The Bender-Gestalt test: ananalysis of certain clinical groups

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Authors Kim, Luke I. C., 1930-

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KIM, Ik Chang. THE BENDER-QESTALT TEST: AN ANALYSIS OF CERTAIN CLINICAL j GROUPS. , |

i

University of Arizona, Ph. O., 1960 Psychology, clinical

University Microfilms, Inc., Ann Arbor, Michigan j

THE BEMDER-6ESTALT TEST: AM ANALYSIS OF

CERTAIN CLINICAL (ROOFS

by

Ik Chang Kia

A Dissertation Submitted to the Faculty of the

DEPARTMENT OF PHILOSOPHY AND PSYCHOLOGY

In Partial Fulfillment afc the Requirements -J fflr the Degree of

DOGTCE OF PHILOSOPHY

La the Graduate College

UNIVERSITY GF ARIZONA

I960

THE UNIVERSITY OF ARIZONA

GRADUATE COLLEGE

I hereby recommend that this dissertation prepared under my

direction by nnrnthy T. Mar quart., Fh.n.

entitled The Bonder-Qeattalt Test; An Analysis of

Certain Clinical Qroupa

be accepted as fulfilling the dissertation requirement of the

degree of Doctor of Philosophy

Dissertation Director/" Date

After inspection of the dissertation, the following members

of the Final Examination Committee concur in its approval and

recommend its acceptance:1*

QeyitU V, /9^o

'Afi. l 7 )1 s . 6, /It* —-r

*This approval and acceptance is contingent on the candidate's adequate performance and defense of this dissertation at the final oral examination. The Inclusion of this sheet bound into the library copy of the dissertation is evidence of satisfactory performance at the final examination.

V'

STATEMENT BY AUTHOR

This dissertation has been subnitted in partial fulfillment of requirements for an advanced degree at the University of Ari­zona and is deposited in The University Library to be made avail­able to borrowers under rules of the library.

Brief quotations from this dissertation are allowable without special permission, provided that aeourate acknowledaaent of source is aade* Requests far permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in their judpnent the proposed use of the material is in the interests of scholarship* in all other instances, however, permission must be obtained Item the author*

This dissertation has been approved on the date shewn below:

SIGNED:

APPROVAL BY DISSERTATION DIRECTOR

\/Dorothy 1. iMuart Associate Professor of Psychology

0

ACKNONLEDGMENTS

The author wishes to express his gratitude to all members

of the faculty of the Department of Philosophy and Psychology. In

particular, he wishes to thank Neil R. Bartlett, Ph.D., Head of the

Department; Arnold Meadow, Ph.D.; Lewis Hertz, Ph.D. and William

J. MacKinnon, Ph.D who gave generously of their time and encour­

agement.

The author is especially indebted to Dorothy I. Marquart,

Ph.D., who directed this dissertation, for her inspiration, under­

standing, and patience.

TABLE OF CONTENTS

\

££!•

LIST CF TABLES ....... ..../•

I. INTHCDUCTIDN . « . . . ...... 1

A* ^Historical Review and a Stat went of the Present Status of the Bender-Qestalt Test •••••;. 3

B. Theoretical Considerations • ••••«•• 13

1. Perceptual Aspects «•••••••••••••••• 13

2. Motor Aspects ...••••o..... •••••• 17

11. STATEMENT CF PROBLEM .......... . . 20

III. METHODS. .......... . 21 ; t i i

A* Subjects • 21

B. Administration of the Test • 25

C. Scoring. • •••»...• • ••••••• 26

D. Attitude of the Subject 27

IT* RESULTS • •••... 28

A. Comparisons of Pascal and Snttell Scores of the Various Qroups Disregarding Age Variation 28

B. Effects of Age Variation Upon the Pascal and Suttell S o a r e s • • • • • • • • • • • • • • • • • • . . . 32

C. Comparisons of the Pascal and Suttell Raw Scores ^ far Qroups with Age* Sex, and Idtucstion Matched. .... 36

D. Effects of Education on Pascal and Suttell Soares .... 39

E. Comparisons of Frequencies of Deviations Within Soaring Categories For Qroups With Age, Sex, and Education Matched • ..••••••••• U8

F. Categary Analysls A*ong Vwiousa-oupeWithin the Age Rang® of 1$ and $0 Years • *6

iii

*S2»

1* Group A $6

2. Qroup B .•••••• 60

Q. Age Effects Upon Category Deviations Produced by the Noraal Subjects, .. ••••• 60

V. CONCLUSIONS AND DISCUSSION 66

VI. 3UMIUBI . . . c ... 75

APPENDIX A • • • • » . 78

APFSND2XB 82

t t W K H K H C K S « • • • • • • • • • • • • • • • • • • • • • • • • • • • 8 7

iY

LIST OF TABLES

Table 1 Age, Sex, and Educational Background of the Subjects Employed ............... 22

Table 2 Type* of Schisophrenic Subjects . , 2k

Table 3 Distribution of Pascal and Suttell Raw Scores For All Clinical Groups . . . 29

Table U The Pasoal and Suttell Raw Score Means and Standard Deriations for Each Gtoup »••••••• 30

Table 5 Significance of Differences Between Pascal and Suttell Raw Score Means of Each Group 31

Table 6 Relationship Between Age and Score Obtained By the Normal Subjects * 33

Table 7 Median Test and Kruskel-Wallis Test Measures of the Effect of the Age of the Normal Subjects Upon Pasoal-and Suttell Raw Scores •••••••••• 3U

Table 8 Test of Significance for Raw Scare Mean Differences Among Three Age Levels Between 15 and 50 Tears i n t h e . N o r m a l O r o u p , • • • • • • • • • • • • • • . . • 3 5

Table 9 Relationships Between Age and Score of Schisophrenic and Alcoholio Subjects 37

Table 10 Test of Significance of Differences Between Pascal and Sottell Raw Score Means of (froups Matched for Age, Sex, and Education ••••••••• 38

Table 11 Effects of Education on the Pascal and Suttell Raw Scores of Various Groups (15 and 50 Tears) • • • •' 1*0

Table 12 Analysis of Variance of Pascal and Suttell Raw Scores of the Three Educational Groups of Schisophrenics . . 1*1

Table 13 Analysis of Variance of Pascal and Suttell Raw Scores of the Three Educational Groups of Alcoholics « • • • U2

Table I4 Analysis of Variance of Pascal and Suttell Raw Scores of the Three Educational Groups of Control Subjects. • U3

•

Table 1$

Table 16

Table 17

Table 18

Table 19

Table 20

Table 21

Table 22

Table 23

Table 2lt

Table 2J>

Table 26

Table 27

Table 28

Contrasts Aaong the Mean Scores of the Three Educational Oroups of Schisophrenics

«

Contrasts Anong the Mean Scores of the Three Educational (froups of Alcoholics . .

Contrasts Among the Mean Scores of the Three Educational Groups of Control Subjects •

Pascal and Suttell Mean Raw Scores of the Schisophrenic, Alcoholic* and Control Subjects Within the Age Range of 1$ and 50 Years. . . .

Z Score Means of the Schisophrenic* Alcoholic, "and Control Subjects Within Range of l£ and $ 0 Y e a r s o f A g e • • • • • • • • • • • • • • •

Vilcozon Test for Differences in Category Scores of 31 Pairs of Schisophrenic and Control Subjects Matched for Age, Sex, and Education

Wilooxon Test for Differences in Category Scores of 33 Pairs of Alcoholic and Control Subjects Matched for Age, Sex, and Education <

Wilcoxon Test for Differences in Category Scores of 21 Pairs of Qironic BraiA Syndrome and Control Subjects Matched for Age, Sex, and Education . . • ,

Wilcoxon Test for Differences in Category Scores of 30 Pairs of Alcoholic and Schisophrenic Subjects Matched far Age, Sex, and Education • ••••••«

Chi Square Measures of Differences Between Schisophrenic and Control Subjects (Oroup A) f o r S c o r i n g C a t e g o r i e s • • • • • • • • • • • « • • <

Chi Square Measures of Differences Between Alcoholic and Control Subjects (Group A) for Scoring Categories • ... • •••• • • •• • .

Chi Square Measures of Differences Between Schisophrenic and Alcoholic Subjects (Group A) f o r S c o r i n g c a t e g o r i e s • • • • • • • • • • » •

Chi Square Measures of Differences Between Schisophrenic and Control Mashers of Group B for the Scoring Categories Which were Significantly Different,in.Group A •

Chi Square Measures of Differences Between Alcoholic and Control Msabers of Group B for the Scoring Categories which ware Significantly D i f f e r e n t i n G r o u p , A * * * * * * * * * * * * * * 62

•i

/ . v,

Table 29 Chi Square Measures of Differences Between Alcoholic and Schisophrenic Menbara of Oroup B Page for the Scaring Categories which were Significantly Different in Group 63

Table 30 Category Deviation Analysis Between the Narnal 15-50 Tear Old Subjects and the Normal 51-8U Tear Old Subjects • 65

Table 31 Differences Significant at the 5 per cent Level Between Deviation Categories for Various Or cups. . , 72

APPENDIX A

Table 1 Age, Sax, and Education of Schisophrenic and Control Matched Oroups ••»••••••••.••• 78

Table 2 Age, Sex, and Education of Alcoholic and Control Matched Groups ..••••••••»«••• 19

Table 3 Age, Sex, and Education of Chronic Brain Syndrome and Control Matched Groups ••••••. •••••• 80

Table U Age, Sex, and Eduoation of Alcoholio and Schisophrenic Matched Groups ••«••••••••* 81

Til

I. INTRODUCTION

In the past two or three decades, there has been an increasing

interest shown in perception and in psycho-motor activities as a means

of gaining a more complete understanding of personality and behavior.

This increased emphasis on a broad aspect of perception is due to recog­

nition of findings that perception is not a passive and literal copying

of stimuli, but has a project!** cor expressive nature reflecting the

observer*s inner state (22, 60), Gardner iiurphy said, "the perceived

world mirrors the organized need pattern within" (62, p. 351)* 2n order

to develop a technique through which one can explore the "organised need

pattern11, many investigators have studied intensively various potential

tools with different theoretical frameworks.

One approach has been to study perception in an ambiguous situa­

tion where "in the, absence of any compelling organization in the; material

itself, the person has greater opportunity to structure it in his own

unique fashion" (22, p. 11*6). However, Witkin (22) suggested that under-

standing of perceptual processes in well-structured conditions is just as

important as in unstructured situations to form a comprehensive estimate

of the role of personal factors in perception. The present writer believes

that this is the more common process in daily life, and that this approach

can be more MflTy controlled and handled than the approach utilizing

anbiguous stimuli. With these different emphases, some investigators have

constructed highly asbiguous projective tests and others, mare structured

tests*

Seme of the tests, such as the Rorschach Inkblot Test, the

Thematic Apperception Test, the Blacky Pictures, the Rosenzweig Pic­

ture-Frustration Study, and the Word Association Test, utilize verbal

responses. Others, such as the Draw-A-Person Test, Bender Visual llotor

Gestalt Test, House-Tree-Person Test, and the Gehl-Kutash Graphomotor

Projective Test, utilize the graphic-motor approach. A third approach

x includes painting, free play, and dramatic methods. These include

the World Test, Psychodraaa, the free play technique, et cetera.

It is claimed by supporters of the graphic-motor tests that

oneis graphic performance has greater individuality and is less subject

to voluntary control than are his verbal responsea^(12, 28). Thus they

consider that graphic reproduction presents a truer picture than the

verbal response.

Graphic-motor tests can be divided into two groups: 1) Tests

demanding performance of a structured task, and 2) tests demanding

performance of unstructured tasks. The first of these two types is

illustrated by Machover«s Draw-A-Person Test ($8), the Bender Visual

Motor Gestalt Test, the Mirror Drawing Test of Wechsler and Hartogs (87),

and the Kouse-Tree-Person Test (21*, 25). In these tests, the nature

of the task in which the subject is to engage is set by the examiner.

The second is illustrated by the Gehl-Kutash Test (55) in which no

model is given to the subject to be followed and the subject draws while

blind-folded. A second test belonging to this category is the Scrib­

bling Game of Paula Elkisch (30)*

Anastasi and Foley, in their series of articles on "A survey of

the literature on artistic behavior in the abnormal" (U, 5, 6, 7» 8),

point out that drawings as an index of perceptual disorder drew much

attention and interest from earlier researchers* especially Gestalt

psychologists. After gathering data available in the existing liter­

ature on drawing, they concluded that "among the characteristics found

to differentiate more clearly among different psychoses may be mention­

ed: the subject's attitude toward the drawing, before, during and after

its production; the degree of pressure exerted on the paper; evidence

of tremor and motor incoordination; alteration in size of drawing;

stereotypy; relative poverty or richness of detail; and the use of -

color" (7, p. 232).

Among the drawing tests, the Bender Visual Uotor Gestalt Test

(to be referred to as the Bender-Gestalt Test from now on) has been

one of the very widely used clinical tools* Recently an increasing

amount of literature and interest in this test has been noted. However,

in the midst of inconclusive and conflicting results, the Bender-

Qestalt Test awaits further validation and improvement of scoring meth­

ods before it can be used with confidence for clinical diagnoses. The

purpose of this paper is to explore more fully the Bender-Gestalt Test

and its clinical use.

A. A HistoricalReview and a Statement of the fresent Status of the Bender-Gestalt Test

The Bender-Gestalt Test consists of nine relatively simple

designs which the subject is asked to copy as they ere presented to

him one at a time on separate cards. The designs, which include geo­

metrical configurations composed of dots, straight lines and curved

lines, were constructed to bring out certain Gestalt principles*

These designs were originally used by Wertheimer, and Bender selected

nine designs from approximately thirty patterns which Wertheimer used

in his 1923 classical paper on Qestalt principles (88),

It was Bender who first postulated the value of these drawings

as a measure of clinical disturbances. She published a monograph in

1938 (13) in which she discussed and summarised her findings from var­

ious psychiatric patients' reproductions. Her subjects included chil­

dren, schisophrenics, manic-depressive psychotics, mental defectives,

and sensory aphasics. She also described the genetic development of

visual-motor functions among children of American as well as of prim­

itive African culture. Bender's Gestalt concepts include regression

to more primitive gestalten in psychotics; disturbances in the rela­

tionship between figure and ground; the tendency to use "compact, en- >

closed and 'energy-saving' units"; and spatial disorientation.

After the first publication by Bender in 1938 on the Bender-

Gestalt Test as a clinical tool, clinical researchers were quick to

follow in attempting to improve standardization procedures and scoring

methods of the test, and to verify the usefulness of the test. Bender

provided in her monograph (13) many clinical materials illustrating

the Bender-Gestalt performances of different psychiatric groups, but

she did not attempt to provide a quantified sooring method.

Hutt, in 19U5 (£0, £l), proposed a standard method of admin­

istration of the test performance! as a projective technique. Although

Hutt's study rendered a valuable contribution and prompted other re­

searchers to do follow-up investigations, his study did not employ a

statistical method and relied on intuitive interpretation based on

v

clinical experience. Gobetz (36) criticized Hutt's method as utilising

the subjective rather than the objective approach and as lacking clear

objective definitions of his diagnostic "syndromes." X .. .

A comprehensive study of the Bender-Gestalt Test was conducted

in 19k& by fiillingslea (lit) in an attempt to establish an objective

scoring method* He compared the reproductions made by 100 psychoneurotic

male adults with those of $0 normal males. He concluded that 63 indices,

involving such things as the measurement of lengths of lines, angles,

areas, irregularities In shape, and rotation of a whole figure or part

of a figure, can be established to give "quantifying" coefficients to

2$ test factors. The split-half index-score intercarrelations can be

illustrated by the following values: total rotation,«61; closure, .50;

and size difference, .62. Comparing Billingalea's results with those

of Hutt, on*) finds that Hutt's Bender-Qestalt signs of psychoneurosis

are not supported; that there is little agreement between the two

studies as to diagnostically significant patterns. Billingslea also

concluded that, "though three factors show a degree of inter-figure

reliability, test factors with indices from several of the figures tend

to be unreliable and to lack validity" (lU, p. 19)*

Other objective scoring systems have been developed by Pascal

and Suttell (6$), by Peek and Quast (66), and by Gobetz (36). Pascal

and Suttell published, in 1951, a book designed to be a scoring manual

for the Bender-Qestalt Test (65). The merit of their system is that

each scorable deviation is clearly defined, not only in verbal description

but also in appropriate illustrations for each deviation so as to provide

such, facilitation to a scorer. Scoring is audi less tedious than by other

methods partially because of the existence of a convenient score sheet

and the manual, A table is provided for converting raw scores to Z

scares for high school and college groups* No converting table is pro­

vided for those with only a grade school education. The principal

weakness in the sampling employed in this study is the assumption for

the purpose of establishing norms, that all in-patients are psychotics

and that all out-patients are neurotics.

A number of studies have been conducted to prove or disprove

the Pascal and Suttell system. Addington (1) found that Pascal and

Suttell's method significantly discriminated between non-clinical sub­

jects and schizophrenic patients. Addington found test-retest reliabil­

ity coefficients of .71 for schisophrenics and of .76 for the non-clin­

ical group. Lonatein (57)# Curnutt (26), and B car land and Deabler (20)

have also supported the Pascal and Suttell system.

On the other hand, Tamkin, in a study of 27 psychotics and 27

patients suffering from neurotic conditions or personality disorders,

concluded that "the Bender-Gestalt, scored by the Pascal and Suttell

method, has dubious effectiveness as a differential diagnostic instru­

ment for the functional mental disorders" (82, p. 356). Qobets also

concluded in his study that "the scoring method developed by Pascal

and Suttell fails to differentiate the 138 normal and neurotic subjects

of the matched criterion groups" (36, P* 27)*

Peek and Quast's relatively simple scoring method (66) was

presented in 1951# Their system is to tally instances of certain per­

formance characteristics. Thus the recording may be, instead of a

point scoring system as seen in Pascal and Suttell's method, a simple

counting of the occurrences of the factors in question* or the notation

of the specific elements or figures in which the factor occurs. They

presented convenient ways of defining the relative size dimension such

as constriction or expansion, and paid attention to some features which

other investigators failed to consider* The disadvantages of their

method are the fact that reliability and validity of the method are not

given in theii- manual* that the scoring categories were selected on an

a priori basis* and that the definition of scorable categories is not

as clear as that presented by Pascal and Suttell.

A fifth scoring system was developed by Oobets (36) in 1953*

He tested 168 neurotics and 28$ control white male veterans for an ini­

tial validation study, and 118 adults of both sexes for a cross-valida­

tion study* He collected a total of 1,533 test records ($11 initial

tests, $11 ret est a, and $11 recall tests) which he examined for 82 gen­

eral categories and 312 specific signs* From these signs 30 were select­

ed as a scoring system which "discriminated consistently between normal

and neurotics." Qobetz's results did not support Hutt*s "neurotic

syndrome." The scoring method of Pascal and Suttell also failed to

differentiate between Qobets's 136 normal and neurotic subjects.

Oobets should be complimented for a thorough and elaborate In­

vestigation and for using large samples. However, the total 312 scoring

signs which he originally used are much more difficult to utilise than

those of Pascal and Suttell* partially because they are numerous and

yet not presented systematically* It' has not been determined whether

Oobets «s "neurotic" signs are applicable to psychotics as well as

neurotios, since his extraction of the signs was based on neurotics.

Several psychologists* besides Hutt who was mentioned above* have

attempted to utilise the Bender-Gestalt Test as a projective technique.

Kitay in 19$2 ($1*) proposed a scoring method for projective usage. She

presented the V score which "measures intra-individual variability*" and

is related to "the degree of adherence to* or departure from font ele­

ments* " and the D score which seems to measure "the relative control or

lack of control of affect" (£U* p. 17U). The following correlations of

the V score-with certain Rorschach response categories are reported in

her paper: sum C* 0.27$ (CF / C), 0.28; M plus sum C* 0.3U; end U plus

sum (GF / C)* 0.37* Sucsek and Klopfer (80) attempted to determine the

associative values and affective associations of the figures.

If these scoring methods are to be evaluated* consideration should

be made of the criteria of a satisfactory scoring method. Peek (67)

pointed out that a^scoring system should bet 1) clearly defined in ob­

jective terms to make reliability possible* 2) must be simple enough to

meet the needs of the time-pressed clinicians* 3) must be optimal in the

level of function so that it will not exclude psychologically meaningful

data* nor combine variables which are not psychologically compatible*

thus losing the power of the test. The first of these criteria is not

met by the scoring systems devised by Binder and Butt. Both of these

systems are not objective. The second criterion i3 not met by Billings-

lea nor by Qobets. Their systems are so exhaustive that scoring time

makes the test impractical. For example* BiUlngslea (111) describes 100

records that took him 15 hours each to score. Peek and Quast »s system

as well as that of Pascal and Suttell may fall to meet the third cri­

terion. The relatively simple and convenient method used in these

9

systems sacrifices some subtle and detailed yet meaningful data.

Many studies hare been conducted to determine the clinical ap­

plication of the Bender-Gestalt Test. A few representative studies will

be discussed here. Zolik (90) reported that the mean Bender-Gestalt

performance of his 1*3 adolescent delinquents (mean score of 70.79 by

Pascal and Suttell method) is significantly different from that of his

1*3 nondeliquent adolescents (mean score U7.72). Tripp (63) also studied

some features which discriminate between delinquents and nondelinquents

in the Bender-Gestalt performance of a total of $0 white males ranging

between 2$ and 20 years of age. She reported 12 features discriminating

significantly between the two groups. For a cross-validation* two Judges

were asked to decide whether each of the 12 test features was. present

or absent on each of the 5>0 records. The result indicated that there

was agreement on six out of 12 features and that these six test features

can be used to discriminate between delinquents and nondelinquents.

Dimriddie (27) and Curnutt (26) did studies on alcoholics using

the Bender-Gestalt Test. Curnutt found, in his study of 25 alcoholics

25 nonalcoholics using the Pascal and Suttell system* that the exper­

imental group had a 20 point higher mean score than the control group in

the Bender-Gestalt Test. He also proposed "alcoholic signs."

Slocombe (77) investigated certain correlates of anxiety found in

Bender-Gestalt performance. She used 1$6 graduate student subjects re­

lating Bender-Gestalt drawings to scores obtained from the Taylor Scale

of Ibnifest Anxiety and the flnne Scale of Neuroticism. She*concluded:

Individual measures found significantly discriminating between normal and neurotic subjects by Pascal and Suttell,, Billingslea* and Gobets did not discriminate between high and lew anxiety sub­jects in this study Indicators of anxiety proposed by Hutt

showed slight but significant difference between criterion groups...... (the Bender-Qestalt Test) is dubious as a tech­nique for assessing the level of anxiety In normal subjects (77).

Sonder (p8) reported on the prognostic relationship between scores

obtained from the Bender-Qestalt Test and acute and chronic states of

psychoses. Hanvik (U3) pointed out the limitation of the use of the

Bender-Qestalt Test as a diagnostic aid for differentiating patients with

functional back pain from those with organic diseases of the back*

Harrloan and Harriman (1*5) suggested that reproduction of the

Bender-Qestalt designs are useful as a measure of sohool readiness in

normal children between five and seven years of age. They presented four

major determinants which discriminated significantly between those stu­

dents ready and not ready for school attendance* Baldwin (10) questioned

Harr loan's conclusion as the result of a study which he conducted*

Fabian (31) studied, with the aid of the Bender-Qestalt Test, the

tendencies of children with reading problems to rotate their reproductions

of figures. The results reveal that in the non-reader group of 21 chil-. »

dren 76 per cent of them rotated one or more of the horizontal figures to

the vertical position, that 60 per cent of the poor reader group showed

the same tendency to "verticalise", and that few normal subjects over eight

years of age did so*

Peek (67) studied in psychiatric patients directionality of lines

i in drawings of the Bender-Qestalt figures, particularly the direction of

the reproduction of the dotted line on card five. Hannah (U2) pointed

out that rotation of figures can be caused by factors other than clinical

impairment of mental functioning* He reported that fewer rotations were

made when the cards were given in a vertical rather than in the usual

11

harisontal orientation* This caused the card to approximate the shape

of the page of a book,

Sueselc (79)# in his study of reliability, generality, and some

personality correlates of the Bender-Gestalt responses, concluded that *

"the majority of perceptual-motor behavior that is general and differ­

entiating in the Bender-Qestalt Test is aooeunted for by three dimensions.

These may be termed flexibility, expansIreness, and attention to detail.n

He said that the level of these dimensions can be estimated from Bender-

Qestalt reproductions.

Peixotto gave the Bender-Geotalt Test to 35 subjects in Hawaii

representing seven different nationalities and concluded that Nthe results

do suggest the probability that various ethnic groups will produce dif­

ferent protocol*, so that in this sense, the technique is not cultura-

free" (68, p. 372). (Slueok (35) administered the test to psychiatrio

groups In Italy and could not discover differences in the performances

of psychotics and normals.

Factor analysis has recently been employed in the study of the

Bender-Oestalt Test. In 1?£2 Ouertin (38) factor-analysed the results

of the scoring of reproductions made by 100 white mental hospital patients.

The intercarrelation matrix was factored using the Multiple-group centroid

method. Five oblique factors were found and described as follows: 1)

propensity for curvilinear movement evidenced by such deviations as ex­

cessive numbers of waves and non-closures j 2) poor reality eontact shown

by return to circular patterns and other regressive patterns} 3) careless

execution factor shown by lack of care, inaccuracy and poor motivationj

U) constriction indicated primarily by timidity, small reproductions, and

confinement to a small part of the paper; 5) poor spatial contiguity

shewn by a difficulty in juxaposing elements of the figures*

3Ji 195U Quertin (39, UO) factor-analysed the scores attained

by 32 sale schizophrenics. He found four types of schizophrenia: (A)

chronic undifferentiated schizophrenia marked by long response time,

erasures, minor inaccuracies, but not by bizarre reproductions; (B)

disorganized schizophrenia revealed by poor gestalten, disorganized

confusion, et cetera; (C) conforming and non-defensive schizophrenia

shown by some gross disorganization but to lesser degree than in the

disorganized schizophrenia, and an attempt to conform evidenced by re-

stroking; and (D) actively defensive schizophrenia shown by restitu-

tional symptoms, self-critical behavior, and few gross distortions*

(fa art in (I4I) also factor-analysed the response scorings of

"orgaiiics" and reported three types: (A) organica with curvilinear

distortion related to emotional instability, (B) organics with spatial

disability and loss of control, related to personality disorganization,

and (G) organics with constriction and feelings of inadequacy related

to ego compensation for recognized deficits.

In summary, this survey of the literature relating to the Bender-

Gestalt Test indicates: 1) the test is widely used clinically, by some

routinely; 2) there is considerable diversity of opinions and results

among researchers who established scaring methods and diagnostic cri­

teria; 3) the Fascal and Suttell system is the most frequently utilized

of the scoring methods, and appears to be favored at the movent; U) the

test is commonly recommended as a screening test to be used as a supple­

ment to other psychological tests; 5) despite weakness, however, the

13

testy in the hands of an experienced clinician, does provide some

significant information; and 6) further improvements of standardi­

zation and scoring are needed.

B. Theoretical Considerations

1. Perceptual aspects

The Bender-Gestalt Test is based on the premise that the per­

ception of the normal individual is marked by an integration of what

is being received through our sensory receptors to form a good gestalt

or coherent whole. Thus, to use Cameron's words,

If need, time and the opportunity are present, however, human beings show irresistible tendencies to supplement the fragmentary pattern, to terminate a series once begun, to group scattered objects and complete an unfinished state-

y ment, to make a pointless incident into a meaningful story. They embrace isolated perceptual elements within a coherent whole that is integrated by their need and by the thinking which satisfies the need (15, p« 292).

Bender, in her 1938 monograph, made this point clear by saying,

"there is a tendency not only to perceive gestalt en but to complete

gestalt en and to reorganize them in accordance with principles biolog­

ically determined by the sensory motor pattern of action* This pattern

of action may be expected to vary in different maturation or growth

levels and in pathological states organically or functionally deter- &

mined" (13* p. $)•

There has been a large volume of literature published in recent

years relating perception to personality, and interest in this area seems

to be increasing* Determinants of perception may be classified, according

to Bruner ywd postman (69)* into two categories: the "autochthonous" or

functional on the one hand, and the "behavioral" or motivational on the

lU

other. The autochthonous perceptual level represents the innate and

relatively unchangeable endowment of perceptual activites. An example

of this is the law of perceptual organization of the Gestaltists. Kurt

Goldstein (37), for instance, described the figure-ground principle as

general organismic behavior. On the other hand, those who stress a

motivational factor as the perceptual determinant deal with neads* ten­

sions, values, defenses, and emotional condition*. These have been

collectively called "the central directive state" by Allport (2).

The impressive list of motivation-centered studies of perception

includes such experiments as Murray's study of the influence of fear on

perception (63)> Bruner and Goodmans analysis of the perception of coin

size of the poor as contrasted with that of the well-to-do (21), Sherif's

autokinetic phenomenon related to need for conformity (7U, 75, 76) and

others (29, 86, 89).

In addition to the motivation-centered analysis, Frenkel-Brunswik

(15, 33, 3U) proposed a third variable, which she calls "the personality-

centered" factor. She related this factor to basic personality make-up

rather than to relatively temporary motivational situations* She studied,

for example, the relationship between tolerance versus intolerance of

ambiguity and perception.

The perceptual correlates of personality have been analysed con­

siderably in order to establish clinical tools as well as to provide evi­

dence for against certain theories. A few of these studies have in­

volved size constancy (23, 71), area judgment (91), coin-size judgment (21),

the illusions and distance judgments using thereness-thatness equipment (1*6)

In an experiment dealing with size constancy, for example, Raush(71)

1$

hypothesized that the paranoid schizophrenic interprets reality in terms

of his own frame of reference but is very concerned with the outside world.

He, in order to maintain a constancy which 4is necessary for his security,

fails to recognize "ambiguities of environmental cues." He "attempts to

impose an overstability on a situation involving somewhat imperfect cues"

(71, p. 179)* Thus he would tend to show over-constancy. The non-par-

anoid schizophrenic, on the other hand, is withdrawn from reality and

thus is not concerned with the numerous characteristics of the world* He

should, therefore, show under-constancy. In the test results, paranoid

schizophrenics showed the greatest amount of constancy, non-paranoid schiz­

ophrenics next, and the control group of normal subjects least. All three

groups showed over-constancy.

In an unpublished study by Marquart (59)» subjects who were above

the 60th percentile on the Schizophrenia Scale of the Minnesota Multiphasic

Personality Inventory were found to show higher constancy than those sub­

jects scoring below the 60th percentile.

The reactions of man under the influence of alcohol readily show

the relationship between alcoholic content of the blood and perception.

According to Beach (15, 52), the cutaneous sensation is impaired and the

two point threshold increases 90 per cent by the influence of alcohol.

Alcohol markedly reduces the ability to recognize words presented tachis-

tosopically, and it increases sensitivity to light.

Many other examples could be cited. However, since the present

study constitutes an analysis of personality related to Bender—Gestalt

drawings, the following discussion will be confined to an analysis of

perceptual disturbances and drawing errors of the Bender-Gestalt figures

16

in various types of pathological conditions. In a study- by Orenatein

and Schilder (6U)» 19 subjects were given the Bender-Qestalt Test as

they awakened fro* insulin shock. Their reproductions showed distur­

bances in gestalt functions revealed by such distortions as substitu­

tions of curves for angles, and of circles or loops for dots; changes

of angles into straight lines; and a tendency to perseverate.

Pascal and Suttell included in their manual the results of a

study of the effects of electro-convulsive therapy on Bender-Qestalt

scores. They reported that: "Mounting confusion with continuous ECT

is shewn in increased B-G score. Improvement after ECT is shown in

lowered B-Q score" (65, p. 33)* In another article* Suttell and Paacal(65)

described regression in schizophrenia as measured by performance on

the Bender-Qestalt Test.

Rupp (72) mentions "gestalt disintegration" as one of the char­

acteristics of the drawings of the feeble-minded. In completing a honey­

comb pattern, for example, the retarded children often showed a loosening

of the individual cells in the design and an inability to see same line

simultaneously as part of two different wholes* Lswin (56), in a similar

type of study, described the copying by intellectually retarded subjects

of the Stanford-Binet diamond as a circle with four corners added to it.

Ketsner (53) conducted an intensive experiment on "perseveration of

Gestalt" and revealed a close relationship between the amount of persever­

ation and poor school progress.

yiav and his group (16, 17) studied the relationship between

abnormal KEG and results obtained from psychological tests such as the

Spiral Aftereffect Test and the Bender-Qestalt Teat. They reported that

when the Bender-Gestalt Test reproductions were examined and separated

into "predicted normal" and "predicted abnormal" EEG groups on a basis

of a fire-point scale, and compared with the actual EEG findings of the

same individuals, a Hii coefficient of .36 was obtained (significant at

•01 level). Seventy per cent of the normal EEG records and 65 per cent

of the abnormal EEG records were correctly predicted from the Bender-

Gestalt drawings. The same experimenters also reported that a Fhi co­

efficient of .1*2 was obtained between the results from the Bender-Gestalt

Test, and that 100 per cent of the "normal11 records and 86 per cent of the

abnormal EEG records were correctly predicted by the Spiral Aftereffect

Test.

2. Motor aspects

Much more study is needed relating psychomotor activities to

psychiatric disorders. Psychomotor disturbances were described as psych­

iatric symptoms by early authorities. For example, Bleuler in his 1908

textbook on schizophrenia (18) discussed the importance of motor symptoms.

It is common to hear mentally ill individuals referred to as restless,

tremarous, fidgetting, ri^d, et cetera. These descriptions imply muscular

involvement. Ferencsi in 1919 wrote that "in mild cyclothymics one sees

conditions of inhibited and exaggerated phantasy running parallel with

variations in liveliness of movement"(32).

In 1935, Huston (1*9) conducted a series of studies of reflex time

in psychiatric patients* He found that the patellar reflex time of 66

male schizophrenics did not differ significantly from that of 53 normal

control subjects "when compared with ratio of height over reflex time, or

thigh length over reflex time." However, in a later study, Huston and

Shakow (48) found that, in three types of reaction time (simple audi­

tory, simple visual, and discrimination visual), 38 male schizophrenics

reacted significantly more slowly and with significantly greater vari-~

ability than did the normal group.

others have studied the relationships between motor function

and sensory deprivation '(85), between psychomotor performance and EEG

variables (11, 44), and between age and perceptual-motor skills {47).

Recently van Bergeijk and David (84) performed an experiment

using the ''delayed handwriting" technique. Ill this technique the sub­

ject writes words with a delay (e.g. 520 msec) inserted between the ·

act of writing and appearance of his script. This procedure shows the

effect of visual monitoring of a motor task which has its own kinesthe-

tic feedback. The experimenters concluded that both kinesthetic sen­

sation and visual stimulation aid in the continued performance of the

task. They say:

We think that the experiments described here shed some light on the visual monitoring of a motor task which has its own kinesthetic feedback. The latter sensations, originating in the hand and arm muscles and tensions, give information about the progress of writing, while the eye also generates information about the same process. With delay inserted in the visual path, a conflict between the two sources of infor­mation arises. Depending on s•s intent he can resolve the difficulty in this or that way. The difficulty is really twofold. It is one of letter production (keeping the letter smooth and _ in their proper shape and one of preserving the letter-order of the word. From the results it appears that the first difficulty is not under s•s rigid voluntar.y control --the distortion of the writing increases with delay, irre­spective of instructions. However, the second difficulty is amenable to voluntary control •••••• (84, p. 357).

18

It is readily seen that some clinical groups, especially alcoholics

and senile psychotics, have more motor dysfunctions including poor coordina-

tion and hand tremor than other clinical groups* Few studies relating

motor dysfunction to different psychiatric disorders have been published.

In discussion of the Digit Symbol subtest of the Wechsler-Bellevue Intel­

ligence Scale, Bapaport writes "that motor action is of primary signifi­

cance in the Digit Symbol subtest is commonplace knowledge to anyone who

ever tested a case in which brain injury has impaired motor action* Such

a subject may well see, and may well verbalize* the symbol he wants to

write* and nevertheless the hand may not obey " (70, p. 2$2) ,

' This type of observation applies also to many senile patients*

Rapaport further points out that "acute tension, anxiety, and hyperactivity

are sctie of the factors whose impact on motor action prevents whatever

visual organization would bring about* On the other hand, schizophrenic

chronicity and deterioration may result in visual disorganization pre­

venting the breakdown of visual patterns into parts" (70, p* 253 )• Im­

pairment of motor efficiency is also closely related to the severity

of depressive trends*

II. STATEMENT OF PROBLEM

Billingslea pointed oat that the Bender-Qestalt Test is a

test of visual-motor perceptual behavior which "is considered to in­

volve (a) sensory reception, (b) central neural interpretation, and

(c) motor reproduction (hand writing) by perceiving subject of the

test stimulus object" (lU, p. 1)* "Abnormal" performance, then may

occur as a result of disturbance at any one of these levels. A dis­

turbance at any level contributes to a total score, for example, to

the Pascal and Suttell score obtained. As in an intelligence test,

a mere total score does not give information about weak and strong

points and thus provides much less information than a knowledge of

sub-test performances.

It can be hypothesized that scoring in terms of particular

categories will result in more valuable diagnostic evidence than will

a total score. It may be possible to divide the performance material

on the basis of perceptual or motor impairment, since it is possible

that impairment of motor and perceptual functions may be different in

different psychiatric groups.

An attempt will be made in this study to determine character­

istic categories far each clinical group, to improve the diagnostic

power of the test, and to test Influences of variables such as age and

education on Bender-Qestalt performance.

20

III. METHODS

A. Subjects

V A total of 265 subjects was used In this study. 3- Eighty of

these subjects had been diagnosed as schisophrenics* 76 were chronic

alcoholics* 32 belonged to the chronic brain syndrome associated with

cerebral arteriosclerosis} and 77 were "normal" subjects.

The age, sex* and educational background of the subjects are

shown in Table 1. The clinical groups were selected from the patients

who were* at the time of testing, hospitalized in the Neuro-Psychiatric

Ward of the Pima County General Hospital* Tucson* Arizona.- The psy­

chiatric diagnosis2 was based on agreement in diagnoses made by two

psychiatrists and one psychiatric resident. The patients whose di­

agnoses were uncertain or not unanimous in the mind of the staff were

not included in this study.

All of the schizophrenic subjects used in this study were

committed to the Arizona State Hospital upon Superior Court order

after psychiatric examinations and a court sanity hearing had been

conducted for each subject. Those schizophrenics who had significant

medical complications or had a history of heavy drinking were not

1. Twenty-two additional subjects were tested with unsatis­factory results* The results obtained tram these subjects hare not been Included in the data*

2. The nosological nomenclature and the diagnostic criterion were based on the Diagnostic and Statistical Manual: Mental Disorders (3) prepared and puDJLosned oyTEe American wycniatric Association.

21

22

TABLE 1

Age, Sex, and Educational Background of the Subjects Employed

Age

13

15-30

31-Uo

la-5o

51-60

61-70

71-r80

80-

Schlzophrenla

H - 80 -i

1

25

25

15

12

2

Alcoholic*

N - 76

3

18

39

11

5

Chronic Brain Control mtms

n a 77

19

11

20

2 8

10 9

13 7

7 3

Mean Age 36*1(0 Standard DeTiationl2.79

Male Feaale

One year or more of college fee year or more of high school Mean length of education

llO 1+0

10

Ui

9.51

U5.26 9.03

51 15

ll

32

9.b2

76.69 8.69

27 5

1

9

6.67

146.30 19.01

S 10

hp

9.81

included. Disposition conference reports obtained from the Arizona

State Hospital with respect to the majority of the subjects confirmed

the previous psychiatric diagnoses closelY. Sub-classifications of

the schizophrenic subjects used are listed in Table 2. This sub-clas­

sification is provided as an analYsis of the nature of the subjects

used.

Ninety per cent of the Chronic Brain Syndrome subjects asso­

ciated with cerebral arteriosclerosis were committed to the Arizona

State Hospital for custodial and geriatric care.

For the chronic alcoholism group, special care was taken not

to include those who ware temporarilY intoxicated with alcohol and

otherwise not "alcoholic." About 75 per cent of the alcoholic sub­

jects used in this study had a history of heavy drinking for more

than 10 years. Sixty-one per cent of them had joined Alcoholic

Anonymous activities at some time during their lives. Thirty per

cent of them had experienced delirium tremens in the past. About

4o per cent of them had a history of repeated admissions to the hos­

pital for alcoholism. If a patient was admitted to the hospital in

an acutely intoxicated state, the Bender-Gestalt Test was not admin­

istered until he or she became "sober" and clear mentally; usually

several days after admission.

The control group consisted of 21 hospital employees {orderlies,

nurses' aids, ward clerks, et cetera), 20 practical nursing students,

28 in-patients or out-patients coming to the hospital for minor surgical

care, and eight elderly people who reside in a rest home in Tucson.

This group was selected to approximate the educational level and ages

23

TABLE 2

Types of Sohiaophrenle Subjects

Type of Schisophrenic Nuaber SMJ'W

Simple type 3

Hebephrenic type 2

Paranoid type 27

Acute undifferentiated type 17

Chronic undifferentiated type 13

Schiio-affectiire type 17

Childhood type 1

Nr 60

of the clinical groups*

B. Administration of the Test

The Bender-Gestalt Test was given individually and privately

by the experimenter. The Pascal and Suttell standard method of ad­

ministration was adopted. The subject was seated at a table, and

given a blank sheet of white paper (8j x 11),and a sharp pointed pen­

cil with an eraser. The table top was smooth and hard-surfaced. The

experimenter was seated at the opposite side of the table facing the

subject. Upon completion of one design, the subject was given the

next design until all the nine designs had been copied. The cards

were handed to the subject in the standardized manner.

~ Pascal and Suttell's method differs from others in that the

subject is instructed not to sketch the design, but to use a single

solid line in drawing* This Is to avoid the common practice of

sketching which many artistically trained people are likely to do

when they draw designs. Sketching is a scorable deviation in the

Pascal and Suttell system. Instructions given to each subject before

drawing were as follows t

1 have nine simple designs, one on each card, which I would like to have you copy on this paper. Use free hand drawing and do not sketch* I will give you the cards one at a time. There is no time limit*

Many subjects asked what was meant by "sketching." Ihen

this occurred, they were told that they were to use single, solid

lines instead of many little lines for outlining the figures. Non-

eommital answers were given to such questions as whether the number

of the dots should be reproduced exactly, whether erasing is allowed,

how the drawings should be spaced, et cetera. Additional paper was

provided when it ·was requested by the subject. Special notation was

made of significant remarks or behavior of the subject during the

drawing period.

c. Scoring

Selection of an appropriate scoring method was a difficult

task. As reported in the introduction, there are several scoring

systems and each system has merits as well ·as draw-backs. After a

careful evaluation of the scoring methods presently existing, it

was decided that the Pascal and Suttell method should be used.

Their method is not recommended by all investigators who have

studied it. However, the literature contains a sizable number of

studies utilizing the Pascal and Suttell scoring method. It is

easier to compare the results of an experiment with those from

other experiments if the same standardized administration and

scoring methods have been used. Also the Pascal and Suttell

method has well defined scoring categories and is practical for

use.

Scoring was done using code numbers and without a know­

ledge of the diagnostic category to which the subject belonged.

The cases were accumulated and scoring was not done until after all

of the protocols had been collected.

26

D* Attitude of the Sub^ot

Satisfactory motivation tcwrard drawing oa the part of the

subject is regarded as important to make the test data meaningful*

Obviously, the reproductions of negativistic psychotics or those

who are not motivated to draw pan not be valid measures of motor-

perceptual behavior. They can be used only as a measure of atti­

tude. The reproductions of subjects who could not be adequately

motivated or whose records could not be scored were eliminated

from the study. Among the originally selected subjects, twelve

schizophrenic subjects were withdrawn to the degree that they were

not readily motivated to make any drawings* Ten senile patients

produced nothing but scribbling which could not be scored. How­

ever, most of the subjects used in the study seemed to be motivated

to cooperate in drawing. Some patients seemed to fear that the

test results might be used unfavorably in determining their disposi-,r

tion.

IV. RESULTS

A. Comparisons of Pascal and SuttelX Scares

of the Various Groups Disregarding Age Variation

Table 3 shows the distribution of the Pascal and Suttell

total raw scores for the members of each of the four groups em­

ployed in the study.3 The Pascal and Suttell raw score mean and

standard deviation for each group is shown in Table U. Table $ : /

shows the differences between means, the Fisher t's of the differ-""k

ences, and the probability that each difference is attributable

to factors beyond chance. The table indicates that there are dif­

ferences significant to the .£ per cent level between the schiso­

phrenic and control subjects, between schizophrenic and chronic

brain syndrome groups, between the alcoholic and chronic brain syn­

drome groups, and between the chronic brain syndrome and the con­

trol groups. The difference between the alcoholic and the control

subjects is significant at the 1 per cent level. However» the

is cores obtained by the alcoholios and by the schizophrenics are

not significantly different from one another.

3* The Pascal and Suttell raw_score is the sum of the weighted deviation scores.

28

TABLE 3

Distribution of Pascal and Suttall Ranr Scores

For All Clinical Oroups

Score Schisophrenic Alcoholic Chronic Brain Control _ SySSHSS

N - 80 N * 76 N-32 N v 77

I-5 U 8

6-10 3 1 7

II-15 U 3 12

16-20 5 5 8

21-25 5 U 1 8

26-30 8 6 10

31-35 3 10 6

36-1*0 5 J 1 1

U1-U5 6 2 " 1 3

1*6-50 U 8 2

51-55 8 U 2

56-60 7 10 2

61-65 l 2 11

66-70 U 2 2

71-75 1 1 2

76-80 3 U 1

81-85 2 3 3

86-90 ̂ ̂ ̂

' 91-# 1 2 1

96-100 i 1 3

101-105 i 2

106-110 2

III-120 3 2 **

121-130

130-

3

3

TABLE U

The Pascal and Suttall Raw Score Heans

and Standard Deviations for Each Group

Nuaber Raw Score Mean Standard usnatioh

Schisophrenics 80 • 27*37

Alcoholics 76 U6.18 22.68

Chronic Brain Syndrome 32 92*91 29*68

Control Group 77 27*87 21.$0

4

I TABLE 5

Signifieanee of Differences Between

Pascal and Suttell Raw Score Means of Each Oroup

Alcoholics Chronic Brain Control smdrose ———

N - 76 MU 32 N = 77

Schizophrenics t * .0060 t s 7.^600 t r 5•2700 N * 80 P - .5000 P • *000$ P = .0050

Alcoholics t t s 8.9700 t = 5*1000 N » 76 Pa .0005 P - .0100

Chronic Brain Syndrome t = 13.0100 N s 32 P = .0005

\ *

B. Effects of Age Variation

Upon the Pascal and Suttell Scores

The Pascal and Suttell mean raw scares for six different

age lerels of the normal group are shown in Table 6. The results

show that there is a tendency for the mean raw score to increase

with increased age. The index of order association between each

control subject>s age and raw score is .77. When the older subjects

are not considered and the index of order association is computed

for subjects between 15 and 50 years of age, the value is ,22 ,

To investigate further the relationship between raw scares

and age, the median test was employed to relate position above or

below the median score for all subjects included in the analysis to

the age group to which the subject belongs. This test was first

utilized using normal subjects through 50 years of age; then through

60 years of age, through 70 years of age, and through 8U years of

age. The results are shown in Table 7. According to the table,

differences in age between 15 and $0 years do not significant ly

affect the Pascal and Suttell raw scores. However, age becomes a

significant factor If the subject is older than 50 years* Table 7

also shows the results of an anlysis of the effect of age using the i

Kruskal-Wallia Test. It indicates that there is no significant dif­

ference in raw scares between the ages of 15 and 50, but that one

appears if the age range is extended from 15 through 60 years*

Table 8 shows Fisher t's of the differences between means

of pairs of the three age groups t 15-30, 31-Uo* and 1*1-50. Hone

v

33

TABLE 6

Relationship Between Age and Score

Obtained By the Noraal Subjects

Age Number Mean Raw Score Standard Deviation

15-30 19 15.53 29.67

31-1*0 11 111. 18 11.85

Ul-50 20 22.05 13.53

51-60 8 37.87 13.09

61-70 9 36.22 20.90

71-8U 30 62.25 20.97

TABLE 7

Median Test and Kruskal-Wallis Test Measures

of the Effect of the Age of the Normal Subjects

Upon Pascal and Suttell Raw Scores

Age Groups Compared Median Test Kruakal-Waxlia

15-30, 31-UO, 1*1-50 x2 . U.0200 h s U.1970 P - .1350 P - .1225

15-30, 31-Uo, Ul-50, x2 -15.5500 h =16.9700 5i-6o P »• .ooiii p 9 .0007

15-30, 31-Uo, Ul-50, x2 =17.7800 51-60, 61-70 P - .001U

15-30, 31-U0, Ul-50, X2 =25.1000 5l-6o, 61-70, 71-8U p = .0001

"A

TABLE 8

Test of Significance for Raw Score Mean Differences

Among Three Age Levels Between 15 and 50 Years

in the Normal Group

30 - Uo years Ul - 50 years Mean Score r ill. 18 Mean ijccre = 22.05

S. D. r 11.85 S. D. = 13.53 N - 11 N m 20

15-30 years t • .1390 t = .8970 Mean Score - 1^.53 *P » .1750 *P s .3750 S. D. . 29.67

N = 19

31 - hO years t s 1.5600 Mean score * iU.16 *P • .129 S. D. a 11.85 — -

N = 11

*P is obtained from the two-bailed table.

of the differences are significant at the 5 par cent level. Table

9 shows that age does not significantly influence Pascal and Suttell

scares within the range of 1£> and $0 years for schisophrenics and \ * •

alcoholics. The median test and the Kruskal-Wallis Test using three

age levels (15-30, 31-UO, 1*1-50) do not show differences significant

at the 5 per cent level.

G. Comparisons of the Pascal and Suttell Raw Scores

For Groups with Age, Sex, and Education Matched

Comparisons of the scares attained by the groups used in the

experiment were first made by* the formation of equivalent groups and

working only with the matched subjects. The subjects were matched,

using the paired method, for age, sex, and education. The matching

for age was rigid and complete, that for sex. and education was not

perfect. This method reduces the number of subjects available for

each group. There were 31 pairs of schizophrenic and control sub­

jects, 33 pairs of alcoholic and control subjects, 22 pairs of chron­

ic brain syndrome and control subjects, and 30 pairs of alcoholics

i»nri schizophrenicsTables showing the mean and variability of the

sex, age, and education of the matched groups are to be found in

Appendix A*

Table 10 shows the mean scores, the standard deviations, the

U. Hatched comparisons between the chronic brain syndrome and the alcoholics, and between the chronic brain syndrome and the schisophrenic subjects were not done due to marked age discrepancy and consequent inability to match for age*

TABLE 9

Relationships Between Age and Score

of Schizophrenic and Alcoholic Subjects

(15 to 50 years)*

Median Test Kruskal-Walllg Test

Schizophrenics = 1.7U60 h = 2.9160 P - .1*200 P s .2300

Alcoholics 3 2.2900 h - 5.U000 Pa .3200 P - .0672

i

*Three age levels: 15-30> 31-UO, Ul-50 are compared.

38

TABLE 10

Test of Significance of Differences

— Between Fiscal and Suttell Raw Score Ueans of Groups

Matched for Age, Sex, and Education

Groups Number Hean Raw Standard t for the difference Probabil-Score Donation "between correlated lty xerox

Beans

Schisophrenics 31 U9.26 28.21 5*8300 P - .0050

Control 31 17.29 10.3U

Alcoholics 33 1+6.61 22.68 U.5U00 P - ,0500

Control 33 23.6U 17.55

Chronic Brain 22 92.00 27.75 5.5000 P » .0050 Syndrome

Control 22 U7.57 2lu52

Alcoholics 30 U2.60 20.53 .9100 P s .3700

Schizophrenics 30 U9.00 31.8U _ •

Fisher t*a, and the probabilities that there are differences between

each clinical group and its control group.

According to the table, the Pascal and Suttell raw scores be­

tween the schizophrenic and; control subjects, and between the chronic

brain syndrome and the control subjects are different significantly to

the .£ per cent level. The difference of means between the alcoholic

and the control subjects is significant at the five per cent level*

However, the mean raw score of the alcoholics does not differ sig­

nificantly from that of the schisophrenics.

D. Effects of Education on Pascal and Suttell Scores

Pascal and Suttell (65) report a difference in raw scores

obtained using their scoring method between high school and college

educated groups. Da order to analyse the effect of education in

the present study, the schizophrenic, alcoholic and control groups

within the 15 and 50 years of age range were divided into three ed­

ucational levels t college, high school, and grade school. The mean

raw score and standard deviation of each educational group of the

three clinical groups are shown in Table 11. The table shows that

with mora education lower raw scores are obtained.

Analysis of variance of the mean scores of the three educa­

tional subgroups for the schisophrenics, the alcoholics, and the con­

trol group are shown in Tables 12, 13, and lii respectively. The

tables indicate that in the schisophrenics and the control subjects,

the raw score means of the three educational subgroups are different

enough to make the variance of the combined subgroups much larger i

than the variances of the separate subgroups. Both F ratio and q

ijo

TABUS 11

Effects of Education on the Pascal and Suttell

Raw Scores of Various Groups

(15 and 50 years)

College High School Grade School

Schisophrenics Mean Score = 19*70 Mean Score = 1*2.28 Mean Score r 63.31 Standard Deviation: Standard Deviation: Standard Deviation:

15.60 25.12 31.25 N a 10 N s 37 N r 19

TV

Alcoholics Mean Score • 33.63 Mean Score s 1*2.58 Mean Score • U5.70 Standard Deviations Standard Deviation: Standard Deviation:

19.83 21.19 __ i lit. 16 N x 8 N s 26 N - 20

Control Subjec&sMean Score • 12.33 Standard Deviation:

10.02 H - 9

Mean Score =• 16.09 Standard Deviation:

9.67 N * 33

Mean Score s 26.55 Standard Deviation:

20.19 N * 8

Ul

TABLE 12

Analysis of Variance of Pascal and Suttell Raw Scores

of the Three Educational Groups of Schisophrenics

Source Sum of Squares DF Mean Square F q Test

Between 13029.1 2 651U.5 F r 9.2500 q s 7.7100

Within Uk3h6*9 63 703.9 P = .0100 P «... .0100

Total 57376.0 65

TABIX 13

Analysis of Variance of Pascal and Suttell Raw Scares

of the Three Educational Groups of Alcoholics

Source Sua of Squares DF Mean Square F q Test

Between 83U.5U 2 1*17.27 F r 1.1300 q = 2.6600 P s .2800 P - .0500

Within 18836.50 5l 369.3U

Total 19671.0U ~~~ 53

1*3

TABLE IU

Analysis of Variance of Pascal and Sattell Raw Scores

of the Three Educational a*craps of Control Subjects

Source Sua of Squares DF

Between 1530.18

Within 5739.60

Total 7269*78

2

U7

U9

Mean Square

765.09

122.12

q Test

F - 6.2600 q s U.8900 P = .ooUo P « .0500

statistic in the analysis of variance of the schizophrenic subjects

are significant at the 1 per cent level* and those of the control

group are significant at the 5 per cent level. However, they are

not significant at the 5 per cent level in the alcoholio group.

Table 15 shews the contrasts among the raw score means of

the three educational subgroups of schisophrenics* Comparisons of

the mean scores, utilizing the q statistic, between the college and

high school groups, and between the high school and the grade school

groups are not significant at the 5 per cent level* The difference

between the college and the grade school groups is significant at

the $ per cent level. It was also found that the differences of the

mean scores between the grade school subjects and the average of the

college and high school groups, and between the college group and the

average of the high school and grade school groups are significant at

the $ per cent level.

Table 16 shows the individual cooparisons among the mean

scores of the three educational groups of alcoholic subjects. None

of the comparisons fox* each mean difference is significant at the

$ per cent level. r

Table 17 shows the same types of contrast analysis far the

control subjects. According to the table, there is no significant

difference between the raw score mean of the college group and that

of the high school group. Significant differences in mean score

exist, however, .between the college and grade school subjects, be­

tween the high school and grade school subjects« and between the

grade school and an average of the college and high school groups.

h$

TABLE 1$

Contrast* Among the Mean Scares

of the Three Educational Groups of Schisophrenics

College Higfr School Grade School Confidence Limits Population Contrast

Ix-19.70 Xt * U2.28 I3* 63.31 Z*±X £

1 - 1 0 - 2 2 . $ 8 £ 2 6 . 2 1 u x - u 2

1 0 -1 -U3.61 £ 26.21* ux - u3

0 1 -1 -21.03 £ 26.21 u2 - U3

1 £ -1 -32.32 £ 26.21* ui / a2 _ u3

i -1 | .78 ̂ 26.21 ui/u3 2 — 2

-1 i £ 33.09 / 26.21* u2 / u3 „ —- u3

•NThese contrasts by the q statistic are significant at the $ per cent level*

46

TABLE 16

Contrasts Among the Mean Scores

of the Three Educational Groups of Alcoholics

College High School Grade School Confidence Limits Population Contrast

1 -1

1 0

0 1

.l. t 2

J.. -1 2

-1 t

0

-1

-1

-1

t

t

- 8.95 t 15.40

-12.07 t 15.40

- 3.12 t 15.40

- 7.60 t. 15.40

2.92 t 15.40

10.51 t 15.40

ul - u2

u1 - u3

u2- u3

U1 f. U2 - UJ

u1 f u3 ----- U2 2 u2 f u3

2 - u3

U7

TABLE 17

Contrasts Anong the Ifean Scores

of the Three Educational Groups of Control Subjects

College High School Grade School Confidence Liaits Population Contrast

1 -1

1 0

0 1

* i

* -i

-l " i

r 26.55 Ta I / VP L i*i c flr

0 - 5.76 £ 9.18 U1 * u2

-1 -1U.22 £ 9.18* U1-U3

-1 -1D.U6 £ 9.18* u2 - U3

-1

*

*

-12.3U £ 9.18*

2.35 £ 9.18

8.89 £ 9.18

U1 + u2 u,

Un ? U-» -±-L_2-U2

u2 / u.

2 . ~ u3

«The contrasts by the q test are significant at the 5 per cent level.

In order to correct for the effecta of education, Pascal and

Suttell presented tables by which raw scores of the high school and

college groups can be converted to Z scores. Table 18 shows the

Pascal and Suttell mean raw scores and standard deviations of the

schizophrenic, alcoholic, and control subjects within the range of

15 and $0 years of age, and Table 19 shows the Z score means and

standard deviations of the same groups. In Table 18 the standard

deviations of the raw scores become larger in the order of the con­

trol group, alcoholics, and schizophrenics, giving standard deviations

of 11.U2, 19*18 and 29*26 respectively. The F ratio for the differ­

ence of the variance between each group is significant beyond the .5

per cent level.

E. Comparisons of Frequencies

of Deviations Within Scoring Categories

For Groups With Age, Sex, and Education Hatched

In order to investigate characteristics of the drawings

made by each group, acorable deviations which belong to the same

category were combined. Thus, for example, Workover is scared in

cards 2, 3, 5>, 6, and 8* 3b the present study attention was paid

to the number of cards on which it occurred rather than to the num­

ber of the card on which it occurred.

Tn this manner, the number of deviations in each category^

was counted for each subject* The Wilcoxon Test was applied to the

5* The definition of each category is presented in Appen­dix B.

h9

TABLE 18

Pascal and Suttell Mean Raw Scores

of the Schisophrenic, Alcoholic, and Control

Subjects Within the Age Range of 15 and J>0 years

Nunber Mean Raw Score Standard F Probabil-Donation ~ lty Levi'

Schisophrenics 6U U5.95 29.26 2.3200 P » .0005

Alcoholics 60 1*1*39 19.18 2.8100 P = .0005

Control Subjects $0 17.1U 11.U2

TABLE 19

Z Score Means of the Schizophrenic, Alcoholic, and

Control Subjects Within Range of 15 and £0 Years of Age

Number Mean Z Score Standard Deviation

Schizophrenics^- 6U 80. $3 29*92

Alcoholics2 60 75«66 20.17

Control Subjects3 J>0 $0.7U 12,81

1* Number of S's who had some college education was 10*

2. Number of S's who had some college education was 9*

3. Number of S's who had some college education was 9*

51

differences in the number of deviations in each category for the groups

matched for age, sex, and education. Tables 20, 21, 22, and 23 show the

results of these comparisons. Table 20 compares the 31 pairs of schizo­

phrenic and control subjects, Table 21 compares the 33 pairs of alcoholic

and control subjects. Table 22 compares the 21 pairs of chronic brain

syndrome and control subjects. Table 23 compares the schizophrenic and

alcoholic subjects.

The results show that six categories significantly differentiate

the schizophrenic group from the control group at the J> per cent level.

The categories are Workovar, Rotation, Design Missing, Distortion, An­

gles, and Poor or No Order.

Five categories differentiate between the alcoholic and control

groups. These are: Workover, Tremor, Asymmetry, Rotation of the Ex­

tension and Curve, and Dots, Dashes and Circles. Far the chronic brain

syndrome and control subjects, five categories (Number of Dots, Design

Missing, Asymmetry, Dashes, and Rotation of the Extension and Curve) dif-A

ferenbiate at the 5 per cent level* However, Tremor is the only cat­

egory that differentiates between the alcoholics and the schizophrenics•

Obtaining one significant result out of 21 tests of significance can be

due to change alone. The probability of obtaining five differences

significant at the 5 per cent level is .01, and that of obtaining six

is even lower.

*

TABLE 20 '" '

Wileoxon Test for Differences in Category Scares

of 31 Pairs of Schisophrenic and Control Subjects Ifetched

$ar Age, Sex, and Education

Deviation Category

Dots, Dashes and Circles Circles Number of Dots

Workover

Second Attempt

Rotation

Tremor

Design Missing Distortion

Asymmetry Dashes Double Line Guide Line

Angles

Ends of Lines Not Joined Rotation of the Extension and Touch-up Place of a Design Over-lap

Poor or Ho Order

Compression

Significance at*TSrT]^ cent WeS

Insignificant insignificant insignificant

Significant

Insignificant

Significant

Insignificant

Significant Significant

Insignificant Insignificant Insignificant Insignificant

Significant

Insignificant Curve Insignificant *

Insignificant Insignificant Insignificant

Significant

Insignificant

Probability Level

P s .0200

P * .0100

P - .01(00 P = .0080

P • .0080

P - ,0500

•By a two-tailed test.

TABLE 21

Wilcoxon Test for Differences in Category Scores

of 33 Pairs of Alcoholic and Control Subjects Matched

for Age* Sex, and Education

Deviation Category

Dots, Dashes and Circles

Circles Rotation Number of Dots

Workover

Second Attempt

Tremor

Design Missing Distortion

Asymmetry

Dashes Double Line Guide Line Angles Ends of Lines Not Joined

Significance at the ;> per cent

-leregr

Significaot

Insignificant Insignificant Insignificant.

Significant

Insignificant

Significant

Insignificant Insignificant

Significant

Insignificant Insignificant Insignificant insignificant Insignificant

Rotation of the Extension and Curve Significant

Touch-up Place of a Design Over-lap Poor or No Order Compression

insignificant Insignificant Insignificant insignificant insignificant

Probability EW8I

P r .0500

p - .0100

p s .0100

P • .0100

P * ,0320

•By a two-tailed test*

TABLE 22

Wilcoxon Test for Differenoes in Category Scores

of 21 Pairs of Chronic Brain Syndrome and Control Subjects

Matched for Age, Sex, and Education

Deviation Category

Wavy Line Dots, Dashes and Circles Circles

Number of Dots

Workover Second Attempt Rotation Tremor

Design Kissing Asymmetry Dash

Double Line Guide Line -Angles Bods of Lines Not Joined

Signif at tSe5

ioance er cent at the > per

ft™**"

Insignificant Insignificant Insignificant

Significant

Insignificant Insignificant Insignificant Insignificant

Significant Significant Significant

Insignificant Biaignificant Insignificant Insignificant

Rotation of the Extension and Curve Significant

Touch-up Orer-lap Total Configuration

Insignificant Insignificant Insignificant

Probability

P = «0U20

P = .0100 P * .0120 P m .0080

P =• .0080

*By a two-tailed test.

TABLE 23

Wllcoxon Test for Differences in Category Scores

of 30 Pairs of Alcoholic and Schizophrenic Subjects

Matched for Age, Sex, and Education

Deviation Category Significance Probability at the pear cent Lerex

EeVel*

Dots, Dashes and Circles Insignificant Circles insignificant Number of Dots Insignificant Workorer Insignificant Second Attempt Insignificant Rotation Insignificant

Tremor Significant

Design Kissing Insignificant Distortion Insignificant Asymmetry Insignificant Dashes Insignificant Double Line Insignificant Guide Line . Insignificant Angles Insignificant Ends-of Line Not Joined Insignificant Rotation of the Extension and Curve insignificant Touch-nip Insignificant Place of a Design Insignificant Orer-lap Insignificant Poor or no order insignificant Compression Insignificant

P = .0500

*3y a two-tailed test.

F. Category Analysis

Among Various Groups

Within the Age Range of l£ and $0 Years

4t

1. Qroup A

For more complete deviation analysis of each group, approx­

imately half of the number of the schisophrenic, alcoholic, and con­

trol subjects between 1$ and 50 years of age were selected randomly*

Thus, 30 schizophrenics, 30 alcoholics, and 30 control subjects were

selected, on a random basis to constitute Group A.

Characteristic signs of each clinical group were obtained by

applying the chi-square test to frequencies of appearance of deviation

within each category*

Table 24 shows the results of the analysis comparing the schis­

ophrenic and control subjects* Those deviations which differentiate

between the two groups at the 5 per cent level are: Number of Dots,

Workover, Rotation, Tremor, Distortion, Asymmetry, Angles, and Dots,

Dashes and Circles*

Table 2J> shows the results of this type of analysis of the

scores obtained by alcoholic and control groups* Circles, Workover,

Tremor, Asymmetry, Guide Lines, Angles, and Dots, Dashes and Circles

were found to differentiate between the two groups at the $ per cent

level*

Table 26 shorn the results of the chi-square comparisons of

the schisophrenic and alcoholic subjects* There are three categories

which differentiate between the two groups. They ares Extension

Joined to Curve at Dot, Tragi or, and Double Line*

57

TABUS 2U

Chi Square Measures of Differenoes

Between Schizophrenic and Control Subjects (Group A)

for Scoring Categories

( Nr 30 each)

Deviation Category Number of Deviations Compared

Qroup Showing Larger"*5core

Wavy Line Circles Extension join Dot

0 with 1 or more 0 with 1 or more 0 with 1

Dots, Dashes & CirclesO with 1 or more Number of Dots Workover

Second Attempt

Rotation Tremor

Design Missing

Distortion Asymmetry

0 and 1 with 2 or more 0 and 1 with 2 or more

0 with 1 or more

0 with 1 or more 0 with 1 or more

0 with 1 or more

0 with 1 or more 0,1 and 2 with 3 or moreU.9300

•6000 .1*190 Schisophrenic •6500 .1*190 Schisophrenic 3.5200 .0610 Control

8.U000 .0037 Schizophrenic U.6300 .030U Schisophrenic 6.2800 *0122 Schizophrenic

.081*0 .7720 Control

]*.7000 6.0800

•0302 Schisophrenic •0137 Schizophrenic

1.7800 .1820 Schisophrenic

lu7000

Dashes 0 with 1 or more Double Line 0 with 1 or more Guide Line 0 with 1 or more

Angles 0 with 1 or more

Bods of Lines Not 0 with 1 or more Joined Rotation of the Exten-0 with 1 or more sion and Curve Touch-up 0 with 1 or more Poor or No Order 0 with 1 or more Total Configuration 0 with 1 or more

0.0000 .2700 .6500

9.8700

2.1*100

0.0000

0*0000 .6500 •0660

•0302 •026U

•0000 •60U0 .1*190

.0017

.1200

.0000

.0000 .1*190 .7970

Schisophrenic Schisophrenic

Schisophrenic Schizophrenic Schizophrenic

Schizophrenic

Schizophrenic

Schizophrenic Schizophrenic

TABLE 25

Chi Square Measures of Differences

Between Alcoholic and Control Subjects (Group A)

for Scoring Categories

(N s 30 each)

Deviation Category Number of Deviations Cogparea ~~

P Group Show-~ ing Larger

""Score

navy Line Extension Join Dot Dots, Dashes & Circles Circles t

Number of Dots

Workover

Second Attempt Rotation

Tremor

Design Missing Distortion

Asymmetry

Dashes Touch-up Double Line

Guide Lines Angles

Ends of Lines Mot Joined Rotation of the Exten­sion and Curve Poor or No Order Total Configuration

0 with 1 or more 0 with 1 0 and 1 with 2 or 0 with 1 or more

0 with 1 or more

0 and 1 with 2 or

0 with 1 or more 0 with 1 or more

0 with 1 or more

0 with 1 or more 0 with 1 or more

1.U300 .0060

more 6.2800 8.8800

.0900

morell.8000

1.1300 2.5900

.2320

.9680

.0123

.0027

.761*0

.0007

.2870

.1080

Alcoholic Alcoholic Alcoholic Alcoholic

Alcoholic

Alcoholic

Alcoholic Alcoholic

17.0800 .0001 Alcoholic

0.0000 0.0000

.0000

.0000

0 and 1 with 2 or more 8.1(000 *0037 Alcoholic

0 with 1 or more 0 with 1 or more 0 with 1 or more

0 with 1 or more 0 with 1 or more

0 with 1 or more

0 with 1 or more

0 with 1 or more 0 with 1 or more

0.0000 0.0000 .6100

6.2800 8.1*000

.0000

.0000

.1*370

.0123

.0037

Alcoholic

Alcoholic Alcoholic

0.0000 .0000

0.0000 .0000

0.0000 .0000 3.2000 .0736 Alcoholic

$9

TABLE 26

v

Ghl Square Measure of Differences

Between Schizophrenic and Alcoholic Subjects (Group A)

for Scoring Categories

(N = 30 each)

Deviation Category Number of Deviations Coapareq

Group Shcwr-5!E

Wavy Line

Extension Join Dot

Dots, Dashes & Circles Circles Number of Dots Workover Second Attempt Rotation

Tremor

Design Missing Distortion Asymmetry Dashes

Double Line Guide Line Angles finds of Lines Not joined Rotation of the Exten­sion and Curve Touch-up, Poor or No order Total Configuration

0 with 1 or more

0 with 1

0 with 1 or more 0 with 1 or more 0 with 1 or more 0 and 1 with 2 or more 0 with 1 or more 0 with 1 or more

0 with 1 or more

0 with 1 or more 0 with 1 or more 0 and 1 with 2 or more 0 with 1 or more

2 or more

0.0000 .0000

5.6200 .0171 Alcoholic ,ti

1.3100 .2^20 Schisophrenic 3.2800 .070U Alcoholic 1.1700 .2790 Schisophrenic .6100 .U370 Alcoholic 2.61(00 .1070 Alcoholic .0900 .761*0 Schizophrenic

U.9200 .0266 Alcoholic

1.7800 .1820 Schisophrenic 3.0000 .0833 Schisophrenic 1.3100 .2520 Alcoholic .0660 ,1910 Schisophrenic

•0360 Alcoholic 0 with 1 or more 2.1300 .lU$0 Alcoholic 0 with 1 or more 0.0000 .0000 0 with 1 or more 0.8700 .3U8O Schisophrenic

0 with 1 or more 0.0000 .0000

0 with 1 or more t r 0.0000 .0000

0 with 1 or more < ' .moo .7130 Schisophrenic 0 with 1 or mare 1.8700 .1710 Schizophrenia

Group B> the cross-validation group, consisted of 30 schizo­

phrenics, 30 alcoholics, and 20 control subjects. Chi-squara tests

were conducted to determine which scoring categories found to dis­

criminate for Group A also discriminate between the clinical and con­

trol groups constituting Group 8.

Of the eight categories which discriminated between the

schizophrenic and control subjects of Group A, four remain significant

at the 5 per cent level for Qroup B. These are Rotation, Tremor,

Asymmetry, and Angles. (See Table 27*)

Of the seven categories which were significant in Qroup A

of the alcoholic and control subjects, four remain significantly dif­

ferentiating between the two groups constituting Group B. They are:

Work over, Tremor, Asymmetry, and Dots, Dashes and Circles, The

results are shown in Table 26*

When the three categories which were significant in Group A

of the alcoholic and schizophrenic subjects were retested in Group B

of the two groups, only one category, Tremor, discriminates between

the two groups at the five per cent level. Table 29 shows the results r ,

of the analysis. Obtaining one significant result out of'the original

21 tests of significance can be due to chance alone*

0. Age Effects Upon Category Deviations

Produced by the Normal Subjects

To further investigate the effects of age variation upon the

particular deviation categories, the 77 normal subjects were divided

61

TABLE 27

Chi Square Measures of Differences Between

Schizophrenic and Contrdl Members of Qroup B for the Scoring

Categories Which were Significantly Different in Qroup A

(Schizophrenics « 30» Control Subjects e 20)

Deviation Category Number of Deviations Coaparea

P Qroup Show-

Dots, Dashes & Circles 0 with 1 or more

Nunfcer of Dots

Workover

Rotation

Tremor

Distortion

Asymmetry

Angles

0 with 1 or more

0 with 1 or more

0 with 1 or more

0 with 1 or more

0 with 1 or more

0 and 1 with 2 or more $.8200

0 with 1 or more U.0U00

1.5600

1.0000

.OUUO

U.OUOO

6.8700

3.6600

•2l£0 Schizophrenic

.3170 Schizophrenic

•8330 Schizophrenic

•0UU5 Schizophrenic

.0088 Schizophrenic

.0$$8 Schizophrenic

.0016 Schizophrenic

Schizophrenic

62

TABLE 28

Chi Square Measures of Differences Between

Alcoholic and Control Members of Group B for the Scaring

Categories which were Significantly Different in Group A

(Alcoholics s 30, Controls • 20)

Deviation Category Number of Deviations Compared

x2 P Group Show-ing Larger Score

Circles 0 with 1 or more 1.1700 .2790 Alcoholic

Workover 0 and 1 with 2 or more U.OliOO •0UU5 Alcoholic

Tremor 0 with 1 or more 3U.6700 .0001 Alcoholic

Asymmetry 0 and 1 with 2 or more 3.9700 .01*63 Alcoholic

Guide Line 0 with 1 or more .OOUO .9UU0 Alcoholic

Angles 0 with 1 or more .3900 .5320 Alcoholic

Dots, Dashes & Circles 0 with 1 or more U.S900 .0321 Alcoholic

63

TABIE 29

Chi Square Measures of Differences Between . > Alcoholic and Schizophrenic Members of Group B for the Scaring

Categories which were Significantly Different in Group A

(Alcoholics - 30, Schisophrenics • 30)

Deviation Category Number of Deviations uowparea

P Group sncnr-" Larger

Score

Extension Join Dot

Tremor

Double Line

0 with 1

0 with 1 or more

0 with 1 oif more

•0680 ,79UO Schisophrenic

13.UOOO .0002 Alcoholic

.6000 .1*380 Alcoholic

into two age groups. The first group consisted of 50 subjects be­

tween 15 and 50 years of age. The second group was composed of 27

subjects who were within the age range of 51 and 8U years. Differ­

ences in deviation between the two age groups for each oategary were

analysed using the chi-aquare test# The results are shewn in Table

30. The table indicates that the categories differentiating be­

tween the two age groups at the 5 per cent level of significance

are: Circlet Rotation, Tremor, Design Missing, Distortion, Asymmetry,

Double Line, Angles, and Dots, Dashes and Circles»

TABLE 30 I

Category Deviation Analysis Between the

Normal 15-50 Year Old Subjects ( N m 50 ) and

the Noraal 51-8U Tear old Subjects ( N • 27)

65

Deviation Category Number of Deviations Compared

x2

Wavy Line Extension Join Dot

Dots, Dashes & Circles Circle

Number of Dots Workorer Second Attempt

Rotation Tremor Design Missing Distortion Asymmetry

Dashes

Double Line

Guide line

Angles

Ends of Lines Not Joined Rotation of the Extension

• and' Curve Touch-up Total Configuration

0 with 1 or more 0 with 1

.Ullib

.5110 ^•5230 .U75o

0, 1 with 2 or more 0 with 1 or more

6.7UOO 12.2600

.0095

.0005

0 with 1 or more 0,1 with 2 or more 0 with 1 or more

.0310

.7980

.0110

.8600

.3750

.9170

0 with 1 or more 0 with 1 or more 0 with 1 or more 0 with 1 or more 0, 1 w ith 2 or ntore

8.3110 26.2560 3.8UOO 6.U000 5.9500

.OOliP .0001 .0U93 .OllU •0lU6

0 with 1 or more 0.0000 .0000

0 with 1 or more U.5200 .0336

0 with 1 or more 0.0000 .0000

0 with 1 or more 10.6700 .0010

0 with 1 or more 0 with 1 or moire

0.0000 •0002

•0000 .97U8

0 with 1 or more 0 with 1 or more T

0.0000 .56to

.0000

.U55o

T. CONCLUSIONS AND DISCUSSION

III* results of the present study suggest the following

conclusions:

1. Each of the clinical groups (schisophrenics, alcoholics,

and chronic brain syndrome subjects) produced higher average Pascal

and Suttell raw scores than did the control groups. There are dif­

ferences of at least 20 points between the control group and each

of these groups. The differences are all significant beyond the

5 per cent level.

2. The mean raw score for the chronic brain syndrome group

is significantly (F = .0005) higher than that of the alcoholics and

that of the schisophrenics.

3. The span raw soore pf the schisophrenics does not differ

significantly froa that of the alcoholics.

U. The raw score variance for subjects between.the ages of

15 and $0 years is smallest for the control group* second smallest for

the alcoholics, and largest for the schisophrenics. The standard

deviations are 11.U2, 19.18, and 29.26 respectively. These differences

are significant beyond the .5 per cent level*

5. The median test and the Kruskal-Wallis Test fail to shew

significant relationships between age and Pascal and Suttell scores

within the 15 and $0 year age groups. Above the age of 50 years* how­

ever* age was found to be an important variable*

6. Analysis of variance shows that there is a difference in

66

Pascal and Suttell scores related to the educational level of the

members of the schisophrenic and control groups. No significant

relationship, however, was found between the educational level of

the alcoholic subjects and their raw scores,

7. The q test for comparisons among individual educational

groups reveals that there is a difference between the grade school

and college groups. The differences between the scores of the high

school and college subjects and between those of the high school

and grade school subjects were not found to be significant*

8* Ihen the TTilcoxon Test was applied to the differences O

in the number^ of deviations in each category for the various experi­

mental and control groups matched for age, sex, and education, the

following differences were found to be significant:

(a) For the schisophrenics and the control subjects:

Workover, Rotation, Design Missing, Distortion, Angles, and Poor

or No Order.

(b) For the alcoholics and the control subjects: Tremor,

Workover, Asyatry, Rotation of the Extension and Carve, and Dot,

Dashes and Circles,

(c) For the chronic brain syndrome and the control subjects:

Number of Dots, Design Missing, Asymmetry, Dashes, and Rotation of

the Extension and Curve. I

(d) For the alcoholics and schisophrenics: Tremor.

9. The schisophrenics, alcoholics7 and control subjects

between 1$ yd $0 years of age were divided into two groups, Group

A awl Gfroup B, on a rando* basis. Those categories which differentiate

significantly between the clinical and control subjects for both

groups using the chi-square test are:

(a) For the schisophrenics and control subjects: Rotation,

Tremor, Asymmetry, and Angles.

(b) For the alcoholios and control Subjects: Workovar,

Tremor, Asymmetry, and Dots, Dashes and ciroles.

(c) For the alcoholics and the schizophrenicst Tremor*

10* The normal subjects were divided into two age groups:

the first group between 15 and $0 years of age, and the second

group between 51 and 8U years of age* Differences in deviation of . i

the two age groups for each category were analysed using the chi-;

square test* The results show that the categories differentiating

between the two age groups at the 5 per cent level of significance

are» Circle, Rotation, Tremor, Design Missing, Distortion, Asym~

metry, Double Line, Angles, and Dots, Dashes and Circles*

lb the present study investigating the Bender-Gestalt

drawings of four groups (schisophrenic, alcoholic,Chronic brain

syndrome, and control subjects), the clinical groups produced

•ore deviations than do control subjects* The average Z score

of 50.7U obtained from the normal group in the present study is

in accord with Pascal and Suttell's finding t^iat "adults of aver­

age I* Q*, between the ages of 15 and $0, Without damage to the

cortex, have the capaolty to execute drawings resulting, on the

average, in a Z score of 50" (65, p. 69)*

fpe*ig the clinical groups, the chronic brain syndrome

subjects produced the highest raw score mean* As will be discussed

later, the difference may be, at least partially, attributable to

age differences*

Comparisons of the Bean scores of the group must consider

the influence of age Yariation and vast equate for this factor, at

least for subjects above $0* Table U (p. 30) shows the mean scares

of all subjects of each group without equating for age* Ibis is not

an entirely satisfactory comparison* The groups, therefore, were

compared after matching for age, sex, and education* The results are

shown in Table 10, page 38* These more rigorous comparisons also

rereal that the difference between the mean score of each clinical

group and its control group is significant beyond the $ per cent level*

The difference in scores between the chronic brain syndrome

and the schizophrenic subjects, and that between the chronic brain

syndrome and the alcoholic subjects are significant at the *$ per

cent level when the age factor is not considered* However, this dif­

ference may be due to the age factor and the groups could not be

equated for age* The difference in mean raw scores of the alcoholic

«nd schisophrenic subjects is significant when age variation is

ignored* However, when age is equated, the difference is nob signi­

ficant at the 5 per cent level*

It is also interesting to note that score variance is signi-

oantly different from one group to another* The control subjects

shoved the smallest variance and schisophrenics the most variance

with an intermediate value for the alcoholics.

Following a suggestion of Qobets (39, p. 22), four possible

bypothese have been testedt (a) deviations of the reproductions from

the stimulus figures are more frequent among abnormals than normals)

(b) deviations are more frequent among normals than abnormals; i4e»,

abnormals tend to conform more rigidly to the stimuli} (e) deviations

are equally characteristic of both normals and abnormals} and (d)

certain deviations are more characteristic of abnormals than normals.

The finding of this study that the clinical groups had larger Pascal

and Suttell raw scare deviations and wider variances than the control

groups certainly rules out the hypothesis that abnormals tend to con­

form more rigidly to the stimuli than normals, and supports the hypo­

thesis that deviations are more frequent among abnormals than normals.

The p resent study also confirms the findings of Pascal and

Suttell that the response to the Bender-Gestalt drawings is not signi-

fioantly related to age within the 15 and $0 years age group, whether

it is a normal or an abnormal group. However, age influences the test

drawings if the subject is older than $0 years. The mean raw scare of

the older normal group (mean age of 70 with a standard deviation of

8*1*8) exceeds that of the younger alcoholics and does not differ signi­

ficantly from that of the younger schisophrenics who were between 15

and $0 years of age.

It seems that once one reaches the level of maturation of the

l$-year-old (or less), the function of visual-motor drawing remains

stable until about $6 years of age. Ihen one becomes older than that

age, however, either motor coordination, perception of visual pattern,

or both, begin to deteriorate*

Pascal and Suttell found a sufficient difference between the

scores of high school and college trained subjects, to convince them

that they should devise a Z score to which raw scores could be con­

I

71

verted. Oobetfe, however, reports that education above the eighth grade

level does not appreciably influence Bender-Gestalt drawings. In the

present study, an analysis of variance revealed a significant relation­

ship between scores and eduoational level (grade school, high sahool,

and college) for both the normal and the schisophrenic subjects. The

three educational groups of alcoholic subjects did not differ signi­

ficantly fro* one another. The q test for comparisons of the individual

educational groups showed that the differences for the normal and schis­

ophrenic subjects were significant between grade school and college sub­

jects. But the differences between grade school and high school, and

between high school and college were not significant. The average

Pascal and Suttell raw scares appear to decrease with increased education.

Thus, neither Pascal and Suttell nor Gobets may be correct. Pascal and

Suttell provide a conversion table only for high school and college.

They do not include a correction for grade school subjects.

Table 31 suamarises the results of the analysis of specific de­

viations characteristic of each clinical group. The differences between

the schisophrenics and their control subjects, and between the alcoholics

and their control subjects provide suggestion# of the nature of the

difficulties. All measures used yielded significant differences be­

tween the schisophrenic and the control subjects In Rotation and An—

gles. Rotation is scored if the design is rotated U5 degrees or sore.

. Rotation can occur if the card is turned and the figure is drawn in this

new orientation or if the card is placed in the original orientation

and the drawing is rotated. Angles are considered to deviate if extra

angles are added or If angles are missing in the reproduction. These

TABLE 31

Differences Significant at the 5 Per Cent Level

Between Deviation Categories For Various Groups

Schizophrenics versus

Normal Subjects

Alcoholics versus

Normal Subjects

Wilcoxon Test (~ Matched m:olips)

Work over Rotation Design Missing Distortion Angles Poor or No Order

Work over Tremor Asymmetry

Chi-Stuare Tests (Signit cant for Both Group ! and GrOUp -m-Rotation Tremor Asymmetry Angles

Work over Tremor Asymmetry

72

Rotation of the Extension and Curve

Dots, Dashes and Circles

Dots, Dashes and Circles

Chronic Brain Syndrome Number of Dots - versus Design Missing

Normal SUbjects Asymmetry

Alcoholics versus

Schizophrenics

Old Normal Gr-oup {51-84 years)

versus Young Normal Group

(15-50 years)

Dashes Rotation of the Extension

and Curve

Tremor Tremor

*Circle Rotation Tremor Design Missing :Qistortion Asymmetry Double Line Angles Dots, Dashes and Circles

iE'!'his particular analysis was done on the total group only.

two deviations appear to be more closely related to perceptual vnd/ov

conceptual than to sot or ability. Rotation could occur as the result

of lack of attention to the orientation of the card or to a failure to

perceive, or to be concerned with the upright. Angle deviations ap­

pear, also, to be perceptual and/or conceptual rather than motor be­

cause a person with a mot or problem would be expeoted to at least try

to put angles in the correct places* The angles produoed might be de­

fective and migit include considerable workover or erasures, but they

should exist*

Between the alcoholics and control subjects, the discriminating

categories that remained significant for both groups and for both sta­

tistical analyses ares Tremor, Workover, Asymmetry, and Dots, Dashes

and Circles, Tremor and Workover would appear to be due to lack of

motor coordination rather than to perceptual weakness. Poor motor co­

ordination would be expected to result in tremulous lines and in the

superimposing of several lines in an attempt to improve drawings that

were unsatisfactory to the subject. Asymmetry and use of Dots, Dashes

and Circles can not be conclusively attributed to either motor or to

perceptual problems.

It would appear, from this analysis, that differentiation be­

tween schisophrenics and alcoholics should be possible from the Bender-

Oast alt records. Comparison of the two groups, however, reveals only

one significantly different category. Tremor appears more frequently

in the alcoholics than In the schisophrenics. This supports the view­

point that motor Impairment is greater in the alcoholic than In the

schisophrenic. It does not support the existence of greater perceptual

7U

and/or conceptual Impairment In the schisophrenic than in the alcoholic*

The chronic brain syndrome subjects can be compared with their

control group by the use of the Wiloozon Test only* This is true because

of the need to eliminate age differences for subjects over 5>0 years of

age.

The categories significantly differentiating the chronic brain

syndrome subjects frost the matched control subjects for age* a ex, and

education are: Muabar of Dots# Design Missing, Asymaetry, Dashes, and

Rotation of Extension and Qarre. The chronic brain syndrome is pri­

marily related to the aging process* Drawings of these subjects may*

therefore, be hypothesised as representing, at least partially, the

effects of aging on the visual-motor capacity. The comparison between

the categories significantly differentiating between chronic brain

syndroms subjects and their matched control subjects, and the cate­

gories varying significantly with the age of the subject fail, however,

to reveal a close relationship* Only two categories differentiate in

both oases. These categories are Design Missing and Asymmetry. ]fuy

of the deviations in drawing found in the chronic brain syndrome group

give an impression of being due to disorientation and lack of attention

to the task. However, there appears to be a visual-motor deterioration

as well in this group.

VI. SUMMART

The present study- was conducted to investigate the effects

of age, education}and clinical grouping upon Pascal and Suttell raw

scares froa the Bender-Oestalt Test, and to determine the nature of

impairment found in the clinical groups in terms of deviation cate­

gories. An additional purpose of this study was to provide aiare in-

faraation about the Bender-Qestslt Test as a differential diagnostic

tool*

The subjects consisted of 60 schisophrenics, 76 chronic al-

ooholics, 32 patients of chronic brain syndroae associated with cere­

bral arteriosclerosis* and 77 normal subjects* The Bender-Gestalt

Test was administered to each subject individually and the reproduc­

tions were scored according to the Pascal and Suttell scoring method.

Pasoal and Suttell mean raw scores of the clinical groups are

all higher than those of the control groups beyond the 5 per cent

level of significance* Among the clinical groups, the aean raw score

of the chronic brain syndrome cases is significantly higher than that

of the alcoholics and that of the schisophrenics* However, there is

no significant difference between the alcoholics and the schisophrenics*

The raw score variance far subjects between the ages of 1$ and

$0 years is smallest for the control group, second smallest far the

alcoholics, largest for the schisophrenics* These differences

in variance are significant at the 5 per cent level*

75

The median test and the Bruskal-Wallis Test fall to show a

significant relationship between age and Pascal and Suttell scares

within the 15 *nd $0 years age group. Age becomes an lap art ant

factor, however, if the subject is older than $0 years of age.

This finding is In agreement with that of Pascal and Suttell*

Analysis of variance shows that there is a difference in

score related to the educational level for the control and schiso­

phrenic subjects. The q test for comparisons of individual edu­

cational groups reveals that there is a difference between the grade

school and college groups.

An Investigation of the deviation categories characteristic

of each clinical group was made using the Wilcoxon Test and the chi-

square test. The Wilcoxon Test was applied to the differences in

the number of deviations in each category for the groups matched for

age, sex, and education* The schisophrenics, alcoholics, and the

normal subjects between 15 and $0 years of age were divided into two

groups, Group a a*** Group B, on a rand ok basis. The chi-square test

was employed to investigate the differences in the number of devia­

tions in each category between the clinical and control subjects.

This was conducted in both Group A and Qroup B. Deviation categories

which remained significant in all three statistical analyses as dis­

criminating between the groups are as follows t

(a) For the schisophrenics and normal subjects) Rotation

and Angles.

(b) For the alcoholic and normal subjects: Workover,

Tremor, Asyetry, and Dots, Bashes and Circles.

(•) For the alcoholics and schizophrenics: Tremor.

The Wilcoxon Test for the chronic brain syndrome and control

subjects is significant for Number of Dots, Design Missing, Asymmetry,

Dashes, and Rotation of Ixtension and Cur re. The chi-equare tests for f

the differences between category scores attained by the older ambers

of the normal group (51-8U years) and by the younger members of the

normal group (l£-£0 years) yielded significant differences in Circle,

Rotation, Treaor, Design Missing, Distortion, Asyametry, Double Line,

Angles, and Dots, Dashes and Circles.

In the analysis of deviation categories, the categories dif­

ferentiating between the schisophrenics and the normal subjects appear

to indicate that the difficulties in schisophrenics are primarily re­

lated to perceptual and/or conceptual rather than to motor ability.

Among the four categories significantly differentiating be­

tween the alcoholics and the normal subjects, two categories (Tremor

and Warkover) appear to be due to poor motor coordination; the other

two categories cannnt be explained with certainty*

The categories which both significantly differentiated between

the chronic brain syndrome and its normal control group, and between

the young normal group (l5-J>0 years) and the older normal group (£L-

81* years) aret Design Missing and Asymmetry. Many of the deviations

•in drawing made by the chronic brain syndrome subjects appear to be

due to disorientation and lack of attention to the task as well as

visual-motor deterioration.

APPENDIX A

Table 1

, Sex, end Bduoation of Sehliopbrenie and Control Matched Qroups

Schisophrenics Control (M » 31) (H r 31)

Mean Age 36.16 36.16

Standard Deviation 12.02 12.02

Range 15-59 15-59

Male 12 il

Female 19 20

Noaber of Subjects with > 5 6 College Bduoation

78

?

— Table 2

Age, Sex, and Education

of Alcoholic and Control Hatched Qroupa

Alcoholics Control (N = 33) (N s 33)

Mean Age U5.03 1*5.03

Standard Deviation 9*55 9*55

Range l£-67 lS-67

Male 18 lit

Female 1$ 19

Nnaber of Subjects with U 3 College Education

Table 3 '

Age* Sex, and Education

of Chronic Brain Syndraae and Control Matched Group*

Chronic Brain Control

VT5!) (" *22)

Mean Age 67.72 70,00

Standard Deviation 8*72 8.U8

Range 52*81* 52-83

Male 17 lit

Female 5 8

Nuaber of Subjects -with 1 1 College Education

Nuuober of Subjects with $ U High School Education

TafapU k 4u'

Age* Sex* and Bduoatlon

of Alcoholic and Schisophrenic Matched Groups

Alcoholics Schizophrenics (N • 30) (N - 30)

Mean A«e 1*3.60 U3.60

Standard Deviation 9.U9 9.U9

Range 25-67 25-67

Male 25 23

Feaale 5 7

Number of Subjects with U College Education

3

APPENDIX B

Each deviation category utilised in this study consists of

one or more scorable items from the Pascal and Suttell scoring sys­

tem. The Pascal and Suttell scorable items which belong to a same

type of deviation (for example, the wavy line of Design 1 and the

wavy line of Design 2) were treated together under the same devia­

tion oategory. Attention was paid to the muber of cards on which

the deviation occurred, rather than to the number of the card on

which it occurred. Definitions of each scotrable item of the Pascal

and Suttell system can be obtained frcm their manual (6$).

The following analysis shews the Pascal and Suttell scorable

items included In each deviation category*

Wavy Linet

It am 1 of Design 1

Item 1 of Design 2

Extension Join Dot (Extension Joined to Carre at Dot)}

Item 5 of Design $

Dots* Dashes and Circlest

Item 2 of Design 1

Item 2 of Design 2

Item 2 of Design 3

item 2 of Design $

Circle:

Item U of Design 1

Item k of Design 3

lb em k of Design $

Nonber of Dots:

Item $ o f Design 1

It7 Of Design 2

item $ of Design 3

Item 7 of Design $

Workorer:

Itea 7 of Design 1

Item 10 of Design 2

Itea 10 of Design 3

Itea 10 of Design 5

Itea 10 of Design 6

Item 9 of Design 8

Second Attempts

Itea 8 of Design 1

Itea 11 of Design 2

Itea 11 of Design 3

Itea 11 of Design U

Itea 11 of Design $

Itea 11 of Design 6

Item 9 of Design 7

Item 10 of Design 8

Rotation:

Item 9 of Design 1

Item 12 of Design 2

Item 12 of Design 3

Item 12 of Design U

item 12 of Design 5

Rotation Continued:

Itea 12 of Design 6

Itea 10 of Design 7

Item U of Design 8

Treaor:

Item 8 of Design U

Itea 7 of Design 6

Itea 6 of Design 7

Item 6 of Design 8

Design Missing:

— Item 10 of Design 1

Item 13 of Design 2

Item 13 of Design 3

Item 13 of Design U

Item 13 of Design $

Item 13 of Design 6 -L,

Ite* 11 of Design 7

Item 12 of Design 8

Distortion:

Item 8 of Design 3

Item 9 of Design k

Item 8 of Design $

Item 8 of Design 6

item 7 of besiga 7

item 7 of Design 8

Asymmetry:

Dashes:

Double Line:

Guide Line:

Angles:

Item 1 of Design 3

Item 1 of Design 1*

Item 1 of Design 6

Item 3 of Design 1

Item 3 of Design 3

Itea 3 of Design $

Itea 5 of Design 6

Item $ of Design 7

Item ^ of Design 8

Itea 9 of Design 3

Itea 10 of Design U

Item 9 of Design $

Item 9 of Design 6

Item 8 of Design 7

Item 8 of Design 8

Itea 2 of Design 6

Item 2 of Design 7

item 3 of Design 7

item 2 of Design 8

item 3 Dssign 8

Ends of Linos Not Joined: •v

It en $ of Design U

K« 1 of Design 7

Itea 1 of Desiga 8

Rotation of the Sztension and Carre:

Itea 6 of Design U

Itea 6 of Design 5

Touch-up:

Orer-lap:

Poor or No Order:

Total Configuration:

Item 7 of Design k

Item 6 of Design 6

itea k of Design 7

Item U of Design 8

Item 2 of Configuration Design

Itea 5 of Configuration Design

Ibea 6 of Configuration Design

All seren iteas of the Configuration Design

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