SIS Journal of Projective Psychology & Mental Health

JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH The Official Publication of the Somatic Inkblot Society Volume 5 Number 2 July 1998 SIS ISSN 0971 - 6610

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & 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. Chief Editor SIS Journal, P.O.Box 1107, Sector-15 Post Office, Chandigarh 160015 (India) e-mail: sisdubey@ch1.vsnl.net.in Manuscript can also be submitted to Wilfred A. Cassell. M.D., Editor , 4105 Tudor Center Drive, Space B-6, Anchorage, AK-99508 (USA) e-mail:drcassell@corecom.net 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 $40 for foreign members and Rs. 150, for Indian members, Institutional subscriptions are US $60 for Foreign institutions and Rs. 500 for Indian institutions. Life membership is US $300 for foreign members and Rs. 1000 for Indian members. Non-members may subscribe for $30 or Rs. 100 per issue. Cheques should be made payable to ’SOMATIC INKBLOT SOCIETY’ Chandigarh and should reach Dr. B.L. Dubey, Chief Editor, (Address given above). Please add $5./Rs. 20 if you are sending subscription through cheque. CHANGE OF ADDRESS. Society / journal members should inform Mrs Padma Dwivedi, Secretary, Somatic Inkblot Center, P.O.Box 1107, Sector-15 Post Office, Chandigarh-160015 (India), Tel/Fax 91-172-710986, e-mail: sisdubey@ch1.vsnl.net.in and Foreign Members should inform Mrs. Mary Cassell, Executive Director, Somatic Inkblot Center, 4105 Tudor Center Drive, Space B-6, Anchorage, AK - 99508 (USA) Tel : (907) 562-2400. Fax : (907) 563- 3746, e-mail:drcassell@corecom.net of any change of mailing address. Copyright @ 1994. SOMATIC INKBLOT SOCIETY, Anchorage (USA)/India

SIS Journal of Projective Psychology & Mental Health Volume 5, Number 2, July 1998 CONTENTS Page Nos. 1. Editorial : Projective Psychology in India N. L. Dosajh 83-86 2. Mental Disorders Triggered by Exposure to Violent Imagery in the Media and in Electronic Games Wilfred A. Cassell & B. L. Dubey 87-104 3. SIS-I and Body Image Evaluation in Subjects Suffering from Serious Obesity Sguazzin Cinzia and Ferro Roberto 105-113 4. A Correlational Study of Selected Rorschach and SIS-II Variables in Psychiatric Patients Rajinder P. Kaur and S. K. Verma 115-118 5. Aggression in Reaction to Frustration among Adolescent Boys with Depression and Conduct Disorder Ramanath Kundu and Jayanti Basu 119-126 6. Evaluation of Piotrowski's Organic Signs in Epilepsy S. Chaudhury, T. Rajan and S. Rohatgi 127-130 7. A Proposed Model for Assessment of Mental Disability S. K. Verma 131-135 8. Somatic Inkblot Series- An Excellent Psychodiagnostic Tool N. L. Dosajh 136-138 9. Diagnostic Validity of SIS-II Among Psychopathological Cases of Armed Forces. S.P. Rathee, P. Sarkar and A. Singh 139-144 10. An Exploratory Investigation of Age Differences on the Hand Test in Atlantic Canada Paul E. Panek, Annabel J. Cohen, Lynette Barrett and Angela Matheson 145-149 11. Somatic Inkblot Series on a Sexually Traumatized Female Padma Dwivedi, Nalini Mishra and Mridula Mishra 150-153

SOMATIC INKBLOT SOCIETY is an International organization helping thru SOMATIC INKBLOT SERIES TEST (SIS). The SIS is a structured, projective, diagnostic test and an adjunct to psychotherapy. It helps in hearing the inner cry of suffering individuals. SOMATIC INKBLOT SOCIETY is publishing its Journal SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH a half yearly publication in January and July. It has 2 Awards of $250 employing the use of Inkblot Tests SIS & Rorschach. For details please contact : Wilfred A. Cassell, M.D., FAPA, APC, FSIS, Director, Somatic Inkblot Center, President, Somatic Inkblot Society and Editor, SIS Journal of Projective Psychology & Mental Health, 4105 Tudor Center Drive, B-6, Anchorage, AK- 99508 (USA). e-mail : drcassell@corecom.net Web Site at http: //www.owt.com/sis/ OR B.L. Dubey, Ph.D., DPM, FSIS, Chief Editor, SIS J. of Proj. Psy. & Mental Health, Director, Somatic Inkblot Center India, P.O.Box 1107, Sector 15 Post Office, Chandigarh-160015 (India) Tele/Fax : 91 - 172 - 710986, Tel. : 91 - 172-710985, e-mail: sisdubey@ch1.vsnl.net.in

Editorial Projective Psychology in India : The real beginning of Projective Psychology in india may be credited to the author with his first exposure with Rorschach test under the guidance of Dr. James Silverberg (1955) who had administered Rorschach Test to the author in 1949 and on the basis of author's performance on this test, he was selected to work with the Columbia University Team under Dr. Gitel P. Steed on the project 'An Approach to a Study of Personality Formation in a Hindu Village in Gujrat' (1955). It was first time here while working on this project that he administered Horn Hellersberg Test (a Figure Diagram Test 1949). He collected data on this test (1955) and thought of administering this test to B.T. students. He found that Imagination and Emotional Maturity measured by this test correlated highly with Skill in Teaching. So he thought of working on this test using Rorschach Test for finding the validity of the H.H Test. In 1950, while working on the 'Tensions Project,' as a UNESCO scholar, under Dr. Gardener Murphy (1953), he devised a TAT for refugees but it could not be put into use for want of time and money. Again he thought of submitting a study on H.H test for Ph.D in Psychology to the Punjab University. The author contacted a number of Professors for acting as the supervisor but all declined because of ignorance about projective tests, till at last Dr. A.K.P. Sinha, the then Head of the Department of Psychology of Patna University, agreed to supervise his Ph. D work. Then the difficulty arose that very scanty literature was available in India in the field of Projective Psychology. Such was the state of affairs regarding Projective Psychology in India in Nineteen Forties and early Fifties. Anyway when the author got his doctorate from Punjab University, there was no Department of Psychology in the University and Projective Psychology was very little known in India. Dr. H.S. Asthana (1950) was another pioneer in India in the field of Projective Psychology. He worked on Rorschach Test and prepared Indian norms for Rorschach responses. Bagh (1955) published his work on Rorschach with school children. Dosajh (1958) published an article 'The place of Projective Techniques in Guidance and Counselling'. Mathur, et al. (1963) studied Extratensive and intratensive experiential balance as tested by Rorschach. Mukherjee (1950) studied normal Indian personality as projected in the Rorschach Test. Ray (1955) studied the tensional feelings among Abors and Galongs and Shankar (1956) studied the Rorschach responses of a group of juvenile thieves. Shanmugam (1959) studied stars and isolates among high school students and Shapira (1950) studied color responses of Rorschach. In nineteen sixties many persons worked on Projective Tests. Asthana (1961) published a comparative study of Rorschach responses

of the delinquents and the non-delinquents. Then Asthana (1963) published' A Rorschach study of the Indians'. Asthana (1965, 1966) published Rorschach study of child development in India. Chaudhary (1960) published an article on Thematic Apperception Test and Indian Adaptation of TAT with 13 cards (1967). Dixit (1964) conducted a developmental study of the Rorschach response pattern of children between 5 plus and 10 plus. The author published a Monograph (1960) of his Ph.D work in which he had used Rorschach Test. In Nineteen Seventies a lot of work was done on projective tests some of the important studies on projective test published during sixties and seventies are as follows :- Ardhapurkar, et al. (1965, 1967) published Rorschach in Ischaemic heart diseases and bronchial astham. Arundale and Chandra (1967) studied the attitudes using projective tests and especially the Rorschach Test. Akhtar, et al. (1975) published a 'Rorschach study of obsessional neurosis. Blat (1973) worked on the validity of projective techniques. Dubey (1972, 1975, 1976, 1977, 1982, 1988, 1989, 1993) published several studies on Tuborculosis patients, impotence cases, psychiatric nurses and business executives using Rorschach test. He (1979) worked out Rorschach indicators in normal and clinical groups in military population. Again Dubey and Dosajh (1979) studied Rorschach responses in normal army personnel. Dubey et al. (1978, 1979) prepared a validation design for Rorschach and worked out Rorschach responses of different types of neurotics. Dubey et al. (1977) conducted a comparative study of overinclusive thinking on Rorschach Inkblot Test. Dutta et al. (1976) conducted a Rorschach study of peptic ulcer patients. Gulati (1977), standardised D Test as a psychodiagnostic tool. Jain and Prakash (1967) and Dubey (1982) worked out linearity relation between sum R and other Rorschach score variables. Kumar, (1959, 1960, 1961, 1962, 1963, 1965) did a lot of work on Rorschach. Kundu (1969) worked out the inkblot responses of some tribal delinquents. Lambley (1977) worked out Rorschach scores in schizophrenics. Majumdar, et al. (1969) examined certain Rorschach ratios. Malaviya (1973) replicated Rorschach signs with suicide attempted schizophrenics. Mukherjee, et al (1965) studied personality of criminals through Rorschach Test. They also assessed (1970) equivalence of clinical ratings, structural and projective measures of Personality. Pershad, et al. (1977) proposed a statistical design for Rorschach Indices and studied pathognomic signs on the Rorschach (1979). Prabhu (1967) administered Rorschach to normal adult Indians and studied the clinical utility of Piotrowski's alpha diagnostic formula. Prakash et al (1977) conducted a study of institutionalized orphan children with Rorschach Test. Ray (1963) studied juvenile delinquency pattern by Rorschach Inkblots. Ray Chaudhuri (1963) studied the Personality of Indian Musicians with Rorschach and found (1971) relationship of creativity and sex with Rorschach. Ray 84 Dosajh

Chaudhuri et al (1965) further found developmental parallels in the Rorschach responses. They studied (1965, 1968) with Rorschach normal convicted and incipient delinquent adolescents and found relationship between level of creativity and projection of movement responses. They further studied (1969, 1970) effects of inhibition of agitated aggressive expression on Rorschach movement responses and Rorschach differentials of homosexuality in male convicts. They found out (1969) Rorschach indices of aggression and maladjustment. Sethi, et al. (1971) used Rorschach as a measure of psychopathology in murderers. They also made a psychological study (1976) of delinquents with special reference to aggression. Shankar (1968) studied the effective factors of Harijans with Rorschach. Sharma, (1969) made a comparative study of colour pyramid and Rorschach Inkblot Test responses. Shivadasani (1971) studied Rorschach content and its relation to various forms of aggression-hostility. Singh (1965) studied effects of color on associational and perceptual functions with reference to Rorschach color shock. Somasundaram (1964) studied Rorschach responses of people of Kerala. He further (1971) applied the Rorschach technique to patients disabled by convulsive disorders. Tripathi et al. (1960) did content analysis of the Rorschach test. Vagrecha, et al. (1975) found the diagnostic value of Piotrowski's sign of Rorschach responses in epileptic patients. Yadav, (1977) studied Rorschach responses of institutionalised offenders. The editor has tried to include as many studies as possible but there may be many more that have been left out for non-availability of complete information to the editor for which the editor expresses his apologies. During the eighties and nineties Projective Psychology in India spread practically in all departments of Psychology leading to many research studies. Dr. B.L. Dubey brought Somatic Inkblot Series (SIS) test to India in 1988. The SIS is based on the assumption of the Rorschach Test and is a further extension of Rorschach. It is a self-administered test. It is the first video test in inkblot testing and can be used as a group administered test. Dr. Wilfred Cassell is credited to be the leader and poineer in the inkblot video technology. Lot of work is being carried out on this test in different countries including M.Phil and Ph.D work (Mishra, 1996; Gayatri 1997; Rathi 1998; Mitra 1998; Singh 1998; Singla 1994; Bellamy, 1995 and Brady, 1995). Normative data and clinical indices (Cassell and Dubey, 1994, 1995, 1996, 1997, 1998, Dwivedi et at. 1994, 1995, 1997, 1998, Mishra 1997, Dosajh 1996, 1997, 1998, Verma et al. 1994, 1995, 1997, 1998). The test is being used successfully during selection in industry and has attracted researchers, clinicians and psychotherapists. The Somatic Inkblot Society was formed in 1992 and it started its Journal 'SIS Proj. Psy.in India 85

Journal of Projective Psychology & Mental Health' in 1994 published biannually in January and July. The Journal is exclusively devoted to highlight and share research work on Somatic Inkblot Series and other projective tests. The articles of the Journal are being abstracted in "Indian Psychological Abstract" and "Psychological Abstracts" of APA, USA. The Journal and related matrial on SIS can be viewed on our "website" http://www.owt.com/sis/. This Journal is an excellent medium of expression and communication among the international Projective Professionals. References : Cassell W.A. and Dubey B.L. (1997). SIS-II/Video Mannual SIS Center, 4105 Tudor Center Drive, Anchorage, AK- 99508 (USA). Dosajh, N.L. (1958) The Place of Projective Techniques in Guidance & Counselling, Ind. J. of Psy., III, 205-207. Dosajh, N.L: (1953) A Psychological study of the Attitudes of Refugees in the Ahmedabad Area, Ind. Jr. of Psy., Vol. VIII, 39-46. Dosajh, N.L: (1955) Imagination and Maturity as Factors indicative of success in teaching , Ph.D Thesis, Panjab University, Chandigarh. Dubey, B.L. (1982), A Pragmatic view of Rorschach Inkblot Technique, National Psychological Corporation, Bhargava Bhawan, 4/230, Kacheri Ghat, Agra-282004 (India). Gitel P. Steed (1955) Notes on an Approach to a Study of Personality Formation in a Hindu Village in Gujrat, Village India, Studies in the little community. Edited by McKim Marriot, the University Chicago Press, p. 102. Hellersberg, Elizabeth F (1949): The Horn Hellersberg Test, A Personality Test Used for testing the individual's relation to reality Mimeographed manual, copyright, 2nd edition. Murphy Gardener (1953) In the minds of Men., basic books, inc. publishers, New York 168-177. References cited in text can be seen in the books Dubey (1982) and Cassell and Dubey (1997) Prof. N.L. Dosajh Ph.D. Diplomate in Professional Counselling (USA) 1121, Sector 15-B, Chandigarh-160015 (India) 86 Dosajh

Mental Disorders Triggered By Exposure to Violent Imagery in the Media and in Electronic Games Wilfred A. Cassell and Bankey L. Dubey At this time consideration needs to be given to the scientific examination of the risk factors in the spreading virus of violence. This would appear to be especially true in the United States. More and more, the media are reporting mass acts of violence by school-age children. Many teachers no longer feel that there is safety in our schools. Many educators date the onset of this national trend to the assessination of president Kennedy in the early 1960's. While there may be many theories to account for the destructive behaviour of young people, there is a need for more objective data in the field. As this article was being prepared, a 15-year-old youth went on a shooting rampage in Springfield, Oregon. After murdering his parents with guns that they recently had purchased for him to more appropriately channel his anger into sociallyacceptable sporting modalities, he entered the school cafeteria with weapons. Over 20 people were shot, with 2 dead at this time and several on the critical injury list. This presentation employs a clinical case history approach. Part I assesses two adults who were severely disturbed by the media effects of addictive-type playing of violent electronic games and Part II deals a fourteen year old male admitted to a psychiatric hospital for highly dangerous and threatening behaviour. Part I : On April 15th, 1995 terrorists set off a massive explosion outside of a United States federal building in Oklahoma City. Surviving residents were in a state of shock, disbelief and denial; acute symptoms of posttraumatic stress disorder (PTSD) were common place (Davis, 1996). One clinical follow-up study, six months afterwards, of adults who locally sought mental help for distress, observed that immediate reactions of being nervous or upset when the bombing occurred accounted for about one- third of the total variation in PTSD symptoms (Tucker, Dickson, Pfefferbaum, McDonald and Allen 1997). This observation contrasts with the existing literature in which pretraumatic dissociation, or dissociation at the time of the trauma were more predictive of anxiety for later developing distress. In any case, a task force of mental health experts predicts that the psychological trauma will continue to require assessment for many years (Jacobs, 1997). Projective techniques which appraise traumatic imagery are a particularly Wilfred A., Cassell, MD., APC, FAPA, Director SIS Center, 4105, Tudor Center Drive, #B6, Anchorage, AK-99508 (USA) Bankey L. Dubey, Ph.D., DPM, FIACP, Director SIS Center, India, P.O. Box 1107, Sector-15 Post Office, Chandigarh - 160015 (India). Authors are grateful to Mrs Mary Cassell, Executive Director, SIS Center, Anchorage, Alaska for her kind assistance in preparing the manuscript.

effective assessment approach (Cassell and Dubey 1996, 1997, 1998, Dosajh, 1997; Savage, 1995). Graphic scenes of this act of destruction and carnage immediately filled the television screens around the world. The victims were from all age groups. The terrorists knew that many innocent children were in the building when they set off the bomb. Images of the injured and the dying, as well as mutilated bodies were repeatedly presented by the various news media. Over the ensuing weeks, millions of captivated viewers were exposed to a flood of psychologically toxic traumatic scenes. Around the world, these highly charged images evoked great empathetic suffering. Many viewers had their memories triggered recalling instances of past trauma, either personal or witnessed scenes (Cassell 1980, Cassell et al 1998, Dubey et al 1993, 1995) of death and destruction impinged upon consciousness at bedtime. These were incorporated into emotionally-charged dreams in which the terrorists were depicted in menancing human forms or symbolic representations, such as threatening ghost figures. The autonomic nervous system arousal frequently caused the dreamer to awake in terror with psychophysiologic symptoms. These events triggered various stress-induced syndromes in vulnerable adults and children. Many investigators focused on the psychological impact of Oklahomans who were directly exposed to these stressful events. Less is known about the deleterious effects elsewhere of the saturation coverage by the various media. A female clinical psychologist who coordinated mental health activities at the death notification center in Oklahoma observed that in addition to the traumatization of the local population. "that children across the nation lost a sense of safety". It remains unclear the extent to which the traumatic images emanating from television screens got pathologically incorporated into their "nightmares" and subsequent lives. One existing study (Breslau, Davis, Andreski, Peterson and Schultz 1997), suggests that little girls may be more vulnerable to developing posttraumatic stress disorder (PTSD) and that susceptibility after exposure to traumatic events might be higher prior to age fifteen. A number of epidemiologic surveys in the general population indicate a higher rate of PTSD in women. More relevant to the Oklahoma tragedy is one report by Moyers (1996), who observed that the bombing caused an exacerbation of symptoms in veterans from World War II, the Korean War and Vietnam, as illustrated by activation of highly emotionally - charged combat imagery dreams. In the immediate weeks following the Oklahoma bomb blast, television viewers throughout the nation who were in ongoing mental health therapy at the time of the blast brought their resultant media- induced distress into therapeutic discussion. 88 Cassell & Dubey

Federal workers were especially vulnerable to the notion that they might be victims of further terrorist attacks. Female employees in treatment for PTSD were especially vulnerable. An example contributed by a female psychologist practising in the pacific northwest will be reviewed. She was treating a 32 years old woman of Spanish background for Major Depression and Dissociative Disorder with somatization. Her client had partially decompensated after witnessing the media flood of events following detonation of the bomb. A central manifestation was in the intensity of her PTSD dreams. After the Oklahoma bombing, she reported the following highly threatening dream: "I just dreamt of a man and I sitting and looking at each other... it wasn't a familiar face... but he was holding a brown bag... it looked like a lunch bag... and somehow I knew it was explosives in this bag... there was just eye to eye contact for what seemed like five minutes in my dream". After this series of emotionally charged images, she woke in horror with her heart pounding. Her associations suggested that the male figure in the dream represented a yet to be detected, unapprehended terrorist, whom she feared might unleash an attack on the federal building where she worked. The threatening person also had other symbolic connotations. In her immediate situation, he depicted a male who had been stalking her a few months earlier. In the more distant past, the dream figure denoted her ex-husband, who had threatened her life if she attempted to get money from him during a stressful divorce. In the remote past, the figure represented former male sexual perpetrators from childhood. To illustrate more especifically some of her reactions to the bombing, a few more excerpts from the recorded therapy session will be given: Dr. "And in real life, you say that you would have left horrified if you had known that a man was in the federal building with explosives?" "I would have in reality... I would have felt horrified and followed procedures of calling security and alerting coworkers to the fact". Dr. "How have you felt in the federal building since the bombing?' "I never considered being safe before, but after the bombing... I just don't feel safe at all... anywhere really... especially being a federal employee." (It may be observed that the previous dormant paranoid fears became activated). Dr. "How did the Oklahoma bombing affect you emotionally?" "At the time, I was really devastated... I cried for several days... of course all Violent imagery & SIS 89

the workers were crying...some of them knew or had been associated with some of the people in the building." Dr. "So they had personal grief?" "Right, and some of them had relatives within the three-block area that was concerned... and it made me sick and angry that someone could do that to another human being, you know?" Dr. "What made you feel sick?" "Just sick physically," (The flood of imagery overwhelmed her poorly compensated psychological state resulting in an intensification of her depression and conversion pain)... "and I emotionally felt devasted... of course, seeing it on TV and..." Dr. "How did the TV images impact you?" "Horrified! I was... I felt it personally!... I felt grief!" Dr. "Which of the scenes bothered you the most?" "I think the children... them carrying the children bleeding and scary eyed... and that hurt me the worse than anything.: (This represents natural feminine emphathetic concern for children suffering. However, it triggered her dissociative disorder's partial decompensation by activating in deeper layers of consciousness, memories of her own childhood sexual prepetrators that had terrorized and immobilized her.) Dr. "And then the anger?" "That another human being could do that to another person... could do that possibly!" Dr. "If the prepetrators of the bombing were here, what would you say to them?" "I don't know... I would just be so angry... I wouldn't want to look at them. (Recall that in her dream she sat paralysed with fear and stared eye to eye with the terrorist who had complete power over her for "five minutes." This recapitulated her childhood powerless overincestous victimization)... I'd just hope that they would be dealt with properly!" Dr. "And as you are talking now, you are beginning to shake and tremble?" "Yeah... but that's my hand... it just weak from fibromyalgia." (Consistent with her dissociative disorder and conversion symptoms, she used a somatic explanation to explain her emotional discomfort in speaking her exaggerated reactions to the media horror.) 90 Cassell & Dubey

The second, a case history presentation, illustrates how television exposure to the traumatic imagery of the Oklahoma bombing precipitated overt PTSD in a man. He had never sought mental health treatment before in his life. He was a single oil field worker in his thirties. His mental susceptibility had been established a year earlier when he was injured in a Texas oil tank explosion. He had moved to Alaska to obtain work a few months before the terrorist tragedy. At this time some excerpts from a taped interview will be presented: Dr. C. "Could you tell me about the incident when the welder lit the torch. "When he struck an arc to do some welding, it ignited the gas. In turn, it caused a rather large explosion. I and five others were burned and affected by the explosion." Dr. C. "How badly were you burned?" "Well. I was burned on about half to three quarters of my neck, and all my exposed hair was burned and singed. Luckily, I was overdressed and had a hard hat on, so I was shielded from some of the heat... I was hit by a lot of paint fragments and melted plastic, and of course just the raw heat from the flame. The fireball that came out of there was quite large... it threw... there were two people in the vessel that were badly injured. One who was at the two story level fell all the way down onto a bunch of pipes and valves until he hit the metal floor below. By the time he landed he had no clothes on... His boots were knocked off and he was very badly burned." Dr. C. "It was horrible. Could you give some of the highlights of your dreams following this tragedy?" "Well I have a lot of dreams about the situation...I seem I don't know how to say it." (He became anxious and started to block in attempting to recall the disturbing dreams which he had previously reported.) Dr. C. "Some of the images of the actual explosion come to mind?" "Well, I see the fireball quite a lot in my dreams and I see the images of the panic that was kind of surrounding the whole incident a lot in my dreams." Dr. C. "And what do you feel emotionally in those dreams?" "Confusion and anger... kind of helpless...after the explosion we were all so disoriented... there was a lot of just screaming and yelling...some people were just running around...it seems like in circles... there was just nobody... there was no real order... and it is just a real bad thing for me to think about." Fortunately his physical injuries were only minor. After only a few days following Violent imagery & SIS 91

minor medical treatment, he was able to resume work. On the surface, it appeared that he had successfully resolved the stress and functioned in his occupation without incapacitating psychological symptoms. In sharp contrast, after watching television coverage of the Oklahoma tragedy, he developed overt and totally debilitating symptoms of PTSD. The following is a partial transcript of the recorded interview, when he was asked how the television coverage caused him to breakdown. Dr. C. "I know that when you experienced the original tank explosion, it was traumatic. You had dreams of the event, but somehow you were about to compensate... and then after the Oklahoma City bombing you decompensated... tell me about how it activated things." "Well it started off, I was just, I was just... I just woke up and turned on the TV (it may be observed that the traumatic images first imposed upon his vulnerable nervous system when his psychological defenses were low first thing in the morning while still in bed.)... and I saw... I was lying in bed watching the news and I saw all these people running around in total chaos!... I didn't understand what was going on... but a lot of people were just screaming and yelling... people were carrying each other out... and uh...anyways uh. So uh... I don't know... then the report came on and said that a bomb or something had exploded in a building." Dr. C. "It brought back memories?" "Oh yeah...because the people looked... the way I remembered my co-workers looking." Dr. C. "What was going on?" "A lot of them were holding their faces...a lot of them were bloody and a lot of them were screaming and yelling...and nobody knew what was going on." Dr. C. "And you had some upsetting dreams after this incident? Could you tell me about them?" "Well, most of the dreams I had previous to that were just dreams about people on the slope...where people were yelling and screaming and running around...not knowing where they were going...yelling at the top of their lungs...yelling how loud the boom was...nobody knowing what really to do...and people were holding their faces and necks...people's clothes were ripped up...and on the TV, that is basically what they were doing except on a larger scale...sigh!!!...people were being carried out in every which manner...by people carrying them in their arms...the stretchers eventually got there and people were being carried out on 92 Cassell & Dubey

stretchers...and when we were getting out of our area...we were...I had to carry...kinda guide one guy...and every so often I had to drag the guy to get out of that area into a safer area." As part of the diagnostic assessment and treatment planning, projective testing was completed. This was done with two forms of the SIS: (1) the 62 image video version (Cassell, 1984) and (2) the 20 card form (Cassell, 1980). With the video procedure, he rated image 15B as the most "threatening" of the 62 images. He responded to this as follows: "I kind of see...the kind of the way that I feel...right there...I see a bunch of knives and it looks like half of scissors...it reminds me of confusion...the sharp knives and you know...like saw blades and halves of scissors and knives all coming towards the center...just the black scribbly things remind me of confusion...that's kinda the way I felt during the explosion...before the explosion...we were, I mean things were pretty calm...things were we were going about things pretty safe...everything seemed to be going okay...we were paying attention to our job...you know...just doing our..minding our own business and doing our thing...and the next thing you know there was this huge explosion and there were people burned all over the place...carrying stretchers... people were hurt... there was stuff flying...I was hit by a bunch of flying debris, you know." (apparently the SIS video visual stimuli accessed the same stream of disturbed imagery as his PTSD dreams.) Dr. C. "And in your dreams you relived that repeatedly?" "Well in my dreams, it's the same kind of thing...I used to never really get nightmare and bad dreams... Now I don't like going to bed at night and turning out the light...because I know what is in store and I just get...all those things just remind me of just...like junk and the confusion over me." Certain other responses evoked by the SIS video warrant brief comment in terms of their relationship to the tank explosion. One depicting a worker who fell two stories was 2A, A guy falling." In regard to the burning plastic which flew through the air "plastic melting". The fragments of flying metal were depicted in 11A as "sharp cutters, two weapons and knives". Several responses related to the harmful physical effects of the explosion, such as 22B, "wound or gash", 14B, "bone infection". Consistent with his panic psychophysiologic symptoms (e.g. heart pounding) and hypochondriacal concerns - especially those concerning cardiac status - 19B was seen to represent "two hearts and a bud with legs coming out...I hate that one...the way it is grabbing for those hearts and gobbling them up like a cancer... I like to see hearts peaceful (13A "a plead for peace"). For the card form of the SIS, he projected onto inkblot 7, the response "A sick heart split up", Violent imagery & SIS 93

and for card 8, "a heart in the middle being attacked by a weird creature." Another inkblot in the SIS that was therapeutically helpful was the one originally designed to symbolize death (Card 20). After viewing this initially, he responded as follows: "It looks like a... kind of looks like the way I feel sometimes...it looks like kind of like a face in range...it looks like it is getting ready to attack something...or it also looks like it is laughing...it also looks kind of sinister...it kind of reminds me of some of my confusing dreams that I've had." Dr. C. "In what way confusing dreams?" "Well...just... I've never really had much... I've never really had nightmares... really pretty much most of my life... and lately I've had a bunch..and just they are confusing to me...and I mean it's just like this thing here (pointing to Card 20)." Dr. C. "And the emotions...what is the feeling tone as you look at this...and then the dreams?" "Uhm...pain...just like evil things are happening...pain." Dr. C. "And you have had some panic symptoms where your heart will beat rapidly...could you share those?" (In addition to PTSD, the trauma produced symptoms consistent with Major depression and panic disorder.) "Yeah...I wound up checking my blood pressure...because I've got my machine sitting in the bathroom...and I was really concerned about the feelings that I was having...and I did feel... my heart was beating more pronounced." Dr. C. "Some people see death here (pointing to card 20)...has death been on your mind more?" "Well, yeah...I used to not think much about it...but there have been days where I actually...for some weird reason thought that I was going to die...I don't know why," (This card facilitated expression of his rage as well as his fears of dying. Without this interview aid, many who fear death employ the defense mechanism of denial (Becker, 1970.) Over time, as therapy progressed, rather than having the images concretely depicting the explosion intrude upon his dreams, the imagery became more symbolic and consequently, less threatening. It was also possible to use the death card to train him in the self analysis of the threatening dreams signifying his demise. The following interview material serves to illustrate this educational process. 94 Cassell & Dubey

Dr. C. "It seems as though you are not having as horrible, vivid dreams of the actual explosion. Could you share last night's dream?" "Well, you are right... the more graphic dreams are not as common as they were...last night I had a dream that was kind of like the one I had a week and a half ago...I was in this apartment that I don't live in...and this green ghost...I don't understand the logic behind that...told me that he was going to come and get me." Dr. C. "Scary!" "Yeah, I was real scared...and I left the house...left the apartment and I didn't go back in...and I remember that I was real hungry and I went and got a ladder because I didn't want to go into the apartment...I went and got a ladder and I crawled into the window and my brother and sister whom I don't even live with were in the apartment." Dr. C. "Dreams are interesting...they put together various fragments." "I mean, its pretty weird...and so I put a burrito into the microwave and was cooking...I was getting ready to cook the burrito or whatever I put in there...and as I pressed the button to started to cook, the microwave exploded outwardly...and since I was on the other side of the window I didn't get burned very bad...but my brother who was standing right there and my sister...they were standing on the other side...they got burned really bad." (His siblings symbolized his fellow workers who had been severely burned in the tank explosion.) Dr. C. "So how did you feel?" "I should have... I felt I probably should have told them." Dr. C. "So you felt guilt there." (Defusing his irrational guilt was an important part of the cognitive therapy.) "I had to get out of the house...and last night I had a dream that was a continuation of that one". Dr. C. "Ok, let's hear it. " "Thanks...this happened in my house that I live in now...and the same green ghost came up to me and says we are going to get you!" (The green ghost symbolized his angry self, the terrorists and ultimately death.) Dr. C. "Very scary." "I was very scared...and I remembered that there was danger in the house and I had to leave the house...and I remembered that the microwave had blown up Violent imagery & SIS 95

once...so I thought of all the things that I didn't want to do...so I thought that I couldn't turn on the light switch...couldn't turn off the light switch...couldn't cook anything... couldn't open the refrigerator... couldn't open any door...couldn't do anything and I felt helpless and then woke up." Dr. C. "What did you feel at the time?" "I was very stressed!" Dr. C. "And was your heart pounding?" (Attempts to associate mental distress and body reactions during panic attacks assisted in educating him concerning the emotional significance of his heart's pounding.) "Yes!" Dr. C. (Showing him Card 20 again) "What is the parallel between the green ghost images and this?" "It doesn't look the same...but the kind of sinister look and the kind of evil looking face...kind of half-laughing, half-mean face is kind of similar...the figure I had in my dream was kind of evil...but laughing at me at the same time." Dr. C. "What does the green ghost symbolize to you, do you think?" "I have no idea," Dr. C. "Please try." "I...(Stammerising with anxiety)...I don't know...may be that there is... I've thought about this before." Dr. C. "Does it bring to mind death?" "Well yeah...definitely!" Dr. C. "Tell us about it." "Well, there is a danger in the house...and if I didn't leave, I'd be dead." "Dr. C. "Right...and what is happening is that there has been a transformation in the horrible image... You no longer are seeing the flashbacks of the explosion... you are moving into a safer thing...but is still very scary - the microwave explosion which is less scary than the original explosion...as time goes on those images will melt away...they will fall behind you and you will feel better...you won't even have the panic attacks in the day...so the outlook is very good." Part II : One of the most psychologically destructive trends in the media is the tendency 96 Cassell & Dubey

to aggrandize and make "heroes" or "heroines" of the perpetrators of evil. At the national level in the United States, the O.J. Simpson trial recently preoccupied the nation. Because of the court rules in one trial, this sports hero was acquitted. In a subsequent trial with different regulations, the second jury considered him guilty of stabbing his ex-wife to death. Following this, he has appeared on various television talk shows. During one such show, he used a banana to make stabbing gestures after bragging about his wet dreams in prison and his more recent sexual conquests following his release. At a local level, the same aggradization of criminals exists. For example, recently the publisher of the Anchorage newspaper presented a sizeable photograph of a handsome looking man, emphasizing his powerful hands. He was accused of strangling a policeman. Below this was a picture of the " unibomber", a man who had killed several people with mail bombs. Angry adolescent males with a poor sense of masculine identity are especially influenced in their sexual and aggressive fantasy lives. By acts of violence such as murder, they will get their picture in the media and become celebrities. The recent killings in a few schools across the country adds strength to this concern, with more frequent copycat acts of homocide. Acts of suicide are known to trigger other disturbed individuals to acts of self destruction. Similarly, acts of violence may encourage others to be aggressive, as illustrated by an angry crowd on a rampage. Currently, television and movie viewers are flooded with images of violence. There is also an abundance of electronic games and computer internet connections where "victims" are murdered by the press of a button. When you add in the additional risk factor of easy access to weapons, including the internet information on the manufacture of bombs, the situation becomes highly volatile. A recent survey in Alaska estimated that among male adolescent, nineteen percent carried a gun to school "on one or more of the last 30 days". (Middaugh, 1998). While school administrators, teachers, other students and parents have been murdered, one of the most common targets for homicide are taxi drivers. In Anchorage, with a population of 1/4 million, three cab drivers were murdered in the last three months. In the clinical examination of the murders, one is struck by the lack of empathetic concern for the victims or their loved ones. It is a though they are shooting imagery characters in a video game. At this time, the case history of "a 14 years old black youth who lit a fire in a school storage room", whom the police transported to a psychiatric hospital in Alaska, will be reviewed. After he had been expelled from school, he had made Violent imagery & SIS 97

a serious threat, backed up by the warning, "You know me... I am capable of doing it." He said that he would shoot school staff and fellow students just like he had observed on television from another part of the country. He also threatened to burn down or blow up the school. When asked later about his intention, he claimed that "it was just a joke." Several months earlier, he had been expelled for a brief period of time for acting on angry threats to burn the school. He had been totally noncompliant in avoiding court orders to participate in anger management training and community service. The only punishment that his mother was able to enforce was restricting him from playing electronic video and computer games of violence. She did this by simply getting rid of them from the home and restricting his funds, as best she could, for playing them elsewhere. This was a great loss to him since, previously, he played them with an addictive frequency. This adolescent youth was administered the Rorschach test by a clinical psychologist. The test failed to detect the projection of murderous imaginary characters from his preoccupation with computer games of violence. It found no reference to his phallic anxiety or his extensive pyromanic behaviours. The only common finding was that the projected images of distorted forms. He was later administered SIS-I card form of the test and certain of his responses to the Card Form helped to conceptualize his violent fantasy life. Card 7: "This one is kinda cool...it reminds me a video game that I used to play...it looks like an end guy with giant horns."The video game was called "Save The Princess." He added that it was a "super game that wasn't bloody" like many to which he had become addicted. After further questioning, he indicated that he loved to play such games because they made him feel powerful. "If I won a game I'd be almighty...I can really "kick butt" and beat the scores of my friends. In this fashion, he thought he improved his social status. Next, he was asked which was the most "bloody" game that he had ever played. He said that is was called "Resident Evil II". He proudly exclaimed "It is so gory that it even has a warning at the beginning indicating that it had graphic violence and bloody gore in it." He described it with excitement as "having everything such as zombies and if you hit them you see blood fly and they fall on the ground in a pool of blood and quiver as they die." When asked if he had any concerns about hurting them, he stated that "they are just games and nobody really got hurt." He had totally become unaware of the suffering that could come from hurting others. Card 1: "A deformed pig". As will be shown later with his phallic response to Card 8, he sees his own body image as deformed. 98 Cassell & Dubey

Card 3: "Numbers". He responds to this card rather concretely. In doing so, he fails to recognize the embedded structure, denoting a loving relationship between a man and woman. Card 8: "A penis deformed". Before he verbalized this response, he appeared to become anxious and grimaced. After he revealed his projection of sexual deformity, he became even more defensive, refusing to give further associations. He has had no father or positive male role model with whom to identify. At a later time, he indicated that he had been sexually active and had first begun intercourse with girls at age ten. This was done more as a reflex without awareness of loving sexual intimacy, as noted by his failure to detect this theme in Card 3. It appeared that the only time he felt potent or powerful was in indentifying with violent perpetrators of violence in his video games. Card 9: "A bizarre space alien with lips that go out on tentacles and want to kiss." This response shows heightened oral sexuality. It is consistent with the fact that, in addition to aggressive imagery, many electronic games have seductive sexual connotations. The victor in the game, "Save the Princess" would be an example. Card 14: "A bizarre space alien skull". This projects his heightened awareness of electronic game characters. It fails to take note of the sexual structure suggestive of a woman's body. Card 15: "A club". This response denotes a weapon. It is consistent with his having acquired a violent fantasy life by having been repeatedly exposed to images of destruction in the electronic games. Card 16: "A giant eyeball with a nose". The emphasis on the extreme size of the eye relicts his paranoid concerns. When he was again asked if the what he saw brought forth emotions, he denied having any emotional linkage to the response. He then exclaimed angrily, "I feel nothing!" In fact it was significant that even though many of his responses suggested he had very violent fantasies, most of the time, he inhibited any empathetic considerations for the imaginary victims. Card 20: "An evil wizard with a mask on". He then indicated that it specifically resembled a character from a video game. "It's like a guy in the game called Mortal Combat...he is very old with a blue robe and strangly white hair...he is evil...he brings the evil forces to earth to destroy and conquer". The teenager then made the animated movements of boxing towards the older male father figure. He then proudly exclaimed that when he fought him electronically, "I always win!". All individuals have a capacity for both good and evil. These games of violence Violent imagery & SIS 99

100 Cassell & Dubey A Few Significant SIS Images Interpreted in the Study

Violent imagery & SIS 101 tend to accentuate the evil potential of youth who become addicted to them. They also activate repressed feelings of become addicted to them. They also activate repressed feelings of aggression towards father figures who have neglected or abandoned them in the real world. In the United States, aside from athletes, few men in the public realm represent hero figures for positive identification by male adolescents. At the end of the session, all twenty cards were placed in view and he was requested to pick his favourite. He selected Card 7 saying that it represented "one of the evil bosses in a video game". He complained that he missed him almost as though this electronic figure was a real person. He then explained that this fantasy person fights particularly well and that "When I beat him, I can brag to my friends". Finally, he was highly reluctant to choose the one that bothered him the most. He eventually indicated that it was the card seen as "A deformed penis." This suggested that he truly had a poor sense of masculine identity. After completing the card form of the SIS, the 62 image booklet form was administered. As might be expected, his responses were parallel to the card form. However, two were more specific to his pyromanic tendencies. For 3A, he envisioned "A burned man caught in a forest fire". For 13 A, he projected the response "A hand reaching out of flames." Discussion : The first case presentation illustrates how a woman, working in federal building thousands of miles from the Oklahoma City blast was detrimentally affected. She incorporated images from the news media into disturbing dreams, producing an exacerbation of her pre-existing mental disorders. Previous traumatic memories from being stalked, a sadistic ex-husband, and her unhappy childhood were activated. These caused a summation of threatening images, resulting in an overload of stressful symptoms. After several months of therapy, she returned to her previous level of compensated morbidity. However, she continued to fear working in a federal building, especially during bomb threats and at anniversary times of the Oklahoma tragedy. The second case presented an individual who had been traumatized a year earlier in an industrial tank explosion, but who had never fully decompensated. However, after waking up to the highly graphic television coverage, he developed serious mental disorders frequently associated with PTSD. With active treatment, he became relatively free of symptoms and was rehabilitated. For him, projective testing with the SIS proved helpful in his understanding his

102 Cassell & Dubey disturbing dreams, his emotions, his irrational fear of dying and his psychophysiologic cardiac symptoms (Baily et al 1996, Cassell et al 1994, 1996, 1997, Mishra 1996, Rathee et al 1994, Singh & Dwivedi 1997). The video viewing of image 15b activated memories of the explosive event in the oil field, months earlier. Having the video equipment to re-activate this in the relative safety of a clinical office setting was highly useful in the debriefing psychotherapy sessions. It technically facilitated dipping into the memory stream of PTSD dreams images for therapeutic processing. It enabled the clinical conditions to closely approximate the visual reality of the previous traumatic experience, along with the higly charged emotions. This enabled cathartic expression of feelings, analytic educational exploration and cognitive therapy (Cassell et al 1995, 1996, 1997, Dubey et al 1994, 1996). This use of the SIS enables the traumatized person to understand and analyse the disturbing dreams and other confusing symptoms in the therapist's supportive presence. The clinical setting contrasts sharply with the victim's home situation at night. In the latter, the dreamer wakes up physiologically aroused in terror. At that time, reality testing may be weak, and there is great vulnerability to culturallyheld, erroneous interpretations concerning the significance of "night terrors". Frequently, victims are highly reluctant to share such distorted beliefs. They do not want to be seen by anyone, including professionals, as mentally unbalanced. In connection with the latter, at this time, an attempt will be made to enter the inner world of the oilfield worker, as revealed by responses projected onto the SIS. When he opened his eyes in the morning to the television of the Oklahoma bombing tragedy, his emphathetic compassion with victims was intense. It triggered memories of the suffering experienced by himself and his fellow workers a year earlier in the tank explosion. Although, this was an accident, he had great anger towards himself and irrational guilt. After the bombing event, he also had to mentally process an image of the terrorist. Cognitively, this took on the evil features of Card 20, symbolizing death. In his disturbed state, he wondered if he, too, could lose control and do something harmful to others. Consequently, he felt anger towards himself, as well as the murderers. Like the woman outlined in Case 1, he also had paranoid fears that somehow, he would be killed too. In order to quickly grasp the public's attention, potentially destructive arousing stimuli are frequently thrust upon the senses by the various media. In many instances, these impinge upon consciousness at multiple levels of awareness - including the subliminal. Frequently, these have been specifically constructed to appeal to the basic mental dimensions of sex, aggression and power.

Violent imagery & SIS 103 Sometimes such stimulation can be potentially upsetting, such as the capacity of traumatizing scenes, seen prior to sleep, to trigger disturbing dreams. Such material, if observed when the sleeper first awakens, can also produce deleterious effects. More research must be conducted on the psychic numbing and dehumanizing effects of such media flooding - especially in susceptible children with histories of trauma and the mentally ill. The oil field worker volunteered the notion that it would have been helpful for him to have been warned by a television insert: "For some people, viewing this material may be deleterious to mental health". In the United States, there needs to be more in-depth, scientific research concerning the effects of destructive, rather than constructive, news reporting. While the Constitution is a well thought out document, guaranteeing the rights of individuals to form a free society, there has to be some balance and responsibility taken for individual actions. Just as tobacco companies are now being restricted by law in their advertising, the media may need comparable restrictions, so that liberty and the freedom of the press exits, but in a manner that is wholesome for the general public. The same might apply to the video and computer games disseminating the destructive images of violence. It might be noted that the teen aged youth described in this study was not deterred by a warning about the graphic images' ability to stimulate murderous fantasies. Certainly, parents and educators must be made aware of the potential for harm from such activities. However, much work needs to be done by the scientific community before realistic guidelines can be established. It is suggested that projective techniques such as the SIS, which can appraise the harmful effects of certain types of violent fantasies and imagery, can sometimes be useful. It is hoped that the three case histories presented in this article represent one small step in this direction. References : Baily, C. and Murstein B.I. (1996) Paranoia Assessment with the SIS-II, SIS J. Proj. Psy. & Ment. Health, 3:2, 109-122. Breslau, N., Davis, G.C., Andreski, P., Peterson, E.L. (1997) Sex Differences in Posttraumatic Stress Disorder. Archives of General Psychiatry, 54:1044-1048. Cassell, W.A. (1980) Body Symbolism and the Somatic Inkblot Series, Aurora Publishing, Anchorage, AK, (USA). Cassell, W.A. (1984) SIS-Video Test, SIS Center, Anchorage, AK, (USA). Cassell, W.A. (1994) Continuing Rorschach's Conceptualization, SIS J. Proj. Psy. & Ment. Health, 1:3-14.

104 Cassell & Dubey Cassell, W.A. (1996) Future Direction of Projective Technique. SIS J. Proj. Psy. & Ment. Health, 3:2, 89-90. Cassell, W.A. and Dubey, B.L. (1996) Efficacy of the Booklet and Monochromatic version of the SIS in a Case of Repeated Miscarriages, SIS J. Proj. Psy. & Ment. Health, 3:2, 131-145. Cassell, W.A. and Dubey, B.L. (1996) The use of the Rorschach and SIS in Releasing Somatised Grief. SIS J. Proj. Psy. & Ment. Health, 3:1, 3-32. Cassell, W.A. and Dubey, B.L. (1997) Therapeutic Dream Stimulation with the SIS-Video, SIS J. Proj. Psy. & Ment. Health, 4:1, 3-23. Cassell, W.A., Dubey, B.L. and Roth., G.J. (1997) Medical Psychological and Spiritual Application of SIS Inkblots. SIS J. Proj. Psy. & Ment. Health, 4:2, 89-112. Cassell, W.A. and Dubey, B.L. (1997) SIS-II/Video Manual. SIS Center, Anchorage, AK (USA). Cassell, W.A. and Dubey, B.L. (1998) Application of SIS in Personality Assessment, Diagnosis, Screening and Therapy, SIS J. Proj. Psy. & Ment. Health, 5:1, 3-32. Cassell, W. A. and Fields, D. (1995) SIS-Video : Case Report and Disscussion. SIS J. Proj. Psy. & Ment. Health, 2:3-18 Davis J.A. (1996) Sadness, Tragedy and Mass Disaster in Oklahoma City: Providing Critical Incident Stress Debriefing to a Community in Crisis. Accident & Emergency Nursing 4 (2) : 59-64 Dosajh, N.L. (1997) How a Single Image of SIS-II Leads to Complete Psychodiagnosis, SIS J. Proj. Psy. & Ment. Health, 4:2, 152-154. Dubey, B.L. (1996) SIS as a Projective Psychotherapeutic Tool for the 21st Century. SIS J. Proj. Psy. & Ment. Health, 3:2, 95-107. Dubey, B.L. and Cassell, W.A. (1993) Some Experience with SIS-II. Brit. J. Proj. Psy. 38:1, 19-41. Dubey, B.L., Cassell, W.A., Dwivedi, P. and Mishra, M. (1995) Inner Cry through SIS Test, SIS J. Proj. Psy. a Ment, Health 2:2, 129-134. Dubey, B.L. Mishra, M., Dwivedi, C. B. and Mishra N. (1994) Diagnostic and Therapuetic Utility of SIS-II and Rorschach, SIS J. Proj. Psy. & Ment. Health, 1:19-26 Dwivedi, P. Mishra M. and Cassell, W.A. (1994) SIS-Video in Adolescents, SIS J. Proj. Psy. & Ment Health 1:27-32. Jacobs, G. (1997) American Psychological Association task force to the Mental Health Response to the Oklahoma City Bombing. Middaugh, J. (1998) May 14, Physical Fighting and Weapon Carrying Behaviour among Alaskan Adolescents, State of Alaska Epidemiology Bulletin No. 8. Mishra, M. and Dwivedi, C.B. (1997) Content Scale Based Diagnostic Compatibility of the SIS- II with Rorschach test in Normal, Neurotics and Schizophrenics, SIS J. Proj. Psy. & Ment. Health, 4:3, 121-140. Moyers, F. (1996) Oklahoma Bombing: Exacerbation of Symptoms in Veterans with PTSD. Archives of Psychiatric Nursing 10 (1):5-9 Rathee S. P., Goel, D. S., Chawla, M. L., Saldanha, D. and Dubey, B.L. (1994) A study of SIS-I in Coronary Cases. SIS J. Proj. Psy. & Ment. Health, 1:51-64. Savage, G. (1995) Bereavement and Hypnosis : A Case Study, SIS J. Proj. Psy. & Ment. Health, 2:1, 29-40. Singh, M. and Dwivedi, P. (1997) Somatised pain : A Case Study with the Help of SIS-II. SIS J. Proj. Psy. & Ment. Health, 4:2, 173-177 Tucker, P., Dickson, W., Pferrbaum, B., McDonald, N. and Allen G.B. (1997) Traumatic Reactions as Predictors of Stress after the Oklahoma Bombing, Psychiatric Services, 48:1191- 1194.

The SIS-I and Body Image Evaluation in Subjects Suffering from Serious Obesity Sguazzin Cinzia and Ferro Roberto Thirty hospitalised female obese patients, in the age group of 20-59 years were studied with the help of Cognitive Behavioral Assessment 2.0 and Somatic Inkblot Series - I. (a) Subjects with high scores of psycho-physiological activation, depression and anxiety gave greater number of anatomical content and typical responses. (b) Higher scores on neuroticism and psychoticism were associated with lower number of dehumanized content. (c) Anxiety and fear contents responses were associated with sexual content. (d) Lie scores were associatedwith lower pathological emotional content. The studies concerning serious eating disorders unequivocally lay stress on the importance of a distorted body image in increasing emotional discomfort and rational isolation ( Yager et al, 1987; Roth and Ross, 1988; Oesterheld et al , 1987; Schneider and Agras, 1985). At present the treatment require the introduction of a very strict diet, pharmacological and surgical interventions (Adjustable Gastric Banding and vertical Banded Gastroplasty), or an integration of these various techniques. In all cases patients reach a more less drastic reduction in their body image with an increase or reappearance of such problems that were absent or latent before clinical intervention. These problematic conditions are very well known to clinicians and therapeutic protocols provided for individual or group therapy and periodical follow-up. Many studies have used psychometric instruments such as cheek lists, inventories and scales (administered or self-administered) and/or diagnosis based on DSM-IV criteria. Only Boskind -Lodhal and white, 1978 and connors et al. 1984 used a specific instrument for the evaluation of body image (Modified Body Cathexis). So far the specific aspect of modification of body image and somatic anxiety appear almost absent in literature. For this reason, a new specific method for the evaluation of Body Cathexis has been undertaken (Cassell, 1990), which has been already applied in other cases, but not for the treatment of serious obesity. We may suppose that the subjects who undertook a considerable reduction of their body mass are likely to reveal themselves to the SIS-I indications relative to the modification of their body image. In our scheme of research the administration of SIS-I precedes any therapeutic intervention and represents the initial point for successive change in perception of the body. Our research takes into consideration a group of women affected by serious Sguazzin Cinzia, Unit of Psychology, Fondazione S. Maugeri Clinica del Lavoro e della Riabilitazione, Istituto di Ricoveroe Cura a Carattere Scientifico, Medical Centre of Pavia,Via Ferrata,, 8, Pavia, Italy. Ferro Roberto, Ph.D., Psychologist and Psychotherapist, via Bernardino Bellincione -14, 20134 Milano (Italy).

obesity (Body Mass Index>30) hospitalized in the Medical Centre of Pavia for a treatment aimed at weight reduction. All the subjects were hospitalized for a period of two weeks during which they participated in a program that provided clinical and psychological evaluations, health education and nursing. The goal was to reach a better consciousness of the patient's discomfort, a motivation to change and a better compliance to the proposed intervention strategy. The psychological intervention requires an initial phase of assessment with the administration of a wide ranging battery of tests, viz, routinely applied Cognitive Behavioural Assessment 2.0-Primary Scales (CBA 2.0), the administration of specific tests for eating disorders that discriminate the presence/absence of binge behaviour, and the administration of the Somatic Inkblot Series-Form-I for the evaluation of Psycho-somatic representation ; followed by individual interviews useful to ameliorate the psychodiagnosis and a psychiatric evaluation. During their stay in the Medical Centre the patients participated in daily group psychotherapy (15 sessions) with a group of participants ranging between 8 and 12 patients. The sessions are conducted by the psychologist following the new orientation of the systemic-constructivist approach. The present research tries to evaluate the body perception-in its affective and cognitive aspect-of 35 women preceding their loss of weight identified as the period of greater investment on the body and of greater cognitive and emotional activation. Thus it attempts to identify the possible presence of a pattern of answers obtained from the administration of SIS-Form-I which can be correlated with the results obtained from the Primary Scales of Cognitive Behavioural Assessment 2.0, routinely used by us. Material and Methods : Sample : The sample consists of 35 females hospitalized with II and III degree of obesity (BMI>30) The subjects were in age range from 20-59 yrs (u=36.91;DS=9.47), with a men of 8 years of completed studies. Subjects with a serious psychopathology were excluded from the study. 45% of the subjects were housewives, 15% were in search of an employment, 35% were employed and 5% had ceased their working activity. 75% of the subjects were married, 15% divorced and 10% of the subject did not have an affective relationship. Instruments : To every subject the Primary Scales of the Cognitive Behavioural Assesment 2.0 and the Somatic Inkblot Series -I were administered. The Cognitive Behavioural Assessment 2.0 is a wide range battery that: - furnishes a precise evaluation of the problems that the patients present 106 Cinzia & Roberto

at the moment; - offers a psychosocial anamensis; - furnished a wide measurement to the specific period examined, of some psychological construct of primary importance, such as state anxiety, depression, fears obsessions, compulsive and psychophysiological disturbance. - furnishes an evaluation, independent of the examined period, of some variables that constitute prognostic indices referred to the risk of developing in the presence of certain environmental pressure as disturbance and maladaptations; such as trait anxiety, psychophysiological reaction, emotional stability, asocial and antisocial behaviours (Shown in Table 1). The Somatic Inkblot Series-I is a structured Projective inkblot test comprising 20 cards. Each card represents an ambiguous or semi-ambiguous visual stimulus based on a specific body imagery and projection answers furnished by the patients. The card Form of SIS test has been accepted and used earlier in our clinical setting. Administration : The Cognitive Behavioural Assessment 2.0 was self-administered and the Somatic Inkblot Series-I was administered by a trained person during hospitalization of the subjects. The Analysis of Data : The evaluation of the SIS- was done independently by two psychologists. The concordance rate of evaluation, using the Weighted Kappa Coefficient resulted in a value of .90. For all the protocols the first Response was taken into consideration. The results obtained from the Scales of the CBA 2.0 were correlated (Pearson's) with the results reported on the SIS-I. The goal was to find a relationship between psychological characteristics of the subjects their Response patterns. A descriptive evaluation was also performed on the content of the responses of some specific cards (10,13,14,18) for the peculiar answers of their content. Results : In our subjects the data analysis demonstrated a general tendency to provide animal responses and in particular the original /animal responses representing the 25.28% of the total responses. The correlation between the two instruments has put in light the presence of statistical significance between the Scales of the CBA 2.0 and the categories of Responses of the SIS-I. In particular the subject with high score of psychophysiological activation (QPF), with the presence of depression (QD) and of anxiety STAIX-3) furnished significantly more responses of anatomical content (Anat) which are characterized as Very Typical Responses (VT). To an increase in the score of Neuroticism (EPQ-N), Psychoticism (EPQ- P) and to those related to Obsessive-Compulsive Behaviours, lead to decrease in the number of dehumanized content. A general increase of the scores of the SIS-I in Obesity 107

Fear Survey Schedule (IPF, IPPH, IP1 IP2) produces significantly more responses with a negative emotional content (anxiety and fear) to a greater number of sexual content. Table 1 Congnitive Behavioural Assessment 2.0 (Primary Scales) Scale Score Investigation Subscale Area SCHEDULE 1 - - General data SCHEDULE 2 STAI-X1 Scale STAI-X1 State anxiety State Anxiety Inventory SCHEDULE 3 STAI-X2 Scale STAI-X2 Trait anxiety Trait Anxiety Inventory SCHEDULE 4 - - Personal history SCHEDULE 5 E Scale EPQ-E Introversion/ Eysenck Personality Extroversion Questionnaire N Scale EPQ-N Neuroticism P Scale EPQ-P Psychoticism L Scale EPQ-L Lie SCHEDULE 6 QPF/R Scale QPF/R Psychophysiological symptoms Psycholotical Questionnaire SCHEDULE 7 IP/R Scale IP/R-F Fears Fear Survey Schedule IP/R/PH Number of maximum fear Subscale 1 IP-1 answers Subscale 2 IP-2 Fears : calamity Fears : social Subscale 3 IP-3 refusal/anxiety Subscale 4 IP-4 Fears : repulsive animals Subscale 5 IP-5 Fears : agoraphobia/ claustrophobia Fears: medical fears SCHEDULE 8 QD Scale QD Depression Depression Questionnaire SCHEDULE 9 MOCQ 7 R MOCQ/R Obsession and Maudsley Obsessive Subscale1 MOCQ-1 compulsion Compulsive Subcale 2 MOCQ-2 Checking Questionnaire Subscale 3 MOCQ-3 Cleaning Doubting-ruminating SCHEDULE 10 STAI-X1/R Scale STAI-X3 State anxiety State Anxiety Inventory 108 Cinzia & Roberto

An increase in the scores of the Lie Scale (EPQ-L) is associated with a less number of responses with pathological emotional content. Table 2 Correlations between CBA and SIS Scores VTR OR ANIM ANAT SEX OTH.R PAT.R EPQ N r= -.329 r= .05 EPQ P r= -.33 p= .05 EPQ L r=-.45 p=.007 QPF r= .365 r= -.383 p= .031 p= .023 IPF r=.397 p=.018 IPPH r=.348 r=.355 p=.04 p=.036 IP1 r=.450 r=.38 p=.007 p=.025 IP2 r=.387 p= .021 QD r=.392 r=.449 r=.436 p= .02 p= .007 p= .009 MPCQ R r=-.449 p= .007 MOCQ1 r=-.400 p= .017 MOCQ2 r=.348 p= .041 MOCQ3 r=-.372 p= .028 STAIX3 r=.432 r=-.369 p=.01 p=.029 NB. : VTR - Very Typical Response, ANAT - Anatomical Response OR - Original Response SEX - Sex Response ANIM - Animal Response OTH.R - Other Response PATH.R - Pathological Response SIS-I in Obesity 109

Regarding the contents of the responses on the cards 10,13,14 & 18 it was found that 62.8% of the subject responded Anatomical contents (month and stomach) to card 10;28.5% furnished response of Other type; 2.8% furnished response of Animal content and 5.7% could not see anything. On card 13 only 5.7% of the subjects gave response of Sexual content, 51.4% gave General Anatomical content with no reference to sexual organs; 31.4% gave Animal content 11.4% furnished response of "Other" type and 5.7% could not see anything. On card 14, 20% of the subjects gave response of sexual content; 22.8% gave generic Anatomical content; 34.28% of Animal content; 20% of "Other" type and 5.7% rejected the cards. To card 18, the 17.1% of the subjects gave responses characterised by a strong emotional content; 5.7% furnished response of Human content; 60% of responses were of "other" catagory; 35% of Animal content and 5.7% did not see any thing on this card. Table 3 Percentage of Responses for some Specific Cards Cards Animal Human Anatom. Sexual Other Patholog. Rejection Resp. Resp. Resp. Resp. Resp. Resp. of images 2.8% 62.8% 28.5% 5.7% 31.4% 51.4% 5.7% 11.4% 5.7% 34.28% 22.8% 20% 20% 5.7% 35% 5.7% 60% 17.1% 5.7% Comment : According to our data it appears that in our sample there is the presence of psychological suffering characterized by anxiety, depression, emotional liability, psychoticism and obsessive compulsive traits. This makes possible a more sintonic perception of the body and its problems. Infact the more number of Anatomical and Human content shows how subjects are activated in this phase of their life by the perception of their problematic physical body. The psychological suffering of the patients makes it difficult to perceive realistic imagery of the body on SIS images the reality of the body and the idea that everyone has of his own body. The subjects with phobic symptomatology seem to be more able to communicate 110 Cinzia & Roberto

their emotions openly. On the contrary, subjects who portray more defence, that usually tend to show the best side of their Self demonstrate a minor degree of psychological discomfort. This could be indicative of a less consciousness of their own condition and therefore of a low motivation of change. The high frequency of Anatomical responses to the card 10 and in particular the identification of the Oro-Gastric Trait in the card ("my big stomach", "my mouth and the stomach ") are correlated to problems regarding food. The low frequency of answers with Sexual content to card 13 and 14 could indicate the difficulty of the patients to identify a significant area of their body which seems to be perceived as desexualized. At the same card 14 has brought more frequent responses with Animal content. To the card 18 which is aimed to elicit imagination of the facial area and which has features that can stimulate anxiety, we observe a strong tendency to the denial of negative emotions with a prevalence of answers with "Other" and Animal content. Discussion : Obesity is a disease of body and the side effect of the overindulgence in eating, like getting drunk is the result of alcohol abuse for the alcoholic. The body is the means by which every individual of every age gets in touch with the surrounding world. A body perceived by oneself and by others as inadequate and out of the culturally defined norms creates a low self esteem and suffering. In the daily clinical practice with patients suffering from obesity it is frequently observed that it is the body that pushed the patient to seek help and it is unusual that this kind of patient is conscious of the disturbance in his/her previous eating habit. He describes his body as another entity, a body that for some mysterious reason started to widen out, to get bigger and transform itself in a delirious way, along a process in which the patient acts like a spectator. Afterward the moment arrives when the body expresses its sickness and needs attention. At this point the individual looks at himself and discovers the transformation that has occurred. It is now that he/she discovers the helplessness and seeks help. The body becomes a gym of fantasies, a heavy baggage of preoccupations and suffering. It is important to understand the critical factors which affect (i) the success of the treatment, (ii) the prevention of relapsing, (iii) for social adaptation Schneider and Agras, Other authors (Bailey and Murstein 1966, Dwivedi et al 1994) have already observed that the changes of the body image are particularly relevant in adolescence and normally get stabilized in adulthood. In presence of disturbances as obesity, the evolution appears to be slowed down or even blocked. This way also demonstrated by our data based on the high frequency of dehumanized and desexualized responses. The reduced frequency of responses of SIS-I in Obesity 111

sexual content seems to confirm the findings of Roth and Ross (1988) that dissatisfied sex relationship may also lead to eating disorders. The defenses rigidity and the denial of affectivity seems to be negative indicators for the outcome of treatment. This was also found in the studies of Dwivedi etal 1994). " It can be concluded that the correlation between the tests that were used by us permitted to identify more accurately the problematic area useful predictor of the success or the failure of treatment and to personalize the model intervention. This research defines itself as a preliminary work waiting for the results of the 1 year follow up from the beginning of weight loss as to verify any changes in body image. Furthermore, the data on the evaluation of the Somatic Inkblot Series-Form-I have made more evident the necessity of a general evaluation of the responses to the SIS-I cards in order to get to a standardized categorization now lacking in our country. References : Bailey C.J. and Murstein B.I. (1996); Paranoia Assessment with the SIS-I in a College Student Sample. SIS Journal of Projective Psychology and Mental Health . 3 109-122. Boskind-Lodhal M., and White W. (1978) The Definition of Treatment of Bulimia-rexia in College Women. A Pilot Study. Journal of American Coll. Health Association. 27; 84-97. Cassel W.A. (1980); Body Sybolism and Somatic Inkblot Series. Anchorage, Alaska. (USA) Cassell W.A. and Dubey, B. L. (1997) SIS-II/Video Mnnual. SIS Centre, Anchorage, Alaska (USA). Connors M., Johnson C., and Stuckey M. (1984); Treatment of Bulimia with Brief Psychoeducational Group Therapy. American Journal of Psychotherapy. 141: 1512-1516. Dubey B.L.; Mishra M., Dwivedi C.B. and Mishra N. (1994) Diagnostic and Therapeutic Utility of Somatic Inkblot Serious-II and Rorschach. SIS Journal of Projective Psychology and Mental Health. 1;19-26. Dubey B.L., and Cassell W.A. (1993) Some Experiences with the SIS. British Journal of Projective Psychology. 38; 19-47. Dwivedi P. Mishra M. and Cassell W.A. (1994) Somatic Inkblot Series-Video in Adolescents. SIS Journal of Projective Psychology and Mental Health 1, 27-32. Hendren R.L., Atkins D.M. Summer C.R.and Barbar J.K. (oct. 1987): Model for the Group-Treatment of Eating Disorders. International Journal of Group Psychotherapy. 37, 589-602. Herrera A., Riquelme J.J. Krivoy F., and Meza A. (1997) Sexual and Aggressive Contents is Rorschach Card II. SIS Journal of Projective Psychology and Mental Health. 4, 57-68. Oesterheld J.R., McKenna M.S. and Gould N.B.(1987) Group Psychotherapy of Bulimia; a Critical Review. International Journal of Group Psychotherapy. 37, 163-184. 112 Cinzia & Roberto

Roth D.M. , Ross D.R. (oct. 1998) Long-term Cognitive- Interpersonal Group Therapy for Eating Disorders. International Journal of Group Psychotherapy. 38 491-510. Schneider J. , and Agras w. (1985) A Cognitive-Behavioural Treatment of Bulimia. British Journal of Psychiatry. 146, 66-69. Sguazzin C., Giorgi, I. and Gabanelli, P. (1994) Aspetti Psicologici nell' Obesita. In Bertolotti G., Sanavio E., Vidotto G. and Zotti A.M. Un Modello di Valutazione Psicologica in Medicina Riabilitativa. Quaderni di Medicina del Lavora e Medicina Riabilitativa, Fondazione Clinica del Lavoro; PP. 193-203. Sguazzin C., and Giorgi I., (1996) Valutazione Psicologica di Pazienti Sottoposti ad Intervntochirurgico Per Obesita. In Sanavio E., Vidotto G. UPSEL ED., pp 107-112. Sguazzin C., Giorgi I., and La Manna A. (1996) Psychological Traits in Obese Patients Undergoing a Surgical Operation to Reduce Food Intake. International Journal of Obesity and Related Metabolic Disorders. 20 159. Sguazzin C., Ferro R., Omodeo O., Giorgi I., BaiardiP., and Nervi O. (1997) Evaluation of Body Perception in Overweight Subjects. International Journal of Obesity and Related Metabolic Disorders. 21. 115. Weiss L. and Katezman M. (1984) Group Treatment for Bulimic Women. Arizone Medicine. 41, 100-104. Wolchick S., Weiss L., and Katzman M. (1981) An Experimental-Behavioural Approach to the Treatment of Bulimarexia. Psychotherapy Theory and Research Practice. 18,501-507. Yager J., Landsverk J. and Edelstein C.K. (1987) A 20-months follow up Study of 628 Women with Eating Disorders-I Course and Severity. American Journal of Psychiatry. 144, 1172-1177. Yates A., and Sambrailo F. (1984) Bulimia Nervosa; A Descriptive and Therapeutic Study. Behaviour Research and Therapy. 22, 503-517. SIS-I in Obesity 113

New Members J. C. Bubber, MBA. General Manager (HRD) Punjab Alkalies & Chemicals Ltd. SCO 125-127, Sector 17-B, Chandigarh - 160017 (India) Tel. : 91-172-713823 (W) 91-172-742628 (H) Neeraj Shayam Deo, DMSP. C/o Dr. S. R. Deo, Gandhi Chowk, Jalna - 421203 (India) (M 98) Tel. : (0252) 225445 (W), (02482) 33831 (H) Rajinder P. Kaur, Ph.D. Social Scientist, Dept. of Psychiatry, Post-Graduate Medical Institute, Chandigarh - 160012 (India) (M 98) H. N. Mahto, Ph.D. Head, PG Dept of Psychology, LN. Mithila University, Kameshwar Nagar, Durbhanga - 846004 Bihar (India) (M-97-2001) Librarian, Bhavnagar, University Library, University Campus, Gijubhai Badheka Marg, Bhavnagar - 364002 India (M 98) Ann M. O' Roark, Ph.D. 866 Amelia Court NE, St. Petersburg, FL-33702-2784 (USA) Tel. : (813) 527-9863 Mrs. Amandeep K. Sandhu, MPMIR. Tej Form, Manimajra, Chandigarh - 160 101 (India) Tel. : 91-172-740991 (H) 91-172-782135 (W) Prof. Narendra K. Sharma, Ph.D. Dean Academic Affairs, Professor of Psychology, House No. 4055, Type-IV, P.O.- IIT, Kanpur - 208016 (India) LM 98 Tel. : 91-512-261737 (H) Fax : 91-512-590260, 590007 e-mail : doac@iitk.ernet.in Technical Library & Documentation, Indian Farmers Fertilisers Corporation (IFFCO) Aonla Unit, P.O. IFFCO Township, Bareilly - 243403 (India) M-97 Kiran Bala Verma, Ph. D. Head Department of Psychology, Harishchandra Post-Graduate College, Varanasi - 221001 (India) M 98 Tel. : (0542) 332042 (W) (0542) 31031 (H)

A Correlational Study of Selected Rorschach and SIS-II Variables in Psychiatric Patients Rajinder P. Kaur and S.K. Verma Rorschach and SIS-II, the two most popular inkblot tests of personality, were administered to 32 psychiatric patients in order to see their inter-relations on selected variables. Both the scales showed some degree of overlap with significant correlations between the two scales on Movement, Human, Animal and Popular responses (r=ranging between. 42 to .58) but insignificant correlations for Anatomy, Sex, F+ and Total responses. Results and their implications are discussed. Inkblot techniques are important and useful tools in the assessment of personality variables. Two of the popular standard inkblot series are Rorschach (Rorschach 1951) and Somatic Inkblot Series (Cassell, 1964, 1994) the first and the latest ones in this area. It would be interesting to compare them on selected variables. Such a comparison can be made from different angles and one such angle is through the use of coefficients of correlations. A set of comparable variables in the two techniques are used here in the present study on a sample of psychiatric patients. A number of earlier attempts comparing the two had used different methods (Dubey et. al. 1994; Dwivedi et.al. 1995; Mishra and Dwivedi, 1996, 1997; Verma 1996; Cassell & Dubey 1996, 1997; Pershad & Verma 1996; etc.) Although both are projective techniques and are inkblots, the number of figures differ in the two as also the way they are constructed e.g. in case of Rorschach, inkblots were prepared by throwing the ink on the paper and folding it in the middle, in SIS-the stimulus material was generated purposefully by making the designs to give some sort of resemblance/structure to either internal body organs or external body parts. (Verma et.al. 1996). SIS-II is relatively easier to score and is self-administered under guided instructions. (Pershad and Verma, 1996). Objectives : To find out the interrelatedness of selected Rorschach and SIS-II variables. Material and Method : Sample : The sample for the study was taken from the patients attending the division of Clinical Psychology of the Dept. of Psychiatry attached to the Postgraduate Institute of Medical Education and Research, Chandigarh for psychodiagnostic evaluation. Only those cases were taken where alongwith routinely required psychometric evaluation, SIS- II and Rorschach could also be administered. The total number of subjects who volunteered to take these tests Rajinder P. Kaur, Ph.D., Social Scientist, and S.K. Verma, Ph.D, Addl. Professor of Clinical Psychology, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, (India)

was 32. The age range was 16 to 50 years with a mean of 29.13 years and all had education level above VI class. The male-female ratio was 2:1. Tools : 1. Somatic Inkblot Series II (Cassell, 1980) was selected. It has 62 images in Series A and B each with 31 images. It is self-administered under supervised instructions and was scored for 9 variables. There were: Total responses, Most typical, Typical, Atypical, Human, Human Movement, Animal, Anatomy and Sex. 2. Rorschach Inkblots (Rorschach, 1951) consists of ten cards, scored for 8 variables for comparison with corresponding variables of SIS-II. Rorschach variables used were Populars, Total responses, Human movement, Animal, Anatomy, Sex and F+ responses. Results : Results are shown in Table 1. Table 1 Inter- correlations between SIS-II and Rorschach on some selected variables. S. No. Rorschach SIS-II Description Mean S.D. Mean S.D. Description r I Populars 5.13 1.92 12.41 2.15 Most typical .44* (P) 23.94 6.05 Typical .42* 19.28 7.29 Atypical -.10* II Total 16.59 5.05 55.63 7.90 Total Responses .14 Response (R) III Human Movement (M) 1.28 1.07 4.25 4.95 Human Movement .58** IV Human (H+Hd) 1.75 1.28 18.55 4.98 Human .47** V Animal (A+Ad) 7.38 3.17 8.22 3.30 Animal .53** VI Anatomy 1.22 1.90 7.78 4.03 Anatomy .24 VII Sex .34 1.27 1.81 3.47 Sex .14 VIII F+ 8.13 3.36 12.41 2.15 Most Typical -.10 23.94 6.11 Typical .08 * P<.05 ** P <.01 116 Kaur & Verma

Discussion and Conclusions: Rorschach and SIS-II have many things in common but the differences in the number of figures (10 in Rorschach versus 62 in SIS -II Booklet form) make any comparisons of Mean unmeaningful. Means and SD's are mentioned in table 1 only to show the dispersion of scores around the mean and not for any direct comparisons. The two projective techniques give many comparable scores which may be inter-correlated to see the degree and direction of overlap, if any. Significant degree of overlap could be seen only in cases of Human, Movement, Animal, Most typical and Typical Responses of SIS-II only. The directions were always positive. It was also expected that human and movement responses on both these scales would be inter-related, even if the obtained correlations (.47 and .58) are not very high. Since this is a patient population, this finding cannot be called as very surprising as both types of responses are lower than what is expected in normal healthy individuals. Sample size is also small. A possible explanation for low correlations could also be that- the Human and Movement responses of Rorschach are also indicators of creativity, in addition to that of adjustment and maturity- which may not be true to the same degree in case of these responses on SIS- II. Same thing can be said about Animal responses also- the correlation is significant, positive and as expected, of moderate degree only. Sharing of common experiences is reflected in the number of populars on Rorschach and in most typical and typical responses on SIS-II. The intercorrelations of .44 and .42, though significant are even lower than those for Human, Human Movement and Animal responses. The concepts here are similar but not identical and/or inter changeable. Both refer to most frequently given responses and are normally expected from relatively healthy persons. Some of the surprising and un-expected findings are the insignificant correlations (a) between total responses on Rorschach and on SIS-II. (b) between anatomy responses on the two tools, and (c) between sex responses on them. A number of questions come to the mind- are these concepts unrelated? Do different/unknown factors contribute to these differences? How much chance factor contributes to this? etc. The reasons are not very clear at the moment. We did, in fact, explect some degree of significance- even if of a moderate degree, relations for these related variables on the two scales because of the similar basis for these scores. There is need for further work on a larger sample and on different groups to understand these concepts better. The work is continuing and shall be reported later on. We do invite and welcome comments and suggestions of other researchers also - if they can throw light on this rather unexpected finding. SIS-II in Psychiatric Patients 117

If these findings are confirmed through other studies also, it may lead to some interesting observations, results and theories. References : Cassell, W.A. (1964) A Projective Index of Body Interior Awareness. Psychosomatic Medicine. 26, 172-177. Cassell, W.A. (1980) Body Symbolism and Somatic Inkblot Series. Aurora Pub. Co, Anchorage, Alaska. Cassell, W.A. (1994). The Somatic Inkblot Series: Continuing Rorschach's Conceptualizations. SIS Journal of Projective Psychology and Mental Health. 1: 3-14. Cassell, W.A. and Dubey, B.L. (1996) The Use of the Rorschach and Somatic Inkblot Series in Releasing Somatised grief. SIS Journal of Projective Psychology and Mental Health. 3: 3-32. Cassell, W.A. and Dubey, B.L. (1997) Somatic Inkblot Series II/Video-Manual. SIS Center, Anchorage, Alaska (USA). Dubey, B.L., Mishra, M., Dwivedi, C.B. and Mishra, N. (1994). Diagnostic and Therapeutic Utility of Somatic Inkblot Series -II and Rorschach. SIS Journal of Projective Psychology and Mental Health. 1: 19-26. Dwivedi, C. B., Mishra, M. and Dubey, B.L. (1995) Diagnostic Significance of the Indices of SIS - II and the Rorschach Inkblot Test. SIS Journal of Projective Psychology and Mental Health. 2: 165-170. Mishra, M. (1996) Compatibility of SIS-II and Rorschach Test in Normal, Neurotics and Schizophrenics. Ph.D. Thesis, Banaras Hindu University, Varanasi. Mishra, M. and Dwivedi, C.B. (1997) Content Scale Based Diagnostic Compatibility of the SIS- II with Rorschach Test in Normal, Neurotics and Schizophrenics, SIS J. Proj. Psy. and Ment. Health, 4:121-140. Pershad, D. and Verma, S.K. (1996) Body Image Disturbances in Psychiatric Cases. P.G.I. Research : Chandigarh Rorschach. H. (1951). Psychodiagnostics. Berne, Switzerland ; Hans Huber. Verma, S.K. (1996) Newer Trends in Inkblot Techniques. (Editorial). SIS Journal of Projective Psychology and Mental Health. 3: 1-2. 118 Kaur & Verma

Aggression in reaction to frustration among adolescent boys with depression and conduct disorder Ramanath Kundu and Jayanti Basu The study compared the direction and type of aggressive reaction to frustration among adolescent boys with conduct disorder (n=20), depression (n=20) as well as a group of normal subjects (n=40). The diagnosis of the two clinical groups was confirmed by two psychiatrists and two psychologists independently as well as by administerising the Developmental Psychopathology Check list by Kapur (1995) to their parents. All the subjects were administered an adapted version of the Rosenzweig Picture Frustration Study (child form) by Rosenzweig (1944). One way ANOVA and subsequent t-tests were done for comparison. It was observed that the depressed group and the conduct disorder group of boys differed on all the aggression categories. The depressed group was less extraggressive, more intraggressive, more imaggressive, more obstacle dominant, more ego defensive and less need persistent than the subjects with conduct disorder. As compared to the normals, the depressed subjects were less extraggressive, and more intraggressive and imaggressive, while the conduct disorder subjects were more extraggressive, less ego-defensive and more need-persistent. The psychodynamic view considers depression as a state of aggression turned toward oneself. Freud (1957) in his seminal work on "Mourning and melancholia" hypothesized that when any hate or disappointment generated within the organism and previously attached to an outside person can no longer be expressed openly it may turn inward. The surface expression then takes the form of guilt and self incrimination. Depression in children may be understood, in terms of the above schema, as a reaction to frustrated love- whereby the children experience themselves as unworthy and unlovable, and loss of self esteem becomes manifest (Bibring, 1953). Unlike adult depression, anhedonia is less commonly observed in child and adolescent depression, the major clinical features being lethargy, withdrawal, anxiety and lack of initiative. Adolescents with conduct disorder on the other hand are characterized by behaviour which violates social rules and regulations. Although the final expression of conduct disorder is variable and dependent upon situational differences, aggressive manouvers constitute the most common symptom of this problem (Wolff, 1985). This aggression is essentially externalized in nature, and causes considerable social disruption. The patients with conduct disorder are moreover, particularly characterized by their apparent insensitivity toward the feelings and reactions of others - a feature earlier described by Ramanath Kundu, Ph.D., Former Head and Retired Professor of Psychology, Calcutta University (Residential Address: Jadu Ghosh Lane, Chandernagore-712136, Hooghly, W.B.). Jayanti Basu, Ph.D., Sr. Lecturer, Department of Psychology, University College of Science, 92, A.P.C. Road, Calcutta-700009.

psychoanalysts as anomalous superego (Fenichel, 1946). Thus, the two groups can be theoretically distinguished in terms of their handling of aggression. When some thwarting event takes place the aggressive impluse would be generated in both the groups, but then the course taken by the impulse would be divergent. For the depressed group the spontaneous external expression of aggression becomes inhibited and results in self depreciation; for the conduct disorder group this expression is not only uninhibited, even beyond the point of civilized norm, but also utilized readily for satisfaction of other personal needs. It is of course important to note here that the internalization and externalization of aggression in the depressed and the conduct disorder group respectively are not absolute; because among children and adolescents with depression, anger outbursts are not uncommon, and similarly conduct disorder among adolescents often entails bouts of depression resulting in the separate nomenclature of "mixed disorder of conduct and emotion" in ICD-10. In the present study our purpose is to verify the validity of this theoretical distinction in aggression between the depressed and the conduct disordered adolescents with the help of the Rosenzweig Picture Frustration Study. The Rosenzweig PF study is a semi-projective test involving 24 cartoon like pictures depicting various socially frustrating situations. This test is based on the frustration-aggression hypotheses (Dollard et. al, 1939; Rosenzweig, 1944; Berkowitz, 1969). It assumes that frustration elicits aggressive tendency which may or may not be directly expressed, and may or may not serve an adaptive purpose. Rosenzweig (1954) classified the aggressive tendencies in response to frustration along two dimensions, each dimension further subdivided in three categories. On the dimension of direction of aggression we have extraggression (aggression directed outward), intraggression (aggresssion directed toward oneself) and imaggression (aggression denied or glossed over). Along the type of aggression dimension the three categories are obstacle dominance (sticking to the point of frustration), ego-defense (defending ones own ego) and need persistence (continuing expressing one's needs and working with it). Earlier works have attempted to record the P-F Study responses on various depressed and delinquent groups. Some studies with depressed patients are those by Bulato (1961), Wittenborn and Plante (1963), Arneson and Feldman (1968). Reaction to frustration among delinquent has been studied by Mitchell (1967), Rocha (1981), and in India by Singh and Kaur (1977), Mishra (1981), Rangaswami and Ananthraman (1982). Comparisions between neurotic and delinquent groups have been relatively few, 120 Kundu & Basu

some studies to be mentioned are those by Rauchfleish (1971), Singh et. al. (1972) and Daniel (1989). It is observed in general that the children with socially disruptive behaviour usually have greater extraggression than the normals and the depressed. But the differences on the other categories are relatively unstable and varies from study to study. The scrutiny of the methodology of most of the earlier studies evince that the 'delinquent' or the socially disruptive group was often not screened properly for absence of depressive syndromes, and considerable overlap might have occurred. One exception was the study by Daniel (1989) where emotional disorder, mixed disorder of conduct and emotion and conduct disorder were carefully discriminated in the sample. In the present study this methodological aspect has been taken care of. Objective : The objective of the present study is to examine whether normal, depressed and conduct disordered adolescents differ in terms of the type and direction of aggressive reactions to frustrations. Method : Sample : The sample consisted of 40 normal, 20 depressed and 20 conduct disordered adolescent boys with age ranging between 13 and 14, mean age being 13.67 years. The normal group was collected from various schools of Calcutta following a stratified random sampling technique. None of them had any history of chronic physical illness or episode of mental illness or behavioural disruption. The adolescents with clinical depression and conduct disorder were contacted from a few mental health clinics of Calcutta. The depressed group was diagnosed as sufferising from major depression, although, as is common among children and adolescents, anxiety symptoms were also present among them. There was no history of socially disruptive behaviour among their group. The adolescent with conduct disorder were referred mainly for their socially unacceptable aggressive behaviour. Apparently they did not demonstrate any emotional disorder symptom like anxiety or depression. The diagnosis was confirmed independently by two psychiatrists and two psychologists independently. To cross check for the absence of conduct problems in the depressed group and depression in the conduct disorder group the Developmental Psychopathology Checklist (selected items only) by Kapur (1995) was administered to their parents. If the test confirmed the interview results by the psychiatrists and the psychologists, only then the Aggression in Adolescents 121

subject was included for the study. All the clinical subjects were drug free, had their onset within one year and contacted on their first referral to the mental health professionals. The three groups were matched in terms of their socio-economic status, so far as all of them belonged to middle class as assessed on a scale. All of them were students of Class VII or VIII at various schools of Calcutta. Tools : 1. A detailed information schedule for the purpose of eliciting information about personal and family history. 2. The Socio-economic Status Scale (Urban) by Kuppuswami (1970) to assess the socio-economic status of the subjects. 3. The Psychopathology section (Section C) of the Developmental Psychopathology Checklist by Kapur (1995) to ensure that the subjects with conduct disorder were free from any other disorder including emotional disorder, and that the subjects with depression were free from conduct disorder and any other major disturbance. This scale was used only for the clinical sample and administered to both their parents as they visited the clinic. 4. The Rosenzweig Picture Frustration Study (Childrens form) by Rosenzweig (1954) adapted in India by Pareek (1959), and translated in Bengali and standardized by Ray Chaudhuri (1988). Procedure : The normal sample was collected from various schools in the 4 zones of Calcutta. The school authorities were initially contacted and with their permission the students of Class VII and VIII were contacted. Data were collected in small groups of three to four subjects within the classroom. The clinical sample was contacted at the clinic set up with the help of the consultant psychiatrists. Their parents were also contacted in the same situation. Individual administration of tests was done. Scoring was done according to the manuals. For the Developmental Psychopathology Checklist standard cut off points were taken as reference points. It was ensured that the conduct disorder subjects had their scores on conduct disorder above this point and all the other scores were below the respective cut off points. The depressed group similarly had their scores on emotional disorder above the cut off point, and all other scores below the respective cut off points. The Rosenzweig P-F Study yields six major aggression categories stated earlier and a number of other indices. In the present study however only these six 122 Kundu & Basu

aggression categories were utilized. Results : The Means and Standard deviations of the six aggressive reaction categories are presented in Table 1. It is found that apparently the conduct disorder group has the highest extraggression (E) and need persistence (NP), while the depressed group had the highest intragression (I), imaggression (M) and obstacle dominance (OD). Table 1 Showing Means and Standard Deviations of each Aggression Category for the Three Groups of Subjects Aggression Categories Direction Type Groups Statistic E I M OD ED NP Normal Mean 48.75 26.30 35.05 12.65 55.23 32.40 n = 40 SD 8.23 5.67 8.34 5.38 6.31 7.90 Depressed Mean 32.40 36.70 30.85 14.65 56.00 29.20 n = 20 SD 8.18 6.69 7.49 5.32 6.09 8.14 Conduct Mean 54.65 24.50 20.80 10.65 50.70 38.25 disorder n = 20 SD 7.91 6.14 7.09 5.46 5.89 7.84 To determine the extent to which the mean differences between the three groups were significant, one way analysis of variance was conducted for each category. The results are presented in Table 2. Table 2 demonstrates that the two groups differ in all the categories except on obstacle dominance (OD). Table 2 Showing F-values from one way ANOVA for Determining the Significance of Differences between the Three Groups on each Aggression Category Aggression Categories Direction Type E I M OD ED NP F Values 39.94 24.37 8.01 2.65 4.47 6.51 df 2,77 2,77 2,77 2,77 2,77 2,77 p <.01 <.01 <.01 >.05 <.05 <.01 Aggression in Adolescents 123

Table 3 Showing t -values for each Aggression Category to Determine the Significance of Mean Differeces between each Pair of Groups Aggression Categories Direction Type E I M OD ED NP Between Normal & Depressed 7.15** -6.19** -2.58* 1.34 0.44 1.44 Between Normals & Conduct Disorder -2.61* 1.11 1.92 1.33 2.63* -2.67* Between Depressed and ConductDisorder -8.52** 5.87** 4.24** 2.29 2.73* -3.49** * P <.05 ** P <.01 Subsequently, t-tests were computed to find out which of the two susbject groups differed between themselves on each aggression category. The results are presented in Table 3. It is observed from Table 3 that as far as extraggression (E) is concerned the conduct disorder group has the highest score, followed by the normals and the by the depressed subjects. The differences are significant between each pair. As far as intraggression (I) is concerned the depressed group has significantly greater score than both the normal and those with conduct disorder. But the last two groups do not differ between themselves. Imaggression (M) scores also follow the same pattern. The obstacle dominance scores (OD) differ only between the depressed and the conduct disorder groups with higher loading for the former group. As far as ego defense (ED) scores are concerned, the normal group is equivalent to the depressed patients, but the conduct disorder group has less scores than the other two groups. Exactly opposite pattern is seen for need persistence (NP) where the conduct disorder group has higher scores than the normal and the depressed groups, but the latter two groups do not differ among themselves. Discussion : The overall aggression profile provides a basis for intrapsychic discrimination between the adolescent boys with depression and conduct disorder. Table 3 shows that these two groups differ in all the 6 categories- the depressed groups demonstrating significantly less extraggression and need persistence, but more imaggression, intraggression, obstacle dominance and ego defense. The findings imply that the boys with conduct disorder have the capacity to thrive on a desired job more persistently despite frustration and they can assert 124 Kundu & Basu

their needs strongly. The depressed group on the other hand is more busy defending their own selves and more prone to stick to the frustrating condition. They cannot vent their aggression outward but feel inhibited to express it. This might be due to the punitive super-ego condition of the depressed. The psychodynamic school of thought states that the super-ego of the depressed is so authoritarian and strict that it inhibits any expression of aggression out for the fear of retaliation (Fenichel, 1946). The boys with depression here demonstrated a tendency to gloss over aggression or to direct it on themselves as self blame. This tendency also corresponds to the low self esteem of the depressed (Freden, 1982). The boys with conduct disorder on the other hand have an inconsistent or distorted super-ego whereby the anti-social activities including even undue aggression to others is atleast occasionally leniently allowed. Therefore it is easier for them to break social rules and use the aggressive impulse for serving self needs. This tendency is evident here also, as they presumably utilize external expression of aggression to satisfy their personal need. In comparision to the normals it is observed that the depressed group deviates from the normals in terms of direction of aggression, but not in type of aggression. The conduct disorder group deviates from the normals in extraggression which is a directional category, but also in the two types of aggression categories - ego defense and need persistence. Thus the pattern of deviation from normalcy is distinct in the two groups. Present day research on these two groups also supports this view. For example, Hall and Cipriano (1996) stated that when the aggressive drive set toward a particular direction is inhibited it leads to psychiatric morbidity. Again researches have indicated that when conduct disordered persons face some frustration they tend to become more reward dominated, that is they are more motivated by anticipated reward than by apprehended punishment; and thus may retain the pursuit of their needs even if they have to withstand more hurts (O 'Brien and Frick, 1996). The present study might serve as a preliminary one in unravelling the differences in dynamics between these two groups. Further in-depth studies with greater number of subjects are required to provide a full intrapsychic scenario of these two groups with respect to deviation in aggression pattern. References : Arneson, G. & Feldman, J. (1968). Utilization of the Rosenzweig Picture Frustration Test to Distinguish Suicidal Gestures from Suicidal Attempts. Paper Presented at the First National Conference on Suicidology, Chicago. Berkowitz, L. (1969). The Frustration- Aggression Hypothesis Revisited in L. Berkowitz (ed). Roots of Aggression. Atherton Press, New York. Aggression in Adolescents 125

Bibring, E. (1953). The Mechanism of Depression, in P. Greenacrs (ed). Affective Disorder, International Unit. Press, N. Y. 13-48. Bulato, J.C. (1961). The Direction of Aggression in Clinically Depressed Women. Dissertation Abstracts. 22, 1248. Daniel, E. (1989). A Study of Disorders of Conduct and Emotion. Doctoral Thesis, Bangalore Univ, NIMHANS, Bangalore. Dollard, J., Miller, N.E., doob, L. W., Mowrer, O.H. and Sears, R.R. (1939). Frustration and Aggression. Kegan Paul, London. Fenichel, O. (1946). The Psychoanalytic Theory of Neurosis. Routledge & Kegan Paul, London. Freden, L. (1982). Psychosicial Aspects of Depression : No Way out Wiley, N.Y. Freud, S. (1957). Mourning and Melancholia. Hogarth Press, London. Hall, D.P. & Cipriano, E.D. (1996). Frustrated Aggression in Psychiatric Casualties of Operation "Uphold Democracy". Journal of Nervous and Mental Diseases, 184 (6), 377-378. Kapur, M. (1995). Mental Health of Indian Children. Sage, New Delhi. Kuppuswami, B. (1970). Manual of Socio-economic Status Scale (Urban), Manasayan, New Delhi. Misra, V.D. (1981). Direction of Aggression and Reaction to Frustration in Juvenile Delinquents. Indian Journal of Criminology, 9, 110-113. Mitchell, K.M. (1967). The Rosenzweig Picture Frustration Study as a Measure of Reaction to Personal Evaluation. Journal of Projective Techniques and Personality Assessment, 31, 65-68. O' Brien, B.S. and Frick, P.J. (1996). Reward Dominance : Association with Anxiety, Conduct Problem and Psychopathy in Children. Journal of Abnormal Child Psychology, 24 (2), 223-240. Pareek, U. (1959). Manual of the Rosenzweig Picture Frustration Study (Child Form). Manasayan, New Delhi. Rangaswami, K. and Ananthraman, R. N. (1982). Responses of the Juvenile Deliquents on Picture-Frustration Test. Psychological Studies, 27(1), 1-3. Raufchfleisch, U. (1971). The RPF Test in Clinical Psychodiagnostic Work : A Study with Psychically Normal Persons, Addicts and Neurotics (Germ)- Zeitschrift fur Psychotherapie and Medizinische Psychologie, 21 (4), 151-154. Ray Chaudhury, J. (1988). Frustration Reactions of School Children Associated with some Psychosocial Variables. Unpublished PhD. Dissertation, Calcutta University, Calcutta. Rocha, Z. (1981). Comparative Study of the Aggressive Behaviour of Delinquent and Nondelinquent Adolescents (Port). Arguiros Brasileiros de Psicologia, 33 (1-2), 84-94). Rosenzweig, S. (1944). An outline of Frustration Theory, in J. Mcv. Hunt (ed.). Personality and the Behaviour Disorders, Vol. I, Ronald Press, N. Y. 379-388. Singh, L. and Kapur, H. (1977). Relation of Frustration towards the Incidence of Truancy. Indian Psychological Review, 15 (2), 15-18. Singh, M. V., Paliwal, T.R. and Gupta, S. (1972). Frustration Reactions among Emotionally Disturbed Children. Child Psychiatry Quarterly, 5 (2), 3-10. Wittenborn, J. R. and Plante, M. (1963). Pattern of Response to Placebo, Iproniazid and Electroconvulsive Therapy among Young Depressed Females. Journal of Nervous and Mental Disease, 137, 155-161. Wolff, S. (1985). Non-delinquent Disturbances of Conduct. In M Rutter & L. Hersov (eds.). Child and Adolesecent Psychiatry : Modern Approaches. Blackwell Scientific Foundation, London. 126 Kundu & Basu

Evaluation of Piotrowski's Organic Signs in Epilepsy S. Chaudhury, T. Rajan John and S. Rohatgi Sixty consecutive epilepsy patients and equal number of age, sex, education level, marital status, economic status, domicile and intelligence quotient matched normal control subjects were given the Rorschach test by Klopfen's method. The Piotrowski signs identified 39 of the epilepsy patients and 6 of the control subjects positive for organic disease process of the cerebral cortex. The difference was highly statistically significant. The Piotrowski organic sign in epilepsy patients had a sensitivity of 65.0% and specificity of 90.0% which indicates that it is a useful test for clinical use. A number of different sets of Rorschach " Organic signs" have appeared in the literature over the years. The first set of Rorschach signs of organicity to be published, and the one which has received the most attention by investigators, is the system suggested by Piotrowski (1937, 1940). Despite a myriod of criticism, it seems to be the most effective of the existing Rorschach techniques for the detection of brain damage. A common drawback of many of the studies was the inclusion of mixed organic patients and mixed or unspecified control groups while a few did not use controls at all. However, the most appropriate approach to evaluate the organic signs would be through the study of groups of patients who were homogenous as to lesion characteristics, age and intelligence (Goldfried et al, 1971). In view of the shortcomings of the early studies and the paucity of Indian studies the present work was undertaken to evaluate the Piotrowski signs in epilepsy patients. Material and Method : The study was carried out at Neurosciences centre, Command Hospital, Northern Command. The sample for the study was drawn from consecutive male inpatients who were diagnosed as epilepsy by the neurophysician, had been symptomatic for at least one year, with an abnormal EEG and normal CT scan. All patients were on appropriate antiepileptic drugs, and had not suffered from an epileptic fit on the day or the day prior to administration of the Rorschach test. Intelligence quotient was assessed by the Revised Bhatias Short battery of performance test of intelligence for adults (Verma et al. 1988). Age, sex, education, marital status, economic status, domicile and IQ matched healthy normal controls without any physical or psychological illness formed the control group. Control subjects were also examined by neurophysician to ruleout organicity and underwent the Rorschach test. Suprakash Chaudhury, M.D., Ph.D., Head Department of Psychiatry, T. Rajan John, M.D., Psychiatrist and Shalesh Rohatgi, M.D. (Med) D.M. (Neurology), Neurophysician, Command Hospital, North Command C/o 56 APO

The Rorschach test was administered individually to the subjects and scored by Klopfers method. The ten Piotrowski signs of brain damage are as under : 1. R. Total responses are less than 15. 2. T. Average time for response is more than 1 minute. 3. M. Number of human movement responses <1. 4. Cn. Scored in the usual way. 5. F%. The percentage of good form responses is below 70. 6. P%. The percentage of popular responses is below 25. This sign is not computed if there are more than 25 responses in a protocol. 7. Repetition, Rpt. Scored when same response is given on 3 or more cards. 8. Importance, Imp. Scored when the response is given inspite of the patients recognition that it is an inadequate response. 9. Perplexity, Plx. Scored when the patient shows a distrust of his own ability, and a quest for reassurance. 10. Automatic phrases, AP. Scored when the patient shows a frequent use of a pet phrase in an indiscriminate fashion. As a guide to scoring, Piotrowski (1940) suggested that if there is any doubt as to whether or not a response is to be scored, it is better to leave out a sign than to score it. If a record contains at least five out of the ten signs, it is considered to be a diagnostic sign of a marked personality change whose atiology rests in an organic disease process which involves the cerebral cortex. If the record contains less than five signs, this does not allow a positive conclusion. The scorer went through the individual Rorschach protocols and marked the presence of absence of each sign. Statistical comparisons were performed using the Chi Square test. Results : There was no significant difference between the epilepsy patients, and control subjects with regard to age, education level, marital status, domicile and IQ. All subjects of the study were male. By the criteria of five or more Piotrowski signs, 39 of the epilepsy Patients and 6 of the control subjects were diagnosed as organic. The difference was statistically significant (X2=38.72; df=1;P<0.01). The percentage of occurrence of the individual Piotrowski signs in the present study and two earlier studies is shown in Table 1 for epilepsy Patients and Table 2 for control subjects. Comparison of incidence of Piotrowski signs in epilepsy patients and control subjects is given in Table 3, while the efficiency of Piotrowski sign in the diagnosis of organicity in epilepsy patients is given in Table 4. 128 Chaudhury et al

Piotrowski's Organic Signs 129 Table 4 Efficacy of Piotrowski's Signs in the Diagnosis of Organicity in Epilepsy Study Sample size Sensitivity specificity Predictive Value of Epilepsy Normal Positive Test Negative test patient controls Loveland (1961) 57.7 73.1 68.2 63.3 Vagrecha and Sen Mazumdar (1974) 83.3 64.3 Neiger et al (1962) 95.0 88.8 67.9 98.6 Present study 65.0 90.0 86.7 72.0 Table 1 Occurrence of Piotrowski's Signs in Epilepsy patients in percentage Study Sample size R T M Cn F% P% Rpt Imp Plx AP Loveland (1961) 24.0 20.0 48.0 12.0 48.0 48.0 60.0 16.0 56.0 64.0 Neiger et al (1962) 40.0 95.0 90.0 20.0 80.0 75.0 50.0 50.5 45.0 15.0 Present study 81.7 33.3 90.0 6.7 81.7 48.3 50.0 25.0 46.7 13.3 Table 2 Occurrence of Piotrowski's Signs in non-brain damaged subjects Study Sample size R T M Cn F% P% Rpt Imp Plx AP Loveland (1961) 20.0 24.0 48.0 0.0 44.0 44.0 40.0 12.0 32.0 44.0 Neiger et al (1962) 10.0 58.75 52.5 1.25 7.5 51.25 7.5 0.0 8.75 1.25 Present study 53.3 20.0 50.0 0.0 20.0 26.67 10.0 6.67 6.67 0.0 Table 3 Comparisons of Incidence of Piotrowski's Signs in Epilepsy Patients and Normal Control Subjects Study R T M Cn F% P% Rpt Imp Plx AP Loveland (1961) NS NS NS NS NS NS NS NS NS NS Neiger et al (1962)20 S S S S S S S S S S Present study S NS S NS S NS S NS S NS S= Significant NS= Not Significant Sample size Epilepsy Normal patients Controls Piotrowski's Signs

130 Chaudhury et al Discussion : The identification of a high number of epilepsy patients and a significantly lesser number of normal subjects as positive for Piotrowski signs is in agreement with earlier studies (Loveland, 1961, Neiger et al, 1962) and indicates the robustness of the signs. The limiting factor of course was the presence of too many false negative for which the Piotrowski signs have often been criticised (Goldfreid et al, 1971). However, it should be remembered here that technically the Piotrowski system does not produce any false negatives because it never arrives at a definitive diagnosis of nonorganicity. Persual of Table 1-3 reveals that there are no signs which consistently appear in such an overwhelming proportion of the epilepsy patients or which appear so infrequently in the normal subjects while occurring with greater frequency in the epilepsy patients as to be considered to be clearly pathognomonic of organicity. On the other hand it is evident from Table 4 that Piotrowski sign in the present study and the three earlier studies have a high specificity but moderate sensitivity for the diagnosis of organicity in epilepsy patients. Further, the sum of sensitivity and specificity of the Piotrowski signs in all the four studies is consistently greater than 140 which proves that it is useful test in the clinical setting. Further studies of Piotrowski signs in the various subtypes of epilepsy would be of interest. References : Godfried, M.R., Striker, G., & Weiner, I.B. (1971). Rorschach Handbook of Clinical and Research Applications. New Jersey : Prentice Hall Inc. pp 291-295. Loveland, N.T. (1961). Epileptic Personality and Cognitive Functioning. Journal of Projective Techniques. 25 : 54-68. Neiger, S., Slemon. A.G. & Quirk, D.A. *1962). The Performance of Chronic Schizophrenic Patients on Piotrowski's Rorschach Sign List for Organic CNS Pathology. Journal of Projective Techniques. 26, 419-428. Piotrowski, Z.A. (1937) The Rorschach Inkblot Method in Organic Disturbances of the Central Nervous System. Journal of Nervous and Mental Disease, 86 : 525 - 537. Piotrowski, Z.A. (1940) Positive and Negative Rorschach Organic Reactions. Rorschach Research Exchange, 4 : 147 - 151. Vagrecha, Y. S. & Sen Mazumdar, D.P. (1974) Relevance of Piotrowski's Signs in Relation to Intellectual Deficit in Organic (epileptic) and Normal Subjects. Indian Journal of Clinical Psychology, 1 : 64 - 66. Verma, S. K., Pershad, D., Malhotra, A. & Arunima (1988) The Revised Bhatias Short Battery of Performance Tests of Intelligence for Adults. National Psychological Corporation Agra.

A Proposed Model for Assessment of Mental Disability S. K. Verma Cases are often referred to a Clinical Psychologist for assessment of percentage disability-particularly about intellectual functions. Dependable information on this are not available, though literature on the cognitive functions and their measures are many. In this article, a model is proposed for making a comprehensive assessment on the basis of measurements of (a) I.Q. level, (b) Memory (through the use of a comprehensive battery of memory test viz. P.G.I. Battery of Memory functions and (c) Psychosocial Dysfunction through P.G.I. Dysfunctional Analysis Questionnaire (Personal, Social, Family, Vocation and Personal Areas). Theoretical discussion is avoided-only practical considerations are given proper emphasis. Reasons for Referral to a Clinical Psychologist for Disability Assessments : Clinical psychologists are frequently called upon to assess the percentage disability in patients/subjects suspected/claimed/or, of known mental handicap, by the psychiatrists/neurologists/judiciary/community workers/parents/school authorities/industrialists/governmental agencies as well as private authorities-including non-governmental organizations-for various reasons. The Judiciary may want to decide the ability of a prisoner to stand trial; to fix the quantum of compensation to industrial worker or to victim of an accident or assault, to determine the criminal responsibility or, to determine rights over property, etc. etc. Government may want to provide means of social security. Community workers may need such information to emphasize the need for adequate policy formulation for reducing social burden. Clinicians may want to evolve a holistic rehabilitatory regimen for an individual and his family-or, to evaluate the effect of intervening variables and efficacy of treatment models-or, to give eugenic counselling to the parents-including marital counselling to the marital partners. These are only a few of the reasons for such a referral to the psychologists. Disabilities : The persons with disabilities (equal opportunities, protection of rights and full participation) Act 1995, defines "disability means (i) blindness, (ii) low vision (iii) leprosy-cured, (iv) hearing impairment, (v) locomotor disability, (vi) mental retardation and (vii) mental illness" -and-"persons with disability means- a person suffering from not less than forty percent of any disability as certified by a medical authority". (Chapter 1-2) As clinical psychologists are more concerned with mental retardation and mental illness, let us discuss about these disabilities only. S. K. Verma, Ph.D., Addl. Professor of Clinical Psychology, Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012 (India).

The background/complicating factors : There are many factors that may confound such a disability assessment. The disability may be primary or secondary and reversible or irreversible, depending upon the early identification, proper treatment available/given in adequate doses, for appropriate length of time and in therapeutic atmosphere by trained/competent, helping professionals. Here, the background factors play an important role. The socio-economic factors, biological/foster parents, broken families, parental involvement, early intellectual stimulation, education, occupation, etc. have to be considered in any assessment. Similarly, use of correct assessing tool, constructed and standardized in one's own culture, with relevant, local norms, can not be overemphasized in such a case. Subjects or patients abilities before the accident or intervention cannot be ignored in any subsequent assessment(s) for comparison purposes. All such assessments of abilities/disabilities are done keeping in mind the reference point. The ideal one would be any previous assessment, failing which comparisons have to be made in terms of the relative distribution of ability scores in the general population. One can, of course, have a reference point of one's own perception of failing abilities as compared to earlier stage (premorbidity). Such assessments are subject to memory and perceptual distortions and to that extent less objective or, more subjective-although some assessment is better than no assessment at all. All the above complicating background factors need to be taken into consideration while making/interpreting disability assessments. A. Disabilities of intelligence : Pershad (1994) has suggested the following classification of Percentage disability in intellectual functions according to the patients'/subjects' I.Q. level assessed (modified slightly) : Table 1 Percentage Disability in Intellectual Functions I.Q. Level Category Percentage Disability above 70 Negligible Below 20% 50 - 70 Mild degree 40% 35 - 49 Moderate " 40 to 75% 20 - 34 Severe " 75+% Below 20 Profound " 100% 132 Verma

It seems logical also and goes well with the International Classification of Diseases - 10th Revision by the World Health Organization (1992). Lower the assessed I.Q. (reliable measurements on well standardized tools with local, relevant norms) higher would be the degree of percentage disability. One can also draw - a graph with these anchor points for any value - only one has to understand that these are to some extent arbitrary (--like all other psychological measures). B. Percentage Disabilities of Memory : The suggested rating is applicable, wherever the memory scores are converted into Percentile Ranks - as is done for P.G.I. Memory Scale (Pershad 1977) and is given below : - Table 2 Percentage Disability in Memory Percentile Rank (P.R.) Category Percentage Disability in Memory 50th Percentile nil nil 40th Percentile Negligible below 20% 30th Percentile Mild 20 - 40% 20th Percentile Moderate 40 - 60% 10th Percentile Severe 60 - 80% below 10th Percentile Severe 80+% This is a modification by the authors (Verma, 1998) partly based on Pershad and Verma (1993) and seems logical enough to be followed at Department of Psychiatry. PGIMER, Chandigarh. The 50th Percentile is average, (middle point in a normal distribution and equivalent to Mean, Mode also) - hence no deficit may be rated at this point although for a person of superior premorbid memory, it may be considered a climb down. C. Percentage Disability in Psychosocial functioning : The scoring suggested here is based on Dysfunctional Analysis Questionnaire (Pershad et.al. 1992) constructed and standardized in the Department of Psychiatry, PGIMER, Chandigarh. There are 6 areas of psychosocial functioning and reference point in each area is the perceived psychosocial functioning at the premorbid level. These areas are : Personal, Social, Family, Occupational Mental Disability 133

and Cognitive, with the overall dysfunctioning also. A Score of 40 is average here, below it is "same as before" or even "better than that." Higher the score, greater is the psychosocial dysfunctioning. Pershad's (1994) Ratings - has been slightly modified here. Table 3 Percentage Disability in Psychosocial Function D.A.Q. Score Category Percentage Disability Below 40 Nil Nil 40 - 50 Negligible below 20% 50 - 60 Mild 20 - 40% 60 - 80 Moderate 40 - 80% Above 80 Severe above 80% Here also, the anchor points are given, other points can be obtained by interpolation from the graph (Figure 1). A Graphic Presentation : The three variables viz. intelligence, memory and psychosocial dysfunctioning have been given in Figure 1. Figure 1 Percentage of Disability for different I.Q. points / memory / DAQ Memory Percentile Ranks I.Q. Points DAQ Scores 90 100 % Disability * * * * * l l l l l l l * 134 Verma

It is for practical utility that this single graph is shown, depicting percentage disability for different scores on the three variables. It is hoped that a uniform policy be adopted for such ratings, so that no confusion is created in any one's mind. Initially, it can be accepted and further modifications and refinements can be attempted and if found satisfactory, may be accepted and followed in all centres in India. References : Pershad, D. (1977) Construction and Standarization of P.G.I. Memory Scale. Agra : National Psychological Corporation. Pershad, D. (1992) Proposed model for the Assessment of Psychosocial Dysfunctioning in Chronic Illnesses. Mind. 18(3) 21-24. Pershad, D. (1994) Assessment of Degree of Mental Handicap for Certification. Indian Journal of Behaviour Sciences. 1:33-40 Pershad, D. and Verma, S. K. (1993) Proposed Model for Assessing Psychosocial Disability. Dept. of Psychiatry, P.G.I., Chandigarh(Unpublished Manuscript). Pershad, D., Verma S. K. , Malhotra, A. K. and Malhotra, S. (1983) Manual for Dysfunctional Analysis Questionnaire. Agra : National Psychological Corporation. The Persons' with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act. 1995. Government of India, Delhi. Verma, S. K. (1998) Suggested Model for the Assessment of Percentage Disability of Memory. Unpublished Manuscript. Dept. of Psychiatry, P.G.I., Chandigarh. World Health Organization (1992) International Classification of Diseases. Tenth Revision. (ICD- 10), Geneva, Switzerland. APPEAL Members of Somatic Inkblot Society are requested to kindly sent their Annual dues before the 31st of January each year, to enable the society to meet its expenses and smooth publication of the Journal. Chief Editor Mental Disability 135

Somatic Inkblot Series-An Excellent Psychodiagnostic Tool N.L. Dosajh This case-history shows how Somatic Inkblot Series act as excellent psychodiagnostic tools. When other tests failed, SIS came to the help of the author for psychodiagnosis. This is clear from this case-history. The patient rejected cards numbering XII, XIII & XIV of SIS-I and this led to the diagnosis of the patient's trouble. How the diagnosis was arrived at has been explained in this case history. "Somatic Inkblot Series Tests, are excellent for psychodiagnostic purposes," this is what author's experience of working with Projective Tests for about fifty years shows. Where all other projective tests failed, Somatic Inkblot Series Tests (SIS) succeeded." The above statement is illustrated by a very recent case of the author. A girl of 30 years, B.A., belonging to a very respectable family, reported to the author with an ailment that an evil spirit had entered her body and was troubling her and the evil spirit was saying to her that she would not allow her to stay with her husband. The patient would talk for sometime and then another voice would come from within the patient and would say, "I will tease you, trouble you and turn you mad". The patient was treated by a number of psychiatrists, medical men, Tantriks and Spiritualists but to no effect. Ultimately a friend of the author, who is a retired senior officer of the Education Department and is himself a Spiritualist brought the patient to the author. The patient had been administered Ativan, Prodep, Prothocedene etc. The trantriks had tried many tantras and mantras, but there was no relief. The husband had left the patient and her daughter, about 8 years old, with the mother of the patient for the last about five years. The patient would talk for sometime and then would say, "Now the evil spirit has come. She would now trouble me". She would then cry again and again saying." The evil spirit has overtaken me and it would harm every one even you. The evil spirit would curse me and would say that it would not allow me to stay with my husband and would make me mad. "The patient would make the in-laws responsible for her that condition and especially her sister-in-law. She would say that her sister-in-law had given her Bhasam (Ashes of a dead body) in tea and was herself sleeping with her husband. The patient would often have fits of depression. The early history of the patient showed that she was operated upon for some trouble in her nose and was confined to bed for a month or so. She was thrice taken to Dera Wadh Bhag Singh where they carry out 'Faith Healing'. She was made to bathe there in the tank situated in the Dera Professor N.L. Dosajh, Ph.D., 1121, Sector 15-B, Chandigarh-160 015 (India)

itself. Then she was blessed by the Guru of the Dera, who was dressed in black robes from top to bottom. After establishing rapport with the patient, the researcher administered Rorschach Test to the patient in the presence of her mother. Her responses were very delayed, about 1 to 3 minutes and sometimes after a good deal of persuation. She rejected cards numbering IV, VII, IX and X. For other cards, the responses were animal figures and anatomical responses. There was also lot of bodily imagery. During the test she would often complain of evil spirit having come and disturbing her. She would often say that her nerves of the head were tense too. She had lot of faith in her Spiritual Guru and would like to go to him. She called him Pita ji (Father). Whenever in distress, she would eat Prasadam, that her Guru had given her and would feel relief after eating it. Her Guru is X, who is a follower of Swami Satya Nand Ji. He has his Ashram in Gohana, in the State of Haryana. The patient told the author that her Guru had adopted her as his daughter and had told her that he would not rest till he drives out the evil spirit from her body. The patient had learnt Amrit Vani in the Ashram and could sing it very well when asked to do so. She was then administered SIS-I and her responses are as follows :- 1. Bird like; It can be an animal also. 2. Bird like; Like Earthworm also. 3. A sea-fish; It is a print but is not exactly red. 4. Fruit like apple. It is the lip of a child or an animal. 5. Bird like. 6. Balloon. 7. Bird shape. It is a baby part. It is like a mosquito also. 8. Man's part - Lungs. 9. Body part; X-ray of the lower part of the body. 10. Body part; Lips type; Necktie. 11. Frog. 12. I can't tell you about it. 13. Can't tell. 14. Can't say anything. 15. Sea Animal. 16. Face of a bird. 17. Decoration Piece. 18. Insignia. 19. Flower, Flies and Leaves. 20. Part of the body. She rejected cards 12, 13, & 14 outright and even cried saying 'I can't tell you SIS-I Diagnostic Tool 137

about that'. Now rejection of images, according to Cassell and Dubey (1997) shows thought blockage and an inability to think properly. According to Cassell (1980), the normative data for Card 12, 13 & 14 of SIS-I is as follows :- XII - Female reproductive System; Other Anatomy. Body missing & head Nonanatomy. XIII - External Female Genitalia, Heart, Buttocks or 'rear', Other Anatomy, Non-anatomy. XIV - External Female Genitalia. From this information, the writer suspected something wrong in the genital region of the patient. So after establishing a deeper rapport with the patient, the writer pressed the patient to give responses to cards XII, XIII & XIV and here are the results:- XII - She cried a lot and said, "I can't tell you about it but let me tell you because you insist, I get the image of someone trying to have intercourse with me-again cries. This image I get very often. I used to have intercourse many a time and I did not tell you about it. I should have told you that but I could not help. XIII - It is a housefly or butterfly; May be a baby part - kidney. XIV - I see a man with black clothes having intercourse with me. I see the male organ very often and desire for intercourse. I get images of some one kissing and hugging me. The patient was put on Yoga Therapy and Pranayam of the simple type - Type- I (1998-under print). References :- Cassell Wilfred (1980), Body Symbolism, p. 40, Aurora Publishing Co., 213 West Sixth Avenue, Suite 8, Anchorage, Alaska - 99501. Cassell & Dubey (1997), Somatic Inkblot Series II & Video, First Revision, p-44. Dosajh, N.L. (1996) : Projective Techniques with Particular Reference to Inkblot Tests, SIS Jr. Proj. Psycho1 and Ment. Health 3 (1) : 59-68. Dosajh, N.L. (1998) Psychotherapy; III Edition (under Print), 1121, Sector 15-B, Chandigarh - 160 015. 138 Dosajh

Diagnostic Validity of SIS-II Among Psychopathological Cases of Armed Forces S.P. Rathee, P. Sarkar and Agyajit Singh The Somatic Inkblot Series-II (SIS-II) has been recognised as one of the most powerful psychodiagnostic instrument among various psychiatric groups. To find out its diagnostic validity against Rorschach test among psychopathological cases of Armed Forces, the SIS-II was administered on two hundred psycho-pathological cases, following Rorschach test after a gap of one or two days. Cassell's (1990, 1995) and Klopfer's, et. al. (1954) standard procedures were adopted to analyse the protocols of both tests on 10 common variables. Statistical analysis of data obtained revealed that out of 10 common indices of both tests, five variables in schizophrenia, four in affective psychosis and seven in unspecified psychosis, five in Anxiety, four in Depression and seven in Hysteria, showed high and positive correlation between common indices of both tests. The present findings predict the high diagnostic validity of SIS-II indices against those of Rorschach's among six psycho-pathological groups of armed forces. The results are discussed in the paper. The Somatic Inkblot Series-II has been found to be one of the most sensitive psycho-diagnostic tests. It has all those qualities which a standardized test should possess. The stimulus is ambiguous, situation more or less semi-structured and the aim is disguised (Cassell, 1990, Cassell and Dubey 1995). Moreover the SIS-II is more suitable for clinical population of armed forces, because of its rich inherent qualities of material, easy scoring and useful interpretation. As compared to other projective tests, the test brings the therapist closer to the unexpressed miseries and agony of the suffering individual (Rathee, et. al 1994, 1995, Saldanha & Dubey, 1995). The test is said to be sensitive enough to listen the inner cry of a suffering individual, the inner cry which is sometimes hidden not only from others but often one's own conscious awareness as well (Cassell, 1990). The SIS is based on Rorschach conceptualization and has been proved to be an improvement over existing inkblot techniques (Cassell, 1994, Dosajh 1996), even a single image can provide much diagnostic help in understanding the patients inner psycho-pathology (Dosajh, 1997). The reliability and validity of SIS-II has been judged to be very high by Cassell (1988) and his followers in different cases (Dubey & Cassell, 1993; Pershad & Dubey, 1994). Verma & Pershad (1995) experienced the diagnostic sensitivity among psychiatric patients and found it to be of great help. It was observed to be a very useful tool in understanding the inner dynamics of male transsexuals cases (Sahay & Srivastava, 1994). In an other study, the SIS-II was found to be S.P. Rathee, Clinical Psychologist, P. Sarkar, Classified Specialist (Psychiatry), Deptt. of Psychiatry, Comd. Hosp. (WC) Chandimandir (Haryana) and Agyajit Singh, Head Deptt. of Psychology, Punjabi University, Patiala, Punjab.

a more useful clinical tool as compared to Rorschach among psychiatric patients (Dubey, Mishra, Dwivedi & Mishra, 1995). The diagnostic validity of SIS- II has not been unpredicted among psychiatric patients of armed forces. It was found to be a highly valid diagnostic test among these patients (Rathee, et al 1995), psychotic and neurotic in differentiating from normal population of armed forces (Rathee, Sarkar & Singh, 1996). The SIS-II has been found to differentiate not only among psychotic and neurotic patients but also within their subgroups i.e. schizophrenia, unspecified psychosis & affective psychosis, in psychosis and anxiety, depression and hysteria, in neurosis (Rathee, 1997). So far, there have been many studies reflecting its diagnostic and therapeutic efficacy and its clinical significance in understanding the unique problems of individual cases; yet there are not much published studies, which can show its diagnostic validity against some of the standardized tools, except a few (Cassell, 1988, Dwivedi, Mishra, Dubey, 1995 and Mishra & Dwivedi, 1997). The present study is aimed to find out the diagnostic validity of SIS-II against Rorschach among psycho-pathological cases of armed forces. Material and Method : To study the diagnostic validity of SIS-II indices against Rorschach test, two hundred psycho-pathological cases, one hundred each of psychosis and neurosis with confirmed subdiagnosis of schizophrenia, affective psychosis & unspecified psychosis under psychosis and anxiety, depression & hysteria under Neurosis. They were in the age range of 20 to 50 years (mean age : 30.0 yrs.), educational qualification ranging from middle to graduation level (mean : High School passed) and were belonging to the ranks of sepoy to officer level, maximum of these were from NCO's category. All of them were fresh cases and got admitted during their first attack and were diagnosed independently by a well qualified and experienced psychiatrist following standard criteria in vogue. Procedure : All of these psycho-pathological cases were administered Rorschach and SIS- II following standard instructions as per their respective manuals, individually (Klopfer, et al 1954 and Cassell, 1990). The SIS-II protocols were scored on the basis of 8 quality of responses, 11 contents and responses were further rated on 4 rating scales and their test comment were also taken. The Rorschach protocols were also scored as usual, but only 10 common variables from both tests were taken into consideration, for the present aims of the study. These variables were Total Number of Responses, Typical/Popular responses, Atypical/Form responses and other responses of SIS-II were matched with poorly formed responses of Rorschach test. Among contents were, Human, Human Movement, Animal, Animal Movement, Anatomy and rejection of images,/ 140 Rathee et al

cards. In order to see the validity of SIS-II indices, coefficient of correlations using product moment method, between these 10 common indices of both tests were found out. Result and Discussion : After statistical analysis of the obtained data among 6 groups of psycho-pathological cases following results were obtained which are shown in the following tables : Table 1 : Significance of Coefficient of Correlation between Common Indices, of SIS-II & Rorschach among Three Groups of Psychosis Common Schizo Affective Un-Specified Indices of phrenia Psychosis Psychosis Rorschach & (n= = 30) (n = 40) (n= 30) SIS-II r r r Total No. Resp. +.60** +.29 +.54** Typical/Pop. +.60** +.39* +.21 Atypical/F +.26 +.35* +.44** Others/F +.26 +.27 +.29 Human +.54** +.20 +.43** H/Movement +.32 +.49** +.13 Animals +.57** +.20 +.63** A/Movement +.10 +.28 +.50** Anatomy +.20 +.61** +.38** Rejection Images/ +.67** +.14 +.57** Total The table 1 reveals the significance of coefficient of correlation of ten common indices of Rorschach & SIS-II among three groups of psychosis i.e. schizophrenia, affective psychosis and unspecified psychosis. It shows that out of 10 common indices, schizophrenic patients tend to show high and positive correlations on five indices which are, total number of responses (r= +.60**), typical & popular responses (r= +.60),** Human (r= + .54**), Animals contents (r=+.57**) and rejection of images (r=+.67**). Affective psychotics showed positive correlation on typical/popular (r=+.39*), and Anatomy (r= +.61**). The patients suffering from unspecified psychosis showed on higher number of indices (7) as compared to other two groups, these were total number of responses (r= +.54**), Atypical/Form responses (r=+.44**), Human (r= +.43**), Animal (r=+.63**). Animal movement (r=+.50**), and rejection of images/card (r=+.57**). The present significance of correlations, reveal SIS-II indices have SIS-II in Armed Forces 141

higher validity against Rorschach among Un-specified Psychosis, followed by Affective Psychosis and least among schizophrenia patients. Table 2 Significance of Coefficient of Correlation between Common Indices of SIS-II and Rorschach among Three Groups of Neurosis Common Indices of Anxiety State Depression Hysteria Rorschach (n=30) (n=30) (n=40) SIS-II r r r 1. Total No. Resp. +.05 +.59** +.60** 2. Typical/Pop. +.27 +.62** +.07 3. Atypical/F +.36* +.01 +.20 4. Other/F- +.34 +.38* +.42** 5. Human +.24 +.58** +.59** 6. H/Movement +.16 +.55** +.13 7. Animal +.63** +.26 +.36* 8. A/Movement +.58** +.29 +.07 9. Anatomy +.66** +.70** +.43** 10. Raj. of Images/cards +.45* +.64** +.38* Total Table II reveals the significance of coefficient of correlation of 10 common indices of Rorschach & SIS-II among three groups of neurosis i.e. anxiety, depression and hysteria. It shows that out of 10 such common indices, patients suffering from anxiety state showed high and positive correlation on Atypical and Form responses (r= +.36*), Animals (r=+.63**), Animal Movement (r=+.58**), Anatomy (r=+.66**) and Rejection of images/ cards (r= +.45*). The Depressive subjects showed higher degree of correlation on 7 indices, which were total number of responses (r= +.59**), Typical/Form response (r= +.62**), Other/Poorly formed responses (r=+.38*), Human (r=+.58), Human Movement (r=+.55**), Anatomy (r=+. 70**) and Rejection of images/cards (r=+.64**). The Hysterical patients also showed higher correlation on indices such as total number of responses (r= +.60**), other/poor form level (r= +.42**), Human (r=+.59**), Animals (r=+.36*), Anatomy (r=+.43**) and Rejection of images/ cards (r=+.38*). Discussion : The Somatic Inkblot Series-II, no doubt possesses higher validity against Rorschach indices among three groups of psychosis and neurosis. The higher degree of correlation on each index in different groups predicts that Rorschach 142 Rathee et al

and SIS-II follow the same conceptualization in understanding the individual (Cassell, 1990, 1994). Since both tests belong to inkblot family, material, method and way of interpretation is almost similar, except the latter one (SIS) has covered all those qualities which Rorschach lacked, hence the higher correlation especially among these groups are quite understandable, the reason being, the army population has been found to be restricted in giving responses (Dubey, 1982, Chaudhary & Angustine, 1990, Rathee, et al, 1995) on Rorschach like projective tests yet they feel comfortable while responding on SIS-II, being easier and images being familiar. This is probably the reason that psycho-pathological cases of this group showed high correlation, as compared to study on non-army subjects (Dwivedi, et. al, 1995), in which neurotics and schizophrenics showed significant but lesser degree of correlation on common indices such as Animals (r=+0.38** neurotics) & (r=0.35** schizo), Anatomy (r= .49** neurotics) & (r= 0.20** schizo), and sex contents (r= .28* neurotics) & (r=0.65** schizo). The other variables were Human & Most typical/popular responses, where only normal subjects showed (r=.27*) schizophrenics (r=.32*). No correlation was reported on important indices such as total number of responses, human & animal movement and rejection of images/cards. Whereas comparing with the present study on army population, wide differences may be witnessed in the degree, as well on number of indices which clearly demonstrate that SIS-II is more valid and useful in population with more restriction, discipline and strictness, because suppression of one's needs, urges or other aspects of behaviour etc. will take place only under present circumstances. The sensitivity of SIS-II becomes more when suffering individual has inner cry. And this inner cry may not be only because of the on set of illness but due to poor interpersonal relations, conflicts, frustrated needs, urges and other adjustment problems. Conclusion : It can be concluded that the Somatic Inkblot Series-II possesses higher diagnostic validity against Rorschach test among psycho-pathological cases of armed forces. It may prove more useful when its findings are compared with another inkblot test. References : Cassell, Wa (1988) : Validity Study of SIS-II Booklet in Pregnant and Non-pregnant Women. Paper Presented in the Meeting of the International Congress of Psychology. Sydney Australia. Cassell, W.A (1990): Mannal : Administration, Scoring and Interpretation of Somatic Inkblot Series. 4045 Lake Otis Suite 101 Anchorage, Alaska -99508. Cassell, W.A. (1994) : The Somatic Inkblot Series Continuing Rorschach's Conceptualization. SIS Jr. Proj. Psycho. & Ment. Health, Vol I (1) 13-14. Cassell, W.A. and Dubey, B.L. (1997) : Somatic Inkblot Series II/Video : Mannual SIS Centre SIS-II in Armed Forces 143

4105, Tudor Center Dr., B-6 Anchorage - Alarka 99508. Chaudhary, S. and Angustine, M. (1990) : Rorschach Profile of Normal Army Personnel, Medical Journal of Armed Forces of India 46, 4:263-265. Dosajh, N.L. (1996) : Projective Techniques with Particular Reference to Inkblot Tests, SIS Jr. Proj. Psycho1 and Ment. Health 3 (1) : 59-68. Dosajh, N.L. (1997) : How a Single Image of SIS-II Leads to Complete psychodiagnosis, SIS Jr. Proj. Psycho1 and Ment. Health 4 (2) : 152-154. Dubey, B.L. (1982) : A Progmatic view of Rorschach Inkblot Technique. National Psychological Corporation. Bhargava Bhawan 4/230 Kacheri Ghat. Agra India. Dubey, B.L. and Cassell, W.A. (1993) : Some Experience with SIS-II. Br. Jr. Proj. Psychol. 38, 1:19-41. Dubey, B.L. Mishra, M. Dwivedi, C.B. and Mishra N.(1994) : Diagnostic and Therapeutic utility of SIS-II and Rorschach. SIS Jr. Proj. Psychol. and Ment. Health Vol. 1 (1) : 19-26. Dwivedi, C.B. Mishra, M. and Dubey, B.L. (1995) : Diagnostic Significance of the SIS-II and Rorschach Tests, SIS Jr. Proj. Psychol. and Ment. Health, Vol. 2 (2) : 165-170. Klopfer, B. Ainsworth, M.D. Klopfer, W.G. and Holt, R.R. (1954) : Development in Rorschach Techniques. Techniques and Theory. Vol. 1, World Book coy. New York. Mishra, M. and Dwivedi, C.B. (1997) : Content Scale Based Diagnostic Compatibility of SIS-II and Rorschach Test in Normals, Neurotics and Schizophrenia. SIS Jr. Proj. Psychol. and Ment. Health. Vol 4 (2) : 121-140. Pershad, D. and Dubey, B.L. (1994) : Reliability and Validity of Somatic Inkblot Series in India. SIS Jr. Proj. Psychol. and Ment. Health Vol 1 (1) : 33-38. Rathee, S.P., Goel, D.S. Saldanha, D. Chawala, M.N. and Dubey, B.L. (1994): A Study of Somatic Inkblot Series I in Coronary Cases, SIS Jr. Proj. Psychol. and Ment Health. Vol. I (1) : 54-64. Rathee, S.P., Pandey, V. and Agyajit Singh (1995) : Diagnostic Efficacy of SIS-II among Psychiatric Patients of Armed Forces, SIS Jr. Proj. Psychol. and Ment. Health Vol. 2 (1) 61-66. Rathee, S.P., Sarkar, P. and Agyajit Singh (1996) : Diagnostic Significance of SIS-II Between Psychotic and Neurotic Patients of Armed Forces. Paper Read in 3rd International Conference of SIS and AICP. Punjab University, Chandigarh. Rathee, S.P. (1997) : Diagnostic Value of SIS-II for Psycho-pathological Cases of Armed Forces. PhD. Thesis Submitted in Pujabi University, Patiala. Rorschach, Hermann (1921) : Psychodiagnostic Ernst Bircher, Bern. Sahay, M. and Srivastava, P.K. (1994) : Somatic Inkblot Series-I Male Transexuals. SIS Jr. Proj. Psychol. and Ment. Health. Vol I (1) : 73-78. Saldanha, D. and Dubey, B.L. (1995) : Effects of Sodium Pentothal on SIS-Video. SIS Jr. Proj. Psychol. and Ment. Health. Vol II (2) 19-28. Verma, S.K., Pershad, D. and Nehra, R. (1994) : Cross validity of SIS-II in Psychiatric Patients. SIS Jr. Proj. Psychol. and Ment. Health. Vol. I (1) : 15-18. Verma, S.K. and Pershad, D. (1995) : Reliability and Validity of SIS -II. SIS Jr. Proj. Psychol. and Ment. Health. Vol. 2 (1) 67-71. 144 Rathee et al

An exploratory Investigation of Age Differences on the Hand Test in Atlantic Canada Paul E. Panek, Annabel J. Cohen, Lynette Barrett and Angela Matheson The Hand Test (HT) was administered to young (n=50, M age=19.94 yrs., SD=4.23) and older Atlantic Canadian adults (n=50 M age=73.16 yrs., SD=7.74), with 25 men and 25 women in each group, for the purposes of: 1) investigating age differences in personality; and, 2) to determine if the observed patterns of age differences are similar to results obtained in the United States. Results indicated both similarities and differences in the patterns of age differences with regard to findings on United States samples. The Canadian data reveal increases with age on variables presumably measuring the following personality characteristics: desire for help from others; difficulty in achieving needs or goals; inner personality weakness, perhaps associated with concern with illness and declining health delays and "shock" in coping with situations; less active engagement with the environment; less random energy; and, reduced aggression. This pattern of age differences was similar to those found in United States samples. However, compared to US samples, the protocols of Atlantic Canadian older adults exhibited less personality constriction and generally exhibited a more "psychologically intact" profile. Implications of the results were discussed. In general, results with United States samples, using projective techniques such as the Rorschach, Thematic Apperception Test, Draw-A-Person Test, and the Hand Test (see Panek, Wagner, & Kennedy-Zwergel, 1983 for review) have regularly conveyed the impression of personality deterioration with normal aging. Specifically, results of studies with the Hand Test (e.g., Hayslip & Panek, 1990; Panek Wagner & Sterns, 1976; Panek, Wagner & Avolio, 1978; Panek & Rush, 1985) suggest that the aging individual, despite individual differences, can be typified as a person whose reality contact has begun to recede, who tends to withdraw from meaningful interactions with life, experiences delays in coping quickly with important life situations, and exhibits less willingness to exert him/ herself in order to attain important goals or to be assertive in life situations. Further, aging individuals display an increasing need for others, while their mode of responding becomes more stereotyped and rigid. Although research indicates that Canadians and Americans have stereotypic images of each other such as, Americans are aggressive, outspoken, arrogant, etc., while Canadians are considered ultraconservative, uncertain, inhibited, passive, etc., (Diemer & Dietz, 1970), there has been very little research Paul E. Panek, Ph.D., Associate Dean and Professor of Psychology, The Ohio State University at Newark, 1179 University Drive, Newark, Ohio-43055 Tel. : (744) 366-3312 (Request for reprints should be addressed to : Dr. Paul E. Panek) Annabel J. Cohen, Lynette Barrett and Angela Matheson, Dept of Psychology, University of Prince Edward Island, USA.

investigating actual personality differences between Americans and Canadians. Further, those studies that are available have not used projective techniques, nor have they found substantial differences in personalities between Canadians and Americans (e.g., West, 1993). Finally, there have been no investigations of age differences with Canadian samples using projective techniques. Consequently, the purposes of the present exploratory study were to: (i) investigate potential age differences in Hand Test personality variables between Canadian younger and older adults; and, (ii) determine if the observed patterns of age differences are similar to results obtained with previous samples in the United States. Method : Participants : Participants were 100 "community-living" individuals in rural and urban areas of a province in Atlantic Canada ranging in age from 17 to 95 years, who were divided into two distinct age groups: Young Adult (n=50, M age= 19.94 yrs., SD= 4.23; Men, n= 25, M age= 19.16 yrs., SD= 2.17; women, n=25, M age= 20.70 yrs., SD= 5.53 and older Adult n= 50 M age = 73.16 yrs., SD= 7.74; Men, n= 25, M age= 71.60 yrs., SD= 7.49; Women, n= 25, M age = 74.72 yrs., SD= 7.82). The participants in the young adult group were obtained from an introductory psychology class in a small University in Atlantic Canada, and received a bonus mark for participating in the study. Participants in the older adult group were obtained from various senior's organizations in rural and urban areas of the same Atlantic Canadian Province as the young adult group and received $5.00 or a movie pass for participating in the study. Procedure : Participants were individually administered the Hand Test (Wagner, 1962/1983) by one of the authors (AM or LB), according to standard instructions. All participants were in relatively good health (self-rated questionnaire) and had intellectual functioning levels at or above the average range on the Quick Test of Intelligence (Ammons & Ammons, 1962). Hand Test protocols were scored blind by one of the authors (PEP), who did not know the age group or gender of the protocol scored. In order to check for scoring reliability, twenty protocols were selected at random and scored blind by the developer of the Hand Test (Dr. Edwin E. Wagner). The twenty protocols consisted of 322 responses. The percent agreement between scores was 84% (270 responses), indicating high inter-rater reliability. Interestingly, of the 52 total scoring disagreements, on 29 (58%) of these disagreements were the scores given by the raters within the same Summary 146 Panek et al

Score category e.g., ACT vs. ACQ; TEN vs. FEAA; DEP vs. COM. Results and Discussion : In line with the purpose of the study, two-tailed Mann-Whitney U Tests (corrected for ties) were computed between the combined sample of Canadian Young Adults and the combined sample of Older Adults for 26 Hand Test variables. This analysis resulted in significant age group differences (p<.05) for 11 of the 26 investigated Hand Test (Table 1). Variables, which were : Dependence (p<.01), Aggression (p.<05), (Active Movement Content) (p<.05), Passive (p<.05), Tension (p<.05), Crippled (p<.001), Maladjustive (p<.001), Total Responses (p<.001), High-Low (p<.001), Average- Initial-Reaction-Time (p<.001), and Pathology (p<.001). Interpreting directly for the Hand Test manual (Wagner, 1962,1983), results suggest that, as age increases, individuals express significantly more need for help from others (Dependence); relate in a more quiescent manner to the environment (Passive); display less excess or random energy (Movement-Content); manifest less hostility (Aggression); express more inner psychological weaknesses (maladjustive pathology); are more concerned with psychological incapacity, perhaps related to illness and declining health condition (Crippled, Tension); manifest delays in coping quickly with important life situations (Average-Initial-Reaction-Time); and, are more prone to cautious or guarded (High-Low), but exhibit more psychological reactivity to external stimuli (Total Responses). Overall, these findings, with regard to age differences on the Hand Test are similar to findings on United States samples (see Hayslip et. at., 1990; Panek et al., 1978; Panek and Rush 1985, Panek & Wagner, 1985). Thus, the effects of the normal aging process on those aspects of personality processes measured by the Hand Test appear to be relatively constant in Atlantic Canada and the United States. However, contrary to what has been repeatedly observed in United States samples (e.g., Panek et. al., 1978; Panek & Rush, 1985; Panek et al., 1976), the Total number of responses was significantly higher in the older adults compared to younger adults, suggesting more complexity and flexibility of personality with aging in the Atlantic Canadian sample. Also, the overall response pattern observed in older adults in Canada can be considered a generally more "psychologically intact" profile, compared to older adult samples in the United States, due to the absence of significant age differences scores/variables often associated with "organic" changes or "personality deterioration" such as Repetitions, Failure, and the Withdrawal score. However, in the absence of a direct comparison with American sample this hypothesis should be considered only speculative. Hand Test in Atlantic Canada 147

Table 1 Medians for Investigated Hand Test by Age Group and Mann-Whitney U-test Young Adults Older Adults U p (n=50) (n=50) Affection (MDN) 2.00 1.00 1177.0 .603 Dependence (MDN) 0.00 1.00 790.5 .000 Communication (MDN) 2.00 2.00 1066.0 .189 Exhibition (MDN) 0.00 0.00 1019.5 .072 Direction (MDN) 1.00 2.00 1018.5 .101 Aggression (MDN) 1.00 1.00 965.0 .037 ΣInterpersonal (MDN) 7.00 8.50 1029.0 .126 Active (MDN) 3.00 3.00 1104.5 .308 Passive (MDN) 0.00 1.00 957.0 .026 Acquisition (MDN) 2.00 1.00 1012.0 0.92 ΣEnvironmental (MDN) 5.00 6.00 1102.0 .304 Tension (MDN) 0.00 1.00 978.5 .039 Crippled (MDN) 0.00 0.50 789.5 .000 Fear (MDN) 0.00 0.00 1072.0 .146 ΣMaladjustive (MDN) 1.00 2.00 708.0 .000 Description (MDN) 0.00 0.00 1225.0 .648 Bizarre (MDN) 0.00 0.00 1200.0 .155 Failure (MDN) 0.00 0.00 1225.0 .317 ΣWithdrawal (MDN) 0.00 0.00 1197.0 .437 ΣResponses (MDN) 13.00 16.50 782.0 .001 Average Initial RT (MDN) 4.50 7.55 617.5 .000 High-Low (MDN) 8.50 14.50 737.5 .000 Pathology (MDN) 1.00 2.00 690.0 .000 Repetitions (MDN) 1.00 1.00 1182.0 .615 Movement Content (MDN) 0.00 0.00 1026.5 .030 Overall, results suggest a consistency in personality differences as measured by the Hand Test accompanying the process of normal aging in Atlantic Canada, and similar to the United States which is typified by increased dependency, passivity, reduced energy, lessened hostility, greater maladjustment which is most likely a reflection of concern with illness or declining health condition, a propensity 148 Panek et al

to experience a delay in reacting to environmental stimuli, but increased psychological reactivity to external stimuli. However, these results should not be interpreted rigidly to imply " personality deterioration" per se, since these differences may reflect successful adaptation and coping to environmental and interpersonal events, and changes that are experienced as part of the normal aging process. Specifically, as suggested by Baltes (1997) with increasing age individuals, in order to maintain effective or optimal functioning he must learn to compensate and be selective in all aspects of activity and functioning. Thus, delay in coping quickly (Average-Initial-Reaction-Time), increased cautiousness (High - Low), and the increased need for help from others (Dependence), etc., may not be "negative", but may in fact be adaptive for the individual, such as compensation for decreased abilities. Finally, results of the current investigation suggest that the Hand Test can be used effectively with Canadian samples, and provides data which would eventually lead to the development of Canadians norms of the Hand Test. However, due to the limitations associated with crosssectional research designs we caution against overgeneralization of the data, since "age differences" do not necessarily imply "age changes." References : Ammons, R.B., & Ammons, C. H. (1962). The Quick Test (QT) : Provisional Manual. Psychological Reports, 11, 111-61. (Monograph Supplement I-VII) Baltes, P.B. (1997). On the Incomplete Architecture of Human Ontogency: Selection, optimization, and Compensation as Foundation of Developmental Theory. American Psychologist 52, 366-380. Diemer, A.H., & Dietz, M.L. (1970). Canadian University Students' Stereotypes of Canadians and Americans. Mc Gill Journal of Education 5, 29-37. Hayslip, B. J., Panek, P.E., & Stoner, S. B. (1990). Cohort Differences in Hand Test Performance : A Time lagged Analysis. Journal of Personality Assessment 54, 704-710. Panek, P.E., & Rush, M. C. (1985). Response Pattern Analysis of the Hand Test: Age Differences. Journal of Personality Assessment 49, 37-42. Panek, P.E., Sterns, H.L. & Wagner, E. E. (1976)., An Exploratory Investigation of the Personality Correlates of Aging Using the Hand Test. Perceptual and Motor Skills 43, 331-336. Panek, P. E., Wagner, E.E., & Avolio. B.J. (1978). A Review of Projective Test Findings with Older Adults. Journal of Personality Assessment 47, 562-582. Panek, P. E., & Wagner, E. E. (1985). The Use of the Hand Test with Older Adults, Springfield, IL: Charles C. Thomas. Wagner, E. E. (1962/1983). The Hand Test : Manual for Administration Scoring, and Interpretation. Los Angles, CA: Western Psychological Servies. West, D.C. (1993). Cross-National Creative Personalities, Processes, and Agency Philosophies. Journal of Advertising Research 33, 53-62. Hand Test in Atlantic Canada 149

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

Somatic Inkblot Series on a Sexually Traumatized Female Padma Dwivedi, Nalini Mishra and Mridula Mishra The Somatic Inkblot Series-Video was administered to a 22 years old young, unmarried, graduate lady who had reported history of rape. The SIS responses revealed her traumatic experiences. Her hatred and aggression alongwith feeling of helplessness and craving for protection were brought out. The SIS procedure worked as a time machine and took her back in time, helping in processing unprocessed painful material. After needed intervention she reflected a lot of positive changes in her total outlook. Ms. X. is a 22 years, unmarried, graduate with Psychology honors, belonging to a middle class family, with a history of sexual abuse at the age of 17. She had complained of low self, depressive features and feeling of loneliness. Presently this lady is working in an organization, which is committed to the welfare of sexually harassed females. She showed interest in the SIS images before it could be administered to other sexually traumatized females taking help from the organization. Ms. X was administered 62 image SIS-Video and a few significant responses are discussed here. It is important to note that SIS images help in peeping into the inner deep of the suffering individuals and the responses projected by the subjects help in corroborating the information obtained through machine which brings out internal agony and distress a person might have undergone. Least Liked Images In reviewing her responses, 11-A was found to be the least liked. Instead of seeing human body, particularly a person sitting or leaning forward, she could perceive it as "something half made-I can't understand." Here she avoids reference to the person sitting/ body parts: reason being her bad experience related to such a posture evoking distress. It may be noted that many persons feel happy to perceive this image as a lady sleeping because legs are visible in the suggestive posture. And non-admission to this fact suggests the defenses being used while rejecting such common percept. The second least liked image was 18-B where she perceived "I do not like the Padma Dwivedi, M.A. (Soc), Social Worker, Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigrh - 160012 (India). Nalini Mishra, Ph.D., Lecturer in Sociology, Maharani Banaras Mahila Mahavidyalaya, Ramnagar, Varanasi (India). Mridula Mishra, Ph.D. Lecturer in Psychology, Jagatpur Degree College, Varanasi (India) The authors are grateful to Dr. B. L. Dubey and Dr. K. N. Ojha for their help in interpretation of this case.

penis standing upward and ejaculating. It does not give me a nice feeling." On inquiry she went back in time and started sobbing with tears in her eyes. She narrated the "sexual abuse" by a known person when she was about 17 years old. The worst part she narrated that the man discharged semen inside and lot of the seminal fluid she could see around her private part. She was worried to death until next menstrual cycle date when she got relieved of the fear of becoming pregnant. Ejaculating penis/ penis in action is the most common response of people on this image. The lady was not interested to narrate her traumatized experience to the therapist until this image provided her a platform to project the painful past. She felt comfortable after discussion and interview proceeded further to interpret other significant responses. Most liked Images : Image 2A : Her response to this image was "I love flowers and bouquets. This makes me feel great." It is her wishful thinking, like any other person, to bloom like a flower and lead a happy life. Image 31A: She viewed it as "I like these women. I also like to wear ornaments." Almost always people see two persons - a male and a female but she failed to see male figure, even after suggestion. Not being able to perceive a male figure on this image may indicate her hatred towards the male. This is but natural in her case as her first experience with a male was most shocking and distressing. Image 31B: This being the last image of the series, it is expected to provide a good carry home feeling for the subject. A happy family-father, mother and two children is the most common response on this image. The lady under discussion viewed "I always want to be in a happy family-no tension, disturbances, misunderstanding. Everyone should be close to each other." Once again her wishful thinking to have a happy family is projected here. She is staying away from her family and working in an organization where such disturbed females are being treated. Description of Other Significant Images : Image 3A: "A plant plugged out from the roots" was perceived on this image. During interview she came out with the feeling as if she was plugged out from the roots and thrown away. This brings out her depressive contents and feelings of being rejected. Image 13A: She viewed it as, "someone's hand coming out from a ball of fire." Once again her feeling of being saved from difficult situation is brought out. The ball of fire signifies the trauma she has undergone and the hand coming out from the fire might indicate her ability to manager the painful 152 Dwivedi et al

situation on her own. This suggests her ego strength and good prognosis. Image 22A: She projected, "a basket with an ugly head. Does not make me feel good," on this image. Usually this image brings out sexual content particularly the male genitalia. Perceiving this image as ugly and expressing feeling of disliking suggests her hatred and aggression towards the perpetrators. Image 1B: She perceived this image as "A man with fire on his back. Things around him are also burning." Once again her feeling of dejection and hurt are brought out. Symbolically things around her are burning and inducing lot of pain to her self. Image 19B: She viewed this image as, " a ball of fire with its raise coming out." This further signifies the previous theme of pain and aggression inflicted on her. Such repeated feelings of aggression might be seen as serious indices and call for immediate intervention. Such subjects might otherwise inflict pain to others to release their aggression. Image 28B: She perceived, "a monster catching hold of a child." Perceiving a monster brings back the memory of her perpetrator and catching hold of a child signifies her helplessness to protect herself from the monster perpetrator. Mostly people perceive, "a mother with a child" on this image. The mother with a child provides the sense of security. Instead of mother the lady here perceives the monster, revealing thereby her feeling that the mother (protector) has become the monster because the man being a known person deceived her. Image 29B: She projected, on this image, "Someone running and coming inside the house through a door." This suggests her insecurity and brings out her feeling to have a safe place like a home. This may also suggest her regression and wish to remain indoor. She needs support, help and assurance from her therapist as the running person is welcomed through the door. The SIS responses revealed Ms. X's traumatic past and feelings. Her hatred and fear of being oppressed upon are quite vivid through the quality of responses. She has shown the feelings of helplessness and protection alongwith a wish to regain her place in the happy family. The SIS-Video worked as a time machine and took her back in time, helping in processing unprocessed painful material. She reflected a lot of positive changes in her total outlook, after intervention. SIS in a Traumatized Female 153

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 Teen-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 Impairment following Recovery from Coma Psychological 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 - I Videotape SIS - Living Images A Walk Through The Garden of Life and many more Audio & Videotapes (Contact : SIS Center, 4105 Tudor Center Drive, Space B-6, Anchorage Alaska-99508 (USA) e-mail : drcassell@corecom.net Web Site @ http : //www.owt.com/sis/ for getting the above material)

THE SOMATIC INKBLOT SOCIETY I wish to be a Member____________ Student Affiliate __________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 Member ($40), Associate ($30), Student Affiliate ($20). For India; Life Member Rs. 1000/- Member Rs. 150/- & Students Rs. 100/- Total Cheque $/Rs. ___________ Drawn at ______________________________________ Signature of applicant : __________________________________ Date : ______________ PLEASE RETURN with your cheque to : B.L. Dubey, Ph.D., Vice-President, P.O. Box 1107, Sector-15 Post Office, Chandigarh - 160015 (India). Tel./Fax 91-172-710986, Tel. : 91-172-710985, e-mail: sisdubey@ch1.vsnl.net.in Make cheque payable to Somatic Inkblot Society, Chandigarh. (INDIA) N.B. Please add Rs. 50/- as one time registration fee; and $5/ Rs. 20 if you are sending subscription thru out station cheque.

SIS Instruments can be Obtained from : Somatic Inkblot Center 4105, Tudor Center Drive, Space B-6, Anchorage, Alaska - 99508 (U.S.A.) Tel. : (907) 562-2400 Fax : (907) 563-3746 e-mail : drcassell@corecom.com Web Site at : http://www.owt.com/sis/ Somatic Inkblot Center, P.O. Box 1107, Sector - 15, Post Office; Chandigarh - 160 015 (India) Tel./Fax. : 91-172-710986, Tel. : 91-172-710985 e-mail: sisdubey@ch1.vsnl.net.in National Psychological Corporation 4/230, Kacherighat, Agra - 282 004 Tel. : 91-562-364926, 350113 F F F ANNOUNCEMENT SOMATIC INKBLOT SOCIETY is a non-profit International Social Organization (Tax relief for Donation/Advertisement under section 80G by Income Tax in India and Tax relief for Donation to SIS corporation, Anchorage, USA). Please help the Society by Donation/Advertisement to it's "SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH." President, Somatic Inkblot Society

SIS JOURNAL OF PROJECTIVE PSYCHOLOTY & MENTAL HEALTH (OFFICIAL JOURNAL OF SOMATIC INKBLOT SOCIETY) CHIEF EDITOR : B.L. Dubey, Ph.D., Director, Somatic Inkblot Center, P.O. Box 1107, Sector 15 Post Office, Chandigarh-160 015 (Res: T2/15, Sector 25, Chandigarh-160014) Tel/fax : 91-172-710986, Tel.: 91-172-710985, e-mail: sisdubey@ch1.vsnl.net.in EDITORS : Wilfred A. Cassell, MD, Director, Somatic Inkblot Center, 4105 Tudor Center Drive, B-6, Anchorage, AK 99508 (USA) Fax: (907)563-3746 Tel: (907) 562-2400, e-mail: drcassell@corecom.net : N.L. Dosajh, Ph.D., 1121, Sector 15-B, Chandigarh-160 015 (INDIA) Tel: 91-172-772651 : S.K. Verma, Ph.D., Addl. Prof. Dept. of Psychiatry, P.G.I.M.E.R., Chandigarh-160 012. Tel. : 91-172-715844 : Gilbert J. Roth, D. Min. 62 Timmerman Drive, Richland, WA-99352 (USA) Tel./Fax : (509) 628-2132 JOINT EDITORS : Mrs. Padma Dwivedi, M.A., Social Worker, Dept. of Cardiology, P.G.I.M.E.R., Chandigarh-160 012 Tel./Fax : 91-172-710986, 710985 : A. Dubey, Somatic Inkblot Center, P.O. Box 1107, Sector-15, P.O., Chandigarh - 160 015 Tel./Fax : 91-172-710986, 710985 ASSIT. EDITOR : Miss Mridula Mishra Ph.D. Lecturer in Psychology, 196, Saket Colony, Naria, Varanasi - 221005 (India) Tel. : 91-542-312703 : M.P. Singh, M.Phil., Lecturer in Psychology, 1329, Sector 70, Mohali, Chandigarh - 160059 Tel. : 91-172-223658 EDITORIAL CONSULTANTS Phillip W. Baker, Ed.D. U.S.A. Shubhra Banerjee, Ph.D., India R.S. Basi. Ph.D., USA Jayanti Basu, Ph.D., India Mahesh Bhargava, Ph.D., India J. C. Bubber, MBA, India S. Chaudhury, M.D., Ph.D., India Alfred Collins, Ph.D., U.S.A. Anna L. Comunian, Ph.D., Italy C.B. Dwivedi. Ph.D., India Justice G.C. Garg, India Ron Ginsberg, U.S.A. Ravi Kant Gunthey, Ph.D., India M.R. Jhanwar, D.P.M., India K.V. Kaliappan, Ph.D., India Malay Kapoor, M.A., India Anatoly Khromov, Russia Raj Kumar, I.A.S., India Z. Mahmood, Ph.D., U.K. Seema Malhotra, Ph. D., India Nalini Mishra, Ph.D., India Executive Director : Mrs. Mary Cassell, Somatic Inkblot Center, 4105 Tudor Center Drive, B-6, Anchorage, AK-99508, (USA) Fax: (907) 563-3746 Tel: (907) 562-2400 e-mail: drcassell@corecom.net web site at : http://www.owt.com/sis/ Reetinder Mohan, Ph.D., India Anjana Mukhopadhyay, Ph.D. India B.L. Murstein. Ph.D., U.S.A. Ashima Nehra, Ph.D., India Les Nyman, M.D., U.S.A. K.N. Ojha, Ph.D., India Rakesh Pandey, Ph.D., India S. Ramachandra, Ph.D., India S.P.Rathee, M.A., India Barry A. Ritzler, Ph.D., U.S.A. Ferro Roberto Ph.D., Italy Ann O'Roark, Ph.D., U.S.A. Gilbert J. Roth, D.Min., U.S.A. M. Sahay, Ph.D. India George Savage, M.Sc., S. Africa Hemant K. Sharma, Ph.D., India Vinod K. Sharma, M.D., India Amool R. Singh, Ph.D., India M.K. Tewari, MS, M.Ch., India Ailo Uhinki Ps.D., Finland De-Cicero E. Vaz, Ph.D., Brazil Abstracted in "APA'S Psychological Abstract"