ”anywhere else?" after each response to a stimulation. No question was asked of the 'no-inquiry’ group, which consisted of 27 convulsive and 15 subconvulsive $5. (The total number of Ss exceeds 61, since 1 S in the 'inquiry’ group and 13 Ss in the ‘no-inquiry’ group were included both in the convulsive and the subconvulsive series.) Electroencephalograms were obtained weekly, on a day following a treatment. These records were quantitatively measured for the degree of induced slow-wave (delta) activity.9 Both the convulsive and the subconvulsive treatments were administered three times weekly on alternative days. Remltr: (1) Errors of confabulation. A response was scored as a confabulation if two stimuli were reported when only a single stimulus was applied. The observations are noted in Table I. In the 'inquiry’ group, confabulatory errors were elicted before treatment from both types of Ss—convulsive and subconvulsive. During treatment, the mean error increased from 0.08 to 0.72 among the ‘convulsive’ Ss and from 0.22 to 0.70 among the ‘subconvulsive’ ones. After treatment, the mean number of confabulations persisted in the ‘subconvulsive’ 55 (1.00) but declined in the ‘convulsive’ ones (0.10); the difference 0.90 being significant at better than the 5% level.10 In the 'no-inquiry’ 9Max Fink and R. L. Kahn, Relation of EEG delta activity to behavioral response in electroshock: Quantitative serial studies, A.M.A. Arc/9. Neural. <5 Psytbidt., 78, 1957, 516-525. 1” The Mann-Whitney ‘U'-test was used to test the significance of these data and those that follow as the scores were not drawn from a normally distributed population. Since the 'U'-test is based on rank-order of the scores, the differences between means are only grossly related to level of significance. �387 SIMULTANEOUS TACTILE STIMULI group, few confabulations occurred at any interval of testing for either the convulsive or the subconvulsive 55. Before treatment, the subconvulsive, ‘inquiry’ 55 made significantly more confabulatory errors than the subconvulsive, ‘no-inquiry’ 55. In a comparison of the ‘inquiry and ‘no-inquiry’ procedures during treatment, the differences were significant both in the convulsive and subconvulsive groups of $5. The differences during treatment are based on the substantial increase in the number of confabulations of the ‘inquiry’ group. After treatment, the confabulations of the convulsive, ‘inquiry’ group decreased to the pretreatment level, and the differences between the convulsive, 'inquiry’ and ‘no-inquiry’ groups were not significant. Though the mean TABLE I MEAN NUMBER ERRORS 0P CONFABULATION No inquiry Inquiry Period convul’ subr convul. sive (N: 24) Pretreatment Treatment Post’treatment * p<o.os; .08 .72 . 10 (N= 9) . 22 .70 I .oo Tp<o.o3; ——————— convul’ subr convul. sive (N: 27) (N: 15) o .11 . 06 o .05 —-— Diff. between inquiry and no! —— inquiry convul’ subr sive convul. .08 .22: .61]L . o4 .65T — Diff. between convulsive and subconvulsive —— inquiry n0r inquiry . 14 .02 . 90* 0 .06 — Ip<o.01. number of errors of the subconvulsive, 'inquiry’ 55 increased after treatment, a comparison between the ‘inquiry’ and 'no-inquiry’ subconvulsive 55 could not be made. Data were not obtained after treatment from the subconvulsive ‘no-inquiry’ 55 because they were transferred to convulsive treatment and were not available for testing. (2) Error; of dirplacement. A response was scored as a displacement if the locus of one of two stimuli was reported correctly and the other incorrectly. Displacements were rarely elicited from the Ss in any of the groups (Table II). The mean number of displacements tended to increase during treatment for the convulsive 55, but the differences from the pretreatment period lack significance. ( 3 ) Error: of extinction. An error was scored as an extinction if only one of two simultaneously applied stimuli was reported. The difference in the number of errors of extinction between the ‘inquiry’ and ‘no-inquiry’ groups was not significant at any period during the course of therapy both for the convulsive and subconvulsive 55 (Table III). During treatment, the mean number of extinctions decreased in all groups. At this period, �388 KORIN AND FINK the difference between the convulsive and subconvulsive, 'inquiry’ 55 was significant. After treatment the errors of all the groups decreased further. (-4) Errors of confaémlatz'on and change: in EEG. An analysis was made of the number of confabulatory errors elicited in convulsive Ss in relation to the degree of electroencephalographic change. ‘Inquiry’ $3 with high degrees of delta activity made significantly more confabulatory errors than inquiry patients with moderate and low degrees of delta activity (Table IV), while few errors were reported by the ‘no-inquiry’ Ss regardless of the change in the EEG. The mean scores of the moderate and low EEG among the ‘inquiry’ 55 was similar to the mean scores of the ‘no-inquiry' ones. N0 EEG slow-wave activity or low degrees of such activity occurred in TABLE II MEAN NUMBER ERRORS Post—treatment * DISPLACEMENT Convulsive Period* Pretreatment Treatment or inquiry . o6 . 09 . 08 Subconvulsive no’inquiry - . 07 . IO . 02 inquiry o .02 . 06 nOrinquiry 0 .01 o Inter! and intrargroup differences are not significant at any period. the subconvulsive 55. As had been indicated, however, the number of confabulatory errors of the subconvulsive group increased significantly during and after treatment. This increase resulted from increasing confabulatory errors in four of the nine patients. Dircmrz'on. Errors of displacement, confabulation, and extinction are elicited when sequences of multiple and single tactile stimuli are applied to various parts of the body. In clinical tests with touch stimulation, these errors are most prominent in patients with cerebral disease.11 Theories which have been advanced to account for the occurrence of such errors have therefore emphasized endogenous factors involving the central nervous system. Numerous studies of the role of set in perception indicate, nevertheless, that the frequency and type of response to a perceptual task may be markedly altered by the immediate aspects of a situation.12 In this study the stimulus-situation has been varied to bring about differing conditions of mental set. The endogenous factors have not, however, been 11Pink, Green, and Bender, op. cit., 46-58. 12Leeper, op. cit, 752-757; Max Pollack, W. S. Battersby, and M. B. Bender, Tachistoscopic identification of contours in patients with brain damage, I. romp. playriol. Pry/301., 50, 1957, 220-227. �389 SIMULTANEO US TACTILE STIMULI neglected and the relation between the effects of diflerent degrees of brain dysfunction has also been determined. In the course of convulsive therapy a marked increase in the number of confabulatory errors is brought about by the ES query: “anywhere else?” which followed every stimulation. Of the convulsive 55 who were asked this question, confabulations were elicited primarily in the group with high degrees of EEG slow-wave activity (marked cerebral dysfuncTABLE III MEAN NUMBER ERRORS 0F EXTINCTION Period Inquiry ———————-——— convul— sive Pretreatment Treatment Postvtreatment * subr convul. (N: 24) (N: 9) I6 2.03 1.37 I . 67 1.14 2. .89 Diff. between No inquiry ————— convulv sive (N= 27) 2. 76 1.71 1.44 sub convul. (N: 15') inquiry and n0vinquiry -——-—~—convulr subv vulsive convul. 2. 37 1.27 —— .60 .32 .07 .70 \ .13 — Diff. between convulsive and subconvulsive N0 inquiry .49 .39 .89* .44 — .48 inquiry p<o.os. TABLE IV RELATION BETWEEN EEG DELTA ACTIVITY AND MEAN NUMBER OF CONFABULATORY ERRORS Degree of Delta activity Group inquiry no inquiry .81 .10 high moderatealow Diff. Signif. (N= 9) (N=2I) .19 (N= 10) .07 (N: 6) .62 .03 p<0.05 N.S. tion) and not in the group with low and moderate degrees (minimal cerebral dysfunction). The importance of the inquiry is emphasized by the consideration that, regardless of changes in the EEG, there was little tendency for confabulatory errors to occur among the convulsive 55 when no inquiry was made. Thus both inquiry and high degrees of EEG delta activity provided the milieu favorable to evoking confabulatory errors in the c0nvulsive therapy 55. Subconvulsive 35 present a different picture. Although virtually no delta activity is induced by subconvulsive therapy, the number of confabulatory errors of four of the nine subconvulsive Ss queried increased substantially during the treatment. Furthermore, while the confabulatory errors of these four subconvulsive Ss persisted and even increased following the course of therapy, the errors of the convulsive Ss queried, in contrast, decreased to the pretreatment level. Patterns of reversible error manifested �390 KORIN AND FINK by convulsive 55 have been reported in the various studies of the effects of electroshock on different types of mental functioning.13 It was expected, however, that confabulations would not be elicited in subconvulsive $5 at is cerebral that earlier observations of view dysfunction in period, any not induced in these patients.14 An explanation for the differences between the ‘convulsive’ and subc0nvulsive ‘inquiry’ 55 is that their therapies had differing effects on the factor of practice. In 'convulsive’ 55, treatment diminished the practiceeffect, including those both with low and high degrees of slow-wave EEG activity. For each test-interval, it was as if the ‘convulsive’ 55 were starting anew. Under these conditions, only $5 with high EEG delta activity manifested a confabulatory set within a single test-period. After the course of therapy, with the disappearance of the delta activity, convulsive 35 were performing at the pretreatment-level. In the ‘subconvulsive’ $5, the set established in the pretreatment-interval was reinforced during each test-period during treatment. Thus the subconvulsive S 5 made even more confabulatory errors after treatment. The results for the subconvulsive group of 55 indicate that certain of them Such brain-function. of alteration without make an errors confabulatory may 53 are apparently influenced by the E and may be described as being suggestible or acquiescent. The failure of the convulsive $5 to establish a set which persisted for prolonged intervals of time, as did the subconvulsive SS, sugS’s If convulsive from effect derived for the basis therapy. a therapeutic gests such mental set, an interpretation as a pathological, regarded are symptoms is particularly appropriate. From the point of view of concepts of mental set, the effect of induced convulsions is to bring about a disruption of maladaptive patterns of behavior. The number of displacement-errors remained the same regardless of whether an inquiry was made. These errors occurred much less frequently than confabulations. During treatment, approximately 30% of the convulsive $5 of both the ‘inquiry’ and ‘no inquiry’ groups responded with at least one displacement. This finding compares closely with the results of 33% with displacements obtained in a study of a similar population of Hyman Korin, Max Fink, and S. Kwalwasser, Relation of changes in memory and learning to improvement in electroshock. Conf. Neurol., 16, 1956, 88-96; Max Fink, R. L. Kahn. and Hyman Korin, Effects of diffuse altered brain function on XV C(mf. of Pryc/ool. Proceed, 1958, 238—239. perception. 1“ Fink, Kahn, and Green, Experimental studies of the electroshock process, Dir. New. $315., 19, 1958, 113-118. ’3 �SIMULTANEOUS TACTILE STIMULI 391 electroshock Ss in which touch-stimuli were applied by the clinical method. Errors of displacement are not a prominent type of error in an electroshock population. With regard to errors of extinction, differences were not significant between the ‘inquiry’ and ‘no inquiry’ groups. The high number of errors of extinction before treatment and the subsequent decrease in errors during treatment, noted in this study, is in contrast to the results obtained with clinical tactile techniques. If clinical methods are used, few errors of extinction are elicited before treatment and there is a marked increase in error during treatment. The results obtained in this study are probably related to the initial difliculty experienced by Ss in perceiving electrical stimuli at threshold and the rapid adaptation to the technique in further testing. These factors play a greater role than the changes induced by the treatment. In initial studies with threshold electrical stimuli, it was believed that a more sensitive test of changes in brain-function than the clinical tactile method could be devised.15 For clinical purposes, however, the perceptual patterns obtained with electrical stimulation lack sufficient discriminability as indices of brain dysfunction. In part, the deficiencies of the method may be ascribed to the necessity for using fixed electrodes and limitations in switching arrangements at threshold. For clinical testing, therefore, simultaneous tactile stimuli applied rapidly in a varied sequence remains the best index of altered brain function.1‘6 Summary and conclmiom. This study of the perception of simultaneously applied tactile stimuli was undertaken to determine the relation between the frequency of perceptual errors to the inquiry made by E. The relations among inquiry, perceptual response, and the degree of brain dysfunction were also considered. In the test-procedure, the threshold (100% point) for square-wave electrical stimuli applied to the hand and cheek of 61 psychiatric patients was determined. Sequences of two simultaneous and single stimuli were applied in a mixed order for the hand and cheek (heterologous stimulation) and both cheeks (homologous stimulation). Heterologous and homologous trials were alternated for each patient. For one group, an inquiry was made following each response to a stimulation, while in a second 15 16 217. Fink, Green, and Bender, op. (13., 46-58. Green and Fink, Standardization of the face-hand test, Neurology, 4, 1954, 211- �392 KORIN AND FINK convulsive 55 treated either made. or The by were was no inquiry group, subconvulsive courses of therapy, at three times a week for 12—20 applications. There was a significant relationship between the frequency of confabulatory errors and the inquiry (suggestion-induced set’) in both convulsive and subconvulsive patients. The confabulatory tendencies of these patients, however, differed greatly. Although the errors for both increased during treatment, errors decreased after treatment for the convulsive differfurther. increased The subconvulsive but in the errors group group, ences between 'inquiry’ and 'no inquiry’ groups with regard to errors of extinction or displacement were insignificant. In 'convulsive-inquiry’ 55, the confabulatory errors of those with high degrees of EEG slow-wave activity were significantly more frequent than those with a low or moderate degrees of slow wave activity. The results of this study lead to the following conclusions: (1) In tests with simultaneous electrical tactile stimuli the number of confabulatory errors is related to an induced set suggested by ES inquiry. (2 ) The number of confabultory errors is increased in $5 with braindysfunction in relation to an inquiry, but may also be induced in patients without brain-dysfunction who are acquiescent and susceptible to suggestion. (3) The frequency of errors of displacement or extinction is not related to the ‘inquiry’ procedure. ��”era Role of Stimulus Intensity in Perception of Simultaneous Tactile Stimuli Hyman Karin, H!» on. and max From ELY. fink, MOD. the Department of Experimental Psychiatry, Hillside Hospital, Glen Oaks, Aided by Institute 10-9 ’57 of the National Institute of Mental Health, National of Health, 11.5. Public Health Service. grant M—927 .M/J- I 44/ f7 �III: Role of Stimulus 10/9/57 Intensity in Perception of Simultaneous Tactile Stimuli and his coIn the course of the extensive investigations by Bender stimuli, workers (1, 2, 3,) into the perception of multiple simultaneous of two stimuli the pattern of failure of subjects to accurately report one Since led to a concept of an "order of dominance" in cutaneous perception. dominance to biologic and then, the relationShip of the observed pattern of been the subject of psychiatric concepts of body image and body scheme has considerable speculation (h, 7, 8, 1h). The interrelationship of body areas was initially clearly demonstrated was noted in simultaneous tactile tests of face and hand (2) in which it that the stimuli to the hand were frequently not reported or mislocalized. inference These phenomena of "extinction" and "displacement“ led to the that cheek area stimuli were "dominant" to reports, Bender, Pink inance for and Green (3, 10, tactile stimuli in ll, fell stimuli. In subsequent 12) described a pattern of dom- which the face and the primary genital areas were the most perceptive or dominant body dominant; and the shoulder, hand areas; the hand was the foot, buttock, breast, back, thigh, between these extremes in a mild gradient. least and abdomen These observations were made were most in normal adults and children and psychiatric patients, but the major portion clearly discerned in patients with brain disease. Indeed, of the data relates to a group of patients with severe diffuse brain dys- function under observation in a general psychiatric hospital. Bender, The basis for these phenomena is unclear. In their review, Green and Fink (3), after considering hypotheses ascribing significance to and neurophysiologic anatomic, psychophysiologic, genetic, environmental �i "no one theory‘adequately explains the organization factors, conclude that of .2- this pattern. Learning and maturation are probably factors, but appears to be mostly inherent." brain disease and normal young it (h, 5), in studies of patients with Cohn children, emphasized the rostral order of significance to "an ontogenetic or phylogenetic thalamic residue in the sensory organization of the human brain." He noted specifically, also, that this pattern was primarily associated with "the dominance and ascribed over-all sentient function of the brain." A elaboration of a maturational more extensive and developmental explanation of the order of dominance was proposed by Linn (1h). Taking the infantile patterns of sucking and feeding as a model, Linn ascribes primitiveness in the development of the body image; the dominant role of the genital area to the intensity of pleasurable sensation that the infant elicits from masturbation; and the subordinate position face dominance to role as an exploring and tension-relieving appendage holds second place in awareness to its stimulation of the more of the hand to it wherein exciting A its its mouth and genitalia. neurophysiologic view was advanced by Critchley (6, 7), who after expressing a preference for the term "tactile inattention" instead of "extinction," emphasized the rostral order of dominance. He stated that "strong stimulation of the healthy side suppresses the attentuated sensations on the impaired side," patients is probably no more than an which may be demonstrated besides the tactile - that "tactile inattention in parietal and concluded instance of local neglect or disregard, at times in many other spheres of consciousness whether motor, visual or spatial." �.3... A psychophysiologic explanation workers (10, 11), who found no tactile threshold for was eschewed by Bender and relation between the order of touch or pin prick. (8), however, insisted that these patterns an overcome by were only apparent when They hand stimulus by a stimulus four stimuli to the hand. dominance and Denny-Brown, Meyer and Horenstein alteration or loss of two-point discrimination. that the extinction of the his co- The dominance there was further demonstrated to the leg could be of the cheek to the hand could not, however, be altered by ten stimuli to the hand. following data further emphasizes psychophysiologic factors. These The studies represent the initial report of the technic of simultaneous hand of tactile stimulation tests to the alteration in brain function induced measurment of the In the course of of an investigation into the application problem of by electroshock therapy. this study electrical stimuli were applied to the cheek and psychiatric patients. Stimuli were either at threshold or supra- threshold levels. Two (a) aspects of the data are presented: The effect of alteration of relative strength of stimulus in the order of dominance (b) :3va JECTS The on face-hand tests; and Relation of perceptual thresholds to the order of dominance. ms I-‘IETHOD: subjects were electroshock therapy. mean age was 3h consecutive psychiatric patients referred for The range of their ages was between 21 and 65 and the h5. Eleven patients were diagnosed as involutional melancholia, thirteen as manic-depressive, depressed, eight as schizophrenia,and two as psychoneurosis mixed type. All testing was done prior to a course of electro- �.11.. shock therapy and no patient had clinical or EEG evidence of altered brain function. Two model S—hB Grass squareswave stimulators were synchronized to deliver either single or unit was connected was monitored two simultaneous electrical stimuli. to each stimulator to eliminate artifacts visually by an oscilloscope. A An isolation and the output switch bdx inserted in the circuit permitted independent selection of the various body parts. An active and an indifferent electrode required for each body part were small 3/8" steel discs placed 1" apart and secured with tape. Bentonite electrode paste (Medcraft) was rubbed into the skin of each area before the electrodes were applied. patient was placed on a couch in a relaxed and supine pbsiticn.. To alleviate undue anxiety the nature of the testing was described. It was emphasized that only a slight tap-like sensation would be felt. The electrodes The were then placed on (1) the dorsum of the hands, (2) the mandibular area of both cheeks and (3) the medial calf area of the legs. In the testing procedure, thresholds for the various first determined. At 50 body parts were a frequency of .3 cycles/second, and a pulse duration of milliseconds, the voltage was increased in uniform time increments of .67 seconds (2 pulses) monitored from the oscilloscope, ceived 100 percent of the stimuli. Increments of hand and increments of 1 5 until the subject pervolts were applied to the volt to the cheeks. After a ten second interval, until sensation disappeared.' After another ten second interval, the voltage was gradually increased by 1 volt each 6 seconds until the patient reported 100 percent of the stimuli again. This reading was the voltage was decreased considered the minimal voltage required to produce threshold sensation. �-5- and After the thresholds were determined, testing with a series of single double simultaneous stimuli followed. The body parts tested were the right and hand and left left cheek (heterologous stimulation) and the cheek homologous stimulation). taneously or one part singly in a Both mixed order parts right cheek were stimulated simul- for ten trials for each of the iollowing conditions:(l) threshold (2) suprathreshold (10 percent above the threshold), (3) one body part at suprathreshold and the other at threshold and (h) the reverse (3). The order of presentation of conditions (1) and (2) for conditions (3) was alternated for different subjects and (h). Similarly the order of presentation of the heterologous logous stimulation was and the same was done and homo- alternated. Single stimuli were introduced as a control. Failure to report the single stimulus indicated that the threshold had changed. occurred, stimulation was increased until a and 10 new threshold When this change was determined trails were started anew. RESULTS: A. Threshold Values. The threshold stimulation for perception cheeks and legs. (Table for the hands, was determined I). TABLE Mean Thresholds and I Standard Deviations of Body Parts Right Hand Hand Left Right Left 7.85 29.25 22.35 2h.50 19.52 h.86 1h.88 '13.60 13.99 Left Cheek Cheek Threshold (volts) 6.76 Standard Deviation h.h7 Mean Right Leg Leg ' 13.6h �~6The threshold values for the hands and legs are 3 to h times higher than the thresholds for the cheeks. While the threshold values in the legs are less than in the hands, these differences lack statistical significance. Variability of the threshold is considerably greater in the hands and legs, than in the cheeks. There is virtually no overlapping of thresholds, however, where the cheeks and the hands are concerned. B. Extinction Patterns: difference between the The or the left number of extinctions of the right cheek on stimulation of both parts with hand either threshold or suprathreshold stimuli was not significant (Table II). Also, when both cheeks were stimulated with either threshold or suprathreshold stimuli, there were no differences in the number of extinctionszhzeach cheek . (Table III). In contrast to these observations, stimulating one body part with a suprathreshold stimulus and the other at threshold, resulted in a significant increase in the failure to report the body part stimulated at threshold. Thus the cheek was dominant over the hand, or the hand was dominant over the cheek depending on the body part to which the stronger stimulus was applied (Table II). Altering the relative strength of the stimuli applied to the cheeks resulted in a similar predictable change in the pattern of dominance (Table III). Further analysis of the data in Table II indicates that the hand was dominant over the cheek with greater mean frequency (2.08) than the cheek was dominant over the hand (1.0h) for the threshold - suprathreshold condition. This tendency is also evident at suprathreshold. If it is considerefi when both that the parts were stimulated mean threshold for the hands �mua mama mmbn mmma nwmmw eUHmmwowa mmeOWmmw ma mmuo m& ma mcwuwdwwmmwowa mfi mum mum ofimmw oummw fin pa mcmumwuwmmuowm mcvumdunmmuowa efiflmmUowa awnmmwowa Kama counudwoum ow .wm m.wo H.0m zwmb H.ww nummw mxdwunawoum ow mxaqudMosm afiammwowo om saws ow H.wm .mm .mm abwbm mum H.mm cummw -mma mmuo HH madusodwoum mun mcwwpdwummwowa mmum mow v.0: m.om .m4 .OH <muwwnm dwwwmwmuom mwwe:Hdeou z.m. wAAuow vAnuow 2.m. mwmswwwombom �Emma abomw Hmwfi wear wumue wows avummuowm drummvown ma mcwuwawuwmwowm mchm&UHmmwowm owmmw ofimmw numGWm owwmwm ma ma QUGmW mum mw ma ma grammwowa meU& mum mcvum: awnmmuowm on .om .wm .Hm .ww saws nonmwdHOUm Hmwd mxwucnduoam Kama Qummw ow mxauuodwoum awwmmwowm on ow 3mm: avwbm H.mm .H# .w4 .rw mum mumwfi . mxwwannwoum md woaw.nwmme owmmw mcwumauammUowo won <muewum H.mm .mm .Hm .om wanmuwuom mdwstwmawou u‘AmoH v_Auom z.m. z.m. mumsuwwnmbnm HHH - �-7- is approximately 30 volts, while for the the difference in incidence of extinction stimulation was set at ten percent may be explained. above the threshold stimulus was therefore increased by 3 is cheeks the threshold volts 7 volts, Suprathreshold value. The hand and the face stimulus by only increase, although proportionately equivalent, appears to have given greater relative strength to the hand 1 volt above the threshold value. Such an stimulus. C. Incidence of Extinction: Regardless of pattern, the mean total of the number of extinctions heterologous body parts were stimulated at threshold than when these parts were stimulated with suprathreshold stimuli (Table IV). For these same conditions of stimulation the differences between the mean was greater number of when extinctions obtained on homologous stimulation of the cheeks lack statistical significance but the results are in the direction that a greater number of extinctions occur when two body which indicate parts are stimulated at threshold (Table IV). The failure to obtain a significant difference in the latter instance is partly due to the fact that relatively few extinctions are elicited total when homologous number of parts are stimulated. These findings on the extinctions are in agreement with previous observations (2). �2. TABLE Mean IV of Combined Number of extinctions For Varying Conditions of Threshold and Suprathreshold Both Parts at Threshold A - Cheek B — Band A - Left B - Right % Cheek Cheek Both Parts SuprathreShold 3.11 1.63 .85 .56 Differences between the at mean number of % Stimuli A B - SuprathreShold - Threshold A B 1.68 1.31 extinctions at threshold - Threshold — 2oh3 1.10 and the other three conditions of stimulation are significant for the cheek and hand but are insignificant for both cheeks. SupraThreshold �-8DISCUSSION: pattern of extinction following stimulation.with threshold and suprathreshold stimuli has been determined. In contrast to the findings The of Bender, link and Green (2), face stimuli were not reported more frequently than hand stimuli when either simultaneous threShold or suprathreshold stimuli were applied. Under these conditions, neverthless, it is clear that the pattern.of extinction for any the body parts can be readily altered by stimulus varying the relative strength of the stimuli. Thus,a suprathreshold applied to the hand tends to obscure a threshold stimulus applied to the cheek and when these stimuli intensities are reversed, the cheek tends to obscure the hand. Theories which hold that dominance of the cheek over the hand is due to an inherent factor, perceived body image, rostral dominance, developmental principle, or a learned factor, are not supported by these observations. If any of these been elicited factors were involved, a pattern of face when dominance should have the hand and cheek were stimulated with equivalent stimuli at threshold and suprathreshold intensities. Although, more recently, Bender (3) has advanced an inherent factor theory, he previously attributed the extinction phenomenon to differences in the thresholds of the various body parts and to the intensity of the stimulation used (1), strength of the The finding. in this study, that differences in the simu taneous stimuli can supports a stimulus intensity hypothesis. alter the pattern By of extinction inference, differences in threshold also play a significant role. That an intense stimulus elsewhere could raise the pain threshold as This much as 35% has been denonstrated by Hardy, Wolf and Goodell (13). �-9:- effect of a relatively intense stimulus on the threshold of another stimulus has also been found by investigators using other stimuli (8, 9). The problem still remains, however, how it is that a pattern of dominance, particularly of the hierarchy determined by Bender and his coworkers, may be elicited when presumably equivalent stimuli are applied by touch of hand. The results of this study suggest an explanation. Stimuli of differing intensities are required to elicit a threshold sensation for various body parts. ’Uhen these stimuli are increased 10 percent, the resultant stimuli are proportional and are perceived as equivalent. In contrast, in clinically touching two body parts, the stimuli are disproportionate relative to the threshold value although approximately of equal intensity in their application. differences in threShold for the hand and cheek, the tactile to the cheek stimulus/is proportionately more above the threshold than the stimulus to the hand. Thus the cheek is perceived more frequently than the hand stimulus and Because of the has been considered "dominant." A threshold hypothesis was rejected (3) on the basis that the thresholds for pressure and pain do not strictly corre5pond to the dominance order elicited by the double simultaneous stimulation tests. Most difficult to reconcile is Von Frey's finding that the pressure threshold obtained by Von Frey (16) of the glans penis, which is second in dominance rank only to the cheek in tested, is 111 grams per square millimeter; While the hand, whichzislll least dominant, is only 12 grams per a group of ten body parts the threshold of square millimeter. Unfortunately, thresholds in the genital area for male and female have seldom been determined. Von Frey's list of thresholds (16) is based on a single subject. His more detailed observations (17), however, indicate that �.10- is virtually there no pressure sense the perception of pain, warmth, and in the glans penis or clitoris, although cold is well developed. It is quite with touch possible that the punctate pressure threshold does not correlate there the genital area is concerned but that instead some other sense or combination of senses Thresholds and is involved. for the dorsum of the hand and the cheek obtained by Von Frey other investigators indicate that the cheek is considerably more sensitive in agreement with the thresholds obtained in this study. In a recent study of thresholds at various body sites Sigel than the hand. These findings are dorsum of the (15) reported that "leg areas including thigh and ankle, also definite tendency for higher thresholds. Scalp, The anterior chest temple, forehead and face tended to have lower thresholds. lower thresholds. arm and anterior wrist areas showed a tendency for and hands and the palm showed a upper Neck areas, ment there Bender and abdomen and upper back showed no is no disagreement with definite trend." In this state- the order of dominance as determined by his coworkers. the experimental results obtained here, it is proposed that the may dominance hierarchy elicited under the conditions of simultaneous testing of the be explained in rational terms on the basis of the relative strength From stimuli and the area stimulus theoretic constructs:n threshold, without the invocation of other �-llSUM-JURY: Using square wave the hands, cheeks, and electrical stimuli, the threshold for perception in calves were detennined in 3h psychiatric patients. Simultaneous stimuli were applied in random sequence to combinations of cheek and hand and both cheeks, at threshold, suprathreshold and combinations of threshold and suprathreshold intensities. MWSmmmmwsmmwdmcrfimhwmwswmmmwddmmmwwm the differences between the number of extinctions in either part were NOT significant. With stimuli of unequal intensity, however, (one stimulus at threshold and one suprathreshold) there was a significant increase in the failure to report the threshold stimulus. The total number of extinctions is greater with threshold, than with suprathreshold stimuli; ans greater in heterologous than in homologous patterns of stimulation. LOPELEQ-‘Pist The tests may clinically observed order of dominance in simultaneous tactile he explained by psychophysiological phenomena without resort to theoretic constructs. Differences in the hireshold of perception in various body parts provide the basis for the observed pattern of errors on simultaneous tactile tests at suprathreshold levels, �Biblio ranhv 1. W“ Bender, M;B. (1952): Disorders in Perception Sprin Bender, HgB., Fink, M; and Green, M.A. (1951): Patterns in Perception Tests of Face on Simultaneous field, Illinois. and Hand, A.M.A: Arch. Neurol. & Psychiat. éé} 355-362. 3. Bender, H.B., Green, H.A. and Fink, M. (l95h): Patterns of Perceptual Organization with Simultaneous Stimuli, EgyChiat., Neurol. n lg: 233-255. Cohn, R. (1951): On Certain Aspects of Human A.M.A. Arch. Brain: A the Sensory Organization of the Study in Rostral Dominance as Determined by Ipsilateral Simultaneous Stimulation, J. Nerv: Ment. Dis. 113: h71~h8h. S. Cohn, R. (1951): On Certain Aspects of Sensory Organization of the Brain: II — Human A Study in Rostral Dominance in Children, Neuroloav, 1; 119-122. Critchley, n. (1953): Critchley, M. The Parietal Lobes, a Go. (19h9): Phenomenon of Tactile Inattention with Special Reference to Earietal Lesions. Denny-Brown, London: Edward Arnold 3., Meyer, J.S: grain, 12: 538-561. and Horenstein, S. (1952): The Significance of Perceptual Rivalry Resulting from Parietal Lesion, grain, 15; h33~h7la 9. Dunoker, K. (1937): Some Preliminary Exneriments on the Mutual Influence of Seine, Psychpl. Forsdh, g1: 311-326. 10. Fink, M. and Bender, H.E. (1953): Perception of Simultaneous Stimuli in Normal ChilCren, 1-Ieurologq, ;: 27~3h. Tactile �Bibliograghv 11. Fink, H., Green, M.A. and Bender, M.D. (1953): Perception of Simultaneous Tactile Stimuli by Mentally Defective Subjects, gig. , Q1: . LLB-449 12. Fink, M., Green, M.A. and Bender, M.B. J. Merv. & Ment. (l952):The Face-Hand Test as a Diagnostic Sign of Organic Mental 85ndrome, Neurologz, g; hé-SB. 13. Haroy, J.D., wolf, H.S. and Goodall, H. (19h0): Studies on Pain. New Method for measuring Pain Threshold: Observations Summation of Pain, J. Clin. Invest., l2: on A Spatial 6&9-658. Linn, L. (1955): Some Developmental Aspects of the Body Image, 223! J. Eszchoana1., 2g; 1-7. Sigel, H. (1952): Cutaneous Sensory Threshold Frequency Squareédave Current: Site II. - The Stimulation with High Relationship of and Skin Diseases to the Seesory Threshold, Body J. Invest. Derm., lg: hh7-h51. 16. Von Frey, E. (189M): Beitrage zur Physiologie des Schmerzinns, Egg. Sachs. Ges. 17. diss., Von Frey, M. (1895): gé: 185-196 and 283-296. Beitrege znr sinnephysiologie Haut, Ber. Sachs. 99g. ‘L;iss., £2: 166-18u. �Karin: Amer. J. Psychol. VI: 8-12-58 Role of Suggestion-Induced Set in the Perception of Simultaneous Tactile Stimuli Hyman Korin.fh.D. and max Fink M.D. From the Department of Experimental Paychiatry, Hillside Hospital, Glen Oaks, L.I., (in part) by grant 14-927 of the National Institute of Mental Health, National Institutes of Health, U.S. Public Health Service. Read at the Eastern PSydhological AsSOCiation, Philadelphia, April 11, 1958. Aided N.Y. �Role of Suggestion-Induced Set in the Perception of Simultaneous Tactile Stimuli influential role of "mental set" in determining subject response to a perceptual task has been well documented (1). In studies of the The perception of simultaneous tactile stimuli, various patterns of response were observed which seemed to be the result of "suggestion-induced set." This investigation was undertaken, to determine the different conditions of "set" relation between and the frequency and type of perceptual error elicited in tests with simultaneous stimuli. Recently the advantages of the simultaneous stimulation of body parts in tactile perceptual tests has been stressed (2). simultaneous stimulation may elicit The technique of perceptual errors under conditions in which successive single stimuli are correctly perceived. 'are applied to body parts at the same time, for example, only may be reported - may be perceived correctly and the other'mislocalized an error referred to as "extinction"; or "displacement." Uccasionally, if testing sequence, these stimuli - stimuli two stimulus one one stimulus error called single stimuli are interspersed in the may be an correctly reported, but an additional, extraneous stimulus, (referred to as a "confabulation") Such ‘When errors of extinction, displacement, may also and confabulation are be reported. significantly increased in patients with brain dysfunction. 1. R. Leeper, Cognitive processes, in 5.5. Stevens, Handbook of Experimental Psychology, 1951. 2. M. B. Bender, Disorders in Perception, 1952; Bender, Patterns of perceptual organization with simultaneous stimuli; A.M.A. Arch. Neurgl. & Psychiat. M.A. Green and M. Fink, 1g: 195h, 233-255; Fink, Green and Bender. The face hand test as a diagnostic sign of organic mental syndrome, Neurcl. g: 1952, h6—58. �.2errors of extinction and diaplacement occur, they are elicited in a consistent pattern. Thus, on stimulation of the hand and face, the stimulus to the face is usually reported correctly while that to the hand When is mislocalized or not reported. parts, an "order of and testing various combinations of dominance" may be described genital areas are often perceived. By in which body stimuli to the face most often perceived and those to the hand are least stimuli to the shoulder, foot, are perceived in a gradient (3). Between these extremes, buttock, breast, back, thigh and abdomen Theories inyolving factors of rostral dominance (h), maturation (S), inattention (6), and inherent body image (7) have been advanced to explain the organization of these perceptual patterns, but no one theory has adequately explained all the facts. Previously (8) we have ascribed significance to the relative intensity of the stimuli and the threshold value in the frequency and the pattern of the "extinction" error, when electrical stimuli are applied 3. Bender, h. Green and Fink, 02. cit., 233-255. certain aspects of the sensory organization of the brain. I: A study in rostral dominance as determined by ipsilateral simultaneous stimulation, g, Nerv. Ment. Dis. Eli: 1951, h7l-h8h; II: A study in rostral dominance in children, 32339;. I, 1951, 110-122. R. Cohn, On human S. Linn, Louis: Some developnental aspects of the body images, Int. Jour. Psychoanal. 2gp 1955, 1-7. 6. Critchley, The phenomena of tactile inattention with specific references to parietal lesions, Brain 1;, l9h9, 538-561. M. _ 7. Rnder, 8. Op. Cite, 77-88. Fink, Role of stimulus intensity in perception of simultaneous electrical cutaneous stimuli, J. Hillside Hosp. H. Korin and M. Q, 1957, 2&1-250. �.3threshold and suprathreshold intensities. The present study was undertaken to assess the-relation between "suggestion-induced set" and errors of confaoulaticn and diSplacement. The Specific problem studied is whether in the testing procedure is significantly related to the frequency and type of these errors. Since these errors are most prominent an "inquiry" in Subjects with cerebral dysfunction, patients undergoing convulsive and subconvulsive therapies were studied. Subjects: The subjects were 61 consecutive psychotic electroconvulsive therapy. patients referred for Their ages ranged between 21 and 67 and the ho. Thirty-seven patients received convulsive therapy, While fourteen first received subconvulsive therapy and then were transferred to mean age was convulsive therapy. Ten patients were treated with subconvulsive therapy only. Patients were selected for the convulsive or subconvulsive treatment on a random basis by the supervising psychiatrist. �Procedure: Two model S-hB Grass squaredwave stimulators were synchronized to deliver either single or simultaneous electrical stimuli. An isolation unit was connected with each stimulator to eliminate artifacts and the output was visually monitored by an oscilloscope. A switch box was inserted in the circuit to permit independent selection of the various body parts. The active and indifferent electrodes for each body part were small 3/8" steel discs, placed 1" apart and secured with tape. Bentonite electrode paste was rubbed into the skin of each area before the electrodes were applied. The patient was placed on a couch in a relaxed and supine position. alleviate undue anxiety the nature of the testing was described. It was emphasized that a slight tap-like sensation.would be felt. The electrodes To were then placed on (a) the dorsum of the hands, (b) the mandibular area of both cheeks and (c) the medial aspect of the calves of the legs. Thresholds for the various body parts were first determined. At a frequency of .3 cycles per second and a pulse duration of the voltage was increased in SO millbeccnds, uniform increments of five volts to the hands volt to the cheeks every 6.7 seconds (2 pulses) until the subject perceived 100 per cent of the stimuli. After a ten second interval, voltages and One were decreased second until the sensation was no longer interval, voltages were increased patient again reported 100 by 1 reported. After another ten volt every 6 seconds per cent of the stimuli. This reading until the was considered the minimal voltage required to produce threshold sensation. After thresholds h single were were determined, and 6 double simultaneous the right hand and left testing with a random stimuli followed. In body series of parts tested cheek (heterologous stimulation) and the right �-scheek and left cheek (homologous stimulation). Stimuli were applied either simultaneously or to one part singly, in a mixed order for ten trials (Table homologous I). The order of presentation of the heterologous and stimulation was alternated. TABLE I Failure to report the interSpersed single stimuli served as an index that the perceptual threshold had changed. Such a change occurred infrequently, and at these times the threShold was again determined, and the 10 testing trials were repeated. patients were tested in The "no-inquiry" group. The and nine'subconvulsive two groups: an "inquiry" group and a "inquiry“ group, consisting of 2h convulsive subjects, was asked the question-"anywhere after each responseto a stimulation. No question "no-inquiry" group, which consisted of 27 convulsive and was asked else" of the 15 suboonvulsive patients. This total exceeds 61, since one patient in the inquiry group and thirteen in the no-inquiry group were included both in the convulsive and the subconvulsive series. Electroencephalograms were obtained day following a treatment. in each patient weekly These records were quantitatively for the degree of induced leW'wave (delta) activity (9). on the meaSured Both the convulsive and the subconvulsive treatments were administered three times weekly on alternate days. 9. Pink and R.L. Kahn, Relation of EEG delta activity to behavioral reSponse in electroshock: Quantitative serial studies, A.M.A. Arch. Neurol. & Psychiat. 78 M. 1957: 516‘525 o �TABLE I Order of Presentation of Stimuli Right Hand Left Cheek Right Cheek Left Cheek 'Right hand-Left cheek Right cheek Right hand Right cheekéLeft cheek Left cheek Left cheek Right hand-Left cheek Right cheek Right hand-Left cheek Right cheek-Left cheek Left cheek Right cheek-Left cheek Right hand-Left cheek Left cheek Right hand Right cheek-Left cheek Right hand-Left cheek Right cheek Right hand-Left cheek Right cheek-Left cheek �“HW1 Results: A. two Confabulation Error: stimuli were reported A reaponse was scored as a confabulation when only a single stimulus was applied. if The II. observations are noted in Table TmBLE Convulsive vs Subconvulsive: II Confabulatory errors were elicited pretreatment both in the convulsive and the subconvulsive patients. During treatment the errors increased with approximately the same frequency. The in the convulsive treated patients and from .22 to .70 in the subconvulsive treated patients. Post-treatment, mean error increased from .08 to .72 however, the mean number of confabuLations persisted in the subconvulsive patients (1.00) but declined in the convulsive patients (.10). The difference in number of errors between the convulsive and subconvulsive groups is significant post-treatment, but not in either the pretreatment or treatment periods. In the no-inquiry group few confabulations occurred at any interval of testing for either the convulsive or the subccnvulsive patients. Inquiry vs No-Inquiry: While the differences in the mean number of errors reported by the subconvulsive and the convulsive patients lacks 'significance pretreatment, that between the subconvulsive inquiry differed significantly from the subconvulsive no-inquiry patients. During treatment the number df confabulations increased, and this difference in a comparison of the inquiry and is significant the no-inquiry procedures, both in the convulsive and subconvulsive groups. These differences during the treatment interval are based on the of the inquiry group. substantial increase in the number of confabulations �Hangs». Wmdgmgmfi womduagmggd Ex» % dwm awm mmdm * .1. 6 u w .8. .8. .8 A A km .8 Zn»: conqspmw<m A Huncwnw Foo mum mumswwwomsom. .8 moouwm. .8 .mm .E o 2% mucoouafiwmw<w 3M55L23H¢3m% duo awm mm¢m ac: .8 swwow zaps zug oon<deH<m mwwwmwmsomm domd zusvoa zongncwuw mowwoz. AHNV n cwwtmmu swm .om 0 ow zuwm Hpmnm mscoonqswmw<m Iml mwbnm HH smmsm mvuPHmm oouwmcspmdwob awn muw ad: we onww .8 wome .3 .0m Hunmwuq. oouafiwqum ZonHunnMHw Upwwmwmbom «ama wuwowm .3. wm mou mwommpw % dmmma u .0m .3 Hupswflw. ZouHunswww dwawmuobom mzwoqachqum mwmbwmwombom HmHmdma on 5. is Hmbw ac wow enamw Hm4mH .8 * éwmmm ow om .8 .E Hunzwaw wawmambom mayooudcpmw<m oon<¢wqumu mguooudcwqum oos<sHmH4m. - u .oo o zoquncwuw uwwmmambnm �-9After the course of therapy, the confabulations of the convulsive inquiry patients decreased to the pretreatment level, between the convulsive inquiry and no-inquiry groups not significant. In contrast, the mean number and differences at this time were of errors of the subconvulsive inquiry patients increased. Data for the post-treatment subconvulsive no-inquiry group was not available as these patients to convulsive treatment A and were not were usually transferred available for post-treatment tests. comparison between the inquiry and no-inquiry subconvulsive patients post-treatment cannot be made. B. Displacement Error: one of two stimuli was reported A reSponse was scored as a displacement correctly and the other was if mislocalized. rarely elicited in any of the greups (Table III). of displacements tended to be greater, however, during Displacements were The mean number treatment for the convulsive patients but the differences from the pretreatment interval lack significance. �—10‘TABLE mean Number III of Digplacement Errors Convulsive No-Inqyiry Inquiry Subconvulsive No-Inquiry Inquiry Pretreatment .06 .07 0 Treatment .09 .10 .02 .01 Post-Treatment .08 .02 .06 0 Inter and intra group differences are not significant 0 at any interval. �-llC. Extinction Error: An error one of two simultaneously applied stimuli extinction error between the inquiry at any scored as an "extinction" was reported. was if only difference in The and no-inquiry groups was not significant interval during the course of therapy both for the convulsive and subconvulsive patients (Table IV). During treatment, the mean number of extinctions decreased in all groups. this interval, the difference At between the convulsive and subconvulsive inquiry patients was Postetreatment the errors of D. Confabulation number Error all and significant. the groups decreased further. EEG Change; An analysis was made of the of confabulation errors elicited in convulsive patients in relation Inquiry patients with high to the degree of encephalographic change. degrees of delta activity made significantly more confabulation errors than inquiry patients with moderate and low degrees of delta activity. (Table V), while few errors were reported in the no-inquiry patients regardless of the degree of and low EEG inquiry groups EEG was change. The mean similar to the score of the moderate mean scores of the no-inquiry ‘ patients. No EEG slow wave subconvulsive activity or patients. number of confabulation significantly during low degrees of such occurred activity/in the However, as had previously been indicated, the errors of the subconvulsive group increased and after treatment. increasing confabulation errors in four This increase resulted from of the nine Pqu-u-u-Iu-o-O-u ‘- patients. �eaflsma Wmfimfifia womdlawmmdsmuw H.w< PS who 2n»: ooudswmwdm .x. annwnw 6A. .mw FE ”7% zuw mfidaobdspmwdo 00“ :wms H.rr ffi mid Zamq ZdSUmH oosagHmH<m ow zoquncHHw wabm I VB PS spun mdeHOdHob zuHm mscoos<¢wmw<w H< muaoum .ON .3 .8 Huncwuwu oon<cwmw<m ZOIHsnsHHw mHHmmHmbnm ZOIHSQsHHwHsnzwnw. t .S .3 wawmnmuom mcvaon<cwmw<m . bHHonmbom mzvooudcwmw<m .rw .mw .5 oosdswquou Hangwaq * I .E .3 uwmwmwmbow mcvoob<¢wmw<m zongnsqu aoadcwmwdm. �.13.. TABLE V Relation Between Degree of EEG-Delta Activity and Number of Confabulation Errors Mean Degree of Delta Activity High Mean Number Confabulation Errors ) ) ) Inquiry No Inquiry .81 (N.=9) .10 (N=21) Mederete-Low Difference .19 (Halo) .62 .07 (N=b) .03 Significance p 4 .05 N.S. �Discussion: elicited Displacement, confabulation and extinction errors are sequences of multiple and single tactile stimuli are applied to tests with touch stimulation, these errors are In clinical when body parts. most prominent in patients with cerebral disease (10). Theories Which have been advanced to account for the occurrence of such errors have therefore emphasized endogenous factors involving the central nervous system. That the fre- quency and type of response to a perceptual task may be markedly altered by the immediate aspects of a situation is indicated by the numerous studies of the role of set in perception (11). In this study the stimulus situation has been varied to bring about differing conditions of mental set. factors have not been neglected, and the relation between the effects of different degrees of brain dysfunction has also been However, the endogenous determined. In the course of convulsive therapy a marked increase in the number of confabulation errors is brought about by the examiner's query of "anywhere else?" following each stimulation. of the convulsive patients who were asked the question, confabulations were elicited primarily inthe group with high degrees of EEG 81 w wave activity (marked cerebral dysfunction) and not in the group with low and moderate degrees (minimal cerebral dysfunction). The importance of the inquiry is thus enphasized by the consideration that activity, there was little tendency for confabulation errors to occur in convulsive patients when no inquiry was regardless of changes in EEG 10. Fink, Green and Bender, op. 11. Leeper, op. M. Pollack, cit., - cit. , 146-58. . .S. Battersby and M.B.Bender, Tachistoscopic identification of contours in patients with brain damage, J. Comp. Physiol. Bszghol. g9, 1957, 220-227. made. �.15Thus both inquiry and high degrees of EEG delta activity provided the milieu faVOrable to evoking confabulatory errors. patients present a different picture. Although, virtually delta activity is induced by subconvulsive therapy, the number of Subconvulsive no confabulation errors of four of the nine subconvulsive patients queried increased substantially during the treatment. Furthermore, While the confabulation errors of these subconvulsive patients persisted and even increased following the course of flierapy, those of the convulsive patients queried, in contrast, decreased to the pretreatment level. Patterns of reversible decrement manifested by convulsive patients has been reported WW studies of the effects of electroShock in the of mental functioning (12). However, it was on different types expected that confabulations elicited in subconvulsive patients at any interval, in.view of earlier observations that cerebral dysfunction is not induced in these would not be patients (13). An explanation for the differences between the convulsive and convulsive inquiry patients is that their therapies had differing sub— effects- the practice factor. In convulsive patients, treatment diminished the practice effect in all subjects, including those both with low and high on degrees of slow wave activity. Fbr each test interval, it was as if the 12. H.Korin, M. Fink and S. Kwalwasser, Relation of changes in memory and learning to ercts improvement in electroshock, lg, 1956, 88-96; M. Fink, R.L. Kahn andon of diffuse altered brain function of Psychol. Proceed., 1958, 238-239. EE’Conf. perception, Conf. Neural. 13. Fink, R.L. Kahn and M.A. Green, Experimental Studies of the electroshock process, Dis. Nerv. 528. 12, 1958, M. 113-118. �-16convulsive patients were starting anew. patients with high EEG Under these conditions only delta activity manifested a confabulatory set within a single test period. After the course of therapy, with the disappearance of the delta activity, convulsive patients were performing at the pretreatment level. In the subconvulsive patients, the set established in the pretreatment interval test period during treatment. more confebulatory The may make Such was re-enforced during each Thus the subconvulsive patients made even errors post-treatment. results for the subconvulsive group indicate that certain patients confabulation errors without an alteration of brain function. patients are apparently influenced as being suggestible or acquiescent. by the examiner and may be described The failure of the convulsive patients .to establish a set which persisted for prolonged intervals of time as did the subconvulsive patients suggests a basis for the therapeutic effect derived from convulsive therapy. ‘If the symptoms of the patient are interpretation is particularly appropriate. From the point of view of concepts of mental set, the effect of induced convulsions is to bring about a disruption of maladaptive patterns regarded as a pathologic mental set, such an of behavior. The number of displacement errors remained the whether an inquiry was made. than confabulations. same regardless of errors occurred much During treatment approximately 30% patients of both the inquiry These less frequently of the convulsive and no-inquiry groups responded with one diaplacement. This finding compares at least closely with the results of 33% with displacements obtained in a study of a similar population of electroshock patients in which touch stimuli were applied by the 1h. M. Fink, unpublished data. clinical method (1h) �Displacement errors are not a prominent type of error in an electroShock pepulation. With regard to the extinction error, differences were not significant between inquiry and no-inquiry groups. The high number of extinction errors pretreatment and the subsequent decrease in errors during treatment, in this study, is in contrast If clinical-tactile to the results obtained with clinical tactile techniques. extinction errors are elicited increase in error during treatment. The methods are used, few is a marked results obtained in this Study are probably related to the initial difficulty experienced by the patient in perceiving electrical stimuli at threshold pretreatment and there the rapid adaptation to the technique in further testing. play a greater role than the changes induced by the treatment. and In that a initial studies Bore with threShold electrical stimuli, it These factors was believed sensitive test of changes in brain function than the clinical- for clinical purposes the perceptual patterns obtained with electrical stimulation lack sufficient tactile method (15) could be devised. however, discriminability as indices of brain dysfunction. In part, the deficiences of the method may be ascribed to the necessity for using fixed electrodes and limitations in switching arrangements at threshold. For clinical . testing, therefore, simultaneous tactile stimuli applied rapidly in varied sequence remains the best index= of altered brain function (16). 15. Fink, Green.and Bender, gghgit,, h6-58 16. M. Green and M. Fink, Standardization of the face-hand test, Neurology, h l95h, 211-217. �-18.. Summary: tactile This study of the perception of simultaneously applied stimuli was undertaken to determine the relation between the frequency of perceptual errors to the inquiry made by the examiner. The relation between inquiry, perceptual response and the degree of brain dysfunction was also considered. In the test procedure, the threshold (100 per cent point) for square wave electrical stimuli, applied to the patients was applied and in a mixed order to both cheeks trials made determined. Sequences of was two simultaneous and for the hand (homologous were alternated hand and cheek of 61 psychiatric single stimuli and cheek (heterogenous stimulation) stimulation) Heterologous and for each patient. For one group, an homologous inquiry was following each reSponse to a stimulation, while in a second group, Patients were treated either-by convulsive or subconvulsive courses of therapy, at three times per-week for 12-20 applications. no inquiry was made. There errors significant relationdhip between the frequency of confabulation the inquiry ("suggestion-induced set") in both convulsive and Was and subconVulsive a patients.v However, the confabulatory tendencies of these patients differed. Although the errors for both increased during treatment, errors decreased post-treatment for the convulsive group, but in the subconvulsive group errors increased inquiry errors further. differences between and no-inquiry groups with regard to were extinction or displacement insignificant. £:;.convulsive-inquiry patients, the confabulatory errors of patients with high degrees of more frequent than those of wave The activity. slow-wave patients with a low activity were significantly or moderate degrees of slow �.19- Conclusions: tests with simultaneous electrical tactile stimuli the number of Confabulatory errors is related to an induced set suggested uy the In examiner' s inquiry. The number of confabulatory errors is increased in patients with brain dysfunction in relation to an inquiry, but may also in patientS'without brain dysfunction.who are acquiescent be induced and susceptible to suggestion. The frequency of displacement or extinction errors to the inquiry procedure. is not related � 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 The Role of set in the perception of simultaneous tactile stimuli. Amer J Psychol. 72:384-392. Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-02-01-003-40-006 Date A point or period of time associated with an event in the lifecycle of the resource 1959 Creator An entity primarily responsible for making the resource <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 offprint. OFFPRINT FROM THE AMERICAN JOURNAL OF PSYCHOLOGY 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