SIS Journal of Projective Psychology & Mental Health

JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH The Official Publication of the Somatic Inkblot Society Volume 3 Number 2 July 1996 SIS ISSN 0971 - 6610 Vol. 3, No. 2, Pgs. 89-144 SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH 1996

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH is published twice a year (January & July) by the SOMATIC INKBLOT SOCIETY and is devoted to the advancement of research in the areas of projective psychology, personality assessment, psychotherapy and mental health. The journal is broadly concerned with the development of inkblot tests and personality assessment in clinical, counselling, cross cultural, organizational and health psychology settings. It aims to reach clinical psychologists, psychotherapists, psychiatrists, social workers, medical professionals and professional managers interested in the understanding and modification of human behaviour. The journal includes (a) research articles (b) book reviews (c) brief reports (d) news about conferences etc. and letters to the editor. MANUSCRIPTS PREPARATION : Manuscripts should be typewritten (double spaced throughout) submitted in duplicate to B.L. Dubey, Ph.D. Editor- in - Chief SIS Journal, P.O.Box 1107, Sector-15 Post Office, Chandigarh 160015 (India). E-mail : sisdubey@hotmail.com Manuscript can also be submitted to Wilfred A. Cassell. M.D., Editor, 4501E, 104th Avenue, Anchorage, AK-99516 (USA). The Editors reserve the right to refuse manuscript submitted and to make minor additions/deletions. Authors should prepare their manuscripts according to the Journal of Personality Assessment. SUBSCRIPTION : The journal is free to members of the Society, Annual membership fees are US $50 for foreign members and Rs. 250, for Indian members, Institutional subscriptions are US $100 for Foreign institutions and Rs. 500 for Indian institutions. Life membership is US $300 for foreign members and Rs. 1500 for Indian members. Non-members may subscribe for $30 or Rs. 150/- per issue. Cheques should be made payable to 'SOMATIC INKBLOT SOCIETY’ Chandigarh and should reach Dr. B.L. Dubey, Editor- in -Chief, (Address given above). Please add $5./Rs. 30 if you are sending subscription through cheque. CHANGE OF ADDRESS : Society / journal members should inform Mrs Padma Dwivedi, Secretary, SIS Center, Post Box 1107, Sector-15 Post Office, Chandigarh-160015 (India), Tel/Fax 91-172-710986, E-Mail: sisdubey@hotmail.com and Foreign Members should inform, Anand Dubey, Joint Editor, SIS Journal, Post Box 244045, Anchorage, AK-99524 (USA), E-Mail : adubey@hotmail.com of any change of mailing address. Copyright @ 1994. SOMATIC INKBLOT SOCIETY

STATEMENT SHOWING OWNERSHIP AND OTHER PARTICULARS ABOUT SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH PLACE OF PUBLICATION : T-2/15, Sector-25 Chandigarh - 160014 PERIODICITY OF PUBLICATION : Half Yearly EDITOR'S PRINTER'S Name : Dr. B.L. Dubey PUBLISHER'S NATIONALITY : Indian ADDRESS : T-2/15, Sector 25, Chandigarh - 160015 OWNER : SOMATIC INKBLOT SOCIETY I, Dr. B.L. Dubey, hereby declare that the particulars given above are true to the best of my knowledge and belief. Sd/ Dr. B.L. Dubey, Editor-in-Chief SIS Journal of Projective Psychology and Mental Health Printed and Published by Dr. B.L. Dubey on behalf of Somatic Inkblot Society from T-2/15, Sector 25, Chandigarh - 160014 & Printed at Juneja Trading Agencies Pvt. Ltd. Printing Press, SCO 131-132, Sector 17-C, Chandigarh. Tel. : 702675, 704715. Editor : Dr. B.L. Dubey

SIS Journal of Projective Psychology & Mental Health Volume 3, Number 2, July 1996. Contents Page Nos. 1. Editorial : N.L. Dosajh. 89-90 2. Future Direction of Projective Technique 91-93 Wilfred A. Cassell. 3. SIS as a Projective Psychotherapeutic 94-102 Tool for the 21st Century B.L. Dubey 4. Paranoia Assessment with the SIS-II : In a 103-111 College Student Sample Christopher J. Bailey and Bernard I. Murstein 5. A Quantitative Analysis of Like and Disliked 112-117 SIS-II Images Rakesh Pandey, M. Mishra, & C.B. Dwivedi 6. Efficacy of Booklet and Monochromatic 118-128 Version of SIS In a Case of Repeated Miscarriages Wilfred A. Casell & B.L. Dubey 7. Relationship Between Homosexuality And 129-132 Paranoid Schizophrenia – Rorschach Study S. Chaudhary & S. G. Jyothi 8. SIS and Social Anxiety – An Assessment of 133-140 Personality Factors of Drug Addicts Gopa Mitra and Anjana Mukhopadhyay 9. Efficacy of SIS-II in Discriminating O.C.D. 141-144 Patients and Normals Amool R. Singh & K.R. Banerjee

SIS J. Proj. Pst. & Ment Health (1996) 3:2, 89-90 Editorial It is very encouraging to note that research on SIS and other projective techniques is going at quite a rapid pace. There is not only quantitative improvement but also a qualitative one. The general trend seems to be accepted very warmly by Clinical Psychologists in Indian and Abroad. In this issue of the ‘SIS Journal of Projective Psychology and Mental Health’ it has been shown that how “Three most liked pictures’ and Three least liked pictures’ of the SIS stimuli have been used for clinical diagnosis; the diagnosis of Paranoiaa has been firmly established merely by using the ‘Eye responses” of patients. The findings are based on an excellent research design and sophisticated statistical analysis, leaving little doubt about the diagnosis of Paranoia. Such studies in the long run will make SIS and excellent tool for psycho diagnostic purposes, perhaps that best in the world. Further pattern for diagnosis of Drug addicts’, with the help of SIS has been worked out. Further areas of diagnosis, will only be possible if carefully worked out local norms are made available as early as possible. So there is an urgent need for collecting more and more data in this direction by the researchers. They may plan their researches / doctoral thesis in this direction because there is ample scope in this unexplored area. I am glad to note that Case history data is being collected to show how images of the SIS evoke the deeply repressed emotional experiences which are brought on the surface and thus providing relief and giving vent to the ‘inner cry’ of the patients. The guilt feelings associated with recovery of the traumatic experiences are being gradually expressed, leading to recovery of the patients; thus establishing the effectiveness of SIS as a strong psychotherapeutic tool as well. The limitation of all such diagnostic method and therapeutic techniques are well known and applicable to some extent to this newer and promising technique as well. The relative importance of SIS as a stimulus, the importance of the characteristics of therapist and the merits and demerits of analytic interpretation, as well as their respective roles in an individual case, thus can be further investigated in future researches. This however, is an ongoing, never ending process.

90 Dosajh I can foresee that the day is not far now, when local norms of SIS will be available for psycho diagnostic purposes for use in different Mental Hospitals and Clinics. Psycho diagnosis of mental patients will become an easy affair with the help of SIS. Thus the otherwise difficult psycho diagnosis and psychotherapy can be and should be adequately tackled by the use of SIS. N.L. Dosajh

SIS J. Proj. Pst. & Ment Health (1994) 3:2 91-93 Wilfred A, Cassell, MD, Director SIS Center, 4450 Cordova Street, # 100, Anchorage, AK – 99503 (USA). Fax: (907) 563-3746. Inaugural Address Delivered by Wilfred A. Cassell at the 3rd International Conference of Somatic Inkblot Society held at Chandigarh, India on Feb. 22-25, 1996 Future Direction of Projective Technique Thank you for attending this international meeting of the SIS society. It is a privilege and honor for me to address this most innovative and learned group. This is my wife Mary’s and my second visit to India. We very much look forward to renewing friendships made on our last visit. I also warmly anticipate extending professional relationships, which have meant so much to me since the last visit. I also welcome the opportunity to meet new colleagues on this second venture into such a wonderful and interesting country. There are many determinants of human behavior. A central one over the history of culture and science has been man’s search for knowledge. A natural curiosity about the nature of the universe along with a desire to use the position of heavenly bodies in navigation motivated the early astronomers to scientifically study the heavens. For many, the gradual accumulation of knowledge was intellectually rewarding, positively reinforcing earlier, more casual viewings with the human eye. For some whose observations challenged existing beliefs, their publication led to great hardship professional ostracism, and in extreme instances, death. Consider how the religious and police authorities in the eighteenth century punished Copernicus when he concluded that the earth was round. Over the centuries, intellectually courageous and pioneering people in India contributed much to our early understanding of the universe. For example in ancient times the mathematical concept of zero (shunya) was first recognized by Indian thinker. Indian psychologists were the first to recognize the centrality of the concept of self in the personality and developed technique of yogic meditation, which are the basis of many healing programs, which aim at the psychological control of body functions. A logical extension of this is the interest of Indians in Somatic Inkblot Series methodology, which attempts to bridge the psychological, and the somatic in health and disease. There have been such advance thinkers from India over the years. In the setting of this conference, the SIS Society must recognize the insightful and important contributions of Dr. Bankey Lal Dubey. As an experienced researcher with the Rorschach, when I first met him in 1988 at an international psychological meeting in Sydney,

92 Cassell Australia, he insightfully recognized that for the exploration of psychological inner space, technological innovations in SIS stimuli opened new and highly promising horizons. With this creative leadership and sincere dedication, many members and fellows of this society as well as graduate students have advanced knowledge in the rapidly evolving SIS technology. These pioneering individuals are to be complimented on their many successes in moving this country into an international leadership role in psychology and medicine. As we rapidly move toward the 21st century, once again Indian initiative promises to enlighten mankind in the inner world of consciousness as the Hubble telescope allows modern astronomers to view the outer universe in a way that could hardly be imagined a few years ago. As we gaze into the future, I would like to briefly outline some of the new psychological “telescopes” that we hope to employ. Since Hermann Rorschach is an important hero figure for me personally – and trust for many of those here today, a few comments about advancing Hermann’s contributions might be envisioned. As I noted in the July edition of the Journal, we have available now videotape presentation of the original ten plates. In addition, at the SIS center in Alaska, we currently are exploring the presentation of this system on computer screens. Unfortunately, we are unable to extend the electronic imaging presentation format for my friend Wayne Holtzman’s Inkblot Series. Sadly, the publisher has refused permission even for research purposes. This narrow-minded attitude like that shared by those psychologists who insist on the standard Rorschach card presentation, in my opinion should be categorized with the church hierarchy’s suppression of Copernicus’ astronomical findings. Not limited by such archaic thinking, workers in the 21st century will be able to employ many fascinating and highly promising new electronic methods of presentation of the sixty two SIS images. Two examples among many others might be of interest. By employing advances in telephone technology, it is possible to project an SIS image onto a television screen in a remote area hundreds of miles from Anchorage and access the viewer’s response pattern for the purpose of diagnosis and treatment. The second involves presenting the SIS images on a computer screen and having the individual interact with the presentation. This would be done both locally and via Internet transmission of images. There are many ways of doing this such as typing the responses into the computer or actually touching the screen to create a new type of data response profile. Internet transmission of data is at the setting edge of SIS research and development. Considerable excitement has been generated by this technology in the scientific community around the world. We are very privileged to have my friend and long-time colleague Dr. Gilbert Roth here from the United States to outline the evolving communication opportunities of the Internet.

Inagurall Address 93 Lastly, it is my hope that this meeting does more than providing us food for thought and cognitive stimulation. Workers employing the SIS technology need support at multiple levels. Challenging the mysticism and almost cult like use of existing psychological instruments and reductionistic scoring system may cause one to be viewed as a heretic and suffer some degree of professional stigma. At a personal level, because of the immense power of the SIS to relapse the suffering person’s inner cry, clinicians employing this approach risk a much greater degree of empathetic pain than with other methods. Just as the early physicians who introduced X-rays into medicine developed forms of sickness, the pioneering efforts of those with the SIS could be potentially hazardous to their mental health. It is my belief that we need to establish opportunities to debrief our professional fellows who are exposing themselves to imagery that at time can be horrible and debilitating. Consistent with my belief that there has to be a balance between work and play at this meeting, I would now like to present what I hope will be experienced as beautiful and healing images of Alaska. As you view this material, I would like to have you travel in your imagination for where we are now in Chandigarh across the ocean to Alaska. Hopefully many of you will actualize this in real life. My wife, Mary, who has been so helpful over the years, and I would be most happy to welcome you and your loved ones.

SIS J. Proj. Pst. & Ment Health (1996) 3:2 94-102 Presidential Address Delivered by Dr. B. L. Dubey at the 3rd International Conference of SIS held at Chandigarh, India on Feb. 22-25, 1996 SIS as a Projective Psychotherapeutic Tool for the 21st Century Respected Chief Guest, Patron Dr. Wilfred A. Cassell founder of SIS and Dr. S. P. Singh, Chairman of University Business School, Chairman of the Organizing Committee Dr. N. L. Dosajh, Members of the Organizing Committee, Office Bearers of SIS and IACP, distinguished delegates from India and abroad, friends and colleagues, ladies and gentlemen. On behalf of the members of the Somatic Inkblot Society an international organization and on my own behalf, I express deep sense of gratitude to the well wishers and contributors for helping me in organizing this Conference. It is customary that the President of the Association delivers an address on such an occasion. Accordingly, I have the privilege of addressing this august body. The theme of the conference is projective psychology - Screening, Application and Mental Health with sub-themes of Personality Assessment, Clinical evaluation, Mental Health in Industry, Stress Management and Therapeutic intervention. This conference becomes more important because it is being held at the completion of century for the concept of projective psychology used by Freud in 1896 and the completion of 100 years of Clinical Psychology started by Lightner Witmer in 1896. Witmer started Clinical Psychology Journal in 1907. The concept of projection, as used in projective tests now a days, is generally credited to Freud who had used this term as early as 1896 (Freud, 1950) and defined it as a defensive process in which impulses, wishes and ideas of aggressive and sexual nature are internalized because their conscious recognition would be painful to the ego. The subject matter used in this procedure serves as a lens of projection, and the recorded material of elicited behavior is the screen with the picture projected on it (Rapaport, Gill and Schafer, 1968). Since projective tests are not based on verbal communication, they more effectively penetrate a person’s ‘Outer Shell’ of defenses and surface behavior. Unlike personality questionnaires and intelligence tests, projective tests do not require reading questions or manuals, so they more directly assess mental processes. They use the language of dreams, visual imagery and symbolic thought, the most basic forms of thinking and expression. Projective tests speak the language of repression and bring whatever is buried in the mind closer to consciousness, so it is accessible for processing (Cassell, 1990) B.L.Duhey, Ph.D. Professor, Univer. Busi.School, Panjab Univ., Chandigarh-160014 (India).

Projective techniques were born as a revolt against the paper and pencil tests of the first half of the twentieth century, which were extremely susceptible to ‘social desirability’ effects, or the tendency of test-takers to present them-selves in the most positive light. Projective techniques were envisioned by their creators as depth instruments, which could penetrate the individuals’ defenses, and would thereby provide a royal road to the unconscious (Murstein, 1995). Two main criticisms by the critics were, first, that the techniques did not correlate highly with overt behavior, and second, that they did not correlate highly with other paper and pencil tests, and were, therefore, invalid. The critics failed to grasp that these techniques were exactly those techniques, not tests in the psychometric sense. As techniques they were highly dependent on the skill of the examiner. Just as a Stradivarius violin in the hands of a chimpanzee would not result in rhythmical music, an unskilled, or insufficiently trained examiner should not be expected to utilize projective techniques to their full potential (Murstein, 1995). Professor Murstein was very right in his contention to support the power of projective technique over so called objective techniques. The use of inkblots has evolved from a type of Parlor game to an incredibly useful projective aid for psychological assessment and healing. It gives a voice to the speechless and the previously unheard inner cry, allowing both the suffering individual’s own special language of pain. It gives the sufferer and the therapist a tool for hearing, helping and healing. With hearing comes the potential for understanding, and with understanding, the potential for empathy. Empathy is something we probably all strive for, yet one of its by products is pain for the therapist (Cassell, 1994). The history of inkblot procedure is not easily traced. It is traceable only through Rorschach’s own writing and through the writings of Emil Oberholzer, Zubin (1965) indicated the use of formless stimuli in the forms of inkblots to stimulate the imagination which in turn can be traced back to Leonardo Da Vinci and Botticelli in the 15th century. However, credit of inkblot technique goes to Hermann Rorschach a Swiss Psychiatrist known as ‘KLEX’ by his peers in school for his ability to produce artistic inkblot configurations, who developed the first inkblot test known as “The Rorschach Test” in 1911. Hermann Rorschach conducted clinical trials with hospitalized psychiatric patients and eventually selected 15 blots, which met his criteria. Unfortunately, for economic reasons, the Swiss publisher refused to print all of these cards and five blots were eliminated. Imagine how frustrating this must have been to him at that time. Perhaps this played a role in his untimely death at age 37. He died from what many modern physicians consider to be a stress induced gastrointestinal illness. Probably because of his untimely death he could not publish the Manual of his test, which was published later on by Emil Oberholzer in 1921 (Cassell, 1995). Presidential Address 95

96 Dubey The use of this test to explore the subject’s psychopathology and basic personality structure is well known. The test is ranked as number one by different studies (Reynolds and Sundberg, 1976; Wade et al 1978; Piotrowski and KeIIer, 1978 and Dubey, 1982). In spite of its wide use there is no dearth of those who have criticized the Rorschach test (Fiske and Baughman, 1953; Holtzman, 1956; Dubey, 1982). Holtzman (1956) pointed out that much of the controversy over the Rorschach arises from the failure to distinguish between the Rorschach as a psychometric device, that yields scores having relevance for personality assessment. The analysis of responses to inkblots has ranged all the way from one extreme to the other of the projective psychometric continuum. Wayne Holtzman developed “Holtzman Inkblot Test” in 1956 to overcome some of the limitations of the Rorschach. The main limitation of the Rorschach, as experimentally determined, was the problem of variation in the length of the protocol (Fiske and Baughman, 1953; Dubey, 1982). As Fiske and Baughman pointed out, the relationship between Rorschach scores and the total number of responses are complex and curvilinear. Consequently, the usual effect of R linear regression method for removing the confounding effect of R will generally fail. The Holtzman Test was developed to take care of the limitations of the Rorschach test particularly by controlling the number of responses on each card. People working in the area later on found that by restricting only to one response on each card, the test has lost its projective value and it has become like an objective questionnaire. The Somatic Inkblot Series (SIS) evolved from an investigation of body image distortion in women with hirsutism (Fisher and Cleveland, 1958; Hollender and Cassell, 1965) and a study of Rorschach “penetration scores” (Cassell, 1964, 1965). The first two tests of the Somatic Inkblot Series (515-I and 515-Il) were developed in 1960. After an extensive clinical work both the forms 515-I and 515-Il were made available for testing in 1980. The test continued Rorschach’s concept that ambiguous and semi-ambiguous visual stimuli evoke spontaneous responses associated with body imagery, need and drive states, personality dynamics, and the respondent’s unique percepts. Like the Rorschach, Somatic inkblots tap both conscious and unconscious mind but they extend beyond Rorschach in a multi-sensory approach with more inkblot imagery available in traditional card format, paper booklet and most innovative VHS Videotape. The test is found reliable and valid (Dubey et al. 1992; Pershad and Dubey, 1994; Verma, Pershad and Nehra, 1994; Verma, 1995). If Hermann was alive, he would have appreciated SIS Video and probably he would have developed Video of Rorschach with us. We are in fact doing what Hermann has left behind. Professor Cassell Says “Hermann Rorschach is still alive and living in Alaska”. Dr. Cassell developed a Video version of 10 plates Rorschach on the pattern of SIS Video. Upon completion, he met with the representative of the Rorschach publisher who was shown the video and he expressed considerable interest in this new

Presidential Address 97 technology. Dr. Cassell got permission for its research application, provided it was not sold commercially. However, the publisher wanted to check this new technique with certain old fashioned indices based Rorschachians before proceeding further. Unfortunately the idea to develop Rorschach’s video was turned down after 5 years probably because the author’s emphasis on content analysis was not relished. During my frequent visits to Alaska I found the Rorschach video equally helpful provided SIS technique of exploration and content analysis were incorporated there in. The SIS has five test forms in the Series: SIS-20 cards set like Rorschach for individual administration. SIS-II 62 images booklet for self-administration. This form can also be used as a group test. SIS - Video is the VHS Video version of 62 images 515-Il test. This is the first inkblot video test in psychological testing. The SIS video begins with pictures of flowers and soft background music followed by stimulus images one at a time. Each image stays on screen for about 30 seconds. The background music continues up to the presentation of the sample image, and then it stops. The floral presentation, however, precedes each image. The floral presentation and soft background music induces the subject to relax. The fourth form of the series is the Video Version of SIS-I card set which can be taken as a self-administered test. The fifth form of the series is SIS-Living images exclusively made to help sexually traumatized female patients. So there are 3 Video Versions in addition to the card and booklet forms. Clinical significance of various forms have been tried and found successful in a variety of clinical cases and diagnostic groups (Bellamy, 1995; Brady, 1995; Cassell, 1972, 1980, 1980a, 1994, 1995, 1996; Cassell and Fields, 1995a, Dosajh, 1995, 1996; Dubey et al 1993, 1993a, 1994, 1995, 1995a; Dwivedi et al, 1994, 1995; Gaetani et al, 1995; Pandey, 1995; Ramachandra et al, 1995; Rathee et al, 1994; Sahay et al, 1994; Saldanha et al, 1995; Savage, 1995; Verma et al, 1995). Employing any of the SIS procedures is not like using non -projective tests, which are multiple levels of abstraction away from the images of human suffering. The reviewer is necessarily forced to share the pathological projection and the nightmares of the suffering individuals. The SIS society will help professionals process such painful material (Cassell, 1994). Due to their ambiguous nature, inkblot techniques are more amenable to the use of content analysis, rather than the highly abstract statistical scoring systems frequently used. This may affect how that part of the scientific community, to whom measurements

and statistics are important, views the efficacy of the various SIS instruments. While mathematical scoring is important, most indices cannot reflect the intensity of the pain experienced by the suffering individual, who frequently may not even be aware of what is troubling him or her. No projective techniques ordinarily only measures what the person already understands about his situation, not what is hidden deep inside? The SIS procedure also evaluates positive traits, such as the love of the individual for himself and others (Cassell, 1994). Somatic Inkblot Series is backed by theories of “Somatic Imagery Theory”, “Theory of Body Symbolism” and “The Cry for Help”. Somatic Imagery Theory proposes that everyone has a unique and highly personalized system of attitudes, both conscious and unconscious, that is projected on to the body concept as a special entity. These interact with feedback sources and internal sensations. Relatively discrete mental representations exist for particular somatic regions, which constantly compete for full registration on consciousness. Somatic awareness transiently increases in states of hunger, physical exertion, emotional arousal and sexual excitement. Subsequently, the mental representations in the body fade into the background of consciousness. Clinical experiences, upon which the 515 procedure builds indicates that persons suffering from physical illness, psychosomatic illness or conversion reaction will perceive abnormal anatomical structure in the semi-ambiguous SIS images. There may be sensitization with anatomy (increase in number of anatomical responses) or repression with avoidance of somatic content. By assessing an individual’s responses and his/her association with them, much can be learned about the person’s innermost thoughts and feelings. What he sees in ambiguous and semi-ambiguous images reveals his self-perception. Theory of Body Symbolism: emphasizes symbolic interpretation of the responses given on SIS images. Psychoanalytical interpretation of responses as suggested by Freud and further propagated by Roy Schafer (1954), Paul Lerner (1991), Cassell and Dubey (1995) is well known. Body symbolism helps us to understand the inner feelings of a person. The Cry for Help: Clinicians worldwide have heard the cry for help in a variety of ways. These range from abused children who escape ~ through dissociative disorders to victims of catastrophe or war, who suffer from post-traumatic stress disorders. Other manifestations include ongoing frustrations in their life situations and in affective disorders or abnormal behavior. Physical symptoms, such as functional borders, hypersensitivity of an organ system, or pain all in themselves may present a form of a cry for help. The Somatic Inkblot Series can help therapists more sensitively “hear” a suffering individual’s cry for help, the “inner cry” that is not hidden from others, but often hidden from one’s own conscious awareness as well. While the SIS uses Somatic inkblots that involve body and organ they have identified 98 Dubey

a variety of personal problems and mental disorders also. Every day conversations are replete with examples of the mind-body connection such as “broken heart” for depression or “what a headache” for anger or frustration. By developing a practiced eye and ear for such imagery, therapists can more directly share the perpetual world of their patients with less interference, and fewer variables than in structured interviews or paper and pencil tests. The Somatic Inkblot Series-Il and video were administered during selection to find out the personality traits, interpersonal relationship, Ego/Self image, healthy body imagery, erotic imagery, hostility/aggression, insecurity and team building concepts. The procedure was found to be a successful screening test. The subjects who did not reject images, gave more than 13 Most Typical Responses, more than 20 percent Human responses, less than 15 percent Animal and Anatomical responses and no pathological responses were recommended for inclusion. However, none was rejected on the basis of psychological tests. Selection was finalized on the basis of overall performance in the interview. The Somatic Inkblot Series was also used as a therapeutic intervention technique for managers having stress due to work/family pressure. The outcome of the therapy was very encouraging and people become symptom free. We all are aware of the concept of Telemedicine, through global computer network and video. We sincerely hope that the beneficial effects of SIS would be available to the patients residing any where in the world by the beginning of 21st century. A therapist while sitting in his clinic in another part of the world can still provide therapeutic aid to such a person through this modern technology. Our vision to reach the un-reached would be complete through the help of SIS Video. Such a network will help us in sharing the human sufferings in different cultures and further searching a way to improve human lives. References: Bellamy, E.N. (1995) Hospitalised Suicidal Patients and the Somatic Video Procedure, A Descriptive Study, SIS J. Proj. Psy. & Ment. Health, 2:85-91. Brady, D. (1995) A Study of Somatic Inkblot Series, Application in Medical Setting, SIS J. Proj. Psy. & Mental Health, 2:129-934. Cassell, W.A. (1964) A Projective Index of Body Interior Awareness, Psychosomatic Medicine, 26:172-177. Cassell, W.A. (1965) Body Perception and Symptom Localization, Psychosomatic Medicine, 27:171-176. Cassell, W.A. (1990) Somatic Inkblot Series Manual, SIS Centre, Anchorage, Alaska (USA). Cassell, W. A. (1994); The Somatic Inkblot Series: Continuing Rorschach’s Conceptualization. Presidential Address 99

Cassell, W.A. (1995) Somatic Inkblot Series - Video:Case Report & discussion, SIS J. Proj. Psy. and Mental Health. 2:3-18. Cassell, W.A. and Dubey, B.L. (1996) The use of Rorschach and SIS in releasing Somatised Grief,SIS J.Proj.Psy & Ment. Health, 3:3-32. Dosajh, N.L. (1995) A new combination of therapies for the treatment of Schizophrenic of less than five years duration, SIS J. Proj. Psy. and Mental Health. 2:135-138. Dosajh, N. L. (1996) Projective Technique with Particular Reference to Inkblot Test, SIS J. Proj. Psy. & Mental Health. 3:1-59-68. Dubey,B. L. (1982) A Pragmatic View of Rorschach Inkblot Technique, National Psychological Corporation, Agra, India. Dubey, B. L. (1994) Reliability and Validity of Somatic Inkblot Series in India, SIS. J. Proj. Psy. and Mental Health, 1:33-38. Dubey, B. L. (1993) Somatic Inkblot Technique: Evolution and Current Status, The Mind, 2:22-31. Dubey, B. L. and Cassell, W. A. (1993) Some Expcrience with the Somatic Inkblot Series, British J. Proj. Technique, 38:1941. Dubey, B.L., Cassell, W.A., Dwivedi, P. & Mishra, M. (1995) Inner Cry through Somatic Inkblot Series, SIS J. Proj. Psy. and Mental Health.2:119-128. Dubey, B. L., Cassell, W. A., Pershad, D., and Dwivedi, P. (1995) Diagnostic Utility of Somatic Inkblot Series, SIS J. Proj. Psy. and Mental Health, 2,77-84.. Dubey,B. L. and Cassell, W. A., (1992) Diagnostic Utility of Somatic Inkblot Series Video, Proceedings of 25th International Congress of Psychology, Brusells, Belgium. Dwivedi, P., Mishra, Mridula and Cassell, W.A. (1994) Somatic Inkblot Series video in Adolescents, Dwivedi, C.B., Mishra, Mridula and Dubey, B.L (1995) Diagnostic Significance of the Indices of SIS -Il and the Rorschach Inkblot Tests, SIS J. Proj. Psy. and Mental Health, 2:165-170. Fisher,S. and Cleveland, S.E. (1968) Body Image and Personality, Van Norstrand, Princeton, New Jersey. Fiske,D.W. and Baughman, E.E. (1953) Relationship between Rorschach Scoring Categories and the total number of responses, The journal of Abnormal and Social Psychology, 48:25-32. Freud,S. (1950); Further Remarks on the Defense Neuro-Psychoses (1896) Collected Papers, Vol. I, Hograth Press London, pp. 155-182. 100 Dubey

Gaetani, G., Fiorenzo, L., Alfio, L., Giovanni, S., Rossano, Y. & Ferro, Roberto (1995) Corporal Perception in HIV Positive and Negative Heroin Addicts assessed with SIS -I. SIS J. Proj. Psy. and Mental Health, 2:97-118. Hollender, M.H. and Cassell, W.A. (1965) Psychological Problems Associated with Hirsutism, International Psychiatry Clinics, 3:2. Holtzman, W.H. (1956) Inkblot Perception and Personality, University of Texas Press, Texas. Lerner, P. (1991) Psychoanalytic Theory and the Rorschach’, The Analytic Press, Hillsdale N.J. USA. Murstein, B. I. (1995) The Relationship of Stimulus, Projection and Pathology in Projective Techniques and the “Levels Effect”. SIS J. Projective Psychology and Mental Health, 2:41-52. Pandey, R. (1995) Projective Measures of Alexithymia and the SIS. SIS J. Proj.. Psy. and Mental Health, 2:145-152. Pershad, D., and Dubey, B.L. (1994) Reliability and Validity of Somatic Inkblot Series in India, 51S4, SIS J. Proj. Psy. and Mental Health, 33-38. Pershad, D., and Verma, S. K. (1995) Diagnostic Significance of Content Analysis of SIS-Il, SIS J. Projective Psychology and Mental Health, 2: 139-144. Piotrowski, Z.A. and Keller, J.W. (1978) Psychological Test Usage in South Eastern Outpatient Mental Health Facilities in 1975, Professional Psychology, 6: 3-7. Ramachandra, S., and Chatiuvedi, S.K. (1995) Body Imagery in SIS Test, SIS J.. Proj. Psy. and Mental Health, 2:53~0. Rapaport, D., Gill, M.M. and Schafer, R. (1968) Diagnostic Psychological Testing, International Universities Press Inc., New York. Rathee, S. P., Goel, D. S., Saldanha, D., Chawla, M. L. and Duhey, B. L. (1994) A Study of SIS- I in Coronary Cases. SIS Journal of Projective Psychology and Mental Health, 51-64. Reynolds, W.M. and Sundberg, A. (1976) A Survey of Rorschach Teachings in APA Approved Clinical Graduate Programs, Journal of Personality Assessment, 40:228-233. Rorschach, H. (1921) Psychodiagnostic, Ernst Bircher. Sahay, M. and Srivastava, P. K. (1994) Somatic Inkblot Series-Il, In Male Tran-sexuals, SIS J. Proj. Psy. and Mental Health, 1:73-78. Saldanha, D. and Dubey, B. L. (1995) Effect of Sodium Pantathol on SIS- video-A Inkblot Images, Savage,G.(1995) Bereavement and Hypnosis, A Case Study, SIS J. of Proj. Psy. and Mental Health, 2:29-10. Presidential Address 101

Schafer,R.(1954) Psychoanalytic Interpretation in Rorschach Testing, Gryne & Straflen, Inc., NewYork. Verma,S.K. (1995) Reliability and Validity of Somatic Inkblot Series Tests, SIS J. Proj. Psy. and Mental Health, 2:67-71. Verma, S. K., Pershad, D. and Nehra,R.(1994) Cross Validation of SIS-II in Psychiatric Population, Verma, S. K., Pershatl, D., Kaur, IL awl Nehra,R.(1995) Diagnostic Significance of SIS.. SIS Journal of Projecrive Psychology and Mental Health 2:72-76. Zubin, J., Eron, L.D. and Schumer, F. (1965) An Experimental Approach of Projective Techniques, New York, John Wiley. 102 Dubey

SIS J. Proj. Pst. & Ment Health (1996) 3:2, 103-111 Correspondence regarding this article should be addressed to Christopher J. Bailey or Bernard I. Mustering, Detriment of Psychology, Connecticut College, 270 Mohegan Avenue, New London, CT 06320-4196 (USA). Electronic mail may be sent via Internet to cjbia@conncoll.edu. Paranoia Assessment with the SIS-II: in a College Student Sample Christopher J. Bailey and Bernard I. Murstein The relationship between the Somatic Inkblot Series ii and a self-report Paranoia Scale was investigated in a college-age student sample (N=60). The content of written responses to the Somatic Inkblot Series II were Analyzed for paranoid content. Based on past research with other projective devices, a content analysis of Somatic Inkblot Series responses featuring eye references, facial references, atypical references, and paranoid ideation was conducted. The result indicated that two of the scoring methods, those for eye content and paranoid ideation, were positively associated (p< .05) with self-reported Paranoia Scale score. The findings lend support to the Cassell (1990) eye paranoia scale for the Somatic Inkblot Series II, and extend these findings to a nonclinical sample. Somatic Inkblots were designed for the assessment of body imagery and somatic symptoms to potentially aid the clinicians in the diagnostic identification of various mental disorders. Both the Somatic Inkblot Series-I (SIS-I; Cassell, 1980) and the Somatic Inkblot Series-II (SIS-II; Cassell,1990) involve the presentation of ambiguous and semi ambiguous inkblot stimuli in response to which the test-taker is presumed to reveal aspects of personality. One of the assumptions upon which the development of the SIS was based is the somatic imagery hypothesis, which suggests that individuals possess “relatively discrete mental representations… for particular somatic regions which consciously compete for full registration in the consciousness’ (Cassell, 1990, p.4). By interpreting the content of responses to the SIS, the clinician can assess an individual’s cognitive, affective, and attitudinal processes that may involved a preoccupation with particular somatic regions (e.g., “peering eyes”). Cassell (1990) indicated that content analysis reveals the “symbolism and meaning unique to the individual that can be differentiated from typical and atypical peer norms and current diagnostic criteria (latest DSM manual, P.7). Recent applications of the SIS have featured the analysis of respondents’ fear of death (Gaetani et al., 1995) somatic disorders (Brady, 1995), and alexithymia (Pandey, 1995). In the area of paranoia assessment, other projective instruments, including the Rorschach (Piotrowski, 1995), the Holtzman Inkblot Test (Andrews, 1972), and thematic analysis of TAT Card 9GF (Groth Marnat, 1990), have been used. Many clinicians have hypothesized that content responses regarding eyes are positively associated with greater paranoia (Beck, 1952, Exner & Weiner, 1972; Miale, 1960; Piotrowski, 1957).

104 Bailey & Murstein Individuals with paranoia are presumed to have a heightened awareness of eyes, possibly representative of sensitivity to observation, criticism, or attention. Similarly, Cassell (1980, 1990) detailed a Paranoia (P) scale quantified by the summation of eye responses to the Somatic Inkblot Series. For both the Rorschach and the Holtzman Inkblot Test, empirical studies have lent some support to this clinical hypothesis. Du Brin (1962) searched for eye, head, and mask references in the Rorschach records of 1600 individuals diagnosed as paranoid schizophrenic and found significantly higher numbers of such references than in the records of a non-paranoid schizophrenic group and a neurotic group. Andrews (1972) found that individuals diagnosed with paranoia had a greater number of eye references to Hotzman inkblots than concern about the eye region of their own bodies. He interpreted this finding as an indication than paranoia is associated with a particular interest in the eyes of others peering at oneself as opposed to one’s eyes being granted special importance. A perception that the attention of other is directed towards the self has been described as a central feature of various forms of paranoia (Greenwald, 1980). The study of paranoid content has typically included samples of psychiatric inpatients, mostly notably those diagnosed with paranoid schizophrenia. Recent empirical research has focused on the cognitive distortions and delusional thoughts within non-clinical “normal” populations (Chapman & Chapman, 1988; Maher, 1988). Non-clinical college and university students have been characterized as having varying digress of “paranoid” ideation. Such ideation of students has been tapped with self-report measures and was described by Fenigstein and Vanable (1992) as “self-centered thought, suspiciousness, assumptions of ill will and hostility, and even notions of conspirational intent-reminiscent of paranoia”. In paranoia, a greater awareness of the self as an object of attention from others can involve a heightened sense of being noticed (Cameron, 1943; Laing, 1969; Shapiro, 1965). It may be that the importance given to being an object of attention in paranoid ideation may be represented in the perception of eyes in the relatively ambiguous structures of inkblots. Since paranoia is demonstrated by college student’s samples (Fenigstein and Vanable, 1992), this suggests that a test like the SIS-II can be used to identify this paranoia. The current study was designed to analyze the relationship between a self-report measure of paranoid ideation and the assessment of paranoia with the Somatic Inkblot Series-II for a college sample. The analysis of paranoia on the SIS-II may be consistent with the paranoid ideation self reported by such respondents. Thus, the validity of the projective measure, the SIS-II, in relation to an objective measure, the self-report Paranoia Scale (Fenigstein and Vanable, 1992), can be addressed. It was hypothesized higher self-reported Paranoia Scale scores will be positively associated with all paranoid content scores derived from the SIS-II. The scoring of paranoid content on the SIS-I will be described shortly.

Paranoia Assessment 105 Method: Participants: Sixty participates were recruited from introductory psychology classes at a small private northeastern college in the United States. The sample included 38 women and 22 men in which the mean age of participants was 21.62 years (SD=7.87). The study was conducted either individually or in small groups of 2-8 students at a time, with most participants taking approximately 1 hour to complete the procedure. Participant earned research credit towards psychology course completion for participating in the study. Instruments: Somatic Inkblot Series –II: The SIS-II is a paper test booklet containing a total of 62 inkblot images. Respondents record their perceptions of what an image looks like in the space adjustment to each picture. Administration and scoring procedures are detailed by Cassell (1990). He claimed evidence for content validity in his finding that the SIS-II elicited more frequent themes of pregnancy in group of pregnant women than in a control group of women. Verma (1995) indicated that reliability and validity have been supported (see also Pershad and Dubey, 1994), but gave no specific values. The two authors completed all scoring for paranoid content for the SIS-II in the current study. The authors attained an interpreter agreement of r=.85, a value sufficiently high for the purpose or absence of paranoid content regardless of the number of perceptions to the blot reported. No distinction in scoring was made with respect to whether the participant used a part of or the whole inkblot. Paranoid content on the SIS-II was scored in 5 ways. First, the number of “eye(s)” references was summed to produce an eye paranoid score. References such as “eyeball” or “eyelid” were scored because of their definitional consistency with the eyes structure. References outside of this somatic context or those involving metaphoric or symbolic language (e.g., “eye of the storm”) were not scored. Second, the number of “face” “head”, “skull”, and “mask” references was summed to produce to facial paranoid score. I this way the content responses towards the general upper body region of a figure percept could also be measured. Third, the eye paranoid score and the facial paranoid score were themselves summed to produce an eye /facial paranoid score. The purposed of this summed score was to verify the findings of Du Brin (1962) who similarly used “eye”, “head”, and “mask” Rorschach references in his analysis of the “eye hypothesis” of paranoia. Fourth, content responses were analyzed according to the degree to which they might be considered “typical” (i.e., “popular”) responses for a particular inkblot. Typical references for “eye(s)” occur on 10A; for “face” or “head” on 10A, 30A, 31A, 4B, 8B, 10B, and 12B; and for “skull” on 30A as detailed in the set of normative responses

106 Bailey & Mustein developed by Cassell (1990). References to eye(s), face, head, make, or skull not listed as “typical” were considered “atypical”. Atypical scores were summed to produce an atypical paranoid score. Eye references designated as “atypical” were also tabulated and scored in a separate analysis. Lastly, it seemed reasonable that if the somatic structure of the eye was scored as indicative of paranoid content, then the function of the eye might be considered as well. The main function of the eye is the visual process, of seeing and looking. Thus content reference consistent with the visual process, such as “seeing”, “glancing”, peeping”, “staring”, spying”, or “looking”, formed the basis of the paranoid ideation score. However, it seemed most consistent with the defining characteristics of paranoid (Andrews, 1972; Greenwald, 1980) to score only responses in which the participant described someone or something as “looking”, or “staring”, etc. at wither the participant him or herself or at another part of the stimulus. A participant who described his or her own visual process to the stimulus (e.g. “I am looking at a turtle”) was not scored for paranoid ideation. Thus, to meet the criteria for paranoid ideation it was considered necessary that the participant describe himself of herself or some other stimulus as the object or target of observation. Paranoia Scale: The Paranoia Scale (PS) (Fenigstein and Vanable, 1992) was designed to measure paranoia in a college student population. The PS consists of 20 items scored along a 5 point scale ranging from I, not at all applicable to me, to 5 extremely applicable to me. Scale item responses are summed and total score range from 20- 100 with higher score indicative of greater paranoia. Items for the scale were selected according to criteria of paranoid ideation as conceptualized by Magaro (1980) and Millon (1981). The items were generated from a number of existing paranoia scales for clinical populations (e.g. the MMPI), but were tailored for utilization with college students for whom the PS was intended. Fenigstein and Vanable (1992) noted that the addition of filler items to the scale proved unnecessary, as the psychometric properties of the scale were unaffected, and few participants were able to report the purpose of the scale. Internal reliability for the Paranoia Scale was supported by an overall alpha coefficient of .84 and a mean item-whole r of .42 for combined sample of 581 college participants (Fenigstein and Vanable, 1992). They also found a test-retest reliability of .70 after 6 months. Construct validity was supported with the finding of significant relationships between Paranoia Scale scores and anger expressed outwardly (.18), need for personal control (.29), interpersonal trust (-.30), trust in close relationships (-.32) belief in the control of powerful others (.34) public self-consciousness (.40), and anger expressed inwardly (.51). Additionally, participants who scored high on the Paranoia Scale reported more self-attention and a greater sense of being observed by others in an experimental context. No gender differences were noted in PS scores. Factor analysis

Paranoia Assessment 107 of the scale indicated the emergence of a single, general unrelated factor accounting for 25% of the total variance of the scale. A second factor accounted for only 7% of the variance. Procedure: When participants arrived in prearranged classroom, they completed an informal consent sheet. Participants then received the SIS-II with its back cover facing upward. Participants were asked to fill in the date, age, sex, and educational level, and “ any visual impairments” answer form spaces on this back cover. Due to time considerations, the brief health history and test comment sections, usually part of the SIS-II, were not completed. Participants were then prompted to read the instructions section and begin after turing the booklet over to the front cover. They were informed that “labeling an inkblot as in the sample inkblot is optional, but identifying each inkblot in the box below it is desired”, paraphrased from the instructions of Cassell (1990). The test administrator (one of the two authors) remained seated at a table before collecting finished SIS-II booklets. After completing the SIS-II, participants received and completed the Paranoia Scale. Before exiting the classroom, participants received a debriefing form that provided a short and general explanation of the study. Results: The descriptive statistics of each of the 5 SIS-II paranoid content variables and the Paranoia Scale score are presented in Table-1. Table 1 Mean, Standard Deviations and Ranges of SIS-II and PS Scores Variables Mean SD Range SIS-II Content Eye paranoia 2.90 2.35 0-11 Facial paranoia 7.35 3.86 0-23 Eye/Facial paranoia 10.25 5.44 1-30 Atypical paranoia 6.28 4.54 0-24 Paranoid ideation 1.55 1.49 0-05 Paranoia Scale 42.72 12.22 23-82 In 62 potential responses for each participant to the SIS-II, the average number of eye references and facial references approximated 3 and 7 respectively. All 60 participants had either an eye paranoia or facial paranoia score of at least 1.

108 Bailey & Murstein The mean and standard deviation for the Paranoia Scale in this sample (M=42.72, SD- 12. 22) is quite similar to the mean and standard deviation of the Fenigstein and Vanable (1992) sample (M=42.7, SD=12.53). A t-test indicated that the difference was not significant, t(58)= 1.13, p>.26. Therefore, the sexes were combined into a single group for statistical analysis. To test the hypothesis of primary interest in the study, the relationships between each of the SIS-II content variables and the PS were analyzed and are presented in Table 2. Table 2 Interco relation Between SIS-ii content Scores And Paranoia Scale Secures Variables Eye paranoia …. Facial paranoia .51** …. Eye / Facial paranoia .79** .93** …. Atypical paranoia .77** .89** .96** …. 5. Paranoid ideation .33* .22 .30* .24 …. 6. Paranoia Scale .26+ -.05 .08 ..10 .24+ …. +p< .05, one-tailed * p< .05, two-tailed ** p<.0001, two-tailed Because the relationship between SIS content scores and PS secures were hypothesized to occur in the positive direction, one-tailed test of significance were utilized to analyze these relationships. Two-tailed tests were used for all other analyses. The results indicate that eye paranoia scores were positively correlated with PS scores, r=.26, p<.05, one- tailed. Paranoids ideation scores were also positively correlated with PS scores, r=.24, p<.50, one tailed. None of the other SIS content variables were productive of PS scores and these rs hovered around 0. Atypical responses for eye paranoia references (without the addition of the facial paranoia references) were also tabulated separately, and similarly were found d to be predictive of PS score, r= .16, p>.11, one-tailed. Because eye paranoia scores and facial paranoia scores were used to create composite eye/ facial paranoia scores, spuriously high positive correlations were found for these scores with eye paranoia scores, r=.79, p<.0001, and facial paranoia scores, r-.93, p<.0001. Likewise, atypical paranoia scores were positively and spuriously associated with higher number of eye paranoia scores, r=.77, p<.0001, facial paranoia scores, r=.89, p<.001, and eye/facial paranoia scores, r=.96, p<.0001.

Paranoia Assessment 109 It was also determined that males had greater number of eye references (M=-3.73, SD= 3.000 than did female participants (M=2.42,SD=1.75). However, using the separate variance t-test because of a significant disparity in variances, this sex difference did not quite reach significance, t(29.47) = 1.87, p>.07. Males also had slightly higher paranoid ideation scores on the SIS-II (M-1.73, SD-1.55) than females (M=1.45, SD-1.47), but a t=test indicated that this difference also was not statistically significant, t(58)= 0.70, p>.48. Discussion: This study offers some support for the use of the Somatic Inkblot Series II as a means to assess paranoia. The hypothesized relationship between eye responses to inkblot and paranoia demonstrated in previous studies with the Rorschach and the Huntsman Inkblot Test can be extended to the SIS-II. Cassell’s (1990) stipulation of summing eye responses on the Somatic Inkblot Series was found to be predictive of paranoia as measured by an external criterion, the self-report Paranoia Scale. Additionally, the scoring of visual process references as “paranoid ideation” was also predictive of PS scores. It should be noted that the significant positive correlation found in the study between SIS eye paranoia and the PS accounted for only 6.8% of the total variance. The positive relationship between SIS paranoid ideation and the PS accounted for 5.8% of the total variance. Thus, although statistically significant, the magnitude of these relationships to the PS was small. The use of a nonlinear sample would restrict the distribute of scores, which involve references of the “head”, “face”, “mask”, or “skull” or norms for atypical responses, were not significantly related to paranoia self report scores. The self-report Paranoia Scale of Fenigstein and Vanable (1992) was selected for this study because of its usefulness as an objective measure of paranoia in the college student population. The PS has demonstrated strong reliability and construct validity with other self report paranoia scales ranging from the MMPI to more specialized scales. Fenigstein and Vanable (1992) also described how the PS demonstrated the capacity to predict actual paranoid-like behavior within experimental situations. For example, participants scoring high on the PS exhibited a greater concern for the presence of window in an experimental room. Findings in this study also suggest the applicability of the SIS-II as a diagnostic tool for a non clinical sample. Less frequent or less intensive paranoid ideation might be expected in these kinds of samples, but the findings in this study show that the SIS-II is probably of sufficient sensitivity to tap this ideation. Perhaps eye paranoid content analysis on the SIS-II would be most useful in studying and predicting high PS score. In the analysis of paranoia among such samples, a battery of psychological tests might include both a projective measure and an objective measure because each has advantages and disadvantages that the other does not possess.

110 Bailey & Murstein The PS offers short administration time and expediency in scoring, but may lack the descriptive quality and complexity of responses and interpretation offered by the SIS- II. Although fenigstein and vanable (1992) reported that few participants were able to devise the intent of research with their Paranoia Scale, several participants in the present study were able to identify the scale as a measure of paranoia. Thus, the SIS- II my have the additional advantage of being a useful covert assessment tool in that self-presentation concerns rose by the use of self-report devices could be by-passed. The result of this study could have been influenced by the scoring methods administered. A rather conservative approach was used in that the presentations of written words (e.g., “looking”) were tabulated. In a further study, the qualitative nature of responses that may be indicative of negative or hostile content (e.g., “looking angrily”) might also be assessed, though a focus on process as well as on content may have the effect of lowering the interrater reliability. If the interrater reliability remained high, score could be trained for more complex interpretations that may tap the more subtle paranoid responses of participants. Going beyond the simple use of content in diagnosis paranoia may allow for expanded use of the SIS-II in diagnosis paranoia. The current study indicates that the SIS may be predicative of self reported paranoia and indirectly paranoid behavioral responses as well, since relationships between two content scores. On The SIS-II and self-reported paranoia were demonstrated in this study, a next step might be to measure the relationships between eye paranoia content and paranoid ideation on the SIS-II and actual paranoid behavioral responses. References: Andrews, J. (1972) Projection of Eyes in Paranoids Schizophrenia: Perceptual; and Motor Skills, 34: 789-790. Beck, S.J. (1952) Rorschach’s Test Volume 1: Advances in Interpretation, New York: Grune & Stratton. Brady, D. (1995) A Study of Somatic Inkblot Series Application in Medical Setting, SIS Journal of Projective Psychology and Manta Health, 2: 129-134. Cameron, N. (1943) The Development of Paranoia Thinking. Psychological Review, 50: 219 – 233. Cassell, W.A. (1980) Body Symbolism and Somatic Inkblot Sires, Northern Light Pub Inc. Anchorage. Cassell, W.A. (1990) Inner World Reflection Through Dreams and Art: Manual of the Somatic Inkblot Series Anchorage AK : SIS Center.

Paranoia Assessment 111 Chapman, L.J. & Chapman, J.P. (1988) The Genesis of Delusion. In T.e. Ottomans & B.A. Maher (Eds.), Delusional Beliefs (pp.167-183). New York : Wiley. Du Brin, A.J. (1962) The Rorschach “Eyes” Hypothesis and Paranoid Schizophrenia. Journal of Clinical Psychology, 18: 468-471. Exner, J.E. Jr., & Weiner, I.B. (1982) The Rorschach:. A Comprehensive System. Volume 3: Assessment of Children and Adolescents, New York: Wiley. Fenigstein, A. and Vanable, P.A. (1992) Paranoia and Self-consciousness. Journal of Personality & Social Psychology, 62: 129-138. Gaetani, G. Fiorenzo, L., Alfo, L., Giovanni, S., Rossano, V. & Roberto, F. (1995) Corporal Perception in HIV Positive and Negative Heroin Addicts Assessed with Somatic Inkblot Series-I. SIS Journal of Projective Psychology and Mental Health, 2: 97-118. Greenwald, A.G. (1980) The Totalitarian Ego: Fabrication and Revision of Personal History. American Psychologist, 35: 603-618. Groth-Marnat, G. (1990) Handbook of Psychological Assessment, (2nd ed.) New York: Wiley. Laing, R.D. (1969) The Divided Self. New York: Pantheno Books. Magaro, P.A. (1980) cognition in Paranoia and Schizophrenia: The Interpretation of Cognitive Process, Hillsdale, NJ Erlbaum Maher,B.A.(1988) Anomalous Experience and Delusional Thinking: The Logic of Explanations. In T.F. Oltmanns & B.A. Maher (Eds), Delusional Beliefs (pp.15-33) New York: Wiley. Miale, F.R. (1960) Rorschach Sequence Analysis in a Case of Paranoid Schizophrenia. In M.H. Sherman (Ed.), A Rorschach Reader (pp. 82-100). New York: Wiley. Pandey, R. (1995) Projective Measure of Alexithymia and the SIS. SIS Journal of Projective Psychology and Mental Health, 2: 145-152. Pershad, D. and Dubey B.L. (1994) Reliability and Validity of the Somatic Inkblot Series SIS Journal of Projective Psychology and Mental Health, 1: 33-38. Piotrowski, Z. (1957) Percept Analysis, New. York: Macmillan. Shapiro, D. (1965) Neurotic Styles. New York: Basic Books. Verma, S.K. (1995) Reliability and Validity of the Somatic Inkblot Series Test. SIS Journal of Projective Psychology and Mental Health, 2: 67-71. Author Note: We would like to thank Wilfred A. Cassell for his assistance in the design and implementation of this study.

SIS J. Proj. Pst. & Ment Health (1996) 3:2 112-117 Rakesh Pandey, PH.D., Mirdula Mishra, PH.D. and C.B. Dwivwdi, Ph.D., department of Psychology, Banars Hindu University, Varanasi-221 005 (India) Adress for corresponsence : Rakesh Pandey, Department of Psychology, Banras Hindu University, Varanasi 221 005 (India). A Quantitative Analysis of Like and Disliked SIS-II Images Rakesh Pandey, Mridula. Mishra and C.B. Dwivedi This paper reports and analysis of three most liked and three least like images on SIS-II by neurotics, Schizophrenics and normal controls (N=50 in each). A differential pattern of preferences emerged such as normal controls showed positive affect for healthy body imagery (Image 5 A and 13A), whereas neurotics, and schizophrenics had poor concept (image 31A and 5B). Image 31B was most liked by all subjects which supports the contention of Dr. Cassell to carry pleasant feelings way back home by the subject at the end of the test. Analysis of disliked images revealed that images pertaining to erotic/ sex and insecurity were more disliked by the clinical subjects, while the normal controls showed no such differences. Theoretical issues pertaining to these results have been discussed. The Rorschach Inkblot Test is one of the most widely used tests in clinical research and practice despite several limitations, which have often been pointed out by a number of researchers (Cassell, 1980, 1990). Moreover, attempts to develop a more objective system for the Rorschach Test have life little room for subjective inquiry into the psychological determinants of the responses. For example, the inquiry in most scoring systems, focuses on responses determinants on the perceived stimulus attributes (e.g. from, color texture etc.) and thus disregards the exploration of the underling conscious/ unconscious conflicts (Dubey, 1982, Dubey & Cassell, 1993). Somatic Inkblot Series (SIS) test has taken into account quite a few limitations of the Rorschach including those mentioned above (Cassell, 1980. Inquiry in the SIS testing proceeds from arranging the images in descending order in terms of positive (liking) and negative (disliking) affects associated with them. Usually the tested is asked to select three most liked and three least liked images. Cassell (1994) has pointed out that this process of arranging of images “beginning with most positive imagery lessens anxiety and defensiveness and facilitates later detailed inquiry “(Cassell, 1994, p.4). However, the conventional SIS inquiry focuses more on the responses content of the liked and disliked images and largely ignores the image structure of those images. Relying on the premises that analysis of the image structure could provide more revelations. The present study objectively examines the subjective preferences shown by neurotics, Schizophrenics and normal controls to ascertain whether or not their liking and disliking follows psychopathology-specific image structures.

Three are several reasons for focusing on the image structure rather than on the response content of like and dislike images. Firstly, a number of research evidences suggest that responses projected to an unstructured or semi structured image might be symbolic in nature very similar to the symbolic transformations observed in dream (Cassell, 1980). Secondly, number of researchers has contended that individuals can show preferences for stimuli without knowing what they were (Zaonc, 1980, 1981). Studies on perceptual defense have often demonstrated that degraded, subliminal or ambiguous affective stimuli brought some emotional changes (e.g. autonomic arousal without actual detection of the stimuli (See Dember & Warm, 1979 for a review). Family, it has also been noted that affective stimuli related to a given psychology may produce attentional bias even when they are not required to process (e.g.. McNally, Riemann & Kin, 1990). It is thus expected that the projected structure by the theses in the unstructured SIS-II images would generate effective presence independent of the responses given to them. It is also expected that the preferences (liking and disliking) would be related to the given psychology specific image structure. Method: Sample: The sample comprised fifty neurotics (mean age 26.33 yrs.) (25 patients in each of the DSM-III-R diagnostic category of Generalized Anxiety Disorder and Dysthymia), 50 schizophrenics (mean age 28.88 yrs) (25 in each of the DSM-III-R diagnostic category of paranoid and undifferentiated types) and 50 normal controls (mean age 27.43 yrs.). Tool: The Somatic Inkblot Series-II (SIS-II Cassell, 1980) consisting of 62 images printed in blue and white in to series, A and B with 31 images in each was used. Procedure: The SIS-II was administered individually following its standard instructions (Cassell, 1990). After completion of the test, subjects were asked to indicate the three mages, which they liked most and three images which they liked least. Subjects were not asked to justify their likings or disliking and no comments were made on their preferences by the tester. Results: Table 1 shoes the most frequent percent endorsements for each of the three most liked and most disliked images. Image 31B has been equally liked by all the testers, through the percent liking has declined in the schizophrenic group. The other two images extended a pathology specific pattern. Liked & Disliked SIS-II Images 113

114 Pandey et. al. Table-1 Most Frequently Endorsed Liked and Disliked SIS-II Images by Normal Controls, Neurotics and Schizophrenics Normal Comtrols Nerotics Schizophrenics Images Image Structure/ % Image Image Structure/ % Image Image Structure/ % No. Response content edorsement No Response content edorsement No Response content edorsement 5A Human Gestalt/ 31A Man & Women/ 31A Man & Women/ L Happy person Two human faces Two human faces I K 13A Hand/hand reaching 5B Two people talking 5B Two people talking E for help D 31B Parents & children/ 31B Parents & children/ 31B Parents & children/ Family standing Family standing Family standing Together Together Together D I 29A Projective image 30A Death symbol/skull 26A Fetus/embryo S L 30A Death symbol/skull 12B Angry face / man 30A Death symbol/skull I K 14B Less structured image 14B Less structured image 14B Less strutured image E lower back/pelvis lower back/pelvis lower back/pelvis D

Liked & Disliked SIS-II Images 115 Table-2 Prcent endorsements for liking and disking of various categories of SIS-II image structure by psychiatric patients and normal controls Liking (%) Disiking (%) Z for difference between Image Category *1 liking and disliking Normal Neurotics Normal Neurotics Normal Neurotics Schizoohrenics Schizoohrenics Schizoohrenics 1) Interpersonal 2.89** 3.88** 2.96** images A: 9,21,24 28, 31 B: 4,5,28,31 2) Egoo/Self Images 12+ 2.24* 2.46* NS A: 5,6,7 B: 22,27,28,29 3) Insecurity NS NS 2.15 A: 13,24,26 B: 19 4) Erotic Images NS 1.75 NS A: 4,8,22,25 B: 18,25 *1 Classiification is based on Dubey et al., 1995 * p<0.05 + Significant difference between normals and schizophrenics ** p< 0.01

Majority of normal subjects showed liking for healthy body imagery, while the neurotics and schizophrenics showed liking for interpersonal images, albeit in a different manner. The disliking showed that majority of normal subjects (30%) disliked image 29A while the clinical groups not at all disliked this image. Images 30A (skull) and 14B (less structured images) were disliked by all tastees and their percentages also differed very marginally. A startling peep into the pathology, is however, found by the other disliked image 12B (angry face) by the neurotics and image 26A (fetus) by the schizophrenics. Perceiving angry face as threatening reveals a strong pathological emotional content in the neurotic while perceiving of the fetus as an affront by the schizophrenics reveals their flight from reality and traumatic experience during early childhood. Following the classification of images by Dubey et al (1995) the liked and disliked images were broadly classified into four categories, viz, interpersonal, ego/self, insecurity, and erotic. Table-2 presents the endorsements in percentage for these categories by the normal and clinical groups. The interpersonal images have been equally liked by all subjects and their likings and disliking for this category showed significant differences. Erotic images were the least like images while the neurotics disliked them the most (4% liking and 14% disliking, Z = 1.75). The percent liking for various categories by the clinical groups showed significant differences. The schizophrenics and the neurotics accordingly showed lowest liking for erotic and insecurity categories in view of the fact that they longed for improving interpersonal relationship. The image category of ego/self showed significant difference (P<0.05) between normal and schizophrenics. Percent endorsements of liking and disliking for ego/self category showed significant difference for normal (Z= 2.24, P<0.05) and neurotics (Z= 2.46, p<0.05). The percent disliking of schizophrenics was significantly higher than their liking (Z= 2.15, P<0.05). Neurotics and Schizophrenics are known for having impersonal relationship and evade reality leading to poor self-concept and impoverished ego. Discussion: The result of the present study lends and unequivocal support to the contention that the affective preferences startlingly reveal the latent personality dynamics of the clinical groups. Significantly lesser liking of ego/self images by the schizophrenics reflects the dividing of self in them (Laing, 1965). Similarly, the erotic image category showed its dominant role in the onset of neurotic pathology. Significantly hightend perception of insecurity by the schizophrenics highlight the abiding role of this factor in their personality structure (Laing, 1969). The classification scheme proposed by Dubey et. al. (1995) appears to bring out the latent dynamics of the testees in a more fruitful manner and the affective preferences in terms of these categories support the rationale of aforesaid classification. The neurotics appear to show greater liking for interpersonal 116 Pandey et. al.

images so as to cope with the general deterioration in their sphere of life. On the other hand, the schizophrenics prefer to enhance their interpersonal relations, which remain disturbed beyond repair for them. These results thus, show a potential factor in terms of the affective presences by the testers. Conclusion: SIS-II was administered to 50 neurotics, 50 schizophrenics and 50 normal subjects. Only three most liked and three least liked images perceived by them were analyzed. The results suggest that neurotics and schizophrenics responded differently than normal subjects on various images. References: Cassell, W.A. (1980) Symbolism and Somatic Inkblot Series, Aurora Publishing Co. Anchorage, Alaska. Cassell, W.A. (1990) Somatic Inkblot Test-II Manual. SIS Center, Anchorage, Alaska. Cassell, W.A. (1994) The Somatic Series: Continuing Rorschach Conceptualization. SIS J. Proj. Psy. & Mental Health, 1: 13-14. Dember, W.N. & Warm, J.S. (1979) Psychology of Perception. New York: Holt Rinehart & Winston. Dubey, B.L. (1982) Pragmatic View of Rorschach Inkblot Test. National Psychological Corporation, Agra. Dubey, B.L. and Cassell, W.A.(1993) Some Experience with SIS-II. British Jr. Projective Technique, 38: 19-41. Dubey, B.L. Cassell, W.A., Pershad, D. & Dwivedi, P. (1995) Diagnostic Utility of Somatic Inkblot Series. SIS J. Proj. Psy. & Mental Health, 2: 23, 1995. Laing, R.D. (1965) The Divided Self. Middlsex: Aenguin. Laing, R.D. (1969) Self and Other. Middlesex: Pelicon. McNally, E., Reimann, B.C. & Kim, E. (1990) Selective processing of threat cues in panic disorder. Behavior Research and Therapy, 28, 407-412. Zaonc, R.B. (1980) Feeling and Thinking: Preferences need no inferences. American Psychologist, 35, 151-175. Zaonc, R.B. (1981) A One-factor Mind About Mind and Emotion, American Psychologist, 36, 102- 101. Liked & Disliked SIS-II Images 117

SIS J. Proj. Pst. & Ment Health (1996) 3:2 118-128 W.A. Cassell, M.D., FAPA, APC,FSIS, Director, SIS Center, 4459 Cordova Street, # 100, Anchorage, AK-99503 (USA). B.L. Dubey, Ph.D., FIACP, FSIS, Director SIS Center India, T-II/15, University Campus Sector-25, Chandigarh – 160014. (INDIA). Efficacy of Booklet and Monochromatic Version of SIS In a Case of Repeated Miscarriages Wilfred A. Cassell and B.L. Dubey This case was selected to illustrate the use of the monochromatic version of the SIS in a woman who had been traumatized by multiple miscarriages. She had originally presented herself, five years earlier, for treatment of depression. Because she was highly unstable emotionally with Borderline Personality traits, she was given the BOOKLET version of the SIS to complete at home after the first session. As she walked through the interview room door on the second visit she exclaimed “Dr. Cassell, you must have designed this test for me”. She then spoke about the fact that she had, for the first time in years, gotten in touch with memories of repeated miscarriages as a teenage girl. She said that when this material was released, it was painful for her. Since this material surfaced upon completion of the SIS BOOKLET, she has done much grieving on her own. However, she dropped out of therapy after relapsing with her alcoholism and was not seen again for five years. In the follow-up series of interviews she reported that she had terminated therapy even though she had been helped through previous therapy. However, she went back into an abusive relationship and relapsed with alcohol. On this occasion, she said she was very motivated for treatment. Because of her long standing severe personality problems, week ego and the fact that earlier the BOOKLET had produced so many painful} memories, a decision was made to retest her with the monochromatic version of the SIS. The name of the patient is not mentioned in the case study. The interview begins with the question, “Do you recall what you saw in 1986?” Ann : Yes, everything had the aura of death-pictures. Dr. C: And, when you came in you said “Dr. Cassell, I think you made this just for me.” Do you recall making that statement? Ann : That I made that just for you. Dr. C: That I made that just for you. Ann : Well, it seemed like everything leaped off the figures—it had some connotation attached with death of my children.

Dr. C: You mean the miscarriage. Could you recall what the miscarriage traumas were about? Ann : I just turned 15 and I had a miscarriage, about two, three months along and I was scared to death. I didn’t tell anybody about it—I don’t know my mother suspected -I don’t know. But, I had repeated miscarriages and I believe it was due to an incompetent cervix—throughout, I might have had anywhere from five to eight. Dr. C: What did you do with the miscarriages when you were a teenager? Ann : Buried them in the desert. I blacked it all out. Dr. C: What were your feelings about that at the time? Ann : Fear. Dr. C: And, what were you afraid of? Ann : May be my father’s reaction. Dr. C: And then, there was some guilt as well? Ann : I should have confided in somebody and, therefore, probably maybe the miscarriages would have been avoided. I had a first birth two months premature-he was 2 pounds 14 ounces. Dr. C: What age were you? Ann : Age 28. He is all right; he is 14 years old now. The miscarriage I had with the first husband I married, I think the baby was about five months along. For the second pregnancy (I had been divorced from my first husband) with my third husband I had a cerclage put in because I had an incompetent cervix while I was pregnant with my second carriage. I carried that child to term. Dr. C: Tell me, when you viewed the video version here recently, you feel that somehow the responses didn’t reflect the level of morbidity. Before we go into the specifics, could you comment in general about that, Ann, please? Ann : I am not really sure. In the pictures, I see pregnancy and I see a child. It takes me back to a painful subject which is the death of my children that could have been, (if I had called somebody’s attention to it-instead I kept it secret), a lot of guilt and I believe that in getting into abusive relationships after, I was punishing myself for the guilt. I was in pretty bad relationships-broken jaws. Alcohol right immediately after I started taking hold to forget-I blocked it didn’t happen... Dr. C: In our first therapy experience, how did that help alleviate some of your SIS in Miscarriages 119

120 Cassell & Dubey pain? Ann: You put me on the Prozac. After a few days I noticed there wasn’t like a black cloud hanging over and I dreaded everything-I was always expecting the worst, was very pessimistic about every aspect of my life, and I started to feel, I guess, what normal people feel-motivation-optimistic about everything. Dr. C: How about the therapy sessions-in what way did they help? Ann: They helped, I believe, immensely. I feel a rapport with you and I started to realize that it was the guilt over that it was another human life that I was dealing with and I didn’t deal with it in the right way. I started thinking of ways that I could lessen the guilt on the anxiety and myself over it and channel my energies (instead of beating myself up over it) into constructive ways to handle things in my life to benefit and not destroy myself. Alcohol was a slow suicide. Dr. C: That is helpful. I wonder if we can just look at the current SIS. The one that you found most favorable was 3l B. Could you tell us what you see there, please? Ann: A family. It looks like they have their heads bowed, but they are all together and there is unity there even though they might be feeling sadness. Dr. C: Okay. Thank you. What do you think the sadness might be? Ann: died. Maybe the loss of someone, something-a traumatic type of experiencemaybe a grandmother has Dr. C: The second favorite was 9A. What did you see with 9A, please? Ann: It seemed to be two people enjoying each other-no tension-there is a bond between them-opposite sexes, there is rapport and they are getting along. Dr. C: What does that bring to mind? Ann: The type of relationship I have been searching for all of my life-it could be family. Dr. C: Down the road as we process more of the pain that is a real possibility. And, then l6A was the one that you found third most attractive. This was seen as... Ann : Hummingbirds, maybe union. Again, it is like the last picture in a way there is a common bond, harmonious-something I’ve not had my life-and love. They share maybe the joys and sadness. I see what looks like teardrops above the birds and a heart and with sadness comes joy, but not fighting each other-it helps alleviate sadness.

Dr. C: Then, moving on to the three that bothered you, really 1 OA appeared to be the most upsetting. Could you indicate what you saw in 10A, please? Ann: A lot of pain. I look at myself when I see the picture and I am looking at the past and I know I can’t undo it, but I carry a great burden-very sad. Dr. C: And, specially, you see... Ann: Thoughtful, pensive eyes. They are looking very deeply into that person’s past. Dr. C: When you look into your past, what is the pain like, Ann? Ann: Horrible. Dr. C: Okay, and 36A was another one you found threatening. As you know, as you process the pain, it will be less. What did you see there? Ann: A small fetus, and I put it age two months. Dr. C: In what way does that bother you? Ann: That is probably the age of the miscarriages. Dr. C: What is the sadness like you are feeling-I notice you are feeling sad now? Ann: That they could have grown up to be another person and could have made more of their lives than I ever made of mine. I feel terrible, no self-worth and a lot of guilt. Dr. C: Then, the third one that bothered you most was 1 5A. Here, again, you saw... Ann: That is probably one month, (6 weeks I put down) and the beginning of a child. I don’t know too much of what else is there. Dr. C: Okay. Let’s go on and look at the ones as we go through it. Could you read what you saw on 2A and how do you feel looking at it? Ann: sad and I see caring in it-a young child and maybe the child is very she is soothing it, the young child. Dr. C: And you saw... Ann: It looks like velvet garments-something befitting a queen-robes. Dr. C: Holding the child that is moaning. Ann: Yes. Dr. C: What did that bring to mind? Ann: Compassion. My mother was very compassionate with and her children and my dad was the opposite. SIS in Miscarriages 121

Dr. C: Regimental, no love or affection shown. We knew he loved us. Dr. C: Image 3A you saw as ugliness. Could you expound on that, please. Ann: Yes. Sharpness-the edge is jagged. Dr. C: What does that bring to mind, and how does that make you feel? Ann: Again, may be my father, regimented. Everything is black and white-there is no in-between. Militaristic, rigid, and that reminds me of my father. Dr. C: Okay. On 5A you saw a figure of a person who has no expression-you don’t see any expression on that person. Ann: There are no eyes to me. He seems to be happy but no eyes. I read a lot into the eyes, the mirror of the soul or whatever. Dr. C: On 6A, could you read what you saw there, please? Ann: Well, I see a stick type of person who could be throwing hen his hands up in the air from exasperation-that maybe the teddy bear that won’t do what he wants to play a ball. It seems to me to be a child. He is giving up on the animal because he won’t play ball. Dr. C: And, you reported seeing loneliness in the teddy bear and a sense of hopelessness. Do you feel hopeless at times? Ann : I have. I feel almost like something. ..I’ am going to drink myself to death-like it is already predestined. Dr. C: So, we really need to work and help you so you can deal with the pain and not have to use alcohol in the future. 7A, you saw as an apple above a woman with uterus outlined. She is blindfolded. Could you comment more on that, please? Ann : It is a women because that reminds me of a uterus. It looks like she has a blindfold on but I don’t know what the significance would be there. Dr. C: When you think of a uterus, what comes to mind? Ann: Children, every one of them. Dr. C: She is blindfold so she is not able to see. What does that symbolize, supposing that represents you? Ann : Maybe, I didn’t realize what I was getting into when I had sex with my future husband. I didn’t realize the seriousness of becoming pregnant and I just didn’t know-naive, I guess. Dr. C: At what age did you start having intercourse? Ann: I believe 14-if not-almost 14. 122 Cassell & Dubey

Dr. C: Did you think about getting pregnant or any of that? Ann: No, I didn’t. I had a just “it doesn’t happen” and when it did, “it didn’t happen”. Dr. C: 8A, you saw as a man with sexual organ and a smile on his face-what does that bring to mind and how do you feel looking at it? Ann: Well, right now, all I can think of is that I took on the responsibility of being pregnant and it was “yippy skippy” with the guy. Dr. C: He had no sense of responsibility, and how do you feel about those males who got you pregnant and were not involved? Ann: Not too good. Dr. C: You must have some anger and resentment. Ann: Well, I probably do. I never thought of that, really. Dr. C: Yes, we need to explore that. 10A we did do. 12A, “womb of a women pregnant”. Did you want to say more about that? Ann: No. No, I don’t. Dr. C: Okay, and 1 3A, “a hand reaching out for help and forgiveness”. Would you comment on that, please? Ann: It could be me when I die and go to hell for everything I’ve done, reaching out of the fire of hell, asking God’s forgiveness. Dr. C: What is your religion, Ann? Ann: Catholic. Dr. C: How do you feel about talking to a priest about that sort of guilt? Ann: I have put that on my agenda, I definitely have. Dr. C: Okay. 14A, “an umbilical cord with fetus attached.” What does that bring to mind? Ann: Again, miscarriages, because it does look like that to me. Dr. C: 18A, uterus? Ann: Yes. Pelvic bones and that’s a women. Dr. C: 20A, “ovaries, fallopian tubes to the uterus.” Do you think about your uterus and your fallopian tubes much? Ann: No, I don’t believe I do. Dr. C: What does that bring to mind-that response? SIS in Miscarriages 123

Ann: Well, these pictures do look like that to me... Dr. C: Sure, that is fine. 24A “a pelvic region with malaise.” Ann: Possibly tumors from so many miscarriages maybe, scarring Dr. C: Are you concerned about your own pelvis from the scarring? Ann: No, the cerclage was removed. Probably cancer and stuff like that-both my parents had cancer. Dr. C: 25A, “A beetle with pinchers”. How do you feel looking at that? Ann: Ugliness-something I would ‘want to squash. If I were walking go out of my way to squash it. Dr. C: Could it be anything else? Ann: Like an old fossil, like a trilobite, or whatever they call them. Dr.C.: Some people see female genitalia there. Ann: Oh, yes, the cervix, the vagina, the labia, whatever. Dr.C.: How do you feel about that part in your body? Ann: I could do without sex, believe me, because just can-I sure Dr.C: Why is that? Ann: Because I believe that it is not really important to me. What is important is caring for each other’s feelings. Dr. C: Right. Okay, and then 26A “another fetus”. Ann: Yes, definitely. That really looks like it. Dr. C: 27A “swollen tissue”. What type of tissue and what does that bring to mind, Ann? Ann: I don’t remember this one... Dr. C: Does it bring anything to mind? Ann: Well, the vaginal area, maybe. Dr. C: Okay. 28A, “a head drooped in sadness”. What does that bring to mind? Ann: The body, the waist region just sadness. Dr. C: On 30A you saw “a skull with front teeth knocked out”. What does that bring to mind? Ann: My jaw was broken two times...it was re broken and wired back up. 124 Cassell & Dubey

Dr. C: How was it broken ? Ann: From a very abusive relationship. When I first saw you, Dr. Cassell, I was off and on involved with it Dr. C: On 3lA “Unhappy-sadness between a man and a women. Did you want to elaborate on that? Ann : The eyes are downcast and I don’t really see happiness. I just feel that there is an unconscious feeling between both of them-they are both feeling the same sadness. Dr. C: And, that has been your experience with men. Ann: Pretty much. Dr. C: Okay. Lets Look at to be, “Fallopian tubes and ovaries”. Ann: And the next …3B… Dr. C: Lets do 8B, “Pregnant women” there. Was does that bring to mind? Ann : Again, the children I’ve lost due to alcoholism or the way I have messed my daughter up4he pulmonary atresia, and tetra logy of Fallot-was probably due to my alcohol. Dr. C: So, there is a lot of guilt there? Ann : Yes, awful guilt? Dr. C: On 9B “a necrosis of the kidneys”. What does that tell us? Ann : Deteriorated, atrophy of the kidneys. Dr. C: And, what does that bring to mind? Ann : Something slowly rotting away. Dr. C: Do you worry about your kidneys-are you concerned? Ann: Yes, of alcoholism. I did have pancreatitis. Dr. C: On 10B, “a pregnant women the beginning stage”. How do you feel looking at that one? Ann: The child has a chance if she can just keep it. Dr. C: On 7B “Twin fetuses”. Do you want to comment on that? Ann: I had twins; one is healthy and one is not so healthy-more guilt, a lot, and lots of guilt. Dr. C: On 12B, “A man sneezing with a tumor on his nose”. Any thoughts or feelings about that one? SIS in Miscarriages 125

Ann: Ugliness. Something that I would not want to look at. Dr. C: 13B, “The road going nowhere”. What does that bring to mind? Ann: Maybe my life. If I keep living it the way I’ve been living it. My kids would have done better with their lives, I’am sure, than I’ve done with mine. Dr. C: And on 14B you saw “lungs, cancerous, attached to the esophagus”. What does that bring to mind-cancerous lungs? Ann: Well, drinking. I know there is increased risk of cancer to the esophagus. I do see this and then maybe a growth. Dr. C: And then, 15B you saw as “knives, barbed wire aimed at someone”. What does that bring to mind? Ann: Harsh, again jaded, something that is very disagreeable for me to look at. It looks like there is somebody in the middle of it receiving all of this. Dr. C: Who could that person symbolize? Ann: It could be me; it could be the abusive relationships I’ve been in. Dr. C: Then, on 18B you saw “penis traveling up towards cervix Any feelings about that? Ann: Probably male enjoyment, and, I’am not getting any. I don’t think I’ve ever had an orgasm anyway, and who cares? Dr. C: Did you resent the fact that the males used you and you didn’t... Ann: Pretty much. Dr. C: 24B, “ovaries”-over here? Ann: Yes, again, something identified with the female. Dr. C: And then, 26B, 91fallopian tubes”. On 27B “twins, fetus”. What do you feel looking at those twin fetuses this morning? Ann: Reminds me of my two children out there somewhere one is okay and one is not okay, thanks to me. Dr. C: And, 30B, “CAT scan pf the left and right side of the brain”. Do you think about your brain much? Ann: Yes. My dad died of something comparable to Alzheimer’s. Who knows if it is hereditary? Dr. C: How is your memory at this point? Ann: Short term, I guess, memory loss. 126 Cassell & Dubey

Dr. C: In talking about how you feel about taking the test-it brought up some sad memories. Sometimes people have dreams after this. Did you have dreams about doing the video, Ann? Ann: No, I had been sleeping pretty well; I had dreams but they weren’t bizarre like they had been when I was not. This was about the same time before you put me on Prozac in 1986, I was having horrible dreams about children. One dream that stands out was I walked into a room and there were babies (I don’t know whether they were still alive-maybe newborns) and they had been electrocuted somehow and I bent down to try to help them and touch them and their skin came off. Dr. C: How did you feel? Ann: It was horrible. I remember the dream-very bad...death, death. Dr. C: What do you think those dreams symbolized at the time? Ann: Well, maybe something I couldn’t do anything about-it’s in the past-the death of my children. Dr. C: And, you had many other related dreams? Ann: Yes, where there is a child who is hurt-who wants help and I’am unable to give it. Dr. C: How about the little girl inside you, Ann-do you ever feel she is hurting herself? Ann: Yes, I know I am. Dr. C: In what way is that? Ann: My children-they should have had a chance to live like I’ve had. It seems like the way I’ve been going; I am not going to ever... Dr. C: Before when you were in therapy, you got some relief and yet you stopped. What was the reason that you stopped before we worked it through, Ann? Ann: The person who had broken my jaw came back in my life. It seemed like it was simpler to let him back in than try to fence him off every time-it was easier to give in than to fight and keep the restraining orders active. I just threw the towel in. Maybe I figured I deserved being abused because I deserved to be punished. Dr. C: Did you find our session painful, trying to deal with some of the material? Ann: Yes, but it needs to come out because I would rather block my feelings and pretend they do not exist and that does not work. SIS in Miscarriages 127

Dr. C: I hope that you sincerely work at the therapy and are willing to face some of the pain. What is your plan at this time? Ann: To remain sober and start doing things-becoming involved with groups where I alleviate some of the guilt and feel more self worth-feeling that I’m contributing something to society instead of just becoming a corpse. Dr. C: There is lots of hope, Ann, and thanks very much. Ann: Thank you. This is an overview of responses. It might be noted that the favorite image she selected was 31B. She saw this as a “family engulfed in sadness”. What appealed to her was the idea of a family. The fact that she projects her depression directly into the affective associations is significant. In reviewing the images that she found most threatening, first of all, there was 1 OA. Her response shows clear identification with this image-really, she sees herself and the video as a mirror of her own sadness and pain. With individuals who have poor ego boundaries, such as borderlines, this type of intensive identification is not uncommon. The second most threatening image was 26A. She, in her associations, recalled the series of miscarriage traumas that she had, starting in adolescence. This theme continues with 15A and also throughout the SIS series. In the detailed interview of other responses, it is clear that there is a recurrent theme in terms of her past abusive relationships with males. There is also a focusing on diseased body parts or pathologic anatomy, in association with her fears that her body had seen severely damaged by alcohol. Her response to 25A has some specific significance in terms of her sexuality. It is evident that even when she was giving associations to this in the detailed inquiry, that content related to sexuality did not emerge. Only when the interpretation was made that “some people see sexual material here” could she process this in consciousness. At this time in the interview, she became more anxious and defensive. She then went on to speak about how, for her, sexual intercourse was not especially fulfilling, nor did she ever achieve orgasms. It is quite understandable how the repression of the SIS content in 25A depicting external genitalia could be associated with repression of genital sexual sensations during intercourse. She was referred to a female psychotherapist to process this material. 128 Cassell & Dubey

SIS J. Proj. Pst. & Ment Health (1996) 3:2 129-132 Lt Col. Suparkash Chaudhary, M.D. Ph.D. Psychiatrist, Military Hospital, Meerut-250001. Lt. S.G. Jyothi, D.P.N., Specialist Sister (Psychiatry), Military Hospital, Merit – 250001. Relationship Between Homosexuality And Paranoid Schizophrenia – Rorschach Study S. Chaudhary and S. G. Jyothi The Rorschach test Klopfer’s method was administered to thirty matched pairs of paranoid and non-paranoid schizophrenia patients. Records of paranoid schizophrenia patients contained significantly greater number of Wheeler’s homosexual signs as compared to those of nonparanoid schizophrenia patients However, complete absence f homosexual signs in the records of on paranoid schizophrenic patients was observed. Implications of the findings to the psychoanalytic theory of paranoid delusions are discussed. Freud proposed a relationship between the delusions of persecution of paranoids and homosexuality or conflicts over homosexual wishes after the analysis of Schrader’s autobiography. He beloved that the defense against homosexual yearning consisted of denying them and projecting them into the environment in the from of delusions of persecution. The patient is persuaded by his own homosexual fantasies and constructs his own notions of persecution. Love is transformed into hatred (Freud, 1984) Freud’s theories thought widely known, remain controversial due to the lack of objective evidence. On the basis of their own studies some authors have strongly supported Freud’s doctrine (Aronson, 1952; Zamansky, 1958; Zeichner, 1955), while others vehemently rejected it (Graver, 1952; Plananski & Johnston, 1962). A third group believes that while homosexual conflicts are present in some patients, nonsexual factor are important in others (Bhaskaran, 1963; Klein & Horwitz, 1949; Miller, 1941). Based on the writings of Bergmann (1945), Due and Wright (1945) and lindner (1945), as well as general clinical experience, wheeler (1949) compiled a list of 20 signs presumably indicative of homosexuality. The signs are based on the content of the response; some of the scored responses must be given to specific blot areas (Signs 1-14) but others may occur anywhere in the record (Sign 15-20). In the search for objective evidence to resolve the controversy regarding the roe of homosexuality in the development of persecutor delusions, few works have utilized the Rorsch homosexual signs proposed by Wheeler. While Aronson (1952) and Mujtaba & Mujtaba (1985) supported Freud’s contradictory, Graver (1954) reported opposite findings. In view of the contradictor resists, the present study was undertaken to determine whether the Rorschach records of patients with paranoid schizophrenia contain evidence of high degree of homosexuality as compared to those of no paranoid schizophrenia.

130 Chaudhary & Jyothi Material and Method: Thirty male in-patients with paranoid schizophrenia and an equal number of inpatients with no paranoid schizophrenia, matched with reference to age, sex (all male), area of domicile, education and socioeconomic status, were included in the study. Psychiatric diagnosis was made as per DSM IIIR criteria (APA 1987). All subject were free from physical illness. Subjects were in the age range of 18-49 years and educational levels ranging from illiterate to graduate. The Rorschach test was administered individual and scored by Klopfer’s method (Klopfer et al., 1954). The list of twenty Rorschach indices of homosexuality evolved by Wheeler (1949) was followed fore scoring of homosexuality. These signs of homosexuality have been extensively evaluated and found to have high reliability and validity (Davids et al., 1956; Gold friend et al 1971). The score went through the individual Rorschach protocols of both group and marked the presence or absence of each sign and recorded the total number of homosexual signs in each protocol. Statistical comparisons were done by the Median test. Results: The mean age of the paranoid schizophrenia patients was 30.03 years (range 18-49 years) while the mean age of the no paranoid schizophrenia patients was 28.53 years (range 20-47 years). The number homosexual signs present in the Rorschach protocols of paranoid and no paranoid schizophrenia patients ranged from 2-19 and 0-12 respectively. Comparison of the homosexual scores in the two groups of patients showed that paranoid schizophrenia patties obtained significantly higher scores as compared to the no paranoid schizophrenia patients (Table 1). The frequency distribution of the signs of homosexuality in the two groups of patients is given in Table 2. Table 1 Comparison of Rorschach Homosexual Scores of Paranoid and No paranoid Schizophrenia Patients Group n Mean SD Median P (Chi-square Test) Paranoid 9.70 4.03 Schizophrenia 24.50 <0.01 No paranoid 3.63 2.89 Schizophrenia

A Rorschach Study 131 Table 2 Frequency Distribution of Rorschach homosexual Signs in Paranoid and No paranoid Schizophrenia Patients Number of paranoid No paranoid Homosexual Schizophrenia Schizophrenia Signs (n=30) (n=30) 0-2 3-5 6-8 9-11 12-14 15-17 18-20 Discussion: The major finding of our study is the significantly higher occurrence of Wheeler’s homosexual signs in the Rorschach protocols of paranoid schizophrenia patients as compared to those of no paranoid schizophrenia patients. Our results are in consonance with the finding of Aronson (1952) and Mujtaba & Mujtaba (1985) but not with Graver 1954). On the basis of these findings it can be stated that patients with paranoid schizophrenia digger significantly from those of no paranoid schizophrenia with respect to homosexuality as revealed by the Rorschach test. Further this finding, along with the earlier studies supports the Freudian doctrine of a positive relationship between homosexuality and paranoid schizophrenia. On the other hand, if Freud’s postulates universe applicable than the Rorschach homosexual signs should have been uniformly high in all the paranoid schizophrenia patients. However, it is evident from Table 2 that such is not the case. This indicated that in some patients nonsexual factors may be important in the development of persecutory delusions. We conclude from our study that while Freud’s theory of the relationship between homosexuality and persecutory delusions is true in some patients, factors other than homosexuality play the dominant role in the psychopathology of persecutory delusions in other patients.

132 Chaudhary & Jyothi References: American Psychiatrist Association (1987) Diagnostic and Statistical. Manual of Mental Disorders, ed 3 revised. Washington: APA. Aronson, M.L. (1952) a Study of the Freudian Theory of Paranoia by Means of the Rorschach Test. Journal of Projective Techniques, 16, 397-441. Bergman, M.S. (1945) Homosexuality on the Rorschach Test. Bulletin of the Meninger Clinic 9,78,83. Bhaskaran, K. (1963) A psychiatric Study of Paranoid Schizophrenia in Mental Hospital in India, Psychiatric Quarterly, 97, 334-351. Davids, A., Joelson, M. & McArthur, C. (1956) Rorschach and TAT Indices of Homosexuality in Overt Homosexuals, Neurotics and Normal Males. Journal of Abnormal and Social Psychology, 53, 161-172. Due, F.D. & Wright, M.E. (1945) The Use of Content Analysis in Rorschach Interpretation Differential Characteristics of Male Homosexuals. Rorschach Research Exchange, 9, 169-177. Freud, S. (1984) Case Histories-II. The Pelican Freud Library. Vol. 9. Hammondsport, Penguin Books. Goldfried, M.R. Stricker, G. & Weiner, I.B. (1971) Rorschach Handbook of Clinical & Research Applications. New Jersey: Prentice-Hall Inc. Graver, D. (1954) Homosexuality in Paranoid Schizophrenia as Revealed by Rorschach Test. Journal of Consulting Psychology, 18, 549-562. Klein, H.R. & W.A. (1949) Psychosexual Factors in Paranoid Phenomena. American Journal of Psychiatry, 105, 697-701. Klopfer, B., Ainsworth, M.D. Klopfer W.G. & Holt, R.R. (1954) Developments in the Rorschach Technique. Vol I. New York; World Book. Lindner, R.M. (1946) Content Analysis in Rorschach Work. Rorschach Research Exchange 10, 121-129. Miller, C.W. (1941) The Paranoid Syndrome. American Journal of Psychiatry 119, 743-747. Mujtaba, B. & Mujtaba, V. (1985) Homosexuality and Paranoid Schizophrenia Journal of Personality and Clinical Studies, 1, 27-29. Planansky, K. & Johnston, R. (1962) The Incidence and Relationship of Homosexual and Paranoid Features in Schizophrenia. Journal of Mental Science, 108, 604-615. Wheeler, U.M. (1949) An Analysis of Rorschach Indices of Male Homosexuality. Rorschach Research Exchange, 13, 97-126. Zamasky, H.S. (1958) An Investigation of the Psychoanalytic Theory of Paranoid Delusions.. Journal of Personality, 26, 410-425. Zeichner, A.M. (1955) Psychosexual Identification in Paranoid Schizophrenia, Journal of Projective Techniques, 19, 67-77.

SIS J. Proj. Pst. & Ment Health (1996) 3:2 133-140 Gopa Mitra, M.A. (Psy.), Research Scholar, Dept. of Psychology, Banaras Hindu University, Varanasi – 221005 (INDIA). Anjana Mukhopadhyay, Ph.D., Lecturer in Psychology, Mahila Maha Vidyalaya, Banaras Hindu University, Varanasi – 221005 (India). SIS and Social Anxiety – An Assessment of Personality Factors of Drug Addicts Gopa Mitra and Anjana Mukhopadhyay Forty adult male opiate drug addicts were sampled into three subcategories namely, Heroin (N=19), Brown Sugar (N=12), Tidies (N=9) groups. The social anxiety level of the clinical samples was measured in terms of social avoidance and distress (SAD) and fear of negative evaluation (FNE). SIS-I measured the pathological personality components of the drug addicts. Rest of the qualitative components analyzed the significance of the result obtained by objective measure. Results revealed that the three groups significantly differ in SAD (p<. 01) and FNE (p<. 05) of social anxiety scale. Tidies group reported highest score in social anxiety and distress and lowest score in fear of negative evaluative and the lowest in social avoidance and distress. SIS pathological indices do not differentiate the groups. Qualitative components are also reporting a predominance of specified components such as anatomical responses (At), atypical responses (Aty) and human responses (HR). This suggests an uniformity in personality components among opiate addicts which may be termed as the drug dependency traits. An increasing surrender to drug addiction is posing challenge to Indian society and responsive personality traits require through expiration that compels one to become the victim of drug abuse. Research efforts are focused on identifying the personality characteristics and psychosocial variables related to the addicts. Studies are also available on the pharmacological effect on the body functions due to drug abuse, which develop psychological and psychopathic problems and result in physical dependence. Drug dependence was defined as a compulsion to take the drug on a continuous or periodic basis in order to experience psychic effects and sometimes to avoid discomfort in its absence (WHO, 1969). Last two decades have attempted to investigate the personality components of drug addicts, their typological clustering and symptomatic dominance. The great bulk of addicts are thought to be the products of psychological and social process. Sugar, et. al. (1978) observed that there is a close relationship between sensation seeking (High, medium, low) and personality dimension. Drug abusers were classified as high sensation seekers, reflected sociopath, attitudinal deviance and high tend activity and low measures indicating denial, hypochondriacally

134 Mitra & Mukhopdhaya preoccupation, hysteria and social introversion. Low sensation seekers on the other hand, appeared with higher elevations on measures of neurotic involvement, repression of four multiple drug clusters I which heroin and alcohol through used frequently were not found a part of the cluster. The multiple drug abusers were again identified into eight types in terms of quantitative and qualitative measures which were differentially related with the set of psychosocial factor. Caring and Olson (1990) reported that drug addicts who have attempted suicide were found maladjusted. The impairment found particularly due to depression, feelings of alienation, use of projection and externalization and an emotional withdrawal was also observed. Maqbool and Hussain (1993) reported higher death sensitivity among smack addicts than the alcoholics. In the correlation study of drug use and parameters of moral character, namely, socialization and empathy, Jurkovic (1979) found significant negative correlation beet drug use and socialization while empathy could not approach the level of significance in correlation measures. Taylor and Depillar (1992) evaluated that drug use and selfesteem were negatively correlated while a positive correlation was found with trait anxiety. Steer and Haslett (1982) examined the most salient syndromes for the substance abuse patients and found anxiety and paranoid ideation to be the focal symptoms. The present study aims to assess personality factors of the drug addicts and compare between he groups on the basis of social avoidance and distress and fear of negative evaluation factors of social anxiety. Methodology: Sample: The sample comprised of 40 male adult drug addicts (Mean age 27 yrs.) The selection criteria for the study sample had a minimum six moths adduction of drug. The categories of habitual drug addicts considered for the sample are heroin, brown sugar, and tidies abusers. The sample collected from the Drug de-addiction center, Vinauaka, Bhelupur, Varanasi. The admitted cases of the center, after one week’s treatment for de-addiction, were considered for the study so that a convenient communication is possible to have the reliable assessment of their personality. Tools: Somatic Inkblot Series (Cassell, 1980). This is a projective test. The first set of the series contains 20 inkblot images, printed in black, red, and gray. Three images are exclusively red and nine are achromatic. Images provided enough obvious anatomical structure to name the specific body part and helps in measuring four pathological indices such as pathological anatomy score (PAS), depression (D), hostility and aggression (HAS) and paranoia (P).

Social Evaluative Anxiety Scale (Sheikh, (989). This is an objective questionnaire consisting of 56 items. The items are to be assessed in the trued or false pattern. Results: Table 1 Mean and S.D. of the Three Drug Addict Groups for SIS Indices Heroin (N=19) Brown Sugar(N=12) Tidigesic (N=19) M S.D. M S.D. M S.D. PAS 10.68 18.91 11.17 16.50 5.33 4.72 D 5.63 9.67 3.50 6.18 4.00 7.83 HAS 5.95 10.17 5.50 6.12 3.78 2.93 P 1.95 4.00 2.442 11.88 1.67 2.20 The responses obtained for the SIS scale were scored in terms of intensity of the factors from 0 to 3. All the four personality components i.e., PAS, D, HAS and P rated as per the defined category, namely totally absent, mild, moderate and severe. The M- scores obtained for the three groups are recorded in Table 1. Consistently higher Mean PAS scores may be observed for all the three sub groups, Heroin addicts (N=19), Brown sugar (N=12) and Tidies abusers (N=9). This is also reflecting lowest M-Score in paranoid ideation uniformly for the clinical groups. Depression (D) and Hostility and aggression (HAS) score projecting the presence of moderate quantity and a consistency among the three groups may be seen. Table 2 Kruskal Wallis (H) One Way Analysis of Variance on SIS Indices Among Heroin, Brown sugar and Tidies group. Ramk Mean K. Wallis Level of H B.S. T (H) Significance PAS 21.26 22.13 16.78 1.37 N.S. D 23.26 19.92 15.44 2.77 N.S. HAS 21.24 21.25 17.94 0.55 N.S. P 24.34 18.54 15.00 4.38 N.S. The measurable indices of these components projecting the degree of pathology in response among the drug abusers. Table 2 reports Kruskal Wallis one way analysis of variance (H) for the components among the three clinical groups. ‘H’ contained for the SIS & Social Anxiety 135

components i.e. PAS, D, HAS and P are 1.37, 2.77, 0.55 and 4.38 respectively while are not statistically significant establishing the homos\genetic among the groups r that the sample are drawn from the sample population. Table 3 includes the Mean scores of social evaluative anxiety scale for the three clinical samples. Fear of negative evaluation (FNE), M scores is reflecting a higher trend than the M scores of social avoidance and distress (SAD) for all the samples. Table 3 Mean and S.D. of the Three Drug Addict Groups of Social Anxiety Measures. Heroin (N=19) Brown Sugar(N=12) Tidigesic (N=19) M S.D. M S.D. M S.D. SAD 13.58 5.18 14.83 5.13 15.78 8.17 FNE 20.63 7.68 16.83 7.91 16.33 4.18 Table 4 Krusak Wallis (H) One Way Analysis of Variance on Social Anxiety Measures Among Heroin, Brown Sugar & Tidigesic groups. Ramk Mean K. Wallis Level of H B.S. T (H) Significance SAD 18.74 22.29 26.78 16.85 0.01 FEN 25.34 16.92 15.06 6.34 0.05 Table 4 is providing the H scores for the two dimensions SAD and FNE which is 16.85 (p<.01) and 6.34 (p p<.05) respectively. The objective measures of SAD and FNE proves heterogeneity among the three groups. It may be observed that the tidigesic abusers are more conscious about social avoidance while heroin abusers are more conscious about The SIS responses of the three groups again categories into eight components, first three of which are divided into typical (T), atypical (Aty) and most typical (MT), next two are type t human (H.R.) and animal responses (A.R.) and the third section converse sex (S), anatomy (At), and Rejection (R). The responses scored this third section reports of the highest percentage in At. I.e. 25.18, 24.42 and 23.25 in the Heroin, Brown sugar and Tidigesic abusers respectively. Lowest response percentage among the groups may be observed in the rejection category (Table 5). 136 Mitra & Mukhopdhaya

Table 5 Total Response Score Scores and Percentage of SIS Indices of Heroin, Brown Sugar And Timid sic Heroin (N=19) Brown Sugar(N=12) Tidigesic (N=19) Total % Total % Total % T 13.17 12.46 14.69 Aty 22.76 22.59 22.15 MT 4.43 5.32 4.17 H.R. 16.65 45.61 12.50 A.R. 7.48 8.47 13.16 Sex 8.01 8.97 8.99 At 25.18 24.42 23.25 R 2.32 2.16 1.10 A consistency in response percentage may be observed among the groups for the T, Aty and MT responses of while all the groups are scoring highest percentage in Aty category and lowest percentage in MT category. The response pattern is showing highest trend in H.R. for the Heroin group while A.R. is providing the highest response percentage for the Tidigesic group. Table 6 Inter Groups Comparison of SIS Indices (Chi-Square) Heroin Brown SugarHeroin Vs. Vs. Vs. Brown Sugar Tidigesic Tidigesic Typical (T) 1.05 0.58 0.01 Atypical (Aty) 0.34 0.15 0.05 Most Typical (MT) 2.82 0.58 0.49 Human Responses (HR) 0.02 0.06 0.02 Animal Responses (AR) 0.02 0.49 Sex (S) 0.07 0.15 0.03 Anatomy (At) 0.19 0.06 0.01 Rejection ® 0.24 3.71 5.30 Results “Not Significant. SIS & Social Anxiety 137

The x2 reported between all the possible combinations of the three groups for the components are not showing the statistical significance (Table 6). This suggests that the groups are drawn from the same population or the response measures for all such clinically addict samples projecting a similar pattern. Discussion: The results obtained through objective measures reflecting the trait dominance of social anxiety and distress (SAD) among heroin group and fear of negative evaluation (FEN) in the tidigesic group. The tidigesic groups who are habituated in opiate analgesic drugs are socially anxious, feel discomfort in society and want social approval. Observations and enquiry from the addicts have revealed that they developed tidigesic habituation in an attempt to deadest heroin or opiates. This promotes their trend of social anxiety and of addiction dependence in their personality trait. To substantiate the results, obtained projective test result is showing that tidigesic group scores low on depression scale than PAS and HAS which may be covert depression for social situation. It is also found that people who are high in fear of negative evaluation are more likely to experience social anxiety that people who are low in fear of negative evaluation (Leary, 1980; Watson and friend, 1969). Drug addicts may be anxious with personal health. Their responses are projected in which the body appeared as diseased (PAS). These are usually related to specific regions and the body anxiety can be appraised by evaluation the qualitative nature of the somatic material projected (De Vos, 1952). Heroin addicts appeared to be highly anxious with their body, which is projected, in their high PAS score. Subjects who depression is concealed usually deny their feelings, may be termed as astute of ‘masked depression’ (Keilholz, 1974). Quite frequently these persons are preoccupied with the body in a hypochondriacally manner and project anatomical responses which is likely to be pathological. Heroin addicts projected high depression score than Brown Sugar. PAS measures have been proved higher in Brown Sugar addict’s ad Heroin addicts. Aggression has been found to be a reaction commonly triggered by frustration. Physical, psychological or social barriers may frustrate the aggression itself. Frustrated people may project their frustration by hostility. Needs, frustration, conflict, anxiety, defense mechanisms and self-concepts are related to each other in an endless sequence of dynamic interactions for the human personality in complex fluid system. Uniformity in HAS score may be seen for all the drug addict groups. Brown sugar group who have sown a stable higher FNE than SAD are also been conserved with a similar traits of high PAS and low rejection (R) in terms of projective technique. 138 Mitra & Mukhopdhaya

The high percentage of anatomy (At) response among those three groups suggests that the drug addicts are body conscious. Somatic awareness transiently increases in states of hunger, physical exertion emotional arousal and sexual excitement. Subsequently the mental representation in the body fades into background of consciousness (Cassell, 1980). The reaction percentages for typical and human responses are also high among the three groups. Higher percentage of atypical responses as in found in schizophrenia compared to neurotics and normal (Dubey, 1995) supports a similar trend in clinical diagnosed drug addicts. Of the three clinical categories, heroin group responded more percentage for human responses (H.R.) and tidigesic group responded low percentage for the same. Low percentage of human responses indicates failure to identify with others. A reverse pattern may be seen for the animal responses where tidigesic group score high percentage. More animal responses might be indicative of frustration, hostility and primitive behavior. It is also indicative of low socialization (Dubey, 1982). The tidigesic injection abusers sampled for this study have a background of other drugs. In an attempt of dead diction they are now addicted to buprenorphin, nonprime/ indigotic injections. This indicates that their emotional state has not been disciplined and an attempt to control the addiction they subjected the drug. The personality make up of addiction dependency focusing the underlying components. As all the three groups are not conforming normality the projection may be seen in low percentage of most typical responses are researchers suggest that normal subjects perceive more of popular concepts than clinical subjects. Typical responses are those commonly perceived responses by normal subjects (Rathee et. al., 1994). All the groups score lower percentage for typical responses. Studies suggest that clinical case did not perceive the usual sex components projected through SIS images (Rathee, et. al., 1995). Present study also reports of low [percentage of sex content. Out of various content categories perceived, no significant differences achieved between sugar and tidigesic addiction cases have an uniformity in personality component which maul be termed as the drug dependency trait. The social anxiety develops as a consequence of addiction when the flexibility in trait pattern is overlooked in the course of treatment. De-addiction needs medical as ell as psychological counseling to avoid a relapse and control the menace. References:s Braucht, G.N., Kirley, M.W., & Berry, G.J. (1978) Psychological Correlates of empirical Typical of Multiple Drug Abusers. Journal of Consulting & Clinical Psychology, 46, 1463-1475. Cassell, W.A. (1980) Body Symbolism and Somatic Inkblot Series, Aurora Publishing Co. Anchorage, Alaska. SIS & Social Anxiety 139

Craig, R.J. and Olson, R.E. (1990) MMPI Characteristics of Drug Abuse With and Without Histories of Suicide Attempts Journal of Personality assessment, 55, 717-728. Devos, G. (1952) A Quantitative Approach to Affective Symbolism in Rorschach Responses. Journal of Projective Technique and Personality Assessment 36, 133-150. Dubey, B.L. (1982) A pragmatic View of Rorschach Inkblot Technique. National Psychological Corporation, Agra. Dubey, B.L. Casell, W.A. Pershad D., and Dwivedi, P (1995) Diagnostic Utility of Somatic Inkblot SerieS. SIS Journal of Projective Psychology and Mental Health, 2, 77-84. Jukovic, G.J. (1979) Dimensional of Moral Character and Drug Use Among Rural High School Student, Journal of Clinical Psychology, 35, 894-896. Kielholz, P. (1974) Opening Address In P. Kielholz. Depression in Everyday Practice. Viena Austria, Hans Haber. Leary, M.R. (1980) The Social Psychology of Shyness, Testing a Self Presentation Model. Doctoral Dissertation, University of Florida. Maqbool, S., and Hussain, A. (1993) Defeat Sensitivity Among Drug Addicts. Journal of the Indian Academy of Applied Psychology, 19, 53-56. Rathee, S.P. Goel, D.S. Chawls, M. Laladnha, D., and Dubey B.L. (1994) A Study of Somatic Inkblot Series-I in Coronary Cases. SIS Journal of Projective Psychology and Mental Health, 1, 51-64. Rathee, S.P. Pande V., and Singh A (1995) Diagnostic Efficacy of Somatic Inkblot Series-II Among Psychiatric Patients of Armed Forces: A Preliminary Study. SIS Journal of Projective Psychology and Mental Health, 2, 61-66. Sheikh, K. (1989) Behavioural Analysis and Treatment of Stage-freight in Orthopaedicaly Handicapped Youth. Doctoral Thesis (Unpublished), Danaras Hindu University. Steer, R.A. and Hassett, T. (1982) Contributions of Individual Syndromes to Global Psychopathology Ratings of Mental Health and Substance Abuse Patients. Journal of Clinical Psychology, 38, 448-451. Sutkar, P.B. Archar, R.P., and Allain, A.N. (1978) drug Abuse Patterns, Personality Characteristic and Relationship with Sex, Race and Sensation Seeking. Journal of Consulting and Clinical Psychology, 46, 1374-1378. Taylor, D.N., and Depillar, J. (1992) Self –Esteem, Anxiety, and Drug use. Psychological Reports, 71, 896-898. Watson, D., and Friend, R. (1969) Measurement of Social-evaluative Anxiety. Journal of Consulting and Clinical Psychology, 33 448-459. World Health Organization (1969) Technical Report Series No. 47,Who Expert Committee on Drug Dependence Sixteenth Report, Geneva. 140 Mitra & Mukhopdhaya

SIS J. Proj. Pst. & Ment Health (1996) 3:2 141-144 Amol Rajan Singh, Ph.D., M.M. & S.P., Consultant Clinical Psychologist, Samvedna Clinic S-325, Greater Kailash-II, New Delhi. K.R., Banerjee, DPM, Former Prof. Of Psychiatry, Institute of Aviation Medicine Bangalore. Efficacy of SIS-II in Discriminating O.C.D. Patients and Normal Amool R. Singh & K.R. Banerjee In the present investigation SIS-II was administered on 38 O.C.D. patients in order to study the response patterns on chosen variables. The results suggested that SIS-II could be a useful psycho diagnostic tool in clinical set up. Further studies are justified and will be reported in due course of time. SIS is the latest development in the inkblot techniques which was conceived in 1959 by Cassell and since then lots of work had been carried out by various researchers in different parts of the world (Cassell 1965, 1980, 1980a, 1984, 1987, 1988, 1989, 1990, 1994, 1995, Dubey et al 1991, 1994, 1995, Dwivedi et al 1992, 1994, Pershad et al 1994, 1995, Verma et al 1994, 1995, Gateman et al 1995, Bellamy 1995, etc.) Somatic inkblot series-II (SIS-II) was developed in 1980.It is a paper self test booklet, consisting of series A and B each with 31 images (total 62 images). SIS-II can be used in a variety of ways, but was designed for self-administration. None of the other existing inkblot tests are designed to be self-administered. The SIS-II has been found to discriminate different clinical groups (psychotic, Neurotics, and their subtypes) from normal subjects (Cassell 1980, Verma et al 1994, 1995, Dubey et al. 1995). Continuing the same theme, the present study was undertaken to find out the efficacy of SIS-II in discriminating OCD (Obsessive Compulsive Disorder) patients from normal subjects. Objective: 1. To study the response patterns of O.C.D. patients on chosen variables of SIS-II. 2. To compare their score with norms developed earlier by Dubey et. al (1995). Material and Methods: Sample: Thirty-eight consecutive adult case of obsessive-compulsive disorder, diagnosed as per I.C.D. 10 criteria by qualified psychiatrists practicing in Delhi constituted the sample. The duration of illness varied from 6 months to 10 years.

142 Singh & Banerjee All the patients had undergone at least 10 years of schooling. The sample consisted of 15 females and 32 males and all were adult volunteers in the age range of 19 years to 32 years Procedures: After establishing satisfactory level of report with the patients and taking informed consent from them, the SIS-II was administered individually to each subjects following standard procedures (Cassell 1990). The protocols were analyzed for nine SIS variables viz; Total number of responses (R), rejection of images, Sex, Movement, Human, Animal, Anatomical, Most Typical and Atypical responses. The means and S.D.s. were calculated for each indices, separately. Only descriptive statistics has been used here. Results and Discussion: None of the patients approached, refused to take the test. The O.C.D. group was compared with the norms as reported by Dubey et al (1995) for normal population. Table 1 Comparison of SIS-II Indices of Normal and O.C.D. Subjects SIS Normal Subjects O.C.D. Cases Remarks Abbot the Indices (n-100) n-38) Direction of Differences Dubey et al (1995)Present Study Total R M 74.08 78.02 Higher in OCD S.D. 12.40 12.56 Movement R M 9.60 15.50 High in OCD S.D. 5.33 6.23 Animal R M 14.666 19.85 High in OCD S.D. 4.69 4.35 Anat. R M 9.18 12.30 High in OCD S.D. 4/24 4/21 Sex R M 4.12 3.85 Lower in OCD S.D. 2.58 3.10 Rej.of images M 0.82 0.52 Lower in OCD S.D. 2.00 2.50 M T Res. M 13.68 14.38 High in OCD S.D. 1.98 2.15 Atypical R M - 1.50 High in OCD S.D. - 0.50 M: Mean, SD: Standard Deviation

Efficancy of SIS-II 143 From Table 1 it is clear that O.C.D. patients have obtained higher means on most of the SIS-II indices e.g. Total responses, Movement, Human, Animal Anatomical, Most Typical responses and Atypical than normal subjects. On the other to indices viz Sex responses and Rejection of images, scores were higher in the normal subjects than the OCD patients. The results obtained are in conformity with those reported earlier on Neurotic groups (Dubey et al 1995). Only the descriptive statistics is used as the two groups were from different strata. Further studies, on a large sample are needed to confirm the findings. Conclusion: From the present study it is clear that SIS-II could be a promising tool in discriminating OCD patients on a selected SIS variables. As our OCD sample was comparatively small, clearer picture is likely to emerge when a larger number of patients are included in the study. Further work is justified; it is in fact going on and shall be reported in due course of time. References: Bellamy E.N. (1995) Hospitalized Suicidal Patients and the Somatic Video Procedure. A Descriptive Study. SIS-Journal of Proj. & Mental Health , 2 (1), 85-91. Cassell, W.A. (1965) Body Symbolism and Somatic Localization. Psychosomatic Medicine, 27, 171-176. Cassell, W.A. (1980) Body Symbolism and Somatic Inkblot Series, Aurora Publishing Co. Anchorage, Alaska. Cassell, W.A. (1980a) Somatic Inkblot series-II, Aurora Publishing Co. Anchorage. Cassell, W.A. (1984) Computerized Projective Testing as an AID in Medical Diagnosis. Alaska Medicine, 26, 1-9. Cassell, W.A. (1987) The SIS-Video Version Paper Presented to Society for Personality Assessment. New Orleans, Louisiana. Cassell, W.A. (1988) Validity Study of the SIS-II Booklet in Pregnant and Non-pregnant women. Paper Presented in International Congress of Psychology, Sydney, Australia. Cassell, W.A. (1989) Therapeutic Applications of the SIS. Paper Presented to Society for Persobality Assessment, New York. Cassell. W.A. (1990) Somatic Inkblot Test-II Manual. SIS Center, Anchorage, Alaska CasselL, W.A. (1994) The Somatic Inkblot Series: Continuing Rorschach Conceptualization. SIS j. Proj. Psy. & Mental Health, 1, 3-14.

144 Singh& Banerjee Cassell, W.A.,Dubey, B.L. and Pershad, (1995) Manual of Somatic Inkblot Series-II, SIS Center, Anchorage, Alaska. Dwivedi, P., Dubey B.L. and Cassell, W.A. (1994) Somatic Inkblot Series-Video in Adolescents 50th Conference f International Council of Psychologists, Amsterdam. Dwivedi, P., Mishra, M. and Cassell W.A. (1994) Somatic Inkblot Series –Video in Adolescents. SISJ. Proj & Mental Health 1, 27-32. Dubey, B.L. and Cassell, W.A., Pershad, D. and Dwivedi, P. (1995) Diagnostic Utility of Somatic Inblot Series. SIS J. Proj. Psy. & Mental Helalth, 2 (1), 77-84. Dubey, B.L., Mishra, M., Dwivedi, C.B. and Mishra, N. (1994) Diagnostic and Therapeutic Utility of Somatic Inkblot Series-II and Rorschach. SIS Journal Proj. Psy. & Mental Health, (1), 19-26. Gaetani, G., Fiorenzo. L., Alfio, L. and Giovanni, S. (1995) Corporal Perception in HIV Positive and Hematite Heroin Addicts Assessed with Somatic Inkblot Series-I. SIS Journal Proj. Psy. & Mental Health, 2 (2), 97-118. Pershad, D. and Dubey, B.L. (1994) Reliability and Validity of Somatic Inkblot Series in India. SIS J.Proj. Psy. & Mental Health (1), 33-38. Pershad, D. and Verma, S.K. (1995) Diagnostic Significance of Content Analysis of SIS-II.SIS Journal Proj. Psy. & Mental Health, 2 (2), 139-144. Verma, S.K., Pershad, D., Kaur, R. and Nehra, R. (1995) Diagnostic Significance of SIS-II. SIS Journal Proj. Psy. & Mental Health, 2 (1) 72-76. Verma, S.K., Pershad, D., and Nehra R. (1994) Cross Validation of SIS-II in Psychiatric Population. SIS Journal Proj. Psy. & Mental Health, 1 (1), 15-18

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH is a refereed journal and published twice a year (January, July) by the SOMATIC INKBLOT SOCIETY and is devoted to the advancement of research in the areas of projective psychology, personality assessment, psychotherapy and mental health. The journal is broadly concerned with the development of inkblot tests and personality assessment in clinical, counseling, cross-cultural, organizational and health psychology settings. It aims to reach clinical psychologists, psychotherapists, psychiatrists, social workers, medical professionals and professional managers interested in the understanding and modification of human behaviour. The journal includes (a) research articles (b) book reviews (c) brief reports (d) news about conferences etc. and letters to the editor. MANUSCRIPTS PREPARATION: Manuscripts should be typewritten (doublespaced throughout) submitted through E-mail or in CD to B.L. Dubey, Ph.D. Editor Emeritus, SIS Journal, E-mail:sisdubey@rediffmail.com. or sisdubey@yahoomail.com with a copy to Amool Ranjan Singh, Ph.D. Editor In Chief and Head of Clinical Psychology,RINPAS,Kanke,Ranchi-834006. E-mail:dr_amool_r_singh@rediffmail.com. The Editors reserve the right to refuse manuscript submitted and to make minor additions/deletions. Authors should prepare their manuscripts according to the Journal of Personality Assessment/ SIS Journal of Projective Psychology & Mental Health. SUBSCRIPTION: The journal is free to members of the Society, Annual membership fees are US $40 for foreign members and Rs. 300, for Indian members, Institutional subscriptions are US $60. for Foreign institutions and Rs. 600 for Indian institutions. Life membership is US $300. for foreign members and Rs. 2500/- for Indian members. Non-members may subscribe for $30 or Rs. 200 per issue. Cheques should be made payable to "SIS Journal of Projective Psychology and Mental Health" and should reach Amool Ranjan Singh, Ph.D. Editor In Chief. Members in foreign countries should send the cheque to B.L. Dubey, Ph.D. Editor Emeritus, 4406 Forest Road, Anchorage, AK-99517 (USA) Please add $5./Rs.60/- if you are sending subscription through cheque. CHANGE OF ADDRESS. Society / journal members should inform B.L. Dubey Ph.D, Director SIS Center, Email : sisdubey@rediffmail.com Copyright @ 1994. SOMATIC INKBLOT CENTER, India/Anchorage U.S.A. Website: http://www.somaticinkblots.com

Abstracted in “APA’s Psychological Abstract” Regd. No. 71632/99, RNI Delhi EDITORIAL CONSULTANTS SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH (OFFICIAL JOURNAL OF SOMATIC INKBLOT SOCIETY) EDITOR-IN-CHIEF : Bankey L. Dubey, Ph.D., Director SIS Center, 4406 Forest Road, Anchorage, AK 99517 (USA) E-mail: sisdubey@rediffmail.com : Wilfred A. Cassell, MD, Director, SIS Center, 4501E, 104th Ave. Anchorage, AK 99516 (USA). E-Mail: siscassell@yahoo.com EDITORS : Amool Ranjan Singh, Ph.D. Prof. & Head, Dept. of Clinical Psychology, RINPAS,Kanke,Ranchi-834006. Tel.:91-651-2233687 E-mail:dr_amool_r_singh@rediffmail.com : S. Chaudhury, MD, Ph.D., Prof. Dept. of Psychiatry, RINPAS, Kanke,Ranchi-834006.Mob.:91-9371019351 E-mail : suprakashch@hotmail.com : Prakash Chandran,Ph.D. Dhanya Nursing Home, Palarivattom, Edappally P.O. Kochin-682024 (India) Mob.: 91-9847039971 Email: prakasharackal@rediffmail.com : Anand Dubey,B.E., MBA, SIS Center, 4406 Forest Road, Anchorage, AK 99517 (USA) E-Mail: anand.dubey@gmail.com : Padma Dwivedi, M.A., 1671, Sector 49-B, Pushpak Society, Chandigarh 160 047 (India) : L. Sam Manickam, Ph.D. Prof. Dept. of Cl.Psy., SRMC and RI, Porur, Chennai-600116 (India) Tel: 91-044-24765512, Cell:91-9447009032 E-mail : sammanickam@sify.com : Rakesh Pandey, Ph.D. Reader, Dept. of Psy., M.G.Kashi Vidya Peeth, Varanasi-221001. Tel.: 91-542-2318246 E-mail : rpan_in@yahoo.com : Tamera Randolph, PO Box 244045, Anchorage, AK 99524 (USA) E-mail: tamerarandolph@hotmail.com John Baby, Ph.D., India Philip W. Baker, Ed.D., U.S.A. Mahesh Bhargava, Ph.D., India T.K. Chakraborty, M.D., India Carina Coulacoglou, Ph.D., Greece Philip Greenway, Ph.D, Australia K.V. Kaliappan, Ph.D., India Arvind Keshary, Ph.D, India Anatoly B. Khromov, Russia R. Kumar, Ph.D. India Sudhir Kumar, M.D. India Lisa Milne, Ph.D., Australia David Miller, Ph.D., U.S.A. Mridula Mishra, Ph.D., India Nalini Mishra, Ph.D., India Paola Nicolini, M.A., Italy Paul E. Panek, Ph.D., U.S.A. Edward M. Petrosky, Ph.D., U.S.A. Marisa Porecca, Ph.D., Italy C.S. Rao, Ph.D., India Stefano Reschini, M.A, Italy Barry A. Ritzler, Ph.D., U.S.A. D. Saldanha, M.D., India Archana Singh, M.A., India M.P. Singh, Ph.D., India R.N. Singh, Ph.D., India Umed Singh, Ph.D.India David Sperbeck, Ph.D., U.S.A. Ajay K.Srivastava, Ph.D., India Ramjee Srivastava, Ph.D., India Ailo Uhinki, Ps.D., Finland Yasho V. Verma, Ph.D., India