SIS Journal of Projective Psychology & Mental Health

JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH The Official Publication of the Somatic Inkblot Society Volume 4 Number 1 July 1997 SIS ISSN 0971 - 6610 Vol. 4, No. 1, Pgs. 1-78 SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH 1997

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 4, Number 2, July 1997 Contents Page Nos. 1. Editorial : SWilfred A. Cassell 87-88 2. Medical, Psychological and Spiritual Application of the 89-110 SIS Inkblots Wilfred A. Cassell, Bankey L. Dubey and Gilbert J. Roth 3. Improvement of Psychosomatic Disorders among Tension 111-118 Headache Subjects Usng Behaviour Therapy and Somatic Inkblot Series S. Gayatri Devi And K.V. Kaliappan 4. Content Scale Based Diagostic Compatibility of the SIS-II with 119-137 Rorschach Test in Normal, Neurotics and Schizophrenics Mridula Mishra C.B. Dwivedi 5. Prognostic Utility of Somatic Inkblot Series-II 138-141 Amool R. Singh, B.L.Dubey and K.R. Banerjee 6. Recondition of Psychological Problems in Patients Suffering 142-148 from Speech Defects with the Help of SIS-II AshimaNehra, M. Raghunathan,S.K. Verma ad S..S. Mann 7. How a Single Image of SIS-II Leads to Complete 149-151 Psycho diagnosis N.L. Dosajh 8. Sex Differences in Personality Dynamics of Extremely 152-157 Prolonged Derived Adolescents Mahesh Bhargava and Anju Sexena 9. Psychological Profile of Patients with Alopecia Areata 158-163 Vinod K. Sharma, B.L. Dubey, S. Muralidharan and Bhushan Kumar Somatised Pain : A Case Study with The Help of SIS-II 164-168 Manidra Pal Singh and Padma Dwivedi

SIS J. Proj. Pst. & Ment Health (1997) 4: 87 Editorial It is with great sadness that write this editorial. This particular journal is dedicated to the spirit of Professor Seymour Fisher who died suddenly on December 5th in Syracuse. New York. During his lifetime. He was one of the great leaders in American psychology. He was an outstanding scientist and scholar. He was a wonderful human being who truly cared about human suffering. At the time of his physical departure from this world, he was actively researching what he perceived as an excessive use of psychopharmacologic during in children. During my intellectually formative years – while at Syracuse-he was a most important father figure. Research work with him on the significance of anatomical Rorschach responses ultimately stimulated me towards designing the somatic inkblots. After I moved away in 1966, over the years, he continued to give me support and encouragement. For example, he worth n 1980 a positive review for the twenty card form of the SIS which is published on the back cover of the book “Body Symbolism”. Even thought we will never speak again, I feel spiritually connected to his energy. The forces that I derived from the stimulating conversations continue to motivate me. A few weeks before he died, during our last telephone conversation, he spoke about our sharing a mutual “lust for knowledge”. He encouraged creative research in a society where scientists struggle financially, while obscenely enough in a society where scientists struggle financially, while obscenely enough, internet astrologers and national sport figures collect fortunes. He will always be a role model and a personal hero. Please contact me and I will send you a bibliography of his extensive publications so that you share in the intellectual feast. Wilfred A. Cassell, M.D., FAPA, APC Director Somatic Inkblot Center 4105, Tubor Center Drive Space – B6, Anchorage, Alaska – 99508 (U.S.A.)

Professional Quality VHS Videotapes (specify NTSC, PAL or SECAM), as well as Audio Tapes and Transcripts of Interviews are Available for Teaching/Clinical Purpose. Police case--"Witnessing an Accident" Vietnam Veteran -- "Unresolved Guilt" Therapeutic Dream Stimulation Anniversary Reaction to Miscarriage Grieving a Still Birth : Conversion Reaction Fear of Cancer and Hypochondriasis (includes Rorschach imagery) Alcohol and Cocaine Depended : Father/Son Incest : Tee-age Alaska Native's Death by Gas Inhalation Suicide Behaviour in Adolescent Alaska Native Nightmare Vision (Sexually Abused Adolescent Girl and Absence of Father Figures in Black Adolescent Boy) Auschwitz Revisited Neuropsychological Reactions to Life Threatening Accident & SIS Occupational Stress and the SIS The use of the SIS as an Aide in Meditation while Grieving a Miscarriage SIS-Video (A&B Series), SIS-II Images in CD, SIS-I Videotape and SIS-Living Images A Walk Through The Garden of Life and many more, Audio & Videotapes SIS Journal of Projective Psychology & Mental Health in C D (Acrobat and Page Maker) from Volume 1-13 Contact : SIS Center, 4501 E, 104th Ave, Anchorage, Alaska-99516 (USA) E-mail : siscassell@yahoo.com OR sisdubey@rediffmail.com Web Site : http://www.somaticinkblots.com for getting the above material

Medical, Psychological and Spiritual Application of the SIS Inkblots Wilfred A. Cassell, Bankey L. Dubey and Gilbert J. Roth Shortly after world war II, investigators began to study the interaction between psychological and physiological process in health and disease. More recently, there has been consideration into assessing the impact of spirituality on this complex interact ional system. This presentation outlines how the Somatic Inkblot Series (SIS) may be used in this type of investigation. It employs as phenomenological approach with outlines of case histories to illustrate how what is projected onto the SIS inkblots relates to the stream of consciousness associated with the highly personal imagery of dreams, hallucinations and religious experience. “There is a strong possibility that the evolutionary characteristics that are enfolded into and define our society may continue to be marginalized. Bottom line/ fiscal/ capitalization models for managing human difficulties will overshadow our biopsychological model unless we continuer to care very deeply about it” (Theodore Nadelson, 1996). With the exception of pastoral counselors, few professional in the United Satiates are skill in corpora ting religious teachings in caring for those who have a strong concept of the healing power of spirituality, although the work of Herbert Benson and other may be changing the situation (Benson, 1996, Session, 1997). Projective techniques in are- sand tray therapy, native dance rituals and the symbolization of poetry, which have long been used therapeutically – naturally lead to the spiritual dimension. However, only a few professionals are skilled with theist approaches. Hence, there is a need for training members of the healing arts and sciences both in the spiritual realm and in the symbolic. New technologies of video and computer therapies make this even more essential as we rapidly approach the twenty first century. When modern electronic visual imagery is employed as a triggering stimulus rather than words as in a traditional medical interviews, the expression of the subjective experience of illness and spiritual forces if a healing nature can occur at a deeper level of consciousness. The release of this material can have both diagnostic and therapeutic and therapeutic significance when combined with procedures of modern medical science. This presentation outlines a new visual technique called the Somatic Inkblot Series (SIS). Wilfred A. Cassell, M.D., FAPA, APC, Director, Somatic Inkblot Center, 4105,Tubor Center Drive, Space B-6, Anchorage, AK- 99508 (USA). Banke L. Dubey, Ph,D. DMSP, FIACP, Director, Somatic Inkblot Center (India), P.O. Box 1107, Sector 15 P.O., Chandigarh – 160015 (India) Gilbert J. Roth, D, Min, Pastoral Therapist, 62, Timmerman Drive, Richland, WA 99352 (USA) SIS J. Proj. Pst. & Ment Health (1997) 4: 89-110

Health professionals interested in training need not have formal credentials in psychology. While a background with any of the existing projective therapies facilitates the learning process, it is not essential. The SIS represents structured interviewing with what were originally referred to as somatic inkblots because of their high degree of anatomical resemblance. With the addition of new stimuli and modern forms of electronic presentation, these now range from those comparable in their vagueness to the Rorschach at one extreme to those at the opposite pole resembling pictures in the Thematic Apperception Test. The SIS was originally conceived in 1959 in a medical research setting at the upstate Medical Center in Syracuse, New York during a study of body image disturbances of women with hirsutism. This led to the investigation of how physical symptoms were subjectively experienced (Hollender & Cassell, 1972). To more effectively study body awareness, inkblots with a high degree of somatic structure were designed. Pathological, anatomical responses provided a scientific method for understanding the subjective experience of illness. (Cassell, 1965, 1972, 1980; Adamson et al, 1977). A number of investigators have employed the SIS in evaluating patients with medical conditions e.g. coronary artery disease (Cassell, 1984, Rathee et al, 1994) and AIDS (Gaetani et al, 1995). This projective procedure has also been employed in a number of psychiatric studies (Gaetani et al, 1995, Rathee et al, 1995, Mishra, 1996, Dwivedi et al, 1994, Cassell et al, 1996), including one involving the use of sodium pentothal (Saldanha & Dubey, 1995). It has also been shown to be useful in assessing the personality profiles of those suffering from chemical dependency problems (Singh et al, 1996,1997, Mukhopadhyay et al, 1996). A recently developed version of the SIS includes inkblots with structure resembling the traumatic events experienced by such addicted patients and their families. Apart from the above applications, there are also a number of psychological uses. After much field testing of new stimuli, non-anatomical ambiguous structure was added to the inkblot series in order to assess other issues of clinical and developmental significance. Examples follow: Image B5 depicts two people sitting down talking to each other. Much can be learned about how the patient views treatment - when for example it is suggested that the scene depict a doctor explaining about the use of antidepressant medication. Issues of future noncompliance may be identified, that may not have been evident through direct questioning.(e.g. “the man in the video would not follow the doctor’s advice”). In regard to the stimulation of images having spiritual connotations, there are also a number of applications. For example, in working with Christians, Image A3 can evoke imagery of Jesus on the cross. In terms of negative spirituality, which has been shown to be detrimental to health, other inkblots can stimulate awareness of satanic imagery. An example of one inkblot that can evoke trust 90 Cassell et al.

and the ability to engage in psychological intimacy during nurturing medical and nursing care is image B28, which portrays “a loving mother hugging a child”. A patient, who fails to detect this embedded material, may be highly dependent and difficult to manage in a treatment setting. There may be an unconscious desire to retain the sick role in order to obtain nurturing which was never received in childhood. There are many other applications, which will be subsequently reviewed. Professionals with a variety of theoretical backgrounds have been trained in this approach. In analyzing responses, while psychometric indices are available, interpretation in most clinical setting largely relies on content analysis. The diagnostician can learn much by assuming that the projected material relates either directly or symbolically to the viewer or a loved one. Sometimes what is not seen in the embedded structure for a particular inkblot may have more clinical significance than that which is actually reported. Responders suffering from conversion disorder characteristically avoid reference to anatomical structure depicting the painful region and this has been referred to as “somatic repression” (Cassell, 1980). Work with severely traumatized individuals suggests that the self-administered video version of the SIS can function as a type of electronic time machine. It employs beautiful mountains, mesmerizing flowers and a sound track with instructions to relax so-like in hypnotherapy - the viewer may go back in time to earlier stressful periods. In these conditions the flow of projected responses may approximate imagery originally present in long forgotten nightmares. This pictorial stream provides the disturbing material in consciousness, which is eventually projected as SIS responses. At times, the viewing procedure gives much cathartic relief - a form of therapy in itself (Cassell, 1995, 1996, 2001,2002). Dr. Wayne Holtzman, Developer of the Holtzman Inkblots, Described the power of the SIS video as follows, “Considerable effort and artistic talent has gone into this method which clearly deserves further research. In the hands of an experienced clinician, particularly after receiving competent training and supervision, the SIS is a most welcome new projective technique for the assessment of personality and psychopathology . Unlike many other methods, it is particularly appealing when used be the clinical and subject as an interactive interpretative mode as part of the total diagnostic and treatment process. The dynamic nature of the stimulus presented by video in color reaches beyond the Limitations of traditional projective techniques”. Certain responses have special significance to physicians working with patients experiencing death anxiety (Cassell, 1979). It is also useful as a releasing trigger in the management of delayed grief reactions (Cassell and Dubey, 1996). Therapists with a religious orientation are much more effective in comforting Spiritual Application of SIS 91

such people than those who avoid the discussion of spirituality or who are atheists. The latter need to refer such patients to those who are experienced in working therapeutically within the systems of religious beliefs. Otherwise, it represents a form of spiritual malpractice. It is imperative to support and not undermine the faith of an individual. For example, in treating Christians, it is essential to reinforce the Easter message of hope. Because of the common use of symbolism, training with SIS can provide insights into dream interpretation. In regard to significance of dreams, Barrett (l996) summarised the diverse literature as follows: According to the poet Elias Canetti, “All the things one has forgotten scream for help in dreams.” To the ancient Egyptians they were prophecies, and in world folklore they have often marked visitations from the dead. For Freud they were expressions of “wishfulfilment” and for Jung, symbolic representations of mythical archetypes. Although there is still much disagreement about the significance and function of dreams, they seem to serve as a barometer of current mind and body states”. This latter statement has particular relevance in understanding the striking parallel between post-traumatic dreams, visual hallucinations and SIS responses. It is hypothesised that the visual cortex is episodically excited with neural impulses during sleep - much the way a computer monitor screen saver program functions. Certain of these are derived from peripheral body sensations; others from memory storage sites. The individual senses these as cerebral excitations having the vague color - movement - form characteristics of the electronic versions of the SIS inkblots. The dreamer’s psyche then projects images onto these brain sensory patterns. Many of these simply reflect residual from the stimulation received earlier in the day. What is seen has little meaning except according to Crick and Mitchison (1983) as “reverse learning” designed to remove the overloads of “neural garbage” from the brain. However, others may have considerable proprioceptive emotional and cognitive significance. For examples, when the dreamer envisions a personal scene of urinating the imagery reflects accentuated proprioceptive stimulation from a full bladder, which then may be interpreted consciously as a warning to get up and go to the bathroom. When the dreamer’s mind attempts to interpret the brain’s neural excitations, scenes of a recent stressful life event-for example having been injured in an accident-the subjective interpretation of the cerebral sensory input continues to be strongly influenced by processes of psyche projection and a number of additional factors. These include perseverating recent memory engrams of visual, auditory and pain sensations experienced at the time of the trauma. When these are correlated in time and space- by Pavlovian conditioning-with the traumatic events of a particular day in the year, the neural memory basis are laid down for 92 Cassell et al.

subsequent anniversary reactions. Research measuring relative regional blood flow during activation of traumatic imagery suggests that the ventral anterior cingulate gyrus and right amygdala may be brain sites for such memory storage (Shin et al, 1997). For those suffering from post-traumatic stress disorder, in sleep a type of behavioural therapy induces homeostatic healing naturally in the central nervous system by the association of the traumatic imagery with a state of relaxation. With the SIS a similar desensitisation (Cassell, 1977) occurs when the stressful images are immediately followed by flowers and nature scenes designed to reduce anxiety. Guidelines for interpretation of SIS responses Anatomy responses depicting pathology may reflect fears of imaginary illness or represent subjective perceptions of actual physical disease (Adamson, Greengrass and Martin 1977, Brady, 1995). An example of the former is an apparently healthy individual who smokes heavily and consequently projects fears of developing cancer in envisioning A20 as “cancerous lungs”. Eventually, that individual might succumb to the carcinogenic effects of tobacco and then perceive “a tumour blocking breathing”. Questioning about the significance of the latter response could lead to a therapeutically meaningful exploration of the physical pain, subjective suffering and concerns about dying. Projected anatomy responses depicting “a broken heart” or “a sad face ”may symbolically signify depression and underlying suicidal ideation even though the responder may avoid reference to such painful affect upon direct questioning. The psychological defence mechanism of denial is commonly employed when the individual fears body disintegration or realises that a loved one is dying. The SIS was originally proven to be an aid in getting around denial in order to release grief in therapy. Older individuals may deny that they are preoccupied with imminent death yet project anatomical responses symbolising this anxiety (Cassell, 1980). Because of the all-pervasive nature of such concerns in the seriously ill, a number of SIS inkblots were specifically designed to facilitate therapeutic exploration of death concerns. Another way the SIS explores this area involves the use of cards having embedded structure capable of evoking highly threatening imagery. Certain of the blots resemble what children perceive in their dreams as “monsters”. For example, Card 18 may suggest a demon- like monster with sharp teeth. While some clinicians may choose to ignore childhood nightmares- because they are so common - the projective use of the SIS can uncover areas of undetected trauma crying out for therapeutic processing. Spiritual Application of SIS 93

Rejection of SIS Images In evaluating prognosis, one of the most important SIS indices quantifies the number of rejections. Since these inkblots are highly structured- in the absence of organic brain disease- failure to respond to a particular blot can be quite revealing. It can be helpful to understand the viewer’s interpersonal interactions to observe the interaction of the human figures that are perceived in the inkblots (Lerner, 1991). The avoidance of human content may reflect a lack of interest or discomfort in relating to people. Difficulty in detecting the anatomical structure may suggest a detachment from body experiences and reduced awareness of emotionally cued body sensations. Individuals with a high somatic rejection index may manifest an inability to introspect. In regard to perceiving others they may lack empathy. Such people have considerable difficulty in focusing in on their own internal sensations associated with increase in heart rate and changes in gastric motility at times of intimate arousal. These mind- body connections begin to be laid down early in life when the infant associates the warm gastrointestinal sensations of feeding with images of the mother’s body. Failure to experience nurturing from parental figures in childhood leads to developmentally impoverished people. Just like animals that are reared without maternal contact, these fail to develop neural connections to their peripheral autonomic system. As adults they are resistant to entering close loving human relationships. Sadly enough, such concrete thinking individuals are unable to accept or express love. Sensing their lack of internal physiologic reactivity, they may report feeling, “empty or hollow inside.” Just like their inability to respond to the SIS inkblots maturely, they have great difficulty projecting positive feelings onto images of spirituality. For example, in the Christian religion, a central concept involves the trinity of the Holy Spirit, God and Jesus Christ. The first two refer to loving spirituality in the absence of visual imagery. When people think about God, they usually project human characteristics and ordinarily consider him to have a masculine sexual identity. While no one has seen Jesus in our century, there are a number of artistic representations on his physical appearance. In addition, there are religious symbols depicting his life and crucifixion (i.e., the communion bread representing his body and wine symbolizing his blood). All of these images are experienced with psychological principles of projection operating. Consequently, they lend themselves to assessment with the SIS. A case history will be outlined to illustrate the emptiness within the body image that such a spiritually impoverished individual experiences. The patient came to therapy because of a life long history of severe panic attacks and depression. He had experienced his first panic attack in adolescence after waking from a dream with terrifying death images. He was highly anxious experiencing 94 Cassell et al.

psychophysiologic cardiac symptoms (i.e. heart palpitations). These had been triggered by the nightmare and the subsequent thought that someday he would die. Since he had no belief in God, he commented, “it would be all over-there would be nothing more”. His panic attacks were mentally associated with the obsessive phase going through his mind “0h!!!no!!!no!!!no!!!”. To understand him better, certain observations about him might be helpful. He had been raised in an alcoholic dysfunctional family. Only rarely had he experienced love and then mainly at an oral phase of psychosexual development. Consistent with this he was able to identify the breast anatomical content in Image A27. However, his mother had not been especially nurturing beyond infancy, so he was unable to perceive Image B28 as “a mother hugging a child”. Consequently as he matured he distanced himself in interpersonal relationships. He also isolated himself from all internal body sensations associated with the psychophysiology of mature love. With regard to spirituality, as a youth he learned intellectually about the Christian concepts of love. However, he blocked the positive affective component from his own heart sensations. As a psychological defensive measure to isolate religious teaching, he exaggerated the human frailties of various churches. With a cynical humour he cited repeated instances of self righteous clergy claiming their members were “holy” while labeling other congregations in the community as “evil”. He took particular glee in describing his memories of “Holy Rollers” involving Christian sects that he had witnessed rolling about the floor of a tent. The notion that religious services could evoke feeling of ecstasy was beyond his scope of body consciousness. When he was in his early twenties, he married. Eventually his wife gave birth to a daughter. However, his emotional isolation continued and he was aloof from both. To fill the emptiness in the vessel image of his body, he turned to the false sense of warmth derived from psychophysiological stimulation with nicotine and alcohol. Ultimately, he became divorced. Although his daughter tried unsuccessfully to emotionally reach out to him, he defended against her attempts at intimacy by directing sarcastic humor at her. Consequently, he remained essentially alone. Later in life, as a result of heavy smoking, he developed emphysema. He also suffered from “Essential Hypertension”. As his breathing became labored, he became more and more obsessed in the day time with ever more intense death fears. At night, more terrifying symbols threatened him in dreams. Eventually he became angry at his family physician and sought help elsewhere. When his health began to seriously deteriorate, his daughter developed a psychotic depression. She could not deal with the imminent loss of a father who was so Spiritual Application of SIS 95

emotionally remote. Both were atheists and resisted attempts to discuss spiritual concepts or referral to a pastoral counselor. In responding to the 62-item SIS booklet, the lonely old man rejected 40 images. He avoided reference to the human and anatomical content. This paralleled his subjective blindness to positive affectual body sensations of love. For image A3 he projected his own emptiness within the body gestalt with the response “A wolf peering out of a hollow log from a fallen tree”. The symbolism is noteworthy in that in his social isolation he identifies with the cultural myth of the lone wolf. The “hollow log” symbolizes how he perceives his own body with diminished positive affectual psychophysiologic sensations. The response “fallen tree” denotes his fear of his body’s imminent death. Another response symbolized how he masked his true feelings: Image A19 “It looks like a human face with a mask”. Lastly, his anger about dying was directly projected in the response for Image B10 as “an angry dog!”. No doubt his affectual disturbance played both a role in his hypertension. Apart from his pulmonary problems, he was also at higher risk for dying, in view of recent research indicating that coronary patients who survive a myocardial infarction but who are depressed, are more prone to die than non depressed ones. Group Demonstration Project Another way that the SIS may be used is in a family therapy or group setting. The latter approach was demonstrated as a teaching exercise at the sparing meting of the “Washington State Pastoral Counselors” meting 3-5-97 at Alder brook. Four licensed therapists who had considerable experience graciously agreed to participate for teaching purposes. The takes involved getting the volunteers to respond freely to the first for SIS inkblot in the Card version. After each individual responded, the group was asked to report on overall responses which all members could agree. As might be expected this represented a potentially anxiety provoking challenge First, it involved self disclosure in a setting one’s professional peers; secondly, it necessitated the resolution of differences in perception to reach agreement on a common vision. The volunteers initially expected this to be a fun game. However, because of the psyche powerful pulling power of projective tech unique, it proved to be quite anxiety provoking with Cards 3 and 4. It demanded accessing interapsyche imagery ad then public ally sharing this highly personal material. In viewing Card 1, the group gave the following responses two chickens, Mickey Mouse two dancers motion dance and movement, One attempted to like I order to reduce twist anxiety with the question “Where’s the sex?” The group consensus was that the card most likely represented dancers moving over chickens”. Card II was stated to look like the following” clown’s face movement upwards and 96 Cassell et al.

brides about to move up. They’ll easily agree upon the first response as the consensus vision. At this stage their test anxiety was falling rapidly and the appeared to me enjoying the “game”. However their confidence and fun like attitudes quickly changed as they responded to the multiple structures embedded in Card 3. The fro up support enabled then to allow their creative perceptions to surface in an analogous fashion to psychotics. A flood of images appeared in perceptual valves like drug induced visual hallucinations and dream imagery. It proceeded with relentless pressure as follows “two people in love”, “two females in love”, “two men with penises-gay”, bisexuality”, “lonely moving away”, “the right is looking away over space barrier”, “ conflicthearts spit”, “ and hearts gang out-still connected”. Initially this Card stimulated human content with themes of over, sexuality, loneliness and connectedness. In the next layer of imagery, responses denoting the facial are were projected as follows: “ face of a clown”, “ghost in between there are eyes on nostrils”, “fear in flight”, “two close monkeys and their tails” , “ brightness of eyes and neck” , “candle forms on the inside of the body” ,”fear-hope” and “evil eyes of ghost in black”. At the end of this effectual laden rush of associations one group member commented, “you can be not hold two images at the same time”. Then they agreed to select the first response as the consensual perception. For Card IV the highly affect charged flood of images continued to flow rapidly as follows: Hutchie cookie dancer”, “uterus”, apple of temptation”, “balloon tossing”, apple”, “balloon expanding”, “Adam picking apple”, “Even and apple Stacy” ape representing temptation, the temptress, green pepper-it doesn’t seem part of the picture”, “balloon symbolizing joy” “party lanterns”, “ menstrual blood… this makes me have clammy hands”, “futility”, “initiating rites”, “black wig is blindfold”, “eye with mascara”, deigning to see the upper object as a mode from the back lying brown with the buttocks showing”, “dancing and energy contrasting with being quiet symbolizing a person actively external but internally sad”, “young female at the bottom with the top objectively actively external but internally sad”, “young female at the bottom with the top object representing a mother or grandmother turned away sadness or letting down of emotion and walking around” “My hands are clammy” , “river delta with an island- the red is a shallow data”, “a pair of snakes”, “joy and sadness” , “celebrating the sensual side a shallow delta” “a pair of snakes”, “joy and sadness”, “celebrating the sensual side of a woman” “fertility” and “inward emotions that contrast the two ways of being” finally the group settled upon the perception of a” “dancing woman”. During the demonstration, it was possible for both the volunteers and the audience to learn about how a teaching session can be helpful. Observers and participants acquired insights concerning individual psychology and group process. In a clinical setting, it is readily apparent that a similar approach can potentially have diagnostic and therapeutic applications. Spiritual Application of SIS 97

SIS- II/Video Death Scene When the 62 item SIS-II/Video was created, previous experience had indicated the importance of having specific inkblot structure to symbolize death and dying. Image B22 illustrated was specifically designed with this in mind. It depicts a dying person lying down having ambiguous age, sex and race characteristics. In the video version, the objects over the abdominal area move upward signify to some “the spirit leaving the dying person’s body”. Certain clinical case studies might be of value. The first was a middle-aged woman who was in long term treatment for affective illness. During the course of this, her mother developed cerebral vascular disease and suffered from multiple strokes. Eventually she lost all her faculties including bowel control. Not only was this highly stressful to the daughter, it required extensive nursing care, since she cared for her at home without professional help. When the mother eventually died, it was a blessing but the grieving was difficult. When the SIS was administered, Image B22 was seen to represent her mother’s dying body with her spirit ascending. Afterwards, she had a healing spiritual dream: she witnessed her mother getting out of bed wearing a beautiful nightgown. Her mother expressed love and appreciation for all the care that she had received. She danced in joy showing her restored health. It was interpreted as a reassuring spiritual visitation from the mother. To interpret it as “wish fulfilment” would have totally undermined the grieving process. The dream signalled the resolution of her depression. After this message, during the day she was able to experience special psychic moments, the loving spiritual presence of her mother. Another clinically depressed Christian woman, with comparable response to Image B22 and a history of also having lost her mother to chronic illness (cancer), experienced an analogous series of healing images. These appeared during meditation when she closed her eyes in communion at church. Her experience follows: “I saw heaven-a place of gold, shimmering lights and “light”... lots of lights. I saw a banquet table surrounded with lots of food and happy people. In the midst of this joyous scene sat my mother. She was smiling and laughing with her new friends. Then I saw my mother and me both clothed in white gowns as we danced with Jesus. What was my mother saying? I believe that she wanted me to know that she’ll be there to greet me with open arms when the gates of pearl open for me one day.” After this vision, her depression rapidly resolved and she once more could feel joy. A few additional case histories might be helpful. The first concerns a teen-age youth that had been admitted to a psychiatric hospital for severe depression and suicidal behaviour. In viewing the booklet, he envisioned Image B22 as the body of his father who had shot himself five years earlier. His father had been a 98 Cassell et al.

Vietnam veteran who had suffered from post traumatic stress disorder and alcoholism after the war. He had been highly abusive and the boy had never been able to effectively express his grief. Another example was a woman who had found her husband’s body after he had shot himself. The terrible traumatic imagery from eighteen months earlier had made her psychologically numb. In the detailed inquiry, this numbness was dissolved and she was able to process the trauma more emotionally and cognitively. Following this, she became less depressed and more in touch with her emotions. Also, themes of her deceased husband’s bleeding body faded from her post-traumatic dreams. Sometimes, in highly resistant cases, a therapist may elect to use hypnotherapy to release deeply buried or repressed grief. An example from South Africa involves a 31 year old widow who had not been able to grieve, following the murder of her husband (Savage, 1995). Traditional psychotherapies failed. Ultimately, a treatment plan was developed in which a hypnotic trance was induced during which she viewed the booklet form of the 62 Image SIS. When she viewed Image B22, she was able to release her pent-up emotions for the first time, as follows: “It is a graveyard. It lets me think of my husband’s death. It is not right that he should be there! He did not die as he should have - he was murdered and that is not right! It brings many questions to my mind: Why him? Where was God? Why did God allow it? It is only people whom I love that die!” This began the grieving process and opened the way for cognitive therapy to correct her illogical thinking. Hallucinations and Delayed Grief Reactions In certain native-American cultures-especially for males-it is not socially acceptable to show feelings of grief. These individuals are extremely reluctant to seek professional help and are ordinarily not suitable candidates for traditional therapy procedures. Adolescent natives have the highest rate of suicide in the United States. When these present in severe states of depression with psychotic features such as hallucinations, the beautiful nature scenes in the video version of SIS-II may be particularly useful. One Alaska native teenage youth that required psychiatric hospitalization illustrates this phenomenon. He had been seriously playing Russian roulette with a revolver and then tried to jump off the school’s roof. In responding to Image B22, he saw his uncle’s body after it had been pulled from the river eight years earlier. The cause of the drowning was unclear. It may have been an accident related to the consumption of alcohol, or it could have been suicide. For Image B18, he saw a graveyard scene of his uncle’s body being lowered into the ground. With the emergence of this childhood death imagery into full conscious awareness, he began to cry for the first time. It also provided insights into why, Spiritual Application of SIS 99

in his psychotic depression, he had hallucinated his uncle calling him to join him in death. Because he projected the graveyard scene over an SIS image with phallic content, for the first time it alerted the treatment team to the possibility that his uncle had perpetrated sexual abuse. The second case to be reviewed involving hallucinations was a teen-aged girl who was admitted to a psychiatric hospital with a psychotic depression with paranoid ideation. She suffered from both suicidal and homicidal ideation. Several months earlier, a younger sister who had a series of birth defects had died at surgery. She had suffered extensively and her older sister was enraged at the surgeons and also irrationally blamed herself. She was tormented by recurring nightmares. In these, a “shadow man” threatened to kill her as punishment for allowing her little sister to die. During the day, she was also terrified by similar images of him in the form of hallucinations. In both the dreams and hallucinations, he was always dressed in black with penetrating green eyes. Emphasis on eyes has been found with the SIS to relate to paranoid tendencies (Bailey and Murstein, 1996, Savage, 1995). After viewing the 62 image SIS II, she selected Image A17 as the most threatening. She saw it to represent “two smiling fishes with a stolen heart. In the detailed inquiry, she said that the “fish” were “hurting someone just for pleasure-like the shadow man in my dream”. The parallel between her hallucinatory experiences and the SIS response continued, when she described the second most threatening image, which was A30. It resembled “a human skull waved by black”. This had a dual meaning. In the first instance, it looked like the feared “shadow man”. Secondly, it was seen to depict her sister’s “rotting head after death”. In terms of spirituality, she felt that she was beyond hope because of not saving her sister from the “evil murderous surgeons” towards whom she had homicidal thoughts. Consistent with her hopelessness, image A21 was seen as “a raven with a heart so heavy, it can not be thrown up to fly-even by angels”. Other responses relating to her clinical state follow: Image A22 “A face with a screwdriver coming out of the skull-it reminds me of killing my sister. I want to hurt or kill people just to make them feel pain and suffer the way my sister did”, Image A23 “An angry groundhog looking for revenge- it brings to mind the shadow man”, Image B12 “A muscle caught by a metal clamp like the one they took from my sister’s leg”, Image B15 “Shards of glass and knives flying out of fire- I hate the doctors”, Image B16 “a tarantula pulling it prey”. In obtaining associations to this, she indicated that it reminded her of the “shadow man who is like a tarantula jerking me around... he talks to me when I am awake... he tells me that I am a murderer and killer... I need to die... I should put a knife through my heart... he wants me to leave the knife there while my body rots... he calls me by my sister’s name... he wants me to be her and to be like her in heaven, where I can 100 Cassell et al.

have a life too”. These responses were then used as a basis for the cognitive therapy to correct her delusional thinking and to establish more appropriate reality testing. Dream Programming Another application of the video version of the SIS-II involves showing the video version at night-time prior to sleep. This can stimulate therapeutic dreams in individuals suffering from chronic depression illness dating back to losses sustained many years earlier (Cassell and Dubey, 1997, 2000, 2001). One example involves a forty-year-old woman who at age three witnessed her eighteen months old brother torn apart by an attacking pack of dogs. As a child, she was never able to process this terrible trauma. In viewing the video, for the first time in adult life she recalled long forgotten nightmares depicting the horrible traumatic memories. When this material was subsequently reported, her therapist first became aware of the need to therapeutically assist her with the loss. Television Trauma Watching violent material in television can be dexterous to health. An example of this occurred at the time of the Oklahoma City bombing. After watching some of the horrible video specifically relating to the tremendous execution that occurred, one patient developed panic disorder. He sought help when he no longer was able to work because of sever anxiety attacker associated with palpitations and chest discomfort. During the day, he was preoccupied with hypochondriacally fears focusing on his heart. At night, his sleep was disrupted by terrifying dreams. A history revealed that several months earlier, he had been injured in an explosion in the oil industry. A fellow worker had sustained major physical injuries and he only minor ones. However, he was psychologically traumatized from the stressful event and, for a short period, had post-traumatic dreams relieving the accident. In spite of these, he was able to continue working and appeared on the surface to be relatively comfortable. After watching scenes of the Oklahoma City tragedy, he totally decompensated. When he viewed the SIS video, he experienced Image 15B as highly threatening. It reminded him of a composite picture of what he had seen on television, his post-traumatic dreams and the visual images of the original explosion. Also Card 20 depicting a human skull-the death symbol was equated with the face of the terrifying man in his dreams who was threatening to murder him. He blamed himself his friend’s severe injuries even thought it was not his fault. With Spiritual Application of SIS 101

appropriate medication and psychotherapy, eventually his panic symptoms and irrational guilt were resolved. In the final phases of his treatment, the images in his dreams became less threatening but still symbolic of the oil tank that concerning how interpreting his SIS responses had facilitated emotional expression and cognitive understanding of his traumatic experience. Releasing Repressed Satanic Memories Physicians and counselors sometimes have to evaluate patients with histories of physical, psychological and sexual abuse. In many areas of the United States with the breakdown in the family and the high rates of drug related crimes this may involve disturbed adolescents who become attracted to satanic cults. Their memories are readily available for therapeutic processing. By contrast, it may be adults who have no conscious recollection of childhood trauma, which can in rare instances, involve organised cult activity. In extreme instances, such individuals may suffer from serious dissociative disorders such as multiple personality. Two examples will be reviewed of women who had features of this condition. Both initially came for treatment when conversion pains syndromes led to drug seeking behavior with many doctors resulting in addiction to prescription medication. Each had repeated psychiatric hospitalizations for dangerous suicidal and homicidal ideation. There multiple personalities manifested themselves through different handwriting and strange negative behaviors for which there was total amnesia. The first case involved a middle age black woman. When she viewed the SIS video images, she was highly threatened by Image A10 envisioned as “Satan looking back at you through the mirror”. This projective response reflected her projecting her bad personalities on to the inkblot’s human facial structure. These personalities encompassed both threatening suicidal thoughts of self-destruction and homicidal impulses towards her husband. These had never been verbalized directly to him but revealed through the handwriting of her satanic personalities. Naturally, the notes he found got his attention, making him aware of the serious implications of her illness. The next most threatening projection was in relation to Image B19 seen to depict “the end of the world”. This is consistent with the dire predictions of many fundamental religious groups who are always predicting doomsday. She verbalized positive attributes to this vision saying that at the end “Christ would come”. Another response, which carried a high degree of disturbing affect, was given in relation to Image B15 “knives flying against someone up against the wall”. Detailed 102 Cassell et al.

inquiry led to repressed childhood memories. When no adults were home, her older brother had chased her with a long meat knife and gestured at cutting her throat. Relating to her flashbacks and nightmares of past sexual abuse by her father, and marital rape type sex, many responses symbolized such horrible memories: Image A22 “A man’s hard penis ready to enter”, Image A24 “A vagina red and sore” image A28, “A naked man pulling off his shirt”, Image B18 “A man’s penis that wants action”, B24 “Man’s testicles”, Image A7 “Eve enticing Adam to eat the apple”. Finally, a series of responses related to the conflict in her personalities between good and evil: Image A2 “A creature from the War of The Worlds”, A18 “A heart of life surrounding an angel”, Image A31 “A man and woman yelling at each other!”, B2 “Two furry angels coming up from Hell”, Image B4 “A ghost with hollow eyes”, B12 “Someone hanging on a cross with life coming out of them”. In her intense suffering, she had the good aspects of her personalities positively identified with Jesus on the cross; Image B22 “A dead man’s soul rising to Heaven” and Image B25 “The angel of death”. With a version of the SIS called Living Images made by women artists to focus on feminine issues, certain of her responses denoted the splitting in her personality were projected as follows: “Two people becoming one trying to separate to get control again” and “Tired of the battle to separate-getting weaker”. Others picked up the pain and demonic imagery as follows: “A person being blown away-needless pain”, “the penis of the devil” and “Satan looking into my soul”. The second woman had a similar history of incestuous trauma eventually acknowledged by her father. What she did not report was that his own father had been trained in satanic cult rituals prior to immigrating to this country from Eastern Europe. Initially, when the granddaughter viewed the video version of the SIS, many responses related to the past sexual trauma. However, one response was at the time unexplainable. Image B24 was envisioned as “a burning baby”. Two years later after hypnotherapy memories returned of participating in ritual sacrifice. The use of this SIS video facilitated the evaluation process and the ultimate therapeutic reduction in her dissociative symptoms. Stimulating Christian Imagery When the twenty card form of the SIS was first used in field trials, there was an unexpected finding concerning the projection of Christian imagery in relation to one of the SIS Inkblots. This was a card, which has anatomical content, which Spiritual Application of SIS 103

some responders see as depicting the female genitalia. Remarkably enough, others who avoided the sexual material saw religious symbols such as a “crucifix”, “a stained glass window” etc. One interpretation was that they employed these symbols in defending against the sexual material. This is analogous to how Christian teaching about morality may assist in preventing the acting out of socially unacceptable sexual impulses. In any case, when the new series of SIS inkblots were field tested on the Internet, another inkblot was found to evoke Christian imagery (Image A3). These were not considered to be defensive in nature, but rather a direct projection of what the inkblot actually represents. Examples follow: “Christ ascendant”, “I see Christ on the cross with his purple representing his royalty”, “Jesus Christ on the cross”, “A cross with rays coming from the point where it crosses. It’s planted in the ground. See the roots? It reminded me of Jesus’ death. I’m sad now”, “A bloodied cross such as the one that Jesus was crucified on. It is wet and dripping and it is back grounded by the lights of Heaven”, “I see pain and suffering, but it is Jesus who is suffering for the great good of many”, “Jesus dying on the cross”, “I see the crucifixion, the roots symbolize the tree of eternal life and the yellow is the light of God shining down upon Christ” and “A cross, the blood remains, but around it are vivid colors and light-perhaps symbolic of the light offered by Christ’s sacrifice!” Other example of religious symbolism - some good and others evil - follows. “Someone just died and their soul is just emerging from their bloody body as an angel”, and “it looks like a cross with its roots in front of a stained glass window”, “An errant angel ascending to Heaven”. This looks like an angel, maybe it comes from deeper religious belief”. “A bleeding cross on a stained glass window”, “A holy woman in front of a great light who is beckoning to me with either great sadness or great joy”, “A vagina or a cross” and “an angel trying to fly through a gap”. These responses show you how some of these inkblots may be used for stimulation purposes. Examples of satanic imagery follow: “l see Satan going up to take over heaven”, “Satan: he’s eating your soul raw with a sprinkle of garlic and a dab of honey. Hmm honey, I’m only three and half years old” and “If you look at it upside down it appears to be an ugly reindeer, covered in the blood of slaughtered elves, exploding from the bowels of Hell from whence Satan has expelled him for only wounding that pesky Santa, instead of bringing back his dismembered disloyal body to the Hell he(Santa) once called home...(Satan speaking)” “Rudolph, how dare you offer me these petty corpses of pathetic elves. Bring me Malladeigo... I mean, Santa Clause!!”. 104 Cassell et al.

Finally it might be of interest to note one Internet responder’s summary comments as follows: “l have read a lot of very strange ideas here. Blood and gore seems to hold a fascination for many. Flowers, birds and religion seem to be the lead. Initially I could see about nine splotches of color smeared about in a vague symmetrical layout. Second impression was that of Christ hanging on the cross with a stained glass window effect in the background. “As far as some body’s privates, you gotta be sick!” The use of the SIS to stimulate religious imagery is a fascinating new area of investigation. Research on this could have much relevance for learning about spiritual imagery. Interested readers may review the overall responses evoked on the Internet by visiting SIS web site at http: //www.somaticinkblots.com. Discussion The intellectual stimulus for this article was a meeting of pastoral counselors just before of the Easter season. Unfortunately, not all people are able to appreciate this special time for spiritual renewal. Mental health professionals especially in the Holy city of Jerusalem-have observed an annual increase in the number of psychotic individual presenting in delusional state during this season. May with a distorted sense of identity and body awareness (Cassell. 1980) claim that they may be Jesus Christ and report bizarre delusions. Some may experience hallucinations of being directly in contact with God or the devil. Writers have referred to this phenomenon as “Divine Madness”. In spite o the need for scientific research, studies on the etiology of mental illness and substance abuse genially ignore the religious variable (Kindler, Gardner and Prescott 1997). Yet research suggests that religious convictions play an important role in emotion and behavior (Gallop Institute 1995). More recently there has been the beginning of a movement scientific circle to consider the impact of religious belief on health (Gardner, Larson and Allen, 1991). Preliminary investigations to quantify and measure the spiritual dimension have shown promise. While no projective techniques have pioneered the way in this field, there is also a need for projective inkblot procedures such as the SIS. This is true even thought the results of testing are less easily quantified through existing statistical systems f analysis. What is lost in mathematical quantification may be partially offset by the power of the inkblots to pull deeper material. The procedures can reach beyond the superficial levels of cognition and behavior. Deeper areas of the psyche and some can be reached. The image reveals information that may be unknown vaguely sensed byte person projecting the responses the technical Spiritual Application of SIS 105

ability to stimulate positive spirituality and satanic imagery allows the exploration of the spiritual balance spirituality and satanic imagery allows the exploration of the spiritual balance between god and evil with which all of use battle-both internally and within society. The many applications discussed in this paper and may other not-may be learned at SIS seminars of by Internet communication. Academic exposure can be of value even for those in training who will never use the procedures professionally. Becoming familiar with principles of projection and symbolization can enhance the understanding one has of oneself and others. Trains can lean about how medically sick patients subjectively experience physical pain. They can become familiar with clinical criteria on how to distinguish the latter for somatic symptoms, which may symbolize psychological and spiritual conflicts. As another example, therapists can better learn to interpret the language of body symbolism during grieving (Cassell and Dubey, 1996, 2000). When the grief stricken individual complains about a heavy sensation in the chest (e.g. “a broken heart”), the empathetic listener may interpret this for the sadness that it represents, rather than as a symptom of physical illness. The trained listener will be able to understand it as the symbolic communication of emptiness-resulting from a loss of the joyful psycho physiologic sensations stimulated by imagery of a loved one. Given this insight, they will then be more knowledgeable about how to therapeutically introduce loving spirituality to fill the inner void in the body gestalt. For Christians, actively imaging Jesus through visual aids and meditation can effectively restore sensations of love and fill the empty heart. Adherents of other religions will achieve similar health benefits, although the imagery will necessarily be different. For example Hindus can visualize Krishna or Shiva, Buddhists the goddess Kuan Yin, Muslims the Holy city of Mecca etc. These changes in body awareness can reduce somatic suffering until imagery from dreams meditation and other spiritual experiences restore the broken love bond. This is highly important during the early stages of grieving. It is also critical at anniversaries of times of loss. (Cassell et al, 1999, 2001, 2002). Another application of the SIS involves educating trainees concerning the many parallels between what a particular individual envisions in an inkblot and what that same person projects onto spirituality. Courses can include studies using the inkblots to educate about how subjective perception operates under a variety of circumstances. For example, this can apply to understanding how different readers perceive scripture differently. They may acquire better insights into conflicts concerning the meaning of ambiguous religious writings. Those clinicians 106 Cassell et al.

and clergy who become educated may be more adept at bringing cult members who have been brainwashed by a demonic leader back to reality. At the time of writing, the news media are currently flooded with reports about the “Heavens Gate Cult” in California. As an extreme response to celibacy, one third of the men were castrated. These fanatics committed mass suicide because their deluded leader convinced them that the Hale-Bopp comet was being followed by a space ship which would take them to heaven. Those entering the healing fields need guidance on how God gives guidance and healing through the media of dreams. When a grieving person has dream imagery of a diseased loved one appearing healthy, the therapist needs to support the faithful’s belief that this is a spiritual visitation. It is abusive for an atheist analyst to interpret this in some analytic jargon such as “wish fulfillment”. For Christians, there is also the central need to identify with imagery of Jesus, which can be stimulated by SIS viewing. Another application involves the use of the SIS as a screening procedure in assessing applicants for the health sciences and clergy. It also can be used to assist in the study of occupational stress or burnout in these highly stressful vocations. In an earlier section, it was observed that the responses given by the volunteers revealed a modest level of psychological distress. These fields require individuals who can be earthly transmitters of loving spirituality, yet they must empathetically bear the heavy burden of suffering. They need to realize their own human limitations in order to retain realistic sized egos, even when placed upon pedestals. Many of the inkblots with human characteristics can access this level of functioning. Similarly, the anatomical structure can evaluate sexuality. Prospective trainees who are vulnerable to boundary or counter transference issues can be identified early in their careers. They may be referred for personal therapy prior to acting out their problems. Boundary issues will always require special attention. Unfortunately, in some religious settings there has been much confusion between sexuality and interpersonal spiritual intimacy. Whatever one’s personal views about celibacy, prospective clerics in the Roman Catholic Church have to struggle with this issue? Given rare but highly publicized sexual abuse tragedies, it would seem that traditional methods of assessment have not been especially effective in screening out perpetrators (i.e. pedophilias). Certain of the inkblots access erotically perverse satanic forces. This area of assessment has particular clinical relevance in the evaluation of victims of abuse. In the Living Images Series for women, a few of the inkblots were designed Spiritual Application of SIS 107

specifically to evaluate dissociation by presenting outlines of the body, which depict splitting. The cases reviewed represented examples of this reaction to sexual trauma. It is suggested that the SIS approaches may be used as a projective technique in association with structured interviews (Gould et al, 1996, Pelcovitz et al, 1997) to better evaluate at a multidimensional level, reactions to extreme stress. They also may be effectively employed to supplement questioned at assessing death anxiety (Cella & Tross, 1987). Commonly, clinicians encounter patients with a lesser degree of dissociative illness. These may suffer from pain in the absence of detectable physical illness. The use of the SIS may enable trained professionals to give projective dataderived consultations regarding the diagnostic significance of such “hysterical” somatic symptoms. Similarly, the inkblot information may be useful in identifying depressive symptoms, which are denied but symbolically projected. The latter can be of value the decision whether to use antidepressant medication. The clergy can acquire skills to better assist suffering people who withdraw from loving spirituality and destructively project evil onto themselves, their families, their physicians and other health care providers as well as religious support systems. Other applications concern the growing number of healing benefits that can come from the mesmerizing aspects of the SIS video. As previously indicated the mountain and floral scenes produce an altered state of awareness. This can approximate the trance experiences that some American native religious leaders induce through religious rituals incorporating spirituality with all aspects of nature. Alaskan natives now have incredibly high rates of alcoholism, dysfunctional families and elevated morbidity and mortality scores. Some native leaders now trace these problems to the decline in their culture secondary to the deleterious impact of Christian missionaries. These well-meaning clergy preached that it was a sin for the shamans to pass on ancient myths and legends. Native dancing was also frowned on. It is entirely possible that in the absence of their spiritual energy system, the natives may be more vulnerable to their many health problems. It is also relevant that investigators and clinicians have provided cross-cultural insights. In Japan, therapists quickly recognized the therapeutic power of electronically associating traumatic SIS imagery with natural beauty (Cassell, 1991). The mystical arts of Shinto and Buddhist religions induce spiritual effects by creating environment replete with natural and artistic beauty. Consistent with the healing power of flowers and projective technique, two videotapes have been 108 Cassell et al.

produced; “A Walk Through the Garden of Life” and “Fantasy Flowers” to reduce anxiety prior to medical, dental and surgical procedures. Research has flourished in India where there is a vast heritage and sophistication concerning the ability of meditation to positively alter physiologic function. World-wide experience suggests that a promising area of future investigation concern exploring how that the SIS approaches can effectively bridge physical-psychological-spiritual dimensions. When appropriately integrated with modern medical and surgical therapies, this promises to play a role in enhancing the profound healing powers of spirituality. References Cassell,W.A.(1977) Aggressive Imagery and Clinical Symptoms in Schizophrenia, British J. of Proj.Techniques, 16:21-31 Cassell,W.A.(1980) Body Symbolism and the Somatic Inkblot Series. SIS Center, Anchorage(USA) Cassell,W.A.(2001) SIS Exploration of Human Consciousness, SIS J. Proj. Psy. & Mental Health: 9:3-14. Cassell, W.A. and Dubey, B.L.(1997) Somatic Inkblot Series Video/SIS-II Manual. SIS Center, 4501E, 104th Ave, Anchorage, AK-99516(USA). Cassell, W.A, and Dubey, B.L.(1997) Therapeutic Dream Stimulation with SIS- Video, SIS J. Proj. Psy. & Mental Health, 1997, 4: 3-23 Cassell, W.A, Dubey, B.L.and Gilbert J.Roth (1997a) Medical, Psychological and Spiritual Application of the SIS Inkblots. SIS J. Proj. Psy. & Mental, Health, 4: 89-112 Cassell, W.A, and Dubey, B.L. (1998) Application of Somatic Inkblot Series in Personality Assessment, Screening, Diagnosis and Therapy, SIS J. Proj. Psy & Mental Health, 5:3-32. Cassell, W.A, and Dubey, B.L.(1998) Mental Disorders Triggered by Exposure to Violent Imagery in the Media and in Electronic Games, SIS J.Proj.Psy & Mental Health ,5:87-104 Cassell, W.A; Dubey, B.L.; Molchanov, E. and Roth, L (1999) Stimulating Beacon Images for Meditation and Projective Psychotherapy, SIS J.Proj Psy. & Ment. Health, 1999, 6: (2) 7-30 Cassell, W.A; Dubey, A. and Dubey, B.L.(2000) SIS Projective Responses in PTSD and Dissociative Disorder, SIS J.Proj Psy. & Ment. Health, 2000, 7: 93-108 Cassell, W.A; Illardi, F.J.; A. Collins; Mishra, M. and Dubey, B.L (2001) Optimizing Spiritual Healing by Assessing Dream and SIS Imagery, SIS J.Proj Psy. & Ment. Health, 8:75-94 Spiritual Application of SIS 109

Cassell, W.A, and Dubey, B.L.(1996) The Use of the Rorschach and SIS in Releasing Somatised Grief. J. Proj. Psy. & Mental Health, 3: 3 -32 De Vos (1952) A Quantitative Approach to Affective Symbolism in Rorschach Responses, J. Proj.Tech and Personality Assessment,36:133-150 Dubey,B.L. and Cassell, W.A.(1993)Some Experiences with Somatic Inkblots-II, British J. of Proj.Psychology,38:,1,19-41 Dubey,B.L. and Cassell, W.A.(1997)Clinical Utility of Somatic Inkblot Series- Video. Perspective in Psychological Researches, 20:10-15 Dubey,B.L. and Cassell, W.A.(1997Application of Somatic Inkblot Series in Personality Assessment and Psychotherapy, Indian Journal of Psychology, 72:73-80 Dubey,B.L. and Cassell, W.A.(2000) Inkblot Responses as an Aide to Therapy, SIS J.Proj Psy. & Ment. Health, 7: 3-10 Dubey, B.L., Cassell, W.A, Pershad D. and Dwivedi,P.(1995) Diagnostic Utility of Somatic Inkblot Series. SIS J. Proj. Psy. & Mental Health,2: 77-84 . Dubey, B.L., Cassell, W.A, Pershad, D and Dwivedi,P.(1995) Diagnostic Significance of the Indices of the SIS-II and the Rorschach Inkblot Tests. SIS J. Proj, Psy. & Mental Health, 2: 165-170 . Dubey, B.L., Cassell, W.A, Dwivedi,P. and Mishra, M.(1995) Inner Cry Through Somatic Inkblot Series. J. of Proj. Psy. And Mental Health, 5, 2: 119-128 Holtzman,W.H.(1956)Inkblot Perception and Personality,University of Texax Press, Texas. Kwiatkowska,H.Y.(1978)Family Therapy and Evaluation through Art. Springfield,IL, Charles C. Thomas. Ulman,E.(1965) A New Use of Art in Psychiatric Diagnosis, Bulletin of Art Therapy, 4:91-116 110 Cassell et al. 112 Gayatri and Kalippan

Improvement of Psychosomatic Disorders among Tension Headache Subjects Usng Behaviour Therapy and Somatic Inkblot Series S. Gayatri Devi And K.V. Kaliappan The present study attempts to find out whether Somatic Inkblot Series could improvement in the inner life of tension headache subjects. Nineteen-tension headache subjects from the Banking Industry were administered the Somatic Inkblot Series-II, a Rating Scale and Visual Analogue Scale. Multimode behavior therapy was applied for treating the tension headache subjects. Findings showed a significant reduction in the atypical responses and an increase in the typical and most typical responses among the tension headache subjects due to multi modal behavior therapy. Pain is a psychosomatic phenomenon and a universal human experience. It has been described as nature’s biological invention and on numerous occasions, it gives advance warning of a danger to be avoided. Tension headache may be facing disappointments. They are found in those who are very ambitious and facing disappointments. They are found in those who are very additions and feel the need to achieve. Headaches are also found amongst perfectionists and those tithe low self-concept. They occur when the skeletal muscles of the head and neck contract, and contraction is an indication that the muscles of the head and neck contract, and contraction is an indication that the musicales are prepared for action. Also at time contraction severs to inhibited\t the motor emersion of the aggression due to suppressed hostility of all inhibit the motor expression of the aggression due to suppressed hostility of all the headache patients seen by the physician, 80% suffer from muscle contraction of tension headaches. Muscle contraction headache can manifest itself in relationship to stress, depression, anxiety, emotional conflicts, fatigue, repressed hostility or simply creating an environment too difficult for the patients to handle. Muscle contraction headaches can occur at any age but are more common in adulthood, when life’s frustrations tend to dominate. Friedman and his colleagues (1964) in their review of 2000 cases noted that most of the patients with muscle contraction headaches were females. Most of their patients indicated that the onset of headache occurred between the ages of 20 and 40 years. Many had daily pains, and 20% had persistent pains occurring at lest for times a week. Human figure drawings have been used to evaluate the subjective experiencing S. Gayatri Devi, Research Scholar, and Dr. V.K. Kaliappan, Professor and Head, Department of Psychology, University of Mardras- 608005 (India) The auditors thank Dr, Wilfred A. Cassell for his comments in improving this research paper. SIS J. Proj. Pst. & Ment Health (1997) 4: 111-118

of illness. Tait & Ashore (1995) described their Inside the Body Test to study body image is a variety of medical conditions. The procedure involved having patients draw and label their perception of their illness from an outline of the human body presented to them. Wickelgren (1989) reported on how migraine patients perceived their headaches in are. Nina T. Mathew of the Houston Headache Clinic had observed that paintings and drawing can portray y suffering and physical symptoms with a vividness lacking in viral description. In Boston, Exiles L.H. Spieling and John R. Graham have collected and art series in this subject area. They have observed that migraine suffers have subjective experiences are due to a bonfire medical condition. Upon seeing “headache art” Speirling was told by several patients-“this is exactly like my pain, I can’t believe it’. British headache art provides the first examples of the perceptual distortion long observed in classical migraines. This was pioneered by Marcia Wilkinson of the London Migraine Clinic who found that many paintings and drawings of headache sufferers had a pattern to zigzag lines representing visual abnormalities associated with migraines (Cassell, 1990). Somatic Inkblot series developed by Casselll seems to be a better projective diagnostic tool and an adjunct psychotherapy especially with psychosomatic disorders. The present investigation is to understand the inner cry, and “cry for help” of the Tension Headache subjects and also to find out the reduction in frequency, Duration and Intensity among the Tension Headache subjects by using Somatic Inkblot Series due to application of multimode behavior therapy. The study also aims in assessing the predictive ability of the Somatic Inkblot Series in the improvement of tension headache subjects. Method: Sample: The sample for the present study was of 19 subjects (13 females, and 6 males) suffering from tension headache working in Banking Industries. The sub jests volunteered themselves for therapy to reduce the tension headache. The age of the sunsets varies for therapy to reduce the tension headache. The age of the subjects varied from 22 to 52 years. All of them were graduates. Design: Multiple Baseline Design Across subjects was used. He data was collected before the treatment, after the treatment, and follow-up after six months. The behavior therapy constituted of Jacobson Progressive Muscular Relaxation. Systematic Desensitization, Cognitive Restructuring and A assertive Training as per the subjects requirements. 112 Gayatri and Kalippan

Tools: A Ratinf Scale (Latha and Kalpiappan, 1987) was used collect the personal details such as age, educational qualifications , number of children, number of dependents, family type and headache frequency, intensity duration. Accompanying symptoms and precipitating factors. Somatic Inkblot consisting 0f 62 pictures (31 in each series A and B) constructed by Wilfred A. Cassell (1980) and also the Visual Analogue Scale (Aitken, 1969) were administered. Results: The data collected were analyzed by using repeated Measure Man ova. The differences in the pre, post and follow-up assessment of mean squires, sum of squares, ‘F’ ratio and significance on frequency, duration, intensity, accompanying symptoms, precipitating factors, Visual Analogues Scale, total responses, typical, atypical, human. Animal, sex, most typical, anatomical ad rejection responses were given Rating Scale and Visual Analogues Scale The Mean and S.D.’s of the Rating Scale and Visual Analogue Scale in the pre post, and follow-up assessment is presented in Table1. Table 1 Mean and S.D.’s of Pre, Post, and Follow-up in Frequency, Duration Intensity, Accompanying Symptoms, Precipitating Factors and Visual Analogue Scale. Pre Post Follow-up Rating Mean S.D. Mean S.D. Mean S.D. Frequency 3.84 0.69 1.37 0.50 0.58 0.51 Duration 4.42 0.84 0.95 0.62 0.47 0.51 Intensity 4.21 0.54 1.37 0.90 0.47 0.70 Accompany Symptoms 2.31 0.92 0.42 0.77 0.00 0.00 Precipitating Factors 1.90 1.20 0.16 0.50 0.00 0.00 Visual Analogue Scale 9.16 0.77 1.47 1.50 0.68 1.38 SIS in Tension Headache 113

Table 2 shows the sum of squares, mean squares, Degrees of freedom, “F” value and the level of significance in the Rating Scale and Visual Analogues scale. The frequency, duration, intensity, accompanying symptoms, precipitating factors and severity of the headache was treated with the multimode behavior therapy. The treatment of the tension headache subjects in the multimode behavior therapy for the frequency, duration, intensity, accompanying symptoms, precipitation factors and severity of the headache reveals a significant difference at 0.00 level of significance in the pre, post and follow-up, but no difference was found between the male and female subjects in the pre, post and follow-up assessment of the Rating Scale and Visual Analogue Scale. Table 2 Sum of Squares, Mean Squares, Degrees of Freedom, F Value and the Level of Significance Rating Scale & Visual Analogue Scale SS DF MS F SIG. Within cells 11.27 0.33 Frequency Time 9.88 49.994 150.662 *** Sex by time 0.50 0.29 0.88 N.S. Within cells 12.76 0.38 Duration Time 161.66 80.83 215.37 *** Sex by time 1.38 0.69 1.84 N.S. Within cells 14.40 0.42 Intensity Time 124.51 62.26 146.97 *** Sex by time 0.93 0.47 1.10 N.S. Within cells 14.05 0.42 Accompanying Time 40.83 20.41 49.39 *** Symptoms Sex by time 2.93 1.47 2.55 * Within cells 19.86 0.58 Precipitating Time 36.63 18.31 31.35 *** Factors Sex by time 0.14 0.07 0.12 N.S. Within cells 33.85 1.000 Visual Analogue Time 693.10 346.55 348.3 *** Scale Sex by time 2.15 1.08 .08 N.S. *** = Significant at .001 Level *=Significant at .05 level N.S. = Not Significant 114 Gayatri and Kalippan

The means and S.D.’s in the pre, post and follow-up assessment for Somatic Inkblot Series-II is presented in the Table-3 Table 3 Mean and S.D.’s OF Pre, Post and Follow-up in Total Responses, Human, Animal, Anatomical, Sex, Most Typical, Typical, Atypical, and Rejection of Images Pre Post Follow-up Rating Mean S.D. Mean S.D. Mean S.D. Total responses 66.58 8.66 62.90 4.40 63.58 3.72 Human 336.0 34.42 5.50 36.42 5.53 Animal 10.90 7.30 11.16 5.25 10.00 4.80 Anatomical 11.37 6.30 13.26 5.01 13.53 5.41 Sex 0.42 0.96 0.05 0.23 0.11 0.46 Most Typical 14.05 1.55 15.79 0.98 16.74 1.05 Typical 39.58 7.73 52.05 4.40 56.26 4.15 Atypical 26.90 6.72 10.53 3.17 7.47 2.88 Rejection 0.79 2.76 1.53 2.16 1.21 1.96 The table 4 shows the sum of square, mean squares, Degrees of freedom, F Value, and the level of significance of the Somatic Inkblot Series-II in the pre, post and follow-up assessment of the tension headache subjects. The effect of the multimode behavior therapy indicates a significant reduction in the total responses at 0.05 level of significances and typical responses at 0.001 level of significance. The most typical and atypical responses found to have significantly improved at 0.001 level of significance. Whereas there was no significant difference found in Human, Animal, Anatomical, Sex and Rejection responses of tension headache subjects in the Somatic Inkblot Series –II Since. It is considered as a social stigma of speaking about sex in public or discussing with friends, hence the lack of significant difference in the sex responses of Indian subjects might be due to this factor. SIS in Tension Headache 115

Table 4 Sum of Squares, Mean Squares, Degrees of Freedom, F Value and the Leavel of Significance Source of Somatic Inkblot Variation SS DF MS F SIG. Within cell 804.97 23.68 Total responses Time 193.28 96.64 4.08 * Sex by time 65.77 32.89 1.39 N.S. Within cells 681.00 20.03 Human Time 46.84 23.43 1.17 N.S Sex by time 91.28 45.64 2.28 N.S. With in cells 317.58 9.34 Animal Time 26.41 13.21 0.85 N.S. Sex by time 53.75 26.88 2.88 N.S. Within cells 530.74 15.61 Anatomical Time 26.41 13.21 0.85 N.S. Sex by time 19.26 9.63 0.62 N.S. Within cells 8.46 0.25 Sex Time 0.70 0.35 1.40 N.S. Sex by time 0.70 0.35 1.40 N.S. Within cells 52.71 1.55 Most Typical Ti me 65.36 32.68 21.08 *** Sex by time .87 0.43 0.28 N.S. With cells 780.99 34 22.97 Typical Time 2390.03 1195.01 52.02 *** Sex by time 84.34 42.17 1.84 N.S. Within cells 559.25 16.45 Atypical Times 3677.31 1838.66 111.78 *** Sex by times 7.42 3.71 0.23 N.S. Within cells 189.79 5.58 Rejection Times 13.79 6.90 1.24 N.S. Sex by time 25.02 12.51 2.24 N.S. *** = Significant at .001 Level *=Significant at .05 level N.S. = Not Significant 116 Gayatri and Kalippan

Discussion: The Frequency, Duration, Intercity, Accompanying Symptoms and Precipitating Factors were studies by Latha and Kaliappan (1987) using the same rating scale among tension headache and migraine headache subjects. These subjects could improve in their headaches by having less frequently attacks of headache due to the Yoga training. Brenda (1985, 1989(administered Pathogenic training, Jacobson Progressive Muscular Relation and Biofeedback among the tension headache subjects to reduce the severity of headache as measured by the Visual Analogue Scale. The subjects reported a significant reduction in the severity of headache in the post and follw-up. The tension headache which is experienced by every one at one time or other was found to be associated with the psychosomatic disorder it was made clear by the screening of the tension headache subjects with Somatic Inkblot Series- II. These psychosomatic factors were found to be indirect causative agents of the tension headache among the sufferers. With the administration of multimode behavior therapy these were found to have reduced in the total and atypical responses and a significant increase is seen in the typical and most typical responses, thus indicating the effect of multimode behavior therapy in redacting tension headache with reference to psychosomatic factors. Conclusion: The multimode behavior therapy was found to be more effective I reducing the tension headache associated with psychosomatic disorders and Somatic Inkblot SERIES-II was found to be an effective tool to identify the inner cry for help from the tension headache subjects and the follow-up of the cases showed improvement. References: Aiten R.C. (1996) Mearsuof Feedings Using Visual Analogue Scale Seale Journal of Royal Society of Mediccal 62 989-993. Bruta, A. (1985) Authoric Therapy in Tension Headache- Unpblished M.Phill DixcertationNIMHANS. Banglore Brutda, A (989) Behavioural Manage,ment of Tension Headache Upnblishe-Unpublished ph.D. Dissertation NIMHANS. Banglore SIS in Tension Headache 117

Cassell. W.A.. (1980) Body Symbolism and Soamtic Inkblot Series Arora Publisjing Company Anchorage Alasska. Cassell W.A. (1990) Somatic Inkblot Seroes Manual Administrations, Scoring and Interpertation Paloo Alto C.A. Fridman A.P.P. Von Storch, T.J.C. & Merrit H.H. (1964) Migrain and Tension Headches A Clinical Studyy 2000 cases Neurology 4,773 Tait C.D. and Ascher R.C.. (1955) Indide the Body Test Psychosomatic Medicine, 17, 139 Wickelgren I (1989) Images of Pain Science Neews 136-137. 118 Gayatri and Kalippan

Content Scale Based Diagostic Compatibility of the SIS-II with Rorschach Test in Normal, Neurotics and Schizophrenics Mridula Mishra C.B. Dwivedi The present study compares the diagnostic indices of the SIS-II with the Rorschach test in Normal. Neurotic and schizophrenics. The sample is comprised of normal, 50 neurotics and 50 schizophrenics. The results suggest that the diagnostic confidence certainly, which is achieved by the SIS-II and the Rorschach in diagnosing and schizophrenics compares well. The study further suggest that both the tests provide ample support to the theory that SIS-II provides certain additional diagnostic information’s which are not available through the Rorschach, The results also suggest that the SIS-II indices as compared with the Rorschach indices, discriminate better the normal subjects and parade schizophrenics whereas the Rorschach indices discriminate better the depressive neurotics and undifferentiated schizophrenics. An overview of the studies conducted to ascertain the differential diagnostic capacities of the Rorschach test and the SIS-II brigs out certain inherent inadequacies in their research designs. One of the innovations of the present research is a design, which attempts an examination of the diagnostic compatibility of the two tests on some indices which have been unanimously found to be hard core indicators. This permits a methodological congruence’s in the two tests based on their commonality with reference to the test administration, scoring and interpretation. A number of different system have been proposed (Exner, 1986; Klopfer et. al. 1954; Piotrowski 1965) for scoring and interpreting the Rorschach protocols, of which the systems proposed by back (1945, 1952, 1960), Beek et al (1971) have received more attention. However, inspire of wide variations among the above mentioned systems, none of them differs completely either from each other or from the Rorschach’s original conception (Dubey, 1982). Little has been done for quantifying the contents of the SIS-II responses. An attempt was made by Dubey and Cassell (1993), who tried to quantitatively Mridula Mishra, Ph.d. Clinical Psychologist and Leerier in Psychology. Diva Institute of Mental Heallth, B-27/70, Durga Kuna, Varanasi – 221 005 and C.B. Dwivedi. Ph.D., Dept. of Psychology, B.H.U., Varanasi – 221 005. This paper is based on the doctoral research carried out by the first author under the supervision and guidance of the second author. Part of the paper was presented in the III International Conference of the SIS heal at Chandigarh, From Fed. 22-25. 1996. We gratefully acknowledge the comments and suggestions of Wilfred A. Cassell B.L. Dubey. M.K. Mandal and Rakesh Pandey on an earlier draft of this paper. SIS J. Proj. Pst. & Ment Health (1997) 4: 119-137

some the SIS responses contents according to the Rorschach content categories. They categorized the SIS-II responses under the following content categories; Human details, Animal, Animal details, Anatomical, Flying animals and others. Following this work, several other researchers utilized similar content categories for scoring the SIS-II responses (Dubey, et.al., 1994; Dwivedi et, al., 1995 Pershad & Dubey, 1994, Peshad & Verma, 1995 Verma et. al., 1995). These studies revealed the following commonly used content categories: Animals (A), Anatomical (At). Human (H) Sex (Sex), and the most typical (MT). (similar to the popular (P) responses of the Rorschach). Besides test content categories there are certain other common indices, where an agreement exists between the Rorschach and the SIS in their respective scoring of responses. There are the ‘total number of responses ® rejection fof the images inkblot (Rej), human movement (M) Dwivedi et. al., 1994 Pershad & Dubey 1994: Pershad & Verma, 1995 Verma et.al., 1994 Although the scoring of movement (M and FM) responses in the SIS-II is done in the same way as is done in the Rorschach, the Rorschach scoring systems consider these indices as the determinants of certain responses. Contrary to this, the SIS does not score movement responses as a determinant. Against theist line of agreement between the scoring scheme of content categories of the two tests, it is hypothesized that the SIS-II would provide the same diagnostic information’s as the Rorschach, when both the tests are scored for the following confluent content indices; the R, Rej, M, FM, A, At, Sex, H. and the MT/Pop. Nevertheless, the interpretations f these scoring indices hardly follow a reselect between the two test. Different researchers attribute different psychological functions in Rorschach test to the same index (Exner, 1986 for a review). For example, in interpreting the pure form responses Rapport and associated (Rapport et, al., 1946) suggested them to reflect a conflict – free sphete of ego-functioning, but on the other Hans, Beck (1945) and klopfer et. al. (1954) argued that in given pure form responses, conflicts SIS J. Proj Psy. & Ment Health (1997) 4:2 SISJ. Proj Psy. & Ment Health (1997) 4:2 controlled by conscious operations are present. It is thus intuitively clear that there are apparent differences in interpretation of the above-mentioned congruent content indices. To address this problem of an apparent differenced in interpretation of Rorschach and SIS-II indices, the present woks has not made any attempt either to interpret the indices or to provide a diagnosis based on the, the present study has followed a pure quantitative-statistical approach for examinant the diagnostic significance of the above mentioned content indices. In other, the present research has only attempted to examine the discriminative capacity of each if the above mentioned 120 Mishra & Dwivedi

commonly scored nine indices for discriminating reclassified and pre diagnosed pathological cases as well as normal controls. It has been reported that the schizophrenic patients usually give more anatomical, blood, and sex responses as compared to other clinical and normal categories (Asthana, 1971: Asthana & Mohan, 1977; Dubey, 1982; Kumar, 1963). The indices found to be helpful in discriminating neurotics were number of responses ®, F+%, M (less in neurotics as compared to normal but more than schizophrenics). Anatomical responses, shading responses and rejection of cards were some of the other significant diagnostic indicators of neurosis (Dubey, 1982; Sharma & Khanna, 1977; Ojha, 1992; Ramachandra, 1994). Dubey, et al (1994) conducted a cross-cultural study using the SIS-II on 220 subjects (including 100 normal controls, 39 neurotics, 41 schizophrenics and 40 American neurotics). The results showed that normal subjects gave more responses than neurotics and schizophrenics. Consequently, the rejection was more in clinical groups than in normal. Dubey and Cassell (1993) administered SIS-II on 165 subjects including 30 schizophrenics, 25 neurotics, 10 psychosomatics and 100 healthy subjects to find out the normal pattern of responses. It was observed that a normal subject generally gave 70 responses on an average; 25 percent human content, 13 percent animal and nearly 18 percent anatomical content. 13 percent animal content and nearly 18 percent anatomical content. The SIS-II test was administered to 300 normal subjects, 100 neurotoics and 100 schizophrenic subjects by Dubey, Cassell, Pershad and Dwivedi (1995) to find out whether some of the objective scoring criteria can be formulated to differentiate patients of neurotic and schizophrenic groups from the normal subjects. It was found that certain indices such as most-typical responses, rejection of images, pathological responses and a typical responses were able to discriminate normal subjects from clinical groups. Normal subjects gave more of most-typical responses than did the neurotics and schizophrenic subjects. Schizophrenics gave lowest number of most typical responses. Rejection of images was lowest in normal subjects and it was high in clinical groups. Rathee et al (1995) administered SIS-II to 150 army subjects (50 each of psychotic, neurotic, and normal groups) and found that psychotic patients tend to produce higher number of rejection of images. Normal subjects projected more typical responses with less rejection of images. Besides the above, an attempt has been made in the present study to use the pathological cases of sub types of schizophrenia. Most of the studies have examined mixed schizophrenic population and compared their scores against normal controls. In sharp contrast to those studies, the present research aims SIS & Rorschach 121

at examining the diagnostic efficacy of the Rorschach and the SIS-II in differentiating (i) normal controls from various pathological groups (viz., paranoid schizophrenia and undifferentiated schizophrenia), (ii) neurotics depressives and anxiety neurotics from paranoid schizophrenia and undifferentiated schizophrenics, (iii) specific subtype of neurosis or schizophrenia from and other subtypes of the same major pathological group (such as undifferentiated schizophrenics from paranoid schizophrenics) and anxiety neurotics from neurotic depressives. Psychometric literature suggests that for any diagnostic test sensitivity and specificity must be reported. However, scant quantitiative information is available regarding the sensitivity and specificity of the Rorschach test and SIS-II indices for schizophrenics and normals. Most of the studies examining the diagnostic confidence of the Rorschach test have followed a subjective approach. For example, Bagadia et al (1971) tried to diagnose schizophrenia on the basis of Rorschach alone and found that 83% of the pre-diagnosed schizophrenics were correctly diagnosed by the Rorschach test. However, due to the subjective approach this index of diagnostic certainty appears to be seriously restricted. Towards this end, in the present research an attempt has been made to ascertain the index of diagnostic certainty of the Rorschach and the SIS-II by using an objective statistical technique of multiple discriminant analysis. Relatively fewer studies have been done to examine the diagnostic sensitivity of the SIS-II for schizophrenic and neurotic patients. Most of the studies have examined its efficacy for psychosomatic patients and other patients with somatic concern (Rathee et al. 1994). In this context, it is imperative that external validity of the Sis-II must be established on a sound scientific footing so that the criticisms lavelled against the Rorschach may be dispelled. Despite the fact that on certain aspects of scoring of content categories, the Rorschach and the SIS-II are comparable, so far only two studies have tried to compare the Rorschach with the SIS-II (Dubey & Cassell, 1993; Dwivedi, Mishra & Dubey, 1995). On a closer scrutiny it becomes clear that even these studies in fact provide only empirical support to the compatibility of the scoring indices. They do not address the problem of diagnostic compatibility of the two tests. Besides ascertaining the diagnostic compatibility of the two tests an attempt has also been made to establish the normative data for the nine content indices of the SIS-II. It is expected that the norms so developed will be helpful in interpreting this test by later researchers. In a nutshell the specific objectives of the present study are; 1. to find out the SIS-II and Rorschach indices discriminating amongst normal, anxiety neurotics, neurotic depressives, paranoid schizophrenics and undifferentiated schizophrenics. 122 Mishra & Dwivedi

2. to prepare a normative profile of SIS-II on normal testees. Method: Sample: The sample consisted of 300 adults (193 males and 107 females) aged 20 to 50 years (mean = 26 years 3 months). There were 200 normal (nonclinical) subjects (mean age = 26 years 4 months) and 100 pathological cases [ 25 each in anxiety neurosis (17 males and 8 females, mean age = 31 years 7 months), depressive neurosis (19 males and 6 females, mean age 28 years 1 month), paranoid schizophrenia (19 males and 6 females, mean age = 28 years 7 months) and undifferentiated schizophrenia (14 males and 11 females, mean age = 26 years)] on whom SIS-II was individually administered. Besides the SIS-II test, all pathological cases and 50 normal subjects were also tested on the Rorschach inkblot test. The pathological cases for this study were taken from the Deva Institute of Neuropsychiatry, Varanasi. Only those cases were taken which had confirmed clinical diagnosis of anxiety neurosis, depressive neurosis, paranoid schizophrenia or undifferentiated schizophrenia as per D.S.M. III-R (1987). The normal healthy control subjects were the non-blood relative attendants of the patients. Procedure: The data collection was done after the confirmed diagnosis of a pathological case. The preliminary biographical information about the case was noted on the response sheet. This was done to ensure the establishment of a workable rapport after which the instructions were imparted in an informal manner. The instructions were read slowly. The example blot printed in the SIS-II booklet was shown to explain the manner of responding. The Rorschach test was administered on a separate day as per instructions and directions of Klopfer et al. (1954). Results: Obtained responses on the SIS and the Rorschach test were scored following the standard procedures as given in their respective manuals. Tables 1 and 2 respectively present the means and S.D.s for the above stated nine indices of the SIS-II and the Rorschach tests computed separately for the neurotics and schizophrenic as well as normal. SIS & Rorschach 123

Table 1 Mean Scores and S.D.s on Nine Indices of the SIS-II for Normal and Pathological Groups Scoring Indices Normal Neurotics Schizophrenics (N=50) Anxiety Neurotic Paranoid Undifferen Neurotics depressives tidated (n=25) (n=25) (n=25) (n=25) Total number M 64.34 64.28 63.16 61.68 61.76 of Responses SD 4.21 5.45 3.39 3.36 2.28 Human M 21.86 20.80 20.88 19.96 17.888 responses SD 4.34 4.77 3.47 5.66 4.24 Animal M 7.80 11.12 10.44 10.12 11.36 responses SD 3.23 4.46 4.13 4.93 5.17 Anatomical M 12.20 13.44 14.40 12.44 16.04 responses SD 3.79 5.94 5.66 6.69 7.63 Sex M 1.12 1.16 1.28 2.08 1.44 responses SD 1.32 1.62 1.43 2.85 1.75 Human M 3.46 2.44 3.48 3.12 2.24 movement SD 2.58 1.90 2.90 3.00 2.08 responses Animal M 1.14 1.32 1.20 1.44 0.72 movement SD 1.23 1.22 1.20 2.37 0.87 responses Most M 16.30 14.56 14.72 11.20 10.84 typical SD 1.32 0.85 1.00 2.28 1.32 responses Rejection M 0.58 1.56 1.44 2.56 2.28 of images SD 1.40 1.24 1.36 2.53 2.16 Mean total number of SIS responses for four pathological groups range from M =61, 68, S.D. = 3.36 (paranoid schizophrenics) to M= 64.28. S.D. = 5.45 (anxiety neurotics). The corresponding mean total responses of normal subjects was M= 64.34, S.D.= 4.21. The trend of mean scores for pathological groups was almost similar where the highest mean score was amassed by the human move- 124 Mishra & Dwivedi

ment, rejection, animal movement and sex categories. The depressive neurotics, and paranoid, and undifferentiated schizophrenic groups, however followed a slightly different pattern where the mean sex responses outnumbered animal movement responses. A comparison of means of the pathological and normal groups shows that the SIS can clearly distinguish the patients on the indices of rejection, animal movement and sex responses. The mean rejection scores of normal subjects was 0.58, S.D.=1.40 while the mean score for pathological groups were invariably higher. The higher mean rejection has been obtained by the paranoid schizophrenics (=2.56 S.D.=2.53) anxiety neurotics (M=1.56, S.D.=1.24), and depresses neurotics (M=1.44, S.D. =1.36). A similar picture emerged for the other two indices where pathological groups overshadowed normal. However the mean scores for the animal movement by undifferentiated schizophrenic groups (M-0.72, S.D. –0.87) was slightly lesser than that of te normal group (M=1.14, S.D. =1.23). It can safely concluded that the indices pf animal responses, most-typical responses and rejection of images very well differentiated normal from four pathological groups. Hence, these can be taken as hard-core indicators. Other indices such as total number of responses, anatomical responses, human movement responses, and human responses have been found to differentiate normal from undifferentiated schizophrenics. The schizophrenic patients are known to have thinking disturbances. Therefore, their imagination for SIS images is likely to differ greatly with normal subjects. The present findings support the contention of Cassell et. al. (1995). On the other hand the mean total number of Rorschach responses (Table-2) by the anxiety neurotics (Mean=15.80, S.D.=2.56) was the highest amongst the four pathological groups. Depressive neurotic subjects (M=15.08, SD=2.37) obtained slightly less than that of anxiety neurotic subjects. Undifferentiated schizophrenics obtained a mean of 14.04 with S.D., = 4.14. The variability was highest in this group. The paranoid schizophrenic’s mean total number was the lowest (Mean – 13.96, S.D. = 3.82)). A similar trend was visible in other two indices, i.e., animal responses and animal movement responses. Popular responses were highest in anxiety neurotics (Mean = 4.36, S.D. =0.62), followed by the depressive neurotics (Mean=4.28, S.D. =0.53) paranoid schizophrenics (Mean = 2.04, S.D. = 0.87), and undifferentiated schizophrenics (Mean=1.88, S.D. = 0.95. Both the neurotic groups contained significantly higher popular responses than both the \schizophrenic groups. This trend is universal and the schizophrenics are known to give low popular responses because of their poor contact with the reality (Aroma & Reznikoff, 1973). SIS & Rorschach 125

The schizophrenic groups rejected more cads than the neurotic groups. The mean number of rejection was 0.16 in anxiety neurosis as well as depressive neurosis groups. Paranoid schizophrenics rejected highest number of cards(mean- 0.68, S.D.=1.17) followed by the undifferentiated schizophrenics (Mean=0.60, S.D. =0.85). Depressive neurotics obtained maximum anatomical responses (Mean=2.56, S.D.=1.88 (Cassell, 1979), followed by the undifferentiated schizophrenics (Mean =2.44 S.D. 2.58) and paranoid schizophrenics (Mean = 2.40, S.D.2.99). Table 2 Mean Scores and S.D.s on Nine Indices of the SIS-II for Normal and Pathological Groups Scoring Indices Normal Neurotics Schizophrenics (N=50) Anxiety Neurotic Paranoid Undifferen Neurotics depressives tidated (n=25) (n=25) (n=25) (n=25) Total number M 2.50 15.80 15.08 13.96 14.04 of Responses SD 4.78 2.56 2.37 3.82 4.14 Human M 3.38 2.16 2.48 1.92 1.88 responses SD 1.94 1.22 1.58 1.29 1.56 Animal M 10.68 9.44 8.247 6.56 7.24 responses SD 4.37 3.15 2.58 2.17 3.05 Anatomical M 1.882 1.88 2.56 2.40 2.44 responses SD 1.93 1.56 1.88 2.99 2.58 Sex M 0.34 0.32 0.44 0.48 0.60 responses SD 0.79 0.93 1.10 1.30 0.89 Human M 2.06 1.08 1.24 0.60 0.68 movement SD 1.64 1.20 .24 0.57 1.04 responses Animal M 4.86 3.56 2.64 2.17 1.76 movement SD 3.11 2.17 1.26 1.70 1.74 responses Popular M 5.44 4.36 4.28 2.04 1.88 responses SD 0.80 0.62 0.53 0.87 0.95 Rejection M 0.04 0.16 0.16 0.68 0.60 of images SD 0.20 0.46 0.37 1.17 0.85 Higher mean number of human response and human movement responses were observed I the two neurotic groups than that of the two schizophrenic groups. 126 Mishra & Dwivedi

Human response s were highest in depressive neurotics (Mean = 2.48. S.D. = 1.58) followed by that of the anxiety neurotics (Mean=2.16, S.D. = 1.22). Paranoid schizophrenics 9Mean = 1.92, S.D. = 1.29) and undifferentiated schizophrenics (Mean=1.88, S.D. = 1.56. Human movement responses were neurotics (Mean=1.08, S.D. –1.20), undifferentiated schizophrenics (Mean= 0.68, S.D. = 1.04) and paranoid schizophrenics (Mean = 0.60, S.D. 0.57). Almost a similar trend was conserved in four pathological groups on human responses and human movement responses categories. Both the schizophrenic groups gave more number of sex responses than neurotic groups. However, the mean values were quite similar I te two groups. The Rorschach indices of normal subjects vis-à-vis the four pathological groups extend the theory that normal subjects elicit higher total number of response stets (see, for example, Asthenia, 1971; Beck, Beck, Levitt, & Molish 1971; Dubey, Pershad & Cassell 199; Klopfer et al., 1954). Provide support to this observation. The normal subjects however, gave lowest number of anatomical responses while depressive neurotics gave the highest number of anatomical responses. Because of somatic preoccupation neurotics are known to give more somatic and anatomical responses. On one hand, normal subjects give almost lowest sex responses. On the other hand, preoccupation has been described as characteristic phenomenon o schizophrenia and the present finding supports this contention. Schizophrenics rejected maximum number of cards followed by normal and neurotics (Dubey, 1981,Dubey & Cassell, 1993). Tables 3 and 4 display the ‘t’ values obtained from the intercrops comparisons for various scoring Indies of the SIS-II and Rorschach tests, respectively. The norms subjects elicited more number of total responses on SIS-II than the four pathological groups. The paranoid and undifferentiated schizophrenics have given significantly lesser number of total responses than either normal of anxiety neurotic groups. The normal subjects scored significantly higher mean human responses (Mean= 21.86, S.D. 4.34) than did the undifferentiated schizophrenics (Mean = 17.88. S.D. = 4.24; t = 3.79. p< 0.01). On the other hand, the mean human responses of undifferentiated schizophrenics was significantly lesser than the of anxiety neurotics (t=2.30. p<0.05) and depressive neurotics (t=2.75. O< 0.01). Mean number of animal response by the normal subjects was the lowest (Mean = 7.80, S.D. = 3.32) than were of their pathological counterparts whose mean values ranged between 10.12 (paranoid schizophrenics) to 11.36 (undifferentiated schizphr3ncs). The differentiating characteristic of SIS-II on this scoring category is thus attested by the present results. As the test is of the somatic inkblots any resemblance with animals beyond a reasonable proportion repre- SIS & Rorschach 127

sents deviation from the normalcy. The standard deviations of the pathological groups are also very high which supports the contention that these cases have a high variability in their pattern of responding. Comparisons of mean animal Reponses between normal and pathological groups shoed pathological groups to elicit significantly higher number of animal responses (t=3.32, 2.78, 2.13 and 3.15 for the comparisons between normal group and anxiety neurotics depressive neurotic, paranoid schizophrenic and undifferentiated schizophrenic groups respectively). Table 3 Intercrops Comparisons for Different Scoring Categories of the SIS-II Scoring NvsA NvsD NvsPS AvsUS AvsD AvsPS AvsUS DvsPS DvsUS PsvsUS Indices Total 0.11 1.36 3.03** 3.49** 0.87 2.03* 2.14 1.56 1.71 0.10 Number of Responses Human 0.94 1.07 1.47 3.79** 0.07 0.57 2.30 0.63 2.75** 1.46 responses Animal 3.32** 2.78** 2.13* 3.15** 0.56 0.75 0.18 0.25 0.70 0.87 responses Anatomical 1.11 1.92 0.31 2.49* 0.59 0.56 1.34 1.12 0.86 1.77 responses Sex 0.07 0.46 1.71 0.80 0.20 1.24 0.44 1.33 0.11 1.00 responses Human 1.96 0.03 0.49 2.22* 1.46 0.96 0.35 0.42 1.70 1.21 movement responses Animal 0.62 0.21 0.60 0.62 0.35 0.23 0.86 0.42 0.71 0.89 responses Most-typical 6.96** 5.64** 15.94** 17.06** 0.62 10.84** 12.00** 10.67** 11.76** 0.76 responses Rejection 3.116** 2.53* 3.60** 3.62** 0.33 1.79 0.24 1.93 1.65 0.42 *p<0.05; **p<0.01 Normal subjects gave the lowest number of anatomical responses than the four pathological group which goes hand in hand with the animal response category In the anatomical responses category the normal subjects and undifferentiated schizophrenics have shown statistically reliable difference (t=2.49, p<0.05) while other groups have failed to eddo so. This pattern of results is contrary to the often-voiced emphasis placed ion the SIS test. It is however, quite surprising as 128 Mishra & Dwivedi

to why all groups of the present study contained similar mean anatomical responses. It is possible that qualitatively anatomical responses might be different in five groups. A normal subject is likely to elicit anatomical responses on the images strutted to elicit anatomy. The clinical groups divided somatic imagery n images meant to elicit it and perceived anatomy on the structures generally not st6imulating any anatomy. This process of evading reality has been observed by Dharamveer et. Al. (1994) The theory of somatic repression also support our contention (Cassell, 1979, 1980b: Crog et.al. 1971; Savage 1995). The normal subjects have emitted less number of sex responses as compared to the gourd pathological groups. Higher mean number of sex responses by the paranoid schizophrenics with reference to their delusions of infidelity supports the observation of most researchers on the SIS. The mean numbers of human movement responses by the normal subjects have nee found to be quite high and it is almost similar to that of depressive neurotics. A similar pattern of responding was evident for animal movement category where the mean of normal group was less than most of the pathological groups. However, none of the comparisons reached a level of statistical significance. The mean number of most typical responses by the normal subjects was higher (Mean = 16.30, S.D. –1.32) than that of the four pathological groups whose means range between 10.84 (indifferences were found among all the groups except the ones between anxiety and depressive neurotics (t=0.62) and between paranoid and undifferentiated schizophrenics ( t=0.76). Normal subjects rejected significantly lesser number of images than did the four pathological groups. The difference between normal controls and anxiety neurotics, normal controls and paranoid schizophrenics and normal controls and undifferentiated schizophrenics were found significant at 0.01 level of confidence while the difference between normal controls and depressive neurotic group was significant at 0.05 level of confidence. The two schizophrenic groups rejected more number of inkblot images than did their neurotic counterparts. There was a suggestive difference in favor of neurotic groups but it failed to reach the significance level. These results suggest that most-typical responses, rejection of responses, animal responses and total number of responses are hard core indicators in differentiating normal subjects from the four pathological groups can also be considered as second order indicators which discriminate undifferentiated schizophrenics from normal subjects. However, sex responses and animal movement responses neither could nor prove to be diagnostic indicators in this study. Undifferentiated schizophrenics and paranoid schizophrenics gave lower number of most-typical SIS & Rorschach 129

responses, less number of total responses and human responses with higher number of rejection of images. Theses four indices i.e. low R, low MT and high rejection of images may be taken as indicators of undifferentiated and paranoid schizophrenia (Dubey et.al. 1995). Anxiety neurotics and depressive neurotics gave more animal responses, rejected more images and gave less number of most-typical responses than did comparable normal controls. These results suggest that these three indices can help in discriminating anxiety neurotics and depressive neurotics from the normal subjects. Table 4 Intercrop Comparisons for Different Scoring Categories of the Rorschach Scoring NvsA NvsD NvsPS AvsUS AvsD AvsPS AvsUS DvsPS DvsUS PsvsUS Indices Total 5.54 6.53** 6.41** 6.03** 1.04 2.01 1.81 1.26 1.09 0.07 Number of Responses Human 3.39 1.58 3.95*** 3.36*** 0.80 0.69 1.54 1.37 0.45 0.10 responses Animal 1.41 3.01** 5.49** 3.75** 1.46 0.56 2.31 22.51 1.05 1.08 responses Anatomical 0.15 1.57 0.997 1.05 1.39 0.78 .922 0.23 0.19 0.05 responses Sex 0.09 0.40 0.50 1.24 0.41 0.50 1.08 0.12 0.57 0.38 responses Human 3.06 2.14 5.84** 4.60** 0.46 1.85 1.29 1.78 1.75 0.35 movement responses Animal 2.10 4.35** 4.89** 5.668** 1.884 2.62 3.42 1.24 2.23 0.90 responses Popular 6.75** 7.25** 17.00** 16.18** 0.05 11.05** 11.27** 11.20** 10.91** 0.64 responses Rejection 1.33 1.58 2.78** 3.29 0.00 2.08* 2.32* 2.17* 2.44* 0.28 *p<0.05; **p<0.01 Comparisons between mean total numbers of Rorschach responses of normal controls with four pathological groups (see Table 4) extended highly significant differences. Normal controls significantly outdid the anxiety neurotics (t=5.54, 130 Mishra & Dwivedi

p<0.01) as also the depressive neurotics (t= 6.53, p< 0.01), paranoid schizophrenics (t=6.41,p< 0.01 and undifferentiated schizophrenics (t=6.03,p<0.01). The normal controls generated significantly more human responses than did the anxiety neurotics (t=3.39, p<0.01), paranoid schizophrenics (t=3.95, p< 0.01) and undifferentiated schizophrenics (t=3.36, p<0.01). Comparisons among four pathological groups showed statistically unimportant difference even thought depressive neurotics showed a suggestive superiority and elicited more human response than did the other three pathological groups. This factor is known to depict the phenomenon of contact with reality of respondents and an observation of mean values of this factor shows that the neurotics are more in contact with reality than are the schizophrenics (see George & Prema, 1966). Barring the comparisons between anxiety neurotics and undifferentiated schizophrenics (t=2.31, p< 0.05) as also between depressive neurotics and paranoid schizophrenics (t= 2.51, p< 0.05) on the animal responses category, none of the remaining comparisons were statistically significant. The normal controls have emitted lesser number of anatomical responses compared to the four pathological groups. Through the comparisons have not reached a level of statistical significance a suggestive of neurotic depressives and undifferentiated schizophrenics over that of paranoid schizophrenics was evident. A dismal pattern of responding was evident for sex responses category where none of the comparisons reached a level of statistical significance. Similar finding have been observed on SIS also. Both the SIS and Rorschach could not differentiate amongst the five groups on anatomical indices. The normal controls have given significantly more number of human movement responses than did the four pathological groups. Coarsen among four pathological groups showed statistically unimportant differences. Similar observations have come out of mean number of animal movement responses. Interrupts comprising among fur pathological groups showed all comparisons as statistically significant except those between nicety and depressive neurotics (t=1.84), depressive neurotics and paranoid schizophrenics (t=1.24) and between paranoid schizophrenics and undifferentiated schizophrenics (t=0.90). The mean number of popular responses by the normal subjects has been found to be fighter than that of te four pathological groups. Significant differences were SIS & Rorschach 131

found among all the groups except between anxiety neurotics and depressive neurotics 9T=0,.05) and between paranoid and undifferentiated schizophrenics (t = 0.64)> Mean number of rejection responses revealed that the normal control subjects rejected significantly lesser number of cards than did the four pathological fro up. The two schizophrenic groups rejected significantly more umber of cards than did their neurotic counterparts. The responses categories of popular responses, animal movement rejection, total number of responses, animal and human movement emerged as reliable indicators in differentiating normal subjects from the four pathological groups. Normal subjects evoked more number of responses as well as number pf popular responses, less number of human as well as anatomical responses besides low number of rejection of cards. Animal responses and animal movement responses were higher in normal subjects than were in undifferentiated schizophrenics and such categories stand out as the second order indicators which discriminate undifferentiated schizophrenics from normal subjects. Anatomical responses and sex responses could not prove to be diagnostic indicators in this study. The diagnostic certainty of the SIS-II and the Rorschach was ascertained by applying the statistics f multiple discriminate function analysis. The U-caules and their corresponding F-values demarcating the diagnostic compatibility of the SIS with the Rorschach test showed the popular responses (U=0.2231, F (4,145)+ 126.25, p<0.001) of Rorschach as the best indicator followed by human movement and total number of responses. On the other hand, the anatomical responses of SIS stepped out as the best predictor {U= 0.0971, F (24,490)= 19,408, p< 0.001} followed by animal responses of Rorschach an animal movement responses of the SIS-II. All the indices of the SIS-II were fund to be as powerful discriminator as were fund for the Rorschach test, which establishes the diagnostic certainty of the SIS-II. The contention of Casell et.al. (1995) that SIS-II is an extension f the Rorschach thus gets statistically supported 9Cassell et. Al.. 1995). It also validate the discriminating power of SIS-II and as SIS fares quite well with the Rorschach, the parallel status of the SIS is established by the present findings (Misra, 19945). Table 5 presents the percentile norms for the nine indices employed in this study. These norms extend some interesting features of responding by the nor- 132 Mishra & Dwivedi

mal control subjects. These norms also vindicate the contention that this test can easily discriminate normal subjects from other pathological groups. Although this holds true for all the nine indices used in the present study, yet some factors clearly stand out as hard core markers which need to be briefly mentioned. Total responses emerge as a key marker in as much as it is noticed that at P5 there are 55 responses, which reach unto 79 at P100. The medical pint of this index is 66. In other words, this index clearly discriminates normal subjects from other scores range from 14 to 31 with median at 2. The scores of pathological groups on this index are much less. The animal responses are lesser in normal controls, which range from 2 to 20 with a median at 8. Index of rejection shoes zero response unto p60 while the pathological groups evince much higher rejection of images. The norms derived on the basis of the normative sample of the present study have, however drastically limited value and it needs to further enriched by administering SIS-II on a much larger normal control group. Discussion: One of the main objectives of the present study was to examine the diagnostic sensitivity of specific indices of the SIS-II and Rorschach. The results brought to that the total number of response index on the Rorschach test was sensitive in discriminating normal controls fro the pathological groups while the same index on the SIS-II was found sufficiently sensitive in discriminating schizophrenics from wither the neurotics or normal groups. The index of human responses on the Rorschach adequately discriminated the normal controls from the pathological groups of anxiety neurosis, paranoid schizophrenia, and undifferentiated schizophrenia (but not from the depressive neurosis) On the other hand, this as well as anatomical indices on the SIS-II were found most sensitive to discriminate undifferentiated schizophrenics from other groups. The indices of animal responses and the rejection on the SIS-II were found sufficiently sensitive to discriminate normal controls from other psychopathological groups. On the contrary these indices on the Rorschach were found sensitive to discriminate schizophrenia from other psychological groups controls from other psychological groups. Finally, the indices of human movement animal movements were found sensitive indicators of psychopathology on the Rorschach but they failed to do so on the SIS-II. The reasons for this are not far to seek as the SIS-II is a structured test; its specificity is more with the anatomical and human responses rather than on the movement per se (Cassell et. Al. 1995) Dubey & Cassell, 1993) SIS & Rorschach 133

Table 5 Percentile Norma\s Based on the Responses of Normal Controls for Nine Scoring Indices of the SIS-II Percentile Total Human Animal Anatomical Sex Human Animal Most Reje Points no. of responses mica responses respon movement movement typical ction Responses ses responsesresponses responses P100 P 95 P90 P85 P80 P75 P70 P65 P60 P55 P50 P45 P40 P35 P30 P25 P20 P15 P10 P5 There are certain reasons for the differential sensitivity of thaws tests. For example, the finding that total number pf responses on the Rorschach discriminated normal subjects from the psychopathological groups but the same index 134 Mishra & Dwivedi

on the SIS-II failed to so, may be explained if the nature of the stimuli wised in both the tests is taken into account. In the SIS-II, most of the stimulus images are dominated by a definite structure while it the images of the Rorschach test are unstructured. The unstructured image of the Rorschach provides an opportunity for the normal subjects to produce more than one response. On the other hadn’the more structure d in ages of the SIS-II restrict the pattern of responding to that very structure which remains embedded in the give image. Presumably because o this, the normal and patients with soft psychopathology (e.g., neurotics) give almost equal number of responses (usually one for each in age) on the SIS-II while on the Rorschach the normal subjects, produce more than one responses (due to unstructured nature of the inkblot plates)> This finding attests most of the earlier studies (Cassell, 1980b: Dubey & Cassell. 1993: Cassel et. Al., 1995, Dwivedi et. Al. 1995) Similarly, the observation about the “rejection” response on the SIS-II as not being able to discriminate among psychopathological groups can be explained wit reference to the specific image structure or content of the images of SIS-II. For example, the rejection of interpersonal situation (reject of image 9A, 21A, 28A, 31A, 4B, 5B, 31B), or the rejections of sex/erotic imagery (rejection of images 4A, 8A, 22A, 25A, 27A, 18B, 25B) were differentially visible in pathological cases with those specific syndromes. This can be analyzed only individually. However in order to have a compatibility in the devoting systems, the present study screed only the total number of rejection responses on the SIS-II as was done with the RORSCHACH. Cassell (1980b) has suggested that the rejection of specific image provides information about specific psychopathology (e.g., rejection of sex content is very common among the patients with sexual deviation). In such a situation the total umber of rejection of SIS0II images would presumably fail to discriminate between the psychological groups. The human and animal movement responses emerged as sensitive indicators of psychology on the Rorschach but similar was not visible on thesis-II. Similarly, it has seen reported that responses storable on the animal index are mostly found on the Rorschach (around 40 to 60%) while they are very rare on supported the contenting of near “floor effect” for these indices of the SIS-II, and as such it presumably failed to discriminate between normal neurotics and schizophrenics. The present results have attested the contentions of Cassell (1980a) that the SIS & Rorschach 135

SIS-II provides a better insight into the problems of ailing patients by bringing out his “inner cry” to the forefront. This assertion becomes all the more visible if the SIS-II is analyzed quantitatively. In such a situation it is expected to provide diagnostic information similar to that of the Rorschach as well as some additional information not provided b the Rorschach (e.g. the image-specific) sex responses and the percent-specific anatomical responses). The present study also compared the diagnostic confidence/certainty, which can be achieved by the SIS-II and the Rorschach in diagnosis the neurotic and schizophrenic as psychopathology. This observes increase in the diagnostic confidence when both the test is used provide sample support to the theory that the SIS-II provides certain additional diagnostic information’s which are not available through the Rorschach. The results of the present study revealed that the SIS-II indices comparable with the Rorschach indices better discriminate the normal subjects and paranoid schizophrenics where the Rorschach indices between discriminate the depressive neurotics and undifferentiated schizophrenics. References: Cassell,W.A.(1977) Aggressive Imagery and Clinical Symptoms in Schizophrenia, British J. of Proj.Techniques, 16:21-31 Cassell,W.A.(1980) Body Symbolism and the Somatic Inkblot Series. SIS Center, Anchorage (USA) Cassell,W.A.(2001) SIS Exploration of Human Consciousness, SIS J. Proj. Psy. & Mental Health: 9:3-14. Cassell, W.A. and Dubey, B.L.(1997) Somatic Inkblot Series Video/SIS-II Manual. SIS Center, 4501E, 104th Ave, Anchorage, AK-99516(USA). Cassell, W.A, and Dubey, B.L.(1997) Therapeutic Dream Stimulation with SIS- Video, SIS J. Proj. Psy. & Mental Health, 1997, 4: 3-23 Cassell, W.A, Dubey, B.L.and Gilbert J.Roth (1997a) Medical, Psychological and Spiritual Application of the SIS Inkblots. SIS J. Proj. Psy. & Mental, Health, 4: 89-112 Cassell, W.A, and Dubey, B.L. (1998) Application of Somatic Inkblot Series in Personality Assessment, Screening, Diagnosis and Therapy, SIS J. Proj. Psy & Mental Health, 5:3-32. Cassell, W.A, and Dubey, B.L.(1998) Mental Disorders Triggered by Exposure to Violent Imagery in the Media and in Electronic Games, SIS J.Proj.Psy & Mental Health ,5:87-104 136 Mishra & Dwivedi

Cassell, W.A; Dubey, B.L.; Molchanov, E. and Roth, L (1999) Stimulating Beacon Images for Meditation and Projective Psychotherapy, SIS J.Proj Psy. & Ment. Health, 1999, 6: (2) 7-30 Cassell, W.A; Dubey, A. and Dubey, B.L.(2000) SIS Projective Responses in PTSD and Dissociative Disorder, SIS J.Proj Psy. & Ment. Health, 2000, 7: 93-108 Cassell, W.A; Illardi, F.J.; A. Collins; Mishra, M. and Dubey, B.L (2001) Optimizing Spiritual Healing by Assessing Dream and SIS Imagery, SIS J.Proj Psy. & Ment. Health, 8:75-94 Cassell, W.A, and Dubey, B.L.(1996) The Use of the Rorschach and SIS in Releasing Somatised Grief. J. Proj. Psy. & Mental Health, 3: 3 -32 De Vos (1952) A Quantitative Approach to Affective Symbolism in Rorschach Responses, J. Proj.Tech and Personality Assessment,36:133-150 Dubey,B.L. and Cassell, W.A.(1993)Some Experiences with Somatic Inkblots-II, British J. of Proj.Psychology,38:,1,19-41 Dubey,B.L. and Cassell, W.A.(1997)Clinical Utility of Somatic Inkblot Series- Video. Perspective in Psychological Researches, 20:10-15 Dubey,B.L. and Cassell, W.A.(1997Application of Somatic Inkblot Series in Personality Assessment and Psychotherapy, Indian Journal of Psychology, 72:73-80 Dubey,B.L. and Cassell, W.A.(2000) Inkblot Responses as an Aide to Therapy, SIS J.Proj Psy. & Ment. Health, 7: 3-10 Dubey, B.L., Cassell, W.A, Pershad D. and Dwivedi,P.(1995) Diagnostic Utility of Somatic Inkblot Series. SIS J. Proj. Psy. & Mental Health, 2: 77-84. Dubey, B.L., Cassell, W.A, Pershad, D and Dwivedi,P.(1995) Diagnostic Significance of the Indices of the SIS-II and the Rorschach Inkblot Tests. SIS J. Proj, Psy. & Mental Health, 2: 165-170 . Dubey, B.L., Cassell, W.A, Dwivedi,P. and Mishra, M.(1995) Inner Cry Through Somatic Inkblot Series. J. of Proj. Psy. And Mental Health, 5, 2: 119-128 Holtzman,W.H.(1956)Inkblot Perception and Personality,University of Texax Press, Texas. Kwiatkowska,H.Y.(1978)Family Therapy and Evaluation through Art. Springfield,IL, Charles C. Thomas. Ulman,E.(1965) A New Use of Art in Psychiatric Diagnosis, Bulletin of Art Therapy, 4:91-116 SIS & Rorschach 137

Prognostic Utility of Somatic Inkblot Series-II Amool R. Singh, B.L.Dubey and K.R. Banerjee Initially Somatic Inkblot Series-II (SIS-II ) protocols of 100 cases (50 each of alcohol and drug dependence) were examined after a follow-up period of six months. The patients why ‘improved’ and failed to improve’ were kept in separate groups and were compared for selected SIS-II indices. The findings suggest that SIS-II is a sensitive tool to be used as a prognostic indicator to a certain extent. The efficacy of Somatic Inkblot Series (SIS-II) as a useful psycho diagnostic tool has been well established as reported by various researchers (Bailey and Murstein, 1995; Cassell, 1994, Cassell et. al. 1995; Dubey et. al. 1993, 1994, 195. Rathee et. al. 1995; erma et. al. 1994, 1995; Singh & Banerjee 1996; Singh & Dubey 1997) in recent past. Some of the studies also confirm it’s therapeutic utility (Dubey et. al. 1994, 1995); Cassell & Bubey 1996; Dubey 1996; and Sahay & Srivastava (1994). Apart from diagnostic and therapeutic use various projective psychological tools have been reported to be capable of predicting outcome of the treatment to same extent. The prognostic indicators of SIS-II have not been reported so far. Keynote this notion in mind, the present study was undertaken with following objectives. Objectives: Ro examine the SIS-II indices of Alcohol and Drug Dependent cases who “improved” and “flailed to improve” after treatment. To find out whether there was significant difference in the average number of responses of cases ‘failing in improved’ categories for the chosen variables for the study. Material and Method: The sample consisted of 100 patients (50 each of alcohol and drug dependent cases as reported by Singh & Dubey 1997). These cases were followed up to six Amool Rajan Singh M. Phil M & S.P., Ph.D. Consultant cum State Coordinator (UNDP/ UNFPA Project), Ministry of Health & Family Welfare, Govt. of India. Bikaner House Sahajahan Road New Delhi (INDIA). v.l. Dubey D.M.S.P., Ph.D, Director, Somatic Inkblot Center, P.O. Box 1107, Sector-15 Post Office, Chandigarh – 160 015 (India) K.R. Banerjee, M.R.C.P. (London), F.A.PA.A. (U.S.A.) Director, Ranchi Mental Hospital Kanke Ranchi 83400 (INDIA). SIS J. Proj. Pst. & Ment Health (1997) 4: 138-141

months after treatment. The cases who remained alcohol; of drug free during follow up period after discharge from the hospital, was included in” improved” category. On the other hand patties, who relapsed/no contact with the hospital, were put in “failed to improve” category. The SIS-II protocols f both the categories of cases (improved Vs failed to improve) were pooled in respect to alcohol and drug dependent groups. The cases falling in other the categories were compared for the indices taken the index study, computing Critical Ratio (S.E.of the differences between two uncorrelated percentage) for alcohol and drug dependent groups separately. Results and Discussion: An impressive body of literature is available otconfi4rm high rate or readmission in cases of alcohol and drug dependence., positive patient characteristics are the greatest predator of treatment outcome and it is often assumed by many that the outcome is bleak, no matter what the treatment intervention, if the patients characteristics are unfavorable (Singh et.al. 1997; Hoffman & Miller 1992, Goodwin 1988; Emetic 1975) Table 1 Showing Comparison of SIS indices for Alchol Group (N=50) SIS Indices No of Patients Patients Failed Level of Responses Improved to Improve Significance (n1=32) (n2=18) Total number of <70 90.62%(29) 33.33% (06) Responses Movement <15 81.25% (26) 38.88% (07) .05 Animal <9 81.25% (26) 33.33% (06) .01 Human >15 90.62% (29) 55.55% (10) .01 Anatomical >12 84.37% (27) 61.11 % (11) N.S. Sex <2 78.12% (25) 50.00% (09) .05 Rejection of Images <1 87.5% (28) 61.11% (11) .05 Most Typical Responses >13 78.12% (25) 55.55% (10) N.S. Figure in parenthesis indicate number of cases From Table-I, it is evident that alcohol dependent cases who improved’, differed significantly from the cases who failed to ‘improve’ in respect to most of the SIS- II indices i.e. Total number of responses Movement Animal Human Sex and 139 Singh et al.

Rejection of Images. The improved category of alcohol dependent \cases were significantly more likely than failed to improve cases to give less number of Total Movement Animal Sex and Rejection of Images categories of responses. On the other hand improved alcohol dependent case gave significantly more number of Human responses I both the group, did not differ significantly in respect to ‘Anatomical and Most typical categories of responses. Table 2 Showing Comparison of SIS Indices for Drug Groups (N=50) SIS Indices No of Patients Patients Failed Level of Responses Improved to Improve Significance (n1=32) (n2=18) Total number of >66 85.18% )23) 60.86 % (14) .05 Responses Movement <10 74.07% (18) 39.12% (09) .05 Animal <10 66.66% (20) 52.17% (12) .N.S. Human >15 81.48 % (22) 60.86% (14) n.s. Anatomical >13 81.48% (22) 39.12% (09) .01 Sex <3 88.88% (24) 65.21% (15) .05 Rejection of Images <1 81.48% (22) 73.91% (17) N.S. Most Typical Responses >10 74.07% (20) 65.21% (15) N.S. Figure in parenthesis indicate number of cases From Table-II, it is apparent that at least four indices of SIS-II could discriminate significantly both categories “improved’ and “failed to improve” of drug dependent cases. The improved categories of cases are likely to give significantly more number of Total Response and Anatomical Response on one hand and significantly lesser number of Movement and Sex responses than the “failed to improve” category on other hand. The Animal response. Human response and Rejection of Images did not discriminate significantly both the categories of drug dependent cases. Conclusion: Present study suggests that the Somatic Inkblot series-II is a successful diag- 140 Singh et al.

nostic test. Some of the indices such as Total R, Anatomical, Sex and Movement responses were found as a hardcore indicator in discriminating alcoholic or drug dependent cases. The content analysis of the cases helps in therapeutic planning and management of Alcoholic and drug dependent cases. Reference: Cassell, W. A. and Dubey, B. L. (1997) Manual of Somatic Inkblot Series-II SIS Centre, Anchorage, Alaska, Dubey, B. L. Cassell, W. A. : Parshad, D. and Dwivedi, P. (1995); Diagnostic utility of Somatic Inkblot Series. SIS J. Proj. Psy & Mental Health, 2 (1), 77-84. Singh, Amool R. and Banerjee, K. R. (1996) : Efficacy of SIS-II in discriminating O.C.D. Patients and normals. SIS J. Proj. Psy. & Mental Health, 3 (2), 165-169. Singh, Amool R. and Dubey, B. L. (1997) : SIS-II Profile of drug and alcohol dependent cases, SIS J. Proj. Psy. & Mental Health 4 (1), 69-74. Singh Amool R., Dubey B. L., Sahu L. M. and Banerjee K. R. (2000) : SIS-II Profile of Murderers. Prognostic Utility of SIS 141

Recondition of Psychological Problems in Patients Suffering from Speech Defects with the Help of SIS-II AshimaNehra, M. Raghunathan,S.K. Verma ad S..S. Mann The present study aims to find out the personality of patients suffering from speech defects with the help of SIS-II and to find the contents heeling in understanding the psychopathology and inner cry of such patients. To achieve the above objectives, eighteen cases having speech problem were administered SIS-II individually. All were O.P.D. patients of the Nehru Hospital, Postgraduate Institute of Medical Education and Research, Canoga in the age range of 15 years to 64 years with the mean age of 27.44 years. The results showed better productive (greater number of responses) low rejection of images, disturbed interpersonal relations with somatic preoccupation (higher anatomical, but lower sex responses with moderate human and most typical responses). The cases that rejected more images also were found to give low number of responses and most typical Reponses. One of the patients with lots of psychological responses s discussed to bring our how SIS-II has helped in understanding the psychopathology of the case. According to Murphy and Fissions (1960) Speech development and disk tapiocas best be understood in relation to what is happening to entire human system i.e. in relation to what conflict comforts confusion, freedom, frustration or satisfactions the person may e experiencing and the degree to which the experiences may be affecting (or be affected by) the verbal behavior. In clinical practice, the onset of speech disorders is often associated with a breakdown of psychological defenses which ordinarily protégé the patient from intensive emotional arousal. Such disruptions in psychological defenses mechanisms are likely to stem from the patients conflicts mostly surrounding his relationships with other people. The psychodynamic considerations such as regression, unconscious motivation disturbance in object relationship and the breakdown of psychological defenses may e important for understanding and treatment to the psychological defenses may one portent for understanding and treats net of the patient’s psychological problems. Alexander’s (1950) key contribution to psychosomatic medicine was the concept that psychosomatic symptoms result from the psychological concomitant of psychic conflict and trauma. Alexander postulated that emotional arousal gives rise to profound psychological stress as crucial intervening variables in the dev- Ashima Nehra, DGC. Ph.D. Psychologist, M. Raghuynaathan. MSc. (Speech & Hearing) Ph.D. Associate Professor, S.B.S. Mann, MS MNAMS, Professor & Head, Department of Otolaryngology & S.K. Verma, DMSP, DPG, Ph.D. Additional Professor Department of Psychiatry, Postgraduate Institute of Medical Education and Research Chandigarh 160 012 (INDIA) Corresponding author: Dr. S.B.S. Mann. SIS J. Proj. Pst. & Ment Health (1997) 4: 142-148

ilment of psychosomatic symptoms and diseases. There are certain other individuals who are originally vulnerable to the physiological concomitants of affect and may develop psychobiological disorder are most likely to develop when where a high degree of organic vulnerability together with substantial emotional disorders is. Everyday conversations are replete with examples of the mound body connection such as “broken heart” for depression as grief “pain in the neck” for frustration. By developing a perceptual eye and ear for such imagery, therapists can more directly share the perceptual word of the suffering individuals. According to Dubey, Cassell, Dwivedi and Mishra (1995) such projection of inner cry are never possible through paper-pencil tests. The SIS inkblot tests are found to be reliable and valid (Verma, 1995) instrument for such assessment. Projective tests, especially inkblot imagery are more powerful in bringing out inner feelings (Dubey et. al., 1994). Somatic Inkblot Series is backed by the theories of somatic imagery boy symbolism, body perception and cry for help’ (Cassell et. al. 1995). It emphasizes mainly on content analysis and on psychoanalytical interpretation though it has indic3es for quantitative analysis. The SIS test (Cassell, 1990) employs the same principal of projection as that of the Rorschach or the Huntsman inkblot tests except that the SIS images are largely developed to elicit somatic awareness and to establish psychopathology for intervention (Cassell, 1965;1977; 1980). Because of the simplicity of the test, clinicians in India had become interested to evaluate its psychometric properties and usability as a psycho diagnostic tool (Dubey et al 1995). Keeping this in mind the present study was undertaken to recognize the underlying psychological problems of patients with speech defects. Since the literature related to speech defects and somatic inkblot series is scant, the present paper is a modest attempt with the following objectives. Objectives: 1. To find out the personality pattern of patients suffering from speech defects with the help of SIS-II. 2. To find out the contents helping in understanding the psychopathology and inner cry of such patients. 143 Nehra et al.

Material and Method: Eighteen subjects diagnosed as having g speech defects in the age range of 15 years to 64 years with the mean age 27.44 years were taken form the Speech and Hearing Unit of the Development of Otolaryngology & Head and Neck Surrey (ENT) OF Nehru Hospital, Post Graduate Institute of Medical Education and Research, Chandigarh. These patients were administered SIS-II individually follow ding the standard procedure (Cassell, 1980). Rorschach of patients were analyzed for finding out the mean values and percentage of important indices i.e. number of responses, human content, animal content anatomical content, sex content, most typical responses, typical responses, rejection images and human movement responses. These were compared with the norms reported earlier (Dubey and Cassell, 1993; Dubey et. Al., 1995) About the Test: The Somatic Inkblot Series (SIS) (Cassell, 1990) is a projective test used for the assessment of personality. After initial success with SIS-I, Sis-II was developed in 1980 by proof. Wilfred A. Cassell. The test was developed specifically t understand the manifestations of problems. It helps therapists more sensitively, hear a suffering individual’s cry for help. The inner cry is hidden not only from others but often from ones own conscious awareness as well. It is a paper-pencil, selfadministered test booklet. It consists of series A and B, each with 31 images (total 62 images). In addition there is a sample image in the beginning. All the images are printed on a eight page billet. Because there is no time limit, test anxiety is greatly reduced and the individual is free to reach in his own time, often exhibiting significant verbal and non-verbal clues to each of the inkblots. The subjects are asked to select 3 images which positive or negative effectual discharge, the emotional investment on the continuum from objective reality to subjective metaphor and meaning. Results and Discussion: Information regarding the distribution of sample characteristics are shown in table-1. The patients were mostly young (15-25 years), males (16) females (2) and educated (matriculates and graduates). 144 Nehra et al.

Table 1 Sample Characteistics Background Variable Speech Defects (n=18) Age 46-65 years 36-45 years 26-35 years 15-25 years Sex Male Female Education Middle Matric Graduate Professionals Postgraduates The results of the present study are shown in Table 2, along with the comparative data from other studies with normal population Table –2 Comparison of Present Study with Earlier Normative Studies Categories/Indices Normals (n=100) Normals (n=300) Present study Dubey et. a. (1993)Dubey et al. (1995)(N=18) Mean SD Mean SD Percentage Total number 74.08 12.440 61-75 80.85 20.42 — of Responses Human content 14.66 5.46 20-25% 24.88 08.69 30.91 Animal content 8.65 4.69 <11% 12.22 05.81 15.18 Anatomical content 9.188 4.24 <15% 13.27 06.18 16.48 Sex content 4.12 2.58 About 6% 00.83 01.67 01.03 Most typical responses 13.68 1.98 >13 12.11 01.48 15.04 Typical responses - - >50% 21.72 07.999 26.98 Rejection of images 0.82 2.00 <1 images00.94 01.50 01.16 Movement responses 9.60 5.33 <13 04.72 03.29 05.86 SIS-II in Speech Defects 145

A perusal of table 2 shoes the speech problem patients, as a group do not differ from the normal adults on most of the variables studied except that (a) they show relatively higher productivity on inkblots (as stimulated by the projective test to give greater number of responses); (b) give great number of human an animal responses but lower number of movement and sex responses (which shoes some withdrawal in interpersonal situations; (c) anatomical content is greater (which suggests greater somatic preoccupation in spec defect patients) and (b) moderate levels of most typical and typical responses. Rejection of images, atypical and pathological responses are almost nil or negligible. The cases that rejected more images were found to give low number of responses. For better understanding a case history of a patient included in this study is described below: Mr. X: Mr. X, aged 64 years, a matriculate married, whose wife along with children deserted him at the age of 36 years. At the time of study he resided with his elder sister. The responses are given below: Image 21A - bird Image 25A - Rejection Image 27A - Water fall Image 19B - Some Sea creature Image 28 B - Somebody standing Image 31 B - Mushroom Images 21A: On this image he has seen ‘birds and avoided viewing two children. This suggests the separation from his two children. He could not process such a traumatic experiences thus avoided seeing two children on this image. It also suggests his inner cy fro his children. Images 22 A: He has avoided seeing anything and the usual responses on this image are female sex organ. Because of his separation from his wife he feels desperate and dejected for want of the company of his wife. Under such a situation, unconscious rejection of female sex organ is but natural. Image 23A: Inserted of seeing ‘female breast’ he seen waterfall. Once again the feeling of love and rejection has come under cloud and the person has unconsciously avoid viewing the breast. The other possible interpretation could be the 146 Nehra et al.

feeling of love and affection, which one can get from the mother or the mother figure. Wife, at this stage to this patient, may also serve as mother figure and separation from her might be leading to the feeling of such maternal deprivation. Image 19B: He has seen “some Sea Creator” instead of seeing two hearts side by side. Once again the feeling of denial of being together and the real separation from his wife brings such contention. Image 28B: He has viewed it as ‘somebody stands’ and avoided seeing mother holding the child. Once again his own story of getting separated from his wife and children was brought back through this image. Image 31B: On this image he has viewed ‘Mushroom’ whereas most of the persons perceive female including wife, husband and two children. Seeing wife husband and children might have been more painfully to him and consciously he avoided it. This supports the psychoanalytic theory of avoiding what he does boot want to remember. In a nutshell, the responses give by the subject on various images suggest that the whole problem lies in the area of family, interpersonal relationship and sex. This is true and supports his case history. His physical symptoms are in a real sense, psychological manifestations of his traumatic experiences, which he had undergone 28 years back. Probably, he was able to support and manage himself earlier but when the symptoms aggravated he thought to seek help and landed in the hospital. The content analysis of the responses of other cases also suggests some pathology and inner cry. Conclusion: It can be concluded that the Somatic Inkblot Series (SIS-II) is a useful instrument, which helps in understanding the psychopathology of the case. It brings out the unprocessed material which needs processing. It also provides and opportunity to the patients to share the give and agony which he is undergoing. Therapist can peep into the inner deep of the patients and would be in comfortable position to have therapeutic planning. References: Alexander F (1950) Psychosomatic medicine : Its principles and Applications. W.W. Norton New York. Cassell W.A. (1965) body symptom localization Psuychosomatic Medicine 27: 171-176 SIS-II in Speech Defects 147

Cassell (1977) Desenstization therapy for body image anxiety Vanadian Psychiatric Assocuatuin Jouranl 22 239-242. Cassell, W. A. and Dubey, B. L. (1997) Manual of Somatic Inkblot Series-II SIS Centre, Anchorage, Alaska, Dubey, B. L. Cassell, W. A. : Parshad, D. and Dwivedi, P. (1995); Diagnostic utility of Somatic Inkblot Series. SIS J. Proj. Psy & Mental Health, 2 (1), 77-84. Dubey, B.L., Cassell, W.A, Pershad D. and Dwivedi,P.(1995) Diagnostic Utility of Somatic Inkblot Series. SIS J. Proj. Psy. & Mental Health,2: 77-84 . Bubey B.L. Mishra dfM., Dwivedi C.B. and Mishra N. 919994) Disgnostic and therapeutic utility of SIS-II and Rorschach, 1: 19-41. 148 Nehra et al.

How a Single Image of SIS-II Leads to Complete Psycho diagnosis N.L. Dosajh SIS-II is a very sensitive instrument for psycho diagnosis. Sometimes a response to a single image of SIS-II is able to diagnose the trouble. In this paper two cases of the author have been given to illustrate this good quality of SIS-II. In the first case response to image 18-B, followed by interview led to diagnosis. How it was done has been explained in this paper. Case 1: This case study is of a young man aged 21 years, a student of second year B.E. of an Engineering College. His performance in studies started deteriorating so much that he failed in six papers of second year examination. He left his college and returned home. He would sit indoors and would do nothing except brooding all the time. He refused to study further. It became very difficult to diagnose his trouble. His spatial ability, as measured by Standard Progressive Material, was found to b about 121. A number of techniques like Interview, Rorschach test, Dosajh Test (D), were employed but the trouble could not be diagnosed. All medical check-ups like EEG, Cats Can Blood Tests etc. were found to be normal. Lastly the administration of SIS-II (Cassell, 1990), especially Image-18 B led to psycho diagnosis. Interview with the father of the patient: Dosajh: What is the trouble with your son? Father: My son, a student of II year engineering, has become very hyperactive and lost his power of concentration on studies. At an early age he was very intelligent. He joined an Engineering College in I year electronics. In second year he failed because he forgets things very soon. He has no interest in studies now. He feels lot of inferiority and gets foots of depression very often. (Father was a very dominating type and would beat his son very often over minor mistakes). Interview with the patties: I have difficulty in concentration. I like Mathematics, but the subjects where cramming is involved, I don’t like, because whatever I learn, I forget very soon. He was administered SIS-II . In the interview which followed, to the Image, 18-B he response-“It is like a penis with leaking sperms like after mastication”. Dosajh : How did you get this idea? Prof, N.L. Dosajh, Ph.D. 1121, Sector –15-B, Chandigarh – 160 015 (India) SIS J. Proj. Pst. & Ment Health (1997) 4: 149-151

Patient: (With excitement) It applies to me. I masturbate very often and the condition of my penis becomes like this image at that time. Dosajh : Since when is that? Patient: Since I passed my 10th class. Dosajh : Did anything happen before that? Patient : Yes, I used to love a girl in my neighborhood. The love affairs continued for a year or so. Then I proposed to this girl and she replied that she was already engaged to a boy. On hearing this I felt very bad. Since then I used to masturbate very often. Whenever I used to be free, I would think of this girl and would masturbate and this would happen very often. (Evidently it was a case of Spermatorrhoe and SIS-II Image 18 B led to diagnosis). Dosajh : Hooting did you masturbate? Patient : Nearly twice or thrice a week and even more often, when I used to be free and without any work. The patient was trained to perform GORAKSH ASAN (1983), which he practiced for about a week; his father’s attitude towards the patients was made sympathetic. He became all right and went back to his college to pursue his studies. His SPM score had risen to 128. Case-2: This is the case of a boy aged 24 years, doing graduation. He is the son of a very rich businessman. His father was an alcoholic and also addicted to drug. The family life was not pleasant. Father and mother would quarrel very often till the mother took charge of the business of their branch in Delhi and father was in overall charge of the branch in Chandigarh. This boy would do up and down between Delhi and Chandigarh very often-sometimes with mother and at other times with father. Father’s behavior towards his son was very bad and he would beat his son on trifles specially when he was drunk. Father died in 1991, and his mother took charge of the business at Chandigarh also.Later on the boy was given charge of the business at Chandigarh after sometimes and the profits would be shared in the ratio of 6 to 4 between the mother and the son. When the patient contacted the author his condition was very bad. He wood beat his younger sister who was student of a dental college. He did not taken interest in his business and wanted to go to Australia for MBA. He had some of his close friends living in Australia. He was suffering from depression and would not like to do anything. He would keep sitting indoors and would often show fits of anger. He had become very suspiciously nature, would tell lies, and would dominate 150 Dosajh

over others, specially the maid servants in the house. He was totally confused and did not know what to do. His relations with his mother were not cordial and very often he would not like to talk to her. He would often say that he would like to go to Australia or USA. He was administered Rorschach test and was found to be a schizophrenic. He was further administered SIS-II and was interviewed on the various images. His response to image 17A was ‘Head’. The Typical response to Image 17A as cited in the manual (Classell, 1990) are:Chest/Ribs/ Heart/Lungs. Interview with Patient : Dosajh : How did you get the idea of Head? Patient : Because I generally have headaches. Dosajh : When do you get headaches? Patient : Generally always. I remain confused. I don’t know what to do. The ‘Head’ is a very unusual response to 17 A and according to Dr. Cassell while some normal and non psychotic individuals anxious about real or imagined neurological illness may project brain responses, the author has found approximately one in ten schizophrenics do so. It may be that the schizophrenics’ experiences of “ ‘thought rushing’ or ‘thought blocking’ and the preoccupation with thought implantation, transfer, or broadcasting ffocuses attention on the brain (Cassell, 1980). So form these two cases, it is clear that even a single image of SIS-II may lead to psycho diagnosis. The problems of the patient were discussed and the attitude of the family members was made sympathetic to wards the patients. The patients showed improvement in their behavior in a few sittings. References: Dosajh N.L. (1983), Psychotherapy Including Yoga Therapy, Kohli Publishers, Chandigarh Wilfred A Cassell (1980), Body Symptom, Aurora Publishing Co., Anchorage, Alaska. Wilfred A. Cassell (1990)\, Somatic Inkblot Series-II Manual SIS Center Anchorage, Alaska. SIS in Psychodiagnosis 151

Sex Differences in Personality Dynamics of Extremely Prolonged Derived Adolescents Mahesh Bhargava and Anju Sexena The present study aims at striding the sex difference in various personality domains of extremely prolonged deprived segment. The study was conducted on Intermediate students in the age group between 16 to 18 years and equal number of 30 respondents were included of both the sexes of this segment. For measurement of deprivation, Prolonged Deprivation Scale by Misra and Tripartite was used whereas Rorschach Inkblot Test was used for evaluating the personality significantly on FC criteria of emotional construct and difficulty in establishing close personal relationship, FM criteria of abundance of creative impulses and develop, Fc criteria of higher degree of empathy and Ad criteria of anxiety concerning bodily functions of extremely prolonged deprived segment. Prolonged Deprived adolescents are the end products of the social, economical cultural disparities in their relative societies, even agar a good deal of scientific technological and economic progress, there are still many groups in various societies who are living in very unhealthy environments and are deprived of the pre-requisites for their development. In this category, the children and adolescents of the lower economic groups are also included. They cannot develop their basic requirements of life in this democratic country (Misra and Tripathi (1977) presented the concept of prolonged deprivation which is based on the individual’s experiential background. If the qualitative and quantitative experience as the vivacity of life be kept on continuum, them, it will become clear that every person differs in quantity. The present paper is concerned with the sex differences in relation to various personality dynamics of the adolescents belonging to the extremely prolonged deprived segment where housing conditions, home environment, economic insufficiency, lack of food and clothes, lack of education and other facilities in succinct, lack of food and clothiers, lack of education and other facilities essential for life are dominant for a long period. This group hardly fulfills their essential needs for their survival. Therefore, the present study was undertaken. Extremely prolonged deprived adolescents usually have disorganized personality as human life is greatly influenced by its culture, society, environment and geographic surroundings and guided by human experiences. There are a number of empirical investigations which throw light on the various personalities and movement correlates of deprived children and adolescents. Misra and Tripathi (1978) found significant differences with respect to achieve- Mahesh Bhargava, Ph.D., Director, National Psychological Corporation, 42/30, Kacheri Ghat, Agra 282004, Anju Saxena, Ph.D., Jalun (U.P.) SIS J. Proj. Pst. & Ment Health (1997) 4: 152-157

ment motivation, state and trait anxiety between high and low deprived groups. Further, it was also noticed that deprivation was positively related with state and trait anxieties where as achievement, affiliation, approval and power motives were negatively correlated with deprivation. Shukla (1988) found that prolonged derivational factors. Lower deprived group was found with more motivational tendencies than the high-deprived group. Aurora and Bhagava (1980) advocated that the amount of deprivation must lead to the formation and development of certain dyadic traits of motivation. Deprived children has more motivational instincts-narcissism, mating, pugnacity assertiveness and self concept as compared to their counterparts-non deprived children and both these groups showed significant differences on these traits. While on one side, deprived children were found to be introverted, of low intelligence level, emotionally unstable serious, emotionally matured, happy tension free progressive and dominating (Bharagava and Aurora 1981). Bhargava and Singhal (1988) noticed that furls from advantaged fro up were found high on need variables of exhibition and change while girls from disadvantaged group ewer found high on difference and succedanea. Hussein and Hairy (1989) arrived at the conclusion that deprivation was significantly associated with maladjustment; disadvantaged children were found maladjusted in all the areas with a lesser need for approval seeking. Singh and Sinha 91990) studied the personality characteristic of socially advantaged and socially disadvantaged children. It was found that socially disadvantaged children were inferior on the immorality dimensions like decisiveness, responsibility, emotional stability, friendliness, ego-strength, curiosity, dominance heterosexuality and masculinity. Sexena and Bhargava (1994) found that advantaged children were superior on the fifteen personality traits. Bhargava and Sexena (1995a) concluded that F, FS, and M factors occupied significantly higher on Rorschach Criteria among the low deprived group whereas KF was higher among high-deprived adolescents. Further results indicated that in comparison to high deprived adolescents, the low deprived group has developed better covert and overt control over their behaviors as indicators of their better covert experiential balance in their personalities. Consequently there existed significant differences in their personality structures particularly in F,M, Fc, FK and Hd criteria of Rorschach Inkblot Test accounting for the differences in their personality structure (Bhagava and Saxena, 1995b). The overview of various investigators that few systematic studies were conducted in the area of disadvantaged or derived children regarding personality and motivational variables. Still there are a lot of variables, which are neglected. Therefore, the present researchers had chosen this problem in this context. Bhargava & Saxena 153

The present study aims to see the sex differences in personality dynamics of extremely prolonged deprived adolescents. Therefore, it was hypothesized that boys and girls belonging to extremely prolonged deprived segment would not differ significantly on various traits of personality dynamics as measured by Rorschach Ink Blot Test. Method: Sample: Sample was drawn from the different intermediate College of Orai (Jalaun) and Prolonged Deprivation Scale was initially administered on 120 boys and 120 girls and for the sample top 30 boys and top 30 girls were considered as extremely deprived groups on the basis of prolonged Deprivation Scores. The age range of subjects were from 16 to 18 years and they all belonged to semi urban area Tools: Prolonged Deprivation Scale (PDS) by Mishra and Tripathi (1977), containing 15 dimensions of Indian socio-cultural environment was used for screening the extremely or highly prolonged deprived adolescents. An adolescent regardless of sex pleased above 75th percentile was categorized as high-deprived adolescent. Rorschach Inkblot test by merman Rorschach (1921) was used for assessing the personality dynamics of the respondents included in the sample employing Klopfer et. al. (1954) technique for interpretation and analysis of the data. Results and Interpretation: Rorschach Criteria of 15 personality dynamics of extremely prolonged deprived group of boys and girls adolescents was presented interims o Mean and S.D. in Table-1. Table1 indicates that sex differences were found in certain personality dynamics of Rorschach criteria like FC, FM, Fc and Ad. Extremely high deprived female group showed significantly higher score on all the above four criteria which group showed significantly higher score on all the above four criteria which indicate that girls were found more emotionally balanced, abundance of creative impulses, dependent, head higher drear of empathy expressed more difficulties in establishing close personal relationship and more anxiety concerning body functions as compared to their counterparts. Insignificant differences were found in remaining traits of personality. This it can be sid that deprivation is related with certain personality dynamics. 154 Bhargava & Saxena

Table 1 Rorschach Criteria Yielding Experiential Balance of the EPD Giirls and EPD Boys Groups Sr. Personality Rorschach EPD Girls EPD Boys No. Dynamics Criteria Mean SD Mean SD t Value 1. Emotional M 2.55 4.60 3.20 2.86 0.76 construction F 14.30 7.26 14.35 7.29 0.03 1.13 1.55 0.58 0.73 2.12* 2. Abundance of M 2.55 4.60 5.20 2.8 0.76 Creative Impulses FM 17.20 10.40 8.25 4.76 4.94* 3. Marked Inhibition H 3.03 1.51 3.93 2.73 0.18 of Sexuality Hd 1.45 1.09 1.12 1.41 1.18 4. Dependency cF 1.28 .99 1.05 1.56 8.82 FM 17.20 10.40 8.25 4.76 4.94* M 2.55 4.60 3.20 2.86 0.76 5. Higher Degree Fc 1.33 0.92 0.58 0.67 4.41 of Empathy 6. Inhibition of Sum C 1.42 2.664 1.57 2.61 0.25 Emotional C 0.28 0.69 0.35 1.02 1.76 Expression 7. Relish For Sensual F 1.28 0.69 1.05 1.56 0.82 Expression 8. Difficulty in FC 1.13 1.55 0.58 0.73 2.12** Establishing Close Personal Relationship 9. More Interested in M 2.55 4.60 3.20 2.86 0.76 Personal Concern 10. Level of General FK 0.10 0.48 0.13 0.31 0.38 Anxiety 11. Anxiety concerning At 3.89 2.19 2.85 2.16 2.17* Bodily Functions 12. Given to M 2.55 4.60 3.20 2.86 0.76 Introspection 13. Attempt at Strong F 14.30 7.26 14.35 7.29 0.03 Ego Function Fails 14. Inhibition of d 5.25 4.06 5.18 3.27 0.08 Aggression 15. Awe of Father H 3.03 1.51 3.93 2.73 0.18 Figure Deprived Adolescents 155

Discussion and Conclusion: On the basis of the results it might by concluded that our hypothesis s partially retained that boys and girls belonging to extremely prolonged deprived segment would not differ significantly on various traits of persona; personality byname as measured in the form of Rorschach criteria. Both the groups showed differences in certain factors-like emotional construction, abundance of creative impulses dependency, high degree of empathy, difficulty in establishing close persona relationship and anxiety concerning bodily functions. Our findings are inconformity with Linger (1972), Sexena and Bhargava (1994) and Baraga and Saxena (1995b). Langmeir (1972) studied the personality development of deprived pupils and arrived at the conclusion that socio- economical deprivation resulted in hardening the emotional feelings, insecurity and inferiority Chug (1979) also reported that a deprivation increases the worrying depressive and troubled tendencies showed a corresponding increase whereas low deprived group was found more critical liberal, inimical radical and thought provoking as compared to high deprived group. Sexena and Baraga (1994) observed that all positive characteristics of personality were possessed by advantaged children and sex differences existed significantly between advantaged and disadvantaged boys as we;; as girls. On the basis of our result and in the light to the discussions of a few studies, it can be said that in deprived society, sex differences were found in some of the personality characteristics like emotional make-up abundance of creative imposes, dependency, higher degree of empathy functions of various Rorschach criteria. On all the criteria girls scored significantly higher than boys so it can be said that girl were more affected by derivational conditions. References: Aurora Saroj andBargava, M (80) Dynamic Structure of Prologned Disadvanged Girl Papoer preseted at the 11th Anual convention of All India Association of Clinical Psychologists Nagput 26-28 Nov. Bharagava M., and Aurora Saroj(19810 Personality traits as a function of prologed deprivation India Journal of Clinical Psychology 8: 167-171. Bharagava, M and Saxena Anju (1995a) Rorschach differentials of deproved adolescets. India Journal of Clinical Psychology 22-24-29. Bharagava M and Saxena, Anju (1995b) Basic Personality strure of the deprived adolescen6tts SIS Journal of Projective Psychology and Mental Helath 2: 159-164. Bharaggava M and Uma (1988) Need Patterns of Socio-economically Disadvataged Female Adolescents. Prachi Journal of Psycho-cultural Demenson 4: 27-31. 156 Bhargava & Saxena

Carstairesm G.M. Payne R.W. and Whittaker, S. (1960) Rorschach responses of Hindus and Bhils Journal of Social Psychologu, 151: 217-227. Chyg Reny (1979) A Conmparative study of personality characteristics of deprived and priviledged female adolescents Master’sThesis in Home Science Agra University Hussain S and Haiudry M, N. 91989) A study of socially disadvantaged group oin contect of some personality variables Advances in Psychology, 4 103-109 Klopfer B, Ainssworth M andHolt R. (1954) Develoment with Rorschach Techxique; Vol I Techniques and Theory New York World Press. Mishra G. and Tripthi L.B. (1978) Prolonged Deprivation Scale Agra National Psychological Researches 22: 171-179. Rorschach H (1921) Psycho-diagnostics Ernst Brocher Berg, Shukla Majul (1988) A Coomparative study of academic achievement and motivationof hogh and low prologed deproved adolescents Master’s Thesis in Education Agra University. Deprived Adolescents 157

Psychological Profile of Patients with Alopecia Areata Vinod K. Sharma, B.L. Dubey, S. Muralidharan and Bhushan Kumar Alopecia areata is a disease of unknown etiology but factors like heredity autoimmunity and psychological disturbances are implicated. The present study is an attempt to find out psychological profile of patients with alpaca seriate. The somatic Inkblot Series-II was administered to 22 patients with alpaca aerate. Psychotically disturbances were found in 55 percent of cases. One case is described in detail to illustrate the pullout power of somatic images. Psychological causes in the onset of certain psychosomatic disorders like asthma, impotence, peptic ulcer etc. are well known (Schatia, 1941; Dubey and Singh, 1977; Vander et. al. 1992). As far as alopecia areata is concerned, very low to high occurrence of psychological disturbances has been reported in the literature Greenberg (1955) had studied 44 patients of alpaca aerate and found 93 percent of them having some psychiatric disorder,73 percent being psychoneurotic Berg (1951) and Spearing (1954) had earlier higher emotional factors in relation to alpaca. Mac alpine (1958) did not find any evidence of psychological factors stress-precipitating alopecia areata. However, the incidence of actuate emotional stress preceding an attack of alopecia areata has been found to vary from 5 percent to 96 percent (Anderson, 1950; Greasier, 1978; Perini et. al. 1984; De Weert et. al. 1984). Somatic Inkblot Series (SIS) is a structured projective, diagnostic instrument and an adjunct to psychotherapy. It helps the therapist to peep into the inner deep of the patient and allows to hear the inner cry of the individual. It brings out the unprocessed material from the unconscious. Somatic image provide a platform for catharsis and the patient feels released after viewing the images9Cassell and Dubey, 1995). The present study is an attempt to determine the significance of emotional stress in patients with alpaca aerate. Material and Method: Twenty two consecutive graduate patients with alpaca aerate attending OPD of the Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, suffering from alopecia areata were taken for the Vinod K. Sharma, MD MNAMS, Additional Professor, Dermatology; S. Muralidharan, MD, Senior Resident, Dermatology; Bhaushan Kumar, MD, MNAMS, Professor & Head Dermatology, B.L. Dubey, Ph. D., DPM, FSIS Hon. Consultant Psychologist; Department of Dermatology neurology and Nephrology, Post-graduate Institute of Medical Education and Research Chandigarh – 160 012 (India) SIS J. Proj. Pst. & Ment Health (1997) 4: 158-163

study. Details case history was taken to find out psychological stresses if any preceding the occurrence of alpaca aerate. Somatic Inkblot Series-II a self-administered projective test was administered individual to each patient following standard procedure (Cassell, 1990). Responses on the image were analysed to find out pathological contents and psychological disturbances mainly in the area related to family, presents, and occupation. A case history is also presented along with the responses on SIS and its interpretation to understand the content analysis of somatic imagery. Results and Discussion: Twelve out of twenty two (55 percent) patients give history of psychological Inkblot images suggested depressive content, hostility, feeling of insecurity, deprived parental affection during childhood, emotional blocking, lot of inner cry which the wanted to bring out, conflict in relations with opposite, sex, conflicting erotic imagery and unhealthy boy imagery with preoccupation with his symptoms of the loss of hair. These finding may support psychological stresses as precipitin contributory factors leasing to alopecia areata. The findings of this study are in like with earlier studies which reported psychological disturbances as precipitating factors. Case of Mr. X Mr. X 29 years old, Ph.D. student, presented in July 1992 with recurrent loss to hair over scalp, arms, legs and trunk for last 23 years. His mother had history of alopecia areata and bronchial asthma. In view of alopecia totals, he was treated with prednisolone pulse 300 mg once a month for four months and had complete regret of hair (Sharma, 1996). Subsequently he presented with relapse of alopecia totals in July 1994 and gave history of stress due to conflict with Ph.D. thesis guide. He was treated with topical sensitize diphencyprone and had complete regret of hair at 6 months and is on maintenance therapy for almost 3 years. As he narrated, he was frequently given severe beating by his father to the extent of beige physically abused. He perceives his father to be very authoritarian. Aggressive and dominant, therefore leading to frequent quarrels between his parents, and he feels most families in India are like his family. He is aggressive towards his brother and sister. He finds it to be broken family. He has few friends and very limited contacts. He got familiar with a female university student and soon married her. It is a sort of arranged marriage by his friends, through his parents gave their consent at the end. Initially he was withdrawn from his wife as he was feeling sexually weak. There was problem of Sharma et al.159

erection, which improved to some extent after medication. Medical treatment and supportive psychotherapy helped in improving his symptoms. A few significant responses on Somatic Inkblot Test with content analysis are given below: Image 5: He perceived this image as “A man crying for freedom with his body torn apart”. It bring out this inner cry and desire to get away from his broken family home/ He further confirmed this feeling during interview and therapy session. He finds his home worth living and wants to flee. Image 10 A: He has viewed this image as “The face of a gloomy woman marred by distressful life”. It may depict his projection towards his mother who often received physical assault from his father and is depressed. The patient projects that most of the Indian families have such bad atmosphere. This may also bring out his sympathy towards her mother and his inability to help her because of the dominant father. Image 13A: He saw “The hand / palm of a person caught in a fire as if crying our for help”. Once again his inner cry has come out on surface indicating that he needs help from others. This may also be indicative of his wishful thinking to get support and help from his physician/ therapist for his physical symptoms in the form of alopecia or even sexual inadequacy. Image 15A: He has seen” An infant priced/pierced/stabbed by a long knife in womb itself’. This may be indicative of his regressive phenomenon, which takes the person back in time and he feels that it could have been netter if he had died as a fetus. It suggests his depressive mood and that the person wants to bring the womb itself may also be indicative of severe pain inflicted by his father during his early childhood. Such information is very important for a therapist as it helps him in therapeutic intervention. Image 22A: He viewed it as a “scorpion” rather than seeing it as backbone or male genital organ. The plausible could be that because of his “impotence” he has avoided seeing backbone/ male sex organ even on suggestion. Since it is painful to think of importance to a newly married person, he has projected it as a ‘scorpion’ – a pain-inducing insect. Image 23A: He has seen” a baby scorpion”. Once again the imagery of male genital organ has been suppressed and painful imagination in form of a scorpion is brought out on the surface. The other possible explanation could be his injured “tailbone’ a few years before for which he had lot of pain and suffering. 160 Sharma et al.

Image 31 A : He perceived “ A couple sharing their common woes” on this image. Seeing a couple is the most typical response but “common woes” may bring out his inner cry particularly because of his sexual weakness ad inability to perform the role of a husband. Image 4B: He viewed on this image “A happy man but a woeful woman”, suggesting his projection of seeing his wife under woeful imagery. This may also be the projection of his mother whom he always finds in a miserable situating. Once again the theme of disturbed family life and his own withdrawal from reality as a deference mechanism has been brought out. Image 11 B: He has seen “a wig kept on the heaps of a person”. This may suggest his fear of becoming “bald”. The loss of hair due to alopecia areata has created in him a lot of tension and he is worried to the extent of becoming bald. Such anxiety is quite expected in a young man. Image 20B: He viewed” The rear view of a head with long hair” which suggests his wishful thinking to have long hair. He further elaborates that he has seen his own photograph with long hair and wishes to have long hair once again. Image 28B: He has seen “A distressful passionate person” on this image, which people generally see as ‘a lady with her child’. Avoiding seeing a lady may be due to his conflict with his wife and “passionate person” could be the projection of himself. Image 31B: He has seen “A family with their children knitted together tightly out of some unknown uncertainty./fear/ upheaval or resolution” on this image. Since it is the last mage of the test, the theme of a happy family is projected on this image so that the person could carry positive feeling at the end of the test. Instead of seeing a happy family, he had seen a family with their children knitted together tightly – is a painful back in time to help him to process the painful memories of childhood. Physical abuse, lot of uncertainty and strict discipline might be a few of the reasons for such an imagination. As a whole it can be concluded that the Somatic Inkblot Test had hoped the patient in projecting the painful childhood experiences, disturbed family relationship, fear of being bald and disturbed physical/emotional relationship with his wife. The test had further helper in establishing the psychopathology leading to psychosomatic disturbances (alopecia areata) and the need for counseling. Alopecia areata is known to be associated with emotional factors (Dubey and Das, 1977). In recent study from India emotional factors were clamed in 7 percent in inducing or perpetuating alopecia (Sharma et al, 1996). SIS-II in Alopercia Areata 161

These figures of 5 to7 percent emotional factors in alopecia areata suggests patients own view point but when a projective inkblot test like the Rorschach or the Somatic Inkblot Series was administered, altogether a different picture emerged as disused in the case of Mr. X. It is painful to accept and reveal one’s own suffering before a physician but the patient feels easy to project his 55 percent patient reveled psychological disturbances through projection on inkblot imagery and later on owned the sufferings. Conclusion The percent study suggests psychological disturbances in 55 percent of patients with alopecia areata. Somatic Inkblot Test was successful in electing psychological disturbances in these patients. References Aderson I (1950) Alopecia areata: a clinical study. Br Med J., 1250-1252 Berg, (1951) The unonscious significance of hair Londin. George Allen and Univ Ltd. Cassell W.A. (1990) Somatic Inkblot Series-II Manual Center, Anchhorage (USA). Cassell, W.A. and Dubey, B.L. (1995) The use of the Rorschach and Somatic Inkblot Series in releasing somatised Grief, SIS J. Proj Psy. Ment Health 3: 3-32. De Weert, J. Temmerman, L. and Kint, A (1984) Aloppecia areata: a clinical study Dermatologica 168: 224-229 Dubey and Das K.D. (1997) Personlity patterns of alopecia areata. Ind J. Cl Psy 4: 45-50. Dubey B.L. and Singh R. (1977) Personnality pattern of importence cases Ind J. Cl Psy 4: 45-50. Greenberg, S.L. (1955) Alopecia areata: Psychatric Survey. Arch. Derm., 72: 454-457. Griesmer, R.D. (1978) Emotionally triggered disease in a dermatologic practice. Psychatric Annual, 8: 407-412. Macalpine I., (1958) Is alopecia areata psychosomatic? A psychiatric study Br. J. Dermatology, 70: 117-131. Perini, G.L., Fornasa, C.V. and Cipriani, R. (1984) Life vents and alopecia areata. Psychother Psychosom., 41:48-52. Schatia, V. (1941) The incidence of neurosis in case of bronchial asthma as determined by the Rorschach test with psychiatruc examination. Psychosoma. Med., 3: 156-169. Sharma. V.K. (1996) Pulsed administration of corticosteroid in the treatment of alopecia areata. Int. J. Dermatol., 35: 133-136. 162 Sharma et al.

Sharma V.K., Dawn, G. and Kumar B, (1996) Profile of alopecia areata in northern India Int. J. Dermat. 35: 22-27. Vander. S.P., Boezeman, J., Duller, P. and Happle, R. (1992) Can alopica areat be triggered by emotional stress: An uncontrolled evaluation of 178 patients with extensive hair loss. Act Derm. Venerreol (Stockh). SIS-II in Alopercia Areata 163

Somatised Pain : A Case Study with The Help of SIS-II Manidra Pal Singh and Padma Dwivedi Somatic Inkblot Series-II (SIS) was administered to a 35 years old, educated, married lady who is suffering from ulcer. Somatic Inkblot images brought out her cold feelings for her husband, conflicting family life, broken love affair, affectional deprivation and suicidal ideation. SIS worked as a time machine and helped her in processing a lot of unprocessed unconscious material. Somatic Inkblot Series is a powerful test. It helps in hearing the inner cry of the suffering individuals. Images are powerful enough to bring out unprocessed material, which needs processing. The Rorschach Inkblot was the first test in inkblot testing. Clinicians generally follow indices based interpretation and because of this they restrict more to diagnosis. Somatic Inkblot Series is a further development of the Rorschach test. It has taken the content analysis, through a few indices are taken for comparison. Content analysis helps in understanding the patients in a few personality traits. The present study is a case interpretation based on content analyses with the help of Somatic Inkblot Series (SIS-II). Mrs. ‘X’ is a 35 years old lady, educated upto M. Phil married with a practicing physician and having an eight years old son. She belongs to a middle class family. She had complained of frequent burning sensation in the stomach and was getting irritated quite often. She was a diagnosed case of peptic ulcer for which she is undergoing treatment. She was interested in understanding her own personality and approached the clinician for help. SIS-II booklet form, was administered upon her following standard procedure (Cassell, 1990). A lot of material was brought out through her response. A few significant responses given by the subject have been analysed through content analysis as advised by Cassell (1980). Image 2A: She has viewed this image as, “Sita sharing her suffering with ‘Kush’ and facing the “Agni Pariksha’”. This indicated her guilt feeling and unshared sufferings, she wanted to open herself to some person in her immediate vicinity, May be even the therapist. It may further indicate her poor interpersonal relation- Manindra Pal Singh M. Phil., Kecturer in Psychological, Desh Bhagat College, Dhuri – 148 024 Punjab (India). Padma Dwivedi, M.A. Social Worker, Dept. of Cardiology, Post Graduate Instate of Medical Education & Research, Chandigarh – 160 012 (India). SIS J. Proj. Pst. & Ment Health (1997) 4: 164-

ship and disturbed family life which she wanted to share with her eight years old son as he is closest to her. Image 3A: ‘Chariest being crucified” indicates her sad feeling and suicidal ideation. It suggests that she has lot of depressive content indeed. Image 4 A: The feeling of her suffering and inner cry has come out more directly thorough her response to this image, “ Chekhov’s horse” listening to its master’s grief, when he fails to find a human as his companion.” Where master is getting none other than a pet animal with whom he can share his grief. This projects her sufferings and grief ridden unconscious material. Image 5A: She has viewed this image as, “Man’s effort to steal fire from the sun like ‘Prometheus,” indicated the myth where God provided fire to man which gives light and energy. Here her responses signifies that she once again wants to be war and energetic. Image 6 A: Her response in this image, “Suddenly, one day, one feels that childhood is far away and one has top comate the journey of life bar-footed,: suggests her regression and takes her back in time when once again she wanted to be a child, free from problems and sufferings. Image 8A: I this images she could see, “A in search of his identity” as she had lost her own identity. On interview she confirms the fact that nobody listens to her in the family and she has no special identity. Image 9A: Her reponse,”Chalte-Chalte youhee koi mil gays tha”, (By chance someone met me on the way) takes her back in time when she can remember the time she spent with a good friend. On interview she came out with her own story of a love affair with someone whom she wanted to marry but her family didn’t allow and unwillingly she gore married to the present husband. She admits that she could not develop a internal liking for this man. They do not speak to each other frequently and to the extent of not having physical relationship for months. The same feeling has been brought by her response on Image 10A, where she saw “two newly born chicken feels it’s better not to speak”. Image 13A: She perceived, “Remember, the icy hand of death is approaching! Her cold feeling and suicidal ideational been brought out. Somatised Pain : A Case Study 165

Image 14A: She has viewed “The candle of life is burring but fails to remove the shadow of memories. “It suggests her pensive feeling towards life with a lot of uncertainty and insecurity. She is not able to ride over the unpleasant memories, which she wanted to control and remove forever. Image 16A: She has responded, “Two brands consulting each other, where to marketwise nest?” This response once again brings back the feeling of insecurity and search for a place called “ Home” where she can live peacefully. The present home seems to be a broken one where she finds herself to be alone. Image 17A: She has responded, “Two unlucky fish that have no brains yet existing”, indicates her own disturbed family life. This image generally beings out beautiful imagery of two loving birds/fishes. Instead of seeing them together she is finding them as easting without any interest. Image 18A: She viewed, “How painful the art of creativeness is!” As she avoided seeing the commonly perceived response “Heart”. She is feeling hurt and insecure in relationship with her husband. Image 23A: She had avoided seeing the commonly perceived response “Backbone’ and has expressed the “fear of breast cancer”. Avoiding backbone on this image may indicate her disturbed cancer”. Avoiding backbone on this image may indicate her disturbed cancer”. Avoiding backbone on this image may indicate her disturbed sex life. During interview she has accepted her hatred towards her husband. Image 25A: She has viewed, “An effort to provide more light as bareness prevails all veer! “ Her sexual conflict has been further brought out by avoiding seeing female genital organ in this image. Image 31A: She has avoided seeing male and female in this image and has responded, “Do not open your eyes. Otherwise your dreams will be shattered“ It suggests her flight from reality and adoption of life in none- realistic state. She is unable to face the reality and to manage the situation in her favor. Image 3B: She has responded, “Hearts once broken never heal”. Once again the broken heart concept has come back suggesting her depressive content and broken affair. 165 Singh & Dwivedi

Image 4 B: Once again the depressive content is brought back by her response, “Kabhi kissi ko mukkamal jahan nahin milta.” No one gets all his desires fulfilled). She is not satisfied with has been provided to her particularly, the family. Image 5 B: The wishful think9ing of eking fortunate and having nice time has been depicted by her response in this image, “Lucky ones! Having their full moons!” She feels as she has not enjoyed ‘full moon reason being her disturbed relations with her husband. On interview, she accepted that her moon is always in could and she cannot imagine the pleasant feeling of a full moon. Image 7B: She has viewed this image as, “The dancing peacock”. It suggests her ego strength and wish to have a happy life. Image 8 B: She has perceived, “The moon during eclipse. “This image brings back the depressive content. The same contents have been depicted in image 5 B also. The concept of moon during eclipse in Indian mythology suggests that the demon ‘Rahu is torturing the moon. The patient is comparing herself to the moon and perceives as if she were under the cultch of her unmanageable husband. This brings out her suffering through lunar eclipse. Image 11B: She has rejected this image and couldn’t perceive anything. Generally people perceive lungs, two birds or flowers. Because of her disturbed interpersonal relationship with her husband she is unable to view two birds together. Even flower is not being perceived on this image. It is indicating her painful memory. Image 14B: She has viewed, “Let us wait for the dawn”. This indicates her positive attitude towards future. She is definitely hopeful of a bright future. Waiting for the dawn indicates symbolically that after every night (bad time) drawn (good time) will come. Such response indicate good prognosis. Image 15B: Her response, “Stop this violence please” suggests that she is not interested in violence any more. This reflects probably the bad time she had, in her life. Image 16 B: She has rejected this image. People generally perceive spine or vertebrae which connote the imagery of male sex organ. Denial of this imagery may indicate her conflicting sex relations, which have been confirmed by the subject. She has also avoided perceiving spinal cord on image 23A earlier. Somatised Pain : A Case Study 167

Image 19B: She has perceived, “Whine the sun begins to burn you, no shade will give you protection. “This suggests her broken home situation. She feels that outsiders can’t help if you are not helped by your family. Her depression has come up on the surface through this image. Image 22B: She has responded, “Let me take rest. I have endured a lot and feel a little bit tired, “suggests her helplessness and feelings of being tired with her own family life. Image 31B: She has perceived “We won’t be able to grow properly if we are too many! Being the last image of the test, it has been created in such a way that people should carry on the way back home a concept of a happy family. Sine the subject is not having a happy family life she has failed to perceive a happy family. Conclusion: Somatic Inkblot Series is a powerful projective instrument. It worked as a time machine and took the patient back in time where she started projecting her broken love affairs. She is passing through deprived family life, constant stress; affect ional deprivation with a lot of hostility and insecurity. The patient is still having good ego strength, which had protected her from break down completely. She is hopeful towards a bright future which is a positive strength. SIS worked as a therapeutic tool and she was quite cheerful at the end of the test. References: Cassell, W.A. (1980) Body symbolism, Aurora Publishers, Anchorage, Alaska. Cassell, W.A. (1990). Somatic Inkblot Series-II Manual., SIS Center, Anchorage Alaska. 168 Singh & Dwivedi

THE SOMATIC INKBLOT SOCIETY I wish to be a Member __________ a Life Member ________ of the Somatic Inkblot Society. Please submit this request to the Membership Committee. NAME ____________________________________ Birth date __________________ (Print or type) First Middle Last ________________________________________________ Zip _________________ Business/Office Address : ________________________________________________ ______________________________________________Tel. : (W)_________________ ___________________________________________________(H)_________________ EDUCATION Degree Year Institution Major Field of Study EMPLOYMENT : Current position, employer, dates (Graduate Students indicate area of study and degree toward which you are working). MEMBERSHIP : ________________________________________________________ TRAINING AND EXPERIENCE IN PERSONALITY ASSESSMENT : SPONSOR (S) Name Address Telephone 1. ____________________________________________________________________ 2. ____________________________________________________________________ SIS subscription payable every year in January through Cashier Cheque/Draft I certify that the information provided above is accurate and correct. An APPLICATION FEE Cheque is enclosed for Foreign Members ($40) & Life Membership ($300). For Members in India Rs. 250/- & Life Membership Rs. 1500/- Total Cheque $/Rs._______________Drawn at________________________________ Signature of applicant : _______________________________ Date :_______________ PLEASE RETURN with your cheque to : B.L. Dubey, Ph.D., Vice-President, Post Box No. 1107, Sector 15 Post Office, Chandigarh – 160 015 (India). Tele/Fax : 91-172-710986, Tel. : 91-172-710985, E-mail : sisdubey@hotmail.com Make cheques payable to Somatic Inkblot Society, Chandigarh (India) N.B. : Please add Rs. 50/- as one time registration fee; and $5 / Rs. 30 if you are sending subscription through out station cheque.

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH (OFFICIAL JOURNAL OF SOMATIC INKBLOT SOCIETY) EDITOR-IN-CHIEF : B.L. Dubey, Ph.D., Director SIS Center India, Post Box 1107, Sector 15 Post Office, Chandigarh-160 015 [Res. : T2/15, Sector 25, Chandigarh-160014 (India)] Tel/fax : 91-172-710986, Tel.: 91-172-710985, E-Mail: sisdubey@hotmail.com OR sisdubey@sancharnet.in EDITORS : Wilfred A. Cassell, MD, Director, SIS Center, 4501E, 104th Avenue, Anchorage, AK 99516 (USA) Fax: (907) 563-3746 E-Mail: drcassell@corecom.net : Padma Dwivedi, M.A., Social Worker, Dept. of Cardiology, Post Graduate Medical Institute, Chandigarh-160 012 Tel/fax : 91-172-710986, Tel.: 91-172-710985, E-Mail: sisdubey@hotmail.com : C. B. Dwivedi, Ph.D., Prof. Dept. of Psychology, Banaras Hindu University, Varanasi-221005 (INDIA) Tel. : 91-542-317430 : Ravi S. Palia, M.S.W., Vice President HRD, Brar Group of Co. 68-70, Sector 17C, Chandigarh-160 017 e-mail : ravipalia@hotmail.com : S. K. Verma, Ph.D., 5522 Modern Housing Complex, Manimajra, Chandigarh-160001. Tel. : 91-172-730993 JOINT EDITORS : D. Saldanha, M.D., Psychiatrist, Dept. of Psychriatry, Military Hospital, Meerut U.P. India, E-mail : danval4@hotmail.com : A. Dubey, MBA, SIS Center, 4220 Edinburg Drive, Anchorage, AK 99515 (USA) E-Mail: adubey@hotmail.com ASST. EDITORS : M.P. Singh, Ph.D, Lecturer, 1329, Sector 70, Mohali-Chandigarh Tel. : 91-172-223658 (H) E-mail : drmps@usa.net : Mridula Mishra, Ph.D., Lecturer, Bihar Yoga Bharati, Munger-811201 (India) Tel. : 91-6344-22430 E-Mail : sisdubey@hotmail.com EDITORIAL CONSULTANTS R. N. Agnihotri, M.Sc., India Anil Agrawal, MBA,India Phillip W. Baker, Ed.D., U.S.A Mahesh Bhargava, Ph.D., India D.K. Bhatt, B.E., India J.C. Bubber, MBA, India S.Chaudhury, M.D. Ph.D., India Alfred Collins, Ph.D., U.S.A. Carina Coulacoglou, Ph.D., Greece K.V. Kaliappan, Ph.D., India Anatoly B. Khromov, Russia Nalini Mishra, Ph.D., India Vipul Mittra, IAS, India Anjana Mukhopadhyay, Ph.D. India Ravi Palia, MSW, India Rakesh Pandey, Ph.D., India Paul E. Panek, Ph.D., U.S.A. Marisa Porecca, Ph.D., Italy S. Ramachandra, Ph.D., India C.S. Rao, Ph.D., India Barry A. Ritzler, Ph.D., U.S.A. Ferro Roberto, Ph.D., Italy Ann C. O'Roark, Ph.D., U.S.A. M. Sahay, Ph.D., India Abhayman Sidhu, MBA, India B. P. Singla, LL.B., India Amool R. Singh, Ph.D., India David Sperbeck, Ph.D., USA M.K. Tewari, MS, M.Ch., India M.S. Thimmappa, Ph.D., India Ailo Uhinki Ps.D., Finland De-Cicero E. Vaz, Ph.D., Brazil Yasho V. Verma, Ph.D., India Abstracted in “APA’s Psychological Abstract” Regd. No. 71632/99, RNI Delhi