The Analytical Diagnosis
- Author:
Humpstone, Ph.D.,
University of Pennsylvania In arriving at a final diagnosis in a clinical examination the examiner should be able to state the specific defects and abilities of the individual and give some estimate of their extent. No matter what tests are used, whether the estimates are stated or not there is in every examination an analysis of the performances of the subject, and the interpretation is made in terms of specific abilities and defects. Every qualified clinical examiner must have as a background an intimate knowledge of Psychology, especially of that part of the science which we know as Clinical Psychology.
Contrasted with that larger background there are certain specificities which the examiner must be able to recognize and upon which ratings must be made. If the subject shows defects in one or more of these, there still may be compensation through others. The mentality is a complex; it is not to be determined by the score of any one test or of a set of tests, however significant such a score may be. We have used the following schedule of capabilities in the teaching and practice of clinical diagnosis, and have found it to stand the test of use for both purposes:
VITALITY 1. Energy. 2. Rate of Discharge. 3. Endurance (Resistance to fatigue). 4. Health. MOVEMENT 5. Control. 6. Coordination. 7. Initiative. 8. Responsiveness. (a) Complexity. (b) Vivacity. ATTENTION 9. Concentration, analytic. 10. Concentration, persistent. 11. Distribution. 12. Alertness. 13. Interest. (171) 172 THE PSYCHOLOGICAL CLINIC. SENSATION 14. Sensibility: visual, auditory, kinesthetic, pain, general. IMAGINATION 15. Imageability. 16. Assoeiability (memory span). 17. Memory (?) Trainability. (?) Retentiveness. 18. Understanding. 19. Planfulness. 20. Observation. 21. Intellect. 22. Intelligence.
These are congenital capabilities. They are developed as the child grows and may be trained by exercise and guidance. They atrophy for want of use and are impaired by improper training. At each stage of development certain abilities may be displayed in a performance. We estimate the amount of each ability and give a rating upon the five-point scale. From these ratings we may make a general estimate of the mentality and give a diagnosis accordingly. Energy refers to the quantity at the disposal of the individual. It is not as easy to estimate as the rate of discharge which is shown in the movement and responses made in the performance. Endurance, or resistance to fatigue, must be distinguished from boredom, or loss of interest in the task set. Health must be taken into consideration in making any estimate of the other specificities, because the condition may be only temporary or it may permanently modify the ability. Control is the ability to employ a capability to accomplish a result. Walking, talking, the larger muscular movements, which give success in performance are included under control. Coordination is the organization of the muscular elements necessary to produce a successful performance. Initiative may be shown in the way the problem is attacked. Often, for instance, a child will pick up the blocks or other apparatus before he is told to do so. In their responsiveness, again, children show differences in the complexity and liveliness of their movements or the language they use. In giving attention one may select one small part and concentrate on it, or he may successively, yet rapidly attend to the several parts. Young children and low-grade feebleminded ones show this distribution by their movements. Some do not concentrate long enough to accomplish the task or solve the problem. Persistent concentration of attention is a very important factor in success. Alertness is expectant attention, an attitude of readiness. Interest is emotionalized attention.
Sensibility may be directly measured by careful tests, or may be inferred from the reactions to different stimuli. One may have apparently perfect sense organs and yet have little sensibility. Under the heading of imagination is placed first imageability. This is the ability to have correct images in any sense field. If a child is blind from birth it has no visual images. Associability is the ability to distribute attention over a number of discrete images and is generally called memory span. It is really an after-image and is not memory nor does the usual test for this ability test memory. Memory is a specific form of imagination and presents two aspects which can be tested. Trainability refers to the ease with which the child learns and is measured by the number of repetitions necessary to fix the material, while retentiveness refers to the permanence of the modification and is measured by the length of time the material is retained or by the amount retained after the lapse of a given time.
The remaining specificities are imagination complexes of different kinds. Intellect is the ability to use knowledge either for pleasure or to gain new knowledge. Intelligence is the ability to solve what for the individual is a new problem.
The mental examination should employ tests designed to elicit performances which will enable the examiner to estimate all of these specificities, if the performance is interpreted in the light of the history of the performer, his environment and opportunities.
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