McGlashan T H, Wadeson H S, Carpenter W T, Levy S T
J Nerv Ment Dis. 1977 Mar;164(3):182-90. doi: 10.1097/00005053-197703000-00004.
The concepts of integration and sealing-over as recover styles from acute psychosis are common clinical parlance. Our experience with acute schizophrenic patients has led to specific operational definitions and a scale which can reliably assign patients to these two categories. All acutely schizophrenic patients on an NIH Clinical Center research ward participated in individual art sessions during drug-free periods at admission, at discharge, and at 1-year follow-up. In each session, the patient drew: a) a picture of his choice; b) a self-portrat; and c) a picture of his psychiatric illness. We hypothesized that integrators would pictorially represent themselves and their illness with greater expression, ideational fullness, and affective force than patients who sealed-over. Twenty-four patients were divided equally into integrator and sealing-over groups (based upon ratings at follow-up) and matched for age, sex, and race. Their art productions were presented randomly to two independent raters unfamiliar with the patients. They scored pictures quantitatively for color, motion, detail, empty space, and global expressiveness. Inter-rater reliability was satisfactory. A mean rating was obtained for all pictures from each patient on each of the five art variables. Paired t-tests (two-tailed) were applied to contrast the two groups on each of the five art variables. The results were that the integrators used more color (p less than .05), drew with greater detail (p less than .01), and more globally more expressive (p less than .05). Integrators also tended to depict more motion (p less than .10), but were not different from the sealing-over patients in amount of space left empty. These results support the validity of integration and sealing-over as defined and support the use of art as a medium through which differences in individual styles of coping with the psychosis can be discriminated. Slides of the patients' artwork illustrate the findings.
作为急性精神病恢复方式的整合和封闭概念是常见的临床用语。我们对急性精神分裂症患者的经验产生了特定的操作定义和一个量表，该量表可以可靠地将患者分为这两类。国立卫生研究院临床中心研究病房的所有急性精神分裂症患者在入院、出院和1年随访的无药期都参加了个人艺术活动。在每次活动中，患者绘制：a）一幅他选择的画；b）一幅自画像；c）一幅他精神疾病的画。我们假设，与采用封闭方式的患者相比，采用整合方式的患者在绘画中会以更丰富的表达、更充实的思维和更强的情感力量来展现自己和自己的疾病。24名患者被平均分为整合组和封闭组（基于随访评分），并在年龄、性别和种族上进行了匹配。他们的艺术作品被随机呈现给两名不熟悉这些患者的独立评分者。他们对画作在颜色、动态、细节、空白空间和整体表现力方面进行了定量评分。评分者间的信度令人满意。对每位患者在五个艺术变量上的所有画作获得一个平均评分。应用配对t检验（双侧）来对比两组在五个艺术变量上的差异。结果是，整合组使用了更多颜色（p<0.05），绘画细节更丰富（p<0.01），整体表现力更强（p<0.05）。整合组也倾向于描绘更多动态（p<0.10），但在留白量方面与封闭组患者没有差异。这些结果支持了所定义的整合和封闭方式的有效性，并支持将艺术作为一种媒介，通过它可以区分个体应对精神病方式的差异。患者艺术作品的幻灯片展示了这些发现。
