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The effect of verbal reward on schizophrenic patients' performance of the Bender-Gestalt test Harrison, Donna Marian 1961

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THE EFFECT OF VERBAL REWARD ON SCHIZOPHRENIC PATIENTS' PERFORMANCE OF THE BEND ER-GESTALT TEST  by DONNA MARIAN HARRISON  A T h e s i s Submitted i n p a r t i a l f u l f i l m e n t o f The Requirements f o r t h e Degree o f MASTER OF ARTS i n t h e Department o f PSYCHOLOGY  We accept t h i s t h e s i s as conforming t o the standard r e q u i r e d from c a n d i d a t e s f o r t h e degree o f MASTER OF ARTS  Members o f t h e Department o f Psychology  THE UNIVERSITY OF BRITISH COLUMBIA May, 1961  In p r e s e n t i n g  t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of  the r e q u i r e m e n t s f o r an advanced, degree a t the  University  o f B r i t i s h C o l u m b i a , I agree t h a t the L i b r a r y s h a l l make i t . . f r e e l y a v a i l a b l e f o r r e f e r e n c e and agree t h a t p e r m i s s i o n f o r e x t e n s i v e f o r s c h o l a r l y purposes may  study.  I further  copying of t h i s  be g r a n t e d by the Head o f  Department o r by h i s r e p r e s e n t a t i v e s .  my  I t i s understood  t h a t c o p y i n g or p u b l i c a t i o n of t h i s t h e s i s f o r g a i n s h a l l not  be a l l o w e d w i t h o u t my w r i t t e n  Department o f  'Ivlap,  The U n i v e r s i t y of B r i t i s h Columbia, Vancouver Canada.  thesis  financial  permission.  ABSTRACT  In t h e p r e s e n t i n v e s t i g a t i o n , an attempt was made t o t e s t t h e h y p o t h e s i s t h a t e x p e r i m e n t a l l y induced m o t i v a t i o n w i l l improve s c h i z o p h r e n i c p a t i e n t s * performance o f the BenderGestalt test. F o r t h i s purpose, the t e s t was a d m i n i s t e r e d i n d i v i d u a l l l y , under s t a n d a r d i z e d c o n d i t i o n s , t o a group o f p a t i e n t s diagnosed as s c h i z o p h r e n i c , and to another group o f s c h i z o p h r e n i c p a t i e n t s t o whom v e r b a l reward was a l s o g i v e n d u r i n g t h e i r performance o f t h e t e s t . The experimental and c o n t r o l group were s i m i l a r w i t h r e s p e c t t o age, e d u c a t i o n , l e n g t h o f h o s p i t a l i z a t i o n , geographic area and s u b - c l a s s i f i cation. Between seven and s i x t y days a f t e r admission, each s u b j e c t was g i v e n the B e n d e r - G e s t a l t t e s t , e i t h e r under c o n t r o l (no reward) o r experimental ( v e r b a l reward) c o n d i t i o n s . T e s t performances were s c o r e d a c c o r d i n g t o the c r i t e r i a s e t down by P a s c a l and S u t t e l l (1951) and a n a l y z e d on t h e b a s i s o f o v e r a l l s c o r e and i n d i v i d u a l c a r d s c o r e s . A d e f i n i t e d i f f e r e n c e e x i s t e d between t h e s c o r e s o b t a i n e d by the c o n t r o l and e x p e r i mental group. I n a l l cases, the scores made by t h e s u b j e c t s i n the experimental group were c o n s i s t e n t l y more f a v o u r a b l e than those o f the c o n t r o l group. To determine whether these d i f f e r ences were due to o t h e r f a c t o r s such as age, education, e t c . , these f a c t o r s were compared w i t h o b t a i n e d t e s t s c o r e s . No r e l a t i o n s h i p was e s t a b l i s h e d between any o f these v a r i a b l e s and test scores. T h e r e f o r e , i t was concluded t h a t v e r b a l reward was a s i g n i f i c a n t determinant o f t h e improved performance o f the experimental group. The f i n d i n g s o f t h i s study a l s o support the theory t h a t s c h i z o p h r e n i c d i s t u r b a n c e s i n performance o f the Bender-Gestalt t e s t a r e due t o m o t i v a t i o n a l i n f l u e n c e s r a t h e r than d i s t o r t i o n s i n p e r c e p t i o n . F u r t h e r suggested i s the p o s s i b i l i t y t h a t f a u l t y m o t i v a t i o n a l systems r a t h e r than an i r r e v e r s i b l e l o s s o f fundamental i n t e l l e c t u a l a b i l i t y , i s the major source o f impaired performance o f s c h i z o p h r e n i c p a t i e n t s .  11  ACKNOWLEDGEMENT  The w r i t e r wishes t o express h e r a p p r e c i a t i o n and thanks t o h e r a d v i s e r s , D r . R. P o t a s h i n and D r . D.C. F r a s e r , f o r t h e i r h e l p f u l c r i t i c i s m , guidance, and p a t i e n c e .  Also,  the w r i t e r wishes t o thank Mr. J . W. Borthwick, C h i e f P s y c h o l o g i s t a t t h e Crease C l i n i c , f o r sponsoring  this  study.  iii  TABLE OF CONTENTS  Chapter  I II  III  Page  STATEMENT OF THE PROBLEM  1  THEORETICAL BACKGROUND AND RELATED STUDIES  5  S c h i z o p h r e n i a .. . ....". S t u d i e s on S c h i z o p h r e n i c Performance and M o t i v a t i o n The Bender-Gestalt T e s t Summary  5  METHOD S e l e c t i o n o f Subjects Experimental Procedure S t a t i s t i c a l Treatment o f t h e Data  IV V  17 21 24 26 26 30 32  RESULTS AND DISCUSSION  34  SUMMARY AND CONCLUSIONS  40  REFERENCES APPENDIX A:  43 Copy o f t h e Score Sheet f o r t h e BenderGestalt Test  47  iv  TABLES  Table  1  2  3  4  Page  Age, Education, and Length of H o s p i t a l i z a t i o n of Experimental and C o n t r o l Groups  28  S u b d i a g n o s t i c and G e o g r a p h i c a l Breakdown o f Experimental and C o n t r o l Groups  29  Medians and S e m i - I n t e r q u a r t i l e Ranges of the E i g h t Design and C o n f i g u r a t i o n Scores f o r the Experimental and C o n t r o l Groups  35  Median B e n d e r - G e s t a l t Score f o r each D i a g n o s t i c Subtype of the Experimental and C o n t r o l Groups "  37  Chapter I STATEMENT OF THE  PROBLEM  In p s y c h i a t r i c and p s y c h o l o g i c a l l i t e r a t u r e , p h r e n i a i s d e f i n e d and d e s c r i b e d  i n many d i f f e r e n t ways,  t h e r e appears to be a wide range o f d i f f e r e n c e of about the n a t u r e and  schizoand  opinion  e t i o l o g y o f t h i s type of mental i l l n e s s .  T h i s i s r e f l e c t e d i n the v a r i e t y o f d i f f e r e n t symptoms by which t h i s d i s e a s e  i s i d e n t i f i e d , the d i f f i c u l t y  f r e q u e n t l y i n e s t a b l i s h i n g the d i a g n o s i s  experienced  i n i n d i v i d u a l cases,  and i n t h e c o n f l i c t i n g diagnoses made of the same p a t i e n t a t d i f f e r e n t times and by d i f f e r e n t p r a c t i t i o n e r s . t h i s apparent c o n f u s i o n phrenia  i s and how  and  In s p i t e of  l a c k of agreement about what s c h i z o -  i t comes about, t h e r e are a few  accepted by most as c l e a r l y a s s o c i a t e d w i t h t h i s  symptoms  condition,  such as withdrawal o r remoteness from immediate r e a l i t y , h a l l u c i n a t i o n s , d e l u s i o n s , p e c u l i a r o r b i z a r r e i d e a s , and Among the most f r e q u e n t l y r e p o r t e d  c h a r a c t e r i s t i c s , there i s  a l s o d e f i c i t , d e t e r i o r a t i o n , or impairment of functioning.  negativism.  intellectual  T h i s i s demonstrated i n b o t h day-to-day f u n c t i o n -  i n g , where persons diagnosed as s c h i z o p h r e n i c  are unable to  r e a c t e f f i c i e n t l y to the demands o f the environment, and i n performance on standard  also  psychological tests.  To e x p l a i n the i n t e l l e c t u a l impairment, as w e l l as features of schizophrenic  b e h a v i o r and  other  development, some w r i t e r s  2 imply a b a s i c and i r r e v e r s i b l e l o s s o f h i g h e r mental processes n o t u n l i k e t h a t which o c c u r s i n p a t i e n t s w i t h known damage.  Such a view i s c o n s i s t e n t w i t h some b i o l o g i c a l l y  o r i e n t e d t h e o r i e s o f the o r i g i n and development o f ia.  organic  schizophren-  Other w r i t e r s , however, p o s t u l a t i n g a more p s y c h o l o g i c a l  b a s i s f o r t h e c o n d i t i o n , suggest t h a t the i n t e l l e c t u a l  impair-  ment i t s e l f r e f l e c t s emotional and p e r s o n a l i t y s t a t e s which a c t as b a r r i e r s p r e v e n t i n g  the i n d i v i d u a l from r e l a t i n g  effect-  i v e l y and r e a l i s t i c a l l y t o the demands o f h i s environment. Npyes and Kolb (1958, p. 419) s t a t e t h a t - " .  . . there i s a d i s -  o r g a n i z a t i o n o f p s y c h i c f u n c t i o n s , a r e d u c t i o n o f , and s u b t l e change i n , i n t e l l e c t u a l performance because o f the  long-continued  i n f l u e n c e on b e h a v i o r o f h a l l u c i n a t i o n s , d e l u s i o n s ,  disorganiz-  i n g f a n t a s y s t a t e s and t h e p a t i e n t ' s a u t i s t i c withdrawal i n t o self." From t h e p o i n t o f view o f such t h e o r i e s , i t might be hypothesized f u r t h e r , that the schizophrenic  p a t i e n t performs  p o o r l y , n o t because he l a c k s the p o t e n t i a l a b i l i t y t o do w e l l , but r a t h e r because he l a c k s the m o t i v a t i o n  t o do o t h e r w i s e .  W i t h t h i s i n mind, i t may be t h a t e x p e r i m e n t a l l y t i o n would a l t e r s c h i z o p h r e n i c i n a favourable present  induced motiva-  performance on s t a n d a r d i z e d  tests  d i r e c t i o n and i t i s t h i s h y p o t h e s i s which t h e  study seeks to t e s t . For t h i s purpose, the Bender-Gestalt t e s t appears t o be  a p a r t i c u l a r l y s u i t a b l e instrument, because o f i t s b r e v i t y and s i m p l i c i t y o f procedure, and because i t c l e a r l y shows a d i f f e r ence i n performance between s c h i z o p h r e n i c s  and normals.  3 Constructed  by Bender as an a p p l i c a t i o n o f t h e g e s t a l t p r i n -  c i p l e that p e r c e p t i o n  i s (Bender, 1938,  p. 3) ". . . t h a t  f u n c t i o n o f the i n t e g r a t e d organism whereby i t responds to a g i v e n c o n s t e l l a t i o n o f s t i m u l i as a whole; being  the response i t s e l f  a c o n s t e l l a t i o n , o r p a t t e r n , o r g e s t a l t . " , the t e s t con-  s i s t s of nine geometrical used by Wertheimer  f i g u r e s s e l e c t e d from a l o n g e r  i n h i s studies of v i s u a l perception.  The  s u b j e c t i s r e q u i r e d t o copy each d e s i g n w i t h t h e sample him.  P a s c a l and S u t t e l l (1951) s t a n d a r d i z e d  adult population  and formulated  series  before  the t e s t on an  a r e l a t i v e l y objective scoring  key based on the d i f f e r e n c e s between performance by normal persons and t h a t by p s y c h o t i c s  and n e u r o t i c s .  f o r s c o r i n g demonstrates the f a c t of impaired schizophrenic  patients.  This very  performance by  At a l a t e r p o i n t i n t h e i r  studies  ( P a s c a l and S u t t e l l , 1952), they found t h a t there was  a degree  o f s i m i l a r i t y between the performance o f s c h i z o p h r e n i c s that of organics.  and  The s i m i l a r i t y o f t h e i r performance might  suggest, i n l i n e w i t h the b i o l o g i c a l and h e r e d i t a r y that schizophrenia  basis  theories,  i s based on a p h y s i o l o g i c a l cause.  From the  p o i n t o f view o f the more p s y c h o l o g i c a l l y o r i e n t e d t h e o r i e s , however, i t i s e q u a l l y c o n c e i v a b l e t i e s of schizophrenic  t h a t the d e t e r i o r a t i v e q u a l i -  performance r e s u l t from p s y c h o l o g i c a l  b a r r i e r s , such as inadequate m o t i v a t i o n ,  l a c k of i n t e r e s t , or  negativism. Perhaps- because of the d i f f i c u l t y i n e s t a b l i s h i n g r a p p o r t and a r o u s i n g  motivation  i n schizophrenic  patients,  s t u d i e s so f a r have attempted to assess the e f f e c t s of  few  4 e x p e r i m e n t a l l y induced m o t i v a t i o n on s c h i z o p h r e n i c performance. In t h i s study such an attempt w i l l be made w i t h a group o f s c h i z o p h r e n i c p a t i e n t s by o f f e r i n g v e r b a l reward  t o them w h i l e  p e r f o r m i n g the B e n d e r - G e s t a l t t e s t , and by comparing the performances so o b t a i n e d w i t h t h a t produced by another group of s c h i z o p h r e n i c s under o r d i n a r y c o n d i t i o n s of B e n d e r - G e s t a l t administration.  Chapter I I THEORETICAL BACKGROUND AND  RELATED STUDIES  Schizophrenia While i t i s r e l a t i v e l y easy to d e s c r i b e some o f more s t r i k i n g c h a r a c t e r i s t i c s of s c h i z o p h r e n i a , no of  one o f the most common mental d i s o r d e r s , i t s b a s i c  n a t u r e i s p r o b a b l y the l e a s t understood.  due  definition  t h i s mental d i s e a s e has y e t achieved u n i v e r s a l agreement.  Although  of  the  The  accurate diagnosis  an i n d i v i d u a l as s c h i z o p h r e n i c i s v e r y d i f f i c u l t ,  largely  t o the v a r i e t y of symptoms a s c r i b e d to t h i s d i s e a s e and  to  t h e i r o v e r l a p w i t h the symptoms i d e n t i f y i n g o t h e r d i s o r d e r s . Because o f the h e t e r o g e n e i t y of the m a n i f e s t a t i o n s of illness,  some have even suggested  t h a t i t may  this  be more c o r r e c t  to r e f e r to a group of s c h i z o p h r e n i a s r a t h e r than to t h i n k of t h i s c o n d i t i o n as a s i n g l e d i s e a s e  entity.  With such u n c e r t a i n t y about the exact nature of s c h i z o p h r e n i a , the problem o f i t s e t i o l o g y i s indeed d i f f i c u l t  to  s o l v e , and i t has been the s u b j e c t of much study f o r many y e a r s . The wide v a r i e t y of e t i o l o g i c a l f a c t o r s c o n s i d e r e d over y e a r s suggests  t h a t many have been a c c u r a t e l y observed  the and  i n t e r p r e t e d , but t h a t no s i n g l e f a c t o r i s by i t s e l f r e s p o n s i b l e for  the c l i n i c a l  schizophrenic.  psychopathology c o n v e n t i o n a l l y d e s c r i b e d as A c c o r d i n g to p a s t and p r e s e n t r e s e a r c h , s c h i z o -  p h r e n i a appears to be a syndrome or a r e a c t i o n type a s s o c i a t e d w i t h numerous e t i o l o g i c a l f a c t o r s . rounding  The v a r i o u s t h e o r i e s s u r -  these e t i o l o g i c a l f a c t o r s are as y e t o n l y  personal  6  vi ew points  on an undefined  p e r s o n a l viewpoints  h y p o t h e t i c a l continuum.  These  w i l l be c o n s i d e r e d i n the f o l l o w i n g d i s -  c u s s i o n of the v a r i o u s s t u d i e s which have been c a r r i e d out the t h e o r i e s which have been put f o r t h , as to why  and  certain  i n d i v i d u a l s develop a p r e d i s p o s i t i o n t o s c h i z o p h r e n i a .  The  e t i o l o g y of s c h i z o p h r e n i a w i l l be c o n s i d e r e d under the f o l l o w i n g topics:  (1)  (1)  Hereditary  studies  (2)  B i o l o g i c a l t h e o r i e s and  (3)  S o c i o l o g i c a l and c u l t u r a l  (4)  Psychological theories  studies studies  HEREDITARY STUDIES Kallmann (1938, 1946)  has probably  c o n t r i b u t e d the most  d e t a i l e d i n f o r m a t i o n r e g a r d i n g the r o l e of h e r e d i t y i n s c h i z o phrenic e t i o l o g y .  B a s i n g h i s work on e a r l i e r i n v e s t i g a t i o n s of  the f a m i l y backgrounds of s c h i z o p h r e n i c p a t i e n t s , he his  concentrated  a t t e n t i o n mainly on s c h i z o p h r e n i c i d e n t i c a l twins and  twin s i b l i n g s .  He a l s o s t u d i e d over one  and n i n e thousand o f t h e i r r e l a t i v e s .  thousand  non-  schizophrenics  I n summarizing h i s  own  work, as w e l l as t h a t of o t h e r s , he shows very c l e a r l y t h a t s c h i z o p h r e n i a occurs more o f t e n i n the b l o o d r e l a t i v e s of s c h i z o p h r e n i c s than i n the g e n e r a l p o p u l a t i o n . when one  o f a p a i r o f i d e n t i c a l twins develops  the p r o b a b i l i t y o f t h e occurrence  For example, schizophrenia,  of s i m i l a r maladjustment i n  the other twin i s f i v e to s i x times as g r e a t as i t would be i n n o n - i d e n t i c a l twins o r non-twin s i b l i n g s . s c h i z o p h r e n i a occurs i n o n l y 0.85  Further,  per cent of the  although  general  7 population,  i t apparently  o c c u r s at a r a t e of about 4 per  i n the d i s t a n t r e l a t i v e s o f s c h i z o p h r e n i c s , from 10  to 12 per cent among the p a r e n t s and  schizophrenics.  According  i s even more f r e q u e n t two  a t a r a t e of  s i b l i n g s of  to Kallman's r e s u l t s ,  schizophrenia  i n f a m i l i e s where i t i s known t h a t  i n d i v i d u a l s have the d i s e a s e .  schizophrenic,  and  cent  When o n l y one  the  parent i s  f o r example, about 16 per cent of the c h i l d r e n  are a f f l i c t e d , but when both parents are s c h i z o p h r e n i c , 68 per cent of the c h i l d r e n are a l s o s c h i z o p h r e n i c .  about  Kallman,  on the b a s i s of h i s s t u d i e s , concluded t h a t the p r e d i s p o s i t i o n to s c h i z o p h r e n i a  i s i n h e r i t e d and probably depends upon a  s p e c i f i c g e n e t i c f a c t o r which he b e l i e v e d to be  recessive.  In c o n t r a s t to Kallman, B l e u l e r (1950), on the b a s i s extensive  reviews of the l i t e r a t u r e on h e r e d i t a r y f a c t o r s i n  schizophrenia,  found no  c o n c l u s i v e proof f o r o r a g a i n s t  as an e t i o l o g i c a l f a c t o r . v a l u e may  of  be attached  He i n d i c a t e d that l i t t l e  heredity  practical  to an i s o l a t e d g e n e t i c approach u n t i l i t  i s c e r t a i n t h a t h e r e d i t y i s a major f a c t o r i n the c a u s a t i o n this disease.  of  He went on to suggest t h a t t h i s approach might  more p r o f i t a b l y be combined w i t h a b i o - p h y s i o l o g i c a l approach to e t i o l o g y . A study of h e r e d i t a r y and  environmental f a c t o r s  t h e i r r e l a t i o n to the e t i o l o g y of s c h i z o p h r e n i a was by P o l l o c k and Malzberg (1940).  t h a t b o t h combined, i n t h e i r more u n d e s i r a b l e  do so.  They ( P o l l o c k and Malzberg, 1940,  although there i s no proof  c a r r i e d out  Their f i n d i n g s i n d i c a t e that  n e i t h e r of these f a c t o r s i n i s o l a t i o n g i v e r i s e to but  and  p. 1240)  of s c h i z o p h r e n i c  schizophrenia, aspects,  may  conclude t h a t  inheritance,  there  8 i s a ".  . . g e n e r a l i z e d f a m i l i a l b a s i s f o r such d i s o r d e r s . "  They do not accept h e r e d i t y alone as a b a s i s f o r s c h i z o p h r e n i a , b e l i e v i n g s a t i s f a c t o r y adjustment to be p o s s i b l e i n the r i g h t k i n d of environment, and maladjustment g i v i n g r i s e to s c h i z o p h r e n i a almost i n e v i t a b l e i n an u n s a t i s f a c t o r y environment. They do not s p e c i f y j u s t what c o n s t i t u t e s the environment, but to support  precipitating  t h i s t h e o r y they quote the many  cases of s c h i z o p h r e n i a which occur i n f a m i l i e s where i t i s not p o s s i b l e to t r a c e u n f a v o r a b l e  heredity.  Most o f the g e n e t i c a l l y o r i e n t e d s t u d i e s (Malamud and Overholser, i n the way  1958;  Gregory, 1960;  provide  little  of c o n c l u s i v e proof f o r or a g a i n s t a g e n e t i c  theory  of s c h i z o p h r e n i c e t i o l o g y . t h e r e i s a g r e a t e r frequency  B l e u l e r , 1947)  They p r o v i d e mere i n d i c a t i o n s t h a t o f s c h i z o p h r e n i c pathology  f a m i l y t r e e s than i n the p o p u l a t i o n a t l a r g e .  i n some  Unanswered ques-  t i o n s about t h i s t o p i c , such as: "Are g e n e t i c f a c t o r s alone s u f f i c i e n t f o r the development of s c h i z o p h r e n i a ? " — "Do f a c t o r s determine the way  the i n d i v i d u a l r e a c t s to h i s  genetic environ-  ment?" -"Are g e n e t i c f a c t o r s determinants of o n l y some forms o f s c h i z o p h r e n i a ? " e t c . , a r e s t i l l unanswered though being Perhaps the most v a l u a b l e c o n t r i b u t i o n made by g e n e t i c has been the suggesting  studied. research  o f areas f o r more e x t e n s i v e study  and  the i d e a of v i e w i n g h e r e d i t y , not i n i s o l a t i o n , but i n the cont e x t o f p h y s i o l o g i c a l , b i o l o g i c a l , p s y c h o l o g i c a l and  environmen-  tal conditions. (2)  BIOLOGICAL THEORIES AND In r e c e n t years  STUDIES  there has been an i n c r e a s i n g number of  i n v e s t i g a t i o n s seeking evidence  of d e f i n i t e and d i s c r e t e  9 b i o l o g i c a l a b n o r m a l i t i e s d i s t i n c t i v e l y a s s o c i a t e d w i t h the e t i o l o g y o r development o f s c h i z o p h r e n i a .  Part of t h i s  inter-  e s t has a r i s e n as a r e s u l t o f t h e s i m i l a r i t i e s t h a t have been noted between the i n t e l l e c t u a l impairment o f s c h i z o p h r e n i c s and  t h a t o f i n d i v i d u a l s w i t h o r g a n i c b r a i n damage.  Much r e c e n t  r e s e a r c h has stemmed from t h e b e l i e f t h a t s c h i z o p h r e n i a i s n o t merely a d i s o r g a n i z a t i o n o f p e r s o n a l i t y , b u t r a t h e r t h a t a r e d i s t u r b a n c e s i n metabolism, endocrine chemistry  balance  there  and body  t h a t f a c i l i t a t e and enhance t h i s d i s o r g a n i z e d s t a t e .  Benjamin (1958) made an i n t e n s i v e survey o f past b i o l o g i c a l and p h y s i o l o g i c a l r e s e a r c h on s c h i z o p h r e n i a and summari z e d t h e f i n d i n g s i n the areas o f g e n e t i c s , endocrinology,  and b i o c h e m i s t r y .  s t u d i e s (Colony  neurophysiology,  Some n e u r o p h y s i o l o g i c a l  and W i l l i s , 1956; Hurst,  1952) have shown a  c o n s i s t e n t d i f f e r e n c e between t h e EEC's o f s c h i z o p h r e n i c s and normals. Kelsey,  P h y s i o l o g i c a l i n v e s t i g a t i o n s (Kelsey, G u l l o c k , and 1957) i n t h e f i e l d o f endocrinology  demonstrate a s i g -  n i f i c a n t d i f f e r e n c e between s c h i z o p h r e n i c and normal i n d i v i d u a l s with regard to i o d i n e intake.  Biochemical  s t u d i e s ( H o f f e r , 1957;  Osmotid and Smythies, 1952) show a s i g n i f i c a n t d i f f e r e n c e between s c h i z o p h r e n i c s and normals w i t h r e g a r d t o the a d r e n a l i n e noradrenaline  level.  Adrenochrome was a l s o found i n g r e a t e r  q u a n t i t i e s i n s c h i z o p h r e n i c s than i n normals.  There a r e a l s o  i n d i c a t i o n s ( B r o d i e e t a l . , 1957) t h a t a r e c e n t l y d i s c o v e r e d hormone, s e r o t o n i n , may, i n a s t a t e o f abnormal metabolism, be i n v o l v e d i n the e t i o l o g y and pathogenesis o f s c h i z o p h r e n i a . T a r a x e i n and o t h e r b l o o d substances have a l s o been i s o l a t e d (Heath e t a l . , 1957; F e d o r o f f and H o f f e r , 1956) i n s c h i z o p h r e n i c s  10 but not i n normals.  A l t h o u g h the exact r e l a t i o n these v a r i o u s  substances have to s c h i z o p h r e n i a  i s as y e t u n c e r t a i n ,  these  s t u d i e s suggest that they are d i r e c t l y i n v o l v e d i n the e t i o l o g y of  schizophrenia. Other areas of b i o - p h y s i o l o g i c a l r e s e a r c h i n s c h i z o -  phrenia  (Hoskins, 1946;  Wittman, 1937;  Angyal, Freeman, and Hoskins,  1940;  Werkman, 1959), such as neuropathology and  induced psychoses, are c u r r e n t l y being  investigated.  This  of study i s as y e t of too r e c e n t o r i g i n to have produced questionable  conclusions.  patients.  However, w h i l e such r e l a t i o n -  the r o l e of e x p l i c i t v a r i a b l e s has y e t to be SOCIOLOGICAL AND  the nature of  revealed.  CULTURAL STUDIES  Weinberg (1952, p. 233)  summarizes the major f i n d i n g s  about the r e l a t i o n s h i p between s o c i o l o g i c a l o r c u l t u r a l t i o n s and ".  the development o f s c h i z o p h r e n i a ,  . . schizophrenia  un-  psychological  s h i p s can i n p a r t be demonstrated e x p e r i m e n t a l l y ,  (3)  field  Nonetheless, there appears to be some  k i n d of r e l a t i o n s h i p between the b i o l o g i c a l and s t a t e s of s c h i z o p h r e n i c  drug  i s l e s s frequent  homogeneous and have i n t i m a t e c o n t a c t s  condi-  by s t a t i n g t h a t  i n c u l t u r e s which are than i n c u l t u r e s which  are heterogeneous and have impersonal and h o s t i l e c o n t a c t s . " S i m i l a r l y , Malamud and  O v e r h o l s e r (1958) found t h a t an  industrial  as opposed to n o n - i n d u s t r i a l c u l t u r e , an urban r a t h e r than r u r a l l o c a t i o n , the s t a t u s of immigrant r a t h e r than n a t i v e , and  so  on,  are among the c u l t u r a l f a c t o r s enhancing a p r e d i s p o s i t i o n to schizophrenic  development.  ments made by A r i e t i  T h i s i s i n keeping a l s o w i t h s t a t e -  (1955, p. 84)  that " . . .  the presence of  an i n d u s t r i a l c u l t u r e r a t h e r than a p r e - i n d u s t r i a l , an urban  11 l o c a t i o n r a t h e r than a r u r a l ,  the e m i g r a t i o n  country r a t h e r than l i v i n g i n a n a t i v e l a n d , f a c t o r s which p r e d i s p o s e  to s c h i z o p h r e n i a  to a f o r e i g n e t c . , are a l l  as w e l l as to  other  mental d i s o r d e r s . " To e x p l a i n some o f the s o c i o l o g i c a l r e l a t i o n s h i p s , P o l l o c k and Malzberg (1940) and Weinburg (1952) suggest t h a t the c u l t u r e may  a f f e c t the i n d i v i d u a l ' s adjustment through the  involvement o f s p e c i f i c mores and  by the d i r e c t e f f e c t o f  c u l t u r e on the i n t e r n a l o r g a n i z a t i o n of the f a m i l y and previously established patterns.  These mores and  the  their  patterns,  when i n d i r e c t o p p o s i t i o n to those of the c u l t u r e i n g e n e r a l , may  i n f l i c t adverse p s y c h o l o g i c a l pressures  causing  severe s t r e s s , a n x i e t y ,  and  on the i n d i v i d u a l ,  t e n s i o n , which the  individ-  u a l becomes i n c r e a s i n g l y unable to combat.  Thus, c u l t u r a l  f a c t o r s i n the i n d i v i d u a l ' s environment may  create a predisposi-  t i o n to  schizophrenia. A l t h o u g h there are d i f f e r e n c e s i n r a t e s o f h o s p i t a l i z a -  t i o n between l i t e r a t e and n o n - l i t e r a t e s o c i e t i e s , Western  and  non-Western c u l t u r e , s o c i o l o g i c a l s t u d i e s seem to i n d i c a t e t h a t schizophrenia  i s universal.  t h e o r i e s which c o n s i d e r as such can occur i n any  T h i s i s i n keeping w i t h those  schizophrenia culture.  emphasis seems to be upon the way  a b i o l o g i c a l disorder  In s o c i o l o g i c a l s t u d i e s  the  i n which the i n d i v i d u a l  i n t e r p r e t s h i s c u l t u r a l environment to meet h i s own (4)  and  needs.  PSYCHOLOGICAL THEORIES One  of the more p o p u l a r v i e w p o i n t s o f the developmental  process l e a d i n g to s c h i z o p h r e n i a  i s t h a t i t i s an  illness  12 r e s u l t i n g i n b e h a v i o r a l d i s o r g a n i z a t i o n and d e s o c i a l i z a t i o n , i n which the i n d i v i d u a l ' s b e h a v i o r i s determined by h i s own p r i v a t e thoughts and f a n t a s i e s . phrenic  That i s t o say, the s c h i z o -  i n h i s attempt t o a v o i d o r decrease a n x i e t y ,  from r e a l i t y .  Arieti  (1955, p. 284) has p r o v i d e d  more p r e c i s e d e f i n i t i o n s o f s c h i z o p h r e n i a , It  is  escapes  one o f the  o r dementia praecox.  . . a s p e c i f i c r e a c t i o n to an extreme s t a t e o f a n x i e t y ,  o r i g i n a t i n g i n childhood,  and r e a c t i v a t e d l a t e r i n l i f e by  psychological f actors." While t h i s may d e s c r i b e it  some f e a t u r e s o f s c h i z o p h r e n i a ,  does n o t r e a l l y t e l l us anything  illness.  about the cause o f t h i s  That i s , i t t e l l s us t h a t there i s b e h a v i o r a l d i s o r -  g a n i z a t i o n and d e s o c i a l i z a t i o n , but these i n r e a l i t y a r e o n l y symptoms o f a more b a s i c d i f f i c u l t y which i s n o t c l a r i f i e d . Such i s o f t e n the case i n d e s c r i p t i o n s o f the p s y c h o l o g i c a l aspects of schizophrenia. behavioral  Very o f t e n they r e f e r t o o b s e r v e a b l e  symptoms o f maladjustment such as p e c u l i a r mannerisms,  b i z a r r e behavior, lack of appropriate  a f f e c t , d e l u s i o n s and  h a l l u c i n a t i o n s , but they do not show t h e causes o f them. other words, they t e l l what s c h i z o p h r e n i a If  schizophrenia  In  i s , n o t how i t a r i s e s .  i s to be viewed i n t h e l i g h t o f pos-  s i b l e p s y c h o l o g i c a l e t i o l o g y , i t should  probably be  the end r e s u l t o f a long developmental process,  considered  a continuum  w i t h no d i s t i n g u i s h a b l e p o i n t a t which the i n d i v i d u a l c o u l d be s a i d t o be s c h i z o p h r e n i c .  There i s no s i n g l e p e r i o d i n the  i n d i v i d u a l ' s h i s t o r y t o which one c o u l d r e f e r and say t h a t p r i o r to t h a t p o i n t he was n o t s c h i z o p h r e n i c  and a f t e r t h a t p o i n t he  13 was s c h i z o p h r e n i c .  One must then c o n s i d e r what f a c t o r s c o u l d  have been r e s p o n s i b l e f o r o r c o n t r i b u t e d t o t h e development o f his  illness.  S i n c e t h e f a m i l y i s the b a s i c s o c i a l u n i t i n t h e  l i f e o f any i n d i v i d u a l , and i s thought t o be a s t r o n g c o n t r i b u t o r y f a c t o r t o the way he develops,  one should f i r s t  the f a m i l y r e l a t i o n s h i p s o f the i n d i v i d u a l . essary i n o r d e r t o understand  understand  T h i s i s a l s o nec-  schizophrenia.  Much a t t e n t i o n ( A r i e t i , 1955;  Weinberg, 1952) has been  g i v e n t o s o c i a b i l i t y o r l a c k o f i t , i n both the parents c h i l d , d u r i n g the p r e s c h i z o p h r e n i c c h i l d h o o d .  and the  A lack of natural  human warmth f r e q u e n t l y appears d u r i n g t h e e a r l y adolescence the p r e s c h i z o p h r e n i c  individual.  towards o v e r - s e r i o u s n e s s , for  one's own company.  of  T h i s i s observed i n a tendency  s e l f - c o n s c i o u s n e s s , and a p r e f e r e n c e  The i n d i v i d u a l may become p r e o c c u p i e d  by  daydreams and f a n t a s i e s which a r e p r e f e r r e d to t h e problems o f reality.  L i t t l e i n t e r e s t i s shown i n t h e o p p o s i t e sex.  These  a r e the c h a r a c t e r i s t i c s which a r e f r e q u e n t l y mentioned as b e i n g found i n the type o f i n d i v i d u a l who i s prone to develop s c h i z o phrenia. P s y c h o l o g i c a l t h e o r i e s s t r e s s t h e r e l a t i o n s h i p between e a r l y c h i l d h o o d and t h e development o f s c h i z o p h r e n i a .  Arieti  (1955, p. 52) s t a t e s t h a t , " . . . from the h i s t o r y o f the c h i l d hood o f t h e s c h i z o p h r e n i c p a t i e n t we l e a r n t h a t i n t h a t p e r i o d of l i f e  t h e a n x i e t y o f t h e p a t i e n t was o f such tremendous  i n t e n s i t y t h a t no s u f f i c i e n t s e l f - e s t e e m and sense o f s e l f i d e n t i t y c o u l d be b u i l t .  . . ."  he s p e c i f i e s even more f u l l y  I n another statement (p.384),  t h a t the s p e c i f i c r e a c t i o n r e f e r r e d  14  to as s c h i z o p h r e n i a : . . . c o n s i s t s of the a d o p t i o n o f a r c h a i c mental mechanisms, which belong to lower l e v e l s o f i n t e g ration. Inasmuch as the r e s u l t i s a r e g r e s s i o n t o , but n o t an i n t e g r a t i o n a t lower l e v e l s , a d i s e q u i l i b r i u m i s engendered which causes f u r t h e r r e g r e s s i o n , a t times t o l e v e l s even lower than t h e one i n which c e r t a i n p e r c e p t i o n s a r e p o s s i b l e . Among t h e f a c t o r s mentioned as p o t e n t i a l l y d e s t r u c t i v e and found i n t h e c h i l d h o o d of s c h i z o p h r e n i a , a r e a demanding, domineering, h o s t i l e parent o r parents; protection or rejection;  parental  over-  l a c k o f a p p r o v a l , warm s o c i a l con-  t a c t s , o r a s a t i s f a c t o r y parent s u b s t i t u t e . Recent s t u d i e s (Weinberg, 1952, A r i e t i , 1955) on t h e o r i g i n s o f s c h i z o p h r e n i a seem t o have been more concerned w i t h p a r e n t - c h i l d r e l a t i o n s h i p s than w i t h any other s i n g l e t o p i c . Although t h e r e i s a wealth o f data a v a i l a b l e on t h i s  subject,  few o f t h e c o n c l u s i o n s drawn have been u n i v e r s a l l y accepted. The v a r i o u s authors  appear t o have observed c e r t a i n common  elements i n t h e r e l a t i o n s h i p o f the parents  to t h e p r e s c h i z o -  phrenic c h i l d which l e d them t o view s c h i z o p h r e n i a as a persona l i t y d i s o r d e r having  i t s roots i n the e a r l y childhood of the  individual, p a r t i c u l a r l y i n faulty relationships with  parents  d u r i n g t h a t time. Maternal  domination appears to be the most f r e q u e n t l y  r e p o r t e d f e a t u r e of the p r e s c h i z o p h r e n i c  childhood,  paternal  domination b e i n g r e f e r r e d to only r a r e l y ( L i d z , Parker, and G o r n e l i s o n , 1956; Freeman and Grayson, 1955; Prout 1950).  Extending  and White,  t h i s i d e a f u r t h e r , these s t u d i e s p o i n t o u t  the l a c k o f a f f e c t i o n shown between t h e p r e s c h i z o p h r e n i c  child  15  and  h i s p a r e n t s , p a r t i c u l a r l y t h e mother.  Even so, t h e c h i l d  i s u s u a l l y s t r o n g l y dependent upon and e m o t i o n a l l y  attached t o  the mother, p o s s i b l y due to t h e f a c t t h a t the f a t h e r i s u s u a l l y weak and s u b m i s s i v e .  Many i n v e s t i g a t o r s f e e l t h a t t h i s  emotional attachment t o t h e mother i s the c r u c i a l element i-n schizophrenic  development.  Another f e a t u r e o f the p a r e n t - c h i l d r e l a t i o n t h a t has been emphasized (Kasanin, Knight, and Sage, 1934; Kohn and Clausen, 1956) i s maternal o v e r - p r o t e c t i o n .  By  over-protection  the f o l l o w i n g o r s i m i l a r a t t i t u d e s o r a c t i v i t i e s on the p a r t o f the mother, sometimes t h e f a t h e r , a r e r e f e r r e d t o : contact  (e.g. mother s l e e p i n g w i t h c h i l d ) ;  l a c k o f c o n t r o l and d i s c i p l i n e . buted s c h i z o p h r e n i c  excessive  overindulgence;  These same w r i t e r s have a t t r i -  f a i l u r e i n h e t e r o - s e x u a l adjustment, t h e i r  l a c k o f marriage, and t h e i r f a i l u r e t o make f r i e n d s , t o t h i s combination o f maternal o v e r - p r o t e c t i o n f a i l u r e o f the s c h i z o p h r e n i c over o f t h e p o s s e s s i v e  m o t h e r - c h i l d r e l a t i o n s h i p , and over-  P s y c h o a n a l y s t s (Modell,  o f the i n d i v i d u a l . 1956) g e n e r a l l y view  as t h e r e s u l t o f p a r e n t a l  (1956) c o n c e i v e s o f s c h i z o p h r e n i a ations.  The  to make f r i e n d s may a l s o be a c a r r y -  protection, i n t o the adult l i f e  schizophrenia  and domination.  Others (Hunt and C o f e r ,  attitudes.  childhood Bettelheim  as a r e a c t i o n t o extreme s i t u 1944) conceive o f t h i s  disease  as a r e a c t i o n t o s t r e s s , t h e i l l n e s s b e i n g a s u b s t i t u t e f o r those defence mechanisms t h e i n d i v i d u a l d i d n o t develop o r developed i n a d e q u a t e l y e a r l i e r i n h i s  life.  16 In agreement w i t h t h e f o r e g o i n g phrenic  theories of schizo-  p a r e n t - c h i l d r e l a t i o n s h i p s a r e the f o l l o w i n g  specific  f i n d i n g s r e p o r t e d by Kohn and C l a u s e n (1956, p. 309): " ( a ) . . . schizophrenic  p a t i e n t s more f r e q u e n t l y than normal persons o f •  comparable background r e p o r t t h a t t h e i r mothers played  a very  s t r o n g a u t h o r i t y r o l e and t h e i r f a t h e r s a v e r y weak a u t h o r i t y role;  (b) that normal males r e p o r t d i f f e r e n t p a t t e r n s o f  p a r e n t a l a u t h o r i t y behavior from those r e p o r t e d by normal females, but  schizophrenic  phrenic  females;  males r e p o r t much t h e same p a t t e r n as s c h i z o s i m i l a r l y ( c ) normal respondents o f d i f f e r i n g  socioeconomic background r e p o r t d i f f e r e n t p a t t e r n s , b u t s c h i z o phrenics  o f d i f f e r i n g socioeconomic backgrounds r e p o r t much t h e  same p a t t e r n s schizophrenics  of parental authority r e l a t i o n s ; who r e p o r t  and ( d ) female  strong maternal and weak p a t e r n a l  a u t h o r i t y b e h a v i o r say they were c l o s e r to t h e i r f a t h e r s to t h e i r mothers."  than  Because these p a r e n t - c h i l d r e l a t i o n s h i p s  are r e l e v a n t t o i l l n e s s e s other  than s c h i z o p h r e n i a , we cannot  assume t h a t t h e f a c t o r s mentioned a r e common p r e d i s p o s i n g of s c h i z o p h r e n i a ,  causes  only t h a t they may be.  Regardless o f i t s o r i g i n , s c h i z o p h r e n i a  i s characterized  by i n t e l l e c t u a l impairment, d i s t o r t i o n s i n p e r c e p t i o n , and blunted  o r p e r v e r s e emotional r e a c t i o n s .  The i n t e l l e c t u a l im-  pairment i s observed b o t h i n day-to-day f u n c t i o n i n g , and a l s o i n performance on standard  psychological t e s t s .  Symptoms such  as withdrawal, d i s i n t e r e s t , i n a t t e n t i o n , h o s t i l i t y ,  e t c . , which  may have e i t h e r a p h y s i o l o g i c a l o r p s y c h o l o g i c a l b a s i s , may be the t r u e o r i g i n s o f t h i s impairment o f i n t e l l e c t u a l  functioning.  However, i n the l i g h t o f what i s known about the e t i o l o g y o f  17 s c h i z o p h r e n i a , i t i s more l i k e l y t h a t these p s y c h o l o g i c a l factors, i n conjunction with b i o - p h y s i o l o g i c a l p e c u l i a r i t i e s , are t h e t r u e b a s i s f o r t h i s d e t e r i o r a t i o n i n i n t e l l e c t u a l f u n c t i o n i n g and performance. S t u d i e s oh S c h i z o p h r e n i c  Performance and M o t i v a t i o n  Many s t u d i e s have demonstrated t h a t  schizophrenia,  regardless of i t s o r i g i n , i s associated with a l o s s of i n t e l lectual efficiency.  I n a d d i t i o n to evidence  s t a n d a r d i z e d p s y c h o l o g i c a l t e s t s , impaired been demonstrated on v i s u a l - m o t o r  a c q u i r e d from  performance has  and p h y s i o l o g i c a l t e s t s .  I t has o f t e n been suggested t h a t s c h i z o p h r e n i c s  will  show a performance decrement on t a s k s i n v o l v i n g a b s t r a c t thought processes  and r e a s o n i n g .  T h i s i d e a i s supported  by Norman and  Wilensky (1961) who compared the WAIS i n f o r m a t i o n s c o r e s o f one hundred s c h i z o p h r e n i c s w i t h t h e scores o b t a i n e d by 1700 normals i n Wechsler's s t a n d a r d i z a t i o n group.  They found t h a t  s c h i z o p h r e n i c decrement was g r e a t e r on those items r e q u i r i n g r e a s o n i n g than on those r e q u i r i n g pure r e c a l l .  Rabin (1941)  i n h i s s t u d i e s o f s c h i z o p h r e n i c performance on the WAIS, found s c h i z o p h r e n i c v e r b a l IQ t o be s i g n i f i c a n t l y h i g h e r than performance IQ.  He found s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s  between h i s s c h i z o p h r e n i c and normal group, the d i f f e r e n c e s between the s c h i z o p h r e n i c and o t h e r non-psychotic l e s s marked, though s t i l l o f some s i g n i f i c a n c e . are c o n s i s t e n t w i t h those o f Wechsler (1958).  groups being »• These f i n d i n g s  Although he  found t h a t s c h i z o p h r e n i c performance was b e t t e r i n those  areas  c a l l i n g f o r v e r b a l s o l u t i o n s than those r e q u i r i n g non-verbal  18  s o l u t i o n s , the v e r b a l t e s t s on which the s c h i z o p h r e n i c d i d w e l l were those which d i d not r e q u i r e spontaneous Severe impairment was  verbalization.  evidenced on those t e s t s r e q u i r i n g immed-  i a t e and d i r e c t e d e f f o r t , and the a b i l i t y to d e a l w i t h c o n c r e t e and s p e c i f i c  situations.  Zucker and Hubert (1935) observed the changes i n f u n c t i o n found i n s c h i z o p h r e n i c thought d i s o r d e r and from p u r e l y s u b j e c t i v e o b s e r v a t i o n s concluded that thought removal o c c u r s . By thought removal they r e f e r to s u c h t h i n g s as s c h i z o p h r e n i c m i s i n t e r p r e t a t i o n of words i n p a r t i c u l a r and r e a l i t y i n g e n e r a l , which r e s u l t i n impairment  o f the i n d i v i d u a l ' s mental  efficiency.  They b e l i e v e d t h i s thought removal t o occur o n l y where the s c h i z o p h r e n i c r e t a i n e d f a i r l y w e l l - p r e s e r v e d powers o f observation.  Thought removal, when observed, o c c u r r e d suddenly and  c o u l d be seen as something s p e c i a l i n the e x p e r i e n c e o f s c h i z o phrenics. Shapiro, K e s s e l l , and Maxwell  (1960) i n v e s t i g a t e d the  e f f e c t s o f d i s t r a c t i o n c o n d i t i o n s on the speed o f  psychomotor  performance i n o r g a n i c p a t i e n t s , c h r o n i c s c h i z o p h r e n i c s , and normals.  D i s t r a c t i o n took the form o f h a v i n g the s u b j e c t count  a f t e r the experimenter, a t the r a t e o f one number per second, from the moment the i n d i v i d u a l Porteus Mazes were p r e s e n t e d to him to the moment the maze was  completed.  I t was  found t h a t  under these d i s t r a c t i n g c i r c u m s t a n c e s , q u a l i t y and speed o f psychomotor  performance were r e l a t e d to the type o f mental d i s -  o r d e r , the brain-damaged  group performing at a l e v e l  inferior  to the o t h e r two groups, and the s c h i z o p h r e n i c s performing a t a s i g n i f i c a n t l y poorer l e v e l than the normals.  19 Weckowicz and H a l l (1960) c a r r i e d out a study o f d i s tance constancy i n s c h i z o p h r e n i c and non-schizophrenic patients.  The  mental  s c h i z o p h r e n i c s u b j e c t s and c o n t r o l s were r e -  q u i r e d to judge s u c c e s s i v e one-yard i n t e r v a l s i n depth towards the h o r i z o n by t e l l i n g the experimenter t o stop a marker which was  b e i n g moved away from another s t a t i o n a r y marker.  authors were attempting constancy was  The  to determine whether poor d i s t a n c e  a s p e c i f i c c h a r a c t e r i s t i c of s c h i z o p h r e n i c  or whether i t was illness.  The  also a c h a r a c t e r i s t i c of  illness  non-schizophrenic  r e s u l t s of t h e i r study i n d i c a t e t h a t poor d i s t a n c e  constancy i s s p e c i f i c to s c h i z o p h r e n i a . While the f o r e g o i n g s t u d i e s demonstrate the r e a l i t i e s s c h i z o p h r e n i c impairment, l i t t l e other than g e n e r a l about s c h i z o p h r e n i a have been presented  ities,  due  irreversible  to b i o l o g i c a l abnormal-  o t h e r s see these d i s t o r t i o n s i n p e r c e p t i o n and  ance as a concomitant of m o t i v a t i o n a l f a c t o r s . motivation  exact  While some  t h e o r i s t s b e l i e v e t h i s i l l n e s s i n v o l v e s a b a s i c and l o s s of the h i g h e r mental processes  theories  to c l a r i f y the  b a s i s f o r t h i s impairment of mental e f f i c i e n c y .  of  perform-  If faulty  i s a s i g n i f i c a n t determinant of the performance  p e c u l i a r i t i e s observed i n s c h i z o p h r e n i c p a t i e n t s , then an p e r i m e n t a l l y produced i n c r e a s e i n m o t i v a t i o n should performance.  Few  studies i n v o l v i n g experimentally  m o t i v a t i o n a l v a r i a b l e s have been c a r r i e d out w i t h p a t i e n t s , p o s s i b l y due  ex-  improve manipulated  schizophrenic  to the g e n e r a l problem of e s t a b l i s h i n g  r a p p o r t w i t h and a r o u s i n g m o t i v a t i o n i n them.  20 V a r i o u s methods have been u t i l i z e d  i n an attempt to  study m o t i v a t i o n i n the "normal" human organism.  For many years  the human l e a r n i n g v a r i a b l e s of v e r b a l r e i n f o r c e m e n t  and  reinforcement  Various  have r e c e i v e d c o n s i d e r a b l e a t t e n t i o n .  non-  techniques f o r a r o u s i n g m o t i v a t i o n have been and are b e i n g employed — v e r b a l reward, p r a i s e , shock, e t c . (Garmezy, 1952) experimenter's  Much s t r e s s  has been p l a c e d upon the r e l a t i o n between the v e r b a l i s a t i o n s and the s u b j e c t ' s l e a r n i n g .  In one of the few  s t u d i e s attempting  to r e l a t e s c h i z o -  p h r e n i c performance to m o t i v a t i o n a l v a r i a b l e s , Cohen (1956) used an escape from noxious s t i m u l i d e s i g n on a t a s k i n v o l v i n g the l e a r n i n g o f a s e r i e s of motor responses to s u c c e s s i v e l y presented v i s u a l s t i m u l i . for  t h e more motivated  His r e s u l t s i n d i c a t e f a c i l i t a t i o n  s c h i z o p h r e n i c s as compared to p a t i e n t s  under mere r a p p o r t c o n d i t i o n s . P r e v i o u s s t u d i e s of m o t i v a t i o n and performance i n s c h i z o p h r e n i a have f r e q u e n t l y c o r r e l a t e d t e s t s c o r e s w i t h b e h a v i o r a l r a t i n g s d e f i n e d as i n d i c e s of m o t i v a t i o n .  For a group o f s c h i z -  o p h r e n i c p a t i e n t s , Wittman (1937) found h i g h p o s i t i v e t i o n s (median r = +.75)  between c o o p e r a t i v e n e s s  correla-  r a t i n g s and  s c o r e s on a b a t t e r y of r e a s o n i n g and memory t e s t s .  Corresponding  c o r r e l a t i o n s f o r a group of p a r e t i c p a t i e n t s were low, ing  zero.  approach-  Wittman i n t e r p r e t e d her r e s u l t s as i n d i c a t i n g t h a t  m o t i v a t i o n a l f a c t o r s were r e s p o n s i b l e f o r the d e f i c i t the s c h i z o p h r e n i c group.  She a t t r i b u t e d the d e f i c i t  the p a r e t i c p a t i e n t s to n o n - m o t i v a t i o n a l  shown by shown by  factors, since their  t e s t scores were u n r e l a t e d to t h e i r c o o p e r a t i o n r a t i n g s .  21 Shakow (1946) summarized r e s u l t s o f c o - o p e r a t i o n - performance c o r r e l a t i o n s f o r a s e r i e s o f s t u d i e s of motor f u n c t i o n , r e a c t i o n time, and g e n e r a l i n t e l l i g e n c e i n s c h i z o p h r e n i a . r e p o r t e d was +.56. observations  The median r  These r e s u l t s a r e complemented  by  clinical  t h a t s c h i z o p h r e n i c p a t i e n t s ' e f f i c i e n c y can be  r a i s e d w i t h f a v o r a b l e changes i n examiner-patient  relationships  (Cameron, 1944). The Bender-Gestalt  Test  Before the i n t r o d u c t i o n o f the Bender-Gestalt  test,  p e r c e p t i o n and r e p r o d u c t i o n o f d e s i g n by p s y c h o t i c p a t i e n t s had r e c e i v e d o n l y a minimum o f a t t e n t i o n .  Bender (1938) assembled  the Bender V i s u a l Motor G e s t a l t t e s t by s e l e c t i n g , from a l o n g s e r i e s o f g e s t a l t forms o r i g i n a l l y employed by Wertheimer, simple d e s i g n s ,  each o f which i s presented  on a separate  nine  card.  To perform t h e t e s t , the s u b j e c t merely draws the d e s i g n s . The t e s t was b u i l t on the premise t h a t the r e p r o d u c t i o n o f t e s t designs  i s a visual-motor  a c t i n which d i s t o r t i o n s o f  the o r i g i n a l p a t t e r n i n d i c a t e m a l f u n c t i o n i n g o r n e u r a l i n j u r y , . v a r i a t i o n s i n i n t e l l e c t u a l l e v e l s , or maladjustment i n the emotional  f i e l d o f the p e r c e i v i n g s u b j e c t .  s t u d i e s were done on v i s u a l - m o t o r schizophrenia. Schizophrenia  Bender's o r i g i n a l  functioning i n catatonic  She found t h a t (Bender, 1938, p. 106) ". . . i n t h e r e i s n o t o n l y an abnormal d i s s o c i a t i n g and  s p l i t t i n g of f u n c t i o n s t h a t should remain as wholes, b u t t h e r e i s a l s o a f a i l u r e to d i s s o c i a t e f u n c t i o n s which tend to s t i c k too c l o s e l y together so t h a t the experience may be r e p r e s e n t e d  o f the p e r s o n a l i t y  by any unwieldy conglomeration."  Whether  22 Bender's theory i s v a l i d or not, t h e r e i s c o n s i d e r a b l e (Bowland and Deabler, Bender-Gestalt  1956;  evidence  Mehlman and Vatovec, 1956)  t e s t d i s t i n g u i s h e s between normals and  that  the  schizo-  phrenics. P a s c a l and S u t t e l l (1951) undertook a s t a n d a r d i z a t i o n and q u a n t i f i c a t i o n of the B e n d e r - G e s t a l t lation.  t e s t on an a d u l t popu-  Through s t a t i s t i c a l a n a l y s i s o f the drawings reproduced  by matched samples of normal and  abnormal s u b j e c t s , 105  o r s c o r a b l e d e t a i l s were s e l e c t e d .  This l i s t  "items"  of items r e p r e s -  ents a r e l a t i v e l y o b j e c t i v e s c o r i n g key, which can be a p p l i e d to the drawings.  P a s c a l and S u t t e l l a l s o determined the r e l a t i o n -  s h i p between age,  education,  normal p o p u l a t i o n .  and Bender-Gestalt  score f o r t h e i r ,  They found l i t t l e e f f e c t of age upon  B-G  score between the ages of 15 and 50, r e p o r t i n g a c o r r e l a t i o n +.02  between age and B-G  s c o r e f o r a normal p o p u l a t i o n pf  s u b j e c t s w i t h h i g h s c h o o l education, for  a normal p o p u l a t i o n of 203  and  A s i g n i f i c a n t b i s e r i a l c o r r e l a t i o n of +.38 between e d u c a t i o n and population.  B-G  was  education.  s c o r e f o r P a s c a l and S u t t e l l * s normal  w i t h the s e v e r i t y of p s y c h i a t r i c i l l n e s s .  scores c o r r e l a t e  S p e c i f i c aspects  s c h i z o p h r e n i c performance on the Bender-Gestalt  two  of  t e s t were con-  t r a s t e d w i t h comparable groups o f a d u l t p s y c h o n e u r o t i c and  +.03  found to e x i s t  They found some i n d i c a t i o n t h a t B-G  adult non-patients,  271  a c o r r e l a t i o n of  subjects with c o l l e g e  of  patients,  groups of non-patient c h i l d r e n .  They found t h a t t h e i r s c h i z o p h r e n i c group was  "regressive" only  on those items the r e p r o d u c t i o n of which seemed more dependent on learning than on maturation  of c a p a c i t y .  They concluded  that  23 the s i m i l a r i t y of s c h i z o p h r e n i c  perceptual-motor b e h a v i o r to  t h a t of the young c h i l d was  to d i s r u p t i o n of a l e a r n e d motor  due  response and  t h a t r e g r e s s i o n , as d e f i n e d by them, was  p e c u l i a r to  schizophrenia.  Because of i t s dependence on v i s u a l - m o t o r t h i s t e s t has been used i n d e t e c t i n g o r g a n i c  functions,  pathology.  s i m i l a r i t y between the performance of s c h i z o p h r e n i c p a t i e n t s has  o f t e n been emphasized.  appears to be t h a t d i s t u r b a n c e s  not  and  With t h i s , c u r r e n t  i n schizophrenic  The organic belief  performance on  the B e n d e r - G e s t a l t t e s t are a f u n c t i o n o f d i s t o r t i o n s i n perception.  T h i s has not been proven and  some i n v e s t i g a t o r s have  suggested t h a t t h i s t e s t might r e v e a l not o n l y p e r c e p t u a l orders,  but a l s o d i s t u r b a n c e s  the t a s k .  P a s c a l and  dis-  i n the s u b j e c t ' s a t t i t u d e toward  S u t t e l l (1951, p. 9) s t a t e t h a t ,  . . . deviations r e s u l t i n g i n high scores are a l s o a f u n c t i o n of what we have reason to b e l i e v e i s a t t i t u d e toward the t a s k . These l a t t e r d e v i a t i o n s are, as our d a t a w i l l show, a f u n c t i o n of the s e v e r i t y of psychol o g i c a l d i s t u r b a n c e as i n d i c a t e d by d i a g n o s t i c c a t e g o r y . We b e l i e v e t h a t d e v i a t i o n s i n i n d i v i d u a l s o f normal i n t e l l i g e n c e w i t h o u t demonstrable b r a i n damage r e f l e c t the i n d i v i d u a l ' s a t t i t u d e toward r e a l i t y . This a t t i t u d e we b e l i e v e to be a f u n c t i o n o f the i n t e g r a t i v e c a p a c i t y o f the organism, the ego. They ( P a s c a l and  S u t t e l l , 1951,  p. 69) go on to say  that,  In a d d i t i o n to the p o s s i b i l i t y t h a t performance may be a f u n c t i o n o f the a f f e c t i v e tone of the i n d i v i d u a l d e s i g n f o r the s u b j e c t (which may a l s o be a f u n c t i o n of ideomotor a p t i t u d e ) we need to c o n s i d e r , as a poss i b l e f a c t o r i n f l u e n c i n g performance, the s u b j e c t ' s a t t i t u d e to the t e s t as a whole, i . e . , as a task, any task, of work under the g i v e n circumstances of t e s t i n g . In t h i s c a s e the e f f e c t of a t t i t u d e , i f i t i n f l u e n c e d b e h a v i o r on the t e s t , would be g e n e r a l , a p p l y i n g e q u a l l y to a l l d e s i g n s . Obviously, i n our method of  24 s c o r i n g we do n o t know t o what extent scores a r e i n f l u e n c e d by t h e e f f e c t o f t h e i n d i v i d u a l d e s i g n on t h e s u b j e c t , and t o what extent by t h e s u b j e c t s a t t i t u d e toward t h e t a s k o f t a k i n g t h e t e s t . 1  Consequently, i t might be h y p o t h e s i z e d  that schizophrenic  t o r t i o n s a r e due t o m o t i v a t i o n a l f a c t o r s ,  t h i s theory  dis-  being  c o n c e i v a b l e a l s o i n t h e l i g h t o f p s y c h o l o g i c a l t h e o r i e s about the s c h i z o p h r e n i c p e r s o n a l i t y .  L i t t l e r e s e a r c h has been done  i n which m o t i v a t i o n a l v a r i a b l e s have been manipulated i n order to assess t h e i r e f f e c t s on s c h i z o p h r e n i c performance on t h i s test.  The present  study was designed  t o t e s t the h y p o t h e s i s  t h a t an e x p e r i m e n t a l l y produced i n c r e a s e i n m o t i v a t i o n ,  i n the  form o f v e r b a l reward, would improve the performance o f s c h i z o p h r e n i c p a t i e n t s on t h e Bender-Gestalt  test.  d e v i a t i o n s would be seen i n the r e p r o d u c t i o n s the B e n d e r - G e s t a l t  That i s , fewer o f the d e s i g n s o f  t e s t by those s c h i z o p h r e n i c p a t i e n t s who had  r e c e i v e d the v e r b a l reward than by those who had n o t . Summary Schizophrenia,  o r dementia praecox, appears to comprise  a r e l a t e d group o f i l l n e s s e s r a t h e r than a s i n g l e d i s e a s e The  entity.  c l a s s i c a l d i v i s i o n o f s c h i z o p h r e n i a i n t o f o u r major subtypes,  paranoid,  c a t a t o n i c , hebephrenic, and simple,  suggests t h a t  t h e r e i s g r e a t v a r i a t i o n among s c h i z o p h r e n i c s w i t h r e g a r d to symptoms and m a n i f e s t a t i o n .  Whatever e t i o l o g y of t h i s  disease,  impairment o f mental e f f i c i e n c y seems to be the most obvious e f f e c t o f the schizophrenic process.  T h i s impairment i s shown  i n b o t h day-to-day f u n c t i o n i n g , and i n performance on standardized psychological tests.  I f t h i s impairment i s due t o psycho-™  l o g i c a l p e c u l i a r i t i e s such as d i s i n t e r e s t , n e g a t i v i s m ,  or lack  25 of motivation, In such case, one  the c o n d i t i o n i s u n l i k e l y to be  irreversible.  improved performance might be brought about i f  c o u l d c r e a t e a more p o s i t i v e a t t i t u d e and arouse g r e a t e r  m o t i v a t i o n i n the s u b j e c t .  I t i s j u s t such a s i t u a t i o n t h a t  t h i s study seeks to c r e a t e and assess by o f f e r i n g v e r b a l reward to a group of s c h i z o p h r e n i c p a t i e n t s w h i l e they are the Bender-Gestalt  performing  t e s t , and by comparing the performances so  o b t a i n e d w i t h those produced by another group of under o r d i n a r y c o n d i t i o n s of Bender-Gestalt  schizophrenics  administration.  Chapter I I I METHOD  In the p r e s e n t  i n v e s t i g a t i o n , an attempt was made t o  test the hypothesis that experimentally improve s c h i z o p h r e n i c Gestalt test.  induced m o t i v a t i o n  will  p a t i e n t s ' performance on the Bender-  F o r t h i s purpose, t h e t e s t was administered  under  ordinary  c o n d i t i o n s t o a group o f p a t i e n t s diagnosed as s c h i z o -  phrenic,  and t h e r e s u l t s obtained were compared w i t h those from  another group o f p a t i e n t s when v e r b a l reward was d u r i n g a d m i n i s t r a t i o n o f the t e s t .  introduced  The f o l l o w i n g d e s c r i b e s the  procedure by which t h e i n v e s t i g a t i o n was conducted. S e l e c t i o n o f Subjects From p a t i e n t s admitted to t h e Crease C l i n i c d u r i n g t h e F a l l o f 1960, 46 s u b j e c t s were s e l e c t e d f o r t h i s study. A l l s u b j e c t s had been diagnosed by c l i n i c s t a f f as s c h i z o p h r e n i c , uncomplicated by n e u r o l o g i c a l involvement o r primary p h y s i c a l d i s a b i l i t y , such as e p i l e p s y , and c h a r a c t e r i z e d as r e l a t i v e l y undeteriorated.  To c o n t r o l the p o s s i b l e i n f l u e n c e s on t e s t per-  formance o f c u l t u r a l background, sex, experience w i t h h o s p i t a l i z a t i o n , and w i l l i n g n e s s f o r t e s t i n g , s e l e c t i o n was f u r t h e r r e s t r i c t e d to p a t i e n t s who were: (1)  white, n a t i v e born;  (2)  female ( t h i s c h o i c e o f sex based p a r t l y on t h e f a c t t h a t t h e examiner was a l s o  female);  27 (3) f i r s t admission without p r e v i o u s h o s p i t a l i z a t i o n and/or p s y c h i a t r i c  treatment;  (4) p s y c h o l o g i c a l l y a c c e s s i b l e f o r t e s t i n g  purposes.  As each p a t i e n t was s e l e c t e d as a s u b j e c t f o r t h i s  study,  she was a s s i g n e d t o e i t h e r t h e experimental o r c o n t r o l group. Assignment was made by matching each member of the experimental group w i t h a c o n t r o l on the b a s i s o f : (1) age — w i t h i n a two year  range;  (2) e d u c a t i o n - w i t h i n a one grade range. Age and e d u c a t i o n were chosen as matching c r i t e r i a because t h e r e i s some evidence ( P a s c a l , 1950; P a s c a l and S u t t e l l , 1951) t h a t these two v a r i a b l e s have a s i g n i f i c a n t i n f l u e n c e upon performance on the B e n d e r - G e s t a l t  test.  To check the a c t u a l e q u i v a l e n c e of the groups thus achieved, t h e median and s e m i - i n t e r q u a r t i l e range o f the two groups f o r age, e d u c a t i o n , and l e n g t h o f h o s p i t a l i z a t i o n were o b t a i n e d and a r e presented i n T a b l e I .  TABLE I  Though no attempt was made by r e s t r i c t i o n o r matching t o c o n t r o l s u b - d i a g n o s t i c group and g e o g r a p h i c a l area, t h e d i s t r i b u t i o n s shown i n T a b l e 2 suggest t h a t the two groups a r e a p p a r e n t l y s i m i l a r i n these r e s p e c t s a l s o .  TABLE 2  28  TABLE I AGE, EDUCATION, AND LENGTH OF HOSPITALIZATION OF EXPERIMENTAL AND CONTROL GROUPS  Group  N  Age i n y r s . Median  Experimental  23  32  Control  23  32  Yea:rs of Educaltion  S.I.R.* Median S.I.R.  9.2  *S.I.R. ( s e m i - i n t e r q u a r t i l e range)  Days of Hospitalization Median  S.I.R.  11  1.5  22  13.5  11  1.5  35  11  29  TABLE 2 SUBDIAGNOSTIG AND GEOGRAPHICAL BREAKDOWN OF EXPERIMENTAL AND CONTROL GROUPS  N Diagnosis Experimental  Paranoid  schizophrenia  Control  8  11  0  1  2  1  1  2  8  5  4  3  Urban  12  14  Rural  11  9  Hebephrenic Catatonic Simple  schizophrenia  schizophrenia  schizophrenia  Undifferentiated Schizoaffective  Geographical  schizophrenia  area  30 Although i t would have been d e s i r a b l e t o have t e s t e d the s u b j e c t s b e f o r e commencement of p h y s i c a l o r chemical ments, t h i s was such treatment all  treat-  not f e a s i b l e as i t i s C l i n i c p o l i c y to s t a r t almost immediately  a f t e r admission.  As i t was,  s u b j e c t s were r e c e i v i n g t r a n q u i l i z i n g drugs a t the time of  testing. Experimental  Procedure  Between seven and s i x t y days a f t e r admission, j e c t was  each sub-  g i v e n t h e B e n d e r - G e s t a l t t e s t , under e i t h e r c o n t r o l o r  experimental c o n d i t i o n s .  Regardless o f group, the t e s t was  m i n i s t e r e d as t h e s u b j e c t became a v a i l a b l e .  ad-  A l l s u b j e c t s were  t e s t e d i n d i v i d u a l l y , by the same examiner, i n the same room under s i m i l a r c o n d i t i o n s of l i g h t i n g , h e a t i n g , n o i s e , e t c . , d u r i n g p e r i o d s of the day t h a t d i d not c o n f l i c t w i t h p a t i e n t treatment,  a c t i v i t i e s , o r meal hours.  The examiner met  each  s u b j e c t on her ward and accompanied her to the Psychology ment o f f i c e where the t e s t was  done.  I n b o t h the c o n t r o l and experimental groups, was  t o l d t h a t the examiner was  Depart-  each s u b j e c t  from the u n i v e r s i t y and was  some work on t h a t p a r t i c u l a r t e s t t o see how  i t c o u l d be  doing  used  to h e l p people w i t h d i f f i c u l t i e s o r problems such as t h e i r s . The examiner e x p l a i n e d t h a t the t e s t c o n s i s t e d o f n i n e d e s i g n s ( o r f i g u r e s ) which the s u b j e c t was  simple  to copy, f r e e hand,  without s k e t c h i n g ( s i n g l e l i n e drawing) on the paper w i t h which she had been p r o v i d e d . each d e s i g n was  The examiner then went on t o say t h a t  on one o f the cards which would be shown to the  31 s u b j e c t one a t a time.^"  No other comments were made by  examiner except i n r e p l y to questions  asked by the  subjects  about the t e s t , such as, "Should I s t a r t at the top of page?" or "Must they a l l go on one page?" e t c .  the  the  I f a subject  h e s i t a t e d or stopped d u r i n g her performance o f the drawings, the examiner simply s a i d " c o n t i n u e " o r "go  on."  An e f f o r t  was  made to see t h a t a l l i n s t r u c t i o n s and v e r b a l i z a t i o n s were g i v e n i n e x a c t l y the same words and i n the same tone of v o i c e f o r each s u b j e c t . With the experimental  group, a f u r t h e r element, i n the  form of v e r b a l reward i n t r o d u c e d at f o u r s p e c i f i c p o i n t s d u r i n g the t e s t , was  added to the f o r e g o i n g procedure.  of t h i s v e r b a l reward and CD  did quite well.  Now,  try  one."  (2) a f t e r F i g u r e 2 - "You  are p r o g r e s s i n g q u i t e w e l l . "  (3) a f t e r F i g u r e 4 - "You  d i d a v e r y good j o b .  see how  these l a s t two decided  Let's  much b e t t e r you can do on the next ones."  (4) a f t e r F i g u r e 6 - "I'm  I t was  placement  the form i t took a r e as f o l l o w s :  a f t e r F i g u r e A - "You the next  The  sure you can do v e r y w e l l  on  designs."  t h a t i f i t was  a t any time necessary  to g i v e more  than the s p e c i f i e d amount o f encouragement o r reward t o a subj e c t , the t e s t r e s u l t s would be a u t o m a t i c a l l y d i s c a r d e d , t h i s did not  but  occur.  1 T h i s procedure f o l l o w s the p r i n c i p l e s l a i d down by Bender (1946) f o r a d m i n i s t r a t i o n of the Bender-Gestalt t e s t .  32 T e s t performances were scored a c c o r d i n g to the s e t down by P a s c a l and  S u t t e l l (1951).  sheet f o r the Bender-Gestalt  criteria  A copy of t h e i r  score  t e s t i s i n c l u d e d i n Appendix A.  T h e i r s c o r i n g system i s based on the b e l i e f t h a t s c h i z o p h r e n i c i n t e l l e c t u a l impairment w i l l be r e f l e c t e d by d e v i a t i o n s i n t h e i r reproductions  o f the d e s i g n s of the Bender-Gestalt  test.  This  means t h a t the higher the score, as r e f l e c t e d by an i n c r e a s e d number of d e v i a t i o n s , the more severe i s the s c h i z o p h r e n i c cond i t i o n , and v i c e v e r s a .  For each s u b j e c t a t o t a l t e s t  e i g h t i n d i v i d u a l d e s i g n s c o r e s , and derived.  The  score,  a " c o n f i g u r a t i o n s c o r e " were  c o n f i g u r a t i o n s c o r e i s based upon the  placement, s i z e , and o r d e r of d e s i g n s .  subject's  A r e c o r d a l s o was  kept  of the time taken by each s u b j e c t to complete the test. * 0  S t a t i s t i c a l Treatment of the Data (1) The n u l l h y p o t h e s i s may  be formulated  f e r e n c e i n performance on the Bender-Gestalt  t e s t , as  i n t e s t s c o r e s , e x i s t s between the experimental group and the c o n t r o l (no reward) group. to t e s t t h i s  t h a t no  dif-  reflected  ( v e r b a l reward)  " C h i square" was  used  hypothesis.  (2) The medians and  s e m i - i n t e r q u a r t i l e ranges o f  e i g h t d e s i g n and c o n f i g u r a t i o n scores were o b t a i n e d and  the compared  f o r b o t h groups i n o r d e r to determine whether the v e r b a l reward produced i n t r a - t e s t v a r i a t i o n s i n performance. (3) I n o r d e r to determine whether one group might have had l o n g e r p e r s o n a l c o n t a c t w i t h the examiner than the group, a comparison was s u b j e c t s i n the two  other  made of the r e l a t i v e time taken by  groups to complete the  test.  the  33  (4) Because o f s u g g e s t i o n s t h a t d i a g n o s t i c subtype accounts f o r d i f f e r e n c e s i n s c h i z o p h r e n i c performance, t h e two groups were a l s o compared w i t h r e g a r d t o t h e median  test  score  o b t a i n e d by each d i a g n o s t i c subtype. ( 5 ) Because o f s u g g e s t i o n s made by o t h e r s t u d i e s t h a t v a r i a b l e s other than reward might be r e s p o n s i b l e f o r d i f f e r e n c e s i n performance between t h e two groups, a comparison was made between t e s t s c o r e s and: (a) education (b) l e n g t h o f h o s p i t a l i z a t i o n ( c ) urban v e r s u s r u r a l  environment  Chapter RESULTS AND  IV  DISCUSSION  D i f f e r e n c e s i n B e n d e r - G e s t a l t performance l e v e l by experimental and c o n t r o l groups a r e apparent (1) " C h i square" was  the  i n two ways.  used t o t e s t the n u l l  t h a t no d i f f e r e n c e e x i s t s between the experimental  hypothesis (verbal re-  ward) group and the c o n t r o l (no reward) group, w i t h r e s p e c t t o t e s t performance.  On the Bender-Gestalt t e s t a good s c o r e (low  s c o r e ) i s r e c e i v e d upon r e p r o d u c t i o n o f the d e s i g n s w i t h a minimum of d e v i a t i o n from, or d i s t o r t i o n Of,  the o r i g i n a l  figures.  The observed f r e q u e n c i e s of performance were 18 and 5, i . e . , 18 s u b j e c t s i n the experimental group had a b e t t e r (lower) s c o r e than t h e i r matched p a r t n e r s i n the c o n t r o l group, w h i l e 5 had worse s c o r e than t h e i r p a r t n e r s . 6.26  The o b t a i n e d v a l u e for")( 2  which i s s i g n i f i c a n t a t b e t t e r than the 2% l e v e l .  a was  This  suggests t h a t chance f a c t o r s alone were not r e s p o n s i b l e f o r the d i s p a r i t y i n performance between the two  groups.  (2) The median s c o r e of the s c h i z o p h r e n i c experimental group on the B-G f o r the group was  t e s t was 17.5.  p a t i e n t s the median was 31.  29 w h i l e the s e m i - i n t e r q u a r t i l e range For the c o n t r o l group of s c h i z o p h r e n i c  50 and the s e m i - i n t e r q u a r t i l e range  T a b l e 3 p r e s e n t s the medians and s e m i - i n t e r q u a r t i l e  of the e i g h t d e s i g n and c o n f i g u r a t i o n s c o r e s f o r both  TABLE 3  the  was  ranges  35  TABLE 3 MEDIANS AND SEMI-INTERQUARTILE RANGES OF THE EIGHT DESIGN AND CONFIGURATION SCORES FOR THE EXPERIMENTAL AND CONTROL GROUPS  Control  Experimental  Design  Median  S.I.R.  Median  S.I.R  1  2  1  5  4  2  2  1.5  5  4  3  3  4  4  4.5  4  4  4  4  3.5  5  3  2.5  4  4  6  5  2  5  3.5  7  3  2  3  5  8  3  2  4  4  2  3  2  4.5  Config.  36 s c h i z o p h r e n i c experimental and c o n t r o l groups.  Although the  median s c o r e s f o r t h e two groups a r e the same i n f o u r out o f n i n e c a s e s , the o t h e r f i v e a r e c o n s i s t e n t l y i n f a v o r o f the experimental group, as i s the o v e r a l l l e v e l o f performance. Both o f t h e f o r e g o i n g comparisons demonstrate a c l e a r d i f f e r e n c e i n B e n d e r - G e s t a l t performance by t h e experimental and c o n t r o l groups.  The d i f f e r e n c e s i n performance a r e c l e a r l y  i n f a v o r o f t h e e x p e r i m e n t a l group.  To determine whether t h i s  i s a r e f l e c t i o n o f the e f f e c t s o f v e r b a l reward, other p o s s i b l e sources o f d i f f e r e n c e were c o n s i d e r e d . (1) The median time taken by the s c h i z o p h r e n i c  experi-  mental group to complete the t e s t was 7 minutes and the semii n t e r q u a r t i l e range was 2.  For the schizophrenic control  group  the median was 7.5 minutes and the s e m i - i n t e r q u a r t i l e range was 2.5.  Although some s c h i z o p h r e n i c p a t i e n t s i n b o t h groups  pondered an e x c e s s i v e l y l o n g time over both easy and d i f f i c u l t d e c i s i o n s , w h i l e o t h e r s gave almost spontaneous,  uncritical  responses, i t can r e a d i l y be seen t h a t the above d i f f e r e n c e s are u n l i k e l y t o be s i g n i f i c a n t .  N e i t h e r group had a l o n g e r dur-  a t i o n o f c o n t a c t w i t h the examiner than t h e o t h e r . (2)  I n Table 4 a r e p r e s e n t e d the median t e s t  scores  f o r each d i a g n o s t i c subtype i n b o t h the experimental and c o n t r o l  TABLE 4  groups.  A l t h o u g h t h e number o f s u b j e c t s i n v o l v e d was too s m a l l  to r e a c h any f i r m c o n c l u s i o n s , d i a g n o s t i c subtype may account  TABLE 4 MEDIAN BENDER-GESTALT SCORE FOR EACH DIAGNOSTIC SUBTYPE OF THE EXPERIMENTAL AND CONTROL GROUPS  Schizophrenic subtype  Control  Experimental N  Median  N  Median  Paranoid  8  27.5  11  55  Hebephrenic  -  1  30  Catatonic  2  22  1  26  Simple  1  24  2  24.5  Undif f e r e n t i a t e c  8  48  5  72  Schizoaffective  4  27.5  3  33  -  38 f o r some d i f f e r e n c e s i n s c h i z o p h r e n i c performance.  Though the  two groups demonstrate s i m i l a r orders of achievement, t h e r e appears to be n o t i c e a b l y p o o r e r performance by t h e p a r a n o i d and u n d i f f e r e n t i a t e d s c h i z o p h r e n i c s than t h e o t h e r p a r t i c u l a r l y i n t h e c o n t r o l group.  classifications,  A t the same time, t h e  g r e a t e s t d i f f e r e n c e i n achievement between the two groups i s n o t i c e d i n two of these subtypes, s u g g e s t i n g t h a t c e r t a i n types of s c h i z o p h r e n i a a r e more s u s c e p t i b l e t o v e r b a l reward.  However,  s i n c e the number of s u b j e c t s i s g r e a t e r i n these i n s t a n c e s , the subtypes a r e not r e a l l y  comparable.  (3) K e n d a l l ' s tau was used t o compare o b t a i n e d t e s t scores w i t h e d u c a t i o n and l e n g t h o f h o s p i t a l i z a t i o n .  The present  study found a c o r r e l a t i o n o f -.35 between e d u c a t i o n and  B-G  scores f o r the e x p e r i m e n t a l group and a c o r r e l a t i o n o f -.13 f o r the c o n t r o l group. +.16  F o r the experimental group a c o r r e l a t i o n o f  was found to e x i s t between t e s t score and l e n g t h o f h o s p i -  t a l i z a t i o n , w h i l e f o r the c o n t r o l group a c o r r e l a t i o n o f was  obtained.  from z e r o .  These c o r r e l a t i o n s a r e not s i g n i f i c a n t l y  +.09 different  The median t e s t score made by p a t i e n t s coming from  a r u r a l area was  28 and the s e m i - i n t e r q u a r t i l e range was  For those coming from an urban environment the median was the s e m i - i n t e r q u a r t i l e range was  23.5.  32.5. 38 and  These f i n d i n g s suggest  t h a t none o f these f a c t o r s was o f s i g n i f i c a n c e i n the determinat i o n o f the r e s u l t s o f t h i s study.  However, these l a t t e r  results  might repay f u r t h e r i n v e s t i g a t i o n . From the f o r e g o i n g a n a l y s i s , d i f f e r e n c e s i n BenderG e s t a l t performance appear to have o c c u r r e d mainly as a r e s u l t  of the presence o r absence o f v e r b a l reward.  Given v e r b a l  reward, s c h i z o p h r e n i c p a t i e n t s i n t h i s i n v e s t i g a t i o n showed d e f i n i t e l y more f a v o r a b l e performance.  I t appears t h a t the  v e r b a l reward g i v e n t o the experimental  group a c t u a l l y produced  a more p o s i t i v e a t t i t u d e and h i g h e r m o t i v a t i o n ,  thus r e s u l t i n g  i n improved performance. The f i n d i n g s o f t h i s study c h a l l e n g e the theory d i s t u r b e d Bender-Gestalt tions i n perception.  that  performance i s a f u n c t i o n o f d i s t o r -  While m o t i v a t i o n a l v a r i a b l e s may not en-  t i r e l y account f o r t h e d i f f e r e n c e s between the c o n t r o l and experimental  groups, they appear t c be among t h e more s i g n i f i c a n t  influences.  T h i s i s i n keeping w i t h some o f the more  psycholog-  i c a l l y o r i e n t e d t h e o r i e s as t o t h e nature o f s c h i z o p h r e n i a .  In  view o f t h e degree t o which t r a n q u i l i z e r s modify s c h i z o p h r e n i c responses,  great c a u t i o n i s a d v i s a b l e i n i n t e r p r e t i n g f i n d i n g s  a r r i v e d a t under these  circumstances.  Chapter V SUMMARY AND  CONCLUSIONS  The purpose o f the p r e s e n t study was  to i n v e s t i g a t e  the e f f e c t o f v e r b a l reward upon s c h i z o p h r e n i c p a t i e n t s formance o f the B e n d e r - G e s t a l t t e s t .  F o r t y - s i x female p a t i e n t s ,  admitted to the Crease C l i n i c d u r i n g the F a l l o f 1960  and  diagnosed as s c h i z o p h r e n i c , were used f o r t h i s study. s u b j e c t was  per-  1  As each  s e l e c t e d , she was a s s i g n e d to e i t h e r the c o n t r o l  group o r the e x p e r i m e n t a l group.  Assignment was made by match-  i n g the members o f the two groups on the b a s i s o f age and education.  To reduce the p o s s i b l e i n f l u e n c e s o f o t h e r v a r i a b l e s such  as c u l t u r a l background and d u r a t i o n o f h o s p i t a l i z a t i o n , was f u r t h e r r e s t r i c t e d to p a t i e n t s who were:  selection  white, n a t i v e born;  a f i r s t admission w i t h o u t p r e v i o u s h o s p i t a l i z a t i o n and/or ment;  c o o p e r a t i v e and t e s t a b l e ;  treat-  and had been i n h o s p i t a l more  than seven and l e s s than s i x t y days.  Although s u b - c l a s s i f i c a t i o n  and geographic a r e a were n o t c o n t r o l l e d o r r e s t r i c t e d , the groups are a p p a r e n t l y s i m i l a r i n these r e s p e c t s . Between seven and s i x t y days a f t e r admission, each subj e c t was g i v e n t h e B e n d e r - G e s t a l t t e s t , under e i t h e r c o n t r o l o r experimental c o n d i t i o n s .  The c o n t r o l group was g i v e n the t e s t  under s t a n d a r d i z e d c o n d i t i o n s of a d m i n i s t r a t i o n . mental group, a f u r t h e r element was  F o r the e x p e r i -  added, i n the form of v e r b a l  reward i n t r o d u c e d a t f o u r s p e c i f i c p o i n t s d u r i n g the t e s t .  Test  41  performances were s c o r e d a c c o r d i n g to the c r i t e r i a s e t down by P a s c a l and S u t t e l l (1951).  For each s u b j e c t a t o t a l t e s t s c o r e ,  e i g h t i n d i v i d u a l d e s i g n s c o r e s , and a " c o n f i g u r a t i o n " score were obtained. There was  a d e f i n i t e d i f f e r e n c e i n the s c o r e s o b t a i n e d  by the c o n t r o l and experimental  group on the B e n d e r - G e s t a l t  test.  On the t e s t as a whole, the experimental group c o n s i s t e n t l y achieved more f a v o u r a b l e r e s u l t s than d i d the c o n t r o l group. " C h i square"  showed t h a t these d i f f e r e n c e s were s i g n i f i c a n t at  the 2 per cent l e v e l . the two  A comparison of the f i g u r e scores made by  groups r e v e a l e d a performance l e v e l c o n s i s t e n t l y i n f a v o r  o f the experimental by the two  group, as d i d the median o v e r a l l s c o r e s made  groups.  The p o s s i b i l i t y t h a t the d i f f e r e n c e s o b t a i n e d may been due  have  to o t h e r c o n d i t i o n s than v e r b a l reward (e.g., d i f f e r -  ences i n education, d u r a t i o n of c o n t a c t w i t h examiner,  geographic  area, d i a g n o s t i c subtype), l e d to a comparison between the groups w i t h r e s p e c t to these v a r i a b l e s .  The r e s u l t s of  two  these  comparisons r e v e a l e d no s i g n i f i c a n t d i f f e r e n c e s between the  two  groups. Thus, i t appears warranted reward was  to conclude  a s i g n i f i c a n t determinant  of t h e experimental group.  that v e r b a l  of the improved performance  T h i s suggests  that motivational  i n f l u e n c e s , though not e n t i r e l y r e s p o n s i b l e f o r the impairment of s c h i z o p h r e n i c i n t e l l e c t u a l f u n c t i o n i n g , may important determinants  of i t .  be among the more  F u r t h e r i n d i c a t e d i s the  42  p o s s i b i l i t y t h a t the apparent b e h a v i o r a l d e t e r i o r a t i o n observed i n s c h i z o p h r e n i a even r e v e r s e d ,  s i n c e i t may  and may  intellectual be l e s s e n e d ,  be f a u l t y m o t i v a t i o n a l  and  systems  r a t h e r than i r r e v e r s i b l e l o s s e s of fundamental c a p a c i t i e s i n thinking, conceptualizing,  and  acquiring s k i l l s ,  t h a t are i n -  v o l v e d i n t h i s type of d i s o r d e r . 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Rabin, A . I . T e s t - s c o r e p a t t e r n s i n s c h i z o p h r e n i c and nonp s y c h o t i c s t a t e s . J . Gen. P s y c h o l . . 1941, 12, 91-100. Shakow, D. tions.  The nature o f d e t e r i o r a t i o n i n s c h i z o p h r e n i c Nerv. Ment. P i s . Monogr.. 1946, No. 70.  condi-  Shapiro, M.B., K e s s e l l , R., and Maxwell, A.E. Speed and q u a l i t y of psychomotor performance i n p s y c h i a t r i c p a t i e n t s . J . C l i n . P s y c h o l . . 1960, 16, 266-271. Wechsler, D. The measurement and a p p r a i s a l o f a d u l t i n t e l l i g e n c e . B a l t i m o r e : The W i l l i a m s & W i l k i n s Co., 1958. Weckowicz, T.E., and H a l l , R. O i s t a n c e constancy i n s c h i z o p h r e n i c and n o n - s c h i z o p h r e n i c mental p a t i e n t s . J . C l i n . P s y c h o l . . 1960, 16, 272-276. Weinberg, S.K. S o c i e t y and p e r s o n a l i t y d i s o r d e r s . P r e n t i c e - H a l l , I n c . , 1952, 182-234.  New York:  46  Werkman, S.L. Present trends i n s c h i z o p h r e n i c r e s e a r c h : i m p l i c a t i o n s f o r c h i l d h o o d s c h i z o p h r e n i a . Amer. J . Orthop s y c h i a t .. 1959, 29, 473-478. Wittman, M.P. An e v a l u a t i o n o f opposed t h e o r i e s concerning the e t i o l o g y o f s o - c a l l e d "dementia" i n eiementia praecox. Amer. J . P s y c h i a t . . 1937, 93, 1363-1377. Zucker, K., and Hubert, W.H. A study o f t h e changes i n f u n c t i o n found i n s c h i z o p h r e n i c thought d i s o r d e r . J . Ment. S c i . . 1935, 81, 1-45.  APPENDIX A  Copy of the Score Sheet for the BENDER-GESTALT TEST  Date . SCORE SHEET - BENDER-GESTALT TEST Age  Name Education  Sex Diagnosis  I.Q.  Design 1  Design 2  1. 2. 3. 4. 5. 6. 7. 8. 9. 10.  1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.  Wavy l i n e (2) Dot, dash, c i r (3) Dashes (2) C i r c l e s (8) No d o t s (2) each D b l . row ( 8 ) Workover (2) Sec. attempt ( 3 ea) R o t a t i o n (8) Des. m i s s ( 8 ) , Design T o t a l  Wavy l i n e (2) Dash o r dots ( 3 ) Shape c i r . (3) C i r c . miss, e x t . (3) C i r c . touch. (5) Dev. s l a n t (3) No. c o l . (2 ea) F i g . on 2 l i n e s (8) Guide l i n e s (2) Workover (2) Sec. attempt ( 3 ea) R o t a t i o n (8) Des. miss, (8) Design T o t a l  Design 3  Design 4  1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.  1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.  Asymmetry (3) Dot, dash, c i r . ( 3 ) Dashes (2) Circles.(8) No. d o t s (2) E x t r a row (8) B l u n t i n g (8) D i s t o r t i o n (8) Guide l i n e s . ( 2 ) Workover (2) Sec. attempt (3 ea) R o t a t i o n (8) . Des. miss (8) Design T o t a l  -47-  Asym. C r v . (3) Break c r v . (4) C r v . n o t c e n t e r (1) C u r l s (4) Not j o i n e d ( 8 ) C r v . r o t a t i o n (3) Touch-up (8) . Tremor (4) D i s t o r t i o n (8) Guide l i n e s , ( 2 ) Sec. attempt.(3 ea) Rotation (8) Des. miss. (8) Design T o t a l  SCORE SHEET - BENDER-GESTALT TEST page 2: Design 5  Design 6  1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.  1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.  Asymmetry (3) Dot, dash, c i r c . ( 3 ) Dashes (2) C i r c l e s (8) Ext. J o i n , d o t (2) Ext. r o t a t i o n (3) No. d o t s (2) D i s t o r t i o n (8) Guide l i n e s (2) Workover (2) Sec. attempt (3 ea) R o t a t i o n (8) Des. m i s s . (8) Design T o t a l  Asymmetry (3) Angles (2) P t . C r o s s i n g (2ea) Crv. e x t r a (8) Dble. l i n e (1 ea) Touch-up (8) Tremor (4) D i s t o r t i o n (8) Guide l i n e s 02) Workover (2) Sec.attempt (3 ea) R o t a t i o n (8) Des. miss. (8) Design T o t a l  Design 7  Design 8  1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.  1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.  Ends no. j o i n (8) Angles e x t . (3) Angles miss (3) Ext. s c a t . (3) D b l . l i n e (1 ea) Tremor (4) D i s t o r t i o n s (8 ea) Guide l i n e s (2) Sec. attempt (3 ea) R o t a t i o n (8) Des. miss (8) Design T o t a l  Config. 1. 2. 3. 4. 5. 6. 7.  DESIGN TOTALS  Design  1. ... 2. 3. ... 4 Config.  Place.Des. A.(2) Overlap (2 ea) Compression (3) L i n e s Drawn (8) Order (2) No o r d e r (8) R e l . s i z e (8) Total  T o t a l Raw  Ends no j o i n (8) Angles e x t . (3) Angles m i s s . (3) Ext. s c a t . (3) D b l . l i n e (1 ea) Tremor (4) D i s t o r t i o n (8 ea) Guide l i n e s (2) . Workover (2) Sec. attempt (3ea) R o t a t i o n (8) Des. miss (8) Design T o t a l  Standard  Score  -48-  5. 6. 7. 8.  Score  

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