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THE armcm 0? mm; GAMMA SURGERY
(GHEMOPALLIDECTOMY) ON DEVELOPMENTAL LEVELS

Thesis for the Degree of Ph. D.
MICHIGAN STATE UNIVERSITY

Carming Frank Case“:

1962

W‘vnv

mu.-

.' '3,

 

TH ESIS

This is to certify that the

thesis entitled

THE EFFECTS OF BASAL CANOE-IA BURGER!
(CHEMOPALLI DECTOII ) ON DEVELOPER] TAL
LEVELS

presented by

CABHINE FRANK CASELLA

has been accepted towards fulfillment
of the requirements for

M— degree 111W

Mafi professor

Date_fi¢V30/t /7éal

0-169

 

   
 

  

LIBRARY

* Michigan State

University

    

THE
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Rorschach Ink-
System. To ac
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perimental Sar
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recently (1 eve
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additional sa
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ABSTRACT

THE EFFECTS OF BASAL GANGLIA SURGERY
(CHEMOPALLIDECTOMY) ON DEVELOPMENTAL
LEVELS

by Carmine Frank Casella

This investigation has concerned itself with the study
of the effects of brain damage on responses given to the
Rorschach Ink-Blot test as treated by the Genetic Scoring
System. To accomplish this, three samples were employed
which were equated for age, sex, education and wechsler-
Bellevue Verbal Intelligence Quotient (Form I). The ex—
perimental sample consisted of twenty-six patients suffering
from Parkinson's disease who had elected to undergo a
recently developed neurosurgical technique, the Chemopalli-
dectomy, intended to alleviate Parkinsonian symptoms through
the placement of an exact, circumscribed neurolytic lesion
in a basal ganglia structure, the globus pallidus. Two
additional samples consisting of twentyvsix Rheumatoid
arithritics et als. and twenty-six NOrmal subjects were in-
cluded in this study as controls.

The Parkinsonian subjects underwent three administrations

of the Rorschach Ink—Blot test. The first administration

was given three
occurred twelve
whereas the th
days following
arithrictic et
two administra
the intertest

Using Dew
questions wer
celctual regre
structuraliza
SCknitted to
bong the tin
findings Obt,‘

results as w

Carmine Frank Casella

was given three days prior to the neurosurgery, the second
occurred twelve days following the Chemopallidectomy,
whereas the third administration was given some thirty-seven
days following the second test session. The Rheumatoid
arithrictic et als. and the Nbrmal control groups underwent
two administrations of the Rorschach Ink—Blot test Where

the intertest interval was some forty-three days.

Using Developmental Theory as a guide, several research
questions were generated, particularly the concept of per-
ceptual regression. The Genetic levels of perceptual
structuralization attained by the three groups were then
submitted to statistical comparison both between as well as
among the three groups for all the testing sessions. The
findings obtained were presented and a discussion of the

results as well as their implications was undertaken.

THE EFFECTS OF BASAL GANGLIA SURGERY
(CHEMOPALLIDECTOMY) ON DEVELOPMENTAL

LEVELS

BY

Carmine Frank Casella

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Psychology

1962

The author
.. persons who

stages of deveio;

 

.
"fin-Mn
VsVHU‘ 0
.

Dr. Albert i
:Iy‘stallizing th
tsshniques used
azxility for dis<
£39513 be remem

So, too, t
353:3’, who late
Eliittee, and
33 its complet

3?“ Bans Toch

Wish to ex.
Dr. Ger;

iii

ACKNOWLEDGMENTS

The author wishes to express his indebtedness to the
many persons who helped in shaping this dissertation in its
stages of development from the initial idea to the finished
product.

Dr. Albert I. Rabin was most helpful to the writer in
crystallizing the problem and in selecting the measuring
techniques used in this study. His never failing avail-
ability for discussion and his constant encouragement will
always be remembered.

So. too, the author is deeply indebted to Dr. M. Ray
Denny, who later assumed chairmanship of the doctoral
committee, and whose sound judgement guided this research
to its completion. Dr. Terrence Allen's rare understanding,
Dr. Hans Toch's genuine warmth and Dr. Irwin Kremen's insight—
fulness will be deeply cherished. It is impossible to cata-
loque the events and incidents where each gave so generously
Of himself in encouragement, support and guidance. To them
31 Wish to express my heartfelt thanks.

Dr. Gerald F. King was also a committee member, but his

Lnutimely death deprived both the writer, as well as his col-

Leagues of his
Silii. Be prm
was most neede
Appreciat
of Saint Barrie
Fézorial and i
Siiiiects and
A Specia
531' his 1mm“
aims Studj
LaSt bu

. .
nah
‘zgt

iv
leagues ¢of his great personal generosity and professional
skill. He provided help, insight and friendship when it
was most needed.

Appreciation is similarly due to Dr. Irving S. Cooper
of Saint Barnabas Hospital and Dr. Jack Sokolw of Goldwater
Memorial and Bird S. Coler Hospitals for furniShing both
subjects and facilities for testing.

A special debt of thanks is due to Dr. Manuel Riklan
for his innumerable contributions throughout the course
of this study.

Last but not least the writer wishes to express his
debt of gratitude to Lorayne Rodner who prepared the
manuscript through its several revisions. She provided
endless encouragement during some trying set backs and
was ever ready to help iron out problems as they developed.

WOrds are inadequate to convey his sincere appreciation.

THEY made

To Mary and Carmine Jr.

They made this thesis both possible and necessary

{BEOMEDGMENT S
TABLE OF CONTE‘D‘
LIST OF TABLES

LIST OF FIGURE:

...l?TER I - Pa

K
‘ "TN
“A:

SR II -

TABLE OF CONTENTS

ACKNOWLEDGMENTS . . . . . . . ‘. . . . .
TABLE OF CONTENTS. . . . . . . . . . . .
LIST OF TABLES . . . . . . . . . . . .
LIST OF FIGURES . . . . . . . . . . .
CHAPTER I - Parkinson's Disease . . . .
Definition . . . . . . .
Psychogenic Approaches .
Neurological Approaches .

Treatment Techniques . .

COOper's Chemopallidectomy

vi

Page

- i i i

vi

viii

ix

10.

12.

Chemopallidectomy: Research Possibilitiesl4.

CHAPTER II — Effects of Brain Damage on Psychological

Functioning

Theories of Brain Functionins

Attempts at Assessment .
Psychometric Attempts
Rorschach Attempts .
Sign Approaches . . .

Genetic Scoring System

15.

15.

18.

18.

20.

21.

Purpose of
Methodologf

.vztezioLooy

Procedure

Reliabil it

7:3 ‘1qu S . .

LocatiOn <

Genetic L

Purpose of Proposed Study . . . .

Methodological Considerations .

METHODOLOGY . . . . . . . . . . . .
Samples . . . . . . . . . . .
Procedure . . . . . . . . . . . . . .
Methodology . . . . . . . . . . . . .

Reliability . . . . . . . . . . .
RESULTS . . . . . . . . . . . . . .

Location Choices . . . . . . . . . .

Genetic Level of Responses , , , .

DISCUSSION . . . . . - . . . . . . . .

Phase I - Comparisons Between Groups

vii

Phase I, II and III - Comparisons of the Parkin-

sonians

Phase II - Comparisons Between Groups

SUMMARY . . . . . . . . . . . . . . . . .
APPENDIX A — Genetic Scoring System .
APPENDIX B - Correlation Coefficients

BIBLIOGRAPHY . . . . . . . . . . . . . .

Page
34.

36.

39.

39.

41.

45.

46.

50.

50.

58.

78.

78.

82.

91.

100.

102.

124.

125.

viii
LIST OF TABLES
Table Page

1 The Ranges, Medians and Means for Age,
Wechsler-Bellevue Verbal Intelligence
Quotient, Years of Education and
Duration of Illness for the Parkinson-
ians (Group A), Rheumatoids et als.

(Group B) and the Normals (Group C). . . . A2

2 Median test P-values for comparisons
of W%, D% and Dd% in Phase I test
session for Groups A,B and C . . . . . . . 50

3 Sign test P-values for comparisons of
W%, D% and Dd% obtained in Phase I and
Phase II testing for Group A . . . . . . . 54

A Median test P-values for comparisons
of W%, D% and Dd% obtained by Groups A,
B and C. . . , , , . . . . . . . . . . . . 56

5 Median test P-values for high and low
level W and D modes of response in
Groups A, B and C in Phase I . . . . . . . 61

6 Sign test P-values for comparisons of
high and low W and D levels of response
in Group A for Phase I and II. . . . . . . 65

7 Sign test P-values for comparisons of
high and low W and D levels of response
in Group A for Phase II and III. . . . . . 67

8 Median test P-values for high and low
level W and D levels of response in

Groups A, B and C in Phase III . . . . . . 7O
9 Sign test P-values for comparisons of

high and low W and D levels of response

in Group B in Phases I and III . . . . . . 75
10 Sign test P-values for comparisons of

high and low W and D levels of response
in Group C in Phases I and III . . . . . . 77

,.,.
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viiii
LIST OF FIGURES
Figure Page

1 Sites of pathology encountered in
Parkinson's disease. . . . . . . . . . . . . 9

2 Chemopallidectomy--convexity approach
to the Globus Pallidus . . . . . . . . . . .13

3 Graphic comparisons of the Median
percentages for high and low W and D
Genetic levels obtained by Groups A,
B and C during Phase I . . . . . . . . . .59

4 Graphic comparisons of the Median
percentages for high and low W and D
Genetic levels obtained by Group A in
Phases I, II and III . . . . . . . . . . .63

5 Graphic comparisons of the Median
percentages for high and low W and D
Genetic levels obtained by Groups A,
B and C in Phase III . . . . . . . . . . . .68

6 Graphic comparisons of the Median
percentages for High and low W and D
Genetic levels obtained by Group B
in Phases I and III. . . . . . . . . . . . .74

7 Graphic comparisons of the Median
percentages for high and low W and D
Genetic levels obtained by Group C
in Phases I and III. . . . . . . . . . . . .76

Parkinson' s

;:son's syndrome,

 

egress, is a chr
It is characteriz
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1‘1 insidious or 1
{-53 Present an

#56 fixed postu

CHAPTER I

Parkinson's Disease

Definition

Parkinson's disease, variously referred to as Park-
inson's syndrome, Parkinsonism, Shaking Palsy or Paralysis
agitans, is a chronic disorder of the central nervous system.
It is characterized by a chronic, progressive muscular
rigidity, weakness and spontaneous tremor. Its course may
be insidious or extremely rapid. Victims of the disease
also present an additional range of symptoms among which
is a fixed posture of flexion of the neck and trunk. In
many cases, too, one finds facies, bradykinesia and sometimes
excessive salivation (Brain,l955).

As a disease process, it was recognized as early as the
second century A.D. by Claudius Galen (Button, 1953). From
that time up until 18l7 when James Parkinson, himself a

victim of the disease, wrote his essay, Essay on the Shaking

 

Palsy (Parkinson, 1817) little additional information was
added towards an understanding of the disease. Through his

work, Parkinson hoped that it would ... excite the attention

of those who may point out the most appropriate means of

sieving this ted

26

 

 

. His cont
etc-irate descript
:i the available
L;::le else. Jot
ears later sped
iiit " paral
3310 the seat c
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relieving this tedious and most distressing affliction"

(p. 26). His contribution furnished a more detailed and
accurate description of the disease but the limitations

of the available fund of knowledge at the time precluded
little else. John Hughlings Jackson (1958) some thirty
years later speculated on a more theoretical plane saying
that " ... paralysis agitans ... apart from all speculation
as to the seat of the disease ... illustrates the disso-
lution of the nervous system very well" (p. 48).

In view of the impasse to causation of the disease,
subsequent investigators have attempted to weave the
disease into some sort of theoretical rationale. Two basic
approaches have occupied the center of attention in this
connection, one being psychogenic, the second being neuro-

logical in nature.

Psychogenic Approaches
The psychological aspects that are readily apparent in
the disease process have been generally acknowledged dating
bacm.to Galen (Button, l953). But it remained for later

investigators to attempt to relate them to a personality

:rzented framex
Jellitte
tohetter unde
feeling was t}
EXPitssive of

Giigin. He a

oriented framework.

Jelliffe (1940) Sought to apply psychoanalytic theory
to better understand the dynamics of the disorder. His
feeling was that the motor feature of the disorder is
expressive of deeper ambivalences that are pre-genital in
origin. He asserts that the Parkinsonian's posture is in
fact " ... a voluntary attitude of defense comparable to
the stealthy approach of the boxer to his opponent ... or
the expectant creeping posture of so many primitive
religious dance rituals” (p. 468).

Another approach to the disease was to conceive of
certain personality types as being much more susceptible
to the pathology than is the case with different person—
ality types.

Booth in his several studies (1946, 1948) has been
the stronges:advocate of the viewpoint. On the basis of
his investigations with the Rorschach, he concluded that
Parkinsonism is a syndrome " ... with a specific personality
pattern characterized by marked impulses towards action.
motor activity and industriousness accompanied by a

striving for independence, authority and success" (1948

 

5.3). He WW

i
The Parkinson:
azia tendenZY ti
Eesunnarizes "

filly integrated

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salty in the m0
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p.13). He further asserts that the personality structure
in the Parkinsonians show an emphasis on aggressiveness
and a tendency to be identified with a dominant parent.
He summarizes " ... when the personality is not success-
fully integrated the disease symptoms appear, satisfying
on a symbolic level, rigidity of behavior and a compul-
sivity in the motor system" ( 1948, p. 14).

Machover (1957) on the other hand arrives at different
conclusions from that obtained by Booth in his investi-
gations. He analysed the Rorschach protocols of Parkin-
sonians and compared those patients having the disease
‘for a relatively Short time to those having the illness
fin:a longer period. He found that a good deal of inter-
individual variation in the personality of the short duration
group. The long duration group on the other hand demon-
strated a greater similarity in personality structure.
These patients showed more constriction, rigidity, emotion-
al impoverishment and regressive pathology. He concluded
that these characteristics are more the effect of living
With the disease over a prolonged period rather than the

Causal determiners of the disease. A number of studies

(Diller and Riklan, 1957; Diller and Riklan, 1956;
Riklan, Weiner and Diller, 1959: Riklan, Diller and
Weiner, 1960) partly support this conclusion that there
is in fact no distinct Parkinsonian personality.

The failure to establish some form of consistent
psychogenic causation or correlate for Parkinson's
disease to date, has necessitated a continued adherence
to the more traditional neurological approaches to under-

stand and treat the disease.

Neurological Approaches

Concerning Parkinson's disease, Carpenter (1958)
reports that the " ... neuroanatomical basis of Parkin-
sonian dyskinesia remains one of the great enigmas of
neurology. ... Attempts to seek and understand it in
many instances have proved frustrating and unrewarding"
( p. 50). Many efforts have been turned towards this
end of determining the etiology of the disease and many
agents have been found that are capable of producing the

Parkinsonian symptoms. Among these are encephalitis,

arteriosclero
Eran asphyxia
gnlizing dru
however, are
fiercentage o:
c year in
apparent aff
led some res
has been an
following Wc
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51f

ferent p;

23+ - .
~ lfldlcat

arteriosclerosis and a host of toxic substances ranging

from asphyxiating gases such as carbon monoxide to tran—
quilizing drugs (Kurland. 1958). These types of onset,
however, are reported to account for only a slight
percentage of the fifty thousand new cases that develOp

each year in the fifty year old and over group. The
apparent affinity of the age group for the disease has

led some researchers to epidemiological approaches. There
has been an effort to implicate the influenza epidemics
following World War I as well as the varied types of enceph-
alitis outbreaks whichhave occurred from time to time in
different parts of the world. Kurland (1959) has noted this
but indicates that while the data are impressive they

remain largely correlational rather than causal. In spite of
these tantillizing relationships, the bulk of the newly
afflicted report no history of exposure to these agents or
infections, and so they are placed into a group classified
as idiopathic in origin (Denny-Brown, 1954). To account for
this large group of patients, many views, largely predicted
on little or no theory, have been expressed but no consensus

on any View exists (Bucy, 1957; Cooper, 1956, 1960). Some of

:‘rese views wi‘
Buoy in a
itself with t
reduce the tr
contends that
:Lited over t
pacefiral gy
based on this
The Operatic}
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574939 occurr
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Cooper

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these views will be presented for contrast.

Bucy in a series of papers (1957, 1958) concerns
himself with the neural mechanisms which he believes
produce the tremor observed in Parkinson's disease. He
contends that the tremor is produced by impulses trans-
mitted over the cortico-spinal tracts arising from the
precentral gyrus. He devised a neuro-surgical procedure
based on this model and was able to eliminate tremor. But
the operation necessitated an excision of parts of the
motor strip and so while there was relief of tremor,
there occurred also a paralysis of the limbs for the side
relieved.

Cooper (1958, 1960, 1956) on the other hand, contends
that the origin of the tremor producing impulses is in the
sub-cortical structure, the globus pallidus. In a later
section, the rationale for this position will be given in
more detail. Bucy (1958) rejects this View on neuro—
anatomical grounds indicating that " ... the pathway by
which such tremor producing impulses from the globus
pallidus might be transmitted to the anterior horn cells

of the spinal cord is as yet unknown" (p. 276).

There being
:::.-:erning the e”

the disease, 0t?»

 

::servation of ti
32:5 :00, unfort'

isagreenent bet

 

 

tie observed pat
tag the range

.1955) and Heath
521‘ the substant

55590335, most f :

iiidreds of bra
‘igi‘ire l Presen
Structures and

”“3351 brain

1“ Spite

There being no accord on the theoretical level
concerning the etiology or neuroanatomical operation of
the disease, other workers have turned to more empirical
observation of the disease's locus via autopsy material.
Here too, unfortunately, Heath (1947) notes " ... the
disagreement between the strong internal consistency of
the observed pathologic changes reported by others" ( p. 487).
Among the range of loci reported by pathologists, Greenfield
(1955) and Heath (1947) both note that the globus pallidus
and the substantia nigra are cited as the primary sites
effected most frequently by pathologists who have autopsied
hundreds of brains where Parkinson's disease was present.
Figure 1 presents a schematic representation of these
structures and shows their inter—relationships with other
critical brain structures.

In spite of the lack of accord on etiology or locus
of the specific cites in the brain involved in Parkinson's
disease, the disease is a clinical problem and many efforts
have been made to furnish these patients with treatment

intended to alleviate their symptoms.

Cl

Corticospinal

   
    

GLOBUS
w

\ -‘~Reticular Formation
\\Q# Pyramidal decussations

Figure 1: Sites of pathology encountered in Parkinson's
disease

 

 

 

 

 

 

Until the
are that coul:
isastrous than
merful drugs,
first of newly s

Fzznt out that

10.

Treatment Techniques

Until the last decade, the major therapeutic assis-
tance that could be provided, which was not in effect more
disastrous than the disease itself, has been a range of
'powerful drugs,.such as Artane and Pagitane, as well as a
host of newly synthesized ones. Schwab and Prichard (1951)
point out that the current drugs, either singly or in com-
bination, provide only slight degrees of symptomatic relief
and at best only fifteen percent improvement could be
expected from the then current medical therapy. This
apparent impasse in the treatment and the minimal expec-
tations they permitted for the Parkinsonian patients,
Cooper (1956) indicates, necessitated a more drastic
approach to the problem by means of neurosurgical inter-
vention. In his review, Cooper (1956) points out that-
the first serious attempts to alleviate Parkinsonian
symptoms were undertaken in 1937. Surgery was initially
aimed at the motor and the premotor cortex. Subsequent
attempts were directed at various levels of the pyramidal
tract, from the cortex to the spinal cord. These pro-

cedures however, resulted in either hemiplegia or hemiparesis.

11.

Thus, the price of symptomatic relief depended on the
willingness to sacrifice motor power. The next surgical
target was the basal ganglia which in several cases
resulted in alleviation of symptoms without the paral-
ysis seen in the cortical procedures. Subsequent techni—
cal developments saw the introduction of stereotaxic
apparatus which enabled the accurate placement of lesions
in basal ganglia structures, particularly the globus
pallidus, and the resulting relief in symptoms that
small electrolytic lesions produced.

Accidently, Cooper same upon a new procedure which
entailed a ligation of the anterior choroidal artery,
and he found that there resulted a complete alleviation
of both tremor and rigidity with no loss in motor power.
He replicated the procedure on some twenty—five patients
and found the same result in seventy percent of the cases
operated upon (Cooper, 1953, 1954, 1956). This technique
however, required modification since older patients,
because of the lack of collateral blood supply, ran a
greater risk of complication via hemiplegia even in

successful cases where the symptoms were alleviated.

 

lesionical inve’

gallidus was th

 

szterior choroi
Silittd to this

the Chemopall id

 

 

12.

Anatomical investigations revealed that the globus
pallidus was the major structure irrigated by the
anterior choroidal artery and so the surgical target
shifted to this structure in his new surgical technique,

the Chemopallidectomy (Cooper, 1955).

Cooper's Chemopallidectomy

The Chemopallidectomy is a neurosurgical procedure
devised by Cooper (1955) which is designed to destroy
the globus pallidus within the basal ganglia. A repre-
sentation of the technique is presented in Figure 2. The
procedure essentially consists of the placement of a
brain cannula by hand through a small trephine in the
skull, under radiographic control into the globus
pallidus. Upon ascertaining the correctness of the
placement through x-ray visualization, a permanent
neurolytic lesion is made by injection of a viscous
alcohol, Eotoplin. The alcohol is made radio—opaque in
order to visualize the size, extent and exact location

of the resulting lesion upon x-ray examination.

13.

  

PALL I DU S

Figure 2. Chemopallidectomy - convexity approach to the
Globus Pallidus

l4.

Chemopallidectomy: Research Possibilities

For the psychologist interested in the effects of
brain damage on psychological functioning, the Chemo-
pallidectomy offers some unique research possibilities.
The one opportunity which seems most promising is seen
in the possibility of measuring changes in psychological
functioning caused by specific and clearly circumscribed
brain lesions. The possibility of doing this is due to
the unique condition of patient availability both before
and after the actual placement of the lesion. In this
way, through a properly controlled investigation, it
may be possible to partial out the effects due to the
brain lesion pg; gg through a comparison of performances
by these patients on successive testing sessions over

apprOpriate periods of time.

15.

CHAPTER II
Effectg of Brain Damage on Psychological Functioning

Historically, there has existed and still exists a
tacit belief among investigators which holds that any
damage or insult to the brain will result in some definite
change, usually a decrement, in performance on the part of
‘the functioning organism compared to its pre-damage or pre-
insult level of functioning (Boring, 1950). In keeping with
this general belief, several theories of brain functioning

have resulted.

Theories of Brain Functioning
The basic theories have been advanced concerning the
way the brain is supposed to be organized and function:
1. The brain is in essence mosaic-like in structure and
each tile of the pattern represents a particular, discrete
and totally circumscribed function; 2. The brain is in
essence functionally homogeneous in nature, wherein the
varied parts interact to produce any given function. The

first view is that of a Localization of Function, the

'0‘

 

 

 

 

 

 

 

:,_

...

 

16.

second in the view of Mass Action Functioning (Boring, 1950).

Actually, both of these views hold that a performance
decrement follows brain damage, but it is in specifics that
the two views differ. For example, if a lesion is intro-
duced in an area of the brain where a function is not
”localized" or represented via projection fiber pathways,
there would not occur a decrement. To illustrate this, a
surgical extirpation of a portion of the motor strip of the
precentral gyrus where the fingers are represented would
not affect any other function of the organism other than
the fingers and their activity. Thus the damage will
result in a performance decrement, but merely for the
specific localized function which was extirpated. No
decrement should be evident in other performance areas
of the organism since their localized functions would
not have been directly disturbed.

The Mass Action View takes a different approach to
the problem. Lashley in his series of epoch making studies
concluded that performance decrement does indeed result
from brain lesions (1920, 1921, 1922, 1924, 1929). His

interpretation of this decrement revolved about not where

17.

the lesion was in terms of localized function, but rather
in terms of the amount of brain tissue, both cortical and
sub-cortical, remaining intact after extirpation. From
the results of his investigation, Lashley promulgated two
laws, Mass Action and Equipoteniality of brain tissue
functioning. The first law states that the more the
tissue remaining the better will be the subject's per-
formance on any given task. The second law holds that
regardless of which tissue remains intact after extir-
pation and which tissue is extirpated, there occurs some
functional restitution. This concept of equipotentiality
is most evident in cases where cerebrovascular accidents
of “strokes" have occurred involving the motor areas.

The initial symptoms that these persons show are a paralysis
of the body portions corresponding to the areas involved
in the cerebral hemisphere representation or projection
system. However, in time there appears to develop some
amount of restitution of function with motor capacities
returning in some degree to their pre-stroke levels of
performance.

In an effort to present decisive proof for one or the

 

 

 

 

 

.
u

18.

other of these theoretical positions, a vast body of
literature has accumulated through the years, but no clear
resolution of the issue has occurred to date (Boring, 1950).
Because of this impasse, the trend in research in the area
of brain damage has shifted. The current trend focuses
instead on merely attempting to detect and measure changes
resulting from brain injury independent of any theoretical
affiliation with either Localization of Function or Mass

Action views.

Attempts at Assessment

In the attempts to assess the effects of brain damage
on psychological functioning, the total repetoire of both
the experimental and clinical fields have been marshalled
to detect and measure behavioral changes which are assumed
to be the result of the brain damage per se.
Psychometric Attempts

The oldest and perhaps most consistent assessment
techniques have been those that presumably tap the simpler
sensory and motor functions, the "brass instrument" tech-
niques are the von Frey hairs, two point limen, critical

flicker fusion, visual field perimetry and apparent movement

19.

thresholds (Teuber, 1950, 1955; Teuber, Battersby and
Bender, 1962; Semmes, Weinstein, Ghent and Teuber, 1962).
These procedures have been particularly effective in de-
tecting even the slightest lesions. For this reason, some
reviewers of the topic see a greater measure of promise in
them to provide an enhancement of our knowledge of the
brain and its functional correlates (Yates, 1954; Klebanoff,
Singer and Wilensky, 1954).

Attempts to assess the higher mental processes of
intelligence, perception, concept formation and person—
ality have necessitated a shift from the simple "brass
instrument" techniques to more comprehensive omnibus test
batteries which include many dimensions of intellectual,
perceptual, motor and concept formation tasks (Rylander,l939;
Shipley, 1940; Goldstein and Scheerer, 1941; Halstead, 1947).
The success of these test batteries in detecting or measuring
brain damage has been equivocal in most instances since there
is reported to be a lack of consistency in the findings when
replication of the procedures is undertaken by independent
investigators (Aita, Armitage, Reitan and Rabinovitz, 1947;

Armitage, 1946; Teuber, 1950; Klebanoff, Singer and Wilensy,

20.

1954).

Similarly, non-specialized instruments such as the
vmchsler tests have been bent to the purpose of assessing
the intellectual facets as they covary with brain damage.
Vkukers have utilized a range of short-cut schemas such as
"Signs", "patterns" and "hold-don't hold" sub-tests which
were intended to be sensitive to brain damage (Schager, 1948;
wachsler, 1944). These attempts at detecting and measuring
changes resulting from brain damage failed in most instances
when independent investigators attempted to replicate them
(Teuber, 1950; Geurtin, Rabin and Frank, 1956; Yates, 1954;
Morrow and Mark, 1955).

Rorschach Attempts

Rorschach's (1951) "little experiment" has similarly
been incorporated into the diagnostic repetoire for the
detection and assessment of changes resulting from brain
damage. His own hopes were that "After a further period
of development, it should be possible in almost every case
to come to definite conclusion as to whether the subject is
normal ... or brain damaged" (p. 120). As a technique,

it was wholeheartedly accepted by many clinical investigators

 

21.

since the method enabled a more comprehensive and dynamic
understanding of the person rather than the mere assertion
of the presence, diminution or absence of sensory or motor
capacities.
Sign Apprggghes

Rorschach was constantly mindful of the empirical
nature of his instrument, hence its salient limitation,
its lack of theoretical foundation upon which to test
deductions or from which to generate inferences (Rorschach,
1951; Rikers-Ovsiankina, 1960). With this reservation in
mind, he suggested some ”signs" which he had found in
organic brain damage protocols. Oberholtzer seized upon
these and supplemented them with additional "signs" which
he had found empirically among brain damaged persons
(Rorschach, 1951; Bohm, 1958). The approach appeared
promising since it made possible a quasi-quantitative
method by which to make differential diagnoses of brain
damaged cases from other groups. However, subsequent
investigators appear to have lost sight of Rorschach's
caution and the provisional nature of the sign approach.

The signs themselves were empirically derived and thus

22.

were subject to much variation in diagnostic accuracy as

a function of patient sample and the particular testing
techniques from clinic to clinic. Largely because of

this source of variation, subsequent investigators felt
free to add newly discovered signs or subtract non-discrim-
inating ones from those initially proposed by Rorschach and
Oberholtzer. The result of this addition and subtraction
of signs has been the presentation of a sizable number of
indicies, configurations or systems of signs over the

last twenty years (Piotrowski, 1937; Harrower—Erickson,
1940; Klopfer and Kelley, 1942; Aita, Reitan and Ruth,
1947; Grassi, 1947; Ross and Ross, 1944; Bochner and
Halpern, 1945; Dorken and Kral, 1951; Hertz and Loehrke,
1955).

Many of these proposed systems were short lived. A
few of them, however, were well received and subsequently
stimulated a range of replicatory studies to investigate
their validities and reliabilities. The general findings
of these critical studies has found little in the way of
validity for these systems either taken singly or collec-

tively (Nadel, 1938; Aita, Reitan and Ruth, 1947; Reitan,

23.

1953a, 1953b, 1954, 1955; Hertz and Loehrke, 1954; Diers
and Brown, 1951; Saslow and Shipman, 1957; Fisher, Gonda
and Little,l955).

The result of these claims and counter claims as to
the validity of Sign approaches has served to spread a
mantle of confusion over the entire area of detection
and measurement of brain damage (Klebanoff, Singer and
Wilensky, 1954; Yates, 1954). The more vitriolic critics
of the Rorschach,in general and Sign systems in particular,
have not passed up the opportunity to hurl a stinging
rebuke to their advocates. Jenson's (1958) statement is
a typical summary of the critical view. "The Rorschach
in particular has been waflhless as an instrument. Though
claiming for decades to be the method par excellence ...
after thirty years of research, the vast bulk of Rorschach
literature is still concerned with demonstrating validity"
(p. 296).

Yates (1954L no less dissatisfied with the failure to
validate the sign approaches, offers some reasons fo; the
failure to do so. "A purely empirical approach is unlikely

to yield any satisfactory result ... A test of brain damage

ta

(:1

24.

Should be based on a reasonabLe theory, supported by
adequate statistical treatment, taking into account all
relevant variables. Such an approach would at least help
to Overcome the impasse which seems to have been reached.
The constant 'dog-eat—dog' method by which one set of
signs is set aside and replaced by a new set by a sub-
sequent worker does not inspire confidence" (p. 371).

Cronbach (1956), in a similar vein states, "They
have not demonstrated that the test is precise enough
or invariant enough for clinical decision. It has re-
peatedly failed as a predictor for practical criteria"
(p. 184). He does, however, see some measure of hope for
the instrument if it is used in a systematic, non-empirical
fashion. " ... a scientific study of the Rorschach has
barely begun. It is now evidenced in studies which
translate classical theory into experimental designs and
which adopt proper methodology" (p. 183).

Among clinicians, more intimately involved with
these problems, there has been a growing realization and
acceptance of this position indicated by Cronbach. In

the light of these criticisms, researchers have attempted

25.

to use the Rorschach in terms of a theoretically based
framework (Fisher and Cleveland, 1955; Holt, 1956;
Friedman, 1953). Of these systems, that devised by
Friedman and called the Genetic Scoring System seems
to this writer to be the most appropriate for purposes
of determining and measuring changes resulting from brain
damage as we shall see in the following discussion.
Genetic Scoring System
Friedman's Genetic Scoring System was derived from
the DevelOpmental Theory which was enunciated in Werner's
(1948) Comparative Psychology of Mental Development and
has since been reiterated by its author (1957). In these
works, werner attempts to demonstrate that child, individual
and animal psychology, was well as psychopathology can
be fruitfully approached from the developmental point of
View. Since Friedman's Genetic Scoring System is based
on this theory, it may be well at this point to present
some of the main points of Developmental Theory in order
to make the Genetic Scoring System more meaningful.
Werner sees development as a process of increasing

differentiation followed by a subsequent integration.

26.

He holds that at the earliestand primitive levels, organi—
zation, regardless of the particular mode or content, is
said to be more homogeneous and less differentiated than
at the more advanced stages of development. This is
Werner's basic ggvelopmental law and it is seen as a con-
tinuum wherein behavior proceeds from undifferentiated
responses to a stimulus pattern by way of a process of
selective attention to its parts and ultimately to a
stage of appropriate integration of the entire stimulus
configuration. This, Werner feels, is the basic proto—
type of development. It is felt by him to hold for per-
ception, learning, thinking, problem-solving, or any
other type of activity engaged in by the organism. With-
in this developmental progression are constructs which
Werner arranges as "paired opposites“, designating them:
Synqratic-discrete, diffuse—articulated, rigid-flexible
and labile-stable. It is the process of transition from
One pole to the other of these ”paired opposites” which
exemplifies the developmental progression. In the normal
Case, this progression is directional and proceeds from

"globality" and "lack of differentiation" to "specificity"

27.

and "differentiation".

According to Werner, this developmental process is
capable of operating in a reverse fashion. In this case,
there occurs a directional shift which proceeds from the
higher levels of integration attained by the organism to
the lower, more primitive and "dedifferentiated" levels.
This regression is said to manifest itself in varying
degrees in the presence of major pathology. Further,
Werner asserts that the degree of this "organismic
regression" will vary with the extent or severity of the
pathological process precipitating the regression.

From this theoretical framework, Friedman (1953)
developed his Genetic Scoring System for the Rorschach
Ink-Blot test. The purpose of the system is to provide
a graduated continuum to quantify the perceptual—
structural elements of responses given by subjects to
the ink-blots. The scoring system allows for a range which
extends from the lowest levels tc the highest levels of
perceptual structurization as would be required by Werner's
theory. Interpretation is then based on the inference

that levels of perceptual structuralization in the Rorschach

28.

responses reflects and is indicative of a given subject's
Developmental level in Werner's terms.

Drawing on the pioneer efforts of Meili—Dworetzki
(1957) and Beck (1944), Friedman's system provides for
the evaluation of any given response to the Rorschach
Ink-Blot in terms of a continuum of Perceptual Structur-
aligation ranging from the most diffuse to those that are
highly organized and integrated (see scoring manual included
under Appendix A). In scoring the responses, the form
level of the percept; the specificity of the blot struc-
ture for any given content; and the nature of the organ-
ization of the responses are evaluated. The adequacy of
the form level of any given response is determined by
Beck's (1944) tables, whereas the specificity of the
blot structure requirements are evaluated according to
the rules described by Phillips and Smith (1955).

The Genetic Scoring System, by virtue of its theo-
retical underpinnings in Developmental Theory was sub-
jected to tests of validity by Hemmendinger (1953). In
his dissertation, he sought to test Werner's view that

perceptual development proceeds from simple to comlex

29.

levels. Utilizing a sample of one hundred and sixty-

nine children between the ages of three and eleven, he
found, as predicted by the theory, an increase in "geneti—
cally high" responses with increasing chronological age

and a decrease in "genetically low' responses.

A second validational procedure, that of "micro-
genesis", was undertaken by Framo (1952). Developmental
Theory specifies that the forming of a gnnn percept pro-
ceeds sequentially from syncratic to discrete. To each of
four groups consisting of twenty subjects, he tachisto-
scopically exposed Rorschach cards for .01, .10, 1 and
10 seconds. The findings he obtained were consistent
with those predicted by the theory, namely that longer
exposure times were paralleled by an increase in the
Developmental level of the percepts given by the subjects.

The reliability of the scoring system was approached
by a succession of studies by Hemmendinger (1953), Friedman
(1953), Lane (1950) and Siegel (1953). Phillips, Kaden
and Waldman (1959) summarize their findings and indicate
that the percentage agreement among independent scorers

ranged well into the nineties.

30.

Further studies have been directed to using the
scoring system and applying the Developmental Theory to
psychopathology in order to demonstrate regression, i.e.,
the increase of "genetically low" level responses in varied
pathological groups.

Friedman (1953) undertook to test his system of
scoring to detect regression in perceptual structural—
ization in pathology. Using a sample of schizophrenics.
normal adults and normal children, he found that schizo—
phrenics show much lower levels in their perceptual
structuralization of the Rorschach Ink-Blot cards than
do the normal adult control subjects. Further, and per—
haps much more critical for DevelOpmental Theory, the
schizophrenics' response levels of perceptual structur-
alization showed a similarity to, but not an identity
to the performances given by the child control group.

Siegel (1953) went a step further in his use of the
Genetic Scoring System. He attempted to evaluate the
relative intactness of the different psychiatric groups
as suggested by psychoanalytic theory. He used a sample

of paranoids, hebephrenics, catatonics, normal adults

31.

and normal children. His predictions, in keeping with
Psychoanalytic theory, were that the normals would show
the highest Developmental levels; next would be the para—
noids: the lowest levels would be attained by the hebe-
phrenic and catatonic groups. These predictions were
confirmed. Further, he noted that the genetic level
scores obtained by the hebephrenics and catatonics corre-
sponded closely to those evidenced by the younger children
when the genetic level scores of the groups were expressed
in percentages. The paranoid group on the other hand,
were found to show a marked similarity in terms of the
genetic level of scores obtained to those obtained by
the older children. His conclusion based on the genetic
scoring system, he felt coincided very well with the pre-
dictions that would be expected from Werner's Developmental
theory in terms of there having occurred a perceptual
regression which was more marked in the hebephrenics and
catatonics than was the case for the paranoids when they
were compared to the normal control groups.

Friedman's Genetic Scoring System for the Rorschach

has also been used to test other hypotheses deduced from

32.

Developmental theory and the areas studied have included
perception in the aged (Rochwarg, 1954); social effective—
ness (Lane, 1955); Process-reactive schizophrenia (Becker,
1956; Fine and Zimet, 1959); social adequacy (Fowler, 1957);
artistic creativity (Hersch, 1957); hospital adjustment

and social participation (Wilensky, 1959). Hemmendinger
(1960) has recently presented a detailed review of these
studies.

A number of more recent studies have expanded the list
of research which has successfully used the Genetic Scoring
System to investigate varied other topic areas among which
are: Levine's study (1959) which found a measure of relation—
ship between genetic level attained and prognosis for
discharge from psychiatric hospitals; Kaden (1960) related
high genetic level attainment and successful post-hospital
adjustment among male schizophrenics; Eissendorfer (1960)
related impaired sensory capacity, i.e., hearing deficit,
to lower levels of genetic level score attainment when
these subjects' performances were compared to those ob—
tained by normal control subjects.

Pefia's (1953) study is the only study to date that

33.

has applied the Genetic Scoring System to brain pathology.
His purpose was to apply Developmental theory and its
predictions to the performance of brain damaged persons,
hypothesizing, " ... that cerebral damage in adults is
accompanied by the appearance, in perceptual structural-
ization, of a relative increase in qualities seen in
developmentally earlier levels than normal adulthood,

with a simultaneous retention of traces of all the

phases traversed in the course of deve10pment” (p. 186).

In his study, Pena utilized a sample of thirty patients

with cerebral pathology among which were included cases

of brain trauma, brain tumor and cases with cerebral
necrosis due to compression or ischemia. As controls

he had thirty normal adults, one hundred sixty-nine

normal children between the ages of three and ten as well

as thirty patients with a diagnosis of hebephrenic or
catatonic schizophrenia. The findings Of the study con-
firmed the hypothesis that he had advance in keeping with
Developmental theory, i.e., the brain damaged group attained
Developmental levels lower than those obtained by the normal,

but as a group could not be strictly identified with any

34.

particular developmental phase as had been the case
with the psychiatric groups used by Friedman (1953) and
Siegel (1953). "The results then point to the conclusion
that the perceptual structuring of cerebrally damaged
adults displays certain qualitative aspects which, while
most like that of older children, are in some important
respects analogus to characteristics seen in the youngest
and in other respects like the stabilizing and econom-
ical features in normal adults" (Pefia, 1953, p. 198).
From this study and the ones mentioned earlier, it
appears that the Genetic Scoring System might have value

for other studies of brain damage effects.

Purpose of the Proposed Study
The recent development of the Chemopallidectomy as
a neurosurgical technique to alleviate the incapacitating
motor symptoms of Parkinson"s disease provides the writer
with an opportunity to investigate the effects of brain
damage. A review of the literature, both theoretical and
empirical, indicates a general consensus which in effect

states that brain damage has as its result a decrement

35.

in performance when these performances are compared to
those of non-brain damage controls. Most of these investi-
gations have been cross—sectional in nature and the
brain damage groups were compared to normal groups. With
the Chemopallidectomy, a unique opportunity has been
provided in which it becomes possible to make a longi—
tudinal analysis of the performance of the same subjects
before and after the placement of an exact neurolytic
lesion in a circumsribed structure of the basal ganglia,
the globus pallidus. Because of this availability of
the subjects before and after the placement of the lesion,
it is felt that an empirical investigation can be under-
taken in which it would be possible to partial out the
effects of the lesion caused by the surgery.

As the measuring instrument to detect any change in
performance, the Rorschach was used and the Genetic Scoring
System was applied to the responses, essentially the

methodology of Pena.

36.

flgtholdological Considerations

Some design problems have to be considered in such a
research undertaking. In attempting to measure any changes
which may occur in subjects undergoing the Chemopallidectomy,
there must be at least two testing session, one before the
operation and the second session following the operation.
But in such a design the effects of practice are-confounded
with the actual changes due to the neurosurgery. The pro-
tuem of repeated administrations of the Rorschach on res-
ponses was studied by Schneider (1955). He observed that
when normal subjects are retested at different time inter—
vals, there is a general decline in the number of responses
reproduced in subsequent readministrations of the Rorschach.
His experimental design involved three groups of subjects,
one of which was tested and retested four hours later;
the second group was tested and retested twelve days later;
whereas,the third group was tested and retested thirty days
later. With the decline in the number of responses repro-
duced and recalled, there occurred an increase in the
number of new responses which were 25%, 32.2% and 29.5%

respectively for the three groups. Schneider thus concludes

37.

tflnat over increasing time periods, starting with the four
Imour test-retest, there is a lesser effect due to practice,
zand practice alone. This finding is essentially in accord
‘yith the conclusions reported by Swift (1944) and.Stein
(1960).

In view of this information concerning the effects of
repeated Rorschach test administrations, any testing design
‘used to study the effects of change following the Chemo-
pallidectomy should incorporate several post-operative test
administrations. For maximal detection of changes, if any,
it seems advisable to test subjects as soon as possible after
the operation and then to test them again after a period
not less than thirty days following the operation. In
this way there will be a greater measure of “true" effects
of the operation while there is least effect due to the
influence of practice.

The next problem that should be considered in any
study to investigate the effects due to the Chemopalli—
dectomy concerns the matter of suitable control subjects.
As has been pointed out in Chapter I, Parkinson's disease

is a chronic disorder affecting the motor functions of the

38.

patient involing a restriction of movements. Since the
Inain concern of the proposed study is the effect of brain
«damage solely, it becomes necessary to introduce a control
group which has similar symptoms but no actual brain
(damage. Of the patients groups which were available to
the writer, Rheumatoid Arthritics and Post-Polio cases
approximated the Parkinsonians for the factors of chron-
icity and motor incapacitation but with no known brain
damage involvement. In the absence of a non-operative
group of Parkinsonians, these subjects approximate an ade-
quate control group for the Parkinsonians. A normal
control group was also included to serve as a frame of
reference for the results obtained in the study.

In the light of the foregoing discussion, it becomes
feasible to ask the following questions;

(1) Will the level of perceptual structural-
ization of Parkinsonian patients be
lower than those of non-brain damage
control groups?

(2) Will subjects whose existing brain
damage has been extended by the Chemo-
pallidectomy regress to lower levels of

perceptual structuralization than they
attained pre-operatively?

39.

METHODOLOGY
Samples

Three samples were employed in this study, a Park-
insonian and two control groups. Table 1 presents a
breakdown for all groups in terms of age, verbal intelli-
gence quotient, educational level and duration of illness.

The Parkinsonian group, Group A, constituted the
experimental sample. It was drawn from successive admis-
sions to the Neurological and Neurosurgical Division of
Saint Barnabas Hospital in New York City. The selection
of particular patients for inclusion in this study was
based on their availability for follow—up testing, thus,
only patients from the New York Metropolitan area were
selected.

The Parkinsonian group was composed of twenty-six
subjects, twenty males and six females, who had decided to
undergo the Chemopallidectomy in hopes that it would
alleviate their symptoms. In age they ranged from thirty-
seven to sixty years, the mean age being 46.8 years. The
duration of their illness, from onset of the first symptom,

ranged from two to ten years, the mean duration being 6.5 years.

40.

The second sample, Control Group B, was selected
from the clinic lists of Goldwater Memorial and Bird S.
Coler Hospitals in New York City. The aim in selecting
this group was to furnish a control for motor restriction,
as well as the chronic factor involved in the Parkinsonian
group. In addition to being matched to the Parkinsonians
for these two variables, they were also matched for age,
years of education and Wechsler-Bellevue Verbal Intelli-
gence Quotient (Form II). The results of this selection
were fourteen subjects with a diagnosis of Rheumatoid
Arthritis; eight subjects with a diagnosis of Post-Polio;
two subjects with a diagnosis of Spinal Incomplete Trans-
section; two Above Knee Amputees. In the Rheumatoid
group six subjects were females, the remaining subjects
in all groups were males. Table 1 gives a breakdown for
the variables which were matched for all the groups.

The third group, Control C, consisted of twenty-
six normal subjects, twenty males and six females, who
were in no way incapacitated physically or mentally. They
came from an urban neighborhood cross-section and volun-

teered to be tested when informed that data was needed

41.

for the writer's dissertation. They consisted of small
business owners, housewives and professional persons. Of
the group initially tested, one subject died of a heart
attach three daysfollowing the first test session and so
his test data was discarded and another subject was
recruited. For this group the variables for which they
were matched to Parkinsonians were: age, Wechsler-Bellevue
Verbal Intelligence Quotient and years of education. The
means and ranges for these variables are presented in

Table 1.

Procedure

 

On admission to the Neurological Service, the Parkin-
sonians were selected as outlined above. Following this,
as part of the routine selection procedure, a personal
interview elicited relevent information concerning age,
educational and occupational levels- When this was com-
pleted testing began with an administration of the
Wechsler-Bellevue Intelligence Test (Form II) consisting
solely of the verbal subtests. When this test was com-
pleted, a ten minute rest period was given during which

the patients could sit and relax and talk of whatever they

Table 1

‘Ce.

The Ranges, Medians and Means for Age, Weclsler-Bellevue
Verbal Intelligence Quotient, Years of Education and
Duration of Illness for the Parkinsonians (Group A),
Rheumatoids et als. (Group B) and the Normals (Group C).

Groups:
Number:

Age:
Range

Median
Mean

V.I.Q.:
Range

Median

Mean

Education:

Range
Median
Mean

Duration:
Range

Median

Mean

Parkinsonians

 

26

37 to 60

49
46.8

80 to 127
105
106.2

4 to 20
12
12.9

2 to 20

6.5

2 (f)

34 to 60
47

E 7

89 to 127

104

105.2

3 to 20
10

11.1

3 to 12

Rheumatoigs

Normals

26

30 to 63
48
47.7

90 to 129
105
104.3

4 to 20
12
12.3

43.

wished. After the rest period there was an administration
of the Rorschach test with the standard instructions as
given by Klopfer et. als. (1952). Two to three days of
.medical and neurological examination followed before
they actually were to undergo the Chemopallidectomy.
Following the Operation, depending on the subject's
clinical condition, e.g., his state of consciousness,
alertness and his ability to cooperate, a post-operative
test period took place during which there was a second
standard administration of the Rorschach alone. The time
interval between test and second retest ranged from nine
to fourteen days with a mean inter—test interval of
twelve days. Following this test session, the subjects
were discharged from the hospital with instructions to
return in from one to two months for a follow-up of the
surgery. Upon their return, the third administration of
the Rorschach test alone was given with the same standard
instructions. This third administration occurred from
forty-two to fifty—two days following test session one
and was on the average some thirty-seven days from test

session two.

44.

The Rheumatoid Arthritics were selected as stated
above and the procedure for the first testing session was
identical with that of the Parkinsonians. The sole
difference in procedure was that there occurred only
two administrations of the Rorschach. The inter-test
interval between administration ranged from forty-one
to fifty-three days with the mean interval being forty-
five days.

The normal group, Group C, was selected as stated
above from a cross-section of volunteensfrom the Green-
point district in Brooklyn. The procedures for testing
in this group were identical with those administered
to the Rheumatoids, Group B. The inter-test interval
between test and retest of the Rorschach ranged from
thirty-eight and fifty-two days, the mean interval
being forty-one days.

In terms of an overall experimental design, this
study involved three distinct phases in which the Ror-
schach test was administered. The following diagram

illustrates this:

45.

 

 

Groups Phase I Phase II Phase III
Parkinsonians Test 1 Test 2 Test 3
Rheumatoids Test 1 ‘ Test 2
Normals Test 1 Test 2

The Phase III sessions were arranged so as to
minimize the effects of practice as suggested by the

studies of Schneider (1955) and Swift (1944).

Methodology

The Rorschach Ink-Blot Test was administered to
each of the groups separately, i.e., all the pre—
operative Parkinsonians; all the post-operative Parkin-
sonians; all the long range post—operative Parkinsonians.
Similarly, all the Rheumatoids as well as the Normals
were tested as groups in both phases of the testing
situation. Upon the completion of this testing, the
protocols were scored according to the method proposed
by Friedman (1953). The manual for this Genetic Scoring
System is included under Appendix A. The system as
earlier stated, has as its purpose the quantification

of the formal perceptual structure underlying the

46.

the responses to the ink—blot stimuli. The specific
scores of Friedman's system which will be used are
those used by Pena (1953) and found to be discrimi-
nating on a brain damage population. These scores are:

1. Location Choice, 1, e, m W%; D%; and Dd%.

2. Genetic Level of Response. i.e., genetically
low attainment as seen in low W and D as
occurring in minus (-), vague (v) and amor-
phous (a); or genetically high W and D attain-
ment as seen in the mediocre (m), plus ({) and
integrated (1) responses. (See Appendix A
for details).

This adherence to the indicies employed by Pefia
is intended to permit a measure of methodological
Continuity as well as provide an independent source
of confirmation for his results if the the findings

of this study so indicate.

Reliability
A measure of scorer reliability was undertaken on

a Sanmfle of the protocols. The procedure involved the

47.

removal of all identifying or scoring data from the
protocols-and assigning a code number to each protocol
which was unknown to the independent scorer. Following
this, there were assigned random numbers to each of the
protocols of all three groups for all testing sessions.
This being accomplished, nine protocols from each
group for each testing session were then selected by
the independent scorer using the Table of Random
Numbers. In this way, a total of twenty-seven proto-
cols were selected from the Parkinsonians, i.e., nine
from Phase I, nine from Phase II and nine from Phase III
testing sessions. For the Rheumatoids, eighteen proto-
cols were selected, i.e., nine from Phase I testing and
nine from Phase III testing sessions. The same proce-
dure was used for selection of the Normal group's
protocols. This selection process being completed,
the independent scorer who was trained in the Genetic
Scoring System then proceeded to score tha protocols
using the manual under Appendix A for criteria.
Adhering to Cronbach's (1949) suggestions as to

the appropriate statistic to be used for reliability

48.

measures on Rorschachgdata, a Spearman Rank Order
correlation coefficient (Rho) was computed in the
manner outlined by Siegel (1956). Rho's were computed
between the author's scoring and the scores obtained
by the independent rater for the four general scoring
categories, i.e., high W, high D, low W and low D
genetic levels. The resulting Rank Order Coefficients
(Rho) are presented under Appendix B. As can be seen,
they range from a low of .84 to a high of .96, with the
median Rho being .91. Thus, the inter-scorer relia-
bilities obtained in this study compare favorably
with those obtained by the investigators cited earlier
(Hemmendinger, 1953; Friedman, 1953; Siegel, 1953:
Phillips, Kaden and Waldman, 1959).

The statistical analysis of the Rorschach data
was accomplished by the Median Test. This procedure
was suggested by Friedman (1953) and used by Pefia (1953).
In this study, as was the case in their investigations,
chi-square probabilities of .02 or less will be considered
significant. Probability values between .10 and .02

are taken as suggestive of differences. The Sign Test

will be used for comparisons where the assumptions

for the Median Test cannot be met.

49.

50.

RESULTS

In the interest of clarity of presentation, the
writer will present the findings for Location choice
and Genetic level of responses under separate headings.
W:

Location choice refers to the amount of the blot
area of the Rorschach cards delineated and included by
the subjects in their percepts. The scoring system
used in evaluating the location of responses allows
for three possibilities which are W, D and Dd. (W
refers to the use of the whole ink-blot in the percepts;
D refers to the use of a large area, whereas Dd refers
to the utilization of small areas in the stated percepts.)

In Table 2 is presented a comparison of the location
choices expressed in percentages for the three groups
during Phase I test sessions. As can be seen, the pre-
operative Parkinsonians, Group A, obtained a median per-
centage for 57 for W%. The Rheumatoids, Group B, and
the Normals, Group C, obtained median percentages of
25 and 26 respectively. The difference between the

Parkinsonians and both control groups was found to be

51.
Table 2

Median test P- values for comparisons of W96 D% and Dd%
in Phase I test session for Groups A. B and C.

 

 

 

 

w%
Groups A B C
Median %
A 57 x
B 25 .01 x
C 26 .01 - x
D%
Groups A B C
Median %
A 36 x
B 36 - x
C 42 - - x
Dd%
Groups. A B C
Median %
A 0(.32)* x
B 10 ' .01 x
C 8 .01 - x

* In tables where the majority of the median scores
are zero, the percentage of cases using the particular
response scores will be indicated in parentheses.

52.

significant. However, a comparison between the two
control groups for W% fails to show any significant
differences. These findings suggest that the Parkinq
sonians emphasize W as a response mode to a greater degree
than is true for the Normal and Rheumatoid control groups.
The use of large details, i.e., D, as a mode of response
appears to have been about equally stressed in all groups.
the median percentages for Groups A, B and C being 36,

36 and 42 respectively. Thus, they show no significant
differences when the groups are compared for D%. Dd or
the utilization of small details as a mode of perceptual
structuring of the blot material is found to be a lesser
trend for all three groups. The use of this location
category seems to have been employed more extensively

by the controls, since all the subjects of these groups
used it at least once. The median percentages for the
Rheumatoid and Normal groups being 10 and 8 respectively.
For the Parkinsonians, Group A. only thirty-two percent

of the subjects used this location choice, the group's
median percent was 0. The result of the comparisons

between the three groups shows that there exists a signi-

53.

cant difference between the Parkinsonians and the two
control groups, however, there were no statistically
significant differences between the B and C groups.

A statistical comparison of the location choices
used by the Parkinsonians in Phases I and II is presented
in Table 3. The P values presented were obtained by
the use of the Sign test. The results indicate that
there appears to have been no significant shift in
perceptual mode or emphasis in the use of location
choices. Further, the medians can be seen as being
virtually the same.

When comparing location choices for W, D and Dd
among the three groups in Phase III, i.e., test session
three for the Parkinsonians and test session two for
the controls, there appears to be some change in
emphasis relative to test session one, particularly in
the utilization of large details for Group A. As can
be seen in Table 4, a decline occurs in Group A's use
of D relative to the control group's which approaches
the level of significance stipulated above. The relative

use of W and Dd for the three groups appears to be about

Table 3

54.

Sign test P- values for comparisons

of W%.

D% and Dd% obtained in Phase

I and Phase II testing for Group A.

 

 

 

W%
Phase Median % P-value
I 57
.848
II 60
D%
Phase Median % P-value
I 36
.924
II 34
Dd%
Phase Median % P—value
I 0 (.32)
.730
II 0 (.28)

55.

the same as was the case in Phase I. (See median percentages
in Tables 2 and 4). However, some rise in the median
percentages for the Normal group did occur, i.e., from

8 to 16 for Dd, hence, missing significance from .01 to

.001 levels. But the basic relationship of significance
found in Phase I remains essentially the same in Phase III
(See Tables 2 and 4).

Let us turn to a summary of the findings for the
location choice data in the three groups for Phase I, II
and III. The Parkinsonians, in both Phase I and Phase III
tend to produce a higher percentage of W responses than
is the case for both the control groups. Parenthetically,
it should be noted that this excessive use of W is seen
by most clinicians as a major "sign" for organic brain
damage. The control groups have about half as many W's
in their responses and no significant differences between
the Rheumatoid and Normal groups in either Phase I or
Phase III. The Parkinsonians use of D as a location
choice was found to be employed to a lesser extent in
Phase III than was the case in Phase I. The comparisons

of the three groups in Phase III for D was found to be

Table 4

Median test P-values for comparison of W%,
D% and Dd% obtained by Groups A, B and C
in Phase III.

 

 

 

W%
Groups A B C
Median %
A 63 x
B 25 .01 x
C 30 .01 - x
D%
Groups, A B C
Median %
A 31 x
B 40 .10 x
C 40 .10 - x
Dd%
Groupgv A B c
Median %
A 0 (.29) x
B 10 .01 x

C 16 .001 - x

56.

57.

suggestive of, but not actually significant. The Dd
median percentages for the Parkinsonians was 0 in both
Phases I and III, since only about a third of the sub-
jects gave a Dd response. Parenthetically, it may be ';
added that proponents of "signs" for the detection of
brain damage indicate that the absence of Dd is a prime .
"sign" to discriminate brain damaged from non-brain 9
damaged subjects. The control groups on the other hand.
used Dd much more extensively, attaining median percent-
8988”Of 10 and 8 for Groups B and C respectively in
Phase I, 10 and 16 in Phase III and so showed signi-
ficant differences when compared to Group A in Phases
I and III.
We shall now direct our attention to the second
aspect of perceptual functioning under investigation,
namely the findings concerning the qualitative aspects
of the responses given by the subjects to the Rorschach
cards, i.e., the degree of high level or low level
perceptual attainment as scored by Friedman's Genetic

Scoring System (See Appenix A for illustrations).

58.

Mic 1&1 of Resmnses:

The qualitative aspect of responses for the three
types of high genetic level and low genetic level ob-
tained in Phase I from Groups A, B and C are graphically
presented in Figure 3. The three constituent scores
for the higher levels of perceptual attainment, i.e.,
mediocre (m), plus (i) and integrated (i) were combined
into a single percentage value for each subject and
the median was computed. These values are plotted
on Figure 3 over the high level categories of W and D.
Similarly the low level scores, i.e., minus (-), vague
(v), and amorphous (a) have been combined under the low
level categories of W and D.

It can then be seen that the Normal groups' quali-
tative performance is characterized by the highest
percentage of genetically high W and D responses, attain-
ing median percentages of 100 and 90 respectively in
Phase I. Conversely, they show a total absence of reel
sponses which are genetically low level. Group A, the
Parkinsonian group, falls into an intermediate position

on the plot with a median percentage for high W, high D,

" t!
v,
.50

100

90

80

7O

60

50

40'

30

20

10

 

59.
Figure 3
Graphic comparisons of the Median
percents for high and low W and D

Genetic levels obtained by Groups
A, B and C during Phase I

A (Parkinsonians)
.\\\ ___ __ B (Rheumatoids)

\ __ ..__ C (Normals)

 

.mnmefl

l A
High W High D Low W Low D

60.

low W and low D being, 60, 62, 33 and 27 respectively.

The Rheumatoid group shows fewest high level responses

and most genetically low level responses. Their median
percentages for high level W and D are 50 and 41; where-
as their low W and D values were 40 and 40 respectively.
The differences between the three groups for these

scores, i.e., high W and D values as well as the low

W and D of Phase I are presented in Table 5. As can be
seen, there is a partial degree of support for an affirmi-
tive answer to the first question asked earlier. It is

a partial support in that group C is found to be gene-
tically higher than group A. This indicates that the
normal subjects attained higher genetic levels that
exceeded those of the pre—operative Parkinsonians who

have brain damage. However, group B should be genetically
higher than group A according to Developmental Theory.
This is so because it is presumed that the non-brain
damage condition of the chronic Rheumatoid should

exert a lesser depressing effect on the levels of genetic
attainment than should be the case with Parkinsonian

groups who have brain damage. By virtue of the brain

61.
Table 5
Median test P-values for high and low

level W and D modes of response in Groups
A, B and C in Phase I

 

 

 

 

 

High W High D
Groupgi A B C Group§ A B C
Median% Median%
A 60 x A 62 x
B 50 .10 x B 41 .05 x
C 100 .001 .001 x C 90 .001 .001 x
Low W Low D
Groups‘r A B C Groups A B C
Median% Median%
A 33 x A 27 x
B 40 .10 x B 40 .05 x
C 0(.0)*.001 .001 x C O(.0).001.001 x

* Zero percent of the cases in the Normal groups scored
low W or D

62.

the Parkinsonian group would be expected to show
greater deficit in perceptual functioning. This, however,
was not found to be the case.

To summarize the results for the three groups in
Phase I, it has been found that the Normal group
attained the highest genetic levels; the Parkinsonians
had lower genetic levels, and the Rheumatoid group showed
the lowest genetic levels. These findings, particularly
those relating to the Rheumatoid group go counter to
expectations of Developmental Theory.

We shall now compare the levels of genetic attain-
ment for the Parkinsonian group alone overthases I, II
and III. The performances for these three sessions are
presented in graphic form in Figure 4. ~Dpon looking at
this figure, it becomes apparent that the genetic levels
of perceptual structuralization decline markedly in Phase
II from the levels attained in Phase I. Phase II is the
post-operative session. These subjects now show a drop
in their higher level perceptual capacity and a concomi-
tant.rke in their giving lower level perceptual responses.

The median percentages for the high W and D in Phase I

100

90

80

70

60

50

40

30

20

10

 

63.
Figure 4

Graphic comparisons of the Median percent-

ages for high and low W and D obtained by

Group A in Phase I, II and III.

/\ I (pre-operative)

' ._._ II (post-operative)
/

. g__III (follow up)

 

, \

|—.___.-—-! 1 L
High W High D LOW W LOW D
W D W D

64.

were 60 and 62 respectively, but dropped to 0 and O in

Phase II. For the low level W and D in Phase I the median
percentages were 33 and 27 and rose to 83 and 100 in Phase *3
II. As can be seen in Table 6 all comparisons between the

pre-operative performance levels and the post-operative

A—..~.—..r-. ._i_.__r-___...._.-

performance levels are significant. These findings, in so

1g.

far as they compare the relative standings of the Parkin-
sonians in Phase I and Phase II, suggest an affirmative
reply to questions one and two in that the results con-
form to theoretical expectations.

A further comparison is made within Group A involv-
ing results obtained in Phase II and Phase III, i.e.,
the immediate post-operative performance and the follow-
up performance. The former took place about four to
seven days after the operation, whereas the latter
occurred on the average thirty—seven days after the
operation. As can be noted in Figure 4, the relative
standing of the genetic level of responses has changed
markedly. The level of perceptual structuralization has
risen in Phase III and has exceeded even the pre—operative

Performance of Phase I. Table 6 presents the differences

Table 6

65.

Sign test P-values for comparisons of high and

low W and D levels of response in Group A for
Phases I and II.

 

 

 

 

High W
Phase Median % P-value
I 60 .
.001
II 0 (.36)*
High D
Phage Median % P-gglue
I 62
.001
II 0 (.29)*
Low W
Phase Median % P-value
I 33 .001
II 83
Low D
Phage Median % P-value
I 27 .001
II 87

* In tables where the majority of the median scores are
zero, the percentage of the cases using the particular
response, scores will be indicated in parentheses.

S ‘ “A““‘1'

66.

noted in Phases I and II; whereas comparisons of perfor-
mance in Phases II and III are presented in Table 7. The
noteworthy feature seen in Phase III is the apparent contra-
diction existing between the test findings observed and
the theoretical expectations. It seems that the Parkin-
sonians showed an improvement in the genetic level of
responses in spite of the surgical extension of the brain
damge over and above the damage that must have existed
initially to account for the Parkinson's disease.

Now that we have presented the results involving
the Parkinsonians, over the three phases of this study,
let us now direct out attention to these same patients
and how they compare with the controls in Phase III alone.

Figure 5 provides a graphic representation of the
performances of all three groups in Phase III. Shifts
have occurred between the three groups in their relative
standings compared to their performances in Phase III.
This shift is most evident for Group A, less so for

Group B and least for Group C. It can be seen in Table 8

_ A.-. '“P

m-r -— — --

Table 7

67.

Sign test P-values for comparisons of high and
low genetic responses for W and D in Group A
for Phases II and III.

 

 

 

 

High-W
Phage Median % P-value
II 0 (.36)
.001
III 62
High D
Phage Median % P-value
II o (.29)
.001
III 100
Low W
Phage Median % P-value
II 83
.001
III 25
Low D
Phase Median % P-value
II 87
.001
III 0 (.00)

100

90

80

70

60

50

40

30

20

10

 

68.
Figure 5
Graphic comparisons of the Median percents

for the high and low W and D obtained by
Groups A, B anc C in Phase III.

   
  
  

F——-

A (Parkinsonians)

__ . __B (Rheumatoids)

‘__ C (Normals)

  

High w High D 1.0;, w L0,; D
w D w D

69.

that the former clear stratification which characterized
responses in Phase I for the high level W was diminished.
A slight gain seems to have made by Group A and a somewhat
larger one has been made by Group B. The median percent—
ages for Group A in Phase I was 60, whereas it is 62 in
Phase III. Group B, the Rheumatoids, showed a higher

gain in the high W. In Phase I it was 50, however, in
Phase III to rose to 60. For the Normal group the median
percent for W was 100 in both Phase I and Phase III.

The largest gain for Group A is evidenced in the
high level D responses. This gain is of such a magni-
tude as to place this group on a par with the Normal
group, Group C. The Parkinsonian median percent for
high level D in Phase I was 62, but in Phase III it rose
to 100. Table 8 presents the statistical comparisons
between groups in Phase III and it can be seen that the
differences between Group A and Group C are not signi—
ficant. Instead, there is now a statistical signi-
ficance between both Groups A anc C and the Rheumatoid
group, Group B. In terms of the lower genetic level W

responses, the relative positions of Groups A and B,

Table 8

70.

Median test P-values for high and low level
W and D modes of response in Groups A, B and

C in Phase III.

 

 

High W
Groups A B C
Median%
A 62 x
B 60 - x
C 100 .01 .01 x
Low W
Groups A B . C
Median%
A 25 x
B 20 -
C 0(.O).01 .01 x

 

 

High D
Groups A B
Median%

A 100 x

B 57 .01 x

C 100 - .01
Low D

Groups A B
Median%

A 0 (.0)x
B 10 .01 x

C O (.0)—- .01

71.

however, indicate some shift in the direction of a
lower percentage of genetically low level W responses
when comparing their performances in Phase I and Phase
III. The obtained differences in low level W between
Groups A and B and those of Group C are significant as

can be seen in Table 8.

‘6'. ... ‘

For the low level D responses, there appears to be
an even more substantial shift in the direction of a
decreased emphasis compared to the first Phase testing
session. The Normal group remains unchanged with their
median percentages being 0 and O in Phases I and III.
Both groups A and B appear to rely less on low levels
of perceptual structuralization. Group A in Phase I
had a median percent of 27 for low level D, whereas it
dropped off to 0 in Phase III. For Group B, much the
same condition can be seen. In Phase I low level D had
a median percent of 40, but in Phase III it dropped to
10- As can be seen in Figure 5, Group A presented no
low level D responses, whereas Group B showed a substan-
tial decrease in low level D compared to its own perfor-

mance during the Phase I testing session.

72.

Statistical comparisons between the three groups

for Phase III are presented in Table 8. Significance
is seen in the differences between the Normal group and
Groups A and B, but not between Groups A and B themselves F“
for the high level W responses. For the high level D
responses, no significant differences are found between
Group A and Group C, i.e., the post-operative Parkin- g
sonians and the Normal subjects. However, both Groups
A anc C are found to be significantly different from
Group B in a positive direction. For the low level W
responses, no significant differences were obtained
between Groups A and B, but both show a significant
difference from the Normal control, Group C. In the
low D category of responses, Groups A and C converged
and showed no significant differences upon comparisons.
However, both Groups A and C were found to be signi-
ficantly different in a positive direction, i.e., less
low level D responses than was the case for Group B.

To summarize the results noted in Phase III, all

the groups showed a rise in their Genetic levels of

responses compared to their performances in Phase I.

73.

Group B demonstrated the greatest rise; Group B was
next in order; whereas Group C showed the least gain.

To conclude the presentation of the results of
Genetic levels, we shall now compare the genetic levels
obtained by Groups B anc C, the Rheumatoids and Normals,
in Phases I and III. The comparisons of the performances
of Group B in Phases I and III are presented graphically
in Figure 6. It can be seen that there has occurred a
rise in the high level responses with a decline of
the low level responses. However, only in the case
of the low W and low D responses were the differences
found to be significant, as can be seen in Table 9.

In the case of Group C, the performances for both
high and low level responses is noted in Figure 7. Their
performances in Phase I and Phase III were not found to

be significantly different as can be seen in Table 10.

1.. - ...—-....A... -‘j

‘8’ ‘nm~._‘. ...“...

‘ .
A—ug

 

100

90

80

70

60

50

4O

3O

20

10

 

Figure 6

Graphic comparisons of the Median percent
for the high and low level W and D obtained
by Group B in Phases I and III.

 

 

74.

 

I
III
OK
\ .
\
k 5. I 4L
High W High D Low W Low D
W D W ' D

Table 9

Sign test P-values for comparisons of
the high and low genetic level responses

for W and D in Group B in Phases I and III.

 

 

 

 

High W
Phase Median % P-value
I 50
.115
III 60
High D
Phase Median % P—value
I 41
.121
III 57
Low W
Phage Median % P—value
I 40
.022
III 20
Low D
Phase Median % P—value
I 40
.009
III 10

75.

 

100

90

80

70

6O

50

4O

30

20

10

 

Figure 7

Graphic comparisons of the Median percents
for the high and low level W and D modes of
response obtained by Group C in Phases I

and III.

 

 

 

76.

 

t‘ .___ I
III
I Li W j
High W High D Low W Low D
W D W D

-.. I.)
an

0%; -- —-‘- ~

—‘.‘

Table 10

Sign test P-values for comparisons of
high and low Genetic level responses
for W and D in Group C for Phases I and III.

 

 

 

 

High W
Phase Median % P—value
I 100
.924
III 100
High D
Phage Median % P-value
I 90
.846
III 100
Low W
Phase Median % P-value
I O (.0)
III 0 (.0) - - -
Low D
Phase Median %- P-value
I O (.0)

III 0 (.0)

77.

~“2!

‘méi‘

78.

DISCUSSION

The main concern in this investigation has been
to study the effects of brain damage on performance.
However, the overall results obtained in this study
have.been found to be inconsistent with the expecta-
tions derived from Developmental Theory, which had
served as a guide in asking the original research
questions. One of these inconsistencies is seen in
the genetic levels obtained by the three groups rela-
tive to each other in Phase I. A second one is seen
in the significant rise in genetic levels of the
follow-up Parkinsonians: whereas, a third is seen in
the rise of genetic levels for the Rheumatoid control
group in Phase III of the study. The following discus-
sion will be directed toward each of these subjects in

turn.

Phase I - Comparisons Between Groups
The first contradiction in expectations was observed
in the genetic levels obtained by the three groups in

Phase I. According to Werner's theory and its basic organ—

 

79.

ismic position, differing degrees of pathology should
manifest different degrees of regression in perceptual
structuralization. Thus. the severest pathology should
be accompanied by the most regression: whereas, the
least regression should be found in normal subjects

who have no evident pathology. Between these poles of
the continuum, one should theoretically expect inter-
mediate degrees of pathology and the corresponding
degree of regression.

The findings in this study, specifically during
Phase I do not appear to conform to this theoretical
expectation. It has been pointed out in connection
with Figure 3, that the Rheumatoid group, Group B,
occupies the position expected for Group A for all
four measures tested. More specifically, Werner's
theory would hold that the Parkinsonians, of the three

groups employed, by virtue of its existing brain damage,

should show the most degree of regression in perceptual-

structuralization. This was not found to be the case.
Instead, the Rheumatoid group is the one that demon-

strated the greatest amount of perceptual regression of

wig—fr

80.

the three types tested.

The normal subjects, on the other hand, consti-
tuting Group C, distributed themselves as espected.

They had the highest percentage of high genetic level
responses and the lowest percentage of the low genetic
level responses in their perceptual structuralization.

A strict adherence to Developmental Theory makes,
is difficult to explain this unpredicted turn of events
in the relative positions occupied by the three groups
on the Developmental level continua.

It is possible to invoke the concept of stress,
independent of DevelOpmental Theory, to account for
the differences observed in the three groups. In this
connection, thereiexists an ample body of literature
in which it has been demonstrated that stress depresses
perceptual and cognitive functions in normal as well as
pathological populations with psychological or organic
brain involvement. (Bartol, R. and Kui, D., 1959; Chapman,
L, et als, 1958; Weiner, H., 1960.) However, the use of
stress to account for the results in Phase I would be

inadequate, especially for the findings concerning the

81.

Parkinsonian and Rheumatoid groups. While there has
been no actual measure of the amount of stress opera-
ting in the three groups, the writer would intuitively
feel that the Parkinsonians would doubtless have
experienced much more stress,both subjectively and
objectively, than the control groups. This is seen

in that the patients had hopes of undergoing neuro-
surgery involving the brain which could possibly prove
to be fatal. So too, even if they would be selected
for the operation and did manage to survive the proce-
dure, there eXisted a distinct possibility that the
effects of the surgery would not be all that was hoped
for. In the control groups, this form of stress was
not operating. It may be safely assumed that the
Rheumatoid group also experienced stress, but the form
it took must have been different and presumably rather
well adapted to. They had nothing before them which
was in any way different from what they experienced
over the years of living with the disease. There was
.no radical change or expectation which involved the

possibility of life or death nor any alteration

82.

of the status of their physical condition. The
Normal group presumably had the least stress opera-
ting compared to the A and B groups. For all groups
the conditions of location of administration was
different, i.e., the normakswere tested in their
homes or places of business, whereas the Parkin-
sonians and the Rheumatoids were tested in hospital
settings. Thus it is possible that these conditions
of administration may have had a differential stress
effect, but it does not fully explain why the pre-
operative Parkinsonians attained higher genetic levels

than the Rheumatoid group.

Phase I, II andeII — Comparisons of the Parkinsonians
Let us now direct our attention to the second
aspect of the results obtained in this study which
were found to be inconsistent with expectations derived
from Developmental Theory, namely the changes in the
genetic levels of the Parkinsonians over Phases I, II and
III.
Phase II testing occurred several days following

the Chemopallidectomy, when the subjects were up and

83.

about and appeared to be fully recovered from the
operative stress effects as judged by the attending
neuro-surgeon. In mood and manner the subjects appeared
to be happy and full of plans for the new life that
lay ahead of them now that the symptoms of the disease
were removed. However, the Rorschach responses at
this time revealed a significant drop in genetic levels
of perceptual structuralization when comparing their
Phase I and Phase II performances. This drop in
genetic level occurred as expected by Developmental
Theory since there had occurred a surgical extension
of the already existing brain damage. But a contra-
diction of the theory is seen in the genetic levels
attained by this group in Phase III, some thirty-seven
days following surgery. Here the genetic levels rose
again and exceeded even the pre-operative performance
in Phase I. Clearly, Developmental Theory cannot
account for this result.

It should be pointed out that this rise in Phase
III was not uniform for both the W and D modes of response.

The D appears to be a more sensitive index than the W.

84.

This differential sensitivity appears to be bound up
in the nature of the response itself. D is acknow-
ledged to be an easier response to make than the W
response (Klopfer et als., 1952). In the D response,
all that is required is a delineation of a large area
in the response content. The W on the other hand
requires that the subject integrate the entire blot
into some meaningful content.

A possible explanation to account for this shift
in performance in Phases I, II and III would center
about the assumption that the neuro—surgery caused
an. inhibition of the lower genetic levels of response,
while disinhibiting the higher genetic levels of re-
SPonse involved in perceptual structuralization in
some as yet unexplained or unexplainable way. This
type of rationale is extrapolated from the empirical
nature of the disease process and the operation itself.
From what is known of the disease process in Parkin-
sonianism there appears to be some as yet unknown cause
WhiCh accounts for the destruction of the basal ganglia

structures, among which is the globus pallidus and the

85.

substantia nigra. This destruction is presumed to give
rise to the disease symptoms. The Chemopallidectomy
then introduces further destruction of these structures.
The empirical result of this additional destruction,
however, is not an increase in the symptoms, but rather
an alleviation of the symptoms that make up the disease.
While the specifics of how this phenomenon occur are
poorly understood, it is clear that they are not un—
heard of in neurological literatures. For example,
Penfield (1954), in connection with his work in allevi-
ating epileptic attacks due to "scar tissue" and other
"epileptigenic foci" in brain tissue, found that he
could reduce or completely eliminate epileptic attacks
by introducing more brain destruction to remove the
offending tissues. He reasons, in effect, that the
organism is more grossly affected by the presence of
pathologically functioning tissue, than by its total
absence. Viewing the empirical results of his surgery
as well as Cooper's Chemopallidectomy, there appears

to be some justification for this view. The symptoms

caused by some pathological brain tissues, be it epilepsy

 

86.

or Parkinson's disease, are indeed alleviated by a
further extension of the destruction of the brain
tissues involved.

In view of this type of result, is it not then
possible that in some as yet not understood way there
occurs a concomitant improvement in the psychological
“'7:
spheres of functioning? In the case of this study
an improvement in genetic level of perceptual structur—
alization appears to be indicated in the third or long
range testing situation even though it contradicts
Developmental Theory. Empirical findings have been
noted which indicate some measure of support to this
type of contention. For example, Hebb (1945) observed
in patients with extensive removal of cortical and sub—
cortical areas of the frontal lobes no permanent intel-
lectual deficits. In actual fact, they noted a rise in
the level of intellectual functioning. Similarly,
Scherer et al., (1957) in a five year follow-up study
Of a group of bilateralfrontal lobotomy cases, found

the intellectual levels of functioning of this group to

be superior to its own pre-operative level. Indeed, its

87.

level of performance exceeded even its control group
over the interval between the testing sessions.

Similar findings were noted by Forgays (1952)
on a group of brain operated patients. His subjects
showed a post-operative decline in performance some
three days after surgery, he noted a rise in perfor—
mance which exceeded not only the post-operative level,
but even the pre-operative test levels on a test battery
consisting of both verbal and performance types of
intelligence test material.

If such then is the case that varied operatively
produced brain lesions do not necessarily produce a
deficit in the long range testing situations, how then
can the significant decline noted in the Parkinsonian
group in the immediate post—operative test sessions be
accounted for?

On the face of it, the decline seems to have been
at most a transient decline. The groups appear to have
been able to recover from what seems to be an operative
procedure artifact over a period of time and even trans-

cend its pre-operative performance functioning as deter—

88.

mined by genetic level measurements.

Hebb (1949), in his theoretical system can provide
a basis for this form of transient decline in function—
ing and its subsequent recovery. His explanation revolved
about a neurological model with hypothesized "cell
assemblies" and "phase sequences." It is presumed that
these hypothesized units are disrupted by the operation
and thus cause the decline noted in the Phase II testing.
In time however, disorganization of these cortical
circuits decreases and there occurs a reorganization
of these hypothesized units as well as an elaboration
of newer ones. These new units which are generated
presumably encompass functions formerly executed by the
cell assemblies and phase sequences that were destroyed
by the surgery. This form of explanation may very well
be able to explain the initial lower level of function—
ing among the Parkinsonians compared to the Normals, as
well as the subsequent Phase II post—Operative decline
and the ultimate rise to near normal functioning.

Another line of reasoning which could be invoked

to account for the transient decline among the Parkin—

89.

sonians in Phase II compared to Phase I performance

and the subsequent rise in Phase III of their genetic
levels stems from the recent research on the Reticular
Activating System. A sizable body of literature has
been reviewed by Samuels (1959) attesting to the general
as well as specific arousal and alerting functions of”
the diffuse thalamocortical projection fibers that
comprise the system. More recent findings have gone
even further in underscoring the significance of this
system in more specific psychological terms. It

appears that such complex psychological functions as
drive, motivation, perception and learning seem to be
mediated to a large degree by the integrity of this
diffuse system (Lindsley, 1957; Malmo, 1959). It thus
becomes conceivable that the basal ganglia destruction
entailed in the Chemopallidectomy may disrupt this
diffuse system's circuits temporarily and so cause a
lower level of arousal and alerting levels. This lower
level of arousal may conceivably manifest itself in the
perceptual tasks entailed in responding to the Rorschach

Ink-Blot stimuli. The specific "how's“ of this mani-

90.

festation are as yet unknown.

Let us now shift our focus from these more or
less neurologically oriented approaches to a more
straight-forward psychological explanation to account
for the shift in the Parkinsonians in Phase I, II and
III. One such psychological View involves the concept
of stress. A proponent of such a view could very well
state that Developmental Theory, which has served as the
guide for our research questions, has not been legiti-
mately tested in this study. Such a proponent could con-
' tend that the "base line" of genetic level obtained in
Phase I, against which all subsequent comparisons were
made, was not justifiable as a "true" base line. A
proponent of this position would suggest that in Phase
I the patients were subjected to a large measure of stress
associated with the operation and its outcome. These
stresses could have served to depress their "true",
non-stress confounded genetic levels. Thus it could be
argued that the apparent "gains" made by the Parkinsonians
in Phase III were not in actual fact gains in genetic

level, but could be seen as being an approximate return

91.

to the "true” genetic levels which existed before the
stresses concerned With the operation became operative.
This aspect of the criticism is unanswerable at the
present time since a "true" base line in this sense was
not obtained before the actual Phase I testing session.
However, a proponent of such a stress interpretation
would have some difficulty in accounting for the drop
in genetic levels during Phase II compared to Phase I.
It is evident that much of the stress that was present
before the operation should be-considerably diminished
as. the"-operative experience and the doubt about its
success should have been dissipated by the time Phase
II testing. Yet, in spite of the easing of the stress,

the genetic levels decline. This finding would clearly

be difficult to explain via a stress type model.

Phase I;_: Comparisonson Between Groupg,

Let us not turn to the third finding of this study
which appears to be inconsistent with the expectations
of Developmental Theory, namely the rise observed in
Groups B's genetic level in Phase III compared to their

Phase I performance.

92.

As has been shown in Figure 6, there occurred a rise
in the high level W and D responses with a decline for
low level W and D which attained statistical significance.
(See Table 9). No interim event was known to occur
which could account for the changes observed. Further,
the inter-test interval was Specifically designed so as
to minimize or totally eliminate the effects of practice
as suggested by the studies of Schneider (1955) and
Swift (1944). How can this change be accounted for?

It is possible that extra—test factors may have been
operating to elevate the performance level. The Rheuma—
toid group volunteered for the testing, but in the
initial test session showed the uneasiness expected

in the novel testing situation. However, having the
task and finding it interesting and minimally threaten-
ing it was less stressful the second time around. Thus
Phase III testing was accomplished with less stress and
anxiety thannwas associated with Phase I. It may well
be that in virtue of this altered outlook toward the
testing as well as.mere attention that it brought

them in the clinical situation resulted in a better

93.

performance via a "Hawthorne Effect." Some evidence
for this contention can be seen from the nature

of the differences in the performance. The rise in
the high level W and D approached but did not attain
significance. The major differences were seen in
their giving fewer low level W and D responses. This
would reflect a decrement in stress as well as a
possible effect of practice. As can be seen in Table
9 it was here that the statistical significances were
obtained.

Some explanation of the differences obtained in
genetic levels by the Normal group between Phase I and
Phase III seems desirable at this point. It can be
seen in Figure 7 that the sole difference which is
demonstrated is in the high level D mode of response.
yet the magnitude of the differences was not found to
be significant. Among the reasons that could be suggest—
ed to account for this difference would be those given
above to account for the rise in the Rheumatoids, namely
a "Hawthorne Effect" and a lessoned stress associated

with the second testing session. Another factor concerns

94.

an aspect of the test measures themselves. For the

High W, Low W and Low D the Normals reached the limits
of the scale in Phase I. In Phase III, they reached the
scale limit for the High level D also. It is conceiv—
able that the Normals would have shown an even greater
gain as was the case with the Rheumatoids, but may

have been restricted by the artifact of the scale
itself.

In the foregoing discussion, it was the author's
intention to present the findings obtained in this
study and to present some alternative explanations
to account for these results. As can be inferred from
the varied theoretical rationales' invoked, we do not
know why the data distrituted themselves as they did,
clearly being counter to expectations. It thus seems
apparent that no single theoretical approach, of those
presented, can adequately account for the performances
of all the groups in all the test phases.

This in itself is perplexing and points out a need
for further study to ascertain more clearly why the

results arranged themselves as they did. It is likely

95.

that some extraneous factor, nOt controlled in this
study, may prove to be the critical one operating to
color the data of the brain damage dimension. A
specific possibility which may prove helpful, is to
focus attention on the operation's clinical results.
To illustrate, in this study, all of the Parkinsonians
received a complete alleviation of their symptoms.
They thus were no longer in the grips of the disease
symptoms which caused a progressive restriction of
their lives which ultimately confined them to a wheel-
chair. The promise of an independent, useful and pro-
ductive life was now a reality for them. This radical
alteration of the symptoms, may then have exerted an
equally radical alteration in their personality func—
tioning which may have over-ridden the brain damage
effects themselves. This may be the cause for the
significant rise in their levels of perceptual struc-
turalization, since this alteration of personality
outlook may be the factor which was picked up by the
testing rather than a straight-forward assessment of

brain damage effects. Some evidence for this contention

96.

can be culled from the limited amount of literature
available on the psychological and personaltiy effects
of the Chemopallidectomy on Parkinsonians. (Diller and
Riklan, 1957; Diller and Riklan, 1956; Riklan, Diller
and Weiner, 1959; Riklan, Diller and Weiner, 1960).

On the basis of a conventional analysis of Rorschach
responses, these authors observed in post—operative
Parkinsonians " . . . a decline in ability to organize
integrate and synthesize perceptual processes . . .

as well as a loss of intellectual control in the inter-
pretation of environmental stimuli. The pattern of
changes for the total group can be defined as essen-
tially constrictive in nature and reflective of a
general disorganization" (Riklan, Diller and Weiner,
1960, p. 270). However, after the successful allevi-
ation of the Parkinsonian symptoms, a twelve month
post-operative follow—up found that " . . . responses
which can be described as emotionally determined in-
crease significantly as does the presence of global

and detailed responses. Furthermore, there are trends

towards diminution of deficits in accuracy of percep-

97.

tual integration" (Diller, Riklan and weiner, 1960,
p. 270). They note however, that among that propor-
tion of poor operative results, i.e., those patients
who had little or no actual change in their symptom
status, there was a tendency for the patients to show
Rorachach protocols which were basically the same in
both the immediate post—operative test period. They
thus failed to show the positive changes which the
successfully operative patients manifested. They
suggest that the improvement in the conventional
Rorschach performance in the long range follow-up
testing appears to result from the patient's altered
clinical condition and the renewed interest in and
interaction with the world about him.

In this observation, there may lay the key to a
more meaningful interpretation of the findings noted
among the Parkinsonians used in this study. From the
above reasoning, it appears that there is operating
an interaction between the brain surgery per ge on
personality and perceptual functioning may be over-

ridden by the efforts that the clinical relic! exerts

98.

on the functioning personality. The problem then
remains, how can these interaction confounds be
separated for purposes of study?

One possible approach toward overcoming this
impasse of partialling out the effects of the brain
damage from the contaminating personality alteration
effects would involve the utilization of that small
proportion of Parkinsonians who undergo the Chemo-
pallidectomy, but who do not have any appreciable
symptomatic relief. This group presumably will not
have the removal of their symptoms, but they will
have had the operation and its concomitant brain
tissue destruction. If the proposed contention is
valid, one would expect that these patients will not
show the personality alteration and elation shown by
those more fortunate patients who do get symptomatic
relief. The unchanged status of these patients would
then help in partialling out the interacting effects
of the brain surgery from the effects brought about
by the altered clinical status.

Thus in view of the above discussion, any subse-

99.

quent investigatibn which intends to pursue this

tack should include, if at all possible, four groups.
Group 1 would consist of successful symptom alleviation
patients; group 2 would include an unsuccessful allevi-
ation group; group 3 would consist of a non-operative
Parkinsonian group, whereas group 4 would constitute

the normal control.

100.

SUMMARY

This investigation has concerned itself with the
study of the effects of brain damage on responses given
to the RorschachInk-Blot test as treated by the Genetic
Scoring System. To accomplish this, three samples were
employed which were equated for age, sex, education and
Wechsler-Bellevue Verbal Intelligence Quotient (Form I).
The experimental sample consisted of twenty-six patients
suffering from Parkinson's disease who had elected to
undergo a recently developed neurosurgical technique,
the Chemopallidectomy, intended to alleviate Parkinsonian
symptoms through the placement of an exact, circumscribed
neurolytic lesion in a basal ganglia structure, the globus
pallidus. Two additional samples consisting of twenty-
six Rheumatoid arthritics et als. and twenty-six Normal
subjects were included in this study as controls.

The Parkinsonian subjects underwent three admini-
strations of the Rorschach Ink-Blot test. The first admini—
stration was given three days prior to the neurosurgery,
the second occurred twelve days following the Chemopalli-
dectomy, whereas the third administration was given some

thirty-seven days following the second test session. The

101.

Rheumatoid arthrictic et als. and the Normal control
groups underwent two administrations of the Rorschach
Ink—Blot test where the intertest interval was some
forty—three days.

Using Developmental Theory as a guide, several
research questions were generated, particularly the
concept of perceptual regression. The Genetic levels
of perceptual structuralization attained by the three
groups were then submitted to statistical comparison
both between as well as among the three groups for all
the testing sessions. The findings obtained were
presented and a discussion of the results as well as

their implications was undertaken.

102.

APPENDIX A

THE RORSCHACH GENETIC SCORING SYSTEM

Psychology Department
Worcester State Hospital
May, 1960

103.

This manual of the Rorschach Genetic Scoring System,
originally designed by Friedman,* contains the general rules
of scoring and examples of the various genetic scores.

These scoring categories include:

(1) the "mediocre" response

(2) the "minus" response

(3) the "vague" response

(4) the "amorphous" response

(5) the "form dominance" response

(6) the "integrative" response

(7) the "fabulized combination" response
(8) the "contamination" response

(9) the "confabulation" response

The scoring of all the above categories with the ex-
ception of "amorphous" and "form dominance" is based on at
least one of the following three criteria:

(1) the form level of the percept

(2) the specificity of the blot structure require-
ments for any given content**

(3) (the nature of the organization of the response

The scoring of "amorphous" and "form dominance" is
based on the relative importance of the form element and
some other determinant in the percept.

A general rule of scoring is:

Determinants which are developed only in the
inquiry but modify the original percept are
scored: An example is:

 

*Friedman, Howard. Perceptual regression in schizophrenia:
An Hypothesis suggested by the use of the Rorschach test.
J. Gen. Psychol., 1952, §;, 63-98

**Phillips, L., and Smith, J. G. Rorschach Intepretation:
Advanced Technique. Grune and Stratton, New York, 1953

104.

Free Association Inquiry
1. W Bat A black hat and it's flying
wm FC'.FM+ A P

THE MEDIOCRE (m) RESPONSE

"Mediocre" is scored when all four of the following

criteria are met:

(1) there is a scorable single content including
those responses given in a plural form, e.g.,
"animals". (For restriction on this definition
see also "Integrative" responses.)

(2) the content has a specific structural require-
ment. (See "Vague" responses.)

(3) the response is of adequate form level (F+).

(4) the response does not cross color (including
white space) boundaries. (See "Structural
Integrative" responses.)

The majority of all responses will probably be scored
in the "mediocre" category, for this includes all of the
easily achieved, common W, D, and Dd responses.

Some examples of the "mediocre" response are:

I. W Bat Inq. It's black
Wm FC'+ A P

IV. W Butterfly
wm F+ A

III. D3 Red bowtie Inq. The colorhand
Dm CF+ Pr P S ape

II. Dd322 Eyes of some kind of animal

Ddsm F+ Ad

105.

THE MINUS (-) RESPONSE

"Minus" is scored when both of the following criteria

are met:

(1) there is a scorable single content including
those responses given in plural form, e.g.,
"animals." (For restrictions on this definition
see also "Fabulized Combination" and "Contami-
nation.")

(2) the response is of inadequate form level (F—).

Some examples of "minus" responses are:

II. W Insect
W- F- A
VIII. D1 Caterpillar Inq. Shape and
D- FC- A multi-colored
X. Dle Teeth

Dd- F- Hd

106.

VAGUE SCORES (WV, DV, and de)

The criterion for inclusion in this class is as
follows: (1) the content must be F+ and (2) the content
must not imply a specific structural requirement (e.g.,)
"harbor" implies a U shaped structure and so is not
"vague;" the same applies to the V shape implied by
"forceps" or the more complex, but specific, structural
implications of "man" or "animal". This criterion for
inclusion represents the empirical rule that corresponds
wilth a concept of specificity of blot structure require-
ments for a given content. All “mediocre" responses imply
such a specific schema; none of the "vague" or "amorphous"
responses have such a basis.

Phillips and Smith ( ) have ordered all contents, by
class, along a continuum of specificity. By making
reference to these classes, one can judge for inclusion in
the "vague" category. Almost all "vague" responses are
included in the first three classes. The following con-
tent categories meet the specificity requirement for in-
clusion in the "vague" category (provided the response
does not meet the requirement for a scoring of "amorphous"):

Class I
A. Abstraction D. Emblem
B. Art E. Science
C. Blood F. Stain
Class II

A. Fire, Explosion

Class III
A. Sea plants, Shrubbery, Foliage
B. Clouds
C. Food (e.g., bakery products, ice-cream,

but not those requiring specific shape,
e.g., carrot, mushroom

General Map, Island

Mineral

Sky, Snowflake, Sun

Smoke, (non-columnar)

CJWIM U

107.

The following contents from Class IV are scored
"vague":

B. Lakes, Water, Land, Rocks

Primitive organisms such as amoeba are scored
"vague". (Being animals, they fall in Class VII, but
in general have the specificity requirements of Class
III.)

Anatomy contents run the entire range of the
specificity continuum. Therefore, they must be judged
separately. The following anatomy contents, however,
if unelaborated, are scored "vague":

Medical chart, X-ray, Inside of body

AMORPHOUS (a)

Amorphous is scored when all §_of the following criteria
are met:

(1) the percept falls into the class of "vague"
responses
(2) any of the following is given as a determinant:
C, C', c V, up
(3) form is not verbalized as a determinant

Examples are:

II. D3 Blood the color red
Da C Bl

IV. W Night the blackness—all dark
Da C' Ab

X. D13 Sand looks grainy-rough
Da c Mn

IV. W Something disintegrating

Da m Ab

108.

RULES FOR SCORING FORM DOMINANCE (COLOR, ACHROMATIC
COLOR, AND TEXTURE)

Usually, the basis for scoring color, achromatic
color or texture is dependent on the inquiry.

The use Of color, or achromatic color in the Free
Association or the Inquiry to locate percepts does not
influence scoring. Examples are:

The red part - could be a butterfly

The green looks like an insect

The darker gray part lOOks like clouds

FC, FC' Fc

 

In Inquiry, the S:

(1) mentions color, achromatic color, or texture
spontaneously subsequent to details, giving emphasis
to shape. Examples are:

 

Free Association Inguiry
III. D3 Butterfly The wings and the body,
and it's red
Dm FC+ A
I. W Bat The shape and it's black
Wm FC'+ A P
VII. W Clouds The general formation
and it's fluffy
WV Fc+ C1

(2) mentions color, achromatic color or texture only on
question. Examples are:

Free Association Inguiry

III. D3 Butterfly The shape (anything else?)-

it's red - it's colored

109.

A
The wings and the body
(anything else?) - it's
black - a black bat

A P
The shape Of clouds (?)
also, it's fluffy

Cl

Dm FC+
I. W Bat
Wm FC'+
VII. W Clouds
WV FC+
CF, C'P, CF

 

In Inquiry:

(l) the color, achromatic color or texture are given

primacy. Examples are:

Free Association

III. D3 Bow tie
Dm
IX. W Flower
Wi
I. W Bat
Wm
II. D1 Bears
Dm
VI. D1 Bear skin
Dm

(2) color, achromatic color
An example is:

Free Association

IX. W Flower
Wi

II. D1 Bears
Dm

Inguiry

red bow tie

CF+ Pr P

colored flower

CF+ Bt

a black bat

C'F+ A P

black bears

C'F+ A P

it's furry like a skin

cF+ Ad P

or texture mentioned first.

Inguiry

the colors and the shape

CF+ Bt

it's black and it's shaped
like a bear

C'F+ A P

110.

VI. Dl Animal skin furry like an animal's
skin and the four legs
and the body

Dm cF+ Ad P

(3) if color, achromatic color or texture only is used to
define a percept, CF, C'F, or cF is scored if that
percept falls in the class Of "mediocre" responses.
Examples are:

 

Free Association Inguiry
IX. D1 Tree a tree because it's green
D- CF- Bt
I. W Bat because it's black like a
bat
Wm C'F+ A P
II. W Flower because Of the texture-
delicate - fragile
Wi cF+ Bt
C, c;L c

 

C, C', or c is scored when both Of the following criteria
are met. In Inquiry:

(1) color, achromatic color or texture only are verbalized
as a determinant

and

(2) the percept falls in the Class Of "vague" responses.
Examples are:

 

Free Association Inguiry
X. W painting, because Of all the differ-
design ent colors

Wa C Art

111.

 

Free Association Inguiry
II. Dw Blood it's red
Da C Bl
I. W Paint it's black
Wa C' St
X. D13 Sand it's grainy-like sand
Da c Mn

Note: If color, achromatic color or texture as a modifying
word is used in the Free Association, and none Of these
determinants is elicited in the Inquiry:

(l) scoring if 59, FC', or Fg_if the percept falls into
the class of "mediocre" responses. Examples are:

FC: "red butterfly," "green insect"
FC': "black bat"
FC: "furry animal"

(2) scoring is CF,C'F, CF if the percept falls into the
class Of "vague" responses. Examples are:

CF: "colored painting," "pink clouds"
C'F: "black thunderclouds"
cF: "solid looking rOCk"

VISTA

Essentially all responses involving the use Of vista
are scored FV. Beck gives nO examples of VF responses,
and lists only one response scored pure V. This is on
Card Ix, Dds 22, "depth right here as if looking down into
a cavern" (Vol. I., p. 134). Scored: Ddsa V Ab.

112.

INTEGRATIVE SCORES (Wi, Di, and Dd)

An "integrative" (i) scoring requires the appropri-
ate organization (i.e., not "fabulized combination", "fabu-
lation" or "contamination")of two or more adequate perceived
blot elements (i.e., not F-) into a unified response. This
includes the organization Of (a) two more "mediocre" elements,
(b) two or more "vague" elements, (c) a "mediocre" and a
"vague" element, or (d) the combination Of a "mediocre" or
"vague" element with an "amorphous" element. The elements
in the responses may involve either identical or non-iden-
tical contents.

"Integrative" responses fall into three major classes:

 

 

1. "Functional": The integration is based on a relation-
ship between two Or more conceptually independent sub-
units.

A. One type Of relationship is associated with human
or animal movement in which the movement provides
the basis for the interaction. The most common
Of these responses will be the FM response
between two animals on Card II (2 animals fight-
ing), and the M response between 2 humans on
Card II (people playing patti-cake), and Card II
(2 men talking to each other).

B. Often in the functional "integrative" response
the relationship between the elements has a
positional character. This type Of response
involves non-identical contents. Some examples
are:

II - W - fire burning up through the smoke
III D1- 2 men standing at a bowl
.111 D1- 2 persons holding something

IV - W - pair of boots hanging on a post

VI - hanging lamp - D1 is the lamp and it's
hanging from the stem (D3)
VI - W - totem pole set on a rock

113.

VI - plant (D3) coming through soil (D1)
IX - W x-flower coming out Of the earth (underbush)
X — Dll-a limb with a couple Of bugs on it

M responses involving the word "facing" (as contrasted
with "looking") are not scored "integrative."

"Integration" is scored even if the basis for inte-
gration is developed only in the inquiry and modifies the
original percept.

 

Free Association Inguiry
III. 2 men They're dancing together
Di M+ H P

"Integration" is scored if a new percept is developed
in the inquiry for which a relationship is established to
the "basic" percept. Neither the additional percept per se
not the determinants associated with the additional percept
is scored.

 

Egee Association Inguiry
VIII. 2 animals They're climbing over a
mountain covered with green
trees
Di FM+ A P

"Integration" is not scored when additional content
(8.9., clothing) occupies all or part Of the area used for
the original percept.

 

Free Association Inguiry
III. 2 people They have black tuxedos on

Dm FC'+ H,Cg P or
They're wearing high heel
Dm F+ H,Cg P shoes

114.

2. "Collective": Here an overall grouping is actively
imposed on the blot. The essential feature is
evidence Of the conecptualizing, classifying process
as distinct from one Of sheer enumeration. If the
form-level Of the Class term is F+, and "integrative"
scoring is given, even though subsequent enumeration
may involve F- elements. Some Of the key words which
are indicative Of "integration" are: group, garden,
pair, and collection. Examples of some responses
which are scored "integrative" are:

IV - D6 - pair of boots

VII - W - group Of islands
VIII - W - flower garden, both D5 + DS3 — pair Of
‘ Old corsets
? IX - W - group Of flowers
X - W — ocean,garden, aquarium, underwater scene,

sea life, collection Of insects

Part of this category includes such key words as:
bust Of, emblem with, coat Of arms with, ornament Of,
and statue Of. Examples are:

II - Dl - emblem with 2 bears; bust Of 2 dogs
VII - D1 - statue Of 2 dogs
VIII - D1 - statue Of 2 animals

VIII - W - coat Of arms with small animals and
2 flags
Examples which do not reflect integration, but only
numeration are: "lots Of . . .," "a few . . .," "couple
0f . . .," "two . . .," "picture Of . . .," "drawing
Of . . . ." "Bunch" may or may not be integrative, de-

pending On context, e.g., "bunch Of kids" (no); "bunch
0f grapes" (yes).

3- "§tructura1": Here a single content is arrived at
by unifying two or more colored areas. This in-
cludes Object-color images Of white or more colored
space. The essence Of this category is color-
boundary crossing.

 

115.

Examples Of W responses are:

II - volcano; butterfly; clowns (even if not
integrative based on M)
VIII flower; fountain; boat
IX fountain, gladiola bulb

Examples Of structural integration involving D
areas are:

II - D85 + D4 - spinning top
II Lateral 1/2 - man
VIII - D8 - tree
IX - D9 - mushroom from atom bomb
X - D11 + D9 - torch with 2 jets on it - D14 is
stick, D8 is jet, D9 is flame

Note: A single content which falls into the "vague"
category even though crosses color boundaries
continues to be scored "vague", e.g., Card VIII -
W - design; Card IX — W - map; Card X - W -
explosion.

The crossing Of color boundaries is gg£_"integrative"
where one Of the colors (a) occupies substantially all of
the area required for a percept, (b) occupies only a
relatively small area, and (c) is Of indifference to the
subject. For example, D2 Card X is not "integrative" for
"lion" but it is "integrative" for "fried egg" where the
yolk (Dd33) is pointed out.

116.

RULES FOR DOUBLE SCORING
A response is scored double if:

(a) There are at least 2 scorable contents which
occur in the free association, and

(b) The 2 scorable contents are not identical
VIII. 2 animals (D1) climbing over
Wi FM+ A P
DV F+ La
(c) If one Of the contents is minus form level
VIII. 2 caterpillars (D1) crawling
over some shrubbery W- FM- A
Dv F+ Ls

A response is not scored double if:

(a) A new percept which does not modify the original
percept is developed in the inquiry.

 

 

Free Aggociation Inguiry
VIII. 2 animals (D1) They're climbing

over some rocks
Wi FM+ A P

(b) 2 contents occur in the free association but one
of the contents occupies approximately less than
1/4 Of the area Of the figure percept.
III. 2 men (D1) stirring a pot (D7)
Di M+ H P

FABULIZED COMBINATION

117.

(Fab)

"Fabulized Combination" is scored when both Of the follow-
ing criteria are met:

(1) Responses in which two or more areas, separately

interpreted,

are combined on the basis Of

spatial relationship in a way which does not
reasonably occur in nature, and

(2) such a combination is not explained nor is it
reasonably rationalized in a spontaneous fashion,
i.e.,without questioning by examiner.

Rules for "Double Scoring" apply tO "fabulized com-
The "fabulized combination" score is given
to the percept which occurs first in the free association.

binations."

The "fabulized combination"

score does not influence the

scoring Of form level Of the individual percepts.

Some examples Of "fabulized combinations" are:

VII - W

Couple Of baby lambs in the clouds

dancing

X - D12 + D1

Wfab
Dv

FM.Fc+
FC'+

A
Cl

Cloud - can come in any
shape (D4). These II

a couple Of toy lambs
because they're very
woolly(D2) LL woolly?
The color- -the depth--
the gray--it's lighter
--it's solid. Feet
hidden in clouds--
face--home1y4kind of
lamb kid in school
might draw.

-auov

Ia ...... ___..iud

See a couple of strange little green
birds. Standing on some organ of
the body--apparently they're either
bowing to each other or reading a
sermon.

Dfab FC.M A
Da C An

V - W

Also looks like a mule with wings.
That's all.

Wfab F— Ad
Dm F+ Ad

II - W
Well, this looks like 2 bears

holding a lamp.

Dfab FM+ P

A
Dsi F+ Hh
I - D5

Rabbit's head.

118.

All of these tubes
running out here .
could be a color-—
digestive tubes (D1).
Head—-hands--body and
ll they're reading
from a pre-speech.
A.E.L.L. Bird? Shape
(D12)

This could be his back,
legs, and ears. In
other words this way V
looks like butterfly
and this way looks

like mule. M.L.L.
mule? The outline,
the print. A.E.?
No, I think not.

He's like in a sitting

position - nose — ears
Dd3l

D4 — the light part
DSS - the shade

The shape of the head
and also, it looks like
these are caterpillars
(D4) crawling out of

119.

his eyes.

Dfab F+ Ad P
Note: See (1) "General rule for scoring"
(2) "Rules for double scoring"

Examples which are not "fabulized combinations" are:

I — W
Or it could be a person with D3 - there seems to
butterfly wings in a dance recital. be a form of a person
(D4) with arms ex-
tended. (D2 between
Dds 29 and Dds 30).
Holding up this built
stuff - costume we'll
say (D2) feet. D2
A.E.? No.
Wi M+ H,Rc
Dm F+ Ad,Cg
Note: "In a dance recital" rationalizes the response.
II
Some sort of nymphs dancing on Nymphs? Face (D1) and
the top of a cloud. they look light like

they could sit on

top of a cloud (D4)

and nymphs is supposed
to perform the super-
natural. Light? Fluffy?
Oh murder! The light-
ness all the way around
gives the effect of
lightness. Parts?
Hand, body. Cloud?
Light and fluffy and

it resembles the shape
of a cloud.

120.

Wi M+ (H)
Dv cP.C'F+ Cl

Note: The content "nymphs" rationalizes the response.

CONTAMINATION (Contam)

"Contamination" is scored when two independent
responses to the same areas are fused into a single
percept. -

Since "contamination" involves two percepts, the
response is double scored (re: "Rules for Double Scoring").
The "contamination" score is given to the percept which ‘
occurs first in the free association.

"Contamination" does not influence the scoring of
form level of the independent percepts.

Some examples of "contamination" are:
IV - W

Front of a bug - the front of an Because of the shape.
ox — the front of a bug - ox.

Wcontam F— A
W- F- A

Note: F- is scored for both responses because both "bug"
and "ox", if given independently, would warrant
F- scoring.

'VIII - D5

Flag in the sky Flag because of the
form and sky because
of the color.

121.

Dcontam F+ Obj.
Da C Na
VI - W
Two children sitting in a tree. The form on both.
Wcontam M+ H
wm F+ Bt.
III - D2
It looks like blood - also islands- Islands because of
bloody islands. the shape and blood
because of the color.
Dcontam C Bl
D- F- Ge
II - D1
Looks like an animal. It also 11 grass -
the color of grass-
so not it 11 on
animals lying in the
grass.
Dcontam FM+ A
Note: See (1) "General rule for scoring"
(2) "Rules for double scoring“

If a "contamination" is developed in the elaboration
of details, it is treated independently and the rules of
scoring "contamination" apply. An examples is:

IX - D3

That looks like 2 witches - the nose. The witches are
(Dd26) looks like a saw - a saw nose. waving at each other.

122.

Di M+ (H)
Ddcontam F— Hd
Dd- F- Im

CONFABULATION (DWLide, DD, DdDd)

 

"Confabulation" is scored when both of the following
criteria are met:

(1) The interpretation of an area determines the
interpretation of other areas, and

(2) The content developed is not a minor elaboration
of the initiating percept.

There are two types of "confabulated" responses. There
are:

(a) responses in which a larger interpretation is
determined by a smaller, and_

(b) responses in which the same interpretation given
to a detail is also given to a larger blot area.

"Confabulation" does not influence the scoring of form
level (+ or -).

Some examples of type "a" "confabulation" are:
VI - W - Cat Because of the whiskers
(Dd26)
de F- A

IV - W - A human body- a female Entrance to a woman's
body. sexual organs (D3),
and if that were so,
then the whole thing
would pertain to the
different sections of
a woman's body.

Dw F-

I - W - Bat

Dw F+
An example of the "b"
VI - W - Bird

Dw F-

123.

An,Sex
The wings (D8) made me
think of a bat (A.E.?
no - just the wings.

A P

"confabulation" is:

Because the top part (D3)
is a bird.

......m -.,.. . ._ ...,__ ...!
.
‘ . a"

wmmr“

 

124.

APPENDIX B

SPEARMAN RANK ORDER CORRELATION COEFFICIENTS (Rho) BETWEEN
THE AUTHOR AND AN INDEPENDENT SCORER FOR GENETIC SCORING
SYSTEM OF RORSCHACH PROTOCOLS FOR PARKINSONIAN, RHEUMATOID
AND NORMAL GROUPS.

Parkinsonian Rheumatoid Normal
D .90 .93 .89
High
W .86 .90 .87
Phase l
D .91 .92 .92
Low
W .94 .94 .88
D .89 -— ~-
High
W .94 -- —-
Phase 2
D .96 -- --
Low
W .96 -— —-
D .90 .88 .92
High
W .93 .87 .90
Phase 3
D .93 .95 .96
Low

W .91 .93 .88

125.

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ARI

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