2.2 Examples of Oversized Heads
Both of these drawings (after an evaluation of the complete House-Tree-Person assessment, which will be further discussed in Chapter 3) indicate the possibility of organicity (the oversized head being simply one indicator) even though both of the clients spoke well for themselves on a purely verbal level. In addition, the drawn person on the left side of Figure 2.2 was
the client's second attempt. In Figure 2.3 this patient slowly completed a rendering of a circular head with pinpoint eyes, a button nose, and smiley face. He then drew the figure's left arm, worked his way down to the left leg, and in drawing the right leg connected the line to the hand area of the right arm.
At this point he looked at the drawing quizzically, seeming to understand that something was wrong but not what or how to fix the problem. Then he drew in the dwarflike left foot and stated that he had messed up. At this point I gave him a second piece of paper and instructed him to begin over. Throughout the assessment the patient verbalized, "this is hard. . . . This is fun, I'm having a good time. . . .
1 like doing this." 2.3 Dwarf Foot
It is important to state that the left foot (which I call a dwarf foot due to folk belief that dwarfs were often depicted with feet shaped like a duck's) is seen frequently in schizophrenic drawings. It is also a frequent occurrence in the drawings of 5-year-olds. This could be due to the fact that children rely on primary processing until they move into a logical mode of reasoning at roughly the age of seven. Equally, schizophrenics operate on primary processing, which relies heavily on primitive, id-related experiences and also runs counter to a logical mode of reasoning.
Images showing organicity will be reviewed in detail in Chapter 3; however, I have chosen to illustrate one that clearly defines a general retardation in development.
An adult male drew Figure 2.4. A psychiatric evaluation dated one year prior to my assessment stated that the patient had been given drug injections, against his will, which resulted in toxic psychosis.
According to Piaget's theory of child development, during the precon-ceptual phase the child is able to hold mental representations of objects in his or her head. It is also during this phase that tadpole figures emerge. Howard Gardner (1980) says this about tadpole figures: "While they tend to have two protuberances at the bottom, which are usually seen as legs, and may (less frequently) have two extensions on the side, which are perhaps arms, they consist of but a single central circle" (p. 61). Thus, Figure
2.4 shows an adult male drawing in much the same style as a 4-year-old. From the tadpole person playing golf in the foreground to the house, located on the viewer's left, and the tree on the right, each detail points toward an internal model rather than any degree of realism. The house has a garage in the lower right square with a car parked in it, yet the car is drawn from a worm's-eye view and is more a symbol than a representation. The tree has a baseline that wraps around the trunk, while the crown of the tree is drawn as a black ball; the branches extend from the trunk into the air instead of into the crown itself. This distorted and disorganized vision is certainly a trademark of schizophrenia with concomitant pervasive developmental delays, yet in a child's renderings it could designate a normal phase of development.
I cannot stress enough the importance of understanding the developmental stages when interpreting the artwork, yet when utilizing art one must also take into account the chosen medium. The use of media can enhance a client's functioning, frustrate the client, or offer an inaccurate picture of his or her personality and any developmental delays that may exist. By way of example, Figure 2.5 shows two paintings by an adult male. He prefers to paint, and the majority of his projects, when he utilizes acrylics, turn out like the examples in Figure 2.5. He is never satisfied with the result and tends to sulk when the vision in his head is not replicated on the paper. These drawings, with their emphasis on simplistic geometric forms, look as though a child in kindergarten created them, and if these were all we had
interpreted we would have arrived at an assessment that pointed toward significant developmental delays and emotional disturbances for this client.
However, other work created by the same client (Figure 2.6) provides a very different picture. These detailed and integrated renderings, done in marker, also point toward developmental delays, yet they look more like an 11-year-old's drawings—a gain of 5 years, which is considerable, devel-opmentally speaking.
Many examples could be offered that demonstrate developmental delays through the use of artwork. However, at this point I would like to introduce an extremely useful tool on behavioral patterns and modes of growth. Tables 2.1 and 2.2 have been created from the written work of Gesell and Ilg (The Child from Five to Ten, 1940) and Gesell, Ilg, and Ames (Youth: The Years From 10 To 16, 1956). These books have identified repetitious patterns of growth. Table 2.1 identifies parallel patterns.
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