PERSONALITY ADJUSTMENT OF A G I N G WOMEN By ALVIS WA YM A N C A LIM AN A THESIS Submitted to the School of Graduate Studies of M i c h i g a n State College of Agriculture and Applied Science in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Psychology 1951 PxiSSOHAulTY AI>JU3TlIEr? Oi ^.OlHQ By Alvi» V.aymua Calimsa AJT AB3T5U CT iitttaltttd to tho Johool of Graduate stadias of Michigan State College of Agriculture and Applied science in partial fulfillment of the requirement* for tho degree of DOCTOR Or PHILOSOPHY Department of Psychology Year 19(1 ilvla ilagpw The pvrpca* of this U T t o t i g a t i o o « u study of 46 S o g r o m a i n Uailog, Alotigan* (3 * 1 1mow to m k o * poroonality between Itao ogoo of 60 sol 88* roolding in Tho M a p i o hah pmloutljr boon used in a loss! study r e p o r t e d by -Or* Margaret Ohloont Head* ^apartment of r'ooda end nutrition* Miohigaa d t a t e College ( 6 ) . It was hoped th a t tho investigation would provide an answer to tho rellowlng questionst 1* How dL© Rorsc i m a h xiudin&s for those women compare with find­ ings reported f o r other ssoplos of normal adults and aged poisons (1*4 £• ire t h e r e differeaoes related to ago in tho personality structure of those wo.r.en as indicated by the ^orsonsoh test? 5* is aetivity related to ago difierenees* and to dirferenoes in level Of emotional adjustment; 4* Is the health status of the sample related to ago differ* enoos* sod to level ol emotl L.nm\ adjustment? 6* Is dietary status related to age differ eases* and to level of emotionsi adjustment? 6* Is there relationship between sooio-eoomomio faetors sad level of emotional adjustment? Ihe Eorsohaoh test (1) and the lotivity inventory (3) were adraini stored to eaoh woman individually by the writer* Results of medioal examinations* nutritional data* individual health ratings* sod sooio-economic data were sssde available oy •t>r • Ohlson* To ascertain age dlfferenoes* the sample was divided into two groupsi uToap 1* women 60 to 69 years of agei sad Group II, 23 women 60 to 63 years of age* 'ihe Eorsohaoh tests for eaoh age group were rated Individually by three judges in order to determine the beat sad poorest adjusted women* Alvis M | a u 0>11— w The u j e r findings « m 1* raportea m follows* The ^ o r M b a o b finding* Indian tad that the ability to pereelve environmental situations adequately had not dan 11nod with age* Tha aged women aara no mora stereotyped in thair thinking than othar n o n u l aamplas from different aga groups* Tharo had bean no loss of amotionml control for tha sample aa a whole* In raapact to aga differences* Group 1 gave eignifioi.ntly mora Anatomy raaponsaa thun Group II. Thla difference ana lntarpratad aa ra la tad to tho man opansa. £• Tho Activity inventory find Inga indicated that the women of Group I aara more active than tha warnsn in Group II. In addition* women of both age groups rated as bast adjusted, mere more active than tha woman rated poorest in emotional adjustment* 3* vvo^en Judged as bast adjusted mere found to have a better health status than the poorest adjusted women. Am On the whole the bast adjusted wcmen tended to have better dietary intake. 6* In the present sample tharo was no significant relationships between socio-economic factors and level of emotional adjustment* AAT1B Wm&liaflB Bibliography JBeefc, Samuel j. oritbMb'a Peat I. Basic probosses. arose and Stratton, 1944. dew York:* Book:* Samuel J«, hebia, A lbort 1.. i’M e m , *arran C*», Mollah, Kena&a, and Ifcetford, William n . l!ho normal personality as pro­ jected into the aereenash test* J • vayohol,, i960* 30, 241-298, Cowan, **uth s., Burgees, Mrnest *,, fiavi^hurat, dobert J,, and Goldhamer, Lerbert Personal adjustment In old age, Chioago, DOienoe heeeareh Associates, lno,, 1749* Chesrow. s.ugene J., ioaiAa, raul li,. and ^oinits, Arthur H. A psychometric evaluation of aged wliito males, deria^rlos, 1949, 4, 169-177. 0hison, Margaret A. lletary praotioea of 100 women 40 to 75 years Of age, J, Aaor. Aaaoc,, 1943, 24, 234-291. ACKNOWLU.DGMENTS The writer expresses deep gratitude to Dr. Harold H. Anderson, under whose direction the present investigation was carried out. Ghlson, To Dr. i^rgaret A. the writer is great ly indebted. made available the sample, employed in the study, Dr. Ohlson and several kinds of data ana also was of invaluable assistance in the treatment of the nutritional data. Dr. B. Howara Bartley, nr. Albert I. Rabin, and Dr. !*_. nay Denny were especially helpful in initiating the investigation. Dr. Babin also was of great assistance in treating the Rorschach data. thank Dr. Abr aham darp, Dr. The writer wishes to Stewart G. Armitage, and k r . Harry A. Blair for assistance in rati n g the R o r ­ schach protocols. Finally, the author wishes to acknowledge the aid and suggestions given by the p s y ­ chological internes at the Administration Hospital. fort duster Veterans TABLE OF CONTENTS CHAPTER I II PAGE THE NATURE OF THIS S T U D Y .................... 1 Purposes of the Present Investigation... 7 Instruments and Data E m p l o y e d ............ 7 Description o f the S a m p l e ................ 9 PERSONALITY FACTORS AS REVEALED BY R O R ­ SCHACH F I N D I N G S ................................. 19 Comparisons of Rorschach Findings in the Present Sample with Those Reported by Beck and Those by C h e s r o w ................. 19 Comparison of Rorschach Findings in the Two Age Groups of the Present Sample... III A3 FINDINGS CONCERNING SOCIO-ECONOMIC STATUS, PHYSICAL AND SColAL ACTIVITY, HEALTH, AND SOCIAL, AND NUTRITIONAL S T A T U S .............. 55 Rorschach Ratings of A d j u s t m e n t ........... 55 The Relation of Age ana Level of Adjustment to The Activity I n v e n t o r y ............... 56 The Relation of .emotional Adjustment to Socio-Economic F a c t o r s ..................... 63 The Relation of Age and Level of Adjustment to Nutritional S t a t u s ......... 67 The Relation of A g e ana Level of Adjustment to H e a l t h ....................... 80 CHAPTER PAGE The Relation of Age and Levels of Adjustment to Blood P r e s s u r e .......... IV #3 T H e QUESTION OF INFLUENCE OF RACE OR COLOR ON THL F I N D I N G S ............................. S6 S U M M A R Y ...................................... 94 B I B L I O G R A P H Y ........................................ 99 AP P e N D I X ............................................. 102 V LIST OP TABLES TABLE PAGE I Characteristics of the Sam pl e........... II Age Data of Total Sample and S ub -Groups....... 13 17 III Highest School Grades Completed for Total Sample and Su b- Gr o up s .......................... IV Rorschach Responses and Approach........... • ••• 18 20 V Rorschach 2 Score Distributions................ 23 VI Rorschach Movement Re sp on se s................... 25 Color Re s po ns es . .............. 28 Y Re sp on se s........................... 31 Space R e s p o n s e s 34 VII Rorschach Vl'II Rorscnach IX R or schach X Rorschach ............... F Plus Responses Per Cent........... 36 Human R es ponses..................... 38 Animal Response Per C e n t . ........... 40 XIII Anatomy R e s p o ns es .. . ............................. 42 XIV Rorschach Popular R e sponses..................... 44 XV Summary of 16 Rorschach V a r i a b l e s .............. 46 XI Rorschach XII R or schach XVI Rorschach Movement-Color Response Relation­ s hi p ........................... 49 XVII Percentages of Agreement Among Raters A, B, and C in Rating Best Adjusted and Poorest Adjusted From Rorschach P r o t oc o ls ........... XVIII Ratings of Best and Poorest Adjusted Records.. XIX Activity Inventory Scores of Groups I and II.. 59 59 61 TABLE PAGE XX Activity Inventory Scores of Best and Poorest A d j u s t e d ........................................ 61 XXI Mean Daily Intake of Nutrients By the Two Age G r o u p s ....................... 70 xXII Mean Daily Intake of Nutrients By the Best and Poorest Adjusted of Group I .............. 71 XXIII Mean Daily Intake of Nutrients By the Best and Poorest Adjusted of Group I I ............. 72 X X I 7 Health Evaluation Scores of Group I and Group I I * . .................................. 33 XXV Health Evaluation Scores o f Best and Poorest Adjusted Subjects.,,........................... ,1X71 Systolic Blood Pressure (mm); and Diastolic Blood Pressure in the Two Gr ou p s ............. XXVII Systolic Blood Pressure 83 86 (mm); and Diastolic Blood Pressure (mm) in the Best and Poorest Adjusted S u b j e cts..... ....................... 86 CHAPTER I T H E NATURE OF THIS STUDY Within the past two decades an increasing amount of attention and investigation has been focused on the adjustment of the so-called old people in our society. This interest in the problems of the older persons has been reflected in an increasing number o f books concern­ ing the problems of a g i n g , an increasing number of pro­ jects in psychological and sociological research, and the emergence of professional journals such as Geriatrics and G e r o n t o l o g y . which are focused on the area of later maturity. In recent years the American Psychological Association has set up a separate division, the Division on Jviaturity and Old Age, through which the several interests of psychologists in this area are expressed. Beginning with the September, 1947 issue of Psychological Abstracts . the abstracts of publications in the area of old age were presented separately as a part of the section of Developmental Psychology, volume II of the Annual Review of Psychology In (26) a complete chapter was devoted to reviews of studies in the area of later maturity; whereas, in the first volume of that publication the studies in the area o f old age were reviewed in the chapter called, "Growth, Development, 2 and Decline." Most psychological research in old age has to date been concerned with mental disorders and mental capacities. Kaplan (14) has edited a book, which considered in some detail the mental disorders prominent in later life. While presenting with clarity information concerning mental illnesses in old age, the emphasis of the book was primarily in the direction of the abnormal person. In this respect it is illustrative of the emphasis of most of the research about problems of aging, in that the abnormal person rather than the normal has served as the subject. In another volume edited by Lawton (18), the problems of aging persons were presented and discussed by writers of different professional and vocational b ac k ­ grounds. Here, also, the design of the book tended to emphasize persons with problems. This emphasis has not contributed to our knowledge of the later years of normal adult life. Along with studies of mental disorders, one is able to find many studies concerning the performance of aged persons on various tests of mental ability and mechanical aptitude. Wechsler Many investigators, including (28), have pointed out a general decline in mental functioning with age. 3 Of interest to persons working in the area of the problems of the normal aged person, is a recent book by Cavan, Burgess, Havighurst, and Goldhamer Personality Adjustment in Old A g e . obtained from 2,9S& individuals, the book. (7), entitled, Facts and data served as the basis of The book attempts to identify and define the problems occurring in later life, and to analyse the adjustment of the aging. The authors described two instruments which were employed to evaluate adjustment in old age. The instruments were an Activity Inventory, and an Index of Attitudes. The former instrument was employed in the present investigation. In reference to instruments employed in the study of personality adjustment, the Rorschach has been used frequently. This instrument has been in recent years employed to measure personality adjustment in later years. Therefore a review o f its use in such undertakings is in order. Since the introduction of the Rorschach test (24) in 1922, the test has been employed in many studies, with the usual point of departure being the use of the test in clinic settings. It is not difficult to understand why many of the reported investigations in the Rorschach method are based on findings obtained from patients in mental institutions, if one only review the early history of the test. Rorschach based his early findings on investigations carried out with pathological subjects. Investigations in the Rorschach method employing normal subjects are not numerous. Individuals free of person­ ality disorders ordinarily do not present themselves to agencies whose interests lie in the study and treatment of personality disorders. For this reason alone there is some difficulty securing for Rorschach study n o n ­ disturbed individuals; hence most Rorschach research continues wich clinic or agency cases. Most Rorschach studies reported for normal samples, use as subjects students or institution employees. Probably the most extensive normative Rorschach study reported to date, is that by Beck, Rabin, Thiesen, Molish, (5)* and Thetford The study was based on 157 employees of the Spiegel Mail Order House in Chicago, Illinois. This sample in­ cluded various levels of socio-economic status and intel­ lectual achievement. The subjects were not, however, differentiated as to age. Of the Rorschach studies reported on normal persons, very few have been reported on individuals in the later periods of life. Information on the Rorschach performance of older persons is, therefore, limited. Recently, two Rorschach investigations dealing with older persons were published. Chesrow, Woisika, and Reinitz (6) reported 5 Rorschach findings based on 20 male patients at the Oak Forest Infirmary, Oak Forest, Illinois. The ages of these patients ranged from 64 to 83 years. The educa­ tional level was varied, ranging from college training for one patient to no formal training for another. The hospitalization of the patients was due primarily to physical ailments. The authors summed up their findings with the Rorschach as follows: "The evaluation of the Rorschach test generally shows: Delayed responses, reduced number of responses, stereotyped thinking, constriction in intellectual and emotional spheres, and impotence. In this group these are related to the aging of the mental p rocesses.” (8, p. 177). A second study of aging persons by Prados and Fried, (21), reported Rorschach findings based on 35 subjects between the ages of 50 and 80. The sample was not described other than to state that the subjects were able to carry on everyday tasks. The authors pointed out a trend of emotional and intellectual deterioration with age, and appeared to relate these changes to the aging processes. The authors did point out that these changes did not progress at a uniform rate, and were not uniformly present in all subjects. The two studies mentioned, while valuable in presenting data on older persons, are somewhat limited in 6 scope. First, the Rorschach was the only instrument used. Second, the studies were cross sectional and gave no indications of change with age in Rorschach performance. A problem that arises in all investigations with older age groups is that of fixing a point for the begin­ ning of old age. Many age points have been arbitrarily set for various purposes as the beginning of old age. The United States Congress, for the purpose of paying social security benefits, has set age 65 as the b e gi n­ ning age for old age benefits. Recently there have been proposals for a downward revision of this age level. order to designate the various phases of aging, In Stieglitz (26 ) has suggested an overlapping classification of the stages of aging, maturation, including the periods of senescence, and involution. tion is, of course, evolution, This classifica­ based on physiological changes. spite of obvious difficulties, In students of problems of aging usually take some chronological point as their reference. The present study was undertaken with the full cooperation of Dr. Margaret A. Ohlson, Head of the Department of Foods and Nutrition, Michigan State college. Dr. Ohlson very generously made available to the writer the results of dietary studies, physical examinations, health ratings, and socio-economic data. 1. Purpose of the present investigation The general purpose of the present investigation was to make a personality study of the sample of aging women, for w hom certain data had been made available to the writer by Dr, Ohlson, Concisely, gation would, it was hoped that the present investi­ in part, answer the following questions: a. How do Rorschach findings for the present sample compare with findings reported for other samples of normal adult and aged subjects? b. Are there differences related to age in the personality structure of the present sample as indicated by the Rorschach? c. Is the health status of the sample related to age differences, and to level of emotional adjustment? d. Is physical and social activity related to age differences, and to level of emotional adjustment? e. Is dietary status related to age differences, and to level of emotional adjustijient? f. Is there relationship between socio-economic factors and level of emotional adjustment? 2• Instruments and data employed in the present investigation The present study employs the following i ns t r u m e n t s : 8 The Rorschach test, Rorschach test and the Activity Inventory. The (2) is a relatively unstructured p r o­ jective personality test consisting of ten ink blots which yields information on the personality structure, emotional adjustment, methods of dealing with environ­ mental situations, and the integrative capacity of the subject. The Activity Inventory, gess, developed by Cavan, Havighurst, and Goldhamer Bur­ (7), was used in this investigation as an index of social and physical activity in later life. The inventory will be described later. In addition, three kinds of data were made avail­ able from the study conducted by Dr. Ohlson (19)* (a) Results from medical examination were available for each subject. This examination provided information in the following areas: height and weight, blood pressure, blood sugar, reproductive functioning, bone structure, surgery and illnesses, and past (b) A socio-economic questionnaire provided the following information: o f income, home ownership, sources of and amount family membership, length of time in the community, education, and marital status. (c) Dietary summaries provided data on the intake of calories, minerals, adequacy• vitamins, and proteins, and on diet 9 3• Description of the sample Findings in the present investigation are reported for 45 Negro women between the ages of 50 and 83, residing in Lansing, Michigan, an industrial city of approximately 100,000 in central Michigan, The subjects had been obtained by the Department of Foods and Nutrition for the dietary studies conducted by that department. The sub­ jects came from all parts of the city in which colored families lived, and were selected for the purpose of making them representative of Negro women of the stated age range in the city of Lansing, Fifty women were seen in the laboratory of the Department of Foods and Nutri­ tion; of these 50 , 45 of the women composed the present sample• All contacts for the administration of the Ror­ schach and the Activity Inventory were made by the writer. The procedure was for the investigator to call in person at the residence of each subject, either to make an appointment for testing or to administer the instruments during the initial contact. Upon initial contact with the subject, the author asked her if she recalled her visit to the Department of Foods and Nutrition on the campus of Michigan State College. recalled this visit immediately. The subject usually The author next informed the woman that he was from the Department of Psychology 10 at the college, and was cooperating with the Department of Foods and nutrition in a continuation of the study in which she hac previously participated. The woman was asked if the writer might use an hour or so of her time, or, if she was busy at the time, could he make an appoint­ ment for an interview in the next few days. In approx­ imately 50 70 of the contacts the subject had the time for an immediate interview. All testing ana interviewing was cone by the author in the homes of the subjects, usually in the late morning or early afternoon hours for women who were not working outside of their homes, ana in the evening for those women holding outsiae jobs. testing were at a minimum. Disturbances during On the whole fewer disturbances were incurred than one often finas in some clinics and hospitals. The author usually began the interview by asking the subject her impression of the visit to the laboratory at the college. In general most of the women were quite impressed by the treatment they haa been a c e o r d e a , and in particular by the medical examination. This conver­ sation served to establish rapport between the subject ana investigator. versation, after ten or fifteen minutes of con­ the author followeo with the administration of the Rorschach and Activity Inventory. At the conclusion of t.To«? +na t V-or f h e mi f h o r '•;4 + !: t-ao ' uiiion yj 3 i fc-r t e n iniiiu t ~ o 1 ?. >vjo Vti*l f liour • -VC-1 t lie -’Mt'- ':- if ii'i; io .^ i ~ " ' r :■ ’o s ■ '•: 0 0 j c r t - i c 1 M to d . ■> ^ -• •; : .1 r. ^r-•._l' •. r 15. . ' " l a r otouy# *:Yi f - 5eiw of re: ii.oi i-ifc t . I C C ^ r t ^ ;; t J o i ..• l*l>. C: r l-ao r.+ oi , '“joi ■11 r• v' ^ o *• i h •- - ^ t -.* ^ •* Jo •do ot:;sOy. w v ?f >* ■' ^11 • • .’-• " * ■ too i."*itr ttoo f:i ^ . N 4. ,,a- .* . +a j _ ' .C' • i u., 1.i ?•-.f n : • . .- •. 1 . * ] [ •*»>J ~.r •.fI .V O a.1. .. ••. •. •- Ai i/oo ^ f C. w.t.4 - d' * -> 4 - -- • , -v-.;,.i r1 t -• •- i-• * tr; fr* . -• • , a- - ; 0 il-‘ i- c I ; v ? 1 1:. - tit i.uav i- 1. ■ : . - a / ~J.. r- •..♦• uroip T.f-of; Ttit r to’1 •• to 1 *r ’• ■o 0 , > «*i * > •» i ^ •■» _ ♦O 7s 0 1 «r-v.r, tct ‘il iil *. ^ TT -1 . > ^ f ( ♦ * ■1 e l . ■ -‘-^5 . + - 4i-“ *xi on 0,1 t•“-'f • v U i ‘t-* ;lo '.u c eto ^-r ■f'. ^I. ^ •.“* i 1Xj. f.'O il + ' iJ.■*■ * ------- ... 11-'* w rO'1 r* f') ii f per cent of the women were living in homes which were either owned outright, or were in the process of being paid for by the woman ana her husband, alone. or by the woman TaBLa I CHAnAuTiifcIBTIoB Cf THi^ S/UYPLo A ^ode i.o. b C r.ajustment nge b l F ^arital Owns Income otatus Home G K oduca- iMork tion btatus I J Ho. Years in oh. ^ansing *i .1 Sep 21 50 43 56 r-i Pi Yes u 10 Yes 2 4« Yes 1. 10 SO 5 21 Yes T - Yes 6 50 7 Yes 0 6 -< Yet 0 6 10 Yes 1 41 67 P 50 71 L 50 1*1 Yes L i! 50 * Yes a. 2$ 52 46 52 75 52 r-*r~ 4t L 53 96 P 53 ■*• Yes Yes r 10 ,.0 1 *-t i'i 1*0 ij 10 11O 1 32 P. Yes u -■ Yes I 27 Yes c 6 Yes 3 10 i< VjJ TABLii I (Gont Td) B u i’ G H 1 J !. Yes - S Yes 1 30 u L t 53 r 54 i ’i i-O L 10 i^O 1 54 * A Yes K 6 Yes 9 a 6 Yes 5 14 Yes l; 7 Yes 4 27 Yes C 5 Yes r L c/6p t i 0 54 55 » !•; « 55 i' T , A 57 1*1 Yes Ls 56 I. Yes o 2 5c A' Yes r Yes . 59 5 29 . . o 0 24 5 . . 0 0 16 - 8 Yes 4 8 i» 0 0 59 3 59 0 30 59 i’ ’. Yes r' 59 r; Yes L Yes o Yes i. 60 60 Sep 30 1 0 lie . . o 1 yr coll Yes 9 i Yes n O 13 0 T jsEL h, I (Cont'd; h Ls v 61 60 18 61 35 Tj 3 b 62 6 P 62 93 r T . 62 1 63 39 64 62 T • £ i. 61 61 73 L> A 7• 1VL - ep i'l ,1 oep Ok 11 G H Yes 4 wO 1 Yes 9 WO 0 20 Yes 10 No 0 28 i'.O 2 wo 0 17 Yes 7 Yes 1 4 Yes 12 ;.0 0 28 wo 4 WO 5 7 Yes 0 0 63 WO n wO 1 3 aj I1 ( J «**N Yes n Yes c 43 41 65 4 Yes 12 Yes 2 65 64 65 T■ Yes 12 WO 4 23 r*. 66 Yes 4 No 5 06 67 Yes 6 No 4 o7 £( 29 P H VJl Li.Lj-.lJ 1 (wCilt^fl#) nA U fc u 1 0 H 1 J ho o 5 YeS 1 5 3 -.0 3 10 rO 1 33 n' I 67 01 67 it -.0 n. - TLi 71 tt Yes 95 X 75 -V •mO 4 no 5 23 77 A rO 8 rO 8 53 ec rlr Yes £ 6 liO 1 51 u no u 8 uO 2 52 17 ?3 82 b to 5o 2 yr coll rxplanetio:i of fable: column £— B - Subjects rated as best adjusted P - Subjects rated as poorest aajusted c— 1 - harriec. anc living wit.h hucbaad .. - b'idow tep - V.oman living apart from husband, including divorced a— Yes - Owns home outright or paying for same ..o - rents or lives with member of family f--/ - Unoer ,1000 * - ,r15oC to *1999 ^-v250o to 2999 r - flOOO to .*1499 u - v20uo to *2499 r-*30C0 to 3499 G - ,,3500 to 3999 H - „400o to 4999 I-v.5000 to 5999 0— refers to highest grade completed H— Yes - .voman works outside of home :>o - noman does not work outside of home 1— Kefers to number of children born to woman exclusive of still births o 17 TABLE II AGE LATA OF TOTaL SAMPLa ALL SUBGROUPS Group i'J Range Lean SD I 22 50-59 53.77 2.94 II 23 60-63 66.43 6.33 45 50-63 60.13 6.02 Total TABLL III HlGHusT SCHOOL GRALL COi'iI'LriTLL FOR TOTAL BARFLL AHD SUBGROUPS Group H Dean SL I 22 S.l 2.56 II 23 7.4 3.19 45 7.7 3.03 Total CHAPTER II PERSONALITY FACTORS AS R e VEALEL) BY RORSCHACH FIN LINGS In this chapter the Rorschach findings for the present sample will be compared with the findings reported by beck and colleagues, and the findings reported by Chesrow ano associates. In the second part of the chap­ ter the performance of the two age g r o u p s of the present sample will be contrasted. The sample employed by Beck and colleagues will be referred to as the Beck-Spiegel sample; and the sample used by Chesrow ana associates will be referred to as the wuesx-ow-Uak Forest sample . The Rorschachs of the present sample were scored accord­ ing to the Beck methoo (2). A. Comparison Of Rorschach Findings The oaliman Bample Aitli Finding s In The neck-Bpi eg e l , And ChesrowOak Torest Bamples 1. Responses ana Approach Table 4 presents the total responses ano the approach data for the Caliman ano Beck-opiegel samples. The approach data indicate the number of the total responses which are: 1 ) whole responses, 2 ) commonly seen details of the card, or }) less frequently seen details. The mean number of total responses in the present samrle 20 tablr iv RORGCHACH Rt,Gi CNC^S AND APPROACH* Response Per Cent oaliman Per Cent Beck-Cpiegel Cample Cample CP »'*ean CP itean ih dirr R 20.20 5.90 32.65 17.68 24 4.91 2.18 17 jj 73 14.82 4.28 73 3 .69 1.11 10 Pa *The approach data lor the were not available 5.50 3.76 22.85 10.49 3.02 3.38 12.45 7.45 .59 1.31 r'A O• to \j "t" 7.57 2 .67 8.34 -hesrow-Oak Forest- sample 21 was 2 0 .2 0 , which was significantly lower than given by the Eeck-opiegel sample. of 32.65 responses. The oeck-opiegel sample gave a mean The mean number of responses for the ohesrow-Gak forest sample was 1 8 .0 5 , which aid not differ significantly from the mean number given by the present sample. As the Ualiman ana bhesrow-Gak forest samples are c om­ posed of aged persons, the findings appear to indicate a decline in itorschach productivity in the later years of life. Klopfer age home, (1 7 ), reporting on a sample from an old found a mean cf 13 total responses. The age range of the Klopfer sample was 62 to 93 years. Examining the approach aata in the present sample, it was founa that the subjects tended to accentuate the W response, while the Dd response was virtually neglected. The emphasis on the \\ responses occurrec to the extent that the mean response of 4.91 in the present sample approached the 5-50 mean W response of the Eeck-upiegel subjects, although the mean total response of the latter sample was greater by 12.45* The excess of W over bd appearea to indicate less anxiety and neurotic strivings in the declining years of life. The aesire to pursue ana search out various aspects of the environment seemea to give way to a more passive acceptance of the environment, lor the most part the whole responses in the sample of 22 older women were the common, response easily perceived type of , euch as the "bat” and "butterfly.” It is possible that poor vision in the aged group might have accounted in part for the fewer number of Dd responses. For the present sample there was no inform­ ation available on vision. 2 . Z, The Organizational The 1 score concept, Score as developed by neck (2 ), refers to the ability of the subject to perceive two or more parts of the card in relationship; card as a whole. or to perceive the In this framework, Z is inaicative of the intellectual energy of the subject and his present intellectual functioning. This concept does net refer to intelligence per se, or to intellectual potential, but to present intellectual activity. Table V shows the Z score distribution in the Caliman beck-Spiegel and Zhesrow-Gak Forest samples. It is expected that the Z score will be related to the total number of responses. It follows that with a smaller number of responses, Z score will be smaller. the As there was a mean response differential of 12.46 in i'avor of the Beck-Zpiegel sample over the present s a m p l e , it would be expected that the former sample would show a correspondingly higher Z score activity. 23 TABLE V RORSCHACH Z SCORE DISTRIBUTIONS N Mean SD 45 13.91 7.74 Beck-Spiegel 147 22.48 14.91 5.23 Chesrow-Oak Forest 11.92 5.26 1.18 Sample Caliman 20 n-tn * * The " t n scores given refer to the nt n difference between the sample for which the score is given and the Caliman sample. This holds true for the other tables in this report. 24 One ether rinding in regard to 4 score in the Beck-Cpiegel sample may shea some light on Z score act­ ivity in the Caliman sample. The mean Z score Tor the beck-Bpiegel sample was 2 2 .4 b; while that in occupational group "four” for the same sample was 16.20. pational group was an unskilled group, This occu­ composed of persons employed as ushers, warehouse packers, operators, and washroom attendants. relation of 2 to vocation, elevator Concerning the neck ana colleagues statea, "The higher the vocational group, intellectual energy represented by the higher the Z. The has its selective potency in the competitive field which present-day industry i s "(5 , p. 2 5 2 ). The mean Z score for the Caliman sample tended to approach the mean Z score of occupational group "four" of the Beck-Zpiege± sample. There appears to be some basis for assuming that the occupational status and intellectual level of the present sample may have been contributing factors to the lowered 1 score productivity. 3, It, The Movement Response The Movement responses or i. (,Ta clown dancing," or "two persons holding a basket'1) yield an indication of the creativity ana the imaginative processes of the person. The ability for rational evaluation of environ­ mental problems is also reflected in the K response. 25 TABLE VI RORSCHACH MOVEliEET RESPONSES sample Mean • oD Caliman I.33 1.47 beck-Spiegel 3.50 3*24 Chesrow-Oak Forest, 1.65 1.20 26 Table VI shows the number of io responses given by the subjects of the baliman, Ca.c Torcst samples. B e c k - c p i e g e l , and bhesrow- The M response occurred one-half as frequently in the present sample as it occurred in the Beck cpiegel subjects. There was no significant difference between the mean K responses and dhesrow-Oak Forest samples. in the caliman These results were not surprising as the individuals in the two latter samples haa passed their most productive ana creative years. The standard deviations cf the three samples indicate con­ siderable variability an the distribution of the M response. In each of the three samples a relatively small number of the subjects were very productive in --overnent responses, materially elevating the mean for each sample. The majority of the subjects in each sample fell below the f Stan 6 heir sample in M productivity. As A is indicative of creative ability, the consistency in the~e findings may be reflective cf the distribution of creative ability in our culture; or at least reflective of the manifesta­ tions of that ability. 4. dolor Responses The color response in Rorschach framework is indicative cf the amount and t pe of emotional expression. There are primarily (a) Pure wolor, three types of color reap nses: in which the percept is determined solely 27 by the color. (b) dolor-Form, in which the percept is determined primarily by the color and secondarily, form or shape. ror example a butterfly is perceived, because of the color mainly, or form. by the and also because cf the shape (c) F o r m - d o l o r , in w-ich the percept is determined primarily because of the form, anc secondarily because of the color. The example of the butterfly would hole here, with the exception that the iorrn woulo be more important than the color. Table VII shows the mean:, of the three types of color responses ana also the sum of the color values for the three samples. The findings concerning color seem to indicate that the 45 aging colored women of the caliman stucy ana the 20 male patients in the ohesrow-Oak Forest sample shewed a lesser tendency for overt emotional expression and labiiit; Opiegel the., the subjects cl' the Leck- sample, which contained on the whole younger persens. Rorschach findings with children often reveal an unbridled variety of affective expression, illustrated by a predominance of lure dolor and dolor-oorrn responses, in children thio is founa to be normal, and is to be expected in the- normal unhibited child. in her ttucy with of rure dolor anc Ford (10) found children that there was a predominance dolor-*’orm responses over the rorm-^olor TABLo VII RORCCHACL COLOR RECrOl.CbC * Cum of Color vaJues oum of Pure Color Cum of oolor i'orm k Cum of Form Color k CL k Cb oaliman 1.53 1.37 .33 .77 .64 .82 .56 .76 beck-Cpiepel 3.11 2.74 .49 .81 1.44 1.77 1.16 1.15 Chesrow-Oak iorest 1.25 1.91 .90 1.41 .30 .64 .05 .16 Cample Cb M oD *The weightings used for the sum of the color values are those used by beck ( 2): Pure Color responses 1.5, Color-Form responses 1.0, ana Form- Color responses 0.5 N) oa 29 responses. aI so referring to changes in affective responsivity with age, Rabin and Beck stated, "A generalized drop in affactivity, and most particularly in primitive affect, is concomitant with rise in age level.” (23), p. 599). By the time the normal child reaches the early adult years the ability to control childish affectivity is present, however tendencies for labile reactivity may yet r e m a i n . sample, Beck and collaborators refer to their TT. . . a s having made some progress towards maturity and towards capacity for social r a p p ort"(5 , p. 259). The subjects in the present sample appear to be emotionally stable, of excitability. ing years anc to have a relatively lov; degree There is no evidence that the declin­ of the normal adult are marked to childhood emotionality. Ly a return These findings inoicai.e that on the whole normal persons in olo age have adequate control of their overt emotional expression. 5. Y, The Light-determined. Responses The Y response is taken to be indicative of passiv­ ity and especially that passivity stemming from the anxiety'- of the subject. in pathological When this type of response occurs frequency, feelings of depression. it is indicative of fear and 30 For a percept to be labeled as a light-determined response, the percept must be determineo in whole or part by shading or dilTerences in light values. The perceiving of clouds, because of the darkness of the particular card, would be an example of a Y type of response. values, Y responses may be determined wholly by light or in part by form or shape; however, in this report the Y responses are not differentiated. Table VIII presents the mean Y responses for the three samples. In both the Caliman sample ano the Ches­ row-Oak Forest subjects the Y response occurred less frequently than in the sample by Beck and colleagues. o_l normal adults, reported The Y factor in the latter sample was certainly not indicative of clinical abnormality; but in the two samples of olcer persons, anxiety, trayed by Y, appeared to be even further reduced. as por­ This seems tc reflect a tendency of the oloer-agea groups to accept their status in life anc their total adjustment without any great anxiety over effecting a change in con­ ditions. There is no evidence whether the institutional­ ization of the Chesrow-Oak Forest sample affected the anxiety of the twenty aged males. o. V, The Vista Response In Rorschach framework the V response is indicative of the quality of self evaluation. An excess of this 31 TABLr, VIII RORSCHACH Y RSSPOkS^S Sample Caliman Eeck-Spiegel ohearow-Qak rorest Mean SLi "t" .b 2 .54 1.96 2.22 5.15 -5*0 .74 .38 32 quality results in feelings of inferiority txia inadequacy on the part of the indivioual in his present environment. In order for a response to be scorea as vista, the part of the card perceived must be seen as being at a Distance. "The coloring makes that look like a mountain peak in the distance," is an example of a Vista response. in the sample of aged women the V response was practically non-existent. given by the entire sample, were obtained. Out of a total of 909 responses only two Vista responses In the deck-npiegel sample, however, was a mean of l.Sf V responses per subject. data were reported there ho Vista for the sample of aged men. One may only speculate as to the rarity of V responses in the sample ci women over lifty years of a g e . expectea that It might be v activity wculc occur when the inciviaual in his own thinking contrasts hin.eeli with his environ­ ment, anc feels himself inadequate to meet the challenges presented by the environment. It may be expecteo that the women of the present sample felt less challenged by the environment, anc perceived the environment less as a threat than aic; the adults of the neck-bpiegel sample, in essence this explanation seems to incicate a more com­ plete adjustment to the environment by the aging women. 33 7. B, The White Bpace Responses The perception of S in the Rorschach is an indi­ cation of the determination and persistency of an individ­ ual in contacts with his environment. index of the resistance to pressure, on the part of the individual. S may also be an coercion, or change Responses are scored as d, when the subject has used the white or the uncolored part of the card for the p e r c e p t . Table II. shows the mean 5 responses for the caliman and the Beck-apiegel sample s . The women of the present sample were i'ouna to be low in the activity aenotea by the d resp nse, when com­ pared with the Beck-dpiegel sample. The findings in this area appeared to point out a decline in the aggressiveness of the person in the late years of life. 8 . r Plus, The Correct form response The per cent of the Rorschach Form responses which are scored as plus is a very crucial index of the accu­ racy of the perceptions of the person. This inaex p r o ­ vides an answer to the question concerning the accuracy of thinking of the individual in relation to others. In the Caliman sample the form responses have been scored according to norms announced by Beck (3). £>y the Beck system a response is scored as plus, if that response was given by a sufficient number of his sample to merit the 34 TABLE IX RORSCHACH SPACC RESI'OMSES Sample hean Caliman .64 .32 1.90 2.14 6.00 .80 1.18 .53 Beck-Spiegel ohesrow-Oak lorest SD nt M 35 plus score. Table X reveals the mean F Plus per cent of the Caliman, Beck— S p i egel, and ohesrow— daic Forest samples. Mean F Plus per cent for the present sample was 75-62, as contrasted with 79.25 for the Beck-spiegel ssmcle, ana 73-55 for the chesrow-Oak Forest sample. There is no evidence that the subjects of the present sample differ greatly from the sample of younger adults in accuracy of form perception. The dhesrow-Oak Forest subjects who in the main were persons with physical aisorders, maintained their perceptual adequacy in spite of allegea mental deterioration. A Form Plus per cent of 60 is believea to be the critical minimum for aoequacy. line. A percentage that low woulo be considered border i^ven though the accuracy of form perception was adequate for the two aged sampJ.es, accuracy oi form per­ ception for the Beck Bpiegel was higher, which may be indicative of some decline in perceptual adequacy for the two agfca samples. 9. H, The Human Response; and H d , The Part-Human Response Human responses are divided into H, the WholeHuman response, and H d , the Part-Huinan response. Respons are scored as .Vhole-Human, when the entire human f igure 36 TABLE X RORSCHACH F PLUS RESPONSE PER CENT Sample Lean SD ttt" Caliman 75.62 13.96 Beck-Spiegel 79.25 10.20 1.59 Chesrow-Oak Forest 73.35 17*44 .46 37 is seen. *«hen only part of the human is seen the response is scored as Part-Human, eetail. or H d , which refers to Human- Table xl presents the mean H ano Hd responses given by the baliman ana beck-hpiegel samples. The Human response is indicative of the identifi­ cation of the individual with other people in the environ­ ment. The amount of this factor reveals either a con­ sideration and concern for other persons, or a rejection of other people and their interests ana problems. The H, or* 'Whole-Human response is clinically the more healthy response, while an excess of Hd or Fart-Human responses is an indication of anxiety and stress in r ela­ tions with other human beings. One can see in Table XI that H occurs in a varied manner in the two samples. In the present sample there are significantly lower frequen­ cies of H than occur in the beck— Spiegel sample. ^ven when the difference in total number of responses were taken into c o n s i de ration, the H responses in the present sam ie were lov„r. The relatively high stanoard deviation iii the present sample indi cates that the l ow H was not constant throughout the s a m p l e . The reason for the re l a ­ tively low H will be aiscussea iurther in relation to the Anatomy responses. H d , or Part-numan responses are better interpreted when viewea in relation to the H responses. .vhen Hd 36 TABLr, XI RORSdHACH HUKAR R.b3POHS.fcjS # Sample H, Whole-Human Responses Kean Hd, Part-Human Responses SL) wean SD daliman 1.95 1.90 1.35 1.60 beck-Bpiegel 1+ .02 3 .62 1.76 1.95 *Human response data for the dhesrow-Oak forest sample are not available. 39 occurs in excess of H, questions may be raised as to the adequacy of the adjustment of the person to other individ­ uals. In the Beck-cpiegel H than Hd. sample there was significantly more In the present sample H was not significantly higher than Hd, which seemed to indicate that for the sample as a whole there were certain adjustment problems. 10. A Per Cent, The Animal Response Per Cent The per cent of A, or Animal responses in the Rorschach provides an index of the adaptivity and conventionality in thinking of the person. percepts are the easiest to make, As the Animal an excess of A responses is indicative of stereotyped thinking. Table XII shows the mean per cent of Animal responses for the Caliman, Beck-Spiegel, and Chesrow-Oak Forest samples. The table reveals no significant differences between the three samples in respect to per cent of Animal responses, although the Beck-Spiegel sample had a mean per cent of A responses slightly lower than the two aged samples. From these data one might conclude that conditions represented by the per cent of A responses remained rela­ tively constant, aging process. ano did not appear to be affected by the 40 TABLB XII RORSCHACH ANII1AL RBSPOkSS ISR CsRT Sample liean SD "t" Caliman 48.47 18.58 Beck-Spiegel 46.45 13.12 .68 chesrow-Oak rorest 48.85 18.49 .06 41 11. An, The Anatomy Responses An excess or Anatomy responses in the Rorschach shows an unhealthy concern, or anxiety over health and body f u n c t i o n i n g . Concern over anatomy often serves the purpose of establishing a somatic basis for diffuse anxiety feelings. Responses scored as Anatomy, include internal parts of the boay, such as bones and organs. Table XIII presents the mean number of Anatomy responses in the Caliman and Beck-Spiegel samples. The mean of 2.66 An responses in the present sample was certainly a high number, and revealed a gross concern about bodily functioning on the part of the sample as a whole. The relatively large standard deviation of 3.59 indicated that there was wide variation in the distribution of the Anatomy responses in the sample, factors in this variation will be discussed later in the chapter where intra-group comparisons of the sample are made. It might be expected that changes that were occur­ ring and that had occurred in the functioning of the reproductive systems of the women in this sample might have been responsible for the concern with anatomy. In relation to the relatively low number of WholeHuman responses noted previously, certain additional comments are in order at this point. 'While the H response is indicative of concern with other persons, the An 42 TABLE XIII ANATOMY R jlSPONS^S * Mean SD Caliman 2 .66 3 .59 Beck-Spiegel 1.55 1.97 oample "t" 1 .44 * Anatomy responses oi‘ the ohesrow-Oak Forest sample are not a v a i l a b l e . 43 response represents a more personal and private concern— a concern with the body and health of the person himself. When this personal concern is increased it might be expected that the person would be less concerned about other persons. 12. P, The Popular Response The conformity of the individual to social mores, and his adjustment and adherance to group standards are reflected in the Popular responses on the Rorachach. Recent norms by Beck (3) contain 21 P responses. Table XIV shows the mean numbeus of P responses given by the three samples. The table indicates that the differences in P responses for the three samples were small, and that the Caliman sample yielded slightly fewer P responses than did the Beck-Spiegel sample, and slightly more P than did the Chesrow-Oak Forest sample. As the present sample is composed of normal women residing in a commun­ ity situation it would be expected that they would show an average adherance to community standards. This expect­ ation has been met. B. Comparison Of Rorschach Findings In The Two Age Groups Of The Present Sample In the preceding section of this chapter comparisons 44 TABnL XIV RORSCHACH POPULAR R l S . U . ^ S Sample — kean - - SD “- "t" , Caliman 5.69 2.16 Beck-Spiegel 6.79 2.41 2.69 Chesrow-Oak Forest 4.60 2.19 1.82 45 of Rorschach findings between the present, Beck-Spiegel, andChe3row-Oav Forest samples were presented. Wide differences were noted in regard to total number of responses, L scores, Movement responses, Color responses, Human responses, and Y and Vista responses. to the above variables, In regard the Beck-Spiegel sample yielded a gre ter number of 3uch responses. composed of aged persons The two samples tended on the v;hole t o ‘be quite si ilur in respect to the Rorschach variables, relatively the same and ..ere the Beck-Spiegel sample in Porm Plus and Animal pe r cent. By dividing the present 3 anole into two age groups it is possible to tent t e differences ance in the two age groups. i nto two groups, in Itorschac? perform This division of the sample one composed of v/omer. 50 to 50 ye.. ;'s and tl e sec ond com ms'* •*.** in C nap ter T. - ' V :» r,-' rf m the ^orschach v ri-hi es i - '0 t.m 03 y s-.r. , +- no c "f .0 cient* cned t> e « ..omen on in ?• hi c Y7. 1 . Aesr.pr." <-> and ^ o a r o ^ c h 46 TABLb XV SUMMARY OF 16 RORSCHACH VARIABLES Group 1 SD Group II Variable Piean Responses 20.05 5.5 20.35 6.3 <1 W 5.36 2.3 4.47 2.1 <1 b 14.45 4.5 15.17 5.7 <1 Dd r .66 14.30 — Mean .69 7.9 13 .62 oD 7.1 "t" <1 iv* 1.37 1.43 1.83 .91 Y 1.09 .79 .61 .68 <1 Sum C 1.64 1 .24 1.43 1.47 <1 V Negligible 74.93 15.19 76.30 12.62 < 1 F plus >5 1.28 H 1.32 1 .28 2.57 1.67 Ha 1.82 1.41 1.52 2.33 <1 49.09 19.72 47. 57 17.09 <1 3 .66 3.90 1 .60 3.03 2.67 S .91 .90 .39 1.03 1.79 P 5.23 1.97 6.13 2 .22 A% An 2.39 <1 V7 was the small number of* Dd responses. Both groups appeared to concentrate most on the obvious aspects of their environment, and appeared neither anxious nor intellect­ ually curious. This factor appeared constant for both groups, possibly indicative of no significant change in intellectual functioning. 2. Z, The Organizational Bcore Differences in Z scores for the two age groups of the present sample were small and not significant. Since the function measured by the organizational score is assumed to be an intellectual one, we should expect little or no difference in the mean Z scores of the two groups since their academic attainments were quite similar. The lack of differences seemed to point further to an absence of intellectual shift in the sample due to the process of aging. The standard deviations reveal wide differences in the distribution of Z scores in the two groups, but these differences do not appear to be related to age differences. 3. M, The Movement Response As noted previously, M in the present sample was low in comparison with the Beck-Dpiegel sample. The l e s s ­ ening of productivity and creativity in the later years o f life was given as a tentative explanation. Table XV 48 does not indicate a decrease in M activity related to a £ e , but to the contrary, indicates that there was a tendency for M responses to occur with greater frequency in Group II, the older age group, than in Group I, A priori it was assumed that M activity would be present to a greater extent in the younger age group, appears a reversal of expectation, but here in that Group II gave significantly more M responses than did the subjects in Group I. It is suggested that factors other than age may have operated to produce the findings reported for M* One of the factors might have been that of menopause, which will be examined in relation to the Anatomy responses. 4. Color Responses The differences between the two groups in relation to dolor responses were small ana with no apparent trends. Group I yielded 6 C, 13 GF, and 28 FC responses, while Group II yielded 4 C, 16 GF, and 22 FS responses. Table XVI shows the Movement-^olor relationships for the two age groups of the present sample, and appears to indicate that there was some tendency for the subjects of Group II to exhibit a better balance between affective energy, and fantasy or wish fulfillment. However, since both M and Color responses appear to become fewer with age, and the means of such responses were relatively small in the 49 TABLE XVI RORSCHACH MOVEMENT-COLOR RESPONSE RELATIONSHIP Number of Subjects M Group 1 > C 6 Group II Total Sample M 4 . C M = 12 4 9 9 5 15 21 9 0 50 present sample, little significance can be placed on these findings other than to say that this may be another trend indicating better control of the affect with a g e • 5. Y, The Light Determined Response The Y factor, while not high in either of the two groups occurred more frequently in the younger group, Group I. While the differences here are not great, it can be noted that this finding concurs with the findings reported in the previous section of this chapter, where it was found that the younger aged sample, the BeckSpiegel, gave more Y responses than the two older age samples, the ualiman and Ghesrow-Cak Forest. 6. V, The Vista Response As stated previously in this chapter, the Vista response occurred with rarity in the present sample. For the entire sample there were only two V responses, both occurring in Group I. From this lack of V activity, it would not be feasible to attempt age comparisons within the present sample. 7. S, The White Space Response As indicated in Table XV, the S response is rela­ tively low in both age groups, with the tendency for S to occur more frequently in Group I . The difference in S responses between the two groups was small, and the responses were distributed rather unevenly throughout both groups. The trend w as consisttnt with a decline in S activity with age. 3. F Plus, The Correct Form Response The two age groups of the present sample varied only insignificantly with regard to per cent of Correct Form responses, with Group II having a slightly higher F Plus per cent mean. It appeared that in a homogeneous group such as the present sample, there was no decline in perceptual accuracy on the Rorschach related to age differences. From the standard deviations it becomes apparent that some individuals of both age groups had F Plus per cents below what is ordinarily thought of as being adequate. On the other hand some subjects had F Plus percentages of 100. In either case there was no indication that age was a determining factor in the accura­ cy of Rorschach form perception. 9. H, The Human Response It was pointed out in the previous reference to the H response that this activity was indicative of the p e r s o n T's identification with and concern for other human beings in the environment • The mean of H or Whole-Human responses 52 for Group II was nearly twice that for Group I, From this finding it would appear that on the whole, members of Group II were better able to identify with their fellows than were the members of Group I . Table XV reveals that for Group I, the Part-Human responses, exceeded the Whole-Human responses. Hd, Upon tabulating the ratio of Whole-Human to Part-Human responses in the two age groups of the present sample, the 23 subjects in Group H it was found that 16 of gave more H than Hd responses; while only 7 of the 22 subjects of Group I gave more H than Hd responses. This finding is not a healthy one as far as Group I is concerned. It may be posited that the finding in regard to Group I, might be due to the m eno­ pause. This will be discussed more fully in connection with Anatomy responses. Group II appeared to be more stable in its H-Hd ratio, hence it may be hypothesized that this disruption in the psychic balance as protrayed by the Rorschach, corrects itself on the whole as members of Group I move into the age range of Group I I . 10. A, The Animal Response The difference between the two groups in respect to mean per cent of Animal responses was quite small, with Group I having a slightly higher per cent of Animal 53 responses. The conclusion follows that stereotypy as indicated by the per cent of Animal responses did not appear to be related to age differences. 11. An, The Anatomy Response In the foregoing section of this chapter, the high Anatomy responses of the present sample were pointeo out, and labeled as revealing a gross, unhealthy concern over bodily function. Table a V serves to clarify this finding, as the table shows that the younger age group, Group I, had a mean of 3.68 Anatomy responses, twice the size of the mean for Group II, which was 1.68. It is obvious that both groups revealed a concern for anatomical function­ ing, but that this concern was far greater in the group that ranged from 50 to 59 years. Immediately the question arises as to why the greater number of An responses was founo in Group I. Since there is here an apparent age factor in the difference, one must ask what effect might the changes accompanying and immediately following menopause have on the psychological functioning of these women. All the women of Group I were either undergoing menopause, or had recently completed it. It may be positea that many women in Group I arm certainly some of the women in Group II showed concern over the changes in body functioning as an experience concomitant with menopause. 54 This concern over anatomy is certainly self centered behavior, and may divert much of the attention of a woman from family and friends to her own felt personal needs. If this be a correct interpretation, then one can understand the reduction in Whole-Human responses in Group I, and the greater number of Hd responses. 12. P, The Popular Response The difference in mean Popular responses between the two age groups was small, with a tendency for Group II to average about one P response more than Group I. Here one is led to the obvious conclusion that the ability to conform to the social standards of the environment does not appear to decline with aging in the present sample. CHAPTER I I I FINDINGS CONCERNING SOCIO-ECOi,Qi*ilO STATUS, PHYSICAL AND SOCIAL ACTIVITY, AND SOCIAL, HEALTH, AND NUTRITIONAL STATUS From data presented in the previous chapter, certain conclusions have been made concerning the present sample, as contrasted with the younger age sample of Beck (5) and the sample of aging men presented by ChesrowCS). So far, the present sample has been con­ sidered as a whole, without regard for level of per­ sonality adjustment of the individual members of the sample. In the present chapter the manner in which the better adjusted individuals were distinguished from the poorer adjusted individuals of the sample will be presented. Finally data will be presented concerning the adequacy of the best adjusted ana poorest adjusted subjects in terms of activity, socio-economic factors, and dietary and nutritional status. Rorschach Ratings Of Adjustment In order to obtain from their Rorschach perform­ ance some estimate of the aajustment of the subjects, the Rorschach protocols were rated by three raters. raters were designated as A, B, and C. The Raters A and B 56 were advanced graduate students in clinical psychology, each having administered a minimum of one hundred Rorschachs, and interpreted a minimum of 50 records. Rater C held a Ph. L. in clinical psychology, and had wide experience with the Rorschach* After discussion with advisers and colleagues concerning the ratings of the Rorschachs it was decided to have the records of the two groups of the sample rated separately. This pro­ cedure was followed because it was believed that equally good adjustment in the two age groups might be reflected by differing degrees of Rorschach performance. If this proved to be the case, the well adjusted of one of the age groups might have been penalized. In Group I, Rorschachs were obtained from 22 women aged 50-59 years* In Group II there were Rorschach protocols for 23 women aged 6O-S 4 years. The Rorschach protocols for each group were placed in a separate envelope, bach individual record was identified only by the code number of the sub­ ject. The raters received the envelopes separately, with the following instructions: You w i l l be given two envelopes, each containing a number of Rorschachs, complete with typewritten protocol and scoring summary. The records come from a group of aged women. For each group of records you are requested to select the five records you believe from your knowledge of the test to represent the best adjustment in the group, and the five records you believe to represent the poorest adjustment in 57 the group. Please make u s e of the protocol and the scoring summary. In the event you feel some of the records are approximately the same in terms of adjust­ ment, feel free to include more than five records. List the records for each group in order of the good­ ness or poorness of adjustment. In b rief it was the task o f the judges to select from each of the two groups o f the sample the five best adjusted records and the five poorest adjusted records. The immediate question concerns the agreement of the judges. Table XVII shows the percentage of agreement among the three raters in selecting the best and poorest adjusted from each age group. For complete or 100 per cent agreement among the three judges as to the five records that best indicated good adjustment and the five records that best indicated poorest adjustment in a single age group of the sample, the three judges would have had to agree on 30 p o in t s. It is easily seen from the nature of the rating instructions, that complete agreement was quite unlikely. Table XVII reveals that for rating the best and poorest adjusted Rorschach protocols in Group I, the percentage of agreement was 83; while the p e r­ centage of agreement for rating Group II was 67. The percentage of agreement between the individual raters ranged from 60 to 90, as shown in Table XVIII. Table XVIII presents the results of the ratings. For each age group the five records indicating best, adjustment and the five records indicating poorest adjustment are 56 listed in order of average rank. The Relation of Age and Level of Adjustment to the Activity I n v e n t o r y : The Activity Inventory was developed and employed by Cavan, Burgess, Havighurst, and Goldhamer (7). The inventory was designed to yield a relatively objective index of activity of adults in the late years of life. These authors believed that the participation in various activities is one of the criteria of adjustment during this period of life. Following this reasoning, the more active the adult during this age period, the better the adjustment of the person to the environment. The Activity Inventory consists of 20 items covering the areas of religious activity, security status, inter­ personal contacts, leisure activity, and health status. The individual items have been given an arbitrary scoring system by the authors of scale, in such manner as to give the highest score for the greatest degree of participation in the activity measured by the item. The scoring was standardized on a group of 50 subjects with high prelim­ inary scores on the inventory and 30 subjects with low preliminary scores. As was mentioned previously, the Activity Inventory was administered by the writer to each subject of the sample. In analysing the results of the inventory, it TABLE XVII PERCENTAGES OF AGREEMENT AMONG RATERS A, B, AND C IN RATING BEST ADJUSTED AND POOREST ADJUSTED FROM RORSCHACH PROTOCOLS Group Percentage of Agreement A t B, and C Percentage of Agreement A&.B A&C B&C I 63 80 90 80 II 67 80 60 60 TABLE XVIII RATINGS OF BEST AND POOREST ADJUSTED RECORDS Subject Best Adjusted Rank A v e . Rank Subject Poorest Adjusted Rank A v e • Rank GROUP I 9 1 1.0 52 18 14.3 66 2 2.0 22 19 16.8 71 3 3.3 49 20 19.0 50 4 4*0 67 21 19.7 46 5 7-5 96 22 21.3 GROUP II 62 1 2.0 29 19 17.3 1 2 3.0 6 20 18.5 53 3 3.3 93 21 20.3 23 4 6.0 95 22 21.7 60 would be worth while first to ascertain if the inventory discriminates between the two age groups of the sample. As the Activity Inventory was designed to yield an index of participation in various activities, it might be expected that the younger age group as a whole would score higher on the inventory than the older age group. A priori one would assume such difference on the basis of an expected better physical condition in the younger age group. Table XIX reveals the mean Activity Inventory scores on the two age groups. of 36.45 on the inventory, of 32.39 for Group II. the Inventory was 55- Group I had a mean score as compared to a mean score The maximum score possible on The results indicate that the younger group, Group I, scored significantly higher on the Activity Inventory than aid Group II. From these results it may be concluded that the difference was one to be attributed to age. Logically, the next question appears to concern the agreement of performance on the Rorschach with p e r ­ formance on the Activity Inventory. To answer this question for both groups of the sample, the Activity Inventory scores of those persons rated as being of the best adjustment on the Rorschach by the three raters, were compared with the Activity Inventory scores of those 61 TABLE XIX ACTIVITY INVENTORY SCORES OF GROUPS I AND II Group Mean SD I 36.45 6.68 II 32.39 7.06 M diff. TTt ,T score 4.06 1.93 TABLE XX ACTIVITY INVENTORY SCORES OF BEST AND POOREST ADJUSTED Group Mean SD Best Adjusted 39.60 GROUP I 5.72 Poorest Adjusted 31.40 7.37 M diir Mt ” score 8.20 2.08 4.00 .98 GROUP II Best Adjusted 33.40 6.39 Poorest Adjusted 29.40 7.13 62 rated as being of poorest a d j u s t m e n t on the Rorschach. Table XX shows the mean A c t i v i t y Inv en to ry scores of the best and poorest aajusted s u b j e c t s of both age groups. In Group I the best adjusted h a d a mean inventory score of 39.60, while the poorest a d j u s t e d had a mean score of 31.40. This was a s t a t i s t i c a l l y reliable difference. In Group II the best a d j u s t e d subjects scored higher on the Activity Inv en to ry adjusted subjects. t h a n did the poorest The d i f f e r e n c e was in the same direction as for Group I, but was not s t a t i s t i c a l l y reliable for these older subjects. The c a u s e f o r the relatively small mean difference, 4.00, between t h e best and poorest a d ­ justed of Group II, as compared w i t h a mean difference of 6.20 in Group I, is not a l t o g e t h e r clear. posited that the difference is d u e in part to the general reduction in activity as age i n c r e a s e s . It may be It has been mentioned that Group II scored l o w e r on the inventory than Group I. It appears that as activity declined, the difference between the best and p o o r e s t adjusted in terms of activity became less. From the results o b t a i n e d f r o m the Activity Inven­ tory it seems that p ar ti ci pa t io n during the later years of life in various activities is an index of adjustment. The results here would appear to substantiate the hypo­ thesis of the authors of the A c t i v i t y Inventory in this 63 regard. It is also evident that activity alone, measured by the Activity Inventory, as cannot be taken as a sole index of personality adjustment, when the Rorschach ratings of the three judges are used as the index of adjustment. The findings indicate that it is possible for a person to have a high Activity Inventory score and yet be rated by the three judges as being of poor adjustment. Concisely, the findings in this section were as follows: The younger aged group, Group I, was a more active group, when the Activity Inventory was used as the criterion of activity. Second, those subjects rated as being of best adjustment from their Rorschachs were more active than those rated as being of poorest aajustment. The Rorschach findings presented in chapter II and the findings presented concerning the Activity Inventory appear to indicate that there is a reduction in the amount of energy expended by the person in later life. This would seem to result in a general retrenchment in environmental interests and explorations. This retrenchment appears to affect the intellectual sphere as well as the social areas. This retrenchment was demonstrated in the Rorschach performance by a low number of total responses, M responses, Z score. and a relatively low mean The accuracy of perception as indicated by the Form Plus per cent remained more than adequate. Hence, 64 there would appear to be reduction in energy and activity, but not deterioration of the intellectual processes. It appears that the personality structure has accommodated itself to the changes in physical activity and functioning brought about by aging. It will be recalled that the women in Group I had a significantly higher mean score on the Activity Inventory than the women of Group II. Nevertheless, the best adjusted women in Group II were certainly as well adjusted in terms of the Rorschach as the best adjusted women in Group I, although their mean score on the inventory was lower. These findings appear to indicate the manner in which aging may modify physical adjustment without adversely affecting emotional adjustment. The Relation of Emotional Adjustment to Socio-Econcmic factors One of the purposes of this investigation was to attempt to ascertain whether certain social and economic factors played prominent roles in the personality adjust­ ment of these aging women. The factors considered were, marital status, home ownership, number of children born to the woman, Michigan, length of time subject had lived in Lansing, yearly income, ana educational attainment. » Specific information concerning these factors may be found 65 in Table X* This table was referred to in Chapter I. For each of the above factors quantitative dif­ ferences between the best and poorest adjusted individuals of the two groups were small. The small differences were probably due in part to the homogeneous nature of the sample in relation to the factors investigated. It will suffice to mention briefly the factors and compare either qualitatively or quantitatively their distribu­ tion among the best and poorest adjusted persons. 1. Marital Status— Of the 45 women in the sample, 27 were married and living with their husbands, 14 were widowed, and 4 were living apart from their husbands. subjects had been married. All of the Of the best adjusted in Group I, four women were living with their husbands, while one was separated from her husband. There was one wiaow among the poorest adjusted in Group I, whereas, the remaining women were living with their husbands. In the best adjusted of Group II, three women were widowed, one separated, and the remaining band. woman living with her h u s ­ For the poorest adjusted of the group, two women were living with their husbands and remaining three were widows. There are no trends that would indicate any consistent influence of marital status on emotional adjust­ ment. The status of being a widow did not appear in and of itself to be a differentiating factor in personality adjustment during the later years of life. 66 2. Nlimber of Children— There is no evidence from this study that would permit one to assume that the bear­ ing of children was an index of personality adjustment* Of the 45 women in the sample, least one child. 32 had given birth to at In Group I, two of the best adjusted women had given birth to at least one child, with three women for the poorest adjusted. as compared In the best and poorest adjusted of Group II, three women each had given birth to at least one child. 3. Length of Time in Lansing— In the present sample the individuals rated as best adjusted in Group I had lived in Lansing a mean of 27 years, and those rated as being of poorest adjustment had lived in the city a mean of 20 years. For Group II, the best adjusted had lived in the city a mean of 36 years and the poorest adjusted had lived in the city a mean of 30 years. The findings reveal that there was a tendency for the best adjusted persons to have lived in the city longer than the poorest adjusted. The variability between the persons in each group was wide, and it is doubtful that much significance can be placed in this finding. In general both the best and poorest adjusted women had lived in Lansing for a sufficient length of time to become adjusted to the community. 4. Home Ownership— Mention was made in chapter I that 67 over 75$ of the sample were either in the process of pay­ ing for a home, or owned a home outright. In Group I, four of the five best adjusted women were home owners, and for the poorest adjusted, four of the five women were home owners. In Group II, all of the individuals rated as being best adjusted were home owners; this was also true for three of the five women rated as being of poor­ est adjustment. The two individuals rated as being of poorest adjustment and who did not own homes, were two ladies near the upper end of the age distribution of the group, who lived alone in small apartments. It would appear that home ownership was not a discriminating factor in adjustment, but that the loneliness and soli­ tude resulting from living alone during this period of life may well have been a factor in personality adjust­ ment . 5. and 1949• Income--The data on income were obtained in 194b The present sample is composed of women whose family incomes did not exceed six thousand dollars per year in any case. Of the total sample ten of the women lived in families whose yearly income was above 42,500 per year. eighteen women lived in families whose yearly income ranged from ^1,000 to 42,499 per year. Families of thirteen women had incomes below ^1,000 per year. There were no income data available for four of the women. There was no reason to suspect that monetary income was a differentiating factor in level of personality adjust ment. It may be true that lack of financial security could affect the personality functioning of some persons; it is equally true that other persons of like financial status are able to maintain a very adequate level of adjustment• 6. Educational Attainment— Table III revealed that the total sample had a mean school grade attainment of 7.7 grades. There were no significant differences in the school attainments of the best and poorest adjusted persons of the two age groups. From the foregoing discussion of the several social and economic factors it becomes apparent that it would be unfruitful to expect any of these factors to differ­ entiate between the subjects of good anu poor personality adjustment• The Relation of Age and Level of Adjustment to Nutritional Status From the dietary data available on the subjects it is possible to obtain some indication of the relation of diet to emotional adjustment, and to determine if there were differences between the two age groups in relation to dietary status. These data were secured by the 69 Department of Foods and Nutrition from reports furnished by the subjedts of their diets on three days selected by the department. The three days were spaced over a period of approximately two years; and for each subject the three days were selected so that each day came in a different season in the year and on a different day of the week. For example, if the diet of a certain woman had been checked the first time in the winter and on a Monday, this subject would be seen the next time in a different season of the year and on a different day of the week. By this method seasonal variations in the diet of the subjects were taken into account. From this diet survey data were made available on the intake of calories, proteins, calcium, phosphorus, iron, vitamin A, vitamin C, thiamine, riboflavin, and niacin. Data reported in Tables XXI, XXII, ana XXIII show the average daily consumption of the several nutrients during the survey period. The recommended daily allowances of these nutrients mentioned below are those recommended for women by the Food and Nutrition Board of the National Research Council (29). Caloric intake— The recommended daily intake of calories was 2000. Table XXI indicates that both age groups of the present sample were low in respect to the recommended daily allowance of calories. The younger 70 TABLE XXI MEAN DAILY INTAKE OF NUTRIENTS BY THE TWO AG4 GROUPS Group I Mean Calories Proteins 1160 (Gms.) SD Mean 294 49.7 Group II 389 993 16,3 Sd 39-4 n+- n 1.59 21.4 1.76 Calcium (Gms.) .36 .13 .39 .23 Phosphorus .73 -23 .61 .32 1.41 (Gms.) Iron (Gms.) 9.0 Vitamin A 3443 a.u.) Vitamin C (Mgs.) Thiamine (Mgs.) Riboflavin Niacin (Mgs.) (Mgs.) 3.2 3703 45.0 3.2 7425 36.2 3.6 3753 52.1 .17 .73 3.51 33.5 .65 .73 .33 .65 .32 1.31 .93 .45 .99 .32 3.4 2.3 7.3 4.6 .05 .96 *71 TABLE XXII MEAN DAILY INTAKE OF NUTRIENTS BY THE BEST AND POOREST ADJUSTED OF GROUP I Best Adjusted Mean Calories Proteins SD 378 1353 (Gms.) 48.2 Poorest Adjusted Mean 1145 15.8 51.3 SD nt n 3.29 .63 19.1 .25 Calcium (Gms.) .42 .05 .13 .12 4.21 Phosphorus .80 .14 .64 .21 1.27 Iron (Gms.) (Gms.) 9.3 Vitamin A 6103 3.0 5913 10.2 2320 4*2 1666 .15 1.23 (I.U.) Vitamin C (Mgs.) Thiamine (Mgs.) Riboflavin (Mgs.) Niacin (Mgs.) 61.7 46.7 36.3 25.6 .95 .91 .32 .33 .51 .10 1-30 .45 .68 .33 2.24 9.7 4.2 9.3 2.5 .17 72 TABLE XXIII MEAN DAILY INTAKE OF NUTRIENTS BY THE BEST AND POOREST ADJUSTED OF GROUP II Best Adjusted SD Mean Calories Proteins 1167 (Gms.) 51.1 463 21.2 Poorest Adjusted ”t w Mean SD 1020 295 .54 12.5 31.3 1.58 Calcium (Gms.) .51 .37 .26 .11 1.33 Phosphorus .78 .39 .46 .18 1.40 Iron (Gms.) (Gms.) 8.1 Vitamin A (I .U .) Vitamin C (Mgs.) Thiamine (Mgs.) Riboflavin Niacin (Mgs.) ( M g s.) 2635 3.2 2269 41.5 37.6 7.3 10128 2.3 13452 66.0 .42 1.10 43.4 .85 .<31 .46 .55 .12 1.08 1.15 .67 .70 .29 8.1 3.6 5.2 1.1 .96 1.46 73 women, Group I, consumed on the average more calories per day than the subjects in the older age group. The mean daily intake Tor Group I was 1160, as contrasted with 993 for Group II. This difference tended to approach statisti­ cal significance. The difference may be attributed to the difference in the physical activity of the two age groups, a difference that may be assumed to be related to age. Differences between the best and poorest adjusted individuals of the two groups in respect to caloric intake were small, not approaching statistical significance. However, for each sample, the best adjusted subjects had a mean caloric intake higher than that for the poorest adjusted subjects of that group. Proteins--The daily intake of proteins recommended for women was 60 gms. Ordinarily proteins occur in relation to the caloric intake. present in the two age groups. This relationship was The younger age group, which had a higher caloric intake, also had a higher average protein consumption, consuming an average of U 9.7 gms., while Group II had an average of 39-4 gms. In Group I there appeared only a very slight differ­ ence between the best and poorest adjusted in terms of protein intake, the difference being 3.1 gms. in favor of the poorest adjusted. For Group II the difference in 74 consumption was more, with the best adjusted individuals having a mean protein consumption 1 9 .B gms. higher than that Tor the poorest adjusted of that group. Calcium— The recommended daily allowance of calcium was 1.0 gm. Calcium intake is not necessarily related to the caloric intake, of milk in the diet. being related primarily to the amount The difference between the two age groups in terms of calcium intake was negligible, as Group I consumed a mean of .36 gm. of calcium, as compared to .39 gm. for Group II. The best adjusted persons of the two age groups con­ sumed on the average more calcium than the poorest adjusted members of their particular group. The best adjusted subjects of Group I had a mean intake of .42 gm. and the poorest adjusted had a mean of .IS gm. The best adjusted of Group II also exceeded the poorest adjusted in calcium intake, consuming an average of .51 gm., as contrasted to .26 gm. for the poorest adjusted. Phosphorus--Thi s mineral tends to be found in the diet in relationship to caloric intake, and is related to bone and tooth development and to activity in general. The mean daily intake for Group I was higher than that for Group II, as the younger subjects had an average o f .73 gm. while the older subjects had an average of .61 gm. This difference tended to approach statistical significance. V5 The best adjusted subjects of Groups I and II exceeded the poorest adjusted subjects of their respect­ ive groups in the comsumption of phosphorus. The mean phosphorus intake in the best adjusted of Group I was .78 gm., as compared to .48 gm. for the poorest adjusted; while in Group II the best adjusted ahowed a mean daily intake of this mineral of .60 gm., while the poorest adjusted had a mean daily intake of .64 gm. In both groups the differences approached statistical significance. Vitamin A — The recommended daily allowance of vitamin A was 500 International Units. Vitamin A in the diet is not necessarily related to caloric intake, but tends to vary widely from person to person depending upon whether or not the individual in question eats foods that are high in vitamin A. carrots, Certain foods such as liver, spinach, and broccoli are high in vitamin A con­ tent, and if any one of them is eaten in quantity, can increase greatly the vitamin A intake. it The vitamin A range in the present sample was 210 to 50,576 I.U.daily. When the extreme cases (over 10,000) were removed from the samp>le, it was found that neither age nor level of emotional adjustment appeared to be related to the intake of vitamin A. Vitamin d— The recommended daily allowance of this 76 vitamin was 70 mgs. A deficiency of this vitamin is said by Proudfit and Robinson (22) to result in degen­ eration of muscle structure, irritability, in general. and poor health Vitamin G is not related to caloric intake, but rather to the amount of fresh fruit in the diet. Group II consumed on the average more vitamin G than did Group 1:52.1 mgs. as compared to 45.0 mgs. for Group I. This difference does not, however, approach statistical reliability. The mean daily intake of vitamin G for the best adjusted of Group I was 61.7 mgs. as compared to 36.3 mgs. for the poorest adjusted. was reverseo, In Group II this occurrence with the poorest adjusteo having a mean daily intake of 66.0 mgs., as compared with 41.5 for the best adjusted. In both groups the variability in the intake of vitamin G was wide. Thiamine--The recommended daily intake of thia­ mine was 1 mg. A deficit in the intake of this vitamin (22 ) is said to result in loss of interest, irritability, and insomnia. This vitamin is related in the diet to the caloric intake. holds for the present sample. depression, This relationship The intake of thiamine, while approaching adequacy for both groups, was higher in Group I, which had a mean daily intake of compared to .65 mg. for Group II. .?£ nig., as These differences are *7? consistent with the trends in caloric intake# In Group I the best adjusted individuals had a mean intake of .91 mg., as compared to poorest adjusted. .83 mgs. for the In Group II the difference between the best and poorest adjusted in terms of thiamine intake was greater than in Group I. II had a mean intake of The best adjusted in Group .81 mg., end the had a daily mean intake of .55 mg. oorest adjusted Although the differ­ ences were not statistically reliable, the better adjusted fared better in both g r o u p s . Riboflavin— The daily allowance of this vitamin recommended was 1.5 mgs. In experiments with animals (22) riboflavin deficiency in the diet has been related to early senility. The amount of riboflavin in the diet is usually related to the amount of milk ingested, the caloric intake. rather than to In the present sample there was no difference between the two age groups in terms of the daily consumption of riboflavin. for Group I was The mean daily intake .96 mg., and for Group II .99 mg. .both groups were low as compared with the standard. In terms of emotional adjustment, the best adjusted persons in the two age groups of the sample exceeded the poorest adjusted in the intake of riboflavin. The best adjusted of Group I had a daily intake of 1.30 mgs., as against being .68 mg. for the poorest adjusted, the difference statistically reliable. In Group II the best adjusted haa a mean intake of' 1.15 mgs. of riboflavin, 78 as compared with a mean of .70 mg. for the poorest adjusted, this difference being in the same direction as for Group I, but not statistically significant. In the sample there appears to be a trend for a greater intake of ribo­ flavin to accompany emotional adjustment. Niacin— A daily intake of 10 mgs. of niacin was recommended. Both age groups were below this standard. The subjects of Group I consumed on the average slightly more niacin than w^s consumed by subjects of Group II. The difference was small, 6.4 mgs. against 7*3 mgs. In terms of emotional adjustment, niacin intake did not differentiate to any appreciable extent between the best and poorest adjusted subjects of Group I. small difference was in favor of the best adjusted. The In Group II the difference was larger, but in the same direction. The best adjusted had a mean daily intake of 6.1 mgs. of niacin, as compared to 5.2 mgs. for the poorest adjusted, the difference approaching statistical reliability. Iron--For women the recommended daily allowance of iron was 12 gms. Iron, which is the active constituent of hemoglobin content in the blood, occurred i*. both age groups in nearly the same amount. The mean daily intake of iron for Group I was 9.0 gms. and for Group II was 6.2 gms. 79 The difference in iron intake between the best and poorest adjusted of each age group was quite small and not significant. It must be concluded that in the present sample iron intake was not related to age dif­ ferences, nor to differences in emotional adjustment as measured by the Rorschach test. In conclusion it appears that the differences in diet between the two age groups, occur for the most part in calories and in the nutrients that are found in the diet in relation to the caloric intake, teins, phosphorus, and thiamine. such as pro­ The differences in the caloric intake between the two groups may be expected in view of the differences in physical activity. The smallest differences occurred in the intake of calcium and riboflavin, both of which are principally supplied by milk. concerning emotional adjustment and diet, the findings indicate that for the most part there were con­ sistent trends for the best adjusted individuals of both age groups to exceed the poorest adjusted in the intake of the several nutrients. In Group I the best adjusted exceeded the poorest aojusted in the intake of all nutrients, except proteins and iron. In Group II the best adjusted exceeded in all nutrients except v i t a ­ min A and v i t a m i n b. It is suggested that the difference BO in the intake of milk between the best and poorest adjusted in both groups, which is reflected in calcium and riboflavin in the diet, may be related to emotional adjustment as indicated by the Rorschach. The best adjusted in Group I, and to a lesser extent the best adjusted in Group II, had a greater intake of calcium and riboflavin. Caution must be exercised in the inter­ pretation of these f i n d i n g s , as the differences between the best and poorest adjusted in both groups were for the most part small, and the number of individuals classi­ fied as best and poorest adjusted was small. In general, the differences were consistently in the same direction, and would seem to suggest that there may be a relation­ ship between diet as discussed above ana emotional adjust­ ment as previously d e f i n e d . The Rorschach test was employed in the i-innesota experiment to ascertain if there were changes in per­ formance related to rehabilitation following diet. a starvation The test was administered at the end of the starva­ tion per:i od and again after 12 weeks of rehabilitation. The authors concluded, "In our experiment the Rorschach results were essentially negative. This may be inter­ preted as an indication of the absence of psychotic changes ana basic alterations in the personality structure” (1 5 ,p .679X The diet study reported by Ghlson was vastly 81 different from that of the Minnesota experiment, as in the latter study the subjects were placed on starvation diets. In the present study the diets of the women were sampled at intervals, and thereby the data are on the ordinary food intake of the women. The Relation of Age and Level of Adjustment to Health It has been previously mentioned that each woman in the present sample was given a medical examination. The results from the physical examinations were evaluated by the Department of Foods and nutrition, in such a man­ ner as to yield a numerical index of the physical condition of each subject. factors considered ana the methoa employed in the health evaluations will be found in Appendix A. In brief, the common disturbances were divided into major and miner ailments. x-ajor disturb­ ances consisted of poor reproductive record, broken bones, digestive disorders, circulatory disorders, hepatic dis­ orders, major operations, ana major nervous disorders. Minor disturbances included such disturbances as h e a d ­ aches, minor digestive disoraers, minor operations, of appetite, ana other minor disturbances. loss For each item in a major category three points were subtracted from the health score of the subject; ano for each item in a minor category, one point was subtracted. Therefore, the health 62 scores ranged from zero, the best rating, minus scores. downward to For the present sample a score of 0 to -7 was good; -8 to -15 was fair; and below -15 was poor. It can be seen from Table XXIV that the difference between Group I and Group II on the health evaluation was quite small, with a difference of less than one point. The average evaluation of Group I was -11.23, while that of Group II was -12.17. From the foregoing it can be seen that there was little difference between the two groups in terms of health status, with the small difference in health adequacy favoring the younger age group, Group I. It would appear that there was a tendency for the better emotionally adjusted individuals of the two groups to be evaluated as being of better physical health. According to Table XXV, the best adjusted subjects in Group I had a mean health evaluation of -10.A, while the poorest adjusted had a mean evaluation score of -13.6. In Group II the best adjusted subjects had a mean evaluation score of -1 1 .6 , while the poorest adjusted had a mean of -1 3 .6 . While these results were not statistically significant, the differences approached significance, ana trends were in favor of the best adjusted persons of both groups. Briefly, it would seem that in the later years there is some evidence to believe that physical health is a factor in adequacy of emotional adjustment. B3 TABLE XXIV HEALTH EVALUATION SCORES OF GROUP I AND GROUP II Group Range Mean SD I -4 to -1 ? -11.23 3.69 II -7 to -20 -12.17 2.96 "t" .92 TABLE XXV HEALTH EVALUATION SCORES OF BEST AI.D POOREST ADJUSTED SUBJECTS Range Mean SD Best Adjusted GROUP I -4 to -16 -10.4 4.03 Poorest Adjusted -9 to 16 3.07 -13.6 "t" 1.26 GROUP II Best Adjusted -10 to -15 -11.6 . 2.05 Poorest Adjusted -12 to -15 -13.6 1.04 1.74 34 The Relation of Age and Level of Emotional Adjustment to Blood Pressure The systolic blood pressure represents the maximal pressure to which the blood rises. The diastolic pressure represents the constant load which the vascular walls are carrying. Best and Taylor (6 ) stated that the systolic blood pressure was subject to wider variations under ordinary health than diastolic pressure. reason the diastolic pressure, For that according to these authors, reflects better the state of the peripheral vessels. These authors state the average systolic blood pressure at the age of 60 to be 1 3 5 , with a pressure in excess of 150 being abnormal. At age 60 the average diastolic blood pressure was reported to be 69. Table XXVI shows the systolic and diastolic blood pressure for the two age groups of the present sample. Group I had lower mean blood pressures than Group II. The mean systolic pressure of Group I was 154, as compared with 170 for Group II. The diastolic pressure for Group I was 95, as compared with 102 for Group II. Both groups tended to be high in respect to the stated standards. The differences in blood pressure tended to support the view of the above authors, who reported a steady, though not great rise in blooa pressure with age. £5 Table XVII gives the diastolic and systolic blood pressures Tor the best and poorest adjusted individuals of the two age groups. In Group I the best adjusted subjects had lower systolic and diastolic pressures than did the poorest adjusted. In Group II the poorest adjusted had a slightly lower mean systolic blood pressure. The systolic pressure for the poorest adjusted was 1 6 # as compared with 174 for the best adjusted. however, In Group II, the best adjusted were lower than the poorest adjusted in mean diastolic blood pressure 103 to 1 1 5 • In Group I there appeared a tendency for emotional adjustment to accompany blood pressure. In Group II this trend did not appear with systolic pressure, occur with diastolic blood pressure. but did On the whole the findings showed a tendency for the best adjusted subjects to have lower blooa pressures. 86 TABLE XXVI SYSTOLIC BLOOD PRESSURE (mm); AND DIASTOLIC BLOOD PRESSURE IN THE TWO GROUPS Group I N M ean 3D Group II N Mean 3D Mt" Systolic Blood Pressure 20 154 30.5 22 170 32.4 1.61 Diastolic Blood Pressure 20 95 16.6 22 102 20.1 1.20 TABLE XXVII SYSTOLIC BLOOD PRESSURE ( m m ) ; AND DIASTOLIC BLOOD PRESSURE (mm) IN THE BEST AND POOREST ADJUSTED SUBJECTS Best Adjusted Kean SD Poorest A d ­ justed Kean SD "t” GROUP I Systolic Blood Pressure Diastolic Blood Pressure 139 36.6 179 31«7 1.65 91 2 5 «7 104 12.7 .91 .31 GROUP II Systolic Blood Pressure 174 29.6 166 25.4 Diastolic Blood Pressure 103 14.0 115 19.2 1.01 CHAPTER IV THE QUESTION OF INFLUENCE OP RACE OR COLOR ON TH l FINDINGS The subjects employed in this investigation were Negro women. The question, therefore, arises as to whether or not the race or color of the subjects has been a factor in the findings reported. In order to determine the effect of race or color, it would be necessary to have a sample of white women, matched for age, intelligence, attainment, socio-economic status, educational anc living in the same type of community. Such a matched sample was not available. The several kinds of data afforded by this study will, therefore, be reviewed for such meager evidence on racial influ­ ence as may be found. In reference to the data obtained from the Activ­ ity Inventory, it was not fruitful to compare the per­ formance of the present homogeneous sample with the heterogeneous sample employed by Oavan and associates (7 ) to determine if there were differences related to color or race. Generally speaking, t h - y-iscns of the present sample came from low socio-economic and educa­ tional levels, neither of which was comparable with the conditions of the persons used as subjects in the other study. 60 The present study is also based on dietary data. The Food and Nutrition Board of the National Research Council (29) makes certain recommendations concerning the minimum daily intake of calories, proteins, vitamins, and minerals for adequate nutrition. Compared with these recommendations, the majority of women in the present study were considerably below standard in all respects. It might be that through its effect on income and economic status, race has indirectly affected the nutritional status of these women. It is known that low income groups tend to be low in respect to health status. It cannot be said from the data available for the women in this study how their health status compares with that of any other groups, or of women in g e n eral. There are Rorschach studies that have employed Negro and white subjects, who have been matched for certain variables. Three such studies have been found. Abel Piotrowski, and Stone (1) compared Rorschach responses of Negro and white morons. These investigators found that the negro girls gave more movement responses than did the white girls. They interpreted their find­ ings to indicate that the Negro girls were more flexible than white girls, and that white girls were more restricted in responsivity and showed more negativism than the 39 colored girls. Hunter (13), in an investigation designed to evaluate racial differences in response to the Rorschach test, employed 100 subjects each from white and Negro populations in hew York bity in the summer of 1934. A person having any Negro blood in his veins qualified for this sample as being a Negro. The author judged most Negro subjects to be from $0 to 75 per cent negroid, while some subjects claimed to be 100 per cent Negroid. Of the 100 members of the Negro population, 30 per cent were serving as bivil Works Administration employees, working as clerks, teachers, or recreation workers. Thirty per cent of the Negro population were temporarily unemployed professional persons, while the remaining 20 per cent were unemployed persons, answering posted requests for subjects in a YNibA ana the Urban League. Of the 100 white subjects, 94 were students at Teachers bollege, Columbia University, while the 6 were unemployed professional persons. The Otis intelligence test to all subjects. (20) was administered The range on this test for the White group was 6-72, with a mean of 4 2 .6 4 . was 16-75, with a mean of 39.53. The Negro range The Rorschachs were administered by the same examiner to all of the white group ana to all but 16 of the colored group. The 90 remaining 16 Rorschachs were administered to the colored group by a Negro. It was reported that these 16 Negro subjects gave the same expectancy of responses as did the subjects who were tested by the white examiner. The Negro subjects were tested in familiar surroundings, such as the YMCA and the Urban League. No subject was coerced• The major finding of Hunter centers around fewer color responses yielded by the white group, which she states, concerning T,Not only were more of the white group i ntroversive, but they showed a degree of introversity 16 per cent higher on the average than the average of the ^egro group.” ^p. 1 6 7 ) by the same finding the author interpreted the negro group to be more* extratensive, stating, "Moreover in extratensivity negroes exceeded the white group by 14 per cent.” The data presented by Hunter were only summarized anc not presented in detailed form. A stuay reported by otainbrook and Spiegel(25) presented Rorschach findings on Southern Negro and white high school and college students. The high school sample consisted of 40 white and 40 Negro subjects each from the tenth grade class of two high schools in the same city. In the college samples there were 45 Negro and 45 white subjects. The white subjects were from the sophomore 91 and junior classes at a large university in the South. The Regro subjects were sophomores from a junior college The mean score for the white high in the same city. school subjects on the Otis was 41, as contrasted to 27 for the colored. The white college students had an average IQ of 1 2 0 , while the hegroes had a mean IQ of 99. The Rorschachs were administered according to direct­ ions given by Harrower-Rrickson Klopfer (16) system. (12) and scored by the All negro tests were administered by a Negro. For the secondary students there were no signif­ icant differences in regard to F, W, Original responses, b ana A. There were significant aiff'ereuces in regard to R, D, S, Ft, and OF. "The occurrence of all these in­ dices except for Ft was differentially less for the colored group." The authors sum up their findings for the high school groups in this manner, " . . . colored high school pupils could be considered the as less fluid or less differentiated in association than the white. The authors feel the colored high school subjects may be more cautious and deliberate in reaction to color— areas." (p. 1 1 1 ). btill in reference to the secondary groups the authors state, "The Rorschach responses would indicate also that the colored secondary students were more emotionally stable and less impulsive than the white 92 high school students. There was also less Rorschach evidence of anxiety in the colored high school, as com­ pared with the white secondary group "(p .1 1 2 ). Stainbrook and Spiegel reported that at the college level the differentiating signs were less R, L , 0, M, sum C, and CF for the colored subjects. The findings concerning the college groups were interpreted as follows: nThe college colored group also showed more associative paucity or rigidity than the white college students. The university whites could be considered as displaying a more highly differentiated and, perhaps, more daring intellect than the college Negroes, and the general personality resources of the college colored group were indicated as being less adequate than the white college students. The Rorschach also pointed to a greater imma­ turity in the colored college students than in the college whites. Like the colored students in the high school comparison, the college hegroes could be described in Rorschach terms as evidencing less emotional stability than the white university st udents."(25, p. 114). In regard to -the interpretations made by Stainbrook and Spiegel certain observations occur. If it were to be assumed that the two Negro groups were cross sections from the same relative population, it seems from the interpretation by the authors, that there was a tendency 93 for Negroes to display less maturity and stability with age- A simpler explanation would seem to indicate that the differences in findings in regard to maturity and stability might have been due to sampling. The fact that a great number of the white college students in the sample came from the North might have been another important variable 9 and might in part have accounted for some of the differences in maturity and stability between the two groups. The vast cultural chasm separating Negro and white students in the region in which the study was conducted is a factor that cannot be overlooked. From the foregoing studies the effect of race or color alone on Rorschach test performance does not appear to be clearly demonstrated. It would seem that race or color would make a major difference in test findings only when the cultural background and present environment of the group tested differed markedly from the accepted norm. The effect of the acculturation process upon Rorschach test performance has been demonstrated to an ex­ tent by Hallowell (11) . Hallowell employed as subjects two groups of American Indians, representing populations of differing degrees of acculturation. The group who were more isolated from present day American culture tended to be more dominated by fantasy, suspiciousness, 9U and introversiveness. The author believed that these findings were the result of living in a culture that emphasized fantasy rather than reality. The group from the more acculturated population responded better and appeared to be more extrotensive. In still another study the findings for the Alorese (9) were much differ­ ent than have been reported from citizens of America. For the natives of Alor the relatively free expression of emotion, as revealed by color responses on the Rorschach, was normal in that culture, whereas in America such expression would be at variance with existing norms. It may well be that differences reported between Negro and white samples may in the differences. main be due to cultural There appear no consistent findings in the studies reviewed that may be interpreted to be due to race or color of the subjects. It woulo seem that the Negro women employed in the present stucy expressed their needs, fears, and level of adjustment in the same manner as woula a sample of any other group of women taken from the same locality, ana of the same age range and cultural and educational opportunities. CHAPTER V SUMMARY 1. Findings are reported Tor 45 Negro women between the ages of 50 and 83 residing in Lansing, Michigan. 2. The subjects had previously been used in a nutritional study under the direction of L r • Margaret A. Ohlson, Head of the Department of Foods and Nutrition, Michigan State bollege, who made available to the writer data obtained in her study. 3. The purpose of the present investigation was to make a personality study of the sample. The study was designed to provide answers in part to the following questions: (a) How do Rorschach findings in the present sample compare with findings reported for other samples of normal adult and aged subjects? (b) Are there differ­ ences related to age in the personality structure of the present sample as indicated by the Rorschach? (c) Is the health status of the sample related to age differ­ ences, and to level of emotional adjustment? (d) Is physical and social activity related to age differences, and to level of emotional adjustment? (e) Is dietary status related to age differences, and to level of emotional adjustment? (f) Is there relationship between 96 socio-economic factors and level of emotional adjust­ ment? 4. The Rorschach test and an activity inventory were administered to each subject. In addition, socio­ economic data, results from dietary studies, records of medical examinations, ana health evaluations for the subjects were made available by the Department of Foods and Nutrition, Michigan otate College. 5. The Rorschach findings in the present sample were comparea with those reportea by Beck ana colleagues on 157 employees of the Spiegel mail Order House in Chicago, and with those reported on 20 aged white males of the Oak Forest, Illinois, Infirmary, by bhesrow and associates. 6 . findings are reported on the various Rorschach scoring variables. The samples of older individuals were found to be significantly less responsive than the normal adult sample reported by Beck. The members of the present sample showed a tendency not to respond to small detail. The present sample showed significantly less Z-sccre activity than the normal adult group. There is evidence of a decline in M responses with age, however M responses were quite unevenly aistributea in the present sample. color responses, emotional maturity, as inaicacea by appeared further advanced in the aged 97 sample than in the sample of normal adults. There was no evidence that there was a return to childhood labil­ ity in the aged persons of the present study. Anxiety and insecurity, as portrayed by Y ana V responses, ap­ peared greatly reduced in old age. The Vista response was for practical purposes non-existent in the present sample. In the framework of Rorschach interpretation there was no drop in the accuracy of form perception with age. With the A response as its inaicator, typy did not increase with age. stereo­ With age there appeared a definite increase of concern in body functioning, and lessening concern for other persons in the environment. In the present sample the number of Anatomy responses was relatively high. The Popular response appeared to be little influenced by aging. 7. The sample was aividea into two groups, Group I, ages 50-59, and Group II, ages 60-83. This was done to determine if there were any differences in Rorschach performance related to the aging processes. It was found that those persons comprising Group I, had signif­ icantly more Anatomy responses than the older subjects in Group II. This was believed to be related to physiolog­ ical and psychological changes of menopause which were occurring or had just occurred in the women of Group 1. Along with the increase in An responses, was a decrease 96 in Whole-Human responses. Findings for Group II indicated that this tendency corrected itself with aging. 6. Three raters rated the Rorschach protocols of Group I and Group II separately. The raters were asked to select from each group the five records which the rater judged to be indicative of the best adjustment in the group and the five records indicating the poorest adjustment in the group. The percentage of agreement for rating the records in Group I was 63; while that for the Rorschachs in Group II was 60. 9. Findings obtained by an Activity Inventory developed by Cavan, Burgess, Havighurst, and Goldhamer, revealed that the subjects of Group I had a significantly higher mean score on the inventory. The subjects of the two groups who were rated as being better adjusted in terms of their Rorschachs, were also better adjusted in terms of the Activity Inventory. 10. The relationship of the following socio-economic factors on personality adjustment were investigated: Marital status, home ownership, number of children born to the woman, length of time the woman had lived in Lansing, yearly income, and educational attainment. Taken singularly none of these factors appeared to dif­ ferentiate between women of good and poor adjustment as indicated by the raters of the Rorschach. 99 11. From the medical examination, each subject was given a general health r a t i n g . It was found that the younger age group, Group I, had on the average a better health rating. The best adjusted subjects of each of the two groups received better health ratings than did the poorest adjusted persons in their respect­ ive groups. 12. There were founa age differences in respect to blood pressure, as the younger age group haa a mean systolic and diastolic blood pressure lower than that of the older age group. On the whole there was a tendency for the members of the sample rated as being of best adjustment, to have lower blood pressures than those subjects rated as being of poorest adjustment. 13. Dietary differences between the two age groups occurred for the most part in caloric intake, ana in the vitamins and minerals that are found in the diet in relation to calories. In respect to these nutrients the younger age subjects haa a higher intake. nutrients incluaed proteins, phosphorus, These and thiamine. For the most part the best adjusted individuals of each group exceeded the poorest adjusted in the intake of calories, vitamins, and minerals. BIBLIOGRAPHY 1 Abel, T. M. and Piotrowski, Z. Responses of Negro and White Morons to the Rorschach Test. Amer. J. M e n t . Def., 1944, 48, 253-257. 2 Beck, Samuel J. Rorschach’s Test I. basic Processes. New York, Grune and Stratton, 1944. 3 _____ . R o r s c h a c h ’s Test I. Basic Processes. fTew York, Grune and Stratton, 1949. 4 _______ , R o r s c h a c h ’s Test II. A variety of Personality Pictures. New York, Grune and Stratton, 1947* 5 Beck, Samuel J., Rabin, Albert I., Thiesen, Warren G., Herman, and Thetford, William N . The Normal Per­ sonality as Projected into the Rorschach Test. J. Psychol., 1950, 30, 241-298. 6 Best, Charles H. and Taylor, Norman B. The Physiological basis of Medical Practice. (3d Ed) Baltimore, williams and Wilkins, 1942. 7 Cavan, Ruth S., Burgess, tirnest W., Havighurst, Robert J., and Goldhamer, Herbert. Personal Adjustment in Old Age. Chicago, Science Research Associates, Inc., 1949. 8 Chesrow, ^ugene J., Wosika, Paul H., ana Reinitz, Arthur H. A Psychometric Evaluation of Agea White Males, Geriatrics, 1949, 4, 169-177. 9 Dubois, bora A. The People of A l o r . sity of Minnesota Press, 1944. 10 Ford, Mary. The Rorschach Test With Children. M i nne­ apolis, University of Minnesota Press, 1946. 11 Hallowell, A. I. Acculturation Processes and Personality Changes as Indicated by the Rorschach Technique. Rorschach Res. E x c h ., 1942, 6 , 42-50. 12 • 33 (2d Ed) Minneapolis, Univer­ Harrower-nrickson, M. R. Direction for Administration of the Rorschach Group-Test. J. Genet. Psychol., 1943, 6 2 , 105-117. Hunter, M. (Sicha) Responses of Comparable White and Negro 101 Adults to the Rorschach Test. 3, 175-1^2. J. Psychol., 1937, 14 Kaplan, 0. Mental Disorders in Later Life. University Press, 1945. Stanford 15 Keys, Ancel, Brozek, Josef, Henschel, Austin, Mickelsen, Olaf, and Taylor, Henry L. The biology of Human Starva­ tion. M i n n e apolis, University of Minnesota Press. 1950. 16 Klopfer, Bruno. The Rorschach Technique. World Book Co., 1942. 17 Klopfer, Walter G. Personality Patterns of Old Age. Rorschach Res. Bxch., 1946, 10, 145-166. I8 Lawton, G. New Goals for Ola Age. Morningside Heights Columbia University Press, 1943• 19 Ohlson, Margaret A. Dietary Practices of 100 women 40 to 75 Years of Age. J. Amer. Diet. Assoc., 1946, 24, 2 & 4 - 2 9 1 • 2C Otis, Arthur S. Otis Self-Administering Test, Manual of Directions and Key (Revised). New York, World Book Co . , 1928. 21 Prados,M. and Fried, b. G. Personality Structure of the Older Age Groups. J. C l i n . Psychol., 1947, 3, New York, 113 -120 . 22 Proudfit, Fairfax T. and Robinson, Corinne H. Nutrition and Diet Therapy. (9th bd). New York, Macmillan Co., 194C. 23 Rabin, Albert I. and Beck, Samuel J. Genetic Aspects of Some Rorschach Factors. Amer J. Orthopsychiatry, 1 9 5 0 , 2 0 , 595-599. 24 Rorschach, H. Psychodiagnostik. Bern, Huber, 1932. bnglish transl. by Lemkau, P., and Kronenberg, B. New York, Grune and Stratton, 1942. 25 Stainbrook, B. J. and Spiegel, P. S. A Comparative Rorschach Stuay of Southern Negro and White High School and College Students. J. Psychol., 1944, 17, 106-116. ;6 Stieglitz, b* °. Geriatric Medicine. Philadelphia, W. B. 102 Saunders C o ., 1943• 27 Stone, Calvin P. and Taylor, Donald W. Annual Review of Psychology. II, Stanford, C a l ., Annual Reviews, Inc., 1951 2c Wechsler, David. The Measurement of Adult Intelligence. (3rd Ed). Baltimore, Williams and Wilkins, 1944- 29 . . . ., Recommended Dietary Allowances. Washington, B.C. Food and Nutrition Board, National Research Council, 1948. APPENDIX A Iowa State college EVALUATION OF HEALTH N umb e r________________________ Age____________________________ Major disturbances 1. 2. 3. 4. 5. 6. 7. Poor reproductive record broken bones Digestive disorders circulatory disorders Hepatic disorders Major operations Major nervous disorders Minor disturbances 1. 2. 3. 4. 5. 6. 7. 8. 9. 10• 11. 12. 13• 14. 15. 16. 17. 18. excessively overweight or unaer weight Fair reproductive record Difficulty with menopause Broken bones Loss of appetite Tires easily Frequent headaches Difficulty with mastication Minor digestive disorders bore mouth Skin rash, running sores Minor circulatory disorders Pain in joints Diseases of short duration Nervous disorders Minor respiratory disorders Minor operations Thyroid (under control) Total Evaluation Any minor disturbance which becomes intensified to the point where, in the opinion of the interviewer, it may 104 bear the same relation to general health as does the so-called major disturbances should be rated as a major di sturbance. Ratin& Scale Under 50 years Over 50 years 0 to -5 - good -6 to -15 = fair over -11 = poor 0 to -7 s good -3 to -15 = fair over -15 = poor INSTRUCTION SHEET FOR EVALUATION OF HEALTH Subtract 3 for each item in the major category Subtract 1 for each item in the minor category 1. Reproductive Performance a. Good - Normal pregnancies - include premature babies of less than one month b. Fair - No pregnancies or 1 miscarriage plus normal pregnancies c. Poor - Abnormal pregnancies such as stillbirths, repeated miscarriages and infant death from causes possibly related to poor fetal nutrition 2 . Broken bones - Major disturbances if bones broken repeatedly or if healing is accompanied by c o m p l ications; minor if broken bones occur in childhood or early adulthood and healing without complication 3. Hepatic disturbance - Gall bladder, jaundice, etc. 4. circulatory Disturbance - Major, if high or low blood pressure, heart disease, shortness of breath, excessive nose bleeding, etc., minor, anemia controlled by medication, ana varicose veins. If blood pressure available from medical 105 examination -1 if over 150/60 -3 if over 170/90 5- Major operations include hysterectomy before m eno­ pause and resection of any portion of the gastro­ intestinal tract; minor operations include appendectomy tonsilectomy, thyroid, tetc. 6 . Digestive disturbances - Major if ulcers; minor if constipation or gas 7. hervous disorders - Major if multiple sclerosis or if food is refused over long periods of time, otherwise minor 6 . Pain in joints to include rheumatism, swelling of joints, backaches, etc. 9. Disease (item under minor disturbance) equal only -1 unless one or more of them are of unusual severity or of long duration, in that case, list ciseases as - 3 . Diseases include chicken pox, diphtheria polioyelitis, etc. 1 0 . minor respiratory disturbances include asthma, colds, pleurisy, and bronchitis. 1 1 . ..eight - if underweight 15/^ z -1 overweight up to 29/° = beyond 30 + /o = -3 -1 sinus