Close
About
FAQ
Home
Collections
Login
USC Login
Register
0
Selected
Invert selection
Deselect all
Deselect all
Click here to refresh results
Click here to refresh results
USC
/
Digital Library
/
University of Southern California Dissertations and Theses
/
Measuring Thought Process As An Ego Function In Schizophrenic, Mentally Retarded And Normal Adolescents By Means Of The Rorschach
(USC Thesis Other)
Measuring Thought Process As An Ego Function In Schizophrenic, Mentally Retarded And Normal Adolescents By Means Of The Rorschach
PDF
Download
Share
Open document
Flip pages
Contact Us
Contact Us
Copy asset link
Request this asset
Transcript (if available)
Content
This dissertation has been microfilmed exactly as received 6 8 -1 3 ,5 72 CHAPMAN, Mary Veronica, 1927- MEASURING THOUGHT PROCESS AS AN EGO FUNCTION IN SCHIZOPHRENIC, MENTALLY RETARDED AND NORMAL ADOLESCENTS BY MEANS OF THE RORSCHACH. University of Southern California, Ph.D., 1968 Psychology, clinical University Microfilms, Inc., Ann Arbor, M ichigan C o p y r ig h t © b y M A R Y V E R O N I C A C H A P M A N 1968 MEASURING THOUGHT PROCESS AS AN EGO FUNCTION IN SCHIZOPHRENIC, MENTALLY RETARDED AND NORMAL ADOLESCENTS BY MEANS OF THE RORSCHACH by Mary Veronica Chapman A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (Psychology) June 1968 U NIV ERSITY O F S O U T H E R N C A L IF O R N IA T H E G R A D U A T E S C H O O L U N IV E R S IT Y P A R K L O S A N G E L E S , C A L IF O R N IA 9 0 0 0 7 This dissertation, written by ....... MaE.y..Ysjr.Q.ni.c.a..Cl),apmajj........ under the direction of hSX....Dissertation Com mittee, and approved by all its members, has been presented to and accepted by the Graduate School, in partial fulfillment of requirements for the degree of Dean. D a te ... J .u n e , ...19.6.8 iERTATION COMMITTE: ACKNOWLEDGMENTS Whenever a project of this magnitude is undertaken, one's limitations are constantly reaffirmed. Therefore, my deep gratitude is extended to the members of my committee who came to my aid and devoted many hours to this study: Dr. Georgene Seward, Chairman Dr. Norman Cliff Dr. Thomas Lasswell To Dr. Seward who, through the years, has always provided an atmosphere of intellectual stimulation and per sonal warmth for her students, I give special thanks for her help as my advisor throughout my doctoral program. I am obligated to Dr. Robert R. Holt of the New York University Research Center for Mental Health and to Dr. Martin Mayman of the Menninger Foundation for providing the manuals used in this study and indebted to the staff at Fairview, Camarillo, and Pacific State Hospitals for their cooperation-and suggestions. Special appreciation is extended to Dr. Arthur Silverstein, Research Psychologist at Pacific State Hospital, for his constructive criticisms and invaluable contributions to this investigation. To my husband, for his understanding and forbearance during the many hours of separation necessitated by this project, I affectionately dedicate this work. TABLE OF CONTENTS CHAPTER Page I. STATEMENT OF THE PROBLEM Introduction ............... 1 Theoretical Background ......................... 3 Hypotheses...................................... 18 II. PREVIOUS STUDIES Emotional Conflict and Retardation ........... 23 Normative Rorschach Studies .................. 25 Traditional Approaches and Rorschach Findings 28 Contemporary Approaches and Rorschach Findings...................................... 33 Linguistic Expression and Schizophrenia . . . 36 III. METHOD Subjects......................................... 39 Instrumentation ................................ 4 2 Measuring Thought Process .................. . 43 Administration .................................. 49 Statistical Analysis ........................... 50 IV. RESULTS Total Number of Responses.................... 52 Hypothesis I .................................... 52 Hypothesis I I .................................. 55 Hypothesis I I I .................................. 59 Differentiation of Primary Process Scores . . 61 Hypothesis I V .................................. 6 6 V. DISCUSSION Primary Process Manifestations ................ 68 Implications for Future Research ............. 85 VI. SUMMARY 87 CHAPTER Page REFERENCES . ............................................... 91 APPENDICES Appendix A. Primary Process Categories Used for Scoring the Rorschach Protocols, and the Defense Demand (DD) Asso ciated with E a c h .................... 108 Appendix B. Control and Defense Categories Used to Score the Rorschach Protocols...... 110 Appendix C. Form Level Scores Following Mayman's (1964) System with Additions and Descriptions from Holt (1963)...... 112 Appendix D. Analysis of Variance: Total Rorschach Responses.................... ........... 113 Appendix E. Analysis of Variance: Total Primary Process S c o r e s ..................... . . . 114 Appendix F. Analyses of Variance: Level 1 and Level 2 S c o r e s ...................... 115 Appendix G. Analysis of Variance: Defense Demand S c o r e s ............................... 116 Appendix H. Analyses of Variance: Total Content and Total Formal Scores . . -........ 117 Appendix I. Analyses of Variance: Level 1 and Level 2, Content and Formal Scores . . 118 Appendix J. Analysis of Variance: Adaptive Regression Scores . . . . . 119 v LIST OF TABLES TABLE Page 1. Means and SDs for Total Number of Responses for Each Group........................................ 54 2. Means and SDs for Total Primary Process Scores for Each Group.................................... - 55 3. Means and SDs for Total Level 1 and Total Level 2 Scores for Each G r o u p .................. 57 4. Means and SDs for Defense Demand Scores for Each Group........................................ 59 5. Means and SDs for Total Content and Total Formal Scores for Each Group.................... 51 6. Means and SDs for Level 1 and Level 2, Content and Formal Scores for Each Group............... 63 7. Significance Tests (t-tests) for Level 1 Content and Formal Scores and Level 2 Formal Scores for Main Groups...................................... 65 8. Means and SDs for Adaptive Regression Scores for Each Group................................... 6 6 LIST OF FIGURES FIGURE Page 1. Mean Number of Rorschach Responses (R) for Each Group......................................... 53 2. Group Means for Total Primary Process'—Scores . . 56 3. Total Level 1 Mean Scores and Total Level 2 Mean Scores for Main Gr o u p s.................... 58 4. Mean Defense Demand (DD) Scores for Main Groups 60 5. Total Formal Mean Scores and Total Content Mean Scores for Main Groups........................... 62 6. Means on Each Component of Total Primary Process for Main G r o u p s ......................... 64 7. Group Mean Scores on Adaptive Regression .... 67 vii CHAPTER I STATEMENT OF THE PROBLEM Introduction The resemblance between the symptoms of mental defi ciency and schizophrenia has been noted by many observers. This resemblance has resulted in errors of classification and treatment as pointed out by Potter (19 33) over thirty years ago. As recently as 19 58, Sarason and Gladwin have reiterated this problem: As a result of work in the last 20 years on child hood schizophrenia there is little doubt that many children who were committed to an institution for the mentally defective were in fact misdiagnosed and mis placed. . . . While one would like to believe that our institutions are admitting far fewer of these cases, there is not evidence that this is the case [p. 179] . Manner's (1944) description of the autistic child may lend support to the view that personality maldevelopment rather than intellectual maldevelopment was, and possibly still remains, an unrecognized factor in misdiagnosis. There has been increasing concern with ego deviations of the schizophrenic child paralleled by a dearth of research on the problem of ego development of the retardate. Sarason and Gladwin indicate that the diagnostic process is a very 1 complicated one when one is faced with the problem of psy chosis, but rarely is the mental defective studied in this way: "When an individual with an IQ of 180 behaves pecul iarly we do not assign the cause to his IQ, but should an individual with an IQ of 50 behave similarly we usually point to the IQ as the etiological agent [1958, p. 313] ." The mentally retarded individual is not merely a normal whose mental age is lower than his age peers. Dif ferences have been found in many areas of functioning (Berk- son, Hermelin, & O'Conner, 1961; Carrier, Malpass, & Orton, 1961; Cromwell, Palk, & Poshee, 1961; Gibbs, Rich, Fois, & Gibbs, 1960; Martin & Blum, 1961; Merachnik, 1960; Zeaman & House, 1959; Zigler, 19 62) but interest in personality aspects has been negligible (Heber, 19 64). This is high lighted by a recent survey of hospitals for the retarded in the U.S. (Silverstein, 1963) which indicated that personal ity evaluation was the most crucial need at the present time. This study is an attempt to apply recent theoretical advances in ego psychology to two clinical populations: (1) the primarily retarded adolescent and (2) the primarily schizophrenic adolescent. The conceptual framework specif ically relates to the further developments, within ego psy chology , of the psychoanalytic postulation of primary and secondary thought process. The study focuses upon analysis of thinking in terms of manifestations of primary process. It is assumed that ordinarily conflict-free thought proc esses may be affected by emotional factors which introduce conflict, and also by constitutional limitations. Basically the groups differ in tested intelligence, which may be considered an ego function (Hartmann, 1950). Many studies, primarily case histories, repeatedly refer to ego disturb ances in schizophrenic patients. However, ego disturbances are too frequently spoken of in a vague manner which has discouraged experimentation. Although behaviorally the mental retardate shows deficiencies in ego functioning, to the writer's knowledge there has been no systematic investi gation of thought process as an ego function. Theoretical Background Theoretical considerations clearly point to the association of disturbed ego functioning with emotional fac tors. This study is therefore an attempt to test this gene ral hypothesis of defect of ego functioning and to provide clarification and possibly increased precision for the concept of ego functions by specifying the ego function and the actual testing procedures. The contributors to Kasanin's (19 46) monograph all share the view that there are critical formal aspects of schizophrenic thought, but also there is a great need for improved conceptualization of the thought processes involved. Basic to the ego function being investigated is the additional postulate that there is increased differentiation whereby the more primitive thinking is supplemented, although not totally replaced, by secondary processes. Theoretical issues with which this study is prima rily concerned come from the related fields of ego psychol ogy/' genetic psychology, and projective theory. The specif ic issues within each of these areas is the concept of the ego, the developmental progression of thought processes and adaptive regression, and the dynamics of projection. More specifically the theoretical assumptions underlying this study are that ego functions exist, that they develop and mature, and that projective techniques (Rorschach test particularly) not only tap these functions but indicate the form of development as well as regressive features such ego functions may have taken. Although the line of demarcation between these areas frequently becomes blurred, each will be discussed separately with the knowledge that such division is arbitrary. Concept of the Ego and Ego Functions The ego is an abstract concept referring to aspects of behavior which are capable of delay, bring about delay, or are themselves products of delay. The philosopher, Cassirer (1944) indicates that there is a special function which humans in contrast to animals have, which permits delay of response to an impulse. There is an unmistakable difference between organic reactions and human responses. In the first case a direct and immediate answer is given to an outward stim ulus; in the second case the answer is delayed. It is interrupted and retarded by a slow and complicated process of thought [p. 24]. Neither a precise definition of the ego, nor a complete description of ego functions has been made. The most universal definition is that the ego is defined by its functions (Hartmann, 19 50) . This is recognized as an arbi trary designation which will be correspondingly altered as knowledge of ego functioning increases. Hartmann (19 59) elaborated an earlier concept of Freud's (1938, 1958) in which he hypothesizes that the ego develops partly through conflict with reality and partly out of autonomous conflict- free growth. The ego essentially develops, therefore, through learning and maturation whereby environmental, cultural, and inherent factors exert their unique influences on the growing organism. This investigation focuses upon one aspect of ego functioning which is cognitive and central to any concept of ego strength (Hartmann, 19 50). The construct of ego strength is recurrent in literature because of its practical importance in treatment. It was first referred to by Hendricks (1934) as "ego potentiality" and "strength of character." Fenichel (1954) defined it in terms of responses to specific situations. Although his formulation is valuable, doubt has been expressed concerning its working practicality. His formulation is expressed largely in terms of energies and their blocking, with the underlying assumption that ego strength is a simple function of the amount of anxiety to which the individual was exposed during early childhood. More recently White (19 63) has presented a restatement of ego strength in terms of developing compe tence in dealing with impulses and the environment which is closely related to Hartmann's (1958) idea that the ego does not make all its gains in stress situations but also learns and develops in conflict-free situations. That the concept of ego strength is not an artifact of theorizing is suggested by the emergence of a similar concept in the factor analytic approach to the study of per sonality. In his investigations of the measurement of traits Eysenck (1953) has repeatedly come out with a basic dimension characterized at one end as "neuroticism" and at the other as something akin to "will power." Submitting the MMPI to factor analysis, Kassebaum, Couch, & Slater (1959) found what appeared to be the very same factor which they labeled "ego weakness vs. ego strength." Low scorers evi denced general maladjustment, an^^ety, dependencies, and tendencies toward psychological disorders whereas high scorers were free from anxiety and psychopathology and showed tendencies toward leadership and effective intellec tual ability. Recent case studies and theoretical approaches in ego psychology have been increasingly concerned with deline ating the specific ego functions. Marcus (19 61) reveals this increasing trend toward clarification of meaning of the ego functions in discussing ego disintegration in schizo phrenia : What emerges is primary process thinking. Logical thought processes give way to archaic, infantile ways of dealing with the world. Rules of logic, of time and space, of cause and effect cease to exist. The world is perceived in terms of magic and wish fulfillment. Instead of orderly, reality oriented thought processes, there is the use of the primary process mechanisms of displacement, condensation, symbolic thought and con- ' crete—thinking Epp* 369-370]. In clinical practice, however, the emphasis is still primarily centered upon ego dysfunction as a general phenom enon (Bychowski, 1947; Hendrick, 1951; Stern, 1945; Weil, 19 53). At the same time there also appears in the litera ture a trend away from nosological nomenclature and toward a more precise definition based upon ego deviation with the concomitant emphasis on growth process (Erikson, 1950). Esman (19 60), for example, proposes that the term childhood schizophrenia be replaced by "ego pathology." He calls for a more careful delineation of those ego functions which are impaired, maintaining that a review of the literature indi cates that the schizophrenic syndrome in all cases is a state of severe ego disorganization, maldevelopment, or both. Borderline, potential, and ambulatory schizophrenias all refer to gradients of ego disorganization. Contradic tory and often confusing results found in the studies attempting to differentiate schizophrenia from other syn dromes has already led investigators toward attempting to make more careful distinctions between various types, degrees, and forms of schizophrenia. The more clear-cut findings when schizophrenic patients are classified into "process" and "reactive" suggests the value of greater pre cision and homogeneity of samples (Kantor, Wallner, & Winder, 1953). In this connection, Lewinsohn & Riggs (1962) found differential impairment of content reactions between "chronic" and "acute" schizophrenics. Thought Process As an Ego Function The writer has been guided by the categories broadly formulated by Beres (1956) and Beliak (1958). In discussing the disturbance of thought process in schizophrenia Beliak (1958) states: "The formal characteristics of schizophrenic thinking are identical with the formal descriptive charac teristics of the primary process [p. 19]." The particular approach of the present study is an analysis of thinking in terms of manifestations of primary process functioning. Psychoanalytic theory postulates two forms of mental func tioning, primary and secondary, which are considered hypo thetical extremes of a continuum. Secondary process refers to mature, realistic, socialized thought while primary proc ess seeks immediate gratification of drives with formal characteristics which disregard reality and logic. The sys tem of Rorschach analysis utilized in this study grew out of the psychoanalytic distinction between primary and secondary process. This system deals heavily with ideational content of the response in contrast to the traditional focus upon formal aspects. Despite the fact that there appears considerable interrelationship among the various functions, the most feasible approach is to study the development of the separ ate functions. Remaining cognizant of the fact that no ego function is an encapsulated entity, the focus of the study is to analyze the thinking process within the framework of ego psychology. Selection of thought process as the function under study is based on a number of considerations. First of all, and most importantly, disturbances of thought processes are emphasized in all studies of schizophrenia (Beck, 1954; Bender, 1947; Beres, 1956; Bleuler, 1913; Holt & Havel, 19 60). In fact the criterion universally agreed upon for diagnosis of schizophrenia is the presence of primary proc ess thinking. Second, it appears to be highly correlated with the general concept of ego strength. Third, thought disturbance has not been systematically investigated within the retarded population. To understand pathology of thinking we must have some theoretical structure for the development of thought. Whether such cognitive functions have regressed or become fixated must come from a model of normal thought develop ment. For this purpose Rapaport's (1959) integration of the 10 collected material concerning normal and pathological phe nomena of thought will form the framework within which thought process and its disturbance will have greater mean ingfulness as they may be treated in a systematic rather than piecemeal manner. Rapaport indicates that the theory of thought process is a crucial segment of ego psychology/ and the growth of ego psychology depends in part on their exploration. Rapaport1s primary model of thought is: mounting drive-tension— absence of drive object— hallucinatory image of it. The hallucinatory image implies a memory trace of gratification-experiences. In this primary model cathexes are directed toward the memory trace of gratification con ceptualized as wish fulfillment. The motivating force which propels an idea to consciousness is its drive cathexis. Ideas are therefore indicators of drive-tension and also safety valves of drive-tension, and therefore are consid ered drive representations. What Hartmann considers autono mous functions, such as perception, are to be considered structural characteristics which place limits upon cathetic discharge. When the ego emerges these structures are embodied in it and provide the basis of its autonomy. Delay of discharge may be due either to structural limitations or to absence of a need-satisfying object. The immediate effect of delay is that experiences preceding, surrounding, and possibly following gratification accumulate in the form 11 of memory traces. It is the organization of these memory traces which has prime importance in the development of thought processes. All memories are organized around drives which either through delay or discharge emerge first as hallucinatory images and later as ideas. Let us now turn to the development of the secondary process which Rapaport refers to as conceptual organization (as differentiated from drive organization which is the primary process). In the course of accumulating experiences of delay, ideas become no longer bound to a single drive. Delay is a crucial element in the development of the organi zation of controls conceptualized as the ego. An experien tial connection system of progressively more differentiated and discrete ideas are superimposed upon drive organization. The cathexes become more limited as . the cathexes can no longer be concentrates of all other representations of a drive, but only to those meaningfully connected in terms of experience. A stable, reliable, orderly view of the world becomes possible. As a result memories replace hallucinated reality as well as an effort to find a need-satisfying object in reality. Thereby the connection of one idea to another is no longer determined by drive-belongingness but reality belongingness--such as space, time, contiguity, and similarity. Secondary process thought can cathect all but repressed memories and therefore becomes an important means 12 of reality appraisal. A specifically intensive development of secondary process thought is seen in intellectualization which has the effect of neutralizing considerable amounts of drive-energy. Thinking is not ever purely secondary process but reveals through such formal errors as pars pro toto and post hoc propter hoc as well as content reflecting wishful thinking the vestiges of primary process thought. The ability to be aware of oneself and one's thoughts, for example "this is just a dream" involves sus tained thinking within a given realm and direction. Such reflective awareness is characteristic of the secondary process and its disturbance is evident in the conceptual level shifts noted in disordered thinking. Primary process thinking cathects only drive representations and is charac terized by limited or absent reflective awareness. An exam ple of this is seen in the hallucinations and delusions of schizophrenic cases which are drive-cathected and unaccom panied by reflective awareness. Interference of self-aware ness due to either developmental or pathological states is characterized, among other things, by a specific form of thought organization. Piaget's conclusions link reflective awareness to socialization of thought. The changes that occur in development include a shift from the pleasure prin ciple to the reality principle; from the short-cut of reach ing a goal by fantasy, to a detour to the goal in reality; by super-position of a conceptual organization upon the 13 drive organization; by a shift from idiosyncratic ideation to thinking syntonic with society. The process by which socialized thought develops is still only slightly understood. Piaget’s studies (1928, 1932) indicate a transition from "egocentric" to a higher level thought which embraces the relativity of qualities. Psychoanalytic dynamics stress the concepts of introjgction and identification. Briefly, the introjected love objects (the first social relationships) to the extent they become integrated, give rise to a homogeneous ego. The organiza tions which follow introjection, conceptualized as identifi cation, permit the individual to observe himself through the eyes of others thereby allowing himself to be the object of his observation. The development is not independent of reality testing and secondary process, and as with communi cation is closely involved in the developing ego function. The necessity of communication in the development of logical thinking has been emphasized in the studies of Piaget (1930, 1932, 1937). Communication is viewed as both the cardinal means and the index of socialization of thought organization. The significance of communication and inter personal relationships for the development of thinking has been little explored. Besides Piaget, only Sullivan (1944) and Bernfeld (1941) appear to have appreciated its signifi cance. The latter two authorities have expressed their insight as theoretical inference from experience rather than as empirical findings. Sullivan (1944) coined the term "consensual validation" to indicate that concepts and think ing become reality-adequate only by being tested in inter personal communication. .Bernfeld approached the problem from the reverse side, showing the effects of secrets on communication. Rapaport has also made observations on the significance of communication, which he maintains enhances the integrating function of the ego. He essentially sees communication as enriching the store of experiences and thereby creating new relations between ideas, and relation ships between relationships, which in turn combat the spread of ego-limiting defenses. Explanations of thought pathology have generally centered upon one aspect, such as "abstract vs. concrete attitude." Rapaport (1959) maintains that a review of the literature in thought pathology points up the inadequacy of such a narrow formula. Many have advanced formulations which may eventually emerge into a complex explanation for this complex disorder (Bleuler, 1950; Hartmann, 1958 ; Schilder, 1942). The most meaningful approach would seem to lie in attempting to determine differential specificity of thought disorders revealed in various conditions. The mate rial in this area remains fragmentary and highly specula tive . 15 Concept of Developmental Progression Interest in the multiple features of personality development is shared by many psychological disciplines. Piaget (Flavell, 1963) postulates developmental sequences for various aspects of functioning. The developmental sequence is invariant although the age at which a given stage occurs has been shown to vary considerably. Studies of children on the development of thought processes indicate a progression from early prelogical and irrational thought to more mature reasoning and logical thought (Inhelder & Piaget, 1958). These processes have a parallel in the writings of Werner (19 48) who contends that immature and mature psychological development can be described as rela tively undifferentiated or as differentiated and hierarchi cally integrated. Within this conceptual structure develop ment is never complete, proceeding as it does through the dual paths of maturation and learning. Within ego psychology this development is denoted as a progression from primary process thought to secondary process thought. Holt (19 56) defines primary process and the characteristics by which it is recognized most clearly. When primary process thought is dominant ideas shift read ily, lose their identities through fusion and fragmentation become concrete and pictorial, and are combined in seemingly arbitrary ways in disregard of time and logic. The second ary process develops from the primary, the latter consti 16 tuting the underpinning for the more rational secondary process. The thought process, with ego development in gene ral, is therefore a differentiation whereby the more primi tive primary processes are increasingly replaced or supple mented by the more effective secondary processes. It should be noted that progression from primary to secondary process with its basic characteristic of directedness is observed in other areas of functioning also. Rapaport and Gill (1959) cite occurrences in psychopathology which reveal that when the mature aspects break down there is a falling back upon previous modes of adapting. The implications of this for thought as well as affect is that there are qualitative changes; variety increases while intensity becomes less. Fenichel (1954) refers to this as "taming." When there is decompensation of thought and affect regulating attunement to a situation one observes inappropriate affect and think ing, which has been considered the hallmark of schizo phrenia. The postulation of psychic systems which are older and more primitive, as opposed to more recent and mature within ego psychology, permits for a developmental concept of regression. Freud (1938) has stated that thoughts which have been repressed will yield to the primary process and show themselves in the formal qualities of this primitive mode of representation. Subsequent elaborations, incorporating the later 17 ideas of ego psychology, have differentiated between the two modes of thought. It has been affirmed that not only is primary process more primitive and less socialized than sec ondary, but that it operates with unneutralized drive energy while secondary process is relatively neutralized (Rapaport, 1959; Schafer, 1958). In other words, in primary process thought is under the domination of drives. Hartmann postu lates that the degree to which drive energies have been neu tralized may coincide with the degree to which secondary process has replaced primary process. Such impaired ability for neutralization and the concomitant greater reliance in primary process may therefore be the fundamental ego disor der in schizophrenia. Beliak (1958) has also reinforced this view and additionally maintains that thought disturb ances are the most sensitive indicators of ego disturbances. Concept of Projection The projective hypothesis has been extensively dis cussed by writers in the field (Beliak, 1954; Frank, 1939; Rabin, 1960; Rapaport, 1952; Sargent, 1945; Schafer, 1954). Paraphrasing Frank, projection assumes that each person has a private world which is structured according to the organ izing principles of his personality. Projective testing then studies these organizing principles by inducing the subject to bring them to bear on more or less unstructured material. It is now recognized that even the most simple perceptual experience bears the imprint of the perceiving 18 subject. Rapaport, Gill, & Schafer (1946) view the proc esses that occur in the subject as follows: . . . When the subject is asked to respond to a given test-item, a thought process is set off; and when a reaction is obtained it represents the end-point of a thought process. This thought process may be of a purely associative character, as in the Association Test; or of an intertwined associative and perceptual organizing character, as in the Rorschach Test; or of a complex intertwined perceptual and logical-narrative organizing character, as in the Thematic Apperception Test. However, in all of them it is a thought process through which— or through the product of which— person ality manifests itself [p. 10-11]. Both Schafer (1954) and Rapaport (1950, 1952) have made distinguished contributions toward integrating theory and projective techniques. The shortcomings of both attempts at synthesis of theory and technique have been explored by Lindzey (19 61) who indicates that systematic relationships between theory and tests remain unclear. Not withstanding, Rapaport1s and Schafer's works remain the most thorough efforts that have been undertaken. Hypotheses Following the theoretical considerations of Freud, Rapaport, and Hartmann indicating that when there exists a relatively weak ego, e.g., in schizophrenia and mental retardation (Hutt & Gibby, 1960), ability to neutralize energy is reduced or impaired. If we grant the distinction between drive-dominated and concept-dominated thought, degree of impairment in neutralization will be revealed in increased primary process thought. The dimensional scheme 19 is the one favored in this study, based as it is on the notion of growth, assuming that primary process is primitive and early while secondary process is later and more mature. Theoretically, intellectual deficit in the form of mental retardation is barely touched upon in the literature of ego psychology. For example, Rapaport's (1951, 1959) compilation of the major contributions toward the growing concept of ego psychology includes no reference to the effects of intellectual deficit. Therefore the placement of the retarded on any of the continua arises from assumptions and reasoning beyond explicit theory and should be consid ered tentative. The reasoning proceeding from conceptual issues is that: (1) an autonomous ego function, such as intelligence, interacts with all others (Hartmann, 1950), (2) mental retardation suggests fixation of development (Rosenblatt & Solomon, 1954), (3) psychopathology is con ceived as accentuation of primary process thought (Beliak, 1958) , (4) although empirical results based on normal popu lations show regular progression over ascending age levels in the development of ego functions (Hartmann, 19 50; Wyatt, 1958), it is expected that emotional or intellectual dis turbance will result in arrested development of thought process under investigation, and (5) it is expected that severe emotional disturbance which also lowers effective intellectual functioning will have a more pervasive conse quent upon thought process than intellectual deficit alone. 20 The Ss referred to in the following hypotheses are: SC--schizophrenic adolescents, MR--mentally retarded adoles cents, MA— normal adolescents. The levels refer to the position' on the primary-secondary continuum. Level 1 weight represents a predominance of primary process, while a Level 2 weight assumes a greater admixture of secondary process. Defense Demand is partially a refined elaboration of levels. This rating indicates the defensive measure necessary for a response to become a socially acceptable communication. Hypothesis I Schizophrenic adolescents will reveal a higher mean total primary process score than either the normal or the mentally retarded adolescents. SC>MR>NA Hypothesis II Level 1 primary process scores will differentiate the three diagnostic groups more markedly than Level 2, and the schizophrenic adolescents will show the highest mean Level 1 primary process score. SC>MR>NA. Since Defense Demand is also considered a measure of degree of primary process the means are predicted in the same order and direction. Hypothesis III Formal primary process scores will differentiate the three diagnostic groups more markedly than Content, and the schizophrenic adolescents will show the highest mean Formal 21 primary process score. SC MR NA Hypothesis IV Normal adolescents will show greater adaptive regression than either the schizophrenic or mentally retarded adolescent. The hypothesis refers to the S_'s degree of mastery over primary process manifestations. NA MR SC CHAPTER II PREVIOUS STUDIES The Rorschach Diagnostic Test is the instrument of choice for the investigation of ego functioning. Although the literature is.replete with dialectic material it should be noted that there are few studies that bear directly upon the present investigation. It has been attested that the Rorschach record reflects ego organization as it is shaped by the level of maturation (Klopfer, Ainsworth, Klopfer, & Holt, 1954). The writings of Rapaport (1952), Schafer (1954), and Rapaport, et al. (1946), give detailed observa tions of disturbances of thought processes and their diag nostic significance. This section is organized as follows: (1) a review of emotional conflict as it may be associated with mental retardation; (2) normative and developmental studies using the Rorschach test with preadolescents and adolescents will be briefly reviewed; (3) discussion of studies using the Rorschach in the traditional manner in studying the re sponses of mentally retarded and schizophrenic individuals; (4) a review of studies within two contemporary approaches 22 23 applied to Rorschach responses, namely, a developmentally oriented and a psychoanalytically oriented system where one observes greater formalization than heretofore common in Rorschach literature, and (5) related studies of language functioning are considered. Emotional Conflict and Retardation Related to the problem of differential diagnosis has been the research on the interdependence of emotional and intellectual factors. Goldfarb (1943) , Lund (1940) , Richards (1940), and others have revealed the interrelation ship between level of functioning, as measured by IQ, and the emotional status of the individual. Despert & Pierce (1946) emphasized that intellectual functioning showed fluctuations which were influenced by the child's total adjustment. They called for the use of projective tech niques, in addition to the usual psychometric procedures, to aid in detecting those factors inhibiting intellectual func tioning. Others (Jolles, 1947; Sloan, 1947) have investigated the importance of personality adjustment as a factor in the etiology of mental deficiency. Jolles suggests that mental deficiency is a symptom of personality disorder rather than an indication of limited mental ability. His findings have been critically evaluated by Sarason (1949) who maintains that: "All Jolles' data may indicate is that some of his cases give schizophrenic-like responses. It does not follow 24 that these responses have the same significance for both groups [p. 247]." According to Pollack (1958), when both intellectual deficit and emotional disturbance are present, the diag nostic emphasis should be placed on the most prominent aspect. The crucial problem seems to be whether the schizo phrenic reaction is mistaken for signs of mental defect (Bergman, et al., 1951) or whether mental defect is mistaken for schizophrenia. Many of the inconsistencies in the data gathered on the association of schizophrenia and mental retardation appear to be due to differences in the populations studied. Benton (19 64) has indicated that too frequently when a tester finds a high incidence of Rorschach signs of abnor mality in retardates he concludes that many retardates are disturbed without either a control group or an attempt to relate these signs of abnormality to behavior within the retarded group. A careful investigation by Klausmeier & Check (19 59) indicated that there was no evidence that as a group the retardates suffered particularly from emotional inhibition of intellectual function. Beier (1964) mentions that factors contributing to contradictory results include errors in sampling, errors in methodology, and nosological confusions. The discrepant figures presented in O'Conner's (19 51) review would suggest that presently no accurate estimate of the coincidence of psychosis with mental 25 retardation can be made. Although there exist diverse views concerning child hood schizophrenia (Bender, 1942; Kanner, 1957; Mahler, 1952), as well as the relationship of schizophrenia and other emotional disturbances to mental deficiency, there is keen awareness of problems of differential diagnosis between the predominantly emotionally disturbed and the mental defective. Certainly, severe emotional disorders occurring in childhood impair intellectual functioning. Garfield (19 63) points out, however: . . . The incidence of disturbance among retarded indi viduals is not so high that one should associate one with the other. Most mental retardates do not give evi dence of serious emotional disturbance, nor do they manifest a particular stereotyped personality [p. 588]. Normative Rorschach Studies The applicability of the Rorschach to adolescents requires consideration of normative, developmental, and validation studies of adolescent Rorschach responses. There are fewer studies on adolescents than on children, probably due to the fact that young children were found to respond to the Rorschach in deviant ways calling for early normative data. Adolescents, on the other hand, did not appear to respond in a way dramatically different from that of adults. Consequently, until relatively recently, normative data were not gathered. Hertz (1935) was notably the first to compile norms for adolescents. Her longitudinal studies (1942, 1943a, 1943b; Hertz & Baker, 1943) give detailed information 26 on changes that occur in movement and color responses from the age of 12 to 15. Another group of publications on adolescent Ror schach responses have come from the Institute of Child Wel fare at the University of California at Berkeley. These records were collected as part of an eighteen-year longitu dinal study under the direction of Jean MacFarlane. The first study (McFate & Orr, 1949) is a statistical presenta tion of age norms for many of the traditional Rorschach scoring variables. Additional studies analyze Rorschach records in great detail. Ranzoni, Grant, & Ives (19 50) examined the stimulus properties of the cards and cautioned against the use of standard types of injterpretati/e state ments. Ives, Grant, & Ranzoni (1953) studied the incidence of "adjustment signs" and "neurotic signs" for each age. They found a very high incidence of neurotic signs in this group of normal adolescents which makes the validity and usefulness of such signs questionable with adolescents. Beck and associates (Rabin & Beck, 1950; Thetford, Molish, & Beck, 19 51) have presented norms which differ from most of the preceding articles, markedly showing a much r lower W%. This finding is undoubtedly related to a more critical scoring of W within Beck's system. Other normative data are presented by Hershenson (1949), Paulsen (1943), and Suares (19 38) . One of the more unusual approaches is that of Steiner (1951) who used physiological status rather than 27 age as a developmental criterion. This study compares group Rorschach responses of 100 prepubertal girls, aged 10-14 with 100 pubertal girls, aged 10-15. Group averages revealed that the pubertal group were more constricted than the prepubertal group. Validation studies have either used contrasting groups or correlation techniques. The greatest number of studies of any one group of adolescents have used delin quents. In 19 4 7 Schmidl reviewed both American and European juvenile delinquency research using the Rorschach. The major criticism arising from his review was that many investigators considered delinquents as a homogeneous group, while in actuality no adequate topology of delinquency has been established. Much of the recent research in juvenile delinquency retains the shortcomings that Schmidl noted previously. Another shortcoming of many of the studies is the lack of a normal control group (Bowlus & Shotwell, 1947; Endacott, 1941; Weber, 1950). Significant differences have been found between delinquents who have committed particular types of crime and between delinquents and non-delinquents on such Rorschach indices as hostility, anxiety, and fantasy (Gorlow, Zimet, & Fine, 1952; Jacobs & Graham, 1952). The importance and value of using the developmental approach with the Rorschach is clearly delineated by Ricciuti (19 56). He points out that many tests may not 28 measure the same thing at different ages. For example, formboard performance at age 4 or 5 might primarily reflect differences in spatial perception, while with older children the same formboard might principally measure individual dif ferences in psychomotor speed. Tests of this type, utiliz ing a quantitative scoring system alone, may reveal a growth curve combinings several functions, each of which may have a different pattern of growth. Spivack (1963) points out this very problem in the study of perceptual processes. Noting that there are no reports of developmental studies of per ceptual processes, it is an open question whether the lack of differences found on certain perceptual tasks, between adolescent retardates and adolescent normals can imply com parable growth processes. The similar findings between nor mals and retardates on constancy and illusions, for example, may mask the fact that they developed at different rates or had different developmental curves during childhood or latency years. That such developmental research is indi cated finds support in a study by Teuber & Rudel (19 62). Using brain injured and normal groups the performance depended upon the task and chronological age. On one task, for example, the two groups significantly differed at CA 5 but the difference decreased with increased CA, revealing no difference at age 13. Traditional Approaches and Rorschach Findings In 1921, after experimenting with the inkblots for 29 approximately ten years, Rorschach published his monograph, "Psychodiagnostic." His guiding conception was that responses to such stimuli were an indication of both intel lectual level and affective and conative dispositions. He found that the defective protocols, in contrast to the non defectives, were characterized by: (1) responses not fitting the area chosen (F-); (2) pure color (C); (3) no human movement (M); (4) high percentage of animal responses (A%); (5) frequent confabulatory responses (DW); (6) few whole (W) responses; and (7) many oligophrenic details (Do). Rorschach's "norms" have very limited usefulness as certain features raise doubt regarding the representative ness of the sample. His findings are based on only 12 men tal defectives and the criteria by which the individuals were diagnosed is not given. Neither the method of selec tion, CA, nor etiological factors were discussed. Further more, it cannot be determined whether these cases were institutional or not. Despite such shortcomings, subsequent investigators have tended to assign normative importance to Rorschach's results. Beck's (1932) study of mental deficiency represents the first dissertation using the Rorschach test in the U.S. The subjects were all institutionalized and the M.A. range was kept continuous from 2-6 to 10-5. The results generally confirmed Rorschach's findings relating to F% and A% but with fewer Do responses and a slightly higher W range. This 30 latter finding would be expected since Rorschach did not utilize any forms of combinatory wholes, labeling almost all parts of a response as separate details. Recent studies have been generally limited to iden tifying etiologically different mental defectives (Feldman, 1953; Gallagher, 1957; Werner, 1945), differentiation of defectives from groups with normal intelligence (Alvarez- Tostado, 1947; Arbitman, 1953; Davidson & Klopfer, 1938; Sloan, 1947), case studies of defectives (Font, 1950; Hack- bush, 1946; Jolles, 1947), and differentiation between men tal defectives and individuals with personality disorders. The investigation is related to the latter and therefore only those studies comparing presumably organic ally sound mentally retarded children with psychotic chil dren will be included. With the exception of a single case study (Clarke, 1946) in which the Rorschach aided in a differential diag nosis between schizophrenia and mental deficiency, there has only been one Rorschach study attempting such comparison. Piotrowski (1937) used 26 children; 10 schizophrenic and 16 high-grade "unstable mental defectives," roughly within the age range of 6 to 16, MA 3-10. He found that the schizo phrenic children showed: (1) greater perseveration of a personal nature; (2) uneven performance; (3) large per cent of 0- responses; (4) absence of inductive reasoning. It is exceedingly difficult to evaluate this study since much 31 information which any reviewer needs for intelligent evalu ation remains unclear from the report. On what basis was the selection of subjects made? What was the method of administration and scoring? Were all the tests administered by one individual? What group was being referred to as "normal" children? Were all members of the group institu tionalized? Was age of initial institutionalization similar for the two groups? The same intelligence test was not used for all members— what were the other tests used? These are only some of the many methodological questions that may be raised. Thetford's study (1952) focused on differences in fantasy between normal and schizophrenic children aged 6-17. The purpose was to highlight some aspects of normal develop ment through comparison with abnormal fantasy living. He hoped this would provide greater insight into the nature of growth processes which might characterize the two groups. Fifty schizophrenic children (16 girls, 35 boys) and 179 public school children (84 girls, 95 boys) comprised the two groups. He divided the subjects into three age groups cor responding to latency, prepubescent, and adolescent stages. The major findings are reported (except for category com parisons) in terms of number of M responses. Cronbach (19 49) indicated that the significance of a Rorschach vari able depends upon the total number of responses. In this study neither percentage nor total number of responses is 32 reported. What is meant by "significant differences between the groups" cannot be interpreted since neither raw data nor the form of statistical analysis is included. The methods used or criteria for the schizophrenic diagnosis is not given, except that they had previously been diagnosed as schizophrenic. By whom, over what period of time, what was the level of functioning, and were they institutional chil dren are all pertinent but unreported information. Cobrinik and Popper's study (19 61) of thought dis turbance in schizophrenic children, used 4 8 white boys ages 8 to 13. The major weakness of this study is a lack of control group which limits the validity of their finding that there is a decline in thought disturbance in schizo phrenic "children as they approach adolescence. Might a con trol group of normal children show the same reduction of thought disturbance with age? One of their two criteria for inclusion in the sample was "those showing no definite schizophrenic features in the test pattern but where there was no strong impression to contraindicate the diagnosis." Not only is the negative aspect of this criterion question able, but it also could embrace a wide variety of disturb ances . While Beck's study (1954) presents an analysis of thought processes which characterize different schizophrenic types, its focus is upon the interaction of more general aspects of function, such as emotional forces and defenses. 33 From Beck's data it is difficult to define the general inci dence of thought disturbance at different ages or the types of disturbance which may be pathogenic for specific age groups. Contemporary Approaches and Rorschach Findings In developmental Rorschach studies it would seem apparent that the percentage of any location scores for groups of children, adolescents, and adults represent quali tative differences and therefore it is relatively meaning less to plot percentage against age. An example of the qualitative differences in the underlying processes is necessary for an understanding of the psychological impli cations. It is just such a procedure that has been devel oped and refined within Werner's (1948) theoretical formu lation. Wyatt (1953) has indicated that the over-all aim of these studies is "an experimental demonstration of the cog nitive functioning of the ego as determined by development, or by its undoing in psychopathology . . . [p. 149]." The major tenets of this developmental approach are: (1) development proceeds form a state of relative non differentiation to a state of increasing differentiation, articulation, and hierarchic integration, and (2) that much deviant human behavior can be explained in terms of regres sion and fixation of ego functioning. There has been an increasing number of studies indicating support for this 34 theoretical position. The researches of Frank (1951) , Friedman (1953) , Pena (1953), and Siegel (1953) center upon perceptual regression. Regression is here defined as relative accen tuation of genetically early and therefore less differen tiated functioning. The developmental approach predicts that the more seriously impaired clinical groups would show a preponderance of genetically early, or what this group of researchers term "low," responses and that there would be an increase of genetically high responses as impairment decreased. Clinical groups would then show increasing maturity in the following positions: hebephrenic-catatonic schizophrenics, paranoid schizophrenics, neurotics, and normal adults. The over-all evidence from these studies is in close agreement with these expectations. Hemmendinger's (19 53) ontogenetic study of children between 3 and 10 years of age appears to confirm the basic principle of development. With increasing age there was a decrease of undifferentiated responses and an increase of articulated responses. At the ages between 6 to 8 a shift from the early undifferentiated wholes to small details was noted which declines in favor of integrated whole responses in later childhood. Another approach within this developmental frame work, has been the study of perception as a developing process rather than an end result. Such a developing proc- ess has been demonstrated by Framo (19 52), utilizing tachis- toscopic presentation of the Rorschach. A comparison of Framo1s data on normal adults with Hemmendinger's shows a similarity in the shape of the curves as exposure time increases for normal adults and as CA increases for chil dren. An additional implication of developmental theory has been studied by Freed (19 52), which relates to the predic tion that the most immature groups would not show higher level responses with increased time. Freed used the same design as Framo but his clinical group was hebephrenic- catatonic patients. He found that at the shortest exposure time (.01 sec.) the schizophrenic group did not differ from the normal group. However, as presentation time increased, the schizophrenic, unlike the normal, did not reveal improved perceptual performance. Although the above studies adhere quite rigorously to the study of genetic or structural aspects of "percep tion" it is recognized within this group of researchers that location categories may reflect other psychological proc esses, such as thinking. Hemmendinger (19 60) indicates that any of the organizing processes can be conceived in develop mental terms and that the Rorschach can reflect aspects of how thought processes occur and develop. In line with this appeal one notes Rapaport1s (1957) consistent admonishment to distinguish between "fixed tools of thought," involved in tests such as similarities and dif 36 ferences, and "processes of thought" involved where existing concepts are not so relevant. There has already been a broadening of the use of the genetic scoring system in the attempts to relate genetic level to such factors as adap tation to stress, social attainment, and various psycholog ical control mechanisms (Hurwitz, 19 54; Lofchie, 19 55; Wald- man, 1956; Wilson, 1954). Despite the differing theoretical orientation, the Rorschach studies utilizing Holt's system have also dealt with measurement of deviations in thinking. Holt's (19 63) highly elaborate system for the scoring of Rorschach responses has been developed in an attempt to operationalize the concepts of primary and secondary thought. Such studies have ranged from measurement of the effects of perceptual isolation (Goldberger, 1958, 1961; Goldberger & Holt, 1961; Holt & Goldberger, 1959; Leiderman, 1962) to assessment of differences between reactive and process schizophrenic adults (Zimet & Fine, 1965; Zukowsky, 1962) as well as to an attempt to compare thought disturbance of adolescent schizo phrenics with other personality disorders (Silverman, Lap kin, & Rosenbaum, 1962). Several studies (Cohen, 1960; Goldberger & Holt, 1961; Pine & Holt, 1959) have indicated the reliability and construct validity of Holt's system together with its potential usefulness as a research tool. Linguistic Expression and Schizophrenia A process closely related to thinking is the lan- 37 guage function. Frequently whether a study is labeled language or thinking has been an arbitrary decision on the part of the experimenter. This is particularly true where investigations have considered the qualitative character istics of language performance. The studies within this area have been concerned primarily with the analysis of psychotic, principally schizophrenic, linguistic expression. Contradictory findings have been reported where quantitative analysis of parts of speech has been employed. Fairbanks (1944) reported significantly fewer nouns, con junctions, prepositions, adjectives, and articles and greater use of verbs and pronouns by the schizophrenic group as compared to normals. Mabry (1955) found no differences between schizophrenic and normal groups in terms of fre quency of words and parts of speech but did find greater diffuseness and inarticulateness for the schizophrenic group. Ellsworth's (1951) study appears most clearly related to the present investigation since it is a study of the genetic level of schizophrenic language. Using a normal adult control group and several groups of normal children, he compared the percentage of nouns, pronouns, verbs, and adjectives in the responses to a sentence completion test. He found significant differences between the schizophrenic and adult control group, but the differences between the schizophrenic and fifth-grade group was not significant. 38 Certain methodological deficiencies seem to have contributed to the confusion within the area of language and thought. Beliak (1958) points to the heterogeneity of the schizophrenic samples utilized. The differences which have been found when schizophrenic groups are separated on the basis of reactive-process or chronic-acute indicates that this has been a confounding variable. This very factor has undoubtedly interfered with attempts to establish the valid ity of the Rorschach. Anderson and Anderson (1964) explic itly state that the validity of the Rorschach should be established in terms of personality structure and dynamics, not in terms of diagnostic labeling as psychiatric diagnoses are far from being scientific. Therefore a comparison of the Rorschach with psychiatric labels neither establishes nor negates the value of the Rorschach. CHAPTER III METHOD Subj ects This investigation attempted to determine distin guishing features in thought process among mentally retarded and schizophrenic adolescents as compared with normal ado lescents and, furthermore, to note whether divergent pat terns of thought processes may be consistently observable over an age range. A total of 63 individuals equally divided into 3 groups served as Ss: normal (NA), schizo phrenic (SC), and mentally retarded adolescents (MR). Further subdivision into 7 Ss each for the ages of 12-, 14-, and 16-year-olds was made. Within the adolescent years these ages have been found to represent the high points of responsiveness on the Rorschach (Ames, Metraux, & Walker, 19 59). The sample was restricted to white, native-born males in order to minimize effects of socio-cultural and sex differences. The NA sample consisted of members of the Boy Scouts of America. By necessity all the NA S_s were volunteers. The normality criteria for selection were: (1) they had 39 40 never been referred to or received psychiatric care; (2) they were in the appropriate grade for their age level; and (3) they scored within or above the average range on the Wechsler Intelligence Scale for Children (WISC) or Wechsler Adult Intelligence Scale (WAIS) vocabulary subtest. The MR sample was obtained from State Hospital popu lations. The definition of mental retardation is that adopted by the American Association on Mental Deficiency. Mental retardation refers to subaverage general intellectual functioning which originates during the developmental period and is associated with impairment in one or more of the following: (1) maturation, (2) learning, and (3) social adjustment [Heber, 1959, p. 3] . Subaverage refers to performance which is greater than one standard deviation below the population mean of the age group involved on a measure of general intellectual func tioning. The Ss in this investigation were limited to those having IQ scores between 50-70. This would be considered moderate to mild retardation, and between 2 and 4 standard deviations below the mean. Additional criteria are: (1) the retardation was apparent early in life, (2) absence of severe behavioral disturbance, (3) absence of any gross physical or neurological impairment, (4) the Ss had intelli gible speech, and (5) the Ss were not institutionalized prior to the age of three. The problems involved in differ entiating exogenous from endogenous forms are innumerable. Spitz's view (1963) that all mental retardates are brain damaged was adopted. By brain damage is meant a deficit or 41 defect in the structure or functioning of the brain mechan isms which has resulted in a lowered IQ. The SC group was obtained from a State Hospital. The classification of schizophrenia is based on a previous diagnosis of childhood schizophrenia on which at least two psychiatric staff members concur. Additionally the investi gator reviewed the potential cases to determine factors which Bradley (1945) suggested as aids in establishing the diagnosis and which rule out other disorders (Bender, 1942). These factors include: (1) true psychotic reactions, (2) disturbance at every level of adaptive function, (3) fundamental pattern of withdrawal from reality, (4) his tory of difficulties of adaptation to persons and changes in the immediate environment in the early years, (5) predomi nant presence of symptoms generally considered schizophrenic in adults strengthened the diagnosis, and (6) a preliminary period of satisfactory adjustment does not seem essential to a diagnosis of schizophrenia. The primary emphasis of this study, therefore, was upon the period of adolescence. The importance of adoles cence has been indicated by Beres (19 62) as the period when crystallization of character formation takes place. Defini tions of character vary, but in each case it is in some way a function of the ego (Abraham, 1927; Beaglehole, 1944; Erikson, 1950; Fenichel, 1945; Hartmann, 1950). Concern with the processes of ego-synthesis are of particular importance in Erikson's (19 50) conceptualization of the ado lescent issue of identity development which incorporates all previous developmental achievements. The above theoretical assumptions appear paralleled by the Rorschach findings of Ames, Learned, Metraux, & Walker (19 52) and Ames, et al. (1959), where developmental changes, as reflected in the major Rorschach variables, were less rapid in the years 5 to 10 than the years preceding, and where this slowing down continued in the years from 10 to 16. Ins trumentation The projective technique utilized in this study is the Rorschach Diagnostic Test. Not only has it received the most exhaustive treatment of any of the projective tech niques but Rapaport, et al. (1946) , state that it most nearly meets the ideal criteria for projective tests. More specifically, the Rorschach test is most clearly associated with the theoretical framework of this study and therefore should provide an objective test of theoretical assumptions. This study is attempting to determine some specific and testable linkage between theory and technique. Not only is the Rorschach test viewed as revealing ego functioning, but Schafer (1954) has indicated that different levels of "psy chic functioning" can be revealed. The individual may employ modes of thought^that are typical of an earlier and more primitive stage and there are marked differences between Ss in their characteristic level of response. Holt 43 (1956) suggests that the Rorschach is peculiarly effective for eliciting primary thinking for a number of reasons: there is less demand for organization and synthesis (as opposed to telling a narrative, e.g.); the stimulus is both complex and varied to support almost any image the may have without actually representing anything in the real world; permissiveness of the situation permits the person ___ any degree of fantasy or realism depending on his own internal standards. Abt (19 50) also noted that the internal factors in perception are facilitated when the degree of structure in the stimulus is reduced, as in the Rorschach test. All S_s were given the WISC or WAIS vocabulary sub test. Four additional subtests were administered to the retardates. These were comprehension, block design, object assembly, and digit span chosen because, to varying degrees, they are academically less satiated and therefore more justifiable and less stressful for this population. The function of the subtests was to assist in verifying the two diagnostic groups, normals and mental retardates. The administration of the vocabulary subtest to the schizo phrenic group was primarily to maintain equivalence in method. Measuring Thought Process The Rorschach scoring method for measuring thought process is that devised by Holt (1963). The essential 44 purposes of Holt's procedure are to measure the invasion of primary process thinking in Rorschach responses, delineation of defenses employed against primary process intrusion, and the extent to which the ; S is master of or mastered by primary process thought. Holt's system will be briefly described here. For a more detailed elaboration the reader is referred to his most recent manual (Holt, 1963) or to Holt and Havel (19 60). Primary Process Primary process is to be considered an intervening variable referring to a hypothetical set of thought opera tions inferred from observable behavior. Each Rorschach response may receive 0, 1, or more scores for primary process. Holt has divided primary proc ess into two categories labeled content and formal aspects of primary process. Each primary process score is either a content or formal deviation in thinking. More than one formal and more than one content score may be given to a single response. The primary process score refers to the total score on a specified variable and may exceed primary process responses. Any response which can be assigned either a content or formal score is defined as a primary process response. For each primary process score a Level 1 or Level 2 weight is assigned which corresponds to its position on the primary-secondary process continuum. A Level 1 weight 45 represents a marked predominance of primary process, while a Level 2 weight involves a greater admixture of secondary process. The assessment of level placement depends prima rily upon how blatant, direct, and primitive the expression of the drive in question is for the content categories and the degree to which the response violates the dictates of logic and reality for the formal categories. The content categories, of which there are 22, are concerned with ideational drive representations. There are two main subdivisions, (1) libidinal— which is further sub divided into six types, and (2) aggressive— which is further subdivided into five types. The resulting eleven types of scores are each subdivided into two levels. An example of Level 1 oral "an open mouth." And example of Level 2 oral "two people with their mouths wide open." There are 36 formal categories which represent formal aspects of primary process which are not limited to the more generally denoted perceptual-structure scores. This formal classification refers to the measurement of deviations from the orderly and logical thinking character istic of secondary process. Some examples of formal primary process manifestations are: condensations, autistic elaboration, concrete image symbolism, and various forms of deviant verbalizations. Most of the formal types are also subdivided into Level 1 and Level 2. A complete listing of both the formal and content categories will be found in 46 Appendix A. Control and Defense The 50 categories under this heading are designed to determine the nature of controls or their absence on responses scorable for primary process. In other words, control and defense categories are only used when a response has received a score on either a formal or content variable. Some of the categories are more effective than others in containing or justifying the response. Appendix B contains a complete listing of the control and defense categories. Form Level Each response is scored for form level prior to determination of a content or formal score. Form level has traditionally been considered a measure of ego control and thereby reflecting secondary process. The scoring of form level follows Mayman1s (19 64) system (see Appendix C) which has been utilized within the Holt system. Summary Scores The Holt system of Rorschach analysis provides cer tain over-all scores which have shown greater scorer relia bility than individual scoring categories. In addition to the breakdown between levels and categories (content-formal) there are four summary scores utilized in this study. Defense demand (DP)•— This is partially an elaboration and finer assessment of the Level 1 and Level 2 distinction. A DD rating is given to each scored response indicating the degree of primary process influence. A six- point scale is used where the higher numbers reflect greater primary process influence. A DD rating of 1 would be assigned to "a cookie," a DD of 3 to "breasts," a DD of 6 to "a rectum of a dead person after it has been partly eaten by maggots." The parenthetical figures in the right margin of Appendix A indicate DD ratings of the underlying idea of each individual category. Defense effectiveness (DE).--Each response contain ing any scorable content or formal element is also given a DE rating. The rating permits evaluation of the degree to which the subject is master of primary process in his think ing. DE ranges along a six-point scale from +2 to -3. The higher the minus rating the greater the impairment of defensive controls. A few examples may clarify the scoring criteria. A +2 would be attributed to "Here I can also see the outlines of a man— gangster-type person with a hat lowered over his eyes. (Ing.) Looks like a gangster in one of those British mysteries which they show on TV." A O rating would be attained by "It looks like the head of an embryo— well maybe a fetus--embryos don't have heads do they?" A -3 rating would be assigned to "A vagina and it's working up toward here— it's going to blow up— it does— into this and drops like a volcano." 48 Adaptive regression score (AR) .--This over-all meas ure expresses both the degree of primary process in a given S's protocol as well as the effectiveness with which it is defended or controlled. This score is a product of DD and DE divided by total primary process responses. High posi tive AR scores are indicative of adaptive regression, 0 indicates some disturbance and denotes only moderately suc cessful control, and high negative AR scores are suggestive of maladaptive regression. Primary process scores.— The first three hypotheses are primarily concerned with primary process scores. Hy pothesis I refers to total primary process score which is the total score for each subject incorporating all formal and content scores at both Level 1 and Level 2. Hypothesis II is concerned with differentiation of diagnostic groups on the basis of level of primary process. The total number of Level 1 and Level 2 scores was obtained by separately count ing all Level 1 scores and all Level 2 scores regardless of whether they were associated with formal or content devia tions. Hypothesis III separates primary process on the basis of content-formal aspects without discrimination between levels. The total formal and total content score for each subject was the number of scores for each category whether manifested at Level 1 or Level 2 on the primary- secondary continuum. Administration The investigator individually administered both the Rorschach and WISC or WAIS subtests to all S_s. The first session was preceded by a brief contact of a "rapport"- building nature, which was followed by the intellectual testing. The second session was devoted to the Rorschach administration. All protocols had a minimum of ten responses. The complete verbatim record was taped. The procedure described by Rapaport, et al. (19 4 6) was followed with modifications, especially in the inquiry, necessitated by the special problems found in testing defec tives and schizophrenic adolescents. Inquiry to determine location followed immediately after each response for the purpose of minimizing forgotten responses. Inquiry for determinants followed completion of the entire associative period with the cards visible. The same procedure was used with the normal adolescents to maintain equivalence in administrative procedure. In order to insure "blind" scoring, a code number was assigned to each by a person other than the author and this code number was the only means of identifying any Ror schach protocol. Scorer agreement between Es could not be obtained within the confines of this investigation, since the Holt system is relatively so recent that there are few psycholo gists familiar with the scoring techniques. In this study 50 summary scores were used since they have been found more reliable than individual scores. Holt (19 63) reports corre lations which range between a single low correlation of .77 to .98, with the greatest concentration in the .90's. Other reliability measures for the various summary scores reported by other investigators, with less clinical and scoring experience, show a wider range but still reveal a concentra tion in the ,80's and .90's (Banks, 1962; Heath, 1961; Philip, 1959; Saretsky, 1961) . Statistical Analysis The data were subjected to a series of analyses of variance, using a two-factor (Diagnosis X Age) design for each variable (Lindquist, 1953). This design, schematized below, not only provided a direct test of the hypotheses, each of which deals with the main effect of Diagnosis, but also permitted an evaluation of the main effect of Age and the Diagnosis X Age interaction, concerning which no hypoth eses were offered. In those cases where the main effect of Diagnosis was significant, at or beyond the .05 level, indi vidual comparisons of means were conducted, using a series of t tests. The error variance was computed only for the data on which the given means were based (df=40). As Cronbach (19 49) noted, many Rorschach indices are affected by the total number of responses (R). The investigator must therefore consider whether raw scores should be converted by attempting to take R into account. 51 He must also discover a procedure which retains the meaning of the data and can be readily communicated to the reader. In order to ascertain the extent to which the results of this study might be affected by diagnostic or age differ ences in R, an analysis of variance of these variables was also carried out using the design described. Source df Diagnosis 2 Age 2 Diagnosis X Age 4 Ss within groups 54 Total 62 CHAPTER IV RESULTS Total Number of Responses The results of the analysis to determine whether the groups differed on the total number of responses (R) are reported in Appendix D. The main effect of Diagnosis was significant at the -05 level (F=3.31, df=2/54). In this, as in each of the subsequent analyses, the main effect of Age and the Diagnosis X Age interaction were not significant and have therefore been omitted from the table. Figure 1 illustrates the mean number of responses of the three diagnostic groups, and Table 1 gives the relevant means and SDs. Follow-up t tests showed that the normal adolescents were significantly higher than the retardates (t=2.59, P .05), but that the schizophrenics did not differ significantly from either of the two other groups. There fore, one must be alert to the possibility that the normal group will show higher total primary process scores as an artifact of their higher mean R. Hypothesis I Hypothesis I stated that the schizophrenic group MEAN RORSCHACH RESPONSE 53 30 Z O fo O ----------------------------------------------- SC MR NA Fig. 1.— Mean number of Rorschach responses (R) for each group. 54 Means and SDs for Total TABLE 1 Number of Responses for Each Group SC MR NA Mean 22. 0 18.3 23 . 7 SD 7.25 5.07 7 . 69 55 would reveal a higher mean total primary process score than either of the other two groups, and that the normals would show the lowest mean total. Appendix E shows that the main effect of Diagnosis was highly significant (F=19.75, df=2/54, p<.001). The relative magnitudes of the mean total primary process scores are shown in Figure 2. Table 2 shows the pertinent means and SDs. Follow-up t tests demonstrated that the schizophrenics were significantly higher than both the retardates (t=4.52, PC.OOl) and the normals (t=5.05, P <.001) , while the latter two groups did not differ signifi cantly from each other. Hypothesis I, therefore, was con firmed with the qualification, that although the normals and retardates differed in the expected direction, this differ ence did not reach significance. TABLE 2 Means and SDs for Total Primary Process Score for Each Group SC MR NA Mean 44.5 19 . 3 17 . 3 SD 22 . 34 11. 08 8 .86 Hypothesis II The second hypothesis stated that the Level 1 pri mary process scores would differentiate the three groups more markedly than Level 2 and also that the schizophrenics 56 ts o u -/ Cn D<e w c / i W O 2 . - 7 Ph P S P S A, a r t j / , ? < ? sc MR NA Fig. 2.— Group means for total primary process scores. 57 would show the highest Level 1 mean score. In an analysis of the Level 1 and Level 2 data, the F-ratios obtained (Appendix F) showed that the main effect of Diagnosis was not significant for Level 2, but only for Level 1 (F=34.28, df=2/54, P<.001). Figure 3 portrays the means of the three diagnostic groups on the Level 1 and the Level 2 components of primary process. The relevant means and SDs are reported- in Table 3. Follow-up t tests showed that the schizophren ics were significantly higher on Level 1 than both the retardates (t=5.59, P<.001) and the normals (t=6.49, P <". 001). In addition, the retardates were significantly higher than the normals (t=3.81, P<.01). Therefore, on this measure of intensity of primary process, Hypothesis II was supported. TABLE 3 Means and SDs for Total Level 1 and Total Level 2 Scores for Each Group SC MR NA M SD M SD M SD Level 1 28.0 18. 65 4. 2 2 .78 0 . 9 .91 Level 2 16. 5 8.19 15.1 8 .15 16. 4 8 .34 Hypothesis II also predicted that defense demand (DD) would differentiate the groups in the same manner and MEAN PRIMARY PROCESS SCORE SC MR NA SC MR NA Level 1 Level 2 Fig. 3.— Total Level 1 mean scores and total Level 2 mean scores for main groups. 59 direction as would Level 1. The analysis (Appendix G) indi cated that the main effect of Diagnosis was highly signifi cant (F=75.96, df=2/54, PC.001). Figure 4 shows the mean values for each of the three groups. The relevant means and SDs are presented in Table 4. Follow-up t tests indicated that the schizophrenics were significantly higher than both the retardates (t=7.82) and the normal adolescents (t=10.49), and that the retardates were significantly higher than the normals (t=4.07). All three differences were sig nificant at the .001 level. Therefore, Hypothesis II was also confirmed on a second measure of intensity of primary process thinking. TABLE 4 Means and SDs for Defense Demand Scores for Each Group SC MR NA Mean 3.6 2.0 1.6 SD 0 . 85 0.40 0 . 23 Hypothesis III The third hypothesis predicted that the formal scores would differentiate the groups more markedly than the content scores and that the schizophrenics would reveal the highest formal mean score and the normals the lowest. The MEAN D D SCORE 60 t y . o S.o Z.o i-o o sc MR NA Fig. 4.— Mean defense demand (DD) scores for main groups. 61 analysis (Appendix H) showed that the groups did not differ significantly on the content category, but only on the formal category (F=38.31, df=2/54, P<.001). Figure 5 graph ically presents the means of the diagnostic groups. The pertinent means and SDs are shown in Table 5. The results of the follow-up t tests, based on the data for the formal category, revealed that the schizophrenics achieved a sig nificantly higher mean score than both the retardates (t=5.43, P<.001) and the normal adolescents (t=7.77, P<'. 001), and that the retardates were significantly higher than the normals (t=3.78, P<.01). Hypothesis III is there fore supported by the data. TABLE 5 Means and SDs for Total Content and Total Formal Scores for Each Group SC MR NA M SD M SD M SD Content 16.8 10. 82 10. 5 5.96 13 .9 7.06 Formal 27. 6 14. 35 8 . 8 5.86 3.4 2.53 Differentiation of Primary Process Scores The previous analyses demonstrated that the diag nostic groups, while not differing significantly on Level 2 and the content category, did differ significantly on both MEAN PRIMARY PROCESS SCORE 62 2H te /*. Q - g - c — --1 - MR-J NTT Formal SC ~MRT“ N7T Content Fig. 5.— Total formal mean scores and total content mean scores for main groups. 63 Level 1 and the formal category. Further exploration of the data was carried out to determine whether greater specific ity would be obtained by analyzing the primary process scores in the manner shown in Appendix I. These analyses indicated that the main effect of Diagnosis was not signifi cant for Level 2 of the content category, but that it was significant for Level 1 of the content category and both Level 1 and 2 of the formal category. The means shown graphically in Figure 6, are presented with the SDs for each group in Table 6. TABLE 6 Means and SDs for Level 1 and Level 2, Content and Formal Scores for Each Group SC MR NA M SD M SD M SD LI, Content 6.1 6.12 0.7 1.22 0.2 0. 40 L2 , Content 10. 8 6. 30 9.8 5.42 13 .7 6.92 1 * * I 1 —1 1 ih Formal 21.9 14 .09 3.5 3. 20 0 . 7 0 . 70 L2 , Formal 5.7 2. 82 5.3 3.46 2 . 7 2.09 Note.--L refers to Level. The results of the follow-up t tests (Table 7) show that on Level 1 content the schizophrenics were signifi- MEAN PRIMARY PROCESS SCORE 64 2 ¥ - SC /? £ • SC MR I NA CONTENT Level 1 NA SC MR CONTENT Level 2 MR NA FORMAL Level 1 SC MR ! NA FORMAL Level 2 Fig. 6.— Means on each component of total pri mary process for main groups. 65 cantly higher than both the retardates and the normals, while the latter two groups did not differ from one another. On Level 2 formal both the schizophrenics and the retardates were significantly higher than the normals, but did not differ significantly from one another. Only Level 1 formal differentiated all three groups: the schizophrenics scored significantly higher than the retardates, who in turn scored significantly higher than the normals. In this additional exploration, as in all the previ ous analyses, the main effect of Age and the Diagnosis X Age interaction were non-significant. TABLE 7 Significance Tests (t-tests) for Level 1 Content and Formal Scores and Level 2 Formal Scores for Main Groups SC vs. MR SC vs. NA MR vs. NA LI, Content 3.86** 4 .27** 1.66 LI, Formal 5 . 70** 6 . 73** 3.87** L2 , Formal 0. 41 3.79* 2. 85* Note.— L refers to Level. *Significant at .01 level. **Significant at .001 level. 66 Hypothesis IV The fourth hypothesis stated that adaptive regres sion would be greatest for the normal and lowest for the schizophrenic adolescents. The results of the analysis (Appendix J) revealed that the main effect of Diagnosis was highly significant (F=44.92, df=2/54, PC.001). Figure 7 shows the mean scores of the three groups. The relevant means and SDs are presented in Table 8. TABLE 8 Means and SDs for Adaptive Regression Scores for Each Group SC MR NA Mean -3.8 -0.2 +1.7 SD 3.10 0. 71 0.45 Follow-up t tests demonstrated that the schizophren ics were significantly lower than either the retardates (t=5.01) or the normals (t=7.82), and that the retardates were significantly lower than the normals (t=10.17). In each case the difference was significant at the .001 level. Therefore, Hypothesis IV was supported both in the nature and direction of intergroup differences. MEAN ADAPTIVE REGRESSION Adaptive t ^ \ j a\ p- I Maladaptive o . j i i Q H i 0 c t! 3 CD P > 3 m o 0 p CD tn 0 P J & P J t (+ P- < CD H i CD iQ Hi CD ( f l t n p- 0 3 tn o CHAPTER V DISCUSSION Primary Process Manifestations The hypotheses of the study were consistently sup ported by the results of the statistical analysis. Only in the case of Hypothesis I did the obtained difference not reach significance among all three diagnostic groups. It was noted in the initial section of the previous chapter that the normals showed a significantly higher R total than the mental retardates. Logically, it would appear highly improbable that the findings of this investigation are to any degree an artifact of this R difference for the follow ing reasons: (1) With the exception of content, Level 2 (on which the groups did not differ significantly) the normal adolescents in no instance gained a higher primary- process score than any of the other diagnostic groups; (2) Since the schizophrenic adolescents did not differ from the other groups in R, the main findings of the study cannot be attributed to a difference in R. Hypothesis I pertained to the total primary process score without breakdown into levels or categories. As 68 69 expected, the schizophrenics obtained a significantly higher mean total than either of the other diagnostic groups. This finding is in keeping with earlier studies of Rorschach man ifestations of thought disturbance in schizophrenic adults (Hertz & Paolino, 1960; Powers & Hamlin, 1955; Rapaport, 1946), and reveal that thought deviations can also be detected in Rorschach responses of schizophrenic adoles cents. Theoretical considerations led to the expectation that a constitutional limitation of an autonomous ego func tion, in this case intelligence, would influence ego devel opment and specifically be reflected in greater reliance upon the more primitive, genetically earlier, primary proc ess thinking. Although the means of the normals and retard ates were in the predicted direction, the difference between these two groups was not significant. The fact that the normals did obtain a significantly higher R may have obscured an actual difference between the two groups on this measure. Additionally, the total number of primary process scores is a gross measure without consideration of the response’s position on the primary-secondary continuum. Perhaps the meaning of this finding will become less ambigu ous as Hypothesis II is explored which does take into account the position of the score on the primary-secondary continuum. Hypothesis II predicted that Level 1 would more markedly differentiate the three diagnostic groups than 70 Level 2 and, furthermore, that the schizophrenics would obtain the highest Level 1 mean score. The findings revealed that Level 1 primary process scores significantly differentiated the three groups while Level 2 did not dis criminate among the groups. Additionally, the schizophrenic Ss manifested primary process more blatantly, as measured by Level 1, than either of the other diagnostic groups. The second measure of degree of primary process influence, defense demand, paralleled both the order and direction of the less refined binary scoring of levels. Zukowsky's (1962) findings among schizophrenic and normal adults are in accord with this study. Although his groups did not show significant differences on total number of primary process responses, blatancy of primary process was a differentiating factor. Relevant to the present finding, that the schizo phrenics are characterized by greater primitiveness of pri mary process invasions, are studies within the theoretical premises of genetic psychology (Werner, 1948). The system of Rorschach analysis based upon this framework (Friedman, 1953) deals with structural organization in terms of genetic levels which have been related to primary and secondary process (Fine & Zimet, 19 59). The results of studies within this methodology have consistently revealed an accentuation of genetically lowered functioning in the most psycholog ically or organically impaired adults (Friedman, 1953; Pena, 71 1953; Siegel, 1953). Becker (1956) studied the degree of regressive thinking in process and reactive schizophrenic adults and demonstrated lowered cognitive functioning of the ego in the more clinically impaired process-schizophrenic males. The results relating to Hypothesis II revealed not only that the three groups differed on the more direct and blatant expression of primary process but also that they did not differ on Level 2 which is assumed to be closer to sec ondary process thought. This then implies that although the groups differ on blatant, primitive expression of pri mary process they show equivalent facility in thought where ego control may be presumed. Certain possible explanations may be pursued. Examination of the original data indicated that the schizophrenics frequently gave initial Level 2 content responses which regressed to Level 1 in their elaboration. This rather uniform approach of the schizo phrenic Ss would therefore be revealed in a similar Level 2 content score, but increased Level 1 formal or content scores. Perhaps an example may clarify the cognitive approach and "digging in" exemplified by the schizophrenics. Card II: "I see your stomach." For this aspect of the response the S_ receives a Level 2, oral score. The elabora tion of this response resulted in an additional three Level 1 formal scores: "It looks like a stomach because it makes you like, when you're feeling not upset [gasping for 72 breath]. You just don't try...[mumbling]...Stomach makes you go to the bathroom all the time, makes you digest the food. I'm really good at this and they surely do like one another." The retardates, on the other hand, did not show the frequent "digging in" characteristic of the schizophren ics. The mentally retarded, therefore, revealed greater ego control as observed both by the Level 2 scores and the fewer breakthroughs of primitive primary process. A second feature to consider is that the levels may not be on a continuum. Holt (196 6) has presented the inter correlations for the content categories which reveal that, with a few exceptions, the Level 1 form of a drive is no more highly correlated with its Level 2 version than with any other drive form. Hypothesis III specified that the formal component of primary process would more markedly differentiate the groups than the content component and, furthermore, that the schizophrenics would reveal the highest formal score. As predicted, all three groups differed from one another on the formal variable but did not show a similar difference on content expression of primary process. The schizophrenic adolescents also obtained a significantly higher mean formal score than the other two groups. This hypothesis was derived from the psychoanalytic description (Freud, 1938) of the formal characteristics of primary process thought. These methods of thinking form the basis for scoring of 73 formal deviations within Holt's system. Previous studies, as well as theoretical structures, have considered such formal deviations of thought to be closely associated with reality distortion. The evaluation of content as revealing primary process thought in Rorschach responses is consider ably more controversial as it appears to be a less stable measurement. The findings directly relating to Hypothesis III indicate that primary process expressed by means of departures from logical, reality-oriented thinking more clearly distinguishes the groups than does expression of observable drive derivatives. Further exploration of the data adds greater speci ficity to the findings relating to the first three hypothe ses. These analyses indicated that the groups, though not differing on level 2 of content, did differ significantly on Level 1 of content and both Level 1 and 2 of formal. The t tests based on these data specified that only Level 1 of formal differentiated all three diagnostic groups. In brief, the retardates and schizophrenics clearly differ on Level 1 of both the content and formal categories, however only Level 1 formal differentiated all three diagnostic groups. Therefore, in differentiating the mentally retarded and schizophrenic adolescents the most general factor was the blatancy variable or degree of primitive thought rather than the manner (i.e., content vs. formal) by which it was 74 expressed. However, a combination of manner and blatancy differentiated the schizophrenic and retardates from each other as well as from the normals. The meaning of this finding will be more readily comprehended by briefly noting certain characteristics of both formal and Level 1 primary process thinking. Level 1 content is a relatively direct and primitive expression of drive. Formal deviations have no clearly categorizable drive associated with them and fol low the illogic of the dream process. Formal deviations are non-communicable both in the sense that they do not reveal an underlying drive or motive and also in that they are relatively flagrant distortions of realistic and valid logic. Level 1 formal, of course, shows the greatest dis tortion and consequently is the less communicable. There fore, it is appropriate to speak of formal and Level 1 deviations as regression to, or fixation at, a genetically earlier or more primitive thought process. To the extent that Level 1 and formal deviations, as measured in this study, are referents to genetically more primitive thought, the study showed that the schizophrenic Ss employed non-communicable, primitive thought more exten sively than either the retarded or normal adolescents. The mentally retarded did not differ from the normal adolescents in the direct expression of a drive but did differ in the manner in which it was expressed, showing greater reliance on non-communicable illogical thought. 75 The results of the analysis of primary process scores, with two exceptions, showed that the retardates' mean position was somewhere between the schizophrenic and normal adolescents. The exceptions were noted on the total content mean score and the content Level 2 mean score. In neither case did the groups differ significantly. There fore, one may conclude that primary process manifestations, as measured in this study, were highest for schizophrenic Ss, lowest for normal Ss with the mentally retarded posi tioned between the two groups. Furthermore, whenever a change of position was shown for any diagnostic group the difference on that variable was not significant. The last hypothesis, IV, which was concerned with adaptive use of primary process by the three groups, was supported both in the nature and direction of prediction. The schizophrenic adolescents obtained a high maladaptive mean score, and the normals an adaptive mean score, with the mental retardates showing moderately unsuccessful mastery of primary process. Adaptive regression denotes both the amount of primary process and the effectiveness with which it is handled. Therefore, this measure is presumed to reflect the ego's ability to maintain realistic controls while under the sway of primary process thinking which has been labeled "regression in the service of the ego." This investigation supports the theoretical position that schizo phrenia is characterized by ego weakness, while the 76 assumption that normals have greater ego strength is re vealed in their adaptive use of primary process. This also appears to support the postulate that normal regression is under voluntary control and therefore readily reversible, while the schizophrenics' regression is involuntary and therefore beyond rational control. The "digging in" observed among the schizophrenic adolescents may be consid ered related to the compelling nature of primary process material to the exclusion of reality orientation. The retardates again fall in the mid-position showing greater ability to maintain ego control than schizophrenics but less ability than the normals. The finding of clearly maladap tive regression by the schizophrenic Ss is interwoven with blatancy of primary process in the sense that their primi tive responses demand greater control for effective mastery. Several studies (Becker, 1956; Fine & Zimet, 1959; Kantor, Wallner, & Winder, 19 53) have revealed similar trends between level of ego functioning and premorbid status of hospitalized schizophrenic adults. Theoretical Implications Certain implications of the findings for theoretical assumptions have been mentioned in the necessarily frag mented discussion relating to the specific hypotheses. At this point an attempt will be made to review briefly and integrate the major over-all findings with the theoretical assumptions- upon which this study was based. 77 The results did reveal that the schizophrenic ado lescents could be differentiated from the retarded adoles cents on the variable of thought process as an ego function. Additionally, throughout the analysis the difference among the age groups was not significant nor did age interact sig nificantly with diagnosis. The findings can accordingly be considered to have generality over the age range studied, within the limits of the small sample. The major findings relate to the schizophrenic ado lescents' greater use of primary process thinking as well as their dependence on a more primitive level of thinking than the retarded. As compared to the mental retardates, the schizophrenics' more severe ego impairment is further exem plified by their greater inability to use primary process in an adaptive manner. The more highly disturbed ego function of thought in the schizophrenic, as compared with the retardate, indicates that emotional disturbance is more pervasive in preventing ego development and growth than is a structural deficiency in an autonomous conflict-free sphere such as intellectual level. In accord with ego psychology, man's task of reality mastery or adaptation is guaranteed by his primary equipment (including intelligence) and the mature use of this equip ment in such functions as defenses, synthesis, and problem solving. The mental retardate's adaptation is more hampered by primary equipment, the schizophrenic by his use 78 of primary equipment. Following the theoretical postulates of Hartmann (1958), ego development has both conflict-free and conflic- tual sources. Any of the conflict-free sources, for exam ple, thinking, intelligence, perception, as well as their maturational products may become involved in conflict and their functions hampered or facilitated by such ego con flicts. It has been found generally that schizophrenics show functional lowering of intelligence as well as dis turbed thought process. One may hypothesize that in schizo phrenia intelligence and thinking, which normally develop as autonomous functions, have been interrupted somewhere along the developmental path and have become drive-connected. Hartmann (19 58) has pointed out that drive-conflicts and drive-taboos can hamper intellectual development temporarily or permanently. Consequently, secondary process, or real ity-oriented thought, is impaired because of the inability to master drive processes by connecting them to ideas which can be handled in consciousness. Anna Freud (1946) suggests that connecting drives with thoughts is the essence of ego functioning. Rapaport (1950) also points out the role of secondary process in the "binding of energies." The intellectual factor, too, has an effect on the maturation of the thought process. For example, the choice and success of intellectualization as a defense is recog nizably codetermined by the intellectual factor. Although 79 Hartmann notes (19 58) that thought process disturbances due to congenital disorders of such functions as intelligence have been scarcely touched upon, we may speculate that with in the mentally retarded population here studied, intellect and its derivatives have not become involved in conflict. If, on the other hand, intellect did become involved in con flict it was of a temporary nature and therefore thought process was permitted freer experimentation in coping with reality, thereby facilitating maturation and differentiation of thought process. In this manner, to the degree possible within the constitutional limitations of intellectual level, the retarded ego development comes to serve thought process at a higher level than that revealed in schizophrenia. That schizophrenic thought is drive-connected is supported by Rapaport's model of thinking, in his terms "drive organized." When memories are organized around a drive any representation may stand for the drive, in other words, the memory of any segment of experience accrued around gratification can result in mounting drive tension. This is referred to as free mobility of cathexis and is inferred from observations of such mechanisms as displace ment, condensation, and substitution. Such interchangeabil ity suggests that at this stage of memory organization only diffuse objects and ideas exist. In the language of genetic psychology (Werner, 1948) the concepts are syncretic. Thought process which is based on drive organization of 80 memory is conceptualized as primary process. The thinking process repeatedly noted in the content deviations of the adolescent schizophrenics can be readily conceptualized as "drive organized." One abbreviated example may highlight the meaning of this interpretation. The following was obtained from a 16- year-old catatonic schizophrenic and represents the only instance when affect was observable. Card I: "It's like when you sit down and make a stink. What will happen if I poop in the pink bathtub at Mamma's.... If I do a stink in it what will happen [laughing uncontrollably]...the pink bath tub .... Tommie [explosive laughter] did you do that? Why-y- y-y? What comes after President Johnson" [thumb in mouth]. In this example one observes where an entire grati fying experience was aroused by an aspect without reality censorship. It also illustrates the compelling quality of drive-organized memory with concomitant unrestrained tend ency toward full discharge which is characteristic of "mobile" drive energies. The greater amount of blatant pri mary process and "digging in" observed in schizophrenics can therefore be interpreted within ego psychology as drive- organized thought with full discharge of tension via the shortest path (wish fulfillment). Much of the thought proc ess observed in this group of schizophrenic adolescents may be characterized as "fixation in the service of the Id." The findings that the retardates showed both a 81 lowered frequency and less blatancy in primary process scores than the schizophrenics, suggests that drive-organ ized thought has progressed toward concept-organized thought (Rapaport's term for secondary process). The cathexis is more limited to those drive representations which are mean ingfully connected in terms of reality rather than drive belongingness. In secondary process drive-cathexis alone no longer suffices to raise ideas to consciousness. Therefore, the degree of tension discharge is "bound" and "tamed" rather than freely mobile and fully discharged. As a result, primary process expression is less intense, and the implied control also moderates maladaptive regression as designated by both the blatancy and "digging in" nature of schizophrenic thought. Piaget's (1926, 1950) studies are pertinent at this point as he has described the transition from "egocentric" with its absolute qualities to a higher level of thought which recognizes the relativity of qualities. This progress is dependent upon the discovery of the relativity of the self. Only through experiencing the varieties of "me" can the autistic egocentricity be replaced by the relativism of self-awareness. This is the prerequisite by which thinking and knowledge of the world is freed of subjectivity. The constructs of introjection and identification have been offered as the foundations upon which thought process loses its egocentrism. These mechanisms enable individuals to 82 take over feelings, reactions, and even thoughts of other people as their own. They also lay the foundation for socially shared thinking as well as contributing to its building. Introjection makes possible a cathecting of sys tems of behavior-forms, reactions, and thoughts rather than separate cathecting of each. This is analogous to the learnihg process. Knowledge being fragmentary at first, later the dividing lines between facts recede and this is accompanied by progress toward application beyond textbook examples. The result is that the knowledge becomes our own rather than merely that learned from specific teachers or books. Identification has been considered one of the major factors determining ego development. Among the schizophren ic Ss one may speculate that the progression from introjec tion to identification has not been satisfactorily resolved. Normally, maturation and environment necessitate renunci ation of introjected drive-objects. Recent research may be adding support to this theoretical formulation. In studies of schizophrenic families, Hill (1955) has described the symbiotic interlacing of mother and child to the extent that they can be characterized as living and being for each other. There is a free-floating transfer of anxiety between them and any movement toward autonomous identity by the child is met with display of anxiety by the mother. This finding appears extended by the "double bind" hypothesis 83 whereby the child receives conflicting messages (Bateson, et al., 1956; Weakland & Jackson, 1958). The research appears then to support speculation of impaired and abortive attempts in the development of "me" and the resultant conse quences of ego-limiting experiences. The development of introjection-identification is not independent of reality- testing and secondary process but rather another aspect of the indivisible process of maturation and development. Unfortunately, the family of the retarded child has not been studied in this systematic manner. It is reason able to assume that the family of the retarded child may be seriously disturbed but not necessarily so. Additionally, the form of disturbance would most likely be generally less severe and show a greater variety from family to family than in the family of the schizophrenic child. Observation of hospitalized retardates show apparent identification organi zations, although at times not well integrated, with varying degrees of impairment of reality awareness. In this study the schizophrenic's thought process was comparable to Piaget's preoperational level. The mental retardates, on the other hand, showed greater ability for socially shared thought. This difference was revealed, in addition to the quantitative findings, in a genuine effort to communicate, to make intelligible his thoughts, and to explain contradictions, which are all signposts of develop ment beyond preoperational thought. Piaget notes that it is only through social interaction and communication that the child develops beyond egocentric thought. Rapaport (1959) has also indicated that communica tion has been underestimated as a positive force in nurtur ing the growth of ego functions. He sees communication as: (1) counteracting ego-limitations; (2) combatting the dele terious effects of defenses through aiding differentiation and thereby contributing to the process of "binding" drive energies; (3) rendering memories more available for problem solving; (4) combatting the spread of ego limiting defenses by casting light on new relationships; and (5) integrating isolated experiences. The most casual observation of schizophrenic patients shows a marked disturbance in communication. The disorder in communication noted in the adolescent retardate was primarily in the restricted range, as compared to nor mals, rather than in a distortion of its use. The major purpose of thought is to cope with, and adapt to, one's environment. In the schizophrenic adolescent, however, thought is so heavily pervaded with drive cathexis that it can no longer serve the ego in an adaptive manner. It is conceivable that when thought process becomes involved in conflict it may emerge with a changed role or in a changed form. Only as long as that part of the psychic apparatus which subserves communication is in the "conflict-free ego sphere" is it possible to exert the positive influences upon 85 ego growth noted by Rapaport. Implications for Future Research The Holt system for gauging primary process thinking could be profitably utilized in the exploration of many areas. The variability shown by the schizophrenic adoles cents in this study supports the general dissatisfaction with the prevailing psychiatric classification. Esman (19 60) proposed that "childhood schizophrenia" be supplanted by "ego pathology." This system of Rorschach analysis could assist in the task of more clearly delineating a number of ego functions in addition to thought process, such as regu lation and control of drives, synthetic function, and defensive function. In addition to possibly increasing precision of diagnostic categories the Holt system may serve as a prognostic indicator of the subsequent course of dis turbance. The value of Holt's system for differential diag nosis and prognosis of neurotic and various behavioral dis turbances should be investigated. For example, the rela tionship between ego function development and superego development could be pursued utilizing S_s who behaviorally reveal, or who are theoretically expected to have, organiza tional structure defects. This system may provide an entry into the relation ship between manifestations of primary process and secondary process as obtained through intelligence tests, problem solving, and other forms of coping behavior. Within primary 86 process, adaptive versus maladaptive uses could be analyzed. Utilizing successfully creative individuals, the Holt system contains the possibility of determining whether an optimal level or form of regression promotes adaptive use of primary process thinking. Furthermore, within personality research, one may be capable of delineating personality structures which may predictably subserve adaptive and maladaptive regression. Another possible area for future research is in the field of psychotherapy, designed in terms of pre- and post tests. The manner in which primary process was dealt with by the patients before and after therapy, as well as whether or not successful or unsuccessful patients could be differ entiated should be attempted. This is an area where there is considerable contradictory evidence when using the less refined categories of Rorschach analysis. In addition, various psychotherapeutic methods could be evaluated in terms of differential changes by patients in manifestation, control, and use of primary process. Finally there would be replication of the present study with larger sample sizes and where none of the diag nostic groups have been or are hospitalized. The effect of hospitalization may be contributing variables which are not consistent in effect across diagnostic groups. CHAPTER VI SUMMARY The purpose of this investigation was to determine whether schizophrenic and mentally retarded adolescents could be differentiated on the basis of thinking process. The study was conceptualized within the theoretical frame work of ego psychology specifically relating to the recent developments and expansions of the psychoanalytic postu lation of primary and secondary thought process. The focus was on manifestations of primary process. The Rorschach Diagnostic Test was the measuring instrument. The experimenter administered the test to all subjects according to a modification of Rapaport's proce dure. A complete verbatim record was taped. Holt's system for gauging primary process manifestations was utilized in the analysis of responses. There were 21 subjects in each of 3 diagnostic groups, schizophrenic, mentally retarded, and normal adoles cents, which were equally divided among 12-, 14-, and 16- year-olds . Primary process, defense demand, and adaptive 87 88 regression scores were subjected to a series of analyses of variance using a two-factor (Diagnosis X Age) design for each variable. Where significant differences between the means were indicated, the mean score of each diagnostic group was compared with that of every other group by follow- up t tes ts. The study tested four hypotheses. The first pre dicted that the schizophrenic adolescents would reveal a higher mean total primary process score than either of the other groups. Although this hypothesis was confirmed, the mean difference between the retardates and normals did not reach significance. The second hypothesis stated that Level 1 primary process scores would differentiate the three groups more markedly than Level 2, and that the schizophrenic adoles cents would reveal the highest mean Level 1 score. Since defense demand (DD) is considered a refined measure of primitiveness, the DD means were predicted in the same order and direction. This hypothesis was confirmed in its entirety. The third hypothesis signified that formal primary process scores would more markedly differentiate the groups than content scores, and that the schizophrenics would show the highest mean formal score. The findings confirmed the hypothesis since all three groups differed significantly from one another, but did not show a similar difference on 89 content expression of primary process. In addition, the schizophrenics obtained the highest mean formal score. Further exploration of the data revealed that the groups, though not differing on Level 2 of content, did differ sig nificantly on Level 1 of content and Level 1 and 2 of for mal . The t tests based on these data specified that only Level 1 of formal differentiated all three diagnostic groups. Therefore, the most general factor differentiating the schizophrenics from retardates was degree of primitive thought rather than the manner (i.e., content vs. formal) by which primary process was expressed. However, a combination of manner and degree differentiated all three groups. The fourth hypothesis was concerned with the degree of mastery over primary process intrusions. It was predict ed that normal adolescents would show the most adaptive regression while the schizophrenics would reveal the most maladaptive regression. Each group was found to differ sig nificantly from every other, thus supporting both the nature and direction of prediction. This finding further exempli fied the more severe impairment of ego function in schizo phrenic as compared to retarded adolescents. The results of the investigation, therefore, did reveal that schizophrenic and retarded adolescents could be differentiated in specifiable ways on the variable of thought process as measured in this study. To the degree possible, within the limitations of intellectual level, the 90 retardates' ego development serves thought process at a higher level than that revealed in schizophrenia. The find ings were discussed in terms of the interpretative implica tions for ego development and progression within the theo retical assumptions of ego psychology. R E F E RE NC E S 91 REFERENCES Abraham, K. Character-formation on the genital level of the libido. Selected papers of Karl Abraham. London: Hogarth, 1927. Pp. 407—417. Abt, L. E. A theory of projective psychology. In L. E. Abt & L. Beliak (Eds.), Projective psychology. New York: Knopf, 19 50. Pp. 33-66. Alvarez-Tostado, V. J. H. Rigidity theory in light of the Rorschach performances of bright, normal and dull children. Dissertation Abstracts, 1947, 120-124. (Abstract) Ames, L. B., Learned, J., Metraux, R. W., & Walker, R. N. Child Rorschach responses. New York: Hoeber-Harp- er, 1952. Ames, L. B., Metraux, R. W., & Walker, R. N. Adolescent Rorschach responses. New York: Hoeber-Harper, 1959 . Anderson, H. H., & Anderson, G. L. An introduction to pro- jective techniques. New Jersey: Prentice Hall, 1964. Arbitman, H. D. Rorschach determinants in mentally defec tive and normal subjects. Training School Bulletin, 1953' !£' 143-151. Bateson, G., Jackson, D. D., Haley, J., & Weakland, J. H. Toward a theory of schizophrenia. Behavioral Sci ence , 1956, 1_, 251—264. Beaglehole, E. Character structure. Psychiatry, 1944 , 7_, 145-162. Beck, S. J. The Rorschach test as applied to a feeble minded group. Archives of Psychology, New York, 1932, No. 136. 92 93 Beck, S. Becker, % Beier, E Beliak, Beliak, Bender, Bender, Benton, Beres, I Beres, I Bergman Berkson J. The six schizophrenias: Reaction patterns in children and adults. New York: Amer. Orthopsy ch i a tr . Assoc. , 19 54. W. C. A genetic approach to the interpretation and evaluation of the process-reactive distinction in schizophrenia. Journal of Abnormal and Social Psy chology , 1956, 53, 229-236. >. C. Behavioral disturbances in the mentally retarded. In H. A. Stevens & R. Heber (Eds.), Men tal retardation. Chicago: Univer. Chicago Press, 1964. Pp. 453-487. L. A study of limitations and "failures": Toward an ego psychology of projective techniques. Journal of Projective Techniques, 1954 , 1_8, 279-293. L. The schizophrenic syndrome: A further elabora tion of the unified theory of schizophrenia. In L. Beliak (Ed.), Schizophrenia: A review of the syn drome . New York: Logos, 1958. Pp. 3-63. L. Childhood schizophrenia. Nervous Child, 1942, 1, 138. L. Childhood schizophrenia: Clinical study of one hundred schizophrenic children. American Journal of Orthopsychiatry, 1947, 17_, 40-56. A. L. Psychological evaluation and differential diagnosis. In H. A. Stevens & R. Heber (Eds.), Men tal retardation. Chicago: Univer. Chicago Press, 1964. Pp. 16-56. ). Ego deviation and the concept of schizophrenia. The Psychoanalytic Study of the Child, 19 56, 11, 164-234. ). Character formation. In S. Lorand & H. Schneer (Eds.), Adolescents: Psychoanalytic approach to problems and therapy. New York: Hoeber, 1962. Pp. 1-9. , M., Waller, H., & Marchand, J. Schizophrenic reac tions during childhood in mental defectives. Psy chiatric Quarterly, 1951, 2^5, 294-333. , G., Hermelin, B., & O'Conner, N. Physiological responses of normals and institutionalized mental defectives to repeated stimuli. Journal of Mental Deficiency Research, 1961, _5, 30-39 . 94 Bernfeld, S. The facts of observation in psychoanalysis. Journal of Psychology, 1941, 12, 289-305. Bleuler, E. Autistic thinking. American Journal of Insan ity, 1913, 69, 873-886. Bleuler, E. Dementia praecox or the group of schizophren ias . New York: Int. Unxver. Press, 1950. Bowlus, D. E., & Shotwell, A. M. A Rorschach study of psy chopathic delinquency. American Journal of Mental Deficiency, 1947, 52_, 23-30. Bradley, C. Psychoses in children. In N. D. C. Lewis & B. L. Pacella (Eds.), Modern trends in child psychi- atry. New York: Int. Univer. Press, 19 45. Pp. 135-154. Bychowski, G. The preschizophrenic ego. Psychoanalytic Quarterly, 1947, 16_, 225-233. Carrier, N. A., Malpass, L. F., & Orton, K. D. Responses of bright, normal and retarded children to learning tasks. Carbondale: Southern Illinois Univer., 1961. Cassirer, E. An essay on man. New Haven: Yale Univer. Press, 1944. Clarke, H. J. The diagnosis of a patient with limited capacity. Journal of Personality, 1946, 15, 105- 112. Cobrinik, L., & Popper, L. Developmental aspects of thought disturbance in schizophrenic children: A Rorschach study. American Journal of Orthopsychiatry, 1961, 31, 170-179. Cohen, I. H. An investigation of the relationship between adaptive regression, dogmatism and creativity using the Rorschach and dogmatism scale. Unpublished doc toral dissertation, Michigan State Univer., 1960. Cromwell, R. L., Palk, B. E., & Foshee, J. G. Studies in activity level. V. The relationships among eyelid conditioning, intelligence, activity level, and age. American Journal of Mental Deficiency, 19 61, 65, 744-748. Cronbach, L. J. Statistical methods applied to Rorschach scores: A review. Psychological Bulletin, 1949, 46, 393-431. 95 Davidson, H. H., & Klopfer, B. Rorschach statistics. Part I. Mentally retarded, normal and superior adults. Rorschach Research Exchange, 1938, 2_t 164-169. Despert, J. L., & Pierce, H. 0. The relation of emotional adjustment to intellectual function. Genetic Psy chology Monographs, 1946, 34, 3-56. Ellsworth, R. B. The regression of schizophrenic language. Journal of Consulting Psychology, 1951, 1J5, 387-391. Endacott, J. L. The results of 100 male juvenile delin quents on the Rorschach ink-blot test. Journal of Criminal Psychopathology, 1941, 3_, 41-50. Erikson, E. A. Childhood and society. New York: Norton, 1950. Esman, A. H. Childhood psychosis and "childhood schizo phrenia." American Journal of Orthopsychiatry, 1960 , 3_0, 391-396. Eysenck, H. J. The structure of human personality. London: Methuen, 1953. Fairbanks, H. The quantitative differentiation of samples of spoken language. Psychological Monographs, 1944, 56, 19-28. Feldman, I. S. Psychological differences among moron and borderline mental defectives as a function of eti ology. American Journal of Mental Deficiency, 1953, 57, 484-494. Fenichel, O. The psychoanalytic theory of neurosis. New York: Norton, 1945. Fenichel, O. Ego strength and ego weakness. Vol. 2. Col lected papers. New York: Norton, 1954. pp. 70-80. Fine, H. J., & Zimet, C. N. Process-reactive schizophrenia and genetic levels of perception. Journal of Abnormal and Social Psychology, 1959 , 59_, 83-86. Flavell, J. H. The developmental psychology of Jean Piaget. Princeton: D. Van Nostrand, 1963. Font, M. Some clinical applications of the Rorschach tech nique in cases of borderline deficiency. American Journal of Mental Deficiency, 1950, 54, 507-511. 96 Framo, J. L. Structural aspects of perceptual development in normal adults: A tachistoscopic study with the Rorschach technique. Unpublished doctoral disser tation, Boston Univer., 1951. Frank, I. K. Perceptual structuralization in certain psy choneurotic disorders: A genetic evaluation by means of the Rorschach test. Unpublished doctoral dissertation, Boston Univer., 1951. Frank, L. K. Projective methods for the study of personal ity. Journal of Psychology, 1939, £5, 389-413. Freed, E. Perceptual differentiation in schizophrenia: A tachistoscopic study of structural Rorschach ele ments. Unpublished doctoral dissertation, Syracuse Univer., 1952. Freud, A. The ego and the mechanisms of defence. New York: Int. Univer. Press, 1946. Freud, S. The interpretation of dreams. In A. A. Brill (Ed.), The basic writings of Sigmund Freud. New York: Random House, 1938. Pp. 183-549. 1 Freud, S. Formulations on the two principles of mental functioning. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sig mund Freud. London: Hogarth, 1958. Pp..213-226. Friedman, H. Perceptual regression in schizophrenia: An hypothesis suggested by the use of the Rorschach test. Journal of Projective Techniques, 1953, 17, 171-185. Gallagher, J. J. A comparison of brain-injured and non brain-injured mentally retarded children on several psychological variables. Monographs of the Society for Research in Child Development, 19 57, 22, 3-79. Garfield, S. L. Abnormal behavior and mental deficiency. In N. R. Ellis (Ed.), Handbook of mental deficiency. New York: McGraw-Hill"]; 1963 . Pp. 57 4-601. Gibbs, E. L., Rich, C. L., Fois, A., & Gibbs, F. A. Elec- troencephalographic study of mentally retarded persons. American Journal of Mental Deficiency, 1960, 65, 236-247. 97 Goldberger, L. Individual differences in the effects of perceptual isolation as related to Rorschach mani festations of the primary process. Unpublished doc toral dissertation, New York Univer., 1958. Goldberger, L. Reactions to perceptual isolation and Ror schach manifestations of the primary process. Jour nal of Projective Techniques, 1961, 2j5, 227-302. Goldberger, L., & Holt, R. R. Experimental interference with reality contact: Individual differences. In P. Solomon, P. E. Kubzansky, P. H. Leiderman, J. H. Mendelson, R. Trumbull, & D. Wexler (Eds.), Sensory deprivation. Cambridge: Harvard Univer. Press, 1961. Pp. 130-142. Goldfarb, W. The effects of early institutional care on adolescent personality. Journal of Experimental Education, 1943, 12_, 106-129 . Gorlow, L., Zimet, C., & Fine, H. The validity of anxiety and hostility Rorschach content scores among adoles cents. Journal of Consulting Psychology, 19 52, 16, 73-75. Hackbusch, F. The contribution of projective techniques to the understanding and treatment of children psycho- metrically diagnosed as feeble-minded. American Journal of Mental Deficiency, 1946, 5_1, 15-34. Hartmann, H. Comments-on the psychoanalytic theory of the ego. The Psychoanalytic Study of the Child, 19 50, _5, 74-96. Hartmann, H. Ego psychology and the problem of adaptation. New York: Int. Univer. Press, 1958. Hartmann, H. Ego psychology and the problem of adaptation. In D. Rapaport (Ed.), Organization and pathology of thought. New York: Columbia Univer. Press, 1959. Pp. 362-396. Heber, R. A manual on terminology and classification in mental retardation. American Journal of Mental Deficiency, 19 59, 6_4_ (Monogr. Suppl. 2) . Heber, R. Personality. In H. A. Stevens & R. Heber (Eds.), Mental retardation. Chicago: Univer. Chicago Press, 1964. Pp. 143-174. 98 Hemmendinger, L. Perceptual organization and development as reflected in the structure of Rorschach test responses. Journal of Projective Techniques, 1953, 17, 162-170. Heiranendinger, L. Developmental theory and the Rorschach method. In Maria Rickers-Ovsiankina (Ed.), Ror schach psychology. New York: John Wiley, I960. Pp. 58-79. Hendrick, I. Facts and theories of psychoanalysis. York: Knopf, 19 34. New Hendrick, I. Early development of the ego: Identification in infancy. Psychoanalytic Quarterly, 1951, 20, 44- 61. Hershenson, J. R. Preference of adolescents for Rorschach figures. Child Development, 1949, 20_, 101-118. Hertz, M. R. Rorschach norms for an adolescent age group. Child Development, 1935, 6_, 69-76. Hertz, M. R. Personality patterns in adolescence as por trayed by the Rorschach ink-blot method: I. The movement factors. Journal of General Psychology, 1942, 21_, 119-188. Hertz, M. R. Personality patterns in adolescence as por trayed by the Rorschach ink-blot method: III. The "Erlebnistypus" (a normative study). Journal of General Psychology, 1943 , _28, 225-276. (a) Hertz, M. R. Personality patterns in adolescence as por trayed by the Rorschach method: IV. The "Erleb- nistypus" (a typological study). Journal of General Psychology, 1943, 29_, 3-45. (b) Hertz, M. R., & Baker, E. Personality patterns in adoles cence as portrayed by the Rorschach ink-blot method: II. The color factors. Journal of General Psychol ogy , 1943, 28_, 3-61. Hertz, M. R., & Paolino, A. F. Rorschach indices of percep tual and conceptual disorganization. Journal of Projective Techniques, 1960, 24, 370-388. Hill, L. B. ia. Psychotherapeutic intervention in schizophren- Chicago: Univer. Chicago Press, 1955. 99 Holt, R. R. Gauging primary and secondary processes in Ror schach responses. Journal of Projective Techniques, 1956, 20_, 14-25. Holt, R. R. Manual for the scoring of primary process mani festations in Rorschach responses. Unpublished manuscript, New York Univer. Res. Center for Ment. Hith., 1963. Holt, R. R. Measuring libidinal and aggressive motives and their controls by means of the Rorschach test. Nebraska Symposium on Motivation, 1966, 1-47. Holt, R. R., & Goldberger, L. Personological correlates of reactions to perceptual isolation. USAF Wright Development Center Technical Report, 19 59, No. 59- 735. Holt, R. R., & Havel, J. A method for assessing primary and secondary process in the Rorschach. In Maria Rickers-Ovsiankina (Ed.), Rorschach psychology. New York: John Wiley, 1960. Pp. 263-315. Hurwitz, I. A. A developmental study of the relationship between motor activity and perceptual processes as measured by the Rorschach test. Unpublished doc toral dissertation, Clark Univer., 1954. Hutt, M. L., & Gibby, R. G. The mentally retarded child. Boston: Allyn & Bacon, 1960. Inhelder, B., & Piaget, J. The growth of logical thinking from childhood to adolescence. London: Routledge, 1958. Ives, V. , Grant, M. Q., & Ranzoni, J. H. The "neurotic" Rorschachs of normal adolescents. Journal of Genetic Psychology, 1953, 8_3, 31-61. Jacobs, S. M., & Graham, E. E. A comparison of the Ror schach of juvenile auto thieves and juvenile burg lars . Journal of the Colorado-Wyoming Academy of Science, 1952, 4_, 4-76. Jolles, I. The diagnostic implications of Rorschach's test in case studies of mental defectives. Genetic Psy chology Monographs, 1947 , 3_6, 89-197 . Kanner, L. Early infantile autism. Journal of Pediatrics, 1944, 23, 211-217. 100 Kanner, L. Child psychiatry. (3rd ed.) Springfield, 111.: Charles C. Thomas, 1957. Kantor, R. E., Wallner, J. M., & Winder, C. L. Process and reactive schizophrenia. Journal of Consulting Psy chology, 1953, 17, 157-162. Kasanin, J. (Ed.) Language and thought in schizophrenic. Berkeley: Univer. Calif. Press, 1946. Kassebaum, G. G., Couch, A. S., & Slater, P. E. The facto rial dimensions of the MMPI. Journal of Consulting Psychology, 1959, 23_r 226-236. Klausmeier, H. J., & Check, J. Relationships among physi cal, mental, achievement, and personality measures in children of low, average, and high intelligence at 113 months of age. American Journal of Mental Deficiency, 1959, 63^, 1059-1068. Klopfer, B., Ainsworth, M. D., Klopfer, W. G., & Holt, R. R. Developments in the Rorschach technique. Vol. 1. Technique and theory. Yonkers, N.Y.: World Book Co., 1954. Leiderman, P. Imagery and sensory deprivation, an experi mental study. Technical Documentary Report No. MRL-TDR-62-2 8. AFSC, Wright-Paterson Air Force Base, Ohio, May 19 62. Lewinsohn, P. M., & Riggs, A. The effect of content upon the thinking of acute and chronic schizophrenics. Journal of Abnormal and Social Psychology, 19 62, 65, 206-207. Lindquist, E. F. Design and analysis of experiments in psy- chology and education. Boston: Houghton Mifflin, 1953. Lindzey, G. Projective techniques and cross-cultural research. New York: Appleton-Century-Crofts, 1961. Lofchie, S. H. The performance of adults under distraction stress: A developmental approach. Journal of Psy chology, 1955, 39, 109-116. Lund, F. H. Intelligence and emotionality. Yearbook, National Society for the Study of Education, 1940, 39, 282-285. 101 Mabry, M. A study comparing the language characteristics of scattered and non-scattered schizophrenics with normals. Dissertation Abstracts, 1955, 1J5, 457-458. (Abstract) Mahler, M. S. On child psychosis and schizophrenia: Autis tic and symbiotic infantile psychoses. Psychoanaly tic Study of the Child, 1952, 7_, 286-305. Marcus, E. S. Ego breakdown in schizophrenia: Some impli cations for casework treatment. American Journal of Orthopsychiatry, 1961, 3_]^, 368-387. Martin, W. E., & Blum, A. Intertest generalization and learning in mentally normal and subnormal children. Journal of Comparative and Physiological Psychology, 1961, 54, 28-32. Mayman, M. Rorschach form level manual. Unpublished manu script, Menninger Foundation, 1964. McFate, M. Q., & Orr, F. G. Through adolescence with the Rorschach. Rorschach Research Exchange, 1949, 13, 302-319. Merachnik, D. A. A study of color discrimination in adoles cent groups of differing mental capacities. Unpub lished doctoral dissertation, New York Univer., 1960. O'Conner, N. Neuroticism and emotional stability in high- grade defectives. Journal of Neurology, Neurosur gery, and Psychiatry, 1951, 14_, 226-230. Paulsen, A. Personality development in the middle years of childhood: A ten-year longitudinal study of 3 0 pub lic school children by means of Rorschach test and social histories. American Journal of Orthopsychia try, -194 3, 24, 336-350. Pena, C. A genetic evaluation of perceptual structuraliza- tion in cerebral pathology: An investigation by means of the Rorschach test. Journal of Projective Techniques, 1953, 1_7, 186-199. Piaget, J. Judgment and reasoning in the child. New York: Harcourt, Brace, 1928. Piaget, J. The child's conception of physical causality. London: Kegan, 1930. 102 Piaget, J. The language and thought of the child. (2nd ed.) London: Routledge, 19 32. Piaget, J. Principle factors determining intellectual evolution from childhood to adult life. In Harvard Tercentenary Publ., Factors determining human behav- ior. Cambridge: Harvard Univer. Press, 19 37. Pp. 32-48. Piaget, J. The psychology of intelligence. New York: Har- court, Brace, 1950. Pine, F., & Holt, R. R. Creativity and primary process: A study of adaptive regression. Journal of Abnormal and Social Psychology, 1960 , 6_1, 370-379 . Piotrowski, Z. A. A comparison of congenitally defective children with schizophrenic children in regard to personality structure and intelligence type. Pro ceedings of the American Association on Mental Defi ciency , 1937, A2_, 78-90. Pollack, M. Brain damage, mental retardation and childhood schizophrenia. American Journal of Psychiatry, 1958, 115, 422-427. Potter, H. W. Schizophrenia in children. American Journal of Psychiatry, 1933, 89, 1253-1270. Powers, W. T., & Hamlin, R. M. Relationship between diag nostic category and deviant verbalizations on the Rorschach. Journal of Consulting Psychology, 19 55, 14, 120-124. Rabin, A. I. Projective methods and projection in children. In A. I. Rabin & M. Haworth (Eds.), Projective techniques with children. New York: Grune & Stratton, 1960. Pp. 2-11. Rabin, A. I., & Beck, S. J. Genetic aspects of some Ror schach factors. American Journal of Orthopsychia try, 1950, 2£, 595-599. Ranzoni, J. H., Grant, M. Q., & Ives, V. Rorschach "card pull" in a normal adolescent population. Journal of Projective Techniques, 1950 , 1_4_, 107-133. Rapaport, D. On the psychoanalytic theory of thinking. International Journal of Psycho-Analysis, 19 50, 31, 161-170. 103 Rapaport, D. The conceptual model of psychoanalysis. Jour nal of Personality/ 1951, 20^, 56-81. Rapaport, D. Projective techniques and the theory of think ing. Journal of Projective Techniques, 1952, 16, 269-275. Rapaport, D. Toward a theory of thinking. In D. Rapaport (Ed.), Organization and pathology of thought. New York: Columbia Univer. Press, 1959. Pp. 689-730. Rapaport, D., & Gill, M. M. The points of view and assump tions of metapsychology. International Journal of Psycho-Analysis, 1959 , _40_, 153-162 . Rapaport, D., Gill, M. M., & Schafer, R. Diagnostic psycho logical testing. Vol. 1. Chicago: Year Book Publ., 1945. Rapaport, D., Gill, M. M., & Schafer, R. Diagnostic psycho- logical testing. Vol. 2. Chicago: Year Book Publ., 1946. Ricciuti, H. N. Use of the Rorschach test in longitudinal studies of personality development. Journal of Pro jective Techniques, 1956, 20_, 256-260. Richards, T. W. Individual variations in I.Q. and analysis of concomitant factors. Psychological Bulletin, 1940, 37_, 442-443. Rorschach, H. Psychodiagnostik, Methodik und Ergebnisse eines wahrnehmungsdiagnostischen Experiments. Bern: Ernst Bircher, 1921. Rosenblatt, B., & Solomon, P. Structural and genetic aspects of the Rorschach responses in mental defi ciency. Journal of Projective Techniques, 1954, 18, 496-505. Sarason, S. B. Psychological problems in mental deficiency. New York: Harper, 1949. _ Sarason, S. B., & Gladwin, T. Psychological and cultural problems in mental subnormality: A review of research. Genetic Psychology Monographs, 19 58, 57, 3-290. Sargent, H. D. Projective methods: Their origins, theory, and application in personality research. Psycholog ical Bulletin, 1945, 42, 257-293. 104 Schafer, R. Psychoanalytic interpretation in Rorschach testing; Theory and application. New York: Grune & Stratton, 19 54. Schafer, R. Regression in the service of the ego; The relevance of a psychoanalytic concept for personal ity assessment. In G. Lindzey (Ed.), Assessment of human motives. New York: Rinehart, 19 58. Schilder, P. Mind; Perception and thought in their con structive aspects. New York: Columbia Univer. Press, 1942. Schmidl, F. The Rorschach test in juvenile delinquency research. American Journal of Orthopsychiatry, 1947, 17, 151-160. Siegel, E. L. Genetic parallels of perceptual structurali- zation in paranoid schizophrenia; An analysis by means of the Rorschach technique. Journal of Pro jective Techniques, 1953, 1/7, 151-161. Silverman, L. N., Lapkin, B., & Rosenbaum, I. S. Manifesta tions of primary process thinking in schizophrenia. Journal of Projective Techniques, 1962, 2_6, 117-127. Silverstein, A. B. Psychological testing practices in state institutions for the mentally retarded. American Journal of Mental Deficiency, 1963 , 68_, 440-445. Sloan, W. Mental deficiency as a symptom of personality disturbance. American Journal of Mental Deficiency, 1947' 52, 31-36. Spitz, H. H. Field theory in mental deficiency. In N. R. Ellis (Ed.), Handbook of mental deficiency. New York: McGraw-Hill, 1963. Pp. 11-40. Spivack, G. Perceptual processes. In N. R. Ellis (Ed.), Handbook of mental deficiency. New York: McGraw- Hill, 1963. Pp. 480-511. Steiner, M. The Rorschach test. In Frank, L. K., Harrison, R., Hellersberg, E., Machover, K., & Steiner, M. Personality development in adolescent girls. Mono graphs of the Society for Research in Child Develop ment, 1951, 16, 34-59. Stern, A. Psychoanalytic therapy in the borderline neuro ses. Psychoanalytic Quarterly, 1945, 14, 190-198. 105 Suares, N. Personality development in adolescence. Ror schach Research Exchange, 1938, 2, 2-12. Sullivan, H. The language of schizophrenia. In J . S. Kasanin (Ed.), Language and thought in schizo phrenia. Berkeley: Univer. Calif . Press , ITF44. Pp. 4-16. Teuber, H. L., & Rudel, R. Behavior after cerebral lesions in children and adults. Developmental Medicine and Child Neurology, 1962, 4_, 3-20. Thetford, W. N. Fantasy perception in the personality development of normal and deviant children. Ameri can Journal of Orthopsychiatry, 1952, 2_2, 542-550. Thetford, W. N., Molish, H. B., & Beck, S. J. Developmental aspects of personality structures in normal chil- ■ dren. Journal of Projective Techniques, 1951, 15, 58-78. Waldman, M. Personality factors and performances under stress. Unpublished doctoral dissertation, Univer. of Chicago, 1956. Weakland, J. H., & Jackson, D. D. Patient and therapist observations on the circumstances of a schizophrenic episode. Archives of Neurology & Psychiatry, 1958, 79, 554-574. Weber, G. H. Some qualitative aspects of an exploratory personality study of 15 juvenile automobile thieves. Transactions of the Kansas Academy of Science, 1950, 53, 548-556. Weil, A. Certain severe disturbances of ego development in childhood. The Psychoanalytic Study of the Child, 1953, 8, 271-287. Werner, H. Rorschach method applied to two clinical groups of mental defectives. American Journal of Mental Deficiency, 1945, _49, 304-306. Werner, H. Comparative psychology of mental development. (Rev. ed.) Chicago: Follet, 1948. White, R. Ego and reality in psychoanalytic theory. Psy chological Issues, 1963, _3, (Whole No. 11). Wilson, M. T. Regression in perceptual organization: A study of adolescent performance on the Rorschach 106 test. Unpublished doctoral dissertation, Clark Univer., 19 54. Wyatt, F. Symposium: Perceptual structure in pathology and development. Journal of Projective Techniques, 1953, 17, 144-199. Wyatt, F. A principle for the interpretation of fantasy. Journal of Projective Techniques, 1958, 22_r 229-245. Zeaman, D., & House, B. J. Discrimination learning in retardates. Training School Bulletin, 1959, 56, 62- 67. Zigler, E. Rigidity in the feebleminded. In E. Trapp & P. Himelstein (Eds.), Rorschach readings on the excep tional child. New York: Appleton-Century-Crofts, 1962. Zimet, C. N., & Fine, H. J. Primary and secondary process thinking in two types of schizophrenia. Journal of Projective Techniques & Personality Assessment, i9 6 5, 29, 93-99. Zukowsky, E. Measuring primary and secondary process think ing in schizophrenics and normals by means of the Rorschach. Dissertation Abstracts, 1962, 23, 316- 317. (Abstract) a p p e n d i c e s 107 108 APPENDIX A Primary Process Categories Used for Scoring the Rorschach Protocols, and the Defense Demand (DD) Associated with Each CONTENT CATEGORIES __ (DD)* L. Libidinal L 1 0 Oral 1 ...................................... (2-4) L 1 A Anal 1 ......................................(3,4) L I S Sexual 1 ..................................(4,5) L 1 E-V Exhibitionistic-voyeuris tic 1 ......... (3) L 1 H Homosexual 1 ..............................(4,5) L 1 M Miscellaneous libidinal 1 ................ (3,4) L 2 0 Oral 2 ...................................... (1-3) L 2 A Anal 2 ...................................... (1-3) L 2 S Sexual 2 ....................... ' (1,2) L 2 E-V Exhibitionistic-voyeuristic 2 ........... (1-3) L 2 H Homosexual 2 .............................. (1-3) L 2 M Miscellaneous libidinal 2 ................ (2,3) Ag. Aggressive Ag 1 P-S Potential--sub j ect 1 ................... (4) Ag 1 P-O Potential--ob j ect 1 ..................... (3) Ag 1 A-S Active--sub j ect 1 .........................(4,5) Ag 1 A-O Active--ob ject 1 .........................(4,5) Ag 1 R Results 1 .................................. (4,5) Ag 2 P-S Potential— subject 2 .....................(2,3) Ag 2 P-O Potential— object 2 .......................(1,2) Ag 2 A-S Active— subject 2 ........... (2,3) Ag 2 A-0 Active--object 2 (2,3) Ag 2 R Results 2 .................................. (1-3) FORMAL CATEGORIES C. Condensation C f-p 1 Fusion of percepts..................... (4) C i-e 1 Internal-external v i e w ................ (4) C p-f 1 Partial f u s i o n ......................... (3) 109 (DD) * C u-p 1 Unrelinquished percepts ................. (2) C-co 1 Composition 1 .............. (3,4) C-co 2 Composition 2 ....................... (2) C a-1 2 Arbitrary linkage of percepts.....(2,3) C a-c i2 Arbitrary impossible combinations . . . (3) C a-c u2 Arbitrary unlikely combinations .... (2) Arbitrary combinations of color and form FC arb 1 FC arb or CF a r b ........................ (3) F0 2 FC or F / C ................................. (2) Trans 1 Fluid transformation of percept .... (3) C-sym 1 Color symbolism.......................... (3) C-sym 2 Color symbolism.......................... (1) S-sym 1 Spatial symbolism........................ (3) I-sym 1 Concrete image symbolism .............. (3) I-sym 2 Concrete image symbolism .............. (1) Do 2 Fragmentation............................. (1) Imp 2 Impressionistic response ............... (2,3) Au Lg 1 Autistic L o g i c ............................ (4,5) DW 1 D W ........................................ (4) Ctr A 1 Affective contradiction................. (4) Ctr L 1 Logical contradiction................... (3) Ctr In i2 Impossible inappropriate activity . . . (4) Ctr In u2 Unlikely inappropriate activity .... (3) VS 2 Verbal s l i p s ............................. (2) VP 2 Peculiar verbalizations ................. (3) VQ 1 Queer verbalizations................... (4) VC 1 Verbal condensation...................... (4) VI 1 Verbal incoherence; confusion .......... (5) Au El 1 Autistic elaboration, Level 1 ............(4,5) Au El 2 Autistic elaboration, Level 2 .......... (3) S-R 1 Self-reference............................ (2,3) ML 1 Loosening of memory...................... (4) I i 1 Intrusion of irrelevancy............... (3) F-Msc 1 or 2 Miscellaneous formal a s p e c t s ...........(2-4) *DD=Defense Demand. APPENDIX B Control and Defense Categories Used to Score the Rorschach Protocols Sequence Recovery, modifying percept S M 1-0 Level 1— unscorable S M 2-0 Level 2— unscorable S M 1-2 Level 1— Level 2 S M R+,- Rationalization of percept Recovery, changing percept S C 1-0 Level 1— unscorable S C 2-0 Level 2— unscorable S C 1-2 Level 1— Level 2 Regression, modifying percept S M 0-1 Unscorable— Level 1 S M 0-2 Unscorable— Level 2 S M 2-1 Level 2— Level 1 Regression, changing percept S C 2-1 Level 2— Level 1 Delay Inh. Inhibition Reflection on response Isp+,— Introspection Crt+,- Criticism of response Remoteness R-min Minimal remoteness R-eth Ethnically remote from S R-an Animals R-(an) Animals (sub-mammalian) R—pi Plants R-ia Inanimate R-dep Depictions R-geo Geographical remoteness R-tm Remoteness in time Remoteness in level of reality R-fic S+,- Specific fictional R-fic n+,- Non-specific fictional R-rel+,- Religious character or context R-fan+,- Explicit fantasy or dream R-fig+,- Figures of speech R-cond Conditional Overtness O-beh Behavioral O-vbl Verbal O-im Implicit Context of response Cx C+ r— Cultural context Cx E+,— Esthetic context Cx 1+,- Intellectual context Cx H+,— Humorous context Pathological defenses Va- Vagueness of percept Prj- Projection of responsibility Neg+,~ Negation and undoing Eu- Euphemism Minz- Minimization Obs- Obsessional defense Den- Attempted denial Ev- Evasion Imp- Impotence X No Control 112 APPENDIX C Form Level Scores following Mayman's (19 64) System with Additions and Descriptions from Holt (19 63) Score + 3 + 2 + 1 -1 Category F+ Fo F W + Fw- -2 Fv -3 Fa -3 Fs -4 F- Explanation Sharp, convincing forms, easily seen by E. Popular and near popular forms. Fixed list in manual. Reasonably plausible, but not ter ribly convincing forms; takes a little stretching to see. Forms that bear only a slight resemblance to the blot area; not very plausible, or based on one point of resemblance. Vague, non-definitive forms--things that intrinsically do not have spe cific shapes. "Clouds," "Blood stain," "Piece of dough." Amorphous responses, in which form plays no role (and could not by the nature of the concept). Usually pure C, C', or Ch. Spoiled form responses, to be used when the S_ gives what is basically a good response but introduces some specification that has the effect of lowering the acceptability of the response as a whole. Arbitrary forms, bearing very little or no resemblance to the blot. 113 APPENDIX D Analysis of Variance Total Rorschach Responses Source df MS F P Diagnosis 2 155.68 3.31 .05 Ss within groups 54 47 . 04 114 APPENDIX E Analysis of Variance Total Primary Process Scores Source df MS F P Diagnosis 2 4,812. 87 19.75 .001 Ss within groups 54 243 .73 115 APPENDIX F Analyses of Variance Total Level 1 and Level 2 Scores Source df MS F P Level 1 Diagnosis 2 4,588.03 34.28 .001 Ss within groups 54 133.83 Level 2 Diagnosis 2 13.36 <<1 ns Ss within groups 54 66.11 116 APPENDIX G Analysis of Variance Defense Demand Scores Source df MS F P Diagnosis 2 24 . 83 75.96 . 001 Ss within groups 54 . 33 117 APPENDIX H Analyses of Variance Total Content and Total Formal Scores Source df MS F P Content Diagnosis 2 214.24 3 .10 ns Ss within groups 54 69.18 Formal Diagnosis 2 3,392.69 38 .31 . 001 Ss within groups 54 88.55 118 APPENDIX I Analyses of Variance Level 1 and Level 2, Content and Formal Scores Source df MS F P Ll,Content Diagnosis 2 222.21 15.19 .001 Ss within groups 54 14 . 63 L2,Content Diagnosis 2 87. 54 2 .28 ns Ss within groups 54 38 . 35 Ll,Formal Diagnosis 2 2,792.37 36.57 .001 Ss within groups 54 76.36 L2,Formal Diagnosis 2 54.72 6.44 .01 Ss within groups 54 8. 50 Note.--L refers to Level. 119 APPENDIX J Analysis of Variance Adaptive Regression Scores Source df MS ' F P Diagnosis 2 162.75 44 . 92 .001 Ss within groups 54 3 . 62 1
Linked assets
University of Southern California Dissertations and Theses
Conceptually similar
PDF
Self-Worth, Future Goals, Mood And Time Perception
PDF
Effects Of Different Treatment Procedures On Reading Ability And Anxiety Level In Children With Learning Difficulties
PDF
Acculturation And Value Change
PDF
First Steps In An Attempt To Construct An Objective Test Of Character Structure
PDF
Sex-Role Preferences Of Early Adolescents In Relation To Adjustment
PDF
Ego Diffusion In Women With Behavioral Disorders And The Integrating Effects Of Psychodrama In Identity Consolidation
PDF
Prediction Of Therapeutic And Intellectual Potential In Mentally Retardedchildren
PDF
Delinquency As A Function Of Intrafamily Relationships
PDF
A Temporal Approach-Avoidance Conflict In An Academic Test Situation
PDF
Psychological Test Changes In Schizophrenic Patients Under Brief Stimuluselectroconvulsive Therapy
PDF
Intellectual And Cognitive Factors In The Production Of Psychological Stress Reactions
PDF
Behavioral Seriousness And Impulse-Control Balance In Delinquency
PDF
The Concept Of Sexual Identity In Normals And Transvestites: Its Relationship To The Body-Image, Self-Concept And Parental Identification
PDF
The Effects Of Making Social Desirability Judgments On Personality Inventory Scores Of Schizophrenics
PDF
Perceptual Defense And Somatization: A Comparison Of The Perceptual Thresholds Of Obese And Peptic Ulcer Patients
PDF
Improvement Rate In Tuberculosis As A Function Of Accessibility To Repressed Emotional Disturbance
PDF
Non-Specific Treatment Factors And Deconditioning In Fear Reduction
PDF
Experimenter Expectancy Effect Examined As A Function Of Task Ambiguity And Internal Versus External Control Of Reinforcement
PDF
An Investigation Into The Communication Style Of Suicidal Individuals
PDF
A Multidimensional Scaling Of Mood Expressions
Asset Metadata
Creator
Chapman, Mary Veronica
(author)
Core Title
Measuring Thought Process As An Ego Function In Schizophrenic, Mentally Retarded And Normal Adolescents By Means Of The Rorschach
Degree
Doctor of Philosophy
Degree Program
Psychology
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
OAI-PMH Harvest,Psychology, clinical
Language
English
Contributor
Digitized by ProQuest
(provenance)
Advisor
Seward, Georgene H. (
committee chair
), Cliff, Norman (
committee member
), Lasswell, Thomas E. (
committee member
)
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c18-622663
Unique identifier
UC11360193
Identifier
6813572.pdf (filename),usctheses-c18-622663 (legacy record id)
Legacy Identifier
6813572.pdf
Dmrecord
622663
Document Type
Dissertation
Rights
Chapman, Mary Veronica
Type
texts
Source
University of Southern California
(contributing entity),
University of Southern California Dissertations and Theses
(collection)
Access Conditions
The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...
Repository Name
University of Southern California Digital Library
Repository Location
USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA