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A Methodologic Approach

IRVING D. BERG, Lieutenant, MC, USNR

Text and Permissions: Dennie Briggs
html: Craig Fees

U. S. ARMED FORCES MEDICAL JOURNAL  (Vol. VIII, No. 11 November 1957) 1658-1663

Presented at the annual meetings of the American Sociological Society, Washington, D. C., 1955.
U. S. Naval Hospital, Oakland, California. Lt. Briggs is now assigned to U. S. Naval Hospital,Yokosuka, Japan.


A Methodologic Approach


IRVING D. BERG, Lieutenant, MC, USNR


While stationed in a large naval general hospital for the past two years, we were impressed by the interaction among various staff members; between medical, surgical, and psychiatric patients; and between staff and patients. In addition to the medical staff, consisting of career and reserve medical officers, there were medical administrators, officers of the allied medical sciences, nurses, and hospital corpsmen, all with distinct symbols as to their rank either in military or civil service. The patients were officers and enlisted personnel, both men and women, of various ranks and rates, in addition to dependents.

We often were struck by the interaction that took place in so many different ways and on so many different levels, particularly in the formation of groups within the military structure. Often, in the hospital, extraordinary situations occurred that involved personnel with higher or lower professional status and that called for personal and social adjustments not encountered elsewhere in the military. Even within groups formed spontaneously, there was the factor of interrank relationships, where social status was not recognized as easily, but where prescribed behavior was rigidly observed.

        In the course of observations made while teaching, conducting group therapy, and holding ward staff meetings and discussion groups, we were impressed by the development within the groups of a certain hierarchy that seemed to establish itself automatically. We also were aware of what seemed to be the assumption of positions of leadership, “followership,” and “going alongship” by members of the groups. We became interested in how the language, perspective, and viewpoints varied among the different groups. We thus became curious as to what went on in these “natural groups” and what factors took place in the establishment of the hierarchical arrangements within the groups, in addition to finding out more of the purposes served by these relationships.

Noting the observations made by Parsons,1 Caudill and associates,2 Stanton and Schwartz,3 Fox,4 and others concerning the participation of the hospital as a social system in the treatment and course of illness, we were interested in developing more systematic methods of observation, particularly of the groups that formed and of the dynamic interaction that occurred within these groups.

Any particular group that was not formed artificially by calling together various individuals as subjects into a nonmeaningful group became a subject for investigation. We observed the patients getting together themselves, hospital corpsmen working together, the staff of a particular ward, et cetera; thus our studies represent particles of the vastly complex interaction going on in a military hospital.


In this article our main interest is to present a methodologic approach that was designed to integrate sociologic, psychologic, and psychiatric theory and technic. We wished to recapture the social setting of the particular group under study with a minimum of disruption by research procedures. Each technic was chosen as one with which the members were familiar, or one that contributed to the atmosphere being investigated. The groups selected were “natural groups” in the sense that the members themselves had gotten together as friends or associates, or were working together in a staff-patient relationship. Those groups studied had close contact with the investigators in a teaching or therapeutic relationship. It was bur belief that the spirit of co-operation exhibited contained little or no acquiescence. The technics themselves were chosen and adapted to keep the setting as natural as possible within the framework of the hospital.

    In considering the feasibility of adapting acceptable research procedures from the various disciplines to contribute to a holistic approach, we chose those methods that we believed were sound experimentally and acceptable to our participants. Before using any procedure with which the group was not familiar, its use was discussed and worked through in the group. For example, when tape recordings were used—a procedure familiar to most of the participants—group members operated the recording apparatus themselves and were allowed to listen to the playback at any time.

We selected the Rorschach test because it is an accepted technic in clinical psychology, was a familiar procedure at the hospital, yet presented a relatively unstructured stimulus that most of the group members had not actually seen previously, although all knew it was a device to reveal material unknown to the testee. Thus some “test anxiety” was mobilized as part of the experimental procedure. This was utilized and accounted for, as we shall discuss presently.

The Rorschach test was individually administered, and was interpreted in the traditional manner as presented by Beck.5 Later, a modification was introduced that had not to our knowledge been used previously. In one of the group sessions, it was announced that the next session would be devoted to an experiment. In the following session, the Rorschach cards were shown to the group as a stimulus for discussion. The members were asked what they saw as a group in each card in an allotted time, and their impressions were recorded. Immediately following this session, their individual impressions were taken again to measure any possible aftereffects of the interaction that had occurred.

The Rorschach test thus was used clinically to obtain a personality description of each member and of the group as a whole, in addition to being used thereafter as a somewhat familiar stimulus for discussion. Its unique feature in this experiment, however, was that in a sense we also obtained a measure of the “group personality,” together with an estimate of both individual and group dynamics in operation. We saw an individual’s private thoughts as well as those he voiced publicly and the manner in which he operated in a group. In addition, we watched similar interaction for the group as a whole. An individual might see a percept that through previous research has been established as one indicating a particular disturbance in psychic functioning, and introduce this percept into the group discussion. If the percept was ego-alien or not acceptable to the group, disagreement might ensue and the individual would be forced to make a stand or withdraw. Through later content- analysis of the percepts, we were- thus able to gain insight into the particular meaning of the individual’s thinking, both privately and in the group setting.

Group sessions were tape-recorded and transcribed. The interaction was charted according to a modification of Bales’ “Interaction Process Analysis,”6 momentarily disregarding interpretation of the psychologic meaning of the test responses.

At another session, the groups were asked to make various choices of the members’ behavior, utilizing Tagiuri’s “Relational Analysis” technic.”7 Each member was seen individually for psychiatric interviews and an associative anamnesis was taken.8 Impressions also were noted from the content of the group meetings (i. e., reactions to lectures, feelings expressed in therapy sessions, et cetera) by the investigators who were meeting with the groups.


The observations presented here are tentative and warrant extremely cautious interpretation and generalization. We have not yet subjected them to statistical verification and have not applied them outside the clinical setting of the hospital. They form the basis of a number of hypotheses that we are investigating.

We observed through the interaction and the Rorschach responses that there were many personal feelings and ideas present which a person would not voice publicly (i.e., his private ideas), and others that a person could not reveal even to himself, as he was not conscious of their existence. Our research thus far brings out the following points regarding the interaction of the group and the dynamics of the leader in a spontaneous social setting:

(1) In group discussions, the members were selective in the material they brought forth, and tended to reveal those private ideas and feelings least disturbing or alien to the group; i.e., they revealed most often those ideas that were more acceptable to the group or “group syntonic.”

(2) Where some of the group-apparent material coincided with ego. alien material (i.e., material which was unacceptable to the ego and therefore not previously capable of being integrated by the ego) the ego-alien material became integrated into the individuals’ experience and following the group experience, they could safely add these ideas to their conscious repertory.

(3) The leader, as obtained by sociometric choice, was the one who was more capable of incorporating by his ego-integrative capacity ideas that came from the group, and possibly ideas that he could not previously have brought to acceptance; i.e., those that might have been unacceptable to him before. Interestingly enough, this factor appeared to operate in groups of psychiatric patients as well as in nonpatient groups.

(4) The degree of freedom (via the group conscience) seemed to be more limited than that of the individuals composing the group. Socially unacceptable ideas that were not privately ego-alien still tended to be treated as unacceptable in the group. The group served to censor ideas and admitted those considered socially mature and thus more socially acceptable. The individual privately entertained as acceptable ideas that in a social setting were voiced as unacceptable, thus establishing and reinforcing mores and social controls.

(5) The leader subtly introduced his private ideas to the group. If they were rejected, he did not enforce them. (He did not want to press the point when he noticed the tenuous status of his ideas with regard to acceptance by the group.) Did the other members take on his ideas privately, while not publicly?

(6) Those persons whose egos were more capable of integration, while not of leadership caliber, did this more often (i. e., they functioned more at a private level). Are these persons capable of becoming more of a leader in another group, after absorbing something of the leader that they did not have before? We believe they are, depending on the “social climate” of the new group and the new dynamics involved.

(7) The “going-alongers” were the least affected by the responses in any group. They also were the most disturbed clinically, both socially and psychologically (less participation in community affairs, et cetera). They manifested ambivalences of their roles and ideas as contrasted to the leaders and the followers, who presented active expressions of their roles. The members who went along with others only hesitatingly raised points, mainly agreed, and went along with the others.

(8) In general, group experiences seemed to reduce potentials for expression (reduce the number of private ideas that were expressed publicly), but what was individually retained was more reality oriented and thus more socially acceptable. (After group experience, ideas were less frightening to the individual. This is perhaps one of the most important processes involved in group psychotherapy.) Original ideas were not lost, but were condensed or diluted.

(9) The leader was one who was more able to accept his private ideas plus the ideas of the group and to integrate these into his own thinking.

(10) Leadership imparted to the follower and to other group members certain crucial and important information for integrative functions.


It is recognized that mere participation in any sort of experiment engenders a certain amount of apprehensiveness, as does participation in most social situations. We have attempted to minimize “test anxiety” by familiarity with the investigators and by working through the feelings of the group members who are being studied prior to the procedure being introduced.

In the group setting, the leader has to make a choice as to whether he will run the risk of revealing some of his private thoughts and endure the stress involved in facing the possibility of losing his position. If he choses to do so, this course of action is socially meaningful and presumably gives some measure of his stability where real or imagined stress is involved. Thus a man may be an acknowledged leader by military rank, social status, or as empirically defined by Bales’ or Taguiri’s procedure, but under the stress of revealing his inner thoughts he may break down. In a benign setting, decisions of this type are made under no great stress such as would be involved under threat of starvation, loss of one’s life, or extreme pain; yet under these and other types of stress, leaders selected by the best available means do break down. The effect on morale to their associates and to their countrymen, in the case of those to whom the Nation has entrusted its security, is far reaching.

We entered into this research with no preconceived ideas, and have made no attempt to test hypotheses. The research is still in progress and specific findings must await statistical verification. The next phase of our research emphasizes the determinants of ideas that are made public in a spontaneous, small, social group, making use of sound motion pictures to capture the social setting as much as possible.

Our intention in this article has been to present a methodology and an approach to observations on leadership. We hope eventually to arrive at a well-studied, central appraisal, involving the use of acceptable methods drawn from sociology, dynamic psychiatry, psychology, and other behavioral sciences combined in a total approach, rather than from any specific discipline.


1. Parsons, T.: Illness and role of physician: sociological perspective. Am J. Ortbopsycbiat. 21: 452-460, July 1951.

2. Caudill. W.; Redlich, F. C.; Gilmore, H. R.; and Brody, E. B.: Social structure and interaction processes on a psychiatric ward Am J. Orthopsycbiat. 22: 314-334, Apr. 1952.

3. Stanton, A. H., and Schwartz, M. S.: The Mental Hospital. Basic Books, Inc. New York, N.Y. 1954.

4. Fox, R.: Sociological Study of Stress: Physician and Patient on a Research Ward. Unpublished Ph. D. thesis, Radcliff College, 1953.

   5. Beck, S. J.: Rorschah’s Test. Volumes 1, 11, and III. Grune & Stratton, Inc., New York, N. Y., 1944, 1945, 1952.

6. Bales, R. F.: Interaction Process Analysis: A Method for the Study of Small Groups. Addison-Wesley Press, Inc., Cambridge, Mass., 1950.

7. Tagiuri, R. Relational analysis; an extension of sociometric method with emphasis upon social perception. Sociometry 15: 91-104, Feb.- May 1952.

   8. Deutsch, F.: Associative anamnesis. Psycboanal. Quart. 8: 354-381, July 1939.

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