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The Bender-Gestalt test: ananalysis of certain clinical groups
Item Type text; Dissertation-Reproduction (electronic)
Authors Kim, Luke I. C., 1930-
Publisher The University of Arizona.
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KIM, Ik Chang. THE BENDER-QESTALT TEST: AN ANALYSIS OF CERTAIN CLINICAL j GROUPS. , |
i
University of Arizona, Ph. O., 1960 Psychology, clinical
University Microfilms, Inc., Ann Arbor, Michigan j
THE BEMDER-6ESTALT TEST: AM ANALYSIS OF
CERTAIN CLINICAL (ROOFS
by
Ik Chang Kia
A Dissertation Submitted to the Faculty of the
DEPARTMENT OF PHILOSOPHY AND PSYCHOLOGY
In Partial Fulfillment afc the Requirements -J fflr the Degree of
DOGTCE OF PHILOSOPHY
La the Graduate College
UNIVERSITY GF ARIZONA
I960
THE UNIVERSITY OF ARIZONA
GRADUATE COLLEGE
I hereby recommend that this dissertation prepared under my
direction by nnrnthy T. Mar quart., Fh.n.
entitled The Bonder-Qeattalt Test; An Analysis of
Certain Clinical Qroupa
be accepted as fulfilling the dissertation requirement of the
degree of Doctor of Philosophy
Dissertation Director/" Date
After inspection of the dissertation, the following members
of the Final Examination Committee concur in its approval and
recommend its acceptance:1*
QeyitU V, /9^o
'Afi. l 7 )1 s . 6, /It* —-r
*This approval and acceptance is contingent on the candidate's adequate performance and defense of this dissertation at the final oral examination. The Inclusion of this sheet bound into the library copy of the dissertation is evidence of satisfactory performance at the final examination.
V'
STATEMENT BY AUTHOR
This dissertation has been subnitted in partial fulfillment of requirements for an advanced degree at the University of Arizona and is deposited in The University Library to be made available to borrowers under rules of the library.
Brief quotations from this dissertation are allowable without special permission, provided that aeourate acknowledaaent of source is aade* Requests far permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in their judpnent the proposed use of the material is in the interests of scholarship* in all other instances, however, permission must be obtained Item the author*
This dissertation has been approved on the date shewn below:
SIGNED:
APPROVAL BY DISSERTATION DIRECTOR
\/Dorothy 1. iMuart Associate Professor of Psychology
0
ACKNONLEDGMENTS
The author wishes to express his gratitude to all members
of the faculty of the Department of Philosophy and Psychology. In
particular, he wishes to thank Neil R. Bartlett, Ph.D., Head of the
Department; Arnold Meadow, Ph.D.; Lewis Hertz, Ph.D. and William
J. MacKinnon, Ph.D who gave generously of their time and encour
agement.
The author is especially indebted to Dorothy I. Marquart,
Ph.D., who directed this dissertation, for her inspiration, under
standing, and patience.
TABLE OF CONTENTS
\
££!•
LIST CF TABLES ....... ..../•
I. INTHCDUCTIDN . « . . . ...... 1
A* ^Historical Review and a Stat went of the Present Status of the Bender-Qestalt Test •••••;. 3
B. Theoretical Considerations • ••••«•• 13
1. Perceptual Aspects «•••••••••••••••• 13
2. Motor Aspects ...••••o..... •••••• 17
11. STATEMENT CF PROBLEM .......... . . 20
III. METHODS. .......... . 21 ; t i i
A* Subjects • 21
B. Administration of the Test • 25
C. Scoring. • •••»...• • ••••••• 26
D. Attitude of the Subject 27
IT* RESULTS • •••... 28
A. Comparisons of Pascal and Snttell Scores of the Various Qroups Disregarding Age Variation 28
B. Effects of Age Variation Upon the Pascal and Suttell S o a r e s • • • • • • • • • • • • • • • • • • . . . 32
C. Comparisons of the Pascal and Suttell Raw Scores ^ far Qroups with Age* Sex, and Idtucstion Matched. .... 36
D. Effects of Education on Pascal and Suttell Soares .... 39
E. Comparisons of Frequencies of Deviations Within Soaring Categories For Qroups With Age, Sex, and Education Matched • ..••••••••• U8
F. Categary Analysls A*ong Vwiousa-oupeWithin the Age Rang® of 1$ and $0 Years • *6
iii
*S2»
1* Group A $6
2. Qroup B .•••••• 60
Q. Age Effects Upon Category Deviations Produced by the Noraal Subjects, .. ••••• 60
V. CONCLUSIONS AND DISCUSSION 66
VI. 3UMIUBI . . . c ... 75
APPENDIX A • • • • » . 78
APFSND2XB 82
t t W K H K H C K S « • • • • • • • • • • • • • • • • • • • • • • • • • • • 8 7
iY
LIST OF TABLES
Table 1 Age, Sex, and Educational Background of the Subjects Employed ............... 22
Table 2 Type* of Schisophrenic Subjects . , 2k
Table 3 Distribution of Pascal and Suttell Raw Scores For All Clinical Groups . . . 29
Table U The Pasoal and Suttell Raw Score Means and Standard Deriations for Each Gtoup »••••••• 30
Table 5 Significance of Differences Between Pascal and Suttell Raw Score Means of Each Group 31
Table 6 Relationship Between Age and Score Obtained By the Normal Subjects * 33
Table 7 Median Test and Kruskel-Wallis Test Measures of the Effect of the Age of the Normal Subjects Upon Pasoal-and Suttell Raw Scores •••••••••• 3U
Table 8 Test of Significance for Raw Scare Mean Differences Among Three Age Levels Between 15 and 50 Tears i n t h e . N o r m a l O r o u p , • • • • • • • • • • • • • • . . • 3 5
Table 9 Relationships Between Age and Score of Schisophrenic and Alcoholio Subjects 37
Table 10 Test of Significance of Differences Between Pascal and Sottell Raw Score Means of (froups Matched for Age, Sex, and Education ••••••••• 38
Table 11 Effects of Education on the Pascal and Suttell Raw Scores of Various Groups (15 and 50 Tears) • • • •' 1*0
Table 12 Analysis of Variance of Pascal and Suttell Raw Scores of the Three Educational Groups of Schisophrenics . . 1*1
Table 13 Analysis of Variance of Pascal and Suttell Raw Scores of the Three Educational Groups of Alcoholics « • • • U2
Table I4 Analysis of Variance of Pascal and Suttell Raw Scores of the Three Educational Groups of Control Subjects. • U3
•
Table 1$
Table 16
Table 17
Table 18
Table 19
Table 20
Table 21
Table 22
Table 23
Table 2lt
Table 2J>
Table 26
Table 27
Table 28
Contrasts Aaong the Mean Scores of the Three Educational Oroups of Schisophrenics
«
Contrasts Anong the Mean Scores of the Three Educational (froups of Alcoholics . .
Contrasts Among the Mean Scores of the Three Educational Groups of Control Subjects •
Pascal and Suttell Mean Raw Scores of the Schisophrenic, Alcoholic* and Control Subjects Within the Age Range of 1$ and 50 Years. . . .
Z Score Means of the Schisophrenic* Alcoholic, "and Control Subjects Within Range of l£ and $ 0 Y e a r s o f A g e • • • • • • • • • • • • • • •
Vilcozon Test for Differences in Category Scores of 31 Pairs of Schisophrenic and Control Subjects Matched for Age, Sex, and Education
Wilooxon Test for Differences in Category Scores of 33 Pairs of Alcoholic and Control Subjects Matched for Age, Sex, and Education <
Wilcoxon Test for Differences in Category Scores of 21 Pairs of Qironic BraiA Syndrome and Control Subjects Matched for Age, Sex, and Education . . • ,
Wilcoxon Test for Differences in Category Scores of 30 Pairs of Alcoholic and Schisophrenic Subjects Matched far Age, Sex, and Education • ••••••«
Chi Square Measures of Differences Between Schisophrenic and Control Subjects (Oroup A) f o r S c o r i n g C a t e g o r i e s • • • • • • • • • • • « • • <
Chi Square Measures of Differences Between Alcoholic and Control Subjects (Group A) for Scoring Categories • ... • •••• • • •• • .
Chi Square Measures of Differences Between Schisophrenic and Alcoholic Subjects (Group A) f o r S c o r i n g c a t e g o r i e s • • • • • • • • • • » •
Chi Square Measures of Differences Between Schisophrenic and Control Mashers of Group B for the Scoring Categories Which were Significantly Different,in.Group A •
Chi Square Measures of Differences Between Alcoholic and Control Msabers of Group B for the Scoring Categories which ware Significantly D i f f e r e n t i n G r o u p , A * * * * * * * * * * * * * * 62
•i
/ . v,
Table 29 Chi Square Measures of Differences Between Alcoholic and Schisophrenic Menbara of Oroup B Page for the Scaring Categories which were Significantly Different in Group 63
Table 30 Category Deviation Analysis Between the Narnal 15-50 Tear Old Subjects and the Normal 51-8U Tear Old Subjects • 65
Table 31 Differences Significant at the 5 per cent Level Between Deviation Categories for Various Or cups. . , 72
APPENDIX A
Table 1 Age, Sax, and Education of Schisophrenic and Control Matched Oroups ••»••••••••.••• 78
Table 2 Age, Sex, and Education of Alcoholic and Control Matched Groups ..••••••••»«••• 19
Table 3 Age, Sex, and Education of Chronic Brain Syndrome and Control Matched Groups ••••••. •••••• 80
Table U Age, Sex, and Eduoation of Alcoholio and Schisophrenic Matched Groups ••«••••••••* 81
Til
I. INTRODUCTION
In the past two or three decades, there has been an increasing
interest shown in perception and in psycho-motor activities as a means
of gaining a more complete understanding of personality and behavior.
This increased emphasis on a broad aspect of perception is due to recog
nition of findings that perception is not a passive and literal copying
of stimuli, but has a project!** cor expressive nature reflecting the
observer*s inner state (22, 60), Gardner iiurphy said, "the perceived
world mirrors the organized need pattern within" (62, p. 351)* 2n order
to develop a technique through which one can explore the "organised need
pattern11, many investigators have studied intensively various potential
tools with different theoretical frameworks.
One approach has been to study perception in an ambiguous situa
tion where "in the, absence of any compelling organization in the; material
itself, the person has greater opportunity to structure it in his own
unique fashion" (22, p. 11*6). However, Witkin (22) suggested that under-
standing of perceptual processes in well-structured conditions is just as
important as in unstructured situations to form a comprehensive estimate
of the role of personal factors in perception. The present writer believes
that this is the more common process in daily life, and that this approach
can be more MflTy controlled and handled than the approach utilizing
anbiguous stimuli. With these different emphases, some investigators have
constructed highly asbiguous projective tests and others, mare structured
tests*
Seme of the tests, such as the Rorschach Inkblot Test, the
Thematic Apperception Test, the Blacky Pictures, the Rosenzweig Pic
ture-Frustration Study, and the Word Association Test, utilize verbal
responses. Others, such as the Draw-A-Person Test, Bender Visual llotor
Gestalt Test, House-Tree-Person Test, and the Gehl-Kutash Graphomotor
Projective Test, utilize the graphic-motor approach. A third approach
x includes painting, free play, and dramatic methods. These include
the World Test, Psychodraaa, the free play technique, et cetera.
It is claimed by supporters of the graphic-motor tests that
oneis graphic performance has greater individuality and is less subject
to voluntary control than are his verbal responsea^(12, 28). Thus they
consider that graphic reproduction presents a truer picture than the
verbal response.
Graphic-motor tests can be divided into two groups: 1) Tests
demanding performance of a structured task, and 2) tests demanding
performance of unstructured tasks. The first of these two types is
illustrated by Machover«s Draw-A-Person Test ($8), the Bender Visual
Motor Gestalt Test, the Mirror Drawing Test of Wechsler and Hartogs (87),
and the Kouse-Tree-Person Test (21*, 25). In these tests, the nature
of the task in which the subject is to engage is set by the examiner.
The second is illustrated by the Gehl-Kutash Test (55) in which no
model is given to the subject to be followed and the subject draws while
blind-folded. A second test belonging to this category is the Scrib
bling Game of Paula Elkisch (30)*
Anastasi and Foley, in their series of articles on "A survey of
the literature on artistic behavior in the abnormal" (U, 5, 6, 7» 8),
point out that drawings as an index of perceptual disorder drew much
attention and interest from earlier researchers* especially Gestalt
psychologists. After gathering data available in the existing liter
ature on drawing, they concluded that "among the characteristics found
to differentiate more clearly among different psychoses may be mention
ed: the subject's attitude toward the drawing, before, during and after
its production; the degree of pressure exerted on the paper; evidence
of tremor and motor incoordination; alteration in size of drawing;
stereotypy; relative poverty or richness of detail; and the use of -
color" (7, p. 232).
Among the drawing tests, the Bender Visual Uotor Gestalt Test
(to be referred to as the Bender-Gestalt Test from now on) has been
one of the very widely used clinical tools* Recently an increasing
amount of literature and interest in this test has been noted. However,
in the midst of inconclusive and conflicting results, the Bender-
Qestalt Test awaits further validation and improvement of scoring meth
ods before it can be used with confidence for clinical diagnoses. The
purpose of this paper is to explore more fully the Bender-Gestalt Test
and its clinical use.
A. A HistoricalReview and a Statement of the fresent Status of the Bender-Gestalt Test
The Bender-Gestalt Test consists of nine relatively simple
designs which the subject is asked to copy as they ere presented to
him one at a time on separate cards. The designs, which include geo
metrical configurations composed of dots, straight lines and curved
lines, were constructed to bring out certain Gestalt principles*
These designs were originally used by Wertheimer, and Bender selected
nine designs from approximately thirty patterns which Wertheimer used
in his 1923 classical paper on Qestalt principles (88),
It was Bender who first postulated the value of these drawings
as a measure of clinical disturbances. She published a monograph in
1938 (13) in which she discussed and summarised her findings from var
ious psychiatric patients' reproductions. Her subjects included chil
dren, schisophrenics, manic-depressive psychotics, mental defectives,
and sensory aphasics. She also described the genetic development of
visual-motor functions among children of American as well as of prim
itive African culture. Bender's Gestalt concepts include regression
to more primitive gestalten in psychotics; disturbances in the rela
tionship between figure and ground; the tendency to use "compact, en- >
closed and 'energy-saving' units"; and spatial disorientation.
After the first publication by Bender in 1938 on the Bender-
Gestalt Test as a clinical tool, clinical researchers were quick to
follow in attempting to improve standardization procedures and scoring
methods of the test, and to verify the usefulness of the test. Bender
provided in her monograph (13) many clinical materials illustrating
the Bender-Gestalt performances of different psychiatric groups, but
she did not attempt to provide a quantified sooring method.
Hutt, in 19U5 (£0, £l), proposed a standard method of admin
istration of the test performance! as a projective technique. Although
Hutt's study rendered a valuable contribution and prompted other re
searchers to do follow-up investigations, his study did not employ a
statistical method and relied on intuitive interpretation based on
v
clinical experience. Gobetz (36) criticized Hutt's method as utilising
the subjective rather than the objective approach and as lacking clear
objective definitions of his diagnostic "syndromes." X .. .
A comprehensive study of the Bender-Gestalt Test was conducted
in 19k& by fiillingslea (lit) in an attempt to establish an objective
scoring method* He compared the reproductions made by 100 psychoneurotic
male adults with those of $0 normal males. He concluded that 63 indices,
involving such things as the measurement of lengths of lines, angles,
areas, irregularities In shape, and rotation of a whole figure or part
of a figure, can be established to give "quantifying" coefficients to
2$ test factors. The split-half index-score intercarrelations can be
illustrated by the following values: total rotation,«61; closure, .50;
and size difference, .62. Comparing Billingalea's results with those
of Hutt, on*) finds that Hutt's Bender-Qestalt signs of psychoneurosis
are not supported; that there is little agreement between the two
studies as to diagnostically significant patterns. Billingslea also
concluded that, "though three factors show a degree of inter-figure
reliability, test factors with indices from several of the figures tend
to be unreliable and to lack validity" (lU, p. 19)*
Other objective scoring systems have been developed by Pascal
and Suttell (6$), by Peek and Quast (66), and by Gobetz (36). Pascal
and Suttell published, in 1951, a book designed to be a scoring manual
for the Bender-Qestalt Test (65). The merit of their system is that
each scorable deviation is clearly defined, not only in verbal description
but also in appropriate illustrations for each deviation so as to provide
such, facilitation to a scorer. Scoring is audi less tedious than by other
methods partially because of the existence of a convenient score sheet
and the manual, A table is provided for converting raw scores to Z
scares for high school and college groups* No converting table is pro
vided for those with only a grade school education. The principal
weakness in the sampling employed in this study is the assumption for
the purpose of establishing norms, that all in-patients are psychotics
and that all out-patients are neurotics.
A number of studies have been conducted to prove or disprove
the Pascal and Suttell system. Addington (1) found that Pascal and
Suttell's method significantly discriminated between non-clinical sub
jects and schizophrenic patients. Addington found test-retest reliabil
ity coefficients of .71 for schisophrenics and of .76 for the non-clin
ical group. Lonatein (57)# Curnutt (26), and B car land and Deabler (20)
have also supported the Pascal and Suttell system.
On the other hand, Tamkin, in a study of 27 psychotics and 27
patients suffering from neurotic conditions or personality disorders,
concluded that "the Bender-Gestalt, scored by the Pascal and Suttell
method, has dubious effectiveness as a differential diagnostic instru
ment for the functional mental disorders" (82, p. 356). Qobets also
concluded in his study that "the scoring method developed by Pascal
and Suttell fails to differentiate the 138 normal and neurotic subjects
of the matched criterion groups" (36, P* 27)*
Peek and Quast's relatively simple scoring method (66) was
presented in 1951# Their system is to tally instances of certain per
formance characteristics. Thus the recording may be, instead of a
point scoring system as seen in Pascal and Suttell's method, a simple
counting of the occurrences of the factors in question* or the notation
of the specific elements or figures in which the factor occurs. They
presented convenient ways of defining the relative size dimension such
as constriction or expansion, and paid attention to some features which
other investigators failed to consider* The disadvantages of their
method are the fact that reliability and validity of the method are not
given in theii- manual* that the scoring categories were selected on an
a priori basis* and that the definition of scorable categories is not
as clear as that presented by Pascal and Suttell.
A fifth scoring system was developed by Oobets (36) in 1953*
He tested 168 neurotics and 28$ control white male veterans for an ini
tial validation study, and 118 adults of both sexes for a cross-valida
tion study* He collected a total of 1,533 test records ($11 initial
tests, $11 ret est a, and $11 recall tests) which he examined for 82 gen
eral categories and 312 specific signs* From these signs 30 were select
ed as a scoring system which "discriminated consistently between normal
and neurotics." Qobetz's results did not support Hutt*s "neurotic
syndrome." The scoring method of Pascal and Suttell also failed to
differentiate between Qobets's 136 normal and neurotic subjects.
Oobets should be complimented for a thorough and elaborate In
vestigation and for using large samples. However, the total 312 scoring
signs which he originally used are much more difficult to utilise than
those of Pascal and Suttell* partially because they are numerous and
yet not presented systematically* It' has not been determined whether
Oobets «s "neurotic" signs are applicable to psychotics as well as
neurotios, since his extraction of the signs was based on neurotics.
Several psychologists* besides Hutt who was mentioned above* have
attempted to utilise the Bender-Gestalt Test as a projective technique.
Kitay in 19$2 ($1*) proposed a scoring method for projective usage. She
presented the V score which "measures intra-individual variability*" and
is related to "the degree of adherence to* or departure from font ele
ments* " and the D score which seems to measure "the relative control or
lack of control of affect" (£U* p. 17U). The following correlations of
the V score-with certain Rorschach response categories are reported in
her paper: sum C* 0.27$ (CF / C), 0.28; M plus sum C* 0.3U; end U plus
sum (GF / C)* 0.37* Sucsek and Klopfer (80) attempted to determine the
associative values and affective associations of the figures.
If these scoring methods are to be evaluated* consideration should
be made of the criteria of a satisfactory scoring method. Peek (67)
pointed out that a^scoring system should bet 1) clearly defined in ob
jective terms to make reliability possible* 2) must be simple enough to
meet the needs of the time-pressed clinicians* 3) must be optimal in the
level of function so that it will not exclude psychologically meaningful
data* nor combine variables which are not psychologically compatible*
thus losing the power of the test. The first of these criteria is not
met by the scoring systems devised by Binder and Butt. Both of these
systems are not objective. The second criterion i3 not met by Billings-
lea nor by Qobets. Their systems are so exhaustive that scoring time
makes the test impractical. For example* BiUlngslea (111) describes 100
records that took him 15 hours each to score. Peek and Quast »s system
as well as that of Pascal and Suttell may fall to meet the third cri
terion. The relatively simple and convenient method used in these
9
systems sacrifices some subtle and detailed yet meaningful data.
Many studies hare been conducted to determine the clinical ap
plication of the Bender-Gestalt Test. A few representative studies will
be discussed here. Zolik (90) reported that the mean Bender-Gestalt
performance of his 1*3 adolescent delinquents (mean score of 70.79 by
Pascal and Suttell method) is significantly different from that of his
1*3 nondeliquent adolescents (mean score U7.72). Tripp (63) also studied
some features which discriminate between delinquents and nondelinquents
in the Bender-Gestalt performance of a total of $0 white males ranging
between 2$ and 20 years of age. She reported 12 features discriminating
significantly between the two groups. For a cross-validation* two Judges
were asked to decide whether each of the 12 test features was. present
or absent on each of the 5>0 records. The result indicated that there
was agreement on six out of 12 features and that these six test features
can be used to discriminate between delinquents and nondelinquents.
Dimriddie (27) and Curnutt (26) did studies on alcoholics using
the Bender-Gestalt Test. Curnutt found, in his study of 25 alcoholics
25 nonalcoholics using the Pascal and Suttell system* that the exper
imental group had a 20 point higher mean score than the control group in
the Bender-Gestalt Test. He also proposed "alcoholic signs."
Slocombe (77) investigated certain correlates of anxiety found in
Bender-Gestalt performance. She used 1$6 graduate student subjects re
lating Bender-Gestalt drawings to scores obtained from the Taylor Scale
of Ibnifest Anxiety and the flnne Scale of Neuroticism. She*concluded:
Individual measures found significantly discriminating between normal and neurotic subjects by Pascal and Suttell,, Billingslea* and Gobets did not discriminate between high and lew anxiety subjects in this study Indicators of anxiety proposed by Hutt
showed slight but significant difference between criterion groups...... (the Bender-Qestalt Test) is dubious as a technique for assessing the level of anxiety In normal subjects (77).
Sonder (p8) reported on the prognostic relationship between scores
obtained from the Bender-Qestalt Test and acute and chronic states of
psychoses. Hanvik (U3) pointed out the limitation of the use of the
Bender-Qestalt Test as a diagnostic aid for differentiating patients with
functional back pain from those with organic diseases of the back*
Harrloan and Harriman (1*5) suggested that reproduction of the
Bender-Qestalt designs are useful as a measure of sohool readiness in
normal children between five and seven years of age. They presented four
major determinants which discriminated significantly between those stu
dents ready and not ready for school attendance* Baldwin (10) questioned
Harr loan's conclusion as the result of a study which he conducted*
Fabian (31) studied, with the aid of the Bender-Qestalt Test, the
tendencies of children with reading problems to rotate their reproductions
of figures. The results reveal that in the non-reader group of 21 chil-. »
dren 76 per cent of them rotated one or more of the horizontal figures to
the vertical position, that 60 per cent of the poor reader group showed
the same tendency to "verticalise", and that few normal subjects over eight
years of age did so*
Peek (67) studied in psychiatric patients directionality of lines
i in drawings of the Bender-Qestalt figures, particularly the direction of
the reproduction of the dotted line on card five. Hannah (U2) pointed
out that rotation of figures can be caused by factors other than clinical
impairment of mental functioning* He reported that fewer rotations were
made when the cards were given in a vertical rather than in the usual
11
harisontal orientation* This caused the card to approximate the shape
of the page of a book,
Sueselc (79)# in his study of reliability, generality, and some
personality correlates of the Bender-Gestalt responses, concluded that *
"the majority of perceptual-motor behavior that is general and differ
entiating in the Bender-Qestalt Test is aooeunted for by three dimensions.
These may be termed flexibility, expansIreness, and attention to detail.n
He said that the level of these dimensions can be estimated from Bender-
Qestalt reproductions.
Peixotto gave the Bender-Geotalt Test to 35 subjects in Hawaii
representing seven different nationalities and concluded that Nthe results
do suggest the probability that various ethnic groups will produce dif
ferent protocol*, so that in this sense, the technique is not cultura-
free" (68, p. 372). (Slueok (35) administered the test to psychiatrio
groups In Italy and could not discover differences in the performances
of psychotics and normals.
Factor analysis has recently been employed in the study of the
Bender-Oestalt Test. In 1?£2 Ouertin (38) factor-analysed the results
of the scoring of reproductions made by 100 white mental hospital patients.
The intercarrelation matrix was factored using the Multiple-group centroid
method. Five oblique factors were found and described as follows: 1)
propensity for curvilinear movement evidenced by such deviations as ex
cessive numbers of waves and non-closures j 2) poor reality eontact shown
by return to circular patterns and other regressive patterns} 3) careless
execution factor shown by lack of care, inaccuracy and poor motivationj
U) constriction indicated primarily by timidity, small reproductions, and
confinement to a small part of the paper; 5) poor spatial contiguity
shewn by a difficulty in juxaposing elements of the figures*
3Ji 195U Quertin (39, UO) factor-analysed the scores attained
by 32 sale schizophrenics. He found four types of schizophrenia: (A)
chronic undifferentiated schizophrenia marked by long response time,
erasures, minor inaccuracies, but not by bizarre reproductions; (B)
disorganized schizophrenia revealed by poor gestalten, disorganized
confusion, et cetera; (C) conforming and non-defensive schizophrenia
shown by some gross disorganization but to lesser degree than in the
disorganized schizophrenia, and an attempt to conform evidenced by re-
stroking; and (D) actively defensive schizophrenia shown by restitu-
tional symptoms, self-critical behavior, and few gross distortions*
(fa art in (I4I) also factor-analysed the response scorings of
"orgaiiics" and reported three types: (A) organica with curvilinear
distortion related to emotional instability, (B) organics with spatial
disability and loss of control, related to personality disorganization,
and (G) organics with constriction and feelings of inadequacy related
to ego compensation for recognized deficits.
In summary, this survey of the literature relating to the Bender-
Gestalt Test indicates: 1) the test is widely used clinically, by some
routinely; 2) there is considerable diversity of opinions and results
among researchers who established scaring methods and diagnostic cri
teria; 3) the Fascal and Suttell system is the most frequently utilized
of the scoring methods, and appears to be favored at the movent; U) the
test is commonly recommended as a screening test to be used as a supple
ment to other psychological tests; 5) despite weakness, however, the
13
testy in the hands of an experienced clinician, does provide some
significant information; and 6) further improvements of standardi
zation and scoring are needed.
B. Theoretical Considerations
1. Perceptual aspects
The Bender-Gestalt Test is based on the premise that the per
ception of the normal individual is marked by an integration of what
is being received through our sensory receptors to form a good gestalt
or coherent whole. Thus, to use Cameron's words,
If need, time and the opportunity are present, however, human beings show irresistible tendencies to supplement the fragmentary pattern, to terminate a series once begun, to group scattered objects and complete an unfinished state-
y ment, to make a pointless incident into a meaningful story. They embrace isolated perceptual elements within a coherent whole that is integrated by their need and by the thinking which satisfies the need (15, p« 292).
Bender, in her 1938 monograph, made this point clear by saying,
"there is a tendency not only to perceive gestalt en but to complete
gestalt en and to reorganize them in accordance with principles biolog
ically determined by the sensory motor pattern of action* This pattern
of action may be expected to vary in different maturation or growth
levels and in pathological states organically or functionally deter- &
mined" (13* p. $)•
There has been a large volume of literature published in recent
years relating perception to personality, and interest in this area seems
to be increasing* Determinants of perception may be classified, according
to Bruner ywd postman (69)* into two categories: the "autochthonous" or
functional on the one hand, and the "behavioral" or motivational on the
lU
other. The autochthonous perceptual level represents the innate and
relatively unchangeable endowment of perceptual activites. An example
of this is the law of perceptual organization of the Gestaltists. Kurt
Goldstein (37), for instance, described the figure-ground principle as
general organismic behavior. On the other hand, those who stress a
motivational factor as the perceptual determinant deal with neads* ten
sions, values, defenses, and emotional condition*. These have been
collectively called "the central directive state" by Allport (2).
The impressive list of motivation-centered studies of perception
includes such experiments as Murray's study of the influence of fear on
perception (63)> Bruner and Goodmans analysis of the perception of coin
size of the poor as contrasted with that of the well-to-do (21), Sherif's
autokinetic phenomenon related to need for conformity (7U, 75, 76) and
others (29, 86, 89).
In addition to the motivation-centered analysis, Frenkel-Brunswik
(15, 33, 3U) proposed a third variable, which she calls "the personality-
centered" factor. She related this factor to basic personality make-up
rather than to relatively temporary motivational situations* She studied,
for example, the relationship between tolerance versus intolerance of
ambiguity and perception.
The perceptual correlates of personality have been analysed con
siderably in order to establish clinical tools as well as to provide evi
dence for against certain theories. A few of these studies have in
volved size constancy (23, 71), area judgment (91), coin-size judgment (21),
the illusions and distance judgments using thereness-thatness equipment (1*6)
In an experiment dealing with size constancy, for example, Raush(71)
1$
hypothesized that the paranoid schizophrenic interprets reality in terms
of his own frame of reference but is very concerned with the outside world.
He, in order to maintain a constancy which 4is necessary for his security,
fails to recognize "ambiguities of environmental cues." He "attempts to
impose an overstability on a situation involving somewhat imperfect cues"
(71, p. 179)* Thus he would tend to show over-constancy. The non-par-
anoid schizophrenic, on the other hand, is withdrawn from reality and
thus is not concerned with the numerous characteristics of the world* He
should, therefore, show under-constancy. In the test results, paranoid
schizophrenics showed the greatest amount of constancy, non-paranoid schiz
ophrenics next, and the control group of normal subjects least. All three
groups showed over-constancy.
In an unpublished study by Marquart (59)» subjects who were above
the 60th percentile on the Schizophrenia Scale of the Minnesota Multiphasic
Personality Inventory were found to show higher constancy than those sub
jects scoring below the 60th percentile.
The reactions of man under the influence of alcohol readily show
the relationship between alcoholic content of the blood and perception.
According to Beach (15, 52), the cutaneous sensation is impaired and the
two point threshold increases 90 per cent by the influence of alcohol.
Alcohol markedly reduces the ability to recognize words presented tachis-
tosopically, and it increases sensitivity to light.
Many other examples could be cited. However, since the present
study constitutes an analysis of personality related to Bender—Gestalt
drawings, the following discussion will be confined to an analysis of
perceptual disturbances and drawing errors of the Bender-Gestalt figures
16
in various types of pathological conditions. In a study- by Orenatein
and Schilder (6U)» 19 subjects were given the Bender-Qestalt Test as
they awakened fro* insulin shock. Their reproductions showed distur
bances in gestalt functions revealed by such distortions as substitu
tions of curves for angles, and of circles or loops for dots; changes
of angles into straight lines; and a tendency to perseverate.
Pascal and Suttell included in their manual the results of a
study of the effects of electro-convulsive therapy on Bender-Qestalt
scores. They reported that: "Mounting confusion with continuous ECT
is shewn in increased B-G score. Improvement after ECT is shown in
lowered B-Q score" (65, p. 33)* In another article* Suttell and Paacal(65)
described regression in schizophrenia as measured by performance on
the Bender-Qestalt Test.
Rupp (72) mentions "gestalt disintegration" as one of the char
acteristics of the drawings of the feeble-minded. In completing a honey
comb pattern, for example, the retarded children often showed a loosening
of the individual cells in the design and an inability to see same line
simultaneously as part of two different wholes* Lswin (56), in a similar
type of study, described the copying by intellectually retarded subjects
of the Stanford-Binet diamond as a circle with four corners added to it.
Ketsner (53) conducted an intensive experiment on "perseveration of
Gestalt" and revealed a close relationship between the amount of persever
ation and poor school progress.
yiav and his group (16, 17) studied the relationship between
abnormal KEG and results obtained from psychological tests such as the
Spiral Aftereffect Test and the Bender-Qestalt Teat. They reported that
when the Bender-Gestalt Test reproductions were examined and separated
into "predicted normal" and "predicted abnormal" EEG groups on a basis
of a fire-point scale, and compared with the actual EEG findings of the
same individuals, a Hii coefficient of .36 was obtained (significant at
•01 level). Seventy per cent of the normal EEG records and 65 per cent
of the abnormal EEG records were correctly predicted from the Bender-
Gestalt drawings. The same experimenters also reported that a Fhi co
efficient of .1*2 was obtained between the results from the Bender-Gestalt
Test, and that 100 per cent of the "normal11 records and 86 per cent of the
abnormal EEG records were correctly predicted by the Spiral Aftereffect
Test.
2. Motor aspects
Much more study is needed relating psychomotor activities to
psychiatric disorders. Psychomotor disturbances were described as psych
iatric symptoms by early authorities. For example, Bleuler in his 1908
textbook on schizophrenia (18) discussed the importance of motor symptoms.
It is common to hear mentally ill individuals referred to as restless,
tremarous, fidgetting, ri^d, et cetera. These descriptions imply muscular
involvement. Ferencsi in 1919 wrote that "in mild cyclothymics one sees
conditions of inhibited and exaggerated phantasy running parallel with
variations in liveliness of movement"(32).
In 1935, Huston (1*9) conducted a series of studies of reflex time
in psychiatric patients* He found that the patellar reflex time of 66
male schizophrenics did not differ significantly from that of 53 normal
control subjects "when compared with ratio of height over reflex time, or
thigh length over reflex time." However, in a later study, Huston and
Shakow (48) found that, in three types of reaction time (simple audi
tory, simple visual, and discrimination visual), 38 male schizophrenics
reacted significantly more slowly and with significantly greater vari-~
ability than did the normal group.
others have studied the relationships between motor function
and sensory deprivation '(85), between psychomotor performance and EEG
variables (11, 44), and between age and perceptual-motor skills {47).
Recently van Bergeijk and David (84) performed an experiment
using the ''delayed handwriting" technique. Ill this technique the sub
ject writes words with a delay (e.g. 520 msec) inserted between the ·
act of writing and appearance of his script. This procedure shows the
effect of visual monitoring of a motor task which has its own kinesthe-
tic feedback. The experimenters concluded that both kinesthetic sen
sation and visual stimulation aid in the continued performance of the
task. They say:
We think that the experiments described here shed some light on the visual monitoring of a motor task which has its own kinesthetic feedback. The latter sensations, originating in the hand and arm muscles and tensions, give information about the progress of writing, while the eye also generates information about the same process. With delay inserted in the visual path, a conflict between the two sources of information arises. Depending on s•s intent he can resolve the difficulty in this or that way. The difficulty is really twofold. It is one of letter production (keeping the letter smooth and _ in their proper shape and one of preserving the letter-order of the word. From the results it appears that the first difficulty is not under s•s rigid voluntar.y control --the distortion of the writing increases with delay, irrespective of instructions. However, the second difficulty is amenable to voluntary control •••••• (84, p. 357).
18
It is readily seen that some clinical groups, especially alcoholics
and senile psychotics, have more motor dysfunctions including poor coordina-
tion and hand tremor than other clinical groups* Few studies relating
motor dysfunction to different psychiatric disorders have been published.
In discussion of the Digit Symbol subtest of the Wechsler-Bellevue Intel
ligence Scale, Bapaport writes "that motor action is of primary signifi
cance in the Digit Symbol subtest is commonplace knowledge to anyone who
ever tested a case in which brain injury has impaired motor action* Such
a subject may well see, and may well verbalize* the symbol he wants to
write* and nevertheless the hand may not obey " (70, p. 2$2) ,
' This type of observation applies also to many senile patients*
Rapaport further points out that "acute tension, anxiety, and hyperactivity
are sctie of the factors whose impact on motor action prevents whatever
visual organization would bring about* On the other hand, schizophrenic
chronicity and deterioration may result in visual disorganization pre
venting the breakdown of visual patterns into parts" (70, p* 253 )• Im
pairment of motor efficiency is also closely related to the severity
of depressive trends*
II. STATEMENT OF PROBLEM
Billingslea pointed oat that the Bender-Qestalt Test is a
test of visual-motor perceptual behavior which "is considered to in
volve (a) sensory reception, (b) central neural interpretation, and
(c) motor reproduction (hand writing) by perceiving subject of the
test stimulus object" (lU, p. 1)* "Abnormal" performance, then may
occur as a result of disturbance at any one of these levels. A dis
turbance at any level contributes to a total score, for example, to
the Pascal and Suttell score obtained. As in an intelligence test,
a mere total score does not give information about weak and strong
points and thus provides much less information than a knowledge of
sub-test performances.
It can be hypothesized that scoring in terms of particular
categories will result in more valuable diagnostic evidence than will
a total score. It may be possible to divide the performance material
on the basis of perceptual or motor impairment, since it is possible
that impairment of motor and perceptual functions may be different in
different psychiatric groups.
An attempt will be made in this study to determine character
istic categories far each clinical group, to improve the diagnostic
power of the test, and to test Influences of variables such as age and
education on Bender-Qestalt performance.
20
III. METHODS
A. Subjects
V A total of 265 subjects was used In this study. 3- Eighty of
these subjects had been diagnosed as schisophrenics* 76 were chronic
alcoholics* 32 belonged to the chronic brain syndrome associated with
cerebral arteriosclerosis} and 77 were "normal" subjects.
The age, sex* and educational background of the subjects are
shown in Table 1. The clinical groups were selected from the patients
who were* at the time of testing, hospitalized in the Neuro-Psychiatric
Ward of the Pima County General Hospital* Tucson* Arizona.- The psy
chiatric diagnosis2 was based on agreement in diagnoses made by two
psychiatrists and one psychiatric resident. The patients whose di
agnoses were uncertain or not unanimous in the mind of the staff were
not included in this study.
All of the schizophrenic subjects used in this study were
committed to the Arizona State Hospital upon Superior Court order
after psychiatric examinations and a court sanity hearing had been
conducted for each subject. Those schizophrenics who had significant
medical complications or had a history of heavy drinking were not
1. Twenty-two additional subjects were tested with unsatisfactory results* The results obtained tram these subjects hare not been Included in the data*
2. The nosological nomenclature and the diagnostic criterion were based on the Diagnostic and Statistical Manual: Mental Disorders (3) prepared and puDJLosned oyTEe American wycniatric Association.
21
22
TABLE 1
Age, Sex, and Educational Background of the Subjects Employed
Age
13
15-30
31-Uo
la-5o
51-60
61-70
71-r80
80-
Schlzophrenla
H - 80 -i
1
25
25
15
12
2
Alcoholic*
N - 76
3
18
39
11
5
Chronic Brain Control mtms
n a 77
19
11
20
2 8
10 9
13 7
7 3
Mean Age 36*1(0 Standard DeTiationl2.79
Male Feaale
One year or more of college fee year or more of high school Mean length of education
llO 1+0
10
Ui
9.51
U5.26 9.03
51 15
ll
32
9.b2
76.69 8.69
27 5
1
9
6.67
146.30 19.01
S 10
hp
9.81
included. Disposition conference reports obtained from the Arizona
State Hospital with respect to the majority of the subjects confirmed
the previous psychiatric diagnoses closelY. Sub-classifications of
the schizophrenic subjects used are listed in Table 2. This sub-clas
sification is provided as an analYsis of the nature of the subjects
used.
Ninety per cent of the Chronic Brain Syndrome subjects asso
ciated with cerebral arteriosclerosis were committed to the Arizona
State Hospital for custodial and geriatric care.
For the chronic alcoholism group, special care was taken not
to include those who ware temporarilY intoxicated with alcohol and
otherwise not "alcoholic." About 75 per cent of the alcoholic sub
jects used in this study had a history of heavy drinking for more
than 10 years. Sixty-one per cent of them had joined Alcoholic
Anonymous activities at some time during their lives. Thirty per
cent of them had experienced delirium tremens in the past. About
4o per cent of them had a history of repeated admissions to the hos
pital for alcoholism. If a patient was admitted to the hospital in
an acutely intoxicated state, the Bender-Gestalt Test was not admin
istered until he or she became "sober" and clear mentally; usually
several days after admission.
The control group consisted of 21 hospital employees {orderlies,
nurses' aids, ward clerks, et cetera), 20 practical nursing students,
28 in-patients or out-patients coming to the hospital for minor surgical
care, and eight elderly people who reside in a rest home in Tucson.
This group was selected to approximate the educational level and ages
23
TABLE 2
Types of Sohiaophrenle Subjects
Type of Schisophrenic Nuaber SMJ'W
Simple type 3
Hebephrenic type 2
Paranoid type 27
Acute undifferentiated type 17
Chronic undifferentiated type 13
Schiio-affectiire type 17
Childhood type 1
Nr 60
of the clinical groups*
B. Administration of the Test
The Bender-Gestalt Test was given individually and privately
by the experimenter. The Pascal and Suttell standard method of ad
ministration was adopted. The subject was seated at a table, and
given a blank sheet of white paper (8j x 11),and a sharp pointed pen
cil with an eraser. The table top was smooth and hard-surfaced. The
experimenter was seated at the opposite side of the table facing the
subject. Upon completion of one design, the subject was given the
next design until all the nine designs had been copied. The cards
were handed to the subject in the standardized manner.
~ Pascal and Suttell's method differs from others in that the
subject is instructed not to sketch the design, but to use a single
solid line in drawing* This Is to avoid the common practice of
sketching which many artistically trained people are likely to do
when they draw designs. Sketching is a scorable deviation in the
Pascal and Suttell system. Instructions given to each subject before
drawing were as follows t
1 have nine simple designs, one on each card, which I would like to have you copy on this paper. Use free hand drawing and do not sketch* I will give you the cards one at a time. There is no time limit*
Many subjects asked what was meant by "sketching." Ihen
this occurred, they were told that they were to use single, solid
lines instead of many little lines for outlining the figures. Non-
eommital answers were given to such questions as whether the number
of the dots should be reproduced exactly, whether erasing is allowed,
how the drawings should be spaced, et cetera. Additional paper was
provided when it ·was requested by the subject. Special notation was
made of significant remarks or behavior of the subject during the
drawing period.
c. Scoring
Selection of an appropriate scoring method was a difficult
task. As reported in the introduction, there are several scoring
systems and each system has merits as well ·as draw-backs. After a
careful evaluation of the scoring methods presently existing, it
was decided that the Pascal and Suttell method should be used.
Their method is not recommended by all investigators who have
studied it. However, the literature contains a sizable number of
studies utilizing the Pascal and Suttell scoring method. It is
easier to compare the results of an experiment with those from
other experiments if the same standardized administration and
scoring methods have been used. Also the Pascal and Suttell
method has well defined scoring categories and is practical for
use.
Scoring was done using code numbers and without a know
ledge of the diagnostic category to which the subject belonged.
The cases were accumulated and scoring was not done until after all
of the protocols had been collected.
26
D* Attitude of the Sub^ot
Satisfactory motivation tcwrard drawing oa the part of the
subject is regarded as important to make the test data meaningful*
Obviously, the reproductions of negativistic psychotics or those
who are not motivated to draw pan not be valid measures of motor-
perceptual behavior. They can be used only as a measure of atti
tude. The reproductions of subjects who could not be adequately
motivated or whose records could not be scored were eliminated
from the study. Among the originally selected subjects, twelve
schizophrenic subjects were withdrawn to the degree that they were
not readily motivated to make any drawings* Ten senile patients
produced nothing but scribbling which could not be scored. How
ever, most of the subjects used in the study seemed to be motivated
to cooperate in drawing. Some patients seemed to fear that the
test results might be used unfavorably in determining their disposi-,r
tion.
IV. RESULTS
A. Comparisons of Pascal and SuttelX Scares
of the Various Groups Disregarding Age Variation
Table 3 shows the distribution of the Pascal and Suttell
total raw scores for the members of each of the four groups em
ployed in the study.3 The Pascal and Suttell raw score mean and
standard deviation for each group is shown in Table U. Table $ : /
shows the differences between means, the Fisher t's of the differ-""k
ences, and the probability that each difference is attributable
to factors beyond chance. The table indicates that there are dif
ferences significant to the .£ per cent level between the schiso
phrenic and control subjects, between schizophrenic and chronic
brain syndrome groups, between the alcoholic and chronic brain syn
drome groups, and between the chronic brain syndrome and the con
trol groups. The difference between the alcoholic and the control
subjects is significant at the 1 per cent level. However» the
is cores obtained by the alcoholios and by the schizophrenics are
not significantly different from one another.
3* The Pascal and Suttell raw_score is the sum of the weighted deviation scores.
28
TABLE 3
Distribution of Pascal and Suttall Ranr Scores
For All Clinical Oroups
Score Schisophrenic Alcoholic Chronic Brain Control _ SySSHSS
N - 80 N * 76 N-32 N v 77
I-5 U 8
6-10 3 1 7
II-15 U 3 12
16-20 5 5 8
21-25 5 U 1 8
26-30 8 6 10
31-35 3 10 6
36-1*0 5 J 1 1
U1-U5 6 2 " 1 3
1*6-50 U 8 2
51-55 8 U 2
56-60 7 10 2
61-65 l 2 11
66-70 U 2 2
71-75 1 1 2
76-80 3 U 1
81-85 2 3 3
86-90 ̂ ̂ ̂
' 91-# 1 2 1
96-100 i 1 3
101-105 i 2
106-110 2
III-120 3 2 **
121-130
130-
3
3
TABLE U
The Pascal and Suttall Raw Score Heans
and Standard Deviations for Each Group
Nuaber Raw Score Mean Standard usnatioh
Schisophrenics 80 • 27*37
Alcoholics 76 U6.18 22.68
Chronic Brain Syndrome 32 92*91 29*68
Control Group 77 27*87 21.$0
4
I TABLE 5
Signifieanee of Differences Between
Pascal and Suttell Raw Score Means of Each Oroup
Alcoholics Chronic Brain Control smdrose ———
N - 76 MU 32 N = 77
Schizophrenics t * .0060 t s 7.^600 t r 5•2700 N * 80 P - .5000 P • *000$ P = .0050
Alcoholics t t s 8.9700 t = 5*1000 N » 76 Pa .0005 P - .0100
Chronic Brain Syndrome t = 13.0100 N s 32 P = .0005
\ *
B. Effects of Age Variation
Upon the Pascal and Suttell Scores
The Pascal and Suttell mean raw scares for six different
age lerels of the normal group are shown in Table 6. The results
show that there is a tendency for the mean raw score to increase
with increased age. The index of order association between each
control subject>s age and raw score is .77. When the older subjects
are not considered and the index of order association is computed
for subjects between 15 and 50 years of age, the value is ,22 ,
To investigate further the relationship between raw scares
and age, the median test was employed to relate position above or
below the median score for all subjects included in the analysis to
the age group to which the subject belongs. This test was first
utilized using normal subjects through 50 years of age; then through
60 years of age, through 70 years of age, and through 8U years of
age. The results are shown in Table 7. According to the table,
differences in age between 15 and $0 years do not significant ly
affect the Pascal and Suttell raw scores. However, age becomes a
significant factor If the subject is older than 50 years* Table 7
also shows the results of an anlysis of the effect of age using the i
Kruskal-Wallia Test. It indicates that there is no significant dif
ference in raw scares between the ages of 15 and 50, but that one
appears if the age range is extended from 15 through 60 years*
Table 8 shows Fisher t's of the differences between means
of pairs of the three age groups t 15-30, 31-Uo* and 1*1-50. Hone
v
33
TABLE 6
Relationship Between Age and Score
Obtained By the Noraal Subjects
Age Number Mean Raw Score Standard Deviation
15-30 19 15.53 29.67
31-1*0 11 111. 18 11.85
Ul-50 20 22.05 13.53
51-60 8 37.87 13.09
61-70 9 36.22 20.90
71-8U 30 62.25 20.97
TABLE 7
Median Test and Kruskal-Wallis Test Measures
of the Effect of the Age of the Normal Subjects
Upon Pascal and Suttell Raw Scores
Age Groups Compared Median Test Kruakal-Waxlia
15-30, 31-UO, 1*1-50 x2 . U.0200 h s U.1970 P - .1350 P - .1225
15-30, 31-Uo, Ul-50, x2 -15.5500 h =16.9700 5i-6o P »• .ooiii p 9 .0007
15-30, 31-Uo, Ul-50, x2 =17.7800 51-60, 61-70 P - .001U
15-30, 31-U0, Ul-50, X2 =25.1000 5l-6o, 61-70, 71-8U p = .0001
"A
TABLE 8
Test of Significance for Raw Score Mean Differences
Among Three Age Levels Between 15 and 50 Years
in the Normal Group
30 - Uo years Ul - 50 years Mean Score r ill. 18 Mean ijccre = 22.05
S. D. r 11.85 S. D. = 13.53 N - 11 N m 20
15-30 years t • .1390 t = .8970 Mean Score - 1^.53 *P » .1750 *P s .3750 S. D. . 29.67
N = 19
31 - hO years t s 1.5600 Mean score * iU.16 *P • .129 S. D. a 11.85 — -
N = 11
*P is obtained from the two-bailed table.
of the differences are significant at the 5 par cent level. Table
9 shows that age does not significantly influence Pascal and Suttell
scares within the range of 1£> and $0 years for schisophrenics and \ * •
alcoholics. The median test and the Kruskal-Wallis Test using three
age levels (15-30, 31-UO, 1*1-50) do not show differences significant
at the 5 per cent level.
G. Comparisons of the Pascal and Suttell Raw Scores
For Groups with Age, Sex, and Education Matched
Comparisons of the scares attained by the groups used in the
experiment were first made by* the formation of equivalent groups and
working only with the matched subjects. The subjects were matched,
using the paired method, for age, sex, and education. The matching
for age was rigid and complete, that for sex. and education was not
perfect. This method reduces the number of subjects available for
each group. There were 31 pairs of schizophrenic and control sub
jects, 33 pairs of alcoholic and control subjects, 22 pairs of chron
ic brain syndrome and control subjects, and 30 pairs of alcoholics
i»nri schizophrenicsTables showing the mean and variability of the
sex, age, and education of the matched groups are to be found in
Appendix A*
Table 10 shows the mean scores, the standard deviations, the
U. Hatched comparisons between the chronic brain syndrome and the alcoholics, and between the chronic brain syndrome and the schisophrenic subjects were not done due to marked age discrepancy and consequent inability to match for age*
TABLE 9
Relationships Between Age and Score
of Schizophrenic and Alcoholic Subjects
(15 to 50 years)*
Median Test Kruskal-Walllg Test
Schizophrenics = 1.7U60 h = 2.9160 P - .1*200 P s .2300
Alcoholics 3 2.2900 h - 5.U000 Pa .3200 P - .0672
i
*Three age levels: 15-30> 31-UO, Ul-50 are compared.
38
TABLE 10
Test of Significance of Differences
— Between Fiscal and Suttell Raw Score Ueans of Groups
Matched for Age, Sex, and Education
Groups Number Hean Raw Standard t for the difference Probabil-Score Donation "between correlated lty xerox
Beans
Schisophrenics 31 U9.26 28.21 5*8300 P - .0050
Control 31 17.29 10.3U
Alcoholics 33 1+6.61 22.68 U.5U00 P - ,0500
Control 33 23.6U 17.55
Chronic Brain 22 92.00 27.75 5.5000 P » .0050 Syndrome
Control 22 U7.57 2lu52
Alcoholics 30 U2.60 20.53 .9100 P s .3700
Schizophrenics 30 U9.00 31.8U _ •
Fisher t*a, and the probabilities that there are differences between
each clinical group and its control group.
According to the table, the Pascal and Suttell raw scores be
tween the schizophrenic and; control subjects, and between the chronic
brain syndrome and the control subjects are different significantly to
the .£ per cent level. The difference of means between the alcoholic
and the control subjects is significant at the five per cent level*
However, the mean raw score of the alcoholics does not differ sig
nificantly from that of the schisophrenics.
D. Effects of Education on Pascal and Suttell Scores
Pascal and Suttell (65) report a difference in raw scores
obtained using their scoring method between high school and college
educated groups. Da order to analyse the effect of education in
the present study, the schizophrenic, alcoholic and control groups
within the 15 and 50 years of age range were divided into three ed
ucational levels t college, high school, and grade school. The mean
raw score and standard deviation of each educational group of the
three clinical groups are shown in Table 11. The table shows that
with mora education lower raw scores are obtained.
Analysis of variance of the mean scores of the three educa
tional subgroups for the schisophrenics, the alcoholics, and the con
trol group are shown in Tables 12, 13, and lii respectively. The
tables indicate that in the schisophrenics and the control subjects,
the raw score means of the three educational subgroups are different
enough to make the variance of the combined subgroups much larger i
than the variances of the separate subgroups. Both F ratio and q
ijo
TABUS 11
Effects of Education on the Pascal and Suttell
Raw Scores of Various Groups
(15 and 50 years)
College High School Grade School
Schisophrenics Mean Score = 19*70 Mean Score = 1*2.28 Mean Score r 63.31 Standard Deviation: Standard Deviation: Standard Deviation:
15.60 25.12 31.25 N a 10 N s 37 N r 19
TV
Alcoholics Mean Score • 33.63 Mean Score s 1*2.58 Mean Score • U5.70 Standard Deviations Standard Deviation: Standard Deviation:
19.83 21.19 __ i lit. 16 N x 8 N s 26 N - 20
Control Subjec&sMean Score • 12.33 Standard Deviation:
10.02 H - 9
Mean Score =• 16.09 Standard Deviation:
9.67 N * 33
Mean Score s 26.55 Standard Deviation:
20.19 N * 8
Ul
TABLE 12
Analysis of Variance of Pascal and Suttell Raw Scores
of the Three Educational Groups of Schisophrenics
Source Sum of Squares DF Mean Square F q Test
Between 13029.1 2 651U.5 F r 9.2500 q s 7.7100
Within Uk3h6*9 63 703.9 P = .0100 P «... .0100
Total 57376.0 65
TABIX 13
Analysis of Variance of Pascal and Suttell Raw Scares
of the Three Educational Groups of Alcoholics
Source Sua of Squares DF Mean Square F q Test
Between 83U.5U 2 1*17.27 F r 1.1300 q = 2.6600 P s .2800 P - .0500
Within 18836.50 5l 369.3U
Total 19671.0U ~~~ 53
1*3
TABLE IU
Analysis of Variance of Pascal and Sattell Raw Scores
of the Three Educational a*craps of Control Subjects
Source Sua of Squares DF
Between 1530.18
Within 5739.60
Total 7269*78
2
U7
U9
Mean Square
765.09
122.12
q Test
F - 6.2600 q s U.8900 P = .ooUo P « .0500
statistic in the analysis of variance of the schizophrenic subjects
are significant at the 1 per cent level* and those of the control
group are significant at the 5 per cent level. However, they are
not significant at the 5 per cent level in the alcoholio group.
Table 15 shews the contrasts among the raw score means of
the three educational subgroups of schisophrenics* Comparisons of
the mean scores, utilizing the q statistic, between the college and
high school groups, and between the high school and the grade school
groups are not significant at the 5 per cent level* The difference
between the college and the grade school groups is significant at
the $ per cent level. It was also found that the differences of the
mean scores between the grade school subjects and the average of the
college and high school groups, and between the college group and the
average of the high school and grade school groups are significant at
the $ per cent level.
Table 16 shows the individual cooparisons among the mean
scores of the three educational groups of alcoholic subjects. None
of the comparisons fox* each mean difference is significant at the
$ per cent level. r
Table 17 shows the same types of contrast analysis far the
control subjects. According to the table, there is no significant
difference between the raw score mean of the college group and that
of the high school group. Significant differences in mean score
exist, however, .between the college and grade school subjects, be
tween the high school and grade school subjects« and between the
grade school and an average of the college and high school groups.
h$
TABLE 1$
Contrast* Among the Mean Scares
of the Three Educational Groups of Schisophrenics
College Higfr School Grade School Confidence Limits Population Contrast
Ix-19.70 Xt * U2.28 I3* 63.31 Z*±X £
1 - 1 0 - 2 2 . $ 8 £ 2 6 . 2 1 u x - u 2
1 0 -1 -U3.61 £ 26.21* ux - u3
0 1 -1 -21.03 £ 26.21 u2 - U3
1 £ -1 -32.32 £ 26.21* ui / a2 _ u3
i -1 | .78 ̂ 26.21 ui/u3 2 — 2
-1 i £ 33.09 / 26.21* u2 / u3 „ —- u3
•NThese contrasts by the q statistic are significant at the $ per cent level*
46
TABLE 16
Contrasts Among the Mean Scores
of the Three Educational Groups of Alcoholics
College High School Grade School Confidence Limits Population Contrast
1 -1
1 0
0 1
.l. t 2
J.. -1 2
-1 t
0
-1
-1
-1
t
t
- 8.95 t 15.40
-12.07 t 15.40
- 3.12 t 15.40
- 7.60 t. 15.40
2.92 t 15.40
10.51 t 15.40
ul - u2
u1 - u3
u2- u3
U1 f. U2 - UJ
u1 f u3 ----- U2 2 u2 f u3
2 - u3
U7
TABLE 17
Contrasts Anong the Ifean Scores
of the Three Educational Groups of Control Subjects
College High School Grade School Confidence Liaits Population Contrast
1 -1
1 0
0 1
* i
* -i
-l " i
r 26.55 Ta I / VP L i*i c flr
0 - 5.76 £ 9.18 U1 * u2
-1 -1U.22 £ 9.18* U1-U3
-1 -1D.U6 £ 9.18* u2 - U3
-1
*
*
-12.3U £ 9.18*
2.35 £ 9.18
8.89 £ 9.18
U1 + u2 u,
Un ? U-» -±-L_2-U2
u2 / u.
2 . ~ u3
«The contrasts by the q test are significant at the 5 per cent level.
In order to correct for the effecta of education, Pascal and
Suttell presented tables by which raw scores of the high school and
college groups can be converted to Z scores. Table 18 shows the
Pascal and Suttell mean raw scores and standard deviations of the
schizophrenic, alcoholic, and control subjects within the range of
15 and $0 years of age, and Table 19 shows the Z score means and
standard deviations of the same groups. In Table 18 the standard
deviations of the raw scores become larger in the order of the con
trol group, alcoholics, and schizophrenics, giving standard deviations
of 11.U2, 19*18 and 29*26 respectively. The F ratio for the differ
ence of the variance between each group is significant beyond the .5
per cent level.
E. Comparisons of Frequencies
of Deviations Within Scoring Categories
For Groups With Age, Sex, and Education Hatched
In order to investigate characteristics of the drawings
made by each group, acorable deviations which belong to the same
category were combined. Thus, for example, Workover is scared in
cards 2, 3, 5>, 6, and 8* 3b the present study attention was paid
to the number of cards on which it occurred rather than to the num
ber of the card on which it occurred.
Tn this manner, the number of deviations in each category^
was counted for each subject* The Wilcoxon Test was applied to the
5* The definition of each category is presented in Appendix B.
h9
TABLE 18
Pascal and Suttell Mean Raw Scores
of the Schisophrenic, Alcoholic, and Control
Subjects Within the Age Range of 15 and J>0 years
Nunber Mean Raw Score Standard F Probabil-Donation ~ lty Levi'
Schisophrenics 6U U5.95 29.26 2.3200 P » .0005
Alcoholics 60 1*1*39 19.18 2.8100 P = .0005
Control Subjects $0 17.1U 11.U2
TABLE 19
Z Score Means of the Schizophrenic, Alcoholic, and
Control Subjects Within Range of 15 and £0 Years of Age
Number Mean Z Score Standard Deviation
Schizophrenics^- 6U 80. $3 29*92
Alcoholics2 60 75«66 20.17
Control Subjects3 J>0 $0.7U 12,81
1* Number of S's who had some college education was 10*
2. Number of S's who had some college education was 9*
3. Number of S's who had some college education was 9*
51
differences in the number of deviations in each category for the groups
matched for age, sex, and education. Tables 20, 21, 22, and 23 show the
results of these comparisons. Table 20 compares the 31 pairs of schizo
phrenic and control subjects, Table 21 compares the 33 pairs of alcoholic
and control subjects. Table 22 compares the 21 pairs of chronic brain
syndrome and control subjects. Table 23 compares the schizophrenic and
alcoholic subjects.
The results show that six categories significantly differentiate
the schizophrenic group from the control group at the J> per cent level.
The categories are Workovar, Rotation, Design Missing, Distortion, An
gles, and Poor or No Order.
Five categories differentiate between the alcoholic and control
groups. These are: Workover, Tremor, Asymmetry, Rotation of the Ex
tension and Curve, and Dots, Dashes and Circles. Far the chronic brain
syndrome and control subjects, five categories (Number of Dots, Design
Missing, Asymmetry, Dashes, and Rotation of the Extension and Curve) dif-A
ferenbiate at the 5 per cent level* However, Tremor is the only cat
egory that differentiates between the alcoholics and the schizophrenics•
Obtaining one significant result out of 21 tests of significance can be
due to change alone. The probability of obtaining five differences
significant at the 5 per cent level is .01, and that of obtaining six
is even lower.
*
TABLE 20 '" '
Wileoxon Test for Differences in Category Scares
of 31 Pairs of Schisophrenic and Control Subjects Ifetched
$ar Age, Sex, and Education
Deviation Category
Dots, Dashes and Circles Circles Number of Dots
Workover
Second Attempt
Rotation
Tremor
Design Missing Distortion
Asymmetry Dashes Double Line Guide Line
Angles
Ends of Lines Not Joined Rotation of the Extension and Touch-up Place of a Design Over-lap
Poor or Ho Order
Compression
Significance at*TSrT]^ cent WeS
Insignificant insignificant insignificant
Significant
Insignificant
Significant
Insignificant
Significant Significant
Insignificant Insignificant Insignificant Insignificant
Significant
Insignificant Curve Insignificant *
Insignificant Insignificant Insignificant
Significant
Insignificant
Probability Level
P s .0200
P * .0100
P - .01(00 P = .0080
P • .0080
P - ,0500
•By a two-tailed test.
TABLE 21
Wilcoxon Test for Differences in Category Scores
of 33 Pairs of Alcoholic and Control Subjects Matched
for Age* Sex, and Education
Deviation Category
Dots, Dashes and Circles
Circles Rotation Number of Dots
Workover
Second Attempt
Tremor
Design Missing Distortion
Asymmetry
Dashes Double Line Guide Line Angles Ends of Lines Not Joined
Significance at the ;> per cent
-leregr
Significaot
Insignificant Insignificant Insignificant.
Significant
Insignificant
Significant
Insignificant Insignificant
Significant
Insignificant Insignificant Insignificant insignificant Insignificant
Rotation of the Extension and Curve Significant
Touch-up Place of a Design Over-lap Poor or No Order Compression
insignificant Insignificant Insignificant insignificant insignificant
Probability EW8I
P r .0500
p - .0100
p s .0100
P • .0100
P * ,0320
•By a two-tailed test*
TABLE 22
Wilcoxon Test for Differenoes in Category Scores
of 21 Pairs of Chronic Brain Syndrome and Control Subjects
Matched for Age, Sex, and Education
Deviation Category
Wavy Line Dots, Dashes and Circles Circles
Number of Dots
Workover Second Attempt Rotation Tremor
Design Kissing Asymmetry Dash
Double Line Guide Line -Angles Bods of Lines Not Joined
Signif at tSe5
ioance er cent at the > per
ft™**"
Insignificant Insignificant Insignificant
Significant
Insignificant Insignificant Insignificant Insignificant
Significant Significant Significant
Insignificant Biaignificant Insignificant Insignificant
Rotation of the Extension and Curve Significant
Touch-up Orer-lap Total Configuration
Insignificant Insignificant Insignificant
Probability
P = «0U20
P = .0100 P * .0120 P m .0080
P =• .0080
*By a two-tailed test.
TABLE 23
Wllcoxon Test for Differences in Category Scores
of 30 Pairs of Alcoholic and Schizophrenic Subjects
Matched for Age, Sex, and Education
Deviation Category Significance Probability at the pear cent Lerex
EeVel*
Dots, Dashes and Circles Insignificant Circles insignificant Number of Dots Insignificant Workorer Insignificant Second Attempt Insignificant Rotation Insignificant
Tremor Significant
Design Kissing Insignificant Distortion Insignificant Asymmetry Insignificant Dashes Insignificant Double Line Insignificant Guide Line . Insignificant Angles Insignificant Ends-of Line Not Joined Insignificant Rotation of the Extension and Curve insignificant Touch-nip Insignificant Place of a Design Insignificant Orer-lap Insignificant Poor or no order insignificant Compression Insignificant
P = .0500
*3y a two-tailed test.
F. Category Analysis
Among Various Groups
Within the Age Range of l£ and $0 Years
4t
1. Qroup A
For more complete deviation analysis of each group, approx
imately half of the number of the schisophrenic, alcoholic, and con
trol subjects between 1$ and 50 years of age were selected randomly*
Thus, 30 schizophrenics, 30 alcoholics, and 30 control subjects were
selected, on a random basis to constitute Group A.
Characteristic signs of each clinical group were obtained by
applying the chi-square test to frequencies of appearance of deviation
within each category*
Table 24 shows the results of the analysis comparing the schis
ophrenic and control subjects* Those deviations which differentiate
between the two groups at the 5 per cent level are: Number of Dots,
Workover, Rotation, Tremor, Distortion, Asymmetry, Angles, and Dots,
Dashes and Circles*
Table 2J> shows the results of this type of analysis of the
scores obtained by alcoholic and control groups* Circles, Workover,
Tremor, Asymmetry, Guide Lines, Angles, and Dots, Dashes and Circles
were found to differentiate between the two groups at the $ per cent
level*
Table 26 shorn the results of the chi-square comparisons of
the schisophrenic and alcoholic subjects* There are three categories
which differentiate between the two groups. They ares Extension
Joined to Curve at Dot, Tragi or, and Double Line*
57
TABUS 2U
Chi Square Measures of Differenoes
Between Schizophrenic and Control Subjects (Group A)
for Scoring Categories
( Nr 30 each)
Deviation Category Number of Deviations Compared
Qroup Showing Larger"*5core
Wavy Line Circles Extension join Dot
0 with 1 or more 0 with 1 or more 0 with 1
Dots, Dashes & CirclesO with 1 or more Number of Dots Workover
Second Attempt
Rotation Tremor
Design Missing
Distortion Asymmetry
0 and 1 with 2 or more 0 and 1 with 2 or more
0 with 1 or more
0 with 1 or more 0 with 1 or more
0 with 1 or more
0 with 1 or more 0,1 and 2 with 3 or moreU.9300
•6000 .1*190 Schisophrenic •6500 .1*190 Schisophrenic 3.5200 .0610 Control
8.U000 .0037 Schizophrenic U.6300 .030U Schisophrenic 6.2800 *0122 Schizophrenic
.081*0 .7720 Control
]*.7000 6.0800
•0302 Schisophrenic •0137 Schizophrenic
1.7800 .1820 Schisophrenic
lu7000
Dashes 0 with 1 or more Double Line 0 with 1 or more Guide Line 0 with 1 or more
Angles 0 with 1 or more
Bods of Lines Not 0 with 1 or more Joined Rotation of the Exten-0 with 1 or more sion and Curve Touch-up 0 with 1 or more Poor or No Order 0 with 1 or more Total Configuration 0 with 1 or more
0.0000 .2700 .6500
9.8700
2.1*100
0.0000
0*0000 .6500 •0660
•0302 •026U
•0000 •60U0 .1*190
.0017
.1200
.0000
.0000 .1*190 .7970
Schisophrenic Schisophrenic
Schisophrenic Schizophrenic Schizophrenic
Schizophrenic
Schizophrenic
Schizophrenic Schizophrenic
TABLE 25
Chi Square Measures of Differences
Between Alcoholic and Control Subjects (Group A)
for Scoring Categories
(N s 30 each)
Deviation Category Number of Deviations Cogparea ~~
P Group Show-~ ing Larger
""Score
navy Line Extension Join Dot Dots, Dashes & Circles Circles t
Number of Dots
Workover
Second Attempt Rotation
Tremor
Design Missing Distortion
Asymmetry
Dashes Touch-up Double Line
Guide Lines Angles
Ends of Lines Mot Joined Rotation of the Extension and Curve Poor or No Order Total Configuration
0 with 1 or more 0 with 1 0 and 1 with 2 or 0 with 1 or more
0 with 1 or more
0 and 1 with 2 or
0 with 1 or more 0 with 1 or more
0 with 1 or more
0 with 1 or more 0 with 1 or more
1.U300 .0060
more 6.2800 8.8800
.0900
morell.8000
1.1300 2.5900
.2320
.9680
.0123
.0027
.761*0
.0007
.2870
.1080
Alcoholic Alcoholic Alcoholic Alcoholic
Alcoholic
Alcoholic
Alcoholic Alcoholic
17.0800 .0001 Alcoholic
0.0000 0.0000
.0000
.0000
0 and 1 with 2 or more 8.1(000 *0037 Alcoholic
0 with 1 or more 0 with 1 or more 0 with 1 or more
0 with 1 or more 0 with 1 or more
0 with 1 or more
0 with 1 or more
0 with 1 or more 0 with 1 or more
0.0000 0.0000 .6100
6.2800 8.1*000
.0000
.0000
.1*370
.0123
.0037
Alcoholic
Alcoholic Alcoholic
0.0000 .0000
0.0000 .0000
0.0000 .0000 3.2000 .0736 Alcoholic
$9
TABLE 26
v
Ghl Square Measure of Differences
Between Schizophrenic and Alcoholic Subjects (Group A)
for Scoring Categories
(N = 30 each)
Deviation Category Number of Deviations Coapareq
Group Shcwr-5!E
Wavy Line
Extension Join Dot
Dots, Dashes & Circles Circles Number of Dots Workover Second Attempt Rotation
Tremor
Design Missing Distortion Asymmetry Dashes
Double Line Guide Line Angles finds of Lines Not joined Rotation of the Extension and Curve Touch-up, Poor or No order Total Configuration
0 with 1 or more
0 with 1
0 with 1 or more 0 with 1 or more 0 with 1 or more 0 and 1 with 2 or more 0 with 1 or more 0 with 1 or more
0 with 1 or more
0 with 1 or more 0 with 1 or more 0 and 1 with 2 or more 0 with 1 or more
2 or more
0.0000 .0000
5.6200 .0171 Alcoholic ,ti
1.3100 .2^20 Schisophrenic 3.2800 .070U Alcoholic 1.1700 .2790 Schisophrenic .6100 .U370 Alcoholic 2.61(00 .1070 Alcoholic .0900 .761*0 Schizophrenic
U.9200 .0266 Alcoholic
1.7800 .1820 Schisophrenic 3.0000 .0833 Schisophrenic 1.3100 .2520 Alcoholic .0660 ,1910 Schisophrenic
•0360 Alcoholic 0 with 1 or more 2.1300 .lU$0 Alcoholic 0 with 1 or more 0.0000 .0000 0 with 1 or more 0.8700 .3U8O Schisophrenic
0 with 1 or more 0.0000 .0000
0 with 1 or more t r 0.0000 .0000
0 with 1 or more < ' .moo .7130 Schisophrenic 0 with 1 or mare 1.8700 .1710 Schizophrenia
Group B> the cross-validation group, consisted of 30 schizo
phrenics, 30 alcoholics, and 20 control subjects. Chi-squara tests
were conducted to determine which scoring categories found to dis
criminate for Group A also discriminate between the clinical and con
trol groups constituting Group 8.
Of the eight categories which discriminated between the
schizophrenic and control subjects of Group A, four remain significant
at the 5 per cent level for Qroup B. These are Rotation, Tremor,
Asymmetry, and Angles. (See Table 27*)
Of the seven categories which were significant in Qroup A
of the alcoholic and control subjects, four remain significantly dif
ferentiating between the two groups constituting Group B. They are:
Work over, Tremor, Asymmetry, and Dots, Dashes and Circles, The
results are shown in Table 26*
When the three categories which were significant in Group A
of the alcoholic and schizophrenic subjects were retested in Group B
of the two groups, only one category, Tremor, discriminates between
the two groups at the five per cent level. Table 29 shows the results r ,
of the analysis. Obtaining one significant result out of'the original
21 tests of significance can be due to chance alone*
0. Age Effects Upon Category Deviations
Produced by the Normal Subjects
To further investigate the effects of age variation upon the
particular deviation categories, the 77 normal subjects were divided
61
TABLE 27
Chi Square Measures of Differences Between
Schizophrenic and Contrdl Members of Qroup B for the Scoring
Categories Which were Significantly Different in Qroup A
(Schizophrenics « 30» Control Subjects e 20)
Deviation Category Number of Deviations Coaparea
P Qroup Show-
Dots, Dashes & Circles 0 with 1 or more
Nunfcer of Dots
Workover
Rotation
Tremor
Distortion
Asymmetry
Angles
0 with 1 or more
0 with 1 or more
0 with 1 or more
0 with 1 or more
0 with 1 or more
0 and 1 with 2 or more $.8200
0 with 1 or more U.0U00
1.5600
1.0000
.OUUO
U.OUOO
6.8700
3.6600
•2l£0 Schizophrenic
.3170 Schizophrenic
•8330 Schizophrenic
•0UU5 Schizophrenic
.0088 Schizophrenic
.0$$8 Schizophrenic
.0016 Schizophrenic
Schizophrenic
62
TABLE 28
Chi Square Measures of Differences Between
Alcoholic and Control Members of Group B for the Scaring
Categories which were Significantly Different in Group A
(Alcoholics s 30, Controls • 20)
Deviation Category Number of Deviations Compared
x2 P Group Show-ing Larger Score
Circles 0 with 1 or more 1.1700 .2790 Alcoholic
Workover 0 and 1 with 2 or more U.OliOO •0UU5 Alcoholic
Tremor 0 with 1 or more 3U.6700 .0001 Alcoholic
Asymmetry 0 and 1 with 2 or more 3.9700 .01*63 Alcoholic
Guide Line 0 with 1 or more .OOUO .9UU0 Alcoholic
Angles 0 with 1 or more .3900 .5320 Alcoholic
Dots, Dashes & Circles 0 with 1 or more U.S900 .0321 Alcoholic
63
TABIE 29
Chi Square Measures of Differences Between . > Alcoholic and Schizophrenic Members of Group B for the Scaring
Categories which were Significantly Different in Group A
(Alcoholics - 30, Schisophrenics • 30)
Deviation Category Number of Deviations uowparea
P Group sncnr-" Larger
Score
Extension Join Dot
Tremor
Double Line
0 with 1
0 with 1 or more
0 with 1 oif more
•0680 ,79UO Schisophrenic
13.UOOO .0002 Alcoholic
.6000 .1*380 Alcoholic
into two age groups. The first group consisted of 50 subjects be
tween 15 and 50 years of age. The second group was composed of 27
subjects who were within the age range of 51 and 8U years. Differ
ences in deviation between the two age groups for each oategary were
analysed using the chi-aquare test# The results are shewn in Table
30. The table indicates that the categories differentiating be
tween the two age groups at the 5 per cent level of significance
are: Circlet Rotation, Tremor, Design Missing, Distortion, Asymmetry,
Double Line, Angles, and Dots, Dashes and Circles»
TABLE 30 I
Category Deviation Analysis Between the
Normal 15-50 Year Old Subjects ( N m 50 ) and
the Noraal 51-8U Tear old Subjects ( N • 27)
65
Deviation Category Number of Deviations Compared
x2
Wavy Line Extension Join Dot
Dots, Dashes & Circles Circle
Number of Dots Workorer Second Attempt
Rotation Tremor Design Missing Distortion Asymmetry
Dashes
Double Line
Guide line
Angles
Ends of Lines Not Joined Rotation of the Extension
• and' Curve Touch-up Total Configuration
0 with 1 or more 0 with 1
.Ullib
.5110 ^•5230 .U75o
0, 1 with 2 or more 0 with 1 or more
6.7UOO 12.2600
.0095
.0005
0 with 1 or more 0,1 with 2 or more 0 with 1 or more
.0310
.7980
.0110
.8600
.3750
.9170
0 with 1 or more 0 with 1 or more 0 with 1 or more 0 with 1 or more 0, 1 w ith 2 or ntore
8.3110 26.2560 3.8UOO 6.U000 5.9500
.OOliP .0001 .0U93 .OllU •0lU6
0 with 1 or more 0.0000 .0000
0 with 1 or more U.5200 .0336
0 with 1 or more 0.0000 .0000
0 with 1 or more 10.6700 .0010
0 with 1 or more 0 with 1 or moire
0.0000 •0002
•0000 .97U8
0 with 1 or more 0 with 1 or more T
0.0000 .56to
.0000
.U55o
T. CONCLUSIONS AND DISCUSSION
III* results of the present study suggest the following
conclusions:
1. Each of the clinical groups (schisophrenics, alcoholics,
and chronic brain syndrome subjects) produced higher average Pascal
and Suttell raw scores than did the control groups. There are dif
ferences of at least 20 points between the control group and each
of these groups. The differences are all significant beyond the
5 per cent level.
2. The mean raw score for the chronic brain syndrome group
is significantly (F = .0005) higher than that of the alcoholics and
that of the schisophrenics.
3. The span raw soore pf the schisophrenics does not differ
significantly froa that of the alcoholics.
U. The raw score variance for subjects between.the ages of
15 and $0 years is smallest for the control group* second smallest for
the alcoholics, and largest for the schisophrenics. The standard
deviations are 11.U2, 19.18, and 29.26 respectively. These differences
are significant beyond the .5 per cent level*
5. The median test and the Kruskal-Wallis Test fail to shew
significant relationships between age and Pascal and Suttell scores
within the 15 and $0 year age groups. Above the age of 50 years* how
ever* age was found to be an important variable*
6. Analysis of variance shows that there is a difference in
66
Pascal and Suttell scores related to the educational level of the
members of the schisophrenic and control groups. No significant
relationship, however, was found between the educational level of
the alcoholic subjects and their raw scores,
7. The q test for comparisons among individual educational
groups reveals that there is a difference between the grade school
and college groups. The differences between the scores of the high
school and college subjects and between those of the high school
and grade school subjects were not found to be significant*
8* Ihen the TTilcoxon Test was applied to the differences O
in the number^ of deviations in each category for the various experi
mental and control groups matched for age, sex, and education, the
following differences were found to be significant:
(a) For the schisophrenics and the control subjects:
Workover, Rotation, Design Missing, Distortion, Angles, and Poor
or No Order.
(b) For the alcoholics and the control subjects: Tremor,
Workover, Asyatry, Rotation of the Extension and Carve, and Dot,
Dashes and Circles,
(c) For the chronic brain syndrome and the control subjects:
Number of Dots, Design Missing, Asymmetry, Dashes, and Rotation of
the Extension and Curve. I
(d) For the alcoholics and schisophrenics: Tremor.
9. The schisophrenics, alcoholics7 and control subjects
between 1$ yd $0 years of age were divided into two groups, Group
A awl Gfroup B, on a rando* basis. Those categories which differentiate
significantly between the clinical and control subjects for both
groups using the chi-square test are:
(a) For the schisophrenics and control subjects: Rotation,
Tremor, Asymmetry, and Angles.
(b) For the alcoholios and control Subjects: Workovar,
Tremor, Asymmetry, and Dots, Dashes and ciroles.
(c) For the alcoholics and the schizophrenicst Tremor*
10* The normal subjects were divided into two age groups:
the first group between 15 and $0 years of age, and the second
group between 51 and 8U years of age* Differences in deviation of . i
the two age groups for each category were analysed using the chi-;
square test* The results show that the categories differentiating
between the two age groups at the 5 per cent level of significance
are» Circle, Rotation, Tremor, Design Missing, Distortion, Asym~
metry, Double Line, Angles, and Dots, Dashes and Circles*
lb the present study investigating the Bender-Gestalt
drawings of four groups (schisophrenic, alcoholic,Chronic brain
syndrome, and control subjects), the clinical groups produced
•ore deviations than do control subjects* The average Z score
of 50.7U obtained from the normal group in the present study is
in accord with Pascal and Suttell's finding t^iat "adults of aver
age I* Q*, between the ages of 15 and $0, Without damage to the
cortex, have the capaolty to execute drawings resulting, on the
average, in a Z score of 50" (65, p. 69)*
fpe*ig the clinical groups, the chronic brain syndrome
subjects produced the highest raw score mean* As will be discussed
later, the difference may be, at least partially, attributable to
age differences*
Comparisons of the Bean scores of the group must consider
the influence of age Yariation and vast equate for this factor, at
least for subjects above $0* Table U (p. 30) shows the mean scares
of all subjects of each group without equating for age* Ibis is not
an entirely satisfactory comparison* The groups, therefore, were
compared after matching for age, sex, and education* The results are
shown in Table 10, page 38* These more rigorous comparisons also
rereal that the difference between the mean score of each clinical
group and its control group is significant beyond the $ per cent level*
The difference in scores between the chronic brain syndrome
and the schizophrenic subjects, and that between the chronic brain
syndrome and the alcoholic subjects are significant at the *$ per
cent level when the age factor is not considered* However, this dif
ference may be due to the age factor and the groups could not be
equated for age* The difference in mean raw scores of the alcoholic
«nd schisophrenic subjects is significant when age variation is
ignored* However, when age is equated, the difference is nob signi
ficant at the 5 per cent level*
It is also interesting to note that score variance is signi-
oantly different from one group to another* The control subjects
shoved the smallest variance and schisophrenics the most variance
with an intermediate value for the alcoholics.
Following a suggestion of Qobets (39, p. 22), four possible
bypothese have been testedt (a) deviations of the reproductions from
the stimulus figures are more frequent among abnormals than normals)
(b) deviations are more frequent among normals than abnormals; i4e»,
abnormals tend to conform more rigidly to the stimuli} (e) deviations
are equally characteristic of both normals and abnormals} and (d)
certain deviations are more characteristic of abnormals than normals.
The finding of this study that the clinical groups had larger Pascal
and Suttell raw scare deviations and wider variances than the control
groups certainly rules out the hypothesis that abnormals tend to con
form more rigidly to the stimuli than normals, and supports the hypo
thesis that deviations are more frequent among abnormals than normals.
The p resent study also confirms the findings of Pascal and
Suttell that the response to the Bender-Gestalt drawings is not signi-
fioantly related to age within the 15 and $0 years age group, whether
it is a normal or an abnormal group. However, age influences the test
drawings if the subject is older than $0 years. The mean raw scare of
the older normal group (mean age of 70 with a standard deviation of
8*1*8) exceeds that of the younger alcoholics and does not differ signi
ficantly from that of the younger schisophrenics who were between 15
and $0 years of age.
It seems that once one reaches the level of maturation of the
l$-year-old (or less), the function of visual-motor drawing remains
stable until about $6 years of age. Ihen one becomes older than that
age, however, either motor coordination, perception of visual pattern,
or both, begin to deteriorate*
Pascal and Suttell found a sufficient difference between the
scores of high school and college trained subjects, to convince them
that they should devise a Z score to which raw scores could be con
I
71
verted. Oobetfe, however, reports that education above the eighth grade
level does not appreciably influence Bender-Gestalt drawings. In the
present study, an analysis of variance revealed a significant relation
ship between scores and eduoational level (grade school, high sahool,
and college) for both the normal and the schisophrenic subjects. The
three educational groups of alcoholic subjects did not differ signi
ficantly fro* one another. The q test for comparisons of the individual
educational groups showed that the differences for the normal and schis
ophrenic subjects were significant between grade school and college sub
jects. But the differences between grade school and high school, and
between high school and college were not significant. The average
Pascal and Suttell raw scares appear to decrease with increased education.
Thus, neither Pascal and Suttell nor Gobets may be correct. Pascal and
Suttell provide a conversion table only for high school and college.
They do not include a correction for grade school subjects.
Table 31 suamarises the results of the analysis of specific de
viations characteristic of each clinical group. The differences between
the schisophrenics and their control subjects, and between the alcoholics
and their control subjects provide suggestion# of the nature of the
difficulties. All measures used yielded significant differences be
tween the schisophrenic and the control subjects In Rotation and An—
gles. Rotation is scored if the design is rotated U5 degrees or sore.
. Rotation can occur if the card is turned and the figure is drawn in this
new orientation or if the card is placed in the original orientation
and the drawing is rotated. Angles are considered to deviate if extra
angles are added or If angles are missing in the reproduction. These
TABLE 31
Differences Significant at the 5 Per Cent Level
Between Deviation Categories For Various Groups
Schizophrenics versus
Normal Subjects
Alcoholics versus
Normal Subjects
Wilcoxon Test (~ Matched m:olips)
Work over Rotation Design Missing Distortion Angles Poor or No Order
Work over Tremor Asymmetry
Chi-Stuare Tests (Signit cant for Both Group ! and GrOUp -m-Rotation Tremor Asymmetry Angles
Work over Tremor Asymmetry
72
Rotation of the Extension and Curve
Dots, Dashes and Circles
Dots, Dashes and Circles
Chronic Brain Syndrome Number of Dots - versus Design Missing
Normal SUbjects Asymmetry
Alcoholics versus
Schizophrenics
Old Normal Gr-oup {51-84 years)
versus Young Normal Group
(15-50 years)
Dashes Rotation of the Extension
and Curve
Tremor Tremor
*Circle Rotation Tremor Design Missing :Qistortion Asymmetry Double Line Angles Dots, Dashes and Circles
iE'!'his particular analysis was done on the total group only.
two deviations appear to be more closely related to perceptual vnd/ov
conceptual than to sot or ability. Rotation could occur as the result
of lack of attention to the orientation of the card or to a failure to
perceive, or to be concerned with the upright. Angle deviations ap
pear, also, to be perceptual and/or conceptual rather than motor be
cause a person with a mot or problem would be expeoted to at least try
to put angles in the correct places* The angles produoed might be de
fective and migit include considerable workover or erasures, but they
should exist*
Between the alcoholics and control subjects, the discriminating
categories that remained significant for both groups and for both sta
tistical analyses ares Tremor, Workover, Asymmetry, and Dots, Dashes
and Circles, Tremor and Workover would appear to be due to lack of
motor coordination rather than to perceptual weakness. Poor motor co
ordination would be expected to result in tremulous lines and in the
superimposing of several lines in an attempt to improve drawings that
were unsatisfactory to the subject. Asymmetry and use of Dots, Dashes
and Circles can not be conclusively attributed to either motor or to
perceptual problems.
It would appear, from this analysis, that differentiation be
tween schisophrenics and alcoholics should be possible from the Bender-
Oast alt records. Comparison of the two groups, however, reveals only
one significantly different category. Tremor appears more frequently
in the alcoholics than In the schisophrenics. This supports the view
point that motor Impairment is greater in the alcoholic than In the
schisophrenic. It does not support the existence of greater perceptual
7U
and/or conceptual Impairment In the schisophrenic than in the alcoholic*
The chronic brain syndrome subjects can be compared with their
control group by the use of the Wiloozon Test only* This is true because
of the need to eliminate age differences for subjects over 5>0 years of
age.
The categories significantly differentiating the chronic brain
syndrome subjects frost the matched control subjects for age* a ex, and
education are: Muabar of Dots# Design Missing, Asymaetry, Dashes, and
Rotation of Extension and Qarre. The chronic brain syndrome is pri
marily related to the aging process* Drawings of these subjects may*
therefore, be hypothesised as representing, at least partially, the
effects of aging on the visual-motor capacity. The comparison between
the categories significantly differentiating between chronic brain
syndroms subjects and their matched control subjects, and the cate
gories varying significantly with the age of the subject fail, however,
to reveal a close relationship* Only two categories differentiate in
both oases. These categories are Design Missing and Asymmetry. ]fuy
of the deviations in drawing found in the chronic brain syndrome group
give an impression of being due to disorientation and lack of attention
to the task. However, there appears to be a visual-motor deterioration
as well in this group.
VI. SUMMART
The present study- was conducted to investigate the effects
of age, education}and clinical grouping upon Pascal and Suttell raw
scares froa the Bender-Oestalt Test, and to determine the nature of
impairment found in the clinical groups in terms of deviation cate
gories. An additional purpose of this study was to provide aiare in-
faraation about the Bender-Qestslt Test as a differential diagnostic
tool*
The subjects consisted of 60 schisophrenics, 76 chronic al-
ooholics, 32 patients of chronic brain syndroae associated with cere
bral arteriosclerosis* and 77 normal subjects* The Bender-Gestalt
Test was administered to each subject individually and the reproduc
tions were scored according to the Pascal and Suttell scoring method.
Pasoal and Suttell mean raw scores of the clinical groups are
all higher than those of the control groups beyond the 5 per cent
level of significance* Among the clinical groups, the aean raw score
of the chronic brain syndrome cases is significantly higher than that
of the alcoholics and that of the schisophrenics* However, there is
no significant difference between the alcoholics and the schisophrenics*
The raw score variance far subjects between the ages of 1$ and
$0 years is smallest for the control group, second smallest far the
alcoholics, largest for the schisophrenics* These differences
in variance are significant at the 5 per cent level*
75
The median test and the Bruskal-Wallis Test fall to show a
significant relationship between age and Pascal and Suttell scares
within the 15 *nd $0 years age group. Age becomes an lap art ant
factor, however, if the subject is older than $0 years of age.
This finding is In agreement with that of Pascal and Suttell*
Analysis of variance shows that there is a difference in
score related to the educational level for the control and schiso
phrenic subjects. The q test for comparisons of individual edu
cational groups reveals that there is a difference between the grade
school and college groups.
An Investigation of the deviation categories characteristic
of each clinical group was made using the Wilcoxon Test and the chi-
square test. The Wilcoxon Test was applied to the differences in
the number of deviations in each category for the groups matched for
age, sex, and education* The schisophrenics, alcoholics, and the
normal subjects between 15 and $0 years of age were divided into two
groups, Group a a*** Group B, on a rand ok basis. The chi-square test
was employed to investigate the differences in the number of devia
tions in each category between the clinical and control subjects.
This was conducted in both Group A and Qroup B. Deviation categories
which remained significant in all three statistical analyses as dis
criminating between the groups are as follows t
(a) For the schisophrenics and normal subjects) Rotation
and Angles.
(b) For the alcoholic and normal subjects: Workover,
Tremor, Asyetry, and Dots, Bashes and Circles.
(•) For the alcoholics and schizophrenics: Tremor.
The Wilcoxon Test for the chronic brain syndrome and control
subjects is significant for Number of Dots, Design Missing, Asymmetry,
Dashes, and Rotation of Ixtension and Cur re. The chi-equare tests for f
the differences between category scores attained by the older ambers
of the normal group (51-8U years) and by the younger members of the
normal group (l£-£0 years) yielded significant differences in Circle,
Rotation, Treaor, Design Missing, Distortion, Asyametry, Double Line,
Angles, and Dots, Dashes and Circles.
In the analysis of deviation categories, the categories dif
ferentiating between the schisophrenics and the normal subjects appear
to indicate that the difficulties in schisophrenics are primarily re
lated to perceptual and/or conceptual rather than to motor ability.
Among the four categories significantly differentiating be
tween the alcoholics and the normal subjects, two categories (Tremor
and Warkover) appear to be due to poor motor coordination; the other
two categories cannnt be explained with certainty*
The categories which both significantly differentiated between
the chronic brain syndrome and its normal control group, and between
the young normal group (l5-J>0 years) and the older normal group (£L-
81* years) aret Design Missing and Asymmetry. Many of the deviations
•in drawing made by the chronic brain syndrome subjects appear to be
due to disorientation and lack of attention to the task as well as
visual-motor deterioration.
APPENDIX A
Table 1
, Sex, end Bduoation of Sehliopbrenie and Control Matched Qroups
Schisophrenics Control (M » 31) (H r 31)
Mean Age 36.16 36.16
Standard Deviation 12.02 12.02
Range 15-59 15-59
Male 12 il
Female 19 20
Noaber of Subjects with > 5 6 College Bduoation
78
?
— Table 2
Age, Sex, and Education
of Alcoholic and Control Hatched Qroupa
Alcoholics Control (N = 33) (N s 33)
Mean Age U5.03 1*5.03
Standard Deviation 9*55 9*55
Range l£-67 lS-67
Male 18 lit
Female 1$ 19
Nnaber of Subjects with U 3 College Education
Table 3 '
Age* Sex, and Education
of Chronic Brain Syndraae and Control Matched Group*
Chronic Brain Control
VT5!) (" *22)
Mean Age 67.72 70,00
Standard Deviation 8*72 8.U8
Range 52*81* 52-83
Male 17 lit
Female 5 8
Nuaber of Subjects -with 1 1 College Education
Nuuober of Subjects with $ U High School Education
TafapU k 4u'
Age* Sex* and Bduoatlon
of Alcoholic and Schisophrenic Matched Groups
Alcoholics Schizophrenics (N • 30) (N - 30)
Mean A«e 1*3.60 U3.60
Standard Deviation 9.U9 9.U9
Range 25-67 25-67
Male 25 23
Feaale 5 7
Number of Subjects with U College Education
3
APPENDIX B
Each deviation category utilised in this study consists of
one or more scorable items from the Pascal and Suttell scoring sys
tem. The Pascal and Suttell scorable items which belong to a same
type of deviation (for example, the wavy line of Design 1 and the
wavy line of Design 2) were treated together under the same devia
tion oategory. Attention was paid to the muber of cards on which
the deviation occurred, rather than to the number of the card on
which it occurred. Definitions of each scotrable item of the Pascal
and Suttell system can be obtained frcm their manual (6$).
The following analysis shews the Pascal and Suttell scorable
items included In each deviation category*
Wavy Linet
It am 1 of Design 1
Item 1 of Design 2
Extension Join Dot (Extension Joined to Carre at Dot)}
Item 5 of Design $
Dots* Dashes and Circlest
Item 2 of Design 1
Item 2 of Design 2
Item 2 of Design 3
item 2 of Design $
Circle:
Item U of Design 1
Item k of Design 3
lb em k of Design $
Nonber of Dots:
Item $ o f Design 1
It7 Of Design 2
item $ of Design 3
Item 7 of Design $
Workorer:
Itea 7 of Design 1
Item 10 of Design 2
Itea 10 of Design 3
Itea 10 of Design 5
Itea 10 of Design 6
Item 9 of Design 8
Second Attempts
Itea 8 of Design 1
Itea 11 of Design 2
Itea 11 of Design 3
Itea 11 of Design U
Itea 11 of Design $
Itea 11 of Design 6
Item 9 of Design 7
Item 10 of Design 8
Rotation:
Item 9 of Design 1
Item 12 of Design 2
Item 12 of Design 3
Item 12 of Design U
item 12 of Design 5
Rotation Continued:
Itea 12 of Design 6
Itea 10 of Design 7
Item U of Design 8
Treaor:
Item 8 of Design U
Itea 7 of Design 6
Itea 6 of Design 7
Item 6 of Design 8
Design Missing:
— Item 10 of Design 1
Item 13 of Design 2
Item 13 of Design 3
Item 13 of Design U
Item 13 of Design $
Item 13 of Design 6 -L,
Ite* 11 of Design 7
Item 12 of Design 8
Distortion:
Item 8 of Design 3
Item 9 of Design k
Item 8 of Design $
Item 8 of Design 6
item 7 of besiga 7
item 7 of Design 8
Asymmetry:
Dashes:
Double Line:
Guide Line:
Angles:
Item 1 of Design 3
Item 1 of Design 1*
Item 1 of Design 6
Item 3 of Design 1
Item 3 of Design 3
Itea 3 of Design $
Itea 5 of Design 6
Item $ of Design 7
Item ^ of Design 8
Itea 9 of Design 3
Itea 10 of Design U
Item 9 of Design $
Item 9 of Design 6
Item 8 of Design 7
Item 8 of Design 8
Itea 2 of Design 6
Item 2 of Design 7
item 3 of Design 7
item 2 of Design 8
item 3 Dssign 8
Ends of Linos Not Joined: •v
It en $ of Design U
K« 1 of Design 7
Itea 1 of Desiga 8
Rotation of the Sztension and Carre:
Itea 6 of Design U
Itea 6 of Design 5
Touch-up:
Orer-lap:
Poor or No Order:
Total Configuration:
Item 7 of Design k
Item 6 of Design 6
itea k of Design 7
Item U of Design 8
Item 2 of Configuration Design
Itea 5 of Configuration Design
Ibea 6 of Configuration Design
All seren iteas of the Configuration Design
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