THE PERFORMANCE OF POST-TRAUMATICS, POST-TRAUMATIC EPILEPTICS, AND IDIOPATHIC EPILEPTICS ON PSYCHOLOGICAL TESTS: A STUDY OF THE RELATIVE INFLUENCE OF SYMPTOM AND ETIOLOGY UPON PSYCHOLOGICAL PERFORMANCE

225 Pages·010.003 MB·English

by  THEAMAN, MILTON

The student hereby guarantees th at no part of the dissertation
or document which he has submitted for publication has been heretofore
published and (or) copyrighted in the United S tates of America, except
in the case of passages quoted from other published sources; that he is
the sole author and proprietor of said d issertatio n o r document; that
the d issertation or document contains no m atter which, if published,
w ill be libelous or otherwise injurious, or infringe in any way the
copyright of any other party; and that he w ill defend, indemnify and
hold harmless New York University against a ll su its and proceedings
which may be brought and against a ll claims which may be made against
New York University by reason of the publication of said dissertation
or document.
M ilton Theaman
Sponsoring Committee: Professor Brian E. Tomlinson,
Professor Edward L. Kemp, and Professor Leonard A. Larson
THE PERFORMANCE OF POST-TRAUMATICS, POST-TRAUMATIC EPILEPTICS,
AND IDIOPATHIC EPILEPTICS ON PSYCHOLOGICAL TESTS
A Study of the R elative Influence of Symptom and
Etiology upon Psychological Performance
MILTON THEAMAN
Submitted in p a rtia l fulfillm ent of the
requirem ents for the degree of Doctor of
Philosophy in the School of Education of
New York University
ACKNOWLEDGEMENTS
The w riter is indebted to the members of h is sponsoring committee,
Dr. Edward L. Kemp, Dr. Leonard A. Larson, and p articu larly to the chairman
of the committee, Dr. Brian E. Tomlinson, for th eir guidance and cooperation
in the accomplishment of th is research.
Dr. John Harding was generous with h is wise counsel. It was he
who introduced the author to the discrim inant function technique and carefully
nurtured him through its m ysteries.
Mrs, Mildred S. Theaman was invaluable as a motivating influence,
general consultant, and a most alert ty p ist.
Many Veterans Administration employees aided in the identification
of subjects and collection of data. Their assistance is appreciated.
The Veterans Administration o ffic ia lly approved th is project and
perm itted it to be carried on at its fa c ilitie s .
The quotation on pages 64-65 is reprinted by permission from
INTRODUCTION TO MATHEMATICAL STATISTICS by P. G. Hoel, published by
John Wiley & Sons, Inc., 1947.
ii
TAELS OF CONTENTS
Chapter Topic Page
ACKNOWLEDGEMENTS............................................................................................... ii
LIST OF TABLES.................................................................................................... v
I THE PROBLEM........................................................................................................... 1
The Statem ent of the Problem........................................................ 1
Specific Problems........................................................................... 1
D efinition of Terms .................................................... 1
D elim itations.......................................................................................... 2
Basic Assumptions................................................................................ 2
Basic H ypothesis.................................................................................. 2
Need fo r the Study............................................................................. 3
Summary of Chapter................................................................ 6
II RELATED LITERATURE.......................................................................................... 8
H istory of Epilepsy............................................................................ 8
Etiology of Epilepsy......................................................................... 11
Types of S eizures.......................... 13
In te lle c tu a l Functioning................................................................. 14
Psychometric Patterning on the Wechsler-Bellevue.. 14
Epilepsy and Mental Deterioration................................... 21
Frequency of Seizures and Mental Functioning. 26
E ffect of Medication on Mental Functioning.................. 27
Type of Seizure and Mental Functioning......................... 30
P ersonality Functioning................................................................... 30
Rorschach Studies..................................................................... 31
The E pileptic Personality................................................... 41
Post-traum atic Personality......................................... 45
Summary of Chapter.............................................................................. 51
III PROCEDURE................................................................................................................ 54
Selection of Subjects...................................................................... 54
Equating of Groups........................ 57
D escription of Test Materials...................................................... 59
A nalysis of D ata.................................................................................. 61
W echsler-Bellevue Adult Intelligence Scale............... 61
Rorschach Personality Test.................................................. 66
Summary of Chapter.............................................................................. 76
iii
Chapter Topic Page
IV PRESENTATION OF DATA......................................................................................... 79
Wechsler-Bellevue R esults.................................................................. 79
Rorschach R esults.................................................................................... 94
Summary of Chapter.................................................................................. 116
V INTERPRETATION AND DISCUSSION OF RESULTS............................................ 117
W echsler-Bellevue.................................................................................... 117
Interpretation of Results....................................................... 117
Comparison of Results with Other Studies..................... 122
Rorschach....................................................................................................... 129
Interpretation of Results....................................................... 129
Comparison of Results with Other Studies..................... 138
Comparison of Wechsler-Bellevue and Rorschach R esults.. 150
Discussion..................................................................................................... 151
Application of Syndromes to Other Groups..................... 152
Individual Diagnosis.................................................................. 153
The Use of Psychological. Tests in an Out-Patient
C linic....................... 157
Suggestions for Further Research....................................... 159
Summary of Chapter............................................................... 160
VI SUMMARY AND CONCLUSIONS.................................................................................. 161
Wechsler-Bellevue R esults.................................................................. l6 l
Post-traum atic Group.................................................................. 161
Post-traum atic Epileptic Group............................................ 161
Idiopathic Epileptic Group.................................................... 162
Comparison of Groups.................................................................. 163
Rorschach R esults.................................................................................... 164
Comparison of Post-traum atic and Post-traum atic
E pileptic Groups........................................................................... 164
Comparison of Idiopathic Epileptic and Post-
traum atic Epileptic Groups.................................................... 166
Post-traum atic and Epileptic Syndromes......................... 168
Comparison of the Wechsler-Bellevue and Rorschach
R esults................................................................................................ 170
Conclusions......................................... 170
BIBLIOGRAPHY........................................................................................................... 172
APPENDIX.................................................................................................................... 183
iv
LIST OF TABLES
Number Title Page
I Comparison of Mean Weighted Subteat Scores Found in
D ifferent Investigations................................................................. 15
II In tellig en ce and Type of Seizure............................................................ 30
I I I Hughes’ Weighted Signs for Organic Pathology................................. 39
IV R elationship of Time of Examination After Injury to Recovery
from Intellectual Impairment......................................................... 49
V Mean Age of PT, PTE, and IE...................................................................... 57
VI Number of School Years Completed by PT, PTE, and IE. .............. 58
VII W echsler-Bellevue Information Scores for PT, PTE, and IE .... 59
V III W echsler-Bellevue Mean I.Q. & Subtest Scores of the PT,
PTE, and IE............................................................................................. 80
IX D ifference between Verbal & Performance I.Q .'S of the
PT, PTE, & IE........................................................................................ 80
X D eviation of Mean Subtest Scores from Information....................... 82
XI Mean Scores for Digits Forward & Digits Backward......................... 82
XII D ifferences in I.Q. between PT & PTE, and between IE & BTE.. 85
XIII D ifferences between PT & PTE, and between IE & PTE in
Mean Subtest Scores............................................................................ 85
XIV D ifferences between PT & PTE, and between IE & PTE on
D igits Forward & Backward............................................................... 85
XV Comparison of Groups on Difference of Two or More between
D igits Forward and Digits Backward............................................ 87
XVI Ten Simultaneous Equations in the Calculation of the
Discrim inant Function between PT & PTE................................... 90
XVII Subtest Weights for Discriminating between PT & P T E ......... 90
XVIII Ten Simultaneous Equations in the Calculation of the
Discrim inant Function Between IE & PTE................................... 93
XIX Subtest Weights for Discriminating between IE & PTE.................. 93
XX D iscrim ination between IE & PTE by Weighted Subtest Scores.. 92
XXI Post-traum atic Index: Sum of I and C Minus Sum of BD and OA 94
XXII Mean and Standard Deviation Scores of the PT, PTE, & IE on
Rorschach Scoring Categories......................................................... 96
XXIII D ifferences between PT & PTE, and IE & PTE on Rorschach
Scoring Categories.............................................................................. 99
XXIV Frequency of Piotrowski's "Organic" Signs in the PT, PTE,
& IE ............................................................................................................. 102
XXV Frequency of Piotrowski's "Organic? Signs in Each Record 102
XXVI Frequency of Piotrowski's "Epileptii1 Signs in the PT,
PTE, & IE..................................................... 104
XXVII Frequency of Piotrowski's "Epileptic" Signs in Each Record.. 104
XXVIII Frequency of A ita's "Organic" Signs in the PT, PTE, & IE .... 106
XXIX Frequency of A ita1 s "Organic" Signs in Each Record................. 106
XXX Summary of the Calculation of Hughes' "Organic" Score for
a ll Sub ject ................................................................................. 108
v
Number T itle Page
XXXI Rorschach C haracteristics of the PT, PTE, & IE................................ 110
XXXII Frequency of "Bost-trauraatic Syndrome" Signs in Each Record. 114
XXXIII Frequency of "Epileptic Syndrome" Signs in Each Record 114
XXXIV Summary of Calculation of Wechsler Mental D eterioration
Index for the PT, PTE, & IE.............................................................. 125
XXXV Summary of Calculation of the Allen Index for Identification
of Brain Injury for the PT, PTE, & IE........................................ 128
XXXVI Comparison of the PT, PTE, & IE and Piotrowski’s Groups
with Respect to Piotrowski' s "Epileptic" Signs................... 144
XXXVII Comparison of the PT, PTE, & IE, and A ita’s Groups with
Respect to Aita’s "Organic" Signs................................................. 146
XXXVIII PT Biographical Data........................................................................................... 184
XXXIX PTE Biographical Data......................................................................................... 188
XL IE Biographical D ata. ...................... 193
XLI PT Wechsler-Bellevue Scores........................................................................... 194
XLII PTE Wechsler-Bellevue Scores......................................................................... 195
XLIII IE W echsler-Bellevue Scores............................................................................ 196
XLIV PT Rorschach Data...................................................... 197
XLV PTE Rorschach Data................................................................................................ 201
XLVI IE Rorschach Data................................................................................................... 205
vi
CHAPTER I
THE PROBLEM
The Statement of the Problem
This investigation is a study of the performance of three groups
of p atien ts, post-traumatics, post-traumatic epileptics, and idiopathic
ep ilep tics, on psychological tests. The problem is to determine whether,
with respect to their performance on such te sts, the post traumatic
epileptics are more similar to the post-traumatics than to the idiopathic
ep ilep tics.
Specific Problems
The firs t problem is to establish the personality structure of
each of the three groups of patients: post-traumatics, post-traumatic
ep ilep tics, and idiopathic epileptics.
The second problem is to compare the performance of the three
groups to discover in what respects the psychological functioning of these
groups d iffer, and in what respects it is sim ilar.
The third problem is to determine whether the two epileptic
groups form a more homogeneous unit than do the two post-traumatic groups.
D efinition of Terms
For the purpose of this study the following definitions w ill apply:
Poat-trsnm*tic condition refers to an injury to the head which
has not resulted in convulsive seizures.
Post-traumatic epilepsy means convulsive seizures following an
2
injury to the head.
Idiopathic epilepsy refers to convulsive seizures which cannot
be attributed to any known cause.
Psychological tests w ill include the Wechsler-Bellevue Adult
Intelligence Scale and the Rorschach Personality Examination.
By homogeneity is meant the extent to which the performance of
the subgroups within a larger classification is sim ilar.
Delimitations
Only male, white patients who reside in, or close enough to
New York City to be treated by Veterans Administration fac ilitie s in that
area w ill be included.
It w ill be a non-institutionalized veteran population.
All subjects w ill be veterans of World War II and w ill range in
age from 18 to 44 years.
Basic Assumptions
It is assumed that there may be a basic personality structure
characteristic of and differentiating each of the three groups under in­
vestigation.
It is further assumed that the psychological devices used should
reflect these structures, and if there are basic structural differences in
the personalities of the groups, the psychological instruments should establish
these differences.
Basic Hypothesis
To assist in the diagnosis and rehabilitation of patients, psy­
chologists have sought for characteristic patterns of functioning of different
clinical groups. Epileptics have been included in these studies as a clinical
3
group* They have frequently been studied as a clinical entity, w ithout
reference to the character of the etiology of the disease. This was done
even in recent studies, as for example, one reported by Piotrowski^ and
2
another by Sheps. In so doing, the investigators have groups the patien ts
on the basis of a symptom—the convulsive seizure—with disregard fo r the
etiology* To determine the justification for such a classificatio n , th is
investigation intends to test the hypothesis it presumes, i. e*, th at a
classification based upon a symptom w ill form a more homogeneous unit than
one based upon etiology. This w ill be accomplished by determining whether
the performance of post-traumatic epileptics on psychological te s ts is more
sim ilar to that of idiopathic epileptics than to that of post-traum atics.
I f the two epileptic groups function in & more similar manner than do the
post-traum atic groups, then the hypothesis will be upheld. If the reverse
is the case, the hypothesis must be rejected.
Need for the Study
Physical examinations in connection with the draft during World
War I provided the first information about the incidence of epilepsy that
was based upon a study of a large segment of the population. Approximately
0*5 per cent, of those examined were rejected because of having a history
of seizures. This must be considered a conservative estim ate of the
population figures because of the screening out of epileptics in in stitu tio n s,
the absence of the child population with its high seizure rate, and the
1. Z. A. Piotrowski, “The Personality of the Epileptic.” Chapter 8 in
P. H. Hoch and R. P. Knight, Epilepsy, pp. 89-108.
2* J. G. Sheps, “Intelligence of Male Non-Institutionalized E pileptics
of Military Age“, Journal of Mental Sciences. 93 (1947),
3* W. G. Lennox, Science and Seizures, p. 21.