responses to the ambiguous drawings, it is possible to gain insight into his or her thoughts, emotions, and motivations including areas of conflict
Overall, projective techniques have been the subject of great debate and controversy. P. Frick, Barry, and Kamphaus (2010) presented some of the major pros and cons concerning the use of projective techniques (see Table 4.1). Some professionals see their value not in terms of giving exact diagnoses but in their ability to allow a professional to see how an individual responds to ambiguous stimuli—especially in terms of suicidal ideation as well as disorganized thought processes. This may lead to further discussions of areas that a professional would not normally discuss. The major disadvantage of projective techniques centers on questions of validity in terms of both the test’s ability to identify specific disorders and the reliance of the test interpretation on a specific population such as children.
Neuropsychological Testing
Neuropsychological tests have been developed to help mental health professionals assess a person’s general level of cognitive functioning. Intelligence tests, for example, are able to compare a given individual with his or her peers to determine level of functioning. The common intelligence tests, such as the Wechsler Adult Intelligence Scale (WAIS), have a number of subscales designed to measure verbal and performance tasks. The verbal tasks include measurements of acquired knowledge, verbal reasoning, and comprehension of verbal information. The performance tasks include nonverbal reasoning, spatial processing skills, attention to detail, and visuomotor integration.
Wechsler Adult Intelligence Scale (WAIS): a common intelligence test with a number of subscales designed to measure verbal and performance tasks
Table 4.1
Source: Frick et al. (2010), with kind permission from Springer Science+Business Media B.V.
Other neuropsychological tests have been designed to assess specific types of brain functioning as well as brain damage. These include memory, attention, reasoning, emotional processing, and motor processes including inhibition of action. One advantage of traditional neuropsychological tests is that they have been given to a large number of people so that norms could be established. Thus, it is possible to know whether a 70-year-old individual is showing a normal memory decline in certain areas or if there might be the beginning of a neurocognitive disorder, such as Alzheimer’s disease.
Although neuropsychological testing was initially developed to assess brain damage resulting from accidents, strokes, or war, it is now finding a use in delineating deficits in those with mental illness. Today, there is a coming together of neuropsychological tests, measures of cognitive processes in normal individuals, and brain imaging techniques. For example, the Wisconsin Card Sorting Test (WCST) requires that an individual sort cards into four piles. Each card has a specific shape on it, such as a circle or square, and a specific number of these shapes. Each card is also printed in a specific color. Thus, you could sort the cards by shape, by number, or by color. The person administering the test makes note of whether the individual is sorting each card correctly or not. After a number of sorts, the administrator changes the correct sort category. Individuals with frontal lobe damage have difficulty responding to changing demands. Individuals with schizophrenia also have difficulty responding to changing task requirements.
Wisconsin Card Sorting Test (WCST): an assessment instrument that requires an individual to sort cards into four piles; each card has a specific shape on it and a specific number of these shapes, and each card is printed in a specific color; thus, the cards could be sorted by shape, number, or color. The sort criteria are changed throughout the test. The purpose of the test is to measure the person’s ability to adjust to changes in sorting criteria
Continuous Performance Test (CPT): a test that measures attentional characteristics
These sisters were identical quadruplets who all developed schizophrenia by age 24. When they became subjects of study because of their shared disorder, they were given the pseudonym of the “Genain” quadruplets to protect their identity. The word genain, from Greek, translates to “bad gene.”
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Another test that is commonly used in psychopathology research is the Continuous Performance Test (CPT), which measures attentional characteristics. In one version of the test, participants are shown a series of letters and must respond whenever a particular letter is displayed. The test then requires that the person respond when one particular letter followed by another letter is displayed. Children with ADHD have problems with this task. Thus, neuropsychological tests are also being used to understand brain processes in those with mental illness.
Neuropsychological Tests and Mental Illness
Neuropsychological tests can help identify cognitive changes associated with a particular disorder. For example, there is a rare occurrence of four sisters who all developed schizophrenia in their twenties. The Genain sisters were monozygotic quadruplets born in the United States in the early 1930s (see photo on this page). These sisters have been studied throughout their lives in terms of genetic makeup as well as cognitive functioning. When the sisters were 66 years of age, Allan Mirsky and his colleagues (2000) readministered a number of neuropsychological tests including the WAIS, the CPT, and WCST. The scores for each sister at age 66 were compared with their performance at ages 27 and 51. By showing that the test scores of the sisters over their lifetime had not changed, these researchers were able to show that cognitive decline is not part of schizophrenia.
Using Neuroscience Techniques to Identify Mental Illness
As more and more researchers and clinicians have come to see mental illness as representing problems with the brain, there have been a variety of projects to utilize neuroscience approaches to describe psychopathology (Andreasen, 2001). These have ranged from identifying the presence of certain genes and the manner in which they turn on and off in psychopathology to structural and functional descriptions of brain processes and psychophysiological changes measured throughout the body. The potential for using neuroscience approaches to classify mental illness and inform its treatment is an important one (see Cuthbert & Insel, 2010, 2013; Glannon, 2015; Halligan & David, 2001; Hyman, 2007, 2010; Insel, 2009; G. Miller, 2010; Sumner, Powers, Jovanovic, & Koenen, 2015).
Traditionally, psychopathology has been defined in terms of signs and symptoms. The experiences of the client and what is observed by the professional are one level of analysis. In general, the mental health professional identifies symptoms that group together and the time of their appearance. Neuroscience techniques offer another level of analysis. From a research standpoint, scientists have sought to identify underlying markers associated with specific mental disorders. Using various brain imaging techniques described in Chapter 2 such as magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), electroencephalography (EEG), and magnetoencephalography (MEG), there has been a search for structural and functional changes associated with psychopathology. For example, researchers have been able to distinguish individuals with autism (Ecker et al., 2010) and with bipolar disorder (Rocha-Rego et al., 2013) from those without the disorder based on fMRI data.
Part of the potential for using neuroscience markers is related to the fact that not every individual with schizophrenia, for example, reports the same symptoms. Some individuals describe auditory hallucinations, whereas others describe
