Comparative performance of psychotics with brain damage and non-psychotics on an original projective object symbol arrangement test

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COMPARATIVE PERFORMANCE OF PSYCHOTICS WITH BRAIN DAMAGE AND NON-PSYCHOTICS ON AN ORIGINAL PROJECTIVE OBJECT SYMBOL ARRANGEMENT TEST

A Dissertation Presented to the Faculty of the School of Education The University of Southern California

In Partial Fulfillment of the Requirements for.the Degree Doctor of Philosophy

by Theodore Charles Kahn December 1950

UMI Number: DP24000

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T h is disserta tio n , w r it t e n by T M 0 p 0 m _ . C J ^ R M § „ M M ............ u n d e r the g u id a n c e o f h.. j.s „ F a c u lt y C o m m itte e on S tudies, a n d a p p r o v e d by a l l its m em bers, has been presented to a n d a ccep ted by the C o u n c i l on G ra d u a te S tu d y a n d Research, in p a r t i a l f u l ­ f i l l m e n t o f re q u ire m e n ts f o r the degree o f DOCTOR

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ACKNOWLEDGEMENT The Research Committee of the Veterans Administraticn Brentwood Neuropsychiatric Hospital has made this investi­ gation possible by its approval of the project.

Dr. Harry

M. Grayson, Chief of Psychological Services, under whose supervision the investigator worked; Dr. Edwin Schneidmann; and the nurses and psychiatrists of the hospital deserve grateful acknowledgement for their extensive counsel and assistance. The personal interest expressed by Dr. Bruno Klopfer in the Kahn Test of Symbol Arrangement remains a motivating factor in present and future research with this instrument.

TABLE OP CONTENTS CHAPTER I

PAGE

THE PROBLEM AND DEFINITION OFTERMS U S E D ............. 1 The p r o b l e m ........................................2 Statement of the problem . ....................... 3 Importance of this s t u d y ......................... 3 Definitions of terms used

.......................

6

Organization of the s t u d y ........................ 17 II

REVIEW OF THE L I T E R A T U R E ............................ 19 Objective t e c h n i q u e s .............................. 19 Mosaic t e s t .......................................23 Vigotsky test of concept f o r m a t i o n ............... 26 Goldstein-Scheerer t e s t s .......................... 27 The world test

.......................... 31

Dramatic productions t e s t ........................ 33 Three dimensional apperception t e s t ............. 33 Word association t e s t s ............................ 36 Other studies utilizing psychological tests with brain-damaged p s y c h o t i c s ........................ 37 S u m m a r y ........................................... AO III

TEST BACKGROUNDj MATERIAL ANDP R O C E D U R E S ............ A 3 Test b a c k g r o u n d ...........................

.A3

P r o c e d u r e s ......................................... 7 A Summary............................................. 7 6 IV

GENERAL BACKGROUND OF THE NON-PSYCIIOTIC AND PSYCHOTIC WITH BRAIN DAMAGE

G R O U P S ............... 82

V

CHAPTER

PAGE Experimental g r o u p ........................... . .

82

The control g r o u p ................................ 8 5 Comparison of experimental and control groups

.

94

S u m m a r y .......................................... 115 V

TEST RESULTS AND OTHER STATISTICAL D A T A .......... 120 Statistical procedures .................

. . . .

120

Test r e s u l t s ......................................123 ..............................

123

................................

126

Togetherness ..................................

129

Naming variable Symbolization

Reasons for preference liking and disliking

. 134

Preference analysis, objects liked and dlslikedl47 Reasons for l i n e - u p ........................... 152 R e c a l l .......................................... 155 B l o c k i n g ........................................ 1 5 8 Speed of p e r f o r m a n c e ........................... 159 Direction of performance .....................

160

Placement Errors ..............................

163

Other statistical d a t a ........................... 1 6 7 KTSA scores and I.Q............................. 1 6 7 Reliability data for the K T S A ..........

169

Range frequencies and total scores ..........

170

S u m m a r y .......................................... 180

vi CHAPTER

PAGE Differences between the performance of the psychotic and non-psychotic groups not statistically treated . . . .

VI

..............

SUMMARY, CONCLUSIONS ANDRECOMMENDATIONS

. . . .

187

191

S u m m a r y .......................................... 191 P u r p o s e ......................................... 191 M a t e r i a l s .......................................191 Relation to othertests ........................

192

P o p u l a t i o n .....................................192 Test r e s u l t s .................................. 195 C o n c l u s i o n s ....................................... 1 9 8 Recommendations .................................

200

Cautions relating to interpretations of KTSA s c o r e s ................................... 203 BIBLIOGRAPHY ..........................................

205

A P P E N D I X ............................................... 211 Appendix

A

...................................... 211

Appendix

B

...................................... 218

Appendix C

............................. . . . .

236

Appendix

D

........................... ..

243

Appendix

E

...................................... 247

Appendix

F

.........

Appendix

G

250

............................. 252

LIST OF TABLES TABLE I

PAGE Incidence of KTSA Symbols in Current Magazine Advertisement

II

...................

55

Common Symbols Used on Flags of Various Nations and the K T S A ........................56

III IV

Object Selection Chart

......................

69

Distribution of the Psychotics Tested According to Type of Brain D a m a g e ........... &1+

V

List of Cooperating Institutions Furnishing Subjects for Non-Psychotic Group

VI

........

$7

Results of the Minnesota Multiphasic Personality Inventory for the NonPsych otic Group . . . . . ................... 91

VII

Comparison of the Chronological Age of the Non-Psychotic and Psychotic Groups

VIII

. . . .

Comparison of the Occupational Levels the Experimental and Control Groups

X

96

Comparison of Educational Levels for the Psychotic and Non-Psychotic Groups

IX

. . . .

96

of . . . .

102

Comparison of I.Q. for the Experimental and Control G r o u p s .........................110

XI

Comparison of Marital Status for Experimental and Control Groups . ........

113

viii TABLE XII

PAGE Comparison of Military Rank of Experimental and Control G r o u p s .......................... 114

XIII

Comparison of Religious, Racial and Foreign Birth Background of Experimental and Control Groups

XIV

.............................

Summary of Comparisons Between Psychotic and Non-Psychotic Groups

XV

116

..................

117

Differences Between Proportions of Responses of the Psychotic and Non-Psychotic Groups to the Naming V a r i a b l e ......................127

XVI

Differences Between the Means of Responses of the Psychotic and Non-Psychotic Groups to the Naming V a r i a b l e ......................12$

XVII

Difference Between Proportions of Responses to the "Togetherness" Variable for the Psychotic and the Non-Psychotic Groups

XVIII

. •

130

Differences Between the Mean Responses to the Reasons for Preference Liking Variable for the Psychotic and Non-PsychoticGroups

XIX

131

Differences Between the Mean Responses to the Reasons for Preference (Disliking) Variable for the Psychotic and NonPsychotic Groups

...........................

132

ix PAGE

TABLE XX

Difference Between the Mean Responses to the "Lifting Objects" Variable for the Psychotic and Mon-Psychotic Groups . . . .

XXI

13$

Differences Between Proportions of Responses to the Y-Piece Over Variables for the Psychotic and Mon-Psychotic Groups . . . .

XXII

140

Differences Between Proportions of Responses to the Transparent Heart Over Variables for the Psychotic

XXIII

and Non-Psychotic Groups 143

Differences Between Proportions of Responses to the Transparent Star Over Variables for the Psychotic

XXIV

and Non-Psychotic Groups 144

Differences Between Proportions of Responses to the Transparent Butterfly Over Variables for the Psychotic

XXV

and Mon-Psychotic Groups 145

Differences Between Proportions of Responses to the Transparent Circle Over Variables for the Psychotic

Differences Between Proportions of Responses to the Preference Analysis (Objects Liked) Variable for the Psychotic and MonPsychotic G r o u p s .........................

.

XXVI

and Mon-Psychotic Groups 146

14$

PAGE

TABLE XXVII

Differences Between Proportions of Responses to the Preference Analysis (Objects Disliked) Variable to the Psychotic and Non-Psychotic Groups

XXVIII

. . . 149

Differences Between the Mean Responses to the Reasons for Line-Up Variable for the Psychotic and Non-Psychotic Groups

XXIX

• 153

Differences Between the Mean Responses to the Recall Variable for the Psychotic and Non-Psychotic Groups

XXX

. . . . . . . .

157

Differences Between the Mean Responses to the Blocking Variable for the Psychotic and Non-Psychotic Groups

XXXI

. . . . . . . .

157

Differences Between Proportions of Responses to the Speed of Performance Variable for the Psychotic and Non-Psychotic Groups

XXXII

. 161

Differences Between the Proportion of Responses of the Direction of Performance Variable for the Psychotic and NonPsychotic Groups

................ 164

xi TABLE XXXIII

PAGE Differences Between the Mean Response to the Position of Object Placement Variable for the Psychotic and NonPsych otic G r o u p s .....................

XXXIV

• 166

Correlation Between I.Q. of Non-Psychotic Group With Their Total Sub-Total Scores on the K T S A ............................... 166

XXXV

Reliability Data for the KTSA Based on the Test-Retest M e t h o d ................ 172

XXXVI

Means and Standard Deviation of the Total Scores for the Non-Psychotic and the Psychotic Groups

XXXVII

........................

172

Difference Between the Mean Responses of the Total Scores of the Psychotic and Non-Psychotic Groups

XXXVIII

.................... 172

Sample Scores by Six Individuals in this S t u d y ............................... 174

XXXIX

A Comparison of Performance on the KTSA of Two Groups of Non-Psychotics Psychotics With Brain Danage and Mixed S c h i z o p h r e n i c s ....................

175

xii PAGE

TABLE XL

A Comparison of Two Groups of NonPsychotics in Regard to Seventy-two Responses on the KTSA

XL I

.................

131

A Comparison of Brain Damage Psychotics With Schizophrenics in Regard to Seventy-Two Responses on the KTSA

XLII

. ♦ .

131

A Correlation of Weights 'Which "Were Obtained From MttT Ratios Involving Two Non-Psychotic and Two Psychotic Groups •

XLIII

Summary Table Items With t Ratio of Over t$0 Ranked on Strength of Discrimination

XLIV

132

133

Summary Table Showing the Significance of Variables in This Study Tables XV to XXXIII ..................................

190

LIST OP FIGURES FIGURE

PAGE

1.

Component Parts of K T S A .............................70

2.

Materials Used in the K T S A ........................ 71

3-

The Kahn Test of Symbol A r r a n g e m e n t ................ 72

4.

Codes and Abbreviations Used in theAdministration of the K T S A ....................................... 7 7

3 . Additional Scoring Scoring Techniques

Used in

the Administration of the K T S A ................. 79 6.

Range and Frequency Distribution ofKTSA Total Scores Obtained by the Non-Psychotic and Brain Damage-Psychotic Groups .................

7 . Psychograph of a Psychotic with Brain

Damage . .

171

242

CHAPTER I THE PROBLEM AND DEFINITION OF TERMS USED At the end of his volume on Projective Techniques Bell (6 ) gives eleven criticisms of present projective methods.

These criticisms include lack of standardization,

Insensi ti vitj^ of method, lack of description of experimental groups, semantic difficulties in the interpretations, hulk of material, bias of examiner In scoring, lack of demonstra­ ted reliability, questionable validity, indiscriminate re­ lating of test results of personality theories, cultism, and misuse of projective techniques by poorly trained workers. Object symbol arrangement is a new technique design­ ed to overcome some of the drawbacks listed by Bell and concurred In by others in the field.

A Symbol Arrangement

Test has been developed which uniquely permits projective data to be scored objectively.

The new technique also al­

lows for relatively simple statistical comparisons of the performances of selected groups.

If the selected groups

are well defined a research worker may establish reliabili­ ty and validity in a manner which is in accord with the best scientific tradition. One such study has already been completed.

Fils (26)

using the Kahn Test of Symbol Arrangement Fils compared a group of 5 0 normal veterans with 50 mixed schizophrenic

2 veterans.

He took precautions that the groups be well de­

fined and observed other requirements of sound statistics. Fils found 5 6 responses to be significant at the 10, 5* anc^ 1 per cent levels of confidence.

Significant differentiat­

ing performance by the schizophrenic group was found in (a) placement of dogs in all but the upright position,

(b)

tendency to offer bizarre and low abstract responses,

(c)

lesser number of responses of a categorical or organization­ al nature,

(d) a greater number of errors in the memory of

variables,

(e) naming of the objects,

(f) placement of dis­

similar objects together, and (g) slower speed of perform­ ance. Of these seven differentiating factors between the •normal and the schizophrenic group, only two are based on subjective evaluation by the examiner.

Five, including the

most discriminating factor of all (the positioning of cer­ tain objects) are entirely objective--free from any person­ al bias or opinion. The present investigation is a companion study to the research described above.

In the present investigation, a

new non-psychotic group was established; patients with brain deterioration comprised the experimental group. I.

THE PROBLEM

3 Statement of the problem.

The purpose of this study

was to determine whether object symbol arrangement can differentiate between psychotics with brain damage and nonpsychotics, as revealed by the comparative performance on a test of symbol arrangement. The experimental and control groups were matched for age, intelligence, occupation, marital status, religious and racial background, and military rank while in service. The experimental group consisted of patients at a Veterans Administration Neuropsychiatic Hospital with a diagnosis of brain damage with psychosis.

The non-psychotic

group included veterans from a Veterans Administration Domi­ ciliary, a United States Army Post, a municipal junior college, and a Veterans Administration Counseling Service. Case histories, medical and psychiatric opinions, and ob­ jective tests were among the criteria used to establish the non-psychotic group.

All subjects tested were males.

Importance of this study.

The United States Depart­

ment of Commerce, Bureau of Census, published a survey of first admissions to institutions for mental disorder (5 6 ) for the year 1933, thirty-six and six tenths per cent of which were shown to be of organic origin involving brain damage.

Included in this group were cases of general

k paresis,, syphilis of C.N.S.* encephalitis* alcoholism* tra­ uma* cerebral arteriosclerosis* senility* embolisms* and tumors.

In all* 3^*230 first admission patients entered

mental institutions in 1 9 3 $ 2 or these diseases. Thorpe and Katz* in The Psychology of Abnormal Behavv ior, review the increase in the incidence of psychiatric disorder* stating: Although this increase may not be marked as un­ critical observers have supposed* It is probably true that psychiatric disorders are becoming more numerous. Wars* depressions* unemployment* loss of social status* insecurity* increased family tensions* and malnutrition have undoubtedly been contributing factors. (7 5 ) These authors further comment on the expense involved in caring for these patients.

After considering several

factors they conclude: "it has been estimated that the to­ tal yearly expenditure for mental disorders in this country is approximately 7 5 O millions of dollars."

(7 5 )

Regarding these psychiatric disorders* Karl A. Menninger mentions one of the difficulties faced by the modern therapist In his understanding of the problem and his treat­ ment of mental patients.

Menninger says:

How much of this lack (of emotional health) in a given case is due to a lesion in the physiological machinery of the organism--tbe basal ganglia of the brain* the endocrine glands* the autonomic nervous system--and how much of it is due to conflicts of emotional streams which neutralize each other* it is impossible to say from a priori evidence. (5 0 )

There are, available to the therapist, projective tests which have thrown light on the matter of origin of mental dysfunction in a given case.

Most of the research

has been with the Rorschach and, regarding this technique, Stanley Cobb writes: In differential diagnosis the Rorschach method thus becomes useful in distinguishing between personality changes due to cerebral lesion and such conditions as manic-depressive psychosis, schizo­ phrenia, and neurosis. (15) In the same paragraph he adds: "Further careful work with the Rorschach and other psychological tests may show the diagnostician still more refinements.

At the present

the work is in its infancy.” D. H. Fils (26 ) confined his study to schizophrenics in his investigation of psychotics with a technique of sym­ bol arrangement.

His findings indicate that symbol arrange

ment is a useful method of distinguishing between schizo­ phrenics and normals. Bell (6) says: "it is essential that the research trend of collateral studies with a variety of projective methods be continued and enlarged in scope.” If object symbol arrangement can be shown to differ­ entiate between non-psychotics and psychotics with brain deterioration, the device will be more useful to the counse lor and psychologist in four ways: (l) it will provide the

6 counselor and psychologist with a new technique which differentiates between non-psychotics and psychotics with brain damage.;

(2) it will indicate what kinds of motor and

verbal responses to such objects will be made by these two groups;

(3 ) it will provide objective norms for the perform­

ance of psyrchotics with brain damage as well as for that of a new non-psychotic population; and (4) it will permit com­ parisons in performance on object symbol arrangement (a) between two groups of non-psychotics having a different age mean and (b) between psychotics with brain damage and schizophrenics. II. DEFINITIONS OF TERMS USED Object symbol arrangement.

A technique has been de­

veloped by the investigator which is known as the Kahn Test of Symbol Arrangement.

All references to object symbol

arrangement in this study fall within the scope of the nomenclature devised for this test. keep this nomenclature simple.

An attempt was made to

Some projective tests charac­

teristically employ complicated nomenclature, esoteric in nature, making the study and use of these devices more re­ stricted than would otherwise be the case.

Word coining,

special definitions, and obscure phraseology were avoided In the construction of the Kahn Test of Symbol Arrangement.

7 Wherever possible, accepted dictionary definitions of terms were used, and the emphasis was placed on simplicity and ease of administration.

In consequence, the definitions of

terms used in the study seem relatively non-technical when compared to such words as ,?Erlebnistypus", "Conf abula tory W ’s", and '’Chiaroscuro" , familiar to every Rorschach worker. The Kahn Test of Symbol Arrangement will be referred to as the KTSA. tail.

In Chapter III it will be described In. de­

The essentials of the test involve lining up fifteen

objects on a felt strip divided into fifteen squares.

These

objects are made of plastic material, are of different colors, weights, and sizes and, with one exception, are well-defined representations of familiar things in everyday life.

Each

of the objects was selected as being symbolic of values or associations at varying levels of abstraction.

The subject

Is asked to line up the objects on the felt strip five different times under varying conditions and requirements. A sixth time is occasionally used when it is necessary to test the limits of the individual’s response. Naming.

After the first line-up, the subject is ask­

ed to name each object.

For this he is merely required to

tell what each one is; e.g., for the anchor-shaped object he need merely say "anchor."

8 Symbolization.

After the second line-up of objects

on the strip, the subject is asked to symbolize regarding them.

This process is explained to him uniformly as

follows:

"A flag can represent a country, a horseshoe some­

times stands for good luck, a torch (or light) can symbolize knowledge or freedom; tell me what each of these objects can stand for, represent, or symbolize." The definition of "symbolize" as here employed is in agreement with the general use of the term.

The American

College Dictionary defines "symbolize" as: "v.t. 1. to be a symbol of; stand for, or represent as a symbol does."

A

"symbol" is in turn defined as: "n. 1 . something used or regarded as standing for or representing something else; a material object representing something immaterial; an em­ blem, token, or sign." Arrangement.

(5 )

A key factor in the KTSA is the "ar­

rangement" of the fifteen plastic objects.

In three out

of the five line-ups, the arrangement is left to the person taking the test.

The examiner says: "Place these objects

along this strip in any way." jects and then to the strip.

Examiner points to the ob­ If subject requests further

information examiner reiterates: "in any manner you wish." (42)

This placing of object along the felt strip is called

"arrangement."

The American College Dictionary defines

"arrange": "v.t. 1 . to place in proper, desired or con­ venient order; to adjust properly; to arrange books on a shelf." In the case of the KTSA that which the subject con­ siders a "proper", "desired", or "convenient" way to select and line-up the objects; in other words, the choice he makes in placing and arranging the symbols reveals something about his personality structure and, as will be shown In this study, his sanity. Functlona1 and organic psychoses.

There are two

basic classifications in which psychotics fall according to most texts in general psychology. the functional group.

The first Is known as

The other is referred to by many

textbook writers as the organic group.

Richards puts it

this way: When definite tissue changes seem to precede or accompany the symptomatic psychological changes of psychosis, it is said to be organic psychosis. Most psychoses, however, have no demonstrable organic concomitants and are said therefore to be functional psychoses. Of the functional psychoses the most frequently encountered are, In order: schizophrenia, manic-depressive psychosis, involutional melancholia, and paranoia. (6 0 ) Dashiell agrees with this distinction when he says: The preceding forms of psychotic behavior (ManicDepressive, Schizoid, Involutional Melancholia) are among these that are largely psychogenic In causation,

10 that is, are functional disorders. Several kinds, however, have definite organic bases in structural changes of the body. (1 9 ) The New Dictionary of Psychology defines "organic psychosis’' as follows: "a mental disorder which is caused by a dysfunctioning of some organ or by a lesion in the brain or nervous system.”

(3 5 )

Accepting this definition, Munn makes the following distinction: The organic psychoses most clearly recognized are paresis, senile psychosis, and alcholic psychosis. The chief functional psychoses are manic-depressive psychosis and schizophrenia, or dementia praecox. (5 3 ) However, there are voices raised against such an arbitrary division as "functional” and "organic."

Some

feel that not enough is known about the so-called "func­ tional" diseases to warrant any implications regarding tissue changes.

Others believe that any dysfunctioning of

personality (whether tissue changes can be observed or not) has, of necessity, organic involvement.

These psychologists

contend that to call schizophrenia a "functional disease" is misleading and inaccurate. Some confusion regarding these terms may be noted in Taber *s Cyclopedic Medical Dictionary.

Taber defines

"functional" as: A word applied to disturbance of function in a

II variety of ways. The disturbance of one organ by structural changes in another is at times termed functional, but incorrectly, as it represents organic change. Disturbances of function resulting from un­ fortunate conditioning of the organism to an ex­ ternal situation may more suitably be called "functional” though this conditioning may be in­ born and therefore purely structural. (7 1 ) Further exploration of the literature leads to the conclusion that the distinction between "organic" and "functional" may be largely artificial.

Nielsen (5*0 states;

"if a line is drawn betwen functional and organic disease on the basis of psychogenesis or organogenesis, distinctions similarly become vague."

He explains that "We may begin

with a functional state and end with organic disturbances which, by following the chain back far enough, may be said to be psychogenic."

(5*0

To many writers the success of

new types of chemical, surgical, and electric therapies has heaped a -preponderance of evidence to support this view. Klein, after a discussion of this aspect of the problem, concludes: "As was just pointed out, the success of shock therapy has cast doubt on the basic functional status of schizophrenia."

(il7)

Thorpe summarizes his discussion of

this problem with: "The question of reither-orf in regard to functional and organic disorder is still being debated." (75) The most vehement attack on the distinction between

12 the term that has come to the attention of the investigator appears In a chapter by Stanley Cobb.

This well-known

neuropsychiatrist states: There has been much loose thinking and confused writing upon the subject of whether certain phenomena are "mental or physical", "psychic or somatic", "functional or organic". The current medical ver­ nacular that divides all diseases into either "organic” or "functional" is convenient, but entirely Indefensible on either scientific or philosophical grounds. It must be perfectly clear to any physician who will stop to think about It, that all disease is both organic and functional because without functional disturbance there can be no symptoms, and without organic involvement there can be no disturbance of function. (1 5 ) It can be seen from the foregoing that any study whose validity is in part based on a distinction between brain damage, usually called "organic," and schizophrenia, commonly referred to as of a functional nature, must give concern to the confused and debatable nature of psychologi­ cal distinctions and classifications.

For the practical

benefit of this research the investigator has found it use­ ful to agree with Thorpe, who says: Through usage the term functional has come to mean a disorder of personality for which no demonstrable lei^on has been found and which is completely re­ versible. On the other hand, organic has come to mean a disorder of personality which is due to some struc­ tural lesions supposedly present in the so-called functional disorders have escaped notice because of inadequate laboratory tools and techniques, or whether no visible structural changes actually occur. (75)

13 In terms of the above quotation,, the present study falls into the organic category in that the experimental hospital cases were all diagnosed as patients with a person­ ality disorder which, because of a structural alteration or defect, is not reversible.

In order to keep controversy of

a semantic nature at a minnimum the term "brain damage" has been used as specifically descriptive of the experimental group used In this research. Brain damage.

For the purpose of this study brain

damage is defined as a condition or abnormality which occurs when the function of the brain has been disrupted or im­ paired by observable causes, or by diseases or processes known to be associated with cell deterioration of the cere­ bral cortex.

The demonstration of this condition may be

through X-rays, encephalographic records, ''demonstrated bacterial infection, brain Injury caused by head wounds of traumatic origin, drug poisoning with cerebral localization, and degenerative processes in which brain cell deterioration Is ipso facto.

Cameron (13) describes this condition as

"cerebral incompetence." Fitting these descriptions are the following diag­ noses of patients used in this study: Cerebral thrombosis

14 Syphilis with lues,, central nervous system, Encephalitis with psychosis Arteriosclerosis cerebral Malarial encephalitis Organic brain disease due to gunshot wound Encephalopathy traumatic Alcoholic deterioration Subarachnoid hemorrhage Grand mal epilepsy with brain deterioration and psychosis Paresis A description of each of these diseases will be given in Chapter IV.

The diseases are mentioned here to

clarify the diagnostic composition of the experimental group in this Investigation and to show how the term "brain damage" has been used In referring to this group.

Support

for such a classification may be found In several sources including The Psychology of Abnormal Behavior.

(75)

The

authors of this volume state: There are a number of factors in the causation of the organic psychoses. The most frequent of these may be listed as: (1^ infection: paresis, epidemic encephalitis; 2 ) Intoxication: alcohol, drugs, exogenous poisons; 3) trauma: natal and postnatal head injuries; 4) nutritional dysfunction; 5 ) endocrine dysfunction;

15 (6 ) new growth formations in brain: benigh tumors, cancers; (7 ) age factors: arteriosclerosis (hardening of the arteries) senility. Psychotics and non-psychotics.

The study in this

dissertation pertains to a psychotic and to a non-psyehotic group.

For the purposes of this research,

"psychotic" is

defined as descriptive of an individual who, because of his deviant behavior, functions so unsatisfactorily in his interpersonal relationships that, unless institutionalized, he would (in the opinion of a competent psychiatrist) be a danger to himself, to society, or both.

Taber1s Cyclo­

pedic Medical Dictionary (71) defines psychosis as follows: A condition manifested in the behavior, emotional reaction and ideation of the patient. He fails to mirror reality as it is, reacts erroneously to it, builds up false concepts regarding it, and his be­ havior responses are peculiar, abnormal, inefficient, or definitely anti-social. Good (2 9 ) adds the factor which is descriptive of the experimental group used in this study.

After giving a

definition of psychosis similar to the one above, he adds: "...usually of sufficient seriousness to warrant treatment of the individual in an institution for the mentally de­ ranged. " The control group is described as non-psychotic rather than "normal."

In the educational and psychological

16 literature, the use of the term "normal" is often vague, confused and contradictory.

The .term requires an arbitrary

redefinition each time it is used in a study, since even, dictionaries do not agree as to the exact maning of the word "normal."

According to Jones (^0), "This brings us to

the major dilemma of those who wish to characterize person­ alities , a dilemma which is bound up with the standard con­ cepts of reliability and validity." Thorpe says: "The normal person, if such there be, is the individual who has learned to respond to dilemmas in ways well calculated to solve such problems as may be in­ volved."

(7 5 )

It is believed that the use of the term "non-psychotic" is therefore justified as adequately descriptive of the control group, thereby avoiding the confusion of the concept of normalcy.

In terms of this research,

"non-

psychotic" is defined as pertaining to an individual who is able to function satisfactorily In his interpersonal re­ lationships; one who Is not considered a danger to himself or his society because of a misinterpreting or "ignoring of reality and his surroundings."

(2 9 )

In short, a "non-

psychotic" is one whose modes of adjustment and behavior are sufficiently satisfactory that, in the opinion of his group and in competent medical and psychiatric opinion, he

17 does not belong in a mental institution.

He is able to get

along without confinement because of freedom from deviant behavioral symptoms.

Certain terms such as togetherness,

bizzare responses, association, etc., are used in the re­ sponse evaluation of the KTSA which is part of the scoring procedure.

The explanation of these terms will be found in

Chapter III. III. ORGANIZATION OP THE STUDY Chapter I includes the statement of the problem: to determine whether object symbol arrangement can differenti­ ate between psychotics with brain damage and non-psychotics. The importance of this study Is shown in connection with the need for additional instruments for diagnosing or indi­ cating a mental condition which has a significantly high incidence in the general population.

Finally, a definition

of terms is presented to limit possible ambiguity of the meaning of the terms as they appear in this study.

Chapter

II offers a historical summary of the projective techniques and studies which may be related to the present Investi­ gation.

Chapter III describes the rationale for the KTSA,

a presentation of the test materials and the procedures followed In administering the test to the experimental and control groups.

In Chapter IV there is given detailed

18 description of the background of the psychotic and the nonpsychotic groups used in. this study.

Included in this

chapter is a comparison of both groups with regard to age, occupation, marital status, intelligence test scores, educational level, and religious and racial background. In Chapter V the test results are presented.

It includes

the significantly differentiating responses to the test variables, and a comparison of these responses with a pre­ ceding study in which a different psychotic group was used. Reliability data based on the test-retest method are given as well as the correlation of agreement between different scorers of the same tests.

Chapter VI i n d u c e s a summary,

conclusions, and recommendations.

CHAPTER II REVIEW OP THE LITERATURE I. PROJECTIVE TECHNIQUES The term "projection” from its Latin derivative means "the act of casting forwards.”

The Implication is that

which is the inner self falls on some other person, place, or thing. Sears, in Contemporary Psychopathology, attempts to define projection in terms of modern psychological usage. He reviews the meaning of the term as follows:

(64) (37)

Projection has been defined by Healy, Bronner, and Bowers as a defensive process under sway of the pleasure principle whereby the Ego thrusts forth on the external world unconscious wishes and ideas. Later in the same article Sears adds:

"Although pro­

jection ocDurs most frequently and with greatest energy in the neuroses and psychoses it Is found to some degree in many normal persons." An understanding and proper evaluation of person*s projections should provide a measure of the individual's adjustment.

The common saying "One can tell a person by

his friends, " would thus be changed to "One can tell a person by his projections." A review of the literature shows that the problem of personality diagnosis by projection is greatly complicated by the current inability of diagnosticians to evaluate,

20 recognize and measure the projections satisfactorily, and in addition, there is disagreement regarding their clinical implications.

Commenting on one aspect of this problem,

Watson writes: Coming directly to the topic of projective method for personality study, we may say that the dynamic conception of personality as a process of organizing experience and structuralizing life space in a field leads to the problem of how we can reveal the way an individual personality organizes experience, in order to disclose or at least gain insight into that individual's private world of meanings, significances, patterns, and feelings. (8 2 ) A great variety of projective methods exist which, in one way or another, attempt to give the mental adjustment. Bell (6) lists twenty-three such tests in his volume on pro­ jective techniques.

The existence of a wide selection of

such devices does not imply that their use is universally sanctioned nor that the

utility is generally acknowledged.

On the contrary, the techniques currently in use for ana­ lysis of projective dynamics are being subjected to an in­ creasing number of searching (and by no means consistently favorable) observations. The literature on projective techniques reveals three major criticisms of this method of personality diagnosis. Many believe that the subjective interpretations on which projective tests are largely based are inconsistent with sound science.

Science demands a more exact type of veri­

21

fication.

Many point out the limitations in administration

of projective techniques, inasmuch as these methods are tightly restricted to highly trained clinicians.

A third

criticism involves the nature of the materials used.

It is

believed that these materials do not permit a desirable balance between verbal and motor responses. Florence Goodenough’s discussion of the projective theory and methodology is typical.

She states:

If projective methods are to win unqualified ap­ proval of scientific workers, it Is necessary to abandon the attitude that scientific proof can be dispensed with in favor on intuitive judgements often based upon a kind of evidence that smacks dangerously of the witch doctor who mutilates an image to injure his enemy. (3 0 ) In the same vein she writes: Selected case histories do not constitute proof; neither do the pages of little stories and anecdotes by which a surface appearance of plausibility Is sometimes attained. (3 0 ) Cattell Is In agreement with this sentiment when he says: True projection procedures and studies of wit reaction undoubtedly have Immense Importance for the objective measurement of personality, but the begin­ nings are too recent and the workers too few for much to have emerged. (1*0 Considerable hope for projective methods Is held out by Bell and his conclusions should stimulate further research.. His book , Projective Techniques, is considered a classic In the field.

In the last chapter of his book he states:

With all their present deficiencies they have established for themselves a secure position in research and clinical study, and they have shown prospects of reaching a stature commensurate with the energy and time that have been and will be expended in their development. (6) The future of projective methods is seen by many writer as almost unlimited.

Symonds (70) writes: "The field

of projective techniques is now wide open."

Later in the

same article he says: "The writer foresees a great amount of experimentation with a wide variety of stimuli in pro­ jective testing in the nest few years." Cronbach sums up the advantages of the projective methods as follows: Projective methods have special strengths which make them essential in modern research and applied psychology. They stress personality as an inter­ related whole, rather than as a random mixture of isolated traits. They permit every person to have a different final analysis, corresponding to our know­ ledge that each person is unique. They tap forces which underlie overt behaviors and are otherwise not observable, and tendencies which will break through under future stress though they are not yet anparent.

(18) Perhaps the best known of the projective tests are (l) the Rorschach and (2) the Thematic Apperception Test. Both of these consist of cards, the"former of ambiguously shaped inkblots and the latter of situational drawings. These media differ greatly from the KTSA materials.

A com­

parison would be more fruitful if limited to other techniques more closely related.

Sargent’s (6 3 ) grouping of projective

techniques is based on the nature of the materials used for projection and the functional use which the subject makes of the materials.

Frank (2 7 ) describes the category into

which the KTSA most logically falls.

This group includes

"methods which, call upon the subject to organize and arrange materials according to his own conceptions.”

According to

Klopfer (49) other tests falling into this classification are: the Mosaic Test, the Vigotsky Test of Concept Formation, the Goldstein-Scheerer Tests of Abstract Concrete Thinking, the World Test, the Dramatic Production Test, the Three Dimensional Apperception Test, and Word Association Tests. A short description of these tests follows. II.

MOSAIC TEST

In 1929 Lowenfeld designed the Mosaic Test, which is not very well known In the United States.

However, in

England many clinics use it as part of the regular battery of personality tests.

Wertham and Golden (8 5 ) were among

the first to introduce the test to the United States. Compared to the sixteen objects which comprise the KTSA, there are 465 small wooden pieces In the Mosaic Test. These come in 6 colors and In 5 shapes. diamonds, triangles,

There are squares,

(isosceles and scalene) forms.

It

should be noted that all of these are geometric figures.

2^ In the KTSA there Is only one object that may be considered primarily geometric and this is the circle. There are no circles in the Mosaic Test.

As far as

color Is concerned, however, there is a greater resemblance between the KTSA and the Mosaic. red,, white, and green objects.

The former has blue, black, The latter has all of these

and, in addition, yellow. The Instructions fdr the Mosaic Test are simply: ftMake anything you like out of these pieces." corded but not limited.

Time is re­

The behavior of the subject taking

the test is noted carefully.

His verbalizations and ex­

pressions are recorded as are his expressed satisfactions with his work.

The designs created may be classified accord­

ing to a number of characteristics, some of which are given below.

Comparable factors in. the KTSA are also listed.

Factors in the Mosa1c Test

Comparable Factors in the KTSA

Coherence or incoherence

Level of responses

Concreteness or abstraction

Concreteness or abstraction (level of association)

Harmony of design as a whole

Balance, symmetry, design.

Distinctness of configuration Configurational recall in 3rd line-up Position in reference to tray Position in reference to strip Choice of color and shapes

Preference of colors and shapes

25 Repetition; stereotypy

Repetition and inflexibility of line-ups

Relation of design to what subject says.

Reason for line-ups given by subject compared to actual line-up.

Over 1,000 persons were studied by Wertham and Golden as reported in the American Journal Of Psychiatry.(8 5 )

This

group included adults and children: normals, psychotics, neurotics, and criminals.

The investigators gave blind in­

terpretations which were later compared to clinical records. The group tested, which is comparable to the experimental group of this study, included patients with organic brain disease, post-traumatic encephalopathies, subcortical and cortical brain damage.

The investigators found the follow­

ing to be characteristic of this group: (a) Mere influenced more than normals by the shape of each individual piece. (b) Fixated on the piece after placing. (c) Made patterns on a mechanical or automatic level. (d) Made

inflexible use of color.

(e) Used

few pieces with emphasis on simple designs.

The group was outstanding in its failure to achieve a

good configuration.

style,

although the number and kind of patterns were small

and simple. t ray.

The epileptics showed no uniform

Their patterns clung close to the edge of the

26 Concerning another group of patients with brain dam­ age, Diamond and Schmale (20) isolated the following charac­ teristics ,using the Mosaic Test: (a) Moderate to severely defective Gestalt was noted. (b) Color was disregarded. (c) Responses were strikingly similar to those of schizophrenics at times. (d) Patterns with minor defects of organization were observed. III.

VIGOTSKY TEST OP CONCEPT FORMATION

This instrument

is popularly known as theHanfmann-

Kasanin Test (3*0 after the publishers of the test in the United States.

Actually the test was first constructed by

the late Russian psychiatrist L. S. Vigotsky. Thorpe their volume.

and Katz show a photograph of this test in Abnorma1 Psychology and describe it as

follows: In the Hanfmann-Kasanin Test the subject is con­ fronted with the task of dividing 22 small blocks, of 6 different shapes, painted in two different colors, or two different heights, and of two different general widths, into four kinds. This instrument has been used for determining concept formation in schizophrenic individuals. It has been found that psychotic subjects usually behave as though they understood the test instructions, although their performances show that they actually misunderstood them. (75)

27 When the subject has finished taking the test he is asked to give the reason for his classification.

Test re­

sponses are scored on three levels: conceptual, intermediate and primitive. The similarity of this device to the KTSA is limited. It is ture that in both cases the subject is confronted with a task involving colored objects.

However in the

Hanfman-Kasainin Test all objects are geometric--circles, triangles and squares--and the task is a specific one.

In

the KTSA the objects are symbolic in nature, consisting of dogs, butterflies, hearts, etc.; the subject himself de­ termines the task inasmuch as he is asked to line-up the objects iri any way he chooses. Although the Hanfmann-Kasanin Test has been used with some functional psychotics no significant study using this test has been undertaken with patients having brain disease. IV. GOLDSTEIN-SCHEERER TESTS Goldstein has been one of the leading contributors to the literature in the fields of schizophrenia and brain damage.

He is the co-author of five tests designed to pro­

vide quantitative and qualitative measurement of impairment of integrative mental functioning.

These are (a) the

28 Goldstein-Scheerer Cube Test,, (b) Gelb-Golastein Color Sorting Test,

(c) Gelb-Goldstein-Weigl-Scheerer Object

Sorting Test,

(cl) Weigl-Goldstein-Scheerer Color Form Sort­

ing Test, and (e) the Goldstein-Scheerer Stick Test.

(28)

In these tests the need for language in responding to directions is excluded in so far as is possible.

In

this respect they differ notably from the KTSA in which the language responses are an Important factor.

The tests are

designed for schizophrenics as well as for individuals with organic Impairment.

In both of these groups loss of inte­

grative mental functioning is found to exist.

A brief

description of each test follows. Goldstein-Scheerer Cube Test.

This test is de­

signed to discover whether or not the subject can copy colored designs with blocks. the same color.

Each side of four blocks has

If the subject fails to copy the design on

a card, he is given a graded series of additional aids for solution of the problems.

In this manner a quantitative

measure of his concrete-abstract aptitude is obtained. A similarity between this test and the block design section of the Wechsler-Bellevue test may be observed.

Of the lat­

ter, more appears later in this chapter. 2. Gelb-Goldstein Color Sorting Test.

Woolen skeins

of different hues and shades are placed before the subject in a random heap.

He is asked to select the skein he likes

and to select all the skeins grouped with the one originally chosen.

The skeins are then arranged in certain color and

shade sequences and the subject is asked toname the sequence for a particular skein.

In another arrangement of skeins

according to different color, shade, and brightness the sub­ ject is asked which group belongs together and why.

As in

the KTSA there is a random placement followed by selection. However, the Gelb-Goldstein test is limited to color.

The

material differs from the KTSA materials, since the former is

monoshaped and consists of wool, whereas the latter is

multishaped and consists of cut plastics.

The Color Sort­

ing Test Is scored by a system developed by Rapaport (58). It is based on adequacy of sorting and verbalization. 3.

Weigl-Goldstein-Scheerer Color Form Sorting Test.

The materials of this test consist of four equilateral tri­ angles, four squares, and four circles.

In each set of

these three shapes, one figure is red, one green, one yel­ low and one blue. used.

The reverse sides are white and are not

The purpose of the test is to determine how well and

quickly a subject is able to arrange these materials accord­ ing to color or form.

The subject’s ability to shift from

30 one general principle to another is also noted. Here for the first time a technique appears that em­ ploys plastic objects of varying colors.

Unlike the KTSA,

the Color Form Sorting Test does not use a strip for line­ ups,

Essentially the latter is a togetherness test which

is only one of the

aspects of the KTSA.

Again, in the

Color Form Sorting Test, as in all the Goldstein tests, the subject is asked to perform a specific task for which there is an obvious right or wrong way.

In the KTSA the subject

if left to chose his procedure, the actual choice of method or procedure being considered highly significant. Goldstein-Scheerer Stick Test.

The materials for

this test consist of two sets of sticks 3 * 5 and 5 * 5 inches long respectively.

The purpose of the test is to determine

the subject’s ability to copy figures composed of sticks and to reproduce them from memory.

In one sense this is

less a measure of memory than of depth of configurational impression.

In this respect it corresponds with the portion

of the KTSA known as the third line-up.

Here the subject

is asked to line up the objects exactly as he had them just before.

Klopfer pointed out that this was not to be con­

sidered so- much a matter of positional memorization as a measure of the strength of the configuration of the previous

31 line-up.

(49)

A comparison between the Goldstein tests and the KISA has been made by Fils: The Goldstein-Scheerer Tests in employing a variety of materials for manipulation and verbalization all have the same general purpose, namely a quantitative and qualitative measurement of the abstract-concrete attitude. In a number of instances, the relative similarity to the KTSA has been indicated, insofar as this particular function is concerned. Also behavioral analyses are obtainable from extra-test performances on both tests. A number of additional features still maintain the uniqueness of the KTSA. (2 6 ) IV. THE WORLD TEST In 1929 Lowenfeld (45) at the Institute of Child Psychology in London developed the World Test.

The suggest­

ion for the test came from a book entitled Floor Games, pub­ lished by H. G. Wells in 1911.

The primary use of the test

has been diagnostic in relation to child therapy.

In its

present state it owes much to Kelley and Buhler (12) who in 1941 developed uniform test materials, a manual and rec­ ord forms.

However the most complete scoring scheme for the

World Test has been worked out by Bolgar and Fischer,

(10)

Their scoring scheme utilizes 232 pieces of equipment. These pieces include such common objects as trees, fences, common people, special people (such as firemen or policemen) dogs, farm animals, an auto, a bridge, houses, horse and

buggy, and even a soft drink stand. The subject is permitted to "make a world" using as many pieces as he wishes.

Usually between 35 and 125 pieces

are selected by the average subject.

Using 100 adults,,

Bolgar and Fischer (10) analyzed the results, applying the following criteria: 1. 2. 3^. 5•

Order of choice of pieces Form of the design, Gestalt achieved Number, and variety of pieces used Specific items used and rejected Objective evaluation of behavior and ve rba li za ti ons

Another World Test study by Michael and Buhler (52) divided the responses of patients withvaried personality dis­ orders into several categories.

The "worlds" created by

these subjects were seen as: aggressive, unpopulated, disorganized, or rigid.

closed,

It was found that the class of sub­

jects called "psychopathic personalities" constructed un­ populated and rigid worlds whereas psychotic and organic cases had typically aggressive and disorganized worlds. A striking likeness between the KTSA and the World Test is that both techniques use well structured objects. The KTSA uses one amorphously shaped object however and its placement In connection with the others is a distinctive feature of the KTSA.

Other differences are that in the

KTSA all objects must be placed.

It was designed to approxi­

33 mate life where there is a "time and place for everything." Another notable difference is in the kind and number of objects.

In the World Test there is no strip for placement

of objects as there is in the KTSA.

In. the World Test the

emphasis is on construction of a town or village, the emph­ asis in the KTSA is on the symbolization of each individual object.

The World Test consists of real things in miniature

however., the objects of the KTSA have primarily symbolic sign:! f icance. V. DRAMATIC PRODUCTIONS TEST In 1937 Homburger (39) Tna

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59 interpretation as a sign* cross roads. Red Cross, etc.

Thus

the ~ross still could represent Christianity; however, the shape does not exactly correspond to the orthodox cross. Likewise the star could represent Judaism, but again,

that

religion has a six sided star as its symbol whereas the KTSA stars are five sided.

The small stars could represent

Russia except for the fact that they are translucent and of pink-red hue rather than red; the large star is similar to a star on the U. S. flag, but it is transparent instead of white.

The emblem of the Mohammedan sect is represented in

the KTSA by the nY M object, but this, too, fails to approx­ imate the exact shape of the emblem.

This lack of realism

in the symbols was found to have considerable value in terms of revealing personality dynamics.

The subject*s reaction

to this inability to exactly match has meaningful signlfi canoe to the diagnostician.

Another KTSA symbol which

embodies some contradictory qualities is the brown butterfly. Usual associations with this insect are its color and beauty. In the KTSA, this object is among the most drab In appear ance.

Color conflict has been worked out in the selection

of objects.

For example., in the KTSA the subject finds It

impossible to put like objects together and at the same time nut like colors together. shaped objects,

He must either separate like-

or like -colored objects.

One notable

60

exception is the two small, red stars.

These two are ident­

ical, and serve a function in terms of analyzing the prefer­ ence line-up.

If was found that normal subjects tended to

place these in juxtaposition on the strip.

If a subject/

wishes to line up objects by mass or weight he will find it impossible to line them up either by color or kind.

The

same is true of line-ups based on philogenics, alphabet, kinds of materials.

or

The construction of the test requires

that the emphasis of any method of line-up restricts other possibilities.

Various methods of line-ups are, to a large

extent, mutually exclusive.

Thus, the examiner may judge

whether or not the subject carries out manipulatively his verbalized goals In lining up the objects and may recognize discrepancies between the verbal intent and the actual per­ formance of the task. The test In its present form contains:

two butter­

flies, one. anchor, three dogs, one parrot, three stars, a circle, a partial circle, a cross, and three hearts.

Illus­

trated books on the history of art such as ''Styles of Orna­ ment indicate that each one of these symbols has roots that go back historically into early human culture.

The follow­

ing examples are given: 1.

Butterfly;

Butterflies are common in oriental

art and in western literature they have been associated with

61 beauty, daintiness,

or coquettry.

considerable fascination. American artist,

For some people they hold

For example, the well known

James McNeill Whistler signed all his

paintings and correspondence with a little sketch of a butterfly.

(6 8 )

An interesting reference to butterflies occurs in the Taoist Scriptures and is quoted because it illustrates the possibility of human identification with this symbol: Once upon a time I, Chuang Tze dreamt I was a butterfly, fluttering hither and thither, to all intents and purposes a butterfly. I was conscious only of following my fancies as abutterfly and was unconscious of my individuality as a man. Suddenly I awakened, and there I lay, myself again. Now I do not know whether .1 was then a man dreaming that I was a butterfly or whether I am now a butterfly dreaming I am a man. (7f) Dog .

Dogs have been companions of men from the

beginnings of civilization.

In German, French and many

other languages, the word T'dog" may have a negative meaning in the sense well

of low, mean

brought out by Ahura

scurrilous. This is particularly Mazda who inthe Zoroastrian

Scriptures writes: A dog has the characteristics of eight sorts of people: He has the character of a priest, of a warrior, of a husbandman,' of a strolling singer, of a thief, of a disu, of a courtesan, and of a child. He eats the refuse like a priest, he is easily satisfied like a priest: he is patient like a priest: he wants a small piece of bread like a priest: in these things he is like unto a priest.

62 He marches in front like a warrior, he fights for the beneficent cow, he goes first out of the house, in these things he is like a warrior. (73) The Scripture then

continues to show how a dog re­

sembles a strolling singer, how he is fond of darkness and prowls like a thief, how he is a shameless eater like a disu, how he roams along the roads like a courtesan, and how

he is fond of sleep like a child, is "full of tongue"

and

"digs the earth

with his paws like a child".

The dog symbol permits a wide range of projection. This fact is illustrated by the common practice of ascribing qualities of loyalty and companionship to the dog.

It is

usual in Japan for a school house to display statues of a dog as a symbol of the highest virtues.

On the other hand

extreme negative values are also commonly ascribed to the canine species as for example "She treats me like a dog," "I am in the dog house," and that common American epithet of opprobrium "Son of a female dog." Parrot.

Parrots have been companions to sailors and

pets since the days of Rome and before.

They have become

synonymous with mimicry and talkativeness.

However, the

parrot used in the KTSA has been filed down so that it does not resemble its original shape.

In its present form, the

object looks like a phallic symbol, a man, a cat, a gun, an alligator, a baby carriage, and many other things.

To all

Intents and purposes, one In the group.

It Is an amorphous figure ~ the only

It has been found that many In the normal

population nannot say what the parrot really Is. Is the only unknown element in the group.

Thus, this

It is considered

of value to see how an individual will react to the "unknown" to the "different", when required to manipulate it together with well-structured objects. "difference" of the parrot,

To further emphasize the

it is green in color.

It

stands alone In color, shapelessness, and variab ility of identification. h-

Stars.

sciences.

Astrology was one of the earliest

The references to stars In western history and

culture are too numerous to mention. of symbolism,

From the standpoint

stars have represented something greatly out­

standing, either a person or performance. for fate,

constancy, ambition,

They gave stood

superstition, and hope.

The

navigator, the astronomer, and the astrologer who proposes to tell fortunes all look to the stars for the accomplish ment of their mission - and so has It been since time Immemorial.

Drawings of stars occur in the earliest art

in civilized as well as in primitive societies. The circle.

Table I shows that the circle Is the

most common of the KTSA symbols found In magazine advertise­ ments.

The possible conceptions of this object range from

the common ” eye glass11 to 'what E'lee describes ass

” the cos­

mic curve as an eventually infinite movement would separate itself more and more from the earth, and transform into a circle*’1 (48) Great variations of symbolizations are possible with the circle though symbolization generally is harder with this object than with most of the others. izations given by normals ares

Among the symbol­

eternity, "no end no begin­

ning” , money, transparency, ge ometry•

Seen as a wheel,

it

has reminded people of manufacturing and transportation* Considered as an eye glass,

some have felt it stood for a

monocle and therefore aristocracy, clear sightedness.

or vision,

magnification,

The moon, sun, or earth are also common

responses to this object on a different associative level. 7.

Partial Circle.

The partial circle lends itself

to be seen by a number of subjects as something incomplete or defective. drawing device,

On the other hand many saw this as a fan, a or a piece of pie.

Its use in the test is

primarily for associative projection.

3 y placing this piece

over another object, the subject is able to identify the piece which to him has special significance.

In so doing,

the subject would have to resist an observed tendency to place it on the object which it most nearly resembles, namely the circle.

8*

The Cross.

Christianity.'

The cross is the central symbol for

The object used in the ETSA also resembles a

plus sign used in all civilized nations. abounds

in cross symbolism.

Jestern culture

There is the Red. Cross, the

Blue Cross * the Black Cross, and other organizations.

\/e

use such terms as ’'double-crossed1', and "cross roads".

In

addition to religion this object lends itself to many kinds of identification. 9*

The Hearts.

The heart is commonly the symbol of

love, health, vitality, and gambling. It is recognized by the most primitive peoples as the vital organ of the body.

On Valentinefs Bay, the heart is

part of the usual decoration on cards and gift boxes. the acknowledged symbol of love and life.

It is

The subjectfs

reaction to this symbol may be significant in personality d iagn os is . 10.

The strip.

It was intended that this strip rep­

resent the biological and material limitations of man which demand that he make his selections of activity in consecutiv order,

in life, an individual must select one symbolic,

weighted activity over another and arrange them in terms of these limitations.

Likewise, the subject taking the KTSA

selects and arranges the objects on a strip which is repre­ sentative of life#s limitations.

James 3. Platt expresses

this thought when he writes: A large group accepts the growth of the individual as being the result of a series of situations arising from the impingement of the cultural pattern upon the biological equipment. But this is not an accurate or adequate picture of what is involved. Actually in addition to the above there is for each individual a selective process involved in the absorption of the cultural pattern. (57) Concerning the use of the strip in the K T S A > the Manual (42) has this to say: The strip is divided into tv. o inch squares by white lines. Each square is numbered consecutively. Life itself is made consecutive by time. "There is a time and place for everything .n To that degree life is structured. Into this matrix the living organism, introjects his needs. The Manual continues vvith an explanation of the strip as representing the "matrix" and the objects of the KTSA as representing the individual needs.

The Manual concludes

v iths Nevertheless, he must arrange the objects which express his needs on an almost arithmetic basis. He cannot, in an identical way, be at two places at the same time; nor can he simultaneously do two things which are mutually exclusive. Therefore he must select and arrange his activities. This can be "normal1*, neurotic, or psychotic selection, but if the organism is alive, some kind of biological or psychological choice must be made, even if the choice is - no choice. (42) PCSITIOF, DIRECTIOF, SIZE, SHAPE AMD COLOR In order to assist the diagnostician in understanding how the subject handles his needs (KTSA objects) in terms of

the environmental limitations

(the strip), the sequence,

position, direction of placing objects, and reaction to size, shape, brightness and color may be observed* The subjectfs handling of the contradictions in the ETS a

inherent

further help the psychodiagnostician in ascer­

taining the subject,s personality structure*

Regarding this,

Gyorgy Eepes, a member of the faculty of the Massachusetts Institute of Technology writes significantly: Position, direction and differences in size, shape, and brightness, color and texture are measured and assimilated by the eye. The eye lends the character of its neuro-muscular experience to its source. Since each shape, color, value, texture, direction and position produces a different quality of experience, there must arise an inherent contradiction from their being on the same flat surface. (45) Later this

same writer shows how symbolicarrangement

may bring release

from emotional tensions, thereby

ing these for the

psychodiagnostician:

identify­

The selection and arrangement of representational elements are guided by the artistes desire to bring release from emotional tensions by materializing in symbolic forms of representation the objectives of his wishes* (45) Klee

(48) referring to shape,

color, and size,

indi­

cates that, "it is possible to strike a balance between these factors;" however, as shown by the Pi Is (26) study, such a balance is characteristic of normal individuals and not of schizophrenics.

Two hundred sixty-three character­

istics or qualities of the symbols and 56 differentiating

categories are analyzed in Table III. II.

TEST m T E R I A I S

In order to give a close approximation of the actual appearance of the materials used, a list of the KTSA objects appears in Eigure 1.

This list gives the abbreviation of

each symbol and a description of the color and size of each article.

This is followed by a photograph showing the test,

(Eigure 2).

However, this photograph does not show the ob­

jects in their actual size.

To accomplish this, a scale

drawing of the objects and the strip was undertaken.

It

appears as Eigure 3. The test also

includes a record sheet, scoring sheet,

and guide sheet. Record Sheet.

There are three graphic sections on

the front of the Record Sheet.

The back of the sheet is

divided into four parts, used to record verbal and motor responses.

The graphic sections include:

(l) a profile

chart for recording all the symbol arrangements by the sub­ ject,

(2) a naming column on which is recorded the names of

the objects as the subject gives them.

A space is included

for recording whether the subject touches or lifts the ob­ jects as he names them,

(3 ) a symbolization column used to

record the su b j e c t s responses to these objects,

a space is

available here to indicate the time he takes and whether he

TABLE III OBJECT SELECTION CHANT

Variable Categories 263 Characteristics Objective Identical with another object Heart shaped Dog shaped Butterfly shaped Star shaped Symmetrical shape Round shape Pointed

Shape

Color

Red or near red Blue or near blue Black Transparent Only one of this color

Structure

Light- weight Medium weight Meadium-heavy weight Heavy weight

Thickness

Size

Contrast

Location

Frequency

Association*

R

h

X

X

X

3 3 2 3 5 5 9

X

KTSA d W

Symbols B b S

3 It3 10

X

1

2

X

X

X

X X

X

X

X

X

X

X

X

X

X

X

X

c

X X

X X

X X

X

X

X X X

X

X X

X X

X

p

X

X

X

b

A

X X

X

+

X X

X

X

X

X

X

X X

X

X

X

X

X

X

X

X

1 b

- ,>■ '"'■■■ \

X X

5 3 3

X X

X

X

X

X X

X

X

X X

Thin Medium thin Thick

h b b

X

Large Medium Small

6 3 3

X

Blends with strip Contrasts some with strip Contrasts much with strip Great contrast with strip

5 5 it-

X

X X

X

X

X

X

X

X X

X

X X

X X

X

X

X

X

X

X

X

X

X

X

X

X

X

X X X

X

X

3

X X

X

1+

5 3 9 5 b b

X X

X

Common Medium common Rare Subjective Beauty associated with; Out of doors Home Ambition Loyalty Most threatening Escape Most related to security Most impersonal Protective Highest association with humans Most nearly culture-free Totals

8 6

X

X

X

X

X X

X

X

X

X

X

X X

X X

X

X

X

X X

X

X X X

X X

X X

X X

X X

X

X

X

X

X

X X

X

2 X

X

X

X

X

X X

X

X X

X

X

X

X

X

1

X

6

9

8

X

X

X

X X

X X

X X

X X

X X

6

X X

X X

X X

X

X

X

X

X

X

X

X

X

X X X

X X X

X X

X X

X X

X X

X

X

X

X

X

X

X

X

6

9 283

X

X

X X

X X X

X X

5 b

X X X

b

8 8 8

X

X

X

1 1

X X

X

X X

X

X

X

Material things Intangibles Something one can touch Living things Man-made things Capable of being slanted on strip Most difficult to pick up

300 cases.

D

2

3

Below earth On earth Somewhat above earth High above earth

Represents

H

2

Well structured Fairly well structured Amorphic

Wei girt

*Based on

Totals

X

X X X X

X

X

X X X

X X

X X

X

X

X

X

16 17 17 19 19 19 17 17 18 19 19

X

16 16

15 17

CODE

I T E M S

A - Anchor, blue plastic (2 1/2" x 1

l/2" x l/4")

B - Butterfly, brown plastic (2 1/4" x 1" x 1/4") b - Butterfly, clear plastic (2" x 1

1/2" x 1/32")

C - Circle, clear plastic (1 1/2" diameter x l/32tT) D - Dog, black plastic (2" x 1 5/3" x 1/4") d - Dog, black plastic (1 3/4" x 11/4" x 3/16") H - Heart, clear plastic (2" x 2" x l/32") h - Heart, dark blue plastic (1 1/2" x 1 l/2tf x l/4") P - Parrot, green plastic (2l/2tf

x 5/3" x l/4")

R - Heart, red plastic (lrT x 1" x l/4") S - Star, clear plastic (1 7/3" x

1 7/3" x l/32")

W - Dog, white plastic (1 3/4" x 1 1/4" x 3/16") X - Cross, black plastic (1 l/2ft x 1

l/2" x l/4")

Y - Circle Segment, clear plastic (2 5/3" x 1 5/3" x 1/32" 1 - Star, red, translucent plastic

(1" x 1" x 3/16")

2 - Star, red, translucent plastic

(1" x 1" x 3/16")

Brown felt (or leather) strip, 2" x 30"* This strip is divided by white lines, forming fifteen two inch squares* These are numbered consecutively, 1-15 by white numerals 1/2" in height. FIGURE 1 COMPONENT PARTS OF THE KTSA

~

!—

Materials Used in the KTSA Figure 2

1

Y

h

STRIP - IS SQUARES 1

9 FIGljiYi-L

THE KAHN TEST OF SYMBOL ARRANGEMENT

touches or lifts the objects as he symbolizes.

The back of

the record sheet contains space for recording:

(l) the

direction of performance, either right to left, left to right, etc.; (2) the time of performance, slow, medium, fast, etc.;

(3) a code arrangement to note the positions of the

objects;

(4) a record of the reasons given by the subject

for lining up the objects

in the manner he chose; and (5)

a record of the reasons for the subject’s preference for certain objects and rejection of others. tains a Record Sheet.

Appendix S contains:

Sheet of a psychotic with brain damage; patient;

Appendix B con­ (1) Record

(2) a schizophrenic

(3) a non-psychotic♦

Scoring Sheet.

The statistically significant respon­

ses mere weighted for scoring purposes.

The scoring sheet

found in Appendix B contains a breakdown of the various categories in the KTSA.

Statistically computed weights for

each significantly differentiating response are included within each category.

.Each record contains a total score.

The scoring sheet used by Fils which is pertinent to his study of schizophrenics

is also included in Appendix B.

In

Chapter VI there is an analysis of reasons for differences in Fils* scoring sheet, and that used in this study. Guide Sheet.

The Guide Sheet contains a list of the

categories under which the responses to the KTSA variables Ytere tabulated.

It contains an explanation and examples for

each of the categorized responses.

Categories w ere arrived

at by a tabulation of the rationale of the test in its con­ struction and application. are arbitrary.

In that sense, these categories

An effort was made to include the widest

possible range.

Significance and weights assigned to the

responses in these categories were statistically determined. Appendix B contains a Guide Sheet. Other materials* A pen Blue crayon pencil Red era,yon pencil A box or container of the KTSA. III.

PROCEDURES

The directions for administration of the KTSA for the non-psychotic and the psychotic group were identical.

After

the present project had been approved by the Keuropsychiatric Hospital, the following letter was issued to the investigator: FROM:

Harry M. Grayson, Ph.D. Chief, Psychology Service HP Hospital SUBJECT: Research project by H r . Theodore C . Kahn 1. Mr. Theodore C. Kahn is investigating a technique for differentiating between individuals

■with brain damage and normals in connection with a doctoral study conducted under the auspices of U.S.C. This project has been approved by the R e ­ search Committee of the 'Brentwood Hospital and Mr. Kahn is being registered as a volunteer worker under my supervision. 2. Any cooperation you can give him in connection with this study will be greatly appreciat­ ed . (signed) K&rry K. Grayson, Ph.D. As a registered worker it •was required that a record of service hours be maintained.

A Veterans Administration

Employee Identification card was issued.

7/ith this identi­

fication, maximum cooperation from nurses and doctors was obtained•

The patients’ files were available to the investi­

gator as well as a private room for testing.

Dr. Edwin S.

Schneidmann assisted the investigator in locating patients with a bona fide diagnosis of brain damage.

The file of each

patient was also studied by the investigator to assure that the subject qualified for the study in t erms of the require­ ments set up in this investigation for the psychotic group. For both the normal and the psychotic groups, the procedures as outlined in the Manual of Direction for the KTSA were followed without deviation.

The complete directions

for the administration are found in Appendix A.

The average

time for the administration to the control group ranged from twenty-five to forty minutes, and to the experimental group, twenty-five to fifty-five minutes.

The codes and abbrevia-

t ior.s used during the a,dm in istrat ion are sriown in figure 4* figure 5 presents additional scoring techniques used* These codes, abbreviations and scoring techniques are standard procedures for the administration of the KTSA and are described in the Ifanual. IV.

(42)

SUMMARY

The KTSA mas designed on the basis of preferences and rejections shown by purchasers of plastic objects of various shapes*

It was believed that in his choice

of objects the

purchaser revealed an aspect of his personality dynamics* The investigator used fifty such objects and eliminated all but sixteen on the basis of experimental studies with one hundred fifty subjects*

It was believed that these fifty

best lent themselves to projection and meaningful manipula­ tion by the subject. ed squares was

A felt strip with consecutively number­

included in the test to enable the subject to

make his line-ups within the limitations of this strip.

'The

strip was believed to approximate the environmental condition on which a living organism superimposes its needs*

It was

believed that this test situation corresponded to the con­ ditions of life which were seen as spacial and consecutive in nature.

The historical significance of the objects used in

the test was traced; the projectional possibilities explored;

Abbreviations:

E: Examiner S: Subject

Code:

A

- indicates position of object on strip. This is right side up. h/\ - Heart blue at angle to felt edge. \/B - Butterfly brown, upside down.

-h

- indicates position of cross.

.__*

- indicates position of dogs. The long line is parallel to the line between their legs.w^r-— - white dog is upside down facing left.

* - the Circle Segment ITYtf is always referred to as indicator. This shows that the indicator was placed over the Circle. this shows that the Heart clear was placed over the red Star. - after having placed objects on strip, S. inter­ changed objects in third and eighth squares. O

- indicates that S. pointed to the object

Q,

- indicates

that S.touched the object.

Qz

- indicates

that S.picked object up.

o

=

•R

- indicates that S.picked up object and held it for a period of time before replacing it. - indicates S. lined up objects left to right, x .e • 1—15• FIGURE 4 CODES AND ABBREVIATIONS USED IN THE ADMINISTRATION OF THE KTSA

(Continued)

R-L

- indicates S. lined up objects right to left, i.e. 15-1.

C-L

- indicates S. lined up objectscenter to left.

C-R

- indicates S. lined up objects center to right.

Note: If S. begins in the center or lines objects in an unusual sequence, E. should record this thus; 4,6,9,15, 1 ,3,2,etc. showing sequence of placing of objects. - indicates Heart clear has been placed half over top edge of strip in approximately the same position shown. -2,7

- indicates Star clear has beenplacedhalf below the lower edge of strip as shown.

FIGURE 4 (Continued)

Only the position of objects placed at an angle need be shown on the record sheet• However, the position of the dogs is always indicated* If "Ds" represents the three dogs, only one mark is required to show that they are all facing the same direction* The back of the record sheet serves to record the responses of the Subject. It should be divided into five sections by the Examiner as he procodes* Each section is numbered with a Roman Numeral* Lines are drawn to separate these sections* Use extra space in front of Scoring Sheet to record extra long responses in "Naming11 or "Symbolization" when provided space does not suffice. This space may also be used for section V, if the back of the Scoring Sheet be­ comes too crowded* The word "hesitation" is used by the Examiner to meanthe Subject seems to be at a loss as to what to do and how to proceed. It implies that his performance is jerky and uneven. The word "deliberate" is used to mean that S* seems to use care in his selection of the objects and that he exercises control. The Examiner does not use a watch. Time is always estimated and is recognized as approximate. The following designations refer to the period that elapses from the end of the instructions given by the Examiner to the placing of the last object on the strip by the Subject.

FIGURE 5 ADDITIONAL SCORING TECHNIQUES USED IN THE ADMINISTRATION OF THE KTSA (Continued)

Very f a s t ............... approximately

15

Fast

20 seconds

..................

Medium Slow

approximately

seconds

........... approximately 40-50 seconds . . . . . . . . . .

Very s l o w

approximately 100

seconds

approximately 125

seconds

Examiner uses additional descriptions as required by the situation.

FIGURE 5 (Continued)

the frustration potential of the objects explained*

All

three mere influencing factors in the final retention of some of the objects and the discarding of others in the test construction.

Certain codes, abbreviations and directions

mere developed and mere used consistently mith the nonpsychotic and psychotic groups. description of these devices.

This chapter contains a A description of the compo­

sition of the non-psychotic and psychotic groups is presented in the following chapter.

CHAPTER IV GENERAL BACKGROUND OF THE UOH-PSYCKOTIC AHD PSYCHOTIC YITH BRA IIT DAMAGE GROUPS One hundred subjects made up the sample used in the present investigation.

They consisted of fifty veterans

hospitalized at the Brentwood ITeuropsychiatric Hospital with a psychiatric diagnosis of brain damage with psychosis, and fifty veterans who were selected as follows:

20 from Vet-

erans Administration Domiciliary with ailments diagnosed as "other than psychosis or psychoneurosisrt; 20 from Fort McArthur, presently on active duty there; and 10 who appeared for vocational counselling at Veterans Guidance Centers or Los Angeles city schools.

This chapter will con­

cern itself with (l) a description of the brain-damage or experimental group,

(2) a description of the non-psychotic

or control group, and (3) a comparison of brain-damage and non-psychotic groups. I.

EXPERIKEHT a L GROUP

The experimental group consisted of psychotics with brain damage who were veterans from either world war.

They

were selected on the basis of a diagnosis of brain damage by hospital psychiatrists, supported in the main by E.E.G.

findings*

Owing to the difficulty of finding sufficient sub­

jects ^ith one type of brain damage, the psychotic group in this study consisted of patients vvith several kinds of or­ ganic cerebral abnormalities-

The diagnosis mas made by one

and usually concurred in by several of the hospital psychia­ trists*

Of the fifty, forty had E.E.G.’s shorning abnormal

waves.

Eor ten, no E.E.G. mas available.

Table IV lists

the number and kinds of patients used in this study.

The

investigator concluded that a diagnosis of two psychiatrists, or one psychiatrist with E.E.G.

corroboration,

constituted

a reasonable criterion for the selection of the brain-damage group. In addition to these diagnoses, a review

of the

patient’s clinical and personal history files frequently revealed symptomatic behavior associated with the degener­ ative process of the brain.

In many cases the results of

psychological tests and medical history of cerebral accidents helped to give additional weight to the psychiatric diagnosis of brain damage.

The average duration of hospitalization of

the psychotic group was fifty-one months, with a range from three months to fifteen years.

A number of patients

in this

group \iere transfers from other mental hospitals or insti­ tutions. admitted.

Most of them were committed and a, few voluntarily Analysis of the psychotic group showed the largest

TABLE I V

DISTRIBUTION OP THE PSYCHOTICS TESTED ACCORDING TO TYPE OF BRAIN DAMAGE

Type

Number

Epilepsy with brain deterioration and psychosis

- - 7

Cerebral arteriosclerotic degenerative process

- - 7

Syphilitic meningo-encephalitis, psychos is - - - - Syphilis with lues, central nervous system

5

- - - - 5

Post traumatic severe contusions of brain - - - - -

4

General paresis - - - - - - - - - - - - - - - - - - 3 Encephalitis with psychosis - - - - - - - - - - - - 3 Arteriosclerosis, cerebral with psychotic reaction and epilepsy, grand mal - - - - - - - - - - - 2 Encephalopathy, traumatic Arteriosclerosis,

- -

- - . - - - - . - - 2

cerebral thrombosis - - - - - - - 2

Alcoholism with cerebral deterioration

- - - - - -

2

Toxic psychosis, embolic process to brain - - - - -

1

Subaraqhuoid hemorrhage, (CVa ) - - - - - - - - - - i Syphilis, late, central nervous system taboparesis- 1 Psychosis with organic brain disease due to gunshot wound - - - - - - - - - - - - - - - 1 Syphilis with early paresis - - - - - - - - - - - - 1 Epilepsy, cerebral involvement, petit mal, anemic secondary - - - - - - - - - - - - - -- - l Malarial encephalitis - - - - - - - - - - - - - - - 1 Organic brain disease, unspecified - - - - - - - - i T o ta1 50

combined category to be brain damage caused by syphilitic infection.

Cerebral trauma, arteriosclerosis, and epilepsy

with brain deterioration mere other large categories,

alto­

gether, nineteen medical categories are listed on Table I'V. The availability and testability of the brain-damage group mere factors

in the selection.

Data concerning the

age, education, I*^., civilian occupation, marital status, religious and racial background, military rank upon separa­ tion from service are presented in the comparison of both groups in this study in the latter part of this chapter. patients were able to read newsprint.

All

Those patients who

required the use of glasses to read newsprint wore their glasses while taking the test.

Those with non-correctable

defective vision were eliminated from the study* II*

THE! CONTROL CROUP

The control group consisted of fifty veterans, all males, drawn from four sources on the basis of:

(l) avail­

ability of case history and medical opinion to show nonpsychosis;

(2) age, to match the experimental group;

(3)

opportunity for obtaining I.Q,. scores and occupational data; (4) availability of adequate facilities for administration of the KTSA and the Minnesota Multiphasic.

The group con­

sisted of veterans from World Wars I and II and the Spanish

American ,/ar.

Hone of the group had received a dishonorable

or medical discharge.

The non-psychotic nature of the con­

trol group mas based on both subjective and objective cri­ teria.

Table V shows the list of cooperating institutions

who furnished subjects for the control group testing* The sources for the control group of fifty were as follows:

(l) twenty-two soldiers at an army post;

(2) four­

teen patients at a Veterans Administration Domiciliary

(these

were selected by the resident psychiatrist as non-psychotic, and without cerebral damage or aggravated senility);

(3) nine

counselees seeking vocational guidance at a university guid­ ance center under sponsorship of Public Law 346; students attending Harbor Junior College.

(4) five

In each case, the

authorities in charge of the installation provided the in­ vestigator with military, clinical, educational and medical histories as available, and a private room for testing and interviewing,

a psychiatrist or a medical officer under

general supervision of a psychiatrist was consulted in the selection of each case.

In addition, the supervisor of each

subject was interviewed, with the exception of the counselees, for whom two counselors and voluminous case histories were consulted. Particular care was exercised in regard to the choice of subjects at the Domiciliary.

The relatively unsettled

TABLE V LIST OP COOPERATING INSTITUTIONS FURNISHING SUBJECTS FOR NON-PSYCHOTIC GROUP Name of Institution

Authority In contol

Location

Type of subject

Number of subjects

1. Fort MacArthur Sixth Army Headquarters

U . S . Army

San Pedro, Californi a

Soldier

2. Wadsworth Domiciliary

Veterans Administration

Los Angeles, California

Patient non-psychotic

3. Veteran Admini­ stration

University of California Extension Division

Los Angeles, California

Counselee

Q

4. Harbor Junior Technical College

Board of Education City of Los Angeles

Wilmington, California

Student

5

Total

14

50

problem as to -which physical illness may have a psychomatic etiology was taken into account.

The resident physicians

assisted in the selection to eliminate cases with cerebral involvement* available. eliminated.

Complete personal and psychiatric records were All patients with a history of psychosis were Every patient selected had a working status

while undergoing treatment, and the work supervisor was also consulted.

The main ailments of these patients consisted of

heart disease, non-cerebral fractures, and bacterial in­ fections with non-cerebral involvement.

The claim might be

made that some of these maladies had psychosomatic origins, particularly maladies involving heart damage.

However,

even

if this claim could be substantiated, under the definition of “non-psychosis“ (Definitions Chapter I, page 1 5 )these subjects would not necessarily be eliminated for the purposes of this study. The Minnesota, Multiphasic Personality Inventory (36) was used as an objective criterion in selecting the non­ psychotie group.

In terms of the definition of “non-psy­

chosis’*, the use of this test was not strictly necessary. However, an objective test of this nature gave further weight to the objective evaluation of non-psychosis. also employed by Pils control group.

This test was

(26) in his selection of a “normal”

Subjects who gave one T. score above SO or

more than three T. scores above 70 were not included in the study.

Actually only 43 of the non-psychotic group were

tested with this instrument as seven were not available for this purpose.

Only two persons were eliminated from the

study on the basis of the M.M.P.I.

Both of these scored

slightly higher than a T. score of 80 in one of the cate­ gories.

The results obtained from the non-psychotic group

on the Minnesota Multiphaaic Personality Inventory are shown in Table VI. are shown.

Only the scores having diagnostic significance The testing time varied with each individual

from thirty-five minutes to nearly two hours.

The booklet

form of the test was used, consisting of 566 questions of a personal and diagnostic nature.

Only 365 of the total

questions were used in scoring; the remainder were employed to measure carelessness in answering, evasiveness, and validi t y • Reason for choice of institutions from which nonpsychot ic group was drawn. (l) Domiciliary.

The subjects available at the D o m i ­

ciliary, more than any other group, approximated the braindamage group in age.

The matching of ages of the brain-

damage and non-psychotic groups was a difficult task in view of the unavailability of older veterans for testing and screening purposes.

As seen in Table VII, there were eight

veterans sixty-five years of age and over used in the n onpsychotic group and these lere unavailable except at the Domiciliary.

The Domiciliary also had available testing

space, case records, medical history, and psychiatric con­ sultants*

Great care had to be excerclsed with this group

to prevent the impression that the taking of this test was in some manner a screening device used by the hospital for official purposes*

It was pointed out that the study was a

research project under the supervision of the University of Southern California.

The subjects were assured that perfect

anonymity would be observed and that the results of the test would not become part of the patientfs case record.

The

Domiciliary staff cooperated excellently in the investigation. The resident physician called the selected group together and explained in the presence of the investigator, the nature of the research, and the basis for the selection of the control group.

The investigator was then introduced and those who

did not wish to participate in the research were permitted to leave.

The Minnesota Multipfaasic was then administered

in the recreation room and appointments for taking the KTSA were made. 2.

Fort MacArthur.

Twenty-two of the subjects com­

prising the non-psychotic group were obtained from this source*

TABLE 7 T

RESULTS ON THE MINNESOTA MULTIPHA3IC PERSONALITY INVENTORY POR THE N0N-P3YCH0TIC GROUP *

Category

Code

Mean

Range

Hypochondrias i s

Hs

58.2

35-80

Depress ion

D

53.8

38-78

Hysteria

Hy

56.4

37-80

Psychopathic deviance

Pd

53.7

36-77

Masculinity feminity

Mf

55.3

39-71

Paranoia

Pa

52* 0

34-67

Psychasthenia

Pt

53.6

33-69

Schizophren ia

Sc

54.2

35-71

Hypomania

Ma

51.9

37-70

* Based on 43 persons tested*

Cooperation of the military authorities mas obtained to assist in this phase of the research.

In order to match the

ages of the brain-damage group, men between the ages of 45 and 65 were required*

A number of soldiers in the age range,

some near retirement, mere available at this source*

Also

available mere excellent facilities for testing and for ob­ taining military and medical history, scores,

intelligence test

occupational records, and resident medical officers

to assist in the screening.

The fact that the test mas

strictly voluntary mas unfortunately not made clear to the subjects in every case.

Hostility toward taking of the test

mas avoided by a pretest interview.

One person mas permitted

not to take the test as it would have been against his will. The fact that these subjects were at present in the Array may be considered to have been corresponding in a measure to the institutionalization of the psychotic group and thus providing a common element between the two groups. Some test researches may be criticized for the fact that the experimental group is often highly institutionalised if not confined, whereas the control group has no experience compar­ able to institutionalization.

Combining the Domiciliary and

Fort MacArthur group gives 72 percent of the non-psychotic group in this study a certain measure of institutionaliza­ tion, and thus provides for better matching.

3*

teran_s Admin is trat ion Gu idance Center *

The group

from the Veterans Administration Guidance Center consisted of males who appeared for vocational counseling at the U n i ­ versity of California Extension Guidance Center which is under contract and supervision of the Veterans Administra­ tion.

Public Lav 346 provides for vocational counseling for

any veteran honorably discharged who has served for ninety days or more in the armed services.

Each individual in this

group was interviewed for tv o hours, during which time per­ sonal history data was obtained and the LT3A was administer­ ed.

Additional tests such as the California Test of Mental

Maturity (69), tests of achievement and aptitude, as veil as the Minnesota Multi phasic Personality Inventory were given. Subjects who were receiving a veteran’s disability pension or who indicated that they were under a physicianrs care were not included.

Likewise, those who had a history of psychos­

is or mental deficiency were eliminated.

Another subjective

criterion in the selection of this group was based on the judgment of two counselors on the staff of the guidance center.

Their judgment that the subject was non-psychotic

was based on a review of personal history, educational, occupational, and psychological test data.

This last a d ­

ditions,! criterion was used to augment the investigator’s j udgraent •

4*

Harbor Junior Technical College*

This group con­

sisted of students attending .junior college on a part-time and full-time basis*

The group is small, since only five

subjects vsere taken from this source.

Excellent testing

facilities were available, as veil as complete educational and case records.

Each student selected had recently been

examined by the school physician and no indication of cere­ bral pathology was found to exist.

Each student had an

interview by one of the school counselors who judged the student*s emotional stability as well as the adequacy of his vocational selection.

A variety of test scores in the

student*s file were available for perusal*

A cumulative

record and a medical history were also available for each cas e • Additional data concerning the control are presented in the following section where both groups are compared* III.

COMPARISON OF EXPERIMENTAL AND CONTROL CROUPS

A comparison of the brain-damage and non-psychotic groups with reference to age, education, civilian occupation, l.Q,., marital status, racial, religious, and national origin, and military rank earned, reveals likenesses and some dif­ ferences.

A presentation of these data follows:

Age.

The brain-damage group was older by an average

of only 2.0 years.

The mean chronological age of the experi­

mental group

tvas

54.2 years, and that of the control group,

52.2 years.

In their central tendencies and in their range,

the two groups were similar. dence of brain damage,

With reference to the inci­

it may be indicated that both groups

are within the mean age where a high incidence of this dis­ ease may occur, although some forms of cerebral pathology, notably cerebral arteriosclerosis, generally occur at a more advanced age.

The difference in age between the two groups

was found not to be significant, yielded a "t,f value of .8.

x statistical comparison

The data on means, ranges, and

sigmas for the two groups are presented in Table VII. Educational L e v e l .

In comparing the educational

levels attained by both groups, the psychotic population showed the highest and lowest level attained by any subject. See Table VIII.

One of the patients had been a dentist and

four had completed only the third grade.

However, the larg­

est percentage of cases in both groups, were found between the 8th and 12th grades.

Eight percent of the non-psychotica

were college graduates but none of these had gone to graduate school.

Likewise eight percent of the brain-damage group

were college graduates but two of these completed some grad­ uate work.

One

individual in the experimental group had been

a practicing dentist'*

TABLE V I I

COMPARISON OF THE CHRONOLOGICAL AGE OF THE NON-PSYCHOTIC AND PSYCHOTIC GROUPS

Age

Number of cases psychotic group

21 22 27 28 29 30 32 34 39 40 44 45 46 48 49 50 51 52 53

l 0 0 2 0 0 3 0 1 0 1 0 0 2 0 1 0 1 6

0 1 1 0 1 1 1 2 1 1 0 2 2 2 1 4 1 3 0

54 55

7 ^ Mode (both groups)

5 5

56 57 58 59 60 62 65 66 67 68 69

1 3 0 3 2 3 2 0 2 1 0

1 2 3 2 0 0 1 1 0 1 1

(continued)

Number of cases non-psychotic

97 TABLE VII (continued) Number of cases psychotic group

Age

2 1 0

71 73 75 77 79 82 83

Mean Age: Sigma Range Diff M -

0 1

0

50

50

0

2.0, < S w m

= 2.5

0 0 1 1 1 1

0

Totals

Number of cases non-psychotic

5^*2 12.0 21-83 t = .8

52.2 12.3 22-82

table viii COMPARISON OF EDUCATIONAL LEVELS FOR THE PSYCHOTIC AND NOE-PSYCHOTIC GROUPS*

Total Humber

Group

Mean ** Educational Level

Range

S igma

Psychotic

41

8*6

3-18

3.9

Non-psychoti c

50

10*5

4-16

3.0

* Educational data for experimental group based on 41 cases **Ratio of difference of Mean on Educational Level! ~

~

D^ w d ^— - P > Reason: To have them the same as before Y/C III. Medium H/h

L-R S/1

l /b

C/h

IV. Medium L-R (mumbled to self briefly) P ;> w — ^ D _- d r— 1. Christianity, religion 2.-7 Love - its next important 5.-7 Dogs are good friends 15. Because I don't know what it is. lb. Its secondary when compared to the others. One can do without map 13. One can do without this. V. Medium L-R d,D -- ^ W P v' Reason: According to likes--same as beforeWhen I have an opinion I am a man who'll stick to it. I don't believe in changing my opinion around

"remarks stress emotional inflexibility as an outstanding characteristic in the case of this Veteran."

ii •;n\T n j y

c\rr

lmsiiJXh

-n

r

A DESCRIPTION OF A NON-PSYCHOTIC CONTROL GROUP A AND A SCHIZOPHRENIC GROUP* WHICH WERE COMPARED TO THE NON-PSYCHOTIC AND PSYCHOTIC WITH BRAIN DAMAGE GROUPS IN THIS STUDY Non-Psychotic Group

Schizophrenic Group

Sources: Veterans Guidance Center Brentwood Neuro________________________ psychiatric Hosp Number and sex: 50 male veterans

50 male veterans

Normal: Criteria included screening and cut-off scores on Minn.Multipha si c Personality Inven_________________ tory

20 11 k 3 12

Diagnosis:

Examiner and Test Scorer

Hebephrenic Paranoid Catatonic Simple Mixed

D • H . Fils

D. H. Fils

Chronologi cal age:

Mean: 30*9 Range: 20-50 Sigma: 7*0

Mean: 35*6 Range: 20-50 S igma: $.$

Educational level:

Mean: 1 1 •9 Sigma: 2*3 Range: 5-16

Mean: 9*7 Sigma: 3 *0 Range: 3-1$

Occupational level:

Professional and semi-Professional 16% Z% Unskilled labor

Intelligence:

N - 50 Mean IQ 113 Sigma 11♦ $ Range $$-130

Marital Status: Single: 19 Married: 2$ Divorced: 1 Separated: 2 * Fils (26)

8%

32% N - 23 Mean IQ $1.$ Sigma 17*7 Range 50-121 37 9 3 1

Non-Psychotic Group Military Rank:

Schizophrenic Group

Commissioned Officers: 9 3 NCO 31 16 _________________ Privates 10_________________ 31

APPENDIX G TEST C a SE RB

TEST CASE RB In Appendix D of the Doctoral Dissertation by Fils (26) a test case is presented as an example of the possible use of the KTSA as an instrument for psycho-dynamic inter­ pretation of behavior based on a test record alone.

A

number of diagnostic tests including the KTSA were admin­ istered to a patient at the Brentwood Neuropsychiatric Hospital.

The accompanying chart shows the personality

characteristics isolated by each test.

As presented by

Fils, the chart did not include any sign of organic in­ volvement.

However, when the record was scored using

weights established in the present study, the existence of possible brain damage was ascertained by a total score of— 63 • RB is a 27 year old married, male Navy newly admitted

to the hospital at the time of

veteran, the testing.

He is an only child of Catholic parents who were killed in an auto accident when the boy was ten years old. then adopted by an aunt and uncle.

He was

He later entered the

Navy and prior

to discharge he had planned to

Naval Officers

School and make a career of the Service.

He failed to achieve this ambition.

enter the

Extracts from the

patient’s clinical file reveal a personal history sug-

gestive of "basic underlying hostility, aggression and paranoid behavior." The following chart indicates the findings of a psychologist who had no contact with the patient other than seeing the completed record sheet of the KTSA.

The

chart also shows the personality characteristics indicated by tests scored by members of the hospital staff.

These

tests were: the Rorschach (R) Draw a Person Scale (DPS), Shipley Hartford Scale (SH3), Sentence Completion Test (SC), Minnesota Multiphasic Personality Inventory (MMPI), patient’s history taken from clinical file (H). The results of this study led to the conclusions t ha t : Test Case RB demonstrates the possible use of the KTSA as an instrument for psychodynamic interpreta­ tion of behavior. The case reveals significant correspondence not only with the combination of the other tests taken but also with the patient’s case history (Fils).

FACTOR 1• 2. 3• 4• 5* 6• 7* S. 9-

KTSA

•

1—1

Hostility Aggression Impulsiveness Striving for level beyond capacity Organic involvement epileptic type Low emotional control Intellectual capacity Conflict over heterosexuality Compulsiveness, rigidity, perseveration 1 0 . Paranoid features Drive for status 1 1 . 12. Undesirable family background with adoption factor Incapacity for inter-personal relati ons CODE:

X

R

DPS

X

X

X

SC

SHS

MPI

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

H

X

X

X

X

X

X X

X

X

X X X

X

X

X

X

X

X

X

X

?

KTSA— Kahn Test of Symbol Arrangement H— Rorschach DPS— Draw a Person Scale SC— Sentence Completion Test SHS— Shipley Hartford Scale iiMPI— Minnesota Multiphasic Personality Inventory H — patient’s history taken from clinical file