http://exhibits.library.stonybrook.edu/mfp/files/original/c825cf38265f35eaf923d1fdede27f5a.pdf 8e37b7104043290b0428aed652df73e2 PDF Text Text Manhasseit Medical Center Hospital 4CZ54@/¢/;ﬁé€rn.2%éui%§C}¢%;lﬂéd536/ c<lgeyi N ]E W Y O R K PEARL A.KLICK ADMINISTRATOR 35K TELEPHONE MANHASSET 7-4000 1: "VINE February 25, 1957 Dear Doctor: Quarterly Medical Staff Meeting of the Manhasset Medical Center Hospital will be held on Thursday, March 7, 1957, at 8:h5 P.M., promptly at THE ALLISON, 1583 Northern Boulevard, almost directly opposite the hospital. The PART faRT 1. Review and analysis of Clinical werk in the Surgical and Medical Sections for the month of December 1956, and the months of January, February 1957 inclusive. 2. A. Surgical Section - Ralph S. Emerson, M.D., Chairman B. Medical Section - 3 ‘§~ “ Lawrence S. Kryle, M.D., Chairman Tissue Committee Report - Howard L. walker, M.D., Chairman SCIENTIFIC PROGRAM - Arnold G. Blumberg, M.D., Chairman "THE TRANQUILIZERS IN PSYCHIATRIC PRACTICE AND THEIR APPLICATION TO GENERAL PRACTICE." Dr. Maximilian Fink Director of Research in Experimental Psychiatry Hillside Hospital, Glen Oaks, N. Y. COLLNTION. Respectfully yours, John G. Connell, M.D. President - Medical Board Telephone number The MA 0 Allison is 7"558’4v at Harry H. Abrahams, M.D. Secretary - Medical Board ~ﬁg ��mmmwm,wmpmmmmmmmm at then obs-mum, w an both» that m. WW WMMwnwmmoma-pmiwhcwnmmw Mx «811.1% unit-(unmask mmmumtmwumatmimummmmm ”demhmlm,wmm mummmmmmmaMaummmmwm m Intact. WWWuloatmthm. and Minimum new '4» obmﬂw, We!» afresh. mmm»mwmmmt¢mhumo£mpmuyotmwb mm and than mm). mm. m: max-minim at than m mt: dWarinwclm,thntwhu-Wtomuswwmﬂd~ mwhmmmpemﬂmwhopawnmmwhmmml behavior me:- that special mum d um brain {motion (we Seats.“ 6). WWanhnwhduwmamtatolmkawm mmwammmmmmmmmtdmzmmntmt. shock a a manic mutant. 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By entertaining than subject‘ 8 patterns of perception in awfully devolopod arianhatim and visual 1uy tasks, in hope to demonstrate O. “hump batman: those pater-nu and the bov- both havioral under the. special conditim of altered brain funcuun. and the general condition of hospitalisation and plywothompy. 8min a study ream, has bearing on tha problems of the personality upset: of resume to change �«6. in behavior wider stressful maniacs (us in forceful indactrimum, isolatim. atarmtim); a3 well as an «imam at mimic madame fer various W“ chntric therapies. ma mamwwwm me mums“ W w: 2. with elootmahock have led us to Em- theua mute personality factors in the patient and which ing the chain of treatment. a workabla hypothasia. We He of a. hypo— the tharapi‘at affect» am in the process of developing our ideas into antiéipate mdertnking such Mt I stuck by the and of the last report this section has been mdeaigna‘bed an the of Men-1mm thiatry. In addition to the panama]. listed 31am the Department the timofﬂwwtmport,mhmappointad, maparttimbasis, mm at. mm assistant in psychalngy. Dr. Pomek, who has his 111.11. from Kw York: University in 1955, has bean a mum-oh psychologist at tho Haunt Sinai Hospital and the 145mm rmdaum for emu Research for the past six Ha is experienced in both pamanauty and perceptual ”pants in march. years. It. in anticipatod that he will be appoint“ an 2. m1 tin basis on My 131:. A the individual differences in bahavior with specific ambush to study pram Pamela, as on tho perceptual and ation has been made pemmnty sweats has teen «“10de by his and applic- to various foundations for support. mauve April 131:, than will be appeintod to the Duparfanent, a Assistant for linguistic analyses. Under the hem of the E) funds warn and: mm“ x. devised ‘by m: 21:: «:1th Firm.” far a technical assistant he carry Dr. Jane. manna»! 1mm Grant (see out. Senna the language for Renaud: in Psyuhutry has gxmtad Dr. Jute sun or [26,919 plml $5,700 overhud far continuum Fund support for two years in than of the study “Language of the Dyna“ which has been dmlopod during hm past year. �ﬂan MMMMmWVWWrmum. mama-mm «mumspm 1st. 3957 unmmmt. 1959. mmmmmummmmuwudmmwm mararmmawmmmwmam £100»,me mumwmmmxmm-mwmmwmzwnmm ammwmnmmummmsumw,wmmmm InWr,;mawrthammkqu atmmwmammmmmtmummm mummuuwnhumamunumsmmumwwm nmr,nr.ammmmnm mmmmw. inmwmmmmmwhgmwnwnmemum mm‘dWomx-l. kWawﬂmWﬁs dWWWWMMmmmmmammm in m Widv mom 153mm my. autism “MW tho Em MWMWtWamrdmmawvmmmuMmr ﬂammmrmmu»hpoumha1umtorpnmumu an Week mum}: mama. th- smosy or Mom-1 WW, tho Inumhiml Wan of RM and the Imam-Mom}. 0mm! fer WW.‘ hmumnmmmmwwwumwunmmm ma for humﬁml Puma? ”W4. Mm: WM: mum mummnnmmmmmammwnam thrmthMme,uthw-omcmmmmm summeodmga. Womanhmmmmmwupummmma mmwwm.hﬂo,umupmmungmormm mum»“momwmdummotmmrdmwmmmm Chum; �vammamwmmmmmmamw fowlmm. unnaommmwanmnmmum or J. Mt. 1: in Manny mm}. m 3mm mm: Dr. anti-u”. main mum” at. an mum Alma: mu mum means with an W Wthmmuthortmmmmho- W, matmwmmmmumum. of Dr. a mmmamnmsmvm‘mmmm Morn a: thin-Baum: an «an in an «Mama and m... other 19%. numtatmthm; WW: mwmmwmm. DnlgmmbmnmngtMpmbhmof smwwmmmmuhmm 0 Wm wmwammmw‘mﬂammwhmmm. mm puma pm: mm mm is um We Wm mmuwappmuwmmumm. hummmpmaaar with acumen ”mm. Elam during typu of no bu been mpcmm ﬂu «mm-hock maniacal... 69min supports.“ an! that. and In thin new: be mmmwumum. Dr. 3. Fri-mm contributed mun-My to mmamm mm. mmmmmmwwmw. In WWmnodWMme,mmofmmmtmm mm m a may mm“ mm: m- m on at .m u» mam mm: mmmmmmmuw. Manama, WM” W 1913!! a: tum-3mm Mammary: Wm Max Pink. 11.13. �March 1957 Personality Factors in Behavioral Beeponse to Electroshock Therapy Robert L. Kahn, Ph. D. andMax Pink, From New 14. D. the Department of Experimental Psychiatry, Hillside Hospital, Glen Oaks, York. Aided by grant 14-927 of the National Institute of Mental Health, l“aﬁcional Institutes of Health, APublic Health Service. Presented a the Electroshock Research Association, Chicago, May 1957. �INTRODUCTION The behavioral response of patients receiving electroshock therapy is variable. In previous studies of the factors related to this variability we that patients who showed early, persistent and relatively marked degrees of altered brain function, as measured by the e1ectroencephalogram.and the amobarbital test for brain disease (10), were most likely to show a clinical The (h) (6) which (7). improved rated was present study is an as response investigation of the role of personality in the behavioral reSponse. An explicit hypothesis concerning this relationship has been derived noted from previous studies of the patterns of behavioral change occurring with EST. In an analysis of language changes after electroshock (7), that patients who we reported develop such language patterns as explicit denial of ill- and of and symptoms; displacement qualifitemporal Spatial personal, ness; cation, evasion and minimization are rated as improved. These language patterns are similar to those previously described by Weinstein and Kahn (13) in their studies of neurological patients with cerebral dysfunction. They characteru ized this behavior as the "language of denial" and demonstrated a relationship to personality. In particular they described the characteristics of the "ex€M)On the of these the denial" basis verbal observations, personalit plicit hypothesis was advanced that those patients who most closely approximated this "explicit verbal denial" personality type would be more likely to havioral changes after The purpose EST show the be- which are rated as improved. of the present study, therefore, was to determine: 1) whether personality characteristics related to the behavioral reaponse to electroshock therapy show proved. differentiated; and patients with greater "denial" tendencies are more likely behavioral changes after electroshock therapy which are rated as imp 2) whether to can be �.2POPULATION Sixty-three consecutive patients referred for electroshock therapy were studied. staff, The selection of patients for treatment was made by the psychiatric independent of the judgment of the authors. The patients ranged in age from 20 to 66 with a mean of I47, and included 21 men and 142 women. METHOD Prior to treatment each patient was evaluated according to the following methods : l. Structured EM Interviews: Personality was evaluated in inter- patient' 3 family. At the opening of the interview, the relative was asked to describe, in his own words, the patient's usual interests and attitudes. The relatives were encouraged to talk about any aspect they wished, and the interviewer followed the trend of their talk, rather thm proceeding in a serial fashion. The interviewer asked questions, however, to been 15 obtain information in m described as charspecific areas which have views with members of the acteristic of the "explicit verbal denial" personality,“. The number and withgibrelative varied according to the degree of type of questions required spontaneous production and the infomant' 3 capacity to comprehend and 00mm:- icate. The informant was encouraged to give concrete examples of all state- ments. basic items included the presence and extent of each of the following features: 1) stress verbal symbols such as resolutions, homilies, cliches and The rationalization; 2) are prestige and security conscious, and do not enjoy the intrinsic benefits of health, work, leisure, money and property; 3) regard illness as an imperfection or disgrace, keeping neighbors, and are it a secret from the family and reluctant to seek medical care; troubles and are considered practical persons who )4) "shake off" their advise others; 5) have drive and compulsive energr, and are guilty or uneasy if own much not occupied; 6) are conscientious with a high sense of duty and responsibility; 7) are sensitive . �.3to criticism, regarding it as an attack on their integrity; 8) are proud and avoid help from others; 9) are reserved rather than openly affectionate or emotional; 10) emphasize being correct; 11) are not imaginative or creative; 12) are not seen as dependent by their relatives; 1h) do not have temper outbursts; 15) and are not After the interview, each item if score of 0 was given 1 2 was rated on a 13) do not discuss sex openly; ludic (25). scale of 0, 1 or 2. A the aSpect was noted to a minimal degree; a score of indicated that the characteristic was moderately present; while a score of indicated the definite and marked presence of the pattern. The scores for each item were added and the resultant score is termed the "denial personality score". 2. Clinical Evaluation: Each patient weekly intervals during and evaluation prior to and at following the course of treatment. The clinical was determined by was interviewed the patient's behavior in the few weeks following the end of the course of treatment and was based on the evaluation of the pat- ient's therapist, the therapist's supervising psychiatrist and the supervising psychiatrist in charge of the electroshock treatment unit. Patients were classed into three groups: much improved, moderately improved, or unimproved, criteria outlined previously (6). 3. Language gtggy: In addition to the clinical interviews, following the each patient standardized series of questions determining his attitude was examined with a toward his illness. trouble?" and "If you Two of the questions asked were, “What is youi'mein had one wish, what would you wish for?" The patients were tested before and during treatment and the verbatim responses were analyzed for changes in language according to the method previously described (7). RESULTS The relatives of scores ranged from O h? patients were interviewed. The<ienia1 personality to 25, with a median of 11. For statistical comparison �.14- the patients were divided into two groups. Patients with scores ranging from 11 0 to to 25 were 10 were frm considered the "high denial" group, while those with scores classed as low in denial tendencies. 1. Personality score and clinical response: Patients with high denial personality scores in these family interviews were most likely to be rated as much improved, and patients with low scores, however, the basis, with chance only one case was considered unimproved (Table 30% I). In clinical response rating occurred on a of the patients being regarded as mimproved. I TABLE Relation of Denial Personality Scores to Clinical Response to Electroshock Much Improved Moderately Improved Total Unimproved Personality Score 11 0 - 25 1h 9 1 2h 10 7 9 7 23 21 18 8 it? Total The proved difference in the denial scores between the patients, when compared sigzificant.* Although the much and moderately im- to the unimproved patients is statistically much improved patients have a higher mean score is not significant. 2. Qualitative observations: Although there is a relationship between high denial personality scores and the clinical rating, 30% of patients with than the moderately improved group, this difference low denial scores were also evaluated as showing a marked improvement. While trig/1:119 group of seven patients is a small one , certain common characteristics can be described. Although these subjects lack the competitive security needs of the high denial subjects, they or imaginative capacity or ability to think Si ~K- vb; { {ran-M at 1% level of confidence by show drive, prestige and a similar lack of creative critically of their Mann-Whitney U Test. own or other's �.5relate to the environment primarily by non-verbal forms of commmication. They are described by their families as laughing or crying feelings. They excessively; and as showing anger by muteness, ”go into a shell," ”walk out of the room in a huff,” or by violent tempers with table-pounding, throwing objects or direct physical assault. These patients are "ludic," by Weinstein and Kahn (12) to denote comic, language analysis described in a in clinical interviews term used tragic, or melodramatic behavior.* 1m: previous study (7), the 3. Personality score and Meg -a Applying the technic of i__n_ changes in language were compared with the denial personality scores. Nine patterns of language change, such as explicit denial of illness or symptoms, displacement, qualification, £33. have been described as characteristically occurring after electroshock. ified according to the plicit language As in the previous study, each patient was class- dichotomy of whether or not he showed three or more ex- changes. Patients with high denial personality scores showed a greater number of language changes, than those with low denial personality scores (Table II). The coefficient of correlation between the personality scores and the number of language changes the 1% is .71, significant + at better than level of confidence. TABLE II Relation of Denial Personality Scores to Clinical Language Changes During Treatment Number Langggge Changes 0 - 2 3 or more Personality Scores 11 .- 25 (20) 8 12 - (20) 17 3 25 15 o 10 Total This term was taken from Piaget who applied behavior of young children (8). *- it to the play and imitative �h. Illustrative Cases: Case 1. High Denial Personality Score: A 61-yearbold housewife was admitted to the hospital with a 15 history of insomnia, abdominal pain and fear of cancer. On admission she was depressed, retarded, and seclusive, evincing little interest in her month surroundings, and wandering aimlessly about the ward. The patient reaponsible person with and was unable home. her husband as a conscientious, dependable, integrity. She had no hobbies, outside interests, was described by much to relax. She was ”mortally As a consequence, she busied herself with chores at afraid" of doctors, minimized her illnesses and con- cealed ailments, even from her husband. Very restrained, she openly showed no affection or emotion, never discussed sex and rarely lost her temper. She had "a long memory for little things if she felt that she was wronged," a ”streak of stubborness," and would "just as soon hold another person responsible for her mistakes." She was proud and would ”rather go without food" than borrow or take money from others. According to the denial criteria, her score After 20 electroshock treatments, she was 20. became euphoric, took an interest in her personal appearance and participated in hospital activities. Her doc"model" ”while her who, a reluctant to discuss her personal patient toi/called feelings, asserted that she had no difficulties at hue-'had home, a wonderful band.uho was very good to her, considered herself lucky and eagerly anticipated her discharge.” Case She was discharged with a 2. A Low rating of "much improved." Denial Personality Score: hl-year-old housewife was admitted to the hospital with a two year history of depression following the birth of her fourth child. She cried frequently, lost interest in social activities, found it increasingly difficult to take care of her baby and had suicidal thoughts. On admission the patient �was' noted to pay little attention showed psychomotor The whom He it patient retardation and was was described by was not easy to her personal appearance, cried readily, circumstantial in speech. her husband as a "negative personality” with to get along because she was opinionated and argumentative. regarded her as "completely impractical, with no common sense." She was a poor housekeeper, constantly demanding help from other people, although not the kind of person who would put herself out for others. An excessively talkative person, she liked to engage in long, intellectual, pretentious conversations. When angry, however, she would become either completely mute, or "very nasty, just don't know any better.” Although considered a “cold" person, able to talk freely about sex. She frequently complained of physical implying you she was ailments and went to physicians readily. She was ”naive" and "unrealistic," believing, for example, that she had a flair for writing although others con- sidered her amateurish. Her personality score was rated as h. patient received eighteen electroshock treatments, which were terminated at her own insistence because she was too frightened to take any more. At the time of her discharge her doctor noted her as "quite depressed,” but The felt that hospital. it was doubtful that she could benefit from further treatment She was discharged with at the the recommendation for continued psychother- apy. DISCUSSION The structured family interview was designed to test the specific hypo- thesis derived from earlier observations that patients with the "explicit verbal denial” personality are most likely to Show both the language and behavioral changes to electroshock therapy which are rated as the examiner. The much improved by data supports this hypothesis and is also consistent with �the theory of the mode of action of electroshock therapy advanced by Weinstein, that “....the therapeutic efficacy of electroconvulsive therapy....derives from the production of a state of brain function in which the mechanism of denial is facilitated in characterologically Linn and Kahn in 1952 (9). They suggest diaposed individuals." The degree of explicit verbal denial is, however, only one personality aspect affecting the behavioral response to treatment. 0n the basis of the present data and methods of analysis a broader view of personality patterns in relation to improvement with as clinically EST is now possible. improved are characterized by such Those patients who are rated features as: l) non-empathic - unable to think critically or sensitively about the needs,feelings, or - commun- ications of others; 2) non-introspective - - unable to think critically about their own feelings or needs; unable to achieve insight even with the collaboration of others in a psychotherapeutic relationship; 3) rely heavily on nonverbal communication - - even tial when they are talkative there is little referenp communication, the words being cliched, stereotyped, or representative of feelings and emotions rather than transmitters of information and h) highly conventional - - without imaginative or creative capacity, and with few resources to deal with stressful or With re8pond new this pattern as the situations. common background, two classes of patients who to treatment can be defined: a) the driving, conscientious, independent, successful, emotionally-controlled person who can be characterized as the ”explicit verbal denial” personality type; b) the chronically inadequate, affectd::;;;&rfrom and ively labile ludic, dependent person, an impoverished socio- cultural background. While both types are rated as improved in their short tenm response to electroshock, preliminary folloWhup observations indicate that the "explicit verbal denial" personality type clinical response, while the Indie group is more likely to sustain the is likely to relapse quickly. �Consistent with our previous studies we have found that altered brain fun- ction is a necessary condition for behavioral change with electroshock therapy. The kinds of behavioral change shown with altered brain function, however, vary markedly in different patients. ment of symptoms and are states, become withdrawn, Some Show mood rated as improved. Others develop paranoid agitated or show additional somatic or are rated as unimproved. In this study in those cases we who were memory complaints, and here stressed the personality factors whose behavioral reSponse was considered the patients changes and denial or diSplace- rated as improved. we have not rated as only moderately improved or unimproved. If the basic hypothesis is correct, we should also find a relationship between personality and the behavioral response in patients who are rated as unimproved. Present information in this regard is minimal, as this problem has not'been approached with a specific hypothesis. raise questions concerning the relation of personality to type of mental illness and choice of therapy. Clinical observations support These observations the concept of a characteristic predepressed personality. Abraham (I) noted that states of depression occurred in obsessional persons. Arnot ‘2) describes depressions as being overly conscientious and perfectionistic. Hamilton and (5), reporting various aspects of the personality in involutional depression, include such features as "followed a rigid pattern of behavior....displayed a lack of imagination....narrow range of interests....thorough, cone Mann scientious, meticulous devotion to duty....lack of feeling for point of view of others....hard, uncompromising drivers....oversensitive....reserved.“ Cohen, et a1 (3) in an intensive study of manic-depressive psychosis, reported their patients as being highly prestige-conscious; little concerned with prdblems of interpersonal relatedness; stereotyped; conventional; having for communicative interchange; and unaware of little capacity other persons' feelings toward �.10himself or of his feelings toward others. They emphasized the patients' inability to communicate verbally and suggested that the therapeutic relationship should be in nandverbal terms rather than emphasizing the intellectual contents of the exchange. These studies of the personality background of depression show a that is pattern similar to those personality asPects which have been described as the "explicit verbal denial" personality. The factor of personality could thus most explain the fact that depression is the condition which responds best to electroshock treatment. The same personality factors which to a depressive reaction are those which forms of therapy. These factors enable make him him make a person susceptible responsive to noneverbal to respond, under the conditions of altered brain function, with those language and other behavioral changes which are evaluated as improved. Thus, the same stereotypy, conventionality, perfectionism, and prestige-consciousness, which produce a catastrophic response in the individual faced by the loss of a partner, job, business, or loved one permit the development of denial, minimization and displacement under the conditions of altered brain function and are deemed ”improved” by the family and the therapist. �SUMMARY AND CONCLUSIONS 1. Personality factors in 63 consecutive patients referred for electro- shock therapy were studied by means of a structured family interview. 2. The 3. The which results that aSpects of personality can be differentiated are significantly related to the response to treatment. show basic personality pattern of the patients who reSpond best can be characterized as a) non-empathic, b) non-introspective, c) communicate non- verbally, and d) highly conventional and stereotyped, with or creative capacity. h. 'Within the context of this of improved patients. One group is common little imaginative core, there are two main subdivisions comparable to the ”explicit verbal denial" personality, showingiﬁzch features as drive, conscientiousness, independence and emotional control. The other group consists of persons apt to be chron- ically inadequate and dependent, coming from deprived socio-cultural back- grounds, who are affectively 5. labile and ludic. relationship between these personality patterns and descriptions of the personality of depressed persons is noted. The same personality factors The which contribute to a depressive reaction, contribute to a behavioral change under the conditions of altered brain function following electroshock therapy which is evaluated as improvement. �~12REFEEENCES 1. Abraham, K.: Selected Papers Press Ltd., 1919. Amot, on Psychoanalysis. London: The Hogarth Predepressed Personality, A.M.A. Arch. Neural. Chiato, L6: 617-618, 1956. The 12.: & Psy- 3., Baker, G., Cohen, R. A., From—Reichmam, F. and Weigert, E. V.: In Intensive Study of Twelve Cases of Manic-Depressive Psychosis, Psychiat., 1.1: 103-137, 1951. Cohen, M. Pink, and Kahn, R. L.: Quantitative Studies of Slow Wave Activity Following Electroshock, EEG Clin. Neurophysiol., Q: 158, 1956. M. Hamilton, D. M. and Mann, W. A.: The Hospital Treatment of Involutional Psychoses, in Depression (Hock, P. and Zubin, J. , eds.) , New York: Grune & Stratton, 199-209, 1952. L., Fink, M. and Weinstein, E. A.: Relation of Amobarbital Test to Clinical Improvement in Electroshock, 11.14.11. Arch. Neurol. & Psydliato, 16-: 23-29, 1956. Kahn, R. 7. Kahn, R. L. and Fink, 14.: Changes in Language During Electroshock Therapy, in Psychopatholog of Commication (Hock, P. and Zubin, J. , Eds.) in press. ‘ 8. Piaget, J.: Play, Dreams and Imitation in Childhood. New York: W. W. 9. Weimtein, E. 1., Linn, L. and Kahn, R. L.: Psychosis During Electroshock Therapy: Its Relation to the Theory of Shock Therapy, Am. J. PSYChiato’ 3:99.: 22.26, 1952. 10. Weinstein, E. A., Kahn, R. L., Sugaman, L. A. and Linn, 1a.: Diagnostic Use of Amobarbital Sodium ("Anwtal Sodium") in Organic Brain Dis- ease, ll. Weinstein, Am. J. Psychiat., 113: 889-891;, 1953. E. A. and Kahn, R. L.: Personality Factors in Denial of & A.M.A. Arch. Neural. Psychiat., 92: 355-367, 1953. ness, Ill- Weinstein, E. A., Kahn, R. L. and Sugarman, L. A.: Ludic Behavior in Patients with Brain Disease, J. Hillside Hosp. , 2: 98-106, 1951;. 13. Weinstein, E. A. and Kahn, R. L.: Denial of Illness: Symbolic and Physiological Aspects. Springfield, 111.: Charles C. Thomas, 1955. �April 1, 1957. MEMORANDUM TO: Medical Affairs Committee FOR: Dr. Joseph S. A. Miller FROM: Department of Experimental Psychiatry SUBJECT: 1957. 1956 to April 1, September of Departmental Activities, Report Experimental of the Department of the of activities following report since the period covering of’Dr. Miller, the submitted request at Psychiatry is The September 1956. A. Progress in Ongoing Projects: the evaluate The signifito control study Evaluation: 1. Electroshock be com1956, will on April 1, instituted electroshock therapy, cant elements in been has been have studied. It 1957. Seventy patients pleted by the end of’May the electrointo insights have we and gained significant successful a most group, made 1955-56, in observation, the we original verified shock process. First, dethe is electroshock therapy behavior in in change that the prerequisite for function. brain in and sustained alteration degree velopment of a significant Under the conditions of altered brain function, however, patients respond in electroshock is follows that the improvement In some patients, various ways. the that was opinion our It disappears. rapidly while in others, it sustained, observations. these determinant in instrumental the was patient's personality in the of patients the personality studied have intensively we For this reason standard interview developed tests, this last group. By applying specially have we number of questionnaire tests, and a modifying psychological tests, and of type between personality the number of relationships determined a behavioral the we At predicting are time, the present behavioral response. and during our predictions electroshock to therapy, the of patients response As a result chance. than better been have months significantly the past few include to personality extend study our to we planning are of these observations, G). Section (see results psychotherapy in factors changes the been has perceptual of patients Our second interest in this group to deable have been we control of a By group, virtue induced by electroshock. and those treatment the to related which are changes termine those perceptual im— been have we In these observations, which are related to practice effects. and their the of the patients personality close interrelation.bf the pressed by two so behavior of is The these of aspects interrelation perceptual processes. in differences individual of undertake study a decided have to we close, that under the behavior eventual to such differences and to relate hope perception 0). Section (see function brain of altered special conditions Our which electroshock therapy of concept a to have led develop us studies Electrotreatment unit. of this management the in has been of significant help which function brain in induces changes treatment. It shock is a non-specific Under these two months. than less of usually time, persist for varying lengths depending environment different in ways to his the responds patient conditions, his he to better 'With relates certain a personality, upon his personality. �-2The and better that he relates to to other his patients. family, therapist, other people the less reason is there-for him to become tense, anxious or 6nce the feeling of well-being is set into motion, it is sustained depressed. by the patient's better ability to function with others. Electroshock therapy is not a specific treatment for a specific fbrm of mental illness. 2. Biochemical Changes in Electroshock: In the course of these studies of electroshock, we noted that other investigators had reported that there were and the one report fluid after in trauma, in Spinal changes enzymes specific noted similar changes after electroshock. Dr. Goldenberg and I undertook a study of these enzymes in order to verify the previous reports and to clarify our own picture of the electroshock process. To date, we have collected 30 spinal fluids. I anticipate that this phase of the work will continue until the end of 1957. 3. Communication Studies: Our interest in communication problems has led to two types of studies. In one, Dr. J. Jaffe has developed a technique for the analysis of recorded interviews which provides us with an objective index of change in behavior. Support for this phase of the work has been obtained from the Foundations' Fund for Research in Psychiatry. At present, he is analyzing the recordings of interviews with electroshock patients made earlier in the year, and his findings are correlating very well with the clinical results. we antiand the in of language changes to an technique analysis this applying cipate behavior that occur in ps;chotherapeutic interviews. analysis of the structured amytal test intero views according to changes in syntax and content. The original findings of this study were presented to the AmeriCan Psychopathological Association in June. Since then, all our amytal test interviews are being analyzed in like fashion and the original findings have been verified and amplified. ”e have come to understand that the language of our patients tells us readily whether or not changes have occurred in brain function and in behavior. Furthermore, correlations between the personality evaluations and the language changes have shown a direct relationship between high degree language changes and certain personwith other personality types. and changes minimal-to-no language types; ality Language is thus a recordable facet of behavior and we are ODtlmiStiC that a combination of the language analyses developed by Drs. Jaffe and Kahn would be a meaningful index of changes in behavior applicable to any form of psychiatric therapy, including psychotherapy. h. Egrebral Reactivity: As described in the previous report, our interest in the question of individual variability in cerebral reactivity has been stimulated by our electroshock studies. One part of this study is the A second is the study of the biochemical in changes fluid. of spinal study rate of development of electroencephalographic change induced by electroshock. Dr. Green has begun this phase of the work and since September has surveyed all EEG basic of their by records, and their an electroshock analysis our patients been has Mcgimide to the cerebral to Also, response hyperventilation. reSponse A second study is a language assessed and this phase of the work completed (see Section B). Beginning in May, the admissions new hOSpital the to that will screen is laboratory anticipated it and that various activation procedures will be tested, so that the definitive study can be undertaken in the Fall. Concurrently, Dr. Green has assessed the relationship between the electroshock seizure threshhold and cranial resistance as factors influencing the development of electroencephalographic abnormality. This study is in progress. �.3This study, under the direction of Dr. Sidney TaraNew York have and been before the the observations continued has presented chow, Neurological Society in January. The observations have been summarized in a reand A.M.A. Archives of which Neurology the in Psychiatry. will shortly appear port S. B. Ambivalence: Completed Projects: 1. Chlorpromazine-Insulin Coma: Control Study: An interim report on the results of this control study was submitted to the Research Committee of the Medical Board on January 31, 1957. In this study, 59 patients referred for insulin coma were divided into two groups - one-half receiving insulin coma and the other half receiving chlorpromazine therapy. It was our conclusion that chlorpromazine is as effective in modifying psychotic behavior patterns as insulin coma therapy. There was a tendency for the discharge ratings to be better for the chlorpromazine ,we to concluded insulin in comparison coma the than for insulin that, group. group coma therapy, chlorpromazine was safer, easier to administer, more controllable in had Tb evidence concluded had no also and that fewer side effects. apits effects, peared in the fifteen months of the study that either therapy had altered the basic schizophrenic process, nor did we feel that either form of therapy had a greater specificity for schizophrenic illnesses. At the conclusion of the study, the Medical Director placed chlorpromazine in the formulary and permitted its use by the Resident staff. Insulin Coma 2. Megimide Evaluation: During this period, Dr. Green has evaluated a new agent in electroencephalography, megimide, for its ability to bring out defects in brain function. The report of his findings Twere presented at the midwinter meeting of the Eastern Association of Electroencephalographers. 0. Projected Studies It is . 1957-58: in progress in the Department will The electroshock evaluation study will be completed this Spring and the next few months will be spent in correlating the information obtained and writing the reports. As indicated in the ongoing and have of studies these out number of developments grown it a progress notes, is anticipated that these will be incorporated in the_active research program. anticipated that the work continue for the remainder of the year. now A Behavioral Reapgggg: protocol has been 1. £ndividual_Differences in developed by Dr. Max Pollack, which incorporates the problem of personality affecting individual responsivity to electroshock. By determining the subject's patterns of perception in specially developed orientation and visual tasks, we hope to demonstrate a relationship between these patterns and the behavioral response, both under the special condition of altered brain function, and the general condition of hospitalization and psychotherapy. Such a study has bearing on the problems of the personality aspects of resistance to change in behavior under stressful conditions (as in forceful indoctrination, isolation, starvation); as well as the definition of suitable candidates for various psychiatric therapies. 2. Personality Factors in Doctor and Patient Affecting Choice of Thera : Our experiences with electroshock have led us to a unmber of hypotheses which relate personality factors in the patient and the therapist affecting the choice of treatment. We are in the process of developing our ideas into a workable hypothesis. We anticipate undertaking such a study by the end of the year. �D. Changes in rersonnelz- Since the last re\ort, this section has been redesignated as the Department the of time the at the to personnel In addition listed of Experimental Psychiatry. Max Research Dr. as Pollack, a have on we part-time basis, appointed, last report, New York from who University has his_Ph.D. Dr. Pollack, Assistant in Psychology. and mount the Sinai Hospital the at research been has psychologist a in 1955, He is experienced the six for Research Child past years. Ittleson Foundation for he that is anticipated research. in and It perceptual aspects in both personality A the indito study July on program basis a full-time be on lst. appointed will and the on perceptual personemphasis with behavior specific vidual differences in made various been has to and him been application by developed ality aspects has foundations for support. Technical a the be to Department, appointed will there Effective April let, FFRP (see Section Grant Under the of terms the analyses. Assistant for linguistic E) funds were made available for a technical assistant to carry out the language measurements devised by Dr. Jaffe. E. Funds: Foundations' Fund for Research in Psychiatry has granted Dr. Jaffe continuation overhead for h5,700 a26,000 of sum plus two the in years support for the been has developed during which past year. Dyad" the of "Languahe the of study FFRP The Kaufmann Foundation. grant will exthe This work had been supported by tend from April 1, 1957 to March 31, 1959. Health Mental fbr of National made Institute the been to have Applications subthe Green. Dr. protocol Also, work by undertaken of support for the program of Division and Development Research the to been has sent Pollack mitted by Dr. FoundaMalina and the to Army, States United the of the Surgeon-General's Office The tion. F. Publications and rresentations: In November, a summary of our studies on electroshock was presented at the Montreal a in Association in report American the Psychiatric of Meeting Divisional FollowChange Behavioral to Function Brain Altered entitled "Relation of Tests of "Electroencephalothe Green Dr. report December, presented Electroshock". In ing Electroenceh of Association Eastern the Negimide" at of Lffects and Clinical graphic studies during the of electroencephalographic In a summary February phalographers. Differences in "Individual entitled a two in was report presented the past years EEG Besponsivity" before the Metropolitan EEG Society. The Department has submitted a number of reports to various societies for the the at for been have presentation accepted Summer Papers and meetings. Spring the Psychiatry, of Biological Society the Research Association, Electroshock International Congress of Psychology and the International Congress for Psychiatry. American the Psysymposia at in to been have invited participate In addition, we These meetings. for Psychiatry International Congress and chiatric Association Department of this the experiences considerable detail summarize in reports will and to electroshock to with regard and two one-half specific the years, past over methods of the language anato have we present an opportunity also will drugs. to as some of our speculations well as presenting Dr. as devised by Jaffe, lysis the role and mode of action of the newer drug therapies in psychiatry. �G. Educationi_ Various members of this Department are continuing their education by formal courses. Dr. H. Korin has been enrolled in courses at the Graduate School of New York University with specific emphasis on statistics. Dr. J. Jaffe is completing the formal training requirements at the William Alanson White Institute of Psychoanalysis. Dr. Robert L. Kahn has been accepted for training in psychoanalysis at the William Alanson White Institute. H. Other Activities: 1. Israel Strauss November 1953. and Members Volume: The Israel Strauss Volume appeared in of this Department were active in the development fulfillment of that volume. 2. Resident Training: Since September 1956, two Residents have worked H. Esecover has been studying the problem of Dr. the in Department. actively psychotherapy with electroshock patients. In this study he has been supervised He made. has have been number conclusions and of a members the Deiartment of by demonstrated that patients differ considerably during the electroshock process and that no single type of psychotherapy is meaningful. Certain supportive and He is now in the process of have value. definite may approaches interpretive describing his observations. Dr. S. Friedman has contributed considerably to the ambivalence study. this work he was supervised by Dr. Tarachow. In During the period September to February, members of the Department participated in a weekly lecture series for the Resident staff on the subjects of research methodology and newer trends in psychiatry. Respectfully submitted, Max MFzgw Department of Experimental l’sychiatry _ ﬂillside Hospital Glen Oaks, New York Fink, M.D . �HILLSIDE HOSPITAL FOR PSYCHIATRIC TREATMENT. TRAINING AND RESEARCH JOSEPH S. A. MILLER, 75-59 263m: M. D. STREET. GLEN OAKS. NEw YORK FIELD STONE Medical Director LEON $7500 Lowwsrm Honorary Chairman Board of Directors SIMON KWALWASSER, M. D. ROY FOSTER Assoc. Medical Director Chairman Board Of Directors MAURICE BACHRACE Administrator E. COLEMAN President ALVIN Dear Sir : basis for the discussion of the research activities at the meeting of the Medical Affairs Committee on Monday, April 8th, I am herewith enclosing the following memoranda= As a 1. Report of Dr. Fink for the Department of Experimental Psychiatry. 2. Research activities in the Department of Biochemistry, by Dr. Harry Goldenberg. 3. Research in the Department of Medicine, by Dr. Arnold G. Blumberg Aside from the regular Medical Board members of the Medical Affairs Coxmnittee, there will also be present Dr. H. L. Rachlin, Chairman of the Research Comittee of the Medical Board and Dr. Max Fink, Director of the Department of Experimental t’sychia’cry. Yours sincerely, f4,WIM, Joseph S.A.Miller, M.D. JSJALI: 11b Medical Director encl. AN AFFILIATE OF FEDERATION OF JEWISH PHILANTHROPIES OF NEW YORK �April 1, 1957. MEMORANDUM TO: Medical Affairs Committee FOR: Dr. Joseph S. A. Miller FROM: Department of Experimental Psychiatry SUBJECT: Report of Departmental Activities, September 1956 to April 1, 1957. Experimental of the Department of the activities of following report since the period ofHDr. covering Miller, the request Psychiatry is submitted at The September 1956. A. Proggess in Ongoing Projects: the evaluate The signifito control study Evaluation: 1. Electroshock be com1956, will on April 1, instituted electroshock therapy, cant elements in been has studied. been have It pleted by the end ofTMay 1957. Seventy patients the electrointo insights have we and significant gained a most successful group, made 1955-56, in observation, the we original verified shock process. First, the deis electroshock therapy behavior in in change that the prerequisite for function. brain in and sustained alteration velopment of a significant degree Under the conditions of altered brain function, however, patients respond in electroshock is follows that improvement the In some patients, various ways. that the was opinion our It disappears. rapidly while in others, it sustained, observations. these in determinant instrumental the was patient's personality in the of patients the personality For this reason we have studied intensively standard interview developed tests, this last group. By applying specially have we number of questionnaire tests, a and modifying psychological tests, and of type between personality the number of relationships determined a behavioral the we predicting are At the present time, behavioral response. and during our predictions electroshock therapy, to reSponse of the patients As a result chance. than better been have significantly the past few months include to personality extend study our to we planning are of these Observations, G). Section (see results factors in psychotherapy changes the been perceptual has of patients Our second interest in this group deto able been have we control a group, induced by electroshock. By virtue of and those treatment the to which related are termine those perceptual changes imbeen have we In these observations, which are related to practice effects. and their the of patients the personality interrelation.of close the pressed by so behavior two is of The of these aspects interrelation perceptual processes. in differences individual of undertake study a decided to close, that we have under the behavior eventual to such differences and to relate hope perception G). Section (see function brain special conditions of altered which electroshock therapy of a concept to develop have led us Our studies Electrotreatment unit. this of management the in has been of significant help which function brain in changes induces shock is a non-specific treatment. It Under these two months. than less of usually time, persist for varying lengths depending environment different ways in his to responds the patient conditions, his to he better relates With certain a personality, upon his personality. �-2— family, his therapist, and to other patients. The better that he relates to other people, the less reason is there for him to become tense, anxious or depressed. Once the feeling of well-being is set into motion, it is sustained by the patient's better ability to function with others. Electroshock therapy is not a specific treatment for a specific form of mental illness. 2. Biochemical Changes in Electroshock: In the course of these studies of electroshock, we noted that other investigators had reported that there were Specific changes in enzymes in the spinal fluid after trauma, and one report noted similar changes after electroshock. Dr. Goldenberg and I undertook a study of these enzymes in order to verify the previous reports and to clarify our own picture of the electroshock process. To date, we have collected 30 spinal fluids. I anticipate that this phase of the work will continue until the end of 1957. Communication Studies: interest in communication problems has led to two types of studies. Tn one, Dr. J. Jaffe has developed a technique for the analysis of recorded interviews which provides us with an objective index of change in behavior. Support for this phase of the work has been obtained from the Foundations' Fund for Research in Psychiatry. At present, he is analyzing 3. Our the recordings of interviews with electroshock patients made earlier in the year, and his findings are correlating very well with the clinical results. we antiand the in of language changes to an technique analysis this applying cipate behavior that occur in pa chotherapeutic interviews. analysis of the structured amytal test interviews according to changes in syntax and content. The original findings of this study were presented to the American Psychopathological Association in June. Since then, all our amytal test interviews are being analyzed in like fashion and the original findings have been verified and amplified. We have come to understand that the language of our patients tells us readily whether or not changes have occurred in brain function and in behavior. Furthermore, correlations between the personality evaluations and the language changes have shown a direct relationship between high degree language changes and certain personality types; and minimalvto-no language changes with other personality types. Language is thus a recordable facet of behavior and we are optimistic that a combination of the language analyses developed by Drs. Jaffe and Iahn would be a meaningful index of changes in behavior applicable to any form of psychiatric therapy, including psychotherapy. h. Egrebral Reactivity: As described in the previous report, our interest in the question of individual variability in cerebral reactivity has been stimulated by our electroshock studies. One part of this study is the A second is the study of the biochemical in of changes spinal fluid. study rate of development of electroencephalographic change induced by electroshock. Dr. Green has begun this phase of the work and since September has surveyed all our electroshock patients by an analysis of their basic EEG records, and their reSponse to hyperventilation. Also, the cerebral response to Mcgimide has been assessed and this phase of the work completed (see Section B). Beginning in May, is anticipated that the laboratory will screen new admissions to the hospital it and that various activation procedures will be tested, so that the definitive study can be undertaken in the Fall. A second study is a language Concurrently, Dr. Green has assessed the relationship between the electroshock seizure threshhold and cranial resistance as factors influencing the development of electroencephalographic abnormality. This study is in progress. �.3’ 5. Ambivalence: This study, under the direction of Dr. Sidney TaraNew York have before been and the the observations presented chow, has continued Neurological Society in January. The observations have been summarized in a report which will appear shortly in the A.M.A. Archives of Neurology and Psychiatry. B. Completed Progects: 1. Chlorpromazine-Insulin Coma: Control Study: An interim report on the results of this control study was submitted to the Research Committee of the Medical Board on January 31, 1957. In this study, 59 patients referred for insulin coma were divided into two groups - one-half receiving insulin coma and the other half receiving chlorpromazine therapy. It was our conclusion that chlorpromazine is as effective in modifying psychotic behavior patterns as insulin coma therapy. There was a tendency for the discharge ratings to be better fer the chlorprcmazine we concluded that, in comparison to insulin coma the than for insulin group. group coma therapy, chlorpromazine was safer, easier to administer, more controllable in had evidence concluded had no ‘b that also fewer and side apeffects. its effects, peared in the fifteen months of the study that either therapy had altered the basic schizophrenic process, nor did we feel that either form of therapy had a greater specificity for schizophrenic illnesses. At the conclusion of the study, the Medical Director placed chlorpromazine in the formulary and permitted its use by the Resident staff. Insulin Coma 2. Megimide Evaluation: During this period, Dr. Green has evaluated a new agent in electroencephalography, megimide, for its ability to bring out demidTJere the The of his findinas at presented function. brain in report fects winter meeting of the Eastern.Association of Electroencephalographers. C. Projected Studies 7 l9§7~§8: the work now in the in Department will that progress anticipated is It continue for the remainder of the year. The electroshock evaluation study will be completed this Spring and the next few months will be spent in correlating the information obtained and writing the reports. As indicated in the ongoing and have of studies these out number of developments grown it a progress notes, is anticipated that these will be incorporated in the active research program. A i“Response: Behavioral protocol has been 1. lgdividual Differences in IVia}: Dr. Pollack, which incorporates the problem of personality affectdeveloped by ing individual responsivity to electroshock. By determining the subject's patterns of perception in specially developed orientation and visual tasks, we hOpe to demonstrate a relationship between these patterns and the behavioral response, both under the special condition of altered brain function, and the general condition of hospitalization and psychotherapy. Such a study has bearing on the problems of the personality aspects of resistance to change in behavior under stressful conditions (as in forceful indoctrination, isolation, starvation); as well as the definition of suitable candidates for various psychiatric therapies. 2. Personality Factors in Doctor and Patient Affecting Choice of Therapy: Our experiences with electroshock have led us to a number of hypotheses which relate personality factors in the patient and the therapist affecting the choice of treatment. We are in the process of developing our ideas into a workable hypothesis. We anticipate undertaking such a study by the end of the year. 17 , 914.4 f 3 f 1 b Va. 1,5 _. �D. Changes in Fersonnel: the Department been as has redesignated section this Since the last re ort, the time of the at listed the personnel to In addition of Experimental Psychiatry. Max Research as Dr. Pollack, a basis, last report, we have appointed, on part-time New York University from Ph.D. who has Dr. Pollack, his Assistant in Psychologr. and the mount Sinai Hospital the at in 1955, has been a research psychologist He is experienced six the Research for past years. Ittleson Foundation for Child he that anticipated is It in both personality and perceptual aspects in research. A program to study the indiJuly on basis lst. on the perceptual and personwill be appointed on a full-time vidual differences in behavior with Specific emphasis made various been to has and him by application been developed ality aspects has foundations for support. Technical a the Department, to be appointed will there Effective April lst, FFRP Section (see Grant of the Under terms the Assistant for linguistic analyses. the language out to assistant technical a carry made for available E) fUnds were measurements devised by Dr. Jaffe. 3- £211.42: Dr. Jaffe has granted Fund Research Psychiatry Foundations' in for The continuation overhead for $5,700 u26,000 of plus sum the two years in support for the been during past developed has which year. Dyad" the of "Languace the of study FFRP The will Fbundation. exKaufmann grant the by been had work supported This tend from April 1, 1957 to March 31, 1959. Health Mental for of National made Institute the to been Applications have subthe Green. protocol Dr. Also, by work undertaken support for the program of of Division and Development Research the to been sent mitted by Dr. Pollack has FoundaMalino and the to Army, States United the Surgeon-General's Office of the tion. F. Publications and Presentations: the at was presented electroshock on studies of our In November, a summary Montreal a in Association report in American Psychiatric the of Meeting Divisional FollowChange Behavioral to Function Brain entitled "Relation of Tests of Altered "Electroencephalothe Green report Dr. presented December, Electroshock". In ing Electroenceb of Association Eastern the Megimide" of at graphic and Clinical Lffects during studies electroencephalographic the of In a February summary phalographers. Differences in "Individual entitled a in report two was presented the past years EEG Besponsivity" before the Metropolitan EEG Society. the for societies various to number of submitted a reports The Department has the at for been have presentation accepted Summer meetings. Papers Spring and the Psychiatry, Biological of Society the Research Association, Electroshock for Congress Psychiatry. International and the Psychology of Congress International Psy— American the symposia at in In addition, we have been invited to participate These meetings. for Psychiatry International Congress and chiatric Association Department of this the experiences detail considerable summarize in reports will and to electroshock to regard with and one-half specific two years, over the past methods of anathe language to present have we an opportunity also will drugs. to as some of our speculations well as presenting lysis devised by Dr. Jaffe, as in psychiatry. therapies the newer drug of mode and of action the role �-5G. Education: Various members of this Department are continuing their education by formal courses. Dr. H. Korin has been enrolled in courses at the Graduate School of New York University with specific emphasis on statistics. Dr. J. Jaffe is completing the formal training requirements at the William Alanson White Institute of Psychoanalysis. Dr. Robert L. Kahn has been accepted for training in psychoanalysis at the William Alanson White Institute. H. Other Activities: 1. Israel Strauss Volume: November 1955. and Members The Israel Strauss Volume appeared in of this Department were active in the development fulfillment of that volume. 2. Resident Training: Since September 1956, two Residents have worked H. Dr. Esecover has been studying the problem of the in Departnent. actively psychotherapy with electroshock patients. In this study he has been supervised He has made. have been number and conclusions of a members of the Department by demonstrated that patients differ considerably during the electroshock process and that no single type of psychotherapy is meaningful. Certain supportive and He of the now have in value. is definite process may approaches interpretive describing his observations. Dr. S. Friedman has contributed considerably to the ambivalence study. this yprk he was supervised by Dr. Tarachow. In During the period September to February, members of the Department participated in a weekly lecture series for the Resident staff on the subjects of research methodology and newer trends in psychiatry. Respectfully submitted, Max MFzgw Department of Experimental i"sychiatry > hillside Hospital Glen Oaks, New York Fink, M.D. �April 1, 1957 Medical Affairs Cummittee TO: For: Dr. Joseph S.A.Miller From: Department of Biochemistry Subject: Report of Departmental Activities, July 1956 to March 31, 1957. Steroid Studies Studies were continued on the steroid hormones because of their importance in the physiological response to stress. Experiments with rats showed that the liver converts neutral and sex hormones to their sulfate conjugates which are subsequently voided in the urine. Female rat~ liver was far more active than male preparations in conjugating the steroids, particularly the male hormones. These findings indicate that the liver plays a major role in the maintaining hormonal balance, femalssbeing endowed with a regulatory device to dispose of excess male hormones produced in their bodies. Urinary steroid sulfate excretion studies on human subjects were carried out The and total chromatographic techniques. complexation with our newly developed sulfate output was found to be related to both sex and age. Interesting results were obtained with urine from schizophrenics, the level of one fraction (dehydronumber of cases. elevated sulfate) in a being epiandrosterone Drugs and Alkaloids New colorimetric, chromatographic electrophoretic techniques were establipsychothenpeutic drugs. These were recently and for both the psychotomimetic and presented at the American Chemical Society shed Meeting (Brooklyn, February 15, 1957). findings are now being applied to determining the role of trace urinary alkaloids in schizophrenia. our earlier chlorpromazine studies, which were dropped for lack of suitable instrumentation, are again under way with financial help from the National Institutes much throws because The of interest it light on Health. is ver great of subject from the be which cannot gained (microsome action gross liver function liver function tests in currentuse. we find the chlorpromazine molecule is in many ways The from information gleaned to some in isotopes. ways ideal superior an tracer, this study would also throw light on the Akerfeldt "six~minute blood test for from whether suffer a decide schizophrenics should to and us help schizophrenia" defect in oxidative metabolism leading to the in vivo production of hailucinogens. The Electroshock Lavels Therapy. in gholinesterase Earlier investi ations by Tower and others have indicated demonstrable changes in acetylcholine, acetylcholinesterase, and pseudocholinesterase in spinal fluid following electroshock therapy as well as other forms of head trauma. AccordingEEG of have to correlate undertaken Fink patients and Ur. patterns associates ly, EST values cholinesterase in concurrent and with alterations after during before, of spinal fluid. Simultaneous serum cholinesterase determinations on these patients blood red to extend these studies and cell we to carried plan also being out, are (true)cholinesterase. The specific enzyme methods in use were developed at Hillside Hospital and have recently been presented at the American Chemical Society Meeting in Brooklyn. Further reference is made to Dr. Fink's progress report for findings to date. Future plans: More of the same. Harry Goldenberg, Ph.D. �April 1, 1957. Medical Affairs Committee TO For: Dr. Joseph S.A.Miller From: Department of'Medicine subject: Report of Departmental Activities, July 1956 to March 31, 1957. to of An the patients of psychiatric Test: response l. Mecholylof mecholyl analysis between correlation a revealed has striking subcutaneously injections electroshock to and therapy. and diagnosis response age, response have machine blood recording automatic of an studies pressure 2. Preliminary machine for and of this the evaluate practicability to out accuracy been carried now seems As these of result a studies, the work mecholyl it test. on further of the evaluate to used be reproducibility machine usefully can likely that this the mecholyl test. 3. Drug evaluation studies on meprobamate are being carried out. h. Chemical studies with the laboratory department are being conducted on possible hepato-toxic effects of chlorpromazine in our patients. Proposed Research for the coming year: 1. Evaluation of meprobamate in psychiatric patients. three months). 2. (to be completed within Evaluation of reproducibility of mecholyl test employing a recording sphygmo- mamometer. by chromatographic with therapy chlorpromazine alterations of Evaluation 3. protein techniques. h. Evaluation of or Trilafon. a substitute fbr chlorpromazine. This will be either Spaﬁine Arnold Blumberg, M.D. �HILLSIDE HOSPITAL FOR PSYCHIATRIC TREATMENT. TRAINING AND RESEARCH JOSEPH S. A. MILLER, 75-59 263RD M. D. STREET. GLEN OAKS. NEw YORK FIELDSTONE Medical Director LEON LOWENSTEIN 3-7800 Honorary Chairman Board of Directors M. D. Assoc. Medical Director SIMON KWALWASSER, ROY FOSTER Chairman Board of Directors MAURICE BACHRACH E. COLEMAN President Administrator ALVIN A Proposed Study for the Behavioral Max From Assay of New Drugs Fink M.D. the Department of Experimental PBychiatny October 30, 1957. AN AFFILIATE OF FEDERATION OF JEWISH PHILANTHROPIES OF NEW YORK �AProposed Study for theBehavi9ralwg§§ay of New Dm mgs MaxFi‘nk M.D. * 1 . Problem: is little disagreement that the newer psychopharmamode of these drugs of action the behavior, alter cological agents and factors in the marked individual variability in response are unresolved problems. Difficulty in resolving these problems lies, While there in part, in the lack of a theoretic framework subject to operational the is assay perplexing and Particularly experimentation. analysis of new, i;g., clinically untested agents capable of altering behavior. Many the because reports are to assess studies difficult are present and classifications nosologic defined; the poorly population subjective; are unsatisfactory. Based on our previous studies, we have expressed the hypothesis that the efficacy of psychopharmacological agents in psychotic states measurable changes induce to persistent to their related ability is in cerebral function (1). Such alteration in cerebral function provides the milieu for changes in adaptation of the patient in his environmento In this view, alterations in cerebral function following drug administration are not "complications," or "untoward but the sing SEE 293 of the mode effects," of action of these therapies. Changes condition not sufficient but a a cerebral are physiology in necessary, for improvement. * Director, Department of Experimental Psychiatry, Hillside Hospital, Glen Oaks, N.Y. �,2This hypothesis is a direct outgrowth of four years of experimental investigations of electrcconvulsive, insulin coma and various drug therapies in use at Hillside Hospital. These studies are summarized in the appended report (1). we have used a wide t variety of measures of brain function (2, 3, h, 10, 12). Most successful have been changes in the frequency spectrum of the EEG, patterns of language and perceptual tasks. In our experiences with electroshock, slowing of most EEG frequencies has been helpful (2). In drug studies, however, this is less prominent, although fundamental; Language and perceptual tests, however, have given us clues as to ways of measuring brain changes, more subtle than present electroencephalographic techniques. It is this study to logic agents according to their effects the purpose of patterns and on perceptual tasks. to test the following: The compare various psychopharmacoon the study EEG, on language is specifically designed I (a) Can the extent of behavioral change in psychopharmacologic agents be related to the degree of (b) To EEG spectrum changes? what extent can visual discrimination measures of changes in language be tests, and refined to provide reliable, predictablezueasures of changes in clinical behavior? (c) To what extent can such measures predict the clinical usefulness of psychopharmacologic agents? �II. Method: 1. Subjects: All subjects are drawn from the adult impatient service of the Hillside Hospital. In general, these patients are erative, well educated good physical health. intelligent. All are and alert, coopT ambulatory and in 2. Procedure: Two methods of drug assay are in progress. (a) Acutg_Experiments: In the laboratory setting, with simultaneous EEG and language recording in process, single intravenous or oral doses of drugs are administered. the period of drug Patients are under constant observation for activity. (b) Clinical Experiments: Patients are referred by their therapist to the super- vising psychiatrist for treatment with psychopharmacologic agents. Prior to drug administration, EEG and language recording interviews are held. Perceptual tasks are completed. Drug administration then until toxicity is manifest, and drug reduced to a maintenance dose. Testing is repeated, and be- proceeds dosage at a rapid increment havioral observations made, at frequent, defined intervals. in previousstudies, subjects are randomly divided into As groups - an experimental and a control. The experimental group receives the medication, the control group placebo medication. two �3. measurements: (a) 33.29. is Recording with an 8 channel Medcraft instrument in progress. Records have been visually analyzed for changes in frequency, voltage, symmetry and rhythmicity (2). Activation by hyperventilation is routine. validity of other activating and photic hypoglycemia megimide (6), intravenous as procedures The stimulation is being assessed. (b) Perceptual. Within the past decade certain perceptual procedures have been shown to be (11, 12, 13). sensitive measures of cerebral dysfunction Such techniques as critical flicker fusion (OFF), and "embedded" of figures polychromatic the tachistoscopic recognition in a These visual background are being assessed (10, 12, 13). measures have the adVantage of giving a reliable quantitative complex measure of pretreatment functioning in terms of a continuous variable, rather than the qualitative dichotomy of "normal" versus "abnormal;" imposing no undue stress on the patient; and the apparatus and pro- relatively inexpensive. 1) Critical flicker fusion SCFFZ: As the rate of the that the illusion there develops of increased, flicker light is point this at of The the light flickering frequency steady. is light cedure are simple, convenient and is the CFF. The CFF threshold is measured using a Sylvania glow ratio is brightness is varied to robtain thresholds at different tube pulsed by an electronic power supply. The light—dark fixed, and �-5- levels. The psychophysical method of is descending steps limits using ascending and employed. 2) Tachistoscopic recognition of pseudoisochromatic gigures: The H—R-R pseudoisochromatic plates (American Optical Company) con~ sisting of a series of cards with numerous small circles of various sizesare used. The circles vary in color, and form outlines of various geometric patterns, as ring, cross and triangle. These patterns form a "figure" on a constant background. The "neutral" plates are recognized by all subjects - blind." These plates have been photographed and projection slides. initial normal and "color- mounted as 2" x 2" of exposure which permits accurate The speed identification of the figure is the index used. (0) Eggggggg. Interviews with patients are recorded. Both unstructare The records analyzed included. and ured structured periods are for diversity (7) of the dyadic speech. been found useful in analysis of changes in for changes in syntax (9), These methods have and behavior with other therapies. (d) Evaluation of clinical changes. Psychiatric evaluations are made at fixed intervals as to type and degree of changes in behavior, and a rating of "improvement" and is made. in "improvement" are The methods now of rating both change in behavior under study. Present ratings have been based on the Malamud-Sands Rating Scales and have been of limited usefulness. The present descriptive statements of the evaluator, �-6following an outline of specific areas of behavior combined with a review of the nurses' and resident therapist's notes is being continued. h. Pharmacologic Agents: Previous experience with amobarbital (8), megimide (6), reserpine (IA) and chlorpromazine (5) provides the background for the selection of new agents. At present, acute study of diethazine (SKF 1026-A) is in progress. Clinical studies of meprobamate, perphenazine and chlorpromazine are under investigation. have been formulated reaponse. to test other agents, with different spectral Available: The Department of Experimental Psychiatry was established at the Hillside Hospital in l95h. clinical duties. EEG . - III. Facilities Plans of the department have no Members They devote their full at the institution to time the research prognmns. Eight rooms of laboratories and offices in the principle medical building of the hospital are provided. These include: a) EEG Laboratory - equipped with Medcraft encephalograph and Grass photic-stimulator. on a A 8 channel Electro- technician is employed full-time research basis. b) Psychophysical Laboratory - Two Grass stimulators, Dumont oscilloscope and step-up transformer power supply in a rack-mounted assembly. This equipment has been used for the past three years to study threshold and after for simultaneous tactile stimuli of patients before induced states of altered cerebral function. �.37.- A tachistoscopic assembly consisting of two projectors, solenoidaactivated shutters, and opal glass screen is in use. c) Psxcholinggistic Laboratogz: A third laboratory has been established for the recording of interviews. a Magnecord tape recorder, two It is equipped with and mixer. microphones, Electrovoice auxilliary recorders for transcription are available. The available for study. All patients in the hospital are research programs have been well integrated into the hospital Two milieu so that manipulation of experimental variables are readily accomplished. �and Reggrts: Iv. Publications l. 2. of Physiodynamic Action of the Unified Theory Fink, Therapies, J. Hillside Hosp. (in press). M. : A and Kahn, R.L.:' Relation of EEG Delta Activity to Behavioral Response in Electroshock: Quantitative Serial Studies, A.M.A. Arch. Neurol. and Pachiat. (in press). 3. h. m: Diffuse of Effects and H.: Korin, , Altered Brain Function in Perception. Read at XV Int'l Congress of Paychology, Brussels, 1957. , : , Relation of Tests of Altered Brain Function to Behavioral Change Following mectroshock. Read at the A.P.A. Divisional Meeting, Montreal, November, 1956. 5. and Coleman, F.S.: Coma and Insulin of Chlorpromazine Comparative Study in the Therapy of Psychosis, J. Amer. Med. Assoc. , Shaw, R., Cross, 6., (in press). 6. Green, Fink, M.: Megimide, EEG. 7. Jaffe, J.: Clinical Effects of W M.A. and An EEG and Clin. Neuromvsiolu g: 180-181, 1957. Objective Study of Communication in Psychiatric Interviews, J. Hillside Hosp. (in press). 8. Kahn, R.L., Fink, M. and Weinstein, E.A.: Relation of Amobarbital Test to Clinical Improvement in Electro8c Psvchiat. 1956. 23-29, Meurol. A.M.A. Arch. lé: shock, 9. 10. ll. Durinf-j Ele ctroLanguage Changes in , of Cormnunication, shock Therapy, in P cho tholo Ein press). Crune and Stratton : Em‘oedded Figures After of Perception , Induced Altered Brain Function, Am. Psychol” 1.3: 361 (Abst.) 1957. : Effects of Visual, Vestibular and Somatosensorimotor Deficit on Autokinetic Perception, J. @332. §_2_: 398~LLlO, 1956 (with Battersby, 11.3., Pszchol., Pollack, Mr: Kahn, R.L. and Bender, 15.8.) �0-9- 12. Pollack, M.: Tachistoscopic Identification of Contour in Patients with Brain Damage, J, Cam . Ph 101. szchol., 50: 220-227, 1957, {with Battersby,‘W.S. and Bender, M.B.) 13. Visual Deficit After Brain Damage in Man as Measured with Rapidly Exposed Chematic Stimuli, Amer. Peyphol., 12: h68,(Abst.) (with Battersby,‘w.s. : and Bender, M.B{7: 1h. WachSpress, M., Blumberg, A.G., Fink, M. and Miller,J.S.A.: Evaluation of High Dose Reserpine Therapy for Relief of Anxiety, J. Hillside HOSE. 5: 67-77, 1956. �.10V. Financial Support: Support for the ongoing programsof the Department of Experimental ' Psychiatry is provided by U.S, Public Health M-927, (Altered Brain Function Following Electroshock), the Foundations' Fund for Research in Psychiatry grant 56-151 (Language of the Dyed), and the Board of Directors' Research Fund. The proper development of the specific aspects of this protocol require support for the following, for a two year period. 19 8 Dr. M. P01130k, PhoD. Senior Research Asst. Psychology EEG $ _ Technician - Hrs. Hannah Hosquera 12§9 8,250 $ ‘ 8,750 3,720 3,8u0 2,000 2,000 50 th 50 th 200 300 Equipment: (Over 2 year period). Analyzer (Edin) Flicker Fusion Apparatus EEG Projector, Slides Calculator (h,000) (800) (100) (880) hDO hOO Travel: ) (Amer. Psychol. Assoc. (Amer. Psychiatric ASSOC.) $ 15,060 Overhead (15%) TOTAL $ d 15,h80 2,26h 2,327 17,32h n 17,807 ' �\ KILLSIIE mSPITAL Glen Oaks, NOYO January 27, 1958. MORAN!!! '10: Medical Affairs Committee FOR: Joseph FRCM: Merimental Psychiatry 1958. January 1957 1, to 1, Report of Activities, April Miller, M.D. Deparhxent of SUBJECT: I. 30 A. -~.—-- INTROIIJCTION: achieved has professional work Department the of the nine months, In the past various of understanding We our reflecting have presented reports recognition. and these and international societies, national before physiodynamic therapies October the in work were presented of Five our aspects have been well received. psychiatric by been leading have accepted and other Journal reports the of issue Journals and will appear in 1958-59. convulmode of of action the of Our studies have given us a clear picture confidence to has us given information ibis coma and therapies. insulin sive to these in therapies which were fruitful and techniques extend the hypotheses behavioral concerning a ideas in protocols have expressed our drug therapy. We Psychothe both by received been well These having new ideas, of drugs. assay comand various pharmaceutical U.S.P.H.S. the of Center Research pharmacology 1958. for studies new the in been implemented have panies, . , . therapy, we were , . . number a. of ancillary led to electroshock In evaluating The value for psychiatry. have which basic significance broad, investigations found and assessed were change behavioral of indices of language measures as While a studied. "improvement" was The of defining problem satisfactory. been has approach operational an accomplished, not was satisfactory resolution which the criteria Also, studies. recent defined which was successful in our has an to led Hillside at various the therapies for determine patient referral of choice therapy. factors and affecting psychologic the sociologic evaluation of In addition, the ability of this department personnel to work together has been have the in hospital and Our relationships roles been amply demonstrated. hosthe from at staffs all cooperation excellent defined and we have received pital. II. PROGRESS IN (A) ONGOING PROJECTS: Therapy Evaluations: l. Flectroshock. We electroshock therapy. Our studies have defined the process of physiology; brain in induced changes the to behavioral the have related response behavioral of the type affect that and factors sociologic described personality and clinical behavioral between response the and defined relationship response; of various the types to relate us These studies permit ratings of improvement. PM 1090), electroshock and its varieties, (metrazol 3, convulsive therapy as drug "convulsive there. of concept (Indoklon) meaningful into a and lately, inhalant , pies '. �-2Based on these studies, reasonable criteria for the type of patient "do well" with convulsive therapy can be defined. Continuing studies will behavioral the in of role the personality amplify designed.to in this area are non-electroshock referbetween'out-patient differences the define to response; convulsive inhalant of and evaluation an (IIIc) rals and in~patient populations ' who therapy (111a). 2. . £235 Therapy. control coma-chlorpromazine insulin of conclusion our the Following 1958. and .A.M.A. in early will appear study, our report was accepted by he J the experimental program.for have developed a we months, six the During past which begun was (see IIIb), agents psychopharmacological new of evaluation 3. Selection of therapies: of the based on type generally is of therapy While the selection the Such as aspects decisions. such affect factors mental disorder, other and cultural education his communicate verbally, to facility of the patient have we and been have studied, "authoritarianism” background, and the degree of rebear significant a and aspects psychologic such historical reported that These services. for ancillary lationship to the choice of therapy or referral of the in factors these of results studies have led to an interest in the role socioof role the evaluate further to therapy, and we have designed a study (see IIIc). and therapy outpatient of inpatient psychologic factors in results (B) Language as measurable behavior: one. complex "in is a 'improvement psychiatry of definition and change behavioral of In evaluation of various therapies, the definition have sought we adequate, are While descriptions clinical improvement is crucial. Two methods of our behavior patients. the language in guides more objective for interviews of structured analysis of analyses have been developed - a syntactic and a dyadic of unstructured. The non-convulsive and convulsive induced by changes have described the do clinical reflect patterns these language therapy, and find that changes in to these techniques of the have application to led Our experiences evaluation. We the drug evaluation studies. effort in an in are of progress language other analyses In addition, methods. the of present the broaden applicability to (C) Neurophysiology of Behavior: the between relationship the noted we In the electroshock studies We concluded behavioral response. the and change neurophysiologic of degree and behavior in change to a essential was physiology cerebral in change that a coma therapy. insulin for conclusion We same the come had to to "improvement". chlorpromazine in treatment the response between Since we had observed a similarity was mode action of same the that seemed plausible therapy and insulin coma, it drugs. newer tranquilizing the for operative �-3review of the literature and some preliminary experiments supported the to potent are agents psychopharmacologic newer the that this hypothesis We have function. brain and affect predictably extent that they measurably and in of Psychiatry Congress International the at hypothesis this expressed new undertaken have we As a a Hillside the Hospital. result, the Journal of (see IIIb). various drugs therapies evaluating project .A Concomitantly, our interest has continued in the biochemistry of convulsive therapy. we have observed that diethazine, a potent anticholinergic demonstrated has a Further analysis electroshock effect. the drug, reverses These observadiethazine. LSDHZS to and mescaline between marked similarity as system cholinesterase-acetylcholine the of confirm the significance tions which behavior of psychotic the type a basic mechanism for psychotic behavior may be affected by convulsive therapy. Percgption: (D) have change behavioral of index an as studies of perceptual tests continued. We have defined the relationship between the degree of perceptual demonstrated Our have studies function. alteration and the degree of altered brain Our but the response, in perceptual only not type of personality the significance also in the physiologic response, to convulsive therapy. Our studies of tactile perception clarified the role of strength of stimulus and of the type of instructions (set) in the reported reponses. Individual Differences in Behavioral Responses: The program of study of the ways in which individual differences in various to of subjects and affect response physiology the perception, personality of neurophysiologic Green's Dr. studies under well way. is psychiatric therapies Dr. emphasis and Pollack's EEG electroshock, to the response differences affecting of the both phase in are drug to therapies on perceptual aspects as they relate collecting data in consecutive groups of subjects. (E) III. (A) New Pro ects - Pro am.l 8 Inhalant Convulsive Therapz: In the studies of electroshock, we have been puzzled by the significance of the electric current in the treatment response. In the convulsive-subconvulsive was aftreatment the for response seizure the of the control study, significance compound, inhalant an Recently, clear. not was current of the role but firmed, conﬂescribed simple was as a safe, of ether anesthesia, the to ethyl similar vulsant. We visited the laboratory at Spring Grove State Hospital, Maryland, We and observed the treatment. It was reliable, quick and easy for the patient. have obtained a supply of this compound and are undertaking a study on February of biochemical and effects psychologic of neurophysiologic, the clinical, lst, convulsive therapy using this compound. (B) Mbde of Action of Psychophammaoologic agents: experiences with other forms of therapy have led us to formulate a the In agents. essence, psychopharmacologic (see IIc) regarding hypothesis and kind of effect the degree to related behavior which is affect drugs to degree EEG. Fbr this the purpose,we by measurable in part, brain have on function, they and personnel equipment for special obtained and support have written a protocol from.the U.S.P.H.S. and various pharmaceutical concerns. Our �-l+- In these studies, patients referred for drug therapies, as chlorpromazine, promazine, reserpine, meprobamate, etc. , undergo special tests before and during treatment, which may predict and reflect the treatment response. (0) Psychologic and Sociologic Factors in Out Patient Therapy; result of our studies in inpatients defining certain psychologic sociologic factors as they affect treatment choice and treatment response, As a and we have made predictions regarding the outpatient population. to undertake a sociologic study of outpatients, and extend our studies this Spring. IV. (A) W318 We are planning inpatient AND. I’UBLICATIONS: Eigerimental Psychiatry Issue, Journal of Hillside Hospital: of this Department wrote five articles reflecting various aspects of our study program for the October 1957 issue of the Journal. This encompassed the whole issue. Such an effort is unique in the Journal‘s history. At Dr. Tarachow's (B) invitation, members Publications: In addition to these five articles, our report on the relation between EEG changes and treatment response in electroshock appeared in the Archives of Neurology and Psychiatry. Seven other reports have been accepted for publi cation and two others are in the hands of editors as of January let. (G) Presentations: Reports of our studies have been presented to psyc iatric, neurologic and psychologic societies. Twelve reports were made before National societies in the U.S. and three before International Congresses in Brussels and Zurich during the summer. These reports have been generally well received. V. PERSONNEL: changes in personnel have been made. We have requested, and the Research Committee and Medical Director have approved, a restatement of the titles for staff members from "Research Assistant" and "Senior Research Assistant" to "Research Associate". The present staff consists of nine members including: No Martin A. Green, M. D. Joseph Jaffe, M. D. Robert L. Kahn, Ph.D. Hyman Korin, Ph.D. Max Pollack, Ph.D. Associate (Neurophysiology) - Research " " (Psychiatry) -" " " (Experimental Psychology; " " (Experimental Psychology " " (Ehcperimental Psychology) - and four technical assistants: Mrs. Hannah Mosque'ra (EEG) , Mrs. Jean Kolodw and Mrs. Ann Horowitz(~?sycholinguistics) and Mrs. Janet Bowie (Secretary). �-5VI. (A) TENTﬁIIVE BUDGEE PROJECTION: 1228-52. Personnel: In addition to the personnel listed above, we will request the addition of a Research.Associate in Social Psychology; and a redesignation of the halftime neurophysiologist to a full-time status. These items will increase the budget by $9500 above authorized annual increments for ongoing personnel. (B) Supplies. Em ment and Travel: There will be an increase of $l000 in supplies and travel and a specific equipment expense of $5200 for an EEG Analyzer. This instrument will provide greater flexibility in EEG analysis. A supplementary request for this amount has been asked of the U.S.P.H.S. L Total Egpensesz (C) av" . total expenses for 1958-59 1957-58, an increase of $16,98h. The (D) will be $95,796. as against $78,812 k" "u. Income: In the past six months, this Department has been more successful than anticipated in attracting research funds from private and governmental sources. Fbr the current year, we anticipated $33,595 and so far have been advised that we can expect $h3,h31 for 1957-58, an increase of $9,836 over expectations. Fbr 1958-59; we have already been assured of $50,66h which is $7,233 more than 1957-58. It may be of interest that we already have funds for 1959-60 in the amount of $15,297. These grants totalling $115,235 have been made available to the Department for the period April 1, 1957 to December 1960. Max Mszb/b Fink, M. D. A}\ fork¢3”4 We Respectfully submitted, V‘ � 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 Research Files and Unpublished Works 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 Progress and annual reports; research activities (folder title). Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-03-01-001-0-005 Date A point or period of time associated with an event in the lifecycle of the resource 1957 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 <a href="http://id.loc.gov/authorities/subjects/sh85113021">Research Files</a> and Unpublished Works -- Hillside Hospital, Glen Oaks, NY, 1953-1965 Relation A related resource The Max Fink Collection Description An account of the resource Letters; Personality factors in behavioral response to electroshock therapy (draft) by Robert L. Kahn and Max Fink; Progress reports of departmental activities; A proposed study for the behavioral assay of new drugs by Fink; Report of activities 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 Research