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ON THE OBJECTIVE AND SUBJECTIVE ASPECTS OF

DIAGNOSTIC TESTING1

BY ROY SCHAFERTHE MENNINGER CLINIC

THROUGHOUT the history of diag-

nostic psychological testing, thecry "subjective" has been raised against

it. It has been argued, in essence, thatdata which are not subject to quantita-tive expression and to existing statisti-cal tests of significance are not subject

matter of a scientific psychology; and,inasmuch as the clinician necessarily

draws upon nonquantitative aspects ofhis test data and reasons in nonquanti-tative terms about all his data, he iscensured for his disregard of scientificmethod. Scientific method, however,hasbeen redefined by modern science in or-ganismic or field-theoretical terms. Itis the task of today's clinical psycholo-gist to meet the challenge of this redef-inition by reexamining his own conceptsand procedures in the light of this newviewpoint. This task is all the more ur-gent because of the currently greatly in-creased demand for the assistance ofpsychological testing in many fields ofpsychological work.

A cardinal assumption in dynamic

psychological thinking is the relativity

o f significance of any datum. The clini-cian well knows that no test responseor performance has a significance in andof itself, but only with respect to thecontext of responses in which it occurs.Empirically he has been driven to rec-ognize and accept what modern theoreti-

cal psychology would demand: a relati-vistic interpretation of the events he is

1Paper read at the Bound Table on Diag-

nostic Testing, American Psychological Asso-ciation, Philadelphia, Pa., September 6, 1946.

studying. We cannot know the signifi-

cance of any instance of behavior until

we know the constellation of psychologi-cal conditionsfrom which this behavior

issued and the context in which it ap-pears. In diagnostic testing, for exam-ple, the meaning of an absolutely low

Comprehension score on the Wechsler-Bellevue Scale [6] can only be deter-mined by the level of the remainingscores, the qualitative features of ver-balization and the indications providedby all other tests administered. This isso because only by taking reference toevery aspect of the test data can we con-.

struct a unitary picture of the subjectin which poor comprehension becomes

a necessary derivative characteristic.

The process whereby any test datum

takes on its particular significance foran examiner in a given case is the intel-lectual process of insight. It is with testdata as with the materials lying in thecage of Kohler's apes; through a pro-

cess of insight whereby a structuriza-tion of the field of observation takesplace and with it an assignation of de-rived meanings to all the parts of thefield,there results an internally coher-ent, psychologically consistent course ofbehavior. Psychologists may at leastlay claim to the privilege of insight ac-corded to Kohler's apes [2]. In the psy-chologist's insight diagnostic relation-

ships inhering in the test results cometo the fore and an internally consistent

psychological picture of the patient iselaborated.

The necessity for proceeding by in-

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OBJECTIVE AND SUBJECTIVE ASPECTS OP DIAGNOSTIC TESTING

sight in diagnostic testing springs fromseveral particular problems: 1. Manyaspects of the organism's behavior ap-pear to be intrinsically not quantifiable.

How can we, for example, quantify

without artifice a mode of coping withpassive needs? Or a mode of verbaliz-ing one's thoughts? Or an egocentricmode of concept formation? Yet these

are characteristics which are often in-dicated by present tests, in these exam-

ples by Murray's Thematic Appercep-tion Test [3] and the Weigl SortingTest [7] particularly. In essence, how

can we hope to quantify a total person-ality? 2. In working with a battery oftests, how can we quantify without arti-fice the contributions each test makesto the understanding of the results ofthe others? The presence of many indi-cations of free-floating anxiety on the

Rorschach Test [4] often indicates thatimpairment of certain performance

achievements on the Wechsler-BellevueScale [6] is referable to the effects ofstrong feelings of tension rather than

depression or organic pathology. 3. Inworking with any particular test, howcan we hope to quantify the processwhereby a response comes about? Andyet, as Scheerer correctly has pointedout, it is this process and not the endresult scored plus or minus, 3 or 6,

which constitutes our basic material forinterpretation [5], 4. How can wequantify that process of interpretationwhereby a total pattern of subtestscores on the Wechsler-Bellevue Scalenever before seen by the examiner im-mediately and correctly indicates a di-agnosis such as schizophrenia? Wherein the equation could we fit the conno-tations of past experience aroused by

various aspects of the present "unique"pattern?

These four types of obstacles to quan-tification are all realities, facts of diag-nostic experience. They are facts which

at once refute the identification of the

"objective" with the "quantifiable".

Klein has demonstrated that the multi-ple regression technique of finding diag-

nostic patterns of subtest scores on theWechsler-Bellevue Scale is able to dis-tinguish significantly a group of schizo-phrenics from a group of normal con-trols [1], but by this technique it is notdemonstrable that in the absence ofevery aspect of this statistically-estab-

lished diagnostic pattern, a configura-tion of scores can still indicate schizo-phrenia. And this indication

willexist

only in the getting of insightful think-

ing.

Because of these limitations of thediagnostic usefulness of statistical find-ings, it becomes clear that one neces-sary condition fo r diagnostic testing is adynamically-oriented rationale of thefunctions or processes underlying the

various test performances. This ration-

ale must be consistent with what isknown concerning the development of

ego processes in the field comprising thebiological organism and its social sur-roundings. This rationale must recognize

that* the different components of whatis called "intelligence" are merely pointsof view from which it is profitable toconsider the activities of the organism.Intelligence functions are not to be con-

sidered static one-dimensional traits.The impairment of any of them may be

referable to several different pathologi-cal conditions, each condition impairing

a different aspect of the performancebut all the conditions lowering the ob-tained score. Block Designs, in the

Wechsler-Bellevue Scale, for example,may be impaired by (a) organic path-ology disrupting an ordinarily "ab-

stract" conceptual approach to the prob-lem; (b) a state of extreme tension inwhich blocking and a concentration im-

pairment greatly reduce visual-motorcoordination; (c) a severe depression

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6 JOURNAL OF CONSULTING PSYCHOLOGY

retarding the speed of visual organiz-

ing and motor performance; and soforth. The overlapping of functions im -

plicit in thisexample

is acomplicating

factor which can be simplified only byextending our rationale of all the per-

formances elicited by our tests. Ration-

ale must occupya figural position in the

process of diagnostic insight; it allowsthe diagnostician that flexibility of un-derstanding whereby he can transcend

mechanical quantitative thinking and

cope with the new and unique.

What then is the role of statisticalinvestigation in the theory and practiceof diagnostic testing? Statistics canand do point to relationships among

quantifiable aspects of test data whichrecur with significant frequency with

respect to some criterion such as a par-ticular form of neurosis. In this they

render an invaluable service by pointingto the need for psychological hypothe-

ses or rationale at just those placeswhere relationships are discovered. Inthemselves, statistics do not supplythese hypotheses. A correlation coeffici-ent for example cannot establish a diag-nosis, as Klein has shown [1]. Statis-tics, in a dynamic psychology, therefore

are not used to establish the chance

probability of an interpretation or diag-nosis, but rather lead to and subsequent-

ly verify hypotheses which can establishmeaningfully probable diagnostic con-clusions. Statistics serve also to putinto communicable and therefore teach-able form the meaningful or determined

relationships uncoveredby repeated pro-cesses of insight. Thus statistical find-ings are integrally involved in rationale

as described above in that they indicatethe usual forms and locations of thediagnostic relationships explained bythat rationale. Accordingly thoroughfamiliarity with statistically establishedtrends will also occupy a central or fig-ural position in the process of diagnos-

tic insight.

Two additional figural conditions inthe process of insight must be men-

tioned,besides the already mentioned

conditions of thorough familiarity with

the results of statistical investigationsand the meaning given these by a ra-tionale of the functions underlying vari-ous test performances. The third neces-sary condition is a thorough grounding

in psychodynamic concepts, especiallyin those issuing from the psychoanalytic

and organismic schools of thought. Thus

far in the history of diagnostic testingthe most fruitful hypotheses and con-

sequent investigations have been stimu-lated by these schools of thought. Withthe concepts of these schools as a back-

ground, diagnostic insights which areunitary and transposible in characterbecome possible, while juxtaposition ofpsychologically inconsistent fragmentsof "interpretation" tends to reduce to a

minimum. With respect to the fourthand final condition for insight, a pleamust be made that psychologists recog-nize and teach that the richest sourcebook of psychological understanding iscarried by the individual within him-self; that through a process of self-ex-

amination, of reopening of one's experi-

ences with other people and examiningthe intricately intertwined affects, ideas,

needs, that go into these, the individualwill bring to the diagnostic process agreatly heightened sensitivity to thelogic peculiar to psychodynamics. Thedevelopment of this sensitivity is thusan objective condition prerequisite for

insightful thinking.We must now raise the question

whether and to what extent this processof insight is to be considered subjective.

That the diagnostic process will occur"within" the clinician is of course obvi-ous; in this sense it will be subjective;

it will not be worked out on a comptom-eter. However, that the diagnostic pro-

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OBJECTIVE AND SUBJECTIVE ASPECTS OF DIAGNOSTIC TESTING

cess is neither verifiable nor communi-cable—and in this sense not objective-is an entirely different proposition andone which we must reject. Objectivity

is not established by popular agreementor by purely quantitative thinking butonly be agreement among competent ob-servers. In this word competent lies thenecessary condition for establishing the

validity of test findings. Verifiability ofdiagnostic conclusions or predictions is

possible where competent analysis of

case history and current status has beencarried out separately from diagnostic

analysis and where the results of thesetwo processes of insight are checkedagainst each other. Communicabil ity isa more difficult criterion of objectivityto meet. Recognizing as we do thatevery case represents an essentially

unique dynamic picture, we cannot jus-tifiably attempt to teach mechanicalrules of interpretation. But we shouldattempt to introduce into the thinkingof the apt student a number of figural

considerations—in other words, a frameof reference—which will limit and speci-fy the directions available to the pro-cess of diagnostic insight. This frameof reference will include basic psycho-dynamic theory, test rat ionale, familiar-ity with previous f indings and self-kno^uledge. This is the basis on whichagreement among competent diagnosti-cians or in other words objectivity can

be established.The arguments presented in this pa-

per do not imply that all the conditionsfor diagnostic insight are already estab-lished. Far from it. Many of our so-

called "insights" and rationales are still

uncertain and incomplete. The research,tasks lying ahead of clinical psycholo-gists are great in number and scope.Their emphasis will have to be chieflyupon exploring new aspects of the or-

ganization of personality and thoughtprocesses, as well as upon new ap-

proaches to old aspects of these. To alarge extent then this paper has de-

scribed an ideal in diagnostic testing

which we are only slowly approximat-ing.

REFERENCES

1. KLEIN, G. S. The differentiation of schizo-

phrenics and normals on the Bellevue-

Wechsler Intelligence Test by means of a

multiple correlation technique. Amer. Psy-

chologist, 1946, 1, 263-264. (Abstract.)

2. KOEHLEE, W. Th e mentality of apes. New-

York: Harcourt, Brace, 1925.

3. MORGAN, C. D. AND MUERAY, H. A. Amethod for investigating phantasies: the

thematic apperception test. Arch. Neural.

Psyohiat., Chicago, 1935, 34, 289'-306.

4. ROKSCHACH, H. Psychodiagnostics, Berne:

Hans Huber, 1942.

5. SCHEERER, M. Problems of performance

analysis in the study of personality. Ann.

N. Y. Acad. SeL, 1946, 46, 653-675.

6. WECHSLER, D. Th e measurement of adult

intelligence. Baltimore: Williams & Wil-

kins, 1935.7. WEIGL, E. On the psychology of so-called

processes of abstraction. J. abnorm. see.

Psyohol, 1941, 36, 3-33.