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Rorschach and Hand Test Data Comparing

Bipolar Patients in Manic and Depressive
Phases
Edwin E. Wagner & Marion R. Heise
Published online: 10 Jun 2010.

To cite this article: Edwin E. Wagner & Marion R. Heise (1981) Rorschach and Hand Test Data Comparing
Bipolar Patients in Manic and Depressive Phases, Journal of Personality Assessment, 45:3, 240-249, DOI:
10.1207/s15327752jpa4503_3

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 Journal of Personality Assessment, 1981, 45, 3

Rorschach and Hand Test Data Comparing Bipolar Patients

in Manic and Depressive Phases
EDWIN E. WAGNER and MARION R. HElSE
The University of Akron
Abstract: Bipolar patients were compared in their manic and depressive phases with the Ror-
schach and Hand Test. Marked differences were obtained in accord with Structural Analysis
which accounts for the condition in terms of the ebb and flow of the Introspective Self in re-
lation to the Facade Self. The necessityfor carefully selectingsubjects i n a study of this nature
was noted. Interesting qualitative features were observed which trenchantly reflected the
progressive "freezing" of internally motivated action tendencies as the manic cycled into the
depressed phase.
Despite the blatant and seemingly alization is usually so extreme that psy-
obvious symptomotology accompany- chological testing seems irrelevant. Sec-
ing the manic depressive psychosis, un- ond, these patients are often difficult to
certainty still prevails regarding the test, particularly at the zenith or nadir
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etiology, dynamics and even diagnosis
of the disease (Beck, 1972). Further-
more, and interestingly enough, there
are surprisingly few studies comparing
the two phases of the illness by way of
projective techniques. For example,
Rorschach himself reports only one
such case (1921) and subsequent re-
search with this technique has been
limited and circumscribed. Levy and
Beck (1932) studied manics where the
diagnosis was "reasonably certain" but
the depressed phase was not investigat-
ed because of the nonresponsiveness of
the subjects. Again, Schmidt and Fonda
(1956) concentrated on only one phase
of the disorder comparing manics with
normals and schizophrenics. Converse-
ly, Donnelly, Murphy, and Scott (1975)
compared bipolar and unipolar patients
but concentrated on the depressed
phase, ignoring the manic stage. Clear-
ly, it would be advantageous to com-
pare the responses of a reasonably large
number of manic depressives in both
phases, preferably using the same sub-
jects as their own controls.
Why has this not been done? Several
explanations suggest themselves. First,
despite the fact that investigators such
as Lewis and Piotrowski (1954) have
noted that "the diagnosis of the manic
depressive psychosis is frequently diffi-
cult" (p. 25) and often confused with
schizophrenia, the overt behavior of the
manic depressive at the time of hospit-
of the mood swing. Third, follow-up
and correct timing are necessary in or-
der to obtain test data on the same pa-
tient in both phases of the psychosis and
the researcher is usually frustrated by
practical considerations such as termi-
nation of hospitalization before the al-
ternate phase occurs and uncertainly
as to whether, by the time arrangements
have been made to test the patient, the
supposed manic or depressed phase has
already shifted.
The present study attempts to deal
with and surmount the above mentioned
difficulties in order to obtain some re-
liable comparisons between manic and
depressed phases with projective tests.
These data in and of themselves should
prove to be of practical and theoretical
value, at least providing a base for future
speculation and research. However, an
additional purpose of this study is to
check out a theoretical description of
the manic depressive psychosis as for-
mulated by Structural Analysis (SA),
a theory of personality based on projec-
tive testing (Wagner, 1971; Wagner,
1976). Briefly, SA postulates that per-
sonality is mediated through two hypo-
thetical constructs, the Facade Self (FS)
and the Introspective Self (IS) which,
in turn, are surrounded by the trimodal
functions of Emotion, Intellect and Be-
havior (see Figure 1). The FS represents
basic, automatic attitudes and action
tendencies directly interfacing with re-
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E. E. WAGNER and M. R. HEISE

 242
ality through the "Perceptual Motor
Screen" (PMS), i.e., the receptors and
effectors which permit the individual
to become aware of and react to the en-
vironment. This IS is a secondary struc-
ture representing internalized processes
such as imagination, self regard, and a
conception of one's role in life. The IS
must express itself through the FS. The
IS can be overdeveloped, underdevel-
oped or practically nonexistent and an
individual would still be able to func-
tion; but without a viable FS meaning-
ful behavior becomes impossible.
SA has been used to explain the prin-
cipal forms of psychopathology in terms
of the interaction between the FS and
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IS but, for the purposes of this study,
the SA treatment of multiple personal-
ity is especially germane. It was held
that multiple personalities emerge be-
cause of conflicts within the IS which
cause separate "personalities" to con-
stellate and then alternatively break
through a weak FS. The effects of this
process on Rorschach patterning were
specified and then observed in three
cases of multiple personality (Wagner
& Heise, 1974). Essentially the same
Rorschach patterning was subsequently
verified by Danesino, Daniels, and Mc-
Laughin (1979). SA postulates that in
the manic-depressive condition a similar
phenomenon occurs except that, instead
of various components of the IS break-
ing through intermittently, the IS thrusts
itself through the FS more or less as a
unit in the manic phase and then recedes
in the depressed phase. Therefore, in the
manic phqse, the FS merely acts as a
"mouthpiece" for the energized and un-
trammeled IS; conversely, in the de-
pressed phase, the IS withdraws, leaving
a depressed, anergic FS.
The Rorschach and the Hand Test
are often used in tandem to portray SA
configurations since the former, al-
though a "broad band" instrument, is
a little weak in mirroring FS tendencies,
a deficiency which can be compensated
for by the Hand Test which directly re-
flects overt action tendencies (or the
lack of them). Operationally, it would
be predicted that, on the Rorschach, a
Rorschach and Hand Test Data
manic would, of necessity, reveal move-
ment responses (M, FM, m) since these
are the basic indicators of IS processes
(Wagner, 1978). By the same token, in
the depressed phase, a dearth of move-
ment responses both in terms of abso-
lute number and as a percentage of total
R could be expected. On the Hand Test,
a greater number of FAIL and DES
could be anticipated in the depressed
as compared to the manic phase, denot-
ing an anergic facade.
Method
Subjects selected for this study were
included only after various criteria were
met. First, all patients were screened
for a pre-existing psychiatric or physical
illness other than manic depressive psy-
chosis. This qualification served to satis-
fy the criteria for a "primary affective
disorder" as specified by Winokur and
Clayton (1967). Second, each patient
was independently diagnosed as bipolar
type I on the basis of clinical observa-
tion of specific symptoms listed by
Feighner et al. (1972). Observations
were made regarding the phase a patient
was experiencing, by the hospital staff
as well as by the test administrator. Third,
a case history was taken for each patient
which included the following informa-
tion: Type of medication administered,
previous number of hospitalizations,
and family history of affective disorder.
All patients were tested while in local
hospitals with the cooperation of the
patient's attending physician as well as
the patient's voluntary consent to par-
ticipate in the research study. A total of
40 psychiatric inpatients met the criteria
for inclusion in the study. Five patients
in the manic phase of the disorder re-
fused to take part in the study, and three
other patients were too depressed to re-
spond to the stimuli on the projective
instruments. Fifteen of the 32 remaining
subjects were tested in both the manic
and depressive phases of the disorder.
A checklist of symptomatology pres-
ent at the time of testing was maintained
for each patient. This insured accurate
identification of a moodswing as speci-
fied by Feighner et al. (1972), as well as
 E. E. WAGNER and M. R. HEISE
an additional check on the elimination
of the schizophrenic subjects from the
population. Of the 15 patients, 9 were
female, 6 xnale. All were caucasian. Seven
were married, 2 single, 4 divorced and
2 widowed. The average age of onset
ranged fro~m28 to 40 with a mean age of
33.7. Nu~nberof previous hospitaliza-
tions ranged from 2 to 17 with a mean
of 9.7.
A careful attempt was made to clearly
differentiate the manic and depressive
phase in all subjects tested. Several
patients were rejected for retest because
the examiner questioned the state of
mania or depression the subject was
purported to be experiencing. Patients
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were, with three exceptions, tested two
to three days after hospital admission
(or immediately upon release from se-
clusion) for mania, and one day follow-
ing notificartion that the patient had ex-
perienced a moodswing. The system
proved successful for patients in the
manic phase. Stage of mania was deter-
mined by an informal analysis of each
patient according to Young et al.'s rat-
ing scale: for mania (Young, Biggs, Zieg-
ler, & Meyer, 1978). The manic stage
was rated as "acute" for all research sub-
jects in this study, according to this
scale.
It was not possible to follow a specific
format in terms of when patients would
be tested while depressed since all but
one patient were tested initially while
in a manic mood. The single patient test-
ed first in the depressive phase had
cycled into this stage following a manic
episode. However, an informal analysis
of stage of depression was performed
for each patient tested by assessing the
subject on Hamilton's (1960) rating
scale for depression. The depressive
mood, as measured by this scale, ranged
from simple to acute for all patients.
Two attempts were made to retest
subjects while they were experiencing
the delirious phase of mania, but both
ended in failure. The subjects were too
hyperactive and/or distractable to re-
spond to the test stimuli. Attempts were
made to test several patients in an ad-
vanced stage of depression but the ef-
forts also resulted in failure due to the
nonresponsiveness of the patients.
All patients in this study were on med-
ication at tirne of test administration.
Although this is considered to be a lim-
itation of this research, it was not eth-
ically possible to withdraw or withhold
medication from patients participating
in a research study of this type. How-
ever, an effort was made to test all sub-
jects before medication was deemed to
be "effective" in the judgment of the at-
tending physician. Lithium medication
had been administered to all patients
in this study, but, with three exceptions,
lithium chemotherapy had been initiated
less than five days prior to testing. Ac-
cording to Cade (1949) and Gershon
(1976), lithium does not produce behav-
ioral changes in less than five days. The
three subjects who had been on lithium
for more than five days were chronic pa-
tients who, in the judgement of their
attending physician, were not respond-
ing to the drug anyway.
In order to1 calm patients who were
experiencing a manic attack, Haldol
(Haloperidol) was administered upon
hospital admi!;sion to reduce the frenetic
activity evidenced by the manic patients.
Manic patients are often placed in re-
straints and/or seclusion for their own
protection during the first day or two
of hospitalization. Haldol has been
found to be effective in slowing down
motoric behavior, but it does not affect
thought processes for 21 to 42 days
(Goodman & Gilman, 1975). On two
occasions, depressed patients had been
administered Elavil (arrnitriptyline hy-
drochloride) several days to one week
before they were tested. According to
Goodman and Gillnan (1975), Elvail
should produce improvement in de-
pressed patients no sooner than two to
three weeks.
All patients were tested by one of the
authors (MRH) and scored indepen-
dently by the other (EEW). Since this
study was largely exploratory, two-tailed
tests of significance were used with sig-
nificance set at the usual .05 level.
 244 Rorschach and Hand Test Data
Table 1
Medians, Ranges, Wilcoxon Matched-Pairs Signed Ranks Values, andpercentage of Hits
Using a Median Cutoff Point, Comparing Both Phases of a
Bipolar Manic Depressive Group (n = 15) on Rorschach and Hand Test Variables
Groups
Combined W~lcoxonTest
Vanable Manic Depressive Median Hit %
Cutoff
Medlan Range Median Range N T P
Rorschach
W 9 6-14 4 2-6 6 15 0 .008 89
D 7 1-18 6 2-10 6 13 26.5 .203 -
M 2.5 1-6 0 0-2 1 14 0 .008 89
FM 0 0-7 0 0-2 0 14 3.5 .008 89
m 0 0-4 0 0 0 7 0 0.16 -
F+ 6 2-14 8 5-12 8 13 32 NS -
ZC 1 0-3s 0 0-1 0 8 3.5 .047 72
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ZC' 0 0-1 0 0-1" 0 7 6.5 .260 -

ZC 8.5 4-11 0 0-2 3 15 0 ,008 100
Animal 9 3-15 7 4-9 7 12 11 .026 66
(A) 0 0-3 0 0-1 0 6 6 N S -
Ad 1 0-6 1 0-2 1 10 21.5 NS -
A+Ad 10 5-19 7 4-10 8.5 13 10 .010 73
Human 4 2-6 1 0-2 2 14 0 .008 -
Flower 1 0-4 0 0-1 0 8 2.5 .04 81
Food 0 0-4 0 0-2 0 7 6 .21 -
Apparel 1 0-3 0 0-1 0 9 10 .16 -
Implement 1 0-2 0 0-1" 0 7 0 .016 100
Object 2 0-7 1 0-3 2 10 7.5 .048 63
Responses 18 11-32 10 7-16 12 14 0 .008 80
Populars 4 2-7 5 3-9 5 12 24.5 .283 -
AIRT 2 1.0-6.7 15.3 10.7-35.0 8.7 15 0 .008 100
Fail 0 0-1" 1 0-3 0 11 0 .01 93
W-D 5 -9 to 13 -3 -6 to 6 -1.5 14 17 .024 67
W-M 7 3-13 3 1-6 5.5 15 0 .008 80
FM-M 1 -4 to 4 0 -2 to 1 0 12 29.5 NS -
XC-M 3.5 .25-8.5 0 -1.5t02 1 15 0 .008 93
XC-Ic 65 1.25-7.5 0 -1 to 1.5 1.375 15 0 ,008 93
36 17-50 89 677100 53 15 0 .008 100
A% 43 22-60 67 44-100 53 15 6 .008 100
FS% 80 33-100 80 71-100 80 14 26.5 .I11 -
M+FM+m 7 1-13 1 0-3 3 15 8.5 .005 84
M+FMS-m/R .41 .09-.75 .08 0-.38 .25 15 1.5 .005 77
Hand Test
Affection 1 0-4 0 0-2 0 10 15 .232 -
Dependence 2 0-4 1 0-2 1 12 6 .01 87
Communication 2 0-3 1 0-3 1.5 13 13.5 .05 73
Exhibition 1 0-4 0 0-2 .5 11 4 .01 75
Direction 2 0-4 1 0-2 1 12 7 .01 75
Aggression 3 0-4 0 0-2 1 14 5 .O1 82
Interpersonal 11 6-16 4 2-7 6 14 0 .008 91
Acquisition 0 0-2 0 0-1" 0 5 L.J. -ZTS -
Active 3 0-10 1 0-3 2 13 16 ,040 63
 E. E. WAGNER and M. R. HEISE 245

Table 1 (cont'd)

Groups
Comb~ned Wllcoxon Test
Variable Man~c Depressive Med~an Hit %
Cutoff
Median Range Med~an Range N T P

Passive 1 0-2 1 0-2 1 11 28.5 NS -

Environmental 4 1-12 2 1-4 3 14 27 NS -
Tension 1 0-3 0 0-3 0 9 3 .02 89
Cripple 0 0-3 0 0-1 0 7 4 N S -
Fear 0 0-3 0 0-1 0 6 2 N S -
C Maladjustive 2 0-5 0 0-3 1 12 3 .01 73
Description 0 04 3 1-4 1 13 7.5 .008 93
Fail 0 0-1 1 0-2 0 8 2 .024 89
Bizarre 0 0-4 0 0-1" 0 5 2 NS 80
Z Withdrawal 1 0-4 4 1-6 2 15 2.5 .005 85
11 15 0 .008 100
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Responses 17 11-29 9 8-12

AIRT 1.9 1.2-4.0 14.2 9.7-27.2
High-Low 2.0 1-8 10.5
Pathology 5 1-13 8 4-12
Acting-Out 1 -6 to 4 1 -2 to 4
" One subject responding.
Results
Table 1 reports medians, ranges, and
Wilcoxon hlatched-Pairs Signed Ranks
values for those Rorschach and Hand
Test variables occurring with sufficient
frequency to make compar~sonsbetween
the depressed and manic phases mean-
ingful. In th~oseinstances where signifi-
cance was obtained, a "hit rate" percent-
age is also reported showing to what ex-
tent the two phases could be correctly
classified. In cases where data are ordi-
narily summarized as a ratio, such as the
W:D ratio, a simple arithmetic differ-
ence was use (i.e., W-D) for statistical
purposes. Of 57 variables compared, 38
were found to be significant.
Since the Wilcoxon Test eliminates
ties, some of the results reported in Table
1 may be a bit misleading because they
are based on reduced Ns. For the record,
the following variables were 100% ac-
curate in differentiating between the two
phases for all 15 subjects: CC, AIRT
(Rorschach), F%, A%, Responses (Hand
Test), AIRT (Hand Test).
The "Hit" percentage indicates what
percentage of the 30 cases were correct-
ly placed using the combined median
as a cutoff point. With a four cell con-
0.85 15 O .008 100
7-50 6.5 15 0 .DO8 93
5.5 14 11.5 .01 80
1 14 44 NS -
tingency table the ns in the cells were ex-
act reversals the stages. A glance
at the median columns tells which phase
had the and which the lower
Score. For exalm~le,while 100% differ-
entiation was obtained for both 2 C and
WO, the manics showed a higherzC, the
depressives a higher Wo.
Discussion
Ongoing experience with these manic
depressives confirmed an initial assump-
tion that testiing of this nature would
only be meaningful if the sample were
carefully defined. The precaution of hav-
ing the examiner corroborate the mood
by behavioral observation at the time
of testing seems especially relevant. Sev-
eral subjects were rejected on this basis,
apparently having moved away from the
extremity of a moodswing back toward
"normalcy" during the relatively brief
interval between psychiatric diagnosis
and testing. It is possible that some of
the inconsistencies noted in the litera-
ture are due to faulty selection of cases
in terms of ornginal diagnosis and/or
point of testing over the cycle. Studies
which are based on protocols retrieved
from hospital files may be particularly
 Rorschach and Hand Test Data
vulnerable to these kinds of weaknesses. usual conflict or diversity among the
For example, contrary to expectation, Ms produced by patients in the manic
Levy and Beck (1932), and Schmidt and phase as contrasted to the Rorschach
Fonda (1956) did not find numerous M protocols obtained from multiple per-
responses in manics obtained from a file sonality subjects.
search. On the other hand, Donnelly, Although significantly more move-
Murphy, and Scott (1975), using rigid ment responses were given when sub-
selection criteria, were able to demon- jects were experiencing the manic phase
strate important differences between of the manic depressive disorder, a few
unipolar and bipolar manic depressives. movement responses were produced by
A large number of highly significant six subjects in the depressive phase of
differences were obtained in this study. the illness and a comparison was in-
This in itself is not surprising given the structive. considerably more "energy"
diametrically opposed nature of the two was manifested in the M responses pro-
moods. It should be pointed out, how- duced in the manic phase when com-
ever, that the results are in accord with pared to the M response produced by
what Structural Analysis would predict. the same patient in the depressive phase.
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There were substantially more total Qualitatively, the movement responses

movement responses in the manic phase. given by subjects while in the depressive
This was not simply an artifact of the stage were mostly passive and, at times,
larger number of responses given by the resembled "stopped action." An ex-
manics as compared to the depressives ample of this type of movement is pro-
since the difference persisted even when vided by M responses given by a male
the number of movement responses was subject:
expressed as a proportion or percentage Card 111. (depressive phase) Looks
of the total number of responses. Also, like two waiters in a dining room,
as expected, the manics produced sig- sort of stuck there.
nificantly fewer Failures and Descrip-
tions on the Hand Test. Using medians The same subject had seen "Two men
as bench marks the manic could be pro- in tuxedos, drinking and toasting each
filed on the Rorschach as havinga much other" on Card 111 while he was in the
shorter reaction time than the depres- manic phase of the disorder.
sive along with more R, W, color and Other indications of the anergic state
movement. With a median F%of 89 per- present in the depressive phase are ex-
haps the best way to describe the de- emplified by the following responses
pressed protocol is "constricted." A selected from several different proto-
similar situation prevails on the Hand cols:
Test. The depressed patient gives fewer Card 11. Couple of bears around a
Interpersonal and Environmental re- lamp, they're posed there, maybe
sponses and a greater number of With- they're stuffed.
drawal responses. The Rorschachs and Card VIII. Looks like two dogs frozen.
the Hand Tests of depressed patients are Pointers. They just saw something
psychologically similar, presenting a and stopped.
general picture of constriction and in- Card VII. Looks like a statue made
effectualness consistent with the hy- out of marble, a statue of two chil-
pothesis that the IS has withdrawn leav- dren facing each other.
ing behind an anergic FS.
Qualitatively, the Rorschach move- Another trenchant example can be
ment responses produced by subjects found in the responses of a female sub-
in the manic phase in this research also ject:
lend support to SA. Variety was found Card 111. (manic phase) Two dancing
among the movement responses pro- girls with their derrieres sticking
duced by individual subjects in this out, having a wild time.
study, but there did not appear to be un- Card 111. (depressive phase) Looks
 E. E. WAGNER and M. R. HEISE
like two girls, maybe they're danc-
ing girls.
The same percept was seen by the pa-
tient while she was in both the manic
and depressive phases, but the degree
of energy projected is strikingly dif-
ferent.
Confirmatory observations were also
made for color on the Rorschach. While
the protocols of depressed patients were
not totally devoid of color, this variable
was much more prominent during the
manic phase. Furthermore, while mul-
tiple personalities tend to have both
negatively and positively toned color,
no such trend was noted for these sub-
jects. In fact, for many subjects positive
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color pred~ominated. Examples of re-
sponses evidenced by a 44-year-old
manic phase female which included only
positive color were:
Card VIII. Big flowered trees with big
colored flowers.
Card IX. Beautiful colors like the bot-
tom of some tropical paradise.
Card X. Beautiful colored fountains.
The Hand Test supposedly measures
the FS, i.e., action tendencies which are
close to the motor system and apt to be
behaviorally expressed. Hence, the
dearth of responses in the depressed
phase would be in keeping with the SA
position tha~twhen the IS splits off en-
ergy is withdrawn from the psychic
economy resulting in reduced function-
ing of the FS. It is not so much that the
depressed patient misreads reality, but
rather that he simply lacks the where-
withal to cope with his environment. In
this respect, it should be noted that the
Bizarre response on the Hand Test, a
sure sign of aberrated thinking, occurred
with four subjects in the manic mood,
but only one in the depressed mood.
Qualitatively, depressed patients tend-
ed to produce safe, feeble, stereotyped
responses. The inordinate number of F
responses for the depressives on the
Rorschach (mdn. = 89%) points to con-
striction; the Hand Test poignantly de-
tails this con~striction.The patient loses
his uniqueness, assertiveness, and tlan.
He is intellectually aware but unmoti-
vated to perform. He seems bereft of
the specificity needed to perform con-
crete tasks. For example, a 39-year-old
female in the manic phase responded
to Card VIII with: "Picking something
up. (Q) A cigarette butt. Putting a coin
in the bus collection thing." In the de-
pressed phase the same patient said:
"Looks like something between the fin-
gers - looking at it. (Q) Not sure what,
just something." A 50-year-old male in
the manic phase reacted to Card VI with
straightforward aggression: "Going to
hit son~ebody.Ready to fight." But
when depressed he could not even sum-
mon forth an action tendency: "A hand
made into a fist. (Q) No, it's just in a
fist."
Results of this study can also serve to
dispel some possible misconceptions
about the testing characteristics of manic
depressives. Winokur, Clayton, and
Reich (11969), leading authorities on the
manic depressive illness, inferred that
manics produce an inordinate number
of responses an the Rorschach Test. In
describing Elliott Nugent's Rorschach
examination, the authors commented
that the examinee had not finished Card
I at the end of 15 minutes. This, accord-
ing to the authors, was due to the num-
erous choices and associations made by
the subject. It is suggested that they
might have mistakenly concluded that
Nugent was responding to the blots
rather than to cother, extraneous stimuli.
Subjects in this study frequently re-
sponded to the Plates with one or two
actual percepts and then proceeded to
intersperse their responses with remarks
and other associations which did not
pertain to the inkblots or the subject's
percepts of the stimuli. Piotrowski
(1957) noted that manics have a pro-
pensity for this type of test behavior,
and his observaltions were upheld by the
results of this study. Subjects in this
study most frequently responded to the
Plates with ont: or two actual percepts.
The median n~amberof R was only 18
for subjects in the manic phase.
Another possible misc~onceptionin-
volves the Rorschach dark shading or
c'response which is held by some writ-
 248
ers to indicate severe depression such
as might be expected from a manic de-
pressive in the depressive phase. To be
sure, there is some disagreement in the
literature regarding dark shading as an
indicator of "melancholy mood." Ror-
schach maintained that dark shading
was evidence of a tendency toward a
"fundamentally depressive disposition"
although he did not find a c'response
in the protocol he obtained from a
manic depressive, depressive stage sub-
ject. Rorschach further suggested that c '
indicated emotional shyness and a ten-
dency to over-control emotions. Other
writers seem to agree that c' responses
occur in subjects who are anergic and
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depressed. Piotrowski (1957), however,
contended that the dark shading re-
sponse is an indication of the facilita-
tion of, rather than the restraint of, overt
behavior and that the presence of c'does
not necessarily indicate a depressed
mood. Results from this study show that
subjects in the depressive phase did not
produce an abundance of c' responses.
Only one such response was given by a
patient in the depressive mood while
six subjects in the manic phase produced
at least one c'F or Fc' response.
Lastly, keeping in mind that the prob-
lem of differential diagnosis often re-
volves around the question of whether
the patient is manic or schizo-affective,
it seems appropriate to say something
about the response style of manics. TO
begin with, the manic responds very
rapidly to all cards, rarely showing time
shock. Notice that the median AIRTS
for both the Rorschach and Hand Test
were extremely low (2.0 and 1.9, respec-
tively) and that one hundred percent
differentiation between the manic and
depressed phase could have been at-
tained using response time alone! It has
been noted by many authors that the
schizophrenic often becomes greatly in-
volved with his own response, subse-
quently elaborating on various aspects
of the percept. On the other hand, the
manic, hyperactive and distractible,
tends to race from subject to subject,
forgetting or at least losing interest in
previous responses. The manic seems
Rorschach and Hand Test Data
to respond freely and "off the cuff" to
projective stimuli. On the Rorschach
this can result in occasional contamina-
tions and fabulatioss and usually in-
sures that both color and movement
are perceived at the expense of form
responses. Similarly, on the Hand Test,
BIZ percepts can occur and responses
are delivered with an air of assertion
and assuredness, even those with mal-
adjustive implications.
After perusing the records of these
15 subjects it seems clear that schizo-
phrenics do differ significantly from
manic depressives on the Rorschach
and Hand Test and that a differential
diagnosis can be made with reasonable
assurance on the basis of both quanti-
tative and qualitative test features.
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D ~ E,
~h~ university o f ~k~~~
Dept. of Psychology
Akron, Ohlo 44325
Recelved February 22, 1980
Rev~sed: May 1, 1980