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The MMPI: A Contemporary Normative Study
578
BOOK REVIEWS
Mayo Clin Proc, August 1984, Vol 59
facilities added from 1966 to 1982. Because a truly complete history of Mayo's past 40 years could fill three or four volumes, Dr. Johnson has had to abridge many sections to keep his book at a more manageable length. Mayo Clinic: Its Growth and Progress will be of interest to all who know Mayo, or who know of Mayo, and are curious about the character, the functions, and the history of this unique and important medical organization. Robert C. Roesler Former Chairman, Department of Administration
The MMPI: A Contemporary Normative Study, by Robert C. Colligan, David Osborne, Wendell M. Swenson, and Kenneth P. Offord, 432 pp, with illus, $45, New York, Praeger, 1983 In pursuing the development of contemporary norms for the Minnesota M u l t i p h a s i c Personality Inventory (MMPI), Colligan and his colleagues tackled an enormous job that numerous clinicians and researchers had discussed for years. Hathaway and McKinley began their work on the MMPI more than 4 decades ago. Their original samples of patients and normal subjects have long been viewed in MMPI lore as probably outdated and as perhaps limited in current applications because of constraints of geography and changing times. No one, however, had been willing or able to undertake the massive amount of work involved in collecting new normative data. The task was also expensive and timeconsuming. In the preface to their work, Colligan and associates state their purpose as follows: In carrying out this study, we wish to develop new norms and to study changes that have occurred in the way that normal adults in the midwestern region of the United States respond to the items of the MMPI. Thus we intended to obtain a sample of persons comparable to that obtained originally by Hathaway and McKinley, so the changes and response patterns could be seen as a result of changes in social mores rather than as reflecting differences in sampling procedures. Among paper and pencil personality assessment devices, the MMPI has long been premier. It has been more extensively used and more thoroughly researched than any other objective personality assessment instrument. Before the development of the MMPI, objective personality assessment depended on self-reports and questionnaires for which face validity had to be assumed. Hathaway and McKinley took a totally different approach, an empirical one in which it was unnecessary to
assume that subjects who responded to the pool of items in the MMPI were reporting " t r u t h " about their personalities or their reactions. Instead, their responses were related to patterns of behavior, traits, psychiatric diagnoses, or other characteristics of interest to the clinician or researcher. Colligan and co-workers described this new actuarial approach as follows: The meaning to be assigned to those behavioral bits or signs remained a question that was to be answered empirically. Thus, the client's endorsement of certain items might not represent historical fact or reflect current selfattitude, as prior assessment techniques had assumed, but rather represent a bit of similarity to other persons who had answered the same item or collection of items, in the same way as the patient. The original normative sample for the MMPI clearly had limitations built into it by the sampling procedures used. Hathaway and McKinley obtained their largest sample of normal subjects (724 cases) from visitors to the University of Minnesota Hospitals. A second sample (265 cases) was obtained from a normal group from the University Testing Bureau. A third sample (265 cases) was obtained through the local Works Progress Administration. Thus, 1,254 married and single men and women from 16 to 65 years of age constituted the normal group that served as a " n o r m a l " standard against which numerous scales have been developed. During the 40 years of extensive clinical and research applications of the MMPI, multitudes of comparisons have been made against this original normal sample. Several hundred scales for the MMPI have been developed, and interpretative manuals based on the original scales have been published. Thousands of clinicians have been trained to interpret the MMPI profiles on the basis of the scales. Systems for computerized interpretation have proliferated. Colligan and colleagues were interested in investigating several clinical and research issues, including the impact of age, sex, and changing times on the MMPI profile. They were basically interested, however, in "whether the original MMPI norms were outdated for contemporary use." They thus became the first investigators willing and able to invest the time and effort involved in collecting normative data from a large sample of normal people. They obtained a random sample of 1,919 households selected from 8,000 square miles in a three-state midwestern area. Because the investigators work at the Mayo Clinic, they chose their geographic region for its proximity to Rochester, Minnesota, and hence the likely cooperativeness of the inhabitants. A careful selection procedure resulted in 1,408 subjects for whom MMPI profiles were included. The investigators obtained a very high level of cooperation from the sub-
579
BOOK REVIEWS
Mayo Clin Proc, August 1984, Vol 59
jects solicited and a very high percentage of usable profiles. The new normative group does not include minorities, adolescents, or nonmidwestemers. Therefore, the new sample obviously has some of the same limitations as the original one. The data obtained, however, are both extremely impressive and exceedingly useful. The book consists of more than 400 pages of data; it is a treasure, indeed, for clinicians and for researchers. It also presents numerous temptations because countless opportunities exist for making comparisons between the respondents of the 1980s and the respondents of the 1940s. Clinicians at the University of Minnesota have long been trained to avoid analysis of responses to individual MMPI items, inasmuch as the approach was an empirical one in which the patterns of response and the behavioral correlations were the important factors. Colligan and coworkers have provided a vast amount of data for comparisons, and many of us will be unable to resist the temptation to make comparisons for individual items. They are interesting, are often fairly predictable, and will have immense research potential. Colligan and his coinvestigators present a detailed, excellent manual for using the MMPI contemporary norms. This book should become a key volume on the MMPI for clinicians and researchers. Will clinicians use it? Some w i l l , but some may not because of the work involved. Nevertheless, the clinical and research possibilities are numerous and enticing. With this major publication, Colligan and associates have rejuvenated the aging MMPI. Jan Duker, Ph.D. Director, Mississippi Department of Mental Health Jackson, Mississippi
Computed Tomography of the Thorax, by David P. Naidich, Elias A. Zerhouni, and Stanley S. Siegelman, 326 pp, with illus, $65, New York, Raven Press, 1984 The authors have produced a very useful book about computed tomography (CT) of the thorax. The book begins with a brief discussion of some physical principles and techniques involved in thoracic CT, and then separate chapters describe the major anatomic subunits of the chest, including the aorta and great vessels, the mediastinum, the airways, the hila, the pulmonary parenchyma, the pleura and chest wall, the pericardium, and the
diaphragm. Also included are a chapter on lobar collapse and another on pulmonary nodules, which contains up-to-date information about the CT evaluation of a solitary pulmonary nodule. The book contains numerous CT images of the chest. Most of them are of high quality, are well labeled, and have helpful legends. In addition, at the end of each chapter are listed many current references. This book is designed primarily to teach the reader how to interpret thoracic CT examinations rather than to present an exhaustive review of the CT appearance of diseases of the chest. It will be of great value to residents in radiology, practicing radiologists, and any other physicians who are interested in the interpretation of CT images of the chest. The extensive anatomic material in the book should make it valuable for years. John R. Muhm, M.D. Department of Diagnostic Radiology
Peripheral Neuropathy, 2nd ed (in 2 vols), edited by Peter James Dyck, P. K. Thomas, Edward H. Lambert, and Richard Bunge, 2,491 pp, with illus, $240 per set, Philadelphia, W. B. Saunders Company, 1984 The branch of neurology that encompasses diseases of peripheral nerve was a barren clinical field for many decades. In recent years, however, it has excited the interest of clinicians and neuroscientists. Along with reports on diseases of muscle, articles on diseases of peripheral nerve now throng every current journal of neurology. In large measure, this situation has evolved because of technologic innovations in histology, physiology, biochemistry, and pathology, which have been made adaptable to the living patient. The exposition and elaboration of the new findings constitute a medical literature of such magnitude as to be beyond the reach of most neurologists. These two enormous volumes provide a coherent review of this literature and relate the many recent findings to the known diseases of the nervous system. Since the publication of the first edition of this work, which was immediately popular, Professor Bunge was added to the editorial staff, and surely he was influential in greatly expanding the sections on anatomy and molecular biology. These two sections and the one on neurophysiology were covered in 480 pages in the first edition, and these sections have been enlarged to 1,160 pages in the second edition. An illustrious international group of authors have
BOOK REVIEWS
Mayo Clin Proc, August 1984, Vol 59
facilities added from 1966 to 1982. Because a truly complete history of Mayo's past 40 years could fill three or four volumes, Dr. Johnson has had to abridge many sections to keep his book at a more manageable length. Mayo Clinic: Its Growth and Progress will be of interest to all who know Mayo, or who know of Mayo, and are curious about the character, the functions, and the history of this unique and important medical organization. Robert C. Roesler Former Chairman, Department of Administration
The MMPI: A Contemporary Normative Study, by Robert C. Colligan, David Osborne, Wendell M. Swenson, and Kenneth P. Offord, 432 pp, with illus, $45, New York, Praeger, 1983 In pursuing the development of contemporary norms for the Minnesota M u l t i p h a s i c Personality Inventory (MMPI), Colligan and his colleagues tackled an enormous job that numerous clinicians and researchers had discussed for years. Hathaway and McKinley began their work on the MMPI more than 4 decades ago. Their original samples of patients and normal subjects have long been viewed in MMPI lore as probably outdated and as perhaps limited in current applications because of constraints of geography and changing times. No one, however, had been willing or able to undertake the massive amount of work involved in collecting new normative data. The task was also expensive and timeconsuming. In the preface to their work, Colligan and associates state their purpose as follows: In carrying out this study, we wish to develop new norms and to study changes that have occurred in the way that normal adults in the midwestern region of the United States respond to the items of the MMPI. Thus we intended to obtain a sample of persons comparable to that obtained originally by Hathaway and McKinley, so the changes and response patterns could be seen as a result of changes in social mores rather than as reflecting differences in sampling procedures. Among paper and pencil personality assessment devices, the MMPI has long been premier. It has been more extensively used and more thoroughly researched than any other objective personality assessment instrument. Before the development of the MMPI, objective personality assessment depended on self-reports and questionnaires for which face validity had to be assumed. Hathaway and McKinley took a totally different approach, an empirical one in which it was unnecessary to
assume that subjects who responded to the pool of items in the MMPI were reporting " t r u t h " about their personalities or their reactions. Instead, their responses were related to patterns of behavior, traits, psychiatric diagnoses, or other characteristics of interest to the clinician or researcher. Colligan and co-workers described this new actuarial approach as follows: The meaning to be assigned to those behavioral bits or signs remained a question that was to be answered empirically. Thus, the client's endorsement of certain items might not represent historical fact or reflect current selfattitude, as prior assessment techniques had assumed, but rather represent a bit of similarity to other persons who had answered the same item or collection of items, in the same way as the patient. The original normative sample for the MMPI clearly had limitations built into it by the sampling procedures used. Hathaway and McKinley obtained their largest sample of normal subjects (724 cases) from visitors to the University of Minnesota Hospitals. A second sample (265 cases) was obtained from a normal group from the University Testing Bureau. A third sample (265 cases) was obtained through the local Works Progress Administration. Thus, 1,254 married and single men and women from 16 to 65 years of age constituted the normal group that served as a " n o r m a l " standard against which numerous scales have been developed. During the 40 years of extensive clinical and research applications of the MMPI, multitudes of comparisons have been made against this original normal sample. Several hundred scales for the MMPI have been developed, and interpretative manuals based on the original scales have been published. Thousands of clinicians have been trained to interpret the MMPI profiles on the basis of the scales. Systems for computerized interpretation have proliferated. Colligan and colleagues were interested in investigating several clinical and research issues, including the impact of age, sex, and changing times on the MMPI profile. They were basically interested, however, in "whether the original MMPI norms were outdated for contemporary use." They thus became the first investigators willing and able to invest the time and effort involved in collecting normative data from a large sample of normal people. They obtained a random sample of 1,919 households selected from 8,000 square miles in a three-state midwestern area. Because the investigators work at the Mayo Clinic, they chose their geographic region for its proximity to Rochester, Minnesota, and hence the likely cooperativeness of the inhabitants. A careful selection procedure resulted in 1,408 subjects for whom MMPI profiles were included. The investigators obtained a very high level of cooperation from the sub-
579
BOOK REVIEWS
Mayo Clin Proc, August 1984, Vol 59
jects solicited and a very high percentage of usable profiles. The new normative group does not include minorities, adolescents, or nonmidwestemers. Therefore, the new sample obviously has some of the same limitations as the original one. The data obtained, however, are both extremely impressive and exceedingly useful. The book consists of more than 400 pages of data; it is a treasure, indeed, for clinicians and for researchers. It also presents numerous temptations because countless opportunities exist for making comparisons between the respondents of the 1980s and the respondents of the 1940s. Clinicians at the University of Minnesota have long been trained to avoid analysis of responses to individual MMPI items, inasmuch as the approach was an empirical one in which the patterns of response and the behavioral correlations were the important factors. Colligan and coworkers have provided a vast amount of data for comparisons, and many of us will be unable to resist the temptation to make comparisons for individual items. They are interesting, are often fairly predictable, and will have immense research potential. Colligan and his coinvestigators present a detailed, excellent manual for using the MMPI contemporary norms. This book should become a key volume on the MMPI for clinicians and researchers. Will clinicians use it? Some w i l l , but some may not because of the work involved. Nevertheless, the clinical and research possibilities are numerous and enticing. With this major publication, Colligan and associates have rejuvenated the aging MMPI. Jan Duker, Ph.D. Director, Mississippi Department of Mental Health Jackson, Mississippi
Computed Tomography of the Thorax, by David P. Naidich, Elias A. Zerhouni, and Stanley S. Siegelman, 326 pp, with illus, $65, New York, Raven Press, 1984 The authors have produced a very useful book about computed tomography (CT) of the thorax. The book begins with a brief discussion of some physical principles and techniques involved in thoracic CT, and then separate chapters describe the major anatomic subunits of the chest, including the aorta and great vessels, the mediastinum, the airways, the hila, the pulmonary parenchyma, the pleura and chest wall, the pericardium, and the
diaphragm. Also included are a chapter on lobar collapse and another on pulmonary nodules, which contains up-to-date information about the CT evaluation of a solitary pulmonary nodule. The book contains numerous CT images of the chest. Most of them are of high quality, are well labeled, and have helpful legends. In addition, at the end of each chapter are listed many current references. This book is designed primarily to teach the reader how to interpret thoracic CT examinations rather than to present an exhaustive review of the CT appearance of diseases of the chest. It will be of great value to residents in radiology, practicing radiologists, and any other physicians who are interested in the interpretation of CT images of the chest. The extensive anatomic material in the book should make it valuable for years. John R. Muhm, M.D. Department of Diagnostic Radiology
Peripheral Neuropathy, 2nd ed (in 2 vols), edited by Peter James Dyck, P. K. Thomas, Edward H. Lambert, and Richard Bunge, 2,491 pp, with illus, $240 per set, Philadelphia, W. B. Saunders Company, 1984 The branch of neurology that encompasses diseases of peripheral nerve was a barren clinical field for many decades. In recent years, however, it has excited the interest of clinicians and neuroscientists. Along with reports on diseases of muscle, articles on diseases of peripheral nerve now throng every current journal of neurology. In large measure, this situation has evolved because of technologic innovations in histology, physiology, biochemistry, and pathology, which have been made adaptable to the living patient. The exposition and elaboration of the new findings constitute a medical literature of such magnitude as to be beyond the reach of most neurologists. These two enormous volumes provide a coherent review of this literature and relate the many recent findings to the known diseases of the nervous system. Since the publication of the first edition of this work, which was immediately popular, Professor Bunge was added to the editorial staff, and surely he was influential in greatly expanding the sections on anatomy and molecular biology. These two sections and the one on neurophysiology were covered in 480 pages in the first edition, and these sections have been enlarged to 1,160 pages in the second edition. An illustrious international group of authors have