test scores and what they mean

2
BOOK REVIEWS indebtedness to Freud, Erikson and Hartmann. She defines values as "preferred goals" which are part of the self which she defines, in tum, as a "process hav- ing direction" (Erikson), and a "system (whose) direction is toward fulllllment via integrated opera- tion of the four basic tendencies" (p. 81). On the basis of the foregoing constructs, the author approaches various technical problems encountered in psychotherapy from the initial contacts with the patient until its termination. She expresses herseH with a warmly empathic understanding of both the patient and his therapist which consistently pervades all that she has to say, especially in her clinical ex- amples. There is a tendency to be repetitious and, at times, somewhat ambiguous, but these are minor criticisms. The "discussions" of each member of a group of psychologists who participated in a semi- nar, with the author, which was devoted to the sub- ject of the book's title, represent no meaningful addi- tions to the volume. An exception would be the lengthy section written by Rudolf Ekstein on chang- ing values in psychoanalytic treatment as related to the social matrix out of which it evolved and in which it has been practiced. In the main, the author succeeds in her stated goals and, thereby, makes a meaningful contribution to the psychotherapist's problem of making insight functional. This is a book which must be digested slowly, but the rewards make the effort worthwhile because of the productive mental stimulation pro- vided. This reviewer believes that the book will be of greatest value to psychiatrists and those other phy- sicians who have made it a practice to acquire a meaningful understanding of the psychological needs of their patients. SIDNEY L. GHEEN, M.D, EPIDEMIOLOGY OF MENTAL DlSORDER-A Symposium to commemorate the centennial of the birth of Emil Kraepelin, co-sponsored by the American Public Health Association and held at the New York meeting, December 27-28, 1956. Edited by Ben;amin Pasamanick, Washington, D.C.: American Association for the Advancement of Science, 1959. 295 pages. This book contains a considerable wealth of ma- terial mostly concerned with various etiological fac- tors in mental disorders. It is introduced by an ex- tensive presentation of Kraepelin's biography and contributions, which certainly should attract interest. A number of original studies offer many challeng- ing conclusions and give good insight into method- ology of psychiatric research. We find here a study of various factors affecting mental health of adolescents, including family mobility, broken homes, affiliation with community organizations, place of residence, etc. Other studies are concerned with the occurrence of schizophrenia in different social groups. The economic factor and place of residence is stressed again and basic findings agree with some similar investigations in pointing out the prevalence of this condition in the lowest social and economic groups. Here again, however, the basic question of distinguishing be- tween the cart and the horse presents a challenge. Some positive relationship is found between the his- September-October, 1963 tory of early nervousness and premature birth rate. Epidemiological studies of mental disorders in small communities and in larger centers are also reported. An excellent table is prepared by the authors of the paper on epidemiological aspects of prognosis, an- alyzing the prognostic value of a number of the pre- morbid factors and those observed during the course of illness. Such statistics may be of value for the authors of current textbooks on clinical psychiatry. An ingenious study of the deaf population concludes against an increased prevalence of schizophrenia in people deprived of hearing. A peculiar seasonal vari- ation has been found in mental hospital admissions for old-age psychoses. The summer months, from l\1ay to August, appear to provide a considerably larger percentage of admitted cases. An unusual his- torical flavor has been added to this conclusion by comparing it with findings of Dr. Esquirol in his article prepared in France in 1816. In spite of the difference of 150 years, identical conclusions are ob- served. A conclusion of the paper on intellectual potential in infant population is worth quoting here: "At the present time the most useful theory is that while man's fundamental structure and consequently his basic functioning is genetically determined, it is his socio-cultural milieu, affecting biological and psycho- logical variables, which modifies his behavior and, in the absence of organic brain damage, makes one individual significantly different from the next." A research minded psychiatrist and many other medical practitionf'rs will find this hook well worth studying. VICTOR SZYRYNSKI, l\I.D., Ph.D. TEST SCORES AND WHAT THEY 'MEAN. By Howard B. Lyman. 223 pages. Englewood CliDs, N. ].: Prentice Hall, Inc., 1963. This paperback book should be entitled, "Test Scores and Their Statistical Meanings." The author states that his intentions are "to meet the needs of those with Iimitf'd training.... Without a special study of test scores, anyone is likely to confuse per- centage-correct scores with percentile ranks, per- centile ranks with standard scores, standard scores with normalized standard scores, normalized standard scores with I.Q.s, et cetera." The hook covers such topics as: maximum-per- formance vs typical-performance tests and statistical background material for interpreting quantitative results. The author discusses test information and the communication of results. A limited though se- lected bibliography is presented, as well as an ex- cellent glossary of terms, and very valuable conver- sion tables for derived scores. This is an excellent book for students who are studying psychology in the statistical-experimental- laboratory tradition. It should be required reading for the clinician who very often uses a psychological test without examining its statistical construction for strengths and weaknesses. Unfortunately for its potential readers, it is also the kind of book that frightens the practitioner be- cause it is directed toward the understanding of num- 307

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Page 1: Test scores and what they mean

BOOK REVIEWS

indebtedness to Freud, Erikson and Hartmann. Shedefines values as "preferred goals" which are part ofthe self which she defines, in tum, as a "process hav­ing direction" (Erikson), and a "system (whose)direction is toward fulllllment via integrated opera­tion of the four basic tendencies" (p. 81).

On the basis of the foregoing constructs, the authorapproaches various technical problems encounteredin psychotherapy from the initial contacts with thepatient until its termination. She expresses herseHwith a warmly empathic understanding of both thepatient and his therapist which consistently pervadesall that she has to say, especially in her clinical ex­amples. There is a tendency to be repetitious and,at times, somewhat ambiguous, but these are minorcriticisms. The "discussions" of each member of agroup of psychologists who participated in a semi­nar, with the author, which was devoted to the sub­ject of the book's title, represent no meaningful addi­tions to the volume. An exception would be thelengthy section written by Rudolf Ekstein on chang­ing values in psychoanalytic treatment as related tothe social matrix out of which it evolved and inwhich it has been practiced.

In the main, the author succeeds in her stated goalsand, thereby, makes a meaningful contribution tothe psychotherapist's problem of making insightfunctional. This is a book which must be digestedslowly, but the rewards make the effort worthwhilebecause of the productive mental stimulation pro­vided. This reviewer believes that the book will beof greatest value to psychiatrists and those other phy­sicians who have made it a practice to acquire ameaningful understanding of the psychological needsof their patients.

SIDNEY L. GHEEN, M.D,

EPIDEMIOLOGY OF MENTAL DlSORDER-ASymposium to commemorate the centennial of thebirth of Emil Kraepelin, co-sponsored by theAmerican Public Health Association and held atthe New York meeting, December 27-28, 1956.Edited by Ben;amin Pasamanick, Washington, D.C.:American Association for the Advancement ofScience, 1959. 295 pages.

This book contains a considerable wealth of ma­terial mostly concerned with various etiological fac­tors in mental disorders. It is introduced by an ex­tensive presentation of Kraepelin's biography andcontributions, which certainly should attract interest.

A number of original studies offer many challeng­ing conclusions and give good insight into method­ology of psychiatric research. We find here a study ofvarious factors affecting mental health of adolescents,including family mobility, broken homes, affiliationwith community organizations, place of residence, etc.Other studies are concerned with the occurrence ofschizophrenia in different social groups. The economicfactor and place of residence is stressed again andbasic findings agree with some similar investigationsin pointing out the prevalence of this condition inthe lowest social and economic groups. Here again,however, the basic question of distinguishing be­tween the cart and the horse presents a challenge.Some positive relationship is found between the his-

September-October, 1963

tory of early nervousness and premature birth rate.Epidemiological studies of mental disorders in smallcommunities and in larger centers are also reported.An excellent table is prepared by the authors of thepaper on epidemiological aspects of prognosis, an­alyzing the prognostic value of a number of the pre­morbid factors and those observed during the courseof illness. Such statistics may be of value for theauthors of current textbooks on clinical psychiatry.An ingenious study of the deaf population concludesagainst an increased prevalence of schizophrenia inpeople deprived of hearing. A peculiar seasonal vari­ation has been found in mental hospital admissionsfor old-age psychoses. The summer months, froml\1ay to August, appear to provide a considerablylarger percentage of admitted cases. An unusual his­torical flavor has been added to this conclusion bycomparing it with findings of Dr. Esquirol in hisarticle prepared in France in 1816. In spite of thedifference of 150 years, identical conclusions are ob­served.

A conclusion of the paper on intellectual potentialin infant population is worth quoting here: "At thepresent time the most useful theory is that whileman's fundamental structure and consequently hisbasic functioning is genetically determined, it is hissocio-cultural milieu, affecting biological and psycho­logical variables, which modifies his behavior and,in the absence of organic brain damage, makes oneindividual significantly different from the next."

A research minded psychiatrist and many othermedical practitionf'rs will find this hook well worthstudying.

VICTOR SZYRYNSKI, l\I.D., Ph.D.

TEST SCORES AND WHAT THEY 'MEAN. ByHoward B. Lyman. 223 pages. Englewood CliDs,N. ].: Prentice Hall, Inc., 1963.

This paperback book should be entitled, "TestScores and Their Statistical Meanings." The authorstates that his intentions are "to meet the needs ofthose with Iimitf'd training.... Without a specialstudy of test scores, anyone is likely to confuse per­centage-correct scores with percentile ranks, per­centile ranks with standard scores, standard scoreswith normalized standard scores, normalized standardscores with I.Q.s, et cetera."

The hook covers such topics as: maximum-per­formance vs typical-performance tests and statisticalbackground material for interpreting quantitativeresults. The author discusses test information andthe communication of results. A limited though se­lected bibliography is presented, as well as an ex­cellent glossary of terms, and very valuable conver­sion tables for derived scores.

This is an excellent book for students who arestudying psychology in the statistical-experimental­laboratory tradition. It should be required readingfor the clinician who very often uses a psychologicaltest without examining its statistical construction forstrengths and weaknesses.

Unfortunately for its potential readers, it is alsothe kind of book that frightens the practitioner be­cause it is directed toward the understanding of num-

307

Page 2: Test scores and what they mean

PSYCHOSOMATICS

bers rather than patients. The author assumes unjus­tifiably that a lay reader can plunge through thishighly technical material with "little or no trainingin measurements." He does make a substantial con­tribution and he has much to teach, but this worth­while book will only reach students because of re­quired reading, researchers who evaluate tests for thegeneral market and mature professional workers whohave a vigorous curiosity about the tests they use.

BENJAMIN KOTKov, Ph.D.

PHYSIOLOGICAL CORRELATES OF PSYCHOLO­GICAL DISORDER. Edited ~V Robert Roessler,M.D. and Norman S. Greenfield, M.D. 281 pages.Madison, Wise.: University at Wisconsin Press,1962. $6.50

The papers presented in this volume provide anexcellent opportunity for the exploration of interdis­ciplinary problems.

Dr. William Malamud, in the Introduction, dis­cusses major trends in current psychiatric research.He stresses the need for emancipation from the dual­istic mind-body concept.

The biochemical considerations in schizophreniaare considered by Doctors Tourney, Frohman, Beckettand Gottlieb. Their investigations in intermediarycarbohydrate metabolism have demonstrated thatchronic schizophrenics manifest an inability to mo­bilize adenosinetriphosphate (ATP) as an adaptiveresponse. The factor has been identified as an alphaglobulin. They present the hypothesis that certainpatterns of life experiences may activate a dormantinborn metabolic defect.

Dr. Albert F. Ax discusses interdisciplinary researchmethodology. He offers the possibility that the utili­zation of proprioceptive information is impaired insome schizophrenics.

Cortical excitability in psychiatric disorders is con­sidered by Shagass and Schwartz. By recording cor­tical potentials, it is noted that the phase of recoverywas delayed in patients with psychotic depressionand showed a return to normal after successful treat­ment.

J. "V. Lovett Doust reports on "Consciousness inSchizophrenia as a Function of the Peripheral Micro­circulation". Much of the thought disorder, as wellas the ambivalence, catatonia, loss of ego boundariesand the perplexity evidenced by the patient is relatedto a disturbance of consciousness. The author sum­marizes the results of neurophysiological rescarch bystating that the neural lesion in schizophrenia is amidline one, subcortical rather than neocortical, lyingprincipally in the brain stem and extending upwardto the midbrain.

A most significant contribution is offered by Dr.William Pollin. His paper considers questions ofmethodology, especially the use of so-called "normalvolunteers". The relationship of the subject to theresearch environment and the investigator receives amost penetrating analysis.

"Adrenocortical Function During Anxiety" is an­other significant paper. Presented by Dr. HaroldPersky, evidence is again provided that the plasmahydrocortisone level, urinary hydroxycorticoid and17-ketosteroid excretion and blood corticotropin level

308

are all significantly increased in emotionally dis­turbed patients.

Dr. Donald Oken, in a most stimulating paper, ex­plores the role of defense in psychological stress.Novel or ambiguous stimuli are potent. "Maturity",he states, "has sometimes been defined as the abilityto tolerate ambiguity".

Studies in obesity are reported by Dr. AlbertStunkard. The author points up the need to searchfor different types of obesity rather than for theircommon characteristics. In some, obesity is closelyinterrelated with their neurosis. Night-eating is asso­ciated with poor prognosis; it is difficult to influenceby psychotherapy but does respond to some degreeto anti-depressants. "Binge eating" is apparentlybetter influenced by psychotherapy.

These above-mentioned references fail to do jus­tice to the many significant contributions of otherinvestigators. They are only a sample of the richfund of information found in this most valuable con­tribution to psychosomatic medicine.

W.O.

EXPERIMENTAL FOUNDATIONS OF CLINICALPSYCHOLOGY. Edited by Arthur ]. Bachrach.641 pages. New York: Basic Books, 1962. $10.10.

In this major attempt to bring together the experi-mental bases for clinical practice, we meet 21 con­tributors representing nearly every aspect of the field,from history and theory, learning and communication,to psychophysiology and psychotherapy.

Certain sections deserve special attention. Thechapter on psychophysiology by P. B. Dews encour­ages communication between the experimentalists andthe clinicians, and offers criteria which, if violated,should lead the non-expert to question the research:

1. The results of studies conducted in the behavor­ial frame of reference should be described in behavor­ial and not neurophysiological terms. Conversely, thevalidity of conclusions about behavior drawn fromneurophysiological studies is limited by the validity ofthe behavorial technique used-which he says has gen­erally been poor.

2. Since probably all drugs have more than onetype of action, inferences from studies based on as­sumption of specificity of effect must always considerthe possibility that other actions of the drug areinvolved; as an example, the author traces the multi­plicity of effect of d-tubocurarine chloride, which hashad considerable use as a tool in such studies.

3. If the effect of a drug is stated in categoricalterms to be on a certain gross anatomical region ofthe brain, the reader is justified in being skeptical.

4. The same terms used by both psychologists andphysiologists frequently do not have the same mean­ing; it is important to find out in which sense the termis used in a given context.

In short, he cautions mistaking plausible theoriesfor proven explanations.

One of the more unusual chapters is Karl Pribram'sprovocative attempt to put Freudian theory back intoits neurological cradle and to trace its developmentfrom that point. He notes that one of the majorproblems of concern to Freud, one whose unsatisfac­tory outcome led him to turn in other directions, isalso one toward which current research is being di­rected; this is the problem of the organism's need to

Volume IV